Focal segmental glomerulosclerosis(FSGS)is a histological pattern of glomerular damage that significantly contributes to chronic kidney disease and end-stage renal disease.Its incidence is rising globally,necessitatin...Focal segmental glomerulosclerosis(FSGS)is a histological pattern of glomerular damage that significantly contributes to chronic kidney disease and end-stage renal disease.Its incidence is rising globally,necessitating timely and personalized management strategies.This paper aims to provide an updated overview of the pathophysiology,diagnosis,and therapeutic strategies for FSGS,emphasizing the importance of early interventions and tailored treatments.This editorial synthesizes key findings from recent literature to highlight advancements in understanding and managing FSGS.Emerging evidence supports the role of targeted therapies and personalized approaches in improving outcomes for FSGS patients.Advances include novel biomarkers,genetic testing,and innovative therapeutics such as transient receptor potential ion channel blockers and antisense oligonucleotides for apolipoprotein 1-related FSGS.Effective mana-gement of FSGS requires a combination of timely diagnosis,evidence-based therapeutic strategies,and ongoing research to optimize patient outcomes and address gaps in the current understanding of the disease.展开更多
When only a portion of the shield lining structures in a full-line tunnel are overloaded,their bearing and failure characteristics are significantly different from those in the full-line overloaded case.In existing st...When only a portion of the shield lining structures in a full-line tunnel are overloaded,their bearing and failure characteristics are significantly different from those in the full-line overloaded case.In existing studies,one or several segmental lining rings have been studied,with overload applied to selected lining rings to analyze the performance evolution of the lining structures;however,this approach fails to reveal the bearing and failure characteristics of shield lining rings under localized overload.To address this research gap,we employ 3D finite element modeling to investigate the mechanical performance and failure mechanisms of shield segmental linings under localized overload conditions,and compare the results with full-line overload scenarios.Additionally,the impact of reinforcing shield segmental linings with steel rings is studied to address issues arising from localized overloads.The results indicate that localized overloads lead to significant ring joint dislocation and higher stress on longitudinal bolts,potentially causing longitudinal bolt failure.Furthermore,the overall deformation of lining rings,segmental joint opening,and stress in circumferential bolts and steel bars is lower compared to full-line overloads.For the same overload level,the convergence deformation of the lining under full-line overload is 1.5 to 2.0 times higher than that under localized overload.For localized overload situations,a reinforcement scheme with steel rings spanning across two adjacent lining rings is more effective than installing steel rings within individual lining rings.This spanning ring reinforcement strategy not only enhances the structural rigidity of each ring,but also limits joint dislocation and reduces stress on longitudinal bolts,with the reduction in maximum ring joint dislocation ranging from 70%to 82%and the reduction in maximum longitudinal bolt stress ranging from 19%to 57%compared to reinforcement within rings.展开更多
Background:Reliable animal models are crucial to drug development for focal segmental glomerulosclerosis(FSGS),a rare kidney disease.Variability in success rates in literature and significant ethical concerns with ani...Background:Reliable animal models are crucial to drug development for focal segmental glomerulosclerosis(FSGS),a rare kidney disease.Variability in success rates in literature and significant ethical concerns with animal welfare necessitate further optimization of adriamycin(ADR)-induced FSGS model developed on BALB/c mice.Methods:High-performance liquid chromatography(HPLC)was used to assess ADR stability in water and upon light exposure.To identify the optimal ADR level,single intravenous ADR injections with dosing levels from 10 to 17 mg/kg body weight were administered to BALB/c mice to induce FSGS-like pathology.Body weight and proteinuria of FSGS mice were monitored and analyzed for FSGS model-associated morbidity.Animals were euthanized for hematological and kidney histological assessments 8 weeks post induction.To identify the suitable experiment time frame of the ADR-induced FSGS mouse model,a longitudinal study was performed,with an 11-week continuous monitoring of the symptoms.Results:ADR was found to be unstable in aqueous media and light sensitive.A dosing level of 10.5 mg/kg of ADR was optimal for consistent FSGS mouse model induction on BALB/c strain,characterized by minimal mortality and sustained FSGS-like symptoms.Findings from the longitudinal study suggest that 6 weeks post ADR induction may represent the peak of FSGS pathology severity in this mouse model.This time frame may be used for FSGS drug development projects.Conclusion:Based on the outcome from this study,we identified the optimal ADR dosing level and model testing duration.A standard operating procedure(SOP)for the ADR-induced FSGS mouse model was established to facilitate FSGS basic research and drug development.展开更多
This study aims to assess the comprehensive strengthening effect of a steel-ultra high performance concrete(UHPC)composite strengthening method.The axial force-moment interaction curve(N-M curve)was calculated in a no...This study aims to assess the comprehensive strengthening effect of a steel-ultra high performance concrete(UHPC)composite strengthening method.The axial force-moment interaction curve(N-M curve)was calculated in a novel way,using cross-sectional strains at ultimate states as well as real-time stress measurements for each material.The enclosed area of the N-M curve was defined as a comprehensive performance index for the system.We validate our approach with comparisons to numerical modeling and full-scale four-point bending experiments.Additionally,strengthening effects were compared for different sagging and hogging moments based on material stress responses,and the impact of various strengthening parameters was analyzed.We find that the N-M curve of the strengthened cross-section envelops that of the un-strengthened cross-section.Notably,improvements in flexural capacity are greater under sagging moments during the large eccentric failure stage,and greater under hogging moments during the small eccentric failure stage.This discrepancy is attributed to the strength utilization of strengthening materials.These findings provide a reference for understanding the strengthening effects and parameters of steel-UHPC composite.展开更多
Segmental atrophy(SA)of the liver is a rare,often underrecognized,benign condition that presents as a mass lesion,mimicking a neoplasm,which poses a significant diagnostic challenge.Given its rarity,only a limited num...Segmental atrophy(SA)of the liver is a rare,often underrecognized,benign condition that presents as a mass lesion,mimicking a neoplasm,which poses a significant diagnostic challenge.Given its rarity,only a limited number of case reports and series have been published,resulting in sparse literature on the entity.This review aims to summarize the clinicopathologic and diagnostic features of SA and thus improve its recognition.展开更多
Cage plus plate(CP)and zero-profile(Zero-P)devices are widely used in anterior cervical discectomy and fusion(ACDF).This study aimed to compare adjacent segment biomechanical changes after ACDF when using Zero-P devic...Cage plus plate(CP)and zero-profile(Zero-P)devices are widely used in anterior cervical discectomy and fusion(ACDF).This study aimed to compare adjacent segment biomechanical changes after ACDF when using Zero-P device and CP in different segments.First,complete C1—C7 cervical segments were constructed and validated.Meanwhile,four surgery models were developed by implanting the Zero-P device or CP into C4—C5 or C5—C6 segments based on the intact model.The segmental range of motion(ROM)and maximum value of the intradiscal pressure of the surgery models were compared with those of the intact model.The implantation of CP and Zero-P devices in C4—C5 segments decreased ROM by about 91.6%and 84.3%,respectively,and increased adjacent segment ROM by about 8.3%and 6.82%,respectively.The implantation of CP and Zero-P devices in C5—C6 segments decreased ROM by about 93.3%and 89.9%,respectively,while increasing adjacent segment ROM by about 4.9%and 4%,respectively.Furthermore,the implantation of CP and Zero-P devices increased the intradiscal pressure in the adjacent segments of C4—C5 segments by about 4.5%and 6.7%,respectively.The implantation of CP and Zero-P devices significantly increased the intradiscal pressure in the adjacent segments of C5—C6 by about 54.1%and 15.4%,respectively.In conclusion,CP and Zero-P fusion systems can significantly reduce the ROM of the fusion implant segment in ACDF while increasing the ROM and intradiscal pressure of adjacent segments.Results showed that Zero-P fusion system is the best choice for C5—C6 segmental ACDF.However,further studies are needed to select the most suitable cervical fusion system for C4—C5 segmental ACDF.Therefore,this study provides biomechanical recommendations for clinical surgery.展开更多
Background:Warm ischemic injury is one of the most important factors affecting renal function in partial nephrectomy(PN).The technique of segmental renal artery clamping emerges as an alternative to conventional renal...Background:Warm ischemic injury is one of the most important factors affecting renal function in partial nephrectomy(PN).The technique of segmental renal artery clamping emerges as an alternative to conventional renal artery clamping for renal hilar control.Objective:To evaluate the feasibility and efficiency of laparoscopic PN(LPN)with segmental renal artery clamping in comparison with the conventional technique.Design,setting,and participants:A total of 75 patients underwent LPN from June 2007 to November 2009.All patients had T1a or T1b tumor in one kidney and a normal contralateral kidney.Thirty-seven patients underwent surgeries with main renal artery clamping,and 38 underwent surgeries with segmental artery clamping.Intervention:All procedures were performed by the same laparoscopic surgeon.Measurements:Blood loss,operation time,warm ischemia(WI)time,and complications affected renal function before and after operation were recorded.Results and limitations:All LPNs were completed without conversion to open surgery or nephrectomy.The novel technique slightly increased WI time(p<0.001)and intraoperative blood loss(p=0.006),while it provided better postoperative affected renal function(p<0.001)compared with the conventional technique.The total complication rate was 12%.Among the 38 cases where segmental renal artery clamping was performed,7 had to convert to the conventional method.Tumor size and location influenced the number of clamped segmental arteries.Long-term postoperative renal function is still awaited.Conclusions:LPN with segmental artery clamping is safe and feasible in clinical practice.It minimizes the intraoperative WI injury and improves early postoperative affected renal function compared with main renal artery clamping.(C)2010 European Association of Urology.Published by Elsevier B.V.All rights reserved.展开更多
AIM: To study the feasibility and safety of middle segmental pancreatectomy (MSP) compared with pancreaticoduodenectomy (PD) and extended distal pancreatectomy (EDP). METHODS: We studied retrospectively 36 cases that ...AIM: To study the feasibility and safety of middle segmental pancreatectomy (MSP) compared with pancreaticoduodenectomy (PD) and extended distal pancreatectomy (EDP). METHODS: We studied retrospectively 36 cases that underwent MSP, 44 patients who underwent PD, and 26 who underwent EDP with benign or low-grade malignant lesions in the mid-portion of the pancreas, between April 2003 and December 2009 in Ruijin Hospital. The perioperative outcomes and long-term outcomes of MSP were compared with those of EDP and PD. Periop-erative outcomes included operative time, intraoperative hemorrhage, transfusion, pancreatic fistula, intraabdominal abscess/infection, postoperative bleeding, reoperation, mortality, and postoperative hospital time. Long-term outcomes, including tumor recurrence, newonset diabetes mellitus (DM), and pancreatic exocrine insufficiency, were evaluated. RESULTS: Intraoperative hemorrhage was 316.1 ± 309.6, 852.2 ± 877.8 and 526.9 ± 414.5 mL for the MSP, PD and EDP groups, respectively (P < 0.05). The mean postoperative daily fasting blood glucose level was significantly lower in the MSP group than in the EDP group (6.3 ± 1.5 mmol/L vs 7.3 ± 1.5 mmol/L, P < 0.05). The rate of pancreatic fistula was higher in the MSP group than in the PD group (42% vs 20.5%, P = 0.039), all of the fistulas after MSP corresponded to grade A (9/15) or B (6/15) and were sealed following conservative treatment. There was no significant difference in the mean postoperative hospital stay between the MSP group and the other two groups. After a mean follow-up of 44 mo, no tumor recurrences were found, only one patient (2.8%) in the MSP group vs five (21.7%) in the EDP group developed new-onset insulin-dependent DM postoperatively (P = 0.029). Moreover, significantly fewer patients in the MSP group than in the PD (0% vs 33.3%, P < 0.001) and EDP (0% vs 21.7%, P = 0.007) required enzyme substitution. CONCLUSION: MSP is a safe and organ-preserving option for benign or low-grade malignant lesions in the neck and proximal body of the pancreas.展开更多
In recent years, precast segmental concrete bridge columns became prevalent because of the benefits of accelerated construction, low environmental impact, high quality and low life cycle costs. The lack of a detailed ...In recent years, precast segmental concrete bridge columns became prevalent because of the benefits of accelerated construction, low environmental impact, high quality and low life cycle costs. The lack of a detailed configuration and appropriate design procedure to ensure a comparable performance with monolithic construction has impeded this structural system from being widely used in areas of high seismicity. In this study, precast segmental bridge column cyclic loading tests were conducted to investigate the performance of unbonded post-tensioned segmental bridge columns. One monolithic and two precast segmental columns were tested. The preeast segmental column exhibited minor damage and small residual displacement after the maximum 7% cyclic drift; energy dissipation （ED） can be enhanced byadding ED bars. The experimental results were modeled by a simplified pushover method （SPOM）, as well as a fiber model （FIBM） finite element method. Forty-five cases of columns with different aspect ratios, axial load ratios and ED bar ratios were analyzed with the SPOM and FIBM, respectively. Using these parametric results, a simplified design method was suggested by regressive analysis. Satisfactory correlation was found between the experimental results and the simplified design method for preeast segmental columns with different design parameters.展开更多
AIM: To evaluate the results of segmental duodenectomy (SD) and pancreaticoduodenectomy (PD) for duodenal gastrointestinal stromal tumor (GIST) and help clinicians with surgical management. METHODS: All patients who u...AIM: To evaluate the results of segmental duodenectomy (SD) and pancreaticoduodenectomy (PD) for duodenal gastrointestinal stromal tumor (GIST) and help clinicians with surgical management. METHODS: All patients who underwent surgery for non-metastatic GIST of the duodenum in a single institution since 2000 were prospectively followed up. Seven patients (median age 51 years, range: 41-73 years) were enrolled: five underwent SD and two underwent PD. RESULTS: All the patients had a complete resection (R0), with no postoperative morbidity and mortality. Among the SD group, GIST was classified as low risk in two patients, intermediate risk in two, and high risk in one, according to the Fletcher scale, (vs two high risk patients in the PD group). With a median followup of 41 (18-85) mo, disease-free survival (DFS) rateswere 100% after SD and 0% after PD (P < 0.05). The median DFS was 13 mo in the PD group. CONCLUSION: Whenever associated with clear surgical margins, SD is a reliable and curative option for most duodenal GISTs, and is compatible with longterm DFS.展开更多
Switched reluctance motors(SRM)with full-pitch windings and segmental rotors are particularly suitable for the drive systems in aerospace environments because of low wind(oil)resistance and iron losses at high speed.I...Switched reluctance motors(SRM)with full-pitch windings and segmental rotors are particularly suitable for the drive systems in aerospace environments because of low wind(oil)resistance and iron losses at high speed.In this paper,the authors have been studying electromagnetic design of this motor.展开更多
顺式调控模块(Cis-regulatory module,CRM)在真核生物基因的转录调控中起着重要作用,识别顺式调控模块是当前计算生物学的一个重要课题.虽然当前有许多计算方法用于识别顺式调控模块,但识别准确率仍有待进一步提高.将顺式调控模块的多...顺式调控模块(Cis-regulatory module,CRM)在真核生物基因的转录调控中起着重要作用,识别顺式调控模块是当前计算生物学的一个重要课题.虽然当前有许多计算方法用于识别顺式调控模块,但识别准确率仍有待进一步提高.将顺式调控模块的多种特征信息结合在一起,有助于提高识别顺式调控模块的准确率.基于此,本文提出了一种识别顺式调控模块的算法Seg HMC(Segmental HMM model for discovery of cis-regulatory module).该算法建立了一种关于顺式调控模块识别问题的Segmental HMM模型,进一步扩展了顺式调控模块调控结构(或调控语法)的表示,不仅将顺式调控模块表示为模体(Motif)的组合,还进一步将模体共同出现的频率、模体顺序偏好以及顺式调控模块中相邻模体间的距离分布等特征引入到顺式调控模块的调控语法中.在模拟数据集和真实生物数据集上的实验结果表明,本文方法识别顺式调控模块的准确率显著优于当前的主要方法.展开更多
This paper examines the quasi-static cyclic behavior, lateral strength and equivalent damping capacities of a system of post-tensioned segmental bridge columns tied with large diameter martensitic Shape Memory Alloy ...This paper examines the quasi-static cyclic behavior, lateral strength and equivalent damping capacities of a system of post-tensioned segmental bridge columns tied with large diameter martensitic Shape Memory Alloy （SMA） link-bars. Moment-curvature constitutive relationships are formulated and analysis tools are developed for the PT column, including a modified four-spring model prepared for the SMA bars. The suggested system is exemplified using a column with an aspect ratio of 7.5 and twelve 36.5 mm diameter NiTi martensitic SMA bars. A post-tensioning force of 40% to 60% of the tendon yield strength is applied in order to obtain a self re-centering system, considering the residual stress of the martensitie SMA bars. The cyclic response results show that the lateral strength remains consistently around 10% of the total vertical load and the equivalent viscous damping ratios reach 10%-12% of critical. When large diameter NiTi superelastic SMA bars are incorporated into the column system, the cyclic response varies substantially. The creep behavior of the superelastic SMA bar is accounted for since it affects the re-centering capability of the column. Two examples are presented to emphasize the modeling sensitivities for these special bars and quantify their cyclic behavior effects within the column assembly.展开更多
Harmonic drives have various distinctive advantages and are widely used in space drive mechanisms. Accelerated life test （ALT） is commonly conducted to shorten test time and reduce associated costs. An appropriate A...Harmonic drives have various distinctive advantages and are widely used in space drive mechanisms. Accelerated life test （ALT） is commonly conducted to shorten test time and reduce associated costs. An appropriate ALT modet is needed to predict the lifetime of harmonic drives with ALT data. However, harmonic drives which are used in space usually work under a segmental stress history, and traditional ALT models can hardly be used in this situation. This paper proposes a dedicated ALT model for harmonic drives applied in space systems. A comprehensive ALT model is established and genetic algorithm （GA） is adopted to obtain optimal parameters in the model using the Manson fatigue damage rule to describe the fatigue failure process and a cumulative dam- age method to calculate and accumulate the damage caused by each segment in the stress history. An ALT of harmonic drives was carried out and experimental results show that this model is acceptable and effective.展开更多
The treatment of isolated segmental, sectoral and right hepatic bile duct injuries is controversial. Nineteen patients were treated over a 26-year period. Group one was comprised of 4 patients in whom the injury was p...The treatment of isolated segmental, sectoral and right hepatic bile duct injuries is controversial. Nineteen patients were treated over a 26-year period. Group one was comprised of 4 patients in whom the injury was primarily repaired during the original surgery; 3 over a T-tube, 1 with a Roux-en-Y. These patients had an uneventful recovery. The second group consisted of 5 patients in whom the duct was ligated; 4 developed infection, 3 of which required drainage and biliary repair. Two patients had good long-term outcomes; the third developed a late anastomotic stricture requiring further surgery. The fourth patient developed a small bile leak and pain which resolved spontaneously. The fifth patient developed complications from which he died. The third group was comprised of 4 patients referred with biliary peritonitis; all underwent drainage and lavage, and developed biliary fistulae, 3 of which resolved spontaneously, 1 required Roux-en-γ repair, with favorable outcomes. The fourth group consisted of 6 patients with biliary fistulae. Two patients, both with an 8-wk history of a fistula, underwent Roux-en-γ repair. Two others also underwent a Roux-en-γ repair, as their fistulae showed no signs of closure. The remaining 2 patients had spontaneous closure of their biliary fistulae. A primary repair is a reasonable alternative to ligature of injured duct. Patients with ligated ducts may develop complications. Infected ducts require further surgery. Patients with biliary peritonitis must be treated with drainage and lavage. There is a 50% chance that a biliary fistula will close spontaneously. In cases where the biliary fistula does not close within 6 to 8 wk, a Roux-en-γ anastomosis should be considered.展开更多
Segmental ureterectomy is less invasive than radical nephroureterectomy and results in nephron preservation and satisfactory tumor control.This study was to determine the feasibility of segmental ureteroileal conduit ...Segmental ureterectomy is less invasive than radical nephroureterectomy and results in nephron preservation and satisfactory tumor control.This study was to determine the feasibility of segmental ureteroileal conduit resection(SUICR) for patients with distal upper urinary tract recurrence of bladder cancer following radical cystectomy.Four patients with high-grade distal upper urinary tract recurrence underwent SUICR 15-108 months after radical cystectomy.The surgical technique details of SUICR,operative results,and follow-up outcomes are reported.The median operation time was 280 min,and estimated blood loss was less than 100 ml One patient suffered from ileus 5 days after surgery and was managed conservatively.Histopathologic evaluation showed high-grade stages pTa-pT1 diseases for these patients,and ureteral margins were all negative.No patient suffered from tumor recurrence,with a median follow-up of 39 months.SUICR preserved the ipsilateral renal unit and conformed to oncological principles during surgery.The oncological outcome was satisfactory for these properly selected patients.This technique provides a valid alternative to nephroureterectomy for patients with imperative indications and high-grade upper urinary tract recurrence of bladder cancer following radical cystectomy.展开更多
The vascular diseases including aneurysm, occlusion, and thromboses in the mesenteric lesions could cause severe symptoms and appropriate diagnosis and treatment are essential for managing patients. With the developme...The vascular diseases including aneurysm, occlusion, and thromboses in the mesenteric lesions could cause severe symptoms and appropriate diagnosis and treatment are essential for managing patients. With the development and improvement of imaging modalities, diagnostic frequency of these vascular diseases in abdominal lesions is increasing even with the small changes in the vasculatures. Among various vascular diseases, fibromuscular dysplasia(FMD) and segmental arterial mediolysis(SAM) are noninflammatory, nonatherosclerotic arterial diseases which need to be diagnosed urgently because these diseases could affect various organs and be lethal if the appropriate management is not provided. However, because FMD and SAM are rare, the cause, prevalence, clinical characteristics including the symptoms, findings in the imaging studies, pathological findings, management, and prognoses have not been systematically summarized. Therefore, there have been neither standard diagnostic criteria nor therapeutic methodologies established, to date. To systematically summarize the information and to compare these disease entities, we have summarized the characteristics of FMD and SAM in the gastroenterological regions by reviewing the cases reported thus far. The information summarized will be helpful for physicians treating these patients in an emergency care unit and for the differential diagnosis of other diseases showing severe abdominal pain.展开更多
BACKGROUND Since Kambin experimentally induced arthroscopy to treat herniated nucleus pulposus,percutaneous endoscopic lumbar discectomy(PELD)has been developed.The branch of the segmental artery around the neural for...BACKGROUND Since Kambin experimentally induced arthroscopy to treat herniated nucleus pulposus,percutaneous endoscopic lumbar discectomy(PELD)has been developed.The branch of the segmental artery around the neural foramen may be damaged during PELD using the transforaminal approach.We report 2 rare cases in which segmental artery injury that occurred during PELD was treated with emergency embolization.CASE SUMMARY In case 1,a 31-year-old man was transferred to our emergency department with left lower quadrant abdominal pain after PELD at a local hospital.Lumbar spine magnetic resonance imaging after the surgery showed a hematoma of the left retroperitoneal area and the psoas muscle area.Under suspicion of vascular injury,arteriography was performed.Pseudoaneurysm and blood leakage from the left 4th lumbar segmental artery into the abdominal cavity were identified.Emergency transarterial embolization was performed using fibered microcoils for bleeding of the segmental artery.In case 2,a 75-year-old woman was transferred to our emergency department with low blood pressure,right flank pain,and drowsy mental status after PELD at a local hospital.When the patient arrived at the emergency room,the blood pressure decreased from 107/55 mmHg to 72/47 mmHg.Low blood pressure persisted.Under suspicion of vessel injury,arteriography was performed,and the right 4th lumbar segmental artery rupture was confirmed.Emergency transarterial embolization was performed for bleeding of segmental artery.CONCLUSION We were able to find the bleeding focus by angiography and treat the injury of the segmental artery successfully through emergency transarterial embolization.展开更多
BACKGROUND Pancreatic segmental portal hypertension(PSPH) is the only type of portal hypertension that can be completely cured. However, it can easily cause varicose veins in the esophagus and stomach and hemorrhage i...BACKGROUND Pancreatic segmental portal hypertension(PSPH) is the only type of portal hypertension that can be completely cured. However, it can easily cause varicose veins in the esophagus and stomach and hemorrhage in the digestive tract.AIM To explore the application of computed tomography(CT) to examine the characteristics of PSPH and assess the risk level.METHODS This was a retrospective analysis of CT images of 22 patients diagnosed with PSPH at our center. Spearman correlation analysis was performed using the range of esophageal and gastric varices(measured by the vertical gastric wall), the ratio of the width of the splenic portal vein to that of the compression site(S/C ratio), the degree of splenomegaly, and the stage determined by gastroscopy. This study examined whether patients experienced gastrointestinal bleeding within 2 wk and combined CT and gastroscopy to explore the connection between bleeding and CT findings.RESULTS The range of esophageal and gastric varices showed the best correlation in the diagnosis of PSPH(P < 0.001), and the S/C ratio(P = 0.007) was correlated with the degree of splenomegaly(P = 0.021) and PSPH(P < 0.05). This study revealed that male patients were more likely than females to progress to grade 2 or grade 3 as determined by gastroscopy. CT demonstrated excellent performance, with an area under the curve of 0.879.CONCLUSION CT can be used to effectively analyze the imaging signs of PSPH, and CT combined with gastroscopy can effectively predict the risk level of gastrointestinal bleeding.展开更多
文摘Focal segmental glomerulosclerosis(FSGS)is a histological pattern of glomerular damage that significantly contributes to chronic kidney disease and end-stage renal disease.Its incidence is rising globally,necessitating timely and personalized management strategies.This paper aims to provide an updated overview of the pathophysiology,diagnosis,and therapeutic strategies for FSGS,emphasizing the importance of early interventions and tailored treatments.This editorial synthesizes key findings from recent literature to highlight advancements in understanding and managing FSGS.Emerging evidence supports the role of targeted therapies and personalized approaches in improving outcomes for FSGS patients.Advances include novel biomarkers,genetic testing,and innovative therapeutics such as transient receptor potential ion channel blockers and antisense oligonucleotides for apolipoprotein 1-related FSGS.Effective mana-gement of FSGS requires a combination of timely diagnosis,evidence-based therapeutic strategies,and ongoing research to optimize patient outcomes and address gaps in the current understanding of the disease.
基金supported by the National Natural Science Foundation of China(No.52008308).
文摘When only a portion of the shield lining structures in a full-line tunnel are overloaded,their bearing and failure characteristics are significantly different from those in the full-line overloaded case.In existing studies,one or several segmental lining rings have been studied,with overload applied to selected lining rings to analyze the performance evolution of the lining structures;however,this approach fails to reveal the bearing and failure characteristics of shield lining rings under localized overload.To address this research gap,we employ 3D finite element modeling to investigate the mechanical performance and failure mechanisms of shield segmental linings under localized overload conditions,and compare the results with full-line overload scenarios.Additionally,the impact of reinforcing shield segmental linings with steel rings is studied to address issues arising from localized overloads.The results indicate that localized overloads lead to significant ring joint dislocation and higher stress on longitudinal bolts,potentially causing longitudinal bolt failure.Furthermore,the overall deformation of lining rings,segmental joint opening,and stress in circumferential bolts and steel bars is lower compared to full-line overloads.For the same overload level,the convergence deformation of the lining under full-line overload is 1.5 to 2.0 times higher than that under localized overload.For localized overload situations,a reinforcement scheme with steel rings spanning across two adjacent lining rings is more effective than installing steel rings within individual lining rings.This spanning ring reinforcement strategy not only enhances the structural rigidity of each ring,but also limits joint dislocation and reduces stress on longitudinal bolts,with the reduction in maximum ring joint dislocation ranging from 70%to 82%and the reduction in maximum longitudinal bolt stress ranging from 19%to 57%compared to reinforcement within rings.
基金United States Department of Defense Office of the Congressionally Directed Medical Research Programs(CDMRP),Grant/Award Number:W81XWH-22-1-0176。
文摘Background:Reliable animal models are crucial to drug development for focal segmental glomerulosclerosis(FSGS),a rare kidney disease.Variability in success rates in literature and significant ethical concerns with animal welfare necessitate further optimization of adriamycin(ADR)-induced FSGS model developed on BALB/c mice.Methods:High-performance liquid chromatography(HPLC)was used to assess ADR stability in water and upon light exposure.To identify the optimal ADR level,single intravenous ADR injections with dosing levels from 10 to 17 mg/kg body weight were administered to BALB/c mice to induce FSGS-like pathology.Body weight and proteinuria of FSGS mice were monitored and analyzed for FSGS model-associated morbidity.Animals were euthanized for hematological and kidney histological assessments 8 weeks post induction.To identify the suitable experiment time frame of the ADR-induced FSGS mouse model,a longitudinal study was performed,with an 11-week continuous monitoring of the symptoms.Results:ADR was found to be unstable in aqueous media and light sensitive.A dosing level of 10.5 mg/kg of ADR was optimal for consistent FSGS mouse model induction on BALB/c strain,characterized by minimal mortality and sustained FSGS-like symptoms.Findings from the longitudinal study suggest that 6 weeks post ADR induction may represent the peak of FSGS pathology severity in this mouse model.This time frame may be used for FSGS drug development projects.Conclusion:Based on the outcome from this study,we identified the optimal ADR dosing level and model testing duration.A standard operating procedure(SOP)for the ADR-induced FSGS mouse model was established to facilitate FSGS basic research and drug development.
基金supported by the National Natural Science Foundation of China(Nos.51938005,52090082,and 52378395)the National Key Research and Development Program of China(No.2023YFB2604402).
文摘This study aims to assess the comprehensive strengthening effect of a steel-ultra high performance concrete(UHPC)composite strengthening method.The axial force-moment interaction curve(N-M curve)was calculated in a novel way,using cross-sectional strains at ultimate states as well as real-time stress measurements for each material.The enclosed area of the N-M curve was defined as a comprehensive performance index for the system.We validate our approach with comparisons to numerical modeling and full-scale four-point bending experiments.Additionally,strengthening effects were compared for different sagging and hogging moments based on material stress responses,and the impact of various strengthening parameters was analyzed.We find that the N-M curve of the strengthened cross-section envelops that of the un-strengthened cross-section.Notably,improvements in flexural capacity are greater under sagging moments during the large eccentric failure stage,and greater under hogging moments during the small eccentric failure stage.This discrepancy is attributed to the strength utilization of strengthening materials.These findings provide a reference for understanding the strengthening effects and parameters of steel-UHPC composite.
文摘Segmental atrophy(SA)of the liver is a rare,often underrecognized,benign condition that presents as a mass lesion,mimicking a neoplasm,which poses a significant diagnostic challenge.Given its rarity,only a limited number of case reports and series have been published,resulting in sparse literature on the entity.This review aims to summarize the clinicopathologic and diagnostic features of SA and thus improve its recognition.
基金the National Natural Science Foundation of China(Nos.32260235 and 82260446)。
文摘Cage plus plate(CP)and zero-profile(Zero-P)devices are widely used in anterior cervical discectomy and fusion(ACDF).This study aimed to compare adjacent segment biomechanical changes after ACDF when using Zero-P device and CP in different segments.First,complete C1—C7 cervical segments were constructed and validated.Meanwhile,four surgery models were developed by implanting the Zero-P device or CP into C4—C5 or C5—C6 segments based on the intact model.The segmental range of motion(ROM)and maximum value of the intradiscal pressure of the surgery models were compared with those of the intact model.The implantation of CP and Zero-P devices in C4—C5 segments decreased ROM by about 91.6%and 84.3%,respectively,and increased adjacent segment ROM by about 8.3%and 6.82%,respectively.The implantation of CP and Zero-P devices in C5—C6 segments decreased ROM by about 93.3%and 89.9%,respectively,while increasing adjacent segment ROM by about 4.9%and 4%,respectively.Furthermore,the implantation of CP and Zero-P devices increased the intradiscal pressure in the adjacent segments of C4—C5 segments by about 4.5%and 6.7%,respectively.The implantation of CP and Zero-P devices significantly increased the intradiscal pressure in the adjacent segments of C5—C6 by about 54.1%and 15.4%,respectively.In conclusion,CP and Zero-P fusion systems can significantly reduce the ROM of the fusion implant segment in ACDF while increasing the ROM and intradiscal pressure of adjacent segments.Results showed that Zero-P fusion system is the best choice for C5—C6 segmental ACDF.However,further studies are needed to select the most suitable cervical fusion system for C4—C5 segmental ACDF.Therefore,this study provides biomechanical recommendations for clinical surgery.
文摘Background:Warm ischemic injury is one of the most important factors affecting renal function in partial nephrectomy(PN).The technique of segmental renal artery clamping emerges as an alternative to conventional renal artery clamping for renal hilar control.Objective:To evaluate the feasibility and efficiency of laparoscopic PN(LPN)with segmental renal artery clamping in comparison with the conventional technique.Design,setting,and participants:A total of 75 patients underwent LPN from June 2007 to November 2009.All patients had T1a or T1b tumor in one kidney and a normal contralateral kidney.Thirty-seven patients underwent surgeries with main renal artery clamping,and 38 underwent surgeries with segmental artery clamping.Intervention:All procedures were performed by the same laparoscopic surgeon.Measurements:Blood loss,operation time,warm ischemia(WI)time,and complications affected renal function before and after operation were recorded.Results and limitations:All LPNs were completed without conversion to open surgery or nephrectomy.The novel technique slightly increased WI time(p<0.001)and intraoperative blood loss(p=0.006),while it provided better postoperative affected renal function(p<0.001)compared with the conventional technique.The total complication rate was 12%.Among the 38 cases where segmental renal artery clamping was performed,7 had to convert to the conventional method.Tumor size and location influenced the number of clamped segmental arteries.Long-term postoperative renal function is still awaited.Conclusions:LPN with segmental artery clamping is safe and feasible in clinical practice.It minimizes the intraoperative WI injury and improves early postoperative affected renal function compared with main renal artery clamping.(C)2010 European Association of Urology.Published by Elsevier B.V.All rights reserved.
基金Supported by The Ministry of Health Sector Funds of China,No. 201002020
文摘AIM: To study the feasibility and safety of middle segmental pancreatectomy (MSP) compared with pancreaticoduodenectomy (PD) and extended distal pancreatectomy (EDP). METHODS: We studied retrospectively 36 cases that underwent MSP, 44 patients who underwent PD, and 26 who underwent EDP with benign or low-grade malignant lesions in the mid-portion of the pancreas, between April 2003 and December 2009 in Ruijin Hospital. The perioperative outcomes and long-term outcomes of MSP were compared with those of EDP and PD. Periop-erative outcomes included operative time, intraoperative hemorrhage, transfusion, pancreatic fistula, intraabdominal abscess/infection, postoperative bleeding, reoperation, mortality, and postoperative hospital time. Long-term outcomes, including tumor recurrence, newonset diabetes mellitus (DM), and pancreatic exocrine insufficiency, were evaluated. RESULTS: Intraoperative hemorrhage was 316.1 ± 309.6, 852.2 ± 877.8 and 526.9 ± 414.5 mL for the MSP, PD and EDP groups, respectively (P < 0.05). The mean postoperative daily fasting blood glucose level was significantly lower in the MSP group than in the EDP group (6.3 ± 1.5 mmol/L vs 7.3 ± 1.5 mmol/L, P < 0.05). The rate of pancreatic fistula was higher in the MSP group than in the PD group (42% vs 20.5%, P = 0.039), all of the fistulas after MSP corresponded to grade A (9/15) or B (6/15) and were sealed following conservative treatment. There was no significant difference in the mean postoperative hospital stay between the MSP group and the other two groups. After a mean follow-up of 44 mo, no tumor recurrences were found, only one patient (2.8%) in the MSP group vs five (21.7%) in the EDP group developed new-onset insulin-dependent DM postoperatively (P = 0.029). Moreover, significantly fewer patients in the MSP group than in the PD (0% vs 33.3%, P < 0.001) and EDP (0% vs 21.7%, P = 0.007) required enzyme substitution. CONCLUSION: MSP is a safe and organ-preserving option for benign or low-grade malignant lesions in the neck and proximal body of the pancreas.
基金National Natural Science Foundation of China under Grants Nos.51208268 and 51178429K.C.Wong Magna Fund in Ningbo University+1 种基金Transportation Science and Technology Project of Ningbo City under Grant No.201507Natural Science Foundation of Ningbo City under Grant No.2015A610293
文摘In recent years, precast segmental concrete bridge columns became prevalent because of the benefits of accelerated construction, low environmental impact, high quality and low life cycle costs. The lack of a detailed configuration and appropriate design procedure to ensure a comparable performance with monolithic construction has impeded this structural system from being widely used in areas of high seismicity. In this study, precast segmental bridge column cyclic loading tests were conducted to investigate the performance of unbonded post-tensioned segmental bridge columns. One monolithic and two precast segmental columns were tested. The preeast segmental column exhibited minor damage and small residual displacement after the maximum 7% cyclic drift; energy dissipation （ED） can be enhanced byadding ED bars. The experimental results were modeled by a simplified pushover method （SPOM）, as well as a fiber model （FIBM） finite element method. Forty-five cases of columns with different aspect ratios, axial load ratios and ED bar ratios were analyzed with the SPOM and FIBM, respectively. Using these parametric results, a simplified design method was suggested by regressive analysis. Satisfactory correlation was found between the experimental results and the simplified design method for preeast segmental columns with different design parameters.
文摘AIM: To evaluate the results of segmental duodenectomy (SD) and pancreaticoduodenectomy (PD) for duodenal gastrointestinal stromal tumor (GIST) and help clinicians with surgical management. METHODS: All patients who underwent surgery for non-metastatic GIST of the duodenum in a single institution since 2000 were prospectively followed up. Seven patients (median age 51 years, range: 41-73 years) were enrolled: five underwent SD and two underwent PD. RESULTS: All the patients had a complete resection (R0), with no postoperative morbidity and mortality. Among the SD group, GIST was classified as low risk in two patients, intermediate risk in two, and high risk in one, according to the Fletcher scale, (vs two high risk patients in the PD group). With a median followup of 41 (18-85) mo, disease-free survival (DFS) rateswere 100% after SD and 0% after PD (P < 0.05). The median DFS was 13 mo in the PD group. CONCLUSION: Whenever associated with clear surgical margins, SD is a reliable and curative option for most duodenal GISTs, and is compatible with longterm DFS.
文摘Switched reluctance motors(SRM)with full-pitch windings and segmental rotors are particularly suitable for the drive systems in aerospace environments because of low wind(oil)resistance and iron losses at high speed.In this paper,the authors have been studying electromagnetic design of this motor.
文摘顺式调控模块(Cis-regulatory module,CRM)在真核生物基因的转录调控中起着重要作用,识别顺式调控模块是当前计算生物学的一个重要课题.虽然当前有许多计算方法用于识别顺式调控模块,但识别准确率仍有待进一步提高.将顺式调控模块的多种特征信息结合在一起,有助于提高识别顺式调控模块的准确率.基于此,本文提出了一种识别顺式调控模块的算法Seg HMC(Segmental HMM model for discovery of cis-regulatory module).该算法建立了一种关于顺式调控模块识别问题的Segmental HMM模型,进一步扩展了顺式调控模块调控结构(或调控语法)的表示,不仅将顺式调控模块表示为模体(Motif)的组合,还进一步将模体共同出现的频率、模体顺序偏好以及顺式调控模块中相邻模体间的距离分布等特征引入到顺式调控模块的调控语法中.在模拟数据集和真实生物数据集上的实验结果表明,本文方法识别顺式调控模块的准确率显著优于当前的主要方法.
基金Research fund of Hanyang University Under Grant No.HY-2010-N
文摘This paper examines the quasi-static cyclic behavior, lateral strength and equivalent damping capacities of a system of post-tensioned segmental bridge columns tied with large diameter martensitic Shape Memory Alloy （SMA） link-bars. Moment-curvature constitutive relationships are formulated and analysis tools are developed for the PT column, including a modified four-spring model prepared for the SMA bars. The suggested system is exemplified using a column with an aspect ratio of 7.5 and twelve 36.5 mm diameter NiTi martensitic SMA bars. A post-tensioning force of 40% to 60% of the tendon yield strength is applied in order to obtain a self re-centering system, considering the residual stress of the martensitie SMA bars. The cyclic response results show that the lateral strength remains consistently around 10% of the total vertical load and the equivalent viscous damping ratios reach 10%-12% of critical. When large diameter NiTi superelastic SMA bars are incorporated into the column system, the cyclic response varies substantially. The creep behavior of the superelastic SMA bar is accounted for since it affects the re-centering capability of the column. Two examples are presented to emphasize the modeling sensitivities for these special bars and quantify their cyclic behavior effects within the column assembly.
基金co-supported by National Natural Science Foundation of China(Grant No.51505015,51575019)the National Basic Research Program of China(No.2014CB046402)CAST-BISEE Innovation Foundation of China
文摘Harmonic drives have various distinctive advantages and are widely used in space drive mechanisms. Accelerated life test （ALT） is commonly conducted to shorten test time and reduce associated costs. An appropriate ALT modet is needed to predict the lifetime of harmonic drives with ALT data. However, harmonic drives which are used in space usually work under a segmental stress history, and traditional ALT models can hardly be used in this situation. This paper proposes a dedicated ALT model for harmonic drives applied in space systems. A comprehensive ALT model is established and genetic algorithm （GA） is adopted to obtain optimal parameters in the model using the Manson fatigue damage rule to describe the fatigue failure process and a cumulative dam- age method to calculate and accumulate the damage caused by each segment in the stress history. An ALT of harmonic drives was carried out and experimental results show that this model is acceptable and effective.
文摘The treatment of isolated segmental, sectoral and right hepatic bile duct injuries is controversial. Nineteen patients were treated over a 26-year period. Group one was comprised of 4 patients in whom the injury was primarily repaired during the original surgery; 3 over a T-tube, 1 with a Roux-en-Y. These patients had an uneventful recovery. The second group consisted of 5 patients in whom the duct was ligated; 4 developed infection, 3 of which required drainage and biliary repair. Two patients had good long-term outcomes; the third developed a late anastomotic stricture requiring further surgery. The fourth patient developed a small bile leak and pain which resolved spontaneously. The fifth patient developed complications from which he died. The third group was comprised of 4 patients referred with biliary peritonitis; all underwent drainage and lavage, and developed biliary fistulae, 3 of which resolved spontaneously, 1 required Roux-en-γ repair, with favorable outcomes. The fourth group consisted of 6 patients with biliary fistulae. Two patients, both with an 8-wk history of a fistula, underwent Roux-en-γ repair. Two others also underwent a Roux-en-γ repair, as their fistulae showed no signs of closure. The remaining 2 patients had spontaneous closure of their biliary fistulae. A primary repair is a reasonable alternative to ligature of injured duct. Patients with ligated ducts may develop complications. Infected ducts require further surgery. Patients with biliary peritonitis must be treated with drainage and lavage. There is a 50% chance that a biliary fistula will close spontaneously. In cases where the biliary fistula does not close within 6 to 8 wk, a Roux-en-γ anastomosis should be considered.
基金supported by the foundation of Excellent Academic Leaders of Shanghai(XBR2013076)
文摘Segmental ureterectomy is less invasive than radical nephroureterectomy and results in nephron preservation and satisfactory tumor control.This study was to determine the feasibility of segmental ureteroileal conduit resection(SUICR) for patients with distal upper urinary tract recurrence of bladder cancer following radical cystectomy.Four patients with high-grade distal upper urinary tract recurrence underwent SUICR 15-108 months after radical cystectomy.The surgical technique details of SUICR,operative results,and follow-up outcomes are reported.The median operation time was 280 min,and estimated blood loss was less than 100 ml One patient suffered from ileus 5 days after surgery and was managed conservatively.Histopathologic evaluation showed high-grade stages pTa-pT1 diseases for these patients,and ureteral margins were all negative.No patient suffered from tumor recurrence,with a median follow-up of 39 months.SUICR preserved the ipsilateral renal unit and conformed to oncological principles during surgery.The oncological outcome was satisfactory for these properly selected patients.This technique provides a valid alternative to nephroureterectomy for patients with imperative indications and high-grade upper urinary tract recurrence of bladder cancer following radical cystectomy.
文摘The vascular diseases including aneurysm, occlusion, and thromboses in the mesenteric lesions could cause severe symptoms and appropriate diagnosis and treatment are essential for managing patients. With the development and improvement of imaging modalities, diagnostic frequency of these vascular diseases in abdominal lesions is increasing even with the small changes in the vasculatures. Among various vascular diseases, fibromuscular dysplasia(FMD) and segmental arterial mediolysis(SAM) are noninflammatory, nonatherosclerotic arterial diseases which need to be diagnosed urgently because these diseases could affect various organs and be lethal if the appropriate management is not provided. However, because FMD and SAM are rare, the cause, prevalence, clinical characteristics including the symptoms, findings in the imaging studies, pathological findings, management, and prognoses have not been systematically summarized. Therefore, there have been neither standard diagnostic criteria nor therapeutic methodologies established, to date. To systematically summarize the information and to compare these disease entities, we have summarized the characteristics of FMD and SAM in the gastroenterological regions by reviewing the cases reported thus far. The information summarized will be helpful for physicians treating these patients in an emergency care unit and for the differential diagnosis of other diseases showing severe abdominal pain.
文摘BACKGROUND Since Kambin experimentally induced arthroscopy to treat herniated nucleus pulposus,percutaneous endoscopic lumbar discectomy(PELD)has been developed.The branch of the segmental artery around the neural foramen may be damaged during PELD using the transforaminal approach.We report 2 rare cases in which segmental artery injury that occurred during PELD was treated with emergency embolization.CASE SUMMARY In case 1,a 31-year-old man was transferred to our emergency department with left lower quadrant abdominal pain after PELD at a local hospital.Lumbar spine magnetic resonance imaging after the surgery showed a hematoma of the left retroperitoneal area and the psoas muscle area.Under suspicion of vascular injury,arteriography was performed.Pseudoaneurysm and blood leakage from the left 4th lumbar segmental artery into the abdominal cavity were identified.Emergency transarterial embolization was performed using fibered microcoils for bleeding of the segmental artery.In case 2,a 75-year-old woman was transferred to our emergency department with low blood pressure,right flank pain,and drowsy mental status after PELD at a local hospital.When the patient arrived at the emergency room,the blood pressure decreased from 107/55 mmHg to 72/47 mmHg.Low blood pressure persisted.Under suspicion of vessel injury,arteriography was performed,and the right 4th lumbar segmental artery rupture was confirmed.Emergency transarterial embolization was performed for bleeding of segmental artery.CONCLUSION We were able to find the bleeding focus by angiography and treat the injury of the segmental artery successfully through emergency transarterial embolization.
基金Supported by Shenzhen Science and Technology Plan Project,No.JCYJ20180228163333734。
文摘BACKGROUND Pancreatic segmental portal hypertension(PSPH) is the only type of portal hypertension that can be completely cured. However, it can easily cause varicose veins in the esophagus and stomach and hemorrhage in the digestive tract.AIM To explore the application of computed tomography(CT) to examine the characteristics of PSPH and assess the risk level.METHODS This was a retrospective analysis of CT images of 22 patients diagnosed with PSPH at our center. Spearman correlation analysis was performed using the range of esophageal and gastric varices(measured by the vertical gastric wall), the ratio of the width of the splenic portal vein to that of the compression site(S/C ratio), the degree of splenomegaly, and the stage determined by gastroscopy. This study examined whether patients experienced gastrointestinal bleeding within 2 wk and combined CT and gastroscopy to explore the connection between bleeding and CT findings.RESULTS The range of esophageal and gastric varices showed the best correlation in the diagnosis of PSPH(P < 0.001), and the S/C ratio(P = 0.007) was correlated with the degree of splenomegaly(P = 0.021) and PSPH(P < 0.05). This study revealed that male patients were more likely than females to progress to grade 2 or grade 3 as determined by gastroscopy. CT demonstrated excellent performance, with an area under the curve of 0.879.CONCLUSION CT can be used to effectively analyze the imaging signs of PSPH, and CT combined with gastroscopy can effectively predict the risk level of gastrointestinal bleeding.
