Multi-scale data joint inversion of minerals and porosity in altered igneous reservoirs—A case study in the South China Sea

There are abundant igneous gas reservoirs in the South China Sea with significant value of research,and lithology classification,mineral analysis and porosity inversion are important links in reservoir evaluation.However,affected by the diverse lithology,complicated mineral and widespread alteration,conventional logging lithology classification and mineral inversion become considerably difficult.At the same time,owing to the limitation of the wireline log response equation,the quantity and accuracy of minerals can hardly meet the exploration requirements of igneous formations.To overcome those issues,this study takes the South China Sea as an example,and combines multi-scale data such as micro rock slices,petrophysical experiments,wireline log and element cutting log to establish a set of joint inversion methods for minerals and porosity of altered igneous rocks.Specifically,we define the lithology and mineral characteristics through core slices and mineral data,and establish an igneous multi-mineral volumetric model.Then we determine element cutting log correction method based on core element data,and combine wireline log and corrected element cutting log to perform the lithology classification and joint inversion of minerals and porosity.However,it is always difficult to determine the elemental eigenvalues of different minerals in inversion.This paper uses multiple linear regression methods to solve this problem.Finally,an integrated inversion technique for altered igneous formations was developed.The results show that the corrected element cutting log are in good agreement with the core element data,and the mineral and porosity results obtained from the joint inversion based on the wireline log and corrected element cutting log are also in good agreement with the core data from X-ray diffraction.The results demonstrate that the inversion technique is applicable and this study provides a new direction for the mineral inversion research of altered igneous formations.

Endoscopic ultrasound guided biliary drainage in surgically altered anatomy: A comprehensive review of various approaches

Endoscopic retrograde cholangiopancreatography(ERCP)is the preferred modality for drainage of the obstructed biliary tree.In patients with surgically altered anatomy,ERCP using standard techniques may not be feasible.Enteroscope assisted ERCP is usually employed with variable success rate.With advent of endoscopic ultrasound(EUS),biliary drainage procedures in patients with biliary obstruction and surgically altered anatomy is safe and effective.In this narrative review,we discuss role of EUS guided biliary drainage in patients with altered anatomy and the various approaches used in patients with benign and malignant biliary obstruction.

Current status of endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy

Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy must be performed by a highly experienced endoscopist.The challenges are accessing the afferent limb in different types of reconstruction,cannulating a papilla with a reverse orientation,and performing therapeutic interventions with uncommon endoscopic accessories.The development of endoscopic techniques has led to higher success rates in this group of patients.Device-assisted ERCP is the endoscopic procedure of choice for high success rates in short-limb reconstruction;however,these success rate is lower in long-limb reconstruction.ERCP assisted by endoscopic ultrasonography is now popular because it can be performed independent of the limb length;however,it must be performed by a highly experienced and skilled endoscopist.Stent deployment and small stone removal can be performed immediately after ERCP assisted by endoscopic ultrasonography,but the second session is needed for other difficult procedures such as cholangioscopy-guided electrohydraulic lithotripsy.Laparoscopic-assisted ERCP has an almost 100%success rate in longlimb reconstruction because of the use of a conventional side-view duodenoscope,which is compatible with standard accessories.This requires cooperation between the surgeon and endoscopist and is suitable in urgent situations requiring concomitant cholecystectomy.This review focuses on the advantages,disadvantages,and outcomes of various procedures that are suitable in different situations and reconstruction types.Emerging new techniques and their outcomes are also discussed.

Innovations and techniques for balloon-enteroscopeassisted endoscopic retrograde cholangiopancreatography in patients with altered gastrointestinal anatomy

Endoscopic retrograde cholangiopancreatography(ERCP) remains challenging in patients who have undergone surgical reconstruction of the intestine.Recently,many studies have reported that balloonenteroscope-assisted ERCP(BEA-ERCP) is a safe and effective procedure.However,further improvements in outcomes and the development of simplified procedures are required.Percutaneous treatment,Laparoscopy-assisted ERCP,endoscopic ultrasoundguided anterograde intervention,and open surgery are effective treatments.However,treatment should be noninvasive,effective,and safe.We believe that these procedures should be performed only in difficult-to-treat patients because of many potential complications.BEA-ERCP still requires high expertiselevel techniques and is far from a routinely performed procedure.Various techniques have been proposed to facilitate scope insertion(insertion with percutaneous transhepatic biliary drainage(PTBD) rendezvous technique,Short type single-balloon enteroscopes with passive bending section,Intraluminal injection of indigo carmine,CO2 inflation guidance),cannulation(PTBD or percutaneous transgallbladder drainage rendezvous technique,Dilation using screw drill,Rendezvous technique combining DBE with a cholangioscope,endoscopic ultrasound-guided rendezvous technique),and treatment(overtube-assisted technique,Short type balloon enteroscopes) during BEA-ERCP.The use of these techniques may allow treatment to be performed by BEA-ERCP in many patients.A standard procedure for ERCP yet to be established for patients with a reconstructed intestine.At present,BEA-ERCP is considered the safest and most effective procedure and is therefore likely to be recommended as firstline treatment.In this article,we discuss the current status of BEA-ERCP in patients with surgically altered gastrointestinal anatomy.

Endoscopic retrograde cholangiopancreatography in patients with altered anatomy: How to deal with the challenges?

Endoscopic retrograde cholangiopancreatography(ERCP) in patients with surgically altered anatomy is challenging. Several operative interventions of both the gastrointestinal tract and the biliary and/or pancreatic system lead to altered anatomy, rendering ERCP more difficult or even impossible with a conventional side-viewing duodenoscope. Adapted endoscopes are avail-able to reach the biliopancreatic system and to perform ERCP in patients with altered anatomy. However, both technical difficulties and complications determine the procedure's success. Different technical approaches have been described and are highly dependent on local expertise and endoscopic equipment. Standard-ized practical guidelines are currently unavailable. This review focuses on the challenges encountered during ERCP in patients with altered anatomy and how to deal with them. The first challenge is reaching the papilla or the bilioenteric/pancreatoenteric anastomosis in the patient with postoperative altered anatomy. The sec-ond challenge is the cannulation of the biliopancreatic system and performing all conventional ERCP interven-tions and the third challenge is the control of possible complications. The available literature data on this topicis reviewed and illustrated with clinical cases.

Exploring Genome-wide DNA Methylation Profiles Altered in Kashin-Beck Disease Using Infinium Human Methylation 450 Bead Chips

To understand how differentially methylated genes（DMGs）might affect the pathogenesis of Kashin-Beck disease（KBD）.Genome-wide methylation profiling of whole blood from 12matched KBD and controls pairs was performed using a high-resolution Infinium 450 K methylation array.In total,97 CpG sites were differentially

Anal cancer in Chinese:human papillomavirus infection and altered expression of p53

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Evaluation and treatment of altered mental status patients in the emergency department:Life in the fast lane

BACKGROUND:Altered mental status(AMS) is a very common emergency case,but the exact etiology of many AMS patients is unknown.Patients often manifest vague symptoms,thus,AMS diagnosis and treatment are highly challenging for emergency physicians.The aim of this study is to provide a framework for the assessment of AMS patients.This assessment should allow providers to better understand the etiology of mental status changes and therefore improve diagnostic skills and management.METHODS:This is a prospective cohort observational study.We recruited all adult patients with undifferentiated AMS at a single center tertiary care academic emergency department over 24months(June 2009 to June 2011).Demographic characteristics,clinical manifestations,assessment approaches,causative factors,emergency treatments and outcomes were collected prospectively.RESULTS:In 1934 patients with AMS recruited,accounting for 0.93%of all emergency department(ED) patients,1 026(53.1%) were male,and 908(46.9%) female.Their average age was 51.95±15.71 years.Etiologic factors were neurological(n=641;35.0%),pharmacological and toxicological(n=421;23.0%),systemic and organic(n=266;14.5%),infectious(n=167;9.1%),endocrine/metabolic(n=145;7.9%),psychiatric(n=71;3.9%),traumatic(n=38;2.1%),and gynecologic and obstetric(n=35;1.9%).Total mortality rate was 8.1%(n=156).The death rate was higher in elderly patients(≥60) than in younger patients(10.8%vs.6.9%,P=0.003).CONCLUSIONS:Patients with AMS pose a challenge for ED physicians.The most frequently encountered diagnostic categories causing AMS were primary CNS disorders,intoxication,organ system dysfunction,and endocrine/metabolic diseases.AMS has a high fatality rate in the ED.AMS is an important warning signal for ED patients because of its potentially fatal and reversible effects.Prompt evaluation and treatment are essential to decreasing morbidity and mortality associated with AMS.

Significant Mercury Isotope Anomalies in Hydrothermal Altered Coals from the Huaibei Coalfield,China

Igneous intrusion into coal-bearing strata can cause an abrupt increase of temperature-pressure and trigger hydrothermal circulation at the igneous rock-coal contact zone. The conductive heat of intruded lnagma and convective migration of secondary hydrothermal fluids have been observed to significantly alter the concentrations and modes of occurrence of mercury （Hg） in thermally-intruded coals.

Intravascular large B-cell lymphoma presenting with altered mental status: A case report

BACKGROUND Intravascular large B-cell lymphoma(IVLBCL)is a rare and aggressive subtype of non-Hodgkin lymphoma with a varied presentation and no pathognomonic findings.Early diagnosis is critical to altering the disease course as early treatment with chemoimmunotherapy is required to prevent a rapidly fatal outcome.Strategies including improved awareness of this clinical entity through publication of cases with unique presentations are essential to prompt consideration of IVLBCL early in the disease workup.Here,we present a case of IVLBCL presenting with altered mental status and systemic organ dysfunction.CASE SUMMARY A 61-year-old male patient presented with flu-like symptoms and a high fever.He experienced rapid clinical deterioration with liver,kidney failure,and shock despite rapid antibiotic administration and supportive care.A broad infectious workup was negative.Intracranial imaging revealed nonspecific changes to the corpus callosum suspicious for vasculitis.Renal biopsy was non-diagnostic.After further progression of his symptoms,the family elected to withdraw care and the patient died shortly thereafter.Post-mortem analysis revealed clear multi-organ involvement by IVLBCL,prompting re-examination of the ante-mortem renal biopsy that also identified IVLBCL involvement.CONCLUSION IVLBCL is a rare disease.Communication with specialties and early biopsy is critical to establishing the diagnosis and initiating therapy.

Toxoplasma encephalitis and AIDS in a patient with seizure and altered mental status:A case report

INTRODUCTION Increasing incidences of neurological complications are being encountered with the increase in the incidence of human immunodeficiency virus(HIV).[1]These can be due to the direct involvement of the central nervous system(CNS)by the virus or due to other opportunistic infections.Cerebral toxoplasmosis is a common opportunistic infection seen in HIV-infected patients。

EUS FNA of Altered Left Adrenal Gland Morphology Suggests Amending CT and PET-CT Attenuation Threshold Values That Predict Malignancy

Introduction: In the setting of an extra-adrenal malignancy, it is a recognized clinical challenge to try and distinguish a benign adrenal mass from a metastatic deposit. Current non-invasive diagnostic tools for adrenal gland evaluation include CT, MRI, PET and PET-CT. Diagnostic interpretative error can occur as evaluations rarely have complete cytologic or histologic correlation for concordance purposes. Aims: To establish the performance characteristics of non-contrast CT attenuation values (Hounsfield units-HU) and the optimal PET-CT maximum standard uptake value (SUVmax) for predicting adrenal malignancy when correlated with adrenal gland endoscopic ultrasound fine needle aspiration (EUS FNA) cytology results. Methods: A prospectively maintained EUS database was reviewed to identify consecutive patients who underwent a left adrenal gland FNA. Non-contrast CT attenuation values and SUVmax scores were calculated. EUS FNA cytology results were used as the reference standard for determining the presence of benign versus malignant adrenal gland status. Results: Sixty-two patients (69 ± 11 years) underwent adrenal EUS FNA, 34 (54.8%) of whom had a clinically suspected or established extra-adrenal malignancy. Non-invasive imaging was suggestive of abnormal adrenal morphology or altered PET-CT FDG activity in 45 (72.6%) patients. Elevated attenuation values (≥10 HU) by non-enhanced CT had a sensitivity and specificity of 100% and 34.6%, respectively. The SUVmax for malignant altered morphology was significantly higher than that for benign lesions [(8.5 ± 3.1 vs 3.3 ± 0.7;(p = 0.0001)]. ROC curve analysis indicated that an optimum cutoff SUVmax of ≥4.1 (AUC 0.92) yielded the best power distinction for malignancy with a sensitivity and specificity of 89% and 100%. Conclusion: When evaluating altered adrenal morphology by non-invasive methods, the performance characteristics of elevated CT attenuation values are suboptimal. But by adopting a SUVmax cut-off value of ≥4.1 could potentially improve such characteristics to detect malignancy.

Simulation of rock mass balance of two typical altered rocks in Wulong gold deposit of Liaoning, China

Wulong gold deposit hosted in granite and fine-grained d io rite dikes, is a typical gold deposit of quartz vein type. Granite and fine-gra ined diorite dikes in the ore deposit were altered by metallogenic fluid. Based on the altered zoning, the samples of petrochemistry were collected and major an d trace elements were analyzed systematically. Calculation of rock mass balance shows that the major elements (SiO 2, K 2O, P 2O 5, Fe 2O 3) in the two ty pical altered rocks are clearly added into the altered system, and that trace el ements (V, Y, Zr, Ni, Co, Sr) assume an increasing and decreasing tendencies in the altered granite and altered diorite dike, respectively. The fluid/rock ratio s are 30.17-181.00 and 115.44-692.67 respectively for altered granite and alte red diorite dike, they have profoundly effects on metallogenesis.

Altered Host Resistance to Listeria monocytogenes In Mice Exposed to 1-Chloroacetophenone (CN) Vapours

Short term repeated exposure of 1-chloroacetophenone (CN) vapours at a concentration of 0.153 mg per litre for 15 minutes daily on 10 consecuitve days in Swiss albino male mice resulted in increased mortality to Listeria monocytogenes. Significantly elevated bacterial growth was observed in the spleen and liver of the CN exposed animals. The increased bacterial count in these organs was evident within 4-6 days post challenge as compared to vehicle exposed infected and unexposed infected animals. Increased susceptibility to infection has been considered to be the function of immune alteration due to cumulative short term effects ofCN vapour inhalation. This may be attributed to immunotoxic effects of CN on Tcells mediated macrophage functions.

Role of balloon enteroscopy for obscure gastrointestinal bleeding in those with surgically altered anatomy: A systematic review

BACKGROUND Obscure gastrointestinal(GI)bleeding is defined as persistent bleeding despite negative evaluation with both esophagogastroduodenoscopy and colonoscopy and can be secondary to small intestinal pathology.Standard endoscopy as well as push endoscopy can be a challenge in those with altered anatomy given inaccessible areas as well as perforation risk.Single and double balloon enteroscopy can be warranted in this patient population in instances of obscure GI bleed.AIM To assess the safety and diagnostic efficacy of balloon enteroscopy for obscure GI bleeding in patients with surgically altered anatomy.METHODS A search was conducted through PubMed,MEDLINE,Google Scholar,Scopus,and Embase with the key words“enteroscopy,”“obscure bleeding,”and“altered anatomy,”to identify relevant articles in English with no restricted time frame.A search within the Reference Citation Analysis database was conducted to ensure inclusion of the latest high impact articles.Study types included in the review were prospective and retrospective reviews,case series,and case reports.The reference lists of these papers were also reviewed to find further papers that were applicable.The authors extracted the data from the studies that fit inclusion criteria.Data of interest included type of study,type of procedure,and type of altered anatomy,as well as the number of patients with any diagnostic or therapeutic intervention.Data was also recorded on procedure tolerance and complications.The data was analyzed with descriptive statistics.RESULTS Our literature search yielded 14 studies that were included.There were 68 procedures performed with 61 unique patients subjected to these procedures.Forty-four(65%)of the procedures were double balloon,21(31%)were single balloon,and 3(4%)were classified as through the scope balloon assisted.The most common altered anatomy types included Gastric Bypass Roux-en-Y,Pylorus Sparing Whipple,Orthotopic Liver Transplantation with Roux-en-Y,and Gastrojejunostomy Roux-en-Y.The procedures were successfully performed in each patient.There were 5(7%)procedures that were complicated by perforation.Amongst the available data,the diagnostic yield was 48/59(81%)and a therapeutic yield of 39/59(66%).One patient was recommended surgical revision of their altered anatomy following enteroscopy.CONCLUSION Balloon enteroscopy is a useful diagnostic modality in investigating obscure GI bleeding within those with surgically altered anatomy;however,precautions must be taken as this population may have increased perforation risk.

Linking Watershed Scales through Altered Waterways

Nested hierarchy theory advances the idea that rivers have a fractal dimension where processes at the catchment scale (>1 km) control processes at the reach or mesoscale (100 m) and microscale (1 - 10 m). Largely absent from this work is a mesoscale link to the larger and smaller scales. We used stream alteration classifications to provide this link. We used orthophotographs, land cover, and LiDAR derived terrain models to classify stream alterations within four watersheds. We compared phosphorus point data with watershed, sub-watershed, and 100-meter buffers around the point data. In the predominately urban watershed, the 100 m buffer scale correlated better with phosphorus levels. In the predominately agricultural watershed, the sub-watershed scale correlated with phosphorus levels better. We found adding the classification of the stream alteration type clarified anomalously low phosphorus levels.

Endoscopic approaches to biliary intervention in patients with surgically altered gastroduodenal anatomy

Over the past decade the ability of endoscopists to access the biliary tree in patients with surgically altered gastroduodenal anatomy has significantly advanced.Much of the progress has occurred as a result of the development of better tools to navigate the deep small bowel,such as single-balloon-(SBE),double-balloon-(DBE),and spiral-enteroscopy-assisted endoscopic retrograde cholangiopancreatography(ERCP).However,despite using a cap,accessing the papilla or bile duct using these forward-viewing enteroscopy platforms remains challenging,even in expert hands.In patients with Roux-en-Y gastric bypass(RYGB) anatomy,the excluded stomach is a potential point of access for either a delayed transgastric- or immediate laparoscopyassisted-ERCP approach.However,the parallel advancement of therapeutic endoscopic ultrasound(EUS) also provides alternative approaches through which the biliary system can be accessed and intervened on in patients with surgically altered anatomies.Generally speaking,in patients with short gastro-jejunal "Roux" and bilio-pancreatic limbs,ideally less than 150 cm in length,starting with a(cap-assisted) pushenteroscopy or balloon-enteroscopy approach would offer reasonable diagnostic and therapeutic ERCP suc-cess.When available,short-SBE or short-DBE scopes should be used,as they allow the use of conventional ERCP equipment,are associated with shorter procedure times,and are easier to manipulate.In patients with RYGB who have longer Roux and/or bilio-pancreatic limbs(> 150 cm in total length),or in patients who have failed prior attempts at deep enteroscopy-assisted ERCP,transgastric laparoscopy-assisted-ERCP is associated with higher rates of diagnostic and therapeutic success as compared to deep-enteroscopy-assisted ERCP.Finally,EUS-guided biliary access for antegrade biliary intervention or for rendezvous enteroscopyassisted ERCP is possible.While percutaneous transhepatic biliary drainage and surgical bile duct exploration remain viable alternatives,these methods are not without significant morbidity and mortality and should only be considered if less invasive endoscopic interventions are not feasible or appropriate.

Petrographic Studies on Hydrothermally Altered Conglomerates at Naer Creek, Sichuan Province, China

Based on analysing the wall rock alterations and related rocks which were used as a hint for mineral deposits and as a basis of mechanism research of fluid rock interaction, according to the results of petrographic analysis, the authors of this paper consider that the hydrothermally altered conglomerates have the following features. First, the conglomerates studied can be divided into two groups: Group A consists mainly of the gravels of granite and basalt; Group B is mainly composed of the gravels of basalt, limestone, mudstone and granite. Second, three distinct hydrothermal alterations or diagenesis were distinguished in Group A, that is, pre depositional hydrothermal alteration of the volcanic gravels (saussuritzation chloritization, epidotization chloritization, albitization and sericitization), mechanical diagenesis and post diagenetic hydrothermal alteration (epidote chlorite and prehnite calcite association). Third, the Group B is subjected mainly to pre depositional hydrothermal alteration; the alteration types are the same as of Type A. Last, the origin of the post diagenetic hydrothermal alteration of Group A is presumed to be related to the ascending of thermal water along the Naer Creek fault.

Estimate of Uniaxial Compressive Strength of Hydrothermally Altered Soft Rocks Based on Strength Index Tests

The purpose of this study was to clarify the relationships between results of index tests and uniaxial compressive strength (UCS) in hydrothermally altered soft rocks of the Upper Miocene, which are typical of the soft rock found in northeastern Hokkaido, Japan. Index tests were performed using point load testing machine and needle penetrometer with irregular lump specimens under forced-dry, forced-wet, and natural-moist states. The relationships between irregular lump point load strength (IPLS) index and UCS, and needle penetration (NP) index and UCS were “UCS = approximately 19 IPLS index” and “UCS = 0.848 (NP index)0.619”, respectively, in soft rocks with a UCS below 25 MPa. These relationships could be applied to on-site tests of rocks with natural moisture content. The UCS could be calculated from IPLS and NP tests on soft rocks only when UCS was below 25 MPa, using the equations obtained as a result of this study.

Altered expression of EphA2 and EphrinA1 associated with prognosis of malignant glioma patients

Objective Malignant gliomas display over-expression of the receptor tyrosine kinase EphA2. However,expression levels of the EphA2 ligand,EphrinA1,have not been fully elucidated. This study aims to determine the expression of EphA2 / EphrinA1 in detail,and further detect the predictive