The Doppler backscattering(DBS)diagnostic is widely used to measure the localized density fluctuations and the propagation velocity of turbulent structures.Microwave is launched at a frequency that approaches a cutoff...The Doppler backscattering(DBS)diagnostic is widely used to measure the localized density fluctuations and the propagation velocity of turbulent structures.Microwave is launched at a frequency that approaches a cutoff layer in the plasma at an angle oblique to the cutoff layer.A new Q-band multichannel DBS system based on a comb generator has been designed and tested for application on the HL-3 tokamak.With the comb generator and heterodyne scheme,the stability and flexibility of the new DBS system are improved.The new DBS diagnostic has a high output power(~10 dBm),good power flatness(<5 dB in Q-band),and frequency stability,and the inter-frequency separation is tunable remotely.This article introduces the system design,laboratory test results,and initial experimental results from the HL-3 tokamak.With the help of the newly developed multichannel DBS,the turbulence information can be studied with high temporal and spatial resolution.展开更多
In this article,we discuss the recently published article by Soni et al.This study explores the effectiveness of a comprehensive digital health program,RESET care,which integrates personalized dietary plans,structured...In this article,we discuss the recently published article by Soni et al.This study explores the effectiveness of a comprehensive digital health program,RESET care,which integrates personalized dietary plans,structured exercise,and cognitive behavioral therapy delivered through a mobile app equipped with Internet of Things devices such as body composition analyzers and smartwatches.Metabolic dysfunction-associated liver disease(MASLD),a global health burden affecting approximately 25%of the population,demands sustainable lifestyle modifications as its primary management strategy.The study reports that 100%of participants in the comprehensive intervention group(diet+exercise+cognitive behavioral therapy)achieved a weight reduction≥7%(6.99±2.98 kg,7.00%±3.39%;P=0.002),a clinically significant threshold for MASLD improvement.In addition,participants showed a mean weight reduction of 6.99 kg(101.10±17.85 vs 94.11±17.38,P<0.001)and a body mass index reduction of 2.18 kg/m²(32.90±3.02 vs 30.72±3.41,P<0.001).These results underscore the potential of digital health platforms to provide scalable,evidence-based solutions for the treatment of MASLD.While these results highlight the potential of digital platforms in the scalable and personalized management of MASLD,the small study sample size and short duration of follow-up limit the generalizability of the results.Future large-scale,long-term trials are needed to confirm sustained benefits,cost-effectiveness,and broader applicability.This letter contextualizes the study within the evolving landscape of MASLD management and emphasizes the clinical implications of integrating digital technologies into standard care.展开更多
BACKGROUND Heart transplantation is the last and best option for end-stage heart failure management.Early mortality rates have significantly decreased,enabling patients to survive longer with fewer complications,a tre...BACKGROUND Heart transplantation is the last and best option for end-stage heart failure management.Early mortality rates have significantly decreased,enabling patients to survive longer with fewer complications,a trend observed even in our setting.The primary shared challenge has centered on achieving surgical success and immediate survival.The question arises about the medium-and long-term survival of patients with heart transplant in Mexico.AIM To present the results of the medium and long-term follow-up of heart transplant patients.METHODS This was a retrospective study of a single medical unit,and we selected patients who received heart transplants from July 21,1988 to September 30,2023.Selection criteria encompassed age,sex,and primary indication for heart transplantation across all groups.Patients with incomplete information or who died within 30 postoperative days were excluded.Data of primary pathology,ischemic,extracorporeal circulation,aortic cross-clamping times,length of ventilatory support,stay in postoperative therapy,hospitalization,and functional class were analyzed.RESULTS The causes of morbidity,mortality,and percentage of survival at 1,5,and 10 years were examined.Overall,257 heart transplants were performed during the study period.Of the total cases,22 with incomplete data and 47 who died within 30 postoperative days were excluded for the middle-and long-term survival analyses.Of the remaining 188 patients,heart transplantation was performed(males:146,females:42).The average age of the participants was 44.43±14.48 years.The primary indications included ischemic cardiomyopathy(42.55%)and dilated cardiomyopathy(39.36%).The mean durations of mechanical ventilator support,intensive care stay,and hospital stay were 57.55±103.50 hours,9.96±8.59 days,and 19.49±18.23 days,respectively.One-,five-,and ten-year survival rates were 90.7%,71.3%,and 60.3%,respectively.Of the patients,94%and 6%were in functional classes I and II,respectively.Infection and neurological hemorrhagic or ischemic stroke(26%)were the main causes of mortality in the first year.Subsequently,chronic rejection manifesting as graft vasculopathy increased in frequency(30%).CONCLUSION In our setting,heart transplantation yields medium-and long-term survival and quality of life outcomes comparable to those achieved by other international centers.展开更多
BACKGROUND MicroRNAs play a key role in regulating gene expression in human cells.Singlenucleotide variants in these molecules have been linked to cancer development,particularly breast cancer(BrC).AIM To analyze the ...BACKGROUND MicroRNAs play a key role in regulating gene expression in human cells.Singlenucleotide variants in these molecules have been linked to cancer development,particularly breast cancer(BrC).AIM To analyze the association of three microRNA polymorphisms with the risk of BrC in women from western Mexico.METHODS This case-control study included 71 women diagnosed with BrC and 215 women without BrC.Genotypes were determined using a real-time polymerase chain reaction allelic discrimination assay.Multiple genetic models-dominant,recessive,over-dominant,additive,and multiple comparison-were applied to assess the risk.RESULTS The over-dominant model showed that the C/T genotype of MIR196A2(rs11614913)is a protective factor against the ductal histological subtype of BrC in women from western Mexico[odds ratio(OR)=0.4687,95%confidence interval(CI):0.2205-0.9963,P=0.0489].A protective effect was also observed for the C/A genotype(OR=0.2612,95%CI:0.0900-0.7582,P=0.0135)and A allele(OR=0.2826,95%CI:0.0993-0.8044,P=0.0179)of MIR618(rs2682818).No significant association was found between MIR200C(rs73262897)and BrC risk.CONCLUSION The C/T genotype of rs11614913 in MIR196A2,and C/A genotype and A allele of rs2682818 in MIR618,are associated with a protective effect against BrC in women from western Mexico.展开更多
A program developed with COMSOL software integrates EAST four-strap antenna coupling with the double-stub Ferrite tuners(FT)impedance matching,obtaining physical quantities crucial for predicting the overall performan...A program developed with COMSOL software integrates EAST four-strap antenna coupling with the double-stub Ferrite tuners(FT)impedance matching,obtaining physical quantities crucial for predicting the overall performance of the ion cyclotron resonance heating(ICRH)antenna and matching system.These quantities encompass S-matrix,port complex impedance,reflection coefficients,electric field and voltage distribution,and optimal matching settings.In this study,we explore the relationship between S-matrix,reflection coefficients,port complex impedance,and frequency.Then,we analyze the impact of Faraday screens placement position and transparency,the distance from the Faraday screen(FS)to the current straps(CS),the relative distance between ports,and the characteristic impedance of the transmission line on the coupling characteristic impedance of the EAST ICRH system.Finally,we simulate the electric field distribution and voltage distribution of the EAST ICRH system for plasma heating with double-stub FT impedance matching.Using optimized parameters,the coupling power of the ICRH system can be approximately doubled.The results present herein may offer guidance for the design of high-power,long-pulse operation ICRH antenna systems.展开更多
Charge-exchange(CX) recombination spectroscopy is a powerful tool monitoring ion temperature and plasma rotation with good temporal and spatial resolutions. A compact, new design for a high-throughput, tri-band high s...Charge-exchange(CX) recombination spectroscopy is a powerful tool monitoring ion temperature and plasma rotation with good temporal and spatial resolutions. A compact, new design for a high-throughput, tri-band high spectral resolution spectrometer has been developed for the charge-exchange recombination spectroscopy measurement on the HL-2A tokamak. The simultaneous measurements of He II(468.57 nm), C VI(529.1 nm), and Dα(656.1 nm accompanied by beam emission spectra) with an acquisition frequency up to 400 Hz are achieved by vertically binning the spectrum from each fiber in experiments. Initial results indicate that the system can provide radial profiles of not only ion temperature and rotation velocity,but also concentration of carbon. For the case of helium, the measurements for the ion temperature and rotation velocity are straightforward but the apparent concentration associated with the observed CX intensity is obviously too high. Modeling of the active He II CX feature including plume contributions needs to be carried out to extract the true helium concentration.The spectrometer could become a prototype for the ITER charge-exchange recombination spectroscopy diagnostic and the pilot experiments, as presented here, demonstrate the possibility of impurity concentrations measurements based on the combined measurement of local beam emission and charge-exchange recombination spectroscopy spectra.展开更多
Background: Pancreaticoduodenectomy is the standard treatment for resectable periampullary cancer. Surgical site infections(SSI) are common complications with increased morbidity. The study aimed to describe the preva...Background: Pancreaticoduodenectomy is the standard treatment for resectable periampullary cancer. Surgical site infections(SSI) are common complications with increased morbidity. The study aimed to describe the prevalence, risk factors, microbiology, and outcomes of SSI among patients undergoing pancreaticoduodenectomy. Methods: We conducted a retrospective study in a referral cancer center between January 2015 and June 2021. We analyzed baseline patient characteristics and SSI occurrence. Culture results and susceptibility patterns were described. Multivariate logistic regression was used to determine risk factors, proportional hazards model to evaluate mortality, and Kaplan-Meier analysis to assess long-term survival. Results: A total of 219 patients were enrolled in the study;101(46%) developed SSI. Independent factors for SSI were diabetes mellitus, preoperative albumin level, biliary drainage, biliary prostheses, and clinically relevant postoperative pancreatic fistula. The main pathogens were Enterobacteria and Enterococci. Multidrug-resistance rate in SSI was high but not associated with increased mortality. Infected patients had higher odds of sepsis, longer hospital stay and intensive care unit stay, and readmission rate. Neither 30-day mortality nor long-term survival was significantly different between infected and non-infected patients. Conclusions: SSI prevalence among patients undergoing pancreaticoduodenectomy was high and largely caused by resistant microorganisms. Most risk factors were related to preoperative instrumentation of the biliary tree. SSI was associated with greater risk of unfavorable outcomes;however, survival was unaffected.展开更多
The dynamics of long-wavelength(kθ<1.4 cm^(-1)),broadband(20 kHz–200 kHz)electron temperature fluctuations(Te/Te)of plasmas in gas-puff experiments are observed for the first time in HL-2A tokamak.In a relatively...The dynamics of long-wavelength(kθ<1.4 cm^(-1)),broadband(20 kHz–200 kHz)electron temperature fluctuations(Te/Te)of plasmas in gas-puff experiments are observed for the first time in HL-2A tokamak.In a relatively low density(ne(0)■0.91×10^(19)m^(-3)–1.20×10^(19)m^(-3))scenario,after gas-puffing the core temperature increases and the edge temperature drops.On the contrary,temperature fluctuation drops at the core and increases at the edge.Analyses show the non-local emergence is accompanied with a long radial coherent length of turbulent fluctuations.While in a higher density(ne(0)?1.83×10^(19)m^(-3)–2.02×10^(19)m^(-3))scenario,the phenomena are not observed.Furthermore,compelling evidence indicates that E×B shear serves as a substantial contributor to this extensive radial interaction.This finding offers a direct explanatory link to the intriguing core-heating phenomenon witnessed within the realm of non-local transport.展开更多
Based on the EAST equilibrium,the effects of boron(B)and neon(Ne)injected at different locations on the target heat load,and the distributions of B and Ne particles were investigated by transport code SOLPS-ITER.It wa...Based on the EAST equilibrium,the effects of boron(B)and neon(Ne)injected at different locations on the target heat load,and the distributions of B and Ne particles were investigated by transport code SOLPS-ITER.It was found that the B injection was more sensitive to the injection location for heat flux control than impurity Ne.The high electron and ion densities near the inner target in the discharge with impurity B injected from over X-point(R_(1))led to plasma detachment only at the inner target,and the localized B ions in the cases with injection from outer target location(R_(2))and upstream location(R_(3))led to far-SOL detachment at the outer target,but not at the inner target.In contrast,for Ne,the spatial distributions of Ne ions and electrons were found to be similar in all the cases at the three injection locations,and the detached plasma was achieved at the inner target and the electron temperature was reduced at the outer target.For locations R_(2) and R_(3),impurity B showed a more pronounced effect on the heat flux at the far-SOL of the outer target.Further analysis indicated that Ne atoms came mainly from the recycling sources,whereas B atoms came mainly from injection,and that their distinct atomic distributions resulted from the difference in the ionization threshold and ionization mean free path.In addition,the radiation proportion of B in the divertor region was larger than that of Ne when the total radiation power was similar,which suggests that B has less influence on the core region.展开更多
BACKGROUND Preterm birth is the leading cause of mortality in newborns,with very-low-birthweight infants usually experiencing several complications.Breast milk is considered the gold standard of nutrition,especially f...BACKGROUND Preterm birth is the leading cause of mortality in newborns,with very-low-birthweight infants usually experiencing several complications.Breast milk is considered the gold standard of nutrition,especially for preterm infants with delayed gut colonization,because it contains beneficial microorganisms,such as Lactobacilli and Bifidobacteria.AIM To analyze the gut microbiota of breastfed preterm infants with a birth weight of 1500 g or less.METHODS An observational study was performed on preterm infants with up to 36.6 wk of gestation and a birth weight of 1500 g or less,born at the University Hospital Dr.JoséEleuterio González at Monterrey,Mexico.A total of 40 preterm neonates were classified into breast milk feeding(BM)and mixed feeding(MF)groups(21 in the BM group and 19 in the MF group),from October 2017 to June 2019.Fecal samples were collected before they were introduced to any feeding type.After full enteral feeding was achieved,the composition of the gut microbiota was analyzed using 16S rRNA gene sequencing.Numerical variables were compared using Student’s t-test or using the Mann–Whitney U test for nonparametric variables.Dominance,evenness,equitability,Margalef’s index,Fisher’s alpha,Chao-1 index,and Shannon’s diversity index were also calculated.RESULTS No significant differences were observed at the genus level between the groups.Class comparison indicated higher counts of Alphaproteobacteria and Betaproteobacteria in the initial compared to the final sample of the BM group(P<0.011).In addition,higher counts of Gammaproteobacteria were detected in the final than in the initial sample(P=0.040).According to the Margalef index,Fisher’s alpha,and Chao-1 index,a decrease in species richness from the initial to the final sample,regardless of the feeding type,was observed(P<0.050).The four predominant phyla were Bacteroidetes,Actinobacteria,Firmicutes,and Proteobacteria,with Proteobacteria being the most abundant.However,no significant differences were observed between the initial and final samples at the phylum level.CONCLUSION Breastfeeding is associated with a decrease in Alphaproteobacteria and Betaproteobacteria and an increase of Gammaproteobacteria,contributing to the literature of the gut microbiota structure of very low-birth-weight,preterm.展开更多
Background:Traumatic facial nerve injury is the second leading cause of facial paralysis,presenting significant challenges such as difficulties with eating,speaking,impaired vision,and loss of facial expression.Unders...Background:Traumatic facial nerve injury is the second leading cause of facial paralysis,presenting significant challenges such as difficulties with eating,speaking,impaired vision,and loss of facial expression.Understanding these injuries is critical for plastic surgeons to optimize recovery and functional outcomes.This study examined our experience with acute traumatic extratemporal facial nerve injuries,focusing on their characteristics,the frequency of affected nerve branches,and identification using Seckel’s facial danger zones as anatomical landmarks.We also explored the implications of surgical management based on the current literature and our experience.Methods:We reviewed 50 patients with acute traumatic extratemporal facial nerve injuries treated at Hospital General Dr.Manuel Gea Gonzalez in Mexico City from January 2019 to January 2024.The collected data included demographics(age,sex,severity,and time to medical attention),injury mechanism,affected nerve branches using Seckel’s zones,and treatment methods.Results:The majority of the patients were male(82%),with an average age of 2916 years.Sharp trauma from assault was the most common cause(66%).The buccal and frontal branches were most frequently affected,with Seckel zones Ⅳ and Ⅱ involved in 46.86%and 33.33%of cases,respectively.Primary neurorrhaphy was performed in 96%of the patients.Conclusion:The effective management of traumatic facial nerve injuries relies on understanding the characteristics of the injury and using anatomical landmarks for prompt localization.Primary neurorrhaphy is the preferred surgical approach,with nerve grafting being an alternative.Ideally,early intervention within 72 h is crucial for optimal nerve recovery.展开更多
BACKGROUND The impact of social determinants of health in allogeneic transplant recipients in low-and middle-income countries is poorly described.This observational study analyzes the impact of place of residence,refe...BACKGROUND The impact of social determinants of health in allogeneic transplant recipients in low-and middle-income countries is poorly described.This observational study analyzes the impact of place of residence,referring institution,and transplant cost coverage(out-of-pocket vs government-funded vs private insurance)on outcomes after allogeneic hematopoietic stem cell transplantation(alloHSCT)in two of Mexico's largest public and private institutions.AIM To evaluate the impact of social determinants of health and their relationship with outcomes among allogeneic transplant recipients in Mexico.METHODS In this retrospective cohort study,we included adolescents and adults≥16 years who received a matched sibling or haploidentical transplant from 2015-2022.Participants were selected without regard to their diagnosis and were sourced from both a private clinic and a public University Hospital in Mexico.Three payment groups were compared:Out-of-pocket(OOP),private insurance,and a federal Universal healthcare program“Seguro Popular”.Outcomes were compared between referred and institution-diagnosed patients,and between residents of Nuevo Leon and out-of-state.Primary outcomes included overall survival(OS),categorized by residence,referral,and payment source.Secondary outcomes encompassed early mortality,event-free-survival,graft-versus-host-relapse-free survival,and non-relapse-mortality(NRM).Statistical analyses employed appropriate tests,Kaplan-Meier method,and Cox proportional hazard regression modeling.Statistical software included SPSS and R with tidycmprsk library.RESULTS Our primary outcome was overall survival.We included 287 patients,n=164 who lived out of state(57.1%),and n=129 referred from another institution(44.9%).The most frequent payment source was OOP(n=139,48.4%),followed by private insurance(n=75,26.1%)and universal coverage(n=73,25.4%).No differences in OS,event-free-survival,NRM,or graft-versus-host-relapse-free survival were observed for patients diagnosed locally vs in another institution,nor patients who lived in-state vs out-of-state.Patients who covered transplant costs through private insurance had the best outcomes with improved OS(median not reached)and 2-year cumulative incidence of NRM of 14%than patients who covered costs OOP(Median OS and 2-year NRM of 32%)or through a universal healthcare program active during the study period(OS and 2-year NRM of 19%)(P=0.024 and P=0.002,respectively).In a multivariate analysis,payment source and disease risk index were the only factors associated with overall survival.CONCLUSION In this Latin-American multicenter study,the site of residence or referral for alloHSCT did not impact outcomes.However,access to healthcare coverage for alloHSCT was associated with improved OS and reduced NRM.展开更多
Diabetes mellitus(DM) that occurs because of chronic liver disease(CLD) is known as hepatogenous diabetes(HD). Although the association of diabetes and liver cirrhosis was described forty years ago, it was scarcely st...Diabetes mellitus(DM) that occurs because of chronic liver disease(CLD) is known as hepatogenous diabetes(HD). Although the association of diabetes and liver cirrhosis was described forty years ago, it was scarcely studied for long time. Patients suffering from this condition have low frequency of risk factors of type 2 DM. Its incidence is higher in CLD of viral, alcoholic and cryptogenic etiology. Its pathophysiology relates to liver damage, pancreatic dysfunction, interactions between hepatitis C virus(HCV) and glucose metabolism mechanisms and genetic susceptibility. It associates with increased rate of liver complications and hepatocellular carcinoma, and decreased 5-year survival rate. It reduces sustained virological response in HCV infected patients. In spite of these evidences, the American Diabetes Association does not recognize HD. In addition, the impact of glucose control on clinical outcomes of patients has not been evaluated. Treatment of diabetes may be difficult due to liver insufficiency and hepatotoxicity of antidiabetic drugs. Notwithstanding, no therapeutic guidelines have been implemented up to date. In this editorial, authors discuss the reasons why they think that HD may be a neglected pathological condition and call attention to the necessity for more clinical research on different fields of this disease.展开更多
Steroids are drugs that have been used extensively in a variety of conditions. Although widely prescribed for their anti-inflammatory and immunosuppressive properties, glucocorticoids have several side effects, being ...Steroids are drugs that have been used extensively in a variety of conditions. Although widely prescribed for their anti-inflammatory and immunosuppressive properties, glucocorticoids have several side effects, being hyperglycemia one of the most common and representative. In the present review, we discuss the main epidemiologic characteristics associated with steroid use, with emphasis on the identification of high risk populations. Additionally we present the pathophysiology of corticosteroid induced hyperglycemia as well as the pharmacokinetics and pharmacodynamics associated with steroid use. We propose a treatment strategy based on previous reports and the understanding of the mechanism of action of both, the different types of glucocorticoids and the treatment options, in both the ambulatory and the hospital setting. Finally, we present some of the recent scientific advances as well as some options for future use of glucocorticoids.展开更多
Gastrointestinal angiodysplasias (GIADs), also called angioectasias, are the most frequent vascular lesions. Its precise prevalence is unknown since most of them are asymptomatic. However, the incidence may be increas...Gastrointestinal angiodysplasias (GIADs), also called angioectasias, are the most frequent vascular lesions. Its precise prevalence is unknown since most of them are asymptomatic. However, the incidence may be increasing since GIADs affect individuals aged more than 60 years and population life expectancy is globally increasing worldwide. They are responsible of about 5% to 10% of all gastrointestinal bleeding (GIB) cases. Most GIADs are placed in small bowel, where are the cause of 50 to 60% of obscure GIB diagnosed with video capsule endoscopy. They may be the cause of fatal severe bleeding episodes;nevertheless, recurrent overt or occult bleeding episodes requiring repeated expensive treatments and disturbing patient’s quality-of-life are more frequently observed. Diagnosis and treatment of GIADs (particularly those placed in small bowel) are a great challenge due to insidious disease behavior, inaccessibility to affected sites and limitations of available diagnostic procedures. Hemorrhagic causality out of the actively bleeding lesions detected by diagnostic procedures may be difficult to establish. No treatment guidelines are currently available, so there is a high variability in the management of these patients. In this review, the epidemiology and pathophysiology of GIADs and the status in the diagnosis and treatment, with special emphasis on small bowel angiodysplasias based on multiple publications, are critically discussed. In addition, a classification of GIADs based on their endoscopic characteristics is proposed. Finally, some aspects that need to be clarified in future research studies are highlighted.展开更多
Migraine is a recurrent and commonly disabling primary headache disorder that affects over 17% of women and 5%-8% of men. Migraine susceptibility is multifactorial with genetic, hormonal and environmental factors all ...Migraine is a recurrent and commonly disabling primary headache disorder that affects over 17% of women and 5%-8% of men. Migraine susceptibility is multifactorial with genetic, hormonal and environmental factors all playing an important role. The physiopathology of migraine is complex and still not fully understood. Many different neuropeptides, neurotransmitters and brain pathways have been implicated. In connection with the myriad mechanisms and pathways implicated in migraine, a variety of multisystemic comorbidities(e.g., cardiovascular, psychiatric and other neurological conditions) have been found to be closely associated with migraine. Recent reports demonstrate an increased frequency of gastrointestinal(GI) disorders in patients with migraine compared with the general population. Helicobacter pylori infection, irritable bowel syndrome, gastroparesis, hepatobiliary disorders, celiac disease and alterations in the microbiota have been linked to the occurrence of migraine. Several mechanisms involving the gut-brain axis, such as a chronic inflammatory response with inflammatory and vasoactive mediators passing to the circulatory system, intestinal microbiota modulation of the enteric immunological milieu and dysfunction of the autonomic and enteric nervous system, have been postulated to explain these associations. However, the precise mechanisms and pathways related to the gut-brain axis in migraine need to be fully elucidated. In this review, we survey the available literature linking migraine with GI disorders. We discuss the possible physiopathological mechanisms, and clinical implications as well as several future areas of interest for research.展开更多
基金supported by National Natural Science Foundation of China(Nos.12105087,12275096,and 11922503)the Joint Funds of the National Natural Science Foundation of China(No.U21A20440)the Science and Technology Planning Project of Sichuan Province(No.2023YFG0139)。
文摘The Doppler backscattering(DBS)diagnostic is widely used to measure the localized density fluctuations and the propagation velocity of turbulent structures.Microwave is launched at a frequency that approaches a cutoff layer in the plasma at an angle oblique to the cutoff layer.A new Q-band multichannel DBS system based on a comb generator has been designed and tested for application on the HL-3 tokamak.With the comb generator and heterodyne scheme,the stability and flexibility of the new DBS system are improved.The new DBS diagnostic has a high output power(~10 dBm),good power flatness(<5 dB in Q-band),and frequency stability,and the inter-frequency separation is tunable remotely.This article introduces the system design,laboratory test results,and initial experimental results from the HL-3 tokamak.With the help of the newly developed multichannel DBS,the turbulence information can be studied with high temporal and spatial resolution.
文摘In this article,we discuss the recently published article by Soni et al.This study explores the effectiveness of a comprehensive digital health program,RESET care,which integrates personalized dietary plans,structured exercise,and cognitive behavioral therapy delivered through a mobile app equipped with Internet of Things devices such as body composition analyzers and smartwatches.Metabolic dysfunction-associated liver disease(MASLD),a global health burden affecting approximately 25%of the population,demands sustainable lifestyle modifications as its primary management strategy.The study reports that 100%of participants in the comprehensive intervention group(diet+exercise+cognitive behavioral therapy)achieved a weight reduction≥7%(6.99±2.98 kg,7.00%±3.39%;P=0.002),a clinically significant threshold for MASLD improvement.In addition,participants showed a mean weight reduction of 6.99 kg(101.10±17.85 vs 94.11±17.38,P<0.001)and a body mass index reduction of 2.18 kg/m²(32.90±3.02 vs 30.72±3.41,P<0.001).These results underscore the potential of digital health platforms to provide scalable,evidence-based solutions for the treatment of MASLD.While these results highlight the potential of digital platforms in the scalable and personalized management of MASLD,the small study sample size and short duration of follow-up limit the generalizability of the results.Future large-scale,long-term trials are needed to confirm sustained benefits,cost-effectiveness,and broader applicability.This letter contextualizes the study within the evolving landscape of MASLD management and emphasizes the clinical implications of integrating digital technologies into standard care.
文摘BACKGROUND Heart transplantation is the last and best option for end-stage heart failure management.Early mortality rates have significantly decreased,enabling patients to survive longer with fewer complications,a trend observed even in our setting.The primary shared challenge has centered on achieving surgical success and immediate survival.The question arises about the medium-and long-term survival of patients with heart transplant in Mexico.AIM To present the results of the medium and long-term follow-up of heart transplant patients.METHODS This was a retrospective study of a single medical unit,and we selected patients who received heart transplants from July 21,1988 to September 30,2023.Selection criteria encompassed age,sex,and primary indication for heart transplantation across all groups.Patients with incomplete information or who died within 30 postoperative days were excluded.Data of primary pathology,ischemic,extracorporeal circulation,aortic cross-clamping times,length of ventilatory support,stay in postoperative therapy,hospitalization,and functional class were analyzed.RESULTS The causes of morbidity,mortality,and percentage of survival at 1,5,and 10 years were examined.Overall,257 heart transplants were performed during the study period.Of the total cases,22 with incomplete data and 47 who died within 30 postoperative days were excluded for the middle-and long-term survival analyses.Of the remaining 188 patients,heart transplantation was performed(males:146,females:42).The average age of the participants was 44.43±14.48 years.The primary indications included ischemic cardiomyopathy(42.55%)and dilated cardiomyopathy(39.36%).The mean durations of mechanical ventilator support,intensive care stay,and hospital stay were 57.55±103.50 hours,9.96±8.59 days,and 19.49±18.23 days,respectively.One-,five-,and ten-year survival rates were 90.7%,71.3%,and 60.3%,respectively.Of the patients,94%and 6%were in functional classes I and II,respectively.Infection and neurological hemorrhagic or ischemic stroke(26%)were the main causes of mortality in the first year.Subsequently,chronic rejection manifesting as graft vasculopathy increased in frequency(30%).CONCLUSION In our setting,heart transplantation yields medium-and long-term survival and quality of life outcomes comparable to those achieved by other international centers.
基金Supported by Patronage of the Autonomous University of Nayarit,Quality Postgraduate Program with resources from the 15%Special Tax allocated to the UAN 2022.
文摘BACKGROUND MicroRNAs play a key role in regulating gene expression in human cells.Singlenucleotide variants in these molecules have been linked to cancer development,particularly breast cancer(BrC).AIM To analyze the association of three microRNA polymorphisms with the risk of BrC in women from western Mexico.METHODS This case-control study included 71 women diagnosed with BrC and 215 women without BrC.Genotypes were determined using a real-time polymerase chain reaction allelic discrimination assay.Multiple genetic models-dominant,recessive,over-dominant,additive,and multiple comparison-were applied to assess the risk.RESULTS The over-dominant model showed that the C/T genotype of MIR196A2(rs11614913)is a protective factor against the ductal histological subtype of BrC in women from western Mexico[odds ratio(OR)=0.4687,95%confidence interval(CI):0.2205-0.9963,P=0.0489].A protective effect was also observed for the C/A genotype(OR=0.2612,95%CI:0.0900-0.7582,P=0.0135)and A allele(OR=0.2826,95%CI:0.0993-0.8044,P=0.0179)of MIR618(rs2682818).No significant association was found between MIR200C(rs73262897)and BrC risk.CONCLUSION The C/T genotype of rs11614913 in MIR196A2,and C/A genotype and A allele of rs2682818 in MIR618,are associated with a protective effect against BrC in women from western Mexico.
基金supported by National Magnetic Confinement Fusion Energy Development Research Project(Nos.2022YFE03070003 and 2019YFE03070000)Natural Science Foundation of Hunan Province(No.2020JJ4515)+6 种基金Key Projects of Hunan Provincial Department of Education(No.20A432)the Government Sponsored Study Abroad Program of the Chinese Scholarship Council(CSC)(No.202108430056)Anhui Provincial Natural Science Foundation(No.2308085MA23)IAEA Coordinated Research Project F43026(No.26480)the National Key Research&Development Program of China(No.2018YFE0303103)National Natural Science Foundation of China(Nos.11875287 and 12275314)Anhui Provincial Key Research&Development Project(No.205258180096)。
文摘A program developed with COMSOL software integrates EAST four-strap antenna coupling with the double-stub Ferrite tuners(FT)impedance matching,obtaining physical quantities crucial for predicting the overall performance of the ion cyclotron resonance heating(ICRH)antenna and matching system.These quantities encompass S-matrix,port complex impedance,reflection coefficients,electric field and voltage distribution,and optimal matching settings.In this study,we explore the relationship between S-matrix,reflection coefficients,port complex impedance,and frequency.Then,we analyze the impact of Faraday screens placement position and transparency,the distance from the Faraday screen(FS)to the current straps(CS),the relative distance between ports,and the characteristic impedance of the transmission line on the coupling characteristic impedance of the EAST ICRH system.Finally,we simulate the electric field distribution and voltage distribution of the EAST ICRH system for plasma heating with double-stub FT impedance matching.Using optimized parameters,the coupling power of the ICRH system can be approximately doubled.The results present herein may offer guidance for the design of high-power,long-pulse operation ICRH antenna systems.
基金supported in part by National Natural Science Foundation of China (Nos.12275070, 12205084, 12305236 and 11675050)in part by the National Key Research and Development Program of China (Nos. 2022YFE03180200, 2022YFE03020001 and 2019YFE03010004)Innovation Program of Southwestern Institute of Physics (No. 202301XWCX001)。
文摘Charge-exchange(CX) recombination spectroscopy is a powerful tool monitoring ion temperature and plasma rotation with good temporal and spatial resolutions. A compact, new design for a high-throughput, tri-band high spectral resolution spectrometer has been developed for the charge-exchange recombination spectroscopy measurement on the HL-2A tokamak. The simultaneous measurements of He II(468.57 nm), C VI(529.1 nm), and Dα(656.1 nm accompanied by beam emission spectra) with an acquisition frequency up to 400 Hz are achieved by vertically binning the spectrum from each fiber in experiments. Initial results indicate that the system can provide radial profiles of not only ion temperature and rotation velocity,but also concentration of carbon. For the case of helium, the measurements for the ion temperature and rotation velocity are straightforward but the apparent concentration associated with the observed CX intensity is obviously too high. Modeling of the active He II CX feature including plume contributions needs to be carried out to extract the true helium concentration.The spectrometer could become a prototype for the ITER charge-exchange recombination spectroscopy diagnostic and the pilot experiments, as presented here, demonstrate the possibility of impurity concentrations measurements based on the combined measurement of local beam emission and charge-exchange recombination spectroscopy spectra.
文摘Background: Pancreaticoduodenectomy is the standard treatment for resectable periampullary cancer. Surgical site infections(SSI) are common complications with increased morbidity. The study aimed to describe the prevalence, risk factors, microbiology, and outcomes of SSI among patients undergoing pancreaticoduodenectomy. Methods: We conducted a retrospective study in a referral cancer center between January 2015 and June 2021. We analyzed baseline patient characteristics and SSI occurrence. Culture results and susceptibility patterns were described. Multivariate logistic regression was used to determine risk factors, proportional hazards model to evaluate mortality, and Kaplan-Meier analysis to assess long-term survival. Results: A total of 219 patients were enrolled in the study;101(46%) developed SSI. Independent factors for SSI were diabetes mellitus, preoperative albumin level, biliary drainage, biliary prostheses, and clinically relevant postoperative pancreatic fistula. The main pathogens were Enterobacteria and Enterococci. Multidrug-resistance rate in SSI was high but not associated with increased mortality. Infected patients had higher odds of sepsis, longer hospital stay and intensive care unit stay, and readmission rate. Neither 30-day mortality nor long-term survival was significantly different between infected and non-infected patients. Conclusions: SSI prevalence among patients undergoing pancreaticoduodenectomy was high and largely caused by resistant microorganisms. Most risk factors were related to preoperative instrumentation of the biliary tree. SSI was associated with greater risk of unfavorable outcomes;however, survival was unaffected.
基金Project supported by the National Key Research and Development Program of China(Grant No.2017YFE0301203)the Innovation Program of Southwestern Institute of Physics(Grant No.202301XWCX001)+2 种基金the Sichuan Science and Technology Program(Grant Nos.2023ZYD0014 and 2021YFSY0044)the National Natural Science Foundation of China(Grant No.12175055)the Shenzhen Municipal Collaborative Innovation Technology Program-International Science and Technology Cooperation Project(Grant No.GJHZ20220913142609017)。
文摘The dynamics of long-wavelength(kθ<1.4 cm^(-1)),broadband(20 kHz–200 kHz)electron temperature fluctuations(Te/Te)of plasmas in gas-puff experiments are observed for the first time in HL-2A tokamak.In a relatively low density(ne(0)■0.91×10^(19)m^(-3)–1.20×10^(19)m^(-3))scenario,after gas-puffing the core temperature increases and the edge temperature drops.On the contrary,temperature fluctuation drops at the core and increases at the edge.Analyses show the non-local emergence is accompanied with a long radial coherent length of turbulent fluctuations.While in a higher density(ne(0)?1.83×10^(19)m^(-3)–2.02×10^(19)m^(-3))scenario,the phenomena are not observed.Furthermore,compelling evidence indicates that E×B shear serves as a substantial contributor to this extensive radial interaction.This finding offers a direct explanatory link to the intriguing core-heating phenomenon witnessed within the realm of non-local transport.
基金Project supported by the National Key R&D Program of China(Grant No.2019YFE03030004)the National Natural Science Foundation of China(Grant No.12275040)+1 种基金the Users with Excellence Program of Hefei Science Center CAS(Grant No.2020HSC-UE010)This research is also sponsored in part by the U.S.Department of Energy under contract DEAC02-09CH11466.
文摘Based on the EAST equilibrium,the effects of boron(B)and neon(Ne)injected at different locations on the target heat load,and the distributions of B and Ne particles were investigated by transport code SOLPS-ITER.It was found that the B injection was more sensitive to the injection location for heat flux control than impurity Ne.The high electron and ion densities near the inner target in the discharge with impurity B injected from over X-point(R_(1))led to plasma detachment only at the inner target,and the localized B ions in the cases with injection from outer target location(R_(2))and upstream location(R_(3))led to far-SOL detachment at the outer target,but not at the inner target.In contrast,for Ne,the spatial distributions of Ne ions and electrons were found to be similar in all the cases at the three injection locations,and the detached plasma was achieved at the inner target and the electron temperature was reduced at the outer target.For locations R_(2) and R_(3),impurity B showed a more pronounced effect on the heat flux at the far-SOL of the outer target.Further analysis indicated that Ne atoms came mainly from the recycling sources,whereas B atoms came mainly from injection,and that their distinct atomic distributions resulted from the difference in the ionization threshold and ionization mean free path.In addition,the radiation proportion of B in the divertor region was larger than that of Ne when the total radiation power was similar,which suggests that B has less influence on the core region.
文摘BACKGROUND Preterm birth is the leading cause of mortality in newborns,with very-low-birthweight infants usually experiencing several complications.Breast milk is considered the gold standard of nutrition,especially for preterm infants with delayed gut colonization,because it contains beneficial microorganisms,such as Lactobacilli and Bifidobacteria.AIM To analyze the gut microbiota of breastfed preterm infants with a birth weight of 1500 g or less.METHODS An observational study was performed on preterm infants with up to 36.6 wk of gestation and a birth weight of 1500 g or less,born at the University Hospital Dr.JoséEleuterio González at Monterrey,Mexico.A total of 40 preterm neonates were classified into breast milk feeding(BM)and mixed feeding(MF)groups(21 in the BM group and 19 in the MF group),from October 2017 to June 2019.Fecal samples were collected before they were introduced to any feeding type.After full enteral feeding was achieved,the composition of the gut microbiota was analyzed using 16S rRNA gene sequencing.Numerical variables were compared using Student’s t-test or using the Mann–Whitney U test for nonparametric variables.Dominance,evenness,equitability,Margalef’s index,Fisher’s alpha,Chao-1 index,and Shannon’s diversity index were also calculated.RESULTS No significant differences were observed at the genus level between the groups.Class comparison indicated higher counts of Alphaproteobacteria and Betaproteobacteria in the initial compared to the final sample of the BM group(P<0.011).In addition,higher counts of Gammaproteobacteria were detected in the final than in the initial sample(P=0.040).According to the Margalef index,Fisher’s alpha,and Chao-1 index,a decrease in species richness from the initial to the final sample,regardless of the feeding type,was observed(P<0.050).The four predominant phyla were Bacteroidetes,Actinobacteria,Firmicutes,and Proteobacteria,with Proteobacteria being the most abundant.However,no significant differences were observed between the initial and final samples at the phylum level.CONCLUSION Breastfeeding is associated with a decrease in Alphaproteobacteria and Betaproteobacteria and an increase of Gammaproteobacteria,contributing to the literature of the gut microbiota structure of very low-birth-weight,preterm.
文摘Background:Traumatic facial nerve injury is the second leading cause of facial paralysis,presenting significant challenges such as difficulties with eating,speaking,impaired vision,and loss of facial expression.Understanding these injuries is critical for plastic surgeons to optimize recovery and functional outcomes.This study examined our experience with acute traumatic extratemporal facial nerve injuries,focusing on their characteristics,the frequency of affected nerve branches,and identification using Seckel’s facial danger zones as anatomical landmarks.We also explored the implications of surgical management based on the current literature and our experience.Methods:We reviewed 50 patients with acute traumatic extratemporal facial nerve injuries treated at Hospital General Dr.Manuel Gea Gonzalez in Mexico City from January 2019 to January 2024.The collected data included demographics(age,sex,severity,and time to medical attention),injury mechanism,affected nerve branches using Seckel’s zones,and treatment methods.Results:The majority of the patients were male(82%),with an average age of 2916 years.Sharp trauma from assault was the most common cause(66%).The buccal and frontal branches were most frequently affected,with Seckel zones Ⅳ and Ⅱ involved in 46.86%and 33.33%of cases,respectively.Primary neurorrhaphy was performed in 96%of the patients.Conclusion:The effective management of traumatic facial nerve injuries relies on understanding the characteristics of the injury and using anatomical landmarks for prompt localization.Primary neurorrhaphy is the preferred surgical approach,with nerve grafting being an alternative.Ideally,early intervention within 72 h is crucial for optimal nerve recovery.
文摘BACKGROUND The impact of social determinants of health in allogeneic transplant recipients in low-and middle-income countries is poorly described.This observational study analyzes the impact of place of residence,referring institution,and transplant cost coverage(out-of-pocket vs government-funded vs private insurance)on outcomes after allogeneic hematopoietic stem cell transplantation(alloHSCT)in two of Mexico's largest public and private institutions.AIM To evaluate the impact of social determinants of health and their relationship with outcomes among allogeneic transplant recipients in Mexico.METHODS In this retrospective cohort study,we included adolescents and adults≥16 years who received a matched sibling or haploidentical transplant from 2015-2022.Participants were selected without regard to their diagnosis and were sourced from both a private clinic and a public University Hospital in Mexico.Three payment groups were compared:Out-of-pocket(OOP),private insurance,and a federal Universal healthcare program“Seguro Popular”.Outcomes were compared between referred and institution-diagnosed patients,and between residents of Nuevo Leon and out-of-state.Primary outcomes included overall survival(OS),categorized by residence,referral,and payment source.Secondary outcomes encompassed early mortality,event-free-survival,graft-versus-host-relapse-free survival,and non-relapse-mortality(NRM).Statistical analyses employed appropriate tests,Kaplan-Meier method,and Cox proportional hazard regression modeling.Statistical software included SPSS and R with tidycmprsk library.RESULTS Our primary outcome was overall survival.We included 287 patients,n=164 who lived out of state(57.1%),and n=129 referred from another institution(44.9%).The most frequent payment source was OOP(n=139,48.4%),followed by private insurance(n=75,26.1%)and universal coverage(n=73,25.4%).No differences in OS,event-free-survival,NRM,or graft-versus-host-relapse-free survival were observed for patients diagnosed locally vs in another institution,nor patients who lived in-state vs out-of-state.Patients who covered transplant costs through private insurance had the best outcomes with improved OS(median not reached)and 2-year cumulative incidence of NRM of 14%than patients who covered costs OOP(Median OS and 2-year NRM of 32%)or through a universal healthcare program active during the study period(OS and 2-year NRM of 19%)(P=0.024 and P=0.002,respectively).In a multivariate analysis,payment source and disease risk index were the only factors associated with overall survival.CONCLUSION In this Latin-American multicenter study,the site of residence or referral for alloHSCT did not impact outcomes.However,access to healthcare coverage for alloHSCT was associated with improved OS and reduced NRM.
基金Supported by the Department of Endocrinology and Service of Gastroenterology of the Faculty of MedicineAutonomous University of Nuevo Leon
文摘Diabetes mellitus(DM) that occurs because of chronic liver disease(CLD) is known as hepatogenous diabetes(HD). Although the association of diabetes and liver cirrhosis was described forty years ago, it was scarcely studied for long time. Patients suffering from this condition have low frequency of risk factors of type 2 DM. Its incidence is higher in CLD of viral, alcoholic and cryptogenic etiology. Its pathophysiology relates to liver damage, pancreatic dysfunction, interactions between hepatitis C virus(HCV) and glucose metabolism mechanisms and genetic susceptibility. It associates with increased rate of liver complications and hepatocellular carcinoma, and decreased 5-year survival rate. It reduces sustained virological response in HCV infected patients. In spite of these evidences, the American Diabetes Association does not recognize HD. In addition, the impact of glucose control on clinical outcomes of patients has not been evaluated. Treatment of diabetes may be difficult due to liver insufficiency and hepatotoxicity of antidiabetic drugs. Notwithstanding, no therapeutic guidelines have been implemented up to date. In this editorial, authors discuss the reasons why they think that HD may be a neglected pathological condition and call attention to the necessity for more clinical research on different fields of this disease.
文摘Steroids are drugs that have been used extensively in a variety of conditions. Although widely prescribed for their anti-inflammatory and immunosuppressive properties, glucocorticoids have several side effects, being hyperglycemia one of the most common and representative. In the present review, we discuss the main epidemiologic characteristics associated with steroid use, with emphasis on the identification of high risk populations. Additionally we present the pathophysiology of corticosteroid induced hyperglycemia as well as the pharmacokinetics and pharmacodynamics associated with steroid use. We propose a treatment strategy based on previous reports and the understanding of the mechanism of action of both, the different types of glucocorticoids and the treatment options, in both the ambulatory and the hospital setting. Finally, we present some of the recent scientific advances as well as some options for future use of glucocorticoids.
文摘Gastrointestinal angiodysplasias (GIADs), also called angioectasias, are the most frequent vascular lesions. Its precise prevalence is unknown since most of them are asymptomatic. However, the incidence may be increasing since GIADs affect individuals aged more than 60 years and population life expectancy is globally increasing worldwide. They are responsible of about 5% to 10% of all gastrointestinal bleeding (GIB) cases. Most GIADs are placed in small bowel, where are the cause of 50 to 60% of obscure GIB diagnosed with video capsule endoscopy. They may be the cause of fatal severe bleeding episodes;nevertheless, recurrent overt or occult bleeding episodes requiring repeated expensive treatments and disturbing patient’s quality-of-life are more frequently observed. Diagnosis and treatment of GIADs (particularly those placed in small bowel) are a great challenge due to insidious disease behavior, inaccessibility to affected sites and limitations of available diagnostic procedures. Hemorrhagic causality out of the actively bleeding lesions detected by diagnostic procedures may be difficult to establish. No treatment guidelines are currently available, so there is a high variability in the management of these patients. In this review, the epidemiology and pathophysiology of GIADs and the status in the diagnosis and treatment, with special emphasis on small bowel angiodysplasias based on multiple publications, are critically discussed. In addition, a classification of GIADs based on their endoscopic characteristics is proposed. Finally, some aspects that need to be clarified in future research studies are highlighted.
文摘Migraine is a recurrent and commonly disabling primary headache disorder that affects over 17% of women and 5%-8% of men. Migraine susceptibility is multifactorial with genetic, hormonal and environmental factors all playing an important role. The physiopathology of migraine is complex and still not fully understood. Many different neuropeptides, neurotransmitters and brain pathways have been implicated. In connection with the myriad mechanisms and pathways implicated in migraine, a variety of multisystemic comorbidities(e.g., cardiovascular, psychiatric and other neurological conditions) have been found to be closely associated with migraine. Recent reports demonstrate an increased frequency of gastrointestinal(GI) disorders in patients with migraine compared with the general population. Helicobacter pylori infection, irritable bowel syndrome, gastroparesis, hepatobiliary disorders, celiac disease and alterations in the microbiota have been linked to the occurrence of migraine. Several mechanisms involving the gut-brain axis, such as a chronic inflammatory response with inflammatory and vasoactive mediators passing to the circulatory system, intestinal microbiota modulation of the enteric immunological milieu and dysfunction of the autonomic and enteric nervous system, have been postulated to explain these associations. However, the precise mechanisms and pathways related to the gut-brain axis in migraine need to be fully elucidated. In this review, we survey the available literature linking migraine with GI disorders. We discuss the possible physiopathological mechanisms, and clinical implications as well as several future areas of interest for research.
