This study evaluated the molecular characterization of different ecotypes of B. aegyptiaca populations in the four sites: Koily alpha, Labgar, Ranérou and Ballou according to the environment with the aim of devel...This study evaluated the molecular characterization of different ecotypes of B. aegyptiaca populations in the four sites: Koily alpha, Labgar, Ranérou and Ballou according to the environment with the aim of developing protection strategies. We sampled leaves of B. aegyptiaca in each individual from each site to extract and amplify a fragment of mitochondrial DNA including cytochrome b and then carefully preserved. DNA extraction, polymerase chain amplification and sequencing of MT-CYB were performed in 64 individuals. Genetic diversity and structure of B. aegyptiaca were determined using the MEGA, DNasp and Arlequin software. The results showed a high haplotype diversity and low nucleotide diversity, indicating a population expansion linked to an important gene flow. Genetic distances between populations were positively correlated with geographic distance. The importance of having highlighted this genetic differentiation of the B. aegyptiaca species between these sites is to be able to understand the degree of genetic heterogeneity of each and correlate it with adaptability because genetic diversity influences the adaptation of the species.展开更多
Introduction:Heart rate variability(HRV),defined as fluctuations in the time intervals between successive heartbeats,was generated by the sinoatrial node and modulated by the autonomic nervous system(ANS).HRV emerged ...Introduction:Heart rate variability(HRV),defined as fluctuations in the time intervals between successive heartbeats,was generated by the sinoatrial node and modulated by the autonomic nervous system(ANS).HRV emerged as a prognostic marker in chronic heart failure(CHF),particularly for mortality risk assessment in Western countries.This study aimed to evaluate the utility of HRV measurement in the follow-up of CHF patients in a sub-Saharan African context.Methods:We conducted a cross-sectional,descriptive,and analytical study during six months,in the cardiology departments of the YaoundéGeneral Hospital(HGY)and the YaoundéCentral Hospital(HCY).Eligible participants were adults with a confirmed diagnosis of CHF based on clinical,echocardiographic and electrocardiographic criteria,who had been on treatment for at least three months and provided informed consent.Exclusion criteria included atrial disease,non-sinus rhythm(atrial fibrillation,atrial flutter),loss to follow-up,and death.Consecutive sampling was applied.HRV recordings were obtained twice at a two-month interval using a Polar H10^(®)heart rate monitor connected via Bluetooth to the Elite HRV application installed on an iPhone 12 Pro Max.SDNN was the standard deviation of all normal-to-normal(NN)intervals,and RMSSD was Root Mean Square of Successive Differences.HF(High Frequency,0.15-0.40 Hz)corresponds to respiratory sinus arrhythmia;R-R intervals were recorded at rest for 5 minutes.Treat ment adherence was assessed and its relationship to HRV was explored.Data were entered using CS Pro^(®)7.0 and analyzed with SPSS^(®)23.Results:Thirtyone patients were included,with a median age of 64 years;women accounted for 54.8%of the sample.The most prevalent cardiovascular risk factors were dyslipidemia(38.7%)and alcohol consumption(34.6%).The leading etiologies of CHF were hypertensive cardiomyopathy and dilated cardiomyopathy,each representing 54.8%of cases.Left ventricular failure was present in 74.2%,and 61.3%had a left ventricular ejection fraction(LVEF)<40%.The most commonly prescribed medications were ACE inhibitors(80.6%),beta-blockers(77.4%),and loop diuretics(77.4%).Non-adherence to treatment was reported in 45.2%(14/31)of participants.Patients with good adherence demonstrated significantly higher HRV indices at both time points,including SDNN[46.7(37.3-54.4)ms;p<0.050],RMSSD[58.6(49.5-78.9)ms;p<0.010],and HF power[708.2(417.2-1020.0)ms^(2);p=0.040].Factors associated with HRV impairment found a borderline association with BMI:overweight/obese patients tended to have higher odds of HRV impairment(OR=1.7,95%CI:0.4-7.4,p=0.052);age≤60 years(OR=0.8,95%CI:0.4-8.1,p<0.044)and Beta-blocker(OR=0.5,95%CI:0.1-2.5,p=0.030)use was associated with a lower risk of HRV alteration.Treatment with good adherence showed a significant association linked to a lower risk of HRV impairment(OR=0.2,95%CI:0.0-1.3).Conclusion:This study confirms the potential of HRV as a complementary tool for the follow-up of CHF patients.HRV indices,particularly regarding young age,good weight and combined with treatment adherence assessment,may provide a cost-effective,non-invasive method to improve CHF management in resource-limited settings.展开更多
Background:Heart failure(HF)poses a significant global health burden,necessitating effective management strategies.This randomized controlled trial evaluated the effects of a seven-week cardiac rehabilitation program ...Background:Heart failure(HF)poses a significant global health burden,necessitating effective management strategies.This randomized controlled trial evaluated the effects of a seven-week cardiac rehabilitation program on functional capacity and quality of life in patients with stable chronic HF.Methods:Participants were randomly assigned to either a rehabilitation group(n=10)or a control group(n=10).The mean age of participants was 62.9±9.45 years in the intervention group and 60.3±8.23 years with extremes ranging from 45 years to 79 years.The male gender was the most represented in both groups,with a rate of 70%in the intervention group and 60%in the control group,i.e.,a sex ratio of 1.87.The rehabilitation program consisted of structured exercise,education,and psychological support.Functional capacity was assessed using the six-minute walk test(6MWT),exercise testing,and estimated VO_(2max).Quality of life,anxiety,and depression were measured using validated questionnaires.Hemodynamic parameters and physical activity levels were also evaluated.Results:Results demonstrated significant improvements in the rehabilitation group compared to the control group;specifically a significant increase in 6MWT distance(p<0.001)exercise duration(p=0.008)and functional capacity(p=0.029).Furthermore,participants in the rehabilitation group exhibited significant reductions in anxiety and depression scores(p=0.008 and p<0.001,respectively),and reported a significant improvement in quality of life(p=0.002)and PA level(p=0.011).Systolic blood pressure also significantly decreased in the rehabilitation group.Physical activity levels increased significantly in the rehabilitation group.Conclusions:A seven-week cardiac rehabilitation program significantly improved functional capacity,quality of life,and psychological well-being in patients with stable chronic HF.These findings emphasize the importance of integrating cardiac rehabilitation into the comprehensive management of HF patients.展开更多
At the end of 2015, the United States lifted a 40-year ban on crude oil exports, which has far-reaching implications for the global crude oil market and crude oil trade patterns. Since the release of crude oil exports...At the end of 2015, the United States lifted a 40-year ban on crude oil exports, which has far-reaching implications for the global crude oil market and crude oil trade patterns. Since the release of crude oil exports, with the recovery of crude oil production and improved export infrastructure in the United States, U.S. crude oil exports have been growing rapidly, with an average of about one million barrels/day in 2017, making the U.S one of the major global crude oil exporters. Currently, the AsiaPacific region has replaced North America as the first major destination for U.S. crude oil exports. In light of future trends in the oil refining industry of the Asia-Pacific region, it will usher in a new wave of refinery operations around 2020 and crude oil imports will continue to grow rapidly. The American region, represented by the United States, will replace West Africa as the second largest source of crude oil imports to the Asia-Pacific region, and that energy trade cooperation between the Asia-Pacific region and the United States will continue to grow. In particular, for China, the United States will become an important source of crude oil imports for our country in the future, and the two countries will shift from the past of energy competition to energy cooperation. Sino-US energy trade will play a more active role in economic and trade cooperation between the two countries.展开更多
Diclofop-methyl（DM）,a widely used herbicide in food crops,may partly contaminate the soil surface of natural ecosystems in agricultural area and exert toxic effects at low dose to nontarget plants.Even though rhizos...Diclofop-methyl（DM）,a widely used herbicide in food crops,may partly contaminate the soil surface of natural ecosystems in agricultural area and exert toxic effects at low dose to nontarget plants.Even though rhizosphere microorganisms strongly interact with root cells,little is known regarding their potential modulating effect on herbicide toxicity in plants.Here we exposed rice seedlings（Xiushui 63） to 100 μg/L DM for 2 to 8 days and studied the effects of DM on rice rhizosphere microorganisms,rice systemic acquired resistance（SAR） and rice-microorganisms interactions.The results of metagenomic 16 S rDNA Illumina tags show that DM increases bacterial biomass and affects their community structure in the rice rhizosphere.After DM treatment,the relative abundance of the bacterium genera Massilia and Anderseniella increased the most relative to the control.In parallel,malate and oxalate exudation by rice roots increased,potentially acting as a carbon source for several rhizosphere bacteria.Transcriptomic analyses suggest that DM induced SAR in rice seedlings through the salicylic acid（but not the jasmonic acid） signal pathway.This response to DM stress conferred resistance to infection by a pathogenic bacterium,but was not influenced by the presence of bacteria in the rhizosphere since SAR transcripts did not change significantly in xenic and axenic plant roots exposed to DM.The present study provides new insights on the response of rice and its associated microorganisms to DM stress.展开更多
Since the implementation of the Belt and Road Initiative nearly eight years ago,important progress has been made in economic and energy trade cooperation.In terms of the energy industry,the Belt and Road Initiative is...Since the implementation of the Belt and Road Initiative nearly eight years ago,important progress has been made in economic and energy trade cooperation.In terms of the energy industry,the Belt and Road Initiative is also an road to energy,and countries along the Belt and Road are important partners for China in crude oil and oil products trade.1 In 2020,as the global oil demand fell to an unprecedented low and the energy industry suffered a major setback due to the impact of COVID-19,China’s energy trade with countries along the Belt and Road Initiative bucked the trend.2In the medium and long run,energy cooperation between China and countries along the Belt and Road Initiative enjoys broad prospects in the context of China’s goals of achieving carbon neutrality and peaking carbon dioxide emissions and vigorous promotion of energy transition.展开更多
Introduction: Urinary tract infection is one of the most frequent public health problems in the world and concerns all ages. Objective: To describe the epidemiological, clinical and biological profile of urinary tract...Introduction: Urinary tract infection is one of the most frequent public health problems in the world and concerns all ages. Objective: To describe the epidemiological, clinical and biological profile of urinary tract infection in the internal medicine unit of the Fousseyni Daou hospital in Kayes. Methodology: It was a descriptive and cross-sectional study with retrospective data collection which took place from January 1 to December 31, 2020 at the Internal Medicine Unit of the Fousseyni Daou Hospital in Kayes. It covered all outpatients and hospitalized patients presenting with a urinary tract infection during the study period. Results: We identified 79 cases of urinary tract infection out of 145 requests for ECBU, that is a positivity rate of 53.10% and out of a total of 1883 admissions that is a hospital prevalence of 4.19%. The age groups of 36 to 45 years and 46 to 55 years were more represented in 28 cases (35.44%) and 25 cases (31.64%) with an average age of 45 years ± 10. The female sex was predominant, 42 cases (53.16%) with a sex ratio of 0.88. Housewives were more represented 28 cases (34.44%). The majority of patients resided in rural areas 49 cases (62.03%). The history was dominated by the following pathologies: hypertension 48.10%, diabetes 36.70% and gastropathy 30.37%. The main clinical manifestations were: Urinary burning 67 cases (84.81%), Dysuria 65 cases (82.27%), Pelvic pain 59 cases (74.68%), Fever 57 cases (72.15%). The epidemiological profile of the isolated strains was dominated by enterobacteriaceae, followed by gram-positive cocci and gram-negative bacilli. The main bacteria responsible for urinary tract infections in order of frequency: Escherichia coli (45.56%), Klebsiella pneumoniae (11.39%), Pseudomonas aeruginosa (8.86%), Staphylococcus aureus (7.59%), Streptococcus sp (6.33%), Enterobacter cloacae (3.79%), Acinetobacter sp (3.79%). The study of the susceptibility and resistance profiles of the isolated strains showed significant sensitivity of enterobacteriaceae to colistin and resistance to amoxicillin and to the amoxicillin + clavulanic acid combination. Conclusion: Urinary tract infections are a major public health problem since they are responsible for significant morbidity and mortality and a high cost of care. Knowledge of the epidemiological-clinical and bacteriological profile of these infections is essential for efficient management.展开更多
Introduction: Anemia is one of the most common public health problems in the world and affects all ages. Objective: To describe the etiological and evolutionary profile of anemia in patients hospitalized in the Intern...Introduction: Anemia is one of the most common public health problems in the world and affects all ages. Objective: To describe the etiological and evolutionary profile of anemia in patients hospitalized in the Internal Medicine Unit of the Fousseyni Daou Hospital in Kayes. Methodology: It was a descriptive and cross-sectional study with retrospective data collection which took place from January 1 to December 31, 2020 at the Internal Medicine Unit of the Fousseyni Daou Hospital in Kayes. It covered all anemic patients hospitalized during the study period. Results: We identified 91 cases of anemia out of 200 patients admitted to the Unit that is a hospital prevalence of 45.5%. The age group of 26 to 35 years was the most represented, that is to say 29 cases (31.87%) with an average age of 43.55 years ± 17.48 years, the female sex predominated, 51 cases (56.04%) with a sex ratio of 0.78. Housewives represented 41 cases (45.05%). The majority of patients resided in rural areas 48 cases (52.75%). The main manifestations were: asthenia 75 cases (78.02%), vertigo 68 cases (74.72%), dyspnea 62 cases (68.13%), headaches 59 cases (64.83%), palpitations 55 cases (60.44%), conjunctival pallor 53 cases (58.24%), tachycardia 43 cases (47.25%), systolic murmur 18 cases (19.78%) and IMO 11 cases (12.09%). The associated pathologies were: infected diabetic wounds 25.27%, followed by bacterial pleuro-pneumopathy 18.68%. Biologically, microcytic anemia was the most frequent 49 cases (53.84%), followed by normocytic anemia 35 cases (38.46%) and macrocytic anemia 7 cases (7.7%). Anemia was hypochromic, 53 cases (58.24%) were more encountered compared to normochromic anemia 38 cases (41.76%). The anemia was: severe in 43 cases (47.25%), moderate 29 cases (31.87%) and mild 19 cases (20.88%). Inflammatory anemia is the most common etiological diagnosis in 60% of cases, followed by vitamin B12 deficiency anemia observed in 21% of patients and then blood diseases in 7.33% of cases. The main causes of death were HIV (50%) and kidney failure (33.33%). Conclusion: Anemia is a frequent symptom in internal medicine. It constitutes a real diagnostic challenge for the internist and this sometimes in an emergency context. The use of specialized examinations and labile blood products is essential in our hospital.展开更多
Patients with primary sclerosing cholangitis(PSC) complicated by inflammatory bowel disease(IBD) represent a distinct subset of patients with unique characteristics,which have serious clinical implications.The aim of ...Patients with primary sclerosing cholangitis(PSC) complicated by inflammatory bowel disease(IBD) represent a distinct subset of patients with unique characteristics,which have serious clinical implications.The aim of this literature review was to shed light to the obscure clinical and molecular aspects of the two diseases combined utilizing current data available and putting issues of diagnosis and treatment into perspective.The prevalence of IBD,mainly ulcerative colitis in PSC patients is estimated to be 21%-80%,dependent on screening programs and nationality.PSC-associated colitis is likely to be extensive,characterized by rectal sparing,backwash ileitis,and generally mild symptoms.It is also more likely to progress to colorectal malignancy,making it imperative for clinicians to maintain a high level of suspicion when tackling PSC patients.There is no optimal surveillance strategy but current guidelines advocate that colonoscopy is necessary at the time of PSC diagnosis with annual endoscopic follow-up.Random biopsies have been criticized and a shift towards targeted biopsies using chromoendoscopy,laser endomicroscopy and narrow-band imaging has been noted.Techniques directed towards genetic mutations instead of histological abnormalities hold promise for easier,more accurate diagnosis of dysplastic lesions.Chemopreventive measures against colorectal cancer have been sought in these patients.Ursodeoxycholic acid seemed promising at first but subsequent studies yielded conflicting results showing anticarcinogenic effects in low doses(8-15 mg/kg per day) and carcinogenic properties in high doses(15-30 mg/kg per day).展开更多
AIM: To develop and validate a risk score for advanced colorectal adenoma(ACA) recurrence after endoscopic polypectomy.METHODS: Out of 3360 patients who underwent colon polypectomy at University of Foggia between 2004...AIM: To develop and validate a risk score for advanced colorectal adenoma(ACA) recurrence after endoscopic polypectomy.METHODS: Out of 3360 patients who underwent colon polypectomy at University of Foggia between 2004 and 2008, data of 843 patients with 1155 ACAs was retrospectively reviewed. Surveillance intervals were scheduled by guidelines at 3 years and primary endpoint was considered 3-year ACA recurrence. Baseline clinical parameters and the main features of ACAs were entered into a Cox regression analysis and variables with P < 0.05 in the univariate analysis were then tested as candidate variables into a stepwise Cox regression model(conditional backward selection). The regression coefficients of the Cox regression model were multiplied by 2 and rounded in order to obtain easy to use point numbers facilitating the calculation of the score. To avoid overoptimistic results due to model fitting and evaluation in the same dataset, we performed an internal 10-fold cross-validation by means of bootstrap sampling. RESULTS: Median lesion size was 16 mm(12-23) while median number of adenomas was 2.5(1-3), whereof the number of ACAs was 1.5(1-2). At 3 years after polypectomy, recurrence was observed in 229 ACAs(19.8%), of which 157(13.5%) were metachronous neoplasms and 72(6.2%) local recurrences. Multivariate analysis, after exclusion of the variable "type of resection" due to its collinearity with other predictive factors, confirmed lesion size, number of ACAs and grade of dysplasia as significantly associated to the primary outcome. The score was then built by multiplying the regression coefficients times 2 and the cut-off point 5 was selected by means of a Receiver Operating Characteristic curve analysis. In particular, 248 patients with 365 ACAs fell in the higher-risk group(score ≥ 5) where 3-year recurrence was detected in 174 ACAs(47.6%) whereas the remaining 595 patients with 690 ACAs were included in the low-risk group(score < 5) where 3-year recurrence rate was 7.9%(55/690 ACAs). Area under the curve of the model was 0.81(0.72-0.86) with an overall classification error rate of 0.09. The model was finally validated by means of 10-fold cross validation.CONCLUSION: Our study provides support for the use of a novel risk score as a clinical predictor of ACA recurrence after colon polypectomy.展开更多
After the first description of fatty pancreas in 1933,the effects of pancreatic steatosis have been poorly investigated,compared with that of the liver. However,the interest of research is increasing. Fat accumulation...After the first description of fatty pancreas in 1933,the effects of pancreatic steatosis have been poorly investigated,compared with that of the liver. However,the interest of research is increasing. Fat accumulation,associated with obesity and the metabolic syndrome(Met S),has been defined as "fatty infiltration" or "nonalcoholic fatty pancreas disease"(NAFPD). The term "fatty replacement" describes a distinct phenomenon characterized by death of acinar cells and replacement by adipose tissue. Risk factors for developing NAFPD include obesity,increasing age,male sex,hypertension,dyslipidemia,alcohol and hyperferritinemia. Increasing evidence support the role of pancreatic fat in the development of type 2 diabetes mellitus,Met S,atherosclerosis,severe acute pancreatitis and even pancreatic cancer. Evidence exists that fatty pancreas could be used as the initial indicator of "ectopic fat deposition",which is a key element of nonalcoholic fatty liver disease and/or Met S. Moreover,in patients with fatty pancreas,pancreaticoduodenectomy is associated with an increased risk of intraoperative blood loss and post-operative pancreatic fistula.展开更多
Ablative treatments currently represent the first-line option for the treatment of early stage unresectable hepatocellular carcinoma (HCC). Furthermore, they are effective as bridging/downstaging therapies before orth...Ablative treatments currently represent the first-line option for the treatment of early stage unresectable hepatocellular carcinoma (HCC). Furthermore, they are effective as bridging/downstaging therapies before orthotopic liver transplantation. Contraindications based on size, number, and location of nodules are quite variable in literature and strictly dependent on local expertise. Among ablative therapies, radiofrequency ablation (RFA) has gained a pivotal role due to its efficacy, with a reported 5-year survival rate of 40%-70%, and safety. Although survival outcomes are similar to percutaneous ethanol injection, the lower local recurrence rate stands for a wider application of RFA in hepato-oncology. Moreover, RFA seems to be even more cost-effective than liver resection for very early HCC (single nodule ≤ 2 cm) and in the presence of two or three nodules ≤ 3 cm. There is increasing evidence that combining RFA to transarterial chemoembolization may increase the therapeutic benefit in larger HCCs without increasing the major complication rate, but more robust prospective data is still needed to validate these pivotal findings. Among other thermal treatments, microwave ablation (MWA) uses high frequency electromagnetic energy to induce tissue death via coagulation necrosis. In comparison to RFA, MWA has several theoretical advantages such as a broader zone of active heating, higher temperatures within the targeted area in a shorter treatment time and the lack of heat-sink effect. The safety concerns raised on the risks of this procedure, due to the broader and less predictable necrosis areas, have been recently overcome. However, whether MWA ability to generate a larger ablation zone will translate into a survival gain remains unknown. Other treatments, such as high-intensity focused ultrasound ablation, laser ablation, and cryoablation, are less investigated but showed promising results in early HCC patients and could be a valuable therapeutic option in the next future.展开更多
The reaction behavior of oil sand from Inner Mongolia（China） were studied in a fluidizedbed pyrolysis process,and a comparative study was conducted on the properties of the liquid products obtained through fluidized...The reaction behavior of oil sand from Inner Mongolia（China） were studied in a fluidizedbed pyrolysis process,and a comparative study was conducted on the properties of the liquid products obtained through fluidized-bed pyrolysis of oil sand and the native bitumen obtained by solvent extraction.The results indicated that the fluidized-bed pyrolysis,a feasible carbon rejection process,can be used to upgrade oil sand.The reaction temperature and time were found to be the key operating parameters affecting the product distribution and yields in fluidized-bed pyrolysis of oil sand.The optimal temperature was 490℃ and the most suitable reaction time was 5 min.Under these operation conditions,the maximum yield of liquid product was 80wt%.In addition,the pyrolysis kinetics of oil sand at different heating rates of 5,10,20 and 30℃/min was investigated using a thermogravimetric analyzer（TGA）.展开更多
AIM: To test the correlation between lymphocyte-tomonocyte ratio(LMR) and survival after radiofrequency ablation(RFA) for colorectal liver metastasis(CLMs). METHODS: From July 2003 to Feb 2012, 127 consecutive patient...AIM: To test the correlation between lymphocyte-tomonocyte ratio(LMR) and survival after radiofrequency ablation(RFA) for colorectal liver metastasis(CLMs). METHODS: From July 2003 to Feb 2012, 127 consecutive patients with 193 histologically-proven unresectable CLMs were treated with percutaneous RFA at the University of Foggia. All patients had undergone primary colorectal tumor resection before RFA and received systemic chemotherapy. LMR was calculated by dividing lymphocyte count by monocyte count assessed at baseline. Treatment-related toxicity was defined as any adverse events occurred within 4 wk after the procedure. Overall survival(OS) and time to recurrence(TTR) were estimated from the date of RFA by Kaplan-Meier with plots and median(95%CI). The inferential analysis for time to event data was conducted using the Cox univariate and multivariate regression model to estimate hazard ratios(HR) and 95%CI. Statistically significant variables from the univariate Cox analysis were considered for the multivariate models.RESULTS: Median age was 66 years(range 38-88) and patients were prevalently male(69.2%). Median LMR was 4.38%(0.79-88) whereas median number of nodules was 2(1-3) with a median maximum diameter of 27 mm(10-45). Median OS was 38 mo(34-53) and survival rate(SR) was 89.4%, 40.4% and 33.3% at 1, 4 and 5 years respectively in the whole cohort. Running log-rank test analysis found 3.96% as the most significant prognostic cut-off point for LMR and stratifying the study population by this LMR value median OS resulted 55 mo(37-69) in patients with LMR > 3.96% and 34(26-39) mo in patients with LMR ≤ 3.96%(HR = 0.53, 0.34-0.85, P = 0.007). Nodule size and LMR were the only significant predictors for OS in multivariate analysis. Median TTR was 29 mo(22-35) with a recurrence-free survival(RFS) rate of 72.6%, 32.1% and 21.8% at 1, 4 and 5 years, respectively in the whole study group. Nodule size and LMR were confirmed as significant prognostic factors for TTR in multivariate Cox regression. TTR, when stratified by LMR, was 35 mo(28-57) in the group > 3.96% and 25 mo(18-30) in the group ≤ 3.96%(P = 0.02).CONCLUSION: Our study provides support for the use of LMR as a novel predictor of outcome for CLM patients.展开更多
AIM: To investigate the possible association between Tako-tsubo cardiomyopathy(TTC)-a reversible clini-cal condition mimicking an acute myocardial infarction characterized by multifactorial pathophysiologic mecha-nism...AIM: To investigate the possible association between Tako-tsubo cardiomyopathy(TTC)-a reversible clini-cal condition mimicking an acute myocardial infarction characterized by multifactorial pathophysiologic mecha-nisms- and respiratory system diseases. METHODS: We systematically searched PubMed and EMBASE medical information sources, to identify the different triggering causes, limiting our search to ar-ticles in English. The search keywords were: "tako-tsubo cardiomyopathy", "takotsubo", "takotsubo cardiomyopa-thy", "broken heart syndrome", "stress-induced cardio-myopathy", "apical ballooning syndrome", and "ampulla cardiomyopathy in combination with respiratory dis-eases, lung, pulmonary disease. For each kind of dis-ease, we registered: author, year and country of study, patient sex, age, concurring situation, and outcome. RESULTS: Out of a total of 1725 articles found, we se-lected 37 papers reporting a total of 38 patients. As ex-pected, most patients were women(81.6%), mean age was 65 ± 10 years. Outcome was favorable in 100% of cases, and all the patients have been discharged un-eventfully in a few days. CONCLUSION: An association between respiratory diseases and TTC is likely to exist. Patients with severe respiratory diseases, due to the high dosages of β2-agonists used or to the need of invasive procedures, are highly exposed to the risk of developing TTC.展开更多
AIM: To investigate the frequency and timing of post-partum chronic hepatitis B virus(HBV) reactivation and identify its pre-partum predictors. METHODS: Forty-one hepatitis B e antigen(HBe Ag)-negative chronic HBV inf...AIM: To investigate the frequency and timing of post-partum chronic hepatitis B virus(HBV) reactivation and identify its pre-partum predictors. METHODS: Forty-one hepatitis B e antigen(HBe Ag)-negative chronic HBV infected pregnant women were prospectively evaluated between the 28 th and the 32 nd week of gestation. Subjects were re-evaluated at 3-mo intervals during the first post-partum year and every 6 mo during the following years. HBV DNA was determined using real-time reverse transcription polymerase chain reaction(Cobas Taq Man HBV Test) with a lower detection limit of 8 IU/m L. Post-partum reactivation(PPR) was defined as abnormal alanine aminotransaminase(ALT) levels and HBV DNA above 2000 IU/m L. RESULTS: Fourteen out of 41 women(34.1%) had prepartum HBV DNA levels > 2000 IU/m L, 18(43.9%) had levels < 2000 IU/m L and 9(21.9%) had undetectable levels. Fourteen women were lost to follow-up(failure to return). PPR occurred in 8 of the 27(29.6%) women evaluated, all within the first 6 mo after delivery(5 at month 3; 3 at month 6). Five of the 6(83.3%) women with pre-partum HBV DNA > 10000 IU/m L exhibited PPR compared with 3 of the 21(14.3%) women with HBV DNA < 10000 IU/m L(two with HBV DNA > 2000 and the third with HBV DNA of 1850IU/m L), P = 0.004. An HBV DNA level ≥ 10000 IU/m L independently predicted post-partum HBV infection reactivation(OR = 57.02, P = 0.033). Mean pre-partum ALT levels presented a non-significant increase in PPR cases(47.3 IU/L vs 22.2 IU/L, respectively, P = 0.094).CONCLUSION: In the present study, PPR occurred in approximately 30% of HBe Ag-negative pregnant women; all events were observed during the first semester after delivery. Pre-partum HBV DNA level > 10000 IU/m L predicted PPR.展开更多
AIM:To determine the prevalence and incidence of diabetic nephropathy in Africa.METHODS:We performed a systematic narrative review of published literature following the MOOSE Guidelines for Meta-Analysis and Systemati...AIM:To determine the prevalence and incidence of diabetic nephropathy in Africa.METHODS:We performed a systematic narrative review of published literature following the MOOSE Guidelines for Meta-Analysis and Systematic Reviewsof Observational Studies.We searched Pub MedMEDLINE for all articles published in English and French languages between January 1994 and July 2014 using a predefined strategy based on the combination of relevant terms and the names of each of the 54 African countries and African sub-regions to capture the largest number of studies,and hand-searched the reference lists of retrieved articles.Included studies reported on the prevalence,incidence or determinants of chronic kidney disease(CKD) in people with diabetes within African countries.RESULTS:Overall,we included 32 studies from 16 countries;two being population-based studies and the remaining being clinic-based surveys.Most of the studies(90.6%) were conducted in urban settings.Methods for assessing and classifying CKD varied widely.Measurement of urine protein was the most common method of assessing kidney damage(62.5% of studies).The overall prevalence of CKD varied from 11% to 83.7%.Incident event rates were 94.9% for proteinuria at 10 years of follow-up,34.7% for endstage renal disease at 5 years of follow-up and 18.4% for mortality from nephropathy at 20 years of followup.Duration of diabetes,blood pressure,advancing age,obesity and glucose control were the common determinants of kidney disease.CONCLUSION:The burden of CKD is important among people with diabetes in Africa.High quality data from large population-based studies with validated measures of kidney function are still needed to better capture the magnitude and characteristics of diabetic nephropathy in Africa.展开更多
The forum article by Professor Xie [1] raises the broad issue of whether mental health legislation in China needs to respond to the existing realities of the community mental health services system.Given the lack of c...The forum article by Professor Xie [1] raises the broad issue of whether mental health legislation in China needs to respond to the existing realities of the community mental health services system.Given the lack of community mental health resources in China,the burden of caring for persons with mental illnesses has traditionally been borne by families and by psychiatric hospitals.As China introduces its first national mental health legislation the concern is展开更多
Acute calculous cholecystitis(ACC) is the most frequent complication of cholelithiasis and represents one-third of all surgical emergency hospital admissions, many aspects of the disease are still a matter of debate. ...Acute calculous cholecystitis(ACC) is the most frequent complication of cholelithiasis and represents one-third of all surgical emergency hospital admissions, many aspects of the disease are still a matter of debate. Knowledge of the current evidence may allow the surgical team to develop practical bedside decision-making strategies, aiming at a less demanding procedure and lower frequency of complications. In this regard, recommendations on the diagnosis supported by specific criteria and severity scores are being implemented, to prioritize patients eligible for urgency surgery. Laparoscopic cholecystectomy is the best treatment for ACC and the procedure should ideally be performed within 72h. Early surgery is associated with better results in comparison to delayed surgery. In addition, when to suspect associated common bile duct stones and how to treat them when found are still debated. The antimicrobial agents are indicated for high-risk patients and especially in the presence of gallbladder necrosis. The use of broad-spectrum antibiotics and in some cases with antifungal agents is related to better prognosis. Moreover, an emerging strategy of not converting to open, a difficult laparoscopic cholecystectomy and performing a subtotal cholecystectomy is recommended by adept surgical teams. Some authors support the use of percutaneous cholecystostomy as an alternative emergency treatment for acute Cholecystitis for patients with severe comorbidities.展开更多
文摘This study evaluated the molecular characterization of different ecotypes of B. aegyptiaca populations in the four sites: Koily alpha, Labgar, Ranérou and Ballou according to the environment with the aim of developing protection strategies. We sampled leaves of B. aegyptiaca in each individual from each site to extract and amplify a fragment of mitochondrial DNA including cytochrome b and then carefully preserved. DNA extraction, polymerase chain amplification and sequencing of MT-CYB were performed in 64 individuals. Genetic diversity and structure of B. aegyptiaca were determined using the MEGA, DNasp and Arlequin software. The results showed a high haplotype diversity and low nucleotide diversity, indicating a population expansion linked to an important gene flow. Genetic distances between populations were positively correlated with geographic distance. The importance of having highlighted this genetic differentiation of the B. aegyptiaca species between these sites is to be able to understand the degree of genetic heterogeneity of each and correlate it with adaptability because genetic diversity influences the adaptation of the species.
文摘Introduction:Heart rate variability(HRV),defined as fluctuations in the time intervals between successive heartbeats,was generated by the sinoatrial node and modulated by the autonomic nervous system(ANS).HRV emerged as a prognostic marker in chronic heart failure(CHF),particularly for mortality risk assessment in Western countries.This study aimed to evaluate the utility of HRV measurement in the follow-up of CHF patients in a sub-Saharan African context.Methods:We conducted a cross-sectional,descriptive,and analytical study during six months,in the cardiology departments of the YaoundéGeneral Hospital(HGY)and the YaoundéCentral Hospital(HCY).Eligible participants were adults with a confirmed diagnosis of CHF based on clinical,echocardiographic and electrocardiographic criteria,who had been on treatment for at least three months and provided informed consent.Exclusion criteria included atrial disease,non-sinus rhythm(atrial fibrillation,atrial flutter),loss to follow-up,and death.Consecutive sampling was applied.HRV recordings were obtained twice at a two-month interval using a Polar H10^(®)heart rate monitor connected via Bluetooth to the Elite HRV application installed on an iPhone 12 Pro Max.SDNN was the standard deviation of all normal-to-normal(NN)intervals,and RMSSD was Root Mean Square of Successive Differences.HF(High Frequency,0.15-0.40 Hz)corresponds to respiratory sinus arrhythmia;R-R intervals were recorded at rest for 5 minutes.Treat ment adherence was assessed and its relationship to HRV was explored.Data were entered using CS Pro^(®)7.0 and analyzed with SPSS^(®)23.Results:Thirtyone patients were included,with a median age of 64 years;women accounted for 54.8%of the sample.The most prevalent cardiovascular risk factors were dyslipidemia(38.7%)and alcohol consumption(34.6%).The leading etiologies of CHF were hypertensive cardiomyopathy and dilated cardiomyopathy,each representing 54.8%of cases.Left ventricular failure was present in 74.2%,and 61.3%had a left ventricular ejection fraction(LVEF)<40%.The most commonly prescribed medications were ACE inhibitors(80.6%),beta-blockers(77.4%),and loop diuretics(77.4%).Non-adherence to treatment was reported in 45.2%(14/31)of participants.Patients with good adherence demonstrated significantly higher HRV indices at both time points,including SDNN[46.7(37.3-54.4)ms;p<0.050],RMSSD[58.6(49.5-78.9)ms;p<0.010],and HF power[708.2(417.2-1020.0)ms^(2);p=0.040].Factors associated with HRV impairment found a borderline association with BMI:overweight/obese patients tended to have higher odds of HRV impairment(OR=1.7,95%CI:0.4-7.4,p=0.052);age≤60 years(OR=0.8,95%CI:0.4-8.1,p<0.044)and Beta-blocker(OR=0.5,95%CI:0.1-2.5,p=0.030)use was associated with a lower risk of HRV alteration.Treatment with good adherence showed a significant association linked to a lower risk of HRV impairment(OR=0.2,95%CI:0.0-1.3).Conclusion:This study confirms the potential of HRV as a complementary tool for the follow-up of CHF patients.HRV indices,particularly regarding young age,good weight and combined with treatment adherence assessment,may provide a cost-effective,non-invasive method to improve CHF management in resource-limited settings.
文摘Background:Heart failure(HF)poses a significant global health burden,necessitating effective management strategies.This randomized controlled trial evaluated the effects of a seven-week cardiac rehabilitation program on functional capacity and quality of life in patients with stable chronic HF.Methods:Participants were randomly assigned to either a rehabilitation group(n=10)or a control group(n=10).The mean age of participants was 62.9±9.45 years in the intervention group and 60.3±8.23 years with extremes ranging from 45 years to 79 years.The male gender was the most represented in both groups,with a rate of 70%in the intervention group and 60%in the control group,i.e.,a sex ratio of 1.87.The rehabilitation program consisted of structured exercise,education,and psychological support.Functional capacity was assessed using the six-minute walk test(6MWT),exercise testing,and estimated VO_(2max).Quality of life,anxiety,and depression were measured using validated questionnaires.Hemodynamic parameters and physical activity levels were also evaluated.Results:Results demonstrated significant improvements in the rehabilitation group compared to the control group;specifically a significant increase in 6MWT distance(p<0.001)exercise duration(p=0.008)and functional capacity(p=0.029).Furthermore,participants in the rehabilitation group exhibited significant reductions in anxiety and depression scores(p=0.008 and p<0.001,respectively),and reported a significant improvement in quality of life(p=0.002)and PA level(p=0.011).Systolic blood pressure also significantly decreased in the rehabilitation group.Physical activity levels increased significantly in the rehabilitation group.Conclusions:A seven-week cardiac rehabilitation program significantly improved functional capacity,quality of life,and psychological well-being in patients with stable chronic HF.These findings emphasize the importance of integrating cardiac rehabilitation into the comprehensive management of HF patients.
文摘At the end of 2015, the United States lifted a 40-year ban on crude oil exports, which has far-reaching implications for the global crude oil market and crude oil trade patterns. Since the release of crude oil exports, with the recovery of crude oil production and improved export infrastructure in the United States, U.S. crude oil exports have been growing rapidly, with an average of about one million barrels/day in 2017, making the U.S one of the major global crude oil exporters. Currently, the AsiaPacific region has replaced North America as the first major destination for U.S. crude oil exports. In light of future trends in the oil refining industry of the Asia-Pacific region, it will usher in a new wave of refinery operations around 2020 and crude oil imports will continue to grow rapidly. The American region, represented by the United States, will replace West Africa as the second largest source of crude oil imports to the Asia-Pacific region, and that energy trade cooperation between the Asia-Pacific region and the United States will continue to grow. In particular, for China, the United States will become an important source of crude oil imports for our country in the future, and the two countries will shift from the past of energy competition to energy cooperation. Sino-US energy trade will play a more active role in economic and trade cooperation between the two countries.
基金supported by the National Natural Science Foundation of China(Nos.21277125,21577128)Xinmiao Talent Scheme(No.2016R403069)Changjiang Scholars and Innovative Research Team in University(No.IRT13096)
文摘Diclofop-methyl（DM）,a widely used herbicide in food crops,may partly contaminate the soil surface of natural ecosystems in agricultural area and exert toxic effects at low dose to nontarget plants.Even though rhizosphere microorganisms strongly interact with root cells,little is known regarding their potential modulating effect on herbicide toxicity in plants.Here we exposed rice seedlings（Xiushui 63） to 100 μg/L DM for 2 to 8 days and studied the effects of DM on rice rhizosphere microorganisms,rice systemic acquired resistance（SAR） and rice-microorganisms interactions.The results of metagenomic 16 S rDNA Illumina tags show that DM increases bacterial biomass and affects their community structure in the rice rhizosphere.After DM treatment,the relative abundance of the bacterium genera Massilia and Anderseniella increased the most relative to the control.In parallel,malate and oxalate exudation by rice roots increased,potentially acting as a carbon source for several rhizosphere bacteria.Transcriptomic analyses suggest that DM induced SAR in rice seedlings through the salicylic acid（but not the jasmonic acid） signal pathway.This response to DM stress conferred resistance to infection by a pathogenic bacterium,but was not influenced by the presence of bacteria in the rhizosphere since SAR transcripts did not change significantly in xenic and axenic plant roots exposed to DM.The present study provides new insights on the response of rice and its associated microorganisms to DM stress.
文摘Since the implementation of the Belt and Road Initiative nearly eight years ago,important progress has been made in economic and energy trade cooperation.In terms of the energy industry,the Belt and Road Initiative is also an road to energy,and countries along the Belt and Road are important partners for China in crude oil and oil products trade.1 In 2020,as the global oil demand fell to an unprecedented low and the energy industry suffered a major setback due to the impact of COVID-19,China’s energy trade with countries along the Belt and Road Initiative bucked the trend.2In the medium and long run,energy cooperation between China and countries along the Belt and Road Initiative enjoys broad prospects in the context of China’s goals of achieving carbon neutrality and peaking carbon dioxide emissions and vigorous promotion of energy transition.
文摘Introduction: Urinary tract infection is one of the most frequent public health problems in the world and concerns all ages. Objective: To describe the epidemiological, clinical and biological profile of urinary tract infection in the internal medicine unit of the Fousseyni Daou hospital in Kayes. Methodology: It was a descriptive and cross-sectional study with retrospective data collection which took place from January 1 to December 31, 2020 at the Internal Medicine Unit of the Fousseyni Daou Hospital in Kayes. It covered all outpatients and hospitalized patients presenting with a urinary tract infection during the study period. Results: We identified 79 cases of urinary tract infection out of 145 requests for ECBU, that is a positivity rate of 53.10% and out of a total of 1883 admissions that is a hospital prevalence of 4.19%. The age groups of 36 to 45 years and 46 to 55 years were more represented in 28 cases (35.44%) and 25 cases (31.64%) with an average age of 45 years ± 10. The female sex was predominant, 42 cases (53.16%) with a sex ratio of 0.88. Housewives were more represented 28 cases (34.44%). The majority of patients resided in rural areas 49 cases (62.03%). The history was dominated by the following pathologies: hypertension 48.10%, diabetes 36.70% and gastropathy 30.37%. The main clinical manifestations were: Urinary burning 67 cases (84.81%), Dysuria 65 cases (82.27%), Pelvic pain 59 cases (74.68%), Fever 57 cases (72.15%). The epidemiological profile of the isolated strains was dominated by enterobacteriaceae, followed by gram-positive cocci and gram-negative bacilli. The main bacteria responsible for urinary tract infections in order of frequency: Escherichia coli (45.56%), Klebsiella pneumoniae (11.39%), Pseudomonas aeruginosa (8.86%), Staphylococcus aureus (7.59%), Streptococcus sp (6.33%), Enterobacter cloacae (3.79%), Acinetobacter sp (3.79%). The study of the susceptibility and resistance profiles of the isolated strains showed significant sensitivity of enterobacteriaceae to colistin and resistance to amoxicillin and to the amoxicillin + clavulanic acid combination. Conclusion: Urinary tract infections are a major public health problem since they are responsible for significant morbidity and mortality and a high cost of care. Knowledge of the epidemiological-clinical and bacteriological profile of these infections is essential for efficient management.
文摘Introduction: Anemia is one of the most common public health problems in the world and affects all ages. Objective: To describe the etiological and evolutionary profile of anemia in patients hospitalized in the Internal Medicine Unit of the Fousseyni Daou Hospital in Kayes. Methodology: It was a descriptive and cross-sectional study with retrospective data collection which took place from January 1 to December 31, 2020 at the Internal Medicine Unit of the Fousseyni Daou Hospital in Kayes. It covered all anemic patients hospitalized during the study period. Results: We identified 91 cases of anemia out of 200 patients admitted to the Unit that is a hospital prevalence of 45.5%. The age group of 26 to 35 years was the most represented, that is to say 29 cases (31.87%) with an average age of 43.55 years ± 17.48 years, the female sex predominated, 51 cases (56.04%) with a sex ratio of 0.78. Housewives represented 41 cases (45.05%). The majority of patients resided in rural areas 48 cases (52.75%). The main manifestations were: asthenia 75 cases (78.02%), vertigo 68 cases (74.72%), dyspnea 62 cases (68.13%), headaches 59 cases (64.83%), palpitations 55 cases (60.44%), conjunctival pallor 53 cases (58.24%), tachycardia 43 cases (47.25%), systolic murmur 18 cases (19.78%) and IMO 11 cases (12.09%). The associated pathologies were: infected diabetic wounds 25.27%, followed by bacterial pleuro-pneumopathy 18.68%. Biologically, microcytic anemia was the most frequent 49 cases (53.84%), followed by normocytic anemia 35 cases (38.46%) and macrocytic anemia 7 cases (7.7%). Anemia was hypochromic, 53 cases (58.24%) were more encountered compared to normochromic anemia 38 cases (41.76%). The anemia was: severe in 43 cases (47.25%), moderate 29 cases (31.87%) and mild 19 cases (20.88%). Inflammatory anemia is the most common etiological diagnosis in 60% of cases, followed by vitamin B12 deficiency anemia observed in 21% of patients and then blood diseases in 7.33% of cases. The main causes of death were HIV (50%) and kidney failure (33.33%). Conclusion: Anemia is a frequent symptom in internal medicine. It constitutes a real diagnostic challenge for the internist and this sometimes in an emergency context. The use of specialized examinations and labile blood products is essential in our hospital.
文摘Patients with primary sclerosing cholangitis(PSC) complicated by inflammatory bowel disease(IBD) represent a distinct subset of patients with unique characteristics,which have serious clinical implications.The aim of this literature review was to shed light to the obscure clinical and molecular aspects of the two diseases combined utilizing current data available and putting issues of diagnosis and treatment into perspective.The prevalence of IBD,mainly ulcerative colitis in PSC patients is estimated to be 21%-80%,dependent on screening programs and nationality.PSC-associated colitis is likely to be extensive,characterized by rectal sparing,backwash ileitis,and generally mild symptoms.It is also more likely to progress to colorectal malignancy,making it imperative for clinicians to maintain a high level of suspicion when tackling PSC patients.There is no optimal surveillance strategy but current guidelines advocate that colonoscopy is necessary at the time of PSC diagnosis with annual endoscopic follow-up.Random biopsies have been criticized and a shift towards targeted biopsies using chromoendoscopy,laser endomicroscopy and narrow-band imaging has been noted.Techniques directed towards genetic mutations instead of histological abnormalities hold promise for easier,more accurate diagnosis of dysplastic lesions.Chemopreventive measures against colorectal cancer have been sought in these patients.Ursodeoxycholic acid seemed promising at first but subsequent studies yielded conflicting results showing anticarcinogenic effects in low doses(8-15 mg/kg per day) and carcinogenic properties in high doses(15-30 mg/kg per day).
文摘AIM: To develop and validate a risk score for advanced colorectal adenoma(ACA) recurrence after endoscopic polypectomy.METHODS: Out of 3360 patients who underwent colon polypectomy at University of Foggia between 2004 and 2008, data of 843 patients with 1155 ACAs was retrospectively reviewed. Surveillance intervals were scheduled by guidelines at 3 years and primary endpoint was considered 3-year ACA recurrence. Baseline clinical parameters and the main features of ACAs were entered into a Cox regression analysis and variables with P < 0.05 in the univariate analysis were then tested as candidate variables into a stepwise Cox regression model(conditional backward selection). The regression coefficients of the Cox regression model were multiplied by 2 and rounded in order to obtain easy to use point numbers facilitating the calculation of the score. To avoid overoptimistic results due to model fitting and evaluation in the same dataset, we performed an internal 10-fold cross-validation by means of bootstrap sampling. RESULTS: Median lesion size was 16 mm(12-23) while median number of adenomas was 2.5(1-3), whereof the number of ACAs was 1.5(1-2). At 3 years after polypectomy, recurrence was observed in 229 ACAs(19.8%), of which 157(13.5%) were metachronous neoplasms and 72(6.2%) local recurrences. Multivariate analysis, after exclusion of the variable "type of resection" due to its collinearity with other predictive factors, confirmed lesion size, number of ACAs and grade of dysplasia as significantly associated to the primary outcome. The score was then built by multiplying the regression coefficients times 2 and the cut-off point 5 was selected by means of a Receiver Operating Characteristic curve analysis. In particular, 248 patients with 365 ACAs fell in the higher-risk group(score ≥ 5) where 3-year recurrence was detected in 174 ACAs(47.6%) whereas the remaining 595 patients with 690 ACAs were included in the low-risk group(score < 5) where 3-year recurrence rate was 7.9%(55/690 ACAs). Area under the curve of the model was 0.81(0.72-0.86) with an overall classification error rate of 0.09. The model was finally validated by means of 10-fold cross validation.CONCLUSION: Our study provides support for the use of a novel risk score as a clinical predictor of ACA recurrence after colon polypectomy.
文摘After the first description of fatty pancreas in 1933,the effects of pancreatic steatosis have been poorly investigated,compared with that of the liver. However,the interest of research is increasing. Fat accumulation,associated with obesity and the metabolic syndrome(Met S),has been defined as "fatty infiltration" or "nonalcoholic fatty pancreas disease"(NAFPD). The term "fatty replacement" describes a distinct phenomenon characterized by death of acinar cells and replacement by adipose tissue. Risk factors for developing NAFPD include obesity,increasing age,male sex,hypertension,dyslipidemia,alcohol and hyperferritinemia. Increasing evidence support the role of pancreatic fat in the development of type 2 diabetes mellitus,Met S,atherosclerosis,severe acute pancreatitis and even pancreatic cancer. Evidence exists that fatty pancreas could be used as the initial indicator of "ectopic fat deposition",which is a key element of nonalcoholic fatty liver disease and/or Met S. Moreover,in patients with fatty pancreas,pancreaticoduodenectomy is associated with an increased risk of intraoperative blood loss and post-operative pancreatic fistula.
文摘Ablative treatments currently represent the first-line option for the treatment of early stage unresectable hepatocellular carcinoma (HCC). Furthermore, they are effective as bridging/downstaging therapies before orthotopic liver transplantation. Contraindications based on size, number, and location of nodules are quite variable in literature and strictly dependent on local expertise. Among ablative therapies, radiofrequency ablation (RFA) has gained a pivotal role due to its efficacy, with a reported 5-year survival rate of 40%-70%, and safety. Although survival outcomes are similar to percutaneous ethanol injection, the lower local recurrence rate stands for a wider application of RFA in hepato-oncology. Moreover, RFA seems to be even more cost-effective than liver resection for very early HCC (single nodule ≤ 2 cm) and in the presence of two or three nodules ≤ 3 cm. There is increasing evidence that combining RFA to transarterial chemoembolization may increase the therapeutic benefit in larger HCCs without increasing the major complication rate, but more robust prospective data is still needed to validate these pivotal findings. Among other thermal treatments, microwave ablation (MWA) uses high frequency electromagnetic energy to induce tissue death via coagulation necrosis. In comparison to RFA, MWA has several theoretical advantages such as a broader zone of active heating, higher temperatures within the targeted area in a shorter treatment time and the lack of heat-sink effect. The safety concerns raised on the risks of this procedure, due to the broader and less predictable necrosis areas, have been recently overcome. However, whether MWA ability to generate a larger ablation zone will translate into a survival gain remains unknown. Other treatments, such as high-intensity focused ultrasound ablation, laser ablation, and cryoablation, are less investigated but showed promising results in early HCC patients and could be a valuable therapeutic option in the next future.
基金the financial support provided by the National Science Foundation of China (21176252)the China National Petroleum Science Research Program (2011B-2404-01)
文摘The reaction behavior of oil sand from Inner Mongolia（China） were studied in a fluidizedbed pyrolysis process,and a comparative study was conducted on the properties of the liquid products obtained through fluidized-bed pyrolysis of oil sand and the native bitumen obtained by solvent extraction.The results indicated that the fluidized-bed pyrolysis,a feasible carbon rejection process,can be used to upgrade oil sand.The reaction temperature and time were found to be the key operating parameters affecting the product distribution and yields in fluidized-bed pyrolysis of oil sand.The optimal temperature was 490℃ and the most suitable reaction time was 5 min.Under these operation conditions,the maximum yield of liquid product was 80wt%.In addition,the pyrolysis kinetics of oil sand at different heating rates of 5,10,20 and 30℃/min was investigated using a thermogravimetric analyzer（TGA）.
文摘AIM: To test the correlation between lymphocyte-tomonocyte ratio(LMR) and survival after radiofrequency ablation(RFA) for colorectal liver metastasis(CLMs). METHODS: From July 2003 to Feb 2012, 127 consecutive patients with 193 histologically-proven unresectable CLMs were treated with percutaneous RFA at the University of Foggia. All patients had undergone primary colorectal tumor resection before RFA and received systemic chemotherapy. LMR was calculated by dividing lymphocyte count by monocyte count assessed at baseline. Treatment-related toxicity was defined as any adverse events occurred within 4 wk after the procedure. Overall survival(OS) and time to recurrence(TTR) were estimated from the date of RFA by Kaplan-Meier with plots and median(95%CI). The inferential analysis for time to event data was conducted using the Cox univariate and multivariate regression model to estimate hazard ratios(HR) and 95%CI. Statistically significant variables from the univariate Cox analysis were considered for the multivariate models.RESULTS: Median age was 66 years(range 38-88) and patients were prevalently male(69.2%). Median LMR was 4.38%(0.79-88) whereas median number of nodules was 2(1-3) with a median maximum diameter of 27 mm(10-45). Median OS was 38 mo(34-53) and survival rate(SR) was 89.4%, 40.4% and 33.3% at 1, 4 and 5 years respectively in the whole cohort. Running log-rank test analysis found 3.96% as the most significant prognostic cut-off point for LMR and stratifying the study population by this LMR value median OS resulted 55 mo(37-69) in patients with LMR > 3.96% and 34(26-39) mo in patients with LMR ≤ 3.96%(HR = 0.53, 0.34-0.85, P = 0.007). Nodule size and LMR were the only significant predictors for OS in multivariate analysis. Median TTR was 29 mo(22-35) with a recurrence-free survival(RFS) rate of 72.6%, 32.1% and 21.8% at 1, 4 and 5 years, respectively in the whole study group. Nodule size and LMR were confirmed as significant prognostic factors for TTR in multivariate Cox regression. TTR, when stratified by LMR, was 35 mo(28-57) in the group > 3.96% and 25 mo(18-30) in the group ≤ 3.96%(P = 0.02).CONCLUSION: Our study provides support for the use of LMR as a novel predictor of outcome for CLM patients.
基金Supported by A scientific grant(FAR–Fondo Ateneo Ricerca)from the University of Ferrara,Italy(in part)
文摘AIM: To investigate the possible association between Tako-tsubo cardiomyopathy(TTC)-a reversible clini-cal condition mimicking an acute myocardial infarction characterized by multifactorial pathophysiologic mecha-nisms- and respiratory system diseases. METHODS: We systematically searched PubMed and EMBASE medical information sources, to identify the different triggering causes, limiting our search to ar-ticles in English. The search keywords were: "tako-tsubo cardiomyopathy", "takotsubo", "takotsubo cardiomyopa-thy", "broken heart syndrome", "stress-induced cardio-myopathy", "apical ballooning syndrome", and "ampulla cardiomyopathy in combination with respiratory dis-eases, lung, pulmonary disease. For each kind of dis-ease, we registered: author, year and country of study, patient sex, age, concurring situation, and outcome. RESULTS: Out of a total of 1725 articles found, we se-lected 37 papers reporting a total of 38 patients. As ex-pected, most patients were women(81.6%), mean age was 65 ± 10 years. Outcome was favorable in 100% of cases, and all the patients have been discharged un-eventfully in a few days. CONCLUSION: An association between respiratory diseases and TTC is likely to exist. Patients with severe respiratory diseases, due to the high dosages of β2-agonists used or to the need of invasive procedures, are highly exposed to the risk of developing TTC.
文摘AIM: To investigate the frequency and timing of post-partum chronic hepatitis B virus(HBV) reactivation and identify its pre-partum predictors. METHODS: Forty-one hepatitis B e antigen(HBe Ag)-negative chronic HBV infected pregnant women were prospectively evaluated between the 28 th and the 32 nd week of gestation. Subjects were re-evaluated at 3-mo intervals during the first post-partum year and every 6 mo during the following years. HBV DNA was determined using real-time reverse transcription polymerase chain reaction(Cobas Taq Man HBV Test) with a lower detection limit of 8 IU/m L. Post-partum reactivation(PPR) was defined as abnormal alanine aminotransaminase(ALT) levels and HBV DNA above 2000 IU/m L. RESULTS: Fourteen out of 41 women(34.1%) had prepartum HBV DNA levels > 2000 IU/m L, 18(43.9%) had levels < 2000 IU/m L and 9(21.9%) had undetectable levels. Fourteen women were lost to follow-up(failure to return). PPR occurred in 8 of the 27(29.6%) women evaluated, all within the first 6 mo after delivery(5 at month 3; 3 at month 6). Five of the 6(83.3%) women with pre-partum HBV DNA > 10000 IU/m L exhibited PPR compared with 3 of the 21(14.3%) women with HBV DNA < 10000 IU/m L(two with HBV DNA > 2000 and the third with HBV DNA of 1850IU/m L), P = 0.004. An HBV DNA level ≥ 10000 IU/m L independently predicted post-partum HBV infection reactivation(OR = 57.02, P = 0.033). Mean pre-partum ALT levels presented a non-significant increase in PPR cases(47.3 IU/L vs 22.2 IU/L, respectively, P = 0.094).CONCLUSION: In the present study, PPR occurred in approximately 30% of HBe Ag-negative pregnant women; all events were observed during the first semester after delivery. Pre-partum HBV DNA level > 10000 IU/m L predicted PPR.
文摘AIM:To determine the prevalence and incidence of diabetic nephropathy in Africa.METHODS:We performed a systematic narrative review of published literature following the MOOSE Guidelines for Meta-Analysis and Systematic Reviewsof Observational Studies.We searched Pub MedMEDLINE for all articles published in English and French languages between January 1994 and July 2014 using a predefined strategy based on the combination of relevant terms and the names of each of the 54 African countries and African sub-regions to capture the largest number of studies,and hand-searched the reference lists of retrieved articles.Included studies reported on the prevalence,incidence or determinants of chronic kidney disease(CKD) in people with diabetes within African countries.RESULTS:Overall,we included 32 studies from 16 countries;two being population-based studies and the remaining being clinic-based surveys.Most of the studies(90.6%) were conducted in urban settings.Methods for assessing and classifying CKD varied widely.Measurement of urine protein was the most common method of assessing kidney damage(62.5% of studies).The overall prevalence of CKD varied from 11% to 83.7%.Incident event rates were 94.9% for proteinuria at 10 years of follow-up,34.7% for endstage renal disease at 5 years of follow-up and 18.4% for mortality from nephropathy at 20 years of followup.Duration of diabetes,blood pressure,advancing age,obesity and glucose control were the common determinants of kidney disease.CONCLUSION:The burden of CKD is important among people with diabetes in Africa.High quality data from large population-based studies with validated measures of kidney function are still needed to better capture the magnitude and characteristics of diabetic nephropathy in Africa.
文摘The forum article by Professor Xie [1] raises the broad issue of whether mental health legislation in China needs to respond to the existing realities of the community mental health services system.Given the lack of community mental health resources in China,the burden of caring for persons with mental illnesses has traditionally been borne by families and by psychiatric hospitals.As China introduces its first national mental health legislation the concern is
文摘Acute calculous cholecystitis(ACC) is the most frequent complication of cholelithiasis and represents one-third of all surgical emergency hospital admissions, many aspects of the disease are still a matter of debate. Knowledge of the current evidence may allow the surgical team to develop practical bedside decision-making strategies, aiming at a less demanding procedure and lower frequency of complications. In this regard, recommendations on the diagnosis supported by specific criteria and severity scores are being implemented, to prioritize patients eligible for urgency surgery. Laparoscopic cholecystectomy is the best treatment for ACC and the procedure should ideally be performed within 72h. Early surgery is associated with better results in comparison to delayed surgery. In addition, when to suspect associated common bile duct stones and how to treat them when found are still debated. The antimicrobial agents are indicated for high-risk patients and especially in the presence of gallbladder necrosis. The use of broad-spectrum antibiotics and in some cases with antifungal agents is related to better prognosis. Moreover, an emerging strategy of not converting to open, a difficult laparoscopic cholecystectomy and performing a subtotal cholecystectomy is recommended by adept surgical teams. Some authors support the use of percutaneous cholecystostomy as an alternative emergency treatment for acute Cholecystitis for patients with severe comorbidities.
