Background and aim:The transcriptional co-activator Yes-associated protein-1(YAP1)has been impli-cated as an oncogene and is overexpressed in different kinds of human cancers,especially hepatocellular carcinoma(HCC).H...Background and aim:The transcriptional co-activator Yes-associated protein-1(YAP1)has been impli-cated as an oncogene and is overexpressed in different kinds of human cancers,especially hepatocellular carcinoma(HCC).However,the role of YAP1 has not been reported in residual/recurrent HCC after transarterial chemoembolization(TACE).Our aim is to determine whether YAP1 is overexpressed in the residual/recurrent HCC after TACE.Methods:A total of 105 tumor tissues from 71 patients including 30 cases of primary HCC without prior treatment,35 cases of residual/recurrent HCC post TACE,and 6 cases of hepatoblastoma were included in the immunohistochemical study.YAP1 immunoreactivity was blindly scored as 0,1+,2+or 3+in density and percentages of positive cells.Results:About 33.3%(10/30)of primary HCC without prior treatment showed 2+of YAP1 immunore-activity.While 82.8%(29/35)of residual/recurrent HCCs after TACE treatment displayed 2-3+of YAP1 immunoreactivity,which was significantly higher compared to primary HCC without prior treatment(P=0.0002).YAP1 immunoreactivity was moderately to strongly positive(2-3+)in 100%of the hep-atoblastoma,particularly in the embryonal components(3+in 100%cases).Conclusions:YAP1 is significantly upregulated in the residual/recurrent HCCs post TACE treatment,suggesting that YAP1 may serve as a sensitive diagnostic marker and a treatment target for residual/recurrent HCC post TACE.展开更多
Although the surgical treatment is a relatively effective and predictable method for correcting residual or recurrent strabismus, such as posterior fixation sutures,medial rectus marginal myotomy, unilateral or bilate...Although the surgical treatment is a relatively effective and predictable method for correcting residual or recurrent strabismus, such as posterior fixation sutures,medial rectus marginal myotomy, unilateral or bilateral rectus re-recession and resection, unilateral lateral rectus recession and adjustable suture, no standard protocol is established for the surgical style. Different surgical approaches have been recommended for correcting residual or recurrent strabismus. The choice of the surgical procedure depends on the former operation pattern and the surgical dosages applied on the patients, residual or recurrent angle of deviation and the operator’s preference and experience. This review attempts to outline recent publications and current opinion in the management of residual or recurrent esotropia and exotropia.展开更多
Objective:To assess the clinical efficacy and safety of transarterial embolization(TAE)in simultaneous combination with computed tomography(CT)-guided radiofrequency ablation(RFA)for recurrent or residual hepatocellul...Objective:To assess the clinical efficacy and safety of transarterial embolization(TAE)in simultaneous combination with computed tomography(CT)-guided radiofrequency ablation(RFA)for recurrent or residual hepatocellular carcinoma(HCC),and to determine the risk factors influencing local tumor progression following this procedure.Methods:One hundred eighteen patients with recurrent or residual HCC(tumor size,10–30 mm)underwent RFA.During the 19-month follow-up,59 patients received RFA only(RFA group),and the remaining 59 received RFA immediately after TAE(TAE+RFA group).All patients were followed up to observe the short-term therapeutic effects and complications.The cumulative local tumor progression rates in both groups were calculated using unpaired Student’s t tests and the Kaplan-Meier method.Results:The rate of major complications was 5.08%in the TAE+RFA group and 3.39%in the RFA group.The overall response rate was 96.61%in the TAE+RFA group and 79.66%in the RFA group(P=0.008).The disease control rate was significantly higher in the TAE+RFA group than in the RFA group(94.92%vs.79.66%,P=0.024).The median time to local tumor progression was 4.8 months in the RFA group and 9.6 months in the TAE+RFA group.The cumulative local tumor progression rate at 1 year was 10.60%in the RFA group and 23.60%in the TAE+RFA group(P=0.016).Conclusion:TAE in simultaneous combination with CT-guided RFA was effective and safe against recurrent or residual HCC.Local tumor progression can be minimized by the complete ablation of targeted iodized oil deposits after simultaneous TAE.展开更多
Residual useful life(RUL)prediction is a key issue for improving efficiency of aircraft engines and reducing their maintenance cost.Owing to various failure mechanism and operating environment,the application of class...Residual useful life(RUL)prediction is a key issue for improving efficiency of aircraft engines and reducing their maintenance cost.Owing to various failure mechanism and operating environment,the application of classical models in RUL prediction of aircraft engines is fairly difficult.In this study,a novel RUL prognostics method based on using ensemble recurrent neural network to process massive sensor data is proposed.First of all,sensor data obtained from the aircraft engines are preprocessed to eliminate singular values,reduce random fluctuation and preserve degradation trend of the raw sensor data.Secondly,three kinds of recurrent neural networks(RNN),including ordinary RNN,long shortterm memory(LSTM),and gated recurrent unit(GRU),are individually constructed.Thirdly,ensemble learning mechanism is designed to merge the above RNNs for producing a more accurate RUL prediction.The effectiveness of the proposed method is validated using two characteristically different turbofan engine datasets.Experimental results show a competitive performance of the proposed method in comparison with typical methods reported in literatures.展开更多
BACKGROUND At present,the influencing factors of social function in patients with residual depressive symptoms are still unclear.Residual depressive symptoms are highly harmful,leading to low mood in patients,affectin...BACKGROUND At present,the influencing factors of social function in patients with residual depressive symptoms are still unclear.Residual depressive symptoms are highly harmful,leading to low mood in patients,affecting work and interpersonal communication,increasing the risk of recurrence,and adding to the burden on families.Studying the influencing factors of their social function is of great significance.AIM To explore the social function score and its influencing factors in patients with residual depressive symptoms.METHODS This observational study surveyed patients with residual depressive symptoms(case group)and healthy patients undergoing physical examinations(control group).Participants were admitted between January 2022 and December 2023.Social functioning was assessed using the Sheehan Disability Scale(SDS),and scores were compared between groups.Factors influencing SDS scores in patients with residual depressive symptoms were analyzed by applying multiple linear regression while using the receiver operating characteristic curve,and these RESULTS The SDS scores of the 158 patients with depressive symptoms were 11.48±3.26.Compared with the control group,the SDS scores and all items in the case group were higher.SDS scores were higher in patients with relapse,discon-tinuous medication,drug therapy alone,severe somatic symptoms,obvious residual symptoms,and anxiety scores≥8.Disease history,medication compliance,therapy method,and residual symptoms correlated positively with SDS scores(r=0.354,0.414,0.602,and 0.456,respectively).Independent influencing factors included disease history,medication compliance,therapy method,somatic symptoms,residual symptoms,and anxiety scores(P<0.05).The areas under the curve for predicting social functional impairment using these factors were 0.713,0.559,0.684,0.729,0.668,and 0.628,respectively,with sensitivities of 79.2%,61.8%,76.8%,81.7%,63.6%,and 65.5%and specificities of 83.3%,87.5%,82.6%,83.3%,86.7%,and 92.1%,respectively.CONCLUSION The social function scores of patients with residual symptoms of depression are high.They are affected by disease history,medication compliance,therapy method,degree of somatic symptoms,residual symptoms,and anxiety.展开更多
The dominated contradiction in optimizing the performance of magnesium-air battery anode lies in the difficulty of achieving a good balance between activation and passivation during discharge process.To further reconci...The dominated contradiction in optimizing the performance of magnesium-air battery anode lies in the difficulty of achieving a good balance between activation and passivation during discharge process.To further reconcile this contradiction,two Mg-0.1Sc-0.1Y-0.1Ag anodes with different residual strain distribution through extrusion with/without annealing are fabricated.The results indicate that annealing can significantly lessen the“pseudo-anode”regions,thereby changing the dissolution mode of the matrix and achieving an effective dissolution during discharge.Additionally,p-type semiconductor characteristic of discharge productfilm could suppress the self-corrosion reaction without reducing the polarization of anode.The magnesium-air battery utilizing annealed Mg-0.1Sc-0.1Y-0.1Ag as anode achieves a synergistic improvement in specific capacity(1388.89 mA h g^(-1))and energy density(1960.42 mW h g^(-1)).This anode modification method accelerates the advancement of high efficiency and long lifespan magnesium-air batteries,offering renewable and cost-effective energy solutions for electronics and emergency equipment.展开更多
This study investigates the effect of high current density electropulsing on the material in a rapid stress relaxation process.An AISI 1020 steel was shot-peened to induce surface compressive residual stresses in a co...This study investigates the effect of high current density electropulsing on the material in a rapid stress relaxation process.An AISI 1020 steel was shot-peened to induce surface compressive residual stresses in a controlled manner and subsequently electropulsed to investigate the changes in microstructure and defect configuration.AISI 1020 steel was chosen as it has a simple microstructure(plain ferritic)and composition with low alloying conditions.It is an appropriate material to study the effect of trans-mitting electric pulses on the microstructural defect evolution.A combination of electron-backscattered diffraction and transmission electron microscopy proved to be an effective tool in characterizing the post-electropulsing effects critically.By application of electropulsing,a reduction in the surface residual stress layer was noticed.Also,reductions in misorientation and dislocation density together with the disentan-glement of dislocations within the cold-worked layer were observed after electropulsing.Additionally,the annihilation of shot-peening-induced deformation bands beyond the residual layer depth was observed.These effects have been rationalised by taking into account the various possibilities of athermal effects of electropulsing.展开更多
This study presents a comprehensive investigation of residual strength in corroded pipelines within the Yichang-Qianjiang section of the Sichuan-East Gas Pipeline,integrating advanced numerical simulation with experim...This study presents a comprehensive investigation of residual strength in corroded pipelines within the Yichang-Qianjiang section of the Sichuan-East Gas Pipeline,integrating advanced numerical simulation with experimental validation.The research methodology incorporates three distinct parameter grouping approaches:a random group based on statistical analysis of 389 actual corrosion defects detected during 2023 MFL inspection,a deviation group representing historically documented failure scenarios,and a structural group examining systematic parameter variations.Using ABAQUS finite element software,we developed a dynamic implicit analysis model incorporating geometric nonlinearity and validated it through 1:12.7 scaled model testing,achieving prediction deviations consistently within 5%for standard cases.Our analysis revealed distinct failure mechanisms between large and small defects,with large defects exhibiting stress concentration at circumferential edges and small defects concentrating stress centrally.Quantitative analysis identified defect depth as themost significant factor,with every 1mmincrease reducing strength by 0.054MPa,while defect length showed moderate influence at 0.0018MPa reduction per mm.Comparative analysis demonstrated that circumferential defects exhibited 15%higher burst failure pressure compared to axial defects,though this advantage diminished significantly at depths exceeding 40%wall thickness.These findings,validated through experimental testing with deviations within 5%,provide valuable insights for pipeline integrity management,particularly emphasizing the importance of defect depth monitoring and the need for orientation-specific assessment criteria in corrosion evaluation protocols.展开更多
Granite residual soil (GRS) is a type of weathering soil that can decompose upon contact with water, potentially causing geological hazards. In this study, cement, an alkaline solution, and glass fiber were used to re...Granite residual soil (GRS) is a type of weathering soil that can decompose upon contact with water, potentially causing geological hazards. In this study, cement, an alkaline solution, and glass fiber were used to reinforce GRS. The effects of cement content and SiO_(2)/Na2O ratio of the alkaline solution on the static and dynamic strengths of GRS were discussed. Microscopically, the reinforcement mechanism and coupling effect were examined using X-ray diffraction (XRD), micro-computed tomography (micro-CT), and scanning electron microscopy (SEM). The results indicated that the addition of 2% cement and an alkaline solution with an SiO_(2)/Na2O ratio of 0.5 led to the densest matrix, lowest porosity, and highest static compressive strength, which was 4994 kPa with a dynamic impact resistance of 75.4 kN after adding glass fiber. The compressive strength and dynamic impact resistance were a result of the coupling effect of cement hydration, a pozzolanic reaction of clay minerals in the GRS, and the alkali activation of clay minerals. Excessive cement addition or an excessively high SiO_(2)/Na2O ratio in the alkaline solution can have negative effects, such as the destruction of C-(A)-S-H gels by the alkaline solution and hindering the production of N-A-S-H gels. This can result in damage to the matrix of reinforced GRS, leading to a decrease in both static and dynamic strengths. This study suggests that further research is required to gain a more precise understanding of the effects of this mixture in terms of reducing our carbon footprint and optimizing its properties. The findings indicate that cement and alkaline solution are appropriate for GRS and that the reinforced GRS can be used for high-strength foundation and embankment construction. The study provides an analysis of strategies for mitigating and managing GRS slope failures, as well as enhancing roadbed performance.展开更多
7039 Al alloys are widely used in armor vehicles,given the material’s high specific strength and fracture toughness.However,laminar tearing in the thickness plane of the base metal(BM),specifically in the normal dire...7039 Al alloys are widely used in armor vehicles,given the material’s high specific strength and fracture toughness.However,laminar tearing in the thickness plane of the base metal(BM),specifically in the normal direction(ND)and rolling direction(RD)plane,was occasionally observed after the welding of thick plates,resulting in premature material failure.A vertically metal-inert gas(MIG)-welded laminar tearing component of a 30 mm thick plate was analyzed to determine the factors associated with this phenomenon.The texture,residual stress,microhardness,and tensile properties were also investigated.The results indicated that the crack extended along the RD as a transcrystalline fracture and terminated at the BM.The grains near the crack grew preferentially in the(001)crystal direction.Furthermore,the tensile strength(83 MPa)and elongation(6.8%)in the RD were relatively higher than those in the ND.In particular,the primary factors for crack initiation include stronger texture,higher dislocation density,increased Al_(7)Cu_(2)Fe phases,lower proportion of small-angle grain boundaries,and varying grain sizes in different regions,leading to the fragile microstructure.The higher residual stress of the BM promotes the formation and extension of cracks.The restraining force due to fixation and welding shrinkage force transformed the crack into laminar tearing.Preventive measures of laminar tearing were also proposed.展开更多
BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a ...BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a result of pancreaticobiliary reflux.Roux-en-Y choledochojejunostomy is a common surgical method for the treatment of PBM,but there are several associated complications that may occur after this operation.CASE SUMMARY The patient,a 12-year-old female,was hospitalized nearly 20 times in 2021 for recurrent acute pancreatitis.In 2022,she was diagnosed with PBM and underwent laparoscopic common bile duct resection and Roux-en-Y choledochojejunostomy in a tertiary hospital.In the first year after surgery,the patient had more than 10 recurrent acute pancreatitis episodes.After undergoing abdominal computed tomography and other examinations,she was diagnosed with“residual bile duct stones and recurrent acute pancreatitis”.On January 30,2024,the patient was admitted to our hospital due to recurrent upper abdominal pain and was cured through endoscopic retrograde cholangiopancreatography.CONCLUSION This article reports a case of a child with distal residual common bile duct stones and recurrent acute pancreatitis after Roux-en-Y choledochojejunostomy for PBM.The patient was cured through endoscopic retrograde cholangiopancreatography.展开更多
As service conditions become more challenging and production complexity increases,there is an increasing demand for enhanced comprehensive performance of ceramic/metal heterostructures.At present,brazing technique has...As service conditions become more challenging and production complexity increases,there is an increasing demand for enhanced comprehensive performance of ceramic/metal heterostructures.At present,brazing technique has been widely utilized for ceramic-metal heterogeneous joints.However,the residual stress relief in these welding joints is complicated and necessary.Because metals and ceramics have different properties,especially their coefficients of thermal expansion.Welding joints exhibit large residual stresses during the cooling process.The relatively high residual stresses may significantly degrade the joint properties.For this issue,four alleviation routes were reviewed:optimization of process parameters,setting an intermediate layer,surface structure modulation and particle-reinforced composite solder.The states and distribution patterns of residual stress in ceramic-metal brazed joints were summarized,and the generation and detection of residual stress were introduced.Eventually,upcoming prospects and challenges of residual stress research on ceramic/metal heterostructures were pointed out.展开更多
Electromagnetic interference,which necessitates the rapid advancement of substances with exceptional capabilities for bsorbing electromagnetic waves,is of urgent concern in contemporary society.In this work,CoFe_(2)O_...Electromagnetic interference,which necessitates the rapid advancement of substances with exceptional capabilities for bsorbing electromagnetic waves,is of urgent concern in contemporary society.In this work,CoFe_(2)O_(4)/residual carbon from coal gasification fine slag(CFO/RC)composites were created using a novel hydrothermal method.Various mechanisms for microwave absorption,including conductive loss,natural resonance,interfacial dipole polarization,and magnetic flux loss,are involved in these composites.Consequently,compared with pure residual carbon materials,this composite offers superior capabilities in microwave absorption.At 7.76GHz,the CFO/RC-2 composite achieves an impressive minimum reflection loss(RL_(min))of-43.99 dB with a thickness of 2.44 mm.Moreover,CFO/RC-3 demonstrates an effective absorption bandwidth(EAB)of up to 4.16 GHz,accompanied by a thickness of 1.18mm.This study revealed the remarkable capability of the composite to diminish electromagnetic waves,providing a new generation method for microwave absorbing materials of superior quality.展开更多
In the field of image processing,the analysis of Synthetic Aperture Radar(SAR)images is crucial due to its broad range of applications.However,SAR images are often affected by coherent speckle noise,which significantl...In the field of image processing,the analysis of Synthetic Aperture Radar(SAR)images is crucial due to its broad range of applications.However,SAR images are often affected by coherent speckle noise,which significantly degrades image quality.Traditional denoising methods,typically based on filter techniques,often face challenges related to inefficiency and limited adaptability.To address these limitations,this study proposes a novel SAR image denoising algorithm based on an enhanced residual network architecture,with the objective of enhancing the utility of SAR imagery in complex electromagnetic environments.The proposed algorithm integrates residual network modules,which directly process the noisy input images to generate denoised outputs.This approach not only reduces computational complexity but also mitigates the difficulties associated with model training.By combining the Transformer module with the residual block,the algorithm enhances the network's ability to extract global features,offering superior feature extraction capabilities compared to CNN-based residual modules.Additionally,the algorithm employs the adaptive activation function Meta-ACON,which dynamically adjusts the activation patterns of neurons,thereby improving the network's feature extraction efficiency.The effectiveness of the proposed denoising method is empirically validated using real SAR images from the RSOD dataset.The proposed algorithm exhibits remarkable performance in terms of EPI,SSIM,and ENL,while achieving a substantial enhancement in PSNR when compared to traditional and deep learning-based algorithms.The PSNR performance is enhanced by over twofold.Moreover,the evaluation of the MSTAR SAR dataset substantiates the algorithm's robustness and applicability in SAR denoising tasks,with a PSNR of 25.2021 being attained.These findings underscore the efficacy of the proposed algorithm in mitigating speckle noise while preserving critical features in SAR imagery,thereby enhancing its quality and usability in practical scenarios.展开更多
Objective N6-methyladenosine(m6A),the most prevalent epigenetic modification in eukaryotic RNA,plays a pivotal role in regulating cellular differentiation and developmental processes,with its dysregulation implicated ...Objective N6-methyladenosine(m6A),the most prevalent epigenetic modification in eukaryotic RNA,plays a pivotal role in regulating cellular differentiation and developmental processes,with its dysregulation implicated in diverse pathological conditions.Accurate prediction of m6A sites is critical for elucidating their regulatory mechanisms and informing drug development.However,traditional experimental methods are time-consuming and costly.Although various computational approaches have been proposed,challenges remain in feature learning,predictive accuracy,and generalization.Here,we present m6A-PSRA,a dual-branch residual-network-based predictor that fully exploits RNA sequence information to enhance prediction performance and model generalization.Methods m6A-PSRA adopts a parallel dual-branch network architecture to comprehensively extract RNA sequence features via two independent pathways.The first branch applies one-hot encoding to transform the RNA sequence into a numerical matrix while strictly preserving positional information and sequence continuity.This ensures that the biological context conveyed by nucleotide order is retained.A bidirectional long short-term memory network(BiLSTM)then processes the encoded matrix,capturing both forward and backward dependencies between bases to resolve contextual correlations.The second branch employs a k-mer tokenization strategy(k=3),decomposing the sequence into overlapping 3-mer subsequences to capture local sequence patterns.A pre-trained Doc2vec model maps these subsequences into fixeddimensional vectors,reducing feature dimensionality while extracting latent global semantic information via context learning.Both branches integrate residual networks(ResNet)and a self-attention mechanism:ResNet mitigates vanishing gradients through skip connections,preserving feature integrity,while self-attention adaptively assigns weights to focus on sequence regions most relevant to methylation prediction.This synergy enhances both feature learning and generalization capability.Results Across 11 tissues from humans,mice,and rats,m6A-PSRA consistently outperformed existing methods in accuracy(ACC)and area under the curve(AUC),achieving>90%ACC and>95%AUC in every tissue tested,indicating strong cross-species and cross-tissue adaptability.Validation on independent datasets—including three human cell lines(MOLM1,HEK293,A549)and a long-sequence dataset(m6A_IND,1001 nt)—confirmed stable performance across varied biological contexts and sequence lengths.Ablation studies demonstrated that the dual-branch architecture,residual network,and self-attention mechanism each contribute critically to performance,with their combination reducing interference between pathways.Motif analysis revealed an enrichment of m6A sites in guanine(G)and cytosine(C),consistent with known regulatory patterns,supporting the model’s biological plausibility.Conclusion m6A-PSRA effectively captures RNA sequence features,achieving high prediction accuracy and robust generalization across tissues and species,providing an efficient computational tool for m6A methylation site prediction.展开更多
Through a modified inherent strain model based on the minimum residual stress and deformation,three building schemes with different building postures and support structures were evaluated by finite element analysis.Re...Through a modified inherent strain model based on the minimum residual stress and deformation,three building schemes with different building postures and support structures were evaluated by finite element analysis.Results demonstrate that according to the principle of reducing the overall height of the building and reducing the support structure with a large tilt angle from the building direction,the residual stress and deformation can be effectively reduced by proper design of building posture and support before laser powder bed melting.Moreover,without the data of thermophysical property variation of Ti-6Al-4V artificial knee implants with temperature,predicting the residual stress and deformation with acceptable accuracy and reduced time cost can be achieved by the inherent strain model.展开更多
Residual neural network (ResNet) is a powerful neural network architecture that has proven to be excellent in extracting spatial and channel-wise information of images. ResNet employs a residual learning strategy that...Residual neural network (ResNet) is a powerful neural network architecture that has proven to be excellent in extracting spatial and channel-wise information of images. ResNet employs a residual learning strategy that maps inputs directly to outputs, making it less difficult to optimize. In this paper, we incorporate differential information into the original residual block to improve the representative ability of the ResNet, allowing the modified network to capture more complex and metaphysical features. The proposed DFNet preserves the features after each convolutional operation in the residual block, and combines the feature maps of different levels of abstraction through the differential information. To verify the effectiveness of DFNet on image recognition, we select six distinct classification datasets. The experimental results show that our proposed DFNet has better performance and generalization ability than other state-of-the-art variants of ResNet in terms of classification accuracy and other statistical analysis.展开更多
Chronic and acute recurrent appendicitis are often underrecognized in clinical practice,particularly in patients presenting with persistent or recurrent right lower quadrant abdominal pain.It is essential to obtain a ...Chronic and acute recurrent appendicitis are often underrecognized in clinical practice,particularly in patients presenting with persistent or recurrent right lower quadrant abdominal pain.It is essential to obtain a detailed and comprehensive history from the patient,as careful questioning often reveals a history of prior attacks.Diagnosing recurrent and chronic appendicitis remains challenging,necessitating thorough history-taking,awareness of varied clinical presentations,and physical examination integrating specific maneuvers.Maintaining a high index of clinical suspicion is essential for recognizing these atypical presentations.Confirming a high pretest probability prior to surgical intervention is crucial to avoid unnecessary procedures.展开更多
Rationale:Recurrent pregnancy loss and recurrent implantation failure are frequently linked to immune dysregulation,particularly heightened natural killer(NK)cell activity,cytokine imbalance,and autoantibody presence....Rationale:Recurrent pregnancy loss and recurrent implantation failure are frequently linked to immune dysregulation,particularly heightened natural killer(NK)cell activity,cytokine imbalance,and autoantibody presence.Lipid emulsion therapy,originally designed for parenteral nutrition,is increasingly recognized for its immunomodulatory potential in reproductive medicine.Patient concerns:A 34-year-old woman with five years of infertility,four first-trimester miscarriages,and three failed in vitro fertilization(IVF)cycles despite transfer of morphologically optimal embryos presented for evaluation.Diagnosis:Routine genetic,endocrine,metabolic,thrombophilia,and anatomical investigations were unremarkable.Immunological testing revealed elevated antiphospholipid and anti-thyroid peroxidase(anti-TPO)antibodies,increased NK cell activity,an imbalanced Th1/Th2 cytokine ratio,and raised tumor necrosis factor-alpha(TNF-α),suggesting immune-mediated reproductive dysfunction.Interventions:The patient underwent IVF with transfer of a single euploid blastocyst following intravenous lipid emulsion therapy(20%,100 mL),administered before transfer,on transfer day,and biweekly until 12 weeks.Associated therapies included aspirin,enoxaparin,progesterone,levothyroxine,and supplementation.Outcomes:Serum beta-human chorionic gonadotropin(β-hCG)and ultrasound confirmed pregnancy with subsequent NK cell normalization.The pregnancy was uncomplicated,resulting in spontaneous vaginal delivery of a healthy male infant.Lessons:Lipid emulsion therapy may improve implantation and pregnancy outcomes in immune-mediated recurrent pregnancy loss and recurrent implantation failure,but larger trials are required to validate efficacy and optimize protocols.展开更多
基金This study was supported by the USA National Institutes of Health grant R01 CA187027(to N.Kang).
文摘Background and aim:The transcriptional co-activator Yes-associated protein-1(YAP1)has been impli-cated as an oncogene and is overexpressed in different kinds of human cancers,especially hepatocellular carcinoma(HCC).However,the role of YAP1 has not been reported in residual/recurrent HCC after transarterial chemoembolization(TACE).Our aim is to determine whether YAP1 is overexpressed in the residual/recurrent HCC after TACE.Methods:A total of 105 tumor tissues from 71 patients including 30 cases of primary HCC without prior treatment,35 cases of residual/recurrent HCC post TACE,and 6 cases of hepatoblastoma were included in the immunohistochemical study.YAP1 immunoreactivity was blindly scored as 0,1+,2+or 3+in density and percentages of positive cells.Results:About 33.3%(10/30)of primary HCC without prior treatment showed 2+of YAP1 immunore-activity.While 82.8%(29/35)of residual/recurrent HCCs after TACE treatment displayed 2-3+of YAP1 immunoreactivity,which was significantly higher compared to primary HCC without prior treatment(P=0.0002).YAP1 immunoreactivity was moderately to strongly positive(2-3+)in 100%of the hep-atoblastoma,particularly in the embryonal components(3+in 100%cases).Conclusions:YAP1 is significantly upregulated in the residual/recurrent HCCs post TACE treatment,suggesting that YAP1 may serve as a sensitive diagnostic marker and a treatment target for residual/recurrent HCC post TACE.
文摘Although the surgical treatment is a relatively effective and predictable method for correcting residual or recurrent strabismus, such as posterior fixation sutures,medial rectus marginal myotomy, unilateral or bilateral rectus re-recession and resection, unilateral lateral rectus recession and adjustable suture, no standard protocol is established for the surgical style. Different surgical approaches have been recommended for correcting residual or recurrent strabismus. The choice of the surgical procedure depends on the former operation pattern and the surgical dosages applied on the patients, residual or recurrent angle of deviation and the operator’s preference and experience. This review attempts to outline recent publications and current opinion in the management of residual or recurrent esotropia and exotropia.
基金supported by the National Natural Science Foundation of China(No.81771955)Sun Yat-sen University Clinical Trial 5010Project(No.2016002)Guangzhou Science and Technology Program of China(No.201704020134)
文摘Objective:To assess the clinical efficacy and safety of transarterial embolization(TAE)in simultaneous combination with computed tomography(CT)-guided radiofrequency ablation(RFA)for recurrent or residual hepatocellular carcinoma(HCC),and to determine the risk factors influencing local tumor progression following this procedure.Methods:One hundred eighteen patients with recurrent or residual HCC(tumor size,10–30 mm)underwent RFA.During the 19-month follow-up,59 patients received RFA only(RFA group),and the remaining 59 received RFA immediately after TAE(TAE+RFA group).All patients were followed up to observe the short-term therapeutic effects and complications.The cumulative local tumor progression rates in both groups were calculated using unpaired Student’s t tests and the Kaplan-Meier method.Results:The rate of major complications was 5.08%in the TAE+RFA group and 3.39%in the RFA group.The overall response rate was 96.61%in the TAE+RFA group and 79.66%in the RFA group(P=0.008).The disease control rate was significantly higher in the TAE+RFA group than in the RFA group(94.92%vs.79.66%,P=0.024).The median time to local tumor progression was 4.8 months in the RFA group and 9.6 months in the TAE+RFA group.The cumulative local tumor progression rate at 1 year was 10.60%in the RFA group and 23.60%in the TAE+RFA group(P=0.016).Conclusion:TAE in simultaneous combination with CT-guided RFA was effective and safe against recurrent or residual HCC.Local tumor progression can be minimized by the complete ablation of targeted iodized oil deposits after simultaneous TAE.
基金the National Natural Science Foundationof China(Nos.11672098,11502063)the Natural Science Foundation of Anhui Province(No.1608085QA07).
文摘Residual useful life(RUL)prediction is a key issue for improving efficiency of aircraft engines and reducing their maintenance cost.Owing to various failure mechanism and operating environment,the application of classical models in RUL prediction of aircraft engines is fairly difficult.In this study,a novel RUL prognostics method based on using ensemble recurrent neural network to process massive sensor data is proposed.First of all,sensor data obtained from the aircraft engines are preprocessed to eliminate singular values,reduce random fluctuation and preserve degradation trend of the raw sensor data.Secondly,three kinds of recurrent neural networks(RNN),including ordinary RNN,long shortterm memory(LSTM),and gated recurrent unit(GRU),are individually constructed.Thirdly,ensemble learning mechanism is designed to merge the above RNNs for producing a more accurate RUL prediction.The effectiveness of the proposed method is validated using two characteristically different turbofan engine datasets.Experimental results show a competitive performance of the proposed method in comparison with typical methods reported in literatures.
文摘BACKGROUND At present,the influencing factors of social function in patients with residual depressive symptoms are still unclear.Residual depressive symptoms are highly harmful,leading to low mood in patients,affecting work and interpersonal communication,increasing the risk of recurrence,and adding to the burden on families.Studying the influencing factors of their social function is of great significance.AIM To explore the social function score and its influencing factors in patients with residual depressive symptoms.METHODS This observational study surveyed patients with residual depressive symptoms(case group)and healthy patients undergoing physical examinations(control group).Participants were admitted between January 2022 and December 2023.Social functioning was assessed using the Sheehan Disability Scale(SDS),and scores were compared between groups.Factors influencing SDS scores in patients with residual depressive symptoms were analyzed by applying multiple linear regression while using the receiver operating characteristic curve,and these RESULTS The SDS scores of the 158 patients with depressive symptoms were 11.48±3.26.Compared with the control group,the SDS scores and all items in the case group were higher.SDS scores were higher in patients with relapse,discon-tinuous medication,drug therapy alone,severe somatic symptoms,obvious residual symptoms,and anxiety scores≥8.Disease history,medication compliance,therapy method,and residual symptoms correlated positively with SDS scores(r=0.354,0.414,0.602,and 0.456,respectively).Independent influencing factors included disease history,medication compliance,therapy method,somatic symptoms,residual symptoms,and anxiety scores(P<0.05).The areas under the curve for predicting social functional impairment using these factors were 0.713,0.559,0.684,0.729,0.668,and 0.628,respectively,with sensitivities of 79.2%,61.8%,76.8%,81.7%,63.6%,and 65.5%and specificities of 83.3%,87.5%,82.6%,83.3%,86.7%,and 92.1%,respectively.CONCLUSION The social function scores of patients with residual symptoms of depression are high.They are affected by disease history,medication compliance,therapy method,degree of somatic symptoms,residual symptoms,and anxiety.
基金the National Natural Science:Foundation of China(52375370)the Open Project of Salt Lake Chemical Engineering Research Complex,Qinghai University(2023-DXSSKF-Z02)+2 种基金the Nat-ural Science Foundation of Shanxi(202103021224049)GDAS Projects of International cooperation platform of Sci-ence and Technology(2022GDASZH-2022010203-003)Guangdong province Science and Technology Plan Projects(2023B1212060045).
文摘The dominated contradiction in optimizing the performance of magnesium-air battery anode lies in the difficulty of achieving a good balance between activation and passivation during discharge process.To further reconcile this contradiction,two Mg-0.1Sc-0.1Y-0.1Ag anodes with different residual strain distribution through extrusion with/without annealing are fabricated.The results indicate that annealing can significantly lessen the“pseudo-anode”regions,thereby changing the dissolution mode of the matrix and achieving an effective dissolution during discharge.Additionally,p-type semiconductor characteristic of discharge productfilm could suppress the self-corrosion reaction without reducing the polarization of anode.The magnesium-air battery utilizing annealed Mg-0.1Sc-0.1Y-0.1Ag as anode achieves a synergistic improvement in specific capacity(1388.89 mA h g^(-1))and energy density(1960.42 mW h g^(-1)).This anode modification method accelerates the advancement of high efficiency and long lifespan magnesium-air batteries,offering renewable and cost-effective energy solutions for electronics and emergency equipment.
基金supported by the National Research Foundation of Singapore,Rolls-Royce Singapore Pte.Ltd.,and Nanyang Technological University through grants#002123-00009 and #002124-00009.
文摘This study investigates the effect of high current density electropulsing on the material in a rapid stress relaxation process.An AISI 1020 steel was shot-peened to induce surface compressive residual stresses in a controlled manner and subsequently electropulsed to investigate the changes in microstructure and defect configuration.AISI 1020 steel was chosen as it has a simple microstructure(plain ferritic)and composition with low alloying conditions.It is an appropriate material to study the effect of trans-mitting electric pulses on the microstructural defect evolution.A combination of electron-backscattered diffraction and transmission electron microscopy proved to be an effective tool in characterizing the post-electropulsing effects critically.By application of electropulsing,a reduction in the surface residual stress layer was noticed.Also,reductions in misorientation and dislocation density together with the disentan-glement of dislocations within the cold-worked layer were observed after electropulsing.Additionally,the annihilation of shot-peening-induced deformation bands beyond the residual layer depth was observed.These effects have been rationalised by taking into account the various possibilities of athermal effects of electropulsing.
文摘This study presents a comprehensive investigation of residual strength in corroded pipelines within the Yichang-Qianjiang section of the Sichuan-East Gas Pipeline,integrating advanced numerical simulation with experimental validation.The research methodology incorporates three distinct parameter grouping approaches:a random group based on statistical analysis of 389 actual corrosion defects detected during 2023 MFL inspection,a deviation group representing historically documented failure scenarios,and a structural group examining systematic parameter variations.Using ABAQUS finite element software,we developed a dynamic implicit analysis model incorporating geometric nonlinearity and validated it through 1:12.7 scaled model testing,achieving prediction deviations consistently within 5%for standard cases.Our analysis revealed distinct failure mechanisms between large and small defects,with large defects exhibiting stress concentration at circumferential edges and small defects concentrating stress centrally.Quantitative analysis identified defect depth as themost significant factor,with every 1mmincrease reducing strength by 0.054MPa,while defect length showed moderate influence at 0.0018MPa reduction per mm.Comparative analysis demonstrated that circumferential defects exhibited 15%higher burst failure pressure compared to axial defects,though this advantage diminished significantly at depths exceeding 40%wall thickness.These findings,validated through experimental testing with deviations within 5%,provide valuable insights for pipeline integrity management,particularly emphasizing the importance of defect depth monitoring and the need for orientation-specific assessment criteria in corrosion evaluation protocols.
基金the support provided by the National Natural Science Foundation of China(Grant Nos.52278336 and 42302032)Guangdong Basic and Applied Research Foundation(Grant Nos.2023B1515020061).
文摘Granite residual soil (GRS) is a type of weathering soil that can decompose upon contact with water, potentially causing geological hazards. In this study, cement, an alkaline solution, and glass fiber were used to reinforce GRS. The effects of cement content and SiO_(2)/Na2O ratio of the alkaline solution on the static and dynamic strengths of GRS were discussed. Microscopically, the reinforcement mechanism and coupling effect were examined using X-ray diffraction (XRD), micro-computed tomography (micro-CT), and scanning electron microscopy (SEM). The results indicated that the addition of 2% cement and an alkaline solution with an SiO_(2)/Na2O ratio of 0.5 led to the densest matrix, lowest porosity, and highest static compressive strength, which was 4994 kPa with a dynamic impact resistance of 75.4 kN after adding glass fiber. The compressive strength and dynamic impact resistance were a result of the coupling effect of cement hydration, a pozzolanic reaction of clay minerals in the GRS, and the alkali activation of clay minerals. Excessive cement addition or an excessively high SiO_(2)/Na2O ratio in the alkaline solution can have negative effects, such as the destruction of C-(A)-S-H gels by the alkaline solution and hindering the production of N-A-S-H gels. This can result in damage to the matrix of reinforced GRS, leading to a decrease in both static and dynamic strengths. This study suggests that further research is required to gain a more precise understanding of the effects of this mixture in terms of reducing our carbon footprint and optimizing its properties. The findings indicate that cement and alkaline solution are appropriate for GRS and that the reinforced GRS can be used for high-strength foundation and embankment construction. The study provides an analysis of strategies for mitigating and managing GRS slope failures, as well as enhancing roadbed performance.
基金supported by the National Key Research and Development Program of China(No.SQ2021YFF 0600011).
文摘7039 Al alloys are widely used in armor vehicles,given the material’s high specific strength and fracture toughness.However,laminar tearing in the thickness plane of the base metal(BM),specifically in the normal direction(ND)and rolling direction(RD)plane,was occasionally observed after the welding of thick plates,resulting in premature material failure.A vertically metal-inert gas(MIG)-welded laminar tearing component of a 30 mm thick plate was analyzed to determine the factors associated with this phenomenon.The texture,residual stress,microhardness,and tensile properties were also investigated.The results indicated that the crack extended along the RD as a transcrystalline fracture and terminated at the BM.The grains near the crack grew preferentially in the(001)crystal direction.Furthermore,the tensile strength(83 MPa)and elongation(6.8%)in the RD were relatively higher than those in the ND.In particular,the primary factors for crack initiation include stronger texture,higher dislocation density,increased Al_(7)Cu_(2)Fe phases,lower proportion of small-angle grain boundaries,and varying grain sizes in different regions,leading to the fragile microstructure.The higher residual stress of the BM promotes the formation and extension of cracks.The restraining force due to fixation and welding shrinkage force transformed the crack into laminar tearing.Preventive measures of laminar tearing were also proposed.
文摘BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a result of pancreaticobiliary reflux.Roux-en-Y choledochojejunostomy is a common surgical method for the treatment of PBM,but there are several associated complications that may occur after this operation.CASE SUMMARY The patient,a 12-year-old female,was hospitalized nearly 20 times in 2021 for recurrent acute pancreatitis.In 2022,she was diagnosed with PBM and underwent laparoscopic common bile duct resection and Roux-en-Y choledochojejunostomy in a tertiary hospital.In the first year after surgery,the patient had more than 10 recurrent acute pancreatitis episodes.After undergoing abdominal computed tomography and other examinations,she was diagnosed with“residual bile duct stones and recurrent acute pancreatitis”.On January 30,2024,the patient was admitted to our hospital due to recurrent upper abdominal pain and was cured through endoscopic retrograde cholangiopancreatography.CONCLUSION This article reports a case of a child with distal residual common bile duct stones and recurrent acute pancreatitis after Roux-en-Y choledochojejunostomy for PBM.The patient was cured through endoscopic retrograde cholangiopancreatography.
基金National Program of Foreign Experts of China(G2023026003L)National Natural Science Foundation of China(52475347)+4 种基金Postdoctoral Fund(2023M740475)International Science and Technology Cooperation Project of Henan Province(242102521057)Frontier Exploration Projects of Longmen Laboratory(LMQYTSKT016)Central Plains Science and Technology Innovation Leading TalentsProvincial Science and Technology R&D Program Joint Fund Projects(235200810030)。
文摘As service conditions become more challenging and production complexity increases,there is an increasing demand for enhanced comprehensive performance of ceramic/metal heterostructures.At present,brazing technique has been widely utilized for ceramic-metal heterogeneous joints.However,the residual stress relief in these welding joints is complicated and necessary.Because metals and ceramics have different properties,especially their coefficients of thermal expansion.Welding joints exhibit large residual stresses during the cooling process.The relatively high residual stresses may significantly degrade the joint properties.For this issue,four alleviation routes were reviewed:optimization of process parameters,setting an intermediate layer,surface structure modulation and particle-reinforced composite solder.The states and distribution patterns of residual stress in ceramic-metal brazed joints were summarized,and the generation and detection of residual stress were introduced.Eventually,upcoming prospects and challenges of residual stress research on ceramic/metal heterostructures were pointed out.
基金financially supported by the Key Project of Natural Science Research in Colleges and Universities of Anhui Province,China(No.2022AH050816)the Open Research Grant of Joint National-Local Engineering Research Centre for Safe and Precise Coal Mining(Nos.EC2023013 and EC2022018)+1 种基金the National Natural Science Foundation of China(No.52200139)the Introduction of Talent in Anhui University of Science and Technology,China(Nos.2021yjrc18 and 2023yjrc79)。
文摘Electromagnetic interference,which necessitates the rapid advancement of substances with exceptional capabilities for bsorbing electromagnetic waves,is of urgent concern in contemporary society.In this work,CoFe_(2)O_(4)/residual carbon from coal gasification fine slag(CFO/RC)composites were created using a novel hydrothermal method.Various mechanisms for microwave absorption,including conductive loss,natural resonance,interfacial dipole polarization,and magnetic flux loss,are involved in these composites.Consequently,compared with pure residual carbon materials,this composite offers superior capabilities in microwave absorption.At 7.76GHz,the CFO/RC-2 composite achieves an impressive minimum reflection loss(RL_(min))of-43.99 dB with a thickness of 2.44 mm.Moreover,CFO/RC-3 demonstrates an effective absorption bandwidth(EAB)of up to 4.16 GHz,accompanied by a thickness of 1.18mm.This study revealed the remarkable capability of the composite to diminish electromagnetic waves,providing a new generation method for microwave absorbing materials of superior quality.
文摘In the field of image processing,the analysis of Synthetic Aperture Radar(SAR)images is crucial due to its broad range of applications.However,SAR images are often affected by coherent speckle noise,which significantly degrades image quality.Traditional denoising methods,typically based on filter techniques,often face challenges related to inefficiency and limited adaptability.To address these limitations,this study proposes a novel SAR image denoising algorithm based on an enhanced residual network architecture,with the objective of enhancing the utility of SAR imagery in complex electromagnetic environments.The proposed algorithm integrates residual network modules,which directly process the noisy input images to generate denoised outputs.This approach not only reduces computational complexity but also mitigates the difficulties associated with model training.By combining the Transformer module with the residual block,the algorithm enhances the network's ability to extract global features,offering superior feature extraction capabilities compared to CNN-based residual modules.Additionally,the algorithm employs the adaptive activation function Meta-ACON,which dynamically adjusts the activation patterns of neurons,thereby improving the network's feature extraction efficiency.The effectiveness of the proposed denoising method is empirically validated using real SAR images from the RSOD dataset.The proposed algorithm exhibits remarkable performance in terms of EPI,SSIM,and ENL,while achieving a substantial enhancement in PSNR when compared to traditional and deep learning-based algorithms.The PSNR performance is enhanced by over twofold.Moreover,the evaluation of the MSTAR SAR dataset substantiates the algorithm's robustness and applicability in SAR denoising tasks,with a PSNR of 25.2021 being attained.These findings underscore the efficacy of the proposed algorithm in mitigating speckle noise while preserving critical features in SAR imagery,thereby enhancing its quality and usability in practical scenarios.
基金supported by grants from The National Natural Science Foundation of China(12361104)Yunnan Fundamental Research Projects(202301AT070016,202401AT070036)+2 种基金the Youth Talent Program of Xingdian Talent Support Plan(XDYC-QNRC-2022-0514)the Yunnan Province International Joint Laboratory for Intelligent Integration and Application of Ethnic Multilingualism(202403AP140014)the Open Research Fund of Yunnan Key Laboratory of Statistical Modeling and Data Analysis,Yunnan University(SMDAYB2023004)。
文摘Objective N6-methyladenosine(m6A),the most prevalent epigenetic modification in eukaryotic RNA,plays a pivotal role in regulating cellular differentiation and developmental processes,with its dysregulation implicated in diverse pathological conditions.Accurate prediction of m6A sites is critical for elucidating their regulatory mechanisms and informing drug development.However,traditional experimental methods are time-consuming and costly.Although various computational approaches have been proposed,challenges remain in feature learning,predictive accuracy,and generalization.Here,we present m6A-PSRA,a dual-branch residual-network-based predictor that fully exploits RNA sequence information to enhance prediction performance and model generalization.Methods m6A-PSRA adopts a parallel dual-branch network architecture to comprehensively extract RNA sequence features via two independent pathways.The first branch applies one-hot encoding to transform the RNA sequence into a numerical matrix while strictly preserving positional information and sequence continuity.This ensures that the biological context conveyed by nucleotide order is retained.A bidirectional long short-term memory network(BiLSTM)then processes the encoded matrix,capturing both forward and backward dependencies between bases to resolve contextual correlations.The second branch employs a k-mer tokenization strategy(k=3),decomposing the sequence into overlapping 3-mer subsequences to capture local sequence patterns.A pre-trained Doc2vec model maps these subsequences into fixeddimensional vectors,reducing feature dimensionality while extracting latent global semantic information via context learning.Both branches integrate residual networks(ResNet)and a self-attention mechanism:ResNet mitigates vanishing gradients through skip connections,preserving feature integrity,while self-attention adaptively assigns weights to focus on sequence regions most relevant to methylation prediction.This synergy enhances both feature learning and generalization capability.Results Across 11 tissues from humans,mice,and rats,m6A-PSRA consistently outperformed existing methods in accuracy(ACC)and area under the curve(AUC),achieving>90%ACC and>95%AUC in every tissue tested,indicating strong cross-species and cross-tissue adaptability.Validation on independent datasets—including three human cell lines(MOLM1,HEK293,A549)and a long-sequence dataset(m6A_IND,1001 nt)—confirmed stable performance across varied biological contexts and sequence lengths.Ablation studies demonstrated that the dual-branch architecture,residual network,and self-attention mechanism each contribute critically to performance,with their combination reducing interference between pathways.Motif analysis revealed an enrichment of m6A sites in guanine(G)and cytosine(C),consistent with known regulatory patterns,supporting the model’s biological plausibility.Conclusion m6A-PSRA effectively captures RNA sequence features,achieving high prediction accuracy and robust generalization across tissues and species,providing an efficient computational tool for m6A methylation site prediction.
基金Natural Science Foundation of Shandong Province(ZR2020ME020)。
文摘Through a modified inherent strain model based on the minimum residual stress and deformation,three building schemes with different building postures and support structures were evaluated by finite element analysis.Results demonstrate that according to the principle of reducing the overall height of the building and reducing the support structure with a large tilt angle from the building direction,the residual stress and deformation can be effectively reduced by proper design of building posture and support before laser powder bed melting.Moreover,without the data of thermophysical property variation of Ti-6Al-4V artificial knee implants with temperature,predicting the residual stress and deformation with acceptable accuracy and reduced time cost can be achieved by the inherent strain model.
基金supported by the Japan Society for the Promotion of Science(JSPS)KAKENHI under Grant JP22H03643Japan Science and Technology Agency(JST)Support for Pioneering Research Initiated by the Next Generation(SPRING)under Grant JPMJSP2145JST through the Establishment of University Fellowships towards the Creation of Science Technology Innovation under Grant JPMJFS2115.
文摘Residual neural network (ResNet) is a powerful neural network architecture that has proven to be excellent in extracting spatial and channel-wise information of images. ResNet employs a residual learning strategy that maps inputs directly to outputs, making it less difficult to optimize. In this paper, we incorporate differential information into the original residual block to improve the representative ability of the ResNet, allowing the modified network to capture more complex and metaphysical features. The proposed DFNet preserves the features after each convolutional operation in the residual block, and combines the feature maps of different levels of abstraction through the differential information. To verify the effectiveness of DFNet on image recognition, we select six distinct classification datasets. The experimental results show that our proposed DFNet has better performance and generalization ability than other state-of-the-art variants of ResNet in terms of classification accuracy and other statistical analysis.
文摘Chronic and acute recurrent appendicitis are often underrecognized in clinical practice,particularly in patients presenting with persistent or recurrent right lower quadrant abdominal pain.It is essential to obtain a detailed and comprehensive history from the patient,as careful questioning often reveals a history of prior attacks.Diagnosing recurrent and chronic appendicitis remains challenging,necessitating thorough history-taking,awareness of varied clinical presentations,and physical examination integrating specific maneuvers.Maintaining a high index of clinical suspicion is essential for recognizing these atypical presentations.Confirming a high pretest probability prior to surgical intervention is crucial to avoid unnecessary procedures.
文摘Rationale:Recurrent pregnancy loss and recurrent implantation failure are frequently linked to immune dysregulation,particularly heightened natural killer(NK)cell activity,cytokine imbalance,and autoantibody presence.Lipid emulsion therapy,originally designed for parenteral nutrition,is increasingly recognized for its immunomodulatory potential in reproductive medicine.Patient concerns:A 34-year-old woman with five years of infertility,four first-trimester miscarriages,and three failed in vitro fertilization(IVF)cycles despite transfer of morphologically optimal embryos presented for evaluation.Diagnosis:Routine genetic,endocrine,metabolic,thrombophilia,and anatomical investigations were unremarkable.Immunological testing revealed elevated antiphospholipid and anti-thyroid peroxidase(anti-TPO)antibodies,increased NK cell activity,an imbalanced Th1/Th2 cytokine ratio,and raised tumor necrosis factor-alpha(TNF-α),suggesting immune-mediated reproductive dysfunction.Interventions:The patient underwent IVF with transfer of a single euploid blastocyst following intravenous lipid emulsion therapy(20%,100 mL),administered before transfer,on transfer day,and biweekly until 12 weeks.Associated therapies included aspirin,enoxaparin,progesterone,levothyroxine,and supplementation.Outcomes:Serum beta-human chorionic gonadotropin(β-hCG)and ultrasound confirmed pregnancy with subsequent NK cell normalization.The pregnancy was uncomplicated,resulting in spontaneous vaginal delivery of a healthy male infant.Lessons:Lipid emulsion therapy may improve implantation and pregnancy outcomes in immune-mediated recurrent pregnancy loss and recurrent implantation failure,but larger trials are required to validate efficacy and optimize protocols.
