Primary and metastatic liver tumors are an increasing global health problem,with hepatocellular carcinoma(HCC)now being the third leading cause of cancer-related mortality worldwide.Systemic treatment options for HCC ...Primary and metastatic liver tumors are an increasing global health problem,with hepatocellular carcinoma(HCC)now being the third leading cause of cancer-related mortality worldwide.Systemic treatment options for HCC remain limited,with Sorafenib as the only prospectively validated agent shown to increase overall survival.Surgical resection and/or transplantation,locally ablative therapies and regional or locoregional therapies have filled the gap in liver tumor treatments,providing improved survival outcomes for both primary and metastatic tumors.Minimally invasive local therapies have an increasing role in the treatment of both primary and metastatic liver tumors.For patients with low volume disease,these therapies have now been established into consensus practice guidelines.This review highlights technical aspects and outcomes of commonly utilized,minimally invasive local therapies including laparoscopic liver resection(LLR),radiofrequency ablation(RFA),microwave ablation(MWA),high-intensity focused ultrasound(HIFU),irreversible electroporation(IRE),and stereotactic body radiation therapy(SBRT).In addition,the role of combination treatment strategies utilizing these minimally invasive techniques is reviewed.展开更多
The ability to modulate the future liver remnant(FLR) is a key component of modern oncologic hepatobiliary surgery practice and has extended surgical candidacy for patients who may have been previously thought unable ...The ability to modulate the future liver remnant(FLR) is a key component of modern oncologic hepatobiliary surgery practice and has extended surgical candidacy for patients who may have been previously thought unable to survive liver resection. Multiple techniques have been developed to augment the FLR including portal vein embolization(PVE), associating liver partition and portal vein ligation(ALPPS), and the recently reported transhepatic liver venous deprivation(LVD). PVE is a well-established means to improve the safety of liver resection by redirecting blood flow to the FLR in an effort to selectively hypertrophy and ultimately improve functional reserve of the FLR. This article discusses the current practice of PVE with focus on summarizing the large number of published reports from which outcomes based practices have been developed. Both technical aspects of PVE including volumetry, approaches, and embolization agents; and clinical aspects of PVE including data supporting indications, and its role in conjunction with chemotherapy and transarterial embolization will be highlighted. PVE remains an important aspect of oncologic care; in large part due to the substantial foundation of information available demonstrating its clear clinical benefit for hepatic resection candidates with small anticipated FLRs.展开更多
The approval of commercial application transcatheter aortic valve replacement(TAVR)by the FDA in 2011 has revolutionized the management of high-risk surgical patients with severe aortic stenosis(AS).With TAVR being ex...The approval of commercial application transcatheter aortic valve replacement(TAVR)by the FDA in 2011 has revolutionized the management of high-risk surgical patients with severe aortic stenosis(AS).With TAVR being expanded to intermediate surgical risk patients in 2016,the number of patients undergoing TAVR has been increasing rapidly.In fact,since the very first human TAVR procedure in 2002,more than 300,000 TAVRs have been performed worldwide.[1,2]The technological advancements in the TAVR since its early days of clinical adaptation has made this procedure a routine practice in many institutions worldwide.However,one of the most feared complications,ischemic stroke,remains a major concern for clinicians and patients despite all the advancements in the procedure.展开更多
本文从金融科技大数据出发,以人工智能的吉布斯随机搜索(Gibbs Sampling)算法为工具,在大数据框架下建立了针对公司财务欺诈风险的特征因子筛选的一般处理方法与特征提取推断原理,并结合上市公司的财务报表数据进行实证分析,结合从2017...本文从金融科技大数据出发,以人工智能的吉布斯随机搜索(Gibbs Sampling)算法为工具,在大数据框架下建立了针对公司财务欺诈风险的特征因子筛选的一般处理方法与特征提取推断原理,并结合上市公司的财务报表数据进行实证分析,结合从2017年1月到2018年12月证监会对上市公司财务报表信息披露违规的数据样本,筛选出刻画财务欺诈的特征因子并进行了验证测试,支持财务欺诈的识别。本文提出的框架和模型方法可以加强和提升对上市公司财务欺诈风险的识别能力,并实现对公司财务在欺诈方面的探测与预测(Detecting and Predicting)功能。展开更多
Determining the migration routes and connections of migratory birds at the population level helps clarify intraspecific differences in migration.Five subspecies have been recognized in the Whimbrel(Numenius phaeopus)i...Determining the migration routes and connections of migratory birds at the population level helps clarify intraspecific differences in migration.Five subspecies have been recognized in the Whimbrel(Numenius phaeopus)in Eurasia.Ssp.rogachevae is the most recently described subspecies.It breeds in Central Siberia,while its non-breeding region and migration routes are still unclear.We tracked the migration of Eurasian Whimbrels captured at three non-breeding sites(Moreton Bay in east coast of Australia,Roebuck Bay in Northwest Australia and Sungei Buloh Wetland in Singapore)and two migration stopover sites(Chongming Dongtan and Mai Po Wetland in China).We determined the breeding sites and inferred the subspecies of the tagged birds in the East Asian–Australasian Flyway(EAAF)based on the known breeding distribution of each subspecies.Of the 30 tagged birds,6 and 21 birds bred in the breeding range of ssp.rogachevae and variegatus,respectively;one bred in the presumed transition area between the breeding range of ssp.phaeopus and rogachevae,and two bred in the region between the breeding range of ssp.rogachevae and variegatus.The birds that bred in the ssp.rogachevae breeding range spent their non-breeding season in the northern Sumatra,Singapore,East Java and Northwest Australia and mainly stopped over along China's coasts during migration.None of our birds bred in the exclusive breeding range of the phaeopus subspecies.Previous studies have predicted that rogachevae whimbrels migrate along the Central Asian Flyway and spend the non-breeding season in West India and East Africa.We found that at least some rogachevae whimbrels migrate along the EAAF and spend the non-breeding season in Southeast Asia and Australia.The ssp.phaeopus is at best sparsely distributed in the EAAF in the west region,or possibly does not occur at all.展开更多
As the aging population continues to increase worldwide,a proportionally increasing number of elderly patients will be undergoing surgical procedures requiring anesthesia care.It has been estimated that approximately ...As the aging population continues to increase worldwide,a proportionally increasing number of elderly patients will be undergoing surgical procedures requiring anesthesia care.It has been estimated that approximately one of every three surgical procedures are performed on a patient who is 65 years of age or older.展开更多
In our clinical practice, we are accustomed to dealing with perioperative hemodynamic and blood pressure changes on a daily basis. Intraoperative blood pressure variations outside of the accepted ＂normal＂ physiologi...In our clinical practice, we are accustomed to dealing with perioperative hemodynamic and blood pressure changes on a daily basis. Intraoperative blood pressure variations outside of the accepted ＂normal＂ physiologic ranges are in fact very common.展开更多
Until recently,Limosa limosa melanuroides was thought to be the only subspecies of Black-tailed Godwit in the East Asian-Australasian Flyway.For this reason,all previous occurrences and counts of Black-tailed Godwits ...Until recently,Limosa limosa melanuroides was thought to be the only subspecies of Black-tailed Godwit in the East Asian-Australasian Flyway.For this reason,all previous occurrences and counts of Black-tailed Godwits in the flyway have been assigned to melanuroides.However,a larger-bodied subspecies,bohaii,has recently been discovered in the flyway.As a result,the occurrence of Black-tailed Godwits in the flyway needs to be reconsidered such that the specific distribution of each subspecies becomes known.To this end,we developed a simple discriminant function to assign individuals to subspecies based on their bill and wing length.Cross-validation with individuals known to be bohaii or melanuroides,based on molecular analysis,showed the developed function to be 97.7%accurate.When applied to measurements of godwits captured at 22 sites across 9 countries in East-Southeast Asia and Australia,we found that bohaii and melanuroides occurred at most sites and overlapped in their distribution from Kamchatka to Australia.We examined photos from all along the flyway to verify this surprising result,confirming that both subspecies co-occur in most locations.Based on these results,we hypothesise that bohaii and melanuroides from the west of their breeding ranges mostly migrate over Chinese mainland.Birds of both subspecies from the east of their ranges are expected to migrate along the Pacific Ocean.We encourage ringing groups in East-Southeast Asia and Australia to use this simple method to keep adding knowledge about Black-tailed Godwits in the East Asian-Australasian Flyway.展开更多
With continued technological advancement and technical improvement of transcatheter aortic valve replacement(TAVR),it has become a desirable treatment option for aortic valve stenosis.Its minimally invasive approach c...With continued technological advancement and technical improvement of transcatheter aortic valve replacement(TAVR),it has become a desirable treatment option for aortic valve stenosis.Its minimally invasive approach compared to surgical aortic valve replacement offers the treatment to a broader patient population,mainly non-surgical candidates.A feared complication of TAVR is the occlusion of coronary artery ostium by the native aortic valve leaflet due to its displacement by the expanded transcatheter valve.Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction(BASILICA)is a technique developed to mitigate this risk by creating a lengthwise laceration of the left and/or right aortic valve leaflets prior to TAVR.Patient outcomes following TAVR with BASILICA have been promising.Meticulous preoperative examination,patient selection,and hemodynamic management are imperative.With continued refinement,BASILICA may further expand the application of TAVR to patients at high risk for coronary occlusion associated with the procedure.展开更多
Aortic stenosis(AS)is the most common valvular disorder frequently affecting patients as they get older,and resulting in life-altering symptoms such as dyspnea,angina,pre-syncope,and syncope,which are often made worse...Aortic stenosis(AS)is the most common valvular disorder frequently affecting patients as they get older,and resulting in life-altering symptoms such as dyspnea,angina,pre-syncope,and syncope,which are often made worse with exertion.Often,AS is caused by age-related calcification of the valve;in addition,its pathogenetic mechanism also involves the fact that bicuspid aortic valves tend to narrow rapidly compared to other three-leaflet valve.As the aging population continues to grow,an increasing number of patients are seeking treatment for AS,which makes therapies for AS continuing to evolve and improve.Initially,surgical aortic valve replacement(SAVR),requiring a median sternotomy and an extended post-operative intensive care unit stay,was the predominant therapy for patients with AS.展开更多
This paper proposes an online power system voltage stability index(PVSI Online)that quantifies power system voltage stability in real time between an AC network and LCC HVDC using only local measurements.Previous meth...This paper proposes an online power system voltage stability index(PVSI Online)that quantifies power system voltage stability in real time between an AC network and LCC HVDC using only local measurements.Previous methods relied on using telecommunications to inform a change in a predetermined AC network model.The proposed method uses local measurements of voltage and current from the HVDC using a newly developed,numerically robust technique called Moving Window Covariance to detect a change in the AC network in real time.These network parameters are fed to a newly devised index that accurately models and captures the dynamics of the interaction between an LCC HVDC and AC network.The index is used to quantify stability,but also to advise network operation.In an onset of instability due to network degradation,the proposed index can provide a power order value for the HVDC to restore stability.All as a self-contained module that can be implemented within a HVDC scheme.展开更多
文摘Primary and metastatic liver tumors are an increasing global health problem,with hepatocellular carcinoma(HCC)now being the third leading cause of cancer-related mortality worldwide.Systemic treatment options for HCC remain limited,with Sorafenib as the only prospectively validated agent shown to increase overall survival.Surgical resection and/or transplantation,locally ablative therapies and regional or locoregional therapies have filled the gap in liver tumor treatments,providing improved survival outcomes for both primary and metastatic tumors.Minimally invasive local therapies have an increasing role in the treatment of both primary and metastatic liver tumors.For patients with low volume disease,these therapies have now been established into consensus practice guidelines.This review highlights technical aspects and outcomes of commonly utilized,minimally invasive local therapies including laparoscopic liver resection(LLR),radiofrequency ablation(RFA),microwave ablation(MWA),high-intensity focused ultrasound(HIFU),irreversible electroporation(IRE),and stereotactic body radiation therapy(SBRT).In addition,the role of combination treatment strategies utilizing these minimally invasive techniques is reviewed.
文摘The ability to modulate the future liver remnant(FLR) is a key component of modern oncologic hepatobiliary surgery practice and has extended surgical candidacy for patients who may have been previously thought unable to survive liver resection. Multiple techniques have been developed to augment the FLR including portal vein embolization(PVE), associating liver partition and portal vein ligation(ALPPS), and the recently reported transhepatic liver venous deprivation(LVD). PVE is a well-established means to improve the safety of liver resection by redirecting blood flow to the FLR in an effort to selectively hypertrophy and ultimately improve functional reserve of the FLR. This article discusses the current practice of PVE with focus on summarizing the large number of published reports from which outcomes based practices have been developed. Both technical aspects of PVE including volumetry, approaches, and embolization agents; and clinical aspects of PVE including data supporting indications, and its role in conjunction with chemotherapy and transarterial embolization will be highlighted. PVE remains an important aspect of oncologic care; in large part due to the substantial foundation of information available demonstrating its clear clinical benefit for hepatic resection candidates with small anticipated FLRs.
基金This work was supported by the Department of Anesthesiology and Pain Medicine and NIH grant UL1 TR001860 of the University of California Davis Health.
文摘The approval of commercial application transcatheter aortic valve replacement(TAVR)by the FDA in 2011 has revolutionized the management of high-risk surgical patients with severe aortic stenosis(AS).With TAVR being expanded to intermediate surgical risk patients in 2016,the number of patients undergoing TAVR has been increasing rapidly.In fact,since the very first human TAVR procedure in 2002,more than 300,000 TAVRs have been performed worldwide.[1,2]The technological advancements in the TAVR since its early days of clinical adaptation has made this procedure a routine practice in many institutions worldwide.However,one of the most feared complications,ischemic stroke,remains a major concern for clinicians and patients despite all the advancements in the procedure.
文摘本文从金融科技大数据出发,以人工智能的吉布斯随机搜索(Gibbs Sampling)算法为工具,在大数据框架下建立了针对公司财务欺诈风险的特征因子筛选的一般处理方法与特征提取推断原理,并结合上市公司的财务报表数据进行实证分析,结合从2017年1月到2018年12月证监会对上市公司财务报表信息披露违规的数据样本,筛选出刻画财务欺诈的特征因子并进行了验证测试,支持财务欺诈的识别。本文提出的框架和模型方法可以加强和提升对上市公司财务欺诈风险的识别能力,并实现对公司财务在欺诈方面的探测与预测(Detecting and Predicting)功能。
基金financially supported by the National Natural Science Foundation of China (No. 31830089 and 31772467)Science and Technology Commission of Shanghai Municipality (21DZ1201902)+2 种基金World Wide Fund for Nature Beijing Office (10003881)Shanghai Landscaping and City Appearance Administrative Bureau (G201610)Scientific Research Fund of Yunnan Provincial Education Department (2022J0847)
文摘Determining the migration routes and connections of migratory birds at the population level helps clarify intraspecific differences in migration.Five subspecies have been recognized in the Whimbrel(Numenius phaeopus)in Eurasia.Ssp.rogachevae is the most recently described subspecies.It breeds in Central Siberia,while its non-breeding region and migration routes are still unclear.We tracked the migration of Eurasian Whimbrels captured at three non-breeding sites(Moreton Bay in east coast of Australia,Roebuck Bay in Northwest Australia and Sungei Buloh Wetland in Singapore)and two migration stopover sites(Chongming Dongtan and Mai Po Wetland in China).We determined the breeding sites and inferred the subspecies of the tagged birds in the East Asian–Australasian Flyway(EAAF)based on the known breeding distribution of each subspecies.Of the 30 tagged birds,6 and 21 birds bred in the breeding range of ssp.rogachevae and variegatus,respectively;one bred in the presumed transition area between the breeding range of ssp.phaeopus and rogachevae,and two bred in the region between the breeding range of ssp.rogachevae and variegatus.The birds that bred in the ssp.rogachevae breeding range spent their non-breeding season in the northern Sumatra,Singapore,East Java and Northwest Australia and mainly stopped over along China's coasts during migration.None of our birds bred in the exclusive breeding range of the phaeopus subspecies.Previous studies have predicted that rogachevae whimbrels migrate along the Central Asian Flyway and spend the non-breeding season in West India and East Africa.We found that at least some rogachevae whimbrels migrate along the EAAF and spend the non-breeding season in Southeast Asia and Australia.The ssp.phaeopus is at best sparsely distributed in the EAAF in the west region,or possibly does not occur at all.
基金supported by the University of California Davis Health Department of Anesthesiology and Pain MedicineNIH grant UL1 TR001860 of the University of California Davis Health
文摘As the aging population continues to increase worldwide,a proportionally increasing number of elderly patients will be undergoing surgical procedures requiring anesthesia care.It has been estimated that approximately one of every three surgical procedures are performed on a patient who is 65 years of age or older.
基金supported by the Department of Anesthesiology and Pain Medicine,University of California Davis Health and NIH grant ULl TR000002 of the University of California Davis Health
文摘In our clinical practice, we are accustomed to dealing with perioperative hemodynamic and blood pressure changes on a daily basis. Intraoperative blood pressure variations outside of the accepted ＂normal＂ physiologic ranges are in fact very common.
基金funded by the National Natural Science Foundation of China[31830089,31801985,32270518]。
文摘Until recently,Limosa limosa melanuroides was thought to be the only subspecies of Black-tailed Godwit in the East Asian-Australasian Flyway.For this reason,all previous occurrences and counts of Black-tailed Godwits in the flyway have been assigned to melanuroides.However,a larger-bodied subspecies,bohaii,has recently been discovered in the flyway.As a result,the occurrence of Black-tailed Godwits in the flyway needs to be reconsidered such that the specific distribution of each subspecies becomes known.To this end,we developed a simple discriminant function to assign individuals to subspecies based on their bill and wing length.Cross-validation with individuals known to be bohaii or melanuroides,based on molecular analysis,showed the developed function to be 97.7%accurate.When applied to measurements of godwits captured at 22 sites across 9 countries in East-Southeast Asia and Australia,we found that bohaii and melanuroides occurred at most sites and overlapped in their distribution from Kamchatka to Australia.We examined photos from all along the flyway to verify this surprising result,confirming that both subspecies co-occur in most locations.Based on these results,we hypothesise that bohaii and melanuroides from the west of their breeding ranges mostly migrate over Chinese mainland.Birds of both subspecies from the east of their ranges are expected to migrate along the Pacific Ocean.We encourage ringing groups in East-Southeast Asia and Australia to use this simple method to keep adding knowledge about Black-tailed Godwits in the East Asian-Australasian Flyway.
基金supported by the Department of Anesthesiology and Pain Medicine and NIH grant UL1 TR000002 of the University of California Davis Health.
文摘With continued technological advancement and technical improvement of transcatheter aortic valve replacement(TAVR),it has become a desirable treatment option for aortic valve stenosis.Its minimally invasive approach compared to surgical aortic valve replacement offers the treatment to a broader patient population,mainly non-surgical candidates.A feared complication of TAVR is the occlusion of coronary artery ostium by the native aortic valve leaflet due to its displacement by the expanded transcatheter valve.Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction(BASILICA)is a technique developed to mitigate this risk by creating a lengthwise laceration of the left and/or right aortic valve leaflets prior to TAVR.Patient outcomes following TAVR with BASILICA have been promising.Meticulous preoperative examination,patient selection,and hemodynamic management are imperative.With continued refinement,BASILICA may further expand the application of TAVR to patients at high risk for coronary occlusion associated with the procedure.
基金This work was supported in part by the University of California Davis Health Department of Anesthesiology and Pain Medicine and National Institutes of Health grant UL1 TR001860 of the University of California Davis Health.
文摘Aortic stenosis(AS)is the most common valvular disorder frequently affecting patients as they get older,and resulting in life-altering symptoms such as dyspnea,angina,pre-syncope,and syncope,which are often made worse with exertion.Often,AS is caused by age-related calcification of the valve;in addition,its pathogenetic mechanism also involves the fact that bicuspid aortic valves tend to narrow rapidly compared to other three-leaflet valve.As the aging population continues to grow,an increasing number of patients are seeking treatment for AS,which makes therapies for AS continuing to evolve and improve.Initially,surgical aortic valve replacement(SAVR),requiring a median sternotomy and an extended post-operative intensive care unit stay,was the predominant therapy for patients with AS.
文摘This paper proposes an online power system voltage stability index(PVSI Online)that quantifies power system voltage stability in real time between an AC network and LCC HVDC using only local measurements.Previous methods relied on using telecommunications to inform a change in a predetermined AC network model.The proposed method uses local measurements of voltage and current from the HVDC using a newly developed,numerically robust technique called Moving Window Covariance to detect a change in the AC network in real time.These network parameters are fed to a newly devised index that accurately models and captures the dynamics of the interaction between an LCC HVDC and AC network.The index is used to quantify stability,but also to advise network operation.In an onset of instability due to network degradation,the proposed index can provide a power order value for the HVDC to restore stability.All as a self-contained module that can be implemented within a HVDC scheme.
