OBJECTIVE:To investigate the effects of acupuncture combined with upper limb rehabilitation robot on neural remodeling and functional recovery in post-stroke patients.METHODS:There were 50 stroke patients were randoml...OBJECTIVE:To investigate the effects of acupuncture combined with upper limb rehabilitation robot on neural remodeling and functional recovery in post-stroke patients.METHODS:There were 50 stroke patients were randomly divided into an experimental group(acupuncture combined with upper limb rehabilitation robot assisted training)and a control group(upper limb rehabilitation robot assisted training).Various assessments were conducted to compare the effects of the two treatments on neural remodeling and functional recovery.Functional near-infrared spectroscopy technology was used to assess the effects of different treatments on neural plasticity and their impact on upper limb function and activities of daily living.RESULTS:The experimental group showed significantly higher concentrations of oxygenated hemoglobin and total hemoglobin in specific brain regions compared to the control group(P<0.05).Additionally,the experimental group had significantly lower concentrations of deoxygenated hemoglobin(P<0.05).After treatment,both groups showed improvements in various measures,but the experimental group had significantly greater improvements(P<0.05).CONCLUSION:Acupuncture combined with upper limb rehabilitation robot can effectively improve upper limb function and neural remodeling in stroke patients.This study supports the integration of Traditional Chinese and Western Medicine in improving limb dysfunction poststroke.展开更多
Objective:This article reviews the latest updates and outcomes of kidney-sparing surgery(KSS)in patients with upper tract urothelial carcinoma(UTUC).Methods:A comprehensive literature search was performed using the Pu...Objective:This article reviews the latest updates and outcomes of kidney-sparing surgery(KSS)in patients with upper tract urothelial carcinoma(UTUC).Methods:A comprehensive literature search was performed using the PubMed and Embase databases to identify related English-language studies published within the last 10 years.Key search words included“upper urinary tract tumour/cancer/carcinoma”,“kidney-sparing surgery or approach”,“endoscopic treatment for upper tract tumour/cancer/carcinoma”,“topical instillation in the upper urinary tract”,and“urinary marker for urothelial carcinoma”.References within the identified literature were explored and evaluated for relevance.Results:KSS is recommended for both low-risk and selected high-risk UTUC with imperative indications such as solitary kidney.Studies have shown comparable oncological outcomes after KSS including endoscopic ablation,segmental ureterectomy,and topical instillation of novel agents when compared to radical nephroureterectomy in well-selected cases.The development of novel diagnostic tools and risk-stratifying models allows optimal case selection for KSS without compromising oncological outcomes.Conclusion:Kidney-sparing approach for UTUC is an evolving and promising area in urologic oncology,driven by advances in technology,better diagnostic tools,and novel therapeutic agents.Our article provides a comprehensive review of the latest advancements and clinical recommendations.While current evidence is mainly based on retrospective studies,prospective trials are required to address important but unanswered clinical questions in this field.展开更多
Background China is seeing a growing demand for rehabilitation treatments for post-stroke upper limb spastic paresis(PSSP-UL).Although acupuncture is known to be effective for PSSP-UL,there is room to enhance its effi...Background China is seeing a growing demand for rehabilitation treatments for post-stroke upper limb spastic paresis(PSSP-UL).Although acupuncture is known to be effective for PSSP-UL,there is room to enhance its efficacy.Objective This study explored a semi-personalized acupuncture approach for PSSP-UL that used three-dimensional kinematic analysis(3DKA)results to select additional acupoints,and investigated the feasibility,efficacy and safety of this approach.Design,setting,participants and interventions This single-blind,single-center,randomized,controlled trial involved 74 participants who experienced a first-ever ischemic or hemorrhagic stroke with spastic upper limb paresis.The participants were then randomly assigned to the intervention group or the control group in a 1:1 ratio.Both groups received conventional treatments and acupuncture treatment 5 days a week for 4 weeks.The main acupoints in both groups were the same,while participants in the intervention group received additional acupoints selected on the basis of 3DKA results.Follow-up assessments were conducted for 8 weeks after the treatment.Main outcome measures The primary outcome was the Fugl-Meyer Assessment for Upper Extremity(FMA-UE)response rate(≥6-point change)at week 4.Secondary outcomes included changes in motor function(FMA-UE),Brunnstrom recovery stage(BRS),manual muscle test(MMT),spasticity(Modified Ashworth Scale,MAS),and activities of daily life(Modified Barthel Index,MBI)at week 4 and week 12.Results Sixty-four participants completed the trial and underwent analyses.Compared with control group,the intervention group exhibited a significantly higher FMA-UE response rate at week 4(χ^(2)=5.479,P=0.019)and greater improvements in FMA-UE at both week 4 and week 12(both P<0.001).The intervention group also showed bigger improvements from baseline in the MMT grades for shoulder adduction and elbow flexion at weeks 4 and 12 as well as thumb adduction at week 4(P=0.007,P=0.049,P=0.019,P=0.008,P=0.029,respectively).The intervention group showed a better change in the MBI at both week 4 and week 12(P=0.004 and P=0.010,respectively).Although the intervention group had a higher BRS for the hand at week 12(P=0.041),no intergroup differences were observed at week 4(all P>0.05).The two groups showed no differences in MAS grades as well as in BRS for the arm at weeks 4 and 12(all P>0.05).Conclusion Semi-personalized acupuncture prescription based on 3DKA results significantly improved motor function,muscle strength,and activities of daily living in patients with PSSP-UL.展开更多
Upper gastrointestinal cancers,mainly comprising esophageal and gastric cancers,are among the most prevalent cancers worldwide.There are many new cases of upper gastrointestinal cancers annually,and the survival rate ...Upper gastrointestinal cancers,mainly comprising esophageal and gastric cancers,are among the most prevalent cancers worldwide.There are many new cases of upper gastrointestinal cancers annually,and the survival rate tends to be low.Therefore,timely screening,precise diagnosis,appropriate treatment strategies,and effective prognosis are crucial for patients with upper gastrointestinal cancers.In recent years,an increasing number of studies suggest that artificial intelligence(AI)technology can effectively address clinical tasks related to upper gastrointestinal cancers.These studies mainly focus on four aspects:screening,diagnosis,treatment,and progno-sis.In this review,we focus on the application of AI technology in clinical tasks related to upper gastrointestinal cancers.Firstly,the basic application pipelines of radiomics and deep learning in medical image analysis were introduced.Furthermore,we separately reviewed the application of AI technology in the aforementioned aspects for both esophageal and gastric cancers.Finally,the current limitations and challenges faced in the field of upper gastrointestinal cancers were summarized,and explorations were conducted on the selection of AI algorithms in various scenarios,the popularization of early screening,the clinical applications of AI,and large multimodal models.展开更多
The Tan-Lu Fault Zone is a large NNE-trending fault zone that has a substantial effect on the development of eastern China and its earthquake disaster prevention efforts. Aiming at the azimuthally anisotropic structur...The Tan-Lu Fault Zone is a large NNE-trending fault zone that has a substantial effect on the development of eastern China and its earthquake disaster prevention efforts. Aiming at the azimuthally anisotropic structure in the upper crust and seismogenic tectonics in the Hefei segment of this fault, we collected phase velocity dispersion data of fundamental mode Rayleigh waves from ambient noise cross-correlation functions of ~400 temporal seismographs in an area of approximately 80 × 70 km along the fault zone. The period band of the dispersion data was ~0.5–10 s. We inverted for the upper crustal three-dimensional(3-D) shear velocity model with azimuthal anisotropy from the surface to 10 km depth by using a 3-D direct azimuthal anisotropy inversion method. The inversion result shows the spatial distribution characteristics of the tectonic units in the upper crust. Additionally, the deformation of the Tan-Lu Fault Zone and its conjugated fault systems could be inferred from the anisotropy model. In particular, the faults that have remained active from the early and middle Pleistocene control the anisotropic characteristics of the upper crustal structure in this area. The direction of fast axes near the fault zone area in the upper crust is consistent with the strike of the faults, whereas for the region far away from the fault zone, the direction of fast axes is consistent with the direction of the regional principal stress caused by plate movement. Combined with the azimuthal anisotropy models in the deep crust and uppermost mantle from the surface wave and Pn wave, the different anisotropic patterns caused by the Tan-Lu Fault Zone and its conjugated fault system nearby are shown in the upper and lower crust. Furthermore,by using the double-difference method, we relocated the Lujiang earthquake series, which contained 32 earthquakes with a depth shallower than 10 km. Both the Vs model and earthquake relocation results indicate that earthquakes mostly occurred in the vicinity of structural boundaries with fractured media, with high-level development of cracks and small-scale faults jammed between more rigid areas.展开更多
Amyotrophic lateral sclerosis is a rare neurodegenerative disease characterized by the involvement of both upper and lower motor neurons.Early bilateral limb involvement significantly affects patients'daily lives ...Amyotrophic lateral sclerosis is a rare neurodegenerative disease characterized by the involvement of both upper and lower motor neurons.Early bilateral limb involvement significantly affects patients'daily lives and may lead them to be confined to bed.However,the effect of upper and lower motor neuron impairment and other risk factors on bilateral limb involvement is unclear.To address this issue,we retrospectively collected data from 586 amyotrophic lateral sclerosis patients with limb onset diagnosed at Peking University Third Hospital between January 2020 and May 2022.A univariate analysis revealed no significant differences in the time intervals of spread in different directions between individuals with upper motor neuron-dominant amyotrophic lateral sclerosis and those with classic amyotrophic lateral sclerosis.We used causal directed acyclic graphs for risk factor determination and Cox proportional hazards models to investigate the association between the duration of bilateral limb involvement and clinical baseline characteristics in amyotrophic lateral sclerosis patients.Multiple factor analyses revealed that higher upper motor neuron scores(hazard ratio[HR]=1.05,95%confidence interval[CI]=1.01–1.09,P=0.018),onset in the left limb(HR=0.72,95%CI=0.58–0.89,P=0.002),and a horizontal pattern of progression(HR=0.46,95%CI=0.37–0.58,P<0.001)were risk factors for a shorter interval until bilateral limb involvement.The results demonstrated that a greater degree of upper motor neuron involvement might cause contralateral limb involvement to progress more quickly in limb-onset amyotrophic lateral sclerosis patients.These findings may improve the management of amyotrophic lateral sclerosis patients with limb onset and the prediction of patient prognosis.展开更多
The Upper Cretaceous of Tantou Basin in western Henan has yielded many vertebrate fossils,which are featured by several non-avian dinosaurs.Meanwhile,studies on their eggs were yet inadequate though many eggshells hav...The Upper Cretaceous of Tantou Basin in western Henan has yielded many vertebrate fossils,which are featured by several non-avian dinosaurs.Meanwhile,studies on their eggs were yet inadequate though many eggshells have been reported.The newly discovered material 41HⅤ0199 was excavated from the Upper Cretaceous Qiupa Formation in 2021.The block preserves eight complete eggs arranged in two partial rings that form a partial clutch,and there are some scattered eggshells preserved closely with the block,showing a concave-up to concave-down ratio of 54.5:45.5,which indicates that the scattered eggshells come from the clutch and the clutch had been partially broken before it was buried.Based on morphological and microstructural characteristics,the eggs and eggshells can be assigned to Macroolithus yaotunensis(Elongatoolithidae),an oospecies known to be related to oviraptorids,which leads Yulong mini to be its probable producer.Besides,some eggshells show microstructural signs indicating egg retention,which marks the second example of egg retention in the oofamily Elongatoolithidae.展开更多
[Objective]Implementation of the Ten-Year Fishing Ban policy may alter fish diversity and niche characteristics of dominant species in spawning grounds within the National Nature Reserve for Rare and Endemic Fish in t...[Objective]Implementation of the Ten-Year Fishing Ban policy may alter fish diversity and niche characteristics of dominant species in spawning grounds within the National Nature Reserve for Rare and Endemic Fish in the Upper Yangtze River.This study initiated continuous monitoring of natural spawning habitats from February 2022 to assess these ecological changes.[Methods]Environmental DNA(eDNA)metabarcoding was employed to analyze fish species composition,biodiversity patterns,and niche parameters of dominant species.Water sampling followed the CEN/TS 19461 standard across five monitoring transects(ZT1-ZT5).[Results]The eDNA analysis detected 45 species of fish belonging to 38 genera,13 families,and 3 orders were detected through environmental DNA(eDNA)in this survey,including 10 species endemic to the upper reaches of the Yangtze River,such as Procypris rabaudi and Myxocyprinus asiaticus.The fish community was mainly composed of bottom-dwelling,settling ovum-producing,omnivorous fish.The variation ranges of the Chao1 index,ACE index,Shannon index,and Simpson index are 736~996,719~965,1.58~3.23,and 0.83~0.99,respectively,indicating that fish species in spawning sites are abundant and community distribution uniformity is high.All indexes are highest at ZT1 monitoring points.Cluster analysis showed that,at a certain similarity level,fish community types in spawning sites could be basically divided into two groups:ZT1,ZT3,and ZT5 clustered together,and ZT2 and ZT4 clustered together,indicating similar fish community habitats.There are 9 dominant fish species in typical deep pool habitats in the reserve,with niche widths(Bi)ranging from 1.13 to 3.87.The dominant fish species are broad and medium niche fish,such as Cyprinus carpio and Hemiculter tchangi,with the niche overlap index(Oik)of some dominant fish species reaching more than 0.95.This indicates fierce competition for resources among the fish in this spawning ground.[Conclusion]The Zhutuo spawning ground demonstrates high species richness with homogeneous community structure and intense resource competition.This study establishes an eDNA-based monitoring framework that enhances conventional survey method,providing critical baseline data for adaptive management under the fishing moratorium regime.展开更多
Upper gastrointestinal bleeding (UGIB) refers to the bleeding caused by the digestive tract above the flexor ligament, including esophageal, gastric, duodenal, pancreatic and biliary diseases, and lesions after gastro...Upper gastrointestinal bleeding (UGIB) refers to the bleeding caused by the digestive tract above the flexor ligament, including esophageal, gastric, duodenal, pancreatic and biliary diseases, and lesions after gastrojejunostomy. UGIB is one of the common diseases in the clinical work of gastroenterology. There are many causes that can lead to upper gastrointestinal bleeding, which are mainly divided into two categories: one is non-variceal upper gastrointestinal bleeding (NVUGIB), and the other is variceal upper gastrointestinal bleeding (VUGIB). This article reviews various causes of UGIB and the latest progress in treatment, aiming to improve the efficiency of diagnosis and treatment in future clinical work, and reduce the risk of rebleeding and mortality.展开更多
The Upper Cretaceous successions of Wadi Umm-Khayshar,southern Galala Plateau,North Eastern Desert,Egypt,are composed of highly diversified faunas and subdivided from base to top into the Galala(Middle-Late Cenomanian...The Upper Cretaceous successions of Wadi Umm-Khayshar,southern Galala Plateau,North Eastern Desert,Egypt,are composed of highly diversified faunas and subdivided from base to top into the Galala(Middle-Late Cenomanian),Maghra El Hadida(Latest Cenomanian-Late Turonian),Matulla(Coniacian-Santonian),and Sudr(Campanian-Maastrichtian)formations.Five ammonite biozones are recorded in the studied section:Neolobites vibrayeanus,Vascoceras cauvini(late Cenomanian),Vascoceras proprium,Choffaticeras segne,and Coilopoceras requienianum(Turonian)zones.The paleoenvironments of the Upper Cretaceous succession are interpreted based on detailed study and microfacies analysis that reflect a deposition in a homoclinal ramp platform ranging from intertidal to deep subtidal.The paleoecology of the Cenomanian-Turonian succession in the studied section is explained based on a detailed study of macrofaunal associations and sedimentary facies.Quantitative analysis(Q-mode cluster analysis,using the Raup-Crick Paired group method)of 1029 macrobenthic specimens,including 45 species of mollusks and echinoids yielded five macrofaunal associations(A-E)that are described and interpreted as remnants of communities.The nektonic elements are represented by 235 cephalopod specimens of 20 species;heatmap cluster analyses show the distribution of these specimens during the Upper Cenomanian-Turonian stages.Environmental parameters(substrate consistency,rate of sedimentation,water energy,surface-water productivity,and oxygen availability)controlled the distribution of the studied macrofauna.The five associations are divided into two major groups:low-stress associations(A,B,C,and D),and a highstress association(E).The low stress associations are recorded from two different habitats:(1)a high-energy,firm substrate habitat,dominated by epifaunal bivalves,large epifaunal gastropods and a regular echinoid;(2)a low-energy,soft substrate habitat dominated by infaunal bivalves and echinoids.The high stress association is dominated by only two species and recorded from a high-energy shoal environment during a regression phase.A detailed study of macrobenthos and cephalopods provides a good paleoecological understanding of Cenomanian-Turonian succession in the Wadi Umm-Khayshar section.展开更多
Objective:To explore the rehabilitation effect of upper limb rehabilitation robots combined with isokinetic muscle strength training on hemiplegic patients in the recovery phase of stroke,and to provide a more effecti...Objective:To explore the rehabilitation effect of upper limb rehabilitation robots combined with isokinetic muscle strength training on hemiplegic patients in the recovery phase of stroke,and to provide a more effective intervention plan for clinical rehabilitation treatment.Methods:One hundred and sixty type 2 stroke patients with hemiplegia in recovery phase treated at Jintan First People’s Hospital from May 2020 to May 2025 were selected as the research subjects.They were divided into a control group(n=80)and an observation group(n=80)using a random number table method.The control group received isokinetic muscle strength training,while the observation group received additional upper limb rehabilitation robot-assisted intervention based on the control group’s treatment.The general information(age,gender,course of disease),Brunnstrum staging,Barthel index,FMA score,and facial expression pain score were compared between the two groups.Results:After treatment,the indicators of both groups improved compared to before treatment.The observation group showed significant advantages in improving various indicators.In terms of Brunnstrum staging,the number of patients in stage IV and above was significantly higher than that in the control group;in terms of the Barthel index,the increase was more significant than that of the control group(P=0.000<0.001).In terms of the FMA score,the increase was more pronounced(P=0.000<0.001);and in terms of facial expression pain assessment,the decrease was more evident(P=0.000<0.01).Conclusion:The combination of upper limb rehabilitation robots and isokinetic muscle strength training can significantly improve the recovery of limb function and activities of daily living in hemiplegic patients during the recovery phase of stroke,and reduce pain.Compared with simple isokinetic muscle strength training,the rehabilitation effect is better,and it is worthy of clinical application.展开更多
Blepharoplasty is a frequently performed aesthetic surgery today aimed at enhancing eyelid appearance and correcting age-related changes.The traditional method of subtraction blepharoplasty,which involved removing fat...Blepharoplasty is a frequently performed aesthetic surgery today aimed at enhancing eyelid appearance and correcting age-related changes.The traditional method of subtraction blepharoplasty,which involved removing fat and excess skin,is now considered outdated.This letter explores Gorgy et al's commentary on Miotti et al's study,highlighting a shift in upper eyelid blepharoplasty towards a more conservative,volume-preserving approach.The study systematically reviewed 10 publications,including three retrospective studies,five comparative studies,and two clinical trials.It emphasizes the trend towards preserving the patient's natural anatomy and focusing on enhancement rather than alteration.However,the study's limitations,such as the lack of long-term comparative re-search,a relatively small sample size,and a single-center design,indicate that further research with extended follow-up is necessary to validate the safety and effectiveness of these techniques.The focus is increasingly on preserving and augmenting volume in upper blepharoplasty rather than removing tissue.展开更多
BACKGROUND Upper gastrointestinal(UGI)diseases present diagnostic challenges during endoscopy due to visual similarities,indistinct boundaries,and observer variability,which can lead to missed diagnoses and delayed tr...BACKGROUND Upper gastrointestinal(UGI)diseases present diagnostic challenges during endoscopy due to visual similarities,indistinct boundaries,and observer variability,which can lead to missed diagnoses and delayed treatment.Automated segmentation using deep learning(DL)models offers the potential to assist endoscopists,improve diagnostic accuracy,and reduce workload.However,multi-class UGI disease segmentation remains underexplored,with limited annotated datasets and insufficient focus on clinical validation.This study hypothesizes that comparative analysis of different DL architectures can identify models suitable for clinical application,providing actionable insights to reduce diagnostic errors and support clinical decision-making in endoscopic practice.AIM To evaluate 17 state-of-the-art DL models for multi-class UGI disease segmentation,emphasizing clinical translation and real-world applicability.METHODS This study evaluated 17 DL models spanning convolutional neural network(CNN)-,transformer-,and mambabased architectures using a self-collected dataset from two hospitals in Macao and Xiangyang(3313 images,9 classes)and the public EDD2020 dataset(386 images,5 classes).Models were assessed for segmentation performance and performance-efficiency trade-off.Statistical analyses were conducted to examine performance differences across architectures.Generalization capability was measured through a cross-dataset evaluation(training models on the self-collected dataset and testing on the EDD2020 dataset).RESULTS Swin-UMamba achieved the highest segmentation performance across both datasets[intersection over union(IoU):89.06%±0.20%self-collected,77.53%±0.32%EDD2020],followed by SegFormer(IoU:88.94%±0.38%selfcollected,77.20%±0.98%EDD2020)and ConvNeXt+UPerNet(IoU:88.48%±0.09%self-collected,76.90%±0.61%EDD2020).Statistical analyses showed no significant differences between paradigms,though hierarchical architectures with pre-trained encoders consistently outperformed simpler designs.SegFormer achieved the best balance of accuracy and computational efficiency with a performance-efficiency trade-off score of 92.02%,making it suitable for real-time clinical use.Cross-dataset evaluation revealed significant performance drops,with generalization retention rates of 64.78%to 71.52%.Transformer-based models,particularly pyramid vision transformer v2+efficient multi-scale convolutional decoding(IoU:63.35%±1.44%),generalized better than CNN-and mambabased models.CONCLUSION Hierarchical architectures like Swin-UMamba and SegFormer show promise for UGI disease segmentation,reducing missed diagnoses and improving workflows,but robust clinical validation is crucial for real-world deployment.展开更多
The tiered geosynthetic-reinforced soil (GRS) walls have been increasingly applied in the high and steep retaining soil structures. However, very little is known about the design method for the tiered GRS wall in prac...The tiered geosynthetic-reinforced soil (GRS) walls have been increasingly applied in the high and steep retaining soil structures. However, very little is known about the design method for the tiered GRS wall in practice. This study is aimed at proposing an upper-bound stability analysis method of a tiered GRS wall. The proposed method was firstly validated by the existing results from the centrifuge test and the numerical method, and then a parametric study was performed to investigate the effects of the cohesionless backfill friction angle φ1 and the wall geometric parameters including the offset distance, the total wall height, the batter angle δ, the number of tiers n, and wall height ratio of adjacent tiers on the dimensionless equivalent earth pressure coefficient KT. The analysis results demonstrated that as the φ1 increases, the shear strength of backfill is enhanced and thus the KT or the total reinforcement tensile force decreases, and the KT decreases with the increase of the offset distance at the initial stage and then becomes stable when it reaches a certain critical value. For a fixed offset distance, the KT or the total reinforcement tensile force decreases with the increase of the δ. For the two-tiered GRS walls having the offset distance less than the critical value, the wall with the smaller wall height ratio has a larger KT. Further, the variation of the location of the critical failure surfaces of tiered GRS walls was presented in this study with the variation of the φ1 and the wall geometry.展开更多
Based on the test and experimental data from exploration well cores of the Upper Paleozoic in the central-eastern Ordos Basin,combined with structural,burial depth and fluid geochemistry analyses,this study reveals th...Based on the test and experimental data from exploration well cores of the Upper Paleozoic in the central-eastern Ordos Basin,combined with structural,burial depth and fluid geochemistry analyses,this study reveals the fluid characteristics,gas accumulation control factors and accumulation modes in the Upper Paleozoic coal reservoirs.The study indicates findings in two aspects.First,the 1500-1800 m interval represents the critical transition zone between open fluid system in shallow-medium depths and closed fluid system in deep depths.The reservoirs above 1500 m reflect intense water invasion,with discrete pressure gradient distribution,and the presence of methane mixed with varying degrees of secondary biogenic gas,and they generally exhibit high water saturation and adsorbed gas undersaturation.The reservoirs deeper than 1800 m,with extremely low permeability,are self-sealed,and contains closed fluid systems formed jointly by the hydrodynamic lateral blocking and tight caprock confinement.Within these systems,surface runoff infiltration is weak,the degree of secondary fluid transformation is minimal,and the pressure gradient is relatively uniform.The adsorbed gas saturation exceeds 100%in most seams,and the free gas content primarily ranges from 1 m^(3)/t to 8 m^(3)/t(greater than 10 m^(3)/t in some seams).Second,the gas accumulation in deep coals is primarily controlled by coal quality,reservoir-caprock assemblage,and structural position governed storage,wettability and sealing properties,under the constraints of the underground temperature and pressure conditions.High-rank,low-ash yield coals with limestone and mudstone caprocks show superior gas accumulation potential.Positive structural highs and wide and gentle negative structural lows are favorable sites for gas enrichment,while slope belts of fold limbs exhibit relatively lower gas content.This research enhances understanding of gas accumulation mechanisms in coal reservoirs and provides effective parameter reference for precise zone evaluation and innovation of adaptive stimulation technologies for deep resources.展开更多
BACKGROUND Duodenal web is a rare congenital malformation,exceedingly uncommon in adults,and often misdiagnosed due to the subtle imaging features.CASE SUMMARY By analyzing the clinical diagnosis process and various i...BACKGROUND Duodenal web is a rare congenital malformation,exceedingly uncommon in adults,and often misdiagnosed due to the subtle imaging features.CASE SUMMARY By analyzing the clinical diagnosis process and various imaging findings of a patient from our institution,this case report emphasizes the necessity of upper gastrointestinal series in diagnosing duodenal webs,outlines its typical radiographic features,and provides a literature review on the etiology,clinical presentation,and management of this condition.CONCLUSION This case report emphasizes the necessity of upper gastrointestinal series in diagnosing duodenal webs.展开更多
ObjectiveTo review the current literature on ketamine-associated upper urinary tract (UUT) dysfunction and provide an overview of its pathogenesis and treatment principles.MethodsA literature search was conducted usin...ObjectiveTo review the current literature on ketamine-associated upper urinary tract (UUT) dysfunction and provide an overview of its pathogenesis and treatment principles.MethodsA literature search was conducted using PubMed and Cochrane databases for relevant articles published in English between 2008 and 2023. Keywords used included “ketamine” and “upper urinary tract”.ResultsA total of 22 papers were included. Relatively few studies have focused on ketamine-associated UUT dysfunction. Exclusion criteria included lack of hydronephrosis, or pathological findings. After careful screening and exclusion, we finally adopted 11 of these papers and analyzed them. Ketamine-associated UUT dysfunction may be a concern in this field.ConclusionKetamine abuse can lead to UUT impairment and dysfunction, with symptoms such as bladder dysfunction and contracted bladder with vesicoureteral reflux, direct damage and barrier dysfunction, inflammation, apoptosis, fibrosis and stricture, and papillary necrosis. Oxidative stress, autophagy, and microvascular injury are also potential pathogenic mechanisms. The detection of these symptoms largely depends on laboratory and imaging examinations. The treatment principles of ketamine-associated UUT dysfunction are protecting the UUT, improving bladder dysfunction, and resuming normal social life. More investigations are needed to clarify the mechanisms and shed light on the treatment of ketamine-associated UUT damage.展开更多
BACKGROUND Non variceal upper gastrointestinal bleeding(NVUGIB)is a life-threatening condition requiring prompt and effective hemostasis.Various endoscopic inter-ventions,including novel hemostatic powders(HP),over-th...BACKGROUND Non variceal upper gastrointestinal bleeding(NVUGIB)is a life-threatening condition requiring prompt and effective hemostasis.Various endoscopic inter-ventions,including novel hemostatic powders(HP),over-the-scope clips(OTSC),and traditional approaches,have been employed to manage upper gastroin-testinal bleeding(UGIB).Despite advancements,comparative efficacy and safety of these modalities remain uncertain.AIM To evaluate the efficacy and safety of novel hemostatic interventions compared to conventional endoscopic techniques for managing UGIB.METHODS Cochrane,MEDLINE,PubMed and Scopus libraries were searched for rando-mized controlled trials(RCTs)published up to October 2024.Only RCTs compa-ring novel interventions,such as HP or OTSC,with conventional endoscopic treatments computed tomography(CT)were included.The primary outcome was the 30-day rebleeding rate.Secondary outcomes included initial hemostasis,short-term rebleeding rates,need for salvage therapy(surgical/angiographic),30-day all-cause mortality,and bleeding-related mortality.We performed pairwise and network meta-analyses for all treatments.RESULTS Seventeen studies were included in this analysis.Regarding the 30-day rebleeding rate,OTSC and HP showed superior efficacy compared with CT[OTSC vs CT:Relative risk(RR):0.47,95%confidence interval(CI):0.33-0.65;HP vs CT:RR:0.73,95%CI:0.45-1.13],while OTSC and HP had comparable efficacy(RR:0.56,95%CI:0.30-1.05).OTSC ranked the highest in the network ranking estimate for this outcome.For the secondary outcomes,OTSC demonstrated superior efficacy for the short-term rebleeding rate(OTSC vs CT:RR:0.35,95%CI:0.14-0.74;HP vs CT:RR:0.62,95%CI:0.28-1.35;OTSC vs HP:RR:0.59,95%CI:0.17-1.67).Regarding the initial hemostasis rate,OTSC was slightly more effective than CT(OTSC vs CT:RR:1.20,95%CI:1.06-1.57)and comparable to HP(OTSC vs HP:RR:1.08,95%CI:0.89-1.40).There were no significant differences among treatments for all-cause mortality,bleeding-related mortality,or the necessity of surgical or angiographic salvage therapy.OTSC consistently ranked highest across most outcomes in the network ranking estimate.展开更多
The recent discovery of natural gas within the fifth member of the Xujiahe Formation(T_(3)x_(5))in the Dongfeng area within the Sichuan Basin highlights the significant exploration potential of this member.However,the...The recent discovery of natural gas within the fifth member of the Xujiahe Formation(T_(3)x_(5))in the Dongfeng area within the Sichuan Basin highlights the significant exploration potential of this member.However,the unconvincing previous understanding of the sedimentary microfacies,combined with a total lack of studies on the sand body architecture and reservoir distribution,hampers the further exploration of this member.Using core data,log curves,and seismic data,along with sedimentary microfacies analysis,this study investigated the interfaces between the sand bodies of various scales in the Dongfeng area.Furthermore,this study explored the morphological characteristics,types,and stacking patterns of these sand bodies and determined the distributions of sand bodies and reservoirs in the area.The results indicate that the first sand group of the T_(3)x_(5) member(T_(3)x^(1)_(5))exhibits delta-front deposits,including subaqueous distributary channels,sheet sands,and interdistributary bays.Seven levels of sand body interfaces are identified in the T_(3)x^(1)_(5) sand group.Among them,the interfaces of the first and second levels were identified only in cores,those of the third and fourth levels were recog-nizable from cores combined with log curves,while those of the fifth,sixth,and seventh levels were distinguishable using seismic data.Three superimposed subaqueous distributary channel complexes are found in the Dongfeng area.Among them,complex 1 in the northwest exhibits the strongest water body energy,while complex 2 in the south displays the weakest.Complex 2 was formed earlier than com-plexes 1 and 3.Also,complex 1 is further subdivided into three vertically stacked subaqueous distrib-utary channels.The subdivision of sedimentary microfacies in the T_(3)x_(5) member reveals nine lithofacies types.Among them,stacked pancake-shaped,carbonaceous debris-bearing,massive,and cross-bedded medium-grained sandstones are considered favorable lithofacies.These four lithofacies types exhibit high porosity,as well as low natural gamma-ray(GR)values,low-to-medium deep investigate double lateral resistivity(RD),and high interval transit time(AC)on the log curves.Additionally,the reservoir distribution in the Dongfeng area was delineated based on the characterization of the favorable lith-ofacies.This study serves as a guide for future exploration and evaluation of the T_(3)x_(5) member in the Dongfeng area while also augmenting the methodologies for describing tight sandstone reservoirs.展开更多
BACKGROUND Gastric cancer(GC)poses a significant threat to public health.However,the clinicopathological features and tumor biological behaviors vary among the GC patients,leading to individual variations in lymph nod...BACKGROUND Gastric cancer(GC)poses a significant threat to public health.However,the clinicopathological features and tumor biological behaviors vary among the GC patients,leading to individual variations in lymph node metastasis.Consequently,the stratification of lymph node dissection according to the specific type,particularly upper GC,has emerged as a prominent area of research.AIM To investigate the distribution of metastatic lymph nodes in patients with upper and lower GC and to analyze the differences in related pathological elements and prognosis.METHODS Differential analysis between upper and lower GC patients with various clinicopathological factors was performed using the chi-square test and rank-sum regression models were used to analyze risk factors affecting patient prognosis.The Kaplan-Meier method was used to construct survival curves associated with prognostic risk factors for GC.RESULTS Significant differences were observed between the two GC populations regarding tumor diameter,histological grade,pT stage,pN stage,tumor-node-metastasis(pTNM)stage,vascular invasion,and adjuvant chemotherapy usage(all P<0.05).Lymph node metastasis rates were highest for Siewert type II patients in groups Nos.1,3,2 and 7;for Siewert type III patients in groups Nos.3,1,2 and 7;and for other/unclassified patients in groups Nos.1,3,7,2.In the lower GC samples,the sequences were Nos.3,6,7,4.Pathological type,pT stage,pTNM stage,and positive vascular invasion were independent risk factors for development of lymph node metastasis.Age,pathological type,pT stage,pN stage,pTNM stage,vascular invasion,and absence of adjuvant chemotherapy were identified as independent prognostic factors.CONCLUSION Upper GC showed a significantly higher malignancy grade and different lymph node metastasis pattern than lower GC.展开更多
基金Supported by Zhejiang Province Traditional Chinese Medicine Science and Technology Project(2024ZL769):Effect of Xingshen Kaiqiao Acupuncture Method combined with Upper Limb Robot-assisted Training on Upper Limb Function and Neuroplasticity Mechanism of Hemiplegia after Stroke based on Functional Near-Infrared Spectroscopy Technology。
文摘OBJECTIVE:To investigate the effects of acupuncture combined with upper limb rehabilitation robot on neural remodeling and functional recovery in post-stroke patients.METHODS:There were 50 stroke patients were randomly divided into an experimental group(acupuncture combined with upper limb rehabilitation robot assisted training)and a control group(upper limb rehabilitation robot assisted training).Various assessments were conducted to compare the effects of the two treatments on neural remodeling and functional recovery.Functional near-infrared spectroscopy technology was used to assess the effects of different treatments on neural plasticity and their impact on upper limb function and activities of daily living.RESULTS:The experimental group showed significantly higher concentrations of oxygenated hemoglobin and total hemoglobin in specific brain regions compared to the control group(P<0.05).Additionally,the experimental group had significantly lower concentrations of deoxygenated hemoglobin(P<0.05).After treatment,both groups showed improvements in various measures,but the experimental group had significantly greater improvements(P<0.05).CONCLUSION:Acupuncture combined with upper limb rehabilitation robot can effectively improve upper limb function and neural remodeling in stroke patients.This study supports the integration of Traditional Chinese and Western Medicine in improving limb dysfunction poststroke.
文摘Objective:This article reviews the latest updates and outcomes of kidney-sparing surgery(KSS)in patients with upper tract urothelial carcinoma(UTUC).Methods:A comprehensive literature search was performed using the PubMed and Embase databases to identify related English-language studies published within the last 10 years.Key search words included“upper urinary tract tumour/cancer/carcinoma”,“kidney-sparing surgery or approach”,“endoscopic treatment for upper tract tumour/cancer/carcinoma”,“topical instillation in the upper urinary tract”,and“urinary marker for urothelial carcinoma”.References within the identified literature were explored and evaluated for relevance.Results:KSS is recommended for both low-risk and selected high-risk UTUC with imperative indications such as solitary kidney.Studies have shown comparable oncological outcomes after KSS including endoscopic ablation,segmental ureterectomy,and topical instillation of novel agents when compared to radical nephroureterectomy in well-selected cases.The development of novel diagnostic tools and risk-stratifying models allows optimal case selection for KSS without compromising oncological outcomes.Conclusion:Kidney-sparing approach for UTUC is an evolving and promising area in urologic oncology,driven by advances in technology,better diagnostic tools,and novel therapeutic agents.Our article provides a comprehensive review of the latest advancements and clinical recommendations.While current evidence is mainly based on retrospective studies,prospective trials are required to address important but unanswered clinical questions in this field.
基金funded by Science Foundation for Youth supported by Shanghai Municipal Health Commission(No.20204Y0313)Sailing Program with the support of Science and Technology Commission of Shanghai Municipality(No.21YF1443800).
文摘Background China is seeing a growing demand for rehabilitation treatments for post-stroke upper limb spastic paresis(PSSP-UL).Although acupuncture is known to be effective for PSSP-UL,there is room to enhance its efficacy.Objective This study explored a semi-personalized acupuncture approach for PSSP-UL that used three-dimensional kinematic analysis(3DKA)results to select additional acupoints,and investigated the feasibility,efficacy and safety of this approach.Design,setting,participants and interventions This single-blind,single-center,randomized,controlled trial involved 74 participants who experienced a first-ever ischemic or hemorrhagic stroke with spastic upper limb paresis.The participants were then randomly assigned to the intervention group or the control group in a 1:1 ratio.Both groups received conventional treatments and acupuncture treatment 5 days a week for 4 weeks.The main acupoints in both groups were the same,while participants in the intervention group received additional acupoints selected on the basis of 3DKA results.Follow-up assessments were conducted for 8 weeks after the treatment.Main outcome measures The primary outcome was the Fugl-Meyer Assessment for Upper Extremity(FMA-UE)response rate(≥6-point change)at week 4.Secondary outcomes included changes in motor function(FMA-UE),Brunnstrom recovery stage(BRS),manual muscle test(MMT),spasticity(Modified Ashworth Scale,MAS),and activities of daily life(Modified Barthel Index,MBI)at week 4 and week 12.Results Sixty-four participants completed the trial and underwent analyses.Compared with control group,the intervention group exhibited a significantly higher FMA-UE response rate at week 4(χ^(2)=5.479,P=0.019)and greater improvements in FMA-UE at both week 4 and week 12(both P<0.001).The intervention group also showed bigger improvements from baseline in the MMT grades for shoulder adduction and elbow flexion at weeks 4 and 12 as well as thumb adduction at week 4(P=0.007,P=0.049,P=0.019,P=0.008,P=0.029,respectively).The intervention group showed a better change in the MBI at both week 4 and week 12(P=0.004 and P=0.010,respectively).Although the intervention group had a higher BRS for the hand at week 12(P=0.041),no intergroup differences were observed at week 4(all P>0.05).The two groups showed no differences in MAS grades as well as in BRS for the arm at weeks 4 and 12(all P>0.05).Conclusion Semi-personalized acupuncture prescription based on 3DKA results significantly improved motor function,muscle strength,and activities of daily living in patients with PSSP-UL.
基金supported by the National Key R&D Program of China(grant number:2023YFC2415200)National Natural Science Foundation of China(grant numbers:82361168664,U24A20759,82441018,82372053,92259302,62027901,82302296)+6 种基金Science and Technology Development Fund of Macao Special Administrative Region(grant number:0006/2023/AFJ)Strategic Priority Research Program of the Chinese Academy of Sciences(grant number:XDB38040200)Beijing Natural Science Foundation(grant numbers:Z20J00105,JQ24048)Scientific and Technological Innovation Project of China Academy of Chinese Medical Sciences(grant number:CI2023C008YG)Key-Area Re-search and Development Program of Guangdong Province(grant number:2021B0101420005)the Youth Innovation Promotion Association CAS(grant number:Y2021049)China Postdoctoral Science Foun-dation under Grant(grant number:2022M720357)。
文摘Upper gastrointestinal cancers,mainly comprising esophageal and gastric cancers,are among the most prevalent cancers worldwide.There are many new cases of upper gastrointestinal cancers annually,and the survival rate tends to be low.Therefore,timely screening,precise diagnosis,appropriate treatment strategies,and effective prognosis are crucial for patients with upper gastrointestinal cancers.In recent years,an increasing number of studies suggest that artificial intelligence(AI)technology can effectively address clinical tasks related to upper gastrointestinal cancers.These studies mainly focus on four aspects:screening,diagnosis,treatment,and progno-sis.In this review,we focus on the application of AI technology in clinical tasks related to upper gastrointestinal cancers.Firstly,the basic application pipelines of radiomics and deep learning in medical image analysis were introduced.Furthermore,we separately reviewed the application of AI technology in the aforementioned aspects for both esophageal and gastric cancers.Finally,the current limitations and challenges faced in the field of upper gastrointestinal cancers were summarized,and explorations were conducted on the selection of AI algorithms in various scenarios,the popularization of early screening,the clinical applications of AI,and large multimodal models.
基金financially supported by the National Key Research and Development Program of China (2022YFC3005600)the Foundation of the Anhui Educational Commission (2023AH051198)+1 种基金the National Natural Science Foundation of China (42125401 and 42104063)the Joint Open Fund of Mengcheng National Geophysical Observatory (MENGO-202201)。
文摘The Tan-Lu Fault Zone is a large NNE-trending fault zone that has a substantial effect on the development of eastern China and its earthquake disaster prevention efforts. Aiming at the azimuthally anisotropic structure in the upper crust and seismogenic tectonics in the Hefei segment of this fault, we collected phase velocity dispersion data of fundamental mode Rayleigh waves from ambient noise cross-correlation functions of ~400 temporal seismographs in an area of approximately 80 × 70 km along the fault zone. The period band of the dispersion data was ~0.5–10 s. We inverted for the upper crustal three-dimensional(3-D) shear velocity model with azimuthal anisotropy from the surface to 10 km depth by using a 3-D direct azimuthal anisotropy inversion method. The inversion result shows the spatial distribution characteristics of the tectonic units in the upper crust. Additionally, the deformation of the Tan-Lu Fault Zone and its conjugated fault systems could be inferred from the anisotropy model. In particular, the faults that have remained active from the early and middle Pleistocene control the anisotropic characteristics of the upper crustal structure in this area. The direction of fast axes near the fault zone area in the upper crust is consistent with the strike of the faults, whereas for the region far away from the fault zone, the direction of fast axes is consistent with the direction of the regional principal stress caused by plate movement. Combined with the azimuthal anisotropy models in the deep crust and uppermost mantle from the surface wave and Pn wave, the different anisotropic patterns caused by the Tan-Lu Fault Zone and its conjugated fault system nearby are shown in the upper and lower crust. Furthermore,by using the double-difference method, we relocated the Lujiang earthquake series, which contained 32 earthquakes with a depth shallower than 10 km. Both the Vs model and earthquake relocation results indicate that earthquakes mostly occurred in the vicinity of structural boundaries with fractured media, with high-level development of cracks and small-scale faults jammed between more rigid areas.
基金supported by the National Natural Science Foundation of China,Nos.82071426,81873784Clinical Cohort Construction Program of Peking University Third Hospital,No.BYSYDL2019002(all to DF)。
文摘Amyotrophic lateral sclerosis is a rare neurodegenerative disease characterized by the involvement of both upper and lower motor neurons.Early bilateral limb involvement significantly affects patients'daily lives and may lead them to be confined to bed.However,the effect of upper and lower motor neuron impairment and other risk factors on bilateral limb involvement is unclear.To address this issue,we retrospectively collected data from 586 amyotrophic lateral sclerosis patients with limb onset diagnosed at Peking University Third Hospital between January 2020 and May 2022.A univariate analysis revealed no significant differences in the time intervals of spread in different directions between individuals with upper motor neuron-dominant amyotrophic lateral sclerosis and those with classic amyotrophic lateral sclerosis.We used causal directed acyclic graphs for risk factor determination and Cox proportional hazards models to investigate the association between the duration of bilateral limb involvement and clinical baseline characteristics in amyotrophic lateral sclerosis patients.Multiple factor analyses revealed that higher upper motor neuron scores(hazard ratio[HR]=1.05,95%confidence interval[CI]=1.01–1.09,P=0.018),onset in the left limb(HR=0.72,95%CI=0.58–0.89,P=0.002),and a horizontal pattern of progression(HR=0.46,95%CI=0.37–0.58,P<0.001)were risk factors for a shorter interval until bilateral limb involvement.The results demonstrated that a greater degree of upper motor neuron involvement might cause contralateral limb involvement to progress more quickly in limb-onset amyotrophic lateral sclerosis patients.These findings may improve the management of amyotrophic lateral sclerosis patients with limb onset and the prediction of patient prognosis.
文摘The Upper Cretaceous of Tantou Basin in western Henan has yielded many vertebrate fossils,which are featured by several non-avian dinosaurs.Meanwhile,studies on their eggs were yet inadequate though many eggshells have been reported.The newly discovered material 41HⅤ0199 was excavated from the Upper Cretaceous Qiupa Formation in 2021.The block preserves eight complete eggs arranged in two partial rings that form a partial clutch,and there are some scattered eggshells preserved closely with the block,showing a concave-up to concave-down ratio of 54.5:45.5,which indicates that the scattered eggshells come from the clutch and the clutch had been partially broken before it was buried.Based on morphological and microstructural characteristics,the eggs and eggshells can be assigned to Macroolithus yaotunensis(Elongatoolithidae),an oospecies known to be related to oviraptorids,which leads Yulong mini to be its probable producer.Besides,some eggshells show microstructural signs indicating egg retention,which marks the second example of egg retention in the oofamily Elongatoolithidae.
文摘[Objective]Implementation of the Ten-Year Fishing Ban policy may alter fish diversity and niche characteristics of dominant species in spawning grounds within the National Nature Reserve for Rare and Endemic Fish in the Upper Yangtze River.This study initiated continuous monitoring of natural spawning habitats from February 2022 to assess these ecological changes.[Methods]Environmental DNA(eDNA)metabarcoding was employed to analyze fish species composition,biodiversity patterns,and niche parameters of dominant species.Water sampling followed the CEN/TS 19461 standard across five monitoring transects(ZT1-ZT5).[Results]The eDNA analysis detected 45 species of fish belonging to 38 genera,13 families,and 3 orders were detected through environmental DNA(eDNA)in this survey,including 10 species endemic to the upper reaches of the Yangtze River,such as Procypris rabaudi and Myxocyprinus asiaticus.The fish community was mainly composed of bottom-dwelling,settling ovum-producing,omnivorous fish.The variation ranges of the Chao1 index,ACE index,Shannon index,and Simpson index are 736~996,719~965,1.58~3.23,and 0.83~0.99,respectively,indicating that fish species in spawning sites are abundant and community distribution uniformity is high.All indexes are highest at ZT1 monitoring points.Cluster analysis showed that,at a certain similarity level,fish community types in spawning sites could be basically divided into two groups:ZT1,ZT3,and ZT5 clustered together,and ZT2 and ZT4 clustered together,indicating similar fish community habitats.There are 9 dominant fish species in typical deep pool habitats in the reserve,with niche widths(Bi)ranging from 1.13 to 3.87.The dominant fish species are broad and medium niche fish,such as Cyprinus carpio and Hemiculter tchangi,with the niche overlap index(Oik)of some dominant fish species reaching more than 0.95.This indicates fierce competition for resources among the fish in this spawning ground.[Conclusion]The Zhutuo spawning ground demonstrates high species richness with homogeneous community structure and intense resource competition.This study establishes an eDNA-based monitoring framework that enhances conventional survey method,providing critical baseline data for adaptive management under the fishing moratorium regime.
文摘Upper gastrointestinal bleeding (UGIB) refers to the bleeding caused by the digestive tract above the flexor ligament, including esophageal, gastric, duodenal, pancreatic and biliary diseases, and lesions after gastrojejunostomy. UGIB is one of the common diseases in the clinical work of gastroenterology. There are many causes that can lead to upper gastrointestinal bleeding, which are mainly divided into two categories: one is non-variceal upper gastrointestinal bleeding (NVUGIB), and the other is variceal upper gastrointestinal bleeding (VUGIB). This article reviews various causes of UGIB and the latest progress in treatment, aiming to improve the efficiency of diagnosis and treatment in future clinical work, and reduce the risk of rebleeding and mortality.
文摘The Upper Cretaceous successions of Wadi Umm-Khayshar,southern Galala Plateau,North Eastern Desert,Egypt,are composed of highly diversified faunas and subdivided from base to top into the Galala(Middle-Late Cenomanian),Maghra El Hadida(Latest Cenomanian-Late Turonian),Matulla(Coniacian-Santonian),and Sudr(Campanian-Maastrichtian)formations.Five ammonite biozones are recorded in the studied section:Neolobites vibrayeanus,Vascoceras cauvini(late Cenomanian),Vascoceras proprium,Choffaticeras segne,and Coilopoceras requienianum(Turonian)zones.The paleoenvironments of the Upper Cretaceous succession are interpreted based on detailed study and microfacies analysis that reflect a deposition in a homoclinal ramp platform ranging from intertidal to deep subtidal.The paleoecology of the Cenomanian-Turonian succession in the studied section is explained based on a detailed study of macrofaunal associations and sedimentary facies.Quantitative analysis(Q-mode cluster analysis,using the Raup-Crick Paired group method)of 1029 macrobenthic specimens,including 45 species of mollusks and echinoids yielded five macrofaunal associations(A-E)that are described and interpreted as remnants of communities.The nektonic elements are represented by 235 cephalopod specimens of 20 species;heatmap cluster analyses show the distribution of these specimens during the Upper Cenomanian-Turonian stages.Environmental parameters(substrate consistency,rate of sedimentation,water energy,surface-water productivity,and oxygen availability)controlled the distribution of the studied macrofauna.The five associations are divided into two major groups:low-stress associations(A,B,C,and D),and a highstress association(E).The low stress associations are recorded from two different habitats:(1)a high-energy,firm substrate habitat,dominated by epifaunal bivalves,large epifaunal gastropods and a regular echinoid;(2)a low-energy,soft substrate habitat dominated by infaunal bivalves and echinoids.The high stress association is dominated by only two species and recorded from a high-energy shoal environment during a regression phase.A detailed study of macrobenthos and cephalopods provides a good paleoecological understanding of Cenomanian-Turonian succession in the Wadi Umm-Khayshar section.
基金Changzhou Applied Basic Research Program(Project No.:CJ20241042)。
文摘Objective:To explore the rehabilitation effect of upper limb rehabilitation robots combined with isokinetic muscle strength training on hemiplegic patients in the recovery phase of stroke,and to provide a more effective intervention plan for clinical rehabilitation treatment.Methods:One hundred and sixty type 2 stroke patients with hemiplegia in recovery phase treated at Jintan First People’s Hospital from May 2020 to May 2025 were selected as the research subjects.They were divided into a control group(n=80)and an observation group(n=80)using a random number table method.The control group received isokinetic muscle strength training,while the observation group received additional upper limb rehabilitation robot-assisted intervention based on the control group’s treatment.The general information(age,gender,course of disease),Brunnstrum staging,Barthel index,FMA score,and facial expression pain score were compared between the two groups.Results:After treatment,the indicators of both groups improved compared to before treatment.The observation group showed significant advantages in improving various indicators.In terms of Brunnstrum staging,the number of patients in stage IV and above was significantly higher than that in the control group;in terms of the Barthel index,the increase was more significant than that of the control group(P=0.000<0.001).In terms of the FMA score,the increase was more pronounced(P=0.000<0.001);and in terms of facial expression pain assessment,the decrease was more evident(P=0.000<0.01).Conclusion:The combination of upper limb rehabilitation robots and isokinetic muscle strength training can significantly improve the recovery of limb function and activities of daily living in hemiplegic patients during the recovery phase of stroke,and reduce pain.Compared with simple isokinetic muscle strength training,the rehabilitation effect is better,and it is worthy of clinical application.
文摘Blepharoplasty is a frequently performed aesthetic surgery today aimed at enhancing eyelid appearance and correcting age-related changes.The traditional method of subtraction blepharoplasty,which involved removing fat and excess skin,is now considered outdated.This letter explores Gorgy et al's commentary on Miotti et al's study,highlighting a shift in upper eyelid blepharoplasty towards a more conservative,volume-preserving approach.The study systematically reviewed 10 publications,including three retrospective studies,five comparative studies,and two clinical trials.It emphasizes the trend towards preserving the patient's natural anatomy and focusing on enhancement rather than alteration.However,the study's limitations,such as the lack of long-term comparative re-search,a relatively small sample size,and a single-center design,indicate that further research with extended follow-up is necessary to validate the safety and effectiveness of these techniques.The focus is increasingly on preserving and augmenting volume in upper blepharoplasty rather than removing tissue.
基金Supported by the Guangdong Basic and Applied Basic Research Foundation,No.2021B1515130003the Key Research and Development Plan of Hubei Province,No.2022BCE034the Natural Science Foundation of Hubei Province,No.2024AFB1054.
文摘BACKGROUND Upper gastrointestinal(UGI)diseases present diagnostic challenges during endoscopy due to visual similarities,indistinct boundaries,and observer variability,which can lead to missed diagnoses and delayed treatment.Automated segmentation using deep learning(DL)models offers the potential to assist endoscopists,improve diagnostic accuracy,and reduce workload.However,multi-class UGI disease segmentation remains underexplored,with limited annotated datasets and insufficient focus on clinical validation.This study hypothesizes that comparative analysis of different DL architectures can identify models suitable for clinical application,providing actionable insights to reduce diagnostic errors and support clinical decision-making in endoscopic practice.AIM To evaluate 17 state-of-the-art DL models for multi-class UGI disease segmentation,emphasizing clinical translation and real-world applicability.METHODS This study evaluated 17 DL models spanning convolutional neural network(CNN)-,transformer-,and mambabased architectures using a self-collected dataset from two hospitals in Macao and Xiangyang(3313 images,9 classes)and the public EDD2020 dataset(386 images,5 classes).Models were assessed for segmentation performance and performance-efficiency trade-off.Statistical analyses were conducted to examine performance differences across architectures.Generalization capability was measured through a cross-dataset evaluation(training models on the self-collected dataset and testing on the EDD2020 dataset).RESULTS Swin-UMamba achieved the highest segmentation performance across both datasets[intersection over union(IoU):89.06%±0.20%self-collected,77.53%±0.32%EDD2020],followed by SegFormer(IoU:88.94%±0.38%selfcollected,77.20%±0.98%EDD2020)and ConvNeXt+UPerNet(IoU:88.48%±0.09%self-collected,76.90%±0.61%EDD2020).Statistical analyses showed no significant differences between paradigms,though hierarchical architectures with pre-trained encoders consistently outperformed simpler designs.SegFormer achieved the best balance of accuracy and computational efficiency with a performance-efficiency trade-off score of 92.02%,making it suitable for real-time clinical use.Cross-dataset evaluation revealed significant performance drops,with generalization retention rates of 64.78%to 71.52%.Transformer-based models,particularly pyramid vision transformer v2+efficient multi-scale convolutional decoding(IoU:63.35%±1.44%),generalized better than CNN-and mambabased models.CONCLUSION Hierarchical architectures like Swin-UMamba and SegFormer show promise for UGI disease segmentation,reducing missed diagnoses and improving workflows,but robust clinical validation is crucial for real-world deployment.
基金financially supported by the National Natural Science Foundation of China(Grants Nos.41877255,and 52078182).
文摘The tiered geosynthetic-reinforced soil (GRS) walls have been increasingly applied in the high and steep retaining soil structures. However, very little is known about the design method for the tiered GRS wall in practice. This study is aimed at proposing an upper-bound stability analysis method of a tiered GRS wall. The proposed method was firstly validated by the existing results from the centrifuge test and the numerical method, and then a parametric study was performed to investigate the effects of the cohesionless backfill friction angle φ1 and the wall geometric parameters including the offset distance, the total wall height, the batter angle δ, the number of tiers n, and wall height ratio of adjacent tiers on the dimensionless equivalent earth pressure coefficient KT. The analysis results demonstrated that as the φ1 increases, the shear strength of backfill is enhanced and thus the KT or the total reinforcement tensile force decreases, and the KT decreases with the increase of the offset distance at the initial stage and then becomes stable when it reaches a certain critical value. For a fixed offset distance, the KT or the total reinforcement tensile force decreases with the increase of the δ. For the two-tiered GRS walls having the offset distance less than the critical value, the wall with the smaller wall height ratio has a larger KT. Further, the variation of the location of the critical failure surfaces of tiered GRS walls was presented in this study with the variation of the φ1 and the wall geometry.
基金Supported by the National Natural Science Foundation of China(42130802,42272200)CNPC Science and Technology Major Project(2023ZZ18)+1 种基金PetroChina Changqing Oilfield Major Science and Technology Project(2023DZZ01)Technology Project of PetroChina Coalbed Methane Company Limited(2023-KJ-18)。
文摘Based on the test and experimental data from exploration well cores of the Upper Paleozoic in the central-eastern Ordos Basin,combined with structural,burial depth and fluid geochemistry analyses,this study reveals the fluid characteristics,gas accumulation control factors and accumulation modes in the Upper Paleozoic coal reservoirs.The study indicates findings in two aspects.First,the 1500-1800 m interval represents the critical transition zone between open fluid system in shallow-medium depths and closed fluid system in deep depths.The reservoirs above 1500 m reflect intense water invasion,with discrete pressure gradient distribution,and the presence of methane mixed with varying degrees of secondary biogenic gas,and they generally exhibit high water saturation and adsorbed gas undersaturation.The reservoirs deeper than 1800 m,with extremely low permeability,are self-sealed,and contains closed fluid systems formed jointly by the hydrodynamic lateral blocking and tight caprock confinement.Within these systems,surface runoff infiltration is weak,the degree of secondary fluid transformation is minimal,and the pressure gradient is relatively uniform.The adsorbed gas saturation exceeds 100%in most seams,and the free gas content primarily ranges from 1 m^(3)/t to 8 m^(3)/t(greater than 10 m^(3)/t in some seams).Second,the gas accumulation in deep coals is primarily controlled by coal quality,reservoir-caprock assemblage,and structural position governed storage,wettability and sealing properties,under the constraints of the underground temperature and pressure conditions.High-rank,low-ash yield coals with limestone and mudstone caprocks show superior gas accumulation potential.Positive structural highs and wide and gentle negative structural lows are favorable sites for gas enrichment,while slope belts of fold limbs exhibit relatively lower gas content.This research enhances understanding of gas accumulation mechanisms in coal reservoirs and provides effective parameter reference for precise zone evaluation and innovation of adaptive stimulation technologies for deep resources.
文摘BACKGROUND Duodenal web is a rare congenital malformation,exceedingly uncommon in adults,and often misdiagnosed due to the subtle imaging features.CASE SUMMARY By analyzing the clinical diagnosis process and various imaging findings of a patient from our institution,this case report emphasizes the necessity of upper gastrointestinal series in diagnosing duodenal webs,outlines its typical radiographic features,and provides a literature review on the etiology,clinical presentation,and management of this condition.CONCLUSION This case report emphasizes the necessity of upper gastrointestinal series in diagnosing duodenal webs.
文摘ObjectiveTo review the current literature on ketamine-associated upper urinary tract (UUT) dysfunction and provide an overview of its pathogenesis and treatment principles.MethodsA literature search was conducted using PubMed and Cochrane databases for relevant articles published in English between 2008 and 2023. Keywords used included “ketamine” and “upper urinary tract”.ResultsA total of 22 papers were included. Relatively few studies have focused on ketamine-associated UUT dysfunction. Exclusion criteria included lack of hydronephrosis, or pathological findings. After careful screening and exclusion, we finally adopted 11 of these papers and analyzed them. Ketamine-associated UUT dysfunction may be a concern in this field.ConclusionKetamine abuse can lead to UUT impairment and dysfunction, with symptoms such as bladder dysfunction and contracted bladder with vesicoureteral reflux, direct damage and barrier dysfunction, inflammation, apoptosis, fibrosis and stricture, and papillary necrosis. Oxidative stress, autophagy, and microvascular injury are also potential pathogenic mechanisms. The detection of these symptoms largely depends on laboratory and imaging examinations. The treatment principles of ketamine-associated UUT dysfunction are protecting the UUT, improving bladder dysfunction, and resuming normal social life. More investigations are needed to clarify the mechanisms and shed light on the treatment of ketamine-associated UUT damage.
文摘BACKGROUND Non variceal upper gastrointestinal bleeding(NVUGIB)is a life-threatening condition requiring prompt and effective hemostasis.Various endoscopic inter-ventions,including novel hemostatic powders(HP),over-the-scope clips(OTSC),and traditional approaches,have been employed to manage upper gastroin-testinal bleeding(UGIB).Despite advancements,comparative efficacy and safety of these modalities remain uncertain.AIM To evaluate the efficacy and safety of novel hemostatic interventions compared to conventional endoscopic techniques for managing UGIB.METHODS Cochrane,MEDLINE,PubMed and Scopus libraries were searched for rando-mized controlled trials(RCTs)published up to October 2024.Only RCTs compa-ring novel interventions,such as HP or OTSC,with conventional endoscopic treatments computed tomography(CT)were included.The primary outcome was the 30-day rebleeding rate.Secondary outcomes included initial hemostasis,short-term rebleeding rates,need for salvage therapy(surgical/angiographic),30-day all-cause mortality,and bleeding-related mortality.We performed pairwise and network meta-analyses for all treatments.RESULTS Seventeen studies were included in this analysis.Regarding the 30-day rebleeding rate,OTSC and HP showed superior efficacy compared with CT[OTSC vs CT:Relative risk(RR):0.47,95%confidence interval(CI):0.33-0.65;HP vs CT:RR:0.73,95%CI:0.45-1.13],while OTSC and HP had comparable efficacy(RR:0.56,95%CI:0.30-1.05).OTSC ranked the highest in the network ranking estimate for this outcome.For the secondary outcomes,OTSC demonstrated superior efficacy for the short-term rebleeding rate(OTSC vs CT:RR:0.35,95%CI:0.14-0.74;HP vs CT:RR:0.62,95%CI:0.28-1.35;OTSC vs HP:RR:0.59,95%CI:0.17-1.67).Regarding the initial hemostasis rate,OTSC was slightly more effective than CT(OTSC vs CT:RR:1.20,95%CI:1.06-1.57)and comparable to HP(OTSC vs HP:RR:1.08,95%CI:0.89-1.40).There were no significant differences among treatments for all-cause mortality,bleeding-related mortality,or the necessity of surgical or angiographic salvage therapy.OTSC consistently ranked highest across most outcomes in the network ranking estimate.
基金funded by a SINOPEC project entitled Exploration Potential and Target Evaluation of Xujiahe Formation in the Northeastern Sichuan Basin(No.P23130).
文摘The recent discovery of natural gas within the fifth member of the Xujiahe Formation(T_(3)x_(5))in the Dongfeng area within the Sichuan Basin highlights the significant exploration potential of this member.However,the unconvincing previous understanding of the sedimentary microfacies,combined with a total lack of studies on the sand body architecture and reservoir distribution,hampers the further exploration of this member.Using core data,log curves,and seismic data,along with sedimentary microfacies analysis,this study investigated the interfaces between the sand bodies of various scales in the Dongfeng area.Furthermore,this study explored the morphological characteristics,types,and stacking patterns of these sand bodies and determined the distributions of sand bodies and reservoirs in the area.The results indicate that the first sand group of the T_(3)x_(5) member(T_(3)x^(1)_(5))exhibits delta-front deposits,including subaqueous distributary channels,sheet sands,and interdistributary bays.Seven levels of sand body interfaces are identified in the T_(3)x^(1)_(5) sand group.Among them,the interfaces of the first and second levels were identified only in cores,those of the third and fourth levels were recog-nizable from cores combined with log curves,while those of the fifth,sixth,and seventh levels were distinguishable using seismic data.Three superimposed subaqueous distributary channel complexes are found in the Dongfeng area.Among them,complex 1 in the northwest exhibits the strongest water body energy,while complex 2 in the south displays the weakest.Complex 2 was formed earlier than com-plexes 1 and 3.Also,complex 1 is further subdivided into three vertically stacked subaqueous distrib-utary channels.The subdivision of sedimentary microfacies in the T_(3)x_(5) member reveals nine lithofacies types.Among them,stacked pancake-shaped,carbonaceous debris-bearing,massive,and cross-bedded medium-grained sandstones are considered favorable lithofacies.These four lithofacies types exhibit high porosity,as well as low natural gamma-ray(GR)values,low-to-medium deep investigate double lateral resistivity(RD),and high interval transit time(AC)on the log curves.Additionally,the reservoir distribution in the Dongfeng area was delineated based on the characterization of the favorable lith-ofacies.This study serves as a guide for future exploration and evaluation of the T_(3)x_(5) member in the Dongfeng area while also augmenting the methodologies for describing tight sandstone reservoirs.
文摘BACKGROUND Gastric cancer(GC)poses a significant threat to public health.However,the clinicopathological features and tumor biological behaviors vary among the GC patients,leading to individual variations in lymph node metastasis.Consequently,the stratification of lymph node dissection according to the specific type,particularly upper GC,has emerged as a prominent area of research.AIM To investigate the distribution of metastatic lymph nodes in patients with upper and lower GC and to analyze the differences in related pathological elements and prognosis.METHODS Differential analysis between upper and lower GC patients with various clinicopathological factors was performed using the chi-square test and rank-sum regression models were used to analyze risk factors affecting patient prognosis.The Kaplan-Meier method was used to construct survival curves associated with prognostic risk factors for GC.RESULTS Significant differences were observed between the two GC populations regarding tumor diameter,histological grade,pT stage,pN stage,tumor-node-metastasis(pTNM)stage,vascular invasion,and adjuvant chemotherapy usage(all P<0.05).Lymph node metastasis rates were highest for Siewert type II patients in groups Nos.1,3,2 and 7;for Siewert type III patients in groups Nos.3,1,2 and 7;and for other/unclassified patients in groups Nos.1,3,7,2.In the lower GC samples,the sequences were Nos.3,6,7,4.Pathological type,pT stage,pTNM stage,and positive vascular invasion were independent risk factors for development of lymph node metastasis.Age,pathological type,pT stage,pN stage,pTNM stage,vascular invasion,and absence of adjuvant chemotherapy were identified as independent prognostic factors.CONCLUSION Upper GC showed a significantly higher malignancy grade and different lymph node metastasis pattern than lower GC.
