As an effective strategy to address urban traffic congestion,traffic flow prediction has gained attention from Federated-Learning(FL)researchers due FL’s ability to preserving data privacy.However,existing methods fa...As an effective strategy to address urban traffic congestion,traffic flow prediction has gained attention from Federated-Learning(FL)researchers due FL’s ability to preserving data privacy.However,existing methods face challenges:some are too simplistic to capture complex traffic patterns effectively,and others are overly complex,leading to excessive communication overhead between cloud and edge devices.Moreover,the problem of single point failure limits their robustness and reliability in real-world applications.To tackle these challenges,this paper proposes a new method,CMBA-FL,a Communication-Mitigated and Blockchain-Assisted Federated Learning model.First,CMBA-FL improves the client model’s ability to capture temporal traffic patterns by employing the Encoder-Decoder framework for each edge device.Second,to reduce the communication overhead during federated learning,we introduce a verification method based on parameter update consistency,avoiding unnecessary parameter updates.Third,to mitigate the risk of a single point of failure,we integrate consensus mechanisms from blockchain technology.To validate the effectiveness of CMBA-FL,we assess its performance on two widely used traffic datasets.Our experimental results show that CMBA-FL reduces prediction error by 11.46%,significantly lowers communication overhead,and improves security.展开更多
BACKGROUND Meningiomas represent the most common primary intracranial tumor in adults.The majority of meningiomas are indolent,benign,and sporadic in nature.The incidence of meningiomas is directly proportional to the...BACKGROUND Meningiomas represent the most common primary intracranial tumor in adults.The majority of meningiomas are indolent,benign,and sporadic in nature.The incidence of meningiomas is directly proportional to the age,peaking around 65 years.The presenting symptomatology of intracranial meningiomas is mainly dependent on their anatomical location,as with the majority of brain tumors.Surgical resection and radiation therapy remain the treatment modality for meningiomas of all grades.CASE SUMMARY We present a case describing a 78-year-old female who came in following a ground level fall.The primary assessment was notable for a history of similar recurrent falls and subtle left-sided peripheral visual field loss.Further neurological examination was otherwise largely unremarkable.A computed tomography scan of the head revealed a large extra-axial mass located along the posterior aspect of the falx.Follow-up magnetic resonance imaging confirmed a lesion measuring around 6.6 cm×4.2 cm×5.5 cm.A partial surgical resection of the right-sided portion of the lesion was performed.Complete resection was limited by insufficient visualization and challenges with hemostatic control of the left parafalcine region.Further histopathological analysis confirmed a fibrous meningioma with focal necrosis,consistent with World Health Organization Grade 2 classification.She was subsequently scheduled for outpatient follow-up to assess the residual tumor management.CONCLUSION This case highlights the importance of maintaining a high index of suspicion for intracranial pathology in elderly patients with nonspecific presentation.展开更多
BACKGROUND An epidural abscess is a rare but serious medical condition where a pocket of pus forms in the epidural space—the area between the outer covering of the spinal cord(the dura mater)and the bones of the spin...BACKGROUND An epidural abscess is a rare but serious medical condition where a pocket of pus forms in the epidural space—the area between the outer covering of the spinal cord(the dura mater)and the bones of the spine.It’s usually caused by a bacterial infection,most commonly Staphylococcus aureus.The infection can spread to this area from other parts of the body,through the bloodstream,or it may be intro-duced directly during spinal procedures like epidural injections or surgery.Symptoms often include severe back pain,fever,and neurological deficits like weakness or numbness,which can progress quickly if untreated.It's considered a medical emergency because if the abscess compresses the spinal cord,it can lead to permanent paralysis or even death.Treatment usually involves antibiotics and,in many cases,surgical drainage.CASE SUMMARY Spinal epidural abscess(SEA)represents a rare yet potentially severe infection affecting the epidural space.We present the following case of a 54-year-old Hispanic white male who initially presented to the emergency department with acute deteriorating symptoms of bilateral lower extremity weakness,which subsequently progressed to involve the upper extremities.However,further evaluation uncovered additional notable symptoms,including urinary inconti-nence and decreased appetite.Further investigation broadened the differential diagnosis,including meningitis,spinal cord compression,acute pyelonephritis,osteomyelitis,bacteremia,torticollis,and acutely progressive ascending bilateral lower extremity weakness,raising the concern for possible Guillain-Barre syndrome.Diagnostic imaging,including magnetic resonance imaging of the spine,confirmed the presence of C5-C6 osteomyelitis and a C6-C7 spinal epidural abscess with severe canal narrowing.The patient underwent an emergency evacuation of epidural abscess with a C6 corpectomy and C5-C7 cervical fusion,followed by an 8-week course of intravenous antibiotics.Cultures from the abscess and bone revealed Staphylococcal aureus.The patient was discharged after 54 days with significant improvement in power and function.CONCLUSION This case highlights the importance of maintaining a high index of suspicion for SEA in patients presenting with atypical symptoms,even in the setting of seemingly unrelated conditions.Early recognition and prompt intervention are crucial to prevent permanent neurological deficits and improve outcomes in patients with SEA.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
Toxoplasma gondii is a single-celled parasite that infects nearly all warm-blooded animals,including humans(Montoya and Liesenfeld,2004).It occurs worldwide and can persist for a lifetime in mammals.Humans get infecte...Toxoplasma gondii is a single-celled parasite that infects nearly all warm-blooded animals,including humans(Montoya and Liesenfeld,2004).It occurs worldwide and can persist for a lifetime in mammals.Humans get infected by eating undercooked meat of animals containing the tissue cysts of this parasite.In immune-competent individuals,T.展开更多
In this editorial,we comment on the article by Zhao et al which highlighted how patients having nonalcoholic fatty liver disease(NAFLD)were more susceptible to drug-induced lung injury(DILI).This article looked at the...In this editorial,we comment on the article by Zhao et al which highlighted how patients having nonalcoholic fatty liver disease(NAFLD)were more susceptible to drug-induced lung injury(DILI).This article looked at the downstream effects of metabolic profiles and biochemical processes after medication and substance use.Although previous studies looked at how NAFLD and DILI were related,there is a lack of information on the consequences of everyday medication and substance use.NAFLD is one of the most common chronic liver diseases wor-ldwide and it has been found to be closely related to metabolic syndrome and cardiovascular disease.The aim of this editorial is to analyze the interaction between NAFLD and DILI,what clinical manifestations can occur and what the prognosis of these patients will be.展开更多
As the Internet of Medical Things (IoMT) continues to expand, smart health-monitoring devices generate vast amounts of valuable data while simultaneously raising critical security and privacy challenges. Blockchain te...As the Internet of Medical Things (IoMT) continues to expand, smart health-monitoring devices generate vast amounts of valuable data while simultaneously raising critical security and privacy challenges. Blockchain technology presents a promising avenue to address these concerns due to its inherent decentralization and security features. However, scalability remains a persistent hurdle, particularly for IoMT applications that involve large-scale networks and resource-constrained devices. This paper introduces a novel lightweight sharding method tailored to the unique demands of IoMT data sharing. Our approach enhances state bootstrapping efficiency and reduces operational overhead by utilizing a dual-chain structure comprising a main chain and a snapshot chain. The snapshot chain periodically records key blockchain states, allowing nodes to synchronize more efficiently. This mechanism is critical in reducing the time and resources needed for new nodes to join the network or existing nodes to recover from outages. Additionally, a block state pruning technique is implemented, significantly minimizing storage requirements and lowering transaction execution overhead during initialization and reconfiguration processes. This is crucial given the substantial data volumes inherent in IoMT ecosystems. By adopting an optimistic sharding strategy, our model allows nodes to swiftly join the snapshot shard, while full shards retain the complete ledger history to ensure comprehensive transaction verification. Extensive evaluations across diverse shard configurations demonstrate that this method significantly outperforms existing baseline models. It provides a comprehensive solution for IoMT blockchain applications, striking an optimal balance between security, scalability, and operational efficiency.展开更多
With the unprecedented prevalence of Industrial Internet of Things(IIoT)and 5G technology,various applications supported by industrial communication systems have generated exponentially increased processing tasks,whic...With the unprecedented prevalence of Industrial Internet of Things(IIoT)and 5G technology,various applications supported by industrial communication systems have generated exponentially increased processing tasks,which makes task assignment inefficient due to insufficient workers.In this paper,an Intelligent and Trustworthy task assignment method based on Trust and Social relations(ITTS)is proposed for scenarios with many tasks and few workers.Specifically,ITTS first makes initial assignments based on trust and social influences,thereby transforming the complex large-scale industrial task assignment of the platform into the small-scale task assignment for each worker.Then,an intelligent Q-decision mechanism based on workers'social relation is proposed,which adopts the first-exploration-then-utilization principle to allocate tasks.Only when a worker cannot cope with the assigned tasks,it initiates dynamic worker recruitment,thus effectively solving the worker shortage problem as well as the cold start issue.More importantly,we consider trust and security issues,and evaluate the trust and social circles of workers by accumulating task feedback,to provide the platform a reference for worker recruitment,thereby creating a high-quality worker pool.Finally,extensive simulations demonstrate ITTS outperforms two benchmark methods by increasing task completion rates by 56.49%-61.53%and profit by 42.34%-47.19%.展开更多
The ultra-high speed,ultra-low latency,and massive connectivity of the 6 th Generation Mobile Network(6G)present unprecedented challenges to network security.In addition,the deep integration of Artificial Intelligence...The ultra-high speed,ultra-low latency,and massive connectivity of the 6 th Generation Mobile Network(6G)present unprecedented challenges to network security.In addition,the deep integration of Artificial Intelligence(AI)into 6G networks introduces AI-native features that further complicate the design and implementation of secure network architectures.To meet the security demands posed by the massive number of devices and edge nodes in 6G networks,a decentralized security architecture is essential,as it effectively mitigates the performance bottlenecks typically associated with centralized systems.Blockchain technology offers a promising trust mechanism among devices in 6G networks.However,conventional blockchain systems suffer from limited scalability under high-load conditions,making them inadequate for supporting a large volume of nodes and frequent data exchanges.To overcome these limitations,We propose Shard-DAG,a scalable architecture that structurally integrates Directed Acyclic Graphs(DAG)and sharding.Each shard adopts a Block-DAG structure for parallel block processing,effectively overcoming the performance bottlenecks of traditional chain-based blockchains.Furthermore,we introduce a DAG-based transaction ordering mechanism within each shard to defend against double-spending attacks.To ensure inter-shard security,Block-DAG adopts a black-box interaction approach to prevent cross-shard double-spending.Theoretical analysis and experimental evaluations demonstrate that Shard-DAG achieves near-linear scalability.In a network of 1,200 nodes with 8 shards,Shard-DAG achieves peak throughput improvements of 14.64 times over traditional blockchains,8.61 times over standalone BlockDAG,and 2.05 times over conventional sharded blockchains.The results validate Shard-DAG's ability to scale efficiently while maintaining robust security properties.展开更多
Infrequently, psychiatric symptoms may be the only manifestation of brain tumors. They may present with mood symptoms, psychosis, memory problems, personality changes, anxiety, or anorexia. Symptoms may be misleading,...Infrequently, psychiatric symptoms may be the only manifestation of brain tumors. They may present with mood symptoms, psychosis, memory problems, personality changes, anxiety, or anorexia. Symptoms may be misleading, complicating the clinical picture. A comprehensive review of the literature was conducted regarding reports of brain tumors and psychiatric symptoms from 1956-2014. Search engines used include Pub Med, Ovid, Psych Info, MEDLINE, and Med Scape. Search terms included psychiatric manifestations/symptoms, brain tumors/neoplasms. Our literature search yielded case reports, case studies, and case series. There are no double blind studies except for post-diagnosis/-surgery studies. Early diagnosis is critical for improved quality of life. Symptoms that suggest work-up with neuroimaging include: new-onset psychosis, mood/memory symptoms, occurrence of new or atypical symptoms, personality changes, and anorexia without body dysmorphic symptoms. This article reviews the existing literature regarding the diagnosis and management of this clinically complex condition.展开更多
Heart failure continues to be one of the leading causes of morbidity and mortality worldwide.Myocardial infarction is the primary causative agent of chronic heart failure resulting in cardiomyocyte necrosis and the su...Heart failure continues to be one of the leading causes of morbidity and mortality worldwide.Myocardial infarction is the primary causative agent of chronic heart failure resulting in cardiomyocyte necrosis and the subsequent formation of fibrotic scar tissue.Current pharmacological and non-pharmacological therapies focus on managing symptoms of heart failure yet remain unable to reverse the underlying pathology.Heart transplantation usually cannot be relied on,as there is a major discrepancy between the availability of donors and recipients.As a result,heart failure carries a poor prognosis and high mortality rate.As the heart lacks significant endogenous regeneration potential,novel therapeutic approaches have incorporated the use of stem cells as a vehicle to treat heart failure as they possess the ability to self-renew and differentiate into multiple cell lineages and tissues.This review will discuss past,present,and future clinical trials,factors that influence stem cell therapy outcomes as well as ethical and safety considerations.Preclinical and clinical studies have shown a wide spectrum of outcomes when applying stem cells to improve cardiac function.This may reflect the infancy of clinical trials and the limited knowledge on the optimal cell type,dosing,route of administration,patient parameters and other important variables that contribute to successful stem cell therapy.Nonetheless,the field of stem cell therapeutics continues to advance at an unprecedented pace.We remain cautiously optimistic that stem cells will play a role in heart failure management in years to come.展开更多
Objective To evaluate the influence of an extract of Genista tinctoria L. herba （GT） or methylparaben （MP） on histopathological changes and 2 biomarkers of oxidative stress in rats subchronicly exposed to bispheno...Objective To evaluate the influence of an extract of Genista tinctoria L. herba （GT） or methylparaben （MP） on histopathological changes and 2 biomarkers of oxidative stress in rats subchronicly exposed to bisphenol A （BPA）. Methods Adult female Wistar rats were orally exposed for 90 d to BPA （50 mg/kg）, BPA＋GT （35 mg isoflavones/kg） or BPA＋MP （250 mg/kg）. Plasma and tissue samples were taken from liver, kidney, thyroid, uterus, ovary, and mammary gland after 30, 60, and 90 d of exposure respectively. Lipid peroxidation and in vivo hydroxyl radical production were evaluated by histological analysis along with malondialdehyde and 2,3-dihydroxybenzoic acid detection. Results The severity of histopathological changes in liver and kidneys was lower after GT treatment than after BPA or BPA＋MP treatment. A minimal thyroid receptor antagonist effect was only observed after BPA＋MP treatment. The abnormal folliculogenesis increased in a time-dependent manner, and the number of corpus luteum decreased. No significant histological alterations were found in the uterus. The mammary gland displayed specific estrogen stimulation changes at all periods. Both MP and GT revealed antioxidant properties reducing lipid peroxidation and BPA-induced hydroxyl radical generation. Conclusion GT L. extract ameliorates the toxic effects of BPA and is proved to have antioxidant potential and antitoxic effect. MP has antioxidant properties, but has either no effect or exacerbates the BPA-induced histopathological changes.展开更多
Successful treatment of keloids has eluded the medical community since their first description. Multitudes of therapeutic options are available, but none achieves satisfactory resolution of keloids. One major stumblin...Successful treatment of keloids has eluded the medical community since their first description. Multitudes of therapeutic options are available, but none achieves satisfactory resolution of keloids. One major stumbling block is lack of understanding about their genesis. Assuming keloids are tumors, attempts have been made to treat this condition with standard radiotherapy, with dismal results. Keloidal masses are not an active biological entity. They are aggregations of cellular, hypovascular, hypoxic bundles of collagen, which are produced by atypical fibroblasts in the wounds and eventually cease production due to a hostile biological environment. Having no demonstrable inherent process of disposal of these collagen bundles, this excessive collagen tends to linger to form the bulk of keloids. The lesions eventually become symptomatic and aesthetically unacceptable, and therapeutic intervention is sought. Of all available treatments, such as post-resection radiotherapy, primary radiotherapy in selected cases and primary brachytherapy stand out above any other form of treatment. Be it brachytherapy or external beam treatment, one fundamental aspect of radiation action is the process of “radiolysis”, explaining why “radiobiological” approaches have been ineffective.展开更多
Objective: To design and test a treatment regimen which is clinically responsive, readily available, cost effective, and applicable especially to children and women of child bearing age. Design Setting: A prospective ...Objective: To design and test a treatment regimen which is clinically responsive, readily available, cost effective, and applicable especially to children and women of child bearing age. Design Setting: A prospective cohort study. Setting: Two major postgraduate teaching hospitals: one in Tripoli, Libya and the other in Jeddah, Saudi Arabia. Participants: Fifty-seven patients with 79 keloids, referred from Plastic Surgery Units between April 1996 and January 2005. Main Outcome Measure: Degree of flattening of the keloidal lesion and symptomatic recovery. Results: Result of treatment has been analyzed using unified set criteria. Seventy-seven percent of this cohort had complete response. 19% of cases had partial response, 50% acknowledged the treatment outcome had been “satisfactory” and 44% had an “acceptable” outcome. There was no significant acute or delayed reaction. Conclusion: The technique appears universally adaptable, cost effective, and can safely be prescribed for children and women of child-bearing age. In spite of prolonged treatment course, compliance was excellent.展开更多
Presternal butterfly keloid management remains a clinical challenge. This case indicates, with hypo fractionated external beam electron therapy a significant symptomatic and cosmetic benefit may be achieved without an...Presternal butterfly keloid management remains a clinical challenge. This case indicates, with hypo fractionated external beam electron therapy a significant symptomatic and cosmetic benefit may be achieved without any unacceptable acute, chronic or long term toxicity.展开更多
Dear editor,The incidence of emergency department(ED)visits from gastroparesis and cannabinoid hyperemesis syndrome has increased by two folds over the past decade.[1-3]Roldan et al[4]reported that patients with these...Dear editor,The incidence of emergency department(ED)visits from gastroparesis and cannabinoid hyperemesis syndrome has increased by two folds over the past decade.[1-3]Roldan et al[4]reported that patients with these conditions often have prolonged ED stays and are likely to be hospitalized because of the danger of dehydration and challenges inherent in relieving symptoms.Opioid analgesia is a particularly troublesome treatment modality;these conditions are often chronic with frequent recurrences,and repeated opiate therapy can cause opioid dependency and narcotic bowel syndrome.[5]Haloperidol(HP)and droperidol,members of the butyrophenone class,have potent antidopaminergic activity in the chemoreceptor trigger zone.[6,7]Intramuscular administration of HP is being used increasingly in the ED to treat nausea,vomiting secondary to gastroparesis,[6]intractable vomiting,[8]and cyclical vomiting.展开更多
There is considerable pressure on equine veterinarians to achieve good pregnancy rates with very small doses of semen. Phenylephrine administration in the rabbit increased numbers of oviductal, uterine, and cervical s...There is considerable pressure on equine veterinarians to achieve good pregnancy rates with very small doses of semen. Phenylephrine administration in the rabbit increased numbers of oviductal, uterine, and cervical sperm, myometrial contractions, and fertilized ova after low dose insemination. The use of phenylephrine to enhance uterine contractility and fertility has not been investigated in the mare. Thus, the objective of this study was to determine if phenylephrine administration would result in clinically acceptable pregnancy rates in mares bred by low dose insemination. The hypothesis (Ha) was that pregnancy rates would be significantly higher in mares receiving phenylephrine compared to saline controls. Six pony mares and eight horse mares were enrolled in this study. Mares were inseminated within 24 hours of ovulation with 30 million progressively motile spermatozoa from a single fertile stallion. Immediately following insemination, mares were administered either phenylephrine (0.06 mg/kg) or 1mL of saline via IV injection. Pregnancy status was determined 14 days following ovulation via transrectal ultrasonography. Pregnancy rates in phenylephrine treated mares were 44% (4/9) while 22% (2/9) in saline-treated mares (P > 0.05).展开更多
In the era of “test and treat”, when AIDS-defining events have been drastically reduced, chronic liver disease associated with viral hepatitis and antiretroviral therapy (ART) remains an important cause of non-AIDS ...In the era of “test and treat”, when AIDS-defining events have been drastically reduced, chronic liver disease associated with viral hepatitis and antiretroviral therapy (ART) remains an important cause of non-AIDS morbidity and mortality among HIV-infected patients. Compared to the general population, HIV-infected patients are about 10-times at risk of hepatitis B virus infection. Additionally, several antiretroviral regimens are hepatotoxic. Therefore, effective monitoring and management of ART and HBV co-infection are essential to ending the AIDS epidemic and eliminating viral hepatitis by 2030. This was a hospital-based, matched (age and sex) case-control study. HIV patients (case patients) on ART for at least six months and “healthy” controls aged 18 years and older were enrolled. Blood samples were collected for immuno-hematologic indices and transaminases measurements. Data were presented as counts, percentages, median (IQR) and means (SD), and a p-value 1.5) and mild (0.6 - 1.5) liver fibrosis based on the APRI score was 0.5% and 8%, respectively. Significant fibrosis (>3.25) was 0.9%, while 18.4% had inconclusive fibrosis (1.45 - 3.25) based on the FIB-4 score. HIV/HBV co-infected patients had a higher occurrence of liver fibrosis (APRI: 0.5% vs FIB-4: 0.9%). Co-infections with HBV increase the risk of liver-related morbidity in HIV patients. Therefore, screening for serological markers of chronic HBV infection and hepatic transaminase levels in HIV patients remains crucial in the continuum of care.展开更多
Introduction: Blunt trauma to the penis is a rare but potentially serious injury that can occur by various mechanisms (e.g., kicks, accidents, sexual activity, and falls). The most common clinical presentation is sudd...Introduction: Blunt trauma to the penis is a rare but potentially serious injury that can occur by various mechanisms (e.g., kicks, accidents, sexual activity, and falls). The most common clinical presentation is sudden pain, swelling, and discoloration. Depending on the type and severity of injury, management can include conservative treatment or surgery, with the ultimate goal being the prevention of delayed complications. Case presentation: A 30-year-old male presented with penile pain, swelling, and redness as a result of blunt trauma to his penis 1 week after penile enhancement surgery using a subcutaneous soft silicone implant. Once the patient’s blood pressure was stabilized, surgical management consisted of exploration with evacuation of a large hematoma and removal of the subcutaneous penile implant to avoid further perioperative and postoperative bleeding. Discussion: Postoperative bleeding is a risk factor associated with almost all types of surgical procedures, and its prevention is best achieved by identification and elimination of potential causes pre- and postoperatively. Hypertension is another risk factor for excessive postsurgical bleeding, particularly bleeding associated with prosthetic implant surgeries, and should be considered for any potential surgical patient. Conclusion: With penile prosthesis and implant surgery, hypertension is an especially serious risk factor. Early surgical management is warranted in cases involving a major hematoma and swelling. Even cases with minimal bleeding should be evaluated in a timely manner, with surgical treatment indicated, rather than watchful waiting, to prevent further damage to the penis.展开更多
基金supported by the National Natural Science Foundation of China under Grant No.U20A20182.
文摘As an effective strategy to address urban traffic congestion,traffic flow prediction has gained attention from Federated-Learning(FL)researchers due FL’s ability to preserving data privacy.However,existing methods face challenges:some are too simplistic to capture complex traffic patterns effectively,and others are overly complex,leading to excessive communication overhead between cloud and edge devices.Moreover,the problem of single point failure limits their robustness and reliability in real-world applications.To tackle these challenges,this paper proposes a new method,CMBA-FL,a Communication-Mitigated and Blockchain-Assisted Federated Learning model.First,CMBA-FL improves the client model’s ability to capture temporal traffic patterns by employing the Encoder-Decoder framework for each edge device.Second,to reduce the communication overhead during federated learning,we introduce a verification method based on parameter update consistency,avoiding unnecessary parameter updates.Third,to mitigate the risk of a single point of failure,we integrate consensus mechanisms from blockchain technology.To validate the effectiveness of CMBA-FL,we assess its performance on two widely used traffic datasets.Our experimental results show that CMBA-FL reduces prediction error by 11.46%,significantly lowers communication overhead,and improves security.
文摘BACKGROUND Meningiomas represent the most common primary intracranial tumor in adults.The majority of meningiomas are indolent,benign,and sporadic in nature.The incidence of meningiomas is directly proportional to the age,peaking around 65 years.The presenting symptomatology of intracranial meningiomas is mainly dependent on their anatomical location,as with the majority of brain tumors.Surgical resection and radiation therapy remain the treatment modality for meningiomas of all grades.CASE SUMMARY We present a case describing a 78-year-old female who came in following a ground level fall.The primary assessment was notable for a history of similar recurrent falls and subtle left-sided peripheral visual field loss.Further neurological examination was otherwise largely unremarkable.A computed tomography scan of the head revealed a large extra-axial mass located along the posterior aspect of the falx.Follow-up magnetic resonance imaging confirmed a lesion measuring around 6.6 cm×4.2 cm×5.5 cm.A partial surgical resection of the right-sided portion of the lesion was performed.Complete resection was limited by insufficient visualization and challenges with hemostatic control of the left parafalcine region.Further histopathological analysis confirmed a fibrous meningioma with focal necrosis,consistent with World Health Organization Grade 2 classification.She was subsequently scheduled for outpatient follow-up to assess the residual tumor management.CONCLUSION This case highlights the importance of maintaining a high index of suspicion for intracranial pathology in elderly patients with nonspecific presentation.
文摘BACKGROUND An epidural abscess is a rare but serious medical condition where a pocket of pus forms in the epidural space—the area between the outer covering of the spinal cord(the dura mater)and the bones of the spine.It’s usually caused by a bacterial infection,most commonly Staphylococcus aureus.The infection can spread to this area from other parts of the body,through the bloodstream,or it may be intro-duced directly during spinal procedures like epidural injections or surgery.Symptoms often include severe back pain,fever,and neurological deficits like weakness or numbness,which can progress quickly if untreated.It's considered a medical emergency because if the abscess compresses the spinal cord,it can lead to permanent paralysis or even death.Treatment usually involves antibiotics and,in many cases,surgical drainage.CASE SUMMARY Spinal epidural abscess(SEA)represents a rare yet potentially severe infection affecting the epidural space.We present the following case of a 54-year-old Hispanic white male who initially presented to the emergency department with acute deteriorating symptoms of bilateral lower extremity weakness,which subsequently progressed to involve the upper extremities.However,further evaluation uncovered additional notable symptoms,including urinary inconti-nence and decreased appetite.Further investigation broadened the differential diagnosis,including meningitis,spinal cord compression,acute pyelonephritis,osteomyelitis,bacteremia,torticollis,and acutely progressive ascending bilateral lower extremity weakness,raising the concern for possible Guillain-Barre syndrome.Diagnostic imaging,including magnetic resonance imaging of the spine,confirmed the presence of C5-C6 osteomyelitis and a C6-C7 spinal epidural abscess with severe canal narrowing.The patient underwent an emergency evacuation of epidural abscess with a C6 corpectomy and C5-C7 cervical fusion,followed by an 8-week course of intravenous antibiotics.Cultures from the abscess and bone revealed Staphylococcal aureus.The patient was discharged after 54 days with significant improvement in power and function.CONCLUSION This case highlights the importance of maintaining a high index of suspicion for SEA in patients presenting with atypical symptoms,even in the setting of seemingly unrelated conditions.Early recognition and prompt intervention are crucial to prevent permanent neurological deficits and improve outcomes in patients with SEA.
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.
基金supported by the National Natural Sci ence Foundation of China(No.31672543)the Zhejiang Province“Sannongliufang”Science and Technology Coopera tion Project(No.2020SNLF007),China.
文摘Toxoplasma gondii is a single-celled parasite that infects nearly all warm-blooded animals,including humans(Montoya and Liesenfeld,2004).It occurs worldwide and can persist for a lifetime in mammals.Humans get infected by eating undercooked meat of animals containing the tissue cysts of this parasite.In immune-competent individuals,T.
文摘In this editorial,we comment on the article by Zhao et al which highlighted how patients having nonalcoholic fatty liver disease(NAFLD)were more susceptible to drug-induced lung injury(DILI).This article looked at the downstream effects of metabolic profiles and biochemical processes after medication and substance use.Although previous studies looked at how NAFLD and DILI were related,there is a lack of information on the consequences of everyday medication and substance use.NAFLD is one of the most common chronic liver diseases wor-ldwide and it has been found to be closely related to metabolic syndrome and cardiovascular disease.The aim of this editorial is to analyze the interaction between NAFLD and DILI,what clinical manifestations can occur and what the prognosis of these patients will be.
基金supported by the National Natural Science Foundation of China(62272207)the Key Project of Natural Science Foundation of Jiangxi Province(20224ACB202009)+1 种基金the Science and Technology Project of theDepartment of Education of Jiangxi Province(GJJ2200925)the Jiangxi Provincial Health Commission Science and Technology Plan(202311147).
文摘As the Internet of Medical Things (IoMT) continues to expand, smart health-monitoring devices generate vast amounts of valuable data while simultaneously raising critical security and privacy challenges. Blockchain technology presents a promising avenue to address these concerns due to its inherent decentralization and security features. However, scalability remains a persistent hurdle, particularly for IoMT applications that involve large-scale networks and resource-constrained devices. This paper introduces a novel lightweight sharding method tailored to the unique demands of IoMT data sharing. Our approach enhances state bootstrapping efficiency and reduces operational overhead by utilizing a dual-chain structure comprising a main chain and a snapshot chain. The snapshot chain periodically records key blockchain states, allowing nodes to synchronize more efficiently. This mechanism is critical in reducing the time and resources needed for new nodes to join the network or existing nodes to recover from outages. Additionally, a block state pruning technique is implemented, significantly minimizing storage requirements and lowering transaction execution overhead during initialization and reconfiguration processes. This is crucial given the substantial data volumes inherent in IoMT ecosystems. By adopting an optimistic sharding strategy, our model allows nodes to swiftly join the snapshot shard, while full shards retain the complete ledger history to ensure comprehensive transaction verification. Extensive evaluations across diverse shard configurations demonstrate that this method significantly outperforms existing baseline models. It provides a comprehensive solution for IoMT blockchain applications, striking an optimal balance between security, scalability, and operational efficiency.
基金supported by the National Natural Science Foundation of China under Grant No.62072475 and No.62302062in part by the Hunan Provincial Natural Science Foundation of China under Grant Number 2023JJ40081。
文摘With the unprecedented prevalence of Industrial Internet of Things(IIoT)and 5G technology,various applications supported by industrial communication systems have generated exponentially increased processing tasks,which makes task assignment inefficient due to insufficient workers.In this paper,an Intelligent and Trustworthy task assignment method based on Trust and Social relations(ITTS)is proposed for scenarios with many tasks and few workers.Specifically,ITTS first makes initial assignments based on trust and social influences,thereby transforming the complex large-scale industrial task assignment of the platform into the small-scale task assignment for each worker.Then,an intelligent Q-decision mechanism based on workers'social relation is proposed,which adopts the first-exploration-then-utilization principle to allocate tasks.Only when a worker cannot cope with the assigned tasks,it initiates dynamic worker recruitment,thus effectively solving the worker shortage problem as well as the cold start issue.More importantly,we consider trust and security issues,and evaluate the trust and social circles of workers by accumulating task feedback,to provide the platform a reference for worker recruitment,thereby creating a high-quality worker pool.Finally,extensive simulations demonstrate ITTS outperforms two benchmark methods by increasing task completion rates by 56.49%-61.53%and profit by 42.34%-47.19%.
基金supported by National Natural Science Foundation of China:Education Big Data Analysis based on Software Defined Networking Architecture(No.62177019,F0701)。
文摘The ultra-high speed,ultra-low latency,and massive connectivity of the 6 th Generation Mobile Network(6G)present unprecedented challenges to network security.In addition,the deep integration of Artificial Intelligence(AI)into 6G networks introduces AI-native features that further complicate the design and implementation of secure network architectures.To meet the security demands posed by the massive number of devices and edge nodes in 6G networks,a decentralized security architecture is essential,as it effectively mitigates the performance bottlenecks typically associated with centralized systems.Blockchain technology offers a promising trust mechanism among devices in 6G networks.However,conventional blockchain systems suffer from limited scalability under high-load conditions,making them inadequate for supporting a large volume of nodes and frequent data exchanges.To overcome these limitations,We propose Shard-DAG,a scalable architecture that structurally integrates Directed Acyclic Graphs(DAG)and sharding.Each shard adopts a Block-DAG structure for parallel block processing,effectively overcoming the performance bottlenecks of traditional chain-based blockchains.Furthermore,we introduce a DAG-based transaction ordering mechanism within each shard to defend against double-spending attacks.To ensure inter-shard security,Block-DAG adopts a black-box interaction approach to prevent cross-shard double-spending.Theoretical analysis and experimental evaluations demonstrate that Shard-DAG achieves near-linear scalability.In a network of 1,200 nodes with 8 shards,Shard-DAG achieves peak throughput improvements of 14.64 times over traditional blockchains,8.61 times over standalone BlockDAG,and 2.05 times over conventional sharded blockchains.The results validate Shard-DAG's ability to scale efficiently while maintaining robust security properties.
文摘Infrequently, psychiatric symptoms may be the only manifestation of brain tumors. They may present with mood symptoms, psychosis, memory problems, personality changes, anxiety, or anorexia. Symptoms may be misleading, complicating the clinical picture. A comprehensive review of the literature was conducted regarding reports of brain tumors and psychiatric symptoms from 1956-2014. Search engines used include Pub Med, Ovid, Psych Info, MEDLINE, and Med Scape. Search terms included psychiatric manifestations/symptoms, brain tumors/neoplasms. Our literature search yielded case reports, case studies, and case series. There are no double blind studies except for post-diagnosis/-surgery studies. Early diagnosis is critical for improved quality of life. Symptoms that suggest work-up with neuroimaging include: new-onset psychosis, mood/memory symptoms, occurrence of new or atypical symptoms, personality changes, and anorexia without body dysmorphic symptoms. This article reviews the existing literature regarding the diagnosis and management of this clinically complex condition.
文摘Heart failure continues to be one of the leading causes of morbidity and mortality worldwide.Myocardial infarction is the primary causative agent of chronic heart failure resulting in cardiomyocyte necrosis and the subsequent formation of fibrotic scar tissue.Current pharmacological and non-pharmacological therapies focus on managing symptoms of heart failure yet remain unable to reverse the underlying pathology.Heart transplantation usually cannot be relied on,as there is a major discrepancy between the availability of donors and recipients.As a result,heart failure carries a poor prognosis and high mortality rate.As the heart lacks significant endogenous regeneration potential,novel therapeutic approaches have incorporated the use of stem cells as a vehicle to treat heart failure as they possess the ability to self-renew and differentiate into multiple cell lineages and tissues.This review will discuss past,present,and future clinical trials,factors that influence stem cell therapy outcomes as well as ethical and safety considerations.Preclinical and clinical studies have shown a wide spectrum of outcomes when applying stem cells to improve cardiac function.This may reflect the infancy of clinical trials and the limited knowledge on the optimal cell type,dosing,route of administration,patient parameters and other important variables that contribute to successful stem cell therapy.Nonetheless,the field of stem cell therapeutics continues to advance at an unprecedented pace.We remain cautiously optimistic that stem cells will play a role in heart failure management in years to come.
基金supported by CNCSIS-UEFISCSU Romania,project number PNII-IDEI 1337/2008
文摘Objective To evaluate the influence of an extract of Genista tinctoria L. herba （GT） or methylparaben （MP） on histopathological changes and 2 biomarkers of oxidative stress in rats subchronicly exposed to bisphenol A （BPA）. Methods Adult female Wistar rats were orally exposed for 90 d to BPA （50 mg/kg）, BPA＋GT （35 mg isoflavones/kg） or BPA＋MP （250 mg/kg）. Plasma and tissue samples were taken from liver, kidney, thyroid, uterus, ovary, and mammary gland after 30, 60, and 90 d of exposure respectively. Lipid peroxidation and in vivo hydroxyl radical production were evaluated by histological analysis along with malondialdehyde and 2,3-dihydroxybenzoic acid detection. Results The severity of histopathological changes in liver and kidneys was lower after GT treatment than after BPA or BPA＋MP treatment. A minimal thyroid receptor antagonist effect was only observed after BPA＋MP treatment. The abnormal folliculogenesis increased in a time-dependent manner, and the number of corpus luteum decreased. No significant histological alterations were found in the uterus. The mammary gland displayed specific estrogen stimulation changes at all periods. Both MP and GT revealed antioxidant properties reducing lipid peroxidation and BPA-induced hydroxyl radical generation. Conclusion GT L. extract ameliorates the toxic effects of BPA and is proved to have antioxidant potential and antitoxic effect. MP has antioxidant properties, but has either no effect or exacerbates the BPA-induced histopathological changes.
文摘Successful treatment of keloids has eluded the medical community since their first description. Multitudes of therapeutic options are available, but none achieves satisfactory resolution of keloids. One major stumbling block is lack of understanding about their genesis. Assuming keloids are tumors, attempts have been made to treat this condition with standard radiotherapy, with dismal results. Keloidal masses are not an active biological entity. They are aggregations of cellular, hypovascular, hypoxic bundles of collagen, which are produced by atypical fibroblasts in the wounds and eventually cease production due to a hostile biological environment. Having no demonstrable inherent process of disposal of these collagen bundles, this excessive collagen tends to linger to form the bulk of keloids. The lesions eventually become symptomatic and aesthetically unacceptable, and therapeutic intervention is sought. Of all available treatments, such as post-resection radiotherapy, primary radiotherapy in selected cases and primary brachytherapy stand out above any other form of treatment. Be it brachytherapy or external beam treatment, one fundamental aspect of radiation action is the process of “radiolysis”, explaining why “radiobiological” approaches have been ineffective.
文摘Objective: To design and test a treatment regimen which is clinically responsive, readily available, cost effective, and applicable especially to children and women of child bearing age. Design Setting: A prospective cohort study. Setting: Two major postgraduate teaching hospitals: one in Tripoli, Libya and the other in Jeddah, Saudi Arabia. Participants: Fifty-seven patients with 79 keloids, referred from Plastic Surgery Units between April 1996 and January 2005. Main Outcome Measure: Degree of flattening of the keloidal lesion and symptomatic recovery. Results: Result of treatment has been analyzed using unified set criteria. Seventy-seven percent of this cohort had complete response. 19% of cases had partial response, 50% acknowledged the treatment outcome had been “satisfactory” and 44% had an “acceptable” outcome. There was no significant acute or delayed reaction. Conclusion: The technique appears universally adaptable, cost effective, and can safely be prescribed for children and women of child-bearing age. In spite of prolonged treatment course, compliance was excellent.
文摘Presternal butterfly keloid management remains a clinical challenge. This case indicates, with hypo fractionated external beam electron therapy a significant symptomatic and cosmetic benefit may be achieved without any unacceptable acute, chronic or long term toxicity.
文摘Dear editor,The incidence of emergency department(ED)visits from gastroparesis and cannabinoid hyperemesis syndrome has increased by two folds over the past decade.[1-3]Roldan et al[4]reported that patients with these conditions often have prolonged ED stays and are likely to be hospitalized because of the danger of dehydration and challenges inherent in relieving symptoms.Opioid analgesia is a particularly troublesome treatment modality;these conditions are often chronic with frequent recurrences,and repeated opiate therapy can cause opioid dependency and narcotic bowel syndrome.[5]Haloperidol(HP)and droperidol,members of the butyrophenone class,have potent antidopaminergic activity in the chemoreceptor trigger zone.[6,7]Intramuscular administration of HP is being used increasingly in the ED to treat nausea,vomiting secondary to gastroparesis,[6]intractable vomiting,[8]and cyclical vomiting.
文摘There is considerable pressure on equine veterinarians to achieve good pregnancy rates with very small doses of semen. Phenylephrine administration in the rabbit increased numbers of oviductal, uterine, and cervical sperm, myometrial contractions, and fertilized ova after low dose insemination. The use of phenylephrine to enhance uterine contractility and fertility has not been investigated in the mare. Thus, the objective of this study was to determine if phenylephrine administration would result in clinically acceptable pregnancy rates in mares bred by low dose insemination. The hypothesis (Ha) was that pregnancy rates would be significantly higher in mares receiving phenylephrine compared to saline controls. Six pony mares and eight horse mares were enrolled in this study. Mares were inseminated within 24 hours of ovulation with 30 million progressively motile spermatozoa from a single fertile stallion. Immediately following insemination, mares were administered either phenylephrine (0.06 mg/kg) or 1mL of saline via IV injection. Pregnancy status was determined 14 days following ovulation via transrectal ultrasonography. Pregnancy rates in phenylephrine treated mares were 44% (4/9) while 22% (2/9) in saline-treated mares (P > 0.05).
文摘In the era of “test and treat”, when AIDS-defining events have been drastically reduced, chronic liver disease associated with viral hepatitis and antiretroviral therapy (ART) remains an important cause of non-AIDS morbidity and mortality among HIV-infected patients. Compared to the general population, HIV-infected patients are about 10-times at risk of hepatitis B virus infection. Additionally, several antiretroviral regimens are hepatotoxic. Therefore, effective monitoring and management of ART and HBV co-infection are essential to ending the AIDS epidemic and eliminating viral hepatitis by 2030. This was a hospital-based, matched (age and sex) case-control study. HIV patients (case patients) on ART for at least six months and “healthy” controls aged 18 years and older were enrolled. Blood samples were collected for immuno-hematologic indices and transaminases measurements. Data were presented as counts, percentages, median (IQR) and means (SD), and a p-value 1.5) and mild (0.6 - 1.5) liver fibrosis based on the APRI score was 0.5% and 8%, respectively. Significant fibrosis (>3.25) was 0.9%, while 18.4% had inconclusive fibrosis (1.45 - 3.25) based on the FIB-4 score. HIV/HBV co-infected patients had a higher occurrence of liver fibrosis (APRI: 0.5% vs FIB-4: 0.9%). Co-infections with HBV increase the risk of liver-related morbidity in HIV patients. Therefore, screening for serological markers of chronic HBV infection and hepatic transaminase levels in HIV patients remains crucial in the continuum of care.
文摘Introduction: Blunt trauma to the penis is a rare but potentially serious injury that can occur by various mechanisms (e.g., kicks, accidents, sexual activity, and falls). The most common clinical presentation is sudden pain, swelling, and discoloration. Depending on the type and severity of injury, management can include conservative treatment or surgery, with the ultimate goal being the prevention of delayed complications. Case presentation: A 30-year-old male presented with penile pain, swelling, and redness as a result of blunt trauma to his penis 1 week after penile enhancement surgery using a subcutaneous soft silicone implant. Once the patient’s blood pressure was stabilized, surgical management consisted of exploration with evacuation of a large hematoma and removal of the subcutaneous penile implant to avoid further perioperative and postoperative bleeding. Discussion: Postoperative bleeding is a risk factor associated with almost all types of surgical procedures, and its prevention is best achieved by identification and elimination of potential causes pre- and postoperatively. Hypertension is another risk factor for excessive postsurgical bleeding, particularly bleeding associated with prosthetic implant surgeries, and should be considered for any potential surgical patient. Conclusion: With penile prosthesis and implant surgery, hypertension is an especially serious risk factor. Early surgical management is warranted in cases involving a major hematoma and swelling. Even cases with minimal bleeding should be evaluated in a timely manner, with surgical treatment indicated, rather than watchful waiting, to prevent further damage to the penis.
