1.Introduction Hepatocellular carcinoma(HCC)is the most common primary malignancy of the liver.HCC is the sixth most frequently diagnosed cancer and the third leading cause of cancer-relatedmortality worldwide.[1]Part...1.Introduction Hepatocellular carcinoma(HCC)is the most common primary malignancy of the liver.HCC is the sixth most frequently diagnosed cancer and the third leading cause of cancer-relatedmortality worldwide.[1]Partial hepatectomy is recommended for patients with early stage HCC.[2]A large proportion of patients with HCC inChina are diagnosed in the intermediate to advanced HCC stages,rendering them ineligible for hepatectomy due to aspects such as liver dysfunction,insufficient residual liver volume,or surgical technique.展开更多
Delay tolerant wireless sensor networks(DTWSN)is a class of wireless network that finds its deployment in those application scenarios which demand for high packet delivery ratio while maintaining minimal overhead in o...Delay tolerant wireless sensor networks(DTWSN)is a class of wireless network that finds its deployment in those application scenarios which demand for high packet delivery ratio while maintaining minimal overhead in order to prolong network lifetime;owing to resource-constrained nature of sensors.The fundamental requirement of any network is routing a packet from its source to destination.Performance of a routing algorithm depends on the number of network parameters utilized by that routing protocol.In the recent years,various routing protocol has been developed for the delay tolerant networks(DTN).A routing protocol known as spray and wait(SnW)is one of the most widely used routing algorithms for DTN.In this paper,we study the SnW routing protocol and propose a modified version of it referred to as Pentago SnW which is based on pentagonal number series.Comparison to binary SnW shows promising results through simulation using real-life scenarios of cars and pedestrians randomly moving on a map.展开更多
Federated learning combined with edge computing has greatly facilitated transportation in real-time applications such as intelligent traffic sys-tems.However,synchronous federated learning is in-efficient in terms of ...Federated learning combined with edge computing has greatly facilitated transportation in real-time applications such as intelligent traffic sys-tems.However,synchronous federated learning is in-efficient in terms of time and convergence speed,mak-ing it unsuitable for high real-time requirements.To address these issues,this paper proposes an Adap-tive Waiting time Asynchronous Federated Learn-ing(AWTAFL)based on Dueling Double Deep Q-Network(D3QN).The server dynamically adjusts the waiting time using the D3QN algorithm based on the current task progress and energy consumption,aim-ing to accelerate convergence and save energy.Addi-tionally,this paper presents a new federated learning global aggregation scheme,where the central server performs weighted aggregation based on the freshness and contribution of client parameters.Experimen-tal simulations demonstrate that the proposed algo-rithm significantly reduces the convergence time while ensuring model quality and effectively reducing en-ergy consumption in asynchronous federated learning.Furthermore,the improved global aggregation update method enhances training stability and reduces oscil-lations in the global model convergence.展开更多
The aim of this of this experimental study to investigate the effect of 3 voluntary waiting periods (VWP) on health of dairy cows. A total of 100 lactations of 100 Holstein Friesian cows with high milk production (ave...The aim of this of this experimental study to investigate the effect of 3 voluntary waiting periods (VWP) on health of dairy cows. A total of 100 lactations of 100 Holstein Friesian cows with high milk production (average 9.442 ± 620 kg) were randomly (based on the ear tags digits of cows) distributed to 1 to 3 experimental groups with VWP of 50 (VWPG50;n = 32), 100 (VWPG100;n = 34) or 150 days (VWPG150;n = 34). Observations relating to diseases of the cows were made by the farm veterinarian and research personnel. Were defined eight disease: puerperal fever, retained fetal membranes, displaced abomasum, metritis, clinical ketosis, clinical mastitis, ovarian cysts, and claw diseases. The experimental days (ED) were from 4 days in milk (DIM) to 100 days after the next calving. The experiment was managed at Dairy Research Farm ?imnic-Craiova January 2018 to December 2022. A clear set of clinical signs were used to define a case at the diseases without the need for laboratory confirmation. Values of Lactational incidence risk (LIR) median postpartum days at diagnosis and pairwise comparison of proportion between VWPs were calculated. LIR for puerperal fiver, retained fetal membranes, displaced abomasum, clinical ketosis, clinical mastitis, ovarian cysts and claw disease were 4;5;2;8;8;and 4% respectively. Numerically, cows with VWP of 100 and150 days had more disease cases compared with VWP of 50 days. The differences between experimental groups of cows regarding proportions of cows with disease cases were not statistically significant. Any of the eight disorders reported in this study was analyzed independently to other health problems. For all enrolled cows (n = 100) VWP was extended until 100 or 150 days postpartum with no effect on the lactational incidence risk for the eight disorders analyzed.展开更多
Absurdity originated from French existentialism,and Martin Esslin,in categorizing Waiting for Godot as a theater of the absurd,ignores the positive aspects of Camus’s absurdism and regards that as an existential trag...Absurdity originated from French existentialism,and Martin Esslin,in categorizing Waiting for Godot as a theater of the absurd,ignores the positive aspects of Camus’s absurdism and regards that as an existential tragedy of mankind.However,the author Samuel Beckett himself did not approve of such a definition,believing that Esslin’s definition of theater of the absurd was too judgmental and pessimistic.Through the imagery of boots,ropes,hats and baggage in Waiting for Godot,Beckett reveals the rootlessness,constraint and agony of the minds of people born into absurdity in the early 20th century.The luck of Lucky is Beckett’s use of irony:people who have lost the ability to think for themselves escape the absurdity and dystopia of life and descend to slaves.Gogo and Didi,who are waiting and expecting,and thinking in the midst of absurdity,represent“Godot”,the symbol of hope.Their endurance in waiting,akin to Camus’s Sisyphus,underscores a form of existential defiance that challenges the notion of absolute pessimism in absurdist literature.展开更多
Neuroendocrine neoplasms(NENs) are a group of rare and heterogeneous malignancies, which can develop in various organs. The clinical course of NENs is quite heterogeneous, with different spontaneous growth rates after...Neuroendocrine neoplasms(NENs) are a group of rare and heterogeneous malignancies, which can develop in various organs. The clinical course of NENs is quite heterogeneous, with different spontaneous growth rates after diagnosis, and different degrees of sensitivity to the same therapy even when they have similar characteristics. Watch and wait(W and W), is a term coined to indicate observation being conducted to assess the evolution of the tumor without administering any anti-tumor therapy. It has been applied to NENs since in extremely rare cases they tend to remain stable for a long time. Although W and W has been reported in several guidelines and recommendations it has never been validated, nor has it been specifically investigated. Furthermore it is not standardized. Therefore its application in clinical practice can differ in terms of tumor status assessment, type and timing of imaging or other exams utilized. In conclusion, while undertaking W and W to delay the first-line therapy by some weeks may be justified in good performance asymptomatic patients with low-grade NENs in order to usefully characterize the disease and patient and thereby choose the best therapy and therapeutic strategy, it seems to be far more difficult to justify W and W with the intent of avoiding an anti-tumor treatment. It should be considered that not only do NENs tend to grow even when they have very favorable biological characteristics but also that the alternative to W and W is most commonly a low toxic and effective treatment with somatostatin analogs.展开更多
As an important representative of the Theatre of Absurd, in his masterpiece Waiting for Godot, Beckett deserted the traditional dramatic form and adopted a new one that shows us the fragmentary characters and the absu...As an important representative of the Theatre of Absurd, in his masterpiece Waiting for Godot, Beckett deserted the traditional dramatic form and adopted a new one that shows us the fragmentary characters and the absurdity of the modern society. This paper demonstrates his artful creation of the language form from the following three aspects: The use of repetition, use of silence and pause and short sentences.展开更多
Several therapeutic procedures have been proposed as bridging treatments for patients with hepatocellular carcinoma(HCC)awaiting liver transplantation(LT).The most used treatments include transarterial chemoembolizati...Several therapeutic procedures have been proposed as bridging treatments for patients with hepatocellular carcinoma(HCC)awaiting liver transplantation(LT).The most used treatments include transarterial chemoembolization and radiofrequency ablation.Surgical resection has also been successfully used as a bridging procedure,and LT should be considered a rescue treatment in patients with previous HCC resection who experience tumor recurrence or post-treatment severe decompensation of liver function.The aims of bridging treatments include decreasing the waiting list dropout rate before transplantation,reducing HCC recurrence after transplantation,and improving post-transplant overall survival.To date,no data from prospective randomized studies are available;however,for HCC patients listed for LT within the Milan criteria,prolonging the waiting time over 6-12 mo is a risk factor for tumor spread.Bridging treatments are useful in containing tumor progression and decreasing dropout.Furthermore,the response to pre-LT treatments may represent a surrogate marker of tumor biological aggressiveness and could therefore be evaluated to prioritize HCC candidates for LT.Lastly,although a definitive conclusion can not be reached,the experiences reported to date suggest a positive impact of these treatments on both tumor recurrence and post-transplant patient survival.Advanced HCC may be downstaged to achieve and maintain the current conventional criteria for inclusion in the waiting list for LT.Recent studies have demonstrated that successfully downstaged patients can achieve a 5-year survival rate comparable to that of patients meeting the conventional criteria without requiring downstaging.展开更多
According to the main international clinical guidelines,the recommended treatment for locally-advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery.However,doubts have been raised about the appro...According to the main international clinical guidelines,the recommended treatment for locally-advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery.However,doubts have been raised about the appropriate definition of clinical complete response(cCR)after neoadjuvant therapy and the role of surgery in patients who achieve a cCR.Surgical resection is associated with significant morbidity and decreased quality of life(QoL),which is especially relevant given the favourable prognosis in this patient subset. Accordingly, therehas been a growing interest in alternative approaches with less morbidity,including the organ-preserving watch and wait strategy, in which surgery isomitted in patients who have achieved a cCR. These patients are managed with aspecific follow-up protocol to ensure adequate cancer control, including the earlyidentification of recurrent disease. However, there are several open questionsabout this strategy, including patient selection, the clinical and radiologicalcriteria to accurately determine cCR, the duration of neoadjuvant treatment, therole of dose intensification (chemotherapy and/or radiotherapy), optimal followupprotocols, and the future perspectives of this approach. In the present review,we summarize the available evidence on the watch and wait strategy in thisclinical scenario, including ongoing clinical trials, QoL in these patients, and thecontroversies surrounding this treatment approach.展开更多
In 2014, there were an estimated 136800 new cases of colorectal cancer, making it the most common gastrointestinal malignancy. It is the second leadingcause of cancer death in both men and women in the United States a...In 2014, there were an estimated 136800 new cases of colorectal cancer, making it the most common gastrointestinal malignancy. It is the second leadingcause of cancer death in both men and women in the United States and over one-third of newly diagnosed patients have stage Ⅲ(node-positive) disease. For stage Ⅱ and Ⅲ colorectal cancer patients, the mainstay of curative therapy is neoadjuvant therapy, followed by radical surgical resection of the rectum. However, the consequences of a proctectomy, either by low anterior resection or abdominoperineal resection, can lead to very extensive comorbidities, such as the need for a permanent colostomy, fecal incontinence, sexual and urinary dysfunction, and even mortality. Recently, trends of complete regression of the rectal cancer after neoadjuvant chemoradiation therapy have been confirmed by clinical and radiographic evaluationthis is known as complete clinical response(cC R). The "watch and wait" approach was first proposed by Dr. Angelita Habr-Gama in Brazil in 2009. Those patients with c CR are followed with close surveillance physical examinations, endoscopy, and imaging. Here, we review management of rectal cancer, the development of the "watch and wait" approach and its outcomes.展开更多
A field study and analysis about the thermal comfort was carried out in the waiting room at Beijing West Rail Station in Chinese cold region.Passengers' TSV(thermal sense vote)was obtained using statistical method...A field study and analysis about the thermal comfort was carried out in the waiting room at Beijing West Rail Station in Chinese cold region.Passengers' TSV(thermal sense vote)was obtained using statistical method on the basis of more than 1 200 questionnaires.The linear regression between TSV and indoor temperature indicates that thermal neutral temperature is 25.2 ℃.According to the percentage of satisfaction among all passengers under different indoor temperatures,the acceptable temperature range in the waiting room is 24.2～30.2℃.It is also found that passengers' temporary stay should be taken into consideration for the thermal comfort analysis.Passengers' TSV is not a constant value after they enter the waiting room.In fact,ΔTSV increases as passengers are waiting for the train,and the growing rate is dependent on indoor-outdoor temperature difference.The greater the temperature difference,the faster ΔTSV increases.At last,a linear regression between indoor comfortable temperature and outdoor temperature was generated as the adaptive comfort model.展开更多
This paper considers an M/G/1 queue with Poisson rate lambda > 0 and service time distribution G(t) which is supposed to have finite mean 1/mu. The following questions are first studied: (a) The closed bounds of th...This paper considers an M/G/1 queue with Poisson rate lambda > 0 and service time distribution G(t) which is supposed to have finite mean 1/mu. The following questions are first studied: (a) The closed bounds of the probability that waiting time is more than a fixed value; (b)The total busy time of the server, which including the distribution, probability that are more than a fixed value during a given time interval (0, t], and the expected value. Some new and important results are obtained by theories of the classes of life distributions and renewal process.展开更多
Introduction: Studies have shown Emergency Department (ED) crowding contributes to reduced quality of patient care, delays in starting treatments, and increased number of patients leaving without being seen. This anal...Introduction: Studies have shown Emergency Department (ED) crowding contributes to reduced quality of patient care, delays in starting treatments, and increased number of patients leaving without being seen. This analysis shows how to theoretically and optimally align staffing to demand. Methods: The ED value stream was identified and mapped. Patients were stratified into three resource-driven care flow cells based on the severity indices. Time observations were conducted for each of the key care team members and the manual cycle times and service rate were calculated and stratified by severity indices. Using X32 Healthcare’s Online Staffing Optimization (OSO) tool, staffing inefficiencies were identified and an optimal schedule was created for each provider group. Results: Lower Severity Indices (higher acuity patient) led to longer times for providers, nurses, patient care assistants, and clerks. The patient length of stay varied from under one hour to over five hours. The flow of patients varied considerably over the 24 hours’ period but was similar by day of the week. Using flow data, we showed that we needed more nurses, more care team members during peak times of patient flow. Eight hour shifts would allow better flexibility. We showed that the additional salary hours added to the budget would be made up for by increased revenue recognized by decreasing the number of patients who leave without being seen. Conclusion: If implemented, these changes will improve ED flow by using lean tools and principles, ultimately leading to timeliness of care, reduced waits, and improved patient experience.展开更多
Background: Numerous studies of tissues’ regeneration have confessed the recovery of damaged liver by hematopoietic stem cells. The cells act not only by cell replacement in the target organ but also by delivering tr...Background: Numerous studies of tissues’ regeneration have confessed the recovery of damaged liver by hematopoietic stem cells. The cells act not only by cell replacement in the target organ but also by delivering trophic factors that support endogenous liver regeneration. A little is known of how organ-derived signals recruit such committed cells into circulation. Objective: We investigated the roles of noninvasive mechanical percutaneous stress of cirrhotic human liver in numbers fluctuation of trophic, liver-specific alpha-fetoprotein-positive fraction of CD133-positive hematopoietic stem cells in lymphocytes of patients waiting for liver transplantation. Methods: To promote in blood the number of the alpha-fetoprotein-positive fraction of CD133-positive hematopoietic stem cells, committed to liver’ tissue, we activated mechanically the cirrhotic liver of patient by transcutaneous micro vibration received from skin-contacted electro-magnetic vibraphones generated mechanical pulses with amplitude 10 μm and smoothly changing frequency from 0.03 kHz to 18 kHz and back forth during one cycle duration 1 minute. The number of the alpha-fetoprotein-positive fraction of CD133-positive hematopoietic stem cells in lymphocytes of potential recipients was controlled by flow cytometry before and during daily sonication of skin area, which corresponds to liver projection on it. The 15 minutes cyclic sonication of the liver area performed daily for three weeks. Results: The sonication increased significantly averaged number of liver-specific alpha-fetoprotein-positive CD133-positive blood lymphocytes in 2 - 3 times compared to a base lane. The second similar sonication, the same zone after three weeks break showed differences with baseline, but it was statistically insignificant. The result was specifically related to the liver as it showed the control sonication of the backbone’s projection on the skin of a separate group of patients with cirrhotic liver from the waiting list. Conclusion: The stem cells committed to the liver recruit from the bone marrow into circulation, when organ mechanically stresses and secretes specific humoral signals to provoke of lymphopoiesis on host liver repair.展开更多
AIM: To determine parental knowledge about acute otitis media(AOM) and its antibiotic therapy, antibiotic resistance and the willingness to comply with the watchful waiting(WW) approach in primary care settings in sou...AIM: To determine parental knowledge about acute otitis media(AOM) and its antibiotic therapy, antibiotic resistance and the willingness to comply with the watchful waiting(WW) approach in primary care settings in southern Israel.METHODS: The study was conducted in 3 primary care clinics and the pediatric emergency room of Soroka University Medical Center. Questionnaires(20 questions on education background, previous AOM experience, knowledge on antimicrobial resistance and attitude vs the WW approach) were filled by 600 parents(150 at each centers) of children < 6 years of age.RESULTS: Mothers represented 69% of parents; 2% had an education of < 10 school years, 46% had high-school education and 17% had an academic degree. 69% parents reported previous experience with AOM and 56% thought that antibiotics represent the only treatment for AOM. Knowledge on bacterial resistance to antibiotics was reported by 57% of the parents; 86% parents were willing to accept/probably accept the WW approach for their children. Logistic regression analysis revealed a significant association between parental education and knowledge about bacterial resistance to antibiotics and that previous experience with AOM was significantly associated with reluctance to accept the WW approach. More parents with knowledge on bacterial resistance were willing to accept the WW approach compared with parents without such knowledge. No correlation was found between the education level and willingness to accept the WW approach. CONCLUSION: A significant correlation was found between previous parental education and experience with AOM and the knowledge about antibiotic use, bacterial resistance and acceptance of the WW approach.展开更多
文摘1.Introduction Hepatocellular carcinoma(HCC)is the most common primary malignancy of the liver.HCC is the sixth most frequently diagnosed cancer and the third leading cause of cancer-relatedmortality worldwide.[1]Partial hepatectomy is recommended for patients with early stage HCC.[2]A large proportion of patients with HCC inChina are diagnosed in the intermediate to advanced HCC stages,rendering them ineligible for hepatectomy due to aspects such as liver dysfunction,insufficient residual liver volume,or surgical technique.
文摘Delay tolerant wireless sensor networks(DTWSN)is a class of wireless network that finds its deployment in those application scenarios which demand for high packet delivery ratio while maintaining minimal overhead in order to prolong network lifetime;owing to resource-constrained nature of sensors.The fundamental requirement of any network is routing a packet from its source to destination.Performance of a routing algorithm depends on the number of network parameters utilized by that routing protocol.In the recent years,various routing protocol has been developed for the delay tolerant networks(DTN).A routing protocol known as spray and wait(SnW)is one of the most widely used routing algorithms for DTN.In this paper,we study the SnW routing protocol and propose a modified version of it referred to as Pentago SnW which is based on pentagonal number series.Comparison to binary SnW shows promising results through simulation using real-life scenarios of cars and pedestrians randomly moving on a map.
基金supported by the National Natural Science Foundation of China(62371082)Guangxi Science and Technology Project(AB24010317)+1 种基金Science and Technology Project of Chongqing Education Commission(KJZD-K202400606)Natural Science Foundation of Chongqing(CSTB2023NSCQ-MSX0726,CSTB2023NSCQ-LZX0014).
文摘Federated learning combined with edge computing has greatly facilitated transportation in real-time applications such as intelligent traffic sys-tems.However,synchronous federated learning is in-efficient in terms of time and convergence speed,mak-ing it unsuitable for high real-time requirements.To address these issues,this paper proposes an Adap-tive Waiting time Asynchronous Federated Learn-ing(AWTAFL)based on Dueling Double Deep Q-Network(D3QN).The server dynamically adjusts the waiting time using the D3QN algorithm based on the current task progress and energy consumption,aim-ing to accelerate convergence and save energy.Addi-tionally,this paper presents a new federated learning global aggregation scheme,where the central server performs weighted aggregation based on the freshness and contribution of client parameters.Experimen-tal simulations demonstrate that the proposed algo-rithm significantly reduces the convergence time while ensuring model quality and effectively reducing en-ergy consumption in asynchronous federated learning.Furthermore,the improved global aggregation update method enhances training stability and reduces oscil-lations in the global model convergence.
文摘The aim of this of this experimental study to investigate the effect of 3 voluntary waiting periods (VWP) on health of dairy cows. A total of 100 lactations of 100 Holstein Friesian cows with high milk production (average 9.442 ± 620 kg) were randomly (based on the ear tags digits of cows) distributed to 1 to 3 experimental groups with VWP of 50 (VWPG50;n = 32), 100 (VWPG100;n = 34) or 150 days (VWPG150;n = 34). Observations relating to diseases of the cows were made by the farm veterinarian and research personnel. Were defined eight disease: puerperal fever, retained fetal membranes, displaced abomasum, metritis, clinical ketosis, clinical mastitis, ovarian cysts, and claw diseases. The experimental days (ED) were from 4 days in milk (DIM) to 100 days after the next calving. The experiment was managed at Dairy Research Farm ?imnic-Craiova January 2018 to December 2022. A clear set of clinical signs were used to define a case at the diseases without the need for laboratory confirmation. Values of Lactational incidence risk (LIR) median postpartum days at diagnosis and pairwise comparison of proportion between VWPs were calculated. LIR for puerperal fiver, retained fetal membranes, displaced abomasum, clinical ketosis, clinical mastitis, ovarian cysts and claw disease were 4;5;2;8;8;and 4% respectively. Numerically, cows with VWP of 100 and150 days had more disease cases compared with VWP of 50 days. The differences between experimental groups of cows regarding proportions of cows with disease cases were not statistically significant. Any of the eight disorders reported in this study was analyzed independently to other health problems. For all enrolled cows (n = 100) VWP was extended until 100 or 150 days postpartum with no effect on the lactational incidence risk for the eight disorders analyzed.
文摘Absurdity originated from French existentialism,and Martin Esslin,in categorizing Waiting for Godot as a theater of the absurd,ignores the positive aspects of Camus’s absurdism and regards that as an existential tragedy of mankind.However,the author Samuel Beckett himself did not approve of such a definition,believing that Esslin’s definition of theater of the absurd was too judgmental and pessimistic.Through the imagery of boots,ropes,hats and baggage in Waiting for Godot,Beckett reveals the rootlessness,constraint and agony of the minds of people born into absurdity in the early 20th century.The luck of Lucky is Beckett’s use of irony:people who have lost the ability to think for themselves escape the absurdity and dystopia of life and descend to slaves.Gogo and Didi,who are waiting and expecting,and thinking in the midst of absurdity,represent“Godot”,the symbol of hope.Their endurance in waiting,akin to Camus’s Sisyphus,underscores a form of existential defiance that challenges the notion of absolute pessimism in absurdist literature.
文摘Neuroendocrine neoplasms(NENs) are a group of rare and heterogeneous malignancies, which can develop in various organs. The clinical course of NENs is quite heterogeneous, with different spontaneous growth rates after diagnosis, and different degrees of sensitivity to the same therapy even when they have similar characteristics. Watch and wait(W and W), is a term coined to indicate observation being conducted to assess the evolution of the tumor without administering any anti-tumor therapy. It has been applied to NENs since in extremely rare cases they tend to remain stable for a long time. Although W and W has been reported in several guidelines and recommendations it has never been validated, nor has it been specifically investigated. Furthermore it is not standardized. Therefore its application in clinical practice can differ in terms of tumor status assessment, type and timing of imaging or other exams utilized. In conclusion, while undertaking W and W to delay the first-line therapy by some weeks may be justified in good performance asymptomatic patients with low-grade NENs in order to usefully characterize the disease and patient and thereby choose the best therapy and therapeutic strategy, it seems to be far more difficult to justify W and W with the intent of avoiding an anti-tumor treatment. It should be considered that not only do NENs tend to grow even when they have very favorable biological characteristics but also that the alternative to W and W is most commonly a low toxic and effective treatment with somatostatin analogs.
文摘As an important representative of the Theatre of Absurd, in his masterpiece Waiting for Godot, Beckett deserted the traditional dramatic form and adopted a new one that shows us the fragmentary characters and the absurdity of the modern society. This paper demonstrates his artful creation of the language form from the following three aspects: The use of repetition, use of silence and pause and short sentences.
文摘Several therapeutic procedures have been proposed as bridging treatments for patients with hepatocellular carcinoma(HCC)awaiting liver transplantation(LT).The most used treatments include transarterial chemoembolization and radiofrequency ablation.Surgical resection has also been successfully used as a bridging procedure,and LT should be considered a rescue treatment in patients with previous HCC resection who experience tumor recurrence or post-treatment severe decompensation of liver function.The aims of bridging treatments include decreasing the waiting list dropout rate before transplantation,reducing HCC recurrence after transplantation,and improving post-transplant overall survival.To date,no data from prospective randomized studies are available;however,for HCC patients listed for LT within the Milan criteria,prolonging the waiting time over 6-12 mo is a risk factor for tumor spread.Bridging treatments are useful in containing tumor progression and decreasing dropout.Furthermore,the response to pre-LT treatments may represent a surrogate marker of tumor biological aggressiveness and could therefore be evaluated to prioritize HCC candidates for LT.Lastly,although a definitive conclusion can not be reached,the experiences reported to date suggest a positive impact of these treatments on both tumor recurrence and post-transplant patient survival.Advanced HCC may be downstaged to achieve and maintain the current conventional criteria for inclusion in the waiting list for LT.Recent studies have demonstrated that successfully downstaged patients can achieve a 5-year survival rate comparable to that of patients meeting the conventional criteria without requiring downstaging.
文摘According to the main international clinical guidelines,the recommended treatment for locally-advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery.However,doubts have been raised about the appropriate definition of clinical complete response(cCR)after neoadjuvant therapy and the role of surgery in patients who achieve a cCR.Surgical resection is associated with significant morbidity and decreased quality of life(QoL),which is especially relevant given the favourable prognosis in this patient subset. Accordingly, therehas been a growing interest in alternative approaches with less morbidity,including the organ-preserving watch and wait strategy, in which surgery isomitted in patients who have achieved a cCR. These patients are managed with aspecific follow-up protocol to ensure adequate cancer control, including the earlyidentification of recurrent disease. However, there are several open questionsabout this strategy, including patient selection, the clinical and radiologicalcriteria to accurately determine cCR, the duration of neoadjuvant treatment, therole of dose intensification (chemotherapy and/or radiotherapy), optimal followupprotocols, and the future perspectives of this approach. In the present review,we summarize the available evidence on the watch and wait strategy in thisclinical scenario, including ongoing clinical trials, QoL in these patients, and thecontroversies surrounding this treatment approach.
文摘In 2014, there were an estimated 136800 new cases of colorectal cancer, making it the most common gastrointestinal malignancy. It is the second leadingcause of cancer death in both men and women in the United States and over one-third of newly diagnosed patients have stage Ⅲ(node-positive) disease. For stage Ⅱ and Ⅲ colorectal cancer patients, the mainstay of curative therapy is neoadjuvant therapy, followed by radical surgical resection of the rectum. However, the consequences of a proctectomy, either by low anterior resection or abdominoperineal resection, can lead to very extensive comorbidities, such as the need for a permanent colostomy, fecal incontinence, sexual and urinary dysfunction, and even mortality. Recently, trends of complete regression of the rectal cancer after neoadjuvant chemoradiation therapy have been confirmed by clinical and radiographic evaluationthis is known as complete clinical response(cC R). The "watch and wait" approach was first proposed by Dr. Angelita Habr-Gama in Brazil in 2009. Those patients with c CR are followed with close surveillance physical examinations, endoscopy, and imaging. Here, we review management of rectal cancer, the development of the "watch and wait" approach and its outcomes.
基金Supported by National Natural Science Foundation of China(20676154)
文摘A field study and analysis about the thermal comfort was carried out in the waiting room at Beijing West Rail Station in Chinese cold region.Passengers' TSV(thermal sense vote)was obtained using statistical method on the basis of more than 1 200 questionnaires.The linear regression between TSV and indoor temperature indicates that thermal neutral temperature is 25.2 ℃.According to the percentage of satisfaction among all passengers under different indoor temperatures,the acceptable temperature range in the waiting room is 24.2～30.2℃.It is also found that passengers' temporary stay should be taken into consideration for the thermal comfort analysis.Passengers' TSV is not a constant value after they enter the waiting room.In fact,ΔTSV increases as passengers are waiting for the train,and the growing rate is dependent on indoor-outdoor temperature difference.The greater the temperature difference,the faster ΔTSV increases.At last,a linear regression between indoor comfortable temperature and outdoor temperature was generated as the adaptive comfort model.
基金This work was suPPorted by the Natiotal Out-standing YOuth Sdence FOundstion (79725tX)2) the suPporting program of the Nat
文摘This paper considers an M/G/1 queue with Poisson rate lambda > 0 and service time distribution G(t) which is supposed to have finite mean 1/mu. The following questions are first studied: (a) The closed bounds of the probability that waiting time is more than a fixed value; (b)The total busy time of the server, which including the distribution, probability that are more than a fixed value during a given time interval (0, t], and the expected value. Some new and important results are obtained by theories of the classes of life distributions and renewal process.
文摘Introduction: Studies have shown Emergency Department (ED) crowding contributes to reduced quality of patient care, delays in starting treatments, and increased number of patients leaving without being seen. This analysis shows how to theoretically and optimally align staffing to demand. Methods: The ED value stream was identified and mapped. Patients were stratified into three resource-driven care flow cells based on the severity indices. Time observations were conducted for each of the key care team members and the manual cycle times and service rate were calculated and stratified by severity indices. Using X32 Healthcare’s Online Staffing Optimization (OSO) tool, staffing inefficiencies were identified and an optimal schedule was created for each provider group. Results: Lower Severity Indices (higher acuity patient) led to longer times for providers, nurses, patient care assistants, and clerks. The patient length of stay varied from under one hour to over five hours. The flow of patients varied considerably over the 24 hours’ period but was similar by day of the week. Using flow data, we showed that we needed more nurses, more care team members during peak times of patient flow. Eight hour shifts would allow better flexibility. We showed that the additional salary hours added to the budget would be made up for by increased revenue recognized by decreasing the number of patients who leave without being seen. Conclusion: If implemented, these changes will improve ED flow by using lean tools and principles, ultimately leading to timeliness of care, reduced waits, and improved patient experience.
文摘Background: Numerous studies of tissues’ regeneration have confessed the recovery of damaged liver by hematopoietic stem cells. The cells act not only by cell replacement in the target organ but also by delivering trophic factors that support endogenous liver regeneration. A little is known of how organ-derived signals recruit such committed cells into circulation. Objective: We investigated the roles of noninvasive mechanical percutaneous stress of cirrhotic human liver in numbers fluctuation of trophic, liver-specific alpha-fetoprotein-positive fraction of CD133-positive hematopoietic stem cells in lymphocytes of patients waiting for liver transplantation. Methods: To promote in blood the number of the alpha-fetoprotein-positive fraction of CD133-positive hematopoietic stem cells, committed to liver’ tissue, we activated mechanically the cirrhotic liver of patient by transcutaneous micro vibration received from skin-contacted electro-magnetic vibraphones generated mechanical pulses with amplitude 10 μm and smoothly changing frequency from 0.03 kHz to 18 kHz and back forth during one cycle duration 1 minute. The number of the alpha-fetoprotein-positive fraction of CD133-positive hematopoietic stem cells in lymphocytes of potential recipients was controlled by flow cytometry before and during daily sonication of skin area, which corresponds to liver projection on it. The 15 minutes cyclic sonication of the liver area performed daily for three weeks. Results: The sonication increased significantly averaged number of liver-specific alpha-fetoprotein-positive CD133-positive blood lymphocytes in 2 - 3 times compared to a base lane. The second similar sonication, the same zone after three weeks break showed differences with baseline, but it was statistically insignificant. The result was specifically related to the liver as it showed the control sonication of the backbone’s projection on the skin of a separate group of patients with cirrhotic liver from the waiting list. Conclusion: The stem cells committed to the liver recruit from the bone marrow into circulation, when organ mechanically stresses and secretes specific humoral signals to provoke of lymphopoiesis on host liver repair.
文摘AIM: To determine parental knowledge about acute otitis media(AOM) and its antibiotic therapy, antibiotic resistance and the willingness to comply with the watchful waiting(WW) approach in primary care settings in southern Israel.METHODS: The study was conducted in 3 primary care clinics and the pediatric emergency room of Soroka University Medical Center. Questionnaires(20 questions on education background, previous AOM experience, knowledge on antimicrobial resistance and attitude vs the WW approach) were filled by 600 parents(150 at each centers) of children < 6 years of age.RESULTS: Mothers represented 69% of parents; 2% had an education of < 10 school years, 46% had high-school education and 17% had an academic degree. 69% parents reported previous experience with AOM and 56% thought that antibiotics represent the only treatment for AOM. Knowledge on bacterial resistance to antibiotics was reported by 57% of the parents; 86% parents were willing to accept/probably accept the WW approach for their children. Logistic regression analysis revealed a significant association between parental education and knowledge about bacterial resistance to antibiotics and that previous experience with AOM was significantly associated with reluctance to accept the WW approach. More parents with knowledge on bacterial resistance were willing to accept the WW approach compared with parents without such knowledge. No correlation was found between the education level and willingness to accept the WW approach. CONCLUSION: A significant correlation was found between previous parental education and experience with AOM and the knowledge about antibiotic use, bacterial resistance and acceptance of the WW approach.
