异常热报告的确认

本文首次确认Nathan Lewis及其合作者于1989年5月1日在美国马里兰州巴尔的摩举行的美国物理学会(APS)会议上所犯的关键计算错误。Lewis等人分析了Martin Fleischmann及其合作者报告的9轮实验中的热测量结果,并报告在没有催化复合的情况下每轮实验都显示出异常的热功率损失。而本文使用相同的原始数据,经过正确的计算,再次确认每轮实验都显示出异常的功率增益。因此,这些数据意味着可能存在一种能产生能量的新物理现象。

Precision in detecting colon lesions:A key to effective screening policy but will it improve overall outcomes?

Colonoscopy is the gold standard for the screening and diagnosis of colorectal cancer,resulting in a decrease in the incidence and mortality of colon cancer.However,it has a 21%rate of missed polyps.Several strategies have been devised to increase polyp detection rates and improve their characterization and delimi-tation.These include chromoendoscopy(CE),the use of other devices such as Endo cuffs,and major advances in endoscopic equipment[high definition,magnification,narrow band imaging,i-scan,flexible spectral imaging color enhancement,texture and color enhancement imaging(TXI),etc.].In the retrospective study by Hiramatsu et al,they compared white-light imaging with CE,TXI,and CE+TXI to determine which of these strategies allows for better definition and delimitation of polyps.They concluded that employing CE associated with TXI stands out as the most effective method to utilize.It remains to be demonstrated whether these results are extrapolatable to other types of virtual CE.Additionally,further investigation is needed in order to ascertain whether this strategy could lead to a reduction in the recurrence of excised lesions and potentially lower the occurrence of interval cancer.

Has Coca-Cola treatment become the first-line therapy for gastric bezoars,both in general and specifically for western countries?

Phytobezoars is a rare disease and less common in Western countries.The stomach is the primary site for these formations,and endoscopic treatment involving fragmentation and extraction has traditionally been the most effective approach.However,medical treatments using enzymatic and chemical agents,such as cellulase and Coca-Cola,aimed at dissolving the bezoars,have also been utilized,showing varying degrees of resolution success.Notably,the oral dissolution treatment with Coca-Cola has emerged as a promising,simpler,and more costeffective method.The study by Liu et al represents an important step in clinical research on this topic,despite some limitations that need addressing for a more comprehensive understanding of its findings.Key considerations for future research include sample size calculation,endoscopic procedure details,outpatient vs.inpatient treatment,and detailed cost calculations.The study's exclusions,such as patients with upper gastric surgery,phytobezoars older than 14 d,and cases of gastroparesis,limit its applicability to broader populations,especially in Western countries.Given the promising outcomes of the Coca-Cola treatment,it's advocated as a first-line therapy for phytobezoars.Nonetheless,further research is essential to overcome these limitations.However special situations such as perforation or small bowel obstruction will require surgical treatment.

Post-war Sustainability-Driven School Buildings: A Review of the Literature

The Safe Schools Declaration of 2015 is an inter-governmental political agreement signed by several countries designed to protect the schooling of the school-aged population during armed conflicts.Yet,in countries where civil war erupted,schools were demolished.Several school-aged children were either forcibly recruited by governments or coerced by rebel groups to serve in armed fights.As a result,several children were deprived of their education and have remained suffering from deep psychological scars.The central question of the study is:What kind of sustainability-driven school buildings can be initiated in countries that are now enduring peace so that the learning environments are more comfortable and improve the well-being of the war-impacted children and school employees?After reviewing the literature,a strategic conceptual framework that incorporated the synergistic relationship between economic,social,and environmental aspects of sustainability was initiated to map out sustainable school buildings.In short,the conceptual framework proposed to construct school buildings in some of the war-affected developing countries includes assembling cost-efficiency and eco-effectiveness inputs,using renewable energy sources powered by natural sunlight,collecting rainwater in mud cisterns,reducing emissions of carbon oxides,and empowering the local community to be the main actors to design sustainable buildings during the preconstruction,construction,and post-construction stages to serve as learning spaces for the war-affected occupants and their neighborhoods.

Clinical and demographic features of patients undergoing videocapsule endoscopy management:A descriptive study

BACKGROUND Video-capsule endoscopy(VCE)is an efficient tool that has proven to be highly useful in approaching several gastrointestinal diseases.VCE was implemented in Colombia in 2003,however current characterization of patients undergoing VCE in Colombia is limited,and mainly comes from two investigations conducted before the SARS-CoV-2 pandemic period.AIM To describe the characteristics of patients undergoing VCEs and establish the main indications,findings,technical limitations,and other outstanding features.METHODS A descriptive study was carried out using data from reports of VCE(PillCam SB3 system)use in a Gastroenterology Unit in Bogotá,Colombia between September 2019 and January 2023.Demographic and clinical variables such as indication for the VCE,gastric and small bowel transit times(GTT,SBTT),endoscopic preparation quality,and limitations were described[n(%),median(IQR)].RESULTS A total of 133 VCE reports were analyzed.Most were in men with a median age of 70 years.The majority had good preparation(96.2%),and there were technical limitations in 15.8%of cases.The main indications were unexplained anemia(91%)or occult bleeding(23.3%).The median GTT and SBTT were 14 and 30 minutes,respectively.The frequencies of bleeding stigma(3.79%)and active bleeding(9.09%)were low,and the most frequent abnormal findings were red spots(28.3%),erosions(17.6%),and vascular ectasias(12.5%).CONCLUSION VCE showed high-level safety.The main indication was unexplained anemia.Active bleeding was the most frequent finding.Combined with artificial intelligence,VCE can improve diagnostic precision and targeted therapeutic interventions.

Physico-chemical characterization of acid base disorders in patients with COVID-19: A cohort study

BACKGROUND Acid-base imbalance has been poorly described in patients with coronavirus disease 2019(COVID-19).Study by the quantitative acid-base approach may be able to account for minor changes in ion distribution that may have been over-looked using traditional acid-base analysis techniques.In a cohort of critically ill COVID-19 patients,we looked for an association between metabolic acidosis surrogates and worse clinical outcomes,such as mortality,renal dialysis,and length of hospital stay.AIM To describe the acid-base disorders of critically ill COVID-19 patients using Stewart’s approach,associating its variables with poor outcomes.METHODS This study pertained to a retrospective cohort comprised of adult patients who experienced an intensive care unit stay exceeding 4 days and who were diagnosed with severe acute respiratory syndrome coronavirus 2 infection through a positive polymerase chain reaction analysis of a nasal swab and typical pulmonary involvement observed in chest computed tomography scan.Laboratory and clinical data were obtained from electronic records.Categorical variables were compared using Fisher’s exact test.Continuous data were presented as median and interquartile range.The Mann-Whitney U test was used for comparisons.RESULTS In total,211 patients were analyzed.The mortality rate was 13.7%.Overall,149 patients(70.6%)presented with alkalosis,28 patients(13.3%)had acidosis,and the remaining 34 patients(16.2%)had a normal arterial pondus hydrogenii.Of those presenting with acidosis,most had a low apparent strong ion difference(SID)(20 patients,9.5%).Within the group with alkalosis,128 patients(61.0%)had respiratory origin.The non-survivors were older,had more comorbidities,and had higher Charlson’s and simplified acute physiology score 3.We did not find severe acid-base imbalance in this population.The analyzed Stewart’s variables(effective SID,apparent SID,and strong ion gap and the effect of albumin,lactate,phosphorus,and chloride)were not different between the groups.CONCLUSION Alkalemia is prevalent in COVID-19 patients.Although we did not find an association between acid-base variables and mortality,the use of Stewart’s methodology may provide insights into this severe disease.

Artificial Intelligence Based on Resilient Leadership in the Health Sector-A Secondary Publication

At present,it is impossible to deny the existence of artificial intelligence in various areas of social life,understood as the simulation of expert human intelligence from computer processes that involve learning,reasoning,and self-correction,its benefits to the medical field,in particular,are innumerable,but their incorporation into health systems has been gradual for many reasons.According to the above,this research analyzed artificial intelligence based on resilient leadership in the health sector,for which qualitative research was carried out with a documentary-bibliographic design with printed and electronic documentary sources with theoretical contributions fromÁvila,Mayer,and Quesada[1],Morgan[2],Villa[3],and Finol[4],among others.It is highlighted that resilient leadership has become a strategic factor in all organizations,since times of uncertainty and changes lead institutions to properly manage the incorporation of technologies specifically AI,achieving in this way that the centers and professionals in the field of health assume the needs of the contexts and the innovations of the same.It is concluded that resilient leadership will allow artificial intelligence in the health sector to generate higher levels of learning and adaptability to the transformations that are necessary,whose resistance would make its application difficult and in the long run it will leave behind professionals who refuse to assume the contributions of these innovative techniques in medical practice.

The first record of dermochelyid turtles in the Eocene of Tierra del Fuego:new insights on the evolution of the Weddellian faunas

The Antarctic Paleogene marine fossil record has been the key to reconstructing the evolution of the Weddellian Sea and final dismemberment of Southern Gondwana.In this context,Eocene marine vertebrates from Seymour(Marambio)Island have provided valuable information.We present the first Eocene record of marine reptiles from the southern Atlantic Coast of South America.This corresponds to several postcranial turtle remains represented by a proximal end of the right humerus,three caudal and one thoracic vertebrae,a fragment of the left pubis,and ten ossicles of the dorsal carapace,coming from the Leticia Formation(late-mid Eocene)at Cabo Tiburones,Tierra del Fuego,Argentina.These materials show severalfeatures such as the size and general morphology of the humerus and vertebrae,and the presence of relatively small,irregular,smooth,and unkeeled ossicles,which allow us to assign them to Dermochelyidae indet.Dermochelyids are a cosmopolitan group ofcryptodiran turtles,registered from the late Cretaceous up to the recent,with some physiological-biological peculiarities(e.g.,endothermy and an exclusive jellyfish-based diet)and characterized by the presence of an osseous carapace formed by ossicles.The new finding from the Leticia Formation is an addition to the scarce and extremely fragmentary record of Eocene dermochelyids from the southern seas like those from the La Meseta and Submeseta formations(Antarctica)and the Waihao and Burnside formations(New Zealand).This new information allows us to discuss the presence of these turtles in such high latitudes in the past and its implication in the evolution of the Weddellian fauna.

靶向信号通路杀伤结直肠癌干细胞的新型药物

在全球范围内,结直肠癌(colorectal cancer,CRC)是第三大最常见的癌症,也是第二大致死的癌症。目前癌症生物学认为,癌是由一小群肿瘤干细胞(cancer stem cells,CSCs)形成,CSCs具有多潜能和自我更新的特性。CSCs被认为是与肿瘤发展、复发和耐药性有关。有趣的是,一些细胞信号通路参与维持CRC的存活、增殖和自我更新的特性,其中大多数信号通路在CSCs中被异常调控,这些通路包括Wnt(Wingless)/β-catenin、Notch、Hedgehog、NF-κB(nuclear factor kappa B)、JAK/STAT(Janus kinase/signal transducer and activator of transcription)、PPAR(peroxisome proliferator-activated receptor)、PI3K/Akt/mTOR(phosphatidyl-inositol-3-kinase/Akt/mechanistic target of rapamycin)和TGF-β(transforming growth factor-β)/Smad信号通路。在本综述中,我们总结了当前通过调控使这些异常信号通路来杀伤CRC干细胞的策略,这将有可能探索出联合常规药物和CSCs靶向药物的治疗方案,并将有助于提高CRC的治愈率。

Socio-Economic and Political Analysis of a Fragile State:A Reflection on Ethiopia

A review of the literature indicates that,currently,Ethiopia is now beyond the bounds of fragility.The purpose of the study was to investigate whether Ethiopia was experiencing fragility.After a review of the literature on fragility,a theoretical framework lens on fragility was developed to empirically test Ethiopia’s current condition.A longitudinal analysis indicates that before 2018,Ethiopia was regarded as the central economic engine of sub-Saharan Africa.However,as the current regime reversed Ethiopia’s developmental state model and moved to follow a neo-liberal model,Ethiopia’s economy has gradually diminished.More specifically,during the current regime,Ethiopia has experienced a decline in its Gross Domestic Product,faced rampant unemployment,and encountered an increase in inflation.Its foreign exchange currency reserves have declined below the three-month threshold of hard currency required for a country to import goods and services,and its external debt has extended beyond the country’s GDP.By encouraging armed conflict and widespread insurgencies,the current regime has caused social tension and deep humanitarian crises in Ethiopia-resulting in devastation of health and school facilities and causing more than five million Ethiopians to be displaced.Finally,failing to provide leadership to his people,the current regime in Ethiopia has willingly allowed the incursion of Ethiopia’s sovereignty by foreign forces.The conclusion of the study is that,when observed through the lens of fragility using a longitudinal framework,currently,Ethiopia has traversed beyond fragility and seems to be heading toward balkanization.

Numerical Simulation of Bed Load and Suspended Load Sediment Transport Using Well-Balanced Numerical Schemes

Sediment transport can be modelled using hydrodynamic models based on shallow water equations coupled with the sediment concentration conservation equation and the bed con-servation equation.The complete system of equations is made up of the energy balance law and the Exner equations.The numerical solution for this complete system is done in a seg-regated manner.First,the hyperbolic part of the system of balance laws is solved using a finite volume scheme.Three ways to compute the numerical flux have been considered,the Q-scheme of van Leer,the HLLCS approximate Riemann solver,and the last one takes into account the presence of non-conservative products in the model.The discretisation of the source terms is carried out according to the numerical flux chosen.In the second stage,the bed conservation equation is solved by using the approximation computed for the system of balance laws.The numerical schemes have been validated making comparisons between the obtained numerical results and the experimental data for some physical experiments.The numerical results show a good agreement with the experimental data.

Feasibility and safety of autologous bone marrow mononuclear cell transplantation in patients with advanced chronic liver disease

AIM: To evaluate the safety and feasibility of bone marrow cell (BMC) transplantation in patients with chronic liver disease on the waiting list for liver transplantation. METHODS: Ten patients (eight males) with chronic liver disease were enrolled to receive infusion of autologous bone marrow-derived cells. Seven patients were classified as Child-Pugh B and three as Child-Pugh C. Baseline assessment included complete clinical and laboratory evaluation and abdominal MRI. Approximately 50 ml of bone marrow aspirate was prepared by centrifugation in a ficoll-hypaque gradient. At least of 100 millions of mononuclear-enriched BMCs were infused into the hepatic artery using the routine technique for arterial chemoembolization for liver tumors. Patients were followed up for adverse events up to 4 mo. RESULTS: The median age of the patients was 52 years (range 24-70 years). All patients were discharged 48 h after BMC infusion. Two patients complained ofmild pain at the bone marrow needle puncture site. No other complications or specific side effects related to the procedure were observed. Bilirubin levels were lower at 1 (2.19 ± 0.9) and 4 mo (2.10 ± 1.0) after cell transplantation that baseline levels (2.78 ± 1.2). Albumin levels 4 mo after BMC infusion (3.73 ± 0.5) were higher than baseline levels (3.47 ± 0.5). International normalized ratio (INR) decreased from 1.48 (SD = 0.23) to 1.43 (SD = 0.23) one month after cell transplantation. CONCLUSION: BMC infusion into hepatic artery of patients with advanced chronic liver disease is safe and feasible. In addition, a decrease in mean serum bilirubin and INR levels and an increase in albumin levels are observed. Our data warrant further studies in order to evaluate the effect of BMC transplantation in patients with advanced chronic liver disease.

Epidemiology, demographic characteristics and prognostic predictors of ulcerative colitis

Ulcerative colitis(UC)is a chronic disease characterized by diffuse inflammation of the mucosa of the colon and rectum.The hallmark clinical symptom of UC is bloody diarrhea.The clinical course is marked by exacerbations and remissions,which may occur spontaneously or in response to treatment changes or intercurrent illnesses.UC is most commonly diagnosed in late adolescence or early adulthood,but it can occur at any age.The incidence of UC has increased worldwide over recent decades,especially in developing nations.In contrast,during this period,therapeutic advances have improved the life expectancy of patients,and there has been a decrease in the mortality rate over time.It is important to emphasize that there is considerable variability in the phenotypic presentation of UC.Within this context,certain clinical and demographic characteristics are useful in identifying patients who tend to have more severe evolution of the disease and a poor prognosis.In this group of patients,better clinical surveillance and more intensive therapy may change the natural course of the disease.The aim of this article was to review the epidemiology and demographic characteristics of UC and the factors that may be associated with its clinical prognosis.

Thalidomide induces mucosal healing in Crohn's disease: Case report

Crohn's disease is a chronic inflammatory disorder of the gastrointestinal tract that is defi ned by relapsing and remitting episodes. Tumor necrosis factor alpha (TNF-α) appears to play a central role in the pathophysiology of the disease. Standard therapies for inflammatory bowel disease fail to induce remission in about 30% of patients. Biological therapies have been associated with an increased incidence of infections, especially infection by Mycobacterium tuberculosis (Mtb). Thalidomide is an oral immunomodulatory agent with anti-TNF-α properties. Recent studies have suggested that thalidomide is effective in refractory luminal and fistulizing Crohn's disease. Thalidomide costimulates T lymphocytes, with greater effect on CD8+ than on CD4+ T cells, which contributes to the protective immune response to Mtb infection. We present a case of Crohn's disease with gastric, ileal, colon and rectum involvement as well as steroid dependency, which progressed with loss of response to infliximabafter three years of therapy. The thorax computed tomography scan demonstrated a pulmonary nodule suspected to be Mtb infection. The patient was started on thalidomide therapy and exhibited an excellent response.

Re-visiting the mass-flux model for Explosive Reactive Armor and the effect of plate thickness

Explosive Reactive Armor was originally modeled under the assumption that the plates in the cassettes were very thin.Hence their thickness could be ignored,and the thicknesses of the plates were considered only based on their areal mass density.In particular,it was assumed that the jet-plate interaction was controlled by the plates to jet-mass-flux ratio criteria for a specific jet velocity and diameter.In the present study,we extended this analysis,examining the effect of the variation of the mass-flux along the jet on the disruption effect by the two plates.In addition,we examined the thickness effect of the plates on the plate's effectiveness,replacing the steel plates by low-density materials like aluminum and polycarbonate.The mass-flux model was adjusted to account for the plate-thickness effect.It was found that increasing the thickness of the plate,keeping the areal weight unchanged,slightly increases the overall effectiveness of the cassette,in particular by the forward moving plate interacting with the center and the slow parts of the jet.

Association of Helicobacter pylori infection and giardiasis: Results from a study of surrogate markers for fecal exposure among children

AIM: To investigate whether Helicobacter pylori (H pykori)infection is associated with hepatitis A virus (HAV) infection, presence of enteroparasites, and other surrogates of fecal exposure.METHODS: We conducted a cross-sectional study in 121 children consecutively admitted at a pediatric hospital inSalvador, Brazil.H pylori and HAV infection were identified by the presence of serum antibodies. Stool specimens were examined for the presence of ova and parasites. A structured questionnaire inquiring about sanitary conditions and life style was applied to each subject. RESULTS: Fifty-one of the 121 children (42.1%) werefound to be seropositive for H pylori, and 45 (37.2%) for HAV. The seroprevalence ofHpyloriand HAV both increased significantly with age. Cross-tabulation of data showed that 26 (21.5%) were seropositive and 51 (42.1%) were negative for bothHpyloriand HAV antibodies (χ2 = 7.18,OR = 2.8, CI 1.30-5.97). The age adjusted OR for an HAV-infected child being H pylori positive was 2.3 (CI1.02-5.03). The agreement between H pylori and HAVseropositivity was fair (κ = 0.24). After controlling for possible confounding, the variables remaining independently associated with seropositivity to H pyloriwere age,presence of Giardia lamblia in feces (OR = 3.2, 95%CI, 1.1-9.5) and poor garbage disposal quality (OR = 2.4,95%CI, 1.1-5.1).CONCLUSION: Our data suggest that H pylori infection is associated with surrogate markers of fecal exposure. Thus, we conclude that the fecal-oral route is relevant in the transmission of HP among children in an urban setting of a developing country. The association observed between G. lamblia and H pylori infection may have several explanations. Further studies to investigate this relationship are warranted.

Subaxial cervical spine injury classification system: is it most appropriate for classifying cervical injury?

The cervical spine injury represents a potential devastating disease with 6% associated in-hospital mortality （lain et al., 2015）. Neurological deterioration ranging from complete spinal cord injury （SCI） to incomplete SCI or single radiculopathy are potential consequences of the blunt trauma over this region. The subaxial cervical spine accounts the vast majority of cervical injuries, making up two thirds of all cervical fractures （Alday, 1996）. Few classifications （Holdsworth, 1970; White et al., 1975; Mien et al., 1982; Denis, 1984; Vaccaro et al., 2007） have been proposed to describe injuries of the cervical spine for several reasons. First, to delineate the best treatment in each case; second, to determinate an accurate neurological prognosis, and third, to establish a standard way to communicate and describe specific characteristics of cervical injuries patterns. Classical systems are primarily descriptive and no single system has gained widespread use, largely because of restrictions in clinical relevance and its complexity.

Western view of the management of gastroesophageal foreign bodies

The best modality for foreign body removal has beenthe subject of much controversy over the years.We have read with great interest the recent article by Souza Aguiar Municipal Hospital,Rio de Janeiro,Brazil,describing their experience with the management of esophageal foreign bodies in children.Non-endoscopic methods of removing foreign bodies(such as a Foley catheter guided or not by fluoroscopy)have been successfully used at this center.These methods could be an attractive option because of the following advantages:Shorter hospitalization time;easy to perform;no need for anesthesia;avoids esophagoscopy;and lower costs.However,the complications of these procedures can be severe and potentially fatal if not performed correctly,such as bronchoaspiration,perforation,and acute airway obstruction.In addition,it has some disadvantages,such as the inability to directly view the esophagus and the inability to always retrieve foreign bodies.Therefore,in Western countries clinical practice usually recommends endoscopic removal of foreign bodies under direct vision and with airway protection whenever possible.

Synchronic Duodenal Gastrointestinal Stromal Tumor and Neuroendocrine Tumor in Association with Neurofibromatosis Type 1: A Case Report

Introduction: The coexistence of synchronic duodenal gastrointestinal stromal tumor (GIST) and neuroendocrine tumor in a patient with neurofibromatosis type 1 (NF1) is extremely rare, and only eight cases were described in the literature. Clinical Case: This is a rare case of a 38-year-old female patient with NF1 who developed synchronic GIST and neuroendocrine tumor, which were both in the second portion of the duodenum. The first symptoms were abrupt digestive bleeding and anemia. Upper digestive endoscopy revealed two tumors, sizes 2.5 and 3.0 cm, in the second portion of duodenum, with biopsies identifying a GIST and a neuroendocrine tumor. Therapeutic decision was to proceed to surgical resection, and Whipple’s procedure was indicated. Surgical procedure was performed with good outcome. Currently the patient has excellent quality of life and maintains follow up for thirty months without recurrence. Discussion: Long-term disease-free survival and excellent quality of life are reported when these tumors are fully resected in this context. However, it is not always easy to access the gastrointestinal tract, especially the small intestine, and proceed to the histopathologic diagnosis of these tumors. Conclusion: It is important to be aware of the possibility of the coexistence of various tumors in the NF1 scenario for adequate screening, staging, and surgical treatment of these patients, as good prognosis can be achieved when such tumors are detected and treated properly.

The role of tangential velocity in explosive initiation by fragment impact

An initiation study is presented in which we examine the effect of the normal and the tangential velocity components of a fragment that impacts a covered and a bare Comp-B explosive. The study is based on calibrated numerical Lagrangian simulations using the LS-Dyna hydrocode. A special procedure was developed to present the estimated initiation point and the shock wave transition into detonation for various impact angles. The influence of the fragment strength and the steel cover thickness on the detonation threshold were also examined. The velocity threshold results are presented and used to modify the Jacobs-Roslund initiation model.