26
|
Li KX, Wu QB, Zhao FQ, Zhang JL, Luo SL, Hu SD, Wu B, Li HL, Lin GL, Qiu HZ, Lu JY, Xu L, Wang Z, Du XH, Kang L, Wang X, Wang ZQ, Liu Q, Xiao Y. [Development and validation of a prognostic prediction model for patients with stage Ⅰ to Ⅲ colon cancer incorporating high-risk pathological features]. ZHONGHUA WAI KE ZA ZHI [CHINESE JOURNAL OF SURGERY] 2023; 61:753-759. [PMID: 37491167 DOI: 10.3760/cma.j.cn112139-20230403-00137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Objective: To examine a predictive model that incorporating high risk pathological factors for the prognosis of stage Ⅰ to Ⅲ colon cancer. Methods: This study retrospectively collected clinicopathological information and survival outcomes of stage Ⅰ~Ⅲ colon cancer patients who underwent curative surgery in 7 tertiary hospitals in China from January 1, 2016 to December 31, 2017. A total of 1 650 patients were enrolled, aged (M(IQR)) 62 (18) years (range: 14 to 100). There were 963 males and 687 females. The median follow-up period was 51 months. The Cox proportional hazardous regression model was utilized to select high-risk pathological factors, establish the nomogram and scoring system. The Bootstrap resampling method was utilized for internal validation of the model, the concordance index (C-index) was used to assess discrimination and calibration curves were presented to assess model calibration. The Kaplan-Meier method was used to plot survival curves after risk grouping, and Cox regression was used to compare disease-free survival between subgroups. Results: Age (HR=1.020, 95%CI: 1.008 to 1.033, P=0.001), T stage (T3:HR=1.995,95%CI:1.062 to 3.750,P=0.032;T4:HR=4.196, 95%CI: 2.188 to 8.045, P<0.01), N stage (N1: HR=1.834, 95%CI: 1.307 to 2.574, P<0.01; N2: HR=3.970, 95%CI: 2.724 to 5.787, P<0.01) and number of lymph nodes examined (≥36: HR=0.438, 95%CI: 0.242 to 0.790, P=0.006) were independently associated with disease-free survival. The C-index of the scoring model (model 1) based on age, T stage, N stage, and dichotomous variables of the lymph nodes examined (<12 and ≥12) was 0.723, and the C-index of the scoring model (model 2) based on age, T stage, N stage, and multi-categorical variables of the lymph nodes examined (<12, 12 to <24, 24 to <36, and ≥36) was 0.726. A scoring system was established based on age, T stage, N stage, and multi-categorical variables of lymph nodes examined, the 3-year DFS of the low-risk (≤1), middle-risk (2 to 4) and high-risk (≥5) group were 96.3% (n=711), 89.0% (n=626) and 71.4% (n=313), respectively. Statistically significant difference was observed among groups (P<0.01). Conclusions: The number of lymph nodes examined was an independent prognostic factor for disease-free survival after curative surgery in patients with stage Ⅰ to Ⅲ colon cancer. Incorporating the number of lymph nodes examined as a multi-categorical variable into the T and N staging system could improve prognostic predictive validity.
Collapse
|
27
|
Xiao Y, Miao Z, Sun J, Xing W, Wei Y, Bai J, Ye H, Si Y, Cai L. Allisartan Isoproxil Promotes Uric Acid Excretion by Interacting with Intestinal Urate Transporters in Hyperuricemic Zebrafish (Danio rerio). Bull Exp Biol Med 2023; 175:638-643. [PMID: 37853267 DOI: 10.1007/s10517-023-05917-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Indexed: 10/20/2023]
Abstract
To evaluate the urate-lowering effect and potential drug targets of antihypertensive agent allisartan isoproxil (ALI) and its bioactive metabolite EXP3174, we developed an acute hyperuricemic zebrafish model using potassium oxonate and xanthine sodium salt. Losartan potassium served as the positive control (reference drug). In this model, ALI and losartan potassium exerted a greater urate-lowering effect than EXP3174 indicating that the latter is not the critical substance for elimination of uric acid. The quantitative real-time PCR showed that ALI upregulates the expression of intestinal urate transporters genes ABCG2, PDZK1, and SLC2A9 (p<0.01). Thus, we can suggest that this substance promotes uric acid excretion mainly by interacting with intestinal urate transporters.
Collapse
|
28
|
Zhao FQ, Zhou L, Du XH, Wu AW, Yang H, Xu L, Liu XZ, Hu SD, Xiao Y, Liu Q. [Analysis of prognosis and influencing factors of No. 253 lymph node metastasis in descending colon, sigmoid colon, and rectal cancer: a multicenter study]. ZHONGHUA WAI KE ZA ZHI [CHINESE JOURNAL OF SURGERY] 2023; 61:760-767. [PMID: 37491168 DOI: 10.3760/cma.j.cn112139-20230331-00132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Objectives: To analyze the influencing factors of No. 253 lymph node metastasis in descending colon cancer, sigmoid colon cancer, and rectal cancer, and to investigate the prognosis of No. 253 lymph node-positive patients by propensity score matching analysis. Methods: A retrospective analysis was performed on clinical data from patients with descending colon cancer, sigmoid colon cancer, rectosigmoid junction cancer, and rectal cancer who underwent surgery between January 2015 and December 2019 from the Cancer Hospital of the Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Peking Union Medical College Hospital, General Hospital of the Chinese People's Liberation Army, and Peking University Cancer Hospital. A total of 3 016 patients were included according to inclusion and exclusion criteria, comprising 1 848 males and 1 168 females, with 1 675 patients aged≥60 years and 1 341 patients aged<60 years. Clinical and pathological factors from single center data were subjected to univariate analysis to determine influencing factors of No. 253 lymph node metastasis, using a binary Logistic regression model. Based on the results of the multivariate analysis, a nomogram was constructed. External validation was performed using data from other multicenter sources, evaluating the effectiveness through the area under the receiver operating characteristic curve and the calibration curve. Using data from a single center, the No. 253 lymph node-positive group was matched with the negative group in a 1∶2 ratio (caliper value=0.05). Survival analysis was performed using the Kaplan-Meier method and Log-rank test. The Cox proportional hazards model was used to determine independent prognostic factors. Results: (1) The tumor diameter≥5 cm (OR=4.496,95%CI:1.344 to 15.035, P=0.015) T stage (T4 vs. T1: OR=11.284, 95%CI:7.122 to 15.646, P<0.01), N stage (N2 vs. N0: OR=60.554, 95%CI:7.813 to 469.055, P=0.043), tumor differentiation (moderate vs. well differentiated: OR=1.044, 95%CI:1.009 to 1.203, P=0.044; poor vs. well differentiated: OR=1.013, 95%CI:1.002 to 1.081, P=0.013), tumor location (sigmoid colon vs. descending colon: OR=9.307, 95%CI:2.236 to 38.740, P=0.002), pathological type (mucinous adenocarcinoma vs. adenocarcinoma: OR=79.923, 95%CI:15.113 to 422.654, P<0.01; signet ring cell carcinoma vs. adenocarcinoma: OR=27.309, 95%CI:4.191 to 177.944, P<0.01), and positive vascular invasion (OR=3.490, 95%CI:1.033 to 11.793, P=0.044) were independent influencing factors of No. 253 lymph node metastasis. (2) The area under the curve of the nomogram prediction model was 0.912 (95%CI: 0.869 to 0.955) for the training set and 0.921 (95%CI: 0.903 to 0.937) for the external validation set. The calibration curve demonstrated good consistency between the predicted outcomes and the actual observations. (3) After propensity score matching, the No. 253 lymph node-negative group did not reach the median overall survival time, while the positive group had a median overall survival of 20 months. The 1-, 3- and 5-year overall survival rates were 83.9%, 61.3% and 51.6% in the negative group, and 63.2%, 36.8% and 15.8% in the positive group, respectively. Multivariate Cox analysis revealed that the T4 stage (HR=3.067, 95%CI: 2.357 to 3.990, P<0.01), the N2 stage (HR=1.221, 95%CI: 0.979 to 1.523, P=0.043), and No. 253 lymph node positivity (HR=2.902, 95%CI:1.987 to 4.237, P<0.01) were independent adverse prognostic factors. Conclusions: Tumor diameter ≥5 cm, T4 stage, N2 stage, tumor location in the sigmoid colon, adverse pathological type, poor differentiation, and vascular invasion are influencing factors of No. 253 lymph node metastasis. No. 253 lymph node positivity indicates a poorer prognosis. Therefore, strict dissection for No. 253 lymph node should be performed for colorectal cancer patients with these high-risk factors.
Collapse
|
29
|
Zhang HQ, Wang ST, Sun Z, Lin GL, Wu B, Niu BZ, Lu JY, Xu L, Xiao Y. [Analysis of influencing factors and clinical value of anterior peritoneal reflection for patients with rectal cancer]. ZHONGHUA WAI KE ZA ZHI [CHINESE JOURNAL OF SURGERY] 2023; 61:788-794. [PMID: 37491172 DOI: 10.3760/cma.j.cn112139-20230408-00149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Objectives: To investigate the factors influencing the height of anterior peritoneal reflection (APR) for patients with rectal cancer, and to analyze the relationship between the APR and the lateral lymph node metastasis. Methods: Clinical data of 432 patients with tumor located within and below APR were retrospectively collected from the rectal cancer database at the Department of General Surgery, Peking Union Medical College Hospital from August 2020 to September 2022. Ninty-eight non-rectal cancer patients were also enrolled as a control group. There were 308 males and 124 females in the tumor group, aged (M(IQR)) 62 (16) years (range: 24 to 85 years) and 53 males and 45 females in the control group, aged 60 (22) years (range: 27 to 87 years). The APR height, pelvis, and tumor-related parameters were measured by MRI. A multifactor linear regression model was established to analyze the dependent correlation factors of APR height. These factors of the two groups were matched by propensity score matching and their APR heights were compared after matching. An ordinal Logistic regression model was established to explore the relationship between APR-related parameters and radiographic lateral lymph node metastasis. Results: The APR height of the tumor group was (98.7±14.4) mm (range: 43.3 to 154.0 mm) and the control group was (95.1±12.7) mm (range: 68.0 to 137.9 mm). Multivariable linear regression revealed that the greater the weight (B=0.519, 95%CI: 0.399 to 0.640, P<0.01), the anterior pelvic depth (B=0.109, 95%CI: 0.005 to 0.213, P=0.039) and the smaller the bi-ischial diameter (B=-0.172, 95%CI:-0.294 to -0.049, P=0.006), the higher the APR height. The tumor group had a higher APR height than the control group after propensity score matching ((98.3±14.2) mm vs. (95.1±12.7) mm, t=-1.992, P=0.047). Ordinal Logistic regression indicated that the longer segment of the tumor invade the nonperitoneal rectum was an independent influencing factor of radiographic lateral lymph node metastasis (OR=1.016, 95%CI: 1.002 to 1.030, P=0.021), while the distance between the anal verge and the tumor was not (OR=0.986, 95%CI: 0.972 to 1.000, P=0.058). Conclusions: The higher the weight, the deeper and narrower the pelvis, the higher the APR height. There is a certain relationship between APR and lateral lymph node metastasis on imaging.
Collapse
|
30
|
Wang YX, Luo JM, Huang R, Xiao Y. [Continuous positive airway pressure therapy affects the recurrence of atrial fibrillation in patients with obstructive sleep apnea: a systematic review and meta-analysis]. ZHONGHUA JIE HE HE HU XI ZA ZHI = ZHONGHUA JIEHE HE HUXI ZAZHI = CHINESE JOURNAL OF TUBERCULOSIS AND RESPIRATORY DISEASES 2023; 46:751-759. [PMID: 37536985 DOI: 10.3760/cma.j.cn112147-20230213-00064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Objective: A higher incidence of atrial fibrillation is associated with obstructive sleep apnea. The effects of continuous positive airway pressure on atrial fibrillation have been studied in observational studies and randomized controlled trials. We therefore conducted this meta-analysis to assess the effect of continuous positive airway pressure on the recurrence of atrial fibrillation after radiofrequency ablation. Methods: A comprehensive search was conducted in Pubmed, Embase, Cochrane, Web of Science, Wanfang Data and CNKI databases from inception to October 2022. We included cohort studies and randomized controlled trials containing atrial fibrillation situation after catheter ablation with and without continuous positive airway pressure therapy. The random effects model was used to assess odds ratios (OR) and confidence intervals (CI). I2 was used to assess the heterogeneity. Results: Eight studies with a total of 1 395 patients with obstructive sleep apnea met the inclusion criteria. Continuous positive airway pressure therapy decreased atrial fibrillation recurrence by 61% (OR=0.392, 95%CI: 0.267-0.576, I2=37.6%). Subgroup analysis showed that the protective effect was more significant in groups with more hypertension patients (OR=0.272 vs. 0.550, 95%CI: 0.165-0.449 vs. 0.329-0.922). Conclusions: Continuous positive airway pressure therapy reduces the recurrence rate of atrial fibrillation. Patients with hypertension are more likely to benefit from it.
Collapse
|
31
|
Xiao Y, Tao JJ, Busse FH. Instabilities of rotating inclined buoyancy layers. Phys Rev E 2023; 108:025102. [PMID: 37723670 DOI: 10.1103/physreve.108.025102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/20/2023] [Indexed: 09/20/2023]
Abstract
The boundary layer near a cooled inclined plate, which is immersed in a stably stratified fluid rotating about an axis parallel to the direction of gravity, is a model for katabatic flows at high latitudes. In this paper the base flow of such an inclined buoyancy layer is solved analytically for arbitrary Prandtl numbers. By applying linear stability analyses, five unstable modes are identified for both the fixed temperature and the isoflux boundary conditions, i.e., the stationary longitudinal roll (LR) mode, the oblique roll with low streamwise wave-number (OR-1) and high streamwise wave-number (OR-2) modes, and the Tolmien-Schlichting (TS) wave with low streamwise wave-number (TS-1) and high streamwise wave-number (TS-2) modes. It is indicated that the Coriolis effect induced by the rotation leads the critical modes to be three dimensional, and a larger tilt angle of the plate and stronger Coriolis effect cause both TS wave modes to be more unstable for both thermal boundary conditions. When the Coriolis effect is considered, the OR-1 and OR-2 modes are the most unstable mode at low and high tilt angles, respectively, but the TS-1 wave mode may be the most unstable one when the plate is nearly vertical. In addition, the spanwise phase velocities of the TS wave modes change directions as the tilt angle passes some threshold values for both thermal boundary conditions except for the TS-1 wave mode with a fixed temperature boundary condition, which propagates in the same spanwise direction for all explored tilt angles.
Collapse
|
32
|
Agley J, Xiao Y. Low trust in science may foster belief in misinformation by aligning scientifically supported and unsupported statements. Perspect Public Health 2023; 143:199-201. [PMID: 37589323 DOI: 10.1177/17579139221136722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
|
33
|
Xiao Y, Sun Z, Sun R, Hou WY, Xu L, Lu JY. [Safety and feasibility of right colectomy via a transvaginal approach: early experience from a single center]. ZHONGHUA WEI CHANG WAI KE ZA ZHI = CHINESE JOURNAL OF GASTROINTESTINAL SURGERY 2023; 26:588-594. [PMID: 37583013 DOI: 10.3760/cma.j.cn441530-20221020-00422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Objective: To investigate the safety and feasibility of performing right colectomy via a transvaginal approach. Methods: This was a retrospeltive cohort study. Data of 30 patients who had undergone transvaginal laparoscopic right colectomy (transvaginal group) and 23 women who had undergone laparoscopic right colectomy (laparoscopic group) from January 2019 to March 2022 in the Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital were collected retrospectively. The inclusion criteria for the transvaginal group were as follows: (1) post-menopausal woman; (2) transverse diameter of the tumor < 6 cm; and (3) diagnosis of benign polyps that were unresectable by endoscopy, mucinous tumors of the appendix, or confirmed right colon cancer not requiring D3 lymphadenectomy. The inclusion criteria for the laparoscopic group were as follows: (1) pathologically confirmed adenocarcinoma or high-grade intraepithelial neoplasia; (2) lesion located from the cecum to the right third of the transverse colon; and (3) clinically stage T1-4NanyM0. The exclusion criteria for the laparoscopic group were as follows: (1) distant metastasis discovered during surgical exploration; (2) multiple organ resection required or R0 resection not possible; or (3) conversion to open surgery required. Safety was evaluated on the basis of intra- and post-operative complications. Feasibility was assessed by postoperative recovery and quality of operative specimen. The body mass index was lower in the transvaginal than the laparoscopic group (22.0±3.1 kg/m2 vs. 24.1±2.6 kg/m2, t=2.617, P=0.012). Results: Among the 30 transvaginal laparoscopic right colectomies, 26 were pure transvaginal surgeries, three required laparoscopic assistance because of difficulties with anastomosis (n=2) or abdominal adhesions (n=1), and one required conversion to laparoscopic surgery because of vascular injury. Compared with the laparoscopic group, the transvaginal group had a longer surgery time (175.0 [147.5, 216.3] minutes vs. 120.0 [100.0, 120.0] minutes, U=63.000, P<0.001) and more blood loss (30.0 [10.0, 50.0] ml vs. 23.0 [10.0, 20.0] ml, U=208.000, P=0.011). The incidence of intraoperative complications (16.7% [5/30) vs. 0, P=0.061] was comparable between the two groups. In the transvaginal group, the sites of intraoperative injuries were bladder (n=3), ileocecal artery (n=1), and right uterine artery (n=1). The incidence of postoperative complications (20.0% [6/30] vs. 17.4% [4/23], χ2<0.001,P>0.999) was also comparable between the two groups. Clavien-Dindo grade III postoperative complications occurred in two patients in the transvaginal group (one patient had a pelvic hematoma that required embolization; the other had a vesico-vaginal fistula that required surgery). Postoperative visual analogue scale scores were significantly lower (P<0.001) in the transvaginal group. Times to first flatus, ambulation, and first intake and duration of postoperative hospital stay were comparable between the two groups (P>0.05). The proportion of specimens of moderate quality was 83.3% (25/30) in the transvaginal group and 100% (23/23) in the laparoscopic group; this difference is not significant (P=0.061). Among patients who underwent D2 lymph node dissection, the number of lymph nodes examined was comparable between the transvaginal (n=23) and laparoscopic groups (n=7) (18 [15, 27] vs. 20 [16, 29], U=69.500, P=0.589). Conclusion: Transvaginal right colon surgery is associated with less postoperative pain than laparoscopic surgery, but is not yet the preferred alternative because of the incidence of surgical complications.
Collapse
|
34
|
Luo JM, Xiao Y. [Advances in patient-centered medical care for the management of obstructive sleep apnea]. ZHONGHUA NEI KE ZA ZHI 2023; 62:733-736. [PMID: 37263961 DOI: 10.3760/cma.j.cn112138-20220607-00438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|
35
|
Li F, Wan J, Zhai ZG, Xie WM, Gao Y, Liu DT, Dou RY, Guo W, Xiao Y, Zhu GF. [Clinical features and CT findings of fibrosing mediastinitis associated pulmonary hypertension]. ZHONGHUA JIE HE HE HU XI ZA ZHI = ZHONGHUA JIEHE HE HUXI ZAZHI = CHINESE JOURNAL OF TUBERCULOSIS AND RESPIRATORY DISEASES 2023; 46:460-465. [PMID: 37147807 DOI: 10.3760/cma.j.cn112147-20220912-00754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Objective: To investigate the clinical features and CT findings of pulmonary hypertension (PH) in patients with fibrosing mediastinitis (FM). Methods: Thirteen patients with FM diagnosed between September 2015 and June 2022 were studied retrospectively, including patients with PH (FM-PH group) and patients without PH (FM group) confirmed on right heart catheterization. The t test of two independent samples, Mann-Whitney U rank sum and Fisher's test were used to compare the general information, symptoms, laboratory examination, right ventricular and pulmonary artery measurement data and pulmonary artery CT findings between the two groups, respectively. Results: Compared with the 7 FM patients aged 28-79 (60.00±17.69) years, the 6 patients in the FM-PH group, aged from 60 to 82 (68.83±8.35) years, had more peripheral edema, lower percentage of PaO2, wider inner diameters of pulmonary artery and right ventricle, a higher ratio of right ventricle and left ventricular transverse diameter, faster tricuspid regurgitation velocity and higher estimated systolic pulmonary artery pressure (P<0.05). There were no differences in BNP levels and tricuspid annular plane systolic excursion between groups (P>0.05). Of the 6 patients with PH, 5 had precapillary PH and 1 had mixed PH. Except that the pulmonary vascular resistance in patients of the FM-PH group was significantly higher than that in the FM group (P<0.05), there were no significant differences in cardiac output, mixed venous oxygen saturation and pulmonary capillary wedge pressure between the two groups. CT pulmonary angiography (CTPA) showed pulmonary artery and vein stenosis. Patients in the FM-PH group had more severe stenosis and occlusion of pulmonary artery and pulmonary vein (P<0.05), and more involvement of multiple pulmonary veins (P<0.05). Conclusions: The clinical manifestation of FM complicated with PH is related to the degree of involvement of pulmonary artery, vein and airway. It is recommended that the disease be evaluated in combination with multiple parameters such as clinical manifestations, cardiac ultrasound, right cardiac catheter and CTPA.
Collapse
|
36
|
Ding YJ, Xiao Y. Nonperturbative approach to magnetic response of an isolated nanoring in a strongly anharmonic confinement. Sci Rep 2023; 13:6235. [PMID: 37069241 PMCID: PMC10110570 DOI: 10.1038/s41598-023-33544-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 04/14/2023] [Indexed: 04/19/2023] Open
Abstract
It is a huge challenge in both classical and quantum physics to solve analytically the equation of motion in a strongly anharmonic confinement. For an isolated nanoring, we propose a continuous and bounded potential model, which patches up the disadvantages of the usual square-well and parabolic potentials. A fully nonlinear and nonperturbative approach is developed to solve analytically the equation of motion, from which various frequency shifts and dynamic displacements are exactly derived by an order-by-order self-consistent method. A series of new energy levels and new energy states are found, indicating an alternative magnetic response mechanism. In nominally identical rings, especially, we observe a diamagnetic-paramagnetic transition in the period-halving Φ0/2-current with Φ0 the flux quantum and a large increase in the Φ0-current at least one order of magnitude, which explain well the experimental observations. This work opens a new way to solve the strong or weak nonlinear problems.
Collapse
|
37
|
Hu YJ, Xiao Y, Dong SJ, Zhao JY, Li H, Yang DJ, Dong YP, Xu J, Li FQ. [Antimicrobial resistance and plasmid-mediated colistin resistance mechanism of diarrheagenic Escherichia coli recovered from foods in parts of China in 2020]. ZHONGHUA YU FANG YI XUE ZA ZHI [CHINESE JOURNAL OF PREVENTIVE MEDICINE] 2023; 57:557-565. [PMID: 37032165 DOI: 10.3760/cma.j.cn112150-20220427-00422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Objective: To investigate the antimicrobial resistance of food-borne diarrheagenic Escherichia coli (DEC) and the prevalence of mcr genes that mediates mobile colistin resistance in parts of China, 2020. Methods: For 91 DEC isolates recovered from food sources collected from Fujian province, Hebei province, Inner Mongolia Autonomous Region and Shanghai city in 2020, Vitek2 Compact biochemical identification and antimicrobial susceptibility testing platform was used for the detection of antimicrobial susceptibility testing (AST) against to 18 kinds of antimicrobial compounds belonging to 9 categories, and multi-polymerase chain reaction (mPCR) was used to detect the mcr-1-mcr-9 genes, then a further AST, whole genome sequencing (WGS) and bioinformatics analysis were platformed for these DEC isolates which were PCR positive for mcr genes. Results: Seventy in 91 isolates showed different antimicrobial resistance levels to the drugs tested with a resistance rate of 76.92%. The isolates showed the highest antimicrobial resistance rates to ampicillin (69.23%, 63/91) and trimethoprim-sulfamethoxazole (59.34%, 54/91), respectively. The multiple drug-resistant rate was 47.25% (43/91). Two mcr-1 gene and ESBL (extended-spectrum beta-lactamase) positive EAEC (enteroaggregative Escherichia coli) strains were detected. One of them was identified as serotype of O11:H6, which showed a resistance profile to 25 tested drugs referring to 10 classes, and 38 drug resistance genes were predicted by genome analysis. The other one was O16:H48 serotype, which was resistant to 21 tested drugs belonging to 7 classes and carried a new variant of mcr-1 gene (mcr-1.35). Conclusion: An overall high-level antimicrobial resistance was found among foodborne DEC isolates recovered from parts of China in 2020, and so was the MDR (multi-drug resistance) condition. MDR strains carrying multiple resistance genes such as mcr-1 gene were detected, and a new variant of mcr-1 gene was also found. It is necessary to continue with a dynamic monitoring on DEC contamination and an ongoing research into antimicrobial resistance mechanisms.
Collapse
|
38
|
Chiang A, Salomonsen RB, Wang A, Holland R, Cai L, Xiao Y, Sadow S, Davey K, Iyengar P. 168P Demographics, clinical characteristics, treatment (tx) patterns and clinical outcomes for patients (pts) with limited-stage SCLC (LS-SCLC). J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00422-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
|
39
|
Xiao Y, Li S, May G, Teshima C, Mosko J. A126 ASSESSING THE QUALITY OF REFERRALS AND ADJUDICATION FOR ENDOSCOPIC RESECTION OF LARGE COLORECTAL POLYPS AT A CANADIAN TERTIARY REFERRAL CENTRE. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991395 DOI: 10.1093/jcag/gwac036.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Management of large colorectal polyps is increasingly complex with the expansion of endoscopic techniques, including endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and endoscopic full thickness resection. Adjudicating lesions in an effort to select the optimal resection method is hugely dependent on the information included within the referral. At our institution, a referral pathway based on photo and/or video documentation was created to facilitate the timely assessment and treatment of large colorectal polyps. To date, little is known about quality of referrals for endoscopic resection of large colorectal polyps. Purpose Our study aimed to assess the adjudication process and quality of referrals for endoscopic resection of large colorectal polyps at our advanced endoscopy referral center. Method We conducted a single-center prospective study of consecutive colorectal polyps referred for EMR from March 2021 to March 2022. Cases selected upfront for ESD were excluded. Referral information, intraprocedural data and histology was captured. No procedural and histology data were captured if EMR does not occur after adjudication. The outcome was defined as the frequency of adequate referrals. A referral was deemed adequate if it contained: sufficient photo or video documentation, description of any characteristics that increase the difficulty of endoscopic resection, accurate polyp localization/size estimate (with <1 cm discrepancy when compared to real-time endoscopic evaluation), and description of any endoscopic features of advanced dysplasia (AD), including HGD/IMCa, or submucosal invasion (SMI). Result(s) During the study period, 213 referrals were received for colorectal polyps and underwent adjudication for EMR: 211 underwent EMR; 2 underwent ESD despite being triaged for EMR. Only 5% (10/213) of referrals were deemed to be adequate. Only 34% (73/213) contained any photo or video documentation and only 13% (28/213) photos/videos were of sufficient quality for adjudication. Difficult location or polyp characteristics, if present, were accurately described in 86.7% of referrals (183/211) of referrals. The accurate polyp location was described 80.6% of the time (170/211). Polyp size was estimated in 50.2% (107/213) of referrals. Amongst referrals with size estimated, the size was accurate in 73.8% of the time (79/107). On histological evaluation, 35.1% (74/211) of polyps had AD or SMI. Amongst polyps with AD or SMI, 48.6% (36/74) had endoscopic appearance suggestive of HGD/IMCa/SMI but only 69.4% (25/36) of these polyps with high-risk endoscopic features were accurately predicted based on the referral information. Conclusion(s) Referrals for large colorectal polyps often lack important clinical information. This significantly impairs the ability to adjudicate polyps for triage and resection and may negatively impact patient outcomes. To improve referral adequacy and patient outcomes, we plan to evaluate the impact of polyp adjudication on EMR success. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
Collapse
|
40
|
Wu JY, Xu B, Zhu XJ, Ming X, Luo H, Mao X, Gu J, Zhou JF, Xiao Y. [PD-1 inhibitor in chronic active Epstein-Barr virus infection: a report of six cases and literature review]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:165-168. [PMID: 36948875 PMCID: PMC10033261 DOI: 10.3760/cma.j.issn.0253-2727.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
|
41
|
Su LF, Xiao Y. [Annual review of sleep-disordered breathing in 2022]. ZHONGHUA JIE HE HE HU XI ZA ZHI = ZHONGHUA JIEHE HE HUXI ZAZHI = CHINESE JOURNAL OF TUBERCULOSIS AND RESPIRATORY DISEASES 2023; 46:182-186. [PMID: 36740381 DOI: 10.3760/cma.j.cn112147-20221031-00860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In the past year, some important progress has been made in the field of sleep medicine, especially in the diagnosis, classification, evaluation, complications, and individualized treatment of obstructive sleep apnea (OSA). This article briefly introduced the latest progress and research results in the field of sleep medicine at home and abroad from 1st October 2021 to 30th September 2022, hoping to provide more ideas on the diagnosis and treatment of OSA and future research directions.
Collapse
|
42
|
Acero MA, Adamson P, Aliaga L, Anfimov N, Antoshkin A, Arrieta-Diaz E, Asquith L, Aurisano A, Back A, Baird M, Balashov N, Baldi P, Bambah BA, Bashar S, Bays K, Bernstein R, Bhatnagar V, Bhattarai D, Bhuyan B, Bian J, Booth AC, Bowles R, Brahma B, Bromberg C, Buchanan N, Butkevich A, Calvez S, Carroll TJ, Catano-Mur E, Childress S, Chatla A, Chirco R, Choudhary BC, Christensen A, Coan TE, Colo M, Cremonesi L, Davies GS, Derwent PF, Ding P, Djurcic Z, Dolce M, Doyle D, Dueñas Tonguino D, Dukes EC, Ehrlich R, Elkins M, Ewart E, Feldman GJ, Filip P, Franc J, Frank MJ, Gallagher HR, Gandrajula R, Gao F, Giri A, Gomes RA, Goodman MC, Grichine V, Groh M, Group R, Guo B, Habig A, Hakl F, Hall A, Hartnell J, Hatcher R, Hausner H, He M, Heller K, Hewes V, Himmel A, Jargowsky B, Jarosz J, Jediny F, Johnson C, Judah M, Kakorin I, Kaplan DM, Kalitkina A, Keloth R, Klimov O, Koerner LW, Kolupaeva L, Kotelnikov S, Kralik R, Kullenberg C, Kubu M, Kumar A, Kuruppu CD, Kus V, Lackey T, Lang K, Lasorak P, Lesmeister J, Lin S, Lister A, Liu J, Lokajicek M, Lopez JMC, Mahji R, Magill S, Manrique Plata M, Mann WA, Manoharan MT, Marshak ML, Martinez-Casales M, Matveev V, Mayes B, Messier MD, Meyer H, Miao T, Mikola V, Miller WH, Mishra S, Mishra SR, Mislivec A, Mohanta R, Moren A, Morozova A, Mu W, Mualem L, Muether M, Mulder K, Naples D, Nath A, Nayak N, Nelleri S, Nelson JK, Nichol R, Niner E, Norman A, Norrick A, Nosek T, Oh H, Olshevskiy A, Olson T, Ott J, Pal A, Paley J, Panda L, Patterson RB, Pawloski G, Petrova O, Petti R, Phan DD, Plunkett RK, Pobedimov A, Porter JCC, Rafique A, Prais LR, Raj V, Rajaoalisoa M, Ramson B, Rebel B, Rojas P, Roy P, Ryabov V, Samoylov O, Sanchez MC, Sánchez Falero S, Shanahan P, Shukla S, Sheshukov A, Singh I, Singh P, Singh V, Smith E, Smolik J, Snopok P, Solomey N, Sousa A, Soustruznik K, Strait M, Suter L, Sutton A, Swain S, Sweeney C, Sztuc A, Talaga RL, Tapia Oregui B, Tas P, Temizel BN, Thakore T, Thayyullathil RB, Thomas J, Tiras E, Tripathi J, Trokan-Tenorio J, Torun Y, Urheim J, Vahle P, Vallari Z, Vasel J, Vrba T, Wallbank M, Warburton TK, Wetstein M, Whittington D, Wickremasinghe DA, Wieber T, Wolcott J, Wu W, Xiao Y, Yaeggy B, Yallappa Dombara A, Yankelevich A, Yonehara K, Yu S, Yu Y, Zadorozhnyy S, Zalesak J, Zhang Y, Zwaska R. Measurement of the ν_{e}-Nucleus Charged-Current Double-Differential Cross Section at ⟨E_{ν}⟩=2.4 GeV Using NOvA. PHYSICAL REVIEW LETTERS 2023; 130:051802. [PMID: 36800478 DOI: 10.1103/physrevlett.130.051802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/13/2022] [Accepted: 11/08/2022] [Indexed: 06/18/2023]
Abstract
The inclusive electron neutrino charged-current cross section is measured in the NOvA near detector using 8.02×10^{20} protons-on-target in the NuMI beam. The sample of GeV electron neutrino interactions is the largest analyzed to date and is limited by ≃17% systematic rather than the ≃7.4% statistical uncertainties. The double-differential cross section in final-state electron energy and angle is presented for the first time, together with the single-differential dependence on Q^{2} (squared four-momentum transfer) and energy, in the range 1 GeV≤E_{ν}<6 GeV. Detailed comparisons are made to the predictions of the GENIE, GiBUU, NEUT, and NuWro neutrino event generators. The data do not strongly favor a model over the others consistently across all three cross sections measured, though some models have especially good or poor agreement in the single differential cross section vs Q^{2}.
Collapse
|
43
|
Cui J, Bai Y, Xiao Y, Wang J, Yin S, Wang J. Metabolic diseases and kidney stone risk, a Mendelian randomization study. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00430-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
44
|
Cui J, Xiao Y, Yin S, Wang J, Bai Y, Wang J. The association between circadian syndrome and the prevalence of kidney stones in overweight Americans aged ≥20 years old: A cross-sectional analysis of NHANES 2007-2018. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00428-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
45
|
Cui J, Xiao Y, Wang J, Bai Y, Yin S, Wang J. Association between high-density lipoprotein and kidney stones in Americans aged ≥20 years old: A cross-sectional analysis of NHANES 2007-2018. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00427-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
46
|
Ma YN, Lin LL, Zhang Y, Li L, Wu HR, Xiao Y, Pan H, Yang YL, Qi Y. [The study of mitochondrial disorder pedigree associated with FASTKD2 variants and uniparental disomy]. ZHONGHUA YI XUE ZA ZHI 2023; 103:171-177. [PMID: 36649987 DOI: 10.3760/cma.j.cn.112137-20220808-01708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objective: To analyse the genetic cause of a proband with mitochondrial disease caused by FASTKD2 gene variation and uniparental disomy. Methods: Detailed medical history of a child suspected "mitochondrial disease" were inquired in Peking University First Hospital on November 23, 2017. c.810_820dup homozygous variation in FASTKD2 gene was found by high-throughput sequencing, and her mother had heterozygous variation, but her father didn't have such variation, which didn't conform to the genetic law of variation. Further clinical examinations and molecular genetic tests were carried out. The venous blood of the child and her parents was drawn, and genomic DNA was extracted. Sanger sequencing, polymerase chain reaction (PCR) testing, short tandem repeat (STR) analysis, chromosome microarray analysis and loss of heterozygosity (LOH) genetic relationship analysis were performed on the proband and the parents to determine the variation. Results: The clinical manifestations, physical examination and laboratory examination of the child supported the diagnosis of mitochondrial disease. c.810_820dup(p.Ser274Phefs*8) homozygous variant in FASTKD2 gene was identified. Sanger sequencing indicated that the mother was a heterozygote of the variant, while the father had no such variation, which did not conform to the genetic law. PCR testing and Sanger sequencing review to eliminate sampling errors, PCR amplification and sequencing errors. Non-biological father was excluded by STR analysis. Three large segmental LOH of FASTKD2 gene were found by chromosome microarray analysis, then the LOH relative analysis verified the child was a mixed maternal uniparental disomy of chromosome 2. The child was diagnosed as mitochondrial disease caused by oxidative phosphorylation coupling defect of type 44. Conclusions: In this study, an autosomal recessive mitochondrial disease which does not conform to the genetic law was found, and it was confirmed that this mitochondrial disease family had both pathogenic variation and uniparental disomy phenomenon. It was diagnosed as mitochondrial disease caused by type 44 oxidative phosphorylation coupling defect.
Collapse
|
47
|
Bian D, Li X, Xiao Y, Song K, Wang L, Shen J, Aimaiti M, Ma X, Shi C, Li G. Relationship between Social Support, Sarcopenia, and Cognitive Impairment in Chinese Community-Dwelling Older Adults. J Nutr Health Aging 2023; 27:726-733. [PMID: 37754212 DOI: 10.1007/s12603-023-1973-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/24/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Cognitive impairment and sarcopenia have become important challenges for the growing aging population. Social support has been shown to protect against cognitive impairment, but its impact on sarcopenia remains unknown. The purpose of this study was to explore the correlation between social support, sarcopenia, and cognitive impairment in Chinese older adults. METHOD A multi-stage whole group sampling method was used to conduct a cross-sectional survey of 720 community-dwelling older people in Shanghai. The definition of sarcopenia was in accordance with the criteria of the Asian Working Group for Sarcopenia (AWGS) 2019. Cognitive impairment was evaluated using a computerized neuropsychological assessment device that had been previously validated. Social support was assessed using the Social Support Rate Scale. Logistic regression analyses were conducted to explore the relationship between social support cognitive impairment and sarcopenia, fully adjusting for all potential confounding factors. RESULTS Our study found that 230 (31.94%) of the participants had cognitive impairment and 97 (13.47%) of the participants had sarcopenia. The mean social support score was 35.10 ± 7.54. Besides, the results showed that cognitive impairment was associated with sarcopenia (OR:1.650, 95% CI: 1.048, 2.596, P=0.030) after adjusting for confounding factors. Older adults with high level social support had the lowest risk of cognitive impairment (OR: 0.297, 95% CI: 0.115, 0.680, P=0.021) and sarcopenia (OR: 0.113, 95% CI: 0.031, 0.407, P=0.001), respectively. CONCLUSION Our analysis revealed that high level social support was negatively associated with sarcopenia and cognitive impairment. These findings provide strong support for the health promotion effect of social networks against sarcopenia and cognitive impairment in Chinese community-dwelling older adults, with important implications for healthcare policy makers.
Collapse
|
48
|
Sun Z, Hou WY, Liu JJ, Xue HD, Xu PR, Wu B, Lin GL, Xu L, Lu JY, Xiao Y. [Predictive value of MRI pelvic measurements for "difficult pelvis" during total mesorectal excision]. ZHONGHUA WEI CHANG WAI KE ZA ZHI = CHINESE JOURNAL OF GASTROINTESTINAL SURGERY 2022; 25:1089-1097. [PMID: 36562232 DOI: 10.3760/cma.j.cn441530-20211220-00513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: Total mesorectal resection (TME) is difficult to perform for rectal cancer patients with anatomical confines of the pelvis or thick mesorectal fat. This study aimed to evaluate the ability of pelvic dimensions to predict the difficulty of TME, and establish a nomogram for predicting its difficulty. Methods: The inclusion criteria for this retrospective study were as follows: (1) tumor within 15 cm of the anal verge; (2) rectal cancer confirmed by preoperative pathological examination; (3) adequate preoperative MRI data; (4) depth of tumor invasion T1-4a; and (5) grade of surgical difficulty available. Patients who had undergone non-TME surgery were excluded. A total of 88 patients with rectal cancer who underwent TME between March 2019 and November 2021 were eligible for this study. The system for scaling difficulty was as follows: Grade I, easy procedure, no difficulties; Grade II, difficult procedure, but no impact on specimen quality (complete TME); Grade III, difficult procedure, with a slight impact on specimen quality (near-complete TME); Grade IV: very difficult procedure, with remarkable impact on specimen quality (incomplete TME). We classified Grades I-II as no surgical difficulty and grades III-IV as surgical difficulty. Pelvic parameters included pelvic inlet length, anteroposterior length of the mid-pelvis, pelvic outlet length, pubic tubercle height, sacral length, sacral depth, distance from the pubis to the pelvic floor, anterior pelvic depth, interspinous distance, and inter-tuberosity distance. Univariate and multivariate logistic regression analyses were performed to identify the factors associated with the difficulty of TME, and a nomogram predicting the difficulty of the procedure was established. Results: The study cohort comprised 88 patients, 30 (34.1%) of whom were classified as having undergone difficult procedures and 58 (65.9%) non-difficult procedures. The median age was 64 years (56-70), 51 patients were male and 64 received neoadjuvant therapy. The median pelvic inlet length, anteroposterior length of the mid-pelvis, pelvic outlet length, pubic tubercle height, sacral length, sacral depth, distance from the pubis to the pelvic floor, anterior pelvic depth, interspinous distance, and inter-tuberosity distance were 12.0 cm, 11.0 cm, 8.6 cm, 4.9 cm, 12.6 cm, 3.7 cm, 3.0 cm, 13.3 cm, 10.2 cm, and 12.2 cm, respectively. Multivariable analyses showed that preoperative chemoradiotherapy (OR=4.97,95% CI: 1.25-19.71, P=0.023), distance between the tumor and the anal verge (OR=1.31, 95% CI: 1.02-1.67, P=0.035) and pubic tubercle height (OR=3.36, 95% CI: 1.56-7.25, P=0.002) were associated with surgical difficulty. We then built and validated a predictive nomogram based on the above three variables (AUC = 0.795, 95%CI: 0.696-0.895). Conclusion: Our research demonstrated that our system for scaling surgical difficulty of TME is useful and practical. Preoperative chemoradiotherapy, distance between tumor and anal verge, and pubic tubercle height are risk factors for surgical difficulty. These data may aid surgeons in planning appropriate surgical procedures.
Collapse
|
49
|
Peters S, Salomonsen RB, Tattersfield R, Wang A, Xiao Y, Cai L, Sadow S, Jassim R, Liu S. 107P Outcomes of patients with metastatic non-small cell lung cancer (mNSCLC) receiving first-line (1L) immunotherapy (IO) with or without chemotherapy (CT): Real-world (RW) evidence vs clinical trial results - CORRELATE. IMMUNO-ONCOLOGY AND TECHNOLOGY 2022. [DOI: 10.1016/j.iotech.2022.100211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
50
|
Wu ZN, Xiao Y, Wang YD. [New recognition of portal vein thrombosis mechanism and treatment in cirrhosis]. ZHONGHUA GAN ZANG BING ZA ZHI = ZHONGHUA GANZANGBING ZAZHI = CHINESE JOURNAL OF HEPATOLOGY 2022; 30:1280-1284. [PMID: 36891712 DOI: 10.3760/cma.j.cn501113-20220322-00131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Portal vein thrombosis (PVT) is one of the common complications of cirrhosis, which induces or aggravates ascites and upper gastrointestinal bleeding and even impacts the difficulty of liver transplantation by raising portal pressure, hence deteriorating the prognosis of patients. With the revelation of PVT-related research findings in recent years, the recognition of its mechanism and clinical risks has deepened. This article reviews the latest progress in PVT formation mechanisms and treatment strategies to improve clinicians' recognition of the pathogenesis and aid in formulating reasonable prevention and treatment.
Collapse
|