AIM： To determine factors associated with fibrosis progression in hepatitis C virus （HCV）-infected patients without significant initial pathological lesions. METHODS： Seventy six untreated ...HCV-infected patients with initially normal liver as defined by a Knodell score ≤ 3, with 2 liver biopsies and detectable HCVRNA were included. Markers of fibrosis progression were assessed. RESULTS： Median duration of infection and time between paired biopsies was 13 （95% CI： 1-28） and 4 （95% CI： 2-16） years respectively. Alaninetransaminase （ALT） activity was normal in 43.4% of cases. 50% demonstrated progression of the necroinflammation and 34% of fibrosis after a median time evolution of 4 years （95% CI： 2-16）. The median difference in the necro-inflammation and fibrosis score between biopsies was low, 1.5 and 0.0 respectively. Univariate analysis showed there was no difference between fibrosis activity or evolution according to genotype or viral load. A higher fibrosis progression （P = 0.03） was observed in patients with body mass index （BMI） 〉 25. Fibrosis progression correlated with the time interval between biopsies （P = 0.01）. A significant progression of activity （1.7 vs 0.4, P 〈 0.05） or fibrosis （0.9 vs 0.0, P 〈 0.01） was observed in patients with elevated ALT. There was a significant correlation between activity progression and fibrosis progression（P = 0.003）. Multivariate analysis demonstrated that fibrosis progression was associated with elevated ALT, BMI 〉 25 and the time interval between 2 biopsies. CONCLUSION： There is no fibrosis progression in 66% of patients without significant initial histopathological lesion. Fibrosis progression is associated with elevated ALT and BMI 〉 25.
A case report, focused on vasopressor use and presented in this article, is likely to resonate with many critical care nurses. In this article the authors describe opportunities to enhance safety ...with vasopressor therapy. Specifically, the goal of improving communication among physicians, nurses, and pharmacists around desired endpoints for vasopressor therapy, triggers for reassessment of the therapeutic strategy and cause of the patient's shock was identified as an area for improvement. A form piloted within an organization for use during multidisciplinary rounds and key findings is shared. Vasopressors constitute the mainstay of therapy for nearly every hemodynamically unstable patient in critical care. It is hoped that the lessons and information shared help empower critical care nurses to facilitate vasopressor stewardship within their facilities and, ultimately, enhance patient safety.
A case report, focused on vasopressor use and presented in this article, is likely to resonate with many critical care nurses. In this article the authors describe opportunities to enhance safety ...with vasopressor therapy. Specifically, the goal of improving communication among physicians, nurses, and pharmacists around desired endpoints for vasopressor therapy, triggers for reassessment of the therapeutic strategy and cause of the patients shock was identified as an area for improvement. A form piloted within an organization for use during multidisciplinary rounds and key findings is shared. Vasopressors constitute the mainstay of therapy for nearly every hemodynamically unstable patient in critical care. It is hoped that the lessons and information shared help empower critical care nurses to facilitate vasopressor stewardship within their facilities and, ultimately, enhance patient safety.
Untargeted metabolomic measurements using mass spectrometry are a powerful tool for uncovering new small molecules with environmental and biological importance. The small molecule identification ...step, however, still remains an enormous challenge due to fragmentation difficulties or unspecific fragment ion information. Current methods to address this challenge are often dependent on databases or require the use of nuclear magnetic resonance (NMR), which have their own difficulties. The use of the gas-phase collision cross section (CCS) values obtained from ion mobility spectrometry (IMS) measurements were recently demonstrated to reduce the number of false positive metabolite identifications. While promising, the amount of empirical CCS information currently available is limited, thus predictive CCS methods need to be developed. In this article, we expand upon current experimental IMS capabilities by predicting the CCS values using a deep learning algorithm. We successfully developed and trained a prediction model for CCS values requiring only information about a compound’s SMILES notation and ion type. The use of data from five different laboratories using different instruments allowed the algorithm to be trained and tested on more than 2400 molecules. The resulting CCS predictions were found to achieve a coefficient of determination of 0.97 and median relative error of 2.7% for a wide range of molecules. Furthermore, the method requires only a small amount of processing power to predict CCS values. Considering the performance, time, and resources necessary, as well as its applicability to a variety of molecules, this model was able to outperform all currently available CCS prediction algorithms.
Concilier le sujet et la structure dans l'interprétation, revoir le rôle de la subjectivité en tenant compte des acquis du structuralisme, telle est la tâche que se propose Manfred Frank. Cherchant à ...nouer le dialogue entre l'herméneutique existentiale et le positivisme plus ou moins affirmé des tenants de la pensée française et anglaise du langage, il décèle une ouverture possible chez les néo-structuralistes; la notion de «différence» chez Derrida, entre autres, semble requérir un principe actif au sein de la structure, même s'il reste innomé. A partir d'une lecture renouvelée de Schleiermacher, chez qui apparaît déjà l'idée si actuelle de la primauté du signifiant, on retrouverait la subjectivité s'incarnant dans la structure dont elle reste radicalement dépendante en même temps qu'elle la crée. C'est le langage qui est le lieu où se noue «le général individuel» et s'accomplit le Je, dont la présence ne peut jamais être totalement maîtrisée; c'est pourquoi la différence est, pour Derrida, l'originant de toute origine. Cependant la différence elle-même présuppose une certaine présence comme source du sens des déterminations; il s'agirait d'une «conscience pré-réflexive», sans dédoublement représentatif, un événement simple, immédiat, anonyme, que la philosophie a appelé «être», berceau de l'intentionnalité. A-t-on pour autant surmonté l'idéalisme et la pétition de principe qu'il entraîne? Le Même de l'être et de la pensée est toujours à penser. The task that Manfred Frank sets out to accomplish is that of reconciling subject and structure in interpretation and reviewing the rôle of subjectivity while taking into account the achievements of structuralism. While seeking to establish a dialogue between «existential» hermeneutics and the more or less pronounced positivism of the champions of the French and English thought on language, he perceives a possible opening in neostructuralism; the notion of «difference» in Derrida, for example, seems to require an active principle within structure, even it remains unnamed. On the basis of a revised reading of Schleiermacher, who had already reached the concept of the primacy of the signifier that is of such importance at the present time, it is possible to find subjectivity embedded in structure, on which it remains radically dependent while at the same time creating it. Language is the place where «the general individual» is met and where the «I» is accomplished, the presence of which can never be totally mastered; this is why the «difference» for Derrida is the originator of every origin. However, the «difference» itself presupposes a certain presence as the source of the meanings of its determinations; it appears that this is a «prereflexive consciousness», without a representative undoubling, a simple, immediate, anonymous event, which philosophy has called «being», the cradle of intentionality. Have we, however, overcome idealism and the petitio principii which it entails? The Same in being and in thought has always to be thought.
It is generally accepted that the low quality of soil carbon limits the amount of energy available for soil microorganisms, and in turn the rate of soil carbon mineralization. The priming effect, ...i.e. the increase in soil organic matter (SOM) decomposition rate after fresh organic matter input to soil, is often supposed to result from a global increase in microbial activity due to the higher availability of energy released from the decomposition of fresh organic matter. Work to date, however, suggests that supply of available energy induces no effect on SOM mineralization. The mechanisms of the priming effect are much more complex than commonly believed. The objective of this review was to build a conceptual model of the priming effect based on the contradictory results available in the literature adopting the concept of nutritional competition. After fresh organic matter input to soils, many specialized microorganisms grow quickly and only decompose the fresh organic matter. We postulated that the priming effect results from the competition for energy and nutrient acquisition between the microorganisms specialized in the decomposition of fresh organic matter and those feeding on polymerised SOM.
It is commonly predicted that the intensity of primary production and soil carbon (C) content are positively linked. Paradoxically, many long‐term field observations show that although plant litter ...is incorporated to soil in large quantities, soil C content does not necessarily increase. These results suggest that a negative relationship between C input and soil C conservation exists. Here, we demonstrate in controlled conditions that the supply of fresh C may accelerate the decomposition of soil C and induce a negative C balance. We show that soil C losses increase when soil microbes are nutrient limited. Results highlight the need for a better understanding of microbial mechanisms involved in the complex relationship between C input and soil C sequestration. We conclude that energy available to soil microbes and microbial competition are important determinants of soil C decomposition.
Objective:
Seizure is the presenting symptom in most of World Health Organization grade II gliomas (GIIGs). Rarely, a GIIG is discovered incidentally on imaging. Little is known about the natural ...course and prognosis of incidental GIIGs. The aim of the present study is to characterize their natural history and to investigate whether their clinical and radiological behaviors differ from those of symptomatic GIIGs.
Methods:
The clinical and radiological findings, treatments, and outcomes of 47 histologically‐proven incidental GIIGs were compared with those of 1249 symptomatic GIIGs.
Results:
Incidental GIIGs differ significantly from symptomatic GIIGs: they have a female predominance (p = 0.05), smaller initial tumor volumes (p < 0.001), lower incidence of contrast enhancement (p = 0.009), and are more likely to undergo gross total surgical removal (p < 0.001). Proliferation rates were similar to that observed among symptomatic GIIGs. Younger age at the time of discovery, frontal lobes, and noneloquent brain regions were associated with incidental GIIGs, as compared to their symptomatic counterparts. When not treated, incidental GIIGs demonstrated radiological growth (median velocity of diametric expansion at 3.5 mm/year), and became symptomatic at a median interval of 48 months after radiological discovery. Overall, incidental discovery was associated with a significant survival benefit (p = 0.04).
Interpretation:
Incidental GIIGs are progressive tumors leading to clinical transformation toward symptomatic GIIGs. They may represent an earlier step in the natural history of a glioma than the symptomatic GIIGs. ANN NEUROL 2010;68:727–733
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