Deep Venous Thrombosis: Commonly Affected Veins in the Lower Limbs

Aim and Objectives: This study aimed to record the commonly affected veins in the lower limbs, to compare the affected sides and gender and to correlate the Doppler findings and stages of deep venous thrombosis (DVT). Materials and Methods: A descriptive retrospective study of 46 already diagnosed cases of lower limb DVT. Results: Out of 46 cases of DVT, 71.74% were females. The majority of patients (93.47%) were affected in unilateral lower limb with significant predominance (65.22%) to affect the left lower limb (p Conclusion: Lower limb deep venous thrombosis affects left lower limb more than right and females more than males. Superficial femoral vein (SFV) and common femoral vein (CFV) are the most common affected veins. Lower limb DVT predominantly present in acute stage with venous distension and absent blood flow.

Application of Defense Technology Commonly Used in Boxing Match

Boxing defense technology is a kind of techniques to prevent the opponent from attacking successfully. Boxing is a kind of sports that needs close cooperation between attack and defense. Attack is used for defense, where there is no attack, there will be no defense, and vice versa. Defense technology is the foundation of attack technology, therefore, defense is of vital importance in boxing match.

Does ash dieback affect the reproductive ecology of Fraxinus excelsior L.?

Forest tree species reproduction is a key factor in maintaining the genetic diversity of future generations and the stability of forest ecosystems.The ongoing ash dieback disease could affect the reproductive ecology of Fraxinus excelsior L.and have a major impact on the quantity and quality of pollen and seeds.In this study,we investigated pollen production and viability of pollen and seeds of ash trees with different health status from 2018 to 2022.Inflorescences were collected from 105 trees(pollen production),pollen from 125 trees(pollen viability),and seeds from 53 trees(seed quality)in two seed orchards and in one floodplain forest in southern Germany.Not all parameters were examined at every site every year.The average pollen production per tree was estimated at 471.2±647.9 billion pollen grains.In addition,we found that a high number of inflorescences did not equate to high pollen production per inflorescence.Pollen production of healthy and diseased trees did not differ significantly,although only 47%of severely diseased male trees(vs.72%for healthy trees)produced flowers.With regards to pollen viability,the TTC test showed an average viability of 73%±17%.Overall,there was a slight tendency for diseased trees to have less viable pollen.However,a significant difference could only be calculated for trees in the floodplain forest.The percentage of germinable seeds in 2018 was 38%in the floodplain forest and 57%in one of the seed orchards.The percentage of viable seeds(TTC test)ranged from 17 to 22%in the orchards in 2020.Non-viable seeds were usually heavily infested by insects.In general,seed quality was not significantly different between healthy and diseased trees.Our results indicate that ash dieback affects flower formation and pollen viability but not pollen production or seed quality.Nevertheless,the fact that hardly any flowering was observed,especially for trees that were seriously affected,suggests a negative effect of ash dieback on reproductive performance.Thus,severely diseased trees will transfer their genes to a smaller extent to the next generation.

Do brood parasitic Common Cuckoos develop brood patches during the breeding season?

Many birds develop brood patches on their ventral apterium under hormonal regulation to effectively transmit body heat to eggs during incubation.The developed patch has several characteristics,including de-feathering,vascularization,and edema.However,little is known about whether avian brood parasites that do not incubate their eggs exhibit brood patch development during the breeding season.In this study,we measured the size of the ventral apterium in 114 Common Cuckoos(Cuculus canorus)captured in the field throughout the breeding season and examined the appearance of the ventral apterium to confirm the development of brood patches.We also examined whether morphological traits and various factors correlated with the size of the ventral apterium(sternal apterium and abdominal apterium)and how it changed during the breeding season.We found no clear signs of brood patch development in Common Cuckoos captured throughout the breeding season,indicating that they likely did not develop brood patches on the ventral apterium during this period.We also found that ventral apterium size was positively correlated with wing length and body weight.In addition,Common Cuckoos with newly growing feathers on the boundary of the ventral apterium with pteryla were frequently observed as seasons progressed to the end.In conclusion,Common Cuckoos exhibit neither brood patch development nor the vestigial characteristics of ancestral brood patches,except for the growth of feathers on boundary the ventral apterium.Further studies examining brood patches across different groups of avian brood parasites are valuable for enhancing our understanding of the developmental and physiological adaptations of avian brood parasites.

Optimal Cyber Attack Strategy Using Reinforcement Learning Based onCommon Vulnerability Scoring System

Currently,cybersecurity threats such as data breaches and phishing have been on the rise due to the many differentattack strategies of cyber attackers,significantly increasing risks to individuals and organizations.Traditionalsecurity technologies such as intrusion detection have been developed to respond to these cyber threats.Recently,advanced integrated cybersecurity that incorporates Artificial Intelligence has been the focus.In this paper,wepropose a response strategy using a reinforcement-learning-based cyber-attack-defense simulation tool to addresscontinuously evolving cyber threats.Additionally,we have implemented an effective reinforcement-learning-basedcyber-attack scenario using Cyber Battle Simulation,which is a cyber-attack-defense simulator.This scenarioinvolves important security components such as node value,cost,firewalls,and services.Furthermore,we applieda new vulnerability assessment method based on the Common Vulnerability Scoring System.This approach candesign an optimal attack strategy by considering the importance of attack goals,which helps in developing moreeffective response strategies.These attack strategies are evaluated by comparing their performance using a variety ofReinforcement Learning methods.The experimental results show that RL models demonstrate improved learningperformance with the proposed attack strategy compared to the original strategies.In particular,the success rateof the Advantage Actor-Critic-based attack strategy improved by 5.04 percentage points,reaching 10.17%,whichrepresents an impressive 98.24%increase over the original scenario.Consequently,the proposed method canenhance security and risk management capabilities in cyber environments,improving the efficiency of securitymanagement and significantly contributing to the development of security systems.

Oriental Reed Warblers do not abandon Common Cuckoo chicks during prolonged nestling periods

The Oriental Reed Warbler(Acrocephalus orientalis)is one of the most commonly used hosts for the parasitic Common Cuckoo(Cuculus canorus).However,as hosts that feed unrelated parasitic nestlings may suffer extra reproductive costs,they may be less willing to care for nestlings that have prolonged nestling periods.To test this hypothesis,the duration of feeding by Oriental Reed Warblers under natural conditions for their own nestlings was compared with the duration of feeding under natural conditions for Common Cuckoo nestlings and for artificially prolonged cuckoo nestlings.The results showed that Oriental Reed Warblers did not starve,drive away,or desert any of the nestlings in the experiment,and neither parent was left alone.Our experimental study indicates that both Oriental Reed Warbler parents were willing to care for nestlings with a prolonged nestling period(up to 30 days,twice the average duration time that the Oriental Reed Warblers fed their own chicks in natural conditions).However,further experiments and observations are required in other host bird species to examine whether both parents or one of the parents may exhibit the behavior of abandoning nestlings with a prolonged nestling period.

Machine Learning for Selecting Important Clinical Markers of Imaging Subgroups of Cerebral Small Vessel DiseaseBased on a Common Data Model

Differences in the imaging subgroups of cerebral small vessel disease(CSVD)need to be further explored.First,we use propensity score matching to obtain balanced datasets.Then random forest(RF)is adopted to classify the subgroups compared with support vector machine(SVM)and extreme gradient boosting(XGBoost),and to select the features.The top 10 important features are included in the stepwise logistic regression,and the odds ratio(OR)and 95%confidence interval(CI)are obtained.There are 41290 adult inpatient records diagnosed with CSVD.Accuracy and area under curve(AUC)of RF are close to 0.7,which performs best in classification compared to SVM and XGBoost.OR and 95%CI of hematocrit for white matter lesions(WMLs),lacunes,microbleeds,atrophy,and enlarged perivascular space(EPVS)are 0.9875(0.9857−0.9893),0.9728(0.9705−0.9752),0.9782(0.9740−0.9824),1.0093(1.0081−1.0106),and 0.9716(0.9597−0.9832).OR and 95%CI of red cell distribution width for WMLs,lacunes,atrophy,and EPVS are 0.9600(0.9538−0.9662),0.9630(0.9559−0.9702),1.0751(1.0686−1.0817),and 0.9304(0.8864−0.9755).OR and 95%CI of platelet distribution width for WMLs,lacunes,and microbleeds are 1.1796(1.1636−1.1958),1.1663(1.1476−1.1853),and 1.0416(1.0152−1.0687).This study proposes a new analytical framework to select important clinical markers for CSVD with machine learning based on a common data model,which has low cost,fast speed,large sample size,and continuous data sources.

Distal-scanning common path probe for optical coherence tomography

In this paper,we present a distal-scanning common path probe for optical coherence tomography(OCT)equipped with a hollow ultrasonic motor and a simple and specially designed beam-splitter.This novel probe proves to be able to effectively circumvent polarization and dispersion mismatch caused by fiber motion and is more robust to a variety of interfering factors during the imaging process,experimentally compared to a conventional noncommon path probe.Furthermore,our design counteracts the attenuation of backscattering with depth and the fall-off of the signal,resulting in a more balanced signal range and greater imaging depth.Spectral-domain OCT imaging of phantom and biological tissue is also demonstrated with a sensitivity of∼100dB and a lateral resolution of∼3μm.This low-cost probe offers simplified system configuration and excellent robustness,and is therefore particularly suitable for clinical diagnosis as one-off medical apparatus.

Evaluating the relative importance of predictors in Generalized Additive Models using the gam.hp R package

Generalized Additive Models(GAMs)are widely employed in ecological research,serving as a powerful tool for ecologists to explore complex nonlinear relationships between a response variable and predictors.Nevertheless,evaluating the relative importance of predictors with concurvity(analogous to collinearity)on response variables in GAMs remains a challenge.To address this challenge,we developed an R package named gam.hp.gam.hp calculates individual R^(2) values for predictors,based on the concept of'average shared variance',a method previously introduced for multiple regression and canonical analyses.Through these individual R^(2)s,which add up to the overall R^(2),researchers can evaluate the relative importance of each predictor within GAMs.We illustrate the utility of the gam.hp package by evaluating the relative importance of emission sources and meteorological factors in explaining ozone concentration variability in air quality data from London,UK.We believe that the gam.hp package will improve the interpretation of results obtained from GAMs.

Removal of intrahepatic bile duct stone could reduce the risk of cholangiocarcinoma

Hepatolithiasis(HL)poses a significant risk for cholangiocarcinoma(CCA)development,with reported incidences ranging from 5%-13%.Risk factors include older age,smoking,hepatitis B infection,and prolonged HL duration.Chronic inflammation and mechanical stress on the biliary epithelium contribute to CCA pathogenesis.Hepatectomy reduces CCA risk by removing stones and atrophic liver segments.However,residual stones and incomplete removal increase CCA risk.Kim et al identified carbohydrate antigen 19-9,carcinoembryonic antigen,and stone laterality as CCA risk factors,reaffirming the importance of complete stone removal.Nonetheless,challenges remain in preventing CCA recurrence post-surgery.Longer-term studies are needed to elucidate CCA risk factors further.

Undifferentiated high-grade pleomorphic sarcoma of the common bile duct:A case report and review of literature

BACKGROUND Undifferentiated pleomorphic sarcoma(UPS)is a rare malignant mesenchymal tumor with a poor prognosis.It mainly occurs in the extremities,trunk,head and neck,and retroperitoneum regions.Owing to the lack of specific clinical manifestations and imaging features,UPS diagnosis mainly depends on pathological and immunohistochemical examinations for exclusive diagnosis.Here we report an extremely rare case of high-grade UPS in the common bile duct(CBD).There are limited available data on such cases.CASE SUMMARY A 70-year-old woman was admitted to our department with yellow eyes and urine accompanied by upper abdominal distending pain for 2 wk.Her laboratory data suggested significantly elevated hepatorenal function levels.The imaging data revealed calculous cholecystitis,intrahepatic and extrahepatic bile duct dilation with extrahepatic bile duct calculi,and a space-occupying lesion at the distal CBD.After endoscopic biliary stenting and symptomatic support therapy,CBD exploration and biopsy were performed.The frozen section indicated malignant spindle cell tumor of the CBD mass,and further radical pancreaticoduodenectomy was performed.Finally,the neoplasm was diagnosed as a high-grade UPS combined with the light-microscopic morphology and immunohistochemical results.CONCLUSION This extremely rare case highlighted the need for increasing physicians'vigilance,reducing the odds of misdiagnosis,and providing appropriate treatment strategies.

Digital Infrastructure and Common Prosperity: An Influence Mechanism and Effect Test

Common prosperity is an important goal of China’s modernization efforts,and narrowing the income gap among different regions and populations is crucial to achieving common prosperity.The construction of digital infrastructure has significantly boosted productivity and facilitated the diffusion of technology in less developed regions,leading to notable changes in labor employment and the income gap,which aligns with the goal of common prosperity.This paper explores the mechanism through which digital infrastructure influences common prosperity with a focus on employment,using panel data from 30 provinces in China between 2011 and 2021 for an empirical test.The research finds that digital infrastructure significantly promotes common prosperity.By expanding employment and increasing labor remuneration,the influence of digital infrastructure on common prosperity exhibits regional heterogeneity and a nonlinear threshold effect.The research suggests that the government should enhance investment in and construction of digital infrastructure,reduce the digital divide through policy support in rural areas,promote digital employment and skills training,and encourage industrial integration and enterprise participation.

Surgical strategies for challenging common bile duct stones in the endoscopic era: A comprehensive review of current evidence

While endoscopic retrograde cholangiopancreatography(ERCP)remains the primary treatment modality for common bile duct stones(CBDS)or choledocho-lithiasis due to advancements in instruments,surgical intervention,known as common bile duct exploration(CBDE),is still necessary in cases of difficult CBDS,failed endoscopic treatment,or altered anatomy.Recent evidence also supports CBDE in patients requesting single-step cholecystectomy and bile duct stone removal with comparable outcomes.This review elucidates relevant clinical anatomy,selection indications,and outcomes to enhance surgical understanding.The selection between trans-cystic(TC)vs trans-choledochal(TD)approaches is described,along with stone removal techniques and ductal closure.Detailed surgical techniques and strategies for both the TC and TD approaches,including instrument selection,is also provided.Additionally,this review comprehensively addresses operation-specific complications such as bile leakage,stricture,and entrapment,and focuses on preventive measures and treatment strategies.This review aims to optimize the management of CBDS through laparoscopic CBDE,with the goal of improving patient outcomes and minimizing risks.

Comparison of mismatch repair and immune checkpoint protein profile with histopathological parameters in pancreatic,periampullary/ampullary,and choledochal adenocarcinomas

BACKGROUND Pancreatic,periampullary/ampullary,and choledochal adenocarcinomas are aggressive malignancies with a poor prognosis.Immune checkpoint blockade is a promising treatment option for several tumor types.H long terminal repeatassociating 2(HHLA2),which is analogous to programmed death-ligand 1(PDL1),is a recently discovered member of the B7/cluster of differentiation 28 family and is expressed in many malignancies.AIM To analyze the expression of HHLA2 and its association with the pathologic biomarkers that predict sensitivity to immunotherapy.METHODS Ninety-two adenocarcinoma cases located in the pancreas,ampulla,and distal common bile duct were identified.This study assessed 106 pancreaticoduodenectomy and distal/total pancreatectomy samples that were delivered to Ankara City Hospital between 2019 and 2021.Immunohistochemistry was conducted to examine the expression of DNA mismatch repair(MMR),PD-L1,and HHLA2 proteins.RESULTS Patients with high HHLA2 expression had a higher mean age than those with low expression.Low HHLA2 expression was associated with high perineural invasion.HHLA2 expression was low in pathological stage T3(pT)3 cases and high in pathological stage T1,T2,and T4 cases.There was no correlation between HHLA2 expression and the expression of MMR proteins and PD-L1.CONCLUSION Evaluation of HHLA2 expression in microsatellite stable and PD-L1-negative tumors may be useful for predicting the response of individuals to immunotherapy and may serve as a novel therapeutic target for immunotherapy in advanced-stage disease.

Poverty Reduction in China: Experiences and Measurement of Effects

This study employs the generalized method of moments(GMM)and panel vector autoregression(PVAR)models for a multi-factor quantitative dissection of China’s poverty reduction process across multiple stages,using provincial panel data from 2000 to 2019.According to our research,economic growth and social development are the key drivers of poverty reduction in China,but the trickle-down effect of economic growth is diminishing and marketization is having a lesser pro-poor effect.Public expenditure has failed to provide social protection and income redistribution benefits due to issues such as targeting error and elite capture.Increasing the efficiency of the poverty reduction system calls for adaptive adjustments.Finally,this study highlights China’s poverty reduction experiences and analyzes current challenges,which serve as inspiration for consolidating poverty-reduction achievements,combating relative poverty,and attaining countryside vitalization.

Hem-o-lok clip migration to duodenal bulb post-cholecystectomy:A case report

BACKGROUND Hem-o-lok clips are typically used to control the cystic duct and vessels during laparoscopic cholecystectomy(LC)and common bile duct exploration for stones in the bile duct and gallbladder.Here,we report a unique example of Hem-o-lok clip movement towards the duodenal bulb after LC,appearing as a submucosal tumor(SMT).Additionally,we provide initial evidence of gradual and evolving endoscopic manifestations of Hem-o-lok clip migration to the duodenal bulb wall and review the available literature.CASE SUMMARY A 72-year-old man underwent LC for gallstones,and Hem-o-lok clips were used to ligate both the cystic duct and cystic artery.Esophagogastroduodenoscopy(EGD)2 years later revealed an SMT-like lesion in the duodenal bulb.Due to the symptomatology,the clinical examination did not reveal any major abnormalities,and the patient was followed up as an outpatient.A repeat EGD performed 5 months later revealed an SMT-like lesion in the duodenal bulb with raised edges and a central depression.A third EGD was conducted,during which a Hem-o-lok clip was discovered connected to the front side of the duodenum.The clip was extracted easily using biopsy forceps,and no complications occurred.Two months after the fourth EGD,the scar was surrounded by normal mucosa.CONCLUSION Clinicians should be aware of potential post-LC complications.Hem-o-lok clips should be removed if symptomatic.

GNN Representation Learning and Multi-Objective Variable Neighborhood Search Algorithm for Wind Farm Layout Optimization

With the increasing demand for electrical services,wind farm layout optimization has been one of the biggest challenges that we have to deal with.Despite the promising performance of the heuristic algorithm on the route network design problem,the expressive capability and search performance of the algorithm on multi-objective problems remain unexplored.In this paper,the wind farm layout optimization problem is defined.Then,a multi-objective algorithm based on Graph Neural Network(GNN)and Variable Neighborhood Search(VNS)algorithm is proposed.GNN provides the basis representations for the following search algorithm so that the expressiveness and search accuracy of the algorithm can be improved.The multi-objective VNS algorithm is put forward by combining it with the multi-objective optimization algorithm to solve the problem with multiple objectives.The proposed algorithm is applied to the 18-node simulation example to evaluate the feasibility and practicality of the developed optimization strategy.The experiment on the simulation example shows that the proposed algorithm yields a reduction of 6.1% in Point of Common Coupling(PCC)over the current state-of-the-art algorithm,which means that the proposed algorithm designs a layout that improves the quality of the power supply by 6.1%at the same cost.The ablation experiments show that the proposed algorithm improves the power quality by more than 8.6% and 7.8% compared to both the original VNS algorithm and the multi-objective VNS algorithm.

Accelerating the Digitalization Process in Rural China and Promoting Common Prosperity

Under the historical background of promoting agricultural and rural modernization in an all-round way,this paper deeply analyzes the practical significance of digital construction in rural China,and explores the problems in the digitalization level of rural infrastructure,farmers digitalization awareness and accomplishment,and agricultural digital system.Countermeasures and suggestions are put forward from four aspects:digital village construction policy system,rural digital infrastructure construction,rural digital talent cultivation system,and agricultural digital system,and the rural digital construction of Huzhou City is taken as an example,in order to further realize the goal of empowering rural farmers with digital technology for common prosperity.

Risk factors for recurrence of common bile duct stones after surgical treatment and effect of ursodeoxycholic acid intervention

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an accurate diagnostic method for choledocholithiasis and treatment option for stone removal.Additionally,ursodeoxycholic acid(UDCA)can dissolve cholesterol stones and prevent their development and reappearance by lowering the cholesterol concen-tration in bile.Despite these treatment options,there are still patients who experience stone recurrence.The clinical data of 100 patients with choledochal stones who were hospitalized at the Yixing People’s Hospital and underwent ERCP for successful stone extraction between June 2020 and December 2022 were retrospectively collected.According to the post-ERCP treatment plan,100 patients were classified into UDCA(n=47)and control(n=53)groups.We aimed to assess the clinical efficacy and rate of relapse in the two patient populations.We then collected information(basic demographic data,clinical characteristics,and serum biochemical indicators)and determined the factors contributing to relapse using logistic regression analysis.Our secondary goal was to determine the effects of UDCA on liver function after ERCP.Compared to the control group,the UDCA group demonstrated a higher clinical effectiveness rate of 92.45%vs 78.72%(P<0.05).No significant differences were observed in liver function indices,including total bilirubin,direct bilirubin,gamma-glutamyl transpeptidase,alanine aminotransferase,alkaline phosphatase,and aspartate aminotransferase,between the two groups before treatment.After treatment,all liver function indices were significantly reduced.Comparing the control vs UDCA groups,the UDCA group exhibited significantly lower levels of all indices(55.39±6.53 vs 77.31±8.52,32.10±4.62 vs 45.39±5.69,142.32±14.21 vs 189.63±16.87,112.52±14.25 vs 149.36±15.36,122.61±16.00 vs 171.33±22.09,96.98±10.44 vs 121.35±11.57,respectively,all P<0.05).The stone recurrence rate was lower in the UDCA group(13.21%)in contrast with the control group(44.68%).Periampullary diverticula(OR:6.00,95%CI:1.69-21.30),maximum stone diameter(OR:1.69,95%CI:1.01-2.85),stone quantity>3(OR:4.23,95%CI:1.17-15.26),and positive bile culture(OR:7.61,95%CI:2.07-27.91)were independent factors that influenced the relapse of common bile duct stones after ERCP(P<0.05).Furthermore,postoperative UDCA was identified as a preventive factor(OR:0.07;95%CI:0.08-0.09).CONCLUSION The intervention effect of UDCA after ERCP for common bile duct stones is adequate,providing new research directions and references for the prevention and treatment of stone recurrence.

Clinical efficacy of laparoscopic cholecystectomy plus cholangioscopy for the treatment of cholecystolithiasis combined with choledocholithiasis

BACKGROUND Currently,endoscopic retrograde cholangiopancreatography(ERCP)plus laparoscopic cholecystectomy(LC)is the main treatment for cholecystolithiasis combined with choledocholithiasis.However,the treatment is unsatisfactory,and the development of better therapies is needed.AIM To determine the clinical efficacy of LC plus cholangioscopy for cholecystolithiasis combined with choledocholithiasis.METHODS Patients(n=243)with cholecystolithiasis and choledocholithiasis admitted to The Affiliated Haixia Hospital of Huaqiao University(910th Hospital of Joint Logistic Support Force)between January 2019 and December 2023 were included in the study;111 patients(control group)underwent ERCP+LC and 132 patients(observation group)underwent LC+laparoscopic common bile duct exploration(LCBDE).Surgical success rates,residual stone rates,complications(pancreatitis,hyperamylasemia,biliary tract infection,and bile leakage),surgical indicators[intraoperative blood loss(IBL)and operation time(OT)],recovery indices(postoperative exhaust/defecation time and hospital stay),and serum inflammatory markers[C-reactive protein(CRP)],tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6)were compared.RESULTS No significant differences in surgical success rates and residual stone rates were detected between the observation and control groups.However,the complication rate,IBL,OT,postoperative exhaust/defecation time,and hospital stays were significantly reduced in the observation group compared with the control group.Furthermore,CRP,TNF-α,and IL-6 Levels after treatment were reduced in the observation group compared with the levels in the control group.CONCLUSION These results indicate that LC+LCBDE is safer than ERCP+LC for the treatment of cholecystolithiasis combined with choledocholithiasis.The surgical risks and postoperative complications were lower in the observation group compared with the control group.Thus,patients may recover quickly with less inflammation after LCBDE.