ABSTRACT
Objective To investigate the efficacy and safety of preventive anticoagulant therapy at different time windows on formation of portal vein thrombosis after laparoscopic splenectomy and pericardial devascularization.Methods The study was performed as a randomized,prospective trial.83 patients with portal hypertension who underwent laparoscopic splenectomy and pericardial devascularization were divided into four groups:the non preventive anticoagulant group (n =21),the prophylactic anticoagulant group (n =23),the 24 hours of preventive anticoagulant group (n =19) and the 48 hours of preventive anticoagulant group (n =20).The incidences of postoperative portal vein thrombosis,the Yerdel grading,platelet count,APTT,and bleeding complications were studied.Results The incidences of portal vein thrombosis in the four groups were 100％,39.1％,47.3％,55％,respectively,and the difference among the 4 groups was significantly different (P ＜ 0.05).The incidences of portal vein thrombosis between the prophylactic anticoagulant group and the 24 hours of preventive anticoagulant group showed no significant difference (P ＞0.05),but the incidences of portal vein thrombosis after 48 hours of preventive anticoagulant group was significantly higher than the prophylactic anticoagulant group and the 24 hours of preventive anticoagulant group,respectively (P ＜ 0.05).Postoperative bleeding complications,platelet count and APTT after the operations showed no significant differences (P ＞ 0.05).However,the plasma level of D-dimer in the non preventive anticoagulant group was significantly higher than the preventive anticoagulant group (P ＜ 0.05).Conclusion Preventive anticoagulant therapy effectively reduced the incidence of portal vein thrombosis after laparoscopic splenectomy and pericardial devascularization,but it did not significantly increase the risk of postoperative bleeding complications.
ABSTRACT
RESUMEN Se presenta un método para la solución del problema de ruteo de mensajeros en motocicleta con ventanas de tiempo. En este se identifican dos fases: en la primera, se conforman grupos de clientes, cada grupo es asignado a una ruta y cada ruta es atendida por un vehículo; en la segunda, por medio de un modelo de programación lineal entera mixta, se hace un ruteo para cada una de las agrupaciones respetando las ventanas de tiempo estrictas de algunos clientes. Para validar el método, se utilizó como caso de estudio el área de mensajería de un centro de servicios compartidos de Cali, Colombia. Los resultados muestran que, al probar diferentes métodos de agrupación (fase 1), no se influye de forma significativa en el tiempo total de permanencia del vehículo en la ruta; en cambio, una reagrupación de los clientes después del ruteo (fase 2), mejora considerablemente la duración total de la ruta, aunque en algunos casos, aumenta la distancia recorrida por el vehículo.
ABSTRACT In this work, a method to solve a motorcycle messenger routing problem with time windows is presented. This has two phases: in the first one, clusters of clients are formed, each group is assigned to a route and each route is served by a vehicle; in the second phase, through a mixed integer linear programming model the routing for each cluster is made while respecting hard time windows of some clients. To validate the method, the mail delivery section of a shared service center in Cali - Colombia is used as case study The results show that, when testing different clustering methods (phase l) these do not significantly influence the vehicle's duration on the road; On the other hand, regrouping the clients after routing (phase 2) can considerably improve the total duration of the route, although in some cases, increasing the distance traveled by the vehicle.
RESUMO Neste trabalho se apresenta um método para a solução do problema de roteiro de mensageiros de motocicleta com janelas de tempo. Nele identificam-se duas fases: na primeira, conformam-se grupos de clientes, cada grupo é atribuído a uma rota e cada uma delas é servida por um veículo; na segunda, por meio de um modelo de programação linear todo misto, faz-se um roteiro para cada uma das agrupações respeitando as janelas de tempo estritas de alguns clientes. Para validar o método, usou-se como caso de estudo a área de mensageria de um centro de serviços compartilhados na cidade de Cali, na Colômbia. Os resultados mostram que ao testar diferentes métodos de agrupamento (fase l), não influem de maneira significativa no tempo total de permanência do veículo na rota; por outro lado, um reagrupamento dos clientes após do roteiro (fase 2), melhora consideravelmente a duração total do percurso, porém em alguns casos, aumenta a distância percorrida pelo veículo.
ABSTRACT
Objective: To investigate the feasibility of performing endovascular recanalization therapy (ERT) in patients with acute basilar artery occlusion (BAO) of broadened time window (≥24 hours) based on clinical-diffusion mismatch (CDM). Methods: A total of 11 CDM patients whose Glasgow Coma Scale (GCS) score <8 at admission were recruited and the diffusion-weighted imaging (DWI) did not find their brainstem reticular formation and bilateral damage to hypothalamus. Intra-arterial thrombolysis (IAT) with rt-PA alone or in combination with IAT, percutaneous transluminal angioplasty (PTA) and stenting were used. At the same time, the degree of recanalization was evaluated according to the thrombolysis in myocardial infarction (TIMI) criteria and the complications were observed. The modified Rankin scale (mRS) was used to assess after 3 months. Results: Circled digit oneThe mean onset time and duration of coma of the 11 patients were 42 hours (range 25 to 73 hours) and 11 hours (range 2 to 24 hours), respectively. The mean GCS score at admission was 6 (range 3 to 7) and that was 14 (range 3 to 15) at discharge. Circled digit twoNine patients performed ERT successfully (n = 2, TIMI grade 2, n = 7, TIMI grade 3) and 2 failed (TIMI 0). There were no complications such as bleeding. The patients regained consciousness within 9 to 27 hours. Circled digit threeThe patients were followed up after 3 months, 7 had good outcome (mRS, 0 to 2) and 2 had poor outcome (mRS, 3). ERT failed in 2 patients and they died at day 5 and day 21 after the procedures. Conclusion: The patients with broadened time window on CDM who performed ERT may have a higher recanalization rate and relatively good clinical outcome. The patients with collateral circulation has good outcome.