Immunosuppression is essential to ensure recipient and graft survivals after liver transplantation(LT). However, our understanding and management of the immune system remain suboptimal. Current immunosuppressive thera...Immunosuppression is essential to ensure recipient and graft survivals after liver transplantation(LT). However, our understanding and management of the immune system remain suboptimal. Current immunosuppressive therapy cannot selectively inhibit the graft-specific immune response and entails a significant risk of serious side effects, i.e., among others, de novo cancers, infections, cardiovascular events, renal failure, metabolic syndrome, and late graft fibrosis, with progressive loss of graft function. Pharmacological research, aimed to develop alternative immunosuppressive agents in LT, is behind other solidorgan transplantation subspecialties, and, therefore, the development of new compounds and strategies should get priority in LT. The research trajectories cover mechanisms to induce T-cell exhaustion, to inhibit co-stimulation, to mitigate non-antigen-specific inflammatory response, and, lastly, to minimize the development and action of donor-specific antibodies. Moreover, while cellular modulation techniques are complex, active research is underway to foster the action of T-regulatory cells, to induce tolerogenic dendritic cells, and to promote the function of B-regulatory cells. We herein discuss current lines of research in clinical immunosuppression, particularly focusing on possible applications in the LT setting.展开更多
In the United States(US),the Surveillance,Epidemiology,and End Results(SEER)program is the only comprehensive source of population-based information that includes stage of cancer at the time of diagnosis and patient s...In the United States(US),the Surveillance,Epidemiology,and End Results(SEER)program is the only comprehensive source of population-based information that includes stage of cancer at the time of diagnosis and patient survival data.This program aims to provide a database about cancer incidence and survival for studies of surveillance and the development of analytical and methodological tools in the cancer field.Currently,the SEER program covers approximately half of the total cancer patients in the US.A growing number of clinical studies have applied the SEER database in various aspects.However,the intrinsic features of the SEER database,such as the huge data volume and complexity of data types,have hindered its application.In this review,we provided a systematic overview of the commonly used methodologies and study designs for retrospective epidemiological research in order to illustrate the application of the SEER database.Therefore,the goal of this review is to assist researchers in the selection of appropriate methods and study designs for enhancing the robustness and reliability of clinical studies by mining the SEER database.展开更多
Within the framework of quantum statistical mechanics,we have proposed an exact analytical solution to the problemof Bose-Einstein condensation(BEC)of harmonically trapped two-dimensional(2D)ideal photons.We utilize t...Within the framework of quantum statistical mechanics,we have proposed an exact analytical solution to the problemof Bose-Einstein condensation(BEC)of harmonically trapped two-dimensional(2D)ideal photons.We utilize this analyticalsolution to investigate the statistical properties of ideal photons in a 2D dye-filled spherical cap cavity.The resultsof numerical calculation of the analytical solution agree completely with the foregoing experimental results in the BEC ofharmonically trapped 2D ideal photons.The analytical expressions of the critical temperature and the condensate fractionare derived in the thermodynamic limit.It is found that the 2D critical photon number is larger than the one-dimensional(1D)critical photon number by two orders of magnitude.The spectral radiance of a 2D spherical cap cavity has a sharppeak at the frequency of the cavity cutoff when the photon number exceeds the critical value determined by a temperature.展开更多
In generator design field,waveform total harmonic distortion(THD)and telephone harmonic factor(THF)are parameters commonly used to measure the impact of generator no-load voltage harmonics on the power communication q...In generator design field,waveform total harmonic distortion(THD)and telephone harmonic factor(THF)are parameters commonly used to measure the impact of generator no-load voltage harmonics on the power communication quality.Tubular hydrogenerators are considered the optimal generator for exploiting low-head,high-flow hydro resources,and they have seen increasingly widespread application in China's power systems recent years.However,owing to the compact and constrained internal space of such generators,their internal magnetic-field harmonics are pronounced.Therefore,accurate calculation of their THD and THF is crucial during the analysis and design stages to ensure the quality of power communication.Especially in the electromagnetic field finite element modeling analysis of such generators,the type and order of the finite element meshes may have a significant impact on the THD and THF calculation results,which warrants in-depth research.To address this,this study takes a real 34 MW large tubular hydrogenerator as an example,and establishes its electromagnetic field finite element model under no-load conditions.Two types of meshes,five mesh densities,and two mesh orders are analyzed to reveal the effect of electromagnetic field finite element mesh types and orders on the calculation results of THD and THF for such generators.展开更多
Objective To determine the factors that contribute to the survival of elderly individuals diagnosed with brain glioma and develop a prognostic nomogram.Methods Data from elderly individuals(age≥65 years)histologicall...Objective To determine the factors that contribute to the survival of elderly individuals diagnosed with brain glioma and develop a prognostic nomogram.Methods Data from elderly individuals(age≥65 years)histologically diagnosed with brain glioma were sourced from the Surveillance,Epidemiology,and End Results(SEER)database.The dataset was randomly divided into a training cohort and an internal validation cohort at a 6:4 ratio.Additionally,data obtained from Tangdu Hospital constituted an external validation cohort for the study.The identification of independent prognostic factors was achieved through the least absolute shrinkage and selection operator(LASSO)and multivariate Cox regression analysis,enabling the construction of a nomogram.Model performance was evaluated using C-index,ROC curves,calibration plot and decision curve analysis(DCA).Results A cohort of 20483 elderly glioma patients was selected from the SEER database.Five prognostic factors(age,marital status,histological type,stage,and treatment)were found to significantly impact overall survival(OS)and cancer-specific survival(CSS),with tumor location emerging as a sixth variable independently linked to CSS.Subsequently,nomogram models were developed to predict the probabilities of survival at 6,12,and 24 months.The assessment findings from the validation queue indicate a that the model exhibited strong performance.Conclusion Our nomograms serve as valuable prognostic tools for assessing the survival probability of elderly glioma patients.They can potentially assist in risk stratification and clinical decision-making.展开更多
Accurate diagnosis is the foundation of clinical care but accurate diagnosis is not easily reached in some cases.In rare instances,even a sophisticated multidisciplinary team at an academic medical center cannot relia...Accurate diagnosis is the foundation of clinical care but accurate diagnosis is not easily reached in some cases.In rare instances,even a sophisticated multidisciplinary team at an academic medical center cannot reliably reach an accurate diagnosis after extensive testing and imaging,and has to wait until histological diagnosis or even autopsy results are available.The underlying reason of challenging diagnoses is mostly conflicting data from history,tests,and imaging that point to different diagnoses.In this issue of World Journal of Clinical Cases,Huffaker et al reported such a challenging case of a tricuspid mass in a patient with Li-Fraumeni syndrome.The case by Huffaker et al powerfully illustrates the occasional diagnostic challenges inherent in our current diagnostic approach and the current technology.Clinicians should realize that in rare situations,agnosticism in diagnosis is unavoidable but a treatment has to be initiated so long as the principle of primum non nocere is upheld.展开更多
In this editorial I comment on the article by Ahmed et al published in a recent issue of the World J Orthop 2023;14:784-790.It is well known that patients who have undergone a liver transplant(LT)may need to have a to...In this editorial I comment on the article by Ahmed et al published in a recent issue of the World J Orthop 2023;14:784-790.It is well known that patients who have undergone a liver transplant(LT)may need to have a total hip arthroplasty(THA)or total knee arthroplasty(TKA)implanted.Ahmed et al stated that the mortality rate in these patients was similar to the one of the general population.However,there are three articles previously published that found higher mortality in LT patients who experienced THA/TKA than in the general population(individuals without LT).Therefore,in this Editorial I would like to point out that there is controversy in the literature regarding whether LT patients undergoing THA/TKA have higher mortality than the general population.Therefore,future research should attempt to resolve this controversy.展开更多
BACKGROUND Gastric cancer(GC)is prevalent and aggressive,especially when patients have distant lung metastases,which often places patients into advanced stages.By identifying prognostic variables for lung metastasis i...BACKGROUND Gastric cancer(GC)is prevalent and aggressive,especially when patients have distant lung metastases,which often places patients into advanced stages.By identifying prognostic variables for lung metastasis in GC patients,it may be po-ssible to construct a good prediction model for both overall survival(OS)and the cumulative incidence prediction(CIP)plot of the tumour.AIM To investigate the predictors of GC with lung metastasis(GCLM)to produce nomograms for OS and generate CIP by using cancer-specific survival(CSS)data.METHODS Data from January 2000 to December 2020 involving 1652 patients with GCLM were obtained from the Surveillance,epidemiology,and end results program database.The major observational endpoint was OS;hence,patients were se-parated into training and validation groups.Correlation analysis determined va-rious connections.Univariate and multivariate Cox analyses validated the independent predictive factors.Nomogram distinction and calibration were performed with the time-dependent area under the curve(AUC)and calibration curves.To evaluate the accuracy and clinical usefulness of the nomograms,decision curve analysis(DCA)was performed.The clinical utility of the novel prognostic model was compared to that of the 7th edition of the American Joint Committee on Cancer(AJCC)staging system by utilizing Net Reclassification Improvement(NRI)and Integrated Discrimination Improvement(IDI).Finally,the OS prognostic model and Cox-AJCC risk stratification model modified for the AJCC system were compared.RESULTS For the purpose of creating the OS nomogram,a CIP plot based on CSS was generated.Cox multivariate regression analysis identified eleven significant prognostic factors(P<0.05)related to liver metastasis,bone metastasis,primary site,surgery,regional surgery,treatment sequence,chemotherapy,radiotherapy,positive lymph node count,N staging,and time from diagnosis to treatment.It was clear from the DCA(net benefit>0),time-de-pendent ROC curve(training/validation set AUC>0.7),and calibration curve(reliability slope closer to 45 degrees)results that the OS nomogram demonstrated a high level of predictive efficiency.The OS prediction model(New Model AUC=0.83)also performed much better than the old Cox-AJCC model(AUC difference between the new model and the old model greater than 0)in terms of risk stratification(P<0.0001)and verification using the IDI and NRI.CONCLUSION The OS nomogram for GCLM successfully predicts 1-and 3-year OS.Moreover,this approach can help to ap-propriately classify patients into high-risk and low-risk groups,thereby guiding treatment.展开更多
In view of the problems of inconsistent data semantics,inconsistent data formats,and difficult data quality assurance between the railway engineering design phase and the construction and operation phase,as well as th...In view of the problems of inconsistent data semantics,inconsistent data formats,and difficult data quality assurance between the railway engineering design phase and the construction and operation phase,as well as the difficulty in fully realizing the value of design results,this paper proposes a design and implementation scheme for a railway engineering collaborative design platform.The railway engineering collaborative design platform mainly includes functional modules such as metadata management,design collaboration,design delivery management,model component library,model rendering services,and Building Information Modeling(BIM)application services.Based on this,research is conducted on multi-disciplinary parameterized collaborative design technology for railway engineering,infrastructure data management and delivery technology,and design multi-source data fusion and application technology.The railway engineering collaborative design platform is compared with other railway design software to further validate its advantages and advanced features.The platform has been widely applied in multiple railway construction projects,greatly improving the design and project management efficiency.展开更多
BACKGROUND Metastatic colorectal cancer(mCRC)is a common malignancy whose treatment has been a clinical challenge.Cancer-specific survival(CSS)plays a crucial role in assessing patient prognosis and treatment outcomes...BACKGROUND Metastatic colorectal cancer(mCRC)is a common malignancy whose treatment has been a clinical challenge.Cancer-specific survival(CSS)plays a crucial role in assessing patient prognosis and treatment outcomes.However,there is still li-mited research on the factors affecting CSS in mCRC patients and their corre-lation.AIM To predict CSS,we developed a new nomogram model and risk grading system to classify risk levels in patients with mCRC.METHODS Data were extracted from the United States Surveillance,Epidemiology,and End Results database from 2018 to 2023.All eligible patients were randomly divided into a training cohort and a validation cohort.The Cox proportional hazards model was used to investigate the independent risk factors for CSS.A new nomogram model was developed to predict CSS and was evaluated through internal and external validation.RESULTS A multivariate Cox proportional risk model was used to identify independent risk factors for CSS.Then,new CSS columns were developed based on these factors.The consistency index(C-index)of the histogram was 0.718(95%CI:0.712-0.725),and that of the validation cohort was 0.722(95%CI:0.711-0.732),indicating good discrimination ability and better performance than tumor-node-metastasis staging(C-index:0.712-0.732).For the training set,0.533,95%CI:0.525-0.540;for the verification set,0.524,95%CI:0.513-0.535.The calibration map and clinical decision curve showed good agreement and good potential clinical validity.The risk grading system divided all patients into three groups,and the Kaplan-Meier curve showed good stratification and differentiation of CSS between different groups.The median CSS times in the low-risk,medium-risk,and high-risk groups were 36 months(95%CI:34.987-37.013),18 months(95%CI:17.273-18.727),and 5 months(95%CI:4.503-5.497),respectively.CONCLUSION Our study developed a new nomogram model to predict CSS in patients with synchronous mCRC.In addition,the risk-grading system helps to accurately assess patient prognosis and guide treatment.展开更多
We consider a generalized form of the porous medium equation where the porosity ϕis a function of time t: ϕ=ϕ(x,t): ∂(ϕS)∂t−∇⋅(k(S)∇S)=Q(S).In many works, the porosity ϕis either assumed to be independent of (or to de...We consider a generalized form of the porous medium equation where the porosity ϕis a function of time t: ϕ=ϕ(x,t): ∂(ϕS)∂t−∇⋅(k(S)∇S)=Q(S).In many works, the porosity ϕis either assumed to be independent of (or to depend very little of) the time variable t. In this work, we want to study the case where it does depend on t(and xas well). For this purpose, we make a change of unknown function V=ϕSin order to obtain a saturation-like (advection-diffusion) equation. A priori estimates and regularity results are established for the new equation based in part on what is known from the saturation equation, when ϕis independent of the time t. These results are then extended to the full saturation equation with time-dependent porosity ϕ=ϕ(x,t). In this analysis, we make explicitly the dependence of the various constants in the estimates on the porosity ϕby the introduced transport vector w, through the change of unknown function. Also we do not assume zero-flux boundary, but we carry the analysis for the case Q≡0.展开更多
Purpose: Surgical treatment of chronic anterior shoulder instability is a difficult therapeutic challenge for contact athletes. The aim of our study is to evaluate the clinical and radiological results of 40 cases of ...Purpose: Surgical treatment of chronic anterior shoulder instability is a difficult therapeutic challenge for contact athletes. The aim of our study is to evaluate the clinical and radiological results of 40 cases of chronic anterior shoulder instability treated in our institution by Latarjet technique. Methods: We report our experience with the intervention of Latarjet modified by the analysis of a retrospective study of 40 cases. They were all young athletic men, with an average age of 29 years with a predominance of the dominant shoulder. Results: Eighty percent had bone lesions, the first dislocation being traumatic (plating). One patient had a recurrence of his instability due to a new trauma and 67% resumed sport within an average period of eight months, some of whom still had functional discomfort in sports practice (9 patients). After an average follow-up of 75 months, 93% of patients were satisfied with their intervention. Only two mechanical complications were observed. Conclusion: Chronic anterior shoulder instability is pathology of young and active subjects. The preregulenoid coracoid block according to Latarjet represents the therapeutic method of choice in the treatment of chronic anterior instabilities of the shoulder, especially in young and athletic subjects. The result of this intervention remains good despite the complications that can occur such as pseudarthrosis, osteoarthritis, lysis or mobility of the screw.展开更多
We consider a strongly non-linear degenerate parabolic-hyperbolic problem with p(x)-Laplacian diffusion flux function. We propose an entropy formulation and prove the existence of an entropy solution.
Introduction: The incidence of twin pregnancies has increased significantly in recent decades. These pregnancies require more attention due to their worse outcomes than singleton pregnancies. Objective: To analyze the...Introduction: The incidence of twin pregnancies has increased significantly in recent decades. These pregnancies require more attention due to their worse outcomes than singleton pregnancies. Objective: To analyze the characteristics and perinatal outcomes of twin pregnancies at the Caxias do Sul General Hospital. Methods: This is a descriptive and retrospective study that included all births related to twin pregnancies between March 1998 and June 2018. Maternal and perinatal variables were analyzed. Descriptive analyses were carried out using measures of central tendency and dispersion for continuous variables (mean and standard deviation or median and interquartile range), according to a prior assessment of distribution using the Shapiro-Wilk test, and absolute (n) and relative (n%) frequencies for categorical variables. Results: 172 pairs of twins/21,972 births (0.8%) were identified. There was a high percentage of interpartum interval of less than 12 months, adherence and prenatal visits, body mass index, and need for neonatal intensive care. Stillbirth and neomortality rates were within acceptable parameters. Conclusion: The sample studied showed a percentage similar to that in the literature, a high rate of maternal and perinatal complications, characterizing it as a high-risk fetal pregnancy.展开更多
Introduction: The aim of this study was to report the indications and evaluate the results of vulvectomy in the general surgery department of Ignace Deen Hospital, CHU Conakry. Materials and Methods: This was a retros...Introduction: The aim of this study was to report the indications and evaluate the results of vulvectomy in the general surgery department of Ignace Deen Hospital, CHU Conakry. Materials and Methods: This was a retrospective descriptive study, conducted over a period of five (05) years from January 1, 2018 to December 31, 2022, in the general surgery department of Ignace Deen Hospital, CHU Conakry. We included in our study all patient records in whom vulvectomy was performed. Results: We recorded 15 cases of vulvectomy out of 453 perineal surgeries, i.e. 3.31%, with a mean age of 43.56 years and extremes of 35 and 69 years. Vulvar cancer was the most common diagnosis (46.67%), followed by Buschke-Lowenstein (33.33%) and anal canal cancer extending to the vulva (20%). Six patients had undergone biopsy (40%). Vulvectomy with lymph node dissection was performed in only 9 patients (60%), and all surgical specimens were sent to anatomical pathology (100%). Conclusion: Vulvectomy is a surgical technique most often indicated for the treatment of vulvar cancer.展开更多
Research on the use of EHR is contradictory since it presents contradicting results regarding the time spent documenting. There is research that supports the use of electronic records as a tool to speed documentation;...Research on the use of EHR is contradictory since it presents contradicting results regarding the time spent documenting. There is research that supports the use of electronic records as a tool to speed documentation;and research that found that it is time consuming. The purpose of this quantitative retrospective before-after project was to measure the impact of using the laboratory value flowsheet within the EHR on documentation time. The research question was: “Does the use of a laboratory value flowsheet in the EHR impact documentation time by primary care providers (PCPs)?” The theoretical framework utilized in this project was the Donabedian Model. The population in this research was the two PCPs in a small primary care clinic in the northwest of Puerto Rico. The sample was composed of all the encounters during the months of October 2019 and December 2019. The data was obtained through data mining and analyzed using SPSS 27. The evaluative outcome of this project is that there is a decrease in documentation time after implementation of the use of the laboratory value flowsheet in the EHR. However, patients per day increase therefore having an impact on the number of patients seen per day/week/month. The implications for clinical practice include the use of templates to improve workflow and documentation as well as decreasing documentation time while also increasing the number of patients seen per day. .展开更多
The Atlantic Meridional Overturning Circulation(AMOC)is a crucial component of the Earth’s climate system due to its fundamental role in heat distribution,carbon and oxygen transport,and the weather.Other climate com...The Atlantic Meridional Overturning Circulation(AMOC)is a crucial component of the Earth’s climate system due to its fundamental role in heat distribution,carbon and oxygen transport,and the weather.Other climate components,such as the atmosphere and sea ice,influence the AMOC.Evaluating the physical mechanisms of those interactions is paramount to increasing knowledge about AMOC’s functioning.In this study,the authors used outputs from the Community Earth System Model version 2 and observational data to investigate changes in theAMOC and the associated physical processes.Two DECK experiments were evaluated:piControl and 1pctCO_(2),with an annual increase of 1%of atmospheric CO_(2).The analysis revealed a significant decrease in the AMOC,associated with changes in mixed layer depth and buoyancy in high latitudes of the North Atlantic,resulting in the shutdown of deep convection and potentially affecting the formation of North Atlantic Deep Water and Antarctic Bottom Water.A vital aspect observed in this study is the association between increased runoff and reduced water evaporation,giving rise to a positive feedback process.Consequently,the rates of freshwater spreading have intensified during this period,which could lead to an accelerated disruption of the AMOC beyond the projections of existing models.展开更多
This research aims to understand the fractional order dynamics of the deadly Nipah virus(NiV)disease.We focus on using piecewise derivatives in the context of classical and singular kernels of power operators in the C...This research aims to understand the fractional order dynamics of the deadly Nipah virus(NiV)disease.We focus on using piecewise derivatives in the context of classical and singular kernels of power operators in the Caputo sense to investigate the crossover behavior of the considered dynamical system.We establish some qualitative results about the existence and uniqueness of the solution to the proposed problem.By utilizing the Newtonian polynomials interpolation technique,we recall a powerful algorithm to interpret the numerical findings for the aforesaid model.Here,we remark that the said viral infection is caused by an RNA type virus which can transmit from animals and also from an infected person to person.Fruits bats which are also known as flying foxes are one of the sources of transmission of NiV disease.Here in this work,we investigate its transmission mechanism through some new concepts of fractional calculus for further analysis and prediction.We present the approximate results for different compartments using different fractional orders.By using the piecewise derivative concept,we detect the crossover ormulti-steps behavior in the transmission dynamics of the mentioned disease.Therefore,the considered form of the derivative is used to deal with problems exhibiting crossover behaviors.展开更多
BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB)is a rare distinct subtype of precursor lesions of biliary carcinoma.IPNB is considered to originate from luminal biliary epithelial cells,typically disp...BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB)is a rare distinct subtype of precursor lesions of biliary carcinoma.IPNB is considered to originate from luminal biliary epithelial cells,typically displays mucin-hypersecretion or a papillary growth pattern,and results in cystic dilatation[1].IPNB develops anywhere in the intrahepatic and extrahepatic biliary tracts,and can occur in various pathological stages from low-grade dysplasia to invasive carcinoma.IPNBs have similar phenotypic changes in the occurrence and development of all subtypes,and the prognosis is significantly better than that of traditional(nonpapillary)cholangiocarcinoma.AIM To evaluate the clinicopathological features of IPNB to provide evidence-based guidance for treatment.METHODS Invasive IPNB,invasive intraductal papillary mucinous neoplasm of the pancreas(IPMN),and traditional cholangiocarcinoma data for affected individuals from 1975 to 2016 were obtained from the Surveillance,Epidemiology,and End Results(SEER)database.Annual percentage changes(APCs)in the incidence and incidence-based(IB)mortality were calculated.We identified the independent predictors of overall survival(OS)and cancer-specific survival(CSS)in indivi duals with invasive IPNB.RESULTS The incidence and IB mortality of invasive IPNB showed sustained decreases,with an APC of-4.5%(95%CI:-5.1%to-3.8%)and-3.3%(95%CI:-4.1%to-2.6%)(P<0.001),respectively.Similar decreases in incidence and IB mortality were seen for invasive IPMN but not for traditional cholangiocarcinoma.Both OS and CSS for invasive IPNB were better than for invasive IPMN and traditional cholangiocarcinoma.A total of 1635 individuals with invasive IPNB were included in our prognosis analysis.The most common tumor sites were the pancreaticobiliary ampulla(47.9%)and perihilar tract(36.7%),but the mucin-related subtype of invasive IPNB was the main type,intrahepatically(approximately 90%).In the univariate and multivariate Cox regression analysis,age,tumor site,grade and stage,subtype,surgery,and chemotherapy were associated with OS and CSS(P<0.05).CONCLUSION Incidence and IB mortality of invasive IPNB trended steadily downward.The heterogeneity of IPNB comprises site and the tumor’s mucin-producing status.展开更多
文摘Immunosuppression is essential to ensure recipient and graft survivals after liver transplantation(LT). However, our understanding and management of the immune system remain suboptimal. Current immunosuppressive therapy cannot selectively inhibit the graft-specific immune response and entails a significant risk of serious side effects, i.e., among others, de novo cancers, infections, cardiovascular events, renal failure, metabolic syndrome, and late graft fibrosis, with progressive loss of graft function. Pharmacological research, aimed to develop alternative immunosuppressive agents in LT, is behind other solidorgan transplantation subspecialties, and, therefore, the development of new compounds and strategies should get priority in LT. The research trajectories cover mechanisms to induce T-cell exhaustion, to inhibit co-stimulation, to mitigate non-antigen-specific inflammatory response, and, lastly, to minimize the development and action of donor-specific antibodies. Moreover, while cellular modulation techniques are complex, active research is underway to foster the action of T-regulatory cells, to induce tolerogenic dendritic cells, and to promote the function of B-regulatory cells. We herein discuss current lines of research in clinical immunosuppression, particularly focusing on possible applications in the LT setting.
基金Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization(2021B1212040007)Clinical Frontier Technology Program of the First Affiliated Hospital of Jinan University,China(JNU1AF-CFTP-2022-a01235)Science and Technology Projects in Guangzhou,China(202201020054,2023A03J1032).
文摘In the United States(US),the Surveillance,Epidemiology,and End Results(SEER)program is the only comprehensive source of population-based information that includes stage of cancer at the time of diagnosis and patient survival data.This program aims to provide a database about cancer incidence and survival for studies of surveillance and the development of analytical and methodological tools in the cancer field.Currently,the SEER program covers approximately half of the total cancer patients in the US.A growing number of clinical studies have applied the SEER database in various aspects.However,the intrinsic features of the SEER database,such as the huge data volume and complexity of data types,have hindered its application.In this review,we provided a systematic overview of the commonly used methodologies and study designs for retrospective epidemiological research in order to illustrate the application of the SEER database.Therefore,the goal of this review is to assist researchers in the selection of appropriate methods and study designs for enhancing the robustness and reliability of clinical studies by mining the SEER database.
基金supported by the National Natural Science Foundation of China(Grant Nos.10174024 and 10474025).
文摘Within the framework of quantum statistical mechanics,we have proposed an exact analytical solution to the problemof Bose-Einstein condensation(BEC)of harmonically trapped two-dimensional(2D)ideal photons.We utilize this analyticalsolution to investigate the statistical properties of ideal photons in a 2D dye-filled spherical cap cavity.The resultsof numerical calculation of the analytical solution agree completely with the foregoing experimental results in the BEC ofharmonically trapped 2D ideal photons.The analytical expressions of the critical temperature and the condensate fractionare derived in the thermodynamic limit.It is found that the 2D critical photon number is larger than the one-dimensional(1D)critical photon number by two orders of magnitude.The spectral radiance of a 2D spherical cap cavity has a sharppeak at the frequency of the cavity cutoff when the photon number exceeds the critical value determined by a temperature.
基金sponsored by the National Natural Science Foundation,Youth Foundation of China,Grant/Award Number:51607146Sichuan Natural Sciences Fund,Grant/Award Number:2023NSFSC0295。
文摘In generator design field,waveform total harmonic distortion(THD)and telephone harmonic factor(THF)are parameters commonly used to measure the impact of generator no-load voltage harmonics on the power communication quality.Tubular hydrogenerators are considered the optimal generator for exploiting low-head,high-flow hydro resources,and they have seen increasingly widespread application in China's power systems recent years.However,owing to the compact and constrained internal space of such generators,their internal magnetic-field harmonics are pronounced.Therefore,accurate calculation of their THD and THF is crucial during the analysis and design stages to ensure the quality of power communication.Especially in the electromagnetic field finite element modeling analysis of such generators,the type and order of the finite element meshes may have a significant impact on the THD and THF calculation results,which warrants in-depth research.To address this,this study takes a real 34 MW large tubular hydrogenerator as an example,and establishes its electromagnetic field finite element model under no-load conditions.Two types of meshes,five mesh densities,and two mesh orders are analyzed to reveal the effect of electromagnetic field finite element mesh types and orders on the calculation results of THD and THF for such generators.
基金supported by the Fund for Distinguished Young Scientists of the Department of Science and Technology of Shaanxi Province(No.2023-JC-JQ-68).
文摘Objective To determine the factors that contribute to the survival of elderly individuals diagnosed with brain glioma and develop a prognostic nomogram.Methods Data from elderly individuals(age≥65 years)histologically diagnosed with brain glioma were sourced from the Surveillance,Epidemiology,and End Results(SEER)database.The dataset was randomly divided into a training cohort and an internal validation cohort at a 6:4 ratio.Additionally,data obtained from Tangdu Hospital constituted an external validation cohort for the study.The identification of independent prognostic factors was achieved through the least absolute shrinkage and selection operator(LASSO)and multivariate Cox regression analysis,enabling the construction of a nomogram.Model performance was evaluated using C-index,ROC curves,calibration plot and decision curve analysis(DCA).Results A cohort of 20483 elderly glioma patients was selected from the SEER database.Five prognostic factors(age,marital status,histological type,stage,and treatment)were found to significantly impact overall survival(OS)and cancer-specific survival(CSS),with tumor location emerging as a sixth variable independently linked to CSS.Subsequently,nomogram models were developed to predict the probabilities of survival at 6,12,and 24 months.The assessment findings from the validation queue indicate a that the model exhibited strong performance.Conclusion Our nomograms serve as valuable prognostic tools for assessing the survival probability of elderly glioma patients.They can potentially assist in risk stratification and clinical decision-making.
文摘Accurate diagnosis is the foundation of clinical care but accurate diagnosis is not easily reached in some cases.In rare instances,even a sophisticated multidisciplinary team at an academic medical center cannot reliably reach an accurate diagnosis after extensive testing and imaging,and has to wait until histological diagnosis or even autopsy results are available.The underlying reason of challenging diagnoses is mostly conflicting data from history,tests,and imaging that point to different diagnoses.In this issue of World Journal of Clinical Cases,Huffaker et al reported such a challenging case of a tricuspid mass in a patient with Li-Fraumeni syndrome.The case by Huffaker et al powerfully illustrates the occasional diagnostic challenges inherent in our current diagnostic approach and the current technology.Clinicians should realize that in rare situations,agnosticism in diagnosis is unavoidable but a treatment has to be initiated so long as the principle of primum non nocere is upheld.
文摘In this editorial I comment on the article by Ahmed et al published in a recent issue of the World J Orthop 2023;14:784-790.It is well known that patients who have undergone a liver transplant(LT)may need to have a total hip arthroplasty(THA)or total knee arthroplasty(TKA)implanted.Ahmed et al stated that the mortality rate in these patients was similar to the one of the general population.However,there are three articles previously published that found higher mortality in LT patients who experienced THA/TKA than in the general population(individuals without LT).Therefore,in this Editorial I would like to point out that there is controversy in the literature regarding whether LT patients undergoing THA/TKA have higher mortality than the general population.Therefore,future research should attempt to resolve this controversy.
基金Supported by Peng-Cheng Talent-Medical Young Reserve Talent Training Program,No.XWRCHT20220002Xuzhou City Health and Health Commission Technology Project Contract,No.XWKYHT20230081and Key Research and Development Plan Project of Xuzhou City,No.KC22179.
文摘BACKGROUND Gastric cancer(GC)is prevalent and aggressive,especially when patients have distant lung metastases,which often places patients into advanced stages.By identifying prognostic variables for lung metastasis in GC patients,it may be po-ssible to construct a good prediction model for both overall survival(OS)and the cumulative incidence prediction(CIP)plot of the tumour.AIM To investigate the predictors of GC with lung metastasis(GCLM)to produce nomograms for OS and generate CIP by using cancer-specific survival(CSS)data.METHODS Data from January 2000 to December 2020 involving 1652 patients with GCLM were obtained from the Surveillance,epidemiology,and end results program database.The major observational endpoint was OS;hence,patients were se-parated into training and validation groups.Correlation analysis determined va-rious connections.Univariate and multivariate Cox analyses validated the independent predictive factors.Nomogram distinction and calibration were performed with the time-dependent area under the curve(AUC)and calibration curves.To evaluate the accuracy and clinical usefulness of the nomograms,decision curve analysis(DCA)was performed.The clinical utility of the novel prognostic model was compared to that of the 7th edition of the American Joint Committee on Cancer(AJCC)staging system by utilizing Net Reclassification Improvement(NRI)and Integrated Discrimination Improvement(IDI).Finally,the OS prognostic model and Cox-AJCC risk stratification model modified for the AJCC system were compared.RESULTS For the purpose of creating the OS nomogram,a CIP plot based on CSS was generated.Cox multivariate regression analysis identified eleven significant prognostic factors(P<0.05)related to liver metastasis,bone metastasis,primary site,surgery,regional surgery,treatment sequence,chemotherapy,radiotherapy,positive lymph node count,N staging,and time from diagnosis to treatment.It was clear from the DCA(net benefit>0),time-de-pendent ROC curve(training/validation set AUC>0.7),and calibration curve(reliability slope closer to 45 degrees)results that the OS nomogram demonstrated a high level of predictive efficiency.The OS prediction model(New Model AUC=0.83)also performed much better than the old Cox-AJCC model(AUC difference between the new model and the old model greater than 0)in terms of risk stratification(P<0.0001)and verification using the IDI and NRI.CONCLUSION The OS nomogram for GCLM successfully predicts 1-and 3-year OS.Moreover,this approach can help to ap-propriately classify patients into high-risk and low-risk groups,thereby guiding treatment.
基金supported by the National Key Research and Development Program of China(2021YFB2600405).
文摘In view of the problems of inconsistent data semantics,inconsistent data formats,and difficult data quality assurance between the railway engineering design phase and the construction and operation phase,as well as the difficulty in fully realizing the value of design results,this paper proposes a design and implementation scheme for a railway engineering collaborative design platform.The railway engineering collaborative design platform mainly includes functional modules such as metadata management,design collaboration,design delivery management,model component library,model rendering services,and Building Information Modeling(BIM)application services.Based on this,research is conducted on multi-disciplinary parameterized collaborative design technology for railway engineering,infrastructure data management and delivery technology,and design multi-source data fusion and application technology.The railway engineering collaborative design platform is compared with other railway design software to further validate its advantages and advanced features.The platform has been widely applied in multiple railway construction projects,greatly improving the design and project management efficiency.
文摘BACKGROUND Metastatic colorectal cancer(mCRC)is a common malignancy whose treatment has been a clinical challenge.Cancer-specific survival(CSS)plays a crucial role in assessing patient prognosis and treatment outcomes.However,there is still li-mited research on the factors affecting CSS in mCRC patients and their corre-lation.AIM To predict CSS,we developed a new nomogram model and risk grading system to classify risk levels in patients with mCRC.METHODS Data were extracted from the United States Surveillance,Epidemiology,and End Results database from 2018 to 2023.All eligible patients were randomly divided into a training cohort and a validation cohort.The Cox proportional hazards model was used to investigate the independent risk factors for CSS.A new nomogram model was developed to predict CSS and was evaluated through internal and external validation.RESULTS A multivariate Cox proportional risk model was used to identify independent risk factors for CSS.Then,new CSS columns were developed based on these factors.The consistency index(C-index)of the histogram was 0.718(95%CI:0.712-0.725),and that of the validation cohort was 0.722(95%CI:0.711-0.732),indicating good discrimination ability and better performance than tumor-node-metastasis staging(C-index:0.712-0.732).For the training set,0.533,95%CI:0.525-0.540;for the verification set,0.524,95%CI:0.513-0.535.The calibration map and clinical decision curve showed good agreement and good potential clinical validity.The risk grading system divided all patients into three groups,and the Kaplan-Meier curve showed good stratification and differentiation of CSS between different groups.The median CSS times in the low-risk,medium-risk,and high-risk groups were 36 months(95%CI:34.987-37.013),18 months(95%CI:17.273-18.727),and 5 months(95%CI:4.503-5.497),respectively.CONCLUSION Our study developed a new nomogram model to predict CSS in patients with synchronous mCRC.In addition,the risk-grading system helps to accurately assess patient prognosis and guide treatment.
文摘We consider a generalized form of the porous medium equation where the porosity ϕis a function of time t: ϕ=ϕ(x,t): ∂(ϕS)∂t−∇⋅(k(S)∇S)=Q(S).In many works, the porosity ϕis either assumed to be independent of (or to depend very little of) the time variable t. In this work, we want to study the case where it does depend on t(and xas well). For this purpose, we make a change of unknown function V=ϕSin order to obtain a saturation-like (advection-diffusion) equation. A priori estimates and regularity results are established for the new equation based in part on what is known from the saturation equation, when ϕis independent of the time t. These results are then extended to the full saturation equation with time-dependent porosity ϕ=ϕ(x,t). In this analysis, we make explicitly the dependence of the various constants in the estimates on the porosity ϕby the introduced transport vector w, through the change of unknown function. Also we do not assume zero-flux boundary, but we carry the analysis for the case Q≡0.
文摘Purpose: Surgical treatment of chronic anterior shoulder instability is a difficult therapeutic challenge for contact athletes. The aim of our study is to evaluate the clinical and radiological results of 40 cases of chronic anterior shoulder instability treated in our institution by Latarjet technique. Methods: We report our experience with the intervention of Latarjet modified by the analysis of a retrospective study of 40 cases. They were all young athletic men, with an average age of 29 years with a predominance of the dominant shoulder. Results: Eighty percent had bone lesions, the first dislocation being traumatic (plating). One patient had a recurrence of his instability due to a new trauma and 67% resumed sport within an average period of eight months, some of whom still had functional discomfort in sports practice (9 patients). After an average follow-up of 75 months, 93% of patients were satisfied with their intervention. Only two mechanical complications were observed. Conclusion: Chronic anterior shoulder instability is pathology of young and active subjects. The preregulenoid coracoid block according to Latarjet represents the therapeutic method of choice in the treatment of chronic anterior instabilities of the shoulder, especially in young and athletic subjects. The result of this intervention remains good despite the complications that can occur such as pseudarthrosis, osteoarthritis, lysis or mobility of the screw.
文摘We consider a strongly non-linear degenerate parabolic-hyperbolic problem with p(x)-Laplacian diffusion flux function. We propose an entropy formulation and prove the existence of an entropy solution.
文摘Introduction: The incidence of twin pregnancies has increased significantly in recent decades. These pregnancies require more attention due to their worse outcomes than singleton pregnancies. Objective: To analyze the characteristics and perinatal outcomes of twin pregnancies at the Caxias do Sul General Hospital. Methods: This is a descriptive and retrospective study that included all births related to twin pregnancies between March 1998 and June 2018. Maternal and perinatal variables were analyzed. Descriptive analyses were carried out using measures of central tendency and dispersion for continuous variables (mean and standard deviation or median and interquartile range), according to a prior assessment of distribution using the Shapiro-Wilk test, and absolute (n) and relative (n%) frequencies for categorical variables. Results: 172 pairs of twins/21,972 births (0.8%) were identified. There was a high percentage of interpartum interval of less than 12 months, adherence and prenatal visits, body mass index, and need for neonatal intensive care. Stillbirth and neomortality rates were within acceptable parameters. Conclusion: The sample studied showed a percentage similar to that in the literature, a high rate of maternal and perinatal complications, characterizing it as a high-risk fetal pregnancy.
文摘Introduction: The aim of this study was to report the indications and evaluate the results of vulvectomy in the general surgery department of Ignace Deen Hospital, CHU Conakry. Materials and Methods: This was a retrospective descriptive study, conducted over a period of five (05) years from January 1, 2018 to December 31, 2022, in the general surgery department of Ignace Deen Hospital, CHU Conakry. We included in our study all patient records in whom vulvectomy was performed. Results: We recorded 15 cases of vulvectomy out of 453 perineal surgeries, i.e. 3.31%, with a mean age of 43.56 years and extremes of 35 and 69 years. Vulvar cancer was the most common diagnosis (46.67%), followed by Buschke-Lowenstein (33.33%) and anal canal cancer extending to the vulva (20%). Six patients had undergone biopsy (40%). Vulvectomy with lymph node dissection was performed in only 9 patients (60%), and all surgical specimens were sent to anatomical pathology (100%). Conclusion: Vulvectomy is a surgical technique most often indicated for the treatment of vulvar cancer.
文摘Research on the use of EHR is contradictory since it presents contradicting results regarding the time spent documenting. There is research that supports the use of electronic records as a tool to speed documentation;and research that found that it is time consuming. The purpose of this quantitative retrospective before-after project was to measure the impact of using the laboratory value flowsheet within the EHR on documentation time. The research question was: “Does the use of a laboratory value flowsheet in the EHR impact documentation time by primary care providers (PCPs)?” The theoretical framework utilized in this project was the Donabedian Model. The population in this research was the two PCPs in a small primary care clinic in the northwest of Puerto Rico. The sample was composed of all the encounters during the months of October 2019 and December 2019. The data was obtained through data mining and analyzed using SPSS 27. The evaluative outcome of this project is that there is a decrease in documentation time after implementation of the use of the laboratory value flowsheet in the EHR. However, patients per day increase therefore having an impact on the number of patients seen per day/week/month. The implications for clinical practice include the use of templates to improve workflow and documentation as well as decreasing documentation time while also increasing the number of patients seen per day. .
基金This work was possible through the financing of PEC-20480 Project between Royal Dutch Shell(Shell)and the Laboratório de Métodos Computacionais em Engenharia(LAMCE)and through the doctoral fellowship funding by CNPq for Elisa Passos Case number 141819/2016-2the postdoctoral fellowship funding by FAPERJ E 10/2020-Edital Inteligência Artificial Case Number E-26/203.327/2022-Enrollment No.Scholarship 2015.08297.7 for Lívia Sancho.
文摘The Atlantic Meridional Overturning Circulation(AMOC)is a crucial component of the Earth’s climate system due to its fundamental role in heat distribution,carbon and oxygen transport,and the weather.Other climate components,such as the atmosphere and sea ice,influence the AMOC.Evaluating the physical mechanisms of those interactions is paramount to increasing knowledge about AMOC’s functioning.In this study,the authors used outputs from the Community Earth System Model version 2 and observational data to investigate changes in theAMOC and the associated physical processes.Two DECK experiments were evaluated:piControl and 1pctCO_(2),with an annual increase of 1%of atmospheric CO_(2).The analysis revealed a significant decrease in the AMOC,associated with changes in mixed layer depth and buoyancy in high latitudes of the North Atlantic,resulting in the shutdown of deep convection and potentially affecting the formation of North Atlantic Deep Water and Antarctic Bottom Water.A vital aspect observed in this study is the association between increased runoff and reduced water evaporation,giving rise to a positive feedback process.Consequently,the rates of freshwater spreading have intensified during this period,which could lead to an accelerated disruption of the AMOC beyond the projections of existing models.
文摘This research aims to understand the fractional order dynamics of the deadly Nipah virus(NiV)disease.We focus on using piecewise derivatives in the context of classical and singular kernels of power operators in the Caputo sense to investigate the crossover behavior of the considered dynamical system.We establish some qualitative results about the existence and uniqueness of the solution to the proposed problem.By utilizing the Newtonian polynomials interpolation technique,we recall a powerful algorithm to interpret the numerical findings for the aforesaid model.Here,we remark that the said viral infection is caused by an RNA type virus which can transmit from animals and also from an infected person to person.Fruits bats which are also known as flying foxes are one of the sources of transmission of NiV disease.Here in this work,we investigate its transmission mechanism through some new concepts of fractional calculus for further analysis and prediction.We present the approximate results for different compartments using different fractional orders.By using the piecewise derivative concept,we detect the crossover ormulti-steps behavior in the transmission dynamics of the mentioned disease.Therefore,the considered form of the derivative is used to deal with problems exhibiting crossover behaviors.
基金Supported by the National Natural Science Foundation of China,No. 81860431 and 82060447the Jiangxi Natural Science Foundation,No. 20181BBG70025
文摘BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB)is a rare distinct subtype of precursor lesions of biliary carcinoma.IPNB is considered to originate from luminal biliary epithelial cells,typically displays mucin-hypersecretion or a papillary growth pattern,and results in cystic dilatation[1].IPNB develops anywhere in the intrahepatic and extrahepatic biliary tracts,and can occur in various pathological stages from low-grade dysplasia to invasive carcinoma.IPNBs have similar phenotypic changes in the occurrence and development of all subtypes,and the prognosis is significantly better than that of traditional(nonpapillary)cholangiocarcinoma.AIM To evaluate the clinicopathological features of IPNB to provide evidence-based guidance for treatment.METHODS Invasive IPNB,invasive intraductal papillary mucinous neoplasm of the pancreas(IPMN),and traditional cholangiocarcinoma data for affected individuals from 1975 to 2016 were obtained from the Surveillance,Epidemiology,and End Results(SEER)database.Annual percentage changes(APCs)in the incidence and incidence-based(IB)mortality were calculated.We identified the independent predictors of overall survival(OS)and cancer-specific survival(CSS)in indivi duals with invasive IPNB.RESULTS The incidence and IB mortality of invasive IPNB showed sustained decreases,with an APC of-4.5%(95%CI:-5.1%to-3.8%)and-3.3%(95%CI:-4.1%to-2.6%)(P<0.001),respectively.Similar decreases in incidence and IB mortality were seen for invasive IPMN but not for traditional cholangiocarcinoma.Both OS and CSS for invasive IPNB were better than for invasive IPMN and traditional cholangiocarcinoma.A total of 1635 individuals with invasive IPNB were included in our prognosis analysis.The most common tumor sites were the pancreaticobiliary ampulla(47.9%)and perihilar tract(36.7%),but the mucin-related subtype of invasive IPNB was the main type,intrahepatically(approximately 90%).In the univariate and multivariate Cox regression analysis,age,tumor site,grade and stage,subtype,surgery,and chemotherapy were associated with OS and CSS(P<0.05).CONCLUSION Incidence and IB mortality of invasive IPNB trended steadily downward.The heterogeneity of IPNB comprises site and the tumor’s mucin-producing status.
