This paper describes procedure for estimation of travel time on signalized arterial roads based on multiple data sources with application of dimensionality reduction. Travel time estimation approach incorporates forec...This paper describes procedure for estimation of travel time on signalized arterial roads based on multiple data sources with application of dimensionality reduction. Travel time estimation approach incorporates forecast of transportation nodes impendence and travel time on network links. Forecasting period is two hours and the estimation is based on historical data and real time data on traffic conditions. Travel time estimation combines multivariate regression, principal component analysis, KNN （k-nearest neighbours）, cross validation and EWMA （exponentially weighted moving average） methods. When comparing estimation methodologies, relevantly better results were achieved by KNN method than with EWMA method. This is true for every time interval considered except for evening time interval when signalized arterial roads were uncongested.展开更多
BACKGROUND Middle meningeal artery embolization(MMAE)is emerging as a promising treatment for chronic subdural hematoma(CSDH),serving both as an adjunct to surgery and as a primary therapeutic option depending on pati...BACKGROUND Middle meningeal artery embolization(MMAE)is emerging as a promising treatment for chronic subdural hematoma(CSDH),serving both as an adjunct to surgery and as a primary therapeutic option depending on patient presentation.Due to its low recurrence rate and minimal complications,MMAE has gained increasing acceptance among clinicians in recent years.This report presents a case of diplopia following MMAE due to the presence of a potential anastomotic artery,aiming to enhance awareness of this complication.CASE SUMMARY A 60-year-old male patient presented with a headache following head trauma,and cranial computed tomography revealed a left-sided CSDH.The patient underwent left MMAE;however,polyvinyl alcohol particles inadvertently flowed into the lacrimal artery through an anastomotic artery,resulting in diplopia due to impaired abduction of the left eye.The diplopia resolved by postoperative day 40.The patient’s headache resolved by postoperative day 7,and the hematoma completely resolved by postoperative day 108.CONCLUSION Potential anastomotic arteries in the middle meningeal artery(MMA)can lead to serious complications.Superselective angiography of the MMA or its branches prior to embolization is essential.Performing embolization distal to potential anastomotic sites can reduce risks,and the presence of an anastomosis may warrant coil embolization or termination of the procedure.展开更多
This study aims to divide traffic into meaningful clusters （regimes） and to investigate their impact on accident likelihood and accident severity. Furthermore, the likelihood of pow- ered-two-wheelers （PTWs） invol...This study aims to divide traffic into meaningful clusters （regimes） and to investigate their impact on accident likelihood and accident severity. Furthermore, the likelihood of pow- ered-two-wheelers （PTWs） involvement in an accident is examined. To achieve the aims of the study, traffic and accident data during the period 2006-2011 from two major arterials in Athens were collected and processed. Firstly, a finite mixture cluster analysis was imple- mented to classify traffic into clusters. Afterwards, discriminant analysis was carried out in order to correctly assign new cases to the existing regimes by using a training and a testing set. Lastly, Bayesian logistic regression models were developed to investigate the impact of traffic regimes on accident likelihood and severity. The findings of this study suggest that urban traffic can be divided into different regimes by using average traffic occupancy and its standard deviation, measured by nearby upstream and downstream loop detectors. The results revealed potential hazardous traffic conditions, which are discussed in the paper. In general, high occupancy values increase accident likelihood, but tend to lead slight acci- dents, while PTWs are more likely to be involved in an accident, when traffic occupancy is high. Transitions from high to low occupancy also increase accident likelihood.展开更多
Hepatocellular carcinoma(HCC)remains one of the most common cancers worldwide.Transcatheter arterial chemoembolization has become a common treatment modality for some patients with unresectable advanced HCC.Since the ...Hepatocellular carcinoma(HCC)remains one of the most common cancers worldwide.Transcatheter arterial chemoembolization has become a common treatment modality for some patients with unresectable advanced HCC.Since the introduction of nanomaterials in 1974,their use in various fields has evolved rapidly.In medical applications,nanomaterials can serve as carriers for the delivery of chemotherapeutic drugs to tumour tissues.Additionally,nanomaterials have potential for in vivo tumour imaging.This article covers the properties and uses of several kinds of nanomaterials,focusing on their use in transcatheter arterial chemoembolization for HCC treatment.This paper also discusses the limitations currently associated with the use of nanomaterials.展开更多
Objective To develop a non-invasive predictive model for coronary artery stenosis severity based on adaptive multi-modal integration of traditional Chinese and western medicine data.Methods Clinical indicators,echocar...Objective To develop a non-invasive predictive model for coronary artery stenosis severity based on adaptive multi-modal integration of traditional Chinese and western medicine data.Methods Clinical indicators,echocardiographic data,traditional Chinese medicine(TCM)tongue manifestations,and facial features were collected from patients who underwent coro-nary computed tomography angiography(CTA)in the Cardiac Care Unit(CCU)of Shanghai Tenth People's Hospital between May 1,2023 and May 1,2024.An adaptive weighted multi-modal data fusion(AWMDF)model based on deep learning was constructed to predict the severity of coronary artery stenosis.The model was evaluated using metrics including accura-cy,precision,recall,F1 score,and the area under the receiver operating characteristic(ROC)curve(AUC).Further performance assessment was conducted through comparisons with six ensemble machine learning methods,data ablation,model component ablation,and various decision-level fusion strategies.Results A total of 158 patients were included in the study.The AWMDF model achieved ex-cellent predictive performance(AUC=0.973,accuracy=0.937,precision=0.937,recall=0.929,and F1 score=0.933).Compared with model ablation,data ablation experiments,and various traditional machine learning models,the AWMDF model demonstrated superior per-formance.Moreover,the adaptive weighting strategy outperformed alternative approaches,including simple weighting,averaging,voting,and fixed-weight schemes.Conclusion The AWMDF model demonstrates potential clinical value in the non-invasive prediction of coronary artery disease and could serve as a tool for clinical decision support.展开更多
BACKGROUND Transcatheter arterial chemoembolization(TACE)is a key treatment approach for advanced invasive liver cancer(infiltrative hepatocellular carcinoma).However,its therapeutic response can be difficult to evalu...BACKGROUND Transcatheter arterial chemoembolization(TACE)is a key treatment approach for advanced invasive liver cancer(infiltrative hepatocellular carcinoma).However,its therapeutic response can be difficult to evaluate accurately using conventional two-dimensional imaging criteria due to the tumor’s diffuse and multifocal growth pattern.Volumetric imaging,especially enhanced tumor volume(ETV),offers a more comprehensive assessment.Nonetheless,bias field inhomogeneity in magnetic resonance imaging(MRI)poses challenges,potentially skewing volumetric measurements and undermining prognostic evaluation.AIM To investigate whether MRI bias field correction enhances the accuracy of volumetric assessment of infiltrative hepatocellular carcinoma treated with TACE,and to analyze how this improved measurement impacts prognostic prediction.METHODS We retrospectively collected data from 105 patients with invasive liver cancer who underwent TACE treatment at the Affiliated Hospital of Xuzhou Medical University from January 2020 to January 2024.The improved N4 bias field correction algorithm was applied to process MRI images,and the ETV before and after treatment was calculated.The ETV measurements before and after correction were compared,and their relationship with patient prognosis was analyzed.A Cox proportional hazards model was used to evaluate prognostic factors,with Martingale residual analysis determining the optimal cutoff value,followed by survival analysis.RESULTS Bias field correction significantly affected ETV measurements,with the corrected baseline ETV mean(505.235 cm^(3))being significantly lower than before correction(825.632 cm^(3),P<0.001).Cox analysis showed that the hazard ratio(HR)for corrected baseline ETV(HR=1.165,95%CI:1.069-1.268)was higher than before correction(HR=1.063,95%CI:1.031-1.095).Using 412 cm^(3) as the cutoff,the group with baseline ETV<415 cm^(3) had a longer median survival time compared to the≥415 cm^(3) group(18.523 months vs 8.926 months,P<0.001).The group with an ETV reduction rate≥41%had better prognosis than the<41%group(17.862 months vs 9.235 months,P=0.006).Multivariate analysis confirmed that ETV reduction rate(HR=0.412,P<0.001),Child-Pugh classification(HR=0.298,P<0.001),and Barcelona Clinic Liver Cancer stage(HR=0.578,P=0.045)were independent prognostic factors.CONCLUSION Volume imaging based on MRI bias field correction can improve the accuracy of evaluating the efficacy of TACE treatment for invasive liver cancer.The corrected ETV and its reduction rate can serve as independent indicators for predicting patient prognosis,providing important reference for developing individualized treatment strategies.展开更多
The chronic occlusion of intracranial arteries generally has no or mild clinical symptoms,and the clinical symptoms of acute cerebral artery occlusion are mostly manifested as severe cerebral infarction symptoms,which...The chronic occlusion of intracranial arteries generally has no or mild clinical symptoms,and the clinical symptoms of acute cerebral artery occlusion are mostly manifested as severe cerebral infarction symptoms,which often make early diagnosis difficult,thus losing the best treatment opportunity.Once cerebral infarction occurs,the consequences are difficult to recover.This is also an important reason for the high misdiagnosis rate and mortality of this disease.In this paper,the characteristics of the disease were analyzed to provide clinical reference.展开更多
Cerebral ischemia is a major health risk that requires preventive approaches in addition to drug therapy.Physical exercise enhances neurogenesis and synaptogenesis,and has been widely used for functional rehabilitatio...Cerebral ischemia is a major health risk that requires preventive approaches in addition to drug therapy.Physical exercise enhances neurogenesis and synaptogenesis,and has been widely used for functional rehabilitation after stroke.In this study,we determined whether exercise training before disease onset can alleviate the severity of cerebral ischemia.We also examined the role of exercise-induced circulating factors in these effects.Adult mice were subjected to 14 days of treadmill exercise training before surgery for middle cerebral artery occlusion.We found that this exercise pre-conditioning strategy effectively attenuated brain infarct area,inhibited gliogenesis,protected synaptic proteins,and improved novel object and spatial memory function.Further analysis showed that circulating adiponectin plays a critical role in these preventive effects of exercise.Agonist activation of adiponectin receptors by Adipo Ron mimicked the effects of exercise,while inhibiting receptor activation abolished the exercise effects.In summary,our results suggest a crucial role of circulating adiponectin in the effects of exercise pre-conditioning in protecting against cerebral ischemia and supporting the health benefits of exercise.展开更多
This editorial comments on a study by Zuo et al.The focus is on the efficacy of he-patic arterial infusion chemotherapy combined with camrelizumab and apatinib(the TRIPLET regimen),alongside microwave ablation therapy...This editorial comments on a study by Zuo et al.The focus is on the efficacy of he-patic arterial infusion chemotherapy combined with camrelizumab and apatinib(the TRIPLET regimen),alongside microwave ablation therapy,in treating advanced hepatocellular carcinoma(HCC).The potential application of this combination therapy for patients with advanced HCC is evaluated.展开更多
Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality worldwide,with advanced stages posing significant treatment challenges.Al-though hepatic arterial infusion chemotherapy(HAIC)has emerged as a...Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality worldwide,with advanced stages posing significant treatment challenges.Al-though hepatic arterial infusion chemotherapy(HAIC)has emerged as a promising modality for treating advanced HCC,particularly in Asian clinical practice,its adoption in Western medicine remains limited due to a lack of large-scale randomized controlled trials.This editorial reviews and comments on the meta-analysis conducted by Zhou et al,which evaluates the efficacy and safety of HAIC and its combination strategies for advanced HCC.The authors performed a comprehensive meta-analysis of various clinical trials and cohort studies comparing HAIC and its combinations to other first-line treatments,such as sorafenib and transarterial chemoembolization(TACE).In this work,HAIC showed significantly better results regarding overall survival and progression-free survival compared to sorafenib or TACE alone and their combination.HAIC in combination with lenvatinib,ablation,programmed cell death 1 inhibitors,and radiotherapy further enhanced patient outcomes,indicating a synergistic effect.This editorial focuses on the critical role of multimodal treatment strategies in managing advanced HCC.It advocates for a paradigm shift towards integrated treatment approaches to enhance survival rates and improve the quality of life in patients with advanced HCC.展开更多
Kawasaki disease(KD)is a significant pediatric vasculitis known for its potential to cause severe coronary artery complications.Despite the effectiveness of initial treatments,such as intravenous immunoglobulin,KD pat...Kawasaki disease(KD)is a significant pediatric vasculitis known for its potential to cause severe coronary artery complications.Despite the effectiveness of initial treatments,such as intravenous immunoglobulin,KD patients can experience long-term cardiovascular issues,as evidenced by a recent case report of an adult who suffered a ST-segment elevation myocardial infarction due to previous KD in the World Journal of Clinical Cases.This editorial emphasizes the critical need for long-term management and regular surveillance to prevent such complications.By drawing on recent research and case studies,we advocate for a structured approach to follow-up care that includes routine cardiac evaluations and preventive measures.展开更多
This study examines the pivotal findings of the network meta-analysis of Zhou et al,which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinom...This study examines the pivotal findings of the network meta-analysis of Zhou et al,which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinoma(HCC).This meta-analysis suggests that therapeutic combinations have greater efficacy than do standard treatments.The article highlights the key insights that have the potential to shift current clinical practice and enhance outcomes for patients with advanced HCC.Additionally,this article discusses further research that can be conducted to optimize these treatments and achieve personalized care for patients with HCC.展开更多
This article provides a detailed account of the diagnosis and treatment of a case involving a uterine artery pseudoaneurysm(UAP),as well as an analysis of UAP etiology.This finding emphasizes that UAP should be consid...This article provides a detailed account of the diagnosis and treatment of a case involving a uterine artery pseudoaneurysm(UAP),as well as an analysis of UAP etiology.This finding emphasizes that UAP should be considered in patients presenting with abnormal genital bleeding after hysteroscopy and offers valuable insights and lessons for gynecologists in hysteroscopic procedures.The patient underwent timely relevant examinations to confirm the diagnosis,allowing for crucial time required for her treatment.In this study,the primary cause of UAP formation in the patient was attributed to a prior hysteroscopic surgical procedure conducted at another medical facility,suggesting that the selection and imple-mentation of dilatation catheters are some of the predisposing factors for UAP.In conclusion,this case study offers a comprehensive analysis of the etiology of UAP and effectively provides timely diagnosis and treatment,offering valuable in-sights for the clinical diagnosis and management of UAP.展开更多
In this article,we comment on the paper by Kakinuma et al published recently.We focus specifically on the diagnosis of uterine pseudoaneurysm,but we also review other uterine vascular anomalies that may be the cause o...In this article,we comment on the paper by Kakinuma et al published recently.We focus specifically on the diagnosis of uterine pseudoaneurysm,but we also review other uterine vascular anomalies that may be the cause of life-threating hemorrhage and the different causes of uterine pseudoaneurysms.Uterine artery pseudoaneurysm is a complication of both surgical gynecological and nontraumatic procedures.Massive hemorrhage is the consequence of the rupture of the pseudoaneurysm.Uterine artery pseudoaneurysm can develop after obstetric or gynecological procedures,being the most frequent after cesarean or vaginal deliveries,curettage and even during pregnancy.However,there are several cases described unrelated to pregnancy,such as after conization,hysteroscopic surgery or laparoscopic myomectomy.Hemorrhage is the clinical manifestation and it can be life-threatening so suspicion of this vascular lesion is essential for early diagnosis and treatment.However,there are other uterine vascular anomalies that may be the cause of severe hemorrhage,which must be taken into account in the differential diagnosis.Computed tomography angiography and embolization is supposed to be the first therapeutic option in most of them.展开更多
BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the c...BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the cardiovascular outcomes of these patients in association with coronavirus disease 2019(COVID-19).CASE SUMMARY A 34-year-old woman with a history of Alagille syndrome who underwent successful atrial septal defect with partial anomalous pulmonary veins and patent ductus arteriosus repair,as well as left pulmonary artery catheterization and stenting in childhood due to pulmonary stenosis.The patient was without any respiratory symptoms and was a dancer prior to contracting COVID-19.Several weeks after her COVID-19 infection,she developed left pulmonary artery stent thrombosis and subsequent symptomatic pulmonary hypertension.A treatment strategy of anticoagulation alongside pharmacological agents for pulmonary hypertension for 3 months followed by balloon pulmonary artery angioplasty to reopen the stenosis was unsuccessful.CONCLUSION In the era of COVID-19,patients with pulmonary vascular malformations and endovascular stents are at an increased risk for chronic thromboembolic disease.Patients may benefit from prophylactic antiplatelet or anticoagulation therapy.Stent thrombosis is a devastating phenomenon and should be treated urgently and aggressively with balloon pulmonary angioplasty,and/or a thrombolytic agent.展开更多
Human neural stem cell-derived extracellular vesicles exhibit analogous functions to their parental cells,and can thus be used as substitutes for stem cells in stem cell therapy,thereby mitigating the risks of stem ce...Human neural stem cell-derived extracellular vesicles exhibit analogous functions to their parental cells,and can thus be used as substitutes for stem cells in stem cell therapy,thereby mitigating the risks of stem cell therapy and advancing the frontiers of stem cell-derived treatments.This lays a foundation for the development of potentially potent new treatment modalities for ischemic stroke.However,the precise mechanisms underlying the efficacy and safety of human neural stem cell-derived extracellular vesicles remain unclear,presenting challenges for clinical translation.To promote the translation of therapy based on human neural stem cell-derived extracellular vesicles from the bench to the bedside,we conducted a comprehensive preclinical study to evaluate the efficacy and safety of human neural stem cell-derived extracellular vesicles in the treatment of ischemic stroke.We found that administration of human neural stem cell-derived extracellular vesicles to an ischemic stroke rat model reduced the volume of cerebral infarction and promoted functional recovery by alleviating neuronal apoptosis.The human neural stem cell-derived extracellular vesicles reduced neuronal apoptosis by enhancing phosphorylation of phosphoinositide 3-kinase,mammalian target of rapamycin,and protein kinase B,and these effects were reversed by treatment with a phosphoinositide 3-kinase inhibitor.These findings suggest that human neural stem cell-derived extracellular vesicles play a neuroprotective role in ischemic stroke through activation of phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin signaling pathway.Finally,we showed that human neural stem cell-derived extracellular vesicles have a good in vivo safety profile.Therefore,human neural stem cell-derived extracellular vesicles are a promising potential agent for the treatment of ischemic stroke.展开更多
BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of ...BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of patients after pancreatic resections.Globally recognized superior mesenteric artery(SMA)first approaches are invariably performed.The mesenteric dissection through the inferior infracolic approach has been discussed in this study emphasizing its post-operative impact on CL which is the cornerstone of this study.AIM To assess incidence,risk factors,clinical impact of CL following root of mesentery dissection,and the different treatment modalities.METHODS This is a retrospective study incorporating the patients who underwent dissection of the root of mesentery with inferior infracolic SMA first approach pancreat-oduodenectomy for the ventral body and uncinate mass of pancreas in the Department of Gastrointestinal and General Surgery of Kathmandu Medical College and Teaching Hospital from January 1,2021 to February 28,2024.Intraop-erative findings and postoperative outcomes were analyzed.RESULTS In three years,ten patients underwent root of mesentery dissection with inferior infracolic SMA first approach pancreatoduodenectomy.The mean age was 67.6 years with a male-to-female ratio of 4:5.CL was seen in four patients.With virtue of CL,Clavien-Dindo grade Ⅱ or higher morbidity was observed in four patients.Two patients had a hospital stay of more than 20 days with the former having a delayed gastric emptying and the latter with long-term total parenteral nutrition requirement.The mean operative time was 330 minutes.Curative resection was achieved in 100%of the patients.The mean duration of the intensive care unit and hospital stay were 2.55±1.45 days and 15.7±5.32 days,respectively.CONCLUSION Root of mesentery dissection with lymphadenectomy and vascular resection correlated with occurrence of CL.After complete curative resection,these were managed with total parenteral nutrition without adversely impacting outcome.展开更多
文摘This paper describes procedure for estimation of travel time on signalized arterial roads based on multiple data sources with application of dimensionality reduction. Travel time estimation approach incorporates forecast of transportation nodes impendence and travel time on network links. Forecasting period is two hours and the estimation is based on historical data and real time data on traffic conditions. Travel time estimation combines multivariate regression, principal component analysis, KNN （k-nearest neighbours）, cross validation and EWMA （exponentially weighted moving average） methods. When comparing estimation methodologies, relevantly better results were achieved by KNN method than with EWMA method. This is true for every time interval considered except for evening time interval when signalized arterial roads were uncongested.
文摘BACKGROUND Middle meningeal artery embolization(MMAE)is emerging as a promising treatment for chronic subdural hematoma(CSDH),serving both as an adjunct to surgery and as a primary therapeutic option depending on patient presentation.Due to its low recurrence rate and minimal complications,MMAE has gained increasing acceptance among clinicians in recent years.This report presents a case of diplopia following MMAE due to the presence of a potential anastomotic artery,aiming to enhance awareness of this complication.CASE SUMMARY A 60-year-old male patient presented with a headache following head trauma,and cranial computed tomography revealed a left-sided CSDH.The patient underwent left MMAE;however,polyvinyl alcohol particles inadvertently flowed into the lacrimal artery through an anastomotic artery,resulting in diplopia due to impaired abduction of the left eye.The diplopia resolved by postoperative day 40.The patient’s headache resolved by postoperative day 7,and the hematoma completely resolved by postoperative day 108.CONCLUSION Potential anastomotic arteries in the middle meningeal artery(MMA)can lead to serious complications.Superselective angiography of the MMA or its branches prior to embolization is essential.Performing embolization distal to potential anastomotic sites can reduce risks,and the presence of an anastomosis may warrant coil embolization or termination of the procedure.
基金supported by the special fund for research grants of NTUA for PhD studies
文摘This study aims to divide traffic into meaningful clusters （regimes） and to investigate their impact on accident likelihood and accident severity. Furthermore, the likelihood of pow- ered-two-wheelers （PTWs） involvement in an accident is examined. To achieve the aims of the study, traffic and accident data during the period 2006-2011 from two major arterials in Athens were collected and processed. Firstly, a finite mixture cluster analysis was imple- mented to classify traffic into clusters. Afterwards, discriminant analysis was carried out in order to correctly assign new cases to the existing regimes by using a training and a testing set. Lastly, Bayesian logistic regression models were developed to investigate the impact of traffic regimes on accident likelihood and severity. The findings of this study suggest that urban traffic can be divided into different regimes by using average traffic occupancy and its standard deviation, measured by nearby upstream and downstream loop detectors. The results revealed potential hazardous traffic conditions, which are discussed in the paper. In general, high occupancy values increase accident likelihood, but tend to lead slight acci- dents, while PTWs are more likely to be involved in an accident, when traffic occupancy is high. Transitions from high to low occupancy also increase accident likelihood.
文摘Hepatocellular carcinoma(HCC)remains one of the most common cancers worldwide.Transcatheter arterial chemoembolization has become a common treatment modality for some patients with unresectable advanced HCC.Since the introduction of nanomaterials in 1974,their use in various fields has evolved rapidly.In medical applications,nanomaterials can serve as carriers for the delivery of chemotherapeutic drugs to tumour tissues.Additionally,nanomaterials have potential for in vivo tumour imaging.This article covers the properties and uses of several kinds of nanomaterials,focusing on their use in transcatheter arterial chemoembolization for HCC treatment.This paper also discusses the limitations currently associated with the use of nanomaterials.
基金Construction Program of the Key Discipline of State Administration of Traditional Chinese Medicine of China(ZYYZDXK-2023069)Research Project of Shanghai Municipal Health Commission (2024QN018)Shanghai University of Traditional Chinese Medicine Science and Technology Development Program (23KFL005)。
文摘Objective To develop a non-invasive predictive model for coronary artery stenosis severity based on adaptive multi-modal integration of traditional Chinese and western medicine data.Methods Clinical indicators,echocardiographic data,traditional Chinese medicine(TCM)tongue manifestations,and facial features were collected from patients who underwent coro-nary computed tomography angiography(CTA)in the Cardiac Care Unit(CCU)of Shanghai Tenth People's Hospital between May 1,2023 and May 1,2024.An adaptive weighted multi-modal data fusion(AWMDF)model based on deep learning was constructed to predict the severity of coronary artery stenosis.The model was evaluated using metrics including accura-cy,precision,recall,F1 score,and the area under the receiver operating characteristic(ROC)curve(AUC).Further performance assessment was conducted through comparisons with six ensemble machine learning methods,data ablation,model component ablation,and various decision-level fusion strategies.Results A total of 158 patients were included in the study.The AWMDF model achieved ex-cellent predictive performance(AUC=0.973,accuracy=0.937,precision=0.937,recall=0.929,and F1 score=0.933).Compared with model ablation,data ablation experiments,and various traditional machine learning models,the AWMDF model demonstrated superior per-formance.Moreover,the adaptive weighting strategy outperformed alternative approaches,including simple weighting,averaging,voting,and fixed-weight schemes.Conclusion The AWMDF model demonstrates potential clinical value in the non-invasive prediction of coronary artery disease and could serve as a tool for clinical decision support.
文摘BACKGROUND Transcatheter arterial chemoembolization(TACE)is a key treatment approach for advanced invasive liver cancer(infiltrative hepatocellular carcinoma).However,its therapeutic response can be difficult to evaluate accurately using conventional two-dimensional imaging criteria due to the tumor’s diffuse and multifocal growth pattern.Volumetric imaging,especially enhanced tumor volume(ETV),offers a more comprehensive assessment.Nonetheless,bias field inhomogeneity in magnetic resonance imaging(MRI)poses challenges,potentially skewing volumetric measurements and undermining prognostic evaluation.AIM To investigate whether MRI bias field correction enhances the accuracy of volumetric assessment of infiltrative hepatocellular carcinoma treated with TACE,and to analyze how this improved measurement impacts prognostic prediction.METHODS We retrospectively collected data from 105 patients with invasive liver cancer who underwent TACE treatment at the Affiliated Hospital of Xuzhou Medical University from January 2020 to January 2024.The improved N4 bias field correction algorithm was applied to process MRI images,and the ETV before and after treatment was calculated.The ETV measurements before and after correction were compared,and their relationship with patient prognosis was analyzed.A Cox proportional hazards model was used to evaluate prognostic factors,with Martingale residual analysis determining the optimal cutoff value,followed by survival analysis.RESULTS Bias field correction significantly affected ETV measurements,with the corrected baseline ETV mean(505.235 cm^(3))being significantly lower than before correction(825.632 cm^(3),P<0.001).Cox analysis showed that the hazard ratio(HR)for corrected baseline ETV(HR=1.165,95%CI:1.069-1.268)was higher than before correction(HR=1.063,95%CI:1.031-1.095).Using 412 cm^(3) as the cutoff,the group with baseline ETV<415 cm^(3) had a longer median survival time compared to the≥415 cm^(3) group(18.523 months vs 8.926 months,P<0.001).The group with an ETV reduction rate≥41%had better prognosis than the<41%group(17.862 months vs 9.235 months,P=0.006).Multivariate analysis confirmed that ETV reduction rate(HR=0.412,P<0.001),Child-Pugh classification(HR=0.298,P<0.001),and Barcelona Clinic Liver Cancer stage(HR=0.578,P=0.045)were independent prognostic factors.CONCLUSION Volume imaging based on MRI bias field correction can improve the accuracy of evaluating the efficacy of TACE treatment for invasive liver cancer.The corrected ETV and its reduction rate can serve as independent indicators for predicting patient prognosis,providing important reference for developing individualized treatment strategies.
基金Supported by the Science and Technology Program of Nantong Health Committee,No.MA2019003 and No.MA2021017Kangda College of Nanjing Medical University,No.KD2021JYYJYB025,No.KD2022KYJJZD019,and No.KD2022KYJJZD022+1 种基金Research Project of Nantong Health and Health Commission,No.MS2023041the Science and Technology Program of Nantong City,No.Key003 and No.JCZ2022040.
文摘The chronic occlusion of intracranial arteries generally has no or mild clinical symptoms,and the clinical symptoms of acute cerebral artery occlusion are mostly manifested as severe cerebral infarction symptoms,which often make early diagnosis difficult,thus losing the best treatment opportunity.Once cerebral infarction occurs,the consequences are difficult to recover.This is also an important reason for the high misdiagnosis rate and mortality of this disease.In this paper,the characteristics of the disease were analyzed to provide clinical reference.
基金supported by STI2030-Major Projects,No.2022ZD0207600(to LZ)the National Natural Science Foundation of China,Nos.32070955(to LZ),U22A20301(to KFS)+3 种基金the Natural Science Foundation of Guangdong Province,No.2021A1515012197(to HO)Guangzhou Core Medical Disciplines Project,No.2021-2023(to HO)Key Research and Development Plan of Ningxia Hui Automomous Region,No.2022BEG01004(to KFS)Science and Technology Program of Guangzhou,China,No.202007030012(to KFS and LZ)。
文摘Cerebral ischemia is a major health risk that requires preventive approaches in addition to drug therapy.Physical exercise enhances neurogenesis and synaptogenesis,and has been widely used for functional rehabilitation after stroke.In this study,we determined whether exercise training before disease onset can alleviate the severity of cerebral ischemia.We also examined the role of exercise-induced circulating factors in these effects.Adult mice were subjected to 14 days of treadmill exercise training before surgery for middle cerebral artery occlusion.We found that this exercise pre-conditioning strategy effectively attenuated brain infarct area,inhibited gliogenesis,protected synaptic proteins,and improved novel object and spatial memory function.Further analysis showed that circulating adiponectin plays a critical role in these preventive effects of exercise.Agonist activation of adiponectin receptors by Adipo Ron mimicked the effects of exercise,while inhibiting receptor activation abolished the exercise effects.In summary,our results suggest a crucial role of circulating adiponectin in the effects of exercise pre-conditioning in protecting against cerebral ischemia and supporting the health benefits of exercise.
文摘This editorial comments on a study by Zuo et al.The focus is on the efficacy of he-patic arterial infusion chemotherapy combined with camrelizumab and apatinib(the TRIPLET regimen),alongside microwave ablation therapy,in treating advanced hepatocellular carcinoma(HCC).The potential application of this combination therapy for patients with advanced HCC is evaluated.
文摘Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality worldwide,with advanced stages posing significant treatment challenges.Al-though hepatic arterial infusion chemotherapy(HAIC)has emerged as a promising modality for treating advanced HCC,particularly in Asian clinical practice,its adoption in Western medicine remains limited due to a lack of large-scale randomized controlled trials.This editorial reviews and comments on the meta-analysis conducted by Zhou et al,which evaluates the efficacy and safety of HAIC and its combination strategies for advanced HCC.The authors performed a comprehensive meta-analysis of various clinical trials and cohort studies comparing HAIC and its combinations to other first-line treatments,such as sorafenib and transarterial chemoembolization(TACE).In this work,HAIC showed significantly better results regarding overall survival and progression-free survival compared to sorafenib or TACE alone and their combination.HAIC in combination with lenvatinib,ablation,programmed cell death 1 inhibitors,and radiotherapy further enhanced patient outcomes,indicating a synergistic effect.This editorial focuses on the critical role of multimodal treatment strategies in managing advanced HCC.It advocates for a paradigm shift towards integrated treatment approaches to enhance survival rates and improve the quality of life in patients with advanced HCC.
文摘Kawasaki disease(KD)is a significant pediatric vasculitis known for its potential to cause severe coronary artery complications.Despite the effectiveness of initial treatments,such as intravenous immunoglobulin,KD patients can experience long-term cardiovascular issues,as evidenced by a recent case report of an adult who suffered a ST-segment elevation myocardial infarction due to previous KD in the World Journal of Clinical Cases.This editorial emphasizes the critical need for long-term management and regular surveillance to prevent such complications.By drawing on recent research and case studies,we advocate for a structured approach to follow-up care that includes routine cardiac evaluations and preventive measures.
文摘This study examines the pivotal findings of the network meta-analysis of Zhou et al,which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinoma(HCC).This meta-analysis suggests that therapeutic combinations have greater efficacy than do standard treatments.The article highlights the key insights that have the potential to shift current clinical practice and enhance outcomes for patients with advanced HCC.Additionally,this article discusses further research that can be conducted to optimize these treatments and achieve personalized care for patients with HCC.
文摘This article provides a detailed account of the diagnosis and treatment of a case involving a uterine artery pseudoaneurysm(UAP),as well as an analysis of UAP etiology.This finding emphasizes that UAP should be considered in patients presenting with abnormal genital bleeding after hysteroscopy and offers valuable insights and lessons for gynecologists in hysteroscopic procedures.The patient underwent timely relevant examinations to confirm the diagnosis,allowing for crucial time required for her treatment.In this study,the primary cause of UAP formation in the patient was attributed to a prior hysteroscopic surgical procedure conducted at another medical facility,suggesting that the selection and imple-mentation of dilatation catheters are some of the predisposing factors for UAP.In conclusion,this case study offers a comprehensive analysis of the etiology of UAP and effectively provides timely diagnosis and treatment,offering valuable in-sights for the clinical diagnosis and management of UAP.
文摘In this article,we comment on the paper by Kakinuma et al published recently.We focus specifically on the diagnosis of uterine pseudoaneurysm,but we also review other uterine vascular anomalies that may be the cause of life-threating hemorrhage and the different causes of uterine pseudoaneurysms.Uterine artery pseudoaneurysm is a complication of both surgical gynecological and nontraumatic procedures.Massive hemorrhage is the consequence of the rupture of the pseudoaneurysm.Uterine artery pseudoaneurysm can develop after obstetric or gynecological procedures,being the most frequent after cesarean or vaginal deliveries,curettage and even during pregnancy.However,there are several cases described unrelated to pregnancy,such as after conization,hysteroscopic surgery or laparoscopic myomectomy.Hemorrhage is the clinical manifestation and it can be life-threatening so suspicion of this vascular lesion is essential for early diagnosis and treatment.However,there are other uterine vascular anomalies that may be the cause of severe hemorrhage,which must be taken into account in the differential diagnosis.Computed tomography angiography and embolization is supposed to be the first therapeutic option in most of them.
文摘BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the cardiovascular outcomes of these patients in association with coronavirus disease 2019(COVID-19).CASE SUMMARY A 34-year-old woman with a history of Alagille syndrome who underwent successful atrial septal defect with partial anomalous pulmonary veins and patent ductus arteriosus repair,as well as left pulmonary artery catheterization and stenting in childhood due to pulmonary stenosis.The patient was without any respiratory symptoms and was a dancer prior to contracting COVID-19.Several weeks after her COVID-19 infection,she developed left pulmonary artery stent thrombosis and subsequent symptomatic pulmonary hypertension.A treatment strategy of anticoagulation alongside pharmacological agents for pulmonary hypertension for 3 months followed by balloon pulmonary artery angioplasty to reopen the stenosis was unsuccessful.CONCLUSION In the era of COVID-19,patients with pulmonary vascular malformations and endovascular stents are at an increased risk for chronic thromboembolic disease.Patients may benefit from prophylactic antiplatelet or anticoagulation therapy.Stent thrombosis is a devastating phenomenon and should be treated urgently and aggressively with balloon pulmonary angioplasty,and/or a thrombolytic agent.
基金supported by the National Nature Science Foundation of China,No.81471308(to JL)the Innovative Leading Talents of Liaoning Province,No.XLYC1902031(to JL)+2 种基金Science and Technology Projects in Liaoning Province,No.2022-BS-238(to CH)Young Top Talents of Liaoning Province,No.XLYC1907009(to LW)Dalian Science and Technology Innovation Fund,No.2018J11CY025(to JL)。
文摘Human neural stem cell-derived extracellular vesicles exhibit analogous functions to their parental cells,and can thus be used as substitutes for stem cells in stem cell therapy,thereby mitigating the risks of stem cell therapy and advancing the frontiers of stem cell-derived treatments.This lays a foundation for the development of potentially potent new treatment modalities for ischemic stroke.However,the precise mechanisms underlying the efficacy and safety of human neural stem cell-derived extracellular vesicles remain unclear,presenting challenges for clinical translation.To promote the translation of therapy based on human neural stem cell-derived extracellular vesicles from the bench to the bedside,we conducted a comprehensive preclinical study to evaluate the efficacy and safety of human neural stem cell-derived extracellular vesicles in the treatment of ischemic stroke.We found that administration of human neural stem cell-derived extracellular vesicles to an ischemic stroke rat model reduced the volume of cerebral infarction and promoted functional recovery by alleviating neuronal apoptosis.The human neural stem cell-derived extracellular vesicles reduced neuronal apoptosis by enhancing phosphorylation of phosphoinositide 3-kinase,mammalian target of rapamycin,and protein kinase B,and these effects were reversed by treatment with a phosphoinositide 3-kinase inhibitor.These findings suggest that human neural stem cell-derived extracellular vesicles play a neuroprotective role in ischemic stroke through activation of phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin signaling pathway.Finally,we showed that human neural stem cell-derived extracellular vesicles have a good in vivo safety profile.Therefore,human neural stem cell-derived extracellular vesicles are a promising potential agent for the treatment of ischemic stroke.
文摘BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of patients after pancreatic resections.Globally recognized superior mesenteric artery(SMA)first approaches are invariably performed.The mesenteric dissection through the inferior infracolic approach has been discussed in this study emphasizing its post-operative impact on CL which is the cornerstone of this study.AIM To assess incidence,risk factors,clinical impact of CL following root of mesentery dissection,and the different treatment modalities.METHODS This is a retrospective study incorporating the patients who underwent dissection of the root of mesentery with inferior infracolic SMA first approach pancreat-oduodenectomy for the ventral body and uncinate mass of pancreas in the Department of Gastrointestinal and General Surgery of Kathmandu Medical College and Teaching Hospital from January 1,2021 to February 28,2024.Intraop-erative findings and postoperative outcomes were analyzed.RESULTS In three years,ten patients underwent root of mesentery dissection with inferior infracolic SMA first approach pancreatoduodenectomy.The mean age was 67.6 years with a male-to-female ratio of 4:5.CL was seen in four patients.With virtue of CL,Clavien-Dindo grade Ⅱ or higher morbidity was observed in four patients.Two patients had a hospital stay of more than 20 days with the former having a delayed gastric emptying and the latter with long-term total parenteral nutrition requirement.The mean operative time was 330 minutes.Curative resection was achieved in 100%of the patients.The mean duration of the intensive care unit and hospital stay were 2.55±1.45 days and 15.7±5.32 days,respectively.CONCLUSION Root of mesentery dissection with lymphadenectomy and vascular resection correlated with occurrence of CL.After complete curative resection,these were managed with total parenteral nutrition without adversely impacting outcome.
