AIM:To investigate the underlying causes of surgical failure and reoperation management in patients with rhegmatogenous retinal detachment(RRD)who underwent scleral buckle surgery at our institution.METHODS:This was a...AIM:To investigate the underlying causes of surgical failure and reoperation management in patients with rhegmatogenous retinal detachment(RRD)who underwent scleral buckle surgery at our institution.METHODS:This was a single-center,retrospective,descriptive study.The clinical data of 368 patients(387 eyes)with RRD who underwent scleral buckling(SB)surgery between August 2013 and July 2023 at our institution were collected.The aim was to analyze the causes of recurrence and the rationale for selecting reoperation methods.RESULTS:Totally 368 patients(387 eyes)were included in the analysis,comprising 222 males and 146 females.The average age was 30.26±14.18 years,and the mean follow-up duration was(48.33±20.39)mo.The success rate of SB surgery was 90.2%.Recurrent retinal detachment occurred in 38 eyes.Based on surgical records,the causes of SB failure were analyzed.The recurrence causes included abnormal compression ridge position(position,height,or width)in 14 eyes(36.8%,14/38),hole omission in 11 eyes(29.0%,11/38),proliferative vitreoretinopathy(PVR)in 10 eyes(26.3%,10/38),and new holes in 3 eyes(7.9%,3/38).Among these,8 eyes(21.1%,8/38)underwent repeat SB surgery,while the remaining 30 eyes(78.9%,30/38)underwent pars plana vitrectomy(PPV).Regarding tamponade agents,silicone oil was used in 11 eyes(36.7%,11/30),C 3F 8 gas in 12 eyes(40.0%,12/30),and sterile air in 7 eyes(23.3%,7/30).CONCLUSION:SB surgery demonstrates a high success rate in the treatment of RRD.However,abnormal compression ridge position,missed holes during surgery,and PVR are the primary causes of SB failure.After addressing the reasons for failure,re-SB surgery or PPV can be effective alternatives.展开更多
BACKGROUND Anxiety,depression,and other negative emotions are common among patients with chronic renal failure(CRF).Analyzing the factors related to negative emotions is necessary to provide targeted nursing care.AIM ...BACKGROUND Anxiety,depression,and other negative emotions are common among patients with chronic renal failure(CRF).Analyzing the factors related to negative emotions is necessary to provide targeted nursing care.AIM To explore the correlations among life satisfaction,pleasure levels,and negative emotions in patients with CRF.METHODS One hundred patients with CRF who received therapy at the First Affiliated Hospital of Jinzhou Medical University between December 2022 and February 2025 were included.The Depression,Anxiety,and Stress Scale(DASS-21),Satisfaction with Life Scale(SWLS),and Temporal Experience of Pleasure Scale(TEPS)were used to evaluate negative emotions,life satisfaction,and pleasure level,respectively.Pearson’s correlation coefficient analyzed the correlation between life satisfaction,pleasure level,and negative emotions.Linear regression analysis identified the factors affecting negative emotions.RESULTS The average DASS-21 score among patients with CRF was 51.90±2.30,with subscale scores of 17.90±1.50 for depression,18.53±1.18 for anxiety,and 15.47±2.36 for stress,all significantly higher than the domestic norm(P<0.05).The average SWLS score was 22.17±4.90.Correlation analysis revealed a negative correlation between the SWLS and total DASS-21 scores(P<0.05),but not with the individual depression,anxiety,or stress dimensions.The average TEPS score was 67.80±8.34.TEPS scores were negatively correlated with the DASS-21 score and the stress dimension(P<0.05),but not with depression or anxiety.Linear regression analysis showed that TEPS scores significantly influenced DASS-21 scores(P<0.05).CONCLUSION Patients with CRF experience high levels of negative emotions,which are negatively correlated with life satisfaction and pleasure.Furthermore,pleasure level had an impact on negative emotions.展开更多
BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis ...BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis and heart failure has rarely been observed in cases of pediatric patients with CH pathology.Here,we explored the etiological relationship between CH,heart failure,and refractory lactic acidosis to reflect the importance of thyroid function screening in neonates with heart disease.CASE SUMMARY A 33-day-old extremely premature female infant presented with tachypnea,respiratory distress,recurrent infections,and abdominal distension postnatal.On admission to our facility,she had cardiomegaly,hepatomegaly,and lactic acidosis(revealed on blood gas analysis),with lactate progressively rising to 25 mmol/L.Chest radiographs showed pulmonary congestion,while echocardiography revealed cardiac enlargement,left ventricular wall thickening,and pericardial effusion.Initial management aimed at correcting acidosis and treating heart failure proved ineffective.After reassessment,thyroid function tests showed significantly decreased triiodothyronine,free triiodothyronine,thyroxine,and free thyroxine levels,with a significantly increased thyroidstimulating hormone level,confirming a CH diagnosis.Levothyroxine was administered,resulting in rapid correction of lactic acidosis and gradual improvement of thyroid function and systemic symptoms,culminating in full recovery and discharge.We also reviewed the relevant literature on thyroid and cardiac dysfunctions in order to explore their deeper association.CONCLUSION This case links CH-induced heart failure with refractory lactic acidosis,urging prompt thyroid screening in affected neonates to reduce mortality.展开更多
Chronic heart failure(CHF)impairs cognitive function.Xijiaqi Formula(XJQ),a traditional Chinese medicine(TCM)used clinically to treat CHF,demonstrates potential for improving cognition in CHF patients.However,its prec...Chronic heart failure(CHF)impairs cognitive function.Xijiaqi Formula(XJQ),a traditional Chinese medicine(TCM)used clinically to treat CHF,demonstrates potential for improving cognition in CHF patients.However,its precise mechanism in treating post-CHF cognitive dysfunction remains unclear.This study systematically investigates XJQ’s effects on post-CHF cognitive dysfunction and the underlying mechanisms.The components of XJQ were identified through liquid chromatography-mass spectrometry.CHF was induced in rats via ligation of the left anterior descending coronary artery,followed by six weeks of XJQ treatment.Cardiac function was evaluated through echocardiography and hemodynamic parameters,while cognitive function was assessed using Morris water maze(MWM)and open field tests(OFT).XJQ treatment enhanced both cardiac and cognitive functions in CHF rats.Network pharmacology identified 12 core active components of XJQ and indicated its effect on cognitive dysfunction involved regulating synapses,inflammation,and phosphodiesterase 4(PDE4)-dependent cyclic adenosine monophosphate(cAMP)signaling.XJQ inhibited microglial and astrocyte activation,decreased proinflammatory cytokines,and mitigated neuronal damage.Notably,XJQ promoted synaptic repair and dendritic growth by downregulating PDE4 and upregulating cAMP,protein kinase A(PKA),cAMP-response element binding protein(CREB),brain-derived neurotrophic factor(BDNF),PSD95,and synapsin I levels.Molecular docking and Bio-layer interferometry assays confirmed direct binding of quercetin,kaempferol,isorhamnetin,and darutoside to PDE4.In conclusion,XJQ alleviates neuroinflammation and enhances synaptic plasticity to improve cognitive dysfunction in CHF rats via the PDE4/cAMP/PKA/CREB signaling pathway.These findings provide valuable insight into the heart-brain axis.展开更多
The failure mechanisms and structural damage of SiC MOSFETs induced by heavy ion irradiation were demonstrated.The findings reveal three degradation modes,depending on the drain voltage.At a relatively low voltage,the...The failure mechanisms and structural damage of SiC MOSFETs induced by heavy ion irradiation were demonstrated.The findings reveal three degradation modes,depending on the drain voltage.At a relatively low voltage,the damage is triggered by the formation and activation of gate latent damage(LDs),with damage concentrated in the gate oxide.The second degradation mode involves permanent leakage current degradation,with damage progressively transitioning from the oxide to the SiC material as the drain voltage escalates.Ultimately,the device undergoes catastrophic burnout above certain voltages,characterized by the lattice temperature reaching the sublimation point of SiC,resulting in surface cavity and complete structural destruction.This paper presents a comprehensive investigation of SiC MOSFETs under heavy ion exposure,providing radiation resistance methods of SiC-based devices for aerospace applications.展开更多
Rationale:This case report describes a couple with recurrent fertilization failure despite undergoing multiple cycles of intracytoplasmic sperm injection(ICSI).The principal clinical concern was suspected oocyte activ...Rationale:This case report describes a couple with recurrent fertilization failure despite undergoing multiple cycles of intracytoplasmic sperm injection(ICSI).The principal clinical concern was suspected oocyte activation deficiency(OAD),in which fertilization is impeded due to the oocyte’s inability to initiate embryogenesis,commonly attributed to inadequate intracellular calcium(Ca^(2+))release following sperm injection.Patient concerns:The couple repeatedly experienced complete or near-complete fertilization failure in previous ICSI cycles,raising suspicion of an underlying oocyte activation defect.Diagnosis:Based on the repeated absence of fertilization post-ICSI and clinical history,a diagnosis of suspected OAD leading to recurrent ICSI fertilization failure was considered.Interventions:Artificial oocyte activation(AOA)using the calcium ionophore A23187 was performed.After ICSI,unfertilized oocytes were exposed to the ionophore to induce Ca^(2+)influx,simulating physiological calcium oscillations essential for oocyte activation.The efficacy of intervention was evaluated through subsequent embryonic development,morphological grading,and chromosomal integrity.Outcomes:Following AOA treatment,successful oocyte activation occurred,resulting in the formation of high-grade embryos with normal developmental progression.Chromosomal analysis revealed no detectable abnormalities,indicating genomic stability.Lessons:Calcium ionophore–mediated AOA may serve as an effective adjunct in cases of recurrent ICSI failure attributed to OAD.This case highlights the importance of individualized therapeutic strategies in assisted reproduction;however,further research is needed to refine protocols,validate broader clinical efficacy,and assess long-term safety,including potential epigenetic risks.展开更多
INTRODUCTION.On May 1st,2024,around 2:10 a.m.,a catastrophic collapse occurred along the Meilong Expressway near Meizhou City,Guangdong Province,China,at coordinates 24°29′24″N and 116°40′25″E.This colla...INTRODUCTION.On May 1st,2024,around 2:10 a.m.,a catastrophic collapse occurred along the Meilong Expressway near Meizhou City,Guangdong Province,China,at coordinates 24°29′24″N and 116°40′25″E.This collapse resulted in a pavement failure of approximately 17.9 m in length and covering an area of about 184.3 m^(2)(Chinanews,2024).展开更多
BACKGROUND Advanced heart failure and transplant(AHFTC)teams are crucial in the management of patients in cardiogenic shock.We sought to explore the impact of AHFTC physicians on outcomes in patients receiving extraco...BACKGROUND Advanced heart failure and transplant(AHFTC)teams are crucial in the management of patients in cardiogenic shock.We sought to explore the impact of AHFTC physicians on outcomes in patients receiving extracorporeal membrane oxygenation(ECMO)support.AIM To determine whether outcomes differ in the care of ECMO patients when AHFTC physicians serve in a primary vs consultative role.METHODS We conducted a retrospective cohort study of 51 patients placed on veno-venous(VV)and veno-arterial(VA)ECMO between January 2015 and February 2023 at our institution.We compared ECMO outcomes between teams managed primarily by intensivists vs teams where AHFTC physicians played a direct role in ECMO management,including patient selection.Our primary outcome measure was survival to 30 days post hospital discharge.RESULTS For combined VA and VV ECMO patients,survival to 30 days post discharge in the AHFTC cohort was significantly higher(67%vs 30%,P=0.01),largely driven by a significantly increased 30-day post discharge survival in VA ECMO patients in the AHFTC group(64%vs 20%,P=0.05).CONCLUSION This study suggests that patients in shock requiring VA ECMO support may have improved survival 30 days after hospital discharge when an AHFTC team serves in a direct role in the selection and management of patients.Further studies are needed to validate this impact.展开更多
BACKGROUND Acute pancreatitis(AP)is a severe condition,and abdominal effusion is a significant predictor of its severity and prognosis.However,the relationship between ascites characteristics and AP outcomes remains u...BACKGROUND Acute pancreatitis(AP)is a severe condition,and abdominal effusion is a significant predictor of its severity and prognosis.However,the relationship between ascites characteristics and AP outcomes remains undefined.AIM To assess the correlation between ascites characteristics and clinical prognosis in AP patients by comparing color depth and turbidity of early ascites.METHODS This study included 667 AP patients with ascites,categorized by color and turbidity into yellow clear(n=54),yellow turbid(n=293),red brown(n=320).The trendχ2 test was employed to analyze the incidence of organ failure(OF),infected pancreatic necrosis(IPN),and mortality across groups.Receiver operating charac teristic(ROC)curves were used to evaluate the predictive value of ascites cell count,amylase,protein,and lactate dehydrogenase(LDH)for abdominal compartment syndrome(ACS)and intra-abdominal hemorrhage.RESULTS AP patients with ascites exhibited higher scores of scoring systems(such as Bedside index for severity in AP,Acute Physiology and Chronic Health Examination II,etc.)and increased complications and mortality rates(all P<0.05)compared to those without ascites.A linear association was observed between ascites color depth and turbidity and the incidence of OF,pancreatic necrosis,IPN,and mortality(P<0.05).LDH in ascites demonstrated high accuracy in predicting ACS and intra-abdominal hemorrhage,with areas under the ROC curve of 0.77 and 0.79,respectively.CONCLUSION Early in AP,ascites correlates with OF,IPN,and mortality,showing linear associations with color depth and turbidity.Ascitic LDH reliably predicts ACS and intra-abdominal hemorrhage in AP patients.展开更多
Lingguizhugan Decoction(LGZG)demonstrates significant efficacy in treating various cardiovascular diseases clinically,yet its precise mechanism of action remains elusive.This study aimed to elucidate the potential mec...Lingguizhugan Decoction(LGZG)demonstrates significant efficacy in treating various cardiovascular diseases clinically,yet its precise mechanism of action remains elusive.This study aimed to elucidate the potential mechanisms and effects of LGZG on isoproterenol(ISO)continuous stimulation-induced chronic heart failure(CHF)in mice,providing direct experimental evidence for further clinical applications.In vivo,continuous ISO infusion was administered to mice,and ventricular myocytes were utilized to explore LGZG's potential mechanism of action on theβ1-adrenergic receptor(β1-AR)/Gs/G protein-coupled receptor kinases(GRKs)/β-arrestin signaling deflection system in the heart.The findings reveal that LGZG significantly reduced the messenger ribonucleic acid(mRNA)expression of hypertrophy-related biomarkers[atrial natriuretic peptide(ANP)and B-type natriuretic peptide(BNP)]and improved cardiac remodeling and left ventricular diastolic function in mice with ISO-induced CHF.Furthermore,LGZG inhibited the overactivation of Gs/cyclic adenosine monophosphate(c AMP)/protein kinase A(PKA)signaling and downregulated the downstream transcriptional activity of c AMP-response element binding protein(CREB)and the expression of the coactivator CBP/P300.Notably,LGZG downregulated the expression ofβ-arrestin1 and GRK 2/3/5 while upregulating the expression ofβ1-AR andβ-arrestin2.These results suggest that LGZG inhibits Gs/c AMP/PKA signaling andβ-arrestin/GRK-mediated desensitization and internalization ofβ1-AR,potentially exerting cardioprotective effects through the synergistic regulation of theβ1-AR/Gs/GRKs/β-arrestin signaling deflection system via multiple pathways.展开更多
BACKGROUND Acute liver failure(ALF)is a life-threatening multisystemic condition with high short-term mortality.With the growing prevalence of obesity and metabolic syndrome,it is important to investigate the clinical...BACKGROUND Acute liver failure(ALF)is a life-threatening multisystemic condition with high short-term mortality.With the growing prevalence of obesity and metabolic syndrome,it is important to investigate the clinical implications of high body mass index(BMI)on survival outcomes in ALF.AIM To explore the impact of overweight and obesity on the clinical outcomes of patients with ALF.METHODS A retrospective observational cohort study was conducted involving patients with ALF admitted to the Johns Hopkins Health System between January 1,2000 and May 1,2020.We performed Cox proportional hazards regression to identify outcomes,including the need for liver transplantation(LT)or all-cause mortality.RESULTS A total of 196 patients were included,the median age was 43.5 years,63.3%were female,and 59.7%were of Caucasian ethnicity.Acetaminophen-induced ALF was the most common etiology(45%).The mean BMI was significantly greater among patients who underwent LT or died(29.64 kg/m^(2)vs 26.59 kg/m^(2),P=0.008)than among survivors.Patients with overweight and obesity had a higher risk of all-cause mortality or need for LT by 2.22-fold(95%CI:1.30-3.78)and 2.04-fold(95%CI:1.29-3.39),respectively.Elevated BMI was associated with renal failure and higher grades of hepatic encephalopathy.Derangements in serologic markers,including alanine transaminase,lactate,and ammonia,were associated with a mortality risk or need for LT.CONCLUSION In this large,retrospective study,with a diverse cohort of United States patients,Overweight and obese were independently associated with an increased risk of all-cause mortality or need for LT.This work highlights the importance of closely monitoring ALF patients who are overweight or obese for adverse complications and measures to improve outcomes in this vulnerable patient population.展开更多
BACKGROUND Acute-on-chronic liver failure(ACLF)is a liver disease based on chronic liver disease,which is significantly influenced by clinical treatment regimen and disease status,and despite the existence of multiple...BACKGROUND Acute-on-chronic liver failure(ACLF)is a liver disease based on chronic liver disease,which is significantly influenced by clinical treatment regimen and disease status,and despite the existence of multiple prognostic assessment indicators for ACLF,the overall sensitivity and accuracy are relatively low.AIM To investigate the prognostic value of the combined detection of alpha-fetoprotein(AFP),plasma prothrombin activity(PTA),and serum prealbumin(PA)in ACLF.METHODS This retrospective study included 87 patients with ACLF admitted from February 2021 to February 2023 and categorized them into the survival(n=47)and death(n=40)groups according to their clinical outcomes 3 months posttreatment.All the participants underwent AFP,PTA,and PA level measurements upon admission.Baseline data,as well as AFP,PTA,and PA levels,were comparatively analyzed.Pearson correlation coefficients were utilized to analyze the correlations of AFP,PTA,and PA with different survival outcomes in patients with ACLF.Receiver operating characteristic(ROC)curves and areas under the curves were used to evaluate the predictive value of AFP,PTA,and PA for ACLF prognosis.RESULTS AFP,PTA,and PA levels were markedly decreased in the death group than in the survival group(P<0.05).Pearson analysis indicated a positive association of the AFP,PTA,and PA levels with the survival of patients with ACLF(P<0.05).ROC curve analysis determined the sensitivity and specificity of the combined diagnosis at 91.24%and 100.00%,respectively,both of which were notably increased compared to the single-index diagnosis.The ROC of their combined diagnosis was 0.989,significantly surpassing 0.907,0.849,and 0.853 of AFP,PTA,and PA,respectively.No statistically significant variance was determined in the sensitivity and specificity of the combined diagnosis vs the single detection(P>0.05).CONCLUSION The combined detection of AFP,PTA,and PA levels demonstrates favorable diagnostic value for the short-term prognosis of patients with ACLF,featuring high sensitivity and specificity.展开更多
Link failure is a critical issue in large networks and must be effectively addressed.In software-defined networks(SDN),link failure recovery schemes can be categorized into proactive and reactive approaches.Reactive s...Link failure is a critical issue in large networks and must be effectively addressed.In software-defined networks(SDN),link failure recovery schemes can be categorized into proactive and reactive approaches.Reactive schemes have longer recovery times while proactive schemes provide faster recovery but overwhelm the memory of switches by flow entries.As SDN adoption grows,ensuring efficient recovery from link failures in the data plane becomes crucial.In particular,data center networks(DCNs)demand rapid recovery times and efficient resource utilization to meet carrier-grade requirements.This paper proposes an efficient Decentralized Failure Recovery(DFR)model for SDNs,meeting recovery time requirements and optimizing switch memory resource consumption.The DFR model enables switches to autonomously reroute traffic upon link failures without involving the controller,achieving fast recovery times while minimizing memory usage.DFR employs the Fast Failover Group in the OpenFlow standard for local recovery without requiring controller communication and utilizes the k-shortest path algorithm to proactively install backup paths,allowing immediate local recovery without controller intervention and enhancing overall network stability and scalability.DFR employs flow entry aggregation techniques to reduce switch memory usage.Instead of matching flow entries to the destination host’s MAC address,DFR matches packets to the destination switch’s MAC address.This reduces the switches’Ternary Content-Addressable Memory(TCAM)consumption.Additionally,DFR modifies Address Resolution Protocol(ARP)replies to provide source hosts with the destination switch’s MAC address,facilitating flow entry aggregation without affecting normal network operations.The performance of DFR is evaluated through the network emulator Mininet 2.3.1 and Ryu 3.1 as SDN controller.For different number of active flows,number of hosts per edge switch,and different network sizes,the proposed model outperformed various failure recovery models:restoration-based,protection by flow entries,protection by group entries and protection by Vlan-tagging model in terms of recovery time,switch memory consumption and controller overhead which represented the number of flow entry updates to recover from the failure.Experimental results demonstrate that DFR achieves recovery times under 20 milliseconds,satisfying carrier-grade requirements for rapid failure recovery.Additionally,DFR reduces switch memory usage by up to 95%compared to traditional protection methods and minimizes controller load by eliminating the need for controller intervention during failure recovery.Theresults underscore the efficiency and scalability of the DFR model,making it a practical solution for enhancing network resilience in SDN environments.展开更多
Software-defined networking(SDN)is an innovative paradigm that separates the control and data planes,introducing centralized network control.SDN is increasingly being adopted by Carrier Grade networks,offering enhance...Software-defined networking(SDN)is an innovative paradigm that separates the control and data planes,introducing centralized network control.SDN is increasingly being adopted by Carrier Grade networks,offering enhanced networkmanagement capabilities than those of traditional networks.However,because SDN is designed to ensure high-level service availability,it faces additional challenges.One of themost critical challenges is ensuring efficient detection and recovery from link failures in the data plane.Such failures can significantly impact network performance and lead to service outages,making resiliency a key concern for the effective adoption of SDN.Since the recovery process is intrinsically dependent on timely failure detection,this research surveys and analyzes the current literature on both failure detection and recovery approaches in SDN.The survey provides a critical comparison of existing failure detection techniques,highlighting their advantages and disadvantages.Additionally,it examines the current failure recovery methods,categorized as either restoration-based or protection-based,and offers a comprehensive comparison of their strengths and limitations.Lastly,future research challenges and directions are discussed to address the shortcomings of existing failure recovery methods.展开更多
According to the Japanese Ministry of Health,Labour,and Welfare,14.2%of people were aged>75 years in Japan in 2018,and this number continues to rise.With population aging,the incidence of congestive heart failure(C...According to the Japanese Ministry of Health,Labour,and Welfare,14.2%of people were aged>75 years in Japan in 2018,and this number continues to rise.With population aging,the incidence of congestive heart failure(CHF)is also increasing.[1–3]Reports have shown that the presence of cognitive impairment(CI)in patients with CHF is associated with poor prognosis,[4–6]and the degree of CI is related to CHF severity.展开更多
Patients with advanced liver cirrhosis and liver failure frequently experience abnormalities in their serum electrolyte levels.In such patients,hyponatremia has been identified as a predictor of poor outcomes.However,...Patients with advanced liver cirrhosis and liver failure frequently experience abnormalities in their serum electrolyte levels.In such patients,hyponatremia has been identified as a predictor of poor outcomes.However,emerging evidence suggests that serum chloride may provide even better prognostic information in similar situations.Hypochloremia,characterised by low serum chloride levels,has been linked to increased mortality,exacerbated organ dysfunction,and higher requirements for renal replacement therapy and vasopressors in various critical conditions,including advanced liver diseases.The pathophysiological mecha-nisms underlying the association between low serum chloride levels and poor outcomes in liver disease appear to involve complex interactions among electro-lyte imbalances,renal function,and systemic hemodynamics.Chloride dysregu-lation can influence renal salt-sensing mechanisms,disrupt acid-base homeostasis,and exacerbate complications such as hepatic encephalopathy and hepatorenal syndrome.This article aims to elucidate the prognostic significance of lower serum chloride levels in patients with advanced liver disease.By reviewing recent literature and analysing clinical data,we seek to establish serum chloride as an underutilised but valuable prognostic marker.Understanding the role of serum chloride in liver disease could enhance prognostic accuracy,refine treatment strategies,and ultimately improve patient outcomes.展开更多
BACKGROUND Patients with acute-on-chronic liver failure(ACLF)have a high mortality rate,poor prognosis,and often experience concurrent thrombocytopenia and bleeding events.AIM To evaluate the efficacy and safety of re...BACKGROUND Patients with acute-on-chronic liver failure(ACLF)have a high mortality rate,poor prognosis,and often experience concurrent thrombocytopenia and bleeding events.AIM To evaluate the efficacy and safety of recombinant human thrombopoietin(rhTPO)in patients with ACLF with concomitant severe thrombocytopenia.METHODS This was a prospective,open-label study.We assigned 70 ACLF patients with severe thrombocytopenia into the rhTPO group and control group,with 35 patients in each group.Patients in the rhTPO group received subcutaneous injections of rhTPO at a dose of 15000 IU/day for 7 consecutive days,while patients in the control group did not receive rhTPO treatment.The primary endpoint was the proportion of patients with platelet count>50×10^(9)/L on day 14.RESULTS The proportion of patients with platelet count>50×10^(9)/L on day 14 was 60.7%in the rhTPO group,which was significantly higher than that(12.0%)in the control group(P<0.001).The platelet count in the rhTPO group on day 14 was 64×10^(9)/L,exceeding the baseline of 28×10^(9)/L.Compared to the control group,the rhTPO group exhibited a significant increase in platelet count from baseline(P<0.05).Model for end-stage liver disease score,albumin level and international normalized ratio improved significantly from baseline on day 14 after rhTPO injection.The concentrations of serum thrombopoietin and hepatocyte growth factor in the rhTPO group after 7 days were 143.7 and 195.4 pg/mL,respectively,showing a significant increase from baseline(P<0.05).Eight(22.9%)patients had bleeding events in the control group compared with four(11.4%)in the rhTPO group.The incidence of 90-day mortality was also higher in the control group(6,17.1%)than that in the rhTPO group(3,8.6%).CONCLUSION rhTPO significantly increased the platelet count in ACLF patients with thrombocytopenia and reduce the occurrence of bleeding events,with a good safety profile.展开更多
The mechanical parameters and failure characteristics of sandstone under compressive-shear stress states provide crucial theoretical references for underground engineering construction.In this study,a series of varied...The mechanical parameters and failure characteristics of sandstone under compressive-shear stress states provide crucial theoretical references for underground engineering construction.In this study,a series of varied angle shear tests(VASTs)were designed using acoustic emission(AE)detection and digital image correlation technologies to evaluate the mechanical behaviors of typical red sandstone.AE signal parameters revealed differences in the number and intensity of microcracks within the sandstone,with a test angle(α)of 50°identified as a significant turning point for its failure properties.Whenα³50°,microcrack activity intensified,and the proportion of tensile cracks increased.Asαincreased,the number of fragments generated after failure decreased,fragment sizes became smaller,and the crack network simplified.Cracks extended from the two cut slits at the ends of the rock,gradually penetrating along the centerline towards the central location,as observed from the evolution of the strain concentration field.Both cohesion(c)and internal friction angle(ϕ)measured in VAST were lower than those measured under conventional triaxial compression.展开更多
Prediction of weaning success from invasive mechanical ventilation remains a challenge in everyday clinical practice.Several prediction scores have been developed to guide success during spontaneous breathing trials t...Prediction of weaning success from invasive mechanical ventilation remains a challenge in everyday clinical practice.Several prediction scores have been developed to guide success during spontaneous breathing trials to help with weaning decisions.These scores aim to provide a structured framework to support clinical judgment.However,their effectiveness varies across patient populations,and their predictive accuracy remains inconsistent.In this review,we aim to identify the strengths and limitations of commonly used clinical prediction tools in assessing readiness for ventilator liberation.While scores such as the Rapid Shallow Breathing Index and the Integrative Weaning Index are widely adopted,their sensitivity and specificity often fall short in complex clinical settings.Factors such as underlying disease pathophysiology,patient characteristics,and clinician subjectivity impact score performance and reliability.Moreover,disparities in validation across diverse populations limit generalizability.With growing interest in artificial intelligence(AI)and machine learning,there is potential for enhanced prediction models that integrate multidimensional data and adapt to individual patient profiles.However,current AI approaches face challenges related to interpretability,bias,and ethical implementation.This paper underscores the need for more robust,individualized,and transparent prediction systems and advocates for careful integration of emerging technologies into clinical workflows to optimize weaning success and patient outcomes.展开更多
BACKGROUND Anxiety and depression are prevalent among patients with chronic heart failure(CHF)and can adversely contribute to treatment adherence and clinical outcomes.Poor fluid restriction adherence is a widespread ...BACKGROUND Anxiety and depression are prevalent among patients with chronic heart failure(CHF)and can adversely contribute to treatment adherence and clinical outcomes.Poor fluid restriction adherence is a widespread challenge in the management of CHF.To effectively manage disease progression and alleviate symptoms,it is crucial to identify key influencing factors to facilitate the implementation of targeted interventions.AIM To investigate the status of anxiety and depression among patients with CHF and determine the factors contributing to poor fluid restriction adherence.METHODS Three hundred CHF patients seeking medical treatment at The First Hospital of Hunan University of Traditional Chinese Medicine between June 2021 and June 2023 were included in the study.Questionnaires,including the Psychosomatic Symptom Scale,Self-Rating Anxiety Scale,Self-Rating Depression Scale,and Fluid Restriction Adherence Questionnaire were administered to patients.Based on their anxiety and depression scores,patients were categorized into anxiety/depression and non-anxiety/depression groups,as well as fluid restriction adherence and fluid restriction non-adherence groups.General patient data were collected,and univariate and logistic regression analyses were conducted to determine the occurrence of depression and anxiety.Logistic regression analysis was used to identify independent factors influencing fluid restriction adherence.RESULTS Statistically significant differences in age,New York Heart Association(NYHA)grading,marital status,educational attainment,and family support were observed between depressed and non-depressed CHF patients(P<0.05).Age,NYHA grading,marital status,educational attainment,and family support were identified as factors influencing the development of depression.The anxiety and non-anxiety groups differed statistically in terms of gender,age,NYHA grading,smoking history,alcohol consumption history,monthly income,educational attainment,and family support(P<0.05).Gender,smoking,alcohol consumption,monthly income,and educational attainment affected anxiety in these patients.The fluid restriction adherence rate was 28.0%,and thirst sensation,anxiety,and depression were identified as independent influencing factors.CONCLUSION CHF patients are susceptible to anxiety and depression,with multiple associated influencing factors.Moreover,anxiety and depression are independent factors that can influence fluid restriction adherence in these patients.展开更多
文摘AIM:To investigate the underlying causes of surgical failure and reoperation management in patients with rhegmatogenous retinal detachment(RRD)who underwent scleral buckle surgery at our institution.METHODS:This was a single-center,retrospective,descriptive study.The clinical data of 368 patients(387 eyes)with RRD who underwent scleral buckling(SB)surgery between August 2013 and July 2023 at our institution were collected.The aim was to analyze the causes of recurrence and the rationale for selecting reoperation methods.RESULTS:Totally 368 patients(387 eyes)were included in the analysis,comprising 222 males and 146 females.The average age was 30.26±14.18 years,and the mean follow-up duration was(48.33±20.39)mo.The success rate of SB surgery was 90.2%.Recurrent retinal detachment occurred in 38 eyes.Based on surgical records,the causes of SB failure were analyzed.The recurrence causes included abnormal compression ridge position(position,height,or width)in 14 eyes(36.8%,14/38),hole omission in 11 eyes(29.0%,11/38),proliferative vitreoretinopathy(PVR)in 10 eyes(26.3%,10/38),and new holes in 3 eyes(7.9%,3/38).Among these,8 eyes(21.1%,8/38)underwent repeat SB surgery,while the remaining 30 eyes(78.9%,30/38)underwent pars plana vitrectomy(PPV).Regarding tamponade agents,silicone oil was used in 11 eyes(36.7%,11/30),C 3F 8 gas in 12 eyes(40.0%,12/30),and sterile air in 7 eyes(23.3%,7/30).CONCLUSION:SB surgery demonstrates a high success rate in the treatment of RRD.However,abnormal compression ridge position,missed holes during surgery,and PVR are the primary causes of SB failure.After addressing the reasons for failure,re-SB surgery or PPV can be effective alternatives.
文摘BACKGROUND Anxiety,depression,and other negative emotions are common among patients with chronic renal failure(CRF).Analyzing the factors related to negative emotions is necessary to provide targeted nursing care.AIM To explore the correlations among life satisfaction,pleasure levels,and negative emotions in patients with CRF.METHODS One hundred patients with CRF who received therapy at the First Affiliated Hospital of Jinzhou Medical University between December 2022 and February 2025 were included.The Depression,Anxiety,and Stress Scale(DASS-21),Satisfaction with Life Scale(SWLS),and Temporal Experience of Pleasure Scale(TEPS)were used to evaluate negative emotions,life satisfaction,and pleasure level,respectively.Pearson’s correlation coefficient analyzed the correlation between life satisfaction,pleasure level,and negative emotions.Linear regression analysis identified the factors affecting negative emotions.RESULTS The average DASS-21 score among patients with CRF was 51.90±2.30,with subscale scores of 17.90±1.50 for depression,18.53±1.18 for anxiety,and 15.47±2.36 for stress,all significantly higher than the domestic norm(P<0.05).The average SWLS score was 22.17±4.90.Correlation analysis revealed a negative correlation between the SWLS and total DASS-21 scores(P<0.05),but not with the individual depression,anxiety,or stress dimensions.The average TEPS score was 67.80±8.34.TEPS scores were negatively correlated with the DASS-21 score and the stress dimension(P<0.05),but not with depression or anxiety.Linear regression analysis showed that TEPS scores significantly influenced DASS-21 scores(P<0.05).CONCLUSION Patients with CRF experience high levels of negative emotions,which are negatively correlated with life satisfaction and pleasure.Furthermore,pleasure level had an impact on negative emotions.
文摘BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis and heart failure has rarely been observed in cases of pediatric patients with CH pathology.Here,we explored the etiological relationship between CH,heart failure,and refractory lactic acidosis to reflect the importance of thyroid function screening in neonates with heart disease.CASE SUMMARY A 33-day-old extremely premature female infant presented with tachypnea,respiratory distress,recurrent infections,and abdominal distension postnatal.On admission to our facility,she had cardiomegaly,hepatomegaly,and lactic acidosis(revealed on blood gas analysis),with lactate progressively rising to 25 mmol/L.Chest radiographs showed pulmonary congestion,while echocardiography revealed cardiac enlargement,left ventricular wall thickening,and pericardial effusion.Initial management aimed at correcting acidosis and treating heart failure proved ineffective.After reassessment,thyroid function tests showed significantly decreased triiodothyronine,free triiodothyronine,thyroxine,and free thyroxine levels,with a significantly increased thyroidstimulating hormone level,confirming a CH diagnosis.Levothyroxine was administered,resulting in rapid correction of lactic acidosis and gradual improvement of thyroid function and systemic symptoms,culminating in full recovery and discharge.We also reviewed the relevant literature on thyroid and cardiac dysfunctions in order to explore their deeper association.CONCLUSION This case links CH-induced heart failure with refractory lactic acidosis,urging prompt thyroid screening in affected neonates to reduce mortality.
基金supported by the National Natural Science Foundation of China(Nos.82430116 and 82574622)the Special Fund of Central Committee High Level Chinese Medicine Hospital(Nos.DZMG-LJRC-0014,DZMG-ZJXY-23013)+1 种基金Chinese Medicine Inheritance and Innovation“Thousand Million”Talents Project(Qihuang Project 2021)Qihuang Scholarsthe Medical and Health Industry Development Project of Tongzhou District(2023).
文摘Chronic heart failure(CHF)impairs cognitive function.Xijiaqi Formula(XJQ),a traditional Chinese medicine(TCM)used clinically to treat CHF,demonstrates potential for improving cognition in CHF patients.However,its precise mechanism in treating post-CHF cognitive dysfunction remains unclear.This study systematically investigates XJQ’s effects on post-CHF cognitive dysfunction and the underlying mechanisms.The components of XJQ were identified through liquid chromatography-mass spectrometry.CHF was induced in rats via ligation of the left anterior descending coronary artery,followed by six weeks of XJQ treatment.Cardiac function was evaluated through echocardiography and hemodynamic parameters,while cognitive function was assessed using Morris water maze(MWM)and open field tests(OFT).XJQ treatment enhanced both cardiac and cognitive functions in CHF rats.Network pharmacology identified 12 core active components of XJQ and indicated its effect on cognitive dysfunction involved regulating synapses,inflammation,and phosphodiesterase 4(PDE4)-dependent cyclic adenosine monophosphate(cAMP)signaling.XJQ inhibited microglial and astrocyte activation,decreased proinflammatory cytokines,and mitigated neuronal damage.Notably,XJQ promoted synaptic repair and dendritic growth by downregulating PDE4 and upregulating cAMP,protein kinase A(PKA),cAMP-response element binding protein(CREB),brain-derived neurotrophic factor(BDNF),PSD95,and synapsin I levels.Molecular docking and Bio-layer interferometry assays confirmed direct binding of quercetin,kaempferol,isorhamnetin,and darutoside to PDE4.In conclusion,XJQ alleviates neuroinflammation and enhances synaptic plasticity to improve cognitive dysfunction in CHF rats via the PDE4/cAMP/PKA/CREB signaling pathway.These findings provide valuable insight into the heart-brain axis.
基金Project supported by the National Key Research and Development Program of China(Grant No.2023YFA1609000)the National Natural Science Foundation of China(Grant Nos.U2341222,U2441248,12275061,and 12075069)。
文摘The failure mechanisms and structural damage of SiC MOSFETs induced by heavy ion irradiation were demonstrated.The findings reveal three degradation modes,depending on the drain voltage.At a relatively low voltage,the damage is triggered by the formation and activation of gate latent damage(LDs),with damage concentrated in the gate oxide.The second degradation mode involves permanent leakage current degradation,with damage progressively transitioning from the oxide to the SiC material as the drain voltage escalates.Ultimately,the device undergoes catastrophic burnout above certain voltages,characterized by the lattice temperature reaching the sublimation point of SiC,resulting in surface cavity and complete structural destruction.This paper presents a comprehensive investigation of SiC MOSFETs under heavy ion exposure,providing radiation resistance methods of SiC-based devices for aerospace applications.
文摘Rationale:This case report describes a couple with recurrent fertilization failure despite undergoing multiple cycles of intracytoplasmic sperm injection(ICSI).The principal clinical concern was suspected oocyte activation deficiency(OAD),in which fertilization is impeded due to the oocyte’s inability to initiate embryogenesis,commonly attributed to inadequate intracellular calcium(Ca^(2+))release following sperm injection.Patient concerns:The couple repeatedly experienced complete or near-complete fertilization failure in previous ICSI cycles,raising suspicion of an underlying oocyte activation defect.Diagnosis:Based on the repeated absence of fertilization post-ICSI and clinical history,a diagnosis of suspected OAD leading to recurrent ICSI fertilization failure was considered.Interventions:Artificial oocyte activation(AOA)using the calcium ionophore A23187 was performed.After ICSI,unfertilized oocytes were exposed to the ionophore to induce Ca^(2+)influx,simulating physiological calcium oscillations essential for oocyte activation.The efficacy of intervention was evaluated through subsequent embryonic development,morphological grading,and chromosomal integrity.Outcomes:Following AOA treatment,successful oocyte activation occurred,resulting in the formation of high-grade embryos with normal developmental progression.Chromosomal analysis revealed no detectable abnormalities,indicating genomic stability.Lessons:Calcium ionophore–mediated AOA may serve as an effective adjunct in cases of recurrent ICSI failure attributed to OAD.This case highlights the importance of individualized therapeutic strategies in assisted reproduction;however,further research is needed to refine protocols,validate broader clinical efficacy,and assess long-term safety,including potential epigenetic risks.
基金supported by the National Natural Science Foundation of China(Nos.42371094,41907253)partially supported by the Interdisciplinary Cultivation Program of Xidian University(No.21103240005)the Postdoctoral Fellowship Program of CPSF(No.GZB20240589)。
文摘INTRODUCTION.On May 1st,2024,around 2:10 a.m.,a catastrophic collapse occurred along the Meilong Expressway near Meizhou City,Guangdong Province,China,at coordinates 24°29′24″N and 116°40′25″E.This collapse resulted in a pavement failure of approximately 17.9 m in length and covering an area of about 184.3 m^(2)(Chinanews,2024).
文摘BACKGROUND Advanced heart failure and transplant(AHFTC)teams are crucial in the management of patients in cardiogenic shock.We sought to explore the impact of AHFTC physicians on outcomes in patients receiving extracorporeal membrane oxygenation(ECMO)support.AIM To determine whether outcomes differ in the care of ECMO patients when AHFTC physicians serve in a primary vs consultative role.METHODS We conducted a retrospective cohort study of 51 patients placed on veno-venous(VV)and veno-arterial(VA)ECMO between January 2015 and February 2023 at our institution.We compared ECMO outcomes between teams managed primarily by intensivists vs teams where AHFTC physicians played a direct role in ECMO management,including patient selection.Our primary outcome measure was survival to 30 days post hospital discharge.RESULTS For combined VA and VV ECMO patients,survival to 30 days post discharge in the AHFTC cohort was significantly higher(67%vs 30%,P=0.01),largely driven by a significantly increased 30-day post discharge survival in VA ECMO patients in the AHFTC group(64%vs 20%,P=0.05).CONCLUSION This study suggests that patients in shock requiring VA ECMO support may have improved survival 30 days after hospital discharge when an AHFTC team serves in a direct role in the selection and management of patients.Further studies are needed to validate this impact.
基金Supported by National Natural Science Foundation of China,No.82360136Jiangxi Clinical Research Center for Gastroenterology,No.20223BCG74011.
文摘BACKGROUND Acute pancreatitis(AP)is a severe condition,and abdominal effusion is a significant predictor of its severity and prognosis.However,the relationship between ascites characteristics and AP outcomes remains undefined.AIM To assess the correlation between ascites characteristics and clinical prognosis in AP patients by comparing color depth and turbidity of early ascites.METHODS This study included 667 AP patients with ascites,categorized by color and turbidity into yellow clear(n=54),yellow turbid(n=293),red brown(n=320).The trendχ2 test was employed to analyze the incidence of organ failure(OF),infected pancreatic necrosis(IPN),and mortality across groups.Receiver operating charac teristic(ROC)curves were used to evaluate the predictive value of ascites cell count,amylase,protein,and lactate dehydrogenase(LDH)for abdominal compartment syndrome(ACS)and intra-abdominal hemorrhage.RESULTS AP patients with ascites exhibited higher scores of scoring systems(such as Bedside index for severity in AP,Acute Physiology and Chronic Health Examination II,etc.)and increased complications and mortality rates(all P<0.05)compared to those without ascites.A linear association was observed between ascites color depth and turbidity and the incidence of OF,pancreatic necrosis,IPN,and mortality(P<0.05).LDH in ascites demonstrated high accuracy in predicting ACS and intra-abdominal hemorrhage,with areas under the ROC curve of 0.77 and 0.79,respectively.CONCLUSION Early in AP,ascites correlates with OF,IPN,and mortality,showing linear associations with color depth and turbidity.Ascitic LDH reliably predicts ACS and intra-abdominal hemorrhage in AP patients.
基金supported by the National Natural Science Foundation of China(No.82074054)Shanghai Municipal Commission of Health and Family Planning(No.ZY(2021-2023)-0208)+2 种基金Youth Program of the National Natural Science Foundation of China(No.81903831)Shanghai Municipality:Shanghai Chenguang Program(No.19CG48)Natural Science Foundation of Shanghai(No.24ZR1465900)。
文摘Lingguizhugan Decoction(LGZG)demonstrates significant efficacy in treating various cardiovascular diseases clinically,yet its precise mechanism of action remains elusive.This study aimed to elucidate the potential mechanisms and effects of LGZG on isoproterenol(ISO)continuous stimulation-induced chronic heart failure(CHF)in mice,providing direct experimental evidence for further clinical applications.In vivo,continuous ISO infusion was administered to mice,and ventricular myocytes were utilized to explore LGZG's potential mechanism of action on theβ1-adrenergic receptor(β1-AR)/Gs/G protein-coupled receptor kinases(GRKs)/β-arrestin signaling deflection system in the heart.The findings reveal that LGZG significantly reduced the messenger ribonucleic acid(mRNA)expression of hypertrophy-related biomarkers[atrial natriuretic peptide(ANP)and B-type natriuretic peptide(BNP)]and improved cardiac remodeling and left ventricular diastolic function in mice with ISO-induced CHF.Furthermore,LGZG inhibited the overactivation of Gs/cyclic adenosine monophosphate(c AMP)/protein kinase A(PKA)signaling and downregulated the downstream transcriptional activity of c AMP-response element binding protein(CREB)and the expression of the coactivator CBP/P300.Notably,LGZG downregulated the expression ofβ-arrestin1 and GRK 2/3/5 while upregulating the expression ofβ1-AR andβ-arrestin2.These results suggest that LGZG inhibits Gs/c AMP/PKA signaling andβ-arrestin/GRK-mediated desensitization and internalization ofβ1-AR,potentially exerting cardioprotective effects through the synergistic regulation of theβ1-AR/Gs/GRKs/β-arrestin signaling deflection system via multiple pathways.
文摘BACKGROUND Acute liver failure(ALF)is a life-threatening multisystemic condition with high short-term mortality.With the growing prevalence of obesity and metabolic syndrome,it is important to investigate the clinical implications of high body mass index(BMI)on survival outcomes in ALF.AIM To explore the impact of overweight and obesity on the clinical outcomes of patients with ALF.METHODS A retrospective observational cohort study was conducted involving patients with ALF admitted to the Johns Hopkins Health System between January 1,2000 and May 1,2020.We performed Cox proportional hazards regression to identify outcomes,including the need for liver transplantation(LT)or all-cause mortality.RESULTS A total of 196 patients were included,the median age was 43.5 years,63.3%were female,and 59.7%were of Caucasian ethnicity.Acetaminophen-induced ALF was the most common etiology(45%).The mean BMI was significantly greater among patients who underwent LT or died(29.64 kg/m^(2)vs 26.59 kg/m^(2),P=0.008)than among survivors.Patients with overweight and obesity had a higher risk of all-cause mortality or need for LT by 2.22-fold(95%CI:1.30-3.78)and 2.04-fold(95%CI:1.29-3.39),respectively.Elevated BMI was associated with renal failure and higher grades of hepatic encephalopathy.Derangements in serologic markers,including alanine transaminase,lactate,and ammonia,were associated with a mortality risk or need for LT.CONCLUSION In this large,retrospective study,with a diverse cohort of United States patients,Overweight and obese were independently associated with an increased risk of all-cause mortality or need for LT.This work highlights the importance of closely monitoring ALF patients who are overweight or obese for adverse complications and measures to improve outcomes in this vulnerable patient population.
文摘BACKGROUND Acute-on-chronic liver failure(ACLF)is a liver disease based on chronic liver disease,which is significantly influenced by clinical treatment regimen and disease status,and despite the existence of multiple prognostic assessment indicators for ACLF,the overall sensitivity and accuracy are relatively low.AIM To investigate the prognostic value of the combined detection of alpha-fetoprotein(AFP),plasma prothrombin activity(PTA),and serum prealbumin(PA)in ACLF.METHODS This retrospective study included 87 patients with ACLF admitted from February 2021 to February 2023 and categorized them into the survival(n=47)and death(n=40)groups according to their clinical outcomes 3 months posttreatment.All the participants underwent AFP,PTA,and PA level measurements upon admission.Baseline data,as well as AFP,PTA,and PA levels,were comparatively analyzed.Pearson correlation coefficients were utilized to analyze the correlations of AFP,PTA,and PA with different survival outcomes in patients with ACLF.Receiver operating characteristic(ROC)curves and areas under the curves were used to evaluate the predictive value of AFP,PTA,and PA for ACLF prognosis.RESULTS AFP,PTA,and PA levels were markedly decreased in the death group than in the survival group(P<0.05).Pearson analysis indicated a positive association of the AFP,PTA,and PA levels with the survival of patients with ACLF(P<0.05).ROC curve analysis determined the sensitivity and specificity of the combined diagnosis at 91.24%and 100.00%,respectively,both of which were notably increased compared to the single-index diagnosis.The ROC of their combined diagnosis was 0.989,significantly surpassing 0.907,0.849,and 0.853 of AFP,PTA,and PA,respectively.No statistically significant variance was determined in the sensitivity and specificity of the combined diagnosis vs the single detection(P>0.05).CONCLUSION The combined detection of AFP,PTA,and PA levels demonstrates favorable diagnostic value for the short-term prognosis of patients with ACLF,featuring high sensitivity and specificity.
文摘Link failure is a critical issue in large networks and must be effectively addressed.In software-defined networks(SDN),link failure recovery schemes can be categorized into proactive and reactive approaches.Reactive schemes have longer recovery times while proactive schemes provide faster recovery but overwhelm the memory of switches by flow entries.As SDN adoption grows,ensuring efficient recovery from link failures in the data plane becomes crucial.In particular,data center networks(DCNs)demand rapid recovery times and efficient resource utilization to meet carrier-grade requirements.This paper proposes an efficient Decentralized Failure Recovery(DFR)model for SDNs,meeting recovery time requirements and optimizing switch memory resource consumption.The DFR model enables switches to autonomously reroute traffic upon link failures without involving the controller,achieving fast recovery times while minimizing memory usage.DFR employs the Fast Failover Group in the OpenFlow standard for local recovery without requiring controller communication and utilizes the k-shortest path algorithm to proactively install backup paths,allowing immediate local recovery without controller intervention and enhancing overall network stability and scalability.DFR employs flow entry aggregation techniques to reduce switch memory usage.Instead of matching flow entries to the destination host’s MAC address,DFR matches packets to the destination switch’s MAC address.This reduces the switches’Ternary Content-Addressable Memory(TCAM)consumption.Additionally,DFR modifies Address Resolution Protocol(ARP)replies to provide source hosts with the destination switch’s MAC address,facilitating flow entry aggregation without affecting normal network operations.The performance of DFR is evaluated through the network emulator Mininet 2.3.1 and Ryu 3.1 as SDN controller.For different number of active flows,number of hosts per edge switch,and different network sizes,the proposed model outperformed various failure recovery models:restoration-based,protection by flow entries,protection by group entries and protection by Vlan-tagging model in terms of recovery time,switch memory consumption and controller overhead which represented the number of flow entry updates to recover from the failure.Experimental results demonstrate that DFR achieves recovery times under 20 milliseconds,satisfying carrier-grade requirements for rapid failure recovery.Additionally,DFR reduces switch memory usage by up to 95%compared to traditional protection methods and minimizes controller load by eliminating the need for controller intervention during failure recovery.Theresults underscore the efficiency and scalability of the DFR model,making it a practical solution for enhancing network resilience in SDN environments.
文摘Software-defined networking(SDN)is an innovative paradigm that separates the control and data planes,introducing centralized network control.SDN is increasingly being adopted by Carrier Grade networks,offering enhanced networkmanagement capabilities than those of traditional networks.However,because SDN is designed to ensure high-level service availability,it faces additional challenges.One of themost critical challenges is ensuring efficient detection and recovery from link failures in the data plane.Such failures can significantly impact network performance and lead to service outages,making resiliency a key concern for the effective adoption of SDN.Since the recovery process is intrinsically dependent on timely failure detection,this research surveys and analyzes the current literature on both failure detection and recovery approaches in SDN.The survey provides a critical comparison of existing failure detection techniques,highlighting their advantages and disadvantages.Additionally,it examines the current failure recovery methods,categorized as either restoration-based or protection-based,and offers a comprehensive comparison of their strengths and limitations.Lastly,future research challenges and directions are discussed to address the shortcomings of existing failure recovery methods.
文摘According to the Japanese Ministry of Health,Labour,and Welfare,14.2%of people were aged>75 years in Japan in 2018,and this number continues to rise.With population aging,the incidence of congestive heart failure(CHF)is also increasing.[1–3]Reports have shown that the presence of cognitive impairment(CI)in patients with CHF is associated with poor prognosis,[4–6]and the degree of CI is related to CHF severity.
文摘Patients with advanced liver cirrhosis and liver failure frequently experience abnormalities in their serum electrolyte levels.In such patients,hyponatremia has been identified as a predictor of poor outcomes.However,emerging evidence suggests that serum chloride may provide even better prognostic information in similar situations.Hypochloremia,characterised by low serum chloride levels,has been linked to increased mortality,exacerbated organ dysfunction,and higher requirements for renal replacement therapy and vasopressors in various critical conditions,including advanced liver diseases.The pathophysiological mecha-nisms underlying the association between low serum chloride levels and poor outcomes in liver disease appear to involve complex interactions among electro-lyte imbalances,renal function,and systemic hemodynamics.Chloride dysregu-lation can influence renal salt-sensing mechanisms,disrupt acid-base homeostasis,and exacerbate complications such as hepatic encephalopathy and hepatorenal syndrome.This article aims to elucidate the prognostic significance of lower serum chloride levels in patients with advanced liver disease.By reviewing recent literature and analysing clinical data,we seek to establish serum chloride as an underutilised but valuable prognostic marker.Understanding the role of serum chloride in liver disease could enhance prognostic accuracy,refine treatment strategies,and ultimately improve patient outcomes.
基金Supported by Tianjin Key Medical Discipline(Specialty)Construction Project,No.TJYXZDXK-034A.
文摘BACKGROUND Patients with acute-on-chronic liver failure(ACLF)have a high mortality rate,poor prognosis,and often experience concurrent thrombocytopenia and bleeding events.AIM To evaluate the efficacy and safety of recombinant human thrombopoietin(rhTPO)in patients with ACLF with concomitant severe thrombocytopenia.METHODS This was a prospective,open-label study.We assigned 70 ACLF patients with severe thrombocytopenia into the rhTPO group and control group,with 35 patients in each group.Patients in the rhTPO group received subcutaneous injections of rhTPO at a dose of 15000 IU/day for 7 consecutive days,while patients in the control group did not receive rhTPO treatment.The primary endpoint was the proportion of patients with platelet count>50×10^(9)/L on day 14.RESULTS The proportion of patients with platelet count>50×10^(9)/L on day 14 was 60.7%in the rhTPO group,which was significantly higher than that(12.0%)in the control group(P<0.001).The platelet count in the rhTPO group on day 14 was 64×10^(9)/L,exceeding the baseline of 28×10^(9)/L.Compared to the control group,the rhTPO group exhibited a significant increase in platelet count from baseline(P<0.05).Model for end-stage liver disease score,albumin level and international normalized ratio improved significantly from baseline on day 14 after rhTPO injection.The concentrations of serum thrombopoietin and hepatocyte growth factor in the rhTPO group after 7 days were 143.7 and 195.4 pg/mL,respectively,showing a significant increase from baseline(P<0.05).Eight(22.9%)patients had bleeding events in the control group compared with four(11.4%)in the rhTPO group.The incidence of 90-day mortality was also higher in the control group(6,17.1%)than that in the rhTPO group(3,8.6%).CONCLUSION rhTPO significantly increased the platelet count in ACLF patients with thrombocytopenia and reduce the occurrence of bleeding events,with a good safety profile.
基金Project(52374150)supported by the National Natural Science Foundation of ChinaProject(2021RC3007)supported by the Science and Technology Innovation Program of Hunan Province,China。
文摘The mechanical parameters and failure characteristics of sandstone under compressive-shear stress states provide crucial theoretical references for underground engineering construction.In this study,a series of varied angle shear tests(VASTs)were designed using acoustic emission(AE)detection and digital image correlation technologies to evaluate the mechanical behaviors of typical red sandstone.AE signal parameters revealed differences in the number and intensity of microcracks within the sandstone,with a test angle(α)of 50°identified as a significant turning point for its failure properties.Whenα³50°,microcrack activity intensified,and the proportion of tensile cracks increased.Asαincreased,the number of fragments generated after failure decreased,fragment sizes became smaller,and the crack network simplified.Cracks extended from the two cut slits at the ends of the rock,gradually penetrating along the centerline towards the central location,as observed from the evolution of the strain concentration field.Both cohesion(c)and internal friction angle(ϕ)measured in VAST were lower than those measured under conventional triaxial compression.
文摘Prediction of weaning success from invasive mechanical ventilation remains a challenge in everyday clinical practice.Several prediction scores have been developed to guide success during spontaneous breathing trials to help with weaning decisions.These scores aim to provide a structured framework to support clinical judgment.However,their effectiveness varies across patient populations,and their predictive accuracy remains inconsistent.In this review,we aim to identify the strengths and limitations of commonly used clinical prediction tools in assessing readiness for ventilator liberation.While scores such as the Rapid Shallow Breathing Index and the Integrative Weaning Index are widely adopted,their sensitivity and specificity often fall short in complex clinical settings.Factors such as underlying disease pathophysiology,patient characteristics,and clinician subjectivity impact score performance and reliability.Moreover,disparities in validation across diverse populations limit generalizability.With growing interest in artificial intelligence(AI)and machine learning,there is potential for enhanced prediction models that integrate multidimensional data and adapt to individual patient profiles.However,current AI approaches face challenges related to interpretability,bias,and ethical implementation.This paper underscores the need for more robust,individualized,and transparent prediction systems and advocates for careful integration of emerging technologies into clinical workflows to optimize weaning success and patient outcomes.
基金Huxiang TCM Physique Intervention Clinical Research Center,No.2023SK4061Traditional Chinese Medicine Research Project of Hunan Province,No.B2023065+4 种基金Hunan Province"14th Five-Year Plan"key specialty of TCM,No.[2023]4Hunan University of Chinese Medicine and Hospital Joint Foundation,No.2023XYLH019 and 2024XYLH365R&D Plan for Key Areas of Hunan Provincial Department of Science and Technology,No.2019SK2321Excellent Youth Program of Hunan Education Department,No.24B0346Hunan Provincial Natural Science Foundation for Young Scientists,No.2025JJ60626.
文摘BACKGROUND Anxiety and depression are prevalent among patients with chronic heart failure(CHF)and can adversely contribute to treatment adherence and clinical outcomes.Poor fluid restriction adherence is a widespread challenge in the management of CHF.To effectively manage disease progression and alleviate symptoms,it is crucial to identify key influencing factors to facilitate the implementation of targeted interventions.AIM To investigate the status of anxiety and depression among patients with CHF and determine the factors contributing to poor fluid restriction adherence.METHODS Three hundred CHF patients seeking medical treatment at The First Hospital of Hunan University of Traditional Chinese Medicine between June 2021 and June 2023 were included in the study.Questionnaires,including the Psychosomatic Symptom Scale,Self-Rating Anxiety Scale,Self-Rating Depression Scale,and Fluid Restriction Adherence Questionnaire were administered to patients.Based on their anxiety and depression scores,patients were categorized into anxiety/depression and non-anxiety/depression groups,as well as fluid restriction adherence and fluid restriction non-adherence groups.General patient data were collected,and univariate and logistic regression analyses were conducted to determine the occurrence of depression and anxiety.Logistic regression analysis was used to identify independent factors influencing fluid restriction adherence.RESULTS Statistically significant differences in age,New York Heart Association(NYHA)grading,marital status,educational attainment,and family support were observed between depressed and non-depressed CHF patients(P<0.05).Age,NYHA grading,marital status,educational attainment,and family support were identified as factors influencing the development of depression.The anxiety and non-anxiety groups differed statistically in terms of gender,age,NYHA grading,smoking history,alcohol consumption history,monthly income,educational attainment,and family support(P<0.05).Gender,smoking,alcohol consumption,monthly income,and educational attainment affected anxiety in these patients.The fluid restriction adherence rate was 28.0%,and thirst sensation,anxiety,and depression were identified as independent influencing factors.CONCLUSION CHF patients are susceptible to anxiety and depression,with multiple associated influencing factors.Moreover,anxiety and depression are independent factors that can influence fluid restriction adherence in these patients.
