BACKGROUND The accuracy of blind intra-articular injections in the shoulder is rather low.Inaccurate injections tend to lead to poorer treatment outcomes.The“Delaware posterior bone touch technique”has shown higher ...BACKGROUND The accuracy of blind intra-articular injections in the shoulder is rather low.Inaccurate injections tend to lead to poorer treatment outcomes.The“Delaware posterior bone touch technique”has shown higher accuracy in young,slender,healthy volunteers than the classical“Cyriax technique”.AIM To investigate whether the Delaware technique would also be more accurate in older patients with capsulitis.METHODS We analyzed the files of 100 consecutive patients with capsulitis who were treated with an intra-articular injection containing a mixture of triamcinolone,lidocaine,and air.After the injection,the shoulder was moved to determine whether a squishing sound could be produced.The squishing sound was interpreted as an accurate injection.The scores with the new Delaware technique were compared against those with the Cyriax technique in a previous study.RESULTS Squishing was heard after 87%of the injections.This was 13%(10%points)more than the 77%in the previous study(P=0.004).CONCLUSION The Delaware technique was significantly more accurate than the Cyriax technique also in middle aged patients with capsulitis.We hypothesize that the difference is caused by a lower risk that a part of the opening of the needle is still outside the capsule.展开更多
BACKGROUND Non-steroid anti-inflammatory drugs(NSAIDs)have played a crucial role in the treatment of osteoarthritis,especially in the early stages.However,the cardiovascular risk and adverse gastrointestinal reactions...BACKGROUND Non-steroid anti-inflammatory drugs(NSAIDs)have played a crucial role in the treatment of osteoarthritis,especially in the early stages.However,the cardiovascular risk and adverse gastrointestinal reactions of oral NSAIDs in elderly people cannot be underestimated.Intra-articular injection of NSAIDs may be a new attempt for early knee osteoarthritis treatment.Parecoxib may be a suitable drug for intra-articular injection.AIM To observe the clinical efficacy of the intra-articular injection of parecoxib for early knee osteoarthritis.METHODS Early knee osteoarthritis patients(n=110)were retrospectively analyzed.These patients were divided into three groups:Basic treatment+oral glucosamine(group A,n=37),oral celecoxib+basic treatment+oral glucosamine(group B,n=37),and intra-articular injection of parecoxib+basic treatment+oral glucosamine(group C,n=36).Intra-articular injection of parecoxib was performed once every 2 wk at a dose of 40 mg each time,for three times total.The three groups were compared in terms of visual analogue scale(VAS)scores,Hospital for Special Surgery(HSS)scores and patient satisfaction before and after treatment.The levels of inflammatory cytokines in the synovial fluid were detected in the three groups before and after treatment.RESULTS All patients were followed up for an average of 15.5±2.7 mo.The clinical efficacy was estimated by VAS and HSS scores at 12 mo after treatment.Inflammatory cytokine levels in the synovial fluid were evaluated at 3 mo after treatment.VAS and HSS scores were significantly improved in each group compared with before(P<0.001).There were significant differences among the three groups in VAS and HSS scores(P<0.001).The clinical efficacy of group C was superior to that of groups A and B(P<0.001),while group B outperformed group A in this respect(P<0.001).The patient satisfaction was the highest in group C(P<0.001).After treatment,the levels of tumor necrosis factorα(TNF-α)and interleukin(IL)-6 in the synovial fluid decreased in each group compared with before(P<0.001),while the levels of IL-10 increased(P<0.001).The three groups differed significantly in the levels of TNF-a,IL-6 and IL-10 in the synovial fluid after treatment(P<0.001).CONCLUSION For patients with early knee osteoarthritis,intra-articular injection of parecoxib could effectively improve clinical symptoms.This method may be a reliable alternative for early knee osteoarthritis.展开更多
Objective: to explore the long-term therapeutic effect of intra-articular injection of sodium hyaluronate on osteoarthritis and joint function recovery. Methods: the study was conducted according to the principle of g...Objective: to explore the long-term therapeutic effect of intra-articular injection of sodium hyaluronate on osteoarthritis and joint function recovery. Methods: the study was conducted according to the principle of grouping and control. The sample is 86 patients with osteoarthritis treated in our hospital. The period starts in April 2019 and ends in April 2021. They were randomly divided into observation group and control group, each with 43 samples. The control group was treated with triamcinolone acetonide, while the observation group was treated with sodium hyaluronate. The therapeutic effect was analyzed from the functional recovery of joints, long-term curative effect, short-term curative effect and probability index of occurrence rate of complications. Results: the analysis of joint function recovery showed that the observation group had obvious advantages over the control group (P < 0.05). Analysis of the long-term curative effect of the patients in the clinic shows that the observation group has a greater advantage than the control group (P < 0.05). The short-term curative effect of the observation group was significantly superior to that of the control group (P < 0.05). The probability of complications in the observation group was lower than that in the control group (P < 0.05). Conclusion: in the clinical treatment of osteoarthritis, sodium hyaluronate injection in the joint cavity has definite curative effect, which can significantly improve the joint function of patients and reduce the probability of complications such as lower limb fatigue, joint pain and swelling, blood pressure and blood glucose rise.展开更多
Large language models(LLMs)have revolutionized AI applications across diverse domains.However,their widespread deployment has introduced critical security vulnerabilities,particularly prompt injection attacks that man...Large language models(LLMs)have revolutionized AI applications across diverse domains.However,their widespread deployment has introduced critical security vulnerabilities,particularly prompt injection attacks that manipulate model behavior through malicious instructions.Following Kitchenham’s guidelines,this systematic review synthesizes 128 peer-reviewed studies from 2022 to 2025 to provide a unified understanding of this rapidly evolving threat landscape.Our findings reveal a swift progression from simple direct injections to sophisticated multimodal attacks,achieving over 90%success rates against unprotected systems.In response,defense mechanisms show varying effectiveness:input preprocessing achieves 60%–80%detection rates and advanced architectural defenses demonstrate up to 95%protection against known patterns,though significant gaps persist against novel attack vectors.We identified 37 distinct defense approaches across three categories,but standardized evaluation frameworks remain limited.Our analysis attributes these vulnerabilities to fundamental LLM architectural limitations,such as the inability to distinguish instructions from data and attention mechanism vulnerabilities.This highlights critical research directions such as formal verification methods,standardized evaluation protocols,and architectural innovations for inherently secure LLM designs.展开更多
Background:Penile augmentation through injectable substances is becoming increasingly common.A growing number of aesthetic clinics are developing penile enlargement procedures using various injectable materials.Althou...Background:Penile augmentation through injectable substances is becoming increasingly common.A growing number of aesthetic clinics are developing penile enlargement procedures using various injectable materials.Although these procedures are now performed in more controlled and medically supervised environments,their long-term outcomes remain poorly understood.The promotion of such medical treatments contributes to an increasing interest among adult males in self-injection as a method to alleviate psychological distress associated with penile size concerns.At the same time,access to injectable substances through unofficial or unregulated sources has become increasingly easy.Tor our knowledge,we report the first documented case of self-injection with Garamycin®(gentamicin)cream,contributing to the literature on the often multidisciplinary management of penile enlargement injections,a field still lacking well-established guidelines.Case Description:This case report describes a young patient who self-injected Garamycin®into the penis for the purpose of enlargement.He presented to our urology department with worsening symptoms,including severe and poorly tolerated pain.His primary request was prompt relief of pain while preserving,as much as possible,the aesthetic appearance and functional integrity of his penis.This case required a multi-stage surgical approach to salvage the penis and preserve both its structural integrity and functional outcome.Conclusions:To our knowledge,this case report documents the first reported instance of Garamycin®injection performed for the purpose of penile enlargement.It provides insight into the clinical course of such penile cream injections,demonstrates that a two-stage scrotal flap can achieve both functional and aesthetic outcomes,and highlights the importance of comprehensive management particularly addressing the traumatic impact of penile deformity secondary to inflammation and/or infection,as well as the body dysmorphic concerns often associated with these cases.展开更多
While Large Language Models(LLMs)possess the capability to perform a wide range of tasks,security attacks known as prompt injection and jailbreaking remain critical challenges.Existing defense approaches addressing th...While Large Language Models(LLMs)possess the capability to perform a wide range of tasks,security attacks known as prompt injection and jailbreaking remain critical challenges.Existing defense approaches addressing this problem face challenges such as the over-refusal of prompts that contain harmful vocabulary but are semantically benign,and the limited accuracy improvement inmachine learning-based approaches due to the ease of distinguishing benign prompts in existing datasets.Therefore,we propose a multi-LLM agent framework aimed at achieving both the accurate rejection of harmful prompts and appropriate responses to benign prompts.Distinct from prior studies,the proposed method adopts In-Context Learning(ICL)during the learning phase,presenting a novel approach that obviates the need for computationally expensive parameter updates required by conventional fine-tuning.To demonstrate the proposed method’s capability for rapid and easy deployment,this study targets LLMs with insufficient alignment.In the experiments,macro-averaged binary classification metrics were used to comprehensively evaluate harmfulness detection.Experimental results using three LLMs demonstrated that the proposed method achieved performance that surpassed four baselines across all evaluation metrics for the target LLMs,evidencing significant effectiveness with an average improvement of 16.6 points in F1-score compared to the vanilla models.The significance of this study lies in the proposal of a novel approach based on ICL that does not require parameter updates.This framework offers high sustainability in practical deployment,as it allows for the adaptive enhancement of detection performance against continuously evolving attack methods solely through the accumulation of logs,without the necessity of retraining the LLM itself.By mitigating the trade-off between safety and utility,this research contributes to the implementation of robust LLMs.展开更多
Powder-Fueled Water Ramjet Engine(PFWRE)is the most promising powerplant in underwater high-speed propulsion.However,the effect of powder injection mode on its performance and the mechanism of this effect are not well...Powder-Fueled Water Ramjet Engine(PFWRE)is the most promising powerplant in underwater high-speed propulsion.However,the effect of powder injection mode on its performance and the mechanism of this effect are not well understood.In this paper,a computational framework for multiphase combustion flow is developed and validated.Further,the effects of different injection schemes on flow combustion characteristics and engine performance are evaluated via simulation.Our findings indicate that the dominant recirculation zone in front of the primary water inlet delivers water vapor to the combustor head,providing the necessary oxidant for the ignition and combustion of Al particles.Changing the injection parameters directly affects the flame zone distribution and the ability of the recirculation zone to deliver water vapor,leading to variations in particle ignition delay.The engine combustion efficiency and specific impulse efficiency exhibit a negative correlation with injection height,peaking before declining with increased injection angle.It is shown that particle mixing degree and particle dispersion degree are closely related to engine performance.Enhanced particle mixing in front of the primary water inlet and particle dispersion behind the secondary water inlet are considered favorable approaches to improve engine performance,which promotes the particle combustion process and improves the heat-work conversion efficiency.展开更多
OBJECTIVE:To assess the clinical effectiveness and safety of Danshen injection(丹参注射液)following immunosuppressive therapy in primary nephrotic syndrome(PNS)with acute kidney injury(AKI)patients.METHODS:PNS with AK...OBJECTIVE:To assess the clinical effectiveness and safety of Danshen injection(丹参注射液)following immunosuppressive therapy in primary nephrotic syndrome(PNS)with acute kidney injury(AKI)patients.METHODS:PNS with AKI patients selected from nephrotic syndrome inpatients between 2012 and 2022 were divided into two groups according to the treatment regimen:the DS group who were treated with the Danshen injection and the SC group who received supportive care.Propensity score matching was used to balance the confounding factors between the two groups.The outcomes were complete and partial renal function recovery for effectiveness analysis and severe bleeding events for safety analysis.Kaplan-Meier curves and logrank tests were used to compare cumulative recovery rates.Outcome risks were assessed using Cox proportional hazard regression models.RESULTS:The study enrolled 441 patients with PNS and AKI from a population of 3873 inpatients with nephrotic syndrome.Among them,95 received Danshen injection,and 346 received supportive care.After propensity score matching,95 patients in the DS group and 285 patients in the SC group were analyzed.No significant difference was observed in the complete recovery rate for the DS group vs SC group(72.9%vs 65.1%,P=0.130)at 6 months.Compared with the SC group,the DS group was associated with a significantly higher partial recovery rate(71.0%vs 37.5%,P=0.011)at 6 months and all recovery rates(93.4%vs 79.1%,P=0.006)at 6 months.CONCLUSION:In this real-world retrospective study of PNS with AKI patients,Danshen injection following immunosuppressive therapy and prophylactic anticoagulation with low molecular heparin significantly increased 6-month partial renal function recovery and had a safety profile.Further randomized clinical trials are warranted to confirm the benefit of Danshen(Radix Salviae Miltiorrhizae)in these patients.展开更多
This paper presents the results of free-jet experiments conducted on an internal injection oblique detonation engine in a large-scale hypersonic shock tunnel.To overcome the challenges of non-uniform mixing and the fa...This paper presents the results of free-jet experiments conducted on an internal injection oblique detonation engine in a large-scale hypersonic shock tunnel.To overcome the challenges of non-uniform mixing and the failure of oblique detonation wave initiation when using liquid fuel,a combined strut-wall injection configuration was employed.Initiation was achieved by introducing a bump structure on the wedge.The results demonstrate that this strategy for mixing and initiation effectively establishes the oblique detonation wave combustion flow field.To further investigate the fuel mixing and initiation processes in the oblique detonation engine,three-dimensional numerical simulations consistent with the experimental conditions were carried out using the ReynoldsAveraged Navier-Stokes(RANS)method.The simulation results reveal that the high-speed gas flow generates shock waves as it passes through the central strut and transverse fuel jets.These shock waves are reflected by the wall,forming a series of shocks in the mixing section.The kerosene injected from the strut injectors does not react during the mixing phase.However,due to the influence of the high-temperature boundary layer,the kerosene injected through the wall undergoes precombustion.The separation zone upstream of the bump generates separation shock waves,allowing the multi-wave point to stabilize at a short distance from the leading edge of the wedge.展开更多
Objective:To explore the therapeutic effect of double-puncture tympanic membrane puncture and tympanic cavity drug injection in patients with acute secretory otitis media.Methods:A total of 84 patients with acute secr...Objective:To explore the therapeutic effect of double-puncture tympanic membrane puncture and tympanic cavity drug injection in patients with acute secretory otitis media.Methods:A total of 84 patients with acute secretory otitis media admitted to our hospital from June 2024 to June 2025 were selected and randomly divided into two groups by drawing lots.The control group(42 cases)was treated with the traditional single-puncture tympanic membrane puncture and tympanic cavity drug injection method,while the observation group(42 cases)was treated with the double-puncture tympanic membrane puncture and tympanic cavity drug injection method.The therapeutic effects of the two groups were compared.Results:The overall treatment response rate,overall complication rate,time to symptom relief,and improvement in hearing threshold in the observation group were all superior to those in the control group,with statistically significant differences(P<0.05).Conclusion:For acute secretory otitis media,the treatment method of double-puncture tympanic membrane puncture and tympanic cavity drug injection demonstrates definite efficacy,significantly reducing the incidence of complications,accelerating symptom relief,and improving hearing function,making it worthy of promotion.展开更多
Objective:To investigate the impact of anti-Müllerian hormone(AMH)levels on the outcomes of intracytoplasmic sperm injection(ICSI)cycles in women of advanced age and also to explore the effect of age on the ICSI ...Objective:To investigate the impact of anti-Müllerian hormone(AMH)levels on the outcomes of intracytoplasmic sperm injection(ICSI)cycles in women of advanced age and also to explore the effect of age on the ICSI results in patients with low AMH levels.Methods:This retrospective cohort study involved 143 infertile couples undergoing ICSI cycles at a fertility clinic in Iran from November 2021 to November 2023.Women aged<37 years with AMH<1 ng/mL and those aged≥37 years were included.A standardized ovarian stimulation protocol was followed,leading to oocyte retrieval and ICSI on mature oocytes.Key oocyte quality indexes,including the maturation rate,fertilization rate,and embryo quality metrics,were evaluated.Poisson regression analyses were also employed to investigate the association between AMH levels and oocyte quality parameters in the advanced age groups,as well as the association between age and oocyte quality parameters in patients with low AMH.Results:We analyzed 143 ICSI cycles from 143 infertile couples.The mean ages of the women and their partners were(38.2±4.7)years and(40.6±5.9)years,respectively,with a median(IQR)AMH level of 0.7(0.4–2.0)ng/mL.Younger women with low AMH levels(<1 ng/mL)showed significantly better outcomes in terms of the number of MⅡ oocytes[adjusted odds ratio(aOR)1.89,95%CI 1.31-2.71;P=0.001],fertilized(2PN)oocytes(aOR 1.97,95%CI 1.36-2.86;P<0.001),embryo number(aOR 2.16,95%CI 1.44-3.24;P<0.001),and embryos suitable for freezing(aOR 2.88,95%CI 1.80-4.61;P<0.001)compared to advanced-age women.Furthermore,among women of advanced age,those with normal AMH levels exhibited a significantly higher number of MⅡ oocyte(aOR 3.55,95%CI 2.31-5.44;P<0.001),fertilized(2PN)oocytes(aOR 3.54,95%CI 2.29-5.49;P<0.001),embryo number(aOR 3.89,95%CI 2.48-6.10;P<0.001),and embryos suitable for freezing(aOR 4.75,95%CI 2.79-8.09;P<0.001)compared to those with low AMH levels.Conclusions:AMH level is a significant predictor of oocyte and embryo number and quality in infertile women of advanced age undergoing ICSI cycles.Our findings suggest that maternal age markedly impacts the quality of oocytes and embryos in low AMHlevel patients.展开更多
The increasing integration of cyber-physical components in Industry 4.0 water infrastructures has heightened the risk of false data injection(FDI)attacks,posing critical threats to operational integrity,resource manag...The increasing integration of cyber-physical components in Industry 4.0 water infrastructures has heightened the risk of false data injection(FDI)attacks,posing critical threats to operational integrity,resource management,and public safety.Traditional detection mechanisms often struggle to generalize across heterogeneous environments or adapt to sophisticated,stealthy threats.To address these challenges,we propose a novel evolutionary optimized transformer-based deep reinforcement learning framework(Evo-Transformer-DRL)designed for robust and adaptive FDI detection in smart water infrastructures.The proposed architecture integrates three powerful paradigms:a transformer encoder for modeling complex temporal dependencies in multivariate time series,a DRL agent for learning optimal decision policies in dynamic environments,and an evolutionary optimizer to fine-tune model hyper-parameters.This synergy enhances detection performance while maintaining adaptability across varying data distributions.Specifically,hyper-parameters of both the transformer and DRL modules are optimized using an improved grey wolf optimizer(IGWO),ensuring a balanced trade-off between detection accuracy and computational efficiency.The model is trained and evaluated on three realistic Industry 4.0 water datasets:secure water treatment(SWaT),water distribution(WADI),and battle of the attack detection algorithms(BATADAL),which capture diverse attack scenarios in smart treatment and distribution systems.Comparative analysis against state-of-the-art baselines including Transformer,DRL,bidirectional encoder representations from transformers(BERT),convolutional neural network(CNN),long short-term memory(LSTM),and support vector machines(SVM)demonstrates that our proposed Evo-Transformer-DRL framework consistently outperforms others in key metrics such as accuracy,recall,area under the curve(AUC),and execution time.Notably,it achieves a maximum detection accuracy of 99.19%,highlighting its strong generalization capability across different testbeds.These results confirm the suitability of our hybrid framework for real-world Industry 4.0 deployment,where rapid adaptation,scalability,and reliability are paramount for securing critical infrastructure systems.展开更多
BACKGROUND Intra-articular hip injections(IAHIs)are commonly used for diagnostic and therapeutic purposes but are often associated with patient anxiety and fear.The disparity between anticipated and experienced pain d...BACKGROUND Intra-articular hip injections(IAHIs)are commonly used for diagnostic and therapeutic purposes but are often associated with patient anxiety and fear.The disparity between anticipated and experienced pain during IAHIs and the role of preinjection local anesthesia in pain modulation remains unclear.AIM To investigate the difference between anticipated and experienced pain during IAHIs and the impact of pre-injection local anesthesia.METHODS This prospective study enrolled 60 patients undergoing IAHI,30 receiving pre-injection superficial local anesthesia and 30 serving as a control group without pre-injection local anesthesia.Pain levels were assessed using numeric rating scales.RESULTS Patients significantly overestimated anticipated pain compared to experienced pain(6.43±2.48 vs 3.68±2.37,P<0.001).Pre-injection local anesthesia did not significantly reduce experienced pain(3.19±2.38 vs 4.20±2.29,P=0.130).CONCLUSION Patients overestimate anticipated pain during IAHIs.Pre-injection local anesthesia does not reduce experienced pain.展开更多
BACKGROUND Knee osteoarthritis(OA)is a degenerative joint disease traditionally viewed through the lens of cartilage degradation.However,emerging evidence positions subchondral bone pathology-particularly bone marrow ...BACKGROUND Knee osteoarthritis(OA)is a degenerative joint disease traditionally viewed through the lens of cartilage degradation.However,emerging evidence positions subchondral bone pathology-particularly bone marrow lesions(BMLs)-as a key contributor to pain,progression,and structural deterioration.Mesenchymal stem cell exhaustion within the osteoarthritic subchondral zone further impairs intrinsic repair mechanisms,reinforcing the rationale for biologic interventions.AIM To evaluate the clinical efficacy of bone marrow aspirate concentrate(BMAC)therapy for knee OA,comparing subchondral vs intra-articular delivery routes,and elucidating the therapeutic impact on symptom relief and structural preservation.METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines,five clinical studies were included-comprising three randomized controlled trials and two prospective cohorts-with pooled data from 298 knees.Data on functional outcomes,imaging findings,and progression to total knee arthroplasty(TKA)were extracted and qualitatively synthesized.RESULTS Subchondral BMAC injections demonstrated superior improvements compared to intra-articular injection or placebo:Knee Injury and Osteoarthritis Outcome Score improved from 49.1±1.9 to 61.2±6.3 at 12 months(P<0.05),Knee Society Score increased from 57±12 to 87.3±12 at two years,and Western Ontario and McMaster Universities Arthritis Index scores showed significant improvement favoring combined approaches.Magnetic resonance imaging analyses revealed mean BML volume regression of 2.1 cm3,with 80%of knees avoiding TKA over 13-year follow-up.Magnetic resonance imaging analyses revealed regression of BMLs and increased cartilage preservation in subchondral-treated knees.Long-term data indicated delayed progression to TKA and biomechanical improvements(e.g.,Hip-Knee-Ankle angle correction).No major adverse events were reported.CONCLUSION Targeting subchondral bone with BMAC addresses underlying OA pathology and may offer disease-modifying potential beyond symptom relief.These findings support a paradigm shift toward whole-joint biologic therapy,positioning the subchondral matrix as a therapeutic epicenter in OA management.展开更多
Objective To observe the therapeutic efficacy of warm needling moxibustion plus intra-articular injection of sodium hyaluronate in treating chondromalacia patellae and its effect on inflammatory factors in knee joint ...Objective To observe the therapeutic efficacy of warm needling moxibustion plus intra-articular injection of sodium hyaluronate in treating chondromalacia patellae and its effect on inflammatory factors in knee joint fluid.Methods Sixty-eight patients with chondromalacia patellae were randomized into a control group and an observation group,with 34 cases in each group.The control group was treated with intra-articular injection of sodium hyaluronate,while the observation group was given additional warm needling moxibustion treatment.Before and after treatment,the two groups were scored using Western Ontario and McMaster Universities osteoarthritis index(WOMAC)and visual analog scale(VAS),examined by magnetic resonance imaging(MRI)and determined for the levels of nuclear factor-KB(NF-kB),tumor necrosis factor(TNF)-αand interleukin(IL)-1βin knee joint fluid.Clinical efficacy was estimated after treatment.Results The effective rate was higher in the observation group than in the control group(P<0.05).After treatment,the scores of pain,stiffness and daily activities,as well as the general score of WOMAC declined significantly in both groups(all P<0.05),and were lower in the observation group than in the control group(all P<0.05);the time cost for climbing up and down one staircase and VAS score decreased markedly in both groups(all P<0.05),and were shorter or lower in the observation group than in the control group(both P<0.05);the MRI grading showed no significant change in the control group after intervention(P>0.05),while the grading in the observation group showed notable improvement(P<0.05),and was better than that in the control group(P<0.05);the levels of NF-kB and IL-1βin knee joint fluid dropped significantly in the control group after treatment(both P<0.05),while the levels of NF-kB,TNF-αand IL-1βin knee joint fluid all decreased significantly in the observation group(all P<0.05)and were lower than those in the control group(all P<0.05).Conclusion Warm needling moxibustion plus intra-articular injection of sodium hyaluronate can produce definite efficacy in treating chondromalacia patellae;it can mitigate the clinical symptoms,improve the lesion extent of chondromalacia and down-regulate the levels of NF-kB,TNF-αand IL-1βin knee joint fluid.展开更多
BACKGROUND A total of 100 patients diagnosed with mixed hemorrhoids from October 2022 to September 2023 in our hospital were randomly divided into groups by dice rolling and compared with the efficacy of different tre...BACKGROUND A total of 100 patients diagnosed with mixed hemorrhoids from October 2022 to September 2023 in our hospital were randomly divided into groups by dice rolling and compared with the efficacy of different treatment options.AIM To analyze the clinical effect and prognosis of mixed hemorrhoids treated with polidocanol injection combined with automatic elastic thread ligation operation(RPH).METHODS A total of 100 patients with mixed hemorrhoids who visited our hospital from October 2022 to September 2023 were selected and randomly divided into the control group(n=50)and the treatment group(n=50)by rolling the dice.The procedure for prolapse and hemorrhoids(PPH)was adopted in the control group,while polidocanol foam injection+RPH was adopted in the treatment group.The therapeutic effects,operation time,wound healing time,hospital stay,pain situation(24 hours post-operative pain score,first defecation pain score),quality of life(QOL),incidence of complications(post-operative hemorrhage,edema,infection),incidence of anal stenosis 3 months post-operatively and recurrence rate 1 year post-operatively of the two groups were compared.RESULTS Compared with the control group,the total effective rate of treatment group was higher,and the difference was significant(P<0.05).The operation time/wound healing time/hospital stay in the treatment group were shorter than those in the control group(P<0.05).The pain scores at 24 hours after operation/first defecation pain score of the treatment group was significantly lower than those in the control group(P<0.05).After surgery,the QOL scores of the two groups decreased,with the treatment group having higher scores than that of the control group(P<0.05).Compared with the control group,the incidence of postoperative complications in the treatment group was lower,and the difference was significant(P<0.05);However,there was no significant difference in the incidence of postoperative bleeding between the two groups(P>0.05);There was no significant difference in the incidence of anal stenosis 3 months after operation and the recurrence rate 1 year after operation between the two groups(P>0.05).CONCLUSION For patients with mixed hemorrhoids,the therapeutic effect achieved by using polidocanol injection combined with RPH was better.The wounds of the patients healed faster,the postoperative pain was milder,QOL improved,and the incidence of complications was lower,and the short-term and long-term prognosis was good.展开更多
This study proposes and systematically evaluates an optimized integration of warm surface seawater injection with depressurization for the long-term exploitation of marine natural gas hydrates.By employing comprehensi...This study proposes and systematically evaluates an optimized integration of warm surface seawater injection with depressurization for the long-term exploitation of marine natural gas hydrates.By employing comprehensive multiphysics simulations guided by field data from hydrate production tests in the South China Sea,we pinpoint key operational parameters—such as injection rates,depths,and timings—that notably enhance production efficiency.The results indicate that a 3-phase hydrate reservoir transitions from a free-gas-dominated production stage to a hydrate-decomposition-dominated stage.Moderate warm seawater injection supplies additional heat during the hydrate decomposition phase,thereby enhancing stable production;however,excessively high injection rates can impede the depressurization process.Only injection at an appropriate depth simultaneously balances thermal supplementation and the pressure gradient,leading to higher overall productivity.A“depressurization-driven sensible-heat supply window”is introduced,highlighting that timely seawater injection following initial depressurization prolongs reservoir dissociation dynamics.In this study area,commencing seawater injection at 170 d of depressurization proved optimal.This optimized integration leverages clean and renewable thermal energy,providing essential insights into thermal supplementation strategies with significant implications for sustainable,economically feasible,and efficient commercial-scale hydrate production.展开更多
Hydrogen displays the potential to partially replace pulverized coal injection(PCI)in the blast furnace,and it can reduce CO_(2)emissions.In this paper,a three-dimensional mathematical model of hydrogen and pulverized...Hydrogen displays the potential to partially replace pulverized coal injection(PCI)in the blast furnace,and it can reduce CO_(2)emissions.In this paper,a three-dimensional mathematical model of hydrogen and pulverized coal co-injection in blast furnace tuyere was established through numerical simulation,and the effect of hydrogen injection and oxygen enrichment interaction on pulverized coal combustion and raceway smelting was investigated.The simulation results indicate that when the coal injection rate decreased from 36 to 30t/h and the hydrogen injection increased from 0 to 3600 m^(3)/h,the CO_(2)emissions decreased from 1860 to 1551 kg/t,which represents a16.6%reduction,and the pulverized coal burnout decreased from 70.1%to 63.7%.The heat released from hydrogen combustion can not only promote the volatilization of pulverized coal but also affect the combustion reaction between volatilization and oxygen,which resulted in a decrease in the temperature at the end of the raceway.Co-injection of hydrogen with PCI increased the wall temperature near the upper half part of the raceway and at the outlet of the tuyere,which required a high cooling efficiency to extend the service life of the blast furnace.The increase in oxygen level compensated for the decreased average temperature in the raceway due to hydrogen injection.The increase in the oxygen content by 3%while maintaining constant hydrogen and PCI injection rates increased the burnout and average raceway temperature by 4.2%and 43 K,respectively.The mole fraction of CO and H_(2) production increased by 0.04 and 0.02,respectively.Burnout can be improved through optimization of the particle size distribution of pulverized coal.展开更多
During high-speed rotation,the surface of aeronautic spiral bevel gears will generate significant pressure and viscous forces,which will cause a certain amount of windage power loss and reduce the efficiency of the tr...During high-speed rotation,the surface of aeronautic spiral bevel gears will generate significant pressure and viscous forces,which will cause a certain amount of windage power loss and reduce the efficiency of the transmission system.Based on the computational fluid dynamics,this paper analyzes the windage power loss of a single spiral bevel gear and a spiral bevel gear pair under oil injection lubrication.In addition,the shroud is used to suppress gear windage loss,and the clearance size and opening angle of the designed shroud are optimized.Finally,by comparing and analyzing the experimental results,the following conclusions were obtained:(1)For a single gear,the speed is the most important factor affecting windage loss,followed by the hand of spiral,and rotation direction;(2)For gear pairs,under oil injection lubrication,the input speed has the greatest impact on windage power loss,followed by the influence of oil injection port speed,temperature and oil injection port pressure;(3)Installing a shroud is an effective method to reduce windage power loss;(4)In the pure air phase,the smaller the clearance between the shroud and the gear surface,and the smaller the radial direction between the shroud and the shaft,the better the effect of reducing windage;(5)In the two-phase flow of oil and gas,it is necessary to design oil drainage holes on the shroud to ensure the smooth discharge of lubricating oil and improve the drag reduction effect.展开更多
BACKGROUND Although gastroscopy is a commonly used diagnostic and therapeutic technique,postoperative gastrointestinal dysfunction is prone to occur.Traditional Chinese medicine theory suggests that postoperative gast...BACKGROUND Although gastroscopy is a commonly used diagnostic and therapeutic technique,postoperative gastrointestinal dysfunction is prone to occur.Traditional Chinese medicine theory suggests that postoperative gastrointestinal disorders are related to spleen and stomach weakness.This study hypothesizes that the combination of acupoint application at the Ziwu Liuzhu acupoint and percutaneous acupoint electrical stimulation can promote postoperative gastrointestinal function recovery and alleviate stress reactions.AIM To investigate the effects of acupoint application of Ziwu Liuzhu combined with percutaneous acupoint electrical stimulation on postoperative gastrointestinal function recovery and stress response in patients undergoing gastrointestinal endoscopy surgery.METHODS A total of 120 patients who underwent gastroscopy surgery were selected and treated between October 2024 and January 2025.This study used a stratified block randomization method,and then allocated groups using computer-generated random number sequences(SAS 9.4 software).The groups were divided into two groups:A control group of 60 patients who received routine postoperative intervention measures,and an observation group of 60 patients who received acupuncture point application combined with transcutaneous acupoint electrical CONCLUSION The combination of percutaneous acupoint electrical stimulation in gastroscopy patients has been demonstrated to be both highly safe and effective.The benefits of this approach include the promotion of postoperative gastrointestinal function,the reduction of stress response,the attainment of optimal results,and the enhancement of patient satisfaction.展开更多
文摘BACKGROUND The accuracy of blind intra-articular injections in the shoulder is rather low.Inaccurate injections tend to lead to poorer treatment outcomes.The“Delaware posterior bone touch technique”has shown higher accuracy in young,slender,healthy volunteers than the classical“Cyriax technique”.AIM To investigate whether the Delaware technique would also be more accurate in older patients with capsulitis.METHODS We analyzed the files of 100 consecutive patients with capsulitis who were treated with an intra-articular injection containing a mixture of triamcinolone,lidocaine,and air.After the injection,the shoulder was moved to determine whether a squishing sound could be produced.The squishing sound was interpreted as an accurate injection.The scores with the new Delaware technique were compared against those with the Cyriax technique in a previous study.RESULTS Squishing was heard after 87%of the injections.This was 13%(10%points)more than the 77%in the previous study(P=0.004).CONCLUSION The Delaware technique was significantly more accurate than the Cyriax technique also in middle aged patients with capsulitis.We hypothesize that the difference is caused by a lower risk that a part of the opening of the needle is still outside the capsule.
基金National Natural Science Foundation of China,NO.81774274Project of Jiangsu Provincial Hospital of Traditional Chinese Medicine,NO.Y19058
文摘BACKGROUND Non-steroid anti-inflammatory drugs(NSAIDs)have played a crucial role in the treatment of osteoarthritis,especially in the early stages.However,the cardiovascular risk and adverse gastrointestinal reactions of oral NSAIDs in elderly people cannot be underestimated.Intra-articular injection of NSAIDs may be a new attempt for early knee osteoarthritis treatment.Parecoxib may be a suitable drug for intra-articular injection.AIM To observe the clinical efficacy of the intra-articular injection of parecoxib for early knee osteoarthritis.METHODS Early knee osteoarthritis patients(n=110)were retrospectively analyzed.These patients were divided into three groups:Basic treatment+oral glucosamine(group A,n=37),oral celecoxib+basic treatment+oral glucosamine(group B,n=37),and intra-articular injection of parecoxib+basic treatment+oral glucosamine(group C,n=36).Intra-articular injection of parecoxib was performed once every 2 wk at a dose of 40 mg each time,for three times total.The three groups were compared in terms of visual analogue scale(VAS)scores,Hospital for Special Surgery(HSS)scores and patient satisfaction before and after treatment.The levels of inflammatory cytokines in the synovial fluid were detected in the three groups before and after treatment.RESULTS All patients were followed up for an average of 15.5±2.7 mo.The clinical efficacy was estimated by VAS and HSS scores at 12 mo after treatment.Inflammatory cytokine levels in the synovial fluid were evaluated at 3 mo after treatment.VAS and HSS scores were significantly improved in each group compared with before(P<0.001).There were significant differences among the three groups in VAS and HSS scores(P<0.001).The clinical efficacy of group C was superior to that of groups A and B(P<0.001),while group B outperformed group A in this respect(P<0.001).The patient satisfaction was the highest in group C(P<0.001).After treatment,the levels of tumor necrosis factorα(TNF-α)and interleukin(IL)-6 in the synovial fluid decreased in each group compared with before(P<0.001),while the levels of IL-10 increased(P<0.001).The three groups differed significantly in the levels of TNF-a,IL-6 and IL-10 in the synovial fluid after treatment(P<0.001).CONCLUSION For patients with early knee osteoarthritis,intra-articular injection of parecoxib could effectively improve clinical symptoms.This method may be a reliable alternative for early knee osteoarthritis.
文摘Objective: to explore the long-term therapeutic effect of intra-articular injection of sodium hyaluronate on osteoarthritis and joint function recovery. Methods: the study was conducted according to the principle of grouping and control. The sample is 86 patients with osteoarthritis treated in our hospital. The period starts in April 2019 and ends in April 2021. They were randomly divided into observation group and control group, each with 43 samples. The control group was treated with triamcinolone acetonide, while the observation group was treated with sodium hyaluronate. The therapeutic effect was analyzed from the functional recovery of joints, long-term curative effect, short-term curative effect and probability index of occurrence rate of complications. Results: the analysis of joint function recovery showed that the observation group had obvious advantages over the control group (P < 0.05). Analysis of the long-term curative effect of the patients in the clinic shows that the observation group has a greater advantage than the control group (P < 0.05). The short-term curative effect of the observation group was significantly superior to that of the control group (P < 0.05). The probability of complications in the observation group was lower than that in the control group (P < 0.05). Conclusion: in the clinical treatment of osteoarthritis, sodium hyaluronate injection in the joint cavity has definite curative effect, which can significantly improve the joint function of patients and reduce the probability of complications such as lower limb fatigue, joint pain and swelling, blood pressure and blood glucose rise.
基金supported by 2023 Higher Education Scientific Research Planning Project of China Society of Higher Education(No.23PG0408)2023 Philosophy and Social Science Research Programs in Jiangsu Province(No.2023SJSZ0993)+2 种基金Nantong Science and Technology Project(No.JC2023070)Key Project of Jiangsu Province Education Science 14th Five-Year Plan(Grant No.B-b/2024/02/41)the Open Fund of Advanced Cryptography and System Security Key Laboratory of Sichuan Province(Grant No.SKLACSS-202407).
文摘Large language models(LLMs)have revolutionized AI applications across diverse domains.However,their widespread deployment has introduced critical security vulnerabilities,particularly prompt injection attacks that manipulate model behavior through malicious instructions.Following Kitchenham’s guidelines,this systematic review synthesizes 128 peer-reviewed studies from 2022 to 2025 to provide a unified understanding of this rapidly evolving threat landscape.Our findings reveal a swift progression from simple direct injections to sophisticated multimodal attacks,achieving over 90%success rates against unprotected systems.In response,defense mechanisms show varying effectiveness:input preprocessing achieves 60%–80%detection rates and advanced architectural defenses demonstrate up to 95%protection against known patterns,though significant gaps persist against novel attack vectors.We identified 37 distinct defense approaches across three categories,but standardized evaluation frameworks remain limited.Our analysis attributes these vulnerabilities to fundamental LLM architectural limitations,such as the inability to distinguish instructions from data and attention mechanism vulnerabilities.This highlights critical research directions such as formal verification methods,standardized evaluation protocols,and architectural innovations for inherently secure LLM designs.
文摘Background:Penile augmentation through injectable substances is becoming increasingly common.A growing number of aesthetic clinics are developing penile enlargement procedures using various injectable materials.Although these procedures are now performed in more controlled and medically supervised environments,their long-term outcomes remain poorly understood.The promotion of such medical treatments contributes to an increasing interest among adult males in self-injection as a method to alleviate psychological distress associated with penile size concerns.At the same time,access to injectable substances through unofficial or unregulated sources has become increasingly easy.Tor our knowledge,we report the first documented case of self-injection with Garamycin®(gentamicin)cream,contributing to the literature on the often multidisciplinary management of penile enlargement injections,a field still lacking well-established guidelines.Case Description:This case report describes a young patient who self-injected Garamycin®into the penis for the purpose of enlargement.He presented to our urology department with worsening symptoms,including severe and poorly tolerated pain.His primary request was prompt relief of pain while preserving,as much as possible,the aesthetic appearance and functional integrity of his penis.This case required a multi-stage surgical approach to salvage the penis and preserve both its structural integrity and functional outcome.Conclusions:To our knowledge,this case report documents the first reported instance of Garamycin®injection performed for the purpose of penile enlargement.It provides insight into the clinical course of such penile cream injections,demonstrates that a two-stage scrotal flap can achieve both functional and aesthetic outcomes,and highlights the importance of comprehensive management particularly addressing the traumatic impact of penile deformity secondary to inflammation and/or infection,as well as the body dysmorphic concerns often associated with these cases.
基金supported by JSPS KAKENHI Grant Numbers JP23K28377,JP24H00714,JP25K15109,JP25K03190,JP25K03232,JP22K12157The Telecommunications Advancement Foundation.
文摘While Large Language Models(LLMs)possess the capability to perform a wide range of tasks,security attacks known as prompt injection and jailbreaking remain critical challenges.Existing defense approaches addressing this problem face challenges such as the over-refusal of prompts that contain harmful vocabulary but are semantically benign,and the limited accuracy improvement inmachine learning-based approaches due to the ease of distinguishing benign prompts in existing datasets.Therefore,we propose a multi-LLM agent framework aimed at achieving both the accurate rejection of harmful prompts and appropriate responses to benign prompts.Distinct from prior studies,the proposed method adopts In-Context Learning(ICL)during the learning phase,presenting a novel approach that obviates the need for computationally expensive parameter updates required by conventional fine-tuning.To demonstrate the proposed method’s capability for rapid and easy deployment,this study targets LLMs with insufficient alignment.In the experiments,macro-averaged binary classification metrics were used to comprehensively evaluate harmfulness detection.Experimental results using three LLMs demonstrated that the proposed method achieved performance that surpassed four baselines across all evaluation metrics for the target LLMs,evidencing significant effectiveness with an average improvement of 16.6 points in F1-score compared to the vanilla models.The significance of this study lies in the proposal of a novel approach based on ICL that does not require parameter updates.This framework offers high sustainability in practical deployment,as it allows for the adaptive enhancement of detection performance against continuously evolving attack methods solely through the accumulation of logs,without the necessity of retraining the LLM itself.By mitigating the trade-off between safety and utility,this research contributes to the implementation of robust LLMs.
基金supported by the National Natural Science Foundation of China(No.22305053)the Fundamental Research Funds for the Central Universities,China(No.3072024WD0201)。
文摘Powder-Fueled Water Ramjet Engine(PFWRE)is the most promising powerplant in underwater high-speed propulsion.However,the effect of powder injection mode on its performance and the mechanism of this effect are not well understood.In this paper,a computational framework for multiphase combustion flow is developed and validated.Further,the effects of different injection schemes on flow combustion characteristics and engine performance are evaluated via simulation.Our findings indicate that the dominant recirculation zone in front of the primary water inlet delivers water vapor to the combustor head,providing the necessary oxidant for the ignition and combustion of Al particles.Changing the injection parameters directly affects the flame zone distribution and the ability of the recirculation zone to deliver water vapor,leading to variations in particle ignition delay.The engine combustion efficiency and specific impulse efficiency exhibit a negative correlation with injection height,peaking before declining with increased injection angle.It is shown that particle mixing degree and particle dispersion degree are closely related to engine performance.Enhanced particle mixing in front of the primary water inlet and particle dispersion behind the secondary water inlet are considered favorable approaches to improve engine performance,which promotes the particle combustion process and improves the heat-work conversion efficiency.
基金Supported by Key Project of Science and Technology Program Coconstructed by the Science and Technology Department of the National Administration of Traditional Chinese Medicine of China and Administration of Traditional Chinese Medicine of Zhejiang Province:A Study on the Efficacy and Safety of Danshen(Radix Salviae Miltiorrhizae)in Treating Acute Kidney Injury in Patients with Primary Nephrotic Syndrome(GZY-ZJ-KJ-23085)Basic Research Project of Wenzhou Science and Technology Bureau:the Mechanism of Hypoxia Induicible Factor-1 alpha Down-regulating Angiotensinconverting Enzyme 2 in Proximal Renal Tubular Epithelial Cells Leading to Brush Border Shedding in Early Acute Kidney Injury Induced by Sepsis(Y20240071)。
文摘OBJECTIVE:To assess the clinical effectiveness and safety of Danshen injection(丹参注射液)following immunosuppressive therapy in primary nephrotic syndrome(PNS)with acute kidney injury(AKI)patients.METHODS:PNS with AKI patients selected from nephrotic syndrome inpatients between 2012 and 2022 were divided into two groups according to the treatment regimen:the DS group who were treated with the Danshen injection and the SC group who received supportive care.Propensity score matching was used to balance the confounding factors between the two groups.The outcomes were complete and partial renal function recovery for effectiveness analysis and severe bleeding events for safety analysis.Kaplan-Meier curves and logrank tests were used to compare cumulative recovery rates.Outcome risks were assessed using Cox proportional hazard regression models.RESULTS:The study enrolled 441 patients with PNS and AKI from a population of 3873 inpatients with nephrotic syndrome.Among them,95 received Danshen injection,and 346 received supportive care.After propensity score matching,95 patients in the DS group and 285 patients in the SC group were analyzed.No significant difference was observed in the complete recovery rate for the DS group vs SC group(72.9%vs 65.1%,P=0.130)at 6 months.Compared with the SC group,the DS group was associated with a significantly higher partial recovery rate(71.0%vs 37.5%,P=0.011)at 6 months and all recovery rates(93.4%vs 79.1%,P=0.006)at 6 months.CONCLUSION:In this real-world retrospective study of PNS with AKI patients,Danshen injection following immunosuppressive therapy and prophylactic anticoagulation with low molecular heparin significantly increased 6-month partial renal function recovery and had a safety profile.Further randomized clinical trials are warranted to confirm the benefit of Danshen(Radix Salviae Miltiorrhizae)in these patients.
基金National Natural Science Foundation of China(No.52006181)。
文摘This paper presents the results of free-jet experiments conducted on an internal injection oblique detonation engine in a large-scale hypersonic shock tunnel.To overcome the challenges of non-uniform mixing and the failure of oblique detonation wave initiation when using liquid fuel,a combined strut-wall injection configuration was employed.Initiation was achieved by introducing a bump structure on the wedge.The results demonstrate that this strategy for mixing and initiation effectively establishes the oblique detonation wave combustion flow field.To further investigate the fuel mixing and initiation processes in the oblique detonation engine,three-dimensional numerical simulations consistent with the experimental conditions were carried out using the ReynoldsAveraged Navier-Stokes(RANS)method.The simulation results reveal that the high-speed gas flow generates shock waves as it passes through the central strut and transverse fuel jets.These shock waves are reflected by the wall,forming a series of shocks in the mixing section.The kerosene injected from the strut injectors does not react during the mixing phase.However,due to the influence of the high-temperature boundary layer,the kerosene injected through the wall undergoes precombustion.The separation zone upstream of the bump generates separation shock waves,allowing the multi-wave point to stabilize at a short distance from the leading edge of the wedge.
文摘Objective:To explore the therapeutic effect of double-puncture tympanic membrane puncture and tympanic cavity drug injection in patients with acute secretory otitis media.Methods:A total of 84 patients with acute secretory otitis media admitted to our hospital from June 2024 to June 2025 were selected and randomly divided into two groups by drawing lots.The control group(42 cases)was treated with the traditional single-puncture tympanic membrane puncture and tympanic cavity drug injection method,while the observation group(42 cases)was treated with the double-puncture tympanic membrane puncture and tympanic cavity drug injection method.The therapeutic effects of the two groups were compared.Results:The overall treatment response rate,overall complication rate,time to symptom relief,and improvement in hearing threshold in the observation group were all superior to those in the control group,with statistically significant differences(P<0.05).Conclusion:For acute secretory otitis media,the treatment method of double-puncture tympanic membrane puncture and tympanic cavity drug injection demonstrates definite efficacy,significantly reducing the incidence of complications,accelerating symptom relief,and improving hearing function,making it worthy of promotion.
文摘Objective:To investigate the impact of anti-Müllerian hormone(AMH)levels on the outcomes of intracytoplasmic sperm injection(ICSI)cycles in women of advanced age and also to explore the effect of age on the ICSI results in patients with low AMH levels.Methods:This retrospective cohort study involved 143 infertile couples undergoing ICSI cycles at a fertility clinic in Iran from November 2021 to November 2023.Women aged<37 years with AMH<1 ng/mL and those aged≥37 years were included.A standardized ovarian stimulation protocol was followed,leading to oocyte retrieval and ICSI on mature oocytes.Key oocyte quality indexes,including the maturation rate,fertilization rate,and embryo quality metrics,were evaluated.Poisson regression analyses were also employed to investigate the association between AMH levels and oocyte quality parameters in the advanced age groups,as well as the association between age and oocyte quality parameters in patients with low AMH.Results:We analyzed 143 ICSI cycles from 143 infertile couples.The mean ages of the women and their partners were(38.2±4.7)years and(40.6±5.9)years,respectively,with a median(IQR)AMH level of 0.7(0.4–2.0)ng/mL.Younger women with low AMH levels(<1 ng/mL)showed significantly better outcomes in terms of the number of MⅡ oocytes[adjusted odds ratio(aOR)1.89,95%CI 1.31-2.71;P=0.001],fertilized(2PN)oocytes(aOR 1.97,95%CI 1.36-2.86;P<0.001),embryo number(aOR 2.16,95%CI 1.44-3.24;P<0.001),and embryos suitable for freezing(aOR 2.88,95%CI 1.80-4.61;P<0.001)compared to advanced-age women.Furthermore,among women of advanced age,those with normal AMH levels exhibited a significantly higher number of MⅡ oocyte(aOR 3.55,95%CI 2.31-5.44;P<0.001),fertilized(2PN)oocytes(aOR 3.54,95%CI 2.29-5.49;P<0.001),embryo number(aOR 3.89,95%CI 2.48-6.10;P<0.001),and embryos suitable for freezing(aOR 4.75,95%CI 2.79-8.09;P<0.001)compared to those with low AMH levels.Conclusions:AMH level is a significant predictor of oocyte and embryo number and quality in infertile women of advanced age undergoing ICSI cycles.Our findings suggest that maternal age markedly impacts the quality of oocytes and embryos in low AMHlevel patients.
文摘The increasing integration of cyber-physical components in Industry 4.0 water infrastructures has heightened the risk of false data injection(FDI)attacks,posing critical threats to operational integrity,resource management,and public safety.Traditional detection mechanisms often struggle to generalize across heterogeneous environments or adapt to sophisticated,stealthy threats.To address these challenges,we propose a novel evolutionary optimized transformer-based deep reinforcement learning framework(Evo-Transformer-DRL)designed for robust and adaptive FDI detection in smart water infrastructures.The proposed architecture integrates three powerful paradigms:a transformer encoder for modeling complex temporal dependencies in multivariate time series,a DRL agent for learning optimal decision policies in dynamic environments,and an evolutionary optimizer to fine-tune model hyper-parameters.This synergy enhances detection performance while maintaining adaptability across varying data distributions.Specifically,hyper-parameters of both the transformer and DRL modules are optimized using an improved grey wolf optimizer(IGWO),ensuring a balanced trade-off between detection accuracy and computational efficiency.The model is trained and evaluated on three realistic Industry 4.0 water datasets:secure water treatment(SWaT),water distribution(WADI),and battle of the attack detection algorithms(BATADAL),which capture diverse attack scenarios in smart treatment and distribution systems.Comparative analysis against state-of-the-art baselines including Transformer,DRL,bidirectional encoder representations from transformers(BERT),convolutional neural network(CNN),long short-term memory(LSTM),and support vector machines(SVM)demonstrates that our proposed Evo-Transformer-DRL framework consistently outperforms others in key metrics such as accuracy,recall,area under the curve(AUC),and execution time.Notably,it achieves a maximum detection accuracy of 99.19%,highlighting its strong generalization capability across different testbeds.These results confirm the suitability of our hybrid framework for real-world Industry 4.0 deployment,where rapid adaptation,scalability,and reliability are paramount for securing critical infrastructure systems.
基金approved by the Medical Ethics Committee of the Tel Aviv Sourasky Medical Center Institutional Review Board,approval No.TLV-0674-21.
文摘BACKGROUND Intra-articular hip injections(IAHIs)are commonly used for diagnostic and therapeutic purposes but are often associated with patient anxiety and fear.The disparity between anticipated and experienced pain during IAHIs and the role of preinjection local anesthesia in pain modulation remains unclear.AIM To investigate the difference between anticipated and experienced pain during IAHIs and the impact of pre-injection local anesthesia.METHODS This prospective study enrolled 60 patients undergoing IAHI,30 receiving pre-injection superficial local anesthesia and 30 serving as a control group without pre-injection local anesthesia.Pain levels were assessed using numeric rating scales.RESULTS Patients significantly overestimated anticipated pain compared to experienced pain(6.43±2.48 vs 3.68±2.37,P<0.001).Pre-injection local anesthesia did not significantly reduce experienced pain(3.19±2.38 vs 4.20±2.29,P=0.130).CONCLUSION Patients overestimate anticipated pain during IAHIs.Pre-injection local anesthesia does not reduce experienced pain.
文摘BACKGROUND Knee osteoarthritis(OA)is a degenerative joint disease traditionally viewed through the lens of cartilage degradation.However,emerging evidence positions subchondral bone pathology-particularly bone marrow lesions(BMLs)-as a key contributor to pain,progression,and structural deterioration.Mesenchymal stem cell exhaustion within the osteoarthritic subchondral zone further impairs intrinsic repair mechanisms,reinforcing the rationale for biologic interventions.AIM To evaluate the clinical efficacy of bone marrow aspirate concentrate(BMAC)therapy for knee OA,comparing subchondral vs intra-articular delivery routes,and elucidating the therapeutic impact on symptom relief and structural preservation.METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines,five clinical studies were included-comprising three randomized controlled trials and two prospective cohorts-with pooled data from 298 knees.Data on functional outcomes,imaging findings,and progression to total knee arthroplasty(TKA)were extracted and qualitatively synthesized.RESULTS Subchondral BMAC injections demonstrated superior improvements compared to intra-articular injection or placebo:Knee Injury and Osteoarthritis Outcome Score improved from 49.1±1.9 to 61.2±6.3 at 12 months(P<0.05),Knee Society Score increased from 57±12 to 87.3±12 at two years,and Western Ontario and McMaster Universities Arthritis Index scores showed significant improvement favoring combined approaches.Magnetic resonance imaging analyses revealed mean BML volume regression of 2.1 cm3,with 80%of knees avoiding TKA over 13-year follow-up.Magnetic resonance imaging analyses revealed regression of BMLs and increased cartilage preservation in subchondral-treated knees.Long-term data indicated delayed progression to TKA and biomechanical improvements(e.g.,Hip-Knee-Ankle angle correction).No major adverse events were reported.CONCLUSION Targeting subchondral bone with BMAC addresses underlying OA pathology and may offer disease-modifying potential beyond symptom relief.These findings support a paradigm shift toward whole-joint biologic therapy,positioning the subchondral matrix as a therapeutic epicenter in OA management.
文摘Objective To observe the therapeutic efficacy of warm needling moxibustion plus intra-articular injection of sodium hyaluronate in treating chondromalacia patellae and its effect on inflammatory factors in knee joint fluid.Methods Sixty-eight patients with chondromalacia patellae were randomized into a control group and an observation group,with 34 cases in each group.The control group was treated with intra-articular injection of sodium hyaluronate,while the observation group was given additional warm needling moxibustion treatment.Before and after treatment,the two groups were scored using Western Ontario and McMaster Universities osteoarthritis index(WOMAC)and visual analog scale(VAS),examined by magnetic resonance imaging(MRI)and determined for the levels of nuclear factor-KB(NF-kB),tumor necrosis factor(TNF)-αand interleukin(IL)-1βin knee joint fluid.Clinical efficacy was estimated after treatment.Results The effective rate was higher in the observation group than in the control group(P<0.05).After treatment,the scores of pain,stiffness and daily activities,as well as the general score of WOMAC declined significantly in both groups(all P<0.05),and were lower in the observation group than in the control group(all P<0.05);the time cost for climbing up and down one staircase and VAS score decreased markedly in both groups(all P<0.05),and were shorter or lower in the observation group than in the control group(both P<0.05);the MRI grading showed no significant change in the control group after intervention(P>0.05),while the grading in the observation group showed notable improvement(P<0.05),and was better than that in the control group(P<0.05);the levels of NF-kB and IL-1βin knee joint fluid dropped significantly in the control group after treatment(both P<0.05),while the levels of NF-kB,TNF-αand IL-1βin knee joint fluid all decreased significantly in the observation group(all P<0.05)and were lower than those in the control group(all P<0.05).Conclusion Warm needling moxibustion plus intra-articular injection of sodium hyaluronate can produce definite efficacy in treating chondromalacia patellae;it can mitigate the clinical symptoms,improve the lesion extent of chondromalacia and down-regulate the levels of NF-kB,TNF-αand IL-1βin knee joint fluid.
文摘BACKGROUND A total of 100 patients diagnosed with mixed hemorrhoids from October 2022 to September 2023 in our hospital were randomly divided into groups by dice rolling and compared with the efficacy of different treatment options.AIM To analyze the clinical effect and prognosis of mixed hemorrhoids treated with polidocanol injection combined with automatic elastic thread ligation operation(RPH).METHODS A total of 100 patients with mixed hemorrhoids who visited our hospital from October 2022 to September 2023 were selected and randomly divided into the control group(n=50)and the treatment group(n=50)by rolling the dice.The procedure for prolapse and hemorrhoids(PPH)was adopted in the control group,while polidocanol foam injection+RPH was adopted in the treatment group.The therapeutic effects,operation time,wound healing time,hospital stay,pain situation(24 hours post-operative pain score,first defecation pain score),quality of life(QOL),incidence of complications(post-operative hemorrhage,edema,infection),incidence of anal stenosis 3 months post-operatively and recurrence rate 1 year post-operatively of the two groups were compared.RESULTS Compared with the control group,the total effective rate of treatment group was higher,and the difference was significant(P<0.05).The operation time/wound healing time/hospital stay in the treatment group were shorter than those in the control group(P<0.05).The pain scores at 24 hours after operation/first defecation pain score of the treatment group was significantly lower than those in the control group(P<0.05).After surgery,the QOL scores of the two groups decreased,with the treatment group having higher scores than that of the control group(P<0.05).Compared with the control group,the incidence of postoperative complications in the treatment group was lower,and the difference was significant(P<0.05);However,there was no significant difference in the incidence of postoperative bleeding between the two groups(P>0.05);There was no significant difference in the incidence of anal stenosis 3 months after operation and the recurrence rate 1 year after operation between the two groups(P>0.05).CONCLUSION For patients with mixed hemorrhoids,the therapeutic effect achieved by using polidocanol injection combined with RPH was better.The wounds of the patients healed faster,the postoperative pain was milder,QOL improved,and the incidence of complications was lower,and the short-term and long-term prognosis was good.
基金supported by the National Key R&D Program of China(No.2024YFB4206700)the Joint Geological Funds of the National Natural Science Foundation of China(No.U2244223)+5 种基金the China Scholarship Council Program(No.202404910533)the Guangdong Major Project of Basic and Applied Basic Research(No.2020B0301030003)the China Geological Survey Project(No.DD20211350)the Key Deployment Program of Chinese Academy of Sciences(Nos.YJKYYQ20190043,ZDBS-LY-DQC003,KFZD-SW-422,and ZDRW-ZS-2021-3-1)the Scientific Research and Technology Development Project of China National Petroleum Corporation(No.2022DJ5503)the Supercomputing Laboratory,IGGCAS.
文摘This study proposes and systematically evaluates an optimized integration of warm surface seawater injection with depressurization for the long-term exploitation of marine natural gas hydrates.By employing comprehensive multiphysics simulations guided by field data from hydrate production tests in the South China Sea,we pinpoint key operational parameters—such as injection rates,depths,and timings—that notably enhance production efficiency.The results indicate that a 3-phase hydrate reservoir transitions from a free-gas-dominated production stage to a hydrate-decomposition-dominated stage.Moderate warm seawater injection supplies additional heat during the hydrate decomposition phase,thereby enhancing stable production;however,excessively high injection rates can impede the depressurization process.Only injection at an appropriate depth simultaneously balances thermal supplementation and the pressure gradient,leading to higher overall productivity.A“depressurization-driven sensible-heat supply window”is introduced,highlighting that timely seawater injection following initial depressurization prolongs reservoir dissociation dynamics.In this study area,commencing seawater injection at 170 d of depressurization proved optimal.This optimized integration leverages clean and renewable thermal energy,providing essential insights into thermal supplementation strategies with significant implications for sustainable,economically feasible,and efficient commercial-scale hydrate production.
基金financially supported by the National Natural Science Foundation of China(No.51904026)the Fundamental Research Funds for the Central Universities(No.06500108)。
文摘Hydrogen displays the potential to partially replace pulverized coal injection(PCI)in the blast furnace,and it can reduce CO_(2)emissions.In this paper,a three-dimensional mathematical model of hydrogen and pulverized coal co-injection in blast furnace tuyere was established through numerical simulation,and the effect of hydrogen injection and oxygen enrichment interaction on pulverized coal combustion and raceway smelting was investigated.The simulation results indicate that when the coal injection rate decreased from 36 to 30t/h and the hydrogen injection increased from 0 to 3600 m^(3)/h,the CO_(2)emissions decreased from 1860 to 1551 kg/t,which represents a16.6%reduction,and the pulverized coal burnout decreased from 70.1%to 63.7%.The heat released from hydrogen combustion can not only promote the volatilization of pulverized coal but also affect the combustion reaction between volatilization and oxygen,which resulted in a decrease in the temperature at the end of the raceway.Co-injection of hydrogen with PCI increased the wall temperature near the upper half part of the raceway and at the outlet of the tuyere,which required a high cooling efficiency to extend the service life of the blast furnace.The increase in oxygen level compensated for the decreased average temperature in the raceway due to hydrogen injection.The increase in the oxygen content by 3%while maintaining constant hydrogen and PCI injection rates increased the burnout and average raceway temperature by 4.2%and 43 K,respectively.The mole fraction of CO and H_(2) production increased by 0.04 and 0.02,respectively.Burnout can be improved through optimization of the particle size distribution of pulverized coal.
基金Supported by National Natural Science Foundation of China(Grant Nos.51175422,61973011)Shaanxi Provincial Natural Science Basic Research Plan of China(Grant No.2022JM-195)+1 种基金Fundamental Research Funds for the Central Universities of Chinathe Research Start-up Funds of Hangzhou International Innovation Institute of Beihang University(Grant No.2024KQ036)。
文摘During high-speed rotation,the surface of aeronautic spiral bevel gears will generate significant pressure and viscous forces,which will cause a certain amount of windage power loss and reduce the efficiency of the transmission system.Based on the computational fluid dynamics,this paper analyzes the windage power loss of a single spiral bevel gear and a spiral bevel gear pair under oil injection lubrication.In addition,the shroud is used to suppress gear windage loss,and the clearance size and opening angle of the designed shroud are optimized.Finally,by comparing and analyzing the experimental results,the following conclusions were obtained:(1)For a single gear,the speed is the most important factor affecting windage loss,followed by the hand of spiral,and rotation direction;(2)For gear pairs,under oil injection lubrication,the input speed has the greatest impact on windage power loss,followed by the influence of oil injection port speed,temperature and oil injection port pressure;(3)Installing a shroud is an effective method to reduce windage power loss;(4)In the pure air phase,the smaller the clearance between the shroud and the gear surface,and the smaller the radial direction between the shroud and the shaft,the better the effect of reducing windage;(5)In the two-phase flow of oil and gas,it is necessary to design oil drainage holes on the shroud to ensure the smooth discharge of lubricating oil and improve the drag reduction effect.
基金Supported by Zhejiang Province Traditional Chinese Medicine Science and Technology Plan Project,No.2023ZL230。
文摘BACKGROUND Although gastroscopy is a commonly used diagnostic and therapeutic technique,postoperative gastrointestinal dysfunction is prone to occur.Traditional Chinese medicine theory suggests that postoperative gastrointestinal disorders are related to spleen and stomach weakness.This study hypothesizes that the combination of acupoint application at the Ziwu Liuzhu acupoint and percutaneous acupoint electrical stimulation can promote postoperative gastrointestinal function recovery and alleviate stress reactions.AIM To investigate the effects of acupoint application of Ziwu Liuzhu combined with percutaneous acupoint electrical stimulation on postoperative gastrointestinal function recovery and stress response in patients undergoing gastrointestinal endoscopy surgery.METHODS A total of 120 patients who underwent gastroscopy surgery were selected and treated between October 2024 and January 2025.This study used a stratified block randomization method,and then allocated groups using computer-generated random number sequences(SAS 9.4 software).The groups were divided into two groups:A control group of 60 patients who received routine postoperative intervention measures,and an observation group of 60 patients who received acupuncture point application combined with transcutaneous acupoint electrical CONCLUSION The combination of percutaneous acupoint electrical stimulation in gastroscopy patients has been demonstrated to be both highly safe and effective.The benefits of this approach include the promotion of postoperative gastrointestinal function,the reduction of stress response,the attainment of optimal results,and the enhancement of patient satisfaction.
