BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite imp...BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite improved renal function.It is potentially associated with an increased risk of cardiovascular events,renal osteodystrophy,pathologic fractures,graft loss,and mortality.AIM To evaluate the incidence,risk factors,and outcomes of PT-tHPT amongst kidney transplant recipients.METHODS A total of 887 transplant recipients who underwent transplantation between 2000 and 2020 were evaluated.Univariable and multivariable logistic regression was performed to determine the predictors of tertiary hyperparathyroidism.Graft and recipient outcomes were assessed using multivariable Cox regression.A separate multivariable Cox regression was performed to determine the effect of treatment strategies on outcomes.RESULTS PT-tHPT,defined as elevated PTH(>65 ng/L)and persistent hypercalcemia(>2.60 mmol/L),was diagnosed in 14%of recipients.Risk factors for PT-tHPT included older age[odds ratio(OR)=1.36,P<0.001],Asian ethnicity(OR=0.33,P=0.006),total ischemia time(OR=1.03,P=0.048 per hour),pre-transplant serum calcium(OR=1.38,P<0.001)per decile increase,pre-transplant PTH level(OR=1.31,P<0.001)per decile increase,longer dialysis duration(OR=1.12,P=0.002)per year,history of acute rejection(OR=2.37,P=0.012),and slope of estimated glomerular filtration rate change(OR=0.91,P=0.001).There were a 3.4-fold higher risk of death-censored graft loss and a 1.9-fold greater risk of recipient death with PT-tHPT.The three treatment strategies of conservative management,calcimimetic and parathyroidectomy did not significantly change the graft or patient outcome.CONCLUSION Pretransplant elevated calcium and PTH levels,older age and dialysis duration are associated with PT-tHPT.While PT-tHPT significantly affects graft and recipient survival,the treatment strategies did not affect survival.展开更多
Accurate prediction of pure component physiochemical properties is crucial for process integration, multiscale modelling, and optimization. In this work, an enhanced framework for pure component property prediction by...Accurate prediction of pure component physiochemical properties is crucial for process integration, multiscale modelling, and optimization. In this work, an enhanced framework for pure component property prediction by using explainable machine learning methods is proposed. In this framework, the molecular representation method based on the connectivity matrix effectively considers atomic bonding relationships to automatically generate features. The supervised machine learning model random forest is applied for feature ranking and pooling. The adjusted R^(2) is introduced to penalize the inclusion of additional features, providing an assessment of the true contribution of features. The prediction results for normal boiling point (T_(b)), liquid molar volume (L_(mv)), critical temperature (T_(c)) and critical pressure (P_(c)) obtained using Artificial Neural Network and Gaussian Process Regression models confirm the accuracy of the molecular representation method. Comparison with GC based models shows that the root-mean-square error on the test set can be reduced by up to 83.8%. To enhance the interpretability of the model, a feature analysis method based on Shapley values is employed to determine the contribution of each feature to the property predictions. The results indicate that using the feature pooling method reduces the number of features from 13316 to 100 without compromising model accuracy. The feature analysis results for Tb, Lmv, Tc, and Pc confirms that different molecular properties are influenced by different structural features, aligning with mechanistic interpretations. In conclusion, the proposed framework is demonstrated to be feasible and provides a solid foundation for mixture component reconstruction and process integration modelling.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)is increasingly used to treat gastric dysplasia and early neoplasia in the West.Unlike Eastern countries,data for Caucasian patients in the United Kingdom is limited due...BACKGROUND Endoscopic submucosal dissection(ESD)is increasingly used to treat gastric dysplasia and early neoplasia in the West.Unlike Eastern countries,data for Caucasian patients in the United Kingdom is limited due to its limited implementation in a few tertiary centres.AIM To evaluate the outcomes of ESD on gastric dysplasia and neoplasia in Caucasian patients.METHODS Our ten-year retrospective study at a single tertiary centre included data spanning from May 2012 to July 2023.The efficacy of ESD on gastric dysplasia and early neoplasia was measured using parameters set out by the National Institute for Health and Care Excellence,which include en-bloc and curative resection(CR)rates,local recurrence and survival rates.RESULTS ESD was attempted on 111 lesions in 93 patients.95.0%of completed procedures achieved endoscopic clearance.74.3%were en-bloc resections and the rest were hybrid ESD with piecemeal resections.In all,34.7%achieved histological CR.Overall,disease recurrence was 10.9%at latest follow-up(63 months,median follow-up).Importantly 100%of lesions in the CR group showed no disease recurrence at subsequent and latest follow-up.In the Indeterminate and Non-CR group,18.8%of lesions showed disease recurrence at subsequent endoscopic follow-ups.ESD changed the histological staging of 44.5%of lesions.Immediate complications were observed in 9.9%of all ESD procedures.The median survival time was 69 months post-ESD.The mean age at death is 82.2 years old.CONCLUSION The study affirms the long-term efficacy and safety of ESD for gastric dysplasia and early neoplasia in Caucasian patients.展开更多
In the era of rapidly expanding wireless technologies,the push for larger spectrum efficiency and better signal integrity has intensified the need for high-efficient and low noise amplifiers(LNAs).A two-stage LNA base...In the era of rapidly expanding wireless technologies,the push for larger spectrum efficiency and better signal integrity has intensified the need for high-efficient and low noise amplifiers(LNAs).A two-stage LNA based on the GaAs/InGaAs pseudomorphic high electron mobility transistor(pHEMT)with a relatively large gate length of 2μm is designed for high-performance 2.4-GHz wireless communication.The I-V characteristic and two-port high-frequency S-parameter of the transistor are measured by on-wafer probing techniques.The results indicate that a discrete transistor with a gate size of 2μm×50μm can provide a maximum transconductance of 16 mS,corresponding to a maximum current-gain cut-off frequency of 7 GHz and maximum oscillation frequency of 8 GHz at the 1-V drain-source voltage.With the impedance matching networks based transmission line technique,an extended integrated layout structure is designed and simulated by using the momentum simulation tool embedded in Advanced Design System,to alleviate the trade-off between noise figure(NF)and gain of the circuit.The findings show that the transistor based on the GaAs/InGaAs technology is capable of delivering high performance with power consumption low to 16 mW,where the maximum simulated gain of 21.5 dB and minimum NF of 2.4 dB are achieved.In terms of linearity,the proposed LNA provides terrific output 1-dB compression of-3 dBm and output third-order intercept point values of 10 dBm.The bandwidth of 0.12 GHz and figure-of-merit of 12 are obtained,which are comparable to that of existing LNAs based on pHEMT.Such a device may benefit to accelerate the development of more robust and power-efficient front-end modules in modern wireless systems,especially for advancing performance-driven applications.展开更多
To address the dual challenges of resource utilization of mining solid waste(e.g.,coal gangue)and performance enhancement of cemented rockfill,this study systematically investigates the mechanisms of ultrasonic disper...To address the dual challenges of resource utilization of mining solid waste(e.g.,coal gangue)and performance enhancement of cemented rockfill,this study systematically investigates the mechanisms of ultrasonic dispersion time and polycarboxylate superplasti-cizer(PCE)on the properties of cellulose nanofiber(CNF)-modified cemented rockfill.A series of comparative experiments were de-signed with varying ultrasonic dispersion times(0-60 min)and PCE dosages(0.1wt%-0.4wt%).Through mechanical testing,hydration product analysis,and microstructural characterization,the study revealed the advantages of PCE in promoting CNF dispersion to enhance the engineering applicability of cemented rockfill.The results demonstrate that:(1)Ultrasonic dispersion for 30 min increases the com-pressive strength by 37.7%compared to the untreated group;however,excessive ultrasonication(60 min)induces hydrolysis of CNF,re-leasing reducing sugars that retard hydration.(2)PCE facilitates CNF dispersion,achieving a 29.1%increase in compressive strength at a dosage of 0.4wt%,while simultaneously improving hydration products and microstructural development.(3)While ultrasonic dispersion yields slightly higher strength improvements,PCE demonstrates superior cost-effectiveness and operational convenience,rendering it more viable for industrial adoption.This study provides a theoretical foundation for the nano-enhanced modification of cemented rockfill,offering new insights into the recycling of solid waste and the development of high-performance materials.展开更多
In laser wakefield acceleration,injecting an external electron beam at a certain energy is a promising approach for achieving a high-quality electron beam with low energy spread and low emittance.In this paper,the pro...In laser wakefield acceleration,injecting an external electron beam at a certain energy is a promising approach for achieving a high-quality electron beam with low energy spread and low emittance.In this paper,the process of laser wakefield acceleration with an external injection at 10 pC has been studied in simulations.A Bayesian optimization method is used to optimize the key laser and plasma parameters so that the electron beam is accelerated to the expected energy with a small emittance and energy spread growth.The effect of the rising edge of the plasma on the transverse properties of the electron beam is simulated and optimized in order to ensure that the external electron beam is injected into the plasma without significant emittance growth.Finally,a high-quality electron beam with an energy of 1.5 GeV,a normalized transverse emittance of 0.5 mm·mrad and a relative energy spread of 0.5%at 10 pC is obtained.展开更多
Background:Habitual physical activity is known to support cardiovascular health.However,when intensive exercise is performed for long durations,it can negatively affect the cardiovascular system.We evaluated the exerc...Background:Habitual physical activity is known to support cardiovascular health.However,when intensive exercise is performed for long durations,it can negatively affect the cardiovascular system.We evaluated the exercise-induced physiological responses of cardiac markers in male marathon runners based on basal plasma trimethylamine-N-oxide(TMAO)levels,a metabolite related to major adverse cardiovascular events.Methods:Blood samples from 28 marathon runners were collected two weeks before the marathon run(baseline),after finishing the race(post-marathon),and two weeks after the race(2 weeks post-marathon).Serum cardiac troponin I(c Tn I),endothelin-1(ET-1),galectin-3,pentraxin-3,human growth differentiation factor 15,and neopterin were determined by the enzyme immunoassay method.Plasma trimethylamine(TMA)and TMAO were measured by the ultra-high-performance liquid chromatography-mass spectrometry method.Results:Running a marathon increased levels of circulating biomarkers.A greater post-marathon elevation of cTn I and ET-1 was associated with baseline plasma TMAO levels(R=0.400,p=0.035 and R=0.476,p=0.012,respectively).Moreover,we observed an increase in post-marathon TMA levels.Conclusion:Greater post-marathon elevation of cTn I and ET-1 was associated with higher baseline plasma TMAO levels.Therefore,TMAO could potentially serve as a new marker in assessing the response of cardiovascular stress biomarkers to marathon running.展开更多
A frequent cause of unplanned and costly outages in water-cooled nuclear power plants is the premature failure of the fuel rods due to excessive flow-induced vibration in the reactor core.Turbulence and unsteadiness i...A frequent cause of unplanned and costly outages in water-cooled nuclear power plants is the premature failure of the fuel rods due to excessive flow-induced vibration in the reactor core.Turbulence and unsteadiness in the coolant water flowing through the reactor core can cause excessive vibration of the fuel rods,which in turn can result in fretting wear that eventually leads to the fuel rod cladding perforation and subsequent failure.The economic burden of unplanned reactor outages has motivated extensive research into flow-induced vibration.This perspective article provides a brief summary of recent research on flow-induced vibration of cantilever rod systems,which are simplified paradigmatic test configurations that have been instrumental to advance the fundamental physical understanding of axial-flowinduced vibration problems,and have enabled the development of cost-effective numerical methodologies for the simulation of these problems in engineering,with particular application to nuclear reactor systems.This summary covers recent experimental and numerical studies,and includes a description of a novel non-contact Hall-effect-based measuring technique specifically developed to track the vibration of the cantilever rod with gas-liquid two-phase flows.The article concludes by highlighting promising avenues for future research.展开更多
Barrett's esophagus (BE) confers a significant increased risk for development of esophageal adenocarcinoma (EAC), with the pathogenesis appearing to progress through a "metaplasia-dysplasia-carcinoma" (M...Barrett's esophagus (BE) confers a significant increased risk for development of esophageal adenocarcinoma (EAC), with the pathogenesis appearing to progress through a "metaplasia-dysplasia-carcinoma" (MDC) sequence. Many of the genetic insults driving this MDC sequence have recently been characterized, providing targets for candidate biomarkers with potential clinical utility to stratify risk in individual patients. Many clinical risk factors have been investigated, and associations with a variety of genetic, specific gastrointestinal and other modifiable factors have been proposed in the literature. This review summarizes the current understanding of the mechanisms involved in neoplastic progression of BE to EAC and critically appraises the relative roles and contributions of these putative risk factors from the published evidence currently available.展开更多
In today’s digital era,the rapid evolution of image editing technologies has brought about a significant simplification of image manipulation.Unfortunately,this progress has also given rise to the misuse of manipulat...In today’s digital era,the rapid evolution of image editing technologies has brought about a significant simplification of image manipulation.Unfortunately,this progress has also given rise to the misuse of manipulated images across various domains.One of the pressing challenges stemming from this advancement is the increasing difficulty in discerning between unaltered and manipulated images.This paper offers a comprehensive survey of existing methodologies for detecting image tampering,shedding light on the diverse approaches employed in the field of contemporary image forensics.The methods used to identify image forgery can be broadly classified into two primary categories:classical machine learning techniques,heavily reliant on manually crafted features,and deep learning methods.Additionally,this paper explores recent developments in image forensics,placing particular emphasis on the detection of counterfeit colorization.Image colorization involves predicting colors for grayscale images,thereby enhancing their visual appeal.The advancements in colorization techniques have reached a level where distinguishing between authentic and forged images with the naked eye has become an exceptionally challenging task.This paper serves as an in-depth exploration of the intricacies of image forensics in the modern age,with a specific focus on the detection of colorization forgery,presenting a comprehensive overview of methodologies in this critical field.展开更多
The results of experimental study of nanoscale intermetallic formation in surface layer of a metal target at ion implantation are presented. To increase the thickness of the ion implanted surface layer the high intens...The results of experimental study of nanoscale intermetallic formation in surface layer of a metal target at ion implantation are presented. To increase the thickness of the ion implanted surface layer the high intensive ion implantation is used. Compared with the ordinary ion implantation, the high intensive ion implantation allows a much thicker modified surface layer. Pure polycrystalline nickel was chosen as a target. Nickel samples were irradiated with Al ions on the vacuum-arc ion beam and plasma flow source 'Raduga-5'. It was shown that at the high intensity ion implantation the fine dispersed particles of Ni3AI, NiAl intermetallic compounds and solid solution Al in Ni are formed in the nickel surface layer of 200 nm and thicker. The formation of phases takes place in complete correspondence with the Ni-AI phase diagram.展开更多
BACKGROUND Total hip replacements(THR)and total knee replacements(TKR)are effective treatments for severe osteoarthritis(OA).Some studies suggest clinical outcomes following THR are superior to TKR,the reason for whic...BACKGROUND Total hip replacements(THR)and total knee replacements(TKR)are effective treatments for severe osteoarthritis(OA).Some studies suggest clinical outcomes following THR are superior to TKR,the reason for which remains unknown.This study compares clinical outcomes between THR and TKR.AIM To compare the clinic outcomes of THR anad TKR using a comprehensive range of patient reported outcome measures(PROMs).METHODS A prospective longitudinal observational study of patients with OA undergoing THR and TKR were evaluated using a comprehensive range of generic and joint specific PROMs pre-and post-operatively.RESULTS A total of 131 patients were included in the study which comprised the THR group(68 patients)and the TKR group(63 patients).Both groups demonstrated significant post-operative improvements in all PROM scores(P<0.001).There were no significant differences in post-operative PROM scores between the two groups:Hip and Knee Osteoarthritis Outcome scores(P=0.140),Western Ontario and McMaster Universities Osteoarthritis Index pain(P=0.297)stiffness(P=0.309)and function(P=0.945),Oxford Hip and Knee Score(P=0.076),EuroQol-5D index(P=0.386)and Short-Form 12-item survey physical component score(P=0.106).Subgroup analyses showed no significant difference(P>0.05)between cruciate retaining and posterior stabilised prostheses in the TKR group and no significant difference(P>0.05)between cemented and uncemented fixation in the THR group.Obese patients had poorer outcomes following TKR but did not significantly influence the outcome following THR.CONCLUSION Contrary to some literature,THR and TKR are equally efficacious in alleviating the pain and disability of OA when assessed using a comprehensive range of PROMs.The varying knee prosthesis types and hip fixation techniques did not significantly influence clinical outcome.Obesity had a greater influence on the outcome following TKR than that of THR.展开更多
Two posterior distributions for the mean of the Laplace distribution are obtained by deriving the distributions of the product XY and the ratio X/Y when X and Y are Student＇s t and Laplace random variables distribute...Two posterior distributions for the mean of the Laplace distribution are obtained by deriving the distributions of the product XY and the ratio X/Y when X and Y are Student＇s t and Laplace random variables distributed independently of each other. Tabulations of the associated percentage points are given along with computer programs for generating them.展开更多
Type 1 diabetes mellitus(T1DM)is one of the important causes of chronic kidney disease(CKD)and end-stage renal failure(ESRF).Even with the best available treatment options,management of T1DM poses significant challeng...Type 1 diabetes mellitus(T1DM)is one of the important causes of chronic kidney disease(CKD)and end-stage renal failure(ESRF).Even with the best available treatment options,management of T1DM poses significant challenges for clinicians across the world,especially when associated with CKD and ESRF.Substantial increases in morbidity and mortality along with marked rise in treatment costs and marked reduction of quality of life are the usual consequences of onset of CKD and progression to ESRF in patients with T1DM.Simultaneous pancreas-kidney transplant(SPK)is an attractive and promising treatment option for patients with advanced CKD/ESRF and T1DM for potential cure of these diseases and possibly several complications.However,limited availability of the organs for transplantation,the need for long-term immunosuppression to prevent rejection,peri-and post-operative complications of SPK,lack of resources and the expertise for the procedure in many centers,and the cost implications related to the surgery and postoperative care of these patients are major issues faced by clinicians across the globe.This clinical update review compiles the latest evidence and current recommendations of SPK for patients with T1DM and advanced CKD/ESRF to enable clinicians to care for these diseases.展开更多
Accurate knowledge of the kinematics of the in vivo Ankle Joint Complex(AJC)is critical for understanding the biomechanical function of the foot and assessing postoperative rehabilitation of ankle disorders,as well as...Accurate knowledge of the kinematics of the in vivo Ankle Joint Complex(AJC)is critical for understanding the biomechanical function of the foot and assessing postoperative rehabilitation of ankle disorders,as well as an essential guide to the design of ankle–foot assistant devices.However,detailed analysis of the continuous 3D motion of the tibiotalar and subtalar joints during normal walking throughout the stance phase is still considered to be lacking.In this study,dynamic radiographs of the hindfoot were acquired from eight subjects during normal walking.Natural motions with six Degrees of Freedom(DOF)and the coupled patterns of the two joints were analyzed.It was found that the movements of the two joints were mostly in opposite directions(including rotation and translation),mainly in the early and late stages.There were significant differences in the Range of Motion(ROM)in Dorsiflexion/Plantarflexion(D/P),Inversion/Eversion(In/Ev),and Anterior–Posterior(AP)and Medial–Lateral(ML)translation of the tibiotalar and subtalar joints(p<0.05).Plantarflexion of the tibiotalar joint was coupled with eversion and posterior translation of the subtalar joint during the impact phase(R^(2)=0.87 and 0.86,respectively),and plantarflexion of the tibiotalar joint was coupled with inversion and anterior translation of the subtalar joint during the push-off phase(R^(2)=0.93 and 0.75,respectively).This coordinated coupled motion of the two joints may be a manifestation of the AJC to move flexibly while bearing weight and still have stability.展开更多
Access to organ transplantation depends on national circumstances, and is partly determined by the cost of health care, availability of transplant services, the level of technical capacity and the availability of orga...Access to organ transplantation depends on national circumstances, and is partly determined by the cost of health care, availability of transplant services, the level of technical capacity and the availability of organs. Commercial transplantation is estimated to account for 5%-10%(3500-7000) of kidney transplants performed annually throughout the world. This review is to determine the state and outcome of renal transplantation associated with transplant tourism(TT) and the key challenges with such transplantation. The stakeholders of commercial transplantation include: patients on the waiting lists in developed countries or not on any list in developing countries; dialysis funding bodies; middlemen, hosting transplant centres; organ-exporting countries; and organ vendors. TT and commercial kidney transplants are associated with a high incidence of surgical complications, acute rejection and invasive infection which cause major morbidity and mortality. There are ethical and medical concerns regarding the management of recipients of organs from vendors. The growing demand for transplantation, the perceived failure of altruistic donation in providing enough organs has led to calls for a legalised market in organ procurement or regulated trial in incentives for donation. Developing transplant services worldwide has many benefits- improving results of transplantation as they would be performed legally, increasing the donor pool and making TT unnecessary. Meanwhile there is a need to re-examine intrinsic attitudes to TT bearing in mind the cultural and economic realities of globalisation. Perhaps the World Health Organization in conjunction with The Transplantation Society would set up a working party of stakeholders to study this matter in greater detail and make recommendations.展开更多
BACKGROUND Mixed neuroendocrine non-neuroendocrine neoplasm(MiNEN)is a rare diagnosis,mainly encountered in the gastro-entero-pancreatic tract.There is limited knowledge of its epidemiology,prognosis and biology,and t...BACKGROUND Mixed neuroendocrine non-neuroendocrine neoplasm(MiNEN)is a rare diagnosis,mainly encountered in the gastro-entero-pancreatic tract.There is limited knowledge of its epidemiology,prognosis and biology,and the best management for affected patients is still to be defined.AIM To investigate clinical-pathological characteristics,treatment modalities and survival outcomes of a retrospective cohort of patients with a diagnosis of MiNEN.METHODS Consecutive patients with a histologically proven diagnosis of MiNEN were identified at 5 European centres.Patient data were retrospectively collected from medical records.Pathological samples were reviewed to ascertain compliance with the 2017 World Health Organisation definition of MiNEN.Tumour responses to systemic treatment were assessed according to the Response Evaluation Criteria in Solid Tumours 1.1.Kaplan-Meier analysis was applied to estimate survival outcomes.Associations between clinical-pathological characteristics and survival outcomes were explored using Log-rank test for equality of survivors functions(univariate)and Cox-regression analysis(multivariable).RESULTS Sixty-nine consecutive patients identified;Median age at diagnosis:64 years.Males:63.8%.Localised disease(curable):53.6%.Commonest sites of origin:colon-rectum(43.5%)and oesophagus/oesophagogastric junction(15.9%).The neuroendocrine component was;predominant in 58.6%,poorly differentiated in 86.3%,and large cell in 81.25%,of cases analysed.Most distant metastases analysed(73.4%)were occupied only by a poorly differentiated neuroendocrine component.Ninety-four percent of patients with localised disease underwent curative surgery;53%also received perioperative treatment,most often in line with protocols for adenocarcinomas from the same sites of origin.Chemotherapy was offered to most patients(68.1%)with advanced disease,and followed protocols for pure neuroendocrine carcinomas or adenocarcinomas in equal proportion.In localised cases,median recurrence free survival(RFS);14.0 months(95%CI:9.2-24.4),and median overall survival(OS):28.6 months(95%CI:18.3-41.1).On univariate analysis,receipt of perioperative treatment(vs surgery alone)did not improve RFS(P=0.375),or OS(P=0.240).In advanced cases,median progression free survival(PFS);5.6 months(95%CI:4.4-7.4),and median OS;9.0 months(95%CI:5.2-13.4).On univariate analysis,receipt of palliative active treatment(vs best supportive care)prolonged PFS and OS(both,P<0.001).CONCLUSION MiNEN is most commonly driven by a poorly differentiated neuroendocrine component,and has poor prognosis.Advances in its biological understanding are needed to identify effective treatments and improve patient outcomes.展开更多
To report a case of cochlear implantation with a misplaced electrode array in the vestibule and the causes for the delay in identification.A 23-year-old male with left single-sided deafness underwent cochlear implanta...To report a case of cochlear implantation with a misplaced electrode array in the vestibule and the causes for the delay in identification.A 23-year-old male with left single-sided deafness underwent cochlear implantation.The intraoperative assessment did not reveal any major red flags of electrode array misplacement.He did not display any vestibular symptoms postoperatively but showed poor speech performance,even though the aided tone audiometry revealed good sound detection thresholds.High-resolution computed tomography(HRCT)showed that the entire perimodiolar electrode array was situated within the vestibule,and a revision surgery was conducted.Retrospective analysis of the neural response telemetry(NRT)revealed subtle differences in responses between the misplaced and correctly placed electrode arrays.Unlike previously reported cases,the patient did not display vestibular symptoms despite the misplacement of the electrode in the vestibule due to existing weakness in otolithic function.Further investigation is warranted when a motivated patient with normal inner ear anatomy does not show benefit with the cochlear implant post-operatively.展开更多
Many premature babies, especially those with a low birth weight are given multiple transfusions during their first few weeks of life. The major serious complications of prematurity include bronchopulmonary dysplasia, ...Many premature babies, especially those with a low birth weight are given multiple transfusions during their first few weeks of life. The major serious complications of prematurity include bronchopulmonary dysplasia, with lesser incidences of retinopathy of prematurity, intraventricular haemorrhage, and necrotising enterocolitis. Many studies have shown correlations between the receipt of blood transfusions and the development of these conditions, but little is known of the underlying pathophysiology of this relationship. Recent studies are beginning to provide some answers. This review examines recent findings with regard to the influence of preparation and storage of paediatric packed red blood cell units on heme, iron, and oxidative status of the units and relates these to the ability of the premature baby to deal with these changes following the receipt of blood transfusions. Paediatric packed red blood cell units are a potential source of heme, redox active iron and free radicals, and this increases with storage age. Haemolysis of transfused red blood cells may add further iron and cell free haemoglobin to the recipient baby. Premature babies, particularly those with low birth weight and gestational age appear to have littlereserve to cope with any additional iron, heme and/or oxidative load. The consequences of these events are discussed with regard to their contribution to the major complications of prematurity and a novel hypothesis regarding transfusion-related morbidity in premature babies is presented. The review concludes with a discussion of potential means of limiting transfusion related iron/heme and oxidative load through the preparation and storage of packed red blood cell units and through modifications in clinical practice.展开更多
AIM: To compare urological infections in patients with or without stents following transplantation and to determine the effect of such infections on graft function.METHODS: All 285 recipients of kidney transplantation...AIM: To compare urological infections in patients with or without stents following transplantation and to determine the effect of such infections on graft function.METHODS: All 285 recipients of kidney transplantation at our centre between 2006 and 2010 were included in the study. Detailed information including stent use and transplant function was collected prospectively and analysed retrospectively. The diagnosis of urinary tract infection was made on the basis of compatible symptoms supported by urinalysis and/or microbiological culture. Graft function, estimated glomerular filtration rate and creatinine at 6 mo and 12 mo, immediate graft function and infection rates were compared between those with a stent or without a stent.RESULTS: Overall, 196(183 during initial procedure, 13 at reoperation) patients were stented following transplantation. The overall urine leak rate was 4.3%(12/277) with no difference between those with or without stents- 7/183 vs 5/102, P = 0.746. Overall, 54%(99/183) of stented patients developed a urological infection compared to 38.1%(32/84) of those without stents(P = 0.0151). All 18 major urological infections occurred in those with stents. The use of stent(Wald χ2 = 5.505, P = 0.019) and diabetes mellitus(Wald χ2 = 5.197, P = 0.023) were found to have significant influence on urological infection rates on multivariate analysis. There were no deaths or graft losses due to infection. Stenting was associated with poorer transplant function at 12 mo.CONCLUSION: Stents increase the risks of urological infections and have a detrimental effect on early to medium term renal transplant function.展开更多
文摘BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite improved renal function.It is potentially associated with an increased risk of cardiovascular events,renal osteodystrophy,pathologic fractures,graft loss,and mortality.AIM To evaluate the incidence,risk factors,and outcomes of PT-tHPT amongst kidney transplant recipients.METHODS A total of 887 transplant recipients who underwent transplantation between 2000 and 2020 were evaluated.Univariable and multivariable logistic regression was performed to determine the predictors of tertiary hyperparathyroidism.Graft and recipient outcomes were assessed using multivariable Cox regression.A separate multivariable Cox regression was performed to determine the effect of treatment strategies on outcomes.RESULTS PT-tHPT,defined as elevated PTH(>65 ng/L)and persistent hypercalcemia(>2.60 mmol/L),was diagnosed in 14%of recipients.Risk factors for PT-tHPT included older age[odds ratio(OR)=1.36,P<0.001],Asian ethnicity(OR=0.33,P=0.006),total ischemia time(OR=1.03,P=0.048 per hour),pre-transplant serum calcium(OR=1.38,P<0.001)per decile increase,pre-transplant PTH level(OR=1.31,P<0.001)per decile increase,longer dialysis duration(OR=1.12,P=0.002)per year,history of acute rejection(OR=2.37,P=0.012),and slope of estimated glomerular filtration rate change(OR=0.91,P=0.001).There were a 3.4-fold higher risk of death-censored graft loss and a 1.9-fold greater risk of recipient death with PT-tHPT.The three treatment strategies of conservative management,calcimimetic and parathyroidectomy did not significantly change the graft or patient outcome.CONCLUSION Pretransplant elevated calcium and PTH levels,older age and dialysis duration are associated with PT-tHPT.While PT-tHPT significantly affects graft and recipient survival,the treatment strategies did not affect survival.
基金support from China Scholarship Council(CSC)(202406440073).
文摘Accurate prediction of pure component physiochemical properties is crucial for process integration, multiscale modelling, and optimization. In this work, an enhanced framework for pure component property prediction by using explainable machine learning methods is proposed. In this framework, the molecular representation method based on the connectivity matrix effectively considers atomic bonding relationships to automatically generate features. The supervised machine learning model random forest is applied for feature ranking and pooling. The adjusted R^(2) is introduced to penalize the inclusion of additional features, providing an assessment of the true contribution of features. The prediction results for normal boiling point (T_(b)), liquid molar volume (L_(mv)), critical temperature (T_(c)) and critical pressure (P_(c)) obtained using Artificial Neural Network and Gaussian Process Regression models confirm the accuracy of the molecular representation method. Comparison with GC based models shows that the root-mean-square error on the test set can be reduced by up to 83.8%. To enhance the interpretability of the model, a feature analysis method based on Shapley values is employed to determine the contribution of each feature to the property predictions. The results indicate that using the feature pooling method reduces the number of features from 13316 to 100 without compromising model accuracy. The feature analysis results for Tb, Lmv, Tc, and Pc confirms that different molecular properties are influenced by different structural features, aligning with mechanistic interpretations. In conclusion, the proposed framework is demonstrated to be feasible and provides a solid foundation for mixture component reconstruction and process integration modelling.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)is increasingly used to treat gastric dysplasia and early neoplasia in the West.Unlike Eastern countries,data for Caucasian patients in the United Kingdom is limited due to its limited implementation in a few tertiary centres.AIM To evaluate the outcomes of ESD on gastric dysplasia and neoplasia in Caucasian patients.METHODS Our ten-year retrospective study at a single tertiary centre included data spanning from May 2012 to July 2023.The efficacy of ESD on gastric dysplasia and early neoplasia was measured using parameters set out by the National Institute for Health and Care Excellence,which include en-bloc and curative resection(CR)rates,local recurrence and survival rates.RESULTS ESD was attempted on 111 lesions in 93 patients.95.0%of completed procedures achieved endoscopic clearance.74.3%were en-bloc resections and the rest were hybrid ESD with piecemeal resections.In all,34.7%achieved histological CR.Overall,disease recurrence was 10.9%at latest follow-up(63 months,median follow-up).Importantly 100%of lesions in the CR group showed no disease recurrence at subsequent and latest follow-up.In the Indeterminate and Non-CR group,18.8%of lesions showed disease recurrence at subsequent endoscopic follow-ups.ESD changed the histological staging of 44.5%of lesions.Immediate complications were observed in 9.9%of all ESD procedures.The median survival time was 69 months post-ESD.The mean age at death is 82.2 years old.CONCLUSION The study affirms the long-term efficacy and safety of ESD for gastric dysplasia and early neoplasia in Caucasian patients.
基金supported by Engineering and Physical Sciences Research Council(EPSRC)under Grant No.EP/P006973/1.
文摘In the era of rapidly expanding wireless technologies,the push for larger spectrum efficiency and better signal integrity has intensified the need for high-efficient and low noise amplifiers(LNAs).A two-stage LNA based on the GaAs/InGaAs pseudomorphic high electron mobility transistor(pHEMT)with a relatively large gate length of 2μm is designed for high-performance 2.4-GHz wireless communication.The I-V characteristic and two-port high-frequency S-parameter of the transistor are measured by on-wafer probing techniques.The results indicate that a discrete transistor with a gate size of 2μm×50μm can provide a maximum transconductance of 16 mS,corresponding to a maximum current-gain cut-off frequency of 7 GHz and maximum oscillation frequency of 8 GHz at the 1-V drain-source voltage.With the impedance matching networks based transmission line technique,an extended integrated layout structure is designed and simulated by using the momentum simulation tool embedded in Advanced Design System,to alleviate the trade-off between noise figure(NF)and gain of the circuit.The findings show that the transistor based on the GaAs/InGaAs technology is capable of delivering high performance with power consumption low to 16 mW,where the maximum simulated gain of 21.5 dB and minimum NF of 2.4 dB are achieved.In terms of linearity,the proposed LNA provides terrific output 1-dB compression of-3 dBm and output third-order intercept point values of 10 dBm.The bandwidth of 0.12 GHz and figure-of-merit of 12 are obtained,which are comparable to that of existing LNAs based on pHEMT.Such a device may benefit to accelerate the development of more robust and power-efficient front-end modules in modern wireless systems,especially for advancing performance-driven applications.
基金support from the National Natural Science Foundation of China(Nos.42372328,U23B2091,52478253,and 52374147)Natural Science Foundation of Jiangsu Province,China(No.BK20240209).
文摘To address the dual challenges of resource utilization of mining solid waste(e.g.,coal gangue)and performance enhancement of cemented rockfill,this study systematically investigates the mechanisms of ultrasonic dispersion time and polycarboxylate superplasti-cizer(PCE)on the properties of cellulose nanofiber(CNF)-modified cemented rockfill.A series of comparative experiments were de-signed with varying ultrasonic dispersion times(0-60 min)and PCE dosages(0.1wt%-0.4wt%).Through mechanical testing,hydration product analysis,and microstructural characterization,the study revealed the advantages of PCE in promoting CNF dispersion to enhance the engineering applicability of cemented rockfill.The results demonstrate that:(1)Ultrasonic dispersion for 30 min increases the com-pressive strength by 37.7%compared to the untreated group;however,excessive ultrasonication(60 min)induces hydrolysis of CNF,re-leasing reducing sugars that retard hydration.(2)PCE facilitates CNF dispersion,achieving a 29.1%increase in compressive strength at a dosage of 0.4wt%,while simultaneously improving hydration products and microstructural development.(3)While ultrasonic dispersion yields slightly higher strength improvements,PCE demonstrates superior cost-effectiveness and operational convenience,rendering it more viable for industrial adoption.This study provides a theoretical foundation for the nano-enhanced modification of cemented rockfill,offering new insights into the recycling of solid waste and the development of high-performance materials.
基金supported by Science and Technology Major Project of Hubei Province in China(No.2021AFB001)。
文摘In laser wakefield acceleration,injecting an external electron beam at a certain energy is a promising approach for achieving a high-quality electron beam with low energy spread and low emittance.In this paper,the process of laser wakefield acceleration with an external injection at 10 pC has been studied in simulations.A Bayesian optimization method is used to optimize the key laser and plasma parameters so that the electron beam is accelerated to the expected energy with a small emittance and energy spread growth.The effect of the rising edge of the plasma on the transverse properties of the electron beam is simulated and optimized in order to ensure that the external electron beam is injected into the plasma without significant emittance growth.Finally,a high-quality electron beam with an energy of 1.5 GeV,a normalized transverse emittance of 0.5 mm·mrad and a relative energy spread of 0.5%at 10 pC is obtained.
基金supported by the Polish Ministry of Science and Higher Education,grant no.2/566516/SPUB/SP/2023。
文摘Background:Habitual physical activity is known to support cardiovascular health.However,when intensive exercise is performed for long durations,it can negatively affect the cardiovascular system.We evaluated the exercise-induced physiological responses of cardiac markers in male marathon runners based on basal plasma trimethylamine-N-oxide(TMAO)levels,a metabolite related to major adverse cardiovascular events.Methods:Blood samples from 28 marathon runners were collected two weeks before the marathon run(baseline),after finishing the race(post-marathon),and two weeks after the race(2 weeks post-marathon).Serum cardiac troponin I(c Tn I),endothelin-1(ET-1),galectin-3,pentraxin-3,human growth differentiation factor 15,and neopterin were determined by the enzyme immunoassay method.Plasma trimethylamine(TMA)and TMAO were measured by the ultra-high-performance liquid chromatography-mass spectrometry method.Results:Running a marathon increased levels of circulating biomarkers.A greater post-marathon elevation of cTn I and ET-1 was associated with baseline plasma TMAO levels(R=0.400,p=0.035 and R=0.476,p=0.012,respectively).Moreover,we observed an increase in post-marathon TMA levels.Conclusion:Greater post-marathon elevation of cTn I and ET-1 was associated with higher baseline plasma TMAO levels.Therefore,TMAO could potentially serve as a new marker in assessing the response of cardiovascular stress biomarkers to marathon running.
文摘A frequent cause of unplanned and costly outages in water-cooled nuclear power plants is the premature failure of the fuel rods due to excessive flow-induced vibration in the reactor core.Turbulence and unsteadiness in the coolant water flowing through the reactor core can cause excessive vibration of the fuel rods,which in turn can result in fretting wear that eventually leads to the fuel rod cladding perforation and subsequent failure.The economic burden of unplanned reactor outages has motivated extensive research into flow-induced vibration.This perspective article provides a brief summary of recent research on flow-induced vibration of cantilever rod systems,which are simplified paradigmatic test configurations that have been instrumental to advance the fundamental physical understanding of axial-flowinduced vibration problems,and have enabled the development of cost-effective numerical methodologies for the simulation of these problems in engineering,with particular application to nuclear reactor systems.This summary covers recent experimental and numerical studies,and includes a description of a novel non-contact Hall-effect-based measuring technique specifically developed to track the vibration of the cantilever rod with gas-liquid two-phase flows.The article concludes by highlighting promising avenues for future research.
文摘Barrett's esophagus (BE) confers a significant increased risk for development of esophageal adenocarcinoma (EAC), with the pathogenesis appearing to progress through a "metaplasia-dysplasia-carcinoma" (MDC) sequence. Many of the genetic insults driving this MDC sequence have recently been characterized, providing targets for candidate biomarkers with potential clinical utility to stratify risk in individual patients. Many clinical risk factors have been investigated, and associations with a variety of genetic, specific gastrointestinal and other modifiable factors have been proposed in the literature. This review summarizes the current understanding of the mechanisms involved in neoplastic progression of BE to EAC and critically appraises the relative roles and contributions of these putative risk factors from the published evidence currently available.
基金supported by Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Education(2021R1I1A3049788).
文摘In today’s digital era,the rapid evolution of image editing technologies has brought about a significant simplification of image manipulation.Unfortunately,this progress has also given rise to the misuse of manipulated images across various domains.One of the pressing challenges stemming from this advancement is the increasing difficulty in discerning between unaltered and manipulated images.This paper offers a comprehensive survey of existing methodologies for detecting image tampering,shedding light on the diverse approaches employed in the field of contemporary image forensics.The methods used to identify image forgery can be broadly classified into two primary categories:classical machine learning techniques,heavily reliant on manually crafted features,and deep learning methods.Additionally,this paper explores recent developments in image forensics,placing particular emphasis on the detection of counterfeit colorization.Image colorization involves predicting colors for grayscale images,thereby enhancing their visual appeal.The advancements in colorization techniques have reached a level where distinguishing between authentic and forged images with the naked eye has become an exceptionally challenging task.This paper serves as an in-depth exploration of the intricacies of image forensics in the modern age,with a specific focus on the detection of colorization forgery,presenting a comprehensive overview of methodologies in this critical field.
文摘The results of experimental study of nanoscale intermetallic formation in surface layer of a metal target at ion implantation are presented. To increase the thickness of the ion implanted surface layer the high intensive ion implantation is used. Compared with the ordinary ion implantation, the high intensive ion implantation allows a much thicker modified surface layer. Pure polycrystalline nickel was chosen as a target. Nickel samples were irradiated with Al ions on the vacuum-arc ion beam and plasma flow source 'Raduga-5'. It was shown that at the high intensity ion implantation the fine dispersed particles of Ni3AI, NiAl intermetallic compounds and solid solution Al in Ni are formed in the nickel surface layer of 200 nm and thicker. The formation of phases takes place in complete correspondence with the Ni-AI phase diagram.
文摘BACKGROUND Total hip replacements(THR)and total knee replacements(TKR)are effective treatments for severe osteoarthritis(OA).Some studies suggest clinical outcomes following THR are superior to TKR,the reason for which remains unknown.This study compares clinical outcomes between THR and TKR.AIM To compare the clinic outcomes of THR anad TKR using a comprehensive range of patient reported outcome measures(PROMs).METHODS A prospective longitudinal observational study of patients with OA undergoing THR and TKR were evaluated using a comprehensive range of generic and joint specific PROMs pre-and post-operatively.RESULTS A total of 131 patients were included in the study which comprised the THR group(68 patients)and the TKR group(63 patients).Both groups demonstrated significant post-operative improvements in all PROM scores(P<0.001).There were no significant differences in post-operative PROM scores between the two groups:Hip and Knee Osteoarthritis Outcome scores(P=0.140),Western Ontario and McMaster Universities Osteoarthritis Index pain(P=0.297)stiffness(P=0.309)and function(P=0.945),Oxford Hip and Knee Score(P=0.076),EuroQol-5D index(P=0.386)and Short-Form 12-item survey physical component score(P=0.106).Subgroup analyses showed no significant difference(P>0.05)between cruciate retaining and posterior stabilised prostheses in the TKR group and no significant difference(P>0.05)between cemented and uncemented fixation in the THR group.Obese patients had poorer outcomes following TKR but did not significantly influence the outcome following THR.CONCLUSION Contrary to some literature,THR and TKR are equally efficacious in alleviating the pain and disability of OA when assessed using a comprehensive range of PROMs.The varying knee prosthesis types and hip fixation techniques did not significantly influence clinical outcome.Obesity had a greater influence on the outcome following TKR than that of THR.
文摘Two posterior distributions for the mean of the Laplace distribution are obtained by deriving the distributions of the product XY and the ratio X/Y when X and Y are Student＇s t and Laplace random variables distributed independently of each other. Tabulations of the associated percentage points are given along with computer programs for generating them.
文摘Type 1 diabetes mellitus(T1DM)is one of the important causes of chronic kidney disease(CKD)and end-stage renal failure(ESRF).Even with the best available treatment options,management of T1DM poses significant challenges for clinicians across the world,especially when associated with CKD and ESRF.Substantial increases in morbidity and mortality along with marked rise in treatment costs and marked reduction of quality of life are the usual consequences of onset of CKD and progression to ESRF in patients with T1DM.Simultaneous pancreas-kidney transplant(SPK)is an attractive and promising treatment option for patients with advanced CKD/ESRF and T1DM for potential cure of these diseases and possibly several complications.However,limited availability of the organs for transplantation,the need for long-term immunosuppression to prevent rejection,peri-and post-operative complications of SPK,lack of resources and the expertise for the procedure in many centers,and the cost implications related to the surgery and postoperative care of these patients are major issues faced by clinicians across the globe.This clinical update review compiles the latest evidence and current recommendations of SPK for patients with T1DM and advanced CKD/ESRF to enable clinicians to care for these diseases.
基金supported by the National Natural Science Foundation of China(52175270,91848204)the Project of Scientific and Technological Development Plan of Jilin Province(20220508130RC).
文摘Accurate knowledge of the kinematics of the in vivo Ankle Joint Complex(AJC)is critical for understanding the biomechanical function of the foot and assessing postoperative rehabilitation of ankle disorders,as well as an essential guide to the design of ankle–foot assistant devices.However,detailed analysis of the continuous 3D motion of the tibiotalar and subtalar joints during normal walking throughout the stance phase is still considered to be lacking.In this study,dynamic radiographs of the hindfoot were acquired from eight subjects during normal walking.Natural motions with six Degrees of Freedom(DOF)and the coupled patterns of the two joints were analyzed.It was found that the movements of the two joints were mostly in opposite directions(including rotation and translation),mainly in the early and late stages.There were significant differences in the Range of Motion(ROM)in Dorsiflexion/Plantarflexion(D/P),Inversion/Eversion(In/Ev),and Anterior–Posterior(AP)and Medial–Lateral(ML)translation of the tibiotalar and subtalar joints(p<0.05).Plantarflexion of the tibiotalar joint was coupled with eversion and posterior translation of the subtalar joint during the impact phase(R^(2)=0.87 and 0.86,respectively),and plantarflexion of the tibiotalar joint was coupled with inversion and anterior translation of the subtalar joint during the push-off phase(R^(2)=0.93 and 0.75,respectively).This coordinated coupled motion of the two joints may be a manifestation of the AJC to move flexibly while bearing weight and still have stability.
文摘Access to organ transplantation depends on national circumstances, and is partly determined by the cost of health care, availability of transplant services, the level of technical capacity and the availability of organs. Commercial transplantation is estimated to account for 5%-10%(3500-7000) of kidney transplants performed annually throughout the world. This review is to determine the state and outcome of renal transplantation associated with transplant tourism(TT) and the key challenges with such transplantation. The stakeholders of commercial transplantation include: patients on the waiting lists in developed countries or not on any list in developing countries; dialysis funding bodies; middlemen, hosting transplant centres; organ-exporting countries; and organ vendors. TT and commercial kidney transplants are associated with a high incidence of surgical complications, acute rejection and invasive infection which cause major morbidity and mortality. There are ethical and medical concerns regarding the management of recipients of organs from vendors. The growing demand for transplantation, the perceived failure of altruistic donation in providing enough organs has led to calls for a legalised market in organ procurement or regulated trial in incentives for donation. Developing transplant services worldwide has many benefits- improving results of transplantation as they would be performed legally, increasing the donor pool and making TT unnecessary. Meanwhile there is a need to re-examine intrinsic attitudes to TT bearing in mind the cultural and economic realities of globalisation. Perhaps the World Health Organization in conjunction with The Transplantation Society would set up a working party of stakeholders to study this matter in greater detail and make recommendations.
文摘BACKGROUND Mixed neuroendocrine non-neuroendocrine neoplasm(MiNEN)is a rare diagnosis,mainly encountered in the gastro-entero-pancreatic tract.There is limited knowledge of its epidemiology,prognosis and biology,and the best management for affected patients is still to be defined.AIM To investigate clinical-pathological characteristics,treatment modalities and survival outcomes of a retrospective cohort of patients with a diagnosis of MiNEN.METHODS Consecutive patients with a histologically proven diagnosis of MiNEN were identified at 5 European centres.Patient data were retrospectively collected from medical records.Pathological samples were reviewed to ascertain compliance with the 2017 World Health Organisation definition of MiNEN.Tumour responses to systemic treatment were assessed according to the Response Evaluation Criteria in Solid Tumours 1.1.Kaplan-Meier analysis was applied to estimate survival outcomes.Associations between clinical-pathological characteristics and survival outcomes were explored using Log-rank test for equality of survivors functions(univariate)and Cox-regression analysis(multivariable).RESULTS Sixty-nine consecutive patients identified;Median age at diagnosis:64 years.Males:63.8%.Localised disease(curable):53.6%.Commonest sites of origin:colon-rectum(43.5%)and oesophagus/oesophagogastric junction(15.9%).The neuroendocrine component was;predominant in 58.6%,poorly differentiated in 86.3%,and large cell in 81.25%,of cases analysed.Most distant metastases analysed(73.4%)were occupied only by a poorly differentiated neuroendocrine component.Ninety-four percent of patients with localised disease underwent curative surgery;53%also received perioperative treatment,most often in line with protocols for adenocarcinomas from the same sites of origin.Chemotherapy was offered to most patients(68.1%)with advanced disease,and followed protocols for pure neuroendocrine carcinomas or adenocarcinomas in equal proportion.In localised cases,median recurrence free survival(RFS);14.0 months(95%CI:9.2-24.4),and median overall survival(OS):28.6 months(95%CI:18.3-41.1).On univariate analysis,receipt of perioperative treatment(vs surgery alone)did not improve RFS(P=0.375),or OS(P=0.240).In advanced cases,median progression free survival(PFS);5.6 months(95%CI:4.4-7.4),and median OS;9.0 months(95%CI:5.2-13.4).On univariate analysis,receipt of palliative active treatment(vs best supportive care)prolonged PFS and OS(both,P<0.001).CONCLUSION MiNEN is most commonly driven by a poorly differentiated neuroendocrine component,and has poor prognosis.Advances in its biological understanding are needed to identify effective treatments and improve patient outcomes.
文摘To report a case of cochlear implantation with a misplaced electrode array in the vestibule and the causes for the delay in identification.A 23-year-old male with left single-sided deafness underwent cochlear implantation.The intraoperative assessment did not reveal any major red flags of electrode array misplacement.He did not display any vestibular symptoms postoperatively but showed poor speech performance,even though the aided tone audiometry revealed good sound detection thresholds.High-resolution computed tomography(HRCT)showed that the entire perimodiolar electrode array was situated within the vestibule,and a revision surgery was conducted.Retrospective analysis of the neural response telemetry(NRT)revealed subtle differences in responses between the misplaced and correctly placed electrode arrays.Unlike previously reported cases,the patient did not display vestibular symptoms despite the misplacement of the electrode in the vestibule due to existing weakness in otolithic function.Further investigation is warranted when a motivated patient with normal inner ear anatomy does not show benefit with the cochlear implant post-operatively.
基金Supported by The Northcott Devon Medical FoundationThe NHS SW Researchand Development Fund
文摘Many premature babies, especially those with a low birth weight are given multiple transfusions during their first few weeks of life. The major serious complications of prematurity include bronchopulmonary dysplasia, with lesser incidences of retinopathy of prematurity, intraventricular haemorrhage, and necrotising enterocolitis. Many studies have shown correlations between the receipt of blood transfusions and the development of these conditions, but little is known of the underlying pathophysiology of this relationship. Recent studies are beginning to provide some answers. This review examines recent findings with regard to the influence of preparation and storage of paediatric packed red blood cell units on heme, iron, and oxidative status of the units and relates these to the ability of the premature baby to deal with these changes following the receipt of blood transfusions. Paediatric packed red blood cell units are a potential source of heme, redox active iron and free radicals, and this increases with storage age. Haemolysis of transfused red blood cells may add further iron and cell free haemoglobin to the recipient baby. Premature babies, particularly those with low birth weight and gestational age appear to have littlereserve to cope with any additional iron, heme and/or oxidative load. The consequences of these events are discussed with regard to their contribution to the major complications of prematurity and a novel hypothesis regarding transfusion-related morbidity in premature babies is presented. The review concludes with a discussion of potential means of limiting transfusion related iron/heme and oxidative load through the preparation and storage of packed red blood cell units and through modifications in clinical practice.
文摘AIM: To compare urological infections in patients with or without stents following transplantation and to determine the effect of such infections on graft function.METHODS: All 285 recipients of kidney transplantation at our centre between 2006 and 2010 were included in the study. Detailed information including stent use and transplant function was collected prospectively and analysed retrospectively. The diagnosis of urinary tract infection was made on the basis of compatible symptoms supported by urinalysis and/or microbiological culture. Graft function, estimated glomerular filtration rate and creatinine at 6 mo and 12 mo, immediate graft function and infection rates were compared between those with a stent or without a stent.RESULTS: Overall, 196(183 during initial procedure, 13 at reoperation) patients were stented following transplantation. The overall urine leak rate was 4.3%(12/277) with no difference between those with or without stents- 7/183 vs 5/102, P = 0.746. Overall, 54%(99/183) of stented patients developed a urological infection compared to 38.1%(32/84) of those without stents(P = 0.0151). All 18 major urological infections occurred in those with stents. The use of stent(Wald χ2 = 5.505, P = 0.019) and diabetes mellitus(Wald χ2 = 5.197, P = 0.023) were found to have significant influence on urological infection rates on multivariate analysis. There were no deaths or graft losses due to infection. Stenting was associated with poorer transplant function at 12 mo.CONCLUSION: Stents increase the risks of urological infections and have a detrimental effect on early to medium term renal transplant function.
