BACKGROUND Blood glucose and serum albumin have been associated with cardiovascular disease prognosis,but the impact of admission-blood-glucose-to-albumin ratio(AAR)on adverse outcomes in critical ill coronary artery ...BACKGROUND Blood glucose and serum albumin have been associated with cardiovascular disease prognosis,but the impact of admission-blood-glucose-to-albumin ratio(AAR)on adverse outcomes in critical ill coronary artery disease(CAD)patients was not investigated.METHODS Patients diagnosed with CAD were non-consecutively selected from the MIMIC-IV database and categorized into quartiles based on their AAR.The primary outcome was 1-year mortality,and secondary endpoints were in-hospital mortality,acute kidney injury(AKI),and renal replacement therapy(RRT).A restricted cubic splines model and Cox proportional hazard models assessed the association between AAR and adverse outcomes in CAD patients.Kaplan-Meier survival analysis determined differences in endpoints across subgroups.RESULTS A total of 8360 patients were included.There were 726 patients(8.7%)died in the hospital and 1944 patients(23%)died at 1 year.The incidence of AKI and RRT was 63%and 4.3%,respectively.High AAR was markedly associated with in-hospital mortality(HR=1.587,P=0.003),1-year mortality(HR=1.502,P<0.001),AKI incidence(HR=1.579,P<0.001),and RRT(HR=1.640,P<0.016)in CAD patients in the completely adjusted Cox proportional hazard model.Kaplan-Meier survival analysis noted substantial differences in all endpoints based on AAR quartiles.Stratified analysis and interaction test demonstrated stable correlations between AAR and outcomes.CONCLUSIONS The results highlight that AAR may be a potential indicator for assessing in-hospital mortality,1-year mortality,and adverse renal prognosis in critical CAD patients.展开更多
Damage to electrical equipment in an earthquake can lead to power outage of power systems.Seismic fragility analysis is a common method to assess the seismic reliability of electrical equipment.To further guarantee th...Damage to electrical equipment in an earthquake can lead to power outage of power systems.Seismic fragility analysis is a common method to assess the seismic reliability of electrical equipment.To further guarantee the efficiency of analysis,multi-source uncertainties including the structure itself and seismic excitation need to be considered.A method for seismic fragility analysis that reflects structural and seismic parameter uncertainty was developed in this study.The proposed method used a random sampling method based on Latin hypercube sampling(LHS)to account for the structure parameter uncertainty and the group structure characteristics of electrical equipment.Then,logistic Lasso regression(LLR)was used to find the seismic fragility surface based on double ground motion intensity measures(IM).The seismic fragility based on the finite element model of an±1000 kV main transformer(UHVMT)was analyzed using the proposed method.The results show that the seismic fragility function obtained by this method can be used to construct the relationship between the uncertainty parameters and the failure probability.The seismic fragility surface did not only provide the probabilities of seismic damage states under different IMs,but also had better stability than the fragility curve.Furthermore,the sensitivity analysis of the structural parameters revealed that the elastic module of the bushing and the height of the high-voltage bushing may have a greater influence.展开更多
This article presents an adaptive fault-tolerant tracking control strategy for unknown affine nonlinear systems subject to actuator faults and external disturbances.To address the hyperparameter initialization challen...This article presents an adaptive fault-tolerant tracking control strategy for unknown affine nonlinear systems subject to actuator faults and external disturbances.To address the hyperparameter initialization challenges inherent in conventional neural network training,an improved self-organizing radial basis function neural network(SRBFNN)with an input-dependent variable structure is developed.Furthermore,a novel selforganizing RBFNN-based observer is introduced to estimate system states across all dimensions.Leveraging the reconstructed states,the proposed adaptive controller effectively compensates for all uncertainties,including estimation errors in the observer,ensuring accurate state tracking with reduced control effort.The uniform ultimate boundedness of all closed-loop signals and tracking errors is rigorously established via Lyapunov stability analysis.Finally,simulations on two different nonlinear systems comprehensively validate the effectiveness and superiority of the proposed control approach.展开更多
目的系统评价国内外发表的含有抗逆转录病毒疗法(ART)治疗艾滋病的临床实践指南的推荐意见,并总结支持这些推荐意见的证据来源、证据质量、推荐强度以及推荐意见的一致性,为减少医疗资源的浪费和未来制订指南提供参考。方法计算机检索C...目的系统评价国内外发表的含有抗逆转录病毒疗法(ART)治疗艾滋病的临床实践指南的推荐意见,并总结支持这些推荐意见的证据来源、证据质量、推荐强度以及推荐意见的一致性,为减少医疗资源的浪费和未来制订指南提供参考。方法计算机检索CNKI、WanFang Data、VIP、CBM、PubMed、Web of Science、Embase数据库,以及9个指南数据库/学会/协会网站,检索时限均从建库至2024年12月,纳入艾滋病临床实践指南,由两名研究者采用AGREEⅡ和RIGHT工具对纳入指南质量和报告规范进行独立评价,提取指南中ART相关的推荐意见及其证据基础,采用证据图谱方式进行结果总结。结果共纳入18部指南,AGREEⅡ平均得分为62分,整体报告率为69.68%,18部指南共提取出57条ART疗法的推荐意见,主要推荐2种NRTIs联合第三类药物。NRTI类药物主要以TDF+FTC(3TC)、TAF+FTC、ABC+3TC为主干,各指南首选推荐频率相对较高的第三类药物包括INSTI类(DTG、BIC、RAL)、NNRTI类(EFV)和PI类(DRV/r)。替代疗法中推荐频率相对较高的第三类药物包括INSTI类(DTG、RAL)、NNRTI类(EFV、RPV)和PI类(DRV/c)。结论艾滋病临床实践指南方法学质量和报告规范有待提高,指南的证据分级不统一,各指南推荐的联合用药存在差异,推荐强度和证据质量不一致以及支持意见的证据来源存在明显差异,未来艾滋病防治指南的制订应进一步规范化和透明化,采用统一、科学的证据等级与推荐分级标准,完善证据来源与推荐意见形成的过程,加强对证据检索、评价及外部专家和公众参与的详细说明,并充分考虑不同地区经济、资源可及性和患者个体差异等实际情况。与此同时,需开展更多高质量临床试验和真实世界研究,为指南更新提供坚实可信的证据。展开更多
<strong>Objective:</strong> To observe the changes of fetal umbilical vein (UV) Doppler parameters in pregnant women with preeclampsia (PE) and analyze their predictive values for maternal PE. <strong&g...<strong>Objective:</strong> To observe the changes of fetal umbilical vein (UV) Doppler parameters in pregnant women with preeclampsia (PE) and analyze their predictive values for maternal PE. <strong>Methods:</strong> Forty-six patients with PE who underwent systematic ultrasound examination in our hospital from December 2017 to May 2021 were included as the subjects, which were divided into two groups according to the severity of the disease (23 cases in each group). And 120 normal pregnant women who underwent health examination in our hospital during the same period were enrolled as the control group. Color Doppler ultrasonography was used to monitor the umbilical vein flow (QUV), left portal vein flow (QLPV), venous catheter flow (QDV), left portal vein (LPV) shunt rate and venous catheter (DV) shunt rate. And the sensitivity and specificity of the related indexes were calculated and analyzed according to the gold standard for clinical diagnosis of PE. <strong>Results:</strong> As the severity of PE increased, the fetal QUV, QLPV and LPV shunt rates decreased, and the QDV and DV shunt rates increased, with statistically significant differences compared with the control group (P < 0.05). The specificity and sensitivity of the combination of fetal QUV, QLPV, QDV, LPV shunt rate and DV shunt rate in predicting PE were higher than those of the indexes used alone (P < 0.05). <strong>Conclusion:</strong> The fetal umbilical vein Doppler parameters QUV, QLPV, QDV, LPV shunt rate, and DV shunt rate have some value in predicting PE, but their combination showed greater value, as well as higher diagnostic and clinical significance.展开更多
基金supported by the National Nature Science Foundation of China(No.82370336&No.82330014)the Key Research and Development Plan of Heilongjiang Province(2022ZX06C23&JD2023SJ44)the Research Project of the First Affiliated Hospital of Harbin Medical University(No.2021M19).
文摘BACKGROUND Blood glucose and serum albumin have been associated with cardiovascular disease prognosis,but the impact of admission-blood-glucose-to-albumin ratio(AAR)on adverse outcomes in critical ill coronary artery disease(CAD)patients was not investigated.METHODS Patients diagnosed with CAD were non-consecutively selected from the MIMIC-IV database and categorized into quartiles based on their AAR.The primary outcome was 1-year mortality,and secondary endpoints were in-hospital mortality,acute kidney injury(AKI),and renal replacement therapy(RRT).A restricted cubic splines model and Cox proportional hazard models assessed the association between AAR and adverse outcomes in CAD patients.Kaplan-Meier survival analysis determined differences in endpoints across subgroups.RESULTS A total of 8360 patients were included.There were 726 patients(8.7%)died in the hospital and 1944 patients(23%)died at 1 year.The incidence of AKI and RRT was 63%and 4.3%,respectively.High AAR was markedly associated with in-hospital mortality(HR=1.587,P=0.003),1-year mortality(HR=1.502,P<0.001),AKI incidence(HR=1.579,P<0.001),and RRT(HR=1.640,P<0.016)in CAD patients in the completely adjusted Cox proportional hazard model.Kaplan-Meier survival analysis noted substantial differences in all endpoints based on AAR quartiles.Stratified analysis and interaction test demonstrated stable correlations between AAR and outcomes.CONCLUSIONS The results highlight that AAR may be a potential indicator for assessing in-hospital mortality,1-year mortality,and adverse renal prognosis in critical CAD patients.
基金National Key R&D Program of China under Grant Nos.2018YFC1504504 and 2018YFC0809404。
文摘Damage to electrical equipment in an earthquake can lead to power outage of power systems.Seismic fragility analysis is a common method to assess the seismic reliability of electrical equipment.To further guarantee the efficiency of analysis,multi-source uncertainties including the structure itself and seismic excitation need to be considered.A method for seismic fragility analysis that reflects structural and seismic parameter uncertainty was developed in this study.The proposed method used a random sampling method based on Latin hypercube sampling(LHS)to account for the structure parameter uncertainty and the group structure characteristics of electrical equipment.Then,logistic Lasso regression(LLR)was used to find the seismic fragility surface based on double ground motion intensity measures(IM).The seismic fragility based on the finite element model of an±1000 kV main transformer(UHVMT)was analyzed using the proposed method.The results show that the seismic fragility function obtained by this method can be used to construct the relationship between the uncertainty parameters and the failure probability.The seismic fragility surface did not only provide the probabilities of seismic damage states under different IMs,but also had better stability than the fragility curve.Furthermore,the sensitivity analysis of the structural parameters revealed that the elastic module of the bushing and the height of the high-voltage bushing may have a greater influence.
基金supported in part by the National Natural Science Foundation of China(62033008,62188101,62173343,62073339)the Natural Science Foundation of Shandong Province of China(ZR2024MF072,ZR2022ZD34)the Research Fund for the Taishan Scholar Project of Shandong Province of China.
文摘This article presents an adaptive fault-tolerant tracking control strategy for unknown affine nonlinear systems subject to actuator faults and external disturbances.To address the hyperparameter initialization challenges inherent in conventional neural network training,an improved self-organizing radial basis function neural network(SRBFNN)with an input-dependent variable structure is developed.Furthermore,a novel selforganizing RBFNN-based observer is introduced to estimate system states across all dimensions.Leveraging the reconstructed states,the proposed adaptive controller effectively compensates for all uncertainties,including estimation errors in the observer,ensuring accurate state tracking with reduced control effort.The uniform ultimate boundedness of all closed-loop signals and tracking errors is rigorously established via Lyapunov stability analysis.Finally,simulations on two different nonlinear systems comprehensively validate the effectiveness and superiority of the proposed control approach.
文摘目的系统评价国内外发表的含有抗逆转录病毒疗法(ART)治疗艾滋病的临床实践指南的推荐意见,并总结支持这些推荐意见的证据来源、证据质量、推荐强度以及推荐意见的一致性,为减少医疗资源的浪费和未来制订指南提供参考。方法计算机检索CNKI、WanFang Data、VIP、CBM、PubMed、Web of Science、Embase数据库,以及9个指南数据库/学会/协会网站,检索时限均从建库至2024年12月,纳入艾滋病临床实践指南,由两名研究者采用AGREEⅡ和RIGHT工具对纳入指南质量和报告规范进行独立评价,提取指南中ART相关的推荐意见及其证据基础,采用证据图谱方式进行结果总结。结果共纳入18部指南,AGREEⅡ平均得分为62分,整体报告率为69.68%,18部指南共提取出57条ART疗法的推荐意见,主要推荐2种NRTIs联合第三类药物。NRTI类药物主要以TDF+FTC(3TC)、TAF+FTC、ABC+3TC为主干,各指南首选推荐频率相对较高的第三类药物包括INSTI类(DTG、BIC、RAL)、NNRTI类(EFV)和PI类(DRV/r)。替代疗法中推荐频率相对较高的第三类药物包括INSTI类(DTG、RAL)、NNRTI类(EFV、RPV)和PI类(DRV/c)。结论艾滋病临床实践指南方法学质量和报告规范有待提高,指南的证据分级不统一,各指南推荐的联合用药存在差异,推荐强度和证据质量不一致以及支持意见的证据来源存在明显差异,未来艾滋病防治指南的制订应进一步规范化和透明化,采用统一、科学的证据等级与推荐分级标准,完善证据来源与推荐意见形成的过程,加强对证据检索、评价及外部专家和公众参与的详细说明,并充分考虑不同地区经济、资源可及性和患者个体差异等实际情况。与此同时,需开展更多高质量临床试验和真实世界研究,为指南更新提供坚实可信的证据。
文摘<strong>Objective:</strong> To observe the changes of fetal umbilical vein (UV) Doppler parameters in pregnant women with preeclampsia (PE) and analyze their predictive values for maternal PE. <strong>Methods:</strong> Forty-six patients with PE who underwent systematic ultrasound examination in our hospital from December 2017 to May 2021 were included as the subjects, which were divided into two groups according to the severity of the disease (23 cases in each group). And 120 normal pregnant women who underwent health examination in our hospital during the same period were enrolled as the control group. Color Doppler ultrasonography was used to monitor the umbilical vein flow (QUV), left portal vein flow (QLPV), venous catheter flow (QDV), left portal vein (LPV) shunt rate and venous catheter (DV) shunt rate. And the sensitivity and specificity of the related indexes were calculated and analyzed according to the gold standard for clinical diagnosis of PE. <strong>Results:</strong> As the severity of PE increased, the fetal QUV, QLPV and LPV shunt rates decreased, and the QDV and DV shunt rates increased, with statistically significant differences compared with the control group (P < 0.05). The specificity and sensitivity of the combination of fetal QUV, QLPV, QDV, LPV shunt rate and DV shunt rate in predicting PE were higher than those of the indexes used alone (P < 0.05). <strong>Conclusion:</strong> The fetal umbilical vein Doppler parameters QUV, QLPV, QDV, LPV shunt rate, and DV shunt rate have some value in predicting PE, but their combination showed greater value, as well as higher diagnostic and clinical significance.
