Existing studies have focused on the behavior of the retaining wall equipped with expanded polystyrene(EPS)geofoam inclusions under semi-infinite surcharge loading rather than limited surcharge loading.In this paper,t...Existing studies have focused on the behavior of the retaining wall equipped with expanded polystyrene(EPS)geofoam inclusions under semi-infinite surcharge loading rather than limited surcharge loading.In this paper,the failure mode and the earth pressure acting on the rigid retaining wall with EPS geofoam inclusions and granular backfills(henceforth referred to as EPS-wall),under limited surcharge loading are investigated through two-and three-dimensional model tests.The testing results show that different from the sliding of almost all the backfill in the EPS-wall under semi-infinite surcharge loading,only an approximately triangular backfill slides in the wall under limited surcharge loading.The distribution of the lateral earth pressure on the EPS-wall under limited surcharge loading is non-linear,and the distribution changes from the increase of the wall depth to the decrease with the increase of the limited surcharge loading.An approach based on the force equilibrium of a differential element is developed to predict the lateral earth pressure behind the EPS-wall subjected to limited surcharge loading,and its performance was fully validated by the three-dimensional model tests.展开更多
Collisions between a moving mass and an anti-collision device increase structural responses and threaten structural safety.An active mass damper(AMD)with stroke limitations is often used to avoid collisions.However,a ...Collisions between a moving mass and an anti-collision device increase structural responses and threaten structural safety.An active mass damper(AMD)with stroke limitations is often used to avoid collisions.However,a strokelimited AMD control system with a fixed limited area shortens the available AMD stroke and leads to significant control power.To solve this problem,the design approach with variable gain and limited area(VGLA)is proposed in this study.First,the boundary of variable-limited areas is calculated based on the real-time status of the moving mass.The variable gain(VG)expression at the variable limited area is deduced by considering the saturation of AMD stroke.Then,numerical simulations of a stroke-limited AMD control system with VGLA are conducted on a high-rise building structure.These numerical simulations show that the proposed approach has superior strokelimitation performance compared with a stroke-limited AMD control system with a fixed limited area.Finally,the proposed approach is validated through experiments on a four-story steel frame.展开更多
Traditional global sensitivity analysis(GSA)neglects the epistemic uncertainties associated with the probabilistic characteristics(i.e.type of distribution type and its parameters)of input rock properties emanating du...Traditional global sensitivity analysis(GSA)neglects the epistemic uncertainties associated with the probabilistic characteristics(i.e.type of distribution type and its parameters)of input rock properties emanating due to the small size of datasets while mapping the relative importance of properties to the model response.This paper proposes an augmented Bayesian multi-model inference(BMMI)coupled with GSA methodology(BMMI-GSA)to address this issue by estimating the imprecision in the momentindependent sensitivity indices of rock structures arising from the small size of input data.The methodology employs BMMI to quantify the epistemic uncertainties associated with model type and parameters of input properties.The estimated uncertainties are propagated in estimating imprecision in moment-independent Borgonovo’s indices by employing a reweighting approach on candidate probabilistic models.The proposed methodology is showcased for a rock slope prone to stress-controlled failure in the Himalayan region of India.The proposed methodology was superior to the conventional GSA(neglects all epistemic uncertainties)and Bayesian coupled GSA(B-GSA)(neglects model uncertainty)due to its capability to incorporate the uncertainties in both model type and parameters of properties.Imprecise Borgonovo’s indices estimated via proposed methodology provide the confidence intervals of the sensitivity indices instead of their fixed-point estimates,which makes the user more informed in the data collection efforts.Analyses performed with the varying sample sizes suggested that the uncertainties in sensitivity indices reduce significantly with the increasing sample sizes.The accurate importance ranking of properties was only possible via samples of large sizes.Further,the impact of the prior knowledge in terms of prior ranges and distributions was significant;hence,any related assumption should be made carefully.展开更多
Background: Elbow dislocations in pediatric patients are rare injuries. This is a therapeutic emergency because a delay in treatment can have disastrous consequences on the functional level of the upper limb. Objectiv...Background: Elbow dislocations in pediatric patients are rare injuries. This is a therapeutic emergency because a delay in treatment can have disastrous consequences on the functional level of the upper limb. Objective: To present the management of elbow dislocation in children in cases of limited resources. Presentation of the Cases: These were 2 older male children aged 7 and 9 years old, admitted to the emergency room for painful functional impotence of the right elbow after a fall and landing on the right hand. Clinical and radiological examinations were in favor of posterior elbow dislocations. The reductions were carried out under sedation and immobilization in Jersey. According to Robert’s criteria, the functional result was excellent in both patients. Conclusion: Emergency reduction and immobilization whatever the means ensure an excellent functional prognosis even in cases of limited resources.展开更多
The resorption of nutrients by plants before litter fall and the mineralization of nutrients from plant litter by soil processes are both important pathways supporting primary productivity. While the positive relation...The resorption of nutrients by plants before litter fall and the mineralization of nutrients from plant litter by soil processes are both important pathways supporting primary productivity. While the positive relationship between plant biodiversity and primary productivity is widely accepted for natural ecosystems, the roles of nutrient resorption and mineralization in mediating that relationship remains largely unknown. Here, we quantified the relative importance of nitrogen(N) resorption and N mineralization in driving plant community N investment and the correlation between species diversity and community productivity along an N-limited successional chronosequence of the mixed broadleaved–Korean pine(Pinus koraiensis) forest in northeastern China. Leaf N resorption efficiency(NRE) at the community level increased significantly along the successional chronosequence,whereas litter N mineralization rate decreased significantly. Leaf NRE was more important than litter N mineralization rate in driving the diversity–productivity relationship. However, higher leaf NRE led to less N mineralization as succession progressed along the chronosequence. Our results highlight the importance of the N resorption pathway rather than the N mineralization pathway for forest N acquisition with community succession,and they provide mechanistic insights into the positive effects of biodiversity on ecosystem functioning. In future forest management practices, we recommend appropriate application of N fertilizer to mitigate the adverse effects of N-poor soil on seedling regeneration during late succession and thus maintain the sustainable development of temperate forest ecosystems.展开更多
Alzheimer’s Disease(AD)is a progressive neurological disease.Early diagnosis of this illness using conventional methods is very challenging.Deep Learning(DL)is one of the finest solutions for improving diagnostic pro...Alzheimer’s Disease(AD)is a progressive neurological disease.Early diagnosis of this illness using conventional methods is very challenging.Deep Learning(DL)is one of the finest solutions for improving diagnostic procedures’performance and forecast accuracy.The disease’s widespread distribution and elevated mortality rate demonstrate its significance in the older-onset and younger-onset age groups.In light of research investigations,it is vital to consider age as one of the key criteria when choosing the subjects.The younger subjects are more susceptible to the perishable side than the older onset.The proposed investigation concentrated on the younger onset.The research used deep learning models and neuroimages to diagnose and categorize the disease at its early stages automatically.The proposed work is executed in three steps.The 3D input images must first undergo image pre-processing using Weiner filtering and Contrast Limited Adaptive Histogram Equalization(CLAHE)methods.The Transfer Learning(TL)models extract features,which are subsequently compressed using cascaded Auto Encoders(AE).The final phase entails using a Deep Neural Network(DNN)to classify the phases of AD.The model was trained and tested to classify the five stages of AD.The ensemble ResNet-18 and sparse autoencoder with DNN model achieved an accuracy of 98.54%.The method is compared to state-of-the-art approaches to validate its efficacy and performance.展开更多
The prevalence of diabetes mellitus is increasing in resource limited settings.Simultaneously,there has been an increase in the number of novel therapies for the management of diabetes mellitus.However,use of novel an...The prevalence of diabetes mellitus is increasing in resource limited settings.Simultaneously,there has been an increase in the number of novel therapies for the management of diabetes mellitus.However,use of novel antidiabetic therapies is limited because of major market access challenges in resource limited settings.Niching products to those patients with the highest absolute risk for major adverse cardiovascular outcomes,and thus most likely to benefit from the therapy,are less likely to have negative budget impact for funders.To improve access,and reduce morbidity and mortality,requires alignment amongst key stakeholders including patient advocacy groups,health care professional councils,national departments of health,the pharmaceutical industry,treasury and finance departments.展开更多
With the rapid advancements in edge computing and artificial intelligence,federated learning(FL)has gained momentum as a promising approach to collaborative data utilization across organizations and devices,while ensu...With the rapid advancements in edge computing and artificial intelligence,federated learning(FL)has gained momentum as a promising approach to collaborative data utilization across organizations and devices,while ensuring data privacy and information security.In order to further harness the energy efficiency of wireless networks,an integrated sensing,communication and computation(ISCC)framework has been proposed,which is anticipated to be a key enabler in the era of 6G networks.Although the advantages of pushing intelligence to edge devices are multi-fold,some challenges arise when incorporating FL into wireless networks under the umbrella of ISCC.This paper provides a comprehensive survey of FL,with special emphasis on the design and optimization of ISCC.We commence by introducing the background and fundamentals of FL and the ISCC framework.Subsequently,the aforementioned challenges are highlighted and the state of the art in potential solutions is reviewed.Finally,design guidelines are provided for the incorporation of FL and ISCC.Overall,this paper aims to contribute to the understanding of FL in the context of wireless networks,with a focus on the ISCC framework,and provide insights into addressing the challenges and optimizing the design for the integration of FL into future 6G networks.展开更多
BACKGROUND Gastrointestinal stromal tumors(GISTs)are the most frequent mesenchymal tumors of gastrointestinal tract.The most common sites of metastases are the liver and the peritoneum,whereas breast metastases from G...BACKGROUND Gastrointestinal stromal tumors(GISTs)are the most frequent mesenchymal tumors of gastrointestinal tract.The most common sites of metastases are the liver and the peritoneum,whereas breast metastases from GIST are extremely rare.We present a second case of GIST breast metastasis.CASE SUMMARY We found a case of breast metastasis from rectum GIST.A 55-year-old female patient presented with rectum tumor with multiply liver lesions and metastasis in the right breast.Abdominal-perineal extirpation of rectum was performed,histology and immunohistochemistry study showed GIST,mixed type with CD117 and DOG-1 positive staining.The patient was taking imatinib 400 mg for 22 mo with stable disease.Because of growth of the breast metastasis the treatment was changed twice:The dose of imatinib was doubled with further progression in the breast lesion and then the patient was receiving sunitinib for 26 mo with partial response in the right breast and stable disease in the liver lesions.The breast lesion increased and right breast resection was done–surgery on local progression,the liver metastases were stable.Histology and immunohistochemistry studies revealed GIST metastasis,CD 117 and DOG 1 positive with KIT exon 11 mutation.After surgery the patient resumed imatinib.Until now the patient has been taking imatinib 400 mg for 19 mo without progression,last follow up was in November 2022.CONCLUSION GISTs breast metastases are extremely rare,we described the second case.At the same time second primary tumors have been reported frequently in patients diagnosed with GISTs and breast cancer is one of the most common second primary tumors in patients with GISTs.That is why it is very important to distinguish primary from metastatic breast lesions.Surgery on local progression made it possible to resume less toxic treatment.展开更多
Introduction: Gastroschisis is one of the neonatal pathologies with bad prognosis in developing countries due to a lack of equipment. We aim to report one way of managing this malformation that could be practised ever...Introduction: Gastroschisis is one of the neonatal pathologies with bad prognosis in developing countries due to a lack of equipment. We aim to report one way of managing this malformation that could be practised everywhere, constituting an alternative approach to surgery in poor areas. Patients and Methods: This observational and descriptive study included newborn babies with gastroschisis who underwent gradual bedside reduction at the Paediatric Surgery Department of the Yaounde Central Hospital. Results: Our cohort was constituted by 32 newborn babies with a mean age of 18.12 hours on admission. The Lefort type 2 was the most frequent in 81.25% of cases. The mean time for oral feeding after complete reduction was 17.4 days and the duration of hospital stay was 24.91 days. Survival rates were at 40.63%, with a residual hernia after healing in 38.46% of cases. Conclusion: Despite the high rate of mortality, gradual reduction of gastroschisis at the bedside seems to be an opportunity for resource constrained areas and can be an alternative solution to surgery.展开更多
A No-Fly Zone(NFZ)is a unique mode of humanitarian intervention which is understudied in international relations.This article focuses on the political dimension of NFZs in international relations and investigates thei...A No-Fly Zone(NFZ)is a unique mode of humanitarian intervention which is understudied in international relations.This article focuses on the political dimension of NFZs in international relations and investigates their implementations by empirically reviewing all three cases of NFZs to date.There may be efforts by intervening states to highlight humanitarian crises among certain targets to secure UN authorization for the NFZs;yet the implementation of NFZs is also driven largely by the security interests of enforcing states.As a result,there is the potential for those states implementing NFZs to transcend legal authorization and sometimes use excessive force,with likely calamitous results for local populations,or in extreme cases,accomplishing regime change by supporting opposition parties in target states.展开更多
Introduction: Management of open leg bones fractures is a challenging health issue for the surgeon, particularly true in resource-limited settings. In this study, we evaluate exclusive fibular osteosynthesis in the tr...Introduction: Management of open leg bones fractures is a challenging health issue for the surgeon, particularly true in resource-limited settings. In this study, we evaluate exclusive fibular osteosynthesis in the treatment of open fractures of the distal half of the leg bones as a therapeutic option in our context. Methods: This is a prospective, experimental, multicenter study of 30 open fractures of the distal half of the leg bones treated with exclusive fibula osteosynthesis, conducted in 3 hospitals in the DRC from January 1, 2013 to September 30, 2016. Results: The age range of 20 to 40 years grouped 22 (73.4%) patients, the sex ratio was 1:1 and the unemployed were the most involved with 16 (53.3%) cases. The Gustilo II, I, III B and III A types represented 40%, 33.3%, 20% and 6.7%, respectively. The fractures were located in the distal third in 12 (40%) cases, in the middle third in 11 (36.7%) cases, and in both malleoli in 7 cases (23.3%). Osteosynthesis of the fibula by screw plate was applied in 22 (73.3%) patients and pinning in 8 (26.7%). Satisfactory reduction of the tibial fracture site was achieved in 29 (96.7%) cases and 100% bone healing was achieved within an average of 10 weeks. Four (13.3%) loss of alignment, 1 (3.3%) infection, 1 (3.3%) skin necrosis and 2 (6.7%) ankle stiffness complicated our fractures. Conclusion: Exclusive osteosynthesis of the fibula as a common technique for fractures of the distal half of the leg bones allowed us to reduce, immobilize and consolidate the tibial fracture in the required time and to preserve the mobility of the ankle.展开更多
This study,taking the library in Henan University of Urban Construction for an example,points out that constant elements in the evaluation system of architecture are its "skeleton" and "spirit",tha...This study,taking the library in Henan University of Urban Construction for an example,points out that constant elements in the evaluation system of architecture are its "skeleton" and "spirit",that is,"space" and "spirit of place".Through analyzing the significant role of space in modern architecture and the appeal of spirit of place to construction users,it is explained that space and spirit of place are closely related and mutually dependent.展开更多
以“Zespri Group Limited v Gao&Ors”案判决书为研究视角,认为在侵权和损失认定方面,法官通过法律原则、国内外判例与学理学说的运用并通过解释立法目的,创造性地运用国内法律,影响其国外利益格局。该案将成为国内法域外适用向植...以“Zespri Group Limited v Gao&Ors”案判决书为研究视角,认为在侵权和损失认定方面,法官通过法律原则、国内外判例与学理学说的运用并通过解释立法目的,创造性地运用国内法律,影响其国外利益格局。该案将成为国内法域外适用向植物新品种保护领域渗透的标志性事件。为维护我国自身利益,建议进一步做好植物新品种保护制度自身建设,加强植物新品种保护制度和植物遗传资源保护制度之间的协调。展开更多
基金funding support from National Natural Science Foundation of China(Grant No.52179109)Jiangsu Provincial Natural Science Foundation(Grant No.BK20230967)Open Research Fund of State Key Laboratory of Mechanical Behavior and System Safety of Traffic Engineering Structures,Shijiazhuang Tiedao University(Grant No.KF2022-02).
文摘Existing studies have focused on the behavior of the retaining wall equipped with expanded polystyrene(EPS)geofoam inclusions under semi-infinite surcharge loading rather than limited surcharge loading.In this paper,the failure mode and the earth pressure acting on the rigid retaining wall with EPS geofoam inclusions and granular backfills(henceforth referred to as EPS-wall),under limited surcharge loading are investigated through two-and three-dimensional model tests.The testing results show that different from the sliding of almost all the backfill in the EPS-wall under semi-infinite surcharge loading,only an approximately triangular backfill slides in the wall under limited surcharge loading.The distribution of the lateral earth pressure on the EPS-wall under limited surcharge loading is non-linear,and the distribution changes from the increase of the wall depth to the decrease with the increase of the limited surcharge loading.An approach based on the force equilibrium of a differential element is developed to predict the lateral earth pressure behind the EPS-wall subjected to limited surcharge loading,and its performance was fully validated by the three-dimensional model tests.
基金This research was founded by the Funds for Creative Research Groups of National Natural Science Foundation of China(Grant No.51921006)the National Natural Science Foundations of China(Grant No.51978224)+2 种基金the National Major Scientific Research Instrument Development Program of China(Grant No.51827811)the National Natural Science Foundation of China,(Grant No.52008141)the Shenzhen Technology Innovation Program(Grant Nos.JCYJ20170811160003571,JCYJ20180508152238111 and JCYJ20200109112803851).
文摘Collisions between a moving mass and an anti-collision device increase structural responses and threaten structural safety.An active mass damper(AMD)with stroke limitations is often used to avoid collisions.However,a strokelimited AMD control system with a fixed limited area shortens the available AMD stroke and leads to significant control power.To solve this problem,the design approach with variable gain and limited area(VGLA)is proposed in this study.First,the boundary of variable-limited areas is calculated based on the real-time status of the moving mass.The variable gain(VG)expression at the variable limited area is deduced by considering the saturation of AMD stroke.Then,numerical simulations of a stroke-limited AMD control system with VGLA are conducted on a high-rise building structure.These numerical simulations show that the proposed approach has superior strokelimitation performance compared with a stroke-limited AMD control system with a fixed limited area.Finally,the proposed approach is validated through experiments on a four-story steel frame.
文摘Traditional global sensitivity analysis(GSA)neglects the epistemic uncertainties associated with the probabilistic characteristics(i.e.type of distribution type and its parameters)of input rock properties emanating due to the small size of datasets while mapping the relative importance of properties to the model response.This paper proposes an augmented Bayesian multi-model inference(BMMI)coupled with GSA methodology(BMMI-GSA)to address this issue by estimating the imprecision in the momentindependent sensitivity indices of rock structures arising from the small size of input data.The methodology employs BMMI to quantify the epistemic uncertainties associated with model type and parameters of input properties.The estimated uncertainties are propagated in estimating imprecision in moment-independent Borgonovo’s indices by employing a reweighting approach on candidate probabilistic models.The proposed methodology is showcased for a rock slope prone to stress-controlled failure in the Himalayan region of India.The proposed methodology was superior to the conventional GSA(neglects all epistemic uncertainties)and Bayesian coupled GSA(B-GSA)(neglects model uncertainty)due to its capability to incorporate the uncertainties in both model type and parameters of properties.Imprecise Borgonovo’s indices estimated via proposed methodology provide the confidence intervals of the sensitivity indices instead of their fixed-point estimates,which makes the user more informed in the data collection efforts.Analyses performed with the varying sample sizes suggested that the uncertainties in sensitivity indices reduce significantly with the increasing sample sizes.The accurate importance ranking of properties was only possible via samples of large sizes.Further,the impact of the prior knowledge in terms of prior ranges and distributions was significant;hence,any related assumption should be made carefully.
文摘Background: Elbow dislocations in pediatric patients are rare injuries. This is a therapeutic emergency because a delay in treatment can have disastrous consequences on the functional level of the upper limb. Objective: To present the management of elbow dislocation in children in cases of limited resources. Presentation of the Cases: These were 2 older male children aged 7 and 9 years old, admitted to the emergency room for painful functional impotence of the right elbow after a fall and landing on the right hand. Clinical and radiological examinations were in favor of posterior elbow dislocations. The reductions were carried out under sedation and immobilization in Jersey. According to Robert’s criteria, the functional result was excellent in both patients. Conclusion: Emergency reduction and immobilization whatever the means ensure an excellent functional prognosis even in cases of limited resources.
基金financially supported by the National Natural Science Foundation of China(No.32071533)the Fundamental Research Funds for the Central Universities,China(2572020AW13)。
文摘The resorption of nutrients by plants before litter fall and the mineralization of nutrients from plant litter by soil processes are both important pathways supporting primary productivity. While the positive relationship between plant biodiversity and primary productivity is widely accepted for natural ecosystems, the roles of nutrient resorption and mineralization in mediating that relationship remains largely unknown. Here, we quantified the relative importance of nitrogen(N) resorption and N mineralization in driving plant community N investment and the correlation between species diversity and community productivity along an N-limited successional chronosequence of the mixed broadleaved–Korean pine(Pinus koraiensis) forest in northeastern China. Leaf N resorption efficiency(NRE) at the community level increased significantly along the successional chronosequence,whereas litter N mineralization rate decreased significantly. Leaf NRE was more important than litter N mineralization rate in driving the diversity–productivity relationship. However, higher leaf NRE led to less N mineralization as succession progressed along the chronosequence. Our results highlight the importance of the N resorption pathway rather than the N mineralization pathway for forest N acquisition with community succession,and they provide mechanistic insights into the positive effects of biodiversity on ecosystem functioning. In future forest management practices, we recommend appropriate application of N fertilizer to mitigate the adverse effects of N-poor soil on seedling regeneration during late succession and thus maintain the sustainable development of temperate forest ecosystems.
文摘Alzheimer’s Disease(AD)is a progressive neurological disease.Early diagnosis of this illness using conventional methods is very challenging.Deep Learning(DL)is one of the finest solutions for improving diagnostic procedures’performance and forecast accuracy.The disease’s widespread distribution and elevated mortality rate demonstrate its significance in the older-onset and younger-onset age groups.In light of research investigations,it is vital to consider age as one of the key criteria when choosing the subjects.The younger subjects are more susceptible to the perishable side than the older onset.The proposed investigation concentrated on the younger onset.The research used deep learning models and neuroimages to diagnose and categorize the disease at its early stages automatically.The proposed work is executed in three steps.The 3D input images must first undergo image pre-processing using Weiner filtering and Contrast Limited Adaptive Histogram Equalization(CLAHE)methods.The Transfer Learning(TL)models extract features,which are subsequently compressed using cascaded Auto Encoders(AE).The final phase entails using a Deep Neural Network(DNN)to classify the phases of AD.The model was trained and tested to classify the five stages of AD.The ensemble ResNet-18 and sparse autoencoder with DNN model achieved an accuracy of 98.54%.The method is compared to state-of-the-art approaches to validate its efficacy and performance.
文摘The prevalence of diabetes mellitus is increasing in resource limited settings.Simultaneously,there has been an increase in the number of novel therapies for the management of diabetes mellitus.However,use of novel antidiabetic therapies is limited because of major market access challenges in resource limited settings.Niching products to those patients with the highest absolute risk for major adverse cardiovascular outcomes,and thus most likely to benefit from the therapy,are less likely to have negative budget impact for funders.To improve access,and reduce morbidity and mortality,requires alignment amongst key stakeholders including patient advocacy groups,health care professional councils,national departments of health,the pharmaceutical industry,treasury and finance departments.
文摘With the rapid advancements in edge computing and artificial intelligence,federated learning(FL)has gained momentum as a promising approach to collaborative data utilization across organizations and devices,while ensuring data privacy and information security.In order to further harness the energy efficiency of wireless networks,an integrated sensing,communication and computation(ISCC)framework has been proposed,which is anticipated to be a key enabler in the era of 6G networks.Although the advantages of pushing intelligence to edge devices are multi-fold,some challenges arise when incorporating FL into wireless networks under the umbrella of ISCC.This paper provides a comprehensive survey of FL,with special emphasis on the design and optimization of ISCC.We commence by introducing the background and fundamentals of FL and the ISCC framework.Subsequently,the aforementioned challenges are highlighted and the state of the art in potential solutions is reviewed.Finally,design guidelines are provided for the incorporation of FL and ISCC.Overall,this paper aims to contribute to the understanding of FL in the context of wireless networks,with a focus on the ISCC framework,and provide insights into addressing the challenges and optimizing the design for the integration of FL into future 6G networks.
文摘BACKGROUND Gastrointestinal stromal tumors(GISTs)are the most frequent mesenchymal tumors of gastrointestinal tract.The most common sites of metastases are the liver and the peritoneum,whereas breast metastases from GIST are extremely rare.We present a second case of GIST breast metastasis.CASE SUMMARY We found a case of breast metastasis from rectum GIST.A 55-year-old female patient presented with rectum tumor with multiply liver lesions and metastasis in the right breast.Abdominal-perineal extirpation of rectum was performed,histology and immunohistochemistry study showed GIST,mixed type with CD117 and DOG-1 positive staining.The patient was taking imatinib 400 mg for 22 mo with stable disease.Because of growth of the breast metastasis the treatment was changed twice:The dose of imatinib was doubled with further progression in the breast lesion and then the patient was receiving sunitinib for 26 mo with partial response in the right breast and stable disease in the liver lesions.The breast lesion increased and right breast resection was done–surgery on local progression,the liver metastases were stable.Histology and immunohistochemistry studies revealed GIST metastasis,CD 117 and DOG 1 positive with KIT exon 11 mutation.After surgery the patient resumed imatinib.Until now the patient has been taking imatinib 400 mg for 19 mo without progression,last follow up was in November 2022.CONCLUSION GISTs breast metastases are extremely rare,we described the second case.At the same time second primary tumors have been reported frequently in patients diagnosed with GISTs and breast cancer is one of the most common second primary tumors in patients with GISTs.That is why it is very important to distinguish primary from metastatic breast lesions.Surgery on local progression made it possible to resume less toxic treatment.
文摘Introduction: Gastroschisis is one of the neonatal pathologies with bad prognosis in developing countries due to a lack of equipment. We aim to report one way of managing this malformation that could be practised everywhere, constituting an alternative approach to surgery in poor areas. Patients and Methods: This observational and descriptive study included newborn babies with gastroschisis who underwent gradual bedside reduction at the Paediatric Surgery Department of the Yaounde Central Hospital. Results: Our cohort was constituted by 32 newborn babies with a mean age of 18.12 hours on admission. The Lefort type 2 was the most frequent in 81.25% of cases. The mean time for oral feeding after complete reduction was 17.4 days and the duration of hospital stay was 24.91 days. Survival rates were at 40.63%, with a residual hernia after healing in 38.46% of cases. Conclusion: Despite the high rate of mortality, gradual reduction of gastroschisis at the bedside seems to be an opportunity for resource constrained areas and can be an alternative solution to surgery.
基金This article has been sponsored by the Core Research Base Project“The Comparative Study of the States outside the NPT Regime”(project number:11jz004)from Education Department of Shaanxi Provincial Government and two-class General Financial Grant for the China Postdoctoral Science Foundation(Grant No.:2012M521660).
文摘A No-Fly Zone(NFZ)is a unique mode of humanitarian intervention which is understudied in international relations.This article focuses on the political dimension of NFZs in international relations and investigates their implementations by empirically reviewing all three cases of NFZs to date.There may be efforts by intervening states to highlight humanitarian crises among certain targets to secure UN authorization for the NFZs;yet the implementation of NFZs is also driven largely by the security interests of enforcing states.As a result,there is the potential for those states implementing NFZs to transcend legal authorization and sometimes use excessive force,with likely calamitous results for local populations,or in extreme cases,accomplishing regime change by supporting opposition parties in target states.
文摘Introduction: Management of open leg bones fractures is a challenging health issue for the surgeon, particularly true in resource-limited settings. In this study, we evaluate exclusive fibular osteosynthesis in the treatment of open fractures of the distal half of the leg bones as a therapeutic option in our context. Methods: This is a prospective, experimental, multicenter study of 30 open fractures of the distal half of the leg bones treated with exclusive fibula osteosynthesis, conducted in 3 hospitals in the DRC from January 1, 2013 to September 30, 2016. Results: The age range of 20 to 40 years grouped 22 (73.4%) patients, the sex ratio was 1:1 and the unemployed were the most involved with 16 (53.3%) cases. The Gustilo II, I, III B and III A types represented 40%, 33.3%, 20% and 6.7%, respectively. The fractures were located in the distal third in 12 (40%) cases, in the middle third in 11 (36.7%) cases, and in both malleoli in 7 cases (23.3%). Osteosynthesis of the fibula by screw plate was applied in 22 (73.3%) patients and pinning in 8 (26.7%). Satisfactory reduction of the tibial fracture site was achieved in 29 (96.7%) cases and 100% bone healing was achieved within an average of 10 weeks. Four (13.3%) loss of alignment, 1 (3.3%) infection, 1 (3.3%) skin necrosis and 2 (6.7%) ankle stiffness complicated our fractures. Conclusion: Exclusive osteosynthesis of the fibula as a common technique for fractures of the distal half of the leg bones allowed us to reduce, immobilize and consolidate the tibial fracture in the required time and to preserve the mobility of the ankle.
文摘This study,taking the library in Henan University of Urban Construction for an example,points out that constant elements in the evaluation system of architecture are its "skeleton" and "spirit",that is,"space" and "spirit of place".Through analyzing the significant role of space in modern architecture and the appeal of spirit of place to construction users,it is explained that space and spirit of place are closely related and mutually dependent.
文摘以“Zespri Group Limited v Gao&Ors”案判决书为研究视角,认为在侵权和损失认定方面,法官通过法律原则、国内外判例与学理学说的运用并通过解释立法目的,创造性地运用国内法律,影响其国外利益格局。该案将成为国内法域外适用向植物新品种保护领域渗透的标志性事件。为维护我国自身利益,建议进一步做好植物新品种保护制度自身建设,加强植物新品种保护制度和植物遗传资源保护制度之间的协调。