The Unique citing documents Journal Impact Factor(Uniq-JIF)as a supplement for the standard Journal Impact Factor

1 A new type of impact factor The Unique citing documents Journal Impact Factor(Uniq-JIF)is defined as follows:Uniq-JIF=Number of unique citing documents/Number of citable items(1)We note that formula(1)is given in a generic form.In concrete applications,one must state the publication for which the Uniq-JIF is calculated(a journal,an edited book,a conference proceedings).

The Impact of Lifestyle Factors on Migraine Frequency and Severity in Neurology

Objective: This systematic review examines the impact of lifestyle factors on migraine frequency and severity through a comprehensive analysis of lifestyle factors such as diet, physical activity, sleep patterns, stress, mental health, and environmental influences. Methods: We thoroughly searched Google Scholar, PUBMED, Scopus, and Web of Science databases using keywords related to migraines and lifestyle factors. Keywords incorporated the Boolean operator “and” to narrow search results. Following the PRISMA guidelines, we identified, screened, and evaluated studies for inclusion, resulting in nine studies meeting the eligibility criteria. Results: A total of 4917 records were initially identified from Scopus (2786), PubMed (854), and Web of Science (1277). Following deduplication, 3657 records underwent title screening, with 382 additionally screened by abstract. Ultimately, 88 full-text articles were assessed, resulting in 9 studies meeting eligibility for qualitative synthesis: 7 prospective and 2 retrospective studies. Our findings highlight the multifaceted role of lifestyle factors in migraine pathophysiology and management. Dietary habits, such as high-calorie, high-fat, and gluten-containing diets were linked to migraine triggers. Moderate physical activity showed beneficial effects on migraine management, while intense exercise could exacerbate symptoms. Poor sleep hygiene and insomnia were strongly associated with increased migraine frequency and severity. Chronic stress and poor mental health significantly contributed to migraine exacerbation, with stress management techniques proving beneficial. Environmental factors, including light, sound, weather changes, and allergens, were also identified as significant migraine triggers. Conclusions: Personalized lifestyle modifications, tailored to individual patient profiles, are crucial in managing migraines. Evidence-based recommendations include balanced diets, moderate physical activity, improved sleep hygiene, stress management techniques, and environmental adaptations.

Quantifying the impact of earthquakes and geological factors on spatial heterogeneity of debris-flow prone areas:A case study in the Hengduan Mountains

Understanding the spatial heterogeneity of debris-flow-prone areas holds significant implications for regional risk management, particularly in seismically active regions with geological faults. Despite the significance of this knowledge, a comprehensive quantification of the influence of regional topographical and geological factors on the spatial heterogeneity of debris-flow-prone areas has been lacking. This study selected the Hengduan Mountains, an earthquake-prone region characterized by diverse surface conditions and complex landforms, as a representative study area. An improved units zoning and objective factors identification methodology was employed in earthquake and fault analysis to assess the impact of seismic activity and geological factors on spatial heterogeneity of debrisflow prone areas. Results showed that the application of GIS technology with hydrodynamic intensity and geographical units analysis can effectively analyze debris-flow prone areas. Meanwhile, earthquake and fault zones obviously increase the density of debrisflow prone catchments and make them unevenly distributed. The number of debris-flow prone areas shows a nonlinear variation with the gradual increase of geomorphic factor value. Specifically, the area with 1000 m-2500 m elevation difference, 25°-30° average slope, and 0.13-0.15 land use index is the most favorable conditions for debris-flow occurrence;The average annual rainfall from 600 to 1150 mm and landslides gradient from 16° to 35° are the main causal factors to trigger debris flow. Our study sheds light on the quantification of spatial heterogeneity in debris flow-prone areas in earthquake-prone regions, which can offer crucial support for post-debris flow risk management strategies.

The modern textile factory:Charting the impact of a shifting textile supply chain landscape

Smartex is at the forefront of transforming the textile industry through the integration of Artificial Intelligence,focusing specifically on achieving zero waste and traceability in Tier 2,the most impactful step of the textile supply chain.They are part of a larger movement involving dynamic technology companies,forward-thinking factories,pioneering brands,and influential policy-makers all actively addressing challenges within the supply chain.

Efficacy and Impact on Inflammatory Factors and Lung Function in Pediatric Bronchial Asthma Treated with Modified Dingchuan Decoction

Objective:To study the efficacy of treating pediatric bronchial asthma with a modified Dingchuan Decoction and its effect on inflammatory factors and lung function levels.Methods:Sixty cases of bronchial asthma admitted to the hospital between January and December 2023 were divided into two groups using a computerized randomization method.One group of 30 cases received basic treatment with a salmeterol ticarcoson powder inhaler(control group),while the observation group received the same treatment plus a modified Dingchuan Decoction.The disappearance time of symptoms,levels of inflammatory factors,lung function indexes,and clinical efficacy were compared between the two groups.Results:The disappearance time of symptoms in the observation group was shorter than that in the control group.The levels of inflammatory factors after treatment were lower,and lung function indexes were higher in the observation group compared to the control group.Additionally,the total effective rate of treatment in the observation group was higher than that in the control group(P<0.05).Conclusion:In the clinical treatment of pediatric bronchial asthma,supplementing conventional Western medicine with a modified Dingchuan Decoction is effective,as it actively reduces inflammatory factor levels and improves lung function.

Significant risk factors for intensive care unit-acquired weakness:A processing strategy based on repeated machine learning

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.

Spatiotemporal deformation characteristics of Outang landslide and identification of triggering factors using data mining

Since the impoundment of Three Gorges Reservoir(TGR)in 2003,numerous slopes have experienced noticeable movement or destabilization owing to reservoir level changes and seasonal rainfall.One case is the Outang landslide,a large-scale and active landslide,on the south bank of the Yangtze River.The latest monitoring data and site investigations available are analyzed to establish spatial and temporal landslide deformation characteristics.Data mining technology,including the two-step clustering and Apriori algorithm,is then used to identify the dominant triggers of landslide movement.In the data mining process,the two-step clustering method clusters the candidate triggers and displacement rate into several groups,and the Apriori algorithm generates correlation criteria for the cause-and-effect.The analysis considers multiple locations of the landslide and incorporates two types of time scales:longterm deformation on a monthly basis and short-term deformation on a daily basis.This analysis shows that the deformations of the Outang landslide are driven by both rainfall and reservoir water while its deformation varies spatiotemporally mainly due to the difference in local responses to hydrological factors.The data mining results reveal different dominant triggering factors depending on the monitoring frequency:the monthly and bi-monthly cumulative rainfall control the monthly deformation,and the 10-d cumulative rainfall and the 5-d cumulative drop of water level in the reservoir dominate the daily deformation of the landslide.It is concluded that the spatiotemporal deformation pattern and data mining rules associated with precipitation and reservoir water level have the potential to be broadly implemented for improving landslide prevention and control in the dam reservoirs and other landslideprone areas.

Spatial-temporal differentiation and influencing factors of rural settlements in mountainous areas: an example of Liangshan Yi Autonomous Prefecture, Southwestern China

Rural settlement is the basic spatial unit for compact communities in rural area. Scientific exploration of spatial-temporal differentiation and its influencing factors is the premise of spatial layout rationalization. Based on land use data of Liangshan Yi Autonomous Prefecture(hereinafter referred to as Liangshan Prefecture) in Sichuan Province, China from 1980 to 2020, compactness index, fractal dimension, imbalance index, location entropy and the optimal parameters-based geographical detector(OPGD) model are used to analyze the spatial-temporal evolution of the morphological characteristics of rural settlements, and to explore the influence of natural geographical factors, socioeconomic factors, and policy factors on the spatial differentiation of rural settlements. The results show that:(1) From 1980 to 2020, the rural settlements area in Liangshan Prefecture increased by 15.96 km^(2). In space, the rural settlements are generally distributed in a local aggregation, dense in the middle and sparse around the periphery. In 2015, the spatial density and expansion index of rural settlements reached the peak.(2) From 1980 to 2020, the compactness index decreased from 0.7636 to 0.7496, the fractal dimension increased from 1.0283 to 1.0314, and the fragmentation index decreased from 0.1183 to 0.1047. The spatial morphological structure of rural settlements tended to be loose, the shape contour tended to be complex, the degree of fragmentation decreased, and the spatial distribution was significantly imbalanced.(3) The results of OPGD detection in 2015 show that the influence of each factor is slope(0.2371) > traffic accessibility(0.2098) > population(0.1403) > regional GDP(0.1325) > elevation(0.0987) > poverty alleviation(0). The results of OPGD detection in 2020 show that the influence of each factor is slope(0.2339) > traffic accessibility(0.2198) > population(0.1432) > regional GDP(0.1219) > poverty alleviation(0.0992) > elevation(0.093). Natural geographical factors(slope and elevation) are the basic factors affecting the spatial distribution of rural settlements, and rural settlements are widely distributed in the river valley plain and the second half mountain area. Socioeconomic factors(traffic accessibility, population, and regional GDP) have a greater impact on the spatial distribution of rural settlements, which is an important factor affecting the spatial distribution of rural settlements. Policy factors such as poverty alleviation relocation have an indispensable impact on the spatial distribution of rural settlements. The research results can provide decisionmaking basis for the spatial arrangement of rural settlements in Liangshan Prefecture, and optimize the implementation of rural revitalization policies.

Instrumented oscillographic study on impact toughness of an axle steel DZ2 with different tempering temperatures

Compared with the conventional Charpy impact test method,the oscillographic impact test can help in the behavioral analysis of materials during the fracture process.In this study,the trade-off relationship between the strength and toughness of a DZ2 axle steel at various tempering temperatures and the cause of the improvement in impact toughness was evaluated.The tempering process dramatically influenced carbide precipitation behavior,which resulted in different aspect ratios of carbides.Impact toughness improved along with the rise in tempering temperature mainly due to the increase in energy required in impact crack propagation.The characteristics of the impact crack propagation process were studied through a comprehensive analysis of stress distribution,oscilloscopic impact statistics,fracture morphology,and carbide morphology.The poor impact toughness of low-tempering-temperature specimens was attributed to the increased number of stress concentration points caused by carbide morphology in the small plastic zone during the propagation process,which resulted in a mixed distribution of brittle and ductile fractures on the fracture surface.

Nonlinear Impact Damage Evolution of Charpy Type and Analysis of Its Key Influencing Factors

The current research of Charpy impact mainly focuses on obtaining the ductile brittle transition temperature of materials by experiments.Compared with experiments,numerical simulation can study many problems with harsh conditions.However,there are still few studies on the influence of geometric factors such as side grooves.In this paper,the geometry of standard Charpy impact test is designed.Specimens with different widths and side grooves are tested.The finite element model of Charpy impact was established by ABAQUS software.Use test results and simulation results to verify each other.The effects of sample width,side groove depth and side groove bottom fillet on the impact fracture resistance of the sample were studied.The results show that the specimen width is positively correlated with the impact toughness of the specimen.The side groove greatly reduces the impact toughness of the material;the toughness of side groove decreases with the increase of depth;the fracture toughness of side groove decreases with the increase of fillet at the bottom of side groove.The proportion of toughness energy to impact energy of samples was analyzed.The results show that the toughness energy accounts for about 70%of the impact energy of the sample,which has little to do with the geometric characteristics of the sample.This study presents a reliable method for studying Charpy impact tests.The influence of geometric parameters is obtained,which provides a reference method for the study of impact toughness of high toughness materials.

Predicting impact strength of perforated targets using artificial neural networks trained on FEM-generated datasets

The paper considers application of artificial neural networks(ANNs)for fast numerical evaluation of a residual impactor velocity for a family of perforated PMMA(Polymethylmethacrylate)targets.The ANN models were trained using sets of numerical results on impact of PMMA plates obtained via dynamic FEM coupled with incubation time fracture criterion.The developed approach makes it possible to evaluate the impact strength of a particular target configuration without complicated FEM calculations which require considerable computational resources.Moreover,it is shown that the ANN models are able to predict results for the configurations which cannot be processed using the developed FEM routine due to numerical instabilities and errors:the trained neural network uses information from successful computations to obtain results for the problematic cases.A simple static problem of a perforated plate deformation is discussed prior to the impact problem and preferable ANN architectures are presented for both problems.Some insight into the perforation pattern optimization using a genetic algorithm coupled with the ANN is also made and optimized perforation patterns which theoretically enhance the target impact strength are constructed.

Vascular endothelial growth factor/connective tissue growth factor and proteomic analysis of aqueous humor after intravitreal conbercept for proliferative diabetes retinopathy

AIM:To investigate the role of connective tissue growth factor(CTGF)and vascular endothelial growth factor(VEGF)in the protein profile of the aqueous humor in patients with proliferative diabetic retinopathy(PDR)following intravitreal injection of conbercept.METHODS:This study included 72 PDR patients and 8 cataract patients as controls.PDR patients were divided into 3 groups according to the intervals of 3,5,and 7d between intravitreal conbercept(IVC,0.5 mg/0.05 mL)injection and pars plana vitrectomy(PPV)performed.Aqueous humor samples were collected before and after IVC and PPV for VEGF and CTGF levels detected with enzyme-linked immunosorbent assay(ELISA).The differential proteomics of 10 patients who underwent PPV surgery 5d after IVC and 8 normal controls was studied,Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)analysis were performed on the data,and the protein interaction network of 23 differential proteins was studied.RESULTS:Post-IVC,VEGF levels decreased and CTGF levels increased significantly in aqueous humor,with the CTGF/VEGF ratio rising significantly at all intervals.Liquid chromatography tandem mass spectrometry(LC-MS/MS)identified differentially expressed proteins between preand post-IVC samples.GO and KEGG analyses revealed involvement in immune response,stress response,complement and coagulation cascades,ferroptosis,and PPAR signaling pathways.PPI analysis highlighted key proteins like APOA1,C3,and transferrin(TF).ELISA assay confirmed the differential expression of proteins such as HBA1,SERPINA1,COL1A1,and ACTB,with significant changes in the IVC groups.CONCLUSION:The study demonstrates that IVC effectively reduces VEGF levels while increasing CTGF levels,thereby modifying the CTGF/VEGF ratio,and IVC significantly alters the protein profile in the aqueous humor of patients with PDR.Proteomic analysis reveals that these changes are associated with critical biological pathways and protein interactions involved in immune response,stress response,and cellular metabolism.

Identifying the best common factor model via exploratory eactor analysis

Currently,there is no solid criterion for judging the quality of the estimators in factor analysis.This paper presents a new evaluation method for exploratory factor analysis that pinpoints an appropriate number of factors along with the best method for factor extraction.The proposed technique consists of two steps:testing the normality of the residuals from the fitted model via the Shapiro-Wilk test and using an empirical quantified index to judge the quality of the factor model.Examples are presented to demonstrate how the method is implemented and to verify its effectiveness.

Expression and significance of pigment epithelium-derived factor and vascular endothelial growth factor in colorectal adenoma and cancer

BACKGROUND The incidence and mortality of colorectal cancer(CRC)are among the highest in the world,and its occurrence and development are closely related to tumor neovascularization.When the balance between pigment epithelium-derived factors(PEDF)that inhibit angiogenesis and vascular endothelial growth factors(VEGF)that stimulate angiogenesis is broken,angiogenesis is out of control,resulting in tumor development.Therefore,it is very necessary to find more therapeutic targets for CRC for early intervention and later treatment.AIM To investigate the expression and significance of PEDF,VEGF,and CD31-stained microvessel density values(CD31-MVD)in normal colorectal mucosa,adenoma,and CRC.METHODS In this case-control study,we collected archived wax blocks of specimens from the Digestive Endoscopy Center and the General Surgery Department of Chengdu Second People's Hospital from April 2022 to October 2022.Fifty cases of specimen wax blocks were selected as normal intestinal mucosa confirmed by electronic colonoscopy and concurrent biopsy(normal control group),50 cases of specimen wax blocks were selected as colorectal adenoma confirmed by electronic colonoscopy and pathological biopsy(adenoma group),and 50 cases of specimen wax blocks were selected as CRC confirmed by postoperative pathological biopsy after inpatient operation of general surgery(CRC group).An immunohistochemical staining experiment was carried out to detect PEDF and VEGF expression in three groups of specimens,analyze their differences,study the relationship between the two and clinicopathological factors in CRC group,record CD31-MVD in the three groups,and analyze the correlation of PEDF,VEGF,and CD31-MVD in the colorectal adenoma group and the CRC group.The F test or adjusted F test is used to analyze measurement data statistically.Kruskal-Wallis rank sum test was used between groups for ranked data.The chi-square test,adjusted chi-square test,or Fisher's exact test were used to compare the rates between groups.All differences between groups were compared using the Bonferroni method for multiple comparisons.Spearman correlation analysis was used to test the correlation of the data.The test level(α)was 0.05,and a two-sided P<0.05 was considered statistically significant.RESULTS The positive expression rate and expression intensity of PEDF were gradually decreased in the normal control group,adenoma group,and CRC group(100%vs 78%vs 50%,χ^(2)=34.430,P<0.001;++~++vs+~++vs-~+,H=94.059,P<0.001),while VEGF increased gradually(0%vs 68%vs 96%,χ^(2)=98.35,P<0.001;-vs-~+vs++~+++,H=107.734,P<0.001).In the CRC group,the positive expression rate of PEDF decreased with the increase of differen-tiation degree,invasion depth,lymph node metastasis,distant metastasis,and TNM stage(χ^(2)=20.513,4.160,5.128,6.349,5.128,P<0.05);the high expression rate of VEGF was the opposite(χ^(2)=10.317,13.134,17.643,21.844,17.643,P<0.05).In the colorectal adenoma group,the expression intensity of PEDF correlated negatively with CD31-MVD(r=-0.601,P<0.001),whereas VEGF was not significantly different(r=0.258,P=0.07).In the CRC group,the expression intensity of PEDF correlated negatively with the expression intensity of CD31-MVD and VEGF(r=-0.297,P<0.05;r=-0.548,P<0.05),while VEGF expression intensity was positively related to CD31-MVD(r=0.421,P=0.002).CONCLUSION It is possible that PEDF can be used as a new treatment and prevention target for CRC by upregulating the expression of PEDF while inhibiting the expression of VEGF.

Environmental Impact Assessment of Onshore Wind Farms in the Region of Central Greece Using a Modified RIAM Method

Wind energy is one of the most basic forms of renewable energy,which shows an increasing rate of development worldwide and also at the European level.However,this rapid deployment of wind farms makes the need for an impact assessment of this type of projects on the natural and man-made environment imperative.The present paper aims to identify and assess the environmental impacts of wind farm projects in the Region of Central Greece.A modified Rapid Impact Assessment Matrix(RIAM)method is used for this purpose.The methodology includes the identification of the existing onshore wind farm projects in the study area,the appropriate modifications of the RIAM method to respond to the characteristics of the projects and the study area,the qualitative assessment of their potential impacts during construction and operational phases and the computation of the Environmental Performance Grade(EPG)of projects based on the pro-posed modified RIAM method.The results reveal that although there are some slight negative impacts on the natural environment of the study area,the examined wind farms contribute positively both to the atmosphere and to the socio-economic environment of the study.This study extends the potential for using RIAM as a tool in environmental impact assessment studies of renewable energy projects.

Assessment of early factors for identification or prediction severe acute pancreatitis in pregnancy

BACKGROUND Acute pancreatitis in pregnancy(APIP)is a rare and serious condition,and severe APIP(SAPIP)can lead to pancreatic necrosis,abscess,multiple organ dysfunction,and other adverse maternal and infant outcomes.Therefore,early identification or prediction of SAPIP is important.AIM To assess factors for early identification or prediction of SAPIP.METHODS The clinical data of patients with APIP were retrospectively analyzed.Patients were classified with mild acute pancreatitis or severe acute pancreatitis,and the clinical characteristics and laboratory biochemical indexes were compared between the two groups.Logical regression and receiver operating characteristic curve analyses were performed to assess the efficacy of the factors for identification or prediction of SAPIP.RESULTS A total of 45 APIP patients were enrolled.Compared with the mild acute pancreatitis group,the severe acute pancreatitis group had significantly increased(P<0.01)heart rate(HR),hemoglobin,neutrophil ratio(NEUT%),and neutrophil–lymphocyte ratio(NLR),while lymphocytes were significantly decreased(P<0.01).Logical regression analysis showed that HR,NEUT%,NLR,and lymphocyte count differed significantly(P<0.01)between the groups.These may be factors for early identification or prediction of SAPIP.The area under the curve of HR,NEUT%,NLR,and lymphocyte count in the receiver operating characteristic curve analysis was 0.748,0.732,0.821,and 0.774,respectively.The combined analysis showed that the area under the curve,sensitivity,and specificity were 0.869,90.5%,and 70.8%,respectively.CONCLUSION HR,NEUT%,NLR,and lymphocyte count can be used for early identification or prediction of SAPIP,and the combination of the four factors is expected to improve identification or prediction of SAPIP.

Development characteristics and controlling factors of fractures in lacustrine shale and their geological significance for evaluating shale oil sweet spots in the third member of the Shahejie Formation in the Qikou Sag, Bohai Bay Basin

Natural fractures are critical for shale oil and gas enrichment and development. Due to the extremely high heterogeneity of shale, the factors controlling the formation of internal fractures, especially horizontal fractures, remain controversial. In this study, we integrate thin section analysis and microcomputed tomography(CT) data from several lacustrine shale samples from the third member(Es3) of the Shahejie Formation, Qikou Sag, Bohai Bay Basin, to assess the fractures in detail. The goal is to reveal the development characteristics, controlling factors, and geological significance for evaluating sweet spots in a shale oil play. The fractures in the Es3contain high-angle structural and horizontal bed-parallel fractures that are mostly shear and extensional. Various factors influence fracture development,including lithofacies, mineral composition, organic matter content, and the number of laminae. Structural fractures occur predominantly in siltstone, whereas bed-parallel fractures are abundant in laminated shale and layered mudstone. A higher quartz content results in higher shale brittleness, causing fractures, whereas the transformation between clay minerals contributes to the development of bedparallel fractures. Excess pore pressure due to hydrocarbon generation and expulsion during thermal advance can cause the formation of bed-parallel fractures. The density of the bed-parallel and structural fractures increases with the lamina density, and the bed-parallel fractures are more sensitive to the number of laminae. The fractures are critical storage spaces and flow conduits and are indicative of sweet spots. The laminated shale in the Es3with a high organic matter content contains natural fractures and is an organic-rich, liquid-rich, self-sourced shale play. Conversely, the siltstone, massive mudstone, and argillaceous carbonate lithofacies contain lower amounts of organic matter and do not have bed-parallel fractures. However, good reservoirs can form in these areas when structural fractures are present and the source, and storage spaces are separated.

Comparison of clinical characteristics and prognostic factors in two site-specific categories of ampullary cancer

BACKGROUND Ampullary cancer is a relatively rare malignant tumor in the digestive system.Its incidence has increased in recent years.As for now,its biological characteristics have not been fully clarified.Recent studies have primarily focused on the histological classification and genetic changes,but there are fewer investigations into the differences among site-specific subgroups.The clinicopathological charac-teristics of ampullary cancer occurring in different positions have not been elucidated.Furthermore,the role of adjuvant therapy in the treatment of patients with ampullary cancer remains controversial.ampullary cancer and explore the factors affecting prognosis.METHODS A total of 356 patients who met the inclusion and exclusion criteria were enrolled.Patients were divided into ampulla of Vater cancer(AVC)and duodenal papilla cancer(DPC)based on the gross and microscopic findings.Baseline data,admission examination results,and perioperative outcomes were collected and analyzed.The Kaplan-Meier curve was used for survival analysis.Univariate and multivariate analysis was performed to explore the independent risk factors affecting the overall survival(OS)of both groups.RESULTS The preoperative total bilirubin level in patients with AVC was significantly higher than those with DPC(P=0.04).The OS for patients with DPC was 58.90±38.74 months,significantly longer than 44.31±35.90 months for patients with AVC(P<0.01).The independent risk factors affecting the OS of AVC included:Preoperative albumin level(P=0.009),total bilirubin level(P=0.017),and number of positive lymph nodes(P=0.005).For DPC,risk factors included:Age(P=0.004),tumor size(P=0.023),number of positive lymph nodes(P=0.010)and adjuvant treatment(P=0.020).Adjuvant therapy significantly improved the OS rate of patients with DPC,but not for those with AVC.CONCLUSION Patients with AVC had a shorter OS compared to those with DPC.The prognosis factors and the role of adjuvant therapy of two groups were different.

Adverse drug reactions of first-line antitubercular drugs:A retrospective study on characteristics,management,factors,and impacts

Objective:To elucidate the characteristics,management strategies,risk factors,and clinical impacts associated with adverse drug reactions(ADRs)induced by first-line antitubercular drugs to enhance tuberculosis(TB)management.Methods:A retrospective cohort study was conducted by retrieving drug-susceptible TB records among adult patients who received TB treatment from 2018 to 2021 at 10 public health clinics in Sarawak,Malaysia.Only the initial TB treatment and occurrence of specific ADRs within the study period were considered.Regression analysis was performed to identify the risk factors associated with both overall ADRs and individual types of ADRs.Results:Among 2953 cases,705(23.9%)developed ADRs.Cutaneous reactions were the most prevalent(47.1%),followed by hepatotoxicity(32.8%)and gastrointestinal disturbances(29.8%).Six out of seven types of ADRs investigated occurred within the intensive phase,mostly manifesting at approximately 2 weeks of initiation.Hepatotoxicity resulted in the majority(85.3%)of treatment discontinuations,while vision problems led to treatment modifications in half of the cases.Risk factors for all ADRs included age≥60 years,females,illicit drug use,and comorbidities such as HIV-positive,diabetes,and chronic liver disease.Alcohol consumption was independently associated with hepatotoxicity.ADRs caused around one-third of interruptions exceeding 2 weeks(33.0%)and subsequently necessitated treatment restarts(34.5%).Conclusions:Understanding these various aspects contributes to improving the overall management of ADRs in TB treatment.Close ADR monitoring and reporting are essential to strengthen ADR management.

Terrain or climate factor dominates vegetation resilience?Evidence from three national parks across different climatic zones in China

Vegetation resilience(VR),providing an objective measure of ecosystem health,has received considerable attention,however,there is still limited understanding of whether the dominant factors differ across different climate zones.We took the three national parks(Hainan Tropical Rainforest National Park,HTR;Wuyishan National Park,WYS;and Northeast Tiger and Leopard National Park,NTL)of China with less human interference as cases,which are distributed in different climatic zones,including tropical,subtropical and temperate monsoon climates,respectively.Then,we employed the probabilistic decay method to explore the spatio-temporal changes in the VR and their natural driving patterns using Geographically Weighted Regression(GWR)model as well.The results revealed that:(1)from 2000 to 2020,the Normalized Difference Vegetation Index(NDVI)of the three national parks fluctuated between 0.800 and 0.960,exhibiting an overall upward trend,with the mean NDVI of NTL(0.923)>HTR(0.899)>WYS(0.823);(2)the positive trend decay time of vegetation exceeded that of negative trend,indicating vegetation gradual recovery of the three national parks since 2012;(3)the VR of HTR was primarily influenced by elevation,aspect,average annual temperature change(AATC),and average annual precipitation change(AAPC);the WYS'VR was mainly affected by elevation,average annual precipitation(AAP),and AAPC;while the terrain factors(elevation and slope)were the main driving factors of VR in NTL;(4)among the main factors influencing the VR changes,the AAPC had the highest proportion in HTR(66.7%),and the AAP occupied the largest area proportion in WYS(80.4%).While in NTL,elevation served as the main driving factor for the VR,encompassing 64.2%of its area.Consequently,our findings indicated that precipitation factors were the main driving force for the VR changes in HTR and WYS national parks,while elevation was the main factors that drove the VR in NTL.Our research has promoted a deeper understanding of the driving mechanism behind the VR.