BACKGROUND Sorafenib has been the conventional treatment for advanced hepatocellular carcinoma(HCC)since 2008.While radiological complete responses are extremely rare,improved supportive care and multidisciplinary app...BACKGROUND Sorafenib has been the conventional treatment for advanced hepatocellular carcinoma(HCC)since 2008.While radiological complete responses are extremely rare,improved supportive care and multidisciplinary approaches in clinical practice may explain the recent increase in case reports and retrospective series documenting such responses.CASE SUMMARY This case series describes 3 patients with advanced HCC who achieved durable complete responses using first-line sorafenib therapy,even in the presence of portal vein thrombosis or extrahepatic spread,and highlights the potential for sustained remission in selected patients.Dermatologic toxicity and non-viral etiology may correlate with favorable outcomes;however,reliable predictive biomarkers for sorafenib response are lacking.CONCLUSION Future research into the etiology and molecular differences in HCC is necessary to develop more personalized therapy options.展开更多
Foliar uptake of airborne metal(loid)s plays a crucial role in metal(loid)accumulation in plant organs and is influ-enced by the size and emission sources of aerosols.Given the high enrichment of toxic metal(loid)s in...Foliar uptake of airborne metal(loid)s plays a crucial role in metal(loid)accumulation in plant organs and is influ-enced by the size and emission sources of aerosols.Given the high enrichment of toxic metal(loid)s in submicron-scale particulates(PM1),this study established a PM1 exposure system to examine airborne metal(loid)accu-mulation and foliar physiological responses in Oryza sativa L.The results showed that the concentrations of Cu,Zn,As,Pb,and Cd in the leaves and grains were influenced not only by the airborne metal(loid)levels but also by the specific nature of the PM1 particles.The quantitative model for PM1-associated Pb entry into leaf tissue indicated that foliar Pb accumulation was primarily driven by particle adhesion,followed by hydrophilic pene-tration and trans-stomatal liquid film migration,accounting for 87%–89%of the total accumulation.The strong hygroscopicity and high Pb activity of PM1 emitted from waste incineration(WI)increased the Pb absorption coefficient via the hydrophilic and liquid film migration pathway.In contrast,the high hydrophobicity of PM1 from coal burning(CB)led to greater retention of Pb on leaf surfaces.Both foliar reactive oxygen metabolism and photosynthesis indices were sensitive to air pollution.Foliar metal(loid)accumulation and airborne PM1 concentration accounted for the variance in physiological responses in rice leaves.Our results also indicated that Pb was the key element in PM1 emissions from both coal burning(CB)and waste incineration(WI)responsible for significant physiological changes in rice leaves.展开更多
Post-translational modifications(PTMs)regulate the occurrence and development of cancer,and lactylation modification is a new form of PTMs.Recent studies have found that lactic acid modification can regulate the immun...Post-translational modifications(PTMs)regulate the occurrence and development of cancer,and lactylation modification is a new form of PTMs.Recent studies have found that lactic acid modification can regulate the immune tolerance of cancer cells.The classical theory holds that prostate apoptosis response-4(PAR-4)is a tumor suppressor protein.However,our recent research has found that PAR-4 has a biological function of promoting cancer in hepatocellular carcinoma(HCC),and our analysis shows that PAR-4 can be modified of lactic acid.These research evidences suggest that PAR-4 lactylation modification may drive immune tolerance in HCC.Therefore,inhibiting PAR-4 lactylation modification is very likely to increase the sensitivity of HCC to immunotherapy.展开更多
To achieve the goals of sustainable development of the energy system and the construction of a lowcarbon society,this study proposes a multi-energy storage collaborative optimization strategy for industrial park that ...To achieve the goals of sustainable development of the energy system and the construction of a lowcarbon society,this study proposes a multi-energy storage collaborative optimization strategy for industrial park that integrates the laddered carbon trading mechanism with demand response.Firstly,a dual dimensional DR model is constructed based on the characteristics of load elasticity.The alternativeDRenables flexible substitution of energy loads through complementary conversion of electricity/heat/cold multi-energy sources,while the price DR relies on timeof-use electricity price signals to guide load spatiotemporal migration;Secondly,the LCT mechanism is introduced to achieve optimal carbon emission costs through a tiered carbon quota allocation mechanism.On this basis,an optimization decision model is established with the core objective of maximizing the annual net profit of the park.The objective function takes into account energy sales revenue,generator unit costs,and investment and operation costs of multiple types of energy storage facilities.Themodel constraint system covers three key dimensions:dynamic operation constraints of power generation units,including unit output limits,ramping capability,and minimum start-stop time;the physical boundary of an electric/hot/cold multi-energy storage system involves energy storage capacity and charge/discharge efficiency;The multi-energy network coupling balance equation ensures that the energy conversion and transmission process satisfies the law of conservation of energy.Using CPLEX mathematical programming solver for simulation verification,construct an energy storage capacity configuration decision process that includes LCT-DR synergistic effect.The research results show that compared with the traditional single energy storage configuration mode,this strategy effectively enhances the economic feasibility and engineering practicality of industrial park operation by coordinating demand side resource scheduling and finely controlling carbon costs,while maintaining stable system operation.Its methodological framework provides a technical path that combines theoretical rigor and practical operability for the low-carbon transformation of regional integrated energy systems.展开更多
Owing to the inherent limitation of the internal pulse ionization chamber within the AlphaGUARD PQ2000 radon monitor,that is,its inability to discriminate the energy levels of α particles,the ingress of^(220)Rn from ...Owing to the inherent limitation of the internal pulse ionization chamber within the AlphaGUARD PQ2000 radon monitor,that is,its inability to discriminate the energy levels of α particles,the ingress of^(220)Rn from the surrounding environment,along with its decay progeny,poses a substantive challenge in accurately determining the^(222)Rn concentration in the measurement outcomes.Among these,the protracted influence primarily stems from the two enduring decay progenies,namely^(212)Pb with a half-life of 10.64 h and^(212)Bi with a half-life of 60.54 min.This study explored the influence of^(220)Rn progeny on the measurement results of an AlphaGUARD PQ2000 radon monitor by developing a theoretical calculation model.The response coefficient related to the residual^(220)Rn progeny within the AlphaGUARD PQ2000 radon monitor was experimentally validated.In addition,this study investigated the effects of temperature and wind speed on the sensitivity of the instrument to^(220)Rn gas.The research findings revealed commendable agreement between the experimentally measured response coefficients of the residual^(220)Rn progeny and the corresponding values derived from the theoretical model.Notably,both the response coefficients of the AlphaGUARD PQ2000 radon monitor to^(220)Rn gas and its internal residual^(220)Rn progeny increased with elevated temperatures and increased wind speeds,providing a reference for correcting the impact of^(220)Rn and its progeny on the measurement results of^(222)Rn concentration obtained using the AlphaGUARD PQ2000 radon monitor.展开更多
BACKGROUND Rectal cancer management is currently evolving with the advent of different neoadjuvant treatment strategies and organ preservation strategies.A significant proportion of patients could achieve complete cli...BACKGROUND Rectal cancer management is currently evolving with the advent of different neoadjuvant treatment strategies and organ preservation strategies.A significant proportion of patients could achieve complete clinical response after neoadjuvant treatment,which often translates to pathologic complete response(pCR)as assessed on surgical specimens after curative intent surgery.Endoscopy plays a significant role in assessing treatment response to neoadjuvant therapies.AIM To explore the role of endoscopy in predicting subsequent pCR after neoadjuvant treatment in rectal cancer patients.METHODS An extensive literature review was undertaken to identify the criteria used for assessment of endoscopic response and their ability to predict pCR.RESULTS Fifteen studies were identified through literature review.The most commonly used endoscopic criteria for evaluation included the presence of a flat white scar and the absence of nodularity or telangiectasia.Information on the timing of endoscopic assessment in relation to neoadjuvant treatment protocols were also extracted from the studies.In most studies,the diagnostic accuracy for predicting pCR exceeded 0.8.The main limitations identified were the retrospective design of included studies included and a moderate risk of bias.CONCLUSION Endoscopy can be a key prognostic factor in predicting pCR to neoadjuvant treatment in rectal cancer despite significant limitations in currently available data.展开更多
The unfolded protein response pathway is an evolutionarily conserved cytoprotective signaling cascade,essential for cell function and survival.Unfolded protein response signaling is tightly integrated with bone cell d...The unfolded protein response pathway is an evolutionarily conserved cytoprotective signaling cascade,essential for cell function and survival.Unfolded protein response signaling is tightly integrated with bone cell differentiation and function,and chronic unfolded protein response activation has been identified in bone disease.The unfolded protein response has been found to promote oncogenesis and drug resistance,raising the possibility that unfolded protein response modulators may have activity as anti-cancer agents.Cancer-associated bone disease remains a major cause of morbidity for patients with multiple myeloma or bone-metastatic disease.Understanding the critical role of unfolded protein response signaling in cancer development and metastasis,as well as its role in bone homeostasis,may lead to novel mechanisms by which to target cancer-associated bone disease.In this review,we summarize the current research delineating the roles of the unfolded protein response in bone biology and pathophysiology,and furthermore,review unfolded protein response modulating agents in the contexts of cancer and cancer-associated bone disease.展开更多
Imaging plays a crucial role in the evaluation of hepatocellular carcinoma(HCC)treatment response.Contrast enhanced computed tomography and magnetic resonance imaging with extra-cellular or hepatobiliary contrast agen...Imaging plays a crucial role in the evaluation of hepatocellular carcinoma(HCC)treatment response.Contrast enhanced computed tomography and magnetic resonance imaging with extra-cellular or hepatobiliary contrast agents are the imaging techniques of choice.Contrast enhanced ultrasound is a promising technique.In this paper,we describe radiological techniques,imaging findings after HCC treatment,and the criteria of response evaluation.The utility of the structured report is also evaluated.展开更多
This paper presents a new type of triangular Sharp Eagle wave energy converter(WEC)platform.On the basis of the linear potential flow theory and the finite element analysis method,the hydrodynamic performance and stru...This paper presents a new type of triangular Sharp Eagle wave energy converter(WEC)platform.On the basis of the linear potential flow theory and the finite element analysis method,the hydrodynamic performance and structural response of the platform are studied,considering the actual platform motion and free surface rise under extreme sea states.First,the effects of the wave frequency and direction on the wave-induced loads and dynamic responses were examined.The motion at a wave direction angle of 0°is relatively low.On this basis,the angle constrained by the two sides of the Sharp Eagle floaters should be aligned with the main wave direction to avoid significant platform motion under extreme sea states.Additionally,the structural response of the platform,including the wave-absorbing floaters,is investigated.The results highlighted that the conditions or locations where yielding,buckling,and fatigue failures occur were different.In this context,the connection area of the Sharp Eagle floaters and platform is prone to yielding failure under oblique wave action,whereas the pontoon and side of the Sharp Eagle floaters are prone to buckling failure during significant vertical motion.Additionally,fatigue damage is most likely to occur at the connection between the middle column on both sides of the Sharp Eagle floaters and the pontoons.The findings of this paper revealed an intrinsic connection between wave-induced loads and the dynamic and structural responses of the platform,which provides a useful reference for the improved design of WECs.展开更多
The solenoid switching valve(SSV)is the key control component of heavy equipment such as continuous casting machines.However,the incompatibility of structural parameters increases the opening and closing time of the S...The solenoid switching valve(SSV)is the key control component of heavy equipment such as continuous casting machines.However,the incompatibility of structural parameters increases the opening and closing time of the SSV.Therefore,this study proposes an optimized design method for an SSV to improve its dynamic performance.First,a multi-physics field-coupling model of the SSV is built,and the effects of different structural parameters on the electromagnetic characteristics are analyzed.After identifying the key influencing parameters,second-order response surface models are established to efficiently predict the opening and closing time.Subsequently,based on the nondominated sorting genetic algorithmⅡ(NSGA-Ⅱ),multi-objective optimization is applied to obtain the Pareto optimal solution of the structural parameters under the double-voltage driving strategy.The structure of the solenoid and valve as well as the dynamic characteristics of the valve are improved.Compared with those before optimization,the optimization results show that the opening and closing time of the optimized SSV are reduced by 24.38%and 51.8%,respectively,and the volume is reduced by 19.7%.The research results and the influence of the solenoid structural parameters on the electromagnetic force provide significant guidance for the design of this type of valve.展开更多
Both acceleration and pseudo-acceleration response spectra play important roles in structural seismic design.However,only one of them is generally provided in most seismic codes.Therefore,many studies have attempted t...Both acceleration and pseudo-acceleration response spectra play important roles in structural seismic design.However,only one of them is generally provided in most seismic codes.Therefore,many studies have attempted to develop conversion models between the acceleration response spectrum(SA)and the pseudo-acceleration response spectrum(PSA).Our previous studies found that the relationship between SA and PSA is affected by magnitude,distance,and site class.Subsequently,we developed an SA/PSA model incorporating these effects.However,this model is suitable for cases with small and moderate magnitudes and its accuracy is not good enough for cases with large magnitudes.This paper aims to develop an efficient SA/PSA model by considering influences of magnitude,distance,and site class,which can be applied to cases not only with small or moderate magnitudes but also with large ones.For this purpose,regression analyses were conducted using 16,660 horizontal seismic records with a wider range of magnitude.The magnitude of these seismic records varies from 4 to 9 and the distances vary from 10 to 200 km.These ground motions were recorded at 338 stations covering four site classes.By comparing them with existing models,it was found that the proposed model shows better accuracy for cases with any magnitudes,distances,and site classes considered in this study.展开更多
The source region of the Yellow River(SRYR),with its semi-humid to semi-arid climate,is crucial for understanding water resource dynamics.Precipitation is key for replenishing surface water and balancing the ecosystem...The source region of the Yellow River(SRYR),with its semi-humid to semi-arid climate,is crucial for understanding water resource dynamics.Precipitation is key for replenishing surface water and balancing the ecosystem’s water cycle.However,the soil moisture response to precipitation across climate zones and soil layers remains poorly understood due to limited long-term data.This study examines the response of soil moisture to precipitation at multiple time scales in the SRYR,using data from Maqu,Mado,Ngoring Lake sites,and the Maqu monitoring network(MMN),along with CN05.1 precipitation and GLEAM v3.8a soil moisture data.Results show that the semi-humid area requires more precipitation to trigger soil moisture responses compared to the semi-arid area in the SRYR.Surface soil at Maqu,MMN,Ngoring Lake,and Mado sites require at least 8.6,8.4,5.2,and 2.84 mm of precipitation,respectively,for effective replenishment.Significant responses to precipitation events were observed in soil layers at 40 cm and above in the semi-humid area,while at 20 cm and above in the semi-arid area.Precipitation volume is the primary factor influencing soil moisture,affecting both the increment and time lag to maximum moisture.Precipitation intensity and pre-rain moisture have no direct effect.In the central SRYR,accumulated precipitation has a greater impact.Root-zone soil moisture has a weaker correlation with precipitation compared to surface soil moisture but persists longer,responding for up to 10 days,while surface soil moisture responds more immediately but only lasts about 5 days.展开更多
Background The potential of exercise as a concurrent therapy for actively treated primary tumors has been suggested by emerging preclinical and observational studies.However,clinical trials regarding this question are...Background The potential of exercise as a concurrent therapy for actively treated primary tumors has been suggested by emerging preclinical and observational studies.However,clinical trials regarding this question are scarce.Therefore,we conducted a randomized controlled trial investigating the effects of aerobic or resistance exercise concomitant to neoadjuvant chemotherapy(NACT)on tumor size.Methods In the BENEFIT study(German title:Bewegung bei neoadjuvanter chemotherapie zur verbesserung der fitness),patients with breast cancer scheduled for NACT were randomly assigned to supervised resistance training(RT,n=60)or aerobic training(AT,n=60)twice weekly during NACT or to a waitlist control group(WCG,n=60).The primary outcome,“change in tumor size”,as well as the secondary clinical outcomes pathologic complete response(pCR),type of surgery(breast conserving/mastectomy),axillary lymph node dissection(ALND,yes/no),premature discontinuation of chemotherapy(yes/no),and relative dose intensity(RDI)were derived from clinical records.Due to the highly skewed distribution,the primary outcome was categorized.Multiple(ordinal)logistic regression analyses were performed.Results Overall,there was no significant difference in post-intervention tumor size between RT or AT and WCG.However,there was a significant effect modification by hormone receptor(HR)status(P_(interaction)=0.030).Among patients with HR+tumors,results suggest a beneficial effect of AT on tumor shrinkage(odds ratio(OR)=2.37,95%confidence interval(95%CI):0.97‒5.78),on pCR(OR=3.21,95%CI:0.97‒10.61);and on ALND(OR=3.76,95%CI:0.78‒18.06)compared to WCG.The effects of RT were slightly less pronounced.For HR−subtypes,beneficial effects on RDI were found for AT(OR=3.71,95%CI:1.20‒11.50)and similarly for RT(OR=2.58,95%CI:0.88‒7.59).Both AT and RT had favorable effects on premature discontinuation of chemotherapy(OR(no vs.yes)=2.34,95%CI:1.10‒5.06),irrespective of tumor receptor status.Conclusion While there was no significant effect on the primary outcome in the overall group,aerobic and resistance exercise concomitant to NACT seem to beneficially affect tumor shrinkage and pCR,reduce the need for ALND among patients with HR+breast cancers,and prevent low RDI among patients with HR–breast cancers.These results warrant confirmation in further trials.展开更多
Objective:Pathologic complete response(pCR)following neoadjuvant therapy(NAT)for gastric cancer(GC)is rare but associated with a favorable prognosis.This study aims to reassess the optimal response population(ORP)foll...Objective:Pathologic complete response(pCR)following neoadjuvant therapy(NAT)for gastric cancer(GC)is rare but associated with a favorable prognosis.This study aims to reassess the optimal response population(ORP)following NAT by evaluating the prognostic outcomes associated with various T and N stages,utilizing multicenter data from China.Methods:Patients who underwent NAT following radical gastrectomy at 10 tertiary hospitals in China between2008 and 2021 were included.The ORP was introduced to explore the disease-free survival(DFS),overall survival(OS),recurrence patterns,and influencing factors following propensity score matching(PSM).Results:A total of 1,076 patients were enrolled in this study(median follow-up period:60 months).We defined ORP as a pCR or tumor infiltration of the mucosal or submucosal layer without lymph node metastasis(pCR or yp T1N0)after NAT.The ORP group comprised 136 patients(12.6%),while the non-ORP group comprised 940patients(87.4%).After applying a 1:4 PSM,we obtained an ORP group of 136 patients and non-ORP group of 544patients.Survival analysis demonstrated that both the 3-year OS(before PSM:89.0%vs.55.0%,P<0.001;after PSM:89.0%vs.55.4%,P<0.001)and DFS(before PSM:85.8%vs.49.7%,P<0.001;after PSM:85.8%vs.50.6%,P<0.001)were significantly superior in the ORP group compared to that in the non-ORP group.Remarkably,adjuvant chemotherapy did not impact the prognosis of patients in the ORP group(3-year OS:89.0%vs.89.7%,P=0.988;3-year DFS:84.9%vs.89.7%,P=0.700).Conclusions:This study reevaluates patients with ORP following NAT,providing a more comprehensive and accurate depiction of the potential beneficiary group and survival outcomes in patients with locally advanced GC.展开更多
Accumulating evidence indicates that antibiotic exposure may lead to impaired vaccine responses1-4;however,the mechanisms underlying this association remain poorly understood.Here we prospectively followed 191 healthy...Accumulating evidence indicates that antibiotic exposure may lead to impaired vaccine responses1-4;however,the mechanisms underlying this association remain poorly understood.Here we prospectively followed 191 healthy,vaginally born,term infants from birth to 15 months,using a systems vaccinology approach to assess the effects of antibiotic exposure on immune responses to vaccination.Exposure to direct neonatal but not intrapartum antibiotics was associated with significantly lower antibody titres against various polysaccharides in the 13-valent pneumococcal conjugate vaccine and the Haemophilus influenzae type b polyribosylribitol phosphate and diphtheria toxoid antigens in the combined 6-in-1 Infanrix Hexa vaccine at 7 months of age.Blood from infants exposed to neonatal antibiotics had an inflammatory transcriptional profile before vaccination;in addition,faecal metagenomics showed reduced abundance of Bifidobacterium species in these infants at the time of vaccination,which was correlated with reduced vaccine antibody titres 6 months later.In preclinical models,responses to the 13-valent pneumococcal conjugate vaccine were strongly dependent on an intact microbiota but could be restored in germ-free mice by administering a consortium of Bifidobacterium species or a probiotic already widely used in neonatal units.Our data suggest that microbiota-targeted interventions could mitigate the detrimental effects of early-life antibiotics on vaccine immunogenicity.展开更多
BACKGROUND Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery(ERAS)provide recommendations for ERAS in gastrointestinal surgery,the clinical application of standard ERAS nursing...BACKGROUND Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery(ERAS)provide recommendations for ERAS in gastrointestinal surgery,the clinical application of standard ERAS nursing models is challenging due to the variety of diseases involved in gastrointestinal surgery and the com-plex factors contributing to patient stress responses.Moreover,stress responses are more severe in older adult patients.Therefore,precision medicine is required to improve the quality of nursing care and promote postoperative recovery in gastrointestinal surgery.and demonstrate nursing benefits through clinical practice.METHODS This randomized clinical trial first established an evidence-based nursing ERAS protocol in older adult patients based on literature related to perioperative nursing measures for gastrointestinal surgery stress response.Next,392 older adult patients who underwent gastrointestinal surgery and were admitted to our hospital between December 2021 and June 2023 were categorized into two groups to receive evidence-based(study group)or conventional(control group)ERAS nursing models,respectively.Intraoperative physiological parameters during surgery and postoperative recovery indicators were compared between the groups.RESULTS Among 64 domestic and international studies,the stress responses of older adult patients mainly included emotional anxiety,sleep disorders,gastrointestinal discomfort,physical weakness,pain,and swelling.The appropriate nursing interventions included comprehensive psychological counseling,pre-and postoperative nutritional support,temperature control,pain management,and rehabilitation training.Compared with the control group,the study group showed lower heart rate,mean arterial pressure,blood glucose level,and adrenaline level;shorter duration of drainage tube placement,time to first flatus,time to first ambulation,and postoperative hospital stay;lower anxiety scores on postoperative day 3;and lower incidences of postoperative infection,obstruction,poor wound healing,and gastrointestinal reactions were lower in the study group(all P<0.05).CONCLUSION The evidence-based nursing measures targeting stress responses based on the conventional ERAS nursing model resulted in stable intraoperative physiological parameters during surgery,promoted postoperative recovery,and reduced the incidence of complications.展开更多
Macrophages undergo dynamic transitions between M1 and M2 states,exerting profound influences on both inflammatory and regenerative processes.The biocompatible and wound-healing properties of decellularized amniotic m...Macrophages undergo dynamic transitions between M1 and M2 states,exerting profound influences on both inflammatory and regenerative processes.The biocompatible and wound-healing properties of decellularized amniotic membrane(d AM)make it a subject of exploration for its potential impact on the anti-inflammatory response of macrophages.Experimental findings unequivocally demonstrate that d AM promotes anti-inflammatory M2 polarization of macrophage,with its cytokine-rich content posited as a potential mediator.The application of RNA sequencing unveils differential gene expression,implicating the hypoxia inducible factor-1α(HIF-1α)signaling pathway in this intricate interplay.Subsequent investigation further demonstrates that d AM facilitates anti-inflammatory M2 polarization of macrophage through the upregulation of epidermal growth factor(EGF),which,in turn,activates the phosphatidylinositol 3-kinase(PI3K)/protein kinase B(AKT)pathway and stabilizes HIF-1α.This cascade results in a noteworthy augmentation of anti-inflammatory gene expression.This study significantly contributes to advancing our comprehension of d AM's immunomodulatory role in tissue repair,thereby suggesting promising therapeutic potential.展开更多
The occurrence of top-down(TD)cracking has gradually become a prevalent issue in semi-rigid base asphalt pavements after prolonged service.A coupled simulation model integrating the finite difference method(FDM)and di...The occurrence of top-down(TD)cracking has gradually become a prevalent issue in semi-rigid base asphalt pavements after prolonged service.A coupled simulation model integrating the finite difference method(FDM)and discrete element method(DEM)was employed to investigate the mechanical behavior of asphalt pavement containing a pre-existing TD crack.The mesoscopic parameters of the model were calibrated based on the mixture modulus and the static mechanical response on the MLS66 test road.Finally,an analysis was performed to assess how variations in TD crack depth and longitudinal length affect the distribution patterns of transverse tensile stress,vertical shear stress,and vertical compressive stress.The results indicate that the vertical propagation of TD crack significantly increases both the tensile stress value and range on the middle surface,while the longitudinal development of TD crack has minimal impact.This phenomenon may result in more severe fatigue failure on the middle surface.With the vertical and longitudinal development of TD crack,the vertical shear stress and compressive stress show obvious"two-stage"characteristics.When the crack's vertical length reaches 40 mm,there is a sharp increase in stress on the upper surface.As the crack continues to propagate vertically,the growth of stress on the upper surface becomes negligible,while the stress in the middle and lower layers increased significantly.Conversely,for longitudinal development of TD crack,any changes in stress are insignificant when their length is less than 180 mm;however,as they continue to develop longitudinally beyond this threshold,there is a sharp increase in stress levels.These findings hold great significance for understanding pavement structure deterioration and maintenance behavior associated with TD crack.展开更多
The tumor objective response rate(ORR)is an important parameter to demonstrate the efficacy of a treatment in oncology.The ORR is valuable for clinical decision making in routine practice and a significant end-point f...The tumor objective response rate(ORR)is an important parameter to demonstrate the efficacy of a treatment in oncology.The ORR is valuable for clinical decision making in routine practice and a significant end-point for reporting the results of clinical trials.World Health Organization and Response Evaluation Criteria in Solid Tumors(RECIST)are anatomic response criteria developed mainly for cytotoxic chemotherapy.These criteria are based on the visual assessment of tumor size in morphological images provided by computed tomography(CT)or magnetic resonance imaging.Anatomic response criteria may not be optimal for biologic agents,some disease sites,and some regional therapies.Consequently,modifications of RECIST,Choi criteria and Morphologic response criteria were developed based on the concept of the evaluation of viable tumors.Despite its limitations,RECIST v1.1 is validated in prospective studies,is widely accepted by regulatory agencies and has recently shown good performance for targeted cancer agents.Finally,some alternatives of RECIST were developed as immune-specific response criteria for checkpoint inhibitors.Immune RECIST criteria are based essentially on defining true progressive disease after a confirmatory imaging.Some graphical methods may be useful to show longitudinal change in the tumor burden over time.Tumor tissue is a tridimensional heterogenous mass,and tumor shrinkage is not always symmetrical;thus,metabolic response assessments using positron emission tomography(PET)or PET/CT may reflect the viability of cancer cells or functional changes evolving after anticancer treatments.The metabolic response can show the benefit of a treatment earlier than anatomic shrinkage,possibly preventing delays in drug approval.Computer-assisted automated volumetric assessments,quantitative multimodality imaging in radiology,new tracers in nuclear medicine and finally artificial intelligence have great potential in future evaluations.展开更多
The demand response(DR)market,as a vital complement to the electricity spot market,plays a key role in evoking user-side regulation capability to mitigate system-level supply‒demand imbalances during extreme events.Wh...The demand response(DR)market,as a vital complement to the electricity spot market,plays a key role in evoking user-side regulation capability to mitigate system-level supply‒demand imbalances during extreme events.While the DR market offers the load aggregator(LA)additional profitable opportunities beyond the electricity spot market,it also introduces new trading risks due to the significant uncertainty in users’behaviors.Dispatching energy storage systems(ESSs)is an effective means to enhance the risk management capabilities of LAs;however,coordinating ESS operations with dual-market trading strategies remains an urgent challenge.To this end,this paper proposes a novel systematic risk-aware coordinated trading model for the LA in concurrently participating in the day-ahead electricity spot market and DR market,which incorporates the capacity allocation mechanism of ESS based on market clearing rules to jointly formulate bidding and pricing decisions for the dual market.First,the intrinsic coupling characteristics of the LA participating in the dual market are analyzed,and a joint optimization framework for formulating bidding and pricing strategies that integrates ESS facilities is proposed.Second,an uncertain user response model is developed based on price‒response mechanisms,and actual market settlement rules accounting for under-and over-responses are employed to calculate trading revenues,where possible revenue losses are quantified via conditional value at risk.Third,by imposing these terms and the capacity allocation mechanism of ESS,the risk-aware stochastic coordinated trading model of the LA is built,where the bidding and pricing strategies in the dual model that trade off risk and profit are derived.The simulation results of a case study validate the effectiveness of the proposed trading strategy in controlling trading risk and improving the trading income of the LA.展开更多
文摘BACKGROUND Sorafenib has been the conventional treatment for advanced hepatocellular carcinoma(HCC)since 2008.While radiological complete responses are extremely rare,improved supportive care and multidisciplinary approaches in clinical practice may explain the recent increase in case reports and retrospective series documenting such responses.CASE SUMMARY This case series describes 3 patients with advanced HCC who achieved durable complete responses using first-line sorafenib therapy,even in the presence of portal vein thrombosis or extrahepatic spread,and highlights the potential for sustained remission in selected patients.Dermatologic toxicity and non-viral etiology may correlate with favorable outcomes;however,reliable predictive biomarkers for sorafenib response are lacking.CONCLUSION Future research into the etiology and molecular differences in HCC is necessary to develop more personalized therapy options.
基金supported by the National Natural Science Foundation of China(Nos.42077367 and 21677123).
文摘Foliar uptake of airborne metal(loid)s plays a crucial role in metal(loid)accumulation in plant organs and is influ-enced by the size and emission sources of aerosols.Given the high enrichment of toxic metal(loid)s in submicron-scale particulates(PM1),this study established a PM1 exposure system to examine airborne metal(loid)accu-mulation and foliar physiological responses in Oryza sativa L.The results showed that the concentrations of Cu,Zn,As,Pb,and Cd in the leaves and grains were influenced not only by the airborne metal(loid)levels but also by the specific nature of the PM1 particles.The quantitative model for PM1-associated Pb entry into leaf tissue indicated that foliar Pb accumulation was primarily driven by particle adhesion,followed by hydrophilic pene-tration and trans-stomatal liquid film migration,accounting for 87%–89%of the total accumulation.The strong hygroscopicity and high Pb activity of PM1 emitted from waste incineration(WI)increased the Pb absorption coefficient via the hydrophilic and liquid film migration pathway.In contrast,the high hydrophobicity of PM1 from coal burning(CB)led to greater retention of Pb on leaf surfaces.Both foliar reactive oxygen metabolism and photosynthesis indices were sensitive to air pollution.Foliar metal(loid)accumulation and airborne PM1 concentration accounted for the variance in physiological responses in rice leaves.Our results also indicated that Pb was the key element in PM1 emissions from both coal burning(CB)and waste incineration(WI)responsible for significant physiological changes in rice leaves.
基金supported by the National Natural Science Foundation of China(Nos.82573045,82460602,82560459)the Hainan Provincial Graduate Student Innovative Research Project(No.Qhys2024-440).
文摘Post-translational modifications(PTMs)regulate the occurrence and development of cancer,and lactylation modification is a new form of PTMs.Recent studies have found that lactic acid modification can regulate the immune tolerance of cancer cells.The classical theory holds that prostate apoptosis response-4(PAR-4)is a tumor suppressor protein.However,our recent research has found that PAR-4 has a biological function of promoting cancer in hepatocellular carcinoma(HCC),and our analysis shows that PAR-4 can be modified of lactic acid.These research evidences suggest that PAR-4 lactylation modification may drive immune tolerance in HCC.Therefore,inhibiting PAR-4 lactylation modification is very likely to increase the sensitivity of HCC to immunotherapy.
基金funded by Science and Technology Projects from State Grid Corporation of China,(Research on Adaptive Balance Optimization and Simulation Technology of Industrial community Energy System with High Proportion of Distributed Energy,No.:5100-202355752A-3-4-SY).
文摘To achieve the goals of sustainable development of the energy system and the construction of a lowcarbon society,this study proposes a multi-energy storage collaborative optimization strategy for industrial park that integrates the laddered carbon trading mechanism with demand response.Firstly,a dual dimensional DR model is constructed based on the characteristics of load elasticity.The alternativeDRenables flexible substitution of energy loads through complementary conversion of electricity/heat/cold multi-energy sources,while the price DR relies on timeof-use electricity price signals to guide load spatiotemporal migration;Secondly,the LCT mechanism is introduced to achieve optimal carbon emission costs through a tiered carbon quota allocation mechanism.On this basis,an optimization decision model is established with the core objective of maximizing the annual net profit of the park.The objective function takes into account energy sales revenue,generator unit costs,and investment and operation costs of multiple types of energy storage facilities.Themodel constraint system covers three key dimensions:dynamic operation constraints of power generation units,including unit output limits,ramping capability,and minimum start-stop time;the physical boundary of an electric/hot/cold multi-energy storage system involves energy storage capacity and charge/discharge efficiency;The multi-energy network coupling balance equation ensures that the energy conversion and transmission process satisfies the law of conservation of energy.Using CPLEX mathematical programming solver for simulation verification,construct an energy storage capacity configuration decision process that includes LCT-DR synergistic effect.The research results show that compared with the traditional single energy storage configuration mode,this strategy effectively enhances the economic feasibility and engineering practicality of industrial park operation by coordinating demand side resource scheduling and finely controlling carbon costs,while maintaining stable system operation.Its methodological framework provides a technical path that combines theoretical rigor and practical operability for the low-carbon transformation of regional integrated energy systems.
基金supported by the National Natural Science Foundation of China(No.12175102)Hunan Provincial Natural Science Foundation(No.2022JJ40346)the 2022 Hunan Provincial University Student Innovation and Entrepreneurship Training Program(No.S202210555144).
文摘Owing to the inherent limitation of the internal pulse ionization chamber within the AlphaGUARD PQ2000 radon monitor,that is,its inability to discriminate the energy levels of α particles,the ingress of^(220)Rn from the surrounding environment,along with its decay progeny,poses a substantive challenge in accurately determining the^(222)Rn concentration in the measurement outcomes.Among these,the protracted influence primarily stems from the two enduring decay progenies,namely^(212)Pb with a half-life of 10.64 h and^(212)Bi with a half-life of 60.54 min.This study explored the influence of^(220)Rn progeny on the measurement results of an AlphaGUARD PQ2000 radon monitor by developing a theoretical calculation model.The response coefficient related to the residual^(220)Rn progeny within the AlphaGUARD PQ2000 radon monitor was experimentally validated.In addition,this study investigated the effects of temperature and wind speed on the sensitivity of the instrument to^(220)Rn gas.The research findings revealed commendable agreement between the experimentally measured response coefficients of the residual^(220)Rn progeny and the corresponding values derived from the theoretical model.Notably,both the response coefficients of the AlphaGUARD PQ2000 radon monitor to^(220)Rn gas and its internal residual^(220)Rn progeny increased with elevated temperatures and increased wind speeds,providing a reference for correcting the impact of^(220)Rn and its progeny on the measurement results of^(222)Rn concentration obtained using the AlphaGUARD PQ2000 radon monitor.
文摘BACKGROUND Rectal cancer management is currently evolving with the advent of different neoadjuvant treatment strategies and organ preservation strategies.A significant proportion of patients could achieve complete clinical response after neoadjuvant treatment,which often translates to pathologic complete response(pCR)as assessed on surgical specimens after curative intent surgery.Endoscopy plays a significant role in assessing treatment response to neoadjuvant therapies.AIM To explore the role of endoscopy in predicting subsequent pCR after neoadjuvant treatment in rectal cancer patients.METHODS An extensive literature review was undertaken to identify the criteria used for assessment of endoscopic response and their ability to predict pCR.RESULTS Fifteen studies were identified through literature review.The most commonly used endoscopic criteria for evaluation included the presence of a flat white scar and the absence of nodularity or telangiectasia.Information on the timing of endoscopic assessment in relation to neoadjuvant treatment protocols were also extracted from the studies.In most studies,the diagnostic accuracy for predicting pCR exceeded 0.8.The main limitations identified were the retrospective design of included studies included and a moderate risk of bias.CONCLUSION Endoscopy can be a key prognostic factor in predicting pCR to neoadjuvant treatment in rectal cancer despite significant limitations in currently available data.
基金supported by the National Institutes of Health(Grants P30 CA036727 and R01 CA258621)and funding from the University of Nebraska Medical Center Graduate Studies Assistantship.
文摘The unfolded protein response pathway is an evolutionarily conserved cytoprotective signaling cascade,essential for cell function and survival.Unfolded protein response signaling is tightly integrated with bone cell differentiation and function,and chronic unfolded protein response activation has been identified in bone disease.The unfolded protein response has been found to promote oncogenesis and drug resistance,raising the possibility that unfolded protein response modulators may have activity as anti-cancer agents.Cancer-associated bone disease remains a major cause of morbidity for patients with multiple myeloma or bone-metastatic disease.Understanding the critical role of unfolded protein response signaling in cancer development and metastasis,as well as its role in bone homeostasis,may lead to novel mechanisms by which to target cancer-associated bone disease.In this review,we summarize the current research delineating the roles of the unfolded protein response in bone biology and pathophysiology,and furthermore,review unfolded protein response modulating agents in the contexts of cancer and cancer-associated bone disease.
文摘Imaging plays a crucial role in the evaluation of hepatocellular carcinoma(HCC)treatment response.Contrast enhanced computed tomography and magnetic resonance imaging with extra-cellular or hepatobiliary contrast agents are the imaging techniques of choice.Contrast enhanced ultrasound is a promising technique.In this paper,we describe radiological techniques,imaging findings after HCC treatment,and the criteria of response evaluation.The utility of the structured report is also evaluated.
基金supported by the National Key Research and Development Program of China(Grant No.2022YFC3003805)Youth Innovation Promotion Association of the Chinese Academy of Sciences(Grant No.2022356)Guangzhou Basic and Applied Basic Research Project(Grant No.2023A04J0955).
文摘This paper presents a new type of triangular Sharp Eagle wave energy converter(WEC)platform.On the basis of the linear potential flow theory and the finite element analysis method,the hydrodynamic performance and structural response of the platform are studied,considering the actual platform motion and free surface rise under extreme sea states.First,the effects of the wave frequency and direction on the wave-induced loads and dynamic responses were examined.The motion at a wave direction angle of 0°is relatively low.On this basis,the angle constrained by the two sides of the Sharp Eagle floaters should be aligned with the main wave direction to avoid significant platform motion under extreme sea states.Additionally,the structural response of the platform,including the wave-absorbing floaters,is investigated.The results highlighted that the conditions or locations where yielding,buckling,and fatigue failures occur were different.In this context,the connection area of the Sharp Eagle floaters and platform is prone to yielding failure under oblique wave action,whereas the pontoon and side of the Sharp Eagle floaters are prone to buckling failure during significant vertical motion.Additionally,fatigue damage is most likely to occur at the connection between the middle column on both sides of the Sharp Eagle floaters and the pontoons.The findings of this paper revealed an intrinsic connection between wave-induced loads and the dynamic and structural responses of the platform,which provides a useful reference for the improved design of WECs.
基金Supported by National Natural Science Foundation of China(Grant No.2018YFB1703000)State Key Laboratory of Metal Extrusion and Forging Equipment TechnologyChina National Heavy Machinery Research Institute Co.,Ltd.(Grant No.B2408100.W19)。
文摘The solenoid switching valve(SSV)is the key control component of heavy equipment such as continuous casting machines.However,the incompatibility of structural parameters increases the opening and closing time of the SSV.Therefore,this study proposes an optimized design method for an SSV to improve its dynamic performance.First,a multi-physics field-coupling model of the SSV is built,and the effects of different structural parameters on the electromagnetic characteristics are analyzed.After identifying the key influencing parameters,second-order response surface models are established to efficiently predict the opening and closing time.Subsequently,based on the nondominated sorting genetic algorithmⅡ(NSGA-Ⅱ),multi-objective optimization is applied to obtain the Pareto optimal solution of the structural parameters under the double-voltage driving strategy.The structure of the solenoid and valve as well as the dynamic characteristics of the valve are improved.Compared with those before optimization,the optimization results show that the opening and closing time of the optimized SSV are reduced by 24.38%and 51.8%,respectively,and the volume is reduced by 19.7%.The research results and the influence of the solenoid structural parameters on the electromagnetic force provide significant guidance for the design of this type of valve.
基金National Natural Science Foundation of China under Grant No.52278135。
文摘Both acceleration and pseudo-acceleration response spectra play important roles in structural seismic design.However,only one of them is generally provided in most seismic codes.Therefore,many studies have attempted to develop conversion models between the acceleration response spectrum(SA)and the pseudo-acceleration response spectrum(PSA).Our previous studies found that the relationship between SA and PSA is affected by magnitude,distance,and site class.Subsequently,we developed an SA/PSA model incorporating these effects.However,this model is suitable for cases with small and moderate magnitudes and its accuracy is not good enough for cases with large magnitudes.This paper aims to develop an efficient SA/PSA model by considering influences of magnitude,distance,and site class,which can be applied to cases not only with small or moderate magnitudes but also with large ones.For this purpose,regression analyses were conducted using 16,660 horizontal seismic records with a wider range of magnitude.The magnitude of these seismic records varies from 4 to 9 and the distances vary from 10 to 200 km.These ground motions were recorded at 338 stations covering four site classes.By comparing them with existing models,it was found that the proposed model shows better accuracy for cases with any magnitudes,distances,and site classes considered in this study.
基金supported by the National Natural Science Foundation of China(Grant No.42325502,and 42275045)the West Light Foundation of the Chi-nese Academy of Sciences(Grant No.xbzg-zdsys-202215)+1 种基金the Sci-ence and Technology Research Plan of Gansu Province(Grant Nos.23JRRA654 and 20JR10RA070)iLEAPs(Integrated Land Ecosystem-Atmosphere Processes Study).
文摘The source region of the Yellow River(SRYR),with its semi-humid to semi-arid climate,is crucial for understanding water resource dynamics.Precipitation is key for replenishing surface water and balancing the ecosystem’s water cycle.However,the soil moisture response to precipitation across climate zones and soil layers remains poorly understood due to limited long-term data.This study examines the response of soil moisture to precipitation at multiple time scales in the SRYR,using data from Maqu,Mado,Ngoring Lake sites,and the Maqu monitoring network(MMN),along with CN05.1 precipitation and GLEAM v3.8a soil moisture data.Results show that the semi-humid area requires more precipitation to trigger soil moisture responses compared to the semi-arid area in the SRYR.Surface soil at Maqu,MMN,Ngoring Lake,and Mado sites require at least 8.6,8.4,5.2,and 2.84 mm of precipitation,respectively,for effective replenishment.Significant responses to precipitation events were observed in soil layers at 40 cm and above in the semi-humid area,while at 20 cm and above in the semi-arid area.Precipitation volume is the primary factor influencing soil moisture,affecting both the increment and time lag to maximum moisture.Precipitation intensity and pre-rain moisture have no direct effect.In the central SRYR,accumulated precipitation has a greater impact.Root-zone soil moisture has a weaker correlation with precipitation compared to surface soil moisture but persists longer,responding for up to 10 days,while surface soil moisture responds more immediately but only lasts about 5 days.
基金supported by an intramural proof of concept grant of the NCT Heidelberg.
文摘Background The potential of exercise as a concurrent therapy for actively treated primary tumors has been suggested by emerging preclinical and observational studies.However,clinical trials regarding this question are scarce.Therefore,we conducted a randomized controlled trial investigating the effects of aerobic or resistance exercise concomitant to neoadjuvant chemotherapy(NACT)on tumor size.Methods In the BENEFIT study(German title:Bewegung bei neoadjuvanter chemotherapie zur verbesserung der fitness),patients with breast cancer scheduled for NACT were randomly assigned to supervised resistance training(RT,n=60)or aerobic training(AT,n=60)twice weekly during NACT or to a waitlist control group(WCG,n=60).The primary outcome,“change in tumor size”,as well as the secondary clinical outcomes pathologic complete response(pCR),type of surgery(breast conserving/mastectomy),axillary lymph node dissection(ALND,yes/no),premature discontinuation of chemotherapy(yes/no),and relative dose intensity(RDI)were derived from clinical records.Due to the highly skewed distribution,the primary outcome was categorized.Multiple(ordinal)logistic regression analyses were performed.Results Overall,there was no significant difference in post-intervention tumor size between RT or AT and WCG.However,there was a significant effect modification by hormone receptor(HR)status(P_(interaction)=0.030).Among patients with HR+tumors,results suggest a beneficial effect of AT on tumor shrinkage(odds ratio(OR)=2.37,95%confidence interval(95%CI):0.97‒5.78),on pCR(OR=3.21,95%CI:0.97‒10.61);and on ALND(OR=3.76,95%CI:0.78‒18.06)compared to WCG.The effects of RT were slightly less pronounced.For HR−subtypes,beneficial effects on RDI were found for AT(OR=3.71,95%CI:1.20‒11.50)and similarly for RT(OR=2.58,95%CI:0.88‒7.59).Both AT and RT had favorable effects on premature discontinuation of chemotherapy(OR(no vs.yes)=2.34,95%CI:1.10‒5.06),irrespective of tumor receptor status.Conclusion While there was no significant effect on the primary outcome in the overall group,aerobic and resistance exercise concomitant to NACT seem to beneficially affect tumor shrinkage and pCR,reduce the need for ALND among patients with HR+breast cancers,and prevent low RDI among patients with HR–breast cancers.These results warrant confirmation in further trials.
基金supported by the construction funds for“high-level hospitals and clinical specialties”of Fujian Province(No.[2021]76)。
文摘Objective:Pathologic complete response(pCR)following neoadjuvant therapy(NAT)for gastric cancer(GC)is rare but associated with a favorable prognosis.This study aims to reassess the optimal response population(ORP)following NAT by evaluating the prognostic outcomes associated with various T and N stages,utilizing multicenter data from China.Methods:Patients who underwent NAT following radical gastrectomy at 10 tertiary hospitals in China between2008 and 2021 were included.The ORP was introduced to explore the disease-free survival(DFS),overall survival(OS),recurrence patterns,and influencing factors following propensity score matching(PSM).Results:A total of 1,076 patients were enrolled in this study(median follow-up period:60 months).We defined ORP as a pCR or tumor infiltration of the mucosal or submucosal layer without lymph node metastasis(pCR or yp T1N0)after NAT.The ORP group comprised 136 patients(12.6%),while the non-ORP group comprised 940patients(87.4%).After applying a 1:4 PSM,we obtained an ORP group of 136 patients and non-ORP group of 544patients.Survival analysis demonstrated that both the 3-year OS(before PSM:89.0%vs.55.0%,P<0.001;after PSM:89.0%vs.55.4%,P<0.001)and DFS(before PSM:85.8%vs.49.7%,P<0.001;after PSM:85.8%vs.50.6%,P<0.001)were significantly superior in the ORP group compared to that in the non-ORP group.Remarkably,adjuvant chemotherapy did not impact the prognosis of patients in the ORP group(3-year OS:89.0%vs.89.7%,P=0.988;3-year DFS:84.9%vs.89.7%,P=0.700).Conclusions:This study reevaluates patients with ORP following NAT,providing a more comprehensive and accurate depiction of the potential beneficiary group and survival outcomes in patients with locally advanced GC.
文摘Accumulating evidence indicates that antibiotic exposure may lead to impaired vaccine responses1-4;however,the mechanisms underlying this association remain poorly understood.Here we prospectively followed 191 healthy,vaginally born,term infants from birth to 15 months,using a systems vaccinology approach to assess the effects of antibiotic exposure on immune responses to vaccination.Exposure to direct neonatal but not intrapartum antibiotics was associated with significantly lower antibody titres against various polysaccharides in the 13-valent pneumococcal conjugate vaccine and the Haemophilus influenzae type b polyribosylribitol phosphate and diphtheria toxoid antigens in the combined 6-in-1 Infanrix Hexa vaccine at 7 months of age.Blood from infants exposed to neonatal antibiotics had an inflammatory transcriptional profile before vaccination;in addition,faecal metagenomics showed reduced abundance of Bifidobacterium species in these infants at the time of vaccination,which was correlated with reduced vaccine antibody titres 6 months later.In preclinical models,responses to the 13-valent pneumococcal conjugate vaccine were strongly dependent on an intact microbiota but could be restored in germ-free mice by administering a consortium of Bifidobacterium species or a probiotic already widely used in neonatal units.Our data suggest that microbiota-targeted interventions could mitigate the detrimental effects of early-life antibiotics on vaccine immunogenicity.
文摘BACKGROUND Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery(ERAS)provide recommendations for ERAS in gastrointestinal surgery,the clinical application of standard ERAS nursing models is challenging due to the variety of diseases involved in gastrointestinal surgery and the com-plex factors contributing to patient stress responses.Moreover,stress responses are more severe in older adult patients.Therefore,precision medicine is required to improve the quality of nursing care and promote postoperative recovery in gastrointestinal surgery.and demonstrate nursing benefits through clinical practice.METHODS This randomized clinical trial first established an evidence-based nursing ERAS protocol in older adult patients based on literature related to perioperative nursing measures for gastrointestinal surgery stress response.Next,392 older adult patients who underwent gastrointestinal surgery and were admitted to our hospital between December 2021 and June 2023 were categorized into two groups to receive evidence-based(study group)or conventional(control group)ERAS nursing models,respectively.Intraoperative physiological parameters during surgery and postoperative recovery indicators were compared between the groups.RESULTS Among 64 domestic and international studies,the stress responses of older adult patients mainly included emotional anxiety,sleep disorders,gastrointestinal discomfort,physical weakness,pain,and swelling.The appropriate nursing interventions included comprehensive psychological counseling,pre-and postoperative nutritional support,temperature control,pain management,and rehabilitation training.Compared with the control group,the study group showed lower heart rate,mean arterial pressure,blood glucose level,and adrenaline level;shorter duration of drainage tube placement,time to first flatus,time to first ambulation,and postoperative hospital stay;lower anxiety scores on postoperative day 3;and lower incidences of postoperative infection,obstruction,poor wound healing,and gastrointestinal reactions were lower in the study group(all P<0.05).CONCLUSION The evidence-based nursing measures targeting stress responses based on the conventional ERAS nursing model resulted in stable intraoperative physiological parameters during surgery,promoted postoperative recovery,and reduced the incidence of complications.
基金supported by the National Natural Science Foundation of China(No.82302772)Guizhou Basic Research Project(No.ZK[2023]General 201)partially supported by Wuhan Kangchuang Biotechnology Co.,Ltd。
文摘Macrophages undergo dynamic transitions between M1 and M2 states,exerting profound influences on both inflammatory and regenerative processes.The biocompatible and wound-healing properties of decellularized amniotic membrane(d AM)make it a subject of exploration for its potential impact on the anti-inflammatory response of macrophages.Experimental findings unequivocally demonstrate that d AM promotes anti-inflammatory M2 polarization of macrophage,with its cytokine-rich content posited as a potential mediator.The application of RNA sequencing unveils differential gene expression,implicating the hypoxia inducible factor-1α(HIF-1α)signaling pathway in this intricate interplay.Subsequent investigation further demonstrates that d AM facilitates anti-inflammatory M2 polarization of macrophage through the upregulation of epidermal growth factor(EGF),which,in turn,activates the phosphatidylinositol 3-kinase(PI3K)/protein kinase B(AKT)pathway and stabilizes HIF-1α.This cascade results in a noteworthy augmentation of anti-inflammatory gene expression.This study significantly contributes to advancing our comprehension of d AM's immunomodulatory role in tissue repair,thereby suggesting promising therapeutic potential.
基金supported by National Key R&D Program of China(Grant No.2021YFB2601200)Open Fund of National Engineering Research Center of Highway Maintenance Technology(Changsha University of Science&Technology)(No.kfj230207).
文摘The occurrence of top-down(TD)cracking has gradually become a prevalent issue in semi-rigid base asphalt pavements after prolonged service.A coupled simulation model integrating the finite difference method(FDM)and discrete element method(DEM)was employed to investigate the mechanical behavior of asphalt pavement containing a pre-existing TD crack.The mesoscopic parameters of the model were calibrated based on the mixture modulus and the static mechanical response on the MLS66 test road.Finally,an analysis was performed to assess how variations in TD crack depth and longitudinal length affect the distribution patterns of transverse tensile stress,vertical shear stress,and vertical compressive stress.The results indicate that the vertical propagation of TD crack significantly increases both the tensile stress value and range on the middle surface,while the longitudinal development of TD crack has minimal impact.This phenomenon may result in more severe fatigue failure on the middle surface.With the vertical and longitudinal development of TD crack,the vertical shear stress and compressive stress show obvious"two-stage"characteristics.When the crack's vertical length reaches 40 mm,there is a sharp increase in stress on the upper surface.As the crack continues to propagate vertically,the growth of stress on the upper surface becomes negligible,while the stress in the middle and lower layers increased significantly.Conversely,for longitudinal development of TD crack,any changes in stress are insignificant when their length is less than 180 mm;however,as they continue to develop longitudinally beyond this threshold,there is a sharp increase in stress levels.These findings hold great significance for understanding pavement structure deterioration and maintenance behavior associated with TD crack.
文摘The tumor objective response rate(ORR)is an important parameter to demonstrate the efficacy of a treatment in oncology.The ORR is valuable for clinical decision making in routine practice and a significant end-point for reporting the results of clinical trials.World Health Organization and Response Evaluation Criteria in Solid Tumors(RECIST)are anatomic response criteria developed mainly for cytotoxic chemotherapy.These criteria are based on the visual assessment of tumor size in morphological images provided by computed tomography(CT)or magnetic resonance imaging.Anatomic response criteria may not be optimal for biologic agents,some disease sites,and some regional therapies.Consequently,modifications of RECIST,Choi criteria and Morphologic response criteria were developed based on the concept of the evaluation of viable tumors.Despite its limitations,RECIST v1.1 is validated in prospective studies,is widely accepted by regulatory agencies and has recently shown good performance for targeted cancer agents.Finally,some alternatives of RECIST were developed as immune-specific response criteria for checkpoint inhibitors.Immune RECIST criteria are based essentially on defining true progressive disease after a confirmatory imaging.Some graphical methods may be useful to show longitudinal change in the tumor burden over time.Tumor tissue is a tridimensional heterogenous mass,and tumor shrinkage is not always symmetrical;thus,metabolic response assessments using positron emission tomography(PET)or PET/CT may reflect the viability of cancer cells or functional changes evolving after anticancer treatments.The metabolic response can show the benefit of a treatment earlier than anatomic shrinkage,possibly preventing delays in drug approval.Computer-assisted automated volumetric assessments,quantitative multimodality imaging in radiology,new tracers in nuclear medicine and finally artificial intelligence have great potential in future evaluations.
基金supported by National Natural Science Foundation of China(52407126).
文摘The demand response(DR)market,as a vital complement to the electricity spot market,plays a key role in evoking user-side regulation capability to mitigate system-level supply‒demand imbalances during extreme events.While the DR market offers the load aggregator(LA)additional profitable opportunities beyond the electricity spot market,it also introduces new trading risks due to the significant uncertainty in users’behaviors.Dispatching energy storage systems(ESSs)is an effective means to enhance the risk management capabilities of LAs;however,coordinating ESS operations with dual-market trading strategies remains an urgent challenge.To this end,this paper proposes a novel systematic risk-aware coordinated trading model for the LA in concurrently participating in the day-ahead electricity spot market and DR market,which incorporates the capacity allocation mechanism of ESS based on market clearing rules to jointly formulate bidding and pricing decisions for the dual market.First,the intrinsic coupling characteristics of the LA participating in the dual market are analyzed,and a joint optimization framework for formulating bidding and pricing strategies that integrates ESS facilities is proposed.Second,an uncertain user response model is developed based on price‒response mechanisms,and actual market settlement rules accounting for under-and over-responses are employed to calculate trading revenues,where possible revenue losses are quantified via conditional value at risk.Third,by imposing these terms and the capacity allocation mechanism of ESS,the risk-aware stochastic coordinated trading model of the LA is built,where the bidding and pricing strategies in the dual model that trade off risk and profit are derived.The simulation results of a case study validate the effectiveness of the proposed trading strategy in controlling trading risk and improving the trading income of the LA.
