Contralateral haematoma secondary to surgical decompression in head trauma can lead to a poor outcome. The prompt detection and removal of the haematoma are keys to management and routine recurrent computed tomography is recommended after the first operation.
This study aimed to compare the effectiveness and safety of coblation annuloplasty and radiofrequency thermocoagulation for lumbar discogenic pain.Patients who suffered from lumbar discogenic pain and underwent coblation annuloplasty and radiofrequency thermocoagulation surgery were included. A questionnaire, including the visual analo scale (VAS), MacNab criteria, pain relief rate, and any complications due to surgery, was completed by the patients with the help of a trained volunteer who was blinded to the study. Data were collected at 1 week, and 1, 3, 6, and 12 months after surgery. Significant pain relief was defined as postoperative pain relief ≥50% compared with the preoperative state. Any complications during or after surgery were also recorded.A total of 122 patients were included; 37 patients were lost in the follow-up and 85 were evaluated. Among these, 45 patients underwent coblation annuloplasty (CA group, n = 45) and 40 underwent radiofrequency thermocoagulation procedures (RF group, n = 40).VAS pain scores were decreased at 1 week and 1, 3, 6, and 12 months postoperatively compared with preoperation in both groups (P < .05). The CA group had significantly lower VAS scores at 6 and 12 months of follow-up than did the RF group (P < .05). According to the modified MacNab criteria, the proportions of patients with excellent and/or good results at 3, 6, and 12 months of follow-up were significantly higher in the CA group compared with the RF group (P < .05).Only 2 patients reported soreness at the needle insertion site in the CA group. However, 3 patients had soreness at the needle insertion site, 3 had increased intensity of low back pain, 1 had intracranial hypotension, and 2 had new numbness in the leg and foot in the RF group. At the 1-year follow-up, this numbness was present all of the time. No major complications occurred in the CA group.Our study suggests that CA is a more effective and safe minimally invasive procedure than RF for treating lumbar discogenic pain.
This paper proposes a state prediction adaptive sliding mode (SPASM) control method for the remotely piloted system (RPS). With consideration of the time delay caused by the large transmission delay existing in the RPS, a prediction algorithm is proposed to provide the state prediction by using the state transition matrix. To approximate the uncertain lag of the remotely piloted vehicle (RPV) control augmentation system, an adaptive law is proposed to estimate the parameter uncertainties, and the overestimating problem is resolved efficiently. Meanwhile, to deal with the unmodeled dynamics and the predicted errors, a sliding mode controller is designed to guarantee the robustness of the whole closed-loop system. The simulation results show that the SPASM controller can not only guarantee the stability of the RPS in the presence of large time delay but also has a desirable performance of tracking the pilot's inputs while existing the unmodeled dynamics and parameter uncertainties.INDEX TERMS Remotely piloted system (RPS), remotely piloted vehicle (RPV), time delay, state prediction, adaptive sliding mode control.
Hypothesis: Autophagy and its enhancement may have a role in the pathogenesis of acquired cholesteatoma. Background: The etiopathogenesis of acquired cholesteatoma remains unclear. Some clinical features of cholesteatoma are similar to those of cancer. The study of autophagy in cancer has indicated that enhanced autophagy enables tumor cell survival and growth. Methods: Cholesteatoma epithelium and normal external auditory canal (EAC) epithelium were obtained from patients with acquired cholesteatoma, and marginal epithelium of the tympanic membrane perforation was obtained from patients with chronic otitis media (COM). Immunohistochemistry (IHC) was performed to detect the expression of light chain 3 (LC3) in cholesteatoma and EAC epithelium. Western blotting (WB) was performed to detect the expression of LC3, Beclin-1, or the PI3K/AKT pathway in cholesteatoma, EAC, and COM epithelium. Results: LC3 staining of IHC was stronger in cholesteatoma epithelium compared with normal EAC epithelium. The ratios of LC3-II/I and Beclin-1 expression on WB were significantly higher in cholesteatoma epithelium compared with EAC epithelium or COM epithelium, and there was a significantly higher ratio of p-PI3K/PI3K and p-AKT/AKT in cholesteatoma epithelium compared with EAC epithelium. Conclusions: Enhanced autophagy might play a role in the pathogenesis of acquired cholesteatoma. PI3Ks might have different regulatory functions on autophagy in the cholesteatoma epithelium.
For the problem of hypersonic target interception, a novel midcourse guidance method with terminal-angle constraint is proposed. Referring to the air-breathing and the boost-gliding hypersonic targets, flight characteristics and difficulties of interception are analyzed, respectively. The requirements of midcourse guidance for interceptors are provided additionally. The kinematics model of adversaries is established concerning line-of-sight coupling in longitudinal and lateral planes. Suboptimal guidance law with terminal-angle constraint, specifically the final line-of-sight angle or impact angle, is presented by means of model predictive static programming. The trajectory is optimized and the load factor would finally converge after penalizing control sequence and output deviations. The realization of terminal angle is firstly verified with a constant speed target. A full interception scenario is further simulated focusing on a typical boost-gliding target, which flies along a skipping trajectory. Results show the success of providing handover conditions for intercepting hypersonic targets.
3-Substituted phthalides are widely distributed in plants and fungi. They are active ingredients in traditional Chinese herbal medicines, and have attracted much attention in modern medicinal chemistry. The synthetic methods of 3-substituted phthalides are reviewed, especially those in enantioselective manners. The main approach involves: (a) construction of lactones from C-C bond formation reactions, e.g. an aldol/lactonization cascade reaction of 2-acylbenzoates and alikes, (b) construction of lactones via C-O bond formation reactions, e.g. reductive lactonization of 2-acylbenzoates or reduction of 3-alkenyl phthalides, intramolecular oxidation/lactonization, or intramolecular redox/lactonization. These methods are of great significance for the high stereoselective synthesis of phthalides and drug research. Keywords phthalide; isobenzofuran-1(3H)-one; synthesis; enantioselectivity; natural product 天然产物在药物研发中发挥了关键作用, 许多现代 药物的开发受到了各种天然产物的启发 [1][2] . 苯酞, 即异 苯并呋喃-1(3H)-酮, 为具有 γ-内酯与苯稠合的双环结构 物质(图 1, 1). 某些植物(如川芎和当归)以及真菌中就含 有这类化合物 [3] . 目前, 已分离鉴定出近两百种含苯酞 骨架的天然化合物, 这些化合物在取代基的性质、位置 以及苯环的氧化程度方面表现出差异. 根据苯酞单元的 结构特征, 通常分为三类 [4][5] : (a) 3-未取代的苯酞, (b) 3-取代的苯酞和(c)苯酞二聚物. 这些物质显示出重要的 临床特性, 例如抗血小板聚集、抗血栓形成、防止脑缺 血、抗心绞痛、调节心脏功能及中枢神经系统的作 用 [4,[6][7][8] . 这类分子的生物活性归因于苯酞中的环内酯结 构 [9] . 尽管苯酞类化合物的结构和生物多样性引起了人 们广泛的兴趣, 但是大规模从天然产物中获取这类化合 物并不现实, 因此采用化学方法合成这些化合物具有重 要意义. 本综述将简述苯酞类化合物的结构多样性、生 物活性, 总结在生物活性方面更为重要的 3-取代苯酞的 代表性合成方法, 为相关研究提供参考. 生物活性具有苯酞结构骨架的霉酚酸(图 1, 2)是一种免疫抑 制剂, 用于器官移植(如肾脏移植)的术后恢复 [10][11] ; 化 合物 3 能抑制前列腺素 E 2 的生成 [12] ; 4 具有抗癌和抗抑 郁活性 [13] .大多数天然苯酞类化合物属于 3-取代的苯酞(图 1, 5~11), 这些化合物往往具有丰富的药理活性. 具有芹 菜特有气味的丁苯酞 5 (NBP, 图 1), 能够抑制血小板凝 集、改善微循环、减轻缺血性脑损伤, 是治疗缺血性脑 卒中的药物 [14] , (S)-NBP 在某些情况下效果更佳 [15] ; 化
Rationale: Granular cell tumor (GCT) is a relatively uncommon, usually benign lesion that often presents as a solitary, painless cutaneous or submucosal nodule. GCTs of the head and neck are not uncommon; however, involvement of the trunk of the facial nerve is rare. Patient concerns: A 55-year-old woman presented a lesion at the posterior border of the left parotid gland. Doppler ultrasound revealed a hypoechoic mass and magnetic resonance imaging disclosed an irregularly shaped lesion with unsharp borders in the posterior aspect of the left parotid gland that was hyperintense on T2-weighted images and enhancing with contrast on T1-weighted images. The remainder of the parotid gland was normal. Diagnosis: Following excision of the mass, diagnosis of a GCT was established and confirmed by immunohistochemistry. Interventions: The patient underwent surgical excision of the lesion. Outcomes: The patient is currently asymptomatic and without recurrence after 10 months follow-up. Lessons: GCT involvement of the trunk of the facial nerve is rare. Immunohistochemical staining is helpful for its diagnosis.
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