BACKGROUND:Serum C-reactive protein(CRP) increases and albumin decreases in patients with inflammation and infection.However,their role in patients with acute pancreatitis is not clear.The present study was to investi...BACKGROUND:Serum C-reactive protein(CRP) increases and albumin decreases in patients with inflammation and infection.However,their role in patients with acute pancreatitis is not clear.The present study was to investigate the predictive significance of the CRP/albumin ratio for the prognosis and mortality in acute pancreatitis patients.METHODS:This study was performed retrospectively with 192 acute pancreatitis patients between January 2002 and June 2015.Ranson scores,Atlanta classification and CRP/albumin ratios of the patients were calculated.RESULTS:The CRP/albumin ratio was higher in deceased patients compared to survivors.The CRP/albumin ratio was positively correlated with Ranson score and Atlanta classification in particular and with important prognostic markers such as hospitalization time,CRP and erythrocyte sedimentation rate.In addition to the CRP/albumin ratio,necrotizing pancreatitis type,moderately severe and severe Atlanta classification,and total Ranson score were independent risk factors of mortality.It was found that an increase of 1 unit in the CRP/albumin ratio resulted in an increase of 1.52 times in mortality risk.A prediction value about CRP/albumin ratio >16.28 was found to be a significant marker in predicting mortality with 92.1% sensitivity and 58.0% specificity.It was seen that Ranson and Atlanta classification were higher in patients with CRP/albumin ratio >16.28 compared with those with CRP/albumin ratio ≤16.28.Patients with CRP/albumin ratio >16.28 had a 19.3 times higher chance of death.CONCLUSION:The CRP/albumin ratio is a novel but promising,easy-to-measure,repeatable,non-invasive inflammationbased prognostic score in acute pancreatitis.展开更多
This paper presents an extensive survey of the most commonly used tools for diagnosing unbalanced flow in the atmosphere, namely the Lagrangian Rossby number, Psi vector, divergence equation, nonlinear balance equatio...This paper presents an extensive survey of the most commonly used tools for diagnosing unbalanced flow in the atmosphere, namely the Lagrangian Rossby number, Psi vector, divergence equation, nonlinear balance equation, generalized omega-equation, and departure from fields obtained by potential vorticity (PV) inversion. The basic thoery, assumptions as well as implementation and limitations for each of the tools are all discussed. These tools are applied to high—resolution mesoscale model data to assess the role of unbalanced dynamics in the generation of a mesoscale gravity wave event over the East Coast of the United States. Comparison of these tools in this case study shows that these various methods agree to a large extent with each other though they differ in details. Key words Unbalanced flow - Geostrophic adjustment - Gravity waves - Nonlinear balance equation - Potential vorticity inversion - Omega equations - Rossby number This research was conducted under support from NSF grant ATM-9700626 of the United States. The numerical computations described herein were performed on the Cray T90 at the North Carolina Supercomputing Center and the Cray supercomputer at the NCAR Scientific Computing Division, which also provided the initialization fields for the MM5. Thanks are extended to Mark Stoelinga at University of Washington for the RIP post-processing package.展开更多
Colorectal cancer (CRC) is the 3<sup>rd</sup> most common cancer in the United States with more than 10000 new cases diagnosed annually. Approximately 20% of patients with CRC will have distant metastasis ...Colorectal cancer (CRC) is the 3<sup>rd</sup> most common cancer in the United States with more than 10000 new cases diagnosed annually. Approximately 20% of patients with CRC will have distant metastasis at time of diagnosis, making them poor candidates for primary surgical resection. Similarly, 8%-25% of patients with CRC will present with bowel obstruction and will require palliative therapy. Emergent surgical decompression has a high mortality and morbidity, and often leads to a colostomy which impairs the patient’s quality of life. In the last decade, there has been an increasing use of colonic stents for palliative therapy to relieve malignant colonic obstruction. Colonic stents have been shown to be effective and safe to treat obstruction from CRC, and are now the therapy of choice in this scenario. In the setting of an acute bowel obstruction in patients with potentially resectable colon cancer, stents may be used to delay surgery and thus allow for decompression, adequate bowel preparation, and optimization of the patient’s condition for curative surgical intervention. An overall complication rate (major and minor) of up to 25% has been associated with the procedure. Long term failure of stents may result from stent migration and tumor ingrowth. In the majority of cases, repeat stenting or surgical intervention can successfully overcome these adverse effects.展开更多
AIM： To identify the frequency of bacterial growth, the most commonly grown bacteria and their antibiotic susceptibility, and risk factors for bacterial colonization in bile collected from patients with different bil...AIM： To identify the frequency of bacterial growth, the most commonly grown bacteria and their antibiotic susceptibility, and risk factors for bacterial colonization in bile collected from patients with different biliary dis- eases. METHODS： This prospective study was conducted be- tween April 2010 and August 2011. Patients with vari- ous biliary disorders were included. Bile was aspirated by placing a single-use, 5F, standard sphincterotome catheter into the bile duct before the injection of con- trast agent during endoscopic retrograde cholangio- pancreaticography （ERCP）. Bile specimens were trans- ported to the microbiology laboratory in blood culture bottles within an anaerobic transport system. Bacteria were cultured and identified according to the standard protocol used in our clinical microbiology laboratory. The susceptibilities of the organisms recovered were identified using antimicrobial disks, chosen according tothe initial gram stain of the positive cultures RESULTS： Ninety-one patients （27% male, mean age 53.7 4- 17.5 years, range： 17-86 years） were included in the study. The main indication for ERCP was benign biliary disease in 79 patients and malignant disease in 12 patients. The bile culture was positive for bacterial growth in 46 out of 91 （50.5%） patients. The most frequently encountered organisms were Gram-negative bacteria including Escherich/a coli （28.2%）, Pseudo- monas （17.3%） and Stenotrophomonas rnaltophilia （15.2%）. There were no significant differences between patients with malignant and benign disease （58% vs 49%, P = 0.474）, patients with acute cholangitis and without acute cholangitis （52.9% vs 50%, P = 0.827）, patients who were empirically administered antibiotics before intervention and not administered （51.4% vs 60.7%, P = 0.384）, with regard to the bacteriobilia. We observed a large covering spectrum or low resistance to meropenem, amikacin and imipenem. CONCLUSION： We did not find a significant risk fac- tor for bacteriobilia in pa展开更多
The purpose of this paper is to evaluate the role of imaging in inflammatory bowel disease(IBD), including detection of extraluminal complications and extraintestinal manifestations of IBD, assessment of disease activ...The purpose of this paper is to evaluate the role of imaging in inflammatory bowel disease(IBD), including detection of extraluminal complications and extraintestinal manifestations of IBD, assessment of disease activity and treatment response, and discrimination of inflammatory from fibrotic strictures. IBD is a chronic idiopathic disease affecting the gastrointestinal tract that is comprised of two separate, but related intestinal disorders; Crohn's disease and ulcerative colitis. The paper discusses, in detail the pros and cons of the different IBD imaging modalities that need to be considered in order to optimize the imaging and clinical evaluation of patients with IBD. Historically, IBD evaluation of the bowel has included imaging to assess the portions of the small bowel that are inaccessible to optical endoscopic visualization. This traditionally was performed using barium fluoroscopic techniques; however, cross-sectional imaging techniques(computed tomography and magnetic resonance imaging) are being increasingly utilized for IBD evaluation because they can simultaneously assess mural and extramural IBD manifestations. Recent advances in imaging technology, that continue to improve the ability of imaging to noninvasively follow disease activity and treatment response, are also discussed. This review article summarizes the current imaging approach in inflammatory bowel disease as well as the role of emerging imaging modalities.展开更多
The current research joins previous studies in examining post-traumatic stress disorder (PTSD) and burnout among healthcare workers. The research focuses on the experiences of pediatric residents working in an emergen...The current research joins previous studies in examining post-traumatic stress disorder (PTSD) and burnout among healthcare workers. The research focuses on the experiences of pediatric residents working in an emergency department both in normal times and during the Covid pandemic. Research conducted prior to and during the Covid pandemic outbreak shows negative psychological effects among healthcare workers. Most of that research was conducted within the positivistic-quantitative paradigm. The current study is qualitative and focuses on pediatric residents who provide medical services to a unique population in a peripheral region of Israel, namely the Bedouin-Arab population. The research questions are the following: What characterizes pediatric residents’ work, in general and during the pandemic? Do they show signs of burnout and secondary trauma? How do they perceive their work with the Bedouin-Arab population, especially during the pandemic? The study, conducted within the phenomenological genre, included 14 pediatric residents in a large hospital in Israel’s periphery. Semi-structured clinical interviews were employed, in addition to questionnaires that examined PTSD and burnout to enhance the reliability of the findings. The results show that all residents reported stressful incidents in which patients’ physical integrity was threatened. The residents described the special nature of the medical cases they treated in routine times and during the pandemic outbreak, which stems mostly from the specific characteristics the population of Israel’s periphery. While at the early stages of the pandemic, the residents experienced reduced work pressure, they reported substantial difficulties later in the crisis, which intensified their sense of physical and emotional stress. Most residents reported feeling inadequately prepared for dealing with traumatic events. According to the results, most residents displayed secondary trauma (12 participants in interviews and 11 in questionnaires), which can be classified 展开更多
BACKGROUND Peripheral nerve injury can result in significant clinical complications that have uncertain prognoses.Currently,there is a lack of effective pharmacological interventions for nerve damage,despite the exist...BACKGROUND Peripheral nerve injury can result in significant clinical complications that have uncertain prognoses.Currently,there is a lack of effective pharmacological interventions for nerve damage,despite the existence of several small compounds,Despite the objective of achieving full functional restoration by surgical intervention,the persistent challenge of inadequate functional recovery remains a significant concern in the context of peripheral nerve injuries.AIM To examine the impact of exosomes on the process of functional recovery following a complete radial nerve damage.METHODS A male individual,aged 24,who is right-hand dominant and an immigrant,arrived with an injury caused by a knife assault.The cut is located on the left arm,specifically below the elbow.The neurological examination and electrodiagnostic testing reveal evidence of left radial nerve damage.The sural autograft was utilized for repair,followed by the application of 1 mL of mesenchymal stem cell-derived exosome,comprising 5 billion microvesicles.This exosome was split into four equal volumes of 0.25 mL each and delivered microsurgically to both the proximal and distal stumps using the subepineural pathway.The patient was subjected to a period of 180 d during which they had neurological examination and electrodiagnostic testing.RESULTS The duration of the patient’s follow-up period was 180 d.An increasing Tinel’s sign and sensory-motor recovery were detected even at the 10th wk following nerve grafting.Upon the conclusion of the 6-mo post-treatment period,an evaluation was conducted to measure the extent of improvement in motor and sensory functions of the nerve.This assessment was based on the British Medical Research Council scale and the Mackinnon-Dellon scale.The results indicated that the level of improvement in motor function was classified as M5,denoting an excellent outcome.Additionally,the level of improvement in sensory function was classified as S3+,indicating a good outcome.It is noteworthy that these assessments were cond展开更多
The use of testosterone to treat the symptoms of late-onset hypogonadal men has increased recently due to patient and physician awareness. However, concerns regarding the effect of testosterone on the prostate, in par...The use of testosterone to treat the symptoms of late-onset hypogonadal men has increased recently due to patient and physician awareness. However, concerns regarding the effect of testosterone on the prostate, in particular any possible effect on the risk of prostate cancer have prompted further research in this regard. Surprisingly, numerous retrospective or small, randomized trials have pointed to a possible improvement in male lower urinary tract symptoms （LUTS） in patients treated with testosterone. The exact mechanism of this improvement is still debated but may have a close relationship to metabolic syndrome. For the clinician, the results of these studies are promising but do not constitute high levels of evidence. A thorough clinical examination （including history, examination and laboratory testing of testosterone） should be undertaken before considering the diagnosis of late-onset hypogonadism or instigating treatment for it. Warnings still remain on the testosterone supplement product labels regarding the risk of urinary retention and worsening LUTS, and these should be explained to patients.展开更多
Sprouts are ready-to-eat and are recognized worldwide as functional components of the human diet.Recent advances in innovative agricultural techniques could enable an increase in the production of healthy food.The use...Sprouts are ready-to-eat and are recognized worldwide as functional components of the human diet.Recent advances in innovative agricultural techniques could enable an increase in the production of healthy food.The use of light-emitting diode(LED)in indoor agricultural production could alter the biological feedback loop,increasing the functional benefits of plant foods such as wheat and lentil sprouts and promoting the bioavailability of nutrients.The effects of white(W),red(R),and blue(B)light were investigated on the growth parameters and nutritional value of wheat and lentil sprouts.In the laboratory,seeds were sown under three different LED treat-ments:white,red,and blue light,while normal incandescent light served as a control.Percentage seed germina-tion improved by 18.34%and 12.67%for wheat and 18.34%and 12.67%for lentil sprouts under LED treatments R and B,respectively.An increase in total soluble protein and sugar by 33.4%and 9.23%in wheat and by 31.5%and 5.87%in lentils was observed under the R LED treatment.Vitamin C concentrations in wheat and lentils were significantly increased by R LED compared to all other treatments.Other parameters,including potassium and sodium concentrations,were significantly increased under red and blue light compared to the control;white light,on the other hand,significantly decreased all these parameters.According to the experimental data,red and blue LED light could be beneficial in the production of functional wheat and lentil sprouts with high nutrient concentrations.展开更多
The luminescent phosphor powder in the fluorescent lamp constitutes 2%of the lamp’s weight.It can be mentioned that fluorescent wastes are a crucial raw material to produce rare earth oxides.In the present study,micr...The luminescent phosphor powder in the fluorescent lamp constitutes 2%of the lamp’s weight.It can be mentioned that fluorescent wastes are a crucial raw material to produce rare earth oxides.In the present study,microwave leaching process was conducted to dissolve rare earth elements yttrium(Y),europium(Eu),and remaining rare earth elements(REEs)present in the phosphor powder of the fluorescent lamp.and the yields were compared.In the microwave leaching process,the effects of the temperature(80-160℃),acid type(hydrochloric acid(HCl),nitric acid(HNO_(3)),sulphuric acid(H_(2)SO_(4))),acid concentration(0.5-6 mol/L),solid to liquid ratio(0.1:10-0.5:10)and reaction time(5-90 min)parameters on leaching efficiencies of varying rare earth elements and calcium were investigated.The highest yield was obtained in the direct microwave leaching of fluorescent waste with the experimental conditions of 6 mol/L HCl,160℃,0.1:10 solid-to-liquid ratio(S:L),and 90 min.Activation energy calculations were made,and kinetic models of the reactions were obtained,and it is observed that Y and Eu dissolution is diffusion-controlled,on the other hand,lanthanum(La),cerium(Ce),and terbium(Tb)were examined to be chemical reaction controlled.Moreover,calcium(Ca)and gadolinium(Gd)seem coherent with the mixed model.Concurrently,mathematical models of all experimental studies are created with the response surface Box-Behnken method and the correlation coefficients of all the models are over 90%.展开更多
BACKGROUND Cerebral palsy(CP)describes a group of disorders affecting movement,balance,and posture.Disturbances in motor functions constitute the main body of CP symptoms.These symptoms surface in early childhood and ...BACKGROUND Cerebral palsy(CP)describes a group of disorders affecting movement,balance,and posture.Disturbances in motor functions constitute the main body of CP symptoms.These symptoms surface in early childhood and patients are affected for the rest of their lives.Currently,treatment involves various pharmacotherapies for different types of CP,including antiepileptics for epilepsy and Botox A for focal spasticity.However,none of these methods can provide full symptom relief.This has prompted researchers to look for new treatment modalities,one of which is mesenchymal stem cell therapy(MSCT).Despite being a promising tool and offering a wide array of possibilities,mesenchymal stem cells(MSCs)still need to be investigated for their efficacy and safety.AIM To analyze the efficacy and safety of MSCT in CP patients.METHODS Our sample consists of four CP patients who cannot stand or walk without external support.All of these cases received allogeneic MSCT six times as 1×106/kg intrathecally,intravenously,and intramuscularly using umbilical cord-derived MSCs(UC-MSC).We monitored and assessed the patients pre-and post-treatment using the Wee Functional Independence Measure(WeeFIM),Gross Motor Function Classification System(GMFCS),and Manual Ability Classification Scale(MACS)instruments.We utilized the Modified Ashworth Scale(MAS)to measure spasticity.RESULTS We found significant improvements in MAS scores after the intervention on both sides.Two months:Rightχ^(2)=4000,P=0.046,leftχ^(2)=4000,P=0.046;four months:Rightχ^(2)=4000,P=0.046,leftχ^(2)=4000,P=0.046;12 months:Rightχ^(2)=4000,P=0.046,leftχ^(2)=4000,P=0.046.However,there was no significant difference in motor functions based on WeeFIM results(P>0.05).GMFCS and MACS scores differed significantly at 12 months after the intervention(P=0.046,P=0.046).Finally,there was no significant change in cognitive functions(P>0.05).CONCLUSION In light of our findings,we believe that UC-MSC therapy has a positive effect on spasticity,and it partially improves motor function展开更多
BACKGROUND The study investigates the connection between academic productivity and industry earnings in foot and ankle orthopedic surgery fellowships.Utilizing metrics like the H-index and Open Payments Database(OPD)d...BACKGROUND The study investigates the connection between academic productivity and industry earnings in foot and ankle orthopedic surgery fellowships.Utilizing metrics like the H-index and Open Payments Database(OPD)data,it addresses a gap in understanding the relationship between scholarly achievements and financial outcomes,providing a basis for further exploration in this specialized medical field.AIM To elucidate the trends between academic productivity and industry earnings across foot and ankle orthopedic surgery fellowship programs in the United States.METHODS This study is a retrospective analysis of the relationship between academic productivity and industry earnings of foot and ankle orthopedic surgery fellowships at an individual faculty and fellowship level.Academic productivity was defined via H-index and recorded from the Scopus website.Industry earnings were recorded from the OPD.RESULTS Forty-eight foot and ankle orthopedic surgery fellowships(100%of fellowships)in the United States with a combined total of 165 physicians(95.9%of physicians)were included.Mean individual physician(n=165)total life-time earnings reported on the OPD website was United States Dollar(USD)451430.30±1851084.89(range:USD 25.16-21269249.85;median:USD 27839.80).Mean physician(n=165)H-index as reported on Scopus is 14.24±12.39(range:0-63;median:11).There was a significant but weak correlation between individual physician H-index and individual physician total life-time earnings(P<0.001;Spearman’s rho=0.334)and a significant and moderate positive correlation between combined fellowship H-index and total life-time earnings per fellowship(P=0.004,Spearman’s rho=0.409).CONCLUSION There is a significant and positive correlation between academic productivity and industry earnings at foot and ankle orthopedic surgery fellowships in the United States.This observation is true on an individual physician level as well as on a fellowship level.展开更多
BACKGROUND Traumatic brain injury(TBI)is characterized by a disruption in the normal function of the brain due to an injury following a trauma,which can potentially cause severe physical,cognitive,and emotional impair...BACKGROUND Traumatic brain injury(TBI)is characterized by a disruption in the normal function of the brain due to an injury following a trauma,which can potentially cause severe physical,cognitive,and emotional impairment.Stem cell transplantation has evolved as a novel treatment modality in the management of TBI,as it has the potential to arrest the degeneration and promote regeneration of new cells in the brain.Wharton’s Jelly-derived mesenchymal stem cells(WJ-MSCs)have recently shown beneficial effects in the functional recovery of neurological deficits.AIM To evaluate the safety and efficiency of MSC therapy in TBI.METHODS We present 6 patients,4 male and 2 female aged between 21 and 27 years who suffered a TBI.These 6 patients underwent 6 doses of intrathecal,intramuscular(i.m.)and intravenous transplantation of WJ-MSCs at a target dose of 1×106/kg for each application route.Spasticity was assessed using the Modified Ashworth scale(MAS),motor function according to the Medical Research Council Muscle Strength Scale,quality of life was assessed by the Functional Independence Measure(FIM)scale and Karnofsky Performance Status scale.RESULTS Our patients showed only early,transient complications,such as subfebrile fever,mild headache,and muscle pain due to i.m.injection,which resolved within 24 h.During the one year follow-up,no other safety issues or adverse events were reported.These 6 patients showed improvements in their cognitive abilities,muscle spasticity,muscle strength,performance scores and fine motor skills when compared before and after the intervention.MAS values,which we used to assess spasticity,were observed to statistically significantly decrease for both left and right sides(P<0.001).The FIM scale includes both motor scores(P<0.05)and cognitive scores(P<0.001)and showed a significant increase in pretest posttest analyses.The difference observed in the participants’Karnofsky Performance Scale values pre and post the intervention was statistically significant(P<0.001).CONCLUSION This study sh展开更多
Objective Coronary artery bypass grafting （CABG） is gradually increasing in the elderly population. We aimed to investigate the risk factors and the results of CABG along with the long term survival in patients at a...Objective Coronary artery bypass grafting （CABG） is gradually increasing in the elderly population. We aimed to investigate the risk factors and the results of CABG along with the long term survival in patients at an age of 80 and older. Methods Between Januaa-y 2002 and December 201 I, a total of i01 consecutive patients at an age of S0 and older who underwent CABG in our hospital were included in the study. The patients were followed and the long-term survival was estimated. Results The mean age of the patients was 82.98 ~ 2.27 years. Sixty-four （63.4%） were males and 37 （36.6%） were females. Emergency surgery, duration of cardiopulmonary bypass, the intensive care unit （ICU） stay, inotropic support, intra aortic balloon pulsation application, amount oferythrocyte transfusion and flesh frozen plasma transfusion and ventilation period were significantly higher in the patients who died in the hospital. The duration of cardiopulmonary bypass （CPB） was found to be an inde- pendent predictor of mortality （OR： 1.18, 95% CI 1.01-1.38, P = 0.034）. The in-hospital mortality was 16.8%. Kaplan-Meier analyses revealed a survival ratio of 91.3% at one year, 82.9% at three years and 69.0% at five years. Conclusions Patients at the age of 80 and older can be candidates for the CABG procedure bearing in mind that they may have a longer ventilation period and intensive care unit stay. The morbidity and mortality of this age group is considered within an acceptable range. Approaches to minimize CPB, or the choice of off-pump surgery, may be a preventive method to lower the incidence of mortality. Hence, CABG may be performed in this age group with a satisfactory survival ratio.展开更多
The present paper studies the unstable nonlinear Schr¨odinger equations, describing the time evolution of disturbances in marginally stable or unstable media. More precisely, the unstable nonlinear Schr¨odin...The present paper studies the unstable nonlinear Schr¨odinger equations, describing the time evolution of disturbances in marginally stable or unstable media. More precisely, the unstable nonlinear Schr¨odinger equation and its modified form are analytically solved using two efficient distinct techniques, known as the modified Kudraysov method and the sine-Gordon expansion approach. As a result, a wide range of new exact traveling wave solutions for the unstable nonlinear Schr¨odinger equation and its modified form are formally obtained.展开更多
文摘BACKGROUND:Serum C-reactive protein(CRP) increases and albumin decreases in patients with inflammation and infection.However,their role in patients with acute pancreatitis is not clear.The present study was to investigate the predictive significance of the CRP/albumin ratio for the prognosis and mortality in acute pancreatitis patients.METHODS:This study was performed retrospectively with 192 acute pancreatitis patients between January 2002 and June 2015.Ranson scores,Atlanta classification and CRP/albumin ratios of the patients were calculated.RESULTS:The CRP/albumin ratio was higher in deceased patients compared to survivors.The CRP/albumin ratio was positively correlated with Ranson score and Atlanta classification in particular and with important prognostic markers such as hospitalization time,CRP and erythrocyte sedimentation rate.In addition to the CRP/albumin ratio,necrotizing pancreatitis type,moderately severe and severe Atlanta classification,and total Ranson score were independent risk factors of mortality.It was found that an increase of 1 unit in the CRP/albumin ratio resulted in an increase of 1.52 times in mortality risk.A prediction value about CRP/albumin ratio >16.28 was found to be a significant marker in predicting mortality with 92.1% sensitivity and 58.0% specificity.It was seen that Ranson and Atlanta classification were higher in patients with CRP/albumin ratio >16.28 compared with those with CRP/albumin ratio ≤16.28.Patients with CRP/albumin ratio >16.28 had a 19.3 times higher chance of death.CONCLUSION:The CRP/albumin ratio is a novel but promising,easy-to-measure,repeatable,non-invasive inflammationbased prognostic score in acute pancreatitis.
文摘This paper presents an extensive survey of the most commonly used tools for diagnosing unbalanced flow in the atmosphere, namely the Lagrangian Rossby number, Psi vector, divergence equation, nonlinear balance equation, generalized omega-equation, and departure from fields obtained by potential vorticity (PV) inversion. The basic thoery, assumptions as well as implementation and limitations for each of the tools are all discussed. These tools are applied to high—resolution mesoscale model data to assess the role of unbalanced dynamics in the generation of a mesoscale gravity wave event over the East Coast of the United States. Comparison of these tools in this case study shows that these various methods agree to a large extent with each other though they differ in details. Key words Unbalanced flow - Geostrophic adjustment - Gravity waves - Nonlinear balance equation - Potential vorticity inversion - Omega equations - Rossby number This research was conducted under support from NSF grant ATM-9700626 of the United States. The numerical computations described herein were performed on the Cray T90 at the North Carolina Supercomputing Center and the Cray supercomputer at the NCAR Scientific Computing Division, which also provided the initialization fields for the MM5. Thanks are extended to Mark Stoelinga at University of Washington for the RIP post-processing package.
基金Supported by(Entirely)Thomas Jefferson University HospitalUniversity of Utah through existing intramural funds and salary support
文摘Colorectal cancer (CRC) is the 3<sup>rd</sup> most common cancer in the United States with more than 10000 new cases diagnosed annually. Approximately 20% of patients with CRC will have distant metastasis at time of diagnosis, making them poor candidates for primary surgical resection. Similarly, 8%-25% of patients with CRC will present with bowel obstruction and will require palliative therapy. Emergent surgical decompression has a high mortality and morbidity, and often leads to a colostomy which impairs the patient’s quality of life. In the last decade, there has been an increasing use of colonic stents for palliative therapy to relieve malignant colonic obstruction. Colonic stents have been shown to be effective and safe to treat obstruction from CRC, and are now the therapy of choice in this scenario. In the setting of an acute bowel obstruction in patients with potentially resectable colon cancer, stents may be used to delay surgery and thus allow for decompression, adequate bowel preparation, and optimization of the patient’s condition for curative surgical intervention. An overall complication rate (major and minor) of up to 25% has been associated with the procedure. Long term failure of stents may result from stent migration and tumor ingrowth. In the majority of cases, repeat stenting or surgical intervention can successfully overcome these adverse effects.
文摘AIM： To identify the frequency of bacterial growth, the most commonly grown bacteria and their antibiotic susceptibility, and risk factors for bacterial colonization in bile collected from patients with different biliary dis- eases. METHODS： This prospective study was conducted be- tween April 2010 and August 2011. Patients with vari- ous biliary disorders were included. Bile was aspirated by placing a single-use, 5F, standard sphincterotome catheter into the bile duct before the injection of con- trast agent during endoscopic retrograde cholangio- pancreaticography （ERCP）. Bile specimens were trans- ported to the microbiology laboratory in blood culture bottles within an anaerobic transport system. Bacteria were cultured and identified according to the standard protocol used in our clinical microbiology laboratory. The susceptibilities of the organisms recovered were identified using antimicrobial disks, chosen according tothe initial gram stain of the positive cultures RESULTS： Ninety-one patients （27% male, mean age 53.7 4- 17.5 years, range： 17-86 years） were included in the study. The main indication for ERCP was benign biliary disease in 79 patients and malignant disease in 12 patients. The bile culture was positive for bacterial growth in 46 out of 91 （50.5%） patients. The most frequently encountered organisms were Gram-negative bacteria including Escherich/a coli （28.2%）, Pseudo- monas （17.3%） and Stenotrophomonas rnaltophilia （15.2%）. There were no significant differences between patients with malignant and benign disease （58% vs 49%, P = 0.474）, patients with acute cholangitis and without acute cholangitis （52.9% vs 50%, P = 0.827）, patients who were empirically administered antibiotics before intervention and not administered （51.4% vs 60.7%, P = 0.384）, with regard to the bacteriobilia. We observed a large covering spectrum or low resistance to meropenem, amikacin and imipenem. CONCLUSION： We did not find a significant risk fac- tor for bacteriobilia in pa
文摘The purpose of this paper is to evaluate the role of imaging in inflammatory bowel disease(IBD), including detection of extraluminal complications and extraintestinal manifestations of IBD, assessment of disease activity and treatment response, and discrimination of inflammatory from fibrotic strictures. IBD is a chronic idiopathic disease affecting the gastrointestinal tract that is comprised of two separate, but related intestinal disorders; Crohn's disease and ulcerative colitis. The paper discusses, in detail the pros and cons of the different IBD imaging modalities that need to be considered in order to optimize the imaging and clinical evaluation of patients with IBD. Historically, IBD evaluation of the bowel has included imaging to assess the portions of the small bowel that are inaccessible to optical endoscopic visualization. This traditionally was performed using barium fluoroscopic techniques; however, cross-sectional imaging techniques(computed tomography and magnetic resonance imaging) are being increasingly utilized for IBD evaluation because they can simultaneously assess mural and extramural IBD manifestations. Recent advances in imaging technology, that continue to improve the ability of imaging to noninvasively follow disease activity and treatment response, are also discussed. This review article summarizes the current imaging approach in inflammatory bowel disease as well as the role of emerging imaging modalities.
文摘The current research joins previous studies in examining post-traumatic stress disorder (PTSD) and burnout among healthcare workers. The research focuses on the experiences of pediatric residents working in an emergency department both in normal times and during the Covid pandemic. Research conducted prior to and during the Covid pandemic outbreak shows negative psychological effects among healthcare workers. Most of that research was conducted within the positivistic-quantitative paradigm. The current study is qualitative and focuses on pediatric residents who provide medical services to a unique population in a peripheral region of Israel, namely the Bedouin-Arab population. The research questions are the following: What characterizes pediatric residents’ work, in general and during the pandemic? Do they show signs of burnout and secondary trauma? How do they perceive their work with the Bedouin-Arab population, especially during the pandemic? The study, conducted within the phenomenological genre, included 14 pediatric residents in a large hospital in Israel’s periphery. Semi-structured clinical interviews were employed, in addition to questionnaires that examined PTSD and burnout to enhance the reliability of the findings. The results show that all residents reported stressful incidents in which patients’ physical integrity was threatened. The residents described the special nature of the medical cases they treated in routine times and during the pandemic outbreak, which stems mostly from the specific characteristics the population of Israel’s periphery. While at the early stages of the pandemic, the residents experienced reduced work pressure, they reported substantial difficulties later in the crisis, which intensified their sense of physical and emotional stress. Most residents reported feeling inadequately prepared for dealing with traumatic events. According to the results, most residents displayed secondary trauma (12 participants in interviews and 11 in questionnaires), which can be classified
基金approved by the medical ethics committee of the authors’institution(protocol number:56733164-203-E.5863).
文摘BACKGROUND Peripheral nerve injury can result in significant clinical complications that have uncertain prognoses.Currently,there is a lack of effective pharmacological interventions for nerve damage,despite the existence of several small compounds,Despite the objective of achieving full functional restoration by surgical intervention,the persistent challenge of inadequate functional recovery remains a significant concern in the context of peripheral nerve injuries.AIM To examine the impact of exosomes on the process of functional recovery following a complete radial nerve damage.METHODS A male individual,aged 24,who is right-hand dominant and an immigrant,arrived with an injury caused by a knife assault.The cut is located on the left arm,specifically below the elbow.The neurological examination and electrodiagnostic testing reveal evidence of left radial nerve damage.The sural autograft was utilized for repair,followed by the application of 1 mL of mesenchymal stem cell-derived exosome,comprising 5 billion microvesicles.This exosome was split into four equal volumes of 0.25 mL each and delivered microsurgically to both the proximal and distal stumps using the subepineural pathway.The patient was subjected to a period of 180 d during which they had neurological examination and electrodiagnostic testing.RESULTS The duration of the patient’s follow-up period was 180 d.An increasing Tinel’s sign and sensory-motor recovery were detected even at the 10th wk following nerve grafting.Upon the conclusion of the 6-mo post-treatment period,an evaluation was conducted to measure the extent of improvement in motor and sensory functions of the nerve.This assessment was based on the British Medical Research Council scale and the Mackinnon-Dellon scale.The results indicated that the level of improvement in motor function was classified as M5,denoting an excellent outcome.Additionally,the level of improvement in sensory function was classified as S3+,indicating a good outcome.It is noteworthy that these assessments were cond
文摘The use of testosterone to treat the symptoms of late-onset hypogonadal men has increased recently due to patient and physician awareness. However, concerns regarding the effect of testosterone on the prostate, in particular any possible effect on the risk of prostate cancer have prompted further research in this regard. Surprisingly, numerous retrospective or small, randomized trials have pointed to a possible improvement in male lower urinary tract symptoms （LUTS） in patients treated with testosterone. The exact mechanism of this improvement is still debated but may have a close relationship to metabolic syndrome. For the clinician, the results of these studies are promising but do not constitute high levels of evidence. A thorough clinical examination （including history, examination and laboratory testing of testosterone） should be undertaken before considering the diagnosis of late-onset hypogonadism or instigating treatment for it. Warnings still remain on the testosterone supplement product labels regarding the risk of urinary retention and worsening LUTS, and these should be explained to patients.
基金Supported by Researchers Supporting Project Number(RSP2024R410)King Saud University,Riyadh,Saudi Arabia.
文摘Sprouts are ready-to-eat and are recognized worldwide as functional components of the human diet.Recent advances in innovative agricultural techniques could enable an increase in the production of healthy food.The use of light-emitting diode(LED)in indoor agricultural production could alter the biological feedback loop,increasing the functional benefits of plant foods such as wheat and lentil sprouts and promoting the bioavailability of nutrients.The effects of white(W),red(R),and blue(B)light were investigated on the growth parameters and nutritional value of wheat and lentil sprouts.In the laboratory,seeds were sown under three different LED treat-ments:white,red,and blue light,while normal incandescent light served as a control.Percentage seed germina-tion improved by 18.34%and 12.67%for wheat and 18.34%and 12.67%for lentil sprouts under LED treatments R and B,respectively.An increase in total soluble protein and sugar by 33.4%and 9.23%in wheat and by 31.5%and 5.87%in lentils was observed under the R LED treatment.Vitamin C concentrations in wheat and lentils were significantly increased by R LED compared to all other treatments.Other parameters,including potassium and sodium concentrations,were significantly increased under red and blue light compared to the control;white light,on the other hand,significantly decreased all these parameters.According to the experimental data,red and blue LED light could be beneficial in the production of functional wheat and lentil sprouts with high nutrient concentrations.
基金BAP project FBA-2021-4691 for their financial support。
文摘The luminescent phosphor powder in the fluorescent lamp constitutes 2%of the lamp’s weight.It can be mentioned that fluorescent wastes are a crucial raw material to produce rare earth oxides.In the present study,microwave leaching process was conducted to dissolve rare earth elements yttrium(Y),europium(Eu),and remaining rare earth elements(REEs)present in the phosphor powder of the fluorescent lamp.and the yields were compared.In the microwave leaching process,the effects of the temperature(80-160℃),acid type(hydrochloric acid(HCl),nitric acid(HNO_(3)),sulphuric acid(H_(2)SO_(4))),acid concentration(0.5-6 mol/L),solid to liquid ratio(0.1:10-0.5:10)and reaction time(5-90 min)parameters on leaching efficiencies of varying rare earth elements and calcium were investigated.The highest yield was obtained in the direct microwave leaching of fluorescent waste with the experimental conditions of 6 mol/L HCl,160℃,0.1:10 solid-to-liquid ratio(S:L),and 90 min.Activation energy calculations were made,and kinetic models of the reactions were obtained,and it is observed that Y and Eu dissolution is diffusion-controlled,on the other hand,lanthanum(La),cerium(Ce),and terbium(Tb)were examined to be chemical reaction controlled.Moreover,calcium(Ca)and gadolinium(Gd)seem coherent with the mixed model.Concurrently,mathematical models of all experimental studies are created with the response surface Box-Behnken method and the correlation coefficients of all the models are over 90%.
文摘BACKGROUND Cerebral palsy(CP)describes a group of disorders affecting movement,balance,and posture.Disturbances in motor functions constitute the main body of CP symptoms.These symptoms surface in early childhood and patients are affected for the rest of their lives.Currently,treatment involves various pharmacotherapies for different types of CP,including antiepileptics for epilepsy and Botox A for focal spasticity.However,none of these methods can provide full symptom relief.This has prompted researchers to look for new treatment modalities,one of which is mesenchymal stem cell therapy(MSCT).Despite being a promising tool and offering a wide array of possibilities,mesenchymal stem cells(MSCs)still need to be investigated for their efficacy and safety.AIM To analyze the efficacy and safety of MSCT in CP patients.METHODS Our sample consists of four CP patients who cannot stand or walk without external support.All of these cases received allogeneic MSCT six times as 1×106/kg intrathecally,intravenously,and intramuscularly using umbilical cord-derived MSCs(UC-MSC).We monitored and assessed the patients pre-and post-treatment using the Wee Functional Independence Measure(WeeFIM),Gross Motor Function Classification System(GMFCS),and Manual Ability Classification Scale(MACS)instruments.We utilized the Modified Ashworth Scale(MAS)to measure spasticity.RESULTS We found significant improvements in MAS scores after the intervention on both sides.Two months:Rightχ^(2)=4000,P=0.046,leftχ^(2)=4000,P=0.046;four months:Rightχ^(2)=4000,P=0.046,leftχ^(2)=4000,P=0.046;12 months:Rightχ^(2)=4000,P=0.046,leftχ^(2)=4000,P=0.046.However,there was no significant difference in motor functions based on WeeFIM results(P>0.05).GMFCS and MACS scores differed significantly at 12 months after the intervention(P=0.046,P=0.046).Finally,there was no significant change in cognitive functions(P>0.05).CONCLUSION In light of our findings,we believe that UC-MSC therapy has a positive effect on spasticity,and it partially improves motor function
文摘BACKGROUND The study investigates the connection between academic productivity and industry earnings in foot and ankle orthopedic surgery fellowships.Utilizing metrics like the H-index and Open Payments Database(OPD)data,it addresses a gap in understanding the relationship between scholarly achievements and financial outcomes,providing a basis for further exploration in this specialized medical field.AIM To elucidate the trends between academic productivity and industry earnings across foot and ankle orthopedic surgery fellowship programs in the United States.METHODS This study is a retrospective analysis of the relationship between academic productivity and industry earnings of foot and ankle orthopedic surgery fellowships at an individual faculty and fellowship level.Academic productivity was defined via H-index and recorded from the Scopus website.Industry earnings were recorded from the OPD.RESULTS Forty-eight foot and ankle orthopedic surgery fellowships(100%of fellowships)in the United States with a combined total of 165 physicians(95.9%of physicians)were included.Mean individual physician(n=165)total life-time earnings reported on the OPD website was United States Dollar(USD)451430.30±1851084.89(range:USD 25.16-21269249.85;median:USD 27839.80).Mean physician(n=165)H-index as reported on Scopus is 14.24±12.39(range:0-63;median:11).There was a significant but weak correlation between individual physician H-index and individual physician total life-time earnings(P<0.001;Spearman’s rho=0.334)and a significant and moderate positive correlation between combined fellowship H-index and total life-time earnings per fellowship(P=0.004,Spearman’s rho=0.409).CONCLUSION There is a significant and positive correlation between academic productivity and industry earnings at foot and ankle orthopedic surgery fellowships in the United States.This observation is true on an individual physician level as well as on a fellowship level.
文摘BACKGROUND Traumatic brain injury(TBI)is characterized by a disruption in the normal function of the brain due to an injury following a trauma,which can potentially cause severe physical,cognitive,and emotional impairment.Stem cell transplantation has evolved as a novel treatment modality in the management of TBI,as it has the potential to arrest the degeneration and promote regeneration of new cells in the brain.Wharton’s Jelly-derived mesenchymal stem cells(WJ-MSCs)have recently shown beneficial effects in the functional recovery of neurological deficits.AIM To evaluate the safety and efficiency of MSC therapy in TBI.METHODS We present 6 patients,4 male and 2 female aged between 21 and 27 years who suffered a TBI.These 6 patients underwent 6 doses of intrathecal,intramuscular(i.m.)and intravenous transplantation of WJ-MSCs at a target dose of 1×106/kg for each application route.Spasticity was assessed using the Modified Ashworth scale(MAS),motor function according to the Medical Research Council Muscle Strength Scale,quality of life was assessed by the Functional Independence Measure(FIM)scale and Karnofsky Performance Status scale.RESULTS Our patients showed only early,transient complications,such as subfebrile fever,mild headache,and muscle pain due to i.m.injection,which resolved within 24 h.During the one year follow-up,no other safety issues or adverse events were reported.These 6 patients showed improvements in their cognitive abilities,muscle spasticity,muscle strength,performance scores and fine motor skills when compared before and after the intervention.MAS values,which we used to assess spasticity,were observed to statistically significantly decrease for both left and right sides(P<0.001).The FIM scale includes both motor scores(P<0.05)and cognitive scores(P<0.001)and showed a significant increase in pretest posttest analyses.The difference observed in the participants’Karnofsky Performance Scale values pre and post the intervention was statistically significant(P<0.001).CONCLUSION This study sh
文摘Objective Coronary artery bypass grafting （CABG） is gradually increasing in the elderly population. We aimed to investigate the risk factors and the results of CABG along with the long term survival in patients at an age of 80 and older. Methods Between Januaa-y 2002 and December 201 I, a total of i01 consecutive patients at an age of S0 and older who underwent CABG in our hospital were included in the study. The patients were followed and the long-term survival was estimated. Results The mean age of the patients was 82.98 ~ 2.27 years. Sixty-four （63.4%） were males and 37 （36.6%） were females. Emergency surgery, duration of cardiopulmonary bypass, the intensive care unit （ICU） stay, inotropic support, intra aortic balloon pulsation application, amount oferythrocyte transfusion and flesh frozen plasma transfusion and ventilation period were significantly higher in the patients who died in the hospital. The duration of cardiopulmonary bypass （CPB） was found to be an inde- pendent predictor of mortality （OR： 1.18, 95% CI 1.01-1.38, P = 0.034）. The in-hospital mortality was 16.8%. Kaplan-Meier analyses revealed a survival ratio of 91.3% at one year, 82.9% at three years and 69.0% at five years. Conclusions Patients at the age of 80 and older can be candidates for the CABG procedure bearing in mind that they may have a longer ventilation period and intensive care unit stay. The morbidity and mortality of this age group is considered within an acceptable range. Approaches to minimize CPB, or the choice of off-pump surgery, may be a preventive method to lower the incidence of mortality. Hence, CABG may be performed in this age group with a satisfactory survival ratio.
文摘The present paper studies the unstable nonlinear Schr¨odinger equations, describing the time evolution of disturbances in marginally stable or unstable media. More precisely, the unstable nonlinear Schr¨odinger equation and its modified form are analytically solved using two efficient distinct techniques, known as the modified Kudraysov method and the sine-Gordon expansion approach. As a result, a wide range of new exact traveling wave solutions for the unstable nonlinear Schr¨odinger equation and its modified form are formally obtained.
