Spinal cord injury represents a severe form of central nervous system trauma for which effective treatments remain limited.Microglia is the resident immune cells of the central nervous system,play a critical role in s...Spinal cord injury represents a severe form of central nervous system trauma for which effective treatments remain limited.Microglia is the resident immune cells of the central nervous system,play a critical role in spinal cord injury.Previous studies have shown that microglia can promote neuronal survival by phagocytosing dead cells and debris and by releasing neuroprotective and anti-inflammatory factors.However,excessive activation of microglia can lead to persistent inflammation and contribute to the formation of glial scars,which hinder axonal regeneration.Despite this,the precise role and mechanisms of microglia during the acute phase of spinal cord injury remain controversial and poorly understood.To elucidate the role of microglia in spinal cord injury,we employed the colony-stimulating factor 1 receptor inhibitor PLX5622 to deplete microglia.We observed that sustained depletion of microglia resulted in an expansion of the lesion area,downregulation of brain-derived neurotrophic factor,and impaired functional recovery after spinal cord injury.Next,we generated a transgenic mouse line with conditional overexpression of brain-derived neurotrophic factor specifically in microglia.We found that brain-derived neurotrophic factor overexpression in microglia increased angiogenesis and blood flow following spinal cord injury and facilitated the recovery of hindlimb motor function.Additionally,brain-derived neurotrophic factor overexpression in microglia reduced inflammation and neuronal apoptosis during the acute phase of spinal cord injury.Furthermore,through using specific transgenic mouse lines,TMEM119,and the colony-stimulating factor 1 receptor inhibitor PLX73086,we demonstrated that the neuroprotective effects were predominantly due to brain-derived neurotrophic factor overexpression in microglia rather than macrophages.In conclusion,our findings suggest the critical role of microglia in the formation of protective glial scars.Depleting microglia is detrimental to recovery of spinal cord injury,whereas targeting brain-derived neurotrophic factor overexpression in microglia represents a promising and novel therapeutic strategy to enhance motor function recovery in patients with spinal cord injury.展开更多
BACKGROUND Liver transplant(LT)recipients are susceptible to carbapenem-resistant Klebsiella pneumoniae(CRKP)infections.Comprehensive research addressing the incidence,timing,infection sites,resistance patterns,treatm...BACKGROUND Liver transplant(LT)recipients are susceptible to carbapenem-resistant Klebsiella pneumoniae(CRKP)infections.Comprehensive research addressing the incidence,timing,infection sites,resistance patterns,treatment options,and associated risk factors among LT recipients with CRKP is now lacking.AIM To assess the incidence,resistance,therapy,and risk factors of CRKP infections post-LT,and to evaluate the impact of them on prognosis.METHODS A retrospective study was conducted,including 430 consecutive patients who underwent LT between January 2015 and June 2023.This study aimed to investigate the risk factors for CRKP infections and their influence on outcomes using logistic regression analysis.RESULTS Among the 430 patients who underwent LT,20(4.7%)experienced at least one documented CRKP infection within 3 months post-transplantation.The median time from LT to the onset of CRKP infections was 6.5 days.The lungs and bloodstream were the most common sites of CRKP infections.CRKP isolates were relatively susceptible to ceftazidime/avibactam(93.7%),polymyxin B(90.6%),and tigecycline(75.0%)treatment.However,all isolates were resistant to piperacillin/tazobactam,ceftazidime,cefepime,aztreonam,meropenem,and levofloxacin treatment.Recipients with CRKP infections had a mortality rate of 35%,the rate was 12.5%for those receiving ceftazidime/avibactam therapy.Multivariate analysis identified female sex[odds ratio(OR)=3.306;95%confidence interval(CI):1.239-8.822;P=0.017],intraoperative bleeding≥3000 mL(OR=3.269;95%CI:1.018-10.490;P=0.047),alanine aminotransferase on day 1 post-LT≥1500 U/L(OR=4.370;95%CI:1.686-11.326;P=0.002),and post-LT mechanical ventilation(OR=2.772;95%CI:1.077-7.135;P=0.035)as significant variables associated with CRKP.CRKP infections were related to an intensive care unit length(ICU)of stay≥7 days and 6-month all-cause mortality post-LT.CONCLUSION CRKP infections were frequent complications following LT,with poor associated outcomes.Risk factors for post-LT CRKP infections included female sex,significant intraoperative bleeding,elevated alanine aminotransferase levels,and the need for mechanical ventilation.CRKP infections negatively impacted survival and led to prolonged ICU stays.展开更多
BACKGROUND Liver transplantation(LT)is the preferred treatment for end-stage liver diseases.Early allograft failure(EAF)can result in death or retransplantation.One of the key factors predicting EAF is the degree of g...BACKGROUND Liver transplantation(LT)is the preferred treatment for end-stage liver diseases.Early allograft failure(EAF)can result in death or retransplantation.One of the key factors predicting EAF is the degree of graft injury,which is typically assessed by elevated alanine aminotransferase(ALT)and aspartate aminotransferase(AST)levels.Aminotransferase levels exceeding 5000 U/L within 48 hours of LT are indicative of poor short-term graft survival.AIM To investigate outcomes in liver transplant recipients with peak aminotransferase levels exceeding 5000 U/L and to identify predictors of EAF.METHODS Adult patients who underwent LT from a deceased(brain-dead)donor between 2011 and 2024 at Hospital de Clínicas de Porto Alegre were screened.Patients with peak AST or ALT levels>5000 U/L post-LT were included,excluding those with vascular thrombosis.EAF was defined as death or retransplantation within 90 days.A receiver operating characteristic curve were generated for each EAF predictor to determine the area under the curve(AUC).Sensitivity,specificity,negative predictive value,and positive predictive value were calculated for each predictor’s best cutoff,as defined by the Youden Index.Survival curves were plotted using the Kaplan-Meier method.RESULTS Between 2011 and 2024,341 patients underwent LT.Of these,29(8.5%)patients had AST and/or ALT levels exceeding 5000 U/L within the first 48 hours post-LT.Four patients were excluded due to vascular thrombosis,resulting in a study cohort of 25 patients.EAF were also observed in 11 patients.One-year and five-year graft survival rates were 51.7%and 42.6%,respectively.For patients without EAF,one-year and five-year graft survivals were 92.3%and 76.2%,respectively.The key predictors of EAF included serum factor V and arterial lactate levels on postoperative day(POD)1,with AUCs of 0.936 and 0.919,respectively.The optimal cutoff for EAF prediction were 26.2%for serum factor V and 9 mmol/L for arterial lactate.CONCLUSION Aminotransferase levels>5000 U/L were associated with high EAF risk.However,favorable graft function indicators on POD 1 were associated with long-term survival comparable to that of general LT recipients.Serum factor V and arterial lactate levels emerged as valuable prognostic markers.展开更多
BACKGROUND Lung cancer(LC)is one of the most prevalent cancers globally,with a high incidence among the elderly population.Elderly patients,particularly those with diabetes mellitus,are at an increased risk of postope...BACKGROUND Lung cancer(LC)is one of the most prevalent cancers globally,with a high incidence among the elderly population.Elderly patients,particularly those with diabetes mellitus,are at an increased risk of postoperative complications,in-cluding pulmonary infections,due to weakened immune function and metabolic abnormalities.Postoperative pulmonary infection(PPI)is a predominant com-plication after thoracoscopic radical resection of LC,significantly affecting patient outcomes and increasing healthcare burdens.Determining risk factors for PPI in this vulnerable population is crucial for improving surgical outcomes and redu-cing infection rates.AIM To develop and validate a predictive model for PPI in elderly patients with dia-betes undergoing thoracoscopic radical resection for LC and to assess its reliability and validity.METHODS This retrospective study included 212 patients with LC who received treatment at our hospital from March 2015 to March 2022.General clinical information,sur-gical treatment details,and laboratory test results were collected and analyzed.Patients were grouped according to infection occurrence during the postoperative hospitalization period.Risk factors for PPIs were determined through logistic regression analysis,and a nomogram prediction model was established using R software to assess its predictive accuracy and performance.RESULTS Among the 212 patients[median age:72 years(interquartile range:60-82 years)],41 developed PPI(19.34%),with Gram-negative bacteria being the predominant pathogens(64.14%).Factors,such as age of≥70 years,presence of respiratory diseases,maximum tumor diameter of≥4 cm,stages II-III,receiving neoadjuvant chemotherapy of≥2 times preoperatively,surgery duration of≥3 hours,chest drainage tube placement duration of≥3.5 days,preoperative fasting blood glucose levels,hemoglobin A1c(HbA1c)levels,and multi-leaf resection,were markedly higher in the infection group than in the non-infection group.Conversely,forced expiratory volume in 1 second(FEV1)of≥80%and albumin(Alb)levels were lower in the infection group.Multivariate logistic regression analysis revealed that receiving neoadjuvant chemotherapy of≥2 times[odds ratio(OR)=2.987;P=0.036],maximum tumor diameter of≥4 cm(OR=3.959;P=0.013),multi-leaf resection(OR=3.18;P=0.036),preoperative FEV1 of≤80%(OR=3.305;P=0.029),and high HbA1c levels(OR=2.39;P=0.003)as key risk factors for PPI,whereas high Alb levels(OR=0.507;P<0.001)was protective.The nomogram model demonstrated excellent diagnostic ability(area under the curve=0.901,0.915),and calibration curves and decision curve analysis revealed good predictive performance and clinical applicability of the model.CONCLUSION The primary pathogens of PPI in elderly patients with diabetes and LC undergoing thoracoscopic radical resection are Gram-negative bacteria.The nomogram model,based on preoperative neoadjuvant chemotherapy cycles,maximum tumor diameter,range of resection,and preoperative FEV1,Alb,and HbA1c levels,shows high clinical value in predicting the risk of PPI in this patient population.展开更多
Wildfires significantly disrupt the physical and hydrologic conditions of the environment,leading to vegetation loss and altered surface geo-material properties.These complex dynamics promote post-fire gully erosion,y...Wildfires significantly disrupt the physical and hydrologic conditions of the environment,leading to vegetation loss and altered surface geo-material properties.These complex dynamics promote post-fire gully erosion,yet the key conditioning factors(e.g.,topography,hydrology)remain insufficiently understood.This study proposes a novel artificial intelligence(AI)framework that integrates four machine learning(ML)models with Shapley Additive Explanations(SHAP)method,offering a hierarchical perspective from global to local on the dominant factors controlling gully distribution in wildfireaffected areas.In a case study of Xiangjiao catchment burned on March 28,2020,in Muli County in Sichuan Province of Southwest China,we derived 21 geoenvironmental factors to assess the susceptibility of post-fire gully erosion using logistic regression(LR),support vector machine(SVM),random forest(RF),and convolutional neural network(CNN)models.SHAP-based model interpretation revealed eight key conditioning factors:topographic position index(TPI),topographic wetness index(TWI),distance to stream,mean annual precipitation,differenced normalized burn ratio(d NBR),land use/cover,soil type,and distance to road.Comparative model evaluation demonstrated that reduced-variable models incorporating these dominant factors achieved accuracy comparable to that of the initial-variable models,with AUC values exceeding 0.868 across all ML algorithms.These findings provide critical insights into gully erosion behavior in wildfire-affected areas,supporting the decision-making process behind environmental management and hazard mitigation.展开更多
After brain damage,regenerative angiogenesis and neurogenesis have been shown to occur simultaneously in mammals,suggesting a close link between these processes.However,the mechanisms by which these processes interact...After brain damage,regenerative angiogenesis and neurogenesis have been shown to occur simultaneously in mammals,suggesting a close link between these processes.However,the mechanisms by which these processes interact are not well understood.In this work,we aimed to study the correlation between angiogenesis and neurogenesis after a telencephalic stab wound injury.To this end,we used zebrafish as a relevant model of neuroplasticity and brain repair mechanisms.First,using the Tg(fli1:EGFP×mpeg1.1:mCherry)zebrafish line,which enables visualization of blood vessels and microglia respectively,we analyzed regenerative angiogenesis from 1 to 21 days post-lesion.In parallel,we monitored brain cell proliferation in neurogenic niches localized in the ventricular zone by using immunohistochemistry.We found that after brain damage,the blood vessel area and width as well as expression of the fli1 transgene and vascular endothelial growth factor(vegfaa and vegfbb)were increased.At the same time,neural stem cell proliferation was also increased,peaking between 3 and 5 days post-lesion in a manner similar to angiogenesis,along with the recruitment of microglia.Then,through pharmacological manipulation by injecting an anti-angiogenic drug(Tivozanib)or Vegf at the lesion site,we demonstrated that blocking or activating Vegf signaling modulated both angiogenic and neurogenic processes,as well as microglial recruitment.Finally,we showed that inhibition of microglia by clodronate-containing liposome injection or dexamethasone treatment impairs regenerative neurogenesis,as previously described,as well as injury-induced angiogenesis.In conclusion,we have described regenerative angiogenesis in zebrafish for the first time and have highlighted the role of inflammation in this process.In addition,we have shown that both angiogenesis and neurogenesis are involved in brain repair and that microglia and inflammation-dependent mechanisms activated by Vegf signaling are important contributors to these processes.This study paves the way for a better understanding of the effect of Vegf on microglia and for studies aimed at promoting angiogenesis to improve brain plasticity after brain injury.展开更多
Background: Unsafe abortion (USA) is defined as the termination of a non-desired pregnancy, performed by an unqualified person or in an environment without minimum medical standards, or both. It can impact negatively ...Background: Unsafe abortion (USA) is defined as the termination of a non-desired pregnancy, performed by an unqualified person or in an environment without minimum medical standards, or both. It can impact negatively the fertility in the future by tubo-peritoneal lesions. The current study aimed to highlight the infertility factors associated with USA. Material and Methods: From January 1st 2000 to December 31st 2021, a total of 3876 patients that sought care for infertility in the University Clinic of Kinshasa and the Edith Medical Center were enrolled. The socio-demographic, clinical and paraclinical variables were recorded and analyzed in relation to USA history. Results: The patients’ average age was 33.4 ± 5.7 years. Half of them were housewives;about sixty percent of the patients were nulliparous (59.31%). Seventy percent had a secondary infertility with 43.33% having a history of unsafe abortion. The main diagnosis was genital infections and uterus myoma. The chronic endometritis, bilateral tubal occlusion and Uterine synechiae were more associated with USA group. The spermogram anomalies and other partners’ lesions seemed of infectious origin. Conclusion: The USA remains a more frequent phenomenon in our setting. The chronic endometritis, bilateral tubal occlusion, uterine synechiae and indirectly uterus myoma were the infertility factors related to USA. The genital infection of any origin seems to be the main denominator underlying the female and the male infertility in our setting.展开更多
Most research on carbon storage in forests has focused on qualitative studies of carbon storage and influ-encing factors rather than on quantifying the effect of the spatial distribution of carbon storage and of its i...Most research on carbon storage in forests has focused on qualitative studies of carbon storage and influ-encing factors rather than on quantifying the effect of the spatial distribution of carbon storage and of its influencing factors at different scales.Here we described the spatial dis-tribution of aboveground carbon storage(ACS)in a 20-ha plot in a subtropical evergreen broad-leaved forest to evalu-ate and quantify the relative effects of biotic factors(species diversity and structural diversity)and abiotic factors(soil and topographic factors)on ACS at different scales.Scale effects of the spatial distribution of ACS were significant,with higher variability at smaller scales,but less at larger scales.The distribution was also spatially heterogeneous,with more carbon storage on north-and east-facing slopes than on south-and west-facing slopes.At a smaller scale,species diversity and structural diversity each had a direct positive impact on ACS,but soil factors had no significant direct impact.At increasing scales,topographic and soil fac-tors gradually had a greater direct influence,whereas the influence of species diversity gradually decreased.Structural diversity had the greatest impact,followed by topographic factors and soil factors,while species diversity had a rela-tively smaller impact.These findings suggest studies on ACS in subtropical evergreen broadleaf forests in southern China should consider scale effects,specifically on the heterogene-ity of ACS distribution at small scales.Studies and conser-vation efforts need to focus on smaller habitat types with particular emphasis on habitat factors such as aspect and soil conditions,which have significant influences on community species diversity,structural diversity,and ACS distribution.展开更多
The image of China in The Painted Veil by Maugham is complicated and diversified.On the one hand,it predicts numerous representative sceneries of the Chinese village,unveiling the exotic natural sceneries of China.Mor...The image of China in The Painted Veil by Maugham is complicated and diversified.On the one hand,it predicts numerous representative sceneries of the Chinese village,unveiling the exotic natural sceneries of China.Moreover,the spirit of Taoism is stated in the novel,unveiling the mysterious culture of Chinese’concern about the harmony of man and nature,which displays Maugham’s admiration for Chinese exotic flavors.On the other hand,China is depicted as poor and undeveloped,a country stricken by epidemic diseases and opium smokers.This article aims to analyze the factors affecting Maugham’s images of China from the subjective and objective perspectives.Chapter two profoundly explores the significant influence of Maugham’s life experience,religious belief and personal values on his individual images of China.Chapter three expounds the effective factors of social thoughts and economy.From the exploration,it is apparent that the formation of the image of China in The Painted Veil is firstly influenced by the life experience,individual values and religious belief of Maugham.Literary writing is actually a miniature and indirect representation of the author’s life experience.展开更多
The increasing rate of cesarean delivery has become a widespread concern worldwide, nearly half of which is due to previous cesarean deliveries, and elective repeat cesarean delivery (ERCD), which is the main option f...The increasing rate of cesarean delivery has become a widespread concern worldwide, nearly half of which is due to previous cesarean deliveries, and elective repeat cesarean delivery (ERCD), which is the main option for women who have a second pregnancy after cesarean section, is a major factor in this increase. The trial of labor after cesarean section (TOLAC) is considered to be the best method, and the safety and feasibility of TOLAC have been confirmed by numerous studies, but in clinical practice, there are many factors that make TOLAC unsuccessful. This article reviews the factors that influence the choice of delivery method after cesarean section as follows.展开更多
Objective:Many children with fully corrected congenital heart disease(CHD)avoid physicalactivity(PA).This descriptive study sought to determine child and parental factors that could predict PAlevels in Thai dhildren a...Objective:Many children with fully corrected congenital heart disease(CHD)avoid physicalactivity(PA).This descriptive study sought to determine child and parental factors that could predict PAlevels in Thai dhildren after corrective surgery.Methods:Ninety schoolaged children with fully correctedCHD were recruited from a cardiology clinic at a university hospital in northern Thailand.Data collectioninvolved five validated questionnaires:(1)the Modified Thai Adolescent's Fhysical Activity Questionnaire,(2)the Child Health Status Questionnaire-Forms I and II1,(3)the Parental Knowledge on School-agedChildrer's PhysicalActivity Scale,(4)the Perceived Self-efficacy to Physical Activity Questionnaire,and(5)the Parntal Bonding Instrument.The analysis included descriptive statistics and stepwise multipleregression.Results:Results showed that the physical activity(PA.)levels,assessed through total energyexpenditure,of child ran with CHD were below the recommended levels after treatment(t=-8.33,p<0.001).There were sigrificant correlations between PA and factors such as a child's perceived health status,PAself-efficacy,and parentaloverprotection(r=0.39,p<0.050;r=0.46,p<0.050;r=0.25,p<0.050,respectively).After adjustment for demographic data and CHD type,these factors had no association with a child's PA.Only two factors predicted childhood PA—the child's perceived health status and PA self-efficacy whichcould explain27.3%of the variance of PA.(p<0.001).Conclusion:The study highlights the necessity forinterventions to enhance childrer's perception of their health status and PA self-efficacy to increase theirphysical activity levels.展开更多
Objective:To analyze the related factors affecting the professional identity of nursing students before and after clinical practice,hoping to provide reference for the career development and education of nursing stude...Objective:To analyze the related factors affecting the professional identity of nursing students before and after clinical practice,hoping to provide reference for the career development and education of nursing students.Methods:A total of 393 undergraduate nursing students of grade 2020 from the Department of Nursing of a university in Shanxi Province were selected.The professional choice motivation,educational attainment expectation,future career planning,professional practice,and employment prospect expectation of nursing students before clinical practice,and the willingness to upgrade educational attainment,professional experience,career development expectation,and employment planning of nursing students after clinical practice were investigated.Through statistical analysis of the survey data,the related influencing factors affecting the professional identity of nursing students before and after clinical practice were explored.Results:The observation of general data showed that the proportion of female students in the survey sample was higher than that of male students,and the proportion of those whose family residence was in rural areas was slightly higher than that in urban areas.The analysis of students’own situation showed that nursing students chose the nursing major because of the high expected employment rate,but they were generally anxious about the employment prospect before the internship,showing a contradictory mentality.The analysis of students’professional ability showed that nursing students believed that their professional ability was mainly reflected in the vocational adaptability.The analysis of the social environment showed that the educational attainment expectations of nursing students were mainly undergraduate and master’s degrees,and they preferred to engage in clinical nursing work rather than nursing research.The analysis on the selection of internship hospitals shows that nursing students’choice of internship hospitals is mainly influenced by the duration of the internship,and they consider the correlation between the selection of internship hospitals and future employment decisions to be low.The analysis on the surrounding environment such as family and school shows that the professional identity of nursing students is mainly influenced by the opinions of school teachers and parents,but the occupations of most of the family members of nursing students are not related to medicine.Conclusion:Targeted intervention strategies should be formulated based on the relevant influencing factors that affect the professional identity of nursing students before and after clinical internship,to enhance the professional identity and employment confidence of nursing students,and promote the healthy and sustainable development of nursing education and the medical service industry.展开更多
Early recurrence(ER)following surgery for rectal cancer is a significant factor impacting patient survival rates.Tsai et al identified age,preoperative neoadjuvant therapy,length of hospital stay,tumour location,and p...Early recurrence(ER)following surgery for rectal cancer is a significant factor impacting patient survival rates.Tsai et al identified age,preoperative neoadjuvant therapy,length of hospital stay,tumour location,and pathological stage as factors influencing the risk of ER.Postoperative monitoring for ER should encompass a thorough medical history review,physical examination,tumour marker testing,and imaging studies.Additionally,noninvasive circulating tumour cell DNA testing can be utilized to predict ER.Treatment strategies may involve radical surgery,radiation therapy,chemotherapy,and immunotherapy.Through a comprehensive analysis of risk factors,the optimization of monitoring methods,and the development of personalized treatment strategies,it is anticipated that both the efficacy of treatment and the quality of life for rectal cancer patients with postoperative recurrence can be significantly improved.展开更多
Among the four basic skills in language learning,listening seems to present more difficulties for the students in their college English study.This paper tries to examine various obstacles affecting college students’E...Among the four basic skills in language learning,listening seems to present more difficulties for the students in their college English study.This paper tries to examine various obstacles affecting college students’English listening comprehension based on the author’s 20 years of teaching experience.Through systematic analysis of both linguistic and non-linguistic factors,the study proposes targeted teaching methodologies to enhance students’listening proficiency.The research highlights the importance of integrated skill development,psychological factors in language acquisition,and effective listening strategies.Practical classroom techniques are suggested,including the combination of listening and speaking practice,motivation enhancement approaches,and systematic training in listening strategies.The findings emphasize the need for comprehensive solutions addressing multiple dimensions of listening comprehension difficulties in Chinese EFL learners.展开更多
BACKGROUND Liver abscess is a serious hepatic infectious disease for which percutaneous drainage has become the preferred treatment method due to its minimally invasive advantages.With the rising prevalence of non-alc...BACKGROUND Liver abscess is a serious hepatic infectious disease for which percutaneous drainage has become the preferred treatment method due to its minimally invasive advantages.With the rising prevalence of non-alcoholic fatty liver disease reaching 29.2%in Chinese adults,the number of patients with liver abscess combined with fatty liver has shown a significant increasing trend clinically.AIM To analyze risk factors affecting prognosis after percutaneous drainage in liver abscess patients with fatty liver.METHODS A retrospective analysis of 165 liver abscess patients with fatty liver who underwent percutaneous drainage from January 2020 to April 2024.Patients were divided into good prognosis(n=121,73.3%)and poor prognosis groups(n=44,26.7%)based on 30-day outcomes.Univariate and multivariate logistic regression analyses were performed to identify independent risk factors.RESULTS The poor prognosis group had older age(65.2±11.8 years vs 56.1±11.9 years,P<0.001),higher diabetes prevalence(70.5%vs 47.2%,P=0.008),elevated inflammatory markers,and lower serum albumin(26.8±4.2 g/L vs 32.1±5.6 g/L,P<0.001).Moderate-to-severe fatty liver was more prevalent in the poor prognosis group(68.2%vs 38.0%,P=0.001).Multivariate analysis identified five independent risk factors:Age≥65 years(OR=2.847,P=0.007),diabetes history(OR=3.124,P=0.003),abscess diameter≥8 cm(OR=2.591,P=0.015),serum albumin<30 g/L(OR=3.456,P=0.001),and moderate-to-severe fatty liver(OR=2.213,P=CONCLUSION)Advanced age,diabetes history,large abscess,hypoalbuminemia,and moderate-to-severe fatty liver are independent risk factors for poor prognosis after percutaneous drainage in liver abscess patients with fatty liver.展开更多
BACKGROUND Inguinal and umbilical hernias are common neonatal conditions.Open hernia repair is currently the primary surgical treatment,but postoperative recurrence remains a significant risk.AIM To identify the risk ...BACKGROUND Inguinal and umbilical hernias are common neonatal conditions.Open hernia repair is currently the primary surgical treatment,but postoperative recurrence remains a significant risk.AIM To identify the risk factors for recurrence following open neonatal hernia repair.METHODS We retrospectively reviewed the data of 56 neonates who underwent open hernia repair at Shijiazhuang Maternal and Child Health Hospital between March 2021 and December 2023.The patients were categorized into recurrence and non-recurrence groups based on their experience of postoperative recurrence.Uni-variate analysis was performed to examine various factors,and those with P<0.1 in univariate analysis were included in multivariate logistic regression.No-mogram models were constructed,and their performance was evaluated using receiver operating characteristic curves.RESULTS Of the 56 children,11(19.64%)experienced postoperative recurrence,whereas the remaining 45(80.36%)did not.Univariate analysis identified anemia(P=0.079),persistent postoperative pain(P=0.049),and low birth weight(P=0.017)as factors associated with recurrence.Multivariate logistic regression analysis re-vealed that anemia(P=0.029),persistent postoperative pain(P=0.008),and low birth weight(P=0.009)were independent risk factors for recurrence after open hernia repair in neonates.CONCLUSION The risk of recurrence after open hernia repair should be closely monitored in neonates with low birth weight,anemia,and persistent postoperative pain.展开更多
Recrystallization stands as an essential process that influences the microstructure and properties of magnesium(Mg)alloys,yet its mechanisms remain complex and multifaceted.This review explores the key factors affecti...Recrystallization stands as an essential process that influences the microstructure and properties of magnesium(Mg)alloys,yet its mechanisms remain complex and multifaceted.This review explores the key factors affecting the recrystallization behavior of Mg alloys,emphasizing how their unique structural characteristics impact the driving forces and dynamics of recrystallization.Unlike conventional alloys,Mg alloys exhibit distinctive recrystallization kinetics,which is significantly affected by deformation conditions,such as strain rate,temperature,and processing methods(e.g.,rolling,forging,and extrusion).The process is also influenced by material characteristics,including initial grain size,texture,dislocation density,solute clustering,and stacking fault energy.Additionally,uneven strain distribution,stress concentrations,and stored energy play crucial roles in shaping the formation of recrystallized grains,particularly near grain boundaries.Notably,recrystallization is driven by dislocation accumulation and the availability of slip systems,with new strain-free grains typically forming in regions of high dislocation density.This paper synthesizes the existing literature to provide a comprehensive understanding of the mechanisms and kinetics of recrystallization in Mg alloys,highlighting the influence of microstructural features such as second-phase particles and grain boundary characteristics.It also identifies key challenges and suggests promising directions for future research,including optimizing material compositions and the interaction between deformation conditions via machine learning.展开更多
BACKGROUND Colorectal polyps(CPs)are important precursor lesions of colorectal cancer,and endoscopic surgery remains the primary treatment option.However,the shortterm recurrence rate post-surgery is high,and the risk...BACKGROUND Colorectal polyps(CPs)are important precursor lesions of colorectal cancer,and endoscopic surgery remains the primary treatment option.However,the shortterm recurrence rate post-surgery is high,and the risk factors for recurrence remain unknown.AIM To comprehensively explore risk factors for short-term recurrence of CPs after endoscopic surgery and develop a nomogram prediction model.METHODS Overall,362 patients who underwent endoscopic polypectomy between January 2022 and January 2024 at Nanjing Jiangbei Hospital were included.We screened basic demographic data,clinical and polyp characteristics,surgery-related information,and independent risk factors for CPs recurrence using univariate and multivariate logistic regression analyses.The multivariate analysis results were used to construct a nomogram prediction model,internally validated using Bootstrapping,with performance evaluated using area under the curve(AUC),calibration curve,and decision curve analysis.RESULTS CP re-occurred in 166(45.86%)of the 362 patients within 1 year post-surgery.Multivariate logistic regression analysis showed that age(OR=1.04,P=0.002),alcohol consumption(OR=2.07,P=0.012),Helicobacter pylori infection(OR=2.34,P<0.001),polyp number>2(OR=1.98,P=0.005),sessile polyps(OR=2.10,P=0.006),and adenomatous pathological type(OR=3.02,P<0.001)were independent risk factors for post-surgery recurrence.The nomogram prediction model showed good discriminatory(AUC=0.73)and calibrating power,and decision curve analysis showed that the model had good clinical benefit at risk probabilities>20%.CONCLUSION We identified multiple independent risk factors for short-term recurrence after endoscopic surgery.The nomogram prediction model showed a certain degree of differentiation,calibration,and potential clinical applicability.展开更多
BACKGROUND Gastric cancer is a malignant tumor with high morbidity and mortality worldwide.Neoadjuvant chemotherapy(NAC),defined as chemotherapy administered before the primary treatment(usually surgery)to reduce tumo...BACKGROUND Gastric cancer is a malignant tumor with high morbidity and mortality worldwide.Neoadjuvant chemotherapy(NAC),defined as chemotherapy administered before the primary treatment(usually surgery)to reduce tumor size and control micrometastases,has emerged as a crucial therapeutic strategy for locally advanced gastric cancer.Pathological complete response(pCR),characterized by the absence of viable tumor cells in the resected specimen after neoadjuvant treatment,is recognized as a strong predictor of favorable prognosis.However,the factors influencing the achievement of pCR remain incompletely understood.AIM To identify and analyze the predictive factors associated with achieving pCR after NAC in gastric cancer patients,thereby providing evidence-based guidance for clinical decision-making.METHODS A retrospective analysis was performed on 215 patients from Shandong Cancer Hospital and Tai’an Central Hospital with locally advanced gastric cancer who underwent NAC followed by radical surgery at our hospital between January 2015 and December 2023.Comprehensive clinical and pathological data were collected,including age,gender,tumor location,Lauren classification,clinical staging,chemotherapy regimens,number of chemotherapy cycles,and baseline hematological indicators.The baseline hematological indicators included neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio,albumin level,carcinoembryonic antigen(CEA),and carbohydrate antigen 19-9.Univariate and multivariate logistic regression analyses were employed to determine the independent predictive factors for pCR.RESULTS Among 215 gastric cancer patients,41(19.1%)achieved pCR after NAC.Multivariate analysis identified five independent predictive factors for pCR:Lauren intestinal type[odds ratio(OR)=3.28],lower clinical T stage(OR=2.75),CEA decrease≥70%after NAC(OR=3.42),pre-treatment NLR<2.5(OR=2.13),and≥4 chemotherapy cycles(OR=2.87).The fluorouracil,leucovorin,oxaliplatin,docetaxel regimen achieved the highest pCR rate(27.5%),and oxaliplatin-containing regimens were superior to cisplatin-containing regimens(22.3%vs 12.7%,P=0.034).Patients with both low NLR and platelet-to-lymphocyte ratio had the highest pCR rate(33.8%),while those with both high inflammatory markers had the lowest rate(10.7%).Earlier clinical stage disease(cT3N+vs cT4N+:28.6%vs 13.0%)and lower lymph node burden were associated with higher pCR rates.CONCLUSION The achievement of pCR after NAC in gastric cancer patients is closely associated with Lauren intestinal type,lower clinical T stage,a significant decrease in CEA after chemotherapy,low pre-treatment NLR,and an adequate number of chemotherapy cycles.展开更多
BACKGROUND This study aimed to compare and analyze risk factors for pancreatic fistula following pancreaticoduodenectomy(PD)using different definition criteria,and to develop a predictive model for standardized pancre...BACKGROUND This study aimed to compare and analyze risk factors for pancreatic fistula following pancreaticoduodenectomy(PD)using different definition criteria,and to develop a predictive model for standardized pancreatic fistula risk assessment.AIM To identify and compare risk factors for postoperative pancreatic fistula(POPF)following PD using both the 2005 International Study Group of Pancreatic Fistula and updated 2016 International Study Group on Pancreatic Surgery diagnostic criteria,and to develop a clinically applicable predictive model based on objective preoperative parameters for standardized pancreatic fistula risk assessment and perioperative management optimization.METHODS We conducted a retrospective analysis of 303 patients who underwent PD at CR&WISCO General Hospital between January 2017 and May 2023.POPF cases were classified according to both previous and updated diagnostic standards.For statistical analysis,we employed t-tests or Mann-Whitney U tests for continuous variables andχ^(2) tests for categorical data.To identify risk factors associated with POPF under both classification systems,we performed univariate and multivariate logistic regression analyses.RESULTS Univariate analysis identified several factors associated with POPF:Main pancreatic duct diameter(χ^(2)=31.641,P<0.001),main pancreatic duct index(χ^(2)=52.777,P<0.001),portal vein invasion(χ^(2)=6.259,P=0.012),intra-abdominal fat thickness(χ^(2)=7.665,P=0.006),preoperative biliary drainage(χ^(2)=5.999,P=0.014),pancreatic characteristics(χ^(2)=5.544,P=0.019),pancreatic resection margin thickness(t=2.055,P=0.032),pancreatic computed tomography(CT)value(t=-3.224,P=0.002),and preoperative blood amylase level(Z=-2.099,P=0.036).Multivariate logistic regression identified three independent risk factors:Main pancreatic duct index[odds ratio(OR)=0.000,95%confidence interval(CI):0.000-0.011],pancreatic cancer[OR=4.843,95%CI:1.285-18.254],and pancreatic CT value[OR=0.869,95%CI:0.806-0.937](all P<0.05).CONCLUSION The main pancreatic duct index and pancreatic CT value are strongly correlated with pancreatic fistula development after PD.展开更多
基金supported by the National Natural Science Foundation of China,Nos.82072165 and 82272256(both to XM)the Key Project of Xiangyang Central Hospital,No.2023YZ03(to RM)。
文摘Spinal cord injury represents a severe form of central nervous system trauma for which effective treatments remain limited.Microglia is the resident immune cells of the central nervous system,play a critical role in spinal cord injury.Previous studies have shown that microglia can promote neuronal survival by phagocytosing dead cells and debris and by releasing neuroprotective and anti-inflammatory factors.However,excessive activation of microglia can lead to persistent inflammation and contribute to the formation of glial scars,which hinder axonal regeneration.Despite this,the precise role and mechanisms of microglia during the acute phase of spinal cord injury remain controversial and poorly understood.To elucidate the role of microglia in spinal cord injury,we employed the colony-stimulating factor 1 receptor inhibitor PLX5622 to deplete microglia.We observed that sustained depletion of microglia resulted in an expansion of the lesion area,downregulation of brain-derived neurotrophic factor,and impaired functional recovery after spinal cord injury.Next,we generated a transgenic mouse line with conditional overexpression of brain-derived neurotrophic factor specifically in microglia.We found that brain-derived neurotrophic factor overexpression in microglia increased angiogenesis and blood flow following spinal cord injury and facilitated the recovery of hindlimb motor function.Additionally,brain-derived neurotrophic factor overexpression in microglia reduced inflammation and neuronal apoptosis during the acute phase of spinal cord injury.Furthermore,through using specific transgenic mouse lines,TMEM119,and the colony-stimulating factor 1 receptor inhibitor PLX73086,we demonstrated that the neuroprotective effects were predominantly due to brain-derived neurotrophic factor overexpression in microglia rather than macrophages.In conclusion,our findings suggest the critical role of microglia in the formation of protective glial scars.Depleting microglia is detrimental to recovery of spinal cord injury,whereas targeting brain-derived neurotrophic factor overexpression in microglia represents a promising and novel therapeutic strategy to enhance motor function recovery in patients with spinal cord injury.
文摘BACKGROUND Liver transplant(LT)recipients are susceptible to carbapenem-resistant Klebsiella pneumoniae(CRKP)infections.Comprehensive research addressing the incidence,timing,infection sites,resistance patterns,treatment options,and associated risk factors among LT recipients with CRKP is now lacking.AIM To assess the incidence,resistance,therapy,and risk factors of CRKP infections post-LT,and to evaluate the impact of them on prognosis.METHODS A retrospective study was conducted,including 430 consecutive patients who underwent LT between January 2015 and June 2023.This study aimed to investigate the risk factors for CRKP infections and their influence on outcomes using logistic regression analysis.RESULTS Among the 430 patients who underwent LT,20(4.7%)experienced at least one documented CRKP infection within 3 months post-transplantation.The median time from LT to the onset of CRKP infections was 6.5 days.The lungs and bloodstream were the most common sites of CRKP infections.CRKP isolates were relatively susceptible to ceftazidime/avibactam(93.7%),polymyxin B(90.6%),and tigecycline(75.0%)treatment.However,all isolates were resistant to piperacillin/tazobactam,ceftazidime,cefepime,aztreonam,meropenem,and levofloxacin treatment.Recipients with CRKP infections had a mortality rate of 35%,the rate was 12.5%for those receiving ceftazidime/avibactam therapy.Multivariate analysis identified female sex[odds ratio(OR)=3.306;95%confidence interval(CI):1.239-8.822;P=0.017],intraoperative bleeding≥3000 mL(OR=3.269;95%CI:1.018-10.490;P=0.047),alanine aminotransferase on day 1 post-LT≥1500 U/L(OR=4.370;95%CI:1.686-11.326;P=0.002),and post-LT mechanical ventilation(OR=2.772;95%CI:1.077-7.135;P=0.035)as significant variables associated with CRKP.CRKP infections were related to an intensive care unit length(ICU)of stay≥7 days and 6-month all-cause mortality post-LT.CONCLUSION CRKP infections were frequent complications following LT,with poor associated outcomes.Risk factors for post-LT CRKP infections included female sex,significant intraoperative bleeding,elevated alanine aminotransferase levels,and the need for mechanical ventilation.CRKP infections negatively impacted survival and led to prolonged ICU stays.
基金Supported by Financiamento e IncentivoàPesquisa of Hospital de Clínicas de Porto Alegre,No.170271.
文摘BACKGROUND Liver transplantation(LT)is the preferred treatment for end-stage liver diseases.Early allograft failure(EAF)can result in death or retransplantation.One of the key factors predicting EAF is the degree of graft injury,which is typically assessed by elevated alanine aminotransferase(ALT)and aspartate aminotransferase(AST)levels.Aminotransferase levels exceeding 5000 U/L within 48 hours of LT are indicative of poor short-term graft survival.AIM To investigate outcomes in liver transplant recipients with peak aminotransferase levels exceeding 5000 U/L and to identify predictors of EAF.METHODS Adult patients who underwent LT from a deceased(brain-dead)donor between 2011 and 2024 at Hospital de Clínicas de Porto Alegre were screened.Patients with peak AST or ALT levels>5000 U/L post-LT were included,excluding those with vascular thrombosis.EAF was defined as death or retransplantation within 90 days.A receiver operating characteristic curve were generated for each EAF predictor to determine the area under the curve(AUC).Sensitivity,specificity,negative predictive value,and positive predictive value were calculated for each predictor’s best cutoff,as defined by the Youden Index.Survival curves were plotted using the Kaplan-Meier method.RESULTS Between 2011 and 2024,341 patients underwent LT.Of these,29(8.5%)patients had AST and/or ALT levels exceeding 5000 U/L within the first 48 hours post-LT.Four patients were excluded due to vascular thrombosis,resulting in a study cohort of 25 patients.EAF were also observed in 11 patients.One-year and five-year graft survival rates were 51.7%and 42.6%,respectively.For patients without EAF,one-year and five-year graft survivals were 92.3%and 76.2%,respectively.The key predictors of EAF included serum factor V and arterial lactate levels on postoperative day(POD)1,with AUCs of 0.936 and 0.919,respectively.The optimal cutoff for EAF prediction were 26.2%for serum factor V and 9 mmol/L for arterial lactate.CONCLUSION Aminotransferase levels>5000 U/L were associated with high EAF risk.However,favorable graft function indicators on POD 1 were associated with long-term survival comparable to that of general LT recipients.Serum factor V and arterial lactate levels emerged as valuable prognostic markers.
文摘BACKGROUND Lung cancer(LC)is one of the most prevalent cancers globally,with a high incidence among the elderly population.Elderly patients,particularly those with diabetes mellitus,are at an increased risk of postoperative complications,in-cluding pulmonary infections,due to weakened immune function and metabolic abnormalities.Postoperative pulmonary infection(PPI)is a predominant com-plication after thoracoscopic radical resection of LC,significantly affecting patient outcomes and increasing healthcare burdens.Determining risk factors for PPI in this vulnerable population is crucial for improving surgical outcomes and redu-cing infection rates.AIM To develop and validate a predictive model for PPI in elderly patients with dia-betes undergoing thoracoscopic radical resection for LC and to assess its reliability and validity.METHODS This retrospective study included 212 patients with LC who received treatment at our hospital from March 2015 to March 2022.General clinical information,sur-gical treatment details,and laboratory test results were collected and analyzed.Patients were grouped according to infection occurrence during the postoperative hospitalization period.Risk factors for PPIs were determined through logistic regression analysis,and a nomogram prediction model was established using R software to assess its predictive accuracy and performance.RESULTS Among the 212 patients[median age:72 years(interquartile range:60-82 years)],41 developed PPI(19.34%),with Gram-negative bacteria being the predominant pathogens(64.14%).Factors,such as age of≥70 years,presence of respiratory diseases,maximum tumor diameter of≥4 cm,stages II-III,receiving neoadjuvant chemotherapy of≥2 times preoperatively,surgery duration of≥3 hours,chest drainage tube placement duration of≥3.5 days,preoperative fasting blood glucose levels,hemoglobin A1c(HbA1c)levels,and multi-leaf resection,were markedly higher in the infection group than in the non-infection group.Conversely,forced expiratory volume in 1 second(FEV1)of≥80%and albumin(Alb)levels were lower in the infection group.Multivariate logistic regression analysis revealed that receiving neoadjuvant chemotherapy of≥2 times[odds ratio(OR)=2.987;P=0.036],maximum tumor diameter of≥4 cm(OR=3.959;P=0.013),multi-leaf resection(OR=3.18;P=0.036),preoperative FEV1 of≤80%(OR=3.305;P=0.029),and high HbA1c levels(OR=2.39;P=0.003)as key risk factors for PPI,whereas high Alb levels(OR=0.507;P<0.001)was protective.The nomogram model demonstrated excellent diagnostic ability(area under the curve=0.901,0.915),and calibration curves and decision curve analysis revealed good predictive performance and clinical applicability of the model.CONCLUSION The primary pathogens of PPI in elderly patients with diabetes and LC undergoing thoracoscopic radical resection are Gram-negative bacteria.The nomogram model,based on preoperative neoadjuvant chemotherapy cycles,maximum tumor diameter,range of resection,and preoperative FEV1,Alb,and HbA1c levels,shows high clinical value in predicting the risk of PPI in this patient population.
基金the National Natural Science Foundation of China(42377170,42407212)the National Funded Postdoctoral Researcher Program(GZB20230606)+3 种基金the Postdoctoral Research Foundation of China(2024M752679)the Sichuan Natural Science Foundation(2025ZNSFSC1205)the National Key R&D Program of China(2022YFC3005704)the Sichuan Province Science and Technology Support Program(2024NSFSC0100)。
文摘Wildfires significantly disrupt the physical and hydrologic conditions of the environment,leading to vegetation loss and altered surface geo-material properties.These complex dynamics promote post-fire gully erosion,yet the key conditioning factors(e.g.,topography,hydrology)remain insufficiently understood.This study proposes a novel artificial intelligence(AI)framework that integrates four machine learning(ML)models with Shapley Additive Explanations(SHAP)method,offering a hierarchical perspective from global to local on the dominant factors controlling gully distribution in wildfireaffected areas.In a case study of Xiangjiao catchment burned on March 28,2020,in Muli County in Sichuan Province of Southwest China,we derived 21 geoenvironmental factors to assess the susceptibility of post-fire gully erosion using logistic regression(LR),support vector machine(SVM),random forest(RF),and convolutional neural network(CNN)models.SHAP-based model interpretation revealed eight key conditioning factors:topographic position index(TPI),topographic wetness index(TWI),distance to stream,mean annual precipitation,differenced normalized burn ratio(d NBR),land use/cover,soil type,and distance to road.Comparative model evaluation demonstrated that reduced-variable models incorporating these dominant factors achieved accuracy comparable to that of the initial-variable models,with AUC values exceeding 0.868 across all ML algorithms.These findings provide critical insights into gully erosion behavior in wildfire-affected areas,supporting the decision-making process behind environmental management and hazard mitigation.
基金supported by European Regional Development Funds RE0022527 ZEBRATOX(EU-Région Réunion-French State national counterpart,to Nicolas Diotel and Jean-Loup Bascands).
文摘After brain damage,regenerative angiogenesis and neurogenesis have been shown to occur simultaneously in mammals,suggesting a close link between these processes.However,the mechanisms by which these processes interact are not well understood.In this work,we aimed to study the correlation between angiogenesis and neurogenesis after a telencephalic stab wound injury.To this end,we used zebrafish as a relevant model of neuroplasticity and brain repair mechanisms.First,using the Tg(fli1:EGFP×mpeg1.1:mCherry)zebrafish line,which enables visualization of blood vessels and microglia respectively,we analyzed regenerative angiogenesis from 1 to 21 days post-lesion.In parallel,we monitored brain cell proliferation in neurogenic niches localized in the ventricular zone by using immunohistochemistry.We found that after brain damage,the blood vessel area and width as well as expression of the fli1 transgene and vascular endothelial growth factor(vegfaa and vegfbb)were increased.At the same time,neural stem cell proliferation was also increased,peaking between 3 and 5 days post-lesion in a manner similar to angiogenesis,along with the recruitment of microglia.Then,through pharmacological manipulation by injecting an anti-angiogenic drug(Tivozanib)or Vegf at the lesion site,we demonstrated that blocking or activating Vegf signaling modulated both angiogenic and neurogenic processes,as well as microglial recruitment.Finally,we showed that inhibition of microglia by clodronate-containing liposome injection or dexamethasone treatment impairs regenerative neurogenesis,as previously described,as well as injury-induced angiogenesis.In conclusion,we have described regenerative angiogenesis in zebrafish for the first time and have highlighted the role of inflammation in this process.In addition,we have shown that both angiogenesis and neurogenesis are involved in brain repair and that microglia and inflammation-dependent mechanisms activated by Vegf signaling are important contributors to these processes.This study paves the way for a better understanding of the effect of Vegf on microglia and for studies aimed at promoting angiogenesis to improve brain plasticity after brain injury.
文摘Background: Unsafe abortion (USA) is defined as the termination of a non-desired pregnancy, performed by an unqualified person or in an environment without minimum medical standards, or both. It can impact negatively the fertility in the future by tubo-peritoneal lesions. The current study aimed to highlight the infertility factors associated with USA. Material and Methods: From January 1st 2000 to December 31st 2021, a total of 3876 patients that sought care for infertility in the University Clinic of Kinshasa and the Edith Medical Center were enrolled. The socio-demographic, clinical and paraclinical variables were recorded and analyzed in relation to USA history. Results: The patients’ average age was 33.4 ± 5.7 years. Half of them were housewives;about sixty percent of the patients were nulliparous (59.31%). Seventy percent had a secondary infertility with 43.33% having a history of unsafe abortion. The main diagnosis was genital infections and uterus myoma. The chronic endometritis, bilateral tubal occlusion and Uterine synechiae were more associated with USA group. The spermogram anomalies and other partners’ lesions seemed of infectious origin. Conclusion: The USA remains a more frequent phenomenon in our setting. The chronic endometritis, bilateral tubal occlusion, uterine synechiae and indirectly uterus myoma were the infertility factors related to USA. The genital infection of any origin seems to be the main denominator underlying the female and the male infertility in our setting.
基金supported by the Guangxi Natural Science Foundation Program(2022GXNSFAA035583,2021GXNSFBA196052)the National Natural Science Foundation of China(32060305,32460270).
文摘Most research on carbon storage in forests has focused on qualitative studies of carbon storage and influ-encing factors rather than on quantifying the effect of the spatial distribution of carbon storage and of its influencing factors at different scales.Here we described the spatial dis-tribution of aboveground carbon storage(ACS)in a 20-ha plot in a subtropical evergreen broad-leaved forest to evalu-ate and quantify the relative effects of biotic factors(species diversity and structural diversity)and abiotic factors(soil and topographic factors)on ACS at different scales.Scale effects of the spatial distribution of ACS were significant,with higher variability at smaller scales,but less at larger scales.The distribution was also spatially heterogeneous,with more carbon storage on north-and east-facing slopes than on south-and west-facing slopes.At a smaller scale,species diversity and structural diversity each had a direct positive impact on ACS,but soil factors had no significant direct impact.At increasing scales,topographic and soil fac-tors gradually had a greater direct influence,whereas the influence of species diversity gradually decreased.Structural diversity had the greatest impact,followed by topographic factors and soil factors,while species diversity had a rela-tively smaller impact.These findings suggest studies on ACS in subtropical evergreen broadleaf forests in southern China should consider scale effects,specifically on the heterogene-ity of ACS distribution at small scales.Studies and conser-vation efforts need to focus on smaller habitat types with particular emphasis on habitat factors such as aspect and soil conditions,which have significant influences on community species diversity,structural diversity,and ACS distribution.
文摘The image of China in The Painted Veil by Maugham is complicated and diversified.On the one hand,it predicts numerous representative sceneries of the Chinese village,unveiling the exotic natural sceneries of China.Moreover,the spirit of Taoism is stated in the novel,unveiling the mysterious culture of Chinese’concern about the harmony of man and nature,which displays Maugham’s admiration for Chinese exotic flavors.On the other hand,China is depicted as poor and undeveloped,a country stricken by epidemic diseases and opium smokers.This article aims to analyze the factors affecting Maugham’s images of China from the subjective and objective perspectives.Chapter two profoundly explores the significant influence of Maugham’s life experience,religious belief and personal values on his individual images of China.Chapter three expounds the effective factors of social thoughts and economy.From the exploration,it is apparent that the formation of the image of China in The Painted Veil is firstly influenced by the life experience,individual values and religious belief of Maugham.Literary writing is actually a miniature and indirect representation of the author’s life experience.
文摘The increasing rate of cesarean delivery has become a widespread concern worldwide, nearly half of which is due to previous cesarean deliveries, and elective repeat cesarean delivery (ERCD), which is the main option for women who have a second pregnancy after cesarean section, is a major factor in this increase. The trial of labor after cesarean section (TOLAC) is considered to be the best method, and the safety and feasibility of TOLAC have been confirmed by numerous studies, but in clinical practice, there are many factors that make TOLAC unsuccessful. This article reviews the factors that influence the choice of delivery method after cesarean section as follows.
基金the Chiang Mai University Junior ResearchFellowship Program.
文摘Objective:Many children with fully corrected congenital heart disease(CHD)avoid physicalactivity(PA).This descriptive study sought to determine child and parental factors that could predict PAlevels in Thai dhildren after corrective surgery.Methods:Ninety schoolaged children with fully correctedCHD were recruited from a cardiology clinic at a university hospital in northern Thailand.Data collectioninvolved five validated questionnaires:(1)the Modified Thai Adolescent's Fhysical Activity Questionnaire,(2)the Child Health Status Questionnaire-Forms I and II1,(3)the Parental Knowledge on School-agedChildrer's PhysicalActivity Scale,(4)the Perceived Self-efficacy to Physical Activity Questionnaire,and(5)the Parntal Bonding Instrument.The analysis included descriptive statistics and stepwise multipleregression.Results:Results showed that the physical activity(PA.)levels,assessed through total energyexpenditure,of child ran with CHD were below the recommended levels after treatment(t=-8.33,p<0.001).There were sigrificant correlations between PA and factors such as a child's perceived health status,PAself-efficacy,and parentaloverprotection(r=0.39,p<0.050;r=0.46,p<0.050;r=0.25,p<0.050,respectively).After adjustment for demographic data and CHD type,these factors had no association with a child's PA.Only two factors predicted childhood PA—the child's perceived health status and PA self-efficacy whichcould explain27.3%of the variance of PA.(p<0.001).Conclusion:The study highlights the necessity forinterventions to enhance childrer's perception of their health status and PA self-efficacy to increase theirphysical activity levels.
基金Project foundation information:2023 Shanxi Provincial College Student Innovation and Entrepreneurship Training Project(Project No.:20231789)。
文摘Objective:To analyze the related factors affecting the professional identity of nursing students before and after clinical practice,hoping to provide reference for the career development and education of nursing students.Methods:A total of 393 undergraduate nursing students of grade 2020 from the Department of Nursing of a university in Shanxi Province were selected.The professional choice motivation,educational attainment expectation,future career planning,professional practice,and employment prospect expectation of nursing students before clinical practice,and the willingness to upgrade educational attainment,professional experience,career development expectation,and employment planning of nursing students after clinical practice were investigated.Through statistical analysis of the survey data,the related influencing factors affecting the professional identity of nursing students before and after clinical practice were explored.Results:The observation of general data showed that the proportion of female students in the survey sample was higher than that of male students,and the proportion of those whose family residence was in rural areas was slightly higher than that in urban areas.The analysis of students’own situation showed that nursing students chose the nursing major because of the high expected employment rate,but they were generally anxious about the employment prospect before the internship,showing a contradictory mentality.The analysis of students’professional ability showed that nursing students believed that their professional ability was mainly reflected in the vocational adaptability.The analysis of the social environment showed that the educational attainment expectations of nursing students were mainly undergraduate and master’s degrees,and they preferred to engage in clinical nursing work rather than nursing research.The analysis on the selection of internship hospitals shows that nursing students’choice of internship hospitals is mainly influenced by the duration of the internship,and they consider the correlation between the selection of internship hospitals and future employment decisions to be low.The analysis on the surrounding environment such as family and school shows that the professional identity of nursing students is mainly influenced by the opinions of school teachers and parents,but the occupations of most of the family members of nursing students are not related to medicine.Conclusion:Targeted intervention strategies should be formulated based on the relevant influencing factors that affect the professional identity of nursing students before and after clinical internship,to enhance the professional identity and employment confidence of nursing students,and promote the healthy and sustainable development of nursing education and the medical service industry.
基金Supported by the Key Clinical Specialty Discipline Construction Program of Fujian,Fujian Health Medicine and Politics,No.[2022]884.
文摘Early recurrence(ER)following surgery for rectal cancer is a significant factor impacting patient survival rates.Tsai et al identified age,preoperative neoadjuvant therapy,length of hospital stay,tumour location,and pathological stage as factors influencing the risk of ER.Postoperative monitoring for ER should encompass a thorough medical history review,physical examination,tumour marker testing,and imaging studies.Additionally,noninvasive circulating tumour cell DNA testing can be utilized to predict ER.Treatment strategies may involve radical surgery,radiation therapy,chemotherapy,and immunotherapy.Through a comprehensive analysis of risk factors,the optimization of monitoring methods,and the development of personalized treatment strategies,it is anticipated that both the efficacy of treatment and the quality of life for rectal cancer patients with postoperative recurrence can be significantly improved.
文摘Among the four basic skills in language learning,listening seems to present more difficulties for the students in their college English study.This paper tries to examine various obstacles affecting college students’English listening comprehension based on the author’s 20 years of teaching experience.Through systematic analysis of both linguistic and non-linguistic factors,the study proposes targeted teaching methodologies to enhance students’listening proficiency.The research highlights the importance of integrated skill development,psychological factors in language acquisition,and effective listening strategies.Practical classroom techniques are suggested,including the combination of listening and speaking practice,motivation enhancement approaches,and systematic training in listening strategies.The findings emphasize the need for comprehensive solutions addressing multiple dimensions of listening comprehension difficulties in Chinese EFL learners.
基金Supported by Zhejiang Province Traditional Chinese Medicine Science and Technology Plan Project,No.2024ZL039.
文摘BACKGROUND Liver abscess is a serious hepatic infectious disease for which percutaneous drainage has become the preferred treatment method due to its minimally invasive advantages.With the rising prevalence of non-alcoholic fatty liver disease reaching 29.2%in Chinese adults,the number of patients with liver abscess combined with fatty liver has shown a significant increasing trend clinically.AIM To analyze risk factors affecting prognosis after percutaneous drainage in liver abscess patients with fatty liver.METHODS A retrospective analysis of 165 liver abscess patients with fatty liver who underwent percutaneous drainage from January 2020 to April 2024.Patients were divided into good prognosis(n=121,73.3%)and poor prognosis groups(n=44,26.7%)based on 30-day outcomes.Univariate and multivariate logistic regression analyses were performed to identify independent risk factors.RESULTS The poor prognosis group had older age(65.2±11.8 years vs 56.1±11.9 years,P<0.001),higher diabetes prevalence(70.5%vs 47.2%,P=0.008),elevated inflammatory markers,and lower serum albumin(26.8±4.2 g/L vs 32.1±5.6 g/L,P<0.001).Moderate-to-severe fatty liver was more prevalent in the poor prognosis group(68.2%vs 38.0%,P=0.001).Multivariate analysis identified five independent risk factors:Age≥65 years(OR=2.847,P=0.007),diabetes history(OR=3.124,P=0.003),abscess diameter≥8 cm(OR=2.591,P=0.015),serum albumin<30 g/L(OR=3.456,P=0.001),and moderate-to-severe fatty liver(OR=2.213,P=CONCLUSION)Advanced age,diabetes history,large abscess,hypoalbuminemia,and moderate-to-severe fatty liver are independent risk factors for poor prognosis after percutaneous drainage in liver abscess patients with fatty liver.
文摘BACKGROUND Inguinal and umbilical hernias are common neonatal conditions.Open hernia repair is currently the primary surgical treatment,but postoperative recurrence remains a significant risk.AIM To identify the risk factors for recurrence following open neonatal hernia repair.METHODS We retrospectively reviewed the data of 56 neonates who underwent open hernia repair at Shijiazhuang Maternal and Child Health Hospital between March 2021 and December 2023.The patients were categorized into recurrence and non-recurrence groups based on their experience of postoperative recurrence.Uni-variate analysis was performed to examine various factors,and those with P<0.1 in univariate analysis were included in multivariate logistic regression.No-mogram models were constructed,and their performance was evaluated using receiver operating characteristic curves.RESULTS Of the 56 children,11(19.64%)experienced postoperative recurrence,whereas the remaining 45(80.36%)did not.Univariate analysis identified anemia(P=0.079),persistent postoperative pain(P=0.049),and low birth weight(P=0.017)as factors associated with recurrence.Multivariate logistic regression analysis re-vealed that anemia(P=0.029),persistent postoperative pain(P=0.008),and low birth weight(P=0.009)were independent risk factors for recurrence after open hernia repair in neonates.CONCLUSION The risk of recurrence after open hernia repair should be closely monitored in neonates with low birth weight,anemia,and persistent postoperative pain.
基金funding by the National Natural Science Foundation of China(Grant number U22A20187)(Grant No.52271147,No.52471175)China Postdoctoral Science Foundation(grant number 2024M751172)。
文摘Recrystallization stands as an essential process that influences the microstructure and properties of magnesium(Mg)alloys,yet its mechanisms remain complex and multifaceted.This review explores the key factors affecting the recrystallization behavior of Mg alloys,emphasizing how their unique structural characteristics impact the driving forces and dynamics of recrystallization.Unlike conventional alloys,Mg alloys exhibit distinctive recrystallization kinetics,which is significantly affected by deformation conditions,such as strain rate,temperature,and processing methods(e.g.,rolling,forging,and extrusion).The process is also influenced by material characteristics,including initial grain size,texture,dislocation density,solute clustering,and stacking fault energy.Additionally,uneven strain distribution,stress concentrations,and stored energy play crucial roles in shaping the formation of recrystallized grains,particularly near grain boundaries.Notably,recrystallization is driven by dislocation accumulation and the availability of slip systems,with new strain-free grains typically forming in regions of high dislocation density.This paper synthesizes the existing literature to provide a comprehensive understanding of the mechanisms and kinetics of recrystallization in Mg alloys,highlighting the influence of microstructural features such as second-phase particles and grain boundary characteristics.It also identifies key challenges and suggests promising directions for future research,including optimizing material compositions and the interaction between deformation conditions via machine learning.
文摘BACKGROUND Colorectal polyps(CPs)are important precursor lesions of colorectal cancer,and endoscopic surgery remains the primary treatment option.However,the shortterm recurrence rate post-surgery is high,and the risk factors for recurrence remain unknown.AIM To comprehensively explore risk factors for short-term recurrence of CPs after endoscopic surgery and develop a nomogram prediction model.METHODS Overall,362 patients who underwent endoscopic polypectomy between January 2022 and January 2024 at Nanjing Jiangbei Hospital were included.We screened basic demographic data,clinical and polyp characteristics,surgery-related information,and independent risk factors for CPs recurrence using univariate and multivariate logistic regression analyses.The multivariate analysis results were used to construct a nomogram prediction model,internally validated using Bootstrapping,with performance evaluated using area under the curve(AUC),calibration curve,and decision curve analysis.RESULTS CP re-occurred in 166(45.86%)of the 362 patients within 1 year post-surgery.Multivariate logistic regression analysis showed that age(OR=1.04,P=0.002),alcohol consumption(OR=2.07,P=0.012),Helicobacter pylori infection(OR=2.34,P<0.001),polyp number>2(OR=1.98,P=0.005),sessile polyps(OR=2.10,P=0.006),and adenomatous pathological type(OR=3.02,P<0.001)were independent risk factors for post-surgery recurrence.The nomogram prediction model showed good discriminatory(AUC=0.73)and calibrating power,and decision curve analysis showed that the model had good clinical benefit at risk probabilities>20%.CONCLUSION We identified multiple independent risk factors for short-term recurrence after endoscopic surgery.The nomogram prediction model showed a certain degree of differentiation,calibration,and potential clinical applicability.
文摘BACKGROUND Gastric cancer is a malignant tumor with high morbidity and mortality worldwide.Neoadjuvant chemotherapy(NAC),defined as chemotherapy administered before the primary treatment(usually surgery)to reduce tumor size and control micrometastases,has emerged as a crucial therapeutic strategy for locally advanced gastric cancer.Pathological complete response(pCR),characterized by the absence of viable tumor cells in the resected specimen after neoadjuvant treatment,is recognized as a strong predictor of favorable prognosis.However,the factors influencing the achievement of pCR remain incompletely understood.AIM To identify and analyze the predictive factors associated with achieving pCR after NAC in gastric cancer patients,thereby providing evidence-based guidance for clinical decision-making.METHODS A retrospective analysis was performed on 215 patients from Shandong Cancer Hospital and Tai’an Central Hospital with locally advanced gastric cancer who underwent NAC followed by radical surgery at our hospital between January 2015 and December 2023.Comprehensive clinical and pathological data were collected,including age,gender,tumor location,Lauren classification,clinical staging,chemotherapy regimens,number of chemotherapy cycles,and baseline hematological indicators.The baseline hematological indicators included neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio,albumin level,carcinoembryonic antigen(CEA),and carbohydrate antigen 19-9.Univariate and multivariate logistic regression analyses were employed to determine the independent predictive factors for pCR.RESULTS Among 215 gastric cancer patients,41(19.1%)achieved pCR after NAC.Multivariate analysis identified five independent predictive factors for pCR:Lauren intestinal type[odds ratio(OR)=3.28],lower clinical T stage(OR=2.75),CEA decrease≥70%after NAC(OR=3.42),pre-treatment NLR<2.5(OR=2.13),and≥4 chemotherapy cycles(OR=2.87).The fluorouracil,leucovorin,oxaliplatin,docetaxel regimen achieved the highest pCR rate(27.5%),and oxaliplatin-containing regimens were superior to cisplatin-containing regimens(22.3%vs 12.7%,P=0.034).Patients with both low NLR and platelet-to-lymphocyte ratio had the highest pCR rate(33.8%),while those with both high inflammatory markers had the lowest rate(10.7%).Earlier clinical stage disease(cT3N+vs cT4N+:28.6%vs 13.0%)and lower lymph node burden were associated with higher pCR rates.CONCLUSION The achievement of pCR after NAC in gastric cancer patients is closely associated with Lauren intestinal type,lower clinical T stage,a significant decrease in CEA after chemotherapy,low pre-treatment NLR,and an adequate number of chemotherapy cycles.
文摘BACKGROUND This study aimed to compare and analyze risk factors for pancreatic fistula following pancreaticoduodenectomy(PD)using different definition criteria,and to develop a predictive model for standardized pancreatic fistula risk assessment.AIM To identify and compare risk factors for postoperative pancreatic fistula(POPF)following PD using both the 2005 International Study Group of Pancreatic Fistula and updated 2016 International Study Group on Pancreatic Surgery diagnostic criteria,and to develop a clinically applicable predictive model based on objective preoperative parameters for standardized pancreatic fistula risk assessment and perioperative management optimization.METHODS We conducted a retrospective analysis of 303 patients who underwent PD at CR&WISCO General Hospital between January 2017 and May 2023.POPF cases were classified according to both previous and updated diagnostic standards.For statistical analysis,we employed t-tests or Mann-Whitney U tests for continuous variables andχ^(2) tests for categorical data.To identify risk factors associated with POPF under both classification systems,we performed univariate and multivariate logistic regression analyses.RESULTS Univariate analysis identified several factors associated with POPF:Main pancreatic duct diameter(χ^(2)=31.641,P<0.001),main pancreatic duct index(χ^(2)=52.777,P<0.001),portal vein invasion(χ^(2)=6.259,P=0.012),intra-abdominal fat thickness(χ^(2)=7.665,P=0.006),preoperative biliary drainage(χ^(2)=5.999,P=0.014),pancreatic characteristics(χ^(2)=5.544,P=0.019),pancreatic resection margin thickness(t=2.055,P=0.032),pancreatic computed tomography(CT)value(t=-3.224,P=0.002),and preoperative blood amylase level(Z=-2.099,P=0.036).Multivariate logistic regression identified three independent risk factors:Main pancreatic duct index[odds ratio(OR)=0.000,95%confidence interval(CI):0.000-0.011],pancreatic cancer[OR=4.843,95%CI:1.285-18.254],and pancreatic CT value[OR=0.869,95%CI:0.806-0.937](all P<0.05).CONCLUSION The main pancreatic duct index and pancreatic CT value are strongly correlated with pancreatic fistula development after PD.
