BACKGROUND Perioperative anesthesia management of obese patients presents significant challenges as traditional total body weight-based dosing fails to achieve optimal anesthetic effects due to altered pharmacokinetic...BACKGROUND Perioperative anesthesia management of obese patients presents significant challenges as traditional total body weight-based dosing fails to achieve optimal anesthetic effects due to altered pharmacokinetic characteristics including abnormal drug distribution and clearance.Rocuronium exhibits markedly different distribution patterns in obese patients,with conventional weight correction methods inadequately addressing individual muscle mass variations that critically influence drug distribution.AIM To investigate the quantitative relationship between skeletal muscle index(SMI)and rocuronium distribution volume in obese colorectal cancer patients,establish a population pharmacokinetic model,and develop individualized dosing strategies based on muscle mass.METHODS A retrospective cohort study was conducted,including 100 obese patients(body mass index≥30 kg/m^(2))who underwent elective radical colorectal cancer surgery at our hospital from June 2023 to January 2025.Skeletal muscle mass was measured using InBody 260 body composition analyzer and SMI was calculated to assess muscle mass,with male SMI<7.0 kg/m^(2) and female SMI<5.7 kg/m^(2)as diagnostic criteria for sarcopenia.Plasma rocuronium concentrations were detected by liquid chromatography-tandem mass spectrometry/mass spectrometry,and nonlinear mixed-effect modeling was used to establish population pharmacokinetic modeling.Stepwise regression was used to screen covariates,and dosing regimens were optimized through Monte Carlo simulation.The primary endpoint was targeted plasma concentration achievement rate,and the secondary endpoint was postoperative residual muscle relaxation incidence.RESULTS Among 100 patients,35(35.0%)had sarcopenia and 65(65.0%)did not.Patients in the sarcopenia group were older(64.1±9.8 years vs 54.2±10.9 years,P<0.001)and had significantly lower SMI(6.2±0.8 kg/m^(2)vs 8.4±1.2 kg/m^(2),P<0.001).SMI showed strong positive correlation with rocuronium steady-state distribution volume(r=0.718,P<0.001)and moderate negative correlation with clearance(r=-0.502,P<0.001).A two-compartment population pharmacokinetic model was successfully established,with SMI being the most important covariate affecting central compartment distribution volume(△OFV=-41.2,P<0.001).Model validation showed bootstrap successful convergence rate of 92.3%,and 92.1%of observed values fell within prediction intervals in predicted concentration versus predicted concentration.The SMI-based individualized dosing regimen improved target exposure achievement rate from 82.0%in traditional regimen to 93.5%(P=0.009),and reduced postoperative residual muscle relaxation incidence from 13.0%to 3.5%(P=0.018).The sarcopenia group showed the most significant improvement in achievement rate,from 71.4%to 93.8%(P=0.017).CONCLUSION SMI shows strong correlation with rocuronium distribution volume in obese colorectal cancer patients and is a key factor affecting drug distribution.SMI-based individualized dosing strategies can significantly improve target exposure achievement rate and reduce postoperative residual muscle relaxation incidence,providing scientific evidence for precision anesthesia management in obese patients.展开更多
Background:Acupuncture has shown potential therapeutic benefits for individuals with simple obesity.However,some researchers argue that some of the effectiveness of acupuncture may be due to the placebo response.Objec...Background:Acupuncture has shown potential therapeutic benefits for individuals with simple obesity.However,some researchers argue that some of the effectiveness of acupuncture may be due to the placebo response.Objective:To understand the placebo response of acupuncture treatment in simple obesity,a systematic review and meta-analysis was designed based on the comparison between sham acupuncture before and after treatment.Search strategy:Eight databases(Pub Med,Web of Science,Cochrane Library,Embase,China National Knowledge Infrastructure,Wanfang Database,China Biology Medicine Database,and Chinese Scientific Journals Database)were searched from inception to August 1,2023.The Me SH search terms comprised obesity and acupuncture.Inclusion criteria:Randomized controlled trials(RCTs)using sham or placebo acupuncture as a control in treating obesity were enrolled.Data extraction and analysis:Two researchers independently extracted data,and the results were crosschecked after completion.Each RCT’s detailed sham/placebo acupuncture treatment protocol was assessed according to the SHam Acupuncture REporting guidelines.The revised Cochrane risk-of-bias tool for randomized trials and the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)system were used to determine the risk of bias and quality of evidence,respectively.Body mass index(BMI)was defined as the primary outcome.Anthropometric parameters and laboratory test parameters related to obesity were defined as secondary outcomes.We used standardized mean difference(SMD)with 95%confidence interval(CI)to calculate treatment effects of outcomes.Results:Fifteen RCTs with a total of 1250 patients were included.The BMI significantly decreased after treatment in the sham acupuncture group compared to baseline(SMD 0.37,95%CI 0.09–0.66;I2=81%,random model;P<0.01).Treatment duration(P=0.02)and other interventions significantly impacted the placebo response rate(P=0.00).Conclusion:The placebo response of sham acupuncture was strong in the RCTs for simple obesity,and the effect sizes differed between various outcomes.The treatment duration and other interventions emerged as potential influencing factors for the placebo response of sham acupuncture.展开更多
Objective To explore the sequential effects of hypoxic exercising on miR-27/PPARγand lipid metabolism targetgene and protein expression levels in the obesity rats’liver.Methods 13-week-old male diet-induced obesity ...Objective To explore the sequential effects of hypoxic exercising on miR-27/PPARγand lipid metabolism targetgene and protein expression levels in the obesity rats’liver.Methods 13-week-old male diet-induced obesity rats were randomlydivided into three groups(n=10):normal oxygen concentration quiet group(N),hypoxia quiet group(H),hypoxic exercise group(HE).Exercise training on the horizontal animal treadmill for 1 h/d,5 d/week for a total of 4 week,and the intensity of horizontaltreadmill training was 20 m/min(hypoxic concentration was 13.6%).Comparison of the weights of perirenal fat and epididymal fat in rats across different groups and calculation of Lee’s index based on body weight and body length of rats in each group were done.And the serum concentrations of total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high-densitylipoprotein cholesterol(HDL-C)levels were detected.RT-PCR and Western Blot were used to detect the levels of miR-27,PPARγ,CYP7A1 and CD36.Results Hypoxic exercise decreased the expression levels of miR-27 in the obese rats’liver,however,theexpression level of PPARγwas gradually increased.The expression levels of miR-27 in HE group were significantly lower than Ngroup(P<0.05).The expression levels of PPARγmRNA in N group were significantly lower than H group(P<0.05),especially lowerthan HE group(P<0.01).The protein expression of PPARγprotein in N group was significantly lower than that other groups(P<0.01).The expression of lipid metabolism-related genes and proteins increased in the obese rats’liver.The expression of CYP7A1mRNA in N group was significantly lower than H group(P<0.05),especially lower than HE group(P<0.01).The expression ofCYP7A1 protein in the obese rats’liver in N group was extremely lower than H group and HE group(P<0.01).The proteinexpression of CD36 in N group was significantly lower than that in HE group(P<0.05).Hypoxia exercise improved the relatedphysiological and biochemical indexes of lipid metabolism disorder.The perirenal fat weight of obese rats in HE group wasextremely lower than N group and H group(P<0.01),and the perirenal fat weight in N group was significantly higher than H group(P<0.05).The epididymal fat weight in N group was significantly higher than H group(P<0.05),and extremely higher than HEgroup(P<0.01).The Lee’s index in HE group was extremely lower than N group and H group(P<0.01).The serum concentration ofTC in obese rats in HE group was extremely lower than N group and H group(P<0.01).The serum concentration of TG in HE groupwas extremely lower than N group and H group(P<0.01).The serum concentration of LDL-C in N group was extremely higher thanHE group(P<0.01).The serum concentration of HDL-C in N group was extremely lower than H group(P<0.01).Conclusion Hypoxiaand hypoxia exercise may negatively regulate the levels of PPARγby inhibiting miR-27 in the obese rats’liver,thereby affecting theexpression of downstream target genes CYP7A1 and CD36,and promoting cholesterol,fatty acid oxidation and HDL-C transport inthe liver,and ultimately the lipid levels in obese rats were improved.The effect of hypoxia exercise on improving blood lipid isbetter than simple hypoxia intervention.展开更多
Plant roots are widely known to provide mechanical reinforcement to soils against shearing and further increase slope stability.However,whether roots provide reinforcement to loess cyclic re-sistance and how various f...Plant roots are widely known to provide mechanical reinforcement to soils against shearing and further increase slope stability.However,whether roots provide reinforcement to loess cyclic re-sistance and how various factors affect roots reinforcement during seismic loading have rarely been studied.The objective is to conduct a series of cyclic direct simple shear tests and DEM numerical simulation to investigate the cyclic behaviour of rooted loess.The effects of initial static shear stress and loading frequency on the cyclic resistance of root-soil composites were first investigated.After that,cyclic direct simple shear simulations at constant volume were carried out based on the discrete element method(PFC^(3D))to investigate the effects of root geome-try,mechanical traits and root-soil bond strength on the cyclic strength of rooted loess.It was discovered that the roots could effectively improve the cyclic resistance of loess.The cyclic resistance of the root-soil composite decreases with the increase of the initial shear stress,then increases,and improves with the increase of the frequency.The simulation result show that increases in root elastic modulus and root-soil interfacial bond strength can all enhance the cyclic resistance of root-soil composites,and the maximum cyclic resistance of the root-soil composite was obtained when the initial inclination angle of the root system was 90°.展开更多
Mg alloy often undergoes shear deformation during industrial processing.While its anisotropy and tension-compression asymmetry have been thoroughly studied under uniaxial loading,the understanding for shear loading is...Mg alloy often undergoes shear deformation during industrial processing.While its anisotropy and tension-compression asymmetry have been thoroughly studied under uniaxial loading,the understanding for shear loading is still lacking.This study employed a rolled AZ31B plate with typical basal texture to investigate the shear behaviors.Positive and negative simple shear experiments were performed at different angles in the transverse plane,whereby the visco-plastic self-consistent model was calibrated to reveal the deformation mechanisms and predict the mechanical responses at various orientations.Positive-negative shear asymmetry is present because extension twinning preferentially operates in one shear direction but is suppressed in the opposite direction.Simple shear induces multiple twin variants,thus impedes twin growth and slows the consumption of matrix,as compared to in-plane compression.For slip dominated simple shear,the interaction between loading-induced rigid body rotation and slip-induced crystal rotation produces distinct hardening behaviors,namely orthogonally asymmetric mechanical responses at complementary loading angles,which is largely absent in uniaxial loading.Finally,simulation results verify that positive-negative shear asymmetry appears only when the deviatoric normal stress on the sheet plane is non-zero.Positive-negative shear asymmetry persists except for the conditions of shear plane parallel to sheet plane,or shear direction parallel or perpendicular to rolling direction.展开更多
In recent years,the incidence of type 2 diabetes mellitus(T2DM)caused by obesity in China has been increasing continuously,which has become a risk factor for the onset of T2DM and seriously affects the quality of life...In recent years,the incidence of type 2 diabetes mellitus(T2DM)caused by obesity in China has been increasing continuously,which has become a risk factor for the onset of T2DM and seriously affects the quality of life of patients.The conventional treatment methods include weight loss and regulating the body’s metabolism.Semaglutide,as a glucagon-like peptide-1 receptor agonist(GLP-1RA),mainly reduces patients’appetite,decreases their craving for high-fat and high-sugar foods,regulates hypothalamic feeding behavior,inhibits gastric emptying and gastrointestinal motility,and ultimately leads to weight loss.Metformin mainly acts on extra-islet tissues,increasing glucose utilization,reducing glucose production,and ultimately lowering blood glucose levels.Based on this,this article reviews relevant literature on authoritative websites such as CNKI and Wanfang,organizes the data,and analyzes the research progress of semaglutide combined with metformin in the treatment of obese T2DM.The aim is to bring more treatment options for obese T2DM and promote better prognosis for patients.展开更多
Background:Radical prostatectomy has long been the treatment of choice for men with clinically significant prostate cancer(PCa)in those with concurrent significant lower urinary tract symptoms(LUTS).For men who meet t...Background:Radical prostatectomy has long been the treatment of choice for men with clinically significant prostate cancer(PCa)in those with concurrent significant lower urinary tract symptoms(LUTS).For men who meet this description with marked prostatomegaly,we present a multi-institutional proof of concept study describing an alternative pathway of robotic simple prostatectomy(RASP)followed by external beam radiation therapy(EBRT)for the treatment of clinically significant prostate cancer.Methods:A retrospective study was performed of 17 patients with PCa who underwent RASP followed by EBRT at two institutions from 2015–2023.Demographic,peri-operative,and post-radiation treatment functional outcomes are reported.Results:No postoperative or post-EBRT complications were reported for any of the 17 patients who underwent RASP followed by EBRT during a median follow-up time of 12 months.The median time from RASP to EBRT was 9 months.Median prostate size was 135 g(IQR 110–165).13(76.5%)patients received a pre-EBRT rectal spacer.Median IPSS score preoperatively improved at 90 days post-RASP(13.5 vs.2.5;IQR 10.8–15.2),and this benefit was sustained post-EBRT with a median IPSS at 3 vs.12 months(4 vs.0;IQR 0–5).There was no statistically significant difference between postoperative IPSS and post-EBRT IPSS at 3(p=0.677)or 12(p=0.627)months.In all 14 patients with localized disease and PSA data,none had recurrence during the study period.Conclusions:A subset of patients with clinically significant prostate cancer have marked prostatomegaly and LUTS.We report an alternative treatment approach for patients unwilling to undergo radical prostatectomy.We found robotic simple prostatectomy followed by definitive radiation to be feasible and safe.展开更多
Weighted exponential distribution W ED(α,λ)with shape parameterαand scale parameterλpossesses some good properties and can be used as a good fit to survival time data compared to other distributions such as gamma,...Weighted exponential distribution W ED(α,λ)with shape parameterαand scale parameterλpossesses some good properties and can be used as a good fit to survival time data compared to other distributions such as gamma,Weibull,or generalized exponential distribution.In this article,we proved the existence and uniqueness of the maximum likelihood estimator(MLE)of the parameters of W ED(α,λ)in simple random sampling(SRS)and provided explicit expressions for the Fisher information number in SRS.Moreover,we also proved the existence and uniqueness of the MLE of the parameters of W ED(α,λ)in ranked set sampling(RSS)and provided explicit expressions for the Fisher information number in RSS.Simulation studies show that these MLEs in RSS can be real competitors for those in SRS.展开更多
Transparent sand is a special material to realize visualization of concealed work in geotechnical engineering. To investigate the dynamic characteristics of transparent sand, a series of undrained cyclic simple shear ...Transparent sand is a special material to realize visualization of concealed work in geotechnical engineering. To investigate the dynamic characteristics of transparent sand, a series of undrained cyclic simple shear tests were conducted on the saturated transparent sand composed of fused quartz and refractive index-matched oil mixture. The results reveal that an increase in the initial shear stress ratio significantly affects the shape of the hysteresis loop, particularly resulting in more pronounced asymmetrical accumulation. Factors such as lower relative density, higher cyclic stress ratios and higher initial shear stress ratio have been shown to accelerate cyclic deformation, cyclic pore water pressure and stiffness degradation. The cyclic liquefaction resistance curves decrease as the initial shear stress ratio increases or as relative density decreases. Booker model and power law function model were applied to predict the pore water pressure for transparent sand. Both models yielded excellent fits for their respective condition, indicating a similar dynamic liquefaction pattern to that of natural sands. Finally, transparent sand displays similar dynamic characteristics in terms of cyclic liquefaction resistance and Kα correction factor. These comparisons indicate that transparent sand can serve as an effective means to mimic many natural sands in dynamic model tests.展开更多
Simple cubic black phosphorus(BP)has been recognized as a strategic material due to its exceptional structural stability under extreme conditions.In this investigation,simple cubic BP was successfully synthesized thro...Simple cubic black phosphorus(BP)has been recognized as a strategic material due to its exceptional structural stability under extreme conditions.In this investigation,simple cubic BP was successfully synthesized through shock-induced phase transformation,utilizing amorphous red phosphorus as the precursor material.The phase evolution process was systematically investigated using plane shock loading apparatus,with shock pressure and temperature parameters being precisely controlled to optimize transformation kinetics.Comprehensive phase characterization revealed the correlation between thermodynamic loading profiles and cubic BP formation efficiency.Precursor modification strategies were implemented through orthorhombic BP utilization,resulting in enhanced cubic phase yield and crystallinity.The synthesized cubic BP variants are considered promising candidates for advanced protective material systems,particularly where combinations of mechanical resilience and thermal stability are required under extreme operational conditions.This research provides critical insights into shock-induced phase transformation mechanics,while establishing foundational protocols for manufacturing non-equilibrium materials with potential applications in next-generation defensive technologies.展开更多
Objective:Thulium fiber laser enucleation of the prostate(ThuFLEP)and robot-assisted simple prostatectomy(RASP)are two options for treating large benign prostatic hyperplasia.The most appropriate technique remains a m...Objective:Thulium fiber laser enucleation of the prostate(ThuFLEP)and robot-assisted simple prostatectomy(RASP)are two options for treating large benign prostatic hyperplasia.The most appropriate technique remains a matter of debate.We evaluated the efficacy and safety of ThuFLEP compared to RASP.Methods:Between January 2020 and December 2023,all patients who underwent either RASP or ThuFLEP for a prostate volume>80 mL were retrospectively included.The surgical procedure choice was left to the surgeon’s and patient’s discretion.Preoperative patient evaluation included the assessment of functional parameters.The groups were compared.Results:A total of 234 patients were included:106(45%)underwent RASP and 128(55%)underwent ThuFLEP.The mean operative time was shorter in the ThuFLEP group compared to the RASP group(106.4 with standard deviation[SD]46.1 min vs.123.2[SD 32.8]min,p=0.012).The mean lengths of catheterization and stay were significantly longer in the RASP group(5.0[SD 3.9]days vs.1.7[SD 2.0]days,p=0.009[catheterization]and 4.9[SD 3.0]days vs.1.9[SD 1.8]days,p=0.009[stay]).The overall complication rate was significantly higher in the ThuFLEP group(12%vs.2.8%in the RASP group,p=0.022).However,we did not observe significant differences in major complications(Clavien-Dindo≥3)between the two groups(four[3.1%]in the ThuFLEP group vs.one[0.94%]in the RASP group,p=0.073).At 3 months,the rate of stress urinary incontinence was 4.7%after ThuFLEP and 1.9%after RASP(p=0.2).Finally,the quality of life score and maximum urinary flow were comparable between the ThuFLEP and RASP groups,but the International Prostate Symptom Score at 3 months postoperatively was lower in the RASP group(p=0.012).Conclusion:Both ThuFLEP and RASP are safe techniques with comparable functional outcomes for large benign prostatic hyperplasia.ThuFLEP allows a reduction in catheterization and hospitalization durations but presents more complications compared to RASP.展开更多
BACKGROUND Cardiovascular health(CVH)plays a crucial role in overall health,but its association with metabolic-associated fatty liver disease(MAFLD)remains unclear.AIM To investigate the relationship between CVH,measu...BACKGROUND Cardiovascular health(CVH)plays a crucial role in overall health,but its association with metabolic-associated fatty liver disease(MAFLD)remains unclear.AIM To investigate the relationship between CVH,measured using Life’s Essential 8(LE8)and Life’s Simple 7(LS7),and the prevalence of MAFLD.METHODS This cross-sectional study had a sample of 2234 individuals,representing approximately 120 million individuals in the United States.Baseline parameters were compared between the LE8 and LS7 groups.Logistic regression models were used to evaluate the relationship between LE8,LS7,and MAFLD,while taking into account confounding factors.The investigation employed restricted cubic splines to investigate non-linear associations.Subgroup analyses and sensitivity studies were performed to evaluate the strength and reliability of the results.RESULTS Higher LE8 and LS7 scores were significantly associated with a decreased risk of MAFLD,even after controlling for demographic,socioeconomic,and clinical variables.This association demonstrated a non-linear pattern,with the most dramatic risk reduction observed at higher CVH levels.Individual CVH components,notably healthy behaviors and factors,exhibited strong relationships with MAFLD.Subgroup analyses indicated consistent relationships across several demographics.Sensitivity tests utilizing other MAFLD definitions validated the robustness of the findings.CONCLUSION Higher adherence to CVH criteria,as indicated by LE8 and LS7 scores,is associated with a significantly lower risk of MAFLD.These results emphasize the need to advance CVH to control and avoid MAFLD.展开更多
Objective To compare the therapeutic effect on simple obesity of gastrointestinal heat type between electroacupuncture （EA） and conventional acupuncture （CA）. Methods Ninety cases of simple obesity of gastrointest...Objective To compare the therapeutic effect on simple obesity of gastrointestinal heat type between electroacupuncture （EA） and conventional acupuncture （CA）. Methods Ninety cases of simple obesity of gastrointestinal heat type were randomized into an EA group and a CA group, 45 cases in each one. In the EA group, CA was applied at Neiting （内庭 ST 44）, Shangjuxu （上巨虚 ST 37）, Xiajuxu （下巨虚 ST 39）, Fenglong （丰隆 ST 40）, Tianshu （天枢 ST 25）, Zusanli （足三里 ST 36）, YTnlingquan （阴陵泉 SP 9） and Ouchi （曲池 LI 12）. The electric stimulation was attached at ST 37, ST 44, ST 25 and ST 40. In CA group, the simple acupuncture was applied at the same points as the EA group. The treatment was given once every two days, 22 treatments made one session and 3 sessions were required totally in the two groups. The changes in body mass, obesity degree, body mass index （BMI） and body fat percentage （F%） were observed in the patients before and after treatment. The therapeutic effects on weight loss and fat loss were compared between the two groups. Results After treatment, the weight, obesity degree, BMI and F% were all reduced apparently in the patients of the two groups （all P〈0.01）. After the 2st session of treatment, concerning to the effect on weight loss, the total effective rate in the EA group was superior to that in the CA group [95.6% （43/45） vs 77.8% （35/45）, P〈0.05]. The effects were not different apparently between the two groups in the later 2 sessions of treatment （all P〉0.05）. The effect on fat loss was not different significantly in statistics between EA and CA （all P〉0.05）. Conclusion Either EA or CA achieves the significant effect on simple obesity. The therapeutic effect of EA on weight loss in the early stage is obviously superior to that of CA.展开更多
Objec ve To observe the eff ects of meridian massage on body weight（BW）. body mass index（BMI）,waist circumference（WC） and hip circumference（HC） in pa ents of simple obesity. Methods Fi y-four obesity pa ents w...Objec ve To observe the eff ects of meridian massage on body weight（BW）. body mass index（BMI）,waist circumference（WC） and hip circumference（HC） in pa ents of simple obesity. Methods Fi y-four obesity pa ents were randomized into a massage group（28 patients） and a control group（26 patients） with SAS（statistical analysis software）. The patients in the control group were subjected to diet control and exercise program,while the pa ents in the massage group were subjected to diet control and massage program in combina on with meridian massage. Stomach meridian,spleen meridian,bladder meridian,Guānyuán（关元 CV 4）,Qihǎi（气海 CV 6）,Zhōngwǎn（中脘 CV 12）,Dàhéng（大横 SP 15,both sides）,Tiānshū（天枢 ST 25,both sides）,Zúsānl？（足三里 ST 36,both sides）,Fēnglóng（丰隆 ST 40,both sides） and Ashi points（at positions of fat accumulation） were selected,and the massages were mainly rolling manipulation,acupressure and pressing manipulation. The treatment was carried out 3 times a week for totally 24 times. Clinical therapeutic efficacy,BW,BMI,WC and HC of the patients in the two groups before and after treatment were evaluated. Results The difference in the comparison of therapeutic efficacy after treatment between the two groups was sta s cally significant,and the therapeu c effi cacy in the massage group was be er than that in the control group（P？？0.05）; BW,BWI,WC and HC in the massage group were significantly improved a er treatment in comparison to those before treatment and those in the control group after treatment（P？？0.05）. Conclusion Meridian massage can significantly improve body mass and other related indices of pa ents,improve their life quality,and thus may reduce the morbidity of obesity related diseases.展开更多
文摘BACKGROUND Perioperative anesthesia management of obese patients presents significant challenges as traditional total body weight-based dosing fails to achieve optimal anesthetic effects due to altered pharmacokinetic characteristics including abnormal drug distribution and clearance.Rocuronium exhibits markedly different distribution patterns in obese patients,with conventional weight correction methods inadequately addressing individual muscle mass variations that critically influence drug distribution.AIM To investigate the quantitative relationship between skeletal muscle index(SMI)and rocuronium distribution volume in obese colorectal cancer patients,establish a population pharmacokinetic model,and develop individualized dosing strategies based on muscle mass.METHODS A retrospective cohort study was conducted,including 100 obese patients(body mass index≥30 kg/m^(2))who underwent elective radical colorectal cancer surgery at our hospital from June 2023 to January 2025.Skeletal muscle mass was measured using InBody 260 body composition analyzer and SMI was calculated to assess muscle mass,with male SMI<7.0 kg/m^(2) and female SMI<5.7 kg/m^(2)as diagnostic criteria for sarcopenia.Plasma rocuronium concentrations were detected by liquid chromatography-tandem mass spectrometry/mass spectrometry,and nonlinear mixed-effect modeling was used to establish population pharmacokinetic modeling.Stepwise regression was used to screen covariates,and dosing regimens were optimized through Monte Carlo simulation.The primary endpoint was targeted plasma concentration achievement rate,and the secondary endpoint was postoperative residual muscle relaxation incidence.RESULTS Among 100 patients,35(35.0%)had sarcopenia and 65(65.0%)did not.Patients in the sarcopenia group were older(64.1±9.8 years vs 54.2±10.9 years,P<0.001)and had significantly lower SMI(6.2±0.8 kg/m^(2)vs 8.4±1.2 kg/m^(2),P<0.001).SMI showed strong positive correlation with rocuronium steady-state distribution volume(r=0.718,P<0.001)and moderate negative correlation with clearance(r=-0.502,P<0.001).A two-compartment population pharmacokinetic model was successfully established,with SMI being the most important covariate affecting central compartment distribution volume(△OFV=-41.2,P<0.001).Model validation showed bootstrap successful convergence rate of 92.3%,and 92.1%of observed values fell within prediction intervals in predicted concentration versus predicted concentration.The SMI-based individualized dosing regimen improved target exposure achievement rate from 82.0%in traditional regimen to 93.5%(P=0.009),and reduced postoperative residual muscle relaxation incidence from 13.0%to 3.5%(P=0.018).The sarcopenia group showed the most significant improvement in achievement rate,from 71.4%to 93.8%(P=0.017).CONCLUSION SMI shows strong correlation with rocuronium distribution volume in obese colorectal cancer patients and is a key factor affecting drug distribution.SMI-based individualized dosing strategies can significantly improve target exposure achievement rate and reduce postoperative residual muscle relaxation incidence,providing scientific evidence for precision anesthesia management in obese patients.
基金supported by grants from the National Natural Science Foundation of China(82405192)the Capital’s Funds for Health Improvement and Research(CFH 2022-2-20213,CFH 2022-1-2021)+1 种基金the project of"Friendship Seed Plan"Talent Project of Beijing Friendship Hospital,Capital Medical University(YYZZ202333)Beijing key project of major disease by Chinese medicine and Western medicine(Fatty liver,No.2023BJSZDYNJBXTGG-017)。
文摘Background:Acupuncture has shown potential therapeutic benefits for individuals with simple obesity.However,some researchers argue that some of the effectiveness of acupuncture may be due to the placebo response.Objective:To understand the placebo response of acupuncture treatment in simple obesity,a systematic review and meta-analysis was designed based on the comparison between sham acupuncture before and after treatment.Search strategy:Eight databases(Pub Med,Web of Science,Cochrane Library,Embase,China National Knowledge Infrastructure,Wanfang Database,China Biology Medicine Database,and Chinese Scientific Journals Database)were searched from inception to August 1,2023.The Me SH search terms comprised obesity and acupuncture.Inclusion criteria:Randomized controlled trials(RCTs)using sham or placebo acupuncture as a control in treating obesity were enrolled.Data extraction and analysis:Two researchers independently extracted data,and the results were crosschecked after completion.Each RCT’s detailed sham/placebo acupuncture treatment protocol was assessed according to the SHam Acupuncture REporting guidelines.The revised Cochrane risk-of-bias tool for randomized trials and the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)system were used to determine the risk of bias and quality of evidence,respectively.Body mass index(BMI)was defined as the primary outcome.Anthropometric parameters and laboratory test parameters related to obesity were defined as secondary outcomes.We used standardized mean difference(SMD)with 95%confidence interval(CI)to calculate treatment effects of outcomes.Results:Fifteen RCTs with a total of 1250 patients were included.The BMI significantly decreased after treatment in the sham acupuncture group compared to baseline(SMD 0.37,95%CI 0.09–0.66;I2=81%,random model;P<0.01).Treatment duration(P=0.02)and other interventions significantly impacted the placebo response rate(P=0.00).Conclusion:The placebo response of sham acupuncture was strong in the RCTs for simple obesity,and the effect sizes differed between various outcomes.The treatment duration and other interventions emerged as potential influencing factors for the placebo response of sham acupuncture.
文摘Objective To explore the sequential effects of hypoxic exercising on miR-27/PPARγand lipid metabolism targetgene and protein expression levels in the obesity rats’liver.Methods 13-week-old male diet-induced obesity rats were randomlydivided into three groups(n=10):normal oxygen concentration quiet group(N),hypoxia quiet group(H),hypoxic exercise group(HE).Exercise training on the horizontal animal treadmill for 1 h/d,5 d/week for a total of 4 week,and the intensity of horizontaltreadmill training was 20 m/min(hypoxic concentration was 13.6%).Comparison of the weights of perirenal fat and epididymal fat in rats across different groups and calculation of Lee’s index based on body weight and body length of rats in each group were done.And the serum concentrations of total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high-densitylipoprotein cholesterol(HDL-C)levels were detected.RT-PCR and Western Blot were used to detect the levels of miR-27,PPARγ,CYP7A1 and CD36.Results Hypoxic exercise decreased the expression levels of miR-27 in the obese rats’liver,however,theexpression level of PPARγwas gradually increased.The expression levels of miR-27 in HE group were significantly lower than Ngroup(P<0.05).The expression levels of PPARγmRNA in N group were significantly lower than H group(P<0.05),especially lowerthan HE group(P<0.01).The protein expression of PPARγprotein in N group was significantly lower than that other groups(P<0.01).The expression of lipid metabolism-related genes and proteins increased in the obese rats’liver.The expression of CYP7A1mRNA in N group was significantly lower than H group(P<0.05),especially lower than HE group(P<0.01).The expression ofCYP7A1 protein in the obese rats’liver in N group was extremely lower than H group and HE group(P<0.01).The proteinexpression of CD36 in N group was significantly lower than that in HE group(P<0.05).Hypoxia exercise improved the relatedphysiological and biochemical indexes of lipid metabolism disorder.The perirenal fat weight of obese rats in HE group wasextremely lower than N group and H group(P<0.01),and the perirenal fat weight in N group was significantly higher than H group(P<0.05).The epididymal fat weight in N group was significantly higher than H group(P<0.05),and extremely higher than HEgroup(P<0.01).The Lee’s index in HE group was extremely lower than N group and H group(P<0.01).The serum concentration ofTC in obese rats in HE group was extremely lower than N group and H group(P<0.01).The serum concentration of TG in HE groupwas extremely lower than N group and H group(P<0.01).The serum concentration of LDL-C in N group was extremely higher thanHE group(P<0.01).The serum concentration of HDL-C in N group was extremely lower than H group(P<0.01).Conclusion Hypoxiaand hypoxia exercise may negatively regulate the levels of PPARγby inhibiting miR-27 in the obese rats’liver,thereby affecting theexpression of downstream target genes CYP7A1 and CD36,and promoting cholesterol,fatty acid oxidation and HDL-C transport inthe liver,and ultimately the lipid levels in obese rats were improved.The effect of hypoxia exercise on improving blood lipid isbetter than simple hypoxia intervention.
文摘Plant roots are widely known to provide mechanical reinforcement to soils against shearing and further increase slope stability.However,whether roots provide reinforcement to loess cyclic re-sistance and how various factors affect roots reinforcement during seismic loading have rarely been studied.The objective is to conduct a series of cyclic direct simple shear tests and DEM numerical simulation to investigate the cyclic behaviour of rooted loess.The effects of initial static shear stress and loading frequency on the cyclic resistance of root-soil composites were first investigated.After that,cyclic direct simple shear simulations at constant volume were carried out based on the discrete element method(PFC^(3D))to investigate the effects of root geome-try,mechanical traits and root-soil bond strength on the cyclic strength of rooted loess.It was discovered that the roots could effectively improve the cyclic resistance of loess.The cyclic resistance of the root-soil composite decreases with the increase of the initial shear stress,then increases,and improves with the increase of the frequency.The simulation result show that increases in root elastic modulus and root-soil interfacial bond strength can all enhance the cyclic resistance of root-soil composites,and the maximum cyclic resistance of the root-soil composite was obtained when the initial inclination angle of the root system was 90°.
基金supports of the National Key Research and Development Program of China(Grant No.2023YFB3710900)the National Natural Science Foundation of China(Grant Nos.52071211 and 52071208)。
文摘Mg alloy often undergoes shear deformation during industrial processing.While its anisotropy and tension-compression asymmetry have been thoroughly studied under uniaxial loading,the understanding for shear loading is still lacking.This study employed a rolled AZ31B plate with typical basal texture to investigate the shear behaviors.Positive and negative simple shear experiments were performed at different angles in the transverse plane,whereby the visco-plastic self-consistent model was calibrated to reveal the deformation mechanisms and predict the mechanical responses at various orientations.Positive-negative shear asymmetry is present because extension twinning preferentially operates in one shear direction but is suppressed in the opposite direction.Simple shear induces multiple twin variants,thus impedes twin growth and slows the consumption of matrix,as compared to in-plane compression.For slip dominated simple shear,the interaction between loading-induced rigid body rotation and slip-induced crystal rotation produces distinct hardening behaviors,namely orthogonally asymmetric mechanical responses at complementary loading angles,which is largely absent in uniaxial loading.Finally,simulation results verify that positive-negative shear asymmetry appears only when the deviatoric normal stress on the sheet plane is non-zero.Positive-negative shear asymmetry persists except for the conditions of shear plane parallel to sheet plane,or shear direction parallel or perpendicular to rolling direction.
文摘In recent years,the incidence of type 2 diabetes mellitus(T2DM)caused by obesity in China has been increasing continuously,which has become a risk factor for the onset of T2DM and seriously affects the quality of life of patients.The conventional treatment methods include weight loss and regulating the body’s metabolism.Semaglutide,as a glucagon-like peptide-1 receptor agonist(GLP-1RA),mainly reduces patients’appetite,decreases their craving for high-fat and high-sugar foods,regulates hypothalamic feeding behavior,inhibits gastric emptying and gastrointestinal motility,and ultimately leads to weight loss.Metformin mainly acts on extra-islet tissues,increasing glucose utilization,reducing glucose production,and ultimately lowering blood glucose levels.Based on this,this article reviews relevant literature on authoritative websites such as CNKI and Wanfang,organizes the data,and analyzes the research progress of semaglutide combined with metformin in the treatment of obese T2DM.The aim is to bring more treatment options for obese T2DM and promote better prognosis for patients.
文摘Background:Radical prostatectomy has long been the treatment of choice for men with clinically significant prostate cancer(PCa)in those with concurrent significant lower urinary tract symptoms(LUTS).For men who meet this description with marked prostatomegaly,we present a multi-institutional proof of concept study describing an alternative pathway of robotic simple prostatectomy(RASP)followed by external beam radiation therapy(EBRT)for the treatment of clinically significant prostate cancer.Methods:A retrospective study was performed of 17 patients with PCa who underwent RASP followed by EBRT at two institutions from 2015–2023.Demographic,peri-operative,and post-radiation treatment functional outcomes are reported.Results:No postoperative or post-EBRT complications were reported for any of the 17 patients who underwent RASP followed by EBRT during a median follow-up time of 12 months.The median time from RASP to EBRT was 9 months.Median prostate size was 135 g(IQR 110–165).13(76.5%)patients received a pre-EBRT rectal spacer.Median IPSS score preoperatively improved at 90 days post-RASP(13.5 vs.2.5;IQR 10.8–15.2),and this benefit was sustained post-EBRT with a median IPSS at 3 vs.12 months(4 vs.0;IQR 0–5).There was no statistically significant difference between postoperative IPSS and post-EBRT IPSS at 3(p=0.677)or 12(p=0.627)months.In all 14 patients with localized disease and PSA data,none had recurrence during the study period.Conclusions:A subset of patients with clinically significant prostate cancer have marked prostatomegaly and LUTS.We report an alternative treatment approach for patients unwilling to undergo radical prostatectomy.We found robotic simple prostatectomy followed by definitive radiation to be feasible and safe.
基金Supported by the National Science Foundation of China(11901236,12261036)Scientific Research Fund of Hunan Provincial Education Department(21A0328)+2 种基金Provincial Natural Science Foundation of Hunan(2022JJ30469)Young Core Teacher Foundation of Hunan Province([2020]43)Provincial Postgraduate Innovation Foundation of Hunan(CX20221113)。
文摘Weighted exponential distribution W ED(α,λ)with shape parameterαand scale parameterλpossesses some good properties and can be used as a good fit to survival time data compared to other distributions such as gamma,Weibull,or generalized exponential distribution.In this article,we proved the existence and uniqueness of the maximum likelihood estimator(MLE)of the parameters of W ED(α,λ)in simple random sampling(SRS)and provided explicit expressions for the Fisher information number in SRS.Moreover,we also proved the existence and uniqueness of the MLE of the parameters of W ED(α,λ)in ranked set sampling(RSS)and provided explicit expressions for the Fisher information number in RSS.Simulation studies show that these MLEs in RSS can be real competitors for those in SRS.
基金Project(U2268213) supported by the National Natural Science Foundation of ChinaProject(2024YFHZ0121) supported by the Sichuan Science and Technology Program,China。
文摘Transparent sand is a special material to realize visualization of concealed work in geotechnical engineering. To investigate the dynamic characteristics of transparent sand, a series of undrained cyclic simple shear tests were conducted on the saturated transparent sand composed of fused quartz and refractive index-matched oil mixture. The results reveal that an increase in the initial shear stress ratio significantly affects the shape of the hysteresis loop, particularly resulting in more pronounced asymmetrical accumulation. Factors such as lower relative density, higher cyclic stress ratios and higher initial shear stress ratio have been shown to accelerate cyclic deformation, cyclic pore water pressure and stiffness degradation. The cyclic liquefaction resistance curves decrease as the initial shear stress ratio increases or as relative density decreases. Booker model and power law function model were applied to predict the pore water pressure for transparent sand. Both models yielded excellent fits for their respective condition, indicating a similar dynamic liquefaction pattern to that of natural sands. Finally, transparent sand displays similar dynamic characteristics in terms of cyclic liquefaction resistance and Kα correction factor. These comparisons indicate that transparent sand can serve as an effective means to mimic many natural sands in dynamic model tests.
基金supported by the Youth Project of the Independent Subject of the State Key Laboratory of Explosion Science and Safety Protection,Beijing Institute of Technology(Grant Nos.QNKT25-13 and QNKT24-02)the 76th batch of Project funded by China Postdoctoral Science Foundation(Grant No.2024M764116)+3 种基金the National Natural Science Foundation of China(Grant Nos.12002048,12072037,12102050,and 12202067)the Science and Technology Commission,China(Grant No.2019-jcjc-zd-011-00)the Project supported by the Open Funds of Kui Yuan Laboratory(Grant No.KY202431)the State Key Laboratory of Explosion Science and Safety Protection(Grant No.KFJJ25-21M)。
文摘Simple cubic black phosphorus(BP)has been recognized as a strategic material due to its exceptional structural stability under extreme conditions.In this investigation,simple cubic BP was successfully synthesized through shock-induced phase transformation,utilizing amorphous red phosphorus as the precursor material.The phase evolution process was systematically investigated using plane shock loading apparatus,with shock pressure and temperature parameters being precisely controlled to optimize transformation kinetics.Comprehensive phase characterization revealed the correlation between thermodynamic loading profiles and cubic BP formation efficiency.Precursor modification strategies were implemented through orthorhombic BP utilization,resulting in enhanced cubic phase yield and crystallinity.The synthesized cubic BP variants are considered promising candidates for advanced protective material systems,particularly where combinations of mechanical resilience and thermal stability are required under extreme operational conditions.This research provides critical insights into shock-induced phase transformation mechanics,while establishing foundational protocols for manufacturing non-equilibrium materials with potential applications in next-generation defensive technologies.
文摘Objective:Thulium fiber laser enucleation of the prostate(ThuFLEP)and robot-assisted simple prostatectomy(RASP)are two options for treating large benign prostatic hyperplasia.The most appropriate technique remains a matter of debate.We evaluated the efficacy and safety of ThuFLEP compared to RASP.Methods:Between January 2020 and December 2023,all patients who underwent either RASP or ThuFLEP for a prostate volume>80 mL were retrospectively included.The surgical procedure choice was left to the surgeon’s and patient’s discretion.Preoperative patient evaluation included the assessment of functional parameters.The groups were compared.Results:A total of 234 patients were included:106(45%)underwent RASP and 128(55%)underwent ThuFLEP.The mean operative time was shorter in the ThuFLEP group compared to the RASP group(106.4 with standard deviation[SD]46.1 min vs.123.2[SD 32.8]min,p=0.012).The mean lengths of catheterization and stay were significantly longer in the RASP group(5.0[SD 3.9]days vs.1.7[SD 2.0]days,p=0.009[catheterization]and 4.9[SD 3.0]days vs.1.9[SD 1.8]days,p=0.009[stay]).The overall complication rate was significantly higher in the ThuFLEP group(12%vs.2.8%in the RASP group,p=0.022).However,we did not observe significant differences in major complications(Clavien-Dindo≥3)between the two groups(four[3.1%]in the ThuFLEP group vs.one[0.94%]in the RASP group,p=0.073).At 3 months,the rate of stress urinary incontinence was 4.7%after ThuFLEP and 1.9%after RASP(p=0.2).Finally,the quality of life score and maximum urinary flow were comparable between the ThuFLEP and RASP groups,but the International Prostate Symptom Score at 3 months postoperatively was lower in the RASP group(p=0.012).Conclusion:Both ThuFLEP and RASP are safe techniques with comparable functional outcomes for large benign prostatic hyperplasia.ThuFLEP allows a reduction in catheterization and hospitalization durations but presents more complications compared to RASP.
基金Supported by The Science Foundation of 925th Hospital,No.2023[3]and No.2022[3/4]The Guizhou Provincial Health Commission Science and Technology Fund,No.gzwkj2023-135。
文摘BACKGROUND Cardiovascular health(CVH)plays a crucial role in overall health,but its association with metabolic-associated fatty liver disease(MAFLD)remains unclear.AIM To investigate the relationship between CVH,measured using Life’s Essential 8(LE8)and Life’s Simple 7(LS7),and the prevalence of MAFLD.METHODS This cross-sectional study had a sample of 2234 individuals,representing approximately 120 million individuals in the United States.Baseline parameters were compared between the LE8 and LS7 groups.Logistic regression models were used to evaluate the relationship between LE8,LS7,and MAFLD,while taking into account confounding factors.The investigation employed restricted cubic splines to investigate non-linear associations.Subgroup analyses and sensitivity studies were performed to evaluate the strength and reliability of the results.RESULTS Higher LE8 and LS7 scores were significantly associated with a decreased risk of MAFLD,even after controlling for demographic,socioeconomic,and clinical variables.This association demonstrated a non-linear pattern,with the most dramatic risk reduction observed at higher CVH levels.Individual CVH components,notably healthy behaviors and factors,exhibited strong relationships with MAFLD.Subgroup analyses indicated consistent relationships across several demographics.Sensitivity tests utilizing other MAFLD definitions validated the robustness of the findings.CONCLUSION Higher adherence to CVH criteria,as indicated by LE8 and LS7 scores,is associated with a significantly lower risk of MAFLD.These results emphasize the need to advance CVH to control and avoid MAFLD.
基金Naional Natural Science Fund Project: 30873307Jiangsu Characterisic Preponderant Discipline Fund ProjectFund Project of Outstanding Innovaion Team of Science and Technology in Jiangsu Colleges and Universiies Qinglan Engineering
文摘Objective To compare the therapeutic effect on simple obesity of gastrointestinal heat type between electroacupuncture （EA） and conventional acupuncture （CA）. Methods Ninety cases of simple obesity of gastrointestinal heat type were randomized into an EA group and a CA group, 45 cases in each one. In the EA group, CA was applied at Neiting （内庭 ST 44）, Shangjuxu （上巨虚 ST 37）, Xiajuxu （下巨虚 ST 39）, Fenglong （丰隆 ST 40）, Tianshu （天枢 ST 25）, Zusanli （足三里 ST 36）, YTnlingquan （阴陵泉 SP 9） and Ouchi （曲池 LI 12）. The electric stimulation was attached at ST 37, ST 44, ST 25 and ST 40. In CA group, the simple acupuncture was applied at the same points as the EA group. The treatment was given once every two days, 22 treatments made one session and 3 sessions were required totally in the two groups. The changes in body mass, obesity degree, body mass index （BMI） and body fat percentage （F%） were observed in the patients before and after treatment. The therapeutic effects on weight loss and fat loss were compared between the two groups. Results After treatment, the weight, obesity degree, BMI and F% were all reduced apparently in the patients of the two groups （all P〈0.01）. After the 2st session of treatment, concerning to the effect on weight loss, the total effective rate in the EA group was superior to that in the CA group [95.6% （43/45） vs 77.8% （35/45）, P〈0.05]. The effects were not different apparently between the two groups in the later 2 sessions of treatment （all P〉0.05）. The effect on fat loss was not different significantly in statistics between EA and CA （all P〉0.05）. Conclusion Either EA or CA achieves the significant effect on simple obesity. The therapeutic effect of EA on weight loss in the early stage is obviously superior to that of CA.
基金Supported by special project for doctoral program of Ministry of Educa on:20125132120015project of Chengdu University of TCM:ZRYY 201119
文摘Objec ve To observe the eff ects of meridian massage on body weight（BW）. body mass index（BMI）,waist circumference（WC） and hip circumference（HC） in pa ents of simple obesity. Methods Fi y-four obesity pa ents were randomized into a massage group（28 patients） and a control group（26 patients） with SAS（statistical analysis software）. The patients in the control group were subjected to diet control and exercise program,while the pa ents in the massage group were subjected to diet control and massage program in combina on with meridian massage. Stomach meridian,spleen meridian,bladder meridian,Guānyuán（关元 CV 4）,Qihǎi（气海 CV 6）,Zhōngwǎn（中脘 CV 12）,Dàhéng（大横 SP 15,both sides）,Tiānshū（天枢 ST 25,both sides）,Zúsānl？（足三里 ST 36,both sides）,Fēnglóng（丰隆 ST 40,both sides） and Ashi points（at positions of fat accumulation） were selected,and the massages were mainly rolling manipulation,acupressure and pressing manipulation. The treatment was carried out 3 times a week for totally 24 times. Clinical therapeutic efficacy,BW,BMI,WC and HC of the patients in the two groups before and after treatment were evaluated. Results The difference in the comparison of therapeutic efficacy after treatment between the two groups was sta s cally significant,and the therapeu c effi cacy in the massage group was be er than that in the control group（P？？0.05）; BW,BWI,WC and HC in the massage group were significantly improved a er treatment in comparison to those before treatment and those in the control group after treatment（P？？0.05）. Conclusion Meridian massage can significantly improve body mass and other related indices of pa ents,improve their life quality,and thus may reduce the morbidity of obesity related diseases.
