Strengthening Network Security: Deep Learning Models for Intrusion Detectionwith Optimized Feature Subset and Effective Imbalance Handling

In recent years,frequent network attacks have highlighted the importance of efficient detection methods for ensuring cyberspace security.This paper presents a novel intrusion detection system consisting of a data prepro-cessing stage and a deep learning model for accurately identifying network attacks.We have proposed four deep neural network models,which are constructed using architectures such as Convolutional Neural Networks(CNN),Bi-directional Long Short-Term Memory(BiLSTM),Bidirectional Gate Recurrent Unit(BiGRU),and Attention mechanism.These models have been evaluated for their detection performance on the NSL-KDD dataset.To enhance the compatibility between the data and the models,we apply various preprocessing techniques and employ the particle swarm optimization algorithm to perform feature selection on the NSL-KDD dataset,resulting in an optimized feature subset.Moreover,we address class imbalance in the dataset using focal loss.Finally,we employ the BO-TPE algorithm to optimize the hyperparameters of the four models,maximizing their detection performance.The test results demonstrate that the proposed model is capable of extracting the spatiotemporal features of network traffic data effectively.In binary and multiclass experiments,it achieved accuracy rates of 0.999158 and 0.999091,respectively,surpassing other state-of-the-art methods.

Technical note for intraoperative determination of proper acetabular cup size in primary total hip arthroplasty

BACKGROUND Selecting the optimal size of components is crucial when performing a primary total hip arthroplasty.Implanting the accurate size of the acetabular component can occasionally be exacting,chiefly for surgeons with little experience,whilst the complications of imprecise acetabular sizing or over-reaming can be potentially devastating.AIM To assist clinicians intraoperatively with a simple and repeatable tip in elucidating the ambivalence when determining the proper acetabular component size is not straightforwardly achieved,specifically when surgeons are inexperienced or preoperative templating is unavailable.METHODS This method was employed in 263 operations in our department from June 2021 to December 2022.All operations were performed by the same team of joint reconstruction surgeons,employing a typical posterior hip approach technique.The types of acetabular shells implanted were:The Dynasty®acetabular cup system(MicroPort Orthopedics,Shanghai,China)and the R3®acetabular system(Smith&Nephew,Watford,United Kingdom),which both feature cementless press-fit design.RESULTS The mean value of all cases was calculated and collated with each other.We distinguished as oversized an implanted acetabular shell when its size was>2 mm larger than the size of the acetabular size indicator reamer(ASIR)or when the implanted shell was larger than 4 mm compared to the preoperative planned cup.The median size of the implanted acetabular shell was 52(48–54)mm,while the median size of the preoperatively planned cup was 50(48–56)mm,and the median size of the ASIR was 52(50–54)mm.The correlation coefficient between ASIR size and implanted acetabular component size exhibited a high positive correlation with r=0.719(P<0.001).Contrariwise,intraoperative ASIR measurements precisely predicted the implanted cups’size or differed by only one size(2 mm)in 245 cases.CONCLUSION In our study,we demonstrated that the size of the first acetabular reamer not entering freely in the acetabular rim corroborates the final acetabular component size to implant.This was also corresponding in the majority of the cases with conventional preoperative templating.It can be featured as a valid tool for avoiding the potentially pernicious complications of acetabular cup over-reaming and over-sizing in primary total hip arthroplasty.It is a simple and reproducible technical note useful for confirming the predicted acetabular cup size preoperatively;thus,its application could be considered routinely,even in cases where preoperative templating is unavailable.

Single-center experience with Knee+^(TM) augmented reality navigation system in primary total knee arthroplasty

BACKGROUND Computer-assisted systems obtained an increased interest in orthopaedic surgery over the last years,as they enhance precision compared to conventional hardware.The expansion of computer assistance is evolving with the employment of augmented reality.Yet,the accuracy of augmented reality navigation systems has not been determined.AIM To examine the accuracy of component alignment and restoration of the affected limb’s mechanical axis in primary total knee arthroplasty(TKA),utilizing an augmented reality navigation system and to assess whether such systems are conspicuously fruitful for an accomplished knee surgeon.METHODS From May 2021 to December 2021,30 patients,25 women and five men,under-went a primary unilateral TKA.Revision cases were excluded.A preoperative radiographic procedure was performed to evaluate the limb’s axial alignment.All patients were operated on by the same team,without a tourniquet,utilizing three distinct prostheses with the assistance of the Knee+™augmented reality navigation system in every operation.Postoperatively,the same radiographic exam protocol was executed to evaluate the implants’position,orientation and coronal plane alignment.We recorded measurements in 3 stages regarding femoral varus and flexion,tibial varus and posterior slope.Firstly,the expected values from the Augmented Reality system were documented.Then we calculated the same values after each cut and finally,the same measurements were recorded radiolo-gically after the operations.Concerning statistical analysis,Lin’s concordance correlation coefficient was estimated,while Wilcoxon Signed Rank Test was performed when needed.RESULTS A statistically significant difference was observed regarding mean expected values and radiographic mea-surements for femoral flexion measurements only(Z score=2.67,P value=0.01).Nonetheless,this difference was statistically significantly lower than 1 degree(Z score=-4.21,P value<0.01).In terms of discrepancies in the calculations of expected values and controlled measurements,a statistically significant difference between tibial varus values was detected(Z score=-2.33,P value=0.02),which was also statistically significantly lower than 1 degree(Z score=-4.99,P value<0.01).CONCLUSION The results indicate satisfactory postoperative coronal alignment without outliers across all three different implants utilized.Augmented reality navigation systems can bolster orthopaedic surgeons’accuracy in achieving precise axial alignment.However,further research is required to further evaluate their efficacy and potential.

Successful use of adalimumab for treating fistulizing Crohn's disease with pyoderma gangrenosum:Two birds with one stone

Crohn's disease(CD) is a chronic relapsing and remitting autoinflammatory disorder of the gastrointestinal tract that has many intestinal and extraintestinal complications.The purpose of treatment is long-term remission,reduction of complications,and improvement of patients' quality of life.In many cases,this can be quite challenging and it is necessary to have a well thought out management strategy.We present the case of a 38-year-old woman with fistulizing CD that manifested as diffuse abdominal pain and bloody diarrhea accompanied by arthralgia.In addition,there were ulcerative lesions surrounded by cutaneous inflammation and erythema on her extremities,indicative of pyoderma gangrenosum.The patient was treated with high doses of parenteral methylprednisolone without any improvement and was started on adalimumab.A positive response to adalimumab therapy was observed:after 2 mo of therapy,the ulcerative skin lesion healed completely and the enterogastric fistula was closed after 5 mo adalimumab treatment.Adalimumab might be a suitable initial as well as maintenance therapy in patients with complicated CD.

The role of electrocardiography in the elaboration of a new paradigm in cardiac resynchronization therapy for patients with nonspecific intraventricular conduction disturbance

心脏的再同步治疗(CRT ) 与左捆分支块(磅) 仅仅在病人与有利结果被联系模式并且在有 QRS 持续时间 &#x0003e 的病人；150 ms，在有有 120-150 的 QRS 持续时间的 non-LBBB 模式的病人， ms 通常不是有益的。在为 QRS 持续时间调整以后， QRS 形态学不再是对 CRT 的临床的反应的一个决定因素。与主流的看法相对照，我们假设了在有 non-LBBB 和 120-150 ms 的 QRS 持续时间的病人的相反的 CRT 结果不由于 QRS 形态学自己，但是到在这亚群的更少的 dyssynchrony 和相反的耐心的特征，例如更多的 ischemic 病原学和男病人的更大的流行与有磅模式的病人相比。进一步，当前的 CRT 技术被设计与磅模式消除在病人在场的 dyssynchrony 并且对不恰当与 non-LBBB 在病人消除 dyssynchrony 模式。我们也假设了那 electrocardiography 可以也关于 interventricular 和左 intraventricular dyssynchrony 和近似地点的存在提供信息最近激活左室(LV ) 区域。到这个目的，我们设计了新 ECG 标准估计 interventricular 和 LV intraventricular dyssynchrony 和最近的激活的 LV 区域的近似地点。我们的初步的数据证明在有骚乱(NICD ) 模式可能在从那的一个遥远的地点的 nonspecific intraventricular 传导的病人的最近的激活的 LV 区域与磅模式在病人介绍，它可能与 NICD 模式为病人要求一种新奇 CRT 技术的发明。新 interventricular 和 LV intraventricular dyssynchrony ECG 标准和一种潜在的新奇 CRT 技术的申请可能减少在有 NICD 的病人的当前高的 nonresponder 率模式。

Impact of living with bipolar patients: Making sense of caregivers' burden

The aim of the present review was to examine objective and subjective burdens in primary caregivers(usually family members) of patients with bipolar disorder(BD) and to list which symptoms of the patients are considered more burdensome by the caregivers. In order to provide a critical review about caregiver's burden in patients with bipolar disorder, we performed a detailed Pub Med, Bio Med Central, ISI Web of Science, Psyc INFO, Elsevier Science Direct and Cochrane Library search to identify all papers and book chapters in English published during the period between 1963 and November 2011. The highest levels of distress were caused by the patient's behavior and the patient's role dysfunction(work, education and social relationships). Furthermore, the caregiving role compromises other social roles occupied by the caregiver, becoming part of the heavy social cost of bipolar affective disorder. There is a need to better understand caregivers' views and personal perceptions of the stresses and demands arising from caring for someone with BD in order to develop practical appropriate interventions and to improve the training of caregivers.

Bidirectional link between diabetes mellitus and coronavirus disease 2019 leading to cardiovascular disease:A narrative review

Coronavirus disease 2019(COVID-19)is a global pandemic where several comorbidities have been shown to have a significant effect on mortality.Patients with diabetes mellitus(DM)have a higher mortality rate than non-DM patients if they get COVID-19.Recent studies have indicated that patients with a history of diabetes can increase the risk of severe acute respiratory syndrome coronavirus 2 infection.Additionally,patients without any history of diabetes can acquire newonset DM when infected with COVID-19.Thus,there is a need to explore the bidirectional link between these two conditions,confirming the vicious loop between“DM/COVID-19”.This narrative review presents(1)the bidirectional association between the DM and COVID-19,(2)the manifestations of the DM/COVID-19 loop leading to cardiovascular disease,(3)an understanding of primary and secondary factors that influence mortality due to the DM/COVID-19 loop,(4)the role of vitamin-D in DM patients during COVID-19,and finally,(5)the monitoring tools for tracking atherosclerosis burden in DM patients during COVID-19 and“COVID-triggered DM”patients.We conclude that the bidirectional nature of DM/COVID-19 causes acceleration towards cardiovascular events.Due to this alarming condition,early monitoring of atherosclerotic burden is required in“Diabetes patients during COVID-19”or“new-onset Diabetes triggered by COVID-19 in Non-Diabetes patients”.

Inherited arrhythmias and gene therapy: Are there any ethical considerations to take into account?

Interventional electrophysiology represents a relatively recent subspecialty within the field of cardiology.In the past half-century,there has been significant advan-cement in the development and implementation of innovative ablation treatments and approaches.However,the treatment of arrhythmias continues to be inade-quate.Several arrhythmias,such as ventricular tachycardia and atrial fibrillation,pose significant challenges in terms of therapeutic efficacy,whether through interventional procedures or the administration of antiarrhythmic drugs.Cardio-logists are engaged in ongoing research to explore innovative methodologies,such as genome editing,with the purpose of effectively managing arrhythmias and meeting the growing needs of patients afflicted with rhythm disturbances.The field of genome editing has significant promise and has the potential to serve as a highly effective personalized therapy for rhythm disorders in patients.However,several ethical issues must be considered.

关于糖尿病心脏的新观点:从患病到衰竭

近几年来尽管介入心脏病学和心脏外科治疗方法的不断增多和应用,患有急性冠状动脉综合征(ACS)和其它心脏病的糖尿病患者的死亡率仍然很高,并且在西方国家数以百万计的糖尿病患者中每一个过早死亡的几乎都是由心脏病引起的.

Non-parasitic splenic cysts: A report of three cases

Primary splenic cyst is a relatively rare disease, and the majority of cases are classified as epithelial cysts. Three cases with nonparasitic splenic cysts are presented: two epithelial and one pseudocyst. All cases had an atypical symptomatology, consisted mainly of fullness in the left upper abdomen and a palpable mass. Preoperative diagnosis was established with ultrasonography and computerized tomography. Two cases with large cysts located in the splenic hilum were treated with open complete splenectomy. The most recent case, a pseudocyst, was managed laparoscopically with partial cystectomy. All cases did not have any problems or recurrence during follow-up. Laparoscopic partial cystectomy is an acceptable procedure for the treatment of splenic cysts, because it cures the disease preserving the splenic tissue. Complete splenectomy is reserved for cases in which cyst excision cannot be done otherwise.

Circulating tumor cells in pancreatic cancer patients:Enrichment and cultivation

AIM:To investigate the feasibility of separation and cultivation of circulating tumor cells(CTCs)in pancreatic cancer(Pa C)using a filtration device.METHODS:In total,24 Pa C patients who were candidates for surgical treatment were enrolled into the study.Peripheral blood samples were collected before an indicated surgery.For each patient,approximately8 m L of venous blood was drawn from the antecubitalveins.A new size-based separation Meta Cell?technology was used for enrichment and cultivation of CTCs in vitro.(Separated CTCs were cultured on a membrane in FBS enriched RPMI media and observed by inverted microscope.The cultured cells were analyzed by means of histochemistry and immunohistochemistry using the specific antibodies to identify the cell origin.RESULTS:CTCs were detected in 16 patients(66.7%)of the 24 evaluable patients.The CTC positivity did not reflect the disease stage,tumor size,or lymph node involvement.The same percentage of CTC positivity was observed in the metastatic and non-metastatic patients(66.7%vs 66.7%).We report a successful isolation of CTCs in Pa C patients capturing proliferating cells.The cells were captured by a capillary action driven size-based filtration approach that enabled cells cultures from the viable CTCs to be unaffected by any antibodies or lysing solutions.The captured cancer cells displayed plasticity which enabled some cells to invade the separating membrane.Further,the cancer cells in the"bottom fraction",may represent a more invasive CTC-fraction.The CTCs were cultured in vitro for further downstream applications.CONCLUSION:The presented size-based filtration method enables culture of CTCs in vitro for possible downstream applications.

Psychosocial stress and liver disease status

"Psychosocial stress" is an increasingly common concept in the challenging and highly-demanding modern society of today. Organic response to stress implicates two major components of the stress system, namely the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. Stress is anamnestically reported by patients during the course of disease, usually accompanied by a decline in their overall health status. As the mechanisms involving glucocorticoids and catecholamines have been deciphered, and their actions on immune cell function deeper understood, it has become clear that stress has an impact on hepatic inflam-matory response. An increasing number of articles have approached the link between psychosocial stress and the negative evolution of hepatic diseases. This article reviews a number of studies on both human populations and animal models performed in recent years, all linking stress, mainly of psychosocial nature, and the evolution of three important liver-related pathological entities: viral hepatitis, cirrhosis and hepatocellular carcinoma.

Cytopathologic diagnosis of fine needle aspiration biopsies of thyroid nodules

Fine-needle aspiration(FNA) cytology is an important diagnostic tool in patients with thyroid lesions.Several systems have been proposed for the cyropathologic diagnosis of the thyroid nodules.However cases with indeterminate cytological findings still remain a matter of debate.In this review we analyze all literature regarding Thyroid Cytopathology Reporting systems trying to identify the most suitable methodology to use in clinical practice for the preoperative diagnosis of thyroid nodules.A review of the English literature was conducted,and data were analyzed and summarized and integrated from the authors' perspective.The main purpose of thyroid FNA is to identify patients with higher risk for malignancy,and to prevent unnecessary surgeries for benign conditions.The Bethesda System for Reporting Thyroid Cytopathology is the most widely used system for the diagnosis of thyroid FNA specimens.This system also contains guidelines for the diagnosis and treatment of indeterminate or suspicious for malignancy cases.In conclusion,patients who require repeated FNAs for indeterminate diagnoses will be resolved by repeat FNA in a percentage of 72%-80%.

线性/自适应变结构复合控制(英文)

This paper first researches the system's response-feature due to the sliding regime related to the slope of a switching line, and then makes an investigation on the existence condition and hitting condition. Based on these conditions, the paper proposes a switching function that can realize an error adaptive variable structure control (AVSC) successfully. For eliminating the chattering of the sliding regime, this VSS introduces a dead zone, in which the PID control is applied. The composition of the PID control and the AVSC is called composite control of linear / AVSC. When the control signal is a large one, the AVSC is applied in the majority, and when the signal is a low one, the PID control is applied. Finally, an example of overload control of an anti-ship aerodynamic missile is illustrated to show the application of the composite control.

Analysis of miR-205 and miR-155 expression in the blood of breast cancer patients

The purpose of this study was to identify and validate circulating microRNAs （miRNAs） in human plasma for use as breast cancer （BC） biomarkers and to analyze their relationship to clinicopathologic features and its preliminary biological function. Genome-wide expression profiling of miRNAs in BC was investigated by microarray analysis, miR-155 was up-regulated greater than two-fold in BC compared with Normal Adjacent Tissue （NAT）, whereas let-7b, miR-381, miR-10b, miR-125a-Sp, miR-335, miR-205 and miR-145 were down- regulated greater than two-fold. Our hypothesis was that circulating miRNAs are also present and differentially expressed in the serum of BC patients compared to controls. Using real-time PCR （RT-PCR）, we analyzed miR-205 and miR-155 in archived serum from 30 participants, 20 with breast cancer and I0 healthy people, miR-205 was down-regulated in BC patient serum while miR-155 was up-regulated. Furthermore, we analyzed the relationship between the expression levels of these two miRNAs and the clinicopathologic parameters of BC patients. High expression of miR155 was associated with clinical stage, molecular type, Ki-67 and p53 in BC patients （P〈0.05）. By contrast, we found no significant correlation between miR-205 and BC patient clinicopathologic parameters. Functional analysis showed that ectopic expression of miR-205 significantly inhibits cell proliferation and promotes apoptosis, miR-205 was down- regulated and miR-155 was up-regulated in BC patient serum, miR-155 was positive correlated with clinical stage and 16-67 and negatively correlated with p53 status.

Soluble adhesion molecules ICAM-1,VCAM-1,P-selectin in children with Helicobacter pylori infection

AIM: To assess the sICAM-1, sVCAM-1, and sP-selectin levels in children withHelicobacter pylori(H pylori)infection and to evaluate their significance for the morphological changes found in gastric mucosa.METHODS: The study included 106 children: 59children (55.7%) with chronic gastritis and positive IgG against H pylori, 29 children (27.3%) after previous H pylori infection without the bacterium colonization but with positive IgG against H pylori, and 18 children (17%) with functional disorders of the gastrointestinal system but with normal IgG against H pylori. Endoscopic and histopathological evaluation of gastric mucosa was performed based on the Sydney System classification.The evaluation of sP-selectin, sIC AM-1, sVCAM-1 levels in the sera of children was carried out using ELISA test.RESULTS: The assessment of gastritis activity degrees indicated statistically significant values in the antrum and corpus (P＜0.001) of children examined. Serum sVCAM-1 levels were higher in group with gastritis due to H pylori infection than in group without infection and differed statistically (P＜0.05). Serum sVCAM-1 levels proved to be the highest among other adhesive molecules in infected children and decreased after eradication of H pylori. Serum sICAM-1 levels were similar in all examined groups. Serum sP-selectin levels were similar in children with and without H pylori infection.CONCLUSION: Assessment of adhesive molecules (sPselectin, sICAM-1, sVCAM-1) in the sera of children with active H pylori infection can show the participation of sVCAM-1 in the pathogenesis of gastric mucosal inflammation, sP-selectin and sICAM-1 concentrations in the sera of children with H pylori infection after eradication cannot reveal any significant differences as compared to healthy children.

Autoimmune hepatitis triggered by acute hepatitis A

The patient was a 57-year-old woman presenting with jaundice as the chief complaint. She began vomiting on July 10, 2003.Jaundice was noted and admitted to our hospital for thorough testing. Tests on admission indicated severe hepatitis, based on: aspartate aminotransferase (AST), 1 076 IU/L; alanine aminotransferase (ALT), 1 400 IU/L; total bilirubin (TB), 20.9 mg/dL; and prothrombin time rate (PT%), 46.9%. Acute hepatitis A (HA) was diagnosed based on negative hepatitis B surface antigen and hepatitis C virus RNA and positive immunoglobulin (Ig) M HA antibody, but elevation of anti-nuclear antigen (×320) and IgG (3 112 mg/dL) led to suspicion of autoimmune hepatitis (AIH). Plasma exchange was performed for 3 d from July 17, and steroid pulse therapy was performed for 3 d starting on July 18, followed by oral steroid therapy. Liver biopsy was performed on August 5, and the results confirmed acute hepatitis and mild chronic inflammation. Levels of AST and ALT normalized,so dose of oral steroid was markedly reduced. Steroid therapy was terminated after 4 mo, as the patient had glaucoma. Starting 3 mo after cessation of steroid therapy,levels of AST and ALT began to increase again. Another liver biopsy was performed and AIH was diagnosed based on serum data and biopsy specimen. Oral steroid therapy was reinitiated. Levels of AST and ALT again normalized.The present case was thus considered to represent AIH triggered by acute HA.

Laparoscopic splenectomy:Current concepts

Since early 1990's,when it was inaugurally introduced,laparoscopic splenectomy has been performed with excellent results in terms of intraoperative and postoperative complications.Nowadays laparoscopic splenectomy is the approach of choice for both benign and malignant diseases of the spleen.However some contraindications still apply.The evolution of the technology has allowed though,cases which were considered to be absolute contraindications for performing a minimal invasive procedure to be treated with modified laparoscopic approaches.Moreover,the introduction of advanced laparoscopic tools for ligation resulted in less intraoperative complications.Today,laparoscopic splenectomy is considered safe,with better outcomes in comparison to open splenectomy,and the increased experience of surgeons allows operative times comparable to those of an open splenectomy.In this review we discuss the indications and the contraindications of laparoscopic splenectomy.Moreover we analyze the standard and modified surgical approaches,and we evaluate the short-term and long-term outcomes.

Abscesses of the spleen:Report of three cases

Abscess of the spleen is a rare discovery, with about 600 cases in the international literature so far. Although it may have various causes, it is most usually associated with trauma and infections of the spleen. The latter are more common in the presence of a different primary site of infection, especially endocarditis or in cases of ischemic infarcts that are secondarily infected. Moreover, immunosuppression is a major risk factor. Clinical examination usually reveals a combination of fever, left-upper-quadrant abdominal pain and vomiting. Laboratory findings are not constant. Imaging is a necessary tool for establishing the diagnosis, with a choice between ultrasound and computed tomography. Treatment includes conservative measures, and surgical intervention. In children and in cases of solitary abscesses with a thick wall, percutaneous catheter drainage may be attempted. Otherwise, splenectomy is the preferred approach in most centers. Here, we present three cases of splenic abscess. In all three, splenectomy was performed, followed by rapid clinical improvement. These cases emphasize that current understanding of spleen abscess etiology is still limited, and a study for additional risk factors may be necessary.