BACKGROUND Transplant teams often hesitate to use the right kidney(RK)in living donor(LD)transplants due to the complexities of anastomosing the short,thin-walled right renal veins,which can potentially lead to graft ...BACKGROUND Transplant teams often hesitate to use the right kidney(RK)in living donor(LD)transplants due to the complexities of anastomosing the short,thin-walled right renal veins,which can potentially lead to graft loss or graft dysfunction.Nevertheless,circumstances may arise where selecting the RK over the left kidney(LK)is unavoidable.Consequently,it is crucial to thoroughly examine the implications of such a choice on the overall transplant outcome.AIM To compare transplant outcomes between recipients of RK and LK while examining the factors that influence these outcomes.METHODS We retrospectively analyzed data from adult patients who received LD kidney transplants involving meticulous patient selection and surgical techniques at our center from January 2020 to December 2023.We included all kidney donors who were over 18,fit to donate,and had undergone diethylenetriamine pentaacetic acid split function and/or computed tomography based volumetry.The variables examined comprised donor and recipient demographics,and outcome measures included technical graft loss(TGL),delayed or slow graft function(SGF),and post-transplant serum creatinine(SC)trends.We used a logistic regression model to assess the likelihood of adverse outcomes considering the donor kidney side.RESULTS Of the 250 transplants performed during the period,56(22%)were RKs.The recipient demographics and transplant factors were comparable for the right and LKs,except that the donor warm and cold ischemia time were shorter for RKs.TGL and SGF each occurred in 2%(n=1)of RKs and 0.5%(n=1)of LKs,the difference being insignificant.These complications,however,were not related to the venous anastomosis.One RK(2%)developed delayed graft function after 48 hours,which was attributable to postoperative hypoxia rather than the surgical technique.The post-transplant SC trend and mean SC at the last follow-up were similar across both kidney sides.CONCLUSION The donor kidney side has little impact on post-transplant adverse events and graft function in LD transplants,provided that careful patient selection and precise surgical techniques are employed.展开更多
Diabetic cardiomyopathy(DCM)has long been considered as a left ventricular(LV)disease with diastolic dysfunction preceding systolic dysfunction in diabetes.However,it is increasingly recognized that the right ventricl...Diabetic cardiomyopathy(DCM)has long been considered as a left ventricular(LV)disease with diastolic dysfunction preceding systolic dysfunction in diabetes.However,it is increasingly recognized that the right ventricle(RV)is also affected by diabetes and may be independently responsible for adverse outcomes in diabetic patients with or without LV failure.Yu et al conducted a 30-week longitudinal evaluation of biventricular function and pathology in OVE26 diabetic mice and revealed early diastolic dysfunction preceding systolic decline,suggesting that early LV diastolic impairment precedes the later onset of systolic dysfunction.With age,the animals developed fibrosis,hypertrophy,and pulmonary arterial hypertension in the RV.The purpose of this editorial is to contextualize these findings within the existing literature by highlighting the interplay between cardiac chambers and the vasculature.We also seek to reiterate that DCM is a condition extending beyond left ventricular dysfunction.As the authors note,the right side of the heart may remain"the forgotten ventricle"in diabetic patients.We hope that the mechanisms discussed in this paper will help researchers to understand the pathogenesis of cardiovascular disease in this context and encourage clinicians to be more attentive to the associated clinical symptoms.展开更多
To the Editor:Theoretically,autologous liver transplantation is posited as a treatment for patients experiencing traumatic liver rupture.How-ever,the procedural complexity and its infrequent application by the medical...To the Editor:Theoretically,autologous liver transplantation is posited as a treatment for patients experiencing traumatic liver rupture.How-ever,the procedural complexity and its infrequent application by the medical community have resulted in a lack of documented suc-cesses.This report presented the efficacious intervention in a pa-tient presenting with polytraumatic injuries involving the thoracic and abdominal regions,namely right-sided hemothorax,contusion and hematoma of the right lung,splenic rupture,lateral damage to the common bile duct,disruption of the left portal vein branch and left hepatic duct,incisions in the hepatic segments IV,V,VI,VII,and VIII,laceration of the right adrenal gland,rupture of the right hepatic venous trunk and retro-hepatic inferior vena cava(RHIVC),and pancreatic hematoma.展开更多
Among the “three data rights,” the data utilization right has been persistently overlooked, and is similar to a neglected “middle child” in the context of the data rights family. However, it is precisely during th...Among the “three data rights,” the data utilization right has been persistently overlooked, and is similar to a neglected “middle child” in the context of the data rights family. However, it is precisely during the stages of processing and utilization that data undergoes its transformations and where its economic value is ultimately created. A series of recent policy documents on treating data as a factor of production have emphasized that the building of a scientific data property rights system requires a fair and efficient mechanism for benefit distribution, which provides reasonable preference for creators of data value and use value in terms of the income generated by data elements. Constrained by the inertial thinking of property right logic, the data utilization right is often regarded as a “transitional fulcrum” wherein the holders of data resources have to authorize the operators of data products to realize data value thereby. In the future structural design and implementation of the coordination mechanism for the property right system against the backdrop of the data factor-oriented reform, the establishment of data processing and utilization as an independent right will require the implementation of two core initiatives: first, attaching importance to the independent protection of the benefit distribution;second, implementing risk regulation for data security through optimization of governance. These two initiatives will serve as the key for optimizing the data factor governance system and accelerating the release of data value.展开更多
Patient-specific finite element analysis(FEA)is a promising tool for noninvasive quantification of cardiac and vascular structural mechanics in vivo.However,inverse material property identification using FEA,which req...Patient-specific finite element analysis(FEA)is a promising tool for noninvasive quantification of cardiac and vascular structural mechanics in vivo.However,inverse material property identification using FEA,which requires iteratively solving nonlinear hyperelasticity problems,is computationally expensive which limits the ability to provide timely patient-specific insights to clinicians.In this study,we present an inverse material parameter identification strategy that integrates deep neural networks(DNNs)with FEA,namely inverse DNN-FEA.In this framework,a DNN encodes the spatial distribution of material parameters and effectively regularizes the inverse solution,which aims to reduce susceptibility to local optima that often arise in heterogeneous nonlinear hyperelastic problems.Consequently,inverse DNN-FEA enables identification of material parameters at the element level.For validation,we applied DNN-FEA to identify four spatially varying passive Holzapfel-Ogden material parameters of the left ventricular myocardium in synthetic benchmark cases with a clinically-derived geometry.To evaluate the benefit of DNN integration,a baseline FEA-only solver implemented in PyTorch was used for comparison.Results demonstrated that DNN-FEA achieved substantially lower average errors in parameter identification compared to FEA(case 1,DNN-FEA:0.37%~2.15%vs.FEA:2.64%~12.91%).The results also demonstrate that the same DNN architecture is capable of identifying a different spatial material property distribution(case 2,DNN-FEA:0.03%~0.60%vs.FEA:0.93%~16.25%).These findings suggest that DNN-FEA provides an accurate framework for inverse identification of heterogeneous myocardial material properties.This approach may facilitate future applications in patient-specific modeling based on in vivo clinical imaging and could be extended to other biomechanical simulation problems.展开更多
I.INTRODUCTION Against the backdrop of profound transformations in the global energy landscape,China,as the world's largest energy producer and consumer,faces multiple challenges,including energy security,energy t...I.INTRODUCTION Against the backdrop of profound transformations in the global energy landscape,China,as the world's largest energy producer and consumer,faces multiple challenges,including energy security,energy transition,and sustainable development.To address these challenges,the Chinese government has formulated a strategic plan to build a unified national energy market and create a new framework for the energy sector.Article 42 of the Energy Law of the People's Republic of China(hereinafter referred to as the Energy Law)explicitly requires the building of a unified national energy trading market and the improvement of transaction mechanisms and rules.展开更多
With the high older-related accident ratio and increasing population aging problem, understanding older drivers＇ driving behaviors has become more and more important for building and improving transportation system. ...With the high older-related accident ratio and increasing population aging problem, understanding older drivers＇ driving behaviors has become more and more important for building and improving transportation system. This paper examines older driver＇s driving behavior which includes road selection, left/right turn and driving speed. A two-month experiment of 108 participants was carried out in Aichi Prefecture, Japan. Since apparently contradictory statements were often drawn in survey-based or simulators-based studies, this study collected not only drivers＇ basic information but also GPS data. Analysis of road selection demonstrates that older drivers are reluctant to drive on expressway not only in short trips but also in long trips. The present study did not find significant difference be- tween older drivers and others while turning at the intersections. To investigate the impact factors on driving speed, a random-effects regression model is constructed with explan- atory variables including age, gender, road types and the interaction terms between age and road types. Compared with other variables, it fails to find that age （60 years old or over） has significant impact on driving speed. Moreover, the results reflect that older drivers drive even faster than others at particular road types： national road and ordinary municipal road. The results in this study are expected to help improve transportation planning and develop driving assistance systems for older drivers.展开更多
Objective To search for effective methods of acupuncture therapy in treating chronic diarrhea. Methods Treatments were carried out on 52 patients with chronic diarrhea by using the left ascending and right descending ...Objective To search for effective methods of acupuncture therapy in treating chronic diarrhea. Methods Treatments were carried out on 52 patients with chronic diarrhea by using the left ascending and right descending method. Three acupoints at the left side, namely Xiàng （陷谷 ST 43）, Zúsānl （足三 里 ST 36） and Qūchí （曲池 LI 11）, and Lièqūe （列缺 LU 7） at the right side were selected, moxibustion was also carried out according to syndrome differentiation. The operation of left ascending and right descending method were firstly left and then right, first down and then up, firstly four limbs and then abdomen; the thumb moved backward and the index finger moved forward during needle twisting for the acupoints at the left side, and it was on the contrary for the right side. The needles were retained for 1 h for deficiency, and the pinholes were pressed when the needles were withdrawn; the needles were retained for 0.5 h for excess syndrome and newly-contracted disease, and the pinholes were enlarged by shaking the needles when they were withdrawn. Except that the needling was carried out twice a day for the patients with desertion following chronic diarrhea, the needling was carried out once a day, five days as a treatment course, the patients were given an interval for two days after every two treatment courses, and the therapeutic effect was observed after five treatment courses. Results totally 36 patients were cured, among which 11 patients were cured after one treatment course, 19 patients were cured after two to three treatment courses and 6 patients were cured after four to five treatment courses; eight patients were improved; six patients were not cured; the total effective rate was 88.0%. Conclusion the acupuncture with left ascending and right descending method has satisfactory therapeutic effect in treating chronic diarrhea.展开更多
The colon is derived from the embryological midgut and hindgut separately,with the right colon and left colon having different features with regards to both anatomical and physiological characteristics.Cancers located...The colon is derived from the embryological midgut and hindgut separately,with the right colon and left colon having different features with regards to both anatomical and physiological characteristics.Cancers located in the right and left colon are referred to as right colon cancer(RCC) and left colon cancer(LCC),respectively,based on their apparent anatomical positions.Increasing evidence supports the notion that not only are there differences in treatment strategies when dealing with RCC and LCC,but molecular features also vary between them,not to mention the distinguishing clinical manifestations.Disease-free survival after radical surgery of both RCC and LCC are similar.In the treatment of RCC,the benefit gained from adjuvant FOLFIRI chemotherapy is superior,or at least similar,to LCC,but inferior to LCC if FOLFOX regimen is applied.On the other hand,metastatic LCC exhibits longer survival than that of RCC in a palliative chemotherapy setting.For KRAS wild-type cancers,LCC benefits more from cetuximab treatment than RCC.Moreover,advanced LCC shows a higher sensitivity to bevacizumab treatment in comparison with advanced RCC.Significant varieties exist at the molecular level between RCC and LCC,which may serve as the cause of all apparent differences.With respect to carcinogenesis mechanisms,RCC is associated with known gene types,such as MMR,KRAS,BRAF,and mi RNA-31,while LCC is associated with CIN,p53,NRAS,mi RNA-146 a,mi RNA-147 b,and mi RNA-1288.Regarding protein expression,RCC is related to GNAS,NQO1,telomerase activity,P-PDH,and annexin A10,while LCC is related to Topo I,TS,and EGFR.In addition,separated pathways dominate progressionto relapse in RCC and LCC.Therefore,RCC and LCC should be regarded as two heterogeneous entities,with this heterogeneity being used to stratify patients in order for them to have the optimal,current,and novel therapeutic strategies in clinical practice.Additional research is needed to uncover further differences between RCC and LCC.展开更多
Presented in this paper are 3 cases of hemorrhage of ascending aorta and left ventricle after open heart surgery treated by extracardial bypass in our hospital from Oct. 1994 to Dec. 1995. Remained aneurysmal wall enc...Presented in this paper are 3 cases of hemorrhage of ascending aorta and left ventricle after open heart surgery treated by extracardial bypass in our hospital from Oct. 1994 to Dec. 1995. Remained aneurysmal wall enclosing conduit graft was used as a sac bypassed to right atrium to form a extracardial left-toright shunt in order to control bleeding and the results turned out to be satisfactory. The bypass and hemodynamically ignorable shunt can close spontaneously without complications with recovery of coagulation system. The technique may find wide application in clinical practice.展开更多
AIM To explore the differences in the responses of left-sided colorectal cancer(LSCRC) and right-sided colon cancer(RSCC) to traditional Chinese medicine(TCM).METHODS Patients with postoperative stage I-III colorectal...AIM To explore the differences in the responses of left-sided colorectal cancer(LSCRC) and right-sided colon cancer(RSCC) to traditional Chinese medicine(TCM).METHODS Patients with postoperative stage I-III colorectal cancer(CRC) were enrolled and divided into the LSCRC with or without TCM and RSCC with or without TCM groups depending on the primary tumor side and TCM administration. Patients in the TCM group were given TCM for at least 6 mo. Our research adopted diseasefree survival(DFS) as the primary endpoint. We applied a Cox proportional hazards regression model for the multivariate factor analysis using Stata 12.0 and SPSS 22.0 software for data analysis.RESULTS Of the 817 patients included in our study, 617 had LSCRC(TCM group, n = 404; Non-TCM group, n = 213), and 200 had RSCC(TCM group, n = 132; NonTCM group, n = 68). The 6-year DFS for patients with LSCRC was 56.95% in the TCM group and 41.50% in the Non-TCM group(P = 0.000). For patients with RSCC, the 6-year DFS was 52.92% in the TCM group and 37.19% in the Non-TCM group(P = 0.003). Differences between LSCRC and RSCC were not statistically significant regardless of TCM ingestion.CONCLUSION Patients with either LSCRC or RSCC and who took TCM experienced longer DFS; furthermore, patients with RSCC benefited more from TCM in DFS.展开更多
Based on the ABCD matrix formalism,the propagation property of an Airy beam from right-handed material（RHM） to left-handed material（LHM） is investigated.The result shows that when the Airy beam propagates in the L...Based on the ABCD matrix formalism,the propagation property of an Airy beam from right-handed material（RHM） to left-handed material（LHM） is investigated.The result shows that when the Airy beam propagates in the LHM,the intensity self-bending due to its propagation in the RHM can be compensated.In particular,if the propagation distance in the RHM is equal to that in the LHM and the refractive index of the LHM is n L =-1,the transverse intensity distribution of the Airy beam can return to its original state.展开更多
In this study, we investigated the changes in the right-to-left shunt (RLS) of the patent foramen ovale (PFO) at different phases of the Valsalva maneuver and analyzed the possible mechanisms. The study population con...In this study, we investigated the changes in the right-to-left shunt (RLS) of the patent foramen ovale (PFO) at different phases of the Valsalva maneuver and analyzed the possible mechanisms. The study population consisted of 57 patients with symptoms highly suggestive of a PFO. These patients had been diagnosed with apsychia, migraine with aura, cerebral infarction, transient ischemic attack (TIA), and cerebral ischemia with unknown cause. Routine echocardiography was performed in all patients to rule out a cardiac malformation. Contrast-transcranial Doppler (c-TCD) and contrast-enhanced transthoracic echocardiography (c-TTE) were used to visualize and quantify the RLS. The standard apical four chamber view was used to observe the changes of E peak, A peak, and velocity-time integral (VTI) ratio of tricuspid blood flow during the strain phase and release phase of the Valsalva maneuver. Paired t-test was used to compare E peak, A peak, and VTI ratio of tricuspid blood flow during the different phases. The right-to-left shunt across the PFO (PFO-RLS) was graded in the two phases and compared by Kruskal-Wallis test. Compared with the strain phase of the Valsalva maneuver, the parameters of E, A, and VTI in diastolic period in patients with PFO-RLS at the release phase were significantly increased [54.30 ± 13.65 cm/s vs 100.35 ± 21.11 cm/s, 42.21 ± 12.32 cm/s vs 57.30 ± 18.88 cm/s, 10.34 ± 3.27 cm/s vs 19.58 ± 4.56 cm/s, respectively], and the difference was statistically significant. The positive consequence of PFO-RLS, as diagnosed by c-TTE with the Valsalva maneuver at the release phase of the Valsalva maneuver, was significantly higher than that at the strain phase of the Valsalva maneuver. At the beginning of release phase of the Valsalva maneuver, decreased intrathoracic pressure led to increased venous backflow into the right atrium. Thus, high-velocity blood flow rapidly pushed the PFO open, which resulted in a significant increase in the PFO-RLS. Therefore, the increase of the PFO-RLS during the Valsalva maneuver is caused by the impact of high-velocity blood flow the PFO.展开更多
A closed linear relation T in a Banach space X is called left(resp. right) Fredholm if it is upper(resp. lower) semi Fredholm and its range(resp. null space) is topologically complemented in X. We say that T is left(r...A closed linear relation T in a Banach space X is called left(resp. right) Fredholm if it is upper(resp. lower) semi Fredholm and its range(resp. null space) is topologically complemented in X. We say that T is left(resp. right) Browder if it is left(resp. right)Fredholm and has a finite ascent(resp. descent). In this paper, we analyze the stability of the left(resp. right) Fredholm and the left(resp. right) Browder linear relations under commuting Riesz operator perturbations. Recent results of Zivkovic et al. to the case of bounded operators are covered.展开更多
AIM To analyze the outcomes of living-donor liver transplantation(LDLT) using left-lobe(LL) or right-lobe(RL) small-for-size(SFS) grafts.METHODS Prospectively collected data of adult patients who underwent LDLT at our...AIM To analyze the outcomes of living-donor liver transplantation(LDLT) using left-lobe(LL) or right-lobe(RL) small-for-size(SFS) grafts.METHODS Prospectively collected data of adult patients who underwent LDLT at our hospital in the period from January 2003 to December 2013 were reviewed. The patients were divided into the RL-LDLT group and the LL-LDLT group. The two groups were compared in terms of short-and long-term outcomes, including incidence of postoperative complication, graft function, graft survival, and patient survival. A SFS graft was defined as a graft with a ratio of graft weight(GW) to recipient standard liver volume(RSLV)(GW/RSLV) of < 50%. The Urata formula was used to estimate RSLV.RESULTS Totally 218 patients were included for analysis, with 199 patients in the RL-LDLT group and 19 patients in the LL-LDLT group. The two groups were similar in terms of age(median, 53 years in the RL-LDLT group and 52 years in the LL-LDLT group, P = 0.997) but had significantly different ratios of men to women(165:34 in the RL-LDLT group and 8:11 in the LL-LDLT group, P < 0.0001). The two groups were also significantly different in GW(P < 0.0001), GW/RSLV(P < 0.0001), and graft cold ischemic time(P = 0.007). When it comes to postoperative complication, the groups were comparable(P = 0.105). Five patients died in hospital,4(2%) in the RL-LDLT group and 1(5.3%) in the LLLDLT group(P = 0.918). There were 38 graft losses, 33(16.6%) in the RL-LDLT group and 5(26.3%) in the LL-LDLT group(P = 0.452). The 5-year graft survival rate was significantly better in the RL-LDLT group(95.2% vs 89.5%, P = 0.049). The two groups had similar 5-year patient survival rates(RL-LDLT: 86.8%, LL-LDLT: 89.5%, P = 0.476).CONCLUSION The use of SFS graft in LDLT requires careful tailormade surgical planning and meticulous operation. LLLDLT can be a good alternative to RL-LDLT with similar recipient outcomes but a lower donor risk. Further research into different patient conditions is needed in order to validate the use of LL graft.展开更多
专家共识作为临床实践指南的重要补充,在证据不足或存在争议时支持临床决策。与临床实践指南相比,专家共识的呈现更具有多样性。目前,尚无针对临床和公共卫生决策的专家共识报告规范(reporting guideline)。RIGHT(Reporting Items for P...专家共识作为临床实践指南的重要补充,在证据不足或存在争议时支持临床决策。与临床实践指南相比,专家共识的呈现更具有多样性。目前,尚无针对临床和公共卫生决策的专家共识报告规范(reporting guideline)。RIGHT(Reporting Items for Practice Guidelines in Healthcare)清单是目前国际最常用的指南报告规范,常用于专家共识的写作参考。然而,RIGHT清单不包括共识形成方法的部分;而ACCORD(ACcurate COnsensus Reporting Document)清单虽然包含共识形成方法的报告要求,但不包含推荐意见的报告规范。因此,本文综合RIGHT和ACCORD两个报告清单,提出综合记忆框架(TIMER-DO),帮助作者综合两部国际通用的报告规范,完成专家共识的规范化报告。展开更多
Levitation chassis, as an extremely important component of maglev vehicles, provides functions of transmitting levitation force and steering force, and directly affects the safety performance of the vehicle. Based on ...Levitation chassis, as an extremely important component of maglev vehicles, provides functions of transmitting levitation force and steering force, and directly affects the safety performance of the vehicle. Based on the vertical dynamics model of the levitation chassis, kinetic equations of the model are established, and a simulation program is designed to analyze the structural decoupling function of the chassis, especially under the influence of elastic constraints between the left and right modules, which are exclusively owned by maglev vehicles. A finite element model of the levitation chassis based on left-right decoupling is constructed. Analysis results of the model show that the mechanical properties of the chassis tailored for the vehicle meet the design requirements, and the stiffness and strength is adequate to bear the weight of the whole vehicle.展开更多
Two types of dual periodic circuits are introduced. The distributions of passbands and stopbands are generated from their dispersion relationships. Based on the study, Brillouin diagrams of three representative specia...Two types of dual periodic circuits are introduced. The distributions of passbands and stopbands are generated from their dispersion relationships. Based on the study, Brillouin diagrams of three representative special cases are drawn; S parameters of these three cases are simulated by Aglient ADS; the S parameters of one of the three cases are verified by an experiment. The phase characteristics are compared with those generated from the dispersion relationship. The theoretical analysis and the experimental verification show that both types of the periodic structures can behave as electromagnetic band gap （EBG） structures, right-handed structures （RHS）, and left-handed structures （LHS）, when they operate at different frequency ranges. Thus, the possibility of a physical structure showing these three different characteristics at different frequency ranges is proven.展开更多
文摘BACKGROUND Transplant teams often hesitate to use the right kidney(RK)in living donor(LD)transplants due to the complexities of anastomosing the short,thin-walled right renal veins,which can potentially lead to graft loss or graft dysfunction.Nevertheless,circumstances may arise where selecting the RK over the left kidney(LK)is unavoidable.Consequently,it is crucial to thoroughly examine the implications of such a choice on the overall transplant outcome.AIM To compare transplant outcomes between recipients of RK and LK while examining the factors that influence these outcomes.METHODS We retrospectively analyzed data from adult patients who received LD kidney transplants involving meticulous patient selection and surgical techniques at our center from January 2020 to December 2023.We included all kidney donors who were over 18,fit to donate,and had undergone diethylenetriamine pentaacetic acid split function and/or computed tomography based volumetry.The variables examined comprised donor and recipient demographics,and outcome measures included technical graft loss(TGL),delayed or slow graft function(SGF),and post-transplant serum creatinine(SC)trends.We used a logistic regression model to assess the likelihood of adverse outcomes considering the donor kidney side.RESULTS Of the 250 transplants performed during the period,56(22%)were RKs.The recipient demographics and transplant factors were comparable for the right and LKs,except that the donor warm and cold ischemia time were shorter for RKs.TGL and SGF each occurred in 2%(n=1)of RKs and 0.5%(n=1)of LKs,the difference being insignificant.These complications,however,were not related to the venous anastomosis.One RK(2%)developed delayed graft function after 48 hours,which was attributable to postoperative hypoxia rather than the surgical technique.The post-transplant SC trend and mean SC at the last follow-up were similar across both kidney sides.CONCLUSION The donor kidney side has little impact on post-transplant adverse events and graft function in LD transplants,provided that careful patient selection and precise surgical techniques are employed.
文摘Diabetic cardiomyopathy(DCM)has long been considered as a left ventricular(LV)disease with diastolic dysfunction preceding systolic dysfunction in diabetes.However,it is increasingly recognized that the right ventricle(RV)is also affected by diabetes and may be independently responsible for adverse outcomes in diabetic patients with or without LV failure.Yu et al conducted a 30-week longitudinal evaluation of biventricular function and pathology in OVE26 diabetic mice and revealed early diastolic dysfunction preceding systolic decline,suggesting that early LV diastolic impairment precedes the later onset of systolic dysfunction.With age,the animals developed fibrosis,hypertrophy,and pulmonary arterial hypertension in the RV.The purpose of this editorial is to contextualize these findings within the existing literature by highlighting the interplay between cardiac chambers and the vasculature.We also seek to reiterate that DCM is a condition extending beyond left ventricular dysfunction.As the authors note,the right side of the heart may remain"the forgotten ventricle"in diabetic patients.We hope that the mechanisms discussed in this paper will help researchers to understand the pathogenesis of cardiovascular disease in this context and encourage clinicians to be more attentive to the associated clinical symptoms.
基金supported by a grant from the Climbing Project for Medical Talent of Zhongnan Hospital,Wuhan University(PDJH202215).
文摘To the Editor:Theoretically,autologous liver transplantation is posited as a treatment for patients experiencing traumatic liver rupture.How-ever,the procedural complexity and its infrequent application by the medical community have resulted in a lack of documented suc-cesses.This report presented the efficacious intervention in a pa-tient presenting with polytraumatic injuries involving the thoracic and abdominal regions,namely right-sided hemothorax,contusion and hematoma of the right lung,splenic rupture,lateral damage to the common bile duct,disruption of the left portal vein branch and left hepatic duct,incisions in the hepatic segments IV,V,VI,VII,and VIII,laceration of the right adrenal gland,rupture of the right hepatic venous trunk and retro-hepatic inferior vena cava(RHIVC),and pancreatic hematoma.
文摘Among the “three data rights,” the data utilization right has been persistently overlooked, and is similar to a neglected “middle child” in the context of the data rights family. However, it is precisely during the stages of processing and utilization that data undergoes its transformations and where its economic value is ultimately created. A series of recent policy documents on treating data as a factor of production have emphasized that the building of a scientific data property rights system requires a fair and efficient mechanism for benefit distribution, which provides reasonable preference for creators of data value and use value in terms of the income generated by data elements. Constrained by the inertial thinking of property right logic, the data utilization right is often regarded as a “transitional fulcrum” wherein the holders of data resources have to authorize the operators of data products to realize data value thereby. In the future structural design and implementation of the coordination mechanism for the property right system against the backdrop of the data factor-oriented reform, the establishment of data processing and utilization as an independent right will require the implementation of two core initiatives: first, attaching importance to the independent protection of the benefit distribution;second, implementing risk regulation for data security through optimization of governance. These two initiatives will serve as the key for optimizing the data factor governance system and accelerating the release of data value.
基金supported in part by the National Science Foundation under GrantsDMS 2436630 and 2436629.
文摘Patient-specific finite element analysis(FEA)is a promising tool for noninvasive quantification of cardiac and vascular structural mechanics in vivo.However,inverse material property identification using FEA,which requires iteratively solving nonlinear hyperelasticity problems,is computationally expensive which limits the ability to provide timely patient-specific insights to clinicians.In this study,we present an inverse material parameter identification strategy that integrates deep neural networks(DNNs)with FEA,namely inverse DNN-FEA.In this framework,a DNN encodes the spatial distribution of material parameters and effectively regularizes the inverse solution,which aims to reduce susceptibility to local optima that often arise in heterogeneous nonlinear hyperelastic problems.Consequently,inverse DNN-FEA enables identification of material parameters at the element level.For validation,we applied DNN-FEA to identify four spatially varying passive Holzapfel-Ogden material parameters of the left ventricular myocardium in synthetic benchmark cases with a clinically-derived geometry.To evaluate the benefit of DNN integration,a baseline FEA-only solver implemented in PyTorch was used for comparison.Results demonstrated that DNN-FEA achieved substantially lower average errors in parameter identification compared to FEA(case 1,DNN-FEA:0.37%~2.15%vs.FEA:2.64%~12.91%).The results also demonstrate that the same DNN architecture is capable of identifying a different spatial material property distribution(case 2,DNN-FEA:0.03%~0.60%vs.FEA:0.93%~16.25%).These findings suggest that DNN-FEA provides an accurate framework for inverse identification of heterogeneous myocardial material properties.This approach may facilitate future applications in patient-specific modeling based on in vivo clinical imaging and could be extended to other biomechanical simulation problems.
基金research result of the Chongqing Social Science Fund Project,entitled Legal Pathways for the Governance Optimization of Financial Holding Companies(No.21SKJD036).
文摘I.INTRODUCTION Against the backdrop of profound transformations in the global energy landscape,China,as the world's largest energy producer and consumer,faces multiple challenges,including energy security,energy transition,and sustainable development.To address these challenges,the Chinese government has formulated a strategic plan to build a unified national energy market and create a new framework for the energy sector.Article 42 of the Energy Law of the People's Republic of China(hereinafter referred to as the Energy Law)explicitly requires the building of a unified national energy trading market and the improvement of transaction mechanisms and rules.
文摘With the high older-related accident ratio and increasing population aging problem, understanding older drivers＇ driving behaviors has become more and more important for building and improving transportation system. This paper examines older driver＇s driving behavior which includes road selection, left/right turn and driving speed. A two-month experiment of 108 participants was carried out in Aichi Prefecture, Japan. Since apparently contradictory statements were often drawn in survey-based or simulators-based studies, this study collected not only drivers＇ basic information but also GPS data. Analysis of road selection demonstrates that older drivers are reluctant to drive on expressway not only in short trips but also in long trips. The present study did not find significant difference be- tween older drivers and others while turning at the intersections. To investigate the impact factors on driving speed, a random-effects regression model is constructed with explan- atory variables including age, gender, road types and the interaction terms between age and road types. Compared with other variables, it fails to find that age （60 years old or over） has significant impact on driving speed. Moreover, the results reflect that older drivers drive even faster than others at particular road types： national road and ordinary municipal road. The results in this study are expected to help improve transportation planning and develop driving assistance systems for older drivers.
文摘Objective To search for effective methods of acupuncture therapy in treating chronic diarrhea. Methods Treatments were carried out on 52 patients with chronic diarrhea by using the left ascending and right descending method. Three acupoints at the left side, namely Xiàng （陷谷 ST 43）, Zúsānl （足三 里 ST 36） and Qūchí （曲池 LI 11）, and Lièqūe （列缺 LU 7） at the right side were selected, moxibustion was also carried out according to syndrome differentiation. The operation of left ascending and right descending method were firstly left and then right, first down and then up, firstly four limbs and then abdomen; the thumb moved backward and the index finger moved forward during needle twisting for the acupoints at the left side, and it was on the contrary for the right side. The needles were retained for 1 h for deficiency, and the pinholes were pressed when the needles were withdrawn; the needles were retained for 0.5 h for excess syndrome and newly-contracted disease, and the pinholes were enlarged by shaking the needles when they were withdrawn. Except that the needling was carried out twice a day for the patients with desertion following chronic diarrhea, the needling was carried out once a day, five days as a treatment course, the patients were given an interval for two days after every two treatment courses, and the therapeutic effect was observed after five treatment courses. Results totally 36 patients were cured, among which 11 patients were cured after one treatment course, 19 patients were cured after two to three treatment courses and 6 patients were cured after four to five treatment courses; eight patients were improved; six patients were not cured; the total effective rate was 88.0%. Conclusion the acupuncture with left ascending and right descending method has satisfactory therapeutic effect in treating chronic diarrhea.
基金Supported by Grants from Key Projects in the National Science and Technology Pillar Program during the Twelfth Five-year Plan Period,No.2014BAI09B07grants from the National Natural Science Foundation of China,No.81101580 and No.81201640
文摘The colon is derived from the embryological midgut and hindgut separately,with the right colon and left colon having different features with regards to both anatomical and physiological characteristics.Cancers located in the right and left colon are referred to as right colon cancer(RCC) and left colon cancer(LCC),respectively,based on their apparent anatomical positions.Increasing evidence supports the notion that not only are there differences in treatment strategies when dealing with RCC and LCC,but molecular features also vary between them,not to mention the distinguishing clinical manifestations.Disease-free survival after radical surgery of both RCC and LCC are similar.In the treatment of RCC,the benefit gained from adjuvant FOLFIRI chemotherapy is superior,or at least similar,to LCC,but inferior to LCC if FOLFOX regimen is applied.On the other hand,metastatic LCC exhibits longer survival than that of RCC in a palliative chemotherapy setting.For KRAS wild-type cancers,LCC benefits more from cetuximab treatment than RCC.Moreover,advanced LCC shows a higher sensitivity to bevacizumab treatment in comparison with advanced RCC.Significant varieties exist at the molecular level between RCC and LCC,which may serve as the cause of all apparent differences.With respect to carcinogenesis mechanisms,RCC is associated with known gene types,such as MMR,KRAS,BRAF,and mi RNA-31,while LCC is associated with CIN,p53,NRAS,mi RNA-146 a,mi RNA-147 b,and mi RNA-1288.Regarding protein expression,RCC is related to GNAS,NQO1,telomerase activity,P-PDH,and annexin A10,while LCC is related to Topo I,TS,and EGFR.In addition,separated pathways dominate progressionto relapse in RCC and LCC.Therefore,RCC and LCC should be regarded as two heterogeneous entities,with this heterogeneity being used to stratify patients in order for them to have the optimal,current,and novel therapeutic strategies in clinical practice.Additional research is needed to uncover further differences between RCC and LCC.
文摘Presented in this paper are 3 cases of hemorrhage of ascending aorta and left ventricle after open heart surgery treated by extracardial bypass in our hospital from Oct. 1994 to Dec. 1995. Remained aneurysmal wall enclosing conduit graft was used as a sac bypassed to right atrium to form a extracardial left-toright shunt in order to control bleeding and the results turned out to be satisfactory. The bypass and hemodynamically ignorable shunt can close spontaneously without complications with recovery of coagulation system. The technique may find wide application in clinical practice.
基金Supported by the Scientific Research Foundation of Traditional Chinese Medicine of the Shanghai Health Bureau,No.2014LZ079Athe Scientific Research Plan Project of the Shanghai Science and Technology Committee,No.14401930800the Program of Shanghai Municipal Technology and Education Commission,No.16401970500
文摘AIM To explore the differences in the responses of left-sided colorectal cancer(LSCRC) and right-sided colon cancer(RSCC) to traditional Chinese medicine(TCM).METHODS Patients with postoperative stage I-III colorectal cancer(CRC) were enrolled and divided into the LSCRC with or without TCM and RSCC with or without TCM groups depending on the primary tumor side and TCM administration. Patients in the TCM group were given TCM for at least 6 mo. Our research adopted diseasefree survival(DFS) as the primary endpoint. We applied a Cox proportional hazards regression model for the multivariate factor analysis using Stata 12.0 and SPSS 22.0 software for data analysis.RESULTS Of the 817 patients included in our study, 617 had LSCRC(TCM group, n = 404; Non-TCM group, n = 213), and 200 had RSCC(TCM group, n = 132; NonTCM group, n = 68). The 6-year DFS for patients with LSCRC was 56.95% in the TCM group and 41.50% in the Non-TCM group(P = 0.000). For patients with RSCC, the 6-year DFS was 52.92% in the TCM group and 37.19% in the Non-TCM group(P = 0.003). Differences between LSCRC and RSCC were not statistically significant regardless of TCM ingestion.CONCLUSION Patients with either LSCRC or RSCC and who took TCM experienced longer DFS; furthermore, patients with RSCC benefited more from TCM in DFS.
基金Project supported by the National Natural Science Foundation of China (Grant Nos. 60977068,61178015 and 11102100)the Youth Foundation of Sanming University,China (Grant No. B201008/Q)
文摘Based on the ABCD matrix formalism,the propagation property of an Airy beam from right-handed material（RHM） to left-handed material（LHM） is investigated.The result shows that when the Airy beam propagates in the LHM,the intensity self-bending due to its propagation in the RHM can be compensated.In particular,if the propagation distance in the RHM is equal to that in the LHM and the refractive index of the LHM is n L =-1,the transverse intensity distribution of the Airy beam can return to its original state.
文摘In this study, we investigated the changes in the right-to-left shunt (RLS) of the patent foramen ovale (PFO) at different phases of the Valsalva maneuver and analyzed the possible mechanisms. The study population consisted of 57 patients with symptoms highly suggestive of a PFO. These patients had been diagnosed with apsychia, migraine with aura, cerebral infarction, transient ischemic attack (TIA), and cerebral ischemia with unknown cause. Routine echocardiography was performed in all patients to rule out a cardiac malformation. Contrast-transcranial Doppler (c-TCD) and contrast-enhanced transthoracic echocardiography (c-TTE) were used to visualize and quantify the RLS. The standard apical four chamber view was used to observe the changes of E peak, A peak, and velocity-time integral (VTI) ratio of tricuspid blood flow during the strain phase and release phase of the Valsalva maneuver. Paired t-test was used to compare E peak, A peak, and VTI ratio of tricuspid blood flow during the different phases. The right-to-left shunt across the PFO (PFO-RLS) was graded in the two phases and compared by Kruskal-Wallis test. Compared with the strain phase of the Valsalva maneuver, the parameters of E, A, and VTI in diastolic period in patients with PFO-RLS at the release phase were significantly increased [54.30 ± 13.65 cm/s vs 100.35 ± 21.11 cm/s, 42.21 ± 12.32 cm/s vs 57.30 ± 18.88 cm/s, 10.34 ± 3.27 cm/s vs 19.58 ± 4.56 cm/s, respectively], and the difference was statistically significant. The positive consequence of PFO-RLS, as diagnosed by c-TTE with the Valsalva maneuver at the release phase of the Valsalva maneuver, was significantly higher than that at the strain phase of the Valsalva maneuver. At the beginning of release phase of the Valsalva maneuver, decreased intrathoracic pressure led to increased venous backflow into the right atrium. Thus, high-velocity blood flow rapidly pushed the PFO open, which resulted in a significant increase in the PFO-RLS. Therefore, the increase of the PFO-RLS during the Valsalva maneuver is caused by the impact of high-velocity blood flow the PFO.
文摘A closed linear relation T in a Banach space X is called left(resp. right) Fredholm if it is upper(resp. lower) semi Fredholm and its range(resp. null space) is topologically complemented in X. We say that T is left(resp. right) Browder if it is left(resp. right)Fredholm and has a finite ascent(resp. descent). In this paper, we analyze the stability of the left(resp. right) Fredholm and the left(resp. right) Browder linear relations under commuting Riesz operator perturbations. Recent results of Zivkovic et al. to the case of bounded operators are covered.
文摘AIM To analyze the outcomes of living-donor liver transplantation(LDLT) using left-lobe(LL) or right-lobe(RL) small-for-size(SFS) grafts.METHODS Prospectively collected data of adult patients who underwent LDLT at our hospital in the period from January 2003 to December 2013 were reviewed. The patients were divided into the RL-LDLT group and the LL-LDLT group. The two groups were compared in terms of short-and long-term outcomes, including incidence of postoperative complication, graft function, graft survival, and patient survival. A SFS graft was defined as a graft with a ratio of graft weight(GW) to recipient standard liver volume(RSLV)(GW/RSLV) of < 50%. The Urata formula was used to estimate RSLV.RESULTS Totally 218 patients were included for analysis, with 199 patients in the RL-LDLT group and 19 patients in the LL-LDLT group. The two groups were similar in terms of age(median, 53 years in the RL-LDLT group and 52 years in the LL-LDLT group, P = 0.997) but had significantly different ratios of men to women(165:34 in the RL-LDLT group and 8:11 in the LL-LDLT group, P < 0.0001). The two groups were also significantly different in GW(P < 0.0001), GW/RSLV(P < 0.0001), and graft cold ischemic time(P = 0.007). When it comes to postoperative complication, the groups were comparable(P = 0.105). Five patients died in hospital,4(2%) in the RL-LDLT group and 1(5.3%) in the LLLDLT group(P = 0.918). There were 38 graft losses, 33(16.6%) in the RL-LDLT group and 5(26.3%) in the LL-LDLT group(P = 0.452). The 5-year graft survival rate was significantly better in the RL-LDLT group(95.2% vs 89.5%, P = 0.049). The two groups had similar 5-year patient survival rates(RL-LDLT: 86.8%, LL-LDLT: 89.5%, P = 0.476).CONCLUSION The use of SFS graft in LDLT requires careful tailormade surgical planning and meticulous operation. LLLDLT can be a good alternative to RL-LDLT with similar recipient outcomes but a lower donor risk. Further research into different patient conditions is needed in order to validate the use of LL graft.
文摘专家共识作为临床实践指南的重要补充,在证据不足或存在争议时支持临床决策。与临床实践指南相比,专家共识的呈现更具有多样性。目前,尚无针对临床和公共卫生决策的专家共识报告规范(reporting guideline)。RIGHT(Reporting Items for Practice Guidelines in Healthcare)清单是目前国际最常用的指南报告规范,常用于专家共识的写作参考。然而,RIGHT清单不包括共识形成方法的部分;而ACCORD(ACcurate COnsensus Reporting Document)清单虽然包含共识形成方法的报告要求,但不包含推荐意见的报告规范。因此,本文综合RIGHT和ACCORD两个报告清单,提出综合记忆框架(TIMER-DO),帮助作者综合两部国际通用的报告规范,完成专家共识的规范化报告。
基金supported by the National Natural Science Foundation of China (No. 51175442)the Fundamental Research Funds for the Central Universities (SWJTU12CX040)
文摘Levitation chassis, as an extremely important component of maglev vehicles, provides functions of transmitting levitation force and steering force, and directly affects the safety performance of the vehicle. Based on the vertical dynamics model of the levitation chassis, kinetic equations of the model are established, and a simulation program is designed to analyze the structural decoupling function of the chassis, especially under the influence of elastic constraints between the left and right modules, which are exclusively owned by maglev vehicles. A finite element model of the levitation chassis based on left-right decoupling is constructed. Analysis results of the model show that the mechanical properties of the chassis tailored for the vehicle meet the design requirements, and the stiffness and strength is adequate to bear the weight of the whole vehicle.
基金Supported by the National Natural Science Foundation of China (Grant No. 60471018)
文摘Two types of dual periodic circuits are introduced. The distributions of passbands and stopbands are generated from their dispersion relationships. Based on the study, Brillouin diagrams of three representative special cases are drawn; S parameters of these three cases are simulated by Aglient ADS; the S parameters of one of the three cases are verified by an experiment. The phase characteristics are compared with those generated from the dispersion relationship. The theoretical analysis and the experimental verification show that both types of the periodic structures can behave as electromagnetic band gap （EBG） structures, right-handed structures （RHS）, and left-handed structures （LHS）, when they operate at different frequency ranges. Thus, the possibility of a physical structure showing these three different characteristics at different frequency ranges is proven.
