The gut microbiota acts as a real organ. The symbiotic interactions between resident micro-organisms and the digestive tract highly contribute to maintain the gut homeostasis. However, alterations to the microbiome ca...The gut microbiota acts as a real organ. The symbiotic interactions between resident micro-organisms and the digestive tract highly contribute to maintain the gut homeostasis. However, alterations to the microbiome caused by environmental changes(e.g., infection, diet and/or lifestyle) can disturb this symbiotic relationship and promote disease, such as inflammatory bowel diseases and cancer. Colorectal cancer is a complex association of tumoral cells, non-neoplastic cells and a large amount of micro-organisms, and the involvement of the microbiota in colorectal carcinogenesis is becoming increasingly clear. Indeed, many changes in the bacterial composition of the gut microbiota have been reported in colorectal cancer, suggesting a major role of dysbiosis in colorectal carcinogenesis. Some bacterial species have been identified and suspected to play a role in colorectal carcinogenesis, such as Streptococcus bovis, Helicobacter pylori, Bacteroides fragilis, Enterococcus faecalis, Clostridium septicum, Fusobacterium spp. and Escherichia coli. The potential pro-carcinogenic effects of these bacteria are now better understood. In this review, we discuss the possible links between the bacterial microbiota and colorectal carcinogenesis, focusing on dysbiosis and the potential pro-carcinogenic properties of bacteria, such as genotoxicity and other virulence factors, inflammation, host defenses modulation, bacterial derived metabolism, oxidative stress and anti-oxidative defenses modulation. We lastly describe how bacterial microbiota modifications could represent novel prognosis markers and/or targets for innovative therapeutic strategies.展开更多
The outbreak of Coronavirus Disease 2019(COVID-19)has posed a serious threat to global public health,calling for the development of safe and effective prophylactics and therapeutics against infection of its causative ...The outbreak of Coronavirus Disease 2019(COVID-19)has posed a serious threat to global public health,calling for the development of safe and effective prophylactics and therapeutics against infection of its causative agent,severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),also known as 2019 novel coronavirus(2019-nCoV).The CoV spike(S)protein plays the most important roles in viral attachment,fusion and entry,and serves as a target for development of antibodies,entry inhibitors and vaccines.Here,we identified the receptor-binding domain(RBD)in SARS-CoV-2 S protein and found that the RBD protein bound strongly to human and bat angiotensin-converting enzyme 2(ACE2)receptors.SARS-CoV-2 RBD exhibited significantly higher binding affinity to ACE2 receptor than SARS-CoV RBD and could block the binding and,hence,attachment of SARS-CoV-2 RBD and SARS-CoV RBD to ACE2-expressing cells,thus inhibiting their infection to host cells.SARS-CoV RBD-specific antibodies could crossreact with SARS-CoV-2 RBD protein,and SARS-CoV RBD-induced antisera could cross-neutralize SARS-CoV-2,suggesting the potential to develop SARS-CoV RBD-based vaccines for prevention of SARS-CoV-2 and SARS-CoV infection.展开更多
The first seedling or all-stage resistance （R） R gene against stripe rust isolated from Moro wheat （Triticum aes- tivum L.） using a map-based cloning approach was identified as Yr10. Clone 4B of this gene encodes ...The first seedling or all-stage resistance （R） R gene against stripe rust isolated from Moro wheat （Triticum aes- tivum L.） using a map-based cloning approach was identified as Yr10. Clone 4B of this gene encodes a highly evolutionary- conserved and unique CC-NBS-LRR sequence. Clone 4E, a homolog of Yr10, but lacking transcription start site （TSS） and putative TATA-box and CAAT-box, is likely a non-expressed pseudogene. Clones 4B and 4E are 84% identical and divergent in the intron and the LRR domain. Gene silencing and transgenesis were used in conjunction with inoculation with differen- tially avirulent and virulent stripe rust strains to demonstrate Yr10 functionality. The Yr10 CC-NBS-LRR sequence is unique among known CC-NBS-LRR R genes in wheat but highly conserved homologs （E = 0.0） were identified in Aegilops tauschii and other monocots including Hordeum vulgare and Brachypodium distachyon. Related sequences were also identified in genomic databases of maize, rice, and in sorghum. This is the first report of a CC-NBS-LRR resistance gene in plants with limited homologies in its native host, but with numerous homologous R genes in related monocots that are either host or non-hosts for stripe rust. These results represent a unique example of gene evolution and dispersion across species.展开更多
Angiogenesis consists of the sprouting of capillaries from pre-existing vessels. It is well-known that tumor growth is angiogenesis-dependent. Vascular endothelial growth factor （VEGF） and basic fibroblast growth fa...Angiogenesis consists of the sprouting of capillaries from pre-existing vessels. It is well-known that tumor growth is angiogenesis-dependent. Vascular endothelial growth factor （VEGF） and basic fibroblast growth factor （bFGF） stimulated vascular endothelial cell proliferation and are involved in the neoplastic angiogenesis of several types of tumors including those of the intestinal tract. Authors usually investigated VEGF and using immunohistochemistry bFGF protein expressions or Western blotting and VEGF and bFGF transcripts using reverse transcriptase Dolymerase chain reaction （RT-PCR）.展开更多
Acute variceal hemorrhage,a life-threatening condition that requires a multidisciplinary approach for effective therapy,is defined as visible bleeding from an esophageal or gastric varix at the time of endoscopy,the p...Acute variceal hemorrhage,a life-threatening condition that requires a multidisciplinary approach for effective therapy,is defined as visible bleeding from an esophageal or gastric varix at the time of endoscopy,the presence of large esophageal varices with recent stigmata of bleeding,or fresh blood visible in the stomach with no other source of bleeding identified.Transfusion of blood products,pharmacological treatments and early endoscopic therapy are often effective;however,if primary hemostasis cannot be obtained or if uncontrollable early rebleeding occurs,transjugular intrahepatic portosystemic shunt(TIPS)is recommended as rescue treatment.The TIPS represents a major advance in the treatment of complications of portal hypertension.Acute variceal hemorrhage that is poorly controlled with endoscopic therapy is generally well controlled with TIPS,which has a 90%to 100%success rate.However,TIPS is associated with a mortality of 30%to 50%in such a setting.Emergency TIPS should be considered early in patients with refractory variceal bleeding once medical treatment and endoscopic sclerotherapy failure,before the clinical condition worsens.Furthermore,admission to specialized centers is mandatory in such a setting and regional protocols are essential to be organized effectively.This review article discusses initial management and then focuses on the specific role of TIPS as a primary therapy to control acute variceal hemorrhage,particularly as a rescue therapy following failure of endoscopic approaches.展开更多
This paper proposes an optimal day-ahead opti-mization schedule for gas-electric integrated energy system(IES)considering the bi-directional energy flow.The hourly topology of electric power system(EPS),natural gas sy...This paper proposes an optimal day-ahead opti-mization schedule for gas-electric integrated energy system(IES)considering the bi-directional energy flow.The hourly topology of electric power system(EPS),natural gas system(NGS),energy hubs(EH)integrated power to gas(P2G)unit,are modeled to minimize the day-ahead operation cost of IES.Then,a second-order cone programming(SOCP)method is utilized to solve the optimization problem,which is actually a mixed integer nonconvex and nonlinear programming issue.Besides,cutting planes are added to ensure the exactness of the global optimal solution.Finally,simulation results demonstrate that the proposed optimization schedule can provide a safe,effective and economical day-ahead scheduling scheme for gas-electric IES.展开更多
Acute calculous cholecystitis(ACC) is the most frequent complication of cholelithiasis and represents one-third of all surgical emergency hospital admissions, many aspects of the disease are still a matter of debate. ...Acute calculous cholecystitis(ACC) is the most frequent complication of cholelithiasis and represents one-third of all surgical emergency hospital admissions, many aspects of the disease are still a matter of debate. Knowledge of the current evidence may allow the surgical team to develop practical bedside decision-making strategies, aiming at a less demanding procedure and lower frequency of complications. In this regard, recommendations on the diagnosis supported by specific criteria and severity scores are being implemented, to prioritize patients eligible for urgency surgery. Laparoscopic cholecystectomy is the best treatment for ACC and the procedure should ideally be performed within 72h. Early surgery is associated with better results in comparison to delayed surgery. In addition, when to suspect associated common bile duct stones and how to treat them when found are still debated. The antimicrobial agents are indicated for high-risk patients and especially in the presence of gallbladder necrosis. The use of broad-spectrum antibiotics and in some cases with antifungal agents is related to better prognosis. Moreover, an emerging strategy of not converting to open, a difficult laparoscopic cholecystectomy and performing a subtotal cholecystectomy is recommended by adept surgical teams. Some authors support the use of percutaneous cholecystostomy as an alternative emergency treatment for acute Cholecystitis for patients with severe comorbidities.展开更多
Chronic hepatitis B(CHB)is a significant public health problem worldwide.The aim of the present review is to summarize the actual trends in the management of CHB in pregnant women.The prevalence of hepatitis B virus(H...Chronic hepatitis B(CHB)is a significant public health problem worldwide.The aim of the present review is to summarize the actual trends in the management of CHB in pregnant women.The prevalence of hepatitis B virus(HBV)infection in pregnant women is usually comparable to that in the general population in the corresponding geographic area.All women have to be screened for hepatitis B surface antigen(HBsAg)during pregnancy.Additional examinations of pregnant women with CHB may include maternal hepatitis B e antigen,HBV viral load,alanine aminotransferase level,and HBsAg level.The management of pregnancy depends on the phase of the HBV infection,which has to be determined before pregnancy.In women of childbearing age with CHB,antiviral therapy can pursue two main goals:Treatment of active CHB,and vertical transmission prevention.During pregnancy,tenofovir is the drug of choice in both cases.A combination of hepatitis B immunoglobulin and vaccine against hepatitis B should be administered within the first 12 h to all infants born to mothers with CHB.In such cases,there are no contraindications to breastfeeding.展开更多
AIM To investigate the role of minimally invasive surgery for gastric cancer and determine surgical, clinical, and oncological outcomes.METHODS This is a propensity score-matched case-control study, comparing three tr...AIM To investigate the role of minimally invasive surgery for gastric cancer and determine surgical, clinical, and oncological outcomes.METHODS This is a propensity score-matched case-control study, comparing three treatment arms: robotic gastrectomy(RG), laparoscopic gastrectomy(LG), open gastrectomy(OG). Data collection started after sharing a specific study protocol. Data were recorded through a tailored and protected web-based system. Primary outcomes: harvested lymph nodes, estimated blood loss, hospital stay, complications rate. Among the secondary outcomes, there are: operative time, R0 resections, POD of mobilization, POD of starting liquid diet and soft solid diet. The analysis includes the evaluation of type and grade of postoperative complications. Detailed information of anastomotic leakages is also provided.RESULTS The present analysis was carried out of 1026 gastrectomies. To guarantee homogenous distribution of cases, patients in the RG, LG and OG groups were 1:1:2 matched using a propensity score analysis with a caliper = 0.2. The successful matching resulted in a total sample of 604 patients(RG = 151; LG = 151; OG = 302). The three groups showed no differences in all baseline patients characteristics, type of surgery(P = 0.42) and stage of the disease(P = 0.16). Intraoperative blood loss was significantly lower in the LG(95.93 ± 119.22) and RG(117.91 ± 68.11) groups compared to the OG(127.26 ± 79.50, P = 0.002). The mean number of retrieved lymph nodes was similar between the RG(27.78 ± 11.45), LG(24.58 ± 13.56) and OG(25.82 ± 12.07) approach. A benefit in favor of the minimally invasive approaches was found in the length of hospital stay(P < 0.0001). A similar complications rate was found(P = 0.13). The leakage rate was not different(P = 0.78) between groups.CONCLUSION Laparoscopic and robotic surgery can be safely performed and proposed as possible alternative to open surgery. The main highlighted benefit is a faster postoperative functional recovery.展开更多
Melanoma is the most aggressive form of skin cancer.Disrupted intracellular signaling pathways are responsible for melanoma's extraordinary resistance to current chemotherapeutic modalities. The pathophysiologic b...Melanoma is the most aggressive form of skin cancer.Disrupted intracellular signaling pathways are responsible for melanoma's extraordinary resistance to current chemotherapeutic modalities. The pathophysiologic basis for resistance to both chemo- and radiation therapy is rooted in altered genetic and epigenetic mechanisms that, in turn, result in the impairing of cell death machinery and/or excessive activation of cell growth and survival-dependent pathways. Although most current melanoma therapies target mitochondrial dysregulation,there is increasing evidence that endoplasmic reticulum(ER) stress-associated pathways play a role in the potentiation,initiation and maintenance of cell death machinery and autophagy. This review focuses on the reliability of ER-associated pathways as therapeutic targets for melanoma treatment.展开更多
In recent years,the penetration of renewable resources into AC power systems has increased tremendously,creating a significantly impact on the latter’s operations and stability.In this respect,it is also important to...In recent years,the penetration of renewable resources into AC power systems has increased tremendously,creating a significantly impact on the latter’s operations and stability.In this respect,it is also important to gain a basic analytical understanding of such impact on the steady-state stability of power systems with electrically weak AC/DC interconnections,but such works are not very evident in the literature.Therefore,a classical analytic model of the single and multi-infeed HVDC system which now incorporates renewable resources is proposed.Then the well-established concept of voltage sensitivity of the AC/DC interconnection is applied to analyze the impact of the renewable resources on the steady-state stability of these composite system models,as well as on the influence of system conditions and parameters.This impact is also compared with that arising from other types of shunt devices alternatively connected at the same AC/DC interconnection,therefore their relative beneficial or negative impacts will also be benchmarked.展开更多
Complex thin-walled titanium alloy components play a key role in the aircraft,aerospace and marine industries,offering the advantages of reduced weight and increased thermal resistance.The geometrical complexity,dimen...Complex thin-walled titanium alloy components play a key role in the aircraft,aerospace and marine industries,offering the advantages of reduced weight and increased thermal resistance.The geometrical complexity,dimensional accuracy and in-service properties are essential to fulfill the high-performance standards required in new transportation systems,which brings new challenges to titanium alloy forming technologies.Traditional forming processes,such as superplastic forming or hot pressing,cannot meet all demands of modern applications due to their limited properties,low productivity and high cost.This has encouraged industry and research groups to develop novel high-efficiency forming processes.Hot gas pressure forming and hot stamping-quenching technologies have been developed for the manufacture of tubular and panel components,and are believed to be the cut-edge processes guaranteeing dimensional accuracy,microstructure and mechanical properties.This article intends to provide a critical review of high-efficiency titanium alloy forming processes,concentrating on latest investigations of controlling dimensional accuracy,microstructure and properties.The advantages and limitations of individual forming process are comprehensively analyzed,through which,future research trends of high-efficiency forming are identified including trends in process integration,processing window design,full cycle and multi-objective optimization.This review aims to provide a guide for researchers and process designers on the manufacture of thin-walled titanium alloy components whilst achieving high dimensional accuracy and satisfying performance properties with high efficiency and low cost.展开更多
Visceral artery aneurysms(VAA) include splanchnic and renal artery aneurysms. They represent a rare clinical entity, although their detection is rising due to an increased use of cross-sectional imaging. Rupture is th...Visceral artery aneurysms(VAA) include splanchnic and renal artery aneurysms. They represent a rare clinical entity, although their detection is rising due to an increased use of cross-sectional imaging. Rupture is the most devastating complication, and is associated with a high morbidity and mortality. In addition, increased percutaneous endovascular interventions have raised the incidence of iatrogenic visceral artery pseudoaneurysms(VAPAs). For this reason, elective repair is preferable in the appropriately chosen patient. Controversy still exists regarding their treatment. Over the past decade, there has been steady increase in the utilization of minimally invasive, non-operative interventions, for vascular aneurysmal disease. All VAAs and VAPAs can technically be fixed by endovascular techniques but that does not mean they should. These catheter-based techniques constitute an excellent approach in the elective setting. However, in the emergent setting it may carry a higher morbidity and mortality. The decision for intervention has to take into account the size and the natural history of the lesion, the risk of rupture, which is high during pregnancy, and the relative risk of surgical or radiological intervention. For splanchnic artery aneurysms, we should recognize that we are not, in reality, well informed about their natural history. For most asymptomatic aneurysms, expectant treatment is acceptable. For large, symptomatic or aneurysms with a high risk of rupture, endovascular treatment has become the firstline therapy. Treatment of VAPAs is always mandatory because of the high risk of rupture. We present our point of view on interventional radiology in the splanchnic arteries, focusing on what has been achieved and the remaining challenges.展开更多
AIM: To provide further insight into the characterization of mucosa-associated Escherichia coli (E. coli) isolated from the colonic mucosa of cancer patients.
The mirror neuron system consists of a set of brain areas capable of matching action observation with action execution. One core feature of the mirror neuron system is the activation of motor areas by action observati...The mirror neuron system consists of a set of brain areas capable of matching action observation with action execution. One core feature of the mirror neuron system is the activation of motor areas by action observation alone. This unique capacity of the mirror neuron system to match action perception and action execution stimulated the idea that mirror neuron system plays a crucial role in the understanding of the content of observed actions and may participate in procedural learning. These features bear a high potential for neurorehabilitation of motor deficits and of aphasia following stroke. Since the first articles exploring this principle were published, a growing number of follow-up studies have been conducted in the last decade. Though, the combination of action observation with practice of the observed actions seems to constitute the most powerful approach. In the present review, we present the existing studies analyzing the effects of this neurorehabJlitative approach in clinical settings especially in the rehabilitation of stroke associated motor deficits and give a perspective on the ongoing trials by our research group. The data obtained up to date showed significant positive effect of action observation on recovery of motor functions of the upper limbs even in the chronic state after stroke, indicating that our approach might become a new standardized add-on feature of modern neurorehabilitative treatment schemes.展开更多
AIM: To investigate the molecular or cellular mechanisms related to the infection of epithelial colonic mucosa by pks-positive Escherichia coli(E. coli) using optical imaging.METHODS: We choose to evaluate the tumor m...AIM: To investigate the molecular or cellular mechanisms related to the infection of epithelial colonic mucosa by pks-positive Escherichia coli(E. coli) using optical imaging.METHODS: We choose to evaluate the tumor metabolic activity using a fluorodeoxyglucose analogue as 2-deoxyglucosone fluorescent probes and to correlate it with tumoral volume(mm^3). Inflammation measuring myeloperoxidase(MPO) activity and reactive oxygen species production was monitored by a bioluminescent(BLI) inflammation probe and related to histological examination and MPO levels by enzyme-linked immunosorbent assay(ELISA) on tumor specimens. The detection and quantitation of these two signals were validated on a xenograft model of human colon adenocarcinoma epithelial cells(HCT116) in nude mice infected with a pks-positive E. coli. The inflammatory BLI signal was validated intra-digestively in the colitisCEABAC10 DSS models, which mimicked Crohn's disease. RESULTS: Using a 2-deoxyglucosone fluorescent probe, we observed a high and specific HCT116 tumor uptake in correlation with tumoral volume(P = 0.0036). Using the inflammation probe targeting MPO, we detected a rapid systemic elimination and a significant increase of the BLI signal in the pks-positive E. coli-infected HCT116 xenograft group(P < 0.005). ELISA confirmed that MPO levels were significantly higher(1556 ± 313.6 vs 234.6 ± 121.6 ng/m L P = 0.001) in xenografts infected with the pathogenic E. coli strain. Moreover, histological examination of tumor samples confirmed massive infiltration of pks-positive E. coli-infected HCT116 tumors by inflammatory cells compared to the uninfected group. These data showed that infection with the pathogenic E. coli strain enhanced inflammation and ROS production in tumors before tumor growth. Moreover, we demonstrated that the intra-digestive monitoring of inflammation is feasible in a reference colitis murine model(CEABAC10/DSS).CONCLUSION: Using BLI and fluorescence optical imaging, we provided tools to better understand hostpathogen inter展开更多
基金Supported by Inserm and Universitéd’Auvergne(UMR 1071)INRA(USC-2018)+1 种基金grants from“Conseil regional d’Auvergne”“Nuovo Soldati Foundation for Cancer Research”and“Fondation pour la recherche médicale”
文摘The gut microbiota acts as a real organ. The symbiotic interactions between resident micro-organisms and the digestive tract highly contribute to maintain the gut homeostasis. However, alterations to the microbiome caused by environmental changes(e.g., infection, diet and/or lifestyle) can disturb this symbiotic relationship and promote disease, such as inflammatory bowel diseases and cancer. Colorectal cancer is a complex association of tumoral cells, non-neoplastic cells and a large amount of micro-organisms, and the involvement of the microbiota in colorectal carcinogenesis is becoming increasingly clear. Indeed, many changes in the bacterial composition of the gut microbiota have been reported in colorectal cancer, suggesting a major role of dysbiosis in colorectal carcinogenesis. Some bacterial species have been identified and suspected to play a role in colorectal carcinogenesis, such as Streptococcus bovis, Helicobacter pylori, Bacteroides fragilis, Enterococcus faecalis, Clostridium septicum, Fusobacterium spp. and Escherichia coli. The potential pro-carcinogenic effects of these bacteria are now better understood. In this review, we discuss the possible links between the bacterial microbiota and colorectal carcinogenesis, focusing on dysbiosis and the potential pro-carcinogenic properties of bacteria, such as genotoxicity and other virulence factors, inflammation, host defenses modulation, bacterial derived metabolism, oxidative stress and anti-oxidative defenses modulation. We lastly describe how bacterial microbiota modifications could represent novel prognosis markers and/or targets for innovative therapeutic strategies.
基金supported by the NIH grants(R01AI137472 and R01AI139092)intramural funds of the New York Blood Center(VIM-NYB616 and CFM-NYB595).
文摘The outbreak of Coronavirus Disease 2019(COVID-19)has posed a serious threat to global public health,calling for the development of safe and effective prophylactics and therapeutics against infection of its causative agent,severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),also known as 2019 novel coronavirus(2019-nCoV).The CoV spike(S)protein plays the most important roles in viral attachment,fusion and entry,and serves as a target for development of antibodies,entry inhibitors and vaccines.Here,we identified the receptor-binding domain(RBD)in SARS-CoV-2 S protein and found that the RBD protein bound strongly to human and bat angiotensin-converting enzyme 2(ACE2)receptors.SARS-CoV-2 RBD exhibited significantly higher binding affinity to ACE2 receptor than SARS-CoV RBD and could block the binding and,hence,attachment of SARS-CoV-2 RBD and SARS-CoV RBD to ACE2-expressing cells,thus inhibiting their infection to host cells.SARS-CoV RBD-specific antibodies could crossreact with SARS-CoV-2 RBD protein,and SARS-CoV RBD-induced antisera could cross-neutralize SARS-CoV-2,suggesting the potential to develop SARS-CoV RBD-based vaccines for prevention of SARS-CoV-2 and SARS-CoV infection.
文摘The first seedling or all-stage resistance （R） R gene against stripe rust isolated from Moro wheat （Triticum aes- tivum L.） using a map-based cloning approach was identified as Yr10. Clone 4B of this gene encodes a highly evolutionary- conserved and unique CC-NBS-LRR sequence. Clone 4E, a homolog of Yr10, but lacking transcription start site （TSS） and putative TATA-box and CAAT-box, is likely a non-expressed pseudogene. Clones 4B and 4E are 84% identical and divergent in the intron and the LRR domain. Gene silencing and transgenesis were used in conjunction with inoculation with differen- tially avirulent and virulent stripe rust strains to demonstrate Yr10 functionality. The Yr10 CC-NBS-LRR sequence is unique among known CC-NBS-LRR R genes in wheat but highly conserved homologs （E = 0.0） were identified in Aegilops tauschii and other monocots including Hordeum vulgare and Brachypodium distachyon. Related sequences were also identified in genomic databases of maize, rice, and in sorghum. This is the first report of a CC-NBS-LRR resistance gene in plants with limited homologies in its native host, but with numerous homologous R genes in related monocots that are either host or non-hosts for stripe rust. These results represent a unique example of gene evolution and dispersion across species.
基金Supported by La Ligue Nationale Francaise Contre le Cancer (Comitéde la Corrèze et de la Haute Vienne)
文摘Angiogenesis consists of the sprouting of capillaries from pre-existing vessels. It is well-known that tumor growth is angiogenesis-dependent. Vascular endothelial growth factor （VEGF） and basic fibroblast growth factor （bFGF） stimulated vascular endothelial cell proliferation and are involved in the neoplastic angiogenesis of several types of tumors including those of the intestinal tract. Authors usually investigated VEGF and using immunohistochemistry bFGF protein expressions or Western blotting and VEGF and bFGF transcripts using reverse transcriptase Dolymerase chain reaction （RT-PCR）.
文摘Acute variceal hemorrhage,a life-threatening condition that requires a multidisciplinary approach for effective therapy,is defined as visible bleeding from an esophageal or gastric varix at the time of endoscopy,the presence of large esophageal varices with recent stigmata of bleeding,or fresh blood visible in the stomach with no other source of bleeding identified.Transfusion of blood products,pharmacological treatments and early endoscopic therapy are often effective;however,if primary hemostasis cannot be obtained or if uncontrollable early rebleeding occurs,transjugular intrahepatic portosystemic shunt(TIPS)is recommended as rescue treatment.The TIPS represents a major advance in the treatment of complications of portal hypertension.Acute variceal hemorrhage that is poorly controlled with endoscopic therapy is generally well controlled with TIPS,which has a 90%to 100%success rate.However,TIPS is associated with a mortality of 30%to 50%in such a setting.Emergency TIPS should be considered early in patients with refractory variceal bleeding once medical treatment and endoscopic sclerotherapy failure,before the clinical condition worsens.Furthermore,admission to specialized centers is mandatory in such a setting and regional protocols are essential to be organized effectively.This review article discusses initial management and then focuses on the specific role of TIPS as a primary therapy to control acute variceal hemorrhage,particularly as a rescue therapy following failure of endoscopic approaches.
基金This work was supported in part by the National Natural Science Foundation of China under Grants 61673161 and 51807134and in part by the program of fundamental research of the Siberian Branch of Russian Academy of Sciences and carried out within the framework of the research project III.17.3.1,Reg.No.AAAA-A17-117030310442-8.
文摘This paper proposes an optimal day-ahead opti-mization schedule for gas-electric integrated energy system(IES)considering the bi-directional energy flow.The hourly topology of electric power system(EPS),natural gas system(NGS),energy hubs(EH)integrated power to gas(P2G)unit,are modeled to minimize the day-ahead operation cost of IES.Then,a second-order cone programming(SOCP)method is utilized to solve the optimization problem,which is actually a mixed integer nonconvex and nonlinear programming issue.Besides,cutting planes are added to ensure the exactness of the global optimal solution.Finally,simulation results demonstrate that the proposed optimization schedule can provide a safe,effective and economical day-ahead scheduling scheme for gas-electric IES.
文摘Acute calculous cholecystitis(ACC) is the most frequent complication of cholelithiasis and represents one-third of all surgical emergency hospital admissions, many aspects of the disease are still a matter of debate. Knowledge of the current evidence may allow the surgical team to develop practical bedside decision-making strategies, aiming at a less demanding procedure and lower frequency of complications. In this regard, recommendations on the diagnosis supported by specific criteria and severity scores are being implemented, to prioritize patients eligible for urgency surgery. Laparoscopic cholecystectomy is the best treatment for ACC and the procedure should ideally be performed within 72h. Early surgery is associated with better results in comparison to delayed surgery. In addition, when to suspect associated common bile duct stones and how to treat them when found are still debated. The antimicrobial agents are indicated for high-risk patients and especially in the presence of gallbladder necrosis. The use of broad-spectrum antibiotics and in some cases with antifungal agents is related to better prognosis. Moreover, an emerging strategy of not converting to open, a difficult laparoscopic cholecystectomy and performing a subtotal cholecystectomy is recommended by adept surgical teams. Some authors support the use of percutaneous cholecystostomy as an alternative emergency treatment for acute Cholecystitis for patients with severe comorbidities.
文摘Chronic hepatitis B(CHB)is a significant public health problem worldwide.The aim of the present review is to summarize the actual trends in the management of CHB in pregnant women.The prevalence of hepatitis B virus(HBV)infection in pregnant women is usually comparable to that in the general population in the corresponding geographic area.All women have to be screened for hepatitis B surface antigen(HBsAg)during pregnancy.Additional examinations of pregnant women with CHB may include maternal hepatitis B e antigen,HBV viral load,alanine aminotransferase level,and HBsAg level.The management of pregnancy depends on the phase of the HBV infection,which has to be determined before pregnancy.In women of childbearing age with CHB,antiviral therapy can pursue two main goals:Treatment of active CHB,and vertical transmission prevention.During pregnancy,tenofovir is the drug of choice in both cases.A combination of hepatitis B immunoglobulin and vaccine against hepatitis B should be administered within the first 12 h to all infants born to mothers with CHB.In such cases,there are no contraindications to breastfeeding.
基金Supported by CARIT Foundation(Fondazione Cassa di Risparmio di Terni e Narni),No.0024137
文摘AIM To investigate the role of minimally invasive surgery for gastric cancer and determine surgical, clinical, and oncological outcomes.METHODS This is a propensity score-matched case-control study, comparing three treatment arms: robotic gastrectomy(RG), laparoscopic gastrectomy(LG), open gastrectomy(OG). Data collection started after sharing a specific study protocol. Data were recorded through a tailored and protected web-based system. Primary outcomes: harvested lymph nodes, estimated blood loss, hospital stay, complications rate. Among the secondary outcomes, there are: operative time, R0 resections, POD of mobilization, POD of starting liquid diet and soft solid diet. The analysis includes the evaluation of type and grade of postoperative complications. Detailed information of anastomotic leakages is also provided.RESULTS The present analysis was carried out of 1026 gastrectomies. To guarantee homogenous distribution of cases, patients in the RG, LG and OG groups were 1:1:2 matched using a propensity score analysis with a caliper = 0.2. The successful matching resulted in a total sample of 604 patients(RG = 151; LG = 151; OG = 302). The three groups showed no differences in all baseline patients characteristics, type of surgery(P = 0.42) and stage of the disease(P = 0.16). Intraoperative blood loss was significantly lower in the LG(95.93 ± 119.22) and RG(117.91 ± 68.11) groups compared to the OG(127.26 ± 79.50, P = 0.002). The mean number of retrieved lymph nodes was similar between the RG(27.78 ± 11.45), LG(24.58 ± 13.56) and OG(25.82 ± 12.07) approach. A benefit in favor of the minimally invasive approaches was found in the length of hospital stay(P < 0.0001). A similar complications rate was found(P = 0.13). The leakage rate was not different(P = 0.78) between groups.CONCLUSION Laparoscopic and robotic surgery can be safely performed and proposed as possible alternative to open surgery. The main highlighted benefit is a faster postoperative functional recovery.
文摘Melanoma is the most aggressive form of skin cancer.Disrupted intracellular signaling pathways are responsible for melanoma's extraordinary resistance to current chemotherapeutic modalities. The pathophysiologic basis for resistance to both chemo- and radiation therapy is rooted in altered genetic and epigenetic mechanisms that, in turn, result in the impairing of cell death machinery and/or excessive activation of cell growth and survival-dependent pathways. Although most current melanoma therapies target mitochondrial dysregulation,there is increasing evidence that endoplasmic reticulum(ER) stress-associated pathways play a role in the potentiation,initiation and maintenance of cell death machinery and autophagy. This review focuses on the reliability of ER-associated pathways as therapeutic targets for melanoma treatment.
文摘In recent years,the penetration of renewable resources into AC power systems has increased tremendously,creating a significantly impact on the latter’s operations and stability.In this respect,it is also important to gain a basic analytical understanding of such impact on the steady-state stability of power systems with electrically weak AC/DC interconnections,but such works are not very evident in the literature.Therefore,a classical analytic model of the single and multi-infeed HVDC system which now incorporates renewable resources is proposed.Then the well-established concept of voltage sensitivity of the AC/DC interconnection is applied to analyze the impact of the renewable resources on the steady-state stability of these composite system models,as well as on the influence of system conditions and parameters.This impact is also compared with that arising from other types of shunt devices alternatively connected at the same AC/DC interconnection,therefore their relative beneficial or negative impacts will also be benchmarked.
基金This work was financially supported by the Program of National Natural Science Foundation of China(Nos.U1937204 and 51905124)China Postdoctoral Science Foundation(2019M661278).
文摘Complex thin-walled titanium alloy components play a key role in the aircraft,aerospace and marine industries,offering the advantages of reduced weight and increased thermal resistance.The geometrical complexity,dimensional accuracy and in-service properties are essential to fulfill the high-performance standards required in new transportation systems,which brings new challenges to titanium alloy forming technologies.Traditional forming processes,such as superplastic forming or hot pressing,cannot meet all demands of modern applications due to their limited properties,low productivity and high cost.This has encouraged industry and research groups to develop novel high-efficiency forming processes.Hot gas pressure forming and hot stamping-quenching technologies have been developed for the manufacture of tubular and panel components,and are believed to be the cut-edge processes guaranteeing dimensional accuracy,microstructure and mechanical properties.This article intends to provide a critical review of high-efficiency titanium alloy forming processes,concentrating on latest investigations of controlling dimensional accuracy,microstructure and properties.The advantages and limitations of individual forming process are comprehensively analyzed,through which,future research trends of high-efficiency forming are identified including trends in process integration,processing window design,full cycle and multi-objective optimization.This review aims to provide a guide for researchers and process designers on the manufacture of thin-walled titanium alloy components whilst achieving high dimensional accuracy and satisfying performance properties with high efficiency and low cost.
文摘Visceral artery aneurysms(VAA) include splanchnic and renal artery aneurysms. They represent a rare clinical entity, although their detection is rising due to an increased use of cross-sectional imaging. Rupture is the most devastating complication, and is associated with a high morbidity and mortality. In addition, increased percutaneous endovascular interventions have raised the incidence of iatrogenic visceral artery pseudoaneurysms(VAPAs). For this reason, elective repair is preferable in the appropriately chosen patient. Controversy still exists regarding their treatment. Over the past decade, there has been steady increase in the utilization of minimally invasive, non-operative interventions, for vascular aneurysmal disease. All VAAs and VAPAs can technically be fixed by endovascular techniques but that does not mean they should. These catheter-based techniques constitute an excellent approach in the elective setting. However, in the emergent setting it may carry a higher morbidity and mortality. The decision for intervention has to take into account the size and the natural history of the lesion, the risk of rupture, which is high during pregnancy, and the relative risk of surgical or radiological intervention. For splanchnic artery aneurysms, we should recognize that we are not, in reality, well informed about their natural history. For most asymptomatic aneurysms, expectant treatment is acceptable. For large, symptomatic or aneurysms with a high risk of rupture, endovascular treatment has become the firstline therapy. Treatment of VAPAs is always mandatory because of the high risk of rupture. We present our point of view on interventional radiology in the splanchnic arteries, focusing on what has been achieved and the remaining challenges.
基金Supported by Ministère de l’Enseignement supérieur et de la Recherche,Inserm and Universitéd’Auvergne(UMR1071),INRA(USC-2018)Grants from the Association F.Aupetit(AFA)and Ligue contre le cancer
文摘AIM: To provide further insight into the characterization of mucosa-associated Escherichia coli (E. coli) isolated from the colonic mucosa of cancer patients.
文摘The mirror neuron system consists of a set of brain areas capable of matching action observation with action execution. One core feature of the mirror neuron system is the activation of motor areas by action observation alone. This unique capacity of the mirror neuron system to match action perception and action execution stimulated the idea that mirror neuron system plays a crucial role in the understanding of the content of observed actions and may participate in procedural learning. These features bear a high potential for neurorehabilitation of motor deficits and of aphasia following stroke. Since the first articles exploring this principle were published, a growing number of follow-up studies have been conducted in the last decade. Though, the combination of action observation with practice of the observed actions seems to constitute the most powerful approach. In the present review, we present the existing studies analyzing the effects of this neurorehabJlitative approach in clinical settings especially in the rehabilitation of stroke associated motor deficits and give a perspective on the ongoing trials by our research group. The data obtained up to date showed significant positive effect of action observation on recovery of motor functions of the upper limbs even in the chronic state after stroke, indicating that our approach might become a new standardized add-on feature of modern neurorehabilitative treatment schemes.
基金Supported by Veziant J was supported by«année-recherche»grants from the Ministère de la Santéand the Facultéde Médecine de Clermont-FerrandGagnière J was supported by a“Nuovo Soldati Foundation for Cancer Research”grant.
文摘AIM: To investigate the molecular or cellular mechanisms related to the infection of epithelial colonic mucosa by pks-positive Escherichia coli(E. coli) using optical imaging.METHODS: We choose to evaluate the tumor metabolic activity using a fluorodeoxyglucose analogue as 2-deoxyglucosone fluorescent probes and to correlate it with tumoral volume(mm^3). Inflammation measuring myeloperoxidase(MPO) activity and reactive oxygen species production was monitored by a bioluminescent(BLI) inflammation probe and related to histological examination and MPO levels by enzyme-linked immunosorbent assay(ELISA) on tumor specimens. The detection and quantitation of these two signals were validated on a xenograft model of human colon adenocarcinoma epithelial cells(HCT116) in nude mice infected with a pks-positive E. coli. The inflammatory BLI signal was validated intra-digestively in the colitisCEABAC10 DSS models, which mimicked Crohn's disease. RESULTS: Using a 2-deoxyglucosone fluorescent probe, we observed a high and specific HCT116 tumor uptake in correlation with tumoral volume(P = 0.0036). Using the inflammation probe targeting MPO, we detected a rapid systemic elimination and a significant increase of the BLI signal in the pks-positive E. coli-infected HCT116 xenograft group(P < 0.005). ELISA confirmed that MPO levels were significantly higher(1556 ± 313.6 vs 234.6 ± 121.6 ng/m L P = 0.001) in xenografts infected with the pathogenic E. coli strain. Moreover, histological examination of tumor samples confirmed massive infiltration of pks-positive E. coli-infected HCT116 tumors by inflammatory cells compared to the uninfected group. These data showed that infection with the pathogenic E. coli strain enhanced inflammation and ROS production in tumors before tumor growth. Moreover, we demonstrated that the intra-digestive monitoring of inflammation is feasible in a reference colitis murine model(CEABAC10/DSS).CONCLUSION: Using BLI and fluorescence optical imaging, we provided tools to better understand hostpathogen inter
