BACKGROUND The prognosis of hepatocellular carcinoma(HCC)combined with portal and hepatic vein cancerous thrombosis is poor,for unresectable patients the combination of targeted therapy and immune therapy was the firs...BACKGROUND The prognosis of hepatocellular carcinoma(HCC)combined with portal and hepatic vein cancerous thrombosis is poor,for unresectable patients the combination of targeted therapy and immune therapy was the first-line recommended treatment for advanced HCC,with a median survival time of only about 2.7-6 months.In this case report,we present the case of a patient with portal and hepatic vein cancerous thrombosis who achieved pathologic complete response after conversion therapy.CASE SUMMARY In our center,a patient with giant HCC combined with portal vein tumor thrombus and hepatic vein tumor thrombus was treated with transcatheter arterial chemoembolization(TACE),radiotherapy,targeted therapy and immunotherapy,and was continuously given icaritin soft capsules for oral regulation.After 7 months of conversion therapy,the patient's tumor shrank and the tumor thrombus subsided significantly.The pathology of surgical resection was in complete remission,and there was no progression in the postoperative follow-up for 7 months,which provided a basis for the future strategy of combined conversion therapy.CONCLUSION In this case,atezolizumab,bevacizumab,icaritin soft capsules combined with radiotherapy and TACE had a good effect.For patients with hepatocellular carcinoma combined with hepatic vein/inferior vena cava tumor thrombus,adopting a high-intensity,multimodal proactive strategy under the guidance of multidisciplinary team(MDT)is an important attempt to break through the current treatment dilemma.展开更多
Cloud top pressure(CTP)is one of the critical cloud properties that significantly affects the radiative effect of clouds.Multi-angle polarized sensors can employ polarized bands(490 nm)or O_(2)A-bands(763 and 765 nm)t...Cloud top pressure(CTP)is one of the critical cloud properties that significantly affects the radiative effect of clouds.Multi-angle polarized sensors can employ polarized bands(490 nm)or O_(2)A-bands(763 and 765 nm)to retrieve the CTP.However,the CTP retrieved by the two methods shows inconsistent results in certain cases,and large uncertainties in low and thin cloud retrievals,which may lead to challenges in subsequent applications.This study proposes a synergistic algorithm that considers both O_(2)A-bands and polarized bands using a random forest(RF)model.LiDAR CTP data are used as the true values and the polarized and non-polarized measurements are concatenated to train the RF model to determine CTP.Additionally,through analysis,we proposed that the polarized signal becomes saturated as the cloud optical thickness(COT)increases,necessitating a particular treatment for cases where COT<10 to improve the algorithm's stability.The synergistic method was then applied to the directional polarized camera(DPC)and Polarized and Directionality of the Earth’s Reflectance(POLDER)measurements for evaluation,and the resulting retrieval accuracy of the POLDER-based measurements(RMSEPOLDER=205.176 hPa,RMSEDPC=171.141 hPa,R^(2)POLDER=0.636,R^(2)DPC=0.663,respectively)were higher than that of the MODIS and POLDER Rayleigh pressure measurements.The synergistic algorithm also showed good performance with the application of DPC data.This algorithm is expected to provide data support for atmosphere-related fields as an atmospheric remote sensing algorithm within the Cloud Application for Remote Sensing,Atmospheric Radiation,and Updating Energy(CARE)platform.展开更多
Background:The maintenance dosage of selexipag is categorized as low,medium or high.In order to assess the efficacy and safety of different dosages of selexipag for the risk stratification of pulmonary arterial hypert...Background:The maintenance dosage of selexipag is categorized as low,medium or high.In order to assess the efficacy and safety of different dosages of selexipag for the risk stratification of pulmonary arterial hypertension(PAH),we performed a sys-tematic review and meta-analysis.Methods:Studies assessing PAH risk stratification indices,such as the World Health Organization functional class(WHO-FC),six-minute walk distance(6MWD),N-terminal pro-B-type natriuretic peptide(NT-proBNP)level,right atrial pressure(RAP),cardiac index(CI)and mixed venous oxygen saturation(SvO2),were included.Results:Thirteen studies were included.Selexipag led to improvements in the 6MWD(MD:24.20 m,95%CI:10.74-37.67),NT-proBNP(SMD:-0.41,95%CI:-0.79-0.04),CI(MD:0.47 L/min/m^(2),95%CI:0.17-0.77)and WHO-FC(OR:0.564,95%CI:0.457-0.697).Subgroup analysis demonstrated that all three dosages improved the 6MWD.A moderate dosage led to improvements in the CI(MD:0.30 L/min/m^(2),95%CI:0.15-0.46)and WHO-FC(OR:0.589,95%CI:0.376-0.922).Within 6 months of treatment,only the WHO-FC and CI were significantly improved(OR:0.614,95%CI:0.380-0.993;MD:0.30 L/min/m^(2),95%CI:0.16-0.45,respectively).More than 6 months of treatment significantly improved the 6MWD,WHO-FC and NT-proBNP(MD:40.87 m,95%CI:10.97-70.77;OR:0.557,95%CI:0.440-0.705;SMD:-0.61,95%CI:-1.17-0.05,respectively).Conclusions:Low,medium,and high dosages of selexipag all exhibited good effects.When treatment lasted for more than 6 months,selexipag exerted obvious effects,even in the low-dosage group.This finding is important for guiding individualized treatments.展开更多
System logs,serving as a pivotal data source for performance monitoring and anomaly detection,play an indispensable role in assuring service stability and reliability.Despite this,the majority of existing log-based an...System logs,serving as a pivotal data source for performance monitoring and anomaly detection,play an indispensable role in assuring service stability and reliability.Despite this,the majority of existing log-based anomaly detection methodologies predominantly depend on the sequence or quantity attributes of logs,utilizing solely a single Recurrent Neural Network(RNN)and its variant sequence models for detection.These approaches have not thoroughly exploited the semantic information embedded in logs,exhibit limited adaptability to novel logs,and a single model struggles to fully unearth the potential features within the log sequence.Addressing these challenges,this article proposes a hybrid architecture based on amultiscale convolutional neural network,efficient channel attention and mogrifier gated recurrent unit networks(LogCEM),which amalgamates multiple neural network technologies.Capitalizing on the superior performance of robustly optimized BERT approach(RoBERTa)in the realm of natural language processing,we employ RoBERTa to extract the original word vectors from each word in the log template.In conjunction with the enhanced Smooth Inverse Frequency(SIF)algorithm,we generate more precise log sentence vectors,thereby achieving an in-depth representation of log semantics.Subsequently,these log vector sequences are fed into a hybrid neural network,which fuses 1D Multi-Scale Convolutional Neural Network(MSCNN),Efficient Channel Attention Mechanism(ECA),and Mogrifier Gated Recurrent Unit(GRU).This amalgamation enables themodel to concurrently capture the local and global dependencies of the log sequence and autonomously learn the significance of different log sequences,thereby markedly enhancing the efficacy of log anomaly detection.To validate the effectiveness of the LogCEM model,we conducted evaluations on two authoritative open-source datasets.The experimental results demonstrate that LogCEM not only exhibits excellent accuracy and robustness,but also outperforms the current mainstream log anomaly detection methods.展开更多
Left bundle branch area pacing(LBBAP)has emerged as a new physiological pacing mode.Previous studies have confirmed the feasibility and efficacy of LBBAP for cardiac resynchronization therapy(CRT)in heart failure(HF)p...Left bundle branch area pacing(LBBAP)has emerged as a new physiological pacing mode.Previous studies have confirmed the feasibility and efficacy of LBBAP for cardiac resynchronization therapy(CRT)in heart failure(HF)patients with left bundle branch block(LBBB)and a narrower QRS duration(QRSd)to have a higher percentage of super responders,and lower pacing thresholds than biventricular pacing(BiVP).展开更多
BACKGROUND Epithelioid trophoblastic tumor(ETT)is an extremely rare malignant gestational trophoblastic neoplasm commonly presenting with abnormal vaginal bleeding,abdominal pain,and increased human chorionic gonadotr...BACKGROUND Epithelioid trophoblastic tumor(ETT)is an extremely rare malignant gestational trophoblastic neoplasm commonly presenting with abnormal vaginal bleeding,abdominal pain,and increased human chorionic gonadotropin(hCG).This study reported a case of uterine ETT with the main manifestation being increased hCG.CASE SUMMARY A 39-year-old female was referred to the Ningbo Maternal and Child Hospital of China in December 2022,complaining of increased hCG levels for 1 month.Magnetic resonance imaging revealed gestational trophoblastic tumor,and hysteroscopic electrotomy and curettage of intrauterine hyperplasia were performed.The patient was diagnosed with uterine ETT through postoperative pathological examination and immunohistochemical results.Total laparoscopic hysterectomy and bilateral salpingectomy were performed,and hCG levels returned to normal.The patient was without recurrence during the postoperative 3-month follow-up.CONCLUSION This study reported a case of uterine ETT with the main manifestation being increased hCG,highlighting that ETT should be considered in the presence of abnormal hCG.A total laparoscopic hysterectomy is recommended.展开更多
BACKGROUND Vascular malformations(VMs)arise as a result of errors in the process of angiogenesis and are usually present at birth,but may not become apparent until after birth.However,giant VMs of the head and face ar...BACKGROUND Vascular malformations(VMs)arise as a result of errors in the process of angiogenesis and are usually present at birth,but may not become apparent until after birth.However,giant VMs of the head and face are uncommon,with few reported cases,and the prognosis for their surgical intervention is unclear.CASE SUMMARY A 12-year-old girl was admitted to the hospital with findings of an enlarged right temporal scalp.After admission,computed tomography(CT)angiography of cerebral ateries showed a right occlusal gap and a right temporal artery venous malformation.Furthermore,cerebral angiography showed a right temporal lobe VM with multiple vessels supplying blood.The patient underwent surgery to remove the malformed vessels and the eroded skull.Two hours after the surgery,the patient's right pupil was dilated,and an urgent CT scan of the skull showed a right subdural haematoma under the incision,which was urgently removed by a second operation.After surgery,we gave continuous antibiotic anti-infection treatment,and the patient recovered well and was discharged two weeks later.CONCLUSION Surgical removal of giant haemangiomas is risky and adequate preoperative(including interventional embolisation)and intraoperative preparations should be made.展开更多
文摘BACKGROUND The prognosis of hepatocellular carcinoma(HCC)combined with portal and hepatic vein cancerous thrombosis is poor,for unresectable patients the combination of targeted therapy and immune therapy was the first-line recommended treatment for advanced HCC,with a median survival time of only about 2.7-6 months.In this case report,we present the case of a patient with portal and hepatic vein cancerous thrombosis who achieved pathologic complete response after conversion therapy.CASE SUMMARY In our center,a patient with giant HCC combined with portal vein tumor thrombus and hepatic vein tumor thrombus was treated with transcatheter arterial chemoembolization(TACE),radiotherapy,targeted therapy and immunotherapy,and was continuously given icaritin soft capsules for oral regulation.After 7 months of conversion therapy,the patient's tumor shrank and the tumor thrombus subsided significantly.The pathology of surgical resection was in complete remission,and there was no progression in the postoperative follow-up for 7 months,which provided a basis for the future strategy of combined conversion therapy.CONCLUSION In this case,atezolizumab,bevacizumab,icaritin soft capsules combined with radiotherapy and TACE had a good effect.For patients with hepatocellular carcinoma combined with hepatic vein/inferior vena cava tumor thrombus,adopting a high-intensity,multimodal proactive strategy under the guidance of multidisciplinary team(MDT)is an important attempt to break through the current treatment dilemma.
基金the National Natural Science Foundation of China(Grant Nos.42025504,No.41905023)National Natural Science Youth Science Foundation(Grant No.41701406)Youth Innovation Promotion Association of Chinese Academy of Sciences(Grant No.:2021122).
文摘Cloud top pressure(CTP)is one of the critical cloud properties that significantly affects the radiative effect of clouds.Multi-angle polarized sensors can employ polarized bands(490 nm)or O_(2)A-bands(763 and 765 nm)to retrieve the CTP.However,the CTP retrieved by the two methods shows inconsistent results in certain cases,and large uncertainties in low and thin cloud retrievals,which may lead to challenges in subsequent applications.This study proposes a synergistic algorithm that considers both O_(2)A-bands and polarized bands using a random forest(RF)model.LiDAR CTP data are used as the true values and the polarized and non-polarized measurements are concatenated to train the RF model to determine CTP.Additionally,through analysis,we proposed that the polarized signal becomes saturated as the cloud optical thickness(COT)increases,necessitating a particular treatment for cases where COT<10 to improve the algorithm's stability.The synergistic method was then applied to the directional polarized camera(DPC)and Polarized and Directionality of the Earth’s Reflectance(POLDER)measurements for evaluation,and the resulting retrieval accuracy of the POLDER-based measurements(RMSEPOLDER=205.176 hPa,RMSEDPC=171.141 hPa,R^(2)POLDER=0.636,R^(2)DPC=0.663,respectively)were higher than that of the MODIS and POLDER Rayleigh pressure measurements.The synergistic algorithm also showed good performance with the application of DPC data.This algorithm is expected to provide data support for atmosphere-related fields as an atmospheric remote sensing algorithm within the Cloud Application for Remote Sensing,Atmospheric Radiation,and Updating Energy(CARE)platform.
基金Program of the National Natural Science Foundation of China,Grant/Award Number:81700045,81870042 and 82200065The Department Development Fund of Shanghai Pulmonary Hospital,Grant/Award Number:201906-0314+2 种基金The Program of Shanghai Pulmonary Hospital,Grant/Award Number:FKLY20011The Three-year Action Plan to Promote Clinical Skills and Clinical Innovation in Municipal Hospitals,Grant/Award Number:SHDC2020CR4021Young Talent Program of Shanghai Municipal Health Commission,Grant/Award Number:2022YQ070。
文摘Background:The maintenance dosage of selexipag is categorized as low,medium or high.In order to assess the efficacy and safety of different dosages of selexipag for the risk stratification of pulmonary arterial hypertension(PAH),we performed a sys-tematic review and meta-analysis.Methods:Studies assessing PAH risk stratification indices,such as the World Health Organization functional class(WHO-FC),six-minute walk distance(6MWD),N-terminal pro-B-type natriuretic peptide(NT-proBNP)level,right atrial pressure(RAP),cardiac index(CI)and mixed venous oxygen saturation(SvO2),were included.Results:Thirteen studies were included.Selexipag led to improvements in the 6MWD(MD:24.20 m,95%CI:10.74-37.67),NT-proBNP(SMD:-0.41,95%CI:-0.79-0.04),CI(MD:0.47 L/min/m^(2),95%CI:0.17-0.77)and WHO-FC(OR:0.564,95%CI:0.457-0.697).Subgroup analysis demonstrated that all three dosages improved the 6MWD.A moderate dosage led to improvements in the CI(MD:0.30 L/min/m^(2),95%CI:0.15-0.46)and WHO-FC(OR:0.589,95%CI:0.376-0.922).Within 6 months of treatment,only the WHO-FC and CI were significantly improved(OR:0.614,95%CI:0.380-0.993;MD:0.30 L/min/m^(2),95%CI:0.16-0.45,respectively).More than 6 months of treatment significantly improved the 6MWD,WHO-FC and NT-proBNP(MD:40.87 m,95%CI:10.97-70.77;OR:0.557,95%CI:0.440-0.705;SMD:-0.61,95%CI:-1.17-0.05,respectively).Conclusions:Low,medium,and high dosages of selexipag all exhibited good effects.When treatment lasted for more than 6 months,selexipag exerted obvious effects,even in the low-dosage group.This finding is important for guiding individualized treatments.
基金supported by the Science and Technology Program State Grid Corporation of China,Grant SGSXDK00DJJS2250061.
文摘System logs,serving as a pivotal data source for performance monitoring and anomaly detection,play an indispensable role in assuring service stability and reliability.Despite this,the majority of existing log-based anomaly detection methodologies predominantly depend on the sequence or quantity attributes of logs,utilizing solely a single Recurrent Neural Network(RNN)and its variant sequence models for detection.These approaches have not thoroughly exploited the semantic information embedded in logs,exhibit limited adaptability to novel logs,and a single model struggles to fully unearth the potential features within the log sequence.Addressing these challenges,this article proposes a hybrid architecture based on amultiscale convolutional neural network,efficient channel attention and mogrifier gated recurrent unit networks(LogCEM),which amalgamates multiple neural network technologies.Capitalizing on the superior performance of robustly optimized BERT approach(RoBERTa)in the realm of natural language processing,we employ RoBERTa to extract the original word vectors from each word in the log template.In conjunction with the enhanced Smooth Inverse Frequency(SIF)algorithm,we generate more precise log sentence vectors,thereby achieving an in-depth representation of log semantics.Subsequently,these log vector sequences are fed into a hybrid neural network,which fuses 1D Multi-Scale Convolutional Neural Network(MSCNN),Efficient Channel Attention Mechanism(ECA),and Mogrifier Gated Recurrent Unit(GRU).This amalgamation enables themodel to concurrently capture the local and global dependencies of the log sequence and autonomously learn the significance of different log sequences,thereby markedly enhancing the efficacy of log anomaly detection.To validate the effectiveness of the LogCEM model,we conducted evaluations on two authoritative open-source datasets.The experimental results demonstrate that LogCEM not only exhibits excellent accuracy and robustness,but also outperforms the current mainstream log anomaly detection methods.
文摘Left bundle branch area pacing(LBBAP)has emerged as a new physiological pacing mode.Previous studies have confirmed the feasibility and efficacy of LBBAP for cardiac resynchronization therapy(CRT)in heart failure(HF)patients with left bundle branch block(LBBB)and a narrower QRS duration(QRSd)to have a higher percentage of super responders,and lower pacing thresholds than biventricular pacing(BiVP).
文摘BACKGROUND Epithelioid trophoblastic tumor(ETT)is an extremely rare malignant gestational trophoblastic neoplasm commonly presenting with abnormal vaginal bleeding,abdominal pain,and increased human chorionic gonadotropin(hCG).This study reported a case of uterine ETT with the main manifestation being increased hCG.CASE SUMMARY A 39-year-old female was referred to the Ningbo Maternal and Child Hospital of China in December 2022,complaining of increased hCG levels for 1 month.Magnetic resonance imaging revealed gestational trophoblastic tumor,and hysteroscopic electrotomy and curettage of intrauterine hyperplasia were performed.The patient was diagnosed with uterine ETT through postoperative pathological examination and immunohistochemical results.Total laparoscopic hysterectomy and bilateral salpingectomy were performed,and hCG levels returned to normal.The patient was without recurrence during the postoperative 3-month follow-up.CONCLUSION This study reported a case of uterine ETT with the main manifestation being increased hCG,highlighting that ETT should be considered in the presence of abnormal hCG.A total laparoscopic hysterectomy is recommended.
文摘BACKGROUND Vascular malformations(VMs)arise as a result of errors in the process of angiogenesis and are usually present at birth,but may not become apparent until after birth.However,giant VMs of the head and face are uncommon,with few reported cases,and the prognosis for their surgical intervention is unclear.CASE SUMMARY A 12-year-old girl was admitted to the hospital with findings of an enlarged right temporal scalp.After admission,computed tomography(CT)angiography of cerebral ateries showed a right occlusal gap and a right temporal artery venous malformation.Furthermore,cerebral angiography showed a right temporal lobe VM with multiple vessels supplying blood.The patient underwent surgery to remove the malformed vessels and the eroded skull.Two hours after the surgery,the patient's right pupil was dilated,and an urgent CT scan of the skull showed a right subdural haematoma under the incision,which was urgently removed by a second operation.After surgery,we gave continuous antibiotic anti-infection treatment,and the patient recovered well and was discharged two weeks later.CONCLUSION Surgical removal of giant haemangiomas is risky and adequate preoperative(including interventional embolisation)and intraoperative preparations should be made.
