With the widespread application of WIFI networks and embedded system technology, the device monitoring system based on Embedded System and wireless network came into being. In this paper, we introduce a device monitor...With the widespread application of WIFI networks and embedded system technology, the device monitoring system based on Embedded System and wireless network came into being. In this paper, we introduce a device monitoring system based on ARM upper computer and WIFI transmission, and we tested this system on workshop equipment. The hardware adopts ARM Cortex-A8 processor architecture of TI company as the main control chip, using IAC-335X-Kit development board for system design, external USB camera module and WIFI wireless module for video capture and data transmission. The software is based on embedded Linux as the platform. The system will collect production data accurately and objectively, and the statistical analysis. At the same time, the system uses QT to develop the upper computer software GUI interface. Compared with the traditional system based on the wired network, our design is more convenient and flexible, which reduces the implementation restriction and maintenance cost of traditional network cabling.展开更多
Nail changes following upper extremity transplantation(UET)cannot be overlooked as they possess diagnostic and prognostic relevance in allotransplantation of upper limbs.This comprehensive review explores nail and nai...Nail changes following upper extremity transplantation(UET)cannot be overlooked as they possess diagnostic and prognostic relevance in allotransplantation of upper limbs.This comprehensive review explores nail and nail bed related changes encountered in UET recipients in the literature.The differential diagnosis of nail abnormalities in UET includes a wide range of systemic,local and iatrogenic conditions other than immune responses to the allograft.It requires interdisciplinary evaluation by primary transplant surgeons,pathologists,dermatologists and immunologists.The possible underlying mechanisms of nail pathology in UET and the management are discussed.It also underscores the importance of onychodystrophy and need for timely intervention and to improve outcomes in UET recipients.展开更多
Upper gastrointestinal cancers,mainly comprising esophageal and gastric cancers,are among the most prevalent cancers worldwide.There are many new cases of upper gastrointestinal cancers annually,and the survival rate ...Upper gastrointestinal cancers,mainly comprising esophageal and gastric cancers,are among the most prevalent cancers worldwide.There are many new cases of upper gastrointestinal cancers annually,and the survival rate tends to be low.Therefore,timely screening,precise diagnosis,appropriate treatment strategies,and effective prognosis are crucial for patients with upper gastrointestinal cancers.In recent years,an increasing number of studies suggest that artificial intelligence(AI)technology can effectively address clinical tasks related to upper gastrointestinal cancers.These studies mainly focus on four aspects:screening,diagnosis,treatment,and progno-sis.In this review,we focus on the application of AI technology in clinical tasks related to upper gastrointestinal cancers.Firstly,the basic application pipelines of radiomics and deep learning in medical image analysis were introduced.Furthermore,we separately reviewed the application of AI technology in the aforementioned aspects for both esophageal and gastric cancers.Finally,the current limitations and challenges faced in the field of upper gastrointestinal cancers were summarized,and explorations were conducted on the selection of AI algorithms in various scenarios,the popularization of early screening,the clinical applications of AI,and large multimodal models.展开更多
Background China is seeing a growing demand for rehabilitation treatments for post-stroke upper limb spastic paresis(PSSP-UL).Although acupuncture is known to be effective for PSSP-UL,there is room to enhance its effi...Background China is seeing a growing demand for rehabilitation treatments for post-stroke upper limb spastic paresis(PSSP-UL).Although acupuncture is known to be effective for PSSP-UL,there is room to enhance its efficacy.Objective This study explored a semi-personalized acupuncture approach for PSSP-UL that used three-dimensional kinematic analysis(3DKA)results to select additional acupoints,and investigated the feasibility,efficacy and safety of this approach.Design,setting,participants and interventions This single-blind,single-center,randomized,controlled trial involved 74 participants who experienced a first-ever ischemic or hemorrhagic stroke with spastic upper limb paresis.The participants were then randomly assigned to the intervention group or the control group in a 1:1 ratio.Both groups received conventional treatments and acupuncture treatment 5 days a week for 4 weeks.The main acupoints in both groups were the same,while participants in the intervention group received additional acupoints selected on the basis of 3DKA results.Follow-up assessments were conducted for 8 weeks after the treatment.Main outcome measures The primary outcome was the Fugl-Meyer Assessment for Upper Extremity(FMA-UE)response rate(≥6-point change)at week 4.Secondary outcomes included changes in motor function(FMA-UE),Brunnstrom recovery stage(BRS),manual muscle test(MMT),spasticity(Modified Ashworth Scale,MAS),and activities of daily life(Modified Barthel Index,MBI)at week 4 and week 12.Results Sixty-four participants completed the trial and underwent analyses.Compared with control group,the intervention group exhibited a significantly higher FMA-UE response rate at week 4(χ^(2)=5.479,P=0.019)and greater improvements in FMA-UE at both week 4 and week 12(both P<0.001).The intervention group also showed bigger improvements from baseline in the MMT grades for shoulder adduction and elbow flexion at weeks 4 and 12 as well as thumb adduction at week 4(P=0.007,P=0.049,P=0.019,P=0.008,P=0.029,respectively).The intervention group showed a better change in the MBI at both week 4 and week 12(P=0.004 and P=0.010,respectively).Although the intervention group had a higher BRS for the hand at week 12(P=0.041),no intergroup differences were observed at week 4(all P>0.05).The two groups showed no differences in MAS grades as well as in BRS for the arm at weeks 4 and 12(all P>0.05).Conclusion Semi-personalized acupuncture prescription based on 3DKA results significantly improved motor function,muscle strength,and activities of daily living in patients with PSSP-UL.展开更多
The Tan-Lu Fault Zone is a large NNE-trending fault zone that has a substantial effect on the development of eastern China and its earthquake disaster prevention efforts. Aiming at the azimuthally anisotropic structur...The Tan-Lu Fault Zone is a large NNE-trending fault zone that has a substantial effect on the development of eastern China and its earthquake disaster prevention efforts. Aiming at the azimuthally anisotropic structure in the upper crust and seismogenic tectonics in the Hefei segment of this fault, we collected phase velocity dispersion data of fundamental mode Rayleigh waves from ambient noise cross-correlation functions of ~400 temporal seismographs in an area of approximately 80 × 70 km along the fault zone. The period band of the dispersion data was ~0.5–10 s. We inverted for the upper crustal three-dimensional(3-D) shear velocity model with azimuthal anisotropy from the surface to 10 km depth by using a 3-D direct azimuthal anisotropy inversion method. The inversion result shows the spatial distribution characteristics of the tectonic units in the upper crust. Additionally, the deformation of the Tan-Lu Fault Zone and its conjugated fault systems could be inferred from the anisotropy model. In particular, the faults that have remained active from the early and middle Pleistocene control the anisotropic characteristics of the upper crustal structure in this area. The direction of fast axes near the fault zone area in the upper crust is consistent with the strike of the faults, whereas for the region far away from the fault zone, the direction of fast axes is consistent with the direction of the regional principal stress caused by plate movement. Combined with the azimuthal anisotropy models in the deep crust and uppermost mantle from the surface wave and Pn wave, the different anisotropic patterns caused by the Tan-Lu Fault Zone and its conjugated fault system nearby are shown in the upper and lower crust. Furthermore,by using the double-difference method, we relocated the Lujiang earthquake series, which contained 32 earthquakes with a depth shallower than 10 km. Both the Vs model and earthquake relocation results indicate that earthquakes mostly occurred in the vicinity of structural boundaries with fractured media, with high-level development of cracks and small-scale faults jammed between more rigid areas.展开更多
Taking the second member of the Xujiahe Formation of the Upper Triassic in the Xinchang structural belt as an example,based on data such as logging,production,seismic interpretation and test,a systematic analysis was ...Taking the second member of the Xujiahe Formation of the Upper Triassic in the Xinchang structural belt as an example,based on data such as logging,production,seismic interpretation and test,a systematic analysis was conducted on the structural characteristics and evolution,reservoir diagenesis and densification processes,and types and stages of faults/fractures,and revealing the multi-stage and multi-factor dynamic coupled enrichment mechanisms of tight gas reservoirs.(1)In the early Yanshan period,the paleo-structural traps were formed with low-medium maturity hydrocarbons accumulating in structural highs driven by buoyancy since reservoirs were not fully densified in this stage,demonstrating paleo-structure control on traps and early hydrocarbon accumulation.(2)In the middle-late Yanshan period,the source rocks became mature to generate and expel a large quantity of hydrocarbons.Grain size and type of sandstone controlled the time of reservoir densification,which restricted the scale of hydrocarbon charging,allowing for only a small-scale migration through sand bodies near the fault/fracture or less-densified matrix reservoirs.(3)During the Himalayan period,the source rocks reached overmaturity,and the residual oil cracking gas was efficiently transported along the late-stage faults/fractures.Wells with high production capacity were mainly located in Type I and II fault/fracture zones comprising the late-stage north-south trending fourth-order faults and the late-stage fractures.The productivity of the wells was controlled by the transformation of the late-stage faults/fractures.(4)The Xinchang structural belt underwent three stages of tectonic evolution,two stages of reservoir formation,and three stages of fault/fractures development.Hydrocarbons mainly accumulated in the paleo-structure highs.After reservoir densification and late fault/fracture adjustment,a complex gas-water distribution pattern was formed.Thus,it is summarized as the model of“near-source and low-abundance hydrocarbon charging in the early stage,and differential enrichment of natural gas under the joint control of fault-fold-fracture complex,high-quality reservoirs and structural highs in the late stage”.Faults/fractures with well-coupled fault-fold-fracture-pore are favorable exploration targets with high exploration effectiveness.展开更多
Amyotrophic lateral sclerosis is a rare neurodegenerative disease characterized by the involvement of both upper and lower motor neurons.Early bilateral limb involvement significantly affects patients'daily lives ...Amyotrophic lateral sclerosis is a rare neurodegenerative disease characterized by the involvement of both upper and lower motor neurons.Early bilateral limb involvement significantly affects patients'daily lives and may lead them to be confined to bed.However,the effect of upper and lower motor neuron impairment and other risk factors on bilateral limb involvement is unclear.To address this issue,we retrospectively collected data from 586 amyotrophic lateral sclerosis patients with limb onset diagnosed at Peking University Third Hospital between January 2020 and May 2022.A univariate analysis revealed no significant differences in the time intervals of spread in different directions between individuals with upper motor neuron-dominant amyotrophic lateral sclerosis and those with classic amyotrophic lateral sclerosis.We used causal directed acyclic graphs for risk factor determination and Cox proportional hazards models to investigate the association between the duration of bilateral limb involvement and clinical baseline characteristics in amyotrophic lateral sclerosis patients.Multiple factor analyses revealed that higher upper motor neuron scores(hazard ratio[HR]=1.05,95%confidence interval[CI]=1.01–1.09,P=0.018),onset in the left limb(HR=0.72,95%CI=0.58–0.89,P=0.002),and a horizontal pattern of progression(HR=0.46,95%CI=0.37–0.58,P<0.001)were risk factors for a shorter interval until bilateral limb involvement.The results demonstrated that a greater degree of upper motor neuron involvement might cause contralateral limb involvement to progress more quickly in limb-onset amyotrophic lateral sclerosis patients.These findings may improve the management of amyotrophic lateral sclerosis patients with limb onset and the prediction of patient prognosis.展开更多
The Upper Cretaceous of Tantou Basin in western Henan has yielded many vertebrate fossils,which are featured by several non-avian dinosaurs.Meanwhile,studies on their eggs were yet inadequate though many eggshells hav...The Upper Cretaceous of Tantou Basin in western Henan has yielded many vertebrate fossils,which are featured by several non-avian dinosaurs.Meanwhile,studies on their eggs were yet inadequate though many eggshells have been reported.The newly discovered material 41HⅤ0199 was excavated from the Upper Cretaceous Qiupa Formation in 2021.The block preserves eight complete eggs arranged in two partial rings that form a partial clutch,and there are some scattered eggshells preserved closely with the block,showing a concave-up to concave-down ratio of 54.5:45.5,which indicates that the scattered eggshells come from the clutch and the clutch had been partially broken before it was buried.Based on morphological and microstructural characteristics,the eggs and eggshells can be assigned to Macroolithus yaotunensis(Elongatoolithidae),an oospecies known to be related to oviraptorids,which leads Yulong mini to be its probable producer.Besides,some eggshells show microstructural signs indicating egg retention,which marks the second example of egg retention in the oofamily Elongatoolithidae.展开更多
[Objective]Implementation of the Ten-Year Fishing Ban policy may alter fish diversity and niche characteristics of dominant species in spawning grounds within the National Nature Reserve for Rare and Endemic Fish in t...[Objective]Implementation of the Ten-Year Fishing Ban policy may alter fish diversity and niche characteristics of dominant species in spawning grounds within the National Nature Reserve for Rare and Endemic Fish in the Upper Yangtze River.This study initiated continuous monitoring of natural spawning habitats from February 2022 to assess these ecological changes.[Methods]Environmental DNA(eDNA)metabarcoding was employed to analyze fish species composition,biodiversity patterns,and niche parameters of dominant species.Water sampling followed the CEN/TS 19461 standard across five monitoring transects(ZT1-ZT5).[Results]The eDNA analysis detected 45 species of fish belonging to 38 genera,13 families,and 3 orders were detected through environmental DNA(eDNA)in this survey,including 10 species endemic to the upper reaches of the Yangtze River,such as Procypris rabaudi and Myxocyprinus asiaticus.The fish community was mainly composed of bottom-dwelling,settling ovum-producing,omnivorous fish.The variation ranges of the Chao1 index,ACE index,Shannon index,and Simpson index are 736~996,719~965,1.58~3.23,and 0.83~0.99,respectively,indicating that fish species in spawning sites are abundant and community distribution uniformity is high.All indexes are highest at ZT1 monitoring points.Cluster analysis showed that,at a certain similarity level,fish community types in spawning sites could be basically divided into two groups:ZT1,ZT3,and ZT5 clustered together,and ZT2 and ZT4 clustered together,indicating similar fish community habitats.There are 9 dominant fish species in typical deep pool habitats in the reserve,with niche widths(Bi)ranging from 1.13 to 3.87.The dominant fish species are broad and medium niche fish,such as Cyprinus carpio and Hemiculter tchangi,with the niche overlap index(Oik)of some dominant fish species reaching more than 0.95.This indicates fierce competition for resources among the fish in this spawning ground.[Conclusion]The Zhutuo spawning ground demonstrates high species richness with homogeneous community structure and intense resource competition.This study establishes an eDNA-based monitoring framework that enhances conventional survey method,providing critical baseline data for adaptive management under the fishing moratorium regime.展开更多
OBJECTIVE:To investigate the effects of acupuncture combined with upper limb rehabilitation robot on neural remodeling and functional recovery in post-stroke patients.METHODS:There were 50 stroke patients were randoml...OBJECTIVE:To investigate the effects of acupuncture combined with upper limb rehabilitation robot on neural remodeling and functional recovery in post-stroke patients.METHODS:There were 50 stroke patients were randomly divided into an experimental group(acupuncture combined with upper limb rehabilitation robot assisted training)and a control group(upper limb rehabilitation robot assisted training).Various assessments were conducted to compare the effects of the two treatments on neural remodeling and functional recovery.Functional near-infrared spectroscopy technology was used to assess the effects of different treatments on neural plasticity and their impact on upper limb function and activities of daily living.RESULTS:The experimental group showed significantly higher concentrations of oxygenated hemoglobin and total hemoglobin in specific brain regions compared to the control group(P<0.05).Additionally,the experimental group had significantly lower concentrations of deoxygenated hemoglobin(P<0.05).After treatment,both groups showed improvements in various measures,but the experimental group had significantly greater improvements(P<0.05).CONCLUSION:Acupuncture combined with upper limb rehabilitation robot can effectively improve upper limb function and neural remodeling in stroke patients.This study supports the integration of Traditional Chinese and Western Medicine in improving limb dysfunction poststroke.展开更多
Objective:This article reviews the latest updates and outcomes of kidney-sparing surgery(KSS)in patients with upper tract urothelial carcinoma(UTUC).Methods:A comprehensive literature search was performed using the Pu...Objective:This article reviews the latest updates and outcomes of kidney-sparing surgery(KSS)in patients with upper tract urothelial carcinoma(UTUC).Methods:A comprehensive literature search was performed using the PubMed and Embase databases to identify related English-language studies published within the last 10 years.Key search words included“upper urinary tract tumour/cancer/carcinoma”,“kidney-sparing surgery or approach”,“endoscopic treatment for upper tract tumour/cancer/carcinoma”,“topical instillation in the upper urinary tract”,and“urinary marker for urothelial carcinoma”.References within the identified literature were explored and evaluated for relevance.Results:KSS is recommended for both low-risk and selected high-risk UTUC with imperative indications such as solitary kidney.Studies have shown comparable oncological outcomes after KSS including endoscopic ablation,segmental ureterectomy,and topical instillation of novel agents when compared to radical nephroureterectomy in well-selected cases.The development of novel diagnostic tools and risk-stratifying models allows optimal case selection for KSS without compromising oncological outcomes.Conclusion:Kidney-sparing approach for UTUC is an evolving and promising area in urologic oncology,driven by advances in technology,better diagnostic tools,and novel therapeutic agents.Our article provides a comprehensive review of the latest advancements and clinical recommendations.While current evidence is mainly based on retrospective studies,prospective trials are required to address important but unanswered clinical questions in this field.展开更多
The Upper Cretaceous successions of Wadi Umm-Khayshar,southern Galala Plateau,North Eastern Desert,Egypt,are composed of highly diversified faunas and subdivided from base to top into the Galala(Middle-Late Cenomanian...The Upper Cretaceous successions of Wadi Umm-Khayshar,southern Galala Plateau,North Eastern Desert,Egypt,are composed of highly diversified faunas and subdivided from base to top into the Galala(Middle-Late Cenomanian),Maghra El Hadida(Latest Cenomanian-Late Turonian),Matulla(Coniacian-Santonian),and Sudr(Campanian-Maastrichtian)formations.Five ammonite biozones are recorded in the studied section:Neolobites vibrayeanus,Vascoceras cauvini(late Cenomanian),Vascoceras proprium,Choffaticeras segne,and Coilopoceras requienianum(Turonian)zones.The paleoenvironments of the Upper Cretaceous succession are interpreted based on detailed study and microfacies analysis that reflect a deposition in a homoclinal ramp platform ranging from intertidal to deep subtidal.The paleoecology of the Cenomanian-Turonian succession in the studied section is explained based on a detailed study of macrofaunal associations and sedimentary facies.Quantitative analysis(Q-mode cluster analysis,using the Raup-Crick Paired group method)of 1029 macrobenthic specimens,including 45 species of mollusks and echinoids yielded five macrofaunal associations(A-E)that are described and interpreted as remnants of communities.The nektonic elements are represented by 235 cephalopod specimens of 20 species;heatmap cluster analyses show the distribution of these specimens during the Upper Cenomanian-Turonian stages.Environmental parameters(substrate consistency,rate of sedimentation,water energy,surface-water productivity,and oxygen availability)controlled the distribution of the studied macrofauna.The five associations are divided into two major groups:low-stress associations(A,B,C,and D),and a highstress association(E).The low stress associations are recorded from two different habitats:(1)a high-energy,firm substrate habitat,dominated by epifaunal bivalves,large epifaunal gastropods and a regular echinoid;(2)a low-energy,soft substrate habitat dominated by infaunal bivalves and echinoids.The high stress association is dominated by only two species and recorded from a high-energy shoal environment during a regression phase.A detailed study of macrobenthos and cephalopods provides a good paleoecological understanding of Cenomanian-Turonian succession in the Wadi Umm-Khayshar section.展开更多
BACKGROUND Acute nonvariceal upper gastrointestinal bleeding(NVUGIB)is a life-threatening emergency.Endoscopic hemostasis and vascular interventional therapy are two major minimally invasive treatment strategies.Altho...BACKGROUND Acute nonvariceal upper gastrointestinal bleeding(NVUGIB)is a life-threatening emergency.Endoscopic hemostasis and vascular interventional therapy are two major minimally invasive treatment strategies.Although these modalities are widely used,their comparative efficacy and safety across different patient populations and anatomical sites remain controversial.AIM To evaluate the clinical outcomes and safety of endoscopic hemostasis combined with vascular interventional therapy for NVUGIB.METHODS A systematic search was done on PubMed,EMBASE,Cochrane Library,and Web of Science(from database establishment to April 2025).Randomized controlled trial(RCT)quality was assessed via Cochrane RoB 2.0,and observational studies via the Critical Appraisal Skills Program.RevMan 5.4 was used for quantitative analysis;fixed/random-effects models were chosen through I^(2)-assessed heterogeneity.Publication bias was checked using funnel plots and sensitivity analysis via model switching.RESULTS Twenty-one studies(3 RCTs,12 single-group studies,and 6 retrospective cohort studies)with good quality were included.For single-group data,combined therapy had risk differences of 0.70(clinical success),0.24(mortality),and 0.22(rebleeding;all P<0.00001,I^(2)=0).Moreover,the≥60-year rebleeding risk difference was 0.43.Reintervention was found to differ by approach(Z=3.03,P=0.002,inter-subgroup I^(2)=99%).In the RCT and cohort studies,combined vs standard therapy had similar initial hemostasis(Z=0.04,P=0.97)and mortality(Z=1.56,P=0.12)but lower rebleeding(Z=3.26/P=0.001;Z=2.95/P=0.03).Symmetrical funnel plots and robust sensitivity analysis showed no publication bias.CONCLUSION Combined endoscopic hemostasis and vascular interventional therapy for acute NVUGIB can significantly reduce rebleeding,without differences in mortality.Age and vascular interventional methods may influence the therapeutic efficacy.展开更多
Upper gastrointestinal bleeding (UGIB) refers to the bleeding caused by the digestive tract above the flexor ligament, including esophageal, gastric, duodenal, pancreatic and biliary diseases, and lesions after gastro...Upper gastrointestinal bleeding (UGIB) refers to the bleeding caused by the digestive tract above the flexor ligament, including esophageal, gastric, duodenal, pancreatic and biliary diseases, and lesions after gastrojejunostomy. UGIB is one of the common diseases in the clinical work of gastroenterology. There are many causes that can lead to upper gastrointestinal bleeding, which are mainly divided into two categories: one is non-variceal upper gastrointestinal bleeding (NVUGIB), and the other is variceal upper gastrointestinal bleeding (VUGIB). This article reviews various causes of UGIB and the latest progress in treatment, aiming to improve the efficiency of diagnosis and treatment in future clinical work, and reduce the risk of rebleeding and mortality.展开更多
Objective:To explore the rehabilitation effect of upper limb rehabilitation robots combined with isokinetic muscle strength training on hemiplegic patients in the recovery phase of stroke,and to provide a more effecti...Objective:To explore the rehabilitation effect of upper limb rehabilitation robots combined with isokinetic muscle strength training on hemiplegic patients in the recovery phase of stroke,and to provide a more effective intervention plan for clinical rehabilitation treatment.Methods:One hundred and sixty type 2 stroke patients with hemiplegia in recovery phase treated at Jintan First People’s Hospital from May 2020 to May 2025 were selected as the research subjects.They were divided into a control group(n=80)and an observation group(n=80)using a random number table method.The control group received isokinetic muscle strength training,while the observation group received additional upper limb rehabilitation robot-assisted intervention based on the control group’s treatment.The general information(age,gender,course of disease),Brunnstrum staging,Barthel index,FMA score,and facial expression pain score were compared between the two groups.Results:After treatment,the indicators of both groups improved compared to before treatment.The observation group showed significant advantages in improving various indicators.In terms of Brunnstrum staging,the number of patients in stage IV and above was significantly higher than that in the control group;in terms of the Barthel index,the increase was more significant than that of the control group(P=0.000<0.001).In terms of the FMA score,the increase was more pronounced(P=0.000<0.001);and in terms of facial expression pain assessment,the decrease was more evident(P=0.000<0.01).Conclusion:The combination of upper limb rehabilitation robots and isokinetic muscle strength training can significantly improve the recovery of limb function and activities of daily living in hemiplegic patients during the recovery phase of stroke,and reduce pain.Compared with simple isokinetic muscle strength training,the rehabilitation effect is better,and it is worthy of clinical application.展开更多
Upper gastrointestinal(GI)endoscopy is considered an essential procedure in pediatric gastroenterology.It has evolved over many decades into a state where it plays a crucial role in providing diagnostic and therapeuti...Upper gastrointestinal(GI)endoscopy is considered an essential procedure in pediatric gastroenterology.It has evolved over many decades into a state where it plays a crucial role in providing diagnostic and therapeutic advantages across a broad spectrum of diseases.This review examines its role in diagnosing and managing common pediatric GI conditions,emphasizing notable advancements in techniques,clinical use,and future directions.We conducted a detailed literature survey using PubMed,Scopus,and Google Scholar,and English-language articles were reviewed.This review process included the latest articles,guidelines,and conference papers on pediatric and adult upper GI endoscopy.An upper GI endoscopy is imperative in diagnosing many pediatric GI diseases as it enables visualization of the gut mucosa,obtaining mucosal biopsies from suspicious areas or lesions for histological assessment,and selecting an effective management and follow-up plan.New advancements,including high-resolution endoscopy,narrow-band imaging,and confocal laser endomicroscopy,have revolutionized pediatric endoscopy by improving precision and reducing the need for invasive interventions.Furthermore,recent therapeutic developments in the field,such as endoscopic submucosal dissection and endoscopic mucosal resection,are now being utilized to treat preneoplastic lesions or refractory esophageal strictures.However,despite its usefulness,performing this procedure in children is challenging for various reasons,including the need for sedation,anesthesia,and smaller instrument sizes,the unavailability of trained staff,lack of training facilities,and the absence of dedicated endoscopy suites for children.In conclusion,pediatric upper GI endoscopy plays a pivotal role in pediatric gastroenterology,offering both therapeutic and diagnostic benefits.Progress in the field leads to the development of novel techniques that improve overall patient care,such as artificial intelligence in pattern recognition,which enhances lesion detection,predicts premalignant or pre-inflammatory areas,and minimizes investigator-related errors.Additionally,refining protocols and guidelines is essential to improve the safety,efficacy,and precision of upper GI endoscopy,ensuring the best possible care for children.展开更多
Blepharoplasty is a frequently performed aesthetic surgery today aimed at enhancing eyelid appearance and correcting age-related changes.The traditional method of subtraction blepharoplasty,which involved removing fat...Blepharoplasty is a frequently performed aesthetic surgery today aimed at enhancing eyelid appearance and correcting age-related changes.The traditional method of subtraction blepharoplasty,which involved removing fat and excess skin,is now considered outdated.This letter explores Gorgy et al's commentary on Miotti et al's study,highlighting a shift in upper eyelid blepharoplasty towards a more conservative,volume-preserving approach.The study systematically reviewed 10 publications,including three retrospective studies,five comparative studies,and two clinical trials.It emphasizes the trend towards preserving the patient's natural anatomy and focusing on enhancement rather than alteration.However,the study's limitations,such as the lack of long-term comparative re-search,a relatively small sample size,and a single-center design,indicate that further research with extended follow-up is necessary to validate the safety and effectiveness of these techniques.The focus is increasingly on preserving and augmenting volume in upper blepharoplasty rather than removing tissue.展开更多
BACKGROUND Upper gastrointestinal(UGI)diseases present diagnostic challenges during endoscopy due to visual similarities,indistinct boundaries,and observer variability,which can lead to missed diagnoses and delayed tr...BACKGROUND Upper gastrointestinal(UGI)diseases present diagnostic challenges during endoscopy due to visual similarities,indistinct boundaries,and observer variability,which can lead to missed diagnoses and delayed treatment.Automated segmentation using deep learning(DL)models offers the potential to assist endoscopists,improve diagnostic accuracy,and reduce workload.However,multi-class UGI disease segmentation remains underexplored,with limited annotated datasets and insufficient focus on clinical validation.This study hypothesizes that comparative analysis of different DL architectures can identify models suitable for clinical application,providing actionable insights to reduce diagnostic errors and support clinical decision-making in endoscopic practice.AIM To evaluate 17 state-of-the-art DL models for multi-class UGI disease segmentation,emphasizing clinical translation and real-world applicability.METHODS This study evaluated 17 DL models spanning convolutional neural network(CNN)-,transformer-,and mambabased architectures using a self-collected dataset from two hospitals in Macao and Xiangyang(3313 images,9 classes)and the public EDD2020 dataset(386 images,5 classes).Models were assessed for segmentation performance and performance-efficiency trade-off.Statistical analyses were conducted to examine performance differences across architectures.Generalization capability was measured through a cross-dataset evaluation(training models on the self-collected dataset and testing on the EDD2020 dataset).RESULTS Swin-UMamba achieved the highest segmentation performance across both datasets[intersection over union(IoU):89.06%±0.20%self-collected,77.53%±0.32%EDD2020],followed by SegFormer(IoU:88.94%±0.38%selfcollected,77.20%±0.98%EDD2020)and ConvNeXt+UPerNet(IoU:88.48%±0.09%self-collected,76.90%±0.61%EDD2020).Statistical analyses showed no significant differences between paradigms,though hierarchical architectures with pre-trained encoders consistently outperformed simpler designs.SegFormer achieved the best balance of accuracy and computational efficiency with a performance-efficiency trade-off score of 92.02%,making it suitable for real-time clinical use.Cross-dataset evaluation revealed significant performance drops,with generalization retention rates of 64.78%to 71.52%.Transformer-based models,particularly pyramid vision transformer v2+efficient multi-scale convolutional decoding(IoU:63.35%±1.44%),generalized better than CNN-and mambabased models.CONCLUSION Hierarchical architectures like Swin-UMamba and SegFormer show promise for UGI disease segmentation,reducing missed diagnoses and improving workflows,but robust clinical validation is crucial for real-world deployment.展开更多
The tiered geosynthetic-reinforced soil (GRS) walls have been increasingly applied in the high and steep retaining soil structures. However, very little is known about the design method for the tiered GRS wall in prac...The tiered geosynthetic-reinforced soil (GRS) walls have been increasingly applied in the high and steep retaining soil structures. However, very little is known about the design method for the tiered GRS wall in practice. This study is aimed at proposing an upper-bound stability analysis method of a tiered GRS wall. The proposed method was firstly validated by the existing results from the centrifuge test and the numerical method, and then a parametric study was performed to investigate the effects of the cohesionless backfill friction angle φ1 and the wall geometric parameters including the offset distance, the total wall height, the batter angle δ, the number of tiers n, and wall height ratio of adjacent tiers on the dimensionless equivalent earth pressure coefficient KT. The analysis results demonstrated that as the φ1 increases, the shear strength of backfill is enhanced and thus the KT or the total reinforcement tensile force decreases, and the KT decreases with the increase of the offset distance at the initial stage and then becomes stable when it reaches a certain critical value. For a fixed offset distance, the KT or the total reinforcement tensile force decreases with the increase of the δ. For the two-tiered GRS walls having the offset distance less than the critical value, the wall with the smaller wall height ratio has a larger KT. Further, the variation of the location of the critical failure surfaces of tiered GRS walls was presented in this study with the variation of the φ1 and the wall geometry.展开更多
BACKGROUND Upper gastrointestinal cancer(UGIC),including esophageal and gastric cancers,poses a major global health challenge due to its high morbidity and mortality.During the preoperative period,patients often face ...BACKGROUND Upper gastrointestinal cancer(UGIC),including esophageal and gastric cancers,poses a major global health challenge due to its high morbidity and mortality.During the preoperative period,patients often face functional decline,malnutrition,and psychological stress,which can impair recovery.Prehabilitation,a multidisciplinary preoperative intervention,shows promise in optimizing patients'physical and mental status.AIM To evaluate the impact of prehabilitation on patients undergoing UGIC surgery and provide a basis for implementation of the prehabilitation compound plan.METHODS A computerized search of databases including Web of Science,PubMed,EMBASE,The Cochrane Library,Cumulative Index to Nursing and Allied Health Literature,China National Knowledge Infrastructure,Wanfang,and Chinese Science and Technology Journal Database was used to collect clinical trials on the impact of prehabilitation on patients undergoing UGIC surgery.After screening,a meta-analysis was conducted using Review Manager 5.0 software,and linear regression analysis was performed on the prehabilitation duration and outcome indicators.RESULTS A total of 13 clinical trials were ultimately included,with 8 literature quality evaluations at A level and 5 literature quality evaluations at B level.The meta-analysis results showed that compared with conventional nursing,the prehabilitation group had higher six-minute walk distance,lower postoperative complications and mortality rates,and shorter hospital stays,with statistically significant differences;there were no statistically significant differences in intensive care unit monitoring time and albumin levels between the two groups;regression analysis between prehabilitation duration and outcome indicators showed no significant relationship.CONCLUSION Prehabilitation can improve the perioperative functional ability of patients with UGIC and promote postoperative recovery,but its impact on nutrition,psychology,and quality of life needs to be further explored through more high-quality trials;in addition,further research is needed on the prehabilitation time,location,and specific plan.展开更多
文摘With the widespread application of WIFI networks and embedded system technology, the device monitoring system based on Embedded System and wireless network came into being. In this paper, we introduce a device monitoring system based on ARM upper computer and WIFI transmission, and we tested this system on workshop equipment. The hardware adopts ARM Cortex-A8 processor architecture of TI company as the main control chip, using IAC-335X-Kit development board for system design, external USB camera module and WIFI wireless module for video capture and data transmission. The software is based on embedded Linux as the platform. The system will collect production data accurately and objectively, and the statistical analysis. At the same time, the system uses QT to develop the upper computer software GUI interface. Compared with the traditional system based on the wired network, our design is more convenient and flexible, which reduces the implementation restriction and maintenance cost of traditional network cabling.
文摘Nail changes following upper extremity transplantation(UET)cannot be overlooked as they possess diagnostic and prognostic relevance in allotransplantation of upper limbs.This comprehensive review explores nail and nail bed related changes encountered in UET recipients in the literature.The differential diagnosis of nail abnormalities in UET includes a wide range of systemic,local and iatrogenic conditions other than immune responses to the allograft.It requires interdisciplinary evaluation by primary transplant surgeons,pathologists,dermatologists and immunologists.The possible underlying mechanisms of nail pathology in UET and the management are discussed.It also underscores the importance of onychodystrophy and need for timely intervention and to improve outcomes in UET recipients.
基金supported by the National Key R&D Program of China(grant number:2023YFC2415200)National Natural Science Foundation of China(grant numbers:82361168664,U24A20759,82441018,82372053,92259302,62027901,82302296)+6 种基金Science and Technology Development Fund of Macao Special Administrative Region(grant number:0006/2023/AFJ)Strategic Priority Research Program of the Chinese Academy of Sciences(grant number:XDB38040200)Beijing Natural Science Foundation(grant numbers:Z20J00105,JQ24048)Scientific and Technological Innovation Project of China Academy of Chinese Medical Sciences(grant number:CI2023C008YG)Key-Area Re-search and Development Program of Guangdong Province(grant number:2021B0101420005)the Youth Innovation Promotion Association CAS(grant number:Y2021049)China Postdoctoral Science Foun-dation under Grant(grant number:2022M720357)。
文摘Upper gastrointestinal cancers,mainly comprising esophageal and gastric cancers,are among the most prevalent cancers worldwide.There are many new cases of upper gastrointestinal cancers annually,and the survival rate tends to be low.Therefore,timely screening,precise diagnosis,appropriate treatment strategies,and effective prognosis are crucial for patients with upper gastrointestinal cancers.In recent years,an increasing number of studies suggest that artificial intelligence(AI)technology can effectively address clinical tasks related to upper gastrointestinal cancers.These studies mainly focus on four aspects:screening,diagnosis,treatment,and progno-sis.In this review,we focus on the application of AI technology in clinical tasks related to upper gastrointestinal cancers.Firstly,the basic application pipelines of radiomics and deep learning in medical image analysis were introduced.Furthermore,we separately reviewed the application of AI technology in the aforementioned aspects for both esophageal and gastric cancers.Finally,the current limitations and challenges faced in the field of upper gastrointestinal cancers were summarized,and explorations were conducted on the selection of AI algorithms in various scenarios,the popularization of early screening,the clinical applications of AI,and large multimodal models.
基金funded by Science Foundation for Youth supported by Shanghai Municipal Health Commission(No.20204Y0313)Sailing Program with the support of Science and Technology Commission of Shanghai Municipality(No.21YF1443800).
文摘Background China is seeing a growing demand for rehabilitation treatments for post-stroke upper limb spastic paresis(PSSP-UL).Although acupuncture is known to be effective for PSSP-UL,there is room to enhance its efficacy.Objective This study explored a semi-personalized acupuncture approach for PSSP-UL that used three-dimensional kinematic analysis(3DKA)results to select additional acupoints,and investigated the feasibility,efficacy and safety of this approach.Design,setting,participants and interventions This single-blind,single-center,randomized,controlled trial involved 74 participants who experienced a first-ever ischemic or hemorrhagic stroke with spastic upper limb paresis.The participants were then randomly assigned to the intervention group or the control group in a 1:1 ratio.Both groups received conventional treatments and acupuncture treatment 5 days a week for 4 weeks.The main acupoints in both groups were the same,while participants in the intervention group received additional acupoints selected on the basis of 3DKA results.Follow-up assessments were conducted for 8 weeks after the treatment.Main outcome measures The primary outcome was the Fugl-Meyer Assessment for Upper Extremity(FMA-UE)response rate(≥6-point change)at week 4.Secondary outcomes included changes in motor function(FMA-UE),Brunnstrom recovery stage(BRS),manual muscle test(MMT),spasticity(Modified Ashworth Scale,MAS),and activities of daily life(Modified Barthel Index,MBI)at week 4 and week 12.Results Sixty-four participants completed the trial and underwent analyses.Compared with control group,the intervention group exhibited a significantly higher FMA-UE response rate at week 4(χ^(2)=5.479,P=0.019)and greater improvements in FMA-UE at both week 4 and week 12(both P<0.001).The intervention group also showed bigger improvements from baseline in the MMT grades for shoulder adduction and elbow flexion at weeks 4 and 12 as well as thumb adduction at week 4(P=0.007,P=0.049,P=0.019,P=0.008,P=0.029,respectively).The intervention group showed a better change in the MBI at both week 4 and week 12(P=0.004 and P=0.010,respectively).Although the intervention group had a higher BRS for the hand at week 12(P=0.041),no intergroup differences were observed at week 4(all P>0.05).The two groups showed no differences in MAS grades as well as in BRS for the arm at weeks 4 and 12(all P>0.05).Conclusion Semi-personalized acupuncture prescription based on 3DKA results significantly improved motor function,muscle strength,and activities of daily living in patients with PSSP-UL.
基金financially supported by the National Key Research and Development Program of China (2022YFC3005600)the Foundation of the Anhui Educational Commission (2023AH051198)+1 种基金the National Natural Science Foundation of China (42125401 and 42104063)the Joint Open Fund of Mengcheng National Geophysical Observatory (MENGO-202201)。
文摘The Tan-Lu Fault Zone is a large NNE-trending fault zone that has a substantial effect on the development of eastern China and its earthquake disaster prevention efforts. Aiming at the azimuthally anisotropic structure in the upper crust and seismogenic tectonics in the Hefei segment of this fault, we collected phase velocity dispersion data of fundamental mode Rayleigh waves from ambient noise cross-correlation functions of ~400 temporal seismographs in an area of approximately 80 × 70 km along the fault zone. The period band of the dispersion data was ~0.5–10 s. We inverted for the upper crustal three-dimensional(3-D) shear velocity model with azimuthal anisotropy from the surface to 10 km depth by using a 3-D direct azimuthal anisotropy inversion method. The inversion result shows the spatial distribution characteristics of the tectonic units in the upper crust. Additionally, the deformation of the Tan-Lu Fault Zone and its conjugated fault systems could be inferred from the anisotropy model. In particular, the faults that have remained active from the early and middle Pleistocene control the anisotropic characteristics of the upper crustal structure in this area. The direction of fast axes near the fault zone area in the upper crust is consistent with the strike of the faults, whereas for the region far away from the fault zone, the direction of fast axes is consistent with the direction of the regional principal stress caused by plate movement. Combined with the azimuthal anisotropy models in the deep crust and uppermost mantle from the surface wave and Pn wave, the different anisotropic patterns caused by the Tan-Lu Fault Zone and its conjugated fault system nearby are shown in the upper and lower crust. Furthermore,by using the double-difference method, we relocated the Lujiang earthquake series, which contained 32 earthquakes with a depth shallower than 10 km. Both the Vs model and earthquake relocation results indicate that earthquakes mostly occurred in the vicinity of structural boundaries with fractured media, with high-level development of cracks and small-scale faults jammed between more rigid areas.
基金Supported by the National Natural Science Foundation of China(42302141).
文摘Taking the second member of the Xujiahe Formation of the Upper Triassic in the Xinchang structural belt as an example,based on data such as logging,production,seismic interpretation and test,a systematic analysis was conducted on the structural characteristics and evolution,reservoir diagenesis and densification processes,and types and stages of faults/fractures,and revealing the multi-stage and multi-factor dynamic coupled enrichment mechanisms of tight gas reservoirs.(1)In the early Yanshan period,the paleo-structural traps were formed with low-medium maturity hydrocarbons accumulating in structural highs driven by buoyancy since reservoirs were not fully densified in this stage,demonstrating paleo-structure control on traps and early hydrocarbon accumulation.(2)In the middle-late Yanshan period,the source rocks became mature to generate and expel a large quantity of hydrocarbons.Grain size and type of sandstone controlled the time of reservoir densification,which restricted the scale of hydrocarbon charging,allowing for only a small-scale migration through sand bodies near the fault/fracture or less-densified matrix reservoirs.(3)During the Himalayan period,the source rocks reached overmaturity,and the residual oil cracking gas was efficiently transported along the late-stage faults/fractures.Wells with high production capacity were mainly located in Type I and II fault/fracture zones comprising the late-stage north-south trending fourth-order faults and the late-stage fractures.The productivity of the wells was controlled by the transformation of the late-stage faults/fractures.(4)The Xinchang structural belt underwent three stages of tectonic evolution,two stages of reservoir formation,and three stages of fault/fractures development.Hydrocarbons mainly accumulated in the paleo-structure highs.After reservoir densification and late fault/fracture adjustment,a complex gas-water distribution pattern was formed.Thus,it is summarized as the model of“near-source and low-abundance hydrocarbon charging in the early stage,and differential enrichment of natural gas under the joint control of fault-fold-fracture complex,high-quality reservoirs and structural highs in the late stage”.Faults/fractures with well-coupled fault-fold-fracture-pore are favorable exploration targets with high exploration effectiveness.
基金supported by the National Natural Science Foundation of China,Nos.82071426,81873784Clinical Cohort Construction Program of Peking University Third Hospital,No.BYSYDL2019002(all to DF)。
文摘Amyotrophic lateral sclerosis is a rare neurodegenerative disease characterized by the involvement of both upper and lower motor neurons.Early bilateral limb involvement significantly affects patients'daily lives and may lead them to be confined to bed.However,the effect of upper and lower motor neuron impairment and other risk factors on bilateral limb involvement is unclear.To address this issue,we retrospectively collected data from 586 amyotrophic lateral sclerosis patients with limb onset diagnosed at Peking University Third Hospital between January 2020 and May 2022.A univariate analysis revealed no significant differences in the time intervals of spread in different directions between individuals with upper motor neuron-dominant amyotrophic lateral sclerosis and those with classic amyotrophic lateral sclerosis.We used causal directed acyclic graphs for risk factor determination and Cox proportional hazards models to investigate the association between the duration of bilateral limb involvement and clinical baseline characteristics in amyotrophic lateral sclerosis patients.Multiple factor analyses revealed that higher upper motor neuron scores(hazard ratio[HR]=1.05,95%confidence interval[CI]=1.01–1.09,P=0.018),onset in the left limb(HR=0.72,95%CI=0.58–0.89,P=0.002),and a horizontal pattern of progression(HR=0.46,95%CI=0.37–0.58,P<0.001)were risk factors for a shorter interval until bilateral limb involvement.The results demonstrated that a greater degree of upper motor neuron involvement might cause contralateral limb involvement to progress more quickly in limb-onset amyotrophic lateral sclerosis patients.These findings may improve the management of amyotrophic lateral sclerosis patients with limb onset and the prediction of patient prognosis.
文摘The Upper Cretaceous of Tantou Basin in western Henan has yielded many vertebrate fossils,which are featured by several non-avian dinosaurs.Meanwhile,studies on their eggs were yet inadequate though many eggshells have been reported.The newly discovered material 41HⅤ0199 was excavated from the Upper Cretaceous Qiupa Formation in 2021.The block preserves eight complete eggs arranged in two partial rings that form a partial clutch,and there are some scattered eggshells preserved closely with the block,showing a concave-up to concave-down ratio of 54.5:45.5,which indicates that the scattered eggshells come from the clutch and the clutch had been partially broken before it was buried.Based on morphological and microstructural characteristics,the eggs and eggshells can be assigned to Macroolithus yaotunensis(Elongatoolithidae),an oospecies known to be related to oviraptorids,which leads Yulong mini to be its probable producer.Besides,some eggshells show microstructural signs indicating egg retention,which marks the second example of egg retention in the oofamily Elongatoolithidae.
文摘[Objective]Implementation of the Ten-Year Fishing Ban policy may alter fish diversity and niche characteristics of dominant species in spawning grounds within the National Nature Reserve for Rare and Endemic Fish in the Upper Yangtze River.This study initiated continuous monitoring of natural spawning habitats from February 2022 to assess these ecological changes.[Methods]Environmental DNA(eDNA)metabarcoding was employed to analyze fish species composition,biodiversity patterns,and niche parameters of dominant species.Water sampling followed the CEN/TS 19461 standard across five monitoring transects(ZT1-ZT5).[Results]The eDNA analysis detected 45 species of fish belonging to 38 genera,13 families,and 3 orders were detected through environmental DNA(eDNA)in this survey,including 10 species endemic to the upper reaches of the Yangtze River,such as Procypris rabaudi and Myxocyprinus asiaticus.The fish community was mainly composed of bottom-dwelling,settling ovum-producing,omnivorous fish.The variation ranges of the Chao1 index,ACE index,Shannon index,and Simpson index are 736~996,719~965,1.58~3.23,and 0.83~0.99,respectively,indicating that fish species in spawning sites are abundant and community distribution uniformity is high.All indexes are highest at ZT1 monitoring points.Cluster analysis showed that,at a certain similarity level,fish community types in spawning sites could be basically divided into two groups:ZT1,ZT3,and ZT5 clustered together,and ZT2 and ZT4 clustered together,indicating similar fish community habitats.There are 9 dominant fish species in typical deep pool habitats in the reserve,with niche widths(Bi)ranging from 1.13 to 3.87.The dominant fish species are broad and medium niche fish,such as Cyprinus carpio and Hemiculter tchangi,with the niche overlap index(Oik)of some dominant fish species reaching more than 0.95.This indicates fierce competition for resources among the fish in this spawning ground.[Conclusion]The Zhutuo spawning ground demonstrates high species richness with homogeneous community structure and intense resource competition.This study establishes an eDNA-based monitoring framework that enhances conventional survey method,providing critical baseline data for adaptive management under the fishing moratorium regime.
基金Supported by Zhejiang Province Traditional Chinese Medicine Science and Technology Project(2024ZL769):Effect of Xingshen Kaiqiao Acupuncture Method combined with Upper Limb Robot-assisted Training on Upper Limb Function and Neuroplasticity Mechanism of Hemiplegia after Stroke based on Functional Near-Infrared Spectroscopy Technology。
文摘OBJECTIVE:To investigate the effects of acupuncture combined with upper limb rehabilitation robot on neural remodeling and functional recovery in post-stroke patients.METHODS:There were 50 stroke patients were randomly divided into an experimental group(acupuncture combined with upper limb rehabilitation robot assisted training)and a control group(upper limb rehabilitation robot assisted training).Various assessments were conducted to compare the effects of the two treatments on neural remodeling and functional recovery.Functional near-infrared spectroscopy technology was used to assess the effects of different treatments on neural plasticity and their impact on upper limb function and activities of daily living.RESULTS:The experimental group showed significantly higher concentrations of oxygenated hemoglobin and total hemoglobin in specific brain regions compared to the control group(P<0.05).Additionally,the experimental group had significantly lower concentrations of deoxygenated hemoglobin(P<0.05).After treatment,both groups showed improvements in various measures,but the experimental group had significantly greater improvements(P<0.05).CONCLUSION:Acupuncture combined with upper limb rehabilitation robot can effectively improve upper limb function and neural remodeling in stroke patients.This study supports the integration of Traditional Chinese and Western Medicine in improving limb dysfunction poststroke.
文摘Objective:This article reviews the latest updates and outcomes of kidney-sparing surgery(KSS)in patients with upper tract urothelial carcinoma(UTUC).Methods:A comprehensive literature search was performed using the PubMed and Embase databases to identify related English-language studies published within the last 10 years.Key search words included“upper urinary tract tumour/cancer/carcinoma”,“kidney-sparing surgery or approach”,“endoscopic treatment for upper tract tumour/cancer/carcinoma”,“topical instillation in the upper urinary tract”,and“urinary marker for urothelial carcinoma”.References within the identified literature were explored and evaluated for relevance.Results:KSS is recommended for both low-risk and selected high-risk UTUC with imperative indications such as solitary kidney.Studies have shown comparable oncological outcomes after KSS including endoscopic ablation,segmental ureterectomy,and topical instillation of novel agents when compared to radical nephroureterectomy in well-selected cases.The development of novel diagnostic tools and risk-stratifying models allows optimal case selection for KSS without compromising oncological outcomes.Conclusion:Kidney-sparing approach for UTUC is an evolving and promising area in urologic oncology,driven by advances in technology,better diagnostic tools,and novel therapeutic agents.Our article provides a comprehensive review of the latest advancements and clinical recommendations.While current evidence is mainly based on retrospective studies,prospective trials are required to address important but unanswered clinical questions in this field.
文摘The Upper Cretaceous successions of Wadi Umm-Khayshar,southern Galala Plateau,North Eastern Desert,Egypt,are composed of highly diversified faunas and subdivided from base to top into the Galala(Middle-Late Cenomanian),Maghra El Hadida(Latest Cenomanian-Late Turonian),Matulla(Coniacian-Santonian),and Sudr(Campanian-Maastrichtian)formations.Five ammonite biozones are recorded in the studied section:Neolobites vibrayeanus,Vascoceras cauvini(late Cenomanian),Vascoceras proprium,Choffaticeras segne,and Coilopoceras requienianum(Turonian)zones.The paleoenvironments of the Upper Cretaceous succession are interpreted based on detailed study and microfacies analysis that reflect a deposition in a homoclinal ramp platform ranging from intertidal to deep subtidal.The paleoecology of the Cenomanian-Turonian succession in the studied section is explained based on a detailed study of macrofaunal associations and sedimentary facies.Quantitative analysis(Q-mode cluster analysis,using the Raup-Crick Paired group method)of 1029 macrobenthic specimens,including 45 species of mollusks and echinoids yielded five macrofaunal associations(A-E)that are described and interpreted as remnants of communities.The nektonic elements are represented by 235 cephalopod specimens of 20 species;heatmap cluster analyses show the distribution of these specimens during the Upper Cenomanian-Turonian stages.Environmental parameters(substrate consistency,rate of sedimentation,water energy,surface-water productivity,and oxygen availability)controlled the distribution of the studied macrofauna.The five associations are divided into two major groups:low-stress associations(A,B,C,and D),and a highstress association(E).The low stress associations are recorded from two different habitats:(1)a high-energy,firm substrate habitat,dominated by epifaunal bivalves,large epifaunal gastropods and a regular echinoid;(2)a low-energy,soft substrate habitat dominated by infaunal bivalves and echinoids.The high stress association is dominated by only two species and recorded from a high-energy shoal environment during a regression phase.A detailed study of macrobenthos and cephalopods provides a good paleoecological understanding of Cenomanian-Turonian succession in the Wadi Umm-Khayshar section.
文摘BACKGROUND Acute nonvariceal upper gastrointestinal bleeding(NVUGIB)is a life-threatening emergency.Endoscopic hemostasis and vascular interventional therapy are two major minimally invasive treatment strategies.Although these modalities are widely used,their comparative efficacy and safety across different patient populations and anatomical sites remain controversial.AIM To evaluate the clinical outcomes and safety of endoscopic hemostasis combined with vascular interventional therapy for NVUGIB.METHODS A systematic search was done on PubMed,EMBASE,Cochrane Library,and Web of Science(from database establishment to April 2025).Randomized controlled trial(RCT)quality was assessed via Cochrane RoB 2.0,and observational studies via the Critical Appraisal Skills Program.RevMan 5.4 was used for quantitative analysis;fixed/random-effects models were chosen through I^(2)-assessed heterogeneity.Publication bias was checked using funnel plots and sensitivity analysis via model switching.RESULTS Twenty-one studies(3 RCTs,12 single-group studies,and 6 retrospective cohort studies)with good quality were included.For single-group data,combined therapy had risk differences of 0.70(clinical success),0.24(mortality),and 0.22(rebleeding;all P<0.00001,I^(2)=0).Moreover,the≥60-year rebleeding risk difference was 0.43.Reintervention was found to differ by approach(Z=3.03,P=0.002,inter-subgroup I^(2)=99%).In the RCT and cohort studies,combined vs standard therapy had similar initial hemostasis(Z=0.04,P=0.97)and mortality(Z=1.56,P=0.12)but lower rebleeding(Z=3.26/P=0.001;Z=2.95/P=0.03).Symmetrical funnel plots and robust sensitivity analysis showed no publication bias.CONCLUSION Combined endoscopic hemostasis and vascular interventional therapy for acute NVUGIB can significantly reduce rebleeding,without differences in mortality.Age and vascular interventional methods may influence the therapeutic efficacy.
文摘Upper gastrointestinal bleeding (UGIB) refers to the bleeding caused by the digestive tract above the flexor ligament, including esophageal, gastric, duodenal, pancreatic and biliary diseases, and lesions after gastrojejunostomy. UGIB is one of the common diseases in the clinical work of gastroenterology. There are many causes that can lead to upper gastrointestinal bleeding, which are mainly divided into two categories: one is non-variceal upper gastrointestinal bleeding (NVUGIB), and the other is variceal upper gastrointestinal bleeding (VUGIB). This article reviews various causes of UGIB and the latest progress in treatment, aiming to improve the efficiency of diagnosis and treatment in future clinical work, and reduce the risk of rebleeding and mortality.
基金Changzhou Applied Basic Research Program(Project No.:CJ20241042)。
文摘Objective:To explore the rehabilitation effect of upper limb rehabilitation robots combined with isokinetic muscle strength training on hemiplegic patients in the recovery phase of stroke,and to provide a more effective intervention plan for clinical rehabilitation treatment.Methods:One hundred and sixty type 2 stroke patients with hemiplegia in recovery phase treated at Jintan First People’s Hospital from May 2020 to May 2025 were selected as the research subjects.They were divided into a control group(n=80)and an observation group(n=80)using a random number table method.The control group received isokinetic muscle strength training,while the observation group received additional upper limb rehabilitation robot-assisted intervention based on the control group’s treatment.The general information(age,gender,course of disease),Brunnstrum staging,Barthel index,FMA score,and facial expression pain score were compared between the two groups.Results:After treatment,the indicators of both groups improved compared to before treatment.The observation group showed significant advantages in improving various indicators.In terms of Brunnstrum staging,the number of patients in stage IV and above was significantly higher than that in the control group;in terms of the Barthel index,the increase was more significant than that of the control group(P=0.000<0.001).In terms of the FMA score,the increase was more pronounced(P=0.000<0.001);and in terms of facial expression pain assessment,the decrease was more evident(P=0.000<0.01).Conclusion:The combination of upper limb rehabilitation robots and isokinetic muscle strength training can significantly improve the recovery of limb function and activities of daily living in hemiplegic patients during the recovery phase of stroke,and reduce pain.Compared with simple isokinetic muscle strength training,the rehabilitation effect is better,and it is worthy of clinical application.
文摘Upper gastrointestinal(GI)endoscopy is considered an essential procedure in pediatric gastroenterology.It has evolved over many decades into a state where it plays a crucial role in providing diagnostic and therapeutic advantages across a broad spectrum of diseases.This review examines its role in diagnosing and managing common pediatric GI conditions,emphasizing notable advancements in techniques,clinical use,and future directions.We conducted a detailed literature survey using PubMed,Scopus,and Google Scholar,and English-language articles were reviewed.This review process included the latest articles,guidelines,and conference papers on pediatric and adult upper GI endoscopy.An upper GI endoscopy is imperative in diagnosing many pediatric GI diseases as it enables visualization of the gut mucosa,obtaining mucosal biopsies from suspicious areas or lesions for histological assessment,and selecting an effective management and follow-up plan.New advancements,including high-resolution endoscopy,narrow-band imaging,and confocal laser endomicroscopy,have revolutionized pediatric endoscopy by improving precision and reducing the need for invasive interventions.Furthermore,recent therapeutic developments in the field,such as endoscopic submucosal dissection and endoscopic mucosal resection,are now being utilized to treat preneoplastic lesions or refractory esophageal strictures.However,despite its usefulness,performing this procedure in children is challenging for various reasons,including the need for sedation,anesthesia,and smaller instrument sizes,the unavailability of trained staff,lack of training facilities,and the absence of dedicated endoscopy suites for children.In conclusion,pediatric upper GI endoscopy plays a pivotal role in pediatric gastroenterology,offering both therapeutic and diagnostic benefits.Progress in the field leads to the development of novel techniques that improve overall patient care,such as artificial intelligence in pattern recognition,which enhances lesion detection,predicts premalignant or pre-inflammatory areas,and minimizes investigator-related errors.Additionally,refining protocols and guidelines is essential to improve the safety,efficacy,and precision of upper GI endoscopy,ensuring the best possible care for children.
文摘Blepharoplasty is a frequently performed aesthetic surgery today aimed at enhancing eyelid appearance and correcting age-related changes.The traditional method of subtraction blepharoplasty,which involved removing fat and excess skin,is now considered outdated.This letter explores Gorgy et al's commentary on Miotti et al's study,highlighting a shift in upper eyelid blepharoplasty towards a more conservative,volume-preserving approach.The study systematically reviewed 10 publications,including three retrospective studies,five comparative studies,and two clinical trials.It emphasizes the trend towards preserving the patient's natural anatomy and focusing on enhancement rather than alteration.However,the study's limitations,such as the lack of long-term comparative re-search,a relatively small sample size,and a single-center design,indicate that further research with extended follow-up is necessary to validate the safety and effectiveness of these techniques.The focus is increasingly on preserving and augmenting volume in upper blepharoplasty rather than removing tissue.
基金Supported by the Guangdong Basic and Applied Basic Research Foundation,No.2021B1515130003the Key Research and Development Plan of Hubei Province,No.2022BCE034the Natural Science Foundation of Hubei Province,No.2024AFB1054.
文摘BACKGROUND Upper gastrointestinal(UGI)diseases present diagnostic challenges during endoscopy due to visual similarities,indistinct boundaries,and observer variability,which can lead to missed diagnoses and delayed treatment.Automated segmentation using deep learning(DL)models offers the potential to assist endoscopists,improve diagnostic accuracy,and reduce workload.However,multi-class UGI disease segmentation remains underexplored,with limited annotated datasets and insufficient focus on clinical validation.This study hypothesizes that comparative analysis of different DL architectures can identify models suitable for clinical application,providing actionable insights to reduce diagnostic errors and support clinical decision-making in endoscopic practice.AIM To evaluate 17 state-of-the-art DL models for multi-class UGI disease segmentation,emphasizing clinical translation and real-world applicability.METHODS This study evaluated 17 DL models spanning convolutional neural network(CNN)-,transformer-,and mambabased architectures using a self-collected dataset from two hospitals in Macao and Xiangyang(3313 images,9 classes)and the public EDD2020 dataset(386 images,5 classes).Models were assessed for segmentation performance and performance-efficiency trade-off.Statistical analyses were conducted to examine performance differences across architectures.Generalization capability was measured through a cross-dataset evaluation(training models on the self-collected dataset and testing on the EDD2020 dataset).RESULTS Swin-UMamba achieved the highest segmentation performance across both datasets[intersection over union(IoU):89.06%±0.20%self-collected,77.53%±0.32%EDD2020],followed by SegFormer(IoU:88.94%±0.38%selfcollected,77.20%±0.98%EDD2020)and ConvNeXt+UPerNet(IoU:88.48%±0.09%self-collected,76.90%±0.61%EDD2020).Statistical analyses showed no significant differences between paradigms,though hierarchical architectures with pre-trained encoders consistently outperformed simpler designs.SegFormer achieved the best balance of accuracy and computational efficiency with a performance-efficiency trade-off score of 92.02%,making it suitable for real-time clinical use.Cross-dataset evaluation revealed significant performance drops,with generalization retention rates of 64.78%to 71.52%.Transformer-based models,particularly pyramid vision transformer v2+efficient multi-scale convolutional decoding(IoU:63.35%±1.44%),generalized better than CNN-and mambabased models.CONCLUSION Hierarchical architectures like Swin-UMamba and SegFormer show promise for UGI disease segmentation,reducing missed diagnoses and improving workflows,but robust clinical validation is crucial for real-world deployment.
基金financially supported by the National Natural Science Foundation of China(Grants Nos.41877255,and 52078182).
文摘The tiered geosynthetic-reinforced soil (GRS) walls have been increasingly applied in the high and steep retaining soil structures. However, very little is known about the design method for the tiered GRS wall in practice. This study is aimed at proposing an upper-bound stability analysis method of a tiered GRS wall. The proposed method was firstly validated by the existing results from the centrifuge test and the numerical method, and then a parametric study was performed to investigate the effects of the cohesionless backfill friction angle φ1 and the wall geometric parameters including the offset distance, the total wall height, the batter angle δ, the number of tiers n, and wall height ratio of adjacent tiers on the dimensionless equivalent earth pressure coefficient KT. The analysis results demonstrated that as the φ1 increases, the shear strength of backfill is enhanced and thus the KT or the total reinforcement tensile force decreases, and the KT decreases with the increase of the offset distance at the initial stage and then becomes stable when it reaches a certain critical value. For a fixed offset distance, the KT or the total reinforcement tensile force decreases with the increase of the δ. For the two-tiered GRS walls having the offset distance less than the critical value, the wall with the smaller wall height ratio has a larger KT. Further, the variation of the location of the critical failure surfaces of tiered GRS walls was presented in this study with the variation of the φ1 and the wall geometry.
基金Supported by Key Project of Jiangsu Provincial Health(ZD2022052).
文摘BACKGROUND Upper gastrointestinal cancer(UGIC),including esophageal and gastric cancers,poses a major global health challenge due to its high morbidity and mortality.During the preoperative period,patients often face functional decline,malnutrition,and psychological stress,which can impair recovery.Prehabilitation,a multidisciplinary preoperative intervention,shows promise in optimizing patients'physical and mental status.AIM To evaluate the impact of prehabilitation on patients undergoing UGIC surgery and provide a basis for implementation of the prehabilitation compound plan.METHODS A computerized search of databases including Web of Science,PubMed,EMBASE,The Cochrane Library,Cumulative Index to Nursing and Allied Health Literature,China National Knowledge Infrastructure,Wanfang,and Chinese Science and Technology Journal Database was used to collect clinical trials on the impact of prehabilitation on patients undergoing UGIC surgery.After screening,a meta-analysis was conducted using Review Manager 5.0 software,and linear regression analysis was performed on the prehabilitation duration and outcome indicators.RESULTS A total of 13 clinical trials were ultimately included,with 8 literature quality evaluations at A level and 5 literature quality evaluations at B level.The meta-analysis results showed that compared with conventional nursing,the prehabilitation group had higher six-minute walk distance,lower postoperative complications and mortality rates,and shorter hospital stays,with statistically significant differences;there were no statistically significant differences in intensive care unit monitoring time and albumin levels between the two groups;regression analysis between prehabilitation duration and outcome indicators showed no significant relationship.CONCLUSION Prehabilitation can improve the perioperative functional ability of patients with UGIC and promote postoperative recovery,but its impact on nutrition,psychology,and quality of life needs to be further explored through more high-quality trials;in addition,further research is needed on the prehabilitation time,location,and specific plan.
