Addition of a-carbonylketenes, generated from 2-diazo-1, 3-diaryl-1, 3-propandione or 2-diazo-1-phenyl-1,3-butandione by heating, to 2,4-diaryl-2,3-dihydro-[1,5]-benzothiazepines gave 2,3-disubstituted-4a, 6-diaryl-4a...Addition of a-carbonylketenes, generated from 2-diazo-1, 3-diaryl-1, 3-propandione or 2-diazo-1-phenyl-1,3-butandione by heating, to 2,4-diaryl-2,3-dihydro-[1,5]-benzothiazepines gave 2,3-disubstituted-4a, 6-diaryl-4a,5,6,12-telrahydro-1H-1, 3-oxazino[3,2d][1,5]-benzothiazepine-l-ones, a new ring system.展开更多
目的慢性肝病患者常表现出独特的血流动力学异常与代谢紊乱,术后液体管理面临诸多挑战,尤其是术后入住重症监护室(intensive care unit,ICU)的重症患者,亟待深入探究术后液体治疗方案与预后之间的关系。方法本研究基于MIMIC-IV数据库中2...目的慢性肝病患者常表现出独特的血流动力学异常与代谢紊乱,术后液体管理面临诸多挑战,尤其是术后入住重症监护室(intensive care unit,ICU)的重症患者,亟待深入探究术后液体治疗方案与预后之间的关系。方法本研究基于MIMIC-IV数据库中2414名慢性肝病、接受手术治疗,并术后转入ICU的患者,对纳排后最终得到的2143名患者数据进行回顾性队列研究。采用多变量调整Logistic回归模型,分析术后转入ICU首日液体治疗方案与术后7天死亡风险的关联,并通过限制性立方样条(restricted cubic spline,RCS)分析剂量-反应关系。结果多因素分析指出限制性补液为独立保护因素,相较于非限制性补液组,限制性补液显著降低了术后7天死亡率(6.4%vs 12.4%,OR=0.44,95%CI:0.22~0.88,P=0.021)。减少了机械通气的使用(42.9%vs 72.3%,OR=0.29,95%CI:0.24~0.35,P<0.001)和ICU停留时长(1.86 d vs 3.47 d,OR=0.81,95%CI:0.78~0.84,P<0.001)。RCS曲线显示,术后首日液体入量与术后7天死亡风险呈现J型曲线关系,拐点为1850 mL,超过该阈值后,术后7天死亡风险随之增加。亚组分析结果表明,限制性补液的保护作用在不同年龄、合并症群体中均呈现出一致性。结论慢性肝病患者术后首日采取限制性补液方案可有效降低短期死亡风险,且液体入量与7天死亡风险呈非线性剂量效应关联,液体入量超过1850 mL时,死亡风险显著升高。展开更多
BACKGROUND Liver transplantation aims to increase the survival of patients with end-stage liver diseases and improve their quality of life.The number of organs available for transplantation is lower than the demand.To...BACKGROUND Liver transplantation aims to increase the survival of patients with end-stage liver diseases and improve their quality of life.The number of organs available for transplantation is lower than the demand.To provide fair organ distribution,predictive mortality scores have been developed.AIM To compare the Acute Physiology and Chronic Health Evaluation IV(APACHE IV),balance of risk(BAR),and model for end-stage liver disease(MELD)scores as predictors of mortality.METHODS Retrospective cohort study,which included 283 adult patients in the postoperative period of deceased donor liver transplantation from 2014 to 2018.RESULTS The transplant recipients were mainly male,with a mean age of 58.1 years.Donors were mostly male,with a mean age of 41.6 years.The median cold ischemia time was 3.1 hours,and the median intensive care unit stay was 5 days.For APACHE IV,a mean of 59.6 was found,BAR 10.7,and MELD 24.2.The 28-day mortality rate was 9.5%,and at 90 days,it was 3.5%.The 28-day mortality prediction for APACHE IV was very good[area under the curve(AUC):0.85,P<0.001,95%CI:0.76-0.94],P<0.001,BAR(AUC:0.70,P<0.001,95%CI:0.58–0.81),and MELD(AUC:0.66,P<0.006,95%CI:0.55-0.78),P<0.008.At 90 days,the data for APACHE IV were very good(AUC:0.80,P<0.001,95%CI:0.71–0.90)and moderate for BAR and MELD,respectively,(AUC:0.66,P<0.004,95%CI:0.55–0.77),(AUC:0.62,P<0.026,95%CI:0.51–0.72).All showed good discrimination between deaths and survivors.As for the best value for liver transplantation,it was significant only for APACHE IV(P<0.001).CONCLUSION The APACHE IV assessment score was more accurate than BAR and MELD in predicting mortality in deceased donor liver transplant recipients.展开更多
In the current era marked by energy shortages,the advancement of nuclear energy stands as an inevitable progression.The reprocessing of spent nuclear fuel plays a crucial role in determining the sustainability of nucl...In the current era marked by energy shortages,the advancement of nuclear energy stands as an inevitable progression.The reprocessing of spent nuclear fuel plays a crucial role in determining the sustainability of nuclear energy as a viable energy source.Among these processes,the separation and recovery of Pu(Ⅳ)from high-level liquid waste(HLLW)hold paramount significance in terms of safety and strategic implications.Herein,this work focused on the synthesis of two acid-and radiation-resistant pyridine-based sp^(2)c-COFs(COF-IHEP3 and COF-IHEP4),followed by the creation of two pyridine-based ionized sp^(2)c-COFs named COF-IHEP3-CH_(3)NO_(3)and COF-IHEP4-CH3NO3through post-modification.These materials have potential anion exchange capacity for the selective separation of Pu(Ⅳ)in highly acidic conditions.Notably,in 8 mol/L nitric acid solution,COF-IHEP3-CH3NO3demonstrated the capability to eliminate plutonium within 20 min in 98%removal efficiency with a Kdvalue of 2450 m L/g.Experimental and theoretical analysis suggest that the ionized sp^(2)c-COFs exhibit exceptional stability,selectivity,and prevention of secondary contamination towards Pu(Ⅳ)in the presence of multiple ions environments.In short,this work provides an appropriate anion exchange strategy to design ionic sp^(2)c-COFs as a promising platform for Pu(Ⅳ)recovery from HLLW.展开更多
The efficient recovery of silver(Ag)from retired photovoltaic(PV)panels is crucial for resource sustainability and envi-ronmental protection.This study developed an environmentally friendly leaching method using ammon...The efficient recovery of silver(Ag)from retired photovoltaic(PV)panels is crucial for resource sustainability and envi-ronmental protection.This study developed an environmentally friendly leaching method using ammonia(NH_(3)·H_(2)O)and hydrogen peroxide(H_(2)O_(2)),achieving the selective dissolution of Ag from retired crystalline silicon solar panels.Meanwhile,nonprecious metals such as aluminum(Al)and lead(Pb),which are commonly found in PV cells,were barely dissolved,dem-onstrating the excellent selectivity of this method for Ag.Light irradiation significantly improved the dissolution efficiency of Ag and reduced the amount of the reagent used.Ag dissolution occurred owing to a dual-pathway synergistic effect,which stemmed from the direct oxidation of Ag by H_(2)O_(2).The strongly oxidizing hydroxyl radicals generated by photocatalysis accelerated the oxidation and dissolution of Ag.In addition,NH 3·H_(2)O effectively promoted the dissolution and stabilization of oxidation products by forming soluble Ag–NH3·H2O complexes([Ag(NH3)2]+).This article reports an efficient,selective,and environmentally friendly strategy of Ag recovery and elucidates the radical-mediated dissolution mechanism under light-driven conditions,offering a feasible way for sustainably recovering valuable metals from retired PV panels.展开更多
In the Metal-Organic Framework(MOF)panorama,Ce(IV)-based MOFs have emerged as potential candidates for heterogeneous catalysis,not only due to their intrinsic active species but also as a support of single metal sites...In the Metal-Organic Framework(MOF)panorama,Ce(IV)-based MOFs have emerged as potential candidates for heterogeneous catalysis,not only due to their intrinsic active species but also as a support of single metal sites.As the catalytic behavior of these materials is often associated to the redox properties of cerium,a large number of spectroscopic techniques have been employed to characterize them.Unfortunately,both data acquisition and interpretation are not always straightforward and sometimes the data are not well reported and discussed,limiting their impact in the literature.In this perspective review,we critically analyse the contributions provided by different spectroscopic techniques,sometime supported by molecular modelling approaches,to unravel the nature of Ce(IV)-MOFs at any stage of their preparation and along their use(i.e.,post-synthesis treatments and under reaction conditions).A concise description of major results from the recent literature allows to provide basic insights associated to the applicability and limits of most used spectroscopic approaches,showing that more robust understanding of Ce(IV)-MOFs can be achieved when a broad spectrum of techniques are used in parallel,adopting similar conditions and following good practice rules.展开更多
BACKGROUND Split liver transplantation(SLT)effectively expands the donor pool but carries a higher risk of early postoperative complications(EPC)due to the extensive transection surface and altered hemodynamics of par...BACKGROUND Split liver transplantation(SLT)effectively expands the donor pool but carries a higher risk of early postoperative complications(EPC)due to the extensive transection surface and altered hemodynamics of partial grafts.AIM To establish an interpretable machine learning framework to identify risk factors for EPC in adult recipients undergoing right tri-segment SLT.METHODS We retrospectively analyzed 109 adult SLT recipients,including 37 who developed EPC.A comprehensive set of perioperative donor and recipient variables was evaluated using four machine learning algorithms(random forest,support vector machine,extreme gradient boosting,and logistic regression).SHapley Additive exPlanations were employed to rank variable importance.Independent predictors were further validated through multivariate logistic regression,and a diagnostic nomogram was constructed.Restricted cubic spline,receiver operating characteristic,and survival analyses were conducted to evaluate model performance and clinical outcomes.RESULTS EPC occurred in 33.9%of recipients.Among the machine learning models,random forest demonstrated the best predictive performance.SHapley Additive exPlanations analysis identified the log-transformed systemic immune-inflammation index(LnSII),albumin-to-fibrinogen ratio,model for end-stage liver disease(MELD)score,partial lobectomy of segment IV(IV PL),intraoperative blood loss,and operation time as major contributors to the model.Multivariate logistic regression confirmed LnSII,MELD scores,IV PL,and blood loss as independent predictors of EPC.The nomogram constructed from these factors showed good discrimination and calibration(area under the curve=0.788,95%confidence interval:0.734-0.906).Kaplan-Meier analysis revealed that both LnSII and MELD scores were associated with five-year overall survival(P<0.05),while MELD score and IV PL were significantly correlated with early postoperative liver function recovery.CONCLUSION IV PL during right tri-segment SLT appears to reduce the risk of EPC and enhance postoperative liver function recovery.Together with LnSII,blood loss,and MELD score,these factors offer a reliable foundation for individualized perioperative risk stratification and management.展开更多
BACKGROUND Stage IV pancreatic cancer(PC)has a poor prognosis and lacks individualized prognostic tools.Current survival prediction models are limited,and there is a need for more accurate,personalized methods.The Sur...BACKGROUND Stage IV pancreatic cancer(PC)has a poor prognosis and lacks individualized prognostic tools.Current survival prediction models are limited,and there is a need for more accurate,personalized methods.The Surveillance,Epidemiology,and End Results(SEER)database offers a valuable resource for studying large patient cohorts,yet machine learning-based nomograms for stage IV PC prognosis remain underexplored.This study hypothesizes that a machine learning-based nomogram can predict cancer-specific survival(CSS)and overall survival(OS)with high accuracy in stage IV PC patients.AIM To construct and validate a machine learning-based nomogram for predicting survival in stage IV PC patients using real-world data.METHODS Clinical data from stage IV PC patients diagnosed via pathology from 2000 to 2019 INTRODUCTION Pancreatic cancer(PC)is a significant human health issue and,by 2025,is projected to surpass breast cancer as the third leading cause of cancer-related deaths[1].In the United States,an estimated 66440 new cases and 51750 deaths due to PC were reported in 2024.PC is often asymptomatic in its early stages,with more than half of patients presenting with distant organ metastasis at the time of initial diagnosis[2].Consequently,the prognosis is very poor,with a 5-year relative survival rate of only 12.8%[2]In clinical practice,considerable heterogeneity in survival outcomes has been observed among patients with stage IV PC,highlighting the need for an individualized survival prediction tool for this population.Nomograms,which are visual tools incorporating multiple prognostic factors to predict patient survival,aid in person-alized treatment planning and clinical decision-making and are widely used in cancer prognosis evaluation[3-6].Machine learning,a core technique within artificial intelligence,employs algorithms to analyze data,learn from patterns,and predict real-world events with high accuracy,and is increasingly applied in health assessment,medical decision-making,prognosis,and personalized treatment[7-9].This study leverages the large sample size and comprehensive clinical data from the United State Surveillance,Epidemiology,and End Results(SEER)database to develop a prognostic nomogram for stage IV PC patients using machine learning,with the aim of providing individualized prognostic assessments to improve clinical decision-making.展开更多
本研究探讨了无人机巡检系统与组串智能 IV 融合诊断系统在光伏电站运维中的应用及其技术优势。通过分析无人机巡检系统的飞行平台、任务设备、地面控制站和通信系统,以及组串智能 IV 诊断系统的数据采集、数据分析处理和云端数据库,揭...本研究探讨了无人机巡检系统与组串智能 IV 融合诊断系统在光伏电站运维中的应用及其技术优势。通过分析无人机巡检系统的飞行平台、任务设备、地面控制站和通信系统,以及组串智能 IV 诊断系统的数据采集、数据分析处理和云端数据库,揭示了两者融合在提高巡检效率、准确诊断故障和降低运维成本方面的显著效果。实际应用案例表明,该系统有效提升了光伏电站的运维水平,为光伏电站智能化运维提供了有力支持。展开更多
BACKGROUND Radial head fractures constitute approximately one-third of all elbow fractures,significantly impacting the young and active population.While open reduction and internal fixation is the preferred treatment ...BACKGROUND Radial head fractures constitute approximately one-third of all elbow fractures,significantly impacting the young and active population.While open reduction and internal fixation is the preferred treatment for displaced fractures,its high complication rate in comminuted fractures has led to the increasing use of radial head arthroplasty(RHA).RHA provides improved functional outcomes with fewer complications,yet its long-term efficacy remains a topic of debate.AIM To evaluate the functional outcomes of patients undergoing RHA with a modular metallic prosthesis for comminuted Mason type III and IV radial head fractures.METHODS A prospective and retrospective hospital-based study was conducted at Dayanand Medical College and Hospital,Ludhiana over 32 months(January 2021-August 2023).A total of 26 patients with Mason type III and IV fractures were included,with six retrospective and 20 prospective cases.Functional outcomes were assessed using the Mayo Elbow Performance Score(MEPS),elbow range of motion,pain via Visual Analog Scale,and activities of daily living at immediate postoperative,three-month,and six-month follow-ups.RESULTS MEPS at 6 months follow up for 4 cases(15.38%)had good scores,and 22 cases(84.62%)had excellent scores,with a mean±SD of 97.31±6.67.Comparisons showed significant improvement from immediate post-operative to 3 months(P<0.0001),from immediate post-operative to 6 months(P<0.0001),and between 3 months and 6 months(P<0.0001).None of the patients had elbow instability after radial head replacement and 22 cases(84.62%)had no complications,while 3 cases(11.54%)had a stiff elbow,and 1 case(3.85%)had heterotopic ossification.CONCLUSION RHA is an effective treatment for comminuted radial head fractures,providing stable elbow function with minimal complications.展开更多
文摘Addition of a-carbonylketenes, generated from 2-diazo-1, 3-diaryl-1, 3-propandione or 2-diazo-1-phenyl-1,3-butandione by heating, to 2,4-diaryl-2,3-dihydro-[1,5]-benzothiazepines gave 2,3-disubstituted-4a, 6-diaryl-4a,5,6,12-telrahydro-1H-1, 3-oxazino[3,2d][1,5]-benzothiazepine-l-ones, a new ring system.
文摘目的慢性肝病患者常表现出独特的血流动力学异常与代谢紊乱,术后液体管理面临诸多挑战,尤其是术后入住重症监护室(intensive care unit,ICU)的重症患者,亟待深入探究术后液体治疗方案与预后之间的关系。方法本研究基于MIMIC-IV数据库中2414名慢性肝病、接受手术治疗,并术后转入ICU的患者,对纳排后最终得到的2143名患者数据进行回顾性队列研究。采用多变量调整Logistic回归模型,分析术后转入ICU首日液体治疗方案与术后7天死亡风险的关联,并通过限制性立方样条(restricted cubic spline,RCS)分析剂量-反应关系。结果多因素分析指出限制性补液为独立保护因素,相较于非限制性补液组,限制性补液显著降低了术后7天死亡率(6.4%vs 12.4%,OR=0.44,95%CI:0.22~0.88,P=0.021)。减少了机械通气的使用(42.9%vs 72.3%,OR=0.29,95%CI:0.24~0.35,P<0.001)和ICU停留时长(1.86 d vs 3.47 d,OR=0.81,95%CI:0.78~0.84,P<0.001)。RCS曲线显示,术后首日液体入量与术后7天死亡风险呈现J型曲线关系,拐点为1850 mL,超过该阈值后,术后7天死亡风险随之增加。亚组分析结果表明,限制性补液的保护作用在不同年龄、合并症群体中均呈现出一致性。结论慢性肝病患者术后首日采取限制性补液方案可有效降低短期死亡风险,且液体入量与7天死亡风险呈非线性剂量效应关联,液体入量超过1850 mL时,死亡风险显著升高。
文摘BACKGROUND Liver transplantation aims to increase the survival of patients with end-stage liver diseases and improve their quality of life.The number of organs available for transplantation is lower than the demand.To provide fair organ distribution,predictive mortality scores have been developed.AIM To compare the Acute Physiology and Chronic Health Evaluation IV(APACHE IV),balance of risk(BAR),and model for end-stage liver disease(MELD)scores as predictors of mortality.METHODS Retrospective cohort study,which included 283 adult patients in the postoperative period of deceased donor liver transplantation from 2014 to 2018.RESULTS The transplant recipients were mainly male,with a mean age of 58.1 years.Donors were mostly male,with a mean age of 41.6 years.The median cold ischemia time was 3.1 hours,and the median intensive care unit stay was 5 days.For APACHE IV,a mean of 59.6 was found,BAR 10.7,and MELD 24.2.The 28-day mortality rate was 9.5%,and at 90 days,it was 3.5%.The 28-day mortality prediction for APACHE IV was very good[area under the curve(AUC):0.85,P<0.001,95%CI:0.76-0.94],P<0.001,BAR(AUC:0.70,P<0.001,95%CI:0.58–0.81),and MELD(AUC:0.66,P<0.006,95%CI:0.55-0.78),P<0.008.At 90 days,the data for APACHE IV were very good(AUC:0.80,P<0.001,95%CI:0.71–0.90)and moderate for BAR and MELD,respectively,(AUC:0.66,P<0.004,95%CI:0.55–0.77),(AUC:0.62,P<0.026,95%CI:0.51–0.72).All showed good discrimination between deaths and survivors.As for the best value for liver transplantation,it was significant only for APACHE IV(P<0.001).CONCLUSION The APACHE IV assessment score was more accurate than BAR and MELD in predicting mortality in deceased donor liver transplant recipients.
基金supported by the National Natural Science Foundation of China(Nos.U2067212,22176191)the National Science Fund for Distinguished Young Scholars(No.21925603)。
文摘In the current era marked by energy shortages,the advancement of nuclear energy stands as an inevitable progression.The reprocessing of spent nuclear fuel plays a crucial role in determining the sustainability of nuclear energy as a viable energy source.Among these processes,the separation and recovery of Pu(Ⅳ)from high-level liquid waste(HLLW)hold paramount significance in terms of safety and strategic implications.Herein,this work focused on the synthesis of two acid-and radiation-resistant pyridine-based sp^(2)c-COFs(COF-IHEP3 and COF-IHEP4),followed by the creation of two pyridine-based ionized sp^(2)c-COFs named COF-IHEP3-CH_(3)NO_(3)and COF-IHEP4-CH3NO3through post-modification.These materials have potential anion exchange capacity for the selective separation of Pu(Ⅳ)in highly acidic conditions.Notably,in 8 mol/L nitric acid solution,COF-IHEP3-CH3NO3demonstrated the capability to eliminate plutonium within 20 min in 98%removal efficiency with a Kdvalue of 2450 m L/g.Experimental and theoretical analysis suggest that the ionized sp^(2)c-COFs exhibit exceptional stability,selectivity,and prevention of secondary contamination towards Pu(Ⅳ)in the presence of multiple ions environments.In short,this work provides an appropriate anion exchange strategy to design ionic sp^(2)c-COFs as a promising platform for Pu(Ⅳ)recovery from HLLW.
基金supported by the National Science Foundation of China(Nos.22525606,22176128,22236005,22406131,22506126)the Innovation Program of Shanghai Municipal Education Commission(No.2023ZKZD50)+13 种基金Shanghai Leading Talent Program of Eastern Talent Plan(No.LJ2023002)Shanghai Government(Nos.22dz1205400,23520711100)Chinese Education Ministry Key Laboratory and International Joint Laboratory on Resource ChemistryShanghai Eastern Scholar ProgramThe authors also thank Fellowship of China National Postdoctoral Program for Innovative Talents(No.BX20240229)the China Postdoctoral Science(No.2024M762100)the Foundation the Shanghai Science and Technology Commission Project(No.24ZR1455700)Shanghai Post-doctoral Excellence Pro-gram(No.2024787)the Chenguang Program of Shanghai Education Development Foundation and Shanghai Municipal Education Com-mission(No.24CGA49)the“111 Innovation and Talent Recruitment Base on Photochemical and Energy Materials”(No.D18020)Yunnan University Collaborative Innovation Center(Qujing Green Photovoltaic Industry Collaborative Innovation Center)Technology Talent and Platform Plan Project of Yunnan Provincial Department of Science and Technology(No.202305AF150088)Shanghai Engineering Research Center of Green Energy Chemical Engineering(No.18DZ2254200)Shanghai Frontiers Science Center of Biomimetic Catalysis.
文摘The efficient recovery of silver(Ag)from retired photovoltaic(PV)panels is crucial for resource sustainability and envi-ronmental protection.This study developed an environmentally friendly leaching method using ammonia(NH_(3)·H_(2)O)and hydrogen peroxide(H_(2)O_(2)),achieving the selective dissolution of Ag from retired crystalline silicon solar panels.Meanwhile,nonprecious metals such as aluminum(Al)and lead(Pb),which are commonly found in PV cells,were barely dissolved,dem-onstrating the excellent selectivity of this method for Ag.Light irradiation significantly improved the dissolution efficiency of Ag and reduced the amount of the reagent used.Ag dissolution occurred owing to a dual-pathway synergistic effect,which stemmed from the direct oxidation of Ag by H_(2)O_(2).The strongly oxidizing hydroxyl radicals generated by photocatalysis accelerated the oxidation and dissolution of Ag.In addition,NH 3·H_(2)O effectively promoted the dissolution and stabilization of oxidation products by forming soluble Ag–NH3·H2O complexes([Ag(NH3)2]+).This article reports an efficient,selective,and environmentally friendly strategy of Ag recovery and elucidates the radical-mediated dissolution mechanism under light-driven conditions,offering a feasible way for sustainably recovering valuable metals from retired PV panels.
基金the funding from Horizon 2020 Excellence Science ERC-Synergy program 2019-CUBE:“Unravelling the secrets of Cu-based catalysts for C-H activation”(No.856446)from the Project CH4.0 under the MUR Program“Dipartimenti di Eccellenza 2023-2027”(CUPD13C22003520001)+1 种基金Valeria Finelli's activities have been con-ducted during and with the support of the Italian national inter-university PhD course in Sustainable Development and Climate change(PhD-SDC)Sergio Rojas-Buzo acknowledges the Margarita Salas grant financed by the Ministerio de Universidades,Spain,and also funded by the European Union-Next Generation EU.
文摘In the Metal-Organic Framework(MOF)panorama,Ce(IV)-based MOFs have emerged as potential candidates for heterogeneous catalysis,not only due to their intrinsic active species but also as a support of single metal sites.As the catalytic behavior of these materials is often associated to the redox properties of cerium,a large number of spectroscopic techniques have been employed to characterize them.Unfortunately,both data acquisition and interpretation are not always straightforward and sometimes the data are not well reported and discussed,limiting their impact in the literature.In this perspective review,we critically analyse the contributions provided by different spectroscopic techniques,sometime supported by molecular modelling approaches,to unravel the nature of Ce(IV)-MOFs at any stage of their preparation and along their use(i.e.,post-synthesis treatments and under reaction conditions).A concise description of major results from the recent literature allows to provide basic insights associated to the applicability and limits of most used spectroscopic approaches,showing that more robust understanding of Ce(IV)-MOFs can be achieved when a broad spectrum of techniques are used in parallel,adopting similar conditions and following good practice rules.
基金Supported by Tianjin Key Medical Discipline Construction Project,No.TJYXZDXK-3-006ATianjin Municipal Health Commission General Fund Project,No.TJWJ2024MS017+3 种基金Key Project of Tianjin Science and Technology Bureau Applied Basic Research,No.23JCZDJC01200The Independent Research Fund of the Institute of Transplant Medicine at Nankai University,No.NKTM2023004The General Project of the China Medicine Education Association,No.ZJWYH-2023-YIZHI-028General Project of Scientific Research Plan of Tianjin Municipal Education Commission,No.2024ZX013。
文摘BACKGROUND Split liver transplantation(SLT)effectively expands the donor pool but carries a higher risk of early postoperative complications(EPC)due to the extensive transection surface and altered hemodynamics of partial grafts.AIM To establish an interpretable machine learning framework to identify risk factors for EPC in adult recipients undergoing right tri-segment SLT.METHODS We retrospectively analyzed 109 adult SLT recipients,including 37 who developed EPC.A comprehensive set of perioperative donor and recipient variables was evaluated using four machine learning algorithms(random forest,support vector machine,extreme gradient boosting,and logistic regression).SHapley Additive exPlanations were employed to rank variable importance.Independent predictors were further validated through multivariate logistic regression,and a diagnostic nomogram was constructed.Restricted cubic spline,receiver operating characteristic,and survival analyses were conducted to evaluate model performance and clinical outcomes.RESULTS EPC occurred in 33.9%of recipients.Among the machine learning models,random forest demonstrated the best predictive performance.SHapley Additive exPlanations analysis identified the log-transformed systemic immune-inflammation index(LnSII),albumin-to-fibrinogen ratio,model for end-stage liver disease(MELD)score,partial lobectomy of segment IV(IV PL),intraoperative blood loss,and operation time as major contributors to the model.Multivariate logistic regression confirmed LnSII,MELD scores,IV PL,and blood loss as independent predictors of EPC.The nomogram constructed from these factors showed good discrimination and calibration(area under the curve=0.788,95%confidence interval:0.734-0.906).Kaplan-Meier analysis revealed that both LnSII and MELD scores were associated with five-year overall survival(P<0.05),while MELD score and IV PL were significantly correlated with early postoperative liver function recovery.CONCLUSION IV PL during right tri-segment SLT appears to reduce the risk of EPC and enhance postoperative liver function recovery.Together with LnSII,blood loss,and MELD score,these factors offer a reliable foundation for individualized perioperative risk stratification and management.
基金Supported by Mianyang Health and Health Committee 2023 Scientific Research Project,No.202309Chengdu University of Traditional Chinese Medicine University-Hospital Joint Innovation Fund,No.LH202402010Mianyang Chinese Medicine Association 2024 Traditional Chinese Medicine Inheritance and Innovation Science and Technology Project,No.MYSZYYXH-202426.
文摘BACKGROUND Stage IV pancreatic cancer(PC)has a poor prognosis and lacks individualized prognostic tools.Current survival prediction models are limited,and there is a need for more accurate,personalized methods.The Surveillance,Epidemiology,and End Results(SEER)database offers a valuable resource for studying large patient cohorts,yet machine learning-based nomograms for stage IV PC prognosis remain underexplored.This study hypothesizes that a machine learning-based nomogram can predict cancer-specific survival(CSS)and overall survival(OS)with high accuracy in stage IV PC patients.AIM To construct and validate a machine learning-based nomogram for predicting survival in stage IV PC patients using real-world data.METHODS Clinical data from stage IV PC patients diagnosed via pathology from 2000 to 2019 INTRODUCTION Pancreatic cancer(PC)is a significant human health issue and,by 2025,is projected to surpass breast cancer as the third leading cause of cancer-related deaths[1].In the United States,an estimated 66440 new cases and 51750 deaths due to PC were reported in 2024.PC is often asymptomatic in its early stages,with more than half of patients presenting with distant organ metastasis at the time of initial diagnosis[2].Consequently,the prognosis is very poor,with a 5-year relative survival rate of only 12.8%[2]In clinical practice,considerable heterogeneity in survival outcomes has been observed among patients with stage IV PC,highlighting the need for an individualized survival prediction tool for this population.Nomograms,which are visual tools incorporating multiple prognostic factors to predict patient survival,aid in person-alized treatment planning and clinical decision-making and are widely used in cancer prognosis evaluation[3-6].Machine learning,a core technique within artificial intelligence,employs algorithms to analyze data,learn from patterns,and predict real-world events with high accuracy,and is increasingly applied in health assessment,medical decision-making,prognosis,and personalized treatment[7-9].This study leverages the large sample size and comprehensive clinical data from the United State Surveillance,Epidemiology,and End Results(SEER)database to develop a prognostic nomogram for stage IV PC patients using machine learning,with the aim of providing individualized prognostic assessments to improve clinical decision-making.
文摘本研究探讨了无人机巡检系统与组串智能 IV 融合诊断系统在光伏电站运维中的应用及其技术优势。通过分析无人机巡检系统的飞行平台、任务设备、地面控制站和通信系统,以及组串智能 IV 诊断系统的数据采集、数据分析处理和云端数据库,揭示了两者融合在提高巡检效率、准确诊断故障和降低运维成本方面的显著效果。实际应用案例表明,该系统有效提升了光伏电站的运维水平,为光伏电站智能化运维提供了有力支持。
文摘BACKGROUND Radial head fractures constitute approximately one-third of all elbow fractures,significantly impacting the young and active population.While open reduction and internal fixation is the preferred treatment for displaced fractures,its high complication rate in comminuted fractures has led to the increasing use of radial head arthroplasty(RHA).RHA provides improved functional outcomes with fewer complications,yet its long-term efficacy remains a topic of debate.AIM To evaluate the functional outcomes of patients undergoing RHA with a modular metallic prosthesis for comminuted Mason type III and IV radial head fractures.METHODS A prospective and retrospective hospital-based study was conducted at Dayanand Medical College and Hospital,Ludhiana over 32 months(January 2021-August 2023).A total of 26 patients with Mason type III and IV fractures were included,with six retrospective and 20 prospective cases.Functional outcomes were assessed using the Mayo Elbow Performance Score(MEPS),elbow range of motion,pain via Visual Analog Scale,and activities of daily living at immediate postoperative,three-month,and six-month follow-ups.RESULTS MEPS at 6 months follow up for 4 cases(15.38%)had good scores,and 22 cases(84.62%)had excellent scores,with a mean±SD of 97.31±6.67.Comparisons showed significant improvement from immediate post-operative to 3 months(P<0.0001),from immediate post-operative to 6 months(P<0.0001),and between 3 months and 6 months(P<0.0001).None of the patients had elbow instability after radial head replacement and 22 cases(84.62%)had no complications,while 3 cases(11.54%)had a stiff elbow,and 1 case(3.85%)had heterotopic ossification.CONCLUSION RHA is an effective treatment for comminuted radial head fractures,providing stable elbow function with minimal complications.
