BACKGROUND:Pulse indicated continuous cardiac output(PiCCO)has largely replaced Swan-Ganz catheterization in shock patients.However,whether PiCCO monitoring can improve outcomes of shock patients,such as mortality,len...BACKGROUND:Pulse indicated continuous cardiac output(PiCCO)has largely replaced Swan-Ganz catheterization in shock patients.However,whether PiCCO monitoring can improve outcomes of shock patients,such as mortality,length of hospital stay,duration of mechanical ventilation,or laboratory parameters,remains unknown.METHODS:This retrospective cohort study included patients with shock in the intensive care unit(ICU)from January 2013 to January 2020.Patients were divided into PiCCO group and non-PiCCO group based on treatment with PiCCO monitoring or not.Demographic characteristics,Acute Physiology and Chronic Health Evaluation(APACHE)II scores,quick Sequential Organ Failure Assessment(qSOFA)scores,14-day mortality,and N-terminal pro-B-type natriuretic peptide(NT-proBNP)levels at 0,1,3 and 7 days after onset of shock,duration of mechanical ventilation,length of hospital stay and hospitalization costs were compiled and analyzed using propensity score matching(PSM).RESULTS:Real-world analysis of 1,583 ICU patients suff ering shock after propensity score matching revealed that 14-day mortality did not differ between PiCCO and non-PiCCO groups(36.2%vs.32.6%,P=0.343).Duration of mechanical ventilation,hospital stay,and hospitalization costs were also similar between the two groups(P>0.05).No diff erences in changes of NT-proBNP levels on days 0,1,3,and 7 as compared to baseline were noted between the two groups(P>0.05).CONCLUSIONS:The results of our real-world indicate that PiCCO monitoring may not shorten the duration of mechanical ventilation,length of hospital stay,or reduce hospitalization costs,nor will it bring survival benefi ts to ICU patients suff ering shock.展开更多
Matrix metalloproteinases（MMPs）are members of the metzincin superfamily named after the zinc ion and the conserved methionine residue at the active site.In addition to their role in extracellular matrix（ECM）remode...Matrix metalloproteinases（MMPs）are members of the metzincin superfamily named after the zinc ion and the conserved methionine residue at the active site.In addition to their role in extracellular matrix（ECM）remodeling,these proteinases（in）activate many signaling molecules such as growth factors.展开更多
Objective There is a large population of patients classified as complex higher-risk and indicated patients(CHIPs)in China with a poor prognosis.The treatment of these patients is complex and challenging,especially whe...Objective There is a large population of patients classified as complex higher-risk and indicated patients(CHIPs)in China with a poor prognosis.The treatment of these patients is complex and challenging,especially when acute cardiac events occur,such as acute coronary syndrome(ACS)or heart failure.Pharmacotherapy and some mechanical circulatory support(MCS)therapeutic devices can provide stable hemodynamic support for CHIPs-percutaneous coronary intervention(PCI).LDL-C is an important pathogenic factor in atherosclerosis,and the target of blood lipid control.Recent studies have revealed that lipoprotein(a)[Lp(a)],which is formed when a covalent bond between apolipoprotein(a)and apolipoprotein B-100 is made,produces an LDL-like particle.This particle is an independent risk factor for the development of atherosclerosis,and is closely correlated to stent thrombosis and restenosis.Furthermore,this requires active intervention.PCSK9 inhibitors have been used in lipid-lowering treatment,and preventing atherosclerosis.The present study explores the efficacy of PCSK9 inhibitors in CHIPs-ACS,and the association between the change in Lp(a)and survival after 2 years of follow-up.Methods The present real-world,prospective control study enrolled 321 CHIPs-ACS who underwent emergency PCI from August 2019 to November 2020,and these patients were followed up for 2 years.These patients were divided into two groups:PCSK9 group(n=161)given the combined PCSK9 inhibitor(140 mg of evolocumab every 2 weeks)and statins-based therapy,and SOC group(n=160)treated with statin-based lipid-lowering therapy alone.Then,the change in lipid index was measured,and the cardiovascular(CV)event recurrence rate was evaluated after one month and 2 years.Afterwards,the contribution of serum lipid parameters,especially the Lp(a)alteration,in patients with earlier initiation of the PCSK9 inhibitor to the CV outcome was analyzed.Results The LDL-C level was significantly reduced in both groups:52.3%in the PCSK9 group and 32.3%(P<0.001)in the SOC group.It is noteworthy that the Lp(a)level decreased by 13.2%in the PCSK9 group,but increased by 30.3%in the SOC group(P<0.001).Furthermore,the number of CV events was not significantly different between the PCSK9 and SOC groups after the 2-year follow-up period.In the PCSK9 group,the Lp(a)reduction was associated with the baseline Lp(a)levels of the patients(r2=−0.315,P<0.001).Moreover,the decrease in Lp(a)contributed to the decline in CV events in patients who received ACS CHIPs-PCI,and the decrease in Lp(a)level was independent of the LDL-C level reduction.Conclusion The early initiation of PCSK9 inhibitors can significantly reduce the LDL-C and Lp(a)levels in ACS CHIPs-PCI.However,further studies are needed to confirm whether PCSK9 inhibitors can reduce the incidence of CV disease in CHIPs.展开更多
Low hip bone mineral density(BMD)is an important index for osteoporosis and is associated with hip fracture,which leads to more cases of disability and mortality than all other kinds of fractures(Kanis et al.,2007).BM...Low hip bone mineral density(BMD)is an important index for osteoporosis and is associated with hip fracture,which leads to more cases of disability and mortality than all other kinds of fractures(Kanis et al.,2007).BMD’s heritability is more than 60%(Arden et al.,1996).A number of candidate loci for BMD have been previously identified by Genome Wide Association Studies(GWAS)(Xiong et al.,2009;Karasik et al.,2010;Zhang et al.,2013).Nevertheless,many significant signals based on GWAS are展开更多
Objective: We aimed to compare the perinatal outcomes in late preterm spontaneous and indicated birth neonates. Methods: We studied 289 late preterm births, classified as either aspontaneous late preterm birth (sLPTB)...Objective: We aimed to compare the perinatal outcomes in late preterm spontaneous and indicated birth neonates. Methods: We studied 289 late preterm births, classified as either aspontaneous late preterm birth (sLPTB) group (preterm labor with intact membranes and preterm premature rupture of membranes) or an indicated late preterm birth (iLPTB) group (hypertensive disorder in pregnancy, placental causes, and maternal diseases), according to the delivery indication. We then compared the maternal and neonatal characteristics and perinatal outcomes, including the Apgar score, admission to the neonatal intensive care unit (NICU) or special care nursery (SCN), duration of NICU stay, and the rate of composite morbidity (antibiotic use, hypoglycemia, hypocalcemia, hyperbilirubinemia requiring phototherapy, respiratory support, and respiratory distress syndrome). Results: A total of 198 neonates were in the sLPTB group and 91 were in the iLPTB group. In spite of greater gestational age at the time of delivery in the iLPTB group, the mean birth weight was lower than that in the sLPTB group. Additionally, the iLPTB group showed lower Apgar scores, and higher rates of NICU or SCN admission, respiratory support, and hypoglycemia, but there was no difference in the rate of composite morbidity between the two groups. Conclusion: iLPTB neonates had lower birth weights despite greater gestational age than those in the sLPTB group, but there was no difference in the rate of composite morbidity between the two groups.展开更多
Several complications of insertion and use of pulmonary artery catheter （PAC）, including catheter entrapment, are recognized during or after cardiac surgery. Early detection is very important. We report a case of PA...Several complications of insertion and use of pulmonary artery catheter （PAC）, including catheter entrapment, are recognized during or after cardiac surgery. Early detection is very important. We report a case of PAC entrapment because the the catheter was accidentally su- tured to the superior vena cava. Bleeding from the thermistor connector was initially detected after surgery because the needle punctured the lumen of thermistor connector. The PAC was removed through re-exploration. Therefore, bleeding from the thermistor connector could early indicate the PAC entrapment. We suggest that abnormal bleeding from the non-injectate lumen ports of PAC should be checked before sternal closure.展开更多
At each and every moment the things of our universe are subject to change. The human body too,from the very moment it is born, begins the process that will ultimately lead to death.
Complex higher-risk and indicated patients (CHIPs) refers to patients with severe coronary artery disease (CAD) needing revascularization. However, these patients are at an increased risk for this procedure.[1] The CH...Complex higher-risk and indicated patients (CHIPs) refers to patients with severe coronary artery disease (CAD) needing revascularization. However, these patients are at an increased risk for this procedure.[1] The CHIP population is attracting much interest in the field of interventional cardiology, since it was introduced in 2016 by Kirtane et al,[1] and the optimal treatment strategies for this population were fiercely discussed in almost every interventional forum at home and abroad. First of all, a comprehensive risk assessment must be conducted to determine which patients with CAD should undergo revascularization based on clinical presentation, functional tests, and anatomic characteristics. Percutaneous coronary intervention (PCI) might be a beneficial option when complete revascularization can be achieved, especially for patients are either inoperable or at higher surgical risk.[2,3] To treat these high-risk patients safely and effectively with PCI, well-trained interventionalists exhibiting both technical and cognitive skills are needed.展开更多
Metastases may occur in node-negative breast cancer patients. It indicates that breast cancer cells can bypass regional lymph nodes and hematogenously disseminate to distant organs. In a recent paper (Clin Cancer Res ...Metastases may occur in node-negative breast cancer patients. It indicates that breast cancer cells can bypass regional lymph nodes and hematogenously disseminate to distant organs. In a recent paper (Clin Cancer Res 2006, 12:1715-1720) , Wulfing et al. evaluated the prognostic value of blood-borne, HER2-positive circulating tumor cells (CTC) in the peripheral blood from 42 breast cancer patients with a median follow-up of 95 months. HER2-展开更多
China’s shipbuilding industry maintained the world’s largest market share in terms of three major indicators for the 16th consecutive year in 2025,according to data released by the Ministry of Industry and Informati...China’s shipbuilding industry maintained the world’s largest market share in terms of three major indicators for the 16th consecutive year in 2025,according to data released by the Ministry of Industry and Information Technology on 1 February.展开更多
Antibiotics are widespread in aquatic environments due to their extensive use in human healthcare and ani-mal husbandry.However,research on the occurrence and bioaccumulation of antibiotics in aquatic organisms within...Antibiotics are widespread in aquatic environments due to their extensive use in human healthcare and ani-mal husbandry.However,research on the occurrence and bioaccumulation of antibiotics in aquatic organisms within shallow wetland lakes remains limited.This study investigated the occurrence and bioaccumulation of ten commonly used antibiotics in the Baiyang Lake,northern China’s largest shallow wetland lake.The results indicated that sulfonamides and fluoroquinolones were the predominant antibiotics in surface water,whereas fluoroquinolones and macrolides were more prevalent in sediment.Fluoroquinolones demonstrated significant potential for bioaccumulation in targeted aquatic organisms,including both animals and plants(Carassius au-ratus and Phragmites australis).The bioaccumulation of antibiotics in Carassius auratus was correlated with their solubility,whereas in Phragmites australis,this was associated with their octanol-water partition coefficients and molecular weights.Ecological risk assessment indicated that most antibiotics posed minimal to low risk levels.However,four antibiotics were exceptions:clarithromycin(12.5%)and sulfamethoxazole(6.25%)presented a high risk in surface water samples,while norfloxacin(25.0%)and ciprofloxacin(25.0%)posed a high risk in sediment samples.Norfloxacin,ciprofloxacin,and roxithromycin were identified as key indicator antibiotics for enhancing the local monitoring and control of antibiotic contamination based on four criteria:(1)high con-centrations,(2)frequent detection,(3)capacity for bioaccumulation,and(4)ecological risk levels.This study contributes to a deeper understanding of the status of antibiotic contamination,bioaccumulation characteristics,and ecological risk in Baiyang Lake,thereby supporting efforts to monitor and regulate antibiotic pollution.展开更多
Objective:To analyze the therapeutic effect of laparoscopy combined with choledochoscopy in the treatment of difficult cholelithiasis.Methods:A total of 60 patients with difficult cholelithiasis admitted for treatment...Objective:To analyze the therapeutic effect of laparoscopy combined with choledochoscopy in the treatment of difficult cholelithiasis.Methods:A total of 60 patients with difficult cholelithiasis admitted for treatment from January 2022 to December 2024 were selected and evenly divided into two groups using a random number table.The combined group received laparoscopy combined with choledochoscopy treatment,while the single group received laparoscopy treatment alone.The total treatment efficacy,perioperative indicators,angiotensin(Ang)levels,quality of life scores,and complication rates were compared between the two groups.Results:The total treatment efficacy in the combined group was higher than that in the single group;except for operative time,the perioperative indicators in the combined group were superior to those in the single group;the Ang levels after treatment in the combined group were lower than those in the single group,and the quality of life scores were higher(P<0.05).The complication rate in the combined group was lower than that in the single group(P<0.05).Conclusion:Laparoscopy combined with choedochoscopy can enhance the treatment effectiveness for patients with difficult cholelithiasis,improve perioperative indicators,regulate their Ang levels,elevate quality of life,and demonstrate high surgical safety.展开更多
Recently,the China National Intellectual Property Administration released the"List of Enterprises Approved to Use the Geographical Indication Logo."The"Wujiang Silk"geographical indication logo has...Recently,the China National Intellectual Property Administration released the"List of Enterprises Approved to Use the Geographical Indication Logo."The"Wujiang Silk"geographical indication logo has been renewed and launched.This official approval serves to distinguish and celebrate the quality and cultural heritage of Shengze silk,and the use of this symbol is a testament to that distinction.Three enterprises from Shengze have been approved to use the logo:Saint Joy,Huajia Silk,and Xinmin Silk.展开更多
Objective:To investigate the spatial gradient of intraoperative impedance across the cochlear electrode array in pediatric cochlear implant recipients and assess its potential as a physiological indicator for the elec...Objective:To investigate the spatial gradient of intraoperative impedance across the cochlear electrode array in pediatric cochlear implant recipients and assess its potential as a physiological indicator for the electrode-neural interface.Methods:A prospective observational study involving 56 pediatric patients underwent cochlear implantation with Cochlear Nucleus devices.Intraoperative polarized impedance and electrically evoked compound action potential(ECAP)threshold were recorded across all 1232 electrodes using AutoNRT software.Eight electrodes with open-or short-circuit were excluded,leaving 1,224 for analysis.Impedance values were categorized by cochlear region(basal,middle,apical),and electrodes with elevated impedance(10-20 kΩ)were analyzed for regional distribution and clinical relevance.Data were analyzed for spatial patterns and correlation with the ECAP threshold profiles.Results:A consistent basal-to-apical increase in impedance was observed(7.7±1.9,9.2±1.4,10.8±1.5 kΩ;p<0.001).Impedance and ECAP threshold were weakly correlated(ρ=-0.20,p<0.001;β=-1.26,p<0.001),with a positive association in the apical region(ρ=0.12,p=0.048).Electrodes with higher impedance(1020 kΩ)were less likely to show elevated or absent TNRT(OR=0.175,p=0.02).The impedance gradient persisted across age groups and was significantly correlated with ECAP threshold patterns.Conclusion:Intraoperative impedance monitoring reveals a strong and physiologically consistent gradient,with higher values in apical electrodes.This gradient reflects anatomical and tissue interface variations,which may offer a valuable physiological indicator for intraoperative electrode positioning and neural interface integrity.展开更多
Under earthquake action, different site conditions have a notable impact on the dynamic response of high-speed railway bridges after earthquakes, which in turn poses a threat to the running stability of trains in the ...Under earthquake action, different site conditions have a notable impact on the dynamic response of high-speed railway bridges after earthquakes, which in turn poses a threat to the running stability of trains in the post-earthquake period. Therefore, establishing a calculation method for the post-earthquake train speed threshold that considers the influence of different site characteristics is of great engineering significance. Taking the CRTS Ⅲ slab track as the research object, this study is based on the track irregularity root mean square rate(TRR), which the authors proposed earlier to quantify the track regularity level. Using the nonlinear least squares fitting method, the mapping relationship between the TRR and the postearthquake train running performance indicators on bridges is established. Furthermore, the influence of laws governing site categories and train speeds on post-earthquake train running performance on bridges is analyzed, and a train speed threshold for bridges based on running performance under random site conditions is proposed. The research results indicate that all train running performance indicators increase significantly with the increase of train operating speed;different site categories have a significant impact on post-earthquake track residual deformation and train running stability. The greater the amplitude of postearthquake track alignment residual deformation, the lower the threshold for the stable running speed of trains after the earthquake, with the speed threshold decreasing by up to 20%. The research outcomes can provide technical references for the post-earthquake safe operation and maintenance of high-speed railway bridges under complex site conditions, as well as the formulation of targeted train speed control schemes.展开更多
BACKGROUND Inappropriate selection of patients with early gastric cancer(EGC)for endoscopic submucosal dissection(ESD)may lead to non-curative resection,necessitating additional gastrectomy.Conversely,inappropriate se...BACKGROUND Inappropriate selection of patients with early gastric cancer(EGC)for endoscopic submucosal dissection(ESD)may lead to non-curative resection,necessitating additional gastrectomy.Conversely,inappropriate selection for gastrectomy may result in overtreatment,adversely affecting patients’quality of life.Few have systematically evaluated the concordance between therapeutic indications under current Japanese guidelines and pathological criteria in EGC.To minimize noncurative resection risks while sparing unnecessary surgery for low-risk patients’,we specifically assess the suitability of Japanese guidelines in non-Japanese populations.This work aims to optimize clinical practice by refining endoscopic treatment criteria for adoption beyond Japan.AIM To evaluate EGC clinical decision accuracy by comparing therapeutic indication with postoperative pathological criteria and analyzing factors influencing discrepancies.METHODS A retrospective analysis was conducted on 796 EGC cases diagnosed at Peking University Third Hospital between January 2010 and December 2022.Cases were categorized into three groups:Same-estimated(preoperative therapeutic indication with postoperative pathological criteria matched),underestimated(preoperative ESD indication but postoperative surgical criteria),and overestimated(preoperative surgical indication but postoperative ESD criteria).The rate of discrepancy and associated risk factors were assessed.RESULTS The accuracy rates of preoperative evaluation for ESD and gastrectomy indications were 73.0%(321/430)and 76.0%(278/366),respectively.The overall discrepancy rate was 25.6%(204/796).Multivariate analysis identified tumor location in the upper-third stomach(odds ratio=2.158,95%confidence interval:1.373-3.390,P=0.001)was significantly associated with a higher likelihood of being underestimated and undifferentiated histologic type on preoperative biopsy(odds ratio=2.005,95%confidence interval:1.036-3.879,P=0.039)was more likely to be overestimated.Significant differences were observed in tumor diameter(P<0.001),depth of infiltration(P<0.001),ulcerative findings(P<0.001),and histologic type(P<0.001)between preoperative and postoperative evaluations.CONCLUSION The accuracy of preoperative EGC indications is 74.4%.Upper-third stomach and undifferentiated histology are primary discrepancy predictors.Upper-third tumors are prone to underestimation,while undifferentiated tumors are prone to overestimation.展开更多
The Almus Fault Zone(AFZ)is one of the major splay faults of the North Anatolian Fault Zone(NAFZ)and is important for understanding its tectonic features and assessing regional seismic hazards.This research presents t...The Almus Fault Zone(AFZ)is one of the major splay faults of the North Anatolian Fault Zone(NAFZ)and is important for understanding its tectonic features and assessing regional seismic hazards.This research presents the integration of morphometric indices to quantitatively assess the spatial variation of tectonic activity along the AFZ.The AFZ is an active fault with both strike-slip and normal fault components and consists of two main branches,Mercimekdağı-Çamdere Fault(MÇF)and Tokat Fault(TF)segments.This study aims to assess the relative tectonic activity of the AFZ using various morphometric indices,based on a 10 m resolution DEM,with the aid of ArcGIS and MATLAB software.For this purpose,morphometric indices such as hypsometric integral(HI:0.35-0.65),mountain front sinuosity(Smf:1.3-1.44),valley floor width-height ratio(Vf:0.15-2.28),asymmetry factor(AF:23-77),drainage basin shape(Bs:1.13-6.10)and normalized steepness index(ksn:1-498)were applied to 53 drainage basins.When the Smf and mean Vf indices results were evaluated,it was calculated that the uplift ratio of the region was more than 0.5 mm/yr.The spatial distribution of the relative tectonic activity(Iat)of the area was revealed by combining the obtained morphometric indices analysis results.According to the Iat result,it was concluded that the MercimekdağıÇamdere Fault and Tokat Fault segments have high tectonic activity,but the Mercimekdağı-Çamdere Fault segment has higher tectonic activity.The results obtained were also confirmed by field observations.This research provides valuable information for the evaluation of tectonic activity in drainage systems controlled by splay faults.展开更多
We used solidification/stabilization methods to remediate highly concentrated Zn^(2+)-contaminated soil.An industrial waste mixture of red mud,carbide slag,and phosphogypsum is combined with cement as the curing agent...We used solidification/stabilization methods to remediate highly concentrated Zn^(2+)-contaminated soil.An industrial waste mixture of red mud,carbide slag,and phosphogypsum is combined with cement as the curing agent.The mixing ratios of the four materials are determined by comparing the strength,permeability coefficient,pH,and Zn^(2+)-leaching concentration of the solidified soil.Microscopic characteristics of the solidified uncontaminated soil and solidified Zn^(2+)-contaminated soil were observed using scanning electron microscopy,X-ray diffraction,and Fourier-transform infrared spectroscopy.Furthermore,the heavy metals speciation in both pure cement and mixed-material solidified soil was examined,demonstrating the beneficial role of the mixed-type curing agent in stabilizing heavy metals.The research results indicate that Zn^(2+)degrade the strength of the solidified soil by up to 90%.The permeability coefficient,pH,and Zn^(2+)-leaching concentration of the solidified soil easily meet standard,especially with Zn^(2+)leaching concentration well below the environmental protection limit.Furthermore,most Zn^(2+)exists in forms with lower biological and chemical reactivity.Both the solidified Zn^(2+)-contaminated soil and uncontaminated soil resulted in the formation of hydrated products containing elements such as silicon,aluminum,calcium,and sulfur.Additionally,the solidified Zn^(2+)-contaminated soil produced zinc-containing compounds and a large amount of rod-shaped ettringite.展开更多
The concept of geographical indication is similar to the idea of authentic medicinal herbs in traditional Chinese medicine. This paper examines the geographical indication (GI) resources of medicinal herbs in the Wuli...The concept of geographical indication is similar to the idea of authentic medicinal herbs in traditional Chinese medicine. This paper examines the geographical indication (GI) resources of medicinal herbs in the Wuling Mountain Area from various perspectives, including geographical indication products, geographical indication trademarks, China s geographical indication products mutually recognized and protected with the EU, geographical indication standards, and the exclusive geographical indication logo. It studies the regional public brand characteristics of Chinese authentic medicinal herbs, based on hometown of authentic Chinese medicinal herbs, advantageous regions of characteristic agricultural products, important agricultural cultural heritage, national famous and excellent new agricultural products, national characteristic agricultural products, geographical indication Chinese well-known trademarks, advantageous regions of characteristic agricultural products, and regional public brands of agricultural products. It analyzes the main problems in the protection of geographical indications and the creation of regional public brands, and proposes suggestions for building high-quality authentic medicinal herb bases, developing new quality productivity in the authentic medicinal herb industry, implementing regional brand strategies for authentic medicinal herbs, constructing a new development pattern of dual circulation authentic medicinal herbs, etc.展开更多
文摘BACKGROUND:Pulse indicated continuous cardiac output(PiCCO)has largely replaced Swan-Ganz catheterization in shock patients.However,whether PiCCO monitoring can improve outcomes of shock patients,such as mortality,length of hospital stay,duration of mechanical ventilation,or laboratory parameters,remains unknown.METHODS:This retrospective cohort study included patients with shock in the intensive care unit(ICU)from January 2013 to January 2020.Patients were divided into PiCCO group and non-PiCCO group based on treatment with PiCCO monitoring or not.Demographic characteristics,Acute Physiology and Chronic Health Evaluation(APACHE)II scores,quick Sequential Organ Failure Assessment(qSOFA)scores,14-day mortality,and N-terminal pro-B-type natriuretic peptide(NT-proBNP)levels at 0,1,3 and 7 days after onset of shock,duration of mechanical ventilation,length of hospital stay and hospitalization costs were compiled and analyzed using propensity score matching(PSM).RESULTS:Real-world analysis of 1,583 ICU patients suff ering shock after propensity score matching revealed that 14-day mortality did not differ between PiCCO and non-PiCCO groups(36.2%vs.32.6%,P=0.343).Duration of mechanical ventilation,hospital stay,and hospitalization costs were also similar between the two groups(P>0.05).No diff erences in changes of NT-proBNP levels on days 0,1,3,and 7 as compared to baseline were noted between the two groups(P>0.05).CONCLUSIONS:The results of our real-world indicate that PiCCO monitoring may not shorten the duration of mechanical ventilation,length of hospital stay,or reduce hospitalization costs,nor will it bring survival benefi ts to ICU patients suff ering shock.
基金supported by the Hercules Foundation(AKUL/09/038&AKUL/13/09)national grants from the Research Council of KU Leuven(BOF-OT/14/064)+1 种基金the Research Foundation Flanders(FWO G0B2315N)the Flemish Institute for the promotion of scientific research(IWT)
文摘Matrix metalloproteinases（MMPs）are members of the metzincin superfamily named after the zinc ion and the conserved methionine residue at the active site.In addition to their role in extracellular matrix（ECM）remodeling,these proteinases（in）activate many signaling molecules such as growth factors.
基金the Translational Medicine and Interdisciplinary Research Joint Fund of Zhongnan Hospital of Wuhan University(No.ZNLH-201907)the Hubei Province Health and Family Planning Scientific Research Project(No.WJ2019Q041)the Chinese Academy of Medical Science Innovation Fund for Medical Sciences(No.2021-I2M-1-009).
文摘Objective There is a large population of patients classified as complex higher-risk and indicated patients(CHIPs)in China with a poor prognosis.The treatment of these patients is complex and challenging,especially when acute cardiac events occur,such as acute coronary syndrome(ACS)or heart failure.Pharmacotherapy and some mechanical circulatory support(MCS)therapeutic devices can provide stable hemodynamic support for CHIPs-percutaneous coronary intervention(PCI).LDL-C is an important pathogenic factor in atherosclerosis,and the target of blood lipid control.Recent studies have revealed that lipoprotein(a)[Lp(a)],which is formed when a covalent bond between apolipoprotein(a)and apolipoprotein B-100 is made,produces an LDL-like particle.This particle is an independent risk factor for the development of atherosclerosis,and is closely correlated to stent thrombosis and restenosis.Furthermore,this requires active intervention.PCSK9 inhibitors have been used in lipid-lowering treatment,and preventing atherosclerosis.The present study explores the efficacy of PCSK9 inhibitors in CHIPs-ACS,and the association between the change in Lp(a)and survival after 2 years of follow-up.Methods The present real-world,prospective control study enrolled 321 CHIPs-ACS who underwent emergency PCI from August 2019 to November 2020,and these patients were followed up for 2 years.These patients were divided into two groups:PCSK9 group(n=161)given the combined PCSK9 inhibitor(140 mg of evolocumab every 2 weeks)and statins-based therapy,and SOC group(n=160)treated with statin-based lipid-lowering therapy alone.Then,the change in lipid index was measured,and the cardiovascular(CV)event recurrence rate was evaluated after one month and 2 years.Afterwards,the contribution of serum lipid parameters,especially the Lp(a)alteration,in patients with earlier initiation of the PCSK9 inhibitor to the CV outcome was analyzed.Results The LDL-C level was significantly reduced in both groups:52.3%in the PCSK9 group and 32.3%(P<0.001)in the SOC group.It is noteworthy that the Lp(a)level decreased by 13.2%in the PCSK9 group,but increased by 30.3%in the SOC group(P<0.001).Furthermore,the number of CV events was not significantly different between the PCSK9 and SOC groups after the 2-year follow-up period.In the PCSK9 group,the Lp(a)reduction was associated with the baseline Lp(a)levels of the patients(r2=−0.315,P<0.001).Moreover,the decrease in Lp(a)contributed to the decline in CV events in patients who received ACS CHIPs-PCI,and the decrease in Lp(a)level was independent of the LDL-C level reduction.Conclusion The early initiation of PCSK9 inhibitors can significantly reduce the LDL-C and Lp(a)levels in ACS CHIPs-PCI.However,further studies are needed to confirm whether PCSK9 inhibitors can reduce the incidence of CV disease in CHIPs.
基金partially supported by or benefited from grants from NIH (P50AR055081,R01AG026564,R01AR050496,R01AR059781,D43TW009107,P20GM109036,R01GM109068,R01MH104680,R01MH107354,R01AR057049,and R03TW008221)
文摘Low hip bone mineral density(BMD)is an important index for osteoporosis and is associated with hip fracture,which leads to more cases of disability and mortality than all other kinds of fractures(Kanis et al.,2007).BMD’s heritability is more than 60%(Arden et al.,1996).A number of candidate loci for BMD have been previously identified by Genome Wide Association Studies(GWAS)(Xiong et al.,2009;Karasik et al.,2010;Zhang et al.,2013).Nevertheless,many significant signals based on GWAS are
文摘Objective: We aimed to compare the perinatal outcomes in late preterm spontaneous and indicated birth neonates. Methods: We studied 289 late preterm births, classified as either aspontaneous late preterm birth (sLPTB) group (preterm labor with intact membranes and preterm premature rupture of membranes) or an indicated late preterm birth (iLPTB) group (hypertensive disorder in pregnancy, placental causes, and maternal diseases), according to the delivery indication. We then compared the maternal and neonatal characteristics and perinatal outcomes, including the Apgar score, admission to the neonatal intensive care unit (NICU) or special care nursery (SCN), duration of NICU stay, and the rate of composite morbidity (antibiotic use, hypoglycemia, hypocalcemia, hyperbilirubinemia requiring phototherapy, respiratory support, and respiratory distress syndrome). Results: A total of 198 neonates were in the sLPTB group and 91 were in the iLPTB group. In spite of greater gestational age at the time of delivery in the iLPTB group, the mean birth weight was lower than that in the sLPTB group. Additionally, the iLPTB group showed lower Apgar scores, and higher rates of NICU or SCN admission, respiratory support, and hypoglycemia, but there was no difference in the rate of composite morbidity between the two groups. Conclusion: iLPTB neonates had lower birth weights despite greater gestational age than those in the sLPTB group, but there was no difference in the rate of composite morbidity between the two groups.
基金supported by special research program, Ministry of Health, China (200902001)
文摘Several complications of insertion and use of pulmonary artery catheter （PAC）, including catheter entrapment, are recognized during or after cardiac surgery. Early detection is very important. We report a case of PAC entrapment because the the catheter was accidentally su- tured to the superior vena cava. Bleeding from the thermistor connector was initially detected after surgery because the needle punctured the lumen of thermistor connector. The PAC was removed through re-exploration. Therefore, bleeding from the thermistor connector could early indicate the PAC entrapment. We suggest that abnormal bleeding from the non-injectate lumen ports of PAC should be checked before sternal closure.
文摘At each and every moment the things of our universe are subject to change. The human body too,from the very moment it is born, begins the process that will ultimately lead to death.
基金This work was supported by grants from the National Key Research and Development Program of China(2017YFC0908800)Beijing Municipal Administration of Hospitals5 Ascent Plan(DFL20150601)+1 种基金 Mission Plan(SML20180601) Beijing Municipal Health Commission "Project of Science and Technology Innovation Center"(PXM2019_026272_000006)(PXM2019_026272_000005).
文摘Complex higher-risk and indicated patients (CHIPs) refers to patients with severe coronary artery disease (CAD) needing revascularization. However, these patients are at an increased risk for this procedure.[1] The CHIP population is attracting much interest in the field of interventional cardiology, since it was introduced in 2016 by Kirtane et al,[1] and the optimal treatment strategies for this population were fiercely discussed in almost every interventional forum at home and abroad. First of all, a comprehensive risk assessment must be conducted to determine which patients with CAD should undergo revascularization based on clinical presentation, functional tests, and anatomic characteristics. Percutaneous coronary intervention (PCI) might be a beneficial option when complete revascularization can be achieved, especially for patients are either inoperable or at higher surgical risk.[2,3] To treat these high-risk patients safely and effectively with PCI, well-trained interventionalists exhibiting both technical and cognitive skills are needed.
文摘Metastases may occur in node-negative breast cancer patients. It indicates that breast cancer cells can bypass regional lymph nodes and hematogenously disseminate to distant organs. In a recent paper (Clin Cancer Res 2006, 12:1715-1720) , Wulfing et al. evaluated the prognostic value of blood-borne, HER2-positive circulating tumor cells (CTC) in the peripheral blood from 42 breast cancer patients with a median follow-up of 95 months. HER2-
文摘China’s shipbuilding industry maintained the world’s largest market share in terms of three major indicators for the 16th consecutive year in 2025,according to data released by the Ministry of Industry and Information Technology on 1 February.
基金supported by Hebei Natural Science Foundation(No.JZX2023018)Hebei Natural Science Foundation(No.C2022201042)the 100 Foreign Experts Plans of Hebei Province(No.606080123001).
文摘Antibiotics are widespread in aquatic environments due to their extensive use in human healthcare and ani-mal husbandry.However,research on the occurrence and bioaccumulation of antibiotics in aquatic organisms within shallow wetland lakes remains limited.This study investigated the occurrence and bioaccumulation of ten commonly used antibiotics in the Baiyang Lake,northern China’s largest shallow wetland lake.The results indicated that sulfonamides and fluoroquinolones were the predominant antibiotics in surface water,whereas fluoroquinolones and macrolides were more prevalent in sediment.Fluoroquinolones demonstrated significant potential for bioaccumulation in targeted aquatic organisms,including both animals and plants(Carassius au-ratus and Phragmites australis).The bioaccumulation of antibiotics in Carassius auratus was correlated with their solubility,whereas in Phragmites australis,this was associated with their octanol-water partition coefficients and molecular weights.Ecological risk assessment indicated that most antibiotics posed minimal to low risk levels.However,four antibiotics were exceptions:clarithromycin(12.5%)and sulfamethoxazole(6.25%)presented a high risk in surface water samples,while norfloxacin(25.0%)and ciprofloxacin(25.0%)posed a high risk in sediment samples.Norfloxacin,ciprofloxacin,and roxithromycin were identified as key indicator antibiotics for enhancing the local monitoring and control of antibiotic contamination based on four criteria:(1)high con-centrations,(2)frequent detection,(3)capacity for bioaccumulation,and(4)ecological risk levels.This study contributes to a deeper understanding of the status of antibiotic contamination,bioaccumulation characteristics,and ecological risk in Baiyang Lake,thereby supporting efforts to monitor and regulate antibiotic pollution.
文摘Objective:To analyze the therapeutic effect of laparoscopy combined with choledochoscopy in the treatment of difficult cholelithiasis.Methods:A total of 60 patients with difficult cholelithiasis admitted for treatment from January 2022 to December 2024 were selected and evenly divided into two groups using a random number table.The combined group received laparoscopy combined with choledochoscopy treatment,while the single group received laparoscopy treatment alone.The total treatment efficacy,perioperative indicators,angiotensin(Ang)levels,quality of life scores,and complication rates were compared between the two groups.Results:The total treatment efficacy in the combined group was higher than that in the single group;except for operative time,the perioperative indicators in the combined group were superior to those in the single group;the Ang levels after treatment in the combined group were lower than those in the single group,and the quality of life scores were higher(P<0.05).The complication rate in the combined group was lower than that in the single group(P<0.05).Conclusion:Laparoscopy combined with choedochoscopy can enhance the treatment effectiveness for patients with difficult cholelithiasis,improve perioperative indicators,regulate their Ang levels,elevate quality of life,and demonstrate high surgical safety.
文摘Recently,the China National Intellectual Property Administration released the"List of Enterprises Approved to Use the Geographical Indication Logo."The"Wujiang Silk"geographical indication logo has been renewed and launched.This official approval serves to distinguish and celebrate the quality and cultural heritage of Shengze silk,and the use of this symbol is a testament to that distinction.Three enterprises from Shengze have been approved to use the logo:Saint Joy,Huajia Silk,and Xinmin Silk.
文摘Objective:To investigate the spatial gradient of intraoperative impedance across the cochlear electrode array in pediatric cochlear implant recipients and assess its potential as a physiological indicator for the electrode-neural interface.Methods:A prospective observational study involving 56 pediatric patients underwent cochlear implantation with Cochlear Nucleus devices.Intraoperative polarized impedance and electrically evoked compound action potential(ECAP)threshold were recorded across all 1232 electrodes using AutoNRT software.Eight electrodes with open-or short-circuit were excluded,leaving 1,224 for analysis.Impedance values were categorized by cochlear region(basal,middle,apical),and electrodes with elevated impedance(10-20 kΩ)were analyzed for regional distribution and clinical relevance.Data were analyzed for spatial patterns and correlation with the ECAP threshold profiles.Results:A consistent basal-to-apical increase in impedance was observed(7.7±1.9,9.2±1.4,10.8±1.5 kΩ;p<0.001).Impedance and ECAP threshold were weakly correlated(ρ=-0.20,p<0.001;β=-1.26,p<0.001),with a positive association in the apical region(ρ=0.12,p=0.048).Electrodes with higher impedance(1020 kΩ)were less likely to show elevated or absent TNRT(OR=0.175,p=0.02).The impedance gradient persisted across age groups and was significantly correlated with ECAP threshold patterns.Conclusion:Intraoperative impedance monitoring reveals a strong and physiologically consistent gradient,with higher values in apical electrodes.This gradient reflects anatomical and tissue interface variations,which may offer a valuable physiological indicator for intraoperative electrode positioning and neural interface integrity.
基金supported by the Science and Technology Research and Development Program Project of China Railway Group Limited (Grant No.2022-Major-17)the National Natural Science Foundation of China (Grant Nos.52578619,52178180)+2 种基金the National Key Research and Development Program of China (Grant No.2022YFC3004304)the Frontier Cross Research Project of Central South University (Grant No.2023QYJC006)the Natural Science Foundation of Hunan Province Funding Project (Grant No.2023JJ40724)。
文摘Under earthquake action, different site conditions have a notable impact on the dynamic response of high-speed railway bridges after earthquakes, which in turn poses a threat to the running stability of trains in the post-earthquake period. Therefore, establishing a calculation method for the post-earthquake train speed threshold that considers the influence of different site characteristics is of great engineering significance. Taking the CRTS Ⅲ slab track as the research object, this study is based on the track irregularity root mean square rate(TRR), which the authors proposed earlier to quantify the track regularity level. Using the nonlinear least squares fitting method, the mapping relationship between the TRR and the postearthquake train running performance indicators on bridges is established. Furthermore, the influence of laws governing site categories and train speeds on post-earthquake train running performance on bridges is analyzed, and a train speed threshold for bridges based on running performance under random site conditions is proposed. The research results indicate that all train running performance indicators increase significantly with the increase of train operating speed;different site categories have a significant impact on post-earthquake track residual deformation and train running stability. The greater the amplitude of postearthquake track alignment residual deformation, the lower the threshold for the stable running speed of trains after the earthquake, with the speed threshold decreasing by up to 20%. The research outcomes can provide technical references for the post-earthquake safe operation and maintenance of high-speed railway bridges under complex site conditions, as well as the formulation of targeted train speed control schemes.
基金Supported by China Health&Medical Development Foundation,No.M2021551.
文摘BACKGROUND Inappropriate selection of patients with early gastric cancer(EGC)for endoscopic submucosal dissection(ESD)may lead to non-curative resection,necessitating additional gastrectomy.Conversely,inappropriate selection for gastrectomy may result in overtreatment,adversely affecting patients’quality of life.Few have systematically evaluated the concordance between therapeutic indications under current Japanese guidelines and pathological criteria in EGC.To minimize noncurative resection risks while sparing unnecessary surgery for low-risk patients’,we specifically assess the suitability of Japanese guidelines in non-Japanese populations.This work aims to optimize clinical practice by refining endoscopic treatment criteria for adoption beyond Japan.AIM To evaluate EGC clinical decision accuracy by comparing therapeutic indication with postoperative pathological criteria and analyzing factors influencing discrepancies.METHODS A retrospective analysis was conducted on 796 EGC cases diagnosed at Peking University Third Hospital between January 2010 and December 2022.Cases were categorized into three groups:Same-estimated(preoperative therapeutic indication with postoperative pathological criteria matched),underestimated(preoperative ESD indication but postoperative surgical criteria),and overestimated(preoperative surgical indication but postoperative ESD criteria).The rate of discrepancy and associated risk factors were assessed.RESULTS The accuracy rates of preoperative evaluation for ESD and gastrectomy indications were 73.0%(321/430)and 76.0%(278/366),respectively.The overall discrepancy rate was 25.6%(204/796).Multivariate analysis identified tumor location in the upper-third stomach(odds ratio=2.158,95%confidence interval:1.373-3.390,P=0.001)was significantly associated with a higher likelihood of being underestimated and undifferentiated histologic type on preoperative biopsy(odds ratio=2.005,95%confidence interval:1.036-3.879,P=0.039)was more likely to be overestimated.Significant differences were observed in tumor diameter(P<0.001),depth of infiltration(P<0.001),ulcerative findings(P<0.001),and histologic type(P<0.001)between preoperative and postoperative evaluations.CONCLUSION The accuracy of preoperative EGC indications is 74.4%.Upper-third stomach and undifferentiated histology are primary discrepancy predictors.Upper-third tumors are prone to underestimation,while undifferentiated tumors are prone to overestimation.
文摘The Almus Fault Zone(AFZ)is one of the major splay faults of the North Anatolian Fault Zone(NAFZ)and is important for understanding its tectonic features and assessing regional seismic hazards.This research presents the integration of morphometric indices to quantitatively assess the spatial variation of tectonic activity along the AFZ.The AFZ is an active fault with both strike-slip and normal fault components and consists of two main branches,Mercimekdağı-Çamdere Fault(MÇF)and Tokat Fault(TF)segments.This study aims to assess the relative tectonic activity of the AFZ using various morphometric indices,based on a 10 m resolution DEM,with the aid of ArcGIS and MATLAB software.For this purpose,morphometric indices such as hypsometric integral(HI:0.35-0.65),mountain front sinuosity(Smf:1.3-1.44),valley floor width-height ratio(Vf:0.15-2.28),asymmetry factor(AF:23-77),drainage basin shape(Bs:1.13-6.10)and normalized steepness index(ksn:1-498)were applied to 53 drainage basins.When the Smf and mean Vf indices results were evaluated,it was calculated that the uplift ratio of the region was more than 0.5 mm/yr.The spatial distribution of the relative tectonic activity(Iat)of the area was revealed by combining the obtained morphometric indices analysis results.According to the Iat result,it was concluded that the MercimekdağıÇamdere Fault and Tokat Fault segments have high tectonic activity,but the Mercimekdağı-Çamdere Fault segment has higher tectonic activity.The results obtained were also confirmed by field observations.This research provides valuable information for the evaluation of tectonic activity in drainage systems controlled by splay faults.
基金Funded by the National Natural Science Foundation of China(Nos.52378360,51978438)。
文摘We used solidification/stabilization methods to remediate highly concentrated Zn^(2+)-contaminated soil.An industrial waste mixture of red mud,carbide slag,and phosphogypsum is combined with cement as the curing agent.The mixing ratios of the four materials are determined by comparing the strength,permeability coefficient,pH,and Zn^(2+)-leaching concentration of the solidified soil.Microscopic characteristics of the solidified uncontaminated soil and solidified Zn^(2+)-contaminated soil were observed using scanning electron microscopy,X-ray diffraction,and Fourier-transform infrared spectroscopy.Furthermore,the heavy metals speciation in both pure cement and mixed-material solidified soil was examined,demonstrating the beneficial role of the mixed-type curing agent in stabilizing heavy metals.The research results indicate that Zn^(2+)degrade the strength of the solidified soil by up to 90%.The permeability coefficient,pH,and Zn^(2+)-leaching concentration of the solidified soil easily meet standard,especially with Zn^(2+)leaching concentration well below the environmental protection limit.Furthermore,most Zn^(2+)exists in forms with lower biological and chemical reactivity.Both the solidified Zn^(2+)-contaminated soil and uncontaminated soil resulted in the formation of hydrated products containing elements such as silicon,aluminum,calcium,and sulfur.Additionally,the solidified Zn^(2+)-contaminated soil produced zinc-containing compounds and a large amount of rod-shaped ettringite.
基金Supported by the Project of National Social Science Fund of China (22CMZ015).
文摘The concept of geographical indication is similar to the idea of authentic medicinal herbs in traditional Chinese medicine. This paper examines the geographical indication (GI) resources of medicinal herbs in the Wuling Mountain Area from various perspectives, including geographical indication products, geographical indication trademarks, China s geographical indication products mutually recognized and protected with the EU, geographical indication standards, and the exclusive geographical indication logo. It studies the regional public brand characteristics of Chinese authentic medicinal herbs, based on hometown of authentic Chinese medicinal herbs, advantageous regions of characteristic agricultural products, important agricultural cultural heritage, national famous and excellent new agricultural products, national characteristic agricultural products, geographical indication Chinese well-known trademarks, advantageous regions of characteristic agricultural products, and regional public brands of agricultural products. It analyzes the main problems in the protection of geographical indications and the creation of regional public brands, and proposes suggestions for building high-quality authentic medicinal herb bases, developing new quality productivity in the authentic medicinal herb industry, implementing regional brand strategies for authentic medicinal herbs, constructing a new development pattern of dual circulation authentic medicinal herbs, etc.
