Objective This study aimed to evaluate and compare the effectiveness of knowledge base-optimized and unoptimized large language models(LLMs)in the field of orthopedics to explore optimization strategies for the applic...Objective This study aimed to evaluate and compare the effectiveness of knowledge base-optimized and unoptimized large language models(LLMs)in the field of orthopedics to explore optimization strategies for the application of LLMs in specific fields.Methods This research constructed a specialized knowledge base using clinical guidelines from the American Academy of Orthopaedic Surgeons(AAOS)and authoritative orthopedic publications.A total of 30 orthopedic-related questions covering aspects such as anatomical knowledge,disease diagnosis,fracture classification,treatment options,and surgical techniques were input into both the knowledge base-optimized and unoptimized versions of the GPT-4,ChatGLM,and Spark LLM,with their generated responses recorded.The overall quality,accuracy,and comprehensiveness of these responses were evaluated by 3 experienced orthopedic surgeons.Results Compared with their unoptimized LLMs,the optimized version of GPT-4 showed improvements of 15.3%in overall quality,12.5%in accuracy,and 12.8%in comprehensiveness;ChatGLM showed improvements of 24.8%,16.1%,and 19.6%,respectively;and Spark LLM showed improvements of 6.5%,14.5%,and 24.7%,respectively.Conclusion The optimization of knowledge bases significantly enhances the quality,accuracy,and comprehensiveness of the responses provided by the 3 models in the orthopedic field.Therefore,knowledge base optimization is an effective method for improving the performance of LLMs in specific fields.展开更多
BACKGROUND The gastrointestinal tract is a well-known extranodal site of lymphoma.B-cell lymph-oma is the most common type,while T-cell lymphoma is uncommon.Primary gastrointestinal lymphoma mainly occurs in the stoma...BACKGROUND The gastrointestinal tract is a well-known extranodal site of lymphoma.B-cell lymph-oma is the most common type,while T-cell lymphoma is uncommon.Primary gastrointestinal lymphoma mainly occurs in the stomach and small intestine,and the colon is less frequently involved,especially in females.CASE SUMMARY A 45-year-old woman was admitted to our hospital for physical examination.Gastroenteroscopy revealed a visible pedunculated polyp in the transverse colon,for which endoscopic submucosal dissection(ESD)was performed.Pathology suggested highly active proliferation of T lymphocytes with atypical hyperplasia.CONCLUSION A middle-aged female patient was found to have colonic T-cell lymphoma by endoscopy.The lesion was successfully removed by ESD,and the surgical margin was negative.It is essential to raise awareness of colonic T-cell lymphoma and choose the appropriate treatment.展开更多
This study was performed to observe the effects of water on photosynthesis and water-related physiology in dominant shrubs in shell sand habitats.Four-year-old Periploca sepium seedlings were used as model species.A g...This study was performed to observe the effects of water on photosynthesis and water-related physiology in dominant shrubs in shell sand habitats.Four-year-old Periploca sepium seedlings were used as model species.A gradient of 12 water levels was established by artificially supplying the shell sand with water up to saturation and then allowing natural evapotranspiration to occur.The photo synthetic,chlorophyll fluorescence and stem sap flow parameters of P.sepium were measured under a range of water conditions.The different soil water conditions were classified according to the responses of these parameters.(1)With the increase in the relative water content(RWC)of the shell sand,the parameters of leaf photosynthesis,chlorophyll fluorescence and water-related physiology in P.sepium showed significant critical responses.The net photo synthetic rate(Pn),transpiration rate(Tr),instantaneous water use efficiency(WUE),potential water use efficiency(WUEi),maximum photochemical efficiency(Fv/Fm),actual photochemical efficiency(ΦPSII)and daily accumulation of stem sap flow all increased first and then decreased with increasing RWC,but the corresponding water conditions associated with their maximum values were not the same.An RWC of 69.40%was determined to be the optimal water condition for photosynthesis and water-related physiological activity in P.sepium.At an RWC of 36.61%,the mechanism of photosynthetic inhibition in P.sepium changed from stomatal limitation to nonstomatal limitation;this was also the minimum water requirement for maintaining normal photo synthetic processes.An RWC of 50.27%resulted in the highest WUE in P.sepium,indicating that moderate drought stress increased WUE.(2)Based on the quantitative relationship between the photo synthetic parameters of P.sepium and the shell sand water gradient,the soil water availability was classified into 6 water grades.The RWC range for maintaining strong photosynthesis and high WUE in P.sepium was 63.22-69.98%.(3)Gas exchange in P.sepium was inhibited under drought and waterlogging stresses.Under these conditions,the photosynthetic electron transport chain was blocked,and the dissipation of light energy as heat increased,which ultimately led to a decline in photo synthetic productivity;moreover,transpiration and dissipation were aggravated,and water transmission and utilization processes in P.sepium were hindered.A significant negative feedback regulation mechanism in the photosynthetic and water-related physiological processes of P.sepium was observed;this mechanism allowed P.sepium growing in shell sand to be highly adaptable to water stress.展开更多
To test the patterns of the root morphology and architecture indexes of Tamarix chinensis in response to water and salt changes in the two media of the groundwater and soil,three-year-old T.chinensis seedlings were ch...To test the patterns of the root morphology and architecture indexes of Tamarix chinensis in response to water and salt changes in the two media of the groundwater and soil,three-year-old T.chinensis seedlings were chosen as the research object.Groundwater with four salinity levels was created,and three groundwater level(GL)were applied for each salinity treatment to measure the root growth and architecture indexes.In the fresh water and brackish water treatments,the topological index(TI)of the T.chinensis roots was close to 0.5,and the root architecture was close to a dichotomous branching pattern.In the saline water and saltwater treatments,the TI of the T.chinensis roots was large and close to 1.0,and the root architecture was close to a herringbone-like branching pattern.Under different GLs and salinities,the total root length was significantly greater than the internal link length,the external link length was greater than the internal link length,and the root system showed an outward expansion strategy.The treatment with fresh water and a GL of 1.5 m was the most suitable for T.chinensis root growth,while the root growth of T.chinensis was the worst in the treatment with saline water and a GL of 0.3 m.T.chinensis can adapt to the changes in soil water and salt by regulating the growth and morphological characteristics of the root system.T.chinensis can adapt to high-salt environments by reducing its root branching and to water deficiencies by expanding the distribution and absorption area of the root system.展开更多
Graphene oxide(GO)as a new nano-enhancer in cement-based materials has gained wide attention.However,GO is easy to aggregate in alkaline cement mortar with poor dispersibility.This hinders its application in practical...Graphene oxide(GO)as a new nano-enhancer in cement-based materials has gained wide attention.However,GO is easy to aggregate in alkaline cement mortar with poor dispersibility.This hinders its application in practical infrastructure construction.In this work,GO-M18 polycarboxylate compound superplasticizer(GM)were obtained by compounding the M18 polycarboxylate superplasticizer with GO solution at different mass ratios.The dispersion of GM in alkaline solution was systematically studied.The phases and functional groups of GM were characterized by XRD and FTIR.The effects of GM on the cement mortar hydration and the formation of microstructure were investigated by measuring the heat of hydration,MIP,TG/DSC,and SEM.The results show that the long-chain structure of the M18 polycarboxylate superplasticizer can increase the interlayer spacing of GO and weaken the force between GO sheets.The modified GO can be uniformly dispersed in the cement slurry.GM can accelerate the early hydration process of cement,which can increase the content of Ca(OH)2 and decrease the grain size.It can optimize the pore size distribution of cement-based materials,increase the density of harmless and less harmful pores,thereby improving mechanical properties.Such methods can transform traditional cement-based materials into stronger,more durable composites,which prolong the life of cement-based materials and reduce the amount of cement used for later maintenance.This provides an idea for achieving sustainability goals in civil engineering.展开更多
Energy shortage and the emission of greenhouse gases have become a global problem of urgent concern.Therefore,there is an urgent need to develop a low carbon building material.Geopolymers have become a hot topic due t...Energy shortage and the emission of greenhouse gases have become a global problem of urgent concern.Therefore,there is an urgent need to develop a low carbon building material.Geopolymers have become a hot topic due to their environmental sustainability and the feasibility of immobilizing industrial waste.In this paper,steel slag(SS)fines were investigated as auxiliary materials of blast furnace slag(BFS)based geopolymer.The hydration heat properties,flowability,compressive strength,sorptivity coefficient,X-ray diffraction(XRD),and scanning electron microscopy(SEM)of the geopolymer pastes were determined.The results showed that the incorporation of SS weakened the reactivity of the BFS-based geopolymer paste and improved the flow values of the paste.The compressive strength of the geopolymer with 20%SS content reached 117 MPa at 28 d.The geopolymer specimens with high compressive strength showed a low sorptivity coefficient.The microscopic results showed that the addition of the appropriate amount of SS reduced the cracks,improved the density of the geopolymer,and produced a geopolymer composite with excellent mechanical properties.展开更多
With the rise of artificial intelligence and the rapid development of industrial applications based on deep learning,the demand for innovative and practical talents is rapidly increased.The cultivation of talents in c...With the rise of artificial intelligence and the rapid development of industrial applications based on deep learning,the demand for innovative and practical talents is rapidly increased.The cultivation of talents in computer discipline has attracted a lot of attention from universities,research institutions,and Internet giants.Subject contests play a crucial role in cultivating top undergraduate talents.This paper proposes a cultivation model that takes the industry application of deep learning as the background,and guides students to learn,practice,and innovate incrementally from machine learning application to deep learning application by participating in subject contests.It aims to help undergraduates to master the cutting-edge technologies and applications,and ultimately cultivate top,innovative,and practical undergraduate talents in the computer field in the era of artificial intelligence.展开更多
Reinsurance is an effective risk management tool for insurers to stabilize their profitability. In a typical reinsurance treaty, an insurer cedes part of the loss to a reinsurer. As the insurer faces an increasing num...Reinsurance is an effective risk management tool for insurers to stabilize their profitability. In a typical reinsurance treaty, an insurer cedes part of the loss to a reinsurer. As the insurer faces an increasing number of total losses in the insurance market, the insurer might expect the reinsurer to bear an increasing proportion of the total loss, that is the insurer might expect the reinsurer to pay an increasing proportion of the total claim amount when he faces an increasing number of total claims in the insurance market. Motivated by this, we study the optimal reinsurance problem under the Vajda condition. To prevent moral hazard and reflect the spirit of reinsurance, we assume that the retained loss function is increasing and the ceded loss function satisfies the Vajda condition. We derive the explicit expression of the optimal reinsurance under the TVaR risk measure and TVaR premium principle from the perspective of both an insurer and a reinsurer. Our results show that the explicit expression of the optimal reinsurance is in the form of two or three interconnected line segments. Under an additional mild constraint, we get the optimal parameters and find the optimal reinsurance strategy is full reinsurance, no reinsurance, stop loss reinsurance, or quota-share reinsurance. Finally, we gave an example to analyze the impact of the weighting factor on optimal reinsurance.展开更多
AIM: To analyze the clinical characteristics of small bowel tumors detected by double-balloon enteroscopy (DBE) and to evaluate the diagnostic value of DBE in tumors. METHODS: Four hundred and forty consecutive DBE ex...AIM: To analyze the clinical characteristics of small bowel tumors detected by double-balloon enteroscopy (DBE) and to evaluate the diagnostic value of DBE in tumors. METHODS: Four hundred and forty consecutive DBE examinations were performed in 400 patients (250 males and 150 females, mean age 46.9 ± 16.3 years, range 14-86 years) between January 2007 and April 2012. Of these, 252 patients underwent the antegrade approach, and 188 patients underwent the retrograde approach. All the patients enrolled in our study were suspected of having small bowel diseases with a negative etiological diagnosis following other routine examinations, such as upper and lower gastrointestinal endoscopy and radiography tests. Data on tumors, such as clinical information, endoscopic findings and opera-tion results, were retrospectively collected. RESULTS: Small bowel tumors were diagnosed in 78 patients, of whom 67 were diagnosed using DBE, resulting in a diagnostic yield of 16.8% (67/400); the other 11 patients had negative DBE findings and were diagnosed through surgery or capsule endoscopy. Adenocarcinoma (29.5%, 23/78), gastrointestinal stromal tumor (24.4%, 19/78) and lymphoma (15.4%, 12/78) were the most common tumors. Among the 78 tumors, 60.3% (47/78) were located in the jejunum, and the overall number of malignant tumors was 74.4% (58/78). DBE examinations were frequently performed in patients with obscure gastrointestinal bleeding (47.4%) and abdominal pain (24.4%). The positive detection rate for DBE in the 78 patients with small bowel tumors was 85.9% (67/78), which was higher than that of a computed tomography scan (72.9%, 51/70). Based on the operation results, the accuracy rates of DBE for locating small bowel neoplasms, such as adenocarcinoma, gastrointestinal stromal tumor and lymphoma, were 94.4%, 100% and 100%, respectively. The positive biopsy rates for adenocarcinoma and lymphoma were 71.4% and 60%, respectively. CONCLUSION: DBE is a useful diagnostic tool with high clinical practice value and should be considered the gold standard for the investigation of small bowel tumors.展开更多
AIM:To investigate the role of hepatitis B virus (HBV) replication in the development of hepatocellular carcinoma (HCC), a nested case-control study was performed to study the relationship between HBV DNA level and ri...AIM:To investigate the role of hepatitis B virus (HBV) replication in the development of hepatocellular carcinoma (HCC), a nested case-control study was performed to study the relationship between HBV DNA level and risk of HCC. METHODS:One hundred and seventy cases of HCC and 276 control subjects free of HCC and cirrhosis were selected for this study. Serum HBV DNA level was measured using fluorescein quantitative polymerase chain reaction at study entry and the last visit. RESULTS:In a binary unconditional logistic regression analysis adjusted for age, cigarette smoking, alcohol consumption and family history of chronic liver diseases, the adjusted odds ratios (95% confidence intervals) of HCC in patients with increasing HBV DNA level were 2.834 (1.237-6.492), 48.403 (14.392-162.789), 42.252 (14.784-120.750), and 14.819 (6.992-31.411) for HBV DNA levels ≥ 104 to < 105; ≥ 105 to < 106; ≥ 106 to < 107; ≥ 107 copies/mL, respectively. Forty-six HCC cases were selected to compare the serums viral loads of HBV DNA at study entry with those at the last visit. The HBV DNA levels measured at the two time points did not differ significantly.CONCLUSION:The findings of this study provide strong longitudinal evidence of an increased risk of HCC associated with persistent elevation of serum HBV DNA level in the 104-107 range.展开更多
基金supported by the National Natural Science Foundation of China(Grant No.81974355 and No.82172524).
文摘Objective This study aimed to evaluate and compare the effectiveness of knowledge base-optimized and unoptimized large language models(LLMs)in the field of orthopedics to explore optimization strategies for the application of LLMs in specific fields.Methods This research constructed a specialized knowledge base using clinical guidelines from the American Academy of Orthopaedic Surgeons(AAOS)and authoritative orthopedic publications.A total of 30 orthopedic-related questions covering aspects such as anatomical knowledge,disease diagnosis,fracture classification,treatment options,and surgical techniques were input into both the knowledge base-optimized and unoptimized versions of the GPT-4,ChatGLM,and Spark LLM,with their generated responses recorded.The overall quality,accuracy,and comprehensiveness of these responses were evaluated by 3 experienced orthopedic surgeons.Results Compared with their unoptimized LLMs,the optimized version of GPT-4 showed improvements of 15.3%in overall quality,12.5%in accuracy,and 12.8%in comprehensiveness;ChatGLM showed improvements of 24.8%,16.1%,and 19.6%,respectively;and Spark LLM showed improvements of 6.5%,14.5%,and 24.7%,respectively.Conclusion The optimization of knowledge bases significantly enhances the quality,accuracy,and comprehensiveness of the responses provided by the 3 models in the orthopedic field.Therefore,knowledge base optimization is an effective method for improving the performance of LLMs in specific fields.
文摘BACKGROUND The gastrointestinal tract is a well-known extranodal site of lymphoma.B-cell lymph-oma is the most common type,while T-cell lymphoma is uncommon.Primary gastrointestinal lymphoma mainly occurs in the stomach and small intestine,and the colon is less frequently involved,especially in females.CASE SUMMARY A 45-year-old woman was admitted to our hospital for physical examination.Gastroenteroscopy revealed a visible pedunculated polyp in the transverse colon,for which endoscopic submucosal dissection(ESD)was performed.Pathology suggested highly active proliferation of T lymphocytes with atypical hyperplasia.CONCLUSION A middle-aged female patient was found to have colonic T-cell lymphoma by endoscopy.The lesion was successfully removed by ESD,and the surgical margin was negative.It is essential to raise awareness of colonic T-cell lymphoma and choose the appropriate treatment.
基金supported by the Forestry Science and Technology Innovation Project of Shandong Province(No.2019LY006)the National Natural Science Foundation of China(No.31770761)+1 种基金Open Research Fund Program of Shandong Key Laboratory of Eco-Environmental Science for Yellow River Delta(Binzhou University)(No.2020KFJJ03)the Taishan Scholars Program of Shandong ProvincemChina(No.TSQN201909152)。
文摘This study was performed to observe the effects of water on photosynthesis and water-related physiology in dominant shrubs in shell sand habitats.Four-year-old Periploca sepium seedlings were used as model species.A gradient of 12 water levels was established by artificially supplying the shell sand with water up to saturation and then allowing natural evapotranspiration to occur.The photo synthetic,chlorophyll fluorescence and stem sap flow parameters of P.sepium were measured under a range of water conditions.The different soil water conditions were classified according to the responses of these parameters.(1)With the increase in the relative water content(RWC)of the shell sand,the parameters of leaf photosynthesis,chlorophyll fluorescence and water-related physiology in P.sepium showed significant critical responses.The net photo synthetic rate(Pn),transpiration rate(Tr),instantaneous water use efficiency(WUE),potential water use efficiency(WUEi),maximum photochemical efficiency(Fv/Fm),actual photochemical efficiency(ΦPSII)and daily accumulation of stem sap flow all increased first and then decreased with increasing RWC,but the corresponding water conditions associated with their maximum values were not the same.An RWC of 69.40%was determined to be the optimal water condition for photosynthesis and water-related physiological activity in P.sepium.At an RWC of 36.61%,the mechanism of photosynthetic inhibition in P.sepium changed from stomatal limitation to nonstomatal limitation;this was also the minimum water requirement for maintaining normal photo synthetic processes.An RWC of 50.27%resulted in the highest WUE in P.sepium,indicating that moderate drought stress increased WUE.(2)Based on the quantitative relationship between the photo synthetic parameters of P.sepium and the shell sand water gradient,the soil water availability was classified into 6 water grades.The RWC range for maintaining strong photosynthesis and high WUE in P.sepium was 63.22-69.98%.(3)Gas exchange in P.sepium was inhibited under drought and waterlogging stresses.Under these conditions,the photosynthetic electron transport chain was blocked,and the dissipation of light energy as heat increased,which ultimately led to a decline in photo synthetic productivity;moreover,transpiration and dissipation were aggravated,and water transmission and utilization processes in P.sepium were hindered.A significant negative feedback regulation mechanism in the photosynthetic and water-related physiological processes of P.sepium was observed;this mechanism allowed P.sepium growing in shell sand to be highly adaptable to water stress.
基金financially supported by the Joint Funds of the National Natural Science Foundation of China(U2006215)the National Natural Science Foundation of China(31770761)+2 种基金the Shandong Key Laboratory of Coastal Environmental Processes,YICCAS(2019SDHADKFJJ16)the Natural Science Foundation of Shangdong Province(ZR2020QD003)Taishan Scholars Program of Shandong Province,China(TSQN201909152)。
文摘To test the patterns of the root morphology and architecture indexes of Tamarix chinensis in response to water and salt changes in the two media of the groundwater and soil,three-year-old T.chinensis seedlings were chosen as the research object.Groundwater with four salinity levels was created,and three groundwater level(GL)were applied for each salinity treatment to measure the root growth and architecture indexes.In the fresh water and brackish water treatments,the topological index(TI)of the T.chinensis roots was close to 0.5,and the root architecture was close to a dichotomous branching pattern.In the saline water and saltwater treatments,the TI of the T.chinensis roots was large and close to 1.0,and the root architecture was close to a herringbone-like branching pattern.Under different GLs and salinities,the total root length was significantly greater than the internal link length,the external link length was greater than the internal link length,and the root system showed an outward expansion strategy.The treatment with fresh water and a GL of 1.5 m was the most suitable for T.chinensis root growth,while the root growth of T.chinensis was the worst in the treatment with saline water and a GL of 0.3 m.T.chinensis can adapt to the changes in soil water and salt by regulating the growth and morphological characteristics of the root system.T.chinensis can adapt to high-salt environments by reducing its root branching and to water deficiencies by expanding the distribution and absorption area of the root system.
基金funded by the National Natural Science Foundation of China(No.51872137)and Priority Academic Program Development of Jiangsu Higher Education Institutions(PAPD)。
文摘Graphene oxide(GO)as a new nano-enhancer in cement-based materials has gained wide attention.However,GO is easy to aggregate in alkaline cement mortar with poor dispersibility.This hinders its application in practical infrastructure construction.In this work,GO-M18 polycarboxylate compound superplasticizer(GM)were obtained by compounding the M18 polycarboxylate superplasticizer with GO solution at different mass ratios.The dispersion of GM in alkaline solution was systematically studied.The phases and functional groups of GM were characterized by XRD and FTIR.The effects of GM on the cement mortar hydration and the formation of microstructure were investigated by measuring the heat of hydration,MIP,TG/DSC,and SEM.The results show that the long-chain structure of the M18 polycarboxylate superplasticizer can increase the interlayer spacing of GO and weaken the force between GO sheets.The modified GO can be uniformly dispersed in the cement slurry.GM can accelerate the early hydration process of cement,which can increase the content of Ca(OH)2 and decrease the grain size.It can optimize the pore size distribution of cement-based materials,increase the density of harmless and less harmful pores,thereby improving mechanical properties.Such methods can transform traditional cement-based materials into stronger,more durable composites,which prolong the life of cement-based materials and reduce the amount of cement used for later maintenance.This provides an idea for achieving sustainability goals in civil engineering.
基金Funding Statement:This work was supported by the Priority Academic Program Development of Jiangsu Higher Education Institutions(PAPD).
文摘Energy shortage and the emission of greenhouse gases have become a global problem of urgent concern.Therefore,there is an urgent need to develop a low carbon building material.Geopolymers have become a hot topic due to their environmental sustainability and the feasibility of immobilizing industrial waste.In this paper,steel slag(SS)fines were investigated as auxiliary materials of blast furnace slag(BFS)based geopolymer.The hydration heat properties,flowability,compressive strength,sorptivity coefficient,X-ray diffraction(XRD),and scanning electron microscopy(SEM)of the geopolymer pastes were determined.The results showed that the incorporation of SS weakened the reactivity of the BFS-based geopolymer paste and improved the flow values of the paste.The compressive strength of the geopolymer with 20%SS content reached 117 MPa at 28 d.The geopolymer specimens with high compressive strength showed a low sorptivity coefficient.The microscopic results showed that the addition of the appropriate amount of SS reduced the cracks,improved the density of the geopolymer,and produced a geopolymer composite with excellent mechanical properties.
基金supported by the National Natural Science Foundation of China(No.62171325)the Experimental Technology Project of Wuhan University(No.WHU-2022-SYJS-11)the New Generation Computer Innovation and Entrepreneurship Center Project of Wuhan University。
文摘With the rise of artificial intelligence and the rapid development of industrial applications based on deep learning,the demand for innovative and practical talents is rapidly increased.The cultivation of talents in computer discipline has attracted a lot of attention from universities,research institutions,and Internet giants.Subject contests play a crucial role in cultivating top undergraduate talents.This paper proposes a cultivation model that takes the industry application of deep learning as the background,and guides students to learn,practice,and innovate incrementally from machine learning application to deep learning application by participating in subject contests.It aims to help undergraduates to master the cutting-edge technologies and applications,and ultimately cultivate top,innovative,and practical undergraduate talents in the computer field in the era of artificial intelligence.
文摘Reinsurance is an effective risk management tool for insurers to stabilize their profitability. In a typical reinsurance treaty, an insurer cedes part of the loss to a reinsurer. As the insurer faces an increasing number of total losses in the insurance market, the insurer might expect the reinsurer to bear an increasing proportion of the total loss, that is the insurer might expect the reinsurer to pay an increasing proportion of the total claim amount when he faces an increasing number of total claims in the insurance market. Motivated by this, we study the optimal reinsurance problem under the Vajda condition. To prevent moral hazard and reflect the spirit of reinsurance, we assume that the retained loss function is increasing and the ceded loss function satisfies the Vajda condition. We derive the explicit expression of the optimal reinsurance under the TVaR risk measure and TVaR premium principle from the perspective of both an insurer and a reinsurer. Our results show that the explicit expression of the optimal reinsurance is in the form of two or three interconnected line segments. Under an additional mild constraint, we get the optimal parameters and find the optimal reinsurance strategy is full reinsurance, no reinsurance, stop loss reinsurance, or quota-share reinsurance. Finally, we gave an example to analyze the impact of the weighting factor on optimal reinsurance.
文摘AIM: To analyze the clinical characteristics of small bowel tumors detected by double-balloon enteroscopy (DBE) and to evaluate the diagnostic value of DBE in tumors. METHODS: Four hundred and forty consecutive DBE examinations were performed in 400 patients (250 males and 150 females, mean age 46.9 ± 16.3 years, range 14-86 years) between January 2007 and April 2012. Of these, 252 patients underwent the antegrade approach, and 188 patients underwent the retrograde approach. All the patients enrolled in our study were suspected of having small bowel diseases with a negative etiological diagnosis following other routine examinations, such as upper and lower gastrointestinal endoscopy and radiography tests. Data on tumors, such as clinical information, endoscopic findings and opera-tion results, were retrospectively collected. RESULTS: Small bowel tumors were diagnosed in 78 patients, of whom 67 were diagnosed using DBE, resulting in a diagnostic yield of 16.8% (67/400); the other 11 patients had negative DBE findings and were diagnosed through surgery or capsule endoscopy. Adenocarcinoma (29.5%, 23/78), gastrointestinal stromal tumor (24.4%, 19/78) and lymphoma (15.4%, 12/78) were the most common tumors. Among the 78 tumors, 60.3% (47/78) were located in the jejunum, and the overall number of malignant tumors was 74.4% (58/78). DBE examinations were frequently performed in patients with obscure gastrointestinal bleeding (47.4%) and abdominal pain (24.4%). The positive detection rate for DBE in the 78 patients with small bowel tumors was 85.9% (67/78), which was higher than that of a computed tomography scan (72.9%, 51/70). Based on the operation results, the accuracy rates of DBE for locating small bowel neoplasms, such as adenocarcinoma, gastrointestinal stromal tumor and lymphoma, were 94.4%, 100% and 100%, respectively. The positive biopsy rates for adenocarcinoma and lymphoma were 71.4% and 60%, respectively. CONCLUSION: DBE is a useful diagnostic tool with high clinical practice value and should be considered the gold standard for the investigation of small bowel tumors.
基金The National High Technology Research and Development Program of China 863 Project, No. 2006AA02Z4C5
文摘AIM:To investigate the role of hepatitis B virus (HBV) replication in the development of hepatocellular carcinoma (HCC), a nested case-control study was performed to study the relationship between HBV DNA level and risk of HCC. METHODS:One hundred and seventy cases of HCC and 276 control subjects free of HCC and cirrhosis were selected for this study. Serum HBV DNA level was measured using fluorescein quantitative polymerase chain reaction at study entry and the last visit. RESULTS:In a binary unconditional logistic regression analysis adjusted for age, cigarette smoking, alcohol consumption and family history of chronic liver diseases, the adjusted odds ratios (95% confidence intervals) of HCC in patients with increasing HBV DNA level were 2.834 (1.237-6.492), 48.403 (14.392-162.789), 42.252 (14.784-120.750), and 14.819 (6.992-31.411) for HBV DNA levels ≥ 104 to < 105; ≥ 105 to < 106; ≥ 106 to < 107; ≥ 107 copies/mL, respectively. Forty-six HCC cases were selected to compare the serums viral loads of HBV DNA at study entry with those at the last visit. The HBV DNA levels measured at the two time points did not differ significantly.CONCLUSION:The findings of this study provide strong longitudinal evidence of an increased risk of HCC associated with persistent elevation of serum HBV DNA level in the 104-107 range.
