Building a technology alliance is the main strategy for the United States to maintain its scientific and technological hegemony under its technopolitical strategic framework.After Joe Biden took office,the United Stat...Building a technology alliance is the main strategy for the United States to maintain its scientific and technological hegemony under its technopolitical strategic framework.After Joe Biden took office,the United States implemented“small yard with high fences”strategy for scientific and technological competition,as the first step toward building a technology alliance.The main goal is to restrict the flow of strategic emerging technologies and factors of innovation to rival countries.展开更多
Self-serving,rational agents sometimes cooperate to their mutual benefit.The two-player iterated prisoner′s dilemma game is a model for including the emergence of cooperation.It is generally believed that there is no...Self-serving,rational agents sometimes cooperate to their mutual benefit.The two-player iterated prisoner′s dilemma game is a model for including the emergence of cooperation.It is generally believed that there is no simple ultimatum strategy which a player can control the return of the other participants.The zero-determinant strategy in the iterated prisoner′s dilemma dramatically expands our understanding of the classic game by uncovering strategies that provide a unilateral advantage to sentient players pitted against unwitting opponents.However,strategies in the prisoner′s dilemma game are only two strategies.Are there these results for general multi-strategy games?To address this question,the paper develops a theory for zero-determinant strategies for multi-strategy games,with any number of strategies.The analytical results exhibit a similar yet different scenario to the case of two-strategy games.The results are also applied to the Snowdrift game,the Hawk-Dove game and the Chicken game.展开更多
BACKGROUND Intensive care unit-acquired weakness(ICU-AW)is a common complication that significantly impacts the patient's recovery process,even leading to adverse outcomes.Currently,there is a lack of effective pr...BACKGROUND Intensive care unit-acquired weakness(ICU-AW)is a common complication that significantly impacts the patient's recovery process,even leading to adverse outcomes.Currently,there is a lack of effective preventive measures.AIM To identify significant risk factors for ICU-AW through iterative machine learning techniques and offer recommendations for its prevention and treatment.METHODS Patients were categorized into ICU-AW and non-ICU-AW groups on the 14th day post-ICU admission.Relevant data from the initial 14 d of ICU stay,such as age,comorbidities,sedative dosage,vasopressor dosage,duration of mechanical ventilation,length of ICU stay,and rehabilitation therapy,were gathered.The relationships between these variables and ICU-AW were examined.Utilizing iterative machine learning techniques,a multilayer perceptron neural network model was developed,and its predictive performance for ICU-AW was assessed using the receiver operating characteristic curve.RESULTS Within the ICU-AW group,age,duration of mechanical ventilation,lorazepam dosage,adrenaline dosage,and length of ICU stay were significantly higher than in the non-ICU-AW group.Additionally,sepsis,multiple organ dysfunction syndrome,hypoalbuminemia,acute heart failure,respiratory failure,acute kidney injury,anemia,stress-related gastrointestinal bleeding,shock,hypertension,coronary artery disease,malignant tumors,and rehabilitation therapy ratios were significantly higher in the ICU-AW group,demonstrating statistical significance.The most influential factors contributing to ICU-AW were identified as the length of ICU stay(100.0%)and the duration of mechanical ventilation(54.9%).The neural network model predicted ICU-AW with an area under the curve of 0.941,sensitivity of 92.2%,and specificity of 82.7%.CONCLUSION The main factors influencing ICU-AW are the length of ICU stay and the duration of mechanical ventilation.A primary preventive strategy,when feasible,involves minimizing both ICU stay and mechanical ventilation duration.展开更多
Lithium–sulfur(Li–S)batteries are supposed to be one of the most potential next-generation batteries owing to their high theoretical capacity and low cost.Nevertheless,the shuttle effect of firm multi-step two-elect...Lithium–sulfur(Li–S)batteries are supposed to be one of the most potential next-generation batteries owing to their high theoretical capacity and low cost.Nevertheless,the shuttle effect of firm multi-step two-electron reaction between sulfur and lithium in liquid electrolyte makes the capacity much smaller than the theoretical value.Many methods were proposed for inhibiting the shuttle effect of polysulfide,improving corresponding redox kinetics and enhancing the integral performance of Li–S batteries.Here,we will comprehensively and systematically summarize the strategies for inhibiting the shuttle effect from all components of Li–S batteries.First,the electrochemical principles/mechanism and origin of the shuttle effect are described in detail.Moreover,the efficient strategies,including boosting the sulfur conversion rate of sulfur,confining sulfur or lithium polysulfides(LPS)within cathode host,confining LPS in the shield layer,and preventing LPS from contacting the anode,will be discussed to suppress the shuttle effect.Then,recent advances in inhibition of shuttle effect in cathode,electrolyte,separator,and anode with the aforementioned strategies have been summarized to direct the further design of efficient materials for Li–S batteries.Finally,we present prospects for inhibition of the LPS shuttle and potential development directions in Li–S batteries.展开更多
One of the quintessential challenges in cancer treatment is drug resistance.Several mechanisms of drug resistance have been described to date,and new modes of drug resistance continue to be discovered.The phenomenon o...One of the quintessential challenges in cancer treatment is drug resistance.Several mechanisms of drug resistance have been described to date,and new modes of drug resistance continue to be discovered.The phenomenon of cancer drug resistance is now widespread,with approximately 90% of cancer-related deaths associated with drug resistance.Despite significant advances in the drug discovery process,the emergence of innate and acquired mechanisms of drug resistance has impeded the progress in cancer therapy.Therefore,understanding the mechanisms of drug resistance and the various pathways involved is integral to treatment modalities.In the present review,I discuss the different mechanisms of drug resistance in cancer cells,including DNA damage repair,epithelial to mesenchymal transition,inhibition of cell death,alteration of drug targets,inactivation of drugs,deregulation of cellular energetics,immune evasion,tumor-promoting inflammation,genome instability,and other contributing epigenetic factors.Furthermore,I highlight available treatment options and conclude with future directions.展开更多
The aim of this study is to investigate the impacts of the sampling strategy of landslide and non-landslide on the performance of landslide susceptibility assessment(LSA).The study area is the Feiyun catchment in Wenz...The aim of this study is to investigate the impacts of the sampling strategy of landslide and non-landslide on the performance of landslide susceptibility assessment(LSA).The study area is the Feiyun catchment in Wenzhou City,Southeast China.Two types of landslides samples,combined with seven non-landslide sampling strategies,resulted in a total of 14 scenarios.The corresponding landslide susceptibility map(LSM)for each scenario was generated using the random forest model.The receiver operating characteristic(ROC)curve and statistical indicators were calculated and used to assess the impact of the dataset sampling strategy.The results showed that higher accuracies were achieved when using the landslide core as positive samples,combined with non-landslide sampling from the very low zone or buffer zone.The results reveal the influence of landslide and non-landslide sampling strategies on the accuracy of LSA,which provides a reference for subsequent researchers aiming to obtain a more reasonable LSM.展开更多
Hepatitis B virus(HBV)reactivation is a clinically significant challenge in disease management.This review explores the immunological mechanisms underlying HBV reactivation,emphasizing disease progression and manageme...Hepatitis B virus(HBV)reactivation is a clinically significant challenge in disease management.This review explores the immunological mechanisms underlying HBV reactivation,emphasizing disease progression and management.It delves into host immune responses and reactivation’s delicate balance,spanning innate and adaptive immunity.Viral factors’disruption of this balance,as are interac-tions between viral antigens,immune cells,cytokine networks,and immune checkpoint pathways,are examined.Notably,the roles of T cells,natural killer cells,and antigen-presenting cells are discussed,highlighting their influence on disease progression.HBV reactivation’s impact on disease severity,hepatic flares,liver fibrosis progression,and hepatocellular carcinoma is detailed.Management strategies,including anti-viral and immunomodulatory approaches,are critically analyzed.The role of prophylactic anti-viral therapy during immunosuppressive treatments is explored alongside novel immunotherapeutic interventions to restore immune control and prevent reactivation.In conclusion,this compre-hensive review furnishes a holistic view of the immunological mechanisms that propel HBV reactivation.With a dedicated focus on understanding its implic-ations for disease progression and the prospects of efficient management stra-tegies,this article contributes significantly to the knowledge base.The more profound insights into the intricate interactions between viral elements and the immune system will inform evidence-based approaches,ultimately enhancing disease management and elevating patient outcomes.The dynamic landscape of management strategies is critically scrutinized,spanning anti-viral and immunomodulatory approaches.The role of prophylactic anti-viral therapy in preventing reactivation during immunosuppressive treatments and the potential of innovative immunotherapeutic interventions to restore immune control and proactively deter reactivation.展开更多
Since its approval by the Food and Drug Administration in 2011,transcatheter aortic valve implantation(TAVI)has rapidly evolved to become the preferred ultimate intervention for high-and intermediate-risk patients wit...Since its approval by the Food and Drug Administration in 2011,transcatheter aortic valve implantation(TAVI)has rapidly evolved to become the preferred ultimate intervention for high-and intermediate-risk patients with severe symptomatic aortic stenosis.[1]This is due to its non-open-heart,minimally invasive and off-pump advantages.[1]Nevertheless,as a result of the frequent frailty and comorbidity profiles of patients undergoing TAVI,such as advanced cardiac dysfunction and extensive coronary artery disease,or technically difficult anatomy for the procedure itself,[2-4]it is common for these patients to experience critical circulatory collapse perioperatively.These factors are linked to elevated mortality rates,necessitating suitable mechanical circulatory support(MCS)to reverse the disastrous situations.[5]展开更多
Objective: This case report aimed to demonstrate a possible neuromuscular effect of Latarjet nerves transection or truncal vagotomy, in association with sleeve gastrectomy plus antrojejunostomy, in order to reproduce ...Objective: This case report aimed to demonstrate a possible neuromuscular effect of Latarjet nerves transection or truncal vagotomy, in association with sleeve gastrectomy plus antrojejunostomy, in order to reproduce a Roux-en-Y gastric bypass (RYGB) mechanistic principles, in patients with previous Sleeve Gastrectomy (SG) who had had weight regain, with or without concomitant gastroesophageal reflux disease (GERD). Background: Sleeve gastrectomy (SG) is one of the most frequently performed bariatric operations worldwide. Nevertheless, weight regain and gastroesophageal reflux disease (GERD) have been consistently demonstrated, in association with this technique, which may require a revisional procedure. RYGB is an option in such a situation but, implies in gastrointestinal exclusions, which represents a shortcoming of this revision. Surpassing this inconvenient would be of great value for the patients. Methods: We describe herein two cases of SG revision for weight regain and GERD, with a follow-up of one year. Gastroesophageal reflux disease was evaluated by validated questionnaire, upper endoscopy, seriography, high resolution manometry (HRM) and impedance pHmetry (I-pHmetry), in the pre and postoperative periods. A re-Sleeve Gastrectomy with antrojejunal anastomosis was done in both cases, after informed consents. The Latarjet nerves were transected in one case, due to a bleeding in the left gastric vessels and a truncal vagotomy was required in the other, to appropriately treat an associated hiatal hernia. Results: In the postoperative evaluation it was observed a pyloric spasm in both cases, during seriography and endoscopy, kept until the one-year follow-up. There was unidirectional contrast flow to the gastrointestinal anastomosis, filling the jejunal limb, in radiologic contrast study. No contrast passed through the pylorus. Nonetheless, the duodenum was kept endoscopically accessible. In the one-year evaluation, weight loss was adequate and GERD resolution was obtained in both cases, confirmed by endoscopic and functional esophageal assessment, together with symptoms questionnaire. Conclusion: The association of Latarjet nerves sectioning or truncal vagotomy with re-sleeve gastrectomy plus gastrointestinal anastomosis (antrojejunal), in a revision for a failed sleeve, can represent a technical approach, to reproduce RYGB results, without exclusions and with duodenum endoscopic accessibility maintenance. It maybe could be applied for primary surgeries. Additional studies are necessary to confirm this hypothesis.展开更多
Background: Following coronary artery bypass grafting (CABG), delirium emerges as a prevalent complication. This study aimed to assess the correlation between elevated serum cortisol levels and the occurrence of posto...Background: Following coronary artery bypass grafting (CABG), delirium emerges as a prevalent complication. This study aimed to assess the correlation between elevated serum cortisol levels and the occurrence of postoperative delirium subsequent to off-pump CABG. Methods: Conducted in the Department of Cardiac Surgery at BSMMU from October 2020 to September 2022, this comparative cross-sectional study included a total of 44 participants. Subjects, meeting specific criteria, were purposefully assigned to two groups based on off-pump CABG. Group A (n = 22) consisted of patients with normal serum cortisol levels, while Group B (n = 22) comprised individuals with high serum cortisol levels on the first postoperative day. Delirium onset was assessed at the bedside in the ICU on the 1st, 2nd, 3rd, 4th, and 5th postoperative days using standard tools, namely the Richmond Agitation Sedation score (RASS) and The Confusion Assessment Method (CAM-ICU). Data were collected based on the presence or absence of delirium. Statistical analysis utilized SPSS version 26.0, employing an independent Student’s t-test for continuous data and chi-square and Fischer’s exact test for categorical data. A p-value ≤ 0.05 was considered statistically significant. Results: Group-A had a mean age of 54.50 ± 17.97, and Group-B had a mean age of 55.22 ± 15.45, both with a male predominance (81.81% and 86.36% respectively). The mean serum cortisol level was significantly higher in Group B (829.71 ± vs. 389.98 ± 68.77). Postoperative delirium occurred in 27.3% of Group B patients, statistically significant compared to the 4.5% in Group A. However, patients in Group B who developed delirium experienced significantly longer postoperative ICU and hospital stays (79.29 ± 12.27 vs. 11.44 ± 2.85, p ≤ 0.05). There was one mortality in Group B, which was statistically not significant. Conclusion: This study observed a significant association between elevated serum cortisol levels in the postoperative period and the occurrence of postoperative delirium after off-pump coronary artery bypass grafting.展开更多
Adversarial distillation(AD)has emerged as a potential solution to tackle the challenging optimization problem of loss with hard labels in adversarial training.However,fixed sample-agnostic and student-egocentric atta...Adversarial distillation(AD)has emerged as a potential solution to tackle the challenging optimization problem of loss with hard labels in adversarial training.However,fixed sample-agnostic and student-egocentric attack strategies are unsuitable for distillation.Additionally,the reliability of guidance from static teachers diminishes as target models become more robust.This paper proposes an AD method called Learnable Distillation Attack Strategies and Evolvable Teachers Adversarial Distillation(LDAS&ET-AD).Firstly,a learnable distillation attack strategies generating mechanism is developed to automatically generate sample-dependent attack strategies tailored for distillation.A strategy model is introduced to produce attack strategies that enable adversarial examples(AEs)to be created in areas where the target model significantly diverges from the teachers by competing with the target model in minimizing or maximizing the AD loss.Secondly,a teacher evolution strategy is introduced to enhance the reliability and effectiveness of knowledge in improving the generalization performance of the target model.By calculating the experimentally updated target model’s validation performance on both clean samples and AEs,the impact of distillation from each training sample and AE on the target model’s generalization and robustness abilities is assessed to serve as feedback to fine-tune standard and robust teachers accordingly.Experiments evaluate the performance of LDAS&ET-AD against different adversarial attacks on the CIFAR-10 and CIFAR-100 datasets.The experimental results demonstrate that the proposed method achieves a robust precision of 45.39%and 42.63%against AutoAttack(AA)on the CIFAR-10 dataset for ResNet-18 and MobileNet-V2,respectively,marking an improvement of 2.31%and 3.49%over the baseline method.In comparison to state-of-the-art adversarial defense techniques,our method surpasses Introspective Adversarial Distillation,the top-performing method in terms of robustness under AA attack for the CIFAR-10 dataset,with enhancements of 1.40%and 1.43%for ResNet-18 and MobileNet-V2,respectively.These findings demonstrate the effectiveness of our proposed method in enhancing the robustness of deep learning networks(DNNs)against prevalent adversarial attacks when compared to other competing methods.In conclusion,LDAS&ET-AD provides reliable and informative soft labels to one of the most promising defense methods,AT,alleviating the limitations of untrusted teachers and unsuitable AEs in existing AD techniques.We hope this paper promotes the development of DNNs in real-world trust-sensitive fields and helps ensure a more secure and dependable future for artificial intelligence systems.展开更多
Small-break superposed station blackout(SBO)accidents are the basic design accidents of nuclear power plants.Under the condition of a small break in the cold leg,SBO further increases the severity of the accident,and ...Small-break superposed station blackout(SBO)accidents are the basic design accidents of nuclear power plants.Under the condition of a small break in the cold leg,SBO further increases the severity of the accident,and the steam bypass discharg-ing system(GCT)in the second circuit can play an important role in guaranteeing core safety.To explore the influence of the GCT on the thermal-hydraulic characteristics of the primary circuit,RELAP5 software was used to establish a numerical model based on a typical pressurized water reactor nuclear power plant.Five different small breaks in the cold-leg super-posed SBO were selected,and the impact of the GCT operation on the transient response characteristics of the primary and secondary circuit systems was analyzed.The results show that the GCT plays an indispensable role in core heat removal during an accident;otherwise,core safety cannot be guaranteed.The GCT was used in conjunction with the primary safety injection system during the placement process.When the break diameter was greater than a certain critical value,the core cooling rate could not be guaranteed to be less than 100 K/h;however,the core remained in a safe state.展开更多
It is well-known that elevated low-density lipoprotein cholesterol(LDL-C)is a causal risk factor for atheroscler-otic cardiovascular disease(ASCVD),statins are cornerstone drugs for the cause-based treatment of ASCVD,...It is well-known that elevated low-density lipoprotein cholesterol(LDL-C)is a causal risk factor for atheroscler-otic cardiovascular disease(ASCVD),statins are cornerstone drugs for the cause-based treatment of ASCVD,which has created a new era for ASCVD therapy.However,statin intolerance is not clinically uncommon,which there are several issues with confu-sion and misunderstandings.Hence,a file named Chinese Expert Consensus on the Diagnosis and Management Strategy of Pa-tients With Statin Intolerance,like a navigator,has recently been published written by a team of experts from the Cardiovascular Metabolic Medicine Professional Committee,Expert Committee of the National Center for Cardiovascular Diseases aiming to en-hance the standardized clinical application of statins and improve the prevention and clinical outcome.In this article,author briefly summarized the key points of above consensus in order to helping to comprehending the content of the consensus sugges-tions.展开更多
Background: Helicobacter pylori (Hp) infection is the most widespread bacterial infection in the world. The infection is generally acquired in childhood, but can persist into adulthood. Eradication therapy has undergo...Background: Helicobacter pylori (Hp) infection is the most widespread bacterial infection in the world. The infection is generally acquired in childhood, but can persist into adulthood. Eradication therapy has undergone several modifications. The aim of this study was to evaluate the different therapeutic strategies used in the eradication of Helicobacter pylori infection in the Centre Hospitalier Universitaire La Reference Nationale of N’Djaména. Patients and Methods: This was a prospective, descriptive analytical study spread over one year, from September 2021 to September 2022. Patients at least 15 years of age presenting with dyspeptic symptoms, seen consecutively in a hepato-gastroenterology consultation and with a positive stool test for H. pylori infection, were included in the study. Equally, 1/3 of patients were treated with dual or triple therapy. The remaining third received quadritherapy. Results: A total of 268 patients were included in the study (mean age 38.40 ± 14.66 with extremes of 16 and 80 years). Males predominated in 58% of cases. Overall therapeutic efficacy was 88.9%. According to different therapeutic strategies, efficacy was 90.75% for dual therapy with PPI (Rabeprazole) and Amoxicillin. On the other hand, efficacy was 87% and 88.88% for PPI-based triple therapy and dual antibiotic therapy, and for PPI-based quadruple therapy and triple antibiotic therapy. Conclusion: H. pylori infection is a common disease in Chad. Dual therapy with rabeprazole combined with a high dose of amoxicillin over a period of at least two weeks showed similar if not better efficacy than triple or quadruple therapy.展开更多
This is a review of the first 10 coronary artery bypass surgeries performed by the local team. The mean age was 62 years old [45 - 74]. The patients were predominantly male, with a M/F ratio of 4:1. Cardiovascular ris...This is a review of the first 10 coronary artery bypass surgeries performed by the local team. The mean age was 62 years old [45 - 74]. The patients were predominantly male, with a M/F ratio of 4:1. Cardiovascular risk factors were mainly myocardial infarction (MI) (60%), hypertension (50%), obesity (40%) and diabetes (30%), with at least two risk factors per patient. Angina was the main symptom (80%). The average time from presentation to surgery was 8 months. The mean Euroscore 2 was 2.92 ± 1.65 [1.33 - 6.60]. Coronary angiography revealed an average of 2 lesions per patient, with 3-vessel involvement in 70% of cases: the Interventricular artery (IVA) (100%), the right coronary artery (90%) and the circumflex artery (70%). On echocardiography, the mean Left ventricular ejection fraction (LVEF) was 59% [33% - 76%]. All patients underwent median sternotomy with bypass grafting. The average duration of the cardiopulmonary bypass was 150 min [46 - 275 min];that of aortic clamping, 120 min [43 - 232 min]. The grafts used were internal thoracic artery (ITA) in 100% of cases (80% on the left and 20% on the right), and the great saphenous vein (GSV) in 60% of cases (50% on the left and 10 on the right). Double bypass was performed in 60% of cases, single bypass in 30% and triple bypass in 10%. The bypasses were performed on the IVA (100%), the middle lateral of the circumflex (30%) and the bisector (20%). The average time to extubation was 11 hours and the length of stay in the intensive care unit was 7 days [03 - 17 days]. One patient had a reoperation on Day 0 post-op. The average hospital stay was 13 days [06 - 27 days]. Complications occurred in nine of the patients (90%), with a predominance of infectious and neurological complications. Overall operative mortality was 3%, all in intensive care.展开更多
The present study aimed to dynamically observe the segmental and global myocardial movements of the left ventricle during coronary artery bypass grafting by transesophageal speckle-tracking echocardiography,and to ass...The present study aimed to dynamically observe the segmental and global myocardial movements of the left ventricle during coronary artery bypass grafting by transesophageal speckle-tracking echocardiography,and to assess the effect of sevoflurane on cardiac function.Sixty-four patients scheduled for the off-pump coronary artery bypass grafting were randomly divided into a sevoflurane-based anesthesia(AS)group and a propofolbased total intravenous anesthesia(AA)group.The AS group demonstrated a higher absolute value of left ventricular global longitudinal strain than that of the AA group at both T1(after harvesting all grafts and before coronary anastomosis)and T_(2)(30 min after completing all coronary anastomoses)(P<0.05).Moreover,strain improvement in the segment with the highest preoperative strain was significantly reduced in the AS group,compared with the AA group at both T1 and T_(2)(P<0.01).The flow of the left internal mammary artery-left anterior descending artery graft was superior,and the postoperative concentration of troponin T decreased rapidly in the AS group,compared with the AA group(P<0.05).Compared with total intravenous anesthesia,sevoflurane resulted in a significantly higher global longitudinal strain,stroke volume,and cardiac output.Sevoflurane also led to an amelioration in the condition of the arterial graft.Furthermore,sevoflurane significantly reduced strain improvement in the segmental myocardium with a high preoperative strain value.The findings need to be replicated in larger studies.展开更多
BACKGROUND Superficial temporal artery to middle cerebral artery(STA-MCA)bypass is a valuable treatment for preventing ischemia and hemorrhage in occlusive cerebrovascular disease.Anastomosis site dissection is rarely...BACKGROUND Superficial temporal artery to middle cerebral artery(STA-MCA)bypass is a valuable treatment for preventing ischemia and hemorrhage in occlusive cerebrovascular disease.Anastomosis site dissection is rarely reported among the various bypass-related complications.CASE SUMMARY In this case report,we describe two patients,who were 63-and 59-years-old with middle cerebral artery occlusion treated by STA-MCA bypass.During bypass surgery,the recipient M4 artery intima was dissected.We sacrificed the dissecting portion,and no complications occurred during the follow-up period.Postoperative brain imaging revealed improved brain perfusion.We report rare cases of recipient artery dissection located in the extracranial to intracranial bypass site,and we suggest atherosclerotic changes in the recipient artery and insufficient puncture as the causes.CONCLUSION Appropriate recipient artery selection is critical,and if dissection occurs,it is essential to sacrifice the dissecting portion quickly.展开更多
Prekallikrein deficiency is a disorder that often remains undiagnosed. Prekallikrein activates factor XII, which initiates the intrinsic coagulation pathway. Prekallikrein deficiency results in prolonged Partial Throm...Prekallikrein deficiency is a disorder that often remains undiagnosed. Prekallikrein activates factor XII, which initiates the intrinsic coagulation pathway. Prekallikrein deficiency results in prolonged Partial Thromboplastin Time and Activated Clotting Time in absence of anticoagulants or active bleeding. This case report describes the anesthesia management of a patient with Prekallikrein deficiency who underwent cardiac surgery with Cardiopulmonary Bypass for correction of a congenital cardiac malformation. We highlight the importance of understanding the different tests available for the diagnosis of coagulation factors deficiency during administration of heparin in the setting of cardiovascular procedures under general anesthesia.展开更多
The booming live-streaming commerce has significantly changed the traditional e-commerce model,thus attracting much attention from both industry and academia.In recent years,an increasing number of scholars have appli...The booming live-streaming commerce has significantly changed the traditional e-commerce model,thus attracting much attention from both industry and academia.In recent years,an increasing number of scholars have applied analytical models to explore live-streaming strategies for firms in different scenarios.However,the previous literature mainly considers monopolists,while in the real world,competition is not rare.To fill this gap between the literature and practical observations,this paper applies a game theoretical model to study live-streaming adoption and pricing strategy for firms under competitive environments.The results show that,for competitive firms,the equilibrium strategy depends on the relation between the commission rate and the intensity of the market expansion effect.Additionally,compared to the case in which no firm adopts live-streaming,competitive firms do not always benefit from the adoption of live-streaming selling.The paper also shows that competition plays a negative role in inducing a firm to adopt live-streaming.展开更多
Tissue engineering has been striving toward designing and producing natural and functional human tissues.Cells are the fundamental building blocks of tissues.Compared with traditional two-dimensional cultured cells,ce...Tissue engineering has been striving toward designing and producing natural and functional human tissues.Cells are the fundamental building blocks of tissues.Compared with traditional two-dimensional cultured cells,cell spheres are threedimensional(3D)structures that can naturally form complex cell–cell and cell–matrix interactions.This structure is close to the natural environment of cells in living organisms.In addition to being used in disease modeling and drug screening,spheroids have significant potential in tissue regeneration.The 3D bioprinting is an advanced biofabrication technique.It accurately deposits bioinks into predesigned 3D shapes to create complex tissue structures.Although 3D bioprinting is efficient,the time required for cells to develop into complex tissue structures can be lengthy.The 3D bioprinting of spheroids significantly reduces the time required for their development into large tissues/organs during later cultivation stages by printing them with high cell density.Combining spheroid fabrication and bioprinting technology should provide a new solution to many problems in regenerative medicine.This paper systematically elaborates and analyzes the spheroid fabrication methods and 3D bioprinting strategies by introducing spheroids as building blocks.Finally,we present the primary challenges faced by spheroid fabrication and 3D bioprinting with future requirements and some recommendations.展开更多
文摘Building a technology alliance is the main strategy for the United States to maintain its scientific and technological hegemony under its technopolitical strategic framework.After Joe Biden took office,the United States implemented“small yard with high fences”strategy for scientific and technological competition,as the first step toward building a technology alliance.The main goal is to restrict the flow of strategic emerging technologies and factors of innovation to rival countries.
文摘Self-serving,rational agents sometimes cooperate to their mutual benefit.The two-player iterated prisoner′s dilemma game is a model for including the emergence of cooperation.It is generally believed that there is no simple ultimatum strategy which a player can control the return of the other participants.The zero-determinant strategy in the iterated prisoner′s dilemma dramatically expands our understanding of the classic game by uncovering strategies that provide a unilateral advantage to sentient players pitted against unwitting opponents.However,strategies in the prisoner′s dilemma game are only two strategies.Are there these results for general multi-strategy games?To address this question,the paper develops a theory for zero-determinant strategies for multi-strategy games,with any number of strategies.The analytical results exhibit a similar yet different scenario to the case of two-strategy games.The results are also applied to the Snowdrift game,the Hawk-Dove game and the Chicken game.
基金Supported by Science and Technology Support Program of Qiandongnan Prefecture,No.Qiandongnan Sci-Tech Support[2021]12Guizhou Province High-Level Innovative Talent Training Program,No.Qiannan Thousand Talents[2022]201701.
文摘BACKGROUND Intensive care unit-acquired weakness(ICU-AW)is a common complication that significantly impacts the patient's recovery process,even leading to adverse outcomes.Currently,there is a lack of effective preventive measures.AIM To identify significant risk factors for ICU-AW through iterative machine learning techniques and offer recommendations for its prevention and treatment.METHODS Patients were categorized into ICU-AW and non-ICU-AW groups on the 14th day post-ICU admission.Relevant data from the initial 14 d of ICU stay,such as age,comorbidities,sedative dosage,vasopressor dosage,duration of mechanical ventilation,length of ICU stay,and rehabilitation therapy,were gathered.The relationships between these variables and ICU-AW were examined.Utilizing iterative machine learning techniques,a multilayer perceptron neural network model was developed,and its predictive performance for ICU-AW was assessed using the receiver operating characteristic curve.RESULTS Within the ICU-AW group,age,duration of mechanical ventilation,lorazepam dosage,adrenaline dosage,and length of ICU stay were significantly higher than in the non-ICU-AW group.Additionally,sepsis,multiple organ dysfunction syndrome,hypoalbuminemia,acute heart failure,respiratory failure,acute kidney injury,anemia,stress-related gastrointestinal bleeding,shock,hypertension,coronary artery disease,malignant tumors,and rehabilitation therapy ratios were significantly higher in the ICU-AW group,demonstrating statistical significance.The most influential factors contributing to ICU-AW were identified as the length of ICU stay(100.0%)and the duration of mechanical ventilation(54.9%).The neural network model predicted ICU-AW with an area under the curve of 0.941,sensitivity of 92.2%,and specificity of 82.7%.CONCLUSION The main factors influencing ICU-AW are the length of ICU stay and the duration of mechanical ventilation.A primary preventive strategy,when feasible,involves minimizing both ICU stay and mechanical ventilation duration.
基金support from the “Joint International Laboratory on Environmental and Energy Frontier Materials”“Innovation Research Team of High-Level Local Universities in Shanghai”support from the National Natural Science Foundation of China (22209103)
文摘Lithium–sulfur(Li–S)batteries are supposed to be one of the most potential next-generation batteries owing to their high theoretical capacity and low cost.Nevertheless,the shuttle effect of firm multi-step two-electron reaction between sulfur and lithium in liquid electrolyte makes the capacity much smaller than the theoretical value.Many methods were proposed for inhibiting the shuttle effect of polysulfide,improving corresponding redox kinetics and enhancing the integral performance of Li–S batteries.Here,we will comprehensively and systematically summarize the strategies for inhibiting the shuttle effect from all components of Li–S batteries.First,the electrochemical principles/mechanism and origin of the shuttle effect are described in detail.Moreover,the efficient strategies,including boosting the sulfur conversion rate of sulfur,confining sulfur or lithium polysulfides(LPS)within cathode host,confining LPS in the shield layer,and preventing LPS from contacting the anode,will be discussed to suppress the shuttle effect.Then,recent advances in inhibition of shuttle effect in cathode,electrolyte,separator,and anode with the aforementioned strategies have been summarized to direct the further design of efficient materials for Li–S batteries.Finally,we present prospects for inhibition of the LPS shuttle and potential development directions in Li–S batteries.
文摘One of the quintessential challenges in cancer treatment is drug resistance.Several mechanisms of drug resistance have been described to date,and new modes of drug resistance continue to be discovered.The phenomenon of cancer drug resistance is now widespread,with approximately 90% of cancer-related deaths associated with drug resistance.Despite significant advances in the drug discovery process,the emergence of innate and acquired mechanisms of drug resistance has impeded the progress in cancer therapy.Therefore,understanding the mechanisms of drug resistance and the various pathways involved is integral to treatment modalities.In the present review,I discuss the different mechanisms of drug resistance in cancer cells,including DNA damage repair,epithelial to mesenchymal transition,inhibition of cell death,alteration of drug targets,inactivation of drugs,deregulation of cellular energetics,immune evasion,tumor-promoting inflammation,genome instability,and other contributing epigenetic factors.Furthermore,I highlight available treatment options and conclude with future directions.
文摘The aim of this study is to investigate the impacts of the sampling strategy of landslide and non-landslide on the performance of landslide susceptibility assessment(LSA).The study area is the Feiyun catchment in Wenzhou City,Southeast China.Two types of landslides samples,combined with seven non-landslide sampling strategies,resulted in a total of 14 scenarios.The corresponding landslide susceptibility map(LSM)for each scenario was generated using the random forest model.The receiver operating characteristic(ROC)curve and statistical indicators were calculated and used to assess the impact of the dataset sampling strategy.The results showed that higher accuracies were achieved when using the landslide core as positive samples,combined with non-landslide sampling from the very low zone or buffer zone.The results reveal the influence of landslide and non-landslide sampling strategies on the accuracy of LSA,which provides a reference for subsequent researchers aiming to obtain a more reasonable LSM.
文摘Hepatitis B virus(HBV)reactivation is a clinically significant challenge in disease management.This review explores the immunological mechanisms underlying HBV reactivation,emphasizing disease progression and management.It delves into host immune responses and reactivation’s delicate balance,spanning innate and adaptive immunity.Viral factors’disruption of this balance,as are interac-tions between viral antigens,immune cells,cytokine networks,and immune checkpoint pathways,are examined.Notably,the roles of T cells,natural killer cells,and antigen-presenting cells are discussed,highlighting their influence on disease progression.HBV reactivation’s impact on disease severity,hepatic flares,liver fibrosis progression,and hepatocellular carcinoma is detailed.Management strategies,including anti-viral and immunomodulatory approaches,are critically analyzed.The role of prophylactic anti-viral therapy during immunosuppressive treatments is explored alongside novel immunotherapeutic interventions to restore immune control and prevent reactivation.In conclusion,this compre-hensive review furnishes a holistic view of the immunological mechanisms that propel HBV reactivation.With a dedicated focus on understanding its implic-ations for disease progression and the prospects of efficient management stra-tegies,this article contributes significantly to the knowledge base.The more profound insights into the intricate interactions between viral elements and the immune system will inform evidence-based approaches,ultimately enhancing disease management and elevating patient outcomes.The dynamic landscape of management strategies is critically scrutinized,spanning anti-viral and immunomodulatory approaches.The role of prophylactic anti-viral therapy in preventing reactivation during immunosuppressive treatments and the potential of innovative immunotherapeutic interventions to restore immune control and proactively deter reactivation.
基金supported by the Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support(ZYLX202111,to XTH)Beijing Hospitals Authority“Ascent Plan”(FDL20190601,to XTH)+2 种基金Young Elite Scientists Sponsorship Program by CAST(2022QNRC001,to LSW)National Natural Science Foundation of China(82200433,to LSW)Beijing Hospitals Authority Youth Programme(QML20230602,to LSW).
文摘Since its approval by the Food and Drug Administration in 2011,transcatheter aortic valve implantation(TAVI)has rapidly evolved to become the preferred ultimate intervention for high-and intermediate-risk patients with severe symptomatic aortic stenosis.[1]This is due to its non-open-heart,minimally invasive and off-pump advantages.[1]Nevertheless,as a result of the frequent frailty and comorbidity profiles of patients undergoing TAVI,such as advanced cardiac dysfunction and extensive coronary artery disease,or technically difficult anatomy for the procedure itself,[2-4]it is common for these patients to experience critical circulatory collapse perioperatively.These factors are linked to elevated mortality rates,necessitating suitable mechanical circulatory support(MCS)to reverse the disastrous situations.[5]
文摘Objective: This case report aimed to demonstrate a possible neuromuscular effect of Latarjet nerves transection or truncal vagotomy, in association with sleeve gastrectomy plus antrojejunostomy, in order to reproduce a Roux-en-Y gastric bypass (RYGB) mechanistic principles, in patients with previous Sleeve Gastrectomy (SG) who had had weight regain, with or without concomitant gastroesophageal reflux disease (GERD). Background: Sleeve gastrectomy (SG) is one of the most frequently performed bariatric operations worldwide. Nevertheless, weight regain and gastroesophageal reflux disease (GERD) have been consistently demonstrated, in association with this technique, which may require a revisional procedure. RYGB is an option in such a situation but, implies in gastrointestinal exclusions, which represents a shortcoming of this revision. Surpassing this inconvenient would be of great value for the patients. Methods: We describe herein two cases of SG revision for weight regain and GERD, with a follow-up of one year. Gastroesophageal reflux disease was evaluated by validated questionnaire, upper endoscopy, seriography, high resolution manometry (HRM) and impedance pHmetry (I-pHmetry), in the pre and postoperative periods. A re-Sleeve Gastrectomy with antrojejunal anastomosis was done in both cases, after informed consents. The Latarjet nerves were transected in one case, due to a bleeding in the left gastric vessels and a truncal vagotomy was required in the other, to appropriately treat an associated hiatal hernia. Results: In the postoperative evaluation it was observed a pyloric spasm in both cases, during seriography and endoscopy, kept until the one-year follow-up. There was unidirectional contrast flow to the gastrointestinal anastomosis, filling the jejunal limb, in radiologic contrast study. No contrast passed through the pylorus. Nonetheless, the duodenum was kept endoscopically accessible. In the one-year evaluation, weight loss was adequate and GERD resolution was obtained in both cases, confirmed by endoscopic and functional esophageal assessment, together with symptoms questionnaire. Conclusion: The association of Latarjet nerves sectioning or truncal vagotomy with re-sleeve gastrectomy plus gastrointestinal anastomosis (antrojejunal), in a revision for a failed sleeve, can represent a technical approach, to reproduce RYGB results, without exclusions and with duodenum endoscopic accessibility maintenance. It maybe could be applied for primary surgeries. Additional studies are necessary to confirm this hypothesis.
文摘Background: Following coronary artery bypass grafting (CABG), delirium emerges as a prevalent complication. This study aimed to assess the correlation between elevated serum cortisol levels and the occurrence of postoperative delirium subsequent to off-pump CABG. Methods: Conducted in the Department of Cardiac Surgery at BSMMU from October 2020 to September 2022, this comparative cross-sectional study included a total of 44 participants. Subjects, meeting specific criteria, were purposefully assigned to two groups based on off-pump CABG. Group A (n = 22) consisted of patients with normal serum cortisol levels, while Group B (n = 22) comprised individuals with high serum cortisol levels on the first postoperative day. Delirium onset was assessed at the bedside in the ICU on the 1st, 2nd, 3rd, 4th, and 5th postoperative days using standard tools, namely the Richmond Agitation Sedation score (RASS) and The Confusion Assessment Method (CAM-ICU). Data were collected based on the presence or absence of delirium. Statistical analysis utilized SPSS version 26.0, employing an independent Student’s t-test for continuous data and chi-square and Fischer’s exact test for categorical data. A p-value ≤ 0.05 was considered statistically significant. Results: Group-A had a mean age of 54.50 ± 17.97, and Group-B had a mean age of 55.22 ± 15.45, both with a male predominance (81.81% and 86.36% respectively). The mean serum cortisol level was significantly higher in Group B (829.71 ± vs. 389.98 ± 68.77). Postoperative delirium occurred in 27.3% of Group B patients, statistically significant compared to the 4.5% in Group A. However, patients in Group B who developed delirium experienced significantly longer postoperative ICU and hospital stays (79.29 ± 12.27 vs. 11.44 ± 2.85, p ≤ 0.05). There was one mortality in Group B, which was statistically not significant. Conclusion: This study observed a significant association between elevated serum cortisol levels in the postoperative period and the occurrence of postoperative delirium after off-pump coronary artery bypass grafting.
基金the National Key Research and Development Program of China(2021YFB1006200)Major Science and Technology Project of Henan Province in China(221100211200).Grant was received by S.Li.
文摘Adversarial distillation(AD)has emerged as a potential solution to tackle the challenging optimization problem of loss with hard labels in adversarial training.However,fixed sample-agnostic and student-egocentric attack strategies are unsuitable for distillation.Additionally,the reliability of guidance from static teachers diminishes as target models become more robust.This paper proposes an AD method called Learnable Distillation Attack Strategies and Evolvable Teachers Adversarial Distillation(LDAS&ET-AD).Firstly,a learnable distillation attack strategies generating mechanism is developed to automatically generate sample-dependent attack strategies tailored for distillation.A strategy model is introduced to produce attack strategies that enable adversarial examples(AEs)to be created in areas where the target model significantly diverges from the teachers by competing with the target model in minimizing or maximizing the AD loss.Secondly,a teacher evolution strategy is introduced to enhance the reliability and effectiveness of knowledge in improving the generalization performance of the target model.By calculating the experimentally updated target model’s validation performance on both clean samples and AEs,the impact of distillation from each training sample and AE on the target model’s generalization and robustness abilities is assessed to serve as feedback to fine-tune standard and robust teachers accordingly.Experiments evaluate the performance of LDAS&ET-AD against different adversarial attacks on the CIFAR-10 and CIFAR-100 datasets.The experimental results demonstrate that the proposed method achieves a robust precision of 45.39%and 42.63%against AutoAttack(AA)on the CIFAR-10 dataset for ResNet-18 and MobileNet-V2,respectively,marking an improvement of 2.31%and 3.49%over the baseline method.In comparison to state-of-the-art adversarial defense techniques,our method surpasses Introspective Adversarial Distillation,the top-performing method in terms of robustness under AA attack for the CIFAR-10 dataset,with enhancements of 1.40%and 1.43%for ResNet-18 and MobileNet-V2,respectively.These findings demonstrate the effectiveness of our proposed method in enhancing the robustness of deep learning networks(DNNs)against prevalent adversarial attacks when compared to other competing methods.In conclusion,LDAS&ET-AD provides reliable and informative soft labels to one of the most promising defense methods,AT,alleviating the limitations of untrusted teachers and unsuitable AEs in existing AD techniques.We hope this paper promotes the development of DNNs in real-world trust-sensitive fields and helps ensure a more secure and dependable future for artificial intelligence systems.
文摘Small-break superposed station blackout(SBO)accidents are the basic design accidents of nuclear power plants.Under the condition of a small break in the cold leg,SBO further increases the severity of the accident,and the steam bypass discharg-ing system(GCT)in the second circuit can play an important role in guaranteeing core safety.To explore the influence of the GCT on the thermal-hydraulic characteristics of the primary circuit,RELAP5 software was used to establish a numerical model based on a typical pressurized water reactor nuclear power plant.Five different small breaks in the cold-leg super-posed SBO were selected,and the impact of the GCT operation on the transient response characteristics of the primary and secondary circuit systems was analyzed.The results show that the GCT plays an indispensable role in core heat removal during an accident;otherwise,core safety cannot be guaranteed.The GCT was used in conjunction with the primary safety injection system during the placement process.When the break diameter was greater than a certain critical value,the core cooling rate could not be guaranteed to be less than 100 K/h;however,the core remained in a safe state.
基金supported by CAMS Innovation Fund for Medical Sciences(CIFMS,2021-I2M-C&TB-030).
文摘It is well-known that elevated low-density lipoprotein cholesterol(LDL-C)is a causal risk factor for atheroscler-otic cardiovascular disease(ASCVD),statins are cornerstone drugs for the cause-based treatment of ASCVD,which has created a new era for ASCVD therapy.However,statin intolerance is not clinically uncommon,which there are several issues with confu-sion and misunderstandings.Hence,a file named Chinese Expert Consensus on the Diagnosis and Management Strategy of Pa-tients With Statin Intolerance,like a navigator,has recently been published written by a team of experts from the Cardiovascular Metabolic Medicine Professional Committee,Expert Committee of the National Center for Cardiovascular Diseases aiming to en-hance the standardized clinical application of statins and improve the prevention and clinical outcome.In this article,author briefly summarized the key points of above consensus in order to helping to comprehending the content of the consensus sugges-tions.
文摘Background: Helicobacter pylori (Hp) infection is the most widespread bacterial infection in the world. The infection is generally acquired in childhood, but can persist into adulthood. Eradication therapy has undergone several modifications. The aim of this study was to evaluate the different therapeutic strategies used in the eradication of Helicobacter pylori infection in the Centre Hospitalier Universitaire La Reference Nationale of N’Djaména. Patients and Methods: This was a prospective, descriptive analytical study spread over one year, from September 2021 to September 2022. Patients at least 15 years of age presenting with dyspeptic symptoms, seen consecutively in a hepato-gastroenterology consultation and with a positive stool test for H. pylori infection, were included in the study. Equally, 1/3 of patients were treated with dual or triple therapy. The remaining third received quadritherapy. Results: A total of 268 patients were included in the study (mean age 38.40 ± 14.66 with extremes of 16 and 80 years). Males predominated in 58% of cases. Overall therapeutic efficacy was 88.9%. According to different therapeutic strategies, efficacy was 90.75% for dual therapy with PPI (Rabeprazole) and Amoxicillin. On the other hand, efficacy was 87% and 88.88% for PPI-based triple therapy and dual antibiotic therapy, and for PPI-based quadruple therapy and triple antibiotic therapy. Conclusion: H. pylori infection is a common disease in Chad. Dual therapy with rabeprazole combined with a high dose of amoxicillin over a period of at least two weeks showed similar if not better efficacy than triple or quadruple therapy.
文摘This is a review of the first 10 coronary artery bypass surgeries performed by the local team. The mean age was 62 years old [45 - 74]. The patients were predominantly male, with a M/F ratio of 4:1. Cardiovascular risk factors were mainly myocardial infarction (MI) (60%), hypertension (50%), obesity (40%) and diabetes (30%), with at least two risk factors per patient. Angina was the main symptom (80%). The average time from presentation to surgery was 8 months. The mean Euroscore 2 was 2.92 ± 1.65 [1.33 - 6.60]. Coronary angiography revealed an average of 2 lesions per patient, with 3-vessel involvement in 70% of cases: the Interventricular artery (IVA) (100%), the right coronary artery (90%) and the circumflex artery (70%). On echocardiography, the mean Left ventricular ejection fraction (LVEF) was 59% [33% - 76%]. All patients underwent median sternotomy with bypass grafting. The average duration of the cardiopulmonary bypass was 150 min [46 - 275 min];that of aortic clamping, 120 min [43 - 232 min]. The grafts used were internal thoracic artery (ITA) in 100% of cases (80% on the left and 20% on the right), and the great saphenous vein (GSV) in 60% of cases (50% on the left and 10 on the right). Double bypass was performed in 60% of cases, single bypass in 30% and triple bypass in 10%. The bypasses were performed on the IVA (100%), the middle lateral of the circumflex (30%) and the bisector (20%). The average time to extubation was 11 hours and the length of stay in the intensive care unit was 7 days [03 - 17 days]. One patient had a reoperation on Day 0 post-op. The average hospital stay was 13 days [06 - 27 days]. Complications occurred in nine of the patients (90%), with a predominance of infectious and neurological complications. Overall operative mortality was 3%, all in intensive care.
基金supported by Jiangsu Province Hospital(the First Affiliated Hospital of Nanjing Medical University)Clinical Capacity Enhancement and was awarded to the first author,Chanjuan Gong(Grant No.JSPH-MC-2022-4).
文摘The present study aimed to dynamically observe the segmental and global myocardial movements of the left ventricle during coronary artery bypass grafting by transesophageal speckle-tracking echocardiography,and to assess the effect of sevoflurane on cardiac function.Sixty-four patients scheduled for the off-pump coronary artery bypass grafting were randomly divided into a sevoflurane-based anesthesia(AS)group and a propofolbased total intravenous anesthesia(AA)group.The AS group demonstrated a higher absolute value of left ventricular global longitudinal strain than that of the AA group at both T1(after harvesting all grafts and before coronary anastomosis)and T_(2)(30 min after completing all coronary anastomoses)(P<0.05).Moreover,strain improvement in the segment with the highest preoperative strain was significantly reduced in the AS group,compared with the AA group at both T1 and T_(2)(P<0.01).The flow of the left internal mammary artery-left anterior descending artery graft was superior,and the postoperative concentration of troponin T decreased rapidly in the AS group,compared with the AA group(P<0.05).Compared with total intravenous anesthesia,sevoflurane resulted in a significantly higher global longitudinal strain,stroke volume,and cardiac output.Sevoflurane also led to an amelioration in the condition of the arterial graft.Furthermore,sevoflurane significantly reduced strain improvement in the segmental myocardium with a high preoperative strain value.The findings need to be replicated in larger studies.
基金Supported by Chonnam National University Hospital Biomedical Research Institute,No.BCRI24031.
文摘BACKGROUND Superficial temporal artery to middle cerebral artery(STA-MCA)bypass is a valuable treatment for preventing ischemia and hemorrhage in occlusive cerebrovascular disease.Anastomosis site dissection is rarely reported among the various bypass-related complications.CASE SUMMARY In this case report,we describe two patients,who were 63-and 59-years-old with middle cerebral artery occlusion treated by STA-MCA bypass.During bypass surgery,the recipient M4 artery intima was dissected.We sacrificed the dissecting portion,and no complications occurred during the follow-up period.Postoperative brain imaging revealed improved brain perfusion.We report rare cases of recipient artery dissection located in the extracranial to intracranial bypass site,and we suggest atherosclerotic changes in the recipient artery and insufficient puncture as the causes.CONCLUSION Appropriate recipient artery selection is critical,and if dissection occurs,it is essential to sacrifice the dissecting portion quickly.
文摘Prekallikrein deficiency is a disorder that often remains undiagnosed. Prekallikrein activates factor XII, which initiates the intrinsic coagulation pathway. Prekallikrein deficiency results in prolonged Partial Thromboplastin Time and Activated Clotting Time in absence of anticoagulants or active bleeding. This case report describes the anesthesia management of a patient with Prekallikrein deficiency who underwent cardiac surgery with Cardiopulmonary Bypass for correction of a congenital cardiac malformation. We highlight the importance of understanding the different tests available for the diagnosis of coagulation factors deficiency during administration of heparin in the setting of cardiovascular procedures under general anesthesia.
基金supported by the National Natural Science Foundation of China(72171219,72201264,71921001,71801206,71971203)the Fundamental Research Funds for the Central Universities(WK2040000027)+1 种基金the New Liberal Arts Fund of USTC(FSSF-A-230104)the Four Batch Talent Programs of China.
文摘The booming live-streaming commerce has significantly changed the traditional e-commerce model,thus attracting much attention from both industry and academia.In recent years,an increasing number of scholars have applied analytical models to explore live-streaming strategies for firms in different scenarios.However,the previous literature mainly considers monopolists,while in the real world,competition is not rare.To fill this gap between the literature and practical observations,this paper applies a game theoretical model to study live-streaming adoption and pricing strategy for firms under competitive environments.The results show that,for competitive firms,the equilibrium strategy depends on the relation between the commission rate and the intensity of the market expansion effect.Additionally,compared to the case in which no firm adopts live-streaming,competitive firms do not always benefit from the adoption of live-streaming selling.The paper also shows that competition plays a negative role in inducing a firm to adopt live-streaming.
基金supported by the National Natural Science Foundation of China(Nos.61973206,61703265,61803250,and 61933008)the Shanghai Science and Technology Committee Rising-Star Program(No.19QA1403700)the National Center for Translational Medicine(Shanghai)SHU Branch.
文摘Tissue engineering has been striving toward designing and producing natural and functional human tissues.Cells are the fundamental building blocks of tissues.Compared with traditional two-dimensional cultured cells,cell spheres are threedimensional(3D)structures that can naturally form complex cell–cell and cell–matrix interactions.This structure is close to the natural environment of cells in living organisms.In addition to being used in disease modeling and drug screening,spheroids have significant potential in tissue regeneration.The 3D bioprinting is an advanced biofabrication technique.It accurately deposits bioinks into predesigned 3D shapes to create complex tissue structures.Although 3D bioprinting is efficient,the time required for cells to develop into complex tissue structures can be lengthy.The 3D bioprinting of spheroids significantly reduces the time required for their development into large tissues/organs during later cultivation stages by printing them with high cell density.Combining spheroid fabrication and bioprinting technology should provide a new solution to many problems in regenerative medicine.This paper systematically elaborates and analyzes the spheroid fabrication methods and 3D bioprinting strategies by introducing spheroids as building blocks.Finally,we present the primary challenges faced by spheroid fabrication and 3D bioprinting with future requirements and some recommendations.