Acute pancreatitis(AP) is an inflammatory condition of the pancreas caused by an imbalance in factors involved in maintaining cellular homeostasis.Earliest events in AP occur within acinar cells accompanied by other p...Acute pancreatitis(AP) is an inflammatory condition of the pancreas caused by an imbalance in factors involved in maintaining cellular homeostasis.Earliest events in AP occur within acinar cells accompanied by other principal contributors to the inflammatory response i.e.the endothelial cells,immunocytes(granulocytes,monocytes/macrophages,lymphocytes) and neutrophils.Monocytes/macrophages are important inflammatory mediators,involved in the pathophysiology of AP,known to reside in the peritoneal cavity(in the vicinity of the pancreas) and in peripancreatic tissue.Recent studies suggested that impaired clearance of injured acini by macrophages is associated with an altered cytokine reaction which may constitute a basis for progression of AP.This review focuses on the role of monocytes/macrophages in progression of AP and discusses f indings on the inflammatory process involved.展开更多
Magnetic resonance imaging (MRI) is the modality of choice for staging nasopharyngeal carcinoma in the head and neck. This article will review the patterns of primary and nodal spread on MRI with reference to the late...Magnetic resonance imaging (MRI) is the modality of choice for staging nasopharyngeal carcinoma in the head and neck. This article will review the patterns of primary and nodal spread on MRI with reference to the latest 7th edition of the International Union Against Cancer/American Joint Committee on Cancer staging system.展开更多
AIM:To evaluate the efficacy and safety of adjunctive mosapride citrate for bowel preparation before colonoscopy. METHODS:We conducted a randomized,double-blind, placebo-controlled study with mosapride in addition to ...AIM:To evaluate the efficacy and safety of adjunctive mosapride citrate for bowel preparation before colonoscopy. METHODS:We conducted a randomized,double-blind, placebo-controlled study with mosapride in addition to polyethylene glycol(PEG)-electrolyte solution.Of 250 patients undergoing colonoscopy,124 were randomized to receive 2 L PEG plus 15 mg of mosapride citrate (mosapride group),and 126 received 2 L PEG plus placebo(placebo group).Patients completed a questionnaire reporting the acceptability and tolerability of the bowel preparation process.The efficacy of bowel preparation was assessed by colonoscopists using a 5-point scale based on Aronchick's criteria.The primary end point was optimal bowel preparation rates(scores of excellent/good/fair vs poor/inadequate). RESULTS:A total of 249 patients were included in the analysis.In the mosapride group,optimal bowel preparation rates were significantly higher in the left colon compared with the placebo group(78.2%vs 65.6%,P<0.05),but not in the right colon(76.5%vs 66.4%,P=0.08).After excluding patients with severe constipation,there was a significant difference in bowel preparation in both the left and right colon(82.4%vs 66.7%,80.8%vs 67.5%,P<0.05,P<0.01).The incidence of adverse events was similar in both groups. Among the subgroup who had previous colonoscopy experience,a significantly higher number of patients in the mosapride group felt that the current preparation was easier compared with patients in the placebo group(34/72 patients vs 24/74 patients,P<0.05). CONCLUSION:Mosapride citrate may be an effective and safe adjunct to PEG-electrolyte solution that leads to improved quality of bowel preparation,especially in patients without severe constipation.展开更多
AIM： To estimate the prevalence and identify the risk factors for metabolic bone disease in patients with cirrhosis. METHODS： The study was performed on 72 Indian patients with cirrhosis （63 male, 9 female; aged 〈...AIM： To estimate the prevalence and identify the risk factors for metabolic bone disease in patients with cirrhosis. METHODS： The study was performed on 72 Indian patients with cirrhosis （63 male, 9 female; aged 〈 50 years）. Etiology of cirrhosis was alcoholism （n = 37）, hepatitis B （n = 25） and hepatitis C （n = 10）. Twenty-three patients belonged to Child class A, while 39 were in class B and 10 in class C. Secondary causes for metabolic bone disease and osteoporosis were ruled out. Sunlight exposure, physical activity and dietary constituents were calculated. Complete metabolic profiles were derived, and bone mineral density （BMD） was measured using dual energy X ray absorptiometry. Low BMD was defined as a Z score below -2. RESULTS： Low BMD was found in 68% of patients. Lumbar spine was the most frequently and severely affected site. Risk factors for low BMD included low physical activity, decreased sunlight exposure, and low lean body mass. Calcium intake was adequate, with unfavorable calcium： protein ratio and calcium： phosphorus ratio. Vitamin D deficiency was highly prevalent （92%）. There was a high incidence of hypogonadism （41%）. Serum estradiol level was elevated significantly in patients with normal BMD. Insulin-like growth factor （IGF） 1 and IGF binding protein 3 levels were below the age-related normal range in both groups. IGF-1 was significantly lower in patients with low BMD. Serum osteocalcin level was low （68%） and urinary deoxypyridinoline to creatinine ratio was high （79%）, which demonstrated low bone formation with high resorption. CONCLUSION： Patients with cirrhosis have low BMD. Contributory factors are reduced physical activity, low lean body mass, vitamin D deficiency and hypogonadism and low IGF-1 level.展开更多
The gut microbiome is a complex microbial community,recognized for its potential role in physiology,health,and disease.The available evidence supports the role of gut dysbiosis in pancreatic disorders,including acute ...The gut microbiome is a complex microbial community,recognized for its potential role in physiology,health,and disease.The available evidence supports the role of gut dysbiosis in pancreatic disorders,including acute pancreatitis(AP).In AP,the presence of gut barrier damage resulting in increased mucosal permeability may lead to translocation of intestinal bacteria,necrosis of pancreatic and peripancreatic tissue,and infection,often accompanied by multiple organ dysfunction syndrome.Preserving gut microbial homeostasis may reduce the systemic effects of AP.A growing body of evidence suggests the possible involvement of the gut microbiome in various pancreatic diseases,including AP.This review discusses the possible role of the gut microbiome in AP.It highlights AP treatment and supplementation with prebiotics,synbiotics,and probiotics to maintain gastrointestinal microbial balance and effectively reduce hospitalization,morbidity and mortality in an early phase.It also addresses novel therapeutic areas in the gut microbiome,personalized treatment,and provides a roadmap of human microbial contributions to AP that have potential clinical benefit.展开更多
This study examined the individual and simultaneous adsorption of SO{in{itx}} (SO{in{it2}}) and NO{in{itx}} (NO-NO{in{it2}}) on activated carbon prepared from waste palm shell. The adsorption process was examined in a...This study examined the individual and simultaneous adsorption of SO{in{itx}} (SO{in{it2}}) and NO{in{itx}} (NO-NO{in{it2}}) on activated carbon prepared from waste palm shell. The adsorption process was examined in a fixed bed reactor at low temperatures (100\2-300\dgC). For individual adsorption without any catalytic activation, SO{in{itx}} showed good adsorption whereas NO{in{itx}} was very much poor. In the simultaneous adsorption of SO{in{itx}} and NO{in{itx}}, SO{in{itx}} showed greater adsorption affinity than NO{itx}. For palm shell activated carbon (PSAC) impregnated with metal catalyst (Ni and Ce) the concentration adsorbed profile showed that the amount of SO{in{itx}} adsorbed decreased regularly, while the amount of the adsorbed NO{in{itx}} increased irregularly. The properties of the pure and impregnated PSAC were analyzed by BET, SEM and EDX. These investigations indicated that PSAC impregnated with metal catalyst is the determining factor in the adsorption of SO{in{itx}} and NO{in{itx}} simultaneously.展开更多
Necrotizing enterocolitis （NEC） is the most common gastrointestinal emergency and carries with it both morbidity, short and long term, as well as mortality.1,2 It is a world-wide problem in preterm infants with a hi...Necrotizing enterocolitis （NEC） is the most common gastrointestinal emergency and carries with it both morbidity, short and long term, as well as mortality.1,2 It is a world-wide problem in preterm infants with a highly variable incidence varying from 2.6% to 28%.1 It affects 1.0%-7.7% of NICU admissions and is primarily a disease of premature infants with over 90% of cases occurring in infants bom prematurely. In the National Institute of Child Health and Human Development Neonatal Research Network, NEC was noted to occur in 11.5% in infants weighing 401-750 g, 9% in 751-1000 g,6% in 1001-1250 g and 4% in 1251-1500 g.展开更多
For carrier-based unmanned aerial vehicles(UAVs),one of the important problems is the design of an automatic carrier landing system(ACLS)that would enable the UAVs to accomplish autolanding on the aircraft carrier.How...For carrier-based unmanned aerial vehicles(UAVs),one of the important problems is the design of an automatic carrier landing system(ACLS)that would enable the UAVs to accomplish autolanding on the aircraft carrier.However,due to the movements of the flight deck with six degree-of-freedom,the autolanding becomes sophisticated.To solve this problem,an accurate and effective ACLS is developed,which is composed of an optimal preview control based flight control system and a Kalman filter based deck motion predictor.The preview control fuses the future information of the reference glide slope to improve landing precision.The reference glide slope is normally a straight line.However,the deck motion will change the position of the ideal landing point,and tracking the ideal straight glide slope may cause landing failure.Therefore,the predictive deck motion information from the deck motion predictor is used to correct the reference glide slope,which decreases the dispersion around the desired landing point.Finally,simulations are carried out to verify the performance of the designed ACLS based on a nonlinear UAV model.展开更多
AIM:To evaluate the possibility of reducing the volume of polyethylene glycol(PEG)-electrolyte solution using adjunctive mosapride citrate for colonoscopy preparation. METHODS:This was a single-center,prospective, ran...AIM:To evaluate the possibility of reducing the volume of polyethylene glycol(PEG)-electrolyte solution using adjunctive mosapride citrate for colonoscopy preparation. METHODS:This was a single-center,prospective, randomized,investigator-blinded,non-inferiority study involving 252 patients of both sexes,aged from 20 to 80 years,scheduled for screening or diagnostic colonoscopy in our department.A total of 126 patients was randomized to receive 1.5 L PEG-electrolyte solution plus 15 mg of mosapride(1.5 L group),and 126 received 2 L PEG-electrolyte solution plus 15 mg of mosapride(2 L group).Patients completed a questionnaire on the acceptability and tolerability of the bowel preparation process.The efficacy of bowel preparation was assessed using a 5-point scale based on the Aronchick scale.The primary end point was adequate bowel preparation rates(score of excellent/good/fair) vs(poor/inadequate).Acceptability and tolerability,as well as disease detection,were secondary end points. RESULTS:A total of 244 patients was included in the analysis.There were no significant differences between the 2 L and 1.5 L groups in age,sex,body mass index, number of previous colonoscopies,and the preparation method used previously.The adequate bowel preparation rates were 88.5%in the 2 L group and 82.8%in the 1.5 L group[95%lower confidence limit(LCL)for the difference=-14.5%,non-inferiority P=0.019]in the right colon.In the left colon,the adequate bowel preparation rates were 89.3%in the 2 L group and 81.1%in the 1.5 L group(95%LCL=-17.0%,non-inferiority P=0.066).Compliance,defined as complete (100%)intake of the PEG solution,was significantly higher in the 1.5 L group than in the 2 L group(96.8% vs 85.7%,P=0.002).The proportion of abdominal distension(none/mild/moderate/severe)was significantly lower in the 1.5 L group than in the 2 L group (36/65/22/3 vs 58/48/18/2,P=0.040).Within the subgroup who had undergone colonoscopy previously, a significantly higher number of patients in the 1.5 L group than in the 2 L group felt that t展开更多
Chronic pancreatitis(CP)is a progressive and irreversible fibroinflammatory disorder,accompanied by pancreatic exocrine insufficiency and dysregulated gut microbiota.Recently,accumulating evidence has supported a corr...Chronic pancreatitis(CP)is a progressive and irreversible fibroinflammatory disorder,accompanied by pancreatic exocrine insufficiency and dysregulated gut microbiota.Recently,accumulating evidence has supported a correlation between gut dysbiosis and CP development.However,whether gut microbiota dysbiosis contributes to CP pathogenesis remains unclear.Herein,an experimental CP was induced by repeated high-dose caerulein injections.The broad-spectrum antibiotics(ABX)and ABX targeting Gram-positive(G+)or Gram-negative bacteria(G-)were applied to explore the specific roles of these bacteria.Gut dysbiosis was observed in both mice and in CP patients,which was accompanied by a sharply reduced abundance for short-chain fatty acids(SCFAs)-producers,especially G+bacteria.Broad-spectrum ABX exacerbated the severity of CP,as evidenced by aggravated pancreatic fibrosis and gut dysbiosis,especially the depletion of SCFAs-producing G+bacteria.Additionally,depletion of SCFAs-producing G+bacteria rather than G-bacteria intensified CP progression independent of TLR4,which was attenuated by supplementation with exogenous SCFAs.Finally,SCFAs modulated pancreatic fibrosis through inhibition of macrophage infiltration and M2 phenotype switching.The study supports a critical role for SCFAs-producing G+bacteria in CP.Therefore,modulation of dietary-derived SCFAs or G+SCFAs-producing bacteria may be considered a novel interventive approach for the management of CP.展开更多
The emergence of the novel coronavirus has led to a global pandemic which has led to the airline industry facing severe losses. For air travel to recover, airlines need to ensure safe air travel. In this paper, the au...The emergence of the novel coronavirus has led to a global pandemic which has led to the airline industry facing severe losses. For air travel to recover, airlines need to ensure safe air travel. In this paper, the authors have modeled droplet dispersion after a single breath from an index patient. Computational Fluid Dynamics (CFD) simulations are conducted using the k-ωSST turbulence model in ANSYS Fluent. The authors have taken into consideration several parameters such as the size of the mouth opening, the velocity of the cabin air as well as the number of droplets being exhaled by the index patient to ensure a realistic simulation. Preliminary results indicate that after a duration of 20 s, droplets from the index patient disperse within a 10 m2 cabin area. About 75% of the droplets are found disperse for up to 2 m axially behind the index patient. This could possess an enhanced risk to passengers sitting behind the index patient. Ultimately, this paper provides an insight into the potential of CFD to visualise droplet dispersal and give impetus to ensure that necessary mitigating measures can be taken to reduce the risk of infection through droplet dispersal.展开更多
Restorative proctocolectomy is the most common surgical option for patients with familial adenomatous polyposis(FAP). However,adenomas may develop in the ileal pouch mucosa over time,and even carcinoma in the pouch ha...Restorative proctocolectomy is the most common surgical option for patients with familial adenomatous polyposis(FAP). However,adenomas may develop in the ileal pouch mucosa over time,and even carcinoma in the pouch has been reported. We therefore reviewed the prevalence,nature,and treatment of adenomas and carcinoma that develop after proctocolectomy in the ileal pouch mucosa in patients with FAP. In 25 reports that were reviewed,the incidence of adenomas in the ileal pouch varied from 6.7% to 73.9%. Several potential factors that favor the development of pouch polyposis have been investigated,but many remain controversial. Nevertheless,it seems certain that the age of the pouch is important. The risk appears to be 7%to 16% after 5 years,35% to 42% after 10 years,and75% after 15 years. On the other hand,only 21 cases of ileal pouch carcinoma have been recorded in the literature to date. The diagnosis of pouch carcinoma was made between 3 to 20 years(median,10 years) after pouch construction. Although the risk of malignant transformation in ileal pouches is probably low,it is not negligible,and the long-term risk cannot presently be well quantified. Regular endoscopic surveillance,especially using chromoendoscopy,is recommended.展开更多
We aim to evaluate the incidence of incontinence following laser endoscopic enucleation of the prostate(EEP)comparing en-bloc(Group 1)versus 2-lobe/3-lobe techniques(Group 2).We performed a retrospective review of pat...We aim to evaluate the incidence of incontinence following laser endoscopic enucleation of the prostate(EEP)comparing en-bloc(Group 1)versus 2-lobe/3-lobe techniques(Group 2).We performed a retrospective review of patients undergoing EEP for benign prostaticenlargement in 12 centers between January 2020 and January 2022.Data were presented as median and interquartile range(IQR).Univariable and multivariable logistic regression analysis was performed to evaluate factors associated with stress urinary incontinence(SUI)and mixed urinary incontinence(MUI).There were 1711 patients in Group 1 and 3357 patients in Group 2.Patients in Group 2were significantly younger(68[62–73]years vs 69[63–74]years,P=0.002).Median(interquartile range)prostate volume(PV)wassimilar between the groups(70[52–92]ml in Group 1 vs 70[54–90]ml in Group 2,P=0.774).There was no difference in preoperativeInternational Prostate Symptom Score,quality of life,or maximum flow rate.Enucleation,morcellation,and total surgical time weresignificantly shorter in Group 1.Within 1 month,overall incontinence rate was 6.3%in Group 1 versus 5.3%in Group 2(P=0.12),and urge incontinence was significantly higher in Group 1(55.1%vs 37.3%in Group 2,P<0.001).After 3 months,the overall rate ofincontinence was 1.7%in Group 1 versus 2.3%in Group 2(P=0.06),and SUI was significantly higher in Group 2(55.6%vs 24.1%in Group 1,P=0.002).At multivariable analysis,PV and IPSS were factors significantly associated with higher odds of transient SUI/MUI.PV,surgical time,and no early apical release technique were factors associated with higher odds of persistent SUI/MUI.展开更多
AIM: To determine the predictors of 50 d in-hospital mortality in decompensated cirrhosis patients with spontaneous bacterial peritonitis(SBP).METHODS: Two hundred and eighteen patients admitted to an intensive care u...AIM: To determine the predictors of 50 d in-hospital mortality in decompensated cirrhosis patients with spontaneous bacterial peritonitis(SBP).METHODS: Two hundred and eighteen patients admitted to an intensive care unit in a tertiary care hospital between June 2013 and June 2014 with the diagnosis of SBP(during hospitalization) and cirrhosis were retrospectively analysed. SBP was diagnosed by abdominal paracentesis in the presence of polymorphonuclear cell count ≥ 250 cells/mm3 in the peritoneal fluid. Student's t test, multivariate logistic regression, cox proportional hazard ratio(HR), receiver operating characteristics(ROC) curves and Kaplan-Meier survival analysis were utilized for statistical analysis. Predictive abilities of several variables identified by multivariate analysis were compared using the area under ROC curve. P < 0.05 were considered statistical significant. RESULTS: The 50 d in-hospital mortality rate attributable to SBP is 43.11%(n = 94). Median survival duration for those who died was 9 d. In univariate analysis acute kidney injury(AKI), hepatic encephalopathy, septic shock, serum bilirubin, international normalized ratio, aspartate transaminase, and model for end-stage liver disease- sodium(MELD-Na) were significantly associated with in- hospital mortality in patients with SBP(P ≤ 0.001). Multivariate coxproportional regression analysis showed AKI(HR = 2.16, 95%CI: 1.36-3.42, P = 0.001) septic shock(HR = 1.73, 95%CI: 1.05-2.83, P = 0.029) MELD-Na(HR = 1.06, 95%CI: 1.02-1.09, P ≤ 0.001) was significantly associated with 50 d in-hospital mortality. The prognostic accuracy for AKI, MELD-Na and septic shock was 77%, 74% and 71% respectively associated with 50 d inhospital mortality in SBP patients.CONCLUSION: AKI, MELD-Na and septic shock were predictors of 50 d in-hospital mortality in decompensated cirrhosis patients with SBP.展开更多
There are several options for the treatment of varicocele, including surgical repair either by open or microsurgical approach, laparoscopy, or through percutaneous embolization of the internal spermatic vein. The ulti...There are several options for the treatment of varicocele, including surgical repair either by open or microsurgical approach, laparoscopy, or through percutaneous embolization of the internal spermatic vein. The ultimate goal of varicocele treatment relies on the occlusion of the dilated veins that drain the testis. Percutaneous embolization offers a rapid recovery and can be successfully accomplished in approximately 90% of attempts. However, the technique demands interventional radiologic expertise and has potential serious complications, including vascular perforation, coil migration, and thrombosis of pampiniform plexus. This review discusses the common indications, relative contraindications, technical details, and risks associated with percutaneous embolization of varicocele.展开更多
AIM:To study if HER-2 overexpression by locally advanced esophageal cancers increase the chance of brain metastasis following esophagectomy.METHODS:We retrospectively reviewed the medical records of esophageal cancer ...AIM:To study if HER-2 overexpression by locally advanced esophageal cancers increase the chance of brain metastasis following esophagectomy.METHODS:We retrospectively reviewed the medical records of esophageal cancer patients who underwent esophagectomy at University of Iowa Hospitals and Clinics between 2000 and 2010.Data analyzed consisted of demographic and clinical variables.The brain metastasis tissue was assayed for HER-2 overexpression utilizing the FDA approved DAKO Hercept Test.RESULTS:One hundred and forty two patients were reviewed.Median age was 64 years(36-86 years).Eighty eight patients(62%) received neoadjuvant chemoradiotherapy.Pathological complete and partial responses were achieved in 17(19%) and 71(81%) patients.Cancer relapsed in 43/142(30%) patients.The brain was the first site of relapse in 9/43 patients(21%,95% CI:10%-36%).HER-2 immunohistochemistry testing of the brain metastasis tissue showed that 5/9(56%) cases overexpressed HER-2(3+ staining).CONCLUSION:HER-2 overexpression might be associated with increased risk of brain metastasis in esophageal cancer patients following esophagectomy.Further studies will be required to validate this observation.展开更多
Hernias are amongst the oldest afflictions of mankind. The tension-free mesh repairs revolutionized and radically changed the whole concept of anatomical tissue repairs. The introduction of mesh, though beneficial, po...Hernias are amongst the oldest afflictions of mankind. The tension-free mesh repairs revolutionized and radically changed the whole concept of anatomical tissue repairs. The introduction of mesh, though beneficial, posed a new set of postoperative problems with the mesh infection being the most morbid one. Laparoscopic surgery has been able to reduce the incidence of mesh infection as opposed to the open hernia repairs. The infection occurs mostly early but rarely does it present several years after the surgery. Herein we report our case of delayed mesh infection developing 6 years postoperatively. This is our first such case in a series of more than 1000 laparoscopic hernia repairs over a period of 6 years (2010-2016). The patient needed an open exploration which revealed a large preperitoneal cavity containing 770 ml of pus with a mesh floating in it. The mesh was removed and the thorough toileting of the wound was done.展开更多
Background:Forefoot strike(FFS) and rearfoot strike(RFS) runners differ in their kinematics,force loading rates,and joint loading patterns,but the timing of their muscle activation is less clear.Methods:Forty recreati...Background:Forefoot strike(FFS) and rearfoot strike(RFS) runners differ in their kinematics,force loading rates,and joint loading patterns,but the timing of their muscle activation is less clear.Methods:Forty recreational and highly trained runners ran at four speeds barefoot and shod on a motorized treadmill. "Barefoot" runners wore thin,five-toed socks and shod runners wore neutral running shoes.Subjects were instructed to run comfortably at each speed with no instructions about foot strike patterns.Results:Eleven runners landed with an FFS when barefoot and shod and eleven runners landed with an RFS when barefoot and shod.The 18remaining runners shifted from an FFS when barefoot to an RFS when shod(shifters).Shod shifters ran with a lower stride frequency and greater stride length than all other runners.All FFS runners landed with more plantarflexed ankles and more vertical lower legs at the beginning of stance compared to RFS runners.FFS runners activated their plantarflexor muscles 1 1%earlier and 10%longer than RFS runners.Conclusion:This earlier and longer relative activation of the plantarrlexors likely enhances the capacity for the passive structures of the foot and ankle to store elastic energy,and may also enhance the performance of the active muscle by increasing the storage of elastic strain energy in the cross-bridaes and activated thin.展开更多
In Intelligent Manufacturing,Big Data and industrial information enable enterprises to closely monitor and respond to precise changes in both internal processes and external environmental factors,ensuring more informe...In Intelligent Manufacturing,Big Data and industrial information enable enterprises to closely monitor and respond to precise changes in both internal processes and external environmental factors,ensuring more informed decision-making and adaptive system management.It also promotes decision making and provides scientific analysis to enhance the efficiency of the operation,cost reduction,maximizing the process of production and so on.Various methods are employed to enhance productivity,yet achieving sustainable manufacturing remains a complex challenge that requires careful consideration.This study aims to develop a methodology for effective manufacturing sustainability by proposing a novel Hybrid Weighted Support Vector-based Lévy flight(HWS-LF)algorithm.The objective of the HWS-LF method is to improve the environmental,economic,and social aspects of manufacturing processes.In this approach,Support Vector Machines(SVM)are used to classify data points by identifying the optimal hyperplane to separate different classes,thereby supporting predictive maintenance and quality control in manufacturing.Random Forest is applied to boost efficiency,resource allocation,and production optimization.A Weighted Average Ensemble technique is employed to combine predictions from multiple models,assigning different weights to ensure an accurate system for evaluating manufacturing performance.Additionally,Lévy flight Optimization is incorporated to enhance the performance of the HWS-LF method further.The method’s effectiveness is assessed using various evaluation metrics,including accuracy,precision,recall,F1-score,and specificity.Results show that the proposed HWS-LF method outperforms other state-of-the-art techniques,demonstrating superior productivity and system performance.展开更多
文摘Acute pancreatitis(AP) is an inflammatory condition of the pancreas caused by an imbalance in factors involved in maintaining cellular homeostasis.Earliest events in AP occur within acinar cells accompanied by other principal contributors to the inflammatory response i.e.the endothelial cells,immunocytes(granulocytes,monocytes/macrophages,lymphocytes) and neutrophils.Monocytes/macrophages are important inflammatory mediators,involved in the pathophysiology of AP,known to reside in the peritoneal cavity(in the vicinity of the pancreas) and in peripancreatic tissue.Recent studies suggested that impaired clearance of injured acini by macrophages is associated with an altered cytokine reaction which may constitute a basis for progression of AP.This review focuses on the role of monocytes/macrophages in progression of AP and discusses f indings on the inflammatory process involved.
文摘Magnetic resonance imaging (MRI) is the modality of choice for staging nasopharyngeal carcinoma in the head and neck. This article will review the patterns of primary and nodal spread on MRI with reference to the latest 7th edition of the International Union Against Cancer/American Joint Committee on Cancer staging system.
文摘AIM:To evaluate the efficacy and safety of adjunctive mosapride citrate for bowel preparation before colonoscopy. METHODS:We conducted a randomized,double-blind, placebo-controlled study with mosapride in addition to polyethylene glycol(PEG)-electrolyte solution.Of 250 patients undergoing colonoscopy,124 were randomized to receive 2 L PEG plus 15 mg of mosapride citrate (mosapride group),and 126 received 2 L PEG plus placebo(placebo group).Patients completed a questionnaire reporting the acceptability and tolerability of the bowel preparation process.The efficacy of bowel preparation was assessed by colonoscopists using a 5-point scale based on Aronchick's criteria.The primary end point was optimal bowel preparation rates(scores of excellent/good/fair vs poor/inadequate). RESULTS:A total of 249 patients were included in the analysis.In the mosapride group,optimal bowel preparation rates were significantly higher in the left colon compared with the placebo group(78.2%vs 65.6%,P<0.05),but not in the right colon(76.5%vs 66.4%,P=0.08).After excluding patients with severe constipation,there was a significant difference in bowel preparation in both the left and right colon(82.4%vs 66.7%,80.8%vs 67.5%,P<0.05,P<0.01).The incidence of adverse events was similar in both groups. Among the subgroup who had previous colonoscopy experience,a significantly higher number of patients in the mosapride group felt that the current preparation was easier compared with patients in the placebo group(34/72 patients vs 24/74 patients,P<0.05). CONCLUSION:Mosapride citrate may be an effective and safe adjunct to PEG-electrolyte solution that leads to improved quality of bowel preparation,especially in patients without severe constipation.
基金Supported by Corpus generated by Department of Endocrinology, KEM Hospital, Mumbai, India
文摘AIM： To estimate the prevalence and identify the risk factors for metabolic bone disease in patients with cirrhosis. METHODS： The study was performed on 72 Indian patients with cirrhosis （63 male, 9 female; aged 〈 50 years）. Etiology of cirrhosis was alcoholism （n = 37）, hepatitis B （n = 25） and hepatitis C （n = 10）. Twenty-three patients belonged to Child class A, while 39 were in class B and 10 in class C. Secondary causes for metabolic bone disease and osteoporosis were ruled out. Sunlight exposure, physical activity and dietary constituents were calculated. Complete metabolic profiles were derived, and bone mineral density （BMD） was measured using dual energy X ray absorptiometry. Low BMD was defined as a Z score below -2. RESULTS： Low BMD was found in 68% of patients. Lumbar spine was the most frequently and severely affected site. Risk factors for low BMD included low physical activity, decreased sunlight exposure, and low lean body mass. Calcium intake was adequate, with unfavorable calcium： protein ratio and calcium： phosphorus ratio. Vitamin D deficiency was highly prevalent （92%）. There was a high incidence of hypogonadism （41%）. Serum estradiol level was elevated significantly in patients with normal BMD. Insulin-like growth factor （IGF） 1 and IGF binding protein 3 levels were below the age-related normal range in both groups. IGF-1 was significantly lower in patients with low BMD. Serum osteocalcin level was low （68%） and urinary deoxypyridinoline to creatinine ratio was high （79%）, which demonstrated low bone formation with high resorption. CONCLUSION： Patients with cirrhosis have low BMD. Contributory factors are reduced physical activity, low lean body mass, vitamin D deficiency and hypogonadism and low IGF-1 level.
基金Lee Foundation Microbiome Education Grant,No.N:176-000-054-001.
文摘The gut microbiome is a complex microbial community,recognized for its potential role in physiology,health,and disease.The available evidence supports the role of gut dysbiosis in pancreatic disorders,including acute pancreatitis(AP).In AP,the presence of gut barrier damage resulting in increased mucosal permeability may lead to translocation of intestinal bacteria,necrosis of pancreatic and peripancreatic tissue,and infection,often accompanied by multiple organ dysfunction syndrome.Preserving gut microbial homeostasis may reduce the systemic effects of AP.A growing body of evidence suggests the possible involvement of the gut microbiome in various pancreatic diseases,including AP.This review discusses the possible role of the gut microbiome in AP.It highlights AP treatment and supplementation with prebiotics,synbiotics,and probiotics to maintain gastrointestinal microbial balance and effectively reduce hospitalization,morbidity and mortality in an early phase.It also addresses novel therapeutic areas in the gut microbiome,personalized treatment,and provides a roadmap of human microbial contributions to AP that have potential clinical benefit.
基金Supported financially by Yayasan FELDA, Malaysia (Grant No. 6050075)
文摘This study examined the individual and simultaneous adsorption of SO{in{itx}} (SO{in{it2}}) and NO{in{itx}} (NO-NO{in{it2}}) on activated carbon prepared from waste palm shell. The adsorption process was examined in a fixed bed reactor at low temperatures (100\2-300\dgC). For individual adsorption without any catalytic activation, SO{in{itx}} showed good adsorption whereas NO{in{itx}} was very much poor. In the simultaneous adsorption of SO{in{itx}} and NO{in{itx}}, SO{in{itx}} showed greater adsorption affinity than NO{itx}. For palm shell activated carbon (PSAC) impregnated with metal catalyst (Ni and Ce) the concentration adsorbed profile showed that the amount of SO{in{itx}} adsorbed decreased regularly, while the amount of the adsorbed NO{in{itx}} increased irregularly. The properties of the pure and impregnated PSAC were analyzed by BET, SEM and EDX. These investigations indicated that PSAC impregnated with metal catalyst is the determining factor in the adsorption of SO{in{itx}} and NO{in{itx}} simultaneously.
文摘Necrotizing enterocolitis （NEC） is the most common gastrointestinal emergency and carries with it both morbidity, short and long term, as well as mortality.1,2 It is a world-wide problem in preterm infants with a highly variable incidence varying from 2.6% to 28%.1 It affects 1.0%-7.7% of NICU admissions and is primarily a disease of premature infants with over 90% of cases occurring in infants bom prematurely. In the National Institute of Child Health and Human Development Neonatal Research Network, NEC was noted to occur in 11.5% in infants weighing 401-750 g, 9% in 751-1000 g,6% in 1001-1250 g and 4% in 1251-1500 g.
基金supported in part by the National Natural Science Foundations of China(Nos.61304223,61673209,61533008)the Aeronautical Science Foundation(No.2016ZA 52009)the Fundamental Research Funds for the Central Universities(No.NJ20160026)
文摘For carrier-based unmanned aerial vehicles(UAVs),one of the important problems is the design of an automatic carrier landing system(ACLS)that would enable the UAVs to accomplish autolanding on the aircraft carrier.However,due to the movements of the flight deck with six degree-of-freedom,the autolanding becomes sophisticated.To solve this problem,an accurate and effective ACLS is developed,which is composed of an optimal preview control based flight control system and a Kalman filter based deck motion predictor.The preview control fuses the future information of the reference glide slope to improve landing precision.The reference glide slope is normally a straight line.However,the deck motion will change the position of the ideal landing point,and tracking the ideal straight glide slope may cause landing failure.Therefore,the predictive deck motion information from the deck motion predictor is used to correct the reference glide slope,which decreases the dispersion around the desired landing point.Finally,simulations are carried out to verify the performance of the designed ACLS based on a nonlinear UAV model.
文摘AIM:To evaluate the possibility of reducing the volume of polyethylene glycol(PEG)-electrolyte solution using adjunctive mosapride citrate for colonoscopy preparation. METHODS:This was a single-center,prospective, randomized,investigator-blinded,non-inferiority study involving 252 patients of both sexes,aged from 20 to 80 years,scheduled for screening or diagnostic colonoscopy in our department.A total of 126 patients was randomized to receive 1.5 L PEG-electrolyte solution plus 15 mg of mosapride(1.5 L group),and 126 received 2 L PEG-electrolyte solution plus 15 mg of mosapride(2 L group).Patients completed a questionnaire on the acceptability and tolerability of the bowel preparation process.The efficacy of bowel preparation was assessed using a 5-point scale based on the Aronchick scale.The primary end point was adequate bowel preparation rates(score of excellent/good/fair) vs(poor/inadequate).Acceptability and tolerability,as well as disease detection,were secondary end points. RESULTS:A total of 244 patients was included in the analysis.There were no significant differences between the 2 L and 1.5 L groups in age,sex,body mass index, number of previous colonoscopies,and the preparation method used previously.The adequate bowel preparation rates were 88.5%in the 2 L group and 82.8%in the 1.5 L group[95%lower confidence limit(LCL)for the difference=-14.5%,non-inferiority P=0.019]in the right colon.In the left colon,the adequate bowel preparation rates were 89.3%in the 2 L group and 81.1%in the 1.5 L group(95%LCL=-17.0%,non-inferiority P=0.066).Compliance,defined as complete (100%)intake of the PEG solution,was significantly higher in the 1.5 L group than in the 2 L group(96.8% vs 85.7%,P=0.002).The proportion of abdominal distension(none/mild/moderate/severe)was significantly lower in the 1.5 L group than in the 2 L group (36/65/22/3 vs 58/48/18/2,P=0.040).Within the subgroup who had undergone colonoscopy previously, a significantly higher number of patients in the 1.5 L group than in the 2 L group felt that t
基金supported by funds from the National Natural Science Foundation of China(Grant Nos.82070666,82122068)the Natural Science Foundation for Distinguished Young Scholars of Jiangsu Province(Grant No.BK20200026,China)+4 种基金the Collaborative Innovation Center of Food Safety and Quality Control of Jiangsu Province,the Fundamental Research Funds for the Central Universities(Grant Nos.JUSRP221037,JUSRP22007,China)the China Postdoctoral Science Foundation(Grant No.2022M721366)the Excellent Postdoctoral Program of Jiangsu Province(Grant No.2023ZB168,China)Wuxi City’s first“double hundred”young and middle-aged medical and health talents(Grant No:BJ2020045,China)Wuxi Social Development Science and Technology Demonstration Project(Grant No:N20201003,China)。
文摘Chronic pancreatitis(CP)is a progressive and irreversible fibroinflammatory disorder,accompanied by pancreatic exocrine insufficiency and dysregulated gut microbiota.Recently,accumulating evidence has supported a correlation between gut dysbiosis and CP development.However,whether gut microbiota dysbiosis contributes to CP pathogenesis remains unclear.Herein,an experimental CP was induced by repeated high-dose caerulein injections.The broad-spectrum antibiotics(ABX)and ABX targeting Gram-positive(G+)or Gram-negative bacteria(G-)were applied to explore the specific roles of these bacteria.Gut dysbiosis was observed in both mice and in CP patients,which was accompanied by a sharply reduced abundance for short-chain fatty acids(SCFAs)-producers,especially G+bacteria.Broad-spectrum ABX exacerbated the severity of CP,as evidenced by aggravated pancreatic fibrosis and gut dysbiosis,especially the depletion of SCFAs-producing G+bacteria.Additionally,depletion of SCFAs-producing G+bacteria rather than G-bacteria intensified CP progression independent of TLR4,which was attenuated by supplementation with exogenous SCFAs.Finally,SCFAs modulated pancreatic fibrosis through inhibition of macrophage infiltration and M2 phenotype switching.The study supports a critical role for SCFAs-producing G+bacteria in CP.Therefore,modulation of dietary-derived SCFAs or G+SCFAs-producing bacteria may be considered a novel interventive approach for the management of CP.
文摘The emergence of the novel coronavirus has led to a global pandemic which has led to the airline industry facing severe losses. For air travel to recover, airlines need to ensure safe air travel. In this paper, the authors have modeled droplet dispersion after a single breath from an index patient. Computational Fluid Dynamics (CFD) simulations are conducted using the k-ωSST turbulence model in ANSYS Fluent. The authors have taken into consideration several parameters such as the size of the mouth opening, the velocity of the cabin air as well as the number of droplets being exhaled by the index patient to ensure a realistic simulation. Preliminary results indicate that after a duration of 20 s, droplets from the index patient disperse within a 10 m2 cabin area. About 75% of the droplets are found disperse for up to 2 m axially behind the index patient. This could possess an enhanced risk to passengers sitting behind the index patient. Ultimately, this paper provides an insight into the potential of CFD to visualise droplet dispersal and give impetus to ensure that necessary mitigating measures can be taken to reduce the risk of infection through droplet dispersal.
文摘Restorative proctocolectomy is the most common surgical option for patients with familial adenomatous polyposis(FAP). However,adenomas may develop in the ileal pouch mucosa over time,and even carcinoma in the pouch has been reported. We therefore reviewed the prevalence,nature,and treatment of adenomas and carcinoma that develop after proctocolectomy in the ileal pouch mucosa in patients with FAP. In 25 reports that were reviewed,the incidence of adenomas in the ileal pouch varied from 6.7% to 73.9%. Several potential factors that favor the development of pouch polyposis have been investigated,but many remain controversial. Nevertheless,it seems certain that the age of the pouch is important. The risk appears to be 7%to 16% after 5 years,35% to 42% after 10 years,and75% after 15 years. On the other hand,only 21 cases of ileal pouch carcinoma have been recorded in the literature to date. The diagnosis of pouch carcinoma was made between 3 to 20 years(median,10 years) after pouch construction. Although the risk of malignant transformation in ileal pouches is probably low,it is not negligible,and the long-term risk cannot presently be well quantified. Regular endoscopic surveillance,especially using chromoendoscopy,is recommended.
文摘We aim to evaluate the incidence of incontinence following laser endoscopic enucleation of the prostate(EEP)comparing en-bloc(Group 1)versus 2-lobe/3-lobe techniques(Group 2).We performed a retrospective review of patients undergoing EEP for benign prostaticenlargement in 12 centers between January 2020 and January 2022.Data were presented as median and interquartile range(IQR).Univariable and multivariable logistic regression analysis was performed to evaluate factors associated with stress urinary incontinence(SUI)and mixed urinary incontinence(MUI).There were 1711 patients in Group 1 and 3357 patients in Group 2.Patients in Group 2were significantly younger(68[62–73]years vs 69[63–74]years,P=0.002).Median(interquartile range)prostate volume(PV)wassimilar between the groups(70[52–92]ml in Group 1 vs 70[54–90]ml in Group 2,P=0.774).There was no difference in preoperativeInternational Prostate Symptom Score,quality of life,or maximum flow rate.Enucleation,morcellation,and total surgical time weresignificantly shorter in Group 1.Within 1 month,overall incontinence rate was 6.3%in Group 1 versus 5.3%in Group 2(P=0.12),and urge incontinence was significantly higher in Group 1(55.1%vs 37.3%in Group 2,P<0.001).After 3 months,the overall rate ofincontinence was 1.7%in Group 1 versus 2.3%in Group 2(P=0.06),and SUI was significantly higher in Group 2(55.6%vs 24.1%in Group 1,P=0.002).At multivariable analysis,PV and IPSS were factors significantly associated with higher odds of transient SUI/MUI.PV,surgical time,and no early apical release technique were factors associated with higher odds of persistent SUI/MUI.
文摘AIM: To determine the predictors of 50 d in-hospital mortality in decompensated cirrhosis patients with spontaneous bacterial peritonitis(SBP).METHODS: Two hundred and eighteen patients admitted to an intensive care unit in a tertiary care hospital between June 2013 and June 2014 with the diagnosis of SBP(during hospitalization) and cirrhosis were retrospectively analysed. SBP was diagnosed by abdominal paracentesis in the presence of polymorphonuclear cell count ≥ 250 cells/mm3 in the peritoneal fluid. Student's t test, multivariate logistic regression, cox proportional hazard ratio(HR), receiver operating characteristics(ROC) curves and Kaplan-Meier survival analysis were utilized for statistical analysis. Predictive abilities of several variables identified by multivariate analysis were compared using the area under ROC curve. P < 0.05 were considered statistical significant. RESULTS: The 50 d in-hospital mortality rate attributable to SBP is 43.11%(n = 94). Median survival duration for those who died was 9 d. In univariate analysis acute kidney injury(AKI), hepatic encephalopathy, septic shock, serum bilirubin, international normalized ratio, aspartate transaminase, and model for end-stage liver disease- sodium(MELD-Na) were significantly associated with in- hospital mortality in patients with SBP(P ≤ 0.001). Multivariate coxproportional regression analysis showed AKI(HR = 2.16, 95%CI: 1.36-3.42, P = 0.001) septic shock(HR = 1.73, 95%CI: 1.05-2.83, P = 0.029) MELD-Na(HR = 1.06, 95%CI: 1.02-1.09, P ≤ 0.001) was significantly associated with 50 d in-hospital mortality. The prognostic accuracy for AKI, MELD-Na and septic shock was 77%, 74% and 71% respectively associated with 50 d inhospital mortality in SBP patients.CONCLUSION: AKI, MELD-Na and septic shock were predictors of 50 d in-hospital mortality in decompensated cirrhosis patients with SBP.
文摘There are several options for the treatment of varicocele, including surgical repair either by open or microsurgical approach, laparoscopy, or through percutaneous embolization of the internal spermatic vein. The ultimate goal of varicocele treatment relies on the occlusion of the dilated veins that drain the testis. Percutaneous embolization offers a rapid recovery and can be successfully accomplished in approximately 90% of attempts. However, the technique demands interventional radiologic expertise and has potential serious complications, including vascular perforation, coil migration, and thrombosis of pampiniform plexus. This review discusses the common indications, relative contraindications, technical details, and risks associated with percutaneous embolization of varicocele.
基金Supported by The Iowa Leukemia and Cancer Research Fund at University of Iowa Hospitals and clinics
文摘AIM:To study if HER-2 overexpression by locally advanced esophageal cancers increase the chance of brain metastasis following esophagectomy.METHODS:We retrospectively reviewed the medical records of esophageal cancer patients who underwent esophagectomy at University of Iowa Hospitals and Clinics between 2000 and 2010.Data analyzed consisted of demographic and clinical variables.The brain metastasis tissue was assayed for HER-2 overexpression utilizing the FDA approved DAKO Hercept Test.RESULTS:One hundred and forty two patients were reviewed.Median age was 64 years(36-86 years).Eighty eight patients(62%) received neoadjuvant chemoradiotherapy.Pathological complete and partial responses were achieved in 17(19%) and 71(81%) patients.Cancer relapsed in 43/142(30%) patients.The brain was the first site of relapse in 9/43 patients(21%,95% CI:10%-36%).HER-2 immunohistochemistry testing of the brain metastasis tissue showed that 5/9(56%) cases overexpressed HER-2(3+ staining).CONCLUSION:HER-2 overexpression might be associated with increased risk of brain metastasis in esophageal cancer patients following esophagectomy.Further studies will be required to validate this observation.
文摘Hernias are amongst the oldest afflictions of mankind. The tension-free mesh repairs revolutionized and radically changed the whole concept of anatomical tissue repairs. The introduction of mesh, though beneficial, posed a new set of postoperative problems with the mesh infection being the most morbid one. Laparoscopic surgery has been able to reduce the incidence of mesh infection as opposed to the open hernia repairs. The infection occurs mostly early but rarely does it present several years after the surgery. Herein we report our case of delayed mesh infection developing 6 years postoperatively. This is our first such case in a series of more than 1000 laparoscopic hernia repairs over a period of 6 years (2010-2016). The patient needed an open exploration which revealed a large preperitoneal cavity containing 770 ml of pus with a mesh floating in it. The mesh was removed and the thorough toileting of the wound was done.
基金the Purves Summer Research AwardSherman Fairchild Foundation+1 种基金National Science Foundation (NSF-0634592)Howard Hughes Medical Institute Undergraduate Science Program award 52006301 to Harvey Mudd College
文摘Background:Forefoot strike(FFS) and rearfoot strike(RFS) runners differ in their kinematics,force loading rates,and joint loading patterns,but the timing of their muscle activation is less clear.Methods:Forty recreational and highly trained runners ran at four speeds barefoot and shod on a motorized treadmill. "Barefoot" runners wore thin,five-toed socks and shod runners wore neutral running shoes.Subjects were instructed to run comfortably at each speed with no instructions about foot strike patterns.Results:Eleven runners landed with an FFS when barefoot and shod and eleven runners landed with an RFS when barefoot and shod.The 18remaining runners shifted from an FFS when barefoot to an RFS when shod(shifters).Shod shifters ran with a lower stride frequency and greater stride length than all other runners.All FFS runners landed with more plantarflexed ankles and more vertical lower legs at the beginning of stance compared to RFS runners.FFS runners activated their plantarflexor muscles 1 1%earlier and 10%longer than RFS runners.Conclusion:This earlier and longer relative activation of the plantarrlexors likely enhances the capacity for the passive structures of the foot and ankle to store elastic energy,and may also enhance the performance of the active muscle by increasing the storage of elastic strain energy in the cross-bridaes and activated thin.
基金the Deputyship for Research and Innovation,Ministry of Education,Saudi Arabia,for funding this research(IFKSUOR3-176-8).
文摘In Intelligent Manufacturing,Big Data and industrial information enable enterprises to closely monitor and respond to precise changes in both internal processes and external environmental factors,ensuring more informed decision-making and adaptive system management.It also promotes decision making and provides scientific analysis to enhance the efficiency of the operation,cost reduction,maximizing the process of production and so on.Various methods are employed to enhance productivity,yet achieving sustainable manufacturing remains a complex challenge that requires careful consideration.This study aims to develop a methodology for effective manufacturing sustainability by proposing a novel Hybrid Weighted Support Vector-based Lévy flight(HWS-LF)algorithm.The objective of the HWS-LF method is to improve the environmental,economic,and social aspects of manufacturing processes.In this approach,Support Vector Machines(SVM)are used to classify data points by identifying the optimal hyperplane to separate different classes,thereby supporting predictive maintenance and quality control in manufacturing.Random Forest is applied to boost efficiency,resource allocation,and production optimization.A Weighted Average Ensemble technique is employed to combine predictions from multiple models,assigning different weights to ensure an accurate system for evaluating manufacturing performance.Additionally,Lévy flight Optimization is incorporated to enhance the performance of the HWS-LF method further.The method’s effectiveness is assessed using various evaluation metrics,including accuracy,precision,recall,F1-score,and specificity.Results show that the proposed HWS-LF method outperforms other state-of-the-art techniques,demonstrating superior productivity and system performance.
