AIM:To evaluate the best diagnostic technique and risk factors of the human Cytomegalovirus(HCMV)and Epstein-Barr virus(EBV)infection in inflammatory bowel disease(IBD).METHODS:A cohort of 40 IBD patients(17 refractor...AIM:To evaluate the best diagnostic technique and risk factors of the human Cytomegalovirus(HCMV)and Epstein-Barr virus(EBV)infection in inflammatory bowel disease(IBD).METHODS:A cohort of 40 IBD patients(17 refractory)and 40 controls underwent peripheral blood and endoscopic colonic mucosal sample harvest.Viral infection was assessed by quantitative real-time polymerase chain reaction and immunohistochemistry,and correlations with clinical and endoscopic indexes of activity,and risk factors were investigated.RESULTS:All refractory patients carried detectable levels of HCMV and/or EBV mucosal load as comparedto 13/23(56.5%)non-refractory and 13/40(32.5%)controls.The median DNA value was significantly higher in refractory(HCMV 286 and EBV 5.440 copies/105cells)than in non-refractory(HCMV 0 and EBV 6copies/105 cells;P<0.05 and<0.001)IBD patients and controls(HCMV and EBV 0 copies/105 cells;P<0.001 for both).Refractory patients showed DNA peak values≥103 copies/105 cells in diseased mucosa in comparison to non-diseased mucosa(P<0.0121 for HCMV and<0.0004 for EBV),while non-refractory patients and controls invariably displayed levels below this threshold,thus allowing us to differentiate viral colitis from mucosal infection.Moreover,the mucosal load positively correlated with the values found in the peripheral blood,whilst no correlation with the number of positive cells at immunohistochemistry was found.Steroid use was identified as a significant risk factor for both HCMV(P=0.018)and EBV(P=0.002)colitis.Finally,a course of specific antiviral therapy with ganciclovir was successful in all refractory patients with HCMV colitis,whilst refractory patients with EBV colitis did not show any improvement despite steroid tapering and discontinuation of the other medications.CONCLUSION:Viral colitis appeared to contribute to mucosal lesions in refractory IBD,and its correct diagnosis and management require quantitative real-time polymerase chain reaction assay of mucosal specimens.展开更多
Cognitive damage in heart failure （HF） involves different domains thus interfering with the ability for single patient to self-care and to cope with treatment regimens, modifying symptoms and health behaviours. Many...Cognitive damage in heart failure （HF） involves different domains thus interfering with the ability for single patient to self-care and to cope with treatment regimens, modifying symptoms and health behaviours. Many cerebral and functional changes were detected in brain imaging, involving areas of both grey and white matter deputed to cognition. Although various instruments are available to explore cognition, no consensus was obtained on better tools to be used in HF population. Reduction in cerebral blood flow, decreased cardiac output, altera-tions of cerebrovascular reactivity and modification of blood pressure levels are the main features involved in the etiopathogenetic mecha-nisms of cognitive deficit. Several cardiac variables, laboratory parameters, demographic and clinical elements were studied for their possible relation with cognition and should be properly evaluated to define patients at increased risk of impairment. The present review gathers avail-able data pointing out assured information and discussing possible areas of research development.展开更多
AIM: To evaluate the safety and efficacy of the permanent high interventricular septal pacing in a long term follow up, as alternative to right ventricular apical pacing. METHODS: We retrospectively evaluated:(1) 244 ...AIM: To evaluate the safety and efficacy of the permanent high interventricular septal pacing in a long term follow up, as alternative to right ventricular apical pacing. METHODS: We retrospectively evaluated:(1) 244 patients(74 ± 8 years; 169 men, 75 women) implanted with a single(132 pts) or dual chamber(112 pts) pacemaker(PM) with ventricular screw-in lead placed at the right ventricular high septal parahisian site(SEPTAL pacing);(2) 22 patients with permanent pacemaker and low percentage of pacing(< 20%)(NO pacing);(3) 33 patients with high percentage(> 80%) right ventricular apical pacing(RVA). All patients had a narrow spontaneous QRS(101 ± 14 ms). We evaluated New York Heart Association(NYHA) class, quality of life(Qo L), 6 min walking test(6MWT) and left ventricular function(end-diastolic volume, LV-EDV; end-systolic volume, LVESV; ejection fraction, LV-EF) with 2D-echocardiography. RESULTS: Pacing parameters were stable duringfollow up(21 mo/patient). In SEPTAL pacing group we observed an improvement in NYHA class, Qo L score and 6MWT. While LV-EDV didn't significantly increase(104 ± 40 m L vs 100 ± 37 m L; P = 0.35), LV-ESV slightly increased(55 ± 31 m L vs 49 ± 27 m L; P = 0.05) and LV-EF slightly decreased(49% ± 11% vs 53% ± 11%; P = 0.001) but never falling < 45%. In the RVA pacing control group we observed a worsening of NYHA class and an important reduction of LV-EF(from 56% ± 6% to 43% ± 9%, P < 0.0001).CONCLUSION: Right ventricular permanent high septal pacing is safe and effective in a long term follow up evaluation; it could be a good alternative to the conventional RVA pacing in order to avoid its deleterious effects.展开更多
In this paper,we discuss in detail the basic issue of green design and consider an energy efficiency function as the metric to evaluate green cellular networks.Specifically,we investigate the transmit power required f...In this paper,we discuss in detail the basic issue of green design and consider an energy efficiency function as the metric to evaluate green cellular networks.Specifically,we investigate the transmit power required for an expected transmission capacity and propose a capacity-power formula based on the energy conservation and the Shannon capacity theorem.Two novel definitions of cell interference depth and handoff dynamic model are introduced and the corresponding expression of energy efficiency function is derived.Numerical results show that the energy efficiency function is closely correlated with the transmitted/received power required and the cell radius.Our work provides a useful basis for research and evaluation on green design and technology of cellular networks.展开更多
Gastric cancer (GC) remains a leading cause of cancer death worldwide. Radical gastrectomy is the only potentially curative treatment, and perioperative adjuvant therapies may improve the prognosis after curative rese...Gastric cancer (GC) remains a leading cause of cancer death worldwide. Radical gastrectomy is the only potentially curative treatment, and perioperative adjuvant therapies may improve the prognosis after curative resection. Prognosis largely depends on the tumour stage and histology, but the host systemic inflammatory response (SIR) to GC may contribute as well, as has been determined for other malignancies. In GC patients, the potential utility of positron emission tomography/computed tomography (PET/CT) with the imaging radiopharmaceutical <sup>18</sup>F-fluorodeoxyglucose (FDG) is still debated, due to its lower sensitivity in diagnosing and staging GC compared to other imaging modalities. There is, however, growing evidence that FDG uptake in the primary tumour and regional lymph nodes may be efficient for predicting prognosis of resected patients and for monitoring tumour response to perioperative treatments, having prognostic value in that it can change therapeutic strategies. Moreover, FDG uptake in bone marrow seems to be significantly associated with SIR to GC and to represent an efficient prognostic factor after curative surgery. In conclusion, PET/CT technology is efficient in GC patients, since it is useful to integrate other imaging modalities in staging tumours and may have prognostic value that can change therapeutic strategies. With ongoing improvements, PET/CT imaging may gain further importance in the management of GC patients.展开更多
BACKGROUND Despite various therapies to treat sepsis,it is one of the leading causes of mortality in the intensive care unit patients globally.Knowledge about the pathophysiology of sepsis has sparked interest in extr...BACKGROUND Despite various therapies to treat sepsis,it is one of the leading causes of mortality in the intensive care unit patients globally.Knowledge about the pathophysiology of sepsis has sparked interest in extracorporeal therapies(ECT)which are intended to balance the dysregulation of the immune system by removing excessive levels of inflammatory mediators.AIM To review recent data on the use of ECT in sepsis and to assess their effects on various inflammatory and clinical outcomes.METHODS In this review,an extensive English literature search was conducted from the last two decades to identify the use of ECT in sepsis.A total of 68 articles from peer-reviewed and indexed journals were selected excluding publications with only abstracts.RESULTS Results showed that ECT techniques such as high-volume hemofiltration,coupled plasma adsorption/filtration,resin or polymer adsorbers,and CytoSorb®are emerging as adjunct therapies to improve hemodynamic stability in sepsis.CytoSorb®has the most published data in regard to the use in the field of septic shock with reports on improved survival rates and lowered sequential organ failure assessment scores,lactate levels,total leucocyte count,platelet count,interleukin-IL-6,IL-10,and TNF levels.CONCLUSION Clinical acceptance of ECT in sepsis and septic shock is currently still limited due to a lack of large random clinical trials.In addition to patient-tailored therapies,future research developments with therapies targeting the cellular level of the immune response are expected.展开更多
The CAMINO trial by Görgec et al.(1)assessed the added diagnostic value of contrast-enhanced(CE)magnetic resonance imaging(MRI)using gadoxetic acid and diffusion-weighted imaging for patients with colorectal live...The CAMINO trial by Görgec et al.(1)assessed the added diagnostic value of contrast-enhanced(CE)magnetic resonance imaging(MRI)using gadoxetic acid and diffusion-weighted imaging for patients with colorectal liver metastases(CRLMs)scheduled for curative treatment(surgical resection,thermal ablation,or both).The study explored how often liver(MRI)changes therapeutic strategy compared to using only a CE computed tomography(CT)scan.Despite MRI’s widespread use in staging for CRLMs,guidelines remain vague,leaving decisions to the surgeon’s preference and expertise.展开更多
AIM To highlight the rising trend in hospital presentation of foreign bodies retained in the rectum over a 5-year period.METHODS Retrospective review of the cases of retained rectal foreign bodies between 2008 and 201...AIM To highlight the rising trend in hospital presentation of foreign bodies retained in the rectum over a 5-year period.METHODS Retrospective review of the cases of retained rectal foreign bodies between 2008 and 2012 was performed.Patients' clinical data and yearly case presentation with data relating to hospital episodes were collected.Data analysis was by SPSS Inc.Chicago,IL,United States.RESULTS Twenty-five patients presented over a 5-year period with a mean age of 39(17-62) years and M: F ratio of 2:1.A progressive rise in cases was noted from 2008 to 2012 with 3,4,4,6,8 recorded patients per year respectively.The majority of the impacted rectal objects were used for self-/partner-eroticism.The commonest retained foreign bodies were sex vibrators and dildos.Ninty-six percent of the patients required extraction while one passed spontaneously.Two and three patients had retrieval in the Emergency Department and on the ward respectively while 19 patients needed examination under anaesthesia for extraction.The mean hospital stay was 19(2-38) h.Associated psychosocial issues included depression,deliberate self-harm,illicit drug abuse,anxiety and alcoholism.There were no psychosocial problems identified in 15 patients.CONCLUSION There is a progressive rise in hospital presentation of impacted rectal foreign bodies with increasing use of different objects for sexual arousal.展开更多
History textbooks can and primarily should contribute to the strengthening of students’awareness of universal human values.However,history textbooks can also deepen the divisions,prejudices,and uncritical attitudes,c...History textbooks can and primarily should contribute to the strengthening of students’awareness of universal human values.However,history textbooks can also deepen the divisions,prejudices,and uncritical attitudes,contrary to the goals of education.The youth population,which is still building and creating their point of view towards the world is the main group in the education process.The learning period,in the elementary,as well as in the secondary education is of utmost importance for the development of every human.To that end,history,through the contents of the past largely shapes our perceptions of every individual,ourselves,and the others.Since we are living in a multiethnic and multi-confessional society,I have decided to conduct an analysis of the teaching contents of high school textbooks related to religion.Another reason for the analysis is the role of religion in the formation of Balkan nations,which have made it one of the key elements of their national identities.It is often given the role of raising and strengthening the national awareness,patriotism,as well as the country homogeneity,which most often leads to forming prejudices,divisions,and discrimination towards people of minority religions.The large volume of content related to the religion,and also the mere fact that Muslims are the second largest religion group in the population,I have decided to analyze the contents which are related only to the Islamic religion.The goal is to look for both the positive and negative sides of those contents in history textbooks in secondary schools,which are backed by state institutions that are supposed to take care of the development of competitive,creative,progressive,and ethically formed human potential.The critical review will give an additional impulse to the efforts of eliminating those parts of the teaching contents that create divisions and prejudices,especially in history textbooks,so that its studying can become the key factor in the building of trust between people of different religions.展开更多
Among individuals with known alcohol use disorder(AUD),the prevalence of alcoholic fatty liver disease(AFLD)is present in 25-90%of cases(1).Shroff et al.(1)report that the annual progression to cirrhosis is 3%in the p...Among individuals with known alcohol use disorder(AUD),the prevalence of alcoholic fatty liver disease(AFLD)is present in 25-90%of cases(1).Shroff et al.(1)report that the annual progression to cirrhosis is 3%in the presence of AFLD,10%in case of alcohol-related steatohepatitis(ASH)and 8%with any grade of pre-cirrhotic fibrosis.Alcohol-related liver disease(ALD)is the cause of 36%of cases of cirrhosis in the United States and nearly one half of cirrhosis-related deaths worldwide(1).Ethanol is a recognized carcinogen for several malignancies with the risk starting at low dose(10 gr/1 unit/day)(2).The link between alcohol consumption(AC)and hepatocellular carcinoma(HCC)is well known:various evaluations carried out by both USA and Italian groups indicate that such a correlation is present in 32%to 45%of cases(2).With the reduction of hepatitis C virus(HCV)cases,AC will become the main cause of HCC in Western countries.Furthermore,ALD and metabolic syndrome(MS)are currently the main causes of liver transplantation(LT)(3).展开更多
The liver is the most common site of metastases in patients with colorectal cancer.Colorectal liver metastases(CRLMs)are the result of molecular mechanisms that involve different cells of the liver microenvironment.Th...The liver is the most common site of metastases in patients with colorectal cancer.Colorectal liver metastases(CRLMs)are the result of molecular mechanisms that involve different cells of the liver microenvironment.The aberrant activation of Wingless/It(Wnt)/β-catenin signals downstream of Wnt ligands initially drives the oncogenic transformation of the colon epithelium,but also the progression of metastatization through the epithelial-mesenchymal transition/mesenchymalepithelial transition interactions.In liver microenvironment,metastatic cells can also survive and adapt through dormancy,which makes them less susceptible to pro-apoptotic signals and therapies.Treatment of CRLMs is challenging due to its variability and heterogeneity.Advances in surgery and oncology have been made in the last decade and a pivotal role for Wnt/β-catenin pathway has been recognized in chemoresistance.At the state of art,there is a lack of clear understanding of why and how this occurs and thus where exactly the opportunities for developing anti-CRLMs therapies may lie.In this review,current knowledge on the involvement of Wnt signaling in the development of CRLMs was considered.In addition,an overview of useful biomarkers with a revision of surgical and non-surgical therapies currently accepted in the clinical practice for colorectal liver metastasis patients were provided.展开更多
Autonomous vehicles (AVs) hold immense promises in revolutionizing transportation, and their potential benefits extend to individuals with impairments, particularly those with vision and hearing impairments. However, ...Autonomous vehicles (AVs) hold immense promises in revolutionizing transportation, and their potential benefits extend to individuals with impairments, particularly those with vision and hearing impairments. However, the accommodation of these individuals in AVs requires developing advanced user interfaces. This paper describes an explorative study of a multimodal user interface for autonomous vehicles, specifically developed for passengers with sensory (vision and/or hearing) impairments. In a driving simulator, 32 volunteers with simulated sensory impairments, were exposed to multiple drives in an autonomous vehicle while freely interacting with standard and inclusive variants of the infotainment and navigation system interface. The two user interfaces differed in graphical layout and voice messages, which adopted inclusive design principles for the inclusive variant. Questionnaires and structured interviews were conducted to collect participants’ impressions. The data analysis reports positive user experiences, but also identifies technical challenges. Verified guidelines are provided for further development of inclusive user interface solutions.展开更多
BACKGROUND Chronic hepatitis C virus(HCV)has been associated with hepatic and extrahe-patic malignancies.Limited studies have shown an association between colorectal adenomas and HCV populations.AIM To study the preva...BACKGROUND Chronic hepatitis C virus(HCV)has been associated with hepatic and extrahe-patic malignancies.Limited studies have shown an association between colorectal adenomas and HCV populations.AIM To study the prevalence of colorectal adenomas in patients with HCV compared to the general population and to evaluate if it is an independent risk factor for colorectal adenomas.METHODS Patients were divided into HCV and non-HCV based on their HCV RNA titers.Patients with alcoholic liver disease,hepatitis B infection,and inflammatory bowel disease were excluded.Continuous variables were analyzed using the Mann-Whitney U test,and categorical variables usingχ^(2) with P<0.05 were considered statistically significant.The significant covariates(independent variables)were matched in both groups by propensity score matching,followed by multivariate regression analysis.RESULTS Of the 415 patients screened,109 HCV patients and 97 non-HCV patients with colonoscopy results were included in the study.HCV patients were older,had a smoking history,had less frequent aspirin use,and had a lower body mass index(BMI)(P<0.05).The HCV cohort had a significantly increased number of patients with adenomas(adenoma detection rate of 53.2%vs 34%.P=0.006).We performed a propensity-matched multivariate analysis where HCV infection was significantly associated with colorectal adenoma(OR:2.070,P=0.019).CONCLUSION Our study shows a significantly higher rate of adenomas in HCV patients compared to the general population.Prospective studies would help determine if the increase in adenoma detection lowers the risk for colorectal cancer.展开更多
The optimal timing of surgery in case of synchronous presentation of colorectal cancer and liver metastases is still under debate.Staged approach,with initial colorectal resection followed by liver resection(LR),or ev...The optimal timing of surgery in case of synchronous presentation of colorectal cancer and liver metastases is still under debate.Staged approach,with initial colorectal resection followed by liver resection(LR),or even the reverse,liver-first approach in specific situations,is traditionally preferred.Simultaneous resections,however,represent an appealing strategy,because may have perioperative risks comparable to staged resections in appropriately selected patients,while avoiding a second surgical procedure.In patients with larger or multiple synchronous presentation of colorectal cancer and liver metastases,simultaneous major hepatectomies may determine worse perioperative outcomes,so that parenchymal-sparing LR should represent the most appropriate option whenever feasible.Mini-invasive colorectal surgery has experienced rapid spread in the last decades,while laparoscopic LR has progressed much slower,and is usually reserved for limited tumours in favourable locations.Moreover,mini-invasive parenchymal-sparing LR is more complex,especially for larger or multiple tumours in difficult locations.It remains to be established if simultaneous resections are presently feasible with mini-invasive approaches or if we need further technological advances and surgical expertise,at least for more complex procedures.This review aims to critically analyze the current status and future perspectives of simultaneous resections,and the present role of the available miniinvasive techniques.展开更多
Several nuclear genes have been found to be linked to ichthyosis, and Next Generation Sequencing approach on panels of targeted genes has turned out to be particularly useful in analyzing diseases characterized by sig...Several nuclear genes have been found to be linked to ichthyosis, and Next Generation Sequencing approach on panels of targeted genes has turned out to be particularly useful in analyzing diseases characterized by significant genetic and phenotypic heterogeneity. We developed a panel of 26 genes to be screened with the Ion Personal Genome Machine (PGM) for causative mutations relating to ichthyosis. Sequencing runs were obtained from a patient with ichthyosis using the Ion Torrent PGM and then processed with Ion Torrent Suite, Variant Caller, Coverage Analysis and wANNOVER tools. No causative mutations were found using Variant Caller and wANNOVER softwares, whereas the “Coverage Analysis” tool revealed a common large deletion in STS gene in a patient with X-linked ichthyosis. Identification of indels in Next Generation Sequencing (NGS) data is a veritable challenge. This study demonstrates the efficacy and effectiveness of using NGS approach to detect large deletions without resorting to specific algorithms for “indel” detection. Our results indicate that the NGS panel is a useful, rapid and cost-effective screening test for patients whose features are suggestive of a genetic etiology involving one of the genes embedded in the panel. It is an excellent alternative to Sanger sequencing as for costs, ease of analysis, and turnaround time.展开更多
BACKGROUND The therapeutic approach of metastatic renal cell carcinoma(RCC)represents a real challenge for clinicians,because of the variable clinical course;the recent availability of numerous targeted therapies that...BACKGROUND The therapeutic approach of metastatic renal cell carcinoma(RCC)represents a real challenge for clinicians,because of the variable clinical course;the recent availability of numerous targeted therapies that have significantly improved overall oncological results,but still with a low percentage of complete responses;and the increasing role of metastasectomy(MSX)as an effective strategy to achieve a durable cure,or at least defer initiation of systemic therapies,in selected patients and in the context of multimodality treatment strategies.CA^E SUMMARY We report here the case of a 40-year-old man who was referred to our unit in November 2004 with lung and mediastinal lymph nodes metastases identified during periodic surveillance 6 years after a radical nephrectomy for RCC;he underwent MSX of multiple lung nodules and mediastinal lymphadenectomy,with subsequent systemic therapy with Fluorouracil,Interferon-alpha and Interleukin 2.The subsequent clinical course was characterized by multiple sequential abdominal and thoracic recurrences,successfully treated with multiple systemic treatments,repeated local treatments,including two pancreatic resections,conservative resection and ablation of multiple bilobar liver metastases,resection and stereotactic body radiotherapy of multiple lung metastases.He is alive without evidence of recurrence 20 years after initial nephrectomy and sequential treatment of recurrences in multiple sites,including resection of more than 38 metastases,and 5 years after his last MSX.CONCLUSION This case highlights that effective multimodality therapeutic strategies,including multiple systemic treatments and iterative aggressive surgical resection,can be safely performed with long-term survival in selected patients with multiple metachronous sequential metastases from RCC.展开更多
Some petroleum-based packaging materials have a series of safety issues,and as a result,people are more inclined to use biodegradable and nontoxic packaging materials for foods.However,biodegradable alternatives often...Some petroleum-based packaging materials have a series of safety issues,and as a result,people are more inclined to use biodegradable and nontoxic packaging materials for foods.However,biodegradable alternatives often need to be modified to overcome their own shortcomings.In this paper,carboxymethyl chitosan(CMCS)/carboxymethyl cellulose sodium(CMC)+polylactic acid(PLA)nano zinc oxide(ZnO)nanoparticles(CMCS/CMC+PLA/ZnO NPs)multilayer coated paperboard was prepared to explore its potential use in food package applications.The multilayer CMCS/CMC+PLA coating reduced the oxygen transmission rate by 99%and doubled the barrier properties for soybean oil penetration and water vapor compared with a single PLA coating layer in a 23℃/50 RH environment.The oil resistance time of the multilayer CMCS/CMC+PLA coating also increased 28 times,and the water vapor barrier properties increased twofold compared to a single CMCS/CMC coating layer.The water vapor barrier properties increased by a factor of 3 even at 38℃/90 RH.Compared with the CMCS/CMC+PLA coating without nanoparticles,the barrier performance of the CMCS/CMC+PLA/ZnO NPs coating was further improved.The oxygen,water vapor,and heptane vapor barrier properties all doubled,and the oil resistance time reached 235 h.While a corona treatment reduced the polar component content in the CMCS/CMC coating and led to a slight decrease in the barrier properties of the coating to heptane,it was still a good oil-repellent coating overall.The antibacterial activity(A)toward Escherichia coli and Staphylococcus aureus exceeded 2,which meant that the multilayer coating with 1.5%added ZnO NPs reduced the growth of bacteria by more than 99%.The multilayer coated paperboard created here with the blended and modified materials significantly improved the barrier and antibacterial properties,suggesting that multilayer coatings prepared from degradable materials have good commercial prospects as fast food packaging.展开更多
BACKGROUND The direct anterior approach for total hip arthroplasty(DAA-THA)is increasing in popularity due to some advantages such as less surgical trauma,minimal dissection of soft tissues,shorter rehabilitation time...BACKGROUND The direct anterior approach for total hip arthroplasty(DAA-THA)is increasing in popularity due to some advantages such as less surgical trauma,minimal dissection of soft tissues,shorter rehabilitation times,faster return to daily activities,lower incidence of dislocation.On the other hand,the literature reports a high rate of intraoperative complications,with many different rates and complication types in the published papers.AIM To analyze our complications comparing results with the literature;to report measures that we have taken to reduce complications rate.METHODS All DAA-THA patients with one year minimum follow up who were operated at a single high-volume centre,between January 2010 and December 2019 were included in this retrospective study.All surgeries were performed using cementless short anatomical or straight stems and press fit cups.Patients’followup was performed,at 6 wk,3 mo,then annually post-surgery with clinical and radiological evaluation.Primary outcomes were stem revision for aseptic loosening and all-cause stem revision.Second outcome was intra-operative and post-operative complications identification.RESULTS A total of 394 patients underwent DDA-THA from January 2010 and December 2019,for a total of 412 hips;twelve patients lost to follow-up and one patient who died from causes not related to surgery were excluded from the study.The average age at the time of surgery was 61 years(range from 28 to 78 years).Mean follow-up time was 64.8 mo(range 12-120 mo).Seven stems were revised.One cortical perforation,one trochanteric and lateral cortical wall intraoperative fracture,one diaphyseal fracture,three clinically symptomatic early subsidence and one late aseptic loosening.We also observed 3 periprosthetic fractures B1 according to the Vancouver Classification.Other minor complications not requiring stem revision were 5 un-displaced fractures of the calcar region treated with preventive cerclage,one early infection,one case of late posterior dislocation,18 case of asymptomatic ste展开更多
A low complexity Per-Antenna Power Control （PAPC） approach based on Minimum Mean Squared Error （MMSE） detection for V-BLAST is proposed in this paper. The PAPC approach is developed for minimizing the Bit Error Ra...A low complexity Per-Antenna Power Control （PAPC） approach based on Minimum Mean Squared Error （MMSE） detection for V-BLAST is proposed in this paper. The PAPC approach is developed for minimizing the Bit Error Rate （BER） averaged over all substreams when the data throughput and the total transmit power keep constant over time. Simulation results show that the Power-controlled V-BLAST （P-BLAST） outperforms the conventional V-BLAST in terms of BER performance with MMSE detector, especially in presence of high spatial correlation between antennas. However, the additional complexity for P-BLAST is not high. When MMSE detector is adopted, the P-BLAST can achieve a comparable BER performance to that of conventional V-BLAST with Maximum Likelihood （ML） detector but with low complexity.展开更多
基金Supported by(in part)Fondazione IRCCS Policlinico San Matteo(Progetto di Ricerca Corrente)entitled:"Studio della espressione del recettore per i prodotti finali della glicosilazione avanzata(RAGE)nelle Malattie Infiammatorie Croniche Intestinali",No.08064409
文摘AIM:To evaluate the best diagnostic technique and risk factors of the human Cytomegalovirus(HCMV)and Epstein-Barr virus(EBV)infection in inflammatory bowel disease(IBD).METHODS:A cohort of 40 IBD patients(17 refractory)and 40 controls underwent peripheral blood and endoscopic colonic mucosal sample harvest.Viral infection was assessed by quantitative real-time polymerase chain reaction and immunohistochemistry,and correlations with clinical and endoscopic indexes of activity,and risk factors were investigated.RESULTS:All refractory patients carried detectable levels of HCMV and/or EBV mucosal load as comparedto 13/23(56.5%)non-refractory and 13/40(32.5%)controls.The median DNA value was significantly higher in refractory(HCMV 286 and EBV 5.440 copies/105cells)than in non-refractory(HCMV 0 and EBV 6copies/105 cells;P<0.05 and<0.001)IBD patients and controls(HCMV and EBV 0 copies/105 cells;P<0.001 for both).Refractory patients showed DNA peak values≥103 copies/105 cells in diseased mucosa in comparison to non-diseased mucosa(P<0.0121 for HCMV and<0.0004 for EBV),while non-refractory patients and controls invariably displayed levels below this threshold,thus allowing us to differentiate viral colitis from mucosal infection.Moreover,the mucosal load positively correlated with the values found in the peripheral blood,whilst no correlation with the number of positive cells at immunohistochemistry was found.Steroid use was identified as a significant risk factor for both HCMV(P=0.018)and EBV(P=0.002)colitis.Finally,a course of specific antiviral therapy with ganciclovir was successful in all refractory patients with HCMV colitis,whilst refractory patients with EBV colitis did not show any improvement despite steroid tapering and discontinuation of the other medications.CONCLUSION:Viral colitis appeared to contribute to mucosal lesions in refractory IBD,and its correct diagnosis and management require quantitative real-time polymerase chain reaction assay of mucosal specimens.
文摘Cognitive damage in heart failure （HF） involves different domains thus interfering with the ability for single patient to self-care and to cope with treatment regimens, modifying symptoms and health behaviours. Many cerebral and functional changes were detected in brain imaging, involving areas of both grey and white matter deputed to cognition. Although various instruments are available to explore cognition, no consensus was obtained on better tools to be used in HF population. Reduction in cerebral blood flow, decreased cardiac output, altera-tions of cerebrovascular reactivity and modification of blood pressure levels are the main features involved in the etiopathogenetic mecha-nisms of cognitive deficit. Several cardiac variables, laboratory parameters, demographic and clinical elements were studied for their possible relation with cognition and should be properly evaluated to define patients at increased risk of impairment. The present review gathers avail-able data pointing out assured information and discussing possible areas of research development.
文摘AIM: To evaluate the safety and efficacy of the permanent high interventricular septal pacing in a long term follow up, as alternative to right ventricular apical pacing. METHODS: We retrospectively evaluated:(1) 244 patients(74 ± 8 years; 169 men, 75 women) implanted with a single(132 pts) or dual chamber(112 pts) pacemaker(PM) with ventricular screw-in lead placed at the right ventricular high septal parahisian site(SEPTAL pacing);(2) 22 patients with permanent pacemaker and low percentage of pacing(< 20%)(NO pacing);(3) 33 patients with high percentage(> 80%) right ventricular apical pacing(RVA). All patients had a narrow spontaneous QRS(101 ± 14 ms). We evaluated New York Heart Association(NYHA) class, quality of life(Qo L), 6 min walking test(6MWT) and left ventricular function(end-diastolic volume, LV-EDV; end-systolic volume, LVESV; ejection fraction, LV-EF) with 2D-echocardiography. RESULTS: Pacing parameters were stable duringfollow up(21 mo/patient). In SEPTAL pacing group we observed an improvement in NYHA class, Qo L score and 6MWT. While LV-EDV didn't significantly increase(104 ± 40 m L vs 100 ± 37 m L; P = 0.35), LV-ESV slightly increased(55 ± 31 m L vs 49 ± 27 m L; P = 0.05) and LV-EF slightly decreased(49% ± 11% vs 53% ± 11%; P = 0.001) but never falling < 45%. In the RVA pacing control group we observed a worsening of NYHA class and an important reduction of LV-EF(from 56% ± 6% to 43% ± 9%, P < 0.0001).CONCLUSION: Right ventricular permanent high septal pacing is safe and effective in a long term follow up evaluation; it could be a good alternative to the conventional RVA pacing in order to avoid its deleterious effects.
基金the National Science Foundation of China，the Hi-Tech Research and Development Program of China of Mobile Internet
文摘In this paper,we discuss in detail the basic issue of green design and consider an energy efficiency function as the metric to evaluate green cellular networks.Specifically,we investigate the transmit power required for an expected transmission capacity and propose a capacity-power formula based on the energy conservation and the Shannon capacity theorem.Two novel definitions of cell interference depth and handoff dynamic model are introduced and the corresponding expression of energy efficiency function is derived.Numerical results show that the energy efficiency function is closely correlated with the transmitted/received power required and the cell radius.Our work provides a useful basis for research and evaluation on green design and technology of cellular networks.
文摘Gastric cancer (GC) remains a leading cause of cancer death worldwide. Radical gastrectomy is the only potentially curative treatment, and perioperative adjuvant therapies may improve the prognosis after curative resection. Prognosis largely depends on the tumour stage and histology, but the host systemic inflammatory response (SIR) to GC may contribute as well, as has been determined for other malignancies. In GC patients, the potential utility of positron emission tomography/computed tomography (PET/CT) with the imaging radiopharmaceutical <sup>18</sup>F-fluorodeoxyglucose (FDG) is still debated, due to its lower sensitivity in diagnosing and staging GC compared to other imaging modalities. There is, however, growing evidence that FDG uptake in the primary tumour and regional lymph nodes may be efficient for predicting prognosis of resected patients and for monitoring tumour response to perioperative treatments, having prognostic value in that it can change therapeutic strategies. Moreover, FDG uptake in bone marrow seems to be significantly associated with SIR to GC and to represent an efficient prognostic factor after curative surgery. In conclusion, PET/CT technology is efficient in GC patients, since it is useful to integrate other imaging modalities in staging tumours and may have prognostic value that can change therapeutic strategies. With ongoing improvements, PET/CT imaging may gain further importance in the management of GC patients.
文摘BACKGROUND Despite various therapies to treat sepsis,it is one of the leading causes of mortality in the intensive care unit patients globally.Knowledge about the pathophysiology of sepsis has sparked interest in extracorporeal therapies(ECT)which are intended to balance the dysregulation of the immune system by removing excessive levels of inflammatory mediators.AIM To review recent data on the use of ECT in sepsis and to assess their effects on various inflammatory and clinical outcomes.METHODS In this review,an extensive English literature search was conducted from the last two decades to identify the use of ECT in sepsis.A total of 68 articles from peer-reviewed and indexed journals were selected excluding publications with only abstracts.RESULTS Results showed that ECT techniques such as high-volume hemofiltration,coupled plasma adsorption/filtration,resin or polymer adsorbers,and CytoSorb®are emerging as adjunct therapies to improve hemodynamic stability in sepsis.CytoSorb®has the most published data in regard to the use in the field of septic shock with reports on improved survival rates and lowered sequential organ failure assessment scores,lactate levels,total leucocyte count,platelet count,interleukin-IL-6,IL-10,and TNF levels.CONCLUSION Clinical acceptance of ECT in sepsis and septic shock is currently still limited due to a lack of large random clinical trials.In addition to patient-tailored therapies,future research developments with therapies targeting the cellular level of the immune response are expected.
文摘The CAMINO trial by Görgec et al.(1)assessed the added diagnostic value of contrast-enhanced(CE)magnetic resonance imaging(MRI)using gadoxetic acid and diffusion-weighted imaging for patients with colorectal liver metastases(CRLMs)scheduled for curative treatment(surgical resection,thermal ablation,or both).The study explored how often liver(MRI)changes therapeutic strategy compared to using only a CE computed tomography(CT)scan.Despite MRI’s widespread use in staging for CRLMs,guidelines remain vague,leaving decisions to the surgeon’s preference and expertise.
文摘AIM To highlight the rising trend in hospital presentation of foreign bodies retained in the rectum over a 5-year period.METHODS Retrospective review of the cases of retained rectal foreign bodies between 2008 and 2012 was performed.Patients' clinical data and yearly case presentation with data relating to hospital episodes were collected.Data analysis was by SPSS Inc.Chicago,IL,United States.RESULTS Twenty-five patients presented over a 5-year period with a mean age of 39(17-62) years and M: F ratio of 2:1.A progressive rise in cases was noted from 2008 to 2012 with 3,4,4,6,8 recorded patients per year respectively.The majority of the impacted rectal objects were used for self-/partner-eroticism.The commonest retained foreign bodies were sex vibrators and dildos.Ninty-six percent of the patients required extraction while one passed spontaneously.Two and three patients had retrieval in the Emergency Department and on the ward respectively while 19 patients needed examination under anaesthesia for extraction.The mean hospital stay was 19(2-38) h.Associated psychosocial issues included depression,deliberate self-harm,illicit drug abuse,anxiety and alcoholism.There were no psychosocial problems identified in 15 patients.CONCLUSION There is a progressive rise in hospital presentation of impacted rectal foreign bodies with increasing use of different objects for sexual arousal.
文摘History textbooks can and primarily should contribute to the strengthening of students’awareness of universal human values.However,history textbooks can also deepen the divisions,prejudices,and uncritical attitudes,contrary to the goals of education.The youth population,which is still building and creating their point of view towards the world is the main group in the education process.The learning period,in the elementary,as well as in the secondary education is of utmost importance for the development of every human.To that end,history,through the contents of the past largely shapes our perceptions of every individual,ourselves,and the others.Since we are living in a multiethnic and multi-confessional society,I have decided to conduct an analysis of the teaching contents of high school textbooks related to religion.Another reason for the analysis is the role of religion in the formation of Balkan nations,which have made it one of the key elements of their national identities.It is often given the role of raising and strengthening the national awareness,patriotism,as well as the country homogeneity,which most often leads to forming prejudices,divisions,and discrimination towards people of minority religions.The large volume of content related to the religion,and also the mere fact that Muslims are the second largest religion group in the population,I have decided to analyze the contents which are related only to the Islamic religion.The goal is to look for both the positive and negative sides of those contents in history textbooks in secondary schools,which are backed by state institutions that are supposed to take care of the development of competitive,creative,progressive,and ethically formed human potential.The critical review will give an additional impulse to the efforts of eliminating those parts of the teaching contents that create divisions and prejudices,especially in history textbooks,so that its studying can become the key factor in the building of trust between people of different religions.
文摘Among individuals with known alcohol use disorder(AUD),the prevalence of alcoholic fatty liver disease(AFLD)is present in 25-90%of cases(1).Shroff et al.(1)report that the annual progression to cirrhosis is 3%in the presence of AFLD,10%in case of alcohol-related steatohepatitis(ASH)and 8%with any grade of pre-cirrhotic fibrosis.Alcohol-related liver disease(ALD)is the cause of 36%of cases of cirrhosis in the United States and nearly one half of cirrhosis-related deaths worldwide(1).Ethanol is a recognized carcinogen for several malignancies with the risk starting at low dose(10 gr/1 unit/day)(2).The link between alcohol consumption(AC)and hepatocellular carcinoma(HCC)is well known:various evaluations carried out by both USA and Italian groups indicate that such a correlation is present in 32%to 45%of cases(2).With the reduction of hepatitis C virus(HCV)cases,AC will become the main cause of HCC in Western countries.Furthermore,ALD and metabolic syndrome(MS)are currently the main causes of liver transplantation(LT)(3).
文摘The liver is the most common site of metastases in patients with colorectal cancer.Colorectal liver metastases(CRLMs)are the result of molecular mechanisms that involve different cells of the liver microenvironment.The aberrant activation of Wingless/It(Wnt)/β-catenin signals downstream of Wnt ligands initially drives the oncogenic transformation of the colon epithelium,but also the progression of metastatization through the epithelial-mesenchymal transition/mesenchymalepithelial transition interactions.In liver microenvironment,metastatic cells can also survive and adapt through dormancy,which makes them less susceptible to pro-apoptotic signals and therapies.Treatment of CRLMs is challenging due to its variability and heterogeneity.Advances in surgery and oncology have been made in the last decade and a pivotal role for Wnt/β-catenin pathway has been recognized in chemoresistance.At the state of art,there is a lack of clear understanding of why and how this occurs and thus where exactly the opportunities for developing anti-CRLMs therapies may lie.In this review,current knowledge on the involvement of Wnt signaling in the development of CRLMs was considered.In addition,an overview of useful biomarkers with a revision of surgical and non-surgical therapies currently accepted in the clinical practice for colorectal liver metastasis patients were provided.
文摘Autonomous vehicles (AVs) hold immense promises in revolutionizing transportation, and their potential benefits extend to individuals with impairments, particularly those with vision and hearing impairments. However, the accommodation of these individuals in AVs requires developing advanced user interfaces. This paper describes an explorative study of a multimodal user interface for autonomous vehicles, specifically developed for passengers with sensory (vision and/or hearing) impairments. In a driving simulator, 32 volunteers with simulated sensory impairments, were exposed to multiple drives in an autonomous vehicle while freely interacting with standard and inclusive variants of the infotainment and navigation system interface. The two user interfaces differed in graphical layout and voice messages, which adopted inclusive design principles for the inclusive variant. Questionnaires and structured interviews were conducted to collect participants’ impressions. The data analysis reports positive user experiences, but also identifies technical challenges. Verified guidelines are provided for further development of inclusive user interface solutions.
文摘BACKGROUND Chronic hepatitis C virus(HCV)has been associated with hepatic and extrahe-patic malignancies.Limited studies have shown an association between colorectal adenomas and HCV populations.AIM To study the prevalence of colorectal adenomas in patients with HCV compared to the general population and to evaluate if it is an independent risk factor for colorectal adenomas.METHODS Patients were divided into HCV and non-HCV based on their HCV RNA titers.Patients with alcoholic liver disease,hepatitis B infection,and inflammatory bowel disease were excluded.Continuous variables were analyzed using the Mann-Whitney U test,and categorical variables usingχ^(2) with P<0.05 were considered statistically significant.The significant covariates(independent variables)were matched in both groups by propensity score matching,followed by multivariate regression analysis.RESULTS Of the 415 patients screened,109 HCV patients and 97 non-HCV patients with colonoscopy results were included in the study.HCV patients were older,had a smoking history,had less frequent aspirin use,and had a lower body mass index(BMI)(P<0.05).The HCV cohort had a significantly increased number of patients with adenomas(adenoma detection rate of 53.2%vs 34%.P=0.006).We performed a propensity-matched multivariate analysis where HCV infection was significantly associated with colorectal adenoma(OR:2.070,P=0.019).CONCLUSION Our study shows a significantly higher rate of adenomas in HCV patients compared to the general population.Prospective studies would help determine if the increase in adenoma detection lowers the risk for colorectal cancer.
文摘The optimal timing of surgery in case of synchronous presentation of colorectal cancer and liver metastases is still under debate.Staged approach,with initial colorectal resection followed by liver resection(LR),or even the reverse,liver-first approach in specific situations,is traditionally preferred.Simultaneous resections,however,represent an appealing strategy,because may have perioperative risks comparable to staged resections in appropriately selected patients,while avoiding a second surgical procedure.In patients with larger or multiple synchronous presentation of colorectal cancer and liver metastases,simultaneous major hepatectomies may determine worse perioperative outcomes,so that parenchymal-sparing LR should represent the most appropriate option whenever feasible.Mini-invasive colorectal surgery has experienced rapid spread in the last decades,while laparoscopic LR has progressed much slower,and is usually reserved for limited tumours in favourable locations.Moreover,mini-invasive parenchymal-sparing LR is more complex,especially for larger or multiple tumours in difficult locations.It remains to be established if simultaneous resections are presently feasible with mini-invasive approaches or if we need further technological advances and surgical expertise,at least for more complex procedures.This review aims to critically analyze the current status and future perspectives of simultaneous resections,and the present role of the available miniinvasive techniques.
文摘Several nuclear genes have been found to be linked to ichthyosis, and Next Generation Sequencing approach on panels of targeted genes has turned out to be particularly useful in analyzing diseases characterized by significant genetic and phenotypic heterogeneity. We developed a panel of 26 genes to be screened with the Ion Personal Genome Machine (PGM) for causative mutations relating to ichthyosis. Sequencing runs were obtained from a patient with ichthyosis using the Ion Torrent PGM and then processed with Ion Torrent Suite, Variant Caller, Coverage Analysis and wANNOVER tools. No causative mutations were found using Variant Caller and wANNOVER softwares, whereas the “Coverage Analysis” tool revealed a common large deletion in STS gene in a patient with X-linked ichthyosis. Identification of indels in Next Generation Sequencing (NGS) data is a veritable challenge. This study demonstrates the efficacy and effectiveness of using NGS approach to detect large deletions without resorting to specific algorithms for “indel” detection. Our results indicate that the NGS panel is a useful, rapid and cost-effective screening test for patients whose features are suggestive of a genetic etiology involving one of the genes embedded in the panel. It is an excellent alternative to Sanger sequencing as for costs, ease of analysis, and turnaround time.
文摘BACKGROUND The therapeutic approach of metastatic renal cell carcinoma(RCC)represents a real challenge for clinicians,because of the variable clinical course;the recent availability of numerous targeted therapies that have significantly improved overall oncological results,but still with a low percentage of complete responses;and the increasing role of metastasectomy(MSX)as an effective strategy to achieve a durable cure,or at least defer initiation of systemic therapies,in selected patients and in the context of multimodality treatment strategies.CA^E SUMMARY We report here the case of a 40-year-old man who was referred to our unit in November 2004 with lung and mediastinal lymph nodes metastases identified during periodic surveillance 6 years after a radical nephrectomy for RCC;he underwent MSX of multiple lung nodules and mediastinal lymphadenectomy,with subsequent systemic therapy with Fluorouracil,Interferon-alpha and Interleukin 2.The subsequent clinical course was characterized by multiple sequential abdominal and thoracic recurrences,successfully treated with multiple systemic treatments,repeated local treatments,including two pancreatic resections,conservative resection and ablation of multiple bilobar liver metastases,resection and stereotactic body radiotherapy of multiple lung metastases.He is alive without evidence of recurrence 20 years after initial nephrectomy and sequential treatment of recurrences in multiple sites,including resection of more than 38 metastases,and 5 years after his last MSX.CONCLUSION This case highlights that effective multimodality therapeutic strategies,including multiple systemic treatments and iterative aggressive surgical resection,can be safely performed with long-term survival in selected patients with multiple metachronous sequential metastases from RCC.
基金This work is supported by Special Funds for Fundamental Scientific Research Funds of Central Universities(JUSRP21115)the Independent Research Project Funding Project of Jiangsu Key Laboratory of Advanced Food Manufacturing Equipment Technology(FMZ201902).
文摘Some petroleum-based packaging materials have a series of safety issues,and as a result,people are more inclined to use biodegradable and nontoxic packaging materials for foods.However,biodegradable alternatives often need to be modified to overcome their own shortcomings.In this paper,carboxymethyl chitosan(CMCS)/carboxymethyl cellulose sodium(CMC)+polylactic acid(PLA)nano zinc oxide(ZnO)nanoparticles(CMCS/CMC+PLA/ZnO NPs)multilayer coated paperboard was prepared to explore its potential use in food package applications.The multilayer CMCS/CMC+PLA coating reduced the oxygen transmission rate by 99%and doubled the barrier properties for soybean oil penetration and water vapor compared with a single PLA coating layer in a 23℃/50 RH environment.The oil resistance time of the multilayer CMCS/CMC+PLA coating also increased 28 times,and the water vapor barrier properties increased twofold compared to a single CMCS/CMC coating layer.The water vapor barrier properties increased by a factor of 3 even at 38℃/90 RH.Compared with the CMCS/CMC+PLA coating without nanoparticles,the barrier performance of the CMCS/CMC+PLA/ZnO NPs coating was further improved.The oxygen,water vapor,and heptane vapor barrier properties all doubled,and the oil resistance time reached 235 h.While a corona treatment reduced the polar component content in the CMCS/CMC coating and led to a slight decrease in the barrier properties of the coating to heptane,it was still a good oil-repellent coating overall.The antibacterial activity(A)toward Escherichia coli and Staphylococcus aureus exceeded 2,which meant that the multilayer coating with 1.5%added ZnO NPs reduced the growth of bacteria by more than 99%.The multilayer coated paperboard created here with the blended and modified materials significantly improved the barrier and antibacterial properties,suggesting that multilayer coatings prepared from degradable materials have good commercial prospects as fast food packaging.
文摘BACKGROUND The direct anterior approach for total hip arthroplasty(DAA-THA)is increasing in popularity due to some advantages such as less surgical trauma,minimal dissection of soft tissues,shorter rehabilitation times,faster return to daily activities,lower incidence of dislocation.On the other hand,the literature reports a high rate of intraoperative complications,with many different rates and complication types in the published papers.AIM To analyze our complications comparing results with the literature;to report measures that we have taken to reduce complications rate.METHODS All DAA-THA patients with one year minimum follow up who were operated at a single high-volume centre,between January 2010 and December 2019 were included in this retrospective study.All surgeries were performed using cementless short anatomical or straight stems and press fit cups.Patients’followup was performed,at 6 wk,3 mo,then annually post-surgery with clinical and radiological evaluation.Primary outcomes were stem revision for aseptic loosening and all-cause stem revision.Second outcome was intra-operative and post-operative complications identification.RESULTS A total of 394 patients underwent DDA-THA from January 2010 and December 2019,for a total of 412 hips;twelve patients lost to follow-up and one patient who died from causes not related to surgery were excluded from the study.The average age at the time of surgery was 61 years(range from 28 to 78 years).Mean follow-up time was 64.8 mo(range 12-120 mo).Seven stems were revised.One cortical perforation,one trochanteric and lateral cortical wall intraoperative fracture,one diaphyseal fracture,three clinically symptomatic early subsidence and one late aseptic loosening.We also observed 3 periprosthetic fractures B1 according to the Vancouver Classification.Other minor complications not requiring stem revision were 5 un-displaced fractures of the calcar region treated with preventive cerclage,one early infection,one case of late posterior dislocation,18 case of asymptomatic ste
基金This project was supported by the National Natural Science Foundation of China ( 60496314).
文摘A low complexity Per-Antenna Power Control （PAPC） approach based on Minimum Mean Squared Error （MMSE） detection for V-BLAST is proposed in this paper. The PAPC approach is developed for minimizing the Bit Error Rate （BER） averaged over all substreams when the data throughput and the total transmit power keep constant over time. Simulation results show that the Power-controlled V-BLAST （P-BLAST） outperforms the conventional V-BLAST in terms of BER performance with MMSE detector, especially in presence of high spatial correlation between antennas. However, the additional complexity for P-BLAST is not high. When MMSE detector is adopted, the P-BLAST can achieve a comparable BER performance to that of conventional V-BLAST with Maximum Likelihood （ML） detector but with low complexity.
