摘要：
Given the increasing complexity of cancer care,multidisciplinary tumor boards have become essential in daily clinical oncology practice.The Project Extension for Community Healthcare Outcomes(ECHO)initiative developed an innovative telementoring model using a"hub and spoke"design consisting of a team of experts(hub)that offers a full service to multiple participants(the spokes)during regularly scheduled sessions discussing patients'clinical cases.The Alexander Fleming Cancer Institute in Buenos Aires was the first hub in Latin America to implement Project ECHO for gastrointestinal tumors.In our 3-year experience,80 patients from 37 centers were evaluated within Project ECHO and a range of three to five cases were discussed in each meeting.From our perspective,the impact of this novel approach was a remarkable strategy to reduce care disparities by equalizing access to high-quality medical knowledge in a multidisciplinary environment for medical discussions.Additionally,it was shown to have a cost-effective impact directly on the patients and the local health system,since relevant costs were saved after unnecessary treatments,studies and travel expenses were avoided.
摘要：
Energy consumption of the EU has a crucial environmental impact;several efforts are nowadays thus directed into massively reducing energy consumption by envelope improvement,system efficiency and smart control.On the other hand,the indoor thermal and lighting conditions significantly influence users’wellbeing and productivity,which is especially important when dealing with educational and working facilities.Strategies to enhance system efficiency are focused on design and construction aspects.These strategies ease to promote a powerful approach which is needed when focusing on existing buildings in need of retrofit measures.When dealing with new or refurbished buildings,energy saving has a further step to achieve.In the last years,research trends moved towards an increasing inclusion of human factors in energy evaluation.This allows to account for the occupancy variability in the energy analyses,considering how to bridge the performance gap between predictive models and actual consumptions due to indoor thermal settings.In empty buildings energy consumption is huge and economic efforts are wasted,due to unconscious energy-wasting behaviors.Previous studies with Interactive Virtual Environments confirmed that indoor environments illuminated by different color lights lead to the perception of different levels of thermal comfort.The results of the present paper replicate previous evidence collected in real conditions,suggesting that Virtual Reality is a valid and reliable tool to assess thermal comfort more quickly and cheaply.This paper provides a further perspective on this topic,including also the use of different fragrances to understand how the indoor environment could be enhanced and manipulated to increase wellbeing,thermal perception and finally energy saving.
摘要：
An updated approach in the management of 50 patients with foreign body inhalation is presented. Certain risk factors that lead to complications and mortality due to endoscopic extraction of foreign bodies and thus determine prognosis were identified. Remedial measures to reduce morbidity and mortality due to bronchoscopic removal of foreign bodies are suggested. Fifty patients of suspected foreign body inhalation presented to a Unit of the Department of ENT, Head and Neck Surgery of Government Medical College associated SMHS Hospital Srinagar, Kashmir from March 2007 to June 2017. Of these, 49 patients were subjected to rigid tube bronchoscopy for removal of the aspirated foreign bodies and one coughed out the foreign body spontaneously during admission for bronchoscopy. History of foreign body inhalation was positive in 90% of patients and remaining was mostly referred from Paediatric Units with un-resolving collapse-consolidation of the lung. Whereas plain radiography of the chest and the soft tissues of neck were the primary imaging modality used in this study to detect the inhaled foreign bodies or their effects there are reports of virtual bronchoscopy being done with a multidetector computed tomography scanner in 3D image generation from axial cuts of the internal walls of the tracheobronchial tree in the management of patients suspected with foreign body aspiration. Bronchoscopy is a difficult and potentially hazardous procedure in the infant and young child. Telescopes and telescopic forceps were used during bronchoscopy to facilitate extraction of a foreign body inhaled. The type of a foreign body, site of its enlodgement and the complications encountered during its extraction were noted. During bronchoscopy the patients were connected to an ECG monitor and a pulse oximeter. 80% of the patients with foreign body inhalation were children in the age group of 0 - 5 years. There was a definite history of choking over the foreign body in 88% of the patients leading to acute respiratory distress in 46%. Cough alone or along with other symptoms occurred in most of the patients (96%). Persistent fever with respiratory symptoms unresponsive to treatment occurred in 38% of the patients with or without a positive history of foreign body inhalation. Right main bronchus was the commonest site of enlodgement of foreign body. In the present study, bean and peanut were the commonest types of foreign bodies inhaled (34%). Radiological findings in these patients include atelectasis with or without pneumonitis in 46.65% of the patients, normal chest/soft tissues of the neck in 24.45%, obstructive emphysema on the affected side in 24.45%, foreign body seen in the respiratory tract in 8.90% and bronchopneumonia in 2.22%. Complications associated with the endoscopic extraction of foreign bodies and the risk factors that lead to complications and mortality in patients with aspirated foreign bodies were identified in this study and the measures to reduce these complications and mortality rate to very low levels were suggested. Transient hypoxia, hypoxic bradycardia, transient cardiac arrest, bronchial perforation and death, laryngospasm, bronchospasm, subglottic oedema, reflex bradycardia and pneumothorax were among the few complications which occurred with the rigid endoscopic extraction of foreign bodies in the present study. Among the risk factors associated with the complications were prolonged bronchoscopy, semi-blind procedure, a vegetable foreign body, improper size and positioning of a bronchoscope and some other important factors which are detailed in the text of this paper to follow. Remedial measures on the basis of complications and the risk factors are suggested so as to decrease the morbidity and mortality due to endoscopic extraction of foreign bodies inhaled into the tracheobronchial tree.
摘要：
With the rapid development of technology,geological big data is increasing explosively,and plays an increasingly important position in the national economy(Zhang and Zhou,2017;Zhou et al.,2018).Governments and agencies attach great importance to the open internet service of geological big data and information at home,and abroad(Yan et al.,2013;Guo et al.,2014).The basic norms of western countries’geological data information services are rich and varied products.
摘要：
Health information systems are the basis of eHealth at regional and national levels. They provide the maintenance of traditional medical documents in out-patient clinics and hospitals in electronic form. At the same time, specialized registries are monitoring systems for the health status of people with certain diseases. However, the creation of registers as independent information systems, which takes place to this day, is now inadvisable, since the necessary information can be obtained from the Electronic Healthcare Record/ Electronic Medical Record. In this case, specialized registers are implemented as virtual systems of a temporary or permanent type. Regarding patient registers, they integrate data from electronic medical records and information from patients or their relatives.
摘要：
CC chemokine receptor 5 (CCR5), a member of G protein-coupled receptors (GPCRs), not only plays a significant role in inflammatory responses, but also correlates with HIV-1 infection and cancer progression. Recently, blocking of CCR5 has been considered as an effective strategy in HIV-1/cancers therapy. So far, only Maraviroc has been approved by FDA in 2007, while the other CCR5 inhibitors have failed in their clinical trials. In this study, a highly selective structure-based pharmacophore model was constructed, validated, and applied for virtual screening to retrieve novel CCR5 inhibitors from NCI database. Finally, one potential CCR5 inhibitor candidate, NSC13165, was identified after molecular docking, molecular dynamics (MD) simulations, binding free energy analyses and ADMET prediction. Docking and MD simulation results not only suggested that NSC13165 reserves the common binding mode of the most known CCR5 inhibitors, but also provided important insights toward the allosteric inhibition mechanism of CCR5. The results of binding free energy analyses indicated that the binding affinity of NSC13165 is much better than that of Maraviroc and that van der Waals interaction is the key driving force during the binding process. ADMET prediction suggested that NSC13165 exhibits very low risk of causing lethal side effects. Altogether, our results strongly suggest that NSC13165 has great potential to serve as a novel CCR5 inhibitor, which may be further tested in vitro/in vivo as a drug target for HIV-1/cancers therapy or be used as a lead compound for improving its efficacy through chemical modifications.
摘要：
The cosmological picture of the World is complemented by the inclusion of virtual objects, phenomenon of the mass defect, entropic interaction, and bifurcations. During the period before the emergence of our Universe, space is considered as an infinite homogeneous multifold of virtual point objects with a certain energy and are capable of transitioning into a real state of certain masses, electrical charges, and sizes once at irreversible local fluctuations of density and energy. The existence of such virtual point objects is explained on the basis of the mass defect phenomenon known in nuclear physics and the fact that resultant sum of all forces acting on the object is equal to zero at the homogeneous space. It is shown that the entropic changes caused by irreversible fluctuations should have led to bifurcation and produce the “Big Bang” event with the emergence and subsequent evolution of our Universe. The probability of the set of bifurcations and consequent “Big Bang” events, the origin of the corresponding Universes, the time of their occurring, and initial localization is discussed. The possibility of the transition of virtual objects into a real state is proved using the Principle of Least Action and Le Chatelier’s Principle. It is shown that this is a first-order phase transition which is accompanied by radiation of energy, violation of symmetry, the appearance of mass, electrical charge, motion, and other attributes of real state objects. The “negative” and “standard” gravity, the “negative pressure”, the expansion of our Universe and its “inflationary” period are explained as realizations of the entropic interaction between objects. The “Corpuscular-Wave and the Corpuscular-Field dualisms”, being a manifestation of the Complementarity and the Equivalence Principles, are used for the explanation of the evolution of the Universe. The Anthropic Principle is discussed.
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