Opportunistic Research Articles

Analysis of adverse effects of infliximab treatment in 486 patients with Crohn′s disease

Objective To assess the safety of infliximab(IFX) treatment in patients with Crohn′s disease(CD). Methods From January 2009 to May 2018, at inflammatory bowel disease (IBD) center of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 486 CD patients received the treatment of IFX were enrolled and their clinical data were collected. Univariate and multivariate regression of binary logistic were performed for statistical analysis. Results The median follow-up duration was 31.1 months (12.0 months to 40.0 months). The median duration of IFX therapy was 13.0 months (7.0 months to 21.0 months). Among 486 patients, 98 (20.16%) patients reported adverse effects, and 12 (2.47%) patients discontinued the therapy because of adverse effects. Acute infusion reaction was the most common adverse effect in CD patients who received IFX treatment accounting for 41.84%(41/98)of all the adverse effects, and the incidence was 8.44%. Thirty-nine patients had mild and moderate infusion reaction, and all improved after symptomatic treatment (eight patients discontinued IFX therapy because of recurrent infusion reaction). Two patients developed severe infusion reaction as allergic shock, and both relieved after emergency rescue. Four patients developed late-phase allergic reactions. Among 486 patients, 39 (8.02%) patients had infections, including infections of Clostridium difficile, cytomegalovirus, herpeszoster virus, Mycobacterium tuberculosis, and other opportunistic pathogens. There was no cases of infection related death. Thirty-six patients continued with IFX treatment after infection controlled. Among 486 patients, 14(2.88%) patients had severe infection, and all the cases improved after anti-infection treatment. Twenty-seven CD patients with hepatitis B virus (HBV) infection received anti-viral treatments, no active HBV infection was observed. Colon adenocarcinoma was found in one patient under colonoscopy at 22 months after discontinuation of IFX therapy. There were six patients with the history of benign tumors, and no evidence of recurrence, progress or malignancy during treatment. In terms of other rare adverse effects in 486 patients, there were eight (1.64%) patients with liver function injury, two (0.41%) patients with anemia, one (0.21%) patient with peripheral neuropathy, and four (0.82%) patients with skin lesion. Prolonged duration of IFX therapy, without combination of immune-suppressors and with increased baseline body mass index (BMI) were the risk factors of acute infusion reactions. Prolonged duration of IFX therapy and with low baseline albumin level were the risk factors of infections. Conclusions IFX is generally safe as the treatment for CD patients, and its adverse effects can be clinically controlled. Screening before therapy and monitoring during therapy may reduce the risks of adverse effects. Key words: Crohn disease; Infection; Neoplasms; Infliximab; Adverse effects; Infusion reaction

Challenges of Utilizing the Primary Health Safety Index Tool for Assessing the Vulnerability of Healthcare Centers to Disasters.

As important infrastructures in every community, hospitals and healthcare centers are required to continue their operation during normal and disastrous situations and respond to the situation and provide services for the injured. In 2008, the hospital safety index (HSI) was proposed by the Pan American Health Organization (PAHO) for evaluating the safety of hospitals and healthcare facilities in potential hazardous situations. The hazards threatening these facilities can be identified using a checklist, and categorized as structural, non-structural and functional vulnerability while considering their likelihood of occurrence, frequency, harmful outcomes and numerical estimate of damage. In 2016, risk and safety assessments in disasters were performed in 280 healthcare centers affiliated to Ilam University of Medical Sciences, Ilam, Iran, including 204 medical homes, 66 comprehensive urban and rural health centers and 10 district health centers. The present research was conducted using the hazard assessment guidelines developed by the Iranian Ministry of Health. The results revealed that geologic hazards, climatologic threats, epidemics and traffic accidents were respectively the most frequent hazards threatening healthcare centers in Ilam province. Moreover, the levels of the structural, non-structural and functional safety of the healthcare centers were respectively found to be 20.34%, 27.67% and 21.53%. The overall safety of the health centers was also estimated at 22.79%. In fact, the safety level received a score of 3 out of 10. Hatami et al. obtained a safety index of 4 out of 10, and found the level of functional safety to be 51.48%, that of structural safety 33.97%, that of non-structural safety 54.82% and that of overall safety 43.72%. Moreover, an evaluation of the safety level of Iranian health centers in the face of disasters in 2015 reported a functional safety level of 29%, a structural safety level of 36%, a non-structural safety level of 21% and an overall safety level of 29%. The safety levels of healthcare centers in Ilam province were therefore lower than those reported as the national mean safety indices. In addition, the present results were expressed through their root cause analysis. The unsatisfactory preparedness level of healthcare centers in Ilam province on a national scale based on the hazard assessment guidelines developed by the Ministry of Health can be attributed to the following factors: The very old building structures of the health centers contributing to lower safety and higher risks Failing to complete the checklists according to the instructions provided for national assessment tools; the checklists should have been completed by skilled, well-educated experts who were informed of how to use the instruments and how to complete the checklists. The invalidity of the obtained results associated with completing the checklists by experts of the Deputy of Health and subsidiary units, who lacked knowledge about structural engineering and building architecture. In fact, the intrinsic features of some of the instruments required asking for assistance from engineering experts such as architects, civil engineers and urban engineers to complete the checklists; nevertheless, financial limitations prevented the use of specialist expertise. Failing to take the necessary measures to promote the safety and efficiency of the healthcare centers despite the neglect reflected in the annually-completed preparedness assessment tools; the annual status of safety and preparedness of healthcare centers in Ilam was reported to be unsatisfactory. As a major component of management, control is a combination of actions required for identifying strengths, weaknesses, threats and opportunities through monitoring and evaluating the processes and solving the system problems by performing appropriate intervention. The improvement of the status quo is not guaranteed unless controls lead to interventions. The results obtained through assessing the preparedness and safety of hospitals appear to have not affected the strategic programs, policies and procedures of the health system authorities in a way that safety levels are enhanced in healthcare facilities. The policy makers are therefore recommended to revise the methods used to take advantage of this information.

Surgical treatment for acute appendicitis in HIV/AIDS patients

Fifty three HIC/AIDS patients with acute appendicitis treated in our hospital from January 2016 to June 2017 were retrospectively analyzed. The anesthesia and surgery were successfully completed in all patients, and there were no serious intraoperative complications. The postoperative complications occurred in 18 cases (34.0%), including 13 cases (24.5%) of incision infections and 3 cases (5.7%) of lung infections, 1 case of adhesion obstruction (1.9%) and 1 case (1.9%) of new opportunistic infections. All patients were clinically cured after treatment and discharged from the hospital without perioperative death. The characteristics of acute appendicitis in HIV/AIDS patients are emergent onset, poor body condition, lower immunity, more comorbities, rapid condition changes, and high frequency of special infections; the patients with lower CD4 count may have higher postoperative infection, the slower recovery and the poorer outcomes. Key words: HIV infections; Acguired immunodeficiency syndrom; Appendectomy; Appendicitis

European Year of Cultural Heritage 2018. A deeper reflection on the promotion of Europe’s cultural diversity

The European Year of Cultural Heritage has activated a reflection on the European dimension of Cultural Heritage recognizing the value of this fundamental resource for sustainable development. The activities of the Year aimed at enhancing the richness and the diversity of Europe ’s Cultural Heritage and at strengthen ing the sense of belonging to a common European space. They also offered the oppo rtunity to reflect on how to better protect and promote this fundamental resource for Europe, build ing our common future through a shared understanding of the past.

'Ready to Reg' - a pilot trial of experiential medical registrar training.

Pre-registrar experience of the duty medical registrar (DMR) role is limited to opportunistic encounters, often in under-resourced settings with a rota gap. A previous survey has showed that 44% of core medical trainees (CMTs) feel unprepared to take on the role as DMR.1 The role is perceived by some early trainees to be ‘impossible’, requiring ‘superhero’ skills.2 Medical registrars and consultants themselves acknowledge the complexity of juggling a high workload, providing leadership and dealing with acutely unwell patients.3,4 These perceptions and lack of experiential DMR training could contribute to a decline in acute medical specialty recruitment. Further, trainees who eventually take on the role often experience a ‘trial by fire’, leading to undue stress and anxiety. The UCLH ‘Ready to Reg’ programme aims to provide CMTs with hands-on field training as a DMR under direct guidance of another medical registrar.

La anatomía patológica presente y futuro

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May Fourth Movement 1919 in Zhejiang

This article discusses little-known aspects of the May Fourth Movement of 4 May 1919 in the Chinese province. Traditionally, the May Fourth Movement and the connected New Culture Movement and the Literary Revolution are associated with Beijing and Shanghai. However, one of the most important intellectual centers of China at that time was Hangzhou, a city with close economic links to Shanghai. Radical students in Zhejiang in 1919-1920 were active in publishing, and the New Tide magazine they published was in demand in China's largest cities, and solidified the status of Zhejiang as the vanguard of revolution. Looking closely at this collision, we may easily ascertain that the traditional Confucian society during an opportunistic economic upturn caused by World War I was fueling radicalism and at the same time was the object of their struggle. Anarchism was the key ideology of the May Fourth Movement in Zhejiang. A special role in these events is played by Jing Hengyi (1877-1938) and Shi Cuntong (1898-1970), sons of rich landowners who were able to afford publishing and had spare time for intellectual discourse. Realizing the political immaturity of the masses, the Zhejiang radicals focused on publishing rather than on political manifestations.

Uzungwa Scarp Nature Forest Reserve: a unique hotspot for reptiles in Tanzania

While knowledge of African vertebrate biodiversity has increased dramatically in recent years, the field of herpetology which encompasses many threatened and endemic species, has lagged behind, and many areas have not been adequately explored. Intensive field work was conducted during the rainy season from December 2017 to April 2018 to assess reptile occurrence mostly in previously unexplored areas of the Uzungwa Scarp Nature Forest Reserve (USNFR) which is part of the Udzungwa Mountain ranges in the Eastern Arc Mountains (EAM), and adjacent agricultural areas. Bucket pitfall traps, funnel traps, night transects and opportunistic search methods were used to sample reptiles across four zones: in lowland, submontane and montane forests of the USNFR, and in neighboring farmlands. Forty-five reptile species across 14 families were recorded, mostly concentrated on the lowland and submontane forests. The number of endemic and threatened species in the USNFR reaches 20 and 14 respectively, and most are found in the submontane forest. Nineteen species were new records for the USNFR, five of them representing range extensions. Reptile species richness, abundance and diversity differed significantly across the four zones, except between montane and farmland zones and between lowland and submontane. However, farmland zone was discordant from other zones in terms of species composition. This study adds to the importance of the EAM not only in harbouring large numbers of species but also as an important hotspot for endemic and threatened reptiles. It also calls for proper land-use practices in farms adjacent to protected areas for sustainable conservation of biodiversity.

Aprovechar el dinero digital del Banco Central para estimular la actividad económica doméstica

<p align="center"> </p><p>Este documento presenta una propuesta para aprovechar las ventajas de un sistema monetario electrónico (digital) en el que las cuentas y las transacciones internas, mismas que en su mayor parte deben realizarse en el Banco Central o en una entidad similar controlada por el Estado. El Banco Central es el mediador de la moneda digital, sino de todos los pagos, para la mayoría, al menos una gran parte de los flujos de transacciones en un país. Por lo tanto, se propone conseguir que una gran parte de las pequeñas (incluidas de una sola persona), medianas y grandes empresas transiten al dinero del Banco Central digital (BC) para su actividad diaria.</p><div><br /><div><p> </p></div></div>

A fast multi-pattern matching algorithm for mining big network data

The rapid development of mobile network brings opportunities for researchers to analyze user behaviors based on large-scale network traffic data. It is important for Internet Service Providers (ISP) to optimize resource allocation and provide customized services to users. The first step of analyzing user behaviors is to extract information of user actions from HTTP traffic data by multi-pattern URL matching. However, the efficiency is a huge problem when performing this work on massive network traffic data. To solve this problem, we propose a novel and accurate algorithm named Multi-Pattern Parallel Matching (MPPM) that takes advantage of HashMap in data searching for extracting user behaviors from big network data more effectively. Extensive experiments based on real-world traffic data prove the ability of MPPM algorithm to deal with massive HTTP traffic with better performance on accuracy, concurrency and efficiency. We expect the proposed algorithm and it parallelized implementation would be a solid base to build a high-performance analysis engine of user behavior based on massive HTTP traffic data processing.

Planning a New Business: Typical Mistakes of a Business Plan in the Service Sector

According to the statistics, only five percent of the beginning entrepreneurs achieve success and stay afloat. Anyone who has the money can establish a business, but far from everyone can take advantage of opportunities and not become discouraged because of difficulties. Startups start working in the chosen area and do not take into account the business peculiarities of the service sector (or do not know about them), and later pay with their own failure. Thus, analysis of typical mistakes and the development of recommendations are interesting and promising. The article shows the main mistakes of business planning in the service sphere that are the most frequent ones in practice. Their causes and consequences are considered. Recommendations to eliminate these mistakes are made. The article will be useful to a wide range of readers: both beginning entrepreneurs who are only thinking about starting their own business and TOP managers who want to expand their business.

Dynamic System State Estimation and Outlier Detection Using Robust Data Reconciliation

State estimation and detection of measurement systematic errors are critical components of plant monitoring and control procedures. Reliable estimations of the process variables are attained by Classic Dynamic Data Reconciliation procedures when measurements follow exactly a known distribution. However, if this assumption happens approximately due to the presence of systematic errors, as outliers, classic dynamic data reconciliation provides biased results. In this work, a two-step methodology of Robust Dynamic Data Reconciliation and Systematic Error Detection is proposed. It takes advantages of a moving measurement window of fixed dimension and the features of the M-estimators. Furthermore, the presence of outliers is detected using a Robust Measurement Test. Two case studies are proposed, which work with the Huber and Biweigth M-estimators. A nonlinear benchmark extracted from the literature is considered, and performance measures are reported. The results obtained demonstrate the effectiveness of the proposed methodology.

Immobilization of Actinobacillus Succinigenes in Alginate Beads for Succinic Acid Production

Nowadays the succinic acid (SA) - a C-4 dicarboxylic acid - is considered as one of the most promising platform chemicals produced from renewable resources via fermentation. Enhancement of the SA fermentation efficiency and productivity may take advantages from immobilized cultures..This work reports the immobilization of Actinobacillus succinogenes cells in calcium alginate beads. Glucose was used as carbon source for the fermentation. A parallel fermentation test with free cells was carried out to assess the advantages of the immobilization technology.The immobilization in alginate beads was proved to be an effective technique for SA production by A. succinogenes. The fermentation performances of the immobilized cells were higher than those of the free cells. In particular, at initial glucose concentrations of 40 g/L the maximum productivity in immobilized cells fermentation (0.77 g/Lh) is more than twice that measured for free cells (0.32 g/Lh).

Two Cases of Gastroduodenal Perforation Following Cesarean Section

Peptic ulcer disease with its complications in recent centuries has become a disease of global burden associated with high morbidity and mortality. There are several risk factors that have been implicated. These include Helicobacter pylori infection, regular use of non-steroidal anti-inflammatory drugs (NSAIDS), smoking, alcohol use, steroid use, male gender and low socioeconomic status. The ulcer can be either acute or chronic. Acute ulcers are mostly stress ulcerations with documented risk factors. Bleeding, and rarely perforation are the main complications which remain a surgical challenge. Some underlying causes of gastroduodenal perforation have been reported but remain largely rare. These include gastric carcinoma, ingestion of sharp foreign material, opportunistic infections, metastatic cancer, eating disorders and pregnancy. It is in line with these rare causes that we report two cases of gastroduodenal perforation post cesarean section in two young women, both succumbing to complications of the perforation. J Med Cases. 2019;10(5):129-134 doi: https://doi.org/10.14740/jmc3279

Evaluation of screening efficacy of opportunistic disease of eye in health examination

Objective To investigate the screening of opportunistic disease of eye in health examination. Methods A cross section study.Total of 33 437 persons who received health ophthalmologic examination from Jan. to Jun. 2018 were selected.The visual acuity and ophthalmologic examinaion were performed.The prevalence of opportunistic disease of eye and the main causes of blindness were analyzed. Results There were 21 760 cases(65.1%)with ametropia, 3 989 cases(11.9%)with cataract, 1 714 cases(5.1%)with maculopathy, 158 cases(0.47%)with diabetic retinopathy, 165 cases(0.49%)with suspected glaucoma.There were 2 954 cases(8.8%)of visual impairment and blind.The rate of visual impairment(Z=23.087, P=0.000)and blind (Z=32.786, P=0.000) were raised with increasing age.The rate of blindness was 70.47% among old person with aged>60 years. The rate of blindness in female was higher than that in male(χ2=4.534, P=0.033). Conclusion The detection rate of opportunistic disease of eye is high in health examination. Key words: Disease, eye; Visual acuity; Health examination; Screening

Distribution of pathogenic bacteria in women with cystitis in community and treatment strategies

Objective To investigate the bacterial distribution characteristics of female cystitis patients in the community and evaluate the effect of using different antimicrobial agents. Methods Female patients with cystitis from January 2015 to January 2017 in our hospital were selected to receive clean midstream bacteriological culture before treatment to analyze the distribution characteristics of pathogens, and were randomly divided into fosfomycin treatment group and routine treatment. In the fosfomycin-treated group, the fosfomycin tromethamine was scattered, and in the conventional treatment group, according to the conventional anti-infective drugs, the curative effect, the detection index, and the concentration of RhoA/Rho kinase were compared between the two groups after the third and seventh days after taking the drugs. Results The urine cultures of 157 patients were all positive. A total of 144 gram-negative bacteria (91.7%) were isolated with Escherichia coli and 13 were gram-positive (8.3%). After 3 days of treatment, the efficacy of the fosfomycin-treated group was better than that of the conventional treatment group (P 0.05), and the concentration of RhoA/Rho kinase decreased after treatment (P<0.05). In addition to the total amount of urinary excretion in the fosfomycin-treated group, other testing indicators and RhoA/Rho kinase concentrations were lower than those in the conventional treatment group (P<0.05). The Chaol, Simpson index and the relative abundance of all types of bacteria of the fosfomycin-treated group was significantly lower than that of the conventional treatment group (P<0.05). Conclusions The main pathogen of female cystitis in the community is Gram-negative bacteria mainly composed of Escherichia coli, which can be used as the first-line drug for the treatment of female cystitis. Key words: Cystitis; Femininity; Opportunistic Infections

Opportunistic Species and Seasonal Variation in Epiphytic Foraminiferal Assemblages in Abalone Farm Nets

ABSTRACT Choi, Y.H.; Jeong, D.U.; Lee, Y.G.; Choi, J.U.; Kim, S., and Lee, J.S., 2019. Opportunistic species and seasonal variation in epiphytic foraminiferal assemblages in abalone farm nets. Jour...

Triple-Level Opportunistic Maintenance Optimization Policy for Multi-Location Operation and Maintenance of Leasehold Service Network

Triple-Level Opportunistic Maintenance Optimization Policy for Multi-Location Operation and Maintenance of Leasehold Service Network

Take Advantage of Volunteer Authenticity

Take Advantage of Volunteer Authenticity

Is Microfinance Beneficial or Opportunistic?

Is Microfinance Beneficial or Opportunistic?