Clinical manifestations,diagnosis and long-term prognosis of adult autoimmune enteropathy:Experience from Peking Union Medical College Hospital

BACKGROUND Autoimmune enteropathy(AIE)is a rare disease whose diagnosis and long-term prognosis remain challenging,especially for adult AIE patients.AIM To improve overall understanding of this disease’s diagnosis and prognosis.METHODS We retrospectively analyzed the clinical,endoscopic and histopathological characteristics and prognoses of 16 adult AIE patients in our tertiary medical center between 2011 and 2023,whose diagnosis was based on the 2007 diagnostic criteria.RESULTS Diarrhea in AIE patients was characterized by secretory diarrhea.The common endoscopic manifestations were edema,villous blunting and mucosal hyperemia in the duodenum and ileum.Villous blunting(100%),deep crypt lymphocytic infiltration(67%),apoptotic bodies(50%),and mild intraepithelial lymphocytosis(69%)were observed in the duodenal biopsies.Moreover,there were other remarkable abnormalities,including reduced or absent goblet cells(duodenum 94%,ileum 62%),reduced or absent Paneth cells(duodenum 94%,ileum 69%)and neutrophil infiltration(duodenum 100%,ileum 69%).Our patients also fulfilled the 2018 diagnostic criteria but did not match the 2022 diagnostic criteria due to undetectable anti-enterocyte antibodies.All patients received glucocorticoid therapy as the initial medication,of which 14/16 patients achieved a clinical response in 5(IQR:3-20)days.Immunosuppressants were administered to 9 patients with indications of steroid dependence(6/9),steroid refractory status(2/9),or intensified maintenance medication(1/9).During the median of 20.5 months of followup,2 patients died from multiple organ failure,and 1 was diagnosed with non-Hodgkin’s lymphoma.The cumulative relapse-free survival rates were 62.5%,55.6%and 37.0%at 6 months,12 months and 48 months,respectively.CONCLUSION Certain histopathological findings,including a decrease or disappearance of goblet and Paneth cells in intestinal biopsies,might be potential diagnostic criteria for adult AIE.The long-term prognosis is still unsatisfactory despite corticosteroid and immunosuppressant medications,which highlights the need for early diagnosis and novel medications.

ESTIMATION OF AVERAGE DIFFERENTIAL ENTROPY FOR A STATIONARY ERGODIC SPACE-TIME RANDOM FIELD ON A BOUNDED AREA

In this paper,we mainly discuss a discrete estimation of the average differential entropy for a continuous time-stationary ergodic space-time random field.By estimating the probability value of a time-stationary random field in a small range,we give an entropy estimation and obtain the average entropy estimation formula in a certain bounded space region.It can be proven that the estimation of the average differential entropy converges to the theoretical value with a probability of 1.In addition,we also conducted numerical experiments for different parameters to verify the convergence result obtained in the theoretical proofs.

Neurological Manifestations of Vitamin B12 Deficiency: About a Case

The authors report a case of deficient sensory neuropathy secondary to vitamin B12 deficiency, diagnosed in the neurology department of the Sino-Central African Friendship University Hospital in Bangui. The diagnosis was made possible by electroneuromyography which showed subclinical neurological damage associated with hematological damage (anemia). Through this observation, we recall the diagnostic criteria of the disease in a context of difficult medical practice. .

Rare extraintestinal manifestations of ulcerative colitis treated with dual biologic therapy:A case report

BACKGROUND Ulcerative colitis(UC)is an idiopathic,chronic inflammatory bowel disease(IBD)most often located in the rectum,but may involve the entire colon.Extra intestinal manifestations(EIMs)occur with varying frequency depending on the affected organ.The most common ones are musculoskeletal EIMs,affecting up to 33%-40%of IBD patients.These include,among others,inflammatory back pain,tendinitis,plantar fasciitis and arthritis.Only a few case reports in literature discuss Achilles tendinitis.CASE SUMMARY This report describes a patient with UC and Achilles tendinitis in whom after many unsuccessful attempts of treatment with sulfasalazine,mesalazine,glucocorticosteroids,infliximab and tofacitinib,a complete UC remission and resolution of Achilles tendinitis were achieved with the use of dual biologic therapy(DBT)-ustekinumab and adalimumab(ADA).CONCLUSION This case mentions rare EIMs of UC and suggests that DBT may be an alternative for patient with ulcerative colitis and EIMs.

Robust Space-Time Adaptive Track-Before-Detect Algorithm Based on Persymmetry and Symmetric Spectrum

Underwater monopulse space-time adaptive track-before-detect method,which combines space-time adaptive detector(STAD)and the track-before-detect algorithm based on dynamic programming(DP-TBD),denoted as STAD-DP-TBD,can effectively detect low-speed weak targets.However,due to the complexity and variability of the underwater environment,it is difficult to obtain sufficient secondary data,resulting in a serious decline in the detection and tracking performance,and leading to poor robustness of the algorithm.In this paper,based on the adaptive matched filter(AMF)test and the RAO test,underwater monopulse AMF-DP-TBD algorithm and RAO-DP-TBD algorithm which incorporate persymmetry and symmetric spectrum,denoted as PSAMF-DP-TBD and PS-RAO-DP-TBD,are proposed and compared with the AMF-DP-TBD algorithm and RAO-DP-TBD algorithm based on persymmetry array,denoted as P-AMF-DP-TBD and P-RAO-DP-TBD.The simulation results show that the four methods can work normally with sufficient secondary data and slightly insufficient secondary data,but when the secondary data is severely insufficient,the P-AMF-DP-TBD and P-RAO-DP-TBD algorithms has failed while the PSAMF-DP-TBD and PS-RAO-DP-TBD algorithms still have good detection and tracking capabilities.

Curved Space-Time at the Planck Scale

This paper presents a physically plausible and somewhat illuminating first step in extending the fundamental principles of mechanical stress and strain to space-time. Here the geometry of space-time, encoded in the metric tensor, is considered to be made up of a dynamic lattice of extremely small, localized fields that form a perfectly elastic Lorentz symmetric space-time at the global (macroscopic) scale. This theoretical model of space-time at the Planck scale leads to a somewhat surprising result in which matter waves in curved space-time radiate thermal gravitational energy, as well as an equally intriguing relationship for the anomalous dispersion of light in a gravitational field.

Virtually coupled train set control subject to space-time separation:A distributed economic MPC approach with emergency braking configuration

The emerging virtual coupling technology aims to operate multiple train units in a Virtually Coupled Train Set(VCTS)at a minimal but safe distance.To guarantee collision avoidance,the safety distance should be calculated using the state-of-the-art space-time separation principle that separates the Emergency Braking(EB)trajectories of two successive units during the whole EB process.In this case,the minimal safety distance is usually numerically calculated without an analytic formulation.Thus,the constrained VCTS control problem is hard to address with space-time separation,which is still a gap in the existing literature.To solve this problem,we propose a Distributed Economic Model Predictive Control(DEMPC)approach with computation efficiency and theoretical guarantee.Specifically,to alleviate the computation burden,we transform implicit safety constraints into explicitly linear ones,such that the optimal control problem in DEMPC is a quadratic programming problem that can be solved efficiently.For theoretical analysis,sufficient conditions are derived to guarantee the recursive feasibility and stability of DEMPC,employing compatibility constraints,tube techniques and terminal ingredient tuning.Moreover,we extend our approach with globally optimal and distributed online EB configuration methods to shorten the minimal distance among VCTS.Finally,experimental results demonstrate the performance and advantages of the proposed approaches.

Comparison of Oral Manifestations in Hospitalized COVID-19 Positive Patients and COVID-19 Negative Dental Outpatients. A Case Series Study and Literature Review

Background: The Coronavirus disease 2019 (COVID-19) is a respiratory infectious disease, also named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which can cause various systemic manifestations that pose a threat to human life. Oral lesions in patients with COVID-19 may appear during or after the illness and may or may not be a consequence of the viral infection. Objective: In this case series we compare the oral manifestations in hospitalized COVID-19 positive patients and COVID-19 negative dental outpatients. Methods: 60 hospitalized COVID-19 patients and 41 control patients, were examined for oral signs and symptoms. The controls were dental patients who visited the hospital for dental care without complaining of any problems related to the oral cavity itself. Results: We have observed a strong association between certain clinical findings and COVID-19, including alterations in taste (ageusia, dysgeusia, and hypogeusia), anosmia, hairy tongue, tongue imprints, red tongue, erythematous candidiasis, pseudomembranous candidiasis, and exfoliative cheilitis. A trend but not statistically significant association at the level of 5% was also noted for colored tongue, linea alba, and pale mucosa. On the contrary, fissured tongue and oral mucosa pigmentation were more frequent in the controls, statistically significant at the level of 5%. Conclusion: COVID-19 has been found to impact the oral cavity, resulting in various oral lesions that can be attributed to either the direct action of the virus or the patient’s immune response.

The relationship between the distribution of HBcAg in liver cells and the pathological manifestations of the liver in 429 HBeAg-positive chronic HBV-infected individuals

Background:The natural history of chronic HBV infection is typically characterized by four stages:the immune tolerance period,the immune clearance period,the immune control period,and the immune escape period.These stages are associated with the distribution of HBcAg in liver cells;however,this relationship remains a topic of broad debate within the field of liver disease.To objectively and quantitatively measure the intracellular distribution of HBcAg,this paper aims to design a method referred to as the“layered evaluation method”and to examine its validation.Methods:The distribution of HBcAg in liver cells is assessed using Image Pro Plus image processing software,along with calculations of cytoplasmic and nuclear positive staining rates.Results:The findings indicate that the highest proportion of patients exhibited a positive cytoplasmic expression rate ranging from 0-2.5%.More than 40% of the total sample was categorized within the 0-2.5% positive nuclear expression range.The HBcAg cytoplasmic positive staining rates were classified into five levels:a cytoplasmic HBcAg positive staining rate of less than 0.05% is designated as level 0,indicating negative expression;a staining rate between 0.05% and 5% is classified as level 1;a rate from 5% to less than 10% is classified as level 2;a rate from 10% to less than 20% is classified as level 3;and a nuclear positivity rate exceeding 20% is classified as level 4.Conclusion:The inflammatory activity grade in these patients was positively correlated with the cytoplasmic distribution of HBcAg.Furthermore,the nuclear distribution rate of HBcAg was significantly higher in the G3 group compared to the other groups.

Coagulation abnormalities and their relationship with bleeding manifestations in patients with dengue-A single center observational study

Objective:To evaluate coagulation abnormalities and their relationship with bleeding manifestations among patients with dengue.Methods:This observational study was conducted on 292 adult dengue patients who were admitted to a tertiary care hospital of Western India from July 2021 to June 2022.Coagulation tests including prothrombin time(PT),international normalized ratio(INR),activated partial thromboplastin time(aPTT),fibrinogen,and D-dimer were performed.Patients were monitored for bleeding manifestations.Results:Coagulation abnormalities were reported in 42.8%of the patients.Overall,prolonged aPTT was the most common coagulation abnormality(40.8%),followed by low fibrinogen(38.7%),raised D-dimer(31.2%),raised INR(26.0%)and prolonged PT(19.2%).Bleeding manifestations were present in 19.9%patients.PT,INR,aPTT and D-dimer levels were significantly higher(P<0.01)and fibrinogen level was significantly lower(P<0.001)in patients with bleeding compared to patients without bleeding.Patients with bleeding had a significantly higher rate of all coagulation abnormalities than patients without bleeding(P<0.01).Conclusions:Patients with bleeding showed a significantly higher frequency of coagulation abnormalities compared to patients without bleeding.Patients with dengue should be assessed for coagulation abnormalities.

REAL PALEY-WIENER THEOREMS FOR THE SPACE-TIME FOURIER TRANSFORM

This paper presents an extension of certain forms of the real Paley-Wiener theorems to the Minkowski space-time algebra. Our emphasis is dedicated to determining the space-time valued functions whose space-time Fourier transforms(SFT) have compact support using the partial derivatives operator and the Dirac operator of higher order.

Pathogenesis,clinical manifestations,diagnosis,and treatment progress of achalasia of cardia

Achalasia cardia,type of esophageal dynamic disorder,is a relatively rare primary motor esophageal disease characterized by the functional loss of plexus ganglion cells in the distal esophagus and lower esophageal sphincter.Loss of function of the distal and lower esophageal sphincter ganglion cells is the main cause of achalasia cardia,and is more likely to occur in the elderly.Histological changes in the esophageal mucosa are considered pathogenic;however,studies have found that inflammation and genetic changes at the molecular level may also cause achalasia cardia,resulting in dysphagia,reflux,aspiration,retrosternal pain,and weight loss.Currently,the treatment options for achalasia focus on reducing the resting pressure of the lower esophageal sphincter,helping to empty the esophagus and relieve symptoms.Treatment measures include botulinum toxin injection,inflatable dilation,stent insertion,and surgical myotomy(open or laparoscopic).Surgical procedures are often subject to controversy owing to concerns about safety and effectiveness,particularly in older patients.Herein,we review clinical epidemiological and experimental data to determine the prevalence,pathogenesis,clinical presentation,diagnostic criteria,and treatment options for achalasia to support its clinical management.

Space-time correlations of passive scalar in Kraichnan model

We consider the two-point,two-time(space-time)correlation of passive scalar R(r,τ)in the Kraichnan model under the assumption of homogeneity and isotropy.Using the fine-gird PDF method,we find that R(r,τ)satisfies a diffusion equation with constant diffusion coefficient determined by velocity variance and molecular diffusion.Itssolution can be expressed in terms of the two-point,one time correlation of passive scalar,i.e.,R(r,0).Moreover,the decorrelation o R(k,τ),which is the Fourier transform of R(r,τ),is determined byR(k,0)and a diffusion kernal.

Liver manifestations in COVID-19 patients:A review article

The coronavirus disease 2019(COVID-19)initially presented as a disease that affected the lungs.Then,studies revealed that it intricately affected disparate organs in the human body,with the liver being one of the most affected organs.This review aimed to assess the association between COVID-19 and liver function,shedding light on its clinical implication.However,its exact pathophysiology remains unclear,involving many factors,such as active viral replication in the liver cells,direct cytotoxic effects of the virus on the liver or adverse reactions to viral antigens.Liver symptoms are mild-to-moderate transaminase elevation.In some patients,with underlying liver disease,more serious outcomes are observed.Thus,liver function should be meticulously considered in patients with COVID-19.

Hepatobiliary manifestations following two-stages elective laparoscopic restorative proctocolectomy for patients with ulcerative colitis:A prospective observational study

BACKGROUND Hepatobiliary manifestations occur in ulcerative colitis(UC)patients.The effect of laparoscopic restorative proctocolectomy(LRP)with ileal pouch anal anastomosis(IPAA)on hepatobiliary manifestations is debated.AIM To evaluate hepatobiliary changes after two-stages elective laparoscopic restorative proctocolectomy for patients with UC.METHODS Between June 2013 and June 2018,167 patients with hepatobiliary symptoms underwent two-stage elective LRP for UC in a prospective observational study.Patients with UC and having at least one hepatobiliary manifestation who underwent LRP with IPAA were included in the study.The patients were followed up for four years to assess the outcomes of hepatobiliary manifestations.RESULTS The patients'mean age was 36±8 years,and males predominated(67.1%).The most common hepatobiliary diagnostic method was liver biopsy(85.6%),followed by Magnetic resonance cholangiopancreatography(63.5%),Antineutrophil cytoplasmic antibodies(62.5%),abdominal ultrasonography(35.9%),and Endoscopic retrograde cholangiopancreatography(6%).The most common hepatobiliary symptom was Primary sclerosing cholangitis(PSC)(62.3%),followed by fatty liver(16.8%)and gallbladder stone(10.2%).66.4%of patients showed a stable course after surgery.Progressive or regressive courses occurred in 16.8%of each.Mortality was 6%,and recurrence or progression of symptoms required surgery for 15%.Most PSC patients(87.5%)had a stable course,and only 12.5%became worse.Two-thirds(64.3%)of fatty liver patients showed a regressive course,while one-third(35.7%)showed a stable course.Survival rates were 98.8%,97%,95.8%,and 94%at 12 mo,24 mo,36 mo,and at the end of the follow-up.CONCLUSION In patients with UC who had LRP,there is a positive impact on hepatobiliary disease.It caused an improvement in PSC and fatty liver disease.The most prevalent unchanged course was PSC,while the most common improvement was fatty liver disease.

Polyneuropathy organomegaly endocrinopathy M-protein and skin changes syndrome with ascites as an early-stage manifestation:A case report

BACKGROUND Polyneuropathy organomegaly endocrinopathy M-protein and skin changes(POEMS)syndrome is a rare paraneoplastic syndrome caused by a potential plasma cell tumor.The clinical manifestations of POEMS syndrome are diverse.Due to the insidious onset and lack of specific early-stage manifestations,POEMS syndrome is easily misdiagnosed or never diagnosed,leading to delayed treatment.Neurological symptoms are usually the first clinical manifestation,while ascites is a rare symptom in patients with POEMS syndrome.CASE SUMMARY A female patient presented with unexplained ascites as an initial symptom,which is a rare early-stage manifestation of the condition.After 1 year,the patient gradually developed progressive renal impairment,anemia,polyserosal effusion,edema,swollen lymph nodes on the neck,armpits,and groin,and decreased muscle strength of the lower extremities.The patient was eventually diagnosed with POEMS syndrome after multidisciplinary team discussion.Treatment comprised bortezomib+dexamethasone,continuous renal replacement therapy,chest and abdominal closed drainage,transfusions of erythrocytes and platelets,and other symptomatic and supportive treatments.The patient’s condition initially improved after treatment.However,then her symptoms worsened,and she succumbed to the illness and died.CONCLUSION Ascites is a potential early manifestation of POEMS syndrome,and this diagnosis should be considered for patients with unexplained ascites.Furthermore,multidisciplinary team discussion is helpful in diagnosing POEMS syndrome.

Coulomb Force, Charge, and Electric Properties under Collision Space-Time

We have recently published a series of papers on a theory we call collision space-time, that seems to unify gravity and quantum mechanics. In this theory, mass and energy are redefined. We have not so far demonstrated how to make it compatible with electric properties such as charge and the Coulomb force. The aim of this paper is to show how electric properties can be reformulated to make it consistent with collision space-time. It is shown that we need to incorporate the Planck scale into the electric constants to do so. This is also fully possible from a practical point of view, as it has recently been shown how to measure the Planck length independent of other constants and without the need for dimensional analysis.

Scalable transcoding for video transmission over space-time OFDM systems

A new scheme combining a scalable transcoder with space time block codes （STBC） for an orthogonal frequency division multiplexing （OFDM） system is proposed for robust video transmission in dispersive fading channels. The target application for such a scalable transcoder is to provide successful access to the pre-encoded high quality video MPEG-2 from mobile wireless terminals. In the scalable transcoder, besides outputting the MPEG-4 fine granular scalability （FGS） bitstream, both the size of video frames and the bit rate are reduced. And an array processing algorithm of layer interference suppression is used at the receiver which makes the system structure provide different levels of protection to different layers. Furthermore, by considering the important level of scalable bitstream, the different bitstreams can be given different level protection by the system structure and channel coding. With the proposed system, the concurrent large diversity gain characteristic of STBC and alleviation of the frequency-selective fading effect of OFDM can be achieved. The simulation results show that the proposed schemes integrating scalable transcoding can provide a basic quality of video transmission and outperform the conventional single layer transcoding transmitted under the random and bursty error channel conditions.

EM-based detection scheme for differential unitary space-time modulation

The performance loss of an approximately 3 dB signal-to-noise ratio is always paid with conventional differential detection compared to the related coherent detection. A new detection scheme consisting of two steps is proposed for the differential unitary space-time modulation （DUSTM） system. In the first step, the data sequence is estimated by conventional unitary space-time demodulation （DUSTD） and differentially encoded again to produce an initial estimate of the transmitted symbol stream. In the second step, the initial estimate of the symbol stream is utilized to initialize an expectation maximization （EM）-based iterative detector. In each iteration, the most recent detected symbol stream is employed to estimate the channel, which is then used to implement coherent sequence detection to refine the symbol stream. Simulation results show that the proposed detection scheme performs much better than the conventional DUSTD after several iterations.

基于space-time的二叉树表示动态环境中的路径规划

研究具有空间和时间的三维动态环境下的机器人路径规划分析了四叉树表示二维空间的搜索算法,在此基础上,提出采space-time,用二叉树表示二维空间的方法时间信息中增加加速度利用二叉树遍历方法和算法设计一个在动态障碍物环境下进行路径规划的新算法并,,A*,,在足球机器人系统中进行仿真,实现了较好的路径规划。