BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for ...BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.AIM To investigate the analgesic effect and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.METHODS In this retrospective study,94 patients scheduled for laparoscopic minimally invasive surgery for inguinal hernia,admitted to Yiwu Central Hospital between May 2022 and May 2023,were divided into a control group(inhalation combined general anesthesia)and a treatment group(dexmedetomidine-assisted intrave-nous-inhalation combined general anesthesia).Perioperative indicators,analgesic effect,preoperative and postoperative 24-hours blood pressure(BP)and heart rate(HR),stress indicators,immune function levels,and adverse reactions were com-pared between the two groups.RESULTS Baseline data,including age,hernia location,place of residence,weight,monthly income,education level,and underlying diseases,were not significantly different between the two groups,indicating comparability(P>0.05).No significant difference was found in operation time and anesthesia time between the two groups(P>0.05).However,the treatment group exhibited a shorter postoperative urinary catheter removal time and hospital stay than the control group(P<0.05).Preoperatively,no significant differences were found in the visual analog scale(VAS)scores between the two groups(P>0.05).However,at 12,18,and 24 hours postoper-atively,the treatment group had significantly lower VAS scores than the control group(P<0.05).Although no significant differences in preoperative hemodynamic indicators were found between the two groups(P>0.05),both groups experienced some extent of changes in postoperative HR,diastolic BP(DBP),and systolic BP(SBP).Nevertheless,the treatment group showed smaller changes in HR,DBP,and SBP than the control group(P<0.05).Preoperative immune function indicators showed no significant differences between the two groups(P>0.05).However,postoperatively,the treatment group demonstrated higher levels of CD3+,CD4+,and CD4+/CD8+and lower levels of CD8+than the control group(P<0.05).The rates of adverse reactions were 6.38%and 23.40%in the treatment and control groups,respectively,revealing a significant difference(χ2=5.371,P=0.020).CONCLUSION Dexmedetomidine-assisted intravenous-inhalation combined general anesthesia can promote early recovery of patients undergoing laparoscopic minimally invasive surgery for inguinal hernia.It ensures stable blood flow,improves postoperative analgesic effects,reduces postoperative pain intensity,alleviates stress response,improves immune function,facilitates anesthesia recovery,and enhances safety.展开更多
BACKGROUND Type 2 diabetes mellitus(T2DM),a chronic metabolic disease with a high global incidence,has become a serious public health challenge.China has the largest number of T2DM patients worldwide,imposing a signif...BACKGROUND Type 2 diabetes mellitus(T2DM),a chronic metabolic disease with a high global incidence,has become a serious public health challenge.China has the largest number of T2DM patients worldwide,imposing a significant economic burden on the healthcare system.T2DM is closely associated with insulin resistance,impaired pancreatic B cell function,and disordered glucose and lipid metabolism,which can lead to various complications,reducing patients'quality of life and increasing the risk of disability and death.Thus,finding effective preventive and intervention measures is crucial.Exercise therapy,a key part of diabetes management,has gained attention in recent years,with many studies indicating its benefits for blood glucose control and other aspects in diabetic patients.AIM To assess the effectiveness of combined resistance and aerobic exercise interventions on blood glucose control and metabolic indicators in patients with T2DM and to explore their application in diabetes management.METHODS Systematic searches were conducted using PubMed,EMBASE,Cochrane Library,and Chinese databases for relevant randomized controlled trials(RCTs).The inclusion criteria were participants aged≥18 years with T2DM and the intervention involved combined resistance and aerobic exercise for≥8 weeks.The primary outcome indicators were fasting blood glucose,low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),triglycerides(TG),glycated hemoglobin A1c(HbA1c),and total cholesterol(TC)levels.Data analysis was performed using RevMan software,and the interventional effects were assessed using weighted mean differences or standardized mean differences(SMD).RESULTS Six RCTs meeting the inclusion criteria were included,with a total sample size of 366 participants.The meta-analysis results showed that combined resistance and aerobic exercise significantly improved several metabolic indicators in patients with T2DM.Specific results were as follows:(1)For fasting blood glucose,combined exercise was more effective than aerobic exercise alone[SMD=1.22;95%confidence interval(95%CI):0.70,1.74;P<0.00001];(2)LDL-C levels were significantly reduced by the combined intervention(SMD=1.45;95%CI:1.18-1.72;P<0.00001);(3)The combined intervention significantly increased HDL-C levels(SMD=1.42;95%CI:0.98-1.87;P<0.00001);(4)The combined intervention significantly reduced TG levels(SMD=1.12;95%CI:0.85-1.39;P<0.00001;(5)No statistically significant difference was observed in HbA1c between the combined and the aerobic exercise group(SMD=-0.03;95%CI:-1.09 to 1.04;P<0.00001);and(6)The combined exercise intervention group significantly reduced TC levels(SMD=2.66;95%CI:1.93-3.38;P<0.00001).The subgroup analysis results suggest that the effect of exercise interventions may be influenced by various factors,including the patient's age,baseline blood glucose levels,and exercise intensity.CONCLUSION Combined resistance and aerobic exercise intervention significantly improved fasting blood glucose,LDL-C,HDL-C,TG,and TC levels in patients with T2DM,especially in terms of blood glucose control and cardiovascular risk,demonstrating better outcomes than aerobic exercise alone.展开更多
Prepulse combined hydraulic fracturing facilitates the development of fracture networks by integrating prepulse hydraulic loading with conventional hydraulic fracturing.The formation mechanisms of fracture networks be...Prepulse combined hydraulic fracturing facilitates the development of fracture networks by integrating prepulse hydraulic loading with conventional hydraulic fracturing.The formation mechanisms of fracture networks between hydraulic and pre-existing fractures under different prepulse loading parameters remain unclear.This research investigates the impact of prepulse loading parameters,including the prepulse loading number ratio(C),prepulse loading stress ratio(S),and prepulse loading frequency(f),on the formation of fracture networks between hydraulic and pre-existing fractures,using both experimental and numerical methods.The results suggest that low prepulse loading stress ratios and high prepulse loading number ratios are advantageous loading modes.Multiple hydraulic fractures are generated in the specimen under the advantageous loading modes,facilitating the development of a complex fracture network.Fatigue damage occurs in the specimen at the prepulse loading stage.The high water pressure at the secondary conventional hydraulic fracturing promotes the growth of hydraulic fractures along the damage zones.This allows the hydraulic fractures to propagate deeply and interact with pre-existing fractures.Under advantageous loading conditions,multiple hydraulic fractures can extend to pre-existing fractures,and these hydraulic fractures penetrate or propagate along pre-existing fractures.Especially when the approach angle is large,the damage range in the specimen during the prepulse loading stage increases,resulting in the formation of more hydraulic fractures.展开更多
With the continuous escalation of modern war,soldiers need to transport more combat materials to the combat area.The limited load-bearing capacity of soldiers seriously restricts their carrying capacity and mobility.I...With the continuous escalation of modern war,soldiers need to transport more combat materials to the combat area.The limited load-bearing capacity of soldiers seriously restricts their carrying capacity and mobility.It is urgent to develop a power-assisted exoskeleton robot suitable for individual combat.In the past,most power-assisted exoskeleton robots were driven by motors.This driving method has an excellent power-assisted effect,but the endurance is often insufficient.In view of this shortcoming,this study designed an ankle exoskeleton robot based on an active-passive combined drive through simulation analysis of human motion.It used OpenSim software to simulate and verify that the addition of spring could achieve a good effect.At the same time,according to the gait characteristics of the human body,the gait planning of an exoskeleton robot was carried out.Afterwards,theoretical analysis explained that the cooperation among spring,motor and wearer could be realized in this gait.Finally,the assisting ability and driving coordination of the active-passive combination driven ankle exoskeleton robot were verified through experiments.展开更多
Purpose:To investigate the clinical effects of improving adolescents’form anxiety after the intervention of visceral massage technique and form training.Methods:A total of 80 adolescent patients with scoliosis abnorm...Purpose:To investigate the clinical effects of improving adolescents’form anxiety after the intervention of visceral massage technique and form training.Methods:A total of 80 adolescent patients with scoliosis abnormalities were selected for this experiment,and they were intervened with form and body training and form and body training+visceral body acupressure techniques,and the anxiety and depression scores,spinal Cobb angle,vertebral body rotation of the parietal vertebrae,and the treatment efficiency were compared between the groups after the clinical interventions.Results:The anxiety and depression scores of patients in the form group were significantly higher than those of the combined group,P<0.05;the improvement of the Cobb angle and vertebral rotation of the parietal vertebrae of patients in the combined group was better than that of the form group,P<0.05;and the total effective rate of the treatment of patients in the form group was significantly lower than that of the combined group,P<0.05.Conclusion:After intervening in adolescents’abnormalities of form,patients were treated with a combination of the internal organs and body acupressure techniques and form training methods,and the results were compared between groups.After the joint intervention of the visceral massage technique and physical training,the patients’scoliosis and other physical problems were positively improved,and the psychological status of the patients was relatively adjusted to ensure their physical and mental health.展开更多
Following the COVID-19 outbreak,a vast array of chlorine disinfectants was used to eliminate the virus,leading to inevitable discharge into aquatic ecosystems.These environments also contain various anthropogenic micr...Following the COVID-19 outbreak,a vast array of chlorine disinfectants was used to eliminate the virus,leading to inevitable discharge into aquatic ecosystems.These environments also contain various anthropogenic micropollutants,such as pharmaceuticals,which pose threats to the survival and activities of biological communities.Consequently,the presence of discharged chlorine disinfectants and pharmaceuticals can simultaneously impact the structure and function of aquatic ecosystems.To investigate the combined effects of chlorine disinfectants and pharmaceuticals on the periphyton and zoobenthos(Limnodrilus hoffmeisteri)community composition and function,we conducted a 12-flume reactor experiment using sodium hypochlorite and representative pharmaceuticals(abundant in the Yangtze River)as influents.Results demonstrated that the discharge of chlorine disinfectants further altered the composition of river prokaryotic communities.Eukaryotic organisms within the periphyton exhibited greater resilience to chlorine exposure compared to prokaryotic communities.Metagenomic analysis revealed that prokaryotic communities with different compositions can execute similar functions,while RNA sequencing indicated that co-exposure promoted biological processes such as focal adhesion and ribosome synthesis,but inhibited activities related to nitrogen metabolism and resistance to folate antimicrobials.Additionally,co-exposure induced oxidative stress in L.hoffmeisteri,leading to stronger environmental adaptation.展开更多
The effects of combined microwave and hydrogen peroxide(H_(2)O_(2))oxidation on the flotation separation of molybdenite and chalcopyrite,as well as the underlying mechanism were investigated via microflotation,zeta po...The effects of combined microwave and hydrogen peroxide(H_(2)O_(2))oxidation on the flotation separation of molybdenite and chalcopyrite,as well as the underlying mechanism were investigated via microflotation,zeta potential,contact angle,X-ray photoelectron spectroscopy(XPS),scanning electron microscopy(SEM)and atomic force microscopy(AFM)analyses.The microflotation experiments showed that the effective inhibition of chalcopyrite can be obtained through combined oxidation pretreatments with low microwave power and H_(2)O_(2)consumption.The zeta potential,contact angle and XPS analyses indicated that the surface hydrophobicity of molybdenite changed minimally after different treatments,whereas significant amounts of hydrophilic oxidation species were formed on the surface of chalcopyrite,thus decreasing its surface hydrophobicity and floatability.Moreover,the SEM and AFM analyses indicated that more uniform oxidative products were formed on the chalcopyrite surface,further significantly increasing the surface roughness.展开更多
Nanoplastics are emerging contaminants that may co-exist with organochlorine pesticides and adversely affect invertebrates in the environment.However,the impact of environmental aging on the combined toxicity of nanop...Nanoplastics are emerging contaminants that may co-exist with organochlorine pesticides and adversely affect invertebrates in the environment.However,the impact of environmental aging on the combined toxicity of nanoplastics and organochlorine pesticides remains unclear.This study investigated the effects of aging on the combined toxicity of polystyrene nanoplastics(PS NPs)and chlordane against Caenorhabditis elegans.The results showed that photo-aging altered the physicochemical properties of PS NPs and promoted the combined toxicity of PS NPs and chlordane to nematodes by reducing survival rate,body length and enhancing germline apoptosis.Additionally,combined exposure of nematodes to aged PS NPs and chlordane significantly increased reactive oxygen species production and intestinal permeability,suggesting that aging enhances combined toxicity through oxidative stress and intestinal damage.Moreover,aging increased chlordane contents in nematodes without promoting PS NPs accumulation,potentially leading to increased combined toxicity of PS NPs and chlordane.Notably,aging significantly increased the accumulation of PS NPs in the posterior intestine of the nematode during co-exposure,which may be responsible for the most sensitive and highest degree of change in germline apoptosis.These observations emphasize the significance of accounting for environmental aging as well as the accumulation and distribution of nanoplastics in organisms when assessing the combined effects of nanoplastics and coexisting pollutants.展开更多
Combined cycle propulsion shows great potential for wide speed and altitude range flights.However,the jets of different types of engines may interact and form complex flow structures.Given that the specific effects of...Combined cycle propulsion shows great potential for wide speed and altitude range flights.However,the jets of different types of engines may interact and form complex flow structures.Given that the specific effects of jets interaction are closely related to combined nozzle configuration and working conditions,this paper analyzes the experiments of a simplified over-under combined nozzle and attempts to summarize the principles of the influence of twin-jet interaction on over-under combined nozzle performance.Firstly,twin-jet interaction directly changes the combined nozzle gross force via changing flow structure and parameters distribution inside the control volume.For example,the merging of supersonic jets forms wave systems,and the injection effect changes local pressure and the position of Free Shock Separation(FSS).Secondly,twin-jet interaction changes the force counting system.Assuming each flow-path as an isolated control volume leads to a mismatch of local pressure and reference ambient pressure.Thus,the combined nozzle should be considered as a whole control volume.Thirdly,twin-jet interaction may couple with jet-external interaction.On the one hand,jet-external interaction forms additional wave systems.On the other hand,the original expansion state of the nozzle during independent operation alters the performance baseline.Three practical experiments are conducted to verify these principles.These principles indicate that the influence of twin-jet interaction should be carefully considered in combined nozzle design.Utilizing the beneficial effect of twin-jet interaction can increase both the thrust and the lift,making the overall performance of the combined nozzle superior to the sum of two individual nozzles.However,twin-jet interaction may also decrease wall pressure,or alter the FSS position and flow direction of the over-expanded jet,resulting in a decrease in overall performance.These potential adverse effects should be avoided.展开更多
Unstable operating conditions such as surge could cause damage to both aerodynamic performance and structural integrity of a compression system.This paper addresses the critical issue of aerodynamic instability in com...Unstable operating conditions such as surge could cause damage to both aerodynamic performance and structural integrity of a compression system.This paper addresses the critical issue of aerodynamic instability in compressor design,particularly focusing on an axial-centrifugal combined compressor,a widely used yet underexplored configuration.An experimental investigation was conducted on a three-stage axial and one-stage centrifugal compressor(3A1C),using two pipe systems and employing fast-responding transducers to capture the dynamic instability process from choke condition to deep surge.Results reveal that at the design speed,3A1C enters deep surge directly,whereas at off-design speeds,it experiences rotating stall and mild surge across a wide mass flow range.Some special instability features in the combined compressor can be found in the steady state map and dynamic process.The characteristic curve of the first axial stage keeps a positive slope during the whole mass flow range at an off-design speed.The first stage could work stably on the stall characteristic curve because the centrifugal stage has stronger pressurization and plays a dominant role in global aerodynamic instability.Besides,rotating instability occurs at the first rotor tip and disappears as the back pressure increases,which is also rarely seen in a single-axial compressor.This is also related to the strong pressurization of the centrifugal stage.The findings of this paper will contribute to the understanding of aerodynamic instabilities in combined compressors.展开更多
BACKGROUND Alveolar and cystic echinococcoses are lethal zoonotic diseases caused by Echinococcus multilocularis and Echinococcus granulosus infections,leading to alveolar echinococcosis(AE)or cystic echinococcosis(CE...BACKGROUND Alveolar and cystic echinococcoses are lethal zoonotic diseases caused by Echinococcus multilocularis and Echinococcus granulosus infections,leading to alveolar echinococcosis(AE)or cystic echinococcosis(CE),respectively.No study has hitherto reported effective treatment approaches for AE or CE with concurrent hepatorenal involvement.AIM To investigate the feasibility and efficacy of simultaneous combined surgery(SCS)as a comprehensive treatment approach for patients with hepatorenal echinococcosis.METHODS Clinical datasets of hepatorenal AE(n=10)and CE(n=11)patients were retrospectively collected and systematically analyzed.The SCS approach was introduced,and surgical outcomes,complications,and prognoses were documented in detail.RESULTS The SCS approach incorporated hybridized techniques,including partial hepatectomy,partial or total nephrectomy,ex vivo liver resection and autotransplantation,and total or subtotal cystectomy with endocystectomy.Radical SCS was achieved in 100%of AE patients and 63.6%of CE patients.All surgeries were completed without intraoperative complications.The short-term complication rate was 28.6%(Clavien-Dindo classification:AE-1 IIIb,3 IIIa;CE-2 II),while the long-term complication rate was 4.8%(Clavien-Dindo classification:AE-1 IIIb).Patients were followed up for a median of 37 months(AE:6-81 months;CE:34-123 months),with no reported deaths or disease relapses.CONCLUSION CS appears to be a feasible and effective treatment method for patients with hepatorenal involvement of AE or CE.It fulfills the management criteria for advanced AE or CE cases,aiming to maximize patient benefits.展开更多
BACKGROUND Autoimmune autonomic ganglionopathy(AAG),formerly known as acute pandysautonomia,is a rare,acquired,antibody-mediated,potentially curable autonomic disorder that presents with diffuse autonomic failure.High...BACKGROUND Autoimmune autonomic ganglionopathy(AAG),formerly known as acute pandysautonomia,is a rare,acquired,antibody-mediated,potentially curable autonomic disorder that presents with diffuse autonomic failure.High levels of anti-ganglionic nicotinic acetylcholine receptor(gAChR)serum antibodies are detected in approximately 50%of AAG cases,confirming the diagnosis.CASE SUMMARY We present the case of a 68-year-old man who developed autonomic failure gradually over a 2-year period.Recently,the patient was unable to stand upright for more than a few seconds before fainting.Additionally,he presented with decreased sweating,dry mouth,urinary retention,early satiety,weight loss,bloating,constipation,and erectile dysfunction.Neurological examination revealed dilated pupils that were unresponsive to light.Deep tendon reflexes were absent or diminished.Serologic evaluation revealed the presence of gAChR autoantibodies.An orthostatic hypotension test yielded a positive result.The patient did not respond to symptomatic therapy,including midodrine,fludrocortisone and atomoxetine.Second-line therapy with immunoadsorption produced a noticeable clinical improvement;however,orthostatic hypotension persisted.Sequential rituximab infusion therapy successfully led to a significant improvement in symptoms.CONCLUSION Our case report supports the benefit of combined immunomodulatory therapy for refractory AAG cases that are unresponsive to single-agent treatment.展开更多
Combined hepatocellular-cholangiocarcinoma(cHCC-CCA)is a rare hetero-geneous primary malignant liver tumor containing both hepatocellular and cholangiocarcinoma features.The complex presentation of cHCC-CCA tends to b...Combined hepatocellular-cholangiocarcinoma(cHCC-CCA)is a rare hetero-geneous primary malignant liver tumor containing both hepatocellular and cholangiocarcinoma features.The complex presentation of cHCC-CCA tends to be poorly investigated,and the information derived from traditional diagnostic techniques(histopathology and radiological imaging)is often not optimal.Since cHCC-CCA is usually difficult to diagnose due to complex histopathological features(edge learning)as excessive photos,hence,achieves treatment delays and poor prognosis,the incorporation of advanced artificial intelligence like edge learning is able to improve the patient’s outcome.Using artificial intelligence,particularly deep learning,has recently opened new doorways for the impro-vement of diagnostic accuracy.If artificial intelligence models are deployed on local devices,edge learning exercises this type of learning,which provides real time processing,improved data privacy and reduced bandwidth usage.This narrative review investigates the conceptual formulation of edge learning together with its opportunities for clinical applications in the prediction and classification of cHCC-CCA,the technical solution strategies,the clinical benefits it offers,and associated challenges and future directions.展开更多
In the 3D inversion modeling of gravity and magnetic potential field data,the model weighting function is often applied to overcome the skin eff ect of inversion results.However,divergence occurs at the the deep area,...In the 3D inversion modeling of gravity and magnetic potential field data,the model weighting function is often applied to overcome the skin eff ect of inversion results.However,divergence occurs at the the deep area,and artificial weak negative anomalies form around the positive anomalies in the horizontal direction,resulting in a reduction in the overall resolution.To fully utilize the model weighting function,this study constructs a combined model weighting function.First,a new depth weighting function is constructed by adding a regulator into the conventional depth weighting function to overcome the skin eff ect and inhibit the divergence at the deep area of the inversion results.A horizontal weighting function is then constructed by extracting information from the observation data;this function can suppress the formation of artificial weak anomalies and improve the horizontal resolution of the inversion results.Finally,these two functions are coupled to obtain the combined model weighting function,which can replace the conventional depth weighting function in 3D inversion.It improves the vertical and horizontal resolution of the inversion results without increasing the algorithm complexity and calculation amount,is easy to operate,and adapts to any 3D inversion method.Two model experiments are designed to verify the effectiveness,practicability,and anti-noise of the combined model weighting function.Then the function is applied to the 3D inversion of the measured aeromagnetic data in the Jinchuan area in China.The obtained inversion results are in good agreement with the known geological data.展开更多
Combined hepatocellular cholangiocarcinoma(cHCC-CCA)is a rare and ag-gressive primary liver malignancy characterized by features of both HCC and CCA.Preoperative diagnosis remains challenging because of overlapping i-...Combined hepatocellular cholangiocarcinoma(cHCC-CCA)is a rare and ag-gressive primary liver malignancy characterized by features of both HCC and CCA.Preoperative diagnosis remains challenging because of overlapping i-maging and histopathological features,which often lead to misclassification.Although liver resection is the primary curative therapy,the efficacy of liver transplantation(LT)remains controversial.Historically,LT has been considered contraindicated owing to the poor prognosis,high recurrence rate of cHCC-CCA,and the potential for organ wastage.Recent studies have suggested that LT may benefit carefully selected patients,particularly those with early-stage tumors or cirrhosis.However,there is no consensus on the criteria for LT in patients with cHCC-CCA.Lymphadenectomy and vascular resection strategies were discussed along with locoregional and systemic therapies.This review synthesized the current evidence on surgical strategies for cHCC-CCA,focusing on evolving LT criteria and outcomes.展开更多
The paper designs a novel material-level specimen and its dedicated fixture suitable for applying Combined high-and low-Cycle Fatigue(CCF)loads.Unlike full-scale or simulation specimens,the CCF specimen eliminates geo...The paper designs a novel material-level specimen and its dedicated fixture suitable for applying Combined high-and low-Cycle Fatigue(CCF)loads.Unlike full-scale or simulation specimens,the CCF specimen eliminates geometrically induced stress gradients in the test region.Experimental data on CCF life and strain responses of ZSGH4169 alloy are acquired under different CCF loads.The Maximum Strain within Each(MSE)CCF cycle is demonstrated to be independent of the Low-Cycle Fatigue(LCF)loads and High-Cycle Fatigue(HCF)stress amplitudes,but exhibits a correlation with the Cycle Ratio of HCF/LCF(Rf).The growth law of MSE changes from linear to logarithmic as Rfdecreases.Strain amplitudes in the dwell stage,observed unaffected by Rf,are quantified as a function of LCF nominal stresses and HCF stress amplitudes.However,under a defined CCF load,strain amplitudes in the dwell stage remain constant.Strain peaks in the dwell stage in a single CCF cycle decrease in a power function with increasing HCF cycles.展开更多
Cadmium accumulation in seafood has become a major concern for human health.Recently,there has been an increasing focus on the potential risks associated with food-borne fluorescent carbon dots(CDs)that are formed dur...Cadmium accumulation in seafood has become a major concern for human health.Recently,there has been an increasing focus on the potential risks associated with food-borne fluorescent carbon dots(CDs)that are formed during the thermal processing of seafood.The co-occurrence of cadmium and CDs from cooked seafood become a common phenomenon and co-exposure of them to human has been an inevitable route during long-term seafood consuming.In addition,it has been widely recognized that CDs can be used as nanocarriers for metal ion chelation for their transport into organisms,thereby,they could influence the bioavailability of metal ion.While there have been numerous studies on the toxic effects of cadmium or CDs,none have explored the combined toxicity of food-borne CDs from clams(CCDs)and Cd^(2+).In this study,we investigated the single or co-exposure(combined exposure)of Cd^(2+)and CCDs on PC12 cells to investigate the combined toxicity of them.Our analysis of cell viability revealed that CCDs significantly augmented the cytotoxicity induced by Cd^(2+).More in-depth metabolomics and lipidomics investigation indicated that the combined exposure of Cd^(2+)and CCDs led to significant metabolic disorders,causing an antagonistic effect on energy metabolism,and a synergistic effect on amino acids and lipids metabolism.The disturbance in metabolomics and lipidomics was further supported by the disruption of mitochondrial membrane potential and the accumulation of reactive oxygen species following co-exposure.These findings provide new evidence that support the enhanced cytotoxicity of Cd^(2+)by the CCDs derived from the thermal processing of clams.This study also declares the necessary that prioritize the investigation of the potential impact of other thermal processing hazards originating from heat-processed foods on the toxicity of heavy metal ions.展开更多
The choice of biopsy method is critical in diagnosing prostate cancer(PCa).This retrospective cohort study compared systematic biopsy(SB)or cognitive fusion-targeted biopsy combined with SB(CB)in detecting PCa and cli...The choice of biopsy method is critical in diagnosing prostate cancer(PCa).This retrospective cohort study compared systematic biopsy(SB)or cognitive fusion-targeted biopsy combined with SB(CB)in detecting PCa and clinically significant prostate cancer(csPCa).Data from 2572 men who underwent either SB or CB in Fudan University Shanghai Cancer Center(Shanghai,China)between January 2019 and December 2023 were analyzed.Propensity score matching(PSM)was used to balance baseline characteristics,and detection rates were compared before and after PSM.Subgroup analyses based on prostate-specific antigen(PSA)levels and Prostate Imaging-Reporting and Data System(PI-RADS)scores were performed.Primary and secondary outcomes were the detection rates of PCa and csPCa,respectively.Of 2572 men,1778 were included in the PSM analysis.Before PSM,CB had higher detection rates for both PCa(62.9%vs 52.4%,odds ratio[OR]:1.54,P<0.001)and csPCa(54.9%vs 43.3%,OR:1.60,P<0.001)compared to SB.After PSM,CB remained superior in detecting PCa(63.1%vs 47.9%,OR:1.86,P<0.001)and csPCa(55.0%vs 38.2%,OR:1.98,P<0.001).In patients with PSA 4–12 ng ml−1(>4 ng ml-1 and≤12 ng ml-1,which is also applicable to the following text),CB detected more PCa(59.8%vs 40.7%,OR:2.17,P<0.001)and csPCa(48.1%vs 27.7%,OR:2.42,P<0.001).CB also showed superior csPCa detection in those with PI-RADS 3 lesions(32.1%vs 18.0%,OR:2.15,P=0.038).Overall,CB significantly improves PCa and csPCa detection,especially in patients with PSA 4–12 ng ml−1 or PI-RADS 3 lesions.展开更多
Bananas are highly perishable after harvest,and processing them into dried products is a crucial approach to reducing losses and adding their economic values.To address the inefficiency and prolonged duration of tradi...Bananas are highly perishable after harvest,and processing them into dried products is a crucial approach to reducing losses and adding their economic values.To address the inefficiency and prolonged duration of traditional hot air drying(HAD)and the quality inconsistency associated with single infrared drying(IRD),this study proposed a novel hot air-infrared combined drying(HAD-IRD)strategy.The effects of HAD,IRD,and HAD-IRD on the drying kinetics,color,rehydration capacity,moisture diffusion mechanism,and sensory quality of banana slices were systematically investigated.The parameters of the combined drying process were optimized using an L_(9)(3^(3))orthogonal experimental design.Results indicated that both IRD and HAD-IRD significantly reduced drying time compared to single HAD.While single IRD achieved a rapid drying rate,the lack of effective convective airflow led to potential case-hardening and unstable product quality.In contrast,the HAD-IRD strategy demonstrated a synergistic effect.The optimal parameters were determined as follows:hot air temperature of 70℃,infrared temperature of 60℃,and radiation distance of 16 cm.Under these optimized conditions,HAD-IRD reduced the total drying time by over 70%while simultaneously yielding products with superior color,higher sensory scores,and improved rehydration ratio.This study confirms that HAD-IRD is an efficient and high-quality drying method for banana slices,providing a reliable theoretical foundation and technical solution for the drying of thermosensitive fruits.展开更多
The comprehensive status of blast furnaces was one of the most important factors affecting their economy,quality,and longev-ity.The blast furnace comprehensive status had the nature of“black box,”and it was“unpredi...The comprehensive status of blast furnaces was one of the most important factors affecting their economy,quality,and longev-ity.The blast furnace comprehensive status had the nature of“black box,”and it was“unpredictable.”In this study,a blast furnace com-prehensive status score and prediction method based on a cascade system and a combined model were proposed to address this issue.A dual cascade evaluation system was developed by integrating subjective and objective weighting methods.The analytic hierarchy process,coefficient of variation,entropy weight method,and impart combinatorial games were jointly employed to determine the optimal weight distribution across indicators.Categorized statuses(raw material,gas flow,furnace body,furnace cylinder,and iron-slag)were evaluated.Based on the five categories of the status data,the second cascade was applied to upgrade the quantitative evaluation of the comprehens-ive status.The weights of the different categories were 0.22,0.15,0.22,0.21,and 0.20,respectively.According to the data analysis,the results of the comprehensive status score closely matched the on-site production logs.Based on the blast furnace smelting period,the maximal information coefficient method was applied to the 100 parameters that were most relevant to the comprehensive status.A com-bined prediction model for a comprehensive status score was designed using bidirectional long short-term memory(BiLSTM)and categorical boosting(CatBoost).The test results indicated that the combined model reduced the mean absolute error by an average of 0.275 and increased the hit rate by an average of 5.65 percentage points compared to BiLSTM or CatBoost alone.When the er-ror range was±2.5,the combined model predicted a hit rate of 91.66%for the next hour’s comprehensive status score,and its high accur-acy was deemed satisfactory for the field.SHapley Additive exPlanations(SHAP)and regression fitting were applied to analyze the lin-ear quantitative relationship between the key variables and the comprehensive status score.When the furnace bottom center temperature was increased by 10℃,the comprehensive status score increased by 0.44.This method contributes to a more precise management and control of the comprehensive status of the blast furnace on-site.展开更多
文摘BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.AIM To investigate the analgesic effect and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.METHODS In this retrospective study,94 patients scheduled for laparoscopic minimally invasive surgery for inguinal hernia,admitted to Yiwu Central Hospital between May 2022 and May 2023,were divided into a control group(inhalation combined general anesthesia)and a treatment group(dexmedetomidine-assisted intrave-nous-inhalation combined general anesthesia).Perioperative indicators,analgesic effect,preoperative and postoperative 24-hours blood pressure(BP)and heart rate(HR),stress indicators,immune function levels,and adverse reactions were com-pared between the two groups.RESULTS Baseline data,including age,hernia location,place of residence,weight,monthly income,education level,and underlying diseases,were not significantly different between the two groups,indicating comparability(P>0.05).No significant difference was found in operation time and anesthesia time between the two groups(P>0.05).However,the treatment group exhibited a shorter postoperative urinary catheter removal time and hospital stay than the control group(P<0.05).Preoperatively,no significant differences were found in the visual analog scale(VAS)scores between the two groups(P>0.05).However,at 12,18,and 24 hours postoper-atively,the treatment group had significantly lower VAS scores than the control group(P<0.05).Although no significant differences in preoperative hemodynamic indicators were found between the two groups(P>0.05),both groups experienced some extent of changes in postoperative HR,diastolic BP(DBP),and systolic BP(SBP).Nevertheless,the treatment group showed smaller changes in HR,DBP,and SBP than the control group(P<0.05).Preoperative immune function indicators showed no significant differences between the two groups(P>0.05).However,postoperatively,the treatment group demonstrated higher levels of CD3+,CD4+,and CD4+/CD8+and lower levels of CD8+than the control group(P<0.05).The rates of adverse reactions were 6.38%and 23.40%in the treatment and control groups,respectively,revealing a significant difference(χ2=5.371,P=0.020).CONCLUSION Dexmedetomidine-assisted intravenous-inhalation combined general anesthesia can promote early recovery of patients undergoing laparoscopic minimally invasive surgery for inguinal hernia.It ensures stable blood flow,improves postoperative analgesic effects,reduces postoperative pain intensity,alleviates stress response,improves immune function,facilitates anesthesia recovery,and enhances safety.
基金Supported by Research Project of Zhejiang Provincial Science and Technology Plan for Traditional Chinese Medicine,No.2024ZL753and Research Project of Zhejiang Provincial Medical and Health Science and Technology Plan,No.2024KY1406.
文摘BACKGROUND Type 2 diabetes mellitus(T2DM),a chronic metabolic disease with a high global incidence,has become a serious public health challenge.China has the largest number of T2DM patients worldwide,imposing a significant economic burden on the healthcare system.T2DM is closely associated with insulin resistance,impaired pancreatic B cell function,and disordered glucose and lipid metabolism,which can lead to various complications,reducing patients'quality of life and increasing the risk of disability and death.Thus,finding effective preventive and intervention measures is crucial.Exercise therapy,a key part of diabetes management,has gained attention in recent years,with many studies indicating its benefits for blood glucose control and other aspects in diabetic patients.AIM To assess the effectiveness of combined resistance and aerobic exercise interventions on blood glucose control and metabolic indicators in patients with T2DM and to explore their application in diabetes management.METHODS Systematic searches were conducted using PubMed,EMBASE,Cochrane Library,and Chinese databases for relevant randomized controlled trials(RCTs).The inclusion criteria were participants aged≥18 years with T2DM and the intervention involved combined resistance and aerobic exercise for≥8 weeks.The primary outcome indicators were fasting blood glucose,low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),triglycerides(TG),glycated hemoglobin A1c(HbA1c),and total cholesterol(TC)levels.Data analysis was performed using RevMan software,and the interventional effects were assessed using weighted mean differences or standardized mean differences(SMD).RESULTS Six RCTs meeting the inclusion criteria were included,with a total sample size of 366 participants.The meta-analysis results showed that combined resistance and aerobic exercise significantly improved several metabolic indicators in patients with T2DM.Specific results were as follows:(1)For fasting blood glucose,combined exercise was more effective than aerobic exercise alone[SMD=1.22;95%confidence interval(95%CI):0.70,1.74;P<0.00001];(2)LDL-C levels were significantly reduced by the combined intervention(SMD=1.45;95%CI:1.18-1.72;P<0.00001);(3)The combined intervention significantly increased HDL-C levels(SMD=1.42;95%CI:0.98-1.87;P<0.00001);(4)The combined intervention significantly reduced TG levels(SMD=1.12;95%CI:0.85-1.39;P<0.00001;(5)No statistically significant difference was observed in HbA1c between the combined and the aerobic exercise group(SMD=-0.03;95%CI:-1.09 to 1.04;P<0.00001);and(6)The combined exercise intervention group significantly reduced TC levels(SMD=2.66;95%CI:1.93-3.38;P<0.00001).The subgroup analysis results suggest that the effect of exercise interventions may be influenced by various factors,including the patient's age,baseline blood glucose levels,and exercise intensity.CONCLUSION Combined resistance and aerobic exercise intervention significantly improved fasting blood glucose,LDL-C,HDL-C,TG,and TC levels in patients with T2DM,especially in terms of blood glucose control and cardiovascular risk,demonstrating better outcomes than aerobic exercise alone.
基金financially supported by,the Fundamental Research Funds for the Central Universities(Grant No.2023QN1064)the China Postdoctoral Science Foundation(Grant No.2023M733772)Jiangsu Funding Program for Excellent Postdoctoral Talent(Grant No.2023ZB847)。
文摘Prepulse combined hydraulic fracturing facilitates the development of fracture networks by integrating prepulse hydraulic loading with conventional hydraulic fracturing.The formation mechanisms of fracture networks between hydraulic and pre-existing fractures under different prepulse loading parameters remain unclear.This research investigates the impact of prepulse loading parameters,including the prepulse loading number ratio(C),prepulse loading stress ratio(S),and prepulse loading frequency(f),on the formation of fracture networks between hydraulic and pre-existing fractures,using both experimental and numerical methods.The results suggest that low prepulse loading stress ratios and high prepulse loading number ratios are advantageous loading modes.Multiple hydraulic fractures are generated in the specimen under the advantageous loading modes,facilitating the development of a complex fracture network.Fatigue damage occurs in the specimen at the prepulse loading stage.The high water pressure at the secondary conventional hydraulic fracturing promotes the growth of hydraulic fractures along the damage zones.This allows the hydraulic fractures to propagate deeply and interact with pre-existing fractures.Under advantageous loading conditions,multiple hydraulic fractures can extend to pre-existing fractures,and these hydraulic fractures penetrate or propagate along pre-existing fractures.Especially when the approach angle is large,the damage range in the specimen during the prepulse loading stage increases,resulting in the formation of more hydraulic fractures.
基金the National Natural Science Foundation of China(No.52075264)。
文摘With the continuous escalation of modern war,soldiers need to transport more combat materials to the combat area.The limited load-bearing capacity of soldiers seriously restricts their carrying capacity and mobility.It is urgent to develop a power-assisted exoskeleton robot suitable for individual combat.In the past,most power-assisted exoskeleton robots were driven by motors.This driving method has an excellent power-assisted effect,but the endurance is often insufficient.In view of this shortcoming,this study designed an ankle exoskeleton robot based on an active-passive combined drive through simulation analysis of human motion.It used OpenSim software to simulate and verify that the addition of spring could achieve a good effect.At the same time,according to the gait characteristics of the human body,the gait planning of an exoskeleton robot was carried out.Afterwards,theoretical analysis explained that the cooperation among spring,motor and wearer could be realized in this gait.Finally,the assisting ability and driving coordination of the active-passive combination driven ankle exoskeleton robot were verified through experiments.
文摘Purpose:To investigate the clinical effects of improving adolescents’form anxiety after the intervention of visceral massage technique and form training.Methods:A total of 80 adolescent patients with scoliosis abnormalities were selected for this experiment,and they were intervened with form and body training and form and body training+visceral body acupressure techniques,and the anxiety and depression scores,spinal Cobb angle,vertebral body rotation of the parietal vertebrae,and the treatment efficiency were compared between the groups after the clinical interventions.Results:The anxiety and depression scores of patients in the form group were significantly higher than those of the combined group,P<0.05;the improvement of the Cobb angle and vertebral rotation of the parietal vertebrae of patients in the combined group was better than that of the form group,P<0.05;and the total effective rate of the treatment of patients in the form group was significantly lower than that of the combined group,P<0.05.Conclusion:After intervening in adolescents’abnormalities of form,patients were treated with a combination of the internal organs and body acupressure techniques and form training methods,and the results were compared between groups.After the joint intervention of the visceral massage technique and physical training,the patients’scoliosis and other physical problems were positively improved,and the psychological status of the patients was relatively adjusted to ensure their physical and mental health.
基金supported by the National Natural Science Foundation of China(Nos.52293442,52300249,and 52388101)the Scientific Research Project of China Three Gorges Corporation(No.201903139).
文摘Following the COVID-19 outbreak,a vast array of chlorine disinfectants was used to eliminate the virus,leading to inevitable discharge into aquatic ecosystems.These environments also contain various anthropogenic micropollutants,such as pharmaceuticals,which pose threats to the survival and activities of biological communities.Consequently,the presence of discharged chlorine disinfectants and pharmaceuticals can simultaneously impact the structure and function of aquatic ecosystems.To investigate the combined effects of chlorine disinfectants and pharmaceuticals on the periphyton and zoobenthos(Limnodrilus hoffmeisteri)community composition and function,we conducted a 12-flume reactor experiment using sodium hypochlorite and representative pharmaceuticals(abundant in the Yangtze River)as influents.Results demonstrated that the discharge of chlorine disinfectants further altered the composition of river prokaryotic communities.Eukaryotic organisms within the periphyton exhibited greater resilience to chlorine exposure compared to prokaryotic communities.Metagenomic analysis revealed that prokaryotic communities with different compositions can execute similar functions,while RNA sequencing indicated that co-exposure promoted biological processes such as focal adhesion and ribosome synthesis,but inhibited activities related to nitrogen metabolism and resistance to folate antimicrobials.Additionally,co-exposure induced oxidative stress in L.hoffmeisteri,leading to stronger environmental adaptation.
基金support by the National Natural Science Foundation of China(Nos.52104266,52074206,52374278)Key Research and Development Project of Shaanxi Province,China(No.2023GXLH-054).
文摘The effects of combined microwave and hydrogen peroxide(H_(2)O_(2))oxidation on the flotation separation of molybdenite and chalcopyrite,as well as the underlying mechanism were investigated via microflotation,zeta potential,contact angle,X-ray photoelectron spectroscopy(XPS),scanning electron microscopy(SEM)and atomic force microscopy(AFM)analyses.The microflotation experiments showed that the effective inhibition of chalcopyrite can be obtained through combined oxidation pretreatments with low microwave power and H_(2)O_(2)consumption.The zeta potential,contact angle and XPS analyses indicated that the surface hydrophobicity of molybdenite changed minimally after different treatments,whereas significant amounts of hydrophilic oxidation species were formed on the surface of chalcopyrite,thus decreasing its surface hydrophobicity and floatability.Moreover,the SEM and AFM analyses indicated that more uniform oxidative products were formed on the chalcopyrite surface,further significantly increasing the surface roughness.
基金supported by the National Key Research and Development Program of China(No.2020YFC1808204)the National Natural Science Foundation of China(Nos.22206001 and U22A20406)the Scientific Research Foundation of Education Department of Anhui Province of China(No.KJ2021A0074).
文摘Nanoplastics are emerging contaminants that may co-exist with organochlorine pesticides and adversely affect invertebrates in the environment.However,the impact of environmental aging on the combined toxicity of nanoplastics and organochlorine pesticides remains unclear.This study investigated the effects of aging on the combined toxicity of polystyrene nanoplastics(PS NPs)and chlordane against Caenorhabditis elegans.The results showed that photo-aging altered the physicochemical properties of PS NPs and promoted the combined toxicity of PS NPs and chlordane to nematodes by reducing survival rate,body length and enhancing germline apoptosis.Additionally,combined exposure of nematodes to aged PS NPs and chlordane significantly increased reactive oxygen species production and intestinal permeability,suggesting that aging enhances combined toxicity through oxidative stress and intestinal damage.Moreover,aging increased chlordane contents in nematodes without promoting PS NPs accumulation,potentially leading to increased combined toxicity of PS NPs and chlordane.Notably,aging significantly increased the accumulation of PS NPs in the posterior intestine of the nematode during co-exposure,which may be responsible for the most sensitive and highest degree of change in germline apoptosis.These observations emphasize the significance of accounting for environmental aging as well as the accumulation and distribution of nanoplastics in organisms when assessing the combined effects of nanoplastics and coexisting pollutants.
基金funded by the National Natural Science Foundation of China(No.12332018)the Science Center for Gas Turbine Project,China(No.P2022-B-I-006-001)the China Postdoctoral Science Foundation(No.2022M721598)。
文摘Combined cycle propulsion shows great potential for wide speed and altitude range flights.However,the jets of different types of engines may interact and form complex flow structures.Given that the specific effects of jets interaction are closely related to combined nozzle configuration and working conditions,this paper analyzes the experiments of a simplified over-under combined nozzle and attempts to summarize the principles of the influence of twin-jet interaction on over-under combined nozzle performance.Firstly,twin-jet interaction directly changes the combined nozzle gross force via changing flow structure and parameters distribution inside the control volume.For example,the merging of supersonic jets forms wave systems,and the injection effect changes local pressure and the position of Free Shock Separation(FSS).Secondly,twin-jet interaction changes the force counting system.Assuming each flow-path as an isolated control volume leads to a mismatch of local pressure and reference ambient pressure.Thus,the combined nozzle should be considered as a whole control volume.Thirdly,twin-jet interaction may couple with jet-external interaction.On the one hand,jet-external interaction forms additional wave systems.On the other hand,the original expansion state of the nozzle during independent operation alters the performance baseline.Three practical experiments are conducted to verify these principles.These principles indicate that the influence of twin-jet interaction should be carefully considered in combined nozzle design.Utilizing the beneficial effect of twin-jet interaction can increase both the thrust and the lift,making the overall performance of the combined nozzle superior to the sum of two individual nozzles.However,twin-jet interaction may also decrease wall pressure,or alter the FSS position and flow direction of the over-expanded jet,resulting in a decrease in overall performance.These potential adverse effects should be avoided.
基金supported by the National Science and Technology Major Project of China(Nos.2017-II-0004-0016 and J2019-I-0011-0011).
文摘Unstable operating conditions such as surge could cause damage to both aerodynamic performance and structural integrity of a compression system.This paper addresses the critical issue of aerodynamic instability in compressor design,particularly focusing on an axial-centrifugal combined compressor,a widely used yet underexplored configuration.An experimental investigation was conducted on a three-stage axial and one-stage centrifugal compressor(3A1C),using two pipe systems and employing fast-responding transducers to capture the dynamic instability process from choke condition to deep surge.Results reveal that at the design speed,3A1C enters deep surge directly,whereas at off-design speeds,it experiences rotating stall and mild surge across a wide mass flow range.Some special instability features in the combined compressor can be found in the steady state map and dynamic process.The characteristic curve of the first axial stage keeps a positive slope during the whole mass flow range at an off-design speed.The first stage could work stably on the stall characteristic curve because the centrifugal stage has stronger pressurization and plays a dominant role in global aerodynamic instability.Besides,rotating instability occurs at the first rotor tip and disappears as the back pressure increases,which is also rarely seen in a single-axial compressor.This is also related to the strong pressurization of the centrifugal stage.The findings of this paper will contribute to the understanding of aerodynamic instabilities in combined compressors.
基金Supported by the National Natural Science Foundation of China,No.82360111Xinjiang Science and Technology Department-Leading Talents in Technological Innovation-High-Level Leading Talents,No.2022TSYCLJ0034+1 种基金State Key Laboratory for The Cause and Control of High Incidence in Central Asia Jointly Constructed by The Ministry and The Province,No.SKL-HIDCA-2023-2 and No.SKLHIDCA-2024-22Xinjiang Uygur Autonomous Region Graduate Innovation Program,No.XJ2024G153.
文摘BACKGROUND Alveolar and cystic echinococcoses are lethal zoonotic diseases caused by Echinococcus multilocularis and Echinococcus granulosus infections,leading to alveolar echinococcosis(AE)or cystic echinococcosis(CE),respectively.No study has hitherto reported effective treatment approaches for AE or CE with concurrent hepatorenal involvement.AIM To investigate the feasibility and efficacy of simultaneous combined surgery(SCS)as a comprehensive treatment approach for patients with hepatorenal echinococcosis.METHODS Clinical datasets of hepatorenal AE(n=10)and CE(n=11)patients were retrospectively collected and systematically analyzed.The SCS approach was introduced,and surgical outcomes,complications,and prognoses were documented in detail.RESULTS The SCS approach incorporated hybridized techniques,including partial hepatectomy,partial or total nephrectomy,ex vivo liver resection and autotransplantation,and total or subtotal cystectomy with endocystectomy.Radical SCS was achieved in 100%of AE patients and 63.6%of CE patients.All surgeries were completed without intraoperative complications.The short-term complication rate was 28.6%(Clavien-Dindo classification:AE-1 IIIb,3 IIIa;CE-2 II),while the long-term complication rate was 4.8%(Clavien-Dindo classification:AE-1 IIIb).Patients were followed up for a median of 37 months(AE:6-81 months;CE:34-123 months),with no reported deaths or disease relapses.CONCLUSION CS appears to be a feasible and effective treatment method for patients with hepatorenal involvement of AE or CE.It fulfills the management criteria for advanced AE or CE cases,aiming to maximize patient benefits.
文摘BACKGROUND Autoimmune autonomic ganglionopathy(AAG),formerly known as acute pandysautonomia,is a rare,acquired,antibody-mediated,potentially curable autonomic disorder that presents with diffuse autonomic failure.High levels of anti-ganglionic nicotinic acetylcholine receptor(gAChR)serum antibodies are detected in approximately 50%of AAG cases,confirming the diagnosis.CASE SUMMARY We present the case of a 68-year-old man who developed autonomic failure gradually over a 2-year period.Recently,the patient was unable to stand upright for more than a few seconds before fainting.Additionally,he presented with decreased sweating,dry mouth,urinary retention,early satiety,weight loss,bloating,constipation,and erectile dysfunction.Neurological examination revealed dilated pupils that were unresponsive to light.Deep tendon reflexes were absent or diminished.Serologic evaluation revealed the presence of gAChR autoantibodies.An orthostatic hypotension test yielded a positive result.The patient did not respond to symptomatic therapy,including midodrine,fludrocortisone and atomoxetine.Second-line therapy with immunoadsorption produced a noticeable clinical improvement;however,orthostatic hypotension persisted.Sequential rituximab infusion therapy successfully led to a significant improvement in symptoms.CONCLUSION Our case report supports the benefit of combined immunomodulatory therapy for refractory AAG cases that are unresponsive to single-agent treatment.
文摘Combined hepatocellular-cholangiocarcinoma(cHCC-CCA)is a rare hetero-geneous primary malignant liver tumor containing both hepatocellular and cholangiocarcinoma features.The complex presentation of cHCC-CCA tends to be poorly investigated,and the information derived from traditional diagnostic techniques(histopathology and radiological imaging)is often not optimal.Since cHCC-CCA is usually difficult to diagnose due to complex histopathological features(edge learning)as excessive photos,hence,achieves treatment delays and poor prognosis,the incorporation of advanced artificial intelligence like edge learning is able to improve the patient’s outcome.Using artificial intelligence,particularly deep learning,has recently opened new doorways for the impro-vement of diagnostic accuracy.If artificial intelligence models are deployed on local devices,edge learning exercises this type of learning,which provides real time processing,improved data privacy and reduced bandwidth usage.This narrative review investigates the conceptual formulation of edge learning together with its opportunities for clinical applications in the prediction and classification of cHCC-CCA,the technical solution strategies,the clinical benefits it offers,and associated challenges and future directions.
基金jointly funded by the National Natural Science Foundation of China(No.U2244220,No.42004125)the China Geological Survey Projects(No.DD20240119,No.DD20243245,No.DD20230114,No.DD20243244)the China Postdoctoral Science Foundation(No.2020M670601)。
文摘In the 3D inversion modeling of gravity and magnetic potential field data,the model weighting function is often applied to overcome the skin eff ect of inversion results.However,divergence occurs at the the deep area,and artificial weak negative anomalies form around the positive anomalies in the horizontal direction,resulting in a reduction in the overall resolution.To fully utilize the model weighting function,this study constructs a combined model weighting function.First,a new depth weighting function is constructed by adding a regulator into the conventional depth weighting function to overcome the skin eff ect and inhibit the divergence at the deep area of the inversion results.A horizontal weighting function is then constructed by extracting information from the observation data;this function can suppress the formation of artificial weak anomalies and improve the horizontal resolution of the inversion results.Finally,these two functions are coupled to obtain the combined model weighting function,which can replace the conventional depth weighting function in 3D inversion.It improves the vertical and horizontal resolution of the inversion results without increasing the algorithm complexity and calculation amount,is easy to operate,and adapts to any 3D inversion method.Two model experiments are designed to verify the effectiveness,practicability,and anti-noise of the combined model weighting function.Then the function is applied to the 3D inversion of the measured aeromagnetic data in the Jinchuan area in China.The obtained inversion results are in good agreement with the known geological data.
基金Supported by High-level Research Projects of China-Japan Friendship Hospital,No.2022-NHLHCRF-LX-03-0301 and No.2023-NHLHCRF-LXYZ-01.
文摘Combined hepatocellular cholangiocarcinoma(cHCC-CCA)is a rare and ag-gressive primary liver malignancy characterized by features of both HCC and CCA.Preoperative diagnosis remains challenging because of overlapping i-maging and histopathological features,which often lead to misclassification.Although liver resection is the primary curative therapy,the efficacy of liver transplantation(LT)remains controversial.Historically,LT has been considered contraindicated owing to the poor prognosis,high recurrence rate of cHCC-CCA,and the potential for organ wastage.Recent studies have suggested that LT may benefit carefully selected patients,particularly those with early-stage tumors or cirrhosis.However,there is no consensus on the criteria for LT in patients with cHCC-CCA.Lymphadenectomy and vascular resection strategies were discussed along with locoregional and systemic therapies.This review synthesized the current evidence on surgical strategies for cHCC-CCA,focusing on evolving LT criteria and outcomes.
基金co-supported by the National Natural Science Foundation of China(51805017)National Science and Technology Project(J2017-IV-0012-0049)+1 种基金National Science and Technology Project,China(J2019-IV-0007-0075)the Fundamental Research Funds for the Central Universities,China(JKF-20240036).
文摘The paper designs a novel material-level specimen and its dedicated fixture suitable for applying Combined high-and low-Cycle Fatigue(CCF)loads.Unlike full-scale or simulation specimens,the CCF specimen eliminates geometrically induced stress gradients in the test region.Experimental data on CCF life and strain responses of ZSGH4169 alloy are acquired under different CCF loads.The Maximum Strain within Each(MSE)CCF cycle is demonstrated to be independent of the Low-Cycle Fatigue(LCF)loads and High-Cycle Fatigue(HCF)stress amplitudes,but exhibits a correlation with the Cycle Ratio of HCF/LCF(Rf).The growth law of MSE changes from linear to logarithmic as Rfdecreases.Strain amplitudes in the dwell stage,observed unaffected by Rf,are quantified as a function of LCF nominal stresses and HCF stress amplitudes.However,under a defined CCF load,strain amplitudes in the dwell stage remain constant.Strain peaks in the dwell stage in a single CCF cycle decrease in a power function with increasing HCF cycles.
基金supported by the National Key Research and Development Project of China(2017YFC1600702)the Central Funds Guiding the Local Science and Technology Development of China(2020JH6/10500002).
文摘Cadmium accumulation in seafood has become a major concern for human health.Recently,there has been an increasing focus on the potential risks associated with food-borne fluorescent carbon dots(CDs)that are formed during the thermal processing of seafood.The co-occurrence of cadmium and CDs from cooked seafood become a common phenomenon and co-exposure of them to human has been an inevitable route during long-term seafood consuming.In addition,it has been widely recognized that CDs can be used as nanocarriers for metal ion chelation for their transport into organisms,thereby,they could influence the bioavailability of metal ion.While there have been numerous studies on the toxic effects of cadmium or CDs,none have explored the combined toxicity of food-borne CDs from clams(CCDs)and Cd^(2+).In this study,we investigated the single or co-exposure(combined exposure)of Cd^(2+)and CCDs on PC12 cells to investigate the combined toxicity of them.Our analysis of cell viability revealed that CCDs significantly augmented the cytotoxicity induced by Cd^(2+).More in-depth metabolomics and lipidomics investigation indicated that the combined exposure of Cd^(2+)and CCDs led to significant metabolic disorders,causing an antagonistic effect on energy metabolism,and a synergistic effect on amino acids and lipids metabolism.The disturbance in metabolomics and lipidomics was further supported by the disruption of mitochondrial membrane potential and the accumulation of reactive oxygen species following co-exposure.These findings provide new evidence that support the enhanced cytotoxicity of Cd^(2+)by the CCDs derived from the thermal processing of clams.This study also declares the necessary that prioritize the investigation of the potential impact of other thermal processing hazards originating from heat-processed foods on the toxicity of heavy metal ions.
基金supported financially by the National Nature Science Foundation of China(No.82373355,No.82172703,No.82303856,and No.82473505)the Discipline Leader Project of Shanghai Municipal Health Commission(No.2022XD013)the AoXiang Project of Shanghai Anti-Cancer Association(No.SACA-AX202302).
文摘The choice of biopsy method is critical in diagnosing prostate cancer(PCa).This retrospective cohort study compared systematic biopsy(SB)or cognitive fusion-targeted biopsy combined with SB(CB)in detecting PCa and clinically significant prostate cancer(csPCa).Data from 2572 men who underwent either SB or CB in Fudan University Shanghai Cancer Center(Shanghai,China)between January 2019 and December 2023 were analyzed.Propensity score matching(PSM)was used to balance baseline characteristics,and detection rates were compared before and after PSM.Subgroup analyses based on prostate-specific antigen(PSA)levels and Prostate Imaging-Reporting and Data System(PI-RADS)scores were performed.Primary and secondary outcomes were the detection rates of PCa and csPCa,respectively.Of 2572 men,1778 were included in the PSM analysis.Before PSM,CB had higher detection rates for both PCa(62.9%vs 52.4%,odds ratio[OR]:1.54,P<0.001)and csPCa(54.9%vs 43.3%,OR:1.60,P<0.001)compared to SB.After PSM,CB remained superior in detecting PCa(63.1%vs 47.9%,OR:1.86,P<0.001)and csPCa(55.0%vs 38.2%,OR:1.98,P<0.001).In patients with PSA 4–12 ng ml−1(>4 ng ml-1 and≤12 ng ml-1,which is also applicable to the following text),CB detected more PCa(59.8%vs 40.7%,OR:2.17,P<0.001)and csPCa(48.1%vs 27.7%,OR:2.42,P<0.001).CB also showed superior csPCa detection in those with PI-RADS 3 lesions(32.1%vs 18.0%,OR:2.15,P=0.038).Overall,CB significantly improves PCa and csPCa detection,especially in patients with PSA 4–12 ng ml−1 or PI-RADS 3 lesions.
基金funded by the National Natural Science Foundation of China,grant number 52306124(received by Dan Huang),URL:https://mp.weixin.qq.com/s/HHNYjgYKAynqYR7ySxYwzQ(accessed on 01 January 2025)the Changsha Municipal Natural Science Foundation,grant number kq2402259(received by Shuai Huang),URL:http://kjj.changsha.gov.cn/zfxxgk/tzgg_27202/202501/t20250122_11726939.html(accessed on 01 January 2025)the Regional Joint Funds of the Natural Science Foundation of Hunan Province,grant num-ber 2025JJ70463(received by Shuai Huang),URL:https://kjt.hunan.gov.cn/kjt/xxgk/tzgg/tzgg_1/202502/t20250212_33585991.html(accessed on 01 January 2025).
文摘Bananas are highly perishable after harvest,and processing them into dried products is a crucial approach to reducing losses and adding their economic values.To address the inefficiency and prolonged duration of traditional hot air drying(HAD)and the quality inconsistency associated with single infrared drying(IRD),this study proposed a novel hot air-infrared combined drying(HAD-IRD)strategy.The effects of HAD,IRD,and HAD-IRD on the drying kinetics,color,rehydration capacity,moisture diffusion mechanism,and sensory quality of banana slices were systematically investigated.The parameters of the combined drying process were optimized using an L_(9)(3^(3))orthogonal experimental design.Results indicated that both IRD and HAD-IRD significantly reduced drying time compared to single HAD.While single IRD achieved a rapid drying rate,the lack of effective convective airflow led to potential case-hardening and unstable product quality.In contrast,the HAD-IRD strategy demonstrated a synergistic effect.The optimal parameters were determined as follows:hot air temperature of 70℃,infrared temperature of 60℃,and radiation distance of 16 cm.Under these optimized conditions,HAD-IRD reduced the total drying time by over 70%while simultaneously yielding products with superior color,higher sensory scores,and improved rehydration ratio.This study confirms that HAD-IRD is an efficient and high-quality drying method for banana slices,providing a reliable theoretical foundation and technical solution for the drying of thermosensitive fruits.
基金supported by the Youth Program of National Natural Science Foundation of China(No.52404343)the General Program of National Natural Science Foundation of China(No.52274326)+2 种基金the Fundamental Research Funds for the Central Universities,China(No.N2425031)the Seventh Batch of Ten Thousand Talents Plan of China(No.ZX20220553)the Liaoning Province Science and Technology Plan Joint Program,China(Key Research and Development Program Project)(No.2023JH2/101800058).
文摘The comprehensive status of blast furnaces was one of the most important factors affecting their economy,quality,and longev-ity.The blast furnace comprehensive status had the nature of“black box,”and it was“unpredictable.”In this study,a blast furnace com-prehensive status score and prediction method based on a cascade system and a combined model were proposed to address this issue.A dual cascade evaluation system was developed by integrating subjective and objective weighting methods.The analytic hierarchy process,coefficient of variation,entropy weight method,and impart combinatorial games were jointly employed to determine the optimal weight distribution across indicators.Categorized statuses(raw material,gas flow,furnace body,furnace cylinder,and iron-slag)were evaluated.Based on the five categories of the status data,the second cascade was applied to upgrade the quantitative evaluation of the comprehens-ive status.The weights of the different categories were 0.22,0.15,0.22,0.21,and 0.20,respectively.According to the data analysis,the results of the comprehensive status score closely matched the on-site production logs.Based on the blast furnace smelting period,the maximal information coefficient method was applied to the 100 parameters that were most relevant to the comprehensive status.A com-bined prediction model for a comprehensive status score was designed using bidirectional long short-term memory(BiLSTM)and categorical boosting(CatBoost).The test results indicated that the combined model reduced the mean absolute error by an average of 0.275 and increased the hit rate by an average of 5.65 percentage points compared to BiLSTM or CatBoost alone.When the er-ror range was±2.5,the combined model predicted a hit rate of 91.66%for the next hour’s comprehensive status score,and its high accur-acy was deemed satisfactory for the field.SHapley Additive exPlanations(SHAP)and regression fitting were applied to analyze the lin-ear quantitative relationship between the key variables and the comprehensive status score.When the furnace bottom center temperature was increased by 10℃,the comprehensive status score increased by 0.44.This method contributes to a more precise management and control of the comprehensive status of the blast furnace on-site.
