Multimodal Machine Learning Guides Low Carbon Aeration Strategies in Urban Wastewater Treatment

The potential for reducing greenhouse gas(GHG)emissions and energy consumption in wastewater treatment can be realized through intelligent control,with machine learning(ML)and multimodality emerging as a promising solution.Here,we introduce an ML technique based on multimodal strategies,focusing specifically on intelligent aeration control in wastewater treatment plants(WWTPs).The generalization of the multimodal strategy is demonstrated on eight ML models.The results demonstrate that this multimodal strategy significantly enhances model indicators for ML in environmental science and the efficiency of aeration control,exhibiting exceptional performance and interpretability.Integrating random forest with visual models achieves the highest accuracy in forecasting aeration quantity in multimodal models,with a mean absolute percentage error of 4.4%and a coefficient of determination of 0.948.Practical testing in a full-scale plant reveals that the multimodal model can reduce operation costs by 19.8%compared to traditional fuzzy control methods.The potential application of these strategies in critical water science domains is discussed.To foster accessibility and promote widespread adoption,the multimodal ML models are freely available on GitHub,thereby eliminating technical barriers and encouraging the application of artificial intelligence in urban wastewater treatment.

Multimodal treatment of hepatocellular carcinoma on cirrhosis: An update

Hepatocellular carcinoma(HCC)is the most frequent primary liver tumor,and overall,it is one of the most frequent cancers.The association of HCC with chronic liver disease,and cirrhosis in particular,is well known,making treatment complex and challenging.The treatment of HCC must take into account the presence and stage of chronic liver disease,with the aim of preserving hepatic function that is often already impaired,the stage of HCC and the clinical condition of the patient.The different treatment options include surgical resection,transplantation,local ablation,chemoembolization,radioembolization and molecular targeted therapies;these treatments can be combined in various ways to achieve different goals.Ideally,liver transplantation is best treatment for early stage HCC on cirrhosis because it removes both the tumor and the chronic disease that produced it;however,the application of this powerful tool is limited by the scarcity of donors.Downstaging and bridging are different strategies for the management of HCC patients who will undergo liver transplantation.Several professionals,including gastroenterologists,radiologists and surgeons,are involved in the choice of the most appropriate treatment for a single case,and a multidisciplinary approach is necessary to optimize the outcome.The purpose of this review is to provide a comprehensive description of the current treatment options for patients with HCC by analyzing the advantages,disadvantages and rationale for their use.

Multimodal treatment of gastric cancer

Gastric cancer is the second leading cause of death from malignant disease worldwide.Although complete surgical resection remains the only curative modality for early stage gastric cancer,surgery alone only provides long-term survival in 20%of patients with advancedstage disease.To improve current results,it is necessary to consider multimodality treatment,including chemotherapy,radiotherapy and surgery.Recent clinical trials have shown survival benefit of combining different neoadjuvant or adjuvant protocols compared with surgery with curative intent.Furthermore,the implementation of chemotherapy with novel targeted agents could play an important role in the multimodal management of advanced gastric cancer.In this paper,we focus on a multidisciplinary approach in the treatment of gastric cancer and discuss future strategies to improve the outcome for these patients.

Multimodal treatment in oligometastatic gastric cancer

Gastric cancer is generally diagnosed at an advanced stage,especially in countries without screening programs.Previously,the metastatic stage was synonymous with palliative management,and surgical indications were only for symptomatic relief.However,this therapeutic option is associated with poor prognosis.A subgroup of patients with limited metastatic disease could benefit from intensive treatment.A combination of chemotherapy,immunotherapy,and targeted therapy could help either maintain a resectable state for oligometastatic disease or diminish the metastasis size to obtain a complete resection configuration.This latter strategy is known as conversion therapy and has growing evidence with favorable outcomes.Oncosurgical approach of metastatic disease could prolong survival in selected patients.The challenge for the surgeon and oncologist is to identify these specific patients to offer the best multimodal management.We review in this article the actual evidence for the treatment of oligometastatic gastric cancer with curative intent.

Multimodality treatment of potentially curative gastric cancer: Geographical variations and future prospects

After much controversy, multimodality therapy is now accepted worldwide as the gold standard for treatment of resectable bulky localized gastric cancer. There is significant regional variation in the style of multimodality treatment with adjuvant chemoradiation the North American standard, neoadjuvant chemotherapy preferred in Europe and Australasia, whilst adjuvant chemotherapy is preferred in Asia. With further standardization of surgery and D1+/D2 resections increasingly accepted world wide, and in particular in the West, as the surgical standard of care for potentially curable disease, it is timely to reassess the multimodality regimes being used. The challenge in the use of multimodality therapy is how current outcomes can be standardized and improved further. Recent studies indicate that mere intensification of the regime in time, dosage or addition of further agents does not improve localized gastric cancer outcomes. More novel strategies including early commencement of adjuvant therapies, intra-peritoneal chemotherapy or assessing neoadjuvant response with positron emission tomography scanning may give improvements in outcomes. The introduction of targeted therapies means that the adjuvant use of biological agents needs to be explored. By proper assessment of the patient’s co-morbidities, full tumour staging, and a better understanding of the tumour’s molecular pathology, multimodality therapy for gastric adenocarcinoma may be individualized to optimize the likelihood of cure.

Multimodality Treatment for Thymic Carcinoma: Review of 11 Cases at a Single Institute

Background: We reported our experience with thymic carcinomas and review their clinical features, treatment strategies, and prognoses. Methods: From April 1998 to November 2012, 11 patients pathologically diagnosed with thymic carcinoma and treated in our hospital were investigated. Results: There were 7 men and 4 women, with a median age of 62 years (range, 35 - 72). According to the Masaoka staging system, 3 patients had stage II, 1 stage III disease, 3 stage IVa disease and 4 stage IVb disease. Ten patients had squamous cell carcinoma, whereas 1 had large cell neuroendocrine carcinoma (LCNEC). We performed surgery or multimodality therapy including surgery as the initial therapy for 8 patients. Of the non-surgical cases, 1 patient received chemoradiotherapy and survived for over 6 years without recurrence, whereas 2 received palliative care. Three of 4 patients who underwent complete resection survived without disease recurrence, whereas only 1 patient with LCNEC survived in the incomplete resection group. Multimodality therapy with cisplatin and docetaxel was provided to 3 patients, and recurrence has not been observed in any of the cases. Conclusions: Favorable outcomes could be achieved in patients with thymic carcinoma who underwent intensive treatment. In particular, surgery combined with cisplatin and docetaxel plus thoracic irradiation may be an attractive approach for thymic carcinoma.

Research progress on risk factors and non-drug treatment of delirium patients in CICU

Delirium is a clinical syndrome of acute brain dysfunction,especially the incidence of delirium in patients in Cardiac Intensive Care Unit(CICU)is relatively high.This paper mainly describes the main risk factors for delirium in CICU patients are patient characteristic,disease,treatment and environment and the research progress of non-pharmacological treatment is reviewed,aiming at nursing staff should pay more attention to the patient characteristics and actively take non-pharmacological nursing measures and prevent the occurrence of delirium.This article focuses on the main risk factors of CICU patients with delirium and the research progress of non-pharmacological treatment.It aims to provide a reference basis for the management and research of CICU delirium patients in China in the future.

Pathogenesis, diagnosis, and treatment of epilepsy: electromagnetic stimulation-mediated neuromodulation therapy and new technologies

Epilepsy is a severe,relapsing,and multifactorial neurological disorder.Studies regarding the accurate diagnosis,prognosis,and in-depth pathogenesis are crucial for the precise and effective treatment of epilepsy.The pathogenesis of epilepsy is complex and involves alterations in variables such as gene expression,protein expression,ion channel activity,energy metabolites,and gut microbiota composition.Satisfactory results are lacking for conventional treatments for epilepsy.Surgical resection of lesions,drug therapy,and non-drug interventions are mainly used in clinical practice to treat pain associated with epilepsy.Non-pharmacological treatments,such as a ketogenic diet,gene therapy for nerve regeneration,and neural regulation,are currently areas of research focus.This review provides a comprehensive overview of the pathogenesis,diagnostic methods,and treatments of epilepsy.It also elaborates on the theoretical basis,treatment modes,and effects of invasive nerve stimulation in neurotherapy,including percutaneous vagus nerve stimulation,deep brain electrical stimulation,repetitive nerve electrical stimulation,in addition to non-invasive transcranial magnetic stimulation and transcranial direct current stimulation.Numerous studies have shown that electromagnetic stimulation-mediated neuromodulation therapy can markedly improve neurological function and reduce the frequency of epileptic seizures.Additionally,many new technologies for the diagnosis and treatment of epilepsy are being explored.However,current research is mainly focused on analyzing patients’clinical manifestations and exploring relevant diagnostic and treatment methods to study the pathogenesis at a molecular level,which has led to a lack of consensus regarding the mechanisms related to the disease.

Multimodality treatment of recurrent pancreatic cancer: Mith or reality?

Pancreatic adenocarcinoma is the fourth cause of cancerrelated death in the United States. Surgery is the only potentially curative treatment, but most patients present at diagnosis with unresectable or metastatic disease. Moreover, even with an R0 resection, the majority of patients will die of disease recurrence. Most recurrencesoccur in the first 2-year after pancreatic resection, and are commonly located in the abdomen, even if distant metastases can occur. Recurrent pancreatic adenocarcinoma remains a significant therapeutic challenge, due to the limited role of surgery and radiochemotherapy. Surgical management of recurrence is usually unreliable because tumor relapse typically presents as a technically unresectable, or as multifocal disease with an aggressive growth. Therefore, treatment of patients with recurrent pancreatic adenocarcinoma has historically been limited to palliative chemotherapy or supportive care. Only few data are available in the Literature about this issue, even if in recent years more studies have been published to determine whether treatment after recurrence have any effect on patients outcome. Recent therapeutic advances have demonstrated the potential to improve survival in selected patients who had undergone resection for pancreatic cancer. Multimodality management of recurrent pancreatic carcinoma may lead to better survival and quality of life in a small but significant percentage of patients; however, more and larger studies are needed to clarify the role of the different therapeutic options and the optimal way to combine them.

Multimodal treatments of right gastroepiploic arterial leiomyosarcoma with hepatic metastasis:A case report and review of the literature

Leiomyosarcoma of an artery is very rare, and cases with hepatic metastasis are even rarer. We describe a case of a 70-year-old man who after follow up due to rectal cancer, presented with an intra-abdominal hypervascular mass and a hepatic mass. After surgical resection, it was diagnosed as a leiomyosarcoma of the right gastroepiploic artery with hepatic metastasis. Multiple metastases had recurred at the liver. He has survived more than 53 mo through multimodal treatments(three surgical resections, radiofrequency ablation, transarterial chemoembolization, chemotherapies, and targeted therapy). Multimodal treatments, including active surgical resection, may behelpful in the treatment of aggressive diseases such as arterial leiomyosarcoma with metastasis.

Acupuncture in the Multimodal Biopsychosocial Pain Management. <br>Towards a New Model in Clinical Practice

The last decennia the multidimensional nature of pain has been recognized and a multimodal bio-psychosocial management has been proposed. Acupuncture has progressively gained a place in this multimodal approach. The principles of traditional Chinese medicine link three major themes, nutrition and microbiome, neuroplasticity, homeostasis and the side effects of medication. For patients with chronic pain and/or chronic pain refractory to conservative medicine it is important to assess all factors involved with the chronicity. The improved biological, genetic and epigenetic knowledge has contributed to a better understanding of the mechanism of action of acupuncture and integrative medicine. Moreover neuroimaging has been able to demonstrate the brain regions activated by acupuncture and also illustrates the differences with sham or placebo. Opponents often claim an absence or weakness of evidence. These claims are based on the observations that the initial reports are predominantly case reports and studies with a poor design quality. In the last decennia well-designed randomized trials have been published, thus improving the quality of the evidence. The most important findings are summarized in this article. As with all controlled trials the inclusion and exclusion criteria as well as the standardization of the treatment do not always reflect daily practice. Therefore we report patient cases as illustration of the integrative approach.

Comprehensive multimodal management of borderline resectable pancreatic cancer:Current status and progress

Borderline resectable pancreatic cancer(BRPC)is a complex clinical entity with specific biological features.Criteria for resectability need to be assessed in combination with tumor anatomy and oncology.Neoadjuvant therapy(NAT)for BRPC patients is associated with additional survival benefits.Research is currently focused on exploring the optimal NAT regimen and more reliable ways of assessing response to NAT.More attention to management standards during NAT,including biliary drainage and nutritional support,is needed.Surgery remains the cornerstone of BRPC treatment and multidisciplinary teams can help to evaluate whether patients are suitable for surgery and provide individualized management during the perioperative period,including NAT responsiveness and the selection of surgical timing.

Treatment patterns and survival outcomes in patients with nonmetastatic early-onset pancreatic cancer

BACKGROUND The incidence of patients with early-onset pancreatic cancer(EOPC;age≤50 years at diagnosis)is on the rise,placing a heavy burden on individuals,families,and society.The role of combination therapy including surgery,radiotherapy,and chemotherapy in non-metastatic EOPC is not well-defined.AIM To investigate the treatment patterns and survival outcomes in patients with non-metastatic EOPC.METHODS A total of 277 patients with non-metastatic EOPC who were treated at our institution between 2017 and 2021 were investigated retrospectively.Overall survival(OS),disease-free survival,and progression-free survival were estimated using the Kaplan-Meier method.Univariate and multivariate analyses with the Cox proportional hazards model were used to identify prognostic factors.RESULTS With a median follow-up time of 34.6 months,the 1-year,2-year,and 3-year OS rates for the entire cohort were 84.3%,51.5%,and 27.6%,respectively.The median OS of patients with localized disease who received surgery alone and adjuvant therapy(AT)were 21.2 months and 28.8 months,respectively(P=0.007).The median OS of patients with locally advanced disease who received radiotherapy-based combination therapy(RCT),surgery after neoadjuvant therapy(NAT),and chemotherapy were 28.5 months,25.6 months,and 14.0 months,respectively(P=0.002).The median OS after regional recurrence were 16.0 months,13.4 months,and 8.9 months in the RCT,chemotherapy,and supportive therapy groups,respectively(P=0.035).Multivariate analysis demonstrated that carbohydrate antigen 19-9 level,pathological grade,T-stage,N-stage,and resection were independent prognostic factors for non-metastatic EOPC.CONCLUSION AT improves postoperative survival in localized patients.Surgery after NAT and RCT are the preferred therapeutic options for patients with locally advanced EOPC.

Research progress on non-drug treatment of diabetic kidney disease

Diabetic kidney disease is one of the most serious and common chronic complications of diabetes and one of the leading causes of death in diabetic patients.In the case of diabetic kidney disease,sustained proteinuria is irreversible until it develops into end-stage renal disease.Drug treatment of diabetic kidney disease is relatively limited.More and more evidences into the effectiveness and safety that related non-drug treatments not only have the characteristics of simple operation and high safety,but also can improve the clinical symptoms of patients with diabetic kidney disease,reduce laboratory indicators,and delay disease progression.This article summarizes the recent literature on non-drug treatment of diabetic kidney disease such as exercise therapy,acupuncture therapy,acupoint application,auricular acupoint pressing pill therapy,moxibustion therapy,in order to provide reference for clinical treatment.

Outcome of transarterial chemoembolization-based multi-modal treatment in patients with unresectable hepatocellular carcinoma

AIM:To investigate the efficacy and safety of transarterial chemoembolization(TACE)-based multimodal treatment in patients with large hepatocellular carcinoma(HCC).METHODS:A total of 146 consecutive patients were included in the analysis,and their medical records and radiological data were reviewed retrospectively.RESULTS:In total,119 patients received TACE-based multi-modal treatments,and the remaining 27 received conservative management.Overall survival(P<0.001)and objective tumor response(P=0.003)were significantly better in the treatment group than in the conservative group.After subgroup analysis,survival benefits were observed not only in the multi-modal treatment group compared with the TACE-only group(P=0.002)but also in the surgical treatment group compared with the loco-regional treatment-only group(P<0.001).Multivariate analysis identified tumor stage(P<0.001)and tumor type(P=0.009)as two independent pre-treatment factors for survival.After adjusting for significant pre-treatment prognostic factors,objective response(P<0.001),surgical treatment(P=0.009),and multi-modal treatment(P=0.002)were identified as independent post-treatment prognostic factors.CONCLUSION:TACE-based multi-modal treatments were safe and more beneficial than conservative management.Salvage surgery after successful downstaging resultedin long-term survival in patients with large,unresectable HCC.

Current status of esophageal cancer treatment

Esophageal cancer(EC) remains one of the most common and aggressive diseases worldwide.This review discusses some debates in the modern management of the disease.Endoscopic procedures for early cancer(T1a-b) are now embedded in routine care and the challenge will be to more accurately select patients for endoscopic resection with or without adjuvant therapy.Perioperative multimodal therapies are associated with improved survival compared to surgery alone for locally advanced esophageal cancer.However, there is no global consensus on the optimal regimen.Furthermore, histological subtype(adenocarcinoma vs.squamous cell cancer) plays a role in the choice for treatment.New studies are underway to resolve some issues.The extent of the lymphadenectomy during esophagectomy remains controversial especially after neoadjuvant chemoradiation.The ideal operation balances between limiting surgical trauma and optimizing survival.Minimally invasive esophagectomy and enhanced recovery pathways are associated with decreased morbidity and faster recovery albeit there is no consensus yet what approach should be used.Finally, immune checkpoint inhibitors present promising preliminary results in the novel treatment of advanced or metastatic EC but their widespread application in clinical practice is still awaited.

Successful Treatment of Adult Pleomorphic Rhabdomyosarcoma in the Posterior Left Femur: A Case Report

Introduction: Rhabdomyosarcoma (RMS) is the most common childhood soft tissue sarcoma, but it represents only a small portion of soft tissue sarcoma in adult population. There is a treatment protocol based on Intergroup Rhabdomyosarcoma Study (IRS) that provides satisfactory results in treating RMS in children, but there is only limited evidence regarding the outcome and prognosis in extrapolating the IRS protocol to treat RMS in adults. We report a case of adult pleomorphic RMS treated with multidisciplinary approach and the results we have obtained. Case presentation: A 48-year-old woman was admitted in February 2011 due to a painful mass on her left thigh. Diagnosis of pleomorphic rhabdomyosarcoma was made by histopathology and immunohistochemistry. After multimodal treatment that includes Trans-Arterial Chemotherapy Infusion, Cryosurgery, and wide excision surgery, our patient remains disease-free as of the latest annual follow up examination on June 2017. Conclusions: The pleomorphic type of Rhabdomyosarcoma is very rare in adults and is often associated with a poor prognosis. In our case, a multidisciplinary approach with multimodal treatment provides excellent result, even after a routine follow up spanning through six years.

RADIOIMMUNOTHERAPY IN TREATMENT OF UNRESECTABLE HEPATOMA－A REPORT OF 43 CASES

Forty-three patients with surgically verified unresectable hepatoma had been treated by radioimmunotherapy(RIT)using￣(131)I antiferritin antibidy as a part of multimodality treatment during 1985 - 1990.The shortand long-term responses were compared with those in control group of 39 patients with unresectable hepatoma receiving conventional multimodality treatment in the same period.The rates of the tumor shrinkage,serum AFP decline and sequence resction were 67. 4% (29/43),69.6%(16/23)and 30.2%(13/43)respectively,which were significantly higher than those in contrul group[23.1%(15/39),40.0%(8/20)and 10.3%(4/39),respectively].The 1-,3- and 5-year survival rates were 61.5%,40.4%and 35.4%,respectively,for the RIT group,and 51.2%,20.1% and 15.5% ,respectrely,for the control group.The tumor size,dose of RIT and sequence resection were identified as significant factors (P=0.005,0.025 and 0.006,respectively, with Cox analysis model in 13 influencing factors.The results indicate that RIT was an effective one in multimodality treatment,particularly in the conversion of unresectable to resectable tumor.

Non-pharmacological therapy of TCM for the treatment of essential hypertension

Non-pharmacotogicat treatment is an important means to control hypertension, with many advantages such as tow cost, tess medication, stable btood pressure, tess compHcations, and improved prognosis. This article reviews the research progress of non-drug treatment of hypertension in Chinese medicine in the past five years, and evaluates traditional Chinese medicine such as TCM Qigong, Wuhuo opera, Ba Duanjin and Taijiquan, and Chinese medicine acupuncture, moxibustion, massage, apptication, acupoint embedding and other traditional Chinese medicine. The effect of external treatment in hypertension control provides guidance for non-drug therapy to control hypertension.

硫酸镁辅助镇痛效果及在无阿片类药物麻醉方案中的应用前景

在疼痛治疗过程中为了减少阿片药物的应用,已经尝试引入辅助镇痛剂。越来越多的数据表明N-甲基-D-天冬氨酸(NMDA)受体拮抗剂可能具有增强阿片样物质的镇痛作用,诸多研究显示硫酸镁的辅助镇痛作用在疼痛治疗和围手术期麻醉方面表现出很好的应用前景。硫酸镁应用于疼痛治疗的药理学机制主要是其具有NMDA偶联通道的生理电压依赖性阻断剂的作用,其抗伤害性作用与镁阻断钙内流,从而抑制中枢敏感化并降低先前存在的痛觉过敏有关。该文综述硫酸镁在围手术期应用的现状,主要介绍硫酸镁静脉给药、鞘内给药、局部给药的辅助镇痛效果和减少阿片类药物消耗作用,以及在无阿片类药物麻醉方案中的作用及应用前景。