Development and validation of a new prognostic model for patients with acute-on-chronic liver failure in intensive care unit

BACKGROUND Cirrhotic patients with acute-on-chronic liver failure(ACLF)in the intensive care unit(ICU)have a poor but variable prognoses.Accurate prognosis evaluation can guide the rational management of patients with ACLF.However,existing prognostic scores for ACLF in the ICU environment lack sufficient accuracy.AIM To develop a new prognostic model for patients with ACLF in ICU.METHODS Data from 938 ACLF patients in the Medical Information Mart for Intensive Care(MIMIC)database were used to develop a new prognostic model(MIMIC ACLF)for ACLF.Discrimination,calibration and clinical utility of MIMIC ACLF were assessed by area under receiver operating characteristic curve(AUROC),calibration curve and decision curve analysis(DCA),respectively.MIMIC ACLF was then externally validated in a multiple-center cohort,the Electronic Intensive Care Collaborative Research Database and a single-center cohort from the Second Hospital of Hebei Medical University in China.RESULTS The MIMIC ACLF score was determined using nine variables:ln(age)×2.2+ln(white blood cell count)×0.22-ln(mean arterial pressure)×2.7+respiratory failure×0.6+renal failure×0.51+cerebral failure×0.31+ln(total bilirubin)×0.44+ln(internationalized normal ratio)×0.59+ln(serum potassium)×0.59.In MIMIC cohort,the AUROC(0.81/0.79)for MIMIC ACLF for 28/90-day ACLF mortality were significantly greater than those of Chronic Liver Failure Consortium ACLF(0.76/0.74),Model for End-stage Liver Disease(MELD;0.73/0.71)and MELD-Na(0.72/0.70)(all P<0.001).The consistency between actual and predicted 28/90-day survival rates of patients according to MIMIC ACLF score was excellent and superior to that of existing scores.The net benefit of MIMIC ACLF was greater than that achieved using existing scores within the 50%threshold probability.The superior predictive accuracy and clinical utility of MIMIC ACLF were validated in the external cohorts.CONCLUSION We developed and validated a new prognostic model with satisfactory accuracy for cirrhotic patients with ACLF hospitalized in the ICU.The model-based risk stratification and online calculator might facilitate the rational management of patients with ACLF.

Nomogram based on liver stiffness and spleen area with ultrasound for posthepatectomy liver failure:A multicenter study

BACKGROUND Liver stiffness(LS)measurement with two-dimensional shear wave elastography(2D-SWE)correlates with the degree of liver fibrosis and thus indirectly reflects liver function reserve.The size of the spleen increases due to tissue proliferation,fibrosis,and portal vein congestion,which can indirectly reflect the situation of liver fibrosis/cirrhosis.It was reported that the size of the spleen was related to posthepatectomy liver failure(PHLF).So far,there has been no study combining 2D-SWE measurements of LS with spleen size to predict PHLF.This prospective study aimed to investigate the utility of 2D-SWE assessing LS and spleen area(SPA)for the prediction of PHLF in hepatocellular carcinoma(HCC)patients and to develop a risk prediction model.AIM To investigate the utility of 2D-SWE assessing LS and SPA for the prediction of PHLF in HCC patients and to develop a risk prediction model.METHODS This was a multicenter observational study prospectively analyzing patients who underwent hepatectomy from October 2020 to March 2022.Within 1 wk before partial hepatectomy,ultrasound examination was performed to measure LS and SPA,and blood was drawn to evaluate the patient’s liver function and other conditions.Least absolute shrinkage and selection operator logistic regression and multivariate logistic regression analysis was applied to identify independent predictors of PHLF and develop a nomogram.Nomogram performance was validated further.The diagnostic performance of the nomogram was evaluated with receiver operating charac-teristic curve compared with the conventional models,including the model for end-stage liver disease(MELD)score and the albumin-bilirubin(ALBI)score.RESULTS A total of 562 HCC patients undergoing hepatectomy(500 in the training cohort and 62 in the validation cohort)were enrolled in this study.The independent predictors of PHLF were LS,SPA,range of resection,blood loss,international normalized ratio,and total bilirubin.Better diagnostic performance of the nomogram was obtained in the training[area under receiver operating characteristic curve(AUC):0.833;95%confidence interval(95%CI):0.792-0.873;sensitivity:83.1%;specificity:73.5%]and validation(AUC:0.802;95%CI:0.684-0.920;sensitivity:95.5%;specificity:52.5%)cohorts compared with the MELD score and the ALBI score.CONCLUSION This PHLF nomogram,mainly based on LS by 2D-SWE and SPA,was useful in predicting PHLF in HCC patients and presented better than MELD score and ALBI score.

Silent information regulator sirtuin 1 ameliorates acute liver failure via the p53/glutathione peroxidase 4/gasdermin D axis

BACKGROUND Acute liver failure(ALF)has a high mortality with widespread hepatocyte death involving ferroptosis and pyroptosis.The silent information regulator sirtuin 1(SIRT1)-mediated deacetylation affects multiple biological processes,including cellular senescence,apoptosis,sugar and lipid metabolism,oxidative stress,and inflammation.AIM To investigate the association between ferroptosis and pyroptosis and the upstream regulatory mechanisms.METHODS This study included 30 patients with ALF and 30 healthy individuals who underwent serum alanine aminotransferase(ALT)and aspartate aminotransferase(AST)testing.C57BL/6 mice were also intraperitoneally pretreated with SIRT1,p53,or glutathione peroxidase 4(GPX4)inducers and inhibitors and injected with lipopolysaccharide(LPS)/D-galactosamine(D-GalN)to induce ALF.Gasdermin D(GSDMD)^(-/-)mice were used as an experimental group.Histological changes in liver tissue were monitored by hematoxylin and eosin staining.ALT,AST,glutathione,reactive oxygen species,and iron levels were measured using commercial kits.Ferroptosis-and pyroptosis-related protein and mRNA expression was detected by western blot and quantitative real-time polymerase chain reaction.SIRT1,p53,and GSDMD were assessed by immunofluorescence analysis.RESULTS Serum AST and ALT levels were elevated in patients with ALF.SIRT1,solute carrier family 7a member 11(SLC7A11),and GPX4 protein expression was decreased and acetylated p5,p53,GSDMD,and acyl-CoA synthetase long-chain family member 4(ACSL4)protein levels were elevated in human ALF liver tissue.In the p53 and ferroptosis inhibitor-treated and GSDMD^(-/-)groups,serum interleukin(IL)-1β,tumour necrosis factor alpha,IL-6,IL-2 and C-C motif ligand 2 levels were decreased and hepatic impairment was mitigated.In mice with GSDMD knockout,p53 was reduced,GPX4 was increased,and ferroptotic events(depletion of SLC7A11,elevation of ACSL4,and iron accumulation)were detected.In vitro,knockdown of p53 and overexpression of GPX4 reduced AST and ALT levels,the cytostatic rate,and GSDMD expression,restoring SLC7A11 depletion.Moreover,SIRT1 agonist and overexpression of SIRT1 alleviated acute liver injury and decreased iron deposition compared with results in the model group,accompanied by reduced p53,GSDMD,and ACSL4,and increased SLC7A11 and GPX4.Inactivation of SIRT1 exacerbated ferroptotic and pyroptotic cell death and aggravated liver injury in LPS/D-GalNinduced in vitro and in vivo models.CONCLUSION SIRT1 activation attenuates LPS/D-GalN-induced ferroptosis and pyroptosis by inhibiting the p53/GPX4/GSDMD signaling pathway in ALF.

Validation and performance of three scoring systems for predicting primary non-function and early allograft failure after liver transplantation

Background: Primary non-function(PNF) and early allograft failure(EAF) after liver transplantation(LT) seriously affect patient outcomes. In clinical practice, effective prognostic tools for early identifying recipients at high risk of PNF and EAF were urgently needed. Recently, the Model for Early Allograft Function(MEAF), PNF score by King's College(King-PNF) and Balance-and-Risk-Lactate(BAR-Lac) score were developed to assess the risks of PNF and EAF. This study aimed to externally validate and compare the prognostic performance of these three scores for predicting PNF and EAF. Methods: A retrospective study included 720 patients with primary LT between January 2015 and December 2020. MEAF, King-PNF and BAR-Lac scores were compared using receiver operating characteristic(ROC) and the net reclassification improvement(NRI) and integrated discrimination improvement(IDI) analyses. Results: Of all 720 patients, 28(3.9%) developed PNF and 67(9.3%) developed EAF in 3 months. The overall early allograft dysfunction(EAD) rate was 39.0%. The 3-month patient mortality was 8.6% while 1-year graft-failure-free survival was 89.2%. The median MEAF, King-PNF and BAR-Lac scores were 5.0(3.5–6.3),-2.1(-2.6 to-1.2), and 5.0(2.0–11.0), respectively. For predicting PNF, MEAF and King-PNF scores had excellent area under curves(AUCs) of 0.872 and 0.891, superior to BAR-Lac(AUC = 0.830). The NRI and IDI analyses confirmed that King-PNF score had the best performance in predicting PNF while MEAF served as a better predictor of EAD. The EAF risk curve and 1-year graft-failure-free survival curve showed that King-PNF was superior to MEAF and BAR-Lac scores for stratifying the risk of EAF. Conclusions: MEAF, King-PNF and BAR-Lac were validated as practical and effective risk assessment tools of PNF. King-PNF score outperformed MEAF and BAR-Lac in predicting PNF and EAF within 6 months. BAR-Lac score had a huge advantage in the prediction for PNF without post-transplant variables. Proper use of these scores will help early identify PNF, standardize grading of EAF and reasonably select clinical endpoints in relative studies.

Heparin is an effective treatment for preventing liver failure after hepatectomy

BACKGROUND Posthepatectomy liver failure(PHLF)is one of the most important causes of death following liver resection.Heparin,an established anticoagulant,can protect liver function through a number of mechanisms,and thus,prevent liver failure.AIM To look at the safety and efficacy of heparin in preventing hepatic dysfunction after hepatectomy.METHODS The data was extracted from Multiparameter Intelligent Monitoring in Intensive Care III(MIMIC-III)v1.4 pinpointed patients who had undergone hepatectomy for liver cancer,subdividing them into two cohorts:Those who were injected with heparin and those who were not.The statistical evaluations used were unpaired ttests,Mann-Whitney U tests,chi-square tests,and Fisher’s exact tests to assess the effect of heparin administration on PHLF,duration of intensive care unit(ICU)stay,need for mechanical ventilation,use of continuous renal replacement therapy(CRRT),incidence of hypoxemia,development of acute kidney injury,and ICU mortality.Logistic regression was utilized to analyze the factors related to PHLF,with propensity score matching(PSM)aiming to balance the preoperative disparities between the two groups.RESULTS In this study,1388 patients who underwent liver cancer hepatectomy were analyzed.PSM yielded 213 matched pairs from the heparin-treated and control groups.Initial univariate analyses indicated that heparin potentially reduces the risk of PHLF in both matched and unmatched samples.Further analysis in the matched cohorts confirmed a significant association,with heparin reducing the risk of PHLF(odds ratio:0.518;95%confidence interval:0.295-0.910;P=0.022).Additionally,heparin treatment correlated with improved short-term postoperative outcomes such as reduced ICU stay durations,diminished requirements for respiratory support and CRRT,and lower incidences of hypoxemia and ICU mortality.CONCLUSION Liver failure is an important hazard following hepatic surgery.During ICU care heparin administration has been proved to decrease the occurrence of hepatectomy induced liver failure.This indicates that heparin may provide a hopeful option for controlling PHLF.

A Comparative Study on the Post-Buckling Behavior of Reinforced Thermoplastic Pipes(RTPs)Under External Pressure Considering Progressive Failure

The collapse pressure is a key parameter when RTPs are applied in harsh deep-water environments.To investigate the collapse of RTPs,numerical simulations and hydrostatic pressure tests are conducted.For the numerical simulations,the eigenvalue analysis and Riks analysis are combined,in which the Hashin failure criterion and fracture energy stiffness degradation model are used to simulate the progressive failure of composites,and the“infinite”boundary conditions are applied to eliminate the boundary effects.As for the hydrostatic pressure tests,RTP specimens were placed in a hydrostatic chamber after filled with water.It has been observed that the cross-section of the middle part collapses when it reaches the maximum pressure.The collapse pressure obtained from the numerical simulations agrees well with that in the experiment.Meanwhile,the applicability of NASA SP-8007 formula on the collapse pressure prediction was also discussed.It has a relatively greater difference because of the ignorance of the progressive failure of composites.For the parametric study,it is found that RTPs have much higher first-ply-failure pressure when the winding angles are between 50°and 70°.Besides,the effect of debonding and initial ovality,and the contribution of the liner and coating are also discussed.

Effect of Interface Form on Creep Failure and Life of Dissimilar Metal Welds Involving Nickel-Based Weld Metal and Ferritic Base Metal

For dissimilar metal welds(DMWs)involving nickel-based weld metal(WM)and ferritic heat resistant steel base metal(BM)in power plants,there must be an interface between WM and BM,and this interface suffers mechanical and microstructure mismatches and is often the rupture location of premature failure.In this study,a new form of WM/BM interface form,namely double Y-type interface was designed for the DMWs.Creep behaviors and life of DMWs containing double Y-type interface and conventional I-type interface were compared by finite element analysis and creep tests,and creep failure mechanisms were investigated by stress-strain analysis and microstructure characterization.By applying double Y-type interface instead of conventional I-type interface,failure location of DMW could be shifted from the WM/ferritic heat-affected zone(HAZ)interface into the ferritic HAZ or even the ferritic BM,and the failure mode change improved the creep life of DMW.The interface premature failure of I-type interface DMW was related to the coupling effect of microstructure degradation,stress and strain concentrations,and oxide notch on the WM/HAZ interface.The creep failure of double Y-type interface DMW was the result of Type IV fracture due to the creep voids and micro-cracks on fine-grain boundaries in HAZ,which was a result of the matrix softening of HAZ and lack of precipitate pinning at fine-grain boundaries.The double Y-type interface form separated the stress and strain concentrations in DMW from the WM/HAZ interface,preventing the trigger effect of oxide notch on interface failure and inhibiting the interfacial microstructure cracking.It is a novel scheme to prolong creep life and enhance reliability of DMW,by means of optimizing the interface form,decoupling the damage factors from WM/HAZ interface,and then changing the failure mechanism and shifting the failure location.

Serum cystatin C,monocyte/high-density lipoprotein-C ratio,and uric acid for the diagnosis of coronary heart disease and heart failure

BACKGROUND Coronary heart disease(CHD)and heart failure(HF)are the major causes of morbidity and mortality worldwide.Early and accurate diagnoses of CHD and HF are essential for optimal management and prognosis.However,conventional diagnostic methods such as electrocardiography,echocardiography,and cardiac biomarkers have certain limitations,such as low sensitivity,specificity,availability,and cost-effectiveness.Therefore,there is a need for simple,noninvasive,and reliable biomarkers to diagnose CHD and HF.AIM To investigate serum cystatin C(Cys-C),monocyte/high-density lipoprotein cholesterol ratio(MHR),and uric acid(UA)diagnostic values for CHD and HF.METHODS We enrolled 80 patients with suspected CHD or HF who were admitted to our hospital between July 2022 and July 2023.The patients were divided into CHD(n=20),HF(n=20),CHD+HF(n=20),and control groups(n=20).The serum levels of Cys-C,MHR,and UA were measured using immunonephelometry and an enzymatic method,respectively,and the diagnostic values for CHD and HF were evaluated using receiver operating characteristic(ROC)curve analysis.RESULTS Serum levels of Cys-C,MHR,and UA were significantly higher in the CHD,HF,and CHD+HF groups than those in the control group.The serum levels of Cys-C,MHR,and UA were significantly higher in the CHD+HF group than those in the CHD or HF group.The ROC curve analysis showed that serum Cys-C,MHR,and UA had good diagnostic performance for CHD and HF,with areas under the curve ranging from 0.78 to 0.93.The optimal cutoff values of serum Cys-C,MHR,and UA for diagnosing CHD,HF,and CHD+HF were 1.2 mg/L,0.9×10^(9),and 389μmol/L;1.4 mg/L,1.0×10^(9),and 449μmol/L;and 1.6 mg/L,1.1×10^(9),and 508μmol/L,respectively.CONCLUSION Serum Cys-C,MHR,and UA are useful biomarkers for diagnosing CHD and HF,and CHD+HF.These can provide information for decision-making and risk stratification in patients with CHD and HF.

Mechanism of principal stress rotation and deformation failure behavior induced by excavation in roadways

The failure modes of rock after roadway excavation are diverse and complex.A comprehensive investigation of the internal stress field and the rotation behavior of the stress axis in roadways is essential for elucidating the mechanism of roadway failure.This study aimed to examine the spatial relationship between roadways and stress fields.The law of stress axis rotation under three-dimensional(3D)stress has been extensively studied.A stress model of roadways in the spatial stress field was established,and the far-field stress state at different spatial positions of the roadways was analyzed.A mechanical model of roadways under a 3D stress state was established using far-field stress solutions as boundary conditions.The distribution of principal stressesσ1,σ2 andσ3 around the roadways and the variation of the stress principal axis were solved.It was found that the stability boundary of the stress principal axis exhibits hysteresis when compared with that of the principal stress magnitudes.A numerical analysis model for spatial roadways was established to validate the distribution of principal stress and the mechanism of principal axis rotation.Research has demonstrated that the stress axis undergoes varying degrees of spatial rotation in different orientations and radial depths.Based on the distribution of principal stress and the rotation law of the stress principal axis,the entire evolution mechanism of the two stress adjustments to form the final failure form after roadway excavation has been revealed.The on-site detection results also corroborate the findings presented in this paper.The results provide a basis for the analysis of the failure mechanism under a 3D stress state.

The Problem of Rehospitalisation for Heart Failure at the Cardiology Department of the Hôpital National Ignace Deen

Introduction: Despite current therapeutic advances, heart failure in sub-Saharan Africa remains a common, serious and costly disease, particularly due to rehospitalizations. The objective of this work was to determine the proportion of rehospitalizations for heart failure and to identify etiological factors. Methodology: This was a retrospective descriptive study with a duration of 8 months from April 1 to November 30, 2021. This study included all patients rehospitalized in the department for Heart Failure and who agreed to participate in our study. Results: During the period of our study, 437 patients were hospitalized in the HF department, among which we collected 126 cases of rehospitalization for HF with a frequency of 28.83%. The mean age of our patients was 46.32 ± 18.98 years with the extremes of 15 to 84 years. The most affected age group was between 35 and 44 years old in 24 cases, i.e. a frequency of 19%. We observed a female predominance of 64 cases, i.e. a frequency of 50.8% compared to 62 cases, i.e. a frequency of 49.2% with a sex ratio (M/F) equal to 0.96. 98 cases of our patients, i.e. a frequency of 77.8%, were mutual insurance companies who felt they had the necessary support from those around them. In our sample, the underlying heart disease was mainly represented by valvular heart disease in 59 cases, followed by hypertensive heart disease in 42 cases with the respective frequencies of 46.82% and 33.33%. The majority of our patients were rehospitalized (1 - 3) times after a first episode of HF flare-up in 117 cases or 92.9%. Irregularity at control and therapeutic break were the most common decompensation factors with frequencies of 75.8% and 74.2% respectively. The majority of our patients were rehospitalized (1 - 3) times after a first episode of HF flare-up in 117 cases or 92.9%. Irregularity at control and therapeutic break were the most common decompensation factors with frequencies of 75.8% and 74.2% respectively. Conclusion: It appears in this study that rehospitalizations for heart failure are frequent, linked to irregularity in control and the lack of therapeutic education.

Assessment of the Physical Capabilities of Heart Failure Patients before and after Cardiovascular Rehabilitation: A Study of 125 Patients from West Africa, Dakar, Senegal

Background: Cardiac rehabilitation represents a critical therapeutic strategy for patients suffering from chronic heart failure. The physical capacity of patients with heart failure, assessed using the exercise test and the 6-minute walk test, is the measure of the patient’s overall functional ability to perform physical activities and tolerate exercise loads. The objective of this study was to assess the impact of cardiac rehabilitation on patients’ physical capabilities and to conduct a thorough comparison of data obtained via exercise testing and the 6-minute walk test before and after the rehabilitation programme. Methods: This was a descriptive and analytical cross-sectional study, conducted from 1 February 2021 to 31 June 2022. Included were heart failure patients who had participated in an outpatient cardiovascular rehabilitation programme. The collected data included anamnestic, clinical, paraclinical data, and the 6-minute walk test. Informed consent was obtained. Data analysis, word processing, and charting were performed using Microsoft Word 2016, Excel 2013, and Sphinx version 5.1.0.2. Data analysis was performed using SPSS (Statistical Package for Social Sciences) version 24.0. Any difference less than 0.05 was considered statistically significant. Results: In a Senegalese study, heart failure patients undergoing rehabilitation in a cardiac unit represented 45.59% of all cases, with a prevalence rate of 3.21%. The average participant was 57.97 years old, with those aged 61 to 70 forming the largest group (35.5%). The study noted a male predominance (sex ratio of 2.1) and identified dyslipidaemia (80.6%) and sedentarism (71%), as prevalent cardiovascular risk factors. All participants initially suffered from NYHA stage 2 or 3 dyspnoea, yet 80.65% showed no symptoms following rehabilitation. Significant improvements were recorded in resting heart rate (from 79 to 67 bpm), and the 6-minute walk test distance (from 328 m to 470 m). Enhanced exercise tolerance and walking test outcomes were particularly notable in patients with LVEF ≥ 50%, women, non-obese individuals, those initially walking less than 300 m, achieving more than 3 METs, and non-smokers. Conclusion: The findings underscore the effectiveness of cardiovascular rehabilitation in improving symptoms, physical capability, and overall quality of life for heart failure patients in Senegal.

Review of Fault-tolerant Control for Motor Inverter Failure with Operational Quality Considered

In recent years,motor drive systems have garnered increasing attention due to their high efficiency and superior control performance.This is especially apparent in aerospace,marine propulsion,and electric vehicles,where high performance,efficiency,and reliability are crucial.The ability of the drive system to maintain long-term fault-tolerant control(FTC)operation after a failure is essential.The likelihood of inverter failures surpasses that of other components in the drive system,highlighting its critical importance.Long-term FTC operation ensures the system retains its fundamental functions until safe repairs or replacements can be made.The focus of developing a FTC strategy has shifted from basic FTC operations to enhancing the post-fault quality to accommodate the realities of prolonged operation post-failure.This paper primarily investigates FTC strategies for inverter failures in various motor drive systems over the past decade.These strategies are categorized into three types based on post-fault operational quality:rescue,remedy,and reestablishment.The paper discusses each typical control strategy and its research focus,the strengths and weaknesses of various algorithms,and recent advancements in FTC.Finally,this review summarizes effective FTC techniques for inverter failures in motor drive systems and suggests directions for future research.

Roughness characterization and shearing dislocation failure for rock-backfill interface

Shearing dislocation is a common failure type for rock–backfill interfaces because of backfill sedimentation and rock strata movement in backfill mining goaf.This paper designed a test method for rock–backfill shearing dislocation.Using digital image techno-logy and three-dimensional(3D)laser morphology scanning techniques,a set of 3D models with rough joint surfaces was established.Further,the mechanical behavior of rock–backfill shearing dislocation was investigated using a direct shear test.The effects of interface roughness on the shear–displacement curve and failure characteristics of rock–backfill specimens were considered.The 3D fractal dimen-sion,profile line joint roughness coefficient(JRC),profile line two-dimensional fractal dimension,and the surface curvature of the frac-tures were obtained.The correlation characterization of surface roughness was then analyzed,and the shear strength could be measured and calculated using JRC.The results showed the following:there were three failure threshold value points in rock–backfill shearing dis-location:30%–50%displacement before the peak,70%–90%displacement before the peak,and 100%displacement before the peak to post-peak,which could be a sign for rock–backfill shearing dislocation failure.The surface JRC could be used to judge the rock–backfill shearing dislocation failure,including post-peak sliding,uniform variations,and gradient change,corresponding to rock–backfill disloca-tion failure on the field site.The research reveals the damage mechanism for rock–backfill complexes based on the free joint surface,fills the gap of existing shearing theoretical systems for isomerism complexes,and provides a theoretical basis for the prevention and control of possible disasters in backfill mining.

Nursing Practice for a Case of Acute Left Heart Failure Complicated with Colonic Impaction

Research Background: Heart failure is a type of organic heart disease caused by excessive ventricular load, leading to insufficient myocardial contractility and decreased cardiac output in the body. With the progression of the patient's condition, gastrointestinal dysfunction is frequently complicated. At the same time, the accumulation of feces in the body (colonic impaction) can also increase the burden on the patient’s heart, triggering or exacerbating the occurrence or progression of heart failure. Purpose: this article focuses on the correlation between colonic impaction and heart failure, using the nursing experience of a case of acute left heart failure complicated by colonic impaction as an example, in order to provide clinical evidence for the care of patients with colonic impaction combined with heart failure in the future. Method: By using innovative thinking, the stomach tube is used to replace the enema tube, which is inserted through the anus to reach the end of the colon. By combining acupressure at points such as Zhongwan, Tianzhu, and Guanyuan, it helps promote the elimination of fecal impaction. Conclusion: This case reflects the innovative thinking and adaptability of nurses, providing a new clinical approach for the aggravation of the condition of long-term heart failure patients due to constipation issues. Further research in clinical practice is warranted.

Current strategies for predicting post-hepatectomy liver failure and a new ultrasound-based nomogram

Liver cancer is associated with a few factors,such as viruses and alcohol con-sumption,and hepatectomy is an important treatment for patients with liver cancer.However,post-hepatectomy liver failure(PHLF)is the most serious complication and has a high mortality rate.Effective prediction of PHLF allows for the adjustment of clinical treatment strategies and is critical to the long-term prognosis of patients.Many factors have been associated with the development of PHLF,so there is an increasing interest in the development of predictive models for PHLF,such as nomograms that integrate intra-operative factors,imaging and biochemical characteristics of the patient.Ultrasound,as a simple and important examination method,plays an important role in predicting PHLF,especially the Nomogram established based on ultrasound measurements of liver stiffness and spleen area provides a more convenient way to predict the occurrence of PHLF.

Living biodrugs and how tissue source influences mesenchymal stem cell therapeutics for heart failure

In this editorial we comment on the article by Safwan M et al.We especially fo-cused on the cardiac function restoration by the use of mesenchymal stem cells(MSCs)therapy for heart failure(HF),which has emerged as a new treatment approach as“Living Biodrugs”.HF remains a significant clinical challenge due to the heart’s inability to pump blood effectively,despite advancements in medical and device-based therapies.MSCs have emerged as a promising therapeutic approach,offering benefits beyond traditional treatments through their ability to modulate inflammation,reduce fibrosis,and promote endogenous tissue rege-neration.MSCs can be derived from various tissues,including bone marrow and umbilical cord.Umbilical cord-derived MSCs exhibit superior expansion ca-pabilities,making them an attractive option for HF therapy.Conversely,bone marrow-derived MSCs have been extensively studied for their potential to im-prove cardiac function but face challenges related to cell retention and delivery.Future research is focusing on optimizing MSC sources,enhancing differentiation and immune modulation,and improving delivery methods to overcome current limitations.

Comparison of engineering failures and seismic responses of 500 kV transformer-bushing systems in the 2022 Luding earthquake

Cemented and mechanically clamped types of end fittings(fitting-C and fitting-M)are commonly used in transformer bushings.During the Luding Ms 6.8 earthquake that occurred in China on September 5,2022,all transformer bushings with the two types of end fittings in a 500 kV substation were damaged.Post-earthquake field investigations were conducted,and the failures of the two types of bushings were compared.Two elementary simulation models of the transformer-bushing systems were developed to simulate the engineering failures,and further compute their seismic responses for comparison.The results indicate that the hitch lugs of the connection flange are structurally harmful to seismic resistance.Fitting-M can decrease the bending stiffness of the bushing due to the flexible sealing rubber gasket.Since it provides a more flexible connection that dissipates energy,the peak accelerations and relative displacements at the top of the bushing are significantly lower than those of the bushing with fitting-C.Compared with fitting-C,fitting-M transfers the high-stress areas from the connection flange to the root of the porcelain,so the latter becomes the most vulnerable component.Fitting-M increases the failure risk of the low-strength porcelain,indicating the unsuitability of applying it in high-intensity fortification regions.

Failure-Informed Adaptive Sampling for PINNs,Part II:Combining with Re-sampling and Subset Simulation

This is the second part of our series works on failure-informed adaptive sampling for physic-informed neural networks(PINNs).In our previous work(SIAM J.Sci.Comput.45:A1971–A1994),we have presented an adaptive sampling framework by using the failure probability as the posterior error indicator,where the truncated Gaussian model has been adopted for estimating the indicator.Here,we present two extensions of that work.The first extension consists in combining with a re-sampling technique,so that the new algorithm can maintain a constant training size.This is achieved through a cosine-annealing,which gradually transforms the sampling of collocation points from uniform to adaptive via the training progress.The second extension is to present the subset simulation(SS)algorithm as the posterior model(instead of the truncated Gaussian model)for estimating the error indicator,which can more effectively estimate the failure probability and generate new effective training points in the failure region.We investigate the performance of the new approach using several challenging problems,and numerical experiments demonstrate a significant improvement over the original algorithm.

Bioinformatics Analysis of the Relationship between Dilated Cardiomyopathy and Chronic Heart Failure

Objective: To screen and analyze the differentially expressed genes between dilated cardiomyopathy (DCM) and chronic heart failure (CHF) based on bioinformatics methods. Methods: The Gene Expression Omnibus (GEO) database was used for data retrieval, and the chip data GSE3585 was downloaded, which was the original data of DCM and normal control group. At the same time, the chip data GSE76701 was downloaded, which was the original data of CHF and control group. Differentially expressed mRNAs (DEmRNAs) were screened by R language limma package, the data were standardized, and the common differentially expressed genes were screened. GO function and KEGG pathway enrichment analysis were performed on the common differentially expressed genes. String11.0 online tool was used for data analysis to obtain differentially expressed genes, and the results were imported into Cytoscape 3.9.1 software. The results were imported into Cytoscape 3.9.1 software, and the common expression gene module was obtained by MOCDE algorithm. Nine Hub genes were obtained by 10 algorithms such as MCC. Results: A total of 248 differentially expressed genes were screened. GO analysis showed that differentially expressed genes were mainly concentrated in 9 different physiological and pathological processes. KEGG analysis showed that the main signaling pathways involved in differentially expressed genes were 2, and 9 key differentially expressed genes were predicted: NPPB, NPPA, MYH6, FRZB, ASPN, SFRP4, RPS4Y1, DDX3Y. Conclusion: This study preliminarily explored the molecular mechanism of DCM and CHF, and obtained the common differentially expressed genes of the two diseases. Further experimental studies are needed to verify the correlation between gene expression and clinicopathological features. Provide new ideas for clinical drug treatment research.

Risk factors for secondary infection after liver failure and effect of comprehensive nursing intervention

BACKGROUND In patients with liver failure(LF),the high rate of secondary infections,which are associated with poor prognosis,highlights the clinical significance of understanding the underlying risk factors and implementing targeted intervention programs.AIM To investigate risk factors for secondary infections in patients with LF and evaluate the effectiveness of comprehensive nursing interventions.METHODS This retrospective study included 64 patients with LF,including 32 with and 32 without secondary infections.A questionnaire was used to collect data on age;laboratory parameters,including total and direct bilirubin,prothrombin time,blood ammonia,and other biochemical parameters;invasive procedures;and complications.Patients with secondary infections received comprehensive nursing intervention in addition to routine nursing care,whereas those without secondary infections received only routine nursing care to compare the effect of nursing intervention on outcomes.RESULTS The infection rate,which was not associated with age or complications,was significantly associated with biochemical parameters and invasive procedures(P<0.05).The infection rate was 61.6%in patients who had undergone invasive procedures and 32.1%in those who had not undergone invasive procedures during the hospital stay.The infection rate was also significantly associated with the type of LF(P<0.05),with the lowest rate observed in patients with acute LF and the highest rate observed in those with subacute LF.The nursing satisfaction rate was 58.3%in the uninfected group and 91.7%in the infected group,indicating significantly higher satisfaction in the infected group(P<0.05).CONCLUSION In patients with LF,the rate of secondary infections was high and associated with biochemical parameters and type of LF.Comprehensive nursing intervention can improve patient satisfaction.