It is estimated that 20000 to 30000 new patients are diagnosed with osteonecrosis annually accounting for approximately 10% of the 250000 total hip arthroplasties done annually in the United States. Thelack of level 1...It is estimated that 20000 to 30000 new patients are diagnosed with osteonecrosis annually accounting for approximately 10% of the 250000 total hip arthroplasties done annually in the United States. Thelack of level 1 evidence in the literature makes it difficult to identify optimal treatment protocols to manage patients with pre-collapse avascular necrosis of the femoral head, and early intervention prior to collapse is critical to successful outcomes in joint preserving procedures. There have been a variety of traumatic and atraumatic factors that have been identified as risk factors for osteonecrosis, but the etiology and pathogenesis still remains unclear. Current osteonecrosis diagnosis is dependent upon plain anteroposterior and frog-leg lateral radiographs of the hip, followed by magnetic resonance imaging(MRI). Generally, the first radiographic changes seen by radiograph will be cystic and sclerotic changes in the femoral head. Although the diagnosis may be made by radiograph, plain radiographs are generally insufficient for early diagnosis, therefore MRI is considered the most accurate benchmark. Treatment options include pharmacologic agents such as bisphosphonates and statins, biophysical treatments, as well as joint-preserving and joint-replacing surgeries. the surgical treatment of osteonecrosis of the femoral head can be divided into two major branches: femoral head sparing procedures(FHSP) and femoral head replacement procedures(FHRP). In general, FHSP are indicated at pre-collapse stages with minimal symptoms whereas FHRP are preferred at post-collapse symptomatic stages. It is difficult to know whether any treatment modality changes the natural history of core decompression since the true natural history of core decompression has not been delineated.展开更多
Capsule endoscopy has revoluzionized the study of the small bowel by providing a reliable method to evaluate, endoscopically, the entire small bowel. In the last six years several papers have been published exploring ...Capsule endoscopy has revoluzionized the study of the small bowel by providing a reliable method to evaluate, endoscopically, the entire small bowel. In the last six years several papers have been published exploring the possible role of this examination in different clinical conditions. At the present time capsule endoscopy is generally recommended as a third examination, after negative bidirectional endoscopy, in patients with obscure gastrointestinal bleeding. A growing body of evidence suggests also an important role for this examination in other clinical conditions such as Crohn＇s disease, celiac disease, small bowel polyposis syndromes or small bowel tumors. The main complication of this examination is the retention of the device at the site of a previously unknown small bowel stricture. However there are also some other open issues mainly due to technical limitations of this tool （which is not driven from remote control, is unable to take biopsies, to insufflate air, to suck fluids or debris and sometimes to correctly size and locate lesions）.The recently developed double balloon enteroscope, owing to its capability to explore a large part of the small bowel and to take targeted biopsies, although being invasive and time consuming, can overcome some limitations of capsule endoscopy. At the present time, in the majority of clinical conditions （i.e. obscure GI bleeding）, the winning strategy seems to be to couple these two techniques to explore the small bowel in a painless, safe and complete way （with capsule endoscopy） and to define and treat the lesions identified （with double balloon enteroscopy）.展开更多
AIM： To investigate the effects of long-term albumin administration on survival, recurrence of ascites and onset of other complications. METHODS： One hundred consecutive patients admitted for first-onset ascites wer...AIM： To investigate the effects of long-term albumin administration on survival, recurrence of ascites and onset of other complications. METHODS： One hundred consecutive patients admitted for first-onset ascites were randomized to receive diuretics plus human albumin 25 g/wk in the first year and 25 g every two wk thereafter （group 1） or diuretics alone （group 2）. The primary endpoint was survival without liver transplantation. Secondary endpoints were recurrence of ascites and occurrence of other complications. RESULTS： Median follow-up was 84 （2-120） mo. Albu- min-treated patients had significantly greater cumulative survival rate （Breslow test= 7.05, P= 0.0078） and lower probability of ascites recurrence （51% versus 94%, P〈0.0001）. Chronic albumin infusion resulted in a mean increase in survival of 16 mo. CONCLUSION： Long-term albumin administration after first-onset ascites significantly improves patients＇ survival and decreases the risk of ascites recurrence.展开更多
The aim of this review is to give a comprehensive and concise overview of coronary embryology and normal coronary anatomy, describe common variants of normal and summarize typical patterns of anomalous coronary artery...The aim of this review is to give a comprehensive and concise overview of coronary embryology and normal coronary anatomy, describe common variants of normal and summarize typical patterns of anomalous coronary artery anatomy. Extensive iconography supports the text, with particular attention to images obtained in vivo using non-invasive imaging. We have divided this article into three groups, according to their frequency in the general population: Normal, normal variant and anomaly. Although congenital coronary artery anomalies are relatively uncommon, they are the second most common cause of sudden cardiac death among young athletes and therefore warrant detailed review. Based on the functional relevance of each abnormality, coronary artery anomalies can be classified as anomalies with obligatory ischemia, without ischemia or with exceptional ischemia. The clinical symptoms may include chest pain, dyspnea, palpitations, syncope, cardiomyopathy, arrhythmia, myocardial infarction and sudden cardiac death. Moreover, it is important to also identify variants and anomalies without clinical relevance in their own right as complications during surgery or angioplasty can occur.展开更多
Diabetes mellitus and associated chronic hyperglycemia enhance the risk of acute ischemic stroke and lead to worsened clinical outcome and increased mortality. However, post-stroke hyperglycemia is also present in a n...Diabetes mellitus and associated chronic hyperglycemia enhance the risk of acute ischemic stroke and lead to worsened clinical outcome and increased mortality. However, post-stroke hyperglycemia is also present in a number of non-diabetic patients after acute ischemic stroke, presumably as a stress response. The aim of this review is to summarize the main effects of hyperglycemia when associated to ischemic injury in acute stroke patients, highlighting the clinical and neurological outcomes in these conditions and after the administration of the currently approved pharmacological treatment, i.e. insulin. The disappointing results of the clinical trials on insulin(including the hypoglycemic events) demand a change of strategy based on more focused therapies. Starting from the comprehensive evaluation of the physiopathological alterations occurring in the ischemic brain during hyperglycemic conditions, the effects of various classes of glucose-lowering drugs are reviewed, such as glucose-like peptide-1 receptor agonists, DPP-4 inhibitors and sodium glucose cotransporter 2 inhibitors, in the perspective of overcoming the up-to-date limitations and of evaluating the effectiveness of new potential therapeutic strategies.展开更多
The opioid epidemic in the United States continues to take the lives of many individuals, with overdoses continuing to rise every year. Naloxone is an opioid antagonist that is efficacious in temporarily reversing opi...The opioid epidemic in the United States continues to take the lives of many individuals, with overdoses continuing to rise every year. Naloxone is an opioid antagonist that is efficacious in temporarily reversing opioid overdoses. Pharmacists play an important role in the accessibility and education of naloxone in both the community and health system settings. Recent efforts, such as co-dispensing naloxone with opioid prescriptions, naloxone training programs, and approval of naloxone to be over-the-counter, have been implemented in hopes to better control the opioid epidemic. Despite the efforts to make naloxone more accessible, there are still some barriers to overcome such as lack of training, cost, stigma, and patient refusal. This review aims to explore the contributions pharmacists have made thus far and define the barriers that still have to be resolved.展开更多
In agreement with Titchmarsh’s theorem, we prove that dispersion relations are just the Fourier-transform of the identity, g(x′)=±Sgn(x′)g(x′), which defines the property of being a truncated functions at the...In agreement with Titchmarsh’s theorem, we prove that dispersion relations are just the Fourier-transform of the identity, g(x′)=±Sgn(x′)g(x′), which defines the property of being a truncated functions at the origin. On the other hand, we prove that the wave-function of a generalized diffraction in time problem is just the Fourier-transform of a truncated function. Consequently, the existence of dispersion relations for the diffraction in time wave-function follows. We derive these explicit dispersion relations.展开更多
Bone remodeling replaces old and damaged bone with new bone through a sequence of cellular events occurring on the same surface without any change in bone shape. It was initially thought that the basic multicellular u...Bone remodeling replaces old and damaged bone with new bone through a sequence of cellular events occurring on the same surface without any change in bone shape. It was initially thought that the basic multicellular unit(BMU) responsible for bone remodeling consists of osteoclasts and osteoblasts functioning through a hierarchical sequence of events organized into distinct stages. However, recent discoveries have indicated that all bone cells participate in BMU formation by interacting both simultaneously and at different differentiation stages with their progenitors, other cells, and bone matrix constituents. Therefore,bone remodeling is currently considered a physiological outcome of continuous cellular operational processes optimized to confer a survival advantage. Bone remodeling defines the primary activities that BMUs need to perform to renew successfully bone structural units. Hence, this review summarizes the current understanding of bone remodeling and future research directions with the aim of providing a clinically relevant biological background with which to identify targets for therapeutic strategies in osteoporosis.展开更多
Peritoneal carcinomatosis represents a devastating form of cancer progression with a very poor prognosis.Its complex pathogenesis is represented by a dynamic process comprising several steps.To the best of our knowled...Peritoneal carcinomatosis represents a devastating form of cancer progression with a very poor prognosis.Its complex pathogenesis is represented by a dynamic process comprising several steps.To the best of our knowledge pathogenesis can be partly explained by 3 major molecular pathways: (1) dissemination from the primary tumor;(2) primary tumor of peritoneum;and (3) independent origins of the primary tumor and peritoneal implants.These are not mutually exclusive and combinations of different mechanisms could occur inside a single case.There are still several aspects which need explanation by future studies.A comprehensive understanding of molecular events involved in peritoneal carcinomatosis is of paramount importance and should be systematically pursued not only to identify novel strategies for the prevention of the condition,but also to obtain therapeutic advances,through the identification of surrogate markers of prognosis and development of future molecular targeted therapies.展开更多
Elucidating how multiple factors affect biodiversity and plant community assembly is a central issue in ecology,especially in vulnerable ecosystems such as tropical mountains.These studies are more relevant in global ...Elucidating how multiple factors affect biodiversity and plant community assembly is a central issue in ecology,especially in vulnerable ecosystems such as tropical mountains.These studies are more relevant in global warming scenarios that induce the upward displacement of plant species towards reduced habitats and hostile environments in tropical mountains.This study aimed to analyze how altitude affects taxonomic and phylogenetic diversity in plant communities of tropical mountains.Thus,we tested if(i)increased altitude works as an environmental filtering promoting decreased species richness,decreased phylogenetic diversity,and increased phylogenetic clustering in these tropical mountains;and if(ii)plant communities of high altitude in tropical mountains are also result of recent diversification with plant species recently split shortening phylogenetic distances between closest related species.We tested effects of altitude on species richness and phylogenetic metrics using linear mixed-effects models.Mount Haleakala presented 114 species,Mount Kilimanjaro presented 231 species and Mount Purace presented 280 species.We found an environmental filtering effect with increasing altitude causing phylogenetic clustering,decreased phylogenetic diversity and decreased species richness.The decreasing phylogenetic distances between closest relatives are congruent with neo-endemics,suggesting recent plant diversification in high altitudes of tropical mountains,possibly driven by geographic isolation and environmental heterogeneity.Consequences of global warming should be monitored in tropical mountains focusing on distribution shifts.展开更多
Introduction: Since the earliest description of spinal fusion in 1911 and later by Dr. Fred H. Albee, it has become one of the most commonly performed procedures by orthopedist and neurosurgeons. The spinal fusion is ...Introduction: Since the earliest description of spinal fusion in 1911 and later by Dr. Fred H. Albee, it has become one of the most commonly performed procedures by orthopedist and neurosurgeons. The spinal fusion is now used to treat a variety of indications, such as traumatic injuries, deformities, primary and secondary tumors, infections and degenerative conditions of the spine. The risk of iatrogenic injury during traditional anterior, posterior, and transforaminal open fusion surgery is significant. The axial lumbar interbody fusion (Axia-LIF) is a minimal invasive technique which uses the retroperitoneumpresacral anatomical corridor to fuse the lumbar vertebral bodies L4-L5-S1 avoiding manipulation of the annular ligament, paravertebral muscles and facet joints. Methods: In this retrospective series, we report all the cases made in the Centro Medico Naval in México City in two years. A total of eleven patients with degenerative disc disease and spondylolisthesis underwent Axia-LIF one or two level systems with a 36 months clinical and radiographic follow-up. The outcomes included Oswestry Disability Index (ODI) score and leg/back pain severity. Radiographic outcome was evaluated with dynamics and orthogonal x-ray, as well as lumbosacral tomography scan to evaluate fusion status. Results: Nine patients underwent Axia-LIF one level system (L5-S1) and the rest two levels system (L4-S1). Ten patients were fixated with transpedicular percutaneous screws and one with facets joints screws. No intraoperative complications were reported. The mean back pain severity improved 57% in 12 months, and the mean leg pain severity improved 50% in the same time (P < 0.001). Mean ODI scores improved 58%, from 60% ± 16% at baseline to 25% ± 8% at twelve months (P < 0.001). At one year, a patient developed pseudoarthrosis that required posterolateral arthrodesis with transpedicular percutaneous screws. At 36 months monitoring, 100% patients presented a total interbody fusion in the tomography scans. At final follow-up, mean O展开更多
Au-based catalysts have been reported to be active in the cyclohexane oxidation to K-A oil, but they showed some limitiations in terms of productivity, selectivity and required reaction conditions. The possibility to ...Au-based catalysts have been reported to be active in the cyclohexane oxidation to K-A oil, but they showed some limitiations in terms of productivity, selectivity and required reaction conditions. The possibility to overcome some of these limits has been explored coupling Au with Cu, which can be suitable for undergoing the electron-switch in the initial step of the cyclohexane oxidation. Hence, a bimetallic 2 wt% Au Cu/Al_(2)O_(3) catalyst was tested in the oxidation of cyclohexane, working at mild conditions of 120 ℃ and 4 bar of O_(2). The combination of the catalyst with a very small amount of benzaldehyde used as cheaper and non-toxic radical initiator allowed to obtain a very high productivity of cyclohexanol and cyclohexanone(45 mmol*m L/mgmet*h) with a selectivity of 94%. Moreover, comparing the catalysed reaction with the non-catalysed one, the role of the catalyst has been disclosed.展开更多
AIM:To investigate the capability of a biochemical and clinical model,BioCliM,in predicting the survival of cirrhotic patients.METHODS:We prospectively evaluated the survival of 172 cirrhotic patients.The model was co...AIM:To investigate the capability of a biochemical and clinical model,BioCliM,in predicting the survival of cirrhotic patients.METHODS:We prospectively evaluated the survival of 172 cirrhotic patients.The model was constructed using clinical(ascites,encephalopathy and variceal bleeding) and biochemical(serum creatinine and serum total bilirubin) variables that were selected from a Cox proportional hazards model.It was applied to estimate 12-,52-and 104-wk survival.The model's calibration using the Hosmer-Lemeshow statistic was computed at 104 wk in a validation dataset.Finally,the model's validity was tested among an independent set of 85 patients who were stratified into 2 risk groups(low risk≤8 and high risk>8).RESULTS:In the validation cohort,all measures of fi t,discrimination and calibration were improved when the biochemical and clinical model was used.The proposed model had better predictive values(c-statistic:0.90,0.91,0.91) than the Model for End-stage Liver Disease(MELD) and Child-Pugh(CP) scores for 12-,52-and 104-wk mortality,respectively.In addition,the Hosmer-Lemeshow(H-L) statistic revealed that the biochemical and clinical model(H-L,4.69) is better calibrated than MELD(H-L,17.06) and CP(H-L,14.23).There were no significant differences between the observed and expected survival curves in the stratified risk groups(low risk,P=0.61;high risk,P=0.77).CONCLUSION:Our data suggest that the proposed model is able to accurately predict survival in cirrhotic patients.展开更多
Tolerogenic dendritic cells(DCs)are key players in maintaining immunological homeostasis,dampening immune responses,and promoting tolerance.DC-10,a tolerogenic population of human IL-10-producing DCs characterized by ...Tolerogenic dendritic cells(DCs)are key players in maintaining immunological homeostasis,dampening immune responses,and promoting tolerance.DC-10,a tolerogenic population of human IL-10-producing DCs characterized by the expression of HLA-G and ILT4,play a pivotal role in promoting tolerance via T regulatory type 1(Tr1)cells.Thus far,the absence of markers that uniquely identify DC-10 has limited in vivo studies.By in vitro gene expression profiling of differentiated human DCs,we identified CD141 and CD163 as surface markers for DC-10.The coexpression of CD141 and CD163 in combination with CD14 and CD16 enables the ex vivo isolation of DC-10 from the peripheral blood.CD14+CD16+CD141+CD163+cells isolated from the peripheral blood of healthy subjects(ex vivo DC-10)produced spontaneously and upon activation of IL-10 and limited levels of IL-12.Moreover,in vitro stimulation of allogeneic naive CD4+T cells with ex vivo DC-10 induced the differentiation of alloantigen-specific CD49b+LAG-3+Tr1 cells.Finally,ex vivo DC-10 and in vitro generated DC-10 exhibited a similar transcriptional profile,which are characterized by an anti-inflammatory and pro-tolerogenic signature.These results provide new insights into the phenotype and molecular signature of DC-10 and highlight the tolerogenic properties of circulating DC-10.These findings open the opportunity to track DC-10 in vivo and to define their role in physiological and pathological settings.展开更多
We propose that the level at which the conodont species Idiognathodus simulator （Ellison 1941） （sensu stricto） first appears be selected to mark the base of the Gzhelian Stage, because we believe that this is the ...We propose that the level at which the conodont species Idiognathodus simulator （Ellison 1941） （sensu stricto） first appears be selected to mark the base of the Gzhelian Stage, because we believe that this is the optimal level by which this boundary can be correlated. This taxon has a short range and a wide distribution, as shown by correlation of glacial-eustatic cyclothems across the Kasimovian-Gzhelian boundary interval among Midcontinent North America and the Moscow and Donets basins of eastern Europe, based on scale of the cyclothems along with several aspects of biostrati- graphy. Outside of these areas, I. simulator （sensu stricto） is known also from other parts of the U.S., and is reported from the southern Urals and south-central China in its expected position between other widespread taxa. Its first appearance is consistent with the current ammonoid placement of the boundary （first appearance of Shumardites cuyleri）, and it is also compatible with certain aspects of the distribution of Eurasian fusulinid faunas （e.g., lectotype ofRauserites rossicus）.展开更多
In Eastern South America, high altitude grasslands represent a mountain system that has a high number of endemic species. However, studies on the ecology of plant communities in these environments remain scarce. We ai...In Eastern South America, high altitude grasslands represent a mountain system that has a high number of endemic species. However, studies on the ecology of plant communities in these environments remain scarce. We aimed to evaluate the patterns of biodiversity and structure of plant communities from rocky outcrops in high altitude grasslands of three areas at the Caparaó National Park, southeastern Brazil, by sampling 300 randomly distributed plots. Then, we compared the floristic composition, relative abundance, and biological and vegetation spectra among areas. We classified species as endemic and non-endemic and verified the occurrence of endangered species. Species richness was evaluated by rarefaction analysis on the sampling units. The importance value and species abundance distribution(SAD) models were assessed. We also performed an indicator species analysis. We sampled 58 species belonging to 49 genera and 32 families. The number of species decreased with increasing altitude, with significant differences being observed among areas regarding richness, abundance, and cover. Of the total number of species, 10 are endemic to the Caparaó National Park and 17 are listed on the Brazilian Red List of endangered species. The dominant families on all peaks were Asteraceae and Poaceae. The SAD models showed lognormal and geometric distributions, corroborating the fact that 10 species that were common to all three areas were also the most dominant ones in the communities and showed the highest importance values, which ranged between 35% and 60%. Indicator species analysis revealed that 28 species(48.27%) were indicators. Of these, 42.85% had maximum specificity, meaning that they occurred only in one area. Thus, the number of species per life form ratio was similar among areas, yet vegetation spectra differed, especially for hemicryptophytes. The altimetric difference among the areas showed to be a very important driver in the community assembly, influencing the evaluated variables, however, other drivers as soil展开更多
Among five types of pulmonary hypertension,chronic thromboembolic pulmonary hypertension(CTEPH)is the only curable form,but prompt and accurate diagnosis can be challenging.Computed tomography and nuclear medicine-bas...Among five types of pulmonary hypertension,chronic thromboembolic pulmonary hypertension(CTEPH)is the only curable form,but prompt and accurate diagnosis can be challenging.Computed tomography and nuclear medicine-based techniques are standard imaging modalities to non-invasively diagnose CTEPH,however these are limited by radiation exposure,subjective qualitative bias,and lack of cardiac functional assessment.This review aims to assess the methodology,diagnostic accuracy of pulmonary perfusion imaging in the current literature and discuss its advantages,limitations and future research scope.展开更多
Understanding the relationships between plant diversity and the environment is an important step towards conservation of species and ecosystems.In this study,we hypothesize that community species richness decreases an...Understanding the relationships between plant diversity and the environment is an important step towards conservation of species and ecosystems.In this study,we hypothesize that community species richness decreases and species composition change along the elevation gradient,with a greater contribution of species turnover than nestedness to beta diversity.We surveyed plant species in 300 plots(1 m×1 m)in four elevational bands(2100 m,2300m,2500 m,and 2700 m)in the CaparaóNational Park,Southeastern Brazil.The samples presented a great number of species(97 spp.,59 genera,27families),however,74%of the species were considered rare with their relative abundance being<1%.Among the four bands along the gradient,we detected two distinct communities with few species in common.The transition between the two communities occurred at 2500 m,and this elevation band also had the highest species richness in total.A non-metric multidimensional scaling(NMDS)showed floristic differences between the bands even though they had similar richness.In 89%of the plot pairs,using pairwise comparison of species composition,only half of the species that occurred in one did occur in the other plot.The dissimilarity among the plots and elevational band reflects a significant contribution of spatial species turnover to the species richness and beta diversity on the Caparaómountain.Beta diversity increased with spatial scale(from plot to elevational-band).The dissimilarity(βSOR=0.907)in the area was due almost exclusively to spatial species turnover(βSIM=0.879),with very low contribution of species nestedness(βSNE=0.028).Our research showed that species richness does not decrease with elevation in the study area,but the floristic composition changes.The clear distinction of species along the gradient show that spatial species turnover is the major diversitygenerating process in the studied area.展开更多
A first search for the Ξ_(bc)^(+)J/ψΞ_(c)^(+) decay is performed by the LHCb experiment with a data sample of proton-proton collisions, corresponding to an integrated luminosity of 9 fb−1 recorded at centre-of-mass...A first search for the Ξ_(bc)^(+)J/ψΞ_(c)^(+) decay is performed by the LHCb experiment with a data sample of proton-proton collisions, corresponding to an integrated luminosity of 9 fb−1 recorded at centre-of-mass energies of 7, 8, and 13 TeV. Two peaking structures are seen with a local (global) significance of 4.3(2.8) and 4.1(2.4) standard deviations at masses of 6571 and 6694 MeV/c2, respectively. Upper limits are set on the Ξ+bc baryon production cross-section times the branching fraction relative to that of the B+c→J/ψD+s decay at centre-of-mass energies of 8 and 13 TeV, in the Ξ+bc and in the B+c rapidity and transverse-momentum ranges from 2.0 to 4.5 and 0 to 20GeV/c, respectively. Upper limits are presented as a function of the Ξ+bc mass and lifetime.展开更多
A search for the rare decays W^(+)→D_(s)^(+)γ and Z→D0γis performed using proton-proton collision data collected by the LHCb experiment at a centre-of-mass energy of 13TeV,corresponding to an integrated luminosity...A search for the rare decays W^(+)→D_(s)^(+)γ and Z→D0γis performed using proton-proton collision data collected by the LHCb experiment at a centre-of-mass energy of 13TeV,corresponding to an integrated luminosity of 2.0fb−1.No significant signal is observed for either decay mode and upper limits on their branching fractions are set using W^(+)→D_(s)^(+)γ and Z→μ+μ−decays as normalization channels.The upper limits are 6.5×10^(−4) and 2.1×10^(−3) at 95% confidence level for the W^(+)→D_(s)^(+)γ and Z→D^(0)γ decay modes,respectively.This is the first reported search for the Z→D^(0)γ decay,while the upper limit on the W+→D+sγbranching fraction improves upon the previous best limit.展开更多
文摘It is estimated that 20000 to 30000 new patients are diagnosed with osteonecrosis annually accounting for approximately 10% of the 250000 total hip arthroplasties done annually in the United States. Thelack of level 1 evidence in the literature makes it difficult to identify optimal treatment protocols to manage patients with pre-collapse avascular necrosis of the femoral head, and early intervention prior to collapse is critical to successful outcomes in joint preserving procedures. There have been a variety of traumatic and atraumatic factors that have been identified as risk factors for osteonecrosis, but the etiology and pathogenesis still remains unclear. Current osteonecrosis diagnosis is dependent upon plain anteroposterior and frog-leg lateral radiographs of the hip, followed by magnetic resonance imaging(MRI). Generally, the first radiographic changes seen by radiograph will be cystic and sclerotic changes in the femoral head. Although the diagnosis may be made by radiograph, plain radiographs are generally insufficient for early diagnosis, therefore MRI is considered the most accurate benchmark. Treatment options include pharmacologic agents such as bisphosphonates and statins, biophysical treatments, as well as joint-preserving and joint-replacing surgeries. the surgical treatment of osteonecrosis of the femoral head can be divided into two major branches: femoral head sparing procedures(FHSP) and femoral head replacement procedures(FHRP). In general, FHSP are indicated at pre-collapse stages with minimal symptoms whereas FHRP are preferred at post-collapse symptomatic stages. It is difficult to know whether any treatment modality changes the natural history of core decompression since the true natural history of core decompression has not been delineated.
文摘Capsule endoscopy has revoluzionized the study of the small bowel by providing a reliable method to evaluate, endoscopically, the entire small bowel. In the last six years several papers have been published exploring the possible role of this examination in different clinical conditions. At the present time capsule endoscopy is generally recommended as a third examination, after negative bidirectional endoscopy, in patients with obscure gastrointestinal bleeding. A growing body of evidence suggests also an important role for this examination in other clinical conditions such as Crohn＇s disease, celiac disease, small bowel polyposis syndromes or small bowel tumors. The main complication of this examination is the retention of the device at the site of a previously unknown small bowel stricture. However there are also some other open issues mainly due to technical limitations of this tool （which is not driven from remote control, is unable to take biopsies, to insufflate air, to suck fluids or debris and sometimes to correctly size and locate lesions）.The recently developed double balloon enteroscope, owing to its capability to explore a large part of the small bowel and to take targeted biopsies, although being invasive and time consuming, can overcome some limitations of capsule endoscopy. At the present time, in the majority of clinical conditions （i.e. obscure GI bleeding）, the winning strategy seems to be to couple these two techniques to explore the small bowel in a painless, safe and complete way （with capsule endoscopy） and to define and treat the lesions identified （with double balloon enteroscopy）.
基金Supported by grants from the Italian Ministry of Education, University and Research and the University of Florence, Italy
文摘AIM： To investigate the effects of long-term albumin administration on survival, recurrence of ascites and onset of other complications. METHODS： One hundred consecutive patients admitted for first-onset ascites were randomized to receive diuretics plus human albumin 25 g/wk in the first year and 25 g every two wk thereafter （group 1） or diuretics alone （group 2）. The primary endpoint was survival without liver transplantation. Secondary endpoints were recurrence of ascites and occurrence of other complications. RESULTS： Median follow-up was 84 （2-120） mo. Albu- min-treated patients had significantly greater cumulative survival rate （Breslow test= 7.05, P= 0.0078） and lower probability of ascites recurrence （51% versus 94%, P〈0.0001）. Chronic albumin infusion resulted in a mean increase in survival of 16 mo. CONCLUSION： Long-term albumin administration after first-onset ascites significantly improves patients＇ survival and decreases the risk of ascites recurrence.
基金financial support from the Department of Health via the National Institute for Health Research comprehensive Biomedical Research Centre award to Guy’s and St Thomas’ NHS Foundation Trust in partnership with King's College London and King’s College Hospital NHS Foundation TrustThe Centre of Excellence in Medical Engineering funded by the Wellcome Trust and EPSRC under grant number WT 088641/Z/09/Z+2 种基金King’s College London and UCL Comprehensive Cancer Imaging CentreFunded by the CRUK and EPSRC in association with the MRC and Do H (England)Funded by the British Heart Foundation award RE/08/003
文摘The aim of this review is to give a comprehensive and concise overview of coronary embryology and normal coronary anatomy, describe common variants of normal and summarize typical patterns of anomalous coronary artery anatomy. Extensive iconography supports the text, with particular attention to images obtained in vivo using non-invasive imaging. We have divided this article into three groups, according to their frequency in the general population: Normal, normal variant and anomaly. Although congenital coronary artery anomalies are relatively uncommon, they are the second most common cause of sudden cardiac death among young athletes and therefore warrant detailed review. Based on the functional relevance of each abnormality, coronary artery anomalies can be classified as anomalies with obligatory ischemia, without ischemia or with exceptional ischemia. The clinical symptoms may include chest pain, dyspnea, palpitations, syncope, cardiomyopathy, arrhythmia, myocardial infarction and sudden cardiac death. Moreover, it is important to also identify variants and anomalies without clinical relevance in their own right as complications during surgery or angioplasty can occur.
基金supported by a grant from Catholic Universitary Center(Centro Universitario Cattolico)-Conferenza Episcopale Italiana,Rome,Italy(to FF)。
文摘Diabetes mellitus and associated chronic hyperglycemia enhance the risk of acute ischemic stroke and lead to worsened clinical outcome and increased mortality. However, post-stroke hyperglycemia is also present in a number of non-diabetic patients after acute ischemic stroke, presumably as a stress response. The aim of this review is to summarize the main effects of hyperglycemia when associated to ischemic injury in acute stroke patients, highlighting the clinical and neurological outcomes in these conditions and after the administration of the currently approved pharmacological treatment, i.e. insulin. The disappointing results of the clinical trials on insulin(including the hypoglycemic events) demand a change of strategy based on more focused therapies. Starting from the comprehensive evaluation of the physiopathological alterations occurring in the ischemic brain during hyperglycemic conditions, the effects of various classes of glucose-lowering drugs are reviewed, such as glucose-like peptide-1 receptor agonists, DPP-4 inhibitors and sodium glucose cotransporter 2 inhibitors, in the perspective of overcoming the up-to-date limitations and of evaluating the effectiveness of new potential therapeutic strategies.
文摘The opioid epidemic in the United States continues to take the lives of many individuals, with overdoses continuing to rise every year. Naloxone is an opioid antagonist that is efficacious in temporarily reversing opioid overdoses. Pharmacists play an important role in the accessibility and education of naloxone in both the community and health system settings. Recent efforts, such as co-dispensing naloxone with opioid prescriptions, naloxone training programs, and approval of naloxone to be over-the-counter, have been implemented in hopes to better control the opioid epidemic. Despite the efforts to make naloxone more accessible, there are still some barriers to overcome such as lack of training, cost, stigma, and patient refusal. This review aims to explore the contributions pharmacists have made thus far and define the barriers that still have to be resolved.
文摘In agreement with Titchmarsh’s theorem, we prove that dispersion relations are just the Fourier-transform of the identity, g(x′)=±Sgn(x′)g(x′), which defines the property of being a truncated functions at the origin. On the other hand, we prove that the wave-function of a generalized diffraction in time problem is just the Fourier-transform of a truncated function. Consequently, the existence of dispersion relations for the diffraction in time wave-function follows. We derive these explicit dispersion relations.
文摘Bone remodeling replaces old and damaged bone with new bone through a sequence of cellular events occurring on the same surface without any change in bone shape. It was initially thought that the basic multicellular unit(BMU) responsible for bone remodeling consists of osteoclasts and osteoblasts functioning through a hierarchical sequence of events organized into distinct stages. However, recent discoveries have indicated that all bone cells participate in BMU formation by interacting both simultaneously and at different differentiation stages with their progenitors, other cells, and bone matrix constituents. Therefore,bone remodeling is currently considered a physiological outcome of continuous cellular operational processes optimized to confer a survival advantage. Bone remodeling defines the primary activities that BMUs need to perform to renew successfully bone structural units. Hence, this review summarizes the current understanding of bone remodeling and future research directions with the aim of providing a clinically relevant biological background with which to identify targets for therapeutic strategies in osteoporosis.
文摘Peritoneal carcinomatosis represents a devastating form of cancer progression with a very poor prognosis.Its complex pathogenesis is represented by a dynamic process comprising several steps.To the best of our knowledge pathogenesis can be partly explained by 3 major molecular pathways: (1) dissemination from the primary tumor;(2) primary tumor of peritoneum;and (3) independent origins of the primary tumor and peritoneal implants.These are not mutually exclusive and combinations of different mechanisms could occur inside a single case.There are still several aspects which need explanation by future studies.A comprehensive understanding of molecular events involved in peritoneal carcinomatosis is of paramount importance and should be systematically pursued not only to identify novel strategies for the prevention of the condition,but also to obtain therapeutic advances,through the identification of surrogate markers of prognosis and development of future molecular targeted therapies.
基金provided by FAPEMIG(FORTIS/PPGBot-UFV,PPM-00584-16,APQ‐01309‐16)CAPES(PROAP and PrInt/PPGBot-UFV),CNPq(307591/2016‐6,306335/2020-4).
文摘Elucidating how multiple factors affect biodiversity and plant community assembly is a central issue in ecology,especially in vulnerable ecosystems such as tropical mountains.These studies are more relevant in global warming scenarios that induce the upward displacement of plant species towards reduced habitats and hostile environments in tropical mountains.This study aimed to analyze how altitude affects taxonomic and phylogenetic diversity in plant communities of tropical mountains.Thus,we tested if(i)increased altitude works as an environmental filtering promoting decreased species richness,decreased phylogenetic diversity,and increased phylogenetic clustering in these tropical mountains;and if(ii)plant communities of high altitude in tropical mountains are also result of recent diversification with plant species recently split shortening phylogenetic distances between closest related species.We tested effects of altitude on species richness and phylogenetic metrics using linear mixed-effects models.Mount Haleakala presented 114 species,Mount Kilimanjaro presented 231 species and Mount Purace presented 280 species.We found an environmental filtering effect with increasing altitude causing phylogenetic clustering,decreased phylogenetic diversity and decreased species richness.The decreasing phylogenetic distances between closest relatives are congruent with neo-endemics,suggesting recent plant diversification in high altitudes of tropical mountains,possibly driven by geographic isolation and environmental heterogeneity.Consequences of global warming should be monitored in tropical mountains focusing on distribution shifts.
文摘Introduction: Since the earliest description of spinal fusion in 1911 and later by Dr. Fred H. Albee, it has become one of the most commonly performed procedures by orthopedist and neurosurgeons. The spinal fusion is now used to treat a variety of indications, such as traumatic injuries, deformities, primary and secondary tumors, infections and degenerative conditions of the spine. The risk of iatrogenic injury during traditional anterior, posterior, and transforaminal open fusion surgery is significant. The axial lumbar interbody fusion (Axia-LIF) is a minimal invasive technique which uses the retroperitoneumpresacral anatomical corridor to fuse the lumbar vertebral bodies L4-L5-S1 avoiding manipulation of the annular ligament, paravertebral muscles and facet joints. Methods: In this retrospective series, we report all the cases made in the Centro Medico Naval in México City in two years. A total of eleven patients with degenerative disc disease and spondylolisthesis underwent Axia-LIF one or two level systems with a 36 months clinical and radiographic follow-up. The outcomes included Oswestry Disability Index (ODI) score and leg/back pain severity. Radiographic outcome was evaluated with dynamics and orthogonal x-ray, as well as lumbosacral tomography scan to evaluate fusion status. Results: Nine patients underwent Axia-LIF one level system (L5-S1) and the rest two levels system (L4-S1). Ten patients were fixated with transpedicular percutaneous screws and one with facets joints screws. No intraoperative complications were reported. The mean back pain severity improved 57% in 12 months, and the mean leg pain severity improved 50% in the same time (P < 0.001). Mean ODI scores improved 58%, from 60% ± 16% at baseline to 25% ± 8% at twelve months (P < 0.001). At one year, a patient developed pseudoarthrosis that required posterolateral arthrodesis with transpedicular percutaneous screws. At 36 months monitoring, 100% patients presented a total interbody fusion in the tomography scans. At final follow-up, mean O
基金The Authors gratefully acknowledge the supportof bilateral project CNR-HAS(MTA)SAC.AD002.037.
文摘Au-based catalysts have been reported to be active in the cyclohexane oxidation to K-A oil, but they showed some limitiations in terms of productivity, selectivity and required reaction conditions. The possibility to overcome some of these limits has been explored coupling Au with Cu, which can be suitable for undergoing the electron-switch in the initial step of the cyclohexane oxidation. Hence, a bimetallic 2 wt% Au Cu/Al_(2)O_(3) catalyst was tested in the oxidation of cyclohexane, working at mild conditions of 120 ℃ and 4 bar of O_(2). The combination of the catalyst with a very small amount of benzaldehyde used as cheaper and non-toxic radical initiator allowed to obtain a very high productivity of cyclohexanol and cyclohexanone(45 mmol*m L/mgmet*h) with a selectivity of 94%. Moreover, comparing the catalysed reaction with the non-catalysed one, the role of the catalyst has been disclosed.
文摘AIM:To investigate the capability of a biochemical and clinical model,BioCliM,in predicting the survival of cirrhotic patients.METHODS:We prospectively evaluated the survival of 172 cirrhotic patients.The model was constructed using clinical(ascites,encephalopathy and variceal bleeding) and biochemical(serum creatinine and serum total bilirubin) variables that were selected from a Cox proportional hazards model.It was applied to estimate 12-,52-and 104-wk survival.The model's calibration using the Hosmer-Lemeshow statistic was computed at 104 wk in a validation dataset.Finally,the model's validity was tested among an independent set of 85 patients who were stratified into 2 risk groups(low risk≤8 and high risk>8).RESULTS:In the validation cohort,all measures of fi t,discrimination and calibration were improved when the biochemical and clinical model was used.The proposed model had better predictive values(c-statistic:0.90,0.91,0.91) than the Model for End-stage Liver Disease(MELD) and Child-Pugh(CP) scores for 12-,52-and 104-wk mortality,respectively.In addition,the Hosmer-Lemeshow(H-L) statistic revealed that the biochemical and clinical model(H-L,4.69) is better calibrated than MELD(H-L,17.06) and CP(H-L,14.23).There were no significant differences between the observed and expected survival curves in the stratified risk groups(low risk,P=0.61;high risk,P=0.77).CONCLUSION:Our data suggest that the proposed model is able to accurately predict survival in cirrhotic patients.
基金This work was supported by research funding from the Italian Telethon Foundation(TGT17G01)the Italian Assodation for Cancer Research,IG-18540,AIRC 2016 to S.G.+1 种基金by COST Action BM1305 A-FAACT(http://www.afactt.eu)and COST Action BM1404 Mye EUNITER(http://www.mye euniter.eu)COST is supported by the EU Framework Program Horizon 2020.MJ.U.was supported by the NSF Graduate Research Fellowship Grant#DGE-1147470.
文摘Tolerogenic dendritic cells(DCs)are key players in maintaining immunological homeostasis,dampening immune responses,and promoting tolerance.DC-10,a tolerogenic population of human IL-10-producing DCs characterized by the expression of HLA-G and ILT4,play a pivotal role in promoting tolerance via T regulatory type 1(Tr1)cells.Thus far,the absence of markers that uniquely identify DC-10 has limited in vivo studies.By in vitro gene expression profiling of differentiated human DCs,we identified CD141 and CD163 as surface markers for DC-10.The coexpression of CD141 and CD163 in combination with CD14 and CD16 enables the ex vivo isolation of DC-10 from the peripheral blood.CD14+CD16+CD141+CD163+cells isolated from the peripheral blood of healthy subjects(ex vivo DC-10)produced spontaneously and upon activation of IL-10 and limited levels of IL-12.Moreover,in vitro stimulation of allogeneic naive CD4+T cells with ex vivo DC-10 induced the differentiation of alloantigen-specific CD49b+LAG-3+Tr1 cells.Finally,ex vivo DC-10 and in vitro generated DC-10 exhibited a similar transcriptional profile,which are characterized by an anti-inflammatory and pro-tolerogenic signature.These results provide new insights into the phenotype and molecular signature of DC-10 and highlight the tolerogenic properties of circulating DC-10.These findings open the opportunity to track DC-10 in vivo and to define their role in physiological and pathological settings.
文摘We propose that the level at which the conodont species Idiognathodus simulator （Ellison 1941） （sensu stricto） first appears be selected to mark the base of the Gzhelian Stage, because we believe that this is the optimal level by which this boundary can be correlated. This taxon has a short range and a wide distribution, as shown by correlation of glacial-eustatic cyclothems across the Kasimovian-Gzhelian boundary interval among Midcontinent North America and the Moscow and Donets basins of eastern Europe, based on scale of the cyclothems along with several aspects of biostrati- graphy. Outside of these areas, I. simulator （sensu stricto） is known also from other parts of the U.S., and is reported from the southern Urals and south-central China in its expected position between other widespread taxa. Its first appearance is consistent with the current ammonoid placement of the boundary （first appearance of Shumardites cuyleri）, and it is also compatible with certain aspects of the distribution of Eurasian fusulinid faunas （e.g., lectotype ofRauserites rossicus）.
文摘In Eastern South America, high altitude grasslands represent a mountain system that has a high number of endemic species. However, studies on the ecology of plant communities in these environments remain scarce. We aimed to evaluate the patterns of biodiversity and structure of plant communities from rocky outcrops in high altitude grasslands of three areas at the Caparaó National Park, southeastern Brazil, by sampling 300 randomly distributed plots. Then, we compared the floristic composition, relative abundance, and biological and vegetation spectra among areas. We classified species as endemic and non-endemic and verified the occurrence of endangered species. Species richness was evaluated by rarefaction analysis on the sampling units. The importance value and species abundance distribution(SAD) models were assessed. We also performed an indicator species analysis. We sampled 58 species belonging to 49 genera and 32 families. The number of species decreased with increasing altitude, with significant differences being observed among areas regarding richness, abundance, and cover. Of the total number of species, 10 are endemic to the Caparaó National Park and 17 are listed on the Brazilian Red List of endangered species. The dominant families on all peaks were Asteraceae and Poaceae. The SAD models showed lognormal and geometric distributions, corroborating the fact that 10 species that were common to all three areas were also the most dominant ones in the communities and showed the highest importance values, which ranged between 35% and 60%. Indicator species analysis revealed that 28 species(48.27%) were indicators. Of these, 42.85% had maximum specificity, meaning that they occurred only in one area. Thus, the number of species per life form ratio was similar among areas, yet vegetation spectra differed, especially for hemicryptophytes. The altimetric difference among the areas showed to be a very important driver in the community assembly, influencing the evaluated variables, however, other drivers as soil
文摘Among five types of pulmonary hypertension,chronic thromboembolic pulmonary hypertension(CTEPH)is the only curable form,but prompt and accurate diagnosis can be challenging.Computed tomography and nuclear medicine-based techniques are standard imaging modalities to non-invasively diagnose CTEPH,however these are limited by radiation exposure,subjective qualitative bias,and lack of cardiac functional assessment.This review aims to assess the methodology,diagnostic accuracy of pulmonary perfusion imaging in the current literature and discuss its advantages,limitations and future research scope.
基金financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brazil(CAPES)-Finance Code 001.
文摘Understanding the relationships between plant diversity and the environment is an important step towards conservation of species and ecosystems.In this study,we hypothesize that community species richness decreases and species composition change along the elevation gradient,with a greater contribution of species turnover than nestedness to beta diversity.We surveyed plant species in 300 plots(1 m×1 m)in four elevational bands(2100 m,2300m,2500 m,and 2700 m)in the CaparaóNational Park,Southeastern Brazil.The samples presented a great number of species(97 spp.,59 genera,27families),however,74%of the species were considered rare with their relative abundance being<1%.Among the four bands along the gradient,we detected two distinct communities with few species in common.The transition between the two communities occurred at 2500 m,and this elevation band also had the highest species richness in total.A non-metric multidimensional scaling(NMDS)showed floristic differences between the bands even though they had similar richness.In 89%of the plot pairs,using pairwise comparison of species composition,only half of the species that occurred in one did occur in the other plot.The dissimilarity among the plots and elevational band reflects a significant contribution of spatial species turnover to the species richness and beta diversity on the Caparaómountain.Beta diversity increased with spatial scale(from plot to elevational-band).The dissimilarity(βSOR=0.907)in the area was due almost exclusively to spatial species turnover(βSIM=0.879),with very low contribution of species nestedness(βSNE=0.028).Our research showed that species richness does not decrease with elevation in the study area,but the floristic composition changes.The clear distinction of species along the gradient show that spatial species turnover is the major diversitygenerating process in the studied area.
基金The project support from CERN and from the national agencies:CAPES,CNPq,FAPERJ and FINEP(Brazil)MOST and NSFC(China)+18 种基金CNRS/IN2P3(France)BMBF,DFG and MPG(Germany)INFN(Italy)NWO(Netherlands)MNiSW and NCN(Poland)MEN/IFA(Romania)MICINN(Spain)SNSF and SER(Switzerland)NASU(Ukraine)STFC(United Kingdom)DOE NP and NSF(USA).We acknowledge the computing resources that are provided by CERN,IN2P3(France),KIT and DESY(Germany),INFN(Italy),SURF(Netherlands),PIC(Spain),GridPP(United Kingdom),CSCS(Switzerland),IFIN-HH(Romania),CBPF(Brazil),Polish WLCG(Poland)and NERSC(USA).Individual groups or members have received support from ARC and ARDC(Australia)Minciencias(Colombia)AvH Foundation(Germany)EPLANET,Marie Sklodowska-Curie Actions and ERC(European Union)A*MIDEX,ANR,IPhU and Labex P2IO,and Région Auvergne-RhôneAlpes(France)Key Research Program of Frontier Sciences of CAS,CAS PIFI,CAS CCEPP,Fundamental Research Funds for the Central Universities,and Sci.&Tech.Program of Guangzhou(China)GVA,XuntaGal,GENCAT and Prog.Atracción Talento,CM(Spain)SRC(Sweden)the Leverhulme Trust,the Royal Society and UKRI(United Kingdom).
文摘A first search for the Ξ_(bc)^(+)J/ψΞ_(c)^(+) decay is performed by the LHCb experiment with a data sample of proton-proton collisions, corresponding to an integrated luminosity of 9 fb−1 recorded at centre-of-mass energies of 7, 8, and 13 TeV. Two peaking structures are seen with a local (global) significance of 4.3(2.8) and 4.1(2.4) standard deviations at masses of 6571 and 6694 MeV/c2, respectively. Upper limits are set on the Ξ+bc baryon production cross-section times the branching fraction relative to that of the B+c→J/ψD+s decay at centre-of-mass energies of 8 and 13 TeV, in the Ξ+bc and in the B+c rapidity and transverse-momentum ranges from 2.0 to 4.5 and 0 to 20GeV/c, respectively. Upper limits are presented as a function of the Ξ+bc mass and lifetime.
文摘A search for the rare decays W^(+)→D_(s)^(+)γ and Z→D0γis performed using proton-proton collision data collected by the LHCb experiment at a centre-of-mass energy of 13TeV,corresponding to an integrated luminosity of 2.0fb−1.No significant signal is observed for either decay mode and upper limits on their branching fractions are set using W^(+)→D_(s)^(+)γ and Z→μ+μ−decays as normalization channels.The upper limits are 6.5×10^(−4) and 2.1×10^(−3) at 95% confidence level for the W^(+)→D_(s)^(+)γ and Z→D^(0)γ decay modes,respectively.This is the first reported search for the Z→D^(0)γ decay,while the upper limit on the W+→D+sγbranching fraction improves upon the previous best limit.
