This study develops a procedure to rank agencies based on their incident responses using roadway clearance times for crashes. This analysis is not intended to grade agencies but to assist in identifying agencies requi...This study develops a procedure to rank agencies based on their incident responses using roadway clearance times for crashes. This analysis is not intended to grade agencies but to assist in identifying agencies requiring more training or resources for incident management. Previous NCHRP reports discussed usage of different factors including incident severity, roadway characteristics, number of lanes involved and time of incident separately for estimating the performance. However, it does not tell us how to incorporate all the factors at the same time. Thus, this study aims to account for multiple factors to ensure fair comparisons. This study used 149,174 crashes from Iowa that occurred from 2018 to 2021. A Tobit regression model was used to find the effect of different variables on roadway clearance time. Variables that cannot be controlled directly by agencies such as crash severity, roadway type, weather conditions, lighting conditions, etc., were included in the analysis as it helps to reduce bias in the ranking procedure. Then clearance time of each crash is normalized into a base condition using the regression coefficients. The normalization makes the process more efficient as the effect of uncontrollable factors has already been mitigated. Finally, the agencies were ranked by their average normalized roadway clearance time. This ranking process allows agencies to track their performance of previous crashes, can be used in identifying low performing agencies that could use additional resources and training, and can be used to identify high performing agencies to recognize for their efforts and performance.展开更多
BACKGROUND Although en bloc dissection of hepatic hilum lymph nodes has many advantages in radical tumor treatment,the feasibility and safety of this approach for laparo-scopic pancreaticoduodenectomy(LPD)require furt...BACKGROUND Although en bloc dissection of hepatic hilum lymph nodes has many advantages in radical tumor treatment,the feasibility and safety of this approach for laparo-scopic pancreaticoduodenectomy(LPD)require further clinical evaluation and investigation.AIM To explore the application value of the"five steps four quadrants"modularized en bloc dissection technique for accessing hepatic hilum lymph nodes in LPD patients.METHODS A total of 52 patients who underwent LPD via the"five steps four quadrants"modularized en bloc dissection technique for hepatic hilum lymph nodes from April 2021 to July 2023 in our department were analyzed retrospectively.The patients'body mass index(BMI),preoperative laboratory indices,intraoperative variables and postoperative complications were recorded.The relationships between preoperative data and intraoperative lymph node dissection time and blood loss were also analyzed.RESULTS Among the 52 patients,36 were males and 16 were females,and the average age was 62.2±11.0 years.There were 26 patients with pancreatic head cancer,16 patients with periampullary cancer,and 10 patients with distal bile duct cancer.The BMI was 22.3±3.3 kg/m²,and the median total bilirubin(TBIL)concentration was 57.7(16.0-155.7)µmol/L.All patients successfully underwent the"five steps four quadrants"modularized en bloc dissection technique without lymph node clearance-related complications such as postoperative bleeding or lymphatic leakage.Correlation analysis revealed significant associations between preoperative BMI(r=0.3581,P=0.0091),TBIL level(r=0.2988,P=0.0341),prothrombin time(r=0.3018,P=0.0297)and lymph node dissection time.Moreover,dissection time was significantly correlated with intraoperative blood loss(r=0.7744,P<0.0001).Further stratified analysis demonstrated that patients with a preoperative BMI≥21.9 kg/m²and a TIBL concentration≥57.7μmol/L had significantly longer lymph node dissection times(both P<0.05).CONCLUSION The"five steps four quadrants"modularized en bloc dissection technique for accessing the hepatic hilum lymph node is safe and feasible for LPD.This technique is expected to improve the efficiency of hepatic hilum lymph node dissection and shorten the learning curve;thus,it is worthy of further clinical promotion and application.展开更多
Advancements in murine modeling systems for ulcerative colitis have diversified our understanding of the pathophysiological factors involved in disease onset and progression.This has fueled the identification of molec...Advancements in murine modeling systems for ulcerative colitis have diversified our understanding of the pathophysiological factors involved in disease onset and progression.This has fueled the identification of molecular targets,resulting in a rapidly expanding therapeutic armamentarium.Subsequently,management strategies have evolved from symptomatic resolution to well-defined objective endpoints,including clinical remission,endoscopic remission and mucosal healing.While the incorporation of these assessment modalities has permitted targeted intervention in the context of a natural disease history and the prevention of complications,studies have consistently depicted discrepancies associated with ascertaining disease status through clinical and endoscopic measures.Current recommendations lack consideration of histological healing.The simultaneous achievement of clinical,endoscopic,and histologic remission has not been fully investigated.This has laid the groundwork for a novel therapeutic outcome termed disease clearance(DC).This article summarizes the concept of DC and its current evidence.展开更多
Alzheimer's disease,the primary cause of dementia,is characterized by neuropathologies,such as amyloid plaques,synaptic and neuronal degeneration,and neurofibrillary tangles.Although amyloid plaques are the primar...Alzheimer's disease,the primary cause of dementia,is characterized by neuropathologies,such as amyloid plaques,synaptic and neuronal degeneration,and neurofibrillary tangles.Although amyloid plaques are the primary characteristic of Alzheimer's disease in the central nervous system and peripheral organs,targeting amyloid-beta clearance in the central nervous system has shown limited clinical efficacy in Alzheimer's disease treatment.Metabolic abnormalities are commonly observed in patients with Alzheimer's disease.The liver is the primary peripheral organ involved in amyloid-beta metabolism,playing a crucial role in the pathophysiology of Alzheimer's disease.Notably,impaired cholesterol metabolism in the liver may exacerbate the development of Alzheimer's disease.In this review,we explore the underlying causes of Alzheimer's disease and elucidate the role of the liver in amyloid-beta clearance and cholesterol metabolism.Furthermore,we propose that restoring normal cholesterol metabolism in the liver could represent a promising therapeutic strategy for addressing Alzheimer's disease.展开更多
The aim of this study was to optimize the geometry and the design of metallic/composite single bolted joints subjected to tension-compression loading. For this purpose, it was necessary to evaluate the stress state in...The aim of this study was to optimize the geometry and the design of metallic/composite single bolted joints subjected to tension-compression loading. For this purpose, it was necessary to evaluate the stress state in each component of the bolted join. The multi-material assembly was based on the principle of double lap bolted joint. It was composed of a symmetrical balanced woven glass-epoxy composite material plate fastened to two stainless sheets using a stainless pre-stressed bolt. In order to optimize the design and the geometry of the assembly, ten configurations were proposed and studied: a classical simple bolted joint, two joints with an insert (a BigHead<sup>R</sup> insert and a stair one) embedded in the composite, two “waved” solutions, three symmetrical configurations composed of a succession of metallic and composites layers, without a sleeve, with one and with two sleeves, and two non-symmetrical constituted of metallic and composites layers associated with a stair-insert (one with a sleeve and one without). A tridimensional Finite Element Method (FEM) was used to model each configuration mentioned above. The FE models taked into account the different materials, the effects of contact between the different sheets of the assembly and the pre-stress in the bolt. The stress state was analyzed in the composite part. The concept of stress concentration factor was used in order to evaluate the stress increase in the highly stressed regions and to compare the ten configurations studied. For this purpose, three stress concentration factors were defined: one for a monotonic loading in tension, another for a monotonic loading in compression, and the third for a tension-compression cyclic loading. The results of the FEM computations showed that the use of alternative metallic and composite layers associated with two sleeves gived low values of stress concentration factors, smaller than 1.4. In this case, there was no contact between the bolt and the composite part and the most stressed region was not the vicinity of the hole but the end of the longest layers of the metallic inserts.展开更多
3GPP在版本16(R16,Release 16)中升级了最小化路测(MDT,minimization of drive test)技术,提出移动终端可利用4G/5G网络自主上报Wi-Fi信号的接收信号强度指示(RSSI,received signal strength indicator),为运营商度量Wi-Fi网络的覆盖率...3GPP在版本16(R16,Release 16)中升级了最小化路测(MDT,minimization of drive test)技术,提出移动终端可利用4G/5G网络自主上报Wi-Fi信号的接收信号强度指示(RSSI,received signal strength indicator),为运营商度量Wi-Fi网络的覆盖率带来了可能性。然而,现有基于MDT技术的网络覆盖度量方法严重依赖GPS提供的位置坐标,但全球定位系统(GPS,global positioning system)不能提供室内精准定位,无法用于室内Wi-Fi网络的覆盖度量。为此,提出了一种不依赖位置坐标的RSSI聚类方法,充分利用室内相近位置RSSI的统计相似性,区分不同位置的RSSI测量差异,在无位置坐标条件下准确估计出室内Wi-Fi网络的覆盖率。实验结果表明,所提方法估计的覆盖率与基于真实位置坐标测量的覆盖率相近,度量准确度明显优于现有的其他方法。展开更多
文摘This study develops a procedure to rank agencies based on their incident responses using roadway clearance times for crashes. This analysis is not intended to grade agencies but to assist in identifying agencies requiring more training or resources for incident management. Previous NCHRP reports discussed usage of different factors including incident severity, roadway characteristics, number of lanes involved and time of incident separately for estimating the performance. However, it does not tell us how to incorporate all the factors at the same time. Thus, this study aims to account for multiple factors to ensure fair comparisons. This study used 149,174 crashes from Iowa that occurred from 2018 to 2021. A Tobit regression model was used to find the effect of different variables on roadway clearance time. Variables that cannot be controlled directly by agencies such as crash severity, roadway type, weather conditions, lighting conditions, etc., were included in the analysis as it helps to reduce bias in the ranking procedure. Then clearance time of each crash is normalized into a base condition using the regression coefficients. The normalization makes the process more efficient as the effect of uncontrollable factors has already been mitigated. Finally, the agencies were ranked by their average normalized roadway clearance time. This ranking process allows agencies to track their performance of previous crashes, can be used in identifying low performing agencies that could use additional resources and training, and can be used to identify high performing agencies to recognize for their efforts and performance.
基金Supported by Health Research Program of Anhui,No.AHWJ2022b032。
文摘BACKGROUND Although en bloc dissection of hepatic hilum lymph nodes has many advantages in radical tumor treatment,the feasibility and safety of this approach for laparo-scopic pancreaticoduodenectomy(LPD)require further clinical evaluation and investigation.AIM To explore the application value of the"five steps four quadrants"modularized en bloc dissection technique for accessing hepatic hilum lymph nodes in LPD patients.METHODS A total of 52 patients who underwent LPD via the"five steps four quadrants"modularized en bloc dissection technique for hepatic hilum lymph nodes from April 2021 to July 2023 in our department were analyzed retrospectively.The patients'body mass index(BMI),preoperative laboratory indices,intraoperative variables and postoperative complications were recorded.The relationships between preoperative data and intraoperative lymph node dissection time and blood loss were also analyzed.RESULTS Among the 52 patients,36 were males and 16 were females,and the average age was 62.2±11.0 years.There were 26 patients with pancreatic head cancer,16 patients with periampullary cancer,and 10 patients with distal bile duct cancer.The BMI was 22.3±3.3 kg/m²,and the median total bilirubin(TBIL)concentration was 57.7(16.0-155.7)µmol/L.All patients successfully underwent the"five steps four quadrants"modularized en bloc dissection technique without lymph node clearance-related complications such as postoperative bleeding or lymphatic leakage.Correlation analysis revealed significant associations between preoperative BMI(r=0.3581,P=0.0091),TBIL level(r=0.2988,P=0.0341),prothrombin time(r=0.3018,P=0.0297)and lymph node dissection time.Moreover,dissection time was significantly correlated with intraoperative blood loss(r=0.7744,P<0.0001).Further stratified analysis demonstrated that patients with a preoperative BMI≥21.9 kg/m²and a TIBL concentration≥57.7μmol/L had significantly longer lymph node dissection times(both P<0.05).CONCLUSION The"five steps four quadrants"modularized en bloc dissection technique for accessing the hepatic hilum lymph node is safe and feasible for LPD.This technique is expected to improve the efficiency of hepatic hilum lymph node dissection and shorten the learning curve;thus,it is worthy of further clinical promotion and application.
文摘Advancements in murine modeling systems for ulcerative colitis have diversified our understanding of the pathophysiological factors involved in disease onset and progression.This has fueled the identification of molecular targets,resulting in a rapidly expanding therapeutic armamentarium.Subsequently,management strategies have evolved from symptomatic resolution to well-defined objective endpoints,including clinical remission,endoscopic remission and mucosal healing.While the incorporation of these assessment modalities has permitted targeted intervention in the context of a natural disease history and the prevention of complications,studies have consistently depicted discrepancies associated with ascertaining disease status through clinical and endoscopic measures.Current recommendations lack consideration of histological healing.The simultaneous achievement of clinical,endoscopic,and histologic remission has not been fully investigated.This has laid the groundwork for a novel therapeutic outcome termed disease clearance(DC).This article summarizes the concept of DC and its current evidence.
基金financially supported by the Science and Technology Innovation Program of Hunan Province,No.2022RC1220(to WP)China Postdoctoral Science Foundation,No.2022M711733(to ZZ)+2 种基金the National Natural Science Foundation of China,No.82160920(to ZZ)Hebei Postdoctoral Scientific Research Project,No.B2022003040(to ZZ)Hunan Flagship Department of Integrated Traditional Chinese and Western Medicine(to WP)。
文摘Alzheimer's disease,the primary cause of dementia,is characterized by neuropathologies,such as amyloid plaques,synaptic and neuronal degeneration,and neurofibrillary tangles.Although amyloid plaques are the primary characteristic of Alzheimer's disease in the central nervous system and peripheral organs,targeting amyloid-beta clearance in the central nervous system has shown limited clinical efficacy in Alzheimer's disease treatment.Metabolic abnormalities are commonly observed in patients with Alzheimer's disease.The liver is the primary peripheral organ involved in amyloid-beta metabolism,playing a crucial role in the pathophysiology of Alzheimer's disease.Notably,impaired cholesterol metabolism in the liver may exacerbate the development of Alzheimer's disease.In this review,we explore the underlying causes of Alzheimer's disease and elucidate the role of the liver in amyloid-beta clearance and cholesterol metabolism.Furthermore,we propose that restoring normal cholesterol metabolism in the liver could represent a promising therapeutic strategy for addressing Alzheimer's disease.
文摘The aim of this study was to optimize the geometry and the design of metallic/composite single bolted joints subjected to tension-compression loading. For this purpose, it was necessary to evaluate the stress state in each component of the bolted join. The multi-material assembly was based on the principle of double lap bolted joint. It was composed of a symmetrical balanced woven glass-epoxy composite material plate fastened to two stainless sheets using a stainless pre-stressed bolt. In order to optimize the design and the geometry of the assembly, ten configurations were proposed and studied: a classical simple bolted joint, two joints with an insert (a BigHead<sup>R</sup> insert and a stair one) embedded in the composite, two “waved” solutions, three symmetrical configurations composed of a succession of metallic and composites layers, without a sleeve, with one and with two sleeves, and two non-symmetrical constituted of metallic and composites layers associated with a stair-insert (one with a sleeve and one without). A tridimensional Finite Element Method (FEM) was used to model each configuration mentioned above. The FE models taked into account the different materials, the effects of contact between the different sheets of the assembly and the pre-stress in the bolt. The stress state was analyzed in the composite part. The concept of stress concentration factor was used in order to evaluate the stress increase in the highly stressed regions and to compare the ten configurations studied. For this purpose, three stress concentration factors were defined: one for a monotonic loading in tension, another for a monotonic loading in compression, and the third for a tension-compression cyclic loading. The results of the FEM computations showed that the use of alternative metallic and composite layers associated with two sleeves gived low values of stress concentration factors, smaller than 1.4. In this case, there was no contact between the bolt and the composite part and the most stressed region was not the vicinity of the hole but the end of the longest layers of the metallic inserts.
文摘3GPP在版本16(R16,Release 16)中升级了最小化路测(MDT,minimization of drive test)技术,提出移动终端可利用4G/5G网络自主上报Wi-Fi信号的接收信号强度指示(RSSI,received signal strength indicator),为运营商度量Wi-Fi网络的覆盖率带来了可能性。然而,现有基于MDT技术的网络覆盖度量方法严重依赖GPS提供的位置坐标,但全球定位系统(GPS,global positioning system)不能提供室内精准定位,无法用于室内Wi-Fi网络的覆盖度量。为此,提出了一种不依赖位置坐标的RSSI聚类方法,充分利用室内相近位置RSSI的统计相似性,区分不同位置的RSSI测量差异,在无位置坐标条件下准确估计出室内Wi-Fi网络的覆盖率。实验结果表明,所提方法估计的覆盖率与基于真实位置坐标测量的覆盖率相近,度量准确度明显优于现有的其他方法。
