Transoral outlet reduction:Outcomes of endoscopic Roux-en-Y gastric bypass revision in 284 patients at a community practice

BACKGROUND Transoral outlet reduction(TORe)is a minimally invasive endoscopic revision of Roux-en-Y gastric bypass(RYGB)for weight recurrence;however,little has been published on its clinical implementation in the community setting.AIM To characterize the safety and efficacy of TORe in the community setting for adults with weight recurrence after RYGB.METHODS This is a retrospective cohort study of argon plasma coagulation and purse-string suturing for gastric outlet reduction in consecutive adults with weight recurrence after RYGB at a single community center from September 2020 to September 2022.Patients were provided longitudinal nutritional support via virtual visits.The primary outcome was total body weight loss(TBWL)at twelve months from TORe.Secondary outcomes included TBWL at three months and six months;excess weight loss(EWL)at three,six,and twelve months;twelve-month TBWL by obesity class;predictors of twelve-month TBWL;rates of post-TORe stenosis;and serious adverse events(SAE).Outcomes were reported with descriptive statistics.RESULTS Two hundred eighty-four adults(91.9%female,age 51.3 years,body mass index 39.3 kg/m^(2))underwent TORe an average of 13.3 years after RYGB.Median pre-and post-TORe outlet diameter was 35 mm and 8 mm,respectively.TBWL was 11.7%±4.6%at three months,14.3%±6.3%at six months,and 17.3%±7.9%at twelve months.EWL was 38.4%±28.2%at three months,46.5%±35.4%at six months,and 53.5%±39.2%at twelve months.The number of follow-up visits attended was the strongest predictor of TBWL at twelve months(R^(2)=0.0139,P=0.0005).Outlet stenosis occurred in 11 patients(3.9%)and was successfully managed with endoscopic dilation.There was one instance of post-procedural nausea requiring overnight observation(SAE rate 0.4%).CONCLUSION When performed by an experienced endoscopist and combined with longitudinal nutritional support,purse-string TORe is safe and effective in the community setting for adults with weight recurrence after RYGB.

Spatial weight matrix in dimensionality reduction reconstruction for microelectromechanical system-based photoacoustic microscopy

A micro-electromechanical system(MEMS)scanning mirror accelerates the raster scanning of optical-resolution photoacoustic microscopy(OR-PAM).However,the nonlinear tilt angular-voltage characteristic of a MEMS mirror introduces distortion into the maximum back-projection image.Moreover,the size of the airy disk,ultrasonic sensor properties,and thermal effects decrease the resolution.Thus,in this study,we proposed a spatial weight matrix(SWM)with a dimensionality reduction for image reconstruction.The three-layer SWM contains the invariable information of the system,which includes a spatial dependent distortion correction and 3D deconvolution.We employed an ordinal-valued Markov random field and the Harris Stephen algorithm,as well as a modified delay-and-sum method during a time reversal.The results from the experiments and a quantitative analysis demonstrate that images can be effectively reconstructed using an SWM;this is also true for severely distorted images.The index of the mutual information between the reference images and registered images was 70.33 times higher than the initial index,on average.Moreover,the peak signal-to-noise ratio was increased by 17.08%after 3D deconvolution.This accomplishment offers a practical approach to image reconstruction and a promising method to achieve a real-time distortion correction for MEMS-based OR-PAM.

Efficacy of intragastric balloon on weight reduction:Saudi perspective

AIM To evaluate the safety and efficacy of intragastric balloon(IGB) in weight reduction in obese patients referred to a tertiary hospital in the Kingdom of Saudi Arabia.METHODS Three hundred and one consecutive obese individuals, who underwent IGB placement during January 2009 to May 2015, were analyzed. The subjects aged 18 to 60 years and had a minimum body mass index(BMI) of 27 kg/m^2. The IGB was placed under conscious sedation and kept for 6 mo. Anthropometric measurements were recorded during and after 6 mo of IGB removal.RESULTS The body weight, excess body weight, and BMI were significantly reduced at the time of IGB removal and 6 mo later. Body weight loss > 10% was achieved in 224 subjects at removal of IGB. End of treatment success and long-term success were both significantly observed in women(70 vs 11)(71 vs 12.5) respectively. Excess BMI loss was significantly higher in subjects retaining the IGB for over 6 mo both at the removal [43.44 ± 19.46(n = 221) vs 55.60 ± 28.69(n = 80); t = 4.19, P = 0.0001] as well as at the end of 6 mo' follow-up [46.57 ± 24.89(n = 221) vs 63.52 ± 31.08(n = 80); t = 4.87, P = 0.0001]. Within 3 d of IGB placement, two subjects developed pancreatitis and one subject developed cardiac arrhythmia. Intestinal obstruction due to displacement of IGB occurred in two subjects. Allthese subjects recovered uneventfully after immediate removal of the IGB. CONCLUSION IGB was effective in our cohorts. The observed weight reduction was maintained for at least 6 mo post IGB removal. IGB placement was safe with a satisfactory tolerance rate.

Risk Assessment Using Two Different Diagnostic Tools: Metabolic Syndrome and Cardiovascular Risk Score (SCORE)—Data from a Weight Reduction Intervention Study

Objective: Risk score models and the diagnosis of a metabolic syndrome are useful for cardiovascular (CV) risk prediction. The identification of individuals with high CV and metabolic risk is essential to provide appropriate prevention and therapy. The present study aims at clarifying whether these indicators are altered by a weight reduction programme. Additionally, which diagnostic tool has a better predictive value is examined. Method: One hundred and twenty overweight and obese subjects aged 30 60 years were included in a 12-week weight reduction programme. The CV risk was assessed by means of German multiple-used risk charts (SCORE) at baseline and at the end of the trial. Furthermore, the prevalence of the metabolic syndrome (three out of five risk factors) was quantified. Results: The initial prevalence of the metabolic syndrome was 63.3% (n = 76) and decreased to 41.7% (n = 50) by the end of the intervention. The SCORE also decreased significantly after twelve weeks (p 5%) was comparatively low (t0: 7.4%, n = 7;t12: 5.3%, n = 5). Conclusion: The weight reduction concept was applicable to improve the CV risk SCORE and decrease the prevalence of the metabolic syndrome. The CV 10-year risk calculated using German risk charts (SCORE) probably underestimated the risk of CV diseases in this collective. In this case, the diagnosis of a metabolic syndrome is more meaningful than risk SCORE calculations.

IMPROVING VOICE ACTIVITY DETECTION VIA WEIGHTING LIKELIHOOD AND DIMENSION REDUCTION

The performance of the traditional Voice Activity Detection (VAD) algorithms declines sharply in lower Signal-to-Noise Ratio (SNR) environments. In this paper, a feature weighting likeli- hood method is proposed for noise-robust VAD. The contribution of dynamic features to likelihood score can be increased via the method, which improves consequently the noise robustness of VAD. Divergence based dimension reduction method is proposed for saving computation, which reduces these feature dimensions with smaller divergence value at the cost of degrading the performance a little. Experimental results on Aurora II database show that the detection performance in noise environments can remarkably be improved by the proposed method when the model trained in clean data is used to detect speech endpoints. Using weighting likelihood on the dimension-reduced features obtains com- parable, even better, performance compared to original full-dimensional feature.

Short term acupressure therapy on weight-reduction in adolescence: A randomized controlled trial

Aim: Common treatment options for obesity include a reduced-calorie diet, increased physical activity, behavioral modification, pharmacotherapy, and surgery. Ear acupressure may also be an effective adjunct therapy. Methods: This study used a randomized controlled design to test the effectiveness of auricular acupressure for weight reduction in young, Taiwan Residents adults with a BMI ≥ 23 kg/m2. Sixty-eight participants aged 18 to 20 years were recruited from Taiwan Residents universities at the beginning of the study. After four weeks of auricular therapy, the total sample included 57 young adults. All participants met one time per week for ten minutes. The treatment group received ear acupressure treatment with Semen Vaccariae sticks on auricular acupoints while the control group had adhesive tape placed on ear acupoints, change in BMI from baseline to trial completion. Results: BMI in controls increased significantly by +0.0133 kg/m2 (P = 0.000) while the intervention group BMI decreased significantly by ?0.8022 kg/m2 (P ≤ 0.0001). Conclusions: Just four weeks of auricular acupressure by Semen Vaccariae, sticks may significantly help to decrease BMI among young adults.

Global variance reduction method for global Monte Carlo particle transport simulations of CFETR

It can be difficult to calculate some under-sampled regions in global Monte Carlo radiation transport calculations. The global variance reduction(GVR) method is a useful solution to the problem of variance reduction everywhere in a phase space. In this research, a GVR procedure was developed and applied to the Chinese Fusion Engineering Testing Reactor(CFETR). A cylindrical CFETR model was utilized for comparing various implementations of the GVR method to find the optimum.It was found that the flux-based GVR method could ensure more reliable statistical results, achieving an efficiency being 7.43 times that of the analog case. A mesh tally of the scalar neutron flux was chosen for the GVR method to simulate global neutron transport in the CFETR model.Particles distributed uniformly in the system were sampled adequately through ten iterations of GVR weight window.All voxels were scored, and the average relative error was 2.4% in the ultimate step of the GVR iteration.

The Beneficial Effect of 12-Hour Fasting, 45 Minutes Exercise Thrice Weekly and Their Combination on Weight Loss, Anthropometric Measures and Metabolic Syndrome

Background: Obesity is the leading preventable cause of death worldwide. It is associated with significant increases in morbidity and mortality. Few studies have addressed, prospectively, the impact of life-style modification in weight-reduction in 1) morbidly obese patients with BMI > 35 kg/m2 and 2) on its associated co-morbid risk factors for metabolic syndrome viz. high blood pressure, diabetes, hyperlipidemia and steatohepatitis as well as psychiatric disorders. Patients and Methods: We prospectively evaluated the role of 1) two meals daily with in between 12-hour fasting, 2) thrice weekly 45-minute active-walk, and 3) their combination, in management of ambulant obese patients, at BMI of 35 to 39.9 kg/m2 who had such multiple acquired metabolic disorders. The study was conducted over 3 years with 45 patients in 3 matched groups with regards to gender, age, BMI, waist circumference, lipid profile (LDL and TG), fibroscan steatosis grade, psychiatric assessment, antidiabetic drugs and antihypertensive ones. Results: At 6 and 12 months, the 3 regimens were well tolerated and were effective in weight loss, improvement in anthropometric measures and management of metabolic syndrome yet the combined one was significantly better in all endpoints. Conclusion: Our protocols of exercise and dieting were effective measures in managing obesity and its associated co-morbidities and their combination is synergetic.

松软煤层钻进钻杆减重降阻机制及应用研究

施工瓦斯抽采钻孔是治理瓦斯危害的必要手段,针对松软煤层钻进因钻杆自重大引起的钻进阻力大、钻进效率低及劳动强度高等问题,提出了优化钻杆结构以减少自重并降低钻进阻力的研究思路,通过设置四翼内凹结构达到减小钻杆自重及降低钻进阻力的目的,并依此设计了四翼内凹刻槽钻杆,兼顾钻杆推进阻力和旋转扭矩损失,建立了钻杆钻进阻力模型,结合ANSYS数值模拟方法对四翼内凹刻槽钻杆进行强度校核分析与参数优化,研制了四翼内凹刻槽钻杆,并进行了现场工业性试验。研究表明:(1)对于100m钻孔深度,四翼内凹刻槽钻杆相对于圆状刻槽钻杆质量减轻了21.88%,在正常钻进时,四翼内凹刻槽钻杆与圆钻杆相比旋转扭矩损失降低了25.10%;与圆状刻槽钻杆相比降低了20.90%。在塌孔10m的情况下,四翼内凹刻槽钻杆钻进阻力相对于圆钻杆降低了51.44%,相对于圆状刻槽钻杆降低了43.65%。(2)对四翼内凹刻槽钻杆进行强度分析与参数优化,结果显示,在常规坑道钻机作用下,钻杆最大应力与内凹深度呈正相关,与壁厚呈负相关,壁厚对于应力的影响大于内凹深度的影响,且在内凹宽度为33mm、深度为4mm、壁厚为11.5mm时,安全系数为1.59。(3)现场工业性试验表明,四翼内凹刻槽钻杆排渣顺畅,强度可靠,钻进深度提高了18.18%,钻进效率提高了17.80%。在保证钻杆强度的前提下、通过钻杆结构创新有效降低钻杆质量,对于降低工人劳动强度、提高钻进效率和成孔率具有显著的效果,为推动复杂地层钻探技术发展提供了新的方法。

“双碳”背景下主产区粮食生产减污降碳综合效益评价

基于2002—2021年中国13个粮食主产区的面板数据,采用熵权TOPSIS法、障碍因子诊断模型与Dagum基尼系数,实证分析主产区粮食生产减污降碳综合效益及其时空演化。结果表明:2002—2021年粮食主产区综合效益指数由0.388提高至0.878,整体为上升态势;主产区综合效益水平呈现“东高西低”的空间分布特征;核心障碍因素存在由粮食产出效率与粮食产出水平向粮食生产投入集约化水平与粮食生产碳排放强度集中的转变过程;总体差异水平未出现进一步缓解的趋势,空间差异主要来源于区域间差异,样本期贡献率均值为56.89%,东西部间差异最大,东部、中部地区区域内的基尼系数水平也存在上升趋势,说明缓解区域内差异同样不容忽视。据此,建议切实提高资源投入集约化程度,统筹协调各区域综合效益均衡发展,建立绿色粮食生产体系,强化绿色低碳收益,进而实现农业高质量发展。

一种基于粗糙熵的改进K-modes聚类算法

K-modes聚类算法被广泛应用于人工智能、数据挖掘等领域。传统的K-modes聚类算法有不错的聚类效果,但是存在迭代次数多、计算量大、容易受到冗余属性的干扰等问题,且仅采用简单的0-1匹配的方法来定义2个样本属性值之间的距离,没有充分考虑每个属性对聚类结果的影响。针对上述问题,该文将粗糙熵引入K-modes算法。首先利用粗糙集属性约简算法消除冗余属性,确定各属性的重要程度;然后利用粗糙熵确定每个属性的权重,从而定义新的类内距离。将该文所提算法与传统的K-modes聚类算法分别在4组公开数据集上进行对比试验。试验结果表明,该文所提算法聚类准确率比传统的K-modes聚类算法更高。

减税降费规模与地方政府债务风险治理——机制与证据

减税降费是中国为积极应对经济下行压力、维护全局经济稳定的重要政策手段,但其规模的不断扩大会加剧地方政府债务风险。本文通过构建包含“借”、“用”、“还”3个环节的风险指标体系,采用熵权-TOPSIS法测算2015~2022年中国省级地方政府债务风险指数,使用双向固定效应模型、面板门槛模型实证分析减税降费规模对地方政府债务风险的影响。研究发现,减税降费规模与地方政府债务风险总体上呈正相关关系,并且存在经济发展水平的门槛效应,当经济发展水平跨过门槛值时,地方政府债务风险增长速度将显著降低。同时,减税降费规模与地方政府债务风险间存在非线性关系,随着减税降费规模不断扩大,地方政府债务风险增速也将被遏制。

随机多属性子空间的ReliefF加权邻域粗糙集与属性约简

属性约简是一种重要的数据降维预处理方法,然而现有的属性约简方法大多没有考虑信息系统中属性权重的信息。ReliefF算法是一种实现简单且运算效率高的属性权重评估方法,提出一种随机多属性子空间的ReliefF加权邻域粗糙集和属性约简算法。该方法生成了多组具有相同大小随机子空间的属性集划分,并对每组划分的随机子空间利用ReliefF算法计算得到属性的局部权重,将所有组得到的属性局部权重求取平均值,得到了信息系统每个属性最终的全局权重;基于属性权重的结果,提出一种新的加权邻域粗糙集模型,并证明了相关理论和性质;在该模型的基础上通过加权邻域依赖度提出一种信息系统的属性约简算法。在公开数据集上的属性约简实验结果表明,所提出的属性约简算法比已有的同类型算法整体上具有更优的约简性能。

考虑碳排放的市政道路绿色施工评价研究

【目的】有效减少施工过程中的碳排放量,优选出绿色施工水平较高的市政道路建造方案,提升市政道路科技创新和绿色建造水平。【方法】从碳减排的角度出发,针对市政道路绿色施工综合评价问题,结合市政道路施工的特点,建立了市政道路绿色施工评价体系和标准,构建了基于组合赋权的灰色关联模型,在综合主、客观权重基础上进一步运用灰色关联法计算各指标和各路段施工方案的灰色关联度,分析比较绿色施工水平。【结果】该研究建立的市政道路绿色施工评价体系具有适用性,通过长沙市某市政道路各路段的施工建造方案对所提出的模型进行了验证,其结果与实际情况相符,据此确定了一套合理的市政道路绿色施工方案。【结论】基于组合赋权的灰色关联理论在市政道路绿色施工评价中的应用具有可行性和科学性,并为市政道路绿色施工方案设计提供了参考依据。

考虑CBAM的中国外贸钢铁碳减排前景分析——基于隐含碳强度预测

欧盟碳边境调节机制(CBAM)正逐步实施,其高额碳关税无疑会加速中国出口钢铁行业碳减排进程,而与此同时,中国为实现“双碳”目标也出台了一系列减碳政策。为探究中国出口钢铁行业在复杂政策下的减排前景与关键因素,使用MRIO方法对隐含碳排放进行计算,构建了基于AO-ELM方法的隐含碳排放强度预测体系,模拟了不同政策情景下该行业的碳排放前景。研究发现,CBAM对该行业碳减排具有推动作用,但作用程度有限,提高中国国内政策的落实速度是更有效的途径;在同时考虑CBAM与国内政策如期落地的情景下,2034年该行业较基准情景可以降低8.35%的隐含碳排放。

结合源偏倚和权窗的蒙特卡罗全局减方差方法

全局计数问题在反应堆pin-by-pin模型蒙特卡罗模拟和多物理耦合计算中动态粒子输运蒙特卡罗模拟等重大研究领域中都有广泛的应用场景.大量的全局减方差算法研究立足于全局计数误差分布的展平,由此提高全局计数的整体效率.本工作针对两种高效全局减方差算法,即均匀计数密度算法(属于源偏倚算法的一种)和权窗算法的结合展开研究,提出利用均匀计数密度算法的偏倚因子调整权窗下限,由此实现两种算法的有机结合.基于Hoogenboom-Martin压水堆全堆基准题中开展了一系列对比测试,验证了混合全局减方差算法更优于单一权窗算法或均匀计数密度算法,尤其是在降低最大误差方面.同时,基于新的指标,验证了均匀计数密度算法较经典的均匀裂变源算法具有更好的表现.研究结果表明,本文提出的混合全局减方差算法能高效求解全局计数问题,进一步促进了相关领域的研究.

全局减方差方法在大空间γ辐射场计算中的应用

为了提高大空间γ辐射场全局计算效率,开展了全局减方差(Global Variance Reduction,GVR)方法在大空间γ辐射场计算中的应用研究。针对计数栅元/网格体积差异造成的过度分裂问题,引入体积修正因子修改全空间权窗参数。体积修正后的基于通量的GVR方法计算的全局品质因子(FOMG)比直接模拟提高约39倍。针对非计数区计算耗时问题,提出了非计数区修正方法,使得FOMG因子进一步提高40%。在引入体积和非计数区修正的基础上,在大空间γ辐射场计算中与基于粒子误差、权重、径迹、数目、能量、碰撞和通量的7种GVR方法进行对比。结果表明:7种GVR方法计算的FOMG因子比直接模拟提高2~3个量级,基于误差的标准差σ降低2~3个量级;而基于权重的GVR方法计算的FOMG因子比直接模拟提高2304倍,在所有GVR方法中减方差效果最好。在基于通量的GVR方法中引入光滑因子SI后,模拟计算的权窗下限随SI增加而减小,FOMG因子随SI的增加先增加后减小。当SI=0.8时,该方法计算的FOMG因子最大,比直接模拟提高3246倍。

一种基于信息熵加权的属性约简算法

针对现有邻域粗糙集模型中存在属性权重都相同,无法保证关键属性在属性约简时能够被保留的问题,提出了一种基于信息熵加权的属性约简算法。首先,采用了类间熵、类内熵策略,以最大化类间熵最小化类内熵为原则给属性赋予权重;其次,构造了基于加权邻域关系的加权邻域粗糙集模型;最后,基于依赖关系评估属性子集的重要性,从而实现属性约简。在基于UCI数据集上与其他三种属性约简算法进行对比实验,结果表明,该算法能够有效去除冗余,提高分类精度。

When the Stars Align: Hypertriglyceridemic Pancreatitis Is Inevitable

Background: Acute pancreatitis (AP) is an inflammatory process affecting the pancreas. Hypertriglyceridemic AP (HTAP) is its third leading cause after gallstones followed by alcohol use. It develops when stars align viz. triggers (acquired surges) in patients with genetic hypertriglyceridemia. Case: severe and acute pancreatitis had developed in a 57-year-old man with type IIb familial hyperlipidemia after heavy fatty meals. The acute phase was controlled by holding oral intake with weekly Evolocumab therapy and long-term prevention by weight reduction and Fenofibrate alone. His pancreatic endocrine and exocrine functions remained normal after 2 years of follow-up. Conclusion: Those four measures were safe, practical and effective for short- and long-term management of HTAP.

直升机旋翼桨叶动力学/强度多学科优化设计

为解决板梁构型桨叶设计方案结构超重和疲劳寿命不足的问题,以旋翼桨叶剖面特性展向分布为设计变量,以桨叶频率配置、气弹稳定性和转动惯量为设计约束,组织多学科优化设计,实现减小桨叶结构重量,提高桨叶疲劳寿命并降低桨叶剖面动载荷的设计目标。取桨叶动载荷最大的高速前飞状态为设计点,采用文中构建的方法,成功实现了该桨叶的调频/减重/减振/提高疲劳寿命优化设计,优化后桨叶结构减重近10%,桨叶控制剖面的动应变降到许用值以下,满足了重量和疲劳寿命设计指标。