BACKGROUND Refractory esophageal strictures(ES)are defined an anatomical restriction without an active endoscopic inflammation resulting in dysphagia after a minimum of five seriated dilatations in a 4-weeks interval....BACKGROUND Refractory esophageal strictures(ES)are defined an anatomical restriction without an active endoscopic inflammation resulting in dysphagia after a minimum of five seriated dilatations in a 4-weeks interval.Recurrent ES(REES)refer to the inability to maintain a satisfactory luminal diameter for four weeks once an ageappropriate feeding diameter was achieved.Seriated endoscopic dilations are the reference maintenance for ES in pediatric age.Iterative dilations increase the risk of complications and may cause significant organic and psychological consequences in children and excessive costs for families and health systems.Furthermore,fibrotic modifications can make the surgery even more challenging.The surgical approach is burdened by high morbidity,with prolonged hospitalization and delayed oral refeeding in fragile patients with comorbidities.AIM To evaluate the efficacy and safety of the most recent adjuvant treatments,with the aim of avoiding or,at least,postponing surgery.METHODS Intralesional steroids or mitomycin C injections with antiproliferative and antifibroblastic properties have been attempted,but have been abandoned because of systemic adsorption,local complications,or lack of efficacy.Self-expanding metal stents are generally designed for the palliation of neoplastic strictures in adults and rarely employed in pediatrics because of the high risk of complications,in terms of stent migration,local pain and perforation.Our group developed a customized dynamic esophageal stent to stabilize esophageal patency and promote continuous dilatation determined by the food passage between the stent and the REES wall,but it requires an appropriate diameter for placement.RESULTS Recently peroral endoscopic tunneling for restoration of the esophagus has been employed to treat esophageal obstructions exploiting the submucosal space.Re-absorbable self-expanding stents(like SX-ELLA Stent Esophageal Degradable BD-BD stent)and energy-delivering surgical devices(HARMONIC ACE^(TM)+7 Laparoscope)have also been proposed.CONCLUSION After an overview about the historically applied adjuvant therapies,we aim to update the common knowledge with our recent experience of these new minimally invasive options for pediatric REES and refractory ES in three exemplary cases,focusing on their mid-term effectiveness and safety for the purpose of maintain the patency after standard endoscopic dilations and avoiding or,at least,postponing an invasive replacement surgery.展开更多
Fibroblast growth factor(FGF)signaling encompasses a multitude of functions,including regulation of cell proliferation,differentiation,morphogenesis,and patterning.FGFs and their receptors(FGFR)are crucial for adult t...Fibroblast growth factor(FGF)signaling encompasses a multitude of functions,including regulation of cell proliferation,differentiation,morphogenesis,and patterning.FGFs and their receptors(FGFR)are crucial for adult tissue repair processes.Aberrant FGF signal transduction is associated with various pathological conditions such as cartilage damage,bone loss,muscle reduction,and other core pathological changes observed in orthopedic degenerative diseases like osteoarthritis(OA),intervertebral disc degeneration(IVDD),osteoporosis(OP),and sarcopenia.In OA and IVDD pathologies specifically,FGF1,FGF2,FGF8,FGF9,FGF18,FGF21,and FGF23 regulate the synthesis,catabolism,and ossification of cartilage tissue.Additionally,the dysregulation of FGFR expression(FGFR1 and FGFR3)promotes the pathological process of cartilage degradation.In OP and sarcopenia,endocrine-derived FGFs(FGF19,FGF21,and FGF23)modulate bone mineral synthesis and decomposition as well as muscle tissues.FGF2 and other FGFs also exert regulatory roles.A growing body of research has focused on understanding the implications of FGF signaling in orthopedic degeneration.Moreover,an increasing number of potential targets within the FGF signaling have been identified,such as FGF9,FGF18,and FGF23.However,it should be noted that most of these discoveries are still in the experimental stage,and further studies are needed before clinical application can be considered.Presently,this review aims to document the association between the FGF signaling pathway and the development and progression of orthopedic diseases.Besides,current therapeutic strategies targeting the FGF signaling pathway to prevent and treat orthopedic degeneration will be evaluated.展开更多
We read the recent minireview by Ding et al.This review provided a structured introduction to the applications of artificial intelligence(AI)in gastrointestinal endoscopy while emphasizing the technical solutions for ...We read the recent minireview by Ding et al.This review provided a structured introduction to the applications of artificial intelligence(AI)in gastrointestinal endoscopy while emphasizing the technical solutions for imaging hurdles.However,we identified some areas that were lacking analytical depth.Specifically,the review oversimplified machine learning and deep learning models(e.g.,generative adversarial networks misclassification)and failed to deeply analyze the explanations for missed tumor rates and the critical role of data quality/bias.In this article,we stress that the potential of AI extends beyond diagnostics and highlight its emerging and crucial role in endoscopist training,skill development,and proficiency enhancement.We conclude that future AI adoption depends on robust multicenter trials and the implementation of AI-assisted educational platforms.展开更多
The abandonment of rural activities in the Mediterranean mid-mountains has led to the activation of revegetation processes,as well as the subsequent implementation of various management measures to mitigate the associ...The abandonment of rural activities in the Mediterranean mid-mountains has led to the activation of revegetation processes,as well as the subsequent implementation of various management measures to mitigate the associated ecosystem disservices.Focusing on soil environment and its growing importance in a climate change scenario,it is of great interest to study how land management and landscape changes can affect,not only the soil carbon storage process,but also its dynamics.A study was conducted in La Rioja(Iberian System,Spain),comparing three post-abandonment management strategies:secondary succession,forest management,and shrub clearing and extensive grazing.These strategies were analysed in two types of soil environments(acid and alkaline)and for two depth ranges(0–20 cm and 20–40 cm).Laboratory analyses were performed on aggregate stability and soil organic carbon fractionation with regard to three aggregate sizes(<2 mm,2–5 mm,>5 mm)and three density fractions(free labile,occluded,and heavy fraction).The results showed that:1)SOC content in aggregates<2 mm(relative to total SOC)increases with shrub clearing and grazing strategy in acid environments;2)aggregate stability benefits from the implementation of afforestation in acid environments and from all three study strategies in alkaline ones;3)in acid environments,the percentage of labile fractions(free and occluded)in afforested sites is significantly higher compared with shrubland,while in alkaline environments,recalcitrant SOC is significantly higher in shrub clearing sites.Thus,land management should be focused on SOC storage after land abandonment in Mediterranean mountainous environments.展开更多
BACKGROUND Esophageal cancer(EC)is one of the most prevalent malignant gastrointestinal tumors;accurate prediction of EC staging has high significance before treatment.AIM To explore a rational radiomic approach for p...BACKGROUND Esophageal cancer(EC)is one of the most prevalent malignant gastrointestinal tumors;accurate prediction of EC staging has high significance before treatment.AIM To explore a rational radiomic approach for predicting preoperative staging of EC based on magnetic resonance imaging(MRI).METHODS This retrospective study included 210 patients with pathologically confirmed EC,randomly divided into a primary cohort(n=147)and a validation cohort(n=63)in a ratio of 7:3.All patients underwent a preoperative MRI scan from the neck to the abdomen.High-throughput and quantitative radiomics features were extracted from T2-weighted imaging(T2WI)and gadolinium contrast-enhanced T1-weighted imaging(T1WI)-Gd images.Radiomics signatures were selected using minimal redundancy maximal relevance and the least absolute shrinkage and selection operator.Then a logistic regression model was built to predict the EC stages.The diagnostic performance of the radiomics model for discriminating between stages Ⅰ-Ⅱ and Ⅲ-Ⅳ was evaluated using the area under the curve(AUC),sensitivity(SEN),and specificity(SPE).RESULTS A total of 214 radiomics features were extracted.Following feature dimension reduction,the T1WI and T2WI sequences were retained,and 14 features from the T1WI sequence and 3 features from the T2WI sequence were selected to construct radiomics signatures.The radiomics signature combining T2WI with T1WI-Gd demonstrated superior discrimination of stages in the validation cohort(AUC:0.851;SEN:0.697;SPE:0.793),which outperformed single-sequence models(AUC:0.779,0.844;SEN:0.667,0.636;SPE:0.8,0.8).CONCLUSION MRI-based radiomics signatures could identify EC stages before treatment,which could serve as a noninvasive and quantitative approach aiding personalized treatment planning.展开更多
BACKGROUND Predicting the pathological response of esophageal cancer(EC)to neoadjuvant therapy(NAT)is of significant clinical importance.AIM To evaluate the pathological response of NAT in EC patients using multiple m...BACKGROUND Predicting the pathological response of esophageal cancer(EC)to neoadjuvant therapy(NAT)is of significant clinical importance.AIM To evaluate the pathological response of NAT in EC patients using multiple machine learning algorithms based on magnetic resonance imaging(MRI)radiomics.METHODS This retrospective study included 132 patients with pathologically confirmed EC,were randomly divided into a training cohort(n=92)and a validation cohort(n=40)in a 7:3 ratio.All patients underwent a preoperative MRI scan from the neck to the abdomen.High-throughput and quantitative radiomics features were extracted from T2-weighted imaging(T2WI).Radiomics signatures were selected using minimal redundancy maximal relevance and the least absolute shrinkage and selection operator.Nine classification algorithms were used to build the models,and the diagnostic performance of each model was evaluated using the area under the curve(AUC),sensitivity(SEN),and specificity(SPE).RESULTS A total of 1834 features were extracted.Following feature dimension reduction,ten radiomics features were selected to construct radiomics signatures.Among the nine classification algorithms,the ExtraTrees algorithm demonstrated the best diagnostic performance in both the training(AUC:0.932;SEN:0.906;SPE:0.817)and validation cohorts(AUC:0.900;SEN:0.667;SPE:0.700).The Delong test proved no significance in the diagnostic efficiency within these models(P>0.05).CONCLUSION T2WI radiomics may aid in determining the pathological response to NAT in EC patients,serving as a noninvasive and quantitative tool to assist personalized treatment planning.展开更多
Enhancing the spatio-temporal connectivity of dynamic landscapes is crucial for species to adapt to climate change.However,the spatio-temporal connectivity network approach considering climate change and species movem...Enhancing the spatio-temporal connectivity of dynamic landscapes is crucial for species to adapt to climate change.However,the spatio-temporal connectivity network approach considering climate change and species movement is often overlooked.Taking Tibetan wild ass on the Qinghai-Xizang Plateau as an example,we simulated species distribution under current(2019)and future scenarios(2100),constructed spatio-temporal connectivity networks,and assessed the spatio-temporal connectivity.The results show that under the current,SSP2–4.5 and SSP3–7.0 scenarios,suitable habitats for the Tibetan wild ass account for 21.11%,21.34%,and 20.95%of the total area,respectively,with increased fragmentation projected by 2100.78.35%of the habitats which are predicted to be suitable under current conditions will remain suitable in the future,which can be regarded as stable climate refuges.With the increase in future emission intensity,the percentage of auxiliary connectivity corridors increases from 27.65%to 33.57%.This indicates that more patches will function as temporary refuges and the auxiliary connectivity corridors will gradually weaken the dominance of direct connectivity corridors.Under different SSP-RCP scenarios,the internal spatio-temporal connectivity is always higher than direct connectivity and auxiliary connectivity,accounting for 42%–43%.Compared with the spatio-temporal perspective,the purely spatial perspective overestimates network connectivity by about 28%considering all current and future patches,and underestimates network connectivity by 16%–21%when only considering all current or future patches.In this study,a new approach of spatio-temporal connectivity network is proposed to bridge climate refuges,which contributes to the long-term effectiveness of conservation networks for species’adaptation to climate change.展开更多
OBJECTIVE:To investigate the anti-inflammatory effect of electroacupuncture in rats with bupivacaine-induced lumbar multifidus injury and its underlying regulatory mechanism on macrophage polarization.METHODS:A total ...OBJECTIVE:To investigate the anti-inflammatory effect of electroacupuncture in rats with bupivacaine-induced lumbar multifidus injury and its underlying regulatory mechanism on macrophage polarization.METHODS:A total of seventy-two Sprague-Dawley male rats were randomly divided into control,model,and electroacupuncture groups.Forty-eight rats categorized in model groups were injected 0.5% bupivacaine(BPVC) into the lumbar multifidus at the L4-L5 segment.Rats in the electroacupuncture groups received the intervention for 1,2,3 and 5 d,respectively.The degree of macrophage infiltration and change of M1/M2 polarization were observed based on hematoxylin and eosin staining,immunohistochemistry and immunofluorescence to evaluate the anti-inflammatory effect of electroacupuncture.Meanwhile,exosomal miRNAsequencing and bioinformatics analysis predicted the pathways and biological processes related to inflammatory response and macrophage polarization regulated by electroacupuncture intervention.RESULTS:BPVC injection induced the infiltration of local macrophages at the L4-L5 segment of lumbar multifidus.Comparison of mean IOD values with 2 d and 5 d post injury revealed the highest expression of CD68+ macrophages on day 3 post injury by immunohistochemistry.(P < 0.001,P < 0.001,respectively).Compared with the model group,the cell counts of iNOs+ CD68+ M1-macrophages were lower in the electroacupuncture group,while the positive percent of CD163+ CD206+ M2-macrophages was higher in the electroacupuncture group,on day 3 after BPVC injection(P < 0.001,P < 0.001,respectively).Moreover,the results of sequencing and bioinformatic analysis suggested that exosomal miRNAs were involved in the EA regulating macrophage polarization.CONCLUSIONS:Electroacupuncture can promote macrophage polarization to reduce inflammation following lumbar multifidus muscular injury.展开更多
Marigolds(Tagetes spp.)are popular horticultural plants worldwide.The current study aimed to investigate the optimal mutagenic conditions for marigold seeds using EMS(ethyl methanesulfonate)mutagenesis.Different con-c...Marigolds(Tagetes spp.)are popular horticultural plants worldwide.The current study aimed to investigate the optimal mutagenic conditions for marigold seeds using EMS(ethyl methanesulfonate)mutagenesis.Different con-centrations and treatment times of EMS were applied to investigate their effects on the marigold seed germination rate,growth traits,antioxidant enzyme activities(i.e.,SOD and POD),and malondialdehyde(MDA)contents.Results indicated that with increasing the EMS treatment duration and concentration,the seed germination rate and growth treatments were reduced,accompanied by elevated MDA content.In addition,SOD and POD activ-ities initially correlated positively with the growth tratis at the lowest concentrations and shortest durations of EMS,but such relationship diminished beyond certain thresholds.The comprehensive analysis identified the opti-mal mutagenic conditions as 1%EMS treatment for 12 h,achieving a semi-lethal dose and enhancing stress-resis-tant components in seedlings.Thesefindings are pivotal for advancing genetic enhancement and germplasm innovation in marigolds.展开更多
The location of an acute ischemic stroke is associated with its prognosis. The widely used Gaussian model-based parameter, apparent diffusion coefficient(ADC), cannot reveal microstructural changes in different locati...The location of an acute ischemic stroke is associated with its prognosis. The widely used Gaussian model-based parameter, apparent diffusion coefficient(ADC), cannot reveal microstructural changes in different locations or the degree of infarction. This prospective observational study was reviewed and approved by the Institutional Review Board of Xiamen Second Hospital, China(approval No. 2014002).Diffusion kurtosis imaging(DKI) was used to detect 199 lesions in 156 patients with acute ischemic stroke(61 males and 95 females), mean age 63.15 ± 12.34 years. A total of 199 lesions were located in the periventricular white matter(n = 52), corpus callosum(n = 14), cerebellum(n = 29), basal ganglia and thalamus(n = 21), brainstem(n = 21) and gray-white matter junctions(n = 62). Percentage changes of apparent diffusion coefficient(ΔADC) and DKI-derived indices(fractional anisotropy [ΔFA], mean diffusivity [ΔMD], axial diffusivity [ΔD_a], radial diffusivity ΔDr, mean kurtosis [ΔMK], axial kurtosis [ΔK_a], and radial kurtosis [ΔK_r]) of each lesion were computed relative to the normal contralateral region. The results showed that(1) there was no significant difference in ΔADC, ΔMD, ΔD_a or ΔD_r among almost all locations.(2) There was significant difference in ΔMK among almost all locations(except basal ganglia and thalamus vs. brain stem; basal ganglia and thalamus vs. gray-white matter junctions; and brainstem vs. gray-white matter junctions.(3) The degree of change in diffusional kurtosis in descending order was as follows: corpus callosum > periventricular white matter > brainstem > gray-white matter junctions > basal ganglia and thalamus > cerebellum. In conclusion, DKI could reveal the differences in microstructure changes among various locations affected by acute ischemic stroke, and performed better than diffusivity among all groups.展开更多
This study explored the application value of iterative decomposition of water and fatwith echo asymmetry and least-squares estimation(IDEAL-IQ)technology in the early diagnosis of ageing osteoporosis(OP).172 participa...This study explored the application value of iterative decomposition of water and fatwith echo asymmetry and least-squares estimation(IDEAL-IQ)technology in the early diagnosis of ageing osteoporosis(OP).172 participants were enrolled and underwentmagnetic resonance imaging(MRI)examinations on a 3.0T scanner.100 cases were included in the normal group(50 males and 50 females;mean age:45 years;age range:20e84 years).33 cases were included in the osteopenia group(17 males and 16 females;mean age:55 years;age range:43e83 years).39 caseswere includedintheOP group(19males and20females;meanage:58years;age range:48 e82 years).Conventional T1WI and T2WI were first obtained,followed by 3D-IDEAL-IQ-acqui-sition.Fat fraction(FF)and apparent transverse relaxation rate(R2*)resultswere automatically calculated from IDEAL-IQ-images on the console.Based on T1Wand T2W-images,300 ROIs for each participantweremanually delineated in L1-L5 vertebral bodies of five middle slices.In each age group of all normal subjects,each parameter was significantly correlated with gender.In male participants from the normal,osteopenia,and OP groups,statistical analysis revealed F values of 11319.292 and 180.130 for comparisons involving FF and R2*values,respectively(all p<0.0001).The sensitivity and specificity of FF values were 0.906 and 0.950,0.994 and 0.997,0.865 and 0.820,respectively.For R2*,they were 0.665 and 0.616,0.563 and 0.519,0.571 and 0.368,respectively.In female participants from the normal,osteopenia,and OP-groups,statis-tical analysis revealed F values of 12461.658 and 548.274 for comparisons involving FF and R2*values,respectively(all p<0.0001).The sensitivity and specificity of FF values were 0.985 and 0.991,0.996 and 0.996,0.581 and 0.678,respectively.For R2*,they were 0.698 and 0.730,0.603 and 0.665,0.622 and 0.525,respectively.Significant differences were indicated in the quanti-tative values among the three groups.FF value had good performance,while R2*value had poor performance indiscriminatingosteopenia andOP-groups.Overall,the IDEAL-IQ techniqueoffers specific reference indices that enable noninvasive and quantitative assessment of lumbar vertebrae bone metabolism,thereby providing diagnostic information for OP.展开更多
Subterranean environments are buffered from external climatic fluctuations due to the absence of light and a delayed thermal response to surface conditions(Mammola 2019).Terrestrial salamanders are often found in subt...Subterranean environments are buffered from external climatic fluctuations due to the absence of light and a delayed thermal response to surface conditions(Mammola 2019).Terrestrial salamanders are often found in subterranean habitats,but few studies have assessed the influence of climatic effects on their long-term spatial distribution and niche breadth.In this study,we investigated the variability over 29 consecutive years of the spatial niche in a terrestrial salamander population inhabiting an artificial subterranean habitat.We hypothesized that juvenile salamanders,which are typically active near cave entrances and more exposed to climatic variability and dehydration(Peterman et al.2013),would exhibit an earlier and more variable behavioral adaptation to increasing external temperatures compared to adults.展开更多
Pelvic fractures are rare but severe injuries that severely affect patients’quality of life.Treatment of these fractures often involves invasive approaches with high risk of injuries to nervous structures,particularl...Pelvic fractures are rare but severe injuries that severely affect patients’quality of life.Treatment of these fractures often involves invasive approaches with high risk of injuries to nervous structures,particularly lumbosacral plexus.The introduction of minimally invasive surgical approaches,such as the lateral rectus approach,not only contributes to preserving lumbar plexus integrity in operated patients but also positively impacts their psychological well-being.Patients treated by surgical reduction of pelvic fractures with lumbosacral plexus injury often experience states of anxiety and depression.The lateral rectus approach is associated with lower levels of anxiety and depression compared to more invasive surgical techniques used for similar fractures.展开更多
BACKGROUND Congenital intrahepatic arterioportal fistula(IAPF) is a rare vascular malformation in infants that causes severe portal hypertension(PH) with poor prognosis if untreated. Currently, radiological embolisati...BACKGROUND Congenital intrahepatic arterioportal fistula(IAPF) is a rare vascular malformation in infants that causes severe portal hypertension(PH) with poor prognosis if untreated. Currently, radiological embolisation is considered the first-line therapy for simple IAPF; however, it might be not resolutive for complex hepatic vascular lesions. When endovascular embolization is not sufficient to completely obliterate the IAPF, surgical intervention is needed, but it has been associated with severe morbidity and mortality in small children.Furthermore, indications are not defined.CASE SUMMARY We present the first case of a 6-month-old girl with trisomy 21 affected by a complex congenital IAFP, which caused severe PH, successfully treated with an endovascular-surgical hybrid procedure. The novel technique comprised a multistep endovascular embolisation, including a superselective transarterial embolisation of the afferent vessels and a direct transhepatic embolisation of the dilated portal vein segment, combined with selective surgical ligation of the arterial branches that supply the fistula, which were too small to be embolised.The complex IAPF was also associated with severe cholestasis and intra/extrahepatic biliary tree dilatation, which was successfully treated by a temporary biliary drainage. At 24-mo follow-up, the hybrid endovascularsurgical procedure achieved complete occlusion of the complex IAPF and resolution of the PH. A comprehensive review of the literature on congenital IAPF management, focussed on alternative treatment strategies, is also reported.CONCLUSION The combined radiological-surgical approach is a safe and effective treatment option for complex IAPF and avoids major invasive surgery.展开更多
Helicobacter pylori(H.pylori),a widespread gram-negative bacterium that colonizes the stomach,causes chronic gastritis,which may progress to peptic ulcer,mucosa-associated lymphoid tissue lymphoma,and gastric cancer.H...Helicobacter pylori(H.pylori),a widespread gram-negative bacterium that colonizes the stomach,causes chronic gastritis,which may progress to peptic ulcer,mucosa-associated lymphoid tissue lymphoma,and gastric cancer.H.pylori infection affects over 50%of people in developing countries and 10%-20%in developed countries.The Kyoto consensus classifies H.pylori gastritis as an infectious disease in the International Classification of Disease 11th Revision.The Maastricht/Florence consensus recommends treatment for all infected individuals,introducing a shift in the management strategies.The prevalence of H.pylori infection is high in the Middle East,with infection rates of 40%-70%and 85%-90%being reported among children and adults,respectively.The increasing resistance to antibiotics,including macrolides and fluoroquinolones,is a major challenge in the management of H.pylori.Clarithromycin resistance,which is associated with reduced effectiveness of standard triple therapy regimens,leading to higher rates of treatment failure,impacts the eradication rates.This emphasizes the need for routine antibiotic susceptibility testing at the national level,the use of alternative therapies,including new molecular methods,and antibiotic stewardship.An online panel of experts from the Middle East,along with an international expert,developed this consensus to provide comprehensive guidelines on the diagnosis,treatment,prevention,and role of gut microbiota in H.pylori infection,with the goal of improving clinical decision-making and reducing the impact of antibiotic resistance in the region.These guidelines are intended to support healthcare professionals involved in the diagnosis and management of H.pylori,including primary care physicians,gastroenterologists,and other specialists.They may also inform future clinical research aimed at optimizing treatment strategies and addressing regional challenges.展开更多
BACKGROUND Benign recurrent intrahepatic cholestasis is a genetic disorder with recurrent cholestatic jaundice due to ATP8B1 and ABCB11 gene mutations encoding for hepato-canalicular transporters.Herein,we firstly pro...BACKGROUND Benign recurrent intrahepatic cholestasis is a genetic disorder with recurrent cholestatic jaundice due to ATP8B1 and ABCB11 gene mutations encoding for hepato-canalicular transporters.Herein,we firstly provide the evidence that a nonsense variant of ATP8B1 gene(c.1558A>T)in heterozygous form is involved in BRIC pathogenesis.CASE SUMMARY A 29-year-old male showed severe jaundice and laboratory tests consistent with intrahepatic cholestasis despite normal gamma-glutamyltranspeptidase.Acute and chronic liver diseases with viral,metabolic and autoimmune etiology were excluded.Normal intra/extra-hepatic bile ducts were demonstrated by magnetic resonance.Liver biopsy showed:Cholestasis in the centrilobular and intermediate zones with bile plugs and intra-hepatocyte pigment,Kupffer’s cell activation/hyperplasia and preserved biliary ducts.Being satisfied benign recurrent intrahepatic cholestasis diagnostic criteria,ATP8B1 and ABCB11 gene analysis was performed.Surprisingly,we found a novel nonsense variant of ATP8B1 gene(c.1558A>T)in heterozygosis.The variant was confirmed by Sanger sequencing following a standard protocol and tested for familial segregation,showing a maternal inheritance.Immunohistochemistry confirmed a significant reduction of mutated gene related protein(familial intrahepatic cholestasis 1).The patient was treated with ursodeoxycholic acid 15 mg/kg per day and colestyramine 8 g daily with total bilirubin decrease and normalization at the 6th and 12th mo.CONCLUSION A genetic abnormality,different from those already known,could be involved in familial intrahepatic cholestatic disorders and/or pro-cholestatic genetic predisposition,thus encouraging further mutation detection in this field.展开更多
The Yadu-Ziyun-Luodian aulacogen(YZLA) developed into being NW-trending in the Late Paleozoic,and was considered as an important passive continental margin aulacogen in Guizhou Province, South China. This tectonic zon...The Yadu-Ziyun-Luodian aulacogen(YZLA) developed into being NW-trending in the Late Paleozoic,and was considered as an important passive continental margin aulacogen in Guizhou Province, South China. This tectonic zone is considered a large intracontinental thrust-slip tectonic unit, which has undergone a long period of development. It was ultimately determined in the Yanshanian, where the typical Upper Paleozoic marine shales were deposited. In 2021, Well QSD-1 was deployed in the Liupanshui area at the northwest margin of the aulacogen, and obtained a daily shale gas flow of 11011 m3in the Carboniferous Dawuba Formation. It thus achieved a breakthrough in the invesgation of shale gas in the Lower Carboniferous in South China, revealing relatively good gas-bearing properties and broad exploration prospects of the aulacogen. Being different from the Lower Paleozoic strata in the Sichuan Basin and the Yichang area of the Middle Yangtze, the development of the Carboniferous Dawuba Formation in the aulacogen exhibits the following characteristics:(1) The Lower Carboniferous shale is thick and widely distributed, with interbedded shale and marlstone of virous thickness;(2) The total organic carbon(TOC) content of the shale in the Dawuba Formation ranges from 1% to 5%, with an average of 2%, and the thermal maturity of organic matter(Ro) varies from 1% to 4%, with an average of2.5%, indicating good hydrocarbon generation capacity;(3) The main shale in the aulacogen was formed during the fault subsidence stage from the Middle Devonian to the Early Permian. Although the strong compression and deformation during the late Indosinian-Himalayan played a certain role in destroying the formed shale gas reservoirs, comparative analysis suggests that the area covered by the current Triassic strata has a low degree of destruction. It therefore provides good conditions for shale gas preservation,which can be regarded as a favorable area for the next exploration.展开更多
Using a bottom-up estimation method,a comprehensive,high-resolution emission inventory of gaseous and particulate atmospheric pollutants for multiple anthropogenic sectors with typical local sources has been developed...Using a bottom-up estimation method,a comprehensive,high-resolution emission inventory of gaseous and particulate atmospheric pollutants for multiple anthropogenic sectors with typical local sources has been developed for the Harbin-Changchun city agglomeration(HCA).The annual emissions for CO,NO_(x),SO_(2),NH_(3),VOC S,PM_(2.5),PM 10,BC and OC during 2017 in the HCA were estimated to be 5.82 Tg,0.70 Tg,0.34 Tg,0.75 Tg,0.81 Tg,0.67 Tg,1.59 Tg,0.12 Tg and 0.26 Tg,respectively.For PM 10 and SO_(2),the emissions from industry processes were the dominant contributors representing 54.7%and 49.5%,respectively,of the total emissions,while 95.3%and 44.5%of the total NH_(3)and NO x emissions,respectively,were from or associated with agricultural activities and transportation.Spatiotemporal distributions showed that most emissions(except NH_(3))occurred in November to March and were concentrated in the central cities of Changchun and Harbin and the surrounding cities.Open burning of straw made an important contribution to PM_(2.5)in the central regions of the northeastern plain during autumn and spring,while domestic coal combustion for heating purposes was significant with respect to SO_(2)and PM_(2.5)emissions during autumn and winter.Furthermore,based on Principal Component Analysis and Multivariable Linear Regression model,air temperature,relative humidity,electricity and energy consumption,and the urban and rural population were optimized to be representative indicators for rapidly assessing the magnitude of regional atmospheric pollutants in the HCA.Such indicators and equations were demonstrated to be useful for local atmospheric environment management.展开更多
文摘BACKGROUND Refractory esophageal strictures(ES)are defined an anatomical restriction without an active endoscopic inflammation resulting in dysphagia after a minimum of five seriated dilatations in a 4-weeks interval.Recurrent ES(REES)refer to the inability to maintain a satisfactory luminal diameter for four weeks once an ageappropriate feeding diameter was achieved.Seriated endoscopic dilations are the reference maintenance for ES in pediatric age.Iterative dilations increase the risk of complications and may cause significant organic and psychological consequences in children and excessive costs for families and health systems.Furthermore,fibrotic modifications can make the surgery even more challenging.The surgical approach is burdened by high morbidity,with prolonged hospitalization and delayed oral refeeding in fragile patients with comorbidities.AIM To evaluate the efficacy and safety of the most recent adjuvant treatments,with the aim of avoiding or,at least,postponing surgery.METHODS Intralesional steroids or mitomycin C injections with antiproliferative and antifibroblastic properties have been attempted,but have been abandoned because of systemic adsorption,local complications,or lack of efficacy.Self-expanding metal stents are generally designed for the palliation of neoplastic strictures in adults and rarely employed in pediatrics because of the high risk of complications,in terms of stent migration,local pain and perforation.Our group developed a customized dynamic esophageal stent to stabilize esophageal patency and promote continuous dilatation determined by the food passage between the stent and the REES wall,but it requires an appropriate diameter for placement.RESULTS Recently peroral endoscopic tunneling for restoration of the esophagus has been employed to treat esophageal obstructions exploiting the submucosal space.Re-absorbable self-expanding stents(like SX-ELLA Stent Esophageal Degradable BD-BD stent)and energy-delivering surgical devices(HARMONIC ACE^(TM)+7 Laparoscope)have also been proposed.CONCLUSION After an overview about the historically applied adjuvant therapies,we aim to update the common knowledge with our recent experience of these new minimally invasive options for pediatric REES and refractory ES in three exemplary cases,focusing on their mid-term effectiveness and safety for the purpose of maintain the patency after standard endoscopic dilations and avoiding or,at least,postponing an invasive replacement surgery.
基金supported by the National Key R&D Program of China(2023YFC3603400)the National Natural Science Foundation of China(82072506,92268115)+2 种基金the Hunan Provincial Science Fund for Distinguished Young Scholars(2024JJ2089)the Science and Technology Innovation Program of Hunan Province(2021RC3025)the National Clinical Research Center for Geriatric Disorders(Xiangya Hospital,2021KF02).
文摘Fibroblast growth factor(FGF)signaling encompasses a multitude of functions,including regulation of cell proliferation,differentiation,morphogenesis,and patterning.FGFs and their receptors(FGFR)are crucial for adult tissue repair processes.Aberrant FGF signal transduction is associated with various pathological conditions such as cartilage damage,bone loss,muscle reduction,and other core pathological changes observed in orthopedic degenerative diseases like osteoarthritis(OA),intervertebral disc degeneration(IVDD),osteoporosis(OP),and sarcopenia.In OA and IVDD pathologies specifically,FGF1,FGF2,FGF8,FGF9,FGF18,FGF21,and FGF23 regulate the synthesis,catabolism,and ossification of cartilage tissue.Additionally,the dysregulation of FGFR expression(FGFR1 and FGFR3)promotes the pathological process of cartilage degradation.In OP and sarcopenia,endocrine-derived FGFs(FGF19,FGF21,and FGF23)modulate bone mineral synthesis and decomposition as well as muscle tissues.FGF2 and other FGFs also exert regulatory roles.A growing body of research has focused on understanding the implications of FGF signaling in orthopedic degeneration.Moreover,an increasing number of potential targets within the FGF signaling have been identified,such as FGF9,FGF18,and FGF23.However,it should be noted that most of these discoveries are still in the experimental stage,and further studies are needed before clinical application can be considered.Presently,this review aims to document the association between the FGF signaling pathway and the development and progression of orthopedic diseases.Besides,current therapeutic strategies targeting the FGF signaling pathway to prevent and treat orthopedic degeneration will be evaluated.
文摘We read the recent minireview by Ding et al.This review provided a structured introduction to the applications of artificial intelligence(AI)in gastrointestinal endoscopy while emphasizing the technical solutions for imaging hurdles.However,we identified some areas that were lacking analytical depth.Specifically,the review oversimplified machine learning and deep learning models(e.g.,generative adversarial networks misclassification)and failed to deeply analyze the explanations for missed tumor rates and the critical role of data quality/bias.In this article,we stress that the potential of AI extends beyond diagnostics and highlight its emerging and crucial role in endoscopist training,skill development,and proficiency enhancement.We conclude that future AI adoption depends on robust multicenter trials and the implementation of AI-assisted educational platforms.
基金supported by the MANMOUNT project(PID2019-105983RB-100)funded by the MICINN-FEDER(MICIU/AEI/10.13039/501100011033)the 570 PRX21/00375 project funded by the Ministry of Universities of Spain from the“Salvador de Madariaga”programme+1 种基金The‘Geoenvironmental Processes and Global Change’(E02_23R)research group is financed by the Aragon Government and the European Social Fund(ESF-FSE)The first author is working with an FPI contract(PRE2020-094509)from the Spanish Ministry of Economy and Competitiveness associated to the MANMOUNT project.
文摘The abandonment of rural activities in the Mediterranean mid-mountains has led to the activation of revegetation processes,as well as the subsequent implementation of various management measures to mitigate the associated ecosystem disservices.Focusing on soil environment and its growing importance in a climate change scenario,it is of great interest to study how land management and landscape changes can affect,not only the soil carbon storage process,but also its dynamics.A study was conducted in La Rioja(Iberian System,Spain),comparing three post-abandonment management strategies:secondary succession,forest management,and shrub clearing and extensive grazing.These strategies were analysed in two types of soil environments(acid and alkaline)and for two depth ranges(0–20 cm and 20–40 cm).Laboratory analyses were performed on aggregate stability and soil organic carbon fractionation with regard to three aggregate sizes(<2 mm,2–5 mm,>5 mm)and three density fractions(free labile,occluded,and heavy fraction).The results showed that:1)SOC content in aggregates<2 mm(relative to total SOC)increases with shrub clearing and grazing strategy in acid environments;2)aggregate stability benefits from the implementation of afforestation in acid environments and from all three study strategies in alkaline ones;3)in acid environments,the percentage of labile fractions(free and occluded)in afforested sites is significantly higher compared with shrubland,while in alkaline environments,recalcitrant SOC is significantly higher in shrub clearing sites.Thus,land management should be focused on SOC storage after land abandonment in Mediterranean mountainous environments.
基金Supported by Guangdong Medical Research Foundation,No.B2023272.
文摘BACKGROUND Esophageal cancer(EC)is one of the most prevalent malignant gastrointestinal tumors;accurate prediction of EC staging has high significance before treatment.AIM To explore a rational radiomic approach for predicting preoperative staging of EC based on magnetic resonance imaging(MRI).METHODS This retrospective study included 210 patients with pathologically confirmed EC,randomly divided into a primary cohort(n=147)and a validation cohort(n=63)in a ratio of 7:3.All patients underwent a preoperative MRI scan from the neck to the abdomen.High-throughput and quantitative radiomics features were extracted from T2-weighted imaging(T2WI)and gadolinium contrast-enhanced T1-weighted imaging(T1WI)-Gd images.Radiomics signatures were selected using minimal redundancy maximal relevance and the least absolute shrinkage and selection operator.Then a logistic regression model was built to predict the EC stages.The diagnostic performance of the radiomics model for discriminating between stages Ⅰ-Ⅱ and Ⅲ-Ⅳ was evaluated using the area under the curve(AUC),sensitivity(SEN),and specificity(SPE).RESULTS A total of 214 radiomics features were extracted.Following feature dimension reduction,the T1WI and T2WI sequences were retained,and 14 features from the T1WI sequence and 3 features from the T2WI sequence were selected to construct radiomics signatures.The radiomics signature combining T2WI with T1WI-Gd demonstrated superior discrimination of stages in the validation cohort(AUC:0.851;SEN:0.697;SPE:0.793),which outperformed single-sequence models(AUC:0.779,0.844;SEN:0.667,0.636;SPE:0.8,0.8).CONCLUSION MRI-based radiomics signatures could identify EC stages before treatment,which could serve as a noninvasive and quantitative approach aiding personalized treatment planning.
基金Supported by Guangdong Medical Research Foundation,No.B2023272.
文摘BACKGROUND Predicting the pathological response of esophageal cancer(EC)to neoadjuvant therapy(NAT)is of significant clinical importance.AIM To evaluate the pathological response of NAT in EC patients using multiple machine learning algorithms based on magnetic resonance imaging(MRI)radiomics.METHODS This retrospective study included 132 patients with pathologically confirmed EC,were randomly divided into a training cohort(n=92)and a validation cohort(n=40)in a 7:3 ratio.All patients underwent a preoperative MRI scan from the neck to the abdomen.High-throughput and quantitative radiomics features were extracted from T2-weighted imaging(T2WI).Radiomics signatures were selected using minimal redundancy maximal relevance and the least absolute shrinkage and selection operator.Nine classification algorithms were used to build the models,and the diagnostic performance of each model was evaluated using the area under the curve(AUC),sensitivity(SEN),and specificity(SPE).RESULTS A total of 1834 features were extracted.Following feature dimension reduction,ten radiomics features were selected to construct radiomics signatures.Among the nine classification algorithms,the ExtraTrees algorithm demonstrated the best diagnostic performance in both the training(AUC:0.932;SEN:0.906;SPE:0.817)and validation cohorts(AUC:0.900;SEN:0.667;SPE:0.700).The Delong test proved no significance in the diagnostic efficiency within these models(P>0.05).CONCLUSION T2WI radiomics may aid in determining the pathological response to NAT in EC patients,serving as a noninvasive and quantitative tool to assist personalized treatment planning.
基金financially supported by the National Key Research and Development Program of China(Grant No.2022YFF1303201).
文摘Enhancing the spatio-temporal connectivity of dynamic landscapes is crucial for species to adapt to climate change.However,the spatio-temporal connectivity network approach considering climate change and species movement is often overlooked.Taking Tibetan wild ass on the Qinghai-Xizang Plateau as an example,we simulated species distribution under current(2019)and future scenarios(2100),constructed spatio-temporal connectivity networks,and assessed the spatio-temporal connectivity.The results show that under the current,SSP2–4.5 and SSP3–7.0 scenarios,suitable habitats for the Tibetan wild ass account for 21.11%,21.34%,and 20.95%of the total area,respectively,with increased fragmentation projected by 2100.78.35%of the habitats which are predicted to be suitable under current conditions will remain suitable in the future,which can be regarded as stable climate refuges.With the increase in future emission intensity,the percentage of auxiliary connectivity corridors increases from 27.65%to 33.57%.This indicates that more patches will function as temporary refuges and the auxiliary connectivity corridors will gradually weaken the dominance of direct connectivity corridors.Under different SSP-RCP scenarios,the internal spatio-temporal connectivity is always higher than direct connectivity and auxiliary connectivity,accounting for 42%–43%.Compared with the spatio-temporal perspective,the purely spatial perspective overestimates network connectivity by about 28%considering all current and future patches,and underestimates network connectivity by 16%–21%when only considering all current or future patches.In this study,a new approach of spatio-temporal connectivity network is proposed to bridge climate refuges,which contributes to the long-term effectiveness of conservation networks for species’adaptation to climate change.
基金Natural Science Foundation-funded Project:Regulation of Autophagy by Electroacupuncture at Weizhong Point on the Proliferation of Multifidus Muscle Satellite Cells (No.81574052) and Exosomes Arounding Acupoints Deliver miR-206 to Mediate Insulin-like Growth Factor 1/Phosphatidylinositol 3-Kinase/Protein Kinase B Pathway and Regulate Muscle Satellite Cell Differentiation:Mechanism of Electroacupuncture in Promoting Rehabilization of Lumbar Multifidus Muscles Injury in Model Rats (No.82174482)Major Program of Foundation of Inner Mongolia Autonomous Region:Study on the Eeffect of Pediatric Tuina Combined with Acupuncture on the Intestinal Microflora Structure in Children with Provisional Tic Disorder and its Therapeutic Mechanism (201802127)。
文摘OBJECTIVE:To investigate the anti-inflammatory effect of electroacupuncture in rats with bupivacaine-induced lumbar multifidus injury and its underlying regulatory mechanism on macrophage polarization.METHODS:A total of seventy-two Sprague-Dawley male rats were randomly divided into control,model,and electroacupuncture groups.Forty-eight rats categorized in model groups were injected 0.5% bupivacaine(BPVC) into the lumbar multifidus at the L4-L5 segment.Rats in the electroacupuncture groups received the intervention for 1,2,3 and 5 d,respectively.The degree of macrophage infiltration and change of M1/M2 polarization were observed based on hematoxylin and eosin staining,immunohistochemistry and immunofluorescence to evaluate the anti-inflammatory effect of electroacupuncture.Meanwhile,exosomal miRNAsequencing and bioinformatics analysis predicted the pathways and biological processes related to inflammatory response and macrophage polarization regulated by electroacupuncture intervention.RESULTS:BPVC injection induced the infiltration of local macrophages at the L4-L5 segment of lumbar multifidus.Comparison of mean IOD values with 2 d and 5 d post injury revealed the highest expression of CD68+ macrophages on day 3 post injury by immunohistochemistry.(P < 0.001,P < 0.001,respectively).Compared with the model group,the cell counts of iNOs+ CD68+ M1-macrophages were lower in the electroacupuncture group,while the positive percent of CD163+ CD206+ M2-macrophages was higher in the electroacupuncture group,on day 3 after BPVC injection(P < 0.001,P < 0.001,respectively).Moreover,the results of sequencing and bioinformatic analysis suggested that exosomal miRNAs were involved in the EA regulating macrophage polarization.CONCLUSIONS:Electroacupuncture can promote macrophage polarization to reduce inflammation following lumbar multifidus muscular injury.
基金This work was supported by Yunnan Provincial Department of Science and Technology Key R&D Plan(202303AM140018,202303AK140029,202303AK140028)Yunnan Flower Breeding Key Experiment Open Foundation(FKL-202203)+2 种基金Yunnan Provincial Department of Science and Technology Science and Technology Project Agriculture Joint Foundation(202301BD070001-208)Yunnan Provincial Expert Basic Research Workstation FoundationWe also acknowledge the financial support from the Researchers Supporting Project(RSPD2025R751),King Saud University,Riyadh,Saudi Arabia.
文摘Marigolds(Tagetes spp.)are popular horticultural plants worldwide.The current study aimed to investigate the optimal mutagenic conditions for marigold seeds using EMS(ethyl methanesulfonate)mutagenesis.Different con-centrations and treatment times of EMS were applied to investigate their effects on the marigold seed germination rate,growth traits,antioxidant enzyme activities(i.e.,SOD and POD),and malondialdehyde(MDA)contents.Results indicated that with increasing the EMS treatment duration and concentration,the seed germination rate and growth treatments were reduced,accompanied by elevated MDA content.In addition,SOD and POD activ-ities initially correlated positively with the growth tratis at the lowest concentrations and shortest durations of EMS,but such relationship diminished beyond certain thresholds.The comprehensive analysis identified the opti-mal mutagenic conditions as 1%EMS treatment for 12 h,achieving a semi-lethal dose and enhancing stress-resis-tant components in seedlings.Thesefindings are pivotal for advancing genetic enhancement and germplasm innovation in marigolds.
基金supported by the Science and Technology Planned Project from Xiamen Science and Technology Bureau,China,No.3502Z20154065(to LHZ)the Joint Project for Xiamen Key Diseases from Xiamen Science and Technology Bureau,China,No.3502Z20149032(to GG)
文摘The location of an acute ischemic stroke is associated with its prognosis. The widely used Gaussian model-based parameter, apparent diffusion coefficient(ADC), cannot reveal microstructural changes in different locations or the degree of infarction. This prospective observational study was reviewed and approved by the Institutional Review Board of Xiamen Second Hospital, China(approval No. 2014002).Diffusion kurtosis imaging(DKI) was used to detect 199 lesions in 156 patients with acute ischemic stroke(61 males and 95 females), mean age 63.15 ± 12.34 years. A total of 199 lesions were located in the periventricular white matter(n = 52), corpus callosum(n = 14), cerebellum(n = 29), basal ganglia and thalamus(n = 21), brainstem(n = 21) and gray-white matter junctions(n = 62). Percentage changes of apparent diffusion coefficient(ΔADC) and DKI-derived indices(fractional anisotropy [ΔFA], mean diffusivity [ΔMD], axial diffusivity [ΔD_a], radial diffusivity ΔDr, mean kurtosis [ΔMK], axial kurtosis [ΔK_a], and radial kurtosis [ΔK_r]) of each lesion were computed relative to the normal contralateral region. The results showed that(1) there was no significant difference in ΔADC, ΔMD, ΔD_a or ΔD_r among almost all locations.(2) There was significant difference in ΔMK among almost all locations(except basal ganglia and thalamus vs. brain stem; basal ganglia and thalamus vs. gray-white matter junctions; and brainstem vs. gray-white matter junctions.(3) The degree of change in diffusional kurtosis in descending order was as follows: corpus callosum > periventricular white matter > brainstem > gray-white matter junctions > basal ganglia and thalamus > cerebellum. In conclusion, DKI could reveal the differences in microstructure changes among various locations affected by acute ischemic stroke, and performed better than diffusivity among all groups.
基金supported by the Planned Project Grant(Grant No.3502Z20199064)from the Science and Technology Bureau of Xiamen(CN)the training project(Grant No.2020GGB067)of the youth and middle-aged talents of Fujian Provincial Health Commission(CN).
文摘This study explored the application value of iterative decomposition of water and fatwith echo asymmetry and least-squares estimation(IDEAL-IQ)technology in the early diagnosis of ageing osteoporosis(OP).172 participants were enrolled and underwentmagnetic resonance imaging(MRI)examinations on a 3.0T scanner.100 cases were included in the normal group(50 males and 50 females;mean age:45 years;age range:20e84 years).33 cases were included in the osteopenia group(17 males and 16 females;mean age:55 years;age range:43e83 years).39 caseswere includedintheOP group(19males and20females;meanage:58years;age range:48 e82 years).Conventional T1WI and T2WI were first obtained,followed by 3D-IDEAL-IQ-acqui-sition.Fat fraction(FF)and apparent transverse relaxation rate(R2*)resultswere automatically calculated from IDEAL-IQ-images on the console.Based on T1Wand T2W-images,300 ROIs for each participantweremanually delineated in L1-L5 vertebral bodies of five middle slices.In each age group of all normal subjects,each parameter was significantly correlated with gender.In male participants from the normal,osteopenia,and OP groups,statistical analysis revealed F values of 11319.292 and 180.130 for comparisons involving FF and R2*values,respectively(all p<0.0001).The sensitivity and specificity of FF values were 0.906 and 0.950,0.994 and 0.997,0.865 and 0.820,respectively.For R2*,they were 0.665 and 0.616,0.563 and 0.519,0.571 and 0.368,respectively.In female participants from the normal,osteopenia,and OP-groups,statis-tical analysis revealed F values of 12461.658 and 548.274 for comparisons involving FF and R2*values,respectively(all p<0.0001).The sensitivity and specificity of FF values were 0.985 and 0.991,0.996 and 0.996,0.581 and 0.678,respectively.For R2*,they were 0.698 and 0.730,0.603 and 0.665,0.622 and 0.525,respectively.Significant differences were indicated in the quanti-tative values among the three groups.FF value had good performance,while R2*value had poor performance indiscriminatingosteopenia andOP-groups.Overall,the IDEAL-IQ techniqueoffers specific reference indices that enable noninvasive and quantitative assessment of lumbar vertebrae bone metabolism,thereby providing diagnostic information for OP.
文摘Subterranean environments are buffered from external climatic fluctuations due to the absence of light and a delayed thermal response to surface conditions(Mammola 2019).Terrestrial salamanders are often found in subterranean habitats,but few studies have assessed the influence of climatic effects on their long-term spatial distribution and niche breadth.In this study,we investigated the variability over 29 consecutive years of the spatial niche in a terrestrial salamander population inhabiting an artificial subterranean habitat.We hypothesized that juvenile salamanders,which are typically active near cave entrances and more exposed to climatic variability and dehydration(Peterman et al.2013),would exhibit an earlier and more variable behavioral adaptation to increasing external temperatures compared to adults.
文摘Pelvic fractures are rare but severe injuries that severely affect patients’quality of life.Treatment of these fractures often involves invasive approaches with high risk of injuries to nervous structures,particularly lumbosacral plexus.The introduction of minimally invasive surgical approaches,such as the lateral rectus approach,not only contributes to preserving lumbar plexus integrity in operated patients but also positively impacts their psychological well-being.Patients treated by surgical reduction of pelvic fractures with lumbosacral plexus injury often experience states of anxiety and depression.The lateral rectus approach is associated with lower levels of anxiety and depression compared to more invasive surgical techniques used for similar fractures.
文摘BACKGROUND Congenital intrahepatic arterioportal fistula(IAPF) is a rare vascular malformation in infants that causes severe portal hypertension(PH) with poor prognosis if untreated. Currently, radiological embolisation is considered the first-line therapy for simple IAPF; however, it might be not resolutive for complex hepatic vascular lesions. When endovascular embolization is not sufficient to completely obliterate the IAPF, surgical intervention is needed, but it has been associated with severe morbidity and mortality in small children.Furthermore, indications are not defined.CASE SUMMARY We present the first case of a 6-month-old girl with trisomy 21 affected by a complex congenital IAFP, which caused severe PH, successfully treated with an endovascular-surgical hybrid procedure. The novel technique comprised a multistep endovascular embolisation, including a superselective transarterial embolisation of the afferent vessels and a direct transhepatic embolisation of the dilated portal vein segment, combined with selective surgical ligation of the arterial branches that supply the fistula, which were too small to be embolised.The complex IAPF was also associated with severe cholestasis and intra/extrahepatic biliary tree dilatation, which was successfully treated by a temporary biliary drainage. At 24-mo follow-up, the hybrid endovascularsurgical procedure achieved complete occlusion of the complex IAPF and resolution of the PH. A comprehensive review of the literature on congenital IAPF management, focussed on alternative treatment strategies, is also reported.CONCLUSION The combined radiological-surgical approach is a safe and effective treatment option for complex IAPF and avoids major invasive surgery.
文摘Helicobacter pylori(H.pylori),a widespread gram-negative bacterium that colonizes the stomach,causes chronic gastritis,which may progress to peptic ulcer,mucosa-associated lymphoid tissue lymphoma,and gastric cancer.H.pylori infection affects over 50%of people in developing countries and 10%-20%in developed countries.The Kyoto consensus classifies H.pylori gastritis as an infectious disease in the International Classification of Disease 11th Revision.The Maastricht/Florence consensus recommends treatment for all infected individuals,introducing a shift in the management strategies.The prevalence of H.pylori infection is high in the Middle East,with infection rates of 40%-70%and 85%-90%being reported among children and adults,respectively.The increasing resistance to antibiotics,including macrolides and fluoroquinolones,is a major challenge in the management of H.pylori.Clarithromycin resistance,which is associated with reduced effectiveness of standard triple therapy regimens,leading to higher rates of treatment failure,impacts the eradication rates.This emphasizes the need for routine antibiotic susceptibility testing at the national level,the use of alternative therapies,including new molecular methods,and antibiotic stewardship.An online panel of experts from the Middle East,along with an international expert,developed this consensus to provide comprehensive guidelines on the diagnosis,treatment,prevention,and role of gut microbiota in H.pylori infection,with the goal of improving clinical decision-making and reducing the impact of antibiotic resistance in the region.These guidelines are intended to support healthcare professionals involved in the diagnosis and management of H.pylori,including primary care physicians,gastroenterologists,and other specialists.They may also inform future clinical research aimed at optimizing treatment strategies and addressing regional challenges.
文摘BACKGROUND Benign recurrent intrahepatic cholestasis is a genetic disorder with recurrent cholestatic jaundice due to ATP8B1 and ABCB11 gene mutations encoding for hepato-canalicular transporters.Herein,we firstly provide the evidence that a nonsense variant of ATP8B1 gene(c.1558A>T)in heterozygous form is involved in BRIC pathogenesis.CASE SUMMARY A 29-year-old male showed severe jaundice and laboratory tests consistent with intrahepatic cholestasis despite normal gamma-glutamyltranspeptidase.Acute and chronic liver diseases with viral,metabolic and autoimmune etiology were excluded.Normal intra/extra-hepatic bile ducts were demonstrated by magnetic resonance.Liver biopsy showed:Cholestasis in the centrilobular and intermediate zones with bile plugs and intra-hepatocyte pigment,Kupffer’s cell activation/hyperplasia and preserved biliary ducts.Being satisfied benign recurrent intrahepatic cholestasis diagnostic criteria,ATP8B1 and ABCB11 gene analysis was performed.Surprisingly,we found a novel nonsense variant of ATP8B1 gene(c.1558A>T)in heterozygosis.The variant was confirmed by Sanger sequencing following a standard protocol and tested for familial segregation,showing a maternal inheritance.Immunohistochemistry confirmed a significant reduction of mutated gene related protein(familial intrahepatic cholestasis 1).The patient was treated with ursodeoxycholic acid 15 mg/kg per day and colestyramine 8 g daily with total bilirubin decrease and normalization at the 6th and 12th mo.CONCLUSION A genetic abnormality,different from those already known,could be involved in familial intrahepatic cholestatic disorders and/or pro-cholestatic genetic predisposition,thus encouraging further mutation detection in this field.
基金supported by the China Geological Survey Projects of Shale Gas Survey in the GuizhongNanpanjiang Area (DD20190088)Investigation and evaluation of Paleozoic shale gas in Yunnan-Guizhou-Guangxi region (DD20230264)+1 种基金Investigation and Evaluation of Carboniferous Shale Gas in Southern Guizhou-Central Guangxi (ZDDYR2023018)Reservoir Characteristics and Gas Accumulation of Trough-platform Shale: A Case Study of Early Carboniferous Shale in Yaziluo Rift Trough (YKC2023-YC08)。
文摘The Yadu-Ziyun-Luodian aulacogen(YZLA) developed into being NW-trending in the Late Paleozoic,and was considered as an important passive continental margin aulacogen in Guizhou Province, South China. This tectonic zone is considered a large intracontinental thrust-slip tectonic unit, which has undergone a long period of development. It was ultimately determined in the Yanshanian, where the typical Upper Paleozoic marine shales were deposited. In 2021, Well QSD-1 was deployed in the Liupanshui area at the northwest margin of the aulacogen, and obtained a daily shale gas flow of 11011 m3in the Carboniferous Dawuba Formation. It thus achieved a breakthrough in the invesgation of shale gas in the Lower Carboniferous in South China, revealing relatively good gas-bearing properties and broad exploration prospects of the aulacogen. Being different from the Lower Paleozoic strata in the Sichuan Basin and the Yichang area of the Middle Yangtze, the development of the Carboniferous Dawuba Formation in the aulacogen exhibits the following characteristics:(1) The Lower Carboniferous shale is thick and widely distributed, with interbedded shale and marlstone of virous thickness;(2) The total organic carbon(TOC) content of the shale in the Dawuba Formation ranges from 1% to 5%, with an average of 2%, and the thermal maturity of organic matter(Ro) varies from 1% to 4%, with an average of2.5%, indicating good hydrocarbon generation capacity;(3) The main shale in the aulacogen was formed during the fault subsidence stage from the Middle Devonian to the Early Permian. Although the strong compression and deformation during the late Indosinian-Himalayan played a certain role in destroying the formed shale gas reservoirs, comparative analysis suggests that the area covered by the current Triassic strata has a low degree of destruction. It therefore provides good conditions for shale gas preservation,which can be regarded as a favorable area for the next exploration.
基金funded under the auspices of the National Key R&D Program of China(No.2017YFC0212303)the Key Research Program of Frontier Sciences,Chinese Academy of Sciences(No.QYZDB-SSW-DQC045)+3 种基金the National Natural Science Foundation of China(No.41775116)the Youth Innovation Promotion Association of Chinese Academy of Sciences(No.2017275)Northeast Institute of Geography and Agroecology,CAS(No.IGA-135-05)Science and Technology Development Project in Jilin Province(No.20180520095JH)。
文摘Using a bottom-up estimation method,a comprehensive,high-resolution emission inventory of gaseous and particulate atmospheric pollutants for multiple anthropogenic sectors with typical local sources has been developed for the Harbin-Changchun city agglomeration(HCA).The annual emissions for CO,NO_(x),SO_(2),NH_(3),VOC S,PM_(2.5),PM 10,BC and OC during 2017 in the HCA were estimated to be 5.82 Tg,0.70 Tg,0.34 Tg,0.75 Tg,0.81 Tg,0.67 Tg,1.59 Tg,0.12 Tg and 0.26 Tg,respectively.For PM 10 and SO_(2),the emissions from industry processes were the dominant contributors representing 54.7%and 49.5%,respectively,of the total emissions,while 95.3%and 44.5%of the total NH_(3)and NO x emissions,respectively,were from or associated with agricultural activities and transportation.Spatiotemporal distributions showed that most emissions(except NH_(3))occurred in November to March and were concentrated in the central cities of Changchun and Harbin and the surrounding cities.Open burning of straw made an important contribution to PM_(2.5)in the central regions of the northeastern plain during autumn and spring,while domestic coal combustion for heating purposes was significant with respect to SO_(2)and PM_(2.5)emissions during autumn and winter.Furthermore,based on Principal Component Analysis and Multivariable Linear Regression model,air temperature,relative humidity,electricity and energy consumption,and the urban and rural population were optimized to be representative indicators for rapidly assessing the magnitude of regional atmospheric pollutants in the HCA.Such indicators and equations were demonstrated to be useful for local atmospheric environment management.
