The etiopathogenesis of gastrointestinal diseases is varied in nature.Various etiogenic factors described are infective,inflammatory,viral,bacterial,parasitic,dietary and lifestyle change.Rare causative agents are imm...The etiopathogenesis of gastrointestinal diseases is varied in nature.Various etiogenic factors described are infective,inflammatory,viral,bacterial,parasitic,dietary and lifestyle change.Rare causative agents are immunological,and others associated as idiopathic,are undiagnosed by all possible means.Some of the rare diseases are congenital in nature,passing from the parent to the child.Many of the undiagnosed diseases are now being diagnosed as genetic and the genes have been implicated as a causative agent.There is a search for newer treatments for such diseases,which is called genomic medicine.Genomic medicine is an emerging medical discipline that involves the use of genomic information about an individual.This is used both for diagnostic as well as therapeutic decisions to improve the current health domain and pave the way for policymakers for its clinical use.In the developing era of precision medicine,genomics,epigenomics,environmental exposure,and other data would be used to more accurately guide individual diagnosis and treatment.Genomic medicine is already making an impact in the fields of oncology,pharmacology,rare,infectious and many undiagnosed diseases.It is beginning to fuel new approaches in certain medical specialties.Oncology is at the leading edge of incorporating genomics,as diagnostics for genetic and genomic markers are increasingly included in cancer screening,and to guide tailored treatment strategies.Genetics and genetic medicine have been reported to play a role in gastroenterology in several ways,including genetic testing(hereditary pancreatitis and hereditary gastrointestinal cancer syndromes).Genetic testing can also help subtype diseases,such as classifying pancreatitis as idiopathic or hereditary.Gene therapy is a promising approach for treating gastrointestinal diseases that are not effectively treated by conventional pharmaceuticals and surgeries.Gene therapy strategies include gene addition,gene editing,messenger RNA therapy,and gene silencing.Understanding genetic determinants,advances in genetics,have led to a better understanding of the genetic factors that contribute to human disease.Family-member risk stratification and genetic diagnosis can help identify family members who are at risk,which can lead to preventive treatments,lifestyle recommendations,and routine follow ups.Selecting target genes helps identify the gene targets associated with each gastrointestinal disease.Common gastrointestinal diseases associated with genetic abnormalities include-inflammatory bowel disease,gastroesophageal reflux disease,non-alcoholic fatty liver disease,and irritable bowel syndrome.With advancing tools and technology,research in the search of newer and individualized treatment,genes and genetic medicines are expected to play a significant role in human health and gastroenterology.展开更多
BACKGROUND Drug utilization research has an important role in assisting the healthcare administration to know,compute,and refine the prescription whose principal objective is to enable the rational use of drugs.Resear...BACKGROUND Drug utilization research has an important role in assisting the healthcare administration to know,compute,and refine the prescription whose principal objective is to enable the rational use of drugs.Research in developing nations relating to the cost of treatment is scarce when compared with developed countries.Thus,the drug utilization research studies from developing nations are most needed,and their number has been growing.AIM To evaluate patterns of utilization of antipsychotic drugs and direct medical cost analysis in patients newly diagnosed with schizophrenia.METHODS The present study was observational in type and based on a retrospective cohort to evaluate patterns of utilization of antipsychotic drugs using World Health Organization(WHO)core prescribing indicators and anatomical therapeutic chemical/defined daily dose indicators.We also calculated direct medical costs for a period of 6 months.RESULTS This study has found that atypical antipsychotics are the mainstay of treatment for schizophrenia in every age group and subcategories of schizophrenia.The evaluation based on WHO prescribing indicators showed a low average number of drugs per prescription and low prescribing frequency of antipsychotics from the National List of Essential Medicines 2015 and the WHO Essential Medicines List 2019.The total mean drug cost of our study was 1396 Indian rupees.The total mean cost due to the investigation in our study was 1017.34 Indian rupees.Therefore,the total mean direct medical cost incurred on patients in our study was 4337.28 Indian rupees.CONCLUSION The information from the present study can be used for reviewing and updating treatment policy at the institutional level.展开更多
BACKGROUND Intimate partner violence(IPV)is a major public health concern linked to psychiatric and physical morbidity.However,evidence from East Asia,particularly from registry-based and sex-inclusive analyses,remain...BACKGROUND Intimate partner violence(IPV)is a major public health concern linked to psychiatric and physical morbidity.However,evidence from East Asia,particularly from registry-based and sex-inclusive analyses,remains limited.We hypothesized that IPV survivors would have elevated risks of psychiatric disorders and stressrelated physical conditions.AIM To assess psychiatric and physical health risks following IPV exposure in Taiwan.METHODS We conducted a nationwide,registry-based case control study using data from Taiwan’s Health and Welfare Data Science Center.Adults aged 18-64 years with a first IPV report in 2019(n=43393)were matched 1:1 by sex and age to controls.Incident diagnoses within 1 year were identified from claims data.Conditional logistic regression was used to estimate adjusted odds ratios(AORs).RESULTS Compared to controls,IPV survivors had higher risks of depressive disorders[AOR=4.18,95%confidence interval(CI):3.78-4.60,P<0.001],bipolar disorder(AOR=4.81,95%CI:3.83-6.10,P<0.001),schizophrenia(AOR=1.75,95%CI:1.46-2.10,P<0.001),and alcohol/substance use disorders(AOR=5.98,95%CI:2.21-8.50,P<0.001).The risk of asthma was modestly elevated(AOR=1.31,95%CI:1.08-1.60,P=0.006).No significant association was observed for irritable bowel syndrome(P=0.94).CONCLUSION IPV survivors in Taiwan face substantially increased psychiatric risk and a modestly elevated risk of asthma,warranting early screening and integrated mental and physical health care.展开更多
Background:Corchorus olitorius L.(Malvaceae)is a green leafy vegetable widely consumed in the Middle East and valued for its rich nutritional content.Its essential oils,an important class of secondary metabolites,are ...Background:Corchorus olitorius L.(Malvaceae)is a green leafy vegetable widely consumed in the Middle East and valued for its rich nutritional content.Its essential oils,an important class of secondary metabolites,are of growing interest for potential use in cosmetics and fragrance industries due to their bioactive properties.Methods:Leaves of C.olitorius cultivated in Egypt were extracted using microwave-assisted hydrodistillation(MAHD)and conventional hydrodistillation(HD).The oils were analyzed by gas chromatography-mass spectrometry(GC-MS)to characterize their chemical profiles.In vitro assays were conducted to evaluate their anti-elastase and anti-collagenase activities,and in silico studies were performed to predict the pharmacokinetic and pharmacodynamic properties of major constituents.Results:GC-MS analysis showed that aldehydes,alkanes,fatty alcohols,fatty acids,and their derivatives were the predominant compound classes in both oils.Notably,oxygenated diterpenes(11.22%)were present exclusively in the MAHD oil,while triterpenoids(16.37%)were found only in the HD oil.The MAHD oil demonstrated stronger In vitro anti-elastase(IC_(50)=42.5μg/mL)and anti-collagenase(IC_(50)=131.5μg/mL)activities compared to the HD oil(IC_(50)=66.7 and 206.8μg/mL,respectively),reflecting an approximate 36.3%improvement in elastase inhibition and 36.4%improvement in collagenase inhibition.In silico docking indicated that the triterpenoidβ-amyrin acetate showed the highest predicted binding affinity for porcine pancreatic elastase(PDB ID:6QEO,ΔG=−8.1 kcal/mol)and collagenase(PDB ID:456C,ΔG=−9.1 kcal/mol)among the major compounds analyzed.Conclusion:These findings demonstrate that MAHD is a greener and more efficient extraction method,yielding oil with enhanced enzyme inhibitory activity compared to conventional HD.The promising anti-elastase and anti-collagenase properties suggest that C.olitorius MAHD oil could serve as a potential candidate for anti-aging cosmetic formulations,following further validation.展开更多
BACKGROUND The incidence of diabetic atherosclerosis(DMA)is increasing worldwide,but its pathogenesis remains incompletely understood.In addition to cardiovascular complications,bladder dysfunction is one of the commo...BACKGROUND The incidence of diabetic atherosclerosis(DMA)is increasing worldwide,but its pathogenesis remains incompletely understood.In addition to cardiovascular complications,bladder dysfunction is one of the common comorbidities associated with DMA but is often refractory to current treatments.AIM To investigate the therapeutic effect of human amniotic fluid stem cell-derived extracellular vesicles(hAFSC-EVs)on the recovery of bladder dysfunction in DMA rats.METHODS Eighty rats were divided into normal control,streptozotocin-induced diabetic rats,diabetic rats subjected to arterial balloon endothelial injury of common iliac artery(DMA),and DMA rats treated with hAFSC-EVs(DMA+hAFSC-EVs).At 4 weeks and 12 weeks after DMA induction,levels of blood glucose,total cholesterol,triglyceride,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,homeostasis model assessment(HOMA)-insulin resistance,and HOMA-βwere measured.Cystometry,common iliac artery wall thickness,and bladder tumor necrosis factor(TNF)-α,interleukin(IL)-6,transforming growth factor(TGF)-β1,Smad3,connective tissue growth factor(CTGF)and fibronectin were also evaluated.RESULTS Bladder weight and blood glucose,triglyceride,HOMA-insulin resistance,common iliac artery intima thickness,voided volume,intercontraction interval,bladder capacity,and mRNA expression of TNF-α,IL-6,TGF-β1,Smad3,CTGF and fibronectin were significantly increased at 4 weeks and 12 weeks after induction,while the HOMA-βlevel decreased at 4 weeks and 12 weeks,and the high-density lipoprotein cholesterol level decreased at 12 weeks.hAFSC-EVs treatment in DMA rats significantly reduced bladder weight and blood glucose,thickness of common iliac arterial intima,voided volume,intercontraction interval and bladder capacity at 4 weeks.The mRNA expression of TNF-α,TGF-β1,and CTGF in DMA rats treated with hAFSC-EVs were significantly decreased at 4 weeks,while the mRNA expressions of IL-6 and Smad3 were significantly decreased 12 weeks.CONCLUSION hAFSC-EVs treatment can help restore DMA-induced bladder dysfunction,which is associated with lowered blood glucose levels,reduced arterial wall thickness,and decreased TNF-α,IL-6,TGF-β1,Smad3,and CTGF expression.展开更多
Background:To determine whether initiating a glucagon-like peptide-1 receptor agonist(GLP-1 RA)within 3 months of type 2 diabetes(T2DM)diagnosis alters the subsequent risk of overall and site-specific cancer and wheth...Background:To determine whether initiating a glucagon-like peptide-1 receptor agonist(GLP-1 RA)within 3 months of type 2 diabetes(T2DM)diagnosis alters the subsequent risk of overall and site-specific cancer and whether this association differs by baseline body-mass index(BMI).Methods:This retrospective cohort study used electronic health records from the TriNetX U.S.research network.Adults aged 20 years or older diagnosed with T2DM between 2016 and 2024 were included if they received any hypoglycemic agents within 3 months before and after diagnosis.Following 1:1 propensity score matching,both the GLP-1 RA user and non-user groups included 183,264 patients.The study outcome was defined as a diagnosis of malignant neoplasms.Hazard ratios(HRs)for overall and site-specific cancer risk were estimated using Cox proportional hazards models.Kaplan–Meier analysis and stratified analysis by BMI were performed.Results:Early GLP-1 RA use demonstrated a modest but significant association with reduced overall cancer risk(HR 0.93;95%CI:0.90–0.96).Reduced risks were noted for cancers of the digestive(HR 0.81),respiratory(HR 0.66),and female genital(HR 0.87)systems.In stratified analysis,benefits were more pronounced in patients with BMI≥30,particularly for pancreatic and colorectal cancers.Conclusion:Early initiation of GLP-1 receptor agonists in patients with diagnosed T2DM was associated with a modest reduction in overall cancer risk,particularly among individuals with obesity.These findings highlight the dual metabolic and oncologic value of prompt GLP-1 RA therapy.展开更多
Kidney transplantation(KT)accounts for nearly three-fourths of organ transplants in India,with living donors contributing to 82%of cases.Induction immunosuppression is essential to optimize initial immunosuppression,r...Kidney transplantation(KT)accounts for nearly three-fourths of organ transplants in India,with living donors contributing to 82%of cases.Induction immunosuppression is essential to optimize initial immunosuppression,reduce acute rejections,and enable tailored use of maintenance agents.Rabbit anti-thymocyte globulin(rATG)and interleukin-2 receptor anatagonists(IL-2RA/IL-2RBs)are the most widely used induction therapies.However,data on induction practices across India are limited.To evaluate induction immunosuppression practices across KT centers in India and establish a consensus for different subsets of KT recipients.A nationwide online survey was conducted by the Indian Society of Organ Transplantation(ISOT)among its members(400 KT centers).Responses were analyzed to assess induction practices across diverse donor types,age groups,and immunological risk profiles.Heterogeneity in practices prompted consensus building using a modified Delphi process.Literature review and expert panel discussions(April 2024)were followed by structured voting,and 16 consensus statements were finalized.Of 400 centers approached,254 participated.rATG was the most commonly used induction therapy,followed by IL-2RBs;alemtuzumab was least used.Significant heterogeneity was observed in type,dose,and duration of induction therapy.Consensus recommendations were framed:rATG for high immunological risk recipients and deceased donor KTs;IL-2RB or low-dose rATG for low immunological risk;rituximab in ABOincompatible KTs;and tailoring based on age,diabetes,donor type,infection risk,and affordability.This first ISOT consensus provides 16 India-specific statements on induction therapy in KT.It emphasizes risk-stratified,evidenceinformed,and context-appropriate induction strategies,supporting standardization of care across the country.展开更多
BACKGROUND: As per the "Disaster Management Act, 2005" of India, it is mandatory for government hospitals in India to prepare a disaster plan. This study aimed to prepare a disaster manual of a 1 900 bed ter...BACKGROUND: As per the "Disaster Management Act, 2005" of India, it is mandatory for government hospitals in India to prepare a disaster plan. This study aimed to prepare a disaster manual of a 1 900 bed tertiary care hospital, in consultation and involvement of all concerned stakeholders.METHODS: A committee of members from hospital administration, clinical, diagnostic and supportive departments worked on an initial document prepared according to the Act and gave their inputs to frame a final disaster manual.RESULTS: The prepared departmental standard operating procedures involved 116 people(doctors and paramedical staff), and were then synchronized, in 12 committee meetings, to produce the final hospital disaster manual.CONCLUSIONS: The present disaster manual is one of the few comprehensive plans prepared by the stakeholders of a government hospital in India, who themselves form a part of the disaster response team. It also helped in co-ordinated conduction of mock drills.展开更多
Background:With the global popularity of short videos,particularly among young people,short video addiction has become a worrying phenomenon that poses significant risks to individual health and adaptability.Self-regu...Background:With the global popularity of short videos,particularly among young people,short video addiction has become a worrying phenomenon that poses significant risks to individual health and adaptability.Self-regulated learning(SRL)strategies are key factors in predicting learning outcomes.This study,based on the SRL theory,uses short video addiction as the independent variable,SRL strategies as the mediating variable,and learning well-being as the outcome variable,aiming to reveal the relationships among short video addiction,self-regulated learning,and learning well-being among Chinese college students.Methods:Using a cross-sectional study design and applying the snowball sampling technique,an online survey was administered to Chinese undergraduate students.A total of 706 valid questionnaires were collected,with an effective response rate of 85.7%.The average age of the participants was 20.5 years.Results:The results of structural equation modeling indicate that 7 hypotheses were supported.Short video addiction was negatively correlated with self-regulated learning strategies(preparatory,performance,and appraisal strategy),while SRL strategies were positively correlated with learning well-being.Additionally,short video addiction had a mediating effect on learning well-being through the three types of SRL strategies.The three types of SRL strategies explained 39%of the variance in learning well-being.Conclusion:Previous research has typically focused on the impact of self-regulated learning strategies on media addiction or problematic media use.This study,based on the SRL model,highlights the negative issues caused by short video addiction and emphasizes the importance of cultivating self-regulation abilities and media literacy.Short video addiction stems from failures in trait self-regulation,which naturally impairs the ability to effectively engage in self-regulation during the learning process.This study confirms and underscores that the SRL model can serve as an effective theoretical framework for helping students prevent short video addiction,engage in high-quality learning,and consequently enhance their learning well-being.展开更多
Objective:Pediatric burns pose difficult healthcare issues in underdeveloped nations.Due to the scarcity of pediatric burn care facilities and qualified burn‑care staff,patients are frequently referred from a rural ho...Objective:Pediatric burns pose difficult healthcare issues in underdeveloped nations.Due to the scarcity of pediatric burn care facilities and qualified burn‑care staff,patients are frequently referred from a rural hospital.This study explores the burn‑treatment approach that could be used in rural hospitals in the absence of a dedicated pediatric burn care facility.Materials and Methods:A retrospective analysis of clinical data of 199 children who received treatment for burn‑injury in an isolated general surgical ward.Wound debridement under anesthesia at the earliest was the cornerstone of the treatment plan for this cohort.Until the wounds healed,the treatment was repeated every alternate day.The patient’s demographic data,number of surgical dressings,length of hospital stay,and outcome were analyzed.Results:The mean age of the patients was 51.68±23.79 months.The male‑female ratio was 1.45:1.The survival rate was 99.00%.The disability rate was 4.52%.Univariate logistic regression identified the age group,total body surface area affected,depth of the wound,and time of intervention as statistically significant variables(P<0.05)predicting the disfigurement.Multivariate logistic regression identified the time intervals between surgical intervention and injury as an important predictor of morbidity.In addition,delayed presentation and delayed intervention led to a longer hospital stay,and more interventions than the early intervention cohort.Conclusions:Early debridement accelerates recovery and lessens the need for future skin grafts or contracture procedures.This approach can be used in rural hospitals as well because pediatric burns can be manageable in an isolated general ward.展开更多
BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improp...BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improper treatment,and subsequent morbidity and mortality.AIM To determine the clinico-demographic profile,radiological and operative findings,and postoperative course of patients with IH and its association with SBO.METHODS Medical records of 586 patients with features of SBO presenting at a tertiary care centre at Lucknow,India between September 2010 and August 2023 were reviewed.RESULTS Out of 586 patients,7(1.2%)were diagnosed with IH.Among these,4 had congenital IH and 3 had acquired IH.The male-to-female ratio was 4:3.The median age at presentation was 32 years.Contrast-enhanced computed tomography(CECT)was the most reliable investigation for preoperative identification,demonstrating mesenteric whirling and clumped-up bowel loops.Left paraduodenal hernia and transmesenteric hernia occurred with an equal frequency(approximately 43%each).Intraoperatively,one patient was found to have bowel ischemia and one had associated malrotation of gut.During follow-up,no recurrences were reported.CONCLUSION IH,being a rare cause,must be considered as a differential diagnosis for SBO,especially in young patients in their 30s or with unexplained abdominal pain or discomfort post-surgery.A rapid imaging evaluation,preferably with CECT,is necessary to aid in an early diagnosis and prompt intervention,thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel.展开更多
The endothelium modulates vascular homeostasis owing to a variety of vasoconstrictors and vasodilators.Endothelial dysfunction(ED),characterized by impaired vasodilation,inflammation,and thrombosis,triggers future car...The endothelium modulates vascular homeostasis owing to a variety of vasoconstrictors and vasodilators.Endothelial dysfunction(ED),characterized by impaired vasodilation,inflammation,and thrombosis,triggers future cardiovascular(CV)diseases.Chronic kidney disease,a state of chronic inflammation caused by oxidative stress,metabolic abnormalities,infection,and uremic toxins damages the endothelium.ED is also associated with a decline in estimated glomerular filtration rate.After kidney transplantation,endothelial functions undergo immediate but partial restoration,promising graft longevity and enhanced CV health.However,the anticipated CV outcomes do not happen due to various transplant-related and unrelated risk factors for ED,culminating in poor CV health and graft survival.ED in kidney transplant recipients is an underrecognized and poorly studied entity.CV diseases are the leading cause of death among kidney transplant candidates with functioning grafts.ED contributes to the pathogenesis of many of the CV diseases.Various biomarkers and vasoreactivity tests are available to study endothelial functions.With an increasing number of transplants happening every year,and improved graft rejection rates due to the availability of effective immunosuppressants,the focus has now shifted to endothelial protection for the prevention,early recognition,and treatment of CV diseases.展开更多
Chemotherapy-induced intestinal mucositis(IM)is a prevalent complication affecting up to 80%of cancer patients undergoing treatment.Current therapies focus on symptomatic relief rather than addressing the underlying m...Chemotherapy-induced intestinal mucositis(IM)is a prevalent complication affecting up to 80%of cancer patients undergoing treatment.Current therapies focus on symptomatic relief rather than addressing the underlying mechanism.Recent advances in integrative medicine highlight the potential of traditional Chinese medicine formulations as alternatives or adjuncts to existing therapies.In this context,this editorial discusses the recent results of a study published by Qiu et al,which investigates the multifaceted potential of modified Pulsatilla decoction(PD),a formulation of PD with licorice(Glycyrrhiza uralensis)and Ejiao(Colla corii asini),on 5-fluorouracil-induced IM in mice to alleviate clinical symptoms including diarrhea,weight loss,and intestinal damage.A series of histological,biochemical,bioinformatic,and microbiological assays evaluated body weight,diarrhea scores,inflammatory cytokine profiles,oxidative stress modulation,and microbiota composition.The findings indicated a reduction in diarrhea and oxidative stress,as well as an improvement in body weight and intestinal histopathology.Furthermore,the modified PD suppressed the TLR4/MyD88/nuclear factor kappa-B inflammatory pathway and down-regulated key proinflammatory cytokines.Moreover,the study underscores the role of gut microbiota in IM pathogenesis.Modified PD treatment reshaped microbial diversity by promoting beneficial genera such as Bacteroides acidifaciens while suppressing pathogenic species like Salmonella.These findings suggest that the therapeutic effects of the modified PD extend beyond inflammation modulation to encompass microbiome reprogramming and mucosal barrier repair.Although the study provides significant insights,several limitations still prevail.The broader implications of modified PD in gastrointestinal disorders and integrative oncology need further exploration.展开更多
The study by Cao et al aimed to identify early second-trimester biomarkers that could predict gestational diabetes mellitus(GDM)development using advanced proteomic techniques,such as Isobaric tags for relative and ab...The study by Cao et al aimed to identify early second-trimester biomarkers that could predict gestational diabetes mellitus(GDM)development using advanced proteomic techniques,such as Isobaric tags for relative and absolute quantitation isobaric tags for relative and absolute quantitation and liquid chromatography-mass spectrometry liquid chromatography-mass spectrometry.Their analysis revealed 47 differentially expressed proteins in the GDM group,with retinol-binding protein 4 and angiopoietin-like 8 showing significantly elevated serum levels compared to controls.Although these findings are promising,the study is limited by its small sample size(n=4 per group)and lacks essential details on the reproducibility and reliability of the protein quantification methods used.Furthermore,the absence of experimental validation weakens the interpretation of the protein-protein interaction network identified through bioinformatics analysis.The study's focus on second-trimester biomarkers raises concerns about whether this is a sufficiently early period to implement preventive interventions for GDM.Predicting GDM risk during the first trimester or pre-conceptional period may offer more clinical relevance.Despite its limitations,the study presents valuable insights into potential GDM biomarkers,but larger,well-validated studies are needed to establish their predictive utility and generalizability.展开更多
To effectively regulate the grain boundary infiltration in CoCrFeMnNi high-entropy alloy(Cantor alloys,HEA)caused by the violent atomic interdiffusion,the higher configuration entropy on Cantor alloys surface was desi...To effectively regulate the grain boundary infiltration in CoCrFeMnNi high-entropy alloy(Cantor alloys,HEA)caused by the violent atomic interdiffusion,the higher configuration entropy on Cantor alloys surface was designed and realized via eutectic high-entropy(EHEA)transformation.Meanwhile,to effectively alleviate the residual stress caused by the notable difference in the thermal expansion coefficient(CTE)between Cantor alloys and Zr-3 alloys,a cladding layer was applied to the HEA surface using laser cladding technology of Nb,followed by brazing to Zr-3 alloys with Zr63.2Cu filler.The cladding layer’s microstructure comprised Nbss and FCC+(Co,Ni)_(2) Nb eutectic structure,resulting from an in-situ reaction between Cantor alloys and Nb.The Nbss and FCC demonstrated good plasticity,and the(Co,Ni)_(2) Nb Laves phase provided increased strength,endowing both good plastic deformation ability and strength of the cladding layer.Notably,the existence of EHEA in the laser cladding layer made the Cantor alloy entropy from 1.61 R to 1.77 R,greatly enhancing its thermal stability and suppressing the grave grain boundary infiltration.Joints produced via laser cladding with Nb-assisted brazing exhibited a complex microstructure(HEA/Nbss+FCC+(Co,Ni)_(2)Nb/(Zr,Nb)(Cr,Mn)_(2)+(Zr,Nb)ss/(Zr,Nb)_(2)(Cu,Ni,Co,Fe)+(Zr,Nb)(Cr,Mn)_(2)+(Zr,Nb)ss/Zr-3) and a significantly improved shear strength of 242.8 MPa at 1010℃ for 10 min,42.4%higher than that of directly brazed joints.This improvement was attributed to reduced grain boundary infiltration,alleviated residual stress due to CTE disparity,and eliminated micro-cracks in the brazing seam.This study presents an effective solution for reducing residual stresses and achieving reliable bonding between Cantor alloys and Zr-3 alloys,with potential applications in brazing CoCrFeNi-based HEA and Zr-3 due to the beneficial eutectic reaction between CoCrFeNi and Nb.展开更多
Large interfacial strains in particles are crucial for promoting bonding in cold spraying(CS),initiated either by adiabatic shear instability(ASI)due to softening prevailing over strain hardening or by hydrostatic pla...Large interfacial strains in particles are crucial for promoting bonding in cold spraying(CS),initiated either by adiabatic shear instability(ASI)due to softening prevailing over strain hardening or by hydrostatic plasticity,which is claimed to promote bonding even without ASI.A thorough microstructural analysis is vital to fully understand the bonding mechanisms at play during microparticle impacts and throughout the CS process.In this study,the HEA CoCrFeMnNi,known for its relatively high strain hardening and resistance to softening,was selected to investigate the microstructure characteristics and bonding mech-anisms in CS.This study used characterization techniques covering a range of length scales,including electron channeling contrast imaging(ECCI),electron backscatter diffraction(EBSD),and high-resolution transmission microscopy(HR-TEM),to explore the microstructure characteristics of bonding and overall structure development of CoCrFeMnNi microparticles after impact in CS.HR-TEM lamellae were prepared using focused ion beam milling.Additionally,the effects of deformation field variables on microstructure development were determined through finite element modeling(FEM)of microparticle impacts.The ECCI,EBSD,and HR-TEM analyses revealed an interplay between dislocation-driven processes and twinning,leading to the development of four distinct deformation microstructures.Significant grain refinement occurs at the interface through continuous dynamic recrystallization(CDRX)due to high strain and temperature rise from adiabatic deformation,signs of softening,and ASI.Near the interface,a necklace-like structure of refined grains forms around grain boundaries,along with elongated grains,resulting from the coexistence of dynamic recovery and discontinuous dynamic recrystallization(DDRX)due to lower temperature rise and strain.Towards the particle or substrate interior,concurrent twinning and dislocation-mediated mechanisms refine the structure,forming straight,curved,and intersected twins.At the top of the particles,only deformed grains with a low dislocation density are observed.Our results showed that DRX induces microstructure softening in highly strained interface areas,facilitating atomic bonding in CoCrFeMnNi.HR-TEM investigation confirms the formation of atomic bonds between particles and substrate,with a gradual change in crystal lattice orientation from the particle to the substrate and the occurrence of some misfit dislocations and vacancies at the interface.Finally,the findings of this research suggest that softening and ASI,even in materials resistant to softening,are required to establish bonding in CS.展开更多
Lightweight,high-strength,and heat-resistant protective structures have consistently been crucial for applications in extreme environments,such as aerospace,semiconductors,and nuclear power industries.Multilayered TC4...Lightweight,high-strength,and heat-resistant protective structures have consistently been crucial for applications in extreme environments,such as aerospace,semiconductors,and nuclear power industries.Multilayered TC4/TB8 titanium(Ti)laminates,inspired by theheterostructures of natural biological shells,were fabricated using a hybrid diffusion bonding-hot rolling process followed by an aging treatment,resulting in an architected micro structure.The laminate achieves an ultra-high yield stress of 1020 MPa and proper uniform elongation of 4.2%at 500℃.The TB8 layers with high-density nano-precipitates and dislocations act as hard zone,contributing to high strength.The TC4 layers,with their bimodal structure consisting of coarse and fine grains characterized by equiaxed and lamellar structures,experience more plastic strain than the TB8 layers.The hetero deformation associated with the detwinning ofαgrains in the TC4 layer induces toughening at high temperatures.展开更多
The use of virtual reality to educate preoperative patients has a positive impact on nurses as well as patients undergoing treatment.It can help improve patient satisfaction and improve favorable outcomes by reducing ...The use of virtual reality to educate preoperative patients has a positive impact on nurses as well as patients undergoing treatment.It can help improve patient satisfaction and improve favorable outcomes by reducing patient anxiety and proving adequate knowledge about the procedure and possible outcomes to the patient.It also reduces burden on nursing staff and counsellors.Larger and more diverse cohort studies will help us understand the wider application of this tool on the patient population.It may be difficult to apply this tool on elderly patients with failing eyesight,multiple physical comorbidities.Also,there may be reduced acceptance of this modality by older nursing staff and practitioners who may prefer the traditional verbal version for counselling.We will benefit from a combined approach of using virtual reality apps with tradition one-on-one counselling to help alleviate patient concerns and improve patient and healthcare professional satisfaction.展开更多
BACKGROUND 2D-echocardiography(2DE)has been the primary imaging modality in children with Kawasaki disease(KD)to assess coronary arteries.AIM To report the presence and implications of incidental congenital coronary a...BACKGROUND 2D-echocardiography(2DE)has been the primary imaging modality in children with Kawasaki disease(KD)to assess coronary arteries.AIM To report the presence and implications of incidental congenital coronary artery anomalies that had been misinterpreted as coronary artery abnormalities(CAAs)on 2DE.METHODS Records of children diagnosed with KD,who underwent computed tomography coronary angiography(CTCA)at our center between 2013-2023 were reviewed.We identified 3 children with congenital coronary artery anomalies in this cohort on CTCA.Findings of CTCA and 2DE were compared in these 3 children.RESULTS Of the 241 patients with KD who underwent CTCA,3(1.24%)had congenital coronary artery anomalies on CTCA detected incidentally.In all 3 patients,baseline 2DE had identified CAAs.CTCA was then performed for detailed evaluation as per our unit protocol.One(11-year-boy)amongst the 3 patients had complete KD,while the other two(3.3-year-boy;4-month-girl)had incomplete KD.CTCA revealed separate origins of left anterior descending artery and left circumflex from left sinus[misinterpreted as dilated left main coronary artery(LCA)on 2DE],single coronary artery(interpreted as dilated LCA on 2DE)and dilated right coronary artery on 2DE in case of anomalous origin of LCA from the main pulmonary artery.The latter one was subsequently operated upon.CONCLUSION CTCA is essential for detailed assessment of coronary arteries in children with KD especially in cases where there is suspicion of congenital coronary artery anomalies.Relying solely on 2DE may not be sufficient in such cases,and findings from CTCA can significantly impact therapeutic decision-making.展开更多
Male breast disorders,though less prevalent,present unique diagnostic cha-llenges that differ significantly from their female counterparts.While benign entities such as gynecomastia are predominant,the risk of underly...Male breast disorders,though less prevalent,present unique diagnostic cha-llenges that differ significantly from their female counterparts.While benign entities such as gynecomastia are predominant,the risk of underlying malig-nancy,often diagnosed at an advanced stage,highlights the need for a systematic,image-guided assessment.Ultrasound and mammography are the first-line complementary tools,with magnetic resonance imaging reserved for problem-solving.This review outlines the anatomical,pathological,and radiological nu-ances of the male breast,describing crucial red flag signs,sonographic pitfalls,and mammographic mimics that aid in distinguishing benign entities from si-nister pathologies such as invasive ductal carcinoma.Given the increasing visi-bility of transgender individuals,this review also addresses imaging consider-ations and screening recommendations tailored to this population.By integrating clinical insights with radiologic imaging,this review offers a comprehensive approach to both common and not-so-common male breast lesions,with an em-phasis on an algorithmic stepwise diagnostic approach.展开更多
文摘The etiopathogenesis of gastrointestinal diseases is varied in nature.Various etiogenic factors described are infective,inflammatory,viral,bacterial,parasitic,dietary and lifestyle change.Rare causative agents are immunological,and others associated as idiopathic,are undiagnosed by all possible means.Some of the rare diseases are congenital in nature,passing from the parent to the child.Many of the undiagnosed diseases are now being diagnosed as genetic and the genes have been implicated as a causative agent.There is a search for newer treatments for such diseases,which is called genomic medicine.Genomic medicine is an emerging medical discipline that involves the use of genomic information about an individual.This is used both for diagnostic as well as therapeutic decisions to improve the current health domain and pave the way for policymakers for its clinical use.In the developing era of precision medicine,genomics,epigenomics,environmental exposure,and other data would be used to more accurately guide individual diagnosis and treatment.Genomic medicine is already making an impact in the fields of oncology,pharmacology,rare,infectious and many undiagnosed diseases.It is beginning to fuel new approaches in certain medical specialties.Oncology is at the leading edge of incorporating genomics,as diagnostics for genetic and genomic markers are increasingly included in cancer screening,and to guide tailored treatment strategies.Genetics and genetic medicine have been reported to play a role in gastroenterology in several ways,including genetic testing(hereditary pancreatitis and hereditary gastrointestinal cancer syndromes).Genetic testing can also help subtype diseases,such as classifying pancreatitis as idiopathic or hereditary.Gene therapy is a promising approach for treating gastrointestinal diseases that are not effectively treated by conventional pharmaceuticals and surgeries.Gene therapy strategies include gene addition,gene editing,messenger RNA therapy,and gene silencing.Understanding genetic determinants,advances in genetics,have led to a better understanding of the genetic factors that contribute to human disease.Family-member risk stratification and genetic diagnosis can help identify family members who are at risk,which can lead to preventive treatments,lifestyle recommendations,and routine follow ups.Selecting target genes helps identify the gene targets associated with each gastrointestinal disease.Common gastrointestinal diseases associated with genetic abnormalities include-inflammatory bowel disease,gastroesophageal reflux disease,non-alcoholic fatty liver disease,and irritable bowel syndrome.With advancing tools and technology,research in the search of newer and individualized treatment,genes and genetic medicines are expected to play a significant role in human health and gastroenterology.
文摘BACKGROUND Drug utilization research has an important role in assisting the healthcare administration to know,compute,and refine the prescription whose principal objective is to enable the rational use of drugs.Research in developing nations relating to the cost of treatment is scarce when compared with developed countries.Thus,the drug utilization research studies from developing nations are most needed,and their number has been growing.AIM To evaluate patterns of utilization of antipsychotic drugs and direct medical cost analysis in patients newly diagnosed with schizophrenia.METHODS The present study was observational in type and based on a retrospective cohort to evaluate patterns of utilization of antipsychotic drugs using World Health Organization(WHO)core prescribing indicators and anatomical therapeutic chemical/defined daily dose indicators.We also calculated direct medical costs for a period of 6 months.RESULTS This study has found that atypical antipsychotics are the mainstay of treatment for schizophrenia in every age group and subcategories of schizophrenia.The evaluation based on WHO prescribing indicators showed a low average number of drugs per prescription and low prescribing frequency of antipsychotics from the National List of Essential Medicines 2015 and the WHO Essential Medicines List 2019.The total mean drug cost of our study was 1396 Indian rupees.The total mean cost due to the investigation in our study was 1017.34 Indian rupees.Therefore,the total mean direct medical cost incurred on patients in our study was 4337.28 Indian rupees.CONCLUSION The information from the present study can be used for reviewing and updating treatment policy at the institutional level.
基金Supported by National Science and Technology Council,Taiwan,No.MOST 111-2629-H-227-001-MY2.
文摘BACKGROUND Intimate partner violence(IPV)is a major public health concern linked to psychiatric and physical morbidity.However,evidence from East Asia,particularly from registry-based and sex-inclusive analyses,remains limited.We hypothesized that IPV survivors would have elevated risks of psychiatric disorders and stressrelated physical conditions.AIM To assess psychiatric and physical health risks following IPV exposure in Taiwan.METHODS We conducted a nationwide,registry-based case control study using data from Taiwan’s Health and Welfare Data Science Center.Adults aged 18-64 years with a first IPV report in 2019(n=43393)were matched 1:1 by sex and age to controls.Incident diagnoses within 1 year were identified from claims data.Conditional logistic regression was used to estimate adjusted odds ratios(AORs).RESULTS Compared to controls,IPV survivors had higher risks of depressive disorders[AOR=4.18,95%confidence interval(CI):3.78-4.60,P<0.001],bipolar disorder(AOR=4.81,95%CI:3.83-6.10,P<0.001),schizophrenia(AOR=1.75,95%CI:1.46-2.10,P<0.001),and alcohol/substance use disorders(AOR=5.98,95%CI:2.21-8.50,P<0.001).The risk of asthma was modestly elevated(AOR=1.31,95%CI:1.08-1.60,P=0.006).No significant association was observed for irritable bowel syndrome(P=0.94).CONCLUSION IPV survivors in Taiwan face substantially increased psychiatric risk and a modestly elevated risk of asthma,warranting early screening and integrated mental and physical health care.
基金Egyptian Science and Technology and Innovation Fund(STIFA)for the support of the study through grant No.46667 entitled“Sustainability of Lab Capacities of the Center of Drug Discovery Research and Development”.
文摘Background:Corchorus olitorius L.(Malvaceae)is a green leafy vegetable widely consumed in the Middle East and valued for its rich nutritional content.Its essential oils,an important class of secondary metabolites,are of growing interest for potential use in cosmetics and fragrance industries due to their bioactive properties.Methods:Leaves of C.olitorius cultivated in Egypt were extracted using microwave-assisted hydrodistillation(MAHD)and conventional hydrodistillation(HD).The oils were analyzed by gas chromatography-mass spectrometry(GC-MS)to characterize their chemical profiles.In vitro assays were conducted to evaluate their anti-elastase and anti-collagenase activities,and in silico studies were performed to predict the pharmacokinetic and pharmacodynamic properties of major constituents.Results:GC-MS analysis showed that aldehydes,alkanes,fatty alcohols,fatty acids,and their derivatives were the predominant compound classes in both oils.Notably,oxygenated diterpenes(11.22%)were present exclusively in the MAHD oil,while triterpenoids(16.37%)were found only in the HD oil.The MAHD oil demonstrated stronger In vitro anti-elastase(IC_(50)=42.5μg/mL)and anti-collagenase(IC_(50)=131.5μg/mL)activities compared to the HD oil(IC_(50)=66.7 and 206.8μg/mL,respectively),reflecting an approximate 36.3%improvement in elastase inhibition and 36.4%improvement in collagenase inhibition.In silico docking indicated that the triterpenoidβ-amyrin acetate showed the highest predicted binding affinity for porcine pancreatic elastase(PDB ID:6QEO,ΔG=−8.1 kcal/mol)and collagenase(PDB ID:456C,ΔG=−9.1 kcal/mol)among the major compounds analyzed.Conclusion:These findings demonstrate that MAHD is a greener and more efficient extraction method,yielding oil with enhanced enzyme inhibitory activity compared to conventional HD.The promising anti-elastase and anti-collagenase properties suggest that C.olitorius MAHD oil could serve as a potential candidate for anti-aging cosmetic formulations,following further validation.
基金the Ministry of Science and Technology Taiwan,No.MOST 109-2314-B-182A-091,No.NSTC 112-2314-B-182A-062, No.NSTC 113-2314-B-182A-125.
文摘BACKGROUND The incidence of diabetic atherosclerosis(DMA)is increasing worldwide,but its pathogenesis remains incompletely understood.In addition to cardiovascular complications,bladder dysfunction is one of the common comorbidities associated with DMA but is often refractory to current treatments.AIM To investigate the therapeutic effect of human amniotic fluid stem cell-derived extracellular vesicles(hAFSC-EVs)on the recovery of bladder dysfunction in DMA rats.METHODS Eighty rats were divided into normal control,streptozotocin-induced diabetic rats,diabetic rats subjected to arterial balloon endothelial injury of common iliac artery(DMA),and DMA rats treated with hAFSC-EVs(DMA+hAFSC-EVs).At 4 weeks and 12 weeks after DMA induction,levels of blood glucose,total cholesterol,triglyceride,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,homeostasis model assessment(HOMA)-insulin resistance,and HOMA-βwere measured.Cystometry,common iliac artery wall thickness,and bladder tumor necrosis factor(TNF)-α,interleukin(IL)-6,transforming growth factor(TGF)-β1,Smad3,connective tissue growth factor(CTGF)and fibronectin were also evaluated.RESULTS Bladder weight and blood glucose,triglyceride,HOMA-insulin resistance,common iliac artery intima thickness,voided volume,intercontraction interval,bladder capacity,and mRNA expression of TNF-α,IL-6,TGF-β1,Smad3,CTGF and fibronectin were significantly increased at 4 weeks and 12 weeks after induction,while the HOMA-βlevel decreased at 4 weeks and 12 weeks,and the high-density lipoprotein cholesterol level decreased at 12 weeks.hAFSC-EVs treatment in DMA rats significantly reduced bladder weight and blood glucose,thickness of common iliac arterial intima,voided volume,intercontraction interval and bladder capacity at 4 weeks.The mRNA expression of TNF-α,TGF-β1,and CTGF in DMA rats treated with hAFSC-EVs were significantly decreased at 4 weeks,while the mRNA expressions of IL-6 and Smad3 were significantly decreased 12 weeks.CONCLUSION hAFSC-EVs treatment can help restore DMA-induced bladder dysfunction,which is associated with lowered blood glucose levels,reduced arterial wall thickness,and decreased TNF-α,IL-6,TGF-β1,Smad3,and CTGF expression.
基金financial support fromthe Chung Shan Medical University Hospital,Taiwan(CSH-2022-A-009).
文摘Background:To determine whether initiating a glucagon-like peptide-1 receptor agonist(GLP-1 RA)within 3 months of type 2 diabetes(T2DM)diagnosis alters the subsequent risk of overall and site-specific cancer and whether this association differs by baseline body-mass index(BMI).Methods:This retrospective cohort study used electronic health records from the TriNetX U.S.research network.Adults aged 20 years or older diagnosed with T2DM between 2016 and 2024 were included if they received any hypoglycemic agents within 3 months before and after diagnosis.Following 1:1 propensity score matching,both the GLP-1 RA user and non-user groups included 183,264 patients.The study outcome was defined as a diagnosis of malignant neoplasms.Hazard ratios(HRs)for overall and site-specific cancer risk were estimated using Cox proportional hazards models.Kaplan–Meier analysis and stratified analysis by BMI were performed.Results:Early GLP-1 RA use demonstrated a modest but significant association with reduced overall cancer risk(HR 0.93;95%CI:0.90–0.96).Reduced risks were noted for cancers of the digestive(HR 0.81),respiratory(HR 0.66),and female genital(HR 0.87)systems.In stratified analysis,benefits were more pronounced in patients with BMI≥30,particularly for pancreatic and colorectal cancers.Conclusion:Early initiation of GLP-1 receptor agonists in patients with diagnosed T2DM was associated with a modest reduction in overall cancer risk,particularly among individuals with obesity.These findings highlight the dual metabolic and oncologic value of prompt GLP-1 RA therapy.
文摘Kidney transplantation(KT)accounts for nearly three-fourths of organ transplants in India,with living donors contributing to 82%of cases.Induction immunosuppression is essential to optimize initial immunosuppression,reduce acute rejections,and enable tailored use of maintenance agents.Rabbit anti-thymocyte globulin(rATG)and interleukin-2 receptor anatagonists(IL-2RA/IL-2RBs)are the most widely used induction therapies.However,data on induction practices across India are limited.To evaluate induction immunosuppression practices across KT centers in India and establish a consensus for different subsets of KT recipients.A nationwide online survey was conducted by the Indian Society of Organ Transplantation(ISOT)among its members(400 KT centers).Responses were analyzed to assess induction practices across diverse donor types,age groups,and immunological risk profiles.Heterogeneity in practices prompted consensus building using a modified Delphi process.Literature review and expert panel discussions(April 2024)were followed by structured voting,and 16 consensus statements were finalized.Of 400 centers approached,254 participated.rATG was the most commonly used induction therapy,followed by IL-2RBs;alemtuzumab was least used.Significant heterogeneity was observed in type,dose,and duration of induction therapy.Consensus recommendations were framed:rATG for high immunological risk recipients and deceased donor KTs;IL-2RB or low-dose rATG for low immunological risk;rituximab in ABOincompatible KTs;and tailoring based on age,diabetes,donor type,infection risk,and affordability.This first ISOT consensus provides 16 India-specific statements on induction therapy in KT.It emphasizes risk-stratified,evidenceinformed,and context-appropriate induction strategies,supporting standardization of care across the country.
文摘BACKGROUND: As per the "Disaster Management Act, 2005" of India, it is mandatory for government hospitals in India to prepare a disaster plan. This study aimed to prepare a disaster manual of a 1 900 bed tertiary care hospital, in consultation and involvement of all concerned stakeholders.METHODS: A committee of members from hospital administration, clinical, diagnostic and supportive departments worked on an initial document prepared according to the Act and gave their inputs to frame a final disaster manual.RESULTS: The prepared departmental standard operating procedures involved 116 people(doctors and paramedical staff), and were then synchronized, in 12 committee meetings, to produce the final hospital disaster manual.CONCLUSIONS: The present disaster manual is one of the few comprehensive plans prepared by the stakeholders of a government hospital in India, who themselves form a part of the disaster response team. It also helped in co-ordinated conduction of mock drills.
基金supported by Fundamental Research Funds for the Central Universities in China(Grant Number:2022NTSS52)First-Class Education Discipline Development of Beijing Normal University:Excellence Action Project(Grant Number:YLXKPYXSDW202408)Beijing Institute of Education 2024 Youth Research Projects“Research on the Transformation of Training Aimed at Improving the Work of School Principals in the Capital”(Grant Number:QZ2024-02).
文摘Background:With the global popularity of short videos,particularly among young people,short video addiction has become a worrying phenomenon that poses significant risks to individual health and adaptability.Self-regulated learning(SRL)strategies are key factors in predicting learning outcomes.This study,based on the SRL theory,uses short video addiction as the independent variable,SRL strategies as the mediating variable,and learning well-being as the outcome variable,aiming to reveal the relationships among short video addiction,self-regulated learning,and learning well-being among Chinese college students.Methods:Using a cross-sectional study design and applying the snowball sampling technique,an online survey was administered to Chinese undergraduate students.A total of 706 valid questionnaires were collected,with an effective response rate of 85.7%.The average age of the participants was 20.5 years.Results:The results of structural equation modeling indicate that 7 hypotheses were supported.Short video addiction was negatively correlated with self-regulated learning strategies(preparatory,performance,and appraisal strategy),while SRL strategies were positively correlated with learning well-being.Additionally,short video addiction had a mediating effect on learning well-being through the three types of SRL strategies.The three types of SRL strategies explained 39%of the variance in learning well-being.Conclusion:Previous research has typically focused on the impact of self-regulated learning strategies on media addiction or problematic media use.This study,based on the SRL model,highlights the negative issues caused by short video addiction and emphasizes the importance of cultivating self-regulation abilities and media literacy.Short video addiction stems from failures in trait self-regulation,which naturally impairs the ability to effectively engage in self-regulation during the learning process.This study confirms and underscores that the SRL model can serve as an effective theoretical framework for helping students prevent short video addiction,engage in high-quality learning,and consequently enhance their learning well-being.
文摘Objective:Pediatric burns pose difficult healthcare issues in underdeveloped nations.Due to the scarcity of pediatric burn care facilities and qualified burn‑care staff,patients are frequently referred from a rural hospital.This study explores the burn‑treatment approach that could be used in rural hospitals in the absence of a dedicated pediatric burn care facility.Materials and Methods:A retrospective analysis of clinical data of 199 children who received treatment for burn‑injury in an isolated general surgical ward.Wound debridement under anesthesia at the earliest was the cornerstone of the treatment plan for this cohort.Until the wounds healed,the treatment was repeated every alternate day.The patient’s demographic data,number of surgical dressings,length of hospital stay,and outcome were analyzed.Results:The mean age of the patients was 51.68±23.79 months.The male‑female ratio was 1.45:1.The survival rate was 99.00%.The disability rate was 4.52%.Univariate logistic regression identified the age group,total body surface area affected,depth of the wound,and time of intervention as statistically significant variables(P<0.05)predicting the disfigurement.Multivariate logistic regression identified the time intervals between surgical intervention and injury as an important predictor of morbidity.In addition,delayed presentation and delayed intervention led to a longer hospital stay,and more interventions than the early intervention cohort.Conclusions:Early debridement accelerates recovery and lessens the need for future skin grafts or contracture procedures.This approach can be used in rural hospitals as well because pediatric burns can be manageable in an isolated general ward.
文摘BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improper treatment,and subsequent morbidity and mortality.AIM To determine the clinico-demographic profile,radiological and operative findings,and postoperative course of patients with IH and its association with SBO.METHODS Medical records of 586 patients with features of SBO presenting at a tertiary care centre at Lucknow,India between September 2010 and August 2023 were reviewed.RESULTS Out of 586 patients,7(1.2%)were diagnosed with IH.Among these,4 had congenital IH and 3 had acquired IH.The male-to-female ratio was 4:3.The median age at presentation was 32 years.Contrast-enhanced computed tomography(CECT)was the most reliable investigation for preoperative identification,demonstrating mesenteric whirling and clumped-up bowel loops.Left paraduodenal hernia and transmesenteric hernia occurred with an equal frequency(approximately 43%each).Intraoperatively,one patient was found to have bowel ischemia and one had associated malrotation of gut.During follow-up,no recurrences were reported.CONCLUSION IH,being a rare cause,must be considered as a differential diagnosis for SBO,especially in young patients in their 30s or with unexplained abdominal pain or discomfort post-surgery.A rapid imaging evaluation,preferably with CECT,is necessary to aid in an early diagnosis and prompt intervention,thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel.
文摘The endothelium modulates vascular homeostasis owing to a variety of vasoconstrictors and vasodilators.Endothelial dysfunction(ED),characterized by impaired vasodilation,inflammation,and thrombosis,triggers future cardiovascular(CV)diseases.Chronic kidney disease,a state of chronic inflammation caused by oxidative stress,metabolic abnormalities,infection,and uremic toxins damages the endothelium.ED is also associated with a decline in estimated glomerular filtration rate.After kidney transplantation,endothelial functions undergo immediate but partial restoration,promising graft longevity and enhanced CV health.However,the anticipated CV outcomes do not happen due to various transplant-related and unrelated risk factors for ED,culminating in poor CV health and graft survival.ED in kidney transplant recipients is an underrecognized and poorly studied entity.CV diseases are the leading cause of death among kidney transplant candidates with functioning grafts.ED contributes to the pathogenesis of many of the CV diseases.Various biomarkers and vasoreactivity tests are available to study endothelial functions.With an increasing number of transplants happening every year,and improved graft rejection rates due to the availability of effective immunosuppressants,the focus has now shifted to endothelial protection for the prevention,early recognition,and treatment of CV diseases.
文摘Chemotherapy-induced intestinal mucositis(IM)is a prevalent complication affecting up to 80%of cancer patients undergoing treatment.Current therapies focus on symptomatic relief rather than addressing the underlying mechanism.Recent advances in integrative medicine highlight the potential of traditional Chinese medicine formulations as alternatives or adjuncts to existing therapies.In this context,this editorial discusses the recent results of a study published by Qiu et al,which investigates the multifaceted potential of modified Pulsatilla decoction(PD),a formulation of PD with licorice(Glycyrrhiza uralensis)and Ejiao(Colla corii asini),on 5-fluorouracil-induced IM in mice to alleviate clinical symptoms including diarrhea,weight loss,and intestinal damage.A series of histological,biochemical,bioinformatic,and microbiological assays evaluated body weight,diarrhea scores,inflammatory cytokine profiles,oxidative stress modulation,and microbiota composition.The findings indicated a reduction in diarrhea and oxidative stress,as well as an improvement in body weight and intestinal histopathology.Furthermore,the modified PD suppressed the TLR4/MyD88/nuclear factor kappa-B inflammatory pathway and down-regulated key proinflammatory cytokines.Moreover,the study underscores the role of gut microbiota in IM pathogenesis.Modified PD treatment reshaped microbial diversity by promoting beneficial genera such as Bacteroides acidifaciens while suppressing pathogenic species like Salmonella.These findings suggest that the therapeutic effects of the modified PD extend beyond inflammation modulation to encompass microbiome reprogramming and mucosal barrier repair.Although the study provides significant insights,several limitations still prevail.The broader implications of modified PD in gastrointestinal disorders and integrative oncology need further exploration.
文摘The study by Cao et al aimed to identify early second-trimester biomarkers that could predict gestational diabetes mellitus(GDM)development using advanced proteomic techniques,such as Isobaric tags for relative and absolute quantitation isobaric tags for relative and absolute quantitation and liquid chromatography-mass spectrometry liquid chromatography-mass spectrometry.Their analysis revealed 47 differentially expressed proteins in the GDM group,with retinol-binding protein 4 and angiopoietin-like 8 showing significantly elevated serum levels compared to controls.Although these findings are promising,the study is limited by its small sample size(n=4 per group)and lacks essential details on the reproducibility and reliability of the protein quantification methods used.Furthermore,the absence of experimental validation weakens the interpretation of the protein-protein interaction network identified through bioinformatics analysis.The study's focus on second-trimester biomarkers raises concerns about whether this is a sufficiently early period to implement preventive interventions for GDM.Predicting GDM risk during the first trimester or pre-conceptional period may offer more clinical relevance.Despite its limitations,the study presents valuable insights into potential GDM biomarkers,but larger,well-validated studies are needed to establish their predictive utility and generalizability.
基金supported by the National Natural Science Foundation of China(Grant Nos.52275321 and 52205348)the Shandong Natural Science Foundation(Grant No.ZR2023JQ021)+3 种基金the Taishan Scholars Foundation of Shandong Province(No.tsqn 201812128)the Innovation Scientists and Technicians Troop Projects of Henan Province(No.204200510031)the Heilongjiang Touyan Innovation Team Program(No.HITTY-20190013)supported by the National Research Foundation of Korea(NRF)grant funded by the Korea government(MSIP)(Nos.NRF-2021R1A2C3006662 and NRF-2022R1A5A1030054).
文摘To effectively regulate the grain boundary infiltration in CoCrFeMnNi high-entropy alloy(Cantor alloys,HEA)caused by the violent atomic interdiffusion,the higher configuration entropy on Cantor alloys surface was designed and realized via eutectic high-entropy(EHEA)transformation.Meanwhile,to effectively alleviate the residual stress caused by the notable difference in the thermal expansion coefficient(CTE)between Cantor alloys and Zr-3 alloys,a cladding layer was applied to the HEA surface using laser cladding technology of Nb,followed by brazing to Zr-3 alloys with Zr63.2Cu filler.The cladding layer’s microstructure comprised Nbss and FCC+(Co,Ni)_(2) Nb eutectic structure,resulting from an in-situ reaction between Cantor alloys and Nb.The Nbss and FCC demonstrated good plasticity,and the(Co,Ni)_(2) Nb Laves phase provided increased strength,endowing both good plastic deformation ability and strength of the cladding layer.Notably,the existence of EHEA in the laser cladding layer made the Cantor alloy entropy from 1.61 R to 1.77 R,greatly enhancing its thermal stability and suppressing the grave grain boundary infiltration.Joints produced via laser cladding with Nb-assisted brazing exhibited a complex microstructure(HEA/Nbss+FCC+(Co,Ni)_(2)Nb/(Zr,Nb)(Cr,Mn)_(2)+(Zr,Nb)ss/(Zr,Nb)_(2)(Cu,Ni,Co,Fe)+(Zr,Nb)(Cr,Mn)_(2)+(Zr,Nb)ss/Zr-3) and a significantly improved shear strength of 242.8 MPa at 1010℃ for 10 min,42.4%higher than that of directly brazed joints.This improvement was attributed to reduced grain boundary infiltration,alleviated residual stress due to CTE disparity,and eliminated micro-cracks in the brazing seam.This study presents an effective solution for reducing residual stresses and achieving reliable bonding between Cantor alloys and Zr-3 alloys,with potential applications in brazing CoCrFeNi-based HEA and Zr-3 due to the beneficial eutectic reaction between CoCrFeNi and Nb.
文摘Large interfacial strains in particles are crucial for promoting bonding in cold spraying(CS),initiated either by adiabatic shear instability(ASI)due to softening prevailing over strain hardening or by hydrostatic plasticity,which is claimed to promote bonding even without ASI.A thorough microstructural analysis is vital to fully understand the bonding mechanisms at play during microparticle impacts and throughout the CS process.In this study,the HEA CoCrFeMnNi,known for its relatively high strain hardening and resistance to softening,was selected to investigate the microstructure characteristics and bonding mech-anisms in CS.This study used characterization techniques covering a range of length scales,including electron channeling contrast imaging(ECCI),electron backscatter diffraction(EBSD),and high-resolution transmission microscopy(HR-TEM),to explore the microstructure characteristics of bonding and overall structure development of CoCrFeMnNi microparticles after impact in CS.HR-TEM lamellae were prepared using focused ion beam milling.Additionally,the effects of deformation field variables on microstructure development were determined through finite element modeling(FEM)of microparticle impacts.The ECCI,EBSD,and HR-TEM analyses revealed an interplay between dislocation-driven processes and twinning,leading to the development of four distinct deformation microstructures.Significant grain refinement occurs at the interface through continuous dynamic recrystallization(CDRX)due to high strain and temperature rise from adiabatic deformation,signs of softening,and ASI.Near the interface,a necklace-like structure of refined grains forms around grain boundaries,along with elongated grains,resulting from the coexistence of dynamic recovery and discontinuous dynamic recrystallization(DDRX)due to lower temperature rise and strain.Towards the particle or substrate interior,concurrent twinning and dislocation-mediated mechanisms refine the structure,forming straight,curved,and intersected twins.At the top of the particles,only deformed grains with a low dislocation density are observed.Our results showed that DRX induces microstructure softening in highly strained interface areas,facilitating atomic bonding in CoCrFeMnNi.HR-TEM investigation confirms the formation of atomic bonds between particles and substrate,with a gradual change in crystal lattice orientation from the particle to the substrate and the occurrence of some misfit dislocations and vacancies at the interface.Finally,the findings of this research suggest that softening and ASI,even in materials resistant to softening,are required to establish bonding in CS.
基金financially supported by the Natural Science Foundation of Changsha,China(No.kq2402015)the National Research Foundation of Korea(NRF)grant funded by the Korea government(MSIP)(Nos.NRF-2021R1A2C3006662 and NRF-2022R1A5A1030054)supported by Brain Pool Program through the NRF of Korea,funded by the Ministry of Science and ICT(No.NRF-RS_(2)02300263999)
文摘Lightweight,high-strength,and heat-resistant protective structures have consistently been crucial for applications in extreme environments,such as aerospace,semiconductors,and nuclear power industries.Multilayered TC4/TB8 titanium(Ti)laminates,inspired by theheterostructures of natural biological shells,were fabricated using a hybrid diffusion bonding-hot rolling process followed by an aging treatment,resulting in an architected micro structure.The laminate achieves an ultra-high yield stress of 1020 MPa and proper uniform elongation of 4.2%at 500℃.The TB8 layers with high-density nano-precipitates and dislocations act as hard zone,contributing to high strength.The TC4 layers,with their bimodal structure consisting of coarse and fine grains characterized by equiaxed and lamellar structures,experience more plastic strain than the TB8 layers.The hetero deformation associated with the detwinning ofαgrains in the TC4 layer induces toughening at high temperatures.
文摘The use of virtual reality to educate preoperative patients has a positive impact on nurses as well as patients undergoing treatment.It can help improve patient satisfaction and improve favorable outcomes by reducing patient anxiety and proving adequate knowledge about the procedure and possible outcomes to the patient.It also reduces burden on nursing staff and counsellors.Larger and more diverse cohort studies will help us understand the wider application of this tool on the patient population.It may be difficult to apply this tool on elderly patients with failing eyesight,multiple physical comorbidities.Also,there may be reduced acceptance of this modality by older nursing staff and practitioners who may prefer the traditional verbal version for counselling.We will benefit from a combined approach of using virtual reality apps with tradition one-on-one counselling to help alleviate patient concerns and improve patient and healthcare professional satisfaction.
文摘BACKGROUND 2D-echocardiography(2DE)has been the primary imaging modality in children with Kawasaki disease(KD)to assess coronary arteries.AIM To report the presence and implications of incidental congenital coronary artery anomalies that had been misinterpreted as coronary artery abnormalities(CAAs)on 2DE.METHODS Records of children diagnosed with KD,who underwent computed tomography coronary angiography(CTCA)at our center between 2013-2023 were reviewed.We identified 3 children with congenital coronary artery anomalies in this cohort on CTCA.Findings of CTCA and 2DE were compared in these 3 children.RESULTS Of the 241 patients with KD who underwent CTCA,3(1.24%)had congenital coronary artery anomalies on CTCA detected incidentally.In all 3 patients,baseline 2DE had identified CAAs.CTCA was then performed for detailed evaluation as per our unit protocol.One(11-year-boy)amongst the 3 patients had complete KD,while the other two(3.3-year-boy;4-month-girl)had incomplete KD.CTCA revealed separate origins of left anterior descending artery and left circumflex from left sinus[misinterpreted as dilated left main coronary artery(LCA)on 2DE],single coronary artery(interpreted as dilated LCA on 2DE)and dilated right coronary artery on 2DE in case of anomalous origin of LCA from the main pulmonary artery.The latter one was subsequently operated upon.CONCLUSION CTCA is essential for detailed assessment of coronary arteries in children with KD especially in cases where there is suspicion of congenital coronary artery anomalies.Relying solely on 2DE may not be sufficient in such cases,and findings from CTCA can significantly impact therapeutic decision-making.
文摘Male breast disorders,though less prevalent,present unique diagnostic cha-llenges that differ significantly from their female counterparts.While benign entities such as gynecomastia are predominant,the risk of underlying malig-nancy,often diagnosed at an advanced stage,highlights the need for a systematic,image-guided assessment.Ultrasound and mammography are the first-line complementary tools,with magnetic resonance imaging reserved for problem-solving.This review outlines the anatomical,pathological,and radiological nu-ances of the male breast,describing crucial red flag signs,sonographic pitfalls,and mammographic mimics that aid in distinguishing benign entities from si-nister pathologies such as invasive ductal carcinoma.Given the increasing visi-bility of transgender individuals,this review also addresses imaging consider-ations and screening recommendations tailored to this population.By integrating clinical insights with radiologic imaging,this review offers a comprehensive approach to both common and not-so-common male breast lesions,with an em-phasis on an algorithmic stepwise diagnostic approach.
