BACKGROUND:Hemiplegia,a prevalent stroke-related condition,is often studied for motor dysfunction;however,spasticity remains under-researched.Abnormal muscle tone significantly hinders hemiplegic patients’walking rec...BACKGROUND:Hemiplegia,a prevalent stroke-related condition,is often studied for motor dysfunction;however,spasticity remains under-researched.Abnormal muscle tone significantly hinders hemiplegic patients’walking recovery.OBJECTIVE:To determine whether early suspension-protected training with a personal assistant machine for stroke patients enhances walking ability and prevents muscle spasms.METHODS:Thirty-two early-stage stroke patients from Shenzhen University General Hospital and the China Rehabilitation Research Center were randomly assigned to the experimental group(n=16)and the control group(n=16).Both groups underwent 4 weeks of gait training under the suspension protection system for 30 minutes daily,5 days a week.The experimental group used the personal assistant machine during training.Three-dimensional gait analysis(using the Cortex motion capture system),Brunnstrom staging,Fugl-Meyer Assessment for lower limb motor function,Fugl-Meyer balance function,and the modified Ashworth Scale were evaluated within 1 week before the intervention and after 4 weeks of intervention.RESULTS AND CONCLUSION:After the 4-week intervention,all outcome measures showed significant changes in each group.The experimental group had a small but significant increase in the modified Ashworth Scale score(P<0.05,d=|0.15|),while the control group had a large significant increase(P<0.05,d=|1.48|).The experimental group demonstrated greater improvements in walking speed(16.5 to 38.44 cm/s,P<0.05,d=|4.01|),step frequency(46.44 to 64.94 steps/min,P<0.05,d=|2.32|),stride length(15.50 to 29.81 cm,P<0.05,d=|3.44|),and peak hip and knee flexion(d=|1.82|to|2.17|).After treatment,the experimental group showed significantly greater improvements than the control group in walking speed(38.44 vs.26.63 cm/s,P<0.05,d=|2.75|),stride length,peak hip and knee flexion(d=|1.31|to|1.45|),step frequency(64.94 vs.59.38 steps/min,P<0.05,d=|0.85|),and a reduced support phase(bilateral:24.31%vs.28.38%,P<0.05,d=|0.88|;non-paretic:66.19%vs.70.13%,P<0.05,d=|0.94|).For early hemiplegia,personal assistant machine-assisted gait training under the suspension protection system helps establish a correct gait pattern,prevents muscle spasms,and improves motor function.展开更多
The increasing global prevalence of mild cognitive impairment(MCI)necessitates a paradigm shift in early detection strategies.Conventional neuropsychological assessment methods,predominantly paper-and-pencil tests suc...The increasing global prevalence of mild cognitive impairment(MCI)necessitates a paradigm shift in early detection strategies.Conventional neuropsychological assessment methods,predominantly paper-and-pencil tests such as the Mini-Mental State Examination and the Montreal Cognitive Assessment,exhibit inherent limitations with respect to accessibility,administration burden,and sensitivity to subtle cognitive decline,particularly among diverse populations.This commentary critically examines a recent study that champions a novel approach:The integration of gait and handwriting kinematic parameters analyzed via machine learning for MCI screening.The present study positions itself within the broader landscape of MCI detection,with a view to comparing its advantages against established neuropsychological batteries,advanced neuroimaging(e.g.,positron emission tomography,magnetic resonance imaging),and emerging fluid biomarkers(e.g.,cerebrospinal fluid,blood-based assays).While the study demonstrates promising accuracy(74.44%area under the curve 0.74 with gait and graphic handwriting)and addresses key unmet needs in accessibility and objectivity,we highlight its cross-sectional nature,limited sample diversity,and lack of dual-task assessment as areas for future refinement.This commentary posits that kinematic biomarkers offer a distinctive,scalable,and ecologically valid approach to widespread MCI screening,thereby complementing existing methods by providing real-world functional insights.Future research should prioritize longitudinal validation,expansion to diverse cohorts,integration with multimodal data including dual-tasking,and the development of highly portable,artificial intelligence-driven solutions to achieve the democratization of early MCI detection and enable timely interventions.展开更多
BACKGROUND Inappropriate selection of patients with early gastric cancer(EGC)for endoscopic submucosal dissection(ESD)may lead to non-curative resection,necessitating additional gastrectomy.Conversely,inappropriate se...BACKGROUND Inappropriate selection of patients with early gastric cancer(EGC)for endoscopic submucosal dissection(ESD)may lead to non-curative resection,necessitating additional gastrectomy.Conversely,inappropriate selection for gastrectomy may result in overtreatment,adversely affecting patients’quality of life.Few have systematically evaluated the concordance between therapeutic indications under current Japanese guidelines and pathological criteria in EGC.To minimize noncurative resection risks while sparing unnecessary surgery for low-risk patients’,we specifically assess the suitability of Japanese guidelines in non-Japanese populations.This work aims to optimize clinical practice by refining endoscopic treatment criteria for adoption beyond Japan.AIM To evaluate EGC clinical decision accuracy by comparing therapeutic indication with postoperative pathological criteria and analyzing factors influencing discrepancies.METHODS A retrospective analysis was conducted on 796 EGC cases diagnosed at Peking University Third Hospital between January 2010 and December 2022.Cases were categorized into three groups:Same-estimated(preoperative therapeutic indication with postoperative pathological criteria matched),underestimated(preoperative ESD indication but postoperative surgical criteria),and overestimated(preoperative surgical indication but postoperative ESD criteria).The rate of discrepancy and associated risk factors were assessed.RESULTS The accuracy rates of preoperative evaluation for ESD and gastrectomy indications were 73.0%(321/430)and 76.0%(278/366),respectively.The overall discrepancy rate was 25.6%(204/796).Multivariate analysis identified tumor location in the upper-third stomach(odds ratio=2.158,95%confidence interval:1.373-3.390,P=0.001)was significantly associated with a higher likelihood of being underestimated and undifferentiated histologic type on preoperative biopsy(odds ratio=2.005,95%confidence interval:1.036-3.879,P=0.039)was more likely to be overestimated.Significant differences were observed in tumor diameter(P<0.001),depth of infiltration(P<0.001),ulcerative findings(P<0.001),and histologic type(P<0.001)between preoperative and postoperative evaluations.CONCLUSION The accuracy of preoperative EGC indications is 74.4%.Upper-third stomach and undifferentiated histology are primary discrepancy predictors.Upper-third tumors are prone to underestimation,while undifferentiated tumors are prone to overestimation.展开更多
Early life stress correlates with a higher prevalence of neurological disorders,including autism,attention-deficit/hyperactivity disorder,schizophrenia,depression,and Parkinson's disease.These conditions,primarily...Early life stress correlates with a higher prevalence of neurological disorders,including autism,attention-deficit/hyperactivity disorder,schizophrenia,depression,and Parkinson's disease.These conditions,primarily involving abnormal development and damage of the dopaminergic system,pose significant public health challenges.Microglia,as the primary immune cells in the brain,are crucial in regulating neuronal circuit development and survival.From the embryonic stage to adulthood,microglia exhibit stage-specific gene expression profiles,transcriptome characteristics,and functional phenotypes,enhancing the susceptibility to early life stress.However,the role of microglia in mediating dopaminergic system disorders under early life stress conditions remains poorly understood.This review presents an up-to-date overview of preclinical studies elucidating the impact of early life stress on microglia,leading to dopaminergic system disorders,along with the underlying mechanisms and therapeutic potential for neurodegenerative and neurodevelopmental conditions.Impaired microglial activity damages dopaminergic neurons by diminishing neurotrophic support(e.g.,insulin-like growth factor-1)and hinders dopaminergic axon growth through defective phagocytosis and synaptic pruning.Furthermore,blunted microglial immunoreactivity suppresses striatal dopaminergic circuit development and reduces neuronal transmission.Furthermore,inflammation and oxidative stress induced by activated microglia can directly damage dopaminergic neurons,inhibiting dopamine synthesis,reuptake,and receptor activity.Enhanced microglial phagocytosis inhibits dopamine axon extension.These long-lasting effects of microglial perturbations may be driven by early life stress–induced epigenetic reprogramming of microglia.Indirectly,early life stress may influence microglial function through various pathways,such as astrocytic activation,the hypothalamic–pituitary–adrenal axis,the gut–brain axis,and maternal immune signaling.Finally,various therapeutic strategies and molecular mechanisms for targeting microglia to restore the dopaminergic system were summarized and discussed.These strategies include classical antidepressants and antipsychotics,antibiotics and anti-inflammatory agents,and herbal-derived medicine.Further investigations combining pharmacological interventions and genetic strategies are essential to elucidate the causal role of microglial phenotypic and functional perturbations in the dopaminergic system disrupted by early life stress.展开更多
Early diagnosis of rapidly progressive osteoarthritis of the hip(RPOH)remains clinically challenging due to the lack of unified guidelines and standardized diagnostic criteria.Current diagnostic criteria(chondrolysis&...Early diagnosis of rapidly progressive osteoarthritis of the hip(RPOH)remains clinically challenging due to the lack of unified guidelines and standardized diagnostic criteria.Current diagnostic criteria(chondrolysis>2 mm/year)require follow-up for at least 12 months.This review characterizes two types of earlystage RPOH progression:Chondrolysis with or without subsequent femoral head destruction within 12 months of onset.Based on their association with early disease progression in RPOH,elevated serum matrix metalloproteinase-3 levels and spinopelvic malalignment may serve as predictive factors for subsequent bone destruction when only joint space narrowing is observed.This review also proposes potential mechanisms of pathogenesis and intervention strategies for RPOH at its initial stage.Cartilage matrix fragments generated by stress concentrations on the hip joint,resulting from spinopelvic malalignment,may trigger inflammatory pathways involving proinflammatory cytokines and inflammasome activation,ultimately leading to joint destruction in the initial phase of RPOH.Suppression of these early pathological events may prevent joint destruction caused by RPOH.However,further elucidation of the cellular and molecular pathways involved in rapid joint destruction is necessary to identify specific biomarkers for early diagnosis and to facilitate the development of targeted therapies in the initial phase of RPOH.展开更多
BACKGROUND Prolonged immobility during intensive care unit(ICU)admission has been a cause of muscle atrophy and worsening functional outcomes with longer recovery times.Prior research has demonstrated that mobilizatio...BACKGROUND Prolonged immobility during intensive care unit(ICU)admission has been a cause of muscle atrophy and worsening functional outcomes with longer recovery times.Prior research has demonstrated that mobilization within a week of ICU admission potentially benefits physical function in critically ill patients.AIM To evaluate the effects of initiating mobilization within 72 hours of ICU admission in critically ill patients through an updated systematic review and meta-analysis.METHODS A systematic search was performed through MEDLINE,Scopus,and Cochrane Library from inception until September 2024 for randomized controlled trials(RCTs)comparing early mobilization(EM)with usual or conventional care in critically ill adult patients.Primary outcomes included length of ICU(days)and ventilation duration(days).Secondary outcomes included muscle strength,functional status,adverse events,all-cause mortality,and quality of life(QOL).A random effects meta-analysis was performed for pooled effect estimates and to derive risk ratios(RR)and corresponding 95%confidence intervals(CI).RESULTS Out of 3487 results,16 RCTs were included with a population of 2385 patients(1195 receiving EM and 1190 with usual care.)A significant reduction in the length of ICU stays[mean difference(MD)=-1.02,95%CI:-1.96 to-0.09;P=0.03;I2=60%]and ventilation duration(MD=-1.07,95%CI:-1.91 to-0.23,P=0.01;I2=57%)was observed in the EM group compared to usual care.EM significantly improved muscle strength[standard MD(SMD)=0.47,95%CI:0.18-0.75,P=0.001;I2=79%]and functional status(SMD=0.70,95%CI:0.40-1.00,P<0.00001;I2=81%)in ICU patients.No statistically significant difference was observed in adverse events(RR=1.72,95%CI:1.01-2.94,P=0.05;I2=31%),all-cause mortality(RR=1.10,95%CI:0.79-1.53,P=0.57;I2=30%),and QOL(SMD=0.04,95%CI:-0.07-0.15,P=0.50;I2=9%)between the two groups.CONCLUSION Initiating mobilization within 72 hours of ICU admission is associated with improved functional outcomes and reduced ICU length of stay and ventilation duration.These findings indicate that EM may be a safe option for ICU patients,contributing to lower recovery times and healthcare costs.Further extensive research is required to validate the long-term effects on survival and QOL.展开更多
In the era of artificial intelligence(AI),healthcare and medical sciences are inseparable from different AI technologies[1].ChatGPT once shocked the medical field,but the latest AI model DeepSeek has recently taken th...In the era of artificial intelligence(AI),healthcare and medical sciences are inseparable from different AI technologies[1].ChatGPT once shocked the medical field,but the latest AI model DeepSeek has recently taken the lead[2].PubMed indexed publications on DeepSeek are evolving[3],but limited to editorials and news articles.In this Letter,we explore the use of DeepSeek in early symptoms recognition for stroke care.To the best of our knowledge,this is the first DeepSeek-related writing on stroke.展开更多
Osteoarthritis(OA)is one of the most common degenerative joint diseases in the elderly,increasing in prevalence and posing a substantial socioeconomic challenge,while no disease-modifying treatments available.Better u...Osteoarthritis(OA)is one of the most common degenerative joint diseases in the elderly,increasing in prevalence and posing a substantial socioeconomic challenge,while no disease-modifying treatments available.Better understanding of the early molecular events will benefit the early-stage diagnosis and clinical therapy.Here,we observed the nucleus accumulation of ZBTB20,a member of ZBTB-protein family,in the chondrocytes of early-stage OA.Chondrocytes-specific depletion of Zbtb20 in adult mice attenuated DMM-induced OA progress,restored the balance of extracellular matrix anabolism and catabolism.The NF-κB signaling mediated disturbance of ECM maintenance by ZBTB20 requires its suppression of Pten and consequent PI3K-Akt signaling activation.Furthermore,the subcellular localization of ZBTB20 was modulated by the kinase LATS1.Independent approaches to modulating ZBTB20 via utilizing TRULI and DAPA can restore ECM homeostasis,improving the abnormal behavior and moderating cartilage degeneration.The compounds TRULI and DAPA modulating ZBTB20 may serve as anti-OA drugs.展开更多
BACKGROUND Stress hyperglycemia(SH)is a common phenomenon that is present in about 50%of patients with acute ischemic stroke(AIS).It is thought to be a main risk factor for poor functional outcome among patients with ...BACKGROUND Stress hyperglycemia(SH)is a common phenomenon that is present in about 50%of patients with acute ischemic stroke(AIS).It is thought to be a main risk factor for poor functional outcome among patients with AIS undergoing intravenous thrombolysis(IVT).AIM To investigate the predictive value of glycemic indicators for early neurological outcomes(ENOs)in patients with AIS treated with IVT.METHODS We retrospectively reviewed a prospectively collected database of patients with AIS who underwent IVT at the Department of Neurology,Second Affiliated Hospital of Xuzhou Medical University,between January 2017 and June 2022.ENO included early neurological improvement(ENI)and early neurological deterioration(END),defined as a decrease or increase in the National Institutes of Health Stroke Scale(NIHSS)score between baseline and 24 hours after IVT.We analyzed the associations between glycemic indicators[including admission hyperglycemia(AH),fasting blood glucose(FBG),and SH ratio(SHR)]and ENO in all patients and in subgroups stratified by diabetes mellitus(DM).RESULTS A total of 819 patients with AIS treated with IVT were included.Among these,AH was observed in 329 patients(40.2%).Compared with patients without AH,those with AH were more likely to have a higher prevalence of DM(P<0.001)and hypertension(P=0.031)and presented with higher admission NIHSS scores(P<0.001).During the first 24 hours after IVT,END occurred in 208 patients(25.4%)and ENI occurred in 156 patients(19.0%).Multivariate mixed logistic regression analyses indicated that END was independently associated with AH[odds ratio(OR):1.744,95%confidence interval(CI):1.236-2.463;P=0.002].Subjects were classified into four groups representing quartiles.Compared with Q1,patients in the higher quartiles of SHR(Q2:OR:2.306,95%CI:1.342-3.960;P=0.002)(Q3:OR:2.284,95%CI:1.346-3.876;P=0.002)(Q4:OR:3.486,95%CI:2.088-5.820;P=0.001)and FBG(Q3:OR:1.746,95%CI:1.045-2.917;P=0.033)(Q4:OR:2.436,95%CI:1.476-4.022;P=0.001)had a significantly higher risk of END in the overall population.However,none of the glycemic indicators were found to be associated with ENI in patients with or without DM.CONCLUSION Our study demonstrated that glycemic indicators in patients with stroke treated with IVT were associated with the presence of END rather than ENI during the first 24 hours after admission.展开更多
BACKGROUND Extracorporeal membrane oxygenation(ECMO)is mainly applied to patients with significant cardiorespiratory failure who do not respond to existing conventional treatments.Patients that are supported with veno...BACKGROUND Extracorporeal membrane oxygenation(ECMO)is mainly applied to patients with significant cardiorespiratory failure who do not respond to existing conventional treatments.Patients that are supported with veno-arterial ECMO(VA-ECMO)are considered very-high risk patients to participate in any type of physical therapy(PT)or mobilization.However,cumulative evidence suggests that early mobilization of critically ill patients is feasible,safe,and efficient under certain circumstances.AIM To summarize the existing evidence on the impact of early mobilization and physiotherapy on VA-ECMO patients.METHODS This is a scoping review that used systematic electronic literature searches(from inception until January 2025)on MEDLINE(PubMed),PEDro,DynaMed,CINAHL,Scopus,Science direct and Hellenic Academic Libraries.Snowball searching method was also applied.Eligible studies included those reporting patients on VA-ECMO who participated in early mobilization or PT,published in English and utilized any primary evidence study design.Studies on children,animals and patients placed on any other ECMO,secondary evidence,and‘grey’literature were excluded.RESULTS A total of 316 articles were retrieved and 13 were included in the study.Of those,1 study was a randomized control trial,4 retrospective studies,4 retrospective cohort studies,1 case series and 3 case reports.The sample size of the included studies ranged from 1 to 104 VA-ECMO patients,who were ambulated or received PT inter-ventions,and mobilization frequency ranged from 2 per day to 4 per week.Mobilization of VA-ECMO patients seems to be safe regardless the cannula’s position.PT and early mobilization were associated with better weaning from mechanical ventilation,gradual reduction of inotropes and functional capacity improvement after ECMO discharge.CONCLUSION Early mobilization in VA-ECMO seems to be safe and can potentially help reduce vasoconstrictors and speed up rehabilitation times.High quality research on early mobilization in VA-ECMO patients is warranted.展开更多
Cracking of early-age concrete can occur in the track beds of high-speed railways due to changes in material properties,environmental effects,and construction processes.This is a multi-field,time-varying issue involvi...Cracking of early-age concrete can occur in the track beds of high-speed railways due to changes in material properties,environmental effects,and construction processes.This is a multi-field,time-varying issue involving hydro-thermo-chemo-mechanical coupling.However,to date,research has not adequately described the early-age cracking mechanisms in track beds,and few risk control measures have been proposed.To solve this problem,we incorporated the hydration degree of concrete into multi-field coupling equations for early-age concrete,and set boundary conditions that account for environmental influences and various stress factors that typically cause early creep of concrete.A four-field coupled risk prediction model was built based on hydro-thermo-chemo-mechanical properties,and was used to calculate and analyze various time-varying behavior(including the risk and form of cracking)in the hydro,thermo,chemo,and mechanical fields of early-age concrete.Finally,we focused on material-related factors(maximum heat of hydration and peak heat release time),environmental factors(temperature difference between day and night,average daily cooling rate,and intensity of solar radiation),and construction technique factors(molding temperature,pouring time,and thermal insulation coefficient).The influence of these factors on the early-age cracking risk of the track bed was analyzed,and risk control measures against early cracking were proposed accordingly.展开更多
Early identification and treatment of stroke can greatly improve patient outcomes and quality of life.Although clinical tests such as the Cincinnati Pre-hospital Stroke Scale(CPSS)and the Face Arm Speech Test(FAST)are...Early identification and treatment of stroke can greatly improve patient outcomes and quality of life.Although clinical tests such as the Cincinnati Pre-hospital Stroke Scale(CPSS)and the Face Arm Speech Test(FAST)are commonly used for stroke screening,accurate administration is dependent on specialized training.In this study,we proposed a novel multimodal deep learning approach,based on the FAST,for assessing suspected stroke patients exhibiting symptoms such as limb weakness,facial paresis,and speech disorders in acute settings.We collected a dataset comprising videos and audio recordings of emergency room patients performing designated limb movements,facial expressions,and speech tests based on the FAST.We compared the constructed deep learning model,which was designed to process multi-modal datasets,with six prior models that achieved good action classification performance,including the I3D,SlowFast,X3D,TPN,TimeSformer,and MViT.We found that the findings of our deep learning model had a higher clinical value compared with the other approaches.Moreover,the multi-modal model outperformed its single-module variants,highlighting the benefit of utilizing multiple types of patient data,such as action videos and speech audio.These results indicate that a multi-modal deep learning model combined with the FAST could greatly improve the accuracy and sensitivity of early stroke identification of stroke,thus providing a practical and powerful tool for assessing stroke patients in an emergency clinical setting.展开更多
Iced transmission line galloping poses a significant threat to the safety and reliability of power systems,leading directly to line tripping,disconnections,and power outages.Existing early warning methods of iced tran...Iced transmission line galloping poses a significant threat to the safety and reliability of power systems,leading directly to line tripping,disconnections,and power outages.Existing early warning methods of iced transmission line galloping suffer from issues such as reliance on a single data source,neglect of irregular time series,and lack of attention-based closed-loop feedback,resulting in high rates of missed and false alarms.To address these challenges,we propose an Internet of Things(IoT)empowered early warning method of transmission line galloping that integrates time series data from optical fiber sensing and weather forecast.Initially,the method applies a primary adaptive weighted fusion to the IoT empowered optical fiber real-time sensing data and weather forecast data,followed by a secondary fusion based on a Back Propagation(BP)neural network,and uses the K-medoids algorithm for clustering the fused data.Furthermore,an adaptive irregular time series perception adjustment module is introduced into the traditional Gated Recurrent Unit(GRU)network,and closed-loop feedback based on attentionmechanism is employed to update network parameters through gradient feedback of the loss function,enabling closed-loop training and time series data prediction of the GRU network model.Subsequently,considering various types of prediction data and the duration of icing,an iced transmission line galloping risk coefficient is established,and warnings are categorized based on this coefficient.Finally,using an IoT-driven realistic dataset of iced transmission line galloping,the effectiveness of the proposed method is validated through multi-dimensional simulation scenarios.展开更多
Suid is one of the most common taxa among the Pleistocene mammalian fauna in China.However,its phylogenetic taxonomy and evolution are far from clear.The newly recovered suid fossil materials from the Early Pleistocen...Suid is one of the most common taxa among the Pleistocene mammalian fauna in China.However,its phylogenetic taxonomy and evolution are far from clear.The newly recovered suid fossil materials from the Early Pleistocene Shanshenmiaozui site in Nihewan Basin in North China provide new insight into the evolution of its kind in North China.The new materials include partial skulls and mandibles of males,and most of their teeth were preserved in situ.The specimens can be referred to the species Sus lydekkeri,which is the only species of Sus found in North China from the Early Pleistocene.The fossils of the once reported Pleistocene species“Potamochoerus chinhsienensis”should also be provisionally included in the species S.lydekkeri according to its form and size,which at least now excludes it from Potamochoerus.The species S.lydekkeri is very close to the extant species S.scrofa,and even was combined into the latter as a chronological subspecies by some authors,while its larger size,prominent preorbital fossa,backwardly positioned infraorbital foramen,frequently appearing verrucosic type(at least the intermediate type of the male lower canine),and simple crown structures support its validness as an independent species.The Early Pleistocene forms are characterized by a larger size,lower L/W ratio of cheekteeth,both upper and lower M3s having no more than three lobes,and the male lower canine is exclusively of a verrucosic type.Suid fossils are a very good indicator of paleoenvironments and paleoclimate.Both the northern and the southern faunas in China contain suid fossils throughout the Pleistocene Epoch,while the southern fauna has prominently more diversified taxa and more abundant fossil collections;whether that is caused by different origins or by environmental modifications is still not clear.展开更多
Colorectal cancer(CRC)is a prevalent malignancy worldwide,posing a significant public health concern.Mounting evidence has confirmed that timely early screening facilitates the detection of incipient CRC,thereby enhan...Colorectal cancer(CRC)is a prevalent malignancy worldwide,posing a significant public health concern.Mounting evidence has confirmed that timely early screening facilitates the detection of incipient CRC,thereby enhancing patient prognosis.Obviously,non-participation of asymptomatic individuals in screening programs hampers early diagnosis and may adversely affect long-term outcomes for CRC patients.In this letter,we provide a comprehensive overview of the current status of early screening practices,while also thoroughly examine the dilemmas and potential solutions associated with early screening for CRC.In response to these issues,we proffer a set of recommendations directed at governmental authorities and the general public,which focus on augmenting financial investment,establishing standardized screening protocols,advancing technological capabilities,and bolstering public awareness campaigns.The importance of collaborative efforts from various stakeholders cannot be overstated in the quest to enhance early detection rates and alleviate the societal burden of CRC.展开更多
Early correction of childhood malocclusion is timely managing morphological,structural,and functional abnormalities at different dentomaxillofacial developmental stages.The selection of appropriate imaging examination...Early correction of childhood malocclusion is timely managing morphological,structural,and functional abnormalities at different dentomaxillofacial developmental stages.The selection of appropriate imaging examination and comprehensive radiological diagnosis and analysis play an important role in early correction of childhood malocclusion.This expert consensus is a collaborative effort by multidisciplinary experts in dentistry across the nation based on the current clinical evidence,aiming to provide general guidance on appropriate imaging examination selection,comprehensive and accurate imaging assessment for early orthodontic treatment patients.展开更多
Liver transplantation,as an effective therapy for patients with liver cancer,plays an important role in improving the quality of life of patients.However,the com-plexity and trauma of liver transplantation can easily ...Liver transplantation,as an effective therapy for patients with liver cancer,plays an important role in improving the quality of life of patients.However,the com-plexity and trauma of liver transplantation can easily lead to the occurrence of malnutrition in patients,and then increase the risk of postoperative complica-tions,which has aroused widespread clinical attention.Reasonable nutritional support can not only maintain the stability of the body’s internal environment,reduce the occurrence of complications,but also promote the recovery of liver and other organ functions.In recent years,with the in-depth understanding of nut-ritional metabolism after liver transplantation,the application of enteral nutrition and parenteral nutrition in nutritional support after liver transplantation has been increasingly extensive and achieved remarkable results.This paper discusses the effect of early postoperative nutritional intervention on patients with liver cancer and liver transplantation,and combined with its mechanism of action,can better understand the effectiveness of intervention,and provide reference for the deve-lopment of scientific and reasonable nutritional support programs in clinical pra-ctice.展开更多
BACKGROUND Emphysematous pyelonephritis(EPN)is a life-threatening necrotizing renal parenchyma infection characterized by gas formation due to severe bacterial infection,predominantly affecting diabetic and immunocomp...BACKGROUND Emphysematous pyelonephritis(EPN)is a life-threatening necrotizing renal parenchyma infection characterized by gas formation due to severe bacterial infection,predominantly affecting diabetic and immunocompromised patients.It carries high morbidity and mortality,requiring early diagnosis and timely intervention.Various prognostic scoring systems help in triaging critically ill patients.The National Early Warning Score 2(NEWS 2)scoring system is a widely used physiological assessment tool that evaluates clinical deterioration based on vital parameters,but its standard form lacks specificity for risk stratification in EPN,necessitating modifications to improve treatment decisionmaking and prognostic accuracy in this critical condition.AIM To highlight the need to modify the NEWS 2 score to enable more intense monitoring and better treatment outcomes.METHODS This prospective study was done on all EPN patients admitted to our hospital over the past 12 years.A weighted average risk-stratification index was calculated for each of the three groups,mortality risk was calculated for each of the NEWS 2 scores,and the need for intervention for each of the three groups was calculated.The NEWS 2 score was subsequently modified with 0-6,7-14 and 15-20 scores included in groups 1,2 and 3,respectively.RESULTS A total of 171 patients with EPN were included in the study,with a predominant association with diabetes(90.6%)and a female-to-male ratio of 1.5:1.The combined prognostic scoring of the three groups was 10.7,13.0,and 21.9,respectively(P<0.01).All patients managed conservatively belonged to group 1(P<0.01).Eight patients underwent early nephrectomy,with six from group 3(P<0.01).Overall mortality was 8(4.7%),with seven from group 3(87.5%).The cutoff NEWS 2 score for mortality was identified to be 15,with a sensitivity of 87.5%,specificity of 96.9%,and an overall accuracy rate of 96.5%.The area under the curve to predict mortality based on the NEWS 2 score was 0.98,with a confidence interval of(0.97,1.0)and P<0.001.CONCLUSION Modified NEWS 2(mNEWS 2)score dramatically aids in the appropriate assessment of treatment-related outcomes.MNEWS 2 scores should become the practice standard to reduce the morbidity and mortality associated with this dreaded illness.展开更多
文摘BACKGROUND:Hemiplegia,a prevalent stroke-related condition,is often studied for motor dysfunction;however,spasticity remains under-researched.Abnormal muscle tone significantly hinders hemiplegic patients’walking recovery.OBJECTIVE:To determine whether early suspension-protected training with a personal assistant machine for stroke patients enhances walking ability and prevents muscle spasms.METHODS:Thirty-two early-stage stroke patients from Shenzhen University General Hospital and the China Rehabilitation Research Center were randomly assigned to the experimental group(n=16)and the control group(n=16).Both groups underwent 4 weeks of gait training under the suspension protection system for 30 minutes daily,5 days a week.The experimental group used the personal assistant machine during training.Three-dimensional gait analysis(using the Cortex motion capture system),Brunnstrom staging,Fugl-Meyer Assessment for lower limb motor function,Fugl-Meyer balance function,and the modified Ashworth Scale were evaluated within 1 week before the intervention and after 4 weeks of intervention.RESULTS AND CONCLUSION:After the 4-week intervention,all outcome measures showed significant changes in each group.The experimental group had a small but significant increase in the modified Ashworth Scale score(P<0.05,d=|0.15|),while the control group had a large significant increase(P<0.05,d=|1.48|).The experimental group demonstrated greater improvements in walking speed(16.5 to 38.44 cm/s,P<0.05,d=|4.01|),step frequency(46.44 to 64.94 steps/min,P<0.05,d=|2.32|),stride length(15.50 to 29.81 cm,P<0.05,d=|3.44|),and peak hip and knee flexion(d=|1.82|to|2.17|).After treatment,the experimental group showed significantly greater improvements than the control group in walking speed(38.44 vs.26.63 cm/s,P<0.05,d=|2.75|),stride length,peak hip and knee flexion(d=|1.31|to|1.45|),step frequency(64.94 vs.59.38 steps/min,P<0.05,d=|0.85|),and a reduced support phase(bilateral:24.31%vs.28.38%,P<0.05,d=|0.88|;non-paretic:66.19%vs.70.13%,P<0.05,d=|0.94|).For early hemiplegia,personal assistant machine-assisted gait training under the suspension protection system helps establish a correct gait pattern,prevents muscle spasms,and improves motor function.
文摘The increasing global prevalence of mild cognitive impairment(MCI)necessitates a paradigm shift in early detection strategies.Conventional neuropsychological assessment methods,predominantly paper-and-pencil tests such as the Mini-Mental State Examination and the Montreal Cognitive Assessment,exhibit inherent limitations with respect to accessibility,administration burden,and sensitivity to subtle cognitive decline,particularly among diverse populations.This commentary critically examines a recent study that champions a novel approach:The integration of gait and handwriting kinematic parameters analyzed via machine learning for MCI screening.The present study positions itself within the broader landscape of MCI detection,with a view to comparing its advantages against established neuropsychological batteries,advanced neuroimaging(e.g.,positron emission tomography,magnetic resonance imaging),and emerging fluid biomarkers(e.g.,cerebrospinal fluid,blood-based assays).While the study demonstrates promising accuracy(74.44%area under the curve 0.74 with gait and graphic handwriting)and addresses key unmet needs in accessibility and objectivity,we highlight its cross-sectional nature,limited sample diversity,and lack of dual-task assessment as areas for future refinement.This commentary posits that kinematic biomarkers offer a distinctive,scalable,and ecologically valid approach to widespread MCI screening,thereby complementing existing methods by providing real-world functional insights.Future research should prioritize longitudinal validation,expansion to diverse cohorts,integration with multimodal data including dual-tasking,and the development of highly portable,artificial intelligence-driven solutions to achieve the democratization of early MCI detection and enable timely interventions.
基金Supported by China Health&Medical Development Foundation,No.M2021551.
文摘BACKGROUND Inappropriate selection of patients with early gastric cancer(EGC)for endoscopic submucosal dissection(ESD)may lead to non-curative resection,necessitating additional gastrectomy.Conversely,inappropriate selection for gastrectomy may result in overtreatment,adversely affecting patients’quality of life.Few have systematically evaluated the concordance between therapeutic indications under current Japanese guidelines and pathological criteria in EGC.To minimize noncurative resection risks while sparing unnecessary surgery for low-risk patients’,we specifically assess the suitability of Japanese guidelines in non-Japanese populations.This work aims to optimize clinical practice by refining endoscopic treatment criteria for adoption beyond Japan.AIM To evaluate EGC clinical decision accuracy by comparing therapeutic indication with postoperative pathological criteria and analyzing factors influencing discrepancies.METHODS A retrospective analysis was conducted on 796 EGC cases diagnosed at Peking University Third Hospital between January 2010 and December 2022.Cases were categorized into three groups:Same-estimated(preoperative therapeutic indication with postoperative pathological criteria matched),underestimated(preoperative ESD indication but postoperative surgical criteria),and overestimated(preoperative surgical indication but postoperative ESD criteria).The rate of discrepancy and associated risk factors were assessed.RESULTS The accuracy rates of preoperative evaluation for ESD and gastrectomy indications were 73.0%(321/430)and 76.0%(278/366),respectively.The overall discrepancy rate was 25.6%(204/796).Multivariate analysis identified tumor location in the upper-third stomach(odds ratio=2.158,95%confidence interval:1.373-3.390,P=0.001)was significantly associated with a higher likelihood of being underestimated and undifferentiated histologic type on preoperative biopsy(odds ratio=2.005,95%confidence interval:1.036-3.879,P=0.039)was more likely to be overestimated.Significant differences were observed in tumor diameter(P<0.001),depth of infiltration(P<0.001),ulcerative findings(P<0.001),and histologic type(P<0.001)between preoperative and postoperative evaluations.CONCLUSION The accuracy of preoperative EGC indications is 74.4%.Upper-third stomach and undifferentiated histology are primary discrepancy predictors.Upper-third tumors are prone to underestimation,while undifferentiated tumors are prone to overestimation.
基金supported by the National Natural Science Foundation of China,Nos.82304990(to NY),81973748(to JC),82174278(to JC)the National Key R&D Program of China,No.2023YFE0209500(to JC)+4 种基金China Postdoctoral Science Foundation,No.2023M732380(to NY)Guangzhou Key Laboratory of Formula-Pattern of Traditional Chinese Medicine,No.202102010014(to JC)Huang Zhendong Research Fund for Traditional Chinese Medicine of Jinan University,No.201911(to JC)National Innovation and Entrepreneurship Training Program for Undergraduates in China,No.202310559128(to NY and QM)Innovation and Entrepreneurship Training Program for Undergraduates at Jinan University,Nos.CX24380,CX24381(both to NY and QM)。
文摘Early life stress correlates with a higher prevalence of neurological disorders,including autism,attention-deficit/hyperactivity disorder,schizophrenia,depression,and Parkinson's disease.These conditions,primarily involving abnormal development and damage of the dopaminergic system,pose significant public health challenges.Microglia,as the primary immune cells in the brain,are crucial in regulating neuronal circuit development and survival.From the embryonic stage to adulthood,microglia exhibit stage-specific gene expression profiles,transcriptome characteristics,and functional phenotypes,enhancing the susceptibility to early life stress.However,the role of microglia in mediating dopaminergic system disorders under early life stress conditions remains poorly understood.This review presents an up-to-date overview of preclinical studies elucidating the impact of early life stress on microglia,leading to dopaminergic system disorders,along with the underlying mechanisms and therapeutic potential for neurodegenerative and neurodevelopmental conditions.Impaired microglial activity damages dopaminergic neurons by diminishing neurotrophic support(e.g.,insulin-like growth factor-1)and hinders dopaminergic axon growth through defective phagocytosis and synaptic pruning.Furthermore,blunted microglial immunoreactivity suppresses striatal dopaminergic circuit development and reduces neuronal transmission.Furthermore,inflammation and oxidative stress induced by activated microglia can directly damage dopaminergic neurons,inhibiting dopamine synthesis,reuptake,and receptor activity.Enhanced microglial phagocytosis inhibits dopamine axon extension.These long-lasting effects of microglial perturbations may be driven by early life stress–induced epigenetic reprogramming of microglia.Indirectly,early life stress may influence microglial function through various pathways,such as astrocytic activation,the hypothalamic–pituitary–adrenal axis,the gut–brain axis,and maternal immune signaling.Finally,various therapeutic strategies and molecular mechanisms for targeting microglia to restore the dopaminergic system were summarized and discussed.These strategies include classical antidepressants and antipsychotics,antibiotics and anti-inflammatory agents,and herbal-derived medicine.Further investigations combining pharmacological interventions and genetic strategies are essential to elucidate the causal role of microglial phenotypic and functional perturbations in the dopaminergic system disrupted by early life stress.
文摘Early diagnosis of rapidly progressive osteoarthritis of the hip(RPOH)remains clinically challenging due to the lack of unified guidelines and standardized diagnostic criteria.Current diagnostic criteria(chondrolysis>2 mm/year)require follow-up for at least 12 months.This review characterizes two types of earlystage RPOH progression:Chondrolysis with or without subsequent femoral head destruction within 12 months of onset.Based on their association with early disease progression in RPOH,elevated serum matrix metalloproteinase-3 levels and spinopelvic malalignment may serve as predictive factors for subsequent bone destruction when only joint space narrowing is observed.This review also proposes potential mechanisms of pathogenesis and intervention strategies for RPOH at its initial stage.Cartilage matrix fragments generated by stress concentrations on the hip joint,resulting from spinopelvic malalignment,may trigger inflammatory pathways involving proinflammatory cytokines and inflammasome activation,ultimately leading to joint destruction in the initial phase of RPOH.Suppression of these early pathological events may prevent joint destruction caused by RPOH.However,further elucidation of the cellular and molecular pathways involved in rapid joint destruction is necessary to identify specific biomarkers for early diagnosis and to facilitate the development of targeted therapies in the initial phase of RPOH.
文摘BACKGROUND Prolonged immobility during intensive care unit(ICU)admission has been a cause of muscle atrophy and worsening functional outcomes with longer recovery times.Prior research has demonstrated that mobilization within a week of ICU admission potentially benefits physical function in critically ill patients.AIM To evaluate the effects of initiating mobilization within 72 hours of ICU admission in critically ill patients through an updated systematic review and meta-analysis.METHODS A systematic search was performed through MEDLINE,Scopus,and Cochrane Library from inception until September 2024 for randomized controlled trials(RCTs)comparing early mobilization(EM)with usual or conventional care in critically ill adult patients.Primary outcomes included length of ICU(days)and ventilation duration(days).Secondary outcomes included muscle strength,functional status,adverse events,all-cause mortality,and quality of life(QOL).A random effects meta-analysis was performed for pooled effect estimates and to derive risk ratios(RR)and corresponding 95%confidence intervals(CI).RESULTS Out of 3487 results,16 RCTs were included with a population of 2385 patients(1195 receiving EM and 1190 with usual care.)A significant reduction in the length of ICU stays[mean difference(MD)=-1.02,95%CI:-1.96 to-0.09;P=0.03;I2=60%]and ventilation duration(MD=-1.07,95%CI:-1.91 to-0.23,P=0.01;I2=57%)was observed in the EM group compared to usual care.EM significantly improved muscle strength[standard MD(SMD)=0.47,95%CI:0.18-0.75,P=0.001;I2=79%]and functional status(SMD=0.70,95%CI:0.40-1.00,P<0.00001;I2=81%)in ICU patients.No statistically significant difference was observed in adverse events(RR=1.72,95%CI:1.01-2.94,P=0.05;I2=31%),all-cause mortality(RR=1.10,95%CI:0.79-1.53,P=0.57;I2=30%),and QOL(SMD=0.04,95%CI:-0.07-0.15,P=0.50;I2=9%)between the two groups.CONCLUSION Initiating mobilization within 72 hours of ICU admission is associated with improved functional outcomes and reduced ICU length of stay and ventilation duration.These findings indicate that EM may be a safe option for ICU patients,contributing to lower recovery times and healthcare costs.Further extensive research is required to validate the long-term effects on survival and QOL.
文摘In the era of artificial intelligence(AI),healthcare and medical sciences are inseparable from different AI technologies[1].ChatGPT once shocked the medical field,but the latest AI model DeepSeek has recently taken the lead[2].PubMed indexed publications on DeepSeek are evolving[3],but limited to editorials and news articles.In this Letter,we explore the use of DeepSeek in early symptoms recognition for stroke care.To the best of our knowledge,this is the first DeepSeek-related writing on stroke.
基金supported by grants from the National Natural Science Foundation of China(82002351,82394442,82130070,82272442)funded by the Innovation Capability Support Program of Shaanxi Province(2024SF-LCZX-16)+2 种基金the Shaanxi Province Health Scientific Research Innovation Ability Promotion Plan(2024PT-12)the Independent Exploration and Innovation Project of Xi’an Jiaotong University(xzy012023121)the project of Xi’an Postdoctoral Innovation Base.
文摘Osteoarthritis(OA)is one of the most common degenerative joint diseases in the elderly,increasing in prevalence and posing a substantial socioeconomic challenge,while no disease-modifying treatments available.Better understanding of the early molecular events will benefit the early-stage diagnosis and clinical therapy.Here,we observed the nucleus accumulation of ZBTB20,a member of ZBTB-protein family,in the chondrocytes of early-stage OA.Chondrocytes-specific depletion of Zbtb20 in adult mice attenuated DMM-induced OA progress,restored the balance of extracellular matrix anabolism and catabolism.The NF-κB signaling mediated disturbance of ECM maintenance by ZBTB20 requires its suppression of Pten and consequent PI3K-Akt signaling activation.Furthermore,the subcellular localization of ZBTB20 was modulated by the kinase LATS1.Independent approaches to modulating ZBTB20 via utilizing TRULI and DAPA can restore ECM homeostasis,improving the abnormal behavior and moderating cartilage degeneration.The compounds TRULI and DAPA modulating ZBTB20 may serve as anti-OA drugs.
基金Supported by the Foundation of Jiangsu Provincial Commission of Health and Family Planning,No.QNRC2016353the Commission of Health and Family Planning Xuzhou,No.KC22206.
文摘BACKGROUND Stress hyperglycemia(SH)is a common phenomenon that is present in about 50%of patients with acute ischemic stroke(AIS).It is thought to be a main risk factor for poor functional outcome among patients with AIS undergoing intravenous thrombolysis(IVT).AIM To investigate the predictive value of glycemic indicators for early neurological outcomes(ENOs)in patients with AIS treated with IVT.METHODS We retrospectively reviewed a prospectively collected database of patients with AIS who underwent IVT at the Department of Neurology,Second Affiliated Hospital of Xuzhou Medical University,between January 2017 and June 2022.ENO included early neurological improvement(ENI)and early neurological deterioration(END),defined as a decrease or increase in the National Institutes of Health Stroke Scale(NIHSS)score between baseline and 24 hours after IVT.We analyzed the associations between glycemic indicators[including admission hyperglycemia(AH),fasting blood glucose(FBG),and SH ratio(SHR)]and ENO in all patients and in subgroups stratified by diabetes mellitus(DM).RESULTS A total of 819 patients with AIS treated with IVT were included.Among these,AH was observed in 329 patients(40.2%).Compared with patients without AH,those with AH were more likely to have a higher prevalence of DM(P<0.001)and hypertension(P=0.031)and presented with higher admission NIHSS scores(P<0.001).During the first 24 hours after IVT,END occurred in 208 patients(25.4%)and ENI occurred in 156 patients(19.0%).Multivariate mixed logistic regression analyses indicated that END was independently associated with AH[odds ratio(OR):1.744,95%confidence interval(CI):1.236-2.463;P=0.002].Subjects were classified into four groups representing quartiles.Compared with Q1,patients in the higher quartiles of SHR(Q2:OR:2.306,95%CI:1.342-3.960;P=0.002)(Q3:OR:2.284,95%CI:1.346-3.876;P=0.002)(Q4:OR:3.486,95%CI:2.088-5.820;P=0.001)and FBG(Q3:OR:1.746,95%CI:1.045-2.917;P=0.033)(Q4:OR:2.436,95%CI:1.476-4.022;P=0.001)had a significantly higher risk of END in the overall population.However,none of the glycemic indicators were found to be associated with ENI in patients with or without DM.CONCLUSION Our study demonstrated that glycemic indicators in patients with stroke treated with IVT were associated with the presence of END rather than ENI during the first 24 hours after admission.
文摘BACKGROUND Extracorporeal membrane oxygenation(ECMO)is mainly applied to patients with significant cardiorespiratory failure who do not respond to existing conventional treatments.Patients that are supported with veno-arterial ECMO(VA-ECMO)are considered very-high risk patients to participate in any type of physical therapy(PT)or mobilization.However,cumulative evidence suggests that early mobilization of critically ill patients is feasible,safe,and efficient under certain circumstances.AIM To summarize the existing evidence on the impact of early mobilization and physiotherapy on VA-ECMO patients.METHODS This is a scoping review that used systematic electronic literature searches(from inception until January 2025)on MEDLINE(PubMed),PEDro,DynaMed,CINAHL,Scopus,Science direct and Hellenic Academic Libraries.Snowball searching method was also applied.Eligible studies included those reporting patients on VA-ECMO who participated in early mobilization or PT,published in English and utilized any primary evidence study design.Studies on children,animals and patients placed on any other ECMO,secondary evidence,and‘grey’literature were excluded.RESULTS A total of 316 articles were retrieved and 13 were included in the study.Of those,1 study was a randomized control trial,4 retrospective studies,4 retrospective cohort studies,1 case series and 3 case reports.The sample size of the included studies ranged from 1 to 104 VA-ECMO patients,who were ambulated or received PT inter-ventions,and mobilization frequency ranged from 2 per day to 4 per week.Mobilization of VA-ECMO patients seems to be safe regardless the cannula’s position.PT and early mobilization were associated with better weaning from mechanical ventilation,gradual reduction of inotropes and functional capacity improvement after ECMO discharge.CONCLUSION Early mobilization in VA-ECMO seems to be safe and can potentially help reduce vasoconstrictors and speed up rehabilitation times.High quality research on early mobilization in VA-ECMO patients is warranted.
基金supported by the National Key R&D Program of China(No.2021YFF0502100)the National Natural Science Foundation of China(Nos.52278461 and 52308467).
文摘Cracking of early-age concrete can occur in the track beds of high-speed railways due to changes in material properties,environmental effects,and construction processes.This is a multi-field,time-varying issue involving hydro-thermo-chemo-mechanical coupling.However,to date,research has not adequately described the early-age cracking mechanisms in track beds,and few risk control measures have been proposed.To solve this problem,we incorporated the hydration degree of concrete into multi-field coupling equations for early-age concrete,and set boundary conditions that account for environmental influences and various stress factors that typically cause early creep of concrete.A four-field coupled risk prediction model was built based on hydro-thermo-chemo-mechanical properties,and was used to calculate and analyze various time-varying behavior(including the risk and form of cracking)in the hydro,thermo,chemo,and mechanical fields of early-age concrete.Finally,we focused on material-related factors(maximum heat of hydration and peak heat release time),environmental factors(temperature difference between day and night,average daily cooling rate,and intensity of solar radiation),and construction technique factors(molding temperature,pouring time,and thermal insulation coefficient).The influence of these factors on the early-age cracking risk of the track bed was analyzed,and risk control measures against early cracking were proposed accordingly.
基金supported by the Ministry of Science and Technology of China,No.2020AAA0109605(to XL)Meizhou Major Scientific and Technological Innovation PlatformsProjects of Guangdong Provincial Science & Technology Plan Projects,No.2019A0102005(to HW).
文摘Early identification and treatment of stroke can greatly improve patient outcomes and quality of life.Although clinical tests such as the Cincinnati Pre-hospital Stroke Scale(CPSS)and the Face Arm Speech Test(FAST)are commonly used for stroke screening,accurate administration is dependent on specialized training.In this study,we proposed a novel multimodal deep learning approach,based on the FAST,for assessing suspected stroke patients exhibiting symptoms such as limb weakness,facial paresis,and speech disorders in acute settings.We collected a dataset comprising videos and audio recordings of emergency room patients performing designated limb movements,facial expressions,and speech tests based on the FAST.We compared the constructed deep learning model,which was designed to process multi-modal datasets,with six prior models that achieved good action classification performance,including the I3D,SlowFast,X3D,TPN,TimeSformer,and MViT.We found that the findings of our deep learning model had a higher clinical value compared with the other approaches.Moreover,the multi-modal model outperformed its single-module variants,highlighting the benefit of utilizing multiple types of patient data,such as action videos and speech audio.These results indicate that a multi-modal deep learning model combined with the FAST could greatly improve the accuracy and sensitivity of early stroke identification of stroke,thus providing a practical and powerful tool for assessing stroke patients in an emergency clinical setting.
基金research was funded by Science and Technology Project of State Grid Corporation of China under grant number 5200-202319382A-2-3-XG.
文摘Iced transmission line galloping poses a significant threat to the safety and reliability of power systems,leading directly to line tripping,disconnections,and power outages.Existing early warning methods of iced transmission line galloping suffer from issues such as reliance on a single data source,neglect of irregular time series,and lack of attention-based closed-loop feedback,resulting in high rates of missed and false alarms.To address these challenges,we propose an Internet of Things(IoT)empowered early warning method of transmission line galloping that integrates time series data from optical fiber sensing and weather forecast.Initially,the method applies a primary adaptive weighted fusion to the IoT empowered optical fiber real-time sensing data and weather forecast data,followed by a secondary fusion based on a Back Propagation(BP)neural network,and uses the K-medoids algorithm for clustering the fused data.Furthermore,an adaptive irregular time series perception adjustment module is introduced into the traditional Gated Recurrent Unit(GRU)network,and closed-loop feedback based on attentionmechanism is employed to update network parameters through gradient feedback of the loss function,enabling closed-loop training and time series data prediction of the GRU network model.Subsequently,considering various types of prediction data and the duration of icing,an iced transmission line galloping risk coefficient is established,and warnings are categorized based on this coefficient.Finally,using an IoT-driven realistic dataset of iced transmission line galloping,the effectiveness of the proposed method is validated through multi-dimensional simulation scenarios.
文摘Suid is one of the most common taxa among the Pleistocene mammalian fauna in China.However,its phylogenetic taxonomy and evolution are far from clear.The newly recovered suid fossil materials from the Early Pleistocene Shanshenmiaozui site in Nihewan Basin in North China provide new insight into the evolution of its kind in North China.The new materials include partial skulls and mandibles of males,and most of their teeth were preserved in situ.The specimens can be referred to the species Sus lydekkeri,which is the only species of Sus found in North China from the Early Pleistocene.The fossils of the once reported Pleistocene species“Potamochoerus chinhsienensis”should also be provisionally included in the species S.lydekkeri according to its form and size,which at least now excludes it from Potamochoerus.The species S.lydekkeri is very close to the extant species S.scrofa,and even was combined into the latter as a chronological subspecies by some authors,while its larger size,prominent preorbital fossa,backwardly positioned infraorbital foramen,frequently appearing verrucosic type(at least the intermediate type of the male lower canine),and simple crown structures support its validness as an independent species.The Early Pleistocene forms are characterized by a larger size,lower L/W ratio of cheekteeth,both upper and lower M3s having no more than three lobes,and the male lower canine is exclusively of a verrucosic type.Suid fossils are a very good indicator of paleoenvironments and paleoclimate.Both the northern and the southern faunas in China contain suid fossils throughout the Pleistocene Epoch,while the southern fauna has prominently more diversified taxa and more abundant fossil collections;whether that is caused by different origins or by environmental modifications is still not clear.
文摘Colorectal cancer(CRC)is a prevalent malignancy worldwide,posing a significant public health concern.Mounting evidence has confirmed that timely early screening facilitates the detection of incipient CRC,thereby enhancing patient prognosis.Obviously,non-participation of asymptomatic individuals in screening programs hampers early diagnosis and may adversely affect long-term outcomes for CRC patients.In this letter,we provide a comprehensive overview of the current status of early screening practices,while also thoroughly examine the dilemmas and potential solutions associated with early screening for CRC.In response to these issues,we proffer a set of recommendations directed at governmental authorities and the general public,which focus on augmenting financial investment,establishing standardized screening protocols,advancing technological capabilities,and bolstering public awareness campaigns.The importance of collaborative efforts from various stakeholders cannot be overstated in the quest to enhance early detection rates and alleviate the societal burden of CRC.
基金supports by the National Natural Science Foundation of China(Nos.82201135)"2015"Cultivation Program for Reserve Talents for Academic Leaders of Nanjing Stomatological School,Medical School of Nanjing University(No.0223A204).
文摘Early correction of childhood malocclusion is timely managing morphological,structural,and functional abnormalities at different dentomaxillofacial developmental stages.The selection of appropriate imaging examination and comprehensive radiological diagnosis and analysis play an important role in early correction of childhood malocclusion.This expert consensus is a collaborative effort by multidisciplinary experts in dentistry across the nation based on the current clinical evidence,aiming to provide general guidance on appropriate imaging examination selection,comprehensive and accurate imaging assessment for early orthodontic treatment patients.
文摘Liver transplantation,as an effective therapy for patients with liver cancer,plays an important role in improving the quality of life of patients.However,the com-plexity and trauma of liver transplantation can easily lead to the occurrence of malnutrition in patients,and then increase the risk of postoperative complica-tions,which has aroused widespread clinical attention.Reasonable nutritional support can not only maintain the stability of the body’s internal environment,reduce the occurrence of complications,but also promote the recovery of liver and other organ functions.In recent years,with the in-depth understanding of nut-ritional metabolism after liver transplantation,the application of enteral nutrition and parenteral nutrition in nutritional support after liver transplantation has been increasingly extensive and achieved remarkable results.This paper discusses the effect of early postoperative nutritional intervention on patients with liver cancer and liver transplantation,and combined with its mechanism of action,can better understand the effectiveness of intervention,and provide reference for the deve-lopment of scientific and reasonable nutritional support programs in clinical pra-ctice.
文摘BACKGROUND Emphysematous pyelonephritis(EPN)is a life-threatening necrotizing renal parenchyma infection characterized by gas formation due to severe bacterial infection,predominantly affecting diabetic and immunocompromised patients.It carries high morbidity and mortality,requiring early diagnosis and timely intervention.Various prognostic scoring systems help in triaging critically ill patients.The National Early Warning Score 2(NEWS 2)scoring system is a widely used physiological assessment tool that evaluates clinical deterioration based on vital parameters,but its standard form lacks specificity for risk stratification in EPN,necessitating modifications to improve treatment decisionmaking and prognostic accuracy in this critical condition.AIM To highlight the need to modify the NEWS 2 score to enable more intense monitoring and better treatment outcomes.METHODS This prospective study was done on all EPN patients admitted to our hospital over the past 12 years.A weighted average risk-stratification index was calculated for each of the three groups,mortality risk was calculated for each of the NEWS 2 scores,and the need for intervention for each of the three groups was calculated.The NEWS 2 score was subsequently modified with 0-6,7-14 and 15-20 scores included in groups 1,2 and 3,respectively.RESULTS A total of 171 patients with EPN were included in the study,with a predominant association with diabetes(90.6%)and a female-to-male ratio of 1.5:1.The combined prognostic scoring of the three groups was 10.7,13.0,and 21.9,respectively(P<0.01).All patients managed conservatively belonged to group 1(P<0.01).Eight patients underwent early nephrectomy,with six from group 3(P<0.01).Overall mortality was 8(4.7%),with seven from group 3(87.5%).The cutoff NEWS 2 score for mortality was identified to be 15,with a sensitivity of 87.5%,specificity of 96.9%,and an overall accuracy rate of 96.5%.The area under the curve to predict mortality based on the NEWS 2 score was 0.98,with a confidence interval of(0.97,1.0)and P<0.001.CONCLUSION Modified NEWS 2(mNEWS 2)score dramatically aids in the appropriate assessment of treatment-related outcomes.MNEWS 2 scores should become the practice standard to reduce the morbidity and mortality associated with this dreaded illness.
