Background:Due to the high heterogeneity among hepatocellular carcinoma(HCC)patients receiving transarterial chemoembolization(TACE),the prognosis of patients varies significantly.The decisionmaking on the initiation ...Background:Due to the high heterogeneity among hepatocellular carcinoma(HCC)patients receiving transarterial chemoembolization(TACE),the prognosis of patients varies significantly.The decisionmaking on the initiation and/or repetition of TACE under different liver functions is a matter of concern in clinical practice.Thus,we aimed to develop a prediction model for TACE candidates using risk stratification based on varied liver function.Methods:A total of 222 unresectable HCC patients who underwent TACE as their only treatment were included in this study.Cox proportional hazards regression was performed to select the independent risk factors and establish a predictive model for the overall survival(OS).The model was validated in patients with different Child-Pugh class and compared to previous TACE scoring systems.Results:The five independent risk factors,including alpha-fetoprotein(AFP)level,maximal tumor size,the increase of albumin-bilirubin(ALBI)grade score,tumor response,and the increase of aspartate aminotransferase(AST),were used to build a prognostic model(ASARA).In the training and validation cohorts,the OS of patients with ASARA score≤2 was significantly higher than that of patients with ASARA score>2(P<0.001,P=0.006,respectively).The ASARA model and its modified version“AS(ARA)”can effectively distinguish the OS(P<0.001,P=0.004)between patients with Child-Pugh class A and B,and the C-index was 0.687 and 0.706,respectively.For repeated TACE,the ASARA model was superior to Assessment for Retreatment with TACE(ART)and ALBI grade,maximal tumor size,AFP,and tumor response(ASAR)among Child-Pugh class A patients.For the first TACE,the performance of AS(ARA)was better than that of modified hepatoma arterial-embolization prognostic(mHAP),mHAP3,and ASA(R)models among Child-Pugh class B patients.Conclusions:The ASARA scoring system is valuable in the decision-making of TACE repetition for HCC patients,especially Child-Pugh class A patients.The modified AS(ARA)can be used to screen the ideal candidate for TACE initiation in Child-Pugh class B patients with poor liver function.展开更多
There have been increasing efforts to utilize energy by-products (EBP) all over the world. In the Czech Re- public fly ash is usually used in ceramic technology, es- pecially in brick manufacturing and for ceramic t...There have been increasing efforts to utilize energy by-products (EBP) all over the world. In the Czech Re- public fly ash is usually used in ceramic technology, es- pecially in brick manufacturing and for ceramic tiles. The average production of EBP is about Ig million tons per year. The range of potential products, where EBP could be used, is very wide and energy by-products have become an important raw material source. In this paper the attention was focused on class C fly ash and its usage in field of refractory materials. Experimental works were carried out on mixtures with fly ash and clay. There were also tested batches for lightweight fireclay bricks. The maximal amount of CFA should be up to 50%.展开更多
Fly ash particles are usually spherical and based on their chemical composition;they are categorized into two classes: C and F. This study compares the microstructural, mechanical and thermal properties of extruded ri...Fly ash particles are usually spherical and based on their chemical composition;they are categorized into two classes: C and F. This study compares the microstructural, mechanical and thermal properties of extruded rigid PVC foam composites reinforced with class C and class F fly ash. The mechanical properties: such as tensile and flexural strength of composites containing class C fly ash were superior to the composites containing class F fly ash particles. Composites containing 6 phr class C fly ash showed a 24% improvement in the tensile strength in comparison to a mere 0.5% increase in composites reinforced with class F fly ash. Similarly, the addition of 6 phr of class F fly ash to the PVC foam matrix resulted in a 5.74% decrease in the flexural strength, while incorporating the same amount of class C fly ash led to a 95% increase in flexural strength. The impact strength of the composites decreased as the amount of either type of fly ash increased in the composites indicating that fly ash particles improve the rigidity of the PVC foam composites. No significant changes were observed in the thermal properties of the composites containing either type of fly ash particles. However, the thermo-mechanical properties measured by DMA indicated a steep increase in the viscoelastic properties of composites reinforced with class C flyash. The microstructural properties studied by Scanning Electron Microscopy (SEM) confirmed that fly ash particles were mechanically interlocked in the PVC matrix with good interfacial interaction with the matrix. However, particle agglomeration and debonding was observed in composites reinforced with higher amounts of fly ash.展开更多
The feasibility of utilization of flue gas desulfurization (FGD) gypsum and Class-C fly ash (CFA) to prepare CFA-based geopolymer were studied. The results showed that geopolymer made from 90% CFA and 10% FGD gyps...The feasibility of utilization of flue gas desulfurization (FGD) gypsum and Class-C fly ash (CFA) to prepare CFA-based geopolymer were studied. The results showed that geopolymer made from 90% CFA and 10% FGD gypsum (FGDG) which was thermally treated at 800 ℃ for 1 h obtained the better compressive strength of 37.0 MPa. The micro characteristics and structures of the geopolymer samples of CFA and CFA-FGDG were tested by XRD, FT-IR, and SEM-EDXA after these samples cured at 75 ℃ for 8 h followed by 23 ℃ for 28 d. Both the geopolymer samples of CFA and CFA-FGDG have significant asymmetric stretching of A1-O/Si-O bonds and Si-O-Si / Si-O-A1 bending band. In geopolymer sample of CFA-FGDG, a small quantity of lathy products probably being the ettringite wrapped over the spherical fly ash particle, and the concentration of sulfur is much more than that in geopolymer sample of CFA. It is indicated that FGD gypsum may react during alkali-activated and geopolymeric process.展开更多
Objective:To determine the occurrence of class A and class Cβ-Iactamase genes and their cooccurrence in Indian Enterobacteriaceae.Methods:52 third generation cephalosporin resistant isolates were phenotypically detec...Objective:To determine the occurrence of class A and class Cβ-Iactamase genes and their cooccurrence in Indian Enterobacteriaceae.Methods:52 third generation cephalosporin resistant isolates were phenotypically detected by combination disk method and screened by PCR to identify class A and class C typeβ-lactamase genes.Results:Of the 52 isolates,94.2%(49) were found harboring any of the bla<sub>?</sub>,bla<sub>CTX-M</sub>,bla<sub>SHV</sub> and bla<sub>TEM</sub> were present in 82.6%(43/52), 59.6%(31/52),and 42.3%(22/52) isolates,respectively.Of the 49 ESBL positive isolates 57.1% (28/49) showed co-occurrence of bla<sub>ampC</sub>with bla<sub>?</sub>.On the contrary,the collection from 2009 showed their co-occurrence in 81.4%isolates.Conclusions:The comparative study shows a downward trend for co-existence of bla<sub>?</sub> with bla<sub>ampC</sub> from 2009 to 2010.Further large scale studies are needed to address the co-occurrence of class A and class Cβ-lactamases in India and the resistance trend occurring over a period of time.展开更多
This research analyzes the growth impacts promoted by C class in the process of the freezing of the Brazilian industry and increased imports. This emerging market, called class C, which is incorporated in part by the ...This research analyzes the growth impacts promoted by C class in the process of the freezing of the Brazilian industry and increased imports. This emerging market, called class C, which is incorporated in part by the low-income segment, presents distinct characteristics and needs and for this precise reason eventually burdens the short-term production of Brazilian companies, which feel the need to opt for the importation of basic commodities, manufactured, and semi-manufactured goods, in order to maintain a market share and return on their investments. Although this fact is actually part of a trend of global economic transformation, here it is due to a number of irregular actions taken by the Brazilian government facing a short-term political need. Stemming from quantitative researches and qualitative data, this paper sought to learn more about the consumers' profile and draw up some recommendations for the organizations, in order to be better prepared to face this new demand. This paper also sought to know the actions already undertaken by a large cosmetics company, parts of whose products aim at class C.展开更多
BACKGROUND Obesity is an independent risk factor for the development of hepatocellular carcinoma(HCC)and may influence its outcomes.However,after diagnosis of HCC,like other malignancies,the obesity paradox may exist ...BACKGROUND Obesity is an independent risk factor for the development of hepatocellular carcinoma(HCC)and may influence its outcomes.However,after diagnosis of HCC,like other malignancies,the obesity paradox may exist where higher body mass index(BMI)may in fact confer a survival benefit.This is frequently observed in patients with advanced HCC and cirrhosis,who often present late with advanced tumor features and cancer related weight loss.AIM To explore the relationship between BMI and survival in patients with cirrhosis and HCC.METHODS This is a retrospective cohort study of over 2500 patients diagnosed with HCC between 2009-2019 at two United States academic medical centers.Patient and tumor characteristics were extracted manually from medical records of each institutions'cancer registries.Patients were stratified according to BMI classes:<25 kg/m^(2)(lean),25-29.9 kg/m^(2)(overweight),and>30 kg/m^(2)(obese).Patient and tumor characteristics were compared according to BMI classification.We performed an overall survival analysis using Kaplan Meier by the three BMI classes and after adjusting for Milan criteria.A multivariable Cox regression model was then used to assess known risk factors for survival in patients with cirrhosis and HCC.RESULTS A total of 2548 patients with HCC were included in the analysis of which 11.2%(n=286)were classified as noncirrhotic.The three main BMI categories:Lean(n=754),overweight(n=861),and obese(n=933)represented 29.6%,33.8%,and 36.6%of the total population overall.Within each BMI class,the non-cirrhotic patients accounted for 15%(n=100),12%(n=94),and 11%(n=92),respectively.Underweight patients with a BMI<18.5 kg/m^(2)(n=52)were included in the lean cohort.Of the obese cohort,42%(n=396)had a BMI≥35 kg/m^(2).Out of 2262 patients with cirrhosis and HCC,654(29%)were lean,767(34%)were overweight,and 841(37%)were obese.The three BMI classes did not differ by age,MELD,or Child-Pugh class.Chronic hepatitis C was the dominant etiology in lean compared to the overweight and obese patients(71%,62%,49%,P<0.001).Lean patients had significantly larger tumors compared to the other two BMI classes(5.1 vs 4.2 vs 4.2 cm,P<0.001),were more likely outside Milan(56%vs 48%vs 47%,P<0.001),and less likely to undergo transplantation(9%vs 18%vs 18%,P<0.001).While both tumor size(P<0.0001)and elevated alpha fetoprotein(P<0.0001)were associated with worse survival by regression analysis,lean BMI was not(P=0.36).CONCLUSION Lean patients with cirrhosis and HCC present with larger tumors and are more often outside Milan criteria,reflecting cancer related cachexia from delayed diagnosis.Access to care for hepatitis C virus therapy and liver transplantation confer a survival benefit,but not overweight or obese BMI classifications.展开更多
基金This study was supported by a grant from Tianjin Key Medical Discipline(Specialty)Construction Project.
文摘Background:Due to the high heterogeneity among hepatocellular carcinoma(HCC)patients receiving transarterial chemoembolization(TACE),the prognosis of patients varies significantly.The decisionmaking on the initiation and/or repetition of TACE under different liver functions is a matter of concern in clinical practice.Thus,we aimed to develop a prediction model for TACE candidates using risk stratification based on varied liver function.Methods:A total of 222 unresectable HCC patients who underwent TACE as their only treatment were included in this study.Cox proportional hazards regression was performed to select the independent risk factors and establish a predictive model for the overall survival(OS).The model was validated in patients with different Child-Pugh class and compared to previous TACE scoring systems.Results:The five independent risk factors,including alpha-fetoprotein(AFP)level,maximal tumor size,the increase of albumin-bilirubin(ALBI)grade score,tumor response,and the increase of aspartate aminotransferase(AST),were used to build a prognostic model(ASARA).In the training and validation cohorts,the OS of patients with ASARA score≤2 was significantly higher than that of patients with ASARA score>2(P<0.001,P=0.006,respectively).The ASARA model and its modified version“AS(ARA)”can effectively distinguish the OS(P<0.001,P=0.004)between patients with Child-Pugh class A and B,and the C-index was 0.687 and 0.706,respectively.For repeated TACE,the ASARA model was superior to Assessment for Retreatment with TACE(ART)and ALBI grade,maximal tumor size,AFP,and tumor response(ASAR)among Child-Pugh class A patients.For the first TACE,the performance of AS(ARA)was better than that of modified hepatoma arterial-embolization prognostic(mHAP),mHAP3,and ASA(R)models among Child-Pugh class B patients.Conclusions:The ASARA scoring system is valuable in the decision-making of TACE repetition for HCC patients,especially Child-Pugh class A patients.The modified AS(ARA)can be used to screen the ideal candidate for TACE initiation in Child-Pugh class B patients with poor liver function.
文摘There have been increasing efforts to utilize energy by-products (EBP) all over the world. In the Czech Re- public fly ash is usually used in ceramic technology, es- pecially in brick manufacturing and for ceramic tiles. The average production of EBP is about Ig million tons per year. The range of potential products, where EBP could be used, is very wide and energy by-products have become an important raw material source. In this paper the attention was focused on class C fly ash and its usage in field of refractory materials. Experimental works were carried out on mixtures with fly ash and clay. There were also tested batches for lightweight fireclay bricks. The maximal amount of CFA should be up to 50%.
文摘Fly ash particles are usually spherical and based on their chemical composition;they are categorized into two classes: C and F. This study compares the microstructural, mechanical and thermal properties of extruded rigid PVC foam composites reinforced with class C and class F fly ash. The mechanical properties: such as tensile and flexural strength of composites containing class C fly ash were superior to the composites containing class F fly ash particles. Composites containing 6 phr class C fly ash showed a 24% improvement in the tensile strength in comparison to a mere 0.5% increase in composites reinforced with class F fly ash. Similarly, the addition of 6 phr of class F fly ash to the PVC foam matrix resulted in a 5.74% decrease in the flexural strength, while incorporating the same amount of class C fly ash led to a 95% increase in flexural strength. The impact strength of the composites decreased as the amount of either type of fly ash increased in the composites indicating that fly ash particles improve the rigidity of the PVC foam composites. No significant changes were observed in the thermal properties of the composites containing either type of fly ash particles. However, the thermo-mechanical properties measured by DMA indicated a steep increase in the viscoelastic properties of composites reinforced with class C flyash. The microstructural properties studied by Scanning Electron Microscopy (SEM) confirmed that fly ash particles were mechanically interlocked in the PVC matrix with good interfacial interaction with the matrix. However, particle agglomeration and debonding was observed in composites reinforced with higher amounts of fly ash.
基金Funded by the National Natural Science Foundation of China(Nos.51208370,51172164)the Specialized Research Fund for the Doctoral Program of Higher Education(Nos.20110072120046,20090072110010)of China
文摘The feasibility of utilization of flue gas desulfurization (FGD) gypsum and Class-C fly ash (CFA) to prepare CFA-based geopolymer were studied. The results showed that geopolymer made from 90% CFA and 10% FGD gypsum (FGDG) which was thermally treated at 800 ℃ for 1 h obtained the better compressive strength of 37.0 MPa. The micro characteristics and structures of the geopolymer samples of CFA and CFA-FGDG were tested by XRD, FT-IR, and SEM-EDXA after these samples cured at 75 ℃ for 8 h followed by 23 ℃ for 28 d. Both the geopolymer samples of CFA and CFA-FGDG have significant asymmetric stretching of A1-O/Si-O bonds and Si-O-Si / Si-O-A1 bending band. In geopolymer sample of CFA-FGDG, a small quantity of lathy products probably being the ettringite wrapped over the spherical fly ash particle, and the concentration of sulfur is much more than that in geopolymer sample of CFA. It is indicated that FGD gypsum may react during alkali-activated and geopolymeric process.
基金Partially funded by Department of Science & Technology,Ministry of Science & Technology,Govt.of India under Scientist Project SR/FT/L-111/2006
文摘Objective:To determine the occurrence of class A and class Cβ-Iactamase genes and their cooccurrence in Indian Enterobacteriaceae.Methods:52 third generation cephalosporin resistant isolates were phenotypically detected by combination disk method and screened by PCR to identify class A and class C typeβ-lactamase genes.Results:Of the 52 isolates,94.2%(49) were found harboring any of the bla<sub>?</sub>,bla<sub>CTX-M</sub>,bla<sub>SHV</sub> and bla<sub>TEM</sub> were present in 82.6%(43/52), 59.6%(31/52),and 42.3%(22/52) isolates,respectively.Of the 49 ESBL positive isolates 57.1% (28/49) showed co-occurrence of bla<sub>ampC</sub>with bla<sub>?</sub>.On the contrary,the collection from 2009 showed their co-occurrence in 81.4%isolates.Conclusions:The comparative study shows a downward trend for co-existence of bla<sub>?</sub> with bla<sub>ampC</sub> from 2009 to 2010.Further large scale studies are needed to address the co-occurrence of class A and class Cβ-lactamases in India and the resistance trend occurring over a period of time.
文摘This research analyzes the growth impacts promoted by C class in the process of the freezing of the Brazilian industry and increased imports. This emerging market, called class C, which is incorporated in part by the low-income segment, presents distinct characteristics and needs and for this precise reason eventually burdens the short-term production of Brazilian companies, which feel the need to opt for the importation of basic commodities, manufactured, and semi-manufactured goods, in order to maintain a market share and return on their investments. Although this fact is actually part of a trend of global economic transformation, here it is due to a number of irregular actions taken by the Brazilian government facing a short-term political need. Stemming from quantitative researches and qualitative data, this paper sought to learn more about the consumers' profile and draw up some recommendations for the organizations, in order to be better prepared to face this new demand. This paper also sought to know the actions already undertaken by a large cosmetics company, parts of whose products aim at class C.
基金Supported by in part David W Crabb Professorship Endowment at Indiana University School of Medicine and an intramural grant from the Atrium Health Center for Outcomes Research and Evaluation(CORE)(to deLemos AS).
文摘BACKGROUND Obesity is an independent risk factor for the development of hepatocellular carcinoma(HCC)and may influence its outcomes.However,after diagnosis of HCC,like other malignancies,the obesity paradox may exist where higher body mass index(BMI)may in fact confer a survival benefit.This is frequently observed in patients with advanced HCC and cirrhosis,who often present late with advanced tumor features and cancer related weight loss.AIM To explore the relationship between BMI and survival in patients with cirrhosis and HCC.METHODS This is a retrospective cohort study of over 2500 patients diagnosed with HCC between 2009-2019 at two United States academic medical centers.Patient and tumor characteristics were extracted manually from medical records of each institutions'cancer registries.Patients were stratified according to BMI classes:<25 kg/m^(2)(lean),25-29.9 kg/m^(2)(overweight),and>30 kg/m^(2)(obese).Patient and tumor characteristics were compared according to BMI classification.We performed an overall survival analysis using Kaplan Meier by the three BMI classes and after adjusting for Milan criteria.A multivariable Cox regression model was then used to assess known risk factors for survival in patients with cirrhosis and HCC.RESULTS A total of 2548 patients with HCC were included in the analysis of which 11.2%(n=286)were classified as noncirrhotic.The three main BMI categories:Lean(n=754),overweight(n=861),and obese(n=933)represented 29.6%,33.8%,and 36.6%of the total population overall.Within each BMI class,the non-cirrhotic patients accounted for 15%(n=100),12%(n=94),and 11%(n=92),respectively.Underweight patients with a BMI<18.5 kg/m^(2)(n=52)were included in the lean cohort.Of the obese cohort,42%(n=396)had a BMI≥35 kg/m^(2).Out of 2262 patients with cirrhosis and HCC,654(29%)were lean,767(34%)were overweight,and 841(37%)were obese.The three BMI classes did not differ by age,MELD,or Child-Pugh class.Chronic hepatitis C was the dominant etiology in lean compared to the overweight and obese patients(71%,62%,49%,P<0.001).Lean patients had significantly larger tumors compared to the other two BMI classes(5.1 vs 4.2 vs 4.2 cm,P<0.001),were more likely outside Milan(56%vs 48%vs 47%,P<0.001),and less likely to undergo transplantation(9%vs 18%vs 18%,P<0.001).While both tumor size(P<0.0001)and elevated alpha fetoprotein(P<0.0001)were associated with worse survival by regression analysis,lean BMI was not(P=0.36).CONCLUSION Lean patients with cirrhosis and HCC present with larger tumors and are more often outside Milan criteria,reflecting cancer related cachexia from delayed diagnosis.Access to care for hepatitis C virus therapy and liver transplantation confer a survival benefit,but not overweight or obese BMI classifications.