The escalating global dissemination of plasmid-mediated antibiotic resistance poses a formidable threat to global health.Conjugation stands as a pivotal mechanism for horizontal gene transfer among bacterial populatio...The escalating global dissemination of plasmid-mediated antibiotic resistance poses a formidable threat to global health.Conjugation stands as a pivotal mechanism for horizontal gene transfer among bacterial populations,facilitating the spread of antibiotic resistance genes(ARGs).Microelectrolysis has garnered attention as an efficacious strategy for mitigating antibiotic concentrations in wastewater,yet its potential impact on ARG horizontal transfer remain largely unexplored.This comprehensive investigation unveils that microelectrolysis not only influences but significantly accelerates the conjugative transfer of ARG-harboring plasmids.Remarkably,this phenomenon is corroborated at the microbial community scale,underscoring its ecological relevance.Alarmingly,the study highlights the vulnerability of intestinalmicroorganisms to acquire antibiotic resistance under electrolytic stimulation,posing heightened risks to both animal and human health.Delving deeper,the study elucidates the underlyingmechanisms responsible for this enhanced conjugative transfer.It reveals that microelectrolysis augments the abundance of mating-competent cells,triggers the generation of reactive oxygen species,inflicts modest membrane damage,and upregulates the expression of genes critical for conjugation.These findings collectively contribute to a more profound comprehension of the environmental dissemination dynamics and associated public health implications of ARGs in the context of wastewater treatment employing microelectrolytic technologies.展开更多
The poor clinical conditions associated with end-stage cirrhosis,pre-existing pulmonary abnormalities,and high comorbidity rates in patients with high Model for End-Stage Liver Disease scores are all well-recognized f...The poor clinical conditions associated with end-stage cirrhosis,pre-existing pulmonary abnormalities,and high comorbidity rates in patients with high Model for End-Stage Liver Disease scores are all well-recognized factors that increase the risk of pulmonary complications after orthotopic liver transplantation(OLT)surgery.Many intraoperative and postoperative events,such as fluid overload,massive transfusion of blood products,hemodynamic instability,unexpected coagulation abnormalities,renal dysfunction,and serious adverse effects of reperfusion syndrome,are other factors that predispose an individual to postoperative respiratory disorders.Despite advances in surgical techniques and anesthesiological management,the lung may still suffer throughout the perioperative period from various types of injury and ventilatory impairment,with different clinical outcomes.Pulmonary complications after OLT can be classified as infectious or non-infectious.Pleural effusion,atelectasis,pulmonary edema,respiratory distress syndrome,and pneumonia may contribute considerably to early morbidity and mortality in liver transplant patients.It is of paramount importance to accurately identify lung disorders because infectious pulmonary complications warrant speedy and aggressive treatment to prevent diffuse lung injury and the risk of evolution into multisystem organ failure.This review discusses the most common perioperative factors that predispose an individual to postoperative pulmonary complications and these complications’early clinical manifestations after OLT and influence on patient outcome.展开更多
AIM: To evaluate the relationship between glycemic control [assessed by glycated hemoglobin (HbA1c)], antidiabetic therapies and the risk of hepatocellular carcinoma (HCC).METHODS: We recruited 465 patients with HCC, ...AIM: To evaluate the relationship between glycemic control [assessed by glycated hemoglobin (HbA1c)], antidiabetic therapies and the risk of hepatocellular carcinoma (HCC).METHODS: We recruited 465 patients with HCC, 618 cases with liver cirrhosis and 490 controls with no liver disease. Among subjects with type 2 diabetes mellitus (DM2), the associations between the antidiabetic strategies and HbA1c level with HCC were determined through 2 series of multivariate logistic regression models using cirrhotic patients and controls as comparison groups. RESULTS: DM2 prevalence was 31.2% in patients with HCC, 23.2% in cirrhotic patients and 12.6% in controls (P < 0.0001). In 86% of study subjects, DM2 had been diagnosed for more than 1 year before the HCC diagnosis. HCC patients with DM2 had a 1.52.5fold increased risk of liver cancer. The HbA1c mean levels were signif icantly higher in DM2 patients with HCC than in cirrhoticand control DM2 patients. Antidiabetic treatment with metformin was more common among cirrhotic and control DM2 subjects than among cases with HCC. In both series of multivariate analyses, treatment with metformin signif icantly reduced the risk of HCC by more than 80% compared with sulphonylureas and insulin therapy. No signif icant differences were seen between sulphonylureas and insulin treatment. Elevated HbA1c levels were positively related to the risk for HCC in diabetic patients, with a 26%50% increase in risk for each 1% increase in HbA1c values.CONCLUSION: In patients with preexisting DM2, the risk of HCC is positively associated with poor chronic glycemic control and significantly decreased by metformin therapy.展开更多
Nutritional concerns, linear growth deficiency, and delayed puberty are currently detected in up to 85% of patients with Crohn's disease(CD) diagnosed at childhood. To provide advice on how to assess and manage nu...Nutritional concerns, linear growth deficiency, and delayed puberty are currently detected in up to 85% of patients with Crohn's disease(CD) diagnosed at childhood. To provide advice on how to assess and manage nutritional concerns in these patients, a Medline search was conducted using "pediatric inflammatory bowel disease", "pediatric Crohn's disease", "linear growth","pubertal growth", "bone health", and "vitamin D" as key words. Clinical trials, systematic reviews, and metaanalyses published between 2008 and 2013 were selected to produce this narrative review. Studies referring to earlier periods were also considered if the data was relevant to our review. Although current treatment strategies for CD that include anti-tumor necrosis factor-αtherapy have been shown to improve patients' growth rate, linear growth deficiencies are still common. In pediatric CD patients, prolonged diagnostic delay, high initial activity index, and stricturing/penetrating typeof behavior may cause growth deficiencies(in weight and height) and delayed puberty, with several studies reporting that these patients may not reach an optimal bone mass. Glucocorticoids and inflammation inhibit bone formation, though their impact on skeletal modeling remains unclear. Long-term control of active inflammation and an adequate intake of nutrients are both fundamental in promoting normal puberty. Recent evidence suggests that recombinant growth factor therapy is effective in improving short-term linear growth in selected patients, but is of limited benefit for ameliorating mucosal disease and reducing clinical disease activity. The authors conclude that an intense initial treatment(taking a "top-down" approach, with the early introduction of immunomodulatory treatment) may be justified to induce and maintain remission so that the growth of children with CD can catch up, ideally before puberty. Exclusive enteral nutrition has a key role in inducing remission and improving patients' nutritional status.展开更多
Under the demand of urban expansion and the constraints of China’s’National Main Functional Area Planning’policy,urban agglomerations are facing with a huge contradiction between land utilization and ecological pro...Under the demand of urban expansion and the constraints of China’s’National Main Functional Area Planning’policy,urban agglomerations are facing with a huge contradiction between land utilization and ecological protection,especially for HarbinChangchun urban agglomeration who owns a large number of land used for the protection of agricultural production and ecological function.To alleviate this contradiction and provide insight into future land use patterns under different ecological constraints’scenarios,we introduced the patch-based land use simulation(PLUS)model and simulated urban expansion of the Harbin-Changchun urban agglomeration.After verifying the accuracy of the simulation result in 2018,we predicted future urban expansion under the constraints of three different ecological scenarios in 2026.The morphological spatial pattern analysis(MSPA)method and minimum cumulative resistance(MCR)model were also introduced to identify different levels of ecological security pattern(ESP)as ecological constraints.The predicted result of the optimal protection(OP)scenario showed less proportion of water and forest than those of natural expansion(NE)and basic protection(BP)scenarios in 2026.The conclusions are that the PLUS model can improve the simulation accuracy at urban agglomeration scale compared with other cellular automata(CA)models,and the future urban expansion under OP scenario has the least threat to the ecosystem,while the expansion under the natural expansion(NE)scenario poses the greatest threat to the ecosystem.Combined with the MSPA and MCR methods,PLUS model can also be used in other spatial simulations of urban agglomerations under ecological constraints.展开更多
AIMTo evaluate the efficacy and safety of a combined treatment for myopic choroidal neovascularization (CNV) using photodynamic therapy (PDT) and intravitreal bevacizumab and to compare it with intravitreal bevacizuma...AIMTo evaluate the efficacy and safety of a combined treatment for myopic choroidal neovascularization (CNV) using photodynamic therapy (PDT) and intravitreal bevacizumab and to compare it with intravitreal bevacizumab monotherapy.展开更多
Despite the progress made in the prevention and treatment of rejection of the transplanted heart, cardiac allograft vasculopathy(CAV) remains the main cause of death in late survival transplanted patients. CAV consist...Despite the progress made in the prevention and treatment of rejection of the transplanted heart, cardiac allograft vasculopathy(CAV) remains the main cause of death in late survival transplanted patients. CAV consists of a progressive diffuse intimal hyperplasia and the proliferation of vascular smooth muscle cells, ending in wall thickening of epicardial vessels, intramyocardial arteries(50-20 μm), arterioles(20-10 μm), and capillaries(< 10 μm). The etiology of CAV remains unclear; both immunologic and non-immunologic mechanisms contribute to endothelial damage with a sustained inflammatory response. The immunological factors involved are Human Leukocyte Antigen compatibility between donor and recipient, alloreactive T cells and the humoral immune system. The non-immunological factors are older donor age, ischemia-reperfusion time, hyperlipidemia and CMV infections. Diagnostic techniques that are able to assess microvascular function are lacking. Intravascular ultrasound and fractional flow reserve, when performed during coronary angiography, are able to detect epicardial coronary artery disease but are not sensitive enough to assess microvascular changes. Some authors have proposed an index of microcircula-tory resistance during maximal hyperemia, which is calculated by dividing pressure by flow(distal pressure multiplied by the hyperemic mean transit time). Non-invasive methods to assess coronary physiology are stress echocardiography, coronary flow reserve by transthoracic Doppler echocardiography, single photon emission computed tomography, and perfusion cardiac magnetic resonance. In this review, we intend to analyze the mechanisms, consequences and therapeutic implications of microvascular dysfunction, including an extended citation of relevant literature data.展开更多
AIM:To assess B1a cell expression in the rectal mucosa of ulcerative colitis (UC) patients in comparison with healthy controls.METHODS:Rectal mucosa biopsies were collected from 15 UC patients and 17 healthy controls....AIM:To assess B1a cell expression in the rectal mucosa of ulcerative colitis (UC) patients in comparison with healthy controls.METHODS:Rectal mucosa biopsies were collected from 15 UC patients and 17 healthy controls.CD5 + B cells were analysed by three colour flow cytometry from rectal mucosal samples after mechanical disaggregation by Medimachine.Immunohistochemical analysis of B and T lymphocytes was also performed.Correlations between,on the one hand,rectal B1a cell concentrations and,on the other,erythrocyte sedimentation rate and C-reactive protein levels and clinical,endoscopic and histological disease activity indices were evaluated.RESULTS:Rectal B-lymphocyte (CD19 + /CD45 +) rate and concentration were higher in UC patients compared with those in healthy controls (47.85% ± 3.12% vs 26.10% ± 3.40%,P=0.001 and 501 ± 91 cells/mm 2 vs 117 ± 18 cells/mm 2,P < 0.001);Rectal B1a cell density (CD5 + CD19 +) was higher in UC patients than in healthy controls (85 ± 15 cells/mm 2 vs 31 ± 6.7 cells/mm 2,P=0.009).Rectal B1a cell (CD5/CD19 +) rate correlated inversely with endoscopic classification (Rs=-0.637,P < 0.05).CONCLUSION:B1a lymphocytes seem to be involved in the pathogenesis of UC,however,the role they play in its early phases and in disease activity,have yet to be defined.展开更多
Aims: The goal of the present study is to summarize our experience on surgical management of retraction pockets(RP) as a preventive tool against cholesteatomas.Methods:Twenty-five ears have been followed up for a mean...Aims: The goal of the present study is to summarize our experience on surgical management of retraction pockets(RP) as a preventive tool against cholesteatomas.Methods:Twenty-five ears have been followed up for a mean period of 6.16 ± 4.35 years(from 1 to 17 years). The sample presented a mean age of 47.56 + 19.11 years(from 16 to 73 years). All patients underwent cartilage graft surgery. Furthermore 10(40%) underwent tympanoplasty(TPL) type Ⅰ, 14(56%) TPL type Ⅱ and 1(4%) TPL type Ⅴ.Results: Eleven ears(44%) showed cholesteatoma: all these cases were stage Ⅲ according to Charachon staging, and stage Ⅳ or Ⅴ according to Gersdorff classification. Twelve patients(48%) showed erosion of the ossicular chain. Of these, five were associated with cholesteatoma and seven only with retraction. The recurrence rate of cholesteatoma was 12%. None of the patients with a stage Ⅱ or Ⅲ RP(according to Gersdorff classification) developed cholesteatoma. The recurrence of RP was 0%.In regards to literature review, seven references were selected. These studies showed a success rate ranging from 79.1% to 88%, while recurrences of RP varied from 6.4% to 13%. Only one study specified a recurrence rate of cholesteatoma of 28%.Conclusions: Surgical treatment of stages Ⅱ and Ⅲ RP is an effective tool to prevent cholesteatoma formation. The presence of keratin accumulation and cholesteatoma at the RP(stages Ⅳ and Ⅴ, according to Gersdorff) are the real predictors of poor prognosis.展开更多
The aim of this research was to analyze physical and chemical characteristics of high altitude lakes (Gokyo lake series, Imja lake, Pyramid lake) of the Sagarmatha National Park, Khumbu region located above 4500 m alt...The aim of this research was to analyze physical and chemical characteristics of high altitude lakes (Gokyo lake series, Imja lake, Pyramid lake) of the Sagarmatha National Park, Khumbu region located above 4500 m altitude. The lake water was studied for three years (2008, 2009 and 2010) to compare the annual changes in the parameters. The findings created a database for present status of high land lakes of Nepal, which can be used for the management of lakes as well as to study the impact of tourism on water quality. The lake water quality in general still stands good in terms of standards for drinking water (WHO, Nepal standard) but degradation process has started. Total nitrogen in water samples was lower than the WHO standard but an increase in the nitrate nitrogen has been recorded. Similarly, total phosphorrous quality was also found increased.展开更多
Ground ruptures(fractures,earth fissures and reactivation of pre-existing surface faults)caused by extraction of fluids from the subsurface have been observed in hundreds of sedimentary basins worldwide,mainly in semi...Ground ruptures(fractures,earth fissures and reactivation of pre-existing surface faults)caused by extraction of fluids from the subsurface have been observed in hundreds of sedimentary basins worldwide,mainly in semiarid to arid areas of the USA,Mexico,China,India,Libya,Iran,and Saudi Arabia.展开更多
Sagarmatha (Mt. Everest) National Park (SNP) of Nepal is a popular international eco-touristic destination. In the last few years, tourist flow has increased tremendously generating anthropogenic pressure on natural e...Sagarmatha (Mt. Everest) National Park (SNP) of Nepal is a popular international eco-touristic destination. In the last few years, tourist flow has increased tremendously generating anthropogenic pressure on natural environment. Generation of huge solid waste, open defecation and poor septic tank condition of toilets have been considered as the major sources of pollution to water bodies in the area. Heavy metals, such as cadmium, copper, lead, chromium and mercury, are important environmental pollutants, particularly in areas with high anthropogenic pressure. Their presence in the atmosphere, soil and water, even in traces can cause serious problems to all organisms, and heavy metal bioaccumulation in the food chain especially can be highly dangerous to human health. Heavy metals (Cu, Pb, Mn, Fe and Zn) and metals (Na, Mg) were analyzed. Thirty nine (13 samples in each year) water samples were collected from river and springs to assess the water quality in the SNP and its buffer zone. Water quality in the SNP has been found degraded in terms of heavy metals;particularly Na and Mg contents were found higher when compared with the earlier report. Iron content in 46% samples was found more than WHO and Nepalese standard for drinking water. The river water quality in general still stands good in terms of standard for drinking water (WHO, Nepal standard) however degradation process has accelerated.展开更多
The aim of this research was to analyse physical and chemical characteristics of high altitude rivers of the Sagarmatha National Park, Khumbu region. The study was conducted for three years from 2008 to 2010 in the el...The aim of this research was to analyse physical and chemical characteristics of high altitude rivers of the Sagarmatha National Park, Khumbu region. The study was conducted for three years from 2008 to 2010 in the elevation 1900 m to 5300 m of the park. The study develops a database for monitoring high land rivers of Nepal. The river water quality in general still stands good in terms of standards for drinking water (WHO, Nepal standard) but degradation process has started. Certain changes in water quality parameters in water bodies on the major tourist treks have been recorded, mainly due to anthropogenic activities, particularly tourists and waste disposal. Total nitrogen in water samples is lower than the WHO standard but an increase in the nitrate nitrogen has been recorded comparison between 2008, 2009 and 2010 as well as when compared with earlier reports. Similarly total phosphorous value was also found increased annually as well as earlier reports. It is urgent need to check further degradation of river water quality. The outcomes of this research work would be a useful tool to manage the river water ecosystem in Sagarmatha National Park and Buffer Zone.展开更多
Nested stromal-epithelial tumor(NSET) is a nonhepatocytic and non-biliary tumor of the liver consisting of nests of epithelial and spindled cells with associated myofibroblastic stroma and variable intra-lesional calc...Nested stromal-epithelial tumor(NSET) is a nonhepatocytic and non-biliary tumor of the liver consisting of nests of epithelial and spindled cells with associated myofibroblastic stroma and variable intra-lesional calcification and ossification, which represents a very rare and challenging disease. Most of the reported cases have been treated with surgery, obtaining a long survival outcome. Here, we report the case of a 31-year-old Caucasian man who underwent surgery at our institution for a large, lobulated, multinodular mass of the right hemi-liver. The histological exam confirmed the diagnosis of NSET. After 6 mo from surgery, a liver recurrence was described and a chemoembolization was performed. After a further disease progression, based on the correlation between the histological features of the disease and those of the hepatoblastoma, a similar chemotherapy regimen(with cisplatin and ifosfamide/mesna chemotherapy, omitting doxorubicin due to liver impairment) was administered. However, infection of the biliary catheter required a dose modification of the treatment. No benefit was noted and a progression of disease was radiologically assessed after only four cycles. The worsening of the clinical status prevented further treatments, and the patient died a few months later. This case report documents how the NSET might have an aggressive and non-preventable behavior. No chemotherapy schedules with a proved efficacy are available, and new data are needed to shed light on this rare neoplasm.展开更多
The ongoing expansion of P. clarkii in the aquatic environments of northern Italy, where it is very common and abundant in most of the streams, lakes and reservoirs, led us to worry about the possibility of invasion i...The ongoing expansion of P. clarkii in the aquatic environments of northern Italy, where it is very common and abundant in most of the streams, lakes and reservoirs, led us to worry about the possibility of invasion into the estuarine and lagoonal brackish environments of the Adriatic coast, which is important not only for their peculiar fauna and flora and high biodiversity, but also for fishing and aquaculture. We carried out laboratory tests to investigate whether this species could live, moult and breed in water with different salinity levels. Several stocks of adult individuals, acclimated before the laboratory experiments, were maintained and monitored daily for a long period （100 days） in glass aquaria with water salinity varying from 5 to 33 ppt. They not only survived during the whole experiment period in levels up to 25 ppt, but also they regularly moulted and mated. These results confirmed that the species could invade the estuarine and brackish environments of the Adriatic coast, with all the implied consequences for the native species of both vertebrates and invertebrates and for human livelihoods.展开更多
Objective: It is well known that patients with Cochlear Implant (CI) have a large inter-individual variability in linguistic and auditory performances. This can be related to individual auditory processing abilities a...Objective: It is well known that patients with Cochlear Implant (CI) have a large inter-individual variability in linguistic and auditory performances. This can be related to individual auditory processing abilities and integrity of auditory system from auditory nerve to cerebral cortex. P300 can be used for the evaluation of central auditory functions in people with hearing loss and CI. No studies considered the P300 in the population of prelingually deafened adults that underwent CI in old age. The aim of this study is to assess Event Related Potential (ERP) in patients with congenital profound hearing loss with early or late implantation and evaluate these results respect to an age-matched normal hearing group. Methods: ERPs (N100, N200 and P300) and auditory benefit testing (pure tone average and speech audiometric test) and auditory perception testing (Categories of Auditory Performance—CAP) were evaluated in all subjects with their device. Results: All mean latencies (N100, N200 and P300) were found greater in patients group compared to control group. When analyzing all measures in patient group, we did not find any significant differences according to age of implant while significant difference (p > 0.05) in N100 amplitude (p = 0.045) and P300 latency (p = 0.035) were found according to time of CI use. A linear correlation between N200 and P300 latency in control and patients groups was found. Conclusion: In summary, ERPs analysis in the evaluation of CI showed a great importance of long use of the device in addiction to an early time of implant.展开更多
The total ionizing dose（TID） response of 65-nm CMOS transistors is studied by 10-ke V x-ray and 3-Me V protons up to 1 Grad（SiO_2） total dose.The degradation levels induced by the two radiation sources are differe...The total ionizing dose（TID） response of 65-nm CMOS transistors is studied by 10-ke V x-ray and 3-Me V protons up to 1 Grad（SiO_2） total dose.The degradation levels induced by the two radiation sources are different to some extent.The main reason is the interface dose enhancement due to the thin gate oxide and the low energy photons.The holes＇ recombination also contributes to the difference.Compared to these two mechanisms,the influence of the dose rate is negligible.展开更多
Objective:The incidence of Wilms’tumor(WT)among adult individuals accounts for less than 1%of kidney cancer cases,with a prognosis usually less favorable when compared to younger individuals and an overall survival r...Objective:The incidence of Wilms’tumor(WT)among adult individuals accounts for less than 1%of kidney cancer cases,with a prognosis usually less favorable when compared to younger individuals and an overall survival rate of 70%for the adult patients versus 90%for the pediatric cases.The diagnosis and treatment of WT are complex in the preoperative setting;neoadjuvant chemotherapy(NAC)or robotic surgery has rarely been described.This study aimed to review the literature of robotic surgery in WT and report the first adult WT management using both NAC and robotic strategy.Methods:We reported a case of WT managed in a multidisciplinary setting.Furthermore,according to Preferred Reporting Items for Systematic reviews and Meta-Analyses recommendations,a systematic review of the literature until August 2020 of WT treated with a robotic approach was carried out.Results:A 33-year-old female had a diagnosis of WT.She was scheduled to NAC,and according to the clinical and radiological response to a robotic radical nephrectomy with aortic lymph nodes dissection,she was managed with no intraoperative rupture,a favorable surgical outcome,and a follow-up of 25 months,which did not show any recurrence.The systematic review identified a total number of 230 cases of minimally invasive surgery reported in the literature for WT.Of these,approximately 15 patients were carried out using robotic surgery in adolescents while none in adults.Moreover,NAC has not been administered before minimally invasive surgery in adults up until now.Conclusion:WT is a rare condition in adults with only a few cases treated with either NAC or minimally invasive approach so far.The advantage of NAC followed by the robotic approach could lead to favorable outcomes in this complex scenario.Notwithstanding,additional cases of adult WT need to be identified and investigated to improve the oncological outcome.展开更多
基金supported by Jiangsu Agriculture Science and Technology Innovation Fund(No.CX(22)3001)。
文摘The escalating global dissemination of plasmid-mediated antibiotic resistance poses a formidable threat to global health.Conjugation stands as a pivotal mechanism for horizontal gene transfer among bacterial populations,facilitating the spread of antibiotic resistance genes(ARGs).Microelectrolysis has garnered attention as an efficacious strategy for mitigating antibiotic concentrations in wastewater,yet its potential impact on ARG horizontal transfer remain largely unexplored.This comprehensive investigation unveils that microelectrolysis not only influences but significantly accelerates the conjugative transfer of ARG-harboring plasmids.Remarkably,this phenomenon is corroborated at the microbial community scale,underscoring its ecological relevance.Alarmingly,the study highlights the vulnerability of intestinalmicroorganisms to acquire antibiotic resistance under electrolytic stimulation,posing heightened risks to both animal and human health.Delving deeper,the study elucidates the underlyingmechanisms responsible for this enhanced conjugative transfer.It reveals that microelectrolysis augments the abundance of mating-competent cells,triggers the generation of reactive oxygen species,inflicts modest membrane damage,and upregulates the expression of genes critical for conjugation.These findings collectively contribute to a more profound comprehension of the environmental dissemination dynamics and associated public health implications of ARGs in the context of wastewater treatment employing microelectrolytic technologies.
文摘The poor clinical conditions associated with end-stage cirrhosis,pre-existing pulmonary abnormalities,and high comorbidity rates in patients with high Model for End-Stage Liver Disease scores are all well-recognized factors that increase the risk of pulmonary complications after orthotopic liver transplantation(OLT)surgery.Many intraoperative and postoperative events,such as fluid overload,massive transfusion of blood products,hemodynamic instability,unexpected coagulation abnormalities,renal dysfunction,and serious adverse effects of reperfusion syndrome,are other factors that predispose an individual to postoperative respiratory disorders.Despite advances in surgical techniques and anesthesiological management,the lung may still suffer throughout the perioperative period from various types of injury and ventilatory impairment,with different clinical outcomes.Pulmonary complications after OLT can be classified as infectious or non-infectious.Pleural effusion,atelectasis,pulmonary edema,respiratory distress syndrome,and pneumonia may contribute considerably to early morbidity and mortality in liver transplant patients.It is of paramount importance to accurately identify lung disorders because infectious pulmonary complications warrant speedy and aggressive treatment to prevent diffuse lung injury and the risk of evolution into multisystem organ failure.This review discusses the most common perioperative factors that predispose an individual to postoperative pulmonary complications and these complications’early clinical manifestations after OLT and influence on patient outcome.
文摘AIM: To evaluate the relationship between glycemic control [assessed by glycated hemoglobin (HbA1c)], antidiabetic therapies and the risk of hepatocellular carcinoma (HCC).METHODS: We recruited 465 patients with HCC, 618 cases with liver cirrhosis and 490 controls with no liver disease. Among subjects with type 2 diabetes mellitus (DM2), the associations between the antidiabetic strategies and HbA1c level with HCC were determined through 2 series of multivariate logistic regression models using cirrhotic patients and controls as comparison groups. RESULTS: DM2 prevalence was 31.2% in patients with HCC, 23.2% in cirrhotic patients and 12.6% in controls (P < 0.0001). In 86% of study subjects, DM2 had been diagnosed for more than 1 year before the HCC diagnosis. HCC patients with DM2 had a 1.52.5fold increased risk of liver cancer. The HbA1c mean levels were signif icantly higher in DM2 patients with HCC than in cirrhoticand control DM2 patients. Antidiabetic treatment with metformin was more common among cirrhotic and control DM2 subjects than among cases with HCC. In both series of multivariate analyses, treatment with metformin signif icantly reduced the risk of HCC by more than 80% compared with sulphonylureas and insulin therapy. No signif icant differences were seen between sulphonylureas and insulin treatment. Elevated HbA1c levels were positively related to the risk for HCC in diabetic patients, with a 26%50% increase in risk for each 1% increase in HbA1c values.CONCLUSION: In patients with preexisting DM2, the risk of HCC is positively associated with poor chronic glycemic control and significantly decreased by metformin therapy.
文摘Nutritional concerns, linear growth deficiency, and delayed puberty are currently detected in up to 85% of patients with Crohn's disease(CD) diagnosed at childhood. To provide advice on how to assess and manage nutritional concerns in these patients, a Medline search was conducted using "pediatric inflammatory bowel disease", "pediatric Crohn's disease", "linear growth","pubertal growth", "bone health", and "vitamin D" as key words. Clinical trials, systematic reviews, and metaanalyses published between 2008 and 2013 were selected to produce this narrative review. Studies referring to earlier periods were also considered if the data was relevant to our review. Although current treatment strategies for CD that include anti-tumor necrosis factor-αtherapy have been shown to improve patients' growth rate, linear growth deficiencies are still common. In pediatric CD patients, prolonged diagnostic delay, high initial activity index, and stricturing/penetrating typeof behavior may cause growth deficiencies(in weight and height) and delayed puberty, with several studies reporting that these patients may not reach an optimal bone mass. Glucocorticoids and inflammation inhibit bone formation, though their impact on skeletal modeling remains unclear. Long-term control of active inflammation and an adequate intake of nutrients are both fundamental in promoting normal puberty. Recent evidence suggests that recombinant growth factor therapy is effective in improving short-term linear growth in selected patients, but is of limited benefit for ameliorating mucosal disease and reducing clinical disease activity. The authors conclude that an intense initial treatment(taking a "top-down" approach, with the early introduction of immunomodulatory treatment) may be justified to induce and maintain remission so that the growth of children with CD can catch up, ideally before puberty. Exclusive enteral nutrition has a key role in inducing remission and improving patients' nutritional status.
基金Under the auspices of National Key R&D Program of China(No.2018YFC0704705)。
文摘Under the demand of urban expansion and the constraints of China’s’National Main Functional Area Planning’policy,urban agglomerations are facing with a huge contradiction between land utilization and ecological protection,especially for HarbinChangchun urban agglomeration who owns a large number of land used for the protection of agricultural production and ecological function.To alleviate this contradiction and provide insight into future land use patterns under different ecological constraints’scenarios,we introduced the patch-based land use simulation(PLUS)model and simulated urban expansion of the Harbin-Changchun urban agglomeration.After verifying the accuracy of the simulation result in 2018,we predicted future urban expansion under the constraints of three different ecological scenarios in 2026.The morphological spatial pattern analysis(MSPA)method and minimum cumulative resistance(MCR)model were also introduced to identify different levels of ecological security pattern(ESP)as ecological constraints.The predicted result of the optimal protection(OP)scenario showed less proportion of water and forest than those of natural expansion(NE)and basic protection(BP)scenarios in 2026.The conclusions are that the PLUS model can improve the simulation accuracy at urban agglomeration scale compared with other cellular automata(CA)models,and the future urban expansion under OP scenario has the least threat to the ecosystem,while the expansion under the natural expansion(NE)scenario poses the greatest threat to the ecosystem.Combined with the MSPA and MCR methods,PLUS model can also be used in other spatial simulations of urban agglomerations under ecological constraints.
文摘AIMTo evaluate the efficacy and safety of a combined treatment for myopic choroidal neovascularization (CNV) using photodynamic therapy (PDT) and intravitreal bevacizumab and to compare it with intravitreal bevacizumab monotherapy.
文摘Despite the progress made in the prevention and treatment of rejection of the transplanted heart, cardiac allograft vasculopathy(CAV) remains the main cause of death in late survival transplanted patients. CAV consists of a progressive diffuse intimal hyperplasia and the proliferation of vascular smooth muscle cells, ending in wall thickening of epicardial vessels, intramyocardial arteries(50-20 μm), arterioles(20-10 μm), and capillaries(< 10 μm). The etiology of CAV remains unclear; both immunologic and non-immunologic mechanisms contribute to endothelial damage with a sustained inflammatory response. The immunological factors involved are Human Leukocyte Antigen compatibility between donor and recipient, alloreactive T cells and the humoral immune system. The non-immunological factors are older donor age, ischemia-reperfusion time, hyperlipidemia and CMV infections. Diagnostic techniques that are able to assess microvascular function are lacking. Intravascular ultrasound and fractional flow reserve, when performed during coronary angiography, are able to detect epicardial coronary artery disease but are not sensitive enough to assess microvascular changes. Some authors have proposed an index of microcircula-tory resistance during maximal hyperemia, which is calculated by dividing pressure by flow(distal pressure multiplied by the hyperemic mean transit time). Non-invasive methods to assess coronary physiology are stress echocardiography, coronary flow reserve by transthoracic Doppler echocardiography, single photon emission computed tomography, and perfusion cardiac magnetic resonance. In this review, we intend to analyze the mechanisms, consequences and therapeutic implications of microvascular dysfunction, including an extended citation of relevant literature data.
文摘AIM:To assess B1a cell expression in the rectal mucosa of ulcerative colitis (UC) patients in comparison with healthy controls.METHODS:Rectal mucosa biopsies were collected from 15 UC patients and 17 healthy controls.CD5 + B cells were analysed by three colour flow cytometry from rectal mucosal samples after mechanical disaggregation by Medimachine.Immunohistochemical analysis of B and T lymphocytes was also performed.Correlations between,on the one hand,rectal B1a cell concentrations and,on the other,erythrocyte sedimentation rate and C-reactive protein levels and clinical,endoscopic and histological disease activity indices were evaluated.RESULTS:Rectal B-lymphocyte (CD19 + /CD45 +) rate and concentration were higher in UC patients compared with those in healthy controls (47.85% ± 3.12% vs 26.10% ± 3.40%,P=0.001 and 501 ± 91 cells/mm 2 vs 117 ± 18 cells/mm 2,P < 0.001);Rectal B1a cell density (CD5 + CD19 +) was higher in UC patients than in healthy controls (85 ± 15 cells/mm 2 vs 31 ± 6.7 cells/mm 2,P=0.009).Rectal B1a cell (CD5/CD19 +) rate correlated inversely with endoscopic classification (Rs=-0.637,P < 0.05).CONCLUSION:B1a lymphocytes seem to be involved in the pathogenesis of UC,however,the role they play in its early phases and in disease activity,have yet to be defined.
文摘Aims: The goal of the present study is to summarize our experience on surgical management of retraction pockets(RP) as a preventive tool against cholesteatomas.Methods:Twenty-five ears have been followed up for a mean period of 6.16 ± 4.35 years(from 1 to 17 years). The sample presented a mean age of 47.56 + 19.11 years(from 16 to 73 years). All patients underwent cartilage graft surgery. Furthermore 10(40%) underwent tympanoplasty(TPL) type Ⅰ, 14(56%) TPL type Ⅱ and 1(4%) TPL type Ⅴ.Results: Eleven ears(44%) showed cholesteatoma: all these cases were stage Ⅲ according to Charachon staging, and stage Ⅳ or Ⅴ according to Gersdorff classification. Twelve patients(48%) showed erosion of the ossicular chain. Of these, five were associated with cholesteatoma and seven only with retraction. The recurrence rate of cholesteatoma was 12%. None of the patients with a stage Ⅱ or Ⅲ RP(according to Gersdorff classification) developed cholesteatoma. The recurrence of RP was 0%.In regards to literature review, seven references were selected. These studies showed a success rate ranging from 79.1% to 88%, while recurrences of RP varied from 6.4% to 13%. Only one study specified a recurrence rate of cholesteatoma of 28%.Conclusions: Surgical treatment of stages Ⅱ and Ⅲ RP is an effective tool to prevent cholesteatoma formation. The presence of keratin accumulation and cholesteatoma at the RP(stages Ⅳ and Ⅴ, according to Gersdorff) are the real predictors of poor prognosis.
文摘The aim of this research was to analyze physical and chemical characteristics of high altitude lakes (Gokyo lake series, Imja lake, Pyramid lake) of the Sagarmatha National Park, Khumbu region located above 4500 m altitude. The lake water was studied for three years (2008, 2009 and 2010) to compare the annual changes in the parameters. The findings created a database for present status of high land lakes of Nepal, which can be used for the management of lakes as well as to study the impact of tourism on water quality. The lake water quality in general still stands good in terms of standards for drinking water (WHO, Nepal standard) but degradation process has started. Total nitrogen in water samples was lower than the WHO standard but an increase in the nitrate nitrogen has been recorded. Similarly, total phosphorrous quality was also found increased.
基金the IGCP Project 641’Mechanisms,Monitoring and Modeling Earth Fissure Generation and Fault Activation Due to Subsurface Fluid Exploitation(M3EF3)’.
文摘Ground ruptures(fractures,earth fissures and reactivation of pre-existing surface faults)caused by extraction of fluids from the subsurface have been observed in hundreds of sedimentary basins worldwide,mainly in semiarid to arid areas of the USA,Mexico,China,India,Libya,Iran,and Saudi Arabia.
文摘Sagarmatha (Mt. Everest) National Park (SNP) of Nepal is a popular international eco-touristic destination. In the last few years, tourist flow has increased tremendously generating anthropogenic pressure on natural environment. Generation of huge solid waste, open defecation and poor septic tank condition of toilets have been considered as the major sources of pollution to water bodies in the area. Heavy metals, such as cadmium, copper, lead, chromium and mercury, are important environmental pollutants, particularly in areas with high anthropogenic pressure. Their presence in the atmosphere, soil and water, even in traces can cause serious problems to all organisms, and heavy metal bioaccumulation in the food chain especially can be highly dangerous to human health. Heavy metals (Cu, Pb, Mn, Fe and Zn) and metals (Na, Mg) were analyzed. Thirty nine (13 samples in each year) water samples were collected from river and springs to assess the water quality in the SNP and its buffer zone. Water quality in the SNP has been found degraded in terms of heavy metals;particularly Na and Mg contents were found higher when compared with the earlier report. Iron content in 46% samples was found more than WHO and Nepalese standard for drinking water. The river water quality in general still stands good in terms of standard for drinking water (WHO, Nepal standard) however degradation process has accelerated.
文摘The aim of this research was to analyse physical and chemical characteristics of high altitude rivers of the Sagarmatha National Park, Khumbu region. The study was conducted for three years from 2008 to 2010 in the elevation 1900 m to 5300 m of the park. The study develops a database for monitoring high land rivers of Nepal. The river water quality in general still stands good in terms of standards for drinking water (WHO, Nepal standard) but degradation process has started. Certain changes in water quality parameters in water bodies on the major tourist treks have been recorded, mainly due to anthropogenic activities, particularly tourists and waste disposal. Total nitrogen in water samples is lower than the WHO standard but an increase in the nitrate nitrogen has been recorded comparison between 2008, 2009 and 2010 as well as when compared with earlier reports. Similarly total phosphorous value was also found increased annually as well as earlier reports. It is urgent need to check further degradation of river water quality. The outcomes of this research work would be a useful tool to manage the river water ecosystem in Sagarmatha National Park and Buffer Zone.
文摘Nested stromal-epithelial tumor(NSET) is a nonhepatocytic and non-biliary tumor of the liver consisting of nests of epithelial and spindled cells with associated myofibroblastic stroma and variable intra-lesional calcification and ossification, which represents a very rare and challenging disease. Most of the reported cases have been treated with surgery, obtaining a long survival outcome. Here, we report the case of a 31-year-old Caucasian man who underwent surgery at our institution for a large, lobulated, multinodular mass of the right hemi-liver. The histological exam confirmed the diagnosis of NSET. After 6 mo from surgery, a liver recurrence was described and a chemoembolization was performed. After a further disease progression, based on the correlation between the histological features of the disease and those of the hepatoblastoma, a similar chemotherapy regimen(with cisplatin and ifosfamide/mesna chemotherapy, omitting doxorubicin due to liver impairment) was administered. However, infection of the biliary catheter required a dose modification of the treatment. No benefit was noted and a progression of disease was radiologically assessed after only four cycles. The worsening of the clinical status prevented further treatments, and the patient died a few months later. This case report documents how the NSET might have an aggressive and non-preventable behavior. No chemotherapy schedules with a proved efficacy are available, and new data are needed to shed light on this rare neoplasm.
文摘The ongoing expansion of P. clarkii in the aquatic environments of northern Italy, where it is very common and abundant in most of the streams, lakes and reservoirs, led us to worry about the possibility of invasion into the estuarine and lagoonal brackish environments of the Adriatic coast, which is important not only for their peculiar fauna and flora and high biodiversity, but also for fishing and aquaculture. We carried out laboratory tests to investigate whether this species could live, moult and breed in water with different salinity levels. Several stocks of adult individuals, acclimated before the laboratory experiments, were maintained and monitored daily for a long period （100 days） in glass aquaria with water salinity varying from 5 to 33 ppt. They not only survived during the whole experiment period in levels up to 25 ppt, but also they regularly moulted and mated. These results confirmed that the species could invade the estuarine and brackish environments of the Adriatic coast, with all the implied consequences for the native species of both vertebrates and invertebrates and for human livelihoods.
文摘Objective: It is well known that patients with Cochlear Implant (CI) have a large inter-individual variability in linguistic and auditory performances. This can be related to individual auditory processing abilities and integrity of auditory system from auditory nerve to cerebral cortex. P300 can be used for the evaluation of central auditory functions in people with hearing loss and CI. No studies considered the P300 in the population of prelingually deafened adults that underwent CI in old age. The aim of this study is to assess Event Related Potential (ERP) in patients with congenital profound hearing loss with early or late implantation and evaluate these results respect to an age-matched normal hearing group. Methods: ERPs (N100, N200 and P300) and auditory benefit testing (pure tone average and speech audiometric test) and auditory perception testing (Categories of Auditory Performance—CAP) were evaluated in all subjects with their device. Results: All mean latencies (N100, N200 and P300) were found greater in patients group compared to control group. When analyzing all measures in patient group, we did not find any significant differences according to age of implant while significant difference (p > 0.05) in N100 amplitude (p = 0.045) and P300 latency (p = 0.035) were found according to time of CI use. A linear correlation between N200 and P300 latency in control and patients groups was found. Conclusion: In summary, ERPs analysis in the evaluation of CI showed a great importance of long use of the device in addiction to an early time of implant.
文摘The total ionizing dose（TID） response of 65-nm CMOS transistors is studied by 10-ke V x-ray and 3-Me V protons up to 1 Grad（SiO_2） total dose.The degradation levels induced by the two radiation sources are different to some extent.The main reason is the interface dose enhancement due to the thin gate oxide and the low energy photons.The holes＇ recombination also contributes to the difference.Compared to these two mechanisms,the influence of the dose rate is negligible.
文摘Objective:The incidence of Wilms’tumor(WT)among adult individuals accounts for less than 1%of kidney cancer cases,with a prognosis usually less favorable when compared to younger individuals and an overall survival rate of 70%for the adult patients versus 90%for the pediatric cases.The diagnosis and treatment of WT are complex in the preoperative setting;neoadjuvant chemotherapy(NAC)or robotic surgery has rarely been described.This study aimed to review the literature of robotic surgery in WT and report the first adult WT management using both NAC and robotic strategy.Methods:We reported a case of WT managed in a multidisciplinary setting.Furthermore,according to Preferred Reporting Items for Systematic reviews and Meta-Analyses recommendations,a systematic review of the literature until August 2020 of WT treated with a robotic approach was carried out.Results:A 33-year-old female had a diagnosis of WT.She was scheduled to NAC,and according to the clinical and radiological response to a robotic radical nephrectomy with aortic lymph nodes dissection,she was managed with no intraoperative rupture,a favorable surgical outcome,and a follow-up of 25 months,which did not show any recurrence.The systematic review identified a total number of 230 cases of minimally invasive surgery reported in the literature for WT.Of these,approximately 15 patients were carried out using robotic surgery in adolescents while none in adults.Moreover,NAC has not been administered before minimally invasive surgery in adults up until now.Conclusion:WT is a rare condition in adults with only a few cases treated with either NAC or minimally invasive approach so far.The advantage of NAC followed by the robotic approach could lead to favorable outcomes in this complex scenario.Notwithstanding,additional cases of adult WT need to be identified and investigated to improve the oncological outcome.
