Focal segmental glomerulosclerosis(FSGS)is a histological pattern of glomerular damage that significantly contributes to chronic kidney disease and end-stage renal disease.Its incidence is rising globally,necessitatin...Focal segmental glomerulosclerosis(FSGS)is a histological pattern of glomerular damage that significantly contributes to chronic kidney disease and end-stage renal disease.Its incidence is rising globally,necessitating timely and personalized management strategies.This paper aims to provide an updated overview of the pathophysiology,diagnosis,and therapeutic strategies for FSGS,emphasizing the importance of early interventions and tailored treatments.This editorial synthesizes key findings from recent literature to highlight advancements in understanding and managing FSGS.Emerging evidence supports the role of targeted therapies and personalized approaches in improving outcomes for FSGS patients.Advances include novel biomarkers,genetic testing,and innovative therapeutics such as transient receptor potential ion channel blockers and antisense oligonucleotides for apolipoprotein 1-related FSGS.Effective mana-gement of FSGS requires a combination of timely diagnosis,evidence-based therapeutic strategies,and ongoing research to optimize patient outcomes and address gaps in the current understanding of the disease.展开更多
When only a portion of the shield lining structures in a full-line tunnel are overloaded,their bearing and failure characteristics are significantly different from those in the full-line overloaded case.In existing st...When only a portion of the shield lining structures in a full-line tunnel are overloaded,their bearing and failure characteristics are significantly different from those in the full-line overloaded case.In existing studies,one or several segmental lining rings have been studied,with overload applied to selected lining rings to analyze the performance evolution of the lining structures;however,this approach fails to reveal the bearing and failure characteristics of shield lining rings under localized overload.To address this research gap,we employ 3D finite element modeling to investigate the mechanical performance and failure mechanisms of shield segmental linings under localized overload conditions,and compare the results with full-line overload scenarios.Additionally,the impact of reinforcing shield segmental linings with steel rings is studied to address issues arising from localized overloads.The results indicate that localized overloads lead to significant ring joint dislocation and higher stress on longitudinal bolts,potentially causing longitudinal bolt failure.Furthermore,the overall deformation of lining rings,segmental joint opening,and stress in circumferential bolts and steel bars is lower compared to full-line overloads.For the same overload level,the convergence deformation of the lining under full-line overload is 1.5 to 2.0 times higher than that under localized overload.For localized overload situations,a reinforcement scheme with steel rings spanning across two adjacent lining rings is more effective than installing steel rings within individual lining rings.This spanning ring reinforcement strategy not only enhances the structural rigidity of each ring,but also limits joint dislocation and reduces stress on longitudinal bolts,with the reduction in maximum ring joint dislocation ranging from 70%to 82%and the reduction in maximum longitudinal bolt stress ranging from 19%to 57%compared to reinforcement within rings.展开更多
Background:Reliable animal models are crucial to drug development for focal segmental glomerulosclerosis(FSGS),a rare kidney disease.Variability in success rates in literature and significant ethical concerns with ani...Background:Reliable animal models are crucial to drug development for focal segmental glomerulosclerosis(FSGS),a rare kidney disease.Variability in success rates in literature and significant ethical concerns with animal welfare necessitate further optimization of adriamycin(ADR)-induced FSGS model developed on BALB/c mice.Methods:High-performance liquid chromatography(HPLC)was used to assess ADR stability in water and upon light exposure.To identify the optimal ADR level,single intravenous ADR injections with dosing levels from 10 to 17 mg/kg body weight were administered to BALB/c mice to induce FSGS-like pathology.Body weight and proteinuria of FSGS mice were monitored and analyzed for FSGS model-associated morbidity.Animals were euthanized for hematological and kidney histological assessments 8 weeks post induction.To identify the suitable experiment time frame of the ADR-induced FSGS mouse model,a longitudinal study was performed,with an 11-week continuous monitoring of the symptoms.Results:ADR was found to be unstable in aqueous media and light sensitive.A dosing level of 10.5 mg/kg of ADR was optimal for consistent FSGS mouse model induction on BALB/c strain,characterized by minimal mortality and sustained FSGS-like symptoms.Findings from the longitudinal study suggest that 6 weeks post ADR induction may represent the peak of FSGS pathology severity in this mouse model.This time frame may be used for FSGS drug development projects.Conclusion:Based on the outcome from this study,we identified the optimal ADR dosing level and model testing duration.A standard operating procedure(SOP)for the ADR-induced FSGS mouse model was established to facilitate FSGS basic research and drug development.展开更多
This study aims to assess the comprehensive strengthening effect of a steel-ultra high performance concrete(UHPC)composite strengthening method.The axial force-moment interaction curve(N-M curve)was calculated in a no...This study aims to assess the comprehensive strengthening effect of a steel-ultra high performance concrete(UHPC)composite strengthening method.The axial force-moment interaction curve(N-M curve)was calculated in a novel way,using cross-sectional strains at ultimate states as well as real-time stress measurements for each material.The enclosed area of the N-M curve was defined as a comprehensive performance index for the system.We validate our approach with comparisons to numerical modeling and full-scale four-point bending experiments.Additionally,strengthening effects were compared for different sagging and hogging moments based on material stress responses,and the impact of various strengthening parameters was analyzed.We find that the N-M curve of the strengthened cross-section envelops that of the un-strengthened cross-section.Notably,improvements in flexural capacity are greater under sagging moments during the large eccentric failure stage,and greater under hogging moments during the small eccentric failure stage.This discrepancy is attributed to the strength utilization of strengthening materials.These findings provide a reference for understanding the strengthening effects and parameters of steel-UHPC composite.展开更多
Segmental atrophy(SA)of the liver is a rare,often underrecognized,benign condition that presents as a mass lesion,mimicking a neoplasm,which poses a significant diagnostic challenge.Given its rarity,only a limited num...Segmental atrophy(SA)of the liver is a rare,often underrecognized,benign condition that presents as a mass lesion,mimicking a neoplasm,which poses a significant diagnostic challenge.Given its rarity,only a limited number of case reports and series have been published,resulting in sparse literature on the entity.This review aims to summarize the clinicopathologic and diagnostic features of SA and thus improve its recognition.展开更多
Cage plus plate(CP)and zero-profile(Zero-P)devices are widely used in anterior cervical discectomy and fusion(ACDF).This study aimed to compare adjacent segment biomechanical changes after ACDF when using Zero-P devic...Cage plus plate(CP)and zero-profile(Zero-P)devices are widely used in anterior cervical discectomy and fusion(ACDF).This study aimed to compare adjacent segment biomechanical changes after ACDF when using Zero-P device and CP in different segments.First,complete C1—C7 cervical segments were constructed and validated.Meanwhile,four surgery models were developed by implanting the Zero-P device or CP into C4—C5 or C5—C6 segments based on the intact model.The segmental range of motion(ROM)and maximum value of the intradiscal pressure of the surgery models were compared with those of the intact model.The implantation of CP and Zero-P devices in C4—C5 segments decreased ROM by about 91.6%and 84.3%,respectively,and increased adjacent segment ROM by about 8.3%and 6.82%,respectively.The implantation of CP and Zero-P devices in C5—C6 segments decreased ROM by about 93.3%and 89.9%,respectively,while increasing adjacent segment ROM by about 4.9%and 4%,respectively.Furthermore,the implantation of CP and Zero-P devices increased the intradiscal pressure in the adjacent segments of C4—C5 segments by about 4.5%and 6.7%,respectively.The implantation of CP and Zero-P devices significantly increased the intradiscal pressure in the adjacent segments of C5—C6 by about 54.1%and 15.4%,respectively.In conclusion,CP and Zero-P fusion systems can significantly reduce the ROM of the fusion implant segment in ACDF while increasing the ROM and intradiscal pressure of adjacent segments.Results showed that Zero-P fusion system is the best choice for C5—C6 segmental ACDF.However,further studies are needed to select the most suitable cervical fusion system for C4—C5 segmental ACDF.Therefore,this study provides biomechanical recommendations for clinical surgery.展开更多
When subjected to external loads from the ground and nearby construction,tunnel segmental lining joints are prone to damaging deformation.This can result in water leakage into tunnels,posing great safety risks.With th...When subjected to external loads from the ground and nearby construction,tunnel segmental lining joints are prone to damaging deformation.This can result in water leakage into tunnels,posing great safety risks.With this issue in mind,we conducted a series of full-scale tests to study the effects of external loads on the waterproofing performance of longitudinal joints.A customized rig for testing segmental joints was developed to assess the effect of loading magnitude,eccentricity,and loading-unloading-reloading cycles on waterproofing performance.Additionally,the relationship between joint force,sealing gasket deformation,and waterproofing pressure was investigated.The results indicate that:(1)the sealing gasket’s compression rapidly decreases as external loads increase,which weakens the waterproofing capacity of the joint;(2)the watertightness limit dramatically decreases as the bending moment increases;(3)a loading-unloading-reloading cycle leads to degradation of the joint’s waterproofing performance.The findings of this study provide a reference for subsequent waterproofing design of segmental tunnel joints,helping ensure the safety of tunnels throughout their operational lifespans.展开更多
Segmentally assembled bridges are increasinglyfinding engineering applications in recent years due to their unique advantages,especially as urban viaducts.Vehicle loads are one of the most important variable loads acti...Segmentally assembled bridges are increasinglyfinding engineering applications in recent years due to their unique advantages,especially as urban viaducts.Vehicle loads are one of the most important variable loads acting on bridge structures.Accordingly,the influence of overloaded vehicles on existing assembled bridge structures is an urgent concern at present.This paper establishes thefinite element model of the segmentally assembled bridge based on ABAQUS software and analyzes the influence of vehicle overload on an assembled girder bridge struc-ture.First,afinite element model corresponding to the target bridge is established based on ABAQUS software,and the load is controlled to simulate vehicle movement in each area of the traveling zone at different times.Sec-ond,the key cross-sections of segmental girder bridges are monitored in real time based on the force character-istics of continuous girder bridges,and they are compared with the simulation results.Finally,a material damage ontology model is introduced,and the structural damage caused by different overloading rates is compared and analyzed.Results show that thefinite element modeling method is accurate by comparing with on-site measured data,and it is suitable for the numerical simulation of segmental girder bridges;Dynamic sensors installed at 1/4L,1/2L,and 3/4L of the segmental girder main beams could be used to identify the dynamic response of segmental girder bridges;The bottom plate of the segmental girder bridge is mostly damaged at the position where the length of the precast beam section changes and the midspan position.With the increase in load,damage in the direction of the bridge develops faster than that in the direction of the transverse bridge.Thefindings of this study can guide maintenance departments in the management and maintenance of bridges and vehicles.展开更多
BACKGROUND Kidney function loss or renal insufficiency indicated by elevated creatinine levels and/or an estimated glomerular filtration rate(eGFR)<60 mL/minute/1.73 m²at presentation in patients with primary ...BACKGROUND Kidney function loss or renal insufficiency indicated by elevated creatinine levels and/or an estimated glomerular filtration rate(eGFR)<60 mL/minute/1.73 m²at presentation in patients with primary focal segmental glomerulosclerosis(FSGS)is commonly seen as a poor prognostic marker for kidney survival.However,a pre>vious study from our center suggested this may be due to hemodynamic factors.AIM To observe the clinical and biochemical parameters,treatment response,kidney survival,and overall outcomes of adult patients with primary FSGS presenting with kidney function insufficiency.METHODS This retrospective observational study was conducted at the Department of Nephrology,Sindh Institute of Urology and Transplantation,Karachi,Pakistan,from January 1995 to December 2017.During this period,401 biopsy-proven primary FSGS patients were identified,of which 98(24.4%)presented with kidney function loss or renal insufficiency defined as eGFR<60 mL/minute/1.73 m²at presentation and were studied in detail.RESULTS Among the 98 patients with renal function loss on presentation,the mean age was 30.9 years±13.6 years with a male-to-female ratio of 2.5:1.The mean serum creatinine level was 2.2 mg/dL±1.3 mg/dL and mean eGFR 37.1 mL/minute/1.73 m2±12.8 mL/minute/1.73 m2.The mean 24-hour urinary protein excretion was 5.9 g/day±4.0 g/day,and the mean serum albumin was 2.1 g/dL±1.0 g/dL(median:1.5 g/dL).The mean systolic blood pressure(BP)was 132.7 mmHg±19.8 mmHg,and the mean diastolic BP was 87.4 mmHg±12.7 mmHg.Steroid treatment was given to 81(82.6%)of 98 patients for an average duration of 19.9 weeks±14.4 weeks,with a mean total steroid dose of 4.4 g±1.5 g.Treatment response showed that 20(24.6%)patients achieved complete remission,9(11.1%)achieved partial remission,and 52(64.1%)did not respond.The baseline eGFR was significantly lower in the non-responsive group(P=0.006).The distribution of FSGS variants was also significantly different among steroid-responsive and non-responsive groups(P=0.012).CONCLUSION Renal function loss in FSGS patients at presentation does not necessarily indicate irreversible kidney function loss and a significant number of patients respond to appropriate treatment of the underlying disease.展开更多
An improved X-ray apparatus that combines tensile testing and X-ray diffraction has been designed and constructed to conduct timeresolved experiments during uniaxial stretching.By utilizing mortise-like clamping jaws ...An improved X-ray apparatus that combines tensile testing and X-ray diffraction has been designed and constructed to conduct timeresolved experiments during uniaxial stretching.By utilizing mortise-like clamping jaws and dogbone-shaped specimens,this setup allows for the simultaneous recording of high-quality mechanical responses and 2D diffraction patterns due to the minimization of experimental errors from sample slippage or premature fracture.Furthermore,the local extension ratio can be accurately determined based on thickness variation,and the Hermans'orientation function was demonstrated to be a reliable method with high accuracy to calculate the segmental orientation parameter〈P_(2)〉in elastomeric samples under high degree of stretching.In summary,this innovative tensile-WAXD instrument has proven to be a promising and powerful technique for investigating the“stress-deformation-segmental orientation”relationship in elastomers with high extensibilities.展开更多
BACKGROUND Peroral endoscopic myotomy(POEM)has been widely performed as a standard treatment for achalasia;however,its efficacy and safety for treating distal esophageal segmental spasms induced by cancer metastasis r...BACKGROUND Peroral endoscopic myotomy(POEM)has been widely performed as a standard treatment for achalasia;however,its efficacy and safety for treating distal esophageal segmental spasms induced by cancer metastasis remain unknown.CASE SUMMARY A 72-year-old male was referred to our hospital and complained of progressive dysphagia for two years.Endoscopy revealed a 2 cm long segment esophageal stenosis with intact mucosa and normal cardia.Computed tomography showed a right upper lung mass,and pathology of the right pleural effusion confirmed the diagnosis of right upper lung adenocarcinoma with multiple rib and mediastinal lymph node metastases and right malignant pleural effusion.Individualized POEM was performed first to alleviate dysphagia,and the final diagnosis was changed to esophageal muscle metastasis arising from lung adenocarcinoma.After treatment,the patient could eat soft solid food and received multiple rounds of pembrolizumab-combination chemotherapy.The patient’s progression-free survival was approximately 16 months.Long stable disease was obtained during the 24-month follow-up.CONCLUSION The incidence of distal esophageal segmental spasms induced by muscular metastasis arising from lung adenocarcinoma is extremely low.Individualized POEM can effectively improve a patient’s nutritional status before subsequent chemotherapy can be combined with immune checkpoint inhibitors.展开更多
BACKGROUND The Columbia classification identified five histological variants of focal segmental glomerulosclerosis(FSGS).The prognostic significance of these variants remains controversial.AIM To evaluate the relative...BACKGROUND The Columbia classification identified five histological variants of focal segmental glomerulosclerosis(FSGS).The prognostic significance of these variants remains controversial.AIM To evaluate the relative frequency,clinicopathologic characteristics,and medium-term outcomes of FSGS variants at a single center in Pakistan.METHODS This retrospective study was conducted at the Department of Nephrology,Sindh Institute of Urology and Transplantation,Karachi,Pakistan on all consecutive adults(≥16 years)with biopsy-proven primary FSGS from January 1995 to December 2017.Studied subjects were treated with steroids as a first-line therapy.The response rates,doubling of serum creatinine,and kidney failure(KF)with replacement therapy were compared between histological variants using ANOVA or Kruskal Wallis,and Chi-square tests as appropriate.Data were analyzed by SPSS version 22.0.P-value≤0.05 was considered significant.RESULTS A total of 401 patients were diagnosed with primary FSGS during the study period.Among these,352(87.7%)had a designated histological variant.The not otherwise specified(NOS)variant was the commonest,being found in 185(53.9%)patients,followed by the tip variant in 100(29.1%)patients.Collapsing(COL),cellular(CEL),and perihilar(PHI)variants were seen in 58(16.9%),6(1.5%),and 3(0.7%)patients,respectively.CEL and PHI variants were excluded from further analysis due to small patient numbers.The mean follow-up period was 36.5±29.2 months.Regarding response rates of variants,patients with TIP lesions achieved remission more frequently(59.5%)than patients with NOS(41.8%)and COL(24.52%)variants(P<0.001).The hazard ratio of complete response among patients with the COL variant was 0.163[95%confidence interval(CI):0.039-0.67]as compared to patients with NOS.The TIP variant showed a hazard ratio of 2.5(95%CI:1.61-3.89)for complete remission compared to the NOS variant.Overall,progressive KF was observed more frequently in patients with the COL variant,43.4%(P<0.001).Among these,24.53%of patients required kidney replacement therapy(P<0.001).The hazard ratio of doubling of serum creatinine among patients with the COL variant was 14.57(95%CI:1.87-113.49)as compared to patients with the TIP variant.CONCLUSION In conclusion,histological variants of FSGS are predictive of response to treatment with immunosuppressants and progressive KF in adults in our setup.展开更多
We develop assembled reinforcement structures(ARSs)composed of connection parts,connecting rods,and straight bolts to strengthen segmental joints in the lining of shield tunnels.Through full-scale bending experiments ...We develop assembled reinforcement structures(ARSs)composed of connection parts,connecting rods,and straight bolts to strengthen segmental joints in the lining of shield tunnels.Through full-scale bending experiments and numerical simulations,we investigate the deformation and failure characteristics of segmental joints strengthened by ARSs,and propose a novel optimization method for ARSs.The experimental results show that the ARSs can effectively limit the opening of a segmental joint,but also that separation can occur during loading if the connection between the ARSs and segments is not designed properly.Importantly,this connection can be improved by embedding anchor parts in the concrete.In numerical modeling,we investigate the failure modes of segmental joints strengthened by ARSs for both positive bending and negative bending loading cases.In the case of positive bending loading,first the concrete around the anchor parts cracks,and subsequently the concrete on the external side of the joint is crushed.The joint failure is caused by the crushing of concrete on the external side of the joint.While the un-strengthened segmental joint fails with an opening of 5.884 mm,the strengthened segmental joint only opens by 0.288 mm under the same loading,corresponding to a reduction of 95.1%.In the case of negative bending loading,the concrete around the anchor parts first cracks,and then the amount of joint opening exceeds a limiting value for waterproofing(6 mm),i.e.,the joint’s failure is caused by water leakage.While the opening of the un-strengthened segmental joint is 9.033 mm and experiences waterproofing failure,the opening of the strengthened segmental joint is only 2.793 mm under the same loading,corresponding to a reduction of 69.1%.When constructing a new shield tunnel,anchor parts could be embedded in the concrete segments in tandem with ARSs for improved resistance to joint opening.For existing shield tunnel linings,anchor parts cannot be embedded in the concrete segments;therefore,the connections between the ARSs and concrete need to be optimized to strengthen the segmental joint.展开更多
BACKGROUND Focal segmental glomerulosclerosis(FSGS)often recurs after transplantation,leading to graft dysfunction and graft loss.Patients who have lost prior grafts due to recurrence are at particularly high risk of ...BACKGROUND Focal segmental glomerulosclerosis(FSGS)often recurs after transplantation,leading to graft dysfunction and graft loss.Patients who have lost prior grafts due to recurrence are at particularly high risk of re-recurrence in subsequent grafts.Rituximab and plasma exchange have been used pre-emptively to prevent post-transplant recurrence.However,the efficacy of such preventative measures remains unclear.AIM To investigate the outcomes of preventative rituximab and plasma exchange for recurrent FSGS in transplant recipients after prior graft loss.METHODS We conducted a systematic review of 11 studies with 32 patients who had experienced prior graft loss due to post-transplant FSGS recurrence and were treated with either pre-emptive plasma exchange alone,rituximab alone,or a combination of both.RESULTS Overall,47%of the 32 patients experienced recurrence despite prophylactic treatment.Re-recurrence was seen in 25%(1/4)with pre-emptive rituximab alone,and 45%recurrence(9/20)with plasma exchange alone.Re-recurrence was noted in 63%with the use of combined plasma exchange and rituximab.CONCLUSION There is a paucity of available evidence in the literature to draw clear conclusions on the benefits of pre-emptive measures to prevent FSGS re-recurrence.The small sample sizes and variations in protocols call for larger and controlled studies to serve this patient population at high risk of recurrence and graft loss.展开更多
Background: Previous studies suggested that the focal and segmental nature of focal segmental glomerulosclerosis (FSGS) may lead to sample error or diagnosis error that results in minimal change disease (MCD) misdiagn...Background: Previous studies suggested that the focal and segmental nature of focal segmental glomerulosclerosis (FSGS) may lead to sample error or diagnosis error that results in minimal change disease (MCD) misdiagnosis, or FSGS being missed especially in patients with early lesions or limited glomeruli in the biopsy specimens. Patients and methods: Over the past 5 years, patients were included in the study if they had (a) relapse of nephrotic syndrome (NS), (b) biopsy-proven FSGS without immune deposits, (c) long-remission (years) after biopsy-proven Corticosteroid-refractory NS due to MCD, (c) negative history, clinical examination, radiological scans as well as laboratory and serological tests for autoimmune diseases, infections, malignancy and drugs-side effect. Results: After 3 months of therapy with Losartan alone;Proteinuria decreased only by 22% improvement with a mild decrease in Creatinine clearance (ClCr) by 1.5%. However, the addition of Mycophenolate mofetil (MMF) resulted in a further significant decrease in Pr to 72% compared to Losartan alone. Moreover, there were no significant changes in CrCl after 1- and 2 years of follow up. Our data indicates that such a transition may not be due to inadequate sampling but a new lesion. Initial hemodynamic therapy with Losartan was not adequate and immunosuppressive therapy with MMF significantly improved proteinuria and stabilized their kidney function. The data is promising with regard to the management of patients with such relentless disease. In conclusion, a true transition from MCD to FSGS is amenable to therapy with MMF.展开更多
Objective:To analyze the clinical effect of high-dose citrate in segmental extracorporeal anticoagulation for high-throughput hemodialysis.Methods:The subjects included in this study were admitted to the hospital for ...Objective:To analyze the clinical effect of high-dose citrate in segmental extracorporeal anticoagulation for high-throughput hemodialysis.Methods:The subjects included in this study were admitted to the hospital for maintenance hemodialysis treatment from January 2021 to January 2023.All patients had a high risk of bleeding and received 4%trisodium citrate anticoagulant treatment,administered at a rate of 200 mL/h before and after the dialyzer.The anticoagulant effects achieved by the patients were observed and analyzed.Results:The total number of patients who received high-dose segmented citrate extracorporeal anticoagulation dialysis treatment was 50,with each patient undergoing 100 treatments.During the treatment,2 patients had to end the treatment early due to transmembrane pressure exceeding 30 mmHg and an increase in venous pressure exceeding 250 mmHg;the treatment times for these patients were 20 minutes and 200 minutes,respectively.The remaining patients successfully completed the 4-hour treatment.Blood pH and calcium ion concentration in the venous pot were monitored.It was observed that before dialysis,after 2 hours of dialysis,and at the end of dialysis,the blood pH of the patients remained within a relatively normal range.Although some patient levels changed after dialysis,they remained within the normal range.No adverse reactions(such as numbness of the limbs or convulsions)were observed during the anticoagulant treatment.Conclusion:Administering 4%trisodium citrate at a rate of 200 mL/h before and after the dialyzer achieves a good anticoagulant effect,maintains the patient’s blood gas levels within the normal range at the end of dialysis,and causes no adverse reactions.展开更多
AIM: To study the feasibility and safety of middle segmental pancreatectomy (MSP) compared with pancreaticoduodenectomy (PD) and extended distal pancreatectomy (EDP). METHODS: We studied retrospectively 36 cases that ...AIM: To study the feasibility and safety of middle segmental pancreatectomy (MSP) compared with pancreaticoduodenectomy (PD) and extended distal pancreatectomy (EDP). METHODS: We studied retrospectively 36 cases that underwent MSP, 44 patients who underwent PD, and 26 who underwent EDP with benign or low-grade malignant lesions in the mid-portion of the pancreas, between April 2003 and December 2009 in Ruijin Hospital. The perioperative outcomes and long-term outcomes of MSP were compared with those of EDP and PD. Periop-erative outcomes included operative time, intraoperative hemorrhage, transfusion, pancreatic fistula, intraabdominal abscess/infection, postoperative bleeding, reoperation, mortality, and postoperative hospital time. Long-term outcomes, including tumor recurrence, newonset diabetes mellitus (DM), and pancreatic exocrine insufficiency, were evaluated. RESULTS: Intraoperative hemorrhage was 316.1 ± 309.6, 852.2 ± 877.8 and 526.9 ± 414.5 mL for the MSP, PD and EDP groups, respectively (P < 0.05). The mean postoperative daily fasting blood glucose level was significantly lower in the MSP group than in the EDP group (6.3 ± 1.5 mmol/L vs 7.3 ± 1.5 mmol/L, P < 0.05). The rate of pancreatic fistula was higher in the MSP group than in the PD group (42% vs 20.5%, P = 0.039), all of the fistulas after MSP corresponded to grade A (9/15) or B (6/15) and were sealed following conservative treatment. There was no significant difference in the mean postoperative hospital stay between the MSP group and the other two groups. After a mean follow-up of 44 mo, no tumor recurrences were found, only one patient (2.8%) in the MSP group vs five (21.7%) in the EDP group developed new-onset insulin-dependent DM postoperatively (P = 0.029). Moreover, significantly fewer patients in the MSP group than in the PD (0% vs 33.3%, P < 0.001) and EDP (0% vs 21.7%, P = 0.007) required enzyme substitution. CONCLUSION: MSP is a safe and organ-preserving option for benign or low-grade malignant lesions in the neck and proximal body of the pancreas.展开更多
In recent years, precast segmental concrete bridge columns became prevalent because of the benefits of accelerated construction, low environmental impact, high quality and low life cycle costs. The lack of a detailed ...In recent years, precast segmental concrete bridge columns became prevalent because of the benefits of accelerated construction, low environmental impact, high quality and low life cycle costs. The lack of a detailed configuration and appropriate design procedure to ensure a comparable performance with monolithic construction has impeded this structural system from being widely used in areas of high seismicity. In this study, precast segmental bridge column cyclic loading tests were conducted to investigate the performance of unbonded post-tensioned segmental bridge columns. One monolithic and two precast segmental columns were tested. The preeast segmental column exhibited minor damage and small residual displacement after the maximum 7% cyclic drift; energy dissipation （ED） can be enhanced byadding ED bars. The experimental results were modeled by a simplified pushover method （SPOM）, as well as a fiber model （FIBM） finite element method. Forty-five cases of columns with different aspect ratios, axial load ratios and ED bar ratios were analyzed with the SPOM and FIBM, respectively. Using these parametric results, a simplified design method was suggested by regressive analysis. Satisfactory correlation was found between the experimental results and the simplified design method for preeast segmental columns with different design parameters.展开更多
AIM: To evaluate the results of segmental duodenectomy (SD) and pancreaticoduodenectomy (PD) for duodenal gastrointestinal stromal tumor (GIST) and help clinicians with surgical management. METHODS: All patients who u...AIM: To evaluate the results of segmental duodenectomy (SD) and pancreaticoduodenectomy (PD) for duodenal gastrointestinal stromal tumor (GIST) and help clinicians with surgical management. METHODS: All patients who underwent surgery for non-metastatic GIST of the duodenum in a single institution since 2000 were prospectively followed up. Seven patients (median age 51 years, range: 41-73 years) were enrolled: five underwent SD and two underwent PD. RESULTS: All the patients had a complete resection (R0), with no postoperative morbidity and mortality. Among the SD group, GIST was classified as low risk in two patients, intermediate risk in two, and high risk in one, according to the Fletcher scale, (vs two high risk patients in the PD group). With a median followup of 41 (18-85) mo, disease-free survival (DFS) rateswere 100% after SD and 0% after PD (P < 0.05). The median DFS was 13 mo in the PD group. CONCLUSION: Whenever associated with clear surgical margins, SD is a reliable and curative option for most duodenal GISTs, and is compatible with longterm DFS.展开更多
文摘Focal segmental glomerulosclerosis(FSGS)is a histological pattern of glomerular damage that significantly contributes to chronic kidney disease and end-stage renal disease.Its incidence is rising globally,necessitating timely and personalized management strategies.This paper aims to provide an updated overview of the pathophysiology,diagnosis,and therapeutic strategies for FSGS,emphasizing the importance of early interventions and tailored treatments.This editorial synthesizes key findings from recent literature to highlight advancements in understanding and managing FSGS.Emerging evidence supports the role of targeted therapies and personalized approaches in improving outcomes for FSGS patients.Advances include novel biomarkers,genetic testing,and innovative therapeutics such as transient receptor potential ion channel blockers and antisense oligonucleotides for apolipoprotein 1-related FSGS.Effective mana-gement of FSGS requires a combination of timely diagnosis,evidence-based therapeutic strategies,and ongoing research to optimize patient outcomes and address gaps in the current understanding of the disease.
基金supported by the National Natural Science Foundation of China(No.52008308).
文摘When only a portion of the shield lining structures in a full-line tunnel are overloaded,their bearing and failure characteristics are significantly different from those in the full-line overloaded case.In existing studies,one or several segmental lining rings have been studied,with overload applied to selected lining rings to analyze the performance evolution of the lining structures;however,this approach fails to reveal the bearing and failure characteristics of shield lining rings under localized overload.To address this research gap,we employ 3D finite element modeling to investigate the mechanical performance and failure mechanisms of shield segmental linings under localized overload conditions,and compare the results with full-line overload scenarios.Additionally,the impact of reinforcing shield segmental linings with steel rings is studied to address issues arising from localized overloads.The results indicate that localized overloads lead to significant ring joint dislocation and higher stress on longitudinal bolts,potentially causing longitudinal bolt failure.Furthermore,the overall deformation of lining rings,segmental joint opening,and stress in circumferential bolts and steel bars is lower compared to full-line overloads.For the same overload level,the convergence deformation of the lining under full-line overload is 1.5 to 2.0 times higher than that under localized overload.For localized overload situations,a reinforcement scheme with steel rings spanning across two adjacent lining rings is more effective than installing steel rings within individual lining rings.This spanning ring reinforcement strategy not only enhances the structural rigidity of each ring,but also limits joint dislocation and reduces stress on longitudinal bolts,with the reduction in maximum ring joint dislocation ranging from 70%to 82%and the reduction in maximum longitudinal bolt stress ranging from 19%to 57%compared to reinforcement within rings.
基金United States Department of Defense Office of the Congressionally Directed Medical Research Programs(CDMRP),Grant/Award Number:W81XWH-22-1-0176。
文摘Background:Reliable animal models are crucial to drug development for focal segmental glomerulosclerosis(FSGS),a rare kidney disease.Variability in success rates in literature and significant ethical concerns with animal welfare necessitate further optimization of adriamycin(ADR)-induced FSGS model developed on BALB/c mice.Methods:High-performance liquid chromatography(HPLC)was used to assess ADR stability in water and upon light exposure.To identify the optimal ADR level,single intravenous ADR injections with dosing levels from 10 to 17 mg/kg body weight were administered to BALB/c mice to induce FSGS-like pathology.Body weight and proteinuria of FSGS mice were monitored and analyzed for FSGS model-associated morbidity.Animals were euthanized for hematological and kidney histological assessments 8 weeks post induction.To identify the suitable experiment time frame of the ADR-induced FSGS mouse model,a longitudinal study was performed,with an 11-week continuous monitoring of the symptoms.Results:ADR was found to be unstable in aqueous media and light sensitive.A dosing level of 10.5 mg/kg of ADR was optimal for consistent FSGS mouse model induction on BALB/c strain,characterized by minimal mortality and sustained FSGS-like symptoms.Findings from the longitudinal study suggest that 6 weeks post ADR induction may represent the peak of FSGS pathology severity in this mouse model.This time frame may be used for FSGS drug development projects.Conclusion:Based on the outcome from this study,we identified the optimal ADR dosing level and model testing duration.A standard operating procedure(SOP)for the ADR-induced FSGS mouse model was established to facilitate FSGS basic research and drug development.
基金supported by the National Natural Science Foundation of China(Nos.51938005,52090082,and 52378395)the National Key Research and Development Program of China(No.2023YFB2604402).
文摘This study aims to assess the comprehensive strengthening effect of a steel-ultra high performance concrete(UHPC)composite strengthening method.The axial force-moment interaction curve(N-M curve)was calculated in a novel way,using cross-sectional strains at ultimate states as well as real-time stress measurements for each material.The enclosed area of the N-M curve was defined as a comprehensive performance index for the system.We validate our approach with comparisons to numerical modeling and full-scale four-point bending experiments.Additionally,strengthening effects were compared for different sagging and hogging moments based on material stress responses,and the impact of various strengthening parameters was analyzed.We find that the N-M curve of the strengthened cross-section envelops that of the un-strengthened cross-section.Notably,improvements in flexural capacity are greater under sagging moments during the large eccentric failure stage,and greater under hogging moments during the small eccentric failure stage.This discrepancy is attributed to the strength utilization of strengthening materials.These findings provide a reference for understanding the strengthening effects and parameters of steel-UHPC composite.
文摘Segmental atrophy(SA)of the liver is a rare,often underrecognized,benign condition that presents as a mass lesion,mimicking a neoplasm,which poses a significant diagnostic challenge.Given its rarity,only a limited number of case reports and series have been published,resulting in sparse literature on the entity.This review aims to summarize the clinicopathologic and diagnostic features of SA and thus improve its recognition.
基金the National Natural Science Foundation of China(Nos.32260235 and 82260446)。
文摘Cage plus plate(CP)and zero-profile(Zero-P)devices are widely used in anterior cervical discectomy and fusion(ACDF).This study aimed to compare adjacent segment biomechanical changes after ACDF when using Zero-P device and CP in different segments.First,complete C1—C7 cervical segments were constructed and validated.Meanwhile,four surgery models were developed by implanting the Zero-P device or CP into C4—C5 or C5—C6 segments based on the intact model.The segmental range of motion(ROM)and maximum value of the intradiscal pressure of the surgery models were compared with those of the intact model.The implantation of CP and Zero-P devices in C4—C5 segments decreased ROM by about 91.6%and 84.3%,respectively,and increased adjacent segment ROM by about 8.3%and 6.82%,respectively.The implantation of CP and Zero-P devices in C5—C6 segments decreased ROM by about 93.3%and 89.9%,respectively,while increasing adjacent segment ROM by about 4.9%and 4%,respectively.Furthermore,the implantation of CP and Zero-P devices increased the intradiscal pressure in the adjacent segments of C4—C5 segments by about 4.5%and 6.7%,respectively.The implantation of CP and Zero-P devices significantly increased the intradiscal pressure in the adjacent segments of C5—C6 by about 54.1%and 15.4%,respectively.In conclusion,CP and Zero-P fusion systems can significantly reduce the ROM of the fusion implant segment in ACDF while increasing the ROM and intradiscal pressure of adjacent segments.Results showed that Zero-P fusion system is the best choice for C5—C6 segmental ACDF.However,further studies are needed to select the most suitable cervical fusion system for C4—C5 segmental ACDF.Therefore,this study provides biomechanical recommendations for clinical surgery.
基金supported by the National Key Research and Development Program of China(No.2022YFC3800905)the National Natural Science Foundation of China(Nos.52238010,52090082,and 52108381)+2 种基金the Shanghai Science and Technology Committee Program(Nos.22XD1430200,23DZ1202806,and 21DZ1200601)the Young Elite Scientists Sponsorship Program by the China Association for Science and Technology(No.2023QNRC001)the Fundamental Research Funds for the Central Universities,China.
文摘When subjected to external loads from the ground and nearby construction,tunnel segmental lining joints are prone to damaging deformation.This can result in water leakage into tunnels,posing great safety risks.With this issue in mind,we conducted a series of full-scale tests to study the effects of external loads on the waterproofing performance of longitudinal joints.A customized rig for testing segmental joints was developed to assess the effect of loading magnitude,eccentricity,and loading-unloading-reloading cycles on waterproofing performance.Additionally,the relationship between joint force,sealing gasket deformation,and waterproofing pressure was investigated.The results indicate that:(1)the sealing gasket’s compression rapidly decreases as external loads increase,which weakens the waterproofing capacity of the joint;(2)the watertightness limit dramatically decreases as the bending moment increases;(3)a loading-unloading-reloading cycle leads to degradation of the joint’s waterproofing performance.The findings of this study provide a reference for subsequent waterproofing design of segmental tunnel joints,helping ensure the safety of tunnels throughout their operational lifespans.
基金supported in part by the Key Research Projects of Higher Education Institutions in Henan Province(Grant No.24A560021)in part by the Henan Postdoctoral Foundation(Grant No.202102015).
文摘Segmentally assembled bridges are increasinglyfinding engineering applications in recent years due to their unique advantages,especially as urban viaducts.Vehicle loads are one of the most important variable loads acting on bridge structures.Accordingly,the influence of overloaded vehicles on existing assembled bridge structures is an urgent concern at present.This paper establishes thefinite element model of the segmentally assembled bridge based on ABAQUS software and analyzes the influence of vehicle overload on an assembled girder bridge struc-ture.First,afinite element model corresponding to the target bridge is established based on ABAQUS software,and the load is controlled to simulate vehicle movement in each area of the traveling zone at different times.Sec-ond,the key cross-sections of segmental girder bridges are monitored in real time based on the force character-istics of continuous girder bridges,and they are compared with the simulation results.Finally,a material damage ontology model is introduced,and the structural damage caused by different overloading rates is compared and analyzed.Results show that thefinite element modeling method is accurate by comparing with on-site measured data,and it is suitable for the numerical simulation of segmental girder bridges;Dynamic sensors installed at 1/4L,1/2L,and 3/4L of the segmental girder main beams could be used to identify the dynamic response of segmental girder bridges;The bottom plate of the segmental girder bridge is mostly damaged at the position where the length of the precast beam section changes and the midspan position.With the increase in load,damage in the direction of the bridge develops faster than that in the direction of the transverse bridge.Thefindings of this study can guide maintenance departments in the management and maintenance of bridges and vehicles.
文摘BACKGROUND Kidney function loss or renal insufficiency indicated by elevated creatinine levels and/or an estimated glomerular filtration rate(eGFR)<60 mL/minute/1.73 m²at presentation in patients with primary focal segmental glomerulosclerosis(FSGS)is commonly seen as a poor prognostic marker for kidney survival.However,a pre>vious study from our center suggested this may be due to hemodynamic factors.AIM To observe the clinical and biochemical parameters,treatment response,kidney survival,and overall outcomes of adult patients with primary FSGS presenting with kidney function insufficiency.METHODS This retrospective observational study was conducted at the Department of Nephrology,Sindh Institute of Urology and Transplantation,Karachi,Pakistan,from January 1995 to December 2017.During this period,401 biopsy-proven primary FSGS patients were identified,of which 98(24.4%)presented with kidney function loss or renal insufficiency defined as eGFR<60 mL/minute/1.73 m²at presentation and were studied in detail.RESULTS Among the 98 patients with renal function loss on presentation,the mean age was 30.9 years±13.6 years with a male-to-female ratio of 2.5:1.The mean serum creatinine level was 2.2 mg/dL±1.3 mg/dL and mean eGFR 37.1 mL/minute/1.73 m2±12.8 mL/minute/1.73 m2.The mean 24-hour urinary protein excretion was 5.9 g/day±4.0 g/day,and the mean serum albumin was 2.1 g/dL±1.0 g/dL(median:1.5 g/dL).The mean systolic blood pressure(BP)was 132.7 mmHg±19.8 mmHg,and the mean diastolic BP was 87.4 mmHg±12.7 mmHg.Steroid treatment was given to 81(82.6%)of 98 patients for an average duration of 19.9 weeks±14.4 weeks,with a mean total steroid dose of 4.4 g±1.5 g.Treatment response showed that 20(24.6%)patients achieved complete remission,9(11.1%)achieved partial remission,and 52(64.1%)did not respond.The baseline eGFR was significantly lower in the non-responsive group(P=0.006).The distribution of FSGS variants was also significantly different among steroid-responsive and non-responsive groups(P=0.012).CONCLUSION Renal function loss in FSGS patients at presentation does not necessarily indicate irreversible kidney function loss and a significant number of patients respond to appropriate treatment of the underlying disease.
基金financial support of China CSC Scholarship(No.201604910522).
文摘An improved X-ray apparatus that combines tensile testing and X-ray diffraction has been designed and constructed to conduct timeresolved experiments during uniaxial stretching.By utilizing mortise-like clamping jaws and dogbone-shaped specimens,this setup allows for the simultaneous recording of high-quality mechanical responses and 2D diffraction patterns due to the minimization of experimental errors from sample slippage or premature fracture.Furthermore,the local extension ratio can be accurately determined based on thickness variation,and the Hermans'orientation function was demonstrated to be a reliable method with high accuracy to calculate the segmental orientation parameter〈P_(2)〉in elastomeric samples under high degree of stretching.In summary,this innovative tensile-WAXD instrument has proven to be a promising and powerful technique for investigating the“stress-deformation-segmental orientation”relationship in elastomers with high extensibilities.
基金Supported by The Young and Middle-aged Mainstay Talent Training Program of Fujian Provincial Health System,China,No.2017-ZQN-16The Science and Technology Project of Fujian Province,China,No.2020Y0068The Joint Funds for the Innovation of Science and Technology of Fujian Province,China,No.2023Y9414.
文摘BACKGROUND Peroral endoscopic myotomy(POEM)has been widely performed as a standard treatment for achalasia;however,its efficacy and safety for treating distal esophageal segmental spasms induced by cancer metastasis remain unknown.CASE SUMMARY A 72-year-old male was referred to our hospital and complained of progressive dysphagia for two years.Endoscopy revealed a 2 cm long segment esophageal stenosis with intact mucosa and normal cardia.Computed tomography showed a right upper lung mass,and pathology of the right pleural effusion confirmed the diagnosis of right upper lung adenocarcinoma with multiple rib and mediastinal lymph node metastases and right malignant pleural effusion.Individualized POEM was performed first to alleviate dysphagia,and the final diagnosis was changed to esophageal muscle metastasis arising from lung adenocarcinoma.After treatment,the patient could eat soft solid food and received multiple rounds of pembrolizumab-combination chemotherapy.The patient’s progression-free survival was approximately 16 months.Long stable disease was obtained during the 24-month follow-up.CONCLUSION The incidence of distal esophageal segmental spasms induced by muscular metastasis arising from lung adenocarcinoma is extremely low.Individualized POEM can effectively improve a patient’s nutritional status before subsequent chemotherapy can be combined with immune checkpoint inhibitors.
文摘BACKGROUND The Columbia classification identified five histological variants of focal segmental glomerulosclerosis(FSGS).The prognostic significance of these variants remains controversial.AIM To evaluate the relative frequency,clinicopathologic characteristics,and medium-term outcomes of FSGS variants at a single center in Pakistan.METHODS This retrospective study was conducted at the Department of Nephrology,Sindh Institute of Urology and Transplantation,Karachi,Pakistan on all consecutive adults(≥16 years)with biopsy-proven primary FSGS from January 1995 to December 2017.Studied subjects were treated with steroids as a first-line therapy.The response rates,doubling of serum creatinine,and kidney failure(KF)with replacement therapy were compared between histological variants using ANOVA or Kruskal Wallis,and Chi-square tests as appropriate.Data were analyzed by SPSS version 22.0.P-value≤0.05 was considered significant.RESULTS A total of 401 patients were diagnosed with primary FSGS during the study period.Among these,352(87.7%)had a designated histological variant.The not otherwise specified(NOS)variant was the commonest,being found in 185(53.9%)patients,followed by the tip variant in 100(29.1%)patients.Collapsing(COL),cellular(CEL),and perihilar(PHI)variants were seen in 58(16.9%),6(1.5%),and 3(0.7%)patients,respectively.CEL and PHI variants were excluded from further analysis due to small patient numbers.The mean follow-up period was 36.5±29.2 months.Regarding response rates of variants,patients with TIP lesions achieved remission more frequently(59.5%)than patients with NOS(41.8%)and COL(24.52%)variants(P<0.001).The hazard ratio of complete response among patients with the COL variant was 0.163[95%confidence interval(CI):0.039-0.67]as compared to patients with NOS.The TIP variant showed a hazard ratio of 2.5(95%CI:1.61-3.89)for complete remission compared to the NOS variant.Overall,progressive KF was observed more frequently in patients with the COL variant,43.4%(P<0.001).Among these,24.53%of patients required kidney replacement therapy(P<0.001).The hazard ratio of doubling of serum creatinine among patients with the COL variant was 14.57(95%CI:1.87-113.49)as compared to patients with the TIP variant.CONCLUSION In conclusion,histological variants of FSGS are predictive of response to treatment with immunosuppressants and progressive KF in adults in our setup.
基金supported by the National Natural Science Foundation of China(No.52008308)the China Postdoctoral Science Foundation(Nos.BX20200247 and 2021M692447)the Research Project from Jinan Rail Transit Group Co.,Ltd.and China Railway No.5 Engineering Group Co.,Ltd.(No.R2-ZF-2019-039).
文摘We develop assembled reinforcement structures(ARSs)composed of connection parts,connecting rods,and straight bolts to strengthen segmental joints in the lining of shield tunnels.Through full-scale bending experiments and numerical simulations,we investigate the deformation and failure characteristics of segmental joints strengthened by ARSs,and propose a novel optimization method for ARSs.The experimental results show that the ARSs can effectively limit the opening of a segmental joint,but also that separation can occur during loading if the connection between the ARSs and segments is not designed properly.Importantly,this connection can be improved by embedding anchor parts in the concrete.In numerical modeling,we investigate the failure modes of segmental joints strengthened by ARSs for both positive bending and negative bending loading cases.In the case of positive bending loading,first the concrete around the anchor parts cracks,and subsequently the concrete on the external side of the joint is crushed.The joint failure is caused by the crushing of concrete on the external side of the joint.While the un-strengthened segmental joint fails with an opening of 5.884 mm,the strengthened segmental joint only opens by 0.288 mm under the same loading,corresponding to a reduction of 95.1%.In the case of negative bending loading,the concrete around the anchor parts first cracks,and then the amount of joint opening exceeds a limiting value for waterproofing(6 mm),i.e.,the joint’s failure is caused by water leakage.While the opening of the un-strengthened segmental joint is 9.033 mm and experiences waterproofing failure,the opening of the strengthened segmental joint is only 2.793 mm under the same loading,corresponding to a reduction of 69.1%.When constructing a new shield tunnel,anchor parts could be embedded in the concrete segments in tandem with ARSs for improved resistance to joint opening.For existing shield tunnel linings,anchor parts cannot be embedded in the concrete segments;therefore,the connections between the ARSs and concrete need to be optimized to strengthen the segmental joint.
文摘BACKGROUND Focal segmental glomerulosclerosis(FSGS)often recurs after transplantation,leading to graft dysfunction and graft loss.Patients who have lost prior grafts due to recurrence are at particularly high risk of re-recurrence in subsequent grafts.Rituximab and plasma exchange have been used pre-emptively to prevent post-transplant recurrence.However,the efficacy of such preventative measures remains unclear.AIM To investigate the outcomes of preventative rituximab and plasma exchange for recurrent FSGS in transplant recipients after prior graft loss.METHODS We conducted a systematic review of 11 studies with 32 patients who had experienced prior graft loss due to post-transplant FSGS recurrence and were treated with either pre-emptive plasma exchange alone,rituximab alone,or a combination of both.RESULTS Overall,47%of the 32 patients experienced recurrence despite prophylactic treatment.Re-recurrence was seen in 25%(1/4)with pre-emptive rituximab alone,and 45%recurrence(9/20)with plasma exchange alone.Re-recurrence was noted in 63%with the use of combined plasma exchange and rituximab.CONCLUSION There is a paucity of available evidence in the literature to draw clear conclusions on the benefits of pre-emptive measures to prevent FSGS re-recurrence.The small sample sizes and variations in protocols call for larger and controlled studies to serve this patient population at high risk of recurrence and graft loss.
文摘Background: Previous studies suggested that the focal and segmental nature of focal segmental glomerulosclerosis (FSGS) may lead to sample error or diagnosis error that results in minimal change disease (MCD) misdiagnosis, or FSGS being missed especially in patients with early lesions or limited glomeruli in the biopsy specimens. Patients and methods: Over the past 5 years, patients were included in the study if they had (a) relapse of nephrotic syndrome (NS), (b) biopsy-proven FSGS without immune deposits, (c) long-remission (years) after biopsy-proven Corticosteroid-refractory NS due to MCD, (c) negative history, clinical examination, radiological scans as well as laboratory and serological tests for autoimmune diseases, infections, malignancy and drugs-side effect. Results: After 3 months of therapy with Losartan alone;Proteinuria decreased only by 22% improvement with a mild decrease in Creatinine clearance (ClCr) by 1.5%. However, the addition of Mycophenolate mofetil (MMF) resulted in a further significant decrease in Pr to 72% compared to Losartan alone. Moreover, there were no significant changes in CrCl after 1- and 2 years of follow up. Our data indicates that such a transition may not be due to inadequate sampling but a new lesion. Initial hemodynamic therapy with Losartan was not adequate and immunosuppressive therapy with MMF significantly improved proteinuria and stabilized their kidney function. The data is promising with regard to the management of patients with such relentless disease. In conclusion, a true transition from MCD to FSGS is amenable to therapy with MMF.
文摘Objective:To analyze the clinical effect of high-dose citrate in segmental extracorporeal anticoagulation for high-throughput hemodialysis.Methods:The subjects included in this study were admitted to the hospital for maintenance hemodialysis treatment from January 2021 to January 2023.All patients had a high risk of bleeding and received 4%trisodium citrate anticoagulant treatment,administered at a rate of 200 mL/h before and after the dialyzer.The anticoagulant effects achieved by the patients were observed and analyzed.Results:The total number of patients who received high-dose segmented citrate extracorporeal anticoagulation dialysis treatment was 50,with each patient undergoing 100 treatments.During the treatment,2 patients had to end the treatment early due to transmembrane pressure exceeding 30 mmHg and an increase in venous pressure exceeding 250 mmHg;the treatment times for these patients were 20 minutes and 200 minutes,respectively.The remaining patients successfully completed the 4-hour treatment.Blood pH and calcium ion concentration in the venous pot were monitored.It was observed that before dialysis,after 2 hours of dialysis,and at the end of dialysis,the blood pH of the patients remained within a relatively normal range.Although some patient levels changed after dialysis,they remained within the normal range.No adverse reactions(such as numbness of the limbs or convulsions)were observed during the anticoagulant treatment.Conclusion:Administering 4%trisodium citrate at a rate of 200 mL/h before and after the dialyzer achieves a good anticoagulant effect,maintains the patient’s blood gas levels within the normal range at the end of dialysis,and causes no adverse reactions.
基金Supported by The Ministry of Health Sector Funds of China,No. 201002020
文摘AIM: To study the feasibility and safety of middle segmental pancreatectomy (MSP) compared with pancreaticoduodenectomy (PD) and extended distal pancreatectomy (EDP). METHODS: We studied retrospectively 36 cases that underwent MSP, 44 patients who underwent PD, and 26 who underwent EDP with benign or low-grade malignant lesions in the mid-portion of the pancreas, between April 2003 and December 2009 in Ruijin Hospital. The perioperative outcomes and long-term outcomes of MSP were compared with those of EDP and PD. Periop-erative outcomes included operative time, intraoperative hemorrhage, transfusion, pancreatic fistula, intraabdominal abscess/infection, postoperative bleeding, reoperation, mortality, and postoperative hospital time. Long-term outcomes, including tumor recurrence, newonset diabetes mellitus (DM), and pancreatic exocrine insufficiency, were evaluated. RESULTS: Intraoperative hemorrhage was 316.1 ± 309.6, 852.2 ± 877.8 and 526.9 ± 414.5 mL for the MSP, PD and EDP groups, respectively (P < 0.05). The mean postoperative daily fasting blood glucose level was significantly lower in the MSP group than in the EDP group (6.3 ± 1.5 mmol/L vs 7.3 ± 1.5 mmol/L, P < 0.05). The rate of pancreatic fistula was higher in the MSP group than in the PD group (42% vs 20.5%, P = 0.039), all of the fistulas after MSP corresponded to grade A (9/15) or B (6/15) and were sealed following conservative treatment. There was no significant difference in the mean postoperative hospital stay between the MSP group and the other two groups. After a mean follow-up of 44 mo, no tumor recurrences were found, only one patient (2.8%) in the MSP group vs five (21.7%) in the EDP group developed new-onset insulin-dependent DM postoperatively (P = 0.029). Moreover, significantly fewer patients in the MSP group than in the PD (0% vs 33.3%, P < 0.001) and EDP (0% vs 21.7%, P = 0.007) required enzyme substitution. CONCLUSION: MSP is a safe and organ-preserving option for benign or low-grade malignant lesions in the neck and proximal body of the pancreas.
基金National Natural Science Foundation of China under Grants Nos.51208268 and 51178429K.C.Wong Magna Fund in Ningbo University+1 种基金Transportation Science and Technology Project of Ningbo City under Grant No.201507Natural Science Foundation of Ningbo City under Grant No.2015A610293
文摘In recent years, precast segmental concrete bridge columns became prevalent because of the benefits of accelerated construction, low environmental impact, high quality and low life cycle costs. The lack of a detailed configuration and appropriate design procedure to ensure a comparable performance with monolithic construction has impeded this structural system from being widely used in areas of high seismicity. In this study, precast segmental bridge column cyclic loading tests were conducted to investigate the performance of unbonded post-tensioned segmental bridge columns. One monolithic and two precast segmental columns were tested. The preeast segmental column exhibited minor damage and small residual displacement after the maximum 7% cyclic drift; energy dissipation （ED） can be enhanced byadding ED bars. The experimental results were modeled by a simplified pushover method （SPOM）, as well as a fiber model （FIBM） finite element method. Forty-five cases of columns with different aspect ratios, axial load ratios and ED bar ratios were analyzed with the SPOM and FIBM, respectively. Using these parametric results, a simplified design method was suggested by regressive analysis. Satisfactory correlation was found between the experimental results and the simplified design method for preeast segmental columns with different design parameters.
文摘AIM: To evaluate the results of segmental duodenectomy (SD) and pancreaticoduodenectomy (PD) for duodenal gastrointestinal stromal tumor (GIST) and help clinicians with surgical management. METHODS: All patients who underwent surgery for non-metastatic GIST of the duodenum in a single institution since 2000 were prospectively followed up. Seven patients (median age 51 years, range: 41-73 years) were enrolled: five underwent SD and two underwent PD. RESULTS: All the patients had a complete resection (R0), with no postoperative morbidity and mortality. Among the SD group, GIST was classified as low risk in two patients, intermediate risk in two, and high risk in one, according to the Fletcher scale, (vs two high risk patients in the PD group). With a median followup of 41 (18-85) mo, disease-free survival (DFS) rateswere 100% after SD and 0% after PD (P < 0.05). The median DFS was 13 mo in the PD group. CONCLUSION: Whenever associated with clear surgical margins, SD is a reliable and curative option for most duodenal GISTs, and is compatible with longterm DFS.
