摘要： Objective: Microprolactinomas are currently treated with dopamine agonists. Outcome information on microprolactinoma patients treated by surgery is limited. This study reports the first large series of consecutive noninvasive microprolactinoma patients treated by pituitary surgery and evaluates the efficiency and safety of this treatment. Design: Follow-up of a cohort of consecutive patients treated by surgery. Methods: Between January 2008 and October 2020, 114 adult patients with pure microprolactinomas were operated on in a single tertiary expert neurosurgical department, using an endoscopic endonasal transsphenoidal approach. Eligible patients presented with a microprolactinoma with no obvious cavernous invasion on MRI. Prolactin was assayed before and after surgery. Disease-free survival was modeled using Kaplan-Meier representation. A cox regression model was used to predict remission. Results: Median follow-up was 18.2 months (range: 2.8-155). In this cohort, 14/114 (12%) patients were not cured by surgery, including ten early surgical failures and four late relapses occurring 37.4 months (33-41.8) after surgery. From Kaplan-Meier estimates, 1-year and 5-year disease free survival was 90.9% (95% CI: 85.6-96.4%) and 81% (95% CI: 71.2-92.1%) respectively. The preoperative prolactinemia was the only significant preoperative predictive factor for remission (P < 0.05). No severe complication was reported, with no anterior pituitary deficiency after surgery, one diabetes insipidus, and one postoperative cerebrospinal fluid leakage properly treated by muscle plasty. Conclusions: In well-selected microprolactinoma patients, pituitary surgery performed by an expert neurosurgical team is a valid first-line alternative treatment to dopamine agonists.

关键词： hepatitis B   liver   chronic liver disease  

摘要： Regulation of alternative splicing is one of the most efficient mechanisms to enlarge the proteomic diversity in eukaryotic organisms. Many viruses hijack the splicing machinery following infection to accomplish their replication cycle. Regarding the HBV, numerous reports have described alternative splicing events of the long viral transcript (pregenomic RNA), which also acts as a template for viral genome replication. Alternative splicing of HBV pregenomic RNAs allows the synthesis of at least 20 spliced variants. In addition, almost all these spliced forms give rise to defective particles, detected in the blood of infected patients. HBV-spliced RNAs have long been unconsidered, probably due to their uneasy detection in comparison to unspliced forms as well as for their dispensable role during viral replication. However, recent data highlighted the relevance of these HBV-spliced variants through (1) the trans-regulation of the alternative splicing of viral transcripts along the course of liver disease;(2) the ability to generate defective particle formation, putative biomarker of the liver disease progression;(3) modulation of viral replication;and (4) their intrinsic propensity to encode for novel viral proteins involved in liver pathogenesis and immune response. Altogether, tricky regulation of HBV alternative splicing may contribute to modulate multiple viral and cellular processes all along the course of HBV-related liver disease.

关键词： tenotomy   elbow   fracture   approach   intra-articular  

摘要： Intra-articular fractures of the distal humerus present challenges to treating physician and patient alike. The olecranon osteotomy is accepted as the standard exposure for intra-articular distal humerus fractures;nevertheless, complications such as nonunion and implant prominence are common. In this article, we describe the clinical outcomes and anatomic features of the triceps tenotomy as an alternative method of exposure for internal fixation of intra-articular distal humerus fractures. The olecranon osteotomy approach affords greater exposure of the distal humerus articular surface;however, there was no difference in quality of fracture reduction, progression to fracture union, posttraumatic arthrosis, or implant failure between approaches in our series. The osteotomy approach resulted in a greater need for reoperation (15% vs. 46%, respectively);largely as a result of olecranon implant-related complications. In summary, the triceps tenotomy offers an alternative exposure for intra-articular distal humerus fracture fixation with comparable clinical outcomes to the olecranon osteotomy technique.

关键词： Charging Station   Dlc   Phev   Gams   Incentive   Optimization  

摘要： Optimal participation of charging stations is considered to increase the performance of smart grids. During the implementation of the direct load control (DLC) demand response program (DRP), the optimal distribution of plug-in hybrid electric vehicles (PHEVs) from primary charging stations (PCSs) to alternative or secondary charging stations (SCSs) could alleviate congestion of charging stations, power lines, and traffic of paths. To this end, the optimal economic dispatch of charging stations during the self-healing period in three proposed managerial modes, including 1) equal-economic optimization (EEO), 2) economic optimization (EO), and 3) priority-economic optimization (PEO) has been performed. The results show the maximum reduction in incentive costs for the operating company and taken times for customers. Execution of operations in urban areas, the ability to be combined with electricity grid constraints, and attention to the responsiveness of SCSs are other advantages. The project optimizations and calculations with numerical experiments based on Gams solution approach are performed.

关键词： Aviation Fuel   Kinematic Viscosity   Pressure Swirl Atomizer   Combustion Chambers   Gas Turbine Engines   Aviation   Pilot   Discharge Coefficient   Alternative Fuels   Static Pressure  

摘要： The spray characteristics of standard and alternative aviation fuels created by a hybrid pressure-swirl airblast (HPSA) atomizer were investigated at conditions corresponding to engine cold start for an aviation gas turbine. Drop size and drop velocity of sprays from three different fuels, Jet-A (A-2), JP-5 (A-3), and a JP-5/farnesane blend (C-3) were investigated using a phase Doppler anemometry. The spatially resolved drop measurements were obtained at three axial locations downstream of the swirler exit plane and up to 30 mm in the radial direction from the spray centerline. Smaller D-10, D-32, and MMD were observed when increasing the pressure drop across the atomizer swirler (Delta P/P). Increasing Delta P/P also increased the mean axial velocity. No definitive trend was observed with viscosity on drop size, while liquid-gas surface tension showed a weak correlation with drop size due to its small variation in value among fuels. The spray unsteadiness was examined using interparticle arrival time distribution functions. A semi-empirical model was also developed using a phenomenological three-step model for the atomization process of the HPSA atomizer and was used to predict drop-size values at engine cold-start conditions in this work and near lean blowout conditions presented in earlier work.

关键词： Second generation tyrosine kinase inhibitor   Dasatinib   Nilotinib   Chronic phase chronic myeloid leukemia   Chronic myeloid leukemia   Switch  

摘要： While second generation tyrosine kinase inhibitors (2GTKIs) are highly effective therapies for chronic myeloid leukemia (CML), a significant minority of patients who initiate a 2GTKI will require a switch to an alternative TKI. The long-term outcomes of those who require a change in therapy after front-line 2GTKI therapy are largely undescribed. Here we describe the clinical outcomes associated with switch to an alternative TKI after first-line therapy with a 2GTKI. Of 232 patients who initiated a 2GTKI during the study period, 76 (33 %) switched to an alternative TKI. Reasons for switching included intolerance (79 %) and resistance (21 %). Among the 60 patients who switched due to intolerance, 53 (88 %) were able to achieve or maintain a major molecular response (MMR) with 5-year progression-free survival (PFS) 90.5 % (95 % CI 90.4-90.6 %). Amongst the 16 patients who switched due to resistance, 8 patients (50 %) were able to achieve MMR with 5-year PFS 80.4 % (95 % CI 80.2-80.6 %). Most patients who switched due to intolerance remained on their second-line TKI. Approximately 25 % of patients who initiate first-line 2GTKI in a real world setting will ultimately switch to an alternate TKI due to intolerance. Patients who switch for intolerance continue to enjoy excellent clinical outcomes.

关键词： Coronavirus disease 2019   MIS-C   Mesenchymal stem cell   Exosomes  

摘要： Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new type of coronavirus causing coronavirus 2019 (COVID-19) that was first observed in Wuhan, China, in Dec. 2019. An inflammatory immune response targeting children appeared during the pandemic, which was associated with COVID-19 named multisystem inflammatory syndrome in children (MIS-C). Characteristics of MIS-C include the classic inflammation findings, multi-organ dysfunction, and fever as the cardinal feature. Up to now, no specific therapy has been identified for MIS-C. Currently, considerable progress has been obtained in the MIS-C treatment by cell therapy, specially Mesenchymal stem cells (MSCs). Unique properties have been reported for MSCs, such as various resources for purification of cell, high proliferation, self-renewal, non-invasive procedure, tissue regenerator, multidirectional differentiation, and immunosuppression. As indicated by a recent clinical research, MSCs have the ability of reducing disease inflammation and severity in children with MIS-C. In the present review study, the benefits and characteristics of MSCs and exosomes are discussed for treating patients with MIS-C.

关键词： alternative medicine   complementary medicine   epidemiology  

摘要： Objective The aim of the study was to determine the prevalence and types of complementary and alternative medicine (CAM) use among pediatric emergency department (ED) patients and perceptions of CAM among the caregivers who administer CAM in Singapore. Methods A survey was administered in a Singapore ED (June 2016-June 2017). A convenience sample of parents/carers accompanying pediatric patients completed a self-administered questionnaire. The primary outcome measures were prevalence of CAM use and perceptions of CAM. Results Parents/carers of 610 patients participated. Four hundred seventy-five (78.0%, 95% confidence interval, 74.5-81.0) had taken a CAM within the previous 12 months and 110 (18.1%;95% confidence interval, 14.8-21.0) had taken a CAM on the day of presentation. There were no sex differences between CAM users and nonusers (P = 0.691). The use of CAM was more common among preschool children and younger (62.9%). There was no difference in CAM use among those with and without chronic disease (P = 0.878). Vitamins/supplements, cod liver oil, and probiotics were the most commonly used CAM. A total of 0.7% of CAM use was reported to the ED doctor. There were no adverse effects reported. The perception that CAMs are safe was more common among parents or caregivers who had administered CAM (P = 0.008). Conclusions Complementary and alternative medicine use is very common among pediatric ED patients in Singapore and is more prevalent than in Australia and the United Kingdom. However, it is not always reported to the doctor. Parents or caregivers who administer CAM are more likely to perceive CAMs to be safe.

关键词： Frequency-droop control   Frequency regulation   Operating reserve   Rotor speed control  

摘要： This paper proposes a frequency-droop control scheme for wind turbines using rotor speed control. The control scheme is proposed as a better alternative to conventional frequency-droop control techniques. When conventional frequency-droop control is used, the frequency response produced by the wind turbine is dependent on the method of power tracking employed. When power tracking is achieved using torque control, the wind turbine's frequency response is limited to short duration responses, even when operating reserve is available via de-loaded power tracking. This means that reserves cannot be fully utilised. When power tracking is achieved using power signal feedback, conventional frequency-droop methods under-deliver on the expected frequency-droop response due to rotor deceleration during frequency response. The proposed control scheme is unaffected by rotor deceleration and the method of power tracking employed as primary frequency regulation is achieved by varying the wind turbine's power tracking curve, rather than adding droop control signals to the wind turbine's power tracking reference. The effectiveness of the control scheme is validated through simulations using DIgSILENT PowerFactory. The results show that the control scheme produces the same frequency regulating response in wind turbines that achieve power tracking using torque control as those that use power signal feedback. This is an improvement on conventional frequency-droop control techniques and will improve the consistency and predictability of frequency regulating services procured from wind farms.

关键词： Psoas muscle index   Sarcopenia   Asian population   Trauma  

摘要： Background Sarcopenia has been shown to be an independent negative predictor in various diseases. The measurement of pre-defined criteria of skeletal muscle in patients with acute disease is usually unavailable. Therefore, we evaluate the psoas muscle area based on computed tomography (CT) imaging as an alternative for sarcopenia in an Asian trauma population. Methods 939 trauma patients were enrolled and had CT imaging performed primarily for trauma indications. The cross-sectional area of psoas muscle at the base of the fourth lumbar vertebral was measured on these CTs. Psoas muscle index (PMI) was calculated and analyzed to determine sex-specific cut-off values to define the "extremely low psoas muscle index" (ELPMI) group. Results Psoas muscle index was significantly higher in males (1065.09 +/- 230.51 mm(2)/m(2) in males vs 719.57 +/- 147.39 mm(2)/m(2) in females, p < 0.001) and decreased gradually with aging (p < 0.001). PMI of the subset of patients aged 18-40 (n = 462) weas analyzed to determine sex-specific cut-off values for ELPMI. PMI cut-off values for ELPMI (2 SD below mean) were 675 mm(2)/m(2) for males and 490 mm(2)/m(2) for females. The entire trauma cohort was further analyzed, and ELPMI was identified as an independent risk factor for a longer length of intensive unit stay (beta coefficient = 3.881, p = 0.011). Conclusion Data from young trauma adults were used to establish cut-off values for ELPMI, which is a longer ICU stay predictor. These cut-off values for ELPMI may apply to other acute disease entities.