This editorial comments on the article by Desai et al,which investigates the impact of coronavirus disease 2019(COVID-19)on in-hospital mortality among patients with recurrent stroke using data from the 2020 National ...This editorial comments on the article by Desai et al,which investigates the impact of coronavirus disease 2019(COVID-19)on in-hospital mortality among patients with recurrent stroke using data from the 2020 National Inpatient Sample.The findings reveal significantly higher mortality rates in COVID-19-positive patients compared to non-COVID-19 patients,particularly among middle-aged individuals,males,and ethnic minorities.This editorial explores the underlying mechanisms contributing to these outcomes and discusses the clinical implications for targeted management strategies in high-risk groups.The results emphasize the need for comprehensive approaches to mitigate the heightened risks faced by recurrent stroke patients during the COVID-19 pandemic.展开更多
BACKGROUND Paraganglioma(PGL)is a neuroendocrine tumor originating from paraganglia that can occur in various locations,such as the head,neck,chest,abdomen,and pelvis.Retroperitoneal PGLs are rare,and recurrent cases ...BACKGROUND Paraganglioma(PGL)is a neuroendocrine tumor originating from paraganglia that can occur in various locations,such as the head,neck,chest,abdomen,and pelvis.Retroperitoneal PGLs are rare,and recurrent cases in this area are partic-ularly uncommon,posing considerable surgical complexities.Owing to their neu-roendocrine activity,PGLs are capable of secreting hormones like catecholamines,thereby presenting significant challenges in hemodynamic management during the perioperative period.CASE SUMMARY We report a 64-year-old man with a recurrent retroperitoneal PGL.The patient underwent retroperitoneal mass resection in 2013,with postoperative pathology revealing a PGL.Regular follow-up was not conducted until April 2024,when a computed tomography scan revealed a huge mass in the retroperitoneum,closely adjacent to the abdominal aorta.Laboratory examinations revealed elevated levels of catecholamines in the patient's blood serum.Upon admission,volume expan-sion and blood pressure(BP)monitoring were carried out for one week,with catecholamine levels reviewed and normalized.Adequate preoperative prepa-ration was conducted,including central venous access,arterial BP monitoring,and the preparation of vasoactive agents.During tumor resection,the patient ex-perienced acute,significant fluctuations in BP.The timely intervention of the anesthesiologist stabilized the BP,facilitating the successful resection of the tumor which was confirmed as a recurrent PGL.Postoperative follow-up revealed no evidence of tumor residual or recurrence.CONCLUSION PGL recurrence is rare but non-negligible.PGLs adjacent to major arteries com-plicate surgery,and perioperative hemodynamic stability demands meticulous attention.Core Tip:Recurrent retroperitoneal paragangliomas are infrequent but pose substantial surgical challenges,particularly when located adjacent to critical vascular structures such as the abdominal aorta.Effective perioperative management of he-modynamic fluctuations,driven by catecholamine secretion,requires meticulous preoperative planning,including volume expansion,blood pressure monitoring,and vasoactive agent preparation.Surgical intervention demands prompt and coordinated anesthetic support to stabilize hemodynamics,ensuring successful tumor resection.Given the potential for late recurrence,long-term follow-up is essential for early detection and management of asymptomatic recurrences.INTRODUCTION Paraganglioma(PGL)is a neuroendocrine tumor originating from paraganglia,which are associated with the autonomic nervous system[1].These tumors arise from chromaffin cells or similar cells capable of secreting catecholamines,such as adrenaline and noradrenaline.PGLs manifest in various anatomical locations,including the head,neck,chest,abdomen,and pelvis,and are characterized by neurosecretory and chief cells surrounded by prominent vascular stroma.Although typically benign,malignant forms of PGL are also recognized,and they may exhibit a tendency for recurrence or me-tastasis[2].PGLs located in the retroperitoneum are relatively uncommon and present greater surgical challenges because of their complex anatomical location near vital organs and major blood vessels.Their catecholamine-secreting nature further complicates the maintenance of hemodynamic stability during the perioperative period.In May 2024,a patient with recurrent retroperitoneal PGL was admitted to our hospital,and the details are reported below.展开更多
BACKGROUND Early anal canal cancer is frequently treated with endoscopic submucosal dis-section(ESD)to preserve anal function.However,if the lesion is in the anal canal,then significant difficulties such as bleeding a...BACKGROUND Early anal canal cancer is frequently treated with endoscopic submucosal dis-section(ESD)to preserve anal function.However,if the lesion is in the anal canal,then significant difficulties such as bleeding and challenges associated with scope manipulation can arise.CASE SUMMARY A 70-year-old woman undergoing follow-up after transverse colon cancer surgery was diagnosed with anal canal cancer extending to the dentate line.The patient underwent a combination of ESD and transanal resection(TAR).The specimen was excised in pieces,which resulted in difficulty performing the pathological evaluation of the margins,especially on the anal side where TAR was performed and severe crushing was observed.Careful follow-up was performed,and local recurrence was observed 3 years postoperatively.Because the patient had super-ficial cancer without lymph node metastasis,local resection was performed again.The second treatment attempt was improved as follows:(1)TAR and ESD were performed appropriately based on the situation by the same physician;(2)A needle scalpel was used during TAR to prevent tissue crushing;and(3)The lesion borders were marked using ESD techniques before treatment.Complete resection was performed without complications.CONCLUSION Anal canal lesions can be safely and reliably removed when ESD and TAR are used appropriately.展开更多
BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a ...BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a result of pancreaticobiliary reflux.Roux-en-Y choledochojejunostomy is a common surgical method for the treatment of PBM,but there are several associated complications that may occur after this operation.CASE SUMMARY The patient,a 12-year-old female,was hospitalized nearly 20 times in 2021 for recurrent acute pancreatitis.In 2022,she was diagnosed with PBM and underwent laparoscopic common bile duct resection and Roux-en-Y choledochojejunostomy in a tertiary hospital.In the first year after surgery,the patient had more than 10 recurrent acute pancreatitis episodes.After undergoing abdominal computed tomography and other examinations,she was diagnosed with“residual bile duct stones and recurrent acute pancreatitis”.On January 30,2024,the patient was admitted to our hospital due to recurrent upper abdominal pain and was cured through endoscopic retrograde cholangiopancreatography.CONCLUSION This article reports a case of a child with distal residual common bile duct stones and recurrent acute pancreatitis after Roux-en-Y choledochojejunostomy for PBM.The patient was cured through endoscopic retrograde cholangiopancreatography.展开更多
Research Background: Pre-eclampsia is one of main causes of materno-foetal mortality and morbidity worldwide, with a prevalence of 3% - 7%. Although considered a primiparous condition, it can nevertheless recur. Sever...Research Background: Pre-eclampsia is one of main causes of materno-foetal mortality and morbidity worldwide, with a prevalence of 3% - 7%. Although considered a primiparous condition, it can nevertheless recur. Several factors appear to be associated with risk of recurrence of pre-eclampsia, such as the term of delivery of previous pregnancy, severity of disease, the existence of co-morbidities and the inter-genital space. Purpose: The aim of our study will be to analyse and identify in a population of pregnant women with a history of preeclampsia risk factors associated with occurrence of recurrent preeclampsia at University clinics of Kinshasa (Democratic Republic of Congo) and at Victor Dupouy Hospital Center (France). Methods: In this study, pregnant women with an history of preeclampsia who will give birth between November 2018 and October 2024 at University Clinics of Kinshasa (UCK) and Victor Dupouy Hospital Center (VDHC) will be included. This will be a cross-sectional analytical study, data from previous and subsequent pregnancies will be studied. Expected Result: The prevalence of recurrent preeclampsia in the study population will be determined. And we will highlight the factors that will determine the recurrence of preeclampsia by analysing the risk factors. Conclusion: Knowledge of the factors associated with recurrent preeclampsia could be an excellent tool for predicting and preventing the disease.展开更多
BACKGROUND With 4.9 to 35 instances per 100000 cases,hyperparathyroidism is one of the rarest causes of acute pancreatitis.The major cause of primary hyperparathyroidism is a parathyroid adenoma,which can manifest cli...BACKGROUND With 4.9 to 35 instances per 100000 cases,hyperparathyroidism is one of the rarest causes of acute pancreatitis.The major cause of primary hyperparathyroidism is a parathyroid adenoma,which can manifest clinically in various ways.CASE SUMMARY We discuss the unusual case of a 13-year-old boy with recurrent pancreatitis as the initial presentation of primary hyperparathyroidism.The cause of his recurrent pancreatitis remained unknown,and the patient had multiple admissions with acute pancreatitis over 3 years.His diagnosis was delayed due to the initial normal levels of parathyroid hormone,which were later reported elevated in a subsequent episode where ultrasound neck and thyroid scintigraphy revealed a parathyroid adenoma as the underlying cause.After the diagnosis was made,he underwent surgical resection of the adenoma.CONCLUSION This case study stresses the importance of considering uncommon causes for recurrent pancreatitis.展开更多
Accurately predicting fluid forces acting on the sur-face of a structure is crucial in engineering design.However,this task becomes particularly challenging in turbulent flow,due to the complex and irregular changes i...Accurately predicting fluid forces acting on the sur-face of a structure is crucial in engineering design.However,this task becomes particularly challenging in turbulent flow,due to the complex and irregular changes in the flow field.In this study,we propose a novel deep learning method,named mapping net-work-coordinated stacked gated recurrent units(MSU),for pre-dicting pressure on a circular cylinder from velocity data.Specifi-cally,our coordinated learning strategy is designed to extract the most critical velocity point for prediction,a process that has not been explored before.In our experiments,MSU extracts one point from a velocity field containing 121 points and utilizes this point to accurately predict 100 pressure points on the cylinder.This method significantly reduces the workload of data measure-ment in practical engineering applications.Our experimental results demonstrate that MSU predictions are highly similar to the real turbulent data in both spatio-temporal and individual aspects.Furthermore,the comparison results show that MSU predicts more precise results,even outperforming models that use all velocity field points.Compared with state-of-the-art methods,MSU has an average improvement of more than 45%in various indicators such as root mean square error(RMSE).Through comprehensive and authoritative physical verification,we estab-lished that MSU’s prediction results closely align with pressure field data obtained in real turbulence fields.This confirmation underscores the considerable potential of MSU for practical applications in real engineering scenarios.The code is available at https://github.com/zhangzm0128/MSU.展开更多
Microvasculature of the retina is considered an alternative marker of cerebral vascular risk in healthy populations.However,the ability of retinal vasculature changes,specifically focusing on retinal vessel diameter,t...Microvasculature of the retina is considered an alternative marker of cerebral vascular risk in healthy populations.However,the ability of retinal vasculature changes,specifically focusing on retinal vessel diameter,to predict the recurrence of cerebrovascular events in patients with ischemic stroke has not been determined comprehensively.While previous studies have shown a link between retinal vessel diameter and recurrent cerebrovascular events,they have not incorporated this information into a predictive model.Therefore,this study aimed to investigate the relationship between retinal vessel diameter and subsequent cerebrovascular events in patients with acute ischemic stroke.Additionally,we sought to establish a predictive model by combining retinal veessel diameter with traditional risk factors.We performed a prospective observational study of 141 patients with acute ischemic stroke who were admitted to the First Affiliated Hospital of Jinan University.All of these patients underwent digital retinal imaging within 72 hours of admission and were followed up for 3 years.We found that,after adjusting for related risk factors,patients with acute ischemic stroke with mean arteriolar diameter within 0.5-1.0 disc diameters of the disc margin(MAD_(0.5-1.0DD))of≥74.14μm and mean venular diameter within 0.5-1.0 disc diameters of the disc margin(MVD_(0.5-1.0DD))of≥83.91μm tended to experience recurrent cerebrovascular events.We established three multivariate Cox proportional hazard regression models:model 1 included traditional risk factors,model 2 added MAD_(0.5-1.0DD)to model 1,and model 3 added MVD0.5-1.0DD to model 1.Model 3 had the greatest potential to predict subsequent cerebrovascular events,followed by model 2,and finally model 1.These findings indicate that combining retinal venular or arteriolar diameter with traditional risk factors could improve the prediction of recurrent cerebrovascular events in patients with acute ischemic stroke,and that retinal imaging could be a useful and non-invasive method for identifying high-risk patients who require closer monitoring and more aggressive management.展开更多
Tunnel boring machines(TBMs)have been widely utilised in tunnel construction due to their high efficiency and reliability.Accurately predicting TBM performance can improve project time management,cost control,and risk...Tunnel boring machines(TBMs)have been widely utilised in tunnel construction due to their high efficiency and reliability.Accurately predicting TBM performance can improve project time management,cost control,and risk management.This study aims to use deep learning to develop real-time models for predicting the penetration rate(PR).The models are built using data from the Changsha metro project,and their performances are evaluated using unseen data from the Zhengzhou Metro project.In one-step forecast,the predicted penetration rate follows the trend of the measured penetration rate in both training and testing.The autoregressive integrated moving average(ARIMA)model is compared with the recurrent neural network(RNN)model.The results show that univariate models,which only consider historical penetration rate itself,perform better than multivariate models that take into account multiple geological and operational parameters(GEO and OP).Next,an RNN variant combining time series of penetration rate with the last-step geological and operational parameters is developed,and it performs better than other models.A sensitivity analysis shows that the penetration rate is the most important parameter,while other parameters have a smaller impact on time series forecasting.It is also found that smoothed data are easier to predict with high accuracy.Nevertheless,over-simplified data can lose real characteristics in time series.In conclusion,the RNN variant can accurately predict the next-step penetration rate,and data smoothing is crucial in time series forecasting.This study provides practical guidance for TBM performance forecasting in practical engineering.展开更多
Static Poisson’s ratio(vs)is crucial for determining geomechanical properties in petroleum applications,namely sand production.Some models have been used to predict vs;however,the published models were limited to spe...Static Poisson’s ratio(vs)is crucial for determining geomechanical properties in petroleum applications,namely sand production.Some models have been used to predict vs;however,the published models were limited to specific data ranges with an average absolute percentage relative error(AAPRE)of more than 10%.The published gated recurrent unit(GRU)models do not consider trend analysis to show physical behaviors.In this study,we aim to develop a GRU model using trend analysis and three inputs for predicting n s based on a broad range of data,n s(value of 0.1627-0.4492),bulk formation density(RHOB)(0.315-2.994 g/mL),compressional time(DTc)(44.43-186.9 μs/ft),and shear time(DTs)(72.9-341.2μ s/ft).The GRU model was evaluated using different approaches,including statistical error an-alyses.The GRU model showed the proper trends,and the model data ranges were wider than previous ones.The GRU model has the largest correlation coefficient(R)of 0.967 and the lowest AAPRE,average percent relative error(APRE),root mean square error(RMSE),and standard deviation(SD)of 3.228%,1.054%,4.389,and 0.013,respectively,compared to other models.The GRU model has a high accuracy for the different datasets:training,validation,testing,and the whole datasets with R and AAPRE values were 0.981 and 2.601%,0.966 and 3.274%,0.967 and 3.228%,and 0.977 and 2.861%,respectively.The group error analyses of all inputs show that the GRU model has less than 5% AAPRE for all input ranges,which is superior to other models that have different AAPRE values of more than 10% at various ranges of inputs.展开更多
BACKGROUND Lower extremity lymphedema is a common complication following treatment for gynecological malignancies.Its incidence rate can reach up to 70%,affecting~20 million people worldwide.However,specialized treatm...BACKGROUND Lower extremity lymphedema is a common complication following treatment for gynecological malignancies.Its incidence rate can reach up to 70%,affecting~20 million people worldwide.However,specialized treatment centers are scarce,and there is a lack of consensus on treatment approaches.Furthermore,there are even fewer reports on the systematic and effective treatment of severe lymphedema with malformations.Effective management of this condition remains a significant challenge for clinicians.CASE SUMMARY A 40-year-old woman developed bilateral leg swelling 6 years after receiving treatment for endometrial cancer.Since August 2018,she experienced>30 episodes of lymphangitis.Upon presentation,she exhibited bilateral leg swelling and deformation,with four large swellings in the posterior thigh that impeded movement,and pain in the limbs.Skin manifestations included lichenoid lesions and features of deep sclerosis.Radionuclide lymphoscintigraphy confirmed the diagnosis of lower limb lymphedema.After 6 mo of complex decongestive therapy(CDT)and three lymphaticovenous anastomosis(LVA)treatments,the patient lost 49 kg in weight.She also experienced a maximum circumference reduction of 35.2 cm in the left lower limb and 37.5 cm in the right lower limb.The leg pain disappeared,her swelling significantly decreased,and she regained the ability to walk,cycle,and run normally.CONCLUSION The combined application of CDT and LVA therapy demonstrates significant positive effects in the treatment of severe,deformed stage III lymphedema.展开更多
BACKGROUND The recurrence rate of liver cancer after surgery is high.Radiofrequency ablation(RFA)combined with transcatheter arterial chemoembolization(TACE)is an effective treatment for liver cancer;however,its effic...BACKGROUND The recurrence rate of liver cancer after surgery is high.Radiofrequency ablation(RFA)combined with transcatheter arterial chemoembolization(TACE)is an effective treatment for liver cancer;however,its efficacy in recurrent liver cancer remains unclear.AIM To investigate the clinical effect of TACE combined with RFA in the treatment of recurrent liver cancer.METHODS Ninety patients with recurrent liver cancer were divided into 2 groups according to treatment plan:Control(RFA alone);and experimental[TACE combined with RFA(TACE+RFA)].The incidence of increased alanine aminotransferase levels,complications,and other indices were compared between the two groups before and after the procedures.RESULTS One month after the procedures,the short-term efficacy rate and Karnofsky Performance Status scores of the experimental group were significantly higher than those of the control group(P<0.05).Alpha-fetoprotein(AFP)and total bilirubin levels were lower than those in the control group(P<0.05);The overall response rate was 82.22%and 66.67%in the experimental and control groups,respectively;The disease control rate was 93.33%and 82.22%in the experimental and control groups,respectively,the differences are statistically significant(P<0.05).And there were no statistical differences in complications between the two groups(P>0.05).CONCLUSION TACE+RFA was effective for the treatment of recurrent liver cancer and significantly reduced AFP levels and improved various indices of liver function.展开更多
BACKGROUND Coronavirus disease 2019(COVID-19)has been shown to increase the risk of stroke.However,the prevalence and risk of recurrent stroke in COVID-19 patients with prior stroke/transient ischemic attack(TIA),as w...BACKGROUND Coronavirus disease 2019(COVID-19)has been shown to increase the risk of stroke.However,the prevalence and risk of recurrent stroke in COVID-19 patients with prior stroke/transient ischemic attack(TIA),as well as its impact on mor-tality,are not established.AIM To evaluate the impact of COVID-19 on in-hospital mortality,length of stay,and healthcare costs in patients with recurrent strokes.METHODS We identified admissions of recurrent stroke(current acute ischemic stroke admissions with at least one prior TIA or stroke)in patients with and without COVID-19 using ICD-10-CM codes using the National Inpatient Sample(2020).We analyzed the impact of COVID-19 on mortality following recurrent stroke admissions by subgroups.RESULTS Of 97455 admissions with recurrent stroke,2140(2.2%)belonged to the COVID-19-positive group.The COVID-19-positive group had a higher prevalence of diabetes and chronic kidney disease vs the COVID-19 negative group(P<0.001).Among the subgroups,patients aged>65 years,patients aged 45–64 years,Asians,Hispanics,whites,and blacks in the COVID-19 positive group had higher rates of all-cause mortality than the COVID-19 negative group(P<0.01).Higher odds of in-hospital mortality were seen in the group aged 45-64(OR:8.40,95%CI:4.18-16.91)vs the group aged>65(OR:7.04,95%CI:5.24-9.44),males(OR:7.82,95%CI:5.38-11.35)compared to females(OR:6.15,95%CI:4.12-9.18),and in Hispanics(OR:15.47,95%CI:7.61-31.44)and Asians/Pacific Islanders(OR:14.93,95%CI:7.22-30.87)compared to blacks(OR:5.73,95%CI:3.08-10.68),and whites(OR:5.54,95%CI:3.79-8.09).CONCLUSION The study highlights the increased risk of all-cause in-hospital mortality in recurrent stroke patients with COVID-19,with a more pronounced increase in middle-aged patients,males,Hispanics,or Asians.展开更多
Objectives:This study aimed to explore the preferences and influencing factors of self-management behaviors in patients with recurrent gout and provide a theoretical basis for developing targeted strategies to improve...Objectives:This study aimed to explore the preferences and influencing factors of self-management behaviors in patients with recurrent gout and provide a theoretical basis for developing targeted strategies to improve self-management preferences.Methods:A total of 10 patients with recurrent gout were recruited from the gout specialist outpatient clinic at a tertiary hospital in Shenyang,Liaoning Province,China.Semi-structured interviews were conducted with these patients,and the Kawakita Jiro(KJ)method was used to analyze the interview data.Results:After four rounds of screening by five researchers,35 codes were selected from an initial 132.After three rounds of discussion and induction,the KJ method identified seven domains of selfmanagement behavior preferences in patients with recurrent gout:1)extensive knowledge of gout,yet difficulty in distinguishing between accurate and inaccurate information;2)a passive attitude of“no pain,no management”;3)the challenge of changing entrenched daily habits;4)the optimistic but unrealistic belief of“self-delusion”;5)a tendency to seek medical attention late due to hopelessness of cure and familiarity with recurrences;6)preference for analgesics for gout recurrences while neglecting long-term urate-lowering therapy(ULT);and 7)gout-related stigma.Conclusion:The results of this study showed that the self-management behavior of patients with recurrent gout could be improved,especially in the aspects of medical seeking behavior,medication compliance,daily management and emotional management.At the same time,we found that gout stigma,difficulty in distinguishing true and false knowledge of gout and negative attitude of“ignoring pain”were significantly associated with self-management behavior.展开更多
BACKGROUND Urethral stricture is a condition that often develops with trauma and results in narrowing of the urethral lumen.Although endoscopic methods are mostly used in its treatment,it has high recurrence rates.The...BACKGROUND Urethral stricture is a condition that often develops with trauma and results in narrowing of the urethral lumen.Although endoscopic methods are mostly used in its treatment,it has high recurrence rates.Therefore,open urethroplasty is recommended after unsuccessful endoscopic treatments.AIM To investigate the risk factors associated with urethral stricture recurrence.METHODS The data of male patients who underwent internal urethrotomy for urethral stricture between January 2017 and January 2023 were retrospectively analyzed.Demographic data,comorbidities,preoperative haemogram,and biochemical values obtained from peripheral blood and operative data were recorded.Patients were divided into two groups in terms of recurrence development;recurrence and non-recurrence.Initially recorded data were compared between the two groups.RESULTS A total of 303 patients were included in the study.The mean age of the patients was 66.6±13.6 years.The mean duration of recurrence development was 9.63±9.84(min-max:1-39)months in the recurrence group.Recurrence did not occur in non-recurrence group throughout the follow-up period with an average time of 44.15±24.07(min-max:12-84)months.In the comparison of both groups,the presence of diabetes mellitus(DM),hypertension(HT),and multiple comorbidi-ties were significantly higher in the recurrence(+)group(P=0.038,P=0.012,P=0.013).Blood group,postoperative use of non-steroidal anti-inflammatory drugs,preoperative cystostomy,cause of stricture,iatrogenic cause of stricture,location and length of stricture,indwelling urinary cathater size and day of catheter removal did not differ between the two groups.No statistically significant difference was observed between the two groups in terms of age,uroflowmetric maximum flow rate value,hemo-gram parameters,aspartate aminotransferase(AST),alanine aminotransferase(ALT),fasting blood sugar,creati-nine,glomerular filtration rate,neutrophil-lymphocyte ratio,platelet-lymphocyte ratio,lymphocyte-monocyte ratio,monocyte-lymphocyte ratio and AST/ALT ratios.CONCLUSION In patients with urethral stricture recurrence,only the frequency of DM and HT was high,while inflammation marker levels and stricture-related parameters were similar between the groups.展开更多
This case report investigates the manifestation of cerebral amyloid angiopathy (CAA) through recurrent Transient Ischemic Attacks (TIAs) in an 82-year-old patient. Despite initial diagnostic complexities, cerebral ang...This case report investigates the manifestation of cerebral amyloid angiopathy (CAA) through recurrent Transient Ischemic Attacks (TIAs) in an 82-year-old patient. Despite initial diagnostic complexities, cerebral angiography-MRI revealed features indicative of CAA. Symptomatic treatment resulted in improvement, but the patient later developed a fatal hematoma. The discussion navigates the intricate therapeutic landscape of repetitive TIAs in the elderly with cardiovascular risk factors, emphasizing the pivotal role of cerebral MRI and meticulous bleeding risk management. The conclusion stresses the importance of incorporating SWI sequences, specifically when suspecting a cardioembolic TIA, as a diagnostic measure to explore and exclude CAA in the differential diagnosis. This case report provides valuable insights into these challenges, highlighting the need to consider CAA in relevant cases.展开更多
Quantum error correction is a crucial technology for realizing quantum computers.These computers achieve faulttolerant quantum computing by detecting and correcting errors using decoding algorithms.Quantum error corre...Quantum error correction is a crucial technology for realizing quantum computers.These computers achieve faulttolerant quantum computing by detecting and correcting errors using decoding algorithms.Quantum error correction using neural network-based machine learning methods is a promising approach that is adapted to physical systems without the need to build noise models.In this paper,we use a distributed decoding strategy,which effectively alleviates the problem of exponential growth of the training set required for neural networks as the code distance of quantum error-correcting codes increases.Our decoding algorithm is based on renormalization group decoding and recurrent neural network decoder.The recurrent neural network is trained through the ResNet architecture to improve its decoding accuracy.Then we test the decoding performance of our distributed strategy decoder,recurrent neural network decoder,and the classic minimum weight perfect matching(MWPM)decoder for rotated surface codes with different code distances under the circuit noise model,the thresholds of these three decoders are about 0.0052,0.0051,and 0.0049,respectively.Our results demonstrate that the distributed strategy decoder outperforms the other two decoders,achieving approximately a 5%improvement in decoding efficiency compared to the MWPM decoder and approximately a 2%improvement compared to the recurrent neural network decoder.展开更多
BACKGROUND Langerhans cell histiocytosis(LCH)is a histiocytic proliferative disease caused by clonal proliferation of Langerhans cells,which is currently defined as an inflam-matory myeloid tumor.It is rare in adults,...BACKGROUND Langerhans cell histiocytosis(LCH)is a histiocytic proliferative disease caused by clonal proliferation of Langerhans cells,which is currently defined as an inflam-matory myeloid tumor.It is rare in adults,with an incidence of 1–2 per million,and is highly heterogeneous in clinical presentation,with unpredictable disease progression and outcome.CASE SUMMARY A 52-year-old postmenopausal female patient presented to the gynecology department in July 2023 with bilateral vulvar masses.She was diagnosed with recurrent multisystem LCH.The patient had previously been diagnosed with a single-system and single-focal LCH in October 2021 due to a right maxillofacial mass,which resolved after surgical treatment.A chemotherapy regimen was developed after multidisciplinary consultation.Six cycles of chemotherapy resulted in partial remission,and maintenance chemotherapy is currently being administered.CONCLUSION Recurrent LCH involving the bilateral vulva has been poorly reported.Compre-hensive imaging and pathological evaluation is important for diagnosis.The model of joint multidisciplinary specialist diagnosis and treatment is worthy of clinical application.展开更多
This work proposes a recorded recurrent twin delayed deep deterministic(RRTD3)policy gradient algorithm to solve the challenge of constructing guidance laws for intercepting endoatmospheric maneuvering missiles with u...This work proposes a recorded recurrent twin delayed deep deterministic(RRTD3)policy gradient algorithm to solve the challenge of constructing guidance laws for intercepting endoatmospheric maneuvering missiles with uncertainties and observation noise.The attack-defense engagement scenario is modeled as a partially observable Markov decision process(POMDP).Given the benefits of recurrent neural networks(RNNs)in processing sequence information,an RNN layer is incorporated into the agent’s policy network to alleviate the bottleneck of traditional deep reinforcement learning methods while dealing with POMDPs.The measurements from the interceptor’s seeker during each guidance cycle are combined into one sequence as the input to the policy network since the detection frequency of an interceptor is usually higher than its guidance frequency.During training,the hidden states of the RNN layer in the policy network are recorded to overcome the partially observable problem that this RNN layer causes inside the agent.The training curves show that the proposed RRTD3 successfully enhances data efficiency,training speed,and training stability.The test results confirm the advantages of the RRTD3-based guidance laws over some conventional guidance laws.展开更多
This paper focuses on wireless-powered communication systems,which are increasingly relevant in the Internet of Things(IoT)due to their ability to extend the operational lifetime of devices with limited energy.The mai...This paper focuses on wireless-powered communication systems,which are increasingly relevant in the Internet of Things(IoT)due to their ability to extend the operational lifetime of devices with limited energy.The main contribution of the paper is a novel approach to minimize the secrecy outage probability(SOP)in these systems.Minimizing SOP is crucial for maintaining the confidentiality and integrity of data,especially in situations where the transmission of sensitive data is critical.Our proposed method harnesses the power of an improved biogeography-based optimization(IBBO)to effectively train a recurrent neural network(RNN).The proposed IBBO introduces an innovative migration model.The core advantage of IBBO lies in its adeptness at maintaining equilibrium between exploration and exploitation.This is accomplished by integrating tactics such as advancing towards a random habitat,adopting the crossover operator from genetic algorithms(GA),and utilizing the global best(Gbest)operator from particle swarm optimization(PSO)into the IBBO framework.The IBBO demonstrates its efficacy by enabling the RNN to optimize the system parameters,resulting in significant outage probability reduction.Through comprehensive simulations,we showcase the superiority of the IBBO-RNN over existing approaches,highlighting its capability to achieve remarkable gains in SOP minimization.This paper compares nine methods for predicting outage probability in wireless-powered communications.The IBBO-RNN achieved the highest accuracy rate of 98.92%,showing a significant performance improvement.In contrast,the standard RNN recorded lower accuracy rates of 91.27%.The IBBO-RNN maintains lower SOP values across the entire signal-to-noise ratio(SNR)spectrum tested,suggesting that the method is highly effective at optimizing system parameters for improved secrecy even at lower SNRs.展开更多
文摘This editorial comments on the article by Desai et al,which investigates the impact of coronavirus disease 2019(COVID-19)on in-hospital mortality among patients with recurrent stroke using data from the 2020 National Inpatient Sample.The findings reveal significantly higher mortality rates in COVID-19-positive patients compared to non-COVID-19 patients,particularly among middle-aged individuals,males,and ethnic minorities.This editorial explores the underlying mechanisms contributing to these outcomes and discusses the clinical implications for targeted management strategies in high-risk groups.The results emphasize the need for comprehensive approaches to mitigate the heightened risks faced by recurrent stroke patients during the COVID-19 pandemic.
基金Supported by Natural Science Foundation of Zhejiang Province,China,No.LQ21H020007.
文摘BACKGROUND Paraganglioma(PGL)is a neuroendocrine tumor originating from paraganglia that can occur in various locations,such as the head,neck,chest,abdomen,and pelvis.Retroperitoneal PGLs are rare,and recurrent cases in this area are partic-ularly uncommon,posing considerable surgical complexities.Owing to their neu-roendocrine activity,PGLs are capable of secreting hormones like catecholamines,thereby presenting significant challenges in hemodynamic management during the perioperative period.CASE SUMMARY We report a 64-year-old man with a recurrent retroperitoneal PGL.The patient underwent retroperitoneal mass resection in 2013,with postoperative pathology revealing a PGL.Regular follow-up was not conducted until April 2024,when a computed tomography scan revealed a huge mass in the retroperitoneum,closely adjacent to the abdominal aorta.Laboratory examinations revealed elevated levels of catecholamines in the patient's blood serum.Upon admission,volume expan-sion and blood pressure(BP)monitoring were carried out for one week,with catecholamine levels reviewed and normalized.Adequate preoperative prepa-ration was conducted,including central venous access,arterial BP monitoring,and the preparation of vasoactive agents.During tumor resection,the patient ex-perienced acute,significant fluctuations in BP.The timely intervention of the anesthesiologist stabilized the BP,facilitating the successful resection of the tumor which was confirmed as a recurrent PGL.Postoperative follow-up revealed no evidence of tumor residual or recurrence.CONCLUSION PGL recurrence is rare but non-negligible.PGLs adjacent to major arteries com-plicate surgery,and perioperative hemodynamic stability demands meticulous attention.Core Tip:Recurrent retroperitoneal paragangliomas are infrequent but pose substantial surgical challenges,particularly when located adjacent to critical vascular structures such as the abdominal aorta.Effective perioperative management of he-modynamic fluctuations,driven by catecholamine secretion,requires meticulous preoperative planning,including volume expansion,blood pressure monitoring,and vasoactive agent preparation.Surgical intervention demands prompt and coordinated anesthetic support to stabilize hemodynamics,ensuring successful tumor resection.Given the potential for late recurrence,long-term follow-up is essential for early detection and management of asymptomatic recurrences.INTRODUCTION Paraganglioma(PGL)is a neuroendocrine tumor originating from paraganglia,which are associated with the autonomic nervous system[1].These tumors arise from chromaffin cells or similar cells capable of secreting catecholamines,such as adrenaline and noradrenaline.PGLs manifest in various anatomical locations,including the head,neck,chest,abdomen,and pelvis,and are characterized by neurosecretory and chief cells surrounded by prominent vascular stroma.Although typically benign,malignant forms of PGL are also recognized,and they may exhibit a tendency for recurrence or me-tastasis[2].PGLs located in the retroperitoneum are relatively uncommon and present greater surgical challenges because of their complex anatomical location near vital organs and major blood vessels.Their catecholamine-secreting nature further complicates the maintenance of hemodynamic stability during the perioperative period.In May 2024,a patient with recurrent retroperitoneal PGL was admitted to our hospital,and the details are reported below.
文摘BACKGROUND Early anal canal cancer is frequently treated with endoscopic submucosal dis-section(ESD)to preserve anal function.However,if the lesion is in the anal canal,then significant difficulties such as bleeding and challenges associated with scope manipulation can arise.CASE SUMMARY A 70-year-old woman undergoing follow-up after transverse colon cancer surgery was diagnosed with anal canal cancer extending to the dentate line.The patient underwent a combination of ESD and transanal resection(TAR).The specimen was excised in pieces,which resulted in difficulty performing the pathological evaluation of the margins,especially on the anal side where TAR was performed and severe crushing was observed.Careful follow-up was performed,and local recurrence was observed 3 years postoperatively.Because the patient had super-ficial cancer without lymph node metastasis,local resection was performed again.The second treatment attempt was improved as follows:(1)TAR and ESD were performed appropriately based on the situation by the same physician;(2)A needle scalpel was used during TAR to prevent tissue crushing;and(3)The lesion borders were marked using ESD techniques before treatment.Complete resection was performed without complications.CONCLUSION Anal canal lesions can be safely and reliably removed when ESD and TAR are used appropriately.
文摘BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a result of pancreaticobiliary reflux.Roux-en-Y choledochojejunostomy is a common surgical method for the treatment of PBM,but there are several associated complications that may occur after this operation.CASE SUMMARY The patient,a 12-year-old female,was hospitalized nearly 20 times in 2021 for recurrent acute pancreatitis.In 2022,she was diagnosed with PBM and underwent laparoscopic common bile duct resection and Roux-en-Y choledochojejunostomy in a tertiary hospital.In the first year after surgery,the patient had more than 10 recurrent acute pancreatitis episodes.After undergoing abdominal computed tomography and other examinations,she was diagnosed with“residual bile duct stones and recurrent acute pancreatitis”.On January 30,2024,the patient was admitted to our hospital due to recurrent upper abdominal pain and was cured through endoscopic retrograde cholangiopancreatography.CONCLUSION This article reports a case of a child with distal residual common bile duct stones and recurrent acute pancreatitis after Roux-en-Y choledochojejunostomy for PBM.The patient was cured through endoscopic retrograde cholangiopancreatography.
文摘Research Background: Pre-eclampsia is one of main causes of materno-foetal mortality and morbidity worldwide, with a prevalence of 3% - 7%. Although considered a primiparous condition, it can nevertheless recur. Several factors appear to be associated with risk of recurrence of pre-eclampsia, such as the term of delivery of previous pregnancy, severity of disease, the existence of co-morbidities and the inter-genital space. Purpose: The aim of our study will be to analyse and identify in a population of pregnant women with a history of preeclampsia risk factors associated with occurrence of recurrent preeclampsia at University clinics of Kinshasa (Democratic Republic of Congo) and at Victor Dupouy Hospital Center (France). Methods: In this study, pregnant women with an history of preeclampsia who will give birth between November 2018 and October 2024 at University Clinics of Kinshasa (UCK) and Victor Dupouy Hospital Center (VDHC) will be included. This will be a cross-sectional analytical study, data from previous and subsequent pregnancies will be studied. Expected Result: The prevalence of recurrent preeclampsia in the study population will be determined. And we will highlight the factors that will determine the recurrence of preeclampsia by analysing the risk factors. Conclusion: Knowledge of the factors associated with recurrent preeclampsia could be an excellent tool for predicting and preventing the disease.
文摘BACKGROUND With 4.9 to 35 instances per 100000 cases,hyperparathyroidism is one of the rarest causes of acute pancreatitis.The major cause of primary hyperparathyroidism is a parathyroid adenoma,which can manifest clinically in various ways.CASE SUMMARY We discuss the unusual case of a 13-year-old boy with recurrent pancreatitis as the initial presentation of primary hyperparathyroidism.The cause of his recurrent pancreatitis remained unknown,and the patient had multiple admissions with acute pancreatitis over 3 years.His diagnosis was delayed due to the initial normal levels of parathyroid hormone,which were later reported elevated in a subsequent episode where ultrasound neck and thyroid scintigraphy revealed a parathyroid adenoma as the underlying cause.After the diagnosis was made,he underwent surgical resection of the adenoma.CONCLUSION This case study stresses the importance of considering uncommon causes for recurrent pancreatitis.
基金supported by the Japan Society for the Promotion of Science(JSPS)KAKENHI(JP22H03643)Japan Science and Technology Agency(JST)Support for Pioneering Research Initiated by the Next Generation(SPRING)(JPMJSP2145)+2 种基金JST Through the Establishment of University Fellowships Towards the Creation of Science Technology Innovation(JPMJFS2115)the National Natural Science Foundation of China(52078382)the State Key Laboratory of Disaster Reduction in Civil Engineering(CE19-A-01)。
文摘Accurately predicting fluid forces acting on the sur-face of a structure is crucial in engineering design.However,this task becomes particularly challenging in turbulent flow,due to the complex and irregular changes in the flow field.In this study,we propose a novel deep learning method,named mapping net-work-coordinated stacked gated recurrent units(MSU),for pre-dicting pressure on a circular cylinder from velocity data.Specifi-cally,our coordinated learning strategy is designed to extract the most critical velocity point for prediction,a process that has not been explored before.In our experiments,MSU extracts one point from a velocity field containing 121 points and utilizes this point to accurately predict 100 pressure points on the cylinder.This method significantly reduces the workload of data measure-ment in practical engineering applications.Our experimental results demonstrate that MSU predictions are highly similar to the real turbulent data in both spatio-temporal and individual aspects.Furthermore,the comparison results show that MSU predicts more precise results,even outperforming models that use all velocity field points.Compared with state-of-the-art methods,MSU has an average improvement of more than 45%in various indicators such as root mean square error(RMSE).Through comprehensive and authoritative physical verification,we estab-lished that MSU’s prediction results closely align with pressure field data obtained in real turbulence fields.This confirmation underscores the considerable potential of MSU for practical applications in real engineering scenarios.The code is available at https://github.com/zhangzm0128/MSU.
基金supported by the Youth Fund of Fundamental Research Fund for the Central Universities of Jinan University,No.11622303(to YZ).
文摘Microvasculature of the retina is considered an alternative marker of cerebral vascular risk in healthy populations.However,the ability of retinal vasculature changes,specifically focusing on retinal vessel diameter,to predict the recurrence of cerebrovascular events in patients with ischemic stroke has not been determined comprehensively.While previous studies have shown a link between retinal vessel diameter and recurrent cerebrovascular events,they have not incorporated this information into a predictive model.Therefore,this study aimed to investigate the relationship between retinal vessel diameter and subsequent cerebrovascular events in patients with acute ischemic stroke.Additionally,we sought to establish a predictive model by combining retinal veessel diameter with traditional risk factors.We performed a prospective observational study of 141 patients with acute ischemic stroke who were admitted to the First Affiliated Hospital of Jinan University.All of these patients underwent digital retinal imaging within 72 hours of admission and were followed up for 3 years.We found that,after adjusting for related risk factors,patients with acute ischemic stroke with mean arteriolar diameter within 0.5-1.0 disc diameters of the disc margin(MAD_(0.5-1.0DD))of≥74.14μm and mean venular diameter within 0.5-1.0 disc diameters of the disc margin(MVD_(0.5-1.0DD))of≥83.91μm tended to experience recurrent cerebrovascular events.We established three multivariate Cox proportional hazard regression models:model 1 included traditional risk factors,model 2 added MAD_(0.5-1.0DD)to model 1,and model 3 added MVD0.5-1.0DD to model 1.Model 3 had the greatest potential to predict subsequent cerebrovascular events,followed by model 2,and finally model 1.These findings indicate that combining retinal venular or arteriolar diameter with traditional risk factors could improve the prediction of recurrent cerebrovascular events in patients with acute ischemic stroke,and that retinal imaging could be a useful and non-invasive method for identifying high-risk patients who require closer monitoring and more aggressive management.
文摘Tunnel boring machines(TBMs)have been widely utilised in tunnel construction due to their high efficiency and reliability.Accurately predicting TBM performance can improve project time management,cost control,and risk management.This study aims to use deep learning to develop real-time models for predicting the penetration rate(PR).The models are built using data from the Changsha metro project,and their performances are evaluated using unseen data from the Zhengzhou Metro project.In one-step forecast,the predicted penetration rate follows the trend of the measured penetration rate in both training and testing.The autoregressive integrated moving average(ARIMA)model is compared with the recurrent neural network(RNN)model.The results show that univariate models,which only consider historical penetration rate itself,perform better than multivariate models that take into account multiple geological and operational parameters(GEO and OP).Next,an RNN variant combining time series of penetration rate with the last-step geological and operational parameters is developed,and it performs better than other models.A sensitivity analysis shows that the penetration rate is the most important parameter,while other parameters have a smaller impact on time series forecasting.It is also found that smoothed data are easier to predict with high accuracy.Nevertheless,over-simplified data can lose real characteristics in time series.In conclusion,the RNN variant can accurately predict the next-step penetration rate,and data smoothing is crucial in time series forecasting.This study provides practical guidance for TBM performance forecasting in practical engineering.
基金The authors thank the Yayasan Universiti Teknologi PETRONAS(YUTP FRG Grant No.015LC0-428)at Universiti Teknologi PETRO-NAS for supporting this study.
文摘Static Poisson’s ratio(vs)is crucial for determining geomechanical properties in petroleum applications,namely sand production.Some models have been used to predict vs;however,the published models were limited to specific data ranges with an average absolute percentage relative error(AAPRE)of more than 10%.The published gated recurrent unit(GRU)models do not consider trend analysis to show physical behaviors.In this study,we aim to develop a GRU model using trend analysis and three inputs for predicting n s based on a broad range of data,n s(value of 0.1627-0.4492),bulk formation density(RHOB)(0.315-2.994 g/mL),compressional time(DTc)(44.43-186.9 μs/ft),and shear time(DTs)(72.9-341.2μ s/ft).The GRU model was evaluated using different approaches,including statistical error an-alyses.The GRU model showed the proper trends,and the model data ranges were wider than previous ones.The GRU model has the largest correlation coefficient(R)of 0.967 and the lowest AAPRE,average percent relative error(APRE),root mean square error(RMSE),and standard deviation(SD)of 3.228%,1.054%,4.389,and 0.013,respectively,compared to other models.The GRU model has a high accuracy for the different datasets:training,validation,testing,and the whole datasets with R and AAPRE values were 0.981 and 2.601%,0.966 and 3.274%,0.967 and 3.228%,and 0.977 and 2.861%,respectively.The group error analyses of all inputs show that the GRU model has less than 5% AAPRE for all input ranges,which is superior to other models that have different AAPRE values of more than 10% at various ranges of inputs.
文摘BACKGROUND Lower extremity lymphedema is a common complication following treatment for gynecological malignancies.Its incidence rate can reach up to 70%,affecting~20 million people worldwide.However,specialized treatment centers are scarce,and there is a lack of consensus on treatment approaches.Furthermore,there are even fewer reports on the systematic and effective treatment of severe lymphedema with malformations.Effective management of this condition remains a significant challenge for clinicians.CASE SUMMARY A 40-year-old woman developed bilateral leg swelling 6 years after receiving treatment for endometrial cancer.Since August 2018,she experienced>30 episodes of lymphangitis.Upon presentation,she exhibited bilateral leg swelling and deformation,with four large swellings in the posterior thigh that impeded movement,and pain in the limbs.Skin manifestations included lichenoid lesions and features of deep sclerosis.Radionuclide lymphoscintigraphy confirmed the diagnosis of lower limb lymphedema.After 6 mo of complex decongestive therapy(CDT)and three lymphaticovenous anastomosis(LVA)treatments,the patient lost 49 kg in weight.She also experienced a maximum circumference reduction of 35.2 cm in the left lower limb and 37.5 cm in the right lower limb.The leg pain disappeared,her swelling significantly decreased,and she regained the ability to walk,cycle,and run normally.CONCLUSION The combined application of CDT and LVA therapy demonstrates significant positive effects in the treatment of severe,deformed stage III lymphedema.
文摘BACKGROUND The recurrence rate of liver cancer after surgery is high.Radiofrequency ablation(RFA)combined with transcatheter arterial chemoembolization(TACE)is an effective treatment for liver cancer;however,its efficacy in recurrent liver cancer remains unclear.AIM To investigate the clinical effect of TACE combined with RFA in the treatment of recurrent liver cancer.METHODS Ninety patients with recurrent liver cancer were divided into 2 groups according to treatment plan:Control(RFA alone);and experimental[TACE combined with RFA(TACE+RFA)].The incidence of increased alanine aminotransferase levels,complications,and other indices were compared between the two groups before and after the procedures.RESULTS One month after the procedures,the short-term efficacy rate and Karnofsky Performance Status scores of the experimental group were significantly higher than those of the control group(P<0.05).Alpha-fetoprotein(AFP)and total bilirubin levels were lower than those in the control group(P<0.05);The overall response rate was 82.22%and 66.67%in the experimental and control groups,respectively;The disease control rate was 93.33%and 82.22%in the experimental and control groups,respectively,the differences are statistically significant(P<0.05).And there were no statistical differences in complications between the two groups(P>0.05).CONCLUSION TACE+RFA was effective for the treatment of recurrent liver cancer and significantly reduced AFP levels and improved various indices of liver function.
文摘BACKGROUND Coronavirus disease 2019(COVID-19)has been shown to increase the risk of stroke.However,the prevalence and risk of recurrent stroke in COVID-19 patients with prior stroke/transient ischemic attack(TIA),as well as its impact on mor-tality,are not established.AIM To evaluate the impact of COVID-19 on in-hospital mortality,length of stay,and healthcare costs in patients with recurrent strokes.METHODS We identified admissions of recurrent stroke(current acute ischemic stroke admissions with at least one prior TIA or stroke)in patients with and without COVID-19 using ICD-10-CM codes using the National Inpatient Sample(2020).We analyzed the impact of COVID-19 on mortality following recurrent stroke admissions by subgroups.RESULTS Of 97455 admissions with recurrent stroke,2140(2.2%)belonged to the COVID-19-positive group.The COVID-19-positive group had a higher prevalence of diabetes and chronic kidney disease vs the COVID-19 negative group(P<0.001).Among the subgroups,patients aged>65 years,patients aged 45–64 years,Asians,Hispanics,whites,and blacks in the COVID-19 positive group had higher rates of all-cause mortality than the COVID-19 negative group(P<0.01).Higher odds of in-hospital mortality were seen in the group aged 45-64(OR:8.40,95%CI:4.18-16.91)vs the group aged>65(OR:7.04,95%CI:5.24-9.44),males(OR:7.82,95%CI:5.38-11.35)compared to females(OR:6.15,95%CI:4.12-9.18),and in Hispanics(OR:15.47,95%CI:7.61-31.44)and Asians/Pacific Islanders(OR:14.93,95%CI:7.22-30.87)compared to blacks(OR:5.73,95%CI:3.08-10.68),and whites(OR:5.54,95%CI:3.79-8.09).CONCLUSION The study highlights the increased risk of all-cause in-hospital mortality in recurrent stroke patients with COVID-19,with a more pronounced increase in middle-aged patients,males,Hispanics,or Asians.
文摘Objectives:This study aimed to explore the preferences and influencing factors of self-management behaviors in patients with recurrent gout and provide a theoretical basis for developing targeted strategies to improve self-management preferences.Methods:A total of 10 patients with recurrent gout were recruited from the gout specialist outpatient clinic at a tertiary hospital in Shenyang,Liaoning Province,China.Semi-structured interviews were conducted with these patients,and the Kawakita Jiro(KJ)method was used to analyze the interview data.Results:After four rounds of screening by five researchers,35 codes were selected from an initial 132.After three rounds of discussion and induction,the KJ method identified seven domains of selfmanagement behavior preferences in patients with recurrent gout:1)extensive knowledge of gout,yet difficulty in distinguishing between accurate and inaccurate information;2)a passive attitude of“no pain,no management”;3)the challenge of changing entrenched daily habits;4)the optimistic but unrealistic belief of“self-delusion”;5)a tendency to seek medical attention late due to hopelessness of cure and familiarity with recurrences;6)preference for analgesics for gout recurrences while neglecting long-term urate-lowering therapy(ULT);and 7)gout-related stigma.Conclusion:The results of this study showed that the self-management behavior of patients with recurrent gout could be improved,especially in the aspects of medical seeking behavior,medication compliance,daily management and emotional management.At the same time,we found that gout stigma,difficulty in distinguishing true and false knowledge of gout and negative attitude of“ignoring pain”were significantly associated with self-management behavior.
文摘BACKGROUND Urethral stricture is a condition that often develops with trauma and results in narrowing of the urethral lumen.Although endoscopic methods are mostly used in its treatment,it has high recurrence rates.Therefore,open urethroplasty is recommended after unsuccessful endoscopic treatments.AIM To investigate the risk factors associated with urethral stricture recurrence.METHODS The data of male patients who underwent internal urethrotomy for urethral stricture between January 2017 and January 2023 were retrospectively analyzed.Demographic data,comorbidities,preoperative haemogram,and biochemical values obtained from peripheral blood and operative data were recorded.Patients were divided into two groups in terms of recurrence development;recurrence and non-recurrence.Initially recorded data were compared between the two groups.RESULTS A total of 303 patients were included in the study.The mean age of the patients was 66.6±13.6 years.The mean duration of recurrence development was 9.63±9.84(min-max:1-39)months in the recurrence group.Recurrence did not occur in non-recurrence group throughout the follow-up period with an average time of 44.15±24.07(min-max:12-84)months.In the comparison of both groups,the presence of diabetes mellitus(DM),hypertension(HT),and multiple comorbidi-ties were significantly higher in the recurrence(+)group(P=0.038,P=0.012,P=0.013).Blood group,postoperative use of non-steroidal anti-inflammatory drugs,preoperative cystostomy,cause of stricture,iatrogenic cause of stricture,location and length of stricture,indwelling urinary cathater size and day of catheter removal did not differ between the two groups.No statistically significant difference was observed between the two groups in terms of age,uroflowmetric maximum flow rate value,hemo-gram parameters,aspartate aminotransferase(AST),alanine aminotransferase(ALT),fasting blood sugar,creati-nine,glomerular filtration rate,neutrophil-lymphocyte ratio,platelet-lymphocyte ratio,lymphocyte-monocyte ratio,monocyte-lymphocyte ratio and AST/ALT ratios.CONCLUSION In patients with urethral stricture recurrence,only the frequency of DM and HT was high,while inflammation marker levels and stricture-related parameters were similar between the groups.
文摘This case report investigates the manifestation of cerebral amyloid angiopathy (CAA) through recurrent Transient Ischemic Attacks (TIAs) in an 82-year-old patient. Despite initial diagnostic complexities, cerebral angiography-MRI revealed features indicative of CAA. Symptomatic treatment resulted in improvement, but the patient later developed a fatal hematoma. The discussion navigates the intricate therapeutic landscape of repetitive TIAs in the elderly with cardiovascular risk factors, emphasizing the pivotal role of cerebral MRI and meticulous bleeding risk management. The conclusion stresses the importance of incorporating SWI sequences, specifically when suspecting a cardioembolic TIA, as a diagnostic measure to explore and exclude CAA in the differential diagnosis. This case report provides valuable insights into these challenges, highlighting the need to consider CAA in relevant cases.
基金Project supported by Natural Science Foundation of Shandong Province,China (Grant Nos.ZR2021MF049,ZR2022LLZ012,and ZR2021LLZ001)。
文摘Quantum error correction is a crucial technology for realizing quantum computers.These computers achieve faulttolerant quantum computing by detecting and correcting errors using decoding algorithms.Quantum error correction using neural network-based machine learning methods is a promising approach that is adapted to physical systems without the need to build noise models.In this paper,we use a distributed decoding strategy,which effectively alleviates the problem of exponential growth of the training set required for neural networks as the code distance of quantum error-correcting codes increases.Our decoding algorithm is based on renormalization group decoding and recurrent neural network decoder.The recurrent neural network is trained through the ResNet architecture to improve its decoding accuracy.Then we test the decoding performance of our distributed strategy decoder,recurrent neural network decoder,and the classic minimum weight perfect matching(MWPM)decoder for rotated surface codes with different code distances under the circuit noise model,the thresholds of these three decoders are about 0.0052,0.0051,and 0.0049,respectively.Our results demonstrate that the distributed strategy decoder outperforms the other two decoders,achieving approximately a 5%improvement in decoding efficiency compared to the MWPM decoder and approximately a 2%improvement compared to the recurrent neural network decoder.
基金the Chongqing Science and Health Committee Joint Medical Scientific Research General Project,No.2021MSXM236the Health Development Promotion Project,No.BJHA-CRP-086.
文摘BACKGROUND Langerhans cell histiocytosis(LCH)is a histiocytic proliferative disease caused by clonal proliferation of Langerhans cells,which is currently defined as an inflam-matory myeloid tumor.It is rare in adults,with an incidence of 1–2 per million,and is highly heterogeneous in clinical presentation,with unpredictable disease progression and outcome.CASE SUMMARY A 52-year-old postmenopausal female patient presented to the gynecology department in July 2023 with bilateral vulvar masses.She was diagnosed with recurrent multisystem LCH.The patient had previously been diagnosed with a single-system and single-focal LCH in October 2021 due to a right maxillofacial mass,which resolved after surgical treatment.A chemotherapy regimen was developed after multidisciplinary consultation.Six cycles of chemotherapy resulted in partial remission,and maintenance chemotherapy is currently being administered.CONCLUSION Recurrent LCH involving the bilateral vulva has been poorly reported.Compre-hensive imaging and pathological evaluation is important for diagnosis.The model of joint multidisciplinary specialist diagnosis and treatment is worthy of clinical application.
基金supported by the National Natural Science Foundation of China(Grant No.12072090)。
文摘This work proposes a recorded recurrent twin delayed deep deterministic(RRTD3)policy gradient algorithm to solve the challenge of constructing guidance laws for intercepting endoatmospheric maneuvering missiles with uncertainties and observation noise.The attack-defense engagement scenario is modeled as a partially observable Markov decision process(POMDP).Given the benefits of recurrent neural networks(RNNs)in processing sequence information,an RNN layer is incorporated into the agent’s policy network to alleviate the bottleneck of traditional deep reinforcement learning methods while dealing with POMDPs.The measurements from the interceptor’s seeker during each guidance cycle are combined into one sequence as the input to the policy network since the detection frequency of an interceptor is usually higher than its guidance frequency.During training,the hidden states of the RNN layer in the policy network are recorded to overcome the partially observable problem that this RNN layer causes inside the agent.The training curves show that the proposed RRTD3 successfully enhances data efficiency,training speed,and training stability.The test results confirm the advantages of the RRTD3-based guidance laws over some conventional guidance laws.
文摘This paper focuses on wireless-powered communication systems,which are increasingly relevant in the Internet of Things(IoT)due to their ability to extend the operational lifetime of devices with limited energy.The main contribution of the paper is a novel approach to minimize the secrecy outage probability(SOP)in these systems.Minimizing SOP is crucial for maintaining the confidentiality and integrity of data,especially in situations where the transmission of sensitive data is critical.Our proposed method harnesses the power of an improved biogeography-based optimization(IBBO)to effectively train a recurrent neural network(RNN).The proposed IBBO introduces an innovative migration model.The core advantage of IBBO lies in its adeptness at maintaining equilibrium between exploration and exploitation.This is accomplished by integrating tactics such as advancing towards a random habitat,adopting the crossover operator from genetic algorithms(GA),and utilizing the global best(Gbest)operator from particle swarm optimization(PSO)into the IBBO framework.The IBBO demonstrates its efficacy by enabling the RNN to optimize the system parameters,resulting in significant outage probability reduction.Through comprehensive simulations,we showcase the superiority of the IBBO-RNN over existing approaches,highlighting its capability to achieve remarkable gains in SOP minimization.This paper compares nine methods for predicting outage probability in wireless-powered communications.The IBBO-RNN achieved the highest accuracy rate of 98.92%,showing a significant performance improvement.In contrast,the standard RNN recorded lower accuracy rates of 91.27%.The IBBO-RNN maintains lower SOP values across the entire signal-to-noise ratio(SNR)spectrum tested,suggesting that the method is highly effective at optimizing system parameters for improved secrecy even at lower SNRs.
