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简介：Anadaptiveactuatorfailurecompensationschemeisproposedforattitudetrackingcontrolofspacecraftwithunknowndisturbancesanduncertainactuatorfailures.Anewfeatureofthisadaptivecontrolschemeistheadaptationofthefailurepatternparameterestimates,aswellasthefailuresignalparameterestimates,fordirectadaptiveactuatorfailurecompensation.Basedonanadaptivebacksteppingcontroldesign,theestimatesofthedisturbanceparametersareusedtosolvethedisturbancerejectionproblem.Theunknowndisturbancesarecompensatedcompletelywiththestabilityofthewholeclosed-loopsystem.Theschemeisnotonlyabletoaccommodateuncertainactuatorfailures,butalsorobustagainstunknownexternaldisturbances.Simulationresultsverifythedesiredadaptiveactuatorfailurecompensationperformance.

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简介：AbstractAcute pancreatitis (AP) is a common acute abdominal condition of the digestive system. In recent years, treatment concepts, methods, and strategies for the diagnosis of AP have advanced, and this has played an important role in promoting the standardization of AP diagnosis and treatment and improving the treatment quality of AP patients. On the basis of previous guidelines and expert consensus, this guideline adopts an evidence-based, problem-based expression; synthesizes important clinical research data at home and abroad in the most recent 5 years; and forms 29 recommendations through multidisciplinary expert discussion, including diagnosis, treatment, and follow-up. It is expected to provide evidence support for the treatment of AP in the clinical setting in China.

简介：AbstractImportance:Acute necrotizing encephalopathy (ANE) is a rare disease with high mortality. Plasma exchange (PLEX) has recently been reported to treat ANE of childhood (ANEC), but its efficacy is uncertain.Objective:This study aimed to investigate the effectiveness of PLEX on ANEC.Methods:A retrospective study was conducted in four pediatric intensive care units from December 2014 to December 2020. All patients who were diagnosed with ANEC were included; however, these patients were excluded if their length of stay was less than 24 h. Participants were classified into PLEX and non-PLEX groups.Results:Twenty-nine patients with ANEC were identified, 10 in the PLEX group and 19 in the non-PLEX group. In the PLEX group, C-reactive protein, procalcitonin, alanine aminotransferase, and aspartate aminotransaminase levels were significantly lower after 3 days of treatment than before treatment (13.1 vs. 8.0, P = 0.043; 9.8 vs. 1.5, P = 0.028; 133.4 vs. 31.9, P = 0.028; 282.4 vs. 50.5, P = 0.046, respectively). Nine patients (31.0%, 9/29) died at discharge, and a significantly difference was found between the PLEX group and non-PLEX group [0 vs. 47.4% (9/19), P = 0.011]. The median follow-up period was 27 months, and three patients were lost to follow-up. Thirteen patients (50.0%, 13/26) died at the last follow-up, comprising three (33.3%, 3/9) in the PLEX group and ten (58.8%, 10/17) in the non-PLEX group, but there was no significant difference between the two groups (P = 0.411). Three patients (10.3%, 3/29) fully recovered.Interpretation:PLEX may reduce serum C-reactive protein and procalcitonin levels and improve liver function in the short term. PLEX may improve the prognosis of ANEC, and further studies are needed.

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简介：AbstractBackground:Acute kidney injury (AKI) is a common and serious complication following lung transplantation (LTx), and it is associated with high mortality and morbidity. This study assessed the incidence of AKI after LTx and analyzed the associated perioperative factors and clinical outcomes.Methods:This retrospective study included all adult LTx recipients at the China-Japan Friendship Hospital in Beijing between March 2017 and December 2019. The outcomes were AKI incidence, risk factors, mortality, and kidney recovery. Multivariate analysis was performed to identify independent risk factors. Survival analysis was presented using the Kaplan-Meier curves.Results:AKI occurred in 137 of the 191 patients (71.7%), with transient AKI in 43 (22.5%) and persistent AKI in 94 (49.2%). AKI stage 1 occurred in 27/191 (14.1%), stage 2 in 46/191 (24.1%), and stage 3 in 64/191 (33.5%) of the AKI patients. Renal replacement therapy (RRT) was administered to 35/191 (18.3%) of the patients. Male sex, older age, mechanical ventilation (MV), severe hypotension, septic shock, multiple organ dysfunction (MODS), prolonged extracorporeal membrane oxygenation (ECMO), reintubation, and nephrotoxic agents were associated with AKI (P < 0.050). Persistent AKI was independently associated with preoperative pulmonary hypertension, severe hypotension, post-operative MODS, and nephrotoxic agents. Severe hypotension, septic shock, MODS, reintubation, prolonged MV, and ECMO during or after LTx were related to severe AKI (stage 3) (P < 0.050). Patients with persistent and severe AKI had a significantly longer duration of MV, longer duration in the intensive care unit (ICU), worse downstream kidney function, and reduced survival (P < 0.050).Conclusions:AKI is common after LTx, but the pathogenic mechanism of AKI is complicated, and prerenal causes are important. Persistent and severe AKI were associated with poor short- and long-term kidney function and reduced survival in LTx patients.

简介：AbstractAcute respiratory distress syndrome (ARDS) is one of the most common severe diseases seen in the clinical setting. With the continuous exploration of ARDS in recent decades, the understanding of ARDS has improved. ARDS is not a simple lung disease but a clinical syndrome with various etiologies and pathophysiological changes. However, in the intensive care unit, ARDS often occurs a few days after primary lung injury or after a few days of treatment for other severe extrapulmonary diseases. Under such conditions, ARDS often progresses rapidly to severe ARDS and is difficult to treat. The occurrence and development of ARDS in these circumstances are thus not related to primary lung injury; the real cause of ARDS may be the "second hit" caused by inappropriate treatment. In view of the limited effective treatments for ARDS, the strategic focus has shifted to identifying potential or high-risk ARDS patients during the early stages of the disease and implementing treatment strategies aimed at reducing ARDS and related organ failure. Future research should focus on the prevention of ARDS.

简介：Theuseofenteralfeedingaspartofthemanagementofacutepancreatitisdatesbackalmosttwodecades.Thisreviewdescribestheindicationsforandlimitationsofenteralfeedingforthetreatmentofacutepancreatitisusingup-to-dateevidence-baseddata.Asystematicreviewwascarriedouttoanalysecurrentdataontheuseofenteralnutritioninthemanagementofacutepancreatitis.Relevantliteraturewasanalysedfromtheviewpointsofenteralvsparenteralfeeding,earlyvsdelayedenteralnutrition,nasogastricvsnasojejunalfeeding,andearlyoraldietandimmunonutrition,particularlyglutamineandprobioticsupplementation.Finally,currentapplicableguidelinesandtheeffectsoftheseguidelinesonclinicalpracticearediscussed.Thelatestmeta-analysessuggestthatenteralnutritionsignificantlyreducesthemortalityrateofsevereacutepancreatitiscomparedtoparenteralfeeding.Tomaintaingutbarrierfunctionandpreventearlybacterialtranslocation,enteralfeedingshouldbecommencedwithinthefirst24hofhospitaladmission.Also,thesafetyofnasogastricfeeding,whicheasestheadministrationofenteralnutrientsintheclinicalsetting,islikelyequaltonasojejunalfeeding.Furthermore,anearlylow-fatoraldietispotentiallybeneficialinpatientswithmildpancreatitis.Despitetheinitialencouragingresults,thecurrentevidencedoesnotsupporttheuseofimmunoenhancednutrientsorprobioticsinpatientswithacutepancreatitis.

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简介：Theeffectofacuteexercise,asingleboutofexercise,oncognitiveperformancehasattractedmuchattention.ThefirstnarrativereviewofthisliteraturewasconductedbyTomporowskiandEllis.1Intheirsummary,theauthorsconcludedthatacuteexercisefacilitatescognitiveperformance;however,theyemphasizedthatthestudiesatthattimewereatheoreticaland

简介：Traumaticmultipleintracranialhematomas(TMICHs)areintracranialhematomas(ICHs)formedinmorethantwopositionsorwithmorethantwotypesafterheadinjury.1Thisarticlereports147casesofTMICHstreatedinourhospitalbetweenJuly1993andDecember1999.

简介：肝的动脉pseudoaneurysm(幸运)是很稀罕的疾病但是在复杂并发症的情况下，有很高的死亡。幸运的最普通的原因是象肝活体检视那样的因医生之治疗而引的损伤，transhepatic胆汁的排水，胆囊炎和hepatectomy。幸运可以也与象与联系的感染或发炎那样的复杂并发症发生腐败emboli。幸运与尖锐胰腺炎在病人很少被报导了。根据我们知道，没有尖锐自发的胰腺炎特别地引起的一个案例的报告。我们报导在一个61岁的女人发展了的尖锐自发的胰腺炎引起的幸运的一个案例。开始由于未知原因与尖锐胰腺炎介绍的女人。在保守管理以后，她的症状似乎改善了。但是在承认以后的八天，腹的疼痛突然地再变得更坏。腹的计算断层摄影术(CT)被再核对，它检测了没在以前的腹的CT被看见的新幸运。内视镜后退因为hemobilia的怀疑，cholangiopancreatography(ERCP)作为加重的腹的疼痛的一个原因被执行。ERCP由在cholangiogram上在远侧的普通胆汁管在两耳细颈瓶和几充满缺点的开始观察新鲜的血块证实了hemobilia。没有象embolization或外科的结扎那样的任何特别治疗，幸运thrombosed自发地。在分泌物以后的三个月，腹的CT证明在左侧面的片断的那幸运消失了。

简介：Acutepancreatitis(AP)isafrequentdiseasewithdegreesofincreasingseverityresponsibleforhighmorbidity.Despitecontinuousimprovementincare,mortalityremainssignificant.Becausehypovolemia,togetherwithmicrocirculatorydysfunctionleadtopooroutcome,fluidtherapyremainsacornerstoneofthesupportivetreatment.However,poorclinicalevidenceactuallysupporttheaggressivefluidtherapyrecommendedinrecentguidelinessinceavailabledataarecontroversial.Fluidmanagementremainsunclearandleadstocurrentheterogeneouspractice.DifferentstrategiesmayhelptoimprovefluidresuscitationinAP.Ononehand,integrationoffluidtherapyinaglobalhemodynamicresuscitationhasbeendemonstratedtoimproveoutcomeinsurgicalorsepticpatients.Tailoredfluidadministrationafterearlyidentificationofpatientswithhigh-riskofpooroutcomepresentinginadequatetissueoxygenationisamajorpartofthisstrategy.Ontheotherhand,newdecisionparametershavebeendevelopedrecentlytoimprovesafetyandefficiencyoffluidtherapyincriticallyillpatients.Inthisreview,weproposeapersonalizedstrategyintegratingthesenewconceptsintheearlyfluidmanagementofAP.ThisnewapproachpavesthewaytoawiderangeofclinicalstudiesinthefieldofAP.

简介：ObjectivesTostudythemonitoringofrejectionafterorthotopicheartthansplantation.MethodsFrom1998to2005,10othotopicheartthansplanswereperformed,andacuterejectionwasmonitoredbyendomyocardialbiopsyaswellasbyclinicalfeatures,ECG,ultrasonocardiographyandbloodserumdeterminationofTropinI,andbythecombinationofthesemethods,weanalysedthemonitoringofacuterejectionafterthehearttransplantation.ResultsWiththecombinationofclinicalfeatures,ECG,ultrasonocardiographyandbloodserumtest,5occurencesofacuterejectionwerejudgedinthepostoperativecourse,whichwerecomfirmedbyendomyocardialbiopsytobe2acuterejectionsinⅠbdegree,3acuterejectionsinⅢadegree.Endomyocardialbiopsywereroutinelyperformed21timespostoperativelyinwhichtherewere1acuterejectioninⅠadegreeand5acuterejectionsinⅠbdegree.ConclusionsAcuterejectionisanimportantfactorinfluencingthepostoperativecourseofhearttransplantation,soitisimperativetohaveanin-time,effectiveandplannedmonitoringprocedureforacuterejection.Endomyocardialbiopsyisasensitiveandreliablemethodindiagnosisofacuterejection,butitisinvasiveandprobableforsomecomplications.Thenoninvasivemethodsuchasclinicalfeatures,ECG,ultrasonocardiographyandbloodserumtestcanbeusedasadditivemeansinthediagnosisofacuterejection.Endomyocardialbiopsyshouldbecombinedwithsomenoninvasivemethodsinmonitoringacuterejectionafterthehearttransplantation.

简介：Theexperimentalstudywasperformedin78rabbits,theexposedanteriorven-tricularsurfaceoftheopen—chestrabbitswereimpactedwithapendulum—likemovementimpactorsystemwhichwascontrolledbytheCardiaccycle.Undrsomegivenconditions,theexperimentalresultswereasfollows:（1）Theimpactsat5.0m·s-1resultedinnocardiacruptureinallattemps（16/16）attheendofsystoleas

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