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
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
BACKGROUND The introduction of pegaspargase has greatly advanced the treatment of acute lymphoblastic leukemia(ALL).In the literature,only one case of pegaspargaseinduced multiple organ failure has been reported,and t...BACKGROUND The introduction of pegaspargase has greatly advanced the treatment of acute lymphoblastic leukemia(ALL).In the literature,only one case of pegaspargaseinduced multiple organ failure has been reported,and the patient died due to multiple organ failure.CASE SUMMARY Herein,we present a rare case of a 40-year-old man with ALL who developed multiple organ failure after treatment with pegaspargase.The patient had two rare phenomena reflecting poor prognosis,including the discrepancy between clinical manifestations and liver function and persistently low alpha-fetoprotein(AFP)levels from subacute liver failure.However,the patient was successfully treated using a multidisciplinary team approach.CONCLUSION This is the first case report of successful treatment of pegaspargase-induced multiple organ failure.The findings emphasize the importance of a multidisciplinary team approach in treating pegaspargase-induced multiple organ failure.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
BACKGROUND The coronavirus disease 2019 pandemic has had an ongoing impact on the public’s mental health that requires long-term attention.Exploring the relationship between mental health indicators would aid in iden...BACKGROUND The coronavirus disease 2019 pandemic has had an ongoing impact on the public’s mental health that requires long-term attention.Exploring the relationship between mental health indicators would aid in identifying solutions to improve public mental health.AIM To investigate the prevalence of anxiety,depression,and insomnia and explore the relationship among neuroticism,cognitive failures,and mental health.METHODS A cross-sectional survey was conducted in December 2023 using an online platform to recruit adult participants.The neuroticism,subjective cognitive function,and mental health of the participants were assessed using the neuroticism subscale of the Chinese Big Five Personality Inventory Brief Version,cognitive failures questionnaire,generalized anxiety disorder-7,patient health questionnaire-9,and insomnia severity index.Pearson's correlation analysis,independent samples t-tests,one-way analysis of variance,and structural equation model were used to examine the relationship between mental health indicators.RESULTS A total of 1011 valid questionnaires were collected,of which 343 were completed by male(33.93%)respondents and 668 were completed by female(66.07%)respondents.The rates of anxiety,depression,and insomnia were 41.3%,44.6%,and 36.3%,respectively,most cases of which were mild.Among the mental health indicators,there were significant differences by age and between those with siblings and those who were only children.Neuroticism and cognitive failures were significantly positively correlated with mental health indicators.Further moderated mediation analysis showed that cognitive failures mediated the relationship between insomnia and anxiety and between insomnia and depression,with neuroticism moderating the first half of this pathway and the effect being greater in the low-neuroticism group.CONCLUSION Cognitive failures and neuroticism play important roles in mental health.Therefore,enhancing subjective cognitive function and regulating emotional stability may contribute to the improvement of mental health.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
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
Objective: Through the treatment of liver failure using artificial liver plasma exchange (PE), this study aims to explore the predictive value and clinical significance of alpha-fetoprotein (AFP) levels in the prognos...Objective: Through the treatment of liver failure using artificial liver plasma exchange (PE), this study aims to explore the predictive value and clinical significance of alpha-fetoprotein (AFP) levels in the prognosis of liver failure patients. Methods: A retrospective analysis was conducted on the clinical data of 96 liver failure patients, all of whom underwent artificial liver plasma exchange therapy in addition to standard medical treatment. Based on AFP test values, patients were divided into three groups: low AFP group (AFP < 100 ng/mL, n = 32), medium AFP group (100 ≤ AFP < 200 ng/mL, n = 32), and high AFP group (AFP ≥ 200 ng/mL, n = 32). Serum AFP levels were measured before artificial liver therapy (on the second day of hospitalization), on days 1, 10, and 20 after treatment, and at the final evaluation (before discharge or prior to death) to observe changes. Results: Among the 96 patients, 4 (4.2%) had acute liver failure (ALF), 7 (7.3%) had subacute liver failure (SALF), 57 (59.4%) had acute-on-chronic liver failure (ACLF), and 28 (29.2%) had chronic liver failure (CLF), with an overall survival rate of 82.3% (79/96). Patients in the AFP < 100 ng/mL group had a lower survival rate compared to the other two groups, and survival rates increased with higher AFP levels (P < 0.05). Conclusion: Serum AFP levels are closely related to the efficacy of artificial liver plasma exchange therapy for liver failure, and dynamic monitoring of AFP changes can help assess disease progression.展开更多
BACKGROUND Post-hepatectomy liver failure(PHLF)after liver resection is one of the main complications causing postoperative death in patients with hepatocellular carcinoma(HCC).It is crucial to help clinicians identif...BACKGROUND Post-hepatectomy liver failure(PHLF)after liver resection is one of the main complications causing postoperative death in patients with hepatocellular carcinoma(HCC).It is crucial to help clinicians identify potential high-risk PHLF patients as early as possible through preoperative evaluation.AIM To identify risk factors for PHLF and develop a prediction model.METHODS This study included 248 patients with HCC at The Second Affiliated Hospital of Air Force Medical University between January 2014 and December 2023;these patients were divided into a training group(n=164)and a validation group(n=84)via random sampling.The independent variables for the occurrence of PHLF were identified by univariate and multivariate analyses and visualized as nomograms.Ultimately,comparisons were made with traditional models via receiver operating characteristic(ROC)curves,calibration curves,and decision curve analysis(DCA).RESULTS In this study,portal vein width[odds ratio(OR)=1.603,95%CI:1.288-1.994,P≤0.001],the preoperative neutrophil-to-lymphocyte ratio(NLR)(OR=1.495,95%CI:1.126-1.984,P=0.005),and the albumin-bilirubin(ALBI)score(OR=8.868,95%CI:2.144-36.678,P=0.003)were independent risk factors for PHLF.A nomogram prediction model was developed using these factors.ROC and DCA analyses revealed that the predictive efficacy and clinical value of this model were better than those of traditional models.CONCLUSION A new Nomogram model for predicting PHLF in HCC patients was successfully established based on portal vein width,the NLR,and the ALBI score,which outperforms the traditional model.展开更多
Loess-mudstone landslides are common in the Loess Plateau.Investigations into the mechanical theory of loess-mudstone landslides have become a challenging undertaking due to the distinctive interfacial properties of l...Loess-mudstone landslides are common in the Loess Plateau.Investigations into the mechanical theory of loess-mudstone landslides have become a challenging undertaking due to the distinctive interfacial properties of loess-mudstone and the unique water sensitivity characteristics of mudstone.Hence,it is imperative to develop innovative mechanical models and mathematical equations specifically tailored to loess-mudstone landslides.In this study,we analyze the fracture mechanism of the loess-mudstone sliding zone using plastic fracture mechanics and develop a unique fracture yield model.To calculate the energy release rate during the expansion of the loess-mudstone interface tip region,the shear fracture energy G is applied,which reflects both the yield failure criterion and the fracture failure criterion.To better understand the instability mechanism of loess-mudstone landslides,equilibrium equations based on G are established for tractive,compressive,and tensile loess-mudstone landslides.Based on the equilibrium equation,the critical length Lc of the sliding zone can be used for the safety evaluation of loess-mudstone landslides.In this way,this study proposes a new method for determining the failure mechanism and equilibrium equation of loessmudstone landslides,which resolves their starting mechanism,mechanical equilibrium equations,and safety evaluation indicators,thus justifying the scientific significance and practical value of this research.展开更多
Objective:To analyze the burden of caregivers of CHF patients in the current environment,to explore the related burden and influencing factors of caring for patients with chronic heart failure,and to explore the impac...Objective:To analyze the burden of caregivers of CHF patients in the current environment,to explore the related burden and influencing factors of caring for patients with chronic heart failure,and to explore the impact of filial piety values on the burden of caring for patients.Methods:192 caregivers of CHF patients in the hospital were selected as the main objects of this study.The main method was convenient sampling.Through a questionnaire survey of 192 CHF patients'caregivers,a unified investigation was conducted from the aspects of patient"'s general condition,objective burden,anxiety and depression degree and relationship quality,etc.The structural equation model was constructed and adjusted by analyzing data entry and variable correlation.Finally,path analysis was used to conduct inferential research on the direct and indirect influencing factors of control burden.Results:More than half of the patients'caregivers had a caregiving burden,and the practical caregiving dimension had the highest score.The total effect values of patient-related factors,including anxiety degree,number of concomitant diseases and half-year readmission rate,were 0.36,0.31 and 0.20,respectively(P<0.05).The total effect values of filial piety,anxiety degree,average care time and understanding degree of disease directly derived from the caregivers themselves were-0.38,0.29,0.29 and-0.23,respectively(P<0.05).In addition,the influence of filial piety values on the caregiver burden was more obvious,and the direct effect value of the value was-0.41(P<0.001).Conclusion:Most caregivers of CHF patients have a certain objective burden of care,and there are many factors that affect it,among which the degree of filial piety value is the most important.This finding provides a clear goal for caregivers to develop measures to improve the caregiver burden.展开更多
Modeling HIV/AIDS progression is critical for understanding disease dynamics and improving patient care. This study compares the Exponential and Weibull survival models, focusing on their ability to capture state-spec...Modeling HIV/AIDS progression is critical for understanding disease dynamics and improving patient care. This study compares the Exponential and Weibull survival models, focusing on their ability to capture state-specific failure rates in HIV/AIDS progression. While the Exponential model offers simplicity with a constant hazard rate, it often fails to accommodate the complexities of dynamic disease progression. In contrast, the Weibull model provides flexibility by allowing hazard rates to vary over time. Both models are evaluated within the frameworks of the Cox Proportional Hazards (Cox PH) and Accelerated Failure Time (AFT) models, incorporating critical covariates such as age, gender, CD4 count, and ART status. Statistical evaluation metrics, including Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), log-likelihood, and Pseudo-R2, were employed to assess model performance across diverse patient subgroups. Results indicate that the Weibull model consistently outperforms the Exponential model in dynamic scenarios, such as younger patients and those with co-infections, while maintaining robustness in stable contexts. This study highlights the trade-off between flexibility and simplicity in survival modeling, advocating for tailored model selection to balance interpretability and predictive accuracy. These findings provide valuable insights for optimizing HIV/AIDS management strategies and advancing survival analysis methodologies.展开更多
This study presents an innovative approach to calculating the failure probability of slopes by incorporating fuzzylimit-state functions,a method that significantly enhances the accuracy and efficiency of slope stabili...This study presents an innovative approach to calculating the failure probability of slopes by incorporating fuzzylimit-state functions,a method that significantly enhances the accuracy and efficiency of slope stability analysis.Unlike traditional probabilistic techniques,this approach utilizes a least squares support vector machine(LSSVM)optimized with a grey wolf optimizer(GWO)and K-fold cross-validation(CV)to approximate the limit-statefunction,thus reducing computational complexity.The novelty of this work lies in its application to one-dimensional(1D),two-dimensional(2D),and three-dimensional(3D)slope models,demonstrating its versatility andhigh precision.The proposed method consistently achieves error margins within 3%of Monte Carlo simulation(MCS)results,while substantially reducing computation time,particularly for 2D and 3D models.This makes theapproach highly practical for real-world engineering applications.Furthermore,by applying fuzzy mathematics tohandle uncertainties in geotechnical properties,the method offers a more realistic and comprehensive understandingof slope stability.As water is the main factor influencing the stability of slopes,this aspect is investigatedby calculating the phreatic line after the change in water level.Relevant examples are used to show that the failureprobability of a slope under water wading condition can increase by more than 20%(increase rates in 1D,2D and3D conditions being 25%,27%and 31%,respectively)compared with the natural condition.The influence ofdiverse fuzzy membership functions—linear,normal,and Cauchy—on failure probability is also considered.Thisresearch not only provides a strategy for better calculation of the slope failure probability but also pioneers theintegration of computational intelligence,fuzzy logic and fluid-dynamics in geotechnical engineering,presentingan innovative and efficient tool for slope stability analysis.展开更多
BACKGROUND Acute liver failure(ALF)may be the first and most dramatic presentation of Wilson’s disease(WD).ALF due to WD(WD-ALF)is difficult to distinguish from other causes of liver disease and is a clear indication...BACKGROUND Acute liver failure(ALF)may be the first and most dramatic presentation of Wilson’s disease(WD).ALF due to WD(WD-ALF)is difficult to distinguish from other causes of liver disease and is a clear indication for liver transplantation.There is no firm recommendation on specific and supportive medical treatment for this condition.AIM To critically evaluate the diagnostic and therapeutic management of WD-ALF patients in order to improve their survival with native liver.METHODS A retrospective analysis of patients with WD-ALF was conducted in two pediatric liver units from 2018 to 2023.RESULTS During the study period,16 children(9 males)received a diagnosis of WD and 2 of them presented with ALF.The first was successfully treated with an unconventional combination of low doses of D-penicillamine and zinc plus steroids,and survived without liver transplant.The second,exclusively treated with supportive therapy,needed a hepatotransplant to overcome ALF.CONCLUSION Successful treatment of 1 WD-ALF patient with low-dose D-penicillamine and zinc plus steroids may provide new perspectives for management of this condition,which is currently only treated with liver transplantation.展开更多
Inflammatory bowel disease(IBD)represents a significant disease burden marked by chronic inflammation and complications that adversely affect patients’quality of life.Effective diagnostic strategies involve clinical ...Inflammatory bowel disease(IBD)represents a significant disease burden marked by chronic inflammation and complications that adversely affect patients’quality of life.Effective diagnostic strategies involve clinical assessments,endoscopic evaluations,imaging studies,and biomarker testing,where early diagnosis is essential for effective management and prevention of long-term complications,highlighting the need for continual advancements in diagnostic methods.The intricate interplay between genetic factors and the outcomes of biological therapy is of critical importance.Unraveling the genetic determinants that influence responses and failures to biological therapy holds significant promise for optimizing treatment strategies for patients with IBD on biologics.Through an indepth examination of current literature,this review article synthesizes critical genetic markers associated with therapeutic efficacy and resistance in IBD.Understanding these genetic actors paves the way for personalized approaches,informing clinicians on predicting,tailoring,and enhancing the effectiveness of biological therapies for improved outcomes in patients with IBD.展开更多
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 National Natural Science Foundation of China,No.82100625Zhejiang Provincial natural Science Foundation of China,No.Q20H030013.
文摘BACKGROUND The introduction of pegaspargase has greatly advanced the treatment of acute lymphoblastic leukemia(ALL).In the literature,only one case of pegaspargaseinduced multiple organ failure has been reported,and the patient died due to multiple organ failure.CASE SUMMARY Herein,we present a rare case of a 40-year-old man with ALL who developed multiple organ failure after treatment with pegaspargase.The patient had two rare phenomena reflecting poor prognosis,including the discrepancy between clinical manifestations and liver function and persistently low alpha-fetoprotein(AFP)levels from subacute liver failure.However,the patient was successfully treated using a multidisciplinary team approach.CONCLUSION This is the first case report of successful treatment of pegaspargase-induced multiple organ failure.The findings emphasize the importance of a multidisciplinary team approach in treating pegaspargase-induced multiple organ failure.
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 National Natural Science Foundation of China,No.82271546 and No.82301744The Shanxi Province Science and Technology Innovation Think Tank Construction Research Project,No.KXKT202317+1 种基金Fundamental Research Program of Shanxi Province,No.202303021222346 and No.202103021223224The Research Foundation of The First Hospital of Shanxi Medical University,No.YQ2208.
文摘BACKGROUND The coronavirus disease 2019 pandemic has had an ongoing impact on the public’s mental health that requires long-term attention.Exploring the relationship between mental health indicators would aid in identifying solutions to improve public mental health.AIM To investigate the prevalence of anxiety,depression,and insomnia and explore the relationship among neuroticism,cognitive failures,and mental health.METHODS A cross-sectional survey was conducted in December 2023 using an online platform to recruit adult participants.The neuroticism,subjective cognitive function,and mental health of the participants were assessed using the neuroticism subscale of the Chinese Big Five Personality Inventory Brief Version,cognitive failures questionnaire,generalized anxiety disorder-7,patient health questionnaire-9,and insomnia severity index.Pearson's correlation analysis,independent samples t-tests,one-way analysis of variance,and structural equation model were used to examine the relationship between mental health indicators.RESULTS A total of 1011 valid questionnaires were collected,of which 343 were completed by male(33.93%)respondents and 668 were completed by female(66.07%)respondents.The rates of anxiety,depression,and insomnia were 41.3%,44.6%,and 36.3%,respectively,most cases of which were mild.Among the mental health indicators,there were significant differences by age and between those with siblings and those who were only children.Neuroticism and cognitive failures were significantly positively correlated with mental health indicators.Further moderated mediation analysis showed that cognitive failures mediated the relationship between insomnia and anxiety and between insomnia and depression,with neuroticism moderating the first half of this pathway and the effect being greater in the low-neuroticism group.CONCLUSION Cognitive failures and neuroticism play important roles in mental health.Therefore,enhancing subjective cognitive function and regulating emotional stability may contribute to the improvement of mental health.
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.
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.
文摘Objective: Through the treatment of liver failure using artificial liver plasma exchange (PE), this study aims to explore the predictive value and clinical significance of alpha-fetoprotein (AFP) levels in the prognosis of liver failure patients. Methods: A retrospective analysis was conducted on the clinical data of 96 liver failure patients, all of whom underwent artificial liver plasma exchange therapy in addition to standard medical treatment. Based on AFP test values, patients were divided into three groups: low AFP group (AFP < 100 ng/mL, n = 32), medium AFP group (100 ≤ AFP < 200 ng/mL, n = 32), and high AFP group (AFP ≥ 200 ng/mL, n = 32). Serum AFP levels were measured before artificial liver therapy (on the second day of hospitalization), on days 1, 10, and 20 after treatment, and at the final evaluation (before discharge or prior to death) to observe changes. Results: Among the 96 patients, 4 (4.2%) had acute liver failure (ALF), 7 (7.3%) had subacute liver failure (SALF), 57 (59.4%) had acute-on-chronic liver failure (ACLF), and 28 (29.2%) had chronic liver failure (CLF), with an overall survival rate of 82.3% (79/96). Patients in the AFP < 100 ng/mL group had a lower survival rate compared to the other two groups, and survival rates increased with higher AFP levels (P < 0.05). Conclusion: Serum AFP levels are closely related to the efficacy of artificial liver plasma exchange therapy for liver failure, and dynamic monitoring of AFP changes can help assess disease progression.
基金Supported by Shaanxi Provincial Social Development Fund,No.2024SF-YBXM-140.
文摘BACKGROUND Post-hepatectomy liver failure(PHLF)after liver resection is one of the main complications causing postoperative death in patients with hepatocellular carcinoma(HCC).It is crucial to help clinicians identify potential high-risk PHLF patients as early as possible through preoperative evaluation.AIM To identify risk factors for PHLF and develop a prediction model.METHODS This study included 248 patients with HCC at The Second Affiliated Hospital of Air Force Medical University between January 2014 and December 2023;these patients were divided into a training group(n=164)and a validation group(n=84)via random sampling.The independent variables for the occurrence of PHLF were identified by univariate and multivariate analyses and visualized as nomograms.Ultimately,comparisons were made with traditional models via receiver operating characteristic(ROC)curves,calibration curves,and decision curve analysis(DCA).RESULTS In this study,portal vein width[odds ratio(OR)=1.603,95%CI:1.288-1.994,P≤0.001],the preoperative neutrophil-to-lymphocyte ratio(NLR)(OR=1.495,95%CI:1.126-1.984,P=0.005),and the albumin-bilirubin(ALBI)score(OR=8.868,95%CI:2.144-36.678,P=0.003)were independent risk factors for PHLF.A nomogram prediction model was developed using these factors.ROC and DCA analyses revealed that the predictive efficacy and clinical value of this model were better than those of traditional models.CONCLUSION A new Nomogram model for predicting PHLF in HCC patients was successfully established based on portal vein width,the NLR,and the ALBI score,which outperforms the traditional model.
基金supported by The National Natural Science Foundation of China(Grant No.12362034)The Scientific Research Project of Inner Mongolia University of Technology(Grant Nos.DC2200000913+1 种基金DC2300001439)The Science and Technology Plan Project of Inner Mongolia Autonomous Region(Grant No.2022YFSH0047)。
文摘Loess-mudstone landslides are common in the Loess Plateau.Investigations into the mechanical theory of loess-mudstone landslides have become a challenging undertaking due to the distinctive interfacial properties of loess-mudstone and the unique water sensitivity characteristics of mudstone.Hence,it is imperative to develop innovative mechanical models and mathematical equations specifically tailored to loess-mudstone landslides.In this study,we analyze the fracture mechanism of the loess-mudstone sliding zone using plastic fracture mechanics and develop a unique fracture yield model.To calculate the energy release rate during the expansion of the loess-mudstone interface tip region,the shear fracture energy G is applied,which reflects both the yield failure criterion and the fracture failure criterion.To better understand the instability mechanism of loess-mudstone landslides,equilibrium equations based on G are established for tractive,compressive,and tensile loess-mudstone landslides.Based on the equilibrium equation,the critical length Lc of the sliding zone can be used for the safety evaluation of loess-mudstone landslides.In this way,this study proposes a new method for determining the failure mechanism and equilibrium equation of loessmudstone landslides,which resolves their starting mechanism,mechanical equilibrium equations,and safety evaluation indicators,thus justifying the scientific significance and practical value of this research.
文摘Objective:To analyze the burden of caregivers of CHF patients in the current environment,to explore the related burden and influencing factors of caring for patients with chronic heart failure,and to explore the impact of filial piety values on the burden of caring for patients.Methods:192 caregivers of CHF patients in the hospital were selected as the main objects of this study.The main method was convenient sampling.Through a questionnaire survey of 192 CHF patients'caregivers,a unified investigation was conducted from the aspects of patient"'s general condition,objective burden,anxiety and depression degree and relationship quality,etc.The structural equation model was constructed and adjusted by analyzing data entry and variable correlation.Finally,path analysis was used to conduct inferential research on the direct and indirect influencing factors of control burden.Results:More than half of the patients'caregivers had a caregiving burden,and the practical caregiving dimension had the highest score.The total effect values of patient-related factors,including anxiety degree,number of concomitant diseases and half-year readmission rate,were 0.36,0.31 and 0.20,respectively(P<0.05).The total effect values of filial piety,anxiety degree,average care time and understanding degree of disease directly derived from the caregivers themselves were-0.38,0.29,0.29 and-0.23,respectively(P<0.05).In addition,the influence of filial piety values on the caregiver burden was more obvious,and the direct effect value of the value was-0.41(P<0.001).Conclusion:Most caregivers of CHF patients have a certain objective burden of care,and there are many factors that affect it,among which the degree of filial piety value is the most important.This finding provides a clear goal for caregivers to develop measures to improve the caregiver burden.
文摘Modeling HIV/AIDS progression is critical for understanding disease dynamics and improving patient care. This study compares the Exponential and Weibull survival models, focusing on their ability to capture state-specific failure rates in HIV/AIDS progression. While the Exponential model offers simplicity with a constant hazard rate, it often fails to accommodate the complexities of dynamic disease progression. In contrast, the Weibull model provides flexibility by allowing hazard rates to vary over time. Both models are evaluated within the frameworks of the Cox Proportional Hazards (Cox PH) and Accelerated Failure Time (AFT) models, incorporating critical covariates such as age, gender, CD4 count, and ART status. Statistical evaluation metrics, including Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), log-likelihood, and Pseudo-R2, were employed to assess model performance across diverse patient subgroups. Results indicate that the Weibull model consistently outperforms the Exponential model in dynamic scenarios, such as younger patients and those with co-infections, while maintaining robustness in stable contexts. This study highlights the trade-off between flexibility and simplicity in survival modeling, advocating for tailored model selection to balance interpretability and predictive accuracy. These findings provide valuable insights for optimizing HIV/AIDS management strategies and advancing survival analysis methodologies.
基金Ministry of Education,Center for Scientific Research and Development of Higher Education Institutions“Innovative Application of Virtual Simulation Technology in Vocational Education Teaching”Special Project,Project No.ZJXF2022110.
文摘This study presents an innovative approach to calculating the failure probability of slopes by incorporating fuzzylimit-state functions,a method that significantly enhances the accuracy and efficiency of slope stability analysis.Unlike traditional probabilistic techniques,this approach utilizes a least squares support vector machine(LSSVM)optimized with a grey wolf optimizer(GWO)and K-fold cross-validation(CV)to approximate the limit-statefunction,thus reducing computational complexity.The novelty of this work lies in its application to one-dimensional(1D),two-dimensional(2D),and three-dimensional(3D)slope models,demonstrating its versatility andhigh precision.The proposed method consistently achieves error margins within 3%of Monte Carlo simulation(MCS)results,while substantially reducing computation time,particularly for 2D and 3D models.This makes theapproach highly practical for real-world engineering applications.Furthermore,by applying fuzzy mathematics tohandle uncertainties in geotechnical properties,the method offers a more realistic and comprehensive understandingof slope stability.As water is the main factor influencing the stability of slopes,this aspect is investigatedby calculating the phreatic line after the change in water level.Relevant examples are used to show that the failureprobability of a slope under water wading condition can increase by more than 20%(increase rates in 1D,2D and3D conditions being 25%,27%and 31%,respectively)compared with the natural condition.The influence ofdiverse fuzzy membership functions—linear,normal,and Cauchy—on failure probability is also considered.Thisresearch not only provides a strategy for better calculation of the slope failure probability but also pioneers theintegration of computational intelligence,fuzzy logic and fluid-dynamics in geotechnical engineering,presentingan innovative and efficient tool for slope stability analysis.
文摘BACKGROUND Acute liver failure(ALF)may be the first and most dramatic presentation of Wilson’s disease(WD).ALF due to WD(WD-ALF)is difficult to distinguish from other causes of liver disease and is a clear indication for liver transplantation.There is no firm recommendation on specific and supportive medical treatment for this condition.AIM To critically evaluate the diagnostic and therapeutic management of WD-ALF patients in order to improve their survival with native liver.METHODS A retrospective analysis of patients with WD-ALF was conducted in two pediatric liver units from 2018 to 2023.RESULTS During the study period,16 children(9 males)received a diagnosis of WD and 2 of them presented with ALF.The first was successfully treated with an unconventional combination of low doses of D-penicillamine and zinc plus steroids,and survived without liver transplant.The second,exclusively treated with supportive therapy,needed a hepatotransplant to overcome ALF.CONCLUSION Successful treatment of 1 WD-ALF patient with low-dose D-penicillamine and zinc plus steroids may provide new perspectives for management of this condition,which is currently only treated with liver transplantation.
基金Supported by The European Union-Next Generation EU,through the National Recovery and Resilience Plan of the Republic of Bulgaria,No.BG-RRP-2.004-0008。
文摘Inflammatory bowel disease(IBD)represents a significant disease burden marked by chronic inflammation and complications that adversely affect patients’quality of life.Effective diagnostic strategies involve clinical assessments,endoscopic evaluations,imaging studies,and biomarker testing,where early diagnosis is essential for effective management and prevention of long-term complications,highlighting the need for continual advancements in diagnostic methods.The intricate interplay between genetic factors and the outcomes of biological therapy is of critical importance.Unraveling the genetic determinants that influence responses and failures to biological therapy holds significant promise for optimizing treatment strategies for patients with IBD on biologics.Through an indepth examination of current literature,this review article synthesizes critical genetic markers associated with therapeutic efficacy and resistance in IBD.Understanding these genetic actors paves the way for personalized approaches,informing clinicians on predicting,tailoring,and enhancing the effectiveness of biological therapies for improved outcomes in patients with IBD.
