Objective:To establish extensively drug-resistant Pseudomonas aeruginosa(XDR-PA)infection-induced pneumonia model in rats.Methods:Twenty-four male SD rats were randomly divided into blank group,low bacterial group,med...Objective:To establish extensively drug-resistant Pseudomonas aeruginosa(XDR-PA)infection-induced pneumonia model in rats.Methods:Twenty-four male SD rats were randomly divided into blank group,low bacterial group,medium bacterial group,and high bacterial group.The low,medium and high bacterial groups were given intratracheal instillation of 0.1 mL of bacterial suspension(bacterial concentration in turn is 7.5×10^(9),3×10^(10),6×10^(10)CFU/mL),while the blank group were given the same volume of sterile normal saline.After modeling,the general conditions of rats in each group were observed,including mental state,hair,respiration,activity,eating,weight,and the survival curve was drawn.The pathological characteristics of lung tissue and the infiltration of inflammatory cells were observed.Pathogenic identification of each group was carried out by bacterial culture of lung tissue homogenate.Results:The general state of the blank group was normal,and the rats in other groups showed signs of mental depression,bristling,shortness of breath,even oral and nasal bleeding,decreased food intake and activity,and significant weight loss,and different degrees of death within 48 hours,the difference was statistically significant(P<0.05).Pathological results showed that the alveolar structure of rats in the blank group was complete,and the alveolar space was clear without exudation.The lung tissue of the low and medium bacterial groups showed obvious inflammatory cell infiltration,alveolar structure destruction,alveolar septum thickening,interstitial edema,but the pathological damage of the medium group was more severe,with a mortality rate of up to 50%,and the mortality rate of the low bacterial group was 17%.In the high bacterial group,red blood cells,inflammatory cells and a large amount of fibrin-like exudation can be seen in the alveolar space,which has the pathological characteristics of acute respiratory failure,and the mortality rate is as high as 67%.The results of bacterial culture of lung tissue homogenate showed that the blank group had no bacterial colonies,while PA colony growth can be seen in low,medium and high bacterial groups.Conclusion:9 Intratracheal instillation of low bacterial count(0.1 mL of 7.5×10^(9) CFU/mL)XDR-PA bacterial suspension can successfully construct a rat pneumonia model of XDR-PA infection.展开更多
Rationale:Longitudinally extensive transverse myelitis(LETM)is a rare inflammatory demyelinating disease predominantly associated with autoimmune and inflammatory disorders.Scrub typhus can cause a variety of neurolog...Rationale:Longitudinally extensive transverse myelitis(LETM)is a rare inflammatory demyelinating disease predominantly associated with autoimmune and inflammatory disorders.Scrub typhus can cause a variety of neurological complications,which may result in poor recovery and long-term disability.This report reveals a rare linkage between LETM and scrub typhus.Patient concerns:A 24-year-old female presented with a history of fever for 10 days associated with progressive quadriparesis.Physical examination revealed bilateral lower limb weakness(grade 0/5)and bilateral upper limb weakness(grade 2/5)with reduced sensation below the T3 dermatome.Diagnosis:Scrub typhus presenting with longitudinally extensive transverse myelitis.Interventions:Steroid pulse therapy with antibiotics supported by early intensive rehabilitation.Outcomes:Complete recovery was achieved.Lessons:This case report highlights the importance of considering scrub typhus as a potential cause of LETM in endemic regions,particularly in patients presenting with febrile illness and neurological symptoms.展开更多
Because of environmental constraints,beef cattle was for more than a century the only viable farming option in the extensive semiarid and subhumid lands of Argentina and the main source of nutrients for humans as well...Because of environmental constraints,beef cattle was for more than a century the only viable farming option in the extensive semiarid and subhumid lands of Argentina and the main source of nutrients for humans as well.However,a growing concern and criticism have risen today about its possible negative impact on the climate and the environment.These worries tend to affect current public opinions,national policies,and international trade.Based on 40 beef cattle farms scattered across different semiarid and subhumid regions of Argentina,here we evaluated the impact of extensive cattle production on carbon,water,and nutrient pollution.Life-Cycle Assessment(LCA)and Land-Based Assessment(LBA)were the two approaches we used here to compare the environmental impact of beef production.While the environmental footprint(EF)resulting from LCA expresses the impact per unit of food,the environmental balance(EB),derived from LBA,aims at quantifying the impact per unit of land.As such,the EB considers both negative and positive impacts on the farm as an integrated system.Following standardized procedures,we evaluated EF and EB up to the farm gate,leaving aside delocalized post-farm impacts such as those of processing,packaging,and transportation that occur beyond the farm gate.In agreement with previous evidence,our results show that the EF tends to decrease as per-head production increases.Correlation coefficients and statistical significance were the following for carbon(R=−0.574;p<0.01),water(R=−0.561;p<0.01),and N(R=−0.704;p<0.01)and Phosphorus(P)pollution(R=−0.802;p<0.01)footprints.On the contrary,the EB seems to be highly sensitive,and as per-hectare beef production increases.Correlations were the following for carbon emissions(CE:R=0.955;p<0.01),water consumption(WC:R=0.822;p<0.01),nitrogen excretion(NE:R=0.948;p<0.01)and phosphorus excretion(PE:R=0.945;p<0.01).What our results suggest is that the notion of EF is useful to evaluate the environmental impact in intensive beef production systems,and the EB is suitable to assess the impact of the extensive ones.In practice,both approaches provide different perspectives on the environmental-impact problem and they should be complementary used.We concluded that the methodological rigidity of EF does not allow proper discrimination among farms in the extensive systems.On the contrary,the EB approach tended to be highly sensitive to detecting differences between individual farms and farmers,thus allowing the identification of successful options for extensive beef production in terms of public image,policy-making,and commercial opportunities.展开更多
AIM: To evaluate the epidemiology and outcomes of culture-positive spontaneous bacterial peritonitis (SBP) and spontaneous bacteremia (SB) in decompensated cirrhosis.METHODS: We prospectively collected clinical, labor...AIM: To evaluate the epidemiology and outcomes of culture-positive spontaneous bacterial peritonitis (SBP) and spontaneous bacteremia (SB) in decompensated cirrhosis.METHODS: We prospectively collected clinical, laboratory characteristics, type of administered antibiotic, susceptibility and resistance of bacteria to antibiotics in one hundred thirty cases (68.5% males) with positive ascitic fluid and/or blood cultures during the period from January 1, 2012 to May 30, 2014. All patients with SBP had polymorphonuclear cell count in ascitic fluid > 250/mm<sup>3</sup>. In patients with SB a thorough study did not reveal any other cause of bacteremia. The patients were followed-up for a 30-d period following diagnosis of the infection. The final outcome of the patients was recorded in the end of follow-up and comparison among 3 groups of patients according to the pattern of drug resistance was performed.RESULTS: Gram-positive-cocci (GPC) were found in half of the cases. The most prevalent organisms in a descending order were Escherichia coli (33), Enterococcus spp (30), Streptococcus spp (25), Klebsiella pneumonia (16), S. aureus (8), Pseudomanas aeruginosa (5), other Gram-negative-bacteria (GNB) (11) and anaerobes (2). Overall, 20.8% of isolates were multidrug-resistant (MDR) and 10% extensively drug-resistant (XDR). Health-care-associated (HCA) and/or nosocomial infections were present in 100% of MDR/XDR and in 65.5% of non-DR cases. Meropenem was the empirically prescribed antibiotic in HCA/nosocomial infections showing a drug-resistance rate of 30.7% while third generation cephalosporins of 43.8%. Meropenem was ineffective on both XDR bacteria and Enterococcus faecium (E. faecium). All but one XDR were susceptible to colistin while all GPC (including E. faecium) and the 86% of GNB to tigecycline. Overall 30-d mortality was 37.7% (69.2% for XDR and 34.2% for the rest of the patients) (log rank, P = 0.015). In multivariate analysis, factors adversely affecting outcome included XDR infection (HR = 2.263, 95%CI: 1.005-5.095, P = 0.049), creatinine (HR = 1.125, 95%CI: 1.024-1.236, P = 0.015) and INR (HR =1.553, 95%CI: 1.106-2.180, P = 0.011).CONCLUSION: XDR bacteria are an independent life-threatening factor in SBP/SB. Strategies aiming at restricting antibiotic overuse and rapid identification of the responsible bacteria could help improve survival.展开更多
BACKGROUND Bedaquiline is among the prioritized drugs recommended by the World Health Organization for the treatment of extensively drug-resistant tuberculosis(XDRTB).Many patients have not achieved better clinical im...BACKGROUND Bedaquiline is among the prioritized drugs recommended by the World Health Organization for the treatment of extensively drug-resistant tuberculosis(XDRTB).Many patients have not achieved better clinical improvement after bedaquiline is stopped at 24 wk.However,there is no recommendation or guideline on bedaquiline administration beyond 24 wk,which is an important consideration when balancing the benefit of prognosis for XDR-TB against the uncertain safety concerning the newer antibiotics.CASE SUMMARY This paper reported 2 patients with XDR-TB(a female of 58 years of age and a female of 18 years of age)who received bedaquiline for 36 wk,as local experience to be shared.The 2 cases had negative cultures after 24 wk of treatment,but lung imaging was still positive.After discussion among experts,the consensus was made to bedaquiline prolongation by another 12 wk.The 36-wk prolonged use of bedaquiline in both cases achieved a favorable response without increasing the risk of cardiac events or new safety signals.CONCLUSION Longer regimen,including 36-wk bedaquiline treatment,might be an option for patients with XDR-TB.More studies are needed to explore the effectiveness and safety of prolonged use of bedaquiline for 36 wk vs standard 24 wk in the treatment of multidrug-resistant/XDR-TB or to investigate further the biomarkers and criteria indicative for extension of bedaquline to facilitate clinical use of thisnovel drug.展开更多
BACKGROUND Pyogenic ventriculitis caused by extensively drug-resistant Acinetobacter baumannii(A.baumannii)is one of the most severe complications associated with craniotomy.However,limited therapeutic options exist f...BACKGROUND Pyogenic ventriculitis caused by extensively drug-resistant Acinetobacter baumannii(A.baumannii)is one of the most severe complications associated with craniotomy.However,limited therapeutic options exist for the treatment of A.baumannii ventriculitis due to the poor penetration rate of most antibiotics through the blood-brain barrier.CASE SUMMARY A 68-year-old male patient with severe traumatic brain injury developed pyogenic ventriculitis on postoperative day 24 caused by extensively drug-resistant A.baumannii susceptible to tigecycline only.Successful treatment was accomplished through multi-route administration of tigecycline,including intravenous combined with continuous ventricular irrigation plus intraventricular administration.The pus was cleared on the 3rd day post-irrigation,and cerebrospinal fluid cultures were negative after 12 d.CONCLUSION Our findings suggest that multi-route administration of tigecycline can be a therapeutic option against pyogenic ventriculitis caused by extensively drugresistant A.baumannii.展开更多
Rationale:Salmonella(S.)typhi is a rare cause of osteomyelitis in immunocompetent adults.Extensive drug resistance(XDR)may lead to more complicated cases of S.typhi osteomyelitis.Patient concern:A 55-year-old female p...Rationale:Salmonella(S.)typhi is a rare cause of osteomyelitis in immunocompetent adults.Extensive drug resistance(XDR)may lead to more complicated cases of S.typhi osteomyelitis.Patient concern:A 55-year-old female presented with a persistent low-grade fever and a swelling on her lower left chest with a sinus discharging purulent fluid for the past 8 months.Her symptoms had been unresponsive to previous anti-microbial therapy.Diagnosis:Rib osteomyelitis caused by XDR S.typhi.Interventions:Surgical wound debridement,left 7th-9th rib resection and intravenous Ⅳ meropenem were done.Outcome:Fever resolved and left-sided swelling resected without recurrence.Lessons:The prevalence of XDR S.typhi is growing in South Asia and should be considered as the differential diagnosis of chronic osteomyelitis.展开更多
A large number of anomalous extension twins,with low or even negative twinning Schmid factors,were found to nucleate and grow in a strongly textured Mg-1Al alloy during tensile deformation along the extruded direction...A large number of anomalous extension twins,with low or even negative twinning Schmid factors,were found to nucleate and grow in a strongly textured Mg-1Al alloy during tensile deformation along the extruded direction.The deformation mechanisms responsible for this behaviour were investigated through in-situ electron back-scattered diffraction,grain reference orientation deviation,and slip trace-modified lattice rotation.It was found that anomalous extension twins nucleated mainly at the onset of plastic deformation at or near grain boundary triple junctions.They were associated with the severe strain incompatibility between neighbour grains as a result from the differentbasal slip-induced lattice rotations.Moreover,the anomalous twins were able to grow with the applied strain due to the continuous activation ofbasal slip in different neighbour grains,which enhanced the strain incompatibility.These results reveal the complexity of the deformation mechanisms in Mg alloys at the local level when deformed along hard orientations.展开更多
Explosive cyclones(ECs)occur frequently over the Kuroshio/Kuroshio Extension region.The most rapidly intensified EC over the Kuroshio/Kuroshio Extension region during the 42 years(1979-2020)of cold seasons(October-Apr...Explosive cyclones(ECs)occur frequently over the Kuroshio/Kuroshio Extension region.The most rapidly intensified EC over the Kuroshio/Kuroshio Extension region during the 42 years(1979-2020)of cold seasons(October-April)was studied to reveal the variations of the key factors at different explosive-developing stages.This EC had weak low-level baroclinicity,mid-level cyclonic-vorticity advection,and strong low-level water vapor convergence at the initial explosive-developing stage.The low-level baroclinicity and mid-level cyclonic-vorticity advection increased substantially during the maximum-deepening-rate stage.The diagnostic analyses using the Zwack-Okossi equation showed that diabatic heating was the main contributor to the initial rapid intensification of this EC.The cyclonic-vorticity advection and warm-air advection enhanced rapidly in the middle and upper troposphere and contributed to the maximum rapid intensification,whereas the diabatic heating weakened slightly in the mid-low troposphere.The relative contribution of the diabatic heating decreased from the initial explosive-developing stage to the maximum-deepening-rate stage due to the enhancement of other factors(the cyclonic-vorticity advection and warm-air advection).Furthermore,the physical factors contributing to this EC varied with the explosive-developing stage.The non-key factors at the initial explosive-developing stage need attention to forecast the rapid intensification.展开更多
BACKGROUND Gastric cancer(GC)is one of the most common malignant tumors.After resection,one of the major problems is its peritoneal dissemination and recurrence.Some free cancer cells may still exist after resection.I...BACKGROUND Gastric cancer(GC)is one of the most common malignant tumors.After resection,one of the major problems is its peritoneal dissemination and recurrence.Some free cancer cells may still exist after resection.In addition,the surgery itself may lead to the dissemination of tumor cells.Therefore,it is necessary to remove residual tumor cells.Recently,some researchers found that extensive intraoperative peritoneal lavage(EIPL)plus intraperitoneal chemotherapy can improve the prognosis of patients and eradicate peritoneal free cancer for GC patients.However,few studies explored the safety and long-term outcome of EIPL after curative gastrectomy.AIM To evaluate the efficacy and long-term outcome of advanced GC patients treated with EIPL.METHODS According to the inclusion and exclusion criteria,a total of 150 patients with advanced GC were enrolled in this study.The patients were randomly allocated to two groups.All patients received laparotomy.For the non-EIPL group,peritoneal lavage was washed using no more than 3 L of warm saline.In the EIPL group,patients received 10 L or more of saline(1 L at a time)before the closure of the abdomen.The surviving rate analysis was compared by the Kaplan-Meier method.The prognostic factors were carried out using the Cox appropriate hazard pattern.RESULTS The basic information in the EIPL group and the non-EIPL group had no significant difference.The median follow-up time was 30 mo(range:0-45 mo).The 1-and 3-year overall survival(OS)rates were 71.0%and 26.5%,respectively.The symptoms of ileus and abdominal abscess appeared more frequently in the non-EIPL group(P<0.05).For the OS of patients,the EIPL,Borrmann classification,tumor size,N stage,T stage and vascular invasion were significant indicators.Then multivariate analysis revealed that EIPL,tumor size,vascular invasion,N stage and T stage were independent prognostic factors.The prognosis of the EIPL group was better than the non-EIPL group(P<0.001).The 3-year survival rate of the EIPL group(38.4%)was higher than the non-EIPL group(21.7%).For the recurrence-free survival(RFS)of patients,the risk factor of RFS included EIPL,N stage,vascular invasion,type of surgery,tumor location,Borrmann classification,and tumor size.EIPL and tumor size were independent risk factors.The RFS curve of the EIPL group was better than the non-EIPL group(P=0.004),and the recurrence rate of the EIPL group(24.7%)was lower than the non-EIPL group(46.4%).The overall recurrence rate and peritoneum recurrence rate in the EIPL group was lower than the non-EIPL group(P<0.05).CONCLUSION EIPL can reduce the possibility of perioperative complications including ileus and abdominal abscess.In addition,the overall survival curve and RFS curve were better in the EIPL group.展开更多
Background: Drug-resistant epilepsy can be defined as the existence of seizures within 6 months, despite adequate therapy regimens with one or more antiepileptic drugs. Epilepsy surgery has been the standard therapy t...Background: Drug-resistant epilepsy can be defined as the existence of seizures within 6 months, despite adequate therapy regimens with one or more antiepileptic drugs. Epilepsy surgery has been the standard therapy to help those patients who suffer from drug-resistant epilepsy. The goal of this surgery is to halt or reduce the intensity of seizures. This literature review aims to provide an overview of existing surgical procedures for the treatment of drug-resistant epilepsy and the degree of seizure control they provide based on available literature. Methods: Data were collected from medical journal databases, aggregators, and individual publications. The most used databases were PubMed, Medline and NCBI. Some of the keywords used to search these databases include: “drug resistant epilepsy”, “seizure control”, and “neurosurgery”. Results: Epileptic surgery is divided into resective and non-resective procedures. Studies have shown that a full resection of the epileptogenic brain area increases the probability of seizure eradication, however, the risks of postoperative impairments grow as the resection area is extended. On the other hand, patients who are unsuitable for seizure focus removal by resective surgery, such as those with multifocal seizures or overlapping epileptogenic zone with a functional cortex, may benefit from non-resective surgical options such as Vagus Nerve Stimulation and Responsive Neurostimulation. Conclusion: This literature review discusses the comprehensive treatment of epilepsy, especially the surgical treatment of drug-resistant epilepsy. The reviewed studies have shown that epilepsy surgery has promising outcomes in achieving seizure freedom/reducing seizure frequency with minimal adverse effects when performed correctly with the appropriate choice of surgical candidates.展开更多
In the case of reverse drag of normal faulting, the displacement and horizontal extension are determined based on the established equations for the three mechanisms: rigid body, vertical shear and inclined shear. Ther...In the case of reverse drag of normal faulting, the displacement and horizontal extension are determined based on the established equations for the three mechanisms: rigid body, vertical shear and inclined shear. There are three sub-cases of basal detachment for the rigid body model: horizontal detachment, antithetic detachment and synthetic detachment. For the rigid body model, the established equations indicate that the total displacement on the synthetic base (D<sub>t2</sub>) is the largest, that on the horizontal base (D<sub>t1</sub>) is moderate, and that on the antithetic base (D<sub>t3</sub>) is the smallest. On the other hand, the value of (D<sub>t1</sub>) is larger than the displacement for the vertical shear (D<sub>t4</sub>). The value of (D<sub>t1</sub>) is larger than or less than the displacement for the inclined shear (D<sub>t5</sub>) depending on the original fault dip δ<sub>0</sub>, bedding angle θ, and the angle of shear direction β. For all original parameters, the value of D<sub>t5</sub> is less than the value of D<sub>t4</sub>. Also, by comparing three rotation mechanisms, we find that the inclined shear produces largest extension, the rigid body model with horizontal detachment produces the smallest extension, and the vertical shear model produces moderate extension.展开更多
The study analysed the digital skill gap of agricultural extension personnel on the use of digital technologies for extension services delivery in South-East, Nigeria. The specific objectives were to describe the soci...The study analysed the digital skill gap of agricultural extension personnel on the use of digital technologies for extension services delivery in South-East, Nigeria. The specific objectives were to describe the socioeconomic characteristics of agricultural extension personnel in South-East Nigeria and identify the digital skill gaps among agricultural extension personnel in the area of study. Purposive sampling technique was used to select 364 Agricultural Extension personnel for the study. Data were collected through the use of structured questionnaire and were analysed using simple descriptive statistical tools such as percentages, mean score, and standard deviation. Findings indicated that most of the personnel were male (57.8%), within the age bracket of 38 - 47 years (62.9%), had B.Sc./HND as their highest educational qualification (74.7%), married (86.3%), and had a household size of 6 - 10 Persons (57.7%). It was further revealed that the majority (70.1%) were members of professional organization, earned a monthly income of N50,001.00 - N100,000.00 (65.7%), had a work experience of 11 - 15 years (51.1%), and owned a smartphone/ iPad/laptop (91.5%). Findings further indicated that they had moderate skill gap in Basic Computer skills (Mean = 4.32), and digital communication and collaboration skills (Mean = 4.26). Findings also showed that they had a high skill gap in digital technical skills (Mean = 2.46), digital data analysis skills (Mean = 2.09), digital content creation skills (Mean = 2.43), digital ethical skills (Mean = 2.79), multimedia production skills (Mean = 2.81), and video library management skills (Mean = 2.39). The study concluded that though there exists a high digital skill gap among agricultural extension personnel in South-East, Nigeria, their socioeconomic characteristics are capable of supporting the implementation of digital extension services in the area. The study recommended that the management of Agricultural Development Programs in South-East, Nigeria, should provide digital training for extension personnel to close the digital skill gap that currently exists among the personnel.展开更多
The study comparatively analysed the socioeconomic characteristics and digital literacy level of Agricultural Extension personnel (AEP) in Ebonyi and Imo States, South-East, Nigeria. The specific objectives were to de...The study comparatively analysed the socioeconomic characteristics and digital literacy level of Agricultural Extension personnel (AEP) in Ebonyi and Imo States, South-East, Nigeria. The specific objectives were to describe the socioeconomic characteristics of agricultural extension personnel in Ebonyi and Imo States, and to ascertain the digital literacy level of AEP in the studied states. Purposive sampling technique was used to select 312 Agricultural Extension personnel (132 from Ebonyi State Agricultural Development Program and 180 from Imo State Agricultural Development Program) for the study. Data were collected through the use of validated and structured questionnaire, and administered through the help of well-trained enumerators. Data were analysed using simple descriptive statistical tools such as percentages mean score, standard deviation and weighted mean. Findings indicated that they were more male in the both States (55.3% and 57.8%) for Ebonyi and Imo State respectively and that the average age of AEP in Ebonyi and Imo States were 44.7 years and 49.2 years respectively. It was further revealed that the majority (77.3% and 82.8%) had B.Sc./HND as their highest academic qualifications, belonged to professional organisations (62.1% and 75%), and were earning an average monthly income of N58,798 and N62,648 for Ebonyi and Imo State respectively. Also, it was revealed that their mean years of service were 12.4 years and 13.4 years for Ebonyi and Imo State respectively. Almost all of them (87.9% and 95.0%) own a smartphone, had access to the internet (80.3% and 90.0%), but do not own a laptop/ipad (82.6% and 72.8%) for Ebon-yi and Imo State respectively. Results further revealed that Agricultural extension personnel in both Ebonyi and Imo State respectively had low digital literacy level ( = 2.41 and 2.32). The study concluded that AEP in Ebonyi and Imo State respectively had similar socioeconomic characteristics and low level of digital literacy. The study recommended that the management of ADPs in both Ebonyi and Imo State should ensure the training of AEP in digital skills to enhance their digital literacy level to enable them use digital technologies in their work.展开更多
The efficient development and exploitation of shale oil depends on long-distance horizontal wells. As the degreeof cleaning of the wellbore plays a key role in these processes, in this study, this problem is investiga...The efficient development and exploitation of shale oil depends on long-distance horizontal wells. As the degreeof cleaning of the wellbore plays a key role in these processes, in this study, this problem is investigated experimentallyby focusing on the dimensionless cuttings bed height. A method is proposed to calculate the horizontalwellhydraulic extension taking into account the influence of the wellbore cleaning degree on the wellborepressure distribution and assess the effect of a variety of factors such as the bottom hole pressure, the circulatingpressure drop, the drilling pump performance and the formation properties. The analysis shows that the hydraulicextension of horizontal wells decreases with an increase in the cuttings bed height, and the higher the displacementof drilling fluid, the faster the hydraulic extension declines. The annular pressure drop of the horizontalsection increases with the increase of the cuttings bed height, resulting in a higher bottom-hole pressure. Severalarguments are provided to guide the safe drilling of shale oil horizontal wells and overcome the limits of currenttechnological approaches.展开更多
Background:The target definition of consolidation radiotherapy(RT)for extensive stage small-cell lung cancer(ES-SCLC)has not been standardized.This study aimed to demonstrate the feasibility of post-chemotherapy based...Background:The target definition of consolidation radiotherapy(RT)for extensive stage small-cell lung cancer(ES-SCLC)has not been standardized.This study aimed to demonstrate the feasibility of post-chemotherapy based consolidation RT in ES-SCLC.Methods:All ES-SCLC patients without initial brain metastases who completed≥4 cycles of systemic therapy at Department of Radiation and Medical Oncology,Zhongnan Hospital of Wuhan University from 2012 to 2021 were included in this retrospective study.We correlated the site of first recurrence to the post-chemotherapy-based radiation volume(small-field).Relapse pattern,progression-free survival(PFS)and overall survival(OS)were compared between those received and did not receive consolidation RT.Results:A total of 152 patients were followed up for a median of 31.7 months(interquartile range[IQR],23.9-39.6 months).The median PFS and OS of the cohort were 8.3 months(IQR,6.1-11.2 months)and 16.2 months(IQR,9.9-24.9 months),respectively.Thoracic consolidation RT served not only as an independent prognostic factor for improved PFS in the entire cohort,but also significantly prolonged OS in the subgroup without syn-chronous liver metastases.Small-field consolidation RT markedly reduced in-field recurrences(hazard ratio[HR],0.28[95%CI,0.12-0.38];P<0.001)without increasing out-of-field recurrences(HR,0.40[95%CI,0.13-1.16];P=0.080).No relapse was observed at the margin of the targets.Treatment-related toxicities were moderate,with grade 3 acute radiation pneumonia,radiation esophagitis,and bone marrow suppression rates of 8.3%,3.1%,and 12.5%,respectively.No grade 5 toxicity occurred.Conclusion:Small-field consolidation RT based on post-chemotherapy volume is safe and can significantly im-prove local control in ES-SCLC.展开更多
This paper uses the HS2 extension cancellation in November 2021 as a quasi-experiment to study its impact on house prices and rents in Leeds.Using a DiD approach on repeat sales and monthly rents,I compare property va...This paper uses the HS2 extension cancellation in November 2021 as a quasi-experiment to study its impact on house prices and rents in Leeds.Using a DiD approach on repeat sales and monthly rents,I compare property values near the HS2 station and proposed construction site before and after the announcement.Results show a 3.6%decrease in house prices and a 3.9%decline in rents near the station,while properties near the construction site experienced a 2.4%increase in prices and a 2.1%rise in rents.This is the first paper to analyse the HS2 cancellation effect using panel data methods.展开更多
Background: The emergence of carbapenemase producing Acinetobacter baumannii is increasingly reported nowadays and constitutes a major problem to the intensive care unit (ICU) patients with notable extensive-drug resi...Background: The emergence of carbapenemase producing Acinetobacter baumannii is increasingly reported nowadays and constitutes a major problem to the intensive care unit (ICU) patients with notable extensive-drug resistance ability. The study investigates carbapenemase producing A. baumannii strains exhibiting an extensively drug-resistant (XDR) phenotype, isolated from ICU patients in Khartoum. Methods: A total of 100 nonduplicate Gram-negative coccobacilli strains were obtained from microbiology laboratory of ICU patients’ clinical isolates. Molecular identification of A. baumannii was performed by targeting 16S rRNA gene using specifically designed primers. Then, XDR strains were determined by susceptibility testing (disc diffusion). For detection of carbapenemase genes Polymerase chain reaction (PCR) was carried out. Result: Of 100 ICU clinical isolates, 38 (38.0%) was confirmed A. baumannii strains, those strains showed 100% carbapenem resistance and 60.5% extensive drug resistance to the antibiotics tested. The frequency of carbapenemase producer was 57.9% (22/38) of carbapenem resistance A. baumannii (CRAB). The most common carbapenemase associated with resistance was blaOXA gene followed by blaNDM and blaGES A. baumannii isolates. The co-occurrence of blaOXA-48-like and blaNDM, blaOXA-23-like and blaOXA-51, and blaNDM-1 and blaOXA-51 was detected in 22.7%, 18.2% strains and 4.5% respectively. A unique characteristic of our findings was the coharbouring of the genes blaNDM-1, blaOXA-23-like, blaOXA-51 and blaOXA-143 in 9.1% strains (2/22), and this was the first report in the Khartoum city, Sudan. Conclusion: We have demonstrated for the first time a high prevalence of XDR-carbapenemase producing A. baumannii clinical isolates from ICU patients in Khartoum. Also an emergent blaOXA-143 was reported as High-Risk Clones. This highlights the routine mentoring of XDR-carbapenemase producing A. baumannii to avoid clone dissemination in our region hospitals.展开更多
Background Tuberculosis(TB),caused by Mycobacterium tuberculosis,remains the second leading cause of death from a single infectious disease globally and poses a significant economic and clinical burden in the world in...Background Tuberculosis(TB),caused by Mycobacterium tuberculosis,remains the second leading cause of death from a single infectious disease globally and poses a significant economic and clinical burden in the world in 2022.Of particular concern is the emergence of drug-resistant TB,accounting for 15%-20%of TB deaths.It is imperative to delve into the global trends of incidence and death rate for multidrug-resistant tuberculosis(MDR-TB)and extensively drug-resistant tuberculosis(XDR-TB),drawing upon the comprehensive Global Burden of Disease(GBD)2021 drug-resistant tuberculosis dataset.Methods From the GBD 2021,data on incidence,prevalence,disability-adjusted life years(DALYs),and death of MDR-TB and XDR-TB from 1990 to 2021 were collected.We calculated the estimated annual percentage changes in age standardized incidence rate(ASIR)and age-standardized death rate(ASDR),segmented by age,sex,and socio-demographic index(SDI).The impacts of various risk factors on MDR-TB and XDR-TB were also analyzed.Results In 2021,there were an estimated 443,680(95%uncertainty interval[UI]:259,196-766,545)incident cases of MDR-TB,and an estimated 106,818(95%UI:41,612-211,854)death cases of MDR-TB,while there were an estimated 24,036(95%UI:17,144-34,587)incident cases of XDR-TB and 7,946(95%UI:3,326-14,859)death cases of XDR-TB.The incidence and death cases of MDR-TB were lowest in high SDI regions,whereas the incidence rates of XDR-TB in high-middle SDI regions were higher than those in middle SDI and high SDI regions.Conclusion This study reported the disease burden of drug-resistant TB from 1990 to 2021.Until 2021,drug-resistant TB is still a serious problem in low SDI countries,especially for high-risk age populations with high-risk factors.Controlling drug-resistant TB requires effective control strategies and healthcare systems.展开更多
Researches on foreign language extensive reading program indicate that students can improve their foreign language reading ability,and develop positive attitudes toward reading and increased motivation to read.Compari...Researches on foreign language extensive reading program indicate that students can improve their foreign language reading ability,and develop positive attitudes toward reading and increased motivation to read.Comparing to the other types of reading.(skimming,scanning,and intensive reading.),reading extensively can result in gains in vocabulary and other aspects of foreign language learning.Teachers should provide various experience and make students have the chance to enjoy reading.and give them more guidance on developing certain reading skills.展开更多
基金Science and Technology Projects in Key Fields of Traditional Chinese Medicine in Tianjin(No.2021010)Discipline Development Fund of First Teaching Hospital of Tianjin University of Traditional Chinese Medicine(No.XKJJ201734)。
文摘Objective:To establish extensively drug-resistant Pseudomonas aeruginosa(XDR-PA)infection-induced pneumonia model in rats.Methods:Twenty-four male SD rats were randomly divided into blank group,low bacterial group,medium bacterial group,and high bacterial group.The low,medium and high bacterial groups were given intratracheal instillation of 0.1 mL of bacterial suspension(bacterial concentration in turn is 7.5×10^(9),3×10^(10),6×10^(10)CFU/mL),while the blank group were given the same volume of sterile normal saline.After modeling,the general conditions of rats in each group were observed,including mental state,hair,respiration,activity,eating,weight,and the survival curve was drawn.The pathological characteristics of lung tissue and the infiltration of inflammatory cells were observed.Pathogenic identification of each group was carried out by bacterial culture of lung tissue homogenate.Results:The general state of the blank group was normal,and the rats in other groups showed signs of mental depression,bristling,shortness of breath,even oral and nasal bleeding,decreased food intake and activity,and significant weight loss,and different degrees of death within 48 hours,the difference was statistically significant(P<0.05).Pathological results showed that the alveolar structure of rats in the blank group was complete,and the alveolar space was clear without exudation.The lung tissue of the low and medium bacterial groups showed obvious inflammatory cell infiltration,alveolar structure destruction,alveolar septum thickening,interstitial edema,but the pathological damage of the medium group was more severe,with a mortality rate of up to 50%,and the mortality rate of the low bacterial group was 17%.In the high bacterial group,red blood cells,inflammatory cells and a large amount of fibrin-like exudation can be seen in the alveolar space,which has the pathological characteristics of acute respiratory failure,and the mortality rate is as high as 67%.The results of bacterial culture of lung tissue homogenate showed that the blank group had no bacterial colonies,while PA colony growth can be seen in low,medium and high bacterial groups.Conclusion:9 Intratracheal instillation of low bacterial count(0.1 mL of 7.5×10^(9) CFU/mL)XDR-PA bacterial suspension can successfully construct a rat pneumonia model of XDR-PA infection.
文摘Rationale:Longitudinally extensive transverse myelitis(LETM)is a rare inflammatory demyelinating disease predominantly associated with autoimmune and inflammatory disorders.Scrub typhus can cause a variety of neurological complications,which may result in poor recovery and long-term disability.This report reveals a rare linkage between LETM and scrub typhus.Patient concerns:A 24-year-old female presented with a history of fever for 10 days associated with progressive quadriparesis.Physical examination revealed bilateral lower limb weakness(grade 0/5)and bilateral upper limb weakness(grade 2/5)with reduced sensation below the T3 dermatome.Diagnosis:Scrub typhus presenting with longitudinally extensive transverse myelitis.Interventions:Steroid pulse therapy with antibiotics supported by early intensive rehabilitation.Outcomes:Complete recovery was achieved.Lessons:This case report highlights the importance of considering scrub typhus as a potential cause of LETM in endemic regions,particularly in patients presenting with febrile illness and neurological symptoms.
文摘Because of environmental constraints,beef cattle was for more than a century the only viable farming option in the extensive semiarid and subhumid lands of Argentina and the main source of nutrients for humans as well.However,a growing concern and criticism have risen today about its possible negative impact on the climate and the environment.These worries tend to affect current public opinions,national policies,and international trade.Based on 40 beef cattle farms scattered across different semiarid and subhumid regions of Argentina,here we evaluated the impact of extensive cattle production on carbon,water,and nutrient pollution.Life-Cycle Assessment(LCA)and Land-Based Assessment(LBA)were the two approaches we used here to compare the environmental impact of beef production.While the environmental footprint(EF)resulting from LCA expresses the impact per unit of food,the environmental balance(EB),derived from LBA,aims at quantifying the impact per unit of land.As such,the EB considers both negative and positive impacts on the farm as an integrated system.Following standardized procedures,we evaluated EF and EB up to the farm gate,leaving aside delocalized post-farm impacts such as those of processing,packaging,and transportation that occur beyond the farm gate.In agreement with previous evidence,our results show that the EF tends to decrease as per-head production increases.Correlation coefficients and statistical significance were the following for carbon(R=−0.574;p<0.01),water(R=−0.561;p<0.01),and N(R=−0.704;p<0.01)and Phosphorus(P)pollution(R=−0.802;p<0.01)footprints.On the contrary,the EB seems to be highly sensitive,and as per-hectare beef production increases.Correlations were the following for carbon emissions(CE:R=0.955;p<0.01),water consumption(WC:R=0.822;p<0.01),nitrogen excretion(NE:R=0.948;p<0.01)and phosphorus excretion(PE:R=0.945;p<0.01).What our results suggest is that the notion of EF is useful to evaluate the environmental impact in intensive beef production systems,and the EB is suitable to assess the impact of the extensive ones.In practice,both approaches provide different perspectives on the environmental-impact problem and they should be complementary used.We concluded that the methodological rigidity of EF does not allow proper discrimination among farms in the extensive systems.On the contrary,the EB approach tended to be highly sensitive to detecting differences between individual farms and farmers,thus allowing the identification of successful options for extensive beef production in terms of public image,policy-making,and commercial opportunities.
文摘AIM: To evaluate the epidemiology and outcomes of culture-positive spontaneous bacterial peritonitis (SBP) and spontaneous bacteremia (SB) in decompensated cirrhosis.METHODS: We prospectively collected clinical, laboratory characteristics, type of administered antibiotic, susceptibility and resistance of bacteria to antibiotics in one hundred thirty cases (68.5% males) with positive ascitic fluid and/or blood cultures during the period from January 1, 2012 to May 30, 2014. All patients with SBP had polymorphonuclear cell count in ascitic fluid > 250/mm<sup>3</sup>. In patients with SB a thorough study did not reveal any other cause of bacteremia. The patients were followed-up for a 30-d period following diagnosis of the infection. The final outcome of the patients was recorded in the end of follow-up and comparison among 3 groups of patients according to the pattern of drug resistance was performed.RESULTS: Gram-positive-cocci (GPC) were found in half of the cases. The most prevalent organisms in a descending order were Escherichia coli (33), Enterococcus spp (30), Streptococcus spp (25), Klebsiella pneumonia (16), S. aureus (8), Pseudomanas aeruginosa (5), other Gram-negative-bacteria (GNB) (11) and anaerobes (2). Overall, 20.8% of isolates were multidrug-resistant (MDR) and 10% extensively drug-resistant (XDR). Health-care-associated (HCA) and/or nosocomial infections were present in 100% of MDR/XDR and in 65.5% of non-DR cases. Meropenem was the empirically prescribed antibiotic in HCA/nosocomial infections showing a drug-resistance rate of 30.7% while third generation cephalosporins of 43.8%. Meropenem was ineffective on both XDR bacteria and Enterococcus faecium (E. faecium). All but one XDR were susceptible to colistin while all GPC (including E. faecium) and the 86% of GNB to tigecycline. Overall 30-d mortality was 37.7% (69.2% for XDR and 34.2% for the rest of the patients) (log rank, P = 0.015). In multivariate analysis, factors adversely affecting outcome included XDR infection (HR = 2.263, 95%CI: 1.005-5.095, P = 0.049), creatinine (HR = 1.125, 95%CI: 1.024-1.236, P = 0.015) and INR (HR =1.553, 95%CI: 1.106-2.180, P = 0.011).CONCLUSION: XDR bacteria are an independent life-threatening factor in SBP/SB. Strategies aiming at restricting antibiotic overuse and rapid identification of the responsible bacteria could help improve survival.
文摘BACKGROUND Bedaquiline is among the prioritized drugs recommended by the World Health Organization for the treatment of extensively drug-resistant tuberculosis(XDRTB).Many patients have not achieved better clinical improvement after bedaquiline is stopped at 24 wk.However,there is no recommendation or guideline on bedaquiline administration beyond 24 wk,which is an important consideration when balancing the benefit of prognosis for XDR-TB against the uncertain safety concerning the newer antibiotics.CASE SUMMARY This paper reported 2 patients with XDR-TB(a female of 58 years of age and a female of 18 years of age)who received bedaquiline for 36 wk,as local experience to be shared.The 2 cases had negative cultures after 24 wk of treatment,but lung imaging was still positive.After discussion among experts,the consensus was made to bedaquiline prolongation by another 12 wk.The 36-wk prolonged use of bedaquiline in both cases achieved a favorable response without increasing the risk of cardiac events or new safety signals.CONCLUSION Longer regimen,including 36-wk bedaquiline treatment,might be an option for patients with XDR-TB.More studies are needed to explore the effectiveness and safety of prolonged use of bedaquiline for 36 wk vs standard 24 wk in the treatment of multidrug-resistant/XDR-TB or to investigate further the biomarkers and criteria indicative for extension of bedaquline to facilitate clinical use of thisnovel drug.
文摘BACKGROUND Pyogenic ventriculitis caused by extensively drug-resistant Acinetobacter baumannii(A.baumannii)is one of the most severe complications associated with craniotomy.However,limited therapeutic options exist for the treatment of A.baumannii ventriculitis due to the poor penetration rate of most antibiotics through the blood-brain barrier.CASE SUMMARY A 68-year-old male patient with severe traumatic brain injury developed pyogenic ventriculitis on postoperative day 24 caused by extensively drug-resistant A.baumannii susceptible to tigecycline only.Successful treatment was accomplished through multi-route administration of tigecycline,including intravenous combined with continuous ventricular irrigation plus intraventricular administration.The pus was cleared on the 3rd day post-irrigation,and cerebrospinal fluid cultures were negative after 12 d.CONCLUSION Our findings suggest that multi-route administration of tigecycline can be a therapeutic option against pyogenic ventriculitis caused by extensively drugresistant A.baumannii.
文摘Rationale:Salmonella(S.)typhi is a rare cause of osteomyelitis in immunocompetent adults.Extensive drug resistance(XDR)may lead to more complicated cases of S.typhi osteomyelitis.Patient concern:A 55-year-old female presented with a persistent low-grade fever and a swelling on her lower left chest with a sinus discharging purulent fluid for the past 8 months.Her symptoms had been unresponsive to previous anti-microbial therapy.Diagnosis:Rib osteomyelitis caused by XDR S.typhi.Interventions:Surgical wound debridement,left 7th-9th rib resection and intravenous Ⅳ meropenem were done.Outcome:Fever resolved and left-sided swelling resected without recurrence.Lessons:The prevalence of XDR S.typhi is growing in South Asia and should be considered as the differential diagnosis of chronic osteomyelitis.
基金supported by the project(MAD2DCM)-IMDEA Materials funded by Comunidad de Madrid and by the Recovery,Transformation and Resilience Plan and by NextGenerationEU from the European Union,and by the María de Maeztu seal of excellence from the Spanish Research Agency(CEX2018-000800-M)Mr.B.Yang wishes to express his gratitude for the support of the China Scholarship Council(202106370122).
文摘A large number of anomalous extension twins,with low or even negative twinning Schmid factors,were found to nucleate and grow in a strongly textured Mg-1Al alloy during tensile deformation along the extruded direction.The deformation mechanisms responsible for this behaviour were investigated through in-situ electron back-scattered diffraction,grain reference orientation deviation,and slip trace-modified lattice rotation.It was found that anomalous extension twins nucleated mainly at the onset of plastic deformation at or near grain boundary triple junctions.They were associated with the severe strain incompatibility between neighbour grains as a result from the differentbasal slip-induced lattice rotations.Moreover,the anomalous twins were able to grow with the applied strain due to the continuous activation ofbasal slip in different neighbour grains,which enhanced the strain incompatibility.These results reveal the complexity of the deformation mechanisms in Mg alloys at the local level when deformed along hard orientations.
基金jointly funded by the State Key Program of the National Natural Science Foundation of China(No.42130605)the Major Program of the National Natural Science Foundation of China(No.72293604)+5 种基金the Youth Innovative Talents Program of Guangdong Colleges and Universities(No.2022KQNCX026)the Natural Science Foundation of Shandong(No.ZR2022MD038)the Project of Enhancing School with Innovation of Guangdong Ocean University(No.230419106)the State Key Program of the National Natural Science Foundation of China(No.42130605)the National Natural Science Foundation of China(Nos.42275001,42276019,42205014,and 42275017)the Guangdong Ocean University Ph.D.Scientific Research Program(No.R19045).
文摘Explosive cyclones(ECs)occur frequently over the Kuroshio/Kuroshio Extension region.The most rapidly intensified EC over the Kuroshio/Kuroshio Extension region during the 42 years(1979-2020)of cold seasons(October-April)was studied to reveal the variations of the key factors at different explosive-developing stages.This EC had weak low-level baroclinicity,mid-level cyclonic-vorticity advection,and strong low-level water vapor convergence at the initial explosive-developing stage.The low-level baroclinicity and mid-level cyclonic-vorticity advection increased substantially during the maximum-deepening-rate stage.The diagnostic analyses using the Zwack-Okossi equation showed that diabatic heating was the main contributor to the initial rapid intensification of this EC.The cyclonic-vorticity advection and warm-air advection enhanced rapidly in the middle and upper troposphere and contributed to the maximum rapid intensification,whereas the diabatic heating weakened slightly in the mid-low troposphere.The relative contribution of the diabatic heating decreased from the initial explosive-developing stage to the maximum-deepening-rate stage due to the enhancement of other factors(the cyclonic-vorticity advection and warm-air advection).Furthermore,the physical factors contributing to this EC varied with the explosive-developing stage.The non-key factors at the initial explosive-developing stage need attention to forecast the rapid intensification.
文摘BACKGROUND Gastric cancer(GC)is one of the most common malignant tumors.After resection,one of the major problems is its peritoneal dissemination and recurrence.Some free cancer cells may still exist after resection.In addition,the surgery itself may lead to the dissemination of tumor cells.Therefore,it is necessary to remove residual tumor cells.Recently,some researchers found that extensive intraoperative peritoneal lavage(EIPL)plus intraperitoneal chemotherapy can improve the prognosis of patients and eradicate peritoneal free cancer for GC patients.However,few studies explored the safety and long-term outcome of EIPL after curative gastrectomy.AIM To evaluate the efficacy and long-term outcome of advanced GC patients treated with EIPL.METHODS According to the inclusion and exclusion criteria,a total of 150 patients with advanced GC were enrolled in this study.The patients were randomly allocated to two groups.All patients received laparotomy.For the non-EIPL group,peritoneal lavage was washed using no more than 3 L of warm saline.In the EIPL group,patients received 10 L or more of saline(1 L at a time)before the closure of the abdomen.The surviving rate analysis was compared by the Kaplan-Meier method.The prognostic factors were carried out using the Cox appropriate hazard pattern.RESULTS The basic information in the EIPL group and the non-EIPL group had no significant difference.The median follow-up time was 30 mo(range:0-45 mo).The 1-and 3-year overall survival(OS)rates were 71.0%and 26.5%,respectively.The symptoms of ileus and abdominal abscess appeared more frequently in the non-EIPL group(P<0.05).For the OS of patients,the EIPL,Borrmann classification,tumor size,N stage,T stage and vascular invasion were significant indicators.Then multivariate analysis revealed that EIPL,tumor size,vascular invasion,N stage and T stage were independent prognostic factors.The prognosis of the EIPL group was better than the non-EIPL group(P<0.001).The 3-year survival rate of the EIPL group(38.4%)was higher than the non-EIPL group(21.7%).For the recurrence-free survival(RFS)of patients,the risk factor of RFS included EIPL,N stage,vascular invasion,type of surgery,tumor location,Borrmann classification,and tumor size.EIPL and tumor size were independent risk factors.The RFS curve of the EIPL group was better than the non-EIPL group(P=0.004),and the recurrence rate of the EIPL group(24.7%)was lower than the non-EIPL group(46.4%).The overall recurrence rate and peritoneum recurrence rate in the EIPL group was lower than the non-EIPL group(P<0.05).CONCLUSION EIPL can reduce the possibility of perioperative complications including ileus and abdominal abscess.In addition,the overall survival curve and RFS curve were better in the EIPL group.
文摘Background: Drug-resistant epilepsy can be defined as the existence of seizures within 6 months, despite adequate therapy regimens with one or more antiepileptic drugs. Epilepsy surgery has been the standard therapy to help those patients who suffer from drug-resistant epilepsy. The goal of this surgery is to halt or reduce the intensity of seizures. This literature review aims to provide an overview of existing surgical procedures for the treatment of drug-resistant epilepsy and the degree of seizure control they provide based on available literature. Methods: Data were collected from medical journal databases, aggregators, and individual publications. The most used databases were PubMed, Medline and NCBI. Some of the keywords used to search these databases include: “drug resistant epilepsy”, “seizure control”, and “neurosurgery”. Results: Epileptic surgery is divided into resective and non-resective procedures. Studies have shown that a full resection of the epileptogenic brain area increases the probability of seizure eradication, however, the risks of postoperative impairments grow as the resection area is extended. On the other hand, patients who are unsuitable for seizure focus removal by resective surgery, such as those with multifocal seizures or overlapping epileptogenic zone with a functional cortex, may benefit from non-resective surgical options such as Vagus Nerve Stimulation and Responsive Neurostimulation. Conclusion: This literature review discusses the comprehensive treatment of epilepsy, especially the surgical treatment of drug-resistant epilepsy. The reviewed studies have shown that epilepsy surgery has promising outcomes in achieving seizure freedom/reducing seizure frequency with minimal adverse effects when performed correctly with the appropriate choice of surgical candidates.
文摘In the case of reverse drag of normal faulting, the displacement and horizontal extension are determined based on the established equations for the three mechanisms: rigid body, vertical shear and inclined shear. There are three sub-cases of basal detachment for the rigid body model: horizontal detachment, antithetic detachment and synthetic detachment. For the rigid body model, the established equations indicate that the total displacement on the synthetic base (D<sub>t2</sub>) is the largest, that on the horizontal base (D<sub>t1</sub>) is moderate, and that on the antithetic base (D<sub>t3</sub>) is the smallest. On the other hand, the value of (D<sub>t1</sub>) is larger than the displacement for the vertical shear (D<sub>t4</sub>). The value of (D<sub>t1</sub>) is larger than or less than the displacement for the inclined shear (D<sub>t5</sub>) depending on the original fault dip δ<sub>0</sub>, bedding angle θ, and the angle of shear direction β. For all original parameters, the value of D<sub>t5</sub> is less than the value of D<sub>t4</sub>. Also, by comparing three rotation mechanisms, we find that the inclined shear produces largest extension, the rigid body model with horizontal detachment produces the smallest extension, and the vertical shear model produces moderate extension.
文摘The study analysed the digital skill gap of agricultural extension personnel on the use of digital technologies for extension services delivery in South-East, Nigeria. The specific objectives were to describe the socioeconomic characteristics of agricultural extension personnel in South-East Nigeria and identify the digital skill gaps among agricultural extension personnel in the area of study. Purposive sampling technique was used to select 364 Agricultural Extension personnel for the study. Data were collected through the use of structured questionnaire and were analysed using simple descriptive statistical tools such as percentages, mean score, and standard deviation. Findings indicated that most of the personnel were male (57.8%), within the age bracket of 38 - 47 years (62.9%), had B.Sc./HND as their highest educational qualification (74.7%), married (86.3%), and had a household size of 6 - 10 Persons (57.7%). It was further revealed that the majority (70.1%) were members of professional organization, earned a monthly income of N50,001.00 - N100,000.00 (65.7%), had a work experience of 11 - 15 years (51.1%), and owned a smartphone/ iPad/laptop (91.5%). Findings further indicated that they had moderate skill gap in Basic Computer skills (Mean = 4.32), and digital communication and collaboration skills (Mean = 4.26). Findings also showed that they had a high skill gap in digital technical skills (Mean = 2.46), digital data analysis skills (Mean = 2.09), digital content creation skills (Mean = 2.43), digital ethical skills (Mean = 2.79), multimedia production skills (Mean = 2.81), and video library management skills (Mean = 2.39). The study concluded that though there exists a high digital skill gap among agricultural extension personnel in South-East, Nigeria, their socioeconomic characteristics are capable of supporting the implementation of digital extension services in the area. The study recommended that the management of Agricultural Development Programs in South-East, Nigeria, should provide digital training for extension personnel to close the digital skill gap that currently exists among the personnel.
文摘The study comparatively analysed the socioeconomic characteristics and digital literacy level of Agricultural Extension personnel (AEP) in Ebonyi and Imo States, South-East, Nigeria. The specific objectives were to describe the socioeconomic characteristics of agricultural extension personnel in Ebonyi and Imo States, and to ascertain the digital literacy level of AEP in the studied states. Purposive sampling technique was used to select 312 Agricultural Extension personnel (132 from Ebonyi State Agricultural Development Program and 180 from Imo State Agricultural Development Program) for the study. Data were collected through the use of validated and structured questionnaire, and administered through the help of well-trained enumerators. Data were analysed using simple descriptive statistical tools such as percentages mean score, standard deviation and weighted mean. Findings indicated that they were more male in the both States (55.3% and 57.8%) for Ebonyi and Imo State respectively and that the average age of AEP in Ebonyi and Imo States were 44.7 years and 49.2 years respectively. It was further revealed that the majority (77.3% and 82.8%) had B.Sc./HND as their highest academic qualifications, belonged to professional organisations (62.1% and 75%), and were earning an average monthly income of N58,798 and N62,648 for Ebonyi and Imo State respectively. Also, it was revealed that their mean years of service were 12.4 years and 13.4 years for Ebonyi and Imo State respectively. Almost all of them (87.9% and 95.0%) own a smartphone, had access to the internet (80.3% and 90.0%), but do not own a laptop/ipad (82.6% and 72.8%) for Ebon-yi and Imo State respectively. Results further revealed that Agricultural extension personnel in both Ebonyi and Imo State respectively had low digital literacy level ( = 2.41 and 2.32). The study concluded that AEP in Ebonyi and Imo State respectively had similar socioeconomic characteristics and low level of digital literacy. The study recommended that the management of ADPs in both Ebonyi and Imo State should ensure the training of AEP in digital skills to enhance their digital literacy level to enable them use digital technologies in their work.
基金supported by CNPC Key Core Technology Research Projects (2022ZG06)project funded by China Postdoctoral Science Foundation (2021M693508)Basic research and strategic reserve technology research fund project of institutes directly under CNPC.
文摘The efficient development and exploitation of shale oil depends on long-distance horizontal wells. As the degreeof cleaning of the wellbore plays a key role in these processes, in this study, this problem is investigated experimentallyby focusing on the dimensionless cuttings bed height. A method is proposed to calculate the horizontalwellhydraulic extension taking into account the influence of the wellbore cleaning degree on the wellborepressure distribution and assess the effect of a variety of factors such as the bottom hole pressure, the circulatingpressure drop, the drilling pump performance and the formation properties. The analysis shows that the hydraulicextension of horizontal wells decreases with an increase in the cuttings bed height, and the higher the displacementof drilling fluid, the faster the hydraulic extension declines. The annular pressure drop of the horizontalsection increases with the increase of the cuttings bed height, resulting in a higher bottom-hole pressure. Severalarguments are provided to guide the safe drilling of shale oil horizontal wells and overcome the limits of currenttechnological approaches.
基金supported by the Health Commission of Hubei Province Scientific Research Project(grant number:WJ2021F108)。
文摘Background:The target definition of consolidation radiotherapy(RT)for extensive stage small-cell lung cancer(ES-SCLC)has not been standardized.This study aimed to demonstrate the feasibility of post-chemotherapy based consolidation RT in ES-SCLC.Methods:All ES-SCLC patients without initial brain metastases who completed≥4 cycles of systemic therapy at Department of Radiation and Medical Oncology,Zhongnan Hospital of Wuhan University from 2012 to 2021 were included in this retrospective study.We correlated the site of first recurrence to the post-chemotherapy-based radiation volume(small-field).Relapse pattern,progression-free survival(PFS)and overall survival(OS)were compared between those received and did not receive consolidation RT.Results:A total of 152 patients were followed up for a median of 31.7 months(interquartile range[IQR],23.9-39.6 months).The median PFS and OS of the cohort were 8.3 months(IQR,6.1-11.2 months)and 16.2 months(IQR,9.9-24.9 months),respectively.Thoracic consolidation RT served not only as an independent prognostic factor for improved PFS in the entire cohort,but also significantly prolonged OS in the subgroup without syn-chronous liver metastases.Small-field consolidation RT markedly reduced in-field recurrences(hazard ratio[HR],0.28[95%CI,0.12-0.38];P<0.001)without increasing out-of-field recurrences(HR,0.40[95%CI,0.13-1.16];P=0.080).No relapse was observed at the margin of the targets.Treatment-related toxicities were moderate,with grade 3 acute radiation pneumonia,radiation esophagitis,and bone marrow suppression rates of 8.3%,3.1%,and 12.5%,respectively.No grade 5 toxicity occurred.Conclusion:Small-field consolidation RT based on post-chemotherapy volume is safe and can significantly im-prove local control in ES-SCLC.
文摘This paper uses the HS2 extension cancellation in November 2021 as a quasi-experiment to study its impact on house prices and rents in Leeds.Using a DiD approach on repeat sales and monthly rents,I compare property values near the HS2 station and proposed construction site before and after the announcement.Results show a 3.6%decrease in house prices and a 3.9%decline in rents near the station,while properties near the construction site experienced a 2.4%increase in prices and a 2.1%rise in rents.This is the first paper to analyse the HS2 cancellation effect using panel data methods.
文摘Background: The emergence of carbapenemase producing Acinetobacter baumannii is increasingly reported nowadays and constitutes a major problem to the intensive care unit (ICU) patients with notable extensive-drug resistance ability. The study investigates carbapenemase producing A. baumannii strains exhibiting an extensively drug-resistant (XDR) phenotype, isolated from ICU patients in Khartoum. Methods: A total of 100 nonduplicate Gram-negative coccobacilli strains were obtained from microbiology laboratory of ICU patients’ clinical isolates. Molecular identification of A. baumannii was performed by targeting 16S rRNA gene using specifically designed primers. Then, XDR strains were determined by susceptibility testing (disc diffusion). For detection of carbapenemase genes Polymerase chain reaction (PCR) was carried out. Result: Of 100 ICU clinical isolates, 38 (38.0%) was confirmed A. baumannii strains, those strains showed 100% carbapenem resistance and 60.5% extensive drug resistance to the antibiotics tested. The frequency of carbapenemase producer was 57.9% (22/38) of carbapenem resistance A. baumannii (CRAB). The most common carbapenemase associated with resistance was blaOXA gene followed by blaNDM and blaGES A. baumannii isolates. The co-occurrence of blaOXA-48-like and blaNDM, blaOXA-23-like and blaOXA-51, and blaNDM-1 and blaOXA-51 was detected in 22.7%, 18.2% strains and 4.5% respectively. A unique characteristic of our findings was the coharbouring of the genes blaNDM-1, blaOXA-23-like, blaOXA-51 and blaOXA-143 in 9.1% strains (2/22), and this was the first report in the Khartoum city, Sudan. Conclusion: We have demonstrated for the first time a high prevalence of XDR-carbapenemase producing A. baumannii clinical isolates from ICU patients in Khartoum. Also an emergent blaOXA-143 was reported as High-Risk Clones. This highlights the routine mentoring of XDR-carbapenemase producing A. baumannii to avoid clone dissemination in our region hospitals.
基金supported by International Joint Laboratory on Tropical Diseases Control in Greater Mekong Subregion(grant number 21410750200)from Shanghai Municipality Government.
文摘Background Tuberculosis(TB),caused by Mycobacterium tuberculosis,remains the second leading cause of death from a single infectious disease globally and poses a significant economic and clinical burden in the world in 2022.Of particular concern is the emergence of drug-resistant TB,accounting for 15%-20%of TB deaths.It is imperative to delve into the global trends of incidence and death rate for multidrug-resistant tuberculosis(MDR-TB)and extensively drug-resistant tuberculosis(XDR-TB),drawing upon the comprehensive Global Burden of Disease(GBD)2021 drug-resistant tuberculosis dataset.Methods From the GBD 2021,data on incidence,prevalence,disability-adjusted life years(DALYs),and death of MDR-TB and XDR-TB from 1990 to 2021 were collected.We calculated the estimated annual percentage changes in age standardized incidence rate(ASIR)and age-standardized death rate(ASDR),segmented by age,sex,and socio-demographic index(SDI).The impacts of various risk factors on MDR-TB and XDR-TB were also analyzed.Results In 2021,there were an estimated 443,680(95%uncertainty interval[UI]:259,196-766,545)incident cases of MDR-TB,and an estimated 106,818(95%UI:41,612-211,854)death cases of MDR-TB,while there were an estimated 24,036(95%UI:17,144-34,587)incident cases of XDR-TB and 7,946(95%UI:3,326-14,859)death cases of XDR-TB.The incidence and death cases of MDR-TB were lowest in high SDI regions,whereas the incidence rates of XDR-TB in high-middle SDI regions were higher than those in middle SDI and high SDI regions.Conclusion This study reported the disease burden of drug-resistant TB from 1990 to 2021.Until 2021,drug-resistant TB is still a serious problem in low SDI countries,especially for high-risk age populations with high-risk factors.Controlling drug-resistant TB requires effective control strategies and healthcare systems.
文摘Researches on foreign language extensive reading program indicate that students can improve their foreign language reading ability,and develop positive attitudes toward reading and increased motivation to read.Comparing to the other types of reading.(skimming,scanning,and intensive reading.),reading extensively can result in gains in vocabulary and other aspects of foreign language learning.Teachers should provide various experience and make students have the chance to enjoy reading.and give them more guidance on developing certain reading skills.
