Reservoir-induced landslides in China's Three Gorges Reservoir area are prone to tensile cracks due to the influenceof their own weight and fluctuationsin water levels.The presence of cracks indicates that the ten...Reservoir-induced landslides in China's Three Gorges Reservoir area are prone to tensile cracks due to the influenceof their own weight and fluctuationsin water levels.The presence of cracks indicates that the tensile stress in the area has exceeded the tensile strength of the soil,leading to local instability.To explore the impact of tensile failure behavior on the stability and failure modes of reservoir landslides,the Huangtupo Riverside Slump#1 is taken as a case study.By considering local tensile failure,potential tensile cracks are incorporated into the analysis via the limit equilibrium method and reliability theory.The reliability of landslides under different tensile failure scenarios is quantified.Strain-softening characteristics of the soil are combined to further analyze the failure transmission path of the landslide.Finally,these potential failure modes were validated through physical model tests.The results show that cracks developing at rear positions reduce the stability of the slope and increase the probability of instability.During the destruction process,retrogressive failures with multiple sliding surfaces are likely to occur.However,tensile failure at the forefront reduces the likelihood of an individual slide mass descending.Progressive failure results in both regular and skip transmission patterns.Additionally,cracks and water level changes can also lead to shifts in the positions of the most dangerous blocks.Therefore,in practical landslide analysis and prevention,it is necessary to consider local tensile damage and identify potential tensile crack locations in advance to optimize prevention measures and accurately evaluate landslide risk.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
Dynamic disturbances with various frequencies could trigger different failure modes of deep excavations.Superimposed on this static stress are dynamic disturbances due to various dynamic vibrations,e.g.excavation blas...Dynamic disturbances with various frequencies could trigger different failure modes of deep excavations.Superimposed on this static stress are dynamic disturbances due to various dynamic vibrations,e.g.excavation blasting,blasting,tunnel boring machine(TBM)vibration,rockburst wave,earthquakes.Specifically,these dynamic sources are characterized by a wide range of wave frequencies f,resulting in differences in failure modes.A series of true-triaxial compression tests were conducted on granite to simulate the excavation-induced stress path in three-dimensional(3D)stresses.Subsequently,a dynamic disturbance with various frequencies was applied to a cuboid specimen,to reveal the behavior associated with brittle failure.The dynamic disturbance with frequencies f of 5 Hz,10 Hz,and 40 Hz generates less disturbed energy components in the granite together with higher peak strength.However,dynamic disturbances with f of 20 Hz and 30 Hz resulted in a lower peak strength;the peak strength of the rock increases sp albeit it decreases at first,then increases.This U-shaped phenomenon relates to the natural frequency of the granite under such stress conditions.Different rock lithologies consisting of diverse mineral composition,respond differently to each sensitive resonance frequency.Interestingly,the weak disturbance stress with a high frequency f and low amplitude A increases the ratio of crack damage to peak strength(scd/sp)in the granite.This leads to the inhibition of the expansion of the granite during the dynamic disturbance process.Multiple penetrating tensileeshear cracks appear in the s3-direction as the disturbance frequency f increases.展开更多
Investigating the damage evolution of surrounding rock under thermal shock cycles is crucial for ensuring the stability of engineering rock masses.This study performed Brazilian splitting tests on granite specimens un...Investigating the damage evolution of surrounding rock under thermal shock cycles is crucial for ensuring the stability of engineering rock masses.This study performed Brazilian splitting tests on granite specimens under varying temperature and cycle conditions,employing acoustic emission monitoring,digital image correlation,and three-dimensional scanning technology.A systematic analysis was conducted on the patterns of damage evolution,failure precursor,and response mechanisms under combined thermal and cyclic loading.Experimental results show that both P-wave velocity and tensile strength degrade significantly with increasing temperature and cycle count,with temperature having a more pronounced effect than cycle count.Notably,damage evolution exhibits a dual-threshold behavior in which degradation accelerates markedly above 400℃ and stabilizes after 5 thermal cycles.Fracture surfaces evolve from initially planar to rugged morphologies,with peak-valley height differences at 600℃ being approximately three times greater than those at 200℃.Furthermore,based on acoustic emission energy entropy analysis,we introduce a novel failure precursor indicator where the sustained increase and critical surge in average entropy serve as reliable early-warning signals for impending rock failure.These findings establish a solid theoretical basis and practical methodology for damage assessment and instability early-warning systems in high-temperature rock engineering.展开更多
Background:“Qi deficiency”(a pathological state where the body’s vital energy(Qi)is insufficient or weakened,impairing physiological functions and diminishing the body’s ability to perform daily activities,defend ...Background:“Qi deficiency”(a pathological state where the body’s vital energy(Qi)is insufficient or weakened,impairing physiological functions and diminishing the body’s ability to perform daily activities,defend against illness,and maintain homeostasis)syndrome is considered a critical syndrome in traditional Chinese medicine(TCM)and is associated with poor prognosis in heart failure(HF).This study investigates the clinical,metabolic,and transcriptomic differences between heart failure patients with and without Qi deficiency syndrome.Methods:56 heart failure patients were evaluated using a Qi deficiency syndrome scale and divided into Qi deficiency syndrome(QD)and non-Qi deficiency(non-QD)groups based on the median score.Clinical characteristics,including baseline N-terminal pro-B-type natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),total diuretic use during hospitalization,and 90-day rehospitalization rates,were compared between the groups.Differentially expressed genes(DEGs)and differential metabolites were identified,followed by enrichment analyses and validation using qPCR and Western blot in AC16 cardiomyocytes.Results:QD patients exhibited significantly higher NT-proBNP levels,lower LVEF,and increased 90-day rehospitalization rates.Metabolomic profiling revealed lipid metabolism disruptions,notably in linoleic acid and phospholipid pathways.Transcriptomic analysis highlighted 17 DEGs,including CISD2,a critical mitochondrial regulator,which was downregulated in QD patients.Correlation analysis identified significant associations between DEGs(e.g.,CISD2,BPGM)and lipid metabolites such as PC(16:0/P-16:0).Functional knockdown of CISD2 in AC16 cells led to upregulation of lipid oxidation enzymes ALOX15 and CYP1A2,linking CISD2 dysfunction to lipid metabolic dysregulation.Conclusion:Qi deficiency is associated with more severe heart failure symptoms,worse prognosis,and distinct metabolic and transcriptomic profiles,particularly in lipid metabolism.CISD2 emerges as a potential therapeutic target,offering new avenues for integrating molecular insights with TCM approaches to optimize HF management.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_(3)F_(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
Shield tunneling in saturated ground poses challenges due to the potential risk of ground collapse resulting from seepage force and inadequate support pressure.This study employed a laboratory model test and a theoret...Shield tunneling in saturated ground poses challenges due to the potential risk of ground collapse resulting from seepage force and inadequate support pressure.This study employed a laboratory model test and a theoretical validation to elucidate the mechanisms of face failure and subsequent ground collapse in saturated ground during slurry pressure-balanced shield(SPBS)tunneling operations.A slurry circulation system was developed to ensure steady shield tunneling and to replicate the phenomena of ground collapse.Investigations into shield tunneling parameters and ground responses,including soil pressure,pore water pressure,and surface subsidence,were conducted to understand the mechanisms of face failure and subsequent ground collapse.The theoretical solution for the critical collapse pressure of the tunnel face,based on the rotational failure mechanism,was validated through the comparison with the experimentally determined critical collapse pressure.The results indicate that:(1)appropriate adjustments of tunneling parameters are crucial for promoting filtercake formation,maintaining chamber pressure,and minimizing ground subsidence;(2)chamber pressure,soil pressure,pore water pressure,and ground subsidence are closely correlated with shield tunneling parameters and the formation of filter cake;(3)ground collapse follows a continuous failure mode due to the destruction of filtercake and the decrease in chamber pressure;(4)the soil pressure at the cutterhead is more sensitive to disturbances from shield tunneling than chamber pressure;and(5)experimentally determined critical collapse pressures is consistent with the theoretical solution of limit analysis.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
This study examines how native pore structures and loading conditions influencethe fracture size distribution and the predictability of catastrophic failure in rocks.Four lithologies with distinct pore characteristics...This study examines how native pore structures and loading conditions influencethe fracture size distribution and the predictability of catastrophic failure in rocks.Four lithologies with distinct pore characteristics,i.e.granite,limestone,red sandstone,and marble,were tested under uniaxial compression and Brazilian splitting.Nuclear magnetic resonance(NMR)was used to characterize pore structures,while acoustic emission(AE)monitoring captured the temporal evolution of microcracking.The relationships among pore properties,AE b-values,and failure predictability were systematically evaluated.Results show that the overall b-value is primarily controlled by native pore size rather than loading condition.Rocks with larger pores display higher b-value and greater temporal variability,whereas those with smaller pores exhibit lower and more stable b-value.To assess failure predictability,the AE count rate was incorporated into an inverse power law model.The model demonstrates higher predictive accuracy for high-porosity rocks.The average predicted failure time(t_(p))decreases monotonically with porosity:under uniaxial compression,t_(p)for granite,marble,limestone,and sandstone are 2.32,1.82,1.42,and 0.03,respectively;under Brazilian splitting,3.54,3.30,0.10,and 0.03.Among the four rock types,sandstone with the highest porosity exhibits the smallest discrepancy between predicted and actual failure time,whereas granite with the lowest porosity shows the largest.As porosity decreases,prediction accuracy progressively declines for limestone and marble.Overall,the findings indicate that native pore heterogeneity governs both fracture scaling behavior and failure predictability,and that these effects are largely independent of the loading conditions examined in this study.展开更多
Inborn errors of metabolism(IEMs)are a large group of disorders resulting from deficient activities in several metabolic pathways due to the dysfunction of a distinct enzyme associated with a biochemical pathway[1,2]....Inborn errors of metabolism(IEMs)are a large group of disorders resulting from deficient activities in several metabolic pathways due to the dysfunction of a distinct enzyme associated with a biochemical pathway[1,2].Toxic intermediates will be produced due to the dysfunction of biochemical pathways.The liver is responsible for many essential metabolic processes,therefore it becomes one of the most severely affected organ by metabolic diseases[3].Early onset of liver disorders in IEMs includes jaundice,hepatomegaly,splenomegaly,ascites,hepatic encephalopathy,and liver failure[4].In infants and young children under 3 years old with acute liver failure(ALF),IEMs account for 18.9%-43%[5].展开更多
Acute liver failure(ALF)and acute-on-chronic LF(ACLF)are prevalent hepatic emergencies characterized by an increased susceptibility to bacterial infections(BI),despite significant systemic inflammation.Literature indi...Acute liver failure(ALF)and acute-on-chronic LF(ACLF)are prevalent hepatic emergencies characterized by an increased susceptibility to bacterial infections(BI),despite significant systemic inflammation.Literature indicates that 30%–80%of ALF patients and 55%–81%of ACLF patients develop BI,attributed to immu-nological dysregulation.Bacterial sepsis in these patients is associated with adverse clinical outcomes,including prolonged hospitalization and increased mortality.Early detection of bacterial sepsis is critical;however,distinguishing between sterile systemic inflammation and sepsis poses a significant challenge due to the overlapping clinical presentations of LF and sepsis.Conventional sepsis biomarkers,such as procalcitonin and C-reactive protein,have shown limited utility in LF patients due to inconsistent results.In contrast,novel biomarkers like presepsin and sTREM-1 have demonstrated promising discrim-inatory performance in this population,pending further validation.Moreover,emerging research highlights the potential of machine learning-based approaches to enhance sepsis detection and characterization.Although preliminary findings are encouraging,further studies are necessary to validate these results across diverse patient cohorts,including those with LF.This article provides a compre-hensive review of the magnitude,impact,and diagnostic challenges associated with BI in LF patients,focusing on novel advancements in early sepsis detection and characterization.展开更多
BACKGROUND Significant gaps in guideline-directed medical therapy(GDMT)for heart failure(HF)stem from shortages of cardiologists and advanced HF providers,as well as a lack of optimal HF management knowledge among hos...BACKGROUND Significant gaps in guideline-directed medical therapy(GDMT)for heart failure(HF)stem from shortages of cardiologists and advanced HF providers,as well as a lack of optimal HF management knowledge among hospitalists.This study compared the impact of optimal medical therapy in HF(OMT-HF)certification on GDMT implementation and patient outcomes between an intervention group(IG)of hospitalists and a standard-of-care comparison group(SOC-CG).METHODS This study was implemented from November 2022 to May 2023.Hospitalized car-diology patients with HF and left ventricular ejection fraction≤40%were rando-mized to IG or SOC-CG.Exclusion criteria included patients in cardiogenic shock,unable to consent,or at high risk.Follow-up was at 30 days post-discharge.Diffe-rences between groups were analyzed using Fisher’s exact test for categorical va-riables and Wilcoxon rank-sum or unpaired t-test for continuous variables.Chan-ges in Minnesota Living with Heart Failure Questionnaire(MLWHFQ)scores were evaluated using a paired t-test.RESULTS IG patients had lower readmission rates[9(42.85%)vs 11(17.46%),P=0.03]and a decreased trend in mortality 30-day post discharge.IG patients also showed greater mean improvements in total(-27.03±24.59 vs-5.85±23.52,P<0.001),physical(-13.8±12.3 vs-2.71±11.16,P<0.001)and emotional(-4.76±8.10 vs-1.42±5.98)dimensions on the MLWHFQ compared to SOC-CG,however,change in emotional dimension did not reach statistical significance.CONCLUSION Hospitalist OMT-HF certification may lead to better 30-day outcomes in hospitalized HF patients including quality of life,mortality and readmission rates.Larger prospective studies are warranted to validate these findings.展开更多
Heart failure(HF)with preserved ejection fraction(HFpEF)has exceeded HF with reduced ejection fraction(HFrEF),becoming the most common type of HF.Unlike HFrEF,HFpEF is primarily a chronic low-grade inflammatory proces...Heart failure(HF)with preserved ejection fraction(HFpEF)has exceeded HF with reduced ejection fraction(HFrEF),becoming the most common type of HF.Unlike HFrEF,HFpEF is primarily a chronic low-grade inflammatory process closely associated with metabolic disorders.The coexistence of HFpEF and metabolic dysfunction-associated steatotic liver disease(MASLD)presents significant clinical challenges due to shared metabolic pathophysiology and complex inter-play.Management strategies for HFpEF and MASLD remain challenging.Sodium-glucose cotransporter 2 inhibitors have shown benefits in managing both conditions.Additionally,glucagon-like peptide-1 receptor agonists are being actively investigated for their potential benefits,particularly in MASLD.A comprehensive,patient-centered approach that combines metabolic and cardiova-scular care is essential for improving outcomes in patients with HFpEF and MASLD,addressing the global metabolic health challenges.展开更多
INTRODUCTION.On May 1st,2024,around 2:10 a.m.,a catastrophic collapse occurred along the Meilong Expressway near Meizhou City,Guangdong Province,China,at coordinates 24°29′24″N and 116°40′25″E.This colla...INTRODUCTION.On May 1st,2024,around 2:10 a.m.,a catastrophic collapse occurred along the Meilong Expressway near Meizhou City,Guangdong Province,China,at coordinates 24°29′24″N and 116°40′25″E.This collapse resulted in a pavement failure of approximately 17.9 m in length and covering an area of about 184.3 m^(2)(Chinanews,2024).展开更多
BACKGROUND Advanced heart failure and transplant(AHFTC)teams are crucial in the management of patients in cardiogenic shock.We sought to explore the impact of AHFTC physicians on outcomes in patients receiving extraco...BACKGROUND Advanced heart failure and transplant(AHFTC)teams are crucial in the management of patients in cardiogenic shock.We sought to explore the impact of AHFTC physicians on outcomes in patients receiving extracorporeal membrane oxygenation(ECMO)support.AIM To determine whether outcomes differ in the care of ECMO patients when AHFTC physicians serve in a primary vs consultative role.METHODS We conducted a retrospective cohort study of 51 patients placed on veno-venous(VV)and veno-arterial(VA)ECMO between January 2015 and February 2023 at our institution.We compared ECMO outcomes between teams managed primarily by intensivists vs teams where AHFTC physicians played a direct role in ECMO management,including patient selection.Our primary outcome measure was survival to 30 days post hospital discharge.RESULTS For combined VA and VV ECMO patients,survival to 30 days post discharge in the AHFTC cohort was significantly higher(67%vs 30%,P=0.01),largely driven by a significantly increased 30-day post discharge survival in VA ECMO patients in the AHFTC group(64%vs 20%,P=0.05).CONCLUSION This study suggests that patients in shock requiring VA ECMO support may have improved survival 30 days after hospital discharge when an AHFTC team serves in a direct role in the selection and management of patients.Further studies are needed to validate this impact.展开更多
BACKGROUND Acute liver failure(ALF)is a life-threatening multisystemic condition with high short-term mortality.With the growing prevalence of obesity and metabolic syndrome,it is important to investigate the clinical...BACKGROUND Acute liver failure(ALF)is a life-threatening multisystemic condition with high short-term mortality.With the growing prevalence of obesity and metabolic syndrome,it is important to investigate the clinical implications of high body mass index(BMI)on survival outcomes in ALF.AIM To explore the impact of overweight and obesity on the clinical outcomes of patients with ALF.METHODS A retrospective observational cohort study was conducted involving patients with ALF admitted to the Johns Hopkins Health System between January 1,2000 and May 1,2020.We performed Cox proportional hazards regression to identify outcomes,including the need for liver transplantation(LT)or all-cause mortality.RESULTS A total of 196 patients were included,the median age was 43.5 years,63.3%were female,and 59.7%were of Caucasian ethnicity.Acetaminophen-induced ALF was the most common etiology(45%).The mean BMI was significantly greater among patients who underwent LT or died(29.64 kg/m^(2)vs 26.59 kg/m^(2),P=0.008)than among survivors.Patients with overweight and obesity had a higher risk of all-cause mortality or need for LT by 2.22-fold(95%CI:1.30-3.78)and 2.04-fold(95%CI:1.29-3.39),respectively.Elevated BMI was associated with renal failure and higher grades of hepatic encephalopathy.Derangements in serologic markers,including alanine transaminase,lactate,and ammonia,were associated with a mortality risk or need for LT.CONCLUSION In this large,retrospective study,with a diverse cohort of United States patients,Overweight and obese were independently associated with an increased risk of all-cause mortality or need for LT.This work highlights the importance of closely monitoring ALF patients who are overweight or obese for adverse complications and measures to improve outcomes in this vulnerable patient population.展开更多
In the past 6 years, significant breakthroughs have been achieved in the treatment of heart failure(HF), especially in drug therapy. The classification of chronic HF and the treatment methods for HF and its complicati...In the past 6 years, significant breakthroughs have been achieved in the treatment of heart failure(HF), especially in drug therapy. The classification of chronic HF and the treatment methods for HF and its complications are also constantly being updated. In order to apply these results to the diagnosis and treatment of patients with HF in China and further improve the level of diagnosis and treatment of HF in China, the HF Group of Chinese Society of Cardiology, Chinese Medical Association, Chinese College of Cardiovascular Physician, Chinese HF Association of Chinese Medical Doctor Association, and Editorial Board of Chinese Journal of Cardiology have organized an expert group and update the consensus and evidence-based treatment methods in the field of HF based on the latest clinical research findings at home and abroad, combined with the national conditions and clinical practice in China, and referring to the latest foreign HF guidelines while maintaining the basic framework of the 2018 Chinese Guidelines for Diagnosis and Treatment of HF.展开更多
According to the Japanese Ministry of Health,Labour,and Welfare,14.2%of people were aged>75 years in Japan in 2018,and this number continues to rise.With population aging,the incidence of congestive heart failure(C...According to the Japanese Ministry of Health,Labour,and Welfare,14.2%of people were aged>75 years in Japan in 2018,and this number continues to rise.With population aging,the incidence of congestive heart failure(CHF)is also increasing.[1–3]Reports have shown that the presence of cognitive impairment(CI)in patients with CHF is associated with poor prognosis,[4–6]and the degree of CI is related to CHF severity.展开更多
Heart failure(HF)is a major public health problem with a prevalence of 1%-2%in developed countries.The underlying pathophysiology of HF is complex and as a clinical syndrome is characterized by various symptoms and si...Heart failure(HF)is a major public health problem with a prevalence of 1%-2%in developed countries.The underlying pathophysiology of HF is complex and as a clinical syndrome is characterized by various symptoms and signs.HF is classified according to left ventricular ejection fraction(LVEF)and falls into three groups:LVEF≥50%-HF with preserved ejection fraction(HFpEF),LVEF<40%-HF with reduced ejection fraction(HFrEF),LVEF 40%-49%-HF with mid-range ejection fraction.Diagnosing HF is primarily a clinical approach and it is based on anamnesis,physical examination,echocardiogram,radiological findings of the heart and lungs and laboratory tests,including a specific markers of HF-brain natriuretic peptide or N-terminal pro-B-type natriuretic peptide as well as other diagnostic tests in order to elucidate possible etiologies.Updated diagnostic algorithms for HFpEF have been recommended(H2FPEF,HFA-PEFF).New therapeutic options improve clinical outcomes as well as functional status in patients with HFrEF(e.g.,sodium-glucose cotransporter-2-SGLT2 inhibitors)and such progress in treatment of HFrEF patients resulted in new working definition of the term“HF with recovered left ventricular ejection fraction”.In line with rapid development of HF treatment,cardiac rehabilitation becomes an increasingly important part of overall approach to patients with chronic HF for it has been proven that exercise training can relieve symptoms,improve exercise capacity and quality of life as well as reduce disability and hospitalization rates.We gave an overview of latest insights in HF diagnosis and treatment with special emphasize on the important role of cardiac rehabilitation in such patients.展开更多
Link failure is a critical issue in large networks and must be effectively addressed.In software-defined networks(SDN),link failure recovery schemes can be categorized into proactive and reactive approaches.Reactive s...Link failure is a critical issue in large networks and must be effectively addressed.In software-defined networks(SDN),link failure recovery schemes can be categorized into proactive and reactive approaches.Reactive schemes have longer recovery times while proactive schemes provide faster recovery but overwhelm the memory of switches by flow entries.As SDN adoption grows,ensuring efficient recovery from link failures in the data plane becomes crucial.In particular,data center networks(DCNs)demand rapid recovery times and efficient resource utilization to meet carrier-grade requirements.This paper proposes an efficient Decentralized Failure Recovery(DFR)model for SDNs,meeting recovery time requirements and optimizing switch memory resource consumption.The DFR model enables switches to autonomously reroute traffic upon link failures without involving the controller,achieving fast recovery times while minimizing memory usage.DFR employs the Fast Failover Group in the OpenFlow standard for local recovery without requiring controller communication and utilizes the k-shortest path algorithm to proactively install backup paths,allowing immediate local recovery without controller intervention and enhancing overall network stability and scalability.DFR employs flow entry aggregation techniques to reduce switch memory usage.Instead of matching flow entries to the destination host’s MAC address,DFR matches packets to the destination switch’s MAC address.This reduces the switches’Ternary Content-Addressable Memory(TCAM)consumption.Additionally,DFR modifies Address Resolution Protocol(ARP)replies to provide source hosts with the destination switch’s MAC address,facilitating flow entry aggregation without affecting normal network operations.The performance of DFR is evaluated through the network emulator Mininet 2.3.1 and Ryu 3.1 as SDN controller.For different number of active flows,number of hosts per edge switch,and different network sizes,the proposed model outperformed various failure recovery models:restoration-based,protection by flow entries,protection by group entries and protection by Vlan-tagging model in terms of recovery time,switch memory consumption and controller overhead which represented the number of flow entry updates to recover from the failure.Experimental results demonstrate that DFR achieves recovery times under 20 milliseconds,satisfying carrier-grade requirements for rapid failure recovery.Additionally,DFR reduces switch memory usage by up to 95%compared to traditional protection methods and minimizes controller load by eliminating the need for controller intervention during failure recovery.Theresults underscore the efficiency and scalability of the DFR model,making it a practical solution for enhancing network resilience in SDN environments.展开更多
基金supported by the Major Program of National Natural Science Foundation of China(Grant No.42090055)the National Key ScientificInstruments and Equipment Development Projects of China(Grant No.41827808)the National Nature Science Foundation of China(Grant No.42207216).
文摘Reservoir-induced landslides in China's Three Gorges Reservoir area are prone to tensile cracks due to the influenceof their own weight and fluctuationsin water levels.The presence of cracks indicates that the tensile stress in the area has exceeded the tensile strength of the soil,leading to local instability.To explore the impact of tensile failure behavior on the stability and failure modes of reservoir landslides,the Huangtupo Riverside Slump#1 is taken as a case study.By considering local tensile failure,potential tensile cracks are incorporated into the analysis via the limit equilibrium method and reliability theory.The reliability of landslides under different tensile failure scenarios is quantified.Strain-softening characteristics of the soil are combined to further analyze the failure transmission path of the landslide.Finally,these potential failure modes were validated through physical model tests.The results show that cracks developing at rear positions reduce the stability of the slope and increase the probability of instability.During the destruction process,retrogressive failures with multiple sliding surfaces are likely to occur.However,tensile failure at the forefront reduces the likelihood of an individual slide mass descending.Progressive failure results in both regular and skip transmission patterns.Additionally,cracks and water level changes can also lead to shifts in the positions of the most dangerous blocks.Therefore,in practical landslide analysis and prevention,it is necessary to consider local tensile damage and identify potential tensile crack locations in advance to optimize prevention measures and accurately evaluate landslide risk.
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.
基金supported by the National Natural Science Foundation of China(Grant Nos.52222810 and 52178383).
文摘Dynamic disturbances with various frequencies could trigger different failure modes of deep excavations.Superimposed on this static stress are dynamic disturbances due to various dynamic vibrations,e.g.excavation blasting,blasting,tunnel boring machine(TBM)vibration,rockburst wave,earthquakes.Specifically,these dynamic sources are characterized by a wide range of wave frequencies f,resulting in differences in failure modes.A series of true-triaxial compression tests were conducted on granite to simulate the excavation-induced stress path in three-dimensional(3D)stresses.Subsequently,a dynamic disturbance with various frequencies was applied to a cuboid specimen,to reveal the behavior associated with brittle failure.The dynamic disturbance with frequencies f of 5 Hz,10 Hz,and 40 Hz generates less disturbed energy components in the granite together with higher peak strength.However,dynamic disturbances with f of 20 Hz and 30 Hz resulted in a lower peak strength;the peak strength of the rock increases sp albeit it decreases at first,then increases.This U-shaped phenomenon relates to the natural frequency of the granite under such stress conditions.Different rock lithologies consisting of diverse mineral composition,respond differently to each sensitive resonance frequency.Interestingly,the weak disturbance stress with a high frequency f and low amplitude A increases the ratio of crack damage to peak strength(scd/sp)in the granite.This leads to the inhibition of the expansion of the granite during the dynamic disturbance process.Multiple penetrating tensileeshear cracks appear in the s3-direction as the disturbance frequency f increases.
基金supported by National Natural Science Foundation of China (Nos.52264006,52364004,and 52464005)the Guizhou Provincial Science and Technology Foundation (No.GCC[2022]005-1)。
文摘Investigating the damage evolution of surrounding rock under thermal shock cycles is crucial for ensuring the stability of engineering rock masses.This study performed Brazilian splitting tests on granite specimens under varying temperature and cycle conditions,employing acoustic emission monitoring,digital image correlation,and three-dimensional scanning technology.A systematic analysis was conducted on the patterns of damage evolution,failure precursor,and response mechanisms under combined thermal and cyclic loading.Experimental results show that both P-wave velocity and tensile strength degrade significantly with increasing temperature and cycle count,with temperature having a more pronounced effect than cycle count.Notably,damage evolution exhibits a dual-threshold behavior in which degradation accelerates markedly above 400℃ and stabilizes after 5 thermal cycles.Fracture surfaces evolve from initially planar to rugged morphologies,with peak-valley height differences at 600℃ being approximately three times greater than those at 200℃.Furthermore,based on acoustic emission energy entropy analysis,we introduce a novel failure precursor indicator where the sustained increase and critical surge in average entropy serve as reliable early-warning signals for impending rock failure.These findings establish a solid theoretical basis and practical methodology for damage assessment and instability early-warning systems in high-temperature rock engineering.
基金supported by the Sanming Project of Medicine in Shenzhen[SZZYSM202206001]National Natural Science Foundation of China[82004320 and 82374383]+3 种基金Natural Science Foundation of Guangdong Province of China[2022A1515011710 and 2022A1515010679]Shenzhen Science and Technology Innovation Committee[JCYJ20220530141407017 and JCYJ20240813153619026]2024 High-quality Development Research Project of Shenzhen Bao’an Public Hospital[YNXM2024078]and Shenzhen Bao’an Chinese Medicine Hospital Research Program[BAZYY20220702].
文摘Background:“Qi deficiency”(a pathological state where the body’s vital energy(Qi)is insufficient or weakened,impairing physiological functions and diminishing the body’s ability to perform daily activities,defend against illness,and maintain homeostasis)syndrome is considered a critical syndrome in traditional Chinese medicine(TCM)and is associated with poor prognosis in heart failure(HF).This study investigates the clinical,metabolic,and transcriptomic differences between heart failure patients with and without Qi deficiency syndrome.Methods:56 heart failure patients were evaluated using a Qi deficiency syndrome scale and divided into Qi deficiency syndrome(QD)and non-Qi deficiency(non-QD)groups based on the median score.Clinical characteristics,including baseline N-terminal pro-B-type natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),total diuretic use during hospitalization,and 90-day rehospitalization rates,were compared between the groups.Differentially expressed genes(DEGs)and differential metabolites were identified,followed by enrichment analyses and validation using qPCR and Western blot in AC16 cardiomyocytes.Results:QD patients exhibited significantly higher NT-proBNP levels,lower LVEF,and increased 90-day rehospitalization rates.Metabolomic profiling revealed lipid metabolism disruptions,notably in linoleic acid and phospholipid pathways.Transcriptomic analysis highlighted 17 DEGs,including CISD2,a critical mitochondrial regulator,which was downregulated in QD patients.Correlation analysis identified significant associations between DEGs(e.g.,CISD2,BPGM)and lipid metabolites such as PC(16:0/P-16:0).Functional knockdown of CISD2 in AC16 cells led to upregulation of lipid oxidation enzymes ALOX15 and CYP1A2,linking CISD2 dysfunction to lipid metabolic dysregulation.Conclusion:Qi deficiency is associated with more severe heart failure symptoms,worse prognosis,and distinct metabolic and transcriptomic profiles,particularly in lipid metabolism.CISD2 emerges as a potential therapeutic target,offering new avenues for integrating molecular insights with TCM approaches to optimize HF management.
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_(3)F_(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.
基金support of the National Natural Science Foundation of China(Grant Nos.52179116 and 51991392)the support of Key Deployment Projects of Chinese Academy of Sciences(Grant No.ZDRW-ZS-2021-3).
文摘Shield tunneling in saturated ground poses challenges due to the potential risk of ground collapse resulting from seepage force and inadequate support pressure.This study employed a laboratory model test and a theoretical validation to elucidate the mechanisms of face failure and subsequent ground collapse in saturated ground during slurry pressure-balanced shield(SPBS)tunneling operations.A slurry circulation system was developed to ensure steady shield tunneling and to replicate the phenomena of ground collapse.Investigations into shield tunneling parameters and ground responses,including soil pressure,pore water pressure,and surface subsidence,were conducted to understand the mechanisms of face failure and subsequent ground collapse.The theoretical solution for the critical collapse pressure of the tunnel face,based on the rotational failure mechanism,was validated through the comparison with the experimentally determined critical collapse pressure.The results indicate that:(1)appropriate adjustments of tunneling parameters are crucial for promoting filtercake formation,maintaining chamber pressure,and minimizing ground subsidence;(2)chamber pressure,soil pressure,pore water pressure,and ground subsidence are closely correlated with shield tunneling parameters and the formation of filter cake;(3)ground collapse follows a continuous failure mode due to the destruction of filtercake and the decrease in chamber pressure;(4)the soil pressure at the cutterhead is more sensitive to disturbances from shield tunneling than chamber pressure;and(5)experimentally determined critical collapse pressures is consistent with the theoretical solution of limit analysis.
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supported by the National Natural Science Foundation of China(Grant No.42172316)the Major National Science and Technology Project for Deep Earth(Grant No.2024ZD100380X)the Natural Science Foundation of Hunan Province of China(2025JJ20030).
文摘This study examines how native pore structures and loading conditions influencethe fracture size distribution and the predictability of catastrophic failure in rocks.Four lithologies with distinct pore characteristics,i.e.granite,limestone,red sandstone,and marble,were tested under uniaxial compression and Brazilian splitting.Nuclear magnetic resonance(NMR)was used to characterize pore structures,while acoustic emission(AE)monitoring captured the temporal evolution of microcracking.The relationships among pore properties,AE b-values,and failure predictability were systematically evaluated.Results show that the overall b-value is primarily controlled by native pore size rather than loading condition.Rocks with larger pores display higher b-value and greater temporal variability,whereas those with smaller pores exhibit lower and more stable b-value.To assess failure predictability,the AE count rate was incorporated into an inverse power law model.The model demonstrates higher predictive accuracy for high-porosity rocks.The average predicted failure time(t_(p))decreases monotonically with porosity:under uniaxial compression,t_(p)for granite,marble,limestone,and sandstone are 2.32,1.82,1.42,and 0.03,respectively;under Brazilian splitting,3.54,3.30,0.10,and 0.03.Among the four rock types,sandstone with the highest porosity exhibits the smallest discrepancy between predicted and actual failure time,whereas granite with the lowest porosity shows the largest.As porosity decreases,prediction accuracy progressively declines for limestone and marble.Overall,the findings indicate that native pore heterogeneity governs both fracture scaling behavior and failure predictability,and that these effects are largely independent of the loading conditions examined in this study.
文摘Inborn errors of metabolism(IEMs)are a large group of disorders resulting from deficient activities in several metabolic pathways due to the dysfunction of a distinct enzyme associated with a biochemical pathway[1,2].Toxic intermediates will be produced due to the dysfunction of biochemical pathways.The liver is responsible for many essential metabolic processes,therefore it becomes one of the most severely affected organ by metabolic diseases[3].Early onset of liver disorders in IEMs includes jaundice,hepatomegaly,splenomegaly,ascites,hepatic encephalopathy,and liver failure[4].In infants and young children under 3 years old with acute liver failure(ALF),IEMs account for 18.9%-43%[5].
文摘Acute liver failure(ALF)and acute-on-chronic LF(ACLF)are prevalent hepatic emergencies characterized by an increased susceptibility to bacterial infections(BI),despite significant systemic inflammation.Literature indicates that 30%–80%of ALF patients and 55%–81%of ACLF patients develop BI,attributed to immu-nological dysregulation.Bacterial sepsis in these patients is associated with adverse clinical outcomes,including prolonged hospitalization and increased mortality.Early detection of bacterial sepsis is critical;however,distinguishing between sterile systemic inflammation and sepsis poses a significant challenge due to the overlapping clinical presentations of LF and sepsis.Conventional sepsis biomarkers,such as procalcitonin and C-reactive protein,have shown limited utility in LF patients due to inconsistent results.In contrast,novel biomarkers like presepsin and sTREM-1 have demonstrated promising discrim-inatory performance in this population,pending further validation.Moreover,emerging research highlights the potential of machine learning-based approaches to enhance sepsis detection and characterization.Although preliminary findings are encouraging,further studies are necessary to validate these results across diverse patient cohorts,including those with LF.This article provides a compre-hensive review of the magnitude,impact,and diagnostic challenges associated with BI in LF patients,focusing on novel advancements in early sepsis detection and characterization.
基金Supported by Houston Methodist DeBakey Heart and Vascular Center Grant.
文摘BACKGROUND Significant gaps in guideline-directed medical therapy(GDMT)for heart failure(HF)stem from shortages of cardiologists and advanced HF providers,as well as a lack of optimal HF management knowledge among hospitalists.This study compared the impact of optimal medical therapy in HF(OMT-HF)certification on GDMT implementation and patient outcomes between an intervention group(IG)of hospitalists and a standard-of-care comparison group(SOC-CG).METHODS This study was implemented from November 2022 to May 2023.Hospitalized car-diology patients with HF and left ventricular ejection fraction≤40%were rando-mized to IG or SOC-CG.Exclusion criteria included patients in cardiogenic shock,unable to consent,or at high risk.Follow-up was at 30 days post-discharge.Diffe-rences between groups were analyzed using Fisher’s exact test for categorical va-riables and Wilcoxon rank-sum or unpaired t-test for continuous variables.Chan-ges in Minnesota Living with Heart Failure Questionnaire(MLWHFQ)scores were evaluated using a paired t-test.RESULTS IG patients had lower readmission rates[9(42.85%)vs 11(17.46%),P=0.03]and a decreased trend in mortality 30-day post discharge.IG patients also showed greater mean improvements in total(-27.03±24.59 vs-5.85±23.52,P<0.001),physical(-13.8±12.3 vs-2.71±11.16,P<0.001)and emotional(-4.76±8.10 vs-1.42±5.98)dimensions on the MLWHFQ compared to SOC-CG,however,change in emotional dimension did not reach statistical significance.CONCLUSION Hospitalist OMT-HF certification may lead to better 30-day outcomes in hospitalized HF patients including quality of life,mortality and readmission rates.Larger prospective studies are warranted to validate these findings.
基金Supported by Wenzhou Science Technology Bureau Foundation,No.2022Y0726.
文摘Heart failure(HF)with preserved ejection fraction(HFpEF)has exceeded HF with reduced ejection fraction(HFrEF),becoming the most common type of HF.Unlike HFrEF,HFpEF is primarily a chronic low-grade inflammatory process closely associated with metabolic disorders.The coexistence of HFpEF and metabolic dysfunction-associated steatotic liver disease(MASLD)presents significant clinical challenges due to shared metabolic pathophysiology and complex inter-play.Management strategies for HFpEF and MASLD remain challenging.Sodium-glucose cotransporter 2 inhibitors have shown benefits in managing both conditions.Additionally,glucagon-like peptide-1 receptor agonists are being actively investigated for their potential benefits,particularly in MASLD.A comprehensive,patient-centered approach that combines metabolic and cardiova-scular care is essential for improving outcomes in patients with HFpEF and MASLD,addressing the global metabolic health challenges.
基金supported by the National Natural Science Foundation of China(Nos.42371094,41907253)partially supported by the Interdisciplinary Cultivation Program of Xidian University(No.21103240005)the Postdoctoral Fellowship Program of CPSF(No.GZB20240589)。
文摘INTRODUCTION.On May 1st,2024,around 2:10 a.m.,a catastrophic collapse occurred along the Meilong Expressway near Meizhou City,Guangdong Province,China,at coordinates 24°29′24″N and 116°40′25″E.This collapse resulted in a pavement failure of approximately 17.9 m in length and covering an area of about 184.3 m^(2)(Chinanews,2024).
文摘BACKGROUND Advanced heart failure and transplant(AHFTC)teams are crucial in the management of patients in cardiogenic shock.We sought to explore the impact of AHFTC physicians on outcomes in patients receiving extracorporeal membrane oxygenation(ECMO)support.AIM To determine whether outcomes differ in the care of ECMO patients when AHFTC physicians serve in a primary vs consultative role.METHODS We conducted a retrospective cohort study of 51 patients placed on veno-venous(VV)and veno-arterial(VA)ECMO between January 2015 and February 2023 at our institution.We compared ECMO outcomes between teams managed primarily by intensivists vs teams where AHFTC physicians played a direct role in ECMO management,including patient selection.Our primary outcome measure was survival to 30 days post hospital discharge.RESULTS For combined VA and VV ECMO patients,survival to 30 days post discharge in the AHFTC cohort was significantly higher(67%vs 30%,P=0.01),largely driven by a significantly increased 30-day post discharge survival in VA ECMO patients in the AHFTC group(64%vs 20%,P=0.05).CONCLUSION This study suggests that patients in shock requiring VA ECMO support may have improved survival 30 days after hospital discharge when an AHFTC team serves in a direct role in the selection and management of patients.Further studies are needed to validate this impact.
文摘BACKGROUND Acute liver failure(ALF)is a life-threatening multisystemic condition with high short-term mortality.With the growing prevalence of obesity and metabolic syndrome,it is important to investigate the clinical implications of high body mass index(BMI)on survival outcomes in ALF.AIM To explore the impact of overweight and obesity on the clinical outcomes of patients with ALF.METHODS A retrospective observational cohort study was conducted involving patients with ALF admitted to the Johns Hopkins Health System between January 1,2000 and May 1,2020.We performed Cox proportional hazards regression to identify outcomes,including the need for liver transplantation(LT)or all-cause mortality.RESULTS A total of 196 patients were included,the median age was 43.5 years,63.3%were female,and 59.7%were of Caucasian ethnicity.Acetaminophen-induced ALF was the most common etiology(45%).The mean BMI was significantly greater among patients who underwent LT or died(29.64 kg/m^(2)vs 26.59 kg/m^(2),P=0.008)than among survivors.Patients with overweight and obesity had a higher risk of all-cause mortality or need for LT by 2.22-fold(95%CI:1.30-3.78)and 2.04-fold(95%CI:1.29-3.39),respectively.Elevated BMI was associated with renal failure and higher grades of hepatic encephalopathy.Derangements in serologic markers,including alanine transaminase,lactate,and ammonia,were associated with a mortality risk or need for LT.CONCLUSION In this large,retrospective study,with a diverse cohort of United States patients,Overweight and obese were independently associated with an increased risk of all-cause mortality or need for LT.This work highlights the importance of closely monitoring ALF patients who are overweight or obese for adverse complications and measures to improve outcomes in this vulnerable patient population.
基金National High Level Hospital Clinical Research Funding(2022-PUMCH-B-098)CAMS Innovation Fund for Medical Sciences (2021-I2M-1-003)。
文摘In the past 6 years, significant breakthroughs have been achieved in the treatment of heart failure(HF), especially in drug therapy. The classification of chronic HF and the treatment methods for HF and its complications are also constantly being updated. In order to apply these results to the diagnosis and treatment of patients with HF in China and further improve the level of diagnosis and treatment of HF in China, the HF Group of Chinese Society of Cardiology, Chinese Medical Association, Chinese College of Cardiovascular Physician, Chinese HF Association of Chinese Medical Doctor Association, and Editorial Board of Chinese Journal of Cardiology have organized an expert group and update the consensus and evidence-based treatment methods in the field of HF based on the latest clinical research findings at home and abroad, combined with the national conditions and clinical practice in China, and referring to the latest foreign HF guidelines while maintaining the basic framework of the 2018 Chinese Guidelines for Diagnosis and Treatment of HF.
文摘According to the Japanese Ministry of Health,Labour,and Welfare,14.2%of people were aged>75 years in Japan in 2018,and this number continues to rise.With population aging,the incidence of congestive heart failure(CHF)is also increasing.[1–3]Reports have shown that the presence of cognitive impairment(CI)in patients with CHF is associated with poor prognosis,[4–6]and the degree of CI is related to CHF severity.
文摘Heart failure(HF)is a major public health problem with a prevalence of 1%-2%in developed countries.The underlying pathophysiology of HF is complex and as a clinical syndrome is characterized by various symptoms and signs.HF is classified according to left ventricular ejection fraction(LVEF)and falls into three groups:LVEF≥50%-HF with preserved ejection fraction(HFpEF),LVEF<40%-HF with reduced ejection fraction(HFrEF),LVEF 40%-49%-HF with mid-range ejection fraction.Diagnosing HF is primarily a clinical approach and it is based on anamnesis,physical examination,echocardiogram,radiological findings of the heart and lungs and laboratory tests,including a specific markers of HF-brain natriuretic peptide or N-terminal pro-B-type natriuretic peptide as well as other diagnostic tests in order to elucidate possible etiologies.Updated diagnostic algorithms for HFpEF have been recommended(H2FPEF,HFA-PEFF).New therapeutic options improve clinical outcomes as well as functional status in patients with HFrEF(e.g.,sodium-glucose cotransporter-2-SGLT2 inhibitors)and such progress in treatment of HFrEF patients resulted in new working definition of the term“HF with recovered left ventricular ejection fraction”.In line with rapid development of HF treatment,cardiac rehabilitation becomes an increasingly important part of overall approach to patients with chronic HF for it has been proven that exercise training can relieve symptoms,improve exercise capacity and quality of life as well as reduce disability and hospitalization rates.We gave an overview of latest insights in HF diagnosis and treatment with special emphasize on the important role of cardiac rehabilitation in such patients.
文摘Link failure is a critical issue in large networks and must be effectively addressed.In software-defined networks(SDN),link failure recovery schemes can be categorized into proactive and reactive approaches.Reactive schemes have longer recovery times while proactive schemes provide faster recovery but overwhelm the memory of switches by flow entries.As SDN adoption grows,ensuring efficient recovery from link failures in the data plane becomes crucial.In particular,data center networks(DCNs)demand rapid recovery times and efficient resource utilization to meet carrier-grade requirements.This paper proposes an efficient Decentralized Failure Recovery(DFR)model for SDNs,meeting recovery time requirements and optimizing switch memory resource consumption.The DFR model enables switches to autonomously reroute traffic upon link failures without involving the controller,achieving fast recovery times while minimizing memory usage.DFR employs the Fast Failover Group in the OpenFlow standard for local recovery without requiring controller communication and utilizes the k-shortest path algorithm to proactively install backup paths,allowing immediate local recovery without controller intervention and enhancing overall network stability and scalability.DFR employs flow entry aggregation techniques to reduce switch memory usage.Instead of matching flow entries to the destination host’s MAC address,DFR matches packets to the destination switch’s MAC address.This reduces the switches’Ternary Content-Addressable Memory(TCAM)consumption.Additionally,DFR modifies Address Resolution Protocol(ARP)replies to provide source hosts with the destination switch’s MAC address,facilitating flow entry aggregation without affecting normal network operations.The performance of DFR is evaluated through the network emulator Mininet 2.3.1 and Ryu 3.1 as SDN controller.For different number of active flows,number of hosts per edge switch,and different network sizes,the proposed model outperformed various failure recovery models:restoration-based,protection by flow entries,protection by group entries and protection by Vlan-tagging model in terms of recovery time,switch memory consumption and controller overhead which represented the number of flow entry updates to recover from the failure.Experimental results demonstrate that DFR achieves recovery times under 20 milliseconds,satisfying carrier-grade requirements for rapid failure recovery.Additionally,DFR reduces switch memory usage by up to 95%compared to traditional protection methods and minimizes controller load by eliminating the need for controller intervention during failure recovery.Theresults underscore the efficiency and scalability of the DFR model,making it a practical solution for enhancing network resilience in SDN environments.
