BACKGROUND Primary renal Ewing’s sarcoma(ES)is extremely rare,and only two cases causing Cushing’s syndrome(CS)have been reported to date.We report that the case of an 18-year-old patient is diagnosed primary renal ...BACKGROUND Primary renal Ewing’s sarcoma(ES)is extremely rare,and only two cases causing Cushing’s syndrome(CS)have been reported to date.We report that the case of an 18-year-old patient is diagnosed primary renal ES with typical CS characterized by purple stripes,weight gain,and hypertension.CASE SUMMARY CS was first diagnosed by laboratory testing.A huge tumor was revealed in the kidney following an imaging examination.Moreover,brain and bone metastases were observed.After comprehensive treatment,primarily based on surgery,primary renal ES was pathologically diagnosed with a typical EWSR1-FLI1 genetic mutation through genetic testing.Furthermore,the glucocorticoid level returned to normal.By the ninth postoperative month of follow-up,the patient was recovering well.Cushing-related symptoms had improved,and a satisfactory curative effect was achieved.CONCLUSION Primary renal ES,a rare adult malignant tumor,can cause CS and a poor prognosis.展开更多
BACKGROUND There is a lack of literature discussing the utilization of the stacking ensemble algorithm for predicting depression in patients with heart failure(HF).AIM To create a stacking model for predicting depress...BACKGROUND There is a lack of literature discussing the utilization of the stacking ensemble algorithm for predicting depression in patients with heart failure(HF).AIM To create a stacking model for predicting depression in patients with HF.METHODS This study analyzed data on 1084 HF patients from the National Health and Nutrition Examination Survey database spanning from 2005 to 2018.Through univariate analysis and the use of an artificial neural network algorithm,predictors significantly linked to depression were identified.These predictors were utilized to create a stacking model employing tree-based learners.The performances of both the individual models and the stacking model were assessed by using the test dataset.Furthermore,the SHapley additive exPlanations(SHAP)model was applied to interpret the stacking model.RESULTS The models included five predictors.Among these models,the stacking model demonstrated the highest performance,achieving an area under the curve of 0.77(95%CI:0.71-0.84),a sensitivity of 0.71,and a specificity of 0.68.The calibration curve supported the reliability of the models,and decision curve analysis confirmed their clinical value.The SHAP plot demonstrated that age had the most significant impact on the stacking model's output.CONCLUSION The stacking model demonstrated strong predictive performance.Clinicians can utilize this model to identify highrisk depression patients with HF,thus enabling early provision of psychological interventions.展开更多
BACKGROUND Compared with patients with other causes of acute pancreatitis,those with hypertriglyceridemia-induced acute pancreatitis(HTG-AP)are more likely to develop persistent organ failure(POF).Therefore,recognizin...BACKGROUND Compared with patients with other causes of acute pancreatitis,those with hypertriglyceridemia-induced acute pancreatitis(HTG-AP)are more likely to develop persistent organ failure(POF).Therefore,recognizing the individuals at risk of developing POF early in the HTG-AP process is a vital for improving outcomes.Bedside index for severity in acute pancreatitis(BISAP),a simple parameter that is obtained 24 h after admission,is an ideal index to predict HTG-AP severity;however,the suboptimal sensitivity limits its clinical application.Hence,current clinical scoring systems and biochemical parameters are not sufficient for predicting HTG-AP severity.AIM To elucidate the early predictive value of red cell distribution width(RDW)for POF in HTG-AP.METHODS In total,102 patients with HTG-AP were retrospectively enrolled.Demographic and clinical data,including RDW,were collected from all patients on admission.RESULTS Based on the Revised Atlanta Classification,37(33%)of 102 patients with HTG-AP were diagnosed with POF.On admission,RDW was significantly higher in patients with HTG-AP and POF than in those without POF(14.4%vs 12.5%,P<0.001).The receiver operating characteristic curve demonstrated a good discrim-inative power of RDW for POF with a cutoff of 13.1%,where the area under the curve(AUC),sensitivity,and specificity were 0.85,82.4%,and 77.9%,respectively.When the RDW was≥13.1%and one point was added to the original BISAP to obtain a new BISAP score,we achieved a higher AUC,sensitivity,and specificity of 0.89,91.2%,and 67.6%,respectively.CONCLUSION RDW is a promising predictor of POF in patients with HTG-AP,and the addition of RDW can promote the sensitivity of BISAP.展开更多
Objective Radiation mucositis,especially pharyngeal mucositis,severely affects the oral intake of patients of head and neck cancer(HNC)during radiotherapy.Whether the nutritional status affects the severity of pharyng...Objective Radiation mucositis,especially pharyngeal mucositis,severely affects the oral intake of patients of head and neck cancer(HNC)during radiotherapy.Whether the nutritional status affects the severity of pharyngeal mucositis is currently unknown.This study investigated the incidence of malnutrition and radiation pharyngeal mucositis in patients with HNC during radiotherapy and analyzed the impact of the nutritional status on radiation pharyngeal mucositis.Methods Consecutive patients with HNC receiving radiotherapy were recruited for this longitudinal observational study.Data were collected at baseline(T_(1)),midtreatment(T_(2)),and at the end of treatment(T3).The Common Terminology Criteria for Adverse Events version 4.0 and the Global Leadership Initiative on Malnutrition criteria were used to assess pharyngeal mucositis and the nutritional status,respectively.Results There were 348 HNC patients who completed all assessments.The pharyngeal mucositis of patients with HNC was aggravated during radiotherapy(χ^(2)=553.521,P<0.001).At T3,56.0%of patients had moderate or severe pharyngeal mucositis.The proportion of patients with malnutrition increased significantly during treatment(21.3%at T_(1)vs 46.8%at T_(2)vs 76.1%at T3,χ^(2)=209.768,P<0.001).Both a multivariable analysis of generalized estimating equations and a logistic regression analysis showed that pharyngeal mucositis was associated with malnutrition.Conclusions Malnutrition was common in patients with HNC during radiotherapy,and it was closely related to pharyngeal mucositis.Joint interventions targeting nutrition and symptom management should be considered for patients with HNC.展开更多
Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethra...Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline “2018 Standard Edition”. However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons’ surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy;the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons’ skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.展开更多
The distribution of SiC particles in Al-SiC composite can greatly influence the mechanical performances of Al-SiC composite. To realize the homogeneous distribution of SiC particles in stir-casting Al-SiC composite, s...The distribution of SiC particles in Al-SiC composite can greatly influence the mechanical performances of Al-SiC composite. To realize the homogeneous distribution of SiC particles in stir-casting Al-SiC composite, semisolid stir casting of Al-4.25 vol.%SiC composite was conducted using a special electromagneticmechanical stirring equipment made by our team, in which there are three uniformly-distributed blades with a horizontal tilt angle of 25 ° to mechanically raise the SiC particles by creating an upward movement of slurry under electromagnetic stirring. The microstructure of the as-cast Al-SiC composites was observed by Scanning Electron Mcroscopy(SEM). The volume fraction of SiC particles was measured by image analysis using the Quantimet 520 Image Processing and Analysis System. The tensile strength of the Al-4.25 vol.%SiC composites was measured by tensile testing. Results show that the Al-4.25 vol.%SiC composites with the homogeneous distrbutin of SiC particles can be obtained by the electromagnetic-mechanical stirring casting with the speed of 300 and 600 r·min-1 at 620 °C. The differences between the volume fraction of Si C particles at the top of ingot and that at the bottom are both ~0.04 vol.% with the stirring speed of 300 and 600 r·min-1, which are so small that the distribution of SiC particles can be seen as the homogeneous. The tensile strength of the Al matrix is enhanced by 51.2% due to the uniformly distributed SiC particles. The porosity of the composite mainly results from the solidification shrinkage of slurry and it is less than 0.04 vol.%.展开更多
It is desirable to develop highly efficient and sustainable catalytic systems for CO_(2) photoreduction using efficient heterogeneous photosensitizers(PSs);however,this remains a great challenge.In this study,we doped...It is desirable to develop highly efficient and sustainable catalytic systems for CO_(2) photoreduction using efficient heterogeneous photosensitizers(PSs);however,this remains a great challenge.In this study,we doped[Ru(bpy)3]^(2+) into UiO-metal-organic frameworks(MOFs)to facilitate the separation and reuse of noble metal PS.By simply adjusting the loading amount,a series of heterogeneous photoactive MOFs,namely,UiO-Ru-1,UiO-Ru-2,and UiO-Ru-3,were constructed to act as heterogeneous PSs to drive the efficient CO_(2) photoreduction under visible-light irradiation.Remarkably,UiO-Ru-2 exhibited the best photosensitizing ability among the prepared MOFs in sensitizing the iron quarterpyridine catalyst(C-l),and the CO yield reached as high as 171 mmol/g with ca.100%selectivity,which is a record value among all the MOF-based photocatalysts.This photoactive MOF can be recycled and reused three times without any obvious activity loss,signifying its good photochemical stability.Experimental investigations confirmed that the strong visible absorption,long-lived excited state,appropriate redox potential,good photocatalytic stability,and excellent collaboration with C-l were attributable to the superior catalytic activity.This work highlights an avenue for constructing heterogeneous PSs with excellent recyclability using MOF as the platform for efficient CO_(2) reduction.展开更多
BACKGROUND Hypophysitis induced by programmed cell death 1 protein(PD-1)immune checkpoint inhibitors is rare and poorly described.We report three patients with non-small cell lung cancer who developed hypophysitis aft...BACKGROUND Hypophysitis induced by programmed cell death 1 protein(PD-1)immune checkpoint inhibitors is rare and poorly described.We report three patients with non-small cell lung cancer who developed hypophysitis after anti-PD-1 immunotherapy.CASE SUMMARY Both case 1 and case 2 presented with common symptoms of fatigue,nausea,and vomiting.However,case 3 showed rare acute severe symptoms such as hoarse voice,bucking,and difficulty in breathing even when sitting.Following two cycles of immunotherapy in case 3,the above severe symptoms and pituitary gland enlargement were found on magnetic resonance imaging at the onset of hypophysitis.These symptoms were relieved after 10 d of steroid treatment.Case 3 was the first patient with these specific symptoms,which provided a new insight into the diagnosis of hypophysitis.In addition,we found that the clinical prognosis of patients with hypophysitis was related to the dose of steroid therapy.Case 3 was treated with high-dose hormone therapy and her pituitary-corticotropic axis dysfunction returned to normal after more than 6 mo of steroid treatment.Cases 1 and 2 were treated with the low-dose hormone,and dysfunction of the pituitary-corticotropic axis was still present after up to 7 mo of steroid treatment.CONCLUSION The clinical symptoms described in this study provide a valuable reference for the diagnosis and treatment of immune-related hypophysitis.展开更多
To suppress the electric field crowding at sidewall and improve the detection sensitivity of the AlGaN separate absorption and multiplication(SAM)avalanche photodiodes(APDs),we propose the new AlGaN APDs structure com...To suppress the electric field crowding at sidewall and improve the detection sensitivity of the AlGaN separate absorption and multiplication(SAM)avalanche photodiodes(APDs),we propose the new AlGaN APDs structure combining a large-area mesa with a field plate(FP).The simulated results show that the proposed AlGaN APDs exhibit a significant increase in avalanche gain,about two orders of magnitude,compared to their counterparts without FP structure,which is attributed to the suppression of electric field crowding at sidewall of multiplication layer and the reduction of the maximum electric field at the p-type GaN sidewall in p-n depletion region.Meanwhile,the APDs can produce an obviously enhanced photocurrent due to the increase in cross sectional area of multiplication region.展开更多
We present SinGRAV, an attempt to learn a generative radiance volume from multi-view observations of a single natural scene, in stark contrast to existing category-level 3D generative models that learn from images of ...We present SinGRAV, an attempt to learn a generative radiance volume from multi-view observations of a single natural scene, in stark contrast to existing category-level 3D generative models that learn from images of many object-centric scenes. Inspired by SinGAN, we also learn the internal distribution of the input scene, which necessitates our key designs w.r.t. the scene representation and network architecture. Unlike popular multi-layer perceptrons (MLP)-based architectures, we particularly employ convolutional generators and discriminators, which inherently possess spatial locality bias, to operate over voxelized volumes for learning the internal distribution over a plethora of overlapping regions. On the other hand, localizing the adversarial generators and discriminators over confined areas with limited receptive fields easily leads to highly implausible geometric structures in the spatial. Our remedy is to use spatial inductive bias and joint discrimination on geometric clues in the form of 2D depth maps. This strategy is effective in improving spatial arrangement while incurring negligible additional computational cost. Experimental results demonstrate the ability of SinGRAV in generating plausible and diverse variations from a single scene, the merits of SinGRAV over state-of-the-art generative neural scene models, and the versatility of SinGRAV by its use in a variety of applications. Code and data will be released to facilitate further research.展开更多
Objective:The transformations that occur in diterpenoid alkaloids during the process of sand frying for Chinese herbal medicine preparation have yet to be clarified.This study investigated the structural changes that ...Objective:The transformations that occur in diterpenoid alkaloids during the process of sand frying for Chinese herbal medicine preparation have yet to be clarified.This study investigated the structural changes that take place in 3-acetylaconitine during a simulation of heat-processing and evaluated the toxicity and biological activity of the pyrolysis products.Methods:The diterpenoid alkaloid 3-acetylaconitine was heated at 180°C for 15 min to simulate the process of sand frying.The pyrolysis products were separated using column chromatography,and their structures were investigated using high-resolution electrospray ionization mass spectroscopy and nuclear magnetic resonance spectroscopy.Further,in vivo cardiotoxicity and acute toxicity of 3-acetylaconitine and its pyrolysis products were compared,and the aconitine-induced arrhythmia model was employed to evaluate the antiarrhythmic effect of the pyrolysis products.Results:Two new diterpenoid alkaloids,pyroacetylaconitine and 16-epi-pyroacetylaconitine,a pair of epimers at C-16,were isolated.After comparing the structures of these compounds,possible transformation pathways were proposed.Compared with the prototype compound,3-acetylaconitine,the cardiotoxicity and acute toxicity of the heat-transformed products were significantly decreased.In the biological activity assay,the two pyrolysis products exhibited an effective increase in ventricular premature beat latency,a reduction in the occurrence of ventricular tachycardia,as well as an increase in the rate of arrhythmia inhibition,implying strong antiarrhythmic activity.Conclusion:Compared with 3-acetylaconitine,its pyrolysis products displayed lower toxicity and good antiarrhythmic effects;thus,they have potential for being developed into antiarrhythmic medicines.展开更多
Ammonia is the feedstock chemical for most fertilizers and the alternative of renewable energy carriers.Environmentally benign electrochemical nitrogen reduction reaction (NRR) under mild conditions has been recognize...Ammonia is the feedstock chemical for most fertilizers and the alternative of renewable energy carriers.Environmentally benign electrochemical nitrogen reduction reaction (NRR) under mild conditions has been recognized as one of the most attractive strategies for N_(2) fixation.Herein,inspired by Mobased nitrogenase,W/Mo-doping electrocatalysts were developed with mixed-metal polyoxometalate H_(3)PW_6Mo_6O_(40) as the precursor for high performance electrocatalytic NRR.Trace amount of Pt was transplanted on the surface of W/Mo@rGO via in situ electroplating treatment to further improve the NRR performance.The resulting Pt-W/Mo@rGO-6 achieves excellent performance for NRR with a high NH_(3)yield of 79.2μg h^(-1)mg_(cat)^(-1) due to the multicomponent synergistic effect in the composite catalyst.The Pt-W/Mo@rGO-6 represents the first example of highly efficient NRR electraocatalyst derived from mixed-metal polyoxometalate,which exhibits outstanding stability confirmed by the constant catalytic performance over 24 h chronoamperometric test.This finding opens a new avenue to construct highly efficient NRR electrocatalyst by employing mixed metal polyoxometalate as the precursor under ambient conditions.展开更多
Rock condition perception based on tunnel boring machine(TBM)data is of great importance for not only ensuring tunnel boring safety but also improving construction efficiency.The prediction of TBM boring responses(i.e...Rock condition perception based on tunnel boring machine(TBM)data is of great importance for not only ensuring tunnel boring safety but also improving construction efficiency.The prediction of TBM boring responses(i.e.,torque and total thrust of the cutterhead)largely determines the reliability of rock condition perception.In this paper,a new architecture of a two-dimensional convolutional neural network(2D-CNN)with a dual-input strategy is proposed to predict the TBM responses.The TBM Lot 3 of the Yinsong project in Jilin province,China,is taken as the case study in this paper.Two types of models that follow different learning strategies are compared:one is defined as the point model,which only learns data of the stable phase,and the other is defined as the line model,which learns data from both the loading and stable boring phases.The line model is further improved by the weighted loss function method.The results indicate that the strategy of learning data from both the loading phase and stable boring phase and increasing the weight of samples from the stable phase is shown to be optimal in predicting TBM boring responses.In terms of learning strategies,the line model can learn the influence of active control parameters on passive response parameters,but the point model cannot.In terms of machine learning algorithms,2D-CNN has the best performance,with R2 values of 0.865 and 0.923 for torque and total thrust,respectively.The proposed line model can overcome the problem that the traditional model failed to learn the influence of control parameters.Such a model can provide a solid base for the timely optimization of the control parameters in TBM boring process.展开更多
Electrochemical CO2 reduction reaction(CO2RR)to formate is economically viable considering the energy input and market value.Through learning nature,a series of chloroplast-like porous bismuth-based core–shell(CPBC)m...Electrochemical CO2 reduction reaction(CO2RR)to formate is economically viable considering the energy input and market value.Through learning nature,a series of chloroplast-like porous bismuth-based core–shell(CPBC)materials have been designed.In these materials,the porous carbon can enrich and transfer CO2 to the core–shell Bi@Bi2O3 in CO2 reduction process,during which Bi2O3 layer can be transformed into activated metastable layer to efficiently convert CO2 into formate and Bi can provide abundant electrons.Based on this,superior performances for most of important parameters in CO2 RR can be achieved and best of them,CPBC-1 presents remarkable Faradaic efficiency(FEformate>94%)over a wide potential range(-0.65 to-1.0 V)with high catalysis durability(>72 h).Noteworthy,its maximum energy efficiency is as high as 76.7%at-0.7 V,the highest one in reported bismuth-based materials.This work opens novel perspectives in designing nature-inspired CO2RR electrocatalysts.展开更多
基金invaluable support and useful discussions with other members of the urology department.
文摘BACKGROUND Primary renal Ewing’s sarcoma(ES)is extremely rare,and only two cases causing Cushing’s syndrome(CS)have been reported to date.We report that the case of an 18-year-old patient is diagnosed primary renal ES with typical CS characterized by purple stripes,weight gain,and hypertension.CASE SUMMARY CS was first diagnosed by laboratory testing.A huge tumor was revealed in the kidney following an imaging examination.Moreover,brain and bone metastases were observed.After comprehensive treatment,primarily based on surgery,primary renal ES was pathologically diagnosed with a typical EWSR1-FLI1 genetic mutation through genetic testing.Furthermore,the glucocorticoid level returned to normal.By the ninth postoperative month of follow-up,the patient was recovering well.Cushing-related symptoms had improved,and a satisfactory curative effect was achieved.CONCLUSION Primary renal ES,a rare adult malignant tumor,can cause CS and a poor prognosis.
文摘BACKGROUND There is a lack of literature discussing the utilization of the stacking ensemble algorithm for predicting depression in patients with heart failure(HF).AIM To create a stacking model for predicting depression in patients with HF.METHODS This study analyzed data on 1084 HF patients from the National Health and Nutrition Examination Survey database spanning from 2005 to 2018.Through univariate analysis and the use of an artificial neural network algorithm,predictors significantly linked to depression were identified.These predictors were utilized to create a stacking model employing tree-based learners.The performances of both the individual models and the stacking model were assessed by using the test dataset.Furthermore,the SHapley additive exPlanations(SHAP)model was applied to interpret the stacking model.RESULTS The models included five predictors.Among these models,the stacking model demonstrated the highest performance,achieving an area under the curve of 0.77(95%CI:0.71-0.84),a sensitivity of 0.71,and a specificity of 0.68.The calibration curve supported the reliability of the models,and decision curve analysis confirmed their clinical value.The SHAP plot demonstrated that age had the most significant impact on the stacking model's output.CONCLUSION The stacking model demonstrated strong predictive performance.Clinicians can utilize this model to identify highrisk depression patients with HF,thus enabling early provision of psychological interventions.
基金the financial supports from the National Natural Science Foundation of China (Nos. 51627802, 51504150, 11875192)the National Key Research and Development Program of China (No. 2020YFB0311200)the Shanghai Science and Technology Committee, China (No.16DZ2260602)
基金the Science and Technology Program of Guiyang Baiyun District Science and Technology Bureau.No.[2017]50Science and Technology Program of Guiyang Municipal Bureau of Science and Technology,No.[2018]1-72Science and Technology Fund Project of Guizhou Provincial Health Commission,No.gzwkj2021-127.
文摘BACKGROUND Compared with patients with other causes of acute pancreatitis,those with hypertriglyceridemia-induced acute pancreatitis(HTG-AP)are more likely to develop persistent organ failure(POF).Therefore,recognizing the individuals at risk of developing POF early in the HTG-AP process is a vital for improving outcomes.Bedside index for severity in acute pancreatitis(BISAP),a simple parameter that is obtained 24 h after admission,is an ideal index to predict HTG-AP severity;however,the suboptimal sensitivity limits its clinical application.Hence,current clinical scoring systems and biochemical parameters are not sufficient for predicting HTG-AP severity.AIM To elucidate the early predictive value of red cell distribution width(RDW)for POF in HTG-AP.METHODS In total,102 patients with HTG-AP were retrospectively enrolled.Demographic and clinical data,including RDW,were collected from all patients on admission.RESULTS Based on the Revised Atlanta Classification,37(33%)of 102 patients with HTG-AP were diagnosed with POF.On admission,RDW was significantly higher in patients with HTG-AP and POF than in those without POF(14.4%vs 12.5%,P<0.001).The receiver operating characteristic curve demonstrated a good discrim-inative power of RDW for POF with a cutoff of 13.1%,where the area under the curve(AUC),sensitivity,and specificity were 0.85,82.4%,and 77.9%,respectively.When the RDW was≥13.1%and one point was added to the original BISAP to obtain a new BISAP score,we achieved a higher AUC,sensitivity,and specificity of 0.89,91.2%,and 67.6%,respectively.CONCLUSION RDW is a promising predictor of POF in patients with HTG-AP,and the addition of RDW can promote the sensitivity of BISAP.
基金This research was supported by the National Key Research and Development Project of China(No.2017YFC1309204)the Medical Nutrition Clinical Research Project of China International Medical Foundation(No.Z-2017-24-2110).
文摘Objective Radiation mucositis,especially pharyngeal mucositis,severely affects the oral intake of patients of head and neck cancer(HNC)during radiotherapy.Whether the nutritional status affects the severity of pharyngeal mucositis is currently unknown.This study investigated the incidence of malnutrition and radiation pharyngeal mucositis in patients with HNC during radiotherapy and analyzed the impact of the nutritional status on radiation pharyngeal mucositis.Methods Consecutive patients with HNC receiving radiotherapy were recruited for this longitudinal observational study.Data were collected at baseline(T_(1)),midtreatment(T_(2)),and at the end of treatment(T3).The Common Terminology Criteria for Adverse Events version 4.0 and the Global Leadership Initiative on Malnutrition criteria were used to assess pharyngeal mucositis and the nutritional status,respectively.Results There were 348 HNC patients who completed all assessments.The pharyngeal mucositis of patients with HNC was aggravated during radiotherapy(χ^(2)=553.521,P<0.001).At T3,56.0%of patients had moderate or severe pharyngeal mucositis.The proportion of patients with malnutrition increased significantly during treatment(21.3%at T_(1)vs 46.8%at T_(2)vs 76.1%at T3,χ^(2)=209.768,P<0.001).Both a multivariable analysis of generalized estimating equations and a logistic regression analysis showed that pharyngeal mucositis was associated with malnutrition.Conclusions Malnutrition was common in patients with HNC during radiotherapy,and it was closely related to pharyngeal mucositis.Joint interventions targeting nutrition and symptom management should be considered for patients with HNC.
基金the National Key Research and Development Plan of China(Technology helps Economy 20202016YFC0106300)+1 种基金the National Natural Science Foundation of China(82174230)Major Program Fund of Technical Innovation Project of Department of Science and Technology of Hubei Province(2016ACAl52).
文摘Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline “2018 Standard Edition”. However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons’ surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy;the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons’ skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.
基金financially supported by the Beijing Natural Science Foundation(No.2162036)
文摘The distribution of SiC particles in Al-SiC composite can greatly influence the mechanical performances of Al-SiC composite. To realize the homogeneous distribution of SiC particles in stir-casting Al-SiC composite, semisolid stir casting of Al-4.25 vol.%SiC composite was conducted using a special electromagneticmechanical stirring equipment made by our team, in which there are three uniformly-distributed blades with a horizontal tilt angle of 25 ° to mechanically raise the SiC particles by creating an upward movement of slurry under electromagnetic stirring. The microstructure of the as-cast Al-SiC composites was observed by Scanning Electron Mcroscopy(SEM). The volume fraction of SiC particles was measured by image analysis using the Quantimet 520 Image Processing and Analysis System. The tensile strength of the Al-4.25 vol.%SiC composites was measured by tensile testing. Results show that the Al-4.25 vol.%SiC composites with the homogeneous distrbutin of SiC particles can be obtained by the electromagnetic-mechanical stirring casting with the speed of 300 and 600 r·min-1 at 620 °C. The differences between the volume fraction of Si C particles at the top of ingot and that at the bottom are both ~0.04 vol.% with the stirring speed of 300 and 600 r·min-1, which are so small that the distribution of SiC particles can be seen as the homogeneous. The tensile strength of the Al matrix is enhanced by 51.2% due to the uniformly distributed SiC particles. The porosity of the composite mainly results from the solidification shrinkage of slurry and it is less than 0.04 vol.%.
文摘It is desirable to develop highly efficient and sustainable catalytic systems for CO_(2) photoreduction using efficient heterogeneous photosensitizers(PSs);however,this remains a great challenge.In this study,we doped[Ru(bpy)3]^(2+) into UiO-metal-organic frameworks(MOFs)to facilitate the separation and reuse of noble metal PS.By simply adjusting the loading amount,a series of heterogeneous photoactive MOFs,namely,UiO-Ru-1,UiO-Ru-2,and UiO-Ru-3,were constructed to act as heterogeneous PSs to drive the efficient CO_(2) photoreduction under visible-light irradiation.Remarkably,UiO-Ru-2 exhibited the best photosensitizing ability among the prepared MOFs in sensitizing the iron quarterpyridine catalyst(C-l),and the CO yield reached as high as 171 mmol/g with ca.100%selectivity,which is a record value among all the MOF-based photocatalysts.This photoactive MOF can be recycled and reused three times without any obvious activity loss,signifying its good photochemical stability.Experimental investigations confirmed that the strong visible absorption,long-lived excited state,appropriate redox potential,good photocatalytic stability,and excellent collaboration with C-l were attributable to the superior catalytic activity.This work highlights an avenue for constructing heterogeneous PSs with excellent recyclability using MOF as the platform for efficient CO_(2) reduction.
文摘BACKGROUND Hypophysitis induced by programmed cell death 1 protein(PD-1)immune checkpoint inhibitors is rare and poorly described.We report three patients with non-small cell lung cancer who developed hypophysitis after anti-PD-1 immunotherapy.CASE SUMMARY Both case 1 and case 2 presented with common symptoms of fatigue,nausea,and vomiting.However,case 3 showed rare acute severe symptoms such as hoarse voice,bucking,and difficulty in breathing even when sitting.Following two cycles of immunotherapy in case 3,the above severe symptoms and pituitary gland enlargement were found on magnetic resonance imaging at the onset of hypophysitis.These symptoms were relieved after 10 d of steroid treatment.Case 3 was the first patient with these specific symptoms,which provided a new insight into the diagnosis of hypophysitis.In addition,we found that the clinical prognosis of patients with hypophysitis was related to the dose of steroid therapy.Case 3 was treated with high-dose hormone therapy and her pituitary-corticotropic axis dysfunction returned to normal after more than 6 mo of steroid treatment.Cases 1 and 2 were treated with the low-dose hormone,and dysfunction of the pituitary-corticotropic axis was still present after up to 7 mo of steroid treatment.CONCLUSION The clinical symptoms described in this study provide a valuable reference for the diagnosis and treatment of immune-related hypophysitis.
基金the Natural Science Research Project of Anhui University,China(Grant No.KJ2019A0644)the National Natural Science Foundation of China(Grant Nos.61634002 and 61804089)+3 种基金the Natural Science Alliance Foundation,China(Grant No.U1830109)the Natural Science Foundation of Anhui Province,China(Grant No.1708085MF149)the Chuzhou University Research Project,China(Grant No.zrjz2019002)the Project of the Higher Educational and Technology Program of Shandong Province,China(Grant No.J16LN04).
文摘To suppress the electric field crowding at sidewall and improve the detection sensitivity of the AlGaN separate absorption and multiplication(SAM)avalanche photodiodes(APDs),we propose the new AlGaN APDs structure combining a large-area mesa with a field plate(FP).The simulated results show that the proposed AlGaN APDs exhibit a significant increase in avalanche gain,about two orders of magnitude,compared to their counterparts without FP structure,which is attributed to the suppression of electric field crowding at sidewall of multiplication layer and the reduction of the maximum electric field at the p-type GaN sidewall in p-n depletion region.Meanwhile,the APDs can produce an obviously enhanced photocurrent due to the increase in cross sectional area of multiplication region.
基金supported by the International(Regional)Cooperation and Exchange Program of National Natural Science Foundation of China under Grant No.62161146002the Shenzhen Collaborative Innovation Program under Grant No.CJGJZD2021048092601003.
文摘We present SinGRAV, an attempt to learn a generative radiance volume from multi-view observations of a single natural scene, in stark contrast to existing category-level 3D generative models that learn from images of many object-centric scenes. Inspired by SinGAN, we also learn the internal distribution of the input scene, which necessitates our key designs w.r.t. the scene representation and network architecture. Unlike popular multi-layer perceptrons (MLP)-based architectures, we particularly employ convolutional generators and discriminators, which inherently possess spatial locality bias, to operate over voxelized volumes for learning the internal distribution over a plethora of overlapping regions. On the other hand, localizing the adversarial generators and discriminators over confined areas with limited receptive fields easily leads to highly implausible geometric structures in the spatial. Our remedy is to use spatial inductive bias and joint discrimination on geometric clues in the form of 2D depth maps. This strategy is effective in improving spatial arrangement while incurring negligible additional computational cost. Experimental results demonstrate the ability of SinGRAV in generating plausible and diverse variations from a single scene, the merits of SinGRAV over state-of-the-art generative neural scene models, and the versatility of SinGRAV by its use in a variety of applications. Code and data will be released to facilitate further research.
基金supported by the National Natural Science Foundation of China(No.81403104)the Sichuan Science and Technology Program(No.2020YJ0131)Xinglin Scholar Research Promotion Project of Chengdu University of Traditional Chinese Medicine,China(No.QNXZ2018042,No.QJRC2022046).
文摘Objective:The transformations that occur in diterpenoid alkaloids during the process of sand frying for Chinese herbal medicine preparation have yet to be clarified.This study investigated the structural changes that take place in 3-acetylaconitine during a simulation of heat-processing and evaluated the toxicity and biological activity of the pyrolysis products.Methods:The diterpenoid alkaloid 3-acetylaconitine was heated at 180°C for 15 min to simulate the process of sand frying.The pyrolysis products were separated using column chromatography,and their structures were investigated using high-resolution electrospray ionization mass spectroscopy and nuclear magnetic resonance spectroscopy.Further,in vivo cardiotoxicity and acute toxicity of 3-acetylaconitine and its pyrolysis products were compared,and the aconitine-induced arrhythmia model was employed to evaluate the antiarrhythmic effect of the pyrolysis products.Results:Two new diterpenoid alkaloids,pyroacetylaconitine and 16-epi-pyroacetylaconitine,a pair of epimers at C-16,were isolated.After comparing the structures of these compounds,possible transformation pathways were proposed.Compared with the prototype compound,3-acetylaconitine,the cardiotoxicity and acute toxicity of the heat-transformed products were significantly decreased.In the biological activity assay,the two pyrolysis products exhibited an effective increase in ventricular premature beat latency,a reduction in the occurrence of ventricular tachycardia,as well as an increase in the rate of arrhythmia inhibition,implying strong antiarrhythmic activity.Conclusion:Compared with 3-acetylaconitine,its pyrolysis products displayed lower toxicity and good antiarrhythmic effects;thus,they have potential for being developed into antiarrhythmic medicines.
基金supported by the National Natural Science Foundation of China(Nos.92161103,U21A20286,22071180)Natural Science Foundation of Tianjin City of China(No.18JCJQJC47700)。
文摘Ammonia is the feedstock chemical for most fertilizers and the alternative of renewable energy carriers.Environmentally benign electrochemical nitrogen reduction reaction (NRR) under mild conditions has been recognized as one of the most attractive strategies for N_(2) fixation.Herein,inspired by Mobased nitrogenase,W/Mo-doping electrocatalysts were developed with mixed-metal polyoxometalate H_(3)PW_6Mo_6O_(40) as the precursor for high performance electrocatalytic NRR.Trace amount of Pt was transplanted on the surface of W/Mo@rGO via in situ electroplating treatment to further improve the NRR performance.The resulting Pt-W/Mo@rGO-6 achieves excellent performance for NRR with a high NH_(3)yield of 79.2μg h^(-1)mg_(cat)^(-1) due to the multicomponent synergistic effect in the composite catalyst.The Pt-W/Mo@rGO-6 represents the first example of highly efficient NRR electraocatalyst derived from mixed-metal polyoxometalate,which exhibits outstanding stability confirmed by the constant catalytic performance over 24 h chronoamperometric test.This finding opens a new avenue to construct highly efficient NRR electrocatalyst by employing mixed metal polyoxometalate as the precursor under ambient conditions.
基金supported by the National Key R&D Program of China(Grant No.2022YFE0200400)the Natural Science Foundation of China(Grant No.52025094)+1 种基金In addition,we sincerely give our thanks to the data support from the National Program on Key Basic Research Project(973 Program,Grant No.2015CB058100)of China,China Railway Engineering Equipment Group Corporationthe Survey and Design Institute of Water Conservancy of Jilin Province,China.
文摘Rock condition perception based on tunnel boring machine(TBM)data is of great importance for not only ensuring tunnel boring safety but also improving construction efficiency.The prediction of TBM boring responses(i.e.,torque and total thrust of the cutterhead)largely determines the reliability of rock condition perception.In this paper,a new architecture of a two-dimensional convolutional neural network(2D-CNN)with a dual-input strategy is proposed to predict the TBM responses.The TBM Lot 3 of the Yinsong project in Jilin province,China,is taken as the case study in this paper.Two types of models that follow different learning strategies are compared:one is defined as the point model,which only learns data of the stable phase,and the other is defined as the line model,which learns data from both the loading and stable boring phases.The line model is further improved by the weighted loss function method.The results indicate that the strategy of learning data from both the loading phase and stable boring phase and increasing the weight of samples from the stable phase is shown to be optimal in predicting TBM boring responses.In terms of learning strategies,the line model can learn the influence of active control parameters on passive response parameters,but the point model cannot.In terms of machine learning algorithms,2D-CNN has the best performance,with R2 values of 0.865 and 0.923 for torque and total thrust,respectively.The proposed line model can overcome the problem that the traditional model failed to learn the influence of control parameters.Such a model can provide a solid base for the timely optimization of the control parameters in TBM boring process.
基金financially supported by the National Natural Science Foundation of China(21622104,21871142 and 21901122)the Natural Science Foundation of Jiangsu Province of China(BK20171032)+3 种基金the Natural Science Research of Jiangsu Higher Education Institutions of China(17KJB150025 and 19KJB150011)Projects funded by China Postdoctoral Science Foundation(2018 M630572 and 2019 M651873)Priority Academic Program Development of Jiangsu Higher Education Institutionsthe Foundation of Jiangsu Collaborative Innovation Center of Biomedical Functional Materials。
文摘Electrochemical CO2 reduction reaction(CO2RR)to formate is economically viable considering the energy input and market value.Through learning nature,a series of chloroplast-like porous bismuth-based core–shell(CPBC)materials have been designed.In these materials,the porous carbon can enrich and transfer CO2 to the core–shell Bi@Bi2O3 in CO2 reduction process,during which Bi2O3 layer can be transformed into activated metastable layer to efficiently convert CO2 into formate and Bi can provide abundant electrons.Based on this,superior performances for most of important parameters in CO2 RR can be achieved and best of them,CPBC-1 presents remarkable Faradaic efficiency(FEformate>94%)over a wide potential range(-0.65 to-1.0 V)with high catalysis durability(>72 h).Noteworthy,its maximum energy efficiency is as high as 76.7%at-0.7 V,the highest one in reported bismuth-based materials.This work opens novel perspectives in designing nature-inspired CO2RR electrocatalysts.
