BACKGROUND Severe hyperthyroidism is a life-threatening exacerbation of thyrotoxicosis,characterized by high fever and multiorgan failure. The most common medical treatments are administration of antithyroid drugs and...BACKGROUND Severe hyperthyroidism is a life-threatening exacerbation of thyrotoxicosis,characterized by high fever and multiorgan failure. The most common medical treatments are administration of antithyroid drugs and radioactive iodine, and thyroidectomy. In some patients, antithyroid therapy is limited due to serious adverse effects or failure to control disease progression. In some extreme cases,such as thyroid storm, conventional therapy alone does not yield effective and rapid improvement before the development of multiorgan failure.CASE SUMMARY This report describes a Chinese patient with severe hyperthyroidism accompanied by multiorgan failure, who was transferred to the medical intensive care unit of our hospital. The patient presented with palpitations, vomiting,diarrhea, and shortness of breath for a week. Laboratory tests showed elevation of thyroid hormones. Hepatic failure occurred with high aminotransferase levels and jaundice. Given her abnormal liver function and medication history, we could not exclude diagnosis of propylthiouracil-induced hepatic failure.Moreover, she also suffered from heart failure. Therapeutic plasma exchange(commonly known as TPE) and continuous renal replacement therapy(commonly known as CRRT) were used as life-saving therapy, which resulted in notable improvement of clinical symptoms and laboratory tests.CONCLUSION Combined TPE and CRRT are safe and effective for patients with hyperthyroidism and multiorgan failure.展开更多
Bacillus Calmette-Guerin(BCG) intravesical instillation has been adopted in the treatment of patients with superficial bladder cancer.BCG-induced disseminated infection,though rare,has been associated with the histolo...Bacillus Calmette-Guerin(BCG) intravesical instillation has been adopted in the treatment of patients with superficial bladder cancer.BCG-induced disseminated infection,though rare,has been associated with the histological finding of epithelioid granulomas in different organs,including the liver.We report the case of an adult patient with multi-organ failure,who developed sepsis,acute respiratory failure and acute hepatic failure with encephalopathy whose liver biopsy confirmed the presence of atypical,granulomatous-like lesions.Recovery was observed only after empirical therapy for Mycobacterium bovis with isoniazid,rifampicin,ethambutol and steroids was introduced.This case highlights the importance of a thorough patient assessment in order to exclude other more common causes of hepatic granulomas and to confirm diagnosis.Histological findings may be non-specific when the liver is involved in BCGinduced disseminated infection.展开更多
Link failure is a critical issue in large networks and must be effectively addressed.In software-defined networks(SDN),link failure recovery schemes can be categorized into proactive and reactive approaches.Reactive s...Link failure is a critical issue in large networks and must be effectively addressed.In software-defined networks(SDN),link failure recovery schemes can be categorized into proactive and reactive approaches.Reactive schemes have longer recovery times while proactive schemes provide faster recovery but overwhelm the memory of switches by flow entries.As SDN adoption grows,ensuring efficient recovery from link failures in the data plane becomes crucial.In particular,data center networks(DCNs)demand rapid recovery times and efficient resource utilization to meet carrier-grade requirements.This paper proposes an efficient Decentralized Failure Recovery(DFR)model for SDNs,meeting recovery time requirements and optimizing switch memory resource consumption.The DFR model enables switches to autonomously reroute traffic upon link failures without involving the controller,achieving fast recovery times while minimizing memory usage.DFR employs the Fast Failover Group in the OpenFlow standard for local recovery without requiring controller communication and utilizes the k-shortest path algorithm to proactively install backup paths,allowing immediate local recovery without controller intervention and enhancing overall network stability and scalability.DFR employs flow entry aggregation techniques to reduce switch memory usage.Instead of matching flow entries to the destination host’s MAC address,DFR matches packets to the destination switch’s MAC address.This reduces the switches’Ternary Content-Addressable Memory(TCAM)consumption.Additionally,DFR modifies Address Resolution Protocol(ARP)replies to provide source hosts with the destination switch’s MAC address,facilitating flow entry aggregation without affecting normal network operations.The performance of DFR is evaluated through the network emulator Mininet 2.3.1 and Ryu 3.1 as SDN controller.For different number of active flows,number of hosts per edge switch,and different network sizes,the proposed model outperformed various failure recovery models:restoration-based,protection by flow entries,protection by group entries and protection by Vlan-tagging model in terms of recovery time,switch memory consumption and controller overhead which represented the number of flow entry updates to recover from the failure.Experimental results demonstrate that DFR achieves recovery times under 20 milliseconds,satisfying carrier-grade requirements for rapid failure recovery.Additionally,DFR reduces switch memory usage by up to 95%compared to traditional protection methods and minimizes controller load by eliminating the need for controller intervention during failure recovery.Theresults underscore the efficiency and scalability of the DFR model,making it a practical solution for enhancing network resilience in SDN environments.展开更多
Software-defined networking(SDN)is an innovative paradigm that separates the control and data planes,introducing centralized network control.SDN is increasingly being adopted by Carrier Grade networks,offering enhance...Software-defined networking(SDN)is an innovative paradigm that separates the control and data planes,introducing centralized network control.SDN is increasingly being adopted by Carrier Grade networks,offering enhanced networkmanagement capabilities than those of traditional networks.However,because SDN is designed to ensure high-level service availability,it faces additional challenges.One of themost critical challenges is ensuring efficient detection and recovery from link failures in the data plane.Such failures can significantly impact network performance and lead to service outages,making resiliency a key concern for the effective adoption of SDN.Since the recovery process is intrinsically dependent on timely failure detection,this research surveys and analyzes the current literature on both failure detection and recovery approaches in SDN.The survey provides a critical comparison of existing failure detection techniques,highlighting their advantages and disadvantages.Additionally,it examines the current failure recovery methods,categorized as either restoration-based or protection-based,and offers a comprehensive comparison of their strengths and limitations.Lastly,future research challenges and directions are discussed to address the shortcomings of existing failure recovery methods.展开更多
This paper is based on retrospective and observational data from the author’s 14 years of practice as a general cardiologist in a rural community hospital, which reported 62 cases with initial encounters as inpatient...This paper is based on retrospective and observational data from the author’s 14 years of practice as a general cardiologist in a rural community hospital, which reported 62 cases with initial encounters as inpatients and followed as outpatients over 14 years, which applied the knowledge of physiology and pathophysiology to everyday practice in treating congestive heart failure (CHF). The 62 patients were reported to have had a normal life with a significantly lower readmission rate [1]. This paper illustrates the application of the author’s understanding of the physiology and pathophysiology of cardiovascular and renal systems to the treatment of CHF patients. It intends to arouse attention in cardiology regarding our current treatment of CHF patients. It is hoped that this paper will help us improve the quality of life of millions of patients suffering from CHF and lower admission and readmission rates of CHF patients and the cost of CHF treatment by tens of billions of dollars annually.展开更多
Acute liver failure(ALF)and acute-on-chronic LF(ACLF)are prevalent hepatic emergencies characterized by an increased susceptibility to bacterial infections(BI),despite significant systemic inflammation.Literature indi...Acute liver failure(ALF)and acute-on-chronic LF(ACLF)are prevalent hepatic emergencies characterized by an increased susceptibility to bacterial infections(BI),despite significant systemic inflammation.Literature indicates that 30%–80%of ALF patients and 55%–81%of ACLF patients develop BI,attributed to immu-nological dysregulation.Bacterial sepsis in these patients is associated with adverse clinical outcomes,including prolonged hospitalization and increased mortality.Early detection of bacterial sepsis is critical;however,distinguishing between sterile systemic inflammation and sepsis poses a significant challenge due to the overlapping clinical presentations of LF and sepsis.Conventional sepsis biomarkers,such as procalcitonin and C-reactive protein,have shown limited utility in LF patients due to inconsistent results.In contrast,novel biomarkers like presepsin and sTREM-1 have demonstrated promising discrim-inatory performance in this population,pending further validation.Moreover,emerging research highlights the potential of machine learning-based approaches to enhance sepsis detection and characterization.Although preliminary findings are encouraging,further studies are necessary to validate these results across diverse patient cohorts,including those with LF.This article provides a compre-hensive review of the magnitude,impact,and diagnostic challenges associated with BI in LF patients,focusing on novel advancements in early sepsis detection and characterization.展开更多
Introduction: Atrial fibrillation (AF) and heart failure (HF) are two closely related cardiovascular diseases, whose association worsens prognosis and is a major public health concern. The aim of this study was to ass...Introduction: Atrial fibrillation (AF) and heart failure (HF) are two closely related cardiovascular diseases, whose association worsens prognosis and is a major public health concern. The aim of this study was to assess the prevalence of AF in patients with chronic heart failure at the cardiology department of CHU Ignace Deen. Methods: This was a cross-sectional, descriptive study conducted over a 7-month period, from April 1 to November 30, 2024, of patients hospitalized for IC associated with AF. Results: Out of 377 admissions, 31 cases of IC associated with AF were identified, representing a hospital prevalence of 8.22%. The majority of patients were men (70.96%;sex ratio: 2.4), with an average age of 58.8 ± 12.4 years. The age groups most affected were 51 - 60 years (41%) and 71 - 80 years (22.5%). The main risk factors included arterial hypertension (48.38%), diabetes (22.58%) and smoking (16.22%). The most frequent etiologies of AF-associated CI were coronary artery disease (48.38%), hypertension (25.89%) and valvular heart disease (9.67%). CHA2DS2-VASc score ≥ 3 was present in 38.70% of patients. Direct oral anticoagulants (DACs) were the most widely used antithrombotic therapy (64.51%), while beta-blockers were the most prescribed antiarrhythmic drugs (58.06%), followed by digoxin (32.25%). Conclusion: The increase in coronary artery disease and hypertension in Africa is helping to make atrial fibrillation a frequent cardiac rhythm disorder in hospitals.展开更多
Objective: To develop a best-evidence-based optimal nutrition management plan for patients with chronic heart failure, apply it in clinical practice, and evaluate its effectiveness. Methods: Use the KTA knowledge tran...Objective: To develop a best-evidence-based optimal nutrition management plan for patients with chronic heart failure, apply it in clinical practice, and evaluate its effectiveness. Methods: Use the KTA knowledge translation model to guide evidence-based practice in nutrition management, and compare the nutritional status, cardiac function status, quality of life, and quality review indicators of chronic heart failure patients before and after the application of evidence. Results: After the application of evidence, the nutritional status indicators (MNA-SF score, albumin, hemoglobin) of two groups of heart failure patients significantly increased compared to before the application of evidence, with statistically significant differences (p Conclusion: The KTA knowledge translation model provides methodological guidance for the implementation of evidence-based practice for heart failure patients. This evidence-based practice project is beneficial for improving the outcomes of malnutrition in chronic heart failure patients and is conducive to standardizing nursing pathways, thereby promoting the improvement of nursing quality.展开更多
Rock slopes with large intersection angles between the strikes of strata and surface(RS-LISS)represent a unique type of layered rock slope.These slopes are usually considered to be well stabilized and less prone to la...Rock slopes with large intersection angles between the strikes of strata and surface(RS-LISS)represent a unique type of layered rock slope.These slopes are usually considered to be well stabilized and less prone to landslides.However,when such slopes contain a significant number of discontinuities,their stability is greatly weakened.This study provided innovative insights into the stability of RS-LISS and conducted an in-depth investigation of their step-path failure mechanisms.The Riyi landslide on the eastern margin of the Qinghai-Tibet Plateau,China,was taken as a typical case and detailed investigations of geological structure and deformation characteristics of the slope were conducted by means of slope mapping,core drilling,and exploratory adits.A large number of steep-dip and gentle-dip joints were discovered in the slope,along with several critical discontinuities such as faults.Analysis shows that the tectonic stresses and river downcutting over geological time played significant roles in the formation of these discontinuities.Based on the investigation results,a numerical model of DFN for the Riyi landslide was developed.The simulation results indicated that the slope could develop a sliding surface characterized by a steep back and a gentle base,formed through the stepped interconnection of various discontinuities.Additionally,the deformation of the rock mass mainly originated from the major fault,progressively extending downward.The sliding mass may slide suddenly as a whole along the stepped bottom surface,with the compressional fracture zones as lateral boundaries,presenting a"drawer-like"movement towards the free surface.展开更多
BACKGROUND Acute liver failure(ALF)is a severe condition characterized by rapid deterioration of liver function in individuals without preexisting liver disease.Liver transplantation(LT)is the most impactful treatment...BACKGROUND Acute liver failure(ALF)is a severe condition characterized by rapid deterioration of liver function in individuals without preexisting liver disease.Liver transplantation(LT)is the most impactful treatment.Yellow fever(YF)is an infectious disease that primarily affects the liver and has a high mortality rate.However,LT can be a viable option for treating rare cases with extensive liver involvement.However,the criteria for assessing the severity of ALF and determining the indications for transplantation have not been specifically validated for cases caused by YF.AIM To present necessary adjustments to established scoring systems for ALF secondary to YF.METHODS This was an observational,retrospective,single-center study.Fourteen consecutive patients with confirmed ALF due to YF were monitored in the intensive care unit by a specialized liver transplant team during a three-month epidemic outbreak in Brazil.During hospitalization,general supportive therapeutic measures were implemented,and the patients were regularly assessed using the King's College criteria and the Clichy-Villejuif criteria to determine the severity of liver failure.LT is considered a viable measure for patients with signs of end-stage liver failure.RESULTS Eight of 14(57%)patients developed severe neurological alterations within the first 96 hours after hospital admission.Four patients underwent emergency LT,and despite a moderate viral infection of the graft after transplantation,the 5-year survival rate was 50%.Although the King's College criteria and the Clichy-Villejuif criteria are the main scoring systems for ALF,they are insufficient for predicting the risk of mortality in this context,primarily because of low serum bilirubin levels in the final stage of the disease and significant disparities between coagulation abnormalities and patient severity.CONCLUSION To ensure good applicability in cases of YF-induced ALF,the authors suggest adaptations to the King's College and Clichy-Villejuif criteria.展开更多
Microscopic dynamic failure behaviors of rocks are significant to rock engineering,which is still insufficiently understood.This study combines split Hopkinson pressure bar(SHPB)and micro-CT(computed tomography)to exp...Microscopic dynamic failure behaviors of rocks are significant to rock engineering,which is still insufficiently understood.This study combines split Hopkinson pressure bar(SHPB)and micro-CT(computed tomography)to explore the microscopic failure characteristics of sandstone under impact loading.SHPB is responsible for the dynamic test,and micro-CT is responsible for pre-and post-test inspections.The results show that the pores and defect influence the dynamic strength but do not alter the overall trend of increased strength with a higher impact level.The dynamical crack development is then analyzed.Three types of cracks(i.e.I-,Y-,and H-type)are identified to describe the crack development.When rock is simply fractured,only I-type crack exists due to tensile failure,and it grows irregularly.As the strain rate increases,I-type crack is transformed into Y-and H-type crack due to shear failure.Crack coalesces at that moment,and the complexity increases along the impact direction.The coalescence occurs preferentially in the area with more pores,and around a third of pores are involved,where the maximum contribution area is in the middle of sample.Microcracks are formed inside the rock blocks,and rock grains and fragments fill in the cracks.The dynamic crack development is accompanied by microcracks,while rock grains and fragments result from the development of these microcracks.In addition,the influence of a semi-penetrating defect perpendicular to the impact direction is investigated.The defect can impede stress transfer and concentrate energy consumption.The findings are expected to enhance understanding of rock dynamics and support rock engineering development.展开更多
Heart failure(HF)with preserved ejection fraction(HFpEF)has exceeded HF with reduced ejection fraction(HFrEF),becoming the most common type of HF.Unlike HFrEF,HFpEF is primarily a chronic low-grade inflammatory proces...Heart failure(HF)with preserved ejection fraction(HFpEF)has exceeded HF with reduced ejection fraction(HFrEF),becoming the most common type of HF.Unlike HFrEF,HFpEF is primarily a chronic low-grade inflammatory process closely associated with metabolic disorders.The coexistence of HFpEF and metabolic dysfunction-associated steatotic liver disease(MASLD)presents significant clinical challenges due to shared metabolic pathophysiology and complex inter-play.Management strategies for HFpEF and MASLD remain challenging.Sodium-glucose cotransporter 2 inhibitors have shown benefits in managing both conditions.Additionally,glucagon-like peptide-1 receptor agonists are being actively investigated for their potential benefits,particularly in MASLD.A comprehensive,patient-centered approach that combines metabolic and cardiova-scular care is essential for improving outcomes in patients with HFpEF and MASLD,addressing the global metabolic health challenges.展开更多
BACKGROUND The central link between septic shock and acute skin failure(ASF)is the inflammatory response,which occurs throughout disease progression and can lead to systemic inflammatory response syndrome.Patients oft...BACKGROUND The central link between septic shock and acute skin failure(ASF)is the inflammatory response,which occurs throughout disease progression and can lead to systemic inflammatory response syndrome.Patients often experience bad moods,sleep disorders,and other health issues.Despite recognizing these factors,no studies have examined the correlation between inflammatory factors,lactic acid levels,ASF,mood disturbances,and sleep quality in critically ill patients.We hypothesize that higher levels of inflammatory factors and lactic acid are associated with more severe ASF and poorer mood and sleep quality,which may inform clinical treatment for septic shock and ASF.AIM To explore the relationship between inflammatory factors,lactic acid levels,the severity of ASF,bad mood,and sleep quality.METHODS The retrospective study included 150 patients with septic shock from the Second Hospital of Dalian Medical University,categorized into ASF(n=35)or non-ASF groups(n=115).We compared the peripheral blood inflammatory factors,including tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6),lactic acid levels,skin mottling score(SMS),modified early warning score(MEWS),self-rating depression scale(SDS),self-rating anxiety scale(SAS),and Pittsburgh sleep quality index(PSQI)scores.Pearson correlation analysis assessed relationships among these variables.RESULTS The ASF group had significantly higher levels of CRP(19.60±4.10 vs 15.30±2.96 mg/mL),IL-6(298.65±48.65 vs 268.66±33.66 pg/L),procalcitonin,lactic acid(8.42±2.32 vs 5.70±1.27 mmol/L),SMS[0(0,1)vs 3(2,3)],MEWS(9.34±1.92 vs 6.48±1.96),SAS(61.63±12.03 vs 53.71±12.48),SDS(60.17±12.64 vs 52.27±12.64),and PSQI scores(14.23±3.94 vs 8.69±2.46)compared with the non-ASF group(all P<0.001).Pearson correlation analysis revealed that IL-6,CRP,TNF-α,and lactic acid were positively correlated with SMS,MEWS,SAS,SDS,and PSQI scores(P<0.05).CONCLUSION Peripheral blood levels of IL-6,CRP,TNF-α,and lactic acid correlate positively with SMS,MEWS,SAS,SDS,and PSQI in critically ill patients with ASF.展开更多
Patients with advanced liver cirrhosis and liver failure frequently experience abnormalities in their serum electrolyte levels.In such patients,hyponatremia has been identified as a predictor of poor outcomes.However,...Patients with advanced liver cirrhosis and liver failure frequently experience abnormalities in their serum electrolyte levels.In such patients,hyponatremia has been identified as a predictor of poor outcomes.However,emerging evidence suggests that serum chloride may provide even better prognostic information in similar situations.Hypochloremia,characterised by low serum chloride levels,has been linked to increased mortality,exacerbated organ dysfunction,and higher requirements for renal replacement therapy and vasopressors in various critical conditions,including advanced liver diseases.The pathophysiological mecha-nisms underlying the association between low serum chloride levels and poor outcomes in liver disease appear to involve complex interactions among electro-lyte imbalances,renal function,and systemic hemodynamics.Chloride dysregu-lation can influence renal salt-sensing mechanisms,disrupt acid-base homeostasis,and exacerbate complications such as hepatic encephalopathy and hepatorenal syndrome.This article aims to elucidate the prognostic significance of lower serum chloride levels in patients with advanced liver disease.By reviewing recent literature and analysing clinical data,we seek to establish serum chloride as an underutilised but valuable prognostic marker.Understanding the role of serum chloride in liver disease could enhance prognostic accuracy,refine treatment strategies,and ultimately improve patient outcomes.展开更多
BACKGROUND Acute liver failure(ALF)is a loss of liver function due to a severe hepatic insult.Studies utilizing the azoxymethane(AOM)mouse model of ALF,which also generates hepatic encephalopathy,have primarily focuse...BACKGROUND Acute liver failure(ALF)is a loss of liver function due to a severe hepatic insult.Studies utilizing the azoxymethane(AOM)mouse model of ALF,which also generates hepatic encephalopathy,have primarily focused on development of neurological deficits.However,the molecular processes that generate liver damage have not been fully characterized.Therefore,a more comprehensive characterization of the hepatic consequences of AOM toxicity is needed to better understand this disease model.AIM To identify molecular pathology contributing to hepatic injury during the progression of AOM-induced ALF.METHODS C57BL/6 mice were injected with AOM to produce ALF and hepatic encephalopathy.Tissue was collected at defined stages of neurological decline up to coma.Liver injury,CYP2E1 expression,oxidative stress,inflammation,apoptosis,necroptosis,and hepatocellular senescence were assessed.RESULTS Increased hepatic necrosis and exacerbated liver injury were observed after AOM injection as mice progressed towards coma.CYP2E1 expression decreased in AOM-treated mice as liver injury progressed.Malondialdehyde,myeloperoxidase and other measures of oxidative stress were significantly increased during AOM-induced ALF.Hepatic CCL2 and tumor necrosis factorαexpression increased as AOM-induced liver injury progressed.Mixed lineage kinase domain-like protein phosphorylation was increased early during the progression of AOM-induced liver injury.Measures of apoptosis and cellular senescence all increased as the time course of AOM progressed.CONCLUSION These data support that necrosis,oxidative stress,inflammation,apoptosis,and senescence were elevated in AOMtreated mice,with inflammation being the earliest significant change.展开更多
Objective:To study the antioxidant protective effect and mechanism of melatonin on cyclophosphamide-induced premature ovarian failure model mice.Methods:Six-month sexually mature female Kunming mice were taken for one...Objective:To study the antioxidant protective effect and mechanism of melatonin on cyclophosphamide-induced premature ovarian failure model mice.Methods:Six-month sexually mature female Kunming mice were taken for one week of acclimatization and then randomly divided into a normal group,blank control group,drug control group,ovarian premature aging model group,and melatonin intervention low,medium,and high dose group,with 20 mice in each group.We observed the status and body mass of the mice in each group;observed and monitored the estrous cycle by HE staining;measured the diameter and size of the ovaries and weighed the wet weight of the ovaries;observed the morphological changes of the ovaries by HE staining and counted the developing follicles at all levels;detected the levels of serum estradiol(E2),follicle-stimulating hormone(FSH),and luteinizing hormone(LH)by ELISA;measured the levels of serum MDA,SOD,and GSH-PX by antioxidant kit;detected the levels of protein immunoblotting by ELISA;protein immunoblotting(Western blot)to examine the expression of DNA damage-related proteinsγH2AX,p53,and p21 in ovarian tissues.Results:Compared with the control group,mice in the premature ovarian failure model group showed reduced mobility,rough hair,decreased body weight,disorganized estrous cycle,decreased ovarian weight(P<0.05),decreased number of follicles at all levels of development(P<0.05),increased number of atretic follicles(P<0.05),significantly elevated levels of serum FSH and LH,significantly decreased levels of E2(P<0.05),significantly increased levels of serum MDA,significantly lower SOD and GSH-PX levels(P<0.05),and the expression of p53,p21,andγH2AX in ovarian tissues was increased(P<0.05).Compared with the model group of premature ovarian failure,melatonin improved the changes of the above indexes induced by cyclophosphamide-induced premature ovarian failure in mice.Conclusion:Melatonin can improve the changes of motility cycle disorders,abnormal follicular development,and abnormal serum hormone levels induced by cyclophosphamide-induced oxidative stress in mice with premature ovarian failure.At the same time,melatonin can improve the oxidative stress induced by cyclophosphamide and alleviate the role of oxidative stress-induced DNA damage in mouse ovaries by exerting its antioxidant effect.展开更多
Background:We investigated the similarities and differences between two experimental approaches using tachy-pacing technology to induce desynchronized heart failure in canines.Methods:A total of eight dogs were includ...Background:We investigated the similarities and differences between two experimental approaches using tachy-pacing technology to induce desynchronized heart failure in canines.Methods:A total of eight dogs were included in the experiment,four were tachypaced in right ventricle apex (RVAP) and 4 were paced in right atrium after the ablation of left bundle branch to achieve left bundle branch block (RAP+LBBB).Three weeks of follow-up were conducted to observe the changes in cardiac function and myocardial staining was performed at the end of the experiment.Results:Both experimental approaches successfully established heart failure with reduced ejection fraction models,with similar trends in declining cardiac function.The RAP+LBBB group exhibited a prolonged overall ventricular activation time, delayed left ventricular activation,and lesser impact on the right ventricle.The RVAP approach led to a reduction in overall right ventricular compliance and right ve ntricular enlargement.The RAP+LBBB group exhibited significant reductions in left heart compliance (LVGLS,%:RAP+LBBB-12.60±0.12 to-5.93±1.25;RVAP-13.28±0.62to-8.05±0.63, p=0.023;LASct,%:RAP+LBBB-15.75±6.85 to-1.50±1.00;RVAP-15.75±2.87 to-10.05±6.16,p=0.035).Histological examination revealed more pronounced fibrosis in the left ventricular wall and left atrium in the RAP+LBBBgroup while the RVAP group showed more prominent fibrosis in the right ventricular myocardium.Conclusion:Both approaches establish HFrEF models with comparable trends.The RVAP group shows impaired right ventricular function,while the RAP+LBBB group exhibits more severe decreased compliance and fibrosis in left ventricle.展开更多
Layered rock formations are frequently encountered during the excavation of underground structures. The stability of such structures is influenced not only by the stress concentration caused by the cavities in the str...Layered rock formations are frequently encountered during the excavation of underground structures. The stability of such structures is influenced not only by the stress concentration caused by the cavities in the strata but also by the anisotropy of the layered rock mass. The interaction between them can lead to critical structural failure, such as rupture, collapse, or significant deformation within the adjacent rock mass, thereby jeopardizing operational safety. However, the coupling law and mechanism between the stress concentration resulting from the cavities and the anisotropy of a layered rock mass remain unclear. In this study, a uniaxial compression test was performed on shale specimens containing a circular hole to investigate the effects of layer inclination and circular holes on the mechanical properties, elastic energy storage, and failure behaviors of these specimens. The failure mechanism of the rock surrounding the hole was analyzed on the basis of the single plane of weakness theory and the Kirsch solution. The test results indicated pronounced anisotropy in the compressive strength, elastic modulus, and elastic strain energy of the specimens, with distinct “V”, “M” and “U”-shaped patterns correlated with varying layer inclination angles. In addition, the combined effect of stress concentration and layer inclination resulted in different failure types, which were classified into four groups according to their failure behavior. Theoretical analysis revealed that failure around circular holes in layered rock is affected by a range of variables, such as layer inclination, layer strength, lateral pressure coefficient, azimuth, and loading stress.展开更多
Objective: This study focuses on the clinical observation of the impact of different treatment methods for gestational heart failure on delivery outcomes. Method: A total of 160 pregnant women with heart failure admit...Objective: This study focuses on the clinical observation of the impact of different treatment methods for gestational heart failure on delivery outcomes. Method: A total of 160 pregnant women with heart failure admitted to our hospital between October 2020 and October 2021 were selected as the study subjects. They were categorized based on delivery mode, delivery timing, heart failure control time, and cardiac function status. The delivery outcomes of the different groups were then compared. Result: In terms of delivery methods, the rate of neonatal asphyxia was higher following vaginal delivery than cesarean section. Regarding delivery timing, the neonatal mortality rate was lower for cesarean sections performed at 32-36 + 6 weeks compared to those conducted at 37-39 + 6 weeks. With respect to heart failure control time, the rates of neonatal asphyxia and pulmonary hyaline membrane disease were lower in the ≤ 48- hour group than in the > 48-hour group. From the perspective of cardiac function status, patients with cardiac function I- II exhibited relatively lower rates of neonatal asphyxia and perinatal mortality compared to those with cardiac function III-IV. The observed differences were statistically significant (P < 0.05). Conclusion: For patients with gestational heart failure, cesarean section is the recommended mode of delivery, with the optimal timing being between 32 and 36+6 weeks of pregnancy. During cesarean section, the timing of delivery should be carefully selected based on the mother’s cardiac function status.展开更多
BACKGROUND Acute-on-chronic liver failure(ACLF)is a liver disease based on chronic liver disease,which is significantly influenced by clinical treatment regimen and disease status,and despite the existence of multiple...BACKGROUND Acute-on-chronic liver failure(ACLF)is a liver disease based on chronic liver disease,which is significantly influenced by clinical treatment regimen and disease status,and despite the existence of multiple prognostic assessment indicators for ACLF,the overall sensitivity and accuracy are relatively low.AIM To investigate the prognostic value of the combined detection of alpha-fetoprotein(AFP),plasma prothrombin activity(PTA),and serum prealbumin(PA)in ACLF.METHODS This retrospective study included 87 patients with ACLF admitted from February 2021 to February 2023 and categorized them into the survival(n=47)and death(n=40)groups according to their clinical outcomes 3 months posttreatment.All the participants underwent AFP,PTA,and PA level measurements upon admission.Baseline data,as well as AFP,PTA,and PA levels,were comparatively analyzed.Pearson correlation coefficients were utilized to analyze the correlations of AFP,PTA,and PA with different survival outcomes in patients with ACLF.Receiver operating characteristic(ROC)curves and areas under the curves were used to evaluate the predictive value of AFP,PTA,and PA for ACLF prognosis.RESULTS AFP,PTA,and PA levels were markedly decreased in the death group than in the survival group(P<0.05).Pearson analysis indicated a positive association of the AFP,PTA,and PA levels with the survival of patients with ACLF(P<0.05).ROC curve analysis determined the sensitivity and specificity of the combined diagnosis at 91.24%and 100.00%,respectively,both of which were notably increased compared to the single-index diagnosis.The ROC of their combined diagnosis was 0.989,significantly surpassing 0.907,0.849,and 0.853 of AFP,PTA,and PA,respectively.No statistically significant variance was determined in the sensitivity and specificity of the combined diagnosis vs the single detection(P>0.05).CONCLUSION The combined detection of AFP,PTA,and PA levels demonstrates favorable diagnostic value for the short-term prognosis of patients with ACLF,featuring high sensitivity and specificity.展开更多
文摘BACKGROUND Severe hyperthyroidism is a life-threatening exacerbation of thyrotoxicosis,characterized by high fever and multiorgan failure. The most common medical treatments are administration of antithyroid drugs and radioactive iodine, and thyroidectomy. In some patients, antithyroid therapy is limited due to serious adverse effects or failure to control disease progression. In some extreme cases,such as thyroid storm, conventional therapy alone does not yield effective and rapid improvement before the development of multiorgan failure.CASE SUMMARY This report describes a Chinese patient with severe hyperthyroidism accompanied by multiorgan failure, who was transferred to the medical intensive care unit of our hospital. The patient presented with palpitations, vomiting,diarrhea, and shortness of breath for a week. Laboratory tests showed elevation of thyroid hormones. Hepatic failure occurred with high aminotransferase levels and jaundice. Given her abnormal liver function and medication history, we could not exclude diagnosis of propylthiouracil-induced hepatic failure.Moreover, she also suffered from heart failure. Therapeutic plasma exchange(commonly known as TPE) and continuous renal replacement therapy(commonly known as CRRT) were used as life-saving therapy, which resulted in notable improvement of clinical symptoms and laboratory tests.CONCLUSION Combined TPE and CRRT are safe and effective for patients with hyperthyroidism and multiorgan failure.
文摘Bacillus Calmette-Guerin(BCG) intravesical instillation has been adopted in the treatment of patients with superficial bladder cancer.BCG-induced disseminated infection,though rare,has been associated with the histological finding of epithelioid granulomas in different organs,including the liver.We report the case of an adult patient with multi-organ failure,who developed sepsis,acute respiratory failure and acute hepatic failure with encephalopathy whose liver biopsy confirmed the presence of atypical,granulomatous-like lesions.Recovery was observed only after empirical therapy for Mycobacterium bovis with isoniazid,rifampicin,ethambutol and steroids was introduced.This case highlights the importance of a thorough patient assessment in order to exclude other more common causes of hepatic granulomas and to confirm diagnosis.Histological findings may be non-specific when the liver is involved in BCGinduced disseminated infection.
文摘Link failure is a critical issue in large networks and must be effectively addressed.In software-defined networks(SDN),link failure recovery schemes can be categorized into proactive and reactive approaches.Reactive schemes have longer recovery times while proactive schemes provide faster recovery but overwhelm the memory of switches by flow entries.As SDN adoption grows,ensuring efficient recovery from link failures in the data plane becomes crucial.In particular,data center networks(DCNs)demand rapid recovery times and efficient resource utilization to meet carrier-grade requirements.This paper proposes an efficient Decentralized Failure Recovery(DFR)model for SDNs,meeting recovery time requirements and optimizing switch memory resource consumption.The DFR model enables switches to autonomously reroute traffic upon link failures without involving the controller,achieving fast recovery times while minimizing memory usage.DFR employs the Fast Failover Group in the OpenFlow standard for local recovery without requiring controller communication and utilizes the k-shortest path algorithm to proactively install backup paths,allowing immediate local recovery without controller intervention and enhancing overall network stability and scalability.DFR employs flow entry aggregation techniques to reduce switch memory usage.Instead of matching flow entries to the destination host’s MAC address,DFR matches packets to the destination switch’s MAC address.This reduces the switches’Ternary Content-Addressable Memory(TCAM)consumption.Additionally,DFR modifies Address Resolution Protocol(ARP)replies to provide source hosts with the destination switch’s MAC address,facilitating flow entry aggregation without affecting normal network operations.The performance of DFR is evaluated through the network emulator Mininet 2.3.1 and Ryu 3.1 as SDN controller.For different number of active flows,number of hosts per edge switch,and different network sizes,the proposed model outperformed various failure recovery models:restoration-based,protection by flow entries,protection by group entries and protection by Vlan-tagging model in terms of recovery time,switch memory consumption and controller overhead which represented the number of flow entry updates to recover from the failure.Experimental results demonstrate that DFR achieves recovery times under 20 milliseconds,satisfying carrier-grade requirements for rapid failure recovery.Additionally,DFR reduces switch memory usage by up to 95%compared to traditional protection methods and minimizes controller load by eliminating the need for controller intervention during failure recovery.Theresults underscore the efficiency and scalability of the DFR model,making it a practical solution for enhancing network resilience in SDN environments.
文摘Software-defined networking(SDN)is an innovative paradigm that separates the control and data planes,introducing centralized network control.SDN is increasingly being adopted by Carrier Grade networks,offering enhanced networkmanagement capabilities than those of traditional networks.However,because SDN is designed to ensure high-level service availability,it faces additional challenges.One of themost critical challenges is ensuring efficient detection and recovery from link failures in the data plane.Such failures can significantly impact network performance and lead to service outages,making resiliency a key concern for the effective adoption of SDN.Since the recovery process is intrinsically dependent on timely failure detection,this research surveys and analyzes the current literature on both failure detection and recovery approaches in SDN.The survey provides a critical comparison of existing failure detection techniques,highlighting their advantages and disadvantages.Additionally,it examines the current failure recovery methods,categorized as either restoration-based or protection-based,and offers a comprehensive comparison of their strengths and limitations.Lastly,future research challenges and directions are discussed to address the shortcomings of existing failure recovery methods.
文摘This paper is based on retrospective and observational data from the author’s 14 years of practice as a general cardiologist in a rural community hospital, which reported 62 cases with initial encounters as inpatients and followed as outpatients over 14 years, which applied the knowledge of physiology and pathophysiology to everyday practice in treating congestive heart failure (CHF). The 62 patients were reported to have had a normal life with a significantly lower readmission rate [1]. This paper illustrates the application of the author’s understanding of the physiology and pathophysiology of cardiovascular and renal systems to the treatment of CHF patients. It intends to arouse attention in cardiology regarding our current treatment of CHF patients. It is hoped that this paper will help us improve the quality of life of millions of patients suffering from CHF and lower admission and readmission rates of CHF patients and the cost of CHF treatment by tens of billions of dollars annually.
文摘Acute liver failure(ALF)and acute-on-chronic LF(ACLF)are prevalent hepatic emergencies characterized by an increased susceptibility to bacterial infections(BI),despite significant systemic inflammation.Literature indicates that 30%–80%of ALF patients and 55%–81%of ACLF patients develop BI,attributed to immu-nological dysregulation.Bacterial sepsis in these patients is associated with adverse clinical outcomes,including prolonged hospitalization and increased mortality.Early detection of bacterial sepsis is critical;however,distinguishing between sterile systemic inflammation and sepsis poses a significant challenge due to the overlapping clinical presentations of LF and sepsis.Conventional sepsis biomarkers,such as procalcitonin and C-reactive protein,have shown limited utility in LF patients due to inconsistent results.In contrast,novel biomarkers like presepsin and sTREM-1 have demonstrated promising discrim-inatory performance in this population,pending further validation.Moreover,emerging research highlights the potential of machine learning-based approaches to enhance sepsis detection and characterization.Although preliminary findings are encouraging,further studies are necessary to validate these results across diverse patient cohorts,including those with LF.This article provides a compre-hensive review of the magnitude,impact,and diagnostic challenges associated with BI in LF patients,focusing on novel advancements in early sepsis detection and characterization.
文摘Introduction: Atrial fibrillation (AF) and heart failure (HF) are two closely related cardiovascular diseases, whose association worsens prognosis and is a major public health concern. The aim of this study was to assess the prevalence of AF in patients with chronic heart failure at the cardiology department of CHU Ignace Deen. Methods: This was a cross-sectional, descriptive study conducted over a 7-month period, from April 1 to November 30, 2024, of patients hospitalized for IC associated with AF. Results: Out of 377 admissions, 31 cases of IC associated with AF were identified, representing a hospital prevalence of 8.22%. The majority of patients were men (70.96%;sex ratio: 2.4), with an average age of 58.8 ± 12.4 years. The age groups most affected were 51 - 60 years (41%) and 71 - 80 years (22.5%). The main risk factors included arterial hypertension (48.38%), diabetes (22.58%) and smoking (16.22%). The most frequent etiologies of AF-associated CI were coronary artery disease (48.38%), hypertension (25.89%) and valvular heart disease (9.67%). CHA2DS2-VASc score ≥ 3 was present in 38.70% of patients. Direct oral anticoagulants (DACs) were the most widely used antithrombotic therapy (64.51%), while beta-blockers were the most prescribed antiarrhythmic drugs (58.06%), followed by digoxin (32.25%). Conclusion: The increase in coronary artery disease and hypertension in Africa is helping to make atrial fibrillation a frequent cardiac rhythm disorder in hospitals.
文摘Objective: To develop a best-evidence-based optimal nutrition management plan for patients with chronic heart failure, apply it in clinical practice, and evaluate its effectiveness. Methods: Use the KTA knowledge translation model to guide evidence-based practice in nutrition management, and compare the nutritional status, cardiac function status, quality of life, and quality review indicators of chronic heart failure patients before and after the application of evidence. Results: After the application of evidence, the nutritional status indicators (MNA-SF score, albumin, hemoglobin) of two groups of heart failure patients significantly increased compared to before the application of evidence, with statistically significant differences (p Conclusion: The KTA knowledge translation model provides methodological guidance for the implementation of evidence-based practice for heart failure patients. This evidence-based practice project is beneficial for improving the outcomes of malnutrition in chronic heart failure patients and is conducive to standardizing nursing pathways, thereby promoting the improvement of nursing quality.
基金supported by the National Natural Science Foundation of China(No.U23A2047,No.42277187,No.42307248)Natural Science Foundation of Hebei Province(No.D2022202005)。
文摘Rock slopes with large intersection angles between the strikes of strata and surface(RS-LISS)represent a unique type of layered rock slope.These slopes are usually considered to be well stabilized and less prone to landslides.However,when such slopes contain a significant number of discontinuities,their stability is greatly weakened.This study provided innovative insights into the stability of RS-LISS and conducted an in-depth investigation of their step-path failure mechanisms.The Riyi landslide on the eastern margin of the Qinghai-Tibet Plateau,China,was taken as a typical case and detailed investigations of geological structure and deformation characteristics of the slope were conducted by means of slope mapping,core drilling,and exploratory adits.A large number of steep-dip and gentle-dip joints were discovered in the slope,along with several critical discontinuities such as faults.Analysis shows that the tectonic stresses and river downcutting over geological time played significant roles in the formation of these discontinuities.Based on the investigation results,a numerical model of DFN for the Riyi landslide was developed.The simulation results indicated that the slope could develop a sliding surface characterized by a steep back and a gentle base,formed through the stepped interconnection of various discontinuities.Additionally,the deformation of the rock mass mainly originated from the major fault,progressively extending downward.The sliding mass may slide suddenly as a whole along the stepped bottom surface,with the compressional fracture zones as lateral boundaries,presenting a"drawer-like"movement towards the free surface.
基金Supported by The INCT-CNPq Program,No.465425/2014-3.
文摘BACKGROUND Acute liver failure(ALF)is a severe condition characterized by rapid deterioration of liver function in individuals without preexisting liver disease.Liver transplantation(LT)is the most impactful treatment.Yellow fever(YF)is an infectious disease that primarily affects the liver and has a high mortality rate.However,LT can be a viable option for treating rare cases with extensive liver involvement.However,the criteria for assessing the severity of ALF and determining the indications for transplantation have not been specifically validated for cases caused by YF.AIM To present necessary adjustments to established scoring systems for ALF secondary to YF.METHODS This was an observational,retrospective,single-center study.Fourteen consecutive patients with confirmed ALF due to YF were monitored in the intensive care unit by a specialized liver transplant team during a three-month epidemic outbreak in Brazil.During hospitalization,general supportive therapeutic measures were implemented,and the patients were regularly assessed using the King's College criteria and the Clichy-Villejuif criteria to determine the severity of liver failure.LT is considered a viable measure for patients with signs of end-stage liver failure.RESULTS Eight of 14(57%)patients developed severe neurological alterations within the first 96 hours after hospital admission.Four patients underwent emergency LT,and despite a moderate viral infection of the graft after transplantation,the 5-year survival rate was 50%.Although the King's College criteria and the Clichy-Villejuif criteria are the main scoring systems for ALF,they are insufficient for predicting the risk of mortality in this context,primarily because of low serum bilirubin levels in the final stage of the disease and significant disparities between coagulation abnormalities and patient severity.CONCLUSION To ensure good applicability in cases of YF-induced ALF,the authors suggest adaptations to the King's College and Clichy-Villejuif criteria.
基金supported by Research Center for Industries of the Future(RCIF)Key Laboratory of Rock Mechanics and Geohazards of Zhejiang Province(No.ZJRMG-2022-03)+1 种基金Key Research and Development Program of Guangxi Province(No.Guike AB22080035)which are gratefully acknowledged.In addition,we are grateful for the valuable and constructive feedback provided by the anonymous reviewers,which has greatly improved this manuscript.
文摘Microscopic dynamic failure behaviors of rocks are significant to rock engineering,which is still insufficiently understood.This study combines split Hopkinson pressure bar(SHPB)and micro-CT(computed tomography)to explore the microscopic failure characteristics of sandstone under impact loading.SHPB is responsible for the dynamic test,and micro-CT is responsible for pre-and post-test inspections.The results show that the pores and defect influence the dynamic strength but do not alter the overall trend of increased strength with a higher impact level.The dynamical crack development is then analyzed.Three types of cracks(i.e.I-,Y-,and H-type)are identified to describe the crack development.When rock is simply fractured,only I-type crack exists due to tensile failure,and it grows irregularly.As the strain rate increases,I-type crack is transformed into Y-and H-type crack due to shear failure.Crack coalesces at that moment,and the complexity increases along the impact direction.The coalescence occurs preferentially in the area with more pores,and around a third of pores are involved,where the maximum contribution area is in the middle of sample.Microcracks are formed inside the rock blocks,and rock grains and fragments fill in the cracks.The dynamic crack development is accompanied by microcracks,while rock grains and fragments result from the development of these microcracks.In addition,the influence of a semi-penetrating defect perpendicular to the impact direction is investigated.The defect can impede stress transfer and concentrate energy consumption.The findings are expected to enhance understanding of rock dynamics and support rock engineering development.
基金Supported by Wenzhou Science Technology Bureau Foundation,No.2022Y0726.
文摘Heart failure(HF)with preserved ejection fraction(HFpEF)has exceeded HF with reduced ejection fraction(HFrEF),becoming the most common type of HF.Unlike HFrEF,HFpEF is primarily a chronic low-grade inflammatory process closely associated with metabolic disorders.The coexistence of HFpEF and metabolic dysfunction-associated steatotic liver disease(MASLD)presents significant clinical challenges due to shared metabolic pathophysiology and complex inter-play.Management strategies for HFpEF and MASLD remain challenging.Sodium-glucose cotransporter 2 inhibitors have shown benefits in managing both conditions.Additionally,glucagon-like peptide-1 receptor agonists are being actively investigated for their potential benefits,particularly in MASLD.A comprehensive,patient-centered approach that combines metabolic and cardiova-scular care is essential for improving outcomes in patients with HFpEF and MASLD,addressing the global metabolic health challenges.
文摘BACKGROUND The central link between septic shock and acute skin failure(ASF)is the inflammatory response,which occurs throughout disease progression and can lead to systemic inflammatory response syndrome.Patients often experience bad moods,sleep disorders,and other health issues.Despite recognizing these factors,no studies have examined the correlation between inflammatory factors,lactic acid levels,ASF,mood disturbances,and sleep quality in critically ill patients.We hypothesize that higher levels of inflammatory factors and lactic acid are associated with more severe ASF and poorer mood and sleep quality,which may inform clinical treatment for septic shock and ASF.AIM To explore the relationship between inflammatory factors,lactic acid levels,the severity of ASF,bad mood,and sleep quality.METHODS The retrospective study included 150 patients with septic shock from the Second Hospital of Dalian Medical University,categorized into ASF(n=35)or non-ASF groups(n=115).We compared the peripheral blood inflammatory factors,including tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6),lactic acid levels,skin mottling score(SMS),modified early warning score(MEWS),self-rating depression scale(SDS),self-rating anxiety scale(SAS),and Pittsburgh sleep quality index(PSQI)scores.Pearson correlation analysis assessed relationships among these variables.RESULTS The ASF group had significantly higher levels of CRP(19.60±4.10 vs 15.30±2.96 mg/mL),IL-6(298.65±48.65 vs 268.66±33.66 pg/L),procalcitonin,lactic acid(8.42±2.32 vs 5.70±1.27 mmol/L),SMS[0(0,1)vs 3(2,3)],MEWS(9.34±1.92 vs 6.48±1.96),SAS(61.63±12.03 vs 53.71±12.48),SDS(60.17±12.64 vs 52.27±12.64),and PSQI scores(14.23±3.94 vs 8.69±2.46)compared with the non-ASF group(all P<0.001).Pearson correlation analysis revealed that IL-6,CRP,TNF-α,and lactic acid were positively correlated with SMS,MEWS,SAS,SDS,and PSQI scores(P<0.05).CONCLUSION Peripheral blood levels of IL-6,CRP,TNF-α,and lactic acid correlate positively with SMS,MEWS,SAS,SDS,and PSQI in critically ill patients with ASF.
文摘Patients with advanced liver cirrhosis and liver failure frequently experience abnormalities in their serum electrolyte levels.In such patients,hyponatremia has been identified as a predictor of poor outcomes.However,emerging evidence suggests that serum chloride may provide even better prognostic information in similar situations.Hypochloremia,characterised by low serum chloride levels,has been linked to increased mortality,exacerbated organ dysfunction,and higher requirements for renal replacement therapy and vasopressors in various critical conditions,including advanced liver diseases.The pathophysiological mecha-nisms underlying the association between low serum chloride levels and poor outcomes in liver disease appear to involve complex interactions among electro-lyte imbalances,renal function,and systemic hemodynamics.Chloride dysregu-lation can influence renal salt-sensing mechanisms,disrupt acid-base homeostasis,and exacerbate complications such as hepatic encephalopathy and hepatorenal syndrome.This article aims to elucidate the prognostic significance of lower serum chloride levels in patients with advanced liver disease.By reviewing recent literature and analysing clinical data,we seek to establish serum chloride as an underutilised but valuable prognostic marker.Understanding the role of serum chloride in liver disease could enhance prognostic accuracy,refine treatment strategies,and ultimately improve patient outcomes.
基金Supported by The Department of Veterans Affairs Biomedical Laboratory Research&Development Service Award,No.BX003486(to McMillin M)National Institutes of Health Awards,No.R01DK112803 and No.R01DK135995(to DeMorrow S).
文摘BACKGROUND Acute liver failure(ALF)is a loss of liver function due to a severe hepatic insult.Studies utilizing the azoxymethane(AOM)mouse model of ALF,which also generates hepatic encephalopathy,have primarily focused on development of neurological deficits.However,the molecular processes that generate liver damage have not been fully characterized.Therefore,a more comprehensive characterization of the hepatic consequences of AOM toxicity is needed to better understand this disease model.AIM To identify molecular pathology contributing to hepatic injury during the progression of AOM-induced ALF.METHODS C57BL/6 mice were injected with AOM to produce ALF and hepatic encephalopathy.Tissue was collected at defined stages of neurological decline up to coma.Liver injury,CYP2E1 expression,oxidative stress,inflammation,apoptosis,necroptosis,and hepatocellular senescence were assessed.RESULTS Increased hepatic necrosis and exacerbated liver injury were observed after AOM injection as mice progressed towards coma.CYP2E1 expression decreased in AOM-treated mice as liver injury progressed.Malondialdehyde,myeloperoxidase and other measures of oxidative stress were significantly increased during AOM-induced ALF.Hepatic CCL2 and tumor necrosis factorαexpression increased as AOM-induced liver injury progressed.Mixed lineage kinase domain-like protein phosphorylation was increased early during the progression of AOM-induced liver injury.Measures of apoptosis and cellular senescence all increased as the time course of AOM progressed.CONCLUSION These data support that necrosis,oxidative stress,inflammation,apoptosis,and senescence were elevated in AOMtreated mice,with inflammation being the earliest significant change.
基金2023 Special Project for Serving the National Development Strategy with Basic Scientific Research Fees from Central Universities(No.31920230188)2023 Northwestern Minzu University College-Level Innovation and Entrepreneurship Training Program(No.X202310742289)2024 National College Students’Innovation and Entrepreneurship Training Program(No.202410742005)。
文摘Objective:To study the antioxidant protective effect and mechanism of melatonin on cyclophosphamide-induced premature ovarian failure model mice.Methods:Six-month sexually mature female Kunming mice were taken for one week of acclimatization and then randomly divided into a normal group,blank control group,drug control group,ovarian premature aging model group,and melatonin intervention low,medium,and high dose group,with 20 mice in each group.We observed the status and body mass of the mice in each group;observed and monitored the estrous cycle by HE staining;measured the diameter and size of the ovaries and weighed the wet weight of the ovaries;observed the morphological changes of the ovaries by HE staining and counted the developing follicles at all levels;detected the levels of serum estradiol(E2),follicle-stimulating hormone(FSH),and luteinizing hormone(LH)by ELISA;measured the levels of serum MDA,SOD,and GSH-PX by antioxidant kit;detected the levels of protein immunoblotting by ELISA;protein immunoblotting(Western blot)to examine the expression of DNA damage-related proteinsγH2AX,p53,and p21 in ovarian tissues.Results:Compared with the control group,mice in the premature ovarian failure model group showed reduced mobility,rough hair,decreased body weight,disorganized estrous cycle,decreased ovarian weight(P<0.05),decreased number of follicles at all levels of development(P<0.05),increased number of atretic follicles(P<0.05),significantly elevated levels of serum FSH and LH,significantly decreased levels of E2(P<0.05),significantly increased levels of serum MDA,significantly lower SOD and GSH-PX levels(P<0.05),and the expression of p53,p21,andγH2AX in ovarian tissues was increased(P<0.05).Compared with the model group of premature ovarian failure,melatonin improved the changes of the above indexes induced by cyclophosphamide-induced premature ovarian failure in mice.Conclusion:Melatonin can improve the changes of motility cycle disorders,abnormal follicular development,and abnormal serum hormone levels induced by cyclophosphamide-induced oxidative stress in mice with premature ovarian failure.At the same time,melatonin can improve the oxidative stress induced by cyclophosphamide and alleviate the role of oxidative stress-induced DNA damage in mouse ovaries by exerting its antioxidant effect.
基金This work was financially supported by National Natural Science Foundation of China(Nos.82000325,82100325,82070349)Young Elite Scientists Sponsorship Program by Beijing Association for Science and Technology(No.BYESS2023392)+2 种基金The Beijing Gold-bridge project(No.ZZ21055)The Peking University First Hospital Seed Foundation(No.2020SF19)High-level hospital clinical research funding of Fuwai Hospital,Chinese Academy of Medical Sciences(No.2022-GSP-GG-11).
文摘Background:We investigated the similarities and differences between two experimental approaches using tachy-pacing technology to induce desynchronized heart failure in canines.Methods:A total of eight dogs were included in the experiment,four were tachypaced in right ventricle apex (RVAP) and 4 were paced in right atrium after the ablation of left bundle branch to achieve left bundle branch block (RAP+LBBB).Three weeks of follow-up were conducted to observe the changes in cardiac function and myocardial staining was performed at the end of the experiment.Results:Both experimental approaches successfully established heart failure with reduced ejection fraction models,with similar trends in declining cardiac function.The RAP+LBBB group exhibited a prolonged overall ventricular activation time, delayed left ventricular activation,and lesser impact on the right ventricle.The RVAP approach led to a reduction in overall right ventricular compliance and right ve ntricular enlargement.The RAP+LBBB group exhibited significant reductions in left heart compliance (LVGLS,%:RAP+LBBB-12.60±0.12 to-5.93±1.25;RVAP-13.28±0.62to-8.05±0.63, p=0.023;LASct,%:RAP+LBBB-15.75±6.85 to-1.50±1.00;RVAP-15.75±2.87 to-10.05±6.16,p=0.035).Histological examination revealed more pronounced fibrosis in the left ventricular wall and left atrium in the RAP+LBBBgroup while the RVAP group showed more prominent fibrosis in the right ventricular myocardium.Conclusion:Both approaches establish HFrEF models with comparable trends.The RVAP group shows impaired right ventricular function,while the RAP+LBBB group exhibits more severe decreased compliance and fibrosis in left ventricle.
基金supported by Beijing Natural Science Foundation of China(Grant No.2244099)the China Postdoctoral Science Foundation(Grant No.2023T0025)the National Natural Science Foundation of China(Grant No.52074020).
文摘Layered rock formations are frequently encountered during the excavation of underground structures. The stability of such structures is influenced not only by the stress concentration caused by the cavities in the strata but also by the anisotropy of the layered rock mass. The interaction between them can lead to critical structural failure, such as rupture, collapse, or significant deformation within the adjacent rock mass, thereby jeopardizing operational safety. However, the coupling law and mechanism between the stress concentration resulting from the cavities and the anisotropy of a layered rock mass remain unclear. In this study, a uniaxial compression test was performed on shale specimens containing a circular hole to investigate the effects of layer inclination and circular holes on the mechanical properties, elastic energy storage, and failure behaviors of these specimens. The failure mechanism of the rock surrounding the hole was analyzed on the basis of the single plane of weakness theory and the Kirsch solution. The test results indicated pronounced anisotropy in the compressive strength, elastic modulus, and elastic strain energy of the specimens, with distinct “V”, “M” and “U”-shaped patterns correlated with varying layer inclination angles. In addition, the combined effect of stress concentration and layer inclination resulted in different failure types, which were classified into four groups according to their failure behavior. Theoretical analysis revealed that failure around circular holes in layered rock is affected by a range of variables, such as layer inclination, layer strength, lateral pressure coefficient, azimuth, and loading stress.
文摘Objective: This study focuses on the clinical observation of the impact of different treatment methods for gestational heart failure on delivery outcomes. Method: A total of 160 pregnant women with heart failure admitted to our hospital between October 2020 and October 2021 were selected as the study subjects. They were categorized based on delivery mode, delivery timing, heart failure control time, and cardiac function status. The delivery outcomes of the different groups were then compared. Result: In terms of delivery methods, the rate of neonatal asphyxia was higher following vaginal delivery than cesarean section. Regarding delivery timing, the neonatal mortality rate was lower for cesarean sections performed at 32-36 + 6 weeks compared to those conducted at 37-39 + 6 weeks. With respect to heart failure control time, the rates of neonatal asphyxia and pulmonary hyaline membrane disease were lower in the ≤ 48- hour group than in the > 48-hour group. From the perspective of cardiac function status, patients with cardiac function I- II exhibited relatively lower rates of neonatal asphyxia and perinatal mortality compared to those with cardiac function III-IV. The observed differences were statistically significant (P < 0.05). Conclusion: For patients with gestational heart failure, cesarean section is the recommended mode of delivery, with the optimal timing being between 32 and 36+6 weeks of pregnancy. During cesarean section, the timing of delivery should be carefully selected based on the mother’s cardiac function status.
文摘BACKGROUND Acute-on-chronic liver failure(ACLF)is a liver disease based on chronic liver disease,which is significantly influenced by clinical treatment regimen and disease status,and despite the existence of multiple prognostic assessment indicators for ACLF,the overall sensitivity and accuracy are relatively low.AIM To investigate the prognostic value of the combined detection of alpha-fetoprotein(AFP),plasma prothrombin activity(PTA),and serum prealbumin(PA)in ACLF.METHODS This retrospective study included 87 patients with ACLF admitted from February 2021 to February 2023 and categorized them into the survival(n=47)and death(n=40)groups according to their clinical outcomes 3 months posttreatment.All the participants underwent AFP,PTA,and PA level measurements upon admission.Baseline data,as well as AFP,PTA,and PA levels,were comparatively analyzed.Pearson correlation coefficients were utilized to analyze the correlations of AFP,PTA,and PA with different survival outcomes in patients with ACLF.Receiver operating characteristic(ROC)curves and areas under the curves were used to evaluate the predictive value of AFP,PTA,and PA for ACLF prognosis.RESULTS AFP,PTA,and PA levels were markedly decreased in the death group than in the survival group(P<0.05).Pearson analysis indicated a positive association of the AFP,PTA,and PA levels with the survival of patients with ACLF(P<0.05).ROC curve analysis determined the sensitivity and specificity of the combined diagnosis at 91.24%and 100.00%,respectively,both of which were notably increased compared to the single-index diagnosis.The ROC of their combined diagnosis was 0.989,significantly surpassing 0.907,0.849,and 0.853 of AFP,PTA,and PA,respectively.No statistically significant variance was determined in the sensitivity and specificity of the combined diagnosis vs the single detection(P>0.05).CONCLUSION The combined detection of AFP,PTA,and PA levels demonstrates favorable diagnostic value for the short-term prognosis of patients with ACLF,featuring high sensitivity and specificity.
