AIM: To determine clinical characteristics and treatment outcome of gastric lymphoma after chemotherapy and immuno-chemotherapy. METHODS: Thirty four patients with primary gastric mucosa associated lymphoid tissue (MA...AIM: To determine clinical characteristics and treatment outcome of gastric lymphoma after chemotherapy and immuno-chemotherapy. METHODS: Thirty four patients with primary gastric mucosa associated lymphoid tissue (MALT) lymphoma (Ann Arbor stages Ⅰ to Ⅳ) were enrolled. All had upper gastric endoscopy, abdominal ultrasonography, CT and H pylori status assessment (histology and serology). After anti-H pylori treatment and initial chemotherapy, patients were re-examined every 4 mo. RESULTS: Histological regression of the lymphoma was complete in 22/34 (64.7%) and partial in 9 (26.5%) patients. Median follow up time for these 31 responders was 60 mo (range 48-120). No regression was noted in 3 patients. Among the 25 (73.5%) H pylori positive patients, the eradication rate was 100%.CONCLUSION: Using univariate analysis, predictive factors for overall survival were international prognostic index (IPI) score, hemoglobin level, erythrocyte sedimentation rate (ESR), and platelet numbers (P < 0.005). In addition to this, Cox proportion hazard model differentiate IPI score, ESR, and platelets as predictors of survival.展开更多
Cystic dystrophy of the duodenal wall is a rare condition characterized by the development of cysts in heterotopic pancreatic tissue localized in the duodenal wall.A 38-year- old man was admitted to the hospital for a...Cystic dystrophy of the duodenal wall is a rare condition characterized by the development of cysts in heterotopic pancreatic tissue localized in the duodenal wall.A 38-year- old man was admitted to the hospital for abdominal pain and vomiting after food intake.The diagnosis of acute pancreatitis was initially suspected.Abdominal ultrasound examination revealed thickening of the second portion of duodenal wall within which,small cysts(diameter,less than 1 cm)were present in the vicinity of pancreatic head. The head of pancreas appeared enlarged(63 mm×42 mm) and hypoechoic.Upper endoscopy and barium X-ray series were performed revealing a severe circumferential deformation,as well as 4 cm long stenosis of the second portion of the duodenum.CT examination revealed multiple cysts located in an enlarged,thickened duodenal wall with moderate to strong post-contrast enhancement.We suspected that patient had cystic dystrophy of duodenal wall developed in the heterotopic pancreas and diagnosis was confirmed by endoscopic ultrasound(EUS).Endoscopic ultrasound(EUS)revealed circular stenosis from the duodenal bulb onwards.A twenty megahertz mini-prope examination further showed diffuse(intramural)infiltration of duodenal wall limited to the submucosa and muscularis propria of the second portion of duodenum with multiple microcysts within the thickened mucosa and submucosa.Patient was successfully surgically treated and pancreatoduodenectomy was performed.The pathological examination confirmed a diagnosis of cystic dystrophy of a heterotopic pancreas. Endoscopic ultrasonography features allow preoperative diagnosis of cystic dystrophy of a heterotopic pancreas in duodenal wall,with intralumina120 MHz mini probe sonography being more efficient in cases of luminal stenosis.展开更多
Among the various congenital anomalies of the biliary system,an ectopic opening of the common bile duct (CBD) in the duodenal bulb is extremely rare. ERCP is essential for diagnosing the anomaly. A 55-year-old male wa...Among the various congenital anomalies of the biliary system,an ectopic opening of the common bile duct (CBD) in the duodenal bulb is extremely rare. ERCP is essential for diagnosing the anomaly. A 55-year-old male was admitted to hospital for severe right upper quadrant abdominal pain,followed by fever, chills, elevated body temperature and mild icterus. The diagnosis of ectopic opening of CBD in the duodenal bulb was established on endoscopic ultraso-nography (EUS),which clearly demonstrated dilated CBD, with multiple stones and air in the lumen, draining into the bulb. A normal pancreatic duct, which did not drain into the bulb, was also observed. This finding was confirmed on ERCP and surgery.As far as we know, this is the first case of this anomaly diagnosed by EUS. Ectopic opening of the CBD in the duodenal bulb is not an incidental finding, but a pathologic condition which can be associated with clinical entities such as recurrent or intractable duodenal ulcer, recurrent biliary pain,choledocholithiasis or acute cholangitis. Endoscopic ultrasonography features allow preoperative diagnosis of this anomaly and can replace ERCP as a first diagnostic tool in such clinical circumstances. Embryology of the anomalies of the extrahepatic biliary tree has been also reviewed.展开更多
AIM： To study the value of biochemical and ultrasonographic parameters in prediction of presence and size of esophageal varices.METHODS： The study includes selected cirrhotic patients who underwent a complete bioche...AIM： To study the value of biochemical and ultrasonographic parameters in prediction of presence and size of esophageal varices.METHODS： The study includes selected cirrhotic patients who underwent a complete biochemical workup, upper digestive endoscopic and ultrasonographic examinations. Albumin/right liver lobe diameter and platelet count/spleen diameter ratios were calculated. The correlation between calculated ratio and the presence and degree of esophageal varices was evaluated.RESULTS： Ninety-four subjects （62 males, 32 females）, with a mean age of 52.32 ± 13.60 years, were studied. Child-Pugh class A accounted for 42.6%, class 13 37.2%, whereas class C 20.2%. Esophageal varices （OE） were not demonstrated by upper digestive endoscopy in 24.5%, while OE grade Iwas found in 22.3% patients, grade Ⅱ in 33.0%, grade m in 16.0%, and grade iV in 4.3%. The mean value of right liver lobe diameter/ albumin ratio was 5.51± 1.82 （range from 2.76 to 11.44）, while the mean platelet count/spleen diameter ratio was 1017.75 ± 729.36 （range from 117.39 to 3362.50）, respectively. Statistically significant correlation was proved by Spearman＇s test between OE grade and calculated ratios. The P values were 0.481 and -0.686, respectively.CONCLUSION： The right liver lobe diameter/albumin and platelet count/spleen diameter ratios are noninvasive parameters providing accurate information pertinent to determination of presence of esophageal varices, and their grading in patients with liver cirrhosis.展开更多
In this editorial,we discuss the status of a therapeutic approach to emotional reactions accompanying thermal skin injuries.Burns are considered a major health problem,as well as an economic and social problem,with po...In this editorial,we discuss the status of a therapeutic approach to emotional reactions accompanying thermal skin injuries.Burns are considered a major health problem,as well as an economic and social problem,with potentially devastating and life-changing consequences.They affect a wide range of patients with different damage mechanisms,varied depths,and localizations of the burns.The most common are thermal burns,with more than 11 million occurrences annually according to the World Health Organization data.Thermal skin injuries are among the most tragic and catastrophic injuries,almost unsurpassed in terms of severity,morbidity,and mortality,as well as functional,aesthetic,social,economic,and psychological consequences.Burn survivors face stress,anxiety,depression,low self-esteem,body deformity,social isolation,unemployment,financial burden,and family problems.The advances in acute burn care have allowed researchers and physicians to pay more attention to other effects of burns,focusing on psychological consequences in particular.Apart from the significant improvements in routine protocols,it seems useful to take care of psychological disturbances that occur simultaneously but may emerge as the most lasting outcome of those injuries.In that sense,various standards and additional approaches may be involved to achieve overall recovery.展开更多
AIM: To evaluate different biochemical markers and their ratios in the assessment of primary biliary cirrhosis (PBC) stages. METHODS: This study included 112 patients with PBC who underwent a complete clinical investi...AIM: To evaluate different biochemical markers and their ratios in the assessment of primary biliary cirrhosis (PBC) stages. METHODS: This study included 112 patients with PBC who underwent a complete clinical investigation. We analyzed the correlation (Spearman's test) between ten biochemical markers and their ratios with different stages of PBC. The discriminative values were compared using areas under receiver operating characteristic (ROC) curves. RESULTS: The mean age of patients included in the study was 53.88 ± 10.59 years, including 104 females and 8 males. We found a statistically significant correlation between PBC stage and Aspartate aminotransferase (AST), Alanine aminotransferase (ALT) to platelet ratio (APRI), ALT/platelet count, AST/ALT, ALT/AST and ALT/Cholesterol ratios, with the values of Spearman's rho of 0.338, 0.476, 0.404, 0.356, 0.351 and 0.325, respectively. The best sensitivity and specificity was shown for AST/ALT, with an area under ROC of 0.660. CONCLUSION: Biochemical markers and their ratios do correlate with different sensitivity to and specificity of PBC disease stage. The use of biochemical markers and their ratios in clinical evaluation of PBC patients may reduce, but not eliminate, the need for liver biopsy.展开更多
BACKGROUND Primary pancreatic lymphoma(PPL)is a rare tumor that mimics pancreatic adenocarcinoma,leading to diagnostic and therapeutic challenges.PPL accounts for 0.2%of all pancreatic tumors and is typically treated ...BACKGROUND Primary pancreatic lymphoma(PPL)is a rare tumor that mimics pancreatic adenocarcinoma,leading to diagnostic and therapeutic challenges.PPL accounts for 0.2%of all pancreatic tumors and is typically treated with chemotherapy.However,the long-term survival rates for PPL with chemotherapy and radiotherapy alone are unsatisfactory.Due to the improvements in pancreatic surgery,there is a need to reevaluate the treatment strategies for PPL.CASE SUMMARY A 62-year-old male presented to our clinic.A biopsy was unsuccessful,and the imaging was suggestive of pancreatic adenocarcinoma.Therefore,subtotal splenopancreatectomy was performed and histopathology was performed.He was then diagnosed with primary pancreatic diffuse large B-cell lymphoma.He received adjuvant chemotherapy and radiotherapy.Currently,the patient is alive with no evidence of disease 36 months after surgery.CONCLUSION The potential role of surgery in the treatment of PPL should be emphasized and added in the management protocol of early stage lymphoma.展开更多
AIM： To search the pathophysiological mechanism of diarrhea based on daily stool weights, fecal electrolytes, osmotic gap and pH. METHODS： Seventy-six patients were included： 51 with microscopic colitis （MC） [40 ...AIM： To search the pathophysiological mechanism of diarrhea based on daily stool weights, fecal electrolytes, osmotic gap and pH. METHODS： Seventy-six patients were included： 51 with microscopic colitis （MC） [40 with lymphocytic colitis （LC）; 11 with collagenous colitis （CC）], 7 with MC without diarrhea and 18 as a control group （CG）. They collected stool for 3 d. Sodium and potassium concentration were determined by flame photometry and chloride concentration by titration method of Schales. Fecal osmotic gap was calculated from the difference of osmolarity of fecal fluid and double sum of sodium and potassium concentration. RESULTS： Fecal fluid sodium concentration was significantly increased in LC 58.11±5.38 mmol/L （P〈0.01） and CC 54.14±8.42 mmol/L （P〈0.05） than in CG 34.28±2.98 mmol/L. Potassium concentration in LC 74.65±5.29 mmol/L （P〈0.01） and CC 75.53±8.78 mmol/L （P〈0.05） was significantly less compared to CG 92.67±2.99 mmol/L. Chloride concentration in CC 36.07±7.29 mmol/L was significantly higher than in CG 24.11±2.05 mmol/L（P〈0.05）. Forty-four （86.7%） patients had a secretory diarrhea compared to fecal osmotic gap. Seven （13.3%） patients had osmotic diarrhea. CONCLUSION： Diarrhea in MC mostly belongs to thesecretory type. The major pathophysiological mechanism in LC could be explained by a decrease of active sodium absorption. In CC, decreased CI/HCO3 exchange rate and increased chloride secretion are coexistent pathways.展开更多
Energy spectra of neutrons are important for identification of unknown neutron sources and for determination of the equivalent dose. Although standard energy spectra of neutrons are available in some situations, e.g.,...Energy spectra of neutrons are important for identification of unknown neutron sources and for determination of the equivalent dose. Although standard energy spectra of neutrons are available in some situations, e.g., for some radiotherapy treatment machines, they are unknown in other cases, e.g., for photoneutrons created in radiotherapy rooms and neutrons generated in nuclear reactors. In situations where neutron energy spectra need to be determined, unfolding the required neutron energy spectra using the Bonner sphere spectrometer (BSS) and nested neutron spectrometer (NNS) has been found promising. However, without any prior knowledge on the spectra, the unfolding process has remained a tedious task. In this work, a standalone numerical tool named ‘‘NRUunfold’’ was developed which could satisfactorily unfold neutron spectra for BSS or NNS, or any other systems using similar detection methodology. A generic and versatile algorithm based on maximum-likelihood expectation– maximization method was developed and benchmarked against the widely used STAY’SL algorithm which was based on the least squares method. The present method could output decent results in the absence of precisely calculated initial guess, although it was also remarked that employment of exceptionally bizarre initial spectra could lead to some unreasonable output spectra. The neutron count rates computed using the manufacturer’s response functions were used for sensitivity studies. The present NRUunfold code could be useful for neutron energy spectrum unfolding for BSS or NNS applications in the absence of a precisely calculated initial guess.展开更多
Retrorectal, developmental tail gut cysts, include dermoid cysts, rectal duplication cysts and retrorectal cyst-hamartomas. Retrorectal cyst-hamartomas （RCH） are derived from remnants of the tail gut, the most cauda...Retrorectal, developmental tail gut cysts, include dermoid cysts, rectal duplication cysts and retrorectal cyst-hamartomas. Retrorectal cyst-hamartomas （RCH） are derived from remnants of the tail gut, the most caudal part of the embryonic hincl gut, which normally involutes by the 8^th wk of embryonic development （3-8 mm stage）. They have specific radiological and histopathological features that distinguish them from other similar formations （dermoid cysts, enteric duplication cysts and teratomas）. We report a patient with adenosquamous carcinoma arising within RCH, who underwent complete resection of the cyst through anterior laparotomy, and reached complete （recurrencefree for 14 mo, so far） functional recovery. The cyst was incidentally discovered during hysterectomy 12 years ago. Diagnostic, therapeutic arid histopathological aspects of this rare case are discussed. The mentioned pedod between diagnosis and surgical treatment suggests that RCH, given enough time, can develop malignant degeneration, and should be resected at the time of diagnosis.展开更多
The thermodynamic properties and the microstructure, hardness and electrical conductivity of shape memory alloys （SMAs） belonging to ternary Cu？Al？Zn system were studied by Muggianu model and experiment, respectiv...The thermodynamic properties and the microstructure, hardness and electrical conductivity of shape memory alloys （SMAs） belonging to ternary Cu？Al？Zn system were studied by Muggianu model and experiment, respectively. The isothermal section of phase diagram at 293 K was calculated using Thermo-Calc software. Experiments were conducted by X-ray diffraction, light optic microscopy, scanning electron microscopy with energy dispersive X-ray spectrometry, hardness and electrical conductivity measurements. The calculated values of thermodynamic properties indicate that Cu shows good miscibility with Al and Zn in all investigated alloys. The microstructural analysis of samples reveals that the structure consists of large and polygonal grains.展开更多
A new prescribed-time state-feedback design is presented for stochastic nonlinear strictfeedback systems.Different from the existing stochastic prescribed-time design where scaling-free quartic Lyapunov functions or s...A new prescribed-time state-feedback design is presented for stochastic nonlinear strictfeedback systems.Different from the existing stochastic prescribed-time design where scaling-free quartic Lyapunov functions or scaled quadratic Lyapunov functions are used,the design is based on new scaled quartic Lyapunov functions.The designed controller can ensure that the plant has an almost surely unique strong solution and the equilibrium at the origin of the plant is prescribed-time mean-square stable.After that,the authors redesign the controller to solve the prescribed-time inverse optimal mean-square stabilization problem.The merit of the design is that the order of the scaling function in the controller is reduced dramatically,which effectively reduces the control effort.Two simulation examples are given to illustrate the designs.展开更多
The effect of Y203 and the total oxide volume fraction (Y203+AI203) on density and mechanical properties of low temperature (1770-1940℃) pressureless sintered β-SiC ceramics were presented. The optimum temperature f...The effect of Y203 and the total oxide volume fraction (Y203+AI203) on density and mechanical properties of low temperature (1770-1940℃) pressureless sintered β-SiC ceramics were presented. The optimum temperature for pressureless sintering of β-SiC was found to be -1850℃ and the optimum content of Y203 in the oxides was found to be between 40 and 57 wt pct. The highest sintered density was achieved by adding oxides at 14 vol. pct. Both of the highest strength and fracture toughness were achieved at -14 vol. pct oxide addition and yttria concentrations between 40 and 57 wt pct in the oxides. Hardness, on the other hand, was found to be the highest for samples with 14 vol. pct oxide addition and -64 wt pct Y2O3 in oxides.展开更多
Overcoming the global sustainability challenges of logistics requires applying solutions that minimize the negative effects of logistics activities.The most efficient way of doing so is through intermodal transportati...Overcoming the global sustainability challenges of logistics requires applying solutions that minimize the negative effects of logistics activities.The most efficient way of doing so is through intermodal transportation(IT).Current IT systems rely mostly on road,rail,and sea transport,not inland waterway transport.Developing dry port(DP)terminals has been proven as a sustainable means of promoting and utilizing IT in the hinterland of seaport container terminals.Conventional DP systems consolidate container flows from/to seaports and integrate road and rail transportation modes in the hinterland which improves the sustainability of the whole logistics system.In this article,to extend literature on the sustainable development of different categories of IT terminals,especially DPs,and their varying roles,we examine the possibility of developing DP terminals within the framework of inland waterway container terminals(IWCTs).Establishing combined road–rail–inland waterway transport for observed container flows is expected to make the IT systems sustainable.As such,this article is the first to address the modelling of such DP systems.After mathematically formulating the problem of modelling DP systems,which entailed determining the number and location of DP terminals for IWCTs,their capacity,and their allocation of container flows,we solved the problem with a hybrid metaheuristic model based on the Bee Colony Optimisation(BCO)algorithmand themeasurement of alternatives and ranking according to compromise solution(i.e.,MARCOS)multi-criteria decision-making method.The results from our case study of the Danube region suggest that planning and developingDP terminals in the framework of IWCTs can indeed be sustainable,as well as contribute to the development of logistics networks,the regionalisation of river ports,and the geographic expansion of their hinterlands.Thus,the main contributions of this article are in proposing a novel DP concept variant,mathematically formulating the problems of its modelling,and developin展开更多
Genotyping of 2 well-known weevil species from the genus Ceutorhynchus （Coleoptera： Curculionidae） distributed in west Palearctic, C. erysimi and C. contractus, revealed phenotype versus genotype inconsistencies in...Genotyping of 2 well-known weevil species from the genus Ceutorhynchus （Coleoptera： Curculionidae） distributed in west Palearctic, C. erysimi and C. contractus, revealed phenotype versus genotype inconsistencies in a set of 56 specimens （25 C. erysimi and 31 C. contractus） collected from 25 locations in Serbia and Montenegro. An analysis of the mitochondrial cytochrome oxidase subunit I gene （CO1）, widely used as a barcoding region, and a nuclear gene, elongation factor-v （EF-1α）, revealed stable genetic divergence among these species. The average uncorrected pairwise distances for the CO1 and EF-1α genes were 3.8%, and 1.3%, respectively, indicating 2 genetically well-segregated species. However, the genetic data were not congruent with the phenotypic characteristics of the studied specimens. In the first place, C. erysimi genotypes were attached to specimens with phenotypic characteristics of C. contractus. Species-specific PCR-RFLP assays for the barcoding gene COIwere applied for the molecular identification of 101 additional specimens of both morphospecies （33 C. erysimi and 68 C. contractus） and were found to confirm this incongruity. The discrepancy between the genetic and morphological data raises the question of the accuracy of using a barcoding approach, as it may result in misleading conclusions about the taxonomic position of the studied organism. Additionally, the typological species concept shows considerable weakness when genetic data are not supported with phenotypic characteristics as in case of asymmetric introgression, which may cause certain problems, especially in applied studies such as biological control programs in which the biological properties of the studied organisms are the main focus.展开更多
Enteropathy-associated T-cell lymphoma （EATCL） is a high grade, pleomorphic peripheral T-cell lymphoma usually with cytotoxic phenotypes. We describe a first case of patient with EATCL that is remarkable for its ful...Enteropathy-associated T-cell lymphoma （EATCL） is a high grade, pleomorphic peripheral T-cell lymphoma usually with cytotoxic phenotypes. We describe a first case of patient with EATCL that is remarkable for its fulminant course and invasion of both kidneys manifested as acute renal failure. The patient was a 23 year old woman with a long history of celiac disease. She was presented with acute renal failure and enlarged mononuclear infiltrated kidneys. Diagnosis of tubuloi-nterstitial nephritis and polyserositis was confirmed with consecutive pulse doses of steroid therapy. After reco-very, she had disseminated disease two months later. Magnetic resonance imaging showed thickened intestine wall, extremely augmented kidneys, enlarged intra-abdominal lymph nodes with extra-luminal compression of common bile duct. Laparotomy with mesenterial adipous tissue and lymph glands biopsy was done. Consecutive pathophysiological and immunohistochemical analyses confirmed the diagnosis of EATCL： CD45RO＋, CD43＋, CD3＋. The revision of renal pathophysiology sub-stantiated the diagnosis. The patient received chemotherapy, but unfortunately she died manifesting signs of pulmonary embolism caused by tumor cells.展开更多
To present a patient diagnosed with pancreatic carcinoidthat was extremely rare and produced an atypical carcinoidsyndrome. We reported a 58-year old male patient whopresented with long standing, prominent cervicallym...To present a patient diagnosed with pancreatic carcinoidthat was extremely rare and produced an atypical carcinoidsyndrome. We reported a 58-year old male patient whopresented with long standing, prominent cervicallymphadenopathy and occasional watery diarrhea.Pathohistologicaf and immunohistochemical examinationof lymph node biopsy showed a metastatic neuroendocrinetumor, which was histological type A of carcinoid (EMA+,cytokeratin+, CEA-, NSE+, chromogranin A+, synaptophysin+,insulin-). Bone marrow biopsy showed identical findings.Primary site of the tumor was pancreas and diagnosis wasmade according to cytological and immunocytochemicalanalysis of the tumor cells obtained with aspiration biopsyof pancreatic mass (12 mm in diameter) under endoscopicultrasound guidance. However, serotonin levels in bloodand urine samples were normal. It is difficulty to establishthe precise diagnosis of a "functionally inactive" pancreaticcarcinoid and aspiration biopsy of pancreatic tumor underendoscopic ultrasound guidance can be used as a newpotent diagnostic tool.展开更多
Villous adenomas are benign epithelial lesions with malignant potential that can occur in any part of the gastrointestinal tract. We present a case of a middle age woman with acromegaly who was investigated for nonspe...Villous adenomas are benign epithelial lesions with malignant potential that can occur in any part of the gastrointestinal tract. We present a case of a middle age woman with acromegaly who was investigated for nonspecific gastrointestinal complaints. Ultrasonography and subsequent endosonography diagnosed a large （4.5 cm）, hyperechoic, sessile polyp with numerous pedicles. An open cholecystectomy was performed and revealed a villous adenoma with several foci of carcinoma in situ. Detailed investigations showed no other tumors of the gastrointestinal tract. After five years of follo up, the patient reports no complaints, and the results of laboratory testing and imaging studies are within the normal range.展开更多
We consider the stabilisation of discrete-time nonlinear systems that are actuated through a pair of transport partial difference equation(PdE)systems that convect in the opposite directions from one another.An explic...We consider the stabilisation of discrete-time nonlinear systems that are actuated through a pair of transport partial difference equation(PdE)systems that convect in the opposite directions from one another.An explicit feedback law that compensates the discrete PdE dynamics is designed.Global asymptotic stability of the closedloop system is proved with the aid of a Lyapunov function.The feedback design is illustrated through an example.The proposed design in this paper allows the delay to be arbitrarily long and time-varying.Furthermore,our predictor feedback law in discrete time is explicit as the predictor state is computed by an algebraic equation.展开更多
基金Supported by Ministry of Science, Project No. 145061
文摘AIM: To determine clinical characteristics and treatment outcome of gastric lymphoma after chemotherapy and immuno-chemotherapy. METHODS: Thirty four patients with primary gastric mucosa associated lymphoid tissue (MALT) lymphoma (Ann Arbor stages Ⅰ to Ⅳ) were enrolled. All had upper gastric endoscopy, abdominal ultrasonography, CT and H pylori status assessment (histology and serology). After anti-H pylori treatment and initial chemotherapy, patients were re-examined every 4 mo. RESULTS: Histological regression of the lymphoma was complete in 22/34 (64.7%) and partial in 9 (26.5%) patients. Median follow up time for these 31 responders was 60 mo (range 48-120). No regression was noted in 3 patients. Among the 25 (73.5%) H pylori positive patients, the eradication rate was 100%.CONCLUSION: Using univariate analysis, predictive factors for overall survival were international prognostic index (IPI) score, hemoglobin level, erythrocyte sedimentation rate (ESR), and platelet numbers (P < 0.005). In addition to this, Cox proportion hazard model differentiate IPI score, ESR, and platelets as predictors of survival.
文摘Cystic dystrophy of the duodenal wall is a rare condition characterized by the development of cysts in heterotopic pancreatic tissue localized in the duodenal wall.A 38-year- old man was admitted to the hospital for abdominal pain and vomiting after food intake.The diagnosis of acute pancreatitis was initially suspected.Abdominal ultrasound examination revealed thickening of the second portion of duodenal wall within which,small cysts(diameter,less than 1 cm)were present in the vicinity of pancreatic head. The head of pancreas appeared enlarged(63 mm×42 mm) and hypoechoic.Upper endoscopy and barium X-ray series were performed revealing a severe circumferential deformation,as well as 4 cm long stenosis of the second portion of the duodenum.CT examination revealed multiple cysts located in an enlarged,thickened duodenal wall with moderate to strong post-contrast enhancement.We suspected that patient had cystic dystrophy of duodenal wall developed in the heterotopic pancreas and diagnosis was confirmed by endoscopic ultrasound(EUS).Endoscopic ultrasound(EUS)revealed circular stenosis from the duodenal bulb onwards.A twenty megahertz mini-prope examination further showed diffuse(intramural)infiltration of duodenal wall limited to the submucosa and muscularis propria of the second portion of duodenum with multiple microcysts within the thickened mucosa and submucosa.Patient was successfully surgically treated and pancreatoduodenectomy was performed.The pathological examination confirmed a diagnosis of cystic dystrophy of a heterotopic pancreas. Endoscopic ultrasonography features allow preoperative diagnosis of cystic dystrophy of a heterotopic pancreas in duodenal wall,with intralumina120 MHz mini probe sonography being more efficient in cases of luminal stenosis.
文摘Among the various congenital anomalies of the biliary system,an ectopic opening of the common bile duct (CBD) in the duodenal bulb is extremely rare. ERCP is essential for diagnosing the anomaly. A 55-year-old male was admitted to hospital for severe right upper quadrant abdominal pain,followed by fever, chills, elevated body temperature and mild icterus. The diagnosis of ectopic opening of CBD in the duodenal bulb was established on endoscopic ultraso-nography (EUS),which clearly demonstrated dilated CBD, with multiple stones and air in the lumen, draining into the bulb. A normal pancreatic duct, which did not drain into the bulb, was also observed. This finding was confirmed on ERCP and surgery.As far as we know, this is the first case of this anomaly diagnosed by EUS. Ectopic opening of the CBD in the duodenal bulb is not an incidental finding, but a pathologic condition which can be associated with clinical entities such as recurrent or intractable duodenal ulcer, recurrent biliary pain,choledocholithiasis or acute cholangitis. Endoscopic ultrasonography features allow preoperative diagnosis of this anomaly and can replace ERCP as a first diagnostic tool in such clinical circumstances. Embryology of the anomalies of the extrahepatic biliary tree has been also reviewed.
文摘AIM： To study the value of biochemical and ultrasonographic parameters in prediction of presence and size of esophageal varices.METHODS： The study includes selected cirrhotic patients who underwent a complete biochemical workup, upper digestive endoscopic and ultrasonographic examinations. Albumin/right liver lobe diameter and platelet count/spleen diameter ratios were calculated. The correlation between calculated ratio and the presence and degree of esophageal varices was evaluated.RESULTS： Ninety-four subjects （62 males, 32 females）, with a mean age of 52.32 ± 13.60 years, were studied. Child-Pugh class A accounted for 42.6%, class 13 37.2%, whereas class C 20.2%. Esophageal varices （OE） were not demonstrated by upper digestive endoscopy in 24.5%, while OE grade Iwas found in 22.3% patients, grade Ⅱ in 33.0%, grade m in 16.0%, and grade iV in 4.3%. The mean value of right liver lobe diameter/ albumin ratio was 5.51± 1.82 （range from 2.76 to 11.44）, while the mean platelet count/spleen diameter ratio was 1017.75 ± 729.36 （range from 117.39 to 3362.50）, respectively. Statistically significant correlation was proved by Spearman＇s test between OE grade and calculated ratios. The P values were 0.481 and -0.686, respectively.CONCLUSION： The right liver lobe diameter/albumin and platelet count/spleen diameter ratios are noninvasive parameters providing accurate information pertinent to determination of presence of esophageal varices, and their grading in patients with liver cirrhosis.
文摘In this editorial,we discuss the status of a therapeutic approach to emotional reactions accompanying thermal skin injuries.Burns are considered a major health problem,as well as an economic and social problem,with potentially devastating and life-changing consequences.They affect a wide range of patients with different damage mechanisms,varied depths,and localizations of the burns.The most common are thermal burns,with more than 11 million occurrences annually according to the World Health Organization data.Thermal skin injuries are among the most tragic and catastrophic injuries,almost unsurpassed in terms of severity,morbidity,and mortality,as well as functional,aesthetic,social,economic,and psychological consequences.Burn survivors face stress,anxiety,depression,low self-esteem,body deformity,social isolation,unemployment,financial burden,and family problems.The advances in acute burn care have allowed researchers and physicians to pay more attention to other effects of burns,focusing on psychological consequences in particular.Apart from the significant improvements in routine protocols,it seems useful to take care of psychological disturbances that occur simultaneously but may emerge as the most lasting outcome of those injuries.In that sense,various standards and additional approaches may be involved to achieve overall recovery.
文摘AIM: To evaluate different biochemical markers and their ratios in the assessment of primary biliary cirrhosis (PBC) stages. METHODS: This study included 112 patients with PBC who underwent a complete clinical investigation. We analyzed the correlation (Spearman's test) between ten biochemical markers and their ratios with different stages of PBC. The discriminative values were compared using areas under receiver operating characteristic (ROC) curves. RESULTS: The mean age of patients included in the study was 53.88 ± 10.59 years, including 104 females and 8 males. We found a statistically significant correlation between PBC stage and Aspartate aminotransferase (AST), Alanine aminotransferase (ALT) to platelet ratio (APRI), ALT/platelet count, AST/ALT, ALT/AST and ALT/Cholesterol ratios, with the values of Spearman's rho of 0.338, 0.476, 0.404, 0.356, 0.351 and 0.325, respectively. The best sensitivity and specificity was shown for AST/ALT, with an area under ROC of 0.660. CONCLUSION: Biochemical markers and their ratios do correlate with different sensitivity to and specificity of PBC disease stage. The use of biochemical markers and their ratios in clinical evaluation of PBC patients may reduce, but not eliminate, the need for liver biopsy.
文摘BACKGROUND Primary pancreatic lymphoma(PPL)is a rare tumor that mimics pancreatic adenocarcinoma,leading to diagnostic and therapeutic challenges.PPL accounts for 0.2%of all pancreatic tumors and is typically treated with chemotherapy.However,the long-term survival rates for PPL with chemotherapy and radiotherapy alone are unsatisfactory.Due to the improvements in pancreatic surgery,there is a need to reevaluate the treatment strategies for PPL.CASE SUMMARY A 62-year-old male presented to our clinic.A biopsy was unsuccessful,and the imaging was suggestive of pancreatic adenocarcinoma.Therefore,subtotal splenopancreatectomy was performed and histopathology was performed.He was then diagnosed with primary pancreatic diffuse large B-cell lymphoma.He received adjuvant chemotherapy and radiotherapy.Currently,the patient is alive with no evidence of disease 36 months after surgery.CONCLUSION The potential role of surgery in the treatment of PPL should be emphasized and added in the management protocol of early stage lymphoma.
文摘AIM： To search the pathophysiological mechanism of diarrhea based on daily stool weights, fecal electrolytes, osmotic gap and pH. METHODS： Seventy-six patients were included： 51 with microscopic colitis （MC） [40 with lymphocytic colitis （LC）; 11 with collagenous colitis （CC）], 7 with MC without diarrhea and 18 as a control group （CG）. They collected stool for 3 d. Sodium and potassium concentration were determined by flame photometry and chloride concentration by titration method of Schales. Fecal osmotic gap was calculated from the difference of osmolarity of fecal fluid and double sum of sodium and potassium concentration. RESULTS： Fecal fluid sodium concentration was significantly increased in LC 58.11±5.38 mmol/L （P〈0.01） and CC 54.14±8.42 mmol/L （P〈0.05） than in CG 34.28±2.98 mmol/L. Potassium concentration in LC 74.65±5.29 mmol/L （P〈0.01） and CC 75.53±8.78 mmol/L （P〈0.05） was significantly less compared to CG 92.67±2.99 mmol/L. Chloride concentration in CC 36.07±7.29 mmol/L was significantly higher than in CG 24.11±2.05 mmol/L（P〈0.05）. Forty-four （86.7%） patients had a secretory diarrhea compared to fecal osmotic gap. Seven （13.3%） patients had osmotic diarrhea. CONCLUSION： Diarrhea in MC mostly belongs to thesecretory type. The major pathophysiological mechanism in LC could be explained by a decrease of active sodium absorption. In CC, decreased CI/HCO3 exchange rate and increased chloride secretion are coexistent pathways.
基金support from the Neutron computer cluster from the Department of Physics, City University of Hong Kong
文摘Energy spectra of neutrons are important for identification of unknown neutron sources and for determination of the equivalent dose. Although standard energy spectra of neutrons are available in some situations, e.g., for some radiotherapy treatment machines, they are unknown in other cases, e.g., for photoneutrons created in radiotherapy rooms and neutrons generated in nuclear reactors. In situations where neutron energy spectra need to be determined, unfolding the required neutron energy spectra using the Bonner sphere spectrometer (BSS) and nested neutron spectrometer (NNS) has been found promising. However, without any prior knowledge on the spectra, the unfolding process has remained a tedious task. In this work, a standalone numerical tool named ‘‘NRUunfold’’ was developed which could satisfactorily unfold neutron spectra for BSS or NNS, or any other systems using similar detection methodology. A generic and versatile algorithm based on maximum-likelihood expectation– maximization method was developed and benchmarked against the widely used STAY’SL algorithm which was based on the least squares method. The present method could output decent results in the absence of precisely calculated initial guess, although it was also remarked that employment of exceptionally bizarre initial spectra could lead to some unreasonable output spectra. The neutron count rates computed using the manufacturer’s response functions were used for sensitivity studies. The present NRUunfold code could be useful for neutron energy spectrum unfolding for BSS or NNS applications in the absence of a precisely calculated initial guess.
文摘Retrorectal, developmental tail gut cysts, include dermoid cysts, rectal duplication cysts and retrorectal cyst-hamartomas. Retrorectal cyst-hamartomas （RCH） are derived from remnants of the tail gut, the most caudal part of the embryonic hincl gut, which normally involutes by the 8^th wk of embryonic development （3-8 mm stage）. They have specific radiological and histopathological features that distinguish them from other similar formations （dermoid cysts, enteric duplication cysts and teratomas）. We report a patient with adenosquamous carcinoma arising within RCH, who underwent complete resection of the cyst through anterior laparotomy, and reached complete （recurrencefree for 14 mo, so far） functional recovery. The cyst was incidentally discovered during hysterectomy 12 years ago. Diagnostic, therapeutic arid histopathological aspects of this rare case are discussed. The mentioned pedod between diagnosis and surgical treatment suggests that RCH, given enough time, can develop malignant degeneration, and should be resected at the time of diagnosis.
基金Projects(34005,172037)supported by the Ministry of Education,Science and Technological Development of the Republic of Serbia
文摘The thermodynamic properties and the microstructure, hardness and electrical conductivity of shape memory alloys （SMAs） belonging to ternary Cu？Al？Zn system were studied by Muggianu model and experiment, respectively. The isothermal section of phase diagram at 293 K was calculated using Thermo-Calc software. Experiments were conducted by X-ray diffraction, light optic microscopy, scanning electron microscopy with energy dispersive X-ray spectrometry, hardness and electrical conductivity measurements. The calculated values of thermodynamic properties indicate that Cu shows good miscibility with Al and Zn in all investigated alloys. The microstructural analysis of samples reveals that the structure consists of large and polygonal grains.
基金the National Natural Science Foundation of China under Grant No.61973150the Young Taishan Scholars Program of Shandong Province of China under Grant No.tsqn20161043+1 种基金Shandong Provincial Natural Science Foundation for Distinguished Young Scholars under Grant No.ZR2019JQ22Shandong Province Higher Educational Excellent Youth Innovation team under Grant No.2019KJN017。
文摘A new prescribed-time state-feedback design is presented for stochastic nonlinear strictfeedback systems.Different from the existing stochastic prescribed-time design where scaling-free quartic Lyapunov functions or scaled quadratic Lyapunov functions are used,the design is based on new scaled quartic Lyapunov functions.The designed controller can ensure that the plant has an almost surely unique strong solution and the equilibrium at the origin of the plant is prescribed-time mean-square stable.After that,the authors redesign the controller to solve the prescribed-time inverse optimal mean-square stabilization problem.The merit of the design is that the order of the scaling function in the controller is reduced dramatically,which effectively reduces the control effort.Two simulation examples are given to illustrate the designs.
文摘The effect of Y203 and the total oxide volume fraction (Y203+AI203) on density and mechanical properties of low temperature (1770-1940℃) pressureless sintered β-SiC ceramics were presented. The optimum temperature for pressureless sintering of β-SiC was found to be -1850℃ and the optimum content of Y203 in the oxides was found to be between 40 and 57 wt pct. The highest sintered density was achieved by adding oxides at 14 vol. pct. Both of the highest strength and fracture toughness were achieved at -14 vol. pct oxide addition and yttria concentrations between 40 and 57 wt pct in the oxides. Hardness, on the other hand, was found to be the highest for samples with 14 vol. pct oxide addition and -64 wt pct Y2O3 in oxides.
文摘Overcoming the global sustainability challenges of logistics requires applying solutions that minimize the negative effects of logistics activities.The most efficient way of doing so is through intermodal transportation(IT).Current IT systems rely mostly on road,rail,and sea transport,not inland waterway transport.Developing dry port(DP)terminals has been proven as a sustainable means of promoting and utilizing IT in the hinterland of seaport container terminals.Conventional DP systems consolidate container flows from/to seaports and integrate road and rail transportation modes in the hinterland which improves the sustainability of the whole logistics system.In this article,to extend literature on the sustainable development of different categories of IT terminals,especially DPs,and their varying roles,we examine the possibility of developing DP terminals within the framework of inland waterway container terminals(IWCTs).Establishing combined road–rail–inland waterway transport for observed container flows is expected to make the IT systems sustainable.As such,this article is the first to address the modelling of such DP systems.After mathematically formulating the problem of modelling DP systems,which entailed determining the number and location of DP terminals for IWCTs,their capacity,and their allocation of container flows,we solved the problem with a hybrid metaheuristic model based on the Bee Colony Optimisation(BCO)algorithmand themeasurement of alternatives and ranking according to compromise solution(i.e.,MARCOS)multi-criteria decision-making method.The results from our case study of the Danube region suggest that planning and developingDP terminals in the framework of IWCTs can indeed be sustainable,as well as contribute to the development of logistics networks,the regionalisation of river ports,and the geographic expansion of their hinterlands.Thus,the main contributions of this article are in proposing a novel DP concept variant,mathematically formulating the problems of its modelling,and developin
文摘Genotyping of 2 well-known weevil species from the genus Ceutorhynchus （Coleoptera： Curculionidae） distributed in west Palearctic, C. erysimi and C. contractus, revealed phenotype versus genotype inconsistencies in a set of 56 specimens （25 C. erysimi and 31 C. contractus） collected from 25 locations in Serbia and Montenegro. An analysis of the mitochondrial cytochrome oxidase subunit I gene （CO1）, widely used as a barcoding region, and a nuclear gene, elongation factor-v （EF-1α）, revealed stable genetic divergence among these species. The average uncorrected pairwise distances for the CO1 and EF-1α genes were 3.8%, and 1.3%, respectively, indicating 2 genetically well-segregated species. However, the genetic data were not congruent with the phenotypic characteristics of the studied specimens. In the first place, C. erysimi genotypes were attached to specimens with phenotypic characteristics of C. contractus. Species-specific PCR-RFLP assays for the barcoding gene COIwere applied for the molecular identification of 101 additional specimens of both morphospecies （33 C. erysimi and 68 C. contractus） and were found to confirm this incongruity. The discrepancy between the genetic and morphological data raises the question of the accuracy of using a barcoding approach, as it may result in misleading conclusions about the taxonomic position of the studied organism. Additionally, the typological species concept shows considerable weakness when genetic data are not supported with phenotypic characteristics as in case of asymmetric introgression, which may cause certain problems, especially in applied studies such as biological control programs in which the biological properties of the studied organisms are the main focus.
文摘Enteropathy-associated T-cell lymphoma （EATCL） is a high grade, pleomorphic peripheral T-cell lymphoma usually with cytotoxic phenotypes. We describe a first case of patient with EATCL that is remarkable for its fulminant course and invasion of both kidneys manifested as acute renal failure. The patient was a 23 year old woman with a long history of celiac disease. She was presented with acute renal failure and enlarged mononuclear infiltrated kidneys. Diagnosis of tubuloi-nterstitial nephritis and polyserositis was confirmed with consecutive pulse doses of steroid therapy. After reco-very, she had disseminated disease two months later. Magnetic resonance imaging showed thickened intestine wall, extremely augmented kidneys, enlarged intra-abdominal lymph nodes with extra-luminal compression of common bile duct. Laparotomy with mesenterial adipous tissue and lymph glands biopsy was done. Consecutive pathophysiological and immunohistochemical analyses confirmed the diagnosis of EATCL： CD45RO＋, CD43＋, CD3＋. The revision of renal pathophysiology sub-stantiated the diagnosis. The patient received chemotherapy, but unfortunately she died manifesting signs of pulmonary embolism caused by tumor cells.
文摘To present a patient diagnosed with pancreatic carcinoidthat was extremely rare and produced an atypical carcinoidsyndrome. We reported a 58-year old male patient whopresented with long standing, prominent cervicallymphadenopathy and occasional watery diarrhea.Pathohistologicaf and immunohistochemical examinationof lymph node biopsy showed a metastatic neuroendocrinetumor, which was histological type A of carcinoid (EMA+,cytokeratin+, CEA-, NSE+, chromogranin A+, synaptophysin+,insulin-). Bone marrow biopsy showed identical findings.Primary site of the tumor was pancreas and diagnosis wasmade according to cytological and immunocytochemicalanalysis of the tumor cells obtained with aspiration biopsyof pancreatic mass (12 mm in diameter) under endoscopicultrasound guidance. However, serotonin levels in bloodand urine samples were normal. It is difficulty to establishthe precise diagnosis of a "functionally inactive" pancreaticcarcinoid and aspiration biopsy of pancreatic tumor underendoscopic ultrasound guidance can be used as a newpotent diagnostic tool.
文摘Villous adenomas are benign epithelial lesions with malignant potential that can occur in any part of the gastrointestinal tract. We present a case of a middle age woman with acromegaly who was investigated for nonspecific gastrointestinal complaints. Ultrasonography and subsequent endosonography diagnosed a large （4.5 cm）, hyperechoic, sessile polyp with numerous pedicles. An open cholecystectomy was performed and revealed a villous adenoma with several foci of carcinoma in situ. Detailed investigations showed no other tumors of the gastrointestinal tract. After five years of follo up, the patient reports no complaints, and the results of laboratory testing and imaging studies are within the normal range.
基金This work is supported by the National Natural Science Foundation of China[grant numbers 61074011 and 61374077].
文摘We consider the stabilisation of discrete-time nonlinear systems that are actuated through a pair of transport partial difference equation(PdE)systems that convect in the opposite directions from one another.An explicit feedback law that compensates the discrete PdE dynamics is designed.Global asymptotic stability of the closedloop system is proved with the aid of a Lyapunov function.The feedback design is illustrated through an example.The proposed design in this paper allows the delay to be arbitrarily long and time-varying.Furthermore,our predictor feedback law in discrete time is explicit as the predictor state is computed by an algebraic equation.
