Treat to target in Crohn’s disease:A practical guide for clinicians

A treat-to-target(T2T)approach applies the principles of early intervention and tight disease control to optimise long-term outcomes in Crohn's disease.The Selecting Therapeutic Targets in Inflammatory Bowel Disease(STRIDE)-II guidelines specify short,intermediate,and long-term treatment goals,documenting specific treatment targets to be achieved at each of these timepoints.Scheduled appraisal of Crohn’s disease activity against pre-defined treatment targets at these timepoints remains central to determining whether current therapy should be continued or modified.Consensus treatment targets in Crohn’s disease comprise combination clinical and patient-reported outcome remission,in conjunction with biomarker normalisation and endoscopic healing.Although the STRIDE-II guidelines endorse the pursuit of endoscopic healing,clinicians must consider that this may not always be appropriate,acceptable,or achievable in all patients.This underscores the need to engage patients at the outset in an effort to personalise care and individualise treatment targets.The use of non-invasive biomarkers such as faecal calprotectin in conjunction with cross-sectional imaging techniques,particularly intestinal ultrasound,holds great promise;as do emerging treatment targets such as transmural healing.Two randomised clinical trials,namely,CALM and STARDUST,have evaluated the efficacy of a T2T approach in achieving endoscopic endpoints in patients with Crohn’s disease.Findings from these studies reflect that patient subgroups and Crohn’s disease characteristics likely to benefit most from a T2T approach,remain to be clarified.Moreover,outside of clinical trials,data pertaining to the real-world effectiveness of a T2T approach remains scare,highlighting the need for pragmatic real-world studies.Despite the obvious promise of a T2T approach,a lack of guidance to support its integration into real-world clinical practice has the potential to limit its uptake.This highlights the need to describe strategies,processes,and models of care capable of supporting the integration and execution of a T2T approach in real-world clinical practice.Hence,this review seeks to examine the current and emerging literature to provide clinicians with practical guidance on how to incorporate the principles of T2T into routine clinical practice for the management of Crohn’s disease.

Evaluating the Impact of the Universal Test and Treat Strategy on the Survival of Patients in the Northwest Region of Cameroon

Introduction: The main outcome of efficiently implemented universal test and treat (UTT) program is improved survival. UTT implementation has been ongoing in Cameroon since 2016 but evaluation data are scarce. This study aims to assess the survival of antiretroviral therapy (ART) patients initiated under UTT in Northwest region of Cameroon. Methods: This retrospective cohort study included HIV-positive patients initiated in 2016 at 27 purposefully selected sites and followed until 2021. Data was anonymously abstracted from ART registers and patients’ charts. Kaplan-Meier survival estimates and Cox model were used to compare the survival of patients initiated under UTT with those initiated otherwise, using stata version 14.0. Results: In total, 2490 HIV-positive patients (median age 42.7 years, 94.7% adults, and 69.0% female) participated in the study. Of 1389 patients with viral load (VL) test results, 55% were initiated on ART late. The VL suppression rate of patients initiated late and those initiated early were similar. During follow-up, 1020 (40.9%) participants censored. The survival curves of patients initiated early on ART and those initiated late were similar during the first 2.5 years of follow-up but significantly (p Conclusions: This study confirms the expected impact of UTT. Programs only need to close existing implementation gaps along the critical pathways (diagnosis and treatment) of UTT, focusing more on males.

Hydraulic characteristics and incubation methods for enhancing durability of Fungi-Mycelium treated silica sand using Rhizopus oligosporus and Rhizopus oryzae combination

Nowadays,the application of Fungi as a bio-mediated soil improvement technique is developing.The hydraulic properties of Rhizopus Fungi-Mycelium Treated Soil are unknown,and the treated sample tends to have low durability.This article presents experimental results on the hydraulic conductivity and shear strength of Fungi-mycelium-treated silica sand.The fungi used in the experiments are a combination ofRhizopus oligosporus andRhizopus oryzae,which are popular for making Tempeh,a local soybean cuisine from Indonesia.The samples were prepared by mixing the sand with Tempeh inoculum at various treatments and Tempe inoculum and rice flour dosages for enhancing the durability of the treated soil.The results showed that the saturated permeability of the treated soil could be reduced by about 10 times compared to the untreated soil.In addition,the Soil-Water Characteristic Curve of the treated soil also developed.The effect of the fungi appears to fill the void of soil and hence increases the Air Entry Value and residual suction of soil.The curing method outside the mold(O-method)with 10%Tempeh inoculum,and 5%Tempeh inoculum with 5%rice flour is proven can extend the durability of the treated sample,the undrained compressive strength is about 40 kPa on day 14.Scanning electron microscope was performed on the samples,which lasted for 4 months.The mycelium and hyphae are still clearly seen covering all sand particles with different percentages of Tempeh inoculum and rice flour.When the mycelium covered all the sand particles and filled the pores,the water flow was partially blocked.It might be attributed to the strong hydrophobicity of the fungi,which could prevent water from penetrating the soil.

Clinical Study on the Effectiveness of Xian Fang Huo Ming Yin for Treating Cutaneous Infections and Promoting Wound Healing in Patients with Perianal Abscess

Objective:To explore the effect of the Xian Fang Huo Ming Yin(XFHM)for treating cutaneous infections and promoting wound healing in patients with perianal abscesses.Methods:Sixty-one patients with perianal abscesses who were admitted to our hospital(Xinghua City People’s Hospital)from May 2022 to May 2023 were selected and randomly divided into two groups,a control group(30 cases)and a study group(31 cases).Both groups received surgical treatment.The control group received conventional treatment and warm water fumigation,sitz bath,and surgical dressing change after surgery,while the research group received XFHM based on the control group.XFHM was taken orally and replaced with warm water for fumigation and sitz bathing.Both groups received treatment for 4 weeks but discontinued sitz bathing after 2 weeks.Various clinical indicators between the two groups were compared.Results:The total clinical effective rate and wound recovery rate of the study group were higher than that of the control group.There were differences in the wound pain scores,surrounding tissue edema,and wound secretions at different time points.Both groups experienced wound pain.The scores of wound pain,surrounding tissue edema,and wound secretions of the study group were lower than those of the control group,7 and 14 days after surgery.The serum interleukin 6(IL-6),tumor necrosis factor-alpha(TNF-α)levels,and pH values of the study group were lower than those of the control group 10 days after surgery(P<0.05).Conclusion:The application of XFHM for treating cutaneous infections and promoting wound healing in patients with perianal abscesses improved the treatment outcome,alleviated clinical symptoms,and promoted healing.

Performance Evaluation of Two Series Vertical Flow Filters for Wastewater Treatment: A Case Study of the Prototype Installed at Gaston Berger University, Saint-Louis, Senegal

This paper evaluates the efficacy of two sequential vertical flow filters (VFF), FV1 and FV2, implanted with Typha, in a pilot-scale wastewater treatment system. FV1 comprises three cells (FV1a, FV1b, and FV1c), while FV2 consists of two cells (FV2a and FV2b), each designed to reduce various physicochemical and microbiological pollutants from wastewater. Quantitative analyses show significant reductions in electrical conductivity (from 1331 to 1061 μS/cm), biochemical oxygen demand (BOD5 from 655.6 to 2.3 mg/L), chemical oxygen demand (COD from 1240 to 82.2 mg/L), total nitrogen (from 188 to 37.3 mg/L), and phosphates (from 70.9 to 14.6 mg/L). Notably, FV2 outperforms FV1, particularly in decreasing dissolved salts and BOD5 to remarkably low levels. Microbiological assessments reveal a substantial reduction in fecal coliforms, from an initial concentration of 7.5 log CFU/100mL to 3.7 log CFU/100mL, and a complete elimination of helminth eggs, achieving a 100% reduction rate in FV2. The study highlights the impact of design parameters, such as filter material, media depth, and plant species selection, on treatment outcomes. The findings suggest that the judicious choice of these components is critical for optimizing pollutant removal. For instance, different filtration materials show varying efficacies, with silex plus river gravel in FV1c achieving superior pollutant reduction rates. In conclusion, VFFs emerge as a promising solution for wastewater treatment, underscoring the importance of design optimization to enhance system efficiency. Continuous monitoring and adaptation of treatment practices are imperative to ensure water quality, allowing for safe environmental discharge or water reuse. The research advocates for ongoing improvements in wastewater treatment technologies, considering the environmental challenges of the current era. The study concludes with a call for further research to maximize the effectiveness of VFFs in water management.

Treated wastewater irrigation effect on soil,crop and environment:Wastewater recycling in the loess area of China

A study was carded out at the Loess Plateau in Dongzhi, China, to test the feasibility of using secondary treatment sewage effluent and to determine whether the water quality would then meet the recommended irrigation norm. Seven crops, including celery, wheat, maize, millet, apples, rapeseed and yellow beans, were tested in the study. Physical and chemical properties of the soil, crop yield and quality and leachate at different soil depths were measured. In most cases, the quality of the crops that made use of treated sewage was not distinctively different from those that did not use treated sewage. However, yields for the former were much higher than they were for the latter. Leachates at different soil depths were analyzed and the results did not show alarming levels of constituents. For a period of approximately 14 months, the treated sewage irrigation had no significant effect on the loess soil and no cases of illness resulting from contact with the treated sewage were reported. With treated sewage irrigation, a slight increase in the organic content of the soil was observed.

Biosorption of copper ions from dilute aqueous solutions on base treated rubber (Hevea brasiliensis) leaves powder: kinetics, isotherm, and biosorption mechanisms

The effciency of sodium hydroxide treated rubber (Hevea brasiliensis) leaves powder (NHBL) for removing copper ions from aqueous solutions has been investigated. The e?ects of physicochemical parameters on biosorption capacities such as stirring speed, pH, biosorbent dose, initial concentrations of copper, and ionic strength were studied. The biosorption capacities of NHBL increased with increase in pH, stirring speed and copper concentration but decreased with increase in biosorbent dose and ionic strength. The isotherm study indicated that NHBL fitted well with Langmuir model compared to Freundlich and Dubinin-Radushkevich models. The maximum biosorption capacity determined from Langmuir isotherm was 14.97 mg/g at 27°C. The kinetic study revealed that pseudo- second order model fitted well the kinetic data, while Boyd kinetic model indicated that film diffusion was the main rate determining step in biosorption process. Based on surface area analysis, NHBL has low surface area and categorized as macroporous. Fourier transform infrared (FT-IR) analyses revealed that hydroxyl, carboxyl, and amino are the main functional groups involved in the binding of copper ions. Complexation was one of the main mechanisms for the removal of copper ions as indicated by FT-IR spectra. Ion exchange was another possible mechanism since the ratio of adsorbed cations (Cu2+ and H+) to the released cations (Na+, Ca2+, and Mg2+) from NHBL was almost unity. Copper ions bound on NHBL were able to be desorbed at > 99% using 0.05 mol/L HCl, 0.01 mol/L HNO3, and 0.01 mol/L EDTA solutions.

Surface Treatment of PET Nonwovens with Atmospheric Plasma

In this study, polyethylene-terephthalate （PET） nonwovens are treated using an atmospheric plasma and the effects of the treatment time, treatment power and discharge distance on the ability of water-penetration into the nonwovens are investigated. The result indicates that the method can improve the wettability of PET nonwovens remarkably, but the aging decay of the sample＇s wettability is found to be notable as a function of the storage time after treatment due to the internal rotation of the single bond of surface macromolecules. As shown by SEM and XPS analysis, the etching and surface reaction are significant, and water-penetration weight is found to increase remarkably with the increasing power. This variation can be attributed to momentum transfer and enhanced higher-energy particle excitation.

Effect of restoration technique on resistance to fracture of endodontically treated anterior teeth with flared root canals

This study was designed to compare the impact of post and core systems on resistance to fracture of endodontically treated anterior teeth with flared root canals and to assess their fracture pattern. Sixty central incisors were cut horizontally 2 mm coronal to the cementoenamel junction(CEJ). After root canal therapy, teeth were assigned into 6 groups(n = 10 each) based on a post system and used as follows: Group C, non-flared root received size #1 glass fiber posts(Control); Group AP, flared root restored with anatomical post; Group RC, flared root restored with size #1 fiber post and cemented with thick layer of resin cement; Group CR, flared root restored with size #1 and reinforced with composite resin; Group CM, cast post-core; Group CP, CAD/CAM polymer-infiltrated ceramic post and core.Following post cementation, core build-up and crown insertion, the specimens were thermo-cycled up to 10,000 cycles(5 C/55 C; 30 seconds dwell time, 6 seconds transition time) and then statically loaded at 1 mm/minute crosshead speed using a universal testing machine. One-way ANOVA and Tukey HSD post hoc test(α= 0.05) were used for data analysis. Group C recorded significantly higher resistance to fracture values [(826.9±39.1) N] followed by group CP [(793.8±55.6) N] while group RC yielded the lowest fracture resistance values [(586.7±51.4) N]. The resistance to fracture of wide root canals can be enhanced by using one-piece CAM/CAM post and core as an alternative to the use of either glass fiber post, relined with composite resin increasing the thickness of luting cement or the use of cast post and core system. However, this was an in vitro investigation and further in vivo studies are necessary.

Characteristics and Driven Factors of Nitrous Oxide and Carbon Dioxide Emissions in Soil Irrigated with Treated Wastewater

The reuse of treated wastewater in agricultural systems could partially help alleviate water resource shortages in developing countries. Treated wastewater differs from fresh water in that it has higher concentrations of salts, Escherichia coli and presence of dissolved organic matter, and inorganic N after secondary treatment, among others. Its application could thus cause environmental consequences such as soil salinization, ammonia volatilization, and greenhouse gas emissions. In an incubation experiment, we evaluated the characteristics and effects of water-filled pore space （WFPS） and N input on the emissions of nitrous oxide （N2O） and carbon dioxide （CO2） from silt loam soil receiving treated wastewater. Irrigation with treated wastewater （vs. distilled water） significantly increased cumulative N2O emission in soil （117.97 μg N kg-1）. Cumulative N2O emissions showed an exponentially increase with the increasing WFPS in unamended soil, but the maximum occurred in the added urea soil incubated at 60% WFPS. N2O emissions caused by irrigation with treated wastewater combined with urea-N fertilization did not simply add linearly, but significant interaction （P〈0.05） caused lower emissions than the production of N2O from the cumulative effects of treated wastewater and fertilizer N. Moreover, a significant impact on cumulative CO2 emission was measured in soil irrigated with treated wastewater. When treated wastewater was applied, there was significant interaction between WFPS and N input on N2O emission. Hence, our results indicated that irrigation with treated wastewater should cause great concern for increasing global warming potential due to enhanced emission of N2O and CO2.

Acute effects of chlorpyryphos-ethyl and secondary treated effluents on acetylcholinesterase and butyrylcholinesterase activities in Carcinus maenas

The acute effects of commercial formulation of chlorpyrifos-ethyl （Dursban ） and the secondary treated industrial/urban effluent （STIUE） exposure on acetylcholinesterase （ACHE） and butyrylcholinesterase （BuChE） activities in hepatopancreas and gills of Mediterranean crab Carcinus maenas were investigated. After 2 d of exposure to chlorpyriphos-ethyl, the AChE activity was inhibited in both organs at concentrations of 3.12 and 7.82 μg/L, whereas the BuCHE was inhibited only at higher concentration 7.82 μg/L of commercial preparation Dursban~. The exposure of crabs to Dursban （3.12 μg/L） showed a significant decrement of ACHE activity at 24 and 48 h, whereas the BuChE was inhibited only after 24 h and no inhibition for both enzymes was observed after 72 h. Moreover, a significant repression of AChE activity was observed in both organs of C. maenas exposed to 5% of STIUE. Our experiments indicated that the measurement of AChE activity in gills and hepatopancreas of C. maenas would be useful biomarker of organophosphorous （OP） and of neurotoxic effects of STIUE in Tunisia.

THE INFLUENCE OF COMPOSITION AND TEMPERATURE OF BATH ANDAFTER-TREATMENT 0N COLORATION IN COLORING HOT DIPGALVANIZATION

The 08 Al steel sheets were hot dip ped into Zn - Mn bath with 0 1 % Mn and 0 2 % Mn at600 ～420 ℃ bath tem perature , and then w ere treated in different w ays . The after - treat ments include cooling in the air at room tem perature directly , holding at the upper part of thehot dip galvanizing furnace for 60 s an d then holding at 510 ±10 ℃for 90 s . The results in dicated that blue , yellow , and purple , w hose coloration varied with the co m position an d thetem perature of bath and the w ays of after - treat ment . Finally , the mechanism of coloredzinc coating w as discussed .

Key parameters controlling electrical resistivity and strength of cement treated soils

The improvement of question soils with cement shows great technical, economic and environmental advantages. And interest in introducing electrical resistivity measurement to assess the quality of cement treated soils has increased markedly recently due to its economical, non-destructive, and relatively non-invasive advantages. This work aims to quantify the effect of cement content （aw）, porosity （nt）, and curing time（T） on the electrical resistivity （p） and unconfined compression strength （UCS） of cement treated soil. A series of electrical resistivity tests and UCS tests of cement treated soil specimen after various curing periods were carried out. A modified Archie empirical law was proposed taking into account the effect of cement content and curing period on the electrical resistivity of cement treated soil. The results show that nt/（aw·T） and nt/（aw·T^1/2） ratio are appropriate parameters to assess electrical resistivity and UCS of cement treated soil, respectively. Finally, the relationship between UCS and electrical resistivity was also established.

Water quality of reclaimed water from treated urban wastewater in Chaobai River Basin,North China

The utilization of reclaimed water could be an efficient tool to alleviate water scarcity,especially for dry river augmentation.However,it is crucial to monitor water quality to ensure safety to human health and to avoid negative effects on the environment.Reclaimed water samples were collected bimonthly from May to November in 2010 in Chaobai River,and the physiochemical parameters were determined.The main results are as follows:The parameters exceeding the threshold value of the water guidelines are mainly nutrition related to nitrogen and phosphorus,which are known to increase the risk of eutrophication in surface waters.Additionally,nitrite and nitrate can be detrimental to human health.The majority of the parameters have a peaking concentration in May,whereas others either show significant temporal variation over the entire period or remain relatively constant in all four months.Correlation analysis shows that some parameters(pH,T and B) have no significant correlation with others,whereas significant positive correlation was found for Sr with EC and TDS,for CI with TDS,for Si02 with TP and for NO3-N with TN and a significant negative correlation between SO4 and Ba.According to principal component analysis,60.108%of the total data is represented by dominant solutes,and the second principal component with a percentage of 31.876 comprises parameters related to nitrogen.Subsequent cluster analysis of parameters identified four groups,which represent different compositions,and samples in May differ from others.

Evolution of deformation property and strength component mobilization for thermally treated Beishan granite under compression

The cohesion weakening and friction strengthening(CWFS)model for rock reveals the strength components mobilization process during progressive brittle failure process of rock,which is very helpful in understanding mechanical properties of rock.However,the used incremental cyclic loading−unloading compression test for the determination of strength components is very complicated,which limits the application of CWFS model.In this paper,incremental cyclic loading−unloading compression test was firstly carried out to study the evolution of deformation and the strength properties of Beishan granite after various temperatures treated under different confining pressures.We found the axial and lateral unloading modulus are closely related to the applied stress and damage state of rock.Based on these findings,we can accurately determine the plastic strain during the entire failure process using conventional tri-axial compression test data.Furthermore,a strength component(cohesive and frictional strength)determination method was developed using conventional triaxial compression test.Using this method,we analyzed the variation of strength mobilization and deformation properties of Beishan granite after various temperatures treated.At last,a non-simultaneous strength mobilization model for thermally treated granite was obtained and verified by numerical simulation,which demonstrated the effectiveness of the proposed strength determination method.

Clinical Observation on 57 Cases with Medical Amenorrhea Treated by Acupuncture

ＣｌｉｎｉｃａｌＯｂｓｅｒｖａｔｉｏｎｏｎ５７ＣａｓｅｓｗｉｔｈＭｅｄｉｃａｌＡｍｅｎｏｒｒｈｅａＴｒｅａｔｅｄｂｙＡｃｕｐｕｎｃｔｕｒｅ￥ＭａＲｅｎ；Ｈａｉｊｉｐｉｎｇ；Ｓｈａｇｉａｅ；ｅｔａｌ．（ＴｈｅＦｉｒｓｔＳｃｉｅｎｔｉｆｉｃＩｎｓｔｉｔｕ...

Transplantation of primary cultured embryonic mesencephalic neural precursor cells for treating Parkinsonian rats

BACKGROUND： Choosing proper donor cells is one of keys in experimental and clinical studies on cell replacement therapy （CRT） for treating Parkinson disease （PD）. Embryonic mesencephalic precursor cells （MPCs） can stably differentiate into dopaminergic neuron after in vitro proliferated culture. As compared with embryonic stem cell and neural stem cell strains, cell composition of embryonic MPCs after primary culture is also the most close to that of embryonic mesencephalic ventral cell suspension without proliferated culture. Successful experience accumulated in the latter suggests that primary cultured embryonic MPCs might be the most potential donor cells in clinical application with CRT for treating PD so far. OBJECTIVE： To investigate the feasibility of primary cultured embryonic precursor cells cultured primarily as donor cells in CRT for treating PD in rats. DESIGN ： A randomized and controlled trial taking SD rats as experimental animals.SETTING： Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University.MATERIALS： This experiment was carried out at the Institute of Neuroscience, Shanghai Institute for Biological Science, Chinese Academy of Sciences from July 2003 to June 2004. Totally 26 female SD rats, with body mass of 200 to 220 g, were provided by Shanghai Experimental Animal Center of Chinese Academy of Sciences. METHODS ： Stereotaxic injection of 6-hydroxydopamine into the medial forebrain bundle were perfored to develop PD model rat. Among 26 SD rats, 20 rats achieved a more than 5 turns/min in apomorphine induced rotation test, reaching the standard of PD model rats. Immunohistochemical detection was performed on 1 out of 20 model rats after execution, and the other 19 rats were randomly divided into control group （n=5）, sham transplantation group （n=5）and cell grafted group （n=9）. Primary cultured E12 MPC cell suspension （1.2×10^11 L^-1）were used as donor cells. 4μL primary cultured E12 MPC cell suspension prepared freshly was injected into the lesioned corpus striatum of rats in cell grafted group, and 4μL D-Hank＇s solution was injected in sham transplantation group in the same way. There was no injection in control group. Apomorphine-induced rotation rate of PD rats were recorded respectively in cell grafted group and sham transplantation group pre-operation （initial value） and at postoperative 2, 4, 6 and 16 weeks. Apomorphine-induced rotation rate of PD rats was recorded in control group at postoperative 2 months （initial value） and following 2,4,6 and 16 weeks. To determine TH antigen with immunohistological ABC method （DAB developing） at 6 months post-transplantation to investigate the differentiation and survival of donor cells in the host body.MAIN OUTCOME MEASURES： Apomorphine-induced rotation behavior before and after transplantation and the survival and differentiation of implanted cells in the host body at 6 months post-transplantation. RESULTS： Among 19 model rats, one rat died after transplantation respectively in the cell grafted group and sham transplantation group; finally 17 model rats entered the stage of result analysis. Relative apomorphine-induced rotation rate was significantly decreased in the cell grafted group as compared with that before transplantation , with significant difference （P 〈 0.01 .P 〈 0.05）;the mean value of relative apomorphine-induced rotation rate was significantly decreased at postoperative 16 weeks in cell grafted group as compared with that of corresponding relative rotation rate in control group , also with significant difference （P 〈 0.05）.Immunohistological results showed that donor cells could differentiate into large and multi-polar dopaminergic neurons in the host body. CONCLUSION ： Primary cultured embryonic MPCs can be used as the donor cells in CRT for treating PD.

Quality Inspection and Preparation of Diarrhea Arresting and Dysentery Treating Dietary Traditional Chinese Herbal Medicine for Livestock

[Objective] This study was aimed to formulate the quality inspection of diarrhea arresting and dysentery treating dietary traditional Chinese herbal medicines for livestock.[Methods] Physiochemical identification and contrast test of UV spectrophotometer qualitative detection were adopted.[Results] The difference in the peak value of maximum adsorption peak detected by diluted water method was greater than 1 nm; the maximum adsorption peak values obtained by the 0.9％ hydrochloric acid and 60％ ethanol methods had a difference of less than 1 nm,and the secondary adsorption peak values also had a difference of less than 1 nm.[Conclusion] The 0.9％ hydrochloric acid and 60％ ethanol methods were selected as the quality inspection standards for the preparation of diarrhea arresting and dysentery treating dietary traditional Chinese herbal medicines for livestock.

PROBING A STOCHASTIC EPIDEMIC HEPATITIS C VIRUS MODEL WITH A CHRONICALLY INFECTED TREATED POPULATION

The hepatitis C virus is hitherto a tremendous threat to human beings,but many researchers have analyzed mathematical models for hepatitis C virus transmission dynamics only in the deterministic case.Stochasticity plays an immense role in pathology and epidemiology.Hence,the main theme of this article is to investigate a stochastic epidemic hepatitis C virus model with five states of epidemiological classification:susceptible,acutely infected,chronically infected,recovered or removed and chronically infected,and treated.The stochastic hepatitis C virus model in epidemiology is established based on the environmental influence on individuals,is manifested by stochastic perturbations,and is proportional to each state.We assert that the stochastic HCV model has a unique global positive solution and attains sufficient conditions for the extinction of the hepatotropic RNA virus.Furthermore,by constructing a suitable Lyapunov function,we obtain sufficient conditions for the existence of an ergodic stationary distribution of the solutions to the stochastic HCV model.Moreover,this article confirms that using numerical simulations,the six parameters of the stochastic HCV model can have a high impact over the disease transmission dynamics,specifically the disease transmission rate,the rate of chronically infected population,the rate of progression to chronic infection,the treatment failure rate of chronically infected population,the recovery rate from chronic infection and the treatment rate of the chronically infected population.Eventually,numerical simulations validate the effectiveness of our theoretical conclusions.

Recent advances in the surgical treatment of hepatocellular carcinoma

Hepatocellular carcinoma(HCC) is the most common primary liver malignancy. The treatment of HCC is complex and complicated by the severity of associated chronic liver disease, the stage of HCC, and the clinical condition of the patient. Liver resection(LR) is one of the most efficient treatments for patients with HCC, with an expected 5-year survival of 38%-61% depending on the stage of the disease. Improved liver function assessment, increased understanding of segmental liver anatomy from advanced imaging studies, and surgical technical progress are important factors that have led to reduced mortality in patients with HCC. The indication for LR may be expanded due to emerging evidences from laparoscopic hepatectomies and combined treatments with newly developed chemotherapies. Liver transplantation(LT) is considered as an ideal treatment for removal of existing tumors and the injured/preneoplastic underlying liver tissue with impaired liver function and the risk of multicentric carcinogenesis that results from chronically injured liver. However, LT is restricted to patients with minimal risk of tumor recurrence under immunosuppression. The expansion of criteria for LT in HCC patients is still under trial and discussion. Limited availability of grafts, as well as the risk and the cost of transplantation have led to considerable interest in expansion of the donor pool, living donor-related transplantation, and combined treatment involving LR and LT. This highlight presents evidence concerning recent studies evaluating LR and LT in HCC patients. In addition, alternative therapies for the treatment of early stage tumors and the management of patients on transplant waiting lists are discussed.