In this editorial,we examined a recent article in the World Journal of Gastroenterology that focused on sepsis-associated liver injury(SLI)and its treatment.SLI is a serious complication of sepsis,primarily caused by ...In this editorial,we examined a recent article in the World Journal of Gastroenterology that focused on sepsis-associated liver injury(SLI)and its treatment.SLI is a serious complication of sepsis,primarily caused by microcirculatory disturbances,the gut-liver axis,and inflammatory responses.Specific treatment recommendations for SLI are lacking.The gut-liver axis represents a potential therapeutic target,with metformin showing promise in modulating the gut microbiome and enhancing intestinal barrier function.Although immunomodulatory therapies are being explored,anti-tumor necrosis factor agents and interleukin-1 receptor antagonists have not demonstrated significant clinical benefits.Statins may reduce liver inflammation and prevent injury in sepsis,but their clinical application is limited.Reduced D-related human leucocyte antigen expression on monocytes and lymphocytes suggests immune suppression in patients,indicating that corticosteroids could reverse clinical deterioration in severe infections and address adrenal cortical insufficiency.Current large-scale studies on glucocorticoid therapy for sepsis have yielded mixed results,likely due to inadequate assessment of the immune status of the host.Future research should prioritize the development of personalized immunotherapy tailored to patients’immune profiles,focusing on identifying novel indicators of immune status and advancing immunomodulatory targets and therapeutics for septic patients.展开更多
Objective:Chronic fatigue syndrome(CFS)is a prevalent symptom of post-coronavirus disease 2019(COVID-19)and is associated with unclear disease mechanisms.The herbal medicine Qingjin Yiqi granules(QJYQ)constitute a cli...Objective:Chronic fatigue syndrome(CFS)is a prevalent symptom of post-coronavirus disease 2019(COVID-19)and is associated with unclear disease mechanisms.The herbal medicine Qingjin Yiqi granules(QJYQ)constitute a clinically approved formula for treating post-COVID-19;however,its potential as a drug target for treating CFS remains largely unknown.This study aimed to identify novel causal factors for CFS and elucidate the potential targets and pharmacological mechanisms of action of QJYQ in treating CFS.Methods:This prospective cohort analysis included 4,212 adults aged≥65 years who were followed up for 7 years with 435 incident CFS cases.Causal modeling and multivariate logistic regression analysis were performed to identify the potential causal determinants of CFS.A proteome-wide,two-sample Mendelian randomization(MR)analysis was employed to explore the proteins associated with the identified causal factors of CFS,which may serve as potential drug targets.Furthermore,we performed a virtual screening analysis to assess the binding affinity between the bioactive compounds in QJYQ and CFS-associated proteins.Results:Among 4,212 participants(47.5%men)with a median age of 69 years(interquartile range:69–70 years)enrolled in 2004,435 developed CFS by 2011.Causal graph analysis with multivariate logistic regression identified frequent cough(odds ratio:1.74,95%confidence interval[CI]:1.15–2.63)and insomnia(odds ratio:2.59,95%CI:1.77–3.79)as novel causal factors of CFS.Proteome-wide MR analysis revealed that the upregulation of endothelial cell-selective adhesion molecule(ESAM)was causally linked to both chronic cough(odds ratio:1.019,95%CI:1.012–1.026,P=2.75 e^(−05))and insomnia(odds ratio:1.015,95%CI:1.008–1.022,P=4.40 e^(−08))in CFS.The major bioactive compounds of QJYQ,ginsenoside Rb2(docking score:−6.03)and RG4(docking score:−6.15),bound to ESAM with high affinity based on virtual screening.Conclusions:Our integrated analytical framework combining epidemiological,genetic,and in silico data provides a novel strategy for elucidating complex disease mechanisms,such as CFS,and informing models of action of traditional Chinese medicines,such as QJYQ.Further validation in animal models is warranted to confirm the potential pharmacological effects of QJYQ on ESAM and as a treatment for CFS.展开更多
Objective Hilar cholangiocarcinoma(HC)is invariably fatal without surgical resection.The primary aim of the current study was to determine the safety of variable surgical resections for patient with HC and their survi...Objective Hilar cholangiocarcinoma(HC)is invariably fatal without surgical resection.The primary aim of the current study was to determine the safety of variable surgical resections for patient with HC and their survival after surgical resection.In addition,prognostic factor for the overall survival was also evaluated.Methods The study included 59 consecutive patients who were newly diagnosed with HC and underwent surgical resections with curative intend between February 2009 and February 2017.Patients were followed up at 3-6 months intervals after hospital discharge.Postoperative complications and overall survival were determined.Associations of clinicopathologic and surgeon-related factors with overall survival were evaluated through univariate analysis and Cox regression analysis.Results Of patients with Bismuth and Corlette(B&C)type HI(n=19)and IV(n=25)HC lesions,33(55.9%)were treated with hilar resection combined with major liver resection(MLR),while the other 11 patients with type HI and IV,and those with type I(n=8)and II(n=7)HC lesions were treated with hilar resection.The overall surgical mortality was 5.1%and surgical morbidity was 35.6%.There was no statistical difference in the mortality between MLR group and hilar resection group(6.1%vs.3.8%;X2=0.703,P=0.145).The median follow-up period was 18 months(range,1-94 months).The 1-,3-,5-year survival rate was 59.3%,36.5%,and 17.7%,respectively.The overall survival after resections was 18 months.In HC patients with B&C type III and IV lesions,the median survival was 23 months for hilar resection with MLR and 8 months for hilar resection alone;the 1-,3-,5-year cumulative survival rate was 63.9%,23.3%,and 15.5%,respectively for hilar resection with MLR,and 11.1%,0,and 0,respectively for hilar resection alone,with significant diflerene observed(HR,9.902;95%CI,2.636-19.571,P=0.001).Four factors were independently associated with overall survival:preoperative serum Cal9-9(HR,7.039;95%CI,2.803-17.678,P<0.001),histopathologic grade(HR,4.964;95%CI,1.046-23.552,?=0.044),surgical margins(P=0.031),andAJCC staging(P=0.015).Conclusions R0 resection is efficacious in surgical treatment of HC.MLR in combination with caudate lobe resection may increase the chance of R0 resection and improve survival of HC patients with B&C type IK and IV lesions.Preoperatively prepared for biliary drainage may ensure the safety of MLR in most HC patients.Novel adjuvant therapies are needed to improve the survival of HC patients with poor prognostic factors.展开更多
The effects of chloride salts(NaCl,MgCl2and NH4Cl)on the hydrolysis kinetics of MgH2prepared by hydridingcombustion synthesis and mechanical milling(HCS+MM)were discussed.X-ray diffraction(XRD)analyses show that high-...The effects of chloride salts(NaCl,MgCl2and NH4Cl)on the hydrolysis kinetics of MgH2prepared by hydridingcombustion synthesis and mechanical milling(HCS+MM)were discussed.X-ray diffraction(XRD)analyses show that high-purityMgH2was successfully prepared by HCS.Hydrolysis performance test results indicate that the chloride salt added during the millingprocess is favorable to the initial reaction rate and hydrogen generation yield within60min.A MgH2?10%NH4Cl composite exhibitsthe best performance with the hydrogen generation yield of1311mL/g and a conversion rate of85.69%in60min at roomtemperature.It is suggested that the chloride salts not only play as grinding aids in the milling process,but also create fresh surface ofreactive materials,favoring the hydrolysis reaction.展开更多
By considering collision-limited growth mode and short-range diffusion-limited growth mode simultaneously,an extended kinetic model for solid−liquid interface with varied kinetic prefactor was developed for binary all...By considering collision-limited growth mode and short-range diffusion-limited growth mode simultaneously,an extended kinetic model for solid−liquid interface with varied kinetic prefactor was developed for binary alloys.Four potential correlations arising from effective kinetics coupling the two growth modes were proposed and studied by application to planar interface migration and dendritic solidification,where the linear correlation between the effective thermodynamic driving force and the effective kinetic energy barrier seems physically realistic.A better agreement between the results of free dendritic growth model and the available experiment data for Ni−0.7at.%B alloy was obtained based on correlation between the thermodynamics and kinetics.As compared to previous models assuming constant kinetic prefactor,a common phenomenon occurring at relatively low undercoolings,i.e.the interface migration slowdown,can be ascribed to both the thermodynamic and the kinetic factors.By considering universality of the correlation between the thermodynamics and kinetics,it is concluded that the correlation should be considered to model the interface kinetics in alloy solidification.展开更多
Considering both the effect of nonisothermal nature of the solid/liquid interface and the microscopic solvability theory (MicST), a further improved version of free dendritic growth model for pure materials was propos...Considering both the effect of nonisothermal nature of the solid/liquid interface and the microscopic solvability theory (MicST), a further improved version of free dendritic growth model for pure materials was proposed. Model comparison indicates that there is a higher temperature at the tip of dendrite predicted by the present model compared with the corresponding model with the isothermal solid/liquid interface assumption. This is attributed to the sidewise thermal diffusion, i.e. the gradient of temperature along the nonisothermal interface. Furthermore, it is indicated that the distinction between the stability criteria from MicST and marginal stability theory (MarST) is more significant with the increase of bath undercoolings. Model test also indicates that the present model can give an agreement with the available experimental data. It is finally concluded that the nonisothermal nature of the solid/liquid interface and the stability criterion from MicST should be taken into account in modeling free dendritic growth.展开更多
BACKGROUND Hepatectomy is the first choice for treating neuroendocrine tumor liver metastases.However,most patients with neuroendocrine tumor liver metastases are not suitable for hepatectomy.Ablation combined with he...BACKGROUND Hepatectomy is the first choice for treating neuroendocrine tumor liver metastases.However,most patients with neuroendocrine tumor liver metastases are not suitable for hepatectomy.Ablation combined with hepatectomy can be an alternative to liver resection.AIM To explore the clinical effect of microwave ablation combined with hepatectomy for the treatment of neuroendocrine tumor liver metastases.METHODS In this study,the data of patients who underwent microwave ablation combined with hepatectomy for the treatment of neuroendocrine tumor liver metastases from June 2015 to January 2018 were reviewed.Before the operation,the patients did not receive any treatment for liver neuroendocrine tumors.After a multidisciplinary expert group discussion,all patients were deemed unsuitable for liver resection.All patients were diagnosed with neuroendocrine tumors by pathology.The overall survival time and progression-free survival time were followed by telephone calls and outpatient visits after surgery.RESULTS Eleven patients with neuroendocrine tumor liver metastases were treated by microwave ablation combined with hepatectomy between June 2015 and January 2018.The median number of liver metastatic nodules was 4(range,2 to 43).The median number of lesions resected was 1(range,1 to 18),and the median number of lesions ablated was 3(range,1 to 38).The mean operation time was 405.6(±39.4)min.The median intraoperative blood loss was 600 mL(range,50 to 3000).Ten patients had a fever after surgery.The median duration of fever was 3 d(range,0 to 21).Elevated bilirubin levels occurred in all patients after surgery.The median bilirubin on the first day after surgery was 28.5(range,10.7 to 98.9)μmol/L.One patient developed respiratory failure,renal insufficiency,and pneumonia after the operation.No patient died postoperatively during hospitalization.The mean overall survival time after surgery was 34.1(±3.7)mo,and the median progression-free survival time was 8(range,2 to 51)mo.One year after surgery,ten patients survived and five patients survived without progression.Three year after surgery,eight patients survived and two patients survived without progression.CONCLUSION Microwave ablation combined with hepatectomy not only makes the patients obtain a survival rate similar to that of patients undergoing hepatectomy,but also has a low incidence of postoperative complications.展开更多
An adaptive support vector machine decision feedback equalizer（ASVM-DFE） based on the least square support vector machine（LS-SVM） is proposed,it solves linear system iteratively with less computational intensity.A...An adaptive support vector machine decision feedback equalizer（ASVM-DFE） based on the least square support vector machine（LS-SVM） is proposed,it solves linear system iteratively with less computational intensity.An adaptive non-singleton fuzzy support vector machine decision feedback equalizer（ANSFSVMDFE） is also presented,it adopts the non-singleton fuzzy Gaussian kernel function with similar characteristic of pre-filter and is modified with a space transformation based approach.Simulations under nonlinear time variant channels show that ASVM-DFE and ANSFSVM-DFE perform very well on nonlinear equalization and ANSFSVM-DFE acts especially well in resisting abrupt interference.展开更多
BACKGROUND:Shared decision-making(SDM)has broad application in emergencies.Most published studies have focused on SDM for a certain disease or expert opinions on future research gaps without revealing the full picture...BACKGROUND:Shared decision-making(SDM)has broad application in emergencies.Most published studies have focused on SDM for a certain disease or expert opinions on future research gaps without revealing the full picture or detailed guidance for clinical practice.This study is to investigate the optimal application of SDM to guide life-sustaining treatment(LST)in emergencies.METHODS:This study was a prospective two-round Delphi consensus-seeking survey among multiple stakeholders at the China Consortium of Elite Teaching Hospitals for Residency Education.Participants were identified based on their expertise in medicine,law,administration,medical education,or patient advocacy.All individual items and questions in the questionnaire were scored using a 5-point Likert scale,with responses ranging from"very unimportant"(a score of 1)to"extremely important"(a score of 5).The percentages of the responses that had scores of 4-5on the 5-point Likert scale were calculated.A Kendall’s W coefficient was calculated to evaluate the consensus of experts.RESULTS:A two-level framework consisting of 4 domains and 22 items as well as a ready-touse checklist for the informed consent process for LST was established.An acceptable Kendall’s W coefficient was achieved.CONCLUSION:A consensus-based framework supporting SDM during LST in an emergency department can inform the implementation of guidelines for clinical interventions,research studies,medical education,and policy initiatives.展开更多
This work is based on a direct current(DC)natural current commutation topology,which uses load-carrying branch contacts carrying rated current and multiple sets of series arcing branch contacts in parallel to achieve ...This work is based on a direct current(DC)natural current commutation topology,which uses load-carrying branch contacts carrying rated current and multiple sets of series arcing branch contacts in parallel to achieve circuit breaking.The proposed topology can meet the new requirements of higher voltage DC switches in aviation,aerospace,energy and other fields.First,a magneto-hydrodynamic arc model is built using COMSOL Multiphysics,and the different arc breaking characteristics of the arcing branch contacts in different gas environments are simulated.Then,a voltage uniformity coefficient is used to measure the voltage sharing effect in the process of dynamic interruption.In order to solve the dispersion of arcing contact action,a structural control method is adopted to improve the voltage uniformity coefficient.The uniform voltage distribution can improve the breaking capacity and electrical life of the series connection structure.展开更多
A blinded retrospective validation study was performed in a university-based hospital in northeastern China to determine whether the breast imaging reporting and data system (BI- RADS) defines a group of patients with...A blinded retrospective validation study was performed in a university-based hospital in northeastern China to determine whether the breast imaging reporting and data system (BI- RADS) defines a group of patients with non- palpable breast lesions (NPBLs) in whom fine- wire localization biopsy (FWLB) is appropriate. We reviewed 182 consecutive patients with NPBLs who underwent FWLB. The patients’ preoperative mammograms were categorized according BI-RADS by 2 radiologists blinded to the pathological findings. The positive predictive values of BI-RADS categories 3-5 were 3.4%, 42.1%, and 76.9%, respectively. For category 4 NPBLs, the percentage of cancer for those aged < 40 years was significantly lower than those aged ≥ 40 years. For category 3 NPBLs, the percentage of precancerous lesions for those aged < 40 years was significantly lower than those aged ≥ 40 years. Chinese NPBL patients aged ≥ 40 years with category 4 mammographic findings, and all patients with category 5 findings should undergo FWLB. FWLB should be offered as a treatment option for Chinese NPBL patients aged < 40 years with category 4 findings or aged ≥ 40 years with category 3 findings.展开更多
Amyotrophic lateral sclerosis is a neurodegenerative disease,and the molecular mechanism underlying its pathology remains poorly understood.However,inflammation is known to play an important role in the development of...Amyotrophic lateral sclerosis is a neurodegenerative disease,and the molecular mechanism underlying its pathology remains poorly understood.However,inflammation is known to play an important role in the development of this condition.To identify driver genes that affect the inflammatory response in amyotrophic lateral sclerosis,as well as potential treatment targets,it is crucial to analyze brain tissue samples from patients with both sporadic amyotrophic lateral sclerosis and C9orf72-related amyotrophic lateral sclerosis.Therefore,in this study we used a network-driven gene analysis tool,NetBID2.0,which is based on SJARACNe,a scalable algorithm for the reconstruction of accurate cellular networks,to experimentally analyze sequencing data from patients with sporadic amyotrophic lateral sclerosis.The results showed that the OSMR gene is pathogenic in amyotrophic lateral sclerosis and participates in the progression of amyotrophic lateral sclerosis by mediating the neuroinflammatory response.Furthermore,there were differences in OSMR activity and expression between patients with sporadic amyotrophic lateral sclerosis and those with C9orf72-related amyotrophic lateral sclerosis.These findings suggest that OSMR may be a diagnostic and prognostic marker for amyotrophic lateral sclerosis.展开更多
Amyotrophic lateral sclerosis refers to a neurodegenerative disease involving the motor system,the cause of which remains unexplained despite several years of research.Thus,the journey to understanding or treating amy...Amyotrophic lateral sclerosis refers to a neurodegenerative disease involving the motor system,the cause of which remains unexplained despite several years of research.Thus,the journey to understanding or treating amyotrophic lateral sclerosis is still a long one.According to current research,amyotrophic lateral sclerosis is likely not due to a single factor but rather to a combination of mechanisms mediated by complex interactions between molecular and genetic pathways.The progression of the disease involves multiple cellular processes and the interaction between different complex mechanisms makes it difficult to identify the causative factors of amyotrophic lateral sclerosis.Here,we review the most common amyotrophic lateral sclerosis-associated pathogenic genes and the pathways involved in amyotrophic lateral sclerosis,as well as summarize currently proposed potential mechanisms responsible for amyotrophic lateral sclerosis disease and their evidence for involvement in amyotrophic lateral sclerosis.In addition,we discuss current emerging strategies for the treatment of amyotrophic lateral sclerosis.Studying the emergence of these new therapies may help to further our understanding of the pathogenic mechanisms of the disease.展开更多
The sensitivity of the dark photon search through invisible decay final states in low-background experiments relies sig-nificantly on the neutron and muon veto efficiencies,which depend on the amount of material used ...The sensitivity of the dark photon search through invisible decay final states in low-background experiments relies sig-nificantly on the neutron and muon veto efficiencies,which depend on the amount of material used and the design of the detector geometry.This paper presents the optimized design of the hadronic calorimeter(HCAL)used in the DarkSHINE experiment,which is studied using a GEANT4-based simulation framework.The geometry is optimized by comparing a traditional design with uniform absorbers to one that uses different thicknesses at different locations on the detector,which enhances the efficiency of vetoing low-energy neutrons at the sub-GeV level.The overall size and total amount of material used in the HCAL are optimized to be lower,owing to the load and budget requirements,whereas the overall performance is studied to satisfy the physical objectives.展开更多
Corona Virus Disease 2019(COVID-19)has brought the new challenges to scientific research.Isodon suzhouensis has good anti-inflammatory and antioxidant stress effects,which is considered as a potential treatment for CO...Corona Virus Disease 2019(COVID-19)has brought the new challenges to scientific research.Isodon suzhouensis has good anti-inflammatory and antioxidant stress effects,which is considered as a potential treatment for COVID-19.The possibility for the treatment of COVID-19 with I.suzhouensis and its potential mechanism of action were explored by employing molecular docking and network pharmacology.Network pharmacology and molecular docking were used to screen drug targets,and lipopolysaccharide(LPS)induced RAW264.7 and NR8383 cells inflammation model was used for experimental verification.Collectively a total of 209 possible linkages against 18 chemical components from I.suzhouensis and 1194 COVID-19 related targets were selected.Among these,164 common targets were obtained from the intersection of I.suzhouensis and COVID-19.Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enriched 582 function targets and 87 target proteins pathways,respectively.The results from molecular docking studies revealed that rutin,vitexin,isoquercitrin and quercetin had significant binding ability with 3 chymotrypsin like protease(3CLpro)and angiotensin converting enzyme 2(ACE2).In vitro studies showed that I.suzhouensis extract(ISE)may inhibit the activation of PI3K/Akt pathway and the expression level of downstream proinflammatory factors by inhibiting the activation of epidermal growth factor receptor(EGFR)in RAW264.7 cells induced by LPS.In addition,ISE was able to inhibit the activation of TLR4/NF-κB signaling pathway in NR8383 cells exposed to LPS.Overall,the network pharmacology and in vitro studies conclude that active components from I.suzhouensis have strong therapeutic potential against COVID-19 through multi-target,multi-pathway dimensions and can be a promising candidate against COVID-19.展开更多
基金The Zhejiang Medical and Health Science and Technology Program,China,No.2021KY205 and No.2024KY139The Wenzhou Science and Technology Plan Project,China,No.Y2023111.
文摘In this editorial,we examined a recent article in the World Journal of Gastroenterology that focused on sepsis-associated liver injury(SLI)and its treatment.SLI is a serious complication of sepsis,primarily caused by microcirculatory disturbances,the gut-liver axis,and inflammatory responses.Specific treatment recommendations for SLI are lacking.The gut-liver axis represents a potential therapeutic target,with metformin showing promise in modulating the gut microbiome and enhancing intestinal barrier function.Although immunomodulatory therapies are being explored,anti-tumor necrosis factor agents and interleukin-1 receptor antagonists have not demonstrated significant clinical benefits.Statins may reduce liver inflammation and prevent injury in sepsis,but their clinical application is limited.Reduced D-related human leucocyte antigen expression on monocytes and lymphocytes suggests immune suppression in patients,indicating that corticosteroids could reverse clinical deterioration in severe infections and address adrenal cortical insufficiency.Current large-scale studies on glucocorticoid therapy for sepsis have yielded mixed results,likely due to inadequate assessment of the immune status of the host.Future research should prioritize the development of personalized immunotherapy tailored to patients’immune profiles,focusing on identifying novel indicators of immune status and advancing immunomodulatory targets and therapeutics for septic patients.
基金supported by an internal fund from Macao Polytechnic University(RP/FCSD-02/2022).
文摘Objective:Chronic fatigue syndrome(CFS)is a prevalent symptom of post-coronavirus disease 2019(COVID-19)and is associated with unclear disease mechanisms.The herbal medicine Qingjin Yiqi granules(QJYQ)constitute a clinically approved formula for treating post-COVID-19;however,its potential as a drug target for treating CFS remains largely unknown.This study aimed to identify novel causal factors for CFS and elucidate the potential targets and pharmacological mechanisms of action of QJYQ in treating CFS.Methods:This prospective cohort analysis included 4,212 adults aged≥65 years who were followed up for 7 years with 435 incident CFS cases.Causal modeling and multivariate logistic regression analysis were performed to identify the potential causal determinants of CFS.A proteome-wide,two-sample Mendelian randomization(MR)analysis was employed to explore the proteins associated with the identified causal factors of CFS,which may serve as potential drug targets.Furthermore,we performed a virtual screening analysis to assess the binding affinity between the bioactive compounds in QJYQ and CFS-associated proteins.Results:Among 4,212 participants(47.5%men)with a median age of 69 years(interquartile range:69–70 years)enrolled in 2004,435 developed CFS by 2011.Causal graph analysis with multivariate logistic regression identified frequent cough(odds ratio:1.74,95%confidence interval[CI]:1.15–2.63)and insomnia(odds ratio:2.59,95%CI:1.77–3.79)as novel causal factors of CFS.Proteome-wide MR analysis revealed that the upregulation of endothelial cell-selective adhesion molecule(ESAM)was causally linked to both chronic cough(odds ratio:1.019,95%CI:1.012–1.026,P=2.75 e^(−05))and insomnia(odds ratio:1.015,95%CI:1.008–1.022,P=4.40 e^(−08))in CFS.The major bioactive compounds of QJYQ,ginsenoside Rb2(docking score:−6.03)and RG4(docking score:−6.15),bound to ESAM with high affinity based on virtual screening.Conclusions:Our integrated analytical framework combining epidemiological,genetic,and in silico data provides a novel strategy for elucidating complex disease mechanisms,such as CFS,and informing models of action of traditional Chinese medicines,such as QJYQ.Further validation in animal models is warranted to confirm the potential pharmacological effects of QJYQ on ESAM and as a treatment for CFS.
文摘Objective Hilar cholangiocarcinoma(HC)is invariably fatal without surgical resection.The primary aim of the current study was to determine the safety of variable surgical resections for patient with HC and their survival after surgical resection.In addition,prognostic factor for the overall survival was also evaluated.Methods The study included 59 consecutive patients who were newly diagnosed with HC and underwent surgical resections with curative intend between February 2009 and February 2017.Patients were followed up at 3-6 months intervals after hospital discharge.Postoperative complications and overall survival were determined.Associations of clinicopathologic and surgeon-related factors with overall survival were evaluated through univariate analysis and Cox regression analysis.Results Of patients with Bismuth and Corlette(B&C)type HI(n=19)and IV(n=25)HC lesions,33(55.9%)were treated with hilar resection combined with major liver resection(MLR),while the other 11 patients with type HI and IV,and those with type I(n=8)and II(n=7)HC lesions were treated with hilar resection.The overall surgical mortality was 5.1%and surgical morbidity was 35.6%.There was no statistical difference in the mortality between MLR group and hilar resection group(6.1%vs.3.8%;X2=0.703,P=0.145).The median follow-up period was 18 months(range,1-94 months).The 1-,3-,5-year survival rate was 59.3%,36.5%,and 17.7%,respectively.The overall survival after resections was 18 months.In HC patients with B&C type III and IV lesions,the median survival was 23 months for hilar resection with MLR and 8 months for hilar resection alone;the 1-,3-,5-year cumulative survival rate was 63.9%,23.3%,and 15.5%,respectively for hilar resection with MLR,and 11.1%,0,and 0,respectively for hilar resection alone,with significant diflerene observed(HR,9.902;95%CI,2.636-19.571,P=0.001).Four factors were independently associated with overall survival:preoperative serum Cal9-9(HR,7.039;95%CI,2.803-17.678,P<0.001),histopathologic grade(HR,4.964;95%CI,1.046-23.552,?=0.044),surgical margins(P=0.031),andAJCC staging(P=0.015).Conclusions R0 resection is efficacious in surgical treatment of HC.MLR in combination with caudate lobe resection may increase the chance of R0 resection and improve survival of HC patients with B&C type IK and IV lesions.Preoperatively prepared for biliary drainage may ensure the safety of MLR in most HC patients.Novel adjuvant therapies are needed to improve the survival of HC patients with poor prognostic factors.
基金Projects(51571112,51171079,51471087) supported by the National Natural Science Foundation of ChinaProject(13KJA430003) supported by Jiangsu Higher Education Institutions of China+1 种基金Project supported by Qing Lan Project,ChinaProject supported by the Priority Academic Program Development(PAPD) of Jiangsu Higher Education Institutions,China
文摘The effects of chloride salts(NaCl,MgCl2and NH4Cl)on the hydrolysis kinetics of MgH2prepared by hydridingcombustion synthesis and mechanical milling(HCS+MM)were discussed.X-ray diffraction(XRD)analyses show that high-purityMgH2was successfully prepared by HCS.Hydrolysis performance test results indicate that the chloride salt added during the millingprocess is favorable to the initial reaction rate and hydrogen generation yield within60min.A MgH2?10%NH4Cl composite exhibitsthe best performance with the hydrogen generation yield of1311mL/g and a conversion rate of85.69%in60min at roomtemperature.It is suggested that the chloride salts not only play as grinding aids in the milling process,but also create fresh surface ofreactive materials,favoring the hydrolysis reaction.
基金The authors are grateful for the financial supports from the National Natural Science Foundation of China(51671075 and 51790481)the National Key R&D Program of China,(2017YFB0703001 and 2017YFB0305100)+3 种基金China Postdoctoral Science Foundation(2016M590970)the Fund of the State Key Laboratory of Solidification Processing in NWPU,China(SKLSP201606)the Fundamental Research Foundation for Universities of Heilongjiang Province,China(LGYC2018JC004)the Heilongjiang Postdoctoral Fund for Scientific Research Initiation,China(LBH-Q16118).
文摘By considering collision-limited growth mode and short-range diffusion-limited growth mode simultaneously,an extended kinetic model for solid−liquid interface with varied kinetic prefactor was developed for binary alloys.Four potential correlations arising from effective kinetics coupling the two growth modes were proposed and studied by application to planar interface migration and dendritic solidification,where the linear correlation between the effective thermodynamic driving force and the effective kinetic energy barrier seems physically realistic.A better agreement between the results of free dendritic growth model and the available experiment data for Ni−0.7at.%B alloy was obtained based on correlation between the thermodynamics and kinetics.As compared to previous models assuming constant kinetic prefactor,a common phenomenon occurring at relatively low undercoolings,i.e.the interface migration slowdown,can be ascribed to both the thermodynamic and the kinetic factors.By considering universality of the correlation between the thermodynamics and kinetics,it is concluded that the correlation should be considered to model the interface kinetics in alloy solidification.
基金Project(51671075) supported by the National Natural Science Foundation of ChinaProject(E201446) supported by the Natural Science Foundation of Heilongjiang Province,China+1 种基金Project(SKLSP201606) supported by Fund of the State Key Laboratory of Solidification Processing in NWPU,ChinaProject(2016M590970) supported by China Postdoctoral Science Foundation
文摘Considering both the effect of nonisothermal nature of the solid/liquid interface and the microscopic solvability theory (MicST), a further improved version of free dendritic growth model for pure materials was proposed. Model comparison indicates that there is a higher temperature at the tip of dendrite predicted by the present model compared with the corresponding model with the isothermal solid/liquid interface assumption. This is attributed to the sidewise thermal diffusion, i.e. the gradient of temperature along the nonisothermal interface. Furthermore, it is indicated that the distinction between the stability criteria from MicST and marginal stability theory (MarST) is more significant with the increase of bath undercoolings. Model test also indicates that the present model can give an agreement with the available experimental data. It is finally concluded that the nonisothermal nature of the solid/liquid interface and the stability criterion from MicST should be taken into account in modeling free dendritic growth.
基金Peking University People’s Hospital Scientific Research Development Funds,No.RDY2017-28.
文摘BACKGROUND Hepatectomy is the first choice for treating neuroendocrine tumor liver metastases.However,most patients with neuroendocrine tumor liver metastases are not suitable for hepatectomy.Ablation combined with hepatectomy can be an alternative to liver resection.AIM To explore the clinical effect of microwave ablation combined with hepatectomy for the treatment of neuroendocrine tumor liver metastases.METHODS In this study,the data of patients who underwent microwave ablation combined with hepatectomy for the treatment of neuroendocrine tumor liver metastases from June 2015 to January 2018 were reviewed.Before the operation,the patients did not receive any treatment for liver neuroendocrine tumors.After a multidisciplinary expert group discussion,all patients were deemed unsuitable for liver resection.All patients were diagnosed with neuroendocrine tumors by pathology.The overall survival time and progression-free survival time were followed by telephone calls and outpatient visits after surgery.RESULTS Eleven patients with neuroendocrine tumor liver metastases were treated by microwave ablation combined with hepatectomy between June 2015 and January 2018.The median number of liver metastatic nodules was 4(range,2 to 43).The median number of lesions resected was 1(range,1 to 18),and the median number of lesions ablated was 3(range,1 to 38).The mean operation time was 405.6(±39.4)min.The median intraoperative blood loss was 600 mL(range,50 to 3000).Ten patients had a fever after surgery.The median duration of fever was 3 d(range,0 to 21).Elevated bilirubin levels occurred in all patients after surgery.The median bilirubin on the first day after surgery was 28.5(range,10.7 to 98.9)μmol/L.One patient developed respiratory failure,renal insufficiency,and pneumonia after the operation.No patient died postoperatively during hospitalization.The mean overall survival time after surgery was 34.1(±3.7)mo,and the median progression-free survival time was 8(range,2 to 51)mo.One year after surgery,ten patients survived and five patients survived without progression.Three year after surgery,eight patients survived and two patients survived without progression.CONCLUSION Microwave ablation combined with hepatectomy not only makes the patients obtain a survival rate similar to that of patients undergoing hepatectomy,but also has a low incidence of postoperative complications.
文摘An adaptive support vector machine decision feedback equalizer（ASVM-DFE） based on the least square support vector machine（LS-SVM） is proposed,it solves linear system iteratively with less computational intensity.An adaptive non-singleton fuzzy support vector machine decision feedback equalizer（ANSFSVMDFE） is also presented,it adopts the non-singleton fuzzy Gaussian kernel function with similar characteristic of pre-filter and is modified with a space transformation based approach.Simulations under nonlinear time variant channels show that ASVM-DFE and ANSFSVM-DFE perform very well on nonlinear equalization and ANSFSVM-DFE acts especially well in resisting abrupt interference.
基金supported by the China Medical BoardOpen Competition Program(20-378)Peking University Third Hospital Fund for Returned Scholars(BYSYLXHG2020004)+1 种基金JX was supported by the Peking Union Medical College Fund for Informatization of Postgraduate Courses(2021YXX001)YLZ was supported by the Sichuan University Graduate Education Reform Project(GSSCU2021046)。
文摘BACKGROUND:Shared decision-making(SDM)has broad application in emergencies.Most published studies have focused on SDM for a certain disease or expert opinions on future research gaps without revealing the full picture or detailed guidance for clinical practice.This study is to investigate the optimal application of SDM to guide life-sustaining treatment(LST)in emergencies.METHODS:This study was a prospective two-round Delphi consensus-seeking survey among multiple stakeholders at the China Consortium of Elite Teaching Hospitals for Residency Education.Participants were identified based on their expertise in medicine,law,administration,medical education,or patient advocacy.All individual items and questions in the questionnaire were scored using a 5-point Likert scale,with responses ranging from"very unimportant"(a score of 1)to"extremely important"(a score of 5).The percentages of the responses that had scores of 4-5on the 5-point Likert scale were calculated.A Kendall’s W coefficient was calculated to evaluate the consensus of experts.RESULTS:A two-level framework consisting of 4 domains and 22 items as well as a ready-touse checklist for the informed consent process for LST was established.An acceptable Kendall’s W coefficient was achieved.CONCLUSION:A consensus-based framework supporting SDM during LST in an emergency department can inform the implementation of guidelines for clinical interventions,research studies,medical education,and policy initiatives.
基金National Natural Science Foundation of China(No.51977002)the Third International Symposium on Insulation and Discharge Computation for Power Equipment(IDCOMPU2021).
文摘This work is based on a direct current(DC)natural current commutation topology,which uses load-carrying branch contacts carrying rated current and multiple sets of series arcing branch contacts in parallel to achieve circuit breaking.The proposed topology can meet the new requirements of higher voltage DC switches in aviation,aerospace,energy and other fields.First,a magneto-hydrodynamic arc model is built using COMSOL Multiphysics,and the different arc breaking characteristics of the arcing branch contacts in different gas environments are simulated.Then,a voltage uniformity coefficient is used to measure the voltage sharing effect in the process of dynamic interruption.In order to solve the dispersion of arcing contact action,a structural control method is adopted to improve the voltage uniformity coefficient.The uniform voltage distribution can improve the breaking capacity and electrical life of the series connection structure.
文摘A blinded retrospective validation study was performed in a university-based hospital in northeastern China to determine whether the breast imaging reporting and data system (BI- RADS) defines a group of patients with non- palpable breast lesions (NPBLs) in whom fine- wire localization biopsy (FWLB) is appropriate. We reviewed 182 consecutive patients with NPBLs who underwent FWLB. The patients’ preoperative mammograms were categorized according BI-RADS by 2 radiologists blinded to the pathological findings. The positive predictive values of BI-RADS categories 3-5 were 3.4%, 42.1%, and 76.9%, respectively. For category 4 NPBLs, the percentage of cancer for those aged < 40 years was significantly lower than those aged ≥ 40 years. For category 3 NPBLs, the percentage of precancerous lesions for those aged < 40 years was significantly lower than those aged ≥ 40 years. Chinese NPBL patients aged ≥ 40 years with category 4 mammographic findings, and all patients with category 5 findings should undergo FWLB. FWLB should be offered as a treatment option for Chinese NPBL patients aged < 40 years with category 4 findings or aged ≥ 40 years with category 3 findings.
基金supported by the National Natural Science Foundation of China,Nos.30560042,81160161,81360198,82160255a grant from Department of Education of Jiangxi Province,Nos.GJJ13198,GJJ170021+1 种基金Jiangxi Provincial Department of Science and Technology,Nos.[2014]-47,20142BBG70062,20171BAB215022,20192BAB205043Science and Technology Plan of Jiangxi Commission of Health,Nos.202210002,202310119(all to RX).
文摘Amyotrophic lateral sclerosis is a neurodegenerative disease,and the molecular mechanism underlying its pathology remains poorly understood.However,inflammation is known to play an important role in the development of this condition.To identify driver genes that affect the inflammatory response in amyotrophic lateral sclerosis,as well as potential treatment targets,it is crucial to analyze brain tissue samples from patients with both sporadic amyotrophic lateral sclerosis and C9orf72-related amyotrophic lateral sclerosis.Therefore,in this study we used a network-driven gene analysis tool,NetBID2.0,which is based on SJARACNe,a scalable algorithm for the reconstruction of accurate cellular networks,to experimentally analyze sequencing data from patients with sporadic amyotrophic lateral sclerosis.The results showed that the OSMR gene is pathogenic in amyotrophic lateral sclerosis and participates in the progression of amyotrophic lateral sclerosis by mediating the neuroinflammatory response.Furthermore,there were differences in OSMR activity and expression between patients with sporadic amyotrophic lateral sclerosis and those with C9orf72-related amyotrophic lateral sclerosis.These findings suggest that OSMR may be a diagnostic and prognostic marker for amyotrophic lateral sclerosis.
基金supported by the National Natural Science Foundation of China,Nos.30560042,81160161,81360198,and 82160255Education Department of Jiangxi Province,Nos.GJJ13198 and GJJ170021+1 种基金Jiangxi Provincial Department of Science and Technology,No.20192BAB205043Health and Family Planning Commission of Jiangxi Province,Nos.20181019 and 202210002(all to RX).
文摘Amyotrophic lateral sclerosis refers to a neurodegenerative disease involving the motor system,the cause of which remains unexplained despite several years of research.Thus,the journey to understanding or treating amyotrophic lateral sclerosis is still a long one.According to current research,amyotrophic lateral sclerosis is likely not due to a single factor but rather to a combination of mechanisms mediated by complex interactions between molecular and genetic pathways.The progression of the disease involves multiple cellular processes and the interaction between different complex mechanisms makes it difficult to identify the causative factors of amyotrophic lateral sclerosis.Here,we review the most common amyotrophic lateral sclerosis-associated pathogenic genes and the pathways involved in amyotrophic lateral sclerosis,as well as summarize currently proposed potential mechanisms responsible for amyotrophic lateral sclerosis disease and their evidence for involvement in amyotrophic lateral sclerosis.In addition,we discuss current emerging strategies for the treatment of amyotrophic lateral sclerosis.Studying the emergence of these new therapies may help to further our understanding of the pathogenic mechanisms of the disease.
基金supported by National Key R&D Program of China(Nos.2023YFA1606904 and 2023YFA1606900)National Natural Science Foundation of China(No.12150006)Shanghai Pilot Program for Basic Research-Shanghai Jiao Tong University(No.21TQ1400209).
文摘The sensitivity of the dark photon search through invisible decay final states in low-background experiments relies sig-nificantly on the neutron and muon veto efficiencies,which depend on the amount of material used and the design of the detector geometry.This paper presents the optimized design of the hadronic calorimeter(HCAL)used in the DarkSHINE experiment,which is studied using a GEANT4-based simulation framework.The geometry is optimized by comparing a traditional design with uniform absorbers to one that uses different thicknesses at different locations on the detector,which enhances the efficiency of vetoing low-energy neutrons at the sub-GeV level.The overall size and total amount of material used in the HCAL are optimized to be lower,owing to the load and budget requirements,whereas the overall performance is studied to satisfy the physical objectives.
基金supported by the National Natural Science Foundation of China(82170481)Anhui Natural Science Foundation(2008085J39 and 2108085MH314)+2 种基金Excellent Top-notch Talents Training Program of Anhui Universities(gxbjZD2022073)Anhui Province Innovation Team of Authentic Medicinal Materials Development and High Value Utilization(2022AH010080)Suzhou University Joint Cultivation Postgraduate Research Innovation Fund Project(2023KYCX04).
文摘Corona Virus Disease 2019(COVID-19)has brought the new challenges to scientific research.Isodon suzhouensis has good anti-inflammatory and antioxidant stress effects,which is considered as a potential treatment for COVID-19.The possibility for the treatment of COVID-19 with I.suzhouensis and its potential mechanism of action were explored by employing molecular docking and network pharmacology.Network pharmacology and molecular docking were used to screen drug targets,and lipopolysaccharide(LPS)induced RAW264.7 and NR8383 cells inflammation model was used for experimental verification.Collectively a total of 209 possible linkages against 18 chemical components from I.suzhouensis and 1194 COVID-19 related targets were selected.Among these,164 common targets were obtained from the intersection of I.suzhouensis and COVID-19.Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enriched 582 function targets and 87 target proteins pathways,respectively.The results from molecular docking studies revealed that rutin,vitexin,isoquercitrin and quercetin had significant binding ability with 3 chymotrypsin like protease(3CLpro)and angiotensin converting enzyme 2(ACE2).In vitro studies showed that I.suzhouensis extract(ISE)may inhibit the activation of PI3K/Akt pathway and the expression level of downstream proinflammatory factors by inhibiting the activation of epidermal growth factor receptor(EGFR)in RAW264.7 cells induced by LPS.In addition,ISE was able to inhibit the activation of TLR4/NF-κB signaling pathway in NR8383 cells exposed to LPS.Overall,the network pharmacology and in vitro studies conclude that active components from I.suzhouensis have strong therapeutic potential against COVID-19 through multi-target,multi-pathway dimensions and can be a promising candidate against COVID-19.
