Background:The COVID-19 pandemic disrupted healthcare systems globally,raising concerns about delayed cancer diagnosis and treatment.In France,transurethral resection of bladder tumors(TURBT)was prioritized in nationa...Background:The COVID-19 pandemic disrupted healthcare systems globally,raising concerns about delayed cancer diagnosis and treatment.In France,transurethral resection of bladder tumors(TURBT)was prioritized in national urology guidelines to ensure the timely management of urothelial carcinoma.This study aimed to assess the impact of care reorganization on tumor staging,recurrence,palliative care,and mortality in bladder cancer patients from the pre-pandemic through late-pandemic periods.Methods:We conducted a retrospective multicenter study including all patients who underwent TURBT with histologically confirmed urothelial carcinoma between April and December of 2019(pre-pandemic),2020(early pandemic),2021(mid-pandemic),and 2022(late pandemic)in two French institutions.TURBT indications were categorized as diagnostic,palliative,or staging.Clinical and pathological data were compared across the four periods.Statistical analyses included Chi-square tests,Estimated Annual Percentage Change(EAPC),and multivariable logistic regression adjusted for age,sex,ASA score,and center.Results:A total of 790 TURBT procedures were analyzed.The proportion of muscle-invasive bladder cancer(pT≥2)declined over time(18.7%in 2019 to 13.2%in 2022;p=0.63),while superficial tumors(pTa)increased(57.2%to 65.5%).All-cause mortality significantly decreased from 38.0%in 2019 to 22.0%in 2020,20.5%in 2021,and 19.5%in 2022(p=0.006).EAPC showed a significant annual decline in mortality(–24.3%,p=0.004).In multivariable analysis,2020,2021,and 2022 were each associated with significantly lower odds of mortality compared to 2019.Recurrence rates remained stable across all periods(p=0.93).Interhospital variation persisted in mortality and recurrence.Conclusions:Despite the pandemic,urothelial bladder cancer outcomes did not worsen through 2022.On the contrary,timely reorganization,prioritization of TURBT,and triage strategies were associated with reduced mortality and palliative care needs,highlighting the resilience of cancer care when guided by adaptive health policies.展开更多
BACKGROUND Probiotics have shown promise in alleviating symptoms of diarrhea-predominant irritable bowel syndrome(IBS-D);however,the certainty of evidence is low.Wellpowered randomized controlled dose-ranging trials a...BACKGROUND Probiotics have shown promise in alleviating symptoms of diarrhea-predominant irritable bowel syndrome(IBS-D);however,the certainty of evidence is low.Wellpowered randomized controlled dose-ranging trials are warranted on promising single-strain candidates.AIM To investigate the clinical efficacy of Lactiplantibacillus plantarum(L.plantarum)Lpla33(DSM34428)in adults with IBS-D.METHODS This is a randomized,double-blind,placebo-controlled,multi-center,and doseranging study.Three hundred and seven adults,18-70 years of age,with IBS-D,according to Rome IV criteria,were allocated(1:1:1)to receive placebo or L.plantarum Lpla33 at 1×10^(9)(1B)or 1×10^(10)(10B)colony-forming units/d over an 8-wk intervention period.The primary outcome was the change in IBS severity scoring system(IBS-SSS)total score after 8 wk,while secondary and exploratory outcomes included abdominal pain severity,IBS related quality of life,stool and microbial profile,and perceived stress.RESULTS IBS-SSS was significantly reduced,after 8 wk,in participants receiving L.plantarum 1B(-128.45±83.30;P<0.001)and L.plantarum 10B(-156.77±99.06;P<0.001),compared to placebo(-58.82±74.75).Further,a dose-ranging effect was observed,with a greater absolute reduction in the L.plantarum 10B group(P<0.05).A reduction in sub-scores related to abdominal pain,abdominal distension,bowel habits,and quality of life was observed in both L.plantarum groups compared to placebo(P<0.001).Further,62.5%and 88.4%of participants administered L.plantarum 1B and 10B,respectively,were classified as stool consistency responders based on a reduction in diarrheal stool form,as compared to 26.3%in the placebo group(P<0.001).In contrast,no significant shifts were observed in microbial diversity.CONCLUSION L.plantarum Lpla33(DSM34428)is well tolerated and improves IBS symptom severity with a dose-ranging effect and a corresponding normalization of bowel habits in adults with IBS-D.展开更多
Background: There is growing evidence to support the beneficial effects of supplementing direct-fed microbials(DFM) on performance, health status, and immune responses of weaned pigs. Therefore, the objective of this ...Background: There is growing evidence to support the beneficial effects of supplementing direct-fed microbials(DFM) on performance, health status, and immune responses of weaned pigs. Therefore, the objective of this study was to investigate dietary supplementation of Bacillus subtilis(DSM 25841) on growth performance, diarrhea, gut permeability and immunity of weaned pigs experimentally infected with a pathogenic F-18 Escherichia coli(E. coli).Results: The F18 E. coli infection reduced(P < 0.05) growth performance and intestinal villi height, whereas increased(P < 0.05) diarrhea and transcellular and paracellular permeability in the jejunum compared with non-challenged control. Supplementation of Bacillus subtilis linearly enhanced average daily gain of E. coli infected pigs from d 0 to 5 post-inoculation(PI)(P < 0.05) and d 0 to 11 PI(P = 0.058). Supplementation of high dose of Bacillus subtilis reduced(P < 0.05) both transcellular and paracellular permeability on d 5 and d11 PI compared with the E. coli infected pigs fed with control diet. E. coli infection up-regulated(P < 0.05)the m RNA expression of SLC5 A10(soluble carrier family 5 member 10) and MUC2(mucin 2) on d 5 PI, but down-regulated(P < 0.05) expression of SLC5 A10, MUC2, and CLDN1 on d 11 PI in jejunal mucosa when pigs were fed with the control diet. Supplementation of Bacillus subtilis linearly up-regulated(P < 0.05) the m RNA expression of CFTR and ZO1 on d 5 PI and SLC5 A10 and MUC2 on d 11 PI in jejunal mucosa of E. coli infected pigs. In addition, E. coli infection increased(P < 0.05) the m RNA expression of several immune genes(IL1 A, IL1 B, and IL7 on d 5 PI, and IL1 B, IL6, IL7, and TNF on d 11 PI) in the ileal mucosa of weaned pigs. Inclusion of Bacillus subtilis to control diet linearly down-regulated gene expression of IL1 A on d 5 PI(P = 0.07) and IL6 on d 11 PI(P < 0.05) in ileal mucosa of E. coli infected pigs.Conclusions: Supplementation of Bacillus subtilis(DSM 25841) enhanced growth rate and improved gut barrier function of weaned pigs experimentally infected with a pathogenic E. coli.展开更多
Hepatitis B （HBV） reactivation induced by chemotherapy is problem encountered recently in the management of malignant diseases. Chemotherapy-induced HBV reacti- vation may ultimately lead to terminal acute liver fai...Hepatitis B （HBV） reactivation induced by chemotherapy is problem encountered recently in the management of malignant diseases. Chemotherapy-induced HBV reacti- vation may ultimately lead to terminal acute liver failure. Liver transplantation （LT） currently remains the only definitive treatment option for such cases, but is generally denied to patients suffering from malignancy. Here, the authors describe 2 cases of cancer-free and HBV graft renfection-free survival after LT performed for terminal liver failure arising from HBV reactivation induced by chemotherapy for advanced stage lymphoma. These 2 cases, and some other reports in the literature, may suggest that patients suffering from hematologic malignan- cies and terminal liver disease can be considered for LT if the prognosis of their hematologic malignancy is good.展开更多
Rainfall measurements are vital for the design of hydraulic structures, climate change studies, irrigation and land drainage works. The most important source of design rainfall data comes from convective storms. Accur...Rainfall measurements are vital for the design of hydraulic structures, climate change studies, irrigation and land drainage works. The most important source of design rainfall data comes from convective storms. Accurate assessment of the storm rainfall requires a fairly dense network of raingauges. In 1963, such a storm took place over Dublin in Ireland. However, the existing raingauge network was insufficient to identify both the depth and pattern of rainfall. An appeal was made by Met Eireann for additional unofficial rainfall data. The result was remarkable in that the estimated maximum rainfall depth was found to be more than double the official value and that the resulting depth area analysis suggested a rainfall volume over a large area much bigger than the original isohyet map indicated. This result has huge implications for the estimation of maximum rainfall and dam safety assessment, especially in countries where the raingauge network has a low density. This paper first provides a description of the synoptic conditions that led to the storm, second an analysis of the rainfall data and how the unofficial measurements produced a very different depth area relationship;third, the social consequences of the resulting flood are described. Fourth, the storm is then placed in the context of other storms in the British Isles Finally the implications for rainfall measurement, gauge density and an example of how revised estimates of probable maximum precipitation (PMP) have been used to improve the safety and design standard of a flood detention dam are discussed.展开更多
Thanks to tremendous advances in sequencing technologies and in particular to whole exome sequencing(WES),many genes have now been linked to severe sperm defects.A precise genetic diagnosis is obtained for a minority ...Thanks to tremendous advances in sequencing technologies and in particular to whole exome sequencing(WES),many genes have now been linked to severe sperm defects.A precise genetic diagnosis is obtained for a minority of patients and only for the most severe defects like azoospermia or macrozoospermia which is very often due to defects in the aurora kinase C(AURKC)gene.Here,we studied a subject with a severe oligozoospermia and a phenotypic diagnosis of macrozoospermia.AURKC analysis did not reveal any deleterious variant.WES was then initiated which permitted to identify a homozygous loss of function variant in the zinc finger MYND-type containing 15(ZMYND15)gene.ZMYND15 has been described to serve as a switch for haploid gene expression,and mice devoid of ZMYND15 were shown to be sterile due to nonobstructive azoospermia(NOA).In man,ZMYND15 has been associated with NOA and severe oligozoospermia.We confirm here that the presence of a bi-allelic ZMYND15 variant induces a severe oligozoospermia.In addition,we show that severe oligozoospermia can be associated macrozoospermia,and that a phenotypic misdiagnosis is possible,potentially delaying the genetic diagnosis.In conclusion,genetic defects in ZMYND15 can induce complete NOA or severe oligozoospermia associated with a very severe teratozoospermia.In our experience,severe oligozoospermia is often associated with severe teratozoospermia and can sometimes be misinterpreted as macrozoospermia or globozoospermia.In these instances,specific AURKC or dpy-19 like 2(DPY19L2)diagnosis is usually negative and we recommend the direct use of a pan-genomic techniques such as WES.展开更多
Objective:To assess the seasonality of the bacterial meningitis and the antibiotic resistance of incriminated bacteria over the last three years in the northern Togo.Methods:From January 2007 to January 2010,533 cereb...Objective:To assess the seasonality of the bacterial meningitis and the antibiotic resistance of incriminated bacteria over the last three years in the northern Togo.Methods:From January 2007 to January 2010,533 cerebrospinal fluids(CSF) samples were collected from patients suspected of meningitis in the Regional Hospital of Dapaong(northern Togo).After microscopic examination,samples were cultured for bacterial identification and antibiotic susceptibility. Results:The study included 533 patients(306 male and 227 female) aged from 1 day to 55 years [average age(13.00±2.07) years].Bacterial isolation and identification were attempted for 254/533 (47.65%) samples.The bacteria]species identified were:Neisseria meningitidis A(N.meningitidis A)(58.27%),Neisseria meningitidis W135(N,meningitidis W135)(7.09%),Streptococcus pneumoniae(S.pneumoniae)(26.77%),Haemophilus influenza B(H.influenza B)(6.30%) and Enterobacteriaceae(1.57%).The results indicated that bacterial meningitis occur from November to May with a peak in February for H.influenzae and S.pneumoniae and March for Neisseriaceae. The distribution of positive CSF with regards to the age showed that subjects between 6 and 12 years followed by subjects of 0 to 5 years were most affected with respective frequencies of 67.82%and 56.52%(P【0.001).Susceptibility tests revealed that bacteria have developed resistance to several antibiotics including aminosides(resistance rate】20%for both bacterial strains),macrolides(resistance rate】30%for H.influenzae) quinolones(resistance rate】15% for H.influenzae and N.meningitidis W135).Over three years,the prevalence of S.pneumoniae significantly increased from 8.48%to 73.33%(P【0.001),while the changes in the prevalence of H.influenzae B were not statistically significant:4.24%,vs.8.89%,(P= 0.233).Conclusions: Our results indicate that data in African countries differ depending on geographical location in relation to the African meningitis belt.This underlines the importance of epidemiological surveillance of bacterial meningitis.展开更多
Background:Probiosis is considered a potential strategy to reduce antibiotics use and prevent postweaning diarrhea(PWD).This study investigated the effect of Bacillus amyloliquefaciens DSM25840 or Bacillus subtilis DS...Background:Probiosis is considered a potential strategy to reduce antibiotics use and prevent postweaning diarrhea(PWD).This study investigated the effect of Bacillus amyloliquefaciens DSM25840 or Bacillus subtilis DSM25841 supplementation on growth,health,immunity,intestinal functionality and microbial profile of post-weaning pigs after enterotoxigenic E.coli(ETEC)F4 challenge.Methods:Sixty-four post-weaning piglets(7748 g±643 g)were randomly al ocated to four groups:control basal diet(CO);CO+1.28×10~6 CFU/g of B.amyloliquefaciens(BAA);CO+1.28×10~6 CFU/g feed of B.subtilis(BAS);CO+1 g colistin/kg of feed(AB).At day(d)7,animals were chal enged with 10~5 CFU/m L of ETEC F4 ac O149 and then fol owed for fecal score and performance until d 21.Blood was col ected at d 6,d 12 and d 21 for immunoglobulins,at d 8 for acute phase proteins,at d 8 and d 21 for metabolomics analysis.Jejunum was sampled for morphometry,quantification of apoptosis,cel proliferation,neutral and acid mucine and Ig A secretory cel s,and microarray analysis at d 21.Jejunum and cecum contents were col ected for microbiota at d 21.Results:AB and BAS reduced the fecal score impairment compared to CO(P<0.05)at d 14.Body weight(BW),average daily weight gain(ADWG),average daily feed intake(ADFI)and gain to feed ratio(G:F)did not differ between Bacil us groups and CO.AB improved BW at d 7,d 14 and d 21,ADWG ADFI and G:F from d 0 to d 7(P<0.05).At d 8,CO had higher plasma arginine,lysine,ornithine,glycine,serine and threonine than other groups,and higher haptoglobin than AB(P<0.05).At d 21,CO had lower blood glycine,glutamine and Ig A than BAS.Morphology,cel s apoptosis and mucins did not differ.BAS and AB increased the vil us mitotic index.Transcriptome profile of BAS and AB were more similar than CO.Gene sets related to adaptive immune response were enriched in BAA,BAS and AB.CO had enriched gene set for nuclear structure and RNA processing.CO had a trend of higher Enterobacteriaceae in cecum than the other groups(P=0.06).Conclusion:Bacil us subtilis DSM25841 treatment may reduce ETEC F4ac infection in weaned piglets,decreasing diarrhea and influencing mucosal transcriptomic profile.展开更多
<strong>Introduction:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Cervico-isthmic pregnancy is rare, and serious bec...<strong>Introduction:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Cervico-isthmic pregnancy is rare, and serious because of its hemorrhagic complication. Its management varies according to the teams. </span><b><span style="font-family:Verdana;">Observation:</span></b><span style="font-family:Verdana;"> We report a case of cervico-isthmic pregnancy on a cesarean scar. This is a 35-year</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">old, G2P2, who consulted for bleeding from the 1st trimester of pregnancy. </span><a name="_Hlk80358912"></a><span style="font-family:Verdana;">The clinical examination found a minimal uterine bleeding. The diagnosis was made by a vaginal ultrasound which found a cervico-isthmic implantation of the pregnancy on the caesarean scar. A protocol of Mifepristone and Misoprostol followed by administration of a single dose of 1 mg/kg of Methotrexate was performed. Cure was obtained 1 month after treatment by negativation of plasma HCG. No bleeding complications were noted. A follow-up ultrasound performed 2 months later showed a uterine vacuity and the presence of an isthmocoele. It was in fact a pregnancy that had implanted in the isthmocoele. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Cervico-isthmic pregnancy is rare. His treatment is not codified. Drug management was successful</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span>展开更多
Preoperative radioembolization may improve the resectability of liver tumor by inducing tumor shrinkage,atrophy of the embolized liver and compensatory hypertrophy of non-embolized liver.We describe the case of a cirr...Preoperative radioembolization may improve the resectability of liver tumor by inducing tumor shrinkage,atrophy of the embolized liver and compensatory hypertrophy of non-embolized liver.We describe the case of a cirrhotic Child-Pugh A patient with a segmentⅣhepatocellular carcinoma requiring a left hepatectomy.Preoperative angiography demonstrated 2 separated left hepatic arteries,for segmentⅣand segmentsⅡ-Ⅲ.This anatomic variant allowed sequential radioembolizations,delivering high-dose^(90)Yttrium(160 Gy)to the tumor,followed 28 d later by lower dose(120 Gy)to segmentsⅡ-Ⅲ.After 3 mo,significant tumor response and atrophy of the future resected liver were obtained,allowing uneventful left hepatectomy.This case illustrates that,when anatomic disposition permits it,sequential radioembolizations,delivering different^(90)Yttrium doses to the tumor and the future resected liver,could represent a new strategy to prepare major hepatectomy in cirrhotic patients,allowing optimal tumoricidal effect while reducing the toxicity of the global procedure.展开更多
Ob</span><span style="font-family:Verdana;">jectives:</span></span></b><span style="font-family:""><span style="font-family:Verdana;"> Descr...Ob</span><span style="font-family:Verdana;">jectives:</span></span></b><span style="font-family:""><span style="font-family:Verdana;"> Describe the socio-demographic characteristics, describe the main indications for LEEP and present the main complications. </span><b><span style="font-family:Verdana;">Methodology:</span></b> </span><span style="font-family:""><span style="font-family:Verdana;">This was a cross-sectional and descriptive study with consecutive recruitment of the study population through cervical cancer screening campaigns throughout the country during the period July 1, 2017 to April 30, 2019. Included were all patients eligible for LEEP and having benefited from this therapeutic method during our study period. Data were collected from a registry and recorded on a questionnaire developed for this study. These data were analyzed using Epi info 3.5.1 software. The following parameters were studied: patient age, indication for LEEP, intraoperative and postoperative complications, histological examination of the specimens, and postoperative surveillance and screening follow-up one year after LEEP. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> During the study period, 12</span></span><span style="font-family:Verdana;">,</span><span style="font-family:""><span style="font-family:Verdana;">595 women were screened for precancerous cervical lesions. A total of 474 women had precancerous lesions. Of these women, 227 had undergone loop resection, a rate of 47.9%. The main indications for LEEP were extensive lesions (68.7%), lesions penetrating the internal cervical os (12.8%). Incidents occurred in 7.5% of patients during the procedure. Post-operative complications occurred in 14.7% of cases. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">LEEP is a better way to treat precancerous lesions but is not well known by medical staff. The equipment of health facilities and the training of medical staff will make it possible to popularize the practice throughout the country. This extension will contribute to the fight against cervical cancer.展开更多
Flash floods are a major cause of death and destruction to property on a worldwide scale. In the UK sudden flooding has been the cause of the loss of over 60 lives during the last century. Forecasting these events to ...Flash floods are a major cause of death and destruction to property on a worldwide scale. In the UK sudden flooding has been the cause of the loss of over 60 lives during the last century. Forecasting these events to give enough warning is a major concern: after the 2004 flood at Boscastle, Cornwall UK the Environment Agency (2004) stated that it was not possible to provide a warning in such a fast reacting and small catchment. This is untrue since the Agency had already implemented a real time non-linear flow model as part of a flood warning system on the upper Brue in Somerset UK. This model is described in this paper as it has been applied to the Lynmouth flood of 1952, and briefly for the Boscastle catchment, both of which have an area of about 20 km2. The model uses locally measured SMD and saturated hydraulic conductivity data. With the addition of further parameters the model has been successfully used nationwide.展开更多
Septic abortions usually result from intrauterine maneuvers using non-sterile instruments or materials;they are much more common when abortion is illegal. We report the clinical case of a 28-year-old patient following...Septic abortions usually result from intrauterine maneuvers using non-sterile instruments or materials;they are much more common when abortion is illegal. We report the clinical case of a 28-year-old patient following a complicated abortion of endometritis and bilateral abscess of the shoulders, requiring surgical drainage and antibiotic therapy. The bacterium identified was Escherichia coli, sensitive to ceftriaxone.展开更多
The 2019-2020 bushfires in Australia caused the loss of 34 lives and an estimated 100 bn AU$ damage. This has sharpened the apparent division between Australians who believe that the increasing number of bushfires is ...The 2019-2020 bushfires in Australia caused the loss of 34 lives and an estimated 100 bn AU$ damage. This has sharpened the apparent division between Australians who believe that the increasing number of bushfires is due to climate change, and those who suggest that fuel loads must be managed more carefully. Bushfires whose area equals or exceeds 1 mHa have been analysed in this paper. The results show that the number, duration, and size have increased over the period 1850-2020, but that since 1953, there has been a downward trend in the number of big bushfires. There is a range of temperatures of about 20<span style="color:#4F4F4F;font-family:" font-size:14px;white-space:normal;background-color:#ffffff;"="">°</span>C that are associated with the fires, with a modal temperature of 30<span style="color:#4F4F4F;font-family:" font-size:14px;white-space:normal;background-color:#ffffff;"="">°</span>C - 32.5<span style="color:#4F4F4F;font-family:" font-size:14px;white-space:normal;background-color:#ffffff;"="">°</span>C. Using an analysis of the maximum temperatures for the period 1970-2020 as a standard for comparison with bushfires for the period 1850-2020, shows that during bushfire events the standardised temperatures have a downward trend. This is most clearly shown by the application of the Fisher Exact Test. This suggests that the fuel load in forests is a key factor for bushfires. The role of pre-bushfire rainfall shows a rapid rise in the area burnt when the rainfall exceeds 150 mm month<span style="color:#4F4F4F;font-family:" font-size:14px;white-space:normal;background-color:#ffffff;"=""><sup>-</sup></span><sup>1</sup> which would lead to more plant growth and hence fuel load. The role of traditional burning over the whole of Australia is described based on documentary evidence. A tentative cost benefit analysis has shown that a comprehensive program of wildfire management is cost effective. The recommendations of previous research, National Inquiries and more recent management practices, have all failed to prevent the 2019-20 fire disaster in Australia.展开更多
By their definition, destructive hailstorms cause a great deal of damage to property and have been known to be fatal to humans. At present the long term changes in the frequency of these storms are unknown. Records of...By their definition, destructive hailstorms cause a great deal of damage to property and have been known to be fatal to humans. At present the long term changes in the frequency of these storms are unknown. Records of destructive hailstorms from many different sources in England and Wales go back for several centuries. Recently discovered records of over 30 destructive hailstorms have allowed a better description of hailstorm history since 1780. The data were grouped into 30, 40, and 50 year non-overlapping time periods in relation to time. Increases in their frequency in the 17th and 18th centuries were probably due to an increase in population and better recording. Since 1900 the frequency has significantly declined so that in the present 50 year time period only 22 have been recorded as compared with an average of 49 in both halves of the 19th century. The decline in frequency may be partly due to the big increase in particulate matter from aviation, which leads to a much higher concentration of ice and cloud condensation nuclei, resulting in fewer destructive hailstorms.展开更多
An analysis of nearly 250 years of flood records on the river Eden at Appleby-in-Westmorland has enabled a flood frequency relationship to be established. The most severe floods were in the late 18th and early 19th ce...An analysis of nearly 250 years of flood records on the river Eden at Appleby-in-Westmorland has enabled a flood frequency relationship to be established. The most severe floods were in the late 18th and early 19th century. With such a long history of flooding, some remedial measures would have been expected but the local people have, to some extent, adapted to the flood hazard by means of temporary and permanent flood proofing methods such as a cemented board across a doorway and removable flood boards. These measures were overwhelmed during the 2015 flood, as were the flood gates installed by the Environment Agency in 1998. A higher level of protection from floods at Appleby is called for.展开更多
文摘Background:The COVID-19 pandemic disrupted healthcare systems globally,raising concerns about delayed cancer diagnosis and treatment.In France,transurethral resection of bladder tumors(TURBT)was prioritized in national urology guidelines to ensure the timely management of urothelial carcinoma.This study aimed to assess the impact of care reorganization on tumor staging,recurrence,palliative care,and mortality in bladder cancer patients from the pre-pandemic through late-pandemic periods.Methods:We conducted a retrospective multicenter study including all patients who underwent TURBT with histologically confirmed urothelial carcinoma between April and December of 2019(pre-pandemic),2020(early pandemic),2021(mid-pandemic),and 2022(late pandemic)in two French institutions.TURBT indications were categorized as diagnostic,palliative,or staging.Clinical and pathological data were compared across the four periods.Statistical analyses included Chi-square tests,Estimated Annual Percentage Change(EAPC),and multivariable logistic regression adjusted for age,sex,ASA score,and center.Results:A total of 790 TURBT procedures were analyzed.The proportion of muscle-invasive bladder cancer(pT≥2)declined over time(18.7%in 2019 to 13.2%in 2022;p=0.63),while superficial tumors(pTa)increased(57.2%to 65.5%).All-cause mortality significantly decreased from 38.0%in 2019 to 22.0%in 2020,20.5%in 2021,and 19.5%in 2022(p=0.006).EAPC showed a significant annual decline in mortality(–24.3%,p=0.004).In multivariable analysis,2020,2021,and 2022 were each associated with significantly lower odds of mortality compared to 2019.Recurrence rates remained stable across all periods(p=0.93).Interhospital variation persisted in mortality and recurrence.Conclusions:Despite the pandemic,urothelial bladder cancer outcomes did not worsen through 2022.On the contrary,timely reorganization,prioritization of TURBT,and triage strategies were associated with reduced mortality and palliative care needs,highlighting the resilience of cancer care when guided by adaptive health policies.
文摘BACKGROUND Probiotics have shown promise in alleviating symptoms of diarrhea-predominant irritable bowel syndrome(IBS-D);however,the certainty of evidence is low.Wellpowered randomized controlled dose-ranging trials are warranted on promising single-strain candidates.AIM To investigate the clinical efficacy of Lactiplantibacillus plantarum(L.plantarum)Lpla33(DSM34428)in adults with IBS-D.METHODS This is a randomized,double-blind,placebo-controlled,multi-center,and doseranging study.Three hundred and seven adults,18-70 years of age,with IBS-D,according to Rome IV criteria,were allocated(1:1:1)to receive placebo or L.plantarum Lpla33 at 1×10^(9)(1B)or 1×10^(10)(10B)colony-forming units/d over an 8-wk intervention period.The primary outcome was the change in IBS severity scoring system(IBS-SSS)total score after 8 wk,while secondary and exploratory outcomes included abdominal pain severity,IBS related quality of life,stool and microbial profile,and perceived stress.RESULTS IBS-SSS was significantly reduced,after 8 wk,in participants receiving L.plantarum 1B(-128.45±83.30;P<0.001)and L.plantarum 10B(-156.77±99.06;P<0.001),compared to placebo(-58.82±74.75).Further,a dose-ranging effect was observed,with a greater absolute reduction in the L.plantarum 10B group(P<0.05).A reduction in sub-scores related to abdominal pain,abdominal distension,bowel habits,and quality of life was observed in both L.plantarum groups compared to placebo(P<0.001).Further,62.5%and 88.4%of participants administered L.plantarum 1B and 10B,respectively,were classified as stool consistency responders based on a reduction in diarrheal stool form,as compared to 26.3%in the placebo group(P<0.001).In contrast,no significant shifts were observed in microbial diversity.CONCLUSION L.plantarum Lpla33(DSM34428)is well tolerated and improves IBS symptom severity with a dose-ranging effect and a corresponding normalization of bowel habits in adults with IBS-D.
基金supported by Chr.Hansen A/S,Hoersholm,Denmark and the United States Department of Agriculture(USDA)National Institute of Food and Agriculture,multistate project W3002
文摘Background: There is growing evidence to support the beneficial effects of supplementing direct-fed microbials(DFM) on performance, health status, and immune responses of weaned pigs. Therefore, the objective of this study was to investigate dietary supplementation of Bacillus subtilis(DSM 25841) on growth performance, diarrhea, gut permeability and immunity of weaned pigs experimentally infected with a pathogenic F-18 Escherichia coli(E. coli).Results: The F18 E. coli infection reduced(P < 0.05) growth performance and intestinal villi height, whereas increased(P < 0.05) diarrhea and transcellular and paracellular permeability in the jejunum compared with non-challenged control. Supplementation of Bacillus subtilis linearly enhanced average daily gain of E. coli infected pigs from d 0 to 5 post-inoculation(PI)(P < 0.05) and d 0 to 11 PI(P = 0.058). Supplementation of high dose of Bacillus subtilis reduced(P < 0.05) both transcellular and paracellular permeability on d 5 and d11 PI compared with the E. coli infected pigs fed with control diet. E. coli infection up-regulated(P < 0.05)the m RNA expression of SLC5 A10(soluble carrier family 5 member 10) and MUC2(mucin 2) on d 5 PI, but down-regulated(P < 0.05) expression of SLC5 A10, MUC2, and CLDN1 on d 11 PI in jejunal mucosa when pigs were fed with the control diet. Supplementation of Bacillus subtilis linearly up-regulated(P < 0.05) the m RNA expression of CFTR and ZO1 on d 5 PI and SLC5 A10 and MUC2 on d 11 PI in jejunal mucosa of E. coli infected pigs. In addition, E. coli infection increased(P < 0.05) the m RNA expression of several immune genes(IL1 A, IL1 B, and IL7 on d 5 PI, and IL1 B, IL6, IL7, and TNF on d 11 PI) in the ileal mucosa of weaned pigs. Inclusion of Bacillus subtilis to control diet linearly down-regulated gene expression of IL1 A on d 5 PI(P = 0.07) and IL6 on d 11 PI(P < 0.05) in ileal mucosa of E. coli infected pigs.Conclusions: Supplementation of Bacillus subtilis(DSM 25841) enhanced growth rate and improved gut barrier function of weaned pigs experimentally infected with a pathogenic E. coli.
文摘Hepatitis B （HBV） reactivation induced by chemotherapy is problem encountered recently in the management of malignant diseases. Chemotherapy-induced HBV reacti- vation may ultimately lead to terminal acute liver failure. Liver transplantation （LT） currently remains the only definitive treatment option for such cases, but is generally denied to patients suffering from malignancy. Here, the authors describe 2 cases of cancer-free and HBV graft renfection-free survival after LT performed for terminal liver failure arising from HBV reactivation induced by chemotherapy for advanced stage lymphoma. These 2 cases, and some other reports in the literature, may suggest that patients suffering from hematologic malignan- cies and terminal liver disease can be considered for LT if the prognosis of their hematologic malignancy is good.
文摘Rainfall measurements are vital for the design of hydraulic structures, climate change studies, irrigation and land drainage works. The most important source of design rainfall data comes from convective storms. Accurate assessment of the storm rainfall requires a fairly dense network of raingauges. In 1963, such a storm took place over Dublin in Ireland. However, the existing raingauge network was insufficient to identify both the depth and pattern of rainfall. An appeal was made by Met Eireann for additional unofficial rainfall data. The result was remarkable in that the estimated maximum rainfall depth was found to be more than double the official value and that the resulting depth area analysis suggested a rainfall volume over a large area much bigger than the original isohyet map indicated. This result has huge implications for the estimation of maximum rainfall and dam safety assessment, especially in countries where the raingauge network has a low density. This paper first provides a description of the synoptic conditions that led to the storm, second an analysis of the rainfall data and how the unofficial measurements produced a very different depth area relationship;third, the social consequences of the resulting flood are described. Fourth, the storm is then placed in the context of other storms in the British Isles Finally the implications for rainfall measurement, gauge density and an example of how revised estimates of probable maximum precipitation (PMP) have been used to improve the safety and design standard of a flood detention dam are discussed.
基金financed in part by the French Research Agency:grant to PFR(FLAGEL-OME:ANR-19-CE17-0014).
文摘Thanks to tremendous advances in sequencing technologies and in particular to whole exome sequencing(WES),many genes have now been linked to severe sperm defects.A precise genetic diagnosis is obtained for a minority of patients and only for the most severe defects like azoospermia or macrozoospermia which is very often due to defects in the aurora kinase C(AURKC)gene.Here,we studied a subject with a severe oligozoospermia and a phenotypic diagnosis of macrozoospermia.AURKC analysis did not reveal any deleterious variant.WES was then initiated which permitted to identify a homozygous loss of function variant in the zinc finger MYND-type containing 15(ZMYND15)gene.ZMYND15 has been described to serve as a switch for haploid gene expression,and mice devoid of ZMYND15 were shown to be sterile due to nonobstructive azoospermia(NOA).In man,ZMYND15 has been associated with NOA and severe oligozoospermia.We confirm here that the presence of a bi-allelic ZMYND15 variant induces a severe oligozoospermia.In addition,we show that severe oligozoospermia can be associated macrozoospermia,and that a phenotypic misdiagnosis is possible,potentially delaying the genetic diagnosis.In conclusion,genetic defects in ZMYND15 can induce complete NOA or severe oligozoospermia associated with a very severe teratozoospermia.In our experience,severe oligozoospermia is often associated with severe teratozoospermia and can sometimes be misinterpreted as macrozoospermia or globozoospermia.In these instances,specific AURKC or dpy-19 like 2(DPY19L2)diagnosis is usually negative and we recommend the direct use of a pan-genomic techniques such as WES.
文摘Objective:To assess the seasonality of the bacterial meningitis and the antibiotic resistance of incriminated bacteria over the last three years in the northern Togo.Methods:From January 2007 to January 2010,533 cerebrospinal fluids(CSF) samples were collected from patients suspected of meningitis in the Regional Hospital of Dapaong(northern Togo).After microscopic examination,samples were cultured for bacterial identification and antibiotic susceptibility. Results:The study included 533 patients(306 male and 227 female) aged from 1 day to 55 years [average age(13.00±2.07) years].Bacterial isolation and identification were attempted for 254/533 (47.65%) samples.The bacteria]species identified were:Neisseria meningitidis A(N.meningitidis A)(58.27%),Neisseria meningitidis W135(N,meningitidis W135)(7.09%),Streptococcus pneumoniae(S.pneumoniae)(26.77%),Haemophilus influenza B(H.influenza B)(6.30%) and Enterobacteriaceae(1.57%).The results indicated that bacterial meningitis occur from November to May with a peak in February for H.influenzae and S.pneumoniae and March for Neisseriaceae. The distribution of positive CSF with regards to the age showed that subjects between 6 and 12 years followed by subjects of 0 to 5 years were most affected with respective frequencies of 67.82%and 56.52%(P【0.001).Susceptibility tests revealed that bacteria have developed resistance to several antibiotics including aminosides(resistance rate】20%for both bacterial strains),macrolides(resistance rate】30%for H.influenzae) quinolones(resistance rate】15% for H.influenzae and N.meningitidis W135).Over three years,the prevalence of S.pneumoniae significantly increased from 8.48%to 73.33%(P【0.001),while the changes in the prevalence of H.influenzae B were not statistically significant:4.24%,vs.8.89%,(P= 0.233).Conclusions: Our results indicate that data in African countries differ depending on geographical location in relation to the African meningitis belt.This underlines the importance of epidemiological surveillance of bacterial meningitis.
基金partly financially supported by Chr.Hansen A/S(Denmark).
文摘Background:Probiosis is considered a potential strategy to reduce antibiotics use and prevent postweaning diarrhea(PWD).This study investigated the effect of Bacillus amyloliquefaciens DSM25840 or Bacillus subtilis DSM25841 supplementation on growth,health,immunity,intestinal functionality and microbial profile of post-weaning pigs after enterotoxigenic E.coli(ETEC)F4 challenge.Methods:Sixty-four post-weaning piglets(7748 g±643 g)were randomly al ocated to four groups:control basal diet(CO);CO+1.28×10~6 CFU/g of B.amyloliquefaciens(BAA);CO+1.28×10~6 CFU/g feed of B.subtilis(BAS);CO+1 g colistin/kg of feed(AB).At day(d)7,animals were chal enged with 10~5 CFU/m L of ETEC F4 ac O149 and then fol owed for fecal score and performance until d 21.Blood was col ected at d 6,d 12 and d 21 for immunoglobulins,at d 8 for acute phase proteins,at d 8 and d 21 for metabolomics analysis.Jejunum was sampled for morphometry,quantification of apoptosis,cel proliferation,neutral and acid mucine and Ig A secretory cel s,and microarray analysis at d 21.Jejunum and cecum contents were col ected for microbiota at d 21.Results:AB and BAS reduced the fecal score impairment compared to CO(P<0.05)at d 14.Body weight(BW),average daily weight gain(ADWG),average daily feed intake(ADFI)and gain to feed ratio(G:F)did not differ between Bacil us groups and CO.AB improved BW at d 7,d 14 and d 21,ADWG ADFI and G:F from d 0 to d 7(P<0.05).At d 8,CO had higher plasma arginine,lysine,ornithine,glycine,serine and threonine than other groups,and higher haptoglobin than AB(P<0.05).At d 21,CO had lower blood glycine,glutamine and Ig A than BAS.Morphology,cel s apoptosis and mucins did not differ.BAS and AB increased the vil us mitotic index.Transcriptome profile of BAS and AB were more similar than CO.Gene sets related to adaptive immune response were enriched in BAA,BAS and AB.CO had enriched gene set for nuclear structure and RNA processing.CO had a trend of higher Enterobacteriaceae in cecum than the other groups(P=0.06).Conclusion:Bacil us subtilis DSM25841 treatment may reduce ETEC F4ac infection in weaned piglets,decreasing diarrhea and influencing mucosal transcriptomic profile.
文摘<strong>Introduction:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Cervico-isthmic pregnancy is rare, and serious because of its hemorrhagic complication. Its management varies according to the teams. </span><b><span style="font-family:Verdana;">Observation:</span></b><span style="font-family:Verdana;"> We report a case of cervico-isthmic pregnancy on a cesarean scar. This is a 35-year</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">old, G2P2, who consulted for bleeding from the 1st trimester of pregnancy. </span><a name="_Hlk80358912"></a><span style="font-family:Verdana;">The clinical examination found a minimal uterine bleeding. The diagnosis was made by a vaginal ultrasound which found a cervico-isthmic implantation of the pregnancy on the caesarean scar. A protocol of Mifepristone and Misoprostol followed by administration of a single dose of 1 mg/kg of Methotrexate was performed. Cure was obtained 1 month after treatment by negativation of plasma HCG. No bleeding complications were noted. A follow-up ultrasound performed 2 months later showed a uterine vacuity and the presence of an isthmocoele. It was in fact a pregnancy that had implanted in the isthmocoele. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Cervico-isthmic pregnancy is rare. His treatment is not codified. Drug management was successful</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span>
文摘Preoperative radioembolization may improve the resectability of liver tumor by inducing tumor shrinkage,atrophy of the embolized liver and compensatory hypertrophy of non-embolized liver.We describe the case of a cirrhotic Child-Pugh A patient with a segmentⅣhepatocellular carcinoma requiring a left hepatectomy.Preoperative angiography demonstrated 2 separated left hepatic arteries,for segmentⅣand segmentsⅡ-Ⅲ.This anatomic variant allowed sequential radioembolizations,delivering high-dose^(90)Yttrium(160 Gy)to the tumor,followed 28 d later by lower dose(120 Gy)to segmentsⅡ-Ⅲ.After 3 mo,significant tumor response and atrophy of the future resected liver were obtained,allowing uneventful left hepatectomy.This case illustrates that,when anatomic disposition permits it,sequential radioembolizations,delivering different^(90)Yttrium doses to the tumor and the future resected liver,could represent a new strategy to prepare major hepatectomy in cirrhotic patients,allowing optimal tumoricidal effect while reducing the toxicity of the global procedure.
文摘Ob</span><span style="font-family:Verdana;">jectives:</span></span></b><span style="font-family:""><span style="font-family:Verdana;"> Describe the socio-demographic characteristics, describe the main indications for LEEP and present the main complications. </span><b><span style="font-family:Verdana;">Methodology:</span></b> </span><span style="font-family:""><span style="font-family:Verdana;">This was a cross-sectional and descriptive study with consecutive recruitment of the study population through cervical cancer screening campaigns throughout the country during the period July 1, 2017 to April 30, 2019. Included were all patients eligible for LEEP and having benefited from this therapeutic method during our study period. Data were collected from a registry and recorded on a questionnaire developed for this study. These data were analyzed using Epi info 3.5.1 software. The following parameters were studied: patient age, indication for LEEP, intraoperative and postoperative complications, histological examination of the specimens, and postoperative surveillance and screening follow-up one year after LEEP. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> During the study period, 12</span></span><span style="font-family:Verdana;">,</span><span style="font-family:""><span style="font-family:Verdana;">595 women were screened for precancerous cervical lesions. A total of 474 women had precancerous lesions. Of these women, 227 had undergone loop resection, a rate of 47.9%. The main indications for LEEP were extensive lesions (68.7%), lesions penetrating the internal cervical os (12.8%). Incidents occurred in 7.5% of patients during the procedure. Post-operative complications occurred in 14.7% of cases. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">LEEP is a better way to treat precancerous lesions but is not well known by medical staff. The equipment of health facilities and the training of medical staff will make it possible to popularize the practice throughout the country. This extension will contribute to the fight against cervical cancer.
文摘Flash floods are a major cause of death and destruction to property on a worldwide scale. In the UK sudden flooding has been the cause of the loss of over 60 lives during the last century. Forecasting these events to give enough warning is a major concern: after the 2004 flood at Boscastle, Cornwall UK the Environment Agency (2004) stated that it was not possible to provide a warning in such a fast reacting and small catchment. This is untrue since the Agency had already implemented a real time non-linear flow model as part of a flood warning system on the upper Brue in Somerset UK. This model is described in this paper as it has been applied to the Lynmouth flood of 1952, and briefly for the Boscastle catchment, both of which have an area of about 20 km2. The model uses locally measured SMD and saturated hydraulic conductivity data. With the addition of further parameters the model has been successfully used nationwide.
文摘Septic abortions usually result from intrauterine maneuvers using non-sterile instruments or materials;they are much more common when abortion is illegal. We report the clinical case of a 28-year-old patient following a complicated abortion of endometritis and bilateral abscess of the shoulders, requiring surgical drainage and antibiotic therapy. The bacterium identified was Escherichia coli, sensitive to ceftriaxone.
文摘The 2019-2020 bushfires in Australia caused the loss of 34 lives and an estimated 100 bn AU$ damage. This has sharpened the apparent division between Australians who believe that the increasing number of bushfires is due to climate change, and those who suggest that fuel loads must be managed more carefully. Bushfires whose area equals or exceeds 1 mHa have been analysed in this paper. The results show that the number, duration, and size have increased over the period 1850-2020, but that since 1953, there has been a downward trend in the number of big bushfires. There is a range of temperatures of about 20<span style="color:#4F4F4F;font-family:" font-size:14px;white-space:normal;background-color:#ffffff;"="">°</span>C that are associated with the fires, with a modal temperature of 30<span style="color:#4F4F4F;font-family:" font-size:14px;white-space:normal;background-color:#ffffff;"="">°</span>C - 32.5<span style="color:#4F4F4F;font-family:" font-size:14px;white-space:normal;background-color:#ffffff;"="">°</span>C. Using an analysis of the maximum temperatures for the period 1970-2020 as a standard for comparison with bushfires for the period 1850-2020, shows that during bushfire events the standardised temperatures have a downward trend. This is most clearly shown by the application of the Fisher Exact Test. This suggests that the fuel load in forests is a key factor for bushfires. The role of pre-bushfire rainfall shows a rapid rise in the area burnt when the rainfall exceeds 150 mm month<span style="color:#4F4F4F;font-family:" font-size:14px;white-space:normal;background-color:#ffffff;"=""><sup>-</sup></span><sup>1</sup> which would lead to more plant growth and hence fuel load. The role of traditional burning over the whole of Australia is described based on documentary evidence. A tentative cost benefit analysis has shown that a comprehensive program of wildfire management is cost effective. The recommendations of previous research, National Inquiries and more recent management practices, have all failed to prevent the 2019-20 fire disaster in Australia.
文摘By their definition, destructive hailstorms cause a great deal of damage to property and have been known to be fatal to humans. At present the long term changes in the frequency of these storms are unknown. Records of destructive hailstorms from many different sources in England and Wales go back for several centuries. Recently discovered records of over 30 destructive hailstorms have allowed a better description of hailstorm history since 1780. The data were grouped into 30, 40, and 50 year non-overlapping time periods in relation to time. Increases in their frequency in the 17th and 18th centuries were probably due to an increase in population and better recording. Since 1900 the frequency has significantly declined so that in the present 50 year time period only 22 have been recorded as compared with an average of 49 in both halves of the 19th century. The decline in frequency may be partly due to the big increase in particulate matter from aviation, which leads to a much higher concentration of ice and cloud condensation nuclei, resulting in fewer destructive hailstorms.
文摘An analysis of nearly 250 years of flood records on the river Eden at Appleby-in-Westmorland has enabled a flood frequency relationship to be established. The most severe floods were in the late 18th and early 19th century. With such a long history of flooding, some remedial measures would have been expected but the local people have, to some extent, adapted to the flood hazard by means of temporary and permanent flood proofing methods such as a cemented board across a doorway and removable flood boards. These measures were overwhelmed during the 2015 flood, as were the flood gates installed by the Environment Agency in 1998. A higher level of protection from floods at Appleby is called for.
