Large language models(LLMs)have revolutionized AI applications across diverse domains.However,their widespread deployment has introduced critical security vulnerabilities,particularly prompt injection attacks that man...Large language models(LLMs)have revolutionized AI applications across diverse domains.However,their widespread deployment has introduced critical security vulnerabilities,particularly prompt injection attacks that manipulate model behavior through malicious instructions.Following Kitchenham’s guidelines,this systematic review synthesizes 128 peer-reviewed studies from 2022 to 2025 to provide a unified understanding of this rapidly evolving threat landscape.Our findings reveal a swift progression from simple direct injections to sophisticated multimodal attacks,achieving over 90%success rates against unprotected systems.In response,defense mechanisms show varying effectiveness:input preprocessing achieves 60%–80%detection rates and advanced architectural defenses demonstrate up to 95%protection against known patterns,though significant gaps persist against novel attack vectors.We identified 37 distinct defense approaches across three categories,but standardized evaluation frameworks remain limited.Our analysis attributes these vulnerabilities to fundamental LLM architectural limitations,such as the inability to distinguish instructions from data and attention mechanism vulnerabilities.This highlights critical research directions such as formal verification methods,standardized evaluation protocols,and architectural innovations for inherently secure LLM designs.展开更多
Background:Penile augmentation through injectable substances is becoming increasingly common.A growing number of aesthetic clinics are developing penile enlargement procedures using various injectable materials.Althou...Background:Penile augmentation through injectable substances is becoming increasingly common.A growing number of aesthetic clinics are developing penile enlargement procedures using various injectable materials.Although these procedures are now performed in more controlled and medically supervised environments,their long-term outcomes remain poorly understood.The promotion of such medical treatments contributes to an increasing interest among adult males in self-injection as a method to alleviate psychological distress associated with penile size concerns.At the same time,access to injectable substances through unofficial or unregulated sources has become increasingly easy.Tor our knowledge,we report the first documented case of self-injection with Garamycin®(gentamicin)cream,contributing to the literature on the often multidisciplinary management of penile enlargement injections,a field still lacking well-established guidelines.Case Description:This case report describes a young patient who self-injected Garamycin®into the penis for the purpose of enlargement.He presented to our urology department with worsening symptoms,including severe and poorly tolerated pain.His primary request was prompt relief of pain while preserving,as much as possible,the aesthetic appearance and functional integrity of his penis.This case required a multi-stage surgical approach to salvage the penis and preserve both its structural integrity and functional outcome.Conclusions:To our knowledge,this case report documents the first reported instance of Garamycin®injection performed for the purpose of penile enlargement.It provides insight into the clinical course of such penile cream injections,demonstrates that a two-stage scrotal flap can achieve both functional and aesthetic outcomes,and highlights the importance of comprehensive management particularly addressing the traumatic impact of penile deformity secondary to inflammation and/or infection,as well as the body dysmorphic concerns often associated with these cases.展开更多
While Large Language Models(LLMs)possess the capability to perform a wide range of tasks,security attacks known as prompt injection and jailbreaking remain critical challenges.Existing defense approaches addressing th...While Large Language Models(LLMs)possess the capability to perform a wide range of tasks,security attacks known as prompt injection and jailbreaking remain critical challenges.Existing defense approaches addressing this problem face challenges such as the over-refusal of prompts that contain harmful vocabulary but are semantically benign,and the limited accuracy improvement inmachine learning-based approaches due to the ease of distinguishing benign prompts in existing datasets.Therefore,we propose a multi-LLM agent framework aimed at achieving both the accurate rejection of harmful prompts and appropriate responses to benign prompts.Distinct from prior studies,the proposed method adopts In-Context Learning(ICL)during the learning phase,presenting a novel approach that obviates the need for computationally expensive parameter updates required by conventional fine-tuning.To demonstrate the proposed method’s capability for rapid and easy deployment,this study targets LLMs with insufficient alignment.In the experiments,macro-averaged binary classification metrics were used to comprehensively evaluate harmfulness detection.Experimental results using three LLMs demonstrated that the proposed method achieved performance that surpassed four baselines across all evaluation metrics for the target LLMs,evidencing significant effectiveness with an average improvement of 16.6 points in F1-score compared to the vanilla models.The significance of this study lies in the proposal of a novel approach based on ICL that does not require parameter updates.This framework offers high sustainability in practical deployment,as it allows for the adaptive enhancement of detection performance against continuously evolving attack methods solely through the accumulation of logs,without the necessity of retraining the LLM itself.By mitigating the trade-off between safety and utility,this research contributes to the implementation of robust LLMs.展开更多
Powder-Fueled Water Ramjet Engine(PFWRE)is the most promising powerplant in underwater high-speed propulsion.However,the effect of powder injection mode on its performance and the mechanism of this effect are not well...Powder-Fueled Water Ramjet Engine(PFWRE)is the most promising powerplant in underwater high-speed propulsion.However,the effect of powder injection mode on its performance and the mechanism of this effect are not well understood.In this paper,a computational framework for multiphase combustion flow is developed and validated.Further,the effects of different injection schemes on flow combustion characteristics and engine performance are evaluated via simulation.Our findings indicate that the dominant recirculation zone in front of the primary water inlet delivers water vapor to the combustor head,providing the necessary oxidant for the ignition and combustion of Al particles.Changing the injection parameters directly affects the flame zone distribution and the ability of the recirculation zone to deliver water vapor,leading to variations in particle ignition delay.The engine combustion efficiency and specific impulse efficiency exhibit a negative correlation with injection height,peaking before declining with increased injection angle.It is shown that particle mixing degree and particle dispersion degree are closely related to engine performance.Enhanced particle mixing in front of the primary water inlet and particle dispersion behind the secondary water inlet are considered favorable approaches to improve engine performance,which promotes the particle combustion process and improves the heat-work conversion efficiency.展开更多
OBJECTIVE:To assess the clinical effectiveness and safety of Danshen injection(丹参注射液)following immunosuppressive therapy in primary nephrotic syndrome(PNS)with acute kidney injury(AKI)patients.METHODS:PNS with AK...OBJECTIVE:To assess the clinical effectiveness and safety of Danshen injection(丹参注射液)following immunosuppressive therapy in primary nephrotic syndrome(PNS)with acute kidney injury(AKI)patients.METHODS:PNS with AKI patients selected from nephrotic syndrome inpatients between 2012 and 2022 were divided into two groups according to the treatment regimen:the DS group who were treated with the Danshen injection and the SC group who received supportive care.Propensity score matching was used to balance the confounding factors between the two groups.The outcomes were complete and partial renal function recovery for effectiveness analysis and severe bleeding events for safety analysis.Kaplan-Meier curves and logrank tests were used to compare cumulative recovery rates.Outcome risks were assessed using Cox proportional hazard regression models.RESULTS:The study enrolled 441 patients with PNS and AKI from a population of 3873 inpatients with nephrotic syndrome.Among them,95 received Danshen injection,and 346 received supportive care.After propensity score matching,95 patients in the DS group and 285 patients in the SC group were analyzed.No significant difference was observed in the complete recovery rate for the DS group vs SC group(72.9%vs 65.1%,P=0.130)at 6 months.Compared with the SC group,the DS group was associated with a significantly higher partial recovery rate(71.0%vs 37.5%,P=0.011)at 6 months and all recovery rates(93.4%vs 79.1%,P=0.006)at 6 months.CONCLUSION:In this real-world retrospective study of PNS with AKI patients,Danshen injection following immunosuppressive therapy and prophylactic anticoagulation with low molecular heparin significantly increased 6-month partial renal function recovery and had a safety profile.Further randomized clinical trials are warranted to confirm the benefit of Danshen(Radix Salviae Miltiorrhizae)in these patients.展开更多
This paper presents the results of free-jet experiments conducted on an internal injection oblique detonation engine in a large-scale hypersonic shock tunnel.To overcome the challenges of non-uniform mixing and the fa...This paper presents the results of free-jet experiments conducted on an internal injection oblique detonation engine in a large-scale hypersonic shock tunnel.To overcome the challenges of non-uniform mixing and the failure of oblique detonation wave initiation when using liquid fuel,a combined strut-wall injection configuration was employed.Initiation was achieved by introducing a bump structure on the wedge.The results demonstrate that this strategy for mixing and initiation effectively establishes the oblique detonation wave combustion flow field.To further investigate the fuel mixing and initiation processes in the oblique detonation engine,three-dimensional numerical simulations consistent with the experimental conditions were carried out using the ReynoldsAveraged Navier-Stokes(RANS)method.The simulation results reveal that the high-speed gas flow generates shock waves as it passes through the central strut and transverse fuel jets.These shock waves are reflected by the wall,forming a series of shocks in the mixing section.The kerosene injected from the strut injectors does not react during the mixing phase.However,due to the influence of the high-temperature boundary layer,the kerosene injected through the wall undergoes precombustion.The separation zone upstream of the bump generates separation shock waves,allowing the multi-wave point to stabilize at a short distance from the leading edge of the wedge.展开更多
Objective:To explore the therapeutic effect of double-puncture tympanic membrane puncture and tympanic cavity drug injection in patients with acute secretory otitis media.Methods:A total of 84 patients with acute secr...Objective:To explore the therapeutic effect of double-puncture tympanic membrane puncture and tympanic cavity drug injection in patients with acute secretory otitis media.Methods:A total of 84 patients with acute secretory otitis media admitted to our hospital from June 2024 to June 2025 were selected and randomly divided into two groups by drawing lots.The control group(42 cases)was treated with the traditional single-puncture tympanic membrane puncture and tympanic cavity drug injection method,while the observation group(42 cases)was treated with the double-puncture tympanic membrane puncture and tympanic cavity drug injection method.The therapeutic effects of the two groups were compared.Results:The overall treatment response rate,overall complication rate,time to symptom relief,and improvement in hearing threshold in the observation group were all superior to those in the control group,with statistically significant differences(P<0.05).Conclusion:For acute secretory otitis media,the treatment method of double-puncture tympanic membrane puncture and tympanic cavity drug injection demonstrates definite efficacy,significantly reducing the incidence of complications,accelerating symptom relief,and improving hearing function,making it worthy of promotion.展开更多
Objective:To investigate the impact of anti-Müllerian hormone(AMH)levels on the outcomes of intracytoplasmic sperm injection(ICSI)cycles in women of advanced age and also to explore the effect of age on the ICSI ...Objective:To investigate the impact of anti-Müllerian hormone(AMH)levels on the outcomes of intracytoplasmic sperm injection(ICSI)cycles in women of advanced age and also to explore the effect of age on the ICSI results in patients with low AMH levels.Methods:This retrospective cohort study involved 143 infertile couples undergoing ICSI cycles at a fertility clinic in Iran from November 2021 to November 2023.Women aged<37 years with AMH<1 ng/mL and those aged≥37 years were included.A standardized ovarian stimulation protocol was followed,leading to oocyte retrieval and ICSI on mature oocytes.Key oocyte quality indexes,including the maturation rate,fertilization rate,and embryo quality metrics,were evaluated.Poisson regression analyses were also employed to investigate the association between AMH levels and oocyte quality parameters in the advanced age groups,as well as the association between age and oocyte quality parameters in patients with low AMH.Results:We analyzed 143 ICSI cycles from 143 infertile couples.The mean ages of the women and their partners were(38.2±4.7)years and(40.6±5.9)years,respectively,with a median(IQR)AMH level of 0.7(0.4–2.0)ng/mL.Younger women with low AMH levels(<1 ng/mL)showed significantly better outcomes in terms of the number of MⅡ oocytes[adjusted odds ratio(aOR)1.89,95%CI 1.31-2.71;P=0.001],fertilized(2PN)oocytes(aOR 1.97,95%CI 1.36-2.86;P<0.001),embryo number(aOR 2.16,95%CI 1.44-3.24;P<0.001),and embryos suitable for freezing(aOR 2.88,95%CI 1.80-4.61;P<0.001)compared to advanced-age women.Furthermore,among women of advanced age,those with normal AMH levels exhibited a significantly higher number of MⅡ oocyte(aOR 3.55,95%CI 2.31-5.44;P<0.001),fertilized(2PN)oocytes(aOR 3.54,95%CI 2.29-5.49;P<0.001),embryo number(aOR 3.89,95%CI 2.48-6.10;P<0.001),and embryos suitable for freezing(aOR 4.75,95%CI 2.79-8.09;P<0.001)compared to those with low AMH levels.Conclusions:AMH level is a significant predictor of oocyte and embryo number and quality in infertile women of advanced age undergoing ICSI cycles.Our findings suggest that maternal age markedly impacts the quality of oocytes and embryos in low AMHlevel patients.展开更多
The increasing integration of cyber-physical components in Industry 4.0 water infrastructures has heightened the risk of false data injection(FDI)attacks,posing critical threats to operational integrity,resource manag...The increasing integration of cyber-physical components in Industry 4.0 water infrastructures has heightened the risk of false data injection(FDI)attacks,posing critical threats to operational integrity,resource management,and public safety.Traditional detection mechanisms often struggle to generalize across heterogeneous environments or adapt to sophisticated,stealthy threats.To address these challenges,we propose a novel evolutionary optimized transformer-based deep reinforcement learning framework(Evo-Transformer-DRL)designed for robust and adaptive FDI detection in smart water infrastructures.The proposed architecture integrates three powerful paradigms:a transformer encoder for modeling complex temporal dependencies in multivariate time series,a DRL agent for learning optimal decision policies in dynamic environments,and an evolutionary optimizer to fine-tune model hyper-parameters.This synergy enhances detection performance while maintaining adaptability across varying data distributions.Specifically,hyper-parameters of both the transformer and DRL modules are optimized using an improved grey wolf optimizer(IGWO),ensuring a balanced trade-off between detection accuracy and computational efficiency.The model is trained and evaluated on three realistic Industry 4.0 water datasets:secure water treatment(SWaT),water distribution(WADI),and battle of the attack detection algorithms(BATADAL),which capture diverse attack scenarios in smart treatment and distribution systems.Comparative analysis against state-of-the-art baselines including Transformer,DRL,bidirectional encoder representations from transformers(BERT),convolutional neural network(CNN),long short-term memory(LSTM),and support vector machines(SVM)demonstrates that our proposed Evo-Transformer-DRL framework consistently outperforms others in key metrics such as accuracy,recall,area under the curve(AUC),and execution time.Notably,it achieves a maximum detection accuracy of 99.19%,highlighting its strong generalization capability across different testbeds.These results confirm the suitability of our hybrid framework for real-world Industry 4.0 deployment,where rapid adaptation,scalability,and reliability are paramount for securing critical infrastructure systems.展开更多
Objective： To compare the effect of Shen-Fu Injection （SFI） and epinephrine on the expression of sarcoplasmic reticulum Ca2. ATPase 2a （SERCA2a） in a pig model with post-resuscitation myocardial dysfunction. Meth...Objective： To compare the effect of Shen-Fu Injection （SFI） and epinephrine on the expression of sarcoplasmic reticulum Ca2. ATPase 2a （SERCA2a） in a pig model with post-resuscitation myocardial dysfunction. Methods： Ventricular fibrillation （VF） was electrically induced in Wu-zhi-shan miniature pigs. After 8 min of untreated VF and 2 min of cardiopulmonary resuscitation （CPR）, all animals were randomly administered a bolus injection of saline placebo （SA group, n=10）, SFI （0.8 mg/kg, SFI group, n=10） or epinephrine （20 t~ g/kg, EPI group, n=10）. After 4 min of CPR, a 100-J shock was delivered. If the defibrillation attempt failed to attain restoration of spontaneous circulation （ROSC）, manual chest compressions were rapidly resumed for a further 2 rain followed by a second defibrillation attempt. Hemodynamic variables were recorded, and plasma concentrations of catecholamines were measured. Adenylate cyclase （AC）, cyclic adenosine monophosphate （cAMP） and the expressions of 13 1-adrenoceptor （AR） and SERCA 2a were determined. Results： Cardiac output, left ventricular dp/dtr,~x and negative dp/dtm^x were significantly higher in the SFI group than in the SA and EPI groups at 4 and 6 h after ROSC. The expression of 13 1-AR and SERCA2a at 24 h after ROSC were significantly higher in the SFI group than in the SA and EPI groups （P〈0.05 or P〈0.01）. Conclusions： The administration of epinephrine during CPR decreased the expression of SERCA2a and aggravated postresuscitation myocardial function （P〈0.01）. SFI attenuated post-resuscitation myocardial dysfunction, and the mechanism might be related to the up-regulation of SERCA2a expression.展开更多
Background Epinephrine has been used as a first-choice vasopressor drug for cardiac arrest （CA） since 1974.However,the administration of epinephrine is controversial.This study aims to compare the effects of Shen-Fu...Background Epinephrine has been used as a first-choice vasopressor drug for cardiac arrest （CA） since 1974.However,the administration of epinephrine is controversial.This study aims to compare the effects of Shen-Fu injection （SFI） and epinephrine on resuscitation outcomes in a porcine model of prolonged CA.Methods Ventricular fibrillation （VF） was electrically induced.After 8 minutes of untreated VF and 2 minutes of chest compressions,24 pigs were randomly divided into 3 groups （n=8 per group）：central venous injection of SFI （SFI group）,epinephrine （EPI group）,or saline solution （SA group）.The haemodynamic status and oxygen metabolism parameters,including cardiac output,mean arterial pressure,left ventricular dp/dtmax and negative dp/dtmax,oxygen delivery （DO2）,and oxygen consumption （VO2）,were calculated.Results SFI shortened the time to restoration of spontaneous circulation （ROSC） and decreased the number of shocks,similar to epinephrine.However,the mean arterial pressure,cardiac output,left ventricular dp/dtmax and negative dp/dtmax were significantly higher in the SFI group than in the EPI group at 4 and 6 hours after ROSC.VO2 and ERO2 decreased after ROSC and then increased.VO2 and ERO2 were significantly higher in the SFI group than in the EPI and SA groups after ROSC,while those were lowest in the EPI group among all groups.Conclusions SFI shortened the time to ROSC and decreased the number of shocks,similar to epinephrine.However,SFI improved oxygen metabolism,and produced a better hemodynamic status compared with epinephrine.SFI might be a potentially vasopressor drug for the treatment of CA.展开更多
Background： Shen-Fu injection （SFI） can attenuate ischemia-reperfusion injury, protect cardiac function, and improve microcirculation during cardiopulmonary resuscitation. We hypothesized that SFI may also have an ...Background： Shen-Fu injection （SFI） can attenuate ischemia-reperfusion injury, protect cardiac function, and improve microcirculation during cardiopulmonary resuscitation. We hypothesized that SFI may also have an influence on myocardial metabolism during ventrictdar fibrillation （VF）. In this study, we used SFI pretreatment prior to VF to discuss the changes of myocardial metabolism and catecholamine （CA） levels during untreated VF, trying to provide new evidence to the protection of SFI to myocardiurn. Methods： Twenty-four pigs were divided into three groups： Saline group （SA group）, SFI group, and SHAM operation group （SHAM group）. Thirty minutes prior to the induction of VF, the SFI group received 0.24 mg/ml SFI through an intravenous injection： the SA group received an equal amount of sodium chloride solution. The interstitial fluid from the left ventricle （LV） wall was collected through the microdialysis tubes during VF. Adenosine diphosphate （ADP）, adenosine triphosphate （ATP）, and Na^＋-K^＋-ATPase and Ca2^＋-ATPase enzyme activities were measured after untreated VF. Peak-to-trough VF amplitude and median frequency were analyzed for each of these 5-s intervals. Results： The levels of glucose and glutamate were lower after VF in both the SA and SFI groups, compared with baseline, and the levels in the SFI group were higher than those in the SA group. Compared with baseline, the levels of lactate and the lactate/pyruvate ratio increased after VF in both SA and SFI groups, and the levels in the SFI group were lower than those in the SA group. In both the SA and SFI groups, the levers of dopamine, norepinephrine, and epinephrine increased significantly. There were no statistical differences between the two groups. The content of ATE ADE and phosphocreatine in the SF1 group was higher than those in the SA group. The activity ofLV Na^＋-K^＋-ATPase was significantly higher in the SFI group than in the SA group. Amplitude mean spectrum area （AMSA） was significantly lower in the SA and SFI groups at 8- and 12-min compared with 4-min. The AMSA in the SFI group was higher than that in the SA group at each time point during untreated VF. Conclusions： SFI pretreatment can improve myocardial metabolism and reduce energy exhaustion during VF, and it does not aggravate the excessive secretion of endogenous CAs.展开更多
Background Post-resuscitation myocardial dysfunction has been implicated as a major cause of fatal outcome in patients who survive initially successful cardiopulmonary resuscitation （CPR）. In our previous study, we ...Background Post-resuscitation myocardial dysfunction has been implicated as a major cause of fatal outcome in patients who survive initially successful cardiopulmonary resuscitation （CPR）. In our previous study, we found that impaired myocardial β-adrenergic receptor （AR） signaling is a key mechanism in post-resuscitation myocardial dysfunction and Shen-Fu injection （SFI） can attenuate post-resuscitation myocardial dysfunction. However, whether SFI can prevent impaired post-resuscitation myocardial β-AR signaling is not yet known. In this study, we investigated the effect of SFI on impaired myocardial β-AR signaling occurring post-resuscitation in a porcine model of cardiac arrest. Methods Ventricular fibrillation was induced electrically in anesthetized male landrace domestic pigs. After 4 minutes of untreated ventricular fibrillation, cardiopulmonary resuscitation was initiated. Sixteen successfully resuscitated pigs were randomized to receive a continuous infusion of either SFI （0.5 ml/min; n=8） or saline （placebo; n=8） for 6 hours, beginning 15 minutes after the return of spontaneous circulation （ROSC）. Hemodynamic and echocardiographic data were recorded. β-AR signaling was assessed at 6 hours after the intervention by measuring myocardial adenylate cyclase activity, β-AR density and β-AR kinase expression. Results Treatment with SFI produced better maximum rate of left ventricular pressure increase （dp/dtmax） and maximum rate of left ventricular pressure decline （-dp/dtmax）, cardiac output, and ejection fraction after ROSC. SFI treatment was also associated with lower myocardial β-adrenergic receptor kinase expression, whereas basal and isoproterenol- stimulated adenylate cyclase activity and the total β-AR density were significantly increased in the SFI group when compared with the placebo group. Conclusion SFI attenuated post-resuscitation myocardial dysfunction by preventing impaired myocardial β-AR signaling after CPR.展开更多
Objective： To investigate whether Shen-Fu Injection（参附注射液, SFI） reduces post-resuscitation immune dysfunction in a porcine model of cardiac arrest by modulating apoptosis of regulatory T lymphocytes（Treg） in...Objective： To investigate whether Shen-Fu Injection（参附注射液, SFI） reduces post-resuscitation immune dysfunction in a porcine model of cardiac arrest by modulating apoptosis of regulatory T lymphocytes（Treg） in the spleen. Methods： After 8-min untreated ventricular fibrillation and 2-min basic life support, 24 pigs were divided into 3 groups with a random number table, i.e. SFI group, epinephrine（EP） group, and saline（SA） group（8 in each group）, which received central venous injection of SFI（1.0 m L/kg）, EP（0.02 mg/kg） and SA, respectively. The same procedure without CA initiation was achieved in the sham-operated（sham） group（n=6）. After successful return of spontaneous circulation（ROSC）, apoptosis rate of splenic Treg was detected by flow cytometry; and the m RNA expression of forkhead/winged helix transcription factor（Foxp3） of splenic Treg was detected by real time-polymerase chain reaction; and the levels of interleukin-4（IL-4） and interferon-γ（IFN-γ） in porcine splenic Treg were detected by using enzyme-linked immunosorbent assay（ELISA）. Results： Compared with the sham group, the apoptosis rate of Treg was significantly decreased, and the levels of Foxp3 m RNA expression, IFN-γ, IL-4 and IFN-γ/IL-4 were increased in the SA group（P〈0.05 or P〈0.01）. Compared with the EP and SA groups, SFI treatment increased the apoptosis rate of Treg and reduced the levels of Foxp3 m RNA expression, IFN-γ and IFN-γ/IL-4（P〈0.05）. Conclusions： SFI has significant effects in attenuating post-resuscitation immune dysfunction by modulating apoptosis of Treg in the spleen.展开更多
Objective: To investigate the hemodynamic effect of Shen-Fu Injection(参附注射液, SFI) in early volume resuscitation treated septic shock patients by monitoring pulse indicator continuous cardiac output(PICCO). Method...Objective: To investigate the hemodynamic effect of Shen-Fu Injection(参附注射液, SFI) in early volume resuscitation treated septic shock patients by monitoring pulse indicator continuous cardiac output(PICCO). Methods: All septic shock patients admitted in the Intensive Care Unit of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 1 st, 2014 to December 31 th, 2015, were reviewed, and totally 65 were enrolled in this study. They were assigned to SFI group(33 cases) and control group(32 cases). All 65 patients underwent conventional treatment mainly including volume resuscitation, antibiotics and vasoactive drugs therapy. The patients of the SFI group received additional 100 mL of SFI intravenously every 12 h. In all 65 patients, the PICCO arterial catheter and vein catheter were implanted within 1 h after the diagnosis of septic shock. In the course of early volume resuscitation, hemodynamic data of patients were recorded by PICCO monitor at 0, 12, and 24 h after the catheter implantation. Results: The hemodynamic indices of the two groups showed no significant differences at the beginning of 0 h(P>0.05). At 12 and 24 h, the hemodynamic indices of SFI group were significantly improved in comparison with the control group(P<0.05), including cardiac index(CI), global end diastolic volume index(GEDI), mean arterial pressure(MAP) and heart rate(HR). In addition, there was no significant change of extra-vascular lung water index between the two groups(P>0.05). Conclusion: SFI significantly improved hemodynamic indices such as CI, GEDI, MAP and HR in early volume resuscitation treated septic shock patients.展开更多
BACKGROUND A total of 100 patients diagnosed with mixed hemorrhoids from October 2022 to September 2023 in our hospital were randomly divided into groups by dice rolling and compared with the efficacy of different tre...BACKGROUND A total of 100 patients diagnosed with mixed hemorrhoids from October 2022 to September 2023 in our hospital were randomly divided into groups by dice rolling and compared with the efficacy of different treatment options.AIM To analyze the clinical effect and prognosis of mixed hemorrhoids treated with polidocanol injection combined with automatic elastic thread ligation operation(RPH).METHODS A total of 100 patients with mixed hemorrhoids who visited our hospital from October 2022 to September 2023 were selected and randomly divided into the control group(n=50)and the treatment group(n=50)by rolling the dice.The procedure for prolapse and hemorrhoids(PPH)was adopted in the control group,while polidocanol foam injection+RPH was adopted in the treatment group.The therapeutic effects,operation time,wound healing time,hospital stay,pain situation(24 hours post-operative pain score,first defecation pain score),quality of life(QOL),incidence of complications(post-operative hemorrhage,edema,infection),incidence of anal stenosis 3 months post-operatively and recurrence rate 1 year post-operatively of the two groups were compared.RESULTS Compared with the control group,the total effective rate of treatment group was higher,and the difference was significant(P<0.05).The operation time/wound healing time/hospital stay in the treatment group were shorter than those in the control group(P<0.05).The pain scores at 24 hours after operation/first defecation pain score of the treatment group was significantly lower than those in the control group(P<0.05).After surgery,the QOL scores of the two groups decreased,with the treatment group having higher scores than that of the control group(P<0.05).Compared with the control group,the incidence of postoperative complications in the treatment group was lower,and the difference was significant(P<0.05);However,there was no significant difference in the incidence of postoperative bleeding between the two groups(P>0.05);There was no significant difference in the incidence of anal stenosis 3 months after operation and the recurrence rate 1 year after operation between the two groups(P>0.05).CONCLUSION For patients with mixed hemorrhoids,the therapeutic effect achieved by using polidocanol injection combined with RPH was better.The wounds of the patients healed faster,the postoperative pain was milder,QOL improved,and the incidence of complications was lower,and the short-term and long-term prognosis was good.展开更多
This study proposes and systematically evaluates an optimized integration of warm surface seawater injection with depressurization for the long-term exploitation of marine natural gas hydrates.By employing comprehensi...This study proposes and systematically evaluates an optimized integration of warm surface seawater injection with depressurization for the long-term exploitation of marine natural gas hydrates.By employing comprehensive multiphysics simulations guided by field data from hydrate production tests in the South China Sea,we pinpoint key operational parameters—such as injection rates,depths,and timings—that notably enhance production efficiency.The results indicate that a 3-phase hydrate reservoir transitions from a free-gas-dominated production stage to a hydrate-decomposition-dominated stage.Moderate warm seawater injection supplies additional heat during the hydrate decomposition phase,thereby enhancing stable production;however,excessively high injection rates can impede the depressurization process.Only injection at an appropriate depth simultaneously balances thermal supplementation and the pressure gradient,leading to higher overall productivity.A“depressurization-driven sensible-heat supply window”is introduced,highlighting that timely seawater injection following initial depressurization prolongs reservoir dissociation dynamics.In this study area,commencing seawater injection at 170 d of depressurization proved optimal.This optimized integration leverages clean and renewable thermal energy,providing essential insights into thermal supplementation strategies with significant implications for sustainable,economically feasible,and efficient commercial-scale hydrate production.展开更多
Hydrogen displays the potential to partially replace pulverized coal injection(PCI)in the blast furnace,and it can reduce CO_(2)emissions.In this paper,a three-dimensional mathematical model of hydrogen and pulverized...Hydrogen displays the potential to partially replace pulverized coal injection(PCI)in the blast furnace,and it can reduce CO_(2)emissions.In this paper,a three-dimensional mathematical model of hydrogen and pulverized coal co-injection in blast furnace tuyere was established through numerical simulation,and the effect of hydrogen injection and oxygen enrichment interaction on pulverized coal combustion and raceway smelting was investigated.The simulation results indicate that when the coal injection rate decreased from 36 to 30t/h and the hydrogen injection increased from 0 to 3600 m^(3)/h,the CO_(2)emissions decreased from 1860 to 1551 kg/t,which represents a16.6%reduction,and the pulverized coal burnout decreased from 70.1%to 63.7%.The heat released from hydrogen combustion can not only promote the volatilization of pulverized coal but also affect the combustion reaction between volatilization and oxygen,which resulted in a decrease in the temperature at the end of the raceway.Co-injection of hydrogen with PCI increased the wall temperature near the upper half part of the raceway and at the outlet of the tuyere,which required a high cooling efficiency to extend the service life of the blast furnace.The increase in oxygen level compensated for the decreased average temperature in the raceway due to hydrogen injection.The increase in the oxygen content by 3%while maintaining constant hydrogen and PCI injection rates increased the burnout and average raceway temperature by 4.2%and 43 K,respectively.The mole fraction of CO and H_(2) production increased by 0.04 and 0.02,respectively.Burnout can be improved through optimization of the particle size distribution of pulverized coal.展开更多
During high-speed rotation,the surface of aeronautic spiral bevel gears will generate significant pressure and viscous forces,which will cause a certain amount of windage power loss and reduce the efficiency of the tr...During high-speed rotation,the surface of aeronautic spiral bevel gears will generate significant pressure and viscous forces,which will cause a certain amount of windage power loss and reduce the efficiency of the transmission system.Based on the computational fluid dynamics,this paper analyzes the windage power loss of a single spiral bevel gear and a spiral bevel gear pair under oil injection lubrication.In addition,the shroud is used to suppress gear windage loss,and the clearance size and opening angle of the designed shroud are optimized.Finally,by comparing and analyzing the experimental results,the following conclusions were obtained:(1)For a single gear,the speed is the most important factor affecting windage loss,followed by the hand of spiral,and rotation direction;(2)For gear pairs,under oil injection lubrication,the input speed has the greatest impact on windage power loss,followed by the influence of oil injection port speed,temperature and oil injection port pressure;(3)Installing a shroud is an effective method to reduce windage power loss;(4)In the pure air phase,the smaller the clearance between the shroud and the gear surface,and the smaller the radial direction between the shroud and the shaft,the better the effect of reducing windage;(5)In the two-phase flow of oil and gas,it is necessary to design oil drainage holes on the shroud to ensure the smooth discharge of lubricating oil and improve the drag reduction effect.展开更多
BACKGROUND Although gastroscopy is a commonly used diagnostic and therapeutic technique,postoperative gastrointestinal dysfunction is prone to occur.Traditional Chinese medicine theory suggests that postoperative gast...BACKGROUND Although gastroscopy is a commonly used diagnostic and therapeutic technique,postoperative gastrointestinal dysfunction is prone to occur.Traditional Chinese medicine theory suggests that postoperative gastrointestinal disorders are related to spleen and stomach weakness.This study hypothesizes that the combination of acupoint application at the Ziwu Liuzhu acupoint and percutaneous acupoint electrical stimulation can promote postoperative gastrointestinal function recovery and alleviate stress reactions.AIM To investigate the effects of acupoint application of Ziwu Liuzhu combined with percutaneous acupoint electrical stimulation on postoperative gastrointestinal function recovery and stress response in patients undergoing gastrointestinal endoscopy surgery.METHODS A total of 120 patients who underwent gastroscopy surgery were selected and treated between October 2024 and January 2025.This study used a stratified block randomization method,and then allocated groups using computer-generated random number sequences(SAS 9.4 software).The groups were divided into two groups:A control group of 60 patients who received routine postoperative intervention measures,and an observation group of 60 patients who received acupuncture point application combined with transcutaneous acupoint electrical CONCLUSION The combination of percutaneous acupoint electrical stimulation in gastroscopy patients has been demonstrated to be both highly safe and effective.The benefits of this approach include the promotion of postoperative gastrointestinal function,the reduction of stress response,the attainment of optimal results,and the enhancement of patient satisfaction.展开更多
基金supported by 2023 Higher Education Scientific Research Planning Project of China Society of Higher Education(No.23PG0408)2023 Philosophy and Social Science Research Programs in Jiangsu Province(No.2023SJSZ0993)+2 种基金Nantong Science and Technology Project(No.JC2023070)Key Project of Jiangsu Province Education Science 14th Five-Year Plan(Grant No.B-b/2024/02/41)the Open Fund of Advanced Cryptography and System Security Key Laboratory of Sichuan Province(Grant No.SKLACSS-202407).
文摘Large language models(LLMs)have revolutionized AI applications across diverse domains.However,their widespread deployment has introduced critical security vulnerabilities,particularly prompt injection attacks that manipulate model behavior through malicious instructions.Following Kitchenham’s guidelines,this systematic review synthesizes 128 peer-reviewed studies from 2022 to 2025 to provide a unified understanding of this rapidly evolving threat landscape.Our findings reveal a swift progression from simple direct injections to sophisticated multimodal attacks,achieving over 90%success rates against unprotected systems.In response,defense mechanisms show varying effectiveness:input preprocessing achieves 60%–80%detection rates and advanced architectural defenses demonstrate up to 95%protection against known patterns,though significant gaps persist against novel attack vectors.We identified 37 distinct defense approaches across three categories,but standardized evaluation frameworks remain limited.Our analysis attributes these vulnerabilities to fundamental LLM architectural limitations,such as the inability to distinguish instructions from data and attention mechanism vulnerabilities.This highlights critical research directions such as formal verification methods,standardized evaluation protocols,and architectural innovations for inherently secure LLM designs.
文摘Background:Penile augmentation through injectable substances is becoming increasingly common.A growing number of aesthetic clinics are developing penile enlargement procedures using various injectable materials.Although these procedures are now performed in more controlled and medically supervised environments,their long-term outcomes remain poorly understood.The promotion of such medical treatments contributes to an increasing interest among adult males in self-injection as a method to alleviate psychological distress associated with penile size concerns.At the same time,access to injectable substances through unofficial or unregulated sources has become increasingly easy.Tor our knowledge,we report the first documented case of self-injection with Garamycin®(gentamicin)cream,contributing to the literature on the often multidisciplinary management of penile enlargement injections,a field still lacking well-established guidelines.Case Description:This case report describes a young patient who self-injected Garamycin®into the penis for the purpose of enlargement.He presented to our urology department with worsening symptoms,including severe and poorly tolerated pain.His primary request was prompt relief of pain while preserving,as much as possible,the aesthetic appearance and functional integrity of his penis.This case required a multi-stage surgical approach to salvage the penis and preserve both its structural integrity and functional outcome.Conclusions:To our knowledge,this case report documents the first reported instance of Garamycin®injection performed for the purpose of penile enlargement.It provides insight into the clinical course of such penile cream injections,demonstrates that a two-stage scrotal flap can achieve both functional and aesthetic outcomes,and highlights the importance of comprehensive management particularly addressing the traumatic impact of penile deformity secondary to inflammation and/or infection,as well as the body dysmorphic concerns often associated with these cases.
基金supported by JSPS KAKENHI Grant Numbers JP23K28377,JP24H00714,JP25K15109,JP25K03190,JP25K03232,JP22K12157The Telecommunications Advancement Foundation.
文摘While Large Language Models(LLMs)possess the capability to perform a wide range of tasks,security attacks known as prompt injection and jailbreaking remain critical challenges.Existing defense approaches addressing this problem face challenges such as the over-refusal of prompts that contain harmful vocabulary but are semantically benign,and the limited accuracy improvement inmachine learning-based approaches due to the ease of distinguishing benign prompts in existing datasets.Therefore,we propose a multi-LLM agent framework aimed at achieving both the accurate rejection of harmful prompts and appropriate responses to benign prompts.Distinct from prior studies,the proposed method adopts In-Context Learning(ICL)during the learning phase,presenting a novel approach that obviates the need for computationally expensive parameter updates required by conventional fine-tuning.To demonstrate the proposed method’s capability for rapid and easy deployment,this study targets LLMs with insufficient alignment.In the experiments,macro-averaged binary classification metrics were used to comprehensively evaluate harmfulness detection.Experimental results using three LLMs demonstrated that the proposed method achieved performance that surpassed four baselines across all evaluation metrics for the target LLMs,evidencing significant effectiveness with an average improvement of 16.6 points in F1-score compared to the vanilla models.The significance of this study lies in the proposal of a novel approach based on ICL that does not require parameter updates.This framework offers high sustainability in practical deployment,as it allows for the adaptive enhancement of detection performance against continuously evolving attack methods solely through the accumulation of logs,without the necessity of retraining the LLM itself.By mitigating the trade-off between safety and utility,this research contributes to the implementation of robust LLMs.
基金supported by the National Natural Science Foundation of China(No.22305053)the Fundamental Research Funds for the Central Universities,China(No.3072024WD0201)。
文摘Powder-Fueled Water Ramjet Engine(PFWRE)is the most promising powerplant in underwater high-speed propulsion.However,the effect of powder injection mode on its performance and the mechanism of this effect are not well understood.In this paper,a computational framework for multiphase combustion flow is developed and validated.Further,the effects of different injection schemes on flow combustion characteristics and engine performance are evaluated via simulation.Our findings indicate that the dominant recirculation zone in front of the primary water inlet delivers water vapor to the combustor head,providing the necessary oxidant for the ignition and combustion of Al particles.Changing the injection parameters directly affects the flame zone distribution and the ability of the recirculation zone to deliver water vapor,leading to variations in particle ignition delay.The engine combustion efficiency and specific impulse efficiency exhibit a negative correlation with injection height,peaking before declining with increased injection angle.It is shown that particle mixing degree and particle dispersion degree are closely related to engine performance.Enhanced particle mixing in front of the primary water inlet and particle dispersion behind the secondary water inlet are considered favorable approaches to improve engine performance,which promotes the particle combustion process and improves the heat-work conversion efficiency.
基金Supported by Key Project of Science and Technology Program Coconstructed by the Science and Technology Department of the National Administration of Traditional Chinese Medicine of China and Administration of Traditional Chinese Medicine of Zhejiang Province:A Study on the Efficacy and Safety of Danshen(Radix Salviae Miltiorrhizae)in Treating Acute Kidney Injury in Patients with Primary Nephrotic Syndrome(GZY-ZJ-KJ-23085)Basic Research Project of Wenzhou Science and Technology Bureau:the Mechanism of Hypoxia Induicible Factor-1 alpha Down-regulating Angiotensinconverting Enzyme 2 in Proximal Renal Tubular Epithelial Cells Leading to Brush Border Shedding in Early Acute Kidney Injury Induced by Sepsis(Y20240071)。
文摘OBJECTIVE:To assess the clinical effectiveness and safety of Danshen injection(丹参注射液)following immunosuppressive therapy in primary nephrotic syndrome(PNS)with acute kidney injury(AKI)patients.METHODS:PNS with AKI patients selected from nephrotic syndrome inpatients between 2012 and 2022 were divided into two groups according to the treatment regimen:the DS group who were treated with the Danshen injection and the SC group who received supportive care.Propensity score matching was used to balance the confounding factors between the two groups.The outcomes were complete and partial renal function recovery for effectiveness analysis and severe bleeding events for safety analysis.Kaplan-Meier curves and logrank tests were used to compare cumulative recovery rates.Outcome risks were assessed using Cox proportional hazard regression models.RESULTS:The study enrolled 441 patients with PNS and AKI from a population of 3873 inpatients with nephrotic syndrome.Among them,95 received Danshen injection,and 346 received supportive care.After propensity score matching,95 patients in the DS group and 285 patients in the SC group were analyzed.No significant difference was observed in the complete recovery rate for the DS group vs SC group(72.9%vs 65.1%,P=0.130)at 6 months.Compared with the SC group,the DS group was associated with a significantly higher partial recovery rate(71.0%vs 37.5%,P=0.011)at 6 months and all recovery rates(93.4%vs 79.1%,P=0.006)at 6 months.CONCLUSION:In this real-world retrospective study of PNS with AKI patients,Danshen injection following immunosuppressive therapy and prophylactic anticoagulation with low molecular heparin significantly increased 6-month partial renal function recovery and had a safety profile.Further randomized clinical trials are warranted to confirm the benefit of Danshen(Radix Salviae Miltiorrhizae)in these patients.
基金National Natural Science Foundation of China(No.52006181)。
文摘This paper presents the results of free-jet experiments conducted on an internal injection oblique detonation engine in a large-scale hypersonic shock tunnel.To overcome the challenges of non-uniform mixing and the failure of oblique detonation wave initiation when using liquid fuel,a combined strut-wall injection configuration was employed.Initiation was achieved by introducing a bump structure on the wedge.The results demonstrate that this strategy for mixing and initiation effectively establishes the oblique detonation wave combustion flow field.To further investigate the fuel mixing and initiation processes in the oblique detonation engine,three-dimensional numerical simulations consistent with the experimental conditions were carried out using the ReynoldsAveraged Navier-Stokes(RANS)method.The simulation results reveal that the high-speed gas flow generates shock waves as it passes through the central strut and transverse fuel jets.These shock waves are reflected by the wall,forming a series of shocks in the mixing section.The kerosene injected from the strut injectors does not react during the mixing phase.However,due to the influence of the high-temperature boundary layer,the kerosene injected through the wall undergoes precombustion.The separation zone upstream of the bump generates separation shock waves,allowing the multi-wave point to stabilize at a short distance from the leading edge of the wedge.
文摘Objective:To explore the therapeutic effect of double-puncture tympanic membrane puncture and tympanic cavity drug injection in patients with acute secretory otitis media.Methods:A total of 84 patients with acute secretory otitis media admitted to our hospital from June 2024 to June 2025 were selected and randomly divided into two groups by drawing lots.The control group(42 cases)was treated with the traditional single-puncture tympanic membrane puncture and tympanic cavity drug injection method,while the observation group(42 cases)was treated with the double-puncture tympanic membrane puncture and tympanic cavity drug injection method.The therapeutic effects of the two groups were compared.Results:The overall treatment response rate,overall complication rate,time to symptom relief,and improvement in hearing threshold in the observation group were all superior to those in the control group,with statistically significant differences(P<0.05).Conclusion:For acute secretory otitis media,the treatment method of double-puncture tympanic membrane puncture and tympanic cavity drug injection demonstrates definite efficacy,significantly reducing the incidence of complications,accelerating symptom relief,and improving hearing function,making it worthy of promotion.
文摘Objective:To investigate the impact of anti-Müllerian hormone(AMH)levels on the outcomes of intracytoplasmic sperm injection(ICSI)cycles in women of advanced age and also to explore the effect of age on the ICSI results in patients with low AMH levels.Methods:This retrospective cohort study involved 143 infertile couples undergoing ICSI cycles at a fertility clinic in Iran from November 2021 to November 2023.Women aged<37 years with AMH<1 ng/mL and those aged≥37 years were included.A standardized ovarian stimulation protocol was followed,leading to oocyte retrieval and ICSI on mature oocytes.Key oocyte quality indexes,including the maturation rate,fertilization rate,and embryo quality metrics,were evaluated.Poisson regression analyses were also employed to investigate the association between AMH levels and oocyte quality parameters in the advanced age groups,as well as the association between age and oocyte quality parameters in patients with low AMH.Results:We analyzed 143 ICSI cycles from 143 infertile couples.The mean ages of the women and their partners were(38.2±4.7)years and(40.6±5.9)years,respectively,with a median(IQR)AMH level of 0.7(0.4–2.0)ng/mL.Younger women with low AMH levels(<1 ng/mL)showed significantly better outcomes in terms of the number of MⅡ oocytes[adjusted odds ratio(aOR)1.89,95%CI 1.31-2.71;P=0.001],fertilized(2PN)oocytes(aOR 1.97,95%CI 1.36-2.86;P<0.001),embryo number(aOR 2.16,95%CI 1.44-3.24;P<0.001),and embryos suitable for freezing(aOR 2.88,95%CI 1.80-4.61;P<0.001)compared to advanced-age women.Furthermore,among women of advanced age,those with normal AMH levels exhibited a significantly higher number of MⅡ oocyte(aOR 3.55,95%CI 2.31-5.44;P<0.001),fertilized(2PN)oocytes(aOR 3.54,95%CI 2.29-5.49;P<0.001),embryo number(aOR 3.89,95%CI 2.48-6.10;P<0.001),and embryos suitable for freezing(aOR 4.75,95%CI 2.79-8.09;P<0.001)compared to those with low AMH levels.Conclusions:AMH level is a significant predictor of oocyte and embryo number and quality in infertile women of advanced age undergoing ICSI cycles.Our findings suggest that maternal age markedly impacts the quality of oocytes and embryos in low AMHlevel patients.
文摘The increasing integration of cyber-physical components in Industry 4.0 water infrastructures has heightened the risk of false data injection(FDI)attacks,posing critical threats to operational integrity,resource management,and public safety.Traditional detection mechanisms often struggle to generalize across heterogeneous environments or adapt to sophisticated,stealthy threats.To address these challenges,we propose a novel evolutionary optimized transformer-based deep reinforcement learning framework(Evo-Transformer-DRL)designed for robust and adaptive FDI detection in smart water infrastructures.The proposed architecture integrates three powerful paradigms:a transformer encoder for modeling complex temporal dependencies in multivariate time series,a DRL agent for learning optimal decision policies in dynamic environments,and an evolutionary optimizer to fine-tune model hyper-parameters.This synergy enhances detection performance while maintaining adaptability across varying data distributions.Specifically,hyper-parameters of both the transformer and DRL modules are optimized using an improved grey wolf optimizer(IGWO),ensuring a balanced trade-off between detection accuracy and computational efficiency.The model is trained and evaluated on three realistic Industry 4.0 water datasets:secure water treatment(SWaT),water distribution(WADI),and battle of the attack detection algorithms(BATADAL),which capture diverse attack scenarios in smart treatment and distribution systems.Comparative analysis against state-of-the-art baselines including Transformer,DRL,bidirectional encoder representations from transformers(BERT),convolutional neural network(CNN),long short-term memory(LSTM),and support vector machines(SVM)demonstrates that our proposed Evo-Transformer-DRL framework consistently outperforms others in key metrics such as accuracy,recall,area under the curve(AUC),and execution time.Notably,it achieves a maximum detection accuracy of 99.19%,highlighting its strong generalization capability across different testbeds.These results confirm the suitability of our hybrid framework for real-world Industry 4.0 deployment,where rapid adaptation,scalability,and reliability are paramount for securing critical infrastructure systems.
文摘Objective： To compare the effect of Shen-Fu Injection （SFI） and epinephrine on the expression of sarcoplasmic reticulum Ca2. ATPase 2a （SERCA2a） in a pig model with post-resuscitation myocardial dysfunction. Methods： Ventricular fibrillation （VF） was electrically induced in Wu-zhi-shan miniature pigs. After 8 min of untreated VF and 2 min of cardiopulmonary resuscitation （CPR）, all animals were randomly administered a bolus injection of saline placebo （SA group, n=10）, SFI （0.8 mg/kg, SFI group, n=10） or epinephrine （20 t~ g/kg, EPI group, n=10）. After 4 min of CPR, a 100-J shock was delivered. If the defibrillation attempt failed to attain restoration of spontaneous circulation （ROSC）, manual chest compressions were rapidly resumed for a further 2 rain followed by a second defibrillation attempt. Hemodynamic variables were recorded, and plasma concentrations of catecholamines were measured. Adenylate cyclase （AC）, cyclic adenosine monophosphate （cAMP） and the expressions of 13 1-adrenoceptor （AR） and SERCA 2a were determined. Results： Cardiac output, left ventricular dp/dtr,~x and negative dp/dtm^x were significantly higher in the SFI group than in the SA and EPI groups at 4 and 6 h after ROSC. The expression of 13 1-AR and SERCA2a at 24 h after ROSC were significantly higher in the SFI group than in the SA and EPI groups （P〈0.05 or P〈0.01）. Conclusions： The administration of epinephrine during CPR decreased the expression of SERCA2a and aggravated postresuscitation myocardial function （P〈0.01）. SFI attenuated post-resuscitation myocardial dysfunction, and the mechanism might be related to the up-regulation of SERCA2a expression.
基金This research was supported by a grant from the Beijing Natural Science Foundation
文摘Background Epinephrine has been used as a first-choice vasopressor drug for cardiac arrest （CA） since 1974.However,the administration of epinephrine is controversial.This study aims to compare the effects of Shen-Fu injection （SFI） and epinephrine on resuscitation outcomes in a porcine model of prolonged CA.Methods Ventricular fibrillation （VF） was electrically induced.After 8 minutes of untreated VF and 2 minutes of chest compressions,24 pigs were randomly divided into 3 groups （n=8 per group）：central venous injection of SFI （SFI group）,epinephrine （EPI group）,or saline solution （SA group）.The haemodynamic status and oxygen metabolism parameters,including cardiac output,mean arterial pressure,left ventricular dp/dtmax and negative dp/dtmax,oxygen delivery （DO2）,and oxygen consumption （VO2）,were calculated.Results SFI shortened the time to restoration of spontaneous circulation （ROSC） and decreased the number of shocks,similar to epinephrine.However,the mean arterial pressure,cardiac output,left ventricular dp/dtmax and negative dp/dtmax were significantly higher in the SFI group than in the EPI group at 4 and 6 hours after ROSC.VO2 and ERO2 decreased after ROSC and then increased.VO2 and ERO2 were significantly higher in the SFI group than in the EPI and SA groups after ROSC,while those were lowest in the EPI group among all groups.Conclusions SFI shortened the time to ROSC and decreased the number of shocks,similar to epinephrine.However,SFI improved oxygen metabolism,and produced a better hemodynamic status compared with epinephrine.SFI might be a potentially vasopressor drug for the treatment of CA.
基金This work was supported b-y grants from the National Natural Science Foundation of China （No. 81372025） and the Beijing Natural Science Foundation （No. 7132092）.
文摘Background： Shen-Fu injection （SFI） can attenuate ischemia-reperfusion injury, protect cardiac function, and improve microcirculation during cardiopulmonary resuscitation. We hypothesized that SFI may also have an influence on myocardial metabolism during ventrictdar fibrillation （VF）. In this study, we used SFI pretreatment prior to VF to discuss the changes of myocardial metabolism and catecholamine （CA） levels during untreated VF, trying to provide new evidence to the protection of SFI to myocardiurn. Methods： Twenty-four pigs were divided into three groups： Saline group （SA group）, SFI group, and SHAM operation group （SHAM group）. Thirty minutes prior to the induction of VF, the SFI group received 0.24 mg/ml SFI through an intravenous injection： the SA group received an equal amount of sodium chloride solution. The interstitial fluid from the left ventricle （LV） wall was collected through the microdialysis tubes during VF. Adenosine diphosphate （ADP）, adenosine triphosphate （ATP）, and Na^＋-K^＋-ATPase and Ca2^＋-ATPase enzyme activities were measured after untreated VF. Peak-to-trough VF amplitude and median frequency were analyzed for each of these 5-s intervals. Results： The levels of glucose and glutamate were lower after VF in both the SA and SFI groups, compared with baseline, and the levels in the SFI group were higher than those in the SA group. Compared with baseline, the levels of lactate and the lactate/pyruvate ratio increased after VF in both SA and SFI groups, and the levels in the SFI group were lower than those in the SA group. In both the SA and SFI groups, the levers of dopamine, norepinephrine, and epinephrine increased significantly. There were no statistical differences between the two groups. The content of ATE ADE and phosphocreatine in the SF1 group was higher than those in the SA group. The activity ofLV Na^＋-K^＋-ATPase was significantly higher in the SFI group than in the SA group. Amplitude mean spectrum area （AMSA） was significantly lower in the SA and SFI groups at 8- and 12-min compared with 4-min. The AMSA in the SFI group was higher than that in the SA group at each time point during untreated VF. Conclusions： SFI pretreatment can improve myocardial metabolism and reduce energy exhaustion during VF, and it does not aggravate the excessive secretion of endogenous CAs.
文摘Background Post-resuscitation myocardial dysfunction has been implicated as a major cause of fatal outcome in patients who survive initially successful cardiopulmonary resuscitation （CPR）. In our previous study, we found that impaired myocardial β-adrenergic receptor （AR） signaling is a key mechanism in post-resuscitation myocardial dysfunction and Shen-Fu injection （SFI） can attenuate post-resuscitation myocardial dysfunction. However, whether SFI can prevent impaired post-resuscitation myocardial β-AR signaling is not yet known. In this study, we investigated the effect of SFI on impaired myocardial β-AR signaling occurring post-resuscitation in a porcine model of cardiac arrest. Methods Ventricular fibrillation was induced electrically in anesthetized male landrace domestic pigs. After 4 minutes of untreated ventricular fibrillation, cardiopulmonary resuscitation was initiated. Sixteen successfully resuscitated pigs were randomized to receive a continuous infusion of either SFI （0.5 ml/min; n=8） or saline （placebo; n=8） for 6 hours, beginning 15 minutes after the return of spontaneous circulation （ROSC）. Hemodynamic and echocardiographic data were recorded. β-AR signaling was assessed at 6 hours after the intervention by measuring myocardial adenylate cyclase activity, β-AR density and β-AR kinase expression. Results Treatment with SFI produced better maximum rate of left ventricular pressure increase （dp/dtmax） and maximum rate of left ventricular pressure decline （-dp/dtmax）, cardiac output, and ejection fraction after ROSC. SFI treatment was also associated with lower myocardial β-adrenergic receptor kinase expression, whereas basal and isoproterenol- stimulated adenylate cyclase activity and the total β-AR density were significantly increased in the SFI group when compared with the placebo group. Conclusion SFI attenuated post-resuscitation myocardial dysfunction by preventing impaired myocardial β-AR signaling after CPR.
基金Supported by the National Natural Science Foundation of China(No.81372025)Basic and Clinical Research Cooperation Project of Capital Medical University(No.15JL42)Beijing Municipal Administration of Hospitals Incubating Program(No.Px2016022)
文摘Objective： To investigate whether Shen-Fu Injection（参附注射液, SFI） reduces post-resuscitation immune dysfunction in a porcine model of cardiac arrest by modulating apoptosis of regulatory T lymphocytes（Treg） in the spleen. Methods： After 8-min untreated ventricular fibrillation and 2-min basic life support, 24 pigs were divided into 3 groups with a random number table, i.e. SFI group, epinephrine（EP） group, and saline（SA） group（8 in each group）, which received central venous injection of SFI（1.0 m L/kg）, EP（0.02 mg/kg） and SA, respectively. The same procedure without CA initiation was achieved in the sham-operated（sham） group（n=6）. After successful return of spontaneous circulation（ROSC）, apoptosis rate of splenic Treg was detected by flow cytometry; and the m RNA expression of forkhead/winged helix transcription factor（Foxp3） of splenic Treg was detected by real time-polymerase chain reaction; and the levels of interleukin-4（IL-4） and interferon-γ（IFN-γ） in porcine splenic Treg were detected by using enzyme-linked immunosorbent assay（ELISA）. Results： Compared with the sham group, the apoptosis rate of Treg was significantly decreased, and the levels of Foxp3 m RNA expression, IFN-γ, IL-4 and IFN-γ/IL-4 were increased in the SA group（P〈0.05 or P〈0.01）. Compared with the EP and SA groups, SFI treatment increased the apoptosis rate of Treg and reduced the levels of Foxp3 m RNA expression, IFN-γ and IFN-γ/IL-4（P〈0.05）. Conclusions： SFI has significant effects in attenuating post-resuscitation immune dysfunction by modulating apoptosis of Treg in the spleen.
基金Supported by Science and Technology Development Plan of Shandong Province(No.2012YD19011)Medical and Health Technology Development Plan of Shandong Province(No.2013WS0250)+2 种基金National Natural Science Foundation of China(No.81503543)Traditional Chinese Medicine Science and Technology Development Plan of Shandong Province(No.2011-095 and 2013-080)Key Development Program of Shandong Province,China(No.2016GSF202029)
文摘Objective: To investigate the hemodynamic effect of Shen-Fu Injection(参附注射液, SFI) in early volume resuscitation treated septic shock patients by monitoring pulse indicator continuous cardiac output(PICCO). Methods: All septic shock patients admitted in the Intensive Care Unit of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 1 st, 2014 to December 31 th, 2015, were reviewed, and totally 65 were enrolled in this study. They were assigned to SFI group(33 cases) and control group(32 cases). All 65 patients underwent conventional treatment mainly including volume resuscitation, antibiotics and vasoactive drugs therapy. The patients of the SFI group received additional 100 mL of SFI intravenously every 12 h. In all 65 patients, the PICCO arterial catheter and vein catheter were implanted within 1 h after the diagnosis of septic shock. In the course of early volume resuscitation, hemodynamic data of patients were recorded by PICCO monitor at 0, 12, and 24 h after the catheter implantation. Results: The hemodynamic indices of the two groups showed no significant differences at the beginning of 0 h(P>0.05). At 12 and 24 h, the hemodynamic indices of SFI group were significantly improved in comparison with the control group(P<0.05), including cardiac index(CI), global end diastolic volume index(GEDI), mean arterial pressure(MAP) and heart rate(HR). In addition, there was no significant change of extra-vascular lung water index between the two groups(P>0.05). Conclusion: SFI significantly improved hemodynamic indices such as CI, GEDI, MAP and HR in early volume resuscitation treated septic shock patients.
文摘BACKGROUND A total of 100 patients diagnosed with mixed hemorrhoids from October 2022 to September 2023 in our hospital were randomly divided into groups by dice rolling and compared with the efficacy of different treatment options.AIM To analyze the clinical effect and prognosis of mixed hemorrhoids treated with polidocanol injection combined with automatic elastic thread ligation operation(RPH).METHODS A total of 100 patients with mixed hemorrhoids who visited our hospital from October 2022 to September 2023 were selected and randomly divided into the control group(n=50)and the treatment group(n=50)by rolling the dice.The procedure for prolapse and hemorrhoids(PPH)was adopted in the control group,while polidocanol foam injection+RPH was adopted in the treatment group.The therapeutic effects,operation time,wound healing time,hospital stay,pain situation(24 hours post-operative pain score,first defecation pain score),quality of life(QOL),incidence of complications(post-operative hemorrhage,edema,infection),incidence of anal stenosis 3 months post-operatively and recurrence rate 1 year post-operatively of the two groups were compared.RESULTS Compared with the control group,the total effective rate of treatment group was higher,and the difference was significant(P<0.05).The operation time/wound healing time/hospital stay in the treatment group were shorter than those in the control group(P<0.05).The pain scores at 24 hours after operation/first defecation pain score of the treatment group was significantly lower than those in the control group(P<0.05).After surgery,the QOL scores of the two groups decreased,with the treatment group having higher scores than that of the control group(P<0.05).Compared with the control group,the incidence of postoperative complications in the treatment group was lower,and the difference was significant(P<0.05);However,there was no significant difference in the incidence of postoperative bleeding between the two groups(P>0.05);There was no significant difference in the incidence of anal stenosis 3 months after operation and the recurrence rate 1 year after operation between the two groups(P>0.05).CONCLUSION For patients with mixed hemorrhoids,the therapeutic effect achieved by using polidocanol injection combined with RPH was better.The wounds of the patients healed faster,the postoperative pain was milder,QOL improved,and the incidence of complications was lower,and the short-term and long-term prognosis was good.
基金supported by the National Key R&D Program of China(No.2024YFB4206700)the Joint Geological Funds of the National Natural Science Foundation of China(No.U2244223)+5 种基金the China Scholarship Council Program(No.202404910533)the Guangdong Major Project of Basic and Applied Basic Research(No.2020B0301030003)the China Geological Survey Project(No.DD20211350)the Key Deployment Program of Chinese Academy of Sciences(Nos.YJKYYQ20190043,ZDBS-LY-DQC003,KFZD-SW-422,and ZDRW-ZS-2021-3-1)the Scientific Research and Technology Development Project of China National Petroleum Corporation(No.2022DJ5503)the Supercomputing Laboratory,IGGCAS.
文摘This study proposes and systematically evaluates an optimized integration of warm surface seawater injection with depressurization for the long-term exploitation of marine natural gas hydrates.By employing comprehensive multiphysics simulations guided by field data from hydrate production tests in the South China Sea,we pinpoint key operational parameters—such as injection rates,depths,and timings—that notably enhance production efficiency.The results indicate that a 3-phase hydrate reservoir transitions from a free-gas-dominated production stage to a hydrate-decomposition-dominated stage.Moderate warm seawater injection supplies additional heat during the hydrate decomposition phase,thereby enhancing stable production;however,excessively high injection rates can impede the depressurization process.Only injection at an appropriate depth simultaneously balances thermal supplementation and the pressure gradient,leading to higher overall productivity.A“depressurization-driven sensible-heat supply window”is introduced,highlighting that timely seawater injection following initial depressurization prolongs reservoir dissociation dynamics.In this study area,commencing seawater injection at 170 d of depressurization proved optimal.This optimized integration leverages clean and renewable thermal energy,providing essential insights into thermal supplementation strategies with significant implications for sustainable,economically feasible,and efficient commercial-scale hydrate production.
基金financially supported by the National Natural Science Foundation of China(No.51904026)the Fundamental Research Funds for the Central Universities(No.06500108)。
文摘Hydrogen displays the potential to partially replace pulverized coal injection(PCI)in the blast furnace,and it can reduce CO_(2)emissions.In this paper,a three-dimensional mathematical model of hydrogen and pulverized coal co-injection in blast furnace tuyere was established through numerical simulation,and the effect of hydrogen injection and oxygen enrichment interaction on pulverized coal combustion and raceway smelting was investigated.The simulation results indicate that when the coal injection rate decreased from 36 to 30t/h and the hydrogen injection increased from 0 to 3600 m^(3)/h,the CO_(2)emissions decreased from 1860 to 1551 kg/t,which represents a16.6%reduction,and the pulverized coal burnout decreased from 70.1%to 63.7%.The heat released from hydrogen combustion can not only promote the volatilization of pulverized coal but also affect the combustion reaction between volatilization and oxygen,which resulted in a decrease in the temperature at the end of the raceway.Co-injection of hydrogen with PCI increased the wall temperature near the upper half part of the raceway and at the outlet of the tuyere,which required a high cooling efficiency to extend the service life of the blast furnace.The increase in oxygen level compensated for the decreased average temperature in the raceway due to hydrogen injection.The increase in the oxygen content by 3%while maintaining constant hydrogen and PCI injection rates increased the burnout and average raceway temperature by 4.2%and 43 K,respectively.The mole fraction of CO and H_(2) production increased by 0.04 and 0.02,respectively.Burnout can be improved through optimization of the particle size distribution of pulverized coal.
基金Supported by National Natural Science Foundation of China(Grant Nos.51175422,61973011)Shaanxi Provincial Natural Science Basic Research Plan of China(Grant No.2022JM-195)+1 种基金Fundamental Research Funds for the Central Universities of Chinathe Research Start-up Funds of Hangzhou International Innovation Institute of Beihang University(Grant No.2024KQ036)。
文摘During high-speed rotation,the surface of aeronautic spiral bevel gears will generate significant pressure and viscous forces,which will cause a certain amount of windage power loss and reduce the efficiency of the transmission system.Based on the computational fluid dynamics,this paper analyzes the windage power loss of a single spiral bevel gear and a spiral bevel gear pair under oil injection lubrication.In addition,the shroud is used to suppress gear windage loss,and the clearance size and opening angle of the designed shroud are optimized.Finally,by comparing and analyzing the experimental results,the following conclusions were obtained:(1)For a single gear,the speed is the most important factor affecting windage loss,followed by the hand of spiral,and rotation direction;(2)For gear pairs,under oil injection lubrication,the input speed has the greatest impact on windage power loss,followed by the influence of oil injection port speed,temperature and oil injection port pressure;(3)Installing a shroud is an effective method to reduce windage power loss;(4)In the pure air phase,the smaller the clearance between the shroud and the gear surface,and the smaller the radial direction between the shroud and the shaft,the better the effect of reducing windage;(5)In the two-phase flow of oil and gas,it is necessary to design oil drainage holes on the shroud to ensure the smooth discharge of lubricating oil and improve the drag reduction effect.
基金Supported by Zhejiang Province Traditional Chinese Medicine Science and Technology Plan Project,No.2023ZL230。
文摘BACKGROUND Although gastroscopy is a commonly used diagnostic and therapeutic technique,postoperative gastrointestinal dysfunction is prone to occur.Traditional Chinese medicine theory suggests that postoperative gastrointestinal disorders are related to spleen and stomach weakness.This study hypothesizes that the combination of acupoint application at the Ziwu Liuzhu acupoint and percutaneous acupoint electrical stimulation can promote postoperative gastrointestinal function recovery and alleviate stress reactions.AIM To investigate the effects of acupoint application of Ziwu Liuzhu combined with percutaneous acupoint electrical stimulation on postoperative gastrointestinal function recovery and stress response in patients undergoing gastrointestinal endoscopy surgery.METHODS A total of 120 patients who underwent gastroscopy surgery were selected and treated between October 2024 and January 2025.This study used a stratified block randomization method,and then allocated groups using computer-generated random number sequences(SAS 9.4 software).The groups were divided into two groups:A control group of 60 patients who received routine postoperative intervention measures,and an observation group of 60 patients who received acupuncture point application combined with transcutaneous acupoint electrical CONCLUSION The combination of percutaneous acupoint electrical stimulation in gastroscopy patients has been demonstrated to be both highly safe and effective.The benefits of this approach include the promotion of postoperative gastrointestinal function,the reduction of stress response,the attainment of optimal results,and the enhancement of patient satisfaction.
