This article presents a case study of a 20-year-old male patient diagnosed with dilated cardiomyopathy(DCM)(NYHA IV).This condition was diagnosed as"heart failure disease"(water overflowing due to yang defic...This article presents a case study of a 20-year-old male patient diagnosed with dilated cardiomyopathy(DCM)(NYHA IV).This condition was diagnosed as"heart failure disease"(water overflowing due to yang deficiency,intermingled phlegm and stasis)in traditional Chinese medicine(TCM).The treatment approach employed a combination of TCM and Western medicine.Western medicine involved the administration of sacubitril valsartan sodium tablets to inhibit ventricular remodeling,in conjunction with diuretics and cardiotonic agents.Initially,TCM utilized a static infusion of Shenfu injection,which was subsequently supplemented with Qiliqiangxin capsules to invigorate qi,warm yang,activate blood circulation,and promote diuresis.After a follow-up period of 3 years,the patient's ejection fraction(EF)improved from 23%to 51%,and the left ventricular end diastolic diameter(LVed)decreased from 68 to 52 mm,accompanied by a significant alleviation of symptoms.These findings indicate that the combined treatment of TCM and Western medicine can synergistically enhance cardiac function and impede the progression of the disease,thereby offering valuable insights for the optimal management of DCM.展开更多
This study explores ethical violations and audit failures in various large-scale corporate fraud cases.Using a qualitative descriptive method and based on secondary data from documented fraud cases and published audit...This study explores ethical violations and audit failures in various large-scale corporate fraud cases.Using a qualitative descriptive method and based on secondary data from documented fraud cases and published audit reports,the study applies the Fraud Triangle framework,focusing on how weak integrity,objectivity,and professional competence have undermined public trust in the auditing profession.Using a qualitative descriptive method and the Fraud Triangle framework,which includes pressure,opportunity,and rationalization,the study analyzes cases from Indonesia(SNP Finance,Jiwasraya),China(Evergrande),and Germany(Wirecard).The analysis reveals that many audit failures observed in this study appear to stem more from ethical challenges than from technical incapability,driven by client pressure,weak internal controls,and compromised auditor independence.These cases demonstrate a recurring global pattern in which auditors neglect their responsibility to act in the public interest.展开更多
This study explores ethical violations and audit failures in various large-scale corporate fraud cases.Using a qualitative descriptive method and based on secondary data from documented fraud cases and published audit...This study explores ethical violations and audit failures in various large-scale corporate fraud cases.Using a qualitative descriptive method and based on secondary data from documented fraud cases and published audit reports,the study applies the Fraud Triangle framework,focusing on how weak integrity,objectivity,and professional competence have undermined public trust in the auditing profession.Using a qualitative descriptive method and the Fraud Triangle framework,which includes pressure,opportunity,and rationalization,the study analyzes cases from Indonesia(SNP Finance,Jiwasraya),China(Evergrande),and Germany(Wirecard).The analysis reveals that many audit failures observed in this study appear to stem more from ethical challenges than from technical incapability,driven by client pressure,weak internal controls,and compromised auditor independence.These cases demonstrate a recurring global pattern in which auditors neglect their responsibility to act in the public interest.展开更多
BACKGROUND Bradycardia,renal failure,atrioventricular nodal blockade,shock,and hyper-kalemia(BRASH)syndrome is an acronym used to describe a constellation of BRASH.It is an underrecognized phenomenon that can be deadl...BACKGROUND Bradycardia,renal failure,atrioventricular nodal blockade,shock,and hyper-kalemia(BRASH)syndrome is an acronym used to describe a constellation of BRASH.It is an underrecognized phenomenon that can be deadly if not appro-priately managed in a timely manner.This case highlights the importance of rapid diagnosis and reviews a multitude of treatment options in a uniquely severe case of BRASH syndrome.CASE SUMMARY We present a case of a 54-year-old male on a beta-blocker and angiotensin-con-verting enzyme inhibitor who presented with one day history of nausea,vomi-ting,and shortness of breath.Upon presentation,he was bradycardic and hypotensive,requiring transcutaneous pacing.Initial electrocardiogram showed atrial fibrillation with ventricular rate in 30’s.He was found to have acute kidney injury,hyperkalemia,and metabolic acidosis.He was successfully treated with multiple potassium lowering agents,continuous renal replacement therapy,four pressors,mechanical ventilation,and transvenous pacing with complete recovery prior to discharge.CONCLUSION Increased awareness of BRASH syndrome may improve outcomes through timely diagnosis and aggressive intervention.展开更多
Inflammatory bowel disease(IBD)represents a significant disease burden marked by chronic inflammation and complications that adversely affect patients’quality of life.Effective diagnostic strategies involve clinical ...Inflammatory bowel disease(IBD)represents a significant disease burden marked by chronic inflammation and complications that adversely affect patients’quality of life.Effective diagnostic strategies involve clinical assessments,endoscopic evaluations,imaging studies,and biomarker testing,where early diagnosis is essential for effective management and prevention of long-term complications,highlighting the need for continual advancements in diagnostic methods.The intricate interplay between genetic factors and the outcomes of biological therapy is of critical importance.Unraveling the genetic determinants that influence responses and failures to biological therapy holds significant promise for optimizing treatment strategies for patients with IBD on biologics.Through an indepth examination of current literature,this review article synthesizes critical genetic markers associated with therapeutic efficacy and resistance in IBD.Understanding these genetic actors paves the way for personalized approaches,informing clinicians on predicting,tailoring,and enhancing the effectiveness of biological therapies for improved outcomes in patients with IBD.展开更多
Falls remain a prevalent source of injury in daily life and underlying aetiology of falls are often complex and multi-factorial.[1,2]Older persons living with heart failure(OPLHF)are of a particular interest when disc...Falls remain a prevalent source of injury in daily life and underlying aetiology of falls are often complex and multi-factorial.[1,2]Older persons living with heart failure(OPLHF)are of a particular interest when discussing falls as multiple factors associated with heart failure(HF)aetiology and treatment are assumedly implicated in falls occurrence.A retrospective study reported a 14%increased risk of falls among OPLHF,and prospective data has shown that up to 40%of HF patients may experience a fall within a year from diagnosis.展开更多
In the past 6 years, significant breakthroughs have been achieved in the treatment of heart failure(HF), especially in drug therapy. The classification of chronic HF and the treatment methods for HF and its complicati...In the past 6 years, significant breakthroughs have been achieved in the treatment of heart failure(HF), especially in drug therapy. The classification of chronic HF and the treatment methods for HF and its complications are also constantly being updated. In order to apply these results to the diagnosis and treatment of patients with HF in China and further improve the level of diagnosis and treatment of HF in China, the HF Group of Chinese Society of Cardiology, Chinese Medical Association, Chinese College of Cardiovascular Physician, Chinese HF Association of Chinese Medical Doctor Association, and Editorial Board of Chinese Journal of Cardiology have organized an expert group and update the consensus and evidence-based treatment methods in the field of HF based on the latest clinical research findings at home and abroad, combined with the national conditions and clinical practice in China, and referring to the latest foreign HF guidelines while maintaining the basic framework of the 2018 Chinese Guidelines for Diagnosis and Treatment of HF.展开更多
Background Patients aged 85 years or older admitted for heart failure(HF)have increased enormously due to improved survival in this disease.However,few studies assess the characteristics,treatments,and prognosis of ve...Background Patients aged 85 years or older admitted for heart failure(HF)have increased enormously due to improved survival in this disease.However,few studies assess the characteristics,treatments,and prognosis of very elderly patients admitted for acute HF.Methods This study is a retrospective analysis of the EPICTER registry,that included patients admitted for acute HF in 74 Spanish hospitals.For this analysis,a total of 1887 patients were included and divided into 2 groups:85 years or older(very elderly,680 patients)and those under 85 years.Results Compared to patients<85 years,very elderly patients were more frequently women,had more hypertension and disease cerebrovascular disease,and less presence of chronic obstructive pulmonary disease(COPD),diabetes,and acute myocardial infarction.There were no differences in symptoms,except for delirium,significantly more common in very elderly patients.Management of these patients was more conservative and died more than the younger ones(41%vs.25%,P<0.001).The predictor variables of mortality in very elderly patients were the presence of COPD and peripheral arterial disease,delirium,and estimated survival of less than 6 months assessed by the physician in charge of the patient care.Conclusion Very elderly patients admitted for HF differ from younger ones in comorbidities,management,and symptoms,and have higher mortality.The presence of delirium,peripheral arterial disease,and COPD worsen the prognosis in these patients and can help to adapt the therapeutic effort and place emphasis on adequate symptom control.展开更多
BACKGROUND Acute decompensated heart failure(ADHF)is one of the leading causes of mortality,highlighting the importance of early identification of high-risk patients.The fibrosis-5(FIB-5)index,traditionally used to ev...BACKGROUND Acute decompensated heart failure(ADHF)is one of the leading causes of mortality,highlighting the importance of early identification of high-risk patients.The fibrosis-5(FIB-5)index,traditionally used to evaluate hepatic fibrosis,may hold prognostic value in ADHF patients by reflecting systemic congestion,inflammation,and organ dysfunction.The hypothesis of this study is that the FIB-5 index is an independent predictor of 1-month mortality in patients with ADHF.METHODS This retrospective study included 155 patients diagnosed with ADHF between 2020 and 2024.Patients were divided into two groups based on their left ventricular ejection fraction(LVEF≤40%or LVEF>50%).Survival was monitored for one month,and clinical,biochemical,and echocardiographic parameters were compared between survivors and death.Logistic regression and receiver operating characteristic curve analyses were performed to assess the prognostic value of the FIB-5 index.RESULTS During the 1-month follow-up,66 patients(42.6%)died.The mean FIB-5 index was significantly lower in non-survivors(−10.46±6.93)compared to survivors(−8.10±6.67)(P=0.03).Multivariate regression analysis identified the FIB-5 index as an independent predictor of 1-month mortality(OR=1.089,95%CI:1.022–1.160,P=0.009).The receiver operating characteristic curve analysis demonstrated an area under the curve of 0.609(95%CI:0.51–0.699)with sensitivity of 59.6%and specificity of 63.4%.Kaplan-Meier survival analysis revealed significantly higher mortality rates among patients with lower FIB-5 values(log-rank:7.887,P=0.005).CONCLUSIONS The FIB-5 index is an independent predictor of 1-month mortality in ADHF patients.Its low cost,non-invasive nature,and ability to reflect systemic inflammation and congestion make it a promising tool for risk stratification.Prospective studies are needed to validate its utility in clinical practice and evaluate its role in guiding therapeutic decisions.展开更多
Dear Editor,This letter focuses on the remaining useful life(RUL)prediction task under limited labeled samples.Existing machine-learning-based RUL prediction methods for this task usually pay attention to mining degra...Dear Editor,This letter focuses on the remaining useful life(RUL)prediction task under limited labeled samples.Existing machine-learning-based RUL prediction methods for this task usually pay attention to mining degradation information to improve the prediction accuracy of degradation value or health indicator for the next epoch.However,they ignore the cumulative prediction error caused by iterations before reaching the failure point.展开更多
Objectives To compare respiratory parameters of peripheral blood mononuclear cell mitochondria and iron metabolism indicators in patients with different NYHA functional classes of ischemic heart failure(HF).Methods Th...Objectives To compare respiratory parameters of peripheral blood mononuclear cell mitochondria and iron metabolism indicators in patients with different NYHA functional classes of ischemic heart failure(HF).Methods This single center, prospective, non-blinded study enrolled 20 patients with diagnosed chronic HF of ischemic genesis with reduced and mildly reduced left ventricle ejection fraction. The maximum oxygen consumption at the peak of the exercise test(VO2peak), iron metabolism parameters and respiratory activity of peripheral blood mononuclear cell mitochondria were assessed.Results Among the patients, a half of individuals were diagnosed with iron deficiency. Subgroups of patients with different HF severity did not significant differ in VO2peak(P=0.209), serum iron(P=0.468) and ferritin(P=0.235) levels. But there was a trend in increasing in these parameters with increasing NYHA HF functional class. Respiratory control coefficient(RC) in NADdependent and FAD-dependent mitochondrial oxidation were lower in patients with NYHA HF Ⅲ functional class compared to individuals with NYHA HF I functional class(P=0.028 and P=0.040, respectively). Serum iron(P=0.026), ferritin(P=0.045)levels, transferrin saturation(P=0.006) were negatively correlated with RC in NAD-dependent mitochondrial oxidation.Conclusions In aggravation of ischemic HF NYHA FC, there is a decrease in RC of PBMC mitochondria during the oxidation of NAD-dependent and FAD-dependent substrates. In the whole sample, patients with laboratory-confirmed iron deficiency accounted a half of the total number. Iron metabolism parameters had a paradoxical inverse relationship with the level of RC in PBMC mitochondria of patients with HF.展开更多
This manuscript provides a commentary on the article by Zhang et al.Patients with heart and pulmonary failure who do not respond to standard treatment may benefit from extracorporeal membrane oxygenation(ECMO)support....This manuscript provides a commentary on the article by Zhang et al.Patients with heart and pulmonary failure who do not respond to standard treatment may benefit from extracorporeal membrane oxygenation(ECMO)support.Advanced heart failure and transplant cardiology(AHFTC)teams play an essential role in managing patients in cardiogenic shock.To determine whether ECMO patient management outcomes differ based on whether AHFTC physicians assume a direct or consultative role,a retrospective cohort study of 51 patients placed on veno-venous and veno-arterial(VA)ECMO between January 2015 and February 2023 was conducted.Results demonstrated a significantly higher 30-day postdischarge survival rate in the AHFTC direct involvement cohort compared to the consultative group(67%vs 30%)for all ECMO patients.This survival benefit was primarily attributable to VA ECMO patients(64%vs 20%).Direct involvement of AHFTC teams in patient selection and management may enhance survival in patients requiring VA ECMO for cardiogenic shock;however,further research is necessary to confirm these findings.展开更多
According to the Japanese Ministry of Health,Labour,and Welfare,14.2%of people were aged>75 years in Japan in 2018,and this number continues to rise.With population aging,the incidence of congestive heart failure(C...According to the Japanese Ministry of Health,Labour,and Welfare,14.2%of people were aged>75 years in Japan in 2018,and this number continues to rise.With population aging,the incidence of congestive heart failure(CHF)is also increasing.[1–3]Reports have shown that the presence of cognitive impairment(CI)in patients with CHF is associated with poor prognosis,[4–6]and the degree of CI is related to CHF severity.展开更多
INTRODUCTION.On May 1st,2024,around 2:10 a.m.,a catastrophic collapse occurred along the Meilong Expressway near Meizhou City,Guangdong Province,China,at coordinates 24°29′24″N and 116°40′25″E.This colla...INTRODUCTION.On May 1st,2024,around 2:10 a.m.,a catastrophic collapse occurred along the Meilong Expressway near Meizhou City,Guangdong Province,China,at coordinates 24°29′24″N and 116°40′25″E.This collapse resulted in a pavement failure of approximately 17.9 m in length and covering an area of about 184.3 m^(2)(Chinanews,2024).展开更多
BACKGROUND Post-pancreaticoduodenectomy(PD)intestinal failure(IF)is rare and associated with poor outcomes.To our knowledge,the role of intestinal transplantation(ITx)as a rescue treatment for this complication has ne...BACKGROUND Post-pancreaticoduodenectomy(PD)intestinal failure(IF)is rare and associated with poor outcomes.To our knowledge,the role of intestinal transplantation(ITx)as a rescue treatment for this complication has never been reported.CASE SUMMARY A 42-year-old female with a benign neurilemmoma of the duodenum underwent PD.Her superior mesenteric vein(SMV)was injured during surgery and required reconstruction.She experienced SMV thrombosis and bowel gangrene requiring massive bowel resection.Consequently,she developed short gut syndrome and an enterocutaneous fistula,leading to prolonged hospitalization for wound care and total parenteral nutrition(TPN)support.She was referred to our hospital for ITx evaluation.Upon arrival,she had cholestasis due to IF-associated liver disease.After gastrointestinal(GI)reconstruction to restore GI continuity,she was eligible for multi-visceral transplantation(MVTx).The anticipated allograft included the stomach,small intestine,liver,pancreas,and duodenum.She found a suitable donor after two years of waiting.The MVTx procedure was straightforward with signs of immediate function.Enteral feeding was initiated on postoperative day(POD)7.TPN weaning was achieved on POD 28,and the patient was discharged on POD 69.Two years post-MVTx,she is healthy with excellent graft function.To our knowledge,this is the first case report on MVTx as the treatment for fatal post-PD complications and also the first reported case of ITx in Southeast Asia.CONCLUSION Post-PD IF is rare and lethal.Intestinal and MVTx might be a rescue treatment for IF after GI surgery in eligible patients.展开更多
This paper investigates the mechanisms of rock failure related to axial splitting and shear failure due to hoop stresses in cylindrical specimens.The hoop stresses are caused by normal viscous stress.The rheological d...This paper investigates the mechanisms of rock failure related to axial splitting and shear failure due to hoop stresses in cylindrical specimens.The hoop stresses are caused by normal viscous stress.The rheological dynamics theory(RDT)is used,with the mechanical parameters being determined by P-and S-wave velocities.The angle of internal friction is determined by the ratio of Young's modulus and the dynamic modulus,while dynamic viscosity defines cohesion and normal viscous stress.The effect of frequency on cohesion is considered.The initial stress state is defined by the minimum cohesion at the elastic limit when axial splitting can occur.However,as radial cracks grow,the stress state becomes oblique and moves towards the shear plane.The maximum and nonlinear cohesions are defined by the rock parameters under compressive strength when the radial crack depth reaches a critical value.The efficacy and precision of RDT are validated through the presentation of ultrasonic measurements on sandstone and rock specimens sourced from the literature.The results presented in dimensionless diagrams can be utilized in microcrack zones in the absence of lateral pressure in rock masses that have undergone disintegration due to excavation.展开更多
OBJECTIVE To investigate possible associations between physical function assessment scales,such as Short Physical Performance Battery(SPPB)and Berg Balance Scale(BBS),with all-cause mortality in acute decompensated he...OBJECTIVE To investigate possible associations between physical function assessment scales,such as Short Physical Performance Battery(SPPB)and Berg Balance Scale(BBS),with all-cause mortality in acute decompensated heart failure(ADHF)patients.METHODS A total of 108 ADHF patients were analyzed from October 2020 to October 2022,and followed up to May 2023.The association between baseline clinical characteristics and all-cause mortality was analyzed by univariate Cox regression analysis,while for SPPB and BBS,univariate Cox regression analysis was followed by receiver operating characteristic curves,in which the area under the curve represented their predictive accuracy for all-cause mortality.Incremental predictive values for both physical function assessments were measured by calculating net reclassification index and integrated discrimination improvement scores.Optimal cutoff value for BBS was then identified using restricted cubic spline plots,and survival differences below and above that cut-off were compared using Kaplan-Meier survival curves and the log-rank test.The clinical utility of BBS was measured using decision curve analysis.RESULTS For baseline characteristics,age,female,blood urea nitrogen,as well as statins,angiotensin-converting enzyme inhibitors,angiotensin II receptor blockers,or angiotensin receptor-neprilysin inhibitors,were predictive for all-cause mortality for ADHF patients.With respect to SPPB and BBS,higher scores were associated with lower all-cause mortality rates for both assessments;similar area under the curves were measured for both(0.774 for SPPB and 0.776 for BBS).Furthermore,BBS≤36.5 was associated with significantly higher mortality,which was still applicable even adjusting for confounding factors;BBS was also found to have great clinical utility under decision curve analysis.CONCLUSIONS BBS or SPPB could be used as tools to assess physical function in ageing ADHF patients,as well as prognosticate on all-cause mortality.Moreover,prioritizing the improvement of balance capabilities of ADHF patients in cardiac rehabilitation regimens could aid in lowering mortality risk.展开更多
The purpose of this study is to clarify the characteristics of patients with decreased cognitive function undergoing treatment for acute exacerbation phase of chronic heart failure as a basic survey with a view to the...The purpose of this study is to clarify the characteristics of patients with decreased cognitive function undergoing treatment for acute exacerbation phase of chronic heart failure as a basic survey with a view to the standardization of nursing to prevent discontinuation of treatment of patients with declining cognitive function in the acute exacerbation phase of chronic heart failure. As the first stage of the research, using the interview guide created based on the background of discontinuation of treatment and symptomatic monitoring from 33 target literature sources, seven certified chronic heart failure nurses and 15 certified dementia nurses were given semi-structured interviews. Data obtained from the interviews was analyzed by qualitative induction. As a result, we obtained opinions/views on 8 situations namely, “cognitive function at hospitalization”, “characteristics at hospitalization, “characteristics when receiving examinations, procedures or treatment”, “characteristics of course of treatment”, “characteristics related to difficulties in grasping the symptoms of chronic heart failure and indices of deterioration”, “characteristics when using diuretics”, “characteristics concerning compliance with dietary restrictions” and “support required for discharge from hospital” concerning patients with declining cognitive function. In the future, it is necessary to prepare nursing protocols incorporating these contents for standardization of nursing.展开更多
Link failure is a critical issue in large networks and must be effectively addressed.In software-defined networks(SDN),link failure recovery schemes can be categorized into proactive and reactive approaches.Reactive s...Link failure is a critical issue in large networks and must be effectively addressed.In software-defined networks(SDN),link failure recovery schemes can be categorized into proactive and reactive approaches.Reactive schemes have longer recovery times while proactive schemes provide faster recovery but overwhelm the memory of switches by flow entries.As SDN adoption grows,ensuring efficient recovery from link failures in the data plane becomes crucial.In particular,data center networks(DCNs)demand rapid recovery times and efficient resource utilization to meet carrier-grade requirements.This paper proposes an efficient Decentralized Failure Recovery(DFR)model for SDNs,meeting recovery time requirements and optimizing switch memory resource consumption.The DFR model enables switches to autonomously reroute traffic upon link failures without involving the controller,achieving fast recovery times while minimizing memory usage.DFR employs the Fast Failover Group in the OpenFlow standard for local recovery without requiring controller communication and utilizes the k-shortest path algorithm to proactively install backup paths,allowing immediate local recovery without controller intervention and enhancing overall network stability and scalability.DFR employs flow entry aggregation techniques to reduce switch memory usage.Instead of matching flow entries to the destination host’s MAC address,DFR matches packets to the destination switch’s MAC address.This reduces the switches’Ternary Content-Addressable Memory(TCAM)consumption.Additionally,DFR modifies Address Resolution Protocol(ARP)replies to provide source hosts with the destination switch’s MAC address,facilitating flow entry aggregation without affecting normal network operations.The performance of DFR is evaluated through the network emulator Mininet 2.3.1 and Ryu 3.1 as SDN controller.For different number of active flows,number of hosts per edge switch,and different network sizes,the proposed model outperformed various failure recovery models:restoration-based,protection by flow entries,protection by group entries and protection by Vlan-tagging model in terms of recovery time,switch memory consumption and controller overhead which represented the number of flow entry updates to recover from the failure.Experimental results demonstrate that DFR achieves recovery times under 20 milliseconds,satisfying carrier-grade requirements for rapid failure recovery.Additionally,DFR reduces switch memory usage by up to 95%compared to traditional protection methods and minimizes controller load by eliminating the need for controller intervention during failure recovery.Theresults underscore the efficiency and scalability of the DFR model,making it a practical solution for enhancing network resilience in SDN environments.展开更多
The giant perilous rock at Wangxia (named Wangxia perilous rock) is representative in Three Gorges of the Yangtze River, China, has threatened badly the navigation of the Yangtze River channel for a long period. The g...The giant perilous rock at Wangxia (named Wangxia perilous rock) is representative in Three Gorges of the Yangtze River, China, has threatened badly the navigation of the Yangtze River channel for a long period. The giant perilous rock is composed of siliceous limestone and argillaceous limestone, and includes two elements marking by W1 and W2, respectively. The W1 is an isolated pillar while the W2 is in clintheriform. The linking segment of dominant fissure in the W2 is composed by moniliform solution funnels at its back, and the locked segment of the dominant fissure at the base of the W2 is composed by two parts. For the locked part of the dominant fissure of the W2, the upper segment shows the same lithology with the perilous rock and it can be simplified as an elastic medium, for the lower segment composed by argillaceous shale and mudstone can be simplified as a strain-softening medium. Introducing the water-softened function, the constitutive curves with two kinds of medium materials for the locked segment in the dominant fissure of the W2 have been proposed. Based on energy principle, the cusp catastrophe model for perilous rock rupture is built and formulas for the transient elastic and impulsive acceleration and the elastic-impulsive velocity of perilous rock catastrophe rupture have been established. By the calculation, the elastic-impulsive acceleration for the catastrophe rupture of the W2 is 531.4 m/s2, while the average elastic-impulsive velocity is 2.608 m/s. Further, it is deduced that the elastic-impulsive velocity at the base of the W2 is about 5.2 m/s. For the transient ruture of the W2, there is a greater speed difference between the top and the base of the W2, which impels the giant perilous rock to be retroverted sliding rupture, coinciding with the fact. Undoubtedly, studies in this paper must play an important role to analyze the catastrophe rupture mechanism of giant perilous rocks at both banks in Three Gorges of the Yangtze River, China.展开更多
文摘This article presents a case study of a 20-year-old male patient diagnosed with dilated cardiomyopathy(DCM)(NYHA IV).This condition was diagnosed as"heart failure disease"(water overflowing due to yang deficiency,intermingled phlegm and stasis)in traditional Chinese medicine(TCM).The treatment approach employed a combination of TCM and Western medicine.Western medicine involved the administration of sacubitril valsartan sodium tablets to inhibit ventricular remodeling,in conjunction with diuretics and cardiotonic agents.Initially,TCM utilized a static infusion of Shenfu injection,which was subsequently supplemented with Qiliqiangxin capsules to invigorate qi,warm yang,activate blood circulation,and promote diuresis.After a follow-up period of 3 years,the patient's ejection fraction(EF)improved from 23%to 51%,and the left ventricular end diastolic diameter(LVed)decreased from 68 to 52 mm,accompanied by a significant alleviation of symptoms.These findings indicate that the combined treatment of TCM and Western medicine can synergistically enhance cardiac function and impede the progression of the disease,thereby offering valuable insights for the optimal management of DCM.
文摘This study explores ethical violations and audit failures in various large-scale corporate fraud cases.Using a qualitative descriptive method and based on secondary data from documented fraud cases and published audit reports,the study applies the Fraud Triangle framework,focusing on how weak integrity,objectivity,and professional competence have undermined public trust in the auditing profession.Using a qualitative descriptive method and the Fraud Triangle framework,which includes pressure,opportunity,and rationalization,the study analyzes cases from Indonesia(SNP Finance,Jiwasraya),China(Evergrande),and Germany(Wirecard).The analysis reveals that many audit failures observed in this study appear to stem more from ethical challenges than from technical incapability,driven by client pressure,weak internal controls,and compromised auditor independence.These cases demonstrate a recurring global pattern in which auditors neglect their responsibility to act in the public interest.
文摘This study explores ethical violations and audit failures in various large-scale corporate fraud cases.Using a qualitative descriptive method and based on secondary data from documented fraud cases and published audit reports,the study applies the Fraud Triangle framework,focusing on how weak integrity,objectivity,and professional competence have undermined public trust in the auditing profession.Using a qualitative descriptive method and the Fraud Triangle framework,which includes pressure,opportunity,and rationalization,the study analyzes cases from Indonesia(SNP Finance,Jiwasraya),China(Evergrande),and Germany(Wirecard).The analysis reveals that many audit failures observed in this study appear to stem more from ethical challenges than from technical incapability,driven by client pressure,weak internal controls,and compromised auditor independence.These cases demonstrate a recurring global pattern in which auditors neglect their responsibility to act in the public interest.
文摘BACKGROUND Bradycardia,renal failure,atrioventricular nodal blockade,shock,and hyper-kalemia(BRASH)syndrome is an acronym used to describe a constellation of BRASH.It is an underrecognized phenomenon that can be deadly if not appro-priately managed in a timely manner.This case highlights the importance of rapid diagnosis and reviews a multitude of treatment options in a uniquely severe case of BRASH syndrome.CASE SUMMARY We present a case of a 54-year-old male on a beta-blocker and angiotensin-con-verting enzyme inhibitor who presented with one day history of nausea,vomi-ting,and shortness of breath.Upon presentation,he was bradycardic and hypotensive,requiring transcutaneous pacing.Initial electrocardiogram showed atrial fibrillation with ventricular rate in 30’s.He was found to have acute kidney injury,hyperkalemia,and metabolic acidosis.He was successfully treated with multiple potassium lowering agents,continuous renal replacement therapy,four pressors,mechanical ventilation,and transvenous pacing with complete recovery prior to discharge.CONCLUSION Increased awareness of BRASH syndrome may improve outcomes through timely diagnosis and aggressive intervention.
基金Supported by The European Union-Next Generation EU,through the National Recovery and Resilience Plan of the Republic of Bulgaria,No.BG-RRP-2.004-0008。
文摘Inflammatory bowel disease(IBD)represents a significant disease burden marked by chronic inflammation and complications that adversely affect patients’quality of life.Effective diagnostic strategies involve clinical assessments,endoscopic evaluations,imaging studies,and biomarker testing,where early diagnosis is essential for effective management and prevention of long-term complications,highlighting the need for continual advancements in diagnostic methods.The intricate interplay between genetic factors and the outcomes of biological therapy is of critical importance.Unraveling the genetic determinants that influence responses and failures to biological therapy holds significant promise for optimizing treatment strategies for patients with IBD on biologics.Through an indepth examination of current literature,this review article synthesizes critical genetic markers associated with therapeutic efficacy and resistance in IBD.Understanding these genetic actors paves the way for personalized approaches,informing clinicians on predicting,tailoring,and enhancing the effectiveness of biological therapies for improved outcomes in patients with IBD.
文摘Falls remain a prevalent source of injury in daily life and underlying aetiology of falls are often complex and multi-factorial.[1,2]Older persons living with heart failure(OPLHF)are of a particular interest when discussing falls as multiple factors associated with heart failure(HF)aetiology and treatment are assumedly implicated in falls occurrence.A retrospective study reported a 14%increased risk of falls among OPLHF,and prospective data has shown that up to 40%of HF patients may experience a fall within a year from diagnosis.
基金National High Level Hospital Clinical Research Funding(2022-PUMCH-B-098)CAMS Innovation Fund for Medical Sciences (2021-I2M-1-003)。
文摘In the past 6 years, significant breakthroughs have been achieved in the treatment of heart failure(HF), especially in drug therapy. The classification of chronic HF and the treatment methods for HF and its complications are also constantly being updated. In order to apply these results to the diagnosis and treatment of patients with HF in China and further improve the level of diagnosis and treatment of HF in China, the HF Group of Chinese Society of Cardiology, Chinese Medical Association, Chinese College of Cardiovascular Physician, Chinese HF Association of Chinese Medical Doctor Association, and Editorial Board of Chinese Journal of Cardiology have organized an expert group and update the consensus and evidence-based treatment methods in the field of HF based on the latest clinical research findings at home and abroad, combined with the national conditions and clinical practice in China, and referring to the latest foreign HF guidelines while maintaining the basic framework of the 2018 Chinese Guidelines for Diagnosis and Treatment of HF.
文摘Background Patients aged 85 years or older admitted for heart failure(HF)have increased enormously due to improved survival in this disease.However,few studies assess the characteristics,treatments,and prognosis of very elderly patients admitted for acute HF.Methods This study is a retrospective analysis of the EPICTER registry,that included patients admitted for acute HF in 74 Spanish hospitals.For this analysis,a total of 1887 patients were included and divided into 2 groups:85 years or older(very elderly,680 patients)and those under 85 years.Results Compared to patients<85 years,very elderly patients were more frequently women,had more hypertension and disease cerebrovascular disease,and less presence of chronic obstructive pulmonary disease(COPD),diabetes,and acute myocardial infarction.There were no differences in symptoms,except for delirium,significantly more common in very elderly patients.Management of these patients was more conservative and died more than the younger ones(41%vs.25%,P<0.001).The predictor variables of mortality in very elderly patients were the presence of COPD and peripheral arterial disease,delirium,and estimated survival of less than 6 months assessed by the physician in charge of the patient care.Conclusion Very elderly patients admitted for HF differ from younger ones in comorbidities,management,and symptoms,and have higher mortality.The presence of delirium,peripheral arterial disease,and COPD worsen the prognosis in these patients and can help to adapt the therapeutic effort and place emphasis on adequate symptom control.
文摘BACKGROUND Acute decompensated heart failure(ADHF)is one of the leading causes of mortality,highlighting the importance of early identification of high-risk patients.The fibrosis-5(FIB-5)index,traditionally used to evaluate hepatic fibrosis,may hold prognostic value in ADHF patients by reflecting systemic congestion,inflammation,and organ dysfunction.The hypothesis of this study is that the FIB-5 index is an independent predictor of 1-month mortality in patients with ADHF.METHODS This retrospective study included 155 patients diagnosed with ADHF between 2020 and 2024.Patients were divided into two groups based on their left ventricular ejection fraction(LVEF≤40%or LVEF>50%).Survival was monitored for one month,and clinical,biochemical,and echocardiographic parameters were compared between survivors and death.Logistic regression and receiver operating characteristic curve analyses were performed to assess the prognostic value of the FIB-5 index.RESULTS During the 1-month follow-up,66 patients(42.6%)died.The mean FIB-5 index was significantly lower in non-survivors(−10.46±6.93)compared to survivors(−8.10±6.67)(P=0.03).Multivariate regression analysis identified the FIB-5 index as an independent predictor of 1-month mortality(OR=1.089,95%CI:1.022–1.160,P=0.009).The receiver operating characteristic curve analysis demonstrated an area under the curve of 0.609(95%CI:0.51–0.699)with sensitivity of 59.6%and specificity of 63.4%.Kaplan-Meier survival analysis revealed significantly higher mortality rates among patients with lower FIB-5 values(log-rank:7.887,P=0.005).CONCLUSIONS The FIB-5 index is an independent predictor of 1-month mortality in ADHF patients.Its low cost,non-invasive nature,and ability to reflect systemic inflammation and congestion make it a promising tool for risk stratification.Prospective studies are needed to validate its utility in clinical practice and evaluate its role in guiding therapeutic decisions.
基金supported in part by the National Natural Science Foundation of China(U2034209)the Postdoctoral Science Foundation of Chongqing(cstc2021jcyj-bsh X0047)+1 种基金the Fundamental Research Funds for the Central Universities(2022CDJJMRH-008)the National Natural Science Foundation of China(62203075)
文摘Dear Editor,This letter focuses on the remaining useful life(RUL)prediction task under limited labeled samples.Existing machine-learning-based RUL prediction methods for this task usually pay attention to mining degradation information to improve the prediction accuracy of degradation value or health indicator for the next epoch.However,they ignore the cumulative prediction error caused by iterations before reaching the failure point.
基金supported by Russian Science Foundation,RSF 23-75-00009(part of the study corresponding to finding 1)Part of the study corresponding to finding 2 was carried out within the state assignment,FSR No.:122020300045-5(03.02.2022).
文摘Objectives To compare respiratory parameters of peripheral blood mononuclear cell mitochondria and iron metabolism indicators in patients with different NYHA functional classes of ischemic heart failure(HF).Methods This single center, prospective, non-blinded study enrolled 20 patients with diagnosed chronic HF of ischemic genesis with reduced and mildly reduced left ventricle ejection fraction. The maximum oxygen consumption at the peak of the exercise test(VO2peak), iron metabolism parameters and respiratory activity of peripheral blood mononuclear cell mitochondria were assessed.Results Among the patients, a half of individuals were diagnosed with iron deficiency. Subgroups of patients with different HF severity did not significant differ in VO2peak(P=0.209), serum iron(P=0.468) and ferritin(P=0.235) levels. But there was a trend in increasing in these parameters with increasing NYHA HF functional class. Respiratory control coefficient(RC) in NADdependent and FAD-dependent mitochondrial oxidation were lower in patients with NYHA HF Ⅲ functional class compared to individuals with NYHA HF I functional class(P=0.028 and P=0.040, respectively). Serum iron(P=0.026), ferritin(P=0.045)levels, transferrin saturation(P=0.006) were negatively correlated with RC in NAD-dependent mitochondrial oxidation.Conclusions In aggravation of ischemic HF NYHA FC, there is a decrease in RC of PBMC mitochondria during the oxidation of NAD-dependent and FAD-dependent substrates. In the whole sample, patients with laboratory-confirmed iron deficiency accounted a half of the total number. Iron metabolism parameters had a paradoxical inverse relationship with the level of RC in PBMC mitochondria of patients with HF.
文摘This manuscript provides a commentary on the article by Zhang et al.Patients with heart and pulmonary failure who do not respond to standard treatment may benefit from extracorporeal membrane oxygenation(ECMO)support.Advanced heart failure and transplant cardiology(AHFTC)teams play an essential role in managing patients in cardiogenic shock.To determine whether ECMO patient management outcomes differ based on whether AHFTC physicians assume a direct or consultative role,a retrospective cohort study of 51 patients placed on veno-venous and veno-arterial(VA)ECMO between January 2015 and February 2023 was conducted.Results demonstrated a significantly higher 30-day postdischarge survival rate in the AHFTC direct involvement cohort compared to the consultative group(67%vs 30%)for all ECMO patients.This survival benefit was primarily attributable to VA ECMO patients(64%vs 20%).Direct involvement of AHFTC teams in patient selection and management may enhance survival in patients requiring VA ECMO for cardiogenic shock;however,further research is necessary to confirm these findings.
文摘According to the Japanese Ministry of Health,Labour,and Welfare,14.2%of people were aged>75 years in Japan in 2018,and this number continues to rise.With population aging,the incidence of congestive heart failure(CHF)is also increasing.[1–3]Reports have shown that the presence of cognitive impairment(CI)in patients with CHF is associated with poor prognosis,[4–6]and the degree of CI is related to CHF severity.
基金supported by the National Natural Science Foundation of China(Nos.42371094,41907253)partially supported by the Interdisciplinary Cultivation Program of Xidian University(No.21103240005)the Postdoctoral Fellowship Program of CPSF(No.GZB20240589)。
文摘INTRODUCTION.On May 1st,2024,around 2:10 a.m.,a catastrophic collapse occurred along the Meilong Expressway near Meizhou City,Guangdong Province,China,at coordinates 24°29′24″N and 116°40′25″E.This collapse resulted in a pavement failure of approximately 17.9 m in length and covering an area of about 184.3 m^(2)(Chinanews,2024).
文摘BACKGROUND Post-pancreaticoduodenectomy(PD)intestinal failure(IF)is rare and associated with poor outcomes.To our knowledge,the role of intestinal transplantation(ITx)as a rescue treatment for this complication has never been reported.CASE SUMMARY A 42-year-old female with a benign neurilemmoma of the duodenum underwent PD.Her superior mesenteric vein(SMV)was injured during surgery and required reconstruction.She experienced SMV thrombosis and bowel gangrene requiring massive bowel resection.Consequently,she developed short gut syndrome and an enterocutaneous fistula,leading to prolonged hospitalization for wound care and total parenteral nutrition(TPN)support.She was referred to our hospital for ITx evaluation.Upon arrival,she had cholestasis due to IF-associated liver disease.After gastrointestinal(GI)reconstruction to restore GI continuity,she was eligible for multi-visceral transplantation(MVTx).The anticipated allograft included the stomach,small intestine,liver,pancreas,and duodenum.She found a suitable donor after two years of waiting.The MVTx procedure was straightforward with signs of immediate function.Enteral feeding was initiated on postoperative day(POD)7.TPN weaning was achieved on POD 28,and the patient was discharged on POD 69.Two years post-MVTx,she is healthy with excellent graft function.To our knowledge,this is the first case report on MVTx as the treatment for fatal post-PD complications and also the first reported case of ITx in Southeast Asia.CONCLUSION Post-PD IF is rare and lethal.Intestinal and MVTx might be a rescue treatment for IF after GI surgery in eligible patients.
文摘This paper investigates the mechanisms of rock failure related to axial splitting and shear failure due to hoop stresses in cylindrical specimens.The hoop stresses are caused by normal viscous stress.The rheological dynamics theory(RDT)is used,with the mechanical parameters being determined by P-and S-wave velocities.The angle of internal friction is determined by the ratio of Young's modulus and the dynamic modulus,while dynamic viscosity defines cohesion and normal viscous stress.The effect of frequency on cohesion is considered.The initial stress state is defined by the minimum cohesion at the elastic limit when axial splitting can occur.However,as radial cracks grow,the stress state becomes oblique and moves towards the shear plane.The maximum and nonlinear cohesions are defined by the rock parameters under compressive strength when the radial crack depth reaches a critical value.The efficacy and precision of RDT are validated through the presentation of ultrasonic measurements on sandstone and rock specimens sourced from the literature.The results presented in dimensionless diagrams can be utilized in microcrack zones in the absence of lateral pressure in rock masses that have undergone disintegration due to excavation.
基金supported by the Key Research and Development Special Project of the Autonomous Region(No.2022B03023-3)the Key Supported Discipline of Health System in Shanghai(No.2023ZDFC0302)。
文摘OBJECTIVE To investigate possible associations between physical function assessment scales,such as Short Physical Performance Battery(SPPB)and Berg Balance Scale(BBS),with all-cause mortality in acute decompensated heart failure(ADHF)patients.METHODS A total of 108 ADHF patients were analyzed from October 2020 to October 2022,and followed up to May 2023.The association between baseline clinical characteristics and all-cause mortality was analyzed by univariate Cox regression analysis,while for SPPB and BBS,univariate Cox regression analysis was followed by receiver operating characteristic curves,in which the area under the curve represented their predictive accuracy for all-cause mortality.Incremental predictive values for both physical function assessments were measured by calculating net reclassification index and integrated discrimination improvement scores.Optimal cutoff value for BBS was then identified using restricted cubic spline plots,and survival differences below and above that cut-off were compared using Kaplan-Meier survival curves and the log-rank test.The clinical utility of BBS was measured using decision curve analysis.RESULTS For baseline characteristics,age,female,blood urea nitrogen,as well as statins,angiotensin-converting enzyme inhibitors,angiotensin II receptor blockers,or angiotensin receptor-neprilysin inhibitors,were predictive for all-cause mortality for ADHF patients.With respect to SPPB and BBS,higher scores were associated with lower all-cause mortality rates for both assessments;similar area under the curves were measured for both(0.774 for SPPB and 0.776 for BBS).Furthermore,BBS≤36.5 was associated with significantly higher mortality,which was still applicable even adjusting for confounding factors;BBS was also found to have great clinical utility under decision curve analysis.CONCLUSIONS BBS or SPPB could be used as tools to assess physical function in ageing ADHF patients,as well as prognosticate on all-cause mortality.Moreover,prioritizing the improvement of balance capabilities of ADHF patients in cardiac rehabilitation regimens could aid in lowering mortality risk.
文摘The purpose of this study is to clarify the characteristics of patients with decreased cognitive function undergoing treatment for acute exacerbation phase of chronic heart failure as a basic survey with a view to the standardization of nursing to prevent discontinuation of treatment of patients with declining cognitive function in the acute exacerbation phase of chronic heart failure. As the first stage of the research, using the interview guide created based on the background of discontinuation of treatment and symptomatic monitoring from 33 target literature sources, seven certified chronic heart failure nurses and 15 certified dementia nurses were given semi-structured interviews. Data obtained from the interviews was analyzed by qualitative induction. As a result, we obtained opinions/views on 8 situations namely, “cognitive function at hospitalization”, “characteristics at hospitalization, “characteristics when receiving examinations, procedures or treatment”, “characteristics of course of treatment”, “characteristics related to difficulties in grasping the symptoms of chronic heart failure and indices of deterioration”, “characteristics when using diuretics”, “characteristics concerning compliance with dietary restrictions” and “support required for discharge from hospital” concerning patients with declining cognitive function. In the future, it is necessary to prepare nursing protocols incorporating these contents for standardization of nursing.
文摘Link failure is a critical issue in large networks and must be effectively addressed.In software-defined networks(SDN),link failure recovery schemes can be categorized into proactive and reactive approaches.Reactive schemes have longer recovery times while proactive schemes provide faster recovery but overwhelm the memory of switches by flow entries.As SDN adoption grows,ensuring efficient recovery from link failures in the data plane becomes crucial.In particular,data center networks(DCNs)demand rapid recovery times and efficient resource utilization to meet carrier-grade requirements.This paper proposes an efficient Decentralized Failure Recovery(DFR)model for SDNs,meeting recovery time requirements and optimizing switch memory resource consumption.The DFR model enables switches to autonomously reroute traffic upon link failures without involving the controller,achieving fast recovery times while minimizing memory usage.DFR employs the Fast Failover Group in the OpenFlow standard for local recovery without requiring controller communication and utilizes the k-shortest path algorithm to proactively install backup paths,allowing immediate local recovery without controller intervention and enhancing overall network stability and scalability.DFR employs flow entry aggregation techniques to reduce switch memory usage.Instead of matching flow entries to the destination host’s MAC address,DFR matches packets to the destination switch’s MAC address.This reduces the switches’Ternary Content-Addressable Memory(TCAM)consumption.Additionally,DFR modifies Address Resolution Protocol(ARP)replies to provide source hosts with the destination switch’s MAC address,facilitating flow entry aggregation without affecting normal network operations.The performance of DFR is evaluated through the network emulator Mininet 2.3.1 and Ryu 3.1 as SDN controller.For different number of active flows,number of hosts per edge switch,and different network sizes,the proposed model outperformed various failure recovery models:restoration-based,protection by flow entries,protection by group entries and protection by Vlan-tagging model in terms of recovery time,switch memory consumption and controller overhead which represented the number of flow entry updates to recover from the failure.Experimental results demonstrate that DFR achieves recovery times under 20 milliseconds,satisfying carrier-grade requirements for rapid failure recovery.Additionally,DFR reduces switch memory usage by up to 95%compared to traditional protection methods and minimizes controller load by eliminating the need for controller intervention during failure recovery.Theresults underscore the efficiency and scalability of the DFR model,making it a practical solution for enhancing network resilience in SDN environments.
文摘The giant perilous rock at Wangxia (named Wangxia perilous rock) is representative in Three Gorges of the Yangtze River, China, has threatened badly the navigation of the Yangtze River channel for a long period. The giant perilous rock is composed of siliceous limestone and argillaceous limestone, and includes two elements marking by W1 and W2, respectively. The W1 is an isolated pillar while the W2 is in clintheriform. The linking segment of dominant fissure in the W2 is composed by moniliform solution funnels at its back, and the locked segment of the dominant fissure at the base of the W2 is composed by two parts. For the locked part of the dominant fissure of the W2, the upper segment shows the same lithology with the perilous rock and it can be simplified as an elastic medium, for the lower segment composed by argillaceous shale and mudstone can be simplified as a strain-softening medium. Introducing the water-softened function, the constitutive curves with two kinds of medium materials for the locked segment in the dominant fissure of the W2 have been proposed. Based on energy principle, the cusp catastrophe model for perilous rock rupture is built and formulas for the transient elastic and impulsive acceleration and the elastic-impulsive velocity of perilous rock catastrophe rupture have been established. By the calculation, the elastic-impulsive acceleration for the catastrophe rupture of the W2 is 531.4 m/s2, while the average elastic-impulsive velocity is 2.608 m/s. Further, it is deduced that the elastic-impulsive velocity at the base of the W2 is about 5.2 m/s. For the transient ruture of the W2, there is a greater speed difference between the top and the base of the W2, which impels the giant perilous rock to be retroverted sliding rupture, coinciding with the fact. Undoubtedly, studies in this paper must play an important role to analyze the catastrophe rupture mechanism of giant perilous rocks at both banks in Three Gorges of the Yangtze River, China.
