BACKGROUND Indeterminate dendritic cell tumor(IDCT)is a rare tumor of immune cells,and IDCT patients without skin lesions are rarely reported.Therefore,the clinical course in this type of patient is unclear,and furthe...BACKGROUND Indeterminate dendritic cell tumor(IDCT)is a rare tumor of immune cells,and IDCT patients without skin lesions are rarely reported.Therefore,the clinical course in this type of patient is unclear,and further research on the underlying pathological mechanisms and appropriate treatments is needed.CASE SUMMARY This study describes a female IDCT patient with bile duct lesions.The strong mimicry of IDCT lesions confused doctors,and consequently,this patient,who had no skin lesions,was first diagnosed with cholangiocarcinoma.Then,she presented with persistent abdominal distension without jaundice.Enlarged mesenteric lymph nodes along with massive ascites were observed in the subsequent imaging examination.However,no tumor cells or pathogens were found in the three subsequent ascites analyses.It took 2 years to reach the correct diagnosis,which was eventually obtained by performing surgery for biopsy of the patient’s abdominal lymph nodes.However,by then,she was already in a cachexic state.Finally,she received a cycle of cyclophosphamide therapy and was advised to visit a hospital specializing in rare diseases.CONCLUSION For IDCT patients without skin lesions,early biopsy is the key to obtaining a correct diagnosis.Moreover,the collective management of IDCT patients is important.Further histological and molecular biology studies based on human specimens are critical for understanding the pathological mechanism of dendritic cell tumors in the future.展开更多
BACKGROUND Studies with large size samples on the liver histological changes of indeterminate phase chronic hepatitis B(CHB)patients were not previously conducted.AIM To assess the liver histological changes in the in...BACKGROUND Studies with large size samples on the liver histological changes of indeterminate phase chronic hepatitis B(CHB)patients were not previously conducted.AIM To assess the liver histological changes in the indeterminate phase CHB patients using liver biopsy.METHODS The clinical and laboratory data of 1532 untreated CHB patients were collected,and all patients had least once liver biopsy from January 2015 to December 2021.The significant differences among different phases of CHB infection were compared with t-test,and the risk factors of significant liver histological changes were analyzed by the multivariate logistic regression analysis.RESULTS Among 1532 untreated CHB patients,814(53.13%)patients were in the indeterminate phase.Significant liver histological changes(defined as biopsy score≥G2 and/or≥S2)were found in 488/814(59.95%)CHB patients in the indete-rminate phase.Significant liver histological changes were significant differences among different age,platelets(PLTs),and alanine aminotransferase(ALT)subgroup in indeterminate patient.Multivariate logistic regression analysis indicated that age≥40 years old[adjust odd risk(aOR),1.44;95%confidence interval(CI):1.06-1.97;P=0.02],PLTs≤150×10^(9)/L(aOR,2.99;95%CI:1.85-4.83;P<0.0001),and ALT≥upper limits of normal(aOR,1.48;95%CI:1.08,2.05,P=0.0163)were independent risk factors for significant liver histological changes in CHB patients in the indeterminate phase.CONCLUSION Our results suggested that significant liver histological changes were not rare among the untreated CHB patients in indeterminate phase,and additional strategies are urgently required for the management of these patients.展开更多
Indeterminate biliary strictures pose a significant diagnostic dilemma for gastroenterologists.Despite advances in endoscopic techniques and instruments,it is difficult to differentiate between benign and malignant pa...Indeterminate biliary strictures pose a significant diagnostic dilemma for gastroenterologists.Despite advances in endoscopic techniques and instruments,it is difficult to differentiate between benign and malignant pathology.A positive histological diagnosis is always preferred prior to high risk hepatobiliary surgery,or to inform other types of therapy.Endoscopic retrograde cholangiopancreato-graphy with brushings has low sensitivity and despite significant improvements in instruments there is still an unacceptably high false negative rate.Other methods such as endoscopic ultrasound and cholangioscopy have improved diagnostic quality.In this review we explore the techniques available to aid accurate diagnosis of indeterminate biliary strictures and obtain accurate histology to facilitate clinical management.展开更多
Biliary strictures are considered indeterminate when basic work-up, including transabdominal imaging and endoscopic retrograde cholangiopancreatography with routine cytologic brushing, are non-diagnostic. Indeterminat...Biliary strictures are considered indeterminate when basic work-up, including transabdominal imaging and endoscopic retrograde cholangiopancreatography with routine cytologic brushing, are non-diagnostic. Indeterminate biliary strictures can easily be mischaracterized which may dramatically affect patient's outcome. Early and accurate diagnosis of malignancy impacts not only a patient's candidacy for surgery, but also potential timely targeted chemotherapies. A significant portion of patients with indeterminate biliary strictures have benign disease and accurate diagnosis is, thus, paramount to avoid unnecessary surgery. Current sampling strategies have suboptimal accuracy for the diagnosis of malignancy. Emerging data on other diagnostic modalities, such as ancillary cytology techniques, single operator cholangioscopy, and endoscopic ultrasonography-guided fine needle aspiration, revealed promising results with much improved sensitivity.展开更多
Despite advances in cross-sectional imaging and endoscopic technology,bile duct strictures remain a challenging clinical entity.It is crucial to make an early determination of benign or malignant nature of biliary str...Despite advances in cross-sectional imaging and endoscopic technology,bile duct strictures remain a challenging clinical entity.It is crucial to make an early determination of benign or malignant nature of biliary strictures.Early diagnosis not only helps with further management but also minimizes mortality and morbidity associated with delayed diagnosis.Conventional imaging and endoscopic techniques,particularly endoscopic retrograde cholangiopancreatography(ERCP)and tissue sampling techniques play a key in establishing a diagnosis.Indeterminate biliary strictures(IDBSs)have no definite mass on imaging or absolute histopathological diagnosis and often warrant utilization of multiple diagnostics to ascertain an etiology.In this review,we discuss possible etiologies,clinical presentation,diagnosis,and management of IDBSs.Based on available data and expert opinion,we depict an evidence based diagnostic algorithm for management of IDBSs.Areas of focus include use of traditional tissue sampling techniques such as ERCP with brush cytology,intraductal biopsies,fluorescence in situ hybridization and flow cytometry.We also describe the role of endoscopic ultrasound(EUS)-guided fine needle aspiration and biopsies,cholangioscopy,confocal laser endomicroscopy,and intraductal EUS in management of IDBSs.展开更多
HIV-indeterminate Western blotting(WB)results are typically obtained in WB confirmatory assays,and the number of indeterminate samples may increase with the detection of HIV infections,which will present considerable ...HIV-indeterminate Western blotting(WB)results are typically obtained in WB confirmatory assays,and the number of indeterminate samples may increase with the detection of HIV infections,which will present considerable challenges for the management of HIV/AIDS.Nucleic acid detection has been used as a laboratory test for screening suspected or indeterminate samples.However,the effectiveness of these assays for the differential diagnosis of HIV-indeterminate WB samples remained undetermined.In this study,210 subjects with HIV-indeterminate WB results were detected from 6360 positive HIV screening samples between 2015 and 2016 in southeastern China,in which HIV-indeterminate WB results accounted for 3.30%.The highest proportion of indeterminate results was observed in pregnant and lying-in women receiving physical examinations(16.67%),followed by that in voluntary blood donors(8.82%).The most common WB band patterns were p24,gpl60 and p24,and gpl60.The follow-up study revealed that the highest negative and positive conversion rates of HIV antibodies were in samples with a single p24 band(80.28%),and with gpl60 and p24 bands(86.21%),respectively.Among the Env,Gag,and Pol antibodies,samples with a Gag band showed the highest negative conversion rate(81.25%),whereas the highest positive conversion rate was observed in samples with an Env band(56.76%).In addition,quantitative and qualitative HIV nucleic acid testing exhibited the highest sensitivity(96.3%)and specificity(97.85%),respectively.Our results indicate a lower proportion of HIV indeterminate WB results in southeastern China compared to previous reports,and the follow-up re-examination of patients with HIV indeterminate results should be performed.Nucleic acid testing facilitates the identification of HIV infections.展开更多
AIM:To investigate the clinicopathologic parameters of pulmonary metastasis in colorectal cancer(CRC) patients after lung operation of indeterminate pulmonary nodules(IPNs).METHODS:From a prospective database of CRCpa...AIM:To investigate the clinicopathologic parameters of pulmonary metastasis in colorectal cancer(CRC) patients after lung operation of indeterminate pulmonary nodules(IPNs).METHODS:From a prospective database of CRCpatients,40 cases that underwent lung operation between November 2008 and December 2012 for suspicious metastatic pulmonary nodules on chest computed tomography(CT)were enrolled.The decision to perform a lung operation was made if the patient met the following criteria:(1)completely resected or resectable primary CRC;(2)completely resectable IPNs;(3)controlled or controllable extrapulmonary metastasis;and(4)adequate general condition and pulmonary function to tolerate pulmonary operation.Lung operation was performed by a thoracic surgeon without CT-guided biopsy for pathologic confirmation.RESULTS:A total of 40 cases of lung resection was performed in 29 patients.Five patients underwent repeated lung resection.The final pathology result showed metastasis from the CRC in 30 cases(75%)and benign pathology in 10 cases(25%).The primary tumor site was the rectum in 26/30(86.6%)cases with pulmonary metastasis,but only 3/10(30%)cases in the benign group had a primary rectal cancer(P=0.001).Positron emission tomography(PET)-CT was performed for 22/30(73.4%)patients in the lung metastasis group and for 6/10(60.0%)patients in the benign group.PET-CT revealed hot uptake of18fluorine 2-fluoro-2-deoxy-D-glucose with all IPNs in both groups.The group with pulmonary metastasis had a higher incidence of primary rectal cancer(P=0.001),a more advanced tumor stage(P=0.011),and more frequent lymphatic invasion of tumor cells(P=0.005).Six cases with previous liver metastasectomy were present in the lung metastasis group.Serum carcinoembryonic antigen levels before lung operation were not elevated in any of the patients.CONCLUSION:The stage and location of the primary tumor and tumor cell infiltration of lymphatics provide useful indicators for deciding on lung resection of IPNs in CRC.展开更多
Patients with indeterminate colitis(IC) are significantly younger at diagnosis with onset of symptoms before the age of 18 years with significant morbidity in the interim. The successful care of IC is based on microsc...Patients with indeterminate colitis(IC) are significantly younger at diagnosis with onset of symptoms before the age of 18 years with significant morbidity in the interim. The successful care of IC is based on microscopic visual predict precision of eventual ulcerative colitis(UC) or Crohn's colitis(CC) which is not offered in 15%-30% of inflammatory bowel disease(IBD) patients even after a combined state-of-the-art classification system of clinical, visual endoscopic, radiologic and histologic examination. These figures have not changed over the past 3 decades despite the introduction of newer diagnostic modalities. The patient outcomes after restorative proctocolectomy and ileal pouch-anal anastomosis may be painstaking if IC turns into CC. Our approach is aiming at developing a single sensitive and absolute accurate diagnostic test tool during the first clinic visit through endoscopic biopsy derived proteomic patterns. Matrix-assisted-laser desorption/ionization mass spectrometry(MS) and/or imaging MS technologies permit a histology-directed cellular test of endoscopy biopsy which identifies phenotype specific proteins, as biomarker that would assist clinicians more accurately delineate IC as beingeither a UC or CC or a non-IBD condition. These novel studies are underway on larger cohorts and are highly innovative with significances in differentiating a UC from CC in patients with IC and could lend mechanistic insights into IBD pathogenesis.展开更多
BACKGROUND Histological changes after direct-acting antivirals(DAAs)therapy in hepatitis C virus(HCV)patients has not been elucidated.Whether the predominantly progressive,indeterminate and predominately regressive(P-...BACKGROUND Histological changes after direct-acting antivirals(DAAs)therapy in hepatitis C virus(HCV)patients has not been elucidated.Whether the predominantly progressive,indeterminate and predominately regressive(P-I-R)score,evaluating fibrosis activity in hepatitis B virus patients has predictive value in HCV patients has not been investigated.AIM To identify histological changes after DAAs therapy and to evaluate the predictive value of the P-I-R score in HCV patients.METHODS Chronic HCV patients with paired liver biopsy specimens before and after DAAs treatment were included.Sustained virologic response(SVR)was defined as an undetectable serum HCV RNA level at 24 wk after treatment cessation.The Ishak system and P-I-R score were assessed.Inflammation improvement and fibrosis regression were defined as a≥2-points decrease in the histology activity index(HAI)score and a≥1-point decrease in the Ishak fibrosis score,respectively.Fibrosis progression was defined as a≥1-point increase in the Ishak fibrosis score.Histologic improvement was defined as a≥2-points decrease in the HAI score without worsening of the Ishak fibrosis score after DAAs therapy.The P-I-R score was also assessed.“absolutely reversing or advancing”was defined as the same directionality implied by both change in the Ishak score and posttreatment P-I-R score;and“probably reversing or advancing”was defined as only one parameter showing directionality.RESULTS Thirty-eight chronic HCV patients with paired liver biopsy specimens before and after DAAs treatment were included.The mean age of these patients was 40.9±14.6 years and there were 53%(20/38)males.Thirty-four percent(13/38)of patients were cirrhotic.Eighty-two percent(31/38)of patients achieved inflammation improvement.The median HAI score decreased significantly after SVR(pretreatment 7.0 vs posttreatment 2.0,Z=-5.146,P=0.000).Thirty-seven percent(14/38)of patients achieved fibrosis improvement.The median Ishak score decreased significantly after SVR(pretreatment 4.0 vs posttreatment 3.0,Z=-2.354,P=0.019).Eighty-two percent(31/38)of patients showed histological improvement.The P-I-R score was evaluated in 61%(23/38)of patients.The progressive group showed lower platelet(P=0.024)and higher HAI scores(P=0.070)before treatment.In patients with stable Ishak stage after treatment:Progressive injury was seen in 22%(4/18)of patients,33%(6/18)were classified as indeterminate and regressive changes were seen in 44%(8/18)of patients who were judged as probably reversing by the Ishak and P-I-R systems.CONCLUSION Significant improvement of necroinflammation and partial remission of fibrosis in HCV patients occurred shortly after DAAs therapy.The P-I-R score has potential in predicting fibrosis in HCV patients.展开更多
Different histopathological manifestations of focal liver lesions show varying common and uncommon imaging findings and some pathologies may show similar appearance despite of different histopathology.It is necessary ...Different histopathological manifestations of focal liver lesions show varying common and uncommon imaging findings and some pathologies may show similar appearance despite of different histopathology.It is necessary to characterise focal liver lesions accurately as not only benign and malignant lesions are managed differently,but also certain benign lesions have differing management.These lesions are increasingly being detected due to rapid growth of use of crosssectional imaging as well as improvement in image quality and new imaging techniques.Contrast enhanced magnetic resonance imaging(MRI)is considered the gold standard technique in characterising focal liver lesions.Addition of gadoxetic acid has been shown to significantly increase diagnostic accuracy in the detection and characterization of liver abnormalities.Classic imaging characteristics of common liver lesions,including their behaviour on gadoxetic acid enhanced MRI,have been described in literature over recent years.It is important to be familiar with the typical aspects of these lesions as well as know the uncommon and overlapping imaging features to reach an accurate diagnosis.In this article,we will review the well-described characteristic imaging findings of common and rare focal liver lesions and present several challenging cases encountered in the clinical setting,namely hepatocellular adenoma,focal nodular hyperplasia,hepatic angiomyolipoma,hepatocellular carcinoma,intrahepatic cholangiocarcinoma,neuroendocrine tumours as well as a pleomorphic liposarcoma of the liver.展开更多
To investigate presence and extent of eosinophilic cholangitis (EC) as well as IgG4-related disease in patients with indeterminate biliary stricture (IBS).METHODSAll patients with diagnosis of sclerosing cholangitis (...To investigate presence and extent of eosinophilic cholangitis (EC) as well as IgG4-related disease in patients with indeterminate biliary stricture (IBS).METHODSAll patients with diagnosis of sclerosing cholangitis (SC) and histopathological samples such as biopsies or surgical specimens at University Hospital Frankfurt from 2005-2015 were included. Histopathological diagnoses as well as further clinical course were reviewed. Tissue samples of patients without definite diagnosis after complete diagnostic work-up were reviewed regarding presence of eosinophilic infiltration and IgG4 positive plasma cells. Eosinophilic infiltration was as well assessed in a control group of liver transplant donors and patients with primary sclerosing cholangitis.RESULTSone hundred and thirty-five patients with SC were included. In 10/135 (13.5%) patients, no potential cause of IBS could be identified after complete diagnostic work-up and further clinical course. After histopathological review, a post-hoc diagnosis of EC was established in three patients resulting in a prevalence of 2.2% (3/135) of all patients with SC as well as 30% (3/10) of patients, where no cause of IBS was identified. 2/3 patients with post-hoc diagnosis of EC underwent surgical resection with suspicion for malignancy. Diagnosis of IgG4-related cholangitis was observed in 7/135 patients (5.1%), whereas 3 cases were discovered in post-hoc analysis. 6/7 cases with IgG4-related cholangitis (85.7%) presented with eosinophilic infiltration in addition to IgG4 positive plasma cells. There was no patient with eosinophilic infiltration in the control group of liver transplant donors (n = 27) and patients with primary sclerosing cholangitis (n = 14).CONCLUSIONEC is an underdiagnosed benign etiology of SC and IBS, which has to be considered in differential diagnosis of IBS.展开更多
The FCSE controlling equation of pinned thinwalled curve box was derived and the indeterminate problem of continuous thin-walled curve box with diaphragm was solved based on flexibility theory. With Bayesian statistic...The FCSE controlling equation of pinned thinwalled curve box was derived and the indeterminate problem of continuous thin-walled curve box with diaphragm was solved based on flexibility theory. With Bayesian statistical theory,dynamic Bayesian error function of displacement parameters of indeterminate curve box was founded. The corresponding formulas of dynamic Bayesian expectation and variance were deduced. Combined with one-dimensional Fibonacci automatic search scheme of optimal step size,the Powell optimization theory was utilized to research the stochastic identification of displacement parameters of indeterminate thin-walled curve box. Then the identification steps were presented in detail and the corresponding calculation procedure was compiled. Through some classic examples,it is obtained that stochastic performances of systematic parameters and systematic responses are simultaneously deliberated in dynamic Bayesian error function. The one-dimensional optimization problem of the optimal step size is solved by adopting Fibonacci search method. And the Powell identification of displacement parameters of indeterminate thin-walled curve box has satisfied numerical stability and convergence,which demonstrates that the presented method and the compiled procedure are correct and reliable.During parameters鈥？iterative processes,the Powell theory is irrelevant with the calculation of finite curve strip element（FCSE） partial differentiation,which proves high computation effciency of the studied method.展开更多
The cytology of 130 indeterminate nodules （Thy 3） was retrospectively reviewed according to the British Thyroid Association 2014 classification. Nodules were divided into Thy 3a （atypical features） and Thy 3f （fo...The cytology of 130 indeterminate nodules （Thy 3） was retrospectively reviewed according to the British Thyroid Association 2014 classification. Nodules were divided into Thy 3a （atypical features） and Thy 3f （follicular lesion） categories. Histology was available as a reference for 97 nodules. Pre-surgical evaluations comprised biochemical tests, color-Doppler ultrasonogrephy （US）, semi-quantitative elastography-US （USE）, contrast-enhanced US （CEUS）, and mutation analysis from cytological slides. Thyroid malignancy was the final diagnosis for 19% of surgically- treated nodules. No statistically significant difference in the risk of malignancy was found between Thy 3a （26%） and Thy 3f （14%） nodules. Histology of the Thy 3a and Thy 3f nodules showed a higher incidence of Hurtle cell adenomas in Thy 3f （29%） than in Thy 3a （3%） nodules （P=0.01）. The only pre-surgical difference concerned the BRAF V600E mutation, which was positive in some Thy 3a but not in any Thy 3f nodules （P=0.04）. Receiver-operating characteristic （ROC） analysis was used to obtain cut-off values from US （score）, USE （ELX 2/1 strain index）, and CEUS （time-to- peak index and peak index） data. The cut-off values were similar for Thy 3a and Thy 3f nodules. Data showed that malignancy can be suspected if the US score is 〉2, ELX 1/2 strain index 〉1, time-to-peakindex 〉1, and peak index 〈1. In a sub-group of 24 revised nodules （12 Thy 3a and 12 Thy 3f） with histology as a reference, the diagnostic power of cumulative pre-surgical analysis by means of US, USE, and CEUS showed high positive and negative predictive values （83% and 100%, respectively） for the presence of malignancy in Thy 3a and Thy 3f nodules. In conclusion, in our series of revised Thy 3 nodules, malignancy was low and displayed no significant differences between Thy 3a and Thy 3f categories. The use of cut-offs based on histology as a reference could reduce surgery. Our data support the conviction that, in mutation-negative Thy 3a and Thy 3f nodules, observation should be the first choice when not all instrumental results are suspect.展开更多
To better estimate the rock joint shear strength,accurately determining the rock joint roughness coefficient(JRC)is the first step faced by researchers and engineers.However,there are incomplete,imprecise,and indeterm...To better estimate the rock joint shear strength,accurately determining the rock joint roughness coefficient(JRC)is the first step faced by researchers and engineers.However,there are incomplete,imprecise,and indeterminate problems during the process of calculating the JRC.This paper proposed to investigate the indeterminate information of rock joint roughness through a neutrosophic number approach and,based on this information,reported a method to capture the incomplete,uncertain,and imprecise information of the JRC in uncertain environments.The uncertainties in the JRC determination were investigated by the regression correlations based on commonly used statistical parameters,which demonstrated the drawbacks of traditional JRC regression correlations in handling the indeterminate information of the JRC.Moreover,the commonly used statistical parameters cannot reflect the roughness contribution differences of the asperities with various scales,which induces additional indeterminate information.A method based on the neutrosophic number(NN)and spectral analysis was proposed to capture the indeterminate information of the JRC.The proposed method was then applied to determine the JRC values for sandstone joint samples collected from a rock landslide.The comparison between the JRC results obtained by the proposed method and experimental results validated the effectiveness of the NN.Additionally,comparisons made between the spectral analysis and common statistical parameters based on the NN also demonstrated the advantage of spectral analysis.Thus,the NN and spectral analysis combined can effectively handle the indeterminate information in the rock joint roughness.展开更多
For statically indeterminate structure, the internal force will be changed with the translation of the supports, because the internal force is related to the absolute value of the stiffness EI. When the tension is dif...For statically indeterminate structure, the internal force will be changed with the translation of the supports, because the internal force is related to the absolute value of the stiffness EI. When the tension is different with the compression modulus, EI is the function of internal force and is not constant any more that is different from classic mechanics. In the other words, it is a nonlinear problem to calculate the internal force. The expression for neutral axis of the statically indeterminate structure was derived in the paper. The iterative program for nonlinear internal force was compiled. One case study was presented to illustrate the difference between the results using the different modulus theory and the single modulus theory as in classical mechanics. Finally, some reasonable suggestions were made for the different modulus structures.展开更多
The paper presents the principles of a method, which in two simple stages makes possible to carry out the statically calculation of values of forces acting in the fiat static indeterminate trusses. In each stage, it i...The paper presents the principles of a method, which in two simple stages makes possible to carry out the statically calculation of values of forces acting in the fiat static indeterminate trusses. In each stage, it is considered the static determinate truss, scheme of which is obtained after remove the suitable number of members from the basic static indeterminate truss. The both intermediate statically determinate trusses are of the same clear span and they are loaded by forces of half values applied to the corresponding truss nodes. The method applies one of the typical procedures of calculation of the statically determinate trusses and then it is applied in an appropriate way the rule of superposition for obtaining the final values of forces acting in particular members of the basic truss. The values of forces calculated in this way are of a very close approximation to the force values determined in the special and complex ways being considered as the exact calculation methods. The proposed method can be useful mostly but not only for the initial structural design of such systems. The simplicity of the two-stage method justifies an assumption that it can be relatively easy and worthy to adjust to the requirements of the computer aided technology of statically calculation of the complex forms of trusses.展开更多
For A∈CmΧn, if the sum of the elements in each row and the sum of the elements in each column are both equal to 0, then A is called an indeterminate admittance matrix. If A is an indeterminate admit...For A∈CmΧn, if the sum of the elements in each row and the sum of the elements in each column are both equal to 0, then A is called an indeterminate admittance matrix. If A is an indeterminate admittance matrix and a Hermitian matrix, then A is called a Hermitian indeterminate admittance matrix. In this paper, we provide two methods to study the least squares Hermitian indeterminate admittance problem of complex matrix equation (AXB,CXD)=(E,F), and give the explicit expressions of least squares Hermitian indeterminate admittance solution with the least norm in each method. We mainly adopt the Moore-Penrose generalized inverse and Kronecker product in Method I and a matrix-vector product in Method II, respectively.展开更多
Based on the character of the internal force distribution of the statically indeterminate truss, the elements stresses were changed by adjusting the length of bars to increase load capacity of structure. The efficienc...Based on the character of the internal force distribution of the statically indeterminate truss, the elements stresses were changed by adjusting the length of bars to increase load capacity of structure. The efficiency of the method is illustrated by several examples.展开更多
Strong and weak limits as well as strong and weak differentials of multi-variable indeterminate forms are discussed based on the thorough exploration of differentiation to solve the strong and weak limits and differen...Strong and weak limits as well as strong and weak differentials of multi-variable indeterminate forms are discussed based on the thorough exploration of differentiation to solve the strong and weak limits and differentials of unitary indeterminate forms. The fruit of this work is going to be reported in three parts. The first part presents the standard analysis on this subject which supplements, systematizes and advances L. Hospital抯 principles on differential calculus by applying special ,general, and limit guaranteeing theories together with K(t) and XhK0 theories. The combination of theoretical analysis and geometric signification makes the derivation intuitional, visual and easy to perceive.展开更多
Various transforms of the indeterminate forms are presented in this part, which include simplification in spherical coordinates, origin translation, axis alteration, transformation of limit conservation and applicatio...Various transforms of the indeterminate forms are presented in this part, which include simplification in spherical coordinates, origin translation, axis alteration, transformation of limit conservation and application of Xh?K0. Fundamental factors for numerical simplification are provided respectively for bi-variable indeterminate forms, tri-variable indeterminate forms and the universal extending multiplier.展开更多
文摘BACKGROUND Indeterminate dendritic cell tumor(IDCT)is a rare tumor of immune cells,and IDCT patients without skin lesions are rarely reported.Therefore,the clinical course in this type of patient is unclear,and further research on the underlying pathological mechanisms and appropriate treatments is needed.CASE SUMMARY This study describes a female IDCT patient with bile duct lesions.The strong mimicry of IDCT lesions confused doctors,and consequently,this patient,who had no skin lesions,was first diagnosed with cholangiocarcinoma.Then,she presented with persistent abdominal distension without jaundice.Enlarged mesenteric lymph nodes along with massive ascites were observed in the subsequent imaging examination.However,no tumor cells or pathogens were found in the three subsequent ascites analyses.It took 2 years to reach the correct diagnosis,which was eventually obtained by performing surgery for biopsy of the patient’s abdominal lymph nodes.However,by then,she was already in a cachexic state.Finally,she received a cycle of cyclophosphamide therapy and was advised to visit a hospital specializing in rare diseases.CONCLUSION For IDCT patients without skin lesions,early biopsy is the key to obtaining a correct diagnosis.Moreover,the collective management of IDCT patients is important.Further histological and molecular biology studies based on human specimens are critical for understanding the pathological mechanism of dendritic cell tumors in the future.
基金Supported by Construction of Key Medical Disciplines in Shenzhen,No.SZXK076.
文摘BACKGROUND Studies with large size samples on the liver histological changes of indeterminate phase chronic hepatitis B(CHB)patients were not previously conducted.AIM To assess the liver histological changes in the indeterminate phase CHB patients using liver biopsy.METHODS The clinical and laboratory data of 1532 untreated CHB patients were collected,and all patients had least once liver biopsy from January 2015 to December 2021.The significant differences among different phases of CHB infection were compared with t-test,and the risk factors of significant liver histological changes were analyzed by the multivariate logistic regression analysis.RESULTS Among 1532 untreated CHB patients,814(53.13%)patients were in the indeterminate phase.Significant liver histological changes(defined as biopsy score≥G2 and/or≥S2)were found in 488/814(59.95%)CHB patients in the indete-rminate phase.Significant liver histological changes were significant differences among different age,platelets(PLTs),and alanine aminotransferase(ALT)subgroup in indeterminate patient.Multivariate logistic regression analysis indicated that age≥40 years old[adjust odd risk(aOR),1.44;95%confidence interval(CI):1.06-1.97;P=0.02],PLTs≤150×10^(9)/L(aOR,2.99;95%CI:1.85-4.83;P<0.0001),and ALT≥upper limits of normal(aOR,1.48;95%CI:1.08,2.05,P=0.0163)were independent risk factors for significant liver histological changes in CHB patients in the indeterminate phase.CONCLUSION Our results suggested that significant liver histological changes were not rare among the untreated CHB patients in indeterminate phase,and additional strategies are urgently required for the management of these patients.
文摘Indeterminate biliary strictures pose a significant diagnostic dilemma for gastroenterologists.Despite advances in endoscopic techniques and instruments,it is difficult to differentiate between benign and malignant pathology.A positive histological diagnosis is always preferred prior to high risk hepatobiliary surgery,or to inform other types of therapy.Endoscopic retrograde cholangiopancreato-graphy with brushings has low sensitivity and despite significant improvements in instruments there is still an unacceptably high false negative rate.Other methods such as endoscopic ultrasound and cholangioscopy have improved diagnostic quality.In this review we explore the techniques available to aid accurate diagnosis of indeterminate biliary strictures and obtain accurate histology to facilitate clinical management.
文摘Biliary strictures are considered indeterminate when basic work-up, including transabdominal imaging and endoscopic retrograde cholangiopancreatography with routine cytologic brushing, are non-diagnostic. Indeterminate biliary strictures can easily be mischaracterized which may dramatically affect patient's outcome. Early and accurate diagnosis of malignancy impacts not only a patient's candidacy for surgery, but also potential timely targeted chemotherapies. A significant portion of patients with indeterminate biliary strictures have benign disease and accurate diagnosis is, thus, paramount to avoid unnecessary surgery. Current sampling strategies have suboptimal accuracy for the diagnosis of malignancy. Emerging data on other diagnostic modalities, such as ancillary cytology techniques, single operator cholangioscopy, and endoscopic ultrasonography-guided fine needle aspiration, revealed promising results with much improved sensitivity.
文摘Despite advances in cross-sectional imaging and endoscopic technology,bile duct strictures remain a challenging clinical entity.It is crucial to make an early determination of benign or malignant nature of biliary strictures.Early diagnosis not only helps with further management but also minimizes mortality and morbidity associated with delayed diagnosis.Conventional imaging and endoscopic techniques,particularly endoscopic retrograde cholangiopancreatography(ERCP)and tissue sampling techniques play a key in establishing a diagnosis.Indeterminate biliary strictures(IDBSs)have no definite mass on imaging or absolute histopathological diagnosis and often warrant utilization of multiple diagnostics to ascertain an etiology.In this review,we discuss possible etiologies,clinical presentation,diagnosis,and management of IDBSs.Based on available data and expert opinion,we depict an evidence based diagnostic algorithm for management of IDBSs.Areas of focus include use of traditional tissue sampling techniques such as ERCP with brush cytology,intraductal biopsies,fluorescence in situ hybridization and flow cytometry.We also describe the role of endoscopic ultrasound(EUS)-guided fine needle aspiration and biopsies,cholangioscopy,confocal laser endomicroscopy,and intraductal EUS in management of IDBSs.
基金supported by grants from the Cultivation of Young Talents Project Fund from the Fujian Provincial Health and Family Planning Commission (Grant No. 2015-ZQN-ZD11)the Pilot Project of Fujian Provincial Department of Science and Technology (Grant No. 2016Y0010)+2 种基金the Jiangsu Provincial Project of Invigorating Health Care through Science, Technology and EducationJiangsu Provincial Medical Youth Talentthe Project of Invigorating Health Care through Science, Technology and Education (Grant No. QNRC2016621)
文摘HIV-indeterminate Western blotting(WB)results are typically obtained in WB confirmatory assays,and the number of indeterminate samples may increase with the detection of HIV infections,which will present considerable challenges for the management of HIV/AIDS.Nucleic acid detection has been used as a laboratory test for screening suspected or indeterminate samples.However,the effectiveness of these assays for the differential diagnosis of HIV-indeterminate WB samples remained undetermined.In this study,210 subjects with HIV-indeterminate WB results were detected from 6360 positive HIV screening samples between 2015 and 2016 in southeastern China,in which HIV-indeterminate WB results accounted for 3.30%.The highest proportion of indeterminate results was observed in pregnant and lying-in women receiving physical examinations(16.67%),followed by that in voluntary blood donors(8.82%).The most common WB band patterns were p24,gpl60 and p24,and gpl60.The follow-up study revealed that the highest negative and positive conversion rates of HIV antibodies were in samples with a single p24 band(80.28%),and with gpl60 and p24 bands(86.21%),respectively.Among the Env,Gag,and Pol antibodies,samples with a Gag band showed the highest negative conversion rate(81.25%),whereas the highest positive conversion rate was observed in samples with an Env band(56.76%).In addition,quantitative and qualitative HIV nucleic acid testing exhibited the highest sensitivity(96.3%)and specificity(97.85%),respectively.Our results indicate a lower proportion of HIV indeterminate WB results in southeastern China compared to previous reports,and the follow-up re-examination of patients with HIV indeterminate results should be performed.Nucleic acid testing facilitates the identification of HIV infections.
文摘AIM:To investigate the clinicopathologic parameters of pulmonary metastasis in colorectal cancer(CRC) patients after lung operation of indeterminate pulmonary nodules(IPNs).METHODS:From a prospective database of CRCpatients,40 cases that underwent lung operation between November 2008 and December 2012 for suspicious metastatic pulmonary nodules on chest computed tomography(CT)were enrolled.The decision to perform a lung operation was made if the patient met the following criteria:(1)completely resected or resectable primary CRC;(2)completely resectable IPNs;(3)controlled or controllable extrapulmonary metastasis;and(4)adequate general condition and pulmonary function to tolerate pulmonary operation.Lung operation was performed by a thoracic surgeon without CT-guided biopsy for pathologic confirmation.RESULTS:A total of 40 cases of lung resection was performed in 29 patients.Five patients underwent repeated lung resection.The final pathology result showed metastasis from the CRC in 30 cases(75%)and benign pathology in 10 cases(25%).The primary tumor site was the rectum in 26/30(86.6%)cases with pulmonary metastasis,but only 3/10(30%)cases in the benign group had a primary rectal cancer(P=0.001).Positron emission tomography(PET)-CT was performed for 22/30(73.4%)patients in the lung metastasis group and for 6/10(60.0%)patients in the benign group.PET-CT revealed hot uptake of18fluorine 2-fluoro-2-deoxy-D-glucose with all IPNs in both groups.The group with pulmonary metastasis had a higher incidence of primary rectal cancer(P=0.001),a more advanced tumor stage(P=0.011),and more frequent lymphatic invasion of tumor cells(P=0.005).Six cases with previous liver metastasectomy were present in the lung metastasis group.Serum carcinoembryonic antigen levels before lung operation were not elevated in any of the patients.CONCLUSION:The stage and location of the primary tumor and tumor cell infiltration of lymphatics provide useful indicators for deciding on lung resection of IPNs in CRC.
基金Supported by NIH/NIDDK R21DK095186-01A1,Nos.3U54 CA091408–09S1,U54RR026140/U54MD007593,and UL1 RR024975Research Foundation,American Society of Colon and Rectal Surgeons,Limited Project Grant(LPG-086)
文摘Patients with indeterminate colitis(IC) are significantly younger at diagnosis with onset of symptoms before the age of 18 years with significant morbidity in the interim. The successful care of IC is based on microscopic visual predict precision of eventual ulcerative colitis(UC) or Crohn's colitis(CC) which is not offered in 15%-30% of inflammatory bowel disease(IBD) patients even after a combined state-of-the-art classification system of clinical, visual endoscopic, radiologic and histologic examination. These figures have not changed over the past 3 decades despite the introduction of newer diagnostic modalities. The patient outcomes after restorative proctocolectomy and ileal pouch-anal anastomosis may be painstaking if IC turns into CC. Our approach is aiming at developing a single sensitive and absolute accurate diagnostic test tool during the first clinic visit through endoscopic biopsy derived proteomic patterns. Matrix-assisted-laser desorption/ionization mass spectrometry(MS) and/or imaging MS technologies permit a histology-directed cellular test of endoscopy biopsy which identifies phenotype specific proteins, as biomarker that would assist clinicians more accurately delineate IC as beingeither a UC or CC or a non-IBD condition. These novel studies are underway on larger cohorts and are highly innovative with significances in differentiating a UC from CC in patients with IC and could lend mechanistic insights into IBD pathogenesis.
基金The National Natural Science Foundation of China,No.81870406the Beijing Natural Science Foundation,No.7182174and the China National Science and Technology Major Project for Infectious Diseases Control during the 13th Five-Year Plan Period,No.2017ZX10202202.
文摘BACKGROUND Histological changes after direct-acting antivirals(DAAs)therapy in hepatitis C virus(HCV)patients has not been elucidated.Whether the predominantly progressive,indeterminate and predominately regressive(P-I-R)score,evaluating fibrosis activity in hepatitis B virus patients has predictive value in HCV patients has not been investigated.AIM To identify histological changes after DAAs therapy and to evaluate the predictive value of the P-I-R score in HCV patients.METHODS Chronic HCV patients with paired liver biopsy specimens before and after DAAs treatment were included.Sustained virologic response(SVR)was defined as an undetectable serum HCV RNA level at 24 wk after treatment cessation.The Ishak system and P-I-R score were assessed.Inflammation improvement and fibrosis regression were defined as a≥2-points decrease in the histology activity index(HAI)score and a≥1-point decrease in the Ishak fibrosis score,respectively.Fibrosis progression was defined as a≥1-point increase in the Ishak fibrosis score.Histologic improvement was defined as a≥2-points decrease in the HAI score without worsening of the Ishak fibrosis score after DAAs therapy.The P-I-R score was also assessed.“absolutely reversing or advancing”was defined as the same directionality implied by both change in the Ishak score and posttreatment P-I-R score;and“probably reversing or advancing”was defined as only one parameter showing directionality.RESULTS Thirty-eight chronic HCV patients with paired liver biopsy specimens before and after DAAs treatment were included.The mean age of these patients was 40.9±14.6 years and there were 53%(20/38)males.Thirty-four percent(13/38)of patients were cirrhotic.Eighty-two percent(31/38)of patients achieved inflammation improvement.The median HAI score decreased significantly after SVR(pretreatment 7.0 vs posttreatment 2.0,Z=-5.146,P=0.000).Thirty-seven percent(14/38)of patients achieved fibrosis improvement.The median Ishak score decreased significantly after SVR(pretreatment 4.0 vs posttreatment 3.0,Z=-2.354,P=0.019).Eighty-two percent(31/38)of patients showed histological improvement.The P-I-R score was evaluated in 61%(23/38)of patients.The progressive group showed lower platelet(P=0.024)and higher HAI scores(P=0.070)before treatment.In patients with stable Ishak stage after treatment:Progressive injury was seen in 22%(4/18)of patients,33%(6/18)were classified as indeterminate and regressive changes were seen in 44%(8/18)of patients who were judged as probably reversing by the Ishak and P-I-R systems.CONCLUSION Significant improvement of necroinflammation and partial remission of fibrosis in HCV patients occurred shortly after DAAs therapy.The P-I-R score has potential in predicting fibrosis in HCV patients.
文摘Different histopathological manifestations of focal liver lesions show varying common and uncommon imaging findings and some pathologies may show similar appearance despite of different histopathology.It is necessary to characterise focal liver lesions accurately as not only benign and malignant lesions are managed differently,but also certain benign lesions have differing management.These lesions are increasingly being detected due to rapid growth of use of crosssectional imaging as well as improvement in image quality and new imaging techniques.Contrast enhanced magnetic resonance imaging(MRI)is considered the gold standard technique in characterising focal liver lesions.Addition of gadoxetic acid has been shown to significantly increase diagnostic accuracy in the detection and characterization of liver abnormalities.Classic imaging characteristics of common liver lesions,including their behaviour on gadoxetic acid enhanced MRI,have been described in literature over recent years.It is important to be familiar with the typical aspects of these lesions as well as know the uncommon and overlapping imaging features to reach an accurate diagnosis.In this article,we will review the well-described characteristic imaging findings of common and rare focal liver lesions and present several challenging cases encountered in the clinical setting,namely hepatocellular adenoma,focal nodular hyperplasia,hepatic angiomyolipoma,hepatocellular carcinoma,intrahepatic cholangiocarcinoma,neuroendocrine tumours as well as a pleomorphic liposarcoma of the liver.
文摘To investigate presence and extent of eosinophilic cholangitis (EC) as well as IgG4-related disease in patients with indeterminate biliary stricture (IBS).METHODSAll patients with diagnosis of sclerosing cholangitis (SC) and histopathological samples such as biopsies or surgical specimens at University Hospital Frankfurt from 2005-2015 were included. Histopathological diagnoses as well as further clinical course were reviewed. Tissue samples of patients without definite diagnosis after complete diagnostic work-up were reviewed regarding presence of eosinophilic infiltration and IgG4 positive plasma cells. Eosinophilic infiltration was as well assessed in a control group of liver transplant donors and patients with primary sclerosing cholangitis.RESULTSone hundred and thirty-five patients with SC were included. In 10/135 (13.5%) patients, no potential cause of IBS could be identified after complete diagnostic work-up and further clinical course. After histopathological review, a post-hoc diagnosis of EC was established in three patients resulting in a prevalence of 2.2% (3/135) of all patients with SC as well as 30% (3/10) of patients, where no cause of IBS was identified. 2/3 patients with post-hoc diagnosis of EC underwent surgical resection with suspicion for malignancy. Diagnosis of IgG4-related cholangitis was observed in 7/135 patients (5.1%), whereas 3 cases were discovered in post-hoc analysis. 6/7 cases with IgG4-related cholangitis (85.7%) presented with eosinophilic infiltration in addition to IgG4 positive plasma cells. There was no patient with eosinophilic infiltration in the control group of liver transplant donors (n = 27) and patients with primary sclerosing cholangitis (n = 14).CONCLUSIONEC is an underdiagnosed benign etiology of SC and IBS, which has to be considered in differential diagnosis of IBS.
基金supported by the National Natural Science Foundation of China (10472045, 10772078 and 11072108)the Science Foundation of NUAA(S0851-013)
文摘The FCSE controlling equation of pinned thinwalled curve box was derived and the indeterminate problem of continuous thin-walled curve box with diaphragm was solved based on flexibility theory. With Bayesian statistical theory,dynamic Bayesian error function of displacement parameters of indeterminate curve box was founded. The corresponding formulas of dynamic Bayesian expectation and variance were deduced. Combined with one-dimensional Fibonacci automatic search scheme of optimal step size,the Powell optimization theory was utilized to research the stochastic identification of displacement parameters of indeterminate thin-walled curve box. Then the identification steps were presented in detail and the corresponding calculation procedure was compiled. Through some classic examples,it is obtained that stochastic performances of systematic parameters and systematic responses are simultaneously deliberated in dynamic Bayesian error function. The one-dimensional optimization problem of the optimal step size is solved by adopting Fibonacci search method. And the Powell identification of displacement parameters of indeterminate thin-walled curve box has satisfied numerical stability and convergence,which demonstrates that the presented method and the compiled procedure are correct and reliable.During parameters鈥？iterative processes,the Powell theory is irrelevant with the calculation of finite curve strip element（FCSE） partial differentiation,which proves high computation effciency of the studied method.
文摘The cytology of 130 indeterminate nodules （Thy 3） was retrospectively reviewed according to the British Thyroid Association 2014 classification. Nodules were divided into Thy 3a （atypical features） and Thy 3f （follicular lesion） categories. Histology was available as a reference for 97 nodules. Pre-surgical evaluations comprised biochemical tests, color-Doppler ultrasonogrephy （US）, semi-quantitative elastography-US （USE）, contrast-enhanced US （CEUS）, and mutation analysis from cytological slides. Thyroid malignancy was the final diagnosis for 19% of surgically- treated nodules. No statistically significant difference in the risk of malignancy was found between Thy 3a （26%） and Thy 3f （14%） nodules. Histology of the Thy 3a and Thy 3f nodules showed a higher incidence of Hurtle cell adenomas in Thy 3f （29%） than in Thy 3a （3%） nodules （P=0.01）. The only pre-surgical difference concerned the BRAF V600E mutation, which was positive in some Thy 3a but not in any Thy 3f nodules （P=0.04）. Receiver-operating characteristic （ROC） analysis was used to obtain cut-off values from US （score）, USE （ELX 2/1 strain index）, and CEUS （time-to- peak index and peak index） data. The cut-off values were similar for Thy 3a and Thy 3f nodules. Data showed that malignancy can be suspected if the US score is 〉2, ELX 1/2 strain index 〉1, time-to-peakindex 〉1, and peak index 〈1. In a sub-group of 24 revised nodules （12 Thy 3a and 12 Thy 3f） with histology as a reference, the diagnostic power of cumulative pre-surgical analysis by means of US, USE, and CEUS showed high positive and negative predictive values （83% and 100%, respectively） for the presence of malignancy in Thy 3a and Thy 3f nodules. In conclusion, in our series of revised Thy 3 nodules, malignancy was low and displayed no significant differences between Thy 3a and Thy 3f categories. The use of cut-offs based on histology as a reference could reduce surgery. Our data support the conviction that, in mutation-negative Thy 3a and Thy 3f nodules, observation should be the first choice when not all instrumental results are suspect.
基金This work is supported by Key Program of National Natural Science Foundation of China(No.41931295)General Program of National Natural Science Foundation of China(No.41877258)。
文摘To better estimate the rock joint shear strength,accurately determining the rock joint roughness coefficient(JRC)is the first step faced by researchers and engineers.However,there are incomplete,imprecise,and indeterminate problems during the process of calculating the JRC.This paper proposed to investigate the indeterminate information of rock joint roughness through a neutrosophic number approach and,based on this information,reported a method to capture the incomplete,uncertain,and imprecise information of the JRC in uncertain environments.The uncertainties in the JRC determination were investigated by the regression correlations based on commonly used statistical parameters,which demonstrated the drawbacks of traditional JRC regression correlations in handling the indeterminate information of the JRC.Moreover,the commonly used statistical parameters cannot reflect the roughness contribution differences of the asperities with various scales,which induces additional indeterminate information.A method based on the neutrosophic number(NN)and spectral analysis was proposed to capture the indeterminate information of the JRC.The proposed method was then applied to determine the JRC values for sandstone joint samples collected from a rock landslide.The comparison between the JRC results obtained by the proposed method and experimental results validated the effectiveness of the NN.Additionally,comparisons made between the spectral analysis and common statistical parameters based on the NN also demonstrated the advantage of spectral analysis.Thus,the NN and spectral analysis combined can effectively handle the indeterminate information in the rock joint roughness.
文摘For statically indeterminate structure, the internal force will be changed with the translation of the supports, because the internal force is related to the absolute value of the stiffness EI. When the tension is different with the compression modulus, EI is the function of internal force and is not constant any more that is different from classic mechanics. In the other words, it is a nonlinear problem to calculate the internal force. The expression for neutral axis of the statically indeterminate structure was derived in the paper. The iterative program for nonlinear internal force was compiled. One case study was presented to illustrate the difference between the results using the different modulus theory and the single modulus theory as in classical mechanics. Finally, some reasonable suggestions were made for the different modulus structures.
文摘The paper presents the principles of a method, which in two simple stages makes possible to carry out the statically calculation of values of forces acting in the fiat static indeterminate trusses. In each stage, it is considered the static determinate truss, scheme of which is obtained after remove the suitable number of members from the basic static indeterminate truss. The both intermediate statically determinate trusses are of the same clear span and they are loaded by forces of half values applied to the corresponding truss nodes. The method applies one of the typical procedures of calculation of the statically determinate trusses and then it is applied in an appropriate way the rule of superposition for obtaining the final values of forces acting in particular members of the basic truss. The values of forces calculated in this way are of a very close approximation to the force values determined in the special and complex ways being considered as the exact calculation methods. The proposed method can be useful mostly but not only for the initial structural design of such systems. The simplicity of the two-stage method justifies an assumption that it can be relatively easy and worthy to adjust to the requirements of the computer aided technology of statically calculation of the complex forms of trusses.
文摘For A∈CmΧn, if the sum of the elements in each row and the sum of the elements in each column are both equal to 0, then A is called an indeterminate admittance matrix. If A is an indeterminate admittance matrix and a Hermitian matrix, then A is called a Hermitian indeterminate admittance matrix. In this paper, we provide two methods to study the least squares Hermitian indeterminate admittance problem of complex matrix equation (AXB,CXD)=(E,F), and give the explicit expressions of least squares Hermitian indeterminate admittance solution with the least norm in each method. We mainly adopt the Moore-Penrose generalized inverse and Kronecker product in Method I and a matrix-vector product in Method II, respectively.
文摘Based on the character of the internal force distribution of the statically indeterminate truss, the elements stresses were changed by adjusting the length of bars to increase load capacity of structure. The efficiency of the method is illustrated by several examples.
文摘Strong and weak limits as well as strong and weak differentials of multi-variable indeterminate forms are discussed based on the thorough exploration of differentiation to solve the strong and weak limits and differentials of unitary indeterminate forms. The fruit of this work is going to be reported in three parts. The first part presents the standard analysis on this subject which supplements, systematizes and advances L. Hospital抯 principles on differential calculus by applying special ,general, and limit guaranteeing theories together with K(t) and XhK0 theories. The combination of theoretical analysis and geometric signification makes the derivation intuitional, visual and easy to perceive.
文摘Various transforms of the indeterminate forms are presented in this part, which include simplification in spherical coordinates, origin translation, axis alteration, transformation of limit conservation and application of Xh?K0. Fundamental factors for numerical simplification are provided respectively for bi-variable indeterminate forms, tri-variable indeterminate forms and the universal extending multiplier.
