Development of diabetic complications and influencing factors among 32653 type 2 diabetes patients:retrospective cohort study using a multi-state Markov

Background:Patients with type 2 diabetes are at high risk for developing multiple chronic complications.However,there is a lack of studies of the cumulative number of diabetic complications in China.Methods:A retrospective cohort study was performed from 2009 to 2021.Type 2 diabetes patients who were first diagnosed after the age of 35 years between January 1,2009,and December 31,2017,were included.Five states were defined according to the number of chronic complications:no(S0),one(S1),two(S2),three(S3),and four or more complications(S4).A multi-state Markov model was constructed to estimate transition probability,transition intensity,mean sojourn time,and the possible factors for each state.Results:The study included 32653 type 2 diabetes patients(mean age,59.59 years;15929(48.8%)male),and mean follow-up time of 7.75 years.In all,4375 transitions were observed.The 12-year transition probability of from state S0 to S1 was the lowest at 16.4%,while that from S2 to S3 was the highest,at 45.6%.Higher fasting blood glucose,lower high-density lipoprotein cholesterol,higher total cholesterol,and an unhealthy diet were associated with higher risk of progression from S0 to S1.Being female,less than 60 years old,weekly physical activity,and vegetarian diet decreased this risk.Being female and less than 60 years old reduced the likelihood of transition from S1 to S2,whereas lower high-density lipoprotein cholesterol increased this likelihood.Conclusions:Following the occurrence of two complications in type 2 diabetes patients,the risk for accumulating a third complication within a short time is significantly increased.It is important to take advantage of the stable window period when patients have fewer than two complications,strengthen the monitoring of blood glucose and blood lipids,and encourage patients to maintain good living habits to prevent further deterioration.

基于改进Node2vec算法的锅炉温度场分割方法研究

针对温度场特征参数差异引发的锅炉温度场分割准确性的问题,以维持温度场特征为目标,引入图结构表达场数据,通过改进Node2vec算法进行聚类分析,进而实现锅炉温度场的最佳分割。该方法基于多维度的特征信息对锅炉温度场实现分割,能够更准确地保留流场特征。在标准数据集上进行了实验验证,结果表明在具有多维度特征的数据集上,所提方法相比其他对比算法在分割效果方面有提升显著。最后将提出的方法用于分割电站锅炉温度场,结果表明该方法可以很好地捕捉温度场数据中的局部和全局特征,且结果具有较好的精确性。

Capacitated stochastic coloured Petri net-based approach for computing two-terminal reliability of multi-state network

Classical network reliability problems assume both net- works and components have only binary states, fully working or fully failed states. But many actual networks are multi-state, such as communication networks and transportation networks. The nodes and arcs in the networks may be in intermediate states which are not fully working either fully failed. A simulation ap- proach for computing the two-terminal reliability of a multi-state network is described. Two-terminal reliability is defined as the probability that d units of demand can be supplied from the source to sink nodes under the time threshold T. The capacities of arcs may be in a stochastic state following any discrete or continuous distribution. The transmission time of each arc is also not a fixed number but stochastic according to its current capacity and de- mand. To solve this problem, a capacitated stochastic coloured Petri net is proposed for modelling the system behaviour. Places and transitions respectively stand for the nodes and arcs of a net- work. Capacitated transition and self-modified token colour with route information are defined to describe the multi-state network. By the simulation, the two-terminal reliability and node importance can be estimated and the optimal route whose reliability is highest can also be given. Finally, two examples of different kinds of multi- state networks are given.

Importance measure of system reliability upgrade for multi-state consecutive k-out-of-n systems

Importance measures in reliability systems are used to identify weak components in contributing to a proper function of the system. Traditional importance measures mainly concerned the changing value of the system reliability caused by the change of the reliability of the component, and seldom considered the joint effect of the probability distribution, improvement rate of the object component. This paper studies the rate of the system reliability upgrading with an improvement of the component reliability for the multi-state consecutive k-out-of-n system. To verify the multi-state consecutive k-out-of-n system reliability upgrading by improving one component based on its improvement rate, an increasing potential importance （IPI） and its physical meaning are described at first. Secondly, the relationship between the IPI and Birnbaum importance measures are discussed. And the IPI for some different improvement actions of the component is further discussed. Thirdly, the characteristics of the IPI are analyzed. Finally, an application to an oil pipeline system is given.

Reliability Modeling and Evaluation of Complex Multi-State System Based on Bayesian Networks Considering Fuzzy Dynamic of Faults

In the traditional reliability evaluation based on the Bayesian method,the failure probability of nodes is usually expressed by the average failure rate within a period of time.Aiming at the shortcomings of traditional Bayesian network reliability evaluation methods,this paper proposes a Bayesian network reliability evaluation method considering dynamics and fuzziness.The fuzzy theory and the dynamic of component failure probability are introduced to construct the dynamic fuzzy set function.Based on the solving characteristics of the dynamic fuzzy set and Bayesian network,the fuzzy dynamic probability and fuzzy dynamic importance degree of the fault state of leaf nodes are solved.Finally,through the dynamic fuzzy reliability analysis of CNC machine tool hydraulic system balance circuit,the application of this method in system reliability evaluation is verified,which provides support for fault diagnosis of CNC machine tools.

Integrated importance measure for multi-state coherent systems of k level

To verify the effectiveness of the integrated importance measure （IIM） for multi-state coherent systems of k level, the definition and physical meaning of IIM are demonstrated. Then, the improvement potential and Δ-importance measures are generalized to multi-state coherent systems based on the system performance level, and the relationships between IIM and traditional importance measures are discussed. The characteristics of IIM are demonstrated in both series and parallel systems. Also, an application to an oil transportation system is given. The comparison results show that： （i） IIM has some useful properties that are not possessed by traditional importance measures; （ii） IIM is effective in evaluating the component role in multi-state systems when the component reliability and the failure rate are simultaneously considered.

A voltage support control strategy based on three-port flexible multi-state switch in distribution networks

Voltage sags in power system may lead to serious problems such as the off-grid of distributed generation and electrical equipment failures.As a novel type of power electronic equipment,a flexible multi-state switch(FMSS)is capable to support the voltage during the grid faults.In this paper,a voltage control strategy to support the voltage in a distribution network is proposed by introducing three-port FMSS.The positive-negative-sequence compensation(PNSC)scheme is adopted to control the active and reactive current.This control scheme eliminates active power oscillations at the port of voltage sags and reduces coupling oscillations of other ports.Based on the characteristics of the voltage support under PNSC scheme,two voltage support strategies are proposed.A proportional-integral controller is introduced to provide the reactive power references,which eliminates the errors when estimating the grid voltage and impedance.A current limiting scheme is adopted to keep the port current in a safe range by adjusting the active and reactive power references.The voltage support strategies in two different voltage sags are simulated,and results show the feasibility and effectiveness of the proposed control strategies.

Optimal transmission lines assignment with maximal reliabilities in multi-source multi-sink multi-state computer network

The optimal transmission lines assignment with maximal reliabilities (OTLAMR) in the multi-source multi-sink multi-state computer network (MMMCN) was investigated. The OTLAMR problem contains two sub-problems: the MMMCN reliabilities evaluation and multi-objective transmission lines assignment optimization. First, a reliability evaluation with a transmission line assignment (RETLA) algorithm is proposed to calculate the MMMCN reliabilities under the cost constraint for a certain transmission lines configuration. Second, the non-dominated sorting genetic algorithm II (NSGA-II) is adopted to find the non-dominated set of the transmission lines assignments based on the reliabilities obtained from the RETLA algorithm. By combining the RETLA and the NSGA-II algorithms together, the RETLA-NSGA II algorithm is proposed to solve the OTLAMR problem. The experiments result show that the RETLA-NSGA II algorithm can provide efficient solutions in a reasonable time, from which the decision makers can choose the best solution based on their preferences and experiences.

Importance Analysis of a Multi-state System Based on Direct Partial Logic Derivatives and Multi-valued Decision Diagrams

Importance analysis quantifies the critical degree of individual component. Compared with the traditional binary state system,importance analysis of the multi-state system is more aligned with the practice. Because the multi-valued decision diagram( MDD) can reflect the relationship between the components and the system state bilaterally, it was introduced into the reliability calculation of the multi-state system( MSS). The building method,simplified criteria,and path search and probability algorithm of MSS structure function MDD were given,and the reliability of the system was calculated. The computing methods of importance based on MDD and direct partial logic derivatives( DPLD) were presented. The diesel engine fuel supply system was taken as an example to illustrate the proposed method. The results show that not only the probability of the system in each state can be easily obtained,but also the influence degree of each component and its state on the system reliability can be obtained,which is conducive to the condition monitoring and structure optimization of the system.

The Mechanical Stabilization and Multi-States of the Stretched VWF A2 Domain

At the vascular injury sites,the ultra-large (UL) multimeric von willebrand Factor (VWF) is released in response to physiological and pathophysiological stimuli,and mediates platelet adhesion,aggregation,and cross-linking to maintain hemostasis.This UL-VWF is specifically cleaved by ADAMTS13(A Disintegrin And Metalloprotease with a ThromboSpondintype-1 motif,member 13)to prevent microvascular thrombosis.Each VWF monomer consists of five types of repeat domains in the order of D1-D2-D’-D3-A1-A2-A3-D4-C1-C2-C3-C4-C5-C6-CK,in which the A2 domain contains the ADAMTS13cleavage site(Tyr1605-Met1606),exposure of which requires mechanical or chemical stimuli.Under flows,fluid shear stress regulates VWF degradation and size distribution through opening the A2 domain and exposing its cleavage site for ADAMTS13.VWF A2 domain contains a C-terminal vicinal disulfide bond,a calcium binding sites,and a flexibleα4-less-loop.These unique structure features together make A2 more sensitive to mechanical signal than other VWF A subdomains,i.e.A1 and A3 domains.It is believed that A2 is first bound with and then cleaved by ADAMTS13,together with force-induced conformation transformation.To reveal molecular basis of this two-step model of VWF hydrolyzation by ADAMTS13,we here examined stretch-induced unfolding processes of VWF A2 domain in more detail by Steered molecular dynamics(SMD)simulations,with the use of crystal structure of VWF A2(PDB ID 3GXB),and observed that there were multiple quasi-stable conformations of stretched A2 until itsβ4-strand and a3-helix were pulled away the central hydrophobic core and the cleavage sites were fully accessible to solvent.Our MD simulation data showed that,in unfolding,at first,the cleavage site residue Tyr1605 was exposed partially and binding sites for Spacer domain of ADAMTS13 were exposed to a high level whenα6-helix was separated from A2 body;then,withβ6-strand and a5-helix been pulled away,the binding sites for Cysrich domain of ADAMTS13 was exposed completely while the exposure degree of Tyr1605 was not improved;further,separation ofβ5-strand andα4-less-loop made Tyr1605 and Met1606 and the respective binding sites for ADAMTS13 Spacer domain,Cys-rich domain,and Disintegrin-like domain be fully exposed to reach the optimal catalytic state;lastly,withβ4-strand separation,the cleavage sites and binding sites all were overstretched,leading to mismatch of ADAMTS13 and A2 conformation especially in the binding sites.This conformational mismatch may cause reduction of ADAMTS13 hydrolysis efficiency.Furthermore,the data of SMD simulations under constant forces demonstrated that,the stretched A2 conformation had different quasi-stable states,which all had the better mechanical stability within simulation time of 100 ns;and the conformational transformation from one state to another must overcome their respective potential barriers.The hydrolysis efficiency should depend on each state of the stretched A2 conformation,because of the exclusive matched-degree of A2 and ADMATS13.This computer prediction on the mechanical stability and multi-states of stretched A2 provides a novel insight into the mechano-chemical regulation on cleavage of A2 by ADAMTS13.It would be helpful for design of related drug targeting the binding sites on A2 and exosites on ADAMTS13 for the treatment of patients with acquired TTP.

A multi-state weather generator for daily precipitation for the Torne River basin, northern Sweden/western Finland

This paper describes a new weather generator e the 10-state empirical model e that combines a 10-state, first-order Markov chain with a non-parametric precipitation amounts model. Using a doubly-stochastic transition-matrix results in a weather generator for which the overall precipitation distribution(including both wet and dry days) and the temporal-correlation can be modified independently for climate change studies. This paper assesses the ability of the 10-state empirical model to simulate daily area-average precipitation in the Torne River catchment in northern Sweden/western Finland in the context of 3 other models: a 10-state model with a parametric(Gamma) amounts model; a wet/dry chain with the empirical amounts model; and a wet/dry chain with the parametric amounts model. The ability to accurately simulate the distribution of multi-day precipitation in the catchment is the primary consideration.Results showed that the 10-state empirical model represented accumulated 2- to 14-day precipitation most realistically. Further, the distribution of precipitation on wet days in the catchment is related to the placement of a wet day within a wet-spell, and the 10-state models represented this realistically, while the wet/dry models did not. Although all four models accurately reproduced the annual and monthly averages in the training data, all models underestimated inter-annual and inter-seasonal variance. Even so, the 10-state empirical model performed best.We conclude that the multi-state model is a promising candidate for hydrological applications, as it simulates multi-day precipitation well, but that further development is required to improve the simulation of interannual variation.

Reliability Improvement of Large Multi-state Series-parallel Systems

In the paper, excess methods for improving the reliability of multi-state series-parallel systems are presented： for the hot reserve of single components, the cold reserve of single components, and the mixed （hot and cold） reserve of single components. A process is also introduced to improve the reliability of these methods by replacing their components with more reliable ones. New theorems for multi-state limit reliability functions in homogeneous and non-homogeneous series-parallel large systems composed of components with improved reliability are presented, and applied to compare the effects of these systems in different reliability improving methods.

Reliability Evaluation and Sensitivity Analysis for Multi-state System Based on Time Degradation Measures

The performance and state of multi-state system depend on its structure and different state combinations of the components. In order to evaluate the reliability of multi-state system effectively,a reliability evaluation and sensitivity analysis method based on the time degradation measures was proposed. The equivalence sets of the multi-state system under different output performances were established. The state combinations were classified according to the performance level. The degradation probability models under different states were established,and the new reliability measures,such as dynamic probability of multi-state system,holding time in each state,dynamic expectation function and integrated expectation function of the performance,were proposed and used to implement the dynamic reliability evaluation and sensitivity analysis. A certain diesel engine fuel feeding system was taken as an application example to illustrate the proposed method. The results show that not only the holding time in the desired state of the components and the system can be predicted,but also the best state component in a certain time period can be obtained.

A Two-Step Algorithm to Estimate Variable Importance for Multi-State Data:An Application to COVID-19

Survival data with amulti-state structure are frequently observed in follow-up studies.An analytic approach based on a multi-state model(MSM)should be used in longitudinal health studies in which a patient experiences a sequence of clinical progression events.One main objective in the MSM framework is variable selection,where attempts are made to identify the risk factors associated with the transition hazard rates or probabilities of disease progression.The usual variable selection methods,including stepwise and penalized methods,do not provide information about the importance of variables.In this context,we present a two-step algorithm to evaluate the importance of variables formulti-state data.Three differentmachine learning approaches(randomforest,gradient boosting,and neural network)as themost widely usedmethods are considered to estimate the variable importance in order to identify the factors affecting disease progression and rank these factors according to their importance.The performance of our proposed methods is validated by simulation and applied to the COVID-19 data set.The results revealed that the proposed two-stage method has promising performance for estimating variable importance.

On the use of residual dipolar couplings in multi-state structure calculation of two-domain proteins

Residual dipolar couplings(RDCs)are powerful nuclear magnetic resonance(NMR)probes for the structure calculation of biomacromolecules.Typically,an alignment tensor that defines the orientation of the entire molecule relative to the magnetic field is determined either before refinement of individual bond vectors or simultaneously with this refinement.For single-domain proteins this approach works well since all bond vectors can be described within the same coordinate frame,which is given by the alignment tensor.However,novel approaches are sought after for systems where no universal alignment tensor can be used.Here,we present an approach that can be applied to two-domain proteins that enables the calculation of multiple states within each domain as well as with respect to the relative positions of the two domains.

Combining lymph node ratio to develop prognostic models for postoperative gastric neuroendocrine neoplasm patients

BACKGROUND Lymph node ratio(LNR)was demonstrated to play a crucial role in the prognosis of many tumors.However,research concerning the prognostic value of LNR in postoperative gastric neuroendocrine neoplasm(NEN)patients was limited.AIM To explore the prognostic value of LNR in postoperative gastric NEN patients and to combine LNR to develop prognostic models.METHODS A total of 286 patients from the Surveillance,Epidemiology,and End Results database were divided into the training set and validation set at a ratio of 8:2.92 patients from the First Affiliated Hospital of Soochow University in China were designated as a test set.Cox regression analysis was used to explore the relationship between LNR and disease-specific survival(DSS)of gastric NEN patients.Random survival forest(RSF)algorithm and Cox proportional hazards(CoxPH)analysis were applied to develop models to predict DSS respectively,and compared with the 8th edition American Joint Committee on Cancer(AJCC)tumornode-metastasis(TNM)staging.RESULTS Multivariate analyses indicated that LNR was an independent prognostic factor for postoperative gastric NEN patients and a higher LNR was accompanied by a higher risk of death.The RSF model exhibited the best performance in predicting DSS,with the C-index in the test set being 0.769[95%confidence interval(CI):0.691-0.846]outperforming the CoxPH model(0.744,95%CI:0.665-0.822)and the 8th edition AJCC TNM staging(0.723,95%CI:0.613-0.833).The calibration curves and decision curve analysis(DCA)demonstrated the RSF model had good calibration and clinical benefits.Furthermore,the RSF model could perform risk stratification and individual prognosis prediction effectively.CONCLUSION A higher LNR indicated a lower DSS in postoperative gastric NEN patients.The RSF model outperformed the CoxPH model and the 8th edition AJCC TNM staging in the test set,showing potential in clinical practice.

"Five steps four quadrants" modularized en bloc dissection technique for accessing hepatic hilum lymph nodes in laparoscopic pancreaticoduodenectomy

BACKGROUND Although en bloc dissection of hepatic hilum lymph nodes has many advantages in radical tumor treatment,the feasibility and safety of this approach for laparo-scopic pancreaticoduodenectomy(LPD)require further clinical evaluation and investigation.AIM To explore the application value of the"five steps four quadrants"modularized en bloc dissection technique for accessing hepatic hilum lymph nodes in LPD patients.METHODS A total of 52 patients who underwent LPD via the"five steps four quadrants"modularized en bloc dissection technique for hepatic hilum lymph nodes from April 2021 to July 2023 in our department were analyzed retrospectively.The patients'body mass index(BMI),preoperative laboratory indices,intraoperative variables and postoperative complications were recorded.The relationships between preoperative data and intraoperative lymph node dissection time and blood loss were also analyzed.RESULTS Among the 52 patients,36 were males and 16 were females,and the average age was 62.2±11.0 years.There were 26 patients with pancreatic head cancer,16 patients with periampullary cancer,and 10 patients with distal bile duct cancer.The BMI was 22.3±3.3 kg/m²,and the median total bilirubin(TBIL)concentration was 57.7(16.0-155.7)µmol/L.All patients successfully underwent the"five steps four quadrants"modularized en bloc dissection technique without lymph node clearance-related complications such as postoperative bleeding or lymphatic leakage.Correlation analysis revealed significant associations between preoperative BMI(r=0.3581,P=0.0091),TBIL level(r=0.2988,P=0.0341),prothrombin time(r=0.3018,P=0.0297)and lymph node dissection time.Moreover,dissection time was significantly correlated with intraoperative blood loss(r=0.7744,P<0.0001).Further stratified analysis demonstrated that patients with a preoperative BMI≥21.9 kg/m²and a TIBL concentration≥57.7μmol/L had significantly longer lymph node dissection times(both P<0.05).CONCLUSION The"five steps four quadrants"modularized en bloc dissection technique for accessing the hepatic hilum lymph node is safe and feasible for LPD.This technique is expected to improve the efficiency of hepatic hilum lymph node dissection and shorten the learning curve;thus,it is worthy of further clinical promotion and application.

基于Node.js的农业物联网应用平台设计

文章的研究目的在于提出基于Node.js的物联网应用平台设计方案,解决物联网实际运行过程中数据上传存在的问题,提出并设计一种基于Node.js的农业物联网应用平台,可以实现对农业生产环境参数的监测与控制。首先介绍农业物联网的背景与需求,明确研究目标,其次详细描述本平台的设计思路与架构,主要应用层平台软件的设计与实现。平台的实际应用显示,本平台能够在实现物联网常见功能的同时,支持更大的数据并发处理需求,对于农业物联网的应用特点有着更好的支持作用。

Analysis of the optimal target node to reduce seizure-like discharge in networks

Network approaches have been widely accepted to guide surgical strategy and predict outcome for epilepsy treatment.This study starts with a single oscillator to explore brain activity,using a phenomenological model capable of describing healthy and epileptic states.The ictal number of seizures decreases or remains unchanged with increasing the speed of oscillator excitability and in each seizure,there is an increasing tendency for ictal duration with respect to the speed.The underlying reason is that the strong excitability speed is conducive to reduce transition behaviors between two attractor basins.Moreover,the selection of the optimal removal node is estimated by an indicator proposed in this study.Results show that when the indicator is less than the threshold,removing the driving node is more possible to reduce seizures significantly,while the indicator exceeds the threshold,the epileptic node could be the removal one.Furthermore,the driving node is such a potential target that stimulating it is obviously effective in suppressing seizure-like activity compared to other nodes,and the propensity of seizures can be reduced 60%with the increased stimulus strength.Our results could provide new therapeutic ideas for epilepsy surgery and neuromodulation.

Clinical Study of Double Contrast-Enhanced Ultrasound Combined with Dye Method and Marker Placement to Identify and Locate Sentinel Lymph Nodes in Patients with Breast Cancer

Objective: To explore the value of percutaneous ultrasonography combined with transvenous ultrasonography for accurate localization of sentinel lymph nodes and diagnosis of metastatic lymph nodes in patients with breast cancer. Methods: 18 cases of patients with breast cancer attending the Hainan General Hospital from May 2022 to June 2024 who were proposed to undergo axillary lymph node dissection were selected, and the ultrasonographic agent was injected subcutaneously through the areola on the 1st day before the operation, and the marker localization of the manifestation of the Sentinel lymph nodes and draw the lymphatic vessel alignment for drainage on the body surface, and record the manifestation of SLN by conventional ultrasound and dual ultrasonography. At the time of surgery, intraoperative melphalan localization was used to identify the SLN, the difference between the number of ultrasound and melphalan localization was observed, and resection was performed for pathological examination to determine whether they were metastatic or not. Results: There were 8 metastatic lymph nodes and 18 non-metastatic lymph nodes among 31 SLN. A total of 62 SLN were localized by intraoperative melphalan, of which 31 were consistent with ultrasound localization and 31 were not identified by ultrasound. The diagnostic sensitivity of SLN metastasis diagnosed by transcutaneous ultrasonography was 62.50%, specificity was 91.30%, positive predictive value was 71.43%, negative predictive value 87.50%, accuracy was 83.87%, and the AUC was 0.769;the diagnostic sensitivityof transvenous ultrasonography diagnosed was 75.00%, specificity was 75.00%, and the accuracy was 83.87%, 75.00%, specificity 91.30%, positive predictive value 75.00%, negative predictive value 91.30%, accuracy 87.10%, AUC 0.832;dual ultrasonography diagnostic sensitivity 87.50%, specificity 91.30%, positive predictive value 77.78%, negative predictive value 95.45%, accuracy 90.32%. The AUC was 0.894. Conclusion: Transcutaneous ultrasonography combined with transvenous ultrasonography can accurately localize sentinel lymph nodes and improve the sensitivity and accuracy of the diagnosis of metastatic SLN.