National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma

A consensus meeting of national experts from all major national hepatobiliary centres in the country was held on May 26,2023,at the Pakistan Kidney and Liver Institute&Research Centre(PKLI&RC)after initial consultations with the experts.The Pakistan Society for the Study of Liver Diseases(PSSLD)and PKLI&RC jointly organised this meeting.This effort was based on a comprehensive literature review to establish national practice guidelines for hilar cholangiocarcinoma(hCCA).The consensus was that hCCA is a complex disease and requires a multidisciplinary team approach to best manage these patients.This coordinated effort can minimise delays and give patients a chance for curative treatment and effective palliation.The diagnostic and staging workup includes high-quality computed tomography,magnetic resonance imaging,and magnetic resonance cholangiopancreato-graphy.Brush cytology or biopsy utilizing endoscopic retrograde cholangiopancreatography is a mainstay for diagnosis.However,histopathologic confirmation is not always required before resection.Endoscopic ultrasound with fine needle aspiration of regional lymph nodes and positron emission tomography scan are valuable adjuncts for staging.The only curative treatment is the surgical resection of the biliary tree based on the Bismuth-Corlette classification.Selected patients with unresectable hCCA can be considered for liver transplantation.Adjuvant chemotherapy should be offered to patients with a high risk of recurrence.The use of preoperative biliary drainage and the need for portal vein embolisation should be based on local multidisciplinary discussions.Patients with acute cholangitis can be drained with endoscopic or percutaneous biliary drainage.Palliative chemotherapy with cisplatin and gemcitabine has shown improved survival in patients with irresectable and recurrent hCCA.

Influence of vapor pressure deficit on vegetation growth in China

Vapor pressure deficit(VPD)plays a crucial role in determining plant physiological functions and exerts a substantial influence on vegetation,second only to carbon dioxide(CO_(2)).As a robust indicator of atmospheric water demand,VPD has implications for global water resources,and its significance extends to the structure and functioning of ecosystems.However,the influence of VPD on vegetation growth under climate change remains unclear in China.This study employed empirical equations to estimate the VPD in China from 2000 to 2020 based on meteorological reanalysis data of the Climatic Research Unit(CRU)Time-Series version 4.06(TS4.06)and European Centre for Medium-Range Weather Forecasts(ECMWF)Reanalysis 5(ERA-5).Vegetation growth status was characterized using three vegetation indices,namely gross primary productivity(GPP),leaf area index(LAI),and near-infrared reflectance of vegetation(NIRv).The spatiotemporal dynamics of VPD and vegetation indices were analyzed using the Theil-Sen median trend analysis and Mann-Kendall test.Furthermore,the influence of VPD on vegetation growth and its relative contribution were assessed using a multiple linear regression model.The results indicated an overall negative correlation between VPD and vegetation indices.Three VPD intervals for the correlations between VPD and vegetation indices were identified:a significant positive correlation at VPD below 4.820 hPa,a significant negative correlation at VPD within 4.820–9.000 hPa,and a notable weakening of negative correlation at VPD above 9.000 hPa.VPD exhibited a pronounced negative impact on vegetation growth,surpassing those of temperature,precipitation,and solar radiation in absolute magnitude.CO_(2) contributed most positively to vegetation growth,with VPD offsetting approximately 30.00%of the positive effect of CO_(2).As the rise of VPD decelerated,its relative contribution to vegetation growth diminished.Additionally,the intensification of spatial variations in temperature and precipitation accentuated the spatial heterogeneity in the impact of VPD on vegetation growth in China.This research provides a theoretical foundation for addressing climate change in China,especially regarding the challenges posed by increasing VPD.

Comprehensive applicability evaluation of four precipitation products at multiple spatiotemporal scales in Northwest China

Precipitation plays a crucial role in the water cycle of Northwest China.Obtaining accurate precipitation data is crucial for regional water resource management,hydrological forecasting,flood control and drought relief.Currently,the applicability of multi-source precipitation products for long time series in Northwest China has not been thoroughly evaluated.In this study,precipitation data from 183 meteorological stations in Northwest China from 1979 to 2020 were selected to assess the regional applicability of four precipitation products(the fifth generation of European Centre for Medium-Range Weather Forecasts(ECMWF)atmospheric reanalysis of the global climate(ERA5),Global Precipitation Climatology Centre(GPCC),Climatic Research Unit gridded Time Series Version 4.07(CRU TS v4.07,hereafter CRU),and Tropical Rainfall Measuring Mission(TRMM))based on the following statistical indicators:correlation coefficient,root mean square error(RMSE),relative bias(RB),mean absolute error(MAE),probability of detection(POD),false alarm ratio(FAR),and equitable threat score(ETS).The results showed that precipitation in Northwest China was generally high in the east and low in the west,and exhibited an increasing trend from 1979 to 2020.Compared with the station observations,ERA5 showed a larger spatial distribution difference than the other products.The overall overestimation of multi-year average precipitation was approximately 200.00 mm and the degree of overestimation increased with increasing precipitation intensity.The multi-year average precipitation of GPCC and CRU was relatively close to that of station observations.The trend of annual precipitation of TRMM was overestimated in high-altitude regions and the eastern part of Lanzhou with more precipitation.At the monthly scale,GPCC performed well but underestimated precipitation in the Tarim Basin(RB=-4.11%),while ERA5 and TRMM exhibited poor accuracy in high-altitude regions.ERA5 had a large bias(RB≥120.00%)in winter months and a strong dispersion(RMSE≥35.00 mm)in summer months.TRMM showed a relatively low correlation with station observations in winter months(correlation coefficients≤0.70).The capture performance analysis showed that ERA5,GPCC,and TRMM had lower POD and ETS values and higher FAR values in Northwest China as the precipitation intensity increased.ERA5 showed a high capture performance for small precipitation events and a slower decreasing trend of POD as the precipitation intensity increased.GPCC had the lowest FAR values.TRMM was statistically ineffective for predicting the occurrence of daily precipitation events.The findings provide a reference for data users to select appropriate datasets in Northwest China and for data developers to develop new precipitation products in the future.

A Systematic Literature Review on Task Allocation and Performance Management Techniques in Cloud Data Center

As cloud computing usage grows,cloud data centers play an increasingly important role.To maximize resource utilization,ensure service quality,and enhance system performance,it is crucial to allocate tasks and manage performance effectively.The purpose of this study is to provide an extensive analysis of task allocation and performance management techniques employed in cloud data centers.The aim is to systematically categorize and organize previous research by identifying the cloud computing methodologies,categories,and gaps.A literature review was conducted,which included the analysis of 463 task allocations and 480 performance management papers.The review revealed three task allocation research topics and seven performance management methods.Task allocation research areas are resource allocation,load-Balancing,and scheduling.Performance management includes monitoring and control,power and energy management,resource utilization optimization,quality of service management,fault management,virtual machine management,and network management.The study proposes new techniques to enhance cloud computing work allocation and performance management.Short-comings in each approach can guide future research.The research’s findings on cloud data center task allocation and performance management can assist academics,practitioners,and cloud service providers in optimizing their systems for dependability,cost-effectiveness,and scalability.Innovative methodologies can steer future research to fill gaps in the literature.

Early postoperative complications after transverse colostomy closure,a retrospective study

BACKGROUND Ostomy is a common surgery usually performed to protect patients from clinical symptoms caused by distal anastomotic leakage after colorectal cancer(CRC)surgery and perforation or to relieve intestinal obstruction.AIM To analyze the complications after transverse colostomy closure.METHODS Patients who underwent transverse colostomy closure from Jan 2015 to Jan 2022 were retrospectively enrolled in a single clinical center.The differences between the complication group and the no complication group were compared.Logistic regression analyses were conducted to find independent factors for overall complications or incision infection.RESULTS A total of 102 patients who underwent transverse colostomy closure were enrolled in the current study.Seventy(68.6%)patients underwent transverse colostomy because of CRC related causes.Postoperative complications occurred in 30(29.4%)patients and the most frequent complication occurring after transverse colostomy closure was incision infection(46.7%).The complication group had longer hospital stays(P<0.01).However,no potential risk factors were identified for overall complications and incision infection.CONCLUSION The most frequent complication occurring after transverse colostomy closure surgery in our center was incision infection.The operation time,interval from transverse colostomy to reversal,and method of anastomosis might have no impact on the postoperative complications.Surgeons should pay more attention to aseptic techniques.

Total hip arthroplasty for sequelae of childhood hip disorders:Current review of management to achieve hip centre restoration

Adults requiring total hip arthroplasty(THA)for childhood disorder sequelae present with shortening,limp,pain,and altered gait.THA,which can be particularly challenging due to altered anatomy,requires careful planning,assessment,and computed tomography evaluation.Preoperative templating is essential to establish the appropriate acetabular and femoral size.Information regarding neck length and offset is needed to ensure the proper options are available at THA.Hip centre restoration must be planned preoperatively and achieved intraoperatively with appropriate exposure,identification,and stable fixation with optimum-size components.Identifying the actual acetabular floor is essential as changes include altered anatomy,distortion of the margins and version changes.Proximal femur changes include anatomical variation,decreased canal diameter,cortical thickness,changes in anteversion,and metaphyseal and diaphyseal mismatch.Preoperative assessment should consist of limb assessment for variations due to prior surgical procedures.Evaluation of the shortening pattern with the relationship of the lesser trochanter to the teardrop would help identify and plan for subtrochanteric shortening osteotomy,especially in high-riding hips.The surgical approach must ensure adequate exposure and soft tissue release to achieve restoration of the anatomical hip centre.The femoral components may require modularity to enable restoration of anteversion and optimum fixation.

Evidence-based Clinical Chinese Medicine:What Has Changed Over the Past 20 Years

Chinese medicine has been used for centuries to treat a range of health conditions.This history has produced a wealth of classical literature,case studies and clinical research data detailing its use and effectiveness.However,high-quality and conclusive evidence that meets modern requirements for clinical decision support is lacking.This evidence gap limits the integration of Chinese medicine with contemporary medicine,which in turn limits global access and acceptance of Chinese medicine as a form of safe and effective health care.Over the past 20 years,researchers and organisations around the world,including the World Health Organization(WHO)and United Nations,have worked to support the integration of traditional medicines,such as Chinese medicine,with conventional medicines to improve global health care.This paper provides an overview of Chinese medicine studies published in the top four general medical journals(BMJ,JAMA,Lancet and New England Journal of Medicine)from February 2005 to February 2024 in the past 20 years to highlight the progress in the development of this evidence base.It also highlights key actions taken to promote evidence-based clinical Chinese medicine,including product and practitioner regulation,formalising education standards,and international collaborations.Research conducted at the China-Australia International Research Centre for Chinese Medicine demonstrates the benefits of such a collaboration.Through development of its unique and inclusive‘whole-evidence’approach,plus clinical studies and systematic reviews,the Centre has significantly contributed to the evidence base for clinical Chinese medicine.In addition,its high-impact papers and groundbreaking monographs have been cited in international conventional medicine guidelines.While progress has certainly been made during the past 20 years to build a stronger evidence base for clinical Chinese medicine,there is still a considerable gap that limits its integration with conventional medicine.Future funding and research are needed to continue this work and achieve to safe,effective and accessible traditional medicine as part of the WHO’s Universal Health Coverage strategy.

Factors Affecting Cotrimoxazole Prophylactic Therapy Compliance in HIV Patients Attending a Care and Treatment Clinic at Bugando Medical Centre in Mwanza, Tanzania

Introduction: Cotrimoxazole Prophylactic Therapy (CPT) compliance lowers the risk of opportunistic infections and other Acquired Immune Deficiency Syndrome (AIDS)-related diseases. The aim of this study was to examine factors that influence compliance with CPT among HIV patients in the Care and Treatment Clinic (CTC) at Bugando Medical Centre (BMC) in Mwanza, Tanzania. Methods: A descriptive cross-sectional study was conducted at the BMC between April 1, 2021, and June 30, 2021. Data were collected using face-to-face interviews and a semi-structured questionnaire. Data are presented in frequency, percentages, and cross-tabulation tables. A P-value of less than 0.05 was considered statistically significant. Results: The prevalence of compliance with CPT by self-reported measurement was 158 (63.7%). Most CPT-compliant participants were more likely to have a spouse who is familiar with CPT, have a family member who is aware of their HIV status, and be aware of the benefits of CPT. The majority of participants who complied with CPT were more likely to have experienced counseling during refill, felt that the length of time spent seeing doctors for treatment was reasonable, and received accurate information from them. Conclusion: Most adult HIV patients attending CTC at BMC were reported to be in compliance with CPT. These findings suggest that improving social support and patient-provider communication may be effective strategies for improving compliance with CPT among HIV patients.

About KIT

The Royal Tropical Institute(KIT)in Amsterdam is an independent centre of knowledge and expertise in the areas of international and intercultural cooperation,operating at the interface between theory and practice and between policy and implementation.The Institute contributes to sustainable development,poverty alleviation and cultural preservation and exchange.

A Study on Reconstruction of Surface Wind Speed in China Due to Various Climate Variabilities

Using European Centre for Medium-Range Weather Forecasts Reanalysis V5(ERA5)reanalysis data,this study investigated the reconstruction effects of various climate variabilities on surface wind speed in China from 1979 to 2022.The results indicated that the reconstructed annual mean wind speed and the standard deviation of the annual mean wind speed,utilizing various climate variability indices,exhibited similar spatial modes to the reanalysis data,with spatial correlation coefficients of 0.99 and 0.94,respectively.In the reconstruction of six major wind power installed capacity provinces/autonomous regions in China,the effects were notably good for Hebei and Shanxi provinces,with the correlation coefficients for the interannual regional average wind speed time series being 0.65 and 0.64,respectively.The reconstruction effects of surface wind speed differed across seasons,with spring and summer reconstructions showing the highest correlation with reanalysis data.The correlation coefficients for all seasons across most regions in China ranged between 0.4 and 0.8.Among the reconstructed seasonal wind speeds for the six provinces/autonomous regions,Shanxi Province in spring exhibited the highest correlation with the reanalysis,with a coefficient of 0.61.The large-scale climate variability indices showed good reconstruction effects on the annual mean wind speed in China,and could explain the interannual variability trends of surface wind speed in most regions of China,particularly in the main wind energy provinces/autonomous regions.

Bridge in Slany:A Conjunction of History,Modern Technology and Sensitive Architectural Approach

The revitalization of the historic centre of Slany(Czech Republic)dealt by architects-experts in a historic town focused on their theoretical principles and verified practice.The bridge U Brodu is the first project of the revitalization.

Contribution of CT Scanning in the Investigation of Cranioencephalic Lesions in Bangui

Introduction: Cranioencephalic exploration has always played a major role in CT scans. In the Central Africa Republic (CAR), the lack of cross-sectional imaging before the year 2020 meant that no study had focused on cranioencephalic lesions. The aim of this study was to contribute to improving the management of cranioencephalic pathologies in CAR. Patients and Method: The study took place at the Bangui National Medical Imaging Centre (CNIMB). It was a retrospective study over a two-year period (March 1, 2021 to February 30, 2023). All patients referred for cranioencephalic CT scans were included, regardless of age or sex. Results: 1745 CT scans were performed, 575 of which were cranioencephalic CT scans. The majority of patients were male (53%). Most lived in the capital Bangui (90.9%). Patients aged 61 and over were the most representative. The distribution of patients by requesting department showed that the reception and emergency department was one of the least requesting departments. The main abnormalities observed were strokes, 82.1% of which were ischaemic strokes and 17.9% haemorrhagic strokes. Strokes were followed by degenerative lesions. Post-traumatic injuries included haemorrhagic contusions (38.3%), subdural haematomas in 20.5% of cases, and extradural haematomas (9.3%). Craniofacial lesions (fractures) were observed in 45.8% of cases. Conclusion: Cranioencephalic scans accounted for 1/3 of CT examinations performed during the study period. It revealed pathologies that could not be detected by conventional means. All in all, CT scans contributed to the diagnosis of cerebral pathologies.

The Effects of the Longitudinal Axis of Loading upon Bending, Shear and Torsion of a Thin-Walled Cantilever Channel Beam

Three aluminium channel sections of US standard extruded dimension are mounted as cantilevers with x-axis symmetry. The flexural bending and shear that arise with applied axial torsion are each considered theoretically and numerically in terms of two longitudinal axes of loading not coincident with the shear centre. In particular, the warping displacements, stiffness and stress distributions are calculated for torsion applied to longitudinal axes passing through the section’s centroid and its web centre. The stress conversions derived from each action are superimposed to reveal a net sectional stress distribution. Therein, the influence of the axis position upon the net axial and shear stress distributions is established compared to previous results for each beam when loading is referred to a flexural axis through the shear centre. Within the net stress analysis is, it is shown how the constraint to free warping presented by the end fixing modifies the axial stress. The latter can be identified with the action of a ‘bimoment’ upon each thin-walled section.

New Paths Towards Modernisation

The 13th Meeting of China-Africa Think Tank Forum held in Dar es Salaam,Tanzania,released a document titled Consensus Among African and Chinese Think Tanks on Deepening Global Development Cooperation.Also known as the Africa-China Dar es Salaam Consensus,the document calls on the international community to deepen development cooperation based on the principles of mutual respect,solidarity,win-win cooperation,openness,and common prosperity.It proposes to adopt a people-centred approach to development to create a friendly institutional environment for everyone to pursue a better life.

Friendship Through Football

Lin Yuexin,a student at Beijing No.12 High School,stands in front of a long roll of paper and looks closely at it.In the centre of the scroll are silhouettes of young Chinese and Africans playing football.In the background,cultural symbols of China,such as the Temple of Heaven and the Great Wall,stand alongside those of Africa,represented by the pyramids of Egypt and other emblematic images.On the left is an inscription in Chinese:“We are family,”symbolising the continued commitment and development of cultural exchanges between the two sides.

A Land of Vitality

People-centred development is the core concept underlining China’s endeavours to improve human rights in China.“People’s happiness is the ultimate human right,while development holds the key to delivering better lives to the people,”Chinese President Xi Jinping reiterated in a letter to the 2023 Forum on the Development of Xizang,China.

For the People

China has taught the world that democracy is not one-dimensional and it can take various forms.Election is a common and important feature of the Western democracy,but it is characterised by weak governance due to short-term planning and lack of people-centred political stances.However,not all Western democracies have the same type of governance system:different countries adopt different models.

Collective Undertaking

Medical institutions and enterprises in Shanghai join hands for technological breakthroughs The medical equipment valley in Jiading District of Shanghai,known as Shanghai MedValley,is a powerhouse of medical innovation.As an industrial park centred on creative medical equipment development,the valley has gathered a cluster of high-end medical device enterprises and highly qualified professionals.

Old Skills Get New Life

Traditional craftsmanship takes centre stage as villages seek to restore ancient buildings.Visitors to Ye Changxian’s workshop in Anleshan Village,Songyang County,Lishui City,Zhejiang Province,are greeted by an intense aroma of cedar wood.The work bench is littered with tools-saws,chisels,planes,files and axes.Ye,57,is a highly respected carpenter with nearly 40 years of experience restoring ancient buildings.Adept at mortise and tenon,a traditional woodworking technique,he can create seamless and sturdy structures without the use of a single nail.He has been involved in the restoration of more than 160 old buildings since 2016 when the county began a programme to restore ancient buildings.“I never imagined that these old skills of mine would be of great use,”he said.

Combating Cholera

Lying in her makeshift hospital bed,Joyce Tembo thanked medical personnel for evacuating her to the designated national cholera treatment centre,6 km north of Zambia’s capital Lusaka.She was recently diagnosed with diarrhoeal disease.Tembo,43,commended the medical sta!stationed at the treatment centre for their great service to thousands of patients,especially women and children seeking urgent treatment.“I am very grateful to the Chinese doctors who attended to me as soon as the ambulance rushed me to the clinic where I received urgent treatment;they have really saved my life,”Tembo told ChinAfrica.But not all residents in her community are as lucky as her.Many in the densely populated slums die every day due to the area’s poor sanitation-one of the major causes of the cholera outbreak.