Antibiotic-associated diarrhea(AAD) and Clostridum difficile infections(CDI) have been well studied for adult cases, but not as well in the pediatric population. Whether the disease process or response to treatments d...Antibiotic-associated diarrhea(AAD) and Clostridum difficile infections(CDI) have been well studied for adult cases, but not as well in the pediatric population. Whether the disease process or response to treatments differs between pediatric and adult patients is an important clinical concern when following global guidelines based largely on adult patients. A systematic review of the literature using databases Pub Med(June 3, 1978-2015) was conducted to compare AAD and CDI in pediatric and adult populations and determine significant differences and similarities that might impact clinical decisions. In general, pediatric AAD and CDI have a more rapid onset of symptoms, a shorter duration of disease and fewer CDI complications(required surgeries and extended hospitalizations) than in adults. Children experience more community-associated CDI and are associated with smaller outbreaks than adult cases of CDI. The ribotype NAP1/027/BI is more common in adults than children. Children and adults share some similar risk factors, but adults have more complex risk factor profiles associated with more co-morbidities, types of disruptive factors and a wider range of exposures to C. difficile in the healthcare environment. The treatment of pediatric and adult AAD is similar(discontinuing or switching the inciting antibiotic), but other treatment strategies for AAD have not been established. Pediatric CDI responds better to metronidazole, while adult CDI responds better to vancomycin. Recurrent CDI is not commonly reported for children. Prevention for both pediatric and adult AAD and CDI relies upon integrated infection control programs, antibiotic stewardship and may include the use of adjunctive probiotics. Clinical presentation of pediatric AAD and CDI are different than adult AAD and CDI symptoms. These differences should be taken into account when rating severity of disease and prescribing antibiotics.展开更多
AIM: To evaluate the long-term effectiveness of colonic stents in colorectal tumors causing large bowel obstruction.METHODS: We retrospectively analyzed data from 49 patients with colorectal cancer who had undergone c...AIM: To evaluate the long-term effectiveness of colonic stents in colorectal tumors causing large bowel obstruction.METHODS: We retrospectively analyzed data from 49 patients with colorectal cancer who had undergone colorectal stent placement between January 2008 and January 2013. Patients' symptoms,characteristics and clinicopathological data were obtained by reviewing medical records. The obstruction was diagnosed clinically and radiologically. Histopathological diagnosis was achieved endoscopically. Technical success rate(TSR)was defined as the ratio of patients with correctly placed SEMS upon stent deployment across the entire stricture length to total number of patients. Clinical success rate(CSR) was defined as the ratio of patients with technical success and successful maintenance of stent function before elective surgery(regardless of number of SEMS deployed) to total number of patients. The surgical success rate(SSR) of colorectal stent as a bridge to surgery was defined as the ratio of patients with successful surgical procedures. Unsuccessful surgical outcomes were defined as being due to insufficient colonic decompression. The technical,clinical,surgical success rates and complications after stenting were assessed.RESULTS: The median age of patients was 64(36 to 89). 44.9% of patients were male and 55.1% were female. Eighteen patients had the obstruction located in the rectum,15 patients in the rectosigmoid region,10 patients in the sigmoid region,and 6 patients had a tumor causing obstruction in the proximal colon. Each patient was categorized pathologically as stage 2(32.7%,16 patients) or stage 3(42.9%,21 patients) and 12 patients(24.4%) had metastatic disease. None of the patients received chemotherapy before stenting. Stenting was undertaken in 37 patients as a bridge to surgery,and in 12 patients stents were used for palliation. Median time to surgery after stenting was 30 ± 91.9 d. All surgery was completed in one single operation and thus no colostomy with stoma was needed. The median overall survival rate of patients with stage 2-3 colorectal cancer was 53.1 mo and stage 4 was 37.1 mo(P = 0.04). Metastatic colorectal patients who were treated palliatively with stents had backbone chemotherapy with oxaliplatin and/or irinotecan-based regimens plus antiangiogenic therapies,especially bevacizumab. Resolution of the obstruction and clinical improvement was achieved in all patients. The technical,clinical and surgical success rates were 95.9%,100% and 94.6%,respectively.CONCLUSION: The efficacy and safety of colonic stents was demonstrated both as a bridge to surgery and for palliative decompression. In addition,results emphasize the importance of the skills of the endoscopist in colonic stenting.展开更多
Prognostic value of haematological indices,especially red cell distribution width,neutrophil lymphocyte ratio and mean platelet volume,was reported with numerous investigations in miscellaneous cardiovascular settings...Prognostic value of haematological indices,especially red cell distribution width,neutrophil lymphocyte ratio and mean platelet volume,was reported with numerous investigations in miscellaneous cardiovascular settings.Their major prognostic value was linked to oxidative stress and inflammation since their level was correlated with major inflammatory markers such as high sensitive C-reactive protein and interleukins.Oxidative stress and chronic inflammation are also postulated as the main pathophysiologic mechanism of essential hypertension(HT) and its vascular complication.Recently,correlation between HT and haematological parameters was searched in numerous studies,which has made the topic more popular.Herein,we reveal the correlation between haematological indices and HT and we also demonstrate the clinical implication of this correlation.Impaired haematological parameters may strongly indicate hypertensive end-organ damage.展开更多
Nonlinear response history analyses and use of strong ground motion data including near-field effects has become a common practice in both performance based design of tall buildings and design of base-isolated buildin...Nonlinear response history analyses and use of strong ground motion data including near-field effects has become a common practice in both performance based design of tall buildings and design of base-isolated buildings. On the other hand, ordinary buildings are commonly analysed via response spectrum analysis following the rules of conventional seismic codes, most of which do not take near-field effects into account. This study evaluates the necessity and the adequacy of near-source factors for ordinary fixed-base buildings that are not specifically classified as tall, by comparing dynamic responses of 3, 8, and 15-story benchmark buildings obtained via （1） linear time history analyses using 220 record components from 13 historical earthquakes and 45 synthetic earthquake records of different magnitudes and fault distances and （2） response spectrum analyses in accordance with the Turkish Earthquake Code 2007 -representing seismic codes not taking near-field effects into account- and the Uniform Building Code 1997 which takes near-field effects into account via near-source factors that amplify design response spectrum. It is shown that near-source factors are crucial for the safe design of not-so-tall ordinary fixed-base buildings but those defined in UBC97 may still not be adequate for those located in the vicinity of the fault.展开更多
The development and wide application of genetic transformation for cotton improvement are restrained by the unresolved problem of genotype dependence in regeneration in vitro.High embryogenic and regenerative potentia...The development and wide application of genetic transformation for cotton improvement are restrained by the unresolved problem of genotype dependence in regeneration in vitro.High embryogenic and regenerative potential have been obtained for limited number of Coker type genotypes。展开更多
Objective: The aim of the study is to compare the efficacy and safety of oral (100 μg) and vaginal (50 μg) misoprostol for labor induction. Study design: Ninety-nine patients with indications for labor induction ran...Objective: The aim of the study is to compare the efficacy and safety of oral (100 μg) and vaginal (50 μg) misoprostol for labor induction. Study design: Ninety-nine patients with indications for labor induction randomly received 100 μg oral misoprostol every 4 h or 50 μg vaginal misoprostol every 4 h, using maximum six doses. Mean induction to delivery interval, mode of delivery, rates of tachysystole, hypertonus and hyperstimulation syndrome, oxytocin use, number of doses used, failed induction rate and neonatal outcomes were compared for the two groups. Results: Mean dose of misoprostol used for oral and vaginal misoprostol groups were 2.17 ±1.35 and 1.91 ±0.94, respectively (p = 0.65). There were two failed inductions in the oral (4%) and one failed induction (2.5%) in the vaginal group after a total of six doses of misoprostol (p = 0.58). There was no significant difference for the mean induction to delivery interval, to the beginning of active phase interval, active phase dura-tion, second stage duration and the number of women who received oxytocin for induction or augmentation between the two groups (p >0.05). There were also no significant differences for intrapartum complications and neonatal outcomes between the oral and vaginal misoprostol groups (p >0.05). Conclusion: Our findings indicate that, in a closely supervised hospital setting with adequate monitoring, 100 μg oral misoprostol has the potential to induce labor as safely and effectively as its 50 μg vaginal analogue. As oral use of the drug is easier for both the patient and the doctor, oral misoprostol will probably be more preferable than the vaginal route.展开更多
文摘Antibiotic-associated diarrhea(AAD) and Clostridum difficile infections(CDI) have been well studied for adult cases, but not as well in the pediatric population. Whether the disease process or response to treatments differs between pediatric and adult patients is an important clinical concern when following global guidelines based largely on adult patients. A systematic review of the literature using databases Pub Med(June 3, 1978-2015) was conducted to compare AAD and CDI in pediatric and adult populations and determine significant differences and similarities that might impact clinical decisions. In general, pediatric AAD and CDI have a more rapid onset of symptoms, a shorter duration of disease and fewer CDI complications(required surgeries and extended hospitalizations) than in adults. Children experience more community-associated CDI and are associated with smaller outbreaks than adult cases of CDI. The ribotype NAP1/027/BI is more common in adults than children. Children and adults share some similar risk factors, but adults have more complex risk factor profiles associated with more co-morbidities, types of disruptive factors and a wider range of exposures to C. difficile in the healthcare environment. The treatment of pediatric and adult AAD is similar(discontinuing or switching the inciting antibiotic), but other treatment strategies for AAD have not been established. Pediatric CDI responds better to metronidazole, while adult CDI responds better to vancomycin. Recurrent CDI is not commonly reported for children. Prevention for both pediatric and adult AAD and CDI relies upon integrated infection control programs, antibiotic stewardship and may include the use of adjunctive probiotics. Clinical presentation of pediatric AAD and CDI are different than adult AAD and CDI symptoms. These differences should be taken into account when rating severity of disease and prescribing antibiotics.
文摘AIM: To evaluate the long-term effectiveness of colonic stents in colorectal tumors causing large bowel obstruction.METHODS: We retrospectively analyzed data from 49 patients with colorectal cancer who had undergone colorectal stent placement between January 2008 and January 2013. Patients' symptoms,characteristics and clinicopathological data were obtained by reviewing medical records. The obstruction was diagnosed clinically and radiologically. Histopathological diagnosis was achieved endoscopically. Technical success rate(TSR)was defined as the ratio of patients with correctly placed SEMS upon stent deployment across the entire stricture length to total number of patients. Clinical success rate(CSR) was defined as the ratio of patients with technical success and successful maintenance of stent function before elective surgery(regardless of number of SEMS deployed) to total number of patients. The surgical success rate(SSR) of colorectal stent as a bridge to surgery was defined as the ratio of patients with successful surgical procedures. Unsuccessful surgical outcomes were defined as being due to insufficient colonic decompression. The technical,clinical,surgical success rates and complications after stenting were assessed.RESULTS: The median age of patients was 64(36 to 89). 44.9% of patients were male and 55.1% were female. Eighteen patients had the obstruction located in the rectum,15 patients in the rectosigmoid region,10 patients in the sigmoid region,and 6 patients had a tumor causing obstruction in the proximal colon. Each patient was categorized pathologically as stage 2(32.7%,16 patients) or stage 3(42.9%,21 patients) and 12 patients(24.4%) had metastatic disease. None of the patients received chemotherapy before stenting. Stenting was undertaken in 37 patients as a bridge to surgery,and in 12 patients stents were used for palliation. Median time to surgery after stenting was 30 ± 91.9 d. All surgery was completed in one single operation and thus no colostomy with stoma was needed. The median overall survival rate of patients with stage 2-3 colorectal cancer was 53.1 mo and stage 4 was 37.1 mo(P = 0.04). Metastatic colorectal patients who were treated palliatively with stents had backbone chemotherapy with oxaliplatin and/or irinotecan-based regimens plus antiangiogenic therapies,especially bevacizumab. Resolution of the obstruction and clinical improvement was achieved in all patients. The technical,clinical and surgical success rates were 95.9%,100% and 94.6%,respectively.CONCLUSION: The efficacy and safety of colonic stents was demonstrated both as a bridge to surgery and for palliative decompression. In addition,results emphasize the importance of the skills of the endoscopist in colonic stenting.
文摘Prognostic value of haematological indices,especially red cell distribution width,neutrophil lymphocyte ratio and mean platelet volume,was reported with numerous investigations in miscellaneous cardiovascular settings.Their major prognostic value was linked to oxidative stress and inflammation since their level was correlated with major inflammatory markers such as high sensitive C-reactive protein and interleukins.Oxidative stress and chronic inflammation are also postulated as the main pathophysiologic mechanism of essential hypertension(HT) and its vascular complication.Recently,correlation between HT and haematological parameters was searched in numerous studies,which has made the topic more popular.Herein,we reveal the correlation between haematological indices and HT and we also demonstrate the clinical implication of this correlation.Impaired haematological parameters may strongly indicate hypertensive end-organ damage.
文摘Nonlinear response history analyses and use of strong ground motion data including near-field effects has become a common practice in both performance based design of tall buildings and design of base-isolated buildings. On the other hand, ordinary buildings are commonly analysed via response spectrum analysis following the rules of conventional seismic codes, most of which do not take near-field effects into account. This study evaluates the necessity and the adequacy of near-source factors for ordinary fixed-base buildings that are not specifically classified as tall, by comparing dynamic responses of 3, 8, and 15-story benchmark buildings obtained via （1） linear time history analyses using 220 record components from 13 historical earthquakes and 45 synthetic earthquake records of different magnitudes and fault distances and （2） response spectrum analyses in accordance with the Turkish Earthquake Code 2007 -representing seismic codes not taking near-field effects into account- and the Uniform Building Code 1997 which takes near-field effects into account via near-source factors that amplify design response spectrum. It is shown that near-source factors are crucial for the safe design of not-so-tall ordinary fixed-base buildings but those defined in UBC97 may still not be adequate for those located in the vicinity of the fault.
文摘The development and wide application of genetic transformation for cotton improvement are restrained by the unresolved problem of genotype dependence in regeneration in vitro.High embryogenic and regenerative potential have been obtained for limited number of Coker type genotypes。
文摘Objective: The aim of the study is to compare the efficacy and safety of oral (100 μg) and vaginal (50 μg) misoprostol for labor induction. Study design: Ninety-nine patients with indications for labor induction randomly received 100 μg oral misoprostol every 4 h or 50 μg vaginal misoprostol every 4 h, using maximum six doses. Mean induction to delivery interval, mode of delivery, rates of tachysystole, hypertonus and hyperstimulation syndrome, oxytocin use, number of doses used, failed induction rate and neonatal outcomes were compared for the two groups. Results: Mean dose of misoprostol used for oral and vaginal misoprostol groups were 2.17 ±1.35 and 1.91 ±0.94, respectively (p = 0.65). There were two failed inductions in the oral (4%) and one failed induction (2.5%) in the vaginal group after a total of six doses of misoprostol (p = 0.58). There was no significant difference for the mean induction to delivery interval, to the beginning of active phase interval, active phase dura-tion, second stage duration and the number of women who received oxytocin for induction or augmentation between the two groups (p >0.05). There were also no significant differences for intrapartum complications and neonatal outcomes between the oral and vaginal misoprostol groups (p >0.05). Conclusion: Our findings indicate that, in a closely supervised hospital setting with adequate monitoring, 100 μg oral misoprostol has the potential to induce labor as safely and effectively as its 50 μg vaginal analogue. As oral use of the drug is easier for both the patient and the doctor, oral misoprostol will probably be more preferable than the vaginal route.
