Non-alcoholic fatty liver disease(NAFLD) is now the most frequent chronic liver disease that occurs across all age groups and is recognized to occur in 14%-30% of the general population, representing a serious and gro...Non-alcoholic fatty liver disease(NAFLD) is now the most frequent chronic liver disease that occurs across all age groups and is recognized to occur in 14%-30% of the general population, representing a serious and growing clinical problem due to the growing prevalence of obesity and overweight. Histologically, it resembles alcoholic liver injury but occurs in patients who deny significant alcohol consumption. NAFLD encompasses a spectrum of conditions, ranging from benign hepatocellular steatosisto inflammatory nonalcoholic steatohepatitis, fibrosis, and cirrhosis. The majority of hepatocellular lipids are stored as triglycerides, but other lipid metabolites, such as free fatty acids, cholesterol, and phospholipids, may also be present and play a role in disease progression. NAFLD is associated with obesity and insulin resistance and is considered the hepatic manifestation of the metabolic syndrome, a combination of medical conditions including type 2 diabetes mellitus, hypertension, hyperlipidemia, and visceral adiposity. Confirmation of the diagnosis of NAFLD can usually be achieved by imaging studies; however, staging the disease requires a liver biopsy. Current treatment relies on weight loss and exercise, although various insulin-sensitizing agents, antioxidants and medications appear promising. The aim of this review is to highlight the current information regarding epidemiology, diagnosis, and management of NAFLD as well as new information about pathogenesis, diagnosis and management of this disease.展开更多
In recent years,natural orifice specimen extraction surgery(NOSES)in the treatment of colorectal cancer has attracted widespread attention.The potential benefits of NOSES including reduction in postoperative pain and ...In recent years,natural orifice specimen extraction surgery(NOSES)in the treatment of colorectal cancer has attracted widespread attention.The potential benefits of NOSES including reduction in postoperative pain and wound complications,less use of postoperative analgesic,faster recovery of bowel function,shorter length of hospital stay,better cosmetic and psychological effect have been described in colorectal surgery.Despite significant decrease in surgical trauma of NOSES have been observed,the potential pitfalls of this technique have been demonstrated.Particularly,several issues including bacteriological concerns,oncological outcomes and patient selection are raised with this new technique.Therefore,it is urgent and necessary to reach a consensus as an industry guideline to standardize the implementation of NOSES in colorectal surgery.After three rounds of discussion by all members of the International Alliance of NOSES,the consensus is finally completed,which is also of great significance to the long-term progress of NOSES worldwide.展开更多
Our trial was conducted to study the effects of formic acid(FA) and potassium di-formate(KDF) in broiler ration on performance, carcass traits, blood biochemical, intestinal microbial load, histological picture of int...Our trial was conducted to study the effects of formic acid(FA) and potassium di-formate(KDF) in broiler ration on performance, carcass traits, blood biochemical, intestinal microbial load, histological picture of intestine and immune parameters of broilers. In this study 360 one-day-old broiler chicks were divided to 3 groups with 3 replicates of 40 chicks each. The trial continued for 35 days. The control group was fed only basal diet(G1). Group 2(G2) were fed basal diet supplemented with FA(5 g/kg diet), and group 3(G3) received basal diet supplemented with KDF(5 g/kg diet). The results showed that both FA and KDF significantly increased body weight gain(BWG), dressing percentage of broilers and significantly decreased feed conversion ratio(FCR)(P < 0.05). The highest percent of breast and thigh was observed in G3. The improvement in villus height was observed in G2 and G3 compared with the control one, and the highest was in G3. The results evidence that the using of FA or KDF in broiler feeds have significant effects on performance, immune parameters, and gut health without having any significant effects on blood biochemical. However, KDF is more effective than FA as little amount of FA reaches the small intestine due to metabolism and absorption, whereas KDF permits a proportion of FA to pass through the fore-gut intact and enter the small intestinal tract. In addition, FA has a strong odor and corrosiveness to gastrointestinal tract which limits its use.展开更多
In k-means clustering, we are given a set of n data points in d-dimensional space R^d and an integer k and the problem is to determine a set of k points in R^d, called centers, so as to minimize the mean squared dista...In k-means clustering, we are given a set of n data points in d-dimensional space R^d and an integer k and the problem is to determine a set of k points in R^d, called centers, so as to minimize the mean squared distance from each data point to its nearest center. In this paper, we present a simple and efficient clustering algorithm based on the k-means algorithm, which we call enhanced k-means algorithm. This algorithm is easy to implement, requiring a simple data structure to keep some information in each iteration to be used in the next iteration. Our experimental results demonstrated that our scheme can improve the computational speed of the k-means algorithm by the magnitude in the total number of distance calculations and the overall time of computation.展开更多
In this short survey, we give a complete list of the most important results obtained by El Naschie’s E-infinity Cantorian space-time theory in the realm of quantum physics and cosmology. Special attention is paid to ...In this short survey, we give a complete list of the most important results obtained by El Naschie’s E-infinity Cantorian space-time theory in the realm of quantum physics and cosmology. Special attention is paid to his recent result on dark energy and revising Einstein’s famous formula .展开更多
Background Acute bilirubin encephalopathy (ABE) still represents a significant cause of morbidity and mortality throughout the world,especially in developing countries.We aimed to determine the prevalence of ABE based...Background Acute bilirubin encephalopathy (ABE) still represents a significant cause of morbidity and mortality throughout the world,especially in developing countries.We aimed to determine the prevalence of ABE based on the Johnson bilirubininduced neurologic dysfunction (BIND) score and to describe the discharge outcomes.Methods We prospectively studied all newborns ≥ 35 weeks with ABE by evaluating signs of mental sensorium,muscle tone,and cry patterns over 1 year.Results 12% (81 out of 674) of the newborns admitted for neonatal hyperbilirubinemia had a BIND score > 1.Their admission age was 6 ± 4.1 days;total serum bilirubin (TSB) was 31.2± 10 mg/dL (range 17.5-75.2).Of these newborns,40.7% and 21% had evidence of haemolysis and sepsis,respectively.Overall mortality was 9.9%;58% of the newborns showed signs of mild-to-moderate BIND at discharge,while 32.1% survived with an apparently normal outcome.Admission BIND score was significantly correlated with admission TSB (r=0.476,P < 0.001).Similarly,BIND score at discharge was correlated with admission TSB (r=0.442,P < 0.001) and admission BIND score (r =0.888,P < 0.001).The regression model showed that admission TSB (P < 0.001) and maternal illiteracy (P =0.034) were predictors of the BIND score at admission,while admission BIND score was the best indicator of the discharge score (P < 0.001).Conclusions ABE is still a major problem in our community.Admission TSB and maternal illiteracy are good predictors of bilirubin encephalopathy at admission and discharge.展开更多
Hepatocellular carcinoma(HCC)is one of the common lethal types of tumor all over the world.The lethality of HCC accounts for many reasons.One of them,the lack of reliable diagnostic markers at the early stage,in this ...Hepatocellular carcinoma(HCC)is one of the common lethal types of tumor all over the world.The lethality of HCC accounts for many reasons.One of them,the lack of reliable diagnostic markers at the early stage,in this context,serum miRNAs became promising diagnostic biomarkers.Herein,we aimed to identify the predictive value of two miRNAs(miR-122 and miR-224)in plasma of patients with HCC preceded by chronic HCV infection.Taqman miRNA assays specific for hsa-miR-122 and hsa-miR-224 were used to assess the expression levels of the chosen miRNAs in plasma samples collected from three groups;40 patients with HCC related to HCV,40 with CHC patients and 20 healthy volunteers.This study revealed that the mean plasma values of miRNA-122 were significantly lower among HCC group when compared to CHC and control groups(P<0.001).Whereas,miR-224 mean plasma values were significantly higher among HCC group when compared to both CHC group and control group.Moreover,it was found that miR-122 can predict development of HCC at cut-off value<0.67(RQ)and(AUC Z 0.98,P<0.001).As regards miR-224,it can predict development of HCC at cut-off value>1.2(RQ)and(AUC Z 0.93,P<0.001),while the accuracy of AFP to diagnose HCC was(AUC:0.619;P Z 0.06).In conclusion,the expression plasma of miR-122 and miR-224 could be used as noninvasive biomarkers for the early prediction of developing HCC at the early stage.展开更多
AIM: To evaluate the effect of portal vein thrombosis and arterioportal shunts on local tumor response in advanced cases of unresectable hepatocellular carcinoma treated by transarterial chemoembolization. METHODS: A ...AIM: To evaluate the effect of portal vein thrombosis and arterioportal shunts on local tumor response in advanced cases of unresectable hepatocellular carcinoma treated by transarterial chemoembolization. METHODS: A retrospective study included 39 patients (mean age: 66.4 years, range: 45-79 years, SD: 7) with unresectable hepatocellular carcinoma (HCC) who were treated with repetitive transarterial chemoembolization (TACE) in the period between March 2006 and October 2009. The effect of portal vein thrombosis (PVT) (in 19 out of 39 patients), the presence of arterioportal shunt (APS) (in 7 out of 39), the underlying liver pathology,Child-Pugh score, initial tumor volume, number of tumors and tumor margin definition on imaging were correlated with the local tumor response after TACE. The initial and end therapy local tumor responses were evaluated according to the response evaluation criteria in solid tumors (RECIST) and magnetic resonance imaging volumetric measurements. RESULTS: The treatment protocols were well tolerated by all patients with no major complications. Local tumor response for all patients according to RECIST criteria were partial response in one patient (2.6%), stable disease in 34 patients (87.1%), and progressive disease in 4 patients (10.2%). The MR volumetric measurements showed that the PVT, APS, underlying liver pathology and tumor margin definition were statistically significant prognostic factors for the local tumor response (P = 0.018, P = 0.008, P = 0.034 and P = 0.001, respectively). The overall 6-, 12- and 18-mo survival rates from the initial TACE were 79.5%, 37.5% and 21%, respectively. CONCLUSION: TACE may be exploited safely for palliative tumor control in patients with advanced unresectable HCC; however, tumor response is significantly affected by the presence or absence of PVT and APS.展开更多
Aim： To assess seminal plasma anti-Müllerian hormone （AMH） level relationships in fertile and infertile males. Methods： Eighty-four male cases were studied and divided into four groups： fertile normozoosperm...Aim： To assess seminal plasma anti-Müllerian hormone （AMH） level relationships in fertile and infertile males. Methods： Eighty-four male cases were studied and divided into four groups： fertile normozoospermia （n = 16）, oligoastheno- teratozoospermia （n = 15）, obstructive azoospermia （OA） （n = 13） and non-obstructive azoospermia （NOA） （n = 40）. Conventional semen analysis was done for all cases. Testicular biopsy was done with histopathology and fresh tissue examination for testicular sperm extraction （TESE） in NOA cases. NOA group was subdivided according to TESE results into unsuccessful TESE （n = 19） and successful TESE （n = 21）. Seminal plasma AMH was estimated by enzyme linked immunosorbent assay （ELISA） and serum follicular stimulating hormone （FSH） was estimated in NOA cases only by radioimmunoassay （RIA）. Results： Mean seminal AMH was significantly higher in fertile group than in oligoasthenoteratozoospermia with significance （41.5±10.9 pmol/L vs. 30.5±10.3 pmol/L, P 〈 0.05）. Seminal AMH was not detected in any OA patients. Seminal AMH wascorrelated positively with testicular volume （r = 0.329, P = 0.005）, sperm count （r = 0.483, P = 0.007）, sperm motility percent （r = 0.419, P = 0.021） and negatively with sperm abnormal forms percent （r = -0.413, p = 0.023）. Nonsignificant correlation was evident with age （r = -0.155, P = 0.414） and plasma FSH （ r = -0.014, P = 0.943）. In NOA cases, seminal AMH was detectable in 23/40 cases, 14 of them were successful TESE （57.5%） and was undetectable in 17/40 cases, 10 of them were unsuccessful TESE （58.2%）. Conclusion： Seminal plasma AMH is an absolute testicular marker being absent in all OA cases. However, seminal AMH has a poor predictability for successful testicular sperm retrieval in NOA cases.展开更多
AIM:To assess the utility of an autologous CD34 + and CD133 + stem cells infusion as a possible therapeutic modality in patients with end-stage liver diseases.METHODS:One hundred and forty patients with endstage liver...AIM:To assess the utility of an autologous CD34 + and CD133 + stem cells infusion as a possible therapeutic modality in patients with end-stage liver diseases.METHODS:One hundred and forty patients with endstage liver diseases were randomized into two groups.Group 1,comprising 90 patients,received granulocyte colony stimulating factor for five days followed by autologous CD34 + and CD133 + stem cell infusion in the portal vein.Group 2,comprising 50 patients,received regular liver treatment only and served as a control group.RESULTS:Near normalization of liver enzymes and improvement in synthetic function were observed in 54.5% of the group 1 patients;13.6% of the patients showed stable states in the infused group.None of the patients in the control group showed improvement.No adverse effects were noted.CONCLUSION:Our data showed that a CD34 + and CD133 + stem cells infusion can be used as supportive treatment for end-stage liver disease with satisfactory tolerability.展开更多
AIM: To explore the potential usefulness of serum miR-122 and miR-221 as non-invasive diagnostic markers of hepatitis C virus(HCV)-related hepatocellular carcinoma(HCC).METHODS: This prospective study was conducted on...AIM: To explore the potential usefulness of serum miR-122 and miR-221 as non-invasive diagnostic markers of hepatitis C virus(HCV)-related hepatocellular carcinoma(HCC).METHODS: This prospective study was conducted on 90 adult patients of both sex with HCV-related chronic liver disease and chronic hepatitis C related HCC. In addition to the 10 healthy control individuals, patients were stratified into; interferon-na?ve chronic hepatitis C(CH)(n = 30), post-hepatitis C compensated cirrhosis(LC)(n = 30) and treatment-naive HCC(n = 30). All patients and controls underwent full clinical assessment and laboratory investigations in addition to the evaluation of the level of serum miR NA expression by RT-PCR.RESULTS: There was a significant fold change in serum mi RNA expression in the different patient groups when compared to normal controls; mi R-122 showed significant fold increasing in both CH and HCC and significant fold decrease in LC. On the other hand, mi R-221 showed significant fold elevation in both CH and LC groups and significant fold decrease in HCC group(P = 0.01). Comparing fold changes in miR NAs in HCC group vs non HCC group(CH and Cirrhosis), there was non-significant fold elevation in miR-122(P = 0.21) and significant fold decreasing in miR-221 in HCC vs non-HCC(P = 0.03). ROC curve analysis for miR-221 yielded 87% sensitivity and 40% specificity for the differentiation of HCC patients from non-HCC at a cutoff 1.82. CONCLUSION: Serum miR-221 has a strong potential to serve as one of the novel non-invasive biomarkers of HCC.展开更多
AIM: To assess vitamin D in hepatitis C patients and its relationship to interleukin (IL)-23, IL-17, and macrophage chemoattractant protein-1 (MCP-1). METHODS: The study was conducted on 50 Egyptian hepatitis C virus ...AIM: To assess vitamin D in hepatitis C patients and its relationship to interleukin (IL)-23, IL-17, and macrophage chemoattractant protein-1 (MCP-1). METHODS: The study was conducted on 50 Egyptian hepatitis C virus (HCV) genotype number IV-infected patients and 25 age- and gender-matched healthy subjects. Venous blood samples were obtained. Samples were allowed to clot and sera were separated by centrifugation and stored at -20?°C. A 25 hydroxy vitamin D assay was carried out using solid phase RIA. A 1,25 dihydroxy vitamin D assay was carried out using a commercial kit purchased from Incstar Corporation. IL-17 and -23 and MCP-1 were assayed by an enzyme immunoassay. Quantitative and qualitative polymerase chain reaction for HCV virus were done by TaqMan technology. Only HCV genotype IV-infected subjects were included in the study. The mean ± SD were determined, a t-test for comparison of means of different parameters was used. Correlation analysis was done using Pearson’s correlation. Differences among different groups were determined using the Kruskal-Wallis test. RESULTS: The mean vitamin D level in HCV patients (group?I) was 15 ± 5.2 ng/mL while in control (group II) was 39.7 ± 10.8. For active vitamin D in group?I?as 16.6 ± 4.8 ng/mL while in group II was 41.9 ± 7.9. IL-23 was 154 ± 97.8 in group?I?and 6.7 ± 2.17 in group II. IL-17 was 70.7 ± 72.5 in cases and 1.2 ± 0.4 in control. MCP-1 was 1582 ± 794.4 in group?I?and 216.1 ± 5.38 in group II. Vitamin D deficiency affected 72% of HCV-infected patients and 0% of the control group. Vitamin D insufficiency existed in 28% of HCV-infected patients and 12% of the control group. One hundred percent of the cirrhotic patients and 40% of non cirrhotic HCV-infected patients had vitamin D deficiency. IL-23, IL-17, and MCP-1 were markedly increased in HCV-infected patients in comparison to controls.A significant negative correlation between vitamin D and IL-17 and -23 and MCP-1 was detected. HCV-infected males and females showed no differences with respec展开更多
Welding is a vital component of several industries such as automotive,aerospace,robotics,and construction.Without welding,these industries utilize aluminum alloys for the manufacturing of many components or systems.Ho...Welding is a vital component of several industries such as automotive,aerospace,robotics,and construction.Without welding,these industries utilize aluminum alloys for the manufacturing of many components or systems.However,fusion welding of aluminum alloys is challenging due to several factors,including the presence of non-heat-treatable alloys,porosity,solidification,and liquation of cracks.Many manufacturers adopt conventional in-air friction stir welding(FSW)to weld metallic alloys and dissimilar materials.Many researchers reported the drawbacks of this traditional in-air FSW technique in welding metallic and polymeric materials in general and aluminum alloys and aluminum matrix composites in specific.A number of FSW techniques were developed recently,such as underwater friction stir welding(UFSW),vibrational friction-stir welding(VFSW),and others,for welding of aluminum alloy joints to overcome the issues of welding using conventional FSW.Therefore,the main objective of this review is to summarize the recent trends in FSW process of aluminum alloys and aluminum metal matrix composites(Al MMCs).Also,it discusses the effect of welding parameters of the traditional and state-of-the-art developed FSW techniques on the welding quality and strength of aluminum alloys and Al MMCs.Comparison among the techniques and advantages and limitations of each are considered.The review suggests that VFSW is a viable option for welding aluminum joints due to its energy efficiency,economic cost,and versatile modifications that can be employed based on the application.This review also illustrated that significantly less attention has been paid to FSW of Al-MMCs and considerable attention is demanded to produce qualified joint.展开更多
AIM: To assess vitamin D (Vit D) abnormalities in hepatitis C infected patients and their relationship with interleukin (IL)-17, IL-23 and N-terminal propeptide of type Ⅲ pro-collagen (PⅢNP) as immune response media...AIM: To assess vitamin D (Vit D) abnormalities in hepatitis C infected patients and their relationship with interleukin (IL)-17, IL-23 and N-terminal propeptide of type Ⅲ pro-collagen (PⅢNP) as immune response mediators. METHODS: The study was conducted on 50 Egyptian patients (36 male, 14 female) with hepatitis C virus (HCV) infection, who visited the Hepatology Outpatient Clinic in the Endemic Disease Hospital at Cairo University. Patients were compared with 25 ageand sexmatched healthy individuals. Inclusion criteria were based on a history of liver disease with HCV genotype 4 (HCV-4) infection (as new patients or under followup). Based on ultrasonography, patients were classified into four subgroups; 14 with bright hepatomegaly; 11 with perihepatic fibrosis; 11 with hepatic cirrhosis; and 14 with cirrhosis and hepatocellular carcinoma (HCC).Total Vit D (i.e., 25-OH-Vit D) and active Vit D [i.e., 1,25-(OH) 2 -Vit D] assays were carried out using commercial kits. IL-17, IL-23 and PⅢNP levels were assayed using enzyme linked immunosorbent assay kits, while HCV virus was measured by quantitative and qualitative polymerase chain reaction. RESULTS: Levels of Vit D and its active form were significantly lower in advanced liver disease (hepatic cirrhosis and/or carcinoma) patients, compared to those with bright hepatomegaly and perihepatic fibrosis. IL-17, IL-23 and PⅢNP levels were markedly increased in HCV patients and correlated with the progression of hepatic damage. The decrease in Vit D and active Vit D was concomitant with an increase in viral load, as well as levels of IL-17, IL-23 and PⅢNP among all subgroups of HCV-infected patients, compared to normal healthy controls. A significant negative correlation was evident between active Vit D and each of IL-17, IL-23 and PⅢNP (r = -0.679, -0.801 and -0.920 at P < 0.001, respectively). HCV-infected men and women showed no differences with respect to Vit D levels. The viral load was negatively correlated with Vit D and active Vit D (r = -0.084 and -0.84展开更多
Mg-Ca alloys have recently attracted great attention towards the research in the field of orthopedic biodegradable implants.This study presents an in vitro degradation assessment of Mg-0.8Ca(0.8 wt.%of Ca)alloy in Han...Mg-Ca alloys have recently attracted great attention towards the research in the field of orthopedic biodegradable implants.This study presents an in vitro degradation assessment of Mg-0.8Ca(0.8 wt.%of Ca)alloy in Hank’s balanced salt solution(HBSS).Immersion,hydrogen evolution and electrochemical behavior was studied as well as the cytotoxicity of the degradation products.Morphology and phase composition of the corrosion products were studied using SEM,EDX and XRD techniques.Degradation in HBSS resulted in the formation of the needle-shaped carbonated hydroxyapatite which was similar to the biological apatite in the human bone.Degradation kinetics showed that Mg-0.8Ca alloy had approximately 3-fold faster degradation rate than the pure Mg(1.08±0.38 mm/year for Mg-0.8Ca and 0.35±0.17 mm/year for pure Mg),as observed in two independent experiments.Both,pure Mg and Mg-0.8Ca alloy were biocompatible,generating no cytotoxic degradation products against human-derived HEK 293 cells.Thus,the Mg-0.8Ca alloy was found to be a promising biodegradable implant in terms of bioactivity and compatibility with human cell lines.Depending on the application of the implant and the estimated healing time of the bone,the desired degradation rate of an implant can be controlled by the Mg-Ca composition of such alloys.展开更多
Climate change and human activities can influence vegetation net primary productivity(NPP), a key component of natural ecosystems. The Qinghai-Tibet Plateau of China, in spite of its significant natural and cultural v...Climate change and human activities can influence vegetation net primary productivity(NPP), a key component of natural ecosystems. The Qinghai-Tibet Plateau of China, in spite of its significant natural and cultural values, is one of the most susceptible regions to climate change and human disturbances in the world. To assess the impact of climate change and human activities on vegetation dynamics in the grassland ecosystems of the northeastern Qinghai-Tibet Plateau, we applied a time-series trend analysis to normalized difference vegetation index(NDVI) datasets from 2000 to 2015 and compared these spatiotemporal variations with trends in climatic variables over the same time period. The constrained ordination approach(redundancy analysis) was used to determine which climatic variables or human-related factors mostly influenced the variation of NDVI. Furthermore, in order to determine whether current conservation measures and programs are effective in ecological protection and reconstruction, we divided the northeastern Qinghai-Tibet Plateau into two parts: the Three-River Headwater conservation area(TRH zone) in the south and the non-conservation area(NTRH zone) in the north. The results indicated an overall(73.32%) increasing trend of vegetation NPP in grasslands throughout the study area. During the period 2000–2015, NDVI in the TRH and NTRH zones increased at the rates of 0.0015/a and 0.0020/a, respectively. Specifically, precipitation accounted for 9.2% of the total variation in NDVI, while temperature accounted for 13.4%. In addition, variation in vegetation NPP of grasslands responded not only to long-and short-term changes in climate, as conceptualized in non-equilibrium theory, but also to the impact of human activities and their associated perturbations. The redundancy analysis successfully separated the relative contributions of climate change and human activities, of which village population and agricultural gross domestic product were the two most important contributors to the NDVI changes, explain展开更多
Chronic kidney disease （CKD） patients are endangered with the highest mortality rate compared to other chronic diseases. Cardiovascular events account for up to 60% of the fatalities. Cardiovascular calcifcations af...Chronic kidney disease （CKD） patients are endangered with the highest mortality rate compared to other chronic diseases. Cardiovascular events account for up to 60% of the fatalities. Cardiovascular calcifcations affect most of the CKD patients. Most of this calcification is related to disturbed renal phosphate handling. Fibroblast growth factor 23 and klotho defciency were incriminated in the pathogenesis of vascular calcification through different mechanisms including their effects on endothelium and arterial wall smooth muscle cells. In addition, deficient klotho gene expression, a constant feature of CKD, pro-motes vascular pathology and shares in progression of the CKD. The role of gut in the etio-pathogenesis of systemic infammation and vascular calcifcation is a newly discovered mechanism. This review will cover the medical history, prevalence, pathogenesis, clinical relevance, different tools used to diagnose, the ideal timing to prevent or to withhold the progression of vascular cal-cification and the different medications and medical procedures that can help to prolong the survival of CKD patients.展开更多
Some patients with ascites due to liver cirrhosis become no longer responsive to diuretics. Once other causes of ascites such as portal vein thrombosis, malignancy or infection and non-compliance with medications and ...Some patients with ascites due to liver cirrhosis become no longer responsive to diuretics. Once other causes of ascites such as portal vein thrombosis, malignancy or infection and non-compliance with medications and low sodium diet have been excluded, the diagnosis of refractory ascites can be made based on strict criteria. Patients with refractory ascites have very poor prognosis and therefore referral for consideration for liver transplantation should be initiated. Search for reversible components of the underlying liver pathology should be undertaken and targeted therapy, when available, should be considered. Currently, serial large volume paracentesis （LVP） and transjugular intrahepatic portasystemic stent-shunt （TIPS） are the two mainstay treatment options for refractory ascites. Other treatment options are available but not widely used either because they carry high morlJidity and mortality （most surgical options） rates, or are new interventions that have shown promise but still need further evaluation. In this comprehensive review, we describe the evaluation and management of patients with refractory ascites from the prospective of the practicing physician.展开更多
A micropolar model for axisymmetric blood flow through an axially nonsymmetreic but radially symmetric mild stenosis tapered artery is presented. To estimate the effect of the stenosis shape, a suitable geometry has b...A micropolar model for axisymmetric blood flow through an axially nonsymmetreic but radially symmetric mild stenosis tapered artery is presented. To estimate the effect of the stenosis shape, a suitable geometry has been considered such that the axial shape of the stenosis can be changed easily just by varying a parameter （referred to as the shape parameter）. The model is also used to study the effect of the taper angle Ф. Flow parameters such as the velocity, the resistance to flow （the resistance impedance）, the wall shear stress distribution in the stenotic region and its magnitude at the maximum height of the stenosis （stenosis throat） have been computed for different values of the shape parameter n, the taper angle Ф, the coupling number N and the micropolar parameter m. It is shown that the resistance to flow decreases with increasing the shape parameter n and the micropolar parameter m while it increases with increasing the coupling number N. So, the magnitude of the resistance impedance is higher for a micropolar fluid than that for a Newtonian fluid model. Finally, the velocity profile, the wall shear stress distribution in the stenotic region and its magnitude at the maximum height of the stenosis are discussed for different values of the parameters involved on the problem.展开更多
AIM To evaluate the accuracy of the elastography score combined to the strain ratio in the diagnosis of solid pancreatic lesions(SPL). METHODS A total of 172 patients with SPL identified by endoscopic ultrasound were ...AIM To evaluate the accuracy of the elastography score combined to the strain ratio in the diagnosis of solid pancreatic lesions(SPL). METHODS A total of 172 patients with SPL identified by endoscopic ultrasound were enrolled in the study to evaluate the efficacy of elastography and strain ratio in differentiating malignant from benign lesions. The semi quantitative score of elastography was represented by the strain ratio method. Two areas were selected, area(A) representing the region of interest and area(B) representing the normal area. Area(B) was then divided by area(A). Sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV), and accuracy were calculated by comparing diagnoses made by elastography, strain ratio and final diagnoses.RESULTS SPL were shown to be benign in 49 patients and malignant in 123 patients. Elastography alone had a sensitivity of 99%, a specificity of 63%, and an accuracy of 88%, a PPV of 87% and an NPV of 96%. The best cut-off level of strain ratio to obtain the maximal area under the curve was 7.8 with a sensitivity of 92%, specificity of 77%, PPV of 91%, NPV of 80% and an accuracy of 88%. Another estimated cut off strain ratio level of 3.8 had a higher sensitivity of 99% and NPV of 96%, but with less specificity, PPV and accuracy 53%, 84% and 86%, respectively. Adding both elastography to strain ratio resulted in a sensitivity of 98%, specificity of 77%, PPV of 91%, NPV of 95% and accuracy of 92% for the diagnosis of SPL. CONCLUSION Combining elastography to strain ratio increases the accuracy of the differentiation of benign from malignant SPL.展开更多
文摘Non-alcoholic fatty liver disease(NAFLD) is now the most frequent chronic liver disease that occurs across all age groups and is recognized to occur in 14%-30% of the general population, representing a serious and growing clinical problem due to the growing prevalence of obesity and overweight. Histologically, it resembles alcoholic liver injury but occurs in patients who deny significant alcohol consumption. NAFLD encompasses a spectrum of conditions, ranging from benign hepatocellular steatosisto inflammatory nonalcoholic steatohepatitis, fibrosis, and cirrhosis. The majority of hepatocellular lipids are stored as triglycerides, but other lipid metabolites, such as free fatty acids, cholesterol, and phospholipids, may also be present and play a role in disease progression. NAFLD is associated with obesity and insulin resistance and is considered the hepatic manifestation of the metabolic syndrome, a combination of medical conditions including type 2 diabetes mellitus, hypertension, hyperlipidemia, and visceral adiposity. Confirmation of the diagnosis of NAFLD can usually be achieved by imaging studies; however, staging the disease requires a liver biopsy. Current treatment relies on weight loss and exercise, although various insulin-sensitizing agents, antioxidants and medications appear promising. The aim of this review is to highlight the current information regarding epidemiology, diagnosis, and management of NAFLD as well as new information about pathogenesis, diagnosis and management of this disease.
文摘In recent years,natural orifice specimen extraction surgery(NOSES)in the treatment of colorectal cancer has attracted widespread attention.The potential benefits of NOSES including reduction in postoperative pain and wound complications,less use of postoperative analgesic,faster recovery of bowel function,shorter length of hospital stay,better cosmetic and psychological effect have been described in colorectal surgery.Despite significant decrease in surgical trauma of NOSES have been observed,the potential pitfalls of this technique have been demonstrated.Particularly,several issues including bacteriological concerns,oncological outcomes and patient selection are raised with this new technique.Therefore,it is urgent and necessary to reach a consensus as an industry guideline to standardize the implementation of NOSES in colorectal surgery.After three rounds of discussion by all members of the International Alliance of NOSES,the consensus is finally completed,which is also of great significance to the long-term progress of NOSES worldwide.
基金support of Dr. Azza M. Kamal, Biochemistry Dept, Animal Health Research Institute, Dokki 12618, Giza, Egypt
文摘Our trial was conducted to study the effects of formic acid(FA) and potassium di-formate(KDF) in broiler ration on performance, carcass traits, blood biochemical, intestinal microbial load, histological picture of intestine and immune parameters of broilers. In this study 360 one-day-old broiler chicks were divided to 3 groups with 3 replicates of 40 chicks each. The trial continued for 35 days. The control group was fed only basal diet(G1). Group 2(G2) were fed basal diet supplemented with FA(5 g/kg diet), and group 3(G3) received basal diet supplemented with KDF(5 g/kg diet). The results showed that both FA and KDF significantly increased body weight gain(BWG), dressing percentage of broilers and significantly decreased feed conversion ratio(FCR)(P < 0.05). The highest percent of breast and thigh was observed in G3. The improvement in villus height was observed in G2 and G3 compared with the control one, and the highest was in G3. The results evidence that the using of FA or KDF in broiler feeds have significant effects on performance, immune parameters, and gut health without having any significant effects on blood biochemical. However, KDF is more effective than FA as little amount of FA reaches the small intestine due to metabolism and absorption, whereas KDF permits a proportion of FA to pass through the fore-gut intact and enter the small intestinal tract. In addition, FA has a strong odor and corrosiveness to gastrointestinal tract which limits its use.
文摘In k-means clustering, we are given a set of n data points in d-dimensional space R^d and an integer k and the problem is to determine a set of k points in R^d, called centers, so as to minimize the mean squared distance from each data point to its nearest center. In this paper, we present a simple and efficient clustering algorithm based on the k-means algorithm, which we call enhanced k-means algorithm. This algorithm is easy to implement, requiring a simple data structure to keep some information in each iteration to be used in the next iteration. Our experimental results demonstrated that our scheme can improve the computational speed of the k-means algorithm by the magnitude in the total number of distance calculations and the overall time of computation.
文摘In this short survey, we give a complete list of the most important results obtained by El Naschie’s E-infinity Cantorian space-time theory in the realm of quantum physics and cosmology. Special attention is paid to his recent result on dark energy and revising Einstein’s famous formula .
文摘Background Acute bilirubin encephalopathy (ABE) still represents a significant cause of morbidity and mortality throughout the world,especially in developing countries.We aimed to determine the prevalence of ABE based on the Johnson bilirubininduced neurologic dysfunction (BIND) score and to describe the discharge outcomes.Methods We prospectively studied all newborns ≥ 35 weeks with ABE by evaluating signs of mental sensorium,muscle tone,and cry patterns over 1 year.Results 12% (81 out of 674) of the newborns admitted for neonatal hyperbilirubinemia had a BIND score > 1.Their admission age was 6 ± 4.1 days;total serum bilirubin (TSB) was 31.2± 10 mg/dL (range 17.5-75.2).Of these newborns,40.7% and 21% had evidence of haemolysis and sepsis,respectively.Overall mortality was 9.9%;58% of the newborns showed signs of mild-to-moderate BIND at discharge,while 32.1% survived with an apparently normal outcome.Admission BIND score was significantly correlated with admission TSB (r=0.476,P < 0.001).Similarly,BIND score at discharge was correlated with admission TSB (r=0.442,P < 0.001) and admission BIND score (r =0.888,P < 0.001).The regression model showed that admission TSB (P < 0.001) and maternal illiteracy (P =0.034) were predictors of the BIND score at admission,while admission BIND score was the best indicator of the discharge score (P < 0.001).Conclusions ABE is still a major problem in our community.Admission TSB and maternal illiteracy are good predictors of bilirubin encephalopathy at admission and discharge.
文摘Hepatocellular carcinoma(HCC)is one of the common lethal types of tumor all over the world.The lethality of HCC accounts for many reasons.One of them,the lack of reliable diagnostic markers at the early stage,in this context,serum miRNAs became promising diagnostic biomarkers.Herein,we aimed to identify the predictive value of two miRNAs(miR-122 and miR-224)in plasma of patients with HCC preceded by chronic HCV infection.Taqman miRNA assays specific for hsa-miR-122 and hsa-miR-224 were used to assess the expression levels of the chosen miRNAs in plasma samples collected from three groups;40 patients with HCC related to HCV,40 with CHC patients and 20 healthy volunteers.This study revealed that the mean plasma values of miRNA-122 were significantly lower among HCC group when compared to CHC and control groups(P<0.001).Whereas,miR-224 mean plasma values were significantly higher among HCC group when compared to both CHC group and control group.Moreover,it was found that miR-122 can predict development of HCC at cut-off value<0.67(RQ)and(AUC Z 0.98,P<0.001).As regards miR-224,it can predict development of HCC at cut-off value>1.2(RQ)and(AUC Z 0.93,P<0.001),while the accuracy of AFP to diagnose HCC was(AUC:0.619;P Z 0.06).In conclusion,the expression plasma of miR-122 and miR-224 could be used as noninvasive biomarkers for the early prediction of developing HCC at the early stage.
文摘AIM: To evaluate the effect of portal vein thrombosis and arterioportal shunts on local tumor response in advanced cases of unresectable hepatocellular carcinoma treated by transarterial chemoembolization. METHODS: A retrospective study included 39 patients (mean age: 66.4 years, range: 45-79 years, SD: 7) with unresectable hepatocellular carcinoma (HCC) who were treated with repetitive transarterial chemoembolization (TACE) in the period between March 2006 and October 2009. The effect of portal vein thrombosis (PVT) (in 19 out of 39 patients), the presence of arterioportal shunt (APS) (in 7 out of 39), the underlying liver pathology,Child-Pugh score, initial tumor volume, number of tumors and tumor margin definition on imaging were correlated with the local tumor response after TACE. The initial and end therapy local tumor responses were evaluated according to the response evaluation criteria in solid tumors (RECIST) and magnetic resonance imaging volumetric measurements. RESULTS: The treatment protocols were well tolerated by all patients with no major complications. Local tumor response for all patients according to RECIST criteria were partial response in one patient (2.6%), stable disease in 34 patients (87.1%), and progressive disease in 4 patients (10.2%). The MR volumetric measurements showed that the PVT, APS, underlying liver pathology and tumor margin definition were statistically significant prognostic factors for the local tumor response (P = 0.018, P = 0.008, P = 0.034 and P = 0.001, respectively). The overall 6-, 12- and 18-mo survival rates from the initial TACE were 79.5%, 37.5% and 21%, respectively. CONCLUSION: TACE may be exploited safely for palliative tumor control in patients with advanced unresectable HCC; however, tumor response is significantly affected by the presence or absence of PVT and APS.
文摘Aim： To assess seminal plasma anti-Müllerian hormone （AMH） level relationships in fertile and infertile males. Methods： Eighty-four male cases were studied and divided into four groups： fertile normozoospermia （n = 16）, oligoastheno- teratozoospermia （n = 15）, obstructive azoospermia （OA） （n = 13） and non-obstructive azoospermia （NOA） （n = 40）. Conventional semen analysis was done for all cases. Testicular biopsy was done with histopathology and fresh tissue examination for testicular sperm extraction （TESE） in NOA cases. NOA group was subdivided according to TESE results into unsuccessful TESE （n = 19） and successful TESE （n = 21）. Seminal plasma AMH was estimated by enzyme linked immunosorbent assay （ELISA） and serum follicular stimulating hormone （FSH） was estimated in NOA cases only by radioimmunoassay （RIA）. Results： Mean seminal AMH was significantly higher in fertile group than in oligoasthenoteratozoospermia with significance （41.5±10.9 pmol/L vs. 30.5±10.3 pmol/L, P 〈 0.05）. Seminal AMH was not detected in any OA patients. Seminal AMH wascorrelated positively with testicular volume （r = 0.329, P = 0.005）, sperm count （r = 0.483, P = 0.007）, sperm motility percent （r = 0.419, P = 0.021） and negatively with sperm abnormal forms percent （r = -0.413, p = 0.023）. Nonsignificant correlation was evident with age （r = -0.155, P = 0.414） and plasma FSH （ r = -0.014, P = 0.943）. In NOA cases, seminal AMH was detectable in 23/40 cases, 14 of them were successful TESE （57.5%） and was undetectable in 17/40 cases, 10 of them were unsuccessful TESE （58.2%）. Conclusion： Seminal plasma AMH is an absolute testicular marker being absent in all OA cases. However, seminal AMH has a poor predictability for successful testicular sperm retrieval in NOA cases.
文摘AIM:To assess the utility of an autologous CD34 + and CD133 + stem cells infusion as a possible therapeutic modality in patients with end-stage liver diseases.METHODS:One hundred and forty patients with endstage liver diseases were randomized into two groups.Group 1,comprising 90 patients,received granulocyte colony stimulating factor for five days followed by autologous CD34 + and CD133 + stem cell infusion in the portal vein.Group 2,comprising 50 patients,received regular liver treatment only and served as a control group.RESULTS:Near normalization of liver enzymes and improvement in synthetic function were observed in 54.5% of the group 1 patients;13.6% of the patients showed stable states in the infused group.None of the patients in the control group showed improvement.No adverse effects were noted.CONCLUSION:Our data showed that a CD34 + and CD133 + stem cells infusion can be used as supportive treatment for end-stage liver disease with satisfactory tolerability.
文摘AIM: To explore the potential usefulness of serum miR-122 and miR-221 as non-invasive diagnostic markers of hepatitis C virus(HCV)-related hepatocellular carcinoma(HCC).METHODS: This prospective study was conducted on 90 adult patients of both sex with HCV-related chronic liver disease and chronic hepatitis C related HCC. In addition to the 10 healthy control individuals, patients were stratified into; interferon-na?ve chronic hepatitis C(CH)(n = 30), post-hepatitis C compensated cirrhosis(LC)(n = 30) and treatment-naive HCC(n = 30). All patients and controls underwent full clinical assessment and laboratory investigations in addition to the evaluation of the level of serum miR NA expression by RT-PCR.RESULTS: There was a significant fold change in serum mi RNA expression in the different patient groups when compared to normal controls; mi R-122 showed significant fold increasing in both CH and HCC and significant fold decrease in LC. On the other hand, mi R-221 showed significant fold elevation in both CH and LC groups and significant fold decrease in HCC group(P = 0.01). Comparing fold changes in miR NAs in HCC group vs non HCC group(CH and Cirrhosis), there was non-significant fold elevation in miR-122(P = 0.21) and significant fold decreasing in miR-221 in HCC vs non-HCC(P = 0.03). ROC curve analysis for miR-221 yielded 87% sensitivity and 40% specificity for the differentiation of HCC patients from non-HCC at a cutoff 1.82. CONCLUSION: Serum miR-221 has a strong potential to serve as one of the novel non-invasive biomarkers of HCC.
文摘AIM: To assess vitamin D in hepatitis C patients and its relationship to interleukin (IL)-23, IL-17, and macrophage chemoattractant protein-1 (MCP-1). METHODS: The study was conducted on 50 Egyptian hepatitis C virus (HCV) genotype number IV-infected patients and 25 age- and gender-matched healthy subjects. Venous blood samples were obtained. Samples were allowed to clot and sera were separated by centrifugation and stored at -20?°C. A 25 hydroxy vitamin D assay was carried out using solid phase RIA. A 1,25 dihydroxy vitamin D assay was carried out using a commercial kit purchased from Incstar Corporation. IL-17 and -23 and MCP-1 were assayed by an enzyme immunoassay. Quantitative and qualitative polymerase chain reaction for HCV virus were done by TaqMan technology. Only HCV genotype IV-infected subjects were included in the study. The mean ± SD were determined, a t-test for comparison of means of different parameters was used. Correlation analysis was done using Pearson’s correlation. Differences among different groups were determined using the Kruskal-Wallis test. RESULTS: The mean vitamin D level in HCV patients (group?I) was 15 ± 5.2 ng/mL while in control (group II) was 39.7 ± 10.8. For active vitamin D in group?I?as 16.6 ± 4.8 ng/mL while in group II was 41.9 ± 7.9. IL-23 was 154 ± 97.8 in group?I?and 6.7 ± 2.17 in group II. IL-17 was 70.7 ± 72.5 in cases and 1.2 ± 0.4 in control. MCP-1 was 1582 ± 794.4 in group?I?and 216.1 ± 5.38 in group II. Vitamin D deficiency affected 72% of HCV-infected patients and 0% of the control group. Vitamin D insufficiency existed in 28% of HCV-infected patients and 12% of the control group. One hundred percent of the cirrhotic patients and 40% of non cirrhotic HCV-infected patients had vitamin D deficiency. IL-23, IL-17, and MCP-1 were markedly increased in HCV-infected patients in comparison to controls.A significant negative correlation between vitamin D and IL-17 and -23 and MCP-1 was detected. HCV-infected males and females showed no differences with respec
基金United Arab Emirates University (UAEU), Al-Ain, UAE, and Sultan Qaboos University (SQU), Muscat, Sultanate of Oman, for providing research support through a collaborative research project (UAEU: 31N270)。
文摘Welding is a vital component of several industries such as automotive,aerospace,robotics,and construction.Without welding,these industries utilize aluminum alloys for the manufacturing of many components or systems.However,fusion welding of aluminum alloys is challenging due to several factors,including the presence of non-heat-treatable alloys,porosity,solidification,and liquation of cracks.Many manufacturers adopt conventional in-air friction stir welding(FSW)to weld metallic alloys and dissimilar materials.Many researchers reported the drawbacks of this traditional in-air FSW technique in welding metallic and polymeric materials in general and aluminum alloys and aluminum matrix composites in specific.A number of FSW techniques were developed recently,such as underwater friction stir welding(UFSW),vibrational friction-stir welding(VFSW),and others,for welding of aluminum alloy joints to overcome the issues of welding using conventional FSW.Therefore,the main objective of this review is to summarize the recent trends in FSW process of aluminum alloys and aluminum metal matrix composites(Al MMCs).Also,it discusses the effect of welding parameters of the traditional and state-of-the-art developed FSW techniques on the welding quality and strength of aluminum alloys and Al MMCs.Comparison among the techniques and advantages and limitations of each are considered.The review suggests that VFSW is a viable option for welding aluminum joints due to its energy efficiency,economic cost,and versatile modifications that can be employed based on the application.This review also illustrated that significantly less attention has been paid to FSW of Al-MMCs and considerable attention is demanded to produce qualified joint.
文摘AIM: To assess vitamin D (Vit D) abnormalities in hepatitis C infected patients and their relationship with interleukin (IL)-17, IL-23 and N-terminal propeptide of type Ⅲ pro-collagen (PⅢNP) as immune response mediators. METHODS: The study was conducted on 50 Egyptian patients (36 male, 14 female) with hepatitis C virus (HCV) infection, who visited the Hepatology Outpatient Clinic in the Endemic Disease Hospital at Cairo University. Patients were compared with 25 ageand sexmatched healthy individuals. Inclusion criteria were based on a history of liver disease with HCV genotype 4 (HCV-4) infection (as new patients or under followup). Based on ultrasonography, patients were classified into four subgroups; 14 with bright hepatomegaly; 11 with perihepatic fibrosis; 11 with hepatic cirrhosis; and 14 with cirrhosis and hepatocellular carcinoma (HCC).Total Vit D (i.e., 25-OH-Vit D) and active Vit D [i.e., 1,25-(OH) 2 -Vit D] assays were carried out using commercial kits. IL-17, IL-23 and PⅢNP levels were assayed using enzyme linked immunosorbent assay kits, while HCV virus was measured by quantitative and qualitative polymerase chain reaction. RESULTS: Levels of Vit D and its active form were significantly lower in advanced liver disease (hepatic cirrhosis and/or carcinoma) patients, compared to those with bright hepatomegaly and perihepatic fibrosis. IL-17, IL-23 and PⅢNP levels were markedly increased in HCV patients and correlated with the progression of hepatic damage. The decrease in Vit D and active Vit D was concomitant with an increase in viral load, as well as levels of IL-17, IL-23 and PⅢNP among all subgroups of HCV-infected patients, compared to normal healthy controls. A significant negative correlation was evident between active Vit D and each of IL-17, IL-23 and PⅢNP (r = -0.679, -0.801 and -0.920 at P < 0.001, respectively). HCV-infected men and women showed no differences with respect to Vit D levels. The viral load was negatively correlated with Vit D and active Vit D (r = -0.084 and -0.84
基金The authors would like to thank the Helmholtz-Zentrum Geesthacht and Fesil Company(Germany)for the alloys syn-thesis and casting.
文摘Mg-Ca alloys have recently attracted great attention towards the research in the field of orthopedic biodegradable implants.This study presents an in vitro degradation assessment of Mg-0.8Ca(0.8 wt.%of Ca)alloy in Hank’s balanced salt solution(HBSS).Immersion,hydrogen evolution and electrochemical behavior was studied as well as the cytotoxicity of the degradation products.Morphology and phase composition of the corrosion products were studied using SEM,EDX and XRD techniques.Degradation in HBSS resulted in the formation of the needle-shaped carbonated hydroxyapatite which was similar to the biological apatite in the human bone.Degradation kinetics showed that Mg-0.8Ca alloy had approximately 3-fold faster degradation rate than the pure Mg(1.08±0.38 mm/year for Mg-0.8Ca and 0.35±0.17 mm/year for pure Mg),as observed in two independent experiments.Both,pure Mg and Mg-0.8Ca alloy were biocompatible,generating no cytotoxic degradation products against human-derived HEK 293 cells.Thus,the Mg-0.8Ca alloy was found to be a promising biodegradable implant in terms of bioactivity and compatibility with human cell lines.Depending on the application of the implant and the estimated healing time of the bone,the desired degradation rate of an implant can be controlled by the Mg-Ca composition of such alloys.
基金funded by the National Key Research and Development Program of China (2016YFC0502101)the National Natural Science Foundation of China (31700544)the Chinese Academy of Sciences (CAS) "Light of West China" Program (2016XBZG-XBQNXZ-B005)
文摘Climate change and human activities can influence vegetation net primary productivity(NPP), a key component of natural ecosystems. The Qinghai-Tibet Plateau of China, in spite of its significant natural and cultural values, is one of the most susceptible regions to climate change and human disturbances in the world. To assess the impact of climate change and human activities on vegetation dynamics in the grassland ecosystems of the northeastern Qinghai-Tibet Plateau, we applied a time-series trend analysis to normalized difference vegetation index(NDVI) datasets from 2000 to 2015 and compared these spatiotemporal variations with trends in climatic variables over the same time period. The constrained ordination approach(redundancy analysis) was used to determine which climatic variables or human-related factors mostly influenced the variation of NDVI. Furthermore, in order to determine whether current conservation measures and programs are effective in ecological protection and reconstruction, we divided the northeastern Qinghai-Tibet Plateau into two parts: the Three-River Headwater conservation area(TRH zone) in the south and the non-conservation area(NTRH zone) in the north. The results indicated an overall(73.32%) increasing trend of vegetation NPP in grasslands throughout the study area. During the period 2000–2015, NDVI in the TRH and NTRH zones increased at the rates of 0.0015/a and 0.0020/a, respectively. Specifically, precipitation accounted for 9.2% of the total variation in NDVI, while temperature accounted for 13.4%. In addition, variation in vegetation NPP of grasslands responded not only to long-and short-term changes in climate, as conceptualized in non-equilibrium theory, but also to the impact of human activities and their associated perturbations. The redundancy analysis successfully separated the relative contributions of climate change and human activities, of which village population and agricultural gross domestic product were the two most important contributors to the NDVI changes, explain
文摘Chronic kidney disease （CKD） patients are endangered with the highest mortality rate compared to other chronic diseases. Cardiovascular events account for up to 60% of the fatalities. Cardiovascular calcifcations affect most of the CKD patients. Most of this calcification is related to disturbed renal phosphate handling. Fibroblast growth factor 23 and klotho defciency were incriminated in the pathogenesis of vascular calcification through different mechanisms including their effects on endothelium and arterial wall smooth muscle cells. In addition, deficient klotho gene expression, a constant feature of CKD, pro-motes vascular pathology and shares in progression of the CKD. The role of gut in the etio-pathogenesis of systemic infammation and vascular calcifcation is a newly discovered mechanism. This review will cover the medical history, prevalence, pathogenesis, clinical relevance, different tools used to diagnose, the ideal timing to prevent or to withhold the progression of vascular cal-cification and the different medications and medical procedures that can help to prolong the survival of CKD patients.
文摘Some patients with ascites due to liver cirrhosis become no longer responsive to diuretics. Once other causes of ascites such as portal vein thrombosis, malignancy or infection and non-compliance with medications and low sodium diet have been excluded, the diagnosis of refractory ascites can be made based on strict criteria. Patients with refractory ascites have very poor prognosis and therefore referral for consideration for liver transplantation should be initiated. Search for reversible components of the underlying liver pathology should be undertaken and targeted therapy, when available, should be considered. Currently, serial large volume paracentesis （LVP） and transjugular intrahepatic portasystemic stent-shunt （TIPS） are the two mainstay treatment options for refractory ascites. Other treatment options are available but not widely used either because they carry high morlJidity and mortality （most surgical options） rates, or are new interventions that have shown promise but still need further evaluation. In this comprehensive review, we describe the evaluation and management of patients with refractory ascites from the prospective of the practicing physician.
文摘A micropolar model for axisymmetric blood flow through an axially nonsymmetreic but radially symmetric mild stenosis tapered artery is presented. To estimate the effect of the stenosis shape, a suitable geometry has been considered such that the axial shape of the stenosis can be changed easily just by varying a parameter （referred to as the shape parameter）. The model is also used to study the effect of the taper angle Ф. Flow parameters such as the velocity, the resistance to flow （the resistance impedance）, the wall shear stress distribution in the stenotic region and its magnitude at the maximum height of the stenosis （stenosis throat） have been computed for different values of the shape parameter n, the taper angle Ф, the coupling number N and the micropolar parameter m. It is shown that the resistance to flow decreases with increasing the shape parameter n and the micropolar parameter m while it increases with increasing the coupling number N. So, the magnitude of the resistance impedance is higher for a micropolar fluid than that for a Newtonian fluid model. Finally, the velocity profile, the wall shear stress distribution in the stenotic region and its magnitude at the maximum height of the stenosis are discussed for different values of the parameters involved on the problem.
文摘AIM To evaluate the accuracy of the elastography score combined to the strain ratio in the diagnosis of solid pancreatic lesions(SPL). METHODS A total of 172 patients with SPL identified by endoscopic ultrasound were enrolled in the study to evaluate the efficacy of elastography and strain ratio in differentiating malignant from benign lesions. The semi quantitative score of elastography was represented by the strain ratio method. Two areas were selected, area(A) representing the region of interest and area(B) representing the normal area. Area(B) was then divided by area(A). Sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV), and accuracy were calculated by comparing diagnoses made by elastography, strain ratio and final diagnoses.RESULTS SPL were shown to be benign in 49 patients and malignant in 123 patients. Elastography alone had a sensitivity of 99%, a specificity of 63%, and an accuracy of 88%, a PPV of 87% and an NPV of 96%. The best cut-off level of strain ratio to obtain the maximal area under the curve was 7.8 with a sensitivity of 92%, specificity of 77%, PPV of 91%, NPV of 80% and an accuracy of 88%. Another estimated cut off strain ratio level of 3.8 had a higher sensitivity of 99% and NPV of 96%, but with less specificity, PPV and accuracy 53%, 84% and 86%, respectively. Adding both elastography to strain ratio resulted in a sensitivity of 98%, specificity of 77%, PPV of 91%, NPV of 95% and accuracy of 92% for the diagnosis of SPL. CONCLUSION Combining elastography to strain ratio increases the accuracy of the differentiation of benign from malignant SPL.
