Mitochondrial dysfunction and oxidative stress are widely regarded as primary drivers of aging and are associated with several neurodegenerative diseases.The degeneration of motor neurons during aging is a critical pa...Mitochondrial dysfunction and oxidative stress are widely regarded as primary drivers of aging and are associated with several neurodegenerative diseases.The degeneration of motor neurons during aging is a critical pathological factor contributing to the progression of sarcopenia.However,the morphological and functional changes in mitochondria and their interplay in the degeneration of the neuromuscular junction during aging remain poorly understood.A defined systematic search of the Pub Med,Web of Science and Embase databases(last accessed on October 30,2024)was conducted with search terms including'mitochondria','aging'and'NMJ'.Clinical and preclinical studies of mitochondrial dysfunction and neuromuscular junction degeneration during aging.Twentyseven studies were included in this systematic review.This systematic review provides a summary of morphological,functional and biological changes in neuromuscular junction,mitochondrial morphology,biosynthesis,respiratory chain function,and mitophagy during aging.We focus on the interactions and mechanisms underlying the relationship between mitochondria and neuromuscular junctions during aging.Aging is characterized by significant reductions in mitochondrial fusion/fission cycles,biosynthesis,and mitochondrial quality control,which may lead to neuromuscular junction dysfunction,denervation and poor physical performance.Motor nerve terminals that exhibit redox sensitivity are among the first to exhibit abnormalities,ultimately leading to an early decline in muscle strength through impaired neuromuscular junction transmission function.Parg coactivator 1 alpha is a crucial molecule that regulates mitochondrial biogenesis and modulates various pathways,including the mitochondrial respiratory chain,energy deficiency,oxidative stress,and inflammation.Mitochondrial dysfunction is correlated with neuromuscular junction denervation and acetylcholine receptor fragmentation,resulting in muscle atrophy and a decrease in strength during aging.Physical therapy,pharmacotherapy,and gene therapy can alleviate the structural degeneration and functional deterioration of neuromuscular junction by restoring mitochondrial function.Therefore,mitochondria are considered potential targets for preserving neuromuscular junction morphology and function during aging to treat sarcopenia.展开更多
BACKGROUND Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty(pTHA).However,the literature demonstrates significant variability regarding the relative contributions of different ...BACKGROUND Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty(pTHA).However,the literature demonstrates significant variability regarding the relative contributions of different factors.AIM To investigate the key determinants of aseptic loosening,we performed a systematic review and meta-analysis.METHODS A comprehensive search of PubMed,Web of Science,EMBASE,and the Cochrane Library was conducted,encompassing studies from database inception to January 1,2025.Meta-analyses were performed to evaluate factors associated with aseptic loosening following pTHA.Inclusion and exclusion criteria were systematically applied at each stage to ensure methodological transparency and reproducibility.Study quality was assessed using standardized categories.Pooled odds ratio(OR)with corresponding 95%confidence interval were calculated with random-or fixed-effects models to generate reliability estimates,and study heterogeneity was visualized using forest plots.Ten factors,categorized into patient-,surgeon-,and device-related domains,were reviewed and meta-analyzed.Funnel plot analysis demonstrated a relatively symmetrical distribution,suggesting minimal publication bias.RESULTS A meta-analysis of 20 studies(520789 participants)found a pooled prevalence of 1.96%.Significant risk factors for aseptic loosening after pTHA included elevated body mass index(OR=1.116,P<0.001),higher Charlson comorbidity index(OR=1.378,P<0.001),prosthesis-related factors(OR=1.497,P<0.001),and adverse lifestyles(OR=2.198,P=0.037).Protective factors were non-white race(OR=0.445,P<0.001)and favorable genetics(OR=0.723,P<0.001).Male sex increased risk(OR=1.232,P=0.016),while age and anatomy were not significant.Surgical expertise showed a slight protective effect(OR=1.048,P<0.001).A comprehensive understanding of the modifiable and non-modifiable factors contributing to aseptic loosening after pTHA requires consideration of patient-related factors,surgical expertise,and prosthesis characteristics.CONCLUSION The identification of these factors is critical for risk mitigation.High-risk patients should receive targeted counseling regarding individualized profiles.Further studies are warranted to establish clearer causal relationships and identify additional contributing factors.展开更多
With the increasing complexity of industrial automation,planetary gearboxes play a vital role in largescale equipment transmission systems,directly impacting operational efficiency and safety.Traditional maintenance s...With the increasing complexity of industrial automation,planetary gearboxes play a vital role in largescale equipment transmission systems,directly impacting operational efficiency and safety.Traditional maintenance strategies often struggle to accurately predict the degradation process of equipment,leading to excessive maintenance costs or potential failure risks.However,existing prediction methods based on statistical models are difficult to adapt to nonlinear degradation processes.To address these challenges,this study proposes a novel condition-based maintenance framework for planetary gearboxes.A comprehensive full-lifecycle degradation experiment was conducted to collect raw vibration signals,which were then processed using a temporal convolutional network autoencoder with multi-scale perception capability to extract deep temporal degradation features,enabling the collaborative extraction of longperiod meshing frequencies and short-term impact features from the vibration signals.Kernel principal component analysis was employed to fuse and normalize these features,enhancing the characterization of degradation progression.A nonlinear Wiener process was used to model the degradation trajectory,with a threshold decay function introduced to dynamically adjust maintenance strategies,and model parameters optimized through maximum likelihood estimation.Meanwhile,the maintenance strategy was optimized to minimize costs per unit time,determining the optimal maintenance timing and preventive maintenance threshold.The comprehensive indicator of degradation trends extracted by this method reaches 0.756,which is 41.2%higher than that of traditional time-domain features;the dynamic threshold strategy reduces the maintenance cost per unit time to 55.56,which is 8.9%better than that of the static threshold optimization.Experimental results demonstrate significant reductions in maintenance costs while enhancing system reliability and safety.This study realizes the organic integration of deep learning and reliability theory in the maintenance of planetary gearboxes,provides an interpretable solution for the predictive maintenance of complex mechanical systems,and promotes the development of condition-based maintenance strategies for planetary gearboxes.展开更多
Stroke remains a leading cause of death and disability worldwide,and electroacupuncture has a long history of use in stroke treatment.This meta-analysis and systematic review aimed to evaluate the efficacy of electroa...Stroke remains a leading cause of death and disability worldwide,and electroacupuncture has a long history of use in stroke treatment.This meta-analysis and systematic review aimed to evaluate the efficacy of electroacupuncture and explore its potential mechanisms in animal models of ischemic stroke.The PubMed,EMBASE,Web of Science,CENTRAL,and CINAHL databases were comprehensively searched up to May 1,2024.This review included articles on preclinical investigations of the efficacy and mechanisms of electroacupuncture in treating ischemic stroke.Data from 70 eligible studies were analyzed in Stata 18.0,using a random-effects model to calculate the standardized mean difference(Hedge’s g).The risk of bias was assessed using RevMan 5.4 software,and the quality of evidence was rated according to the Grading of Recommendations,Assessment,Development,and Evaluation(GRADE)system.Subgroup analyses were conducted to test the consistency of the results and sensitivity analyses were used to assess their robustness.The quality assessment revealed that most studies adequately handled incomplete data and selective reporting.However,several methodological limitations were identified:only 4 studies demonstrated a low risk of allocation concealment,26 achieved a low risk of outcome assessment bias,and 9 had a high risk of randomization bias.Additionally,there was an unclear risk regarding participant blinding and other methodological aspects.The GRADE assessment rated 12 outcomes as moderate quality and 6 as low quality.The mechanisms of electroacupuncture treatment for ischemic stroke can be categorized as five primary pathways:(1)Electroacupuncture significantly reduced infarct volume and apoptotic cell death(P<0.01)in ischemic stroke models;(2)electroacupuncture significantly decreased the levels of pro-inflammatory factors(P<0.01)while increasing the levels of anti-inflammatory factors(P=0.02);(3)electroacupuncture reduced the levels of oxidative stress indicators(P<0.01)and enhanced the expression of antioxidant enzymes(P<0.01);(4)electroacupuncture significantly promoted nerve regeneration(P<0.01);and(5)electroacupuncture influenced blood flow remodeling(P<0.01)and angiogenesis(P<0.01).Subgroup analyses indicated that electroacupuncture was most effective in the transient middle cerebral artery occlusion model(P<0.01)and in post-middle cerebral artery occlusion intervention(P<0.01).Dispersive waves were found to outperform continuous waves with respect to neuroprotection and anti-inflammatory effects(P<0.01),while scalp acupoints demonstrated greater efficacy than body acupoints(P<0.01).The heterogeneity among the included studies was minimal,and sensitivity analyses indicated stable results.Their methodological quality was generally satisfactory.In conclusion,electroacupuncture is effective in treating cerebral ischemia by modulating cell apoptosis,oxidative stress,inflammation,stroke-induced nerve regeneration,blood flow remodeling,and angiogenesis.The efficacy of electroacupuncture may be influenced by factors such as the middle cerebral artery occlusion model,the timing of intervention onset,waveform,and acupoint selection.Despite the moderate to low quality of evidence,these findings suggest that electroacupuncture has clinical potential for improving outcomes in ischemic stroke.展开更多
Background:While the treatment of metastatic renal cell carcinoma(mRCC)is evolving due to immune checkpoint inhibitors(ICIs),optimal strategies for later lines of therapy have yet to be defined.The combination of lenv...Background:While the treatment of metastatic renal cell carcinoma(mRCC)is evolving due to immune checkpoint inhibitors(ICIs),optimal strategies for later lines of therapy have yet to be defined.The combination of lenvatinib and everolimus represents a viable option,and the present review aimed to summarize its activity,effectiveness,and safety.Methods:A systematic review of the literature was conducted using PubMed,targeting studies published between 2018 and 2025.Eligible studies included English-language prospective and retrospective trials reporting survival outcomes in mRCC patients treated with lenvatinib and everolimus after at least one ICI-containing regimen.Results:Nine studies met the inclusion criteria,encompassing a total of 441 patients.The lenvatinib and everolimus combination was primarily used in the third and subsequent lines of therapy.Median overall survival ranged from 7.5 to 24.5 months,while median progression-free survival was more consistent,between 6.1 and 6.7 months,except for one study reporting 12.9 months.Objective response rates varied widely(14.0%–55.7%).Adverse events of grade≥3 did not exceed the expected rate,with diarrhoea and proteinuria as the most reported events.Dose reductions and treatment discontinuations due to toxicity occurred but were generally lower than in prior pivotal trials.Conclusions:Real-world evidence suggests that lenvatinib and everolimus represent an effective and safe option after ICI failure in mRCC patients.Nevertheless,the lack of randomized phase III trials and the heterogeneity of existing studies highlight the need for more robust prospective research to guide post-ICI therapeutic strategies.展开更多
Shared decision-making has been described as allowing patients to gain more control over their life situation and feel less helpless. The aim of this systematic review was to describe the involvement of older patients...Shared decision-making has been described as allowing patients to gain more control over their life situation and feel less helpless. The aim of this systematic review was to describe the involvement of older patients in shared decision-making in community settings. In accordance with the systematic review method, a total of 2468 abstracts were read, after which nine quantitative studies were included. A qualitative thematic analysis was performed and two themes emerged;increased understanding of self-management and a desire to strengthen one’s position in relationship with professionals, both of which were essential for empowering older patients to participate in shared decision-making. Older patients’ shared decision-making was seen as a struggle to maintain their autonomy in different areas of everyday life. Emotional and psychological problems made their position more difficult. In order to empower them in relationships with healthcare professionals, older patients require more knowledge (self-efficacy) and information about their illness, which could strengthen their position in the decision-making process. They also need a greater awareness of decisional conflicts that may arise. Age, gender and health status influence older patients’ chance of being respected and taken seriously in relationship with professionals.展开更多
Due to ever-growing soccer data collection approaches and progressing artificial intelligence(AI) methods, soccer analysis, evaluation, and decision-making have received increasing interest from not only the professio...Due to ever-growing soccer data collection approaches and progressing artificial intelligence(AI) methods, soccer analysis, evaluation, and decision-making have received increasing interest from not only the professional sports analytics realm but also the academic AI research community. AI brings gamechanging approaches for soccer analytics where soccer has been a typical benchmark for AI research. The combination has been an emerging topic. In this paper, soccer match analytics are taken as a complete observation-orientation-decision-action(OODA) loop.In addition, as in AI frameworks such as that for reinforcement learning, interacting with a virtual environment enables an evolving model. Therefore, both soccer analytics in the real world and virtual domains are discussed. With the intersection of the OODA loop and the real-virtual domains, available soccer data, including event and tracking data, and diverse orientation and decisionmaking models for both real-world and virtual soccer matches are comprehensively reviewed. Finally, some promising directions in this interdisciplinary area are pointed out. It is claimed that paradigms for both professional sports analytics and AI research could be combined. Moreover, it is quite promising to bridge the gap between the real and virtual domains for soccer match analysis and decision-making.展开更多
The paper discusses the problems of engineering geology in environmental geoscience from several aspects. For natural sciences and social sciences, it deduces essential theory from logistic cycle model, logic mapping ...The paper discusses the problems of engineering geology in environmental geoscience from several aspects. For natural sciences and social sciences, it deduces essential theory from logistic cycle model, logic mapping and Verhulst model. It had been discovered that these aspects are equal. However, these were the studies of normal effects. We must establish mathematical model to check from contrary course for gray forecasting and decision-making and answer several questions satisfactorily.展开更多
I the context of the Corporate Governance Code enactment in Japan, we examine how newly introduced outside directors in Japanese boards obtain information to take part in the decision-making process. We conducted a sy...I the context of the Corporate Governance Code enactment in Japan, we examine how newly introduced outside directors in Japanese boards obtain information to take part in the decision-making process. We conducted a systematic review of the literature and found 18 peer-reviewed publications in a time span between 2000 and 2016 that described the asymmetry of information between the insider group of board directors （including the CEO） and the outside board members. Our fmdings show that for the course of more than a decade, despite all changes and reforms, the role of board directors, whether insiders or outsiders, is still supplementary. They are treated more as advisors than active part in the decision-making process. We reveal different insider sources of information as forming social ties with the CEO and/or inside board directors and collaboration with Audit ＆ Supervisory Board （Kansayaku）, which can help reduce this asymmetry and improve the decision-making process. We assume that it will be easier for the outsiders to establish contacts and form social ties with the Audit ＆ Supervisory Board members because of their unspoken lower status and thus to obtain more information about the company internal affairs and discussions that take place during the informal meetings, where only insiders （including the CEO） are present.展开更多
Evaluating and selecting players to suit football clubs and decision-makers (coaches, managers, technical, and medical staff) is a difficult process from a managerial-financial and sporting perspective. Football is a ...Evaluating and selecting players to suit football clubs and decision-makers (coaches, managers, technical, and medical staff) is a difficult process from a managerial-financial and sporting perspective. Football is a highly competitive sport where sponsors and fans are attracted by success. The most successful players, based on their characteristics (criteria and sub-criteria), can influence the outcome of a football game at any given time. Consequently, the D-day of selection should employ a more appropriate approach to human resource management. To effectively address this issue, a detailed study and analysis of the available literature are needed to assist practitioners and professionals in making decisions about football player selection and hiring. Peer-reviewed journals were selected for collecting published papers between 2018 and 2023. A total of 66 relevant articles (journal articles, conference articles, book sections, and review articles) were selected for evaluation and analysis. The purpose of the study is to present a systematic literature review (SLR) on how to solve this problem and organize the published research papers that answer our four research questions.展开更多
The critical role of patient-reported outcome measures(PROMs)in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific research.PROMs encapsulate a pati...The critical role of patient-reported outcome measures(PROMs)in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific research.PROMs encapsulate a patient's health status directly from their perspective,encompassing various domains such as symptom severity,functional status,and overall quality of life.By integrating PROMs into routine clinical practice and research,healthcare providers can achieve a more nuanced understanding of patient experiences and tailor treatments accordingly.The deployment of PROMs supports dynamic patient-provider interactions,fostering better patient engagement and adherence to tre-atment plans.Moreover,PROMs are pivotal in clinical settings for monitoring disease progression and treatment efficacy,particularly in chronic and mental health conditions.However,challenges in implementing PROMs include data collection and management,integration into existing health systems,and acceptance by patients and providers.Overcoming these barriers necessitates technological advancements,policy development,and continuous education to enhance the acceptability and effectiveness of PROMs.The paper concludes with recommendations for future research and policy-making aimed at optimizing the use and impact of PROMs across healthcare settings.展开更多
The advancement of Artificial Intelligence(AI)has garnered significant attention within the academic research community,reflecting the prevailing zeitgeist.However,there is a paucity of literature that has delved into...The advancement of Artificial Intelligence(AI)has garnered significant attention within the academic research community,reflecting the prevailing zeitgeist.However,there is a paucity of literature that has delved into its connection with the higher order thinking skills of human beings.The purpose of this systematic review is to investigate the relationship between AI utilization and the development of critical thinking(CT)in the field of education.A systematic literature search was performed in two databases,Web of Science and Scopus,with a focus on empirical studies related to AI and CT.The review process followed the PRISMA framework and adopted a bottom-up approach,Ultimately,the integrated review synthesized 21 eligible studies from a total of 649 articles.The systematic review identified three relationships between AI technologies and CT.The results suggest that AI technologies can help to enhance learners’CT skills(n=13).However,excessive or inappropriate utilization of AI may hinder CT development(n=7).Moreover,the cultivation of CT skills has been shown to positively influence the effectiveness of AI utilization(n=4).This article represents the first literature review to delve into the reciprocal relationship between AI implementation and CT development within the education field,striving to illuminate the ways in which learners can enhance their higher-order thinking skills through more effective utilization of AI technologies.展开更多
Objective This systematic review aimed to identify the predictors of recovery from dysphagia after stroke in the last ten years,thereby providing an evidence-based basis for nurses to identify high-risk patients and d...Objective This systematic review aimed to identify the predictors of recovery from dysphagia after stroke in the last ten years,thereby providing an evidence-based basis for nurses to identify high-risk patients and develop individualized rehabilitation plans to improve patient prognosis.Methods Databases including the China National Knowledge Infrastructure(CNKI),China Biology Medicine disc(CBMdisc),China Science and Technology Journal(VIP),WanFang,PubMed,Embase,CINAHL,Web of Science,the Cochrane Library,and Scopus were retrieved to search for literature on the predictors of recovery from dysphagia after stroke.The retrieval period was from January 2013 to December 2023.The quality of studies was assessed using the Newcastle-Ottawa Scale(NOS)and the Prediction model Risk of Bias Assessment Tool(PROBAST).Meta-analysis was performed using Revman5.3 and Stata15.1 software.The review protocol has been registered with PROSPERO(CRD42024605570).Results A total of 1,216 results were obtained,including 599 in English and 617 in Chinese.A total of 34 studies were included,involving 156,309 patients with post-stroke dysphagia,and the rate of dysphagia recovery increased from 13.53%at 1 week to 95%at 6 months after stroke.Meta-analysis results showed that older age[OR=1.06,95%CI(1.04,1.08),P<0.001],lower BMI[OR=1.28,95%CI(1.17,1.40),P<0.001],bilateral stroke[OR=3.10,95%CI(2.04,4.72),P<0.001],higher National Institutes of Health Stroke Scale(NIHSS)score[OR=1.19,95%CI(1.01,1.39),P=0.030],tracheal intubation[OR=5.08,95%CI(1.57,16.39),P=0.007]and aspiration[OR=4.70,95%CI(3.06,7.20),P<0.001]were unfavorable factors for the recovery of swallowing function in patients with post-stroke dysphagia.Conclusions The lack of standardized criteria for rehabilitation assessment of post-stroke dysphagia has resulted in reported recovery rates of swallowing function exhibiting wide variability.Nurses should take targeted preventive measures for patients aged≥70 years,low BMI,bilateral stroke,high NIHSS score,tracheal intubation,and aspiration to promote the recovery of swallowing function in patients with post-stroke dysphagia.展开更多
To solve problems of poor security guarantee and insufficient training efficiency in the conventional reinforcement learning methods for decision-making,this study proposes a hybrid framework to combine deep reinforce...To solve problems of poor security guarantee and insufficient training efficiency in the conventional reinforcement learning methods for decision-making,this study proposes a hybrid framework to combine deep reinforcement learning with rule-based decision-making methods.A risk assessment model for lane-change maneuvers considering uncertain predictions of surrounding vehicles is established as a safety filter to improve learning efficiency while correcting dangerous actions for safety enhancement.On this basis,a Risk-fused DDQN is constructed utilizing the model-based risk assessment and supervision mechanism.The proposed reinforcement learning algorithm sets up a separate experience buffer for dangerous trials and punishes such actions,which is shown to improve the sampling efficiency and training outcomes.Compared with conventional DDQN methods,the proposed algorithm improves the convergence value of cumulated reward by 7.6%and 2.2%in the two constructed scenarios in the simulation study and reduces the number of training episodes by 52.2%and 66.8%respectively.The success rate of lane change is improved by 57.3%while the time headway is increased at least by 16.5%in real vehicle tests,which confirms the higher training efficiency,scenario adaptability,and security of the proposed Risk-fused DDQN.展开更多
Objectives:Childhood and adolescent obesity are an increasing global health concern.This study aimed to evaluate the effectiveness of digital components and interaction types in counseling interventions for prevention...Objectives:Childhood and adolescent obesity are an increasing global health concern.This study aimed to evaluate the effectiveness of digital components and interaction types in counseling interventions for prevention and treatment.Methods:All studies were searched in online databases and grey literature,including PubMed(Medline),Web of Science,CINAHL,Scopus,IEEE Xplore Digital Library,Journal of Medical Internet Research(JMIR),MedNar,EBSco Open Dissertations.The search period is from inception to June 2023,and the languages are Finnish,English and Swedish.The research quality was evaluated using the web-based data management system Covidence for prevalence studies.The study protocol was registered with PROSPERO(registration number:CRD42021247595).Results:In this review,4,407 studies were screened,and 22 were included.These involved 3,433 participants and 264 child-parent pairs.The digital approaches included multicomponent elements like internet platforms,text messaging,video conferencing,online communities,wearable technology,and mobile apps,allowing one-way,two-way,and face-to-face interactions.Two studies showed statistically significant effects of treatment on BMI and waist-to-hip ratio.Most interventions reported positive outcomes,with no significant differences between groups,and none showed null effects during followup.Conclusions:Digital multicomponents like mobile apps and wearables can help obese children and adolescents adopt healthier lifestyles.While these interventions show promise for obesity management,further research is needed to assess their effectiveness,particularly regarding nurses'perspectives.展开更多
Nausea and vomiting are physiological responses that react to various bodily conditions and play a protective function.Medicinal and nonmedicinal methods,including complementary medicine,treat nausea and vomiting.The ...Nausea and vomiting are physiological responses that react to various bodily conditions and play a protective function.Medicinal and nonmedicinal methods,including complementary medicine,treat nausea and vomiting.The current research aims to investigate the effectiveness of foot reflexology as a complementary medicine method for nausea and vomiting.Based on PRISMA 2020,PubMed,Web of Science,and Scopus were searched until October 2,2024,using a search strategy approved by two researchers.Only randomized controlled trial studies were included in this research.No limitations or filters were applied.The inclusion criteria were selected based on the PICOS framework,and the studies were evaluated according to the National Institutes of Health quality assessment tool,which is related to controlled intervention,and were evaluated by two researchers.Finally,six studies were included in this review.Eighty-four percent of studies were conducted in Asia.Three records are from Iran,and two are from Turkey,and one is from France.The results showed that nausea and vomiting improved in all studies.In most studies(67%),four sessions or less led to improved outcomes.Rhodes index of nausea,vomiting,and retching and visual analog scale were utilized to assess nausea and vomiting.The current systematic review indicated that foot reflexology as a noninvasive intervention could improve nausea and vomiting in patients with cancer problems,pregnancy,hemodialysis,and laparoscopic cholecystectomy。展开更多
BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SA...BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SAVR).However,the compara-tive safety and efficacy of these interventions remain subjects of ongoing investigation.AIM To compare the clinical outcomes and safety of TAVR vs SAVR in patients with severe symptomatic aortic stenosis.METHODS A systematic review and meta-analysis were conducted according to PRISMA guidelines.Randomized controlled trials(RCTs)comparing TAVR and SAVR were identified from databases including PubMed,Scopus,and Web of Science up to May 31,2024.Data were extracted on clinical outcomes,including mortality,procedural compli-cations,and post-procedure adverse events.Risk ratios(RRs)with 95%CIs were calculated using a random-effects model.RESULTS A total of 10 RCTs were included.TAVR demonstrated a significantly lower risk of acute kidney injury(RR:0.33;95%CI:0.25–0.44),major bleeding(RR:0.37;95%CI:0.30–0.46),and new-onset atrial fibrillation(RR:0.44;95%CI:0.34–0.57)compared to SAVR.However,TAVR was associated with higher risks of new permanent pacemaker implantation(RR:3.49;95%CI:2.77–4.39),major vascular complications(RR:2.47;95%CI:1.91–3.21),and paraval-vular leaks(RR:4.15;95%CI:3.14–5.48).Mortality at 30 days was comparable(RR:0.95;95%CI:0.78–1.15),but long-term mortality was slightly higher with TAVR in some analyses(RR:1.23;95%CI:1.01–1.49).Rates of stroke(RR:0.97;95%CI:0.81–1.17)and myocardial infarction(RR:0.91;95%CI:0.67–1.24)were similar between the groups.CONCLUSION TAVR offers a less invasive option with significant benefits in reducing acute kidney injury,major bleeding,and new-onset atrial fibrillation,making it particularly advantageous for high-risk surgical candidates.However,higher risks of permanent pacemaker implantation,vascular complications,and paravalvular leaks highlight the need for individualized patient selection and shared decision-making to optimize outcomes.展开更多
Background:Isotonic crystalloids are recommended as the first choice for fluid therapy in acute pan-creatitis(AP),with normal saline(NS)and lactate Ringer’s(LR)used most often.Evidence based recom-mendations on the t...Background:Isotonic crystalloids are recommended as the first choice for fluid therapy in acute pan-creatitis(AP),with normal saline(NS)and lactate Ringer’s(LR)used most often.Evidence based recom-mendations on the type of fluid are conflicting and generally come from small single-center randomized controlled trials(RCTs).We therefore conducted a systematic review and meta-analysis to compare the effect of balanced solutions(BS)versus NS on patient-centered clinical outcomes in AP.Methods:From four databases searched up to October 2024,we included only RCTs of adult patients with AP that compared the use of BS(including LR,acetate Ringer’s,etc.)with NS.The primary out-come was the disease advances from AP to moderately severe and severe AP(MSAP/SAP).Trial sequential analyses(TSA)were conducted to control for type-I and type-II errors and Grading of Recommendations Assessment,Development,and Evaluation(GRADE)was used to assess the quality of evidence.Results:Six RCTs were identified and included,involving 260 patients treated with BS and 298 patients with NS.Patients who received the BS had less MSAP/SAP[odds ratio(OR)=0.50,95%confidence in-terval(CI):0.29 to 0.85,P=0.01,I^(2)=0%;5 studies,299 patients],reduced the need of ICU admission(OR=0.60,95%CI:0.39 to 0.93,P=0.02,I^(2)=0%;5 studies,507 patients)and shorter length of hospital stay[mean difference(MD)=-0.88,95%CI:-1.48 to-0.28,P=0.004,I^(2)=0%;6 studies,558 patients;confirmed by TSA with high certainty]compared with those who received NS.The evidence for most of the clinical outcomes was rated as moderate to low due to the risk of bias,imprecision and inconsistency.Conclusions:BS,compared with NS,was associated with improved clinical outcomes in patients with AP.However,given the moderate to low quality of evidence for most of the outcomes assessed,further trials are warranted.展开更多
Objectives This systematic review aimed to identify effective and cost-effective digital health interventions to improve self-management behaviors,blood pressure control,and cardiovascular risk reduction.Methods A sea...Objectives This systematic review aimed to identify effective and cost-effective digital health interventions to improve self-management behaviors,blood pressure control,and cardiovascular risk reduction.Methods A search for randomized and non-randomized control trials of digital health interventions among patients with uncontrolled hypertension was conducted from the databases of Embase,PubMed,Scopus,CINAHL,Web of Science,PsycINFO,Thai Journal Online(ThaiJO),the Faculty of Nursing Mahidol University(FON-MU)Nursing Research Database,and gray literature.After conducting the literature screening,the authors completed data extraction,and the risk of bias was assessed using the Joanna Briggs Institute randomized controlled trial checklist and the Joanna Briggs Institute critical appraisal checklist for quasi-experimental studies.Results The study included 22 articles,comprising 30 to 4,118 patients with uncontrolled hypertension.This review classified and summarized the components of digital health interventions and their effects on hypertensive outcomes.It was found that the key elements of digital health interventions include health education,reminders,self-monitoring,feedback and consultation,and instrumental support.Moreover,approximately 81.81%(n=18)of the digital health interventions involved healthcare providers participating in feedback and consultation.Additionally,digital health interventions effectively improve hypertensive outcomes such as self-management behaviors,blood pressure control,and cardiovascular risk reduction,providing cost-effectiveness.Conclusion Based on the available literature,digital health interventions have been shown to effectively enhance behavioral,clinical,and economic outcomes for individuals with uncontrolled hypertension.Moreover,the combination of digital health interventions and healthcare providers’interventions can potentially help patients with uncontrolled hypertension improve adherence to self-management when compared to stand-alone digital health interventions.Digital health interventions to support self-management interventions should be developed for patients by healthcare providers.展开更多
Due to the numerous variables to take into account as well as the inherent ambiguity and uncertainty,evaluating educational institutions can be difficult.The concept of a possibility Pythagorean fuzzy hypersoft set(pP...Due to the numerous variables to take into account as well as the inherent ambiguity and uncertainty,evaluating educational institutions can be difficult.The concept of a possibility Pythagorean fuzzy hypersoft set(pPyFHSS)is more flexible in this regard than other theoretical fuzzy set-like models,even though some attempts have been made in the literature to address such uncertainties.This study investigates the elementary notions of pPyFHSS including its set-theoretic operations union,intersection,complement,OR-and AND-operations.Some results related to these operations are also modified for pPyFHSS.Additionally,the similarity measures between pPyFHSSs are formulated with the assistance of numerical examples and results.Lastly,an intelligent decision-assisted mechanism is developed with the proposal of a robust algorithm based on similarity measures for solving multi-attribute decision-making(MADM)problems.A case study that helps the decision-makers assess the best educational institution is discussed to validate the suggested system.The algorithmic results are compared with the most pertinent model to evaluate the adaptability of pPyFHSS,as it generalizes the classical possibility fuzzy set-like theoretical models.Similarly,while considering significant evaluating factors,the flexibility of pPyFHSS is observed through structural comparison.展开更多
基金supported by grants from Collaborative Research Fund(Ref:C4032-21GF)General Research Grant(Ref:14114822)+1 种基金Group Research Scheme(Ref:3110146)Area of Excellence(Ref:Ao E/M-402/20)。
文摘Mitochondrial dysfunction and oxidative stress are widely regarded as primary drivers of aging and are associated with several neurodegenerative diseases.The degeneration of motor neurons during aging is a critical pathological factor contributing to the progression of sarcopenia.However,the morphological and functional changes in mitochondria and their interplay in the degeneration of the neuromuscular junction during aging remain poorly understood.A defined systematic search of the Pub Med,Web of Science and Embase databases(last accessed on October 30,2024)was conducted with search terms including'mitochondria','aging'and'NMJ'.Clinical and preclinical studies of mitochondrial dysfunction and neuromuscular junction degeneration during aging.Twentyseven studies were included in this systematic review.This systematic review provides a summary of morphological,functional and biological changes in neuromuscular junction,mitochondrial morphology,biosynthesis,respiratory chain function,and mitophagy during aging.We focus on the interactions and mechanisms underlying the relationship between mitochondria and neuromuscular junctions during aging.Aging is characterized by significant reductions in mitochondrial fusion/fission cycles,biosynthesis,and mitochondrial quality control,which may lead to neuromuscular junction dysfunction,denervation and poor physical performance.Motor nerve terminals that exhibit redox sensitivity are among the first to exhibit abnormalities,ultimately leading to an early decline in muscle strength through impaired neuromuscular junction transmission function.Parg coactivator 1 alpha is a crucial molecule that regulates mitochondrial biogenesis and modulates various pathways,including the mitochondrial respiratory chain,energy deficiency,oxidative stress,and inflammation.Mitochondrial dysfunction is correlated with neuromuscular junction denervation and acetylcholine receptor fragmentation,resulting in muscle atrophy and a decrease in strength during aging.Physical therapy,pharmacotherapy,and gene therapy can alleviate the structural degeneration and functional deterioration of neuromuscular junction by restoring mitochondrial function.Therefore,mitochondria are considered potential targets for preserving neuromuscular junction morphology and function during aging to treat sarcopenia.
基金Supported by the National Natural Science Foundation of China,No.82402789Beijing Jishuitan Hospital Youcai Plan,No.KYYC202402+2 种基金Beijing Jishuitan Research Funding,No.HL202402and Beijing Natural Science Foundation,No.L232062No.L222063.
文摘BACKGROUND Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty(pTHA).However,the literature demonstrates significant variability regarding the relative contributions of different factors.AIM To investigate the key determinants of aseptic loosening,we performed a systematic review and meta-analysis.METHODS A comprehensive search of PubMed,Web of Science,EMBASE,and the Cochrane Library was conducted,encompassing studies from database inception to January 1,2025.Meta-analyses were performed to evaluate factors associated with aseptic loosening following pTHA.Inclusion and exclusion criteria were systematically applied at each stage to ensure methodological transparency and reproducibility.Study quality was assessed using standardized categories.Pooled odds ratio(OR)with corresponding 95%confidence interval were calculated with random-or fixed-effects models to generate reliability estimates,and study heterogeneity was visualized using forest plots.Ten factors,categorized into patient-,surgeon-,and device-related domains,were reviewed and meta-analyzed.Funnel plot analysis demonstrated a relatively symmetrical distribution,suggesting minimal publication bias.RESULTS A meta-analysis of 20 studies(520789 participants)found a pooled prevalence of 1.96%.Significant risk factors for aseptic loosening after pTHA included elevated body mass index(OR=1.116,P<0.001),higher Charlson comorbidity index(OR=1.378,P<0.001),prosthesis-related factors(OR=1.497,P<0.001),and adverse lifestyles(OR=2.198,P=0.037).Protective factors were non-white race(OR=0.445,P<0.001)and favorable genetics(OR=0.723,P<0.001).Male sex increased risk(OR=1.232,P=0.016),while age and anatomy were not significant.Surgical expertise showed a slight protective effect(OR=1.048,P<0.001).A comprehensive understanding of the modifiable and non-modifiable factors contributing to aseptic loosening after pTHA requires consideration of patient-related factors,surgical expertise,and prosthesis characteristics.CONCLUSION The identification of these factors is critical for risk mitigation.High-risk patients should receive targeted counseling regarding individualized profiles.Further studies are warranted to establish clearer causal relationships and identify additional contributing factors.
基金funded by scientific research projects under Grant JY2024B011.
文摘With the increasing complexity of industrial automation,planetary gearboxes play a vital role in largescale equipment transmission systems,directly impacting operational efficiency and safety.Traditional maintenance strategies often struggle to accurately predict the degradation process of equipment,leading to excessive maintenance costs or potential failure risks.However,existing prediction methods based on statistical models are difficult to adapt to nonlinear degradation processes.To address these challenges,this study proposes a novel condition-based maintenance framework for planetary gearboxes.A comprehensive full-lifecycle degradation experiment was conducted to collect raw vibration signals,which were then processed using a temporal convolutional network autoencoder with multi-scale perception capability to extract deep temporal degradation features,enabling the collaborative extraction of longperiod meshing frequencies and short-term impact features from the vibration signals.Kernel principal component analysis was employed to fuse and normalize these features,enhancing the characterization of degradation progression.A nonlinear Wiener process was used to model the degradation trajectory,with a threshold decay function introduced to dynamically adjust maintenance strategies,and model parameters optimized through maximum likelihood estimation.Meanwhile,the maintenance strategy was optimized to minimize costs per unit time,determining the optimal maintenance timing and preventive maintenance threshold.The comprehensive indicator of degradation trends extracted by this method reaches 0.756,which is 41.2%higher than that of traditional time-domain features;the dynamic threshold strategy reduces the maintenance cost per unit time to 55.56,which is 8.9%better than that of the static threshold optimization.Experimental results demonstrate significant reductions in maintenance costs while enhancing system reliability and safety.This study realizes the organic integration of deep learning and reliability theory in the maintenance of planetary gearboxes,provides an interpretable solution for the predictive maintenance of complex mechanical systems,and promotes the development of condition-based maintenance strategies for planetary gearboxes.
基金supported by the National Natural Science Foundation of China,Nos.82174496(to NW),82374574(to NW),82302865(to LL)Shanghai Science and Technology Committee Sailing Program,Nos.23YF1403800(to LL),23YF1405200(to YX)Shanghai Hospital Development Center Foundation-Shanghai Municipal Hospital Rehabilitation Medicine Specialty Alliance,No.SHDC22023304(to YW).
文摘Stroke remains a leading cause of death and disability worldwide,and electroacupuncture has a long history of use in stroke treatment.This meta-analysis and systematic review aimed to evaluate the efficacy of electroacupuncture and explore its potential mechanisms in animal models of ischemic stroke.The PubMed,EMBASE,Web of Science,CENTRAL,and CINAHL databases were comprehensively searched up to May 1,2024.This review included articles on preclinical investigations of the efficacy and mechanisms of electroacupuncture in treating ischemic stroke.Data from 70 eligible studies were analyzed in Stata 18.0,using a random-effects model to calculate the standardized mean difference(Hedge’s g).The risk of bias was assessed using RevMan 5.4 software,and the quality of evidence was rated according to the Grading of Recommendations,Assessment,Development,and Evaluation(GRADE)system.Subgroup analyses were conducted to test the consistency of the results and sensitivity analyses were used to assess their robustness.The quality assessment revealed that most studies adequately handled incomplete data and selective reporting.However,several methodological limitations were identified:only 4 studies demonstrated a low risk of allocation concealment,26 achieved a low risk of outcome assessment bias,and 9 had a high risk of randomization bias.Additionally,there was an unclear risk regarding participant blinding and other methodological aspects.The GRADE assessment rated 12 outcomes as moderate quality and 6 as low quality.The mechanisms of electroacupuncture treatment for ischemic stroke can be categorized as five primary pathways:(1)Electroacupuncture significantly reduced infarct volume and apoptotic cell death(P<0.01)in ischemic stroke models;(2)electroacupuncture significantly decreased the levels of pro-inflammatory factors(P<0.01)while increasing the levels of anti-inflammatory factors(P=0.02);(3)electroacupuncture reduced the levels of oxidative stress indicators(P<0.01)and enhanced the expression of antioxidant enzymes(P<0.01);(4)electroacupuncture significantly promoted nerve regeneration(P<0.01);and(5)electroacupuncture influenced blood flow remodeling(P<0.01)and angiogenesis(P<0.01).Subgroup analyses indicated that electroacupuncture was most effective in the transient middle cerebral artery occlusion model(P<0.01)and in post-middle cerebral artery occlusion intervention(P<0.01).Dispersive waves were found to outperform continuous waves with respect to neuroprotection and anti-inflammatory effects(P<0.01),while scalp acupoints demonstrated greater efficacy than body acupoints(P<0.01).The heterogeneity among the included studies was minimal,and sensitivity analyses indicated stable results.Their methodological quality was generally satisfactory.In conclusion,electroacupuncture is effective in treating cerebral ischemia by modulating cell apoptosis,oxidative stress,inflammation,stroke-induced nerve regeneration,blood flow remodeling,and angiogenesis.The efficacy of electroacupuncture may be influenced by factors such as the middle cerebral artery occlusion model,the timing of intervention onset,waveform,and acupoint selection.Despite the moderate to low quality of evidence,these findings suggest that electroacupuncture has clinical potential for improving outcomes in ischemic stroke.
文摘Background:While the treatment of metastatic renal cell carcinoma(mRCC)is evolving due to immune checkpoint inhibitors(ICIs),optimal strategies for later lines of therapy have yet to be defined.The combination of lenvatinib and everolimus represents a viable option,and the present review aimed to summarize its activity,effectiveness,and safety.Methods:A systematic review of the literature was conducted using PubMed,targeting studies published between 2018 and 2025.Eligible studies included English-language prospective and retrospective trials reporting survival outcomes in mRCC patients treated with lenvatinib and everolimus after at least one ICI-containing regimen.Results:Nine studies met the inclusion criteria,encompassing a total of 441 patients.The lenvatinib and everolimus combination was primarily used in the third and subsequent lines of therapy.Median overall survival ranged from 7.5 to 24.5 months,while median progression-free survival was more consistent,between 6.1 and 6.7 months,except for one study reporting 12.9 months.Objective response rates varied widely(14.0%–55.7%).Adverse events of grade≥3 did not exceed the expected rate,with diarrhoea and proteinuria as the most reported events.Dose reductions and treatment discontinuations due to toxicity occurred but were generally lower than in prior pivotal trials.Conclusions:Real-world evidence suggests that lenvatinib and everolimus represent an effective and safe option after ICI failure in mRCC patients.Nevertheless,the lack of randomized phase III trials and the heterogeneity of existing studies highlight the need for more robust prospective research to guide post-ICI therapeutic strategies.
文摘Shared decision-making has been described as allowing patients to gain more control over their life situation and feel less helpless. The aim of this systematic review was to describe the involvement of older patients in shared decision-making in community settings. In accordance with the systematic review method, a total of 2468 abstracts were read, after which nine quantitative studies were included. A qualitative thematic analysis was performed and two themes emerged;increased understanding of self-management and a desire to strengthen one’s position in relationship with professionals, both of which were essential for empowering older patients to participate in shared decision-making. Older patients’ shared decision-making was seen as a struggle to maintain their autonomy in different areas of everyday life. Emotional and psychological problems made their position more difficult. In order to empower them in relationships with healthcare professionals, older patients require more knowledge (self-efficacy) and information about their illness, which could strengthen their position in the decision-making process. They also need a greater awareness of decisional conflicts that may arise. Age, gender and health status influence older patients’ chance of being respected and taken seriously in relationship with professionals.
基金supported by the National Key Research,Development Program of China (2020AAA0103404)the Beijing Nova Program (20220484077)the National Natural Science Foundation of China (62073323)。
文摘Due to ever-growing soccer data collection approaches and progressing artificial intelligence(AI) methods, soccer analysis, evaluation, and decision-making have received increasing interest from not only the professional sports analytics realm but also the academic AI research community. AI brings gamechanging approaches for soccer analytics where soccer has been a typical benchmark for AI research. The combination has been an emerging topic. In this paper, soccer match analytics are taken as a complete observation-orientation-decision-action(OODA) loop.In addition, as in AI frameworks such as that for reinforcement learning, interacting with a virtual environment enables an evolving model. Therefore, both soccer analytics in the real world and virtual domains are discussed. With the intersection of the OODA loop and the real-virtual domains, available soccer data, including event and tracking data, and diverse orientation and decisionmaking models for both real-world and virtual soccer matches are comprehensively reviewed. Finally, some promising directions in this interdisciplinary area are pointed out. It is claimed that paradigms for both professional sports analytics and AI research could be combined. Moreover, it is quite promising to bridge the gap between the real and virtual domains for soccer match analysis and decision-making.
文摘The paper discusses the problems of engineering geology in environmental geoscience from several aspects. For natural sciences and social sciences, it deduces essential theory from logistic cycle model, logic mapping and Verhulst model. It had been discovered that these aspects are equal. However, these were the studies of normal effects. We must establish mathematical model to check from contrary course for gray forecasting and decision-making and answer several questions satisfactorily.
文摘I the context of the Corporate Governance Code enactment in Japan, we examine how newly introduced outside directors in Japanese boards obtain information to take part in the decision-making process. We conducted a systematic review of the literature and found 18 peer-reviewed publications in a time span between 2000 and 2016 that described the asymmetry of information between the insider group of board directors （including the CEO） and the outside board members. Our fmdings show that for the course of more than a decade, despite all changes and reforms, the role of board directors, whether insiders or outsiders, is still supplementary. They are treated more as advisors than active part in the decision-making process. We reveal different insider sources of information as forming social ties with the CEO and/or inside board directors and collaboration with Audit ＆ Supervisory Board （Kansayaku）, which can help reduce this asymmetry and improve the decision-making process. We assume that it will be easier for the outsiders to establish contacts and form social ties with the Audit ＆ Supervisory Board members because of their unspoken lower status and thus to obtain more information about the company internal affairs and discussions that take place during the informal meetings, where only insiders （including the CEO） are present.
文摘Evaluating and selecting players to suit football clubs and decision-makers (coaches, managers, technical, and medical staff) is a difficult process from a managerial-financial and sporting perspective. Football is a highly competitive sport where sponsors and fans are attracted by success. The most successful players, based on their characteristics (criteria and sub-criteria), can influence the outcome of a football game at any given time. Consequently, the D-day of selection should employ a more appropriate approach to human resource management. To effectively address this issue, a detailed study and analysis of the available literature are needed to assist practitioners and professionals in making decisions about football player selection and hiring. Peer-reviewed journals were selected for collecting published papers between 2018 and 2023. A total of 66 relevant articles (journal articles, conference articles, book sections, and review articles) were selected for evaluation and analysis. The purpose of the study is to present a systematic literature review (SLR) on how to solve this problem and organize the published research papers that answer our four research questions.
文摘The critical role of patient-reported outcome measures(PROMs)in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific research.PROMs encapsulate a patient's health status directly from their perspective,encompassing various domains such as symptom severity,functional status,and overall quality of life.By integrating PROMs into routine clinical practice and research,healthcare providers can achieve a more nuanced understanding of patient experiences and tailor treatments accordingly.The deployment of PROMs supports dynamic patient-provider interactions,fostering better patient engagement and adherence to tre-atment plans.Moreover,PROMs are pivotal in clinical settings for monitoring disease progression and treatment efficacy,particularly in chronic and mental health conditions.However,challenges in implementing PROMs include data collection and management,integration into existing health systems,and acceptance by patients and providers.Overcoming these barriers necessitates technological advancements,policy development,and continuous education to enhance the acceptability and effectiveness of PROMs.The paper concludes with recommendations for future research and policy-making aimed at optimizing the use and impact of PROMs across healthcare settings.
基金funded by Macao Polytechnic University grant number RP/FCA-08-2023.
文摘The advancement of Artificial Intelligence(AI)has garnered significant attention within the academic research community,reflecting the prevailing zeitgeist.However,there is a paucity of literature that has delved into its connection with the higher order thinking skills of human beings.The purpose of this systematic review is to investigate the relationship between AI utilization and the development of critical thinking(CT)in the field of education.A systematic literature search was performed in two databases,Web of Science and Scopus,with a focus on empirical studies related to AI and CT.The review process followed the PRISMA framework and adopted a bottom-up approach,Ultimately,the integrated review synthesized 21 eligible studies from a total of 649 articles.The systematic review identified three relationships between AI technologies and CT.The results suggest that AI technologies can help to enhance learners’CT skills(n=13).However,excessive or inappropriate utilization of AI may hinder CT development(n=7).Moreover,the cultivation of CT skills has been shown to positively influence the effectiveness of AI utilization(n=4).This article represents the first literature review to delve into the reciprocal relationship between AI implementation and CT development within the education field,striving to illuminate the ways in which learners can enhance their higher-order thinking skills through more effective utilization of AI technologies.
文摘Objective This systematic review aimed to identify the predictors of recovery from dysphagia after stroke in the last ten years,thereby providing an evidence-based basis for nurses to identify high-risk patients and develop individualized rehabilitation plans to improve patient prognosis.Methods Databases including the China National Knowledge Infrastructure(CNKI),China Biology Medicine disc(CBMdisc),China Science and Technology Journal(VIP),WanFang,PubMed,Embase,CINAHL,Web of Science,the Cochrane Library,and Scopus were retrieved to search for literature on the predictors of recovery from dysphagia after stroke.The retrieval period was from January 2013 to December 2023.The quality of studies was assessed using the Newcastle-Ottawa Scale(NOS)and the Prediction model Risk of Bias Assessment Tool(PROBAST).Meta-analysis was performed using Revman5.3 and Stata15.1 software.The review protocol has been registered with PROSPERO(CRD42024605570).Results A total of 1,216 results were obtained,including 599 in English and 617 in Chinese.A total of 34 studies were included,involving 156,309 patients with post-stroke dysphagia,and the rate of dysphagia recovery increased from 13.53%at 1 week to 95%at 6 months after stroke.Meta-analysis results showed that older age[OR=1.06,95%CI(1.04,1.08),P<0.001],lower BMI[OR=1.28,95%CI(1.17,1.40),P<0.001],bilateral stroke[OR=3.10,95%CI(2.04,4.72),P<0.001],higher National Institutes of Health Stroke Scale(NIHSS)score[OR=1.19,95%CI(1.01,1.39),P=0.030],tracheal intubation[OR=5.08,95%CI(1.57,16.39),P=0.007]and aspiration[OR=4.70,95%CI(3.06,7.20),P<0.001]were unfavorable factors for the recovery of swallowing function in patients with post-stroke dysphagia.Conclusions The lack of standardized criteria for rehabilitation assessment of post-stroke dysphagia has resulted in reported recovery rates of swallowing function exhibiting wide variability.Nurses should take targeted preventive measures for patients aged≥70 years,low BMI,bilateral stroke,high NIHSS score,tracheal intubation,and aspiration to promote the recovery of swallowing function in patients with post-stroke dysphagia.
基金Supported by National Key Research and Development Program of China(Grant No.2022YFE0117100)National Science Foundation of China(Grant No.52102468,52325212)Fundamental Research Funds for the Central Universities。
文摘To solve problems of poor security guarantee and insufficient training efficiency in the conventional reinforcement learning methods for decision-making,this study proposes a hybrid framework to combine deep reinforcement learning with rule-based decision-making methods.A risk assessment model for lane-change maneuvers considering uncertain predictions of surrounding vehicles is established as a safety filter to improve learning efficiency while correcting dangerous actions for safety enhancement.On this basis,a Risk-fused DDQN is constructed utilizing the model-based risk assessment and supervision mechanism.The proposed reinforcement learning algorithm sets up a separate experience buffer for dangerous trials and punishes such actions,which is shown to improve the sampling efficiency and training outcomes.Compared with conventional DDQN methods,the proposed algorithm improves the convergence value of cumulated reward by 7.6%and 2.2%in the two constructed scenarios in the simulation study and reduces the number of training episodes by 52.2%and 66.8%respectively.The success rate of lane change is improved by 57.3%while the time headway is increased at least by 16.5%in real vehicle tests,which confirms the higher training efficiency,scenario adaptability,and security of the proposed Risk-fused DDQN.
文摘Objectives:Childhood and adolescent obesity are an increasing global health concern.This study aimed to evaluate the effectiveness of digital components and interaction types in counseling interventions for prevention and treatment.Methods:All studies were searched in online databases and grey literature,including PubMed(Medline),Web of Science,CINAHL,Scopus,IEEE Xplore Digital Library,Journal of Medical Internet Research(JMIR),MedNar,EBSco Open Dissertations.The search period is from inception to June 2023,and the languages are Finnish,English and Swedish.The research quality was evaluated using the web-based data management system Covidence for prevalence studies.The study protocol was registered with PROSPERO(registration number:CRD42021247595).Results:In this review,4,407 studies were screened,and 22 were included.These involved 3,433 participants and 264 child-parent pairs.The digital approaches included multicomponent elements like internet platforms,text messaging,video conferencing,online communities,wearable technology,and mobile apps,allowing one-way,two-way,and face-to-face interactions.Two studies showed statistically significant effects of treatment on BMI and waist-to-hip ratio.Most interventions reported positive outcomes,with no significant differences between groups,and none showed null effects during followup.Conclusions:Digital multicomponents like mobile apps and wearables can help obese children and adolescents adopt healthier lifestyles.While these interventions show promise for obesity management,further research is needed to assess their effectiveness,particularly regarding nurses'perspectives.
文摘Nausea and vomiting are physiological responses that react to various bodily conditions and play a protective function.Medicinal and nonmedicinal methods,including complementary medicine,treat nausea and vomiting.The current research aims to investigate the effectiveness of foot reflexology as a complementary medicine method for nausea and vomiting.Based on PRISMA 2020,PubMed,Web of Science,and Scopus were searched until October 2,2024,using a search strategy approved by two researchers.Only randomized controlled trial studies were included in this research.No limitations or filters were applied.The inclusion criteria were selected based on the PICOS framework,and the studies were evaluated according to the National Institutes of Health quality assessment tool,which is related to controlled intervention,and were evaluated by two researchers.Finally,six studies were included in this review.Eighty-four percent of studies were conducted in Asia.Three records are from Iran,and two are from Turkey,and one is from France.The results showed that nausea and vomiting improved in all studies.In most studies(67%),four sessions or less led to improved outcomes.Rhodes index of nausea,vomiting,and retching and visual analog scale were utilized to assess nausea and vomiting.The current systematic review indicated that foot reflexology as a noninvasive intervention could improve nausea and vomiting in patients with cancer problems,pregnancy,hemodialysis,and laparoscopic cholecystectomy。
文摘BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SAVR).However,the compara-tive safety and efficacy of these interventions remain subjects of ongoing investigation.AIM To compare the clinical outcomes and safety of TAVR vs SAVR in patients with severe symptomatic aortic stenosis.METHODS A systematic review and meta-analysis were conducted according to PRISMA guidelines.Randomized controlled trials(RCTs)comparing TAVR and SAVR were identified from databases including PubMed,Scopus,and Web of Science up to May 31,2024.Data were extracted on clinical outcomes,including mortality,procedural compli-cations,and post-procedure adverse events.Risk ratios(RRs)with 95%CIs were calculated using a random-effects model.RESULTS A total of 10 RCTs were included.TAVR demonstrated a significantly lower risk of acute kidney injury(RR:0.33;95%CI:0.25–0.44),major bleeding(RR:0.37;95%CI:0.30–0.46),and new-onset atrial fibrillation(RR:0.44;95%CI:0.34–0.57)compared to SAVR.However,TAVR was associated with higher risks of new permanent pacemaker implantation(RR:3.49;95%CI:2.77–4.39),major vascular complications(RR:2.47;95%CI:1.91–3.21),and paraval-vular leaks(RR:4.15;95%CI:3.14–5.48).Mortality at 30 days was comparable(RR:0.95;95%CI:0.78–1.15),but long-term mortality was slightly higher with TAVR in some analyses(RR:1.23;95%CI:1.01–1.49).Rates of stroke(RR:0.97;95%CI:0.81–1.17)and myocardial infarction(RR:0.91;95%CI:0.67–1.24)were similar between the groups.CONCLUSION TAVR offers a less invasive option with significant benefits in reducing acute kidney injury,major bleeding,and new-onset atrial fibrillation,making it particularly advantageous for high-risk surgical candidates.However,higher risks of permanent pacemaker implantation,vascular complications,and paravalvular leaks highlight the need for individualized patient selection and shared decision-making to optimize outcomes.
文摘Background:Isotonic crystalloids are recommended as the first choice for fluid therapy in acute pan-creatitis(AP),with normal saline(NS)and lactate Ringer’s(LR)used most often.Evidence based recom-mendations on the type of fluid are conflicting and generally come from small single-center randomized controlled trials(RCTs).We therefore conducted a systematic review and meta-analysis to compare the effect of balanced solutions(BS)versus NS on patient-centered clinical outcomes in AP.Methods:From four databases searched up to October 2024,we included only RCTs of adult patients with AP that compared the use of BS(including LR,acetate Ringer’s,etc.)with NS.The primary out-come was the disease advances from AP to moderately severe and severe AP(MSAP/SAP).Trial sequential analyses(TSA)were conducted to control for type-I and type-II errors and Grading of Recommendations Assessment,Development,and Evaluation(GRADE)was used to assess the quality of evidence.Results:Six RCTs were identified and included,involving 260 patients treated with BS and 298 patients with NS.Patients who received the BS had less MSAP/SAP[odds ratio(OR)=0.50,95%confidence in-terval(CI):0.29 to 0.85,P=0.01,I^(2)=0%;5 studies,299 patients],reduced the need of ICU admission(OR=0.60,95%CI:0.39 to 0.93,P=0.02,I^(2)=0%;5 studies,507 patients)and shorter length of hospital stay[mean difference(MD)=-0.88,95%CI:-1.48 to-0.28,P=0.004,I^(2)=0%;6 studies,558 patients;confirmed by TSA with high certainty]compared with those who received NS.The evidence for most of the clinical outcomes was rated as moderate to low due to the risk of bias,imprecision and inconsistency.Conclusions:BS,compared with NS,was associated with improved clinical outcomes in patients with AP.However,given the moderate to low quality of evidence for most of the outcomes assessed,further trials are warranted.
基金the support provided by the 2D43 TW009883 D43 Post-Doctoral Program at the School of Nursing,University of Michigan,USA。
文摘Objectives This systematic review aimed to identify effective and cost-effective digital health interventions to improve self-management behaviors,blood pressure control,and cardiovascular risk reduction.Methods A search for randomized and non-randomized control trials of digital health interventions among patients with uncontrolled hypertension was conducted from the databases of Embase,PubMed,Scopus,CINAHL,Web of Science,PsycINFO,Thai Journal Online(ThaiJO),the Faculty of Nursing Mahidol University(FON-MU)Nursing Research Database,and gray literature.After conducting the literature screening,the authors completed data extraction,and the risk of bias was assessed using the Joanna Briggs Institute randomized controlled trial checklist and the Joanna Briggs Institute critical appraisal checklist for quasi-experimental studies.Results The study included 22 articles,comprising 30 to 4,118 patients with uncontrolled hypertension.This review classified and summarized the components of digital health interventions and their effects on hypertensive outcomes.It was found that the key elements of digital health interventions include health education,reminders,self-monitoring,feedback and consultation,and instrumental support.Moreover,approximately 81.81%(n=18)of the digital health interventions involved healthcare providers participating in feedback and consultation.Additionally,digital health interventions effectively improve hypertensive outcomes such as self-management behaviors,blood pressure control,and cardiovascular risk reduction,providing cost-effectiveness.Conclusion Based on the available literature,digital health interventions have been shown to effectively enhance behavioral,clinical,and economic outcomes for individuals with uncontrolled hypertension.Moreover,the combination of digital health interventions and healthcare providers’interventions can potentially help patients with uncontrolled hypertension improve adherence to self-management when compared to stand-alone digital health interventions.Digital health interventions to support self-management interventions should be developed for patients by healthcare providers.
基金supported by the Deanship of Graduate Studies and Scientific Research at Qassim University(QU-APC-2024-9/1).
文摘Due to the numerous variables to take into account as well as the inherent ambiguity and uncertainty,evaluating educational institutions can be difficult.The concept of a possibility Pythagorean fuzzy hypersoft set(pPyFHSS)is more flexible in this regard than other theoretical fuzzy set-like models,even though some attempts have been made in the literature to address such uncertainties.This study investigates the elementary notions of pPyFHSS including its set-theoretic operations union,intersection,complement,OR-and AND-operations.Some results related to these operations are also modified for pPyFHSS.Additionally,the similarity measures between pPyFHSSs are formulated with the assistance of numerical examples and results.Lastly,an intelligent decision-assisted mechanism is developed with the proposal of a robust algorithm based on similarity measures for solving multi-attribute decision-making(MADM)problems.A case study that helps the decision-makers assess the best educational institution is discussed to validate the suggested system.The algorithmic results are compared with the most pertinent model to evaluate the adaptability of pPyFHSS,as it generalizes the classical possibility fuzzy set-like theoretical models.Similarly,while considering significant evaluating factors,the flexibility of pPyFHSS is observed through structural comparison.
