Reservoir-induced landslides in China's Three Gorges Reservoir area are prone to tensile cracks due to the influenceof their own weight and fluctuationsin water levels.The presence of cracks indicates that the ten...Reservoir-induced landslides in China's Three Gorges Reservoir area are prone to tensile cracks due to the influenceof their own weight and fluctuationsin water levels.The presence of cracks indicates that the tensile stress in the area has exceeded the tensile strength of the soil,leading to local instability.To explore the impact of tensile failure behavior on the stability and failure modes of reservoir landslides,the Huangtupo Riverside Slump#1 is taken as a case study.By considering local tensile failure,potential tensile cracks are incorporated into the analysis via the limit equilibrium method and reliability theory.The reliability of landslides under different tensile failure scenarios is quantified.Strain-softening characteristics of the soil are combined to further analyze the failure transmission path of the landslide.Finally,these potential failure modes were validated through physical model tests.The results show that cracks developing at rear positions reduce the stability of the slope and increase the probability of instability.During the destruction process,retrogressive failures with multiple sliding surfaces are likely to occur.However,tensile failure at the forefront reduces the likelihood of an individual slide mass descending.Progressive failure results in both regular and skip transmission patterns.Additionally,cracks and water level changes can also lead to shifts in the positions of the most dangerous blocks.Therefore,in practical landslide analysis and prevention,it is necessary to consider local tensile damage and identify potential tensile crack locations in advance to optimize prevention measures and accurately evaluate landslide risk.展开更多
Cascading failures pose a serious threat to the survivability of underwater unmanned swarm networks(UUSNs),significantly limiting their service ability in collaborative missions such as military reconnaissance and env...Cascading failures pose a serious threat to the survivability of underwater unmanned swarm networks(UUSNs),significantly limiting their service ability in collaborative missions such as military reconnaissance and environmental monitoring.Existing failure models primarily focus on power grids and traffic systems,and don't address the unique challenges of weak-communication UUSNs.In UUSNs,cascading failure present a complex and dynamic process driven by the coupling of unstable acoustic channels,passive node drift,adversarial attacks,and network heterogeneity.To address these challenges,a directed weighted graph model of UUSNs is first developed,in which node positions are updated according to ocean-current-driven drift and link weights reflect the probability of successful acoustic transmission.Building on this UUSNs graph model,a cascading failure model is proposed that integrates a normal-failure-recovery state-cycle mechanism,multiple attack strategies,and routingbased load redistribution.Finally,under a five-level connectivity UUSNs scheme,simulations are conducted to analyze how dynamic topology,network load,node recovery delay,and attack modes jointly affect network survivability.The main findings are:(1)moderate node drift can improve survivability by activating weak links;(2)based-energy routing(BER)outperform based-depth routing(BDR)in harsh conditions;(3)node self-recovery time is critical to network survivability;(4)traditional degree-based critical node metrics are inadequate for weak-communication UUSNs.These results provide a theoretical foundation for designing robust survivability mechanisms in weak-communication UUSNs.展开更多
Background:“Qi deficiency”(a pathological state where the body’s vital energy(Qi)is insufficient or weakened,impairing physiological functions and diminishing the body’s ability to perform daily activities,defend ...Background:“Qi deficiency”(a pathological state where the body’s vital energy(Qi)is insufficient or weakened,impairing physiological functions and diminishing the body’s ability to perform daily activities,defend against illness,and maintain homeostasis)syndrome is considered a critical syndrome in traditional Chinese medicine(TCM)and is associated with poor prognosis in heart failure(HF).This study investigates the clinical,metabolic,and transcriptomic differences between heart failure patients with and without Qi deficiency syndrome.Methods:56 heart failure patients were evaluated using a Qi deficiency syndrome scale and divided into Qi deficiency syndrome(QD)and non-Qi deficiency(non-QD)groups based on the median score.Clinical characteristics,including baseline N-terminal pro-B-type natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),total diuretic use during hospitalization,and 90-day rehospitalization rates,were compared between the groups.Differentially expressed genes(DEGs)and differential metabolites were identified,followed by enrichment analyses and validation using qPCR and Western blot in AC16 cardiomyocytes.Results:QD patients exhibited significantly higher NT-proBNP levels,lower LVEF,and increased 90-day rehospitalization rates.Metabolomic profiling revealed lipid metabolism disruptions,notably in linoleic acid and phospholipid pathways.Transcriptomic analysis highlighted 17 DEGs,including CISD2,a critical mitochondrial regulator,which was downregulated in QD patients.Correlation analysis identified significant associations between DEGs(e.g.,CISD2,BPGM)and lipid metabolites such as PC(16:0/P-16:0).Functional knockdown of CISD2 in AC16 cells led to upregulation of lipid oxidation enzymes ALOX15 and CYP1A2,linking CISD2 dysfunction to lipid metabolic dysregulation.Conclusion:Qi deficiency is associated with more severe heart failure symptoms,worse prognosis,and distinct metabolic and transcriptomic profiles,particularly in lipid metabolism.CISD2 emerges as a potential therapeutic target,offering new avenues for integrating molecular insights with TCM approaches to optimize HF management.展开更多
Carbon fiber-reinforced composites(CFRCs)have a wide range of applications in the aerospace,automotive,and energy sectors.A higher specific strength-to-weight ratio is desired in high-performance applications.The fail...Carbon fiber-reinforced composites(CFRCs)have a wide range of applications in the aerospace,automotive,and energy sectors.A higher specific strength-to-weight ratio is desired in high-performance applications.The failure mechanism of CFRCs involves multiscale phenomena,such as failure that can occur at the matrix,fibers,interface,layers,lamina,and laminates.When an impactor hits the CFRCs,the design involves analyzing each of these stages to prevent failure and optimize the properties of CFRCs under various loading conditions.A numerical model was employed to predict the fracture toughness of CFRCs with varying weight fractions and orientations.Finite Element Analysis(FEA)was conducted at the fiber level on a micrometer scale for the CFRCs against an impact loading.Epoxy composite samples at the coupon level were prepared using the hand layup technique with carbon fibers laid at three different angles,i.e.,longitudinal,transverse,and angular orientations.Samples with five different weight percentages of carbon fibers were prepared and investigated.An Izod impact tester was used to fracture the samples and characterize the energy absorption.The fractured surfaces were observed with a scanning electron microscope(SEM).The numerical and experimental results show that crack propagation is inhibited at higher loading fractions at an angular orientation by creating obstacles for the crack to propagate and arresting the dislocation motion.The fractography analysis through a scanning electron microscope exhibits how the angular orientations of the fibers are reoriented after fracture to prevent further crack propagation.展开更多
The solid electrolyte interphase(SEI)layer,formed on the electrode through electrolyte decomposition,has garnered significant attention over the past several decades.Numerous characterization studies have shown that t...The solid electrolyte interphase(SEI)layer,formed on the electrode through electrolyte decomposition,has garnered significant attention over the past several decades.Numerous characterization studies have shown that the SEI enhances the stability of both the electrolyte and electrode,particularly by mitigating the well-known cation-solvent co-intercalation in graphite electrodes in lithium-ion batteries.However,recent electrolyte exchange experiments have revealed that variations in electrolyte solvation structure and the resulting desolvation behaviors play a more dominant role than the SEI in influencing electrolyte and electrode stability,which in turn critically impacts battery performance.In addition to contributing to the ongoing debate,electrolyte exchange experiments have proven to be a valuable tool for analyzing failures in electrolytes,electrodes,and batteries.This review highlights the application of electrolyte exchange experiments across various metal-ion batteries,incorporating diverse combinations of electrolytes and electrodes.It examines the influence of electrolyte solvation structures and desolvation behaviors on the stability of both electrolytes and electrodes.The aim is to enhance the methodology of electrolyte exchange experiments to deepen the understanding of the molecular interactions among metal ions,anions,and solvents within the electrolyte.This approach complements existing insights into SEI effects,providing a more thorough and accurate framework for battery failure analysis.展开更多
During the construction of bank slopes involving pile driving,ensuring slope stability is crucial.This requires the design of appropriate support systems and a thorough evaluation of the failure mechanisms of pile str...During the construction of bank slopes involving pile driving,ensuring slope stability is crucial.This requires the design of appropriate support systems and a thorough evaluation of the failure mechanisms of pile structures under dynamic loading conditions.Based on the Huarong Coal Wharf project,various support schemes are analyzed using numerical simulation methods to calculate and compare slope stability coefficients.The optimal scheme is then identified.Under the selected support scheme,a numerical model of double-row suspended steel sheet piles is developed to investigate the dynamic response of the pile structures under pile driving loads.A time-history analysis is performed to assess the slope’s dynamic stability.The results show that the maximum displacements of the upper and lower steel sheet pile rows are 2.51 and 3.14 cm,respectively.The maximum principal stresses remain below 20 MPa in both rows,while the maximum von Mises stresses are 20.85 MPa for the upper row and 25.40 MPa for the lower row.The dominant frequencies of the steel sheet pile structures fall between 30 and 35 Hz,with a frequency bandwidth ranging from 0 to 500 Hz.The stability coefficient of the pile structures varies over time during the pile driving process,ultimately reaching a value of 1.26—exceeding the required safety threshold.This research provides practical guidance for designing support systems in wharf piling projects and offers a reliable basis for evaluating the safety performance of steel sheet piles in bank slopes.展开更多
Corrosion failure of N80-Q tubing occurred in a gas well.The causes of corrosion failure were investigated through macroscopic morphology,corrosion product analysis,and microbial analysis.The results show that the cor...Corrosion failure of N80-Q tubing occurred in a gas well.The causes of corrosion failure were investigated through macroscopic morphology,corrosion product analysis,and microbial analysis.The results show that the corrosion patterns of N80-Q tubing were diverse.The failure resulted from the combined action of microbial corrosion,CO_(2)/Cl^(-) corrosion,and erosion corrosion.展开更多
Purpose:To evaluate the effects of healthcare failure mode and effect analysis(FMEA)on the prevention of deep venous thrombosis(DVT)in elderly patients undergoing femoral fracture surgery.Methods:Eighty elderly patien...Purpose:To evaluate the effects of healthcare failure mode and effect analysis(FMEA)on the prevention of deep venous thrombosis(DVT)in elderly patients undergoing femoral fracture surgery.Methods:Eighty elderly patients undergoing femoral fracture surgery who did not apply FMEA in Suzhou BenQ Medical Center from June 1,2022 to May 31,2023 were selected as the control group.According to the equal group experiment method,80 elderly patients who were managed using FMEA from June 1,2023 to May 31,2024 were selected as the FMEA group.The control group received traditional nursing management,while the FMEA group applied FMEA to analyze failure causes,calculate Risk Priority Numbers(RPNs),identify failure modes with higher RPNs,analyze the influencing factors,develop improvement measures,and optimize processes.The RPN values and the incidence of DVT,as well as nursing satisfaction scores,were compared in the two groups.Results:Compared with the control group,the total RPN values of the FEMA group decreased significantly,with a reduction rate of 87.0%.Besides,the incidence of DVT was 1.3%in the FMEA group,lower than 10.0%in the control group(8/80).What’s more,the patients in the FMEA group were more satisfied with the nursing service compared with the patients in the control group.Conclusion:The application of the FMEA in elderly patients undergoing femoral fracture surgery has demonstrated its potential to prevent the incidence of DVT,lower RPN values,and improve nursing satisfaction.展开更多
Objectives:This study aimed to assess the impact of exercise rehabilitation during the vulnerable period on cardiac recovery(CR)outcomes in patients with acute decompensated heart failure(ADHF).Methods:Multiple databa...Objectives:This study aimed to assess the impact of exercise rehabilitation during the vulnerable period on cardiac recovery(CR)outcomes in patients with acute decompensated heart failure(ADHF).Methods:Multiple databases including PubMed,Web of Science,Embase,the Cochrane Library,CINAHL,China National Knowledge Infrastructure(CNKI),Chinese Science and Technology Periodical Database(VIP),Wanfang database,SinoMed,ClinicalTrials.gov,and American Heart Association(AHA)and European Society of Cardiology(ESC)were searched for RCTs on exercise rehabilitation in ADHF patients’vulnerable period from inception to April 2,2025.The risk of bias was assessed with Cochrane Risk of Bias 2.0,and data were analyzed in RevMan 5.3.Results:A total of seven RCTs involving 946 patients were included.The results demonstrated that exercise rehabilitation training during the vulnerable period in patients with ADHF significantly increased the 6-min walk test distance(6-MWTD)(SMD=0.37;95%CI:0.09,0.65;P=0.01),short physical performance battery(SPPB)score(MD=1.26;95%CI:0.82,1.70;P<0.001)and peak oxygen consumption(VO2peak)(SMD=1.43;95%CI:0.53,2.34;P=0.002),improved quality of life(QoL)(SMD=0.85;95%CI:0.07,1.64,P=0.03),reduced depression score(MD=-0.73;95%CI:1.27,-0.18;P=0.009),frailty(MD=-0.22;95%CI:-0.48,0.05;P=0.11),and decreased 6-month all-cause readmission(OR=0.67;95%CI:0.49,0.91;P=0.01).However,no statistically significantdifferences were observed between the two groups in left ventricular ejection fraction(LVEF)(MD=0.96;95%CI:-1.84,3.77;P=0.50),6-month heart failure(HF)-related readmission(OR=1.01;95%CI:0.66,1.53;P=0.98),and all-cause mortality(OR=0.63;95%CI:0.18,2.24;P=0.47).There were no adverse events reported.Conclusions:Exercise rehabilitation during the vulnerable phase improves exercise tolerance,QoL,and depressive symptoms while reducing 6-month all-cause readmissions in ADHF patients,with no reported adverse events.Although trends toward improved LVEF,HF-related readmissions,and all-cause mortality were observed.Large-scale,high-quality studies are warranted to explore individualized responses and long-term outcomes.展开更多
Autonomous Underwater Vehicles(AUVs)are pivotal for deep-sea exploration and resource exploitation,yet their reliability in extreme underwater environments remains a critical barrier to widespread deployment.Through s...Autonomous Underwater Vehicles(AUVs)are pivotal for deep-sea exploration and resource exploitation,yet their reliability in extreme underwater environments remains a critical barrier to widespread deployment.Through systematic analysis of 150 peer-reviewed studies employing mixed-methods research,this review yields three principal advancements to the reliability analysis of AUVs.First,based on the hierarchical functional division of AUVs into six subsystems(propulsion system,navigation system,communication system,power system,environmental detection system,and emergency system),this study systematically identifies the primary failure modes and potential failure causes of each subsystem,providing theoretical support for fault diagnosis and reliability optimization.Subsequently,a comprehensive review of AUV reliability analysis methods is conducted from three perspectives:analytical methods,simulated methods,and surrogate model methods.The applicability and limitations of each method are critically analyzed to offer insights into their suitability for engineering applications.Finally,the study highlights key challenges and research hotpots in AUV reliability analysis,including reliability analysis under limited data,AI-driven reliability analysis,and human reliability analysis.Furthermore,the potential of multi-sensor data fusion,edge computing,and advanced materials in enhancing AUV environmental adaptability and reliability is explored.展开更多
Traditional Chinese medicine(TCM)has played a significant role in the prevention and treatment of chronic heart failure(CHF).To study TCM diagnosis of CHF,a total of 278 Chinese clinical research articles on the study...Traditional Chinese medicine(TCM)has played a significant role in the prevention and treatment of chronic heart failure(CHF).To study TCM diagnosis of CHF,a total of 278 Chinese clinical research articles on the study of CHF syndromes in recent 40 years retrieved from Web of Science,Scopus,Pub Med,Embase,CNKI,Wanfang Data,Cq VIP,and Sino Med.According to cumulative frequency analysis,network analysis,and hierarchical cluster analysis,the study found the distribution of CHF syndromes was syndrome of qi deficiency with blood stasis,syndrome of qi and yin deficiency,syndrome of yang deficiency with water flooding,syndrome of heart blood stasis obstruction,syndrome of turbid phlegm,and syndrome of collapse due to primordial yang deficiency.The syndrome elements on location of illness were heart,kidney,lung,and spleen.The syndrome elements on nature of illness were qi deficiency,blood stasis,yang deficiency,yin deficiency,water retention,and turbid phlegm.These findings can provide reference to the research on diagnosis and treatment of CHF,and contribute to the study on syndrome standardization and objective research of TCM diagnosis.展开更多
BACKGROUND Congestive hepatopathy,also known as nutmeg liver,is liver damage secondary to chronic heart failure(HF).Its morphological characteristics in terms of medical imaging are not defined and remain unclear.AIM ...BACKGROUND Congestive hepatopathy,also known as nutmeg liver,is liver damage secondary to chronic heart failure(HF).Its morphological characteristics in terms of medical imaging are not defined and remain unclear.AIM To leverage machine learning to capture imaging features of congestive hepatopathy using incidentally acquired computed tomography(CT)scans.METHODS We retrospectively analyzed 179 chronic HF patients who underwent echocardiography and CT within one year.Right HF severity was classified into three grades.Liver CT images at the paraumbilical vein level were used to develop a ResNet-based machine learning model to predict tricuspid regurgitation(TR)severity.Model accuracy was compared with that of six gastroenterology and four radiology experts.RESULTS In the included patients,120 were male(mean age:73.1±14.4 years).The accuracy of the results predicting TR severity from a single CT image for the machine learning model was significantly higher than the average accuracy of the experts.The model was found to be exceptionally reliable for predicting severe TR.CONCLUSION Deep learning models,particularly those using ResNet architectures,can help identify morphological changes associated with TR severity,aiding in early liver dysfunction detection in patients with HF,thereby improving outcomes.展开更多
The swinging-loading process is essential for automatic artillery loading systems.This study focuses on the problems of reliability analysis that affect swinging-loading positioning accuracy.A dynamic model for a mult...The swinging-loading process is essential for automatic artillery loading systems.This study focuses on the problems of reliability analysis that affect swinging-loading positioning accuracy.A dynamic model for a multi degree-of-freedom swinging-loading-integrated rigid-flexible coupling system is established.This model is based on the identification of key parameters and platform experiments.Based on the spatial geometric relationship between the breech and loader during modular charge transfer and the possible maximum interference depth of the modular charge,a new failure criterion for estimating the reliability of swinging-loading positioning accuracy is proposed.Considering the uncertainties in the operation of the pendulum loader,the direct probability integration method is introduced to analyze the reliability of the swinging-loading positioning accuracy under three different charge numbers.The results indicate that under two and four charges,the swinging-loading process shows outstanding reliability.However,an unstable stage appears when the swinging motion occurred under six charges,with a maximum positioning failure probability of 0.0712.A comparison between the results obtained under the conventional and proposed criteria further reveals the effectiveness and necessity of the proposed criterion.展开更多
Cutting off or controlling the enemy’s power supply at critical moments or strategic locations may result in a cascade failure,thus gaining an advantage in a war.However,the exist-ing cascading failure modeling analy...Cutting off or controlling the enemy’s power supply at critical moments or strategic locations may result in a cascade failure,thus gaining an advantage in a war.However,the exist-ing cascading failure modeling analysis of interdependent net-works is insufficient for describing the load characteristics and dependencies of subnetworks,and it is difficult to use for model-ing and failure analysis of power-combat(P-C)coupling net-works.This paper considers the physical characteristics of the two subnetworks and studies the mechanism of fault propaga-tion between subnetworks and across systems.Then the surviv-ability of the coupled network is evaluated.Firstly,an integrated modeling approach for the combat system and power system is predicted based on interdependent network theory.A heteroge-neous one-way interdependent network model based on proba-bility dependence is constructed.Secondly,using the operation loop theory,a load-capacity model based on combat-loop betweenness is proposed,and the cascade failure model of the P-C coupling system is investigated from three perspectives:ini-tial capacity,allocation strategy,and failure mechanism.Thirdly,survivability indexes based on load loss rate and network sur-vival rate are proposed.Finally,the P-C coupling system is con-structed based on the IEEE 118-bus system to demonstrate the proposed method.展开更多
The connection efficiency of composite pre-tightened multi-tooth joint is low because of uneven load distribution and single load transmission path.In this paper,based on the principle of bio-tooth(suture)structure,co...The connection efficiency of composite pre-tightened multi-tooth joint is low because of uneven load distribution and single load transmission path.In this paper,based on the principle of bio-tooth(suture)structure,combining soft material with fractal,a composite pre-tightened multi-hierarchy tooth joint is proposed,and the bearing performance and failure process of the joint through experiments and finite element method under tensile load.First,the ultimate bearing capacity,load distribution ratio,and failure process of different hierarchies of teeth joints are studied through experiments.Then,the progressive damage models of different hierarchies of tooth joints are established,and experiments verify the validity of the finite element model.Finally,the effects of soft material and increasing tooth hierarchy on the failure process and bearing capacity of composite pre-tightened tooth joints are analyzed by the finite element method.The following conclusions can be drawn:(1)The embedding of soft materials changed the failure process of the joint.Increasing the tooth hierarchy can give the joint more load transfer paths,but the failure process of the joint is complicated.(2)Embedding soft materials and increasing the tooth hierarchy simultaneously can effectively improve the bearing capacity of composite pre-tightened tooth joints,which is 87.8%higher than that of traditional three-tooth joints.展开更多
BACKGROUND The use of sodium-glucose cotransporter 2(SGLT2)inhibitor in heart failure(HF)patients is increasing significantly,regardless of whether they have a history of diabetes.The effects of SGLT2 inhibitor on HF ...BACKGROUND The use of sodium-glucose cotransporter 2(SGLT2)inhibitor in heart failure(HF)patients is increasing significantly,regardless of whether they have a history of diabetes.The effects of SGLT2 inhibitor on HF are likely mediated through multiple mechanisms,including suppression of the renin-angiotensin-aldosterone system(RAAS),reduction in oxidative stress leading to enhanced myocardial efficiency,and attenuation of adverse cardiac remodeling by preventing fibrosis.These pathways are fundamental to reducing mortality,improving patients'quality of life,and alleviating the burden on the United States healthcare system by decreasing HF-related hospitalizations.AIM To evaluate SGLT2 inhibitor effects on HF,focusing on hospitalization for HF(HHF),cardiovascular(CV)deaths,and all-cause mortality.METHODS A comprehensive search was conducted in PubMed for randomized controlled trials(RCTs)evaluating the effects of SGLT2 inhibitor in HF patients compared to placebo,covering the period from January 1,2014,to January 1,2025.The primary outcomes assessed were HHF,CV deaths,and all-cause mortality.RevMan Web 5.4.1 was used to assess the risk of bias heterogeneity and to perform the statistical analyses.A random-effects model was employed for all statistical evaluations.RESULTS A total of nine RCTs were included in this analysis:DELIVER,DECLARE-TIMI 58,DAPA-HF,EMPA-REG OUTCOME,EMPEROR-Reduced,EMPEROR-Preserved,SOLOIST-WHF,EMPULSE,and VERTIS-CV.For HHF,eight trials(excluding the SOLOIST-WHF;n=25906)were pooled,while CV deaths were assessed using data from eight trials(excluding the EMPULSE;n=26598).Compared to placebo,SGLT2 inhibitor significantly reduced the risk of HHF(relative risk:0.74;95%CI:0.71-0.77;P<0.00001)and CV death(odds ratio:0.88;95%CI:0.83-0.92;P=0.0006).All nine trials(n=27128)were included in the analysis of all-cause mortality.SGLT2 inhibitor were associated with a statistically significant reduction in all-cause mortality compared to placebo(OR:0.91;95%CI:0.84-0.98;P=0.02).CONCLUSION These results suggest that SGLT2 inhibitor significantly reduce the risk of hospitalization for HF,CV deaths,and all-cause mortality.展开更多
Background:To investigate the consistency level of binary symptom assessment in patients with heart failure and their primary caregivers,and to analyze the related factors influencing consistency.Methods:By using the ...Background:To investigate the consistency level of binary symptom assessment in patients with heart failure and their primary caregivers,and to analyze the related factors influencing consistency.Methods:By using the convenience sampling method,patients with heart failure and their main caregivers in the Department of Cardiology of a tertiary hospital in Suzhou from May to November 2023 were selected as the research subjects.The HFSS scale was used for data collection.The paired t-test or paired Wilcoxon test was used to evaluate the differences in the binary symptom assessment scores of heart failure.The intraclass correlation coefficient was used to assess the consistency level of the binary symptom assessment.The Pearson correlation test was used to examine the correlation of the binary symptom assessment.Regression analysis was employed to explore the factors related to the consistency assessment.Results:A total of 103 pairs of valid questionnaires were collected.The consistency levels of symptom evaluations in patients with heart failure and their primary caregivers were statistically significant(P<0.05).The most frequently reported and severe symptom by patients with heart failure and their primary caregivers is shortness of breath during activity.Both have a high consensus on the severity and urgency of most heart failure symptoms.The patient’s gender,body mass index,number of children,history of diabetes,number of comorbidities,mean arterial pressure,LVEF,number of stents,whether a defibrillator was implanted,as well as the gender,marital status,education level,relationship with the patient,care time,whether they lived together,and communication and interaction situation of the main caregiver were the influencing factors for the consistency of binary symptom assessment of heart failure(P<0.05).Conclusion:The degree of consistency in binary symptom assessment between patients with heart failure and their primary caregivers was moderate or higher,which emphasizes the importance of including binary groups in clinical assessment.展开更多
BACKGROUND Acute liver failure(ALF)with sepsis is associated with rapid disease progression and high mortality.Therefore,early detection of high-risk sepsis subgroups in patients with ALF is crucial.AIM To develop and...BACKGROUND Acute liver failure(ALF)with sepsis is associated with rapid disease progression and high mortality.Therefore,early detection of high-risk sepsis subgroups in patients with ALF is crucial.AIM To develop and validate an accurate nomogram model for predicting the risk of sepsis in patients with ALF.METHODS We retrieved data from the Medical Information Mart for Intensive Care(MIMIC)IV database and the Fifth Medical Center of Chinese PLA General Hospital(FMCPH).Univariate and multivariate logistic regression analysis were used to identify risk factors for sepsis in ALF and were subsequently incorporated to construct a nomogram model[sepsis in ALF(SIALF)].The discrimination ability,calibration,and clinical applicability of the SIALF model were evaluated by the area under receiver operating characteristic curve,calibration curves,and decision curve analysis,respectively.The Kaplan-Meier curves were used for robustness check.The SIALF model was internally validated using the bootstrapping method with the MIMIC validation cohort and externally validated by the FMCPH cohort.RESULTS A total of 738 patients with ALF patients were included in this study,with 510 from the MIMIC IV database and 228 from the FMCPH cohort.In the MIMIC IV cohort,387(75.89%)patients developed sepsis.Multivariate logistic regression analysis revealed that age[odds ratio(OR)=1.016,95%confidence interval(CI):1.003-1.028,P=0.017],total bilirubin(OR=1.047,95%CI:1.008-1.088,P=0.017),lactate dehydrogenase(OR=1.001,95%CI:1.000-1.001,P<0.001),albumin(OR=0.436,95%CI:0.274-0.692,P=0.003),and mechanical ventilation(OR=1.985,95%CI:1.269-3.105,P=0.003)were independent risk factors associated with sepsis in patients with ALF.The SIALF model demonstrated satisfactory accuracy and clinical utility with area under receiver operating characteristic curve values of 0.849,0.847,and 0.835 for the internal derivation,internal validation,and external validation cohort,respectively,which outperformed the Sequential Organ Failure Assessment scores of 0.733,0.746,and 0.721 and systemic inflammatory response syndrome scores of 0.578,0.653,and 0.615,respectively.The decision curve analysis and calibration curves indicated superior clinical utility and efficiency than other score systems.Based on the risk stratification score derived from the SIALF model,the Kaplan-Meier curves effectively discriminated the real high-risk subpopulation.To enhance the clinical utility,we constructed an online dynamic version,enabling physicians to evaluate patients’condition and track disease progression in real-time.CONCLUSION Based on easily identifiable clinical data,we developed the SIALF model to predict the risk of sepsis in patients with ALF.The model demonstrated robust predictive efficiency,outperformed Sequential Organ Failure Assessment and systemic inflammatory response syndrome scores,and was validated in an external cohort.The model-based risk stratification and online calculator might further facilitate the early detection and appropriate treatment for this subpopulation.展开更多
BACKGROUND Heart failure(HF),especially in patients with preserved ejection fraction and midrange ejection fraction,remains a significant global health burden.Interatrial shunt devices(IASDs),which allow blood flow fr...BACKGROUND Heart failure(HF),especially in patients with preserved ejection fraction and midrange ejection fraction,remains a significant global health burden.Interatrial shunt devices(IASDs),which allow blood flow from the left to the right atrium,offer a novel treatment approach by reducing left atrial pressure and alleviating symptoms.AIM To evaluate the efficacy and safety of IASDs in patients with HF through a systematic review and meta-analysis.METHODS We performed a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines,analyzing studies up to April 2025.Randomized controlled trials and observational studies comparing interatrial shunt therapy with control groups were included.Data on clinical outcomes were analyzed using Review Manager software.RESULTS Nine studies involving 1689 patients were included.IASDs significantly improved cardiac output[mean difference(MD):0.72,95%CI:0.13-1.32,P=0.02],right atrial pressure(RAP)(MD:0.70,95%CI:0.14-1.26,P=0.01),and 6-minute walk distance(MD:71.63,95%CI:24.13-119.13,P=0.003).There were no significant differences in major adverse cardiac events,myocardial infarction,ischemic stroke,or new-onset atrial fibrillation.However,all-cause mortality[risk ratio(RR):1.49,95%CI:1.02-2.18,P=0.04]and cardiovascular death(RR:1.66,95%CI:1.01-2.74,P=0.05)were significantly higher in the shunt group.CONCLUSION IASDs offer significant short-term improvements in cardiac output,RAP,and exercise capacity in HF patients.However,long-term safety concerns,particularly regarding mortality,necessitate further research and careful patient selection.展开更多
BACKGROUND Liver transplantation(LT)is recognized as an effective approach that offers survival benefits for patients with acute-on-chronic liver failure(ACLF).However,controversies remain regarding the LT selection c...BACKGROUND Liver transplantation(LT)is recognized as an effective approach that offers survival benefits for patients with acute-on-chronic liver failure(ACLF).However,controversies remain regarding the LT selection criteria,and meta-analyses reporting overall survival outcomes across different ACLF severity grades are lacking.AIM To depict a comprehensive postoperative picture of patients with ACLF of varying severity and contribute to updating LT selection.METHODS Systematic searches in Web of Science,EMBASE,PubMed,and Cochrane databases were performed,from inception to December 26,2023,for studies exploring post-transplant outcomes among ACLF patients,stratified by severity grades as identified by the European Association for the Study of the Liver-Chronic Liver Failure criteria.The primary outcome of interest was the survival rate within one year,with post-transplant complications as secondary outcomes.Additionally,the subgroup analysis examined region-specific one-year survival rates.RESULTS A total of 17 studies involving 28025 participants were included.Patients with ACLF-1 and ACLF-2 have favorable survival within one year,with survival rates reaching 87%[95%confidence interval(CI):84%-91%]and 86%(95%CI:81%-91%),respectively.Despite the relatively lower survival(73%,95%CI:66%-80%)and higher incidence of infection(48%,95%CI:29%-67%)observed in ACLF-3 patients,their survival exceeds that of those who do not undergo LT.Moreover,post-transplant survival was highest in North America across all ACLF grades.CONCLUSION LT can provide survival advantages for ACLF patients.To optimize the utilization of scarce donor organs and improve prognosis,comprehensive preoperative health evaluations are essential,especially for ACLF-3 patients.展开更多
基金supported by the Major Program of National Natural Science Foundation of China(Grant No.42090055)the National Key ScientificInstruments and Equipment Development Projects of China(Grant No.41827808)the National Nature Science Foundation of China(Grant No.42207216).
文摘Reservoir-induced landslides in China's Three Gorges Reservoir area are prone to tensile cracks due to the influenceof their own weight and fluctuationsin water levels.The presence of cracks indicates that the tensile stress in the area has exceeded the tensile strength of the soil,leading to local instability.To explore the impact of tensile failure behavior on the stability and failure modes of reservoir landslides,the Huangtupo Riverside Slump#1 is taken as a case study.By considering local tensile failure,potential tensile cracks are incorporated into the analysis via the limit equilibrium method and reliability theory.The reliability of landslides under different tensile failure scenarios is quantified.Strain-softening characteristics of the soil are combined to further analyze the failure transmission path of the landslide.Finally,these potential failure modes were validated through physical model tests.The results show that cracks developing at rear positions reduce the stability of the slope and increase the probability of instability.During the destruction process,retrogressive failures with multiple sliding surfaces are likely to occur.However,tensile failure at the forefront reduces the likelihood of an individual slide mass descending.Progressive failure results in both regular and skip transmission patterns.Additionally,cracks and water level changes can also lead to shifts in the positions of the most dangerous blocks.Therefore,in practical landslide analysis and prevention,it is necessary to consider local tensile damage and identify potential tensile crack locations in advance to optimize prevention measures and accurately evaluate landslide risk.
基金supported in part by the National Natural Science Foundation of China(Key Program)under Grant No.62031021。
文摘Cascading failures pose a serious threat to the survivability of underwater unmanned swarm networks(UUSNs),significantly limiting their service ability in collaborative missions such as military reconnaissance and environmental monitoring.Existing failure models primarily focus on power grids and traffic systems,and don't address the unique challenges of weak-communication UUSNs.In UUSNs,cascading failure present a complex and dynamic process driven by the coupling of unstable acoustic channels,passive node drift,adversarial attacks,and network heterogeneity.To address these challenges,a directed weighted graph model of UUSNs is first developed,in which node positions are updated according to ocean-current-driven drift and link weights reflect the probability of successful acoustic transmission.Building on this UUSNs graph model,a cascading failure model is proposed that integrates a normal-failure-recovery state-cycle mechanism,multiple attack strategies,and routingbased load redistribution.Finally,under a five-level connectivity UUSNs scheme,simulations are conducted to analyze how dynamic topology,network load,node recovery delay,and attack modes jointly affect network survivability.The main findings are:(1)moderate node drift can improve survivability by activating weak links;(2)based-energy routing(BER)outperform based-depth routing(BDR)in harsh conditions;(3)node self-recovery time is critical to network survivability;(4)traditional degree-based critical node metrics are inadequate for weak-communication UUSNs.These results provide a theoretical foundation for designing robust survivability mechanisms in weak-communication UUSNs.
基金supported by the Sanming Project of Medicine in Shenzhen[SZZYSM202206001]National Natural Science Foundation of China[82004320 and 82374383]+3 种基金Natural Science Foundation of Guangdong Province of China[2022A1515011710 and 2022A1515010679]Shenzhen Science and Technology Innovation Committee[JCYJ20220530141407017 and JCYJ20240813153619026]2024 High-quality Development Research Project of Shenzhen Bao’an Public Hospital[YNXM2024078]and Shenzhen Bao’an Chinese Medicine Hospital Research Program[BAZYY20220702].
文摘Background:“Qi deficiency”(a pathological state where the body’s vital energy(Qi)is insufficient or weakened,impairing physiological functions and diminishing the body’s ability to perform daily activities,defend against illness,and maintain homeostasis)syndrome is considered a critical syndrome in traditional Chinese medicine(TCM)and is associated with poor prognosis in heart failure(HF).This study investigates the clinical,metabolic,and transcriptomic differences between heart failure patients with and without Qi deficiency syndrome.Methods:56 heart failure patients were evaluated using a Qi deficiency syndrome scale and divided into Qi deficiency syndrome(QD)and non-Qi deficiency(non-QD)groups based on the median score.Clinical characteristics,including baseline N-terminal pro-B-type natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),total diuretic use during hospitalization,and 90-day rehospitalization rates,were compared between the groups.Differentially expressed genes(DEGs)and differential metabolites were identified,followed by enrichment analyses and validation using qPCR and Western blot in AC16 cardiomyocytes.Results:QD patients exhibited significantly higher NT-proBNP levels,lower LVEF,and increased 90-day rehospitalization rates.Metabolomic profiling revealed lipid metabolism disruptions,notably in linoleic acid and phospholipid pathways.Transcriptomic analysis highlighted 17 DEGs,including CISD2,a critical mitochondrial regulator,which was downregulated in QD patients.Correlation analysis identified significant associations between DEGs(e.g.,CISD2,BPGM)and lipid metabolites such as PC(16:0/P-16:0).Functional knockdown of CISD2 in AC16 cells led to upregulation of lipid oxidation enzymes ALOX15 and CYP1A2,linking CISD2 dysfunction to lipid metabolic dysregulation.Conclusion:Qi deficiency is associated with more severe heart failure symptoms,worse prognosis,and distinct metabolic and transcriptomic profiles,particularly in lipid metabolism.CISD2 emerges as a potential therapeutic target,offering new avenues for integrating molecular insights with TCM approaches to optimize HF management.
基金supported by the University of Texas(UT)system STARs grant,Semester Undergraduate Research Experience(SURE)program at the College of Engineering at the University of Texas Permian Basin(UTPB)EM-STEP(Engineering Minority Student Engagement Project)at UTPB College of Engineering,funded by Department of Education.
文摘Carbon fiber-reinforced composites(CFRCs)have a wide range of applications in the aerospace,automotive,and energy sectors.A higher specific strength-to-weight ratio is desired in high-performance applications.The failure mechanism of CFRCs involves multiscale phenomena,such as failure that can occur at the matrix,fibers,interface,layers,lamina,and laminates.When an impactor hits the CFRCs,the design involves analyzing each of these stages to prevent failure and optimize the properties of CFRCs under various loading conditions.A numerical model was employed to predict the fracture toughness of CFRCs with varying weight fractions and orientations.Finite Element Analysis(FEA)was conducted at the fiber level on a micrometer scale for the CFRCs against an impact loading.Epoxy composite samples at the coupon level were prepared using the hand layup technique with carbon fibers laid at three different angles,i.e.,longitudinal,transverse,and angular orientations.Samples with five different weight percentages of carbon fibers were prepared and investigated.An Izod impact tester was used to fracture the samples and characterize the energy absorption.The fractured surfaces were observed with a scanning electron microscope(SEM).The numerical and experimental results show that crack propagation is inhibited at higher loading fractions at an angular orientation by creating obstacles for the crack to propagate and arresting the dislocation motion.The fractography analysis through a scanning electron microscope exhibits how the angular orientations of the fibers are reoriented after fracture to prevent further crack propagation.
基金supported by the Jilin Provincial Scientific and Technological Development Program(YDZJ202401572ZYTS)the Overseas Expertise Introduction Project for Discipline Innovation of China(D18012)+1 种基金Education Department of Jilin Province(JJKH20240678KJ)the National Natural Science Foundation of China(22122904,22109155,22379136)。
文摘The solid electrolyte interphase(SEI)layer,formed on the electrode through electrolyte decomposition,has garnered significant attention over the past several decades.Numerous characterization studies have shown that the SEI enhances the stability of both the electrolyte and electrode,particularly by mitigating the well-known cation-solvent co-intercalation in graphite electrodes in lithium-ion batteries.However,recent electrolyte exchange experiments have revealed that variations in electrolyte solvation structure and the resulting desolvation behaviors play a more dominant role than the SEI in influencing electrolyte and electrode stability,which in turn critically impacts battery performance.In addition to contributing to the ongoing debate,electrolyte exchange experiments have proven to be a valuable tool for analyzing failures in electrolytes,electrodes,and batteries.This review highlights the application of electrolyte exchange experiments across various metal-ion batteries,incorporating diverse combinations of electrolytes and electrodes.It examines the influence of electrolyte solvation structures and desolvation behaviors on the stability of both electrolytes and electrodes.The aim is to enhance the methodology of electrolyte exchange experiments to deepen the understanding of the molecular interactions among metal ions,anions,and solvents within the electrolyte.This approach complements existing insights into SEI effects,providing a more thorough and accurate framework for battery failure analysis.
基金sponsored by Natural Science Research Project of Anhui Educational Committee(GrantNo.2022AH050810),NationalNatural Science Foundation of China(GrantNos.42402276,41972286,42072309,42102329)State Key Laboratory of Precision Blasting and Hubei Key Laboratory of Blasting Engineering,Jianghan University(No.PBSKL2023A1)the Open Fund of National Center for International Research on Deep Earth Drilling and Resource Development(No.DEDRD-2023-02).
文摘During the construction of bank slopes involving pile driving,ensuring slope stability is crucial.This requires the design of appropriate support systems and a thorough evaluation of the failure mechanisms of pile structures under dynamic loading conditions.Based on the Huarong Coal Wharf project,various support schemes are analyzed using numerical simulation methods to calculate and compare slope stability coefficients.The optimal scheme is then identified.Under the selected support scheme,a numerical model of double-row suspended steel sheet piles is developed to investigate the dynamic response of the pile structures under pile driving loads.A time-history analysis is performed to assess the slope’s dynamic stability.The results show that the maximum displacements of the upper and lower steel sheet pile rows are 2.51 and 3.14 cm,respectively.The maximum principal stresses remain below 20 MPa in both rows,while the maximum von Mises stresses are 20.85 MPa for the upper row and 25.40 MPa for the lower row.The dominant frequencies of the steel sheet pile structures fall between 30 and 35 Hz,with a frequency bandwidth ranging from 0 to 500 Hz.The stability coefficient of the pile structures varies over time during the pile driving process,ultimately reaching a value of 1.26—exceeding the required safety threshold.This research provides practical guidance for designing support systems in wharf piling projects and offers a reliable basis for evaluating the safety performance of steel sheet piles in bank slopes.
文摘Corrosion failure of N80-Q tubing occurred in a gas well.The causes of corrosion failure were investigated through macroscopic morphology,corrosion product analysis,and microbial analysis.The results show that the corrosion patterns of N80-Q tubing were diverse.The failure resulted from the combined action of microbial corrosion,CO_(2)/Cl^(-) corrosion,and erosion corrosion.
文摘Purpose:To evaluate the effects of healthcare failure mode and effect analysis(FMEA)on the prevention of deep venous thrombosis(DVT)in elderly patients undergoing femoral fracture surgery.Methods:Eighty elderly patients undergoing femoral fracture surgery who did not apply FMEA in Suzhou BenQ Medical Center from June 1,2022 to May 31,2023 were selected as the control group.According to the equal group experiment method,80 elderly patients who were managed using FMEA from June 1,2023 to May 31,2024 were selected as the FMEA group.The control group received traditional nursing management,while the FMEA group applied FMEA to analyze failure causes,calculate Risk Priority Numbers(RPNs),identify failure modes with higher RPNs,analyze the influencing factors,develop improvement measures,and optimize processes.The RPN values and the incidence of DVT,as well as nursing satisfaction scores,were compared in the two groups.Results:Compared with the control group,the total RPN values of the FEMA group decreased significantly,with a reduction rate of 87.0%.Besides,the incidence of DVT was 1.3%in the FMEA group,lower than 10.0%in the control group(8/80).What’s more,the patients in the FMEA group were more satisfied with the nursing service compared with the patients in the control group.Conclusion:The application of the FMEA in elderly patients undergoing femoral fracture surgery has demonstrated its potential to prevent the incidence of DVT,lower RPN values,and improve nursing satisfaction.
基金funded by the Young Clinical Research Special Fund Project of Peking University First Hospital(No.2024YC05)。
文摘Objectives:This study aimed to assess the impact of exercise rehabilitation during the vulnerable period on cardiac recovery(CR)outcomes in patients with acute decompensated heart failure(ADHF).Methods:Multiple databases including PubMed,Web of Science,Embase,the Cochrane Library,CINAHL,China National Knowledge Infrastructure(CNKI),Chinese Science and Technology Periodical Database(VIP),Wanfang database,SinoMed,ClinicalTrials.gov,and American Heart Association(AHA)and European Society of Cardiology(ESC)were searched for RCTs on exercise rehabilitation in ADHF patients’vulnerable period from inception to April 2,2025.The risk of bias was assessed with Cochrane Risk of Bias 2.0,and data were analyzed in RevMan 5.3.Results:A total of seven RCTs involving 946 patients were included.The results demonstrated that exercise rehabilitation training during the vulnerable period in patients with ADHF significantly increased the 6-min walk test distance(6-MWTD)(SMD=0.37;95%CI:0.09,0.65;P=0.01),short physical performance battery(SPPB)score(MD=1.26;95%CI:0.82,1.70;P<0.001)and peak oxygen consumption(VO2peak)(SMD=1.43;95%CI:0.53,2.34;P=0.002),improved quality of life(QoL)(SMD=0.85;95%CI:0.07,1.64,P=0.03),reduced depression score(MD=-0.73;95%CI:1.27,-0.18;P=0.009),frailty(MD=-0.22;95%CI:-0.48,0.05;P=0.11),and decreased 6-month all-cause readmission(OR=0.67;95%CI:0.49,0.91;P=0.01).However,no statistically significantdifferences were observed between the two groups in left ventricular ejection fraction(LVEF)(MD=0.96;95%CI:-1.84,3.77;P=0.50),6-month heart failure(HF)-related readmission(OR=1.01;95%CI:0.66,1.53;P=0.98),and all-cause mortality(OR=0.63;95%CI:0.18,2.24;P=0.47).There were no adverse events reported.Conclusions:Exercise rehabilitation during the vulnerable phase improves exercise tolerance,QoL,and depressive symptoms while reducing 6-month all-cause readmissions in ADHF patients,with no reported adverse events.Although trends toward improved LVEF,HF-related readmissions,and all-cause mortality were observed.Large-scale,high-quality studies are warranted to explore individualized responses and long-term outcomes.
基金The National Key R&D Program Projects(Grant No.2022YFC2803601)the Natural Science Foundation of Shandong Province(Grant No.ZR2021YQ29)+1 种基金the Natural Science Foundation of Heilongjiang Province(Grant No.YQ2024E036)the Taishan Scholars Project(Grant No.tsqn202312317).
文摘Autonomous Underwater Vehicles(AUVs)are pivotal for deep-sea exploration and resource exploitation,yet their reliability in extreme underwater environments remains a critical barrier to widespread deployment.Through systematic analysis of 150 peer-reviewed studies employing mixed-methods research,this review yields three principal advancements to the reliability analysis of AUVs.First,based on the hierarchical functional division of AUVs into six subsystems(propulsion system,navigation system,communication system,power system,environmental detection system,and emergency system),this study systematically identifies the primary failure modes and potential failure causes of each subsystem,providing theoretical support for fault diagnosis and reliability optimization.Subsequently,a comprehensive review of AUV reliability analysis methods is conducted from three perspectives:analytical methods,simulated methods,and surrogate model methods.The applicability and limitations of each method are critically analyzed to offer insights into their suitability for engineering applications.Finally,the study highlights key challenges and research hotpots in AUV reliability analysis,including reliability analysis under limited data,AI-driven reliability analysis,and human reliability analysis.Furthermore,the potential of multi-sensor data fusion,edge computing,and advanced materials in enhancing AUV environmental adaptability and reliability is explored.
基金financed by the grants from the National Natural Science Foundation of China(No.81803996)Shanghai Key Laboratory of Health Identification and Assessment(No.21DZ2271000)。
文摘Traditional Chinese medicine(TCM)has played a significant role in the prevention and treatment of chronic heart failure(CHF).To study TCM diagnosis of CHF,a total of 278 Chinese clinical research articles on the study of CHF syndromes in recent 40 years retrieved from Web of Science,Scopus,Pub Med,Embase,CNKI,Wanfang Data,Cq VIP,and Sino Med.According to cumulative frequency analysis,network analysis,and hierarchical cluster analysis,the study found the distribution of CHF syndromes was syndrome of qi deficiency with blood stasis,syndrome of qi and yin deficiency,syndrome of yang deficiency with water flooding,syndrome of heart blood stasis obstruction,syndrome of turbid phlegm,and syndrome of collapse due to primordial yang deficiency.The syndrome elements on location of illness were heart,kidney,lung,and spleen.The syndrome elements on nature of illness were qi deficiency,blood stasis,yang deficiency,yin deficiency,water retention,and turbid phlegm.These findings can provide reference to the research on diagnosis and treatment of CHF,and contribute to the study on syndrome standardization and objective research of TCM diagnosis.
基金Supported by Grant-in-Aid for Research on Hepatitis from the Japan Agency for Medical Research and Development,No.24fk0210128h0002Grant-in-Aid for Scientific Research,No.KAKENHI-23K07372.
文摘BACKGROUND Congestive hepatopathy,also known as nutmeg liver,is liver damage secondary to chronic heart failure(HF).Its morphological characteristics in terms of medical imaging are not defined and remain unclear.AIM To leverage machine learning to capture imaging features of congestive hepatopathy using incidentally acquired computed tomography(CT)scans.METHODS We retrospectively analyzed 179 chronic HF patients who underwent echocardiography and CT within one year.Right HF severity was classified into three grades.Liver CT images at the paraumbilical vein level were used to develop a ResNet-based machine learning model to predict tricuspid regurgitation(TR)severity.Model accuracy was compared with that of six gastroenterology and four radiology experts.RESULTS In the included patients,120 were male(mean age:73.1±14.4 years).The accuracy of the results predicting TR severity from a single CT image for the machine learning model was significantly higher than the average accuracy of the experts.The model was found to be exceptionally reliable for predicting severe TR.CONCLUSION Deep learning models,particularly those using ResNet architectures,can help identify morphological changes associated with TR severity,aiding in early liver dysfunction detection in patients with HF,thereby improving outcomes.
文摘The swinging-loading process is essential for automatic artillery loading systems.This study focuses on the problems of reliability analysis that affect swinging-loading positioning accuracy.A dynamic model for a multi degree-of-freedom swinging-loading-integrated rigid-flexible coupling system is established.This model is based on the identification of key parameters and platform experiments.Based on the spatial geometric relationship between the breech and loader during modular charge transfer and the possible maximum interference depth of the modular charge,a new failure criterion for estimating the reliability of swinging-loading positioning accuracy is proposed.Considering the uncertainties in the operation of the pendulum loader,the direct probability integration method is introduced to analyze the reliability of the swinging-loading positioning accuracy under three different charge numbers.The results indicate that under two and four charges,the swinging-loading process shows outstanding reliability.However,an unstable stage appears when the swinging motion occurred under six charges,with a maximum positioning failure probability of 0.0712.A comparison between the results obtained under the conventional and proposed criteria further reveals the effectiveness and necessity of the proposed criterion.
基金supported by the National Natural Science Foundation of China(72271242)Hunan Provincial Natural Science Foundation of China for Excellent Young Scholars(2022JJ20046).
文摘Cutting off or controlling the enemy’s power supply at critical moments or strategic locations may result in a cascade failure,thus gaining an advantage in a war.However,the exist-ing cascading failure modeling analysis of interdependent net-works is insufficient for describing the load characteristics and dependencies of subnetworks,and it is difficult to use for model-ing and failure analysis of power-combat(P-C)coupling net-works.This paper considers the physical characteristics of the two subnetworks and studies the mechanism of fault propaga-tion between subnetworks and across systems.Then the surviv-ability of the coupled network is evaluated.Firstly,an integrated modeling approach for the combat system and power system is predicted based on interdependent network theory.A heteroge-neous one-way interdependent network model based on proba-bility dependence is constructed.Secondly,using the operation loop theory,a load-capacity model based on combat-loop betweenness is proposed,and the cascade failure model of the P-C coupling system is investigated from three perspectives:ini-tial capacity,allocation strategy,and failure mechanism.Thirdly,survivability indexes based on load loss rate and network sur-vival rate are proposed.Finally,the P-C coupling system is con-structed based on the IEEE 118-bus system to demonstrate the proposed method.
基金funded by the National Natural Science Foundation of China(52478138).
文摘The connection efficiency of composite pre-tightened multi-tooth joint is low because of uneven load distribution and single load transmission path.In this paper,based on the principle of bio-tooth(suture)structure,combining soft material with fractal,a composite pre-tightened multi-hierarchy tooth joint is proposed,and the bearing performance and failure process of the joint through experiments and finite element method under tensile load.First,the ultimate bearing capacity,load distribution ratio,and failure process of different hierarchies of teeth joints are studied through experiments.Then,the progressive damage models of different hierarchies of tooth joints are established,and experiments verify the validity of the finite element model.Finally,the effects of soft material and increasing tooth hierarchy on the failure process and bearing capacity of composite pre-tightened tooth joints are analyzed by the finite element method.The following conclusions can be drawn:(1)The embedding of soft materials changed the failure process of the joint.Increasing the tooth hierarchy can give the joint more load transfer paths,but the failure process of the joint is complicated.(2)Embedding soft materials and increasing the tooth hierarchy simultaneously can effectively improve the bearing capacity of composite pre-tightened tooth joints,which is 87.8%higher than that of traditional three-tooth joints.
文摘BACKGROUND The use of sodium-glucose cotransporter 2(SGLT2)inhibitor in heart failure(HF)patients is increasing significantly,regardless of whether they have a history of diabetes.The effects of SGLT2 inhibitor on HF are likely mediated through multiple mechanisms,including suppression of the renin-angiotensin-aldosterone system(RAAS),reduction in oxidative stress leading to enhanced myocardial efficiency,and attenuation of adverse cardiac remodeling by preventing fibrosis.These pathways are fundamental to reducing mortality,improving patients'quality of life,and alleviating the burden on the United States healthcare system by decreasing HF-related hospitalizations.AIM To evaluate SGLT2 inhibitor effects on HF,focusing on hospitalization for HF(HHF),cardiovascular(CV)deaths,and all-cause mortality.METHODS A comprehensive search was conducted in PubMed for randomized controlled trials(RCTs)evaluating the effects of SGLT2 inhibitor in HF patients compared to placebo,covering the period from January 1,2014,to January 1,2025.The primary outcomes assessed were HHF,CV deaths,and all-cause mortality.RevMan Web 5.4.1 was used to assess the risk of bias heterogeneity and to perform the statistical analyses.A random-effects model was employed for all statistical evaluations.RESULTS A total of nine RCTs were included in this analysis:DELIVER,DECLARE-TIMI 58,DAPA-HF,EMPA-REG OUTCOME,EMPEROR-Reduced,EMPEROR-Preserved,SOLOIST-WHF,EMPULSE,and VERTIS-CV.For HHF,eight trials(excluding the SOLOIST-WHF;n=25906)were pooled,while CV deaths were assessed using data from eight trials(excluding the EMPULSE;n=26598).Compared to placebo,SGLT2 inhibitor significantly reduced the risk of HHF(relative risk:0.74;95%CI:0.71-0.77;P<0.00001)and CV death(odds ratio:0.88;95%CI:0.83-0.92;P=0.0006).All nine trials(n=27128)were included in the analysis of all-cause mortality.SGLT2 inhibitor were associated with a statistically significant reduction in all-cause mortality compared to placebo(OR:0.91;95%CI:0.84-0.98;P=0.02).CONCLUSION These results suggest that SGLT2 inhibitor significantly reduce the risk of hospitalization for HF,CV deaths,and all-cause mortality.
文摘Background:To investigate the consistency level of binary symptom assessment in patients with heart failure and their primary caregivers,and to analyze the related factors influencing consistency.Methods:By using the convenience sampling method,patients with heart failure and their main caregivers in the Department of Cardiology of a tertiary hospital in Suzhou from May to November 2023 were selected as the research subjects.The HFSS scale was used for data collection.The paired t-test or paired Wilcoxon test was used to evaluate the differences in the binary symptom assessment scores of heart failure.The intraclass correlation coefficient was used to assess the consistency level of the binary symptom assessment.The Pearson correlation test was used to examine the correlation of the binary symptom assessment.Regression analysis was employed to explore the factors related to the consistency assessment.Results:A total of 103 pairs of valid questionnaires were collected.The consistency levels of symptom evaluations in patients with heart failure and their primary caregivers were statistically significant(P<0.05).The most frequently reported and severe symptom by patients with heart failure and their primary caregivers is shortness of breath during activity.Both have a high consensus on the severity and urgency of most heart failure symptoms.The patient’s gender,body mass index,number of children,history of diabetes,number of comorbidities,mean arterial pressure,LVEF,number of stents,whether a defibrillator was implanted,as well as the gender,marital status,education level,relationship with the patient,care time,whether they lived together,and communication and interaction situation of the main caregiver were the influencing factors for the consistency of binary symptom assessment of heart failure(P<0.05).Conclusion:The degree of consistency in binary symptom assessment between patients with heart failure and their primary caregivers was moderate or higher,which emphasizes the importance of including binary groups in clinical assessment.
基金Supported by National Key Research and Development Program,No.2022YFA1103501。
文摘BACKGROUND Acute liver failure(ALF)with sepsis is associated with rapid disease progression and high mortality.Therefore,early detection of high-risk sepsis subgroups in patients with ALF is crucial.AIM To develop and validate an accurate nomogram model for predicting the risk of sepsis in patients with ALF.METHODS We retrieved data from the Medical Information Mart for Intensive Care(MIMIC)IV database and the Fifth Medical Center of Chinese PLA General Hospital(FMCPH).Univariate and multivariate logistic regression analysis were used to identify risk factors for sepsis in ALF and were subsequently incorporated to construct a nomogram model[sepsis in ALF(SIALF)].The discrimination ability,calibration,and clinical applicability of the SIALF model were evaluated by the area under receiver operating characteristic curve,calibration curves,and decision curve analysis,respectively.The Kaplan-Meier curves were used for robustness check.The SIALF model was internally validated using the bootstrapping method with the MIMIC validation cohort and externally validated by the FMCPH cohort.RESULTS A total of 738 patients with ALF patients were included in this study,with 510 from the MIMIC IV database and 228 from the FMCPH cohort.In the MIMIC IV cohort,387(75.89%)patients developed sepsis.Multivariate logistic regression analysis revealed that age[odds ratio(OR)=1.016,95%confidence interval(CI):1.003-1.028,P=0.017],total bilirubin(OR=1.047,95%CI:1.008-1.088,P=0.017),lactate dehydrogenase(OR=1.001,95%CI:1.000-1.001,P<0.001),albumin(OR=0.436,95%CI:0.274-0.692,P=0.003),and mechanical ventilation(OR=1.985,95%CI:1.269-3.105,P=0.003)were independent risk factors associated with sepsis in patients with ALF.The SIALF model demonstrated satisfactory accuracy and clinical utility with area under receiver operating characteristic curve values of 0.849,0.847,and 0.835 for the internal derivation,internal validation,and external validation cohort,respectively,which outperformed the Sequential Organ Failure Assessment scores of 0.733,0.746,and 0.721 and systemic inflammatory response syndrome scores of 0.578,0.653,and 0.615,respectively.The decision curve analysis and calibration curves indicated superior clinical utility and efficiency than other score systems.Based on the risk stratification score derived from the SIALF model,the Kaplan-Meier curves effectively discriminated the real high-risk subpopulation.To enhance the clinical utility,we constructed an online dynamic version,enabling physicians to evaluate patients’condition and track disease progression in real-time.CONCLUSION Based on easily identifiable clinical data,we developed the SIALF model to predict the risk of sepsis in patients with ALF.The model demonstrated robust predictive efficiency,outperformed Sequential Organ Failure Assessment and systemic inflammatory response syndrome scores,and was validated in an external cohort.The model-based risk stratification and online calculator might further facilitate the early detection and appropriate treatment for this subpopulation.
文摘BACKGROUND Heart failure(HF),especially in patients with preserved ejection fraction and midrange ejection fraction,remains a significant global health burden.Interatrial shunt devices(IASDs),which allow blood flow from the left to the right atrium,offer a novel treatment approach by reducing left atrial pressure and alleviating symptoms.AIM To evaluate the efficacy and safety of IASDs in patients with HF through a systematic review and meta-analysis.METHODS We performed a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines,analyzing studies up to April 2025.Randomized controlled trials and observational studies comparing interatrial shunt therapy with control groups were included.Data on clinical outcomes were analyzed using Review Manager software.RESULTS Nine studies involving 1689 patients were included.IASDs significantly improved cardiac output[mean difference(MD):0.72,95%CI:0.13-1.32,P=0.02],right atrial pressure(RAP)(MD:0.70,95%CI:0.14-1.26,P=0.01),and 6-minute walk distance(MD:71.63,95%CI:24.13-119.13,P=0.003).There were no significant differences in major adverse cardiac events,myocardial infarction,ischemic stroke,or new-onset atrial fibrillation.However,all-cause mortality[risk ratio(RR):1.49,95%CI:1.02-2.18,P=0.04]and cardiovascular death(RR:1.66,95%CI:1.01-2.74,P=0.05)were significantly higher in the shunt group.CONCLUSION IASDs offer significant short-term improvements in cardiac output,RAP,and exercise capacity in HF patients.However,long-term safety concerns,particularly regarding mortality,necessitate further research and careful patient selection.
基金Supported by National Natural Science Foundation of China,No.82300857.
文摘BACKGROUND Liver transplantation(LT)is recognized as an effective approach that offers survival benefits for patients with acute-on-chronic liver failure(ACLF).However,controversies remain regarding the LT selection criteria,and meta-analyses reporting overall survival outcomes across different ACLF severity grades are lacking.AIM To depict a comprehensive postoperative picture of patients with ACLF of varying severity and contribute to updating LT selection.METHODS Systematic searches in Web of Science,EMBASE,PubMed,and Cochrane databases were performed,from inception to December 26,2023,for studies exploring post-transplant outcomes among ACLF patients,stratified by severity grades as identified by the European Association for the Study of the Liver-Chronic Liver Failure criteria.The primary outcome of interest was the survival rate within one year,with post-transplant complications as secondary outcomes.Additionally,the subgroup analysis examined region-specific one-year survival rates.RESULTS A total of 17 studies involving 28025 participants were included.Patients with ACLF-1 and ACLF-2 have favorable survival within one year,with survival rates reaching 87%[95%confidence interval(CI):84%-91%]and 86%(95%CI:81%-91%),respectively.Despite the relatively lower survival(73%,95%CI:66%-80%)and higher incidence of infection(48%,95%CI:29%-67%)observed in ACLF-3 patients,their survival exceeds that of those who do not undergo LT.Moreover,post-transplant survival was highest in North America across all ACLF grades.CONCLUSION LT can provide survival advantages for ACLF patients.To optimize the utilization of scarce donor organs and improve prognosis,comprehensive preoperative health evaluations are essential,especially for ACLF-3 patients.
