AIM: To investigate the efficacy and clinical outcome of patients treated with an over-the-scope-clip(OTSC) system for severe gastrointestinal hemorrhage, perforations and fistulas.METHODS: From 02-2009 to 10-2012, 84...AIM: To investigate the efficacy and clinical outcome of patients treated with an over-the-scope-clip(OTSC) system for severe gastrointestinal hemorrhage, perforations and fistulas.METHODS: From 02-2009 to 10-2012, 84 patients were treated with 101 OTSC clips. 41 patients(48.8%) presented with severe upper-gastrointestinal(GI) bleeding, 3(3.6%) patients with lower-GI bleeding, 7 patients(8.3%) underwent perforation closure, 18 patients(21.4%) had prevention of secondary perforation, 12 patients(14.3%) had control of secondary bleeding after endoscopic mucosal resection or endoscopic submucosal dissection(ESD) and 3 patients(3.6%) had an intervention on a chronic fistula. RESULTS: In 78/84 patients(92.8%), primary treatment with the OTSC was technically successful. Clinical primary success was achieved in 75/84 patients(89.28%). The overall mortality in the study patients was 11/84(13.1%) and was seen in patients with life threatning upper GI hemorrhage. There was no mortality in any other treatment group. In detail OTSC application lead to a clinical success in 35/41(85.36%) patients with upper GI bleeding and in 3/3 patients with lower GI bleeding. Technical success of perforation closure was 100% while clinical success was seen in 4/7 cases(57.14%) due to attendant circumstances unrelated to the OTSC. Technical and clinic success was achieved in 18/18(100%) patients for the prevention of bleeding or perforation after endoscopic mucosal resection and ESD and in 3/3 cases of fistula closure. Two application-related complications were seen(2%).CONCLUSION: This largest single center experience published so far confirms the value of the OTSC for GI emergencies and complications. Further clinical experience will help to identify optimal indications for its targeted and prophylactic use.展开更多
Among the intrinsic properties of some materials,e.g.,foams,porous materials,and granular materials,are their ability to mitigate shock waves.This paper investigated shock wave mitigation by a sandwich panel with a gr...Among the intrinsic properties of some materials,e.g.,foams,porous materials,and granular materials,are their ability to mitigate shock waves.This paper investigated shock wave mitigation by a sandwich panel with a granular core.Numerical simulations and experimental tests were performed using Autodyn hydro-code software and a shock tube,respectively.The smoothed particle hydrodynamics(SPH)method was used to model granular materials.Sawdust and pumice,whose properties were determined by several compression tests,were used as granular materials in the sandwich panel core.These granular materials possess many mechanisms,including compacting(e.g.,sawdust)and crushing(e.g.,pumice)that mitigate shock/blast wave.The results indicated the ineffectiveness of using a core with low thickness,yet it was demonstrated to be effective with high thickness.Low-thickness pumice yielded better results for wave mitigation.The use of these materials with a core with appropriate core reduces up to 88%of the shock wave.The results of the experiments and numerical simulations were compared,suggesting a good agreement between the two.This indicates the accuracy of simulation and the ability of the SPH method to modeling granular material under shock loading.The effects of grain size and the coefficient of friction between grains have also been investigated using simulation,implying that increasing the grain size and coefficient of friction between grains both reduce overpressure.展开更多
Induction of tolerance remains a major goal in transplantation. Indeed, despite potent immunosuppression, chronic rejection is still a real problem in transplantation. The humoral response is an important mediator of ...Induction of tolerance remains a major goal in transplantation. Indeed, despite potent immunosuppression, chronic rejection is still a real problem in transplantation. The humoral response is an important mediator of chronic rejection, and numerous strategies have been developed to target either B cells or plasma cells. However, the use of anti-CD20 therapy has highlighted the beneficial role of subpopulation of B cells, termed regulatory B cells. These cells have been characterized mainly in mice models of auto-immune diseases but emerging literature suggests their role in graft tolerance in transplantation. Regulatory B cells seem to be induced following inflammation to restrain excessive response. Different phenotypes of regulatory B cells have been described and are functional at various differentiation steps from immature to plasma cells. These cells act by multiple mechanisms such as secretion of immuno-suppressive cytokines interleukin-10(IL-10) or IL-35, cytotoxicity, expression of inhibitory receptors or by secretion of non-inflammatory antibodies. Better characterization of the development, phenotype and mode of action of these cells seems urgent to develop novel approaches to manipulate the different B cell subsets and the response to the graft in a clinical setting.展开更多
Biliary complications(BC) currently represent a major source of morbidity after liver transplantation. Although refinements in surgical technique and medical therapy have had a positive influence on the reduction of p...Biliary complications(BC) currently represent a major source of morbidity after liver transplantation. Although refinements in surgical technique and medical therapy have had a positive influence on the reduction of postoperative morbidity, BC affect 5% to 25% of transplanted patients. Bile leak and anastomotic strictures represent the most common complications. Nowadays, a multidisciplinary approach is required to manage such complications in order to prevent liver failure and retransplantation.展开更多
Atrial fibrillation prevalence is increasing with age, reaching up to 5% of patients older than 65 years, and is associated with 20%-30% of stroke episodes in that population.
Cardiac resynchronization therapy(CRT)has been shown to improve symptoms,left ventricle(LV)performance and long-term survival in patients with heart failure with re-duced ejection fraction(HFrEF)and delayed ventricula...Cardiac resynchronization therapy(CRT)has been shown to improve symptoms,left ventricle(LV)performance and long-term survival in patients with heart failure with re-duced ejection fraction(HFrEF)and delayed ventricular activation.[1]CRT is currently recom-mended in symptomatic patients with LV ejection fraction of≤35%,and ventricular conduction dis-order manifested as left bundle branch block(LBBB)>149 ms,and should be considered in LBBB>129 ms or non-LBBB QRS duration>150 ms.展开更多
Dear Editor,Infertility affects about 48.5 million couples worldwide,and a male disorder is estimated to be a causative or contributing factor in 20%-50%of cases.^1 Notably,increasing data support the view that obese ...Dear Editor,Infertility affects about 48.5 million couples worldwide,and a male disorder is estimated to be a causative or contributing factor in 20%-50%of cases.^1 Notably,increasing data support the view that obese men are at higher risk of fertility disorders.^2 As is known,obesity is defined by an excess of white adipose tissue,currently recognized as being able to secrete many endocrinologically active molecules called adipokines.展开更多
In aircraft wings,aileron mass parameter presents a tremendous effect on the velocity and frequency of the flutter problem.For that purpose,we present the optimization of a composite design wing with an aileron,using ...In aircraft wings,aileron mass parameter presents a tremendous effect on the velocity and frequency of the flutter problem.For that purpose,we present the optimization of a composite design wing with an aileron,using machine-learning approach.Mass properties and its distribution have a great influence on the multi-variate optimization procedure,based on speed and frequency of flutter.First,flutter speed was obtained to estimate aileron impact.Additionally mass-equilibrated and other features were investigated.It can deduced that changing the position and mass properties of the aileron are tangible following the speed and frequency of the wing flutter.Based on the proposed optimization method,the best position of the aileron is determined for the composite wing to postpone flutter instability and decrease the existed stress.The represented coupled aero-structural model is emerged from subsonic aerodynamics model,which has been developed using the panel method in multidimensional space.The structural modeling has been conducted by finite element method,using the p-k method.The fluid-structure equations are solved and the results are extracted.展开更多
Left-side portal hypertension(LSPH)is a rare cause of intraabdominal venous hypertension.In most of cases,LSPH is due to pancreatic diseases,especially chronic pancreatitis,but it is also described in other abdominal ...Left-side portal hypertension(LSPH)is a rare cause of intraabdominal venous hypertension.In most of cases,LSPH is due to pancreatic diseases,especially chronic pancreatitis,but it is also described in other abdominal diseases(i.e.,retroperitoneal fibrosis or perineal abscess)after abdominal surgery(i.e.,pancreatic surgery,liver transplantation)or endovascular procedures[1–4].展开更多
In this article,authors review the current knowledge of Bartonella infection in small mammals including rodents,insectivores,bats and exotic small mammal pets and their vectors in Asia.Species of Bartonella are Gram-n...In this article,authors review the current knowledge of Bartonella infection in small mammals including rodents,insectivores,bats and exotic small mammal pets and their vectors in Asia.Species of Bartonella are Gram-negative intracellular bacteria that infect erythrocytes of various mammalian and non-mammalian animals and mainly transmitted by blood sucking arthropod vectors.The genus Bartonella includes several species of important human diseases with severe clinical signs.Several new Bartonella species were isolated from rodents and other small mammals,and from human patients in Asia.Bartonella species are identified using standard polymerase chain reaction amplification and a sequencing targeting two housekeeping genes(glt.A and rpoB) and the internal transcribed spacer fragment.Authors also discuss the implications in term of potential emerging zoonotic diseases.展开更多
A water distribution problem in the Mexican Valley is modeled first as a three-person noncooperative game. Each player has a five-dimensional strategy vector, the strategy sets are defined by 15 linear constraints, an...A water distribution problem in the Mexican Valley is modeled first as a three-person noncooperative game. Each player has a five-dimensional strategy vector, the strategy sets are defined by 15 linear constraints, and the three payoff functions are also linear. A nonlinear optimization problem is first formulated to obtain the Nash equilibrium based on the Kuhn-Tucker conditions, and then, duality theorem is used to develop a computational procedure. The problem can also be considered as a conflict between the three players. The non-symmetric Nash bargaining solution is suggested to find the solution. Multiobjective programming is an alternative solution concept, when the water supply of the three players are the objectives, and the water authority is considered to be the decision maker. The optimal water distribution strategies are determined by using these solution concepts and methods.展开更多
Background: Several artemisinin-based combination therapies (ACT) are available to treat uncomplicated malaria in Africa. The present study aimed to assess the ranking of their efficacy and tolerance. Methods: A datab...Background: Several artemisinin-based combination therapies (ACT) are available to treat uncomplicated malaria in Africa. The present study aimed to assess the ranking of their efficacy and tolerance. Methods: A database of randomized controlled trials was retrieved from published papers. Network meta-analysis was used to compare efficacy on day 28 and day 42 after initiation of treatment. Age covariate effect on treatment outcome was assessed, and a modeling approach to reduce heterogeneity among trials was evaluated under the hypothesis of consistency in a meta-regression. Safety and adverse events were compared among different ACTs. A Bayesian analysis was performed to implement the consistency models using WinBUGS software. The results were compared to those of the frequentist approach using the R software. Results: Eighty-one articles, in which a total of 15 different ACTs were tested in more than 36,000 patients, were included. On day 28, dihydroartemisinin-piperaquine (DHPP) was more effective than artemether-lumefantrine (AL) before (odds ratio [OR], 1.83;95% confidence interval [CI], 1.31 - 2.56) and after age-covariate adjustment (OR, 1.70;95% CI, 1.20 - 2.43). The result was similar on day 42. DHPP occupied the top rank. The risk of having cough, diarrhoea or headache post-treatment was significantly lower with DHPP than AL. Artesunate-mefloquine (ASMQ) was associated with a significantly lower prevalence of vomiting or nausea (OR, 0.80;95% CI, 0.48 - 1.30) and headache (OR, 0.53;95% CI, 0.40 - 0.68) compared to AL. On the contrary, vomiting and nausea occurred more frequently after fixed-dose artesunate-amodiaquine formulation (ASAQf) than with AL (OR, 1.45;95% CI, 1.18 - 1.78). The risk of anaemia was higher with ASAQf and co-blistered artesunate-amodiaquine (ASAQc) than with AL. There was no significant difference in risk of anaemia (P > 0.05) between AL and different formulations of ASAQ. Conclusions: Based on the available evidence, this study demonstrated the superiority of DHPP, followed by AL, among currently recommended ACTs in terms of efficacy and tolerance. Network meta-analysis could be an alternative analytical tool but needs more data input from therapeutic efficacy studies. The determination of the best available therapy requires data triangulation and data science.展开更多
Toscana virus(TOSV) is an arthropod-borne virus, identified in 1971, from Phlebotomus perniciosus and Phlebotomus perfiliewi in central Italy. TOSV belongs to the Phlebovirus genus within the Bunyaviridae family. As o...Toscana virus(TOSV) is an arthropod-borne virus, identified in 1971, from Phlebotomus perniciosus and Phlebotomus perfiliewi in central Italy. TOSV belongs to the Phlebovirus genus within the Bunyaviridae family. As other bunyaviruses, the genome of TOSV consists of 3 segments(S for small, M for Medium, and L for Large) respectively encoding non structural and capsid proteins, envelope structural proteins, and the viral RNA-dependant RNA-polymerase. It is transmitted by sand flies. Therefore its distribution is dictated by that of the arthropod vectors, and virus circulation peaks during summertime when sandfly populations are active. Here, we reviewed the epidemiology of TOSV in the old world. First evidence of its pathogenicity for humans, specifically its propensity to cause central nervous system(CNS) infections such as meningitis and encephalitis, was reported in central Italy. After 2000, it was recognized that TOSV had a much larger geographic distribution than initially believed, and was present in most of the Western European countries located on the northern border of the Mediterranean Sea(Portugal, Spain, France, Greece, Croatia) as well as eastern countries such as Cyprus and Turkey. In the countries where TOSV is present, it is among the three most prevalent viruses in meningitis during the warm seasons, together with enteroviruses and herpesviruses. Up to now, epidemiological data concerning Northern Africa and other countries located south of the Mediterranean are scarce. TOSV must be considered an emerging pathogen. Despite the important role played by TOSV in CNS infections, it remains a neglected agent and is rarely considered by physicians in diagnostic algorithms of CNS infections and febrile illness during the warm season, probably because of the lack of information.展开更多
The middle layer model has been used in recent years to better describe the connection behavior in composite structures.The influencing parameters including low pre-screw and high preload have the main effects on nonl...The middle layer model has been used in recent years to better describe the connection behavior in composite structures.The influencing parameters including low pre-screw and high preload have the main effects on nonlinear behavior of the connection as well as the amplitude of the excitation force applied to the structure.Therefore,in this study,the effects of connection behavior on the general structure in two sections of increasing damping and reducing the stiffness of the structures that lead to non-linear phenomena have been investigated.Due to the fact that in composite structure we are faced to the limitation of increasing screw preload which tend to structural damage,so the investigation on the hybrid connection(metal-composite)behavior is conducted.In this research,using the two-dimensional middle layer theory,the stiffness properties of the connection are modeled by normal stiffness and the connection damping is modeled using the structural damping in the shear direction.Nonlinear frequency response diagrams have been extracted twice for two different excitation forces and then proposed by a high-order multitasking approximation according to the response range of the nonlinear finite element model for stiffness and damping of the connection.The effect of increasing the amplitude of the excitation force and decreasing the preload of the screw on the nonlinear behavior of the component has been extracted.The results show that the limited presented novel component model has been accurately verified on the model obtained from the vibration experimental test and the reduction of nonlinear model updating based on that is represented.The comparison results show good agreementwith a maximumof 1.33%error.展开更多
Objective Impaired hepatic expression of protein tyrosine phosphatase delta(PTPRD)is associated with increased STAT3 transcriptional activity and reduced survival from hepatocellular carcinoma in patients with chronic...Objective Impaired hepatic expression of protein tyrosine phosphatase delta(PTPRD)is associated with increased STAT3 transcriptional activity and reduced survival from hepatocellular carcinoma in patients with chronic hepatitis C virus infection.However,the PTPRD-expressing hepatic cell types,signalling pathways responsive to PTPRD and their role in non-viral liver disease are largely unknown.Methods We studied PTPRD expression in single-cell and bulk liver transcriptomic data from mice and humans,and established a Ptprd-deficient mouse model for metabolic dysfunction-associated steatohepatitis(MASH).Identified pathways were validated by perturbation studies in human hepatocytes and PTPRD substrates by pull-down assays.The clinical relevance was further explored in a cohort with metabolic disease by ranking patients according to PTPRD expression and analysing its association with metabolic disease markers.Results The analysis of individuals ranked according to PTPRD expression and Ptprd-deficient mice,showed that PTPRD levels were associated with hepatic glucose/lipid signalling and peroxisome function.Hepatic PTPRD expression is impaired in aetiologies of chronic liver diseases that are associated with metabolic disease.We further validated PTPRD as a STAT3 phosphatase in the liver,acting as a regulator of peroxisomal fatty acid metabolism.During MASH,low PTPRD led to increased liver steatosis in Ptprd+/−mice and a pronounced unfolded protein response,which impacts insulin signalling.Accordingly,silencing of PTPRD blunted insulin-induced AKT phosphorylation.Patients with obesity and low hepatic PTPRD expression exhibit increased levels of metabolic risk factors.Conclusion Our data revealed an important regulatory role of the hepatic PTPRD-STAT3 axis in maintaining glucose/lipid homeostasis,which is recapitulated in clinical manifestations of metabolic liver disease.展开更多
Hepatic inflow occlusion(Pringle manoeuvre),is a widely used technique,consisting in temporary intermittent or continuous clamping of the hepatic pedicle.This technique was described in 1908 by Pringle to minimize blo...Hepatic inflow occlusion(Pringle manoeuvre),is a widely used technique,consisting in temporary intermittent or continuous clamping of the hepatic pedicle.This technique was described in 1908 by Pringle to minimize blood loss during emergency surgery for liver trauma.Therefore,in hepatobiliary surgery,the Pringle manoeuvre assumes a primary role especially in complex liver resections where an intraoperative blood loss could be significant.Afterwards.展开更多
Background: The aim of this study was to analyze the clinical and economic impact of robotic distal pancreatectomy, laparoscopic distal pancreatectomy, and open distal pancreatectomy. Methods: All consecutive patients...Background: The aim of this study was to analyze the clinical and economic impact of robotic distal pancreatectomy, laparoscopic distal pancreatectomy, and open distal pancreatectomy. Methods: All consecutive patients who underwent distal pancreatic resection for benign and malignant diseases between January 2012 and December 2015 were prospectively included. Cost analysis was performed;all charges from patient admission to discharge were considered. Results: There were 21 robotic (RDP), 25 laparoscopic (LDP), and 43 open (ODP) procedures. Operative time was longer in the RDP group (RDP =345 minutes, LDP =306 min, ODP =251 min, P=0.01). Blood loss was higher in the ODP group (RDP =192 mL, LDP =356 mL, ODP =573 mL, P=0.0002). Spleen preservation was more frequent in the RDP group (RDP =66.6%, LDP =61.9%, ODP =9.3%, P=0.001). The rate of patients with Clavien-Dindo > grade III was higher in the ODP group (RDP =0%, LDP =12%, ODP =23%, P=0.01), especially for non-surgical complications, which were more frequent in the ODP group (RDP =9.5%, LDP =24%, ODP =41.8%, P=0.02). Length of hospital stay was increased in the ODP group (ODP =19 days, LDP =13 days, RDP =11 days, P=0.007). The total cost of the procedure, including the surgical procedure and postoperative course was higher in the ODP group (ODP =30,929 Euros, LDP=22,150 Euros, RDP =21,219 Euros, P=0.02). Conclusions: Cost-effective results of RDP seem to be similar to LDP with some better short-term outcomes.展开更多
Background::The elimination of Plasmodium vivax malaria requires 8-aminoquinolines,which are contraindicated in patients with glucose-6-phosphate dehydrogenase(G6PD)deficiency due to the risk of acute haemolytic anaem...Background::The elimination of Plasmodium vivax malaria requires 8-aminoquinolines,which are contraindicated in patients with glucose-6-phosphate dehydrogenase(G6PD)deficiency due to the risk of acute haemolytic anaemia.Several point-of-care devices have been developed to detect G6PD deficiency.The objective of the present study was to evaluate the performance of two of these devices against G6PD genotypes in Mauritania.Methods::Outpatients were screened for G6PD deficiency using CareStart?rapid diagnostic test(RDT)and CareStart?G6PD biosensor in Nouakchott,Mauritania,in 2019-2020.African-type and Mediterranean-type G6PD genotypes commonly observed in Africa were determined by polymerase chain reaction-restriction fragment length polymorphism and sequencing.Qualitative variables were compared using Fisher’s exact test.Results::Of 323 patients(74 males and 249 females),5 males and 2 homozygous females had the African-type A-genotype:A-(202)in 3 males and 2 females and G6PD A-(968)in 2 males.Among heterozygous females,13 carried G6PD A-(202),12 G6PD A-(968),and 3 G6PD A-(542)variants.None had the Mediterranean-type G6PD genotype.Eight had a positive G6PD RDT result,including all 7 hemizygous males and homozygous females with A-or A-A-(0.12 to 2.34 IU/g haemoglobin,according to G6PD biosensor),but RDT performed poorly(sensitivity,11.1%at the cutoff level of<30%)and yielded many false negative tests.Thirty-seven(50.0%)males and 141(56.6%)females were anaemic.The adjusted median values of G6PD activity were 5.72 and 5.34 IU/g haemoglobin in non-anaemic males(n=35)and non-anaemic males and females(n=130)with normal G6PD genotypes using G6PD biosensor,respectively.Based on the adjusted median of 5.34 IU/g haemoglobin,the performance of G6PD biosensor against genotyping was as follows:at 30%cut-off,the sensitivity and specificity were 85.7%and 91.7%,respectively,and at 80%cut-off,the sensitivity was 100%while the specificity was 64.9%.Conclusions::Although this pilot study supports the utility of biosensor to screen for G6PD deficiency in patients,further investigation in parallel with spectrophotometry is required to promote and validate a more extensive use of this point-of-care device in areas where P.vivax is highly prevalent in Mauritania.展开更多
Patti et al.(1)have reported an analysis of the literature searching for an evaluation of robotic liver and pancreatic surgery according to a value-based health care(VBHC)approach.This model was developed by Porter(2)...Patti et al.(1)have reported an analysis of the literature searching for an evaluation of robotic liver and pancreatic surgery according to a value-based health care(VBHC)approach.This model was developed by Porter(2)in order to consider the following two aspects:vthe outcomes that matter most to patients,which are defined as the sum of patients’health objectives;vthe costs required to achieve these results.展开更多
We read with great interest the recently published article of Boudjema and collaborators(1).The authors evaluated the safety and efficacy of delayed resection(DR)versus simultaneous resection(SR)for patients with init...We read with great interest the recently published article of Boudjema and collaborators(1).The authors evaluated the safety and efficacy of delayed resection(DR)versus simultaneous resection(SR)for patients with initially resectable synchronous colorectal cancer liver metastases(CRC-SLM).The aforementioned study(METASYNC)was the first randomized controlled trial comparing two resection strategies for CRC-SLM.In the literature,large retrospective studies didn’t seem to favor one type of treatment,particularly when comparisons are based on a propensity match score(2).展开更多
基金Supported by The“Endo-Verein Erlangen”a registered non-profit training organization+1 种基金BaiersdorfGermany
文摘AIM: To investigate the efficacy and clinical outcome of patients treated with an over-the-scope-clip(OTSC) system for severe gastrointestinal hemorrhage, perforations and fistulas.METHODS: From 02-2009 to 10-2012, 84 patients were treated with 101 OTSC clips. 41 patients(48.8%) presented with severe upper-gastrointestinal(GI) bleeding, 3(3.6%) patients with lower-GI bleeding, 7 patients(8.3%) underwent perforation closure, 18 patients(21.4%) had prevention of secondary perforation, 12 patients(14.3%) had control of secondary bleeding after endoscopic mucosal resection or endoscopic submucosal dissection(ESD) and 3 patients(3.6%) had an intervention on a chronic fistula. RESULTS: In 78/84 patients(92.8%), primary treatment with the OTSC was technically successful. Clinical primary success was achieved in 75/84 patients(89.28%). The overall mortality in the study patients was 11/84(13.1%) and was seen in patients with life threatning upper GI hemorrhage. There was no mortality in any other treatment group. In detail OTSC application lead to a clinical success in 35/41(85.36%) patients with upper GI bleeding and in 3/3 patients with lower GI bleeding. Technical success of perforation closure was 100% while clinical success was seen in 4/7 cases(57.14%) due to attendant circumstances unrelated to the OTSC. Technical and clinic success was achieved in 18/18(100%) patients for the prevention of bleeding or perforation after endoscopic mucosal resection and ESD and in 3/3 cases of fistula closure. Two application-related complications were seen(2%).CONCLUSION: This largest single center experience published so far confirms the value of the OTSC for GI emergencies and complications. Further clinical experience will help to identify optimal indications for its targeted and prophylactic use.
文摘Among the intrinsic properties of some materials,e.g.,foams,porous materials,and granular materials,are their ability to mitigate shock waves.This paper investigated shock wave mitigation by a sandwich panel with a granular core.Numerical simulations and experimental tests were performed using Autodyn hydro-code software and a shock tube,respectively.The smoothed particle hydrodynamics(SPH)method was used to model granular materials.Sawdust and pumice,whose properties were determined by several compression tests,were used as granular materials in the sandwich panel core.These granular materials possess many mechanisms,including compacting(e.g.,sawdust)and crushing(e.g.,pumice)that mitigate shock/blast wave.The results indicated the ineffectiveness of using a core with low thickness,yet it was demonstrated to be effective with high thickness.Low-thickness pumice yielded better results for wave mitigation.The use of these materials with a core with appropriate core reduces up to 88%of the shock wave.The results of the experiments and numerical simulations were compared,suggesting a good agreement between the two.This indicates the accuracy of simulation and the ability of the SPH method to modeling granular material under shock loading.The effects of grain size and the coefficient of friction between grains have also been investigated using simulation,implying that increasing the grain size and coefficient of friction between grains both reduce overpressure.
基金Supported by "Fondation PROGREFFE" and "Societé Francophone de Transplantation" to Justine Durandthe National Research Agency via the investment of the future program ANR-10-IBHU-005Nantes Metropole and the Pays de la Loire Region
文摘Induction of tolerance remains a major goal in transplantation. Indeed, despite potent immunosuppression, chronic rejection is still a real problem in transplantation. The humoral response is an important mediator of chronic rejection, and numerous strategies have been developed to target either B cells or plasma cells. However, the use of anti-CD20 therapy has highlighted the beneficial role of subpopulation of B cells, termed regulatory B cells. These cells have been characterized mainly in mice models of auto-immune diseases but emerging literature suggests their role in graft tolerance in transplantation. Regulatory B cells seem to be induced following inflammation to restrain excessive response. Different phenotypes of regulatory B cells have been described and are functional at various differentiation steps from immature to plasma cells. These cells act by multiple mechanisms such as secretion of immuno-suppressive cytokines interleukin-10(IL-10) or IL-35, cytotoxicity, expression of inhibitory receptors or by secretion of non-inflammatory antibodies. Better characterization of the development, phenotype and mode of action of these cells seems urgent to develop novel approaches to manipulate the different B cell subsets and the response to the graft in a clinical setting.
文摘Biliary complications(BC) currently represent a major source of morbidity after liver transplantation. Although refinements in surgical technique and medical therapy have had a positive influence on the reduction of postoperative morbidity, BC affect 5% to 25% of transplanted patients. Bile leak and anastomotic strictures represent the most common complications. Nowadays, a multidisciplinary approach is required to manage such complications in order to prevent liver failure and retransplantation.
文摘Atrial fibrillation prevalence is increasing with age, reaching up to 5% of patients older than 65 years, and is associated with 20%-30% of stroke episodes in that population.
基金This study was supported by the French Government as part of the“Investments of the Future”program managed by the National Research Agency(Grant reference:ANR-10-IAHU-04).
文摘Cardiac resynchronization therapy(CRT)has been shown to improve symptoms,left ventricle(LV)performance and long-term survival in patients with heart failure with re-duced ejection fraction(HFrEF)and delayed ventricular activation.[1]CRT is currently recom-mended in symptomatic patients with LV ejection fraction of≤35%,and ventricular conduction dis-order manifested as left bundle branch block(LBBB)>149 ms,and should be considered in LBBB>129 ms or non-LBBB QRS duration>150 ms.
文摘Dear Editor,Infertility affects about 48.5 million couples worldwide,and a male disorder is estimated to be a causative or contributing factor in 20%-50%of cases.^1 Notably,increasing data support the view that obese men are at higher risk of fertility disorders.^2 As is known,obesity is defined by an excess of white adipose tissue,currently recognized as being able to secrete many endocrinologically active molecules called adipokines.
基金This work was supported by China Medical University.
文摘In aircraft wings,aileron mass parameter presents a tremendous effect on the velocity and frequency of the flutter problem.For that purpose,we present the optimization of a composite design wing with an aileron,using machine-learning approach.Mass properties and its distribution have a great influence on the multi-variate optimization procedure,based on speed and frequency of flutter.First,flutter speed was obtained to estimate aileron impact.Additionally mass-equilibrated and other features were investigated.It can deduced that changing the position and mass properties of the aileron are tangible following the speed and frequency of the wing flutter.Based on the proposed optimization method,the best position of the aileron is determined for the composite wing to postpone flutter instability and decrease the existed stress.The represented coupled aero-structural model is emerged from subsonic aerodynamics model,which has been developed using the panel method in multidimensional space.The structural modeling has been conducted by finite element method,using the p-k method.The fluid-structure equations are solved and the results are extracted.
文摘Left-side portal hypertension(LSPH)is a rare cause of intraabdominal venous hypertension.In most of cases,LSPH is due to pancreatic diseases,especially chronic pancreatitis,but it is also described in other abdominal diseases(i.e.,retroperitoneal fibrosis or perineal abscess)after abdominal surgery(i.e.,pancreatic surgery,liver transplantation)or endovascular procedures[1–4].
基金Supported by the French ANR CERoPath project(number ANR 07 BDIV 012)the French ANR BiodivHealthSEA project(number ANR 11 CPEL.002)
文摘In this article,authors review the current knowledge of Bartonella infection in small mammals including rodents,insectivores,bats and exotic small mammal pets and their vectors in Asia.Species of Bartonella are Gram-negative intracellular bacteria that infect erythrocytes of various mammalian and non-mammalian animals and mainly transmitted by blood sucking arthropod vectors.The genus Bartonella includes several species of important human diseases with severe clinical signs.Several new Bartonella species were isolated from rodents and other small mammals,and from human patients in Asia.Bartonella species are identified using standard polymerase chain reaction amplification and a sequencing targeting two housekeeping genes(glt.A and rpoB) and the internal transcribed spacer fragment.Authors also discuss the implications in term of potential emerging zoonotic diseases.
文摘A water distribution problem in the Mexican Valley is modeled first as a three-person noncooperative game. Each player has a five-dimensional strategy vector, the strategy sets are defined by 15 linear constraints, and the three payoff functions are also linear. A nonlinear optimization problem is first formulated to obtain the Nash equilibrium based on the Kuhn-Tucker conditions, and then, duality theorem is used to develop a computational procedure. The problem can also be considered as a conflict between the three players. The non-symmetric Nash bargaining solution is suggested to find the solution. Multiobjective programming is an alternative solution concept, when the water supply of the three players are the objectives, and the water authority is considered to be the decision maker. The optimal water distribution strategies are determined by using these solution concepts and methods.
文摘Background: Several artemisinin-based combination therapies (ACT) are available to treat uncomplicated malaria in Africa. The present study aimed to assess the ranking of their efficacy and tolerance. Methods: A database of randomized controlled trials was retrieved from published papers. Network meta-analysis was used to compare efficacy on day 28 and day 42 after initiation of treatment. Age covariate effect on treatment outcome was assessed, and a modeling approach to reduce heterogeneity among trials was evaluated under the hypothesis of consistency in a meta-regression. Safety and adverse events were compared among different ACTs. A Bayesian analysis was performed to implement the consistency models using WinBUGS software. The results were compared to those of the frequentist approach using the R software. Results: Eighty-one articles, in which a total of 15 different ACTs were tested in more than 36,000 patients, were included. On day 28, dihydroartemisinin-piperaquine (DHPP) was more effective than artemether-lumefantrine (AL) before (odds ratio [OR], 1.83;95% confidence interval [CI], 1.31 - 2.56) and after age-covariate adjustment (OR, 1.70;95% CI, 1.20 - 2.43). The result was similar on day 42. DHPP occupied the top rank. The risk of having cough, diarrhoea or headache post-treatment was significantly lower with DHPP than AL. Artesunate-mefloquine (ASMQ) was associated with a significantly lower prevalence of vomiting or nausea (OR, 0.80;95% CI, 0.48 - 1.30) and headache (OR, 0.53;95% CI, 0.40 - 0.68) compared to AL. On the contrary, vomiting and nausea occurred more frequently after fixed-dose artesunate-amodiaquine formulation (ASAQf) than with AL (OR, 1.45;95% CI, 1.18 - 1.78). The risk of anaemia was higher with ASAQf and co-blistered artesunate-amodiaquine (ASAQc) than with AL. There was no significant difference in risk of anaemia (P > 0.05) between AL and different formulations of ASAQ. Conclusions: Based on the available evidence, this study demonstrated the superiority of DHPP, followed by AL, among currently recommended ACTs in terms of efficacy and tolerance. Network meta-analysis could be an alternative analytical tool but needs more data input from therapeutic efficacy studies. The determination of the best available therapy requires data triangulation and data science.
文摘Toscana virus(TOSV) is an arthropod-borne virus, identified in 1971, from Phlebotomus perniciosus and Phlebotomus perfiliewi in central Italy. TOSV belongs to the Phlebovirus genus within the Bunyaviridae family. As other bunyaviruses, the genome of TOSV consists of 3 segments(S for small, M for Medium, and L for Large) respectively encoding non structural and capsid proteins, envelope structural proteins, and the viral RNA-dependant RNA-polymerase. It is transmitted by sand flies. Therefore its distribution is dictated by that of the arthropod vectors, and virus circulation peaks during summertime when sandfly populations are active. Here, we reviewed the epidemiology of TOSV in the old world. First evidence of its pathogenicity for humans, specifically its propensity to cause central nervous system(CNS) infections such as meningitis and encephalitis, was reported in central Italy. After 2000, it was recognized that TOSV had a much larger geographic distribution than initially believed, and was present in most of the Western European countries located on the northern border of the Mediterranean Sea(Portugal, Spain, France, Greece, Croatia) as well as eastern countries such as Cyprus and Turkey. In the countries where TOSV is present, it is among the three most prevalent viruses in meningitis during the warm seasons, together with enteroviruses and herpesviruses. Up to now, epidemiological data concerning Northern Africa and other countries located south of the Mediterranean are scarce. TOSV must be considered an emerging pathogen. Despite the important role played by TOSV in CNS infections, it remains a neglected agent and is rarely considered by physicians in diagnostic algorithms of CNS infections and febrile illness during the warm season, probably because of the lack of information.
基金This work was supported by College of Engineering and Technology,American University of the Middle East,Kuwait。
文摘The middle layer model has been used in recent years to better describe the connection behavior in composite structures.The influencing parameters including low pre-screw and high preload have the main effects on nonlinear behavior of the connection as well as the amplitude of the excitation force applied to the structure.Therefore,in this study,the effects of connection behavior on the general structure in two sections of increasing damping and reducing the stiffness of the structures that lead to non-linear phenomena have been investigated.Due to the fact that in composite structure we are faced to the limitation of increasing screw preload which tend to structural damage,so the investigation on the hybrid connection(metal-composite)behavior is conducted.In this research,using the two-dimensional middle layer theory,the stiffness properties of the connection are modeled by normal stiffness and the connection damping is modeled using the structural damping in the shear direction.Nonlinear frequency response diagrams have been extracted twice for two different excitation forces and then proposed by a high-order multitasking approximation according to the response range of the nonlinear finite element model for stiffness and damping of the connection.The effect of increasing the amplitude of the excitation force and decreasing the preload of the screw on the nonlinear behavior of the component has been extracted.The results show that the limited presented novel component model has been accurately verified on the model obtained from the vibration experimental test and the reduction of nonlinear model updating based on that is represented.The comparison results show good agreementwith a maximumof 1.33%error.
基金supported by the European Union(ERC-AdG-2014 HEPCIR ERC POC PRELICAN 755460,ERC POC HEPCAN 862551 to TFB,EU H2020 HEPCAR 667273 to TFB and JL,HORIZON-HLTH-2021-DISEASE-04-07 D-SOLVE#101057917 to TFB and JL,IP-cure-B project#847939 to FZ,ERC-AdG-2020-101021417 to YH)the French Cancer Agency(TheraHCC2.0 IHU201901299 to TFB)+9 种基金the Agence Nationale de la Recherche(ANR-21-RHUS-001 to TFB)the ANRS Maladies infectieusesémergentes(ANRS-MIE)(ECTZ103701,ECTZ131760,ECTZ160436,ECTZ171594 to JL,ECTZ104017 and ECTZ75178 to TFB,ECTZ4446 and ECTZ206376 to AARS)the Fondation de l’Universitéde Strasbourg(HEPKIN)(TBA-DON-0002),SATT Conectus,University of Strasbourg(CANCLAU)(TFB)the Inserm Plan Cancer 2019-2023the US National Institutes of Health(CA233794,CA255621,CA282178,CA288375 and CA283935 to YH)the Cancer Prevention and Research Institute of Texas(RR180016,RP200554 to YH)The AEPIC animal facility platform is financially supported by the CoRTecS network of the University of StrasbourgThis work of the Interdisciplinary Thematic Institute IMCBio,as part of the ITI 2021-2028 programme of the University of Strasbourg,CNRS and Inserm,was supported by IdEx Unistra(ANR-10-IDEX-0002)SFRI-STRAT’US project(ANR 20-SFRI-0012)EUR IMCBio(ANR-17-EURE-0023)under the framework of the French Investments for the Future Programme,as well as state funds managed within the France 2030 programme(reference ANR-21-RHUS-0001).
文摘Objective Impaired hepatic expression of protein tyrosine phosphatase delta(PTPRD)is associated with increased STAT3 transcriptional activity and reduced survival from hepatocellular carcinoma in patients with chronic hepatitis C virus infection.However,the PTPRD-expressing hepatic cell types,signalling pathways responsive to PTPRD and their role in non-viral liver disease are largely unknown.Methods We studied PTPRD expression in single-cell and bulk liver transcriptomic data from mice and humans,and established a Ptprd-deficient mouse model for metabolic dysfunction-associated steatohepatitis(MASH).Identified pathways were validated by perturbation studies in human hepatocytes and PTPRD substrates by pull-down assays.The clinical relevance was further explored in a cohort with metabolic disease by ranking patients according to PTPRD expression and analysing its association with metabolic disease markers.Results The analysis of individuals ranked according to PTPRD expression and Ptprd-deficient mice,showed that PTPRD levels were associated with hepatic glucose/lipid signalling and peroxisome function.Hepatic PTPRD expression is impaired in aetiologies of chronic liver diseases that are associated with metabolic disease.We further validated PTPRD as a STAT3 phosphatase in the liver,acting as a regulator of peroxisomal fatty acid metabolism.During MASH,low PTPRD led to increased liver steatosis in Ptprd+/−mice and a pronounced unfolded protein response,which impacts insulin signalling.Accordingly,silencing of PTPRD blunted insulin-induced AKT phosphorylation.Patients with obesity and low hepatic PTPRD expression exhibit increased levels of metabolic risk factors.Conclusion Our data revealed an important regulatory role of the hepatic PTPRD-STAT3 axis in maintaining glucose/lipid homeostasis,which is recapitulated in clinical manifestations of metabolic liver disease.
文摘Hepatic inflow occlusion(Pringle manoeuvre),is a widely used technique,consisting in temporary intermittent or continuous clamping of the hepatic pedicle.This technique was described in 1908 by Pringle to minimize blood loss during emergency surgery for liver trauma.Therefore,in hepatobiliary surgery,the Pringle manoeuvre assumes a primary role especially in complex liver resections where an intraoperative blood loss could be significant.Afterwards.
文摘Background: The aim of this study was to analyze the clinical and economic impact of robotic distal pancreatectomy, laparoscopic distal pancreatectomy, and open distal pancreatectomy. Methods: All consecutive patients who underwent distal pancreatic resection for benign and malignant diseases between January 2012 and December 2015 were prospectively included. Cost analysis was performed;all charges from patient admission to discharge were considered. Results: There were 21 robotic (RDP), 25 laparoscopic (LDP), and 43 open (ODP) procedures. Operative time was longer in the RDP group (RDP =345 minutes, LDP =306 min, ODP =251 min, P=0.01). Blood loss was higher in the ODP group (RDP =192 mL, LDP =356 mL, ODP =573 mL, P=0.0002). Spleen preservation was more frequent in the RDP group (RDP =66.6%, LDP =61.9%, ODP =9.3%, P=0.001). The rate of patients with Clavien-Dindo > grade III was higher in the ODP group (RDP =0%, LDP =12%, ODP =23%, P=0.01), especially for non-surgical complications, which were more frequent in the ODP group (RDP =9.5%, LDP =24%, ODP =41.8%, P=0.02). Length of hospital stay was increased in the ODP group (ODP =19 days, LDP =13 days, RDP =11 days, P=0.007). The total cost of the procedure, including the surgical procedure and postoperative course was higher in the ODP group (ODP =30,929 Euros, LDP=22,150 Euros, RDP =21,219 Euros, P=0.02). Conclusions: Cost-effective results of RDP seem to be similar to LDP with some better short-term outcomes.
文摘Background::The elimination of Plasmodium vivax malaria requires 8-aminoquinolines,which are contraindicated in patients with glucose-6-phosphate dehydrogenase(G6PD)deficiency due to the risk of acute haemolytic anaemia.Several point-of-care devices have been developed to detect G6PD deficiency.The objective of the present study was to evaluate the performance of two of these devices against G6PD genotypes in Mauritania.Methods::Outpatients were screened for G6PD deficiency using CareStart?rapid diagnostic test(RDT)and CareStart?G6PD biosensor in Nouakchott,Mauritania,in 2019-2020.African-type and Mediterranean-type G6PD genotypes commonly observed in Africa were determined by polymerase chain reaction-restriction fragment length polymorphism and sequencing.Qualitative variables were compared using Fisher’s exact test.Results::Of 323 patients(74 males and 249 females),5 males and 2 homozygous females had the African-type A-genotype:A-(202)in 3 males and 2 females and G6PD A-(968)in 2 males.Among heterozygous females,13 carried G6PD A-(202),12 G6PD A-(968),and 3 G6PD A-(542)variants.None had the Mediterranean-type G6PD genotype.Eight had a positive G6PD RDT result,including all 7 hemizygous males and homozygous females with A-or A-A-(0.12 to 2.34 IU/g haemoglobin,according to G6PD biosensor),but RDT performed poorly(sensitivity,11.1%at the cutoff level of<30%)and yielded many false negative tests.Thirty-seven(50.0%)males and 141(56.6%)females were anaemic.The adjusted median values of G6PD activity were 5.72 and 5.34 IU/g haemoglobin in non-anaemic males(n=35)and non-anaemic males and females(n=130)with normal G6PD genotypes using G6PD biosensor,respectively.Based on the adjusted median of 5.34 IU/g haemoglobin,the performance of G6PD biosensor against genotyping was as follows:at 30%cut-off,the sensitivity and specificity were 85.7%and 91.7%,respectively,and at 80%cut-off,the sensitivity was 100%while the specificity was 64.9%.Conclusions::Although this pilot study supports the utility of biosensor to screen for G6PD deficiency in patients,further investigation in parallel with spectrophotometry is required to promote and validate a more extensive use of this point-of-care device in areas where P.vivax is highly prevalent in Mauritania.
文摘Patti et al.(1)have reported an analysis of the literature searching for an evaluation of robotic liver and pancreatic surgery according to a value-based health care(VBHC)approach.This model was developed by Porter(2)in order to consider the following two aspects:vthe outcomes that matter most to patients,which are defined as the sum of patients’health objectives;vthe costs required to achieve these results.
文摘We read with great interest the recently published article of Boudjema and collaborators(1).The authors evaluated the safety and efficacy of delayed resection(DR)versus simultaneous resection(SR)for patients with initially resectable synchronous colorectal cancer liver metastases(CRC-SLM).The aforementioned study(METASYNC)was the first randomized controlled trial comparing two resection strategies for CRC-SLM.In the literature,large retrospective studies didn’t seem to favor one type of treatment,particularly when comparisons are based on a propensity match score(2).
