In wind and solar renewable-dominant hybrid alternating current/direct current(AC/DC)power systems,the active power of high-voltage direct current(HVDC)system is significantly limited by the security and stability eve...In wind and solar renewable-dominant hybrid alternating current/direct current(AC/DC)power systems,the active power of high-voltage direct current(HVDC)system is significantly limited by the security and stability events caused by cascading failures.To identify critical lines in cascading failures,a rapid risk assessment method is proposed based on the gradient boosting decision tree(GBDT)and frequent pat-tern growth(FP-Growth)algorithms.First,security and stability events triggered by cascading failures are analyzed to explain the impact of cascading failures on the maximum DC power.Then,a cascading failure risk index is defined,focusing on the DC power being limited.To handle the strong nonlinear relationship between the maximum DC power and cascading failures,a GBDT with an update strategy is utilized to rapidly predict the maximum DC power under uncertain operating conditions.Finally,the FP-Growth algorithm is improved to mine frequent patterns in cascading failures.The importance index for each fault in a frequent pattern is defined by evaluating its impact on cascading failures,enabling the identification of critical lines.Simulation results of a modified Ningxia–Shandong hybrid AC/DC system in China demonstrate that the proposed method can rapidly assess the risk of cascading failures and effectively identify critical lines.展开更多
AIM:To investigate the underlying causes of surgical failure and reoperation management in patients with rhegmatogenous retinal detachment(RRD)who underwent scleral buckle surgery at our institution.METHODS:This was a...AIM:To investigate the underlying causes of surgical failure and reoperation management in patients with rhegmatogenous retinal detachment(RRD)who underwent scleral buckle surgery at our institution.METHODS:This was a single-center,retrospective,descriptive study.The clinical data of 368 patients(387 eyes)with RRD who underwent scleral buckling(SB)surgery between August 2013 and July 2023 at our institution were collected.The aim was to analyze the causes of recurrence and the rationale for selecting reoperation methods.RESULTS:Totally 368 patients(387 eyes)were included in the analysis,comprising 222 males and 146 females.The average age was 30.26±14.18 years,and the mean follow-up duration was(48.33±20.39)mo.The success rate of SB surgery was 90.2%.Recurrent retinal detachment occurred in 38 eyes.Based on surgical records,the causes of SB failure were analyzed.The recurrence causes included abnormal compression ridge position(position,height,or width)in 14 eyes(36.8%,14/38),hole omission in 11 eyes(29.0%,11/38),proliferative vitreoretinopathy(PVR)in 10 eyes(26.3%,10/38),and new holes in 3 eyes(7.9%,3/38).Among these,8 eyes(21.1%,8/38)underwent repeat SB surgery,while the remaining 30 eyes(78.9%,30/38)underwent pars plana vitrectomy(PPV).Regarding tamponade agents,silicone oil was used in 11 eyes(36.7%,11/30),C 3F 8 gas in 12 eyes(40.0%,12/30),and sterile air in 7 eyes(23.3%,7/30).CONCLUSION:SB surgery demonstrates a high success rate in the treatment of RRD.However,abnormal compression ridge position,missed holes during surgery,and PVR are the primary causes of SB failure.After addressing the reasons for failure,re-SB surgery or PPV can be effective alternatives.展开更多
BACKGROUND Anxiety,depression,and other negative emotions are common among patients with chronic renal failure(CRF).Analyzing the factors related to negative emotions is necessary to provide targeted nursing care.AIM ...BACKGROUND Anxiety,depression,and other negative emotions are common among patients with chronic renal failure(CRF).Analyzing the factors related to negative emotions is necessary to provide targeted nursing care.AIM To explore the correlations among life satisfaction,pleasure levels,and negative emotions in patients with CRF.METHODS One hundred patients with CRF who received therapy at the First Affiliated Hospital of Jinzhou Medical University between December 2022 and February 2025 were included.The Depression,Anxiety,and Stress Scale(DASS-21),Satisfaction with Life Scale(SWLS),and Temporal Experience of Pleasure Scale(TEPS)were used to evaluate negative emotions,life satisfaction,and pleasure level,respectively.Pearson’s correlation coefficient analyzed the correlation between life satisfaction,pleasure level,and negative emotions.Linear regression analysis identified the factors affecting negative emotions.RESULTS The average DASS-21 score among patients with CRF was 51.90±2.30,with subscale scores of 17.90±1.50 for depression,18.53±1.18 for anxiety,and 15.47±2.36 for stress,all significantly higher than the domestic norm(P<0.05).The average SWLS score was 22.17±4.90.Correlation analysis revealed a negative correlation between the SWLS and total DASS-21 scores(P<0.05),but not with the individual depression,anxiety,or stress dimensions.The average TEPS score was 67.80±8.34.TEPS scores were negatively correlated with the DASS-21 score and the stress dimension(P<0.05),but not with depression or anxiety.Linear regression analysis showed that TEPS scores significantly influenced DASS-21 scores(P<0.05).CONCLUSION Patients with CRF experience high levels of negative emotions,which are negatively correlated with life satisfaction and pleasure.Furthermore,pleasure level had an impact on negative emotions.展开更多
Tajikistan represents a core region of the biodiversity hotspot in Central Asian mountains and has exceptional vascular plant diversity.However,the species diversity of the country faces urgent conservation challenges...Tajikistan represents a core region of the biodiversity hotspot in Central Asian mountains and has exceptional vascular plant diversity.However,the species diversity of the country faces urgent conservation challenges.There has been a lack of a comprehensive and multidimensional assessment to inform strategic conservation planning.Therefore,this study integrated 4 key biodiversity indices including species richness(SR),phylogenetic diversity(PD),threatened species richness(TSR),and endemic species richness(ESR)to map species diversity distribution patterns,identify conservation gaps,and elucidate their effects of climatic factors.This study revealed that species diversity shows a clear trend of decreasing from the western region to the eastern region of Tajikistan.The central–western mountains(specifically the Gissar-Darvasian and Zeravshanian regions)emerge as irreplaceable biodiversity hotspots.However,we found a severe spatial mismatch between these priority areas and the existing protected areas(PAs).Protection coverage for all hotspots was alarmingly low,ranging from 31.00%to 38.00%.Consequently,a critical 64.80%of integrated priority areas fall outside of the current PAs,representing a major conservation gap.This study identified precipitation seasonality and isothermality as the principal drivers,collectively explaining over 50.00%of the diversity variation and suggesting high vulnerability to hydrological shifts.Furthermore,we detected significant geographic sampling bias in the public biodiversity databases,with the most critical hotspot being systematically under-sampled.This study provides a robust scientific basis for conservation action,highlighting the urgent need to strategically expand PAs in the under-protected southwestern region and to mitigate critical sampling gaps through targeted data digitization and field surveys.These measures are indispensable for securing Tajikistan’s unique biodiversity and achieving the Kunming-Montreal Global Biodiversity Framework Target 3(“30×30 Protection”).展开更多
BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis ...BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis and heart failure has rarely been observed in cases of pediatric patients with CH pathology.Here,we explored the etiological relationship between CH,heart failure,and refractory lactic acidosis to reflect the importance of thyroid function screening in neonates with heart disease.CASE SUMMARY A 33-day-old extremely premature female infant presented with tachypnea,respiratory distress,recurrent infections,and abdominal distension postnatal.On admission to our facility,she had cardiomegaly,hepatomegaly,and lactic acidosis(revealed on blood gas analysis),with lactate progressively rising to 25 mmol/L.Chest radiographs showed pulmonary congestion,while echocardiography revealed cardiac enlargement,left ventricular wall thickening,and pericardial effusion.Initial management aimed at correcting acidosis and treating heart failure proved ineffective.After reassessment,thyroid function tests showed significantly decreased triiodothyronine,free triiodothyronine,thyroxine,and free thyroxine levels,with a significantly increased thyroidstimulating hormone level,confirming a CH diagnosis.Levothyroxine was administered,resulting in rapid correction of lactic acidosis and gradual improvement of thyroid function and systemic symptoms,culminating in full recovery and discharge.We also reviewed the relevant literature on thyroid and cardiac dysfunctions in order to explore their deeper association.CONCLUSION This case links CH-induced heart failure with refractory lactic acidosis,urging prompt thyroid screening in affected neonates to reduce mortality.展开更多
BACKGROUND Drug utilization research has an important role in assisting the healthcare administration to know,compute,and refine the prescription whose principal objective is to enable the rational use of drugs.Resear...BACKGROUND Drug utilization research has an important role in assisting the healthcare administration to know,compute,and refine the prescription whose principal objective is to enable the rational use of drugs.Research in developing nations relating to the cost of treatment is scarce when compared with developed countries.Thus,the drug utilization research studies from developing nations are most needed,and their number has been growing.AIM To evaluate patterns of utilization of antipsychotic drugs and direct medical cost analysis in patients newly diagnosed with schizophrenia.METHODS The present study was observational in type and based on a retrospective cohort to evaluate patterns of utilization of antipsychotic drugs using World Health Organization(WHO)core prescribing indicators and anatomical therapeutic chemical/defined daily dose indicators.We also calculated direct medical costs for a period of 6 months.RESULTS This study has found that atypical antipsychotics are the mainstay of treatment for schizophrenia in every age group and subcategories of schizophrenia.The evaluation based on WHO prescribing indicators showed a low average number of drugs per prescription and low prescribing frequency of antipsychotics from the National List of Essential Medicines 2015 and the WHO Essential Medicines List 2019.The total mean drug cost of our study was 1396 Indian rupees.The total mean cost due to the investigation in our study was 1017.34 Indian rupees.Therefore,the total mean direct medical cost incurred on patients in our study was 4337.28 Indian rupees.CONCLUSION The information from the present study can be used for reviewing and updating treatment policy at the institutional level.展开更多
Chronic heart failure(CHF)impairs cognitive function.Xijiaqi Formula(XJQ),a traditional Chinese medicine(TCM)used clinically to treat CHF,demonstrates potential for improving cognition in CHF patients.However,its prec...Chronic heart failure(CHF)impairs cognitive function.Xijiaqi Formula(XJQ),a traditional Chinese medicine(TCM)used clinically to treat CHF,demonstrates potential for improving cognition in CHF patients.However,its precise mechanism in treating post-CHF cognitive dysfunction remains unclear.This study systematically investigates XJQ’s effects on post-CHF cognitive dysfunction and the underlying mechanisms.The components of XJQ were identified through liquid chromatography-mass spectrometry.CHF was induced in rats via ligation of the left anterior descending coronary artery,followed by six weeks of XJQ treatment.Cardiac function was evaluated through echocardiography and hemodynamic parameters,while cognitive function was assessed using Morris water maze(MWM)and open field tests(OFT).XJQ treatment enhanced both cardiac and cognitive functions in CHF rats.Network pharmacology identified 12 core active components of XJQ and indicated its effect on cognitive dysfunction involved regulating synapses,inflammation,and phosphodiesterase 4(PDE4)-dependent cyclic adenosine monophosphate(cAMP)signaling.XJQ inhibited microglial and astrocyte activation,decreased proinflammatory cytokines,and mitigated neuronal damage.Notably,XJQ promoted synaptic repair and dendritic growth by downregulating PDE4 and upregulating cAMP,protein kinase A(PKA),cAMP-response element binding protein(CREB),brain-derived neurotrophic factor(BDNF),PSD95,and synapsin I levels.Molecular docking and Bio-layer interferometry assays confirmed direct binding of quercetin,kaempferol,isorhamnetin,and darutoside to PDE4.In conclusion,XJQ alleviates neuroinflammation and enhances synaptic plasticity to improve cognitive dysfunction in CHF rats via the PDE4/cAMP/PKA/CREB signaling pathway.These findings provide valuable insight into the heart-brain axis.展开更多
The failure mechanisms and structural damage of SiC MOSFETs induced by heavy ion irradiation were demonstrated.The findings reveal three degradation modes,depending on the drain voltage.At a relatively low voltage,the...The failure mechanisms and structural damage of SiC MOSFETs induced by heavy ion irradiation were demonstrated.The findings reveal three degradation modes,depending on the drain voltage.At a relatively low voltage,the damage is triggered by the formation and activation of gate latent damage(LDs),with damage concentrated in the gate oxide.The second degradation mode involves permanent leakage current degradation,with damage progressively transitioning from the oxide to the SiC material as the drain voltage escalates.Ultimately,the device undergoes catastrophic burnout above certain voltages,characterized by the lattice temperature reaching the sublimation point of SiC,resulting in surface cavity and complete structural destruction.This paper presents a comprehensive investigation of SiC MOSFETs under heavy ion exposure,providing radiation resistance methods of SiC-based devices for aerospace applications.展开更多
Rationale:This case report describes a couple with recurrent fertilization failure despite undergoing multiple cycles of intracytoplasmic sperm injection(ICSI).The principal clinical concern was suspected oocyte activ...Rationale:This case report describes a couple with recurrent fertilization failure despite undergoing multiple cycles of intracytoplasmic sperm injection(ICSI).The principal clinical concern was suspected oocyte activation deficiency(OAD),in which fertilization is impeded due to the oocyte’s inability to initiate embryogenesis,commonly attributed to inadequate intracellular calcium(Ca^(2+))release following sperm injection.Patient concerns:The couple repeatedly experienced complete or near-complete fertilization failure in previous ICSI cycles,raising suspicion of an underlying oocyte activation defect.Diagnosis:Based on the repeated absence of fertilization post-ICSI and clinical history,a diagnosis of suspected OAD leading to recurrent ICSI fertilization failure was considered.Interventions:Artificial oocyte activation(AOA)using the calcium ionophore A23187 was performed.After ICSI,unfertilized oocytes were exposed to the ionophore to induce Ca^(2+)influx,simulating physiological calcium oscillations essential for oocyte activation.The efficacy of intervention was evaluated through subsequent embryonic development,morphological grading,and chromosomal integrity.Outcomes:Following AOA treatment,successful oocyte activation occurred,resulting in the formation of high-grade embryos with normal developmental progression.Chromosomal analysis revealed no detectable abnormalities,indicating genomic stability.Lessons:Calcium ionophore–mediated AOA may serve as an effective adjunct in cases of recurrent ICSI failure attributed to OAD.This case highlights the importance of individualized therapeutic strategies in assisted reproduction;however,further research is needed to refine protocols,validate broader clinical efficacy,and assess long-term safety,including potential epigenetic risks.展开更多
Mineral resources in Asia continent and its mining industry play a significant role in the economic growth and industrialization of both Asia and the world.Asia continent boasts the most comprehensive kinds of mineral...Mineral resources in Asia continent and its mining industry play a significant role in the economic growth and industrialization of both Asia and the world.Asia continent boasts the most comprehensive kinds of minerals,with reserves of at least 38 of over 80 widely used minerals worldwide accounting for more than30%of the global total reserves.Asia continent experienced three main tectonic evolution and mineralization stages:The Precambrian,the Paleozoic,and the Mesozoic to Cenozoic.The abundant mineral resources in this continent can be divided into seven first-order metallogenic belts(metallogenic domains),18 second-order metallogenic belts(metallogenic provinces),61 third-order metallogenic belts(metallogenic zones),and nine main minerogenetic series.Asia continent exhibits the most significant metallogenic specialization among all continents.Specifically,granite belts of Asia continent manifest pronounced metallogenic specialization of tin,rare metals,and porphyry Cu-Au-Mo deposits.Its maficultramafic rock belts and ophiolite belts display notable metallogenic specialization of lateritic nickel deposits and magmatic type chromite deposits,while its Mesozoic to Cenozoic basalt belts show remarkable metallogenic specialization of lateritic bauxite deposits.Consequently,many giant metallogenic belts were formed,including the Southeast Asian tin belt,the Qinghai-Xizang Plateau rare metal metallogenic belt,the Tethyan porphyry Cu-Au-Mo metallogenic belt,the circum-Pacific porphyry Cu-Au-Mo metallogenic belt,the Southeast Asian lateritic bauxite metallogenic belt,the Deccan Plateau lateritic bauxite metallogenic belt in India,the Southeast Asian lateritic nickel metallogenic belt,and the Tethyan magmatic type chromite metallogenic belt—all of which are significant metallogenic belts in Asia continent.Future mineral exploration in Asia should focus primarily on the Precambrian mineralization of ancient cratons,the Paleozoic mineralization of the Central Asian-Mongolian orogenic belt,and the Mesozoic to Cenozoic mineralization of the Tethyan and circum-Pacific mobile belts.Asia's mining industry not only underpins its own economic growth but also propels global economic development and industrialization,contributing significantly to the world economy.Asia boasts the highest production value of minerals,the largest annual production of minerals,and the greatest trade value of mineral products among all the continents,having emerged as the trade center of global mineral products and the center of the mining industry economy.China is identified as one of the few countries that possess the most comprehensive kinds of minerals,and its mining industry has supported and driven the economic development and industrialization of Asia and even the world.Standing as the largest mineral producer worldwide,China ranked first in the production of 28 mineral commodities in the world in 2022.Besides,China exhibits the highest annual production value of minerals and the largest trade value of mineral products among all countries.Therefore,China's demand for global mineral products influences the global supply and demand patterns of minerals and the world economic situation.展开更多
Background: The prognostic values of staging parameters require continual re?assessment amid changes in diag?nostic and therapeutic methods. This study aimed to identify the prognostic factors and failure patterns of ...Background: The prognostic values of staging parameters require continual re?assessment amid changes in diag?nostic and therapeutic methods. This study aimed to identify the prognostic factors and failure patterns of non?meta?static nasopharyngeal carcinoma(NPC) in the intensity?modulated radiotherapy(IMRT) era.Methods: We reviewed the data from 749 patients with newly diagnosed, biopsy?proven, non?metastatic NPC in our cancer center(South China, an NPC endemic area) between January 2003 and December 2007. All patients under?went magnetic resonance imaging(MRI) before receiving IMRT. The actuarial survival rates were estimated using the Kaplan–Meier method, and survival curves were compared using the log?rank test. Multivariate analyses with the Cox proportional hazards model were used to test for the independent prognostic factors by backward eliminating insigniicant explanatory variables.Results: The 5?year occurrence rates of local failure, regional failure, locoregional failure, and distant failure were 5.4, 3.0, 7.4, and 17.4%, respectively. The 5?year survival rates were as follows: local relapse?free survival, 94.6%; nodal relapse?free survival, 97.0%; distant metastasis?free survival, 82.6%; disease?free survival, 75.1%; and overall survival, 82.0%. Multivariate Cox regression analysis revealed that orbit involvement was the only signiicant prognostic fac?tor for local failure(P = 0.011). Parapharyngeal tumor extension, retropharyngeal lymph node involvement, and the laterality, longest diameter, and Ho's location of the cervical lymph nodes were signiicant prognostic factors for both distant failure and disease failure(all P < 0.05). Intracranial extension had signiicant prognostic value for distant failure(P = 0.040).Conclusions: The key failure pattern for NPC was distant metastasis in the IMRT era. With changes in diagnostic and therapeutic technologies as well as treatment modalities, the signiicant prognostic parameters for local control have also been altered substantially.展开更多
The failure patterns and energy evolution of three types of shaft lining concrete subjected to static and dynamic loading were reported.The energy and damage characteristics of concrete were determined by means of a u...The failure patterns and energy evolution of three types of shaft lining concrete subjected to static and dynamic loading were reported.The energy and damage characteristics of concrete were determined by means of a uniaxial hydraulic servo machine,acoustic emission (AE) equipment,a split Hopkinson pressure bar (SHPB) and an ultrasonic wave analyser.The experimental results indicate that the confluence of multiple cracks forms a penetrating cross section in normal high-strength concrete (NHSC) under the condition of static loading,while the elastic energy that surges out at failure can cause tremendous damage when subjected to dynamic loading.A single crack was split into multiple propagation directions due to the presence of fibres in steel fibre-reinforced concrete (SFRC);adding fibre to concrete should be an effective way to dissipate energy.The non-steam-cured reactive powder concrete (NSC-RPC) designed in this paper can store and dissipate more energy than normal concrete,as NSC-RPC exhibits a strong ability to resist impact.Applying NSC-RPC to the long-service material of a shaft lining structure in deep underground engineering is quite effective.展开更多
OBJECTIVE： To determine the distribution of Tradi- tional Chinese Medicine （TCM） patterns in hepatitis B-related acute-on-chronic liver failure （HB-ACLF） in different stages for guiding clinical prescriptions and...OBJECTIVE： To determine the distribution of Tradi- tional Chinese Medicine （TCM） patterns in hepatitis B-related acute-on-chronic liver failure （HB-ACLF） in different stages for guiding clinical prescriptions and treatments. METHODS： A prospective, cross-sectional survey method was used in this study. A total of 324 cases with HB-ACLF in China were involved. RESULTS： The general frequency of TCM patterns in HB-ACLF were as follows： Heat Toxin Stagnation Pattern （134/324, 41.36%）, Damp-heat Obstruction Pattern （66/324, 20.37% ）, Yong Qi Deficiency Pat- tern （52/324, 16.05%）, and Liver and Kidney Yin De- ficiency Pattern （26/324, 8.02%）. In the early stage of HB-ACLE there was a remarkably higher percent- age of excessive patterns than those in the middle and late stage. The incidence of Heat Toxin Stagna- tion reached 58.57% （82/140） in the early stage, while it was 33.96% （36/106） in the middle stage and 20.51% （16/78） in the late stage. In the early stage of HB-ACLF, excessive patterns, such as the Heat Toxin Stagnation Pattern, were more preva- lent than those in the middle and late stages （P〈a＇= 0.003）. However, in the late stage of HB-ACLE defi- cient patterns, such as the Yang Qi Deficiency Pat- tern, were more prevalent than those in the early and middle stages. The Yang Qi Deficiency Pattern had a higher rate of 41.03% （32/78） in the late stage compared with that of 20.75% （22/106） in the middle stage and 8.57% （12/140, P〈a＇ =0.003） in the early stage. The distribution of the other pat- terns was not significant between the three stages （P〉0.003）. CONCLUSIONS： There are four major patterns of HI3-ACLF, including the Heat Toxin Stagnation Pat- tern, the Damp-heat Obstruction Pattern, the Yang Qi Deficiency Pattern, and the Liver and Kidney Yin Deficiency Pattern. The Heat Toxin Stagnation and Yang Qi Deficiency Patterns are the representative patterns in the early and late stages of HB-ACLF. In the middle stage of HB-ACLF, the TCM patterns vary in a complicated manner, with no significant differ- ence among the patterns. Treatment for HB-ACLF should vary with the different representative pat- terns in the early and late stages.展开更多
Purpose: To investigate the toxicity, survival and patterns of failure in patients with advanced lung cancer treated with intensity modulated radiation therapy (IMRT) and chemotherapy. Methods and Materials: Retrospec...Purpose: To investigate the toxicity, survival and patterns of failure in patients with advanced lung cancer treated with intensity modulated radiation therapy (IMRT) and chemotherapy. Methods and Materials: Retrospective chart review of 68 total patients: 46 academic and 22 community center. Endpoints: Grade ≥ 3 pneumonitis, Grade ≥ 2 esophagitis, local, regional and distant failure, progression-free survival (PFS) and overall survival (OS). Results: For the academic center patients, median follow-up was 19.2 months. Esophagitis: 0% Grade 3, 35% Grade 2, no significant difference between dose bins: <70 Gy vs. 70 Gy, 25% vs. 45% (p = 0.22), <66 Gy vs. 66 - 70 Gy, 28% vs. 39% (p = 0.53). Lung dose metrics and PTV size were not associated with Grade ≥ 3 pneumonitis. Esophageal V35, V50, and mean dose but not PTV size was associated with Grade 2 esophagitis. 1 year local, regional and distant failure = 6.5%, 6.5%, and 30.4%. No endpoint differences were seen between dose bins, though patients with smaller PTVs treated with 70 Gy did demonstrate improved OS (ns) when compared to those treated with <70 Gy. Community Center: Median follow-up 6.2 months with 15% Grade 2 esophagitis, no Grade 3 esophagitis. Two patients (9%) experienced Grade ≥ 3 pneumonitis. Conclusions: IMRT chemoradiation was well tolerated in a population with advanced NSCLC both in the academic and community settings. Severe pneumonitis rates were low and comparable to other series using IMRT and chemotherapy. Esophagitis was mild and associated with V35, V50 and mean dose. No significant benefit was seen for higher doses regarding survival, local, regional or distant control despite that higher dose bins had smaller tumors. Though not statistically significant, we did find a trend toward worse OS for <70 Gy when the PTV was less than the median PTV.展开更多
BACKGROUND There has been no study comparing the difference in the failure patterns between patients with or without postoperative radiotherapy(PORT)after esophagectomy for pT3-4N0-3M0 esophageal squamous cell carcino...BACKGROUND There has been no study comparing the difference in the failure patterns between patients with or without postoperative radiotherapy(PORT)after esophagectomy for pT3-4N0-3M0 esophageal squamous cell carcinoma(ESCC).AIM To investigate the difference in the failure patterns of stage pT3-4N0-3M0 ESCC patients with or without PORT.METHODS Patients with stage pT3-4N0-3M0 ESCC,who underwent surgery with or without PORT,were enrolled in this study.The primary endpoint was to investigate the difference in the failure patterns between patients with or without PORT after esophagectomy.The secondary endpoint was to estimate whether patients with stage pT3-4 ESCC could achieve a disease-free survival(DFS)advantage after receiving adjuvant PORT.Statistical analyses were performed by the Kaplan-Meier method,Cox regression model,and Chi-squared test or Fisher’s exact test.RESULTS In total,230 patients with stage pT3-4N0-3M0 ESCC were included in this study.Fifty-six patients who received PORT were screened from a prospective cohort(S+R arm).And 174 patients involving surgery alone were retrospectively selected from July 2006 to October 2014(S arm).There were no significant differences in the clinical or pathological characteristics of patients between the two arms,except for tumor location(P=0.031).The failure patterns between the two arms were significantly different(P<0.001).Patients in the S arm had a significantly higher proportion of locoregional recurrence and a lower proportion of distant metastasis than those in the S+R arm(92.0%vs 35.7%,P<0.001 and 19.0%vs 75.0%,P<0.001,respectively).The difference in the median DFS between the two arms was statistically significant(12.7 vs 8 mo,P=0.048).Univariate analysis and multivariate analysis both demonstrated that the number of lymph node metastases≥3(HR=0.572,95% CI:0.430-0.762,P<0.001)was an independent poor prognostic factor for DFS in patients with stage pT3-4N0-3M0 ESCC.CONCLUSION PORT could improve DFS and local control of patients with stage pT3-4N0-3M0 ESCC.However,further studies need to be conducted to control hematogenous metastasis after PORT.展开更多
The large-scale implementation of the Gully Stabilization and Land Reclamation(GSLR)project induces various failures of loess slopes due to excavation in Yan'an,China.However,the deformation and failure behavior o...The large-scale implementation of the Gully Stabilization and Land Reclamation(GSLR)project induces various failures of loess slopes due to excavation in Yan'an,China.However,the deformation and failure behavior of these excavated loess slopes have not been fully understood.In this study,field investigation was undertaken for analyzing the distributions and failure features of excavation-induced loess slope failures.It is found that plastic failure mainly occurs in Q_(3) loess layers and brittle failure in Q_(2).To understand the underlying failure mechanism,a series of triaxial shear tests were conducted on intact Q_(3) and Q_(2) loess samples that with different water contents,namely natural water content(natural),dry side of the natural value(drying 5%),and wet side(wetting 5%).The characteristics of stress-strain curves and failure modes of the samples were analyzed.Results show that the stress-strain curves of Q_(2) samples are dominated by strain-softening characteristics,while Q_(3) samples mainly exhibit strain-harden features except in the drying state.Correspondingly,shear failures of Q_(3) specimens are mainly caused by shear crack planes(single,X or V-shaped).For Q_(2) loess,the dominance of tensile cracks is observed on the surface of damaged specimens.These disclose the different failure modes of excavated slopes located in different strata,that is,the arc sliding failure of Q_(3) loess slopes and the stepped tensile failure of Q_(2) loess slopes,and are helpful in the design and management of the ongoing GSLR projects in the Loess Plateau.展开更多
PURPOSE:To review the efficacy and patterns of failure in average-risk medulloblastoma patients treated withconcurrent chemotherapy and reduced-dose cranial spinal irradiation and a conformal tumor bed boost.METH-ODS ...PURPOSE:To review the efficacy and patterns of failure in average-risk medulloblastoma patients treated withconcurrent chemotherapy and reduced-dose cranial spinal irradiation and a conformal tumor bed boost.METH-ODS AND MATERIALS:Thirty-three patients with average risk(defined as<==1.5 cm(2)of residual tumorafter resection,age>3 years,and no involvement of the cerebrospinal fluid or spine)medulloblastoma werediagnosed at our institution between January 1994 and December 2001.They were enrolled in an institutional展开更多
BACKGROUND Nocturnal hypertension is reported as a risk factor for cardiovascular disease.This study aimed to explore the potential association between nocturnal hypertension and heart failure(HF)rehospitalization in ...BACKGROUND Nocturnal hypertension is reported as a risk factor for cardiovascular disease.This study aimed to explore the potential association between nocturnal hypertension and heart failure(HF)rehospitalization in patients with HF with preserved ejection fraction(HFpEF).METHODS A total of 538 patients with HFpEF from May 2018 to December 2021 were consequently recruited in this study and followed up until they were readmitted for HF or the end of this study.Cox regression analysis was used to reveal the potential association between nighttime blood pressure(BP)levels,nocturnal hypertension and nocturnal BP patterns and HF rehospitalization.Kaplan-Meier curve was used to assess the cumulative event-free survival rate between groups.RESULTS There were 537 patients with HFpEF were included in the final analysis.The mean age of the study population was 77.14±8.68 years,and 41.2% of patients were men.After a median follow-up duration of 10.93(4.19–21.13)months,176 patients(32.7%)with HFpEF were readmitted for HF.Cox regression analysis had revealed that nighttime systolic BP level[hazards ratio(HR)=1.018,95%CI:1.008–1.028,P=0.001],nighttime diastolic BP level(HR=1.024,95%CI:1.007–1.042,P=0.007),nocturnal hypertension(HR=1.688,95%CI:1.229–2.317,P=0.001)were associated with HF rehospitalization.Kaplan-Meier analysis had demonstrated that patients with nocturnal hypertension had significantly lower event-free survival rate(log-rank P<0.001).Furthermore,patients with a riser pattern had a higher risk of HF rehospitalization(HR=1.828,95%CI:1.055–3.166,P=0.031)and lower eventfree survival rate(log-rank P=0.003)than those with a dipper pattern.These findings were also confirmed in patients with HFpEF and hyperuricemia.CONCLUSIONS Nighttime BP levels,nocturnal hypertension and a riser pattern are independently associated with HF rehospitalization in patients with HFpEF,and prominently in patients with HFpEF and hyperuricemia.Well controlled nighttime BP levels should be emphasized and considered in patients with HFpEF.展开更多
BACKGROUND Impressive survival outcome of our previous study in unresectable hepatocellular carcinoma(HCC)patients undergoing yttrium-90 glass microspheres transarterial radioembolization(TARE)with/without sorafenib a...BACKGROUND Impressive survival outcome of our previous study in unresectable hepatocellular carcinoma(HCC)patients undergoing yttrium-90 glass microspheres transarterial radioembolization(TARE)with/without sorafenib according to individuals’disease burden,i.e.,intrahepatic tumor load(IHT)and adverse disease features(ADFs)might partly be confounded by other treatments and underlying hepatic function.Therefore,a dedicated study focusing on treatment response and assessment of failure patterns might be a way to improve treatment outcome in addition to patient selection based on the disease burden.AIM To assess the tumor response,disease control and patterns of disease progression following TARE with/without sorafenib in unresectable HCC patients.METHODS This retrospective study was conducted in successful TARE procedures with available pre-and post-treatment imaging studies(n=169).Three treatment subgroups were(1)TARE only(TARE_alone)for IHT≤50%without ADFs,i.e.,macrovascular invasion,extrahepatic disease(EHD)and infiltrative/ill-defined HCC(n=63);(2)TARE with sorafenib(TARE_sorafenib)for IHT>50%and/or presence of ADFs(n=81);and(3)TARE only for patients who could not receive sorafenib due to contraindication or intolerance(TARE_no_sorafenib)(n=25).Objective response rate(ORR;consisted of complete response(CR)and partial response(PR)),disease control rate(DCR;consisted of CR,PR and stable disease)and failure patterns of treated,intrahepatic and extrahepatic sites were assessed using the modified response evaluation criteria in solid tumors.Time to progression(TTP)was calculated from TARE to the first radiologic progression at any site using Kaplan-Meier method.Identification of prognostic factors for TTP using the univariate Kaplan-Meier method and multivariate Cox proportional hazard model were performed in major population subgroups,TARE_alone and TARE_sorafenib.RESULTS The median radiologic follow-up time was 4.4 mo(range 0.5-48.8).In treated area,ORR was highest in TARE_sorafenib(53.1%),followed by TARE_alone(41.3%)and TARE_no_sorafenib(16%).In intrahepatic area,DCR remained highest in TARE_sorafenib(84%),followed by TARE_alone(79.4%)and TARE_no_sorafenib(44%).The overall DCR was highest in TARE_alone(79.4%),followed by TARE_sorafenib(71.6%)and TARE_no_sorafenib(40%).Dominant failure patterns were intrahepatic for both TARE_alone(44.5%)and TARE_sorafenib(38.4%).Extrahepatic progression was more common in TARE_sorafenib(32%)and TARE_no_sorafenib(40%)than in TARE_alone(12.7%).TTP was longest in TARE_alone(8.6 mo;95%CI:3.4-13.8),followed by TARE_sorafenib(5.1 mo;95%CI:4.0-6.2)and TARE_no_sorafenib(2.7 mo;95%CI:2.2-3.1).Pre-existing EHD(HR:0.37,95%CI:0.24-0.56,P<0.001)was a sole prognostic factor for TTP in TARE_sorafenib with no prognostic factor for TTP in TARE_alone.CONCLUSION TARE with/without sorafenib according to individuals’disease burden provided DCR approximately 70%with intrahepatic progression as dominant failure pattern.Extrahepatic progression was more common in procedures with initially high disease burden.展开更多
Heart Failure (HF) is a syndrome characterized by typical symptoms (e.g. breathlessness, ankle swelling and fatigue) that may be accompanied by signs (e.g. elevated jugular venous pressure, pulmonary crackles and peri...Heart Failure (HF) is a syndrome characterized by typical symptoms (e.g. breathlessness, ankle swelling and fatigue) that may be accompanied by signs (e.g. elevated jugular venous pressure, pulmonary crackles and peripheral oedema) caused by a structural and/or functional cardiac abnormality, resulting in a reduced cardiac output and/or elevated intracardiac pressures at rest or during stress. Clinical studies investigating the aetiological patterns of heart failure in Sub-Saharan Africa (SSA) revealed that hypertension, cardiomyopathy and rheumatic heart disease account for more than two-thirds of cardiac disease cases. The objective of this study therefore is to assess the pattern, precipitating factors and short term outcome of heart failure among patients admitted into our hospital. Method: The study was a prospective cross-sectional type conducted among in patients with heart failure in the medical ward of the hospital. Results: A total of three and fifty four (354) subjects were recruited into the study, comprising one hundred and twenty nine males (36.4%) and two hundred and twenty five (63.4%) females. Majority of the patients were admitted in NYHA functional class IV. This however improved to class II at discharge though few were discharged in NYHA class III. Heart failure secondary to progressive hypertensive heart disease was the most common (39.0%) followed by peripartum cardiomyopathy (22.6%) while idiopathic dilated cardiomyopathy (11.0%) and rheumatic heart disease (7.3%) were the third and fourth causes of heart failure respectively. The most common precipitating factor for heart failure in this study was chest infection (44.9%). In conclusion, the study revealed that progressive hypertensive heart disease was the leading cause of heart failure, followed by peripartum cardiomyopathy while idiopathic dilated cardiomyopathy and rheumatic heart disease were ranked third and fourth causes of heart failure respectively. Though myocardial infarction is on the increase, it was found to be the fifth cause of heart failure. The study also identified the following precipitants of heart failure in decreasing order of occurrence: chest infection, non-adherence to prescription, and urinary tract infection.展开更多
基金supported by the National Key Research and Development Program of China"Key technologies for system stability and HVDC transmission of large-scale renewable energy generation base without conventional power support(2022YFB2402700)"the project of the State Grid Corporation of China(52272222001J).
文摘In wind and solar renewable-dominant hybrid alternating current/direct current(AC/DC)power systems,the active power of high-voltage direct current(HVDC)system is significantly limited by the security and stability events caused by cascading failures.To identify critical lines in cascading failures,a rapid risk assessment method is proposed based on the gradient boosting decision tree(GBDT)and frequent pat-tern growth(FP-Growth)algorithms.First,security and stability events triggered by cascading failures are analyzed to explain the impact of cascading failures on the maximum DC power.Then,a cascading failure risk index is defined,focusing on the DC power being limited.To handle the strong nonlinear relationship between the maximum DC power and cascading failures,a GBDT with an update strategy is utilized to rapidly predict the maximum DC power under uncertain operating conditions.Finally,the FP-Growth algorithm is improved to mine frequent patterns in cascading failures.The importance index for each fault in a frequent pattern is defined by evaluating its impact on cascading failures,enabling the identification of critical lines.Simulation results of a modified Ningxia–Shandong hybrid AC/DC system in China demonstrate that the proposed method can rapidly assess the risk of cascading failures and effectively identify critical lines.
文摘AIM:To investigate the underlying causes of surgical failure and reoperation management in patients with rhegmatogenous retinal detachment(RRD)who underwent scleral buckle surgery at our institution.METHODS:This was a single-center,retrospective,descriptive study.The clinical data of 368 patients(387 eyes)with RRD who underwent scleral buckling(SB)surgery between August 2013 and July 2023 at our institution were collected.The aim was to analyze the causes of recurrence and the rationale for selecting reoperation methods.RESULTS:Totally 368 patients(387 eyes)were included in the analysis,comprising 222 males and 146 females.The average age was 30.26±14.18 years,and the mean follow-up duration was(48.33±20.39)mo.The success rate of SB surgery was 90.2%.Recurrent retinal detachment occurred in 38 eyes.Based on surgical records,the causes of SB failure were analyzed.The recurrence causes included abnormal compression ridge position(position,height,or width)in 14 eyes(36.8%,14/38),hole omission in 11 eyes(29.0%,11/38),proliferative vitreoretinopathy(PVR)in 10 eyes(26.3%,10/38),and new holes in 3 eyes(7.9%,3/38).Among these,8 eyes(21.1%,8/38)underwent repeat SB surgery,while the remaining 30 eyes(78.9%,30/38)underwent pars plana vitrectomy(PPV).Regarding tamponade agents,silicone oil was used in 11 eyes(36.7%,11/30),C 3F 8 gas in 12 eyes(40.0%,12/30),and sterile air in 7 eyes(23.3%,7/30).CONCLUSION:SB surgery demonstrates a high success rate in the treatment of RRD.However,abnormal compression ridge position,missed holes during surgery,and PVR are the primary causes of SB failure.After addressing the reasons for failure,re-SB surgery or PPV can be effective alternatives.
文摘BACKGROUND Anxiety,depression,and other negative emotions are common among patients with chronic renal failure(CRF).Analyzing the factors related to negative emotions is necessary to provide targeted nursing care.AIM To explore the correlations among life satisfaction,pleasure levels,and negative emotions in patients with CRF.METHODS One hundred patients with CRF who received therapy at the First Affiliated Hospital of Jinzhou Medical University between December 2022 and February 2025 were included.The Depression,Anxiety,and Stress Scale(DASS-21),Satisfaction with Life Scale(SWLS),and Temporal Experience of Pleasure Scale(TEPS)were used to evaluate negative emotions,life satisfaction,and pleasure level,respectively.Pearson’s correlation coefficient analyzed the correlation between life satisfaction,pleasure level,and negative emotions.Linear regression analysis identified the factors affecting negative emotions.RESULTS The average DASS-21 score among patients with CRF was 51.90±2.30,with subscale scores of 17.90±1.50 for depression,18.53±1.18 for anxiety,and 15.47±2.36 for stress,all significantly higher than the domestic norm(P<0.05).The average SWLS score was 22.17±4.90.Correlation analysis revealed a negative correlation between the SWLS and total DASS-21 scores(P<0.05),but not with the individual depression,anxiety,or stress dimensions.The average TEPS score was 67.80±8.34.TEPS scores were negatively correlated with the DASS-21 score and the stress dimension(P<0.05),but not with depression or anxiety.Linear regression analysis showed that TEPS scores significantly influenced DASS-21 scores(P<0.05).CONCLUSION Patients with CRF experience high levels of negative emotions,which are negatively correlated with life satisfaction and pleasure.Furthermore,pleasure level had an impact on negative emotions.
基金the Chinese Academy of Sciences Research Center for Ecology and Environment of Central Asia(RCEECA),the construction and joint research for the China-Tajikistan“Belt and Road”Joint Laboratory on Biodiversity Conservation and Sustainable Use(2024YFE0214200)the Shanghai Cooperation Organization Partnership and International Technology Cooperation Plan of Science and Technology Projects(2023E01018,2025E01056)the Chinese Academy of Sciences President’s International Fellowship Initiative(PIFI)(2024VBC0006).
文摘Tajikistan represents a core region of the biodiversity hotspot in Central Asian mountains and has exceptional vascular plant diversity.However,the species diversity of the country faces urgent conservation challenges.There has been a lack of a comprehensive and multidimensional assessment to inform strategic conservation planning.Therefore,this study integrated 4 key biodiversity indices including species richness(SR),phylogenetic diversity(PD),threatened species richness(TSR),and endemic species richness(ESR)to map species diversity distribution patterns,identify conservation gaps,and elucidate their effects of climatic factors.This study revealed that species diversity shows a clear trend of decreasing from the western region to the eastern region of Tajikistan.The central–western mountains(specifically the Gissar-Darvasian and Zeravshanian regions)emerge as irreplaceable biodiversity hotspots.However,we found a severe spatial mismatch between these priority areas and the existing protected areas(PAs).Protection coverage for all hotspots was alarmingly low,ranging from 31.00%to 38.00%.Consequently,a critical 64.80%of integrated priority areas fall outside of the current PAs,representing a major conservation gap.This study identified precipitation seasonality and isothermality as the principal drivers,collectively explaining over 50.00%of the diversity variation and suggesting high vulnerability to hydrological shifts.Furthermore,we detected significant geographic sampling bias in the public biodiversity databases,with the most critical hotspot being systematically under-sampled.This study provides a robust scientific basis for conservation action,highlighting the urgent need to strategically expand PAs in the under-protected southwestern region and to mitigate critical sampling gaps through targeted data digitization and field surveys.These measures are indispensable for securing Tajikistan’s unique biodiversity and achieving the Kunming-Montreal Global Biodiversity Framework Target 3(“30×30 Protection”).
文摘BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis and heart failure has rarely been observed in cases of pediatric patients with CH pathology.Here,we explored the etiological relationship between CH,heart failure,and refractory lactic acidosis to reflect the importance of thyroid function screening in neonates with heart disease.CASE SUMMARY A 33-day-old extremely premature female infant presented with tachypnea,respiratory distress,recurrent infections,and abdominal distension postnatal.On admission to our facility,she had cardiomegaly,hepatomegaly,and lactic acidosis(revealed on blood gas analysis),with lactate progressively rising to 25 mmol/L.Chest radiographs showed pulmonary congestion,while echocardiography revealed cardiac enlargement,left ventricular wall thickening,and pericardial effusion.Initial management aimed at correcting acidosis and treating heart failure proved ineffective.After reassessment,thyroid function tests showed significantly decreased triiodothyronine,free triiodothyronine,thyroxine,and free thyroxine levels,with a significantly increased thyroidstimulating hormone level,confirming a CH diagnosis.Levothyroxine was administered,resulting in rapid correction of lactic acidosis and gradual improvement of thyroid function and systemic symptoms,culminating in full recovery and discharge.We also reviewed the relevant literature on thyroid and cardiac dysfunctions in order to explore their deeper association.CONCLUSION This case links CH-induced heart failure with refractory lactic acidosis,urging prompt thyroid screening in affected neonates to reduce mortality.
文摘BACKGROUND Drug utilization research has an important role in assisting the healthcare administration to know,compute,and refine the prescription whose principal objective is to enable the rational use of drugs.Research in developing nations relating to the cost of treatment is scarce when compared with developed countries.Thus,the drug utilization research studies from developing nations are most needed,and their number has been growing.AIM To evaluate patterns of utilization of antipsychotic drugs and direct medical cost analysis in patients newly diagnosed with schizophrenia.METHODS The present study was observational in type and based on a retrospective cohort to evaluate patterns of utilization of antipsychotic drugs using World Health Organization(WHO)core prescribing indicators and anatomical therapeutic chemical/defined daily dose indicators.We also calculated direct medical costs for a period of 6 months.RESULTS This study has found that atypical antipsychotics are the mainstay of treatment for schizophrenia in every age group and subcategories of schizophrenia.The evaluation based on WHO prescribing indicators showed a low average number of drugs per prescription and low prescribing frequency of antipsychotics from the National List of Essential Medicines 2015 and the WHO Essential Medicines List 2019.The total mean drug cost of our study was 1396 Indian rupees.The total mean cost due to the investigation in our study was 1017.34 Indian rupees.Therefore,the total mean direct medical cost incurred on patients in our study was 4337.28 Indian rupees.CONCLUSION The information from the present study can be used for reviewing and updating treatment policy at the institutional level.
基金supported by the National Natural Science Foundation of China(Nos.82430116 and 82574622)the Special Fund of Central Committee High Level Chinese Medicine Hospital(Nos.DZMG-LJRC-0014,DZMG-ZJXY-23013)+1 种基金Chinese Medicine Inheritance and Innovation“Thousand Million”Talents Project(Qihuang Project 2021)Qihuang Scholarsthe Medical and Health Industry Development Project of Tongzhou District(2023).
文摘Chronic heart failure(CHF)impairs cognitive function.Xijiaqi Formula(XJQ),a traditional Chinese medicine(TCM)used clinically to treat CHF,demonstrates potential for improving cognition in CHF patients.However,its precise mechanism in treating post-CHF cognitive dysfunction remains unclear.This study systematically investigates XJQ’s effects on post-CHF cognitive dysfunction and the underlying mechanisms.The components of XJQ were identified through liquid chromatography-mass spectrometry.CHF was induced in rats via ligation of the left anterior descending coronary artery,followed by six weeks of XJQ treatment.Cardiac function was evaluated through echocardiography and hemodynamic parameters,while cognitive function was assessed using Morris water maze(MWM)and open field tests(OFT).XJQ treatment enhanced both cardiac and cognitive functions in CHF rats.Network pharmacology identified 12 core active components of XJQ and indicated its effect on cognitive dysfunction involved regulating synapses,inflammation,and phosphodiesterase 4(PDE4)-dependent cyclic adenosine monophosphate(cAMP)signaling.XJQ inhibited microglial and astrocyte activation,decreased proinflammatory cytokines,and mitigated neuronal damage.Notably,XJQ promoted synaptic repair and dendritic growth by downregulating PDE4 and upregulating cAMP,protein kinase A(PKA),cAMP-response element binding protein(CREB),brain-derived neurotrophic factor(BDNF),PSD95,and synapsin I levels.Molecular docking and Bio-layer interferometry assays confirmed direct binding of quercetin,kaempferol,isorhamnetin,and darutoside to PDE4.In conclusion,XJQ alleviates neuroinflammation and enhances synaptic plasticity to improve cognitive dysfunction in CHF rats via the PDE4/cAMP/PKA/CREB signaling pathway.These findings provide valuable insight into the heart-brain axis.
基金Project supported by the National Key Research and Development Program of China(Grant No.2023YFA1609000)the National Natural Science Foundation of China(Grant Nos.U2341222,U2441248,12275061,and 12075069)。
文摘The failure mechanisms and structural damage of SiC MOSFETs induced by heavy ion irradiation were demonstrated.The findings reveal three degradation modes,depending on the drain voltage.At a relatively low voltage,the damage is triggered by the formation and activation of gate latent damage(LDs),with damage concentrated in the gate oxide.The second degradation mode involves permanent leakage current degradation,with damage progressively transitioning from the oxide to the SiC material as the drain voltage escalates.Ultimately,the device undergoes catastrophic burnout above certain voltages,characterized by the lattice temperature reaching the sublimation point of SiC,resulting in surface cavity and complete structural destruction.This paper presents a comprehensive investigation of SiC MOSFETs under heavy ion exposure,providing radiation resistance methods of SiC-based devices for aerospace applications.
文摘Rationale:This case report describes a couple with recurrent fertilization failure despite undergoing multiple cycles of intracytoplasmic sperm injection(ICSI).The principal clinical concern was suspected oocyte activation deficiency(OAD),in which fertilization is impeded due to the oocyte’s inability to initiate embryogenesis,commonly attributed to inadequate intracellular calcium(Ca^(2+))release following sperm injection.Patient concerns:The couple repeatedly experienced complete or near-complete fertilization failure in previous ICSI cycles,raising suspicion of an underlying oocyte activation defect.Diagnosis:Based on the repeated absence of fertilization post-ICSI and clinical history,a diagnosis of suspected OAD leading to recurrent ICSI fertilization failure was considered.Interventions:Artificial oocyte activation(AOA)using the calcium ionophore A23187 was performed.After ICSI,unfertilized oocytes were exposed to the ionophore to induce Ca^(2+)influx,simulating physiological calcium oscillations essential for oocyte activation.The efficacy of intervention was evaluated through subsequent embryonic development,morphological grading,and chromosomal integrity.Outcomes:Following AOA treatment,successful oocyte activation occurred,resulting in the formation of high-grade embryos with normal developmental progression.Chromosomal analysis revealed no detectable abnormalities,indicating genomic stability.Lessons:Calcium ionophore–mediated AOA may serve as an effective adjunct in cases of recurrent ICSI failure attributed to OAD.This case highlights the importance of individualized therapeutic strategies in assisted reproduction;however,further research is needed to refine protocols,validate broader clinical efficacy,and assess long-term safety,including potential epigenetic risks.
基金funded by geological survey project of China Geological Survey(DD20211404)。
文摘Mineral resources in Asia continent and its mining industry play a significant role in the economic growth and industrialization of both Asia and the world.Asia continent boasts the most comprehensive kinds of minerals,with reserves of at least 38 of over 80 widely used minerals worldwide accounting for more than30%of the global total reserves.Asia continent experienced three main tectonic evolution and mineralization stages:The Precambrian,the Paleozoic,and the Mesozoic to Cenozoic.The abundant mineral resources in this continent can be divided into seven first-order metallogenic belts(metallogenic domains),18 second-order metallogenic belts(metallogenic provinces),61 third-order metallogenic belts(metallogenic zones),and nine main minerogenetic series.Asia continent exhibits the most significant metallogenic specialization among all continents.Specifically,granite belts of Asia continent manifest pronounced metallogenic specialization of tin,rare metals,and porphyry Cu-Au-Mo deposits.Its maficultramafic rock belts and ophiolite belts display notable metallogenic specialization of lateritic nickel deposits and magmatic type chromite deposits,while its Mesozoic to Cenozoic basalt belts show remarkable metallogenic specialization of lateritic bauxite deposits.Consequently,many giant metallogenic belts were formed,including the Southeast Asian tin belt,the Qinghai-Xizang Plateau rare metal metallogenic belt,the Tethyan porphyry Cu-Au-Mo metallogenic belt,the circum-Pacific porphyry Cu-Au-Mo metallogenic belt,the Southeast Asian lateritic bauxite metallogenic belt,the Deccan Plateau lateritic bauxite metallogenic belt in India,the Southeast Asian lateritic nickel metallogenic belt,and the Tethyan magmatic type chromite metallogenic belt—all of which are significant metallogenic belts in Asia continent.Future mineral exploration in Asia should focus primarily on the Precambrian mineralization of ancient cratons,the Paleozoic mineralization of the Central Asian-Mongolian orogenic belt,and the Mesozoic to Cenozoic mineralization of the Tethyan and circum-Pacific mobile belts.Asia's mining industry not only underpins its own economic growth but also propels global economic development and industrialization,contributing significantly to the world economy.Asia boasts the highest production value of minerals,the largest annual production of minerals,and the greatest trade value of mineral products among all the continents,having emerged as the trade center of global mineral products and the center of the mining industry economy.China is identified as one of the few countries that possess the most comprehensive kinds of minerals,and its mining industry has supported and driven the economic development and industrialization of Asia and even the world.Standing as the largest mineral producer worldwide,China ranked first in the production of 28 mineral commodities in the world in 2022.Besides,China exhibits the highest annual production value of minerals and the largest trade value of mineral products among all countries.Therefore,China's demand for global mineral products influences the global supply and demand patterns of minerals and the world economic situation.
基金supported by grants from the Key Laboratory Construction Project of Guangzhou City,China (121800085)the Health & Medical Collaborative Innovation Project of Guangzhou City,China (201400000001)+2 种基金the National Science & Technology Pillar Program during the Twelfth Five-year Plan Period (2014BAI09B10)the National Natural Science Foundation of China (81201746)the Planned Science and Technology Project of Guangdong Province,China (2013B020400004)
文摘Background: The prognostic values of staging parameters require continual re?assessment amid changes in diag?nostic and therapeutic methods. This study aimed to identify the prognostic factors and failure patterns of non?meta?static nasopharyngeal carcinoma(NPC) in the intensity?modulated radiotherapy(IMRT) era.Methods: We reviewed the data from 749 patients with newly diagnosed, biopsy?proven, non?metastatic NPC in our cancer center(South China, an NPC endemic area) between January 2003 and December 2007. All patients under?went magnetic resonance imaging(MRI) before receiving IMRT. The actuarial survival rates were estimated using the Kaplan–Meier method, and survival curves were compared using the log?rank test. Multivariate analyses with the Cox proportional hazards model were used to test for the independent prognostic factors by backward eliminating insigniicant explanatory variables.Results: The 5?year occurrence rates of local failure, regional failure, locoregional failure, and distant failure were 5.4, 3.0, 7.4, and 17.4%, respectively. The 5?year survival rates were as follows: local relapse?free survival, 94.6%; nodal relapse?free survival, 97.0%; distant metastasis?free survival, 82.6%; disease?free survival, 75.1%; and overall survival, 82.0%. Multivariate Cox regression analysis revealed that orbit involvement was the only signiicant prognostic fac?tor for local failure(P = 0.011). Parapharyngeal tumor extension, retropharyngeal lymph node involvement, and the laterality, longest diameter, and Ho's location of the cervical lymph nodes were signiicant prognostic factors for both distant failure and disease failure(all P < 0.05). Intracranial extension had signiicant prognostic value for distant failure(P = 0.040).Conclusions: The key failure pattern for NPC was distant metastasis in the IMRT era. With changes in diagnostic and therapeutic technologies as well as treatment modalities, the signiicant prognostic parameters for local control have also been altered substantially.
基金the National Natural Science Foundation of China(No.51678049)the State Key Research Development Program of China(No.2016YFC0600803)。
文摘The failure patterns and energy evolution of three types of shaft lining concrete subjected to static and dynamic loading were reported.The energy and damage characteristics of concrete were determined by means of a uniaxial hydraulic servo machine,acoustic emission (AE) equipment,a split Hopkinson pressure bar (SHPB) and an ultrasonic wave analyser.The experimental results indicate that the confluence of multiple cracks forms a penetrating cross section in normal high-strength concrete (NHSC) under the condition of static loading,while the elastic energy that surges out at failure can cause tremendous damage when subjected to dynamic loading.A single crack was split into multiple propagation directions due to the presence of fibres in steel fibre-reinforced concrete (SFRC);adding fibre to concrete should be an effective way to dissipate energy.The non-steam-cured reactive powder concrete (NSC-RPC) designed in this paper can store and dissipate more energy than normal concrete,as NSC-RPC exhibits a strong ability to resist impact.Applying NSC-RPC to the long-service material of a shaft lining structure in deep underground engineering is quite effective.
基金Supported by the National Science and Technology Major Project of the Ministry of Science and Technology of China (No.2008ZX1005)
文摘OBJECTIVE： To determine the distribution of Tradi- tional Chinese Medicine （TCM） patterns in hepatitis B-related acute-on-chronic liver failure （HB-ACLF） in different stages for guiding clinical prescriptions and treatments. METHODS： A prospective, cross-sectional survey method was used in this study. A total of 324 cases with HB-ACLF in China were involved. RESULTS： The general frequency of TCM patterns in HB-ACLF were as follows： Heat Toxin Stagnation Pattern （134/324, 41.36%）, Damp-heat Obstruction Pattern （66/324, 20.37% ）, Yong Qi Deficiency Pat- tern （52/324, 16.05%）, and Liver and Kidney Yin De- ficiency Pattern （26/324, 8.02%）. In the early stage of HB-ACLE there was a remarkably higher percent- age of excessive patterns than those in the middle and late stage. The incidence of Heat Toxin Stagna- tion reached 58.57% （82/140） in the early stage, while it was 33.96% （36/106） in the middle stage and 20.51% （16/78） in the late stage. In the early stage of HB-ACLF, excessive patterns, such as the Heat Toxin Stagnation Pattern, were more preva- lent than those in the middle and late stages （P〈a＇= 0.003）. However, in the late stage of HB-ACLE defi- cient patterns, such as the Yang Qi Deficiency Pat- tern, were more prevalent than those in the early and middle stages. The Yang Qi Deficiency Pattern had a higher rate of 41.03% （32/78） in the late stage compared with that of 20.75% （22/106） in the middle stage and 8.57% （12/140, P〈a＇ =0.003） in the early stage. The distribution of the other pat- terns was not significant between the three stages （P〉0.003）. CONCLUSIONS： There are four major patterns of HI3-ACLF, including the Heat Toxin Stagnation Pat- tern, the Damp-heat Obstruction Pattern, the Yang Qi Deficiency Pattern, and the Liver and Kidney Yin Deficiency Pattern. The Heat Toxin Stagnation and Yang Qi Deficiency Patterns are the representative patterns in the early and late stages of HB-ACLF. In the middle stage of HB-ACLF, the TCM patterns vary in a complicated manner, with no significant differ- ence among the patterns. Treatment for HB-ACLF should vary with the different representative pat- terns in the early and late stages.
文摘Purpose: To investigate the toxicity, survival and patterns of failure in patients with advanced lung cancer treated with intensity modulated radiation therapy (IMRT) and chemotherapy. Methods and Materials: Retrospective chart review of 68 total patients: 46 academic and 22 community center. Endpoints: Grade ≥ 3 pneumonitis, Grade ≥ 2 esophagitis, local, regional and distant failure, progression-free survival (PFS) and overall survival (OS). Results: For the academic center patients, median follow-up was 19.2 months. Esophagitis: 0% Grade 3, 35% Grade 2, no significant difference between dose bins: <70 Gy vs. 70 Gy, 25% vs. 45% (p = 0.22), <66 Gy vs. 66 - 70 Gy, 28% vs. 39% (p = 0.53). Lung dose metrics and PTV size were not associated with Grade ≥ 3 pneumonitis. Esophageal V35, V50, and mean dose but not PTV size was associated with Grade 2 esophagitis. 1 year local, regional and distant failure = 6.5%, 6.5%, and 30.4%. No endpoint differences were seen between dose bins, though patients with smaller PTVs treated with 70 Gy did demonstrate improved OS (ns) when compared to those treated with <70 Gy. Community Center: Median follow-up 6.2 months with 15% Grade 2 esophagitis, no Grade 3 esophagitis. Two patients (9%) experienced Grade ≥ 3 pneumonitis. Conclusions: IMRT chemoradiation was well tolerated in a population with advanced NSCLC both in the academic and community settings. Severe pneumonitis rates were low and comparable to other series using IMRT and chemotherapy. Esophagitis was mild and associated with V35, V50 and mean dose. No significant benefit was seen for higher doses regarding survival, local, regional or distant control despite that higher dose bins had smaller tumors. Though not statistically significant, we did find a trend toward worse OS for <70 Gy when the PTV was less than the median PTV.
基金Supported by Emerging Advanced Technology Joint Research Project of Shanghai Shenkang Hospital Development Center,No.SHDC12017103Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support,No.20161433
文摘BACKGROUND There has been no study comparing the difference in the failure patterns between patients with or without postoperative radiotherapy(PORT)after esophagectomy for pT3-4N0-3M0 esophageal squamous cell carcinoma(ESCC).AIM To investigate the difference in the failure patterns of stage pT3-4N0-3M0 ESCC patients with or without PORT.METHODS Patients with stage pT3-4N0-3M0 ESCC,who underwent surgery with or without PORT,were enrolled in this study.The primary endpoint was to investigate the difference in the failure patterns between patients with or without PORT after esophagectomy.The secondary endpoint was to estimate whether patients with stage pT3-4 ESCC could achieve a disease-free survival(DFS)advantage after receiving adjuvant PORT.Statistical analyses were performed by the Kaplan-Meier method,Cox regression model,and Chi-squared test or Fisher’s exact test.RESULTS In total,230 patients with stage pT3-4N0-3M0 ESCC were included in this study.Fifty-six patients who received PORT were screened from a prospective cohort(S+R arm).And 174 patients involving surgery alone were retrospectively selected from July 2006 to October 2014(S arm).There were no significant differences in the clinical or pathological characteristics of patients between the two arms,except for tumor location(P=0.031).The failure patterns between the two arms were significantly different(P<0.001).Patients in the S arm had a significantly higher proportion of locoregional recurrence and a lower proportion of distant metastasis than those in the S+R arm(92.0%vs 35.7%,P<0.001 and 19.0%vs 75.0%,P<0.001,respectively).The difference in the median DFS between the two arms was statistically significant(12.7 vs 8 mo,P=0.048).Univariate analysis and multivariate analysis both demonstrated that the number of lymph node metastases≥3(HR=0.572,95% CI:0.430-0.762,P<0.001)was an independent poor prognostic factor for DFS in patients with stage pT3-4N0-3M0 ESCC.CONCLUSION PORT could improve DFS and local control of patients with stage pT3-4N0-3M0 ESCC.However,further studies need to be conducted to control hematogenous metastasis after PORT.
基金funded by the Natural Science Foundation of China(Nos.41790442 and 41825018)the Strategic Priority Research Program of the Chinese Academy of Sciences(No.XDA23090402)the State Key Research Development Program of China(No.2017YFD0800501)。
文摘The large-scale implementation of the Gully Stabilization and Land Reclamation(GSLR)project induces various failures of loess slopes due to excavation in Yan'an,China.However,the deformation and failure behavior of these excavated loess slopes have not been fully understood.In this study,field investigation was undertaken for analyzing the distributions and failure features of excavation-induced loess slope failures.It is found that plastic failure mainly occurs in Q_(3) loess layers and brittle failure in Q_(2).To understand the underlying failure mechanism,a series of triaxial shear tests were conducted on intact Q_(3) and Q_(2) loess samples that with different water contents,namely natural water content(natural),dry side of the natural value(drying 5%),and wet side(wetting 5%).The characteristics of stress-strain curves and failure modes of the samples were analyzed.Results show that the stress-strain curves of Q_(2) samples are dominated by strain-softening characteristics,while Q_(3) samples mainly exhibit strain-harden features except in the drying state.Correspondingly,shear failures of Q_(3) specimens are mainly caused by shear crack planes(single,X or V-shaped).For Q_(2) loess,the dominance of tensile cracks is observed on the surface of damaged specimens.These disclose the different failure modes of excavated slopes located in different strata,that is,the arc sliding failure of Q_(3) loess slopes and the stepped tensile failure of Q_(2) loess slopes,and are helpful in the design and management of the ongoing GSLR projects in the Loess Plateau.
文摘PURPOSE:To review the efficacy and patterns of failure in average-risk medulloblastoma patients treated withconcurrent chemotherapy and reduced-dose cranial spinal irradiation and a conformal tumor bed boost.METH-ODS AND MATERIALS:Thirty-three patients with average risk(defined as<==1.5 cm(2)of residual tumorafter resection,age>3 years,and no involvement of the cerebrospinal fluid or spine)medulloblastoma werediagnosed at our institution between January 1994 and December 2001.They were enrolled in an institutional
基金This study was supported by the Department of Human Resources and Social Security of Sichuan Province(No.2021-11)the Chengdu Municipal Health Commission(No.2021200&No.2022392)+1 种基金the Science and Technology Bureau of Chengdu(2019-YF05-00523-SN)the Fundamental Research Funds for the Central Universities(No.2682022ZTPY029&No.2682021ZTPY026).
文摘BACKGROUND Nocturnal hypertension is reported as a risk factor for cardiovascular disease.This study aimed to explore the potential association between nocturnal hypertension and heart failure(HF)rehospitalization in patients with HF with preserved ejection fraction(HFpEF).METHODS A total of 538 patients with HFpEF from May 2018 to December 2021 were consequently recruited in this study and followed up until they were readmitted for HF or the end of this study.Cox regression analysis was used to reveal the potential association between nighttime blood pressure(BP)levels,nocturnal hypertension and nocturnal BP patterns and HF rehospitalization.Kaplan-Meier curve was used to assess the cumulative event-free survival rate between groups.RESULTS There were 537 patients with HFpEF were included in the final analysis.The mean age of the study population was 77.14±8.68 years,and 41.2% of patients were men.After a median follow-up duration of 10.93(4.19–21.13)months,176 patients(32.7%)with HFpEF were readmitted for HF.Cox regression analysis had revealed that nighttime systolic BP level[hazards ratio(HR)=1.018,95%CI:1.008–1.028,P=0.001],nighttime diastolic BP level(HR=1.024,95%CI:1.007–1.042,P=0.007),nocturnal hypertension(HR=1.688,95%CI:1.229–2.317,P=0.001)were associated with HF rehospitalization.Kaplan-Meier analysis had demonstrated that patients with nocturnal hypertension had significantly lower event-free survival rate(log-rank P<0.001).Furthermore,patients with a riser pattern had a higher risk of HF rehospitalization(HR=1.828,95%CI:1.055–3.166,P=0.031)and lower eventfree survival rate(log-rank P=0.003)than those with a dipper pattern.These findings were also confirmed in patients with HFpEF and hyperuricemia.CONCLUSIONS Nighttime BP levels,nocturnal hypertension and a riser pattern are independently associated with HF rehospitalization in patients with HFpEF,and prominently in patients with HFpEF and hyperuricemia.Well controlled nighttime BP levels should be emphasized and considered in patients with HFpEF.
基金Institutional review board of The University of Texas MD Anderson Cancer Center,No.DR09-0025.
文摘BACKGROUND Impressive survival outcome of our previous study in unresectable hepatocellular carcinoma(HCC)patients undergoing yttrium-90 glass microspheres transarterial radioembolization(TARE)with/without sorafenib according to individuals’disease burden,i.e.,intrahepatic tumor load(IHT)and adverse disease features(ADFs)might partly be confounded by other treatments and underlying hepatic function.Therefore,a dedicated study focusing on treatment response and assessment of failure patterns might be a way to improve treatment outcome in addition to patient selection based on the disease burden.AIM To assess the tumor response,disease control and patterns of disease progression following TARE with/without sorafenib in unresectable HCC patients.METHODS This retrospective study was conducted in successful TARE procedures with available pre-and post-treatment imaging studies(n=169).Three treatment subgroups were(1)TARE only(TARE_alone)for IHT≤50%without ADFs,i.e.,macrovascular invasion,extrahepatic disease(EHD)and infiltrative/ill-defined HCC(n=63);(2)TARE with sorafenib(TARE_sorafenib)for IHT>50%and/or presence of ADFs(n=81);and(3)TARE only for patients who could not receive sorafenib due to contraindication or intolerance(TARE_no_sorafenib)(n=25).Objective response rate(ORR;consisted of complete response(CR)and partial response(PR)),disease control rate(DCR;consisted of CR,PR and stable disease)and failure patterns of treated,intrahepatic and extrahepatic sites were assessed using the modified response evaluation criteria in solid tumors.Time to progression(TTP)was calculated from TARE to the first radiologic progression at any site using Kaplan-Meier method.Identification of prognostic factors for TTP using the univariate Kaplan-Meier method and multivariate Cox proportional hazard model were performed in major population subgroups,TARE_alone and TARE_sorafenib.RESULTS The median radiologic follow-up time was 4.4 mo(range 0.5-48.8).In treated area,ORR was highest in TARE_sorafenib(53.1%),followed by TARE_alone(41.3%)and TARE_no_sorafenib(16%).In intrahepatic area,DCR remained highest in TARE_sorafenib(84%),followed by TARE_alone(79.4%)and TARE_no_sorafenib(44%).The overall DCR was highest in TARE_alone(79.4%),followed by TARE_sorafenib(71.6%)and TARE_no_sorafenib(40%).Dominant failure patterns were intrahepatic for both TARE_alone(44.5%)and TARE_sorafenib(38.4%).Extrahepatic progression was more common in TARE_sorafenib(32%)and TARE_no_sorafenib(40%)than in TARE_alone(12.7%).TTP was longest in TARE_alone(8.6 mo;95%CI:3.4-13.8),followed by TARE_sorafenib(5.1 mo;95%CI:4.0-6.2)and TARE_no_sorafenib(2.7 mo;95%CI:2.2-3.1).Pre-existing EHD(HR:0.37,95%CI:0.24-0.56,P<0.001)was a sole prognostic factor for TTP in TARE_sorafenib with no prognostic factor for TTP in TARE_alone.CONCLUSION TARE with/without sorafenib according to individuals’disease burden provided DCR approximately 70%with intrahepatic progression as dominant failure pattern.Extrahepatic progression was more common in procedures with initially high disease burden.
文摘Heart Failure (HF) is a syndrome characterized by typical symptoms (e.g. breathlessness, ankle swelling and fatigue) that may be accompanied by signs (e.g. elevated jugular venous pressure, pulmonary crackles and peripheral oedema) caused by a structural and/or functional cardiac abnormality, resulting in a reduced cardiac output and/or elevated intracardiac pressures at rest or during stress. Clinical studies investigating the aetiological patterns of heart failure in Sub-Saharan Africa (SSA) revealed that hypertension, cardiomyopathy and rheumatic heart disease account for more than two-thirds of cardiac disease cases. The objective of this study therefore is to assess the pattern, precipitating factors and short term outcome of heart failure among patients admitted into our hospital. Method: The study was a prospective cross-sectional type conducted among in patients with heart failure in the medical ward of the hospital. Results: A total of three and fifty four (354) subjects were recruited into the study, comprising one hundred and twenty nine males (36.4%) and two hundred and twenty five (63.4%) females. Majority of the patients were admitted in NYHA functional class IV. This however improved to class II at discharge though few were discharged in NYHA class III. Heart failure secondary to progressive hypertensive heart disease was the most common (39.0%) followed by peripartum cardiomyopathy (22.6%) while idiopathic dilated cardiomyopathy (11.0%) and rheumatic heart disease (7.3%) were the third and fourth causes of heart failure respectively. The most common precipitating factor for heart failure in this study was chest infection (44.9%). In conclusion, the study revealed that progressive hypertensive heart disease was the leading cause of heart failure, followed by peripartum cardiomyopathy while idiopathic dilated cardiomyopathy and rheumatic heart disease were ranked third and fourth causes of heart failure respectively. Though myocardial infarction is on the increase, it was found to be the fifth cause of heart failure. The study also identified the following precipitants of heart failure in decreasing order of occurrence: chest infection, non-adherence to prescription, and urinary tract infection.
