BACKGROUND Gallbladder cancer is a highly malignant and aggressive tumor,often diagnosed at an advanced stage.The prognosis for advanced gallbladder cancer remains poor,with limited options for effective treatment.CAS...BACKGROUND Gallbladder cancer is a highly malignant and aggressive tumor,often diagnosed at an advanced stage.The prognosis for advanced gallbladder cancer remains poor,with limited options for effective treatment.CASE SUMMARY A 65-year-old male patient presented with a soft tissue mass in the gallbladder.Following laparoscopic exploration,he underwent radical surgery for gallbladder cancer,with the tumor staged as pT2N1M0(stage III).Post-surgery,the patient received four cycles of adjuvant chemotherapy.However,one month later,over 60 metastatic lesions were detected in the liver,lungs,and lymph nodes.In response to the widespread metastasis,he underwent six cycles of combination therapy consisting of sintilimab,albumin-bound paclitaxel,and cisplatin.After two cycles,a partial response was achieved.Maintenance therapy was initiated with a combination of sintilimab and albumin-bound paclitaxel for four cycles.Monotherapy with sintilimab was continued thereafter until October 2023.Complete remission was confirmed in September 2021.The patient sustained this complete response for more than three years,including an eleven-month period without disease progression following the discontinuation of sintilimab.Genetic analysis revealed a tumor mutational burden of 15.4 mutations/megabase,which indicates a potentially favorable response to immunotherapy.CONCLUSION This case demonstrates the potential of combining immunotherapy(sintilimab)with chemotherapy to achieve durable remission in metastatic gallbladder cancer,even in a patient with extensive metastasis.In addition,it indicated the importance of tumor mutational burden as a predictive biomarker of immunotherapy.展开更多
The increasing demand for green spaces in cities underscores the urgent need for sustainable solutions to reduce the ecological impact of urban areas.This research focuses on converting unused rooftops into extensive ...The increasing demand for green spaces in cities underscores the urgent need for sustainable solutions to reduce the ecological impact of urban areas.This research focuses on converting unused rooftops into extensive green roofs in Nador,Morocco,offering an innovative approach to enhancing outdoor thermal comfort in this region.Several advanced techniques were used,including photogrammetric restitution(for creating land use maps),integration of light detection and ranging data(for three-dimensional urban modeling),and meteorological data collection(for modeling urban climate conditions).The urban-multiscale-environmental-predictor solar and longwave environmental irradiance geometry(UMEP-SOLWEIG)model was crucial for precisely evaluating the thermal performance of green roofs and their influence on urban microclimates.This model considers considered various parameters,such as the sky view factor,wall height and aspect,and shading conditions,for accurate,comprehensive analysis.Additionally,for accurate,comprehensive analysis,a comparative evaluation was performed between the UMEP-SOLWEIG and ENVI-met models to assess the UMEP SOLWEIG results.The findings were notable,demonstrating a substantial reduction(averaging over 3℃)in the mean radiant temperature on 60%of rooftops,covering 55%of the total surface area.This highlighted the effectiveness of green roofs in improving outdoor thermal comfort.Furthermore,green roofs were closely associated with reductions in air-conditioning energy consumption,with considerable reductions ranging from 17.53%to 43.82%.These savings translated to estimated financial benefits ranging from USD 1.63-4.07 million.These figures clearly verified the notable economic impact of green roofs despite their initially high costs(approximately USD 84.44 million).These potential long-term savings indicated that these investments are financially viable in the long run.The collected data were used to create thermal maps of the area using geographic-information-system tools.A thermal cadaster specific to green roofs was also developed,accessible online through Web mapping.Overall,this approach facilitates decision-making in urban planning by providing visual information on thermal variations,thereby aiding in the precise planning of measures against urban heat and promoting the use of green roofs to reduce environmental impact.展开更多
Background:Tuberculosis(TB),caused by Mycobacterium tuberculosis,remains the second leading cause of death from a single infectious disease globally and poses a significant economic and clinical burden in the world in...Background:Tuberculosis(TB),caused by Mycobacterium tuberculosis,remains the second leading cause of death from a single infectious disease globally and poses a significant economic and clinical burden in the world in 2022.Of particular concern is the emergence of drug-resistant TB,accounting for 15%-20%of TB deaths.It is imperative to delve into the global trends of incidence and death rate for multidrug-resistant tuberculosis(MDRTB)and extensively drug-resistant tuberculosis(XDR-TB),drawing upon the comprehensive Global Burden of Disease(GBD)2021 drug-resistant tuberculosis dataset.Methods:From the GBD 2021,data on incidence,prevalence,disability-adjusted life years(DALYs),and death of MDR-TB and XDR-TB from 1990 to 2021 were collected.We calculated the estimated annual percentage changes in age standardized incidence rate(ASIR)and age-standardized death rate(ASDR),segmented by age,sex,and socio-demographic index(SDI).The impacts of various risk factors on MDR-TB and XDR-TB were also analyzed.Results:In 2021,there were an estimated 443,680(95%uncertainty interval[UI]:259,196-766,545)incident cases of MDR-TB,and an estimated 106,818(95%UI:41,612-211,854)death cases of MDR-TB,while there were an estimated 24,036(95%UI:17,144-34,587)incident cases of XDR-TB and 7,946(95%UI:3,326-14,859)death cases of XDR-TB.The incidence and death cases of MDR-TB were lowest in high SDI regions,whereas the incidence rates of XDR-TB in high-middle SDI regions were higher than those in middle SDI and high SDI regions.Conclusion:This study reported the disease burden of drug-resistant TB from 1990 to 2021.Until 2021,drugresistant TB is still a serious problem in low SDI countries,especially for high-risk age populations with highrisk factors.Controlling drug-resistant TB requires effective control strategies and healthcare systems.展开更多
Rationale:Longitudinally extensive transverse myelitis(LETM)is a rare inflammatory demyelinating disease predominantly associated with autoimmune and inflammatory disorders.Scrub typhus can cause a variety of neurolog...Rationale:Longitudinally extensive transverse myelitis(LETM)is a rare inflammatory demyelinating disease predominantly associated with autoimmune and inflammatory disorders.Scrub typhus can cause a variety of neurological complications,which may result in poor recovery and long-term disability.This report reveals a rare linkage between LETM and scrub typhus.Patient concerns:A 24-year-old female presented with a history of fever for 10 days associated with progressive quadriparesis.Physical examination revealed bilateral lower limb weakness(grade 0/5)and bilateral upper limb weakness(grade 2/5)with reduced sensation below the T3 dermatome.Diagnosis:Scrub typhus presenting with longitudinally extensive transverse myelitis.Interventions:Steroid pulse therapy with antibiotics supported by early intensive rehabilitation.Outcomes:Complete recovery was achieved.Lessons:This case report highlights the importance of considering scrub typhus as a potential cause of LETM in endemic regions,particularly in patients presenting with febrile illness and neurological symptoms.展开更多
Because of environmental constraints,beef cattle was for more than a century the only viable farming option in the extensive semiarid and subhumid lands of Argentina and the main source of nutrients for humans as well...Because of environmental constraints,beef cattle was for more than a century the only viable farming option in the extensive semiarid and subhumid lands of Argentina and the main source of nutrients for humans as well.However,a growing concern and criticism have risen today about its possible negative impact on the climate and the environment.These worries tend to affect current public opinions,national policies,and international trade.Based on 40 beef cattle farms scattered across different semiarid and subhumid regions of Argentina,here we evaluated the impact of extensive cattle production on carbon,water,and nutrient pollution.Life-Cycle Assessment(LCA)and Land-Based Assessment(LBA)were the two approaches we used here to compare the environmental impact of beef production.While the environmental footprint(EF)resulting from LCA expresses the impact per unit of food,the environmental balance(EB),derived from LBA,aims at quantifying the impact per unit of land.As such,the EB considers both negative and positive impacts on the farm as an integrated system.Following standardized procedures,we evaluated EF and EB up to the farm gate,leaving aside delocalized post-farm impacts such as those of processing,packaging,and transportation that occur beyond the farm gate.In agreement with previous evidence,our results show that the EF tends to decrease as per-head production increases.Correlation coefficients and statistical significance were the following for carbon(R=−0.574;p<0.01),water(R=−0.561;p<0.01),and N(R=−0.704;p<0.01)and Phosphorus(P)pollution(R=−0.802;p<0.01)footprints.On the contrary,the EB seems to be highly sensitive,and as per-hectare beef production increases.Correlations were the following for carbon emissions(CE:R=0.955;p<0.01),water consumption(WC:R=0.822;p<0.01),nitrogen excretion(NE:R=0.948;p<0.01)and phosphorus excretion(PE:R=0.945;p<0.01).What our results suggest is that the notion of EF is useful to evaluate the environmental impact in intensive beef production systems,and the EB is suitable to assess the impact of the extensive ones.In practice,both approaches provide different perspectives on the environmental-impact problem and they should be complementary used.We concluded that the methodological rigidity of EF does not allow proper discrimination among farms in the extensive systems.On the contrary,the EB approach tended to be highly sensitive to detecting differences between individual farms and farmers,thus allowing the identification of successful options for extensive beef production in terms of public image,policy-making,and commercial opportunities.展开更多
Based on extenics, an extensive functional information model(function-behavioral action-structure-environmental constraint) of the mechanical productintelligent conceptual design is developed, and the mechanism of the...Based on extenics, an extensive functional information model(function-behavioral action-structure-environmental constraint) of the mechanical productintelligent conceptual design is developed, and the mechanism of theoretic structure solutions isproduced, the mapping relations between function-behavior and behavior-structure are analyzed. Themodel is applied to the filling material system's conceptual design to verify validity.展开更多
Systemic Functional Linguistics is known to people by its special functionalism and social meaning. The study of Systemic Functional Linguistics is also accepted by more and more people. In addition, it means a lot to...Systemic Functional Linguistics is known to people by its special functionalism and social meaning. The study of Systemic Functional Linguistics is also accepted by more and more people. In addition, it means a lot to the learning of lexis, English writing and extensive reading.展开更多
Researches on foreign language extensive reading program indicate that students can improve their foreign language reading ability,and develop positive attitudes toward reading and increased motivation to read.Compari...Researches on foreign language extensive reading program indicate that students can improve their foreign language reading ability,and develop positive attitudes toward reading and increased motivation to read.Comparing to the other types of reading.(skimming,scanning,and intensive reading.),reading extensively can result in gains in vocabulary and other aspects of foreign language learning.Teachers should provide various experience and make students have the chance to enjoy reading.and give them more guidance on developing certain reading skills.展开更多
Alveolar echinococcosis(AE) is a zoonotic disease that is caused by Echinococcus multilocularis that affects liver and a variety of organs and tissues. It differs from other echinococcal disease because it shows tumor...Alveolar echinococcosis(AE) is a zoonotic disease that is caused by Echinococcus multilocularis that affects liver and a variety of organs and tissues. It differs from other echinococcal disease because it shows tumor like behavior in the affected organ and tissues. The treatment of choice is concomitant medical therapy and resection with negative margins. Nevertheless, resection with the intent of negative margins(R0) may lead to serious complications such as liver failure. In the present case report, we used Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy(ALPPS) procedure, which was defined in 2012 by Schnitzbauer et al, in a 28-year-old male patient to avoid complications of major liver resection in order to treat alveolar echinococcosis. Until now, we have not encountered any study using ALPPS procedure for the treatment of alveolar echinococcosis. In the present case report we aimed to show that ALPPS procedure can be safely performed for marginnegative resection of primary or recurrent AE that shows a tumor like behavior. It is our opinion that this procedure should be performed in centers that have expertise and sufficient technical capacity to perform liver transplantation and advanced liver surgery.展开更多
A pair of northeast-southwest-tilted mid-tropospheric ridges and troughs on the continental scale was observed to be the key circulation feature common among wintertime extensive and persistent low tempera-ture events...A pair of northeast-southwest-tilted mid-tropospheric ridges and troughs on the continental scale was observed to be the key circulation feature common among wintertime extensive and persistent low tempera-ture events (EPLTE) in China.During the persistence of such anomalous circulations,the split flow over the inner Asian continent and the influent flow over the southeast-ern coast of China correspond well to the expanded and amplified Siberian high with tightened sea level pressure gradients and hence,a strong,cold advection over south-eastern China.The western Pacific subtropical high tends to expand northward during the early stages of most EPLTEs.展开更多
AIM: To evaluate the epidemiology and outcomes of culture-positive spontaneous bacterial peritonitis (SBP) and spontaneous bacteremia (SB) in decompensated cirrhosis.METHODS: We prospectively collected clinical, labor...AIM: To evaluate the epidemiology and outcomes of culture-positive spontaneous bacterial peritonitis (SBP) and spontaneous bacteremia (SB) in decompensated cirrhosis.METHODS: We prospectively collected clinical, laboratory characteristics, type of administered antibiotic, susceptibility and resistance of bacteria to antibiotics in one hundred thirty cases (68.5% males) with positive ascitic fluid and/or blood cultures during the period from January 1, 2012 to May 30, 2014. All patients with SBP had polymorphonuclear cell count in ascitic fluid > 250/mm<sup>3</sup>. In patients with SB a thorough study did not reveal any other cause of bacteremia. The patients were followed-up for a 30-d period following diagnosis of the infection. The final outcome of the patients was recorded in the end of follow-up and comparison among 3 groups of patients according to the pattern of drug resistance was performed.RESULTS: Gram-positive-cocci (GPC) were found in half of the cases. The most prevalent organisms in a descending order were Escherichia coli (33), Enterococcus spp (30), Streptococcus spp (25), Klebsiella pneumonia (16), S. aureus (8), Pseudomanas aeruginosa (5), other Gram-negative-bacteria (GNB) (11) and anaerobes (2). Overall, 20.8% of isolates were multidrug-resistant (MDR) and 10% extensively drug-resistant (XDR). Health-care-associated (HCA) and/or nosocomial infections were present in 100% of MDR/XDR and in 65.5% of non-DR cases. Meropenem was the empirically prescribed antibiotic in HCA/nosocomial infections showing a drug-resistance rate of 30.7% while third generation cephalosporins of 43.8%. Meropenem was ineffective on both XDR bacteria and Enterococcus faecium (E. faecium). All but one XDR were susceptible to colistin while all GPC (including E. faecium) and the 86% of GNB to tigecycline. Overall 30-d mortality was 37.7% (69.2% for XDR and 34.2% for the rest of the patients) (log rank, P = 0.015). In multivariate analysis, factors adversely affecting outcome included XDR infection (HR = 2.263, 95%CI: 1.005-5.095, P = 0.049), creatinine (HR = 1.125, 95%CI: 1.024-1.236, P = 0.015) and INR (HR =1.553, 95%CI: 1.106-2.180, P = 0.011).CONCLUSION: XDR bacteria are an independent life-threatening factor in SBP/SB. Strategies aiming at restricting antibiotic overuse and rapid identification of the responsible bacteria could help improve survival.展开更多
Concurrence of low temperature,precipitation and freezing weather in an extensive area would cause devastating impacts on local economy and society.We call such a combination of concurrent disastrous weather“extensiv...Concurrence of low temperature,precipitation and freezing weather in an extensive area would cause devastating impacts on local economy and society.We call such a combination of concurrent disastrous weather“extensive coldprecipitation-freezing”events(ECPFEs).In this study,the ECPFEs in southern China(15°−35°N,102°−123°E)are objectively defined by using daily surface observational data for the period 1951−2013.An ECPFE in southern China is defined if the low temperature area,precipitation area and freezing area concurrently exceed their respective thresholds for at least three consecutive days.The identified ECPFEs are shown to be reasonable and reliable,compared with those in previous studies.The circulation anomalies in ECPFEs are characterized by a large-scale tilted ridge and trough pairing over mid-and high-latitude Eurasia,and the intensified subtropical westerlies along the southern foot of the Tibetan Plateau and the anomalous anticyclonic circulation over the subtropical western Pacific.Comparative analysis reveals that the stable cold air from the north and the warm and moist air from the south converge,facilitating a favorable environment for the concurrence of extensive low-temperature,precipitation and freezing weather.展开更多
The distinct precursory signals of countrywide extensive and persistent extreme cold events (CECs) were investigated and contrasted with those of countrywide cold wave events (CCWs). It is shown that most CECs were ac...The distinct precursory signals of countrywide extensive and persistent extreme cold events (CECs) were investigated and contrasted with those of countrywide cold wave events (CCWs). It is shown that most CECs were accompanied by a CCW in the initial stages. From the comparison between the CECs and the CCWs that were independent of any CEC, it is found that a south- west-northeast-oriented tilted ridge at 500 hPa was present around the Europe-Barents Sea regions approximately 10 days prior to the start of the CEC. Consistent with this feature, a high sea level pressure and strong cold air accumulation occurred over a broad extent of northern Eurasia one week prior to the start of the CEC. The tilted ridge and the strong cold air accumulation were the precursory signals that were absent for the CCW, and they provide important clues for the early prediction of whether a CCW event might evolve into a CEC.展开更多
Experiments were carried out on rats anaesthetized with uraethane. The sponta-neous discharges and nociceptive responses of convergent neurons in the right trigerninal nucleus cau-dalis(TNC) to noxious stimuli at rece...Experiments were carried out on rats anaesthetized with uraethane. The sponta-neous discharges and nociceptive responses of convergent neurons in the right trigerninal nucleus cau-dalis(TNC) to noxious stimuli at receptive field (cheek) were recorded extracellularly with glass mi-cro-electrode. Electroacupuncture (EA ) was applied at bilateral " Xiaguan" (ST 7 on face ) or "Zusanli" (ST 36 on shank) acupoint with Iow (2V) and high (18V) intensity. The noclceptive re-sponse of convergent neurons in TNC could be inhihited by low intensity EA applied at "Xiaguan" butnot "Zusanlil", showing the specificity of acupoints. High intensity EA at either "Xiaguan" or "Zusan-li" also reduced the nociceptive responses, showing the analgesic extensiveness of acupoints. We sug-gest that "the gate of control" mechanism plays a main role in low intensity EA and "diffuse noxiousinhibitory controls" (DNIC) rnechanism does so in high intensity EA.The results suggest that we should pay attention to the location of acupoints,展开更多
BACKGROUND Bedaquiline is among the prioritized drugs recommended by the World Health Organization for the treatment of extensively drug-resistant tuberculosis(XDRTB).Many patients have not achieved better clinical im...BACKGROUND Bedaquiline is among the prioritized drugs recommended by the World Health Organization for the treatment of extensively drug-resistant tuberculosis(XDRTB).Many patients have not achieved better clinical improvement after bedaquiline is stopped at 24 wk.However,there is no recommendation or guideline on bedaquiline administration beyond 24 wk,which is an important consideration when balancing the benefit of prognosis for XDR-TB against the uncertain safety concerning the newer antibiotics.CASE SUMMARY This paper reported 2 patients with XDR-TB(a female of 58 years of age and a female of 18 years of age)who received bedaquiline for 36 wk,as local experience to be shared.The 2 cases had negative cultures after 24 wk of treatment,but lung imaging was still positive.After discussion among experts,the consensus was made to bedaquiline prolongation by another 12 wk.The 36-wk prolonged use of bedaquiline in both cases achieved a favorable response without increasing the risk of cardiac events or new safety signals.CONCLUSION Longer regimen,including 36-wk bedaquiline treatment,might be an option for patients with XDR-TB.More studies are needed to explore the effectiveness and safety of prolonged use of bedaquiline for 36 wk vs standard 24 wk in the treatment of multidrug-resistant/XDR-TB or to investigate further the biomarkers and criteria indicative for extension of bedaquline to facilitate clinical use of thisnovel drug.展开更多
This paper examines the problems existing in Extensive Reading Teaching for Vocational Business English Majors and analyses the contributing factors for the time-consuming and inefficient Extensive Reading Teaching.Ba...This paper examines the problems existing in Extensive Reading Teaching for Vocational Business English Majors and analyses the contributing factors for the time-consuming and inefficient Extensive Reading Teaching.Based on the analysis,the author points out some solutions from the following several aspects:the teachers’ roles,the choice of textbooks and the organization of the class as well as the integrated design of the class activities,be carried out in the student-centered class to be practical and helpful in the Extensive Reading Teaching.展开更多
AIM: To compare rabeprazole (RPZ; 10 mg) with Lansoprazole orally disintegrating tablets (LPZ; 30 mg OD) in terms of antisecretory activity and blood drug concentration after a single dose. METHODS: Eight H pylori-neg...AIM: To compare rabeprazole (RPZ; 10 mg) with Lansoprazole orally disintegrating tablets (LPZ; 30 mg OD) in terms of antisecretory activity and blood drug concentration after a single dose. METHODS: Eight H pylori-negative cytochrome P450 (CYP) 2C19 extensive metabolizers were assigned to receive a single oral dose of RPZ 10 mg or LPZ 30 mg OD. Twelve hour intragastric pH monitoring was perform- ed on the day of treatment. Blood samples were also collected after the administration of each drug. RESULTS: LPZ 30 mg OD induced a significantly earlier rise in blood drug concentration than RPZ 10 mg; consequently, LPZ 30 mg OD induced a significantly earlier rise in median pH in the third and fourth hours of the study. CONCLUSION: In H pylori-negative CYP2C19 extensive metabolizers, LPZ 30 mg OD induced a significantly faster inhibition of gastric acid secretion than RPZ 10 mg.展开更多
BACKGROUND Pyogenic ventriculitis caused by extensively drug-resistant Acinetobacter baumannii(A.baumannii)is one of the most severe complications associated with craniotomy.However,limited therapeutic options exist f...BACKGROUND Pyogenic ventriculitis caused by extensively drug-resistant Acinetobacter baumannii(A.baumannii)is one of the most severe complications associated with craniotomy.However,limited therapeutic options exist for the treatment of A.baumannii ventriculitis due to the poor penetration rate of most antibiotics through the blood-brain barrier.CASE SUMMARY A 68-year-old male patient with severe traumatic brain injury developed pyogenic ventriculitis on postoperative day 24 caused by extensively drug-resistant A.baumannii susceptible to tigecycline only.Successful treatment was accomplished through multi-route administration of tigecycline,including intravenous combined with continuous ventricular irrigation plus intraventricular administration.The pus was cleared on the 3rd day post-irrigation,and cerebrospinal fluid cultures were negative after 12 d.CONCLUSION Our findings suggest that multi-route administration of tigecycline can be a therapeutic option against pyogenic ventriculitis caused by extensively drugresistant A.baumannii.展开更多
BACKGROUND Gastric cancer(GC)is one of the most common malignant tumors.After resection,one of the major problems is its peritoneal dissemination and recurrence.Some free cancer cells may still exist after resection.I...BACKGROUND Gastric cancer(GC)is one of the most common malignant tumors.After resection,one of the major problems is its peritoneal dissemination and recurrence.Some free cancer cells may still exist after resection.In addition,the surgery itself may lead to the dissemination of tumor cells.Therefore,it is necessary to remove residual tumor cells.Recently,some researchers found that extensive intraoperative peritoneal lavage(EIPL)plus intraperitoneal chemotherapy can improve the prognosis of patients and eradicate peritoneal free cancer for GC patients.However,few studies explored the safety and long-term outcome of EIPL after curative gastrectomy.AIM To evaluate the efficacy and long-term outcome of advanced GC patients treated with EIPL.METHODS According to the inclusion and exclusion criteria,a total of 150 patients with advanced GC were enrolled in this study.The patients were randomly allocated to two groups.All patients received laparotomy.For the non-EIPL group,peritoneal lavage was washed using no more than 3 L of warm saline.In the EIPL group,patients received 10 L or more of saline(1 L at a time)before the closure of the abdomen.The surviving rate analysis was compared by the Kaplan-Meier method.The prognostic factors were carried out using the Cox appropriate hazard pattern.RESULTS The basic information in the EIPL group and the non-EIPL group had no significant difference.The median follow-up time was 30 mo(range:0-45 mo).The 1-and 3-year overall survival(OS)rates were 71.0%and 26.5%,respectively.The symptoms of ileus and abdominal abscess appeared more frequently in the non-EIPL group(P<0.05).For the OS of patients,the EIPL,Borrmann classification,tumor size,N stage,T stage and vascular invasion were significant indicators.Then multivariate analysis revealed that EIPL,tumor size,vascular invasion,N stage and T stage were independent prognostic factors.The prognosis of the EIPL group was better than the non-EIPL group(P<0.001).The 3-year survival rate of the EIPL group(38.4%)was higher than the non-EIPL group(21.7%).For the recurrence-free survival(RFS)of patients,the risk factor of RFS included EIPL,N stage,vascular invasion,type of surgery,tumor location,Borrmann classification,and tumor size.EIPL and tumor size were independent risk factors.The RFS curve of the EIPL group was better than the non-EIPL group(P=0.004),and the recurrence rate of the EIPL group(24.7%)was lower than the non-EIPL group(46.4%).The overall recurrence rate and peritoneum recurrence rate in the EIPL group was lower than the non-EIPL group(P<0.05).CONCLUSION EIPL can reduce the possibility of perioperative complications including ileus and abdominal abscess.In addition,the overall survival curve and RFS curve were better in the EIPL group.展开更多
文摘BACKGROUND Gallbladder cancer is a highly malignant and aggressive tumor,often diagnosed at an advanced stage.The prognosis for advanced gallbladder cancer remains poor,with limited options for effective treatment.CASE SUMMARY A 65-year-old male patient presented with a soft tissue mass in the gallbladder.Following laparoscopic exploration,he underwent radical surgery for gallbladder cancer,with the tumor staged as pT2N1M0(stage III).Post-surgery,the patient received four cycles of adjuvant chemotherapy.However,one month later,over 60 metastatic lesions were detected in the liver,lungs,and lymph nodes.In response to the widespread metastasis,he underwent six cycles of combination therapy consisting of sintilimab,albumin-bound paclitaxel,and cisplatin.After two cycles,a partial response was achieved.Maintenance therapy was initiated with a combination of sintilimab and albumin-bound paclitaxel for four cycles.Monotherapy with sintilimab was continued thereafter until October 2023.Complete remission was confirmed in September 2021.The patient sustained this complete response for more than three years,including an eleven-month period without disease progression following the discontinuation of sintilimab.Genetic analysis revealed a tumor mutational burden of 15.4 mutations/megabase,which indicates a potentially favorable response to immunotherapy.CONCLUSION This case demonstrates the potential of combining immunotherapy(sintilimab)with chemotherapy to achieve durable remission in metastatic gallbladder cancer,even in a patient with extensive metastasis.In addition,it indicated the importance of tumor mutational burden as a predictive biomarker of immunotherapy.
文摘The increasing demand for green spaces in cities underscores the urgent need for sustainable solutions to reduce the ecological impact of urban areas.This research focuses on converting unused rooftops into extensive green roofs in Nador,Morocco,offering an innovative approach to enhancing outdoor thermal comfort in this region.Several advanced techniques were used,including photogrammetric restitution(for creating land use maps),integration of light detection and ranging data(for three-dimensional urban modeling),and meteorological data collection(for modeling urban climate conditions).The urban-multiscale-environmental-predictor solar and longwave environmental irradiance geometry(UMEP-SOLWEIG)model was crucial for precisely evaluating the thermal performance of green roofs and their influence on urban microclimates.This model considers considered various parameters,such as the sky view factor,wall height and aspect,and shading conditions,for accurate,comprehensive analysis.Additionally,for accurate,comprehensive analysis,a comparative evaluation was performed between the UMEP-SOLWEIG and ENVI-met models to assess the UMEP SOLWEIG results.The findings were notable,demonstrating a substantial reduction(averaging over 3℃)in the mean radiant temperature on 60%of rooftops,covering 55%of the total surface area.This highlighted the effectiveness of green roofs in improving outdoor thermal comfort.Furthermore,green roofs were closely associated with reductions in air-conditioning energy consumption,with considerable reductions ranging from 17.53%to 43.82%.These savings translated to estimated financial benefits ranging from USD 1.63-4.07 million.These figures clearly verified the notable economic impact of green roofs despite their initially high costs(approximately USD 84.44 million).These potential long-term savings indicated that these investments are financially viable in the long run.The collected data were used to create thermal maps of the area using geographic-information-system tools.A thermal cadaster specific to green roofs was also developed,accessible online through Web mapping.Overall,this approach facilitates decision-making in urban planning by providing visual information on thermal variations,thereby aiding in the precise planning of measures against urban heat and promoting the use of green roofs to reduce environmental impact.
基金supported by International Joint Laboratory on Tropical Diseases Control in Greater Mekong Subregion(grant number 21410750200)from Shanghai Municipality Government.
文摘Background:Tuberculosis(TB),caused by Mycobacterium tuberculosis,remains the second leading cause of death from a single infectious disease globally and poses a significant economic and clinical burden in the world in 2022.Of particular concern is the emergence of drug-resistant TB,accounting for 15%-20%of TB deaths.It is imperative to delve into the global trends of incidence and death rate for multidrug-resistant tuberculosis(MDRTB)and extensively drug-resistant tuberculosis(XDR-TB),drawing upon the comprehensive Global Burden of Disease(GBD)2021 drug-resistant tuberculosis dataset.Methods:From the GBD 2021,data on incidence,prevalence,disability-adjusted life years(DALYs),and death of MDR-TB and XDR-TB from 1990 to 2021 were collected.We calculated the estimated annual percentage changes in age standardized incidence rate(ASIR)and age-standardized death rate(ASDR),segmented by age,sex,and socio-demographic index(SDI).The impacts of various risk factors on MDR-TB and XDR-TB were also analyzed.Results:In 2021,there were an estimated 443,680(95%uncertainty interval[UI]:259,196-766,545)incident cases of MDR-TB,and an estimated 106,818(95%UI:41,612-211,854)death cases of MDR-TB,while there were an estimated 24,036(95%UI:17,144-34,587)incident cases of XDR-TB and 7,946(95%UI:3,326-14,859)death cases of XDR-TB.The incidence and death cases of MDR-TB were lowest in high SDI regions,whereas the incidence rates of XDR-TB in high-middle SDI regions were higher than those in middle SDI and high SDI regions.Conclusion:This study reported the disease burden of drug-resistant TB from 1990 to 2021.Until 2021,drugresistant TB is still a serious problem in low SDI countries,especially for high-risk age populations with highrisk factors.Controlling drug-resistant TB requires effective control strategies and healthcare systems.
文摘Rationale:Longitudinally extensive transverse myelitis(LETM)is a rare inflammatory demyelinating disease predominantly associated with autoimmune and inflammatory disorders.Scrub typhus can cause a variety of neurological complications,which may result in poor recovery and long-term disability.This report reveals a rare linkage between LETM and scrub typhus.Patient concerns:A 24-year-old female presented with a history of fever for 10 days associated with progressive quadriparesis.Physical examination revealed bilateral lower limb weakness(grade 0/5)and bilateral upper limb weakness(grade 2/5)with reduced sensation below the T3 dermatome.Diagnosis:Scrub typhus presenting with longitudinally extensive transverse myelitis.Interventions:Steroid pulse therapy with antibiotics supported by early intensive rehabilitation.Outcomes:Complete recovery was achieved.Lessons:This case report highlights the importance of considering scrub typhus as a potential cause of LETM in endemic regions,particularly in patients presenting with febrile illness and neurological symptoms.
文摘Because of environmental constraints,beef cattle was for more than a century the only viable farming option in the extensive semiarid and subhumid lands of Argentina and the main source of nutrients for humans as well.However,a growing concern and criticism have risen today about its possible negative impact on the climate and the environment.These worries tend to affect current public opinions,national policies,and international trade.Based on 40 beef cattle farms scattered across different semiarid and subhumid regions of Argentina,here we evaluated the impact of extensive cattle production on carbon,water,and nutrient pollution.Life-Cycle Assessment(LCA)and Land-Based Assessment(LBA)were the two approaches we used here to compare the environmental impact of beef production.While the environmental footprint(EF)resulting from LCA expresses the impact per unit of food,the environmental balance(EB),derived from LBA,aims at quantifying the impact per unit of land.As such,the EB considers both negative and positive impacts on the farm as an integrated system.Following standardized procedures,we evaluated EF and EB up to the farm gate,leaving aside delocalized post-farm impacts such as those of processing,packaging,and transportation that occur beyond the farm gate.In agreement with previous evidence,our results show that the EF tends to decrease as per-head production increases.Correlation coefficients and statistical significance were the following for carbon(R=−0.574;p<0.01),water(R=−0.561;p<0.01),and N(R=−0.704;p<0.01)and Phosphorus(P)pollution(R=−0.802;p<0.01)footprints.On the contrary,the EB seems to be highly sensitive,and as per-hectare beef production increases.Correlations were the following for carbon emissions(CE:R=0.955;p<0.01),water consumption(WC:R=0.822;p<0.01),nitrogen excretion(NE:R=0.948;p<0.01)and phosphorus excretion(PE:R=0.945;p<0.01).What our results suggest is that the notion of EF is useful to evaluate the environmental impact in intensive beef production systems,and the EB is suitable to assess the impact of the extensive ones.In practice,both approaches provide different perspectives on the environmental-impact problem and they should be complementary used.We concluded that the methodological rigidity of EF does not allow proper discrimination among farms in the extensive systems.On the contrary,the EB approach tended to be highly sensitive to detecting differences between individual farms and farmers,thus allowing the identification of successful options for extensive beef production in terms of public image,policy-making,and commercial opportunities.
基金This project is supported by National Natural Science Foundation of China(No.59990470-2)Doctorate Foundation of China (No.20010487024).
文摘Based on extenics, an extensive functional information model(function-behavioral action-structure-environmental constraint) of the mechanical productintelligent conceptual design is developed, and the mechanism of theoretic structure solutions isproduced, the mapping relations between function-behavior and behavior-structure are analyzed. Themodel is applied to the filling material system's conceptual design to verify validity.
文摘Systemic Functional Linguistics is known to people by its special functionalism and social meaning. The study of Systemic Functional Linguistics is also accepted by more and more people. In addition, it means a lot to the learning of lexis, English writing and extensive reading.
文摘Researches on foreign language extensive reading program indicate that students can improve their foreign language reading ability,and develop positive attitudes toward reading and increased motivation to read.Comparing to the other types of reading.(skimming,scanning,and intensive reading.),reading extensively can result in gains in vocabulary and other aspects of foreign language learning.Teachers should provide various experience and make students have the chance to enjoy reading.and give them more guidance on developing certain reading skills.
文摘Alveolar echinococcosis(AE) is a zoonotic disease that is caused by Echinococcus multilocularis that affects liver and a variety of organs and tissues. It differs from other echinococcal disease because it shows tumor like behavior in the affected organ and tissues. The treatment of choice is concomitant medical therapy and resection with negative margins. Nevertheless, resection with the intent of negative margins(R0) may lead to serious complications such as liver failure. In the present case report, we used Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy(ALPPS) procedure, which was defined in 2012 by Schnitzbauer et al, in a 28-year-old male patient to avoid complications of major liver resection in order to treat alveolar echinococcosis. Until now, we have not encountered any study using ALPPS procedure for the treatment of alveolar echinococcosis. In the present case report we aimed to show that ALPPS procedure can be safely performed for marginnegative resection of primary or recurrent AE that shows a tumor like behavior. It is our opinion that this procedure should be performed in centers that have expertise and sufficient technical capacity to perform liver transplantation and advanced liver surgery.
基金supported by the National Key Technologies R&D Program of China (Grant No.2009BAC51B02)
文摘A pair of northeast-southwest-tilted mid-tropospheric ridges and troughs on the continental scale was observed to be the key circulation feature common among wintertime extensive and persistent low tempera-ture events (EPLTE) in China.During the persistence of such anomalous circulations,the split flow over the inner Asian continent and the influent flow over the southeast-ern coast of China correspond well to the expanded and amplified Siberian high with tightened sea level pressure gradients and hence,a strong,cold advection over south-eastern China.The western Pacific subtropical high tends to expand northward during the early stages of most EPLTEs.
文摘AIM: To evaluate the epidemiology and outcomes of culture-positive spontaneous bacterial peritonitis (SBP) and spontaneous bacteremia (SB) in decompensated cirrhosis.METHODS: We prospectively collected clinical, laboratory characteristics, type of administered antibiotic, susceptibility and resistance of bacteria to antibiotics in one hundred thirty cases (68.5% males) with positive ascitic fluid and/or blood cultures during the period from January 1, 2012 to May 30, 2014. All patients with SBP had polymorphonuclear cell count in ascitic fluid > 250/mm<sup>3</sup>. In patients with SB a thorough study did not reveal any other cause of bacteremia. The patients were followed-up for a 30-d period following diagnosis of the infection. The final outcome of the patients was recorded in the end of follow-up and comparison among 3 groups of patients according to the pattern of drug resistance was performed.RESULTS: Gram-positive-cocci (GPC) were found in half of the cases. The most prevalent organisms in a descending order were Escherichia coli (33), Enterococcus spp (30), Streptococcus spp (25), Klebsiella pneumonia (16), S. aureus (8), Pseudomanas aeruginosa (5), other Gram-negative-bacteria (GNB) (11) and anaerobes (2). Overall, 20.8% of isolates were multidrug-resistant (MDR) and 10% extensively drug-resistant (XDR). Health-care-associated (HCA) and/or nosocomial infections were present in 100% of MDR/XDR and in 65.5% of non-DR cases. Meropenem was the empirically prescribed antibiotic in HCA/nosocomial infections showing a drug-resistance rate of 30.7% while third generation cephalosporins of 43.8%. Meropenem was ineffective on both XDR bacteria and Enterococcus faecium (E. faecium). All but one XDR were susceptible to colistin while all GPC (including E. faecium) and the 86% of GNB to tigecycline. Overall 30-d mortality was 37.7% (69.2% for XDR and 34.2% for the rest of the patients) (log rank, P = 0.015). In multivariate analysis, factors adversely affecting outcome included XDR infection (HR = 2.263, 95%CI: 1.005-5.095, P = 0.049), creatinine (HR = 1.125, 95%CI: 1.024-1.236, P = 0.015) and INR (HR =1.553, 95%CI: 1.106-2.180, P = 0.011).CONCLUSION: XDR bacteria are an independent life-threatening factor in SBP/SB. Strategies aiming at restricting antibiotic overuse and rapid identification of the responsible bacteria could help improve survival.
基金This research was funded by the National Natural Science Foundation of China(Grant Nos.41975072 and 41675086)the National Science and Technology Support Program of China(Grant No.2015BAC03B03).
文摘Concurrence of low temperature,precipitation and freezing weather in an extensive area would cause devastating impacts on local economy and society.We call such a combination of concurrent disastrous weather“extensive coldprecipitation-freezing”events(ECPFEs).In this study,the ECPFEs in southern China(15°−35°N,102°−123°E)are objectively defined by using daily surface observational data for the period 1951−2013.An ECPFE in southern China is defined if the low temperature area,precipitation area and freezing area concurrently exceed their respective thresholds for at least three consecutive days.The identified ECPFEs are shown to be reasonable and reliable,compared with those in previous studies.The circulation anomalies in ECPFEs are characterized by a large-scale tilted ridge and trough pairing over mid-and high-latitude Eurasia,and the intensified subtropical westerlies along the southern foot of the Tibetan Plateau and the anomalous anticyclonic circulation over the subtropical western Pacific.Comparative analysis reveals that the stable cold air from the north and the warm and moist air from the south converge,facilitating a favorable environment for the concurrence of extensive low-temperature,precipitation and freezing weather.
基金supported by the National Key Technologies R&D Program of China (Grant No. 2009BAC51B02)
文摘The distinct precursory signals of countrywide extensive and persistent extreme cold events (CECs) were investigated and contrasted with those of countrywide cold wave events (CCWs). It is shown that most CECs were accompanied by a CCW in the initial stages. From the comparison between the CECs and the CCWs that were independent of any CEC, it is found that a south- west-northeast-oriented tilted ridge at 500 hPa was present around the Europe-Barents Sea regions approximately 10 days prior to the start of the CEC. Consistent with this feature, a high sea level pressure and strong cold air accumulation occurred over a broad extent of northern Eurasia one week prior to the start of the CEC. The tilted ridge and the strong cold air accumulation were the precursory signals that were absent for the CCW, and they provide important clues for the early prediction of whether a CCW event might evolve into a CEC.
文摘Experiments were carried out on rats anaesthetized with uraethane. The sponta-neous discharges and nociceptive responses of convergent neurons in the right trigerninal nucleus cau-dalis(TNC) to noxious stimuli at receptive field (cheek) were recorded extracellularly with glass mi-cro-electrode. Electroacupuncture (EA ) was applied at bilateral " Xiaguan" (ST 7 on face ) or "Zusanli" (ST 36 on shank) acupoint with Iow (2V) and high (18V) intensity. The noclceptive re-sponse of convergent neurons in TNC could be inhihited by low intensity EA applied at "Xiaguan" butnot "Zusanlil", showing the specificity of acupoints. High intensity EA at either "Xiaguan" or "Zusan-li" also reduced the nociceptive responses, showing the analgesic extensiveness of acupoints. We sug-gest that "the gate of control" mechanism plays a main role in low intensity EA and "diffuse noxiousinhibitory controls" (DNIC) rnechanism does so in high intensity EA.The results suggest that we should pay attention to the location of acupoints,
文摘BACKGROUND Bedaquiline is among the prioritized drugs recommended by the World Health Organization for the treatment of extensively drug-resistant tuberculosis(XDRTB).Many patients have not achieved better clinical improvement after bedaquiline is stopped at 24 wk.However,there is no recommendation or guideline on bedaquiline administration beyond 24 wk,which is an important consideration when balancing the benefit of prognosis for XDR-TB against the uncertain safety concerning the newer antibiotics.CASE SUMMARY This paper reported 2 patients with XDR-TB(a female of 58 years of age and a female of 18 years of age)who received bedaquiline for 36 wk,as local experience to be shared.The 2 cases had negative cultures after 24 wk of treatment,but lung imaging was still positive.After discussion among experts,the consensus was made to bedaquiline prolongation by another 12 wk.The 36-wk prolonged use of bedaquiline in both cases achieved a favorable response without increasing the risk of cardiac events or new safety signals.CONCLUSION Longer regimen,including 36-wk bedaquiline treatment,might be an option for patients with XDR-TB.More studies are needed to explore the effectiveness and safety of prolonged use of bedaquiline for 36 wk vs standard 24 wk in the treatment of multidrug-resistant/XDR-TB or to investigate further the biomarkers and criteria indicative for extension of bedaquline to facilitate clinical use of thisnovel drug.
文摘This paper examines the problems existing in Extensive Reading Teaching for Vocational Business English Majors and analyses the contributing factors for the time-consuming and inefficient Extensive Reading Teaching.Based on the analysis,the author points out some solutions from the following several aspects:the teachers’ roles,the choice of textbooks and the organization of the class as well as the integrated design of the class activities,be carried out in the student-centered class to be practical and helpful in the Extensive Reading Teaching.
文摘AIM: To compare rabeprazole (RPZ; 10 mg) with Lansoprazole orally disintegrating tablets (LPZ; 30 mg OD) in terms of antisecretory activity and blood drug concentration after a single dose. METHODS: Eight H pylori-negative cytochrome P450 (CYP) 2C19 extensive metabolizers were assigned to receive a single oral dose of RPZ 10 mg or LPZ 30 mg OD. Twelve hour intragastric pH monitoring was perform- ed on the day of treatment. Blood samples were also collected after the administration of each drug. RESULTS: LPZ 30 mg OD induced a significantly earlier rise in blood drug concentration than RPZ 10 mg; consequently, LPZ 30 mg OD induced a significantly earlier rise in median pH in the third and fourth hours of the study. CONCLUSION: In H pylori-negative CYP2C19 extensive metabolizers, LPZ 30 mg OD induced a significantly faster inhibition of gastric acid secretion than RPZ 10 mg.
文摘BACKGROUND Pyogenic ventriculitis caused by extensively drug-resistant Acinetobacter baumannii(A.baumannii)is one of the most severe complications associated with craniotomy.However,limited therapeutic options exist for the treatment of A.baumannii ventriculitis due to the poor penetration rate of most antibiotics through the blood-brain barrier.CASE SUMMARY A 68-year-old male patient with severe traumatic brain injury developed pyogenic ventriculitis on postoperative day 24 caused by extensively drug-resistant A.baumannii susceptible to tigecycline only.Successful treatment was accomplished through multi-route administration of tigecycline,including intravenous combined with continuous ventricular irrigation plus intraventricular administration.The pus was cleared on the 3rd day post-irrigation,and cerebrospinal fluid cultures were negative after 12 d.CONCLUSION Our findings suggest that multi-route administration of tigecycline can be a therapeutic option against pyogenic ventriculitis caused by extensively drugresistant A.baumannii.
文摘BACKGROUND Gastric cancer(GC)is one of the most common malignant tumors.After resection,one of the major problems is its peritoneal dissemination and recurrence.Some free cancer cells may still exist after resection.In addition,the surgery itself may lead to the dissemination of tumor cells.Therefore,it is necessary to remove residual tumor cells.Recently,some researchers found that extensive intraoperative peritoneal lavage(EIPL)plus intraperitoneal chemotherapy can improve the prognosis of patients and eradicate peritoneal free cancer for GC patients.However,few studies explored the safety and long-term outcome of EIPL after curative gastrectomy.AIM To evaluate the efficacy and long-term outcome of advanced GC patients treated with EIPL.METHODS According to the inclusion and exclusion criteria,a total of 150 patients with advanced GC were enrolled in this study.The patients were randomly allocated to two groups.All patients received laparotomy.For the non-EIPL group,peritoneal lavage was washed using no more than 3 L of warm saline.In the EIPL group,patients received 10 L or more of saline(1 L at a time)before the closure of the abdomen.The surviving rate analysis was compared by the Kaplan-Meier method.The prognostic factors were carried out using the Cox appropriate hazard pattern.RESULTS The basic information in the EIPL group and the non-EIPL group had no significant difference.The median follow-up time was 30 mo(range:0-45 mo).The 1-and 3-year overall survival(OS)rates were 71.0%and 26.5%,respectively.The symptoms of ileus and abdominal abscess appeared more frequently in the non-EIPL group(P<0.05).For the OS of patients,the EIPL,Borrmann classification,tumor size,N stage,T stage and vascular invasion were significant indicators.Then multivariate analysis revealed that EIPL,tumor size,vascular invasion,N stage and T stage were independent prognostic factors.The prognosis of the EIPL group was better than the non-EIPL group(P<0.001).The 3-year survival rate of the EIPL group(38.4%)was higher than the non-EIPL group(21.7%).For the recurrence-free survival(RFS)of patients,the risk factor of RFS included EIPL,N stage,vascular invasion,type of surgery,tumor location,Borrmann classification,and tumor size.EIPL and tumor size were independent risk factors.The RFS curve of the EIPL group was better than the non-EIPL group(P=0.004),and the recurrence rate of the EIPL group(24.7%)was lower than the non-EIPL group(46.4%).The overall recurrence rate and peritoneum recurrence rate in the EIPL group was lower than the non-EIPL group(P<0.05).CONCLUSION EIPL can reduce the possibility of perioperative complications including ileus and abdominal abscess.In addition,the overall survival curve and RFS curve were better in the EIPL group.
