Traumatic injury to the pancreas is rare and difficult to diagnose.In contrast,traumatic injuries to the liver,spleen and kidney are common and are usually identified with ease by imaging modalities.Pancreatic injurie...Traumatic injury to the pancreas is rare and difficult to diagnose.In contrast,traumatic injuries to the liver,spleen and kidney are common and are usually identified with ease by imaging modalities.Pancreatic injuries are usually subtle to identify by different diagnostic imaging modalities,and these injuries are often overlooked in cases with extensive multiorgan trauma.The most evident findings of pancreatic injury are posttraumatic pancreatitis with blood,edema,and soft tissue infiltration of the anterior pararenal space.The alterations of post-traumatic pancreatitis may not be visualized within several hours following trauma as they are time dependent.Delayed diagnoses of traumatic pancreatic injuries are associated with high morbidity and mortality.Imaging plays an important role in diagnosis of pancreatic injuries because early recognition of the disruption of the main pancreatic duct is important.We reviewed our experience with the use of various imaging modalities for diagnosis of blunt pancreatic trauma.展开更多
Abdominal tuberculosis is an increasingly common disease that poses diagnostic challenge,as the nonspecific features of the disease which may lead to diagnostic delays and development of complications.This condition i...Abdominal tuberculosis is an increasingly common disease that poses diagnostic challenge,as the nonspecific features of the disease which may lead to diagnostic delays and development of complications.This condition is regarded as a great mimicker of other abdominal pathology.A high index of suspicion is an important factor in early diagnosis.Abdominal involvement mayoccur in the gastrointestinal tract,peritoneum,lymphnodes or solid viscera.Various investigative methods have been used to aid in the diagnosis of abdominal tuberculosis.Early diagnosis and initiation of antituberculous therapy and surgical treatment are essential to prevent morbidity and mortality.Most of the patients respond very well to standard antitubercular therapy and surgery is required only in a minority of cases.Imaging plays an important role in diagnosis of abdominal tuberculosis because early recognition of this condition is important.We reviewed our experience with the findings on various imaging modalities for diagnosis of this potentially treatable disease.展开更多
Nocturnal enuresis often causes considerable distress or functional impairment to patient and their parents necessitating a multidisciplinary approach from paediatrician, paediatric nephrologist, urologists and psychi...Nocturnal enuresis often causes considerable distress or functional impairment to patient and their parents necessitating a multidisciplinary approach from paediatrician, paediatric nephrologist, urologists and psychiatrist. Mechanisms of monosymptomatic nocturnal enuresis are mainly nocturnal polyuria, bladder overactivity and failure to awaken from sleep in response to bladder sensations. Goal oriented and etiology wise treatment includes simple behavioral intervention, conditioning alarm regimen and pharmacotherapy with desmopressin, imipramine and anticholinergic drugs. Symptoms often recurs requiring change over or combination of different modes of treatment.展开更多
There is increasing evidence that pathogens do not only elicit direct defense responses, but also cause pronounced changes in primary carbohydrate metabolism. Cell-wall-bound invertases belong to the key regulators of...There is increasing evidence that pathogens do not only elicit direct defense responses, but also cause pronounced changes in primary carbohydrate metabolism. Cell-wall-bound invertases belong to the key regulators of carbohydrate partitioning and source-sink relations. Whereas studies have focused so far only on the transcriptional induction of invertase genes in response to pathogen infection, the role of post-translational regulation of invertase activity has been neglected and was the focus of the present study. Expression analyses revealed that the high mRNA level of one out of three proteinaceous invertase inhibitors in source leaves of Arabidopsis thaliana is strongly repressed upon infection by a virulent strain of Pseudomonas syringae pv. tomato DC3000. This repression is paralleled by a decrease in invertase inhibitor activity. The physiological role of this regulatory mechanism is revealed by the finding that in situ invertase activity was detectable only upon infection by P. syringae. In contrast, a high invertase activity could be measured in vitro in crude and cell wall extracts prepared from both infected and non-infected leaves. The discrepancy between the in situ and in vitro invertase activity of control leaves and the high in situ invertase activity in infected leaves can be explained by the pathogen-dependent repression of invertase inhibitor expression and a concomitant reduction in invertase inhibitor activity. The functional importance of the release of invertase from post-translational inhibition for the defense response was substantiated by the application of the competitive chemical invertase inhibitor acarbose. Posttranslational inhibition of extracellular invertase activity by infiltration of acarbose in leaves was shown to increase the susceptibility to P. syringae. The impact of invertase inhibition on spatial and temporal dynamics of the repression of photosynthesis and promotion of bacterial growth during pathogen infection supports a role for extracellular invertase in plant defen展开更多
Benign esophageal strictures refractory to the conventional balloon or bougie dilatation may be subjected to various adjunctive modes of therapy, one of them being endoscopic incisional therapy(EIT). A proper delineat...Benign esophageal strictures refractory to the conventional balloon or bougie dilatation may be subjected to various adjunctive modes of therapy, one of them being endoscopic incisional therapy(EIT). A proper delineation of the stricture anatomy is a prerequisite. A host of electrocautery and mechanical devices may be used, the most common being the use of needle knife, either standard or insulated tip. The technique entails radial incision and cutting off of the stenotic rim. Adjunctive therapies, to prevent re-stenosis, such as balloon dilatation, oral or intralesional steroids or argon plasma coagulation can be used. The common strictures where EIT has been successfully used are Schatzki's rings(SR) and anastomotic strictures(AS). Short segment strictures(< 1 cm) have been found to have the best outcome. When compared with routine balloon dilatation, EIT has equivalent results in treatment na?ve cases but better long term outcome in refractory cases. Anecdotal reports of its use in other types of strictures have been noted. Post procedure complications of EIT are mild and comparable to dilatation therapy. As of the current evidence, incisional therapy can be used for management of refractory AS and SR with relatively short stenosis(< 1 cm) with good safety profile and acceptable long term patency.展开更多
Background:To examine the retinal structure–vascular-function relationship using optical coherence tomography(OCT)and optical coherence tomography angiography(OCTA)in myopia.Methods:This was a prospective cross-secti...Background:To examine the retinal structure–vascular-function relationship using optical coherence tomography(OCT)and optical coherence tomography angiography(OCTA)in myopia.Methods:This was a prospective cross-sectional study comprising 86 eyes of 45 individuals with varying axial lengths and spherical equivalents and no posterior segment abnormalities.All eyes underwent optical coherence tomography with the Spectralis SD-OCT and OCTA with RTVue-XR Avanti;Optovue.Individual macular retinal layer thicknesses and flow areas and vessel densities were measured on OCT and OCTA,respectively.Linear correlations were made between the macular layer thicknesses,flow areas and vessel densities with axial length,spherical equivalent and visual acuity.Results:The participants’mean ages were 33.34±14.45 years,mean spherical equivalent refractions were−7.17±5.71 D and axial lengths were 25.95±2.41 mm.There were significant positive correlations of foveal angle(r=0.757,p=0.001),inner retinal(r=0.764,p=0.001)and outer plexiform layer(r=0.771,p=0.001)thickness on OCT and vessel densities in deep capillary plexus(r=0.313,p=0.003)on OCTA with axial length and negative correlations with spherical equivalents and visual acuity.Significant negative correlations of outer nuclear layer(r=−0.560,p=0.03)and photoreceptor outer segment layer thickness(r=−0.856,p<0.001)were noted on OCT with axial length and positive correlations with spherical equivalents and visual acuity.Conclusion:The lateral retinal stretching in myopia could possibly explain the correlation between retinal layer thickness,vascular density and visual acuity in these eyes.Further research is required to investigate this.展开更多
Although conventional coal mine designs are conservative regarding pillar strength,local failures such as roof-falls and pillar bursts still affect mine safety and operations.Previous studies have identified that disc...Although conventional coal mine designs are conservative regarding pillar strength,local failures such as roof-falls and pillar bursts still affect mine safety and operations.Previous studies have identified that discontinuous,layered roof materials have some self-supporting capacity.This research is a preliminary step towards understanding these mechanics in coal-measure rocks.Although others have considered broad conceptual models and simplified analogs for mine roof behavior,this study presents a unique numerical model that more completely represents in-situ roof conditions.The discrete element method(DEM)is utilized to conduct a parametric analysis considering a range of in-situ stress ratios,material properties,and joint networks to determine the parameters controlling the stability of single-entries modeled in two-dimensions.Model results are compared to empirical observations of roof-support effectiveness(ARBS)in the context of the coal mine roof rating(CMRR)system.Results such as immediate roof displacement,overall stability,and statistical relationships between model parameters and outcomes are presented herein.Potential practical applications of this line of research include:(1)roof-support optimization for a range of coal-measure rocks,(2)establishment of a relationship between roof stability and pillar stress,and(3)determination of which parameters are most critical to roof stability and therefore require concentrated evaluation.展开更多
Tumor development and metastasis are facilitated by the complex interactions between cancer cells and theirmicroenvironment,which comprises stromal cells and extracellular matrix(ECM)components,among other factors.Str...Tumor development and metastasis are facilitated by the complex interactions between cancer cells and theirmicroenvironment,which comprises stromal cells and extracellular matrix(ECM)components,among other factors.Stromal cells can adopt new phenotypes to promote tumor cell invasion.Adeep understanding of the signaling pathways involved in cell-to-cell and cell-to-ECM interactions is needed to design effective intervention strategies that might interrupt these interactions.In this review,we describe the tumor microenvironment(TME)components and associated therapeutics.We discuss the clinical advances in the prevalent and newly discovered signaling pathways in the TME,the immune checkpoints and immunosuppressive chemokines,and currently used inhibitors targeting these pathways.These include both intrinsic and non-autonomous tumor cell signaling pathways in the TME:protein kinase C(PKC)signaling,Notch,and transforming growth factor(TGF-β)signaling,Endoplasmic Reticulum(ER)stress response,lactate signaling,Metabolic reprogramming,cyclic GMP–AMP synthase(cGAS)–stimulator of interferon genes(STING)and Siglec signaling pathways.We also discuss the recent advances in Programmed Cell Death Protein 1(PD-1),Cytotoxic T-Lymphocyte Associated Protein 4(CTLA4),T-cell immunoglobulin mucin-3(TIM-3)and Lymphocyte Activating Gene 3(LAG3)immune checkpoint inhibitors along with the C-C chemokine receptor 4(CCR4)-C-C class chemokines 22(CCL22)/and 17(CCL17),C-C chemokine receptor type 2(CCR2)-chemokine(C-Cmotif)ligand 2(CCL2),C-C chemokine receptor type 5(CCR5)-chemokine(C-C motif)ligand 3(CCL3)chemokine signaling axis in the TME.In addition,this review provides a holistic understanding of the TME as we discuss the three-dimensional and microfluidic models of the TME,which are believed to recapitulate the original characteristics of the patient tumor and hence may be used as a platform to study new mechanisms and screen for various anti-cancer therapies.We further discuss the systemic influences of gut microbiota in TME reprogr展开更多
BACKGROUND Gallbladder cancer(GBC)is one of the leading and aggressive cancers in this region of India.It is very difficult to diagnose in the early stage,as it lacks typical early signs and symptoms;thus,the diagnosi...BACKGROUND Gallbladder cancer(GBC)is one of the leading and aggressive cancers in this region of India.It is very difficult to diagnose in the early stage,as it lacks typical early signs and symptoms;thus,the diagnosis is often in the advanced stage,which ultimately leads to a poor 5-year survival outcome.Tumor markers including carbohydrate antigen 19-9(CA 19-9),carcinoembryonic antigen(CEA),CA 125,CA 242,and alpha fetoprotein are used as indicators in the diagnosis and prognosis of GBC.AIM To compare tumor marker levels between GBC and benign GB diseases(GBDs)and to assess the combined use of tumor markers to increase the diagnostic accuracy for GBC.METHODS Patients of either sex aged≥18 years,with suspected GBC(GB polyp,irregular thick GB wall,GB mass,porcelain GB)on the basis of radiological imaging were included in this study.GB wall thickness using ultrasonography and tumor markers CEA,CA 125,CA 19-9,and CA 242 in all patients were recorded.All cases after surgical intervention were divided into two groups,GBC and benign GBD,according to histopathological examination findings.The cases were followed up and clinical findings,radiological findings,and levels of tumor markers were assessed.RESULTS A total of 200 patients were included in this study,of whom 80 patients had GBC and 120 patients had benign GBD.The median(interquartile range)age was 52.0(41.0-60.0)years and the majority of patients(132,66.0%)were women.Tumor markers including CA 19-9,CA 125,CEA,and CA 242 were significantly elevated in patients with GBC(P<0.001).There was a significant reduction in tumor markers at 3 and 6 mo from baseline(P<0.001).The mean survival of patients with normal and elevated levels of tumor markers CA 125,CA 19-9,and CEA was comparable;however lymph node metastasis and CA 242 expression level were independent prognostic factors.CONCLUSION Serum levels of tumor markers including CA 19-9,CA 125,CEA,and CA 242 were significantly associated with GBC.However,no significant association was observed between the presence of e展开更多
Acute and chronic wounds affect millions of people around the world,imposing a growing financial burden on patients and hospitals.Despite the application of current wound management strategies,the physiological healin...Acute and chronic wounds affect millions of people around the world,imposing a growing financial burden on patients and hospitals.Despite the application of current wound management strategies,the physiological healing process is disrupted in many cases,resulting in impaired wound healing.Therefore,more efficient and easy-to-use treatment modalities are needed.In this study,we demonstrate the benefit of in vivo printed,growth factor-eluting adhesive scaffolds for the treatment of full-thickness wounds in a porcine model.A custom-made handheld printer is implemented to finely print gelatin-methacryloyl(GelMA)hydrogel containing vascular endothelial growth factor(VEGF)into the wounds.In vitro and in vivo results show that the in situ GelMA crosslinking induces a strong scaffold adhesion and enables printing on curved surfaces of wet tissues,without the need for any sutures.The scaffold is further shown to offer a sustained release of VEGF,enhancing the migration of endothelial cells in vitro.Histological analyses demonstrate that the administration of the VEGF-eluting GelMA scaffolds that remain adherent to the wound bed significantly improves the quality of healing in porcine wounds.The introduced in vivo printing strategy for wound healing applications is translational and convenient to use in any place,such as an operating room,and does not require expensive bioprinters or imaging modalities.展开更多
Amplified inter simple sequence repeats （ISSR） markers were used to determine genetic relationships among mutant silkworm strains of Bombyx mori. Fifteen ISSR primers containing simple sequence repeat （SSR） motifs...Amplified inter simple sequence repeats （ISSR） markers were used to determine genetic relationships among mutant silkworm strains of Bombyx mori. Fifteen ISSR primers containing simple sequence repeat （SSR） motifs were used in this study. A total of 113 markers were produced among 20 mutant strains, of which 73.45% were found to be polymorphic. In selected mutant genetic stocks, the average number of observed allele was （1.7080 ± 0.4567）, effective alleles （1.5194 ± 0.3950） and genetic diversity （Ht） （0.2901 ± 0.0415）. The dendrogram produced using the unweighted pair group method with arithmetic means （UPGMA） and cluster analysis made using Nei＇s genetic distance resulted in the formation of one major group containing 6 groups separated 20 mutant silkworm strains. Therefore, ISSR amplification is a valuable method for determining the genetic variability among mutant silkworm strains. This efficient molecular marker would be useful for characterizing a considerable number of silkworm strains maintained at the germplasm center.展开更多
In the retrospective study by Luo et al regarding clinical outcomes in gestational diabetes mellitus(GDM),the results are statistically significant in favour of the benefits of individualized nutrition interventions e...In the retrospective study by Luo et al regarding clinical outcomes in gestational diabetes mellitus(GDM),the results are statistically significant in favour of the benefits of individualized nutrition interventions enumerated therein.The study has provided important evidence to improve maternal and child health in the Asian population.The methods,however,appear to have considerable limi-tations,wherein the time point of diagnosis of GDM,severity of GDM,selection bias,compliance to therapy,important maternal covariates,observable microvascular abnormalities and the confounding effect of added insulin have not been considered.We have provided suggestions to improve the external validity of the study,including the use of Equator Network reporting guidelines and inclusion of overweight and obese patients in future studies.展开更多
We hereby comment on the interesting systematic review by Grewal et al where they have provided an overall picture of the current status of available tele-health programs in the United States with emphasis on the Amaz...We hereby comment on the interesting systematic review by Grewal et al where they have provided an overall picture of the current status of available tele-health programs in the United States with emphasis on the Amazon Clinic.Their analysis is an appreciable effort in discovering the features available and features lacking in these tele-health programs.The concept of tele-health originated to curtail the need for physical attendance of patients at health clinics,and has been beneficial during the coronavirus disease 2019 pandemic.We implore that the pearls and pitfalls of these programs have to be understood by policymakers prior to forming a consensus regarding the availability,accessibility and affordability of these programs as methods of healthcare delivery.Unrestricted proliferation of tele-health programs in their current form may pose threats to patient and provider safety and medicolegal liability.However,patients and providers must work together to improve them to meet their expectations and enable them to provide the best care for the ailing public.展开更多
Inflammatory bowel disease(IBD)is a complex and multifaceted disorder of the gastrointestinal tract that is increasing in incidence worldwide and associated with significant morbidity.The rapid accumulation of large d...Inflammatory bowel disease(IBD)is a complex and multifaceted disorder of the gastrointestinal tract that is increasing in incidence worldwide and associated with significant morbidity.The rapid accumulation of large datasets from electronic health records,high-definition multi-omics(including genomics,proteomics,transcriptomics,and metagenomics),and imaging modalities(endoscopy and endomicroscopy)have provided powerful tools to unravel novel mechanistic insights and help address unmet clinical needs in IBD.Although the application of artificial intelligence(AI)methods has facilitated the analysis,integration,and interpretation of large datasets in IBD,significant heterogeneity in AI methods,datasets,and clinical outcomes and the need for unbiased prospective validations studies are current barriers to incorporation of AI into clinical practice.The purpose of this review is to summarize the most recent advances in the application of AI and machine learning technologies in the diagnosis and risk prediction,assessment of disease severity,and prediction of clinical outcomes in patients with IBD.展开更多
Multi-temporal,globally consistent,high-resolution human population datasets provide consistent and comparable population distributions in support of mapping sub-national heterogeneities in health,wealth,and resource ...Multi-temporal,globally consistent,high-resolution human population datasets provide consistent and comparable population distributions in support of mapping sub-national heterogeneities in health,wealth,and resource access,and monitoring change in these over time.The production of more reliable and spatially detailed population datasets is increasingly necessary due to the importance of improving metrics at sub-national and multitemporal scales.This is in support of measurement and monitoring of UN Sustainable Development Goals and related agendas.In response to these agendas,a method has been developed to assemble and harmonise a unique,open access,archive of geospatial datasets.Datasets are provided as global,annual time series,where pertinent at the timescale of population analyses and where data is available,for use in the construction of population distribution layers.The archive includes sub-national census-based population estimates,matched to a geospatial layer denoting administrative unit boundaries,and a number of co-registered gridded geospatial factors that correlate strongly with population presence and density.Here,we describe these harmonised datasets and their limitations,along with the production workflow.Further,we demonstrate applications of the archive by producing multi-temporal gridded population outputs for Africa and using these to derive health and development metrics.The geospatial archive is available at https://doi.org/10.5258/SOTON/WP00650.展开更多
The recently published mini-review article by Miotti et al is an effort to clarify various aspects regarding the choice between fat grafts and fillers in facial aesthetic surgery.One of the complications associated wi...The recently published mini-review article by Miotti et al is an effort to clarify various aspects regarding the choice between fat grafts and fillers in facial aesthetic surgery.One of the complications associated with the administration of fillers is the possibility of vascular injury and spread of the dermal filler into the orbit,causing unexpected effects at a site distant from that of the initial injection,including ophthalmoplegia,ptosis and even visual compromise.Acute vision loss following filler injection is a devastating complication,occurring in up to 0.0008%of cases.The greatest risk of this complication occurs with nasal augmentation,followed by glabellar wrinkle treatment.While injected autologous fat predominantly occludes the proximal portion of the ophthalmic artery,hyaluronic acid fillers obstruct the ophthalmic artery comparatively distally.Treatment interventions include thrombolysis,hyperbaric oxygen therapy,oral aspirin,cobamamide and acetazolamide and administration of corticosteroids.However,most studies show a poor prognosis in the form of partial or no recovery of vision.Hence,prevention is of paramount importance.A high index of suspicion is also warranted on the part of both those administering as well as receiving injections of facial fillers to prevent potentially vision-threatening complications of this seemingly innocuous procedure.展开更多
文摘Traumatic injury to the pancreas is rare and difficult to diagnose.In contrast,traumatic injuries to the liver,spleen and kidney are common and are usually identified with ease by imaging modalities.Pancreatic injuries are usually subtle to identify by different diagnostic imaging modalities,and these injuries are often overlooked in cases with extensive multiorgan trauma.The most evident findings of pancreatic injury are posttraumatic pancreatitis with blood,edema,and soft tissue infiltration of the anterior pararenal space.The alterations of post-traumatic pancreatitis may not be visualized within several hours following trauma as they are time dependent.Delayed diagnoses of traumatic pancreatic injuries are associated with high morbidity and mortality.Imaging plays an important role in diagnosis of pancreatic injuries because early recognition of the disruption of the main pancreatic duct is important.We reviewed our experience with the use of various imaging modalities for diagnosis of blunt pancreatic trauma.
文摘Abdominal tuberculosis is an increasingly common disease that poses diagnostic challenge,as the nonspecific features of the disease which may lead to diagnostic delays and development of complications.This condition is regarded as a great mimicker of other abdominal pathology.A high index of suspicion is an important factor in early diagnosis.Abdominal involvement mayoccur in the gastrointestinal tract,peritoneum,lymphnodes or solid viscera.Various investigative methods have been used to aid in the diagnosis of abdominal tuberculosis.Early diagnosis and initiation of antituberculous therapy and surgical treatment are essential to prevent morbidity and mortality.Most of the patients respond very well to standard antitubercular therapy and surgery is required only in a minority of cases.Imaging plays an important role in diagnosis of abdominal tuberculosis because early recognition of this condition is important.We reviewed our experience with the findings on various imaging modalities for diagnosis of this potentially treatable disease.
文摘Nocturnal enuresis often causes considerable distress or functional impairment to patient and their parents necessitating a multidisciplinary approach from paediatrician, paediatric nephrologist, urologists and psychiatrist. Mechanisms of monosymptomatic nocturnal enuresis are mainly nocturnal polyuria, bladder overactivity and failure to awaken from sleep in response to bladder sensations. Goal oriented and etiology wise treatment includes simple behavioral intervention, conditioning alarm regimen and pharmacotherapy with desmopressin, imipramine and anticholinergic drugs. Symptoms often recurs requiring change over or combination of different modes of treatment.
文摘There is increasing evidence that pathogens do not only elicit direct defense responses, but also cause pronounced changes in primary carbohydrate metabolism. Cell-wall-bound invertases belong to the key regulators of carbohydrate partitioning and source-sink relations. Whereas studies have focused so far only on the transcriptional induction of invertase genes in response to pathogen infection, the role of post-translational regulation of invertase activity has been neglected and was the focus of the present study. Expression analyses revealed that the high mRNA level of one out of three proteinaceous invertase inhibitors in source leaves of Arabidopsis thaliana is strongly repressed upon infection by a virulent strain of Pseudomonas syringae pv. tomato DC3000. This repression is paralleled by a decrease in invertase inhibitor activity. The physiological role of this regulatory mechanism is revealed by the finding that in situ invertase activity was detectable only upon infection by P. syringae. In contrast, a high invertase activity could be measured in vitro in crude and cell wall extracts prepared from both infected and non-infected leaves. The discrepancy between the in situ and in vitro invertase activity of control leaves and the high in situ invertase activity in infected leaves can be explained by the pathogen-dependent repression of invertase inhibitor expression and a concomitant reduction in invertase inhibitor activity. The functional importance of the release of invertase from post-translational inhibition for the defense response was substantiated by the application of the competitive chemical invertase inhibitor acarbose. Posttranslational inhibition of extracellular invertase activity by infiltration of acarbose in leaves was shown to increase the susceptibility to P. syringae. The impact of invertase inhibition on spatial and temporal dynamics of the repression of photosynthesis and promotion of bacterial growth during pathogen infection supports a role for extracellular invertase in plant defen
文摘Benign esophageal strictures refractory to the conventional balloon or bougie dilatation may be subjected to various adjunctive modes of therapy, one of them being endoscopic incisional therapy(EIT). A proper delineation of the stricture anatomy is a prerequisite. A host of electrocautery and mechanical devices may be used, the most common being the use of needle knife, either standard or insulated tip. The technique entails radial incision and cutting off of the stenotic rim. Adjunctive therapies, to prevent re-stenosis, such as balloon dilatation, oral or intralesional steroids or argon plasma coagulation can be used. The common strictures where EIT has been successfully used are Schatzki's rings(SR) and anastomotic strictures(AS). Short segment strictures(< 1 cm) have been found to have the best outcome. When compared with routine balloon dilatation, EIT has equivalent results in treatment na?ve cases but better long term outcome in refractory cases. Anecdotal reports of its use in other types of strictures have been noted. Post procedure complications of EIT are mild and comparable to dilatation therapy. As of the current evidence, incisional therapy can be used for management of refractory AS and SR with relatively short stenosis(< 1 cm) with good safety profile and acceptable long term patency.
文摘Background:To examine the retinal structure–vascular-function relationship using optical coherence tomography(OCT)and optical coherence tomography angiography(OCTA)in myopia.Methods:This was a prospective cross-sectional study comprising 86 eyes of 45 individuals with varying axial lengths and spherical equivalents and no posterior segment abnormalities.All eyes underwent optical coherence tomography with the Spectralis SD-OCT and OCTA with RTVue-XR Avanti;Optovue.Individual macular retinal layer thicknesses and flow areas and vessel densities were measured on OCT and OCTA,respectively.Linear correlations were made between the macular layer thicknesses,flow areas and vessel densities with axial length,spherical equivalent and visual acuity.Results:The participants’mean ages were 33.34±14.45 years,mean spherical equivalent refractions were−7.17±5.71 D and axial lengths were 25.95±2.41 mm.There were significant positive correlations of foveal angle(r=0.757,p=0.001),inner retinal(r=0.764,p=0.001)and outer plexiform layer(r=0.771,p=0.001)thickness on OCT and vessel densities in deep capillary plexus(r=0.313,p=0.003)on OCTA with axial length and negative correlations with spherical equivalents and visual acuity.Significant negative correlations of outer nuclear layer(r=−0.560,p=0.03)and photoreceptor outer segment layer thickness(r=−0.856,p<0.001)were noted on OCT with axial length and positive correlations with spherical equivalents and visual acuity.Conclusion:The lateral retinal stretching in myopia could possibly explain the correlation between retinal layer thickness,vascular density and visual acuity in these eyes.Further research is required to investigate this.
基金sponsored by the Alpha Foundation for the Improvement of Mine Safety and Health, Inc. (Alpha Foundation)the funding provided for this project by the Alpha Foundationpartially funded by the National Institute of Occupational Health and Science (NIOSH) under Grant Number 200-2016-90154.
文摘Although conventional coal mine designs are conservative regarding pillar strength,local failures such as roof-falls and pillar bursts still affect mine safety and operations.Previous studies have identified that discontinuous,layered roof materials have some self-supporting capacity.This research is a preliminary step towards understanding these mechanics in coal-measure rocks.Although others have considered broad conceptual models and simplified analogs for mine roof behavior,this study presents a unique numerical model that more completely represents in-situ roof conditions.The discrete element method(DEM)is utilized to conduct a parametric analysis considering a range of in-situ stress ratios,material properties,and joint networks to determine the parameters controlling the stability of single-entries modeled in two-dimensions.Model results are compared to empirical observations of roof-support effectiveness(ARBS)in the context of the coal mine roof rating(CMRR)system.Results such as immediate roof displacement,overall stability,and statistical relationships between model parameters and outcomes are presented herein.Potential practical applications of this line of research include:(1)roof-support optimization for a range of coal-measure rocks,(2)establishment of a relationship between roof stability and pillar stress,and(3)determination of which parameters are most critical to roof stability and therefore require concentrated evaluation.
基金National Research Foundation of Korea(NRF)grant funded by the Korea government(MSIT),Grant/Award Number:NRF-2022R1A2C2005057。
文摘Tumor development and metastasis are facilitated by the complex interactions between cancer cells and theirmicroenvironment,which comprises stromal cells and extracellular matrix(ECM)components,among other factors.Stromal cells can adopt new phenotypes to promote tumor cell invasion.Adeep understanding of the signaling pathways involved in cell-to-cell and cell-to-ECM interactions is needed to design effective intervention strategies that might interrupt these interactions.In this review,we describe the tumor microenvironment(TME)components and associated therapeutics.We discuss the clinical advances in the prevalent and newly discovered signaling pathways in the TME,the immune checkpoints and immunosuppressive chemokines,and currently used inhibitors targeting these pathways.These include both intrinsic and non-autonomous tumor cell signaling pathways in the TME:protein kinase C(PKC)signaling,Notch,and transforming growth factor(TGF-β)signaling,Endoplasmic Reticulum(ER)stress response,lactate signaling,Metabolic reprogramming,cyclic GMP–AMP synthase(cGAS)–stimulator of interferon genes(STING)and Siglec signaling pathways.We also discuss the recent advances in Programmed Cell Death Protein 1(PD-1),Cytotoxic T-Lymphocyte Associated Protein 4(CTLA4),T-cell immunoglobulin mucin-3(TIM-3)and Lymphocyte Activating Gene 3(LAG3)immune checkpoint inhibitors along with the C-C chemokine receptor 4(CCR4)-C-C class chemokines 22(CCL22)/and 17(CCL17),C-C chemokine receptor type 2(CCR2)-chemokine(C-Cmotif)ligand 2(CCL2),C-C chemokine receptor type 5(CCR5)-chemokine(C-C motif)ligand 3(CCL3)chemokine signaling axis in the TME.In addition,this review provides a holistic understanding of the TME as we discuss the three-dimensional and microfluidic models of the TME,which are believed to recapitulate the original characteristics of the patient tumor and hence may be used as a platform to study new mechanisms and screen for various anti-cancer therapies.We further discuss the systemic influences of gut microbiota in TME reprogr
文摘BACKGROUND Gallbladder cancer(GBC)is one of the leading and aggressive cancers in this region of India.It is very difficult to diagnose in the early stage,as it lacks typical early signs and symptoms;thus,the diagnosis is often in the advanced stage,which ultimately leads to a poor 5-year survival outcome.Tumor markers including carbohydrate antigen 19-9(CA 19-9),carcinoembryonic antigen(CEA),CA 125,CA 242,and alpha fetoprotein are used as indicators in the diagnosis and prognosis of GBC.AIM To compare tumor marker levels between GBC and benign GB diseases(GBDs)and to assess the combined use of tumor markers to increase the diagnostic accuracy for GBC.METHODS Patients of either sex aged≥18 years,with suspected GBC(GB polyp,irregular thick GB wall,GB mass,porcelain GB)on the basis of radiological imaging were included in this study.GB wall thickness using ultrasonography and tumor markers CEA,CA 125,CA 19-9,and CA 242 in all patients were recorded.All cases after surgical intervention were divided into two groups,GBC and benign GBD,according to histopathological examination findings.The cases were followed up and clinical findings,radiological findings,and levels of tumor markers were assessed.RESULTS A total of 200 patients were included in this study,of whom 80 patients had GBC and 120 patients had benign GBD.The median(interquartile range)age was 52.0(41.0-60.0)years and the majority of patients(132,66.0%)were women.Tumor markers including CA 19-9,CA 125,CEA,and CA 242 were significantly elevated in patients with GBC(P<0.001).There was a significant reduction in tumor markers at 3 and 6 mo from baseline(P<0.001).The mean survival of patients with normal and elevated levels of tumor markers CA 125,CA 19-9,and CEA was comparable;however lymph node metastasis and CA 242 expression level were independent prognostic factors.CONCLUSION Serum levels of tumor markers including CA 19-9,CA 125,CEA,and CA 242 were significantly associated with GBC.However,no significant association was observed between the presence of e
基金The financial support from the National Institutes of Health(GM126831,AR073822)Stepping Strong Innovator Award are gratefully acknowledged.
文摘Acute and chronic wounds affect millions of people around the world,imposing a growing financial burden on patients and hospitals.Despite the application of current wound management strategies,the physiological healing process is disrupted in many cases,resulting in impaired wound healing.Therefore,more efficient and easy-to-use treatment modalities are needed.In this study,we demonstrate the benefit of in vivo printed,growth factor-eluting adhesive scaffolds for the treatment of full-thickness wounds in a porcine model.A custom-made handheld printer is implemented to finely print gelatin-methacryloyl(GelMA)hydrogel containing vascular endothelial growth factor(VEGF)into the wounds.In vitro and in vivo results show that the in situ GelMA crosslinking induces a strong scaffold adhesion and enables printing on curved surfaces of wet tissues,without the need for any sutures.The scaffold is further shown to offer a sustained release of VEGF,enhancing the migration of endothelial cells in vitro.Histological analyses demonstrate that the administration of the VEGF-eluting GelMA scaffolds that remain adherent to the wound bed significantly improves the quality of healing in porcine wounds.The introduced in vivo printing strategy for wound healing applications is translational and convenient to use in any place,such as an operating room,and does not require expensive bioprinters or imaging modalities.
文摘Amplified inter simple sequence repeats （ISSR） markers were used to determine genetic relationships among mutant silkworm strains of Bombyx mori. Fifteen ISSR primers containing simple sequence repeat （SSR） motifs were used in this study. A total of 113 markers were produced among 20 mutant strains, of which 73.45% were found to be polymorphic. In selected mutant genetic stocks, the average number of observed allele was （1.7080 ± 0.4567）, effective alleles （1.5194 ± 0.3950） and genetic diversity （Ht） （0.2901 ± 0.0415）. The dendrogram produced using the unweighted pair group method with arithmetic means （UPGMA） and cluster analysis made using Nei＇s genetic distance resulted in the formation of one major group containing 6 groups separated 20 mutant silkworm strains. Therefore, ISSR amplification is a valuable method for determining the genetic variability among mutant silkworm strains. This efficient molecular marker would be useful for characterizing a considerable number of silkworm strains maintained at the germplasm center.
文摘In the retrospective study by Luo et al regarding clinical outcomes in gestational diabetes mellitus(GDM),the results are statistically significant in favour of the benefits of individualized nutrition interventions enumerated therein.The study has provided important evidence to improve maternal and child health in the Asian population.The methods,however,appear to have considerable limi-tations,wherein the time point of diagnosis of GDM,severity of GDM,selection bias,compliance to therapy,important maternal covariates,observable microvascular abnormalities and the confounding effect of added insulin have not been considered.We have provided suggestions to improve the external validity of the study,including the use of Equator Network reporting guidelines and inclusion of overweight and obese patients in future studies.
文摘We hereby comment on the interesting systematic review by Grewal et al where they have provided an overall picture of the current status of available tele-health programs in the United States with emphasis on the Amazon Clinic.Their analysis is an appreciable effort in discovering the features available and features lacking in these tele-health programs.The concept of tele-health originated to curtail the need for physical attendance of patients at health clinics,and has been beneficial during the coronavirus disease 2019 pandemic.We implore that the pearls and pitfalls of these programs have to be understood by policymakers prior to forming a consensus regarding the availability,accessibility and affordability of these programs as methods of healthcare delivery.Unrestricted proliferation of tele-health programs in their current form may pose threats to patient and provider safety and medicolegal liability.However,patients and providers must work together to improve them to meet their expectations and enable them to provide the best care for the ailing public.
基金Chan Zuckerberg Biohub Physician Scientist Scholar Awardand National Institutes of Health NIDDK Loan Repayment Program Award,No.GTQR5718.
文摘Inflammatory bowel disease(IBD)is a complex and multifaceted disorder of the gastrointestinal tract that is increasing in incidence worldwide and associated with significant morbidity.The rapid accumulation of large datasets from electronic health records,high-definition multi-omics(including genomics,proteomics,transcriptomics,and metagenomics),and imaging modalities(endoscopy and endomicroscopy)have provided powerful tools to unravel novel mechanistic insights and help address unmet clinical needs in IBD.Although the application of artificial intelligence(AI)methods has facilitated the analysis,integration,and interpretation of large datasets in IBD,significant heterogeneity in AI methods,datasets,and clinical outcomes and the need for unbiased prospective validations studies are current barriers to incorporation of AI into clinical practice.The purpose of this review is to summarize the most recent advances in the application of AI and machine learning technologies in the diagnosis and risk prediction,assessment of disease severity,and prediction of clinical outcomes in patients with IBD.
基金This work was supported by the Bill and Melinda Gates Foundation[OPP1134076,OPP1106427,OPP1032350,OPP1094793]National Institute of Allergy and Infectious Diseases[U19AI089674]Wellcome Trust[106866/Z/15/Z].
文摘Multi-temporal,globally consistent,high-resolution human population datasets provide consistent and comparable population distributions in support of mapping sub-national heterogeneities in health,wealth,and resource access,and monitoring change in these over time.The production of more reliable and spatially detailed population datasets is increasingly necessary due to the importance of improving metrics at sub-national and multitemporal scales.This is in support of measurement and monitoring of UN Sustainable Development Goals and related agendas.In response to these agendas,a method has been developed to assemble and harmonise a unique,open access,archive of geospatial datasets.Datasets are provided as global,annual time series,where pertinent at the timescale of population analyses and where data is available,for use in the construction of population distribution layers.The archive includes sub-national census-based population estimates,matched to a geospatial layer denoting administrative unit boundaries,and a number of co-registered gridded geospatial factors that correlate strongly with population presence and density.Here,we describe these harmonised datasets and their limitations,along with the production workflow.Further,we demonstrate applications of the archive by producing multi-temporal gridded population outputs for Africa and using these to derive health and development metrics.The geospatial archive is available at https://doi.org/10.5258/SOTON/WP00650.
文摘The recently published mini-review article by Miotti et al is an effort to clarify various aspects regarding the choice between fat grafts and fillers in facial aesthetic surgery.One of the complications associated with the administration of fillers is the possibility of vascular injury and spread of the dermal filler into the orbit,causing unexpected effects at a site distant from that of the initial injection,including ophthalmoplegia,ptosis and even visual compromise.Acute vision loss following filler injection is a devastating complication,occurring in up to 0.0008%of cases.The greatest risk of this complication occurs with nasal augmentation,followed by glabellar wrinkle treatment.While injected autologous fat predominantly occludes the proximal portion of the ophthalmic artery,hyaluronic acid fillers obstruct the ophthalmic artery comparatively distally.Treatment interventions include thrombolysis,hyperbaric oxygen therapy,oral aspirin,cobamamide and acetazolamide and administration of corticosteroids.However,most studies show a poor prognosis in the form of partial or no recovery of vision.Hence,prevention is of paramount importance.A high index of suspicion is also warranted on the part of both those administering as well as receiving injections of facial fillers to prevent potentially vision-threatening complications of this seemingly innocuous procedure.
