Background: The increasing prevalence of colorectal cancer(CRC) in China and the paucity of information about relevant expenditure highlight the necessity of better understanding the financial burden and effect of CRC...Background: The increasing prevalence of colorectal cancer(CRC) in China and the paucity of information about relevant expenditure highlight the necessity of better understanding the financial burden and effect of CRC diagnosis and treatment. We performed a survey to quantify the direct medical and non-medical expenditure as well as the resulting financial burden of CRC patients in China.Methods: We conducted a multicenter, cross-sectional survey in 37 tertiary hospitals in 13 provinces across China between 2012 and 2014. Each enrolled patient was interviewed using a structured questionnaire. All expenditure data were inflated to the 2014 Chinese Yuan(CNY; 1 CNY = 0.163 USD). We quantified the overall expenditure and financial burden and by subgroup(hospital type, age at diagnosis, sex, education, occupation, insurance type, household income, clinical stage, pathologic type, and therapeutic regimen). We then performed generalized linear modeling to determine the factors associated with overall expenditure.Results: A total of 2356 patients with a mean age of 57.4 years were included, 57.1 % of whom were men; 13.9% of patients had stage I cancer; and the average previous-year household income was 54,525 CNY.The overall average direct expenditure per patient was estimated to be 67,408 CNY, and the expenditures for stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ disease were 56,099 CNY, 59,952 CNY, 67,292 CNY, and 82,729 CNY, respectively. Non-medical expenditure accounted for 8.3%of the overall expenditure. The 1-year out-of-pocket expenditure of a newly diagnosed patient was 32,649 CNY, which accounted for 59.9% of their previous-year household income and caused 75.0% of families to suffer an unmanageable financial burden. Univariate analysis showed that financial burden and overall expenditure differed in almost all subgroups(P < 0.05), except for sex. Multivariate analysis showed that patients who were treated in specialized hospitals and those who were diagnosed with adenocarcinoma or diagnosed at a later stage were likely to spend more,whereas those with a lower household income and those who underwent surgery spent less(all P < 0.05).Conclusions: For patients in China, direct expenditure for the diagnosis and treatment of CRC seemed catastrophic,and non-medical expenditure was non-ignorable. The financial burden varied among subgroups, especially among patients with different clinical stages of disease, which suggests that, in China, CRC screening might be cost-effective.展开更多
This work aimed to analyze the spatial behavior of plant formations and land use in the Ecological Tension Area Amazon—Cerrado. To this end, the Araguaia river basin was selected, in its low course, because it consti...This work aimed to analyze the spatial behavior of plant formations and land use in the Ecological Tension Area Amazon—Cerrado. To this end, the Araguaia river basin was selected, in its low course, because it constitutes a physical-natural limit between the two Biomms, with intense dynamics of use and land cover Thus, in addition to researching scientific references and socioeconomic data from secondary sources, a geographic database was elaborated, with georeferenced data, and spatial operations are carried out. Among them, a supervised classification of land use and coverage, with multi-temporal analysis between the years 1984, 2000 and 2018. Thus, an expansion of 4.2 ha of Forest (Amazon biome) was observed on the savanic phytophysiognomy (Cerrado). However, the suppression of forested areas reached values around 21,700 km2, with direct conversions to anthropic activities, mainly pasture, about 71%. The results of the mapping compared with the data of the agricultural census show that the landscape of the Araguaia river basin, in its low course, is dominated by areas of pasture managed. However, public policies and government investments have fomented the expansion of agriculture in the direct bank of the river Araguaia, from 2000 onwards, and that the landscape of the left bank is dominated by pasture managed. Finally, it was found that the implantation of protective areas contributed to the vegetational regeneration of both biomms.展开更多
In the current report, we describe an 83-year-old biological male who self- identified as a female by legally changing his first and middle names to female ones and whose death certificate states his sex as a female. ...In the current report, we describe an 83-year-old biological male who self- identified as a female by legally changing his first and middle names to female ones and whose death certificate states his sex as a female. The medical history of this individual indicated complete penectomy without further specification. Postmortem physical examination revealed an absence of penis with a large scrotum, transposed urethral orifice, and small testes. The histological analysis of the testes identified abnormal epithelium in the seminiferous tubules that lacked germ and Sertoli cells as well as the interstitium without Leydig cells present. The exome sequencing of the individual’s DNA using the Next Generation Sequencing (NGS) Illumina platform revealed no genetic variants associated with either penile or urethral cancer that could have explained the complete penectomy, but pointed toward a potentially impaired production of T3 and T4 thyroid hormones which could account for the observed testicular malformation. Overall, the data obtained raise an important question as to whether the thyroid hormone axis could be an important part of the hormonal architecture supporting male sexual behavior.展开更多
The fast aging human population requires new approaches to reliable diagnosis and proper treatment of dementia in elderly patients with psychiatric disorders such as bipolar disorder (BD) and schizophrenia (SCZ). As c...The fast aging human population requires new approaches to reliable diagnosis and proper treatment of dementia in elderly patients with psychiatric disorders such as bipolar disorder (BD) and schizophrenia (SCZ). As compared to other psychiatric disorders, BD and SCZ are characterized by increased and similar risk for dementia as well as cerebrovascular (CVD) and Parkinson’s (PD) diseases independent of the patient’s age. There are reports in the literature suggesting BD and SCZ in older patients could cause dementia without contribution from the neurodegenerative diseases, including Alzheimer’s disease (AD), due to the absence of the known neuropathology associated with cognitive decline in such individuals. This view contradicts a plethora of data highlighting AD as a major cause of dementia in the elderly. This issue was addressed by examining postmortem cerebral pathology in an 83-year-old female diagnosed with BD, SCZ, and PD (D1) and comparing it to that of a second donor (D2), an age-matched male diagnosed with Lewy Body Dementia (LBD). Upon thorough histochemical and immunohistochemical examinations of both brains, the PD and LBD diagnoses in D1 and D2 were not confirmed. Instead, AD-related pathology was observed in both subjects with AD advancing to its clinical stage (mild to moderate) only in D1. Diffuse β-amyloid peptide 1-42 (Aβ1-42) staining, most likely reflecting a presence of the Aβ1-42 soluble form, was also detected in cerebellar neurons and cerebellar extracellular space in D1 and D2. Cerebrovascular pathology was pronounced and distinct in both brains and included amyloid angiopathy, hyaline atherosclerosis, microbleeds, and dilated Virchow Robin spaces in D1 as well as thick-walled blood vessels with microbleeds in D2. It was concluded that a mixed AD and cerebrovascular pathology could mimic Lewy Body Disease and potentially contribute to dementia development in elderly BD and SCZ patients.展开更多
Objective:To explore the regulatory mechanism of transient receptor potential melastatin-7(TRPM7)in high glucose-induced renal tubular epithelial cell injury.Methods:The expression of TRPM7 in the serum of diabetic ne...Objective:To explore the regulatory mechanism of transient receptor potential melastatin-7(TRPM7)in high glucose-induced renal tubular epithelial cell injury.Methods:The expression of TRPM7 in the serum of diabetic nephropathy patients and high glucose-induced HK-2 cells was detected by RT-qPCR.Then,the TRPM7 interference vector was constructed,and the downstream high mobility group box 1(HMGB1)/Toll-like receptor 4(TLR4)signaling pathway proteins were detected.Next,in addition to interference with TRPM7 expression,overexpression of HMGB1 in high glucose-induced HK-2 cells was performed.Cell activity,apoptosis,oxidative stress levels,and inflammation levels were determined by CCK8,TUNEL,Western blotting,immunofluorescence and related kits.Results:TRPM7 expression was upregulated in the serum of diabetic nephropathy patients and high glucose-induced HK-2 cells.Interference with TRPM7 reduced cell damage,epithelial-mesenchymal transition,oxidative stress,and inflammatory response in high glucose-induced HK-2 cells via inhibiting the HMGB1/TLR4 signaling pathway.However,the effects induced by TRPM7 silencing were abrogated by HMGB1 overexpression.Conclusions:Decreased TRPM7 alleviates high glucose-induced renal tubular epithelial cell injury by inhibiting the HMGB1/TLR4 signaling pathway.Further animal experiments and clinical trials are warranted to verify its effect.展开更多
Mesenchymal stem cells(MSCs)are gaining the spotlight in research due to their abundant sources,immune privileges,and ability to proliferate and differentiate.These cells provide invaluable resources for stem cell-bas...Mesenchymal stem cells(MSCs)are gaining the spotlight in research due to their abundant sources,immune privileges,and ability to proliferate and differentiate.These cells provide invaluable resources for stem cell-based therapy and present therapeutic opportunities in cell/tissue regeneration medicine.A growing evidence suggests that,mitochondria transfer from MSCs could rescue tissue degeneration caused by mitochondria damage.Although this emerging tissue regeneration treatment method brings hope for the treatment of mitochondria dysfunction related diseases,the necessary conditions and underlying mechanisms for mitochondrial transfer remain poorly understood.In this review,a large number of mitochondrial transfer phenomena between MSCs and recipient cells are summarized,with particular emphasis on the conditions and potential mechanisms of mitochondrial transfer from MSCs,so as to provide reference for the clinical application of MSCs transformation in the future.展开更多
Background: There are few randomized controlled trials with sufficient statistical power to assess the effectiveness of intraoperative cholangiography(IOC) in the detection and treatment of common bile duct injury(BDI...Background: There are few randomized controlled trials with sufficient statistical power to assess the effectiveness of intraoperative cholangiography(IOC) in the detection and treatment of common bile duct injury(BDI) or retained stones during cholecystectomy. The best evidence so far regarding IOC and reduced morbidity related to BDI and retained common bile duct stones was derived from large populationbased cohort studies. Population-based studies also have the advantage of reflecting the outcome of the procedure as it is practiced in the community at large. However, the outcomes of these population-based studies are conflicting. Data sources: A systematic literature search was conducted in 2020 to search for articles that contained the terms “bile duct injury”, “critical view of safety”, “bile duct imaging” or “retained stones” in combination with IOC. All identifed references were screened to select population-based studies and observational studies from large centers where socioeconomic or geographical selections were assumed not to cause selection bias. Results: The search revealed 273 references. A total of 30 articles fulflled the criteria for a large observational study with minimal risk for selection bias. The majority suggested that IOC reduces morbidity associated with BDI and retained common bile duct stones. In the short term, IOC increases the cost of surgery. However, this is offset by reduced costs in the long run since BDI or retained stones detected during surgery are managed immediately. Conclusions: IOC reduces morbidity associated with BDI and retained common bile duct stones. The reports reviewed are derived from large, unselected populations, thereby providing a high external validity. However, more studies on routine and selective IOC with well-defned outcome measures and sufficient statistical power are needed.展开更多
Background: Esophageal cancer is associated with substantial disease burden in China, and data on the economic burden are fundamental for setting priorities in cancer interventions. The medical expenditure for the dia...Background: Esophageal cancer is associated with substantial disease burden in China, and data on the economic burden are fundamental for setting priorities in cancer interventions. The medical expenditure for the diagnosis and treatment of esophageal cancer in China has not been fully quantified. This study aimed to examine the medical expenditure of Chinese patients with esophageal cancer and the associated trends.Methods: From 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 37 hospitals in 13 provinces/municipalities across China as a part of the Cancer Screening Program of Urban China. For each esophageal cancer patient diagnosed between 2002 and 2011, clinical information and expense data were extracted by using structured questionnaires. All expense data were reported in Chinese Yuan(CNY; 1 CNY = 0.155 USD) based on the2011 value and inflated using the year-specific health care consumer price index for China.Results: A total of 14,967 esophageal cancer patients were included in the analysis. It was estimated that the overall average expenditure per patient was 38,666 CNY, and an average annual increase of 6.27% was observed from 2002(25,111 CNY) to 2011(46,124 CNY). The average expenditures were 34,460 CNY for stage Ⅰ,39,302 CNY for stage Ⅱ,40,353 CNY for stage Ⅲ, and 37,432 CNY for stage IV diseases(P < 0.01). The expenditure also differed by the therapy type, which was 38,492 CNY for surgery, 27,933 CNY for radiotherapy, and 27,805 CNY for chemotherapy(P < 0.05).Drugs contributed to 45.02% of the overall expenditure.Conclusions: These conservative estimates suggested that medical expenditures for esophageal cancer in China substantially increased in the last 10 years, treatment for early-stage esophageal cancer costs less than that for advanced cases, and spending on drugs continued to account for a considerable proportion of the overall expenditure.展开更多
Objective:Explore the feasibility of the high precision accelerometer for measuring the human respiratory displacement.Methods:A wireless acceleration acquisition system with the low power consumption and the high pre...Objective:Explore the feasibility of the high precision accelerometer for measuring the human respiratory displacement.Methods:A wireless acceleration acquisition system with the low power consumption and the high precision was designed with the high precision acceleration sensor ADXL355 as the core device.Based on the frequency characteristics of the breathing motion and the principle that the displacement can be calculated by the acceleration quadratic integration,two displacement measurement algorithms for the quasi-periodic weak motion are designed.Results:The simulation results show that the proposed algorithm is effective.The experimental results show that the designed acquisition system and algorithm can calculate the human respiratory displacement.Conclusion:The high precision accelerometer can be used to measure the human respiratory displacement,which provides a new method for the measurement of the human respiratory displacement.展开更多
This study was conducted in the KVRS to;evaluate the seasonal eco-toxicity of water,soil and sediment samples;establish the suitability of using temperate biotest batteries in tropical systems;classify the toxicity of...This study was conducted in the KVRS to;evaluate the seasonal eco-toxicity of water,soil and sediment samples;establish the suitability of using temperate biotest batteries in tropical systems;classify the toxicity of samples using Fuzzy Rules to estimate potential ecological risks.143 water,sediment,and soil samples were collected during dry and rainy seasons in plantation areas.Pseudokirchneriella subcapitata,Aliivibrio fischeri and Arthrobacter globiformis bioassays were used to assess the toxicity of the samples.Results were categorized and classified into toxicity classes.Dry season presented a significantly higher mean inhibition of 31%than 5%shown by rainy season samples(p<0.001)in the bacterial bioassays,indicating a lower concentration of contaminants due to flooding and increased surface runoff.A few sediment samples resulted into 100%inhibition of A.globiformis,implying organisms were physiologically inactive upon exposure to contaminants.Seventy-three percent of samples posed little or no toxic potential risk,25%posed critical risk and 1%posed elevated critical risk,implying the KVRS ecosystem might be at risk if the extensive usage of pesticides in the area is not well managed and monitored.The temperate micro-biotests can be used in tropical systems,but with further research on suitable organisms and standardized methods.展开更多
Using the sea surface temperature and wind anomalies(SSTA and SSWA for short)of thetropical Pacific from January 1970 to December 1989,main spatial patterns of tropical PacificSSTA and SSWA coupling features in the tr...Using the sea surface temperature and wind anomalies(SSTA and SSWA for short)of thetropical Pacific from January 1970 to December 1989,main spatial patterns of tropical PacificSSTA and SSWA coupling features in the transform course from the warm phase to the cold phaseof El Nino-southern Oscillation(ENSO)cycles are discussed.The main conclusions are as follows:(1)air-sea coupling patterns at the mature stage of ElNino(La Nina)are main spatial ones of tropical Pacific SSWA and SSTA coupling:(2)at themature stage of El Nino,the interaction of the anticyclonic anomaly wind,generated by the forcingof distinct meridional SSTA gradient in the Northern Hemisphere tropical central Pacific.with theCalifornia cold current and SSTA is mainly responsible for weakening of El Nino;(3)the secondsea temperature increase along the South American coast in the decaying course of El Nino resultsfrom the eastward movement of the weakened positive SSTA in the tropical central-eastern Pacificforced by anomalous west wind stress:(4)La Nina results from the joint effect of Walkercirculation,Ekman drift and negative SSTA in the tropical central-eastern Pacific.展开更多
After 16 years of continuous hard work,Zhejiang Province’s rivers and mountains are more majestic than ever before.After 16 years of rapid development,Zhejian’s countryside has never been so full of life.In 2003,Xi ...After 16 years of continuous hard work,Zhejiang Province’s rivers and mountains are more majestic than ever before.After 16 years of rapid development,Zhejian’s countryside has never been so full of life.In 2003,Xi Jinping,then secretary of the CPC Zhejiang Provincial Committee,conducted thorough study in order to develop an accurate understanding of work related to agriculture,rural areas,and farmers as well as the relationship between urban and rural areas in Zhejiang province.On this basis,and in consideration of the new expectations of the public。展开更多
基金supported by the grants from the Beijing Hope Run Special Fund(#LC2012YF44)National Natural Science Foundation of China(No.81402740)+1 种基金Specialized Research Fund for the Doctoral Program of Higher Education(No.20131106120014)The National Health and Family Planning Committee of P.R.China
文摘Background: The increasing prevalence of colorectal cancer(CRC) in China and the paucity of information about relevant expenditure highlight the necessity of better understanding the financial burden and effect of CRC diagnosis and treatment. We performed a survey to quantify the direct medical and non-medical expenditure as well as the resulting financial burden of CRC patients in China.Methods: We conducted a multicenter, cross-sectional survey in 37 tertiary hospitals in 13 provinces across China between 2012 and 2014. Each enrolled patient was interviewed using a structured questionnaire. All expenditure data were inflated to the 2014 Chinese Yuan(CNY; 1 CNY = 0.163 USD). We quantified the overall expenditure and financial burden and by subgroup(hospital type, age at diagnosis, sex, education, occupation, insurance type, household income, clinical stage, pathologic type, and therapeutic regimen). We then performed generalized linear modeling to determine the factors associated with overall expenditure.Results: A total of 2356 patients with a mean age of 57.4 years were included, 57.1 % of whom were men; 13.9% of patients had stage I cancer; and the average previous-year household income was 54,525 CNY.The overall average direct expenditure per patient was estimated to be 67,408 CNY, and the expenditures for stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ disease were 56,099 CNY, 59,952 CNY, 67,292 CNY, and 82,729 CNY, respectively. Non-medical expenditure accounted for 8.3%of the overall expenditure. The 1-year out-of-pocket expenditure of a newly diagnosed patient was 32,649 CNY, which accounted for 59.9% of their previous-year household income and caused 75.0% of families to suffer an unmanageable financial burden. Univariate analysis showed that financial burden and overall expenditure differed in almost all subgroups(P < 0.05), except for sex. Multivariate analysis showed that patients who were treated in specialized hospitals and those who were diagnosed with adenocarcinoma or diagnosed at a later stage were likely to spend more,whereas those with a lower household income and those who underwent surgery spent less(all P < 0.05).Conclusions: For patients in China, direct expenditure for the diagnosis and treatment of CRC seemed catastrophic,and non-medical expenditure was non-ignorable. The financial burden varied among subgroups, especially among patients with different clinical stages of disease, which suggests that, in China, CRC screening might be cost-effective.
文摘This work aimed to analyze the spatial behavior of plant formations and land use in the Ecological Tension Area Amazon—Cerrado. To this end, the Araguaia river basin was selected, in its low course, because it constitutes a physical-natural limit between the two Biomms, with intense dynamics of use and land cover Thus, in addition to researching scientific references and socioeconomic data from secondary sources, a geographic database was elaborated, with georeferenced data, and spatial operations are carried out. Among them, a supervised classification of land use and coverage, with multi-temporal analysis between the years 1984, 2000 and 2018. Thus, an expansion of 4.2 ha of Forest (Amazon biome) was observed on the savanic phytophysiognomy (Cerrado). However, the suppression of forested areas reached values around 21,700 km2, with direct conversions to anthropic activities, mainly pasture, about 71%. The results of the mapping compared with the data of the agricultural census show that the landscape of the Araguaia river basin, in its low course, is dominated by areas of pasture managed. However, public policies and government investments have fomented the expansion of agriculture in the direct bank of the river Araguaia, from 2000 onwards, and that the landscape of the left bank is dominated by pasture managed. Finally, it was found that the implantation of protective areas contributed to the vegetational regeneration of both biomms.
文摘In the current report, we describe an 83-year-old biological male who self- identified as a female by legally changing his first and middle names to female ones and whose death certificate states his sex as a female. The medical history of this individual indicated complete penectomy without further specification. Postmortem physical examination revealed an absence of penis with a large scrotum, transposed urethral orifice, and small testes. The histological analysis of the testes identified abnormal epithelium in the seminiferous tubules that lacked germ and Sertoli cells as well as the interstitium without Leydig cells present. The exome sequencing of the individual’s DNA using the Next Generation Sequencing (NGS) Illumina platform revealed no genetic variants associated with either penile or urethral cancer that could have explained the complete penectomy, but pointed toward a potentially impaired production of T3 and T4 thyroid hormones which could account for the observed testicular malformation. Overall, the data obtained raise an important question as to whether the thyroid hormone axis could be an important part of the hormonal architecture supporting male sexual behavior.
文摘The fast aging human population requires new approaches to reliable diagnosis and proper treatment of dementia in elderly patients with psychiatric disorders such as bipolar disorder (BD) and schizophrenia (SCZ). As compared to other psychiatric disorders, BD and SCZ are characterized by increased and similar risk for dementia as well as cerebrovascular (CVD) and Parkinson’s (PD) diseases independent of the patient’s age. There are reports in the literature suggesting BD and SCZ in older patients could cause dementia without contribution from the neurodegenerative diseases, including Alzheimer’s disease (AD), due to the absence of the known neuropathology associated with cognitive decline in such individuals. This view contradicts a plethora of data highlighting AD as a major cause of dementia in the elderly. This issue was addressed by examining postmortem cerebral pathology in an 83-year-old female diagnosed with BD, SCZ, and PD (D1) and comparing it to that of a second donor (D2), an age-matched male diagnosed with Lewy Body Dementia (LBD). Upon thorough histochemical and immunohistochemical examinations of both brains, the PD and LBD diagnoses in D1 and D2 were not confirmed. Instead, AD-related pathology was observed in both subjects with AD advancing to its clinical stage (mild to moderate) only in D1. Diffuse β-amyloid peptide 1-42 (Aβ1-42) staining, most likely reflecting a presence of the Aβ1-42 soluble form, was also detected in cerebellar neurons and cerebellar extracellular space in D1 and D2. Cerebrovascular pathology was pronounced and distinct in both brains and included amyloid angiopathy, hyaline atherosclerosis, microbleeds, and dilated Virchow Robin spaces in D1 as well as thick-walled blood vessels with microbleeds in D2. It was concluded that a mixed AD and cerebrovascular pathology could mimic Lewy Body Disease and potentially contribute to dementia development in elderly BD and SCZ patients.
文摘Objective:To explore the regulatory mechanism of transient receptor potential melastatin-7(TRPM7)in high glucose-induced renal tubular epithelial cell injury.Methods:The expression of TRPM7 in the serum of diabetic nephropathy patients and high glucose-induced HK-2 cells was detected by RT-qPCR.Then,the TRPM7 interference vector was constructed,and the downstream high mobility group box 1(HMGB1)/Toll-like receptor 4(TLR4)signaling pathway proteins were detected.Next,in addition to interference with TRPM7 expression,overexpression of HMGB1 in high glucose-induced HK-2 cells was performed.Cell activity,apoptosis,oxidative stress levels,and inflammation levels were determined by CCK8,TUNEL,Western blotting,immunofluorescence and related kits.Results:TRPM7 expression was upregulated in the serum of diabetic nephropathy patients and high glucose-induced HK-2 cells.Interference with TRPM7 reduced cell damage,epithelial-mesenchymal transition,oxidative stress,and inflammatory response in high glucose-induced HK-2 cells via inhibiting the HMGB1/TLR4 signaling pathway.However,the effects induced by TRPM7 silencing were abrogated by HMGB1 overexpression.Conclusions:Decreased TRPM7 alleviates high glucose-induced renal tubular epithelial cell injury by inhibiting the HMGB1/TLR4 signaling pathway.Further animal experiments and clinical trials are warranted to verify its effect.
基金supported by the Scientific Research Project of Tianjin Education Commission(2017KJ162).
文摘Mesenchymal stem cells(MSCs)are gaining the spotlight in research due to their abundant sources,immune privileges,and ability to proliferate and differentiate.These cells provide invaluable resources for stem cell-based therapy and present therapeutic opportunities in cell/tissue regeneration medicine.A growing evidence suggests that,mitochondria transfer from MSCs could rescue tissue degeneration caused by mitochondria damage.Although this emerging tissue regeneration treatment method brings hope for the treatment of mitochondria dysfunction related diseases,the necessary conditions and underlying mechanisms for mitochondrial transfer remain poorly understood.In this review,a large number of mitochondrial transfer phenomena between MSCs and recipient cells are summarized,with particular emphasis on the conditions and potential mechanisms of mitochondrial transfer from MSCs,so as to provide reference for the clinical application of MSCs transformation in the future.
文摘Background: There are few randomized controlled trials with sufficient statistical power to assess the effectiveness of intraoperative cholangiography(IOC) in the detection and treatment of common bile duct injury(BDI) or retained stones during cholecystectomy. The best evidence so far regarding IOC and reduced morbidity related to BDI and retained common bile duct stones was derived from large populationbased cohort studies. Population-based studies also have the advantage of reflecting the outcome of the procedure as it is practiced in the community at large. However, the outcomes of these population-based studies are conflicting. Data sources: A systematic literature search was conducted in 2020 to search for articles that contained the terms “bile duct injury”, “critical view of safety”, “bile duct imaging” or “retained stones” in combination with IOC. All identifed references were screened to select population-based studies and observational studies from large centers where socioeconomic or geographical selections were assumed not to cause selection bias. Results: The search revealed 273 references. A total of 30 articles fulflled the criteria for a large observational study with minimal risk for selection bias. The majority suggested that IOC reduces morbidity associated with BDI and retained common bile duct stones. In the short term, IOC increases the cost of surgery. However, this is offset by reduced costs in the long run since BDI or retained stones detected during surgery are managed immediately. Conclusions: IOC reduces morbidity associated with BDI and retained common bile duct stones. The reports reviewed are derived from large, unselected populations, thereby providing a high external validity. However, more studies on routine and selective IOC with well-defned outcome measures and sufficient statistical power are needed.
基金supported by the National Health and Family Plan Commission of P. R. China
文摘Background: Esophageal cancer is associated with substantial disease burden in China, and data on the economic burden are fundamental for setting priorities in cancer interventions. The medical expenditure for the diagnosis and treatment of esophageal cancer in China has not been fully quantified. This study aimed to examine the medical expenditure of Chinese patients with esophageal cancer and the associated trends.Methods: From 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 37 hospitals in 13 provinces/municipalities across China as a part of the Cancer Screening Program of Urban China. For each esophageal cancer patient diagnosed between 2002 and 2011, clinical information and expense data were extracted by using structured questionnaires. All expense data were reported in Chinese Yuan(CNY; 1 CNY = 0.155 USD) based on the2011 value and inflated using the year-specific health care consumer price index for China.Results: A total of 14,967 esophageal cancer patients were included in the analysis. It was estimated that the overall average expenditure per patient was 38,666 CNY, and an average annual increase of 6.27% was observed from 2002(25,111 CNY) to 2011(46,124 CNY). The average expenditures were 34,460 CNY for stage Ⅰ,39,302 CNY for stage Ⅱ,40,353 CNY for stage Ⅲ, and 37,432 CNY for stage IV diseases(P < 0.01). The expenditure also differed by the therapy type, which was 38,492 CNY for surgery, 27,933 CNY for radiotherapy, and 27,805 CNY for chemotherapy(P < 0.05).Drugs contributed to 45.02% of the overall expenditure.Conclusions: These conservative estimates suggested that medical expenditures for esophageal cancer in China substantially increased in the last 10 years, treatment for early-stage esophageal cancer costs less than that for advanced cases, and spending on drugs continued to account for a considerable proportion of the overall expenditure.
文摘Objective:Explore the feasibility of the high precision accelerometer for measuring the human respiratory displacement.Methods:A wireless acceleration acquisition system with the low power consumption and the high precision was designed with the high precision acceleration sensor ADXL355 as the core device.Based on the frequency characteristics of the breathing motion and the principle that the displacement can be calculated by the acceleration quadratic integration,two displacement measurement algorithms for the quasi-periodic weak motion are designed.Results:The simulation results show that the proposed algorithm is effective.The experimental results show that the designed acquisition system and algorithm can calculate the human respiratory displacement.Conclusion:The high precision accelerometer can be used to measure the human respiratory displacement,which provides a new method for the measurement of the human respiratory displacement.
基金This work was supported by the Schlumberger Foundation-Faculty for the Future[-]German Academic Exchange Service(DAAD)[-]grants fellowships].
文摘This study was conducted in the KVRS to;evaluate the seasonal eco-toxicity of water,soil and sediment samples;establish the suitability of using temperate biotest batteries in tropical systems;classify the toxicity of samples using Fuzzy Rules to estimate potential ecological risks.143 water,sediment,and soil samples were collected during dry and rainy seasons in plantation areas.Pseudokirchneriella subcapitata,Aliivibrio fischeri and Arthrobacter globiformis bioassays were used to assess the toxicity of the samples.Results were categorized and classified into toxicity classes.Dry season presented a significantly higher mean inhibition of 31%than 5%shown by rainy season samples(p<0.001)in the bacterial bioassays,indicating a lower concentration of contaminants due to flooding and increased surface runoff.A few sediment samples resulted into 100%inhibition of A.globiformis,implying organisms were physiologically inactive upon exposure to contaminants.Seventy-three percent of samples posed little or no toxic potential risk,25%posed critical risk and 1%posed elevated critical risk,implying the KVRS ecosystem might be at risk if the extensive usage of pesticides in the area is not well managed and monitored.The temperate micro-biotests can be used in tropical systems,but with further research on suitable organisms and standardized methods.
基金This work was supported by the National Natural Science Foundation of China under the Grants 49375242.
文摘Using the sea surface temperature and wind anomalies(SSTA and SSWA for short)of thetropical Pacific from January 1970 to December 1989,main spatial patterns of tropical PacificSSTA and SSWA coupling features in the transform course from the warm phase to the cold phaseof El Nino-southern Oscillation(ENSO)cycles are discussed.The main conclusions are as follows:(1)air-sea coupling patterns at the mature stage of ElNino(La Nina)are main spatial ones of tropical Pacific SSWA and SSTA coupling:(2)at themature stage of El Nino,the interaction of the anticyclonic anomaly wind,generated by the forcingof distinct meridional SSTA gradient in the Northern Hemisphere tropical central Pacific.with theCalifornia cold current and SSTA is mainly responsible for weakening of El Nino;(3)the secondsea temperature increase along the South American coast in the decaying course of El Nino resultsfrom the eastward movement of the weakened positive SSTA in the tropical central-eastern Pacificforced by anomalous west wind stress:(4)La Nina results from the joint effect of Walkercirculation,Ekman drift and negative SSTA in the tropical central-eastern Pacific.
文摘After 16 years of continuous hard work,Zhejiang Province’s rivers and mountains are more majestic than ever before.After 16 years of rapid development,Zhejian’s countryside has never been so full of life.In 2003,Xi Jinping,then secretary of the CPC Zhejiang Provincial Committee,conducted thorough study in order to develop an accurate understanding of work related to agriculture,rural areas,and farmers as well as the relationship between urban and rural areas in Zhejiang province.On this basis,and in consideration of the new expectations of the public。
