ASPECTS评分及多模态CT定量分析在AIS预后预测中的应用

目的探讨ASPECTS评分及多模态CT中各参数在急性缺血性脑卒中(AIS)预后预测的应用价值。方法收集2019年1月-2023年4月诊断为AIS并在蚌埠医学院第一附属医院就诊的患者,在治疗前均行多模态CT(包括NCCT、CTA、CTP)检查的患者93例,3个月后随访并根据改良Rankin量表评分(mRs)将患者分为预后良好组(mRs≤2)和预后不良组(mRs>2),收集两组患者的临床资料及多模态CT定量参数比较其在预测AIS中预后中有无意义。结果一般资料分析可见预后不良组患者入院基线NIHSS评分、远端侧支循环及ASPECTS评分均与预后良好组之间有一定的统计学差异(P<0.05);CT灌注定量参数分析可见预后不良组CBF较低,而MTT、Tmax、TTP较预后良好组延长,且具有统计学意义(P<0.05)。其中NIHSS、远端侧支循环及Tmax为影响AIS预后的独立危险因素。结论NIHSS、远端侧支循环、ASPECTS及多模态CT可以对AIS的预后进行评测。均具有较好的预测效能,其中Tmax及NIHSS预测效能最好。

Management of Significant Environmental Aspects and Impacts in Accordance with the ISO 14001:2015 Standard during the Operation and Maintenance Phase of Senegal River Basin Development Authority Hydroelectric Works and Facilities: The Case of Manantali Dam

This study aims to determine the environmental aspects and impacts of the phase relating to the operation of Manantali’s hydroelectric structures and facilities according to the requirements of the ISO 14001 version 2015 standard. To do this, the mapping of the different work areas made it possible to identify all the activities within the framework of the farm. Based on the mapping, environmental measurements made including noise level, brightness, electric and magnetic fields, total particles, PM10, PM2.5, PM1 showed the work areas with the exposure limit values exceeded. The inventories of the waste produced show eighteen (18) types of waste, 67% of which are special industrial waste (SIW), 28% are ordinary industrial waste (OIW) and 5% are inert industrial waste (IIW). The identification and assessment of environmental aspects and impacts made it possible to determine sixteen (16) positive and negative significant environmental aspects (ESAs). The positive AES must be maintained, and for the negative ones, mitigation and mitigation measures must be put in place in order to manage them effectively. This will ultimately improve environmental management in the operation of hydroelectric structures and facilities.

Psychosocial Aspects of Male Infertility at the Service of Urology-Andrology of the Hospital of the Sino-Guinean Friendship

Objective: Describe the psychosocial aspects of male infertility at the hospital of the Sino-Guinean Friendship. Patients and method: It is a prospective study of a descriptive type covering a period of 6 months. The study covered 17 patients, all received for a desire to conceive after at least one year of regular sexual intercourse without contraception. The data were collected from patient interviews using a pre-established questionnaire. Results: The average age of the patients was 32.07 years with extremes of 23 years and 42 years. During this study, 64.70% of patients were no longer participating in community ceremonies. The patients’ relationships with their spouse and family deteriorated in 52.94% and 47.06%, respectively. Conversely, relations with the family of origin remained unchanged in 70.59 percent of cases. The reduction in economic activity was by 13 patients (76.48%). Conclusion: Male infertility causes a real psychic earthquake in men with its corollaries of negative feelings. The rather complex moral repercussions of male infertility affect not only the individual, his/her partner, and family, but also economic activity.

人工智能在急性缺血性脑卒中早期ASPECTS评估中的研究进展

急性缺血性脑卒中(AIS)的早期诊断和及时干预对于降低脑卒中的致死致残率具有重要意义。目前,临床上采用阿尔伯塔卒中项目早期计算机断层扫描评分(ASPECTS)来评估AIS的严重程度,但人为评估方法主观性过强且耗时耗力,极易导致漏诊、误诊。因此,近年来涌现了许多基于人工智能算法对AIS进行ASPECTS自动评分的方法研究。本文对此进行综述,以期为进一步研究探索提供参考。首先,简述ASPECTS评分的可靠性;其次,重点介绍目前基于人工智能的脑区提取及脑区评分的方法,证实计算机辅助ASPECTS评分能够有效提高对病情判断的可靠性;最后,总结现有ASPECTS自动评分方法存在的不足,并对其未来的发展趋势进行展望。

Influence of quarantine during the coronavirus disease 2019(COVID-19)pandemic on physical and psychosocial aspects:perceptions of 214 Brazilian athletes

Background:Social distancing may affect athletes,training,causing negative effects on mental and physical health.Objective:This study therefore aimed to characterize the perception of Brazilian athletes about their physical and psychosocial aspects,sleep quality and coping strategies during the quarantine of the coronavirus disease 2019(COVID-19)pandemic.Methods:This was a cross-sectional study with online survey,performed with Brazilian athletes(amateur and professional)over 18 years.The main outcomes measures assessed were physical and psychosocial aspects,sleep quality and coping strategies.Results:A total of 214 athletes were included.The average weekly hours of training during the quarantine was 4.71±3.71 h,of which 64.5%athletes(138/214)were oriented by medical staff during training.For 52.8%(113/214)of athletes,training intensity during the quarantine was different/very different from the intensity before the quarantine.79.4%athletes(170/214)reported moderate to extreme difficulties in keeping the same level of training during the quarantine.77.1%athletes(165/214)had moderate to extreme anxiety and each of the athletes had concern about his or her athletic career future,including return to the sport.72.9%athletes(156/214)reported change in sleep schedule during the quarantine period.Conclusion:The quarantine period during COVID-19 pandemic negatively affected the athlete^perception about training routine,since athletes reported reduction in training hours and training intensity.Overall,the athletes reported that they were moderately to extremely anxious.They also had concerns about their career in the future,as well as concerns regarding return to sport.

Multi-Level Knowledge Engineering Approach for Mapping Implicit Aspects to Explicit Aspects

Aspect’s extraction is a critical task in aspect-based sentiment analysis,including explicit and implicit aspects identification.While extensive research has identified explicit aspects,little effort has been put forward on implicit aspects extraction due to the complexity of the problem.Moreover,existing research on implicit aspect identification is widely carried out on product reviews targeting specific aspects while neglecting sentences’dependency problems.Therefore,in this paper,a multi-level knowledge engineering approach for identifying implicit movie aspects is proposed.The proposed method first identifies explicit aspects using a variant of BiLSTM and CRF(Bidirectional Long Short Memory-Conditional Random Field),which serve as a memory to process dependent sentences to infer implicit aspects.It can identify implicit aspects from four types of sentences,including independent and three types of dependent sentences.The study is evaluated on a largemovie reviews dataset with 50k examples.The experimental results showed that the explicit aspect identification method achieved 89%F1-score and implicit aspect extraction methods achieved 76%F1-score.In addition,the proposed approach also performs better than the state-of-the-art techniques(NMFIAD andML-KB+)on the product review dataset,where it achieved 93%precision,92%recall,and 93%F1-score.

CT灌注成像ASPECTS在急性缺血性脑卒中溶栓再通中的应用

目的研究CT灌注成像(CTP)、Albertu脑卒中项目早期CT评分(ASPECTS)在检测可逆性脑组织缺血方面的作用。方法回顾62例患者临床和影像学资料,这些患者均因急性缺血性脑卒中(持续时间<3 h)接受了静脉溶栓治疗,脑卒中患者最初影像学评估包括非对比增强CT(NCCT),CT血管造影(CTA)和CTP。结果共25例患者存在CTP ASPECTS不匹配。CTP ASPECTS不匹配亚组最终脑梗死体积分别与NCCT 0 h-ASPECTS,平均间隔时间(MTT)-ASPECTS,脑血容量(CBV)-ASPECTS,NCCT 24 h-ASPECTS均呈负相关,ΔmRS分别与NCCT 0 h-ASPECTS,MTT-ASPECTS,CBV-ASPECTS,NCCT 24 h-ASPECTS间均呈负相关。与所有患者组或所有前循环事件的患者亚组相比,在CTP ASPECTS不匹配亚组,ASPECTS和临床结果之间的相关性较高。MTT-ASPECTS和CBV-ASPECTS分数与临床结果之间的相关性比NCCT 0 h-ASPECTS(即入院时NCCT-ASPECTS)与临床结果的相关性要强。二分ΔmRS,采用ΔmRS≤1表示良好的临床效果,MTT-NCCT 24 h ASPECTS不匹配的统计学显著性最低的阈值为2(P=0.04),该值预测良好的临床结果。在MTT-NCCT 24 h ASPECTS不匹配≥2的患者亚组(n=12),此参数和CTP-ASPECTS不匹配间有较强的相关性(r=0.79,P<0.001),并具有较强的线性相关性(R2=0.671)。结论 CTP ASPECTS不匹配可充分预测潜在的可挽救缺血脑组织的量。

CTP-ASPECTS评分在前循环梗死患者急性期预后判断中的应用

目的探讨前循环梗死患者入院时CT灌注成像(CTP)-ASPECTS评分与急性期预后的关系。方法回顾分析起病时间在4.5～8.0 h的34例急性前循环梗死患者头颅CT平扫、CTP及头颅血管造影(CTA)检查结果,根据患者缺血性中风1周内的预后(有无意识改变或死亡)分为预后较好组及预后较差组,多模CT检查获得脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间等参数图,并对各参数图进行ASPECTS评分,同时获得动态CT血管成像(CTA)。比较两组患者CTP参数ASPECTS评分的差异。结果 34例患者中预后较差组12例,预后较差组CBV-ASPECTS评分较低,与预后较好组比较差异有统计学意义(P<0.01),两组病变侧CBF-ASPECTS与MTT-ASPECTS比较差异无统计学意义(P>0.05)。结论 CBV-ASPECTS评分可以作为前循环梗死患者急性期预后的预测因子。

The Synthesis of Aspects on the Management of Second Language Teaching

Principles which teachers should adhere to in second language class are based on the synthesis of linguistic,cultural and competent aspects.This paper first puts forward linguistic,cultural and competent aspects of second language teaching.Then,the principles which teachers should adhere to in second language class are introduced.Finally,the synthesis implication for second language teaching is presented.

急性缺血性中风证候要素演变规律与ASPECTS影像特征的相关性研究

目的:探讨急性缺血性中风证候要素演变规律,并分析头颅影像学特征与证候演变的相关性。方法:从多中心、前瞻性、随机对照临床研究数据库中,选取120例符合纳入标准的发病24 h以内急性缺血性中风病例,通过ASPECTS评分方法对头颅磁共振图像进行评估,采用多因素Logistic回归分析方法,探索基于ASPECTS影像学特征与证候要素演变的相关性。结果:脑缺血损伤主要累及ASPECTS区域中的额顶叶皮层M5(55.0%),内囊(40.9%)和豆状核(30.8%);与发病7 d内证候演变有显著相关性的部位包括尾状核、内囊,以及岛叶、M1、M5、M6等皮层结构(P<0.05)。结论:基于ASPECTS的影像特征是影响中风病证候演变的重要因素。

ASPECTs联合ASITN/SIR模式评估超时间窗前循环脑梗死血管内治疗临床研究

目的探讨ASPECTs评分联合ASITN/SIR侧支循环评分模式评估前循环急性大动脉脑梗死患者超时间窗血管内治疗的临床效果。方法收集52例超时间窗急性大动脉闭塞脑梗死患者为研究组,以本中心63例标准治疗窗内患者为对照组,在三系统同轴下使用颅内血栓抽吸系统、支架取栓装置进行机械取栓治疗,纵向对比2组术后90 d良好恢复率(mRS≤2分)、安全性(症状性颅内出血转化、病死率),研究组间横向对比有效性,主要对比手术前后NIHSS评分。结果研究组与对照组患者术前NIHSS评分差异无统计学意义(P>0.05)。研究组与对照组术中mTICI分级血管再通率分别为90.4%(47/52)、92.1%(58/63),2组比较差异无统计学意义(P>0.05);2组术后良好恢复率(90 d mRS≤2分)[分别为42.3%(22/52)、40%(25/63)]、安全性[研究组症状性颅内出血转化、病死率分别为13.5%(7/52)、15.4%(8/52),对照组分别为11.1%(6/63)、12.7%(8/63)],2组比较差异均无统计学意义(P>0.05)。结论在ASPECTs评分联合ASITN/SIR侧支循环评估模式下急性缺血性脑卒中超时间窗血管内治疗临床疗效具有可行性。

The Physical and Clinical Aspects of Radiation Therapy in Skin Cancer and Subcutaneous Tissue Neoplasm

Cancers, malignant melanoma and sarcomas of the skin represent the most common group of malignancies in humans. The main treatment method of almost all skin cancers and subcutaneous tissue tumours is surgery, which consists of complete removal of a neoplastic lesion, with an adequate margin of healthy tissue. Radiotherapy plays an adjuvant role in this process, meaning complementing of the surgical procedure. This study compared four methods of irradiation treatment of cancer located in the skin or in subcutaneous tissues: contact brachytherapy, conventional orthovoltage therapy, electron beam conformal teleradiotherapy and IMRT dynamically shaped photonic beams conformal teleradiotherapy. In order to compare the methods and techniques of surface radiotherapy, following specific objectives were formulated. At the beginning in order to compare the scopes of the absorbed doses at different tissue depths, an analysis of parameters describing particular beams or radiation source has been performed—the curves for the absorbed-dose depth drop-offs. Doses distribution in tissue-like phantoms stimulating homogeneous cuboidal tissue block has been determined. A quality comparison of dose distribution in 2D and 3D treatment planning system for contact brachytherapy application has been made. The dose distribution for electron beam in the system has been determined. Conformal plannings for electron beam treatment, contact brachytherapy applicator treatment and 4 photon beams treatment optimized in IMRT technology have been performed. Dose distribution has been performed for the irradiated female patient within the well chest—the target included the recurrence area in the post-operative scar. The radiation therapy with X-rays has actually been completely eliminated from skin cancer and subcutaneous tissue radiotherapy by the electrons generated in linear accelerators, contact brachytherapy HDR and by high-energy photons used in conformal techniques, ex. IMRT. It is because the residual dose beyond the target is the highest for single X-ray beam. Although in brachytherapy HDR a rapid dose drop-off is observed, 5 cm from its normalization level for the target the residual radiation remains at the level of several percent. So, both X-rays beam radiation and brachytherapy in skin cancer treatment is connected with the administration of the dose with a high gradient in the health tissues. The dose distribution for photon conformal techniques IMRT or for electron radiation looks different. There with the dose normalization at the level of 90% or 85% we deal with the dose layer, the division does not exceed 15% of heterogeneity.

Psychological and social aspects of infertility in men： an overview of the evidence and implications for psychologically informed clinical care and future research

Research concerning the psychosocial aspects of infertility and infertility treatment focuses more often on women than men. The aim of this review was to synthesize the English-language evidence related to the psychological and social aspects of infertility in men and discuss the implications of these reports for clinical care and future research. A structured search identified 73 studies that reported data concerning the desire for fatherhood and the psychological and social aspects of diagnosis, assisted reproductive technology （ART） treatment and unsuccessful treatment among men with fertility difficulties. The studies are diverse in conceptualisation, design, setting and data collection, but the findings were reasonably consistent. These studies indicated that fertile and infertile childless men of reproductive age have desires to experience parenthood that are similar to those of their female counterparts; in addition, diagnosis and initiation of treatment are associated with elevated infertility-specific anxiety, and unsuccessful treatment can lead to a state of lasting sadness. However, rates of clinically significant mental health problems among this patient population are no higher than in the general population. Infertile men who are socially isolated, have an avoidant coping style and appraise stressful events as overwhelming, are more vulnerable to severe anxiety than men without these characteristics. Men prefer oral to written treatment information and prefer to receive emotional support from infertility clinicians rather than from mental health professionals, self-help support groups or friends. Nevertheless, structured, facilitated psycho-educational groups that are didactic but permit informal sharing of experiences might be beneficial. There are gaps in knowledge about factors governing seeking, persisting with and deciding to cease treatment; experiences of invasive procedures; parenting after assisted conception; adoption and infertility-related grief and shame among men. Few resource-constrained countries have any data concerning male experiences of infertility.

Large Scale Aspects of India-China Summer Monsoon Rainfall

This study investigates the dominant modes of variability in monthly and seasonal rainfall over the India-China region mainly through Empirical Orthogonal Function (EOF) analysis. The EOFs have shown that whereas the rainfall over India varies as one coherent zone, that over China varies in east-west oriented bands. The influence of this banded structure extends well into India.Relationship of rainfall with large scale parameters such as the subtropical ridge over the Indian and the western Pacific regions, Southern Oscillation, the Northern Hemispheric surface air temperature and stratospheric winds have also been investigated. These results show that the rainfall over the area around 40°N, 110°E over China is highly related with rainfall over India. The subtropical ridge over the Indian region is an important predictor over India as well an over the northern China region. '

Effects of slope aspects on forest compositions, community structures and soil properties in natural temperate forests of Garhwal Himalaya

The present study was undertaken in seven natural forest types of temperate zone （1500 to 3100 m, a.s.l.） of Garhwal Himalaya to understand the effects of slope aspects viz., north-east （NE）, north-west （NW）, south-east （SE） and south-west （SW）, on the forest structure, composition and soil characteristics of each selected forest type. The sample plots in each forest type were laid out by using stratified random approach. The indices i.e., the Importance Value Index, Shannon-Wiener diversity index, Simpson’s concentration of Dominance, Simpson diver-sity index, Pielou equitability and Margalef species richness index were calculated statistically using standard softwares to elucidate the differ-ences in forest structure and composition of forest types on different slope aspects of the sites. The composite soil samples were taken from each forest stand and the physico-chemical properties of the soil i.e., moisture content （MC）, water holding capacity （WHC）, pH, organic carbon （OC）, phosphorus （P）, potassium （K） and available nitrogen （N） were analyzed. The results show that the higher values of total basal cover （74.4 m2·ha-1 in Quercus semecarpifolia forest）, Concentration of dominance （0.85 in Pinus roxburghii forest） and Tree diversity （1.81 in Quercus floribunda forest） in the forests were recorded in the northern aspects. MC （40.8% in Quercus leucotrichophora forest）, WHC （48.9% in Cupressus torulosa forest）, OC （3.8% in Cedrus deodara forest）, P （31.9 kg·ha-1 in Quercus leucotrichophora forest） and N （1.0% in Pinus roxburghii forest） had also higher values in the soils of northern aspects. Consequently the higher productivity of the forests was also noticed on the northern aspects.

Psychological aspects of diabetes care: Effecting behavioral change in patients

Patients with diabetes mellitus(DM) need psychological support throughout their life span from the time of diagnosis. The psychological make-up of the patients with DM play a central role in self-management behaviors. Without patient's adherence to the effective therapies, there would be persistent sub-optimal contro of diseases, increase diabetes-related complications,causing deterioration in quality of life, resulting in increased healthcare utilization and burden on healthcare systems. However, provision of psychosocial support is generally inadequate due to its challenging nature of needs and demands on the healthcare systems. This review article examines patient's psychological aspects in general, elaborates in particular about emotion effects on health, and emotion in relation to other psychological domains such as cognition, self-regulation,self-efficacy and behavior. Some descriptions are also provided on willpower, resilience, illness perception and proactive coping in relating execution of new behaviors,coping with future-oriented thinking and influences of illness perception on health-related behaviors. These psychological aspects are further discussed in relationto DM and interventions for patients with DM. Equipped with the understanding of the pertinent nature of psychology in patients with DM; and knowing the links between the psychological disorders, inflammation and cardiovascular outcomes would hopefully encourages healthcare professionals in giving due attention to the psychological needs of patients with DM.

Positive aspects of caregiving in schizophrenia: A review

Schizophrenia is a severe mental illness which is associated with significant consequences for both the patients and their relatives. Due to chronicity of the illness, the relatives of patients of schizophrenia have to bear the main brunt of the illness. Studies across the world have evaluated various aspects of caregiving and caregivers such as burden, coping, quality of life, social support, expressed emotions, and psychological morbidity. In general the research has looked at caregiving as a negative phenomenon, however, now it is increasingly recognised that caregiving is not only associated with negative consequences only, also experience subjective gains and satisfaction. This review focus on the conceptual issues, instruments available to assess the positive aspects of caregiving and the various correlates of positive aspects of caregiving reported in relation to schizophrenia. The positive aspect of caregiving has been variously measured as positive caregiving experience, caregiving satisfaction, caregiving gains and finding meaning through caregiving scale and positive aspects of caregiving experience. Studies suggests that caregivers of patients with schizophrenia and psychotic disorders experience caregiving gains(in the form of becoming more sensitive to persons with disabilities, clarity about their priorities in life and a greater sense of inner strength), experience good aspects of relationship with the patient, do have personal positive experiences. Some of the studies suggest that those who experience greater negative caregiving experience also do experience positive caregiving experience.

Health aspects of peanuts as an outcome of its chemical composition

Peanut is an energy dense food item and it contains a substantial amount of fat,proteins,carbohydrate,both fat soluble and water soluble vitamins,minerals and phytochemicals.Peanuts are consumed worldwide due to its high nutritional value and pleasant or unique flavor after roasting or boiling.The lipid,protein and carbohydrate not only provide energy,but also provide essential nutrients for normal body functions such as body fat and muscle buildup.Vitamins are needed for normal cell function,growth,development,disease prevention and act as coenzymes during the production of energy.Due to the high nutrient contents of peanuts,they have been used to combat malnutrition in most developing countries.Epidemiologic studies have associated nut consumption with a reduced incidence of cardiovascular heart diseases and gallstones in both genders and diabetes in women.Limited evidence also suggests beneficial effects on hypertension,cancer,and inflammation.The health risk associated with peanut consumption is allergy in developed countries.The review discusses the health aspects,including allergy,of peanut consumption as they related to the chemical composition of peanuts using literatures published in past two decades with exceptions of a few older articles.

CFD-Based Simulation and Analysis of Hydrothermal Aspects in Solar Channel Heat Exchangers with Various Designed Vortex Generators

The hydrothermal behavior of air inside a solar channel heat exchanger equipped with various shaped ribs is analyzed numerically.The bottom wall of the exchanger is kept adiabatic,while a constant value of the temperature is set at the upper wall.The duct is equipped with a flat rectangular fin on the upper wall and an upstream V-shaped baffle on the lower wall.Furthermore,five hot wall-attached rib shapes are considered:trapezoidal,square,triangular pointing upstream(type Ⅰ),triangular pointing downstream(type Ⅱ),and equilateral-triangular(type Ⅲ)cross sections.Effects of the flow rates are also inspected for various Reynolds numbers in the turbulent regime(1.2×10^(4)-3.2×10^(4)).The highest performance(η)value is given for the Ⅱ-triangular rib case in all Re values,while the square-shaped ribs show a significant decrease in the η along the achieved Re range.The η value at Remax is 2.567 for the Ⅱ-triangular roughness case.Compared with the other simulated cases,this performance is decreased by about 3.768%in the case of Ⅰ-triangular ribs,15.249% in the case of Ⅲ-triangular ribs,20.802% in the case of trapezoidal ribs,while 27.541% in the case of square ribs,at the same Remax.Also,a comparison ismade with air-heat exchangers that have non-rough walls and contain cross-shaped VGs presented previously,in order to highlight the effectiveness of the rough surface presence in the baffled and finned channels.The obtained results indicated that the triangular-shaped rib(type Ⅱ)has the most significant hydrothermal behavior than the other cases.This indicates the necessity of roughness heat transfer surfaces for finned and baffled channels to improve significantly the performance of the air-heat exchangers they contain.

Epidemiological aspects of Budd-Chiari in Egyptian patients:A single-center study

AIM： TO describe the socio-demographic features, etiology, and risk factors for Budd-Chiari syndrome （BCS） in Egyptian patients. METHODS： Ninety-four Egyptian patients with confirmed primary Budd-Chiari syndrome were presented to the Budd-Chiari Study Group （BCSG） and admitted to the Tropical Medicine Department of Ain Shams University Hospital （Cairo, Egypt）. Complete clinical evaluation and laboratory investigations, including a thrombophilia workup and full radiological assessment, were performed to determine underlying disease etiologies.RESULTS： BCS was chronic in 79.8% of patients, acute or subacute in 19.1%, and fulminant in 1.1%. Factor V Leiden mutation （FVLM） was the most common etiological cause of disease （53.1%）, followed by mutation of the gene encoding methylene tetrahydrofolate reductase （MTHFR） （51.6%）. Current or recent hormonal treatment was documented in 15.5% of females, and BCS associated with pregnancy was present in 17.2% of females. Etiology could not be determined in 8.5% of patients. Males had significantly higher rates of MTHFR gene mutation and Behcet＇ s disease, and females had significantly higher rates of secondary antiphospholipid antibody syndrome. A highly significant positive relationship was evident between the presence of Behcet＇s disease and inferior vena caval occlusion, either alone or combined with occlusion of the hepatic veins （,0 〈 0.0001）. CONCLUSION： FVLM is the most common disease etiology and MTHFR the second most common in Egyptian BCS patients. BCS etiology tends to vary with geographic region.