W-based WTaVCr refractory high entropy alloys (RHEA) may be novel and promising candidate materials for plasma facing components in the first wall and diverter in fusion reactors. This alloy has been developed by a po...W-based WTaVCr refractory high entropy alloys (RHEA) may be novel and promising candidate materials for plasma facing components in the first wall and diverter in fusion reactors. This alloy has been developed by a powder metallurgy process combining mechanical alloying and spark plasma sintering (SPS). The SPSed samples contained two phases, in which the matrix is RHEA with a body-centered cubic structure, while the oxide phase was most likely Ta2VO6through a combined analysis of X-ray diffraction (XRD),energy-dispersive spectroscopy (EDS), and selected area electron diffraction (SAED). The higher oxygen affinity of Ta and V may explain the preferential formation of their oxide phases based on thermodynamic calculations. Electron backscatter diffraction (EBSD) revealed an average grain size of 6.2μm. WTaVCr RHEA showed a peak compressive strength of 2997 MPa at room temperature and much higher micro-and nano-hardness than W and other W-based RHEAs in the literature. Their high Rockwell hardness can be retained to at least 1000°C.展开更多
AIM:To compare the surgical outcomes of glaucoma drainage device implantation(GDI)and trans-scleral neodymium:YAG cyclophotocoagulation(CPC)in the management of refractory glaucoma after Descemetstripping automated en...AIM:To compare the surgical outcomes of glaucoma drainage device implantation(GDI)and trans-scleral neodymium:YAG cyclophotocoagulation(CPC)in the management of refractory glaucoma after Descemetstripping automated endothelial keratoplasty(DSAEK).METHODS:This retrospective study on observational case series enrolled 29 patients who underwent DSAEK and posterior anti-glaucoma surgery(15 with GDI and 14 with CPC).The main outcome measures were intraocular pressure(IOP),glaucoma surgery success rate(defined as IOP of 6–21 mm Hg without additional anti-glaucoma operation),number of glaucoma medications,endothelial graft status,and best-corrected visual acuity(BCVA).RESULTS:The mean follow-up time was 34.1 and 21.0mo for DSAEK or glaucoma surgeries,both for the GDI and CPC groups.Both groups showed significant IOP reduction after glaucoma surgery.The GDI group presented a significantly higher success rate in IOP control than the CPC group(60%vs 21.4%,P=0.03).Both procedures significantly decreased the number of glaucoma medications(P=0.03).Forty percent and 57%of cases in the GDI and the CPC group,respectively,experienced endothelial graft failure during follow-up(P=0.36).Significantly worse BCVA after surgery was observed in the CPC group but not in the GDI group.CONCLUSION:Both GDI and CPC significantly decrease IOP in eyes with glaucoma after DSAEK.GDI is preferable to CPC in refractory glaucoma cases after DSAEK,as it manifests a significantly higher success rate for IOP control,similar endothelial graft failure rate,and relatively preserves BCVA than CPC.展开更多
BACKGROUND Gastrinoma is characterized by an excessive release of gastrin,leading to hypersecretion of gastric acid,subsequently resulting in recurrent peptic ulcers,chronic diarrhea,and even esophageal strictures.Thi...BACKGROUND Gastrinoma is characterized by an excessive release of gastrin,leading to hypersecretion of gastric acid,subsequently resulting in recurrent peptic ulcers,chronic diarrhea,and even esophageal strictures.This case report aims to improve awareness and facilitate early diagnosis and treatment of gastrinoma by presenting a rare case of gastrinoma with refractory benign esophageal stricture(RBES).Additionally,it highlights the persistent challenges that gastroenterologists encounter in managing RBES.CASE SUMMARY This case demonstrates a patient with gastrinoma who developed RBES and complete esophageal obstruction despite management with maximal acid suppressive therapy,multiple endoscopic bougie dilations and endoscopic incisional therapy(EIT).CONCLUSION It is essential to diagnose gastrinoma as early as possible,as inadequately controlled acid secretion over an extended period increases the risk of developing severe esophageal strictures.In patients with esophageal strictures causing complete luminal obstruction,blind reopening EIT presents challenges and carries a high risk of perforation.展开更多
BACKGROUND Lymphangiomas in the gastrointestinal tract are extremely rare in adults.As a benign lesion,small intestine lymphangiomas often remain asymptomatic and pose challenges for definitive diagnosis.However,lymph...BACKGROUND Lymphangiomas in the gastrointestinal tract are extremely rare in adults.As a benign lesion,small intestine lymphangiomas often remain asymptomatic and pose challenges for definitive diagnosis.However,lymphangiomas can give rise to complications such as abdominal pain,bleeding,volvulus,and intussusception.Here,we report a case of jejunal cavernous lymphangioma that presented with intermittent melena and refractory anemia in a male adult.CASE SUMMARY A 66-year-old man presented with intermittent melena,fatigue and refractory anemia nine months prior.Esophagogastroduodenoscopy and colonoscopy were performed many times and revealed no apparent bleeding.Conservative management,including transfusion,hemostasis,gastric acid secretion inhibition and symptomatic treatment,was performed,but the lesions tended to recur shortly after surgery.Ultimately,the patient underwent capsule endoscopy,which revealed a more than 10 cm lesion accompanied by active bleeding.After singleballoon enteroscopy and biopsy,a diagnosis of jejunal cavernous lymphangioma was confirmed,and the patient underwent surgical resection.No complications or recurrences were observed postoperatively.CONCLUSION Jejunal cavernous lymphangioma should be considered a cause of obscure gastrointestinal bleeding.Capsule endoscopy and single-balloon enteroscopy can facilitate diagnosis.Surgical resection is an effective management method.展开更多
BACKGROUND Due to the lack of published literature about treatment of refractory hepatopulmonary syndrome(HPS)after liver transplant(LT),this case adds information and experience on this issue along with a treatment w...BACKGROUND Due to the lack of published literature about treatment of refractory hepatopulmonary syndrome(HPS)after liver transplant(LT),this case adds information and experience on this issue along with a treatment with positive outcomes.HPS is a complication of end-stage liver disease,with a 10%-30%incidence in cirrhotic patients.LT can reverse the physiopathology of this process and restore normal oxygenation.However,in some cases,refractory hypoxemia persists,and extracorporeal membrane oxygenation(ECMO)can be used as a rescue therapy with good results.CASE SUMMARY A 59-year-old patient with alcohol-related liver cirrhosis and portal hypertension was included in the LT waiting list for HPS.He had good liver function(Model for End-Stage Liver Disease score 12,Child-Pugh class B7).He had pulmonary fibrosis and a mild restrictive respiratory pattern with a basal oxygen saturation of 82%.The macroaggregated albumin test result was>30.Spirometry demonstrated a forced expiratory volume in one second(FEV1)of 78%,forced vital capacity(FVC)of 74%,FEV1/FVC ratio of 81%,diffusion capacity for carbon monoxide of 42%,and carbon monoxide transfer coefficient of 57%.He required domiciliary oxygen at 2 L/min(16 h/d).The patient was admitted to the intensive care unit(ICU)and extubated in the first 24 h,needing high-flow therapy and non-invasive ventilation and inhaled nitric oxide afterwards.Reintubation was needed after 72 h.Due to the non-response to supportive therapies,installation of ECMO was decided with progressive recovery after 9 d.Extubation was possible on the tenth day,maintaining a high-flow nasal cannula and de-escalating to conventional oxygen therapy after 48 h.He was discharged from ICU on postoperative day(POD)20 with a 90%-92%oxygen saturation.Steroid recycling was needed twice for acute rejection.The patient was discharged from hospital on POD 27 with no symptoms,with an 89%-90%oxygen saturation.CONCLUSION Due to the favorable results observed,ECMO could become the central axis of treatment of HPS and refractory hypoxemia after LT.展开更多
In Burkina Faso, one of the three largest gold producers in West Africa, foundry activity is often paralyzed when basic equipment such as crucibles and cups are not available or should be imported. However, previous s...In Burkina Faso, one of the three largest gold producers in West Africa, foundry activity is often paralyzed when basic equipment such as crucibles and cups are not available or should be imported. However, previous studies have shown the availability of kaolinite-rich clay resources that could be used for the local manufacture of silico-aluminous ceramic crucibles. This work allowed to manufacture industrial ceramic crucibles with local clays and then they were tested in foundry industry. The materials were manufactured from three (03) raw materials including two clays (SAB and ROU) and sand. The chemical and mineral analysis has shown that the raw materials are suitable for the formulation of refractory materials. The results of characterization of the materials formulated showed that the properties of use are appreciable. The porosity of the materials is relatively low (23 - 28 vol%) with a diametral compressive strength between 0.61 and 1.34 MPa. Crucibles sintered at 1250˚C with a stay of 2 hours have a mechanical strength capable of supporting the weight of the ores contained. These crucibles have a refractoriness under load (T0.5) above 1141˚C and resist chemical attacks. Tests were carried out in the industry at 1100˚C, and the results were satisfactory.展开更多
BACKGROUND Due to increasing resistance rates of Helicobacter pylori(H.pylori)to different antibiotics,failures in eradication therapies are becoming more frequent.Even though eradication criteria and treatment algori...BACKGROUND Due to increasing resistance rates of Helicobacter pylori(H.pylori)to different antibiotics,failures in eradication therapies are becoming more frequent.Even though eradication criteria and treatment algorithms for first-line and second-line therapy against H.pylori infection are well-established,there is no clear recommendation for third-line and rescue therapy in refractory H.pylori infection.AIM To perform a systematic review evaluating the efficacy and safety of rescue therapies against refractory H.pylori infection.METHODS A systematic search of available rescue treatments for refractory H.pylori infection was conducted on the National Library of Medicine’s PubMed search platform based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Randomized or non-randomized clinical trials and observational studies evaluating the effectiveness of H.pylori infection rescue therapies were included.RESULTS Twenty-eight studies were included in the analysis of mean eradication rates as rescue therapy,and 21 of these were selected for analysis of mean eradication rate as third-line treatment.For rifabutin-,sitafloxacin-,levofloxacin-,or metronidazole-based triple-therapy as third-line treatment,mean eradication rates of 81.6%and 84.4%,79.4%and 81.5%,55.7%and 60.6%,and 62.0%and 63.0%were found in intention-to-treat(ITT)and per-protocol(PP)analysis,respectively.For third-line quadruple therapy,mean eradication rates of 69.2%and 72.1%were found for bismuth quadruple therapy(BQT),88.9%and 90.9%for bismuth quadruple therapy,three-in-one,Pylera®(BQT-Pylera),and 61.3%and 64.2%for non-BQT)in ITT and PP analysis,respectively.For rifabutin-,sitafloxacin-,levofloxacin-,or metronidazole-based triple therapy as rescue therapy,mean eradication rates of 75.4%and 78.8%,79.4 and 81.5%,55.7%and 60.6%,and 62.0%and 63.0%were found in ITT and PP analysis,respectively.For quadruple therapy as rescue treatment,mean eradication rates of 76.7%and 79.2%for BQT,84.9%and 87.8%for BQT-Pylera,and 61.3%and 64.2%for non-BQT were found in ITT and PP analysis,respectively.For susceptibility-guided therapy,mean eradication rates as third-line and rescue treatment were 75.0%in ITT and 79.2%in PP analysis.CONCLUSION We recommend sitafloxacin-based triple therapy containing vonoprazan in regions with low macrolide resistance profile.In regions with known resistance to macrolides or unavailability of bismuth,rifabutin-based triple therapy is recommended.展开更多
The slag composition corresponding to different coals varies significantly,which directly affects the operation of industrial entrained-flow gasifier and the service life of refractory bricks.In this study,the corrosi...The slag composition corresponding to different coals varies significantly,which directly affects the operation of industrial entrained-flow gasifier and the service life of refractory bricks.In this study,the corrosion resistance of several typical coal slags for gasification on high chromia refractory bricks was comparatively investigated by static laboratory crucible tests and thermodynamic simulations.The results demonstrated that the corrosion degree of high chromia refractory bricks by different coal slags was high-Ca/Na slag>high-Fe slag>high-Si/Al slag.The surface structure of the refractory was relatively flat after corrosion by high-Si/Al slag,and the primary corrosion reaction was the partial dissolution of the matrix by the slag.High-Fe slag was prone to the precipitation of iron phases as well as the formation of(Mg,Fe)(Al,Cr)_(2)O_(4)composite spinel layer at the slag/refractory interface.The high-Ca/Na slag was susceptible to react with the refractory to yield a low melting point phase,which led to the destruction of the matrix structure of the refractory and an isolated distribution of particles.In addition,the monoclinic ZrO_(2) in the refractory reacted with CaO in the slag to formed calcium zirconate,which loosened its phase toughening effect,was the primary factor that aggravated the refractory corrosion.展开更多
Hydrogen peroxide(H_(2)O_(2))in situ electrosynthesis by O_(2)reduction reaction is a promising alternative to the conventional Fenton treatment of refractory wastewater.However,O_(2)mass transfer limitation,cathodic ...Hydrogen peroxide(H_(2)O_(2))in situ electrosynthesis by O_(2)reduction reaction is a promising alternative to the conventional Fenton treatment of refractory wastewater.However,O_(2)mass transfer limitation,cathodic catalyst selectivity,and electron transfer in O_(2)reduction remain major engineering obstacles.Here,we have proposed a systematic solution for efficient H_(2)O_(2)generation and its electro-Fenton(EF)application for refractory organic degradation based on the fabrication of a novel ZrO_(2)/CMK-3/PTFE cathode,in which polytetrafluoroethylene(PTFE)acted as a hydrophobic modifier to strengthen the O_(2)mass transfer,ZrO_(2)was adopted as a hydrophilic modifier to enhance the electron transfer of O_(2)reduction,and mesoporous carbon CMK-3 was utilized as a catalyst substrate to provide catalytic active sites.Moreover,feasible mass transfer of O_(2)from the hydrophobic to the hydrophilic layer was designed to increase the contact between O_(2)and the reaction interface.The H_(2)O_(2)yield of the ZrO_(2)/CMK-3/PTFE cathode was significantly improved by approximately 7.56 times compared to that of the co nventional gas diffusion cathode under the same conditions.The H_(2)O_(2)generation rate and Faraday efficiency reached125.98 mg·cm^(-2)·h^(-1)(normalized to 5674.04 mmol·g^(-1)·h^(-1)by catalyst loading)and 78.24%at-1.3 V versus standard hydrogen electrode(current density of-252 mA·cm^(-2)),respectively.The high H_(2)O_(2)yield ensured that sufficient OH was produced for excellent EF performance,resulting in a degradation efficiency of over 96%for refractory organics.This study offers a novel engineering solution for the efficient treatment of refractory wastewater using EF technology based on in situ high-yield H_(2)O_(2)electrosynthesis.展开更多
Refractory high-entropy alloys(RHEAs)have promising applications as the new generation of hightemperature alloys in hypersonic vehicles,aero-engines,gas turbines,and nuclear power plants.This study focuses on the micr...Refractory high-entropy alloys(RHEAs)have promising applications as the new generation of hightemperature alloys in hypersonic vehicles,aero-engines,gas turbines,and nuclear power plants.This study focuses on the microstructures and mechanical properties of the NbMoTaW(HfN)_(x)(x=0,0.3,0.7,and 1.0)RHEAs.The alloys consist of multiple phases of body-centered cubic(BCC),hafnium nitride(HfN),or multicomponent nitride(MN)phases.As the x contents increase,the grain size becomes smaller,and the strength gradually increases.The compressive yield strengths of the NbMoTaWHfN RHEA at ambient temperature,1000,1400,and 1800℃ were found to be 1682,1192,792,and 288 MPa,respectively.The high-temperature strength of this alloy is an inspiring result that exceeds the high temperature and strength of most known alloys,including high-entropy alloys,refractory metals,and superalloys.The HfN phase has a significant effect on strengthening due to its high structural stability and sluggish grain coarsening,even at ultra-high temperatures.Its superior properties endow the NbMoTaWHfN RHEA with potential for a wide range of engineering applications at ultra-high temperatures.This work offers a strategy for the design of high-temperature alloys and proposes an ultra-high-temperature alloy with potential for future engineering applications.展开更多
BACKGROUND Thalidomide is an effective treatment for refractory Crohn’s disease(CD).However,thalidomide-induced peripheral neuropathy(TiPN),which has a large individual variation,is a major cause of treatment failure...BACKGROUND Thalidomide is an effective treatment for refractory Crohn’s disease(CD).However,thalidomide-induced peripheral neuropathy(TiPN),which has a large individual variation,is a major cause of treatment failure.TiPN is rarely predictable and recognized,especially in CD.It is necessary to develop a risk model to predict TiPN occurrence.AIM To develop and compare a predictive model of TiPN using machine learning based on comprehensive clinical and genetic variables.METHODS A retrospective cohort of 164 CD patients from January 2016 to June 2022 was used to establish the model.The National Cancer Institute Common Toxicity Criteria Sensory Scale(version 4.0)was used to assess TiPN.With 18 clinical features and 150 genetic variables,five predictive models were established and evaluated by the confusion matrix receiver operating characteristic curve(AUROC),area under the precision-recall curve(AUPRC),specificity,sensitivity(recall rate),precision,accuracy,and F1 score.RESULTS The top-ranking five risk variables associated with TiPN were interleukin-12 rs1353248[P=0.0004,odds ratio(OR):8.983,95%confidence interval(CI):2.497-30.90],dose(mg/d,P=0.002),brainderived neurotrophic factor(BDNF)rs2030324(P=0.001,OR:3.164,95%CI:1.561-6.434),BDNF rs6265(P=0.001,OR:3.150,95%CI:1.546-6.073)and BDNF rs11030104(P=0.001,OR:3.091,95%CI:1.525-5.960).In the training set,gradient boosting decision tree(GBDT),extremely random trees(ET),random forest,logistic regression and extreme gradient boosting(XGBoost)obtained AUROC values>0.90 and AUPRC>0.87.Among these models,XGBoost and GBDT obtained the first two highest AUROC(0.90 and 1),AUPRC(0.98 and 1),accuracy(0.96 and 0.98),precision(0.90 and 0.95),F1 score(0.95 and 0.98),specificity(0.94 and 0.97),and sensitivity(1).In the validation set,XGBoost algorithm exhibited the best predictive performance with the highest specificity(0.857),accuracy(0.818),AUPRC(0.86)and AUROC(0.89).ET and GBDT obtained the highest sensitivity(1)and F1 score(0.8).Overall,compared with other state-of-the-art classifiers such as ET,GBDT and RF,XGBoost algorithm not only showed a more stable performance,but also yielded higher ROC-AUC and PRC-AUC scores,demonstrating its high accuracy in prediction of TiPN occurrence.CONCLUSION The powerful XGBoost algorithm accurately predicts TiPN using 18 clinical features and 14 genetic variables.With the ability to identify high-risk patients using single nucleotide polymorphisms,it offers a feasible option for improving thalidomide efficacy in CD patients.展开更多
Objective Preclinical evidence and clinical trials have suggested synergistic effects of epigenetic modifiers in combination with cytotoxic agents for the treatment of leukemia.However,their efficacy in patients with ...Objective Preclinical evidence and clinical trials have suggested synergistic effects of epigenetic modifiers in combination with cytotoxic agents for the treatment of leukemia.However,their efficacy in patients with relapsed/refractory acute myeloid leukemia(R/R AML)remains unclear.Methods Clinical data of R/R AML patients who received a CDCAG regimen(chidamide,decitabine,cytarabine,aclarubicin,and granulocyte colony-stimulating factor)from July 1,2018 to October 31,2021 at our center were retrospectively assessed,and the safety and efficacy of the CDCAG regimen were evaluated.Patients were followed up until November 30,2021,with a median follow-up of 21.6 months(95%CI:10.0–33.2 months).Results A total of 67 patients were enrolled.Two patients died within 3 weeks after the initiation,and therefore only 65 patients underwent the assement for clinical response and survival.It was found that 56.9%patients achieved complete remission with a median overall survival(OS)of 9.6 months.The median OS of responders was 25.9 months,while that of non-responders was 5.0 months(P<0.0001).Patients with gene mutations had a superior overall response rate(ORR)(80.4%vs.45.5%,P=0.043)compared to those without gene mutations.The presence of DNA methyltransferase 3 A(DNMT3A),ten-eleven translocation-2(TET2),and isocitrate dehydrogenase 1/2(IDH1/2)mutations did not affect the response rate(88.2%vs.68.9%,P=0.220)and reflected a better OS(not attained vs.9.0 months,P=0.05).The most common non-hematologic adverse events were pulmonary infection(73.1%),followed by febrile neutropenia(23.9%)and sepsis(19.4%).Conclusions The CDCAG regimen was effective and well-tolerated in R/R AML patients,increasing the potential for allogeneic hematopoietic stem cell transplantation.Moreover,patients with DNMT3A,TET2,and IDH1/2 mutations might benefit from this regimen.展开更多
BACKGROUND The lymphatic system is crucial in maintaining the body fluid homeostasis.A dysfunctional lymphatic system may contribute to the refractoriness of ascites and edema in cirrhosis patients.Therefore,assessmen...BACKGROUND The lymphatic system is crucial in maintaining the body fluid homeostasis.A dysfunctional lymphatic system may contribute to the refractoriness of ascites and edema in cirrhosis patients.Therefore,assessment of lymphatic dysfunction in cirrhosis patients with refractory ascites(RA)can be crucial as it would call for using different strategies for fluid mobilization.AIM To assessing the magnitude,spectrum,and clinical associations of lymphatic dysfunction in liver cirrhosis patients with RA.METHODS This observational study included 155 consecutive cirrhosis patients with RA.The presence of clinical signs of lymphedema,such as peau d’orange appearance and positive Stemmer sign,intestinal lymphangiectasia(IL)on duodenal biopsy seen as dilated vessels in the lamina propria with strong D2-40 immunohistochemistry,and chylous ascites were used to diagnose the overt lymphatic dysfunctions.RESULTS A total of 69(44.5%)patients out of 155 had evidence of lymphatic dysfunction.Peripheral lymphedema,found in 52(33.5%)patients,was the most common manifestation,followed by IL in 42(27.0%)patients,and chylous ascites in 2(1.9%)patients.Compared to patients without lymphedema,those with lymphedema had higher mean age,median model for end-stage liver disease scores,mean body mass index,mean ascitic fluid triglyceride levels,and proportion of patients with hypoproteinemia(serum total protein<5 g/dL)and lymphocytopenia(<15%of total leukocyte count).Patients with IL also had a higher prevalence of lymphocytopenia and hypoproteinemia(28.6%vs.9.1%,P=0.004).Seven(13%)patients with lymphedema had lower limb cellulitis compared to none in those without it.On multivariate regression analysis,factors independently associated with lymphatic dysfunction included obesity[odds ratio(OR):4.2,95%confidence intervals(95%CI):1.1–15.2,P=0.027],lymphocytopenia[OR:6.2,95%CI:2.9–13.2,P<0.001],and hypoproteinemia[OR:3.7,95%CI:1.5–8.82,P=0.003].CONCLUSION Lymphatic dysfunction is common in cirrhosis patients with RA.Significant indicators of its presence include hypoproteinemia and lymphocytopenia,which are likely due to the loss of lymphatic fluid from the circulation.Future efforts to mobilize fluid in these patients should focus on methods to improve lymphatic drainage.展开更多
BACKGROUND The recognition of idiopathic membranous nephropathy(IMN)as an autoimmune disease has paved the way for the use of B-cell-depleting agents,such as Rituximab(RTX),which is now a first-line drug for treating ...BACKGROUND The recognition of idiopathic membranous nephropathy(IMN)as an autoimmune disease has paved the way for the use of B-cell-depleting agents,such as Rituximab(RTX),which is now a first-line drug for treating IMN with proven safety and efficacy.Nevertheless,the usage of RTX for the treatment of refractory IMN remains controversial and challenging.AIM To evaluate the efficacy and safety of a new low-dose RTX regimen for the treatment of patients with refractory IMN.METHODS A retrospective study was performed on refractory IMN patients that accepted a low-dose RTX regimen(RTX,200 mg,once a month for five months)in the Xiyuan Hospital of Chinese Academy of Chinese Medical Sciences’Department of Nephrology from October 2019 to December 2021.To assess the clinical and immune remission data,we performed a 24 h urinary protein quantification(UTP)test and measured the serum albumin(ALB)and serum creatinine(SCr)levels,phospholipase A2 receptor(PLA2R)antibody titer,and CD19+B-cell count every three months.RESULTS A total of nine refractory IMN patients were analyzed.During follow-up conducted twelve months later,the results from the 24 h UTP decreased from baseline[8.14±6.05 g/d to 1.24±1.34 g/d(P<0.05)]and the ALB levels increased from baseline[28.06±8.42 g/L to 40.93±5.85 g/L(P<0.01)].Notably,after administering RTX for six months,the SCr decreased from 78.13±16.49μmol/L to 109.67±40.87μmol/L(P<0.05).All of the nine patients were positive for serum anti-PLA2R at the beginning,and four patients had normal anti-PLA2R titer levels at six months.The level of CD19+B-cells decreased to 0 at three months,and CD19+B-cell count remained at 0 up until six months of follow-up.CONCLUSION Our low-dose RTX regimen appears to be a promising treatment strategy for refractory IMN.展开更多
Objective:To evaluate the efficacy and safety of Yishen-Huoxue Formula in the treatment of refractory nephrotic syndrome(RNS)using evidence-based medicine.Methods:Databases CNKI,WanFang,VIP,CBM,PubMed,EMbase,and Cochr...Objective:To evaluate the efficacy and safety of Yishen-Huoxue Formula in the treatment of refractory nephrotic syndrome(RNS)using evidence-based medicine.Methods:Databases CNKI,WanFang,VIP,CBM,PubMed,EMbase,and Cochrane Library were searched for randomized controlled trials(RCTs)on the treatment of RNS with the Yishen-Huoxue Formula from June 2008 to July 2020.The quality of the literature was evaluated by the Cochrane.Meta-analysis was performed using Review Manager 5.3 software.Results:A total of 18 articles and 1432 patients were included in this study.The results showed compared to the control group,Yishen-Huoxue Formula was much better in improving total effectiverate[OR=4.15,(95%CI:3.03,5.68),P<0.05],plasma albumin[MD=5.08,(95%CI:3.42,6.74),P<0.05]and decreasing 24-h urine protein quantitation[MD=-0.99,(95%CI:-1.30,-0,69),P<0.05],recurrence rate[OR=0.21,95%CI(0.11,0.40),P<0.05],and adverse reaction rate[OR=0.33,95%CI(0.21,0.52),P<0.05].However,the improvement of complete remission rate was affected by the course of treatment.The effects were similar in less than or equal to nine weeks[OR=1.52,(95%CI:0.74,3.13),P=0.25],whereas the experimental group was superior to the control group in 12-24 weeks[OR=2.47,(95%CI:1.63,3.74),P<0.05]and more than or equal to 26 weeks[OR=2.04,(95%CI:1.43,2.91),P<0.05].Conclusion:The efficacy and safety of Yishen-Huoxue Formula for refractory nephrotic syndrome is better than that of the Western medicine group,but the exact efficacy still needs to be confirmed by prospective studies of higher quality.展开更多
The dissolution of alumina-based refractory ceramics in CaO-Al2O3-SiO_(2)slag melts was performed based on the in-situ observation system of an ultra-high-temperature laser confocal microscope,and the effect of the Ca...The dissolution of alumina-based refractory ceramics in CaO-Al2O3-SiO_(2)slag melts was performed based on the in-situ observation system of an ultra-high-temperature laser confocal microscope,and the effect of the CaO/SiO_(2)slag mass ratio(C/S ratio)on the dissolution rate of alumina-based refractory ceramics was investigated.The results indicate that the dissolution rate increases with an increase of the C/S ratio and is mainly controlled by diffusion.During the early stage of dissolution,for all C/S ratios,the dissolution process conforms to the classical invariant interface approximation model.During the later stage of dissolution,when the C/S ratio is≥6,the dissolution process is significantly different from the model above because of the formation of a thick interfacial layer,which can be explained by dissolution kinetics.展开更多
Background: Systemic JIA (sJIA) is one of the subtypes of JIA, which is most difficult to treat among all JIA cases. About 50% of sJIA cases did not respond to traditional disease modifying anti-rheumatic drugs (DMAR...Background: Systemic JIA (sJIA) is one of the subtypes of JIA, which is most difficult to treat among all JIA cases. About 50% of sJIA cases did not respond to traditional disease modifying anti-rheumatic drugs (DMARDs)—metho-trexate (MTX). Thalidomide is an immunomodulating and anti-inflammatory drug that induces sustained improvement of refractory sJIA cases. Objectives: To evaluate the efficacy of thalidomide in refractory sJIA patients. Methods: This was a prospective interventional study carried out in the Paediatric Rheumatology and Immunology follow-up clinic run by the Department of Pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from January 2019 to July 2020. Twenty-five sJIA patients who were refractory to conventional DMARDs were included in this study. These patients were prescribed thalidomide at a dose of 3 - 5 mg/kg/day for six months and efficacy was assessed by using juvenile arthritis disease activity score (JADAS 27) at 12<sup>th</sup> and 24<sup>th</sup> weeks of treatment. Result: Active joint counts and ESR improvement were observed in 90.69%, 97.67% and 69.84%, 100% of sJIA patients respectively at 12<sup>th</sup> and 24<sup>th</sup> weeks of treatment. Improvement of physicians and parent global assessment of VAS were 77.56%, 97.43% and 70.62% and 96.04% respectively at 12<sup>th</sup> and 24<sup>th</sup> weeks of treatment. Improvement of the total score of JADAS-27 was 77.51% at 12th week and 97.52% at 24<sup>th</sup> of week follow-up which was statistically significant. Somnolence, constipation and paresthesia were found as common adverse effect in this study. Conclusion: Efficacy of thalidomide was assessed by JADAS 27 criteria showed significant improvement in refractory sJIA patients in this study. It may be concluded that Thalidomide is safe and effective as an adjunct therapy of refractory sJIA patients.展开更多
Objective:To analyze the effect of simplified vacuum sealing drainage(VSD)in the treatment of chronic refractory wounds.Methods:A total of 90 patients with chronic refractory wounds treated from May 2022 to May 2023 w...Objective:To analyze the effect of simplified vacuum sealing drainage(VSD)in the treatment of chronic refractory wounds.Methods:A total of 90 patients with chronic refractory wounds treated from May 2022 to May 2023 were randomly divided into groups.The simplified VSD treatment was employed in group A,and conventional treatment was employed in group B,and the wound healing of both groups were compared.Results:Group A showed better wound healing compared to group B,P<0.05;the wound healing rate,wound healing duration,visual analog scale(VAS)score,wound dressing times and other indicators in group A were better than those in group B,P<0.05.The SF-36 score of group A was higher than that of group B,P<0.05;the complication rate of chronic refractory wounds in group A was no different from that in group B,P>0.05.Conclusion:Simplified VSD treatment is effective in treating patients with chronic refractory wounds,and it reduces the number of wound dressing changes and promote wound healing.展开更多
Aluminous refractory materials with high alumina contents are widely used in the steel industry,and the higher the alumina content,the higher the working temperature.Properties such as high refractoriness and thermal ...Aluminous refractory materials with high alumina contents are widely used in the steel industry,and the higher the alumina content,the higher the working temperature.Properties such as high refractoriness and thermal shock resistance lead these refractory materials to be used as channel linings of blast furnaces,where they are exposed to the attack by slag,molten steel,working cycles and sudden temperature changes between 25℃(room temperature)and 1520℃(the temperature of molten pig iron).In this work,microstructural changes in post-mortem aluminous refractory bricks were investigated by apparent porosity,X-ray diffraction analysis(XRD),Fourier transform infrared spectroscopy(FTIR),scanning electron microscopy,and X-ray dispersion energy spectrometry(SEM/EDS).The results showed an increase in the apparent porosity and the bulk density and the presence of the phases mullite,sillimanite,alumina,and quartz in the post-mortem brick.Calcium and magnesium were not detected in the microstructure of the post-mortem brick,indicating that slags did not corrode these refractory materials.Therefore,the microstructural changes that occurred in the post-mortem bricks must be due to thermal cycling.In the X-ray diffraction(XRD)test,mullite,sillimanite,quartz,andα-alumina phases were identified.These results indicate that the aluminous refractory was obtained from sillimanite.In infrared spectroscopy(FTIR)it was possible to identify the vibration bands referring to the Si-O and Al-O bonds.The increase in the porosity is a result of cracks caused by work cycles at high temperatures and the temperature gradient to which the refractory was subjected during use.Through the micrograph it was possible to identify the presence of acicular mullite.The absence of magnesium and calcium in the microanalysis results by energy dispersed X-ray spectrometry(EDS)indicates that there was no infiltration by slag or liquid iron.These results indicate that the microstructural changes that occurred in the post-mortem aluminous refractory were of a thermal nature.展开更多
Cr_(2)O_(3)-bearing castables bonded with reactive MgO(RM)or calcium aluminate cement(CAC)were studied to evaluate the binder effect on their performance in corrosive environments.The properties of the as-prepared cas...Cr_(2)O_(3)-bearing castables bonded with reactive MgO(RM)or calcium aluminate cement(CAC)were studied to evaluate the binder effect on their performance in corrosive environments.The properties of the as-prepared castables were compared with respect to the differences in phase composition and microstructure.The corrosion behavior of the as-prepared castables by CaO-Al_(2)O_(3)-Fe_(2)O_(3)-SiO_(2)-based slag was systematically compared viarefractory cup testing at 1600℃with respect to the differences in phase composition and microstructure.The analysis indicates that RM bonded castables show higher apparent porosity,lower bulk density and strengths after drying at 110℃and firing at 1300℃,and higher permanent linear change after firing at 1300℃,but better slag corrosion and infiltration resistance compared with CAC bonded castables.展开更多
基金supported by the National Science Foundation under Grant No.CMMI-1762190The research was performed in part in the Nebraska Nanoscale Facility:National Nanotechnology Coordinated Infrastructure and the Nebraska Center for Materials and Nanoscience (and/or NERCF),which are supported by the National Science Foundation under Award ECCS:2025298+1 种基金the Nebraska Research Initiativesupported by the U.S.Department of Energy,Office of Nuclear Energy under DOE Idaho Operations Office Contract DE-AC07-051D14517 as part of a Nuclear Science User Facilities experiment。
文摘W-based WTaVCr refractory high entropy alloys (RHEA) may be novel and promising candidate materials for plasma facing components in the first wall and diverter in fusion reactors. This alloy has been developed by a powder metallurgy process combining mechanical alloying and spark plasma sintering (SPS). The SPSed samples contained two phases, in which the matrix is RHEA with a body-centered cubic structure, while the oxide phase was most likely Ta2VO6through a combined analysis of X-ray diffraction (XRD),energy-dispersive spectroscopy (EDS), and selected area electron diffraction (SAED). The higher oxygen affinity of Ta and V may explain the preferential formation of their oxide phases based on thermodynamic calculations. Electron backscatter diffraction (EBSD) revealed an average grain size of 6.2μm. WTaVCr RHEA showed a peak compressive strength of 2997 MPa at room temperature and much higher micro-and nano-hardness than W and other W-based RHEAs in the literature. Their high Rockwell hardness can be retained to at least 1000°C.
文摘AIM:To compare the surgical outcomes of glaucoma drainage device implantation(GDI)and trans-scleral neodymium:YAG cyclophotocoagulation(CPC)in the management of refractory glaucoma after Descemetstripping automated endothelial keratoplasty(DSAEK).METHODS:This retrospective study on observational case series enrolled 29 patients who underwent DSAEK and posterior anti-glaucoma surgery(15 with GDI and 14 with CPC).The main outcome measures were intraocular pressure(IOP),glaucoma surgery success rate(defined as IOP of 6–21 mm Hg without additional anti-glaucoma operation),number of glaucoma medications,endothelial graft status,and best-corrected visual acuity(BCVA).RESULTS:The mean follow-up time was 34.1 and 21.0mo for DSAEK or glaucoma surgeries,both for the GDI and CPC groups.Both groups showed significant IOP reduction after glaucoma surgery.The GDI group presented a significantly higher success rate in IOP control than the CPC group(60%vs 21.4%,P=0.03).Both procedures significantly decreased the number of glaucoma medications(P=0.03).Forty percent and 57%of cases in the GDI and the CPC group,respectively,experienced endothelial graft failure during follow-up(P=0.36).Significantly worse BCVA after surgery was observed in the CPC group but not in the GDI group.CONCLUSION:Both GDI and CPC significantly decrease IOP in eyes with glaucoma after DSAEK.GDI is preferable to CPC in refractory glaucoma cases after DSAEK,as it manifests a significantly higher success rate for IOP control,similar endothelial graft failure rate,and relatively preserves BCVA than CPC.
文摘BACKGROUND Gastrinoma is characterized by an excessive release of gastrin,leading to hypersecretion of gastric acid,subsequently resulting in recurrent peptic ulcers,chronic diarrhea,and even esophageal strictures.This case report aims to improve awareness and facilitate early diagnosis and treatment of gastrinoma by presenting a rare case of gastrinoma with refractory benign esophageal stricture(RBES).Additionally,it highlights the persistent challenges that gastroenterologists encounter in managing RBES.CASE SUMMARY This case demonstrates a patient with gastrinoma who developed RBES and complete esophageal obstruction despite management with maximal acid suppressive therapy,multiple endoscopic bougie dilations and endoscopic incisional therapy(EIT).CONCLUSION It is essential to diagnose gastrinoma as early as possible,as inadequately controlled acid secretion over an extended period increases the risk of developing severe esophageal strictures.In patients with esophageal strictures causing complete luminal obstruction,blind reopening EIT presents challenges and carries a high risk of perforation.
文摘BACKGROUND Lymphangiomas in the gastrointestinal tract are extremely rare in adults.As a benign lesion,small intestine lymphangiomas often remain asymptomatic and pose challenges for definitive diagnosis.However,lymphangiomas can give rise to complications such as abdominal pain,bleeding,volvulus,and intussusception.Here,we report a case of jejunal cavernous lymphangioma that presented with intermittent melena and refractory anemia in a male adult.CASE SUMMARY A 66-year-old man presented with intermittent melena,fatigue and refractory anemia nine months prior.Esophagogastroduodenoscopy and colonoscopy were performed many times and revealed no apparent bleeding.Conservative management,including transfusion,hemostasis,gastric acid secretion inhibition and symptomatic treatment,was performed,but the lesions tended to recur shortly after surgery.Ultimately,the patient underwent capsule endoscopy,which revealed a more than 10 cm lesion accompanied by active bleeding.After singleballoon enteroscopy and biopsy,a diagnosis of jejunal cavernous lymphangioma was confirmed,and the patient underwent surgical resection.No complications or recurrences were observed postoperatively.CONCLUSION Jejunal cavernous lymphangioma should be considered a cause of obscure gastrointestinal bleeding.Capsule endoscopy and single-balloon enteroscopy can facilitate diagnosis.Surgical resection is an effective management method.
文摘BACKGROUND Due to the lack of published literature about treatment of refractory hepatopulmonary syndrome(HPS)after liver transplant(LT),this case adds information and experience on this issue along with a treatment with positive outcomes.HPS is a complication of end-stage liver disease,with a 10%-30%incidence in cirrhotic patients.LT can reverse the physiopathology of this process and restore normal oxygenation.However,in some cases,refractory hypoxemia persists,and extracorporeal membrane oxygenation(ECMO)can be used as a rescue therapy with good results.CASE SUMMARY A 59-year-old patient with alcohol-related liver cirrhosis and portal hypertension was included in the LT waiting list for HPS.He had good liver function(Model for End-Stage Liver Disease score 12,Child-Pugh class B7).He had pulmonary fibrosis and a mild restrictive respiratory pattern with a basal oxygen saturation of 82%.The macroaggregated albumin test result was>30.Spirometry demonstrated a forced expiratory volume in one second(FEV1)of 78%,forced vital capacity(FVC)of 74%,FEV1/FVC ratio of 81%,diffusion capacity for carbon monoxide of 42%,and carbon monoxide transfer coefficient of 57%.He required domiciliary oxygen at 2 L/min(16 h/d).The patient was admitted to the intensive care unit(ICU)and extubated in the first 24 h,needing high-flow therapy and non-invasive ventilation and inhaled nitric oxide afterwards.Reintubation was needed after 72 h.Due to the non-response to supportive therapies,installation of ECMO was decided with progressive recovery after 9 d.Extubation was possible on the tenth day,maintaining a high-flow nasal cannula and de-escalating to conventional oxygen therapy after 48 h.He was discharged from ICU on postoperative day(POD)20 with a 90%-92%oxygen saturation.Steroid recycling was needed twice for acute rejection.The patient was discharged from hospital on POD 27 with no symptoms,with an 89%-90%oxygen saturation.CONCLUSION Due to the favorable results observed,ECMO could become the central axis of treatment of HPS and refractory hypoxemia after LT.
文摘In Burkina Faso, one of the three largest gold producers in West Africa, foundry activity is often paralyzed when basic equipment such as crucibles and cups are not available or should be imported. However, previous studies have shown the availability of kaolinite-rich clay resources that could be used for the local manufacture of silico-aluminous ceramic crucibles. This work allowed to manufacture industrial ceramic crucibles with local clays and then they were tested in foundry industry. The materials were manufactured from three (03) raw materials including two clays (SAB and ROU) and sand. The chemical and mineral analysis has shown that the raw materials are suitable for the formulation of refractory materials. The results of characterization of the materials formulated showed that the properties of use are appreciable. The porosity of the materials is relatively low (23 - 28 vol%) with a diametral compressive strength between 0.61 and 1.34 MPa. Crucibles sintered at 1250˚C with a stay of 2 hours have a mechanical strength capable of supporting the weight of the ores contained. These crucibles have a refractoriness under load (T0.5) above 1141˚C and resist chemical attacks. Tests were carried out in the industry at 1100˚C, and the results were satisfactory.
文摘BACKGROUND Due to increasing resistance rates of Helicobacter pylori(H.pylori)to different antibiotics,failures in eradication therapies are becoming more frequent.Even though eradication criteria and treatment algorithms for first-line and second-line therapy against H.pylori infection are well-established,there is no clear recommendation for third-line and rescue therapy in refractory H.pylori infection.AIM To perform a systematic review evaluating the efficacy and safety of rescue therapies against refractory H.pylori infection.METHODS A systematic search of available rescue treatments for refractory H.pylori infection was conducted on the National Library of Medicine’s PubMed search platform based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Randomized or non-randomized clinical trials and observational studies evaluating the effectiveness of H.pylori infection rescue therapies were included.RESULTS Twenty-eight studies were included in the analysis of mean eradication rates as rescue therapy,and 21 of these were selected for analysis of mean eradication rate as third-line treatment.For rifabutin-,sitafloxacin-,levofloxacin-,or metronidazole-based triple-therapy as third-line treatment,mean eradication rates of 81.6%and 84.4%,79.4%and 81.5%,55.7%and 60.6%,and 62.0%and 63.0%were found in intention-to-treat(ITT)and per-protocol(PP)analysis,respectively.For third-line quadruple therapy,mean eradication rates of 69.2%and 72.1%were found for bismuth quadruple therapy(BQT),88.9%and 90.9%for bismuth quadruple therapy,three-in-one,Pylera®(BQT-Pylera),and 61.3%and 64.2%for non-BQT)in ITT and PP analysis,respectively.For rifabutin-,sitafloxacin-,levofloxacin-,or metronidazole-based triple therapy as rescue therapy,mean eradication rates of 75.4%and 78.8%,79.4 and 81.5%,55.7%and 60.6%,and 62.0%and 63.0%were found in ITT and PP analysis,respectively.For quadruple therapy as rescue treatment,mean eradication rates of 76.7%and 79.2%for BQT,84.9%and 87.8%for BQT-Pylera,and 61.3%and 64.2%for non-BQT were found in ITT and PP analysis,respectively.For susceptibility-guided therapy,mean eradication rates as third-line and rescue treatment were 75.0%in ITT and 79.2%in PP analysis.CONCLUSION We recommend sitafloxacin-based triple therapy containing vonoprazan in regions with low macrolide resistance profile.In regions with known resistance to macrolides or unavailability of bismuth,rifabutin-based triple therapy is recommended.
基金financial support from the Joint Funds of the National Natural Science Foundation of China(U21A20318).
文摘The slag composition corresponding to different coals varies significantly,which directly affects the operation of industrial entrained-flow gasifier and the service life of refractory bricks.In this study,the corrosion resistance of several typical coal slags for gasification on high chromia refractory bricks was comparatively investigated by static laboratory crucible tests and thermodynamic simulations.The results demonstrated that the corrosion degree of high chromia refractory bricks by different coal slags was high-Ca/Na slag>high-Fe slag>high-Si/Al slag.The surface structure of the refractory was relatively flat after corrosion by high-Si/Al slag,and the primary corrosion reaction was the partial dissolution of the matrix by the slag.High-Fe slag was prone to the precipitation of iron phases as well as the formation of(Mg,Fe)(Al,Cr)_(2)O_(4)composite spinel layer at the slag/refractory interface.The high-Ca/Na slag was susceptible to react with the refractory to yield a low melting point phase,which led to the destruction of the matrix structure of the refractory and an isolated distribution of particles.In addition,the monoclinic ZrO_(2) in the refractory reacted with CaO in the slag to formed calcium zirconate,which loosened its phase toughening effect,was the primary factor that aggravated the refractory corrosion.
基金National Natural Science Foundation of China(22176125,52200103 and22178220)China Postdoctoral Science Foundation(2022 M722081 and 2021 M692064)+1 种基金the Fundamental Research Funds for the Central Universitiesthe Center for Advanced Electronic Materials and Devices and the instrumental Analysis Center,School of Environmental Science and Engineering,Shanghai Jiao Tong University for support。
文摘Hydrogen peroxide(H_(2)O_(2))in situ electrosynthesis by O_(2)reduction reaction is a promising alternative to the conventional Fenton treatment of refractory wastewater.However,O_(2)mass transfer limitation,cathodic catalyst selectivity,and electron transfer in O_(2)reduction remain major engineering obstacles.Here,we have proposed a systematic solution for efficient H_(2)O_(2)generation and its electro-Fenton(EF)application for refractory organic degradation based on the fabrication of a novel ZrO_(2)/CMK-3/PTFE cathode,in which polytetrafluoroethylene(PTFE)acted as a hydrophobic modifier to strengthen the O_(2)mass transfer,ZrO_(2)was adopted as a hydrophilic modifier to enhance the electron transfer of O_(2)reduction,and mesoporous carbon CMK-3 was utilized as a catalyst substrate to provide catalytic active sites.Moreover,feasible mass transfer of O_(2)from the hydrophobic to the hydrophilic layer was designed to increase the contact between O_(2)and the reaction interface.The H_(2)O_(2)yield of the ZrO_(2)/CMK-3/PTFE cathode was significantly improved by approximately 7.56 times compared to that of the co nventional gas diffusion cathode under the same conditions.The H_(2)O_(2)generation rate and Faraday efficiency reached125.98 mg·cm^(-2)·h^(-1)(normalized to 5674.04 mmol·g^(-1)·h^(-1)by catalyst loading)and 78.24%at-1.3 V versus standard hydrogen electrode(current density of-252 mA·cm^(-2)),respectively.The high H_(2)O_(2)yield ensured that sufficient OH was produced for excellent EF performance,resulting in a degradation efficiency of over 96%for refractory organics.This study offers a novel engineering solution for the efficient treatment of refractory wastewater using EF technology based on in situ high-yield H_(2)O_(2)electrosynthesis.
基金supported by the National Key Research and Development Program of China(2023YFE0201600 and 2018YFC1902400)the National Natural Science Foundation of China(51975582)a Project Funded by the Priority Academic Program Development of Jiangsu Higher Education Institutions。
文摘Refractory high-entropy alloys(RHEAs)have promising applications as the new generation of hightemperature alloys in hypersonic vehicles,aero-engines,gas turbines,and nuclear power plants.This study focuses on the microstructures and mechanical properties of the NbMoTaW(HfN)_(x)(x=0,0.3,0.7,and 1.0)RHEAs.The alloys consist of multiple phases of body-centered cubic(BCC),hafnium nitride(HfN),or multicomponent nitride(MN)phases.As the x contents increase,the grain size becomes smaller,and the strength gradually increases.The compressive yield strengths of the NbMoTaWHfN RHEA at ambient temperature,1000,1400,and 1800℃ were found to be 1682,1192,792,and 288 MPa,respectively.The high-temperature strength of this alloy is an inspiring result that exceeds the high temperature and strength of most known alloys,including high-entropy alloys,refractory metals,and superalloys.The HfN phase has a significant effect on strengthening due to its high structural stability and sluggish grain coarsening,even at ultra-high temperatures.Its superior properties endow the NbMoTaWHfN RHEA with potential for a wide range of engineering applications at ultra-high temperatures.This work offers a strategy for the design of high-temperature alloys and proposes an ultra-high-temperature alloy with potential for future engineering applications.
基金National Natural Science Foundation of China,No.81973398,No.81730103,No.81573507 and No.82020108031The National Key Research and Development Program,No.2017YFC0909300 and No.2016YFC0905001+5 种基金Guangdong Provincial Key Laboratory of Construction Foundation,No.2017B030314030 and No.2020B1212060034Science and Technology Program of Guangzhou,No.201607020031National Engineering and Technology Research Center for New Drug Druggability Evaluation(Seed Program of Guangdong Province),No.2017B090903004The 111 Project,No.B16047China Postdoctoral Science Foundation,No.2019M66324,No.2020M683140 and No.2020M683139Natural Science Foundation of Guangdong Province,No.2022A1515012549 and No.2023A1515012667.
文摘BACKGROUND Thalidomide is an effective treatment for refractory Crohn’s disease(CD).However,thalidomide-induced peripheral neuropathy(TiPN),which has a large individual variation,is a major cause of treatment failure.TiPN is rarely predictable and recognized,especially in CD.It is necessary to develop a risk model to predict TiPN occurrence.AIM To develop and compare a predictive model of TiPN using machine learning based on comprehensive clinical and genetic variables.METHODS A retrospective cohort of 164 CD patients from January 2016 to June 2022 was used to establish the model.The National Cancer Institute Common Toxicity Criteria Sensory Scale(version 4.0)was used to assess TiPN.With 18 clinical features and 150 genetic variables,five predictive models were established and evaluated by the confusion matrix receiver operating characteristic curve(AUROC),area under the precision-recall curve(AUPRC),specificity,sensitivity(recall rate),precision,accuracy,and F1 score.RESULTS The top-ranking five risk variables associated with TiPN were interleukin-12 rs1353248[P=0.0004,odds ratio(OR):8.983,95%confidence interval(CI):2.497-30.90],dose(mg/d,P=0.002),brainderived neurotrophic factor(BDNF)rs2030324(P=0.001,OR:3.164,95%CI:1.561-6.434),BDNF rs6265(P=0.001,OR:3.150,95%CI:1.546-6.073)and BDNF rs11030104(P=0.001,OR:3.091,95%CI:1.525-5.960).In the training set,gradient boosting decision tree(GBDT),extremely random trees(ET),random forest,logistic regression and extreme gradient boosting(XGBoost)obtained AUROC values>0.90 and AUPRC>0.87.Among these models,XGBoost and GBDT obtained the first two highest AUROC(0.90 and 1),AUPRC(0.98 and 1),accuracy(0.96 and 0.98),precision(0.90 and 0.95),F1 score(0.95 and 0.98),specificity(0.94 and 0.97),and sensitivity(1).In the validation set,XGBoost algorithm exhibited the best predictive performance with the highest specificity(0.857),accuracy(0.818),AUPRC(0.86)and AUROC(0.89).ET and GBDT obtained the highest sensitivity(1)and F1 score(0.8).Overall,compared with other state-of-the-art classifiers such as ET,GBDT and RF,XGBoost algorithm not only showed a more stable performance,but also yielded higher ROC-AUC and PRC-AUC scores,demonstrating its high accuracy in prediction of TiPN occurrence.CONCLUSION The powerful XGBoost algorithm accurately predicts TiPN using 18 clinical features and 14 genetic variables.With the ability to identify high-risk patients using single nucleotide polymorphisms,it offers a feasible option for improving thalidomide efficacy in CD patients.
基金the National Natural Science Foundation of China(No.81960043 and No.81600180)Natural Science Foundation of Jiangxi Province(No.20192ACB20030 and No.20203BBGL73197)Science and Technology Innovation Base Construction Project of Jiangxi Province(No.20212BCG74001 and No.20211ZDG02006).
文摘Objective Preclinical evidence and clinical trials have suggested synergistic effects of epigenetic modifiers in combination with cytotoxic agents for the treatment of leukemia.However,their efficacy in patients with relapsed/refractory acute myeloid leukemia(R/R AML)remains unclear.Methods Clinical data of R/R AML patients who received a CDCAG regimen(chidamide,decitabine,cytarabine,aclarubicin,and granulocyte colony-stimulating factor)from July 1,2018 to October 31,2021 at our center were retrospectively assessed,and the safety and efficacy of the CDCAG regimen were evaluated.Patients were followed up until November 30,2021,with a median follow-up of 21.6 months(95%CI:10.0–33.2 months).Results A total of 67 patients were enrolled.Two patients died within 3 weeks after the initiation,and therefore only 65 patients underwent the assement for clinical response and survival.It was found that 56.9%patients achieved complete remission with a median overall survival(OS)of 9.6 months.The median OS of responders was 25.9 months,while that of non-responders was 5.0 months(P<0.0001).Patients with gene mutations had a superior overall response rate(ORR)(80.4%vs.45.5%,P=0.043)compared to those without gene mutations.The presence of DNA methyltransferase 3 A(DNMT3A),ten-eleven translocation-2(TET2),and isocitrate dehydrogenase 1/2(IDH1/2)mutations did not affect the response rate(88.2%vs.68.9%,P=0.220)and reflected a better OS(not attained vs.9.0 months,P=0.05).The most common non-hematologic adverse events were pulmonary infection(73.1%),followed by febrile neutropenia(23.9%)and sepsis(19.4%).Conclusions The CDCAG regimen was effective and well-tolerated in R/R AML patients,increasing the potential for allogeneic hematopoietic stem cell transplantation.Moreover,patients with DNMT3A,TET2,and IDH1/2 mutations might benefit from this regimen.
文摘BACKGROUND The lymphatic system is crucial in maintaining the body fluid homeostasis.A dysfunctional lymphatic system may contribute to the refractoriness of ascites and edema in cirrhosis patients.Therefore,assessment of lymphatic dysfunction in cirrhosis patients with refractory ascites(RA)can be crucial as it would call for using different strategies for fluid mobilization.AIM To assessing the magnitude,spectrum,and clinical associations of lymphatic dysfunction in liver cirrhosis patients with RA.METHODS This observational study included 155 consecutive cirrhosis patients with RA.The presence of clinical signs of lymphedema,such as peau d’orange appearance and positive Stemmer sign,intestinal lymphangiectasia(IL)on duodenal biopsy seen as dilated vessels in the lamina propria with strong D2-40 immunohistochemistry,and chylous ascites were used to diagnose the overt lymphatic dysfunctions.RESULTS A total of 69(44.5%)patients out of 155 had evidence of lymphatic dysfunction.Peripheral lymphedema,found in 52(33.5%)patients,was the most common manifestation,followed by IL in 42(27.0%)patients,and chylous ascites in 2(1.9%)patients.Compared to patients without lymphedema,those with lymphedema had higher mean age,median model for end-stage liver disease scores,mean body mass index,mean ascitic fluid triglyceride levels,and proportion of patients with hypoproteinemia(serum total protein<5 g/dL)and lymphocytopenia(<15%of total leukocyte count).Patients with IL also had a higher prevalence of lymphocytopenia and hypoproteinemia(28.6%vs.9.1%,P=0.004).Seven(13%)patients with lymphedema had lower limb cellulitis compared to none in those without it.On multivariate regression analysis,factors independently associated with lymphatic dysfunction included obesity[odds ratio(OR):4.2,95%confidence intervals(95%CI):1.1–15.2,P=0.027],lymphocytopenia[OR:6.2,95%CI:2.9–13.2,P<0.001],and hypoproteinemia[OR:3.7,95%CI:1.5–8.82,P=0.003].CONCLUSION Lymphatic dysfunction is common in cirrhosis patients with RA.Significant indicators of its presence include hypoproteinemia and lymphocytopenia,which are likely due to the loss of lymphatic fluid from the circulation.Future efforts to mobilize fluid in these patients should focus on methods to improve lymphatic drainage.
基金Supported by National Key Research and Development Program of China,No.2019YFC1708503。
文摘BACKGROUND The recognition of idiopathic membranous nephropathy(IMN)as an autoimmune disease has paved the way for the use of B-cell-depleting agents,such as Rituximab(RTX),which is now a first-line drug for treating IMN with proven safety and efficacy.Nevertheless,the usage of RTX for the treatment of refractory IMN remains controversial and challenging.AIM To evaluate the efficacy and safety of a new low-dose RTX regimen for the treatment of patients with refractory IMN.METHODS A retrospective study was performed on refractory IMN patients that accepted a low-dose RTX regimen(RTX,200 mg,once a month for five months)in the Xiyuan Hospital of Chinese Academy of Chinese Medical Sciences’Department of Nephrology from October 2019 to December 2021.To assess the clinical and immune remission data,we performed a 24 h urinary protein quantification(UTP)test and measured the serum albumin(ALB)and serum creatinine(SCr)levels,phospholipase A2 receptor(PLA2R)antibody titer,and CD19+B-cell count every three months.RESULTS A total of nine refractory IMN patients were analyzed.During follow-up conducted twelve months later,the results from the 24 h UTP decreased from baseline[8.14±6.05 g/d to 1.24±1.34 g/d(P<0.05)]and the ALB levels increased from baseline[28.06±8.42 g/L to 40.93±5.85 g/L(P<0.01)].Notably,after administering RTX for six months,the SCr decreased from 78.13±16.49μmol/L to 109.67±40.87μmol/L(P<0.05).All of the nine patients were positive for serum anti-PLA2R at the beginning,and four patients had normal anti-PLA2R titer levels at six months.The level of CD19+B-cells decreased to 0 at three months,and CD19+B-cell count remained at 0 up until six months of follow-up.CONCLUSION Our low-dose RTX regimen appears to be a promising treatment strategy for refractory IMN.
基金Shanxi Province Science and Technology Research Project(2016ZD0307)Jinyao Comprehensive Development and Utilization Collaborative Innovation Center Project(2017-JYXT-32)+2 种基金The Key Project of Shanxi Province Key R&D Program(201603D3113023)The Key R&D Program(Guide)Project of Shanxi Province(201703D421024)Graduate Education Innovation Program of Shanxi University of Traditional Chinese Medicine(2020JG001)。
文摘Objective:To evaluate the efficacy and safety of Yishen-Huoxue Formula in the treatment of refractory nephrotic syndrome(RNS)using evidence-based medicine.Methods:Databases CNKI,WanFang,VIP,CBM,PubMed,EMbase,and Cochrane Library were searched for randomized controlled trials(RCTs)on the treatment of RNS with the Yishen-Huoxue Formula from June 2008 to July 2020.The quality of the literature was evaluated by the Cochrane.Meta-analysis was performed using Review Manager 5.3 software.Results:A total of 18 articles and 1432 patients were included in this study.The results showed compared to the control group,Yishen-Huoxue Formula was much better in improving total effectiverate[OR=4.15,(95%CI:3.03,5.68),P<0.05],plasma albumin[MD=5.08,(95%CI:3.42,6.74),P<0.05]and decreasing 24-h urine protein quantitation[MD=-0.99,(95%CI:-1.30,-0,69),P<0.05],recurrence rate[OR=0.21,95%CI(0.11,0.40),P<0.05],and adverse reaction rate[OR=0.33,95%CI(0.21,0.52),P<0.05].However,the improvement of complete remission rate was affected by the course of treatment.The effects were similar in less than or equal to nine weeks[OR=1.52,(95%CI:0.74,3.13),P=0.25],whereas the experimental group was superior to the control group in 12-24 weeks[OR=2.47,(95%CI:1.63,3.74),P<0.05]and more than or equal to 26 weeks[OR=2.04,(95%CI:1.43,2.91),P<0.05].Conclusion:The efficacy and safety of Yishen-Huoxue Formula for refractory nephrotic syndrome is better than that of the Western medicine group,but the exact efficacy still needs to be confirmed by prospective studies of higher quality.
基金supported by the National Natural Science Foundation of China(52272022)the Special Project of Central Government for Local Science and Technology Development of Hubei Province(2019ZYYD076)the Innovation and Entrepreneurship Fund of Wuhan University of Science and Technology(D202202171045002669).
文摘The dissolution of alumina-based refractory ceramics in CaO-Al2O3-SiO_(2)slag melts was performed based on the in-situ observation system of an ultra-high-temperature laser confocal microscope,and the effect of the CaO/SiO_(2)slag mass ratio(C/S ratio)on the dissolution rate of alumina-based refractory ceramics was investigated.The results indicate that the dissolution rate increases with an increase of the C/S ratio and is mainly controlled by diffusion.During the early stage of dissolution,for all C/S ratios,the dissolution process conforms to the classical invariant interface approximation model.During the later stage of dissolution,when the C/S ratio is≥6,the dissolution process is significantly different from the model above because of the formation of a thick interfacial layer,which can be explained by dissolution kinetics.
文摘Background: Systemic JIA (sJIA) is one of the subtypes of JIA, which is most difficult to treat among all JIA cases. About 50% of sJIA cases did not respond to traditional disease modifying anti-rheumatic drugs (DMARDs)—metho-trexate (MTX). Thalidomide is an immunomodulating and anti-inflammatory drug that induces sustained improvement of refractory sJIA cases. Objectives: To evaluate the efficacy of thalidomide in refractory sJIA patients. Methods: This was a prospective interventional study carried out in the Paediatric Rheumatology and Immunology follow-up clinic run by the Department of Pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from January 2019 to July 2020. Twenty-five sJIA patients who were refractory to conventional DMARDs were included in this study. These patients were prescribed thalidomide at a dose of 3 - 5 mg/kg/day for six months and efficacy was assessed by using juvenile arthritis disease activity score (JADAS 27) at 12<sup>th</sup> and 24<sup>th</sup> weeks of treatment. Result: Active joint counts and ESR improvement were observed in 90.69%, 97.67% and 69.84%, 100% of sJIA patients respectively at 12<sup>th</sup> and 24<sup>th</sup> weeks of treatment. Improvement of physicians and parent global assessment of VAS were 77.56%, 97.43% and 70.62% and 96.04% respectively at 12<sup>th</sup> and 24<sup>th</sup> weeks of treatment. Improvement of the total score of JADAS-27 was 77.51% at 12th week and 97.52% at 24<sup>th</sup> of week follow-up which was statistically significant. Somnolence, constipation and paresthesia were found as common adverse effect in this study. Conclusion: Efficacy of thalidomide was assessed by JADAS 27 criteria showed significant improvement in refractory sJIA patients in this study. It may be concluded that Thalidomide is safe and effective as an adjunct therapy of refractory sJIA patients.
文摘Objective:To analyze the effect of simplified vacuum sealing drainage(VSD)in the treatment of chronic refractory wounds.Methods:A total of 90 patients with chronic refractory wounds treated from May 2022 to May 2023 were randomly divided into groups.The simplified VSD treatment was employed in group A,and conventional treatment was employed in group B,and the wound healing of both groups were compared.Results:Group A showed better wound healing compared to group B,P<0.05;the wound healing rate,wound healing duration,visual analog scale(VAS)score,wound dressing times and other indicators in group A were better than those in group B,P<0.05.The SF-36 score of group A was higher than that of group B,P<0.05;the complication rate of chronic refractory wounds in group A was no different from that in group B,P>0.05.Conclusion:Simplified VSD treatment is effective in treating patients with chronic refractory wounds,and it reduces the number of wound dressing changes and promote wound healing.
基金acknowledged DEQ/IT/UFRRJ,FEG/UNESP-Guaratinguetáand EEL/USP-Lorena for their support in carrying out the analyses.
文摘Aluminous refractory materials with high alumina contents are widely used in the steel industry,and the higher the alumina content,the higher the working temperature.Properties such as high refractoriness and thermal shock resistance lead these refractory materials to be used as channel linings of blast furnaces,where they are exposed to the attack by slag,molten steel,working cycles and sudden temperature changes between 25℃(room temperature)and 1520℃(the temperature of molten pig iron).In this work,microstructural changes in post-mortem aluminous refractory bricks were investigated by apparent porosity,X-ray diffraction analysis(XRD),Fourier transform infrared spectroscopy(FTIR),scanning electron microscopy,and X-ray dispersion energy spectrometry(SEM/EDS).The results showed an increase in the apparent porosity and the bulk density and the presence of the phases mullite,sillimanite,alumina,and quartz in the post-mortem brick.Calcium and magnesium were not detected in the microstructure of the post-mortem brick,indicating that slags did not corrode these refractory materials.Therefore,the microstructural changes that occurred in the post-mortem bricks must be due to thermal cycling.In the X-ray diffraction(XRD)test,mullite,sillimanite,quartz,andα-alumina phases were identified.These results indicate that the aluminous refractory was obtained from sillimanite.In infrared spectroscopy(FTIR)it was possible to identify the vibration bands referring to the Si-O and Al-O bonds.The increase in the porosity is a result of cracks caused by work cycles at high temperatures and the temperature gradient to which the refractory was subjected during use.Through the micrograph it was possible to identify the presence of acicular mullite.The absence of magnesium and calcium in the microanalysis results by energy dispersed X-ray spectrometry(EDS)indicates that there was no infiltration by slag or liquid iron.These results indicate that the microstructural changes that occurred in the post-mortem aluminous refractory were of a thermal nature.
基金the Joint Founds of R&D Program of Henan Province (222301420034)National Natural Science Foundation of China (51802287)Collaborative Innovation Major Special Project of Zhengzhou (No. 20XTZX12025) for the financial support
文摘Cr_(2)O_(3)-bearing castables bonded with reactive MgO(RM)or calcium aluminate cement(CAC)were studied to evaluate the binder effect on their performance in corrosive environments.The properties of the as-prepared castables were compared with respect to the differences in phase composition and microstructure.The corrosion behavior of the as-prepared castables by CaO-Al_(2)O_(3)-Fe_(2)O_(3)-SiO_(2)-based slag was systematically compared viarefractory cup testing at 1600℃with respect to the differences in phase composition and microstructure.The analysis indicates that RM bonded castables show higher apparent porosity,lower bulk density and strengths after drying at 110℃and firing at 1300℃,and higher permanent linear change after firing at 1300℃,but better slag corrosion and infiltration resistance compared with CAC bonded castables.
