The rise of the aging population parallels the rapidly increasing cases of neurological disorders. This puts pressure on scientists and physicians to find novel methods that can prevent and treat neurodegeneration. Th...The rise of the aging population parallels the rapidly increasing cases of neurological disorders. This puts pressure on scientists and physicians to find novel methods that can prevent and treat neurodegeneration. The brain is made up of a complex network of different cell types that work in tandem to maintain systemic homeostasis.展开更多
BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparosc...BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparoscopic procedures,are well-established in high-income countries and are being increasingly adopted worldwide.Nevertheless,no studies have reported surgical outcomes of RALDN donor nephrectomy from a United Kingdom center to date.AIM To compare surgical outcomes between RALDN and HALDN laparoscopic donor nephrectomy in a United Kingdom high-volume living kidney donor transplant program.METHODS A case-control matching analysis was performed based on the following parameters:Sex,age,body mass index,procedure laterality,number of renal arteries,and previous abdominal surgeries.Key surgical outcomes,including primary warm ischemia time,operative duration,and post-operative recovery,were evaluated.RESULTS In this cohort of 140 living donors(70 RALDN vs 70 HALDN),donor and recipient outcomes were equivalent across key metrics:Pain scores,overall complication rates,readmissions,reoperations,and creatinine levels at 30 days and 1 year.Recipient long-term renal function did not differ between groups.Operative time for RALDN decreased significantly over the study period,indicating progressive improvement along the learning curve.Although RALDN was associated with a modestly longer mean warm ischaemia time(3.53 minutes vs 2.76 minutes,P<0.001)and extended hospital stay(4.21 days vs 3.17 days,P<0.001),these did not translate into any disadvantage in clinical outcomes.CONCLUSION In this first United Kingdom comparative cohort,RALDN demonstrated excellent safety and efficacy,even in the early phase of our programme,matching the outcomes of the well-established,gold-standard HALDN approach.Moreover,the pronounced learning-curve trajectory suggests considerable potential for further improvements in robotic surgical outcomes as the programme matures.展开更多
This paper studies two isometric problems between unit spheres of Banach spaces.In the first part,we introduce and study the Figiel type problem of isometric embeddings between unit spheres.However,the classical Figie...This paper studies two isometric problems between unit spheres of Banach spaces.In the first part,we introduce and study the Figiel type problem of isometric embeddings between unit spheres.However,the classical Figiel theorem on the whole space cannot be trivially generalized to this case,and this is pointed out by a counterexample.After establishing this,we find a natural necessary condition required by the existence of the Figiel operator.Furthermore,we prove that when X is a space with the T-property,this condition is also sufficient for an isometric embedding T:S_(X)→S_(Y) to admit the Figiel operator.This answers the Figiel type problem on unit spheres for a large class of spaces.In the second part,we consider the extension of bijectiveε-isometries between unit spheres of two Banach spaces.It is shown that every bijectiveε-isometry between unit spheres of a local GL-space and another Banach space can be extended to be a bijective 5ε-isometry between the corresponding unit balls.In particular,whenε=0,this recovers the MUP for local GL-spaces obtained in[40].展开更多
The new energy power generation is becoming increasingly important in the power system.Such as photovoltaic power generation has become a research hotspot,however,due to the characteristics of light radiation changes,...The new energy power generation is becoming increasingly important in the power system.Such as photovoltaic power generation has become a research hotspot,however,due to the characteristics of light radiation changes,photovoltaic power generation is unstable and random,resulting in a low utilization rate and directly affecting the stability of the power grid.To solve this problem,this paper proposes a coordinated control strategy for a newenergy power generation system with a hybrid energy storage unit based on the lithium iron phosphate-supercapacitor hybrid energy storage unit.Firstly,the variational mode decomposition algorithm is used to separate the high and low frequencies of the power signal,which is conducive to the rapid and accurate suppression of the power fluctuation of the energy storage system.Secondly,the fuzzy control algorithm is introduced to balance the power between energy storage.In this paper,the actual data is used for simulation,and the simulation results show that the strategy realizes the effective suppression of the bus voltage fluctuation and the accurate control of the internal state of the energy storage unit,effectively avoiding problems such as overshoot and over-discharge,and can significantly improve the stability of the photovoltaic power generation systemand the stability of the Direct Current bus.It is of great significance to promote the development of collaborative control technology for photovoltaic hybrid energy storage units.展开更多
This paper aimed at studying the effect of different types of soil tillage systems on the change of total carbon （C） and nitrogen （N） in the soil structural units of different size after dry structural analysis of...This paper aimed at studying the effect of different types of soil tillage systems on the change of total carbon （C） and nitrogen （N） in the soil structural units of different size after dry structural analysis of soil. The research was carried out in a 6-field rotation system （grain maize-wheat-sunflower-wheat-bean-wheat） at the end of the 2nd rotation. Six out of 24 soil tillage systems were selected; they were applied independently and in combination in the crop rotation. After that, they were compared to the system with constant deep plowing. So a total of seven soil tillage systems were investigated. The selected systems for main soil tillage were the following： plowing （control variant）, disking, cutting, nil tillage （direct sowing）, plowing-disking, plowing-nil tillage, disking-nil tillage. Three depths of 0-10, 10-20 and 20-30 cm were studied, as well as soil structural units were of the following sizes： 〉 10 mm, 10-5, 5-3, 3-1, 1-0.25 mm and 〈 0.25 mm. As a result of systematic implementation of different soil tillage systems, higher N and C concentrations were established by the layers according to constant plowing. Constant disking and its alternation with nil tillage increased the total N concentration with 15.6% and 11.1%, respectively, in comparison with the constant plowing. The same was valid for C concentration in soil, but the highest increase was established in the variants with constant cutting and nil tillage. The exceeding was with 14.0% and 13.2%, in comparison to constant plowing. The redistribution of N and C depending on the structural soil units was most expressed in the 0-10 cm and 10-20 cm layers. The highest amounts of C and N were found in the soil units with size less than 5 mm, mainly in the 〈 0.25 mm fraction. At depth of 20-30 cm, the role of the size of soil structural units for C and N redistribution decreased strongly. The values of C/N ratio were moderate only under the use of constant disking. This index was low under all other soil tillage systems. The correlation of total N with C in soil was high, positive and significant depending on the size of structural soil units and the tillage systems, as average for the investigated factors in this experiment. The minimal tillage and the tillage without turning of soil, used independently and in combination, had the highest contribution to preserving the organic matter in the haplic Chernozems of Dobrudzha region.展开更多
BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU ad...BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality.Two different types of unplanned ICU admissions include upgrades(patients admitted to the floor then moved to the ICU)and bounce backs(patients admitted to the ICU,discharged to the floor,and then readmitted to the ICU).Previous studies have shown that geriatric trauma patients are at higher risk for unfavorable outcomes.AIM To analyze the characteristics,management and outcomes of trauma patients who had an unplanned ICU admission during their hospitalization.METHODS This institutional review board approved,retrospective cohort study examined 203 adult trauma patients with unplanned ICU admission at an urban level 1 trauma center over a six-year period(2017-2023).This included 134 upgrades and 69 bounce backs.Analyzed variables included:(1)Age;(2)Sex;(3)Comorbidities;(4)Mechanism of injury(MOI);(5)Injury severity score(ISS);(6)Glasgow Coma Scale(GCS);(7)Type of injury;(8)Transfusions;(9)Consultations;(10)Timing and reason for unplanned admission;(11)Intubations;(12)Surgical interventions;(13)ICU and hospital lengths of stay;and(14)Mortality.RESULTS Unplanned ICU admissions comprised 4.2%of total ICU admissions.Main MOI was falls.Mean age was 70.7 years,ISS was 12.8 and GCS was 13.9.Main injuries were traumatic brain injury(37.4%)and thoracic injury(21.7%),and main reason for unplanned ICU admission was respiratory complication(39.4%).The 47.3%underwent a surgical procedure and 46.8%were intubated.Average timing for unplanned ICU admission was 2.9 days.Bounce backs occurred half as often as upgrades,however had higher rates of transfusions(63.8%vs 40.3%,P=0.002),consultations(4.8 vs 3.0,P<0.001),intubations(63.8%vs 38.1%%,P=0.001),longer ICU lengths of stay(13.2 days vs 6.4 days,P<0.001)and hospital lengths of stay(26.7 days vs 13.0 days,P<0.001).Mortality was 25.6%among unplanned ICU admissions,31.9%among geriatric unplanned ICU admissions and 11.9%among all trauma ICU patients.CONCLUSION Unplanned ICU admissions constituted 4.2%of total ICU admissions.Respiratory complications were the main cause of unplanned ICU admissions.Bounce backs occurred half as often as upgrades,but were associated with worse outcomes.展开更多
BACKGROUND As red blood cell distribution width(RDW)and albumin have been shown to be independent predictors of mortality from various diseases,this study aimed to investigate the effect of the RDW to albumin ratio(RA...BACKGROUND As red blood cell distribution width(RDW)and albumin have been shown to be independent predictors of mortality from various diseases,this study aimed to investigate the effect of the RDW to albumin ratio(RA)as an independent predictor of the prognosis of patients admitted to the coronary care unit(CCU).AIM To use the RDW and albumin level to predict the prognosis of patients in the CCU.METHODS Data were obtained from the Medical Information Mart Intensive Care III database.The primary outcome was 365-day all-cause mortality,whereas the secondary outcomes were 30-and 90-day all-cause mortality,hospital length of stay(LOS),and CCU LOS.Cox proportional hazards regression model,propen-sity score matching,and receiver operating characteristic curve analyses were used.RESULTS The hazard ratio(95%confidence interval)of the upper tertile(RA>4.66)was 1.62(1.29 to 2.03)when compared with the reference(RA<3.84)in 365-day all-cause mortality.This trend persisted after adjusting for demographic and clinical variables in the propensity score-matching analysis.Similar trends were observed for the secondary outcomes of hospital and CCU LOS.Receiver operating characteristic curve analysis was performed by combining the RA and sequential organ failure assessment(SOFA)scores,and the C-statistic was higher than that of the SOFA scores(0.733 vs 0.702,P<0.001).CONCLUSION RA is an independent prognostic factor in patients admitted to the CCU.RA combined with the SOFA score can improve the predictive ability of the SOFA score.However,our results should be verified in future prospective studies.展开更多
Typhoons can cause large-area blackouts or partial outages of distribution networks.We define a partial outage state in the distribution network as a gray state and propose a gray-start strategy and two-stage distribu...Typhoons can cause large-area blackouts or partial outages of distribution networks.We define a partial outage state in the distribution network as a gray state and propose a gray-start strategy and two-stage distribution network emergency recovery framework.A phase-space reconstruction and stacked integrated model for predicting wind and photovoltaic generation during typhoon disasters is proposed in the first stage.This provides guidance for second-stage post-disaster emergency recovery scheduling.The emergency recovery scheduling model is established in the second stage,and this model is supported by a thermal power-generating unit,mobile emergency generators,and distributed generators.Distributed generation includes wind power generation,photovoltaics,fuel cells,etc.Simultaneously,we con-sider the gray-start based on the pumped storage unit to be an important first step in the emergency recovery strategy.This model is val-idated on the improved IEEE 33 node system,which utilizes data from the 2022 super typhoon“Muifa”in Zhoushan,Zhejiang,China.Simulations indicate the superiority of a gray start with a pumped storage unit and the proposed emergency recovery strategy.展开更多
Large-scale new energy grid connection leads to the weakening of the system frequency regulation capability,and the system frequency stability is facing unprecedented challenges.In order to solve rapid frequency fluct...Large-scale new energy grid connection leads to the weakening of the system frequency regulation capability,and the system frequency stability is facing unprecedented challenges.In order to solve rapid frequency fluctuation caused by new energy units,this paper proposes a new energy power system frequency regulation strategy with multiple units including the doubly-fed pumped storage unit(DFPSU).Firstly,based on the model predictive control(MPC)theory,the state space equations are established by considering the operating characteristics of the units and the dynamic behavior of the system;secondly,the proportional-differential control link is introduced to minimize the frequency deviation to further optimize the frequency modulation(FM)output of the DFPSU and inhibit the rapid fluctuation of the frequency;lastly,it is verified on theMatlab/Simulink simulation platform,and the results show that the model predictive control with proportional-differential control link can further release the FM potential of the DFPSU,increase the depth of its FM,effectively reduce the frequency deviation of the system and its rate of change,realize the optimization of the active output of the DFPSU and that of other units,and improve the frequency response capability of the system.展开更多
BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevanc...BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevance in patients with septic shock remains uncertain.AIM To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.METHODS In the present retrospective single-center study,a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University,between August 1,2018,and May 31,2023,were analyzed.Patients were categorized based on the timing of hypernatremia occurrence into the IAH group(n=62),the non-IAH group(n=41),and the normonatremia group(n=54).RESULTS In the present study,there was a significant association between the high serum sodium concentrations,excessive persistent inflammation,immunosuppression and catabolism syndrome and chronic critical illness,while rapid recovery had an apparent association with normonatremia.Moreover,multivariable analyses revealed the following independent risk factors for IAH:Total urinary output over the preceding three days[odds ratio(OR)=1.09;95%CI:1.02–1.17;P=0.014],enteral nutrition(EN)sodium content of 500 mg(OR=2.93;95%CI:1.13–7.60;P=0.027),and EN sodium content of 670 mg(OR=6.19;95%CI:1.75–21.98;P=0.005)were positively correlated with the development of IAH.Notably,the area under the curve for total urinary output over the preceding three days was 0.800(95%CI:0.678–0.922,P=0.001).Furthermore,maximum serum sodium levels,the duration of hypernatremia,and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients(P<0.05).CONCLUSION The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU.It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.展开更多
在一个经过篡改的视频可以传播虚假信息、欺凌他人和煽动负面情绪的时代,加州大学河滨分校和谷歌的研究人员联合开发了“通用篡改与合成视频识别网络”(Universal Network for Identifying Tampered and synth Etic videos, UNITE)的新...在一个经过篡改的视频可以传播虚假信息、欺凌他人和煽动负面情绪的时代,加州大学河滨分校和谷歌的研究人员联合开发了“通用篡改与合成视频识别网络”(Universal Network for Identifying Tampered and synth Etic videos, UNITE)的新系统来揭露这些伪造视频。即使在人脸不可见的情况下,该系统依然能检测深度伪造视频。通过扫描背景、运动和细微线索来识别视频是否伪造。随着虚假内容越来越容易生成且越来越难以检测,该工具可能成为新闻编辑室和社交媒体平台努力捍卫真相的必备武器。展开更多
A unitized regenerative fuel cell(URFC)is a device that may function reversibly as either a fuel cell(FC)or water elec-trolysis(WE).An important component of this device is the Membrane electrode assembly(MEA).Therefo...A unitized regenerative fuel cell(URFC)is a device that may function reversibly as either a fuel cell(FC)or water elec-trolysis(WE).An important component of this device is the Membrane electrode assembly(MEA).Therefore,this study aimed to compare the performance outcomes of MEA using electrodes with single and three catalyst layers.This study measured Electrochemical Surface Area(ECSA),Electrochemical Impedance Spectroscopy(EIS),X-ray Diffraction analysis(XRD),and X-ray Fluorescence(XRF).Furthermore,the round-trip efficiency(RTE)of the MEA,as w ell as the performance in FC and WE mode,was measured.In comparison,The ECSA values of Pt-Ru/C and Pt/C with three catalyst layers were higher than the single catalyst layer.This result was supported by electrode characterization data for XRD and XRF.The respective electrical conductivity values of Pt-Ru/C and Pt/C with three catalyst layers are also higher than the single cata-lyst layer,and the performance of URFC using MEA with three catalyst layers has the highest value of RTE among the MEA performances of URFC,which is 100%at a current density of 4 mA·cm-2.展开更多
On March 24,the international symposium themed“Strengthen the Role of the United Nations and Promote Multilateralism”was held in Beijing.The event was hosted by the Ministry of Foreign Affairs of China,and supported...On March 24,the international symposium themed“Strengthen the Role of the United Nations and Promote Multilateralism”was held in Beijing.The event was hosted by the Ministry of Foreign Affairs of China,and supported by China Institute of International Studies(CIIS),the United Nations Association of China.展开更多
The challenge of this work is to provide new data on the lithostratigraphy and tectono-stratigraphic evolution of two units belonging to the ophiolitic Ligurian-Piedmont zone of the Western Alps,i.e.the Albergian unit...The challenge of this work is to provide new data on the lithostratigraphy and tectono-stratigraphic evolution of two units belonging to the ophiolitic Ligurian-Piedmont zone of the Western Alps,i.e.the Albergian unit and the Lago Nero unit,exposed in the upper Susa and Chisone valleys(Northwestern Italy).展开更多
Intensivists are often plagued with the challenges of managing critically ill patients in the neurocritical intensive care unit(neuro ICU);one such challenge is the level of illness and the need for sedation,inhibitin...Intensivists are often plagued with the challenges of managing critically ill patients in the neurocritical intensive care unit(neuro ICU);one such challenge is the level of illness and the need for sedation,inhibiting the provider’s ability to adequately assess the patient.Most sedatives alter neurological and physical exam findings,only compounding potential barriers to providing the best care for each patient.It is important to emphasize that even in the altered mentation of these patients,physical and neurological exams reign supreme as diagnostic tools and should be used in conjunction with multimodal neuromonitoring methods,rather than labs or imaging alone.Additionally,selecting the appropriate analgesic(s)and sedative(s)based on these findings are highly important when determining the best course of individualized management.Thus,providers in the neuro ICU should be highly familiar with the appropriate analgesic and sedative options available in order to determine not only which may be best for each patient,but to also better understand how each drug may impact assessment findings.This comprehensive review aims to provide a structured overview of the pertinent sedatives commonly used in neuro ICUs,their risks and benefits,and how providers can best utilize each in practice to further improve patient outcomes.The novel contribution of this work provides comparative drug tables,dosing guidance for pediatric and very elderly(>85-years-old)populations,and an exploration into the future possibilities of utilizing artificial intelligence and the human gut microbiome to further enhance the prospects of precision medicine.展开更多
BACKGROUND Prolonged immobility during intensive care unit(ICU)admission has been a cause of muscle atrophy and worsening functional outcomes with longer recovery times.Prior research has demonstrated that mobilizatio...BACKGROUND Prolonged immobility during intensive care unit(ICU)admission has been a cause of muscle atrophy and worsening functional outcomes with longer recovery times.Prior research has demonstrated that mobilization within a week of ICU admission potentially benefits physical function in critically ill patients.AIM To evaluate the effects of initiating mobilization within 72 hours of ICU admission in critically ill patients through an updated systematic review and meta-analysis.METHODS A systematic search was performed through MEDLINE,Scopus,and Cochrane Library from inception until September 2024 for randomized controlled trials(RCTs)comparing early mobilization(EM)with usual or conventional care in critically ill adult patients.Primary outcomes included length of ICU(days)and ventilation duration(days).Secondary outcomes included muscle strength,functional status,adverse events,all-cause mortality,and quality of life(QOL).A random effects meta-analysis was performed for pooled effect estimates and to derive risk ratios(RR)and corresponding 95%confidence intervals(CI).RESULTS Out of 3487 results,16 RCTs were included with a population of 2385 patients(1195 receiving EM and 1190 with usual care.)A significant reduction in the length of ICU stays[mean difference(MD)=-1.02,95%CI:-1.96 to-0.09;P=0.03;I2=60%]and ventilation duration(MD=-1.07,95%CI:-1.91 to-0.23,P=0.01;I2=57%)was observed in the EM group compared to usual care.EM significantly improved muscle strength[standard MD(SMD)=0.47,95%CI:0.18-0.75,P=0.001;I2=79%]and functional status(SMD=0.70,95%CI:0.40-1.00,P<0.00001;I2=81%)in ICU patients.No statistically significant difference was observed in adverse events(RR=1.72,95%CI:1.01-2.94,P=0.05;I2=31%),all-cause mortality(RR=1.10,95%CI:0.79-1.53,P=0.57;I2=30%),and QOL(SMD=0.04,95%CI:-0.07-0.15,P=0.50;I2=9%)between the two groups.CONCLUSION Initiating mobilization within 72 hours of ICU admission is associated with improved functional outcomes and reduced ICU length of stay and ventilation duration.These findings indicate that EM may be a safe option for ICU patients,contributing to lower recovery times and healthcare costs.Further extensive research is required to validate the long-term effects on survival and QOL.展开更多
Transferring patients with critical illnesses from general wards to intensive care units (ICUs) is a crucial and time-sensitive process. This article presents strategies for improving the efficiency of patient transfe...Transferring patients with critical illnesses from general wards to intensive care units (ICUs) is a crucial and time-sensitive process. This article presents strategies for improving the efficiency of patient transfers, particularly in hospitals where intensive care units are located in buildings separate from general wards. Patient transfers comprise several steps: physicians issue orders, relatives are notified, equipment is prepared, and medical staff coordinate. We identified three factors that influence transfer time: preparation time for bed transfer, time required for shift handovers, and time required for between-ward patient movement. Unfamiliarity with transfer routes and long elevator wait times were factors that also influenced transfer time. The following strategies were proposed: develop a standardized material checklist, design key notes for patient transfers, and optimize transfer routes. These strategies reduced transfer times by 40% to 43%. This study demonstrates that by addressing logistical challenges and streamlining relevant procedures, hospitals can enhance safety and quality of care during patient transfers.展开更多
Acute cholangitis(AC)is a heterogeneous disease with considerable variation in clinical presentation and high medical costs.Although the overall mortality rate is decreasing.However,the mortality in severe AC ranged f...Acute cholangitis(AC)is a heterogeneous disease with considerable variation in clinical presentation and high medical costs.Although the overall mortality rate is decreasing.However,the mortality in severe AC ranged from 10%-30%due to sepsis,multi-organ failure,and systemic inflammatory response syndrome.Assessing the predictors of poor outcomes,including mortality,intensive care unit(ICU)admission,and hospital stay,is vital for early and effective intervention.We assessed the predictors of mortality and ICU admission in patients with AC.We conducted a literature search in PubMed/MEDLINE,Google Scholar,and Cochrane Library for relevant articles.The keywords used were acute cholangitis,biliary cholangitis,predictors,mortality,ICU admission,and Hospital stay.In addition,we assessed the role of early vs late endoscopic retrograde cholangiopancreatography on the outcomes.Old age,end-organ failure,red cell distribution width to albumin ratio,neutrophil-to-lymphocyte ratio,platelet-lymphocyte ratio,the need for ventilator support,diabetes,electrolyte imbalance,procalcitonin-to-albumin ratio,C-reactive protein-to-albumin,Glasgow Coma Scale,and systolic hypertension are predictors of poor outcomes in AC of varying etiology,and concurrent acute pancreatitis was not associated with ICU admission.展开更多
文摘The rise of the aging population parallels the rapidly increasing cases of neurological disorders. This puts pressure on scientists and physicians to find novel methods that can prevent and treat neurodegeneration. The brain is made up of a complex network of different cell types that work in tandem to maintain systemic homeostasis.
文摘BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparoscopic procedures,are well-established in high-income countries and are being increasingly adopted worldwide.Nevertheless,no studies have reported surgical outcomes of RALDN donor nephrectomy from a United Kingdom center to date.AIM To compare surgical outcomes between RALDN and HALDN laparoscopic donor nephrectomy in a United Kingdom high-volume living kidney donor transplant program.METHODS A case-control matching analysis was performed based on the following parameters:Sex,age,body mass index,procedure laterality,number of renal arteries,and previous abdominal surgeries.Key surgical outcomes,including primary warm ischemia time,operative duration,and post-operative recovery,were evaluated.RESULTS In this cohort of 140 living donors(70 RALDN vs 70 HALDN),donor and recipient outcomes were equivalent across key metrics:Pain scores,overall complication rates,readmissions,reoperations,and creatinine levels at 30 days and 1 year.Recipient long-term renal function did not differ between groups.Operative time for RALDN decreased significantly over the study period,indicating progressive improvement along the learning curve.Although RALDN was associated with a modestly longer mean warm ischaemia time(3.53 minutes vs 2.76 minutes,P<0.001)and extended hospital stay(4.21 days vs 3.17 days,P<0.001),these did not translate into any disadvantage in clinical outcomes.CONCLUSION In this first United Kingdom comparative cohort,RALDN demonstrated excellent safety and efficacy,even in the early phase of our programme,matching the outcomes of the well-established,gold-standard HALDN approach.Moreover,the pronounced learning-curve trajectory suggests considerable potential for further improvements in robotic surgical outcomes as the programme matures.
基金the National Nature Science Foundation of China(11671214,11971348,12071230)the Hundred Young Academia Leaders Program of Nankai University(63223027,ZB22000105)+1 种基金the Undergraduate Education and Teaching Project of Nankai University(NKJG2022053)the National College Students’Innovation and Entrepreneurship Training Program of Nankai University(202210055048)。
文摘This paper studies two isometric problems between unit spheres of Banach spaces.In the first part,we introduce and study the Figiel type problem of isometric embeddings between unit spheres.However,the classical Figiel theorem on the whole space cannot be trivially generalized to this case,and this is pointed out by a counterexample.After establishing this,we find a natural necessary condition required by the existence of the Figiel operator.Furthermore,we prove that when X is a space with the T-property,this condition is also sufficient for an isometric embedding T:S_(X)→S_(Y) to admit the Figiel operator.This answers the Figiel type problem on unit spheres for a large class of spaces.In the second part,we consider the extension of bijectiveε-isometries between unit spheres of two Banach spaces.It is shown that every bijectiveε-isometry between unit spheres of a local GL-space and another Banach space can be extended to be a bijective 5ε-isometry between the corresponding unit balls.In particular,whenε=0,this recovers the MUP for local GL-spaces obtained in[40].
基金supported by the State Grid Corporation of China Science and Technology Project,grant number 52270723000900K.
文摘The new energy power generation is becoming increasingly important in the power system.Such as photovoltaic power generation has become a research hotspot,however,due to the characteristics of light radiation changes,photovoltaic power generation is unstable and random,resulting in a low utilization rate and directly affecting the stability of the power grid.To solve this problem,this paper proposes a coordinated control strategy for a newenergy power generation system with a hybrid energy storage unit based on the lithium iron phosphate-supercapacitor hybrid energy storage unit.Firstly,the variational mode decomposition algorithm is used to separate the high and low frequencies of the power signal,which is conducive to the rapid and accurate suppression of the power fluctuation of the energy storage system.Secondly,the fuzzy control algorithm is introduced to balance the power between energy storage.In this paper,the actual data is used for simulation,and the simulation results show that the strategy realizes the effective suppression of the bus voltage fluctuation and the accurate control of the internal state of the energy storage unit,effectively avoiding problems such as overshoot and over-discharge,and can significantly improve the stability of the photovoltaic power generation systemand the stability of the Direct Current bus.It is of great significance to promote the development of collaborative control technology for photovoltaic hybrid energy storage units.
文摘This paper aimed at studying the effect of different types of soil tillage systems on the change of total carbon （C） and nitrogen （N） in the soil structural units of different size after dry structural analysis of soil. The research was carried out in a 6-field rotation system （grain maize-wheat-sunflower-wheat-bean-wheat） at the end of the 2nd rotation. Six out of 24 soil tillage systems were selected; they were applied independently and in combination in the crop rotation. After that, they were compared to the system with constant deep plowing. So a total of seven soil tillage systems were investigated. The selected systems for main soil tillage were the following： plowing （control variant）, disking, cutting, nil tillage （direct sowing）, plowing-disking, plowing-nil tillage, disking-nil tillage. Three depths of 0-10, 10-20 and 20-30 cm were studied, as well as soil structural units were of the following sizes： 〉 10 mm, 10-5, 5-3, 3-1, 1-0.25 mm and 〈 0.25 mm. As a result of systematic implementation of different soil tillage systems, higher N and C concentrations were established by the layers according to constant plowing. Constant disking and its alternation with nil tillage increased the total N concentration with 15.6% and 11.1%, respectively, in comparison with the constant plowing. The same was valid for C concentration in soil, but the highest increase was established in the variants with constant cutting and nil tillage. The exceeding was with 14.0% and 13.2%, in comparison to constant plowing. The redistribution of N and C depending on the structural soil units was most expressed in the 0-10 cm and 10-20 cm layers. The highest amounts of C and N were found in the soil units with size less than 5 mm, mainly in the 〈 0.25 mm fraction. At depth of 20-30 cm, the role of the size of soil structural units for C and N redistribution decreased strongly. The values of C/N ratio were moderate only under the use of constant disking. This index was low under all other soil tillage systems. The correlation of total N with C in soil was high, positive and significant depending on the size of structural soil units and the tillage systems, as average for the investigated factors in this experiment. The minimal tillage and the tillage without turning of soil, used independently and in combination, had the highest contribution to preserving the organic matter in the haplic Chernozems of Dobrudzha region.
文摘BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality.Two different types of unplanned ICU admissions include upgrades(patients admitted to the floor then moved to the ICU)and bounce backs(patients admitted to the ICU,discharged to the floor,and then readmitted to the ICU).Previous studies have shown that geriatric trauma patients are at higher risk for unfavorable outcomes.AIM To analyze the characteristics,management and outcomes of trauma patients who had an unplanned ICU admission during their hospitalization.METHODS This institutional review board approved,retrospective cohort study examined 203 adult trauma patients with unplanned ICU admission at an urban level 1 trauma center over a six-year period(2017-2023).This included 134 upgrades and 69 bounce backs.Analyzed variables included:(1)Age;(2)Sex;(3)Comorbidities;(4)Mechanism of injury(MOI);(5)Injury severity score(ISS);(6)Glasgow Coma Scale(GCS);(7)Type of injury;(8)Transfusions;(9)Consultations;(10)Timing and reason for unplanned admission;(11)Intubations;(12)Surgical interventions;(13)ICU and hospital lengths of stay;and(14)Mortality.RESULTS Unplanned ICU admissions comprised 4.2%of total ICU admissions.Main MOI was falls.Mean age was 70.7 years,ISS was 12.8 and GCS was 13.9.Main injuries were traumatic brain injury(37.4%)and thoracic injury(21.7%),and main reason for unplanned ICU admission was respiratory complication(39.4%).The 47.3%underwent a surgical procedure and 46.8%were intubated.Average timing for unplanned ICU admission was 2.9 days.Bounce backs occurred half as often as upgrades,however had higher rates of transfusions(63.8%vs 40.3%,P=0.002),consultations(4.8 vs 3.0,P<0.001),intubations(63.8%vs 38.1%%,P=0.001),longer ICU lengths of stay(13.2 days vs 6.4 days,P<0.001)and hospital lengths of stay(26.7 days vs 13.0 days,P<0.001).Mortality was 25.6%among unplanned ICU admissions,31.9%among geriatric unplanned ICU admissions and 11.9%among all trauma ICU patients.CONCLUSION Unplanned ICU admissions constituted 4.2%of total ICU admissions.Respiratory complications were the main cause of unplanned ICU admissions.Bounce backs occurred half as often as upgrades,but were associated with worse outcomes.
文摘BACKGROUND As red blood cell distribution width(RDW)and albumin have been shown to be independent predictors of mortality from various diseases,this study aimed to investigate the effect of the RDW to albumin ratio(RA)as an independent predictor of the prognosis of patients admitted to the coronary care unit(CCU).AIM To use the RDW and albumin level to predict the prognosis of patients in the CCU.METHODS Data were obtained from the Medical Information Mart Intensive Care III database.The primary outcome was 365-day all-cause mortality,whereas the secondary outcomes were 30-and 90-day all-cause mortality,hospital length of stay(LOS),and CCU LOS.Cox proportional hazards regression model,propen-sity score matching,and receiver operating characteristic curve analyses were used.RESULTS The hazard ratio(95%confidence interval)of the upper tertile(RA>4.66)was 1.62(1.29 to 2.03)when compared with the reference(RA<3.84)in 365-day all-cause mortality.This trend persisted after adjusting for demographic and clinical variables in the propensity score-matching analysis.Similar trends were observed for the secondary outcomes of hospital and CCU LOS.Receiver operating characteristic curve analysis was performed by combining the RA and sequential organ failure assessment(SOFA)scores,and the C-statistic was higher than that of the SOFA scores(0.733 vs 0.702,P<0.001).CONCLUSION RA is an independent prognostic factor in patients admitted to the CCU.RA combined with the SOFA score can improve the predictive ability of the SOFA score.However,our results should be verified in future prospective studies.
基金supported in part by the National Nat-ural Science Foundation of China(52177110)Key Pro-gram of the National Natural Science Foundation of China(U22B20106,U2142206)+2 种基金Shenzhen Science and Technology Program(JCYJ20210324131409026)the Science and Technology Project of the State Grid Corpo-ration of China(5200-202319382A-2-3-XG)State Grid Zhejiang Elctric Power Co.,Ltd.Science and Tech-nology Project(B311DS24001A).
文摘Typhoons can cause large-area blackouts or partial outages of distribution networks.We define a partial outage state in the distribution network as a gray state and propose a gray-start strategy and two-stage distribution network emergency recovery framework.A phase-space reconstruction and stacked integrated model for predicting wind and photovoltaic generation during typhoon disasters is proposed in the first stage.This provides guidance for second-stage post-disaster emergency recovery scheduling.The emergency recovery scheduling model is established in the second stage,and this model is supported by a thermal power-generating unit,mobile emergency generators,and distributed generators.Distributed generation includes wind power generation,photovoltaics,fuel cells,etc.Simultaneously,we con-sider the gray-start based on the pumped storage unit to be an important first step in the emergency recovery strategy.This model is val-idated on the improved IEEE 33 node system,which utilizes data from the 2022 super typhoon“Muifa”in Zhoushan,Zhejiang,China.Simulations indicate the superiority of a gray start with a pumped storage unit and the proposed emergency recovery strategy.
基金supported by the National Natural Science Foundation of China(Project No.52377082)the Scientific Research Program of Jilin Provincial Department of Education(Project No.JJKH20230123KJ).
文摘Large-scale new energy grid connection leads to the weakening of the system frequency regulation capability,and the system frequency stability is facing unprecedented challenges.In order to solve rapid frequency fluctuation caused by new energy units,this paper proposes a new energy power system frequency regulation strategy with multiple units including the doubly-fed pumped storage unit(DFPSU).Firstly,based on the model predictive control(MPC)theory,the state space equations are established by considering the operating characteristics of the units and the dynamic behavior of the system;secondly,the proportional-differential control link is introduced to minimize the frequency deviation to further optimize the frequency modulation(FM)output of the DFPSU and inhibit the rapid fluctuation of the frequency;lastly,it is verified on theMatlab/Simulink simulation platform,and the results show that the model predictive control with proportional-differential control link can further release the FM potential of the DFPSU,increase the depth of its FM,effectively reduce the frequency deviation of the system and its rate of change,realize the optimization of the active output of the DFPSU and that of other units,and improve the frequency response capability of the system.
基金Supported by The National Natural Science Foundation of China,No.82072130Key Medical Research Projects in Jiangsu Province,No.ZD2022021Suzhou Clinical Medical Center for Anesthesiology,No.Szlcyxzxj202102。
文摘BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevance in patients with septic shock remains uncertain.AIM To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.METHODS In the present retrospective single-center study,a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University,between August 1,2018,and May 31,2023,were analyzed.Patients were categorized based on the timing of hypernatremia occurrence into the IAH group(n=62),the non-IAH group(n=41),and the normonatremia group(n=54).RESULTS In the present study,there was a significant association between the high serum sodium concentrations,excessive persistent inflammation,immunosuppression and catabolism syndrome and chronic critical illness,while rapid recovery had an apparent association with normonatremia.Moreover,multivariable analyses revealed the following independent risk factors for IAH:Total urinary output over the preceding three days[odds ratio(OR)=1.09;95%CI:1.02–1.17;P=0.014],enteral nutrition(EN)sodium content of 500 mg(OR=2.93;95%CI:1.13–7.60;P=0.027),and EN sodium content of 670 mg(OR=6.19;95%CI:1.75–21.98;P=0.005)were positively correlated with the development of IAH.Notably,the area under the curve for total urinary output over the preceding three days was 0.800(95%CI:0.678–0.922,P=0.001).Furthermore,maximum serum sodium levels,the duration of hypernatremia,and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients(P<0.05).CONCLUSION The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU.It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.
文摘在一个经过篡改的视频可以传播虚假信息、欺凌他人和煽动负面情绪的时代,加州大学河滨分校和谷歌的研究人员联合开发了“通用篡改与合成视频识别网络”(Universal Network for Identifying Tampered and synth Etic videos, UNITE)的新系统来揭露这些伪造视频。即使在人脸不可见的情况下,该系统依然能检测深度伪造视频。通过扫描背景、运动和细微线索来识别视频是否伪造。随着虚假内容越来越容易生成且越来越难以检测,该工具可能成为新闻编辑室和社交媒体平台努力捍卫真相的必备武器。
基金support from the Ministry of Higher Education Malaysia under grant HICOE-2023-005.
文摘A unitized regenerative fuel cell(URFC)is a device that may function reversibly as either a fuel cell(FC)or water elec-trolysis(WE).An important component of this device is the Membrane electrode assembly(MEA).Therefore,this study aimed to compare the performance outcomes of MEA using electrodes with single and three catalyst layers.This study measured Electrochemical Surface Area(ECSA),Electrochemical Impedance Spectroscopy(EIS),X-ray Diffraction analysis(XRD),and X-ray Fluorescence(XRF).Furthermore,the round-trip efficiency(RTE)of the MEA,as w ell as the performance in FC and WE mode,was measured.In comparison,The ECSA values of Pt-Ru/C and Pt/C with three catalyst layers were higher than the single catalyst layer.This result was supported by electrode characterization data for XRD and XRF.The respective electrical conductivity values of Pt-Ru/C and Pt/C with three catalyst layers are also higher than the single cata-lyst layer,and the performance of URFC using MEA with three catalyst layers has the highest value of RTE among the MEA performances of URFC,which is 100%at a current density of 4 mA·cm-2.
文摘On March 24,the international symposium themed“Strengthen the Role of the United Nations and Promote Multilateralism”was held in Beijing.The event was hosted by the Ministry of Foreign Affairs of China,and supported by China Institute of International Studies(CIIS),the United Nations Association of China.
文摘The challenge of this work is to provide new data on the lithostratigraphy and tectono-stratigraphic evolution of two units belonging to the ophiolitic Ligurian-Piedmont zone of the Western Alps,i.e.the Albergian unit and the Lago Nero unit,exposed in the upper Susa and Chisone valleys(Northwestern Italy).
文摘Intensivists are often plagued with the challenges of managing critically ill patients in the neurocritical intensive care unit(neuro ICU);one such challenge is the level of illness and the need for sedation,inhibiting the provider’s ability to adequately assess the patient.Most sedatives alter neurological and physical exam findings,only compounding potential barriers to providing the best care for each patient.It is important to emphasize that even in the altered mentation of these patients,physical and neurological exams reign supreme as diagnostic tools and should be used in conjunction with multimodal neuromonitoring methods,rather than labs or imaging alone.Additionally,selecting the appropriate analgesic(s)and sedative(s)based on these findings are highly important when determining the best course of individualized management.Thus,providers in the neuro ICU should be highly familiar with the appropriate analgesic and sedative options available in order to determine not only which may be best for each patient,but to also better understand how each drug may impact assessment findings.This comprehensive review aims to provide a structured overview of the pertinent sedatives commonly used in neuro ICUs,their risks and benefits,and how providers can best utilize each in practice to further improve patient outcomes.The novel contribution of this work provides comparative drug tables,dosing guidance for pediatric and very elderly(>85-years-old)populations,and an exploration into the future possibilities of utilizing artificial intelligence and the human gut microbiome to further enhance the prospects of precision medicine.
文摘BACKGROUND Prolonged immobility during intensive care unit(ICU)admission has been a cause of muscle atrophy and worsening functional outcomes with longer recovery times.Prior research has demonstrated that mobilization within a week of ICU admission potentially benefits physical function in critically ill patients.AIM To evaluate the effects of initiating mobilization within 72 hours of ICU admission in critically ill patients through an updated systematic review and meta-analysis.METHODS A systematic search was performed through MEDLINE,Scopus,and Cochrane Library from inception until September 2024 for randomized controlled trials(RCTs)comparing early mobilization(EM)with usual or conventional care in critically ill adult patients.Primary outcomes included length of ICU(days)and ventilation duration(days).Secondary outcomes included muscle strength,functional status,adverse events,all-cause mortality,and quality of life(QOL).A random effects meta-analysis was performed for pooled effect estimates and to derive risk ratios(RR)and corresponding 95%confidence intervals(CI).RESULTS Out of 3487 results,16 RCTs were included with a population of 2385 patients(1195 receiving EM and 1190 with usual care.)A significant reduction in the length of ICU stays[mean difference(MD)=-1.02,95%CI:-1.96 to-0.09;P=0.03;I2=60%]and ventilation duration(MD=-1.07,95%CI:-1.91 to-0.23,P=0.01;I2=57%)was observed in the EM group compared to usual care.EM significantly improved muscle strength[standard MD(SMD)=0.47,95%CI:0.18-0.75,P=0.001;I2=79%]and functional status(SMD=0.70,95%CI:0.40-1.00,P<0.00001;I2=81%)in ICU patients.No statistically significant difference was observed in adverse events(RR=1.72,95%CI:1.01-2.94,P=0.05;I2=31%),all-cause mortality(RR=1.10,95%CI:0.79-1.53,P=0.57;I2=30%),and QOL(SMD=0.04,95%CI:-0.07-0.15,P=0.50;I2=9%)between the two groups.CONCLUSION Initiating mobilization within 72 hours of ICU admission is associated with improved functional outcomes and reduced ICU length of stay and ventilation duration.These findings indicate that EM may be a safe option for ICU patients,contributing to lower recovery times and healthcare costs.Further extensive research is required to validate the long-term effects on survival and QOL.
文摘Transferring patients with critical illnesses from general wards to intensive care units (ICUs) is a crucial and time-sensitive process. This article presents strategies for improving the efficiency of patient transfers, particularly in hospitals where intensive care units are located in buildings separate from general wards. Patient transfers comprise several steps: physicians issue orders, relatives are notified, equipment is prepared, and medical staff coordinate. We identified three factors that influence transfer time: preparation time for bed transfer, time required for shift handovers, and time required for between-ward patient movement. Unfamiliarity with transfer routes and long elevator wait times were factors that also influenced transfer time. The following strategies were proposed: develop a standardized material checklist, design key notes for patient transfers, and optimize transfer routes. These strategies reduced transfer times by 40% to 43%. This study demonstrates that by addressing logistical challenges and streamlining relevant procedures, hospitals can enhance safety and quality of care during patient transfers.
文摘Acute cholangitis(AC)is a heterogeneous disease with considerable variation in clinical presentation and high medical costs.Although the overall mortality rate is decreasing.However,the mortality in severe AC ranged from 10%-30%due to sepsis,multi-organ failure,and systemic inflammatory response syndrome.Assessing the predictors of poor outcomes,including mortality,intensive care unit(ICU)admission,and hospital stay,is vital for early and effective intervention.We assessed the predictors of mortality and ICU admission in patients with AC.We conducted a literature search in PubMed/MEDLINE,Google Scholar,and Cochrane Library for relevant articles.The keywords used were acute cholangitis,biliary cholangitis,predictors,mortality,ICU admission,and Hospital stay.In addition,we assessed the role of early vs late endoscopic retrograde cholangiopancreatography on the outcomes.Old age,end-organ failure,red cell distribution width to albumin ratio,neutrophil-to-lymphocyte ratio,platelet-lymphocyte ratio,the need for ventilator support,diabetes,electrolyte imbalance,procalcitonin-to-albumin ratio,C-reactive protein-to-albumin,Glasgow Coma Scale,and systolic hypertension are predictors of poor outcomes in AC of varying etiology,and concurrent acute pancreatitis was not associated with ICU admission.
