BACKGROUND One of the primary reasons for the dismal survival rates in pancreatic ductal adenocarcinoma(PDAC)is that most patients are usually diagnosed at late stages.There is an urgent unmet clinical need to identif...BACKGROUND One of the primary reasons for the dismal survival rates in pancreatic ductal adenocarcinoma(PDAC)is that most patients are usually diagnosed at late stages.There is an urgent unmet clinical need to identify and develop diagnostic methods that could precisely detect PDAC at its earliest stages.METHODS A total of 71 patients with pathologically proved PDAC based on surgical resection who underwent contrast-enhanced computed tomography(CT)within 30 d prior to surgery were included in the study.Tumor staging was performed in accordance with the 8th edition of the American Joint Committee on Cancer staging system.Radiomics features were extracted from the region of interest(ROI)for each patient using Analysis Kit software.The most important and predictive radiomics features were selected using Mann-Whitney U test,univar-iate logistic regression analysis,and minimum redundancy maximum relevance(MRMR)method.Random forest(RF)method was used to construct the radiomics model,and 10-times leave group out cross-validation(LGOCV)method was used to validate the robustness and reproducibility of the model.RESULTS A total of 792 radiomics features(396 from late arterial phase and 396 from portal venous phase)were extracted from the ROI for each patient using Analysis Kit software.Nine most important and predictive features were selected using Mann-Whitney U test,univariate logistic regression analysis,and MRMR method.RF method was used to construct the radiomics model with the nine most predictive radiomics features,which showed a high discriminative ability with 97.7%accuracy,97.6%sensitivity,97.8%specificity,98.4%positive predictive value,and 96.8%negative predictive value.The radiomics model was proved to be robust and reproducible using 10-times LGOCV method with an average area under the curve of 0.75 by the average performance of the 10 newly built models.CONCLUSION The radiomics model based on CT could serve as a promising non-invasive method in differential diagnosis between early and late stage PDAC.展开更多
The progressive loss of dopaminergic neurons in affected patient brains is one of the pathological features of Parkinson's disease,the second most common human neurodegenerative disease.Although the detailed patho...The progressive loss of dopaminergic neurons in affected patient brains is one of the pathological features of Parkinson's disease,the second most common human neurodegenerative disease.Although the detailed pathogenesis accounting for dopaminergic neuron degeneration in Parkinson's disease is still unclear,the advancement of stem cell approaches has shown promise for Parkinson's disease research and therapy.The induced pluripotent stem cells have been commonly used to generate dopaminergic neurons,which has provided valuable insights to improve our understanding of Parkinson's disease pathogenesis and contributed to anti-Parkinson's disease therapies.The current review discusses the practical approaches and potential applications of induced pluripotent stem cell techniques for generating and differentiating dopaminergic neurons from induced pluripotent stem cells.The benefits of induced pluripotent stem cell-based research are highlighted.Various dopaminergic neuron differentiation protocols from induced pluripotent stem cells are compared.The emerging three-dimension-based brain organoid models compared with conventional two-dimensional cell culture are evaluated.Finally,limitations,challenges,and future directions of induced pluripotent stem cell–based approaches are analyzed and proposed,which will be significant to the future application of induced pluripotent stem cell-related techniques for Parkinson's disease.展开更多
This article provides a comprehensive analysis of the study by Hou et al,focusing on the complex interplay between psychological and physical factors in the postoperative recovery(POR)of patients with perianal disease...This article provides a comprehensive analysis of the study by Hou et al,focusing on the complex interplay between psychological and physical factors in the postoperative recovery(POR)of patients with perianal diseases.The study sheds light on how illness perception,anxiety,and depression significantly influence recovery outcomes.Hou et al developed a predictive model that demonstrated high accuracy in identifying patients at risk of poor recovery.The article explores the critical role of pre-operative psychological assessment,highlighting the need for mental health support and personalized recovery plans in enhancing POR quality.A multidisciplinary approach,integrating mental health professionals with surgeons,anesthesiologists,and other specialists,is emphasized to ensure comprehensive care for patients.The study’s findings serve as a call to integrate psychological care into surgical practice to optimize outcomes for patients with perianal diseases.展开更多
Cracks are important migration channels and storage spaces for oil and gas, and the peripheral cracks in the Ordos Basin have developed extensively after multiple tectonic movements. Using unmanned aerial vehicle obli...Cracks are important migration channels and storage spaces for oil and gas, and the peripheral cracks in the Ordos Basin have developed extensively after multiple tectonic movements. Using unmanned aerial vehicle oblique photogrammetry technology to obtain field outcrop image data and establish a three-dimensional model for observation, the NEE and NNW fractures are the most developed in the Yanchang Formation of the study area, while the NW and NNE fractures are slightly developed, all of which are high angle vertical fractures and belong to regional structural fractures. The NNW oriented cracks are restricted by the NEE oriented cracks and developed in the late stage. Combined with the analysis of regional geological background, fracture intersection relationship and tectonic stress field, it is considered that there are two stages of fractures in Dongjiahe, namely, the late Indosinian and Yanshanian.展开更多
Objective: To explore the effect of Health Action Process Approach (HAPA) theory in patients with type D personality psoriasis. Methods: A total of 66 patients with type D personality psoriasis admitted to the dermato...Objective: To explore the effect of Health Action Process Approach (HAPA) theory in patients with type D personality psoriasis. Methods: A total of 66 patients with type D personality psoriasis admitted to the dermatology department of a top-three hospital in Jingzhou City from November 2022 to July 2023 were selected and divided into control group and test group with 33 cases in each group by random number table method. The control group received routine health education, and the experimental group received health education based on the HAPA theory. Chronic disease self-efficacy scale, hospital anxiety and depression scale and skin disease quality of life scale were used to evaluate the effect of intervention. Results: After 3 months of intervention, the scores of self-efficacy in experimental group were higher than those in control group (P P Conclusion: Health education based on the theory of HAPA can enhance the self-efficacy of patients with type D personality psoriasis, relieve negative emotions and improve their quality of life.展开更多
BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of ...BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of patients after pancreatic resections.Globally recognized superior mesenteric artery(SMA)first approaches are invariably performed.The mesenteric dissection through the inferior infracolic approach has been discussed in this study emphasizing its post-operative impact on CL which is the cornerstone of this study.AIM To assess incidence,risk factors,clinical impact of CL following root of mesentery dissection,and the different treatment modalities.METHODS This is a retrospective study incorporating the patients who underwent dissection of the root of mesentery with inferior infracolic SMA first approach pancreat-oduodenectomy for the ventral body and uncinate mass of pancreas in the Department of Gastrointestinal and General Surgery of Kathmandu Medical College and Teaching Hospital from January 1,2021 to February 28,2024.Intraop-erative findings and postoperative outcomes were analyzed.RESULTS In three years,ten patients underwent root of mesentery dissection with inferior infracolic SMA first approach pancreatoduodenectomy.The mean age was 67.6 years with a male-to-female ratio of 4:5.CL was seen in four patients.With virtue of CL,Clavien-Dindo grade Ⅱ or higher morbidity was observed in four patients.Two patients had a hospital stay of more than 20 days with the former having a delayed gastric emptying and the latter with long-term total parenteral nutrition requirement.The mean operative time was 330 minutes.Curative resection was achieved in 100%of the patients.The mean duration of the intensive care unit and hospital stay were 2.55±1.45 days and 15.7±5.32 days,respectively.CONCLUSION Root of mesentery dissection with lymphadenectomy and vascular resection correlated with occurrence of CL.After complete curative resection,these were managed with total parenteral nutrition without adversely impacting outcome.展开更多
With the growth of the construction industry,risk management in construction projects has garnered significant attention from the academic community.Effective risk management during the decision-making stage can great...With the growth of the construction industry,risk management in construction projects has garnered significant attention from the academic community.Effective risk management during the decision-making stage can greatly enhance project management efficiency.This paper integrates the AHP-entropy value method and constructs a risk management model based on the DPSIR framework for construction projects.The model is applied to evaluate and analyze the risk level of the decision-making stage in a navigation and electricity hub project in Chongqing Municipality.The results demonstrate the scientific validity and effectiveness of the proposed model.展开更多
Background:Dorsal approach is the potentially effective strategy for minimally invasive liver resection.This study aimed to compare the outcomes between robot-assisted and laparoscopic hemihepatectomy through dorsal a...Background:Dorsal approach is the potentially effective strategy for minimally invasive liver resection.This study aimed to compare the outcomes between robot-assisted and laparoscopic hemihepatectomy through dorsal approach.Methods:We compared the patients who underwent robot-assisted hemihepatectomy(Rob-HH)and who had laparoscopic hemihepatectomy(Lap-HH)through dorsal approach between January 2020 and December 2022.A 1:1 propensity score-matching(PSM)analysis was performed to minimize bias and confounding factors.Results:Ninety-six patients were included,41 with Rob-HH and 55 with Lap-HH.Among them,58 underwent left hemihepatectomy(LHH)and 38 underwent right hemihepatectomy(RHH).Compared with LapHH group,patients with Rob-HH had less estimated blood loss(median:100.0 vs.300.0 m L,P=0.016),lower blood transfusion rates(4.9%vs.29.1%,P=0.003)and postoperative complication rates(26.8%vs.54.5%,P=0.016).These significant differences consistently existed after PSM and in the LHH subgroups.Furthermore,robot-assisted LHH was associated with decreased Pringle duration(45 vs.60 min,P=0.047).RHH subgroup analysis showed that compared with Lap-RHH,Rob-RHH was associated with less estimated blood loss(200.0 vs.400.0 m L,P=0.013).No significant differences were found in other perioperative outcomes among pre-and post-PSM cohorts,such as Pringle duration,operative time,and hospital stay.Conclusions:The dorsal approach was a safe and feasible strategy for hemi-hepatectomy with favorable outcomes under robot-assisted system in reducing intraoperative blood loss,transfusion,and postoperative complications.展开更多
In recent years,the production-oriented approach has been applied in the field of teaching Chinese as a foreign language,providing a new perspective for language and cultural instruction.Currently,several issues exist...In recent years,the production-oriented approach has been applied in the field of teaching Chinese as a foreign language,providing a new perspective for language and cultural instruction.Currently,several issues exist in cultural teaching,such as the lack of in-depth cultural input,insufficient training in cross-cultural communication skills,and the over-stylization of cultural teaching in the classroom.The production-oriented approach offers a solution to these challenges.This paper seeks to introduce the production-oriented method into the teaching of Chinese culture as a foreign language,using silk culture as a case study for teaching design.The aim is to implement cultural teaching through a new instructional model and to promote the spread of Chinese silk culture.展开更多
Microplastics(MPs)have garnered significant international scrutiny as an emerging environmental pollutant,constituting one of the four principal global environmental threats and posing potential health hazards to huma...Microplastics(MPs)have garnered significant international scrutiny as an emerging environmental pollutant,constituting one of the four principal global environmental threats and posing potential health hazards to humans.However,data on the impact of MPs on the early life of the commercially important fish remain limited.In this study,polystyrene microspheres(PS-MPs)(1 and 5μm)were used to investigate the effects of MPs on the growth,development,and metabolism in early life stages of large yellow croaker Pseudosciaena crocea.Results indicate that MPs were enriched in the gastrointestinal tract and gills of the fish.In addition,PS-MPs(1μm)exhibited no obvious effects on embryo hatching and heart rates,while increased the mortality rate(23.00%vs.control 14.99%)and decreased the body length(4098.61±447.03μm vs.control with 2827.04±254.75μm)of the larvae at the highest exposure concentration(5×10^(4)items/L).Metabolomics analysis revealed that PS-MPs(5μm)induced mild perturbations in phospholipid metabolism,specifically alterations in phosphatidylethanolamine(PE)levels.These changes influenced the cell membranes of juvenile fish,and consequently elicited inflammatory responses,disrupted lipid homeostasis,and affected other critical physiological processes.Ultimately,these effects may avoid the growth retardation and potential mortality.Therefore,PS-MPs could affect negatively the fish health in the early life stage,which has implications for aquatic ecosystems.展开更多
The rising prevalence of chronic multimorbidity poses substantial challenges to healthcare systems,necessitating the development of innovative management strategies to optimize patient care and system efficiency.The s...The rising prevalence of chronic multimorbidity poses substantial challenges to healthcare systems,necessitating the development of innovative management strategies to optimize patient care and system efficiency.The study by Fontalba-Navas et al investigates the implementation of a novel high complexity unit(HCU)specifically designed to improve the management of patients with chronic complex conditions.By adopting a multidisciplinary approach,the HCU aims to provide comprehensive,patient-centered care that enhances health outcomes and alleviates the strain on traditional hospital services.Utilizing a longitudinal analysis of data from the Basic Minimum Data Set,this study compares hospitalization metrics among the HCU,Internal Medicine,and other departments within a regional hospital throughout 2022.The findings reveal that the HCU's integrated care model significantly reduces readmission rates and boosts patient satisfaction compared to conventional care practices.The study highlights the HCU's potential as a replicable model for managing chronic multimorbidity,emphasizing its effectiveness in minimizing unnecessary hospitalizations and enhancing the overall quality of patient care.This innovative approach not only addresses the complexities associated with chronic multimorbid conditions but also offers a sustainable framework for healthcare systems confronting similar challenges.展开更多
Rectal neuroendocrine neoplasms pose significant challenges due to their varied presentations and prognoses.Traditional prognostic models,while useful,often fall short of accurately predicting clinical outcomes for th...Rectal neuroendocrine neoplasms pose significant challenges due to their varied presentations and prognoses.Traditional prognostic models,while useful,often fall short of accurately predicting clinical outcomes for these patients.This article discusses the development and implications of a novel prognostic tool,the GATIS score,which aims to enhance predictive accuracy and guide treatment strategies more effectively than current methods.Utilizing data from a large cohort and employing sophisticated statistical models,the GATIS score integrates clinical and pathological markers to provide a nuanced assessment of prognosis.We evaluate the potential of this score to transform clinical decision-making processes,its integration into current medical practices,and future directions for its develo-pment.The integration of genetic markers and other biomarkers could further refine its predictive power,highlighting the ongoing need for innovation in the management of rectal neuroendocrine neoplasms.展开更多
The early life stages of marine organisms are pivotal in shaping community dynamics and resource availability.In this study,we focused on Portunus trituberculatus,a crustacean integral to China's fisheries economy...The early life stages of marine organisms are pivotal in shaping community dynamics and resource availability.In this study,we focused on Portunus trituberculatus,a crustacean integral to China's fisheries economy,and examined the effect of sea surface temperature(SST)in its critical early life stages on subsequent yields.To analyze the correlation between SST in different larval stages and the corresponding yield of P.trituberculatus,we simulated the transport and distribution of larvae from 2014 to 2022 by employing circulation models and Lagrangian particle tracking experiments(LPTE).In the five years(2014,2015,2016,2019,and 2020),particles were transported in a northwestern direction and moved in the direction of low SST.The distribution of particles in the megalopa stage(M stage)were located in the region of the lower temperature.In 2017,2018,and 2021,the particles were transported in a northeastern direction but they did not move with the gradient of low SST in these years,and the particles in the last M stage were located in the region where the SST was at the peak of the time period.In 2022,the distribution was observed for most of the particles in the southwestern part of Zhejiang coast,a small part of them were transported in the northwestern direction and a small amount of particles was distributed offshore along the northern area of the Zhejiang coast.The correlations between the SST at each stage of larvae with the corresponding year's yield showed that the yield of P.trituberculatus decreased significantly(R=-0.772,P=0.015)with increasing SST at the M stage.This study preliminarily explains the correlation between SST at the larval stage and the yield of P.trituberculatus and provides essential information for scientific stock enhancement in the future.展开更多
Objective： To predict preoperative staging using a radiomics approach based on computed tomography （CT）images of patients with esophageal squamous cell carcinoma （ESCC）.Methods： This retrospective study included...Objective： To predict preoperative staging using a radiomics approach based on computed tomography （CT）images of patients with esophageal squamous cell carcinoma （ESCC）.Methods： This retrospective study included 154 patients （primary cohort： n： t 14; validation cohort： n：40） withpathologically confirmed ESCC. All patients underwent a preoperative CT scan from the neck to abdomen. Highthroughput and quantitative radiomics features were extracted from the CT images for each patient. A radiomicssignature was constructed using the least absolute shrinkage and selection operator （Lasso）. Associations betweenradiomics signature, tumor volume and ESCC staging were explored. Diagnostic performance of radiomicsapproach and tumor volume for discriminating between stages Ⅰ-Ⅱand Ⅲ-Ⅳ was evaluated and compared usingthe receiver operating characteristics （ROC） curves and net reclassification improvement （NRI）.Results= A total of 9,790 radiomics features were extracted. Ten features were selected to build a radiomicssignature after feature dimension reduction. The radiomics signature was significantly associated with ESCCstaging （P〈0.001）, and yielded a better performance for discrimination of early and advanced stage ESCC comparedto tumor volume in both the primary [area under the receiver operating characteristic curve （AUC）： 0.795 vs. 0.694,P=0.003; NRI=0.424）] and validation cohorts （AUC： 0.762 vs. 0.624, P=0.035; NRI=0.834）.Conclusions： The quantitative approach has the potential to identify stage Ⅰ-Ⅱand Ⅲ-Ⅳ ESCC beforetreatment.展开更多
Hepatocellular carcinoma(HCC)is a high mortality neoplasm which usually appears on a cirrhotic liver.The therapeutic arsenal and subsequent prognostic outlook are intrinsically linked to the HCC stage at diagnosis.Not...Hepatocellular carcinoma(HCC)is a high mortality neoplasm which usually appears on a cirrhotic liver.The therapeutic arsenal and subsequent prognostic outlook are intrinsically linked to the HCC stage at diagnosis.Notwithstanding the current deployment of treatments with curative intent(liver resection/local ablation and liver transplantation)in early and intermediate stages,a high rate of HCC recurrence persists,underscoring a pivotal clinical challenge.Emergent systemic therapies(ST),particularly immunotherapy,have demonstrate promising outcomes in terms of increase overall survival,but they are currently bound to the advanced stage of HCC.This review provides a comprehensive analysis of the literature,encompassing studies up to March 10,2024,evaluating the impact of novel ST in the early and intermediate HCC stages,specially focusing on the findings of neoadjuvant and adjuvant regimens,aimed at increasing significantly overall survival and recurrence-free survival after a treatment with curative intent.We also investigate the potential role of ST in enhancing the downstaging rate for the intermediate-stage HCC initially deemed ineligible for treatment with curative intent.Finally,we critically discuss about the current relevance of the results of these studies and the encouraging future implications of ST in the treatment schedules of early and intermediate HCC stages.展开更多
BACKGROUND Colorectal cancer(CRC)is a global health concern,with advanced-stage diagnoses contributing to poor prognoses.The efficacy of CRC screening has been well-established;nevertheless,a significant proportion of...BACKGROUND Colorectal cancer(CRC)is a global health concern,with advanced-stage diagnoses contributing to poor prognoses.The efficacy of CRC screening has been well-established;nevertheless,a significant proportion of patients remain unscreened,with>70%of cases diagnosed outside screening.Although identifying specific subgroups for whom CRC screening should be particularly recommended is crucial owing to limited resources,the association between the diagnostic routes and identification of these subgroups has been less appreciated.In the Japanese cancer registry,the diagnostic routes for groups discovered outside of screening are primarily categorized into those with comorbidities found during hospital visits and those with CRC-related symptoms.AIM To clarify the stage at CRC diagnosis based on diagnostic routes.METHODS We conducted a retrospective observational study using a cancer registry of patients with CRC between January 2016 and December 2019 at two hospitals.The diagnostic routes were primarily classified into three groups:Cancer screening,follow-up,and symptomatic.The early-stage was defined as Stages 0 or I.Multivariate and univariate logistic regressions were exploited to determine the odds of early-stage diagnosis in the symptomatic and cancer screening groups,referencing the follow-up group.The adjusted covariates were age,sex,and tumor location.RESULTS Of the 2083 patients,715(34.4%),1064(51.1%),and 304(14.6%)belonged to the follow-up,symptomatic,and cancer screening groups,respectively.Among the 2083 patients,CRCs diagnosed at an early stage were 57.3%(410 of 715),23.9%(254 of 1064),and 59.5%(181 of 304)in the follow-up,symptomatic,and cancer screening groups,respectively.The symptomatic group exhibited a lower likelihood of early-stage diagnosis than the follow-up group[P<0.001,adjusted odds ratio(aOR),0.23;95%confidence interval(95%CI):0.19-0.29].The likelihood of diagnosis at an early stage was similar between the follow-up and cancer screening groups(P=0.493,aOR for early-stage diagnosis in the cancer screening group vs follow-up group=1.11;95%CI=0.82-1.49).CONCLUSION CRCs detected during hospital visits for comorbidities were diagnosed earlier,similar to cancer screening.CRC screening should be recommended,particularly for patients without periodical hospital visits for comorbidities.展开更多
Sleep apnea(SA)is a common sleep disorder.Identifying patients at risk by means of comprehensive monitoring that requires overnight stay at professional sleep clinics are costly and inconvenient and can lead to unreli...Sleep apnea(SA)is a common sleep disorder.Identifying patients at risk by means of comprehensive monitoring that requires overnight stay at professional sleep clinics are costly and inconvenient and can lead to unreliable results in view of the unfamiliar sleep environment.Existing wearable devices for sleep monitoring,which can be used in a familiar home environment,do not provide the same comprehensive monitoring as through clinical monitoring.The larger objective of the present work is to develop a sleep monitoring system for home use,which can provide comprehensive monitoring.In the development in this paper,machine learning(ML)models are explored for the classification of SA and sleep stages using multisensory data,without neglecting any of the required signals.The data acquired through the sensors are normalized,their features are extracted using Composite Multiscale Sample Entropy(CMSE)and are standardized using a robust scaling algorithm.Processed features are classified using a Neural Network(NN)and the obtained results for the SA classification are compared with those obtained by using a Support Vector Machine(SVM)approach.The impact of neglecting signals when classifying sleep stages is analyzed as well.The results are presented in the paper and observations are made.The NN model trained with the Bayesian regularization algorithm has provided an overall average accuracy of 94.5%and performed slightly better than when trained using the scaled conjugate gradient backpropagation algorithm(93.2%).The SVMs have yielded lower accuracy levels compared to the NNs(<92%).It is observed that the use of all 14 signals for SS classification yields an overall test accuracy of 72.3%,which is higher than that when one or few signals are used.It is concluded that ML models are effective in classifying sleep data from multiple sensors.Accuracy levels are higher when fused multisensory data are used as inputs.Furthermore,NN models are found to be better suitable in practical application and can be incorporated into an inexpensive and convenient wearable device that can carry out comprehensive monitoring.展开更多
BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with ...BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with no consensus regarding the superiority of any single approach.AIM To compare early postoperative complications after implementing the direct anterior and posterior approaches(PL)for hip hemiarthroplasty after femoral neck fractures.METHODS This is a comparative,retrospective,single-center cohort study conducted at a university hospital.Between March 2008 and December 2018,273 patients(a total of 280 hips)underwent bipolar hemiarthroplasties(n=280)for displaced femoral neck fractures using either the PL(n=171)or the minimally invasive direct anterior approach(DAA)(n=109).The choice of approach was related to the surgeons’practices;the implant types were similar and unrelated to the approach.Dislocation rates and other complications were reviewed after a minimum followup of 6 mo.RESULTS Both treatment groups had similarly aged patients(mean age:82 years),sex ratios,patient body mass indexes,and patient comorbidities.Surgical data(surgery delay time,operative time,and blood loss volume)did not differ significantly between the groups.The 30 d mortality rate was higher in the PL group(9.9%)than in the DAA group(3.7%),but the difference was not statistically significant(P=0.052).Among the one-month survivors,a significantly higher rate of dislocation was observed in the PL group(14/154;9.1%)than in the DAA group(0/105;0%)(P=0.002).Of the 14 patients with dislocation,8 underwent revision surgery for recurrent instability(posterior group),and one of them had 2 additional procedures due to a deep infection.The rate of other complications(e.g.,perioperative and early postoperative periprosthetic fractures and infection-related complications)did not differ significantly between the groups.CONCLUSION These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate(<1%)than the PL.展开更多
We consider an image semantic communication system in a time-varying fading Gaussian MIMO channel,with a finite number of channel states.A deep learning-aided broadcast approach scheme is proposed to benefit the adapt...We consider an image semantic communication system in a time-varying fading Gaussian MIMO channel,with a finite number of channel states.A deep learning-aided broadcast approach scheme is proposed to benefit the adaptive semantic transmission in terms of different channel states.We combine the classic broadcast approach with the image transformer to implement this adaptive joint source and channel coding(JSCC)scheme.Specifically,we utilize the neural network(NN)to jointly optimize the hierarchical image compression and superposition code mapping within this scheme.The learned transformers and codebooks allow recovering of the image with an adaptive quality and low error rate at the receiver side,in each channel state.The simulation results exhibit our proposed scheme can dynamically adapt the coding to the current channel state and outperform some existing intelligent schemes with the fixed coding block.展开更多
In this article, a novel scalarization technique, called the improved objective-constraint approach, is introduced to find efficient solutions of a given multiobjective programming problem. The presented scalarized pr...In this article, a novel scalarization technique, called the improved objective-constraint approach, is introduced to find efficient solutions of a given multiobjective programming problem. The presented scalarized problem extends the objective-constraint problem. It is demonstrated that how adding variables to the scalarized problem, can lead to find conditions for (weakly, properly) Pareto optimal solutions. Applying the obtained necessary and sufficient conditions, two algorithms for generating the Pareto front approximation of bi-objective and three-objective programming problems are designed. These algorithms are easy to implement and can achieve an even approximation of (weakly, properly) Pareto optimal solutions. These algorithms can be generalized for optimization problems with more than three criterion functions, too. The effectiveness and capability of the algorithms are demonstrated in test problems.展开更多
基金Supported by the National Natural Science foundation of China,No.82202135,82371919,82372017,and 82171925China Postdoctoral Science Foundation,No.2023M741808+3 种基金Young Elite Scientists Sponsorship Program by Jiangsu Association for Science and Technology,No.JSTJ-2023-WJ027Foundation of Excellent Young Doctor of Jiangsu Province Hospital of Chinese Medicine,No.2023QB0112Nanjing Postdoctoral Science Foundation,Natural Science Foundation of Nanjing University of Chinese Medicine,No.XZR2023036 and XZR2021050Medical Imaging Artificial Intelligence Special Research Fund Project,Nanjing Medical Association Radiology Branch,Project of National Clinical Research Base of Traditional Chinese Medicine in Jiangsu Province,China,No.JD2023SZ16.
文摘BACKGROUND One of the primary reasons for the dismal survival rates in pancreatic ductal adenocarcinoma(PDAC)is that most patients are usually diagnosed at late stages.There is an urgent unmet clinical need to identify and develop diagnostic methods that could precisely detect PDAC at its earliest stages.METHODS A total of 71 patients with pathologically proved PDAC based on surgical resection who underwent contrast-enhanced computed tomography(CT)within 30 d prior to surgery were included in the study.Tumor staging was performed in accordance with the 8th edition of the American Joint Committee on Cancer staging system.Radiomics features were extracted from the region of interest(ROI)for each patient using Analysis Kit software.The most important and predictive radiomics features were selected using Mann-Whitney U test,univar-iate logistic regression analysis,and minimum redundancy maximum relevance(MRMR)method.Random forest(RF)method was used to construct the radiomics model,and 10-times leave group out cross-validation(LGOCV)method was used to validate the robustness and reproducibility of the model.RESULTS A total of 792 radiomics features(396 from late arterial phase and 396 from portal venous phase)were extracted from the ROI for each patient using Analysis Kit software.Nine most important and predictive features were selected using Mann-Whitney U test,univariate logistic regression analysis,and MRMR method.RF method was used to construct the radiomics model with the nine most predictive radiomics features,which showed a high discriminative ability with 97.7%accuracy,97.6%sensitivity,97.8%specificity,98.4%positive predictive value,and 96.8%negative predictive value.The radiomics model was proved to be robust and reproducible using 10-times LGOCV method with an average area under the curve of 0.75 by the average performance of the 10 newly built models.CONCLUSION The radiomics model based on CT could serve as a promising non-invasive method in differential diagnosis between early and late stage PDAC.
基金supported by Singapore National Medical Research Council(NMRC)grants,including CS-IRG,HLCA2022(to ZDZ),STaR,OF LCG 000207(to EKT)a Clinical Translational Research Programme in Parkinson's DiseaseDuke-Duke-NUS collaboration pilot grant(to ZDZ)。
文摘The progressive loss of dopaminergic neurons in affected patient brains is one of the pathological features of Parkinson's disease,the second most common human neurodegenerative disease.Although the detailed pathogenesis accounting for dopaminergic neuron degeneration in Parkinson's disease is still unclear,the advancement of stem cell approaches has shown promise for Parkinson's disease research and therapy.The induced pluripotent stem cells have been commonly used to generate dopaminergic neurons,which has provided valuable insights to improve our understanding of Parkinson's disease pathogenesis and contributed to anti-Parkinson's disease therapies.The current review discusses the practical approaches and potential applications of induced pluripotent stem cell techniques for generating and differentiating dopaminergic neurons from induced pluripotent stem cells.The benefits of induced pluripotent stem cell-based research are highlighted.Various dopaminergic neuron differentiation protocols from induced pluripotent stem cells are compared.The emerging three-dimension-based brain organoid models compared with conventional two-dimensional cell culture are evaluated.Finally,limitations,challenges,and future directions of induced pluripotent stem cell–based approaches are analyzed and proposed,which will be significant to the future application of induced pluripotent stem cell-related techniques for Parkinson's disease.
基金Supported by National Research Foundation of Korea,No.NRF-2021S1A5A8062526.
文摘This article provides a comprehensive analysis of the study by Hou et al,focusing on the complex interplay between psychological and physical factors in the postoperative recovery(POR)of patients with perianal diseases.The study sheds light on how illness perception,anxiety,and depression significantly influence recovery outcomes.Hou et al developed a predictive model that demonstrated high accuracy in identifying patients at risk of poor recovery.The article explores the critical role of pre-operative psychological assessment,highlighting the need for mental health support and personalized recovery plans in enhancing POR quality.A multidisciplinary approach,integrating mental health professionals with surgeons,anesthesiologists,and other specialists,is emphasized to ensure comprehensive care for patients.The study’s findings serve as a call to integrate psychological care into surgical practice to optimize outcomes for patients with perianal diseases.
文摘Cracks are important migration channels and storage spaces for oil and gas, and the peripheral cracks in the Ordos Basin have developed extensively after multiple tectonic movements. Using unmanned aerial vehicle oblique photogrammetry technology to obtain field outcrop image data and establish a three-dimensional model for observation, the NEE and NNW fractures are the most developed in the Yanchang Formation of the study area, while the NW and NNE fractures are slightly developed, all of which are high angle vertical fractures and belong to regional structural fractures. The NNW oriented cracks are restricted by the NEE oriented cracks and developed in the late stage. Combined with the analysis of regional geological background, fracture intersection relationship and tectonic stress field, it is considered that there are two stages of fractures in Dongjiahe, namely, the late Indosinian and Yanshanian.
文摘Objective: To explore the effect of Health Action Process Approach (HAPA) theory in patients with type D personality psoriasis. Methods: A total of 66 patients with type D personality psoriasis admitted to the dermatology department of a top-three hospital in Jingzhou City from November 2022 to July 2023 were selected and divided into control group and test group with 33 cases in each group by random number table method. The control group received routine health education, and the experimental group received health education based on the HAPA theory. Chronic disease self-efficacy scale, hospital anxiety and depression scale and skin disease quality of life scale were used to evaluate the effect of intervention. Results: After 3 months of intervention, the scores of self-efficacy in experimental group were higher than those in control group (P P Conclusion: Health education based on the theory of HAPA can enhance the self-efficacy of patients with type D personality psoriasis, relieve negative emotions and improve their quality of life.
文摘BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of patients after pancreatic resections.Globally recognized superior mesenteric artery(SMA)first approaches are invariably performed.The mesenteric dissection through the inferior infracolic approach has been discussed in this study emphasizing its post-operative impact on CL which is the cornerstone of this study.AIM To assess incidence,risk factors,clinical impact of CL following root of mesentery dissection,and the different treatment modalities.METHODS This is a retrospective study incorporating the patients who underwent dissection of the root of mesentery with inferior infracolic SMA first approach pancreat-oduodenectomy for the ventral body and uncinate mass of pancreas in the Department of Gastrointestinal and General Surgery of Kathmandu Medical College and Teaching Hospital from January 1,2021 to February 28,2024.Intraop-erative findings and postoperative outcomes were analyzed.RESULTS In three years,ten patients underwent root of mesentery dissection with inferior infracolic SMA first approach pancreatoduodenectomy.The mean age was 67.6 years with a male-to-female ratio of 4:5.CL was seen in four patients.With virtue of CL,Clavien-Dindo grade Ⅱ or higher morbidity was observed in four patients.Two patients had a hospital stay of more than 20 days with the former having a delayed gastric emptying and the latter with long-term total parenteral nutrition requirement.The mean operative time was 330 minutes.Curative resection was achieved in 100%of the patients.The mean duration of the intensive care unit and hospital stay were 2.55±1.45 days and 15.7±5.32 days,respectively.CONCLUSION Root of mesentery dissection with lymphadenectomy and vascular resection correlated with occurrence of CL.After complete curative resection,these were managed with total parenteral nutrition without adversely impacting outcome.
文摘With the growth of the construction industry,risk management in construction projects has garnered significant attention from the academic community.Effective risk management during the decision-making stage can greatly enhance project management efficiency.This paper integrates the AHP-entropy value method and constructs a risk management model based on the DPSIR framework for construction projects.The model is applied to evaluate and analyze the risk level of the decision-making stage in a navigation and electricity hub project in Chongqing Municipality.The results demonstrate the scientific validity and effectiveness of the proposed model.
基金supported by grants from the National Nat-ural Science Foundation of China(82173129)the Innova-tive and Entrepreneurial Talent Doctor of Jiangsu Province,China(JSSCBS20221872)。
文摘Background:Dorsal approach is the potentially effective strategy for minimally invasive liver resection.This study aimed to compare the outcomes between robot-assisted and laparoscopic hemihepatectomy through dorsal approach.Methods:We compared the patients who underwent robot-assisted hemihepatectomy(Rob-HH)and who had laparoscopic hemihepatectomy(Lap-HH)through dorsal approach between January 2020 and December 2022.A 1:1 propensity score-matching(PSM)analysis was performed to minimize bias and confounding factors.Results:Ninety-six patients were included,41 with Rob-HH and 55 with Lap-HH.Among them,58 underwent left hemihepatectomy(LHH)and 38 underwent right hemihepatectomy(RHH).Compared with LapHH group,patients with Rob-HH had less estimated blood loss(median:100.0 vs.300.0 m L,P=0.016),lower blood transfusion rates(4.9%vs.29.1%,P=0.003)and postoperative complication rates(26.8%vs.54.5%,P=0.016).These significant differences consistently existed after PSM and in the LHH subgroups.Furthermore,robot-assisted LHH was associated with decreased Pringle duration(45 vs.60 min,P=0.047).RHH subgroup analysis showed that compared with Lap-RHH,Rob-RHH was associated with less estimated blood loss(200.0 vs.400.0 m L,P=0.013).No significant differences were found in other perioperative outcomes among pre-and post-PSM cohorts,such as Pringle duration,operative time,and hospital stay.Conclusions:The dorsal approach was a safe and feasible strategy for hemi-hepatectomy with favorable outcomes under robot-assisted system in reducing intraoperative blood loss,transfusion,and postoperative complications.
文摘In recent years,the production-oriented approach has been applied in the field of teaching Chinese as a foreign language,providing a new perspective for language and cultural instruction.Currently,several issues exist in cultural teaching,such as the lack of in-depth cultural input,insufficient training in cross-cultural communication skills,and the over-stylization of cultural teaching in the classroom.The production-oriented approach offers a solution to these challenges.This paper seeks to introduce the production-oriented method into the teaching of Chinese culture as a foreign language,using silk culture as a case study for teaching design.The aim is to implement cultural teaching through a new instructional model and to promote the spread of Chinese silk culture.
基金Supported by the Pioneer and Leading Goose R&D Program of Zhejiang(No.2023C03130)the National Key R&D Program of China(No.2019YFD0901101)+4 种基金the National Natural Science Foundation of China(No.42076169)the Oceanic Interdisciplinary Program of Shanghai Jiao Tong University(Nos.SL2022ZD203,SL2022MS012)the Zhejiang Provincial Natural Science Founds for Distinguished Young Scientists(No.LR21D060001)the State Key Laboratory of Satellite Ocean Environment Dynamics(No.SOEDZZ1902)the ChinaAPEC Cooperation Fund(No.2029901)。
文摘Microplastics(MPs)have garnered significant international scrutiny as an emerging environmental pollutant,constituting one of the four principal global environmental threats and posing potential health hazards to humans.However,data on the impact of MPs on the early life of the commercially important fish remain limited.In this study,polystyrene microspheres(PS-MPs)(1 and 5μm)were used to investigate the effects of MPs on the growth,development,and metabolism in early life stages of large yellow croaker Pseudosciaena crocea.Results indicate that MPs were enriched in the gastrointestinal tract and gills of the fish.In addition,PS-MPs(1μm)exhibited no obvious effects on embryo hatching and heart rates,while increased the mortality rate(23.00%vs.control 14.99%)and decreased the body length(4098.61±447.03μm vs.control with 2827.04±254.75μm)of the larvae at the highest exposure concentration(5×10^(4)items/L).Metabolomics analysis revealed that PS-MPs(5μm)induced mild perturbations in phospholipid metabolism,specifically alterations in phosphatidylethanolamine(PE)levels.These changes influenced the cell membranes of juvenile fish,and consequently elicited inflammatory responses,disrupted lipid homeostasis,and affected other critical physiological processes.Ultimately,these effects may avoid the growth retardation and potential mortality.Therefore,PS-MPs could affect negatively the fish health in the early life stage,which has implications for aquatic ecosystems.
基金Supported by Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Education,No.NRF-RS-2023-00237287.
文摘The rising prevalence of chronic multimorbidity poses substantial challenges to healthcare systems,necessitating the development of innovative management strategies to optimize patient care and system efficiency.The study by Fontalba-Navas et al investigates the implementation of a novel high complexity unit(HCU)specifically designed to improve the management of patients with chronic complex conditions.By adopting a multidisciplinary approach,the HCU aims to provide comprehensive,patient-centered care that enhances health outcomes and alleviates the strain on traditional hospital services.Utilizing a longitudinal analysis of data from the Basic Minimum Data Set,this study compares hospitalization metrics among the HCU,Internal Medicine,and other departments within a regional hospital throughout 2022.The findings reveal that the HCU's integrated care model significantly reduces readmission rates and boosts patient satisfaction compared to conventional care practices.The study highlights the HCU's potential as a replicable model for managing chronic multimorbidity,emphasizing its effectiveness in minimizing unnecessary hospitalizations and enhancing the overall quality of patient care.This innovative approach not only addresses the complexities associated with chronic multimorbid conditions but also offers a sustainable framework for healthcare systems confronting similar challenges.
文摘Rectal neuroendocrine neoplasms pose significant challenges due to their varied presentations and prognoses.Traditional prognostic models,while useful,often fall short of accurately predicting clinical outcomes for these patients.This article discusses the development and implications of a novel prognostic tool,the GATIS score,which aims to enhance predictive accuracy and guide treatment strategies more effectively than current methods.Utilizing data from a large cohort and employing sophisticated statistical models,the GATIS score integrates clinical and pathological markers to provide a nuanced assessment of prognosis.We evaluate the potential of this score to transform clinical decision-making processes,its integration into current medical practices,and future directions for its develo-pment.The integration of genetic markers and other biomarkers could further refine its predictive power,highlighting the ongoing need for innovation in the management of rectal neuroendocrine neoplasms.
基金Supported by the National Key Research and Development Program of China(No.2019YFD0901304)the Public Welfare Technology Application Research Project of Zhejiang(No.LGN21C190009)the Science and Technology Project of Zhoushan(No.2022C41003)。
文摘The early life stages of marine organisms are pivotal in shaping community dynamics and resource availability.In this study,we focused on Portunus trituberculatus,a crustacean integral to China's fisheries economy,and examined the effect of sea surface temperature(SST)in its critical early life stages on subsequent yields.To analyze the correlation between SST in different larval stages and the corresponding yield of P.trituberculatus,we simulated the transport and distribution of larvae from 2014 to 2022 by employing circulation models and Lagrangian particle tracking experiments(LPTE).In the five years(2014,2015,2016,2019,and 2020),particles were transported in a northwestern direction and moved in the direction of low SST.The distribution of particles in the megalopa stage(M stage)were located in the region of the lower temperature.In 2017,2018,and 2021,the particles were transported in a northeastern direction but they did not move with the gradient of low SST in these years,and the particles in the last M stage were located in the region where the SST was at the peak of the time period.In 2022,the distribution was observed for most of the particles in the southwestern part of Zhejiang coast,a small part of them were transported in the northwestern direction and a small amount of particles was distributed offshore along the northern area of the Zhejiang coast.The correlations between the SST at each stage of larvae with the corresponding year's yield showed that the yield of P.trituberculatus decreased significantly(R=-0.772,P=0.015)with increasing SST at the M stage.This study preliminarily explains the correlation between SST at the larval stage and the yield of P.trituberculatus and provides essential information for scientific stock enhancement in the future.
基金supported by the National Key R&D Program of China (No. 2017YFC1309100)National Natural Scientific Foundation of China (No. 81771912)Science and Technology Planning Project of Guangdong Province (No. 2017B020227012)
文摘Objective： To predict preoperative staging using a radiomics approach based on computed tomography （CT）images of patients with esophageal squamous cell carcinoma （ESCC）.Methods： This retrospective study included 154 patients （primary cohort： n： t 14; validation cohort： n：40） withpathologically confirmed ESCC. All patients underwent a preoperative CT scan from the neck to abdomen. Highthroughput and quantitative radiomics features were extracted from the CT images for each patient. A radiomicssignature was constructed using the least absolute shrinkage and selection operator （Lasso）. Associations betweenradiomics signature, tumor volume and ESCC staging were explored. Diagnostic performance of radiomicsapproach and tumor volume for discriminating between stages Ⅰ-Ⅱand Ⅲ-Ⅳ was evaluated and compared usingthe receiver operating characteristics （ROC） curves and net reclassification improvement （NRI）.Results= A total of 9,790 radiomics features were extracted. Ten features were selected to build a radiomicssignature after feature dimension reduction. The radiomics signature was significantly associated with ESCCstaging （P〈0.001）, and yielded a better performance for discrimination of early and advanced stage ESCC comparedto tumor volume in both the primary [area under the receiver operating characteristic curve （AUC）： 0.795 vs. 0.694,P=0.003; NRI=0.424）] and validation cohorts （AUC： 0.762 vs. 0.624, P=0.035; NRI=0.834）.Conclusions： The quantitative approach has the potential to identify stage Ⅰ-Ⅱand Ⅲ-Ⅳ ESCC beforetreatment.
文摘Hepatocellular carcinoma(HCC)is a high mortality neoplasm which usually appears on a cirrhotic liver.The therapeutic arsenal and subsequent prognostic outlook are intrinsically linked to the HCC stage at diagnosis.Notwithstanding the current deployment of treatments with curative intent(liver resection/local ablation and liver transplantation)in early and intermediate stages,a high rate of HCC recurrence persists,underscoring a pivotal clinical challenge.Emergent systemic therapies(ST),particularly immunotherapy,have demonstrate promising outcomes in terms of increase overall survival,but they are currently bound to the advanced stage of HCC.This review provides a comprehensive analysis of the literature,encompassing studies up to March 10,2024,evaluating the impact of novel ST in the early and intermediate HCC stages,specially focusing on the findings of neoadjuvant and adjuvant regimens,aimed at increasing significantly overall survival and recurrence-free survival after a treatment with curative intent.We also investigate the potential role of ST in enhancing the downstaging rate for the intermediate-stage HCC initially deemed ineligible for treatment with curative intent.Finally,we critically discuss about the current relevance of the results of these studies and the encouraging future implications of ST in the treatment schedules of early and intermediate HCC stages.
基金the Foundation for Cancer Research supported by Kyoto Preventive Medical Center and the Japan Society for the Promotion of Science(JSPS)Grants-in-Aid KAKENHI,No.JP 22K21080.
文摘BACKGROUND Colorectal cancer(CRC)is a global health concern,with advanced-stage diagnoses contributing to poor prognoses.The efficacy of CRC screening has been well-established;nevertheless,a significant proportion of patients remain unscreened,with>70%of cases diagnosed outside screening.Although identifying specific subgroups for whom CRC screening should be particularly recommended is crucial owing to limited resources,the association between the diagnostic routes and identification of these subgroups has been less appreciated.In the Japanese cancer registry,the diagnostic routes for groups discovered outside of screening are primarily categorized into those with comorbidities found during hospital visits and those with CRC-related symptoms.AIM To clarify the stage at CRC diagnosis based on diagnostic routes.METHODS We conducted a retrospective observational study using a cancer registry of patients with CRC between January 2016 and December 2019 at two hospitals.The diagnostic routes were primarily classified into three groups:Cancer screening,follow-up,and symptomatic.The early-stage was defined as Stages 0 or I.Multivariate and univariate logistic regressions were exploited to determine the odds of early-stage diagnosis in the symptomatic and cancer screening groups,referencing the follow-up group.The adjusted covariates were age,sex,and tumor location.RESULTS Of the 2083 patients,715(34.4%),1064(51.1%),and 304(14.6%)belonged to the follow-up,symptomatic,and cancer screening groups,respectively.Among the 2083 patients,CRCs diagnosed at an early stage were 57.3%(410 of 715),23.9%(254 of 1064),and 59.5%(181 of 304)in the follow-up,symptomatic,and cancer screening groups,respectively.The symptomatic group exhibited a lower likelihood of early-stage diagnosis than the follow-up group[P<0.001,adjusted odds ratio(aOR),0.23;95%confidence interval(95%CI):0.19-0.29].The likelihood of diagnosis at an early stage was similar between the follow-up and cancer screening groups(P=0.493,aOR for early-stage diagnosis in the cancer screening group vs follow-up group=1.11;95%CI=0.82-1.49).CONCLUSION CRCs detected during hospital visits for comorbidities were diagnosed earlier,similar to cancer screening.CRC screening should be recommended,particularly for patients without periodical hospital visits for comorbidities.
基金funded by the Natural Sciences and Engineering Research Council(NSERC)of Canada through the strategic partnership grants project STPGP 493908"Research in Sensory Information Technologies and Implementation in Sleep Monitoring.".
文摘Sleep apnea(SA)is a common sleep disorder.Identifying patients at risk by means of comprehensive monitoring that requires overnight stay at professional sleep clinics are costly and inconvenient and can lead to unreliable results in view of the unfamiliar sleep environment.Existing wearable devices for sleep monitoring,which can be used in a familiar home environment,do not provide the same comprehensive monitoring as through clinical monitoring.The larger objective of the present work is to develop a sleep monitoring system for home use,which can provide comprehensive monitoring.In the development in this paper,machine learning(ML)models are explored for the classification of SA and sleep stages using multisensory data,without neglecting any of the required signals.The data acquired through the sensors are normalized,their features are extracted using Composite Multiscale Sample Entropy(CMSE)and are standardized using a robust scaling algorithm.Processed features are classified using a Neural Network(NN)and the obtained results for the SA classification are compared with those obtained by using a Support Vector Machine(SVM)approach.The impact of neglecting signals when classifying sleep stages is analyzed as well.The results are presented in the paper and observations are made.The NN model trained with the Bayesian regularization algorithm has provided an overall average accuracy of 94.5%and performed slightly better than when trained using the scaled conjugate gradient backpropagation algorithm(93.2%).The SVMs have yielded lower accuracy levels compared to the NNs(<92%).It is observed that the use of all 14 signals for SS classification yields an overall test accuracy of 72.3%,which is higher than that when one or few signals are used.It is concluded that ML models are effective in classifying sleep data from multiple sensors.Accuracy levels are higher when fused multisensory data are used as inputs.Furthermore,NN models are found to be better suitable in practical application and can be incorporated into an inexpensive and convenient wearable device that can carry out comprehensive monitoring.
基金This study was reviewed and approved by the Ethics Committee of the HUB-Hospital Erasme.
文摘BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with no consensus regarding the superiority of any single approach.AIM To compare early postoperative complications after implementing the direct anterior and posterior approaches(PL)for hip hemiarthroplasty after femoral neck fractures.METHODS This is a comparative,retrospective,single-center cohort study conducted at a university hospital.Between March 2008 and December 2018,273 patients(a total of 280 hips)underwent bipolar hemiarthroplasties(n=280)for displaced femoral neck fractures using either the PL(n=171)or the minimally invasive direct anterior approach(DAA)(n=109).The choice of approach was related to the surgeons’practices;the implant types were similar and unrelated to the approach.Dislocation rates and other complications were reviewed after a minimum followup of 6 mo.RESULTS Both treatment groups had similarly aged patients(mean age:82 years),sex ratios,patient body mass indexes,and patient comorbidities.Surgical data(surgery delay time,operative time,and blood loss volume)did not differ significantly between the groups.The 30 d mortality rate was higher in the PL group(9.9%)than in the DAA group(3.7%),but the difference was not statistically significant(P=0.052).Among the one-month survivors,a significantly higher rate of dislocation was observed in the PL group(14/154;9.1%)than in the DAA group(0/105;0%)(P=0.002).Of the 14 patients with dislocation,8 underwent revision surgery for recurrent instability(posterior group),and one of them had 2 additional procedures due to a deep infection.The rate of other complications(e.g.,perioperative and early postoperative periprosthetic fractures and infection-related complications)did not differ significantly between the groups.CONCLUSION These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate(<1%)than the PL.
基金supported in part by the National Key R&D Project of China under Grant 2020YFA0712300National Natural Science Foundation of China under Grant NSFC-62231022,12031011supported in part by the NSF of China under Grant 62125108。
文摘We consider an image semantic communication system in a time-varying fading Gaussian MIMO channel,with a finite number of channel states.A deep learning-aided broadcast approach scheme is proposed to benefit the adaptive semantic transmission in terms of different channel states.We combine the classic broadcast approach with the image transformer to implement this adaptive joint source and channel coding(JSCC)scheme.Specifically,we utilize the neural network(NN)to jointly optimize the hierarchical image compression and superposition code mapping within this scheme.The learned transformers and codebooks allow recovering of the image with an adaptive quality and low error rate at the receiver side,in each channel state.The simulation results exhibit our proposed scheme can dynamically adapt the coding to the current channel state and outperform some existing intelligent schemes with the fixed coding block.
文摘In this article, a novel scalarization technique, called the improved objective-constraint approach, is introduced to find efficient solutions of a given multiobjective programming problem. The presented scalarized problem extends the objective-constraint problem. It is demonstrated that how adding variables to the scalarized problem, can lead to find conditions for (weakly, properly) Pareto optimal solutions. Applying the obtained necessary and sufficient conditions, two algorithms for generating the Pareto front approximation of bi-objective and three-objective programming problems are designed. These algorithms are easy to implement and can achieve an even approximation of (weakly, properly) Pareto optimal solutions. These algorithms can be generalized for optimization problems with more than three criterion functions, too. The effectiveness and capability of the algorithms are demonstrated in test problems.
