Effect of a systemic intervention combined with a psychological intervention in stroke patients with oropharyngeal dysfunction

BACKGROUND Stroke frequently results in oropharyngeal dysfunction(OD),leading to difficulties in swallowing and eating,as well as triggering negative emotions,malnutrition,and aspiration pneumonia,which can be detrimental to patients.However,routine nursing interventions often fail to address these issues adequately.Systemic and psychological interventions can improve dysphagia symptoms,relieve negative emotions,and improve quality of life.However,there are few clinical reports of systemic interventions combined with psychological interventions for stroke patients with OD.AIM To explore the effects of combining systemic and psychological interventions in stroke patients with OD.METHODS This retrospective study included 90 stroke patients with OD,admitted to the Second Affiliated Hospital of Qiqihar Medical College(January 2022–December 2023),who were divided into two groups:regular and coalition.Swallowing function grading(using a water swallow test),swallowing function[using the standardized swallowing assessment(SSA)],negative emotions[using the selfrating anxiety scale(SAS)and self-rating depression scale(SDS)],and quality of life(SWAL-QOL)were compared between groups before and after the intervention;aspiration pneumonia incidence was recorded.RESULTS Post-intervention,the coalition group had a greater number of patients with grade 1 swallowing function compared to the regular group,while the number of patients with grade 5 swallowing function was lower than that in the regular group(P<0.05).Post-intervention,the SSA,SAS,and SDS scores of both groups decreased,with a more significant decrease observed in the coalition group(P<0.05).Additionally,the total SWAL-QOL score in both groups increased,with a more significant increase observed in the coalition group(P<0.05).During the intervention period,the total incidence of aspiration and aspiration pneumonia in the coalition group was lower than that in the control group(4.44%vs 20.00%;P<0.05).CONCLUSION Systemic intervention combined with psychological intervention can improve dysphagia symptoms,alleviate negative emotions,enhance quality of life,and reduce the incidence of aspiration pneumonia in patients with OD.

Cementitious property of NaAlO2-activated Ge slag as cement supplement

Germanium(Ge),a waste residue leaching from zinc(Zn)smelting process,has potential cementitious properties and could be recycled as a cement supplement activated by chemical reagents.In this work,a test was conducted to determine the hydration properties of Ge slag-cement-based composites with Ge slag(GS)/ordinary Portland cement(PC)contents of 0wt%,5wt%,10wt%,15wt%,20wt%,and 25wt% and water-to-binder ratio(w/b)of 0.4.The activators Ca(OH)2,AlCl3,NaAlO2,and Na2CO3 were mixed under 1wt%,2wt%,3wt%,and 4wt% dosages of GS weight.The composition and microstructure of the hydration products were investigated by the combined approaches of X-ray diffraction(XRD),thermogravimetry-differential scanning calorimetry(TG-DSC),scanning electron microscopy(SEM),and energy-dispersive X-ray spectroscopy(EDS).First,the GS cementitious property is attributed to the high content of CaSO4·2H2O.Second,the activators affected the acceleration performance in the following order:NaAlO2,Na2CO3,AlCl3,and Ca(OH)2.More importantly,the 28-day unconfined compressive strength(UCS)is 45.34 MPa at the optimum formula of 0.6wt% NaAlO2,15wt% GS,and 85wt% PC,which is 9.16% higher than the control.Thus,NaAlO2 is beneficial for the ettringite(AFt)generation,resulting in the C-S-H structure compaction.However,the Zn^2+ residue inhibited the AFt formation,representing an important challenge to the strength growth with curing age.Consequently,the GS could be recycled as a supplement to the cement under the activator NaAlO2.

A FEM-DFN model for the interaction and propagation of multi-cluster fractures during variable fluid-viscosity injection in layered shale oil reservoir

To investigate the height growth of multi-cluster fractures during variable fluid-viscosity fracturing in a layered shale oil reservoir,a two-dimensional finite element method(FEM)-discrete fracture network(DFN)model coupled with flow,stress and damage is proposed.A traction-separation law is used to describe the mixed-mode response of the damaged adhesive fractures,and the cubic law is used to describe the fluid flow within the fractures.The rock deformation is controlled by the in-situ stress,fracture cohesion and fluid pressure on the hydraulic fracture surface.The coupled finite element equations are solved by the explicit time difference method.The effects of the fracturing treatment parameters including fluid viscosity,pumping rate and cluster spacing on the geometries of multifractures are investigated.The results show that variable fluid-viscosity injection can improve the complexity of the fracture network and height of the main fractures simultaneously.The pumping rate of15 m^(3)/min,variable fluid-viscosity of 3-9-21-36-45 mPa s with a cluster spacing of 7.5 m is the ideal treatment strategy.The field application shows that the peak daily production of the application well with the optimized injection procedu re of variable fluid-viscosity fracturing is 171 tons(about 2.85 times that of the adjacent well),which is the highest daily production record of a single shale oil well in China,marking a strategic breakthrough of commercial shale oil production in the Jiyang Depression,Shengli Oilfield.The variable fluid-viscosity fracturing technique is proved to be very effective for improving shale oil production.

Hepatocellular carcinoma with tumor thrombus in bile duct:A proposal of new classification according to resectability of primary lesion

BACKGROUND Hepatocellular carcinoma(HCC)with tumor thrombus in the bile duct(BDTT)is easily misdiagnosed or mistreated due to the clinicopathological diversity of the thrombus and its relationship with primary lesions.AIM To propose a new classification for HCC with BDTT in order to guide its diagnosis and treatment.METHODS A retrospective review of the diagnosis and treatment experience regarding seven typical HCC patients with BDTT between January 2010 and December 2019 was conducted.RESULTS BDTT was preoperatively confirmed by computed tomography/magnetic resonance imaging in only four patients.Three patients with recurrent HCC and one patient with first-occurring HCC had no visible intrahepatic tumors;of these,misdiagnosis occurred in two patients,and three patients died.One patient was mistreated as having common bile duct stones,and another patient with a history of multiple recurrent HCC was misdiagnosed until obvious biliary dilation could be detected.Only one patient who received hepatectomy accompanied by BDTT extraction exhibited disease-free survival during the follow-up period.A new classification was proposed for HCC with BDTT as follows:HCC with microscopic BDTT(Type Ⅰ);resectable primary or recurrent HCC mass in the liver with BDTT(Type Ⅱ);BDTT without an obvious HCC mass in the liver(Type Ⅲ)and BDTT accompanied with unresectable intra-or extrahepatic HCC lesions(Type Ⅳ).CONCLUSION We herein propose a new classification system for HCC with BDTT to reflect its pathological characteristics and emphasize the significance of primary tumor resectability in its treatment.

Establishment of a diagnostic model of coronary heart disease in elderly patients with diabetes mellitus based on machine learning algorithms

OBJECTIVE To establish a prediction model of coronary heart disease(CHD)in elderly patients with diabetes mellitus(DM)based on machine learning(ML)algorithms.METHODS Based on the Medical Big Data Research Centre of Chinese PLA General Hospital in Beijing,China,we identified a cohort of elderly inpatients(≥60 years),including 10,533 patients with DM complicated with CHD and 12,634 patients with DM without CHD,from January 2008 to December 2017.We collected demographic characteristics and clinical data.After selecting the important features,we established five ML models,including extreme gradient boosting(XGBoost),random forest(RF),decision tree(DT),adaptive boosting(Adaboost)and logistic regression(LR).We compared the receiver operating characteristic curves,area under the curve(AUC)and other relevant parameters of different models and determined the optimal classification model.The model was then applied to 7447 elderly patients with DM admitted from January 2018 to December 2019 to further validate the performance of the model.RESULTS Fifteen features were selected and included in the ML model.The classification precision in the test set of the XGBoost,RF,DT,Adaboost and LR models was 0.778,0.789,0.753,0.750 and 0.689,respectively;and the AUCs of the subjects were 0.851,0.845,0.823,0.833 and 0.731,respectively.Applying the XGBoost model with optimal performance to a newly recruited dataset for validation,the diagnostic sensitivity,specificity,precision,and AUC were 0.792,0.808,0.748 and 0.880,respectively.CONCLUSIONS The XGBoost model established in the present study had certain predictive value for elderly patients with DM complicated with CHD.

A review on metal additive manufacturing:modeling and application of numerical simulation for heat and mass transfer and microstructure evolution

Metal additive manufacturing technology has been widely used in prototyping,parts manufacturing and repairing.Metal additive manufacturing is a multi-scale and multi-physical coupling process with complex physical phenomena of heat and mass transfer and microstructure evolution.It is hard to directly observe the dynamic behavior and microstructure evolution of molten pool during additive manufacturing.Therefore,numerical simulation of additive manufacturing process is significant since it can efficiently and pertinently predict and analyze the physical phenomena in the process of metal additive manufacturing,and provide a reference for technological parameters selection.In this review,the research progress of numerical simulation of metal additive manufacturing is discussed.Various aspects of numerical simulation models are reviewed,including:(1)Introduction of basic control method and physical description of numerical simulation models;(2)Comparison of various heat and mass transfer models based on different physical assumptions(heat conduction model;heat flux coupling model;discrete powder particle heat flux coupling model);(3)Applications of various microstructure evolution models[phase field(PF),cellular automata(CA),and Monte Carlo(MC)].Finally,the development trend of numerical simulation of metal additive manufacturing,including the thermal-flow-solid coupling model and deep learning for numerical model,is analyzed.

Individualized nomogram improves diagnostic accuracy of stage Ⅰ-Ⅱ gallbladder cancer in chronic cholecystitis patients with gallbladder wall thickening

BACKGROUND： Early diagnosis of gallbladder cancer（GBC） can remarkably improve the prognosis of patients. This study aimed to develop a nomogram for individualized diagnosis of stage Ⅰ-Ⅱ GBC in chronic cholecystitis patients with gallbladder wall thickening.METHODS： The nomogram was developed using logistic regression analyses based on a retrospective cohort consisting of 89 consecutive patients with stage Ⅰ-Ⅱ GBC and 1240 patients with gallbladder wall thickening treated at one biliary surgery center in Shanghai between January 2009 and December 2011. The accuracy of the nomogram was validated by discrimination, calibration and a prospective cohort treated at another center between January 2012 and December 2014（n=928）.RESULTS： Factors included in the nomogram were advanced age, hazardous alcohol consumption, long-standing diagnosed gallstones, atrophic gallbladder, gallbladder wall calcification, intraluminal polypoid lesion, higher wall thickness ratio and mucosal line disruption. The nomogram had concordance indices of 0.889 and 0.856 for the two cohorts, respectively. Internal and external calibration curves fitted well. The area under the receiver-operating characteristic curves of the nomogram was higher than that of multidetector row computed tomography in diagnosis of stage Ⅰ-Ⅱ GBC（P〈0.001）.CONCLUSION： The proposed nomogram improves individualized diagnosis of stage Ⅰ-Ⅱ GBC in chronic cholecystitis patients with gallbladder wall thickening, especially for those the imaging features alone do not allow to confirm the diagnosis.

Correlation between expression of 1 α-hydroxylase and hypocalcaemia in rats with severe pancreatitis

Objective:To investigate the essential biochemical indices like 1-hydroxylase and hypocalcaemia in the rats with severe acute pancreatitis and explore the correlation between them.Methods:A total of 120 SPF grade Wistar male rats which were in similar physiological status were selected and randomly divided into two groups:sham group(SO group) and severe acute pancreatitis group(SAP group).Then they were divided into 1 h,3 h,6 h,and 12 h subgroups according to the killing lime.The severe acute pancreatitis model was established by retrograde injection of 5%sodium taurocholate.Serum calcium,serum creatinine,serum urea nitrogen and serum amylase were measured at different time.Serum 1,25 dihydroxy vitamin D3 level was determined by enzyme linked immunosorbentassay.The expression of 1-hydroxylase protein in the kidney tissue was determined with Western blotting and immunohistochemistry to observe its location.The pathologic features of the kidney tissue section was observed under light microscope and submicroscopic structure of the proximal convoluted tubule epithelial cell was observed under transmission electron microscope.Results:Compared with the SO group,rats in the SAP group showed continuous pathological injury as time went by.There was significant increase in serum creatinine,serum urea nitrogen and serum amylase in SAP group compared with the SO group 1,3,6,12 hours after the operation(P<0.05).There was significant decrease in serum calcium and 1,25 dihydroxy vitamin D3 3.6,12 hours after the operation(P<0.05).It also showed that the expression of the 1-hydroxylase protein in kidney tissues was upregulated at 1 h.3 h and decreased at 6h,12 h compared with the SO group.The serum calcium,1,25 dihydroxy vitamin D3 and the expression of the 1-hydroxylase protein in kidney tissues of the SAP group showed sustaining decrease.Western blotting showed positive correlation between the 1-hydroxylase expression and serum calcium at 3 h.6 h and 12 h(r=0.976,P<0.001;r=0.948.P<0.001;r=0.742,P=0.001) and also positive correlation between the 1-hydroxylase expression and serum1,25 dihydroxy vitamin D3 at 1 h,3 h,6 h and 12 h(r=0.935,P<0.001;r=0.952,P<0.001;r=0.917.P<0.001:r=0.874,P<0.001).Conclusions:At the early stage of the kidney injury,the expression of 1-hydroxylase in the kidney tissue is reduced with the progress of the disease and the decrease in its activity has a correlation with the hypocalcaemia.

Helicobacter pylori and 17β-estradiol induce human intrahepatic biliary epithelial cell abnormal proliferation and oxidative DNA damage

BACKGROUND: Biliary cancers are more common in females, and previous studies have suggested that Helicobacter pylori (H. pylori) exists in the biliary system. However, the effects of H. pylori infection and estrogen on the biological behaviors of human biliary epithelium mucosa remain unknown. The present study aimed to clarify their effects on the proliferation, apoptosis, migration and oxidative DNA damage of a human intrahepatic biliary epithelial cell (HIBEC) line in vitro. METHODS: HIBECs were co -cultured with 17 beta-estradiol (at 10(-9) mol/L, 10(-7) mol/L, and 10(-5) mol/L) and H. pylori (at MOI=0.5:1, 1:1, and 2:1) and continuously passaged until the 15th generation (approximately 45 days). Then, the following assays were performed. HIBEC proliferation was measured using the CCK-8 assay, plate clone-formation assay and by determining Ki-67 expression with immunocytochemistry; cell apoptosis and migration were investigated using Annexin-V/PI and transwell assays, respectively; and reactive oxygen species (ROS) and 8-hydroxy-2'-deoxyguanosine (8-OHdG) production were detected by flow cytometry and immunofluorescence staining combined with confocal laser scanning microscopy, respectively. The results were the basis for evaluating the level of oxidative stress and the related DNA damage in HIBECs. RESULTS: HIBECs maintained a normal morphology and vitality when treated with 17 beta-estradiol (at 10(-9) mol/L) and H. pylori (at MOI=0.5:1 and 1:1). 17 beta-estradiol at 10(-7) mol/L and 10(-5) mol/L and H. pylori at MOI=2:1, by contrast, caused cell death. Compared with controls, HIBECs treated with 17 beta-estradiol (10(-9) mol/L) and H. pylori (MOI=1:1) had a higher up-regulation of proliferation, Ki-67 expression, clone formation, migration activity and the expression of ROS and 8-OHdG and exhibited a down-regulation of apoptosis. The above effects were further increased when 17 beta-estradiol and H. pylori were combined (P<0.05). CONCLUSIONS: H. pylori and 17 beta-estradiol, separately or in combination, promoted cell proliferation and suppressed apoptosis of HIBECs in vitro. The above phenomena might be related to oxidative stress and its subsequent DNA damage with H. pylori and 17 beta-estradiol.

Effect of electropulsing on anisotropy in strength of laser metal deposited Ti-6Al-4V alloy

The effect of electropulsing treatment on microstructure and mechanical strength of laser metal deposited Ti−6Al−4V alloy was investigated in order to eliminate the anisotropy in strength of laser metal deposited Ti−6Al−4V alloy by tensile tests,optical microscopy,scanning electron microscopy,electron back-scattered diffraction analyses and transmission electron microscopy.With increasing applied voltages from 0 to 130 V,the evolution of microstructure within columnarβgrains followed the sequence ofα′martensite→colonyαstructure→basket-weaveαstructure.The electropulsing treated at 130 V weakened the texture of martensite withinβgrains.The as-built Ti−6Al−4V alloy showed an anisotropy in yield strength(6.2%).After processing at 130 V,the anisotropy in yield strength was reduced to 0.6%,which was attributed to the almost equivalent distribution of Schmid factor in the samples deformed along different orientations.

Focal intrahepatic strictures:A proposal classification based on diagnosis-treatment experience and systemic review

BACKGROUND Focal intrahepatic strictures(FIHS)refer to local strictures of the small and medium intrahepatic bile ducts.FIHS are easily misdiagnosed due to their rare incidence,and few studies have focused on the diagnosis and treatment approaches.AIM To propose a new classification for FIHS in order to guide its diagnosis and treatment.METHODS The symptoms,biochemistry results,imaging results,endoscopic examination results and initial and final diagnoses of 6 patients with FIHS admitted between January 2010 and December 2019 were retrospectively analyzed.RESULTS The 6 patients were diagnosed with intratubular growth-type intrahepatic cholangiocarcinoma(IG-ICC),recurrent multiple hepatocellular carcinoma(rmHCC)with bile duct tumor thrombus(BDTT),adenosquamous carcinoma(ASC),hepatolithiasis,small duct primary sclerosing cholangitis(SD-PSC)and autoimmune hepatitis(AIH).The initial and final diagnoses were not consistent in 4 patients.Hepatectomy was performed in patients with IG-ICC,ASC and hepatolithiasis according to the locations of their FIHS.Patients with rmHCC with BDTT received lenvatinib/sintilimab,while patients with SD-PSC and AIH received UDCA.We proposed the following classification system for FIHS:type I:FIHS located within one segment of the liver;type II:FIHS located at the confluence of the bile ducts of one segment or two adjacent segments;type III:FIHS connected to the left or right hepatic duct;and type IV:Multiple FIHS located in both lobes of the liver.CONCLUSION Our proposed classification system might help to guide the diagnosis and treatment of FIHS.Hepatectomy should be performed not only for malignant FIHS but also for benign strictures with severe secondary damage that cannot be improved by nonsurgical methods.

Surgical exposures of the distal humeral fractures: An anatomical study of the anterior, posterior, medial and lateral approaches

Purpose:Exposure of the articular surface is the key to the successful treatment of intra-articular fractures of distal humerus. Anterior, posterior olecranon osteotomy as well as medial and lateral approaches are the four main approaches to the elbow. The aim of this study was to compare the exposure of distal articular surfaces of these surgical approaches.Methods:Twelve cadavers were used in this study. Each approach was performed on six elbows according to previously published procedures. After completion of each approach, the exposed articular surfaces were marked by inserting 0.5 mm K-wires along the margins. The elbow was then disarticulated and the exposed articular surfaces were painted. The distal humeral articular surfaces were then closely wrapped using a piece of fibre-glass screen net with meshes. The exposed articular surfaces and the total articular surfaces were calculated by counting the number of meshes, respectively.Results:The average percentages of the exposed articular surfaces for the anterior, posterior olecranon osteotomy, medial and lateral approaches were 45.7% ± 2.0%, 53.9% ± 7.1%, 20.6% ± 4.9% and 28.5% ± 6.3%, respectively.Conclusion:The anterior and posterior approaches provide greater exposures of distal humeral articular surface than the medial and lateral ones in the treatment of distal humeral fractures.

Clinical practice guidelines for ultrasound-guided vacuum-assisted breast biopsy: Chinese Society of Breast Surgery (CSBrS) practice guidelines 2021

Ultrasound-guided vacuum-assisted breast biopsy(VABB)is a common technique in breast surgery.To standardize this technique,the Chinese Society of Breast Surgery(CSBrS)re-evaluated the quality of evidence for clinical studies of VABB,referring to the grading of recommendations assessment,development,and evaluation,and developed the Clinical Practice Guidelines for Ultrasound-guided vacuum-assisted breast biopsy:CSBrS Practice Guidelines 2021,in accordance with the Expert Consensus and Operation Guidelines for Ultrasound-guided Vacuum-assisted Breast Biopsy Surgery(2017)combined with data from clinical practice in breast surgery in China,providing a reference for breast surgeons in China.

Investigation of the current situation of nipple-sparing mastectomy:a large multicenter study in China(CSBrs-003)

Background:Mastectomy techniques have been extended to nipple-sparing mastectomy(NSM).This study aimed to assess the actual application of NSM in China and identify the factors influencing postoperative complications.Methods:The clinical data of 615 patients(641 surgeries)undergoing NSM from January 1st,2018 to December 31st,2018 at 28 centers nationwide were retrospectively analyzed to obtain the rate of NSM and investigate factors related to NSM surgery.Results:The proportion of NSM surgery performed in this study was 2.67%(17/641).Malignant breast tumors accounted for the majority of NSM surgery(559/641,87.2%).A total of 475(77.3%)patients underwent NSM combined with reconstructive surgery.The rate of reconstruction decreased with age in our study,and implants were the most common option(344/641,53.7%)in reconstruction.Radial incision was the most selected method regardless of reconstruction.However,for those who underwent reconstruction surgery,18.4%(85/462)of cases also chose curvilinear incision,while in the simple NSM surgery group,more patients chose circumareolar incision(26/136,19.1%).The tumor-to-nipple distance(TND)influenced postoperative complications(P=0.004).There were no relationships between postoperative complications and tumor size,tumor location,histologic grade,molecular subtype,nipple discharge,and axillary lymph nodes.Conclusions:NSM surgery is feasible and only TND influenced postoperative complications of NSM surgery.But the proportion of NSM surgery performed is still low in nationwide centers of China.The selection criteria for appropriate surgical methods are important for NSM in clinical practice.To optimize clinical applications of NSM,further multicenter prospective randomized controlled studies are needed.

Impact of climate change on wheat yield and quality in the Yellow River Basin under RCP8.5 during 2020–2050

Studying the impact of future climate change on the yield and quality of wheat in the Yellow River Basin(YRB)is both essential for rationalizing the utilization of climate resources and ensuring national food security.In this study,we employed corrected refined meteorological grid data(30 km×30 km)generated by the Climate-Weather Research and Forecasting model under RCP8.5,coupled with the DSSAT-CERES-Wheat model to predict the impact of climate change on wheat phenology,yield,and grain nitrogen content(GNC)in the YRB from 2020 to 2050.According to the type of wheat variety and planting management in the YRB,we designed five wheat ecological regions(I-V).The results show that from 2020 to 2050,the agro-meteorological resource,involving temperature,solar radiation,and precipitation,would have an overall increasing trend during the wheat growth seasons in the YRB.The growth period of wheat was generally shortened by approximately 8 d,including 6 d less from sowing to anthesis,and 2 d less from anthesis to maturity.In general,the predicted wheat yield showed a decreasing trend in the YRB,with an average reduction of 0.19%over the period from 2020 to 2050 compared with the baseline period from 1975 to 2005,and the spatial variation in wheat yield change was considerably large.In the future,the Qing‒Zang Spring Wheat region(V)in the western part of the YRB would be the only region with a yield increase of 35.4%,whereas the Northern Spring Wheat region(I)in the northern part of the YRB would be the region exhibiting the greatest decrease of 9.9%.Moreover,compared with the baseline,the GNC would increase by an average of 2.3%in the YRB,with a significant increase in the southern and central parts during 2020-2050.The GNC increase in the Huang‒Huai Winter Wheat region(III)was the highest with a 12.5%increment,but the Qing‒Zang Spring Wheat region(V)is the only region where GNC would decline,with an average decrease of 18.9%.This study implies that wheat yield and GNC have a negative correlation constraint.In general,winter wheat yield is less affected by future climate change,and the GNC of winter wheat would increase more than that of spring wheat in the YRB.Tapping the potential pathway for the balance of yield and GNC improvements under future climate change needs more exploration in the future.For instance,appropriate adjustment of the irrigation and fertilizer schedules and regimes could be considered and recommended to ensure the simultaneous improvement of wheat yield and quality in the YRB.