Small cell lung cancer(SCLC)constitutes approximately 15%of all lung cancer cases,characterized by rapid tumor growth,a high pro-liferation rate,and a propensity for early metastasis.1 Approximately one-third of SCLC ...Small cell lung cancer(SCLC)constitutes approximately 15%of all lung cancer cases,characterized by rapid tumor growth,a high pro-liferation rate,and a propensity for early metastasis.1 Approximately one-third of SCLC patients are diagnosed at the limited-stage.Histor-ically,the standard of care for these patients has been 4-6 cycles of concurrent chemoradiotherapy(cCRT),with the exception of a minor-ity of early-stage T1-2N0 patients who may undergo radical surgery.2 Despite an initial high sensitivity to treatment,over 50%of patients experience disease recurrence within two years,with a median overall survival(OS)ranging from 16 to 24 months.For the past three decades,while there have been novel explorations in radiotherapy dosing and fractionation,the treatment paradigm for limited-stage SCLC(LS-SCLC)has remained largely unchanged,with no significant improvement in patient survival outcomes.展开更多
Autologous bone marrow-derived mesenchymal stem cells(BMSCs)have been shown to promote osteogenesis;however,the effects of allogeneic BMSCs(allo-BMSCs)on bone regeneration remain unclear.Therefore,we explored the bone...Autologous bone marrow-derived mesenchymal stem cells(BMSCs)have been shown to promote osteogenesis;however,the effects of allogeneic BMSCs(allo-BMSCs)on bone regeneration remain unclear.Therefore,we explored the bone regeneration promotion effect of allo-BMSCs in 3D-printed autologous bone particle(ABP)scaffolds.First,we concurrently printed scaffolds with polycaprolactone,ABPs,and allo-BMSCs for appropriate support,providing bioactive factors and seed cells to promote osteogenesis.In vitro studies showed that ABP scaffolds promoted allo-BMSC osteogenic differentiation.In vivo studies revealed that the implantation of scaffolds loaded with ABPs and allo-BMSCs into canine skull defects for nine months promoted osteogenesis.Further experiments suggested that only a small portion of implanted allo-BMSCs survived and differentiated into vascular endothelial cells,chondrocytes,and osteocytes.The implanted allo-BMSCs released stromal cell-derived factor 1 through paracrine signaling to recruit native BMSCs into the defect,promoting bone regeneration.This study contributes to our understanding of allo-BMSCs,providing information relevant to their future application.展开更多
BACKGROUND Malignant transformation(MT)of mature cystic teratoma(MCT)has a poor prognosis,especially in advanced cases.Concurrent chemoradiotherapy(CCRT)has an inhibitory effect on MT.CASE SUMMARY Herein,we present a ...BACKGROUND Malignant transformation(MT)of mature cystic teratoma(MCT)has a poor prognosis,especially in advanced cases.Concurrent chemoradiotherapy(CCRT)has an inhibitory effect on MT.CASE SUMMARY Herein,we present a case in which CCRT had a reduction effect preoperatively.A 73-year-old woman with pyelonephritis was referred to our hospital.Computed tomography revealed right hydronephrosis and a 6-cm pelvic mass.Endoscopic ultrasound-guided fine-needle biopsy(EUS-FNB)revealed squamous cell carci-noma.The patient was diagnosed with MT of MCT.Due to her poor general con-dition and renal malfunction,we selected CCRT,expecting fewer adverse effects.After CCRT,her performance status improved,and the tumor size was reduced;surgery was performed.Five months postoperatively,the patient developed dis-semination and lymph node metastases.Palliative chemotherapy was ineffective.She died 18 months after treatment initiation.CONCLUSION EUS-FNB was useful in the diagnosis of MT of MCT;CCRT suppressed the disea-se and improved quality of life.展开更多
Objective:Radiotherapy(RT)is the definitive treatment for stageⅡnasopharyngeal carcinoma(NPC),which is classified as stagesⅠA andⅠB in the latest ninth edition of American Joint Committee on Cancer(AJCC)/Union for ...Objective:Radiotherapy(RT)is the definitive treatment for stageⅡnasopharyngeal carcinoma(NPC),which is classified as stagesⅠA andⅠB in the latest ninth edition of American Joint Committee on Cancer(AJCC)/Union for International Cancer Control(UICC).A crucial question is whether concurrent chemo-radiotherapy(CCRT)could derive additional benefits to this recent“down-staging”subgroup of NPC patients.This study aimed to interrogate clinical and radiomic features for predicting 5-year progression-free survival(PFS)of stageⅡNPC treated with RT alone or CCRT.Methods:Imaging and clinical data of 166 stageⅡNPC(eighth edition AJCC/UICC)patients were collected.Data were allocated into training,internal testing,and external testing sets.For each case,851 radiomic features were extracted and 10 clinical features were collected.Radiomic and clinical features most associated with the 5-year PFS were selected separately.A combined model was developed using multivariate logistic regression by integrating selected features and treatment option to predict 5-year PFS.Model performances were evaluated by area under the receiver operating curve(AUC),prediction accuracy,and decision curve analysis.Survival analyses including Kaplan-Meier analysis and Cox regression model were performed for further analysis.Results:Thirteen radiomic features,three clinical features,and treatment option were considered for model development.The combined model showed higher prognostic performance than using either.For the merged testing set(internal and external testing sets),AUC is 0.76(combined)vs.0.56-0.80(clinical or radiomic alone)and accuracy is 0.75(combined)vs.0.62-0.73(clinical or radiomic alone).Kaplan-Meier analysis using the combined model showed significant discrimination in PFS of the predicted low-risk and high-risk groups in the training and internal testing cohorts(P<0.05).Conclusions:Integrating with clinical and radiomic features could provide prognostic information on 5-year PFS under either treatment regimen,guiding individualized decisions of chemotherapy based on the predicted treatment outcome.展开更多
Defective phononic crystals(PnCs)have enabled spatial localization and quantitative amplification of elastic wave energy.Most previous research has focused on applications such as narrow-bandpass filters,ultrasonic se...Defective phononic crystals(PnCs)have enabled spatial localization and quantitative amplification of elastic wave energy.Most previous research has focused on applications such as narrow-bandpass filters,ultrasonic sensors,and piezoelectric energy harvesters,typically operating under the assumption of an external elastic wave incidence.Recently,a novel approach that uses defective PnCs as ultrasonic actuators to generate amplified waves has emerged.However,the existing studies are limited to the generation of either longitudinal or bending waves,with no research addressing the concurrent generation of both.Hence,this paper proposes a straightforward methodology for the concurrent generation and amplification of both wave types utilizing defect modes at independent defect-band frequencies.Bimorph piezoelectric elements are attached to the defect,with each element connected to independent external voltage sources.By precisely adjusting the magnitude and temporal phase differences between the voltage sources,concurrently amplified wave generation is achieved.The paper highlights the advantages of the proposed analytical model.This model is both computationally time-efficient and accurate,in comparison with the COMSOL simulation results.For instance,in case studies,the analytical model reduces the computational time from one hour to mere seconds,while maintaining acceptable error rates of 1%in peak frequencies.This concurrent wave-generation methodology opens new avenues for applications in rotating machinery fault diagnosis,structural health monitoring,and medical imaging.展开更多
BACKGROUND Patients with concurrent acute biliary pancreatitis(ABP)and acute cholangitis(AC)may experience exacerbated clinical consequences due to bile duct stones.However,studies exploring this topic remain limited....BACKGROUND Patients with concurrent acute biliary pancreatitis(ABP)and acute cholangitis(AC)may experience exacerbated clinical consequences due to bile duct stones.However,studies exploring this topic remain limited.AIM To compare the clinical presentation and outcomes of patients experiencing AC with and without ABP.METHODS This single-center retrospective cohort study included 358 patients with AC who underwent endoscopic retrograde cholangiopancreatography(ERCP)between January 2016 and December 2017.Patients were divided into two groups:AC with ABP(n=90)and AC without ABP(n=268).Clinical characteristics,laboratory data,ERCP results,primary study outcome[intensive care unit(ICU)admission],and secondary outcomes including 30-day mortality,length of hospital stay,and 30-day readmission rate were analyzed and compared.RESULTS All patients in the AC with ABP group had interstitial pancreatitis.The AC with ABP group had significantly higher white cell count(WBC)counts(13.1×10^(3)/μL vs 10.4×10^(3)/μL,P=0.007)and more abnormal WBC results(61.1%vs 42.3%,P=0.015).Liver biochemical tests,AC severity,ERCP success,adverse events,ICU admissions,30-day mortality,hospital stay,and readmission rates did not differ significantly between the two groups.Univariate analysis showed no significant link between concurrent ABP and ICU admission,although significance was marginal in moderate/severe ABP cases(P=0.051).In the multivariate analysis,age(P=0.035)and cardiovascular dysfunction(P<0.001)were independently associated with length of ICU stay.CONCLUSION Concurrent interstitial ABP and AC did not significantly affect outcomes.Age and cardiovascular dysfunction were stronger predictors of ICU admission and should guide clinical monitoring and management.展开更多
A novel Additive Manufacturing(AM)-driven concurrent design strategy based on the beam characterization model considering strength constraints is proposed.The lattice topology,radius size,Building Orientation(BO),and ...A novel Additive Manufacturing(AM)-driven concurrent design strategy based on the beam characterization model considering strength constraints is proposed.The lattice topology,radius size,Building Orientation(BO),and structural yield strength can be simultaneously adjusted by integrating the overall process-structure-performance relationship of the AM process into the optimization.Specifically,the transverse isotropic material model is adopted to describe the material properties induced by the layer-by-layer manner of additive manufacturing.To bolster lattice strength performance,the stress constraints and ratio constraints of lattice struts are employed.The Tsai-Wu yield criterion is implemented to characterize the lattice strut's strength,while the P-norm method streamlines the handling of multiple constraints,minimizing computational overhead.Moreover,the gradient-based optimization model is established,where both the individual struts diameters and BO can be designed,and the buckling-prone spatial struts are strategically eliminated to improve the lattice strength further.Furthermore,several typical structures are optimized to verify the effectiveness of the proposed method.The optimized results are quite encouraging since the heterogeneous lattice structures with optimized BO obtained by the strength-based concurrent method show a remarkably improved performance compared to traditional designs.展开更多
Objectives:The optimal treatment strategy for early-stage natural killer/T-cell lymphoma(NKTCL)remains unclear.This study aimed to evaluate and compare the clinical outcomes and adverse events(AEs)associated with two ...Objectives:The optimal treatment strategy for early-stage natural killer/T-cell lymphoma(NKTCL)remains unclear.This study aimed to evaluate and compare the clinical outcomes and adverse events(AEs)associated with two treatment regimens for early-stage NKTCL:pegaspargase with concurrent radiation therapy(P+CCRT)and pegaspargase,gemcitabine,and oxaliplatin(P-GEMOX)with sequential radiation therapy(SERT).Propensity score matching(PSM)was employed to ensure balanced comparison between these regimens.Methods:We assessed the efficacy of P+CCRT from a phase II trial and P-GEMOX combined with SERT using real-world data.PSM was conducted at a 1:1 ratio with a caliper of 0.18 to align baseline characteristics between the treatment groups.Key outcomes analyzed included overall response rate(ORR),complete response rate(CR),progression-free survival(PFS),overall survival(OS),and AEs.Results:Following PSM,the study included 52 patients,with 26 in each treatment group.Baseline characteristics were balanced between the cohorts.The ORR for P+CCRT group was 100.0%compared to 88.5%for P-GEMOX+SERT group,and the CR rates was 100.0%vs.76.9%,respectively.The 3-year OS and PFS rates were both 92.3%for P+CCRT,while P-GEMOX showed 92.3%OS and 80.8%PFS.Adverse events,including hematological toxicity,hepatotoxicity,and coagulation dysfunction,were comparable between the two regimens.Conclusion:P+CCRT is associated with comparable clinical outcomes compared to P-GEMOX+SERT in early-stage NKTCL,with comparable adverse events.Additionally,P+CCRT offers the benefit of a more streamlined treatment regimen with a shorter cycle.Given these encouraging results,further cohort studies are needed to validate these results.展开更多
The frequency and duration of observed concurrent hot and dry events(HDEs) over China during the growing season(April–September) exhibit significant decadal changes across the mid-1990s. These changes are characteriz...The frequency and duration of observed concurrent hot and dry events(HDEs) over China during the growing season(April–September) exhibit significant decadal changes across the mid-1990s. These changes are characterized by increases in HDE frequency and duration over most of China, with relatively large increases over southeastern China(SEC), northern China(NC), and northeastern China(NEC). The frequency of HDEs averaged over China in the present day(PD,1994–2011) is double that in the early period(EP, 1964–81);the duration of HDEs increases by 60%. Climate experiments with the Met Office Unified Model(MetUM-GOML2) are used to estimate the contributions of anthropogenic forcing to HDE decadal changes over China. Anthropogenic forcing changes can explain 60%–70% of the observed decadal changes,suggesting an important anthropogenic influence on HDE changes over China across the mid-1990s. Single-forcing experiments indicate that the increase in greenhouse gas(GHG) concentrations dominates the simulated decadal changes,increasing the frequency and duration of HDEs throughout China. The change in anthropogenic aerosol(AA) emissions significantly decreases the frequency and duration of HDEs over SEC and NC, but the magnitude of the decrease is much smaller than the increase induced by GHGs. The changes in HDEs in response to anthropogenic forcing are mainly due to the response of climatological mean surface air temperatures. The contributions from changes in variability and changes in climatological mean soil moisture and evapotranspiration are relatively small. The physical processes associated with the response of HDEs to GHG and AA changes are also revealed.展开更多
Reachability graph is a very important tool to analyze the dynamic properties of Petri nets, but the concurrent relation of transitions in Petri nets cannot be represented by reachability graph. Petri net is a concurr...Reachability graph is a very important tool to analyze the dynamic properties of Petri nets, but the concurrent relation of transitions in Petri nets cannot be represented by reachability graph. Petri net is a concurrent system, while reachability graph is a serial one. However, concurrency is a kind of property which is not only very significant but also difficult to be analyzed and controlled. This paper presents the concepts of concurrent reachable marking and concurrent reachable graph in order to represent and analyze the concurrent system. The algorithm constructing concurrent reachable marking set and concurrent reachability graph is also shown so that we can study the response problems among services in a network computing environment and analyze the throughput of the system. The Dining Philosophers Problem, which is a classic problem of describing the management of concurrent resources, is given as an example to illustrate the significance of concurrent reachability graph.展开更多
BACKGROUND Currently,there is no standard adjuvant therapy for patients with resected ampulla of Vater(AoV)cancer.AIM To evaluate the effectiveness of adjuvant concurrent chemoradiotherapy(CCRT)in patients with advanc...BACKGROUND Currently,there is no standard adjuvant therapy for patients with resected ampulla of Vater(AoV)cancer.AIM To evaluate the effectiveness of adjuvant concurrent chemoradiotherapy(CCRT)in patients with advanced AoV cancer who underwent curative resection.METHODS This single-centered,retrospective study included 29 patients with advanced AoV cancer who underwent pancreaticoduodenectomy between 2006 and 2018.The impact of CCRT on advanced AoV cancer was analyzed.RESULTS The 1-,3-,and 5-yr recurrence-free survival(RFS)rates for patients with advanced AoV cancer were 82.8%,48.3%,and 40.8%,respectively,and the overall survival(OS)rates were 89.7%,62.1%,and 51.7%,respectively.Lymphovas-cular invasion was found to be a significant risk factor for RFS and OS in patients with advanced AoV cancer in the univariate analysis,whereas T stage and lymph node metastasis were significantly associated with OS in the multivariate analysis.Compared to the patients who did not receive adjuvant CCRT,those who received adjuvant CCRT did not show statistically significant improvements in the RFS and OS,although they had a significantly lower average age and significantly higher platelet-to-lymphocyte ratio.CONCLUSION Adjuvant CCRT did not improve survival outcomes in patients with advanced AoV cancer.These findings contribute to existing knowledge on the effectiveness of CCRT in this patient population and provide important insights for clinical decision-making.展开更多
BACKGROUND Pancreatic adenocarcinoma,a malignancy that arises in the cells of the pancreas,is a devastating disease with unclear etiology and often poor prognosis.Locally advanced pancreatic cancer,a stage where the t...BACKGROUND Pancreatic adenocarcinoma,a malignancy that arises in the cells of the pancreas,is a devastating disease with unclear etiology and often poor prognosis.Locally advanced pancreatic cancer,a stage where the tumor has grown significantly but has not yet spread to distant organs,presents unique challenges in treatment.This article aims to discuss the current strategies,challenges,and future directions in the management of locally advanced pancreatic adenocarcinoma(LAPC).AIM To investigate the feasibility and efficacy of programmed cell death 1(PD-1)inhibitor sintilimab plus concurrent chemoradiotherapy for LAPC.METHODS Eligible patients had LAPC,an Eastern cooperative oncology group performance status of 0 or 1,adequate organ and marrow functions,and no prior anticancer therapy.In the observation group,participants received intravenous sintilimab 200 mg once every 3 wk,and received concurrent chemoradiotherapy(concurrent conventional fractionated radiotherapy with doses planning target volume 50.4 Gy and gross tumor volume 60 Gy in 28 fractions and oral S-140 mg/m2 twice daily on days 1-14 of a 21-d cycle and intravenous gemcitabine 1000 mg/m2 on days 1 and 8 of a 21-d cycle for eight cycles until disease progression,death,or unacceptable toxicity).In the control group,participants only received concurrent chemoradiotherapy.From April 2020 to November 2021,64 participants were finally enrolled with 34 in the observation group and 30 in the control group.RESULTS Thirty-four patients completed the scheduled course of chemoradiotherapy,while 32(94.1%)received sintilimab plus concurrent chemoradiotherapy with 2 patients discontinuing sintilimab in the observation group.Thirty patients completed the scheduled course of chemoradiotherapy in the control group.Based on the Response Evaluation Criteria in Solid Tumors guidelines,the analysis of the observation group revealed that a partial response was observed in 11 patients(32.4%),stable disease was evident in 19 patients(55.9%),and 4 patients(11.8%)experienced progressive disease;a partial response was observed in 6(20.0%)patients,stable disease in 18(60%),and progressive disease in 6(20%)in the control group.The major toxic effects were leukopenia and nausea.The incidence of severe adverse events(AEs)(grade 3 or 4)was 26.5%(9/34)in the observation group and 23.3%(7/30)in the control group.There were no treatment-related deaths.The observation group demonstrated a significantly longer median overall survival(22.1 mo compared to 15.8 mo)(P<0.05)and progression-free survival(12.2 mo vs 10.1 mo)(P<0.05)in comparison to the control group.The occurrence of severe AEs did not exhibit a statistically significant difference between the observation group and the control group(P>0.05).CONCLUSION Sintilimab plus concurrent chemoradiotherapy was effective and safe for LAPC patients,and warrants further investigation.展开更多
This paper outlines a concurrent engineering environment that supports interaction between members of a geographically dispersed multidisciplinary team who is engaged in engineering design activities. Some ideas of en...This paper outlines a concurrent engineering environment that supports interaction between members of a geographically dispersed multidisciplinary team who is engaged in engineering design activities. Some ideas of engineering design, especially conceptual design are reviewed. A deeper scientific analysis of intelligent design is discussed. A new problem solving strategy and methodologies to implement cooperative design are proposed. Finally, a conceptual model of a blackboard system for accomplishing conceptual design automation is presented. Its fundamental principles, system organization and key implementation techniques are investigated in detail.展开更多
Taking a microwave product as an example, a system of integrated assembly structure design is presented. Getting design constraints from the upstream design section through product data management(PDM), the system gen...Taking a microwave product as an example, a system of integrated assembly structure design is presented. Getting design constraints from the upstream design section through product data management(PDM), the system generates the assembly scheme using the case? based method, then assigns the design requirements into each component of the assembly. The detail design for each component can be performed under these design constraints. In order to practise concurrent design, the system sends the final design result to the upstream section and downstream section through PDM to achieve information sharing and integration.展开更多
A method for modeling crosscutting concerns in the concurrent software system is presented based on the aspect-oriented（A-O） technique and the statechart of unified modeling language （UML）. Modeled with UML statec...A method for modeling crosscutting concerns in the concurrent software system is presented based on the aspect-oriented（A-O） technique and the statechart of unified modeling language （UML）. Modeled with UML statechart diagrams, the primary system functions and corresponding traversal features are enveloped into various orthogonal regions of a composite state. The mutual relationships between orthogonal regions are implied by the orders of broadcast events. Using a modular transition system as a basic computational model, the formalization description of A-O statechart models is proposed. The precise semantics of model elements and modeling procedures is given. The example study indicates that the separation strategy of crosscutting concerns is implemented in the design phase of the concurrent software system with this method. Meanwhile, the software modeling method has advantages of loose coupling, adaptability and traceability.展开更多
Implementation of simultaneous execution phases in the concurrent engineering (CE) needs careful planning when the downstream phase could be activated as the upstream phase developed to a certain point. The determinat...Implementation of simultaneous execution phases in the concurrent engineering (CE) needs careful planning when the downstream phase could be activated as the upstream phase developed to a certain point. The determination of startup time of overlapping jobs in CE has long been a disturbance in manufacturing industry implementing CE programs. A novel model based on both fuzzy logic and neural network is proposed to mathematically formulate the inter-connective information between the two coupled phases in CE projects, and to determine the startup time of downstream phases in real time. The information transferring between the two coupled phases is quantified by using the negative Shannon entropy. Based on this algorithm, a PDM-based framework is proposed to narrow the gap between pro-duct design and manufacture, in which five modules are built to monitor, reshuffle and implement the simultaneous executing processes. Finally, an example is given to illustrate applications of the algorithm in the real world.展开更多
The effect of concurrent precipitation on recrystallization textures in AA 3003 aluminum alloys was investigated using X-ray diffraction and electron backscattering diffraction（EBSD） analyses. A weak recrystallizati...The effect of concurrent precipitation on recrystallization textures in AA 3003 aluminum alloys was investigated using X-ray diffraction and electron backscattering diffraction（EBSD） analyses. A weak recrystallization texture was observed in the AA 3003 alloy annealed at 783 K due to the high annealing temperature. Under the same conditions, extremely high P {011 } （ 111 ） recrystallization textures were detected in the AA 3003 alloy added with 0. 39% Sc. Based on the EBSD results, no intensely preferential orientation nucleation of recrystallization grains was observed in the early stage of recrystallizafion for both alloys. However, concurrent precipitation strongly retarded the growth of recrystallization grains, except for P nucleation sites, thereby conferring an apparent initial growth advantage for P nucleation sites compared with other nucleation sites. Therefore, a sharp P {011 } 〈 111 〉 texture appeared in concurrently precipitated AA 3003 alloys.展开更多
Tolerance analysis is investigated under an environment of concurrent design in order to lead to optimized tolerance, as traditional tolerance analysis is often inefficient and liable to mistakes. Making full use of k...Tolerance analysis is investigated under an environment of concurrent design in order to lead to optimized tolerance, as traditional tolerance analysis is often inefficient and liable to mistakes. Making full use of knowledge in manufacturing tolerance analysis combined with the beta distribution model is introduced and applied. The use of beta distribution reflects fully actual capabilities in manufacture. Concurrent tolerance design is a manufacturing environment oriented design process paying more attention to influences or restraints on product design caused by such factors as the manufacturing process, machine capabilities, economy in manufacturing, etc. Process environment oriented tolerance analysis is more flexible making the designed results more practical and effective.展开更多
Concurrent signature was introduced as an efficient approach to solving the problem of fair exchange of signatures. Almost all fair exchange e-commerce protocols based on concurrent signature that have been proposed u...Concurrent signature was introduced as an efficient approach to solving the problem of fair exchange of signatures. Almost all fair exchange e-commerce protocols based on concurrent signature that have been proposed until now either do not provide message privacy protection or adopt the sign-then-encrypt scheme to provide confidentiality. However,confidentiality is an important requirement of fair exchange e-commerce protocol. In this paper,a new concept called concurrent signcryption which combines the concepts of concurrent signature and signcryption together to resolve the confidentiality problem in e-commerce systems based on concurrent signature. We also propose a concurrent signcryption scheme using bilinear pairings and prove its security in the random oracle model. Compared with the sign-then-encrypt scheme using bilinear pairings,our scheme enjoys shorter message length and less operation cost. Moreover,in our scheme the two ambiguous signcryptions can be published in any order.展开更多
基金supported by the Young Talents Program of Jiangsu Cancer Hospital(grant number:QL201813).
文摘Small cell lung cancer(SCLC)constitutes approximately 15%of all lung cancer cases,characterized by rapid tumor growth,a high pro-liferation rate,and a propensity for early metastasis.1 Approximately one-third of SCLC patients are diagnosed at the limited-stage.Histor-ically,the standard of care for these patients has been 4-6 cycles of concurrent chemoradiotherapy(cCRT),with the exception of a minor-ity of early-stage T1-2N0 patients who may undergo radical surgery.2 Despite an initial high sensitivity to treatment,over 50%of patients experience disease recurrence within two years,with a median overall survival(OS)ranging from 16 to 24 months.For the past three decades,while there have been novel explorations in radiotherapy dosing and fractionation,the treatment paradigm for limited-stage SCLC(LS-SCLC)has remained largely unchanged,with no significant improvement in patient survival outcomes.
基金supported by the Science and Technology Development Fund of the Fourth Military Medical University(No.2016XB051)the Military Medical Promotion Plan of the Fourth Military Medical University(No.2016TSA-005)+2 种基金the Science and Technology Program of Guangzhou(No.201604040002)the Youth Development Project of Air Force Medical University(No.21QNPY072)the Xijing Hospital Booster Program(No.XJZT24CZ10).
文摘Autologous bone marrow-derived mesenchymal stem cells(BMSCs)have been shown to promote osteogenesis;however,the effects of allogeneic BMSCs(allo-BMSCs)on bone regeneration remain unclear.Therefore,we explored the bone regeneration promotion effect of allo-BMSCs in 3D-printed autologous bone particle(ABP)scaffolds.First,we concurrently printed scaffolds with polycaprolactone,ABPs,and allo-BMSCs for appropriate support,providing bioactive factors and seed cells to promote osteogenesis.In vitro studies showed that ABP scaffolds promoted allo-BMSC osteogenic differentiation.In vivo studies revealed that the implantation of scaffolds loaded with ABPs and allo-BMSCs into canine skull defects for nine months promoted osteogenesis.Further experiments suggested that only a small portion of implanted allo-BMSCs survived and differentiated into vascular endothelial cells,chondrocytes,and osteocytes.The implanted allo-BMSCs released stromal cell-derived factor 1 through paracrine signaling to recruit native BMSCs into the defect,promoting bone regeneration.This study contributes to our understanding of allo-BMSCs,providing information relevant to their future application.
文摘BACKGROUND Malignant transformation(MT)of mature cystic teratoma(MCT)has a poor prognosis,especially in advanced cases.Concurrent chemoradiotherapy(CCRT)has an inhibitory effect on MT.CASE SUMMARY Herein,we present a case in which CCRT had a reduction effect preoperatively.A 73-year-old woman with pyelonephritis was referred to our hospital.Computed tomography revealed right hydronephrosis and a 6-cm pelvic mass.Endoscopic ultrasound-guided fine-needle biopsy(EUS-FNB)revealed squamous cell carci-noma.The patient was diagnosed with MT of MCT.Due to her poor general con-dition and renal malfunction,we selected CCRT,expecting fewer adverse effects.After CCRT,her performance status improved,and the tumor size was reduced;surgery was performed.Five months postoperatively,the patient developed dis-semination and lymph node metastases.Palliative chemotherapy was ineffective.She died 18 months after treatment initiation.CONCLUSION EUS-FNB was useful in the diagnosis of MT of MCT;CCRT suppressed the disea-se and improved quality of life.
文摘Objective:Radiotherapy(RT)is the definitive treatment for stageⅡnasopharyngeal carcinoma(NPC),which is classified as stagesⅠA andⅠB in the latest ninth edition of American Joint Committee on Cancer(AJCC)/Union for International Cancer Control(UICC).A crucial question is whether concurrent chemo-radiotherapy(CCRT)could derive additional benefits to this recent“down-staging”subgroup of NPC patients.This study aimed to interrogate clinical and radiomic features for predicting 5-year progression-free survival(PFS)of stageⅡNPC treated with RT alone or CCRT.Methods:Imaging and clinical data of 166 stageⅡNPC(eighth edition AJCC/UICC)patients were collected.Data were allocated into training,internal testing,and external testing sets.For each case,851 radiomic features were extracted and 10 clinical features were collected.Radiomic and clinical features most associated with the 5-year PFS were selected separately.A combined model was developed using multivariate logistic regression by integrating selected features and treatment option to predict 5-year PFS.Model performances were evaluated by area under the receiver operating curve(AUC),prediction accuracy,and decision curve analysis.Survival analyses including Kaplan-Meier analysis and Cox regression model were performed for further analysis.Results:Thirteen radiomic features,three clinical features,and treatment option were considered for model development.The combined model showed higher prognostic performance than using either.For the merged testing set(internal and external testing sets),AUC is 0.76(combined)vs.0.56-0.80(clinical or radiomic alone)and accuracy is 0.75(combined)vs.0.62-0.73(clinical or radiomic alone).Kaplan-Meier analysis using the combined model showed significant discrimination in PFS of the predicted low-risk and high-risk groups in the training and internal testing cohorts(P<0.05).Conclusions:Integrating with clinical and radiomic features could provide prognostic information on 5-year PFS under either treatment regimen,guiding individualized decisions of chemotherapy based on the predicted treatment outcome.
基金supported by the Basic Science Research Program through the National Research Foundation of Korea,funded by the Ministry of Education(No.2022R1I1A1A01056406)。
文摘Defective phononic crystals(PnCs)have enabled spatial localization and quantitative amplification of elastic wave energy.Most previous research has focused on applications such as narrow-bandpass filters,ultrasonic sensors,and piezoelectric energy harvesters,typically operating under the assumption of an external elastic wave incidence.Recently,a novel approach that uses defective PnCs as ultrasonic actuators to generate amplified waves has emerged.However,the existing studies are limited to the generation of either longitudinal or bending waves,with no research addressing the concurrent generation of both.Hence,this paper proposes a straightforward methodology for the concurrent generation and amplification of both wave types utilizing defect modes at independent defect-band frequencies.Bimorph piezoelectric elements are attached to the defect,with each element connected to independent external voltage sources.By precisely adjusting the magnitude and temporal phase differences between the voltage sources,concurrently amplified wave generation is achieved.The paper highlights the advantages of the proposed analytical model.This model is both computationally time-efficient and accurate,in comparison with the COMSOL simulation results.For instance,in case studies,the analytical model reduces the computational time from one hour to mere seconds,while maintaining acceptable error rates of 1%in peak frequencies.This concurrent wave-generation methodology opens new avenues for applications in rotating machinery fault diagnosis,structural health monitoring,and medical imaging.
文摘BACKGROUND Patients with concurrent acute biliary pancreatitis(ABP)and acute cholangitis(AC)may experience exacerbated clinical consequences due to bile duct stones.However,studies exploring this topic remain limited.AIM To compare the clinical presentation and outcomes of patients experiencing AC with and without ABP.METHODS This single-center retrospective cohort study included 358 patients with AC who underwent endoscopic retrograde cholangiopancreatography(ERCP)between January 2016 and December 2017.Patients were divided into two groups:AC with ABP(n=90)and AC without ABP(n=268).Clinical characteristics,laboratory data,ERCP results,primary study outcome[intensive care unit(ICU)admission],and secondary outcomes including 30-day mortality,length of hospital stay,and 30-day readmission rate were analyzed and compared.RESULTS All patients in the AC with ABP group had interstitial pancreatitis.The AC with ABP group had significantly higher white cell count(WBC)counts(13.1×10^(3)/μL vs 10.4×10^(3)/μL,P=0.007)and more abnormal WBC results(61.1%vs 42.3%,P=0.015).Liver biochemical tests,AC severity,ERCP success,adverse events,ICU admissions,30-day mortality,hospital stay,and readmission rates did not differ significantly between the two groups.Univariate analysis showed no significant link between concurrent ABP and ICU admission,although significance was marginal in moderate/severe ABP cases(P=0.051).In the multivariate analysis,age(P=0.035)and cardiovascular dysfunction(P<0.001)were independently associated with length of ICU stay.CONCLUSION Concurrent interstitial ABP and AC did not significantly affect outcomes.Age and cardiovascular dysfunction were stronger predictors of ICU admission and should guide clinical monitoring and management.
基金co-supported by National Key R&D Program of China(No.2022YFB4602003)Key Project of National Natural Science Foundation of China(No.12032018)+2 种基金Guangdong Basic and Applied Basic Research Foundation(No.2022A1515110489)National Natural Science Foundation of China-China Academy of General Technology Joint Fund for Basic Research(No.52375380)National Key Research and Development Program of China(No.2022YFB3402200)。
文摘A novel Additive Manufacturing(AM)-driven concurrent design strategy based on the beam characterization model considering strength constraints is proposed.The lattice topology,radius size,Building Orientation(BO),and structural yield strength can be simultaneously adjusted by integrating the overall process-structure-performance relationship of the AM process into the optimization.Specifically,the transverse isotropic material model is adopted to describe the material properties induced by the layer-by-layer manner of additive manufacturing.To bolster lattice strength performance,the stress constraints and ratio constraints of lattice struts are employed.The Tsai-Wu yield criterion is implemented to characterize the lattice strut's strength,while the P-norm method streamlines the handling of multiple constraints,minimizing computational overhead.Moreover,the gradient-based optimization model is established,where both the individual struts diameters and BO can be designed,and the buckling-prone spatial struts are strategically eliminated to improve the lattice strength further.Furthermore,several typical structures are optimized to verify the effectiveness of the proposed method.The optimized results are quite encouraging since the heterogeneous lattice structures with optimized BO obtained by the strength-based concurrent method show a remarkably improved performance compared to traditional designs.
基金funded by the National Natural Science Foundation of China grant 81700148 and Natural Science Foundation of Guangdong Province grant 2021A1515010093 and 2023A1515011862funded by the National Natural Science Foundation of China grant 82170181funded by the Basic and Applied Basic Research Foundation of Guangdong Province grant 2022B1515120087.
文摘Objectives:The optimal treatment strategy for early-stage natural killer/T-cell lymphoma(NKTCL)remains unclear.This study aimed to evaluate and compare the clinical outcomes and adverse events(AEs)associated with two treatment regimens for early-stage NKTCL:pegaspargase with concurrent radiation therapy(P+CCRT)and pegaspargase,gemcitabine,and oxaliplatin(P-GEMOX)with sequential radiation therapy(SERT).Propensity score matching(PSM)was employed to ensure balanced comparison between these regimens.Methods:We assessed the efficacy of P+CCRT from a phase II trial and P-GEMOX combined with SERT using real-world data.PSM was conducted at a 1:1 ratio with a caliper of 0.18 to align baseline characteristics between the treatment groups.Key outcomes analyzed included overall response rate(ORR),complete response rate(CR),progression-free survival(PFS),overall survival(OS),and AEs.Results:Following PSM,the study included 52 patients,with 26 in each treatment group.Baseline characteristics were balanced between the cohorts.The ORR for P+CCRT group was 100.0%compared to 88.5%for P-GEMOX+SERT group,and the CR rates was 100.0%vs.76.9%,respectively.The 3-year OS and PFS rates were both 92.3%for P+CCRT,while P-GEMOX showed 92.3%OS and 80.8%PFS.Adverse events,including hematological toxicity,hepatotoxicity,and coagulation dysfunction,were comparable between the two regimens.Conclusion:P+CCRT is associated with comparable clinical outcomes compared to P-GEMOX+SERT in early-stage NKTCL,with comparable adverse events.Additionally,P+CCRT offers the benefit of a more streamlined treatment regimen with a shorter cycle.Given these encouraging results,further cohort studies are needed to validate these results.
基金the University of Reading, funded by the UK–China Research and Innovation Partnership Fund through the Met Office Climate Science for Service Partnership (CSSP) China as part of the Newton Fundsupported by the National Natural Science Foundation of China (Grant Nos. 42030603 and 42175044)+1 种基金supported by CSSP-China. NPK was supported by an Independent Research Fellowship from the Natural Environment Research Council (Grant No. NE/L010976/1)supported by the National Centre for Atmospheric Science via the NERC/GCRF programme “Atmospheric hazards in developing countries: risk assessment and early warnings ” (ACREW)。
文摘The frequency and duration of observed concurrent hot and dry events(HDEs) over China during the growing season(April–September) exhibit significant decadal changes across the mid-1990s. These changes are characterized by increases in HDE frequency and duration over most of China, with relatively large increases over southeastern China(SEC), northern China(NC), and northeastern China(NEC). The frequency of HDEs averaged over China in the present day(PD,1994–2011) is double that in the early period(EP, 1964–81);the duration of HDEs increases by 60%. Climate experiments with the Met Office Unified Model(MetUM-GOML2) are used to estimate the contributions of anthropogenic forcing to HDE decadal changes over China. Anthropogenic forcing changes can explain 60%–70% of the observed decadal changes,suggesting an important anthropogenic influence on HDE changes over China across the mid-1990s. Single-forcing experiments indicate that the increase in greenhouse gas(GHG) concentrations dominates the simulated decadal changes,increasing the frequency and duration of HDEs throughout China. The change in anthropogenic aerosol(AA) emissions significantly decreases the frequency and duration of HDEs over SEC and NC, but the magnitude of the decrease is much smaller than the increase induced by GHGs. The changes in HDEs in response to anthropogenic forcing are mainly due to the response of climatological mean surface air temperatures. The contributions from changes in variability and changes in climatological mean soil moisture and evapotranspiration are relatively small. The physical processes associated with the response of HDEs to GHG and AA changes are also revealed.
文摘Reachability graph is a very important tool to analyze the dynamic properties of Petri nets, but the concurrent relation of transitions in Petri nets cannot be represented by reachability graph. Petri net is a concurrent system, while reachability graph is a serial one. However, concurrency is a kind of property which is not only very significant but also difficult to be analyzed and controlled. This paper presents the concepts of concurrent reachable marking and concurrent reachable graph in order to represent and analyze the concurrent system. The algorithm constructing concurrent reachable marking set and concurrent reachability graph is also shown so that we can study the response problems among services in a network computing environment and analyze the throughput of the system. The Dining Philosophers Problem, which is a classic problem of describing the management of concurrent resources, is given as an example to illustrate the significance of concurrent reachability graph.
基金This study was approved by the Institutional Review Board of Clinical Trial Center in Pusan National University hospital(IRB No.2303-007-124).
文摘BACKGROUND Currently,there is no standard adjuvant therapy for patients with resected ampulla of Vater(AoV)cancer.AIM To evaluate the effectiveness of adjuvant concurrent chemoradiotherapy(CCRT)in patients with advanced AoV cancer who underwent curative resection.METHODS This single-centered,retrospective study included 29 patients with advanced AoV cancer who underwent pancreaticoduodenectomy between 2006 and 2018.The impact of CCRT on advanced AoV cancer was analyzed.RESULTS The 1-,3-,and 5-yr recurrence-free survival(RFS)rates for patients with advanced AoV cancer were 82.8%,48.3%,and 40.8%,respectively,and the overall survival(OS)rates were 89.7%,62.1%,and 51.7%,respectively.Lymphovas-cular invasion was found to be a significant risk factor for RFS and OS in patients with advanced AoV cancer in the univariate analysis,whereas T stage and lymph node metastasis were significantly associated with OS in the multivariate analysis.Compared to the patients who did not receive adjuvant CCRT,those who received adjuvant CCRT did not show statistically significant improvements in the RFS and OS,although they had a significantly lower average age and significantly higher platelet-to-lymphocyte ratio.CONCLUSION Adjuvant CCRT did not improve survival outcomes in patients with advanced AoV cancer.These findings contribute to existing knowledge on the effectiveness of CCRT in this patient population and provide important insights for clinical decision-making.
文摘BACKGROUND Pancreatic adenocarcinoma,a malignancy that arises in the cells of the pancreas,is a devastating disease with unclear etiology and often poor prognosis.Locally advanced pancreatic cancer,a stage where the tumor has grown significantly but has not yet spread to distant organs,presents unique challenges in treatment.This article aims to discuss the current strategies,challenges,and future directions in the management of locally advanced pancreatic adenocarcinoma(LAPC).AIM To investigate the feasibility and efficacy of programmed cell death 1(PD-1)inhibitor sintilimab plus concurrent chemoradiotherapy for LAPC.METHODS Eligible patients had LAPC,an Eastern cooperative oncology group performance status of 0 or 1,adequate organ and marrow functions,and no prior anticancer therapy.In the observation group,participants received intravenous sintilimab 200 mg once every 3 wk,and received concurrent chemoradiotherapy(concurrent conventional fractionated radiotherapy with doses planning target volume 50.4 Gy and gross tumor volume 60 Gy in 28 fractions and oral S-140 mg/m2 twice daily on days 1-14 of a 21-d cycle and intravenous gemcitabine 1000 mg/m2 on days 1 and 8 of a 21-d cycle for eight cycles until disease progression,death,or unacceptable toxicity).In the control group,participants only received concurrent chemoradiotherapy.From April 2020 to November 2021,64 participants were finally enrolled with 34 in the observation group and 30 in the control group.RESULTS Thirty-four patients completed the scheduled course of chemoradiotherapy,while 32(94.1%)received sintilimab plus concurrent chemoradiotherapy with 2 patients discontinuing sintilimab in the observation group.Thirty patients completed the scheduled course of chemoradiotherapy in the control group.Based on the Response Evaluation Criteria in Solid Tumors guidelines,the analysis of the observation group revealed that a partial response was observed in 11 patients(32.4%),stable disease was evident in 19 patients(55.9%),and 4 patients(11.8%)experienced progressive disease;a partial response was observed in 6(20.0%)patients,stable disease in 18(60%),and progressive disease in 6(20%)in the control group.The major toxic effects were leukopenia and nausea.The incidence of severe adverse events(AEs)(grade 3 or 4)was 26.5%(9/34)in the observation group and 23.3%(7/30)in the control group.There were no treatment-related deaths.The observation group demonstrated a significantly longer median overall survival(22.1 mo compared to 15.8 mo)(P<0.05)and progression-free survival(12.2 mo vs 10.1 mo)(P<0.05)in comparison to the control group.The occurrence of severe AEs did not exhibit a statistically significant difference between the observation group and the control group(P>0.05).CONCLUSION Sintilimab plus concurrent chemoradiotherapy was effective and safe for LAPC patients,and warrants further investigation.
文摘This paper outlines a concurrent engineering environment that supports interaction between members of a geographically dispersed multidisciplinary team who is engaged in engineering design activities. Some ideas of engineering design, especially conceptual design are reviewed. A deeper scientific analysis of intelligent design is discussed. A new problem solving strategy and methodologies to implement cooperative design are proposed. Finally, a conceptual model of a blackboard system for accomplishing conceptual design automation is presented. Its fundamental principles, system organization and key implementation techniques are investigated in detail.
文摘Taking a microwave product as an example, a system of integrated assembly structure design is presented. Getting design constraints from the upstream design section through product data management(PDM), the system generates the assembly scheme using the case? based method, then assigns the design requirements into each component of the assembly. The detail design for each component can be performed under these design constraints. In order to practise concurrent design, the system sends the final design result to the upstream section and downstream section through PDM to achieve information sharing and integration.
文摘A method for modeling crosscutting concerns in the concurrent software system is presented based on the aspect-oriented（A-O） technique and the statechart of unified modeling language （UML）. Modeled with UML statechart diagrams, the primary system functions and corresponding traversal features are enveloped into various orthogonal regions of a composite state. The mutual relationships between orthogonal regions are implied by the orders of broadcast events. Using a modular transition system as a basic computational model, the formalization description of A-O statechart models is proposed. The precise semantics of model elements and modeling procedures is given. The example study indicates that the separation strategy of crosscutting concerns is implemented in the design phase of the concurrent software system with this method. Meanwhile, the software modeling method has advantages of loose coupling, adaptability and traceability.
文摘Implementation of simultaneous execution phases in the concurrent engineering (CE) needs careful planning when the downstream phase could be activated as the upstream phase developed to a certain point. The determination of startup time of overlapping jobs in CE has long been a disturbance in manufacturing industry implementing CE programs. A novel model based on both fuzzy logic and neural network is proposed to mathematically formulate the inter-connective information between the two coupled phases in CE projects, and to determine the startup time of downstream phases in real time. The information transferring between the two coupled phases is quantified by using the negative Shannon entropy. Based on this algorithm, a PDM-based framework is proposed to narrow the gap between pro-duct design and manufacture, in which five modules are built to monitor, reshuffle and implement the simultaneous executing processes. Finally, an example is given to illustrate applications of the algorithm in the real world.
基金The National Natural Science Foundation of China(No.51201031)the Natural Science Foundation of Jiangsu Province(No.BK2011615)the Transformation Program of Science and Technology Achievements of Jiangsu Province(No.BA2011024)
文摘The effect of concurrent precipitation on recrystallization textures in AA 3003 aluminum alloys was investigated using X-ray diffraction and electron backscattering diffraction（EBSD） analyses. A weak recrystallization texture was observed in the AA 3003 alloy annealed at 783 K due to the high annealing temperature. Under the same conditions, extremely high P {011 } （ 111 ） recrystallization textures were detected in the AA 3003 alloy added with 0. 39% Sc. Based on the EBSD results, no intensely preferential orientation nucleation of recrystallization grains was observed in the early stage of recrystallizafion for both alloys. However, concurrent precipitation strongly retarded the growth of recrystallization grains, except for P nucleation sites, thereby conferring an apparent initial growth advantage for P nucleation sites compared with other nucleation sites. Therefore, a sharp P {011 } 〈 111 〉 texture appeared in concurrently precipitated AA 3003 alloys.
文摘Tolerance analysis is investigated under an environment of concurrent design in order to lead to optimized tolerance, as traditional tolerance analysis is often inefficient and liable to mistakes. Making full use of knowledge in manufacturing tolerance analysis combined with the beta distribution model is introduced and applied. The use of beta distribution reflects fully actual capabilities in manufacture. Concurrent tolerance design is a manufacturing environment oriented design process paying more attention to influences or restraints on product design caused by such factors as the manufacturing process, machine capabilities, economy in manufacturing, etc. Process environment oriented tolerance analysis is more flexible making the designed results more practical and effective.
基金supported by the National Natural Science Foundation of China under contract No. 60803131
文摘Concurrent signature was introduced as an efficient approach to solving the problem of fair exchange of signatures. Almost all fair exchange e-commerce protocols based on concurrent signature that have been proposed until now either do not provide message privacy protection or adopt the sign-then-encrypt scheme to provide confidentiality. However,confidentiality is an important requirement of fair exchange e-commerce protocol. In this paper,a new concept called concurrent signcryption which combines the concepts of concurrent signature and signcryption together to resolve the confidentiality problem in e-commerce systems based on concurrent signature. We also propose a concurrent signcryption scheme using bilinear pairings and prove its security in the random oracle model. Compared with the sign-then-encrypt scheme using bilinear pairings,our scheme enjoys shorter message length and less operation cost. Moreover,in our scheme the two ambiguous signcryptions can be published in any order.
