The time went by fairly fast.I have definitely changed a lot in the past three years.I used to be short,but now I am taller.The biggest change,though,is that I enjoy reading more than I used to.During my first vacatio...The time went by fairly fast.I have definitely changed a lot in the past three years.I used to be short,but now I am taller.The biggest change,though,is that I enjoy reading more than I used to.During my first vacation in junior high school,my teacher asked us to read more classics,so I read a variety of books like The Little Prince and Harry Potter,which taught me to be brave in the face of difficulties and never give up.After that,no matter how busy I was,I would read for an hour every day.展开更多
Background and Objective The development of modern palliative care in China began in the 1980s and is currently in an accelerating phase.However,inconsistencies in terminology and concepts have hindered policy-making,...Background and Objective The development of modern palliative care in China began in the 1980s and is currently in an accelerating phase.However,inconsistencies in terminology and concepts have hindered policy-making,clinical practice,and academic research.The Terminology of Clinical Medicine(2023 edition)has determined huan-he-yi-liao(缓和医疗)and an-ning-liao-hu(安宁疗护)as the formal terms of"palliative care"and"hospice care",respectively.To align with these terms,this study aims to establish expert consensus definitions tailored to the Chinese context.Methods We systematically retrieved and collected domestic and international literature and policy documents related to the definition of palliative care,then deconstructed and analyzed the relevant conceptual elements of these definitions.Core expert panel built the initial recommended definition upon the conceptual elements and consensus definition of palliative care by the International Association for Hospice and Palliative Care(IAHPC)through two rounds of online discussions.After nomination and selection,61 professionals in the field of palliative care in China were invited to participate in the consensus expert group.Two rounds of Delphi consultation were conducted among the consensus experts,who were asked to score their agreement using Likert scale to the items in the initial recommended definition and the definition statements of palliative care and hospice care.Agreement rate of over 80%was considered as reaching consensus for each items.The core expert panel revised the items and the statements of recommended definitions based on the results from Delphi surveys.The final recommended definitions were formulated after feedback from patient and public involvement(PPI)group members.Results The response rates for the first and second round of Delphi surveys were 83.6%and 100.0%,respectively.The agreement rates of the items and statements of the recommended definitions exceeded 90%.Accordingly,the definitions based on Chinese expert consensus are recommended.Palliative care is an active holistic approach aimed at patients of all ages suffering from life-threatening illness and their families and caregivers.It seeks to improve their quality of life by preventing,assessing,and relieving physical,psychological,social,and spiritual suffering.Hospice care is an integral part of palliative care,focusing on holistic care for patients at the end of life and their families and caregivers.Its goal is to help patients to maintain dignity and achieve a good death by alleviating physical,psychological,social,and spiritual distress without intentionally hastening or postponing death,meanwhile improve the quality of life for families and caregivers.Conclusions This study has established the Chinese expert consensus definitions of palliative care and hospice care in China,as well as the relationship between the two.The definitions highlight the holistic nature of palliative care,providing a foundation for discipline development,clinical practice,and public communication.展开更多
Sepsis,characterized as life-threatening organ dysfunction resulting from dysregulated host responses to infection,remains a significant challenge in clinical practice.Despite advancements in understanding host-bacter...Sepsis,characterized as life-threatening organ dysfunction resulting from dysregulated host responses to infection,remains a significant challenge in clinical practice.Despite advancements in understanding host-bacterial interactions,molecular responses,and therapeutic approaches,the mortality rate associated with sepsis has consistently ranged between 10%and 16%.This elevated mortality highlights critical gaps in our comprehension of sepsis etiology.Traditionally linked to bacterial and fungal pathogens,recent outbreaks of acute viral infections,including Middle East respiratory syndrome coronavirus(MERS-CoV),influenza virus,and severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),among other regional epidemics,have underscored the role of viral pathogenesis in sepsis,particularly when critically ill patients exhibit classic symptoms indicative of sepsis.However,many cases of viral-induced sepsis are frequently underdiagnosed because standard evaluations typically exclude viral panels.Moreover,these viruses not only activate conventional pattern recognition receptors(PRRs)and retinoic acid-inducible gene-I(RIG-I)-like receptors(RLRs)but also initiate primary antiviral pathways such as cyclic guanosine monophosphate adenosine monophosphate(GMP-AMP)synthase(cGAS)-stimulator of interferon genes(STING)signaling and interferon response mechanisms.Such activations lead to cellular stress,metabolic disturbances,and extensive cell damage that exacerbate tissue injury while leading to a spectrum of clinical manifestations.This complexity poses substantial challenges for the clinical management of affected cases.In this review,we elucidate the definition and diagnosis criteria for viral sepsis while synthesizing current knowledge regarding its etiology,epidemiology,and pathophysiology,molecular mechanisms involved therein as well as their impact on immune-mediated organ damage.Additionally,we discuss clinical considerations related to both existing therapies and advanced treatment interventions,aiming to enhance the comprehensive understanding surrounding viral sepsis.展开更多
Background:The masseter vestibular evoked myogenic potential(mVEMP) is a novel test that has been explored in various brainstem lesions. However, it has not yet been studied in individuals with definite Meniere's ...Background:The masseter vestibular evoked myogenic potential(mVEMP) is a novel test that has been explored in various brainstem lesions. However, it has not yet been studied in individuals with definite Meniere's disease. Therefore, the current study aimed to investigate m VEMP responses in individuals with definite Meniere's disease and compare them with those of a reference group.Method:The present study investigated narrowband Claus Elberling chirp-evoked m VEMP responses in 22 ears diagnosed with definite Meniere's disease and 22 ears with hearing sensitivity ≤ 15 dB HL across three stimulation frequencies.Results:m VEMP responses in participants with definite Meniere's disease varied from normal to reduced or absent across three octave frequencies. These individuals exhibited significantly reduced P11-N21 peak-to-peak amplitudes compared to those in the reference group. Although a frequency tuning shift toward 1000 Hz was observed, the inter-frequency amplitude ratio of m VEMP was not found to be a sensitive parameter for detecting individuals with definite Meniere's disease. Additionally, no association was found between the degree of hearing loss or the duration of the disease and m VEMP responses. Conclusion: Participants with definite Meniere's disease exhibited reduced P11-N21 amplitude and a tuning shift toward 1000 Hz. These findings suggest the involvement of the vestibulo-trigeminal reflex pathway in this condition.展开更多
BACKGROUND Sepsis is a critical medical condition,and poses a substantial global health burden,with significant morbidity,mortality,and economic costs,particularly pronounced in low-and middle-income countries.Effecti...BACKGROUND Sepsis is a critical medical condition,and poses a substantial global health burden,with significant morbidity,mortality,and economic costs,particularly pronounced in low-and middle-income countries.Effective management of sepsis relies on early recognition and appropriate intervention,underscoring the importance of accurate classification to guide treatment decisions.The correct diagnosis will lead to effective antimicrobial stewardship practices.AIM To assess the distribution of sepsis categories and the use of empirical antibiotics classified by the World Health Organization(WHO)Access,Watch,and Reserve(AWaRe)system in a tertiary care hospital in Northern India and to correlate antibiotic usage with sepsis classifications.METHODS This longitudinal observational study in the Department of General Medicine,in a tertiary care hospital in Northern India,from 2023 to 2024,aimed to assess the use of empirical antibiotics classified by the WHO AWaRe system.The study also aimed to correlate antibiotic usage.Patients were categorized into sepsis classes(Asepsis,Possible Sepsis,Probable Sepsis,Confirmed Sepsis)and followed until discharge or Day-28.Descriptive and inferential statistical analyses were employed to assess sepsis categories and empirical antibiotic usage classified by the WHO AWaRe system.RESULTS A total of 1867 patients admitted with suspected sepsis were screened,with 230 meeting the inclusion criteria.Among the study cohort(mean age 40.70±14.49 years,50.9% female),initial sepsis classification predominantly included probable sepsis(51.3%)and possible sepsis(35.7%),evolving to asepsis(57.8%)upon final classification,but all received antibiotics.Empirical antibiotic use showed a predominance of Watch group antibiotics(72.2%),with ceftriaxone and piperacillin-tazobactam being the most commonly prescribed;however,no statistical association could be established among the different classes of sepsis with the AWaRe groups.CONCLUSION Accurate sepsis classification is pivotal for clinical decision-making,optimizing antibiotic use,and combating antimicrobial resistance.The majority of the asepsis category was labelled as probable or possible sepsis and given antibiotics at initial hospitalization.The high reliance on Watch group antibiotics in empirical therapy signals a need for enhanced diagnostic strategies to refine treatment initiation,potentially reducing unnecessary antibiotic exposure.Future efforts should focus on establishing sepsis classification checklists as in this study and promoting adherence to antimicrobial stewardship principles to mitigate the global threat of antimicrobial resistance.展开更多
BACKGROUND Fever of unknown origin(FUO)remains a diagnostic challenge and was originally defined in 1961.Its classic criteria include fever≥38.3°C(≥101°F)on multiple occasions,fever lasting three weeks or ...BACKGROUND Fever of unknown origin(FUO)remains a diagnostic challenge and was originally defined in 1961.Its classic criteria include fever≥38.3°C(≥101°F)on multiple occasions,fever lasting three weeks or longer,and a diagnosis after one week of inpatient evaluation.However,these criteria may not fully encompass the varied clinical presentations seen in resource-limited settings such as India.The adaptation of FUO definitions to local healthcare contexts is crucial for enhancing diagnostic accuracy and optimizing patient outcomes.AIM To investigate the applicability of revised FUO criteria in a tertiary care setting in India.METHODS This longitudinal-exploratory study at All India Institute of Medical Sciences Rishikesh(January 2018–December 2022)analyzed 228 adult patients with fever≥99.1°F lasting over three days.Patients diagnosed within three days of admission were excluded.Data were collected retrospectively and prospectively using predefined FUO definitions based on durations of nondiagnosis(3-21 days,>21 days),temperature ranges(99.1°F-100.9°F,≥101°F),and hospitalization durations(3-7 days,>7 days).Descriptive statistics and comparative tests(Fisher's exact test,χ2 test)evaluated outcomes across definitions.RESULTS Among the proposed FUO definitions,Definition B(fever lasting 3-21 days,temperatures between 99.1°F-100.9°F,hospitalization>7 days)predominated(40.8%),while only 2.2%met the classical criteria.Notably,36.5%of Definition B patients remained undiagnosed after 7-10 days,despite 94%undergoing diagnostic workups within 21 days.Infection emerged as the leading etiology across definitions,without significant variation in outcomes or mortality during hospitalization(χ2=27.937,P=0.142).CONCLUSION Adapting FUO criteria to local contexts improves diagnostic accuracy and treatment.Definition B(40.8%prevalence)showed practical utility,with higher mortality in patients discharged on empirical'Anti-tuberculosis therapy'.展开更多
Accurate drought assessment demands thoughtful consideration of drought definition first of all.Drought is commonly defined as a prolonged period of below-average precipitation leading to water shortages that impact e...Accurate drought assessment demands thoughtful consideration of drought definition first of all.Drought is commonly defined as a prolonged period of below-average precipitation leading to water shortages that impact ecosystems,agriculture,and human societies.However,meteorologists,hydrologists,and agronomists often use different criteria to define drought,depending on their specific focus areas.For example,hydrologists define drought according to water deficits in some components of the hydrological cycle(such as precipitation,soil moisture,river flow,and groundwater)or its impacts on the level of services provided to public water supply,irrigation,or hydropower demands(Tate and Gustard,2000).Differences in drought definitions may result in great uncertainties in drought assessment(Satoh et al.,2021).We cannot expect the existence of any workable generalized objective definition of drought(Lloyd-Hughes,2014).展开更多
In this paper,a nonlinear control approach for an unstable networked plant in the presence of actuator and sensor limitations using robust right coprime factorization is proposed.The actuator is limited by upper and l...In this paper,a nonlinear control approach for an unstable networked plant in the presence of actuator and sensor limitations using robust right coprime factorization is proposed.The actuator is limited by upper and lower constraints and the sensor in the feedback loop is subjected to network-induced unknown time-varying delay and noise.With this nonlinear control method,we first employ right coprime factorization based on isomorphism and operator theory to factorize the plant,so that bounded input bounded output(BIBO)stability can be guaranteed.Next,continuous-time generalized predictive control(CGPC)is utilized for the unstable operator of the right coprime factorized plant to guarantee inner stability and enables the closed-loop dynamics of the system with predictive characteristics.Meanwhile,a second-Do F(degrees of freedom)switched controller that satisfies a perturbed Bezout identity and a robustness condition is designed.By using the CGPC controller that possesses predictive behavior and the second-Do F switched stabilizer,the overall stability of the plant subjected to actuator limitations is guaranteed.To address sensor limitations that exist in networked plants in the form of delay and noise which often cause system performance degradation,we implement an identity operator definition in the feedback loop to compensate for these adverse effects.Further,a pre-operator is designed to ensure that the plant output tracks the reference input.Finally,the effectiveness of the proposed design scheme is demonstrated by simulations.展开更多
At the beginning of 2024,the cosmetic industry is bustling with prosperity and depression.On one hand,the perfume brand DOCUMENTS and the biotechnology company BIO-REGEN received financial investments.The medical comp...At the beginning of 2024,the cosmetic industry is bustling with prosperity and depression.On one hand,the perfume brand DOCUMENTS and the biotechnology company BIO-REGEN received financial investments.The medical company Trautec started pre-listing counseling.The first new raw material in the new year was registered.While on the other hand,the packaging material company Yiside declared bankruptcy.The beauty brand MAOGEPING failed to go public through an IPO again,after eight years’failure.Jinfa Labi,Watsons and Zhonghao Biology were all mired in recession.Hope and challenge hung over the first half month of 2024.With such a“magical”start,2024 will be definitely a year full of uncertainty.展开更多
Objective:Definitive chemoradiotherapy(dCRT)is the standard treatment for unresectable locally advanced esophageal cancer.However,this treatment is associated with substantial toxicity,and most malnourished or elderly...Objective:Definitive chemoradiotherapy(dCRT)is the standard treatment for unresectable locally advanced esophageal cancer.However,this treatment is associated with substantial toxicity,and most malnourished or elderly patients are unable to complete this therapy.Therefore,there is a need for a more suitable radiotherapy combination regimen for this population.This study was aimed to evaluate the efficacy and safety of a combination regimen comprising chemotherapy with nimotuzumab and S-1 and concurrent radiotherapy for patients with fragile locally advanced esophageal cancer with a high Nutritional Risk Screening 2002(NRS-2002)score.Methods:Eligible patients with unresectable esophageal carcinoma who had an NRS-2002 score of 2 or higher were enrolled.They were treated with S-1 and nimotuzumab with concurrent radiotherapy,followed by surgery or definitive radiotherapy.The primary endpoint was the locoregional control(LRC)rate.Results:A total of 55 patients who met the study criteria were enrolled.After completion of treatment,surgery was performed in 15 patients and radiotherapy was continued in 40 patients.The median follow-up period was 33.3[95%confidence interval(95%CI,31.4−35.1)]months.The LRC rate was 77.2%(95%CI,66.6%−89.4%)at 1 year in the entire population.The overall survival(OS)rate and event-free survival(EFS)rate were 57.5%and 51.5%at 3 years,respectively.Surgery was associated with better LRC[hazard ratio(HR)=0.16;95%CI,0.04−0.70;P=0.015],OS(HR=0.19;95%CI,0.04−0.80;P=0.024),and EFS(HR=0.25;95%CI,0.08−0.75;P=0.013).Most adverse events were of grade 1 or 2,and no severe adverse events occurred.Conclusions:For malnourished or elderly patients with locally advanced esophageal cancer,radiotherapy combined with nimotuzumab and S-1 is effective and has a good safety profile.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the compa...BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the comparative efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC remain unclear.AIM To compare the efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC.METHODS We retrospectively analyzed the hospitalized data of a total of 472 consecutive patients with cT1N0M0 EC treated at Sun Yat-sen University Cancer center between 2017-2019 and followed up until October 30th,2022.We analyzed demographic,medical recorded,histopathologic characteristics,imaging and endoscopic,and follow-up data.The Kaplan-Meier method and Cox proportional hazards modeling were used to analyze the difference of survival outcome by treatments.Inverse probability of treatment weighting(IPTW)was used to minimize potential confounding factors.RESULTS We retrospectively analyzed patients who underwent ESD(n=99)or surgery(n=220)or d-CRT(n=16)at the Sun Yat-sen University Cancer Center from 2017 to 2019.The median follow-up time for the ESD group,the surgery group,and the d-CRT group was 42.0 mo(95%CI:35.0-60.2),45.0 mo(95%CI:34.0-61.75)and 32.5 mo(95%CI:28.3-40.0),respectively.After adjusting for background factors using IPTW,the highest 3-year overall survival(OS)rate and 3-year recurrence-free survival(RFS)rate were observed in the ESD group(3-year OS:99.7% and 94.7% and 79.1%;and 3-year RFS:98.3%,87.4% and 79.1%,in the ESD,surgical,and d-CRT groups,respectively).There was no difference of severe complications occurring between the three groups(P≥0.05).Multivariate analysis showed that treatment method,histology and depth of infiltration were independently associated with OS and RFS.CONCLUSION For cT1N0M0 EC,ESD had better long-term survival and lower hospitalization costs than those who underwent d-CRT and surgery,with a similar rate of severe complications occurring.展开更多
Power electronic-interfaced renewable energy sources(RES)exhibit lower inertia compared to traditional synchronous generators.The large-scale integration of RES has led to a significant reduction in system inertia,pos...Power electronic-interfaced renewable energy sources(RES)exhibit lower inertia compared to traditional synchronous generators.The large-scale integration of RES has led to a significant reduction in system inertia,posing significant challenges for maintaining frequency stability in future power systems.This issue has garnered considerable attention in recent years.However,the existing research has not yet achieved a comprehensive understanding of system inertia and frequency stability in the context of low-inertia systems.To this end,this paper provides a comprehensive review of the definition,modeling,analysis,evaluation,and control for frequency stability.It commences with an exploration of inertia and frequency characteristics in low-inertia systems,followed by a novel definition of frequency stability.A summary of frequency stability modeling,analysis,and evaluation methods is then provided,along with their respective applicability in various scenarios.Additionally,the two critical factors of frequency control—energy sources at the system level and control strategies at the device level—are examined.Finally,an outlook on future research in low-inertia power systems is discussed.展开更多
The Global Stratotype Section and Point(GSSP)of the base-Wuchiapingian Stage was formally ratified at the Penglaitan section in South China in 2005.However,the riverside GSSP section at Penglaitan and its auxiliary se...The Global Stratotype Section and Point(GSSP)of the base-Wuchiapingian Stage was formally ratified at the Penglaitan section in South China in 2005.However,the riverside GSSP section at Penglaitan and its auxiliary section at Tieqiao have been permanently flooded since 2020.We herein designate an excavated section at Penglaitan as the new GSSP and the Fengshan section as a new Standard Auxiliary Boundary Stratotype(SABS).In addition,we revised the original definition based on a detailed restudy of the conodont succession from the two sections.We define the GSSP of the base-Wuchiapingian by the First Appearance Datum(FAD)of Clarkina postbitteri within the lineage Jinogondolella granti→Clarkina postbitteri→C.dukouensis.It represents a major evolutionary turnover in conodonts from Jinogondolella to Clarkina and marks the end-Guadalupian extinction event.The U-Pb date of 259.51±0.21 Ma from the uppermost part of the Emeishan basalt is adopted for the GLB age.δ13Ccarb chemostratigraphy at the SABS exhibits several excursions between 3‰and 5‰across the GLB interval.Carbonate 87Sr/86Sr ratio is 0.707244 at the GLB.Remarkably,the SABS contains six normal and six reverse geomagnetic polarity zones in the uppermost Capitanian and three in the lowest Wuchiapingian.展开更多
Objective:This integrative review aimed to identify the common characteristics of moral distress in nursing and distinguish it from other types of distress by examining nurses’perspectives in the literature.These ins...Objective:This integrative review aimed to identify the common characteristics of moral distress in nursing and distinguish it from other types of distress by examining nurses’perspectives in the literature.These insights will help update existing tools and create new ones to capture moral distress better,guiding the development and implementation of strategies to support nurses in addressing this challenge.Methods:Whittemore and Knafl’s integrative review method was employed to guide a systematic search for literature in three databases(EBSCO Medline,CINAHL,and PubMed).Additionally,two journals,Bioethics and Nursing Ethics,were manually searched to reduce search bias.The included studies were primary resources published in English between 2018 and 2023,utilizing quantitative,qualitative,or mixed methods to examine moral distress’s characteristics,components,and definitions.All of identified studies were screened,extracted,and analyzed independently by two researchers.Results:Nineteen studies were included.The results were grouped into five themes shaping the main characteristics of moral distress:1)experiencing a moral situation,with five ethically conflicted situations identified,including treatment plans,professional and personal moral values,team dynamics,complex contexts,clinical practices,and patient-centered care;2)making a moral judgment,where nurses experience moral distress when they cannot act consistently with their values,ethical principles,and moral duties;3)the presence of constraints,categorized at three levels:individual factors related to the nurse,patient,and patient’s family;team factors related to the team or unit involved;and system factors,including institutional and policy elements;4)moral wrongdoing,which occurs when nurses are unable to perform the right moral action;and 5)moral suffering,with studies showing that moral distress impacts physical,emotional,and psychological well-being.Conclusion:The findings enhance the understanding of moral distress characteristics among nursing staff,highlighting the concept of the crescendo effect,which underscores the cumulative and escalating nature of unresolved moral distress,emphasizing the need to address moral conflicts proactively to prevent the erosion of moral integrity and professional satisfaction.展开更多
The concept of giftedness has evolved significantly over the past century,shifting from a narrow,IQ-based perspective to a more inclusive and multifaceted understanding.Early theories,such as those developed by Alfred...The concept of giftedness has evolved significantly over the past century,shifting from a narrow,IQ-based perspective to a more inclusive and multifaceted understanding.Early theories,such as those developed by Alfred Binet and Lewis Terman,primarily focused on intelligence as a fixed,measurable trait.However,modern theories,including those by Joe Renzulli and Françoi Gagné,have expanded the definition to include creativity,motivation,and task commitment.This review aims to explore the evolution of giftedness definitions,addressing two main questions:How has the definition of giftedness developed over time,and to what extent do current definitions support equitable educational practices for gifted learners?The review analyses models such as Renzulli’s Three-Ring Model and Gagné’s Differentiated Model of Giftedness and Talent(DMGT),highlighting the importance of recognizing both innate potential and developed talent.The findings suggest that inclusive definitions of giftedness foster more effective,equitable educational practices,but challenges remain in implementing these frameworks universally.展开更多
文摘The time went by fairly fast.I have definitely changed a lot in the past three years.I used to be short,but now I am taller.The biggest change,though,is that I enjoy reading more than I used to.During my first vacation in junior high school,my teacher asked us to read more classics,so I read a variety of books like The Little Prince and Harry Potter,which taught me to be brave in the face of difficulties and never give up.After that,no matter how busy I was,I would read for an hour every day.
文摘Background and Objective The development of modern palliative care in China began in the 1980s and is currently in an accelerating phase.However,inconsistencies in terminology and concepts have hindered policy-making,clinical practice,and academic research.The Terminology of Clinical Medicine(2023 edition)has determined huan-he-yi-liao(缓和医疗)and an-ning-liao-hu(安宁疗护)as the formal terms of"palliative care"and"hospice care",respectively.To align with these terms,this study aims to establish expert consensus definitions tailored to the Chinese context.Methods We systematically retrieved and collected domestic and international literature and policy documents related to the definition of palliative care,then deconstructed and analyzed the relevant conceptual elements of these definitions.Core expert panel built the initial recommended definition upon the conceptual elements and consensus definition of palliative care by the International Association for Hospice and Palliative Care(IAHPC)through two rounds of online discussions.After nomination and selection,61 professionals in the field of palliative care in China were invited to participate in the consensus expert group.Two rounds of Delphi consultation were conducted among the consensus experts,who were asked to score their agreement using Likert scale to the items in the initial recommended definition and the definition statements of palliative care and hospice care.Agreement rate of over 80%was considered as reaching consensus for each items.The core expert panel revised the items and the statements of recommended definitions based on the results from Delphi surveys.The final recommended definitions were formulated after feedback from patient and public involvement(PPI)group members.Results The response rates for the first and second round of Delphi surveys were 83.6%and 100.0%,respectively.The agreement rates of the items and statements of the recommended definitions exceeded 90%.Accordingly,the definitions based on Chinese expert consensus are recommended.Palliative care is an active holistic approach aimed at patients of all ages suffering from life-threatening illness and their families and caregivers.It seeks to improve their quality of life by preventing,assessing,and relieving physical,psychological,social,and spiritual suffering.Hospice care is an integral part of palliative care,focusing on holistic care for patients at the end of life and their families and caregivers.Its goal is to help patients to maintain dignity and achieve a good death by alleviating physical,psychological,social,and spiritual distress without intentionally hastening or postponing death,meanwhile improve the quality of life for families and caregivers.Conclusions This study has established the Chinese expert consensus definitions of palliative care and hospice care in China,as well as the relationship between the two.The definitions highlight the holistic nature of palliative care,providing a foundation for discipline development,clinical practice,and public communication.
基金supported by the National Natural Science Foundation of China(82372176,82272217,82002026,81971818)the Hubei Provincial Key Research and Development Program of China(2023BCB091)the National Key Research and Development Program of China(2021YFC2500802,2021YFC2300200).
文摘Sepsis,characterized as life-threatening organ dysfunction resulting from dysregulated host responses to infection,remains a significant challenge in clinical practice.Despite advancements in understanding host-bacterial interactions,molecular responses,and therapeutic approaches,the mortality rate associated with sepsis has consistently ranged between 10%and 16%.This elevated mortality highlights critical gaps in our comprehension of sepsis etiology.Traditionally linked to bacterial and fungal pathogens,recent outbreaks of acute viral infections,including Middle East respiratory syndrome coronavirus(MERS-CoV),influenza virus,and severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),among other regional epidemics,have underscored the role of viral pathogenesis in sepsis,particularly when critically ill patients exhibit classic symptoms indicative of sepsis.However,many cases of viral-induced sepsis are frequently underdiagnosed because standard evaluations typically exclude viral panels.Moreover,these viruses not only activate conventional pattern recognition receptors(PRRs)and retinoic acid-inducible gene-I(RIG-I)-like receptors(RLRs)but also initiate primary antiviral pathways such as cyclic guanosine monophosphate adenosine monophosphate(GMP-AMP)synthase(cGAS)-stimulator of interferon genes(STING)signaling and interferon response mechanisms.Such activations lead to cellular stress,metabolic disturbances,and extensive cell damage that exacerbate tissue injury while leading to a spectrum of clinical manifestations.This complexity poses substantial challenges for the clinical management of affected cases.In this review,we elucidate the definition and diagnosis criteria for viral sepsis while synthesizing current knowledge regarding its etiology,epidemiology,and pathophysiology,molecular mechanisms involved therein as well as their impact on immune-mediated organ damage.Additionally,we discuss clinical considerations related to both existing therapies and advanced treatment interventions,aiming to enhance the comprehensive understanding surrounding viral sepsis.
文摘Background:The masseter vestibular evoked myogenic potential(mVEMP) is a novel test that has been explored in various brainstem lesions. However, it has not yet been studied in individuals with definite Meniere's disease. Therefore, the current study aimed to investigate m VEMP responses in individuals with definite Meniere's disease and compare them with those of a reference group.Method:The present study investigated narrowband Claus Elberling chirp-evoked m VEMP responses in 22 ears diagnosed with definite Meniere's disease and 22 ears with hearing sensitivity ≤ 15 dB HL across three stimulation frequencies.Results:m VEMP responses in participants with definite Meniere's disease varied from normal to reduced or absent across three octave frequencies. These individuals exhibited significantly reduced P11-N21 peak-to-peak amplitudes compared to those in the reference group. Although a frequency tuning shift toward 1000 Hz was observed, the inter-frequency amplitude ratio of m VEMP was not found to be a sensitive parameter for detecting individuals with definite Meniere's disease. Additionally, no association was found between the degree of hearing loss or the duration of the disease and m VEMP responses. Conclusion: Participants with definite Meniere's disease exhibited reduced P11-N21 amplitude and a tuning shift toward 1000 Hz. These findings suggest the involvement of the vestibulo-trigeminal reflex pathway in this condition.
文摘BACKGROUND Sepsis is a critical medical condition,and poses a substantial global health burden,with significant morbidity,mortality,and economic costs,particularly pronounced in low-and middle-income countries.Effective management of sepsis relies on early recognition and appropriate intervention,underscoring the importance of accurate classification to guide treatment decisions.The correct diagnosis will lead to effective antimicrobial stewardship practices.AIM To assess the distribution of sepsis categories and the use of empirical antibiotics classified by the World Health Organization(WHO)Access,Watch,and Reserve(AWaRe)system in a tertiary care hospital in Northern India and to correlate antibiotic usage with sepsis classifications.METHODS This longitudinal observational study in the Department of General Medicine,in a tertiary care hospital in Northern India,from 2023 to 2024,aimed to assess the use of empirical antibiotics classified by the WHO AWaRe system.The study also aimed to correlate antibiotic usage.Patients were categorized into sepsis classes(Asepsis,Possible Sepsis,Probable Sepsis,Confirmed Sepsis)and followed until discharge or Day-28.Descriptive and inferential statistical analyses were employed to assess sepsis categories and empirical antibiotic usage classified by the WHO AWaRe system.RESULTS A total of 1867 patients admitted with suspected sepsis were screened,with 230 meeting the inclusion criteria.Among the study cohort(mean age 40.70±14.49 years,50.9% female),initial sepsis classification predominantly included probable sepsis(51.3%)and possible sepsis(35.7%),evolving to asepsis(57.8%)upon final classification,but all received antibiotics.Empirical antibiotic use showed a predominance of Watch group antibiotics(72.2%),with ceftriaxone and piperacillin-tazobactam being the most commonly prescribed;however,no statistical association could be established among the different classes of sepsis with the AWaRe groups.CONCLUSION Accurate sepsis classification is pivotal for clinical decision-making,optimizing antibiotic use,and combating antimicrobial resistance.The majority of the asepsis category was labelled as probable or possible sepsis and given antibiotics at initial hospitalization.The high reliance on Watch group antibiotics in empirical therapy signals a need for enhanced diagnostic strategies to refine treatment initiation,potentially reducing unnecessary antibiotic exposure.Future efforts should focus on establishing sepsis classification checklists as in this study and promoting adherence to antimicrobial stewardship principles to mitigate the global threat of antimicrobial resistance.
文摘BACKGROUND Fever of unknown origin(FUO)remains a diagnostic challenge and was originally defined in 1961.Its classic criteria include fever≥38.3°C(≥101°F)on multiple occasions,fever lasting three weeks or longer,and a diagnosis after one week of inpatient evaluation.However,these criteria may not fully encompass the varied clinical presentations seen in resource-limited settings such as India.The adaptation of FUO definitions to local healthcare contexts is crucial for enhancing diagnostic accuracy and optimizing patient outcomes.AIM To investigate the applicability of revised FUO criteria in a tertiary care setting in India.METHODS This longitudinal-exploratory study at All India Institute of Medical Sciences Rishikesh(January 2018–December 2022)analyzed 228 adult patients with fever≥99.1°F lasting over three days.Patients diagnosed within three days of admission were excluded.Data were collected retrospectively and prospectively using predefined FUO definitions based on durations of nondiagnosis(3-21 days,>21 days),temperature ranges(99.1°F-100.9°F,≥101°F),and hospitalization durations(3-7 days,>7 days).Descriptive statistics and comparative tests(Fisher's exact test,χ2 test)evaluated outcomes across definitions.RESULTS Among the proposed FUO definitions,Definition B(fever lasting 3-21 days,temperatures between 99.1°F-100.9°F,hospitalization>7 days)predominated(40.8%),while only 2.2%met the classical criteria.Notably,36.5%of Definition B patients remained undiagnosed after 7-10 days,despite 94%undergoing diagnostic workups within 21 days.Infection emerged as the leading etiology across definitions,without significant variation in outcomes or mortality during hospitalization(χ2=27.937,P=0.142).CONCLUSION Adapting FUO criteria to local contexts improves diagnostic accuracy and treatment.Definition B(40.8%prevalence)showed practical utility,with higher mortality in patients discharged on empirical'Anti-tuberculosis therapy'.
基金supported by the National Natural Science Foundation of China(Grant No.42471027).
文摘Accurate drought assessment demands thoughtful consideration of drought definition first of all.Drought is commonly defined as a prolonged period of below-average precipitation leading to water shortages that impact ecosystems,agriculture,and human societies.However,meteorologists,hydrologists,and agronomists often use different criteria to define drought,depending on their specific focus areas.For example,hydrologists define drought according to water deficits in some components of the hydrological cycle(such as precipitation,soil moisture,river flow,and groundwater)or its impacts on the level of services provided to public water supply,irrigation,or hydropower demands(Tate and Gustard,2000).Differences in drought definitions may result in great uncertainties in drought assessment(Satoh et al.,2021).We cannot expect the existence of any workable generalized objective definition of drought(Lloyd-Hughes,2014).
文摘In this paper,a nonlinear control approach for an unstable networked plant in the presence of actuator and sensor limitations using robust right coprime factorization is proposed.The actuator is limited by upper and lower constraints and the sensor in the feedback loop is subjected to network-induced unknown time-varying delay and noise.With this nonlinear control method,we first employ right coprime factorization based on isomorphism and operator theory to factorize the plant,so that bounded input bounded output(BIBO)stability can be guaranteed.Next,continuous-time generalized predictive control(CGPC)is utilized for the unstable operator of the right coprime factorized plant to guarantee inner stability and enables the closed-loop dynamics of the system with predictive characteristics.Meanwhile,a second-Do F(degrees of freedom)switched controller that satisfies a perturbed Bezout identity and a robustness condition is designed.By using the CGPC controller that possesses predictive behavior and the second-Do F switched stabilizer,the overall stability of the plant subjected to actuator limitations is guaranteed.To address sensor limitations that exist in networked plants in the form of delay and noise which often cause system performance degradation,we implement an identity operator definition in the feedback loop to compensate for these adverse effects.Further,a pre-operator is designed to ensure that the plant output tracks the reference input.Finally,the effectiveness of the proposed design scheme is demonstrated by simulations.
文摘At the beginning of 2024,the cosmetic industry is bustling with prosperity and depression.On one hand,the perfume brand DOCUMENTS and the biotechnology company BIO-REGEN received financial investments.The medical company Trautec started pre-listing counseling.The first new raw material in the new year was registered.While on the other hand,the packaging material company Yiside declared bankruptcy.The beauty brand MAOGEPING failed to go public through an IPO again,after eight years’failure.Jinfa Labi,Watsons and Zhonghao Biology were all mired in recession.Hope and challenge hung over the first half month of 2024.With such a“magical”start,2024 will be definitely a year full of uncertainty.
基金supported by grants from Beijing Xisike Clinical Oncology Research Foundation(No.YYoung2023-0114).
文摘Objective:Definitive chemoradiotherapy(dCRT)is the standard treatment for unresectable locally advanced esophageal cancer.However,this treatment is associated with substantial toxicity,and most malnourished or elderly patients are unable to complete this therapy.Therefore,there is a need for a more suitable radiotherapy combination regimen for this population.This study was aimed to evaluate the efficacy and safety of a combination regimen comprising chemotherapy with nimotuzumab and S-1 and concurrent radiotherapy for patients with fragile locally advanced esophageal cancer with a high Nutritional Risk Screening 2002(NRS-2002)score.Methods:Eligible patients with unresectable esophageal carcinoma who had an NRS-2002 score of 2 or higher were enrolled.They were treated with S-1 and nimotuzumab with concurrent radiotherapy,followed by surgery or definitive radiotherapy.The primary endpoint was the locoregional control(LRC)rate.Results:A total of 55 patients who met the study criteria were enrolled.After completion of treatment,surgery was performed in 15 patients and radiotherapy was continued in 40 patients.The median follow-up period was 33.3[95%confidence interval(95%CI,31.4−35.1)]months.The LRC rate was 77.2%(95%CI,66.6%−89.4%)at 1 year in the entire population.The overall survival(OS)rate and event-free survival(EFS)rate were 57.5%and 51.5%at 3 years,respectively.Surgery was associated with better LRC[hazard ratio(HR)=0.16;95%CI,0.04−0.70;P=0.015],OS(HR=0.19;95%CI,0.04−0.80;P=0.024),and EFS(HR=0.25;95%CI,0.08−0.75;P=0.013).Most adverse events were of grade 1 or 2,and no severe adverse events occurred.Conclusions:For malnourished or elderly patients with locally advanced esophageal cancer,radiotherapy combined with nimotuzumab and S-1 is effective and has a good safety profile.
基金Supported by the Guangdong Esophageal Cancer Institute Science and Technology Program,No.M202013Guangdong Medical Research Foundation,No.A2021369.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the comparative efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC remain unclear.AIM To compare the efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC.METHODS We retrospectively analyzed the hospitalized data of a total of 472 consecutive patients with cT1N0M0 EC treated at Sun Yat-sen University Cancer center between 2017-2019 and followed up until October 30th,2022.We analyzed demographic,medical recorded,histopathologic characteristics,imaging and endoscopic,and follow-up data.The Kaplan-Meier method and Cox proportional hazards modeling were used to analyze the difference of survival outcome by treatments.Inverse probability of treatment weighting(IPTW)was used to minimize potential confounding factors.RESULTS We retrospectively analyzed patients who underwent ESD(n=99)or surgery(n=220)or d-CRT(n=16)at the Sun Yat-sen University Cancer Center from 2017 to 2019.The median follow-up time for the ESD group,the surgery group,and the d-CRT group was 42.0 mo(95%CI:35.0-60.2),45.0 mo(95%CI:34.0-61.75)and 32.5 mo(95%CI:28.3-40.0),respectively.After adjusting for background factors using IPTW,the highest 3-year overall survival(OS)rate and 3-year recurrence-free survival(RFS)rate were observed in the ESD group(3-year OS:99.7% and 94.7% and 79.1%;and 3-year RFS:98.3%,87.4% and 79.1%,in the ESD,surgical,and d-CRT groups,respectively).There was no difference of severe complications occurring between the three groups(P≥0.05).Multivariate analysis showed that treatment method,histology and depth of infiltration were independently associated with OS and RFS.CONCLUSION For cT1N0M0 EC,ESD had better long-term survival and lower hospitalization costs than those who underwent d-CRT and surgery,with a similar rate of severe complications occurring.
基金supported by the National Natural Science Foundation of China(U2166601)。
文摘Power electronic-interfaced renewable energy sources(RES)exhibit lower inertia compared to traditional synchronous generators.The large-scale integration of RES has led to a significant reduction in system inertia,posing significant challenges for maintaining frequency stability in future power systems.This issue has garnered considerable attention in recent years.However,the existing research has not yet achieved a comprehensive understanding of system inertia and frequency stability in the context of low-inertia systems.To this end,this paper provides a comprehensive review of the definition,modeling,analysis,evaluation,and control for frequency stability.It commences with an exploration of inertia and frequency characteristics in low-inertia systems,followed by a novel definition of frequency stability.A summary of frequency stability modeling,analysis,and evaluation methods is then provided,along with their respective applicability in various scenarios.Additionally,the two critical factors of frequency control—energy sources at the system level and control strategies at the device level—are examined.Finally,an outlook on future research in low-inertia power systems is discussed.
基金supported by the National Natural Science Foundation of China(42293280,42272031,42250104,42261144668)Strategic Priority Research Program(B)of the Chinese Academy of Sciences(XDB26000000).
文摘The Global Stratotype Section and Point(GSSP)of the base-Wuchiapingian Stage was formally ratified at the Penglaitan section in South China in 2005.However,the riverside GSSP section at Penglaitan and its auxiliary section at Tieqiao have been permanently flooded since 2020.We herein designate an excavated section at Penglaitan as the new GSSP and the Fengshan section as a new Standard Auxiliary Boundary Stratotype(SABS).In addition,we revised the original definition based on a detailed restudy of the conodont succession from the two sections.We define the GSSP of the base-Wuchiapingian by the First Appearance Datum(FAD)of Clarkina postbitteri within the lineage Jinogondolella granti→Clarkina postbitteri→C.dukouensis.It represents a major evolutionary turnover in conodonts from Jinogondolella to Clarkina and marks the end-Guadalupian extinction event.The U-Pb date of 259.51±0.21 Ma from the uppermost part of the Emeishan basalt is adopted for the GLB age.δ13Ccarb chemostratigraphy at the SABS exhibits several excursions between 3‰and 5‰across the GLB interval.Carbonate 87Sr/86Sr ratio is 0.707244 at the GLB.Remarkably,the SABS contains six normal and six reverse geomagnetic polarity zones in the uppermost Capitanian and three in the lowest Wuchiapingian.
文摘Objective:This integrative review aimed to identify the common characteristics of moral distress in nursing and distinguish it from other types of distress by examining nurses’perspectives in the literature.These insights will help update existing tools and create new ones to capture moral distress better,guiding the development and implementation of strategies to support nurses in addressing this challenge.Methods:Whittemore and Knafl’s integrative review method was employed to guide a systematic search for literature in three databases(EBSCO Medline,CINAHL,and PubMed).Additionally,two journals,Bioethics and Nursing Ethics,were manually searched to reduce search bias.The included studies were primary resources published in English between 2018 and 2023,utilizing quantitative,qualitative,or mixed methods to examine moral distress’s characteristics,components,and definitions.All of identified studies were screened,extracted,and analyzed independently by two researchers.Results:Nineteen studies were included.The results were grouped into five themes shaping the main characteristics of moral distress:1)experiencing a moral situation,with five ethically conflicted situations identified,including treatment plans,professional and personal moral values,team dynamics,complex contexts,clinical practices,and patient-centered care;2)making a moral judgment,where nurses experience moral distress when they cannot act consistently with their values,ethical principles,and moral duties;3)the presence of constraints,categorized at three levels:individual factors related to the nurse,patient,and patient’s family;team factors related to the team or unit involved;and system factors,including institutional and policy elements;4)moral wrongdoing,which occurs when nurses are unable to perform the right moral action;and 5)moral suffering,with studies showing that moral distress impacts physical,emotional,and psychological well-being.Conclusion:The findings enhance the understanding of moral distress characteristics among nursing staff,highlighting the concept of the crescendo effect,which underscores the cumulative and escalating nature of unresolved moral distress,emphasizing the need to address moral conflicts proactively to prevent the erosion of moral integrity and professional satisfaction.
文摘The concept of giftedness has evolved significantly over the past century,shifting from a narrow,IQ-based perspective to a more inclusive and multifaceted understanding.Early theories,such as those developed by Alfred Binet and Lewis Terman,primarily focused on intelligence as a fixed,measurable trait.However,modern theories,including those by Joe Renzulli and Françoi Gagné,have expanded the definition to include creativity,motivation,and task commitment.This review aims to explore the evolution of giftedness definitions,addressing two main questions:How has the definition of giftedness developed over time,and to what extent do current definitions support equitable educational practices for gifted learners?The review analyses models such as Renzulli’s Three-Ring Model and Gagné’s Differentiated Model of Giftedness and Talent(DMGT),highlighting the importance of recognizing both innate potential and developed talent.The findings suggest that inclusive definitions of giftedness foster more effective,equitable educational practices,but challenges remain in implementing these frameworks universally.
