Discrete event system(DES)models promote system engineering,including system design,verification,and assessment.The advancement in manufacturing technology has endowed us to fabricate complex industrial systems.Conseq...Discrete event system(DES)models promote system engineering,including system design,verification,and assessment.The advancement in manufacturing technology has endowed us to fabricate complex industrial systems.Consequently,the adoption of advanced modeling methodologies adept at handling complexity and scalability is imperative.Moreover,industrial systems are no longer quiescent,thus the intelligent operations of the systems should be dynamically specified in the model.In this paper,the composition of the subsystem behaviors is studied to generate the complexity and scalability of the global system model,and a Boolean semantic specifying algorithm is proposed for generating dynamic intelligent operations in the model.In traditional modeling approaches,the change or addition of specifications always necessitates the complete resubmission of the system model,a resource-consuming and error-prone process.Compared with traditional approaches,our approach has three remarkable advantages:(i)an established Boolean semantic can be fitful for all kinds of systems;(ii)there is no need to resubmit the system model whenever there is a change or addition of the operations;(iii)multiple specifying tasks can be easily achieved by continuously adding a new semantic.Thus,this general modeling approach has wide potential for future complex and intelligent industrial systems.展开更多
Male sexual behavior is an innate social behavior crucial for reproduction[1].Previous studies have identified several brain regions crucial for the control of both sexual and aggressive behaviors in males.Yet,molecul...Male sexual behavior is an innate social behavior crucial for reproduction[1].Previous studies have identified several brain regions crucial for the control of both sexual and aggressive behaviors in males.Yet,molecularly specified neural circuits that specifically control male sexual behavior remain elusive.Consistent with the inherently rewarding nature of sexual behavior,previous research has implicated the role of the dopamine system in regulating sexual desire[2].However,the interaction between reward and copulation at the circuit level remains largely unexplored.Besides,it is unclear if the associated neural pathways are specific in modulating sexual reward.展开更多
Quantum entanglement is a key resource for achieving superiority of quantum computing.Currently,scientists are extensively focusing on how to integrate quantum entanglement into various components of quantum machine l...Quantum entanglement is a key resource for achieving superiority of quantum computing.Currently,scientists are extensively focusing on how to integrate quantum entanglement into various components of quantum machine learning(QML)models,aiming to surpass the performance of traditional machine learning models.Notable successes include the use of entangled measurements^([1-3])and entangled channels^([4]),which have been shown to reduce query complexity or improve the prediction precision for specified QML tasks.Quantum entangled data,capable of encoding more information compared to classical data of the same size,is recognized for its potential to achieve quantum advantages.Nevertheless,the impact of the entanglement degree in quantum data on model performance remains a challenging and unresolved research question.展开更多
BACKGROUND Gastrointestinal lymphoma typically arises in the stomach,small bowel,or colorectum and is usually a B-cell lymphoma.However,primary T-cell lymp-homas originating in the stomach are particularly rare.Gastri...BACKGROUND Gastrointestinal lymphoma typically arises in the stomach,small bowel,or colorectum and is usually a B-cell lymphoma.However,primary T-cell lymp-homas originating in the stomach are particularly rare.Gastric peripheral T-cell lymphoma-not otherwise specified(PTCL-NOS)is an extremely rare subtype.CASE SUMMARY We report a 63-year-old male presenting with epigastric pain.Esophagogastro-duodenoscopy revealed a large ulcerative lesion in the gastric cardia.Biopsy and immunohistochemical profiling confirmed PTCL-NOS.Imaging indicated stage II disease involving the stomach and intra-abdominal lymph nodes.The patient is planned to undergo cyclophosphamide,doxorubicin,vincristine,and prednisone or cyclophosphamide,doxorubicin,vincristine,prednisone,and etoposide chemo-therapy.CONCLUSION This case highlights the necessity of considering PTCL-NOS in differential diag-noses of gastric lesions.Comprehensive histopathological and immunohistoche-mical analysis is crucial for accurate diagnosis and guiding treatment.展开更多
Background:Adjuvant pembrolizumab therapy after surgery for renal-cell carcinoma was approved on the basis of a significant improvement in disease-free survival in the KEYNOTE-564 trial.Whether the results regarding o...Background:Adjuvant pembrolizumab therapy after surgery for renal-cell carcinoma was approved on the basis of a significant improvement in disease-free survival in the KEYNOTE-564 trial.Whether the results regarding overall survival from the third prespecified interim analysis of the trial would also favor pembrolizumab was uncertain.Methods:In this phase 3,double-blind,placebo-controlled trial,we randomly assigned(in a 1:1 ratio)participants with clear-cell renal-cell carcinoma who had an increased risk of recurrence after surgery to receive pembrolizumab(at a dose of 200 mg)or placebo every 3 weeks for up to 17 cycles(approximately 1 year)or until recurrence,the occurrence of unacceptable toxic effects,or withdrawal of consent.A significant improvement in disease-free survival according to investigator assessment(the primary end point)was shown previously.Overall survival was the key secondary end point.Safety was a secondary end point.展开更多
AIM: To analyze the accuracy of computed tomography (CT) angiography in the diagnosis of acute gastrointestinal (GI) bleeding. METHODS: The MEDLINE, EMBASE, Cancerlit, Cochrane Library database, Sciencedirect, Springe...AIM: To analyze the accuracy of computed tomography (CT) angiography in the diagnosis of acute gastrointestinal (GI) bleeding. METHODS: The MEDLINE, EMBASE, Cancerlit, Cochrane Library database, Sciencedirect, Springerlink and Scopus, from January 1995 to December 2009, were searched for studies evaluating the accuracy of CT angiography in diagnosing acute GI bleeding. Studies were included if the ycompared CT angiography to a reference standard of upper GI endoscopy, colonoscopy, angiography or surgery in the diagnosis of acute GI bleeding. Meta-analysis methods were used to pool sensitivity and specificity and to construct summary receiver-operating characteristic. RESULTS: A total of 9 studies with 198 patients were included in this meta-analysis. Data were used to form 2 × 2 tables. CT angiography showed pooled sensi-tivity of 89% (95% CI: 82%-94%) and specificity of 85% (95% CI: 74%-92%), without showing significant heterogeneity (χ2 = 12.5, P = 0.13) and (χ2 = 22.95, P = 0.003), respectively. Summary receiver operating characteristic analysis showed an area under the curve of 0.9297. CONCLUSION: CT angiography is an accurate, costeffective tool in the diagnosis of acute GI bleeding and can show the precise location of bleeding, thereby directing further management.展开更多
An improved floor field model is proposed to simulate the pedestrian evacuation behavior in a room with multiple exits by modifying the static floor field.The modified static floor field is determined additionally by ...An improved floor field model is proposed to simulate the pedestrian evacuation behavior in a room with multiple exits by modifying the static floor field.The modified static floor field is determined additionally by two cognitive coefficients of exit width and congestion degree around the exits.The logit-based discrete choice principle is used to govern the initial exit selection strategy based on the modified static floor field in such a scenario that pedestrians are distributed in the room's specified zone.Simulation results show that the proposed model can better perform the evacuation process.Sensitivity analyses of the model parameters are also presented.展开更多
In this study,the lock-in phenomenon of Tip Clearance Flow(TCF)instabilities and their relationship to blade vibration are investigated numerically on an axial transonic rotor with a large tip clearance.The capabiliti...In this study,the lock-in phenomenon of Tip Clearance Flow(TCF)instabilities and their relationship to blade vibration are investigated numerically on an axial transonic rotor with a large tip clearance.The capabilities of simulating instability flow and lock-in phenomenon are verified on a transonic rotor and a NACA0012 airfoil by comparing with the test data,respectively.The lock-in phenomenon is first numerically confirmed that may occur to TCF instabilities when its frequency is close to the blade vibration frequency.The lock-in region becomes wider with the vibration amplitude increasing,and it is also affected by modal shapes.For the rotor at the simulation conditions in this study,the bending mode results in a wider lock-in region than the torsional mode.In the lock-in region,the phase difference between the Tip Clearance Vortex(TCV)and the blade vibration changes with the flow condition and the frequency ratio of the blade vibration and the TCV instabilities.The frequency of the TCV instabilities reduces with the mass flow decreasing.Therefore,reducing mass flow and increasing frequency ratio have similar effects on the TCV phase,which causes a significant variation on the unsteady pressure amplitude in the blade tip area.Thus,the aerodynamic damping changes significantly with the TCV phase.The aerodynamic damping displays a nonlinear relationship with the vibration amplitude,and it changes from negative to positive with the vibration amplitude increasing at the same frequency ratio.The negative damping is mainly provided by the tip area of the blade.For unlocked conditions,the period of the TCF instabilities fluctuates over time,and it cannot be directly separated by their frequency features.Inter Blade Phase Angle(IBPA)also has an important influence on the feature of the TCV instabilities.The occurrence of frequency lock-in also requires“appropriate”IBPA.For the examined working conditions,the frequency lock-in occurs under 0 ND(Nodal Diameter),but not under 8 ND.However,no matter 0 ND or 8 ND,the phase of TCV always locks onto the IBPA at the examined conditions.展开更多
Construction of the static admissible residual stress field and searching the optimal field are key tasks in the shakedown analysis methods applying the static theorem. These methods always meet dimension obstacles wh...Construction of the static admissible residual stress field and searching the optimal field are key tasks in the shakedown analysis methods applying the static theorem. These methods always meet dimension obstacles when dealing with complex problems. In this paper, a novel shakedown criterion is proposed employing actual residual stress field based on the static shakedown theorem. The actual residual stress field used here is produced under a specified load path, which is a sequence of proportional loading and unloading from zero to all the vertices of the given load domain. This ensures that the shakedown behavior in the whole load domain can be determined based on the theorem proposed by K6nig. The shakedown criterion is then implemented in numerical shakedown analysis, The actual residual stress fields are calculated by incremental finite element elastic-plastic analysis technique for finite deformation under the specified load path with different load levels. The shakedown behavior and the shakedown limit load are determined according to the proposed criterion. The validation of the criterion is performed by a benchmark shakedown example, which is a square plate with a central hole under biaxial loading. The results are consistent with existing results in the literatures and are validated by full cyclic elastic-plastic finite element analysis. The numerical shakedown analysis applying the proposed criterion avoids processing dimension obstacles and performing full cyclic elastic-plastic analysis under arbitrary load paths which should be accounted for appearing. The effect of material model and geometric changes on shakedown behavior can he considered conveniently.展开更多
BACKGROUND:Early reperfusion can effectively treat acute myocardial infarction(AMI) and reduce the mortality signif icantly. This study aimed to compare the role of plasma microRNA-1(miR-1) and cardiac troponin T(cTnT...BACKGROUND:Early reperfusion can effectively treat acute myocardial infarction(AMI) and reduce the mortality signif icantly. This study aimed to compare the role of plasma microRNA-1(miR-1) and cardiac troponin T(cTnT) in early diagnosis of AMI patients.METHODS:From May 2011 to May 2012,plasma samples were collected from 56 AMI patients and 28 non-AMI controls. The expression of plasma miR-1 was measured by quantitative reverse transcription-polymerase chain reaction(qRT-PCR),and the level of plasma cTnT was measured using electrochemiluminescence-based methods on an Elecsys 2010 Immunoassay Analyzer. SPSS 16.0 was used for the statistical analysis of the results. Data were expressed as mean±standard deviation unless otherwise described. The differences about clinical characteristics between the AMI patients and controls were tested using Student's t test or Fisher's exact test. The Mann-Whitney U test was conducted to compare the expression of microRNAs between the AMI patients and controls. MicroRNAs expression between different intervals of the AMI patients was compared using Wilcoxon's signed-rank test. The receiver operating characteristic(ROC) curve was established to discriminate the AMI patients from the controls.RESULTS:In the present study,the expression of plasma miR-1 was signifi cantly increased in the AMI patients compared with the healthy controls(P<0.01). The plasma miR-1 in the AMI patients decreased to the normal level at 14 days(P>0.05). The expression of plasma miR-1 was not related to the clinical characteristics of the study population(P>0.05). ROC curve analyses demonstrated that miR-1 was specifi c and sensitive for the early diagnosis of AMI,but not superior to cTnT.CONCLUSION:Plasma miR-1 could be used in the early diagnosis of AMI,but it is similar to cTnT.展开更多
Background:Autoimmune pancreatitis(AIP)is a well-recognized fibroinflammatory disease of the pancreas.Despite the significant number of studies published on AIP type 1 and 2,no studies have been focused on AIP type no...Background:Autoimmune pancreatitis(AIP)is a well-recognized fibroinflammatory disease of the pancreas.Despite the significant number of studies published on AIP type 1 and 2,no studies have been focused on AIP type not otherwise specified(NOS)and therefore very little is known about clinical features and long-term outcomes of these patients.The aim of this study was to investigate clinical and radiological features of AIP type NOS-patients.Methods:Patients classified as AIP type NOS at clinical onset included in our database prospectively maintained since 1995 were evaluated.Epidemiological,clinical data were collected and analyzed.Results:Forty-six patients were included in the study.The clinical onset was mainly characterized by weight loss,jaundice and acute pancreatitis.Eight patients(17.4%)were reclassified as AIP type 2 during follow-up because of the development of ulcerative colitis.Seven patients(15.2%)experienced relapse after steroid treatment but only one(2.2%)needed immunosuppressive drugs because of recurrent relapses.Conclusions:AIP type NOS shares clinical features similar to AIP type 2 and a relevant proportion of patients was reclassified as AIP type 2 during follow-up because of the development of ulcerative colitis.The risk of relapse is low but not irrelevant.展开更多
Japan has a long history of using foods with health benefits and Japanese people are well-known for their longevity.In 1991,the Ministry of Health,Labor and Welfare introduced a functional food regulation called“food...Japan has a long history of using foods with health benefits and Japanese people are well-known for their longevity.In 1991,the Ministry of Health,Labor and Welfare introduced a functional food regulation called“foods for specified health uses”(FOSHU)in Japan.After the introduction of the functional food system,many clinically proven FOSHU products with health benefits have been developed and launched in the market.As a result,the net sales of FOSHU products reached 6.2 billion dollars in 2007.Most of the health claims relate to improving gastro-intestinal health using probiotics.Triglycerides,high blood pressure,high LDL-cholesterol,and high blood glucose are mainly associated with the related health claims.After 2007,the market for FOSHU products was almost saturated.However,a novel functional regulatory system\called“Foods with Function Claims”was established in 2015 based on the Dietary Supplement Health and Education Act system established in the USA.Major health claims in the new regulation system are associated with fatigue,eyes,memory,stress,sleep,joints,blood flow,body temperature,muscles,and Body Mass Index.After the introduction of the new system,the total sales for functional foods including FOSHU products reached 8 billion dollars in 2018.The new functional regulatory system is more flexible in terms of health claims,the protocol for clinical studies,and the required results.Therefore,the market for new regulatory products is still growing.In the present paper,the potential of both regulatory systems and some related issues will be discussed.展开更多
Patients with type 1 diabetes mellitus are at high risk for disordered eating behaviors (DEB). Due to the fact that type 1 diabetes mellitus is one of the most common chronic illnesses of childhood and adolescence, th...Patients with type 1 diabetes mellitus are at high risk for disordered eating behaviors (DEB). Due to the fact that type 1 diabetes mellitus is one of the most common chronic illnesses of childhood and adolescence, the coexistence of eating disorders (ED) and diabetes often affects adolescents and young adults. Since weight management during this state of development can be especially diff icult for those with type 1 diabetes, some diabetics may restrict or omit insulin, a condition known as diabulimia, as a form of weight control. It has been clearly shown that ED in type 1 diabetics are associated with impaired metabolic control, more frequent episodes of ketoacidosis and an earlier than expected onset of diabetes-related microvascular complications, particularly retinopathy. The management of these conditions requires a multidisciplinary team formed by an endocrinologist/diabetologist, a nurse educator, a nutritionist, a psychologist and, frequently, a psychiatrist. The treatment of type 1 diabetes patients with DEB and ED should have the following compo- nents: diabetes treatment, nutritional management and psychological therapy. A high index of suspicion of the presence of an eating disturbance, particularly among those patients with persistent poor metabolic control, repeated episodes of ketoacidosis and/or weight andshape concerns are recommended in the initial stage of diabetes treatment, especially in young women. Given the extent of the problem and the severe medical risk associated with it, more clinical and technological research aimed to improve its treatment is critical to the future health of this at-risk population.展开更多
The central nervous system(CNS)is characterized by a remarkably elaborate cellular architecture comprising large numbers of glial and neuronal cells with enormous functional diversity,organized into highly complex and...The central nervous system(CNS)is characterized by a remarkably elaborate cellular architecture comprising large numbers of glial and neuronal cells with enormous functional diversity,organized into highly complex and specific networks.During development,the various neural cell types must first be correctly specified,then assume their appropriate positions through carefully choreographed cellular migration,and finally establish and refine their functional connections,often over long distances.The end result of all these processes is an extraordinarily intricate anatomical structure,able to receive,integrate,and store information and orchestrate appropriate responses.展开更多
This study presents the synchronisation between two non-linear Lorenz chaotic systems using an adaptive intuitionistic fuzzy controller(AIFC).This problem is solved in the presence of external disturbances and uncerta...This study presents the synchronisation between two non-linear Lorenz chaotic systems using an adaptive intuitionistic fuzzy controller(AIFC).This problem is solved in the presence of external disturbances and uncertainties.Two classes of Lorenz systems have been formulated one as the master and the other as the slave.The master and slave systems have different initial conditions.Under different initial conditions,both systems diverge.This is called the butterfly effect that rules the behaviour of chaotic systems.AIFC is chosen as a different method that has not been used before to synchronise the chaotic systems.The scaling factors of the inputs and the output of the intuitionistic fuzzy controller(IFC)are tuned using the artificial bee colony(ABC)algorithm depending on a specified objective function.Then IFC stability is studied when it is applied to synchronise the Lorenz system.The simulation results achieved to assess the adequacy of the proposed control and to exhibit its dependability to synchronise the Lorenz system.展开更多
AIM:To study the prevalence of functional dyspepsia(FD)(Rome Ⅲ criteria) across eating disorders(ED),obese patients,constitutional thinner and healthy volunteers.METHODS:Twenty patients affected by anorexia nervosa,6...AIM:To study the prevalence of functional dyspepsia(FD)(Rome Ⅲ criteria) across eating disorders(ED),obese patients,constitutional thinner and healthy volunteers.METHODS:Twenty patients affected by anorexia nervosa,6 affected by bulimia nervosa,10 affected by ED not otherwise specified according to diagnostic and statistical manual of mental disorders,4th edition,nine constitutional thinner subjects and,thirtytwo obese patients were recruited from an outpatients clinic devoted to eating behavior disorders.Twentytwo healthy volunteers matched for age and gender were enrolled as healthy controls.All participants underwent a careful clinical examination.Demographic and anthropometric characteristics were obtained from a structured questionnaires.The presence of FD and,its subgroups,epigastric pain syndrome and postprandial distress syndrome(PDS) were diagnosed according to Rome Ⅲ criteria.The intensity-frequency score of broader dyspeptic symptoms such as early satiety,epigastric fullness,epigastric pain,epigastric burning,epigastric pressure,belching,nausea and vomiting were studied by a standardized questionnaire(0-6).Analysis of variance and post-hoc Sheffè tests were used for comparisons.RESULTS:90% of patients affected by anorexia nervosa,83.3% of patients affected by bulimia nervosa,90% of patients affected by ED not otherwise specified,55.6% of constitutionally thin subjects and 18.2% healthy volunteers met the Postprandial Distress Syndrome Criteria(χ 2,P < 0.001).Only one bulimic patient met the epigastric pain syndrome diagnosis.Postprandial fullness intensity-frequency score was significantly higher in anorexia nervosa,bulimia nervosa and ED not otherwise specified groups compared to the score calculated in the constitutional thinner group(4.15 ± 2.08 vs 1.44 ± 2.35,P = 0.003;5.00 ± 2.45vs 1.44 ± 2.35,P = 0.003;4.10 ± 2.23vs 1.44 ± 2.35,P = 0.002,respectively),the obese group(4.15 ± 2.08vs 0.00 ± 0.00,P < 0.001;5.00 ± 2.45vs 0.00 ± 0.00,P < 0.001;4.10 ± 2.23 vs 0.00 ± 0.00,P < 0.001,respectively) and healthy volunteers(4.15 ± 2.08 vs 0.36 ± 0.79,P < 0.001;5.00 ± 2.45 vs 0.36 ± 0.79,P < 0.001;4.10 ± 2.23 vs 0.36 ± 0.79,P < 0.001,respectively).Early satiety intensity-frequency score was prominent in anorectic patients compared to bulimic patients(3.85 ± 2.23 vs 1.17 ± 1.83,P = 0.015),obese patients(3.85 ± 2.23 vs 0.00 ± 0.00,P < 0.001) and healthy volunteers(3.85 ± 2.23 vs 0.05 ± 0.21,P < 0.001).Nausea and epigastric pressure were increased in bulimic and ED not otherwise specified patients.Specifically,nausea intensity-frequencyscore was significantly higher in bulimia nervosa and ED not otherwise specified patients compared to anorectic patients(3.17 ± 2.56 vs 0.89 ± 1.66,P = 0.04;2.70 ± 2.91 vs 0.89 ± 1.66,P = 0.05,respectively),constitutional thinner subjects(3.17 ± 2.56 vs 0.00 ± 0.00,P = 0.004;2.70 ± 2.91 vs 0.00 ± 0.00,P = 0.005,respectively),obese patients(3.17 ± 2.56 vs 0.00 ± 0.00,P < 0.001;3.17 ± 2.56 vs 0.00 ± 0.00,P < 0.001 respectively) and,healthy volunteers(3.17 ± 2.56 vs 0.17 ± 0.71,P = 0.002;3.17 ± 2.56 vs 0.17 ± 0.71,P = 0.001,respectively).Epigastric pressure intensityfrequency score was significantly higher in bulimic and ED not otherwise specified patients compared to constitutional thin subjects(4.67 ± 2.42 vs 1.22 ± 1.72,P = 0.03;4.20 ± 2.21 vs 1.22 ± 1.72,P = 0.03,respectively),obese patients(4.67 ± 2.42 vs 0.75 ± 1.32,P = 0.001;4.20 ± 2.21vs 0.75 ± 1.32,P < 0.001,respectively) and,healthy volunteers(4.67 ± 2.42 vs 0.67 ± 1.46,P = 0.001;4.20 ± 2.21vs 0.67 ± 1.46,P = 0.001,respectively).Vomiting was referred in 100% of bulimia nervosa patients,in 20% of ED not otherwise specified patients,in 15% of anorexia nervosa patients,in 22% of constitutional thinner subjects,and,in 5.6% healthy volunteers(χ 2,P < 0.001).CONCLUSION:PDS is common in eating disorders.Is it mandatory in outpatient gastroenterological clinics to investigate eating disorders in patients with PDS?展开更多
Current ICD-11 descriptions for attention deficit hyperactivity disorder(ADHD)were recently published online,in the same year as the DSM-5-TR(text revised edition)was released.In this commentary,we compare and contras...Current ICD-11 descriptions for attention deficit hyperactivity disorder(ADHD)were recently published online,in the same year as the DSM-5-TR(text revised edition)was released.In this commentary,we compare and contrast the DSM-5/DSM-5-TR and ICD-11 diagnostic criteria,summarize important differences,and underscore their clinical and research implications.Overall,three major differences emerge:(1)The number of diagnostic criteria for inattention(IA),hyperactivity(HY)and impulsivity(IM)symptoms(i.e.,DSM-5-TR has nine IA and nine HY/IM symptoms,whereas ICD-11 has 11 IA and 11 HY/IM symptoms);(2)the clarity and standardization of diagnostic thresholds(i.e.,the diagnostic thresholds for symptom count in IA and HY/IM domains are explicitly specified in DSM-5-TR,whereas in ICD-11 they are not);and(3)the partitioning of HY and IM symptoms into sub-dimensions(i.e.,difference in partitioning HY and IM symptom domains relates to the differences between the current and previous editions of DSM and ICD,and this has important research implications).Currently,no ICD-11 based ADHD rating scales exist and while this absence represents an obstacle for respective research and clinical practice,it also presents opportunities for research development.This article highlights these challenges,possible remedies and novel research opportunities.展开更多
Aims In the HORIZONS trial, in-hospital treatment with bivalirudin reduced bleeding and mortality in primary percutaneous coronary intervention（PCI） compared with heparin and routine glycoprotein Ⅱb / Ⅲa inhibitor...Aims In the HORIZONS trial, in-hospital treatment with bivalirudin reduced bleeding and mortality in primary percutaneous coronary intervention（PCI） compared with heparin and routine glycoprotein Ⅱb / Ⅲa inhibitors（GPI）. It is unknown whether this advantage of bivalirudin is observed in comparison with heparins only with GPI used as bailout. Methods and results In the EUROMAX study, 2198 patients with ST-segment elevation myocardial infarction（STEMI） were randomized during transport for primary PCI to bivalirudin or to heparins with optional GPI. Primary and principal outcome was the composites of death or nonCABG-related major bleeding at 30 days. This pre-specified analysis compared patients receiving bivalirudin（n = 1089） with those receiving heparins with routine upstream GPI（n = 649） and those receiving heparins only with GPI use restricted to bailout（n = 460）. The primary outcome death and major bleeding occurred in5.1% with bivalirudin, 7.6% with heparin plus routine GPI（HR 0.67 and 95% CI 0.46-0.97, P = 0.034）,and 9.8% with heparins plus bailout GPI（HR 0.52 and 95% CI 0.35-0.75, P = 0.006）. Following adjustment by logistic regression, bivalirudin was still associated with significantly lower rates of the primary outcome（odds ratio 0.53, 95% CI 0.33-0.87） and major bleeding（odds ratio 0.44, 95% CI 0.24 – 0.82） compared with heparins alone with bailout GPI. Rates of stent thrombosis were higher with bivalirudin（1.6 vs. 0.6 vs.0.4%, P = 0.09 and 0.09）. Conclusion Bivalirudin, started during transport for primary PCI, reduces major bleeding compared with both patients treated with heparin only plus bailout GPI and patients treated with heparin and routine GPI, but increased stent thrombosis.展开更多
Based on domain specified language mechanism(DSLM),the architecture of the robotic training system for the rehabilitation of children with cerebral palsy(CP)is designed.Application of human-computer interaction(HCI)mo...Based on domain specified language mechanism(DSLM),the architecture of the robotic training system for the rehabilitation of children with cerebral palsy(CP)is designed.Application of human-computer interaction(HCI)motion recognition technology is combined with Kinect to improve the effect of cerebral palsy rehabilitation training.In this system,Kinect's bone recognition method is used to judge the patient's training movements,and the collected bone movement information is judged.The human-computer interaction function is based on the Microsoft foundation classes function of Visual Studio based on DSLM development,which can realize real-time interactive training and evaluation of people and actions,and record the training information of patients.The system combines the designed small game to train the upper limb movement ability and reaction ability of the cerebral palsy patient,and provides key technology for improving the cerebral palsy rehabilitation training system.展开更多
基金supported by the National Natural Science Foundation of China(U21B2074,52105070).
文摘Discrete event system(DES)models promote system engineering,including system design,verification,and assessment.The advancement in manufacturing technology has endowed us to fabricate complex industrial systems.Consequently,the adoption of advanced modeling methodologies adept at handling complexity and scalability is imperative.Moreover,industrial systems are no longer quiescent,thus the intelligent operations of the systems should be dynamically specified in the model.In this paper,the composition of the subsystem behaviors is studied to generate the complexity and scalability of the global system model,and a Boolean semantic specifying algorithm is proposed for generating dynamic intelligent operations in the model.In traditional modeling approaches,the change or addition of specifications always necessitates the complete resubmission of the system model,a resource-consuming and error-prone process.Compared with traditional approaches,our approach has three remarkable advantages:(i)an established Boolean semantic can be fitful for all kinds of systems;(ii)there is no need to resubmit the system model whenever there is a change or addition of the operations;(iii)multiple specifying tasks can be easily achieved by continuously adding a new semantic.Thus,this general modeling approach has wide potential for future complex and intelligent industrial systems.
基金supported by grants from the National Natural Science Foundation of China(32125018 and 32071005)the National Key Research and Development Program of China(2021YFA1101701)+2 种基金the Fundamental Research Funds for the Central Universities,the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(2023-PT310-01)the MOE Frontiers Science Center for Brain Science&Brain-Machine Integration of Zhejiang University,the Innovative Research Team of High-level Local Universities in Shanghai(SHSMU-ZDCX20211102)the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(2023-PT310-01).
文摘Male sexual behavior is an innate social behavior crucial for reproduction[1].Previous studies have identified several brain regions crucial for the control of both sexual and aggressive behaviors in males.Yet,molecularly specified neural circuits that specifically control male sexual behavior remain elusive.Consistent with the inherently rewarding nature of sexual behavior,previous research has implicated the role of the dopamine system in regulating sexual desire[2].However,the interaction between reward and copulation at the circuit level remains largely unexplored.Besides,it is unclear if the associated neural pathways are specific in modulating sexual reward.
基金support from the National Natural Science Foundation of China(U23A20318 and 62276195)support from the National Natural Science Foundation of China(12175003,12361161602)NSAF(U2330201)。
文摘Quantum entanglement is a key resource for achieving superiority of quantum computing.Currently,scientists are extensively focusing on how to integrate quantum entanglement into various components of quantum machine learning(QML)models,aiming to surpass the performance of traditional machine learning models.Notable successes include the use of entangled measurements^([1-3])and entangled channels^([4]),which have been shown to reduce query complexity or improve the prediction precision for specified QML tasks.Quantum entangled data,capable of encoding more information compared to classical data of the same size,is recognized for its potential to achieve quantum advantages.Nevertheless,the impact of the entanglement degree in quantum data on model performance remains a challenging and unresolved research question.
基金Supported by 2024 Kangwon National University Hospital Grant,No.KNUH_2024_02_06.
文摘BACKGROUND Gastrointestinal lymphoma typically arises in the stomach,small bowel,or colorectum and is usually a B-cell lymphoma.However,primary T-cell lymp-homas originating in the stomach are particularly rare.Gastric peripheral T-cell lymphoma-not otherwise specified(PTCL-NOS)is an extremely rare subtype.CASE SUMMARY We report a 63-year-old male presenting with epigastric pain.Esophagogastro-duodenoscopy revealed a large ulcerative lesion in the gastric cardia.Biopsy and immunohistochemical profiling confirmed PTCL-NOS.Imaging indicated stage II disease involving the stomach and intra-abdominal lymph nodes.The patient is planned to undergo cyclophosphamide,doxorubicin,vincristine,and prednisone or cyclophosphamide,doxorubicin,vincristine,prednisone,and etoposide chemo-therapy.CONCLUSION This case highlights the necessity of considering PTCL-NOS in differential diag-noses of gastric lesions.Comprehensive histopathological and immunohistoche-mical analysis is crucial for accurate diagnosis and guiding treatment.
文摘Background:Adjuvant pembrolizumab therapy after surgery for renal-cell carcinoma was approved on the basis of a significant improvement in disease-free survival in the KEYNOTE-564 trial.Whether the results regarding overall survival from the third prespecified interim analysis of the trial would also favor pembrolizumab was uncertain.Methods:In this phase 3,double-blind,placebo-controlled trial,we randomly assigned(in a 1:1 ratio)participants with clear-cell renal-cell carcinoma who had an increased risk of recurrence after surgery to receive pembrolizumab(at a dose of 200 mg)or placebo every 3 weeks for up to 17 cycles(approximately 1 year)or until recurrence,the occurrence of unacceptable toxic effects,or withdrawal of consent.A significant improvement in disease-free survival according to investigator assessment(the primary end point)was shown previously.Overall survival was the key secondary end point.Safety was a secondary end point.
基金Supported by Shanghai Leading Academic Discipline Project,No.S30203Shanghai Jiaotong University School of Medi-cine Leading Academic Discipline Project
文摘AIM: To analyze the accuracy of computed tomography (CT) angiography in the diagnosis of acute gastrointestinal (GI) bleeding. METHODS: The MEDLINE, EMBASE, Cancerlit, Cochrane Library database, Sciencedirect, Springerlink and Scopus, from January 1995 to December 2009, were searched for studies evaluating the accuracy of CT angiography in diagnosing acute GI bleeding. Studies were included if the ycompared CT angiography to a reference standard of upper GI endoscopy, colonoscopy, angiography or surgery in the diagnosis of acute GI bleeding. Meta-analysis methods were used to pool sensitivity and specificity and to construct summary receiver-operating characteristic. RESULTS: A total of 9 studies with 198 patients were included in this meta-analysis. Data were used to form 2 × 2 tables. CT angiography showed pooled sensi-tivity of 89% (95% CI: 82%-94%) and specificity of 85% (95% CI: 74%-92%), without showing significant heterogeneity (χ2 = 12.5, P = 0.13) and (χ2 = 22.95, P = 0.003), respectively. Summary receiver operating characteristic analysis showed an area under the curve of 0.9297. CONCLUSION: CT angiography is an accurate, costeffective tool in the diagnosis of acute GI bleeding and can show the precise location of bleeding, thereby directing further management.
基金Supported by the National Basic Research Program of China(2012CB725400)。
文摘An improved floor field model is proposed to simulate the pedestrian evacuation behavior in a room with multiple exits by modifying the static floor field.The modified static floor field is determined additionally by two cognitive coefficients of exit width and congestion degree around the exits.The logit-based discrete choice principle is used to govern the initial exit selection strategy based on the modified static floor field in such a scenario that pedestrians are distributed in the room's specified zone.Simulation results show that the proposed model can better perform the evacuation process.Sensitivity analyses of the model parameters are also presented.
基金supported by the National Natural Science Foundation of China(No.51475022)。
文摘In this study,the lock-in phenomenon of Tip Clearance Flow(TCF)instabilities and their relationship to blade vibration are investigated numerically on an axial transonic rotor with a large tip clearance.The capabilities of simulating instability flow and lock-in phenomenon are verified on a transonic rotor and a NACA0012 airfoil by comparing with the test data,respectively.The lock-in phenomenon is first numerically confirmed that may occur to TCF instabilities when its frequency is close to the blade vibration frequency.The lock-in region becomes wider with the vibration amplitude increasing,and it is also affected by modal shapes.For the rotor at the simulation conditions in this study,the bending mode results in a wider lock-in region than the torsional mode.In the lock-in region,the phase difference between the Tip Clearance Vortex(TCV)and the blade vibration changes with the flow condition and the frequency ratio of the blade vibration and the TCV instabilities.The frequency of the TCV instabilities reduces with the mass flow decreasing.Therefore,reducing mass flow and increasing frequency ratio have similar effects on the TCV phase,which causes a significant variation on the unsteady pressure amplitude in the blade tip area.Thus,the aerodynamic damping changes significantly with the TCV phase.The aerodynamic damping displays a nonlinear relationship with the vibration amplitude,and it changes from negative to positive with the vibration amplitude increasing at the same frequency ratio.The negative damping is mainly provided by the tip area of the blade.For unlocked conditions,the period of the TCF instabilities fluctuates over time,and it cannot be directly separated by their frequency features.Inter Blade Phase Angle(IBPA)also has an important influence on the feature of the TCV instabilities.The occurrence of frequency lock-in also requires“appropriate”IBPA.For the examined working conditions,the frequency lock-in occurs under 0 ND(Nodal Diameter),but not under 8 ND.However,no matter 0 ND or 8 ND,the phase of TCV always locks onto the IBPA at the examined conditions.
基金Supported by National Science and Technology Major Project of China(Grant No.2013ZX04003031)National Natural Science Foundation of China(Grant No.51475408)+1 种基金Hebei Provincial College Innovation Team Leader Training Program of China(Grant No.LJRC012)Hebei Provincial Natural Science Foundation of China(Grant No.E2012203045)
文摘Construction of the static admissible residual stress field and searching the optimal field are key tasks in the shakedown analysis methods applying the static theorem. These methods always meet dimension obstacles when dealing with complex problems. In this paper, a novel shakedown criterion is proposed employing actual residual stress field based on the static shakedown theorem. The actual residual stress field used here is produced under a specified load path, which is a sequence of proportional loading and unloading from zero to all the vertices of the given load domain. This ensures that the shakedown behavior in the whole load domain can be determined based on the theorem proposed by K6nig. The shakedown criterion is then implemented in numerical shakedown analysis, The actual residual stress fields are calculated by incremental finite element elastic-plastic analysis technique for finite deformation under the specified load path with different load levels. The shakedown behavior and the shakedown limit load are determined according to the proposed criterion. The validation of the criterion is performed by a benchmark shakedown example, which is a square plate with a central hole under biaxial loading. The results are consistent with existing results in the literatures and are validated by full cyclic elastic-plastic finite element analysis. The numerical shakedown analysis applying the proposed criterion avoids processing dimension obstacles and performing full cyclic elastic-plastic analysis under arbitrary load paths which should be accounted for appearing. The effect of material model and geometric changes on shakedown behavior can he considered conveniently.
基金supported by grants from the National Natural Science Foundation of China(81071030)the Science and Technology Foundation of Guangdong Province(2011B080701006)
文摘BACKGROUND:Early reperfusion can effectively treat acute myocardial infarction(AMI) and reduce the mortality signif icantly. This study aimed to compare the role of plasma microRNA-1(miR-1) and cardiac troponin T(cTnT) in early diagnosis of AMI patients.METHODS:From May 2011 to May 2012,plasma samples were collected from 56 AMI patients and 28 non-AMI controls. The expression of plasma miR-1 was measured by quantitative reverse transcription-polymerase chain reaction(qRT-PCR),and the level of plasma cTnT was measured using electrochemiluminescence-based methods on an Elecsys 2010 Immunoassay Analyzer. SPSS 16.0 was used for the statistical analysis of the results. Data were expressed as mean±standard deviation unless otherwise described. The differences about clinical characteristics between the AMI patients and controls were tested using Student's t test or Fisher's exact test. The Mann-Whitney U test was conducted to compare the expression of microRNAs between the AMI patients and controls. MicroRNAs expression between different intervals of the AMI patients was compared using Wilcoxon's signed-rank test. The receiver operating characteristic(ROC) curve was established to discriminate the AMI patients from the controls.RESULTS:In the present study,the expression of plasma miR-1 was signifi cantly increased in the AMI patients compared with the healthy controls(P<0.01). The plasma miR-1 in the AMI patients decreased to the normal level at 14 days(P>0.05). The expression of plasma miR-1 was not related to the clinical characteristics of the study population(P>0.05). ROC curve analyses demonstrated that miR-1 was specifi c and sensitive for the early diagnosis of AMI,but not superior to cTnT.CONCLUSION:Plasma miR-1 could be used in the early diagnosis of AMI,but it is similar to cTnT.
文摘Background:Autoimmune pancreatitis(AIP)is a well-recognized fibroinflammatory disease of the pancreas.Despite the significant number of studies published on AIP type 1 and 2,no studies have been focused on AIP type not otherwise specified(NOS)and therefore very little is known about clinical features and long-term outcomes of these patients.The aim of this study was to investigate clinical and radiological features of AIP type NOS-patients.Methods:Patients classified as AIP type NOS at clinical onset included in our database prospectively maintained since 1995 were evaluated.Epidemiological,clinical data were collected and analyzed.Results:Forty-six patients were included in the study.The clinical onset was mainly characterized by weight loss,jaundice and acute pancreatitis.Eight patients(17.4%)were reclassified as AIP type 2 during follow-up because of the development of ulcerative colitis.Seven patients(15.2%)experienced relapse after steroid treatment but only one(2.2%)needed immunosuppressive drugs because of recurrent relapses.Conclusions:AIP type NOS shares clinical features similar to AIP type 2 and a relevant proportion of patients was reclassified as AIP type 2 during follow-up because of the development of ulcerative colitis.The risk of relapse is low but not irrelevant.
文摘Japan has a long history of using foods with health benefits and Japanese people are well-known for their longevity.In 1991,the Ministry of Health,Labor and Welfare introduced a functional food regulation called“foods for specified health uses”(FOSHU)in Japan.After the introduction of the functional food system,many clinically proven FOSHU products with health benefits have been developed and launched in the market.As a result,the net sales of FOSHU products reached 6.2 billion dollars in 2007.Most of the health claims relate to improving gastro-intestinal health using probiotics.Triglycerides,high blood pressure,high LDL-cholesterol,and high blood glucose are mainly associated with the related health claims.After 2007,the market for FOSHU products was almost saturated.However,a novel functional regulatory system\called“Foods with Function Claims”was established in 2015 based on the Dietary Supplement Health and Education Act system established in the USA.Major health claims in the new regulation system are associated with fatigue,eyes,memory,stress,sleep,joints,blood flow,body temperature,muscles,and Body Mass Index.After the introduction of the new system,the total sales for functional foods including FOSHU products reached 8 billion dollars in 2018.The new functional regulatory system is more flexible in terms of health claims,the protocol for clinical studies,and the required results.Therefore,the market for new regulatory products is still growing.In the present paper,the potential of both regulatory systems and some related issues will be discussed.
基金Supported by a grant from INCITE, Consellería Innovación e Industria, Galician Government
文摘Patients with type 1 diabetes mellitus are at high risk for disordered eating behaviors (DEB). Due to the fact that type 1 diabetes mellitus is one of the most common chronic illnesses of childhood and adolescence, the coexistence of eating disorders (ED) and diabetes often affects adolescents and young adults. Since weight management during this state of development can be especially diff icult for those with type 1 diabetes, some diabetics may restrict or omit insulin, a condition known as diabulimia, as a form of weight control. It has been clearly shown that ED in type 1 diabetics are associated with impaired metabolic control, more frequent episodes of ketoacidosis and an earlier than expected onset of diabetes-related microvascular complications, particularly retinopathy. The management of these conditions requires a multidisciplinary team formed by an endocrinologist/diabetologist, a nurse educator, a nutritionist, a psychologist and, frequently, a psychiatrist. The treatment of type 1 diabetes patients with DEB and ED should have the following compo- nents: diabetes treatment, nutritional management and psychological therapy. A high index of suspicion of the presence of an eating disturbance, particularly among those patients with persistent poor metabolic control, repeated episodes of ketoacidosis and/or weight andshape concerns are recommended in the initial stage of diabetes treatment, especially in young women. Given the extent of the problem and the severe medical risk associated with it, more clinical and technological research aimed to improve its treatment is critical to the future health of this at-risk population.
文摘The central nervous system(CNS)is characterized by a remarkably elaborate cellular architecture comprising large numbers of glial and neuronal cells with enormous functional diversity,organized into highly complex and specific networks.During development,the various neural cell types must first be correctly specified,then assume their appropriate positions through carefully choreographed cellular migration,and finally establish and refine their functional connections,often over long distances.The end result of all these processes is an extraordinarily intricate anatomical structure,able to receive,integrate,and store information and orchestrate appropriate responses.
文摘This study presents the synchronisation between two non-linear Lorenz chaotic systems using an adaptive intuitionistic fuzzy controller(AIFC).This problem is solved in the presence of external disturbances and uncertainties.Two classes of Lorenz systems have been formulated one as the master and the other as the slave.The master and slave systems have different initial conditions.Under different initial conditions,both systems diverge.This is called the butterfly effect that rules the behaviour of chaotic systems.AIFC is chosen as a different method that has not been used before to synchronise the chaotic systems.The scaling factors of the inputs and the output of the intuitionistic fuzzy controller(IFC)are tuned using the artificial bee colony(ABC)algorithm depending on a specified objective function.Then IFC stability is studied when it is applied to synchronise the Lorenz system.The simulation results achieved to assess the adequacy of the proposed control and to exhibit its dependability to synchronise the Lorenz system.
文摘AIM:To study the prevalence of functional dyspepsia(FD)(Rome Ⅲ criteria) across eating disorders(ED),obese patients,constitutional thinner and healthy volunteers.METHODS:Twenty patients affected by anorexia nervosa,6 affected by bulimia nervosa,10 affected by ED not otherwise specified according to diagnostic and statistical manual of mental disorders,4th edition,nine constitutional thinner subjects and,thirtytwo obese patients were recruited from an outpatients clinic devoted to eating behavior disorders.Twentytwo healthy volunteers matched for age and gender were enrolled as healthy controls.All participants underwent a careful clinical examination.Demographic and anthropometric characteristics were obtained from a structured questionnaires.The presence of FD and,its subgroups,epigastric pain syndrome and postprandial distress syndrome(PDS) were diagnosed according to Rome Ⅲ criteria.The intensity-frequency score of broader dyspeptic symptoms such as early satiety,epigastric fullness,epigastric pain,epigastric burning,epigastric pressure,belching,nausea and vomiting were studied by a standardized questionnaire(0-6).Analysis of variance and post-hoc Sheffè tests were used for comparisons.RESULTS:90% of patients affected by anorexia nervosa,83.3% of patients affected by bulimia nervosa,90% of patients affected by ED not otherwise specified,55.6% of constitutionally thin subjects and 18.2% healthy volunteers met the Postprandial Distress Syndrome Criteria(χ 2,P < 0.001).Only one bulimic patient met the epigastric pain syndrome diagnosis.Postprandial fullness intensity-frequency score was significantly higher in anorexia nervosa,bulimia nervosa and ED not otherwise specified groups compared to the score calculated in the constitutional thinner group(4.15 ± 2.08 vs 1.44 ± 2.35,P = 0.003;5.00 ± 2.45vs 1.44 ± 2.35,P = 0.003;4.10 ± 2.23vs 1.44 ± 2.35,P = 0.002,respectively),the obese group(4.15 ± 2.08vs 0.00 ± 0.00,P < 0.001;5.00 ± 2.45vs 0.00 ± 0.00,P < 0.001;4.10 ± 2.23 vs 0.00 ± 0.00,P < 0.001,respectively) and healthy volunteers(4.15 ± 2.08 vs 0.36 ± 0.79,P < 0.001;5.00 ± 2.45 vs 0.36 ± 0.79,P < 0.001;4.10 ± 2.23 vs 0.36 ± 0.79,P < 0.001,respectively).Early satiety intensity-frequency score was prominent in anorectic patients compared to bulimic patients(3.85 ± 2.23 vs 1.17 ± 1.83,P = 0.015),obese patients(3.85 ± 2.23 vs 0.00 ± 0.00,P < 0.001) and healthy volunteers(3.85 ± 2.23 vs 0.05 ± 0.21,P < 0.001).Nausea and epigastric pressure were increased in bulimic and ED not otherwise specified patients.Specifically,nausea intensity-frequencyscore was significantly higher in bulimia nervosa and ED not otherwise specified patients compared to anorectic patients(3.17 ± 2.56 vs 0.89 ± 1.66,P = 0.04;2.70 ± 2.91 vs 0.89 ± 1.66,P = 0.05,respectively),constitutional thinner subjects(3.17 ± 2.56 vs 0.00 ± 0.00,P = 0.004;2.70 ± 2.91 vs 0.00 ± 0.00,P = 0.005,respectively),obese patients(3.17 ± 2.56 vs 0.00 ± 0.00,P < 0.001;3.17 ± 2.56 vs 0.00 ± 0.00,P < 0.001 respectively) and,healthy volunteers(3.17 ± 2.56 vs 0.17 ± 0.71,P = 0.002;3.17 ± 2.56 vs 0.17 ± 0.71,P = 0.001,respectively).Epigastric pressure intensityfrequency score was significantly higher in bulimic and ED not otherwise specified patients compared to constitutional thin subjects(4.67 ± 2.42 vs 1.22 ± 1.72,P = 0.03;4.20 ± 2.21 vs 1.22 ± 1.72,P = 0.03,respectively),obese patients(4.67 ± 2.42 vs 0.75 ± 1.32,P = 0.001;4.20 ± 2.21vs 0.75 ± 1.32,P < 0.001,respectively) and,healthy volunteers(4.67 ± 2.42 vs 0.67 ± 1.46,P = 0.001;4.20 ± 2.21vs 0.67 ± 1.46,P = 0.001,respectively).Vomiting was referred in 100% of bulimia nervosa patients,in 20% of ED not otherwise specified patients,in 15% of anorexia nervosa patients,in 22% of constitutional thinner subjects,and,in 5.6% healthy volunteers(χ 2,P < 0.001).CONCLUSION:PDS is common in eating disorders.Is it mandatory in outpatient gastroenterological clinics to investigate eating disorders in patients with PDS?
文摘Current ICD-11 descriptions for attention deficit hyperactivity disorder(ADHD)were recently published online,in the same year as the DSM-5-TR(text revised edition)was released.In this commentary,we compare and contrast the DSM-5/DSM-5-TR and ICD-11 diagnostic criteria,summarize important differences,and underscore their clinical and research implications.Overall,three major differences emerge:(1)The number of diagnostic criteria for inattention(IA),hyperactivity(HY)and impulsivity(IM)symptoms(i.e.,DSM-5-TR has nine IA and nine HY/IM symptoms,whereas ICD-11 has 11 IA and 11 HY/IM symptoms);(2)the clarity and standardization of diagnostic thresholds(i.e.,the diagnostic thresholds for symptom count in IA and HY/IM domains are explicitly specified in DSM-5-TR,whereas in ICD-11 they are not);and(3)the partitioning of HY and IM symptoms into sub-dimensions(i.e.,difference in partitioning HY and IM symptom domains relates to the differences between the current and previous editions of DSM and ICD,and this has important research implications).Currently,no ICD-11 based ADHD rating scales exist and while this absence represents an obstacle for respective research and clinical practice,it also presents opportunities for research development.This article highlights these challenges,possible remedies and novel research opportunities.
文摘Aims In the HORIZONS trial, in-hospital treatment with bivalirudin reduced bleeding and mortality in primary percutaneous coronary intervention（PCI） compared with heparin and routine glycoprotein Ⅱb / Ⅲa inhibitors（GPI）. It is unknown whether this advantage of bivalirudin is observed in comparison with heparins only with GPI used as bailout. Methods and results In the EUROMAX study, 2198 patients with ST-segment elevation myocardial infarction（STEMI） were randomized during transport for primary PCI to bivalirudin or to heparins with optional GPI. Primary and principal outcome was the composites of death or nonCABG-related major bleeding at 30 days. This pre-specified analysis compared patients receiving bivalirudin（n = 1089） with those receiving heparins with routine upstream GPI（n = 649） and those receiving heparins only with GPI use restricted to bailout（n = 460）. The primary outcome death and major bleeding occurred in5.1% with bivalirudin, 7.6% with heparin plus routine GPI（HR 0.67 and 95% CI 0.46-0.97, P = 0.034）,and 9.8% with heparins plus bailout GPI（HR 0.52 and 95% CI 0.35-0.75, P = 0.006）. Following adjustment by logistic regression, bivalirudin was still associated with significantly lower rates of the primary outcome（odds ratio 0.53, 95% CI 0.33-0.87） and major bleeding（odds ratio 0.44, 95% CI 0.24 – 0.82） compared with heparins alone with bailout GPI. Rates of stent thrombosis were higher with bivalirudin（1.6 vs. 0.6 vs.0.4%, P = 0.09 and 0.09）. Conclusion Bivalirudin, started during transport for primary PCI, reduces major bleeding compared with both patients treated with heparin only plus bailout GPI and patients treated with heparin and routine GPI, but increased stent thrombosis.
基金Supported by the China-Slovenia Intergovernmental Science and Technology Cooperation and Exchange Project(2017-21-12-16)China-Serbia Intergovernmental Science and Technology Cooperation and Exchange Project(266-3-1).
文摘Based on domain specified language mechanism(DSLM),the architecture of the robotic training system for the rehabilitation of children with cerebral palsy(CP)is designed.Application of human-computer interaction(HCI)motion recognition technology is combined with Kinect to improve the effect of cerebral palsy rehabilitation training.In this system,Kinect's bone recognition method is used to judge the patient's training movements,and the collected bone movement information is judged.The human-computer interaction function is based on the Microsoft foundation classes function of Visual Studio based on DSLM development,which can realize real-time interactive training and evaluation of people and actions,and record the training information of patients.The system combines the designed small game to train the upper limb movement ability and reaction ability of the cerebral palsy patient,and provides key technology for improving the cerebral palsy rehabilitation training system.
