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简介：为在多孔的媒介包括分子的散开和分散的一个可压缩的能溶合的排水量问题的一个联合混合有限元素和不连续的Galerkin方法被调查。那是说，有Raviart-Thomas空间的混合有限元素方法被用于流动方程，和运输一个人被对称的内部惩罚解决不连续的Galerkin(SIPG)近似。把插值和正式就职假设基于设计，superconvergence估计被获得。在分析期间，沿着高斯线的Darcy速度的延期也为集中在Galerkin过程在系数的评估被使用。

简介：Thispaperpresentstheanalysisofopenmicrostripstructuresbyusingdiakopticmethodoflines(ML)combinedwithperiodicboundaryconditions(PBC).Theparametersofmicrostrippatchareobtainedfrompatchcurrentexcitedbyplanewave.ImpedancematrixelementsarecomputedbyusingfastFouriertransform(FFT),andreducedequationissolvedbyusingdiakoptictechnique.Consequently,thecomputingtimeisreducedsignificantly.TheconvergencepropertyofsimulatingopenstructurebyusingPBCandthecomparisonofthecomputertimebetweenusingPBCandusualabsorbingboundarycondition(ABC)showthevalidityofthemethodproposedinthispaper.Finally,theresonantfrequencyofamicrostrippatchiscomputed.Thenumericalresultsobtainedareingoodagreementwiththosepublished.

简介：AbstractIncreasing numbers of targeted drugs are used in hormone receptor (HR)-positive metastatic breast cancer (MBC) to overcome or delay resistance to endocrine therapy. This study will systemically review the progress made in endocrine therapy combined with targeted therapy in the treatment of HR-positive MBC. From the "AI (aromatase inhibitor) era" represented by aromatase inhibitors, we have gradually entered the "post-AI era" represented by fulvestrant. Under the guidance of research on the molecular mechanism of endocrine therapy resistance, the "combination of endocrine therapy and targeted therapy" era is approaching. The development of drugs that target endocrine therapy resistance has concentrated on cyclin-dependent kinase 4/6 inhibitors, histone deacetylase inhibitors, and inhibitors of drug targets in the phosphatidylinositol 3 kinase-protein kinase B-mammalian target of rapamycin (PI3K-AKT-mTOR) pathway, providing new strategies for HR-positive MBC. Exploring biomarkers to guide the more precise use of targeted drugs in endocrine therapy for MBC is the focus of current and future research.

简介：TheprimarygoalofthispaperistopresentacomprehensivestudyofthenonlinearSchrdingerequationswithcombinednonlinearitiesofthepower-typeandHartreetype.Undercertainstructuralconditions,theauthorsareabletoprovideacompletepictureofhowthenonlinearSchrdingerequationswithcombinednonlinearitiesinteractinthegivenenergyspace.ThemethodusedinthepaperisbasedupontheMorawetzestimatesandperturbationprinciples.

简介：以传统的产品出售企业的一个不同方法提供产品和服务的一个新企业概念特别在生产工业正在得到更多的注意。这篇论文调查借助于产品和服务的集成的这家新企业怎么在德国和意大利被完成。另外，它根据公司尺寸分析差别。结果包括那这类企业在他们顾客的焦点激发的许多情况中并且经常由物理产品和他们的维护组成。与德国的对比，意大利的公司经常为这类提议明确地设计他们的物理产品。从分析基于尺寸差别，当拥有物理产品时，小公司被发现为这类提议完成特定的设计。在那里别似乎是开发支持如此的提议的发展的任何确定的方法或工具，在如此的方法/工具以内，将为更多的改编处于良好的竟技状态有空间物理产品设计。

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简介：ObjectiveToinvestigatetheclinicaloutcomesoffacialneverdecompressionviaacombinedsubtemporal-supralabyrinthineapproachtogeniculateganglionformanagementoffacialparalysisintemporalbonefracture.MethodsEighteenpatientswithunilateralfacialparesisduetotemporalbonefractureweretreatedbetweenMarch2003andMarch2011.FacialfunctionwasHouse-Brackmann(HB)gradeⅢin6patients,HBgradeⅤin9patientsandHBgradeⅥin3patients.Thepreoperativemeanairconductionthresholdwas52dBHLforthe15caseswithlongitudinaltemporalbonefractureandshowedseveresensorineuralhearinglossinthe3caseswithtransversetemporalbonefracture.Fracturelinesweredetectedin15casesontemporalboneaxialCTscansandossiculardisruptionwasdeterminedin11casesbyvirtualCTendoscopy.Thegeniculateganglionorthetympanicmastoidsegmentofthefacialnerveshowedanirregularmorphologyoncurvedplanarreformationimagesofthefacialnervecanal.Afteranintactcanalwallmastoido-epitympanectomy,theossicularchaindamagewasevaluated.Iftheossicularchainwasintact,thesupralabyrinthinerecesswasopenedbydrillingthroughthecellsbetweenthetegmentympaniandossicularchain.Iftheossicularchainwasdisrupted,theincuswasremovedtoaccessthesupralabyrinthinerecess.Thegeniculateganglionandthedistallabyrinthinesegmentofthefacialnervewereexposed.Aftercompletingfacialnervedecompression,thedislocatedincuswasreplaced,orafracturedincuswasreshapedtobridgethespacebetweenthemalleusandthestapes.ResultsPronouncedgangliongeniculatumswellingwasfoundin15casesoflongitudinaltemporalbonefracture,withgreaterpetrosusnervesdamagein3casesandbleedingin5cases.Disruptedossicularchainswereseenin11cases,includingdislocatedincusresultingincrushingofthehorizontalportionofthefacialnervein3casesandfractureoftheincuslongprocessin1case.In3casesoftransversefractures,

简介：AbstractPurpose:It is challenging to prepare military surgeons with the skills of combat damage control surgery (CDCS). The current study aimed to establish a damage control surgery (DCS) training platform for explosive combined thoraco-abdominal injuries.Methods:The training platform established in this study consisted of 3 main components: (1) A 50 m × 50 m square yard was constructed as the explosion site. Safety was assessed through cameras. (2) Sixteen pigs were injured by an explosion of trinitrotoluene attached with steel balls and were randomly divided into the DCS group (accepted DCS) and the control group (have not accepted DCS). The mortality rate was observed. (3) The literature was reviewed to identify the key factors for assessing CDCS, and testing standards for CDCS were then established. Expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards. Then, a 5-day training course with incorporated tests was used to test the efficacy of the established platform. In total, 30 teams attended the first training course. The scores that the trainees received before and after the training were compared. SPSS 11.0 was employed to analyze the results.Results:The high-speed video playback confirmed the safety of the explosion site as no explosion fragments projected beyond the wall. No pig died within 24 h when DCS was performed, while 7 pigs died in the control group. After a literature review, assessment criteria for CDCS were established that had a total score of 100 points and had 4 major parts: leadership and team cooperation, resuscitation, surgical procedure, and final outcome. Expert questionnaire results showed that the scientific score was 8.6 ± 1.25, and the feasibility score was 8.74 ± 1.19. When compared with the basic level, the trainees' score improved significantly after training.Conclusion:The platform established in this study was useful for CDCS training.

简介：AbstractIntroduction:Nevoid basal cell carcinoma syndrome is an autosomal dominant disorder characterized by developmental malformations and carcinogenic activity. Multi-systemic anomalies may occur in this syndrome, such as odentogenic keratocysts of the mandible and postnatal tumors, especially multiple basal cell carcinoma.Case presentation:A 60 year old man presented with systemic plaques and nodules for more than 30 years. Cutaneous examination revealed that invasive erythema and black papules scattered on the face, trunk and limbs. He underwent extended surgical excision of lesions at multiple sites. No new lesions were found in the treated areas during a 3-year follow-up. Topical 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT) was given as a palliative treatment for ulcerated tumors on the right lower eyelid and bleeding of the right temporal lesion. After application of ALA-PDT, the ulcers almost healed and the recurring hemorrhage ceased.Discussion:The management of multiple tumors in patients with nevoid basal cell carcinoma syndrome is extremely difficult, especially in the face. Surgical excision is the standard method, but the procedure can be applied in limited sites and may result in significant disfigurement and the difficulty of wound recovery. PDT can play a significant role in combination therapy for tumors that are extremely difficult to remove completely by surgical excision.Conclusion:We present a rare case manifested as multiple basal cell carcinoma and palmar pits who treated by surgery combined with topical 5-aminolevulinic acid-mediated photodynamic therapy. The combined therapy plays a complementary role in the treatment of nevoid basal cell carcinoma syndrome.

简介：AbstractBackground:Obesity and insulin resistance (IR) are common features of polycystic ovary syndrome (PCOS). Metformin (MET) increases insulin sensitivity, but it is associated with unsatisfactory weight loss. The glucagon-like peptide-1 receptor agonist exenatide has been shown to reduce weight and IR in patients with diabetes. This study aimed to explore the therapeutic effects of exenatide once-weekly (QW) combined with MET on body weight, as well as metabolic and endocrinological parameters in overweight/obese women with PCOS.Methods:Fifty overweight/obese women with PCOS diagnosed via the Rotterdam criteria were randomized to one of two treatment groups: MET (500 mg three times a day [TID]) or combination treatment (COM) (MET 500 mg TID, exenatide 2 mg QW) for 12 weeks. The primary outcomes were anthropometric changes associated with obesity, and the secondary outcomes included changes in reproductive hormone levels, glucose and lipid metabolism, and C-reactive protein.Results:Forty (80%) patients completed the study. COM therapy was superior to MET monotherapy in reducing weight (P = 0.045), body mass index (BMI) (P = 0.041), and waist circumference (P = 0.023). Patients in the COM group on an average lost 3.8 ± 2.4 kg compared with 2.1 ± 3.0 kg in the MET group. In the COM group, BMI and waist circumference decreased by 1.4 ± 0.87 kg/m2 and 4.63 ± 4.42 cm compared with 0.77 ± 1.17 kg/m2 and 1.72 ± 3.07 cm in the MET group, respectively. Moreover, levels of fasting glucose, oral glucose tolerance test (OGTT) 2-h glucose, and OGTT 2-h insulin were significantly lower with COM therapy than with MET (P < 0.050). Mild and moderate gastrointestinal reactions were the most common adverse events in both groups.Conclusions:COM therapy was more effective than MET alone in reducing body weight, BMI, and waist circumference, and improving insulin sensitivity in overweight/obese women with PCOS, with acceptable short-term side effects.Trial registration:ClinicalTrials.gov, NCT04029272. https://clinicaltrials.gov/ct2/show/NCT04029272

简介：AbstractBackground:Delayed graft function (DGF) is the main cause of renal function failure after kidney transplantation. This study aims at investigating the value of hypothermic machine perfusion (HMP) parameters combined with perfusate biomarkers on predicting DGF and the time of renal function recovery after deceased donor (DD) kidney transplantation.Methods:HMP parameters, perfusate biomarkers and baseline characteristics of 113 DD kidney transplantations from January 1, 2019 to August 31, 2019 in the First Affiliated Hospital of Xi’an Jiaotong University were retrospectively analyzed using univariate and multivariate logistic regression analysis.Results:In this study, the DGF incidence was 17.7% (20/113); The multivariate logistic regression results showed that terminal resistance (OR: 1.879, 95% CI 1.145-3.56) and glutathione S-transferase (GST)(OR = 1.62, 95% CI 1.23-2.46) were risk factors for DGF; The Cox model analysis indicated that terminal resistance was an independent hazard factor for renal function recovery time (HR = 0.823, 95% CI 0.735-0.981). The model combining terminal resistance and GST (AUC = 0.888, 95% CI: 0.842-0.933) significantly improved the DGF predictability compared with the use of terminal resistance (AUC = 0.756, 95% CI 0.693-0.818) or GST alone (AUC = 0.729, 95% CI 0.591-0.806).Conclusion:According to the factors analyzed in this study, the combination of HMP parameters and perfusate biomarkers displays a potent DGF predictive value.

简介：AccordingtoVeningMeinesz-Moritz(VMM)globalinverseisostaticproblem,eithertheMohodensitycontrast(crust-mantledensitycontrast)ortheMohogeometrycanbeestimatedbysolvinganon-linearFredholmintegralequationofthefirstkind.HeresolutionstothetwoMohoparametersarepresentedbycombiningtheglobalgeopotentialmodel(GOCO-03S),topography(DTM2006)andaseismiccrustmodel,thelatterbeingtherecentdigitalglobalcrustalmodel(CRUST1.0)witharesolutionof1o×1o.ThenumericalresultsshowthattheestimatedMohodensitycontrastvariesfrom21to637kg/m3,withaglobalaverageof321kg/m3,andtheestimatedMohodepthvariesfrom6to86kmwithaglobalaverageof24km.ComparingtheMohodensitycontrastsestimatedusingourleastsquaresmethodandthosederivedbytheCRUST1.0,CRUST2.0,andPREMmodelsshowsthatourestimateagreesfairlywellwithCRUST1.0modelandratherpoorwithothermodels.TheestimatedMohodepthsbyourleast-squaresmethodandtheCRUST1.0modelagreeto4.8kminRMSandwiththeGEMMA1.0basedmodelto6.3km.

简介：Anewmethodforidentifyingnonlineartime-varyingsystemswithunknownstructureispresented.Themethodextendstheapplicationareaofbasissequenceidentification.Theessentialideaistoutilizethelearningandnonlinearapproximatingabilityofneuralnetworkstomodelthenon-linearityofthesystem,characterizetime-varyingdynamicsofthesystembythetime-varyingparametricvectorofthenetwork,thentheparametricvectorofthenetworkisapproximatedbyaweightedsumofknownbasissequences.Becauseofblack-boxmodelingabilityofneuralnetworks,thepresentedmethodcanidentifynonlineartime-varyingsystemswithunknownstructure.Inordertoimprovethereal-timecapabilityofthealgorithm,theneuralnetworkistrainedbyasimplefastlearningalgorithmbasedonlocalleastsquarespresentedbytheauthors.Theeffectivenessandtheperformanceofthemethodaredemonstratedbysomesimulationresults.

简介：AbstractBackground:Nalbuphine has been suggested to be used for post-cesarean section (CS) intravenous analgesia. However, ideal concentration of nalbuphine for such analgesia remains unclear. The present study was conducted to explore an ideal concentration of nalbuphine for post-CS intravenous analgesia by evaluating the analgesic effects and side-effects of three different concentrations of nalbuphine combined with hydromorphone for post-CS intravenous analgesia in healthy parturients.Methods:One-hundred-and-fourteen parturients undergoing elective CS were randomly allocated to one of three groups (38 subjects per group) according to an Excel-generated random number sheet to receive hydromorphone 0.05 mg/mL + nalbuphine 0.5 mg/mL (group LN), hydromorphone 0.05 mg/mL + nalbuphine 0.7 mg/mL (group MN), and hydromorphone 0.05 mg/mL + nalbuphine 0.9 mg/mL (group HN) using patient-controlled analgesia (PCA) pump. Visual analog scale (VAS) for pain, PCA bolus demands, cumulative PCA dose, satisfaction score, Ramsay score, and side-effects such as urinary retention were recorded.Results:The number of PCA bolus demands and cumulative PCA dose during the first 48 h after CS were significantly higher in group LN (21 ± 16 bolus, 129 ± 25 mL) than those in group MN (15 ± 10 bolus, 120 ± 16 mL) (both P < 0.05) and group HN (13 ± 9 bolus, 117 ± 13 mL) (both P < 0.01), but no difference was found between group HN and group MN (both P > 0.05). VAS scores were significantly lower in group HN than those in group MN and group LN for uterine cramping pain at rest and after breast-feeding within 12 h after CS (all P < 0.01) and VAS scores were significantly higher in group LN than those in group MN and group HN when oxytocin was intravenously infused within 3 days after CS (all P < 0.05), whereas VAS scores were not statistically different among groups for incisional pain (all P > 0.05). Ramsay sedation scale score in group HN was significantly higher than that in group MN at 8 and 12 h after CS (all P < 0.01) and group LN at 4, 8, 12, 24 h after CS (all P < 0.05).Conclusions:Hydromorphone 0.05 mg/mL + nalbuphine 0.7 mg/mL for intravenous PCA could effectively improve the incisional pain and uterine cramping pain management and improve comfort in patients after CS.Trial registration number:ChiCTR1800015014, http://www.chictr.org.cn/Chinese Clinical Trial Registry.

简介：AbstractBlunt traumatic thoracic aortic injury (BTAI) is an extremely serious medical condition with a high rate of associated mortality. Recent advances in techniques such as thoracic endovascular repair offer new opportunities to manage the critical BTAI patients in an efficacious yet less invasive manner. A 65 year-old-male suffered from multiple injuries after a fall, including BTAI in the aortic arch, which resulted in dissection of the descending thoracic-abdominal aorta and iliac artery, development of an intimal flap in the left common carotid artery, and dissection of the left subclavian artery. Based on the imaging information of this patient and our clinical experience, the combined treatment of fenestrated thoracic endovascular repair and a chimney technique was immediately planned to fully repair these dissections and moreover prevent further dissection of the branching vessels, additionally to ensure sufficient blood flow in the left subclavian artery and left common carotid artery. The intervention yielded satisfactory early outcomes. Follow-up assessment at six months reported no symptoms or complications associated with the stent-graft. Computed tomography angiography further confirmed adequate stent-graft coverage of the aortic injury.

简介：Oneofthemainrequirementsofcognitiveradiosystemsistheabilitytodetectthepresenceoftheprimaryuserwithfastspeedandpreciseaccuracy.Toachievethat,apossibletwo-stagespectrumsensingschemeissuggestedinthispaper.Morespecifically,afastspectrumsensingalgorithmbasedontheenergydetectionisintroducedfocusingonthecoarsedetection.Acomplementaryfinespectrumsensingalgorithmadoptsone-ordercyclostationarypropertiesofprimaryuser'ssignalsintimedomain.Sincetheone-orderfeaturedetectionisperformedintimedomain,thereal-timeoperationandlow-computationalcomplexitycanbeachieved.Also,itdrasticallyreduceshardwareburdensandpowerconsumptionasopposedtotwo-orderfeaturedetection.Thesensingperformanceoftheproposedmethodisstudiedandtheanalyticalperformanceresultsaregiven.Theresultsindicatethatbetterperformancecanbeachievedinproposedtwo-stagesensingdetectioncomparedtotheconventionalenergydetector.

简介：Thispaperpresentstwokinematicfailuremechanismsofthree-dimensionalrectangularfootingrestingonhomogeneousundrainedclayfoundationunderuniaxialverticalloadinganduniaxialmomentloading.ThefailuremechanismunderverticalloadingcomprisesaplanestrainPrandtl-typemechanismoverthecentralpartofthelongerside,andthesizeofthemechanismgraduallyreducesattheendsofthelongersideandovertheshortersideasthecornerofrectangularfootingisbeingapproachedwherethedirectionofsoilmotionremainsnormaltoeachcorrespondingsiderespectively.Thefailuremechanismundermomentloadingcomprisesaplanestrainscoopslidingmechanismoverthecentralpartofthelongerside,andtheradiusofscoopslidingmechanismincreaseslinearlyattheendsofthelongerside.Onthebasisofthekinematicfailuremechanismsmentionedabove,theverticalultimatebearingcapacityandtheultimatebearingcapacityagainstmomentormomentultimatebearingcapacityareobtainedbyuseofupperboundlimitanalysistheory.Atthesametime,numericalanalysisresults,Skempton'sresultsandSalgadoetal.'sresultsarecomparedwiththisupperboundsolution.Itshowsthatthepresentedfailuremechanismsandplasticlimitanalysispredictionsarevalidated.Inordertoinvestigatethebehaviorsofundrainedclayfoundationbeneaththerectangularfootingsubjectedtothecombinedloadings,numericalanalysisisadoptedbyvirtueofthegeneral-purposeFEMsoftwareABAQUS,wheretheclayisassumedtoobeytheMohr-Coulombyieldingcriterion.ThefailureenvelopeandtheultimatebearingcapacityareachievedbythenumericalanalysisresultswiththevaryingaspectratiosfromlengthLtobreadthBoftherectangularfooting.ThefailuremechanismsofrectangularfootingwhicharesubjectedtothecombinedverticalloadingVandhorizontalloadingH(VerticalloadingVandmomentloadingM,andhorizontalloadingHandmomentloadingMrespectivelyareobservedinthefiniteelementa