Gastric cancer(GC)and gastroesophageal junction cancer(GEJC)represent a significant burden globally,with complications such as overt bleeding(OB)further exacerbating patient outcomes.A recent study by Yao et al evalua...Gastric cancer(GC)and gastroesophageal junction cancer(GEJC)represent a significant burden globally,with complications such as overt bleeding(OB)further exacerbating patient outcomes.A recent study by Yao et al evaluated the effectiveness and safety of systematic treatment in GC/GEJC patients presenting with OB.Using propensity score matching,the study balanced the comparison groups to investigate overall survival and treatment-related adverse events.The study's findings emphasize that systematic therapy can be safe and effective and contribute to the ongoing debate about the management of advanced GC/GEJC with OB,highlighting the complexities of treatment decisions in these high-risk patients.展开更多
BACKGROUND Hemorrhage,which is not a rare complication in patients with gastric cancer(GC)/gastroesophageal junction cancer(GEJC),can lead to a poor prognosis.However,no study has examined the effectiveness and safety...BACKGROUND Hemorrhage,which is not a rare complication in patients with gastric cancer(GC)/gastroesophageal junction cancer(GEJC),can lead to a poor prognosis.However,no study has examined the effectiveness and safety of chemotherapy as an initial therapy for GC/GEJC patients with overt bleeding(OB).AIM To investigate the impact of OB on the survival and treatment-related adverse events(TRAEs)of GC/GEJC patients.METHODS Patients with advanced or metastatic GC/GEJC who received systematic treatment at Peking University Third Hospital were enrolled in this study.Propensity score matching(PSM)analysis was performed.RESULTS After 1:2 PSM analysis,93 patients were assessed,including 32 patients with OB before treatment(OBBT)and 61 patients without OBBT.The disease control rate was 90.6%in the group with OBBT and 88.5%in the group without OBBT,and this difference was not statistically significant.There was no difference in the incidence of TRAEs between the group with OBBT and the group without OBBT.The median overall survival(mOS)was 15.2 months for patients with OBBT and 23.7 months for those without OBBT[hazard ratio(HR)=1.101,95%confidence interval(CI):0.672-1.804,log rank P=0.701].The mOS was worse for patients with OB after treatment(OBAT)than for those without OBAT(11.4 months vs 23.7 months,HR=1.787,95%CI:1.006-3.175,log rank P=0.044).CONCLUSION The mOS for GC/GEJC patients with OBBT was similar to that for those without OBBT,but the mOS for patients with OBAT was worse than that for those without OBAT.展开更多
AIM To explore the natural history of covert hepatic encephalopathy(CHE) in absence of medication intervention.METHODS Consecutive outpatient cirrhotic patients in a Chinese tertiary care hospital were enrolled and ev...AIM To explore the natural history of covert hepatic encephalopathy(CHE) in absence of medication intervention.METHODS Consecutive outpatient cirrhotic patients in a Chinese tertiary care hospital were enrolled and evaluated for CHE diagnosis. They were followed up for a mean of 11.2 ± 1.3 mo. Time to the first cirrhosis-related complications requiring hospitalization, including overt HE(OHE), resolution of CHE and death/transplantation, were compared between CHE and no-CHE patients. Predictors for complication(s) and death/transplantation were also analyzed.RESULTS A total of 366 patients(age: 47.2 ± 8.6 years, male: 73.0%) were enrolled. CHE was identified in 131 patients(35.8%). CHE patients had higher rates of death and incidence of complications requiring hospitalization, including OHE, compared to unimpaired patients. Moreover, 17.6% of CHE patients developed OHE, 42.0% suffered persistent CHE, and 19.8% of CHE spontaneously resolved. In CHE patients, serum albumin < 30 g/L(HR = 5.22, P = 0.03) was the sole predictor for developing OHE, and blood creatinine > 133 μmol/L(HR = 4.75, P = 0.036) predicted mortality. Child-Pugh B/C(HR = 0.084, P < 0.001) and OHE history(HR = 0.15, P = 0.014) were predictors of spontaneous resolution of CHE.CONCLUSION CHE exacerbates, persists or resolves without medication intervention in clinically stable cirrhosis. Triage of patients based on these predictors will allow for more cost-effect management of CHE.展开更多
Participant observation is often applied in qualitative research to help researchers obtain the overall,useful data,which will lead researchers to gain the knowledge that the academia tries to.However,different levels...Participant observation is often applied in qualitative research to help researchers obtain the overall,useful data,which will lead researchers to gain the knowledge that the academia tries to.However,different levels of participant observation,mainly the covert and overt participant observation,have aroused heated discussions among scholars.Field researchers are faced with many problems when doing research,such as whether they should be a covert participant observer or an overt one;what the research will get when they are in different roles and etc.In order to solve those problems,this article tries to provide some effective methods to field researchers,especially to the new ones.This article mainly talks about two types of participant observation:covert and overt participant observation;tries to explore the issues caused by them and the strategies to help researchers deal with such issues.Finally,in qualitative research,when faced with different fieldworks,researchers should adapt themselves to choosing participant roles flexibly and appropriately.展开更多
Currently,it is key to convey precise meanings to readers for translators.Observing expressing habits between different languages is the precondition to make target texts more readable.It is crucial to ensure the exac...Currently,it is key to convey precise meanings to readers for translators.Observing expressing habits between different languages is the precondition to make target texts more readable.It is crucial to ensure the exactness and seriousness of legal texts,but it does not mean that translators have to take machined way to leave out and even give up transmitting in-deep cultural implications for the intention of achieving the all-inclusive integrity of target content.It is a correct choice for translators to take overt translation and covert translation in line with traits of source language and target language and differences between civil law system and common law system.The intention of the article is to make an empirical study between overt translation and covert translation.展开更多
AIM: To investigate the difference in long-term outcomes between gastric cancer patients with and without a primary symptom of overt bleeding(OB).METHODS: Consecutive patients between January 1, 2007 and March 1, 2012...AIM: To investigate the difference in long-term outcomes between gastric cancer patients with and without a primary symptom of overt bleeding(OB).METHODS: Consecutive patients between January 1, 2007 and March 1, 2012 were identified retrospectively by reviewing a gastric cancer database at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. A follow-up examination was performed on patients who underwent a radical gastrectomy. OB due to gastric cancer included hematemesis, melena or hematochezia, and gastric cancer was confirmed as the source of bleeding by endoscopy. Patients without OB were defined as cases with occult bleeding and those with other initial presentations, including epigastric pain, weakness, weight loss and obstruction. The 3-year overall survival(OS) rate, age, gender, AJCC T stage, AJCC N stage, overall AJCC stage, tumor size, histological type, macroscopic(Borrmann) type, lymphovascular invasion and R status were compared between patients with and without OB. Moreover, we carried out a subgroup analysis based on tumor location(upper, middle and lower).RESULTS: We identified 939 patients. Of these, 695(74.0%) were hospitalized for potential radical gastrectomy and another 244 received palliative resection, rerouting of the gastrointestinal tract, chemotherapy, radiotherapy or no treatment due to the presence of unresectable tumors. Notably, there was no significant difference in the percentage of OB patients between resectable cases and unresectable cases(20.3 % vs 22.1 %, P = 0.541). Fo l l o w- u p examination was performed on 653 patients(94%) who underwent radical gastrectomy. We found no significant difference in 3-year OS rate(68.2% vs 61.2%, P = 0.143) or clinicopathological characteristics(P > 0.05) between these patients with and without OB. Subgroup analysis based on tumor location showed that the 3-year OS rate of upper gastric cancer was significantly higher in patients with OB(84.6%) than in those without OB(48.1%, P < 0.01) and that AJCC stagesⅠ-Ⅱ(56.4% vs 35.1%, P = 0.017) and T1-T2 category tumors(30.8% vs 13%, P = 0.010) were more frequent in patients with OB than in those without OB. There was no significant difference in 3-year OS rate or clinicopathological characteristics between patients with and without OB(P > 0.05) for middle or lower gastric cancer.CONCLUSION: Upper gastric cancer patients with OB exhibited tumors at less advanced pathological stages and had a better prognosis than upper gastric cancer patients without OB.展开更多
Hookworm infection is a relatively common cause of anemia in endemic areas.The most common hookworm species are Ancylostoma duodenale and Necator americanus.In this report we present a case of overt gastrointestinal b...Hookworm infection is a relatively common cause of anemia in endemic areas.The most common hookworm species are Ancylostoma duodenale and Necator americanus.In this report we present a case of overt gastrointestinal bleeding Wause of hookworm infection.Capsule endoscopy revealed many hookworms in the lumen of proximal jejunum where active bleeding was seen. The patient was successfully treated with Albendazole.展开更多
<strong>Background</strong><span><strong>:</strong></span><span> With the rising prevalence in recent years, gestational diabetes mellitus has become one of the leading causes...<strong>Background</strong><span><strong>:</strong></span><span> With the rising prevalence in recent years, gestational diabetes mellitus has become one of the leading causes of maternal and child mortality and morbidity worldwide and has raised health concern. It is seriously detrimental to both the women and fetuses. However, there are limited evidences of two types of gestational diabetes mellitus on clinical characteristics and outcomes.</span><span> </span><span>Therefore, this study was aimed to explore the clinical characteristics and outcomes of patients with overt diabetes mellitus</span><span> </span><span>(ODM) and gestational diabetes mellitus</span><span> </span><span><span>(GDM) at the late pregnancy. </span><b><span>Methods</span></b></span><b><span>:</span></b><span> From January 2015 to August 2016, totally 63 gestational diabetes mellitus from the Department of Clinical Nutrition in Beijing Anzhen Hospital were enrolled in the study.</span><span> </span><span>Patients were classified into two groups.</span><span> </span><span>31 patients with gestational overt diabetes mellitus were grouped into ODM group and 32 patients with gestational diabetes mellitus were grouped into GDM group.</span><span> </span><span>Clinical characteristics and outcomes were compared between ODM and GDM.</span><span> </span><span>We collected records of the age, gestational week, family history, past history, pregnancy complications, insulin use,</span><span> </span><span>blood pressure, clinical nutrition indexes, blood pressure.</span><span> </span><span>Glycosylated hemoglobin</span><span> </span><span>(HbA1c), fasting blood glucose</span><span> </span><span>(FBG), total protein</span><span> </span><span>(TP),</span><span> </span><span>albumin</span><span> </span><span>(ALB), prealbumin</span><span> </span><span>(PALB), hemoglobin</span><span> </span><span>(HGB),</span><span> </span><span>urea nitrogen</span><span> </span><span>(BUN), serum creatinine</span><span> </span><span>(CREA), and dynamic blood glucose monitoring were measured.</span><span> </span><span><span>And we recorded the changes of blood glucose and the test data. We statistically analyzed the data of two groups. </span><b><span>Results</span></b></span><b><span>:</span></b><b><span> </span></b><span>In the ODM group,</span><span> </span><span>HbA1c, FBG, average blood glucose,</span><span> </span><span>two-hour postprandial blood glucose</span><span> </span><span>(2hPBG) after breakfast, 2hPBG after dinner, the number of hyperglycemic events and high blood glucose time ratio are significantly higher than th</span><span>ose</span><span> of GDM and two groups compared with statistical significance</span><span> </span><span>(P</span><span> </span><span><</span><span> </span><span>0.05)</span><span>. </span><span>The number of patients treated with insulin</span><span> </span><span>(10/31) in ODM is significantly more than that in GDM</span><span> </span><span>(1/32) (P</span><span> </span><span><</span><span> </span><span>0.05).</span><span> </span><span>45%</span><span> </span><span>(14/31) of ODM have a family history of diabetes patients.</span><span> </span><span>The ratio is significantly higher than 13%</span><span> </span><span>(4/32) of GDM</span><span> </span><span>(P</span><span> </span><span><</span><span> </span><span>0.05).</span><span> </span><span>There was significant difference in urinary ketone positive rate between the two groups</span><span> </span><span>(P</span><span> </span><span><</span><span> </span><span>0.05), but there was no significant difference in urinary microalbumin abnormal rate between them</span><span> </span><span>(P</span><span> </span><span>></span><span> </span><span>0.05).</span><span> </span><span>The number of preeclampsia in ODM</span><span> </span><span>(8/31) is significantly higher than that of GDM (P</span><span> </span><span><</span><span> </span><span>0.05).</span><span> </span><span>The level of HGB in ODM is lower than that of GDM</span><span> </span><span>(P</span><span> </span><span><</span><span> </span><span>0.05). There was no difference in the pregnancy outcomes between the two groups.</span><span> </span><b><span>Conclusion</span></b><b><span>:</span></b><span> Late pregnancy women with ODM have obvious family history, higher HbA1c, higher FBG, higher glucose levels of two-hours after breakfast and dinner,</span><span> </span><span>higher average blood glucose, longer hypoglycemia time, higher probability of hyperglycemic events and greater opportunity to use insulin in the treatment of symptomatic patients,</span><span> </span><span>higher risk of preeclampsia,</span><span> </span><span>lower HGB level than GDM,</span><span> </span><span>while GDM ha</span><span>s</span><span> higher positive rate of urine ketone than ODM.</span>展开更多
Objective: The aim of the study was to investigate the effects of short-term overt hypothyroidism on lipids after thyroxine-withdrawal in patients with iatrogenically induced hypothyroidism before radioiodine treatmen...Objective: The aim of the study was to investigate the effects of short-term overt hypothyroidism on lipids after thyroxine-withdrawal in patients with iatrogenically induced hypothyroidism before radioiodine treatment for differentiated thyroid carcinoma (DTC). Methods: Thirty patients with a history of differentiated thyroid carcinoma on thyroid-stimulating hormone (TSH)-suppressive thyroxine replacement therapy were studied. Blood sample were taken before and 4 weeks after withdrawal of thyroxine substitution. Venous blood was drawn after an overnight fast and analyzed for serum free T4 (FT4), free T3 (FT3), thyroid-stimulating hormone (TSH), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB). Fifty healthy people matched for age and gender were controls. Their blood samples were taken only once. Results: After thyroxine-withdrawal, the patients presented with increased serum TSH and low serum FT4 and FT3 levels compared with controls. Serum TG, TC, LDL, HDL, ApoB and Lp(a) increased after thyroxine withdrawal, reaching statistical significant differences with previous evaluation. However, when compared to euthyroid controls, only TC, LDL and ApoB were increased when patients were hypothyroidism. No changes were observed in ApoA1 in patients during thyroxine withdrawal, or when comparing the values observed in patients to those of euthyroid controls. Conclusion: TG, TC, LDL, HDL, ApoB and Lp(a) were increased during short-term overt hypothyroidism.展开更多
This paper examines the early acquisition of null subjects and overt subjects and how they are distributed and realized in the early speech of Arabic dialect-speaking children.①The study accounts for the phenomenon o...This paper examines the early acquisition of null subjects and overt subjects and how they are distributed and realized in the early speech of Arabic dialect-speaking children.①The study accounts for the phenomenon of subjects by examining a longitudinal corpus of two children,Wala and Ibraheem,who were around two years old,speaking Yemeni Ibbi Arabic(YIA)dialect.The production and elicited production data collection methods were used in the study to collect the corpus during five months.The results of the study showed that null-subjects appear with a high proportion compared to the overt subjects.It was found that null subjects and overt subjects in the speech of Ibraheem and Wala had a similar distribution in the imperfective and the perfective,of which 86-87%are null subjects and 12-14%are overt subjects.The paper examined the widespread linguistic phenomenon of Null Subject Parameter acquisition,(Rizzi,1982;Hyams,1986,1989)that is emergence of null subjects in line with overt subjects.The paper supports Hyam’s(1982)argument on the acquisition of Null Subject Parameter where we can find children acquire null subjects early around 2 years of age.In contrast to non-null subject languages(like English),Null Subject Languages(NSLs)like Arabic happen to have null subjects appear more frequently and this is due to the rich inflectional morphology of NSLs.展开更多
CHEN Guangbiao,President of Jiangsu Huangpu Renewable Resources,made headlines in January 2011 when he gave out red envelopes stuffed with money to those in need in Taiwan, and again in March when he handed out cash t...CHEN Guangbiao,President of Jiangsu Huangpu Renewable Resources,made headlines in January 2011 when he gave out red envelopes stuffed with money to those in need in Taiwan, and again in March when he handed out cash to survivors of earthquake-stricken Yingjiang County,Yunnan Province.The posed photos of Chen along with earthquake survivors holding展开更多
Background and Aims:The performance of neurodegenerative biomarkers—neurofilament light chain(NfL),glial fibrillary acidic protein(GFAP),tau,and ubiquitin carboxyterminal hydrolase L1(UCHL1)—in diagnosing minimal he...Background and Aims:The performance of neurodegenerative biomarkers—neurofilament light chain(NfL),glial fibrillary acidic protein(GFAP),tau,and ubiquitin carboxyterminal hydrolase L1(UCHL1)—in diagnosing minimal hepatic encephalopathy(MHE)has not been systematically evaluated,simultaneously,nor have their associations with the development of overt hepatic encephalopathy(OHE).This study aimed to evaluate the performance of plasma NfL,GFAP,tau,and UCHL1 in diagnosing MHE and predicting the development of OHE in Chinese patients with hepatic cirrhosis.Methods:In this prospective study,124 patients with hepatic cirrhosis were recruited.The Psychometric Hepatic Encephalopathy Score was used to diagnose MHE,and OHE development was observed during a 30-day follow-up period.Plasma levels of NfL,GFAP,tau,and UCHL1 were measured using the highly sensitive single-molecule array when MHE was diagnosed.Additionally,serum interleukin-6(IL-6)levels and the model for end-stage liver disease(MELD)and MELD-Na scores were also measured.Results:MHE was diagnosed in 57(46.0%)patients.Patients with MHE had significantly higher plasma levels of NfL and GFAP(34.2 vs.22.4 pg/mL and 173 vs.97.6 pg/mL,respectively;both p<0.001)and lower tau levels(8.4 vs.11.6 pg/mL,p=0.048)compared to those without MHE.Plasma NfL(odds ratios=1.027,95%confidence interval[CI]:1.006–1.048;p=0.013)and serum ammonia levels(odds ratios=1.021,95%CI:1.006–1.036;p=0.007)were independently associated with MHE occurrence.A combination of NfL,GFAP,tau,and UCHL1 was effective in diagnosing MHE in all cirrhotic patients(area under the receiver operating characteristic curve[hereinafter referred to as AUROC]:0.748,95%CI:0.662–0.821),with an accuracy,sensitivity,and specificity of 71.0%,71.9%,and 71.6%,respectively.In patients without previous OHE,the combination had an AUROC of 0.764(95%CI:0.673–0.840),with an accuracy,sensitivity,and specificity of 72.5%,71.7%,and 73.0%,respectively.Furthermore,GFAP(hazard ratio(HR)=1.003,95%CI:1.000–1.005;p=0.044),IL-6(HR=1.003,95%CI:1.001–1.004;p<0.001),and MELD score(HR=1.139,95%CI:1.072–1.210;p<0.001)—but not NfL,tau,and UCHL1—were identified as risk factors for 30-day OHE development.Conclusions:The combination of plasma levels of NfL,GFAP,tau,and UCHL1 performs well in diagnosing MHE.Additionally,MELD score,IL-6,and GFAP appear to be significant predictors of OHE development in patients with hepatic cirrhosis.展开更多
BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is an effective intervention for managing complications of portal hypertension,particularly acute variceal bleeding(AVB).While effective in reducing portal...BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is an effective intervention for managing complications of portal hypertension,particularly acute variceal bleeding(AVB).While effective in reducing portal pressure and preventing rebleeding,TIPS is associated with a considerable risk of overt hepatic encephalopathy(OHE),a complication that significantly elevates mortality rates.AIM To develop a machine learning(ML)model to predict OHE occurrence post-TIPS in patients with AVB using a 5-year dataset.METHODS This retrospective single-center study included 218 patients with AVB who underwent TIPS.The dataset was divided into training(70%)and testing(30%)sets.Critical features were identified using embedded methods and recursive feature elimination.Three ML algorithms-random forest,extreme gradient boosting,and logistic regression-were validated via 10-fold cross-validation.SHapley Additive exPlanations analysis was employed to interpret the model’s predictions.Survival analysis was conducted using Kaplan-Meier curves and stepwise Cox regression analysis to compare overall survival(OS)between patients with and without OHE.RESULTS The median OS of the study cohort was 47.83±22.95 months.Among the models evaluated,logistic regression demonstrated the highest performance with an area under the curve(AUC)of 0.825.Key predictors identified were Child-Pugh score,age,and portal vein thrombosis.Kaplan-Meier analysis revealed that patients without OHE had a significantly longer OS(P=0.005).The 5-year survival rate was 78.4%,with an OHE incidence of 15.1%.Both actual OHE status and predicted OHE value were significant predictors in each Cox model,with model-predicted OHE achieving an AUC of 88.1 in survival prediction.CONCLUSION The ML model accurately predicts post-TIPS OHE and outperforms traditional models,supporting its use in improving outcomes in patients with AVB.展开更多
Ever since Schmidt proposed the noticing hypothesis in 1990, the role of consciousness in second language input and output processing has attracted increasing attention from various researchers. In many studies, wheth...Ever since Schmidt proposed the noticing hypothesis in 1990, the role of consciousness in second language input and output processing has attracted increasing attention from various researchers. In many studies, whether or not consciousness is used is deemed as an important factor leading to changes in language learners performance. Current research procedures on measuring consciousness in second language acquisition field are not very satisfactory. The present study, by making use of Levelt s L1 speech pr...展开更多
文摘Gastric cancer(GC)and gastroesophageal junction cancer(GEJC)represent a significant burden globally,with complications such as overt bleeding(OB)further exacerbating patient outcomes.A recent study by Yao et al evaluated the effectiveness and safety of systematic treatment in GC/GEJC patients presenting with OB.Using propensity score matching,the study balanced the comparison groups to investigate overall survival and treatment-related adverse events.The study's findings emphasize that systematic therapy can be safe and effective and contribute to the ongoing debate about the management of advanced GC/GEJC with OB,highlighting the complexities of treatment decisions in these high-risk patients.
基金approved by the Peking University Third Hospital Medical Science Research Ethics Committee(IRB00006761-M2023544).
文摘BACKGROUND Hemorrhage,which is not a rare complication in patients with gastric cancer(GC)/gastroesophageal junction cancer(GEJC),can lead to a poor prognosis.However,no study has examined the effectiveness and safety of chemotherapy as an initial therapy for GC/GEJC patients with overt bleeding(OB).AIM To investigate the impact of OB on the survival and treatment-related adverse events(TRAEs)of GC/GEJC patients.METHODS Patients with advanced or metastatic GC/GEJC who received systematic treatment at Peking University Third Hospital were enrolled in this study.Propensity score matching(PSM)analysis was performed.RESULTS After 1:2 PSM analysis,93 patients were assessed,including 32 patients with OB before treatment(OBBT)and 61 patients without OBBT.The disease control rate was 90.6%in the group with OBBT and 88.5%in the group without OBBT,and this difference was not statistically significant.There was no difference in the incidence of TRAEs between the group with OBBT and the group without OBBT.The median overall survival(mOS)was 15.2 months for patients with OBBT and 23.7 months for those without OBBT[hazard ratio(HR)=1.101,95%confidence interval(CI):0.672-1.804,log rank P=0.701].The mOS was worse for patients with OB after treatment(OBAT)than for those without OBAT(11.4 months vs 23.7 months,HR=1.787,95%CI:1.006-3.175,log rank P=0.044).CONCLUSION The mOS for GC/GEJC patients with OBBT was similar to that for those without OBBT,but the mOS for patients with OBAT was worse than that for those without OBAT.
基金Supported by Science and Technology Planning Project of Health and Family Planning Commission of Jiangxi Province,No.20171022National Natural Science Fund of China,No.81460122+2 种基金Project in the Science and Technology Pillar Program of Jiangxi Provincial Department of Science and Technology,No.20161BBG70166Jiangxi Provincial Outstanding Young Talent Program,No.20171BCB23085Natural Science Fund of Jiangxi Province For Young Scholars,No.20171BAB215008
文摘AIM To explore the natural history of covert hepatic encephalopathy(CHE) in absence of medication intervention.METHODS Consecutive outpatient cirrhotic patients in a Chinese tertiary care hospital were enrolled and evaluated for CHE diagnosis. They were followed up for a mean of 11.2 ± 1.3 mo. Time to the first cirrhosis-related complications requiring hospitalization, including overt HE(OHE), resolution of CHE and death/transplantation, were compared between CHE and no-CHE patients. Predictors for complication(s) and death/transplantation were also analyzed.RESULTS A total of 366 patients(age: 47.2 ± 8.6 years, male: 73.0%) were enrolled. CHE was identified in 131 patients(35.8%). CHE patients had higher rates of death and incidence of complications requiring hospitalization, including OHE, compared to unimpaired patients. Moreover, 17.6% of CHE patients developed OHE, 42.0% suffered persistent CHE, and 19.8% of CHE spontaneously resolved. In CHE patients, serum albumin < 30 g/L(HR = 5.22, P = 0.03) was the sole predictor for developing OHE, and blood creatinine > 133 μmol/L(HR = 4.75, P = 0.036) predicted mortality. Child-Pugh B/C(HR = 0.084, P < 0.001) and OHE history(HR = 0.15, P = 0.014) were predictors of spontaneous resolution of CHE.CONCLUSION CHE exacerbates, persists or resolves without medication intervention in clinically stable cirrhosis. Triage of patients based on these predictors will allow for more cost-effect management of CHE.
文摘Participant observation is often applied in qualitative research to help researchers obtain the overall,useful data,which will lead researchers to gain the knowledge that the academia tries to.However,different levels of participant observation,mainly the covert and overt participant observation,have aroused heated discussions among scholars.Field researchers are faced with many problems when doing research,such as whether they should be a covert participant observer or an overt one;what the research will get when they are in different roles and etc.In order to solve those problems,this article tries to provide some effective methods to field researchers,especially to the new ones.This article mainly talks about two types of participant observation:covert and overt participant observation;tries to explore the issues caused by them and the strategies to help researchers deal with such issues.Finally,in qualitative research,when faced with different fieldworks,researchers should adapt themselves to choosing participant roles flexibly and appropriately.
文摘Currently,it is key to convey precise meanings to readers for translators.Observing expressing habits between different languages is the precondition to make target texts more readable.It is crucial to ensure the exactness and seriousness of legal texts,but it does not mean that translators have to take machined way to leave out and even give up transmitting in-deep cultural implications for the intention of achieving the all-inclusive integrity of target content.It is a correct choice for translators to take overt translation and covert translation in line with traits of source language and target language and differences between civil law system and common law system.The intention of the article is to make an empirical study between overt translation and covert translation.
文摘AIM: To investigate the difference in long-term outcomes between gastric cancer patients with and without a primary symptom of overt bleeding(OB).METHODS: Consecutive patients between January 1, 2007 and March 1, 2012 were identified retrospectively by reviewing a gastric cancer database at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. A follow-up examination was performed on patients who underwent a radical gastrectomy. OB due to gastric cancer included hematemesis, melena or hematochezia, and gastric cancer was confirmed as the source of bleeding by endoscopy. Patients without OB were defined as cases with occult bleeding and those with other initial presentations, including epigastric pain, weakness, weight loss and obstruction. The 3-year overall survival(OS) rate, age, gender, AJCC T stage, AJCC N stage, overall AJCC stage, tumor size, histological type, macroscopic(Borrmann) type, lymphovascular invasion and R status were compared between patients with and without OB. Moreover, we carried out a subgroup analysis based on tumor location(upper, middle and lower).RESULTS: We identified 939 patients. Of these, 695(74.0%) were hospitalized for potential radical gastrectomy and another 244 received palliative resection, rerouting of the gastrointestinal tract, chemotherapy, radiotherapy or no treatment due to the presence of unresectable tumors. Notably, there was no significant difference in the percentage of OB patients between resectable cases and unresectable cases(20.3 % vs 22.1 %, P = 0.541). Fo l l o w- u p examination was performed on 653 patients(94%) who underwent radical gastrectomy. We found no significant difference in 3-year OS rate(68.2% vs 61.2%, P = 0.143) or clinicopathological characteristics(P > 0.05) between these patients with and without OB. Subgroup analysis based on tumor location showed that the 3-year OS rate of upper gastric cancer was significantly higher in patients with OB(84.6%) than in those without OB(48.1%, P < 0.01) and that AJCC stagesⅠ-Ⅱ(56.4% vs 35.1%, P = 0.017) and T1-T2 category tumors(30.8% vs 13%, P = 0.010) were more frequent in patients with OB than in those without OB. There was no significant difference in 3-year OS rate or clinicopathological characteristics between patients with and without OB(P > 0.05) for middle or lower gastric cancer.CONCLUSION: Upper gastric cancer patients with OB exhibited tumors at less advanced pathological stages and had a better prognosis than upper gastric cancer patients without OB.
文摘Hookworm infection is a relatively common cause of anemia in endemic areas.The most common hookworm species are Ancylostoma duodenale and Necator americanus.In this report we present a case of overt gastrointestinal bleeding Wause of hookworm infection.Capsule endoscopy revealed many hookworms in the lumen of proximal jejunum where active bleeding was seen. The patient was successfully treated with Albendazole.
文摘<strong>Background</strong><span><strong>:</strong></span><span> With the rising prevalence in recent years, gestational diabetes mellitus has become one of the leading causes of maternal and child mortality and morbidity worldwide and has raised health concern. It is seriously detrimental to both the women and fetuses. However, there are limited evidences of two types of gestational diabetes mellitus on clinical characteristics and outcomes.</span><span> </span><span>Therefore, this study was aimed to explore the clinical characteristics and outcomes of patients with overt diabetes mellitus</span><span> </span><span>(ODM) and gestational diabetes mellitus</span><span> </span><span><span>(GDM) at the late pregnancy. </span><b><span>Methods</span></b></span><b><span>:</span></b><span> From January 2015 to August 2016, totally 63 gestational diabetes mellitus from the Department of Clinical Nutrition in Beijing Anzhen Hospital were enrolled in the study.</span><span> </span><span>Patients were classified into two groups.</span><span> </span><span>31 patients with gestational overt diabetes mellitus were grouped into ODM group and 32 patients with gestational diabetes mellitus were grouped into GDM group.</span><span> </span><span>Clinical characteristics and outcomes were compared between ODM and GDM.</span><span> </span><span>We collected records of the age, gestational week, family history, past history, pregnancy complications, insulin use,</span><span> </span><span>blood pressure, clinical nutrition indexes, blood pressure.</span><span> </span><span>Glycosylated hemoglobin</span><span> </span><span>(HbA1c), fasting blood glucose</span><span> </span><span>(FBG), total protein</span><span> </span><span>(TP),</span><span> </span><span>albumin</span><span> </span><span>(ALB), prealbumin</span><span> </span><span>(PALB), hemoglobin</span><span> </span><span>(HGB),</span><span> </span><span>urea nitrogen</span><span> </span><span>(BUN), serum creatinine</span><span> </span><span>(CREA), and dynamic blood glucose monitoring were measured.</span><span> </span><span><span>And we recorded the changes of blood glucose and the test data. We statistically analyzed the data of two groups. </span><b><span>Results</span></b></span><b><span>:</span></b><b><span> </span></b><span>In the ODM group,</span><span> </span><span>HbA1c, FBG, average blood glucose,</span><span> </span><span>two-hour postprandial blood glucose</span><span> </span><span>(2hPBG) after breakfast, 2hPBG after dinner, the number of hyperglycemic events and high blood glucose time ratio are significantly higher than th</span><span>ose</span><span> of GDM and two groups compared with statistical significance</span><span> </span><span>(P</span><span> </span><span><</span><span> </span><span>0.05)</span><span>. </span><span>The number of patients treated with insulin</span><span> </span><span>(10/31) in ODM is significantly more than that in GDM</span><span> </span><span>(1/32) (P</span><span> </span><span><</span><span> </span><span>0.05).</span><span> </span><span>45%</span><span> </span><span>(14/31) of ODM have a family history of diabetes patients.</span><span> </span><span>The ratio is significantly higher than 13%</span><span> </span><span>(4/32) of GDM</span><span> </span><span>(P</span><span> </span><span><</span><span> </span><span>0.05).</span><span> </span><span>There was significant difference in urinary ketone positive rate between the two groups</span><span> </span><span>(P</span><span> </span><span><</span><span> </span><span>0.05), but there was no significant difference in urinary microalbumin abnormal rate between them</span><span> </span><span>(P</span><span> </span><span>></span><span> </span><span>0.05).</span><span> </span><span>The number of preeclampsia in ODM</span><span> </span><span>(8/31) is significantly higher than that of GDM (P</span><span> </span><span><</span><span> </span><span>0.05).</span><span> </span><span>The level of HGB in ODM is lower than that of GDM</span><span> </span><span>(P</span><span> </span><span><</span><span> </span><span>0.05). There was no difference in the pregnancy outcomes between the two groups.</span><span> </span><b><span>Conclusion</span></b><b><span>:</span></b><span> Late pregnancy women with ODM have obvious family history, higher HbA1c, higher FBG, higher glucose levels of two-hours after breakfast and dinner,</span><span> </span><span>higher average blood glucose, longer hypoglycemia time, higher probability of hyperglycemic events and greater opportunity to use insulin in the treatment of symptomatic patients,</span><span> </span><span>higher risk of preeclampsia,</span><span> </span><span>lower HGB level than GDM,</span><span> </span><span>while GDM ha</span><span>s</span><span> higher positive rate of urine ketone than ODM.</span>
基金Supported by a grant from the National Natural Science Foundation of China (No. 30700185)
文摘Objective: The aim of the study was to investigate the effects of short-term overt hypothyroidism on lipids after thyroxine-withdrawal in patients with iatrogenically induced hypothyroidism before radioiodine treatment for differentiated thyroid carcinoma (DTC). Methods: Thirty patients with a history of differentiated thyroid carcinoma on thyroid-stimulating hormone (TSH)-suppressive thyroxine replacement therapy were studied. Blood sample were taken before and 4 weeks after withdrawal of thyroxine substitution. Venous blood was drawn after an overnight fast and analyzed for serum free T4 (FT4), free T3 (FT3), thyroid-stimulating hormone (TSH), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB). Fifty healthy people matched for age and gender were controls. Their blood samples were taken only once. Results: After thyroxine-withdrawal, the patients presented with increased serum TSH and low serum FT4 and FT3 levels compared with controls. Serum TG, TC, LDL, HDL, ApoB and Lp(a) increased after thyroxine withdrawal, reaching statistical significant differences with previous evaluation. However, when compared to euthyroid controls, only TC, LDL and ApoB were increased when patients were hypothyroidism. No changes were observed in ApoA1 in patients during thyroxine withdrawal, or when comparing the values observed in patients to those of euthyroid controls. Conclusion: TG, TC, LDL, HDL, ApoB and Lp(a) were increased during short-term overt hypothyroidism.
文摘This paper examines the early acquisition of null subjects and overt subjects and how they are distributed and realized in the early speech of Arabic dialect-speaking children.①The study accounts for the phenomenon of subjects by examining a longitudinal corpus of two children,Wala and Ibraheem,who were around two years old,speaking Yemeni Ibbi Arabic(YIA)dialect.The production and elicited production data collection methods were used in the study to collect the corpus during five months.The results of the study showed that null-subjects appear with a high proportion compared to the overt subjects.It was found that null subjects and overt subjects in the speech of Ibraheem and Wala had a similar distribution in the imperfective and the perfective,of which 86-87%are null subjects and 12-14%are overt subjects.The paper examined the widespread linguistic phenomenon of Null Subject Parameter acquisition,(Rizzi,1982;Hyams,1986,1989)that is emergence of null subjects in line with overt subjects.The paper supports Hyam’s(1982)argument on the acquisition of Null Subject Parameter where we can find children acquire null subjects early around 2 years of age.In contrast to non-null subject languages(like English),Null Subject Languages(NSLs)like Arabic happen to have null subjects appear more frequently and this is due to the rich inflectional morphology of NSLs.
文摘CHEN Guangbiao,President of Jiangsu Huangpu Renewable Resources,made headlines in January 2011 when he gave out red envelopes stuffed with money to those in need in Taiwan, and again in March when he handed out cash to survivors of earthquake-stricken Yingjiang County,Yunnan Province.The posed photos of Chen along with earthquake survivors holding
基金Supported by the National Key Research and Development Program of China(2021YFC2600200)the Natural Science Foundation of Hubei Province of China(2021CFB353).
文摘Background and Aims:The performance of neurodegenerative biomarkers—neurofilament light chain(NfL),glial fibrillary acidic protein(GFAP),tau,and ubiquitin carboxyterminal hydrolase L1(UCHL1)—in diagnosing minimal hepatic encephalopathy(MHE)has not been systematically evaluated,simultaneously,nor have their associations with the development of overt hepatic encephalopathy(OHE).This study aimed to evaluate the performance of plasma NfL,GFAP,tau,and UCHL1 in diagnosing MHE and predicting the development of OHE in Chinese patients with hepatic cirrhosis.Methods:In this prospective study,124 patients with hepatic cirrhosis were recruited.The Psychometric Hepatic Encephalopathy Score was used to diagnose MHE,and OHE development was observed during a 30-day follow-up period.Plasma levels of NfL,GFAP,tau,and UCHL1 were measured using the highly sensitive single-molecule array when MHE was diagnosed.Additionally,serum interleukin-6(IL-6)levels and the model for end-stage liver disease(MELD)and MELD-Na scores were also measured.Results:MHE was diagnosed in 57(46.0%)patients.Patients with MHE had significantly higher plasma levels of NfL and GFAP(34.2 vs.22.4 pg/mL and 173 vs.97.6 pg/mL,respectively;both p<0.001)and lower tau levels(8.4 vs.11.6 pg/mL,p=0.048)compared to those without MHE.Plasma NfL(odds ratios=1.027,95%confidence interval[CI]:1.006–1.048;p=0.013)and serum ammonia levels(odds ratios=1.021,95%CI:1.006–1.036;p=0.007)were independently associated with MHE occurrence.A combination of NfL,GFAP,tau,and UCHL1 was effective in diagnosing MHE in all cirrhotic patients(area under the receiver operating characteristic curve[hereinafter referred to as AUROC]:0.748,95%CI:0.662–0.821),with an accuracy,sensitivity,and specificity of 71.0%,71.9%,and 71.6%,respectively.In patients without previous OHE,the combination had an AUROC of 0.764(95%CI:0.673–0.840),with an accuracy,sensitivity,and specificity of 72.5%,71.7%,and 73.0%,respectively.Furthermore,GFAP(hazard ratio(HR)=1.003,95%CI:1.000–1.005;p=0.044),IL-6(HR=1.003,95%CI:1.001–1.004;p<0.001),and MELD score(HR=1.139,95%CI:1.072–1.210;p<0.001)—but not NfL,tau,and UCHL1—were identified as risk factors for 30-day OHE development.Conclusions:The combination of plasma levels of NfL,GFAP,tau,and UCHL1 performs well in diagnosing MHE.Additionally,MELD score,IL-6,and GFAP appear to be significant predictors of OHE development in patients with hepatic cirrhosis.
基金Natural Science Foundation of Guangdong Province,No.2024A1515013069.
文摘BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is an effective intervention for managing complications of portal hypertension,particularly acute variceal bleeding(AVB).While effective in reducing portal pressure and preventing rebleeding,TIPS is associated with a considerable risk of overt hepatic encephalopathy(OHE),a complication that significantly elevates mortality rates.AIM To develop a machine learning(ML)model to predict OHE occurrence post-TIPS in patients with AVB using a 5-year dataset.METHODS This retrospective single-center study included 218 patients with AVB who underwent TIPS.The dataset was divided into training(70%)and testing(30%)sets.Critical features were identified using embedded methods and recursive feature elimination.Three ML algorithms-random forest,extreme gradient boosting,and logistic regression-were validated via 10-fold cross-validation.SHapley Additive exPlanations analysis was employed to interpret the model’s predictions.Survival analysis was conducted using Kaplan-Meier curves and stepwise Cox regression analysis to compare overall survival(OS)between patients with and without OHE.RESULTS The median OS of the study cohort was 47.83±22.95 months.Among the models evaluated,logistic regression demonstrated the highest performance with an area under the curve(AUC)of 0.825.Key predictors identified were Child-Pugh score,age,and portal vein thrombosis.Kaplan-Meier analysis revealed that patients without OHE had a significantly longer OS(P=0.005).The 5-year survival rate was 78.4%,with an OHE incidence of 15.1%.Both actual OHE status and predicted OHE value were significant predictors in each Cox model,with model-predicted OHE achieving an AUC of 88.1 in survival prediction.CONCLUSION The ML model accurately predicts post-TIPS OHE and outperforms traditional models,supporting its use in improving outcomes in patients with AVB.
文摘Ever since Schmidt proposed the noticing hypothesis in 1990, the role of consciousness in second language input and output processing has attracted increasing attention from various researchers. In many studies, whether or not consciousness is used is deemed as an important factor leading to changes in language learners performance. Current research procedures on measuring consciousness in second language acquisition field are not very satisfactory. The present study, by making use of Levelt s L1 speech pr...
