Solute transport and geochemical modeling of the coastal quaternary aquifer, Delta Dahab Basin, South Sinai, Egypt

The wadi dahab delta is in a dry, arid coastal zone within Egypt’s south Sinai Peninsula’s eastern portion. The primary water source is the Quaternary coastal alluvial aquifer. The groundwater salinity varies from 890to 8213 mg/L, with a mean value of 3417 mg/L. The dissolved major ions have been used to calculate the seawater mixing index(SWMI) using a linear equation that discriminates the groundwater mostly affected by water–rock interaction(SWMI 1>) and other samples mixed with Seawater(SWMI < 1). The isotopic composition of groundwater for specifically chosen groundwater samples ranges from-0.645‰ to +5.212‰ for δ^(18)O and from-9.582‰ to + 22.778‰ for δ^(2)H, where the seawater represented by a Red Sea water sample(δ^(18)O + 1.64‰-δ^(2)H + 9.80‰) and reject brine water are considerably enriched the isotopic groundwater values. The geochemical NETPATH model constrained by the dissolved significant ions, isotopes, and the rock aquifer forming minerals as phases indicate the mixing percent with the seawater ranges from 9% to 97% of seawater from 91% to 3% of original recharge water. According to the SEAWAT 3-D flow models, seawater has penetrated the Northeastern Dahab delta aquifer, with the intrusion zone extending1500 m inland. The salt dissolution, upwelling of saline water, recharge from the upstream mountain block, and seawater encroachment are the primary aspects contributing to the deterioration of groundwater quality. These findings may have significance for effective groundwater withdrawal management in arid locations worldwide with similar hydrogeological systems.

World Class Elite Breaststrokers Downward Kick EMG Muscle Activity of the Gluteus Maximus, Quadriceps Femoris, Hamstring, Gastrocnemius Medialis, Rectus Abdominal, and Erector Spinae

This study analyzed the difference between using a downward breaststroke kick and a horizontal breaststroke kick in a sample of world class elite swimmers.We compared average muscle activity of the gluteus maximus,quadriceps femoris(vastus medialis and rectus femoris),hamstring/long head of the biceps femoris,gastrocnemius medialis,rectus abdominal,and erector spinae when using the downward breaststroke kick technique.We find that when this sample of swimmers utilized the downward breaststroke kick,max speed and velocity per stroke increased,measured by 12,788 EMG samples,where the results are highly correlated to duration of the aerodynamic buoyant force in breaststroke kick technique.The increases in performance observed from measuring the world class elite swimmers is highly correlated to the duration of the kick aerodynamic buoyant force.Among this sample of elite swimmers,the longer a swimmer demonstrates a buoyant force breaststroke kick,the lower the time in a 100 breaststroke.

Effect of obstructive sleep apnea on type 2 diabetes mellitus:A comprehensive literature review

Obstructive sleep apnea(OSA)is frequently associated with obesity and metabolic syndrome.Also frequently associated with metabolic syndrome is type 2 diabetes mellitus(T2DM).Therefore,it is common to find OSA and T2DM together in individuals with metabolic syndrome.Additionally,both OSA and T2DM have a common pathophysiological link with development of insulin resistance.Individuals with severe insulin resistance are likely to have inadequate glycemic control.Long standing poorly controlled T2DM is associated with debilitating microvascular complications such as retinopathy,nephropathy,neuropathy and macrovascular complications such as coronary artery and cerebrovascular disease.There is extensively published literature exploring the cause-effect relationship between OSA and T2DM.In this article we provide an in-depth review of the complex pathophysiological mechanisms linking OSA to T2DM.Specifically,this review focusses on the effect of OSA on the microvascular complications of T2DM such as retinopathy,nephropathy and neuropathy.Additionally,we review the current literature on the effect of continuous positive airway pressure use in individuals with T2DM and OSA.

Guidelines and controversies in the management of diabetic ketoacidosis – A mini-review

Diabetic ketoacidosis(DKA) is a complication seen in patients with both type 1 and type 2 diabetes. Due to its large, growing economic impact with associated morbidity, closer look at proper management is im-portant. Factors involved in appropriate management involves fluid resuscitation, insulin regimen, and elec-trolyte replacement including types of fluid and insulin treatment. The caveat with generalized protocol is application to special populations such as renal or heart failure patients the sequelae of complications due to pathophysiology of the disease processes. This leads to complications and longer length of stay in the hospital, therefore, possibly increased cost and resource utilization during the hospitalization. This review takes a closer look at current guidelines of DKA management and resource utilization, the drawbacks of current management protocols and the cost associated with it. Therefore, a need for amendment to existing protocol or initiation of a newer guideline that properly manages DKA should incorporate special populations and appropriate regimen of fluid resuscitation, insulin therapy and electrolyte management.

Management of critically ill patients with diabetes

Disorders of glucose homeostasis, such as stress-induced hypoglycemia and hyperglycemia, are common complications in patients in the intensive care unit. Patients with preexisting diabetes mellitus(DM) are more susceptible to hyperglycemia, as well as a higher risk from glucose overcorrection, that may results in severe hypoglycemia. In critically ill patients with DM, it is recommended to maintain a blood glucose range between 140-180 mg/d L. In neurological patients and surgical patients, tighter glycemic control(i.e., 110-140 mg/d) is recommended if hypoglycemia can be properly avoided. There is limited evidence that shows that critically ill diabetic patients with a glycosylated hemoglobin levels above 7% may benefit from looser glycemic control, in order to reduce the risk of hypoglycemia and significant glycemic variability.

Hepatic hemangioma:What internists need to know

Hepatic hemangioma(HH)is the most common benign liver tumor and it is usually found incidentally during radiological studies.This tumor arises from a vascular malformation;however,the pathophysiology has not been clearly elucidated.Symptoms usually correlate with the size and location of the tumor.Less commonly the presence of a large HH may cause life-threatening conditions.The diagnosis can be established by the identification of HH hallmarks in several imaging studies.In patients that present with abdominal symptoms other etiologies should be excluded first before attributing HH as the cause.In asymptomatic patient’s treatment is not required and follow up is usually reserved for HH of more than 5 cm.Symptomatic patients can be managed surgically or with other non-surgical modalities such as transcatheter arterial embolization or radiofrequency ablation.Enucleation surgery has shown to have fewer complications as compared to hepatectomy or other surgical techniques.Progression of the tumor is seen in less than 40%.Hormone stimulation may play a role in HH growth;however,there are no contraindications for hormonal therapy in patients with HH due to the lack of concrete evidence.When clinicians encounter this condition,they should discern between observation and surgical or non-surgical management based on the clinical presentation.

Effect of continuous positive airway pressure therapy on glucose control

Obstructive sleep apnea (OSA) and diabetes mellitus are both highly prevalent disorders.There has been a recent recognition of an association between insulin resistance and sleep apnea.Continuous positive airway pressure (CPAP) has emerged as an effective therapy for treatment of OSA and has been shown to positively influence numerous pathophysiological factors that con-tribute to cardiovascular risk.There is emerging data that explores the influence of CPAP therapy,insulin sensitivity and glycemic control.In the current review,we examine this literature critically and formulate a synopsis that summarizes the current knowledge in this field.

Abnormal liver enzymes: A review for clinicians

Liver biochemical tests are some of the most commonly ordered routine tests in the inpatient and outpatient setting,especially with the automatization of testing in this technological era.These tests include aminotransferases,alkaline phosphatase,gamma-glutamyl transferase,bilirubin,albumin,prothrombin time and international normalized ratio(INR).Abnormal liver biochemical tests can be categorized based on the pattern and the magnitude of aminotransferases elevation.Generally,abnormalities in aminotransferases can be classified into a hepatocellular pattern or cholestatic pattern and can be further sub-classified based on the magnitude of aminotransferase elevation to mild[<5×upper limit of normal(ULN)],moderate(>5-<15×ULN)and severe(>15×ULN).Hepatocellular pattern causes include but are not limited to;non-alcoholic fatty liver disease/non-alcoholic steatohepatitis,alcohol use,chronic viral hepatitis,liver cirrhosis(variable),autoimmune hepatitis,hemochromatosis,Wilson’s disease,alpha-1 antitrypsin deficiency,celiac disease,medication-induced and ischemic hepatitis.Cholestatic pattern causes include but is not limited to;biliary pathology(obstruction,autoimmune),other conditions with hyperbilirubinemia(conjugated and unconjugated).It is crucial to interpret these commonly ordered tests accurately as appropriate further workup,treatment and referral can greatly benefit the patient due to prompt treatment which can improve the natural history of several of the diseases mentioned and possibly reduce the risk of progression to the liver cirrhosis.

Abdominal compartment syndrome among surgical patients

Abdominal compartment syndrome(ACS)develops when organ failure arises secondary to an increase in intraabdominal pressure.The abdominal pressure is determined by multiple factors such as blood pressure,abdominal compliance,and other factors that exert a constant pressure within the abdominal cavity.Several conditions in the critically ill may increase abdominal pressure compromising organ perfusion that may lead to renal and respiratory dysfunction.Among surgical and trauma patients,aggressive fluid resuscitation is the most commonly reported risk factor to develop ACS.Other conditions that have also been identified as risk factors are ascites,hemoperitoneum,bowel distention,and large tumors.All patients with abdominal trauma possess a higher risk of developing intra-abdominal hypertension(IAH).Certain surgical interventions are reported to have a higher risk to develop IAH such as damage control surgery,abdominal aortic aneurysm repair,and liver transplantation among others.Close monitoring of organ function and intra-abdominal pressure(IAP)allows clinicians to diagnose ACS rapidly and intervene with target-specific management to reduce IAP.Surgical decompression followed by temporary abdominal closure should be considered in all patients with signs of organ dysfunction.There is still a great need for more studies to determine the adequate timing for interventions to improve patient outcomes.

When a liver transplant recipient goes back to alcohol abuse: Should we be more selective?

Alcoholic liver disease(ALD) is one of the most common indications for liver transplantation(LT). However, it has always remained as a complicated topic from both medical and ethical grounds, as it is seen for many a "self-inflicted disease". Over the years, the survival rate of transplanted patients has significantly improved. The allocation system and the inclusion criteria for LT has also undergone some modifications. Early LT for acute alcoholic hepatitis has been subject to recent clinical studies with encouraging results in highly selected patients. We have learned from studies the importance of a multidisciplinary evaluation of candidates for LT. Complete abstinence should be attempted to overcome addiction issues and to allow spontaneous liver recovery. Risk factors for relapse include the presence of anxiety or depressive disorder, short duration of sobriety pre-LT and lack of social support. The identification of risk factors and the strengthen of social support system may decrease relapse among these patients. Family counseling of candidates is highly encouraged to prevent relapse to alcohol. Relapse has been associated with different histopathological changes, graft damage, graft loss and even decrease in survival among some studies. Therefore, each patient should be carefully selected and priority is to continue to lean on patients with high probability of success. The ethical issue remains as to the patient returning to drinking after the LT, hindering the way for other patients who could have received the same organ.

质谱成像中的计算策略综述

质谱成像(MSI)已广泛应用于蛋白质组学、代谢组学、脂质组学和糖组学,以及与组织医学诊断和临床应用相关的生物医学研究领域。质谱成像能提供生物组织样本中空间分子组成的信息。由于MSI数据量异常庞大,人工数据解析和可视化分析的低效率、低精度已成为了研究中的瓶颈。因此,近年来在MSI的相关研究中出现了各种计算算法协助数据解析。本文综述了MSI最常用的计算策略及其在生物医学研究中的应用,涵盖了MSI数据预处理、降维、聚类、分类等数据分析方法和MSI软件工具包的最新研究成果。

Pulmonary complications of hepatic diseases

Severe chronic liver disease(CLD) may result from portal hypertension, hepatocellular failure or the combination of both. Some of these patients may develop pulmonary complications independent from any pulmonary pathology that they may have. Among them the hepatopulmonary syndrome(HPS), portopulmonary hypertension(PPH) and hepatic hydrothorax(HH) are described in detail in this literature review. HPS is encountered in approximately 15% to 30% of the patients and its presence is associated with increase in mortality and also requires liver transplantation in many cases. PPH has been reported among 4%-8% of the patient with CLD who have undergone liver transplantation. The HH is another entity, which has the prevalence rate of 5% to 6% and is associated in the absence of cardiopulmonary disease. These clinical syndromes occur in similar pathophysiologic environments. Most treatment modalities work as temporizing measures. The ultimate treatment of choice is liver transplant. This clinical review provides basic concepts; pathophysiology and clinical presentation that will allow the clinician to better understand these potentially life-threatening complications. This article will review up-to-date information on the pathophysiology, clinical features and the treatment of the pulmonary complications among liver disease patients.

Asymptomatic bacteriuria among hospitalized diabetic patients:Should they be treated?

Diabetes Mellitus is a significant health care challenge in the United States.The Center for Disease Control and Prevention estimates approximately 9.4%of patients in the United States are afflicted by diabetes.The Infectious Disease Society of America asymptomatic bacteriuria in women as two consecutive cleancatch voided urine specimens with isolation of the same bacterial strain in counts≥105 cfu/mL It is understood that diabetic patients tend to be at higher risk for infections than non-diabetics.Urinary tract infections(UTIs)tend to be the most common infection contracted by this population.UTIs are not only a significant cause of morbidity and mortality,they are also a significant financial burden.The data are conflicting,in regard to treating asymptomatic bacteriuria in diabetic patients to avoid hospital complications and ultimately decrease healthcare costs associated with these complications.However,clinicians continue to prescribe antibiotics empirically.Further randomized controlled study looking into the specific population as immunocompromised diabetic patients,patient with diabetic ketoacidosis and patient in intensive care unit needs to be undertaken.

Severe insulin resistance treatment with intravenous chromium in septic shock patient

Insulin resistance has been well documented in critically ill patients.Adequate blood sugar control has been associated with better wound healing,and better outcomes in selected patient populations.Chromium is an essential component of human diet.It is believed to affect changes in glucose uptake.Several studies have shown beneficial effects of oral chromium in diabetic patients with insulin resistance,but role of intravenous chromium infusion has not been completely evaluated.We present a case of extreme insulin resistance in a 62-year-old woman with history of diabetes who suffered a cardiac arrest and respiratory failure,leading to aspiration pneumonia and septic shock requiring greater than 7000 units of insulin over a period of 12 h which was successfully treated with intravenous chromium replacement.

Hepatopulmonary syndrome: An update

Hepatopulmonary syndrome(HPS)is characterized by defects in oxygenation caused by intra-pulmonary vasodilation occurring because of chronic liver disease,portal hypertension,or congenital portosystemic shunts.Clinical implications of portal hypertension are very well-known,however,awareness of its effect on multiple organs such as the lungs are less known.The presence of HPS in chronic liver disease is associated with increased mortality.Medical therapies available for HPS have not been proven effective and definitive treatment for HPS is mainly liver transplantation(LT).LT improves mortality for patients with HPS drastically.This article provides a review on the definition,clinical presentation,diagnosis,and management of HPS.

踝关节MR断层解剖、解剖变异和病理——第二部分:解剖变异和病理(续)(英文)

踝关节疼痛是一个非常常见的临床症状,病因很多,本文将引起踝关节疼痛病因的MR影像特征分为三部分进行描述:①侧副韧带损伤:侧副韧带损伤分为拉伤、部分撕裂和完全断裂。急性侧副韧带损伤MRI主要表现为韧带信号增高,韧带不规则断裂,界限不清,周围软组织水肿及邻近的骨水肿;慢性期的主要表现为韧带不规则增粗或变细。②肌腱病变:肌腱的病变大体上可分为肌腱病、部分肌腱撕裂、肌腱的完全断裂、肌腱纵向撕裂、肌腱腱鞘滑膜炎和肌腱脱位。单纯创伤性肌腱断裂很少见,多数肌腱断裂发生在肌腱病的基础之上。MRI能够准确显示以上各种病变的特征。③骨、软骨及其他软组织病变:主要包括踝关节骨隐性压缩骨折、跖骨联合、副舟骨综合征、踝关节后撞击综合征、骨三角综合征、距骨骨软骨病变、和距骨缺血性坏死等。MRI能够准确的对上述疾病作出诊断及鉴别诊断。

Correlation between metabolic syndrome and sleep apnea

The so-called "metabolic syndrome"(MS),constitutes a cluster of metabolic and cardiovascular abnormalities,including fasting glucose,blood pressure,triglycerides,high density lipoprotein cholesterol(HDL-C),and waist circumference that arise from insulin resistance. Obstructive sleep apnea(OSA) syndrome is characterized by recurrent episodes of partial or complete obstruction of the upper airway,involving cessation or significant decreased airflow,with intermittent hypoxemia,frequent arousals from sleep and recurrent oxyhemoglobin desaturations that interfere with normal sleep patterns generating difficulty falling asleep,unrefreshing sleep and loud snoring. The relation between these two entities is known as "Syndrome Z",and there is no question about the impact of these risk factors on health and disease. This clinical condition presents a growing epidemic Worldwide,affecting approximately 60% of the general population with both MS and OSA due to the constant increase of body mass index in humans. This article presents evidence-based data that focuses on the direct relationship between MS and OSA.

Hydrocortisone, ascorbic acid and thiamine for sepsis: Is the jury out?

Sepsis and septic shock remain a major cause of morbidity and mortality among patients admitted in the intensive care unit.Diabetes is a major risk factor for the development of sepsis.The global mortality of sepsis remains high,despite significant interventions and guidelines.It has been known for decades that patients with sepsis have reduced levels of antioxidants,most notably vitamin C.Furthermore,experimental data has demonstrated multiple beneficial effects of vitamin C in sepsis.In addition,corticosteroids and thiamine may have synergistic biological effects together with vitamin C.Preliminary data suggests that therapy with hydrocortisone,ascorbic acid and thiamine improves the outcome of patients with sepsis with the potential to save millions of lives.However,this intervention has met with much resistance and has not been widely adopted.Ultimately,we await the final jury verdict on this simple,safe and cheap intervention.

Fungal infections following liver transplantation

With increasing morbidity and mortality from chronic liver disease and acute liver failure,the need for liver transplantation is on the rise.Most of these patients are extremely vulnerable to infections as they are immune-compromised and have other chronic co-morbid conditions.Despite the recent advances in practice and improvement in diagnostic surveillance and treatment modalities,a major portion of these patients continue to be affected by post-transplant infections.Of these,fungal infections are particularly notorious given their vague and insidious onset and are very challenging to diagnose.This mini-review aims to discuss the incidence of fungal infections following liver transplantation,the different fungi involved,the risk factors,which predispose these patients to such infections,associated diagnostic challenges,and the role of prophylaxis.The population at risk is increasingly old and frail,suffering from various other co-morbid conditions,and needs special attention.To improve care and to decrease the burden of such infections,we need to identify the at-risk population with more robust clinical and diagnostic parameters.A more robust global consensus and stringent guidelines are needed to fight against resistant microbes and maintain the longevity of current antimicrobial therapies.

Investigating Temporal Variation of Water Quality and Benthic Macroinvertebrates in Taudaha Lake, Kathmandu, Nepal

Taudaha Lake is one of the important wetlands in Nepal, as it provides critical habitats for thousands of migratory birds and fishes. Despite being a critically important water body, there is a lack of detail chemical and biological studies on this lake. The present study investigates the effects of seasonal water quality variations in distribution and abundance of macroinvertebrates in Taudaha Lake, during four different seasons in 2006. The results indicate that all the water quality parameters, except secchi depth, and total alkalinity, significantly varied among seasons. The gross primary productivity of the lake also significantly varied among the seasons, with highest primary production during summer (3.92 ± 0.18 gC/m3/day) and lowest during spring (2.44 ± 0.67 gC/m3/day). A total of 2166 individual benthic macroinvertebrates from 10 families and 7 orders were collected during the study period. Unlike water quality parameters, the macroinvertebrate species composition did not vary significantly among the seasons. The results suggested that the change in lake water quality did not have significant impacts on community metrics such as species diversity, species richness, and species evenness.