Solar radiation data forecasting algorithms are important,especially in developing countries,as vast solar power plants cannot measure reliable and constant solar irradiance.The challenges of solar irradiance predicti...Solar radiation data forecasting algorithms are important,especially in developing countries,as vast solar power plants cannot measure reliable and constant solar irradiance.The challenges of solar irradiance prediction may be resolved by machine learning using weather datasets.This study emphasises the daily and monthly global solar radiation data predictions of three locations,Pretoria,Bloemfontein,and Vuwani,at different provinces in South Africa with various solar radiation distributions.The study evaluated five different machine learning models.Forecasting models were established to evaluate global solar radiation,focusing on input data.The selected forecast models are centered on their ability to perform with time series data.These models use five years of data from meteorological parameters,such as global horizontal irradiance(GHI),relative humidity,wind speed and ambient temperature between 1 January 2018 and 31 December 2022.The datasets from these meteorological parameters are utilised for training and testing the employed algorithms,which are examined using five statistical metrics.Moreover,the inconsistency of the solar irradiance time series was equally assessed using the clearness index.The results from this study demonstrate that the R2 value recording 0.866 datasets in Bloemfontein of random forest algorithm presents the highest performance during the training processes for all models studied,while the random tree in Vuwani showed the lowest performance of R2 of 0.210 with other algorithms in testing processes.Additionally,the maximum solar radiation was found in December for both Pretoria and Bloemfontein,recorded as 5.347 and 5.844 kWh/m2/day,respectively,while it was 4.692 kWh/m2/day at Vuwani in January.Similarly,the average clearness index of 0.605,0.657 and 0.533 are obtained at Pretoria,Bloemfontein,and Vuwani,respectively.Among the three sites under study,the solar radiation and clearness index are higher in Bloemfontein.Therefore,the proposed algorithms could be used conveniently for short-and long-term solar power plants in South Africa.展开更多
BACKGROUND Total hip arthroplasty(THA)has increased along with an increasing demand for improved quality of life.Combined with prolonged life expectancy,the number of revision surgeries is expected to increase.Stress ...BACKGROUND Total hip arthroplasty(THA)has increased along with an increasing demand for improved quality of life.Combined with prolonged life expectancy,the number of revision surgeries is expected to increase.Stress shielding is a significant issue with traditional femoral stems used in THA,making revision surgeries particularly challenging in younger patients.This has sparked renewed interest in studying safety and functional outcomes of short metaphyseal femoral stems,which have the potential to alleviate these challenges and simplify revision surgeries.AIM To evaluate the long-term outcomes of short-stem THA.METHODS A total of 124 hips that underwent THA using the short femoral stem(TRILOCK®Depuy)between May 2006 and November 2008 were included in this study.Patients were followed for a period of 15 years.Outcomes were assessed in terms of pain relief,hip joint range of motion,improvement in mobility,and functional outcomes using the modified Harris Hip Score,Oxford hip score,and Western Ontario and McMaster Universities Osteoarthritis index score.RESULTS A total of 124 hips in 98 patients were evaluated.Significant improvements in functional outcomes were observed over the 15-year follow-up period,with no cases of subsidence,implant loosening,or complications necessitating revision surgery.The only complication reported was heterotopic ossification in 1 patient.CONCLUSION Short metaphyseal stems provide better functional outcomes with early mobilization,and its long-term follow-up without subsidence,implant loosening,or proximal femoral bone loss simplifies revision surgery in younger patients.展开更多
BACKGROUND Gastric cancer is a major global health issue,and the perioperative period critic-ally influences patient outcomes.The different effects of sevoflurane inhalation anesthesia and propofol total intravenous a...BACKGROUND Gastric cancer is a major global health issue,and the perioperative period critic-ally influences patient outcomes.The different effects of sevoflurane inhalation anesthesia and propofol total intravenous anesthesia on intraoperative stability,postoperative complications,and long-term oncologic outcomes in patients with gastric cancer undergoing radical gastrectomy remain unclear.AIM To compare the effects of sevoflurane inhalation anesthesia and propofol total in-travenous anesthesia on clinical outcomes,including intraoperative indicators,postoperative complications,adverse effects,pain scores,and survival.METHODS This single-center retrospective cohort study included 204 patients who underw-ent radical gastrectomy for gastric cancer from February 2019 to December 2022.Patients were assigned to either the sevoflurane group(n=103)or the propofol group(n=101)based on intraoperative anesthetic regimen.Standardized protoc-ols for anesthesia management,intraoperative monitoring,and postoperative analgesia were applied.Baseline characteristics;intraoperative metrics;adverse events;complications;Visual Analog Scale(VAS)scores at 2,4,6,24,and 48 hours;and survival outcomes were retrospectively collected.Group comparisons were performed usingχ2 for categorical variables,t test for continuous variables,RESULTS Baseline demographic and clinical characteristics were similar between groups.No significant differences were observed in intraoperative indicators or most 30-day postoperative outcomes,including length of stay,emergency department visits,and readmission rates.The propofol group showed elevated mean VAS pain score at 24 hours postoperatively,but no differences were found at other time points.The propofol group also had significantly higher postoperative nausea incidence and transiently higher systolic/diastolic blood pressure and heart rate at the time of incision than the sevoflurane group.No significant differences were seen in overall rates or severity of postoperative complications,intraoperative adverse events,or in overall survival and progression-free survival.CONCLUSION In patients undergoing radical gastrectomy for gastric cancer,sevoflurane and propofol anesthesia demonstrated similar profiles regarding intraoperative safety,postoperative complications,adverse events,postoperative pain,and long-term survival.The selection of anesthesia can be personalized without significantly affecting periop-erative or oncologic outcomes.展开更多
Objective:Robotic gastrectomy(RG)is increasingly used in the treatment of gastric cancer.However,studies on patients with clinical serosa-invasive(cT4a)gastric cancer remain scarce.This study aimed to compare the shor...Objective:Robotic gastrectomy(RG)is increasingly used in the treatment of gastric cancer.However,studies on patients with clinical serosa-invasive(cT4a)gastric cancer remain scarce.This study aimed to compare the shortand long-term outcomes of RG and laparoscopic gastrectomy(LG)in the treatment of stage cT4a gastric cancer.Methods:A retrospective analysis was conducted on the clinical data of patients with stage cT4a gastric cancer diagnosed and treated at eight high-volume tertiary teaching hospitals in China from 2016 to 2019.Propensity score matching(PSM)analysis and inverse probability of treatment weighting(IPTW)analysis was used to adjust for the imbalance in baseline characteristics.The primary research endpoint was the 3-year overall survival(OS)and disease-free survival(DFS).The secondary research endpoint was intraoperative outcomes and postoperative complications.Results:After IPTW and PSM adjustments,baseline characteristics between the RG and LG groups were comparable[standardized mean difference(SMD)<0.10].Post-PSM analysis revealed that the RG group exhibited longer operative time(P<0.001),lower postoperative complication rates(P<0.001),shorter postoperative hospital stays(P=0.037),and earlier initiation of adjuvant chemotherapy(P=0.041)compared with the LG group.Survival analysis demonstrated comparable 3-year OS(P=0.110)and DFS(P=0.088)in the PSM cohort,whereas the IPTW cohort showed superior OS(P=0.030)and DFS(P=0.046)for RG.No significant differences were observed in overall recurrence rates or recurrence sites between groups.Conclusions:For patients with stage cT4a gastric cancer,compared with the LG group,the RG group had shorter postoperative hospital stay,lower incidence of postoperative complications,earlier postoperative adjuvant chemotherapy,and no worse long-term efficacy.展开更多
Short-chain fatty acids,metabolites produced by the fermentation of dietary fiber by gut microbiota,have garnered significant attention due to their correlation with neurodegenerative diseases,particularly Parkinson’...Short-chain fatty acids,metabolites produced by the fermentation of dietary fiber by gut microbiota,have garnered significant attention due to their correlation with neurodegenerative diseases,particularly Parkinson’s disease.In this review,we summarize the changes in short-chain fatty acid levels and the abundance of short-chain fatty acid-producing bacteria in various samples from patients with Parkinson’s disease,highlighting the critical role of gut homeostasis imbalance in the pathogenesis and progression of the disease.Focusing on the nervous system,we discuss the molecular mechanisms by which short-chain fatty acids influence the homeostasis of both the enteric nervous system and the central nervous system.We identify key processes,including the activation of G protein-coupled receptors and the inhibition of histone deacetylases by short-chain fatty acids.Importantly,structural or functional disruptions in the enteric nervous system mediated by these fatty acids may lead to abnormalα-synuclein expression and gastrointestinal dysmotility,which could serve as an initiating event in Parkinson’s disease.Furthermore,we propose that short-chain fatty acids help establish communication between the enteric nervous system and the central nervous system via the vagal nerve,immune circulation,and endocrine signaling.This communication may shed light on their potential role in the transmission ofα-synuclein from the gut to the brain.Finally,we elucidate novel treatment strategies for Parkinson’s disease that target short-chain fatty acids and examine the challenges associated with translating short-chain fatty acid-based therapies into clinical practice.In conclusion,this review emphasizes the pivotal role of short-chain fatty acids in regulating gut-brain axis integrity and their significance in the pathogenesis of Parkinson’s disease from the perspective of the nervous system.Moreover,it highlights the potential value of short-chain fatty acids in early intervention for Parkinson’s disease.Future research into the molecular mechanisms of short-chain fatty acids and their synergistic interactions with other gut metabolites is likely to advance the clinical translation of innovative short-chain fatty acid-based therapies for Parkinson’s disease.展开更多
Founded in September 2020,the International SparkLink Alliance(iSLA)now has approximately 1,200 members in diverse sectors including terminals,homes,vehicles,manufacturing,transportation,finance and healthcare.The iSL...Founded in September 2020,the International SparkLink Alliance(iSLA)now has approximately 1,200 members in diverse sectors including terminals,homes,vehicles,manufacturing,transportation,finance and healthcare.The iSLA has established a technical standards system for wireless short-range communication covering full-stack standards such as the end-to-end protocol system.展开更多
AIM:To investigate the long-term outcomes in acute primary angle closure(APAC)patients treated with lens extraction(LE)surgery and to identify risk factors for glaucomatous optic neuropathy(GON).METHODS:In this longit...AIM:To investigate the long-term outcomes in acute primary angle closure(APAC)patients treated with lens extraction(LE)surgery and to identify risk factors for glaucomatous optic neuropathy(GON).METHODS:In this longitudinal observational study,detailed medical histories of APAC patients and comprehensive ophthalmic examinations at final followup were collected.Logistic regression analysis was performed to identify predictors of blindness.Univariate and multivariate linear regression analyses were conducted to determine risk factors associated with visual outcomes.RESULTS:This study included 39 affected eyes of 31 subjects(26 females)with an average age of 74.1±8.0y.At 6.7±4.2y after APAC attack,2(5.7%)eyes had bestcorrected visual acuity(VA)worse than 3/60.Advanced glaucomatous visual field loss was observed in 15(39.5%)affected eyes and 5(25.0%)fellow eyes.Nine affected eyes(23.7%)had GON,and 11(28.9%)were blind.Six(15.4%)affected eyes and 2(9.1%)fellow eyes had suspicious progression.A significantly higher blindness rate in factory workers compared to office workers.Logistic regression identified that worse VA at attack(OR 10.568,95%CI 1.288-86.695;P=0.028)and worse early postoperative VA(OR 13.214,95%CI 1.157-150.881;P=0.038)were risk factors for blindness.Multivariate regression showed that longer duration of elevated intraocular pressure(P=0.004)and worse early postoperative VA(P=0.009)were associated with worse visual outcomes.CONCLUSION:Despite LE surgery,some APAC patients experience continued visual function deterioration.Lifelong monitoring is necessary.Target pressure and progression rates should be re-evaluated during follow-up.展开更多
Since 2000, the French National Radioactive Waste Management Agency （ANDRA） has been constructing an Underground Research Laboratory （URL） at Bure （east of the Paris Basin） to perform experiments in order to obt...Since 2000, the French National Radioactive Waste Management Agency （ANDRA） has been constructing an Underground Research Laboratory （URL） at Bure （east of the Paris Basin） to perform experiments in order to obtain in situ data necessary to demonstrate the feasibility of geological repository in the Callovo- Oxfordian claystone. An important experimental program is planned to characterize the response of the rock to different drift construction methods, Before 2008, at the main level of the laboratory, most of the drifts were excavated using pneumatic hammer and supported with rock bolts, sliding steel arches and fiber shotcrete. Other techniques, such as road header techniques, stiff and flexible supports, have also been used to characterize their impacts. The drift network is developed following the in situ major stresses. The parallel drifts are separated enough so as they can be considered independently when their hydromechanical （HM） behaviors are compared. Mine-by experiments have been performed to measure the HM response of the rock and the mechanical loading applied to the support system due to the digging and after excavation. Drifts exhibit extensional （mode I） and shear fractures （modes II and III） induced by excavation works. The extent of the induced fracture networks depends on the drift orientation versus the in situ stress field. This paper describes the drift convergence and deformation in the surrounding rock walls as function of time and the impact of different support methods on the rock mass behavior. An observation based method is finally applied to distinguish the instantaneous and time-dependent parts of the rock mass deformation around the drifts.展开更多
AIM To evaluate the clinical and radiological outcome nineand ten years after short-stemmed,bone preserving and anatomical hip arthroplasty with the MiniHip^(TM)system.METHODS In a prospective study,186 patients under...AIM To evaluate the clinical and radiological outcome nineand ten years after short-stemmed,bone preserving and anatomical hip arthroplasty with the MiniHip^(TM)system.METHODS In a prospective study,186 patients underwent hip arthroplasty with a partial neck preserving short stem(MiniHip^(TM),Corin).Elderly patients were not excluded from this study,thus the mean age at the time of surgery was 59.3 years(range 32 to 82 years).Surgery and the follow-up assessments were performed at two Centers.Up until now,the mean follow-up was 112.5±8.2 mo.The Oxford Hip Score(OHS)and the Hip Dysfunction Osteoarthritis and Outcome Score(HOOS)was assessed pre-and each year after surgery.The clinical follow-up was accompanied by standardized a.p.and axial radiological examinations.Periprosthetic lucencies,hypertrophies within the Gruen zones one to fourteen were assessed.A subsidence of the stem was investigated according to Morray and heterotopic ossifications were assessed according to Brooker.RESULTS The OHS and HOOS improved from 18±3.3 to 46±2.0 and from 30±8.3 to 95±4.6 points,P<0.001 respectively.There were no differences regarding age,etiology,friction pairings,etc.,(P>0.05).Two stems were revised due to a symptomatic subsidence four and twelve months postoperatively.Thus,the survivorship for aseptic loosening at nine to ten years was 98.66%.Including one stem revision due to a symptomatic exostosis,bursitis and thigh pain as well as one revision because of a septic stem loosening,the overall survival for the stem with revision for any reason was 97.32%.Besides one asymptomatic patient,radiological signs of a proximal stress-shielding,such as bone resorptions within the proximal Gruen zones,were not noticed.Findings suggesting a distal loading,e.g.,bony hypertrophies or bone appositions of more than 2 mm,were also not detected.CONCLUSION Regarding these first long-term results on the MiniHip^(TM),the implant performed exceedingly well with a high rate of survivorship for aseptic loosening.Our radiological results within the Gruen zones support the design rationale of the Minihip to provide a reliable metaphyseal anchoring with the expected proximal,more physiological load transfer.This might minimize or exclude a stress shielding which might be associated with thigh pain,proximal bone loss and an increased risk of aseptic loosening.The MiniHip^(TM)is a reliable partial-neck retaining prosthesis with good a clinical long-term outcome in younger as well as elderly patients.展开更多
BACKGROUND It is widely recognized that endoscopic resection(ER) of superficial nonampullary duodenal epithelial tumors(SNADETs) is technically challenging and may carry high risks of intraoperative and delayed bleedi...BACKGROUND It is widely recognized that endoscopic resection(ER) of superficial nonampullary duodenal epithelial tumors(SNADETs) is technically challenging and may carry high risks of intraoperative and delayed bleeding and perforation.These adverse events could be more critical than those occurring in other levels of the gastrointestinal tract. Because of the low prevalence of the disease and the high risks of severe adverse events, the curability including short-and long-term outcomes have not been standardized yet.AIM To investigate the curability including short-and long-term outcomes of ER for SNADETs in a large case series.METHODS This retrospective study included cases that underwent ER for SNADETs at our university hospital between March 2004 and July 2017. Short-term outcomes of ER were measured based on en bloc and R0 resection rates as well as adverse events. Long-term outcomes included local recurrence detected on endoscopic surveillance and disease-specific mortality in patients followed up for ≥ 12 mo after ER.RESULTS In the study, 131 patients with 147 SNADETs were analyzed. The 147 ERs consisted of 136 endoscopic mucosal resections(EMRs)(93%) and 11 endoscopic submucosal dissections(ESDs)(7%). The median tumor diameter was 10 mm.The pathology diagnosis was adenocarcinoma(56/147, 38%), high-grade intraepithelial neoplasia(44/147, 30%), or low-grade intraepithelial neoplasia(47/147, 32%). The R0 resection rate was 68%(93/136) in the EMR group and73%(8/11) in the ESD group, respectively. Cap-assisted EMR(known as EMR-C)showed a higher rate of R0 resection compared to the conventional method of EMR using a snare(78% vs 62%, P = 0.06). No adverse event was observed in the EMR group, whereas delayed bleeding, intraoperative perforation, and delayed perforation in 3, 3, and 5 patients occurred in the ESD group, respectively. One patient with perforation required emergency surgery. In the 43 mo median follow-up period, local recurrence was found in four EMR cases and all cases were treated endoscopically. No patient died due to tumor recurrence.CONCLUSION Our findings suggest that ER provides good long-term outcomes in the patients with SNADETs. EMR is likely to become the safe and reliable treatment for small SNADETs.展开更多
AIM: To investigate the quality of life following lapa-roscopic Nissen fundoplication by assessing short-term and long-term outcomes. METHODS: From 1992 to 2005, 249 patients under-went laparoscopic Nissen fundoplicat...AIM: To investigate the quality of life following lapa-roscopic Nissen fundoplication by assessing short-term and long-term outcomes. METHODS: From 1992 to 2005, 249 patients under-went laparoscopic Nissen fundoplication. Short-term outcome data including symptom response, side effects of surgery, endoscopy, and patient's perception of over-all success were collected prospectively. Long-term out-comes were investigated retrospectively in patients witha median follow-up of 10 years by assessment of reflux symptoms, side effects of surgery, durability of antire-flux surgery, need for additional treatment, patient's perception of success, and quality of life. Antireflux sur-gery was considered a failure based on the following criteria: moderate to severe heartburn or regurgitation; moderate to severe dysphagia reported in combination with heartburn or regurgitation; regular proton pump inhibitor medication use; endoscopic evidence of erosive esophagitis Savary-Miller grade 1-4; pathological 24-h pH monitoring; or necessity to undergo an additional surgery. The main outcome measures were short-and long-term cure rates and quality of life, with patient sat-isfaction as a secondary outcome measure. RESULTS: Conversion from laparoscopy to open sur-gery was necessary in 2.4% of patients. Mortality was zero and the 30-d morbidity was 7.6% (95%CI: 4.7%-11.7%). The median postoperative hospital stay was 2 d [interquartile range (IQR) 2-3 d]. Two hundred and forty-seven patients were interviewed for short-term analysis following endoscopy. Gastro-esophageal reflux disease was cured in 98.4% (95%CI: 95.9%-99.6%) of patients three months after surgery. New-onset dysphagia was encountered postoperatively in 13 patients (6.7%); 95% reported that the outcome was better after antireflux surgery than with preopera-tive medical treatment. One hundred and thirty-nine patients with a median follow-up of 10.2 years (IQR 7.2-11.6 years) were available for a long-term evalu-ation. Cumulative long-term cure rates were 87.7% (81.0%-92.2%) at 5 years and 72.9% (64.0%-79.9%) at 10 years. Gastrointestinal symptom rating scores and RAND-36 quality of life scores of patients with treatment success were similar to those of the general population but significantly lower in those with failed antireflux surgery. Of the patients available for long-term follow-up, 83% rated their operation a success. CONCLUSION: For the long-term, our results indicate decreasing effectiveness of laparoscopic antirefluxsurgery, although most of the patients seem to have an overall quality of life similar to that of the general population.展开更多
Hepatitis B virus (HBV) infection is a serious clinical problem worldwide. Conventional interferon (IFN)-α has been approved for the treatment of chronic hepatitis B (CHB). Short-term studies have demonstr...Hepatitis B virus (HBV) infection is a serious clinical problem worldwide. Conventional interferon (IFN)-α has been approved for the treatment of chronic hepatitis B (CHB). Short-term studies have demonstrated that IFN-based therapy is moderately effective in inducing the loss of hepatitis e antigen (HBeAg) or seroconversion (30%-40%) in HBeAg-positive patients and also produces sustained HBV DNA suppression (20%-30%) in HBeAg-negative patients. Many studies have reported a correlation between the HBV genotype and response to IFN treatment. The highest response rate to IFN treatment was found in patients infected with HBV genotype A, followed by HBV genotypes B, C, and D. The long-term effect of IFN-α on CHB has not yet been elucidated. The ability of IFN-α treatment to prevent new cirrhosis, complications associated with cirrhosis, and development of hepatocellular carcinoma (HCC) is controversial. The beneficial effect of IFN-α treatment in reducing the development of HCC has mainly been observed in treatment responders who already have cirrhosis. These inconsistent findings may be attributed to the inevitable limitations of comparisons across studies, including differences in the baseline characteristics of the study and the moderate suppression of HBV replication by IFN-α relative to nucleoside/nucleos(t)ide analogs.展开更多
Changing contexts in a long-term and short-term perspective should be managed within an integrated risk management framework that accounts for both temporary management strategies and permanent preventive measures to ...Changing contexts in a long-term and short-term perspective should be managed within an integrated risk management framework that accounts for both temporary management strategies and permanent preventive measures to reduce the impact of natural hazard processes. In this study, statistical transformation indicators of short-term (20 year) to long-term (30 year) used flood regional coefficients. After the tests of data validation and the reconstruction of missing and outlier data, the data of 18 hydrometric stations were completed for 30 years (1985 to 2014). In the next phase, the return period values were prepared for 20-year and 30-year statistical periods (1985 to 2004 and 1985 to 2014) using the HYFA software. Thus the 20-year to 30-year ratio for various return period discharges obtained and these dimensionless values were plotted for the return periods of 2, 5, 10, 20, 50 and 100 years, also fitted the logarithmic trend line and the values of coefficients of the relationship were obtained. The statistics including average, standard deviation, coefficient of variation (CV), skewness coefficient (CS) and Kurtosis coefficient (CK) were calculated for 20-year data period for each station and we identified the statistics as independent parameters and the coefficients of A and B as dependent parameter, thus analyzed using linear multivariate regression, and regional factors were obtained. In the hydrometric station with 17-027 code, the discharge using the regional factors was calculated and compared with the discharge values of 30 years data. The results showed that there is little difference between the observed and estimated values from regional factors thus this method can be used in projects that require at least 30 years of data.展开更多
While in chronic diseases, such as diabetes, mortalityrates slowly increases with age, in oncological seriesmortality usually changes dramatically during thefollow-up, often in an unpredictable pattern. Forinstance, i...While in chronic diseases, such as diabetes, mortalityrates slowly increases with age, in oncological seriesmortality usually changes dramatically during thefollow-up, often in an unpredictable pattern. Forinstance, in gastric cancer mortality peaks in thefirst two years of follow-up and declines thereafter.Also several risk factors, such as TNM stage, largelyaffect mortality in the first years after surgery, whileafterward their effect tends to fade. Temporal trendsin mortality were compared between a gastric cancerseries and a cohort of type 2 diabetic patients. Forthis purpose, 937 patients, undergoing curativegastrectomy with D1/D2/D3 lymphadenectomy forgastric cancer in three GIRCG （Gruppo Italiano RicercaCancro Gastrico = Italian Research Group for GastricCancer） centers, were compared with 7148 type 2diabetic patients from the Verona Diabetes Study. Inthe early/advanced gastric cancer series, mortality fromrecurrence peaked to 200 deaths per 1000 personyears1 year after gastrectomy and then declined,becoming lower than 40 deaths per 1000 person-yearsafter 5 years and lower than 20 deaths after 8 years.Mortality peak occurred earlier in more advanced Tand N tiers. At variance, in the Verona diabetic cohort overall mortality slowly increased during a 10-yearfollow-up, with ageing of the type 2 diabetic patients.Seasonal oscillations were also recorded, mortalitybeing higher during winter than during summer. Alsothe most important prognostic factors presented adifferent temporal pattern in the two diseases： whilethe prognostic significance of T and N stage markedlydecrease over time, differences in survival amongpatients treated with diet, oral hypoglycemic drugsor insulin were consistent throughout the follow-up.Time variations in prognostic significance of main riskfactors, their impact on survival analysis and possiblesolutions were evaluated in another GIRCG series of568 patients with advanced gastric cancer, undergoingcurative gastrectomy with D2/D3 lymphadenectomy.Survival curves in the two different histotypes （intestinaland mixed/diffuse） were superimposed in the first threeyears of follow-up and diverged thereafter. Likewise,survival curves as a function of site （fundus vs body/antrum） started to diverge after the first year. On thecontrary, survival curves differed among age classesfrom the very beginning, due to different post-operativemortality, which increased from 0.5% in patients aged65-74 years to 9.9% in patients aged 75-91 years;this discrepancy later disappeared. Accordingly, theproportional hazards assumption of the Cox modelwas violated, as regards age, site and histology. Tocope with this problem, multivariable survival analysiswas performed by separately considering either thefirst two years of follow-up or subsequent years.Histology and site were significant predictors only aftertwo years, while T and N, although significant bothin the short-term and in the long-term, became lessimportant in the second part of follow-up. Increasingage was associated with higher mortality in the firsttwo years, but not thereafter. Splitting survival timewhen performing survival analysis allows to distinguishbetween short-term and long-term risk factors.Alternative statistical solutions could be to excludepost-operative mortality, to introduce in the modeltime-dependent covariates or to stratify on variablesviolating proportionality assumption.展开更多
Activity-regulated cytoskeleton-associated protein (Arc/Arg3.1) was originally identified in patients with seizures. It is densely distributed in the hip-pocampus and amygdala in particular. Because the expression of ...Activity-regulated cytoskeleton-associated protein (Arc/Arg3.1) was originally identified in patients with seizures. It is densely distributed in the hip-pocampus and amygdala in particular. Because the expression of Arc/Arg3.1 is regulated by nerve in-puts, it is thought to be an immediate early gene. As shown both in vitro and in vivo, Arc/Arg3.1 is in-volved in synaptic consolidation and regulates some forms of learning and memory in rats and mice [1,2]. Furthermore, a recent study suggests that Arc/Arg3.1 may play a significant role in signal transmission via AMPA-type glutamate receptors [3-5]. Therefore, we conducted a detailed analysis of fear memory in Arc/Arg3.1-deficient mice. As previously reported, the knockout animals exhib-ited impaired fear memory in both contextual and cued test situations. Although Arc/Arg3.1-deficient mice showed almost the same performance as wild-type littermates 4 hr after a conditioning trial, their performance was impaired in the retention test after 24 hr or longer, either with or without reconsolidation. Immunohistochemical analyses showed an abnormal density of GluR1 in the hip-pocampus of Arc/Arg3.1-deficient mice;however, an application of AMPA potentiator did not improve memory performance in the mutant mice. Memory impairment in Arc/Arg3.1-deficient mice is so ro-bust that the mice provide a useful tool for devel-oping treatments for memory impairment.展开更多
Background: Since the outbreak of the COVID-19 pandemic caused massive case fatalities across the world, people have been left with significant physical and mental disabilities, which has had an adverse impact on thei...Background: Since the outbreak of the COVID-19 pandemic caused massive case fatalities across the world, people have been left with significant physical and mental disabilities, which has had an adverse impact on their quality of life. The objective of this study is to measure the short-term and long-term outcomes among COVID-19 survivors. Methods: This is a six-month-long multicentre prospective observational study, carried out in four specialized hospitals in the capital city Dhaka, where six hundred participants were enrolled by non-probability convenience sampling. Data were collected through three structured interviews, and follow-ups were done during discharge, at 1st month, and 6th month. An analytical study was done on demographic variables, socio-economic conditions, physical findings and outcomes. Data were analysed using Statistical Package for Social Sciences (SPSS). Results: A total of 600 participants were enrolled. The mean age was 49.83. Many participants belong to the age range of 31 to 40 years. More than two-thirds (72.7%) of participants were male, whereas 27.30% were female. Most patients admitted had mild and moderate COVID-19 symptoms (40% and 58%, respectively). Among short-term COVID complications, it was found that 43.3% of the participants complained of fatigue, 32.6% of depression, 24.7% of sleep disturbance, 19% of anxiety and, 5% memory loss. In long-term COVID complications the number reduced significantly: 5% of the participants complained of fatigue, 10% of depression, 2.7% of sleep disturbance, 7.3% of anxiety and, 2.7% memory loss. The severity of lung parenchymal disease also reduced in long term COVID symptoms. The study found a statistically significant relationship between age groups and CT severity index (χ2 = 9.458, p = 0.032). Most patients (29.2%) in the under-30 age group had a CT Severity Index score of 2 & 3 (29.2%). The important CT Severity Index scores for individuals aged 30 to 60 years were 3 and 4, accounting for 37.7% and 33.3%, respectively. In the over-60 age group, 40.8% of patients showed a CT Severity Index score of 4, showing a range of 51% - 75%. Conclusion: This study found that fatigue, depression, and sleep disturbances are prevalent among COVID-19 survivors;however, these symptoms generally reduce over time. Lung problems improved;however, some patients suffered from persistent effects. Older patients, especially those with pre-existing conditions, suffer from more severe outcomes. These findings underscore the need for ongoing care for COVID-19 survivors.展开更多
Muscle-in-vein conduits are used alternatively to nerve grafts for bridging nerve defects. The purpose of this study was to examine short- and long-term regeneration results after digital nerve reconstruction with mus...Muscle-in-vein conduits are used alternatively to nerve grafts for bridging nerve defects. The purpose of this study was to examine short- and long-term regeneration results after digital nerve reconstruction with muscle-in-vein conduits. Static and moving two-point discriminations and Semmes-Weinstein Monofilaments were used to evaluate sensory recovery 6–12 months and 14–35 months after repair of digital nerves with muscle-in-vein in 7 cases. Both follow-ups were performed after clinical signs of progressing regeneration disappeared. In 4 of 7 cases, a further recovery of both two-point discriminations and in another case of only the static two-point discrimination of 1–3 mm could be found between the short-term and long-term follow-up examination. Moreover, a late recovery of both two-point discriminations was demonstrated in another case. Four of 7 cases showed a sensory improvement by one Semmes-Weinstein Monofilaments. This pilot study suggests that sensory recovery still takes place even when clinical signs of progressing regeneration disappear.展开更多
Sea buckthorn market floated uncertainly within a narrow range. The market situation provided upward pressure on prices, and producer and consumer interest were poor, coupled with weak prices in the regional markets. ...Sea buckthorn market floated uncertainly within a narrow range. The market situation provided upward pressure on prices, and producer and consumer interest were poor, coupled with weak prices in the regional markets. The objectives of the study are: 1) to estimate the relationship between wild Sea buckthorn (SB) price and Supply, Demand, while some other factors of crude oil price and exchange rate by using simultaneous Supply-Demand and Price system equation and Vector Error Correction Method (VECM);2) to forecast the short-term and long-term SB price;3) to compare and evaluate the price forecasting models. Firstly, the data was analyzed by Ferris and Engle-Granger’s procedure;secondly, both price forecasting methodologies were tested by Pindyck-Rubinfeld and Makridakis’s procedure. The result shows that the VECM model is more efficient using yearly data;a short-term price forecast decreases, and a long-term price forecast is predicted to increase the Mongolian Sea buckthorn market.展开更多
The most common cause of intestinal failure is short bowel syndrome (SBS), occurring as a result of a small functional intestine length, usually less than 200 cm, leading to intestinal malabsorption. A 59-year-old fem...The most common cause of intestinal failure is short bowel syndrome (SBS), occurring as a result of a small functional intestine length, usually less than 200 cm, leading to intestinal malabsorption. A 59-year-old female with a past medical history of Crohns disease status post total colectomy with ileostomy over 20 years ago came to the hospital due to progressive weakness. Despite medical management, the patient had high ileostomy output, leading to electrolyte disbalance, metabolic acidosis, dehydration, and progressive kidney decline. Due to the high dependence on continuous fluid supplementation, it was decided to place a port for parenteral hydration to maintain fluid replacements and homeostasis after discharge. Prompt initiation of parenteral fluid replacement and close follow-up on patients with ileostomy and intestinal failure is strongly recommended to avoid complications and prevent intestinal, liver, or kidney transplants.展开更多
文摘Solar radiation data forecasting algorithms are important,especially in developing countries,as vast solar power plants cannot measure reliable and constant solar irradiance.The challenges of solar irradiance prediction may be resolved by machine learning using weather datasets.This study emphasises the daily and monthly global solar radiation data predictions of three locations,Pretoria,Bloemfontein,and Vuwani,at different provinces in South Africa with various solar radiation distributions.The study evaluated five different machine learning models.Forecasting models were established to evaluate global solar radiation,focusing on input data.The selected forecast models are centered on their ability to perform with time series data.These models use five years of data from meteorological parameters,such as global horizontal irradiance(GHI),relative humidity,wind speed and ambient temperature between 1 January 2018 and 31 December 2022.The datasets from these meteorological parameters are utilised for training and testing the employed algorithms,which are examined using five statistical metrics.Moreover,the inconsistency of the solar irradiance time series was equally assessed using the clearness index.The results from this study demonstrate that the R2 value recording 0.866 datasets in Bloemfontein of random forest algorithm presents the highest performance during the training processes for all models studied,while the random tree in Vuwani showed the lowest performance of R2 of 0.210 with other algorithms in testing processes.Additionally,the maximum solar radiation was found in December for both Pretoria and Bloemfontein,recorded as 5.347 and 5.844 kWh/m2/day,respectively,while it was 4.692 kWh/m2/day at Vuwani in January.Similarly,the average clearness index of 0.605,0.657 and 0.533 are obtained at Pretoria,Bloemfontein,and Vuwani,respectively.Among the three sites under study,the solar radiation and clearness index are higher in Bloemfontein.Therefore,the proposed algorithms could be used conveniently for short-and long-term solar power plants in South Africa.
文摘BACKGROUND Total hip arthroplasty(THA)has increased along with an increasing demand for improved quality of life.Combined with prolonged life expectancy,the number of revision surgeries is expected to increase.Stress shielding is a significant issue with traditional femoral stems used in THA,making revision surgeries particularly challenging in younger patients.This has sparked renewed interest in studying safety and functional outcomes of short metaphyseal femoral stems,which have the potential to alleviate these challenges and simplify revision surgeries.AIM To evaluate the long-term outcomes of short-stem THA.METHODS A total of 124 hips that underwent THA using the short femoral stem(TRILOCK®Depuy)between May 2006 and November 2008 were included in this study.Patients were followed for a period of 15 years.Outcomes were assessed in terms of pain relief,hip joint range of motion,improvement in mobility,and functional outcomes using the modified Harris Hip Score,Oxford hip score,and Western Ontario and McMaster Universities Osteoarthritis index score.RESULTS A total of 124 hips in 98 patients were evaluated.Significant improvements in functional outcomes were observed over the 15-year follow-up period,with no cases of subsidence,implant loosening,or complications necessitating revision surgery.The only complication reported was heterotopic ossification in 1 patient.CONCLUSION Short metaphyseal stems provide better functional outcomes with early mobilization,and its long-term follow-up without subsidence,implant loosening,or proximal femoral bone loss simplifies revision surgery in younger patients.
文摘BACKGROUND Gastric cancer is a major global health issue,and the perioperative period critic-ally influences patient outcomes.The different effects of sevoflurane inhalation anesthesia and propofol total intravenous anesthesia on intraoperative stability,postoperative complications,and long-term oncologic outcomes in patients with gastric cancer undergoing radical gastrectomy remain unclear.AIM To compare the effects of sevoflurane inhalation anesthesia and propofol total in-travenous anesthesia on clinical outcomes,including intraoperative indicators,postoperative complications,adverse effects,pain scores,and survival.METHODS This single-center retrospective cohort study included 204 patients who underw-ent radical gastrectomy for gastric cancer from February 2019 to December 2022.Patients were assigned to either the sevoflurane group(n=103)or the propofol group(n=101)based on intraoperative anesthetic regimen.Standardized protoc-ols for anesthesia management,intraoperative monitoring,and postoperative analgesia were applied.Baseline characteristics;intraoperative metrics;adverse events;complications;Visual Analog Scale(VAS)scores at 2,4,6,24,and 48 hours;and survival outcomes were retrospectively collected.Group comparisons were performed usingχ2 for categorical variables,t test for continuous variables,RESULTS Baseline demographic and clinical characteristics were similar between groups.No significant differences were observed in intraoperative indicators or most 30-day postoperative outcomes,including length of stay,emergency department visits,and readmission rates.The propofol group showed elevated mean VAS pain score at 24 hours postoperatively,but no differences were found at other time points.The propofol group also had significantly higher postoperative nausea incidence and transiently higher systolic/diastolic blood pressure and heart rate at the time of incision than the sevoflurane group.No significant differences were seen in overall rates or severity of postoperative complications,intraoperative adverse events,or in overall survival and progression-free survival.CONCLUSION In patients undergoing radical gastrectomy for gastric cancer,sevoflurane and propofol anesthesia demonstrated similar profiles regarding intraoperative safety,postoperative complications,adverse events,postoperative pain,and long-term survival.The selection of anesthesia can be personalized without significantly affecting periop-erative or oncologic outcomes.
基金supported by Fujian Provincial Medical“Building High-level Hospitals,High-level Clinical Medical Centers and Key Clinical Specialty Projects”([2021]No.76)Fujian Research and Training Grants for Young and Middle-aged Leaders in Healthcare(No.[2022]954)。
文摘Objective:Robotic gastrectomy(RG)is increasingly used in the treatment of gastric cancer.However,studies on patients with clinical serosa-invasive(cT4a)gastric cancer remain scarce.This study aimed to compare the shortand long-term outcomes of RG and laparoscopic gastrectomy(LG)in the treatment of stage cT4a gastric cancer.Methods:A retrospective analysis was conducted on the clinical data of patients with stage cT4a gastric cancer diagnosed and treated at eight high-volume tertiary teaching hospitals in China from 2016 to 2019.Propensity score matching(PSM)analysis and inverse probability of treatment weighting(IPTW)analysis was used to adjust for the imbalance in baseline characteristics.The primary research endpoint was the 3-year overall survival(OS)and disease-free survival(DFS).The secondary research endpoint was intraoperative outcomes and postoperative complications.Results:After IPTW and PSM adjustments,baseline characteristics between the RG and LG groups were comparable[standardized mean difference(SMD)<0.10].Post-PSM analysis revealed that the RG group exhibited longer operative time(P<0.001),lower postoperative complication rates(P<0.001),shorter postoperative hospital stays(P=0.037),and earlier initiation of adjuvant chemotherapy(P=0.041)compared with the LG group.Survival analysis demonstrated comparable 3-year OS(P=0.110)and DFS(P=0.088)in the PSM cohort,whereas the IPTW cohort showed superior OS(P=0.030)and DFS(P=0.046)for RG.No significant differences were observed in overall recurrence rates or recurrence sites between groups.Conclusions:For patients with stage cT4a gastric cancer,compared with the LG group,the RG group had shorter postoperative hospital stay,lower incidence of postoperative complications,earlier postoperative adjuvant chemotherapy,and no worse long-term efficacy.
基金supported by the National Key R&D Program of China,No.2021YFC2501200(to PC).
文摘Short-chain fatty acids,metabolites produced by the fermentation of dietary fiber by gut microbiota,have garnered significant attention due to their correlation with neurodegenerative diseases,particularly Parkinson’s disease.In this review,we summarize the changes in short-chain fatty acid levels and the abundance of short-chain fatty acid-producing bacteria in various samples from patients with Parkinson’s disease,highlighting the critical role of gut homeostasis imbalance in the pathogenesis and progression of the disease.Focusing on the nervous system,we discuss the molecular mechanisms by which short-chain fatty acids influence the homeostasis of both the enteric nervous system and the central nervous system.We identify key processes,including the activation of G protein-coupled receptors and the inhibition of histone deacetylases by short-chain fatty acids.Importantly,structural or functional disruptions in the enteric nervous system mediated by these fatty acids may lead to abnormalα-synuclein expression and gastrointestinal dysmotility,which could serve as an initiating event in Parkinson’s disease.Furthermore,we propose that short-chain fatty acids help establish communication between the enteric nervous system and the central nervous system via the vagal nerve,immune circulation,and endocrine signaling.This communication may shed light on their potential role in the transmission ofα-synuclein from the gut to the brain.Finally,we elucidate novel treatment strategies for Parkinson’s disease that target short-chain fatty acids and examine the challenges associated with translating short-chain fatty acid-based therapies into clinical practice.In conclusion,this review emphasizes the pivotal role of short-chain fatty acids in regulating gut-brain axis integrity and their significance in the pathogenesis of Parkinson’s disease from the perspective of the nervous system.Moreover,it highlights the potential value of short-chain fatty acids in early intervention for Parkinson’s disease.Future research into the molecular mechanisms of short-chain fatty acids and their synergistic interactions with other gut metabolites is likely to advance the clinical translation of innovative short-chain fatty acid-based therapies for Parkinson’s disease.
文摘Founded in September 2020,the International SparkLink Alliance(iSLA)now has approximately 1,200 members in diverse sectors including terminals,homes,vehicles,manufacturing,transportation,finance and healthcare.The iSLA has established a technical standards system for wireless short-range communication covering full-stack standards such as the end-to-end protocol system.
文摘AIM:To investigate the long-term outcomes in acute primary angle closure(APAC)patients treated with lens extraction(LE)surgery and to identify risk factors for glaucomatous optic neuropathy(GON).METHODS:In this longitudinal observational study,detailed medical histories of APAC patients and comprehensive ophthalmic examinations at final followup were collected.Logistic regression analysis was performed to identify predictors of blindness.Univariate and multivariate linear regression analyses were conducted to determine risk factors associated with visual outcomes.RESULTS:This study included 39 affected eyes of 31 subjects(26 females)with an average age of 74.1±8.0y.At 6.7±4.2y after APAC attack,2(5.7%)eyes had bestcorrected visual acuity(VA)worse than 3/60.Advanced glaucomatous visual field loss was observed in 15(39.5%)affected eyes and 5(25.0%)fellow eyes.Nine affected eyes(23.7%)had GON,and 11(28.9%)were blind.Six(15.4%)affected eyes and 2(9.1%)fellow eyes had suspicious progression.A significantly higher blindness rate in factory workers compared to office workers.Logistic regression identified that worse VA at attack(OR 10.568,95%CI 1.288-86.695;P=0.028)and worse early postoperative VA(OR 13.214,95%CI 1.157-150.881;P=0.038)were risk factors for blindness.Multivariate regression showed that longer duration of elevated intraocular pressure(P=0.004)and worse early postoperative VA(P=0.009)were associated with worse visual outcomes.CONCLUSION:Despite LE surgery,some APAC patients experience continued visual function deterioration.Lifelong monitoring is necessary.Target pressure and progression rates should be re-evaluated during follow-up.
文摘Since 2000, the French National Radioactive Waste Management Agency （ANDRA） has been constructing an Underground Research Laboratory （URL） at Bure （east of the Paris Basin） to perform experiments in order to obtain in situ data necessary to demonstrate the feasibility of geological repository in the Callovo- Oxfordian claystone. An important experimental program is planned to characterize the response of the rock to different drift construction methods, Before 2008, at the main level of the laboratory, most of the drifts were excavated using pneumatic hammer and supported with rock bolts, sliding steel arches and fiber shotcrete. Other techniques, such as road header techniques, stiff and flexible supports, have also been used to characterize their impacts. The drift network is developed following the in situ major stresses. The parallel drifts are separated enough so as they can be considered independently when their hydromechanical （HM） behaviors are compared. Mine-by experiments have been performed to measure the HM response of the rock and the mechanical loading applied to the support system due to the digging and after excavation. Drifts exhibit extensional （mode I） and shear fractures （modes II and III） induced by excavation works. The extent of the induced fracture networks depends on the drift orientation versus the in situ stress field. This paper describes the drift convergence and deformation in the surrounding rock walls as function of time and the impact of different support methods on the rock mass behavior. An observation based method is finally applied to distinguish the instantaneous and time-dependent parts of the rock mass deformation around the drifts.
基金Supported by A sponsorship from Corin(Corin Group,Cirencest,United Kingdom)
文摘AIM To evaluate the clinical and radiological outcome nineand ten years after short-stemmed,bone preserving and anatomical hip arthroplasty with the MiniHip^(TM)system.METHODS In a prospective study,186 patients underwent hip arthroplasty with a partial neck preserving short stem(MiniHip^(TM),Corin).Elderly patients were not excluded from this study,thus the mean age at the time of surgery was 59.3 years(range 32 to 82 years).Surgery and the follow-up assessments were performed at two Centers.Up until now,the mean follow-up was 112.5±8.2 mo.The Oxford Hip Score(OHS)and the Hip Dysfunction Osteoarthritis and Outcome Score(HOOS)was assessed pre-and each year after surgery.The clinical follow-up was accompanied by standardized a.p.and axial radiological examinations.Periprosthetic lucencies,hypertrophies within the Gruen zones one to fourteen were assessed.A subsidence of the stem was investigated according to Morray and heterotopic ossifications were assessed according to Brooker.RESULTS The OHS and HOOS improved from 18±3.3 to 46±2.0 and from 30±8.3 to 95±4.6 points,P<0.001 respectively.There were no differences regarding age,etiology,friction pairings,etc.,(P>0.05).Two stems were revised due to a symptomatic subsidence four and twelve months postoperatively.Thus,the survivorship for aseptic loosening at nine to ten years was 98.66%.Including one stem revision due to a symptomatic exostosis,bursitis and thigh pain as well as one revision because of a septic stem loosening,the overall survival for the stem with revision for any reason was 97.32%.Besides one asymptomatic patient,radiological signs of a proximal stress-shielding,such as bone resorptions within the proximal Gruen zones,were not noticed.Findings suggesting a distal loading,e.g.,bony hypertrophies or bone appositions of more than 2 mm,were also not detected.CONCLUSION Regarding these first long-term results on the MiniHip^(TM),the implant performed exceedingly well with a high rate of survivorship for aseptic loosening.Our radiological results within the Gruen zones support the design rationale of the Minihip to provide a reliable metaphyseal anchoring with the expected proximal,more physiological load transfer.This might minimize or exclude a stress shielding which might be associated with thigh pain,proximal bone loss and an increased risk of aseptic loosening.The MiniHip^(TM)is a reliable partial-neck retaining prosthesis with good a clinical long-term outcome in younger as well as elderly patients.
文摘BACKGROUND It is widely recognized that endoscopic resection(ER) of superficial nonampullary duodenal epithelial tumors(SNADETs) is technically challenging and may carry high risks of intraoperative and delayed bleeding and perforation.These adverse events could be more critical than those occurring in other levels of the gastrointestinal tract. Because of the low prevalence of the disease and the high risks of severe adverse events, the curability including short-and long-term outcomes have not been standardized yet.AIM To investigate the curability including short-and long-term outcomes of ER for SNADETs in a large case series.METHODS This retrospective study included cases that underwent ER for SNADETs at our university hospital between March 2004 and July 2017. Short-term outcomes of ER were measured based on en bloc and R0 resection rates as well as adverse events. Long-term outcomes included local recurrence detected on endoscopic surveillance and disease-specific mortality in patients followed up for ≥ 12 mo after ER.RESULTS In the study, 131 patients with 147 SNADETs were analyzed. The 147 ERs consisted of 136 endoscopic mucosal resections(EMRs)(93%) and 11 endoscopic submucosal dissections(ESDs)(7%). The median tumor diameter was 10 mm.The pathology diagnosis was adenocarcinoma(56/147, 38%), high-grade intraepithelial neoplasia(44/147, 30%), or low-grade intraepithelial neoplasia(47/147, 32%). The R0 resection rate was 68%(93/136) in the EMR group and73%(8/11) in the ESD group, respectively. Cap-assisted EMR(known as EMR-C)showed a higher rate of R0 resection compared to the conventional method of EMR using a snare(78% vs 62%, P = 0.06). No adverse event was observed in the EMR group, whereas delayed bleeding, intraoperative perforation, and delayed perforation in 3, 3, and 5 patients occurred in the ESD group, respectively. One patient with perforation required emergency surgery. In the 43 mo median follow-up period, local recurrence was found in four EMR cases and all cases were treated endoscopically. No patient died due to tumor recurrence.CONCLUSION Our findings suggest that ER provides good long-term outcomes in the patients with SNADETs. EMR is likely to become the safe and reliable treatment for small SNADETs.
基金Supported by EVO-funding of the Central Hospital of Central Finland
文摘AIM: To investigate the quality of life following lapa-roscopic Nissen fundoplication by assessing short-term and long-term outcomes. METHODS: From 1992 to 2005, 249 patients under-went laparoscopic Nissen fundoplication. Short-term outcome data including symptom response, side effects of surgery, endoscopy, and patient's perception of over-all success were collected prospectively. Long-term out-comes were investigated retrospectively in patients witha median follow-up of 10 years by assessment of reflux symptoms, side effects of surgery, durability of antire-flux surgery, need for additional treatment, patient's perception of success, and quality of life. Antireflux sur-gery was considered a failure based on the following criteria: moderate to severe heartburn or regurgitation; moderate to severe dysphagia reported in combination with heartburn or regurgitation; regular proton pump inhibitor medication use; endoscopic evidence of erosive esophagitis Savary-Miller grade 1-4; pathological 24-h pH monitoring; or necessity to undergo an additional surgery. The main outcome measures were short-and long-term cure rates and quality of life, with patient sat-isfaction as a secondary outcome measure. RESULTS: Conversion from laparoscopy to open sur-gery was necessary in 2.4% of patients. Mortality was zero and the 30-d morbidity was 7.6% (95%CI: 4.7%-11.7%). The median postoperative hospital stay was 2 d [interquartile range (IQR) 2-3 d]. Two hundred and forty-seven patients were interviewed for short-term analysis following endoscopy. Gastro-esophageal reflux disease was cured in 98.4% (95%CI: 95.9%-99.6%) of patients three months after surgery. New-onset dysphagia was encountered postoperatively in 13 patients (6.7%); 95% reported that the outcome was better after antireflux surgery than with preopera-tive medical treatment. One hundred and thirty-nine patients with a median follow-up of 10.2 years (IQR 7.2-11.6 years) were available for a long-term evalu-ation. Cumulative long-term cure rates were 87.7% (81.0%-92.2%) at 5 years and 72.9% (64.0%-79.9%) at 10 years. Gastrointestinal symptom rating scores and RAND-36 quality of life scores of patients with treatment success were similar to those of the general population but significantly lower in those with failed antireflux surgery. Of the patients available for long-term follow-up, 83% rated their operation a success. CONCLUSION: For the long-term, our results indicate decreasing effectiveness of laparoscopic antirefluxsurgery, although most of the patients seem to have an overall quality of life similar to that of the general population.
文摘Hepatitis B virus (HBV) infection is a serious clinical problem worldwide. Conventional interferon (IFN)-α has been approved for the treatment of chronic hepatitis B (CHB). Short-term studies have demonstrated that IFN-based therapy is moderately effective in inducing the loss of hepatitis e antigen (HBeAg) or seroconversion (30%-40%) in HBeAg-positive patients and also produces sustained HBV DNA suppression (20%-30%) in HBeAg-negative patients. Many studies have reported a correlation between the HBV genotype and response to IFN treatment. The highest response rate to IFN treatment was found in patients infected with HBV genotype A, followed by HBV genotypes B, C, and D. The long-term effect of IFN-α on CHB has not yet been elucidated. The ability of IFN-α treatment to prevent new cirrhosis, complications associated with cirrhosis, and development of hepatocellular carcinoma (HCC) is controversial. The beneficial effect of IFN-α treatment in reducing the development of HCC has mainly been observed in treatment responders who already have cirrhosis. These inconsistent findings may be attributed to the inevitable limitations of comparisons across studies, including differences in the baseline characteristics of the study and the moderate suppression of HBV replication by IFN-α relative to nucleoside/nucleos(t)ide analogs.
文摘Changing contexts in a long-term and short-term perspective should be managed within an integrated risk management framework that accounts for both temporary management strategies and permanent preventive measures to reduce the impact of natural hazard processes. In this study, statistical transformation indicators of short-term (20 year) to long-term (30 year) used flood regional coefficients. After the tests of data validation and the reconstruction of missing and outlier data, the data of 18 hydrometric stations were completed for 30 years (1985 to 2014). In the next phase, the return period values were prepared for 20-year and 30-year statistical periods (1985 to 2004 and 1985 to 2014) using the HYFA software. Thus the 20-year to 30-year ratio for various return period discharges obtained and these dimensionless values were plotted for the return periods of 2, 5, 10, 20, 50 and 100 years, also fitted the logarithmic trend line and the values of coefficients of the relationship were obtained. The statistics including average, standard deviation, coefficient of variation (CV), skewness coefficient (CS) and Kurtosis coefficient (CK) were calculated for 20-year data period for each station and we identified the statistics as independent parameters and the coefficients of A and B as dependent parameter, thus analyzed using linear multivariate regression, and regional factors were obtained. In the hydrometric station with 17-027 code, the discharge using the regional factors was calculated and compared with the discharge values of 30 years data. The results showed that there is little difference between the observed and estimated values from regional factors thus this method can be used in projects that require at least 30 years of data.
文摘While in chronic diseases, such as diabetes, mortalityrates slowly increases with age, in oncological seriesmortality usually changes dramatically during thefollow-up, often in an unpredictable pattern. Forinstance, in gastric cancer mortality peaks in thefirst two years of follow-up and declines thereafter.Also several risk factors, such as TNM stage, largelyaffect mortality in the first years after surgery, whileafterward their effect tends to fade. Temporal trendsin mortality were compared between a gastric cancerseries and a cohort of type 2 diabetic patients. Forthis purpose, 937 patients, undergoing curativegastrectomy with D1/D2/D3 lymphadenectomy forgastric cancer in three GIRCG （Gruppo Italiano RicercaCancro Gastrico = Italian Research Group for GastricCancer） centers, were compared with 7148 type 2diabetic patients from the Verona Diabetes Study. Inthe early/advanced gastric cancer series, mortality fromrecurrence peaked to 200 deaths per 1000 personyears1 year after gastrectomy and then declined,becoming lower than 40 deaths per 1000 person-yearsafter 5 years and lower than 20 deaths after 8 years.Mortality peak occurred earlier in more advanced Tand N tiers. At variance, in the Verona diabetic cohort overall mortality slowly increased during a 10-yearfollow-up, with ageing of the type 2 diabetic patients.Seasonal oscillations were also recorded, mortalitybeing higher during winter than during summer. Alsothe most important prognostic factors presented adifferent temporal pattern in the two diseases： whilethe prognostic significance of T and N stage markedlydecrease over time, differences in survival amongpatients treated with diet, oral hypoglycemic drugsor insulin were consistent throughout the follow-up.Time variations in prognostic significance of main riskfactors, their impact on survival analysis and possiblesolutions were evaluated in another GIRCG series of568 patients with advanced gastric cancer, undergoingcurative gastrectomy with D2/D3 lymphadenectomy.Survival curves in the two different histotypes （intestinaland mixed/diffuse） were superimposed in the first threeyears of follow-up and diverged thereafter. Likewise,survival curves as a function of site （fundus vs body/antrum） started to diverge after the first year. On thecontrary, survival curves differed among age classesfrom the very beginning, due to different post-operativemortality, which increased from 0.5% in patients aged65-74 years to 9.9% in patients aged 75-91 years;this discrepancy later disappeared. Accordingly, theproportional hazards assumption of the Cox modelwas violated, as regards age, site and histology. Tocope with this problem, multivariable survival analysiswas performed by separately considering either thefirst two years of follow-up or subsequent years.Histology and site were significant predictors only aftertwo years, while T and N, although significant bothin the short-term and in the long-term, became lessimportant in the second part of follow-up. Increasingage was associated with higher mortality in the firsttwo years, but not thereafter. Splitting survival timewhen performing survival analysis allows to distinguishbetween short-term and long-term risk factors.Alternative statistical solutions could be to excludepost-operative mortality, to introduce in the modeltime-dependent covariates or to stratify on variablesviolating proportionality assumption.
文摘Activity-regulated cytoskeleton-associated protein (Arc/Arg3.1) was originally identified in patients with seizures. It is densely distributed in the hip-pocampus and amygdala in particular. Because the expression of Arc/Arg3.1 is regulated by nerve in-puts, it is thought to be an immediate early gene. As shown both in vitro and in vivo, Arc/Arg3.1 is in-volved in synaptic consolidation and regulates some forms of learning and memory in rats and mice [1,2]. Furthermore, a recent study suggests that Arc/Arg3.1 may play a significant role in signal transmission via AMPA-type glutamate receptors [3-5]. Therefore, we conducted a detailed analysis of fear memory in Arc/Arg3.1-deficient mice. As previously reported, the knockout animals exhib-ited impaired fear memory in both contextual and cued test situations. Although Arc/Arg3.1-deficient mice showed almost the same performance as wild-type littermates 4 hr after a conditioning trial, their performance was impaired in the retention test after 24 hr or longer, either with or without reconsolidation. Immunohistochemical analyses showed an abnormal density of GluR1 in the hip-pocampus of Arc/Arg3.1-deficient mice;however, an application of AMPA potentiator did not improve memory performance in the mutant mice. Memory impairment in Arc/Arg3.1-deficient mice is so ro-bust that the mice provide a useful tool for devel-oping treatments for memory impairment.
文摘Background: Since the outbreak of the COVID-19 pandemic caused massive case fatalities across the world, people have been left with significant physical and mental disabilities, which has had an adverse impact on their quality of life. The objective of this study is to measure the short-term and long-term outcomes among COVID-19 survivors. Methods: This is a six-month-long multicentre prospective observational study, carried out in four specialized hospitals in the capital city Dhaka, where six hundred participants were enrolled by non-probability convenience sampling. Data were collected through three structured interviews, and follow-ups were done during discharge, at 1st month, and 6th month. An analytical study was done on demographic variables, socio-economic conditions, physical findings and outcomes. Data were analysed using Statistical Package for Social Sciences (SPSS). Results: A total of 600 participants were enrolled. The mean age was 49.83. Many participants belong to the age range of 31 to 40 years. More than two-thirds (72.7%) of participants were male, whereas 27.30% were female. Most patients admitted had mild and moderate COVID-19 symptoms (40% and 58%, respectively). Among short-term COVID complications, it was found that 43.3% of the participants complained of fatigue, 32.6% of depression, 24.7% of sleep disturbance, 19% of anxiety and, 5% memory loss. In long-term COVID complications the number reduced significantly: 5% of the participants complained of fatigue, 10% of depression, 2.7% of sleep disturbance, 7.3% of anxiety and, 2.7% memory loss. The severity of lung parenchymal disease also reduced in long term COVID symptoms. The study found a statistically significant relationship between age groups and CT severity index (χ2 = 9.458, p = 0.032). Most patients (29.2%) in the under-30 age group had a CT Severity Index score of 2 & 3 (29.2%). The important CT Severity Index scores for individuals aged 30 to 60 years were 3 and 4, accounting for 37.7% and 33.3%, respectively. In the over-60 age group, 40.8% of patients showed a CT Severity Index score of 4, showing a range of 51% - 75%. Conclusion: This study found that fatigue, depression, and sleep disturbances are prevalent among COVID-19 survivors;however, these symptoms generally reduce over time. Lung problems improved;however, some patients suffered from persistent effects. Older patients, especially those with pre-existing conditions, suffer from more severe outcomes. These findings underscore the need for ongoing care for COVID-19 survivors.
文摘Muscle-in-vein conduits are used alternatively to nerve grafts for bridging nerve defects. The purpose of this study was to examine short- and long-term regeneration results after digital nerve reconstruction with muscle-in-vein conduits. Static and moving two-point discriminations and Semmes-Weinstein Monofilaments were used to evaluate sensory recovery 6–12 months and 14–35 months after repair of digital nerves with muscle-in-vein in 7 cases. Both follow-ups were performed after clinical signs of progressing regeneration disappeared. In 4 of 7 cases, a further recovery of both two-point discriminations and in another case of only the static two-point discrimination of 1–3 mm could be found between the short-term and long-term follow-up examination. Moreover, a late recovery of both two-point discriminations was demonstrated in another case. Four of 7 cases showed a sensory improvement by one Semmes-Weinstein Monofilaments. This pilot study suggests that sensory recovery still takes place even when clinical signs of progressing regeneration disappear.
文摘Sea buckthorn market floated uncertainly within a narrow range. The market situation provided upward pressure on prices, and producer and consumer interest were poor, coupled with weak prices in the regional markets. The objectives of the study are: 1) to estimate the relationship between wild Sea buckthorn (SB) price and Supply, Demand, while some other factors of crude oil price and exchange rate by using simultaneous Supply-Demand and Price system equation and Vector Error Correction Method (VECM);2) to forecast the short-term and long-term SB price;3) to compare and evaluate the price forecasting models. Firstly, the data was analyzed by Ferris and Engle-Granger’s procedure;secondly, both price forecasting methodologies were tested by Pindyck-Rubinfeld and Makridakis’s procedure. The result shows that the VECM model is more efficient using yearly data;a short-term price forecast decreases, and a long-term price forecast is predicted to increase the Mongolian Sea buckthorn market.
文摘The most common cause of intestinal failure is short bowel syndrome (SBS), occurring as a result of a small functional intestine length, usually less than 200 cm, leading to intestinal malabsorption. A 59-year-old female with a past medical history of Crohns disease status post total colectomy with ileostomy over 20 years ago came to the hospital due to progressive weakness. Despite medical management, the patient had high ileostomy output, leading to electrolyte disbalance, metabolic acidosis, dehydration, and progressive kidney decline. Due to the high dependence on continuous fluid supplementation, it was decided to place a port for parenteral hydration to maintain fluid replacements and homeostasis after discharge. Prompt initiation of parenteral fluid replacement and close follow-up on patients with ileostomy and intestinal failure is strongly recommended to avoid complications and prevent intestinal, liver, or kidney transplants.
