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BACKGROUND: Pancreatic cancer (PC) is characterized by abnormally fibrotic mesenchyme, which notably influences on the effectiveness of immunotherapy. Low-dose arsenic trioxide (ATO, 1.0 µM) can inhibit the activation of pancreatic stellate cells (PSCs) and affect fibrosis, which is a potential strategy for enhancing the sensitivity to immunotherapy. METHODS: Extracellular matrix (ECM) models were employed to assess the regulatory effects of ATO on ECM and peripheral blood mononuclear cells. Orthotopic C57BL/6J models were utilized to evaluate the influence of ATO on CD8+T cell infiltration and immunotherapy in PC. Additionally, nanomaterials loaded with ATO designed to specifically target PSCs (scAbFAP-α-HMSNs-PAA-ATO) were produced to enhance targeting effects of ATO. RESULTS: Low-dose ATO (1.0 µM) suppressed PSCs activation, exhibiting potential for synergistic immunotherapy. Under low-dose ATO intervention, ECM underwent remodeling, leading to increases in CD8+T cell infiltration, thereby enhancing anti-PD-L1 therapy effect. We further demonstrated that low-dose ATO remodeled ECM by regulating the expression of LOXL3 in PSCs. scAbFAP-α-HMSNs-PAA-ATO exhibited improved targeting capabilities, and enhanced capacity to inhibit fibrosis and sensitize immunotherapy. CONCLUSIONS: Our research reveals that low-dose ATO, by regulating LOXL3, remodels the ECM and enhances CD8+T cell infiltration, thus sensitizing the efficacy of immunotherapy, which provides a novel strategy for comprehensive treatment to PC.
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BACKGROUND: Colon cancer, a frequently encountered malignancy, exhibits a comparatively poor survival prognosis. Perineural invasion (PNI), highly correlated with tumor progression and metastasis, is a substantial effective predictor of stage II-III colon cancer. Nonetheless, the lack of effective and facile predictive methodologies for detecting PNI prior operation in colon cancer remains a persistent challenge. METHOD: Pre-operative computer tomography (CT) images and clinical data of patients diagnosed with stage II-III colon cancer between January 2015 and December 2023 were obtained from two sub-districts of Sun Yat-sen Memorial Hospital (SYSUMH). The LASSO/RF/PCA filters were used to screen radiomics features and LR/SVM models were utilized to construct radiomics model. A comprehensive model, shown as nomogram finally, combining with radiomics score and significant clinical features were developed and validated by area under the curve (AUC) and decision curve analysis (DCA). RESULT: The total cohort, comprising 426 individuals, was randomly divided into a development cohort and a validation cohort as a 7:3 ratio. Radiomics scores were extracted from LASSO-SVM models with AUC of 0.898/0.726 in the development and validation cohorts, respectively. Significant clinical features (CA199, CA125, T-stage, and N-stage) were used to establish combining model with radiomics scores. The combined model exhibited superior reliability compared to single radiomics model in AUC value (0.792 vs. 0.726, p = 0.003) in validation cohorts. The radiomics-clinical model demonstrated an AUC of 0.918/0.792, a sensitivity of 0.907/0.813 and a specificity of 0.804/0.716 in the development and validation cohorts, respectively. CONCLUSION: The study developed and validated a predictive nomogram model combining radiomics scores and clinical features, and showed good performance in predicting PNI pre-operation in stage II-III colon cancer patients.
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Neoplasias do Colo , Invasividade Neoplásica , Estadiamento de Neoplasias , Nomogramas , Tomografia Computadorizada por Raios X , Humanos , Neoplasias do Colo/patologia , Neoplasias do Colo/diagnóstico por imagem , Masculino , Feminino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Idoso , Adulto , Prognóstico , Estudos Retrospectivos , Nervos Periféricos/patologia , Nervos Periféricos/diagnóstico por imagem , RadiômicaRESUMO
Negative capacitance effects with fast response times hold great potential for reducing the power consumption in high-frequency nanoelectronics. Nevertheless, the negative capacitance effect faces considerable complexity arising from the dynamic interplay among electrostatic, nucleation energies, and domain evolution. This intricate balance poses a formidable challenge to achieving fast negative capacitance. Herein, we have achieved a fast negative capacitance time of â¼16.23 ns in PbZr0.2Ti0.8O3 (PZT) thin film, and our investigation confirms the presence of acicular ferroelastic domains within the PZT thin film. Under reversal electric fields, these acicular ferroelastic domains undergo a unique flipping process, transitioning through domain expansion and contraction. This distinct domain flipping manner accelerates the nucleation and growth of ferroelectric domains, thereby facilitating the observed fast negative capacitance. The realization of fast negative capacitance holds substantial promise for reducing operational time and power consumption, offering prospects for the design of nanoelectronics with significantly lower power requirements.
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Oxaliplatin (OXA) is the first-line drug for the treatment of colorectal cancer (CRC), and susceptibility to drug resistance affects patient prognosis. However, the exact underlying mechanisms remain unclear. Platinum-acquired resistance in CRC is a continuous transition process; though, current research has mainly focused on the end state of drug resistance, and the early events of drug resistance have been ignored. In this study, single-cell transcriptome sequencing is combined with a dynamic network biomarker (DNB), and found that the functional inhibition of the mitochondrial electron transport chain complex I occur early in the development of attained resistance to OXA in CRC cells, as evidenced by a decrease in the levels of subunit proteins, primarily NDUFB8. Specifically, the mouse double minute 2 homologue (MDM2) mediates the ubiquitination and degradation of NDUFB8, reducing intracellular reactive oxygen species (ROS) generation under chemotherapeutic stress, consequently contributing to drug resistance. Based on this, the study constructs engineered extracellular vesicles carrying siMDM2 by electroporation and validates the application of EV-siMDM2 to improve the efficacy of OXA-based chemotherapy by inhibiting the MDM2/NDUFB8/ROS signaling axis in patient-derived xenograft (PDX) and hepatic and pulmonary metastasis mouse models, thus providing new ideas and an experimental basis for the platinum-resistant treatment of CRC.
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The all-inorganic CsPbBr3 perovskite solar cells exhibit excellent stability against humidity and thermal conditions as well as relatively low production cost, rendering them a gradually emerging research hot spot in the field of photovoltaics. However, the absence of a hole transport layer (HTL) in its common structure and the substantial energy level difference of up to 0.6 eV between the highest occupied molecular orbital (HOMO) level of CsPbBr3 and the work function of the carbon electrode have emerged as the primary factor limiting the improvement of its power conversion efficiency (PCE). In this work, the monomer 2,5-dibromo-3,4-ethylenedioxythiophene (DBEDOT) is spin-coated onto the surface of the CsPbBr3 film directly and then subjected to annealing; DBEDOT undergoes in situ polymerization to form poly(3,4-ethylenedioxythiophene) (PEDOT), which aims to ameliorate the issue of excessive energy level difference between CsPbBr3 and the carbon electrode, and to facilitate the extraction and transport efficiency of holes between the CsPbBr3 perovskite and the carbon electrode. Compared to the pristine device, the PCE of the device based on in situ polymerization is enhanced and achieves a maximum efficiency of 9.81%. Furthermore, the unencapsulated devices based on in situ polymerization maintain 95.9% of their original efficiency after 40 days of stability testing.
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Molecular dynamics (MD) simulations were first employed to achieve the optimal sintering temperature of carboxyl-functionalized graphene (GNS-COOH)-modified polyether ether ketone (PEEK)/polytetrafluoroethylene (PTFE) composites. A model of GNS-COOH/PEEK/PTFE composites was constructed to simulate the effects of different sintering temperatures on the mechanical and tribological properties, as well as their underlying atomic mechanisms. Samples of PTFE composites were prepared and characterized through experimental methods. Results revealed that the sintering temperature significantly affects the intermolecular forces, mechanical properties, and tribological characteristics of the composites. The agglomeration of the PEEK/PTFE composite matrix was effectively mitigated by introducing GNS-COOH. When the sintering temperature was controlled at 360 °C, the compressive strength of GNS-COOH/PEEK/PTFE composites was improved compared to GNS/PEEK/PTFE composites, albeit with a slight reduction in wear resistance. This study provides a theoretical reference for the preparation process and performance evaluation of new materials.
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Metal halide perovskites have emerged as promising materials for X-ray detection due to their high X-ray attenuation coefficients, defect tolerance, and suitability for large-area, low-temperature fabrication. However, the intrinsic high ion conductivity of these materials presents challenges, such as high dark current density and current drift, which impair the stability and sensitivity of perovskite X-ray detectors. This study introduces an approach to mitigating these issues by incorporating 2,2,3,3,3-pentafluoropropylamine hydrochloride (PFH) into polycrystalline MAPbI3-xClx films using a one-step blade-coating method. PFH aggregates at grain boundaries, raising local vacuum energy levels and passivating surface defects, thereby reducing ion conductivity without affecting electron conductivity. As a result, this approach significantly reduces the dark current and enhances sensitivity, achieving a low detection limit of 14.7 nGyair/s. Additionally, it improves signal stability, consistency, and response speed of the detector. These findings suggest that PFH is a promising additive for advancing the performance and practical application of polycrystalline metal halide perovskite-based X-ray detectors.
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The aging process of microplastics (MPs) affects their surface physicochemical properties, thereby influencing their behaviors in releasing harmful chemicals, adsorption of organic contaminants, sinking, and more. Understanding the aging process is crucial for evaluating MPs' environmental behaviors and risks, but tracing the aging process remains challenging. Here, we propose a multimodal deep learning model to trace typical aging factors of aged MPs based on MPs' physicochemical characteristics. A total of 1353 surface morphology images and 1353 Fourier transform infrared spectroscopy spectra were achieved from 130 aged MPs undergoing different aging processes, demonstrating that physicochemical properties of aged MPs vary from aging processes. The multimodal deep learning model achieved an accuracy of 93% in predicting the major aging factors of aged MPs. The multimodal deep learning model improves the model's accuracy by approximately 5-20% and reduces prediction bias compared to the single-modal model. In practice, the established model was performed to predict the major aging factors of naturally aged MPs collected from typical environment matrices. The prediction results aligned with the aging conditions of specific environments, as reported in previous studies. Our findings provide new insights into tracing and understanding the plastic aging process, contributing more accurately to the environmental risk assessment of aged MPs.
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Aprendizado Profundo , Microplásticos , Monitoramento Ambiental/métodos , Espectroscopia de Infravermelho com Transformada de FourierAssuntos
Prostatectomia , Incontinência Urinária , Humanos , Prostatectomia/efeitos adversos , Incontinência Urinária/etiologia , Incontinência Urinária/terapia , Incontinência Urinária/diagnóstico , Masculino , Neoplasias da Próstata/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/diagnóstico , PrognósticoRESUMO
Background: Accurate real-time tumor delineation is essential for achieving curative resection (R0 resection) during non-small cell lung cancer (NSCLC) surgery. The unique characteristics of lung tissue structure significantly challenge the use of video-assisted thoracoscopic surgery in the identification of lung nodules. This difficulty often results in an inability to discern the margins of lung nodules, necessitating either an expansion of the resection scope, or a transition to open surgery. Due to its high spatial resolution, ease of operation, and capacity for real-time observation, near-infrared fluorescence (NIRF) navigation in oncological surgery has emerged as a focal point of clinical research. Targeted NIRF probes, which accumulate preferentially in tumor tissues and are rapidly cleared from normal tissues, enhance diagnostic sensitivity and surgical outcomes. The imaging effect of the clinically approved NIRF probe indocyanine green (ICG) varies significantly from person to person. Therefore, we hope to develop a new generation of targeted NIRF probes targeting lung tumor-specific targets. Methods: First, the peptide iRGD (sequence: CRGDKGPDC) fluorescent tracer was synthesized, and characterized through mass spectrometry (MS), proton nuclear magnetic resonance (1H NMR), and high-performance liquid chromatography (HPLC). Fluorescence properties were tested subsequently. Safety was performed in vitro using both human normal liver cells and human normal breast cells. Second, Metabolism and optimal imaging time were determined by tail vein injection of iRGD fluorescent tracer. Finally, Orthotopic and metastatic lung tumor models were used to evaluate the targeting properties of the iRGD fluorescent tracer. Results: We successfully synthesized an iRGD fluorescent tracer specifically designed to target NSCLC. The molecular docking analyses indicated that this tracer has receptor affinity comparable to that of iRGD for αvß3 integrin, with a purity ≥98%. Additionally, the tracer is highly soluble in water, and its excitation and emission wavelengths are 767 and 799 nm, respectively, positioning it within the near-infrared spectrum. The cellular assays confirmed the tracer's minimal cytotoxicity, underscoring its excellent biosafety profile. In vivo studies further validated the tracer's capacity for specific NSCLC detection at the cellular level, alongside a prolonged imaging window of 6 days or more. Notably, the tracer demonstrated superior specificity in localizing very small lung nodules, which are otherwise clinically indiscernible, outperforming non-targeted ICG. Fluorescence intensity analyses across various organs revealed that the tracer is predominantly metabolized by the liver and kidneys, with excretion via bile and urine, and exhibits minimal toxicity to these organs as well as the lungs. Conclusions: The iRGD fluorescent tracer selectively accumulates in NSCLC tissues by specifically targeting αvß3 receptors, which are overexpressed on the surface of tumor cells. This targeted approach facilitates the real-time intraoperative localization of NSCLC, presenting an improved strategy for intraoperative tumor identification with significant potential for clinical application.
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This paper addresses the challenge of trajectory planning for autonomous vehicles operating in complex, constrained environments. The proposed method enhances the hybrid A-star algorithm through back-end optimization. An adaptive node expansion strategy is introduced to handle varying environmental complexities. By integrating Dijkstra's shortest path search, the method improves direction selection and refines the estimated cost function. Utilizing the characteristics of hybrid A-star path planning, a quadratic programming approach with designed constraints smooths discrete path points. This results in a smoothed trajectory that supports speed planning using S-curve profiles. Both simulation and experimental results demonstrate that the improved hybrid A-star search significantly boosts efficiency. The trajectory shows continuous and smooth transitions in heading angle and speed, leading to notable improvements in trajectory planning efficiency and overall comfort for autonomous vehicles in challenging environments.
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A multi-stage oxic biofilm system based on hydrophilic polyurethane foam was established and operated for advanced treatment of coking wastewater, in which distinct gradient variations of pollutants removal, biofilm properties and microbial community in the 5 stages were evaluated. The system rapidly achieved NH4+-N removal efficiency of 97.51⯱â¯2.29â¯% within 8â¯days. The biofilm growing attached on the carriers exhibited high biomass (≥10.29â¯g/L), which ensured sufficient microbial population. Additionally, the rising extracellular polymeric substance and declining proteins/polysaccharides ratios across stages suggested a dense-to-loose transition in the biofilm's structure, in response to the varying pollutant concentrations. The dominance of Nitrosomonas cluster in the first 3 stages and Nitrospira lineage in the following 2 stages facilitated the complete depletion of high NH4+-N concentration without NO2--N accumulation. Overall, the distinct biofilm property and community at each stage, shaped by the multi-stage configuration, maximized the pollutants removal efficiency.
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Biofilmes , Coque , Águas Residuárias , Águas Residuárias/química , Poluentes Químicos da Água , Reatores Biológicos , Projetos Piloto , Purificação da Água/métodos , Poliuretanos/química , Eliminação de Resíduos Líquidos/métodos , Biodegradação Ambiental , Microbiota , Biomassa , Nitrogênio , Compostos de AmônioRESUMO
OBJECTIVE: The study aimed to evaluate the improvements in pulmonary ventilation following a sitting position in ventilated ARDS patients using electrical impedance tomography. METHODOLOGY: A total of 17 patients with ARDS under mechanical ventilation participated in this study, including 8 with moderate ARDS and 9 with severe ARDS. Each patient was initially placed in the supine position (S1), transitioned to sitting position (SP) for 30 min, and then returned to the supine position (S2). Patients were monitored for each period, with parameters recorded. MAIN OUTCOME MEASURES: The primary outcome included the spatial distribution parameters of EIT, regional of interest (ROI), end-expiratory lung impedance (ΔEELI), and parameters of respiratory mechanics. RESULTS: Compared to S1, the SP significantly altered the distribution in ROI1 (11.29 ± 4.70 vs 14.88 ± 5.00 %, p = 0.003) and ROI2 (35.59 ± 8.99 vs 44.65 ± 6.97 %, p ï¼ 0.001), showing reductions, while ROI3 (39.71 ± 11.49 vs 33.06 ± 6.34 %, p = 0.009), ROI4 (13.35 ± 8.76 vs 7.24 ± 5.23 %, p ï¼ 0.001), along with peak inspiratory pressure (29.24 ± 3.96 vs 27.71 ± 4.00 cmH2O, p = 0.036), showed increases. ΔEELI decreased significantly ventrally (168.3 (40.33 - 189.5), p ï¼ 0.0001) and increased significantly dorsally (461.7 (297.5 - 683.7), p ï¼ 0.0001). The PaO2/FiO2 ratio saw significant improvement in S2 compared to S1 after 30 min in the seated position (108 (73 - 130) vs 96 (57 - 129) mmHg, p = 0.03). CONCLUSIONS: The sitting position is associated with enhanced compliance, improved oxygenation, and more homogenous ventilation in patients with ventilated ARDS compared to the supine position. IMPLICATIONS FOR CLINICAL PRACTICE: It is important to know the impact of postural changes on patient pulmonary ventilation in order to standardize safe practices in critically ill patients. It may be helpful in the management among ventilated patients.
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Impedância Elétrica , Respiração Artificial , Síndrome do Desconforto Respiratório , Postura Sentada , Humanos , Masculino , Feminino , Síndrome do Desconforto Respiratório/terapia , Síndrome do Desconforto Respiratório/fisiopatologia , Pessoa de Meia-Idade , Idoso , Respiração Artificial/métodos , Respiração Artificial/normas , Tomografia/métodos , Tomografia/normas , Adulto , Posicionamento do Paciente/métodos , Posicionamento do Paciente/normasRESUMO
Radical prostatectomy and radiotherapy are common first-line treatments for clinically localized prostate cancer. Despite advances in surgical technology and multidisciplinary management, post-prostatectomy urinary incontinence (PPI) remains a common clinical complication. The incidence and duration of PPI are highly heterogeneous, varying considerably between individuals. Post-prostatectomy urinary incontinence may result from a combination of factors, including patient characteristics, lower urinary tract function, and surgical procedures. Physicians often rely on detailed medical history, physical examinations, voiding diaries, pad tests, and questionnaires-based symptoms to identify critical factors and select appropriate treatment options. Post-prostatectomy urinary incontinence treatment can be divided into conservative treatment and surgical interventions, depending on the severity and type of incontinence. Pelvic floor muscle training and lifestyle interventions are commonly conservative strategies. When conservative treatment fails, surgery is frequently recommended, and the artificial urethral sphincter remains the "gold standard" surgical intervention for PPI. This review focuses on the diagnosis and treatment of PPI, based on the most recent clinical research and recommendations of guidelines, including epidemiology and risk factors, diagnostic methods, and treatment strategies, aimed at presenting a comprehensive overview of the latest advances in this field and assisting doctors in providing personalized treatment options for patients with PPI.
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Prostatectomia , Neoplasias da Próstata , Incontinência Urinária , Humanos , Prostatectomia/efeitos adversos , Incontinência Urinária/etiologia , Incontinência Urinária/terapia , Incontinência Urinária/diagnóstico , Masculino , Neoplasias da Próstata/terapia , Neoplasias da Próstata/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Prognóstico , Esfíncter Urinário ArtificialRESUMO
Mucosa-associated lymphoid tissue (MALT) lymphoma is a low-grade malignant lymphoproliferative disease, representing a low percentage of newly diagnosed lymphoma cases. Although its exact cause is still unclear, it is commonly associated with infections or autoimmune diseases. The stomach is the most frequent site for MALT lymphoma, with primary hepatic MALT lymphoma being exceptionally rare. Cases of primary hepatic MALT lymphoma often coincide with viral hepatitis. In this report, we present a case of primary hepatic MALT lymphoma in a patient with no history of hepatitis but complicated by primary biliary cholangitis (PBC) and Hashimoto's thyroiditis.
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NH2-MIL-88B (Fe) (MOF) is a promising photocatalytic material for antitumor therapy because of its distinctive electronic structure. However, inadequate separation of photo-generated electrons and slow reaction rate in low/high-valence iron (Fe) cycles limit their clinical application. In the present study, "electronic storage station" as a ligand-to-metal charge transfer bridge bond was constructed to inhibit recombination of electron/hole under 650 nm laser irradiation. Cupric (Cu) ions and gallic acid (GA) were self-assembled into a MOF (denoted as CGMOF) to create an FeO(GA)Cu bridge bond. GA, characterized by robust electron delocalization and abundant electron-donating groups, significantly enhances electron transfer efficiency for photodynamic therapy (PDT). CGMOF can respond to endogenous glutathione and release cuprous ions, accelerating the iron ion/ferrous ion cycles for chemodynamic therapy (CDT). The released Fe species can serve as T2-weighted magnetic resonance imaging contrast. Extended X-ray absorption fine structure spectra confirmed the presence of GA-containing FeOCu bonds in CGMOF. Furthermore, a series of photo-electrochemical tests confirmed that the formation of FeO(GA)Cu bond prominently elevated the redox capacity and increased the carrier density of CGMOF by 2.74-fold compared to that of MOF. In addition, cinnamaldehyde was grafted onto CGMOF for tumor-responsive hydrogen peroxide self-supply. Concurrently, hyaluronic acid was surface-modified to achieve the targeted delivery of nano-photosensitizers. In summary, this study presents an innovative approach for engineering Fe-based metal-organic frameworks for synergetic PDT/CDT applications.
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Cobre , Ácido Gálico , Ferro , Estruturas Metalorgânicas , Fármacos Fotossensibilizantes , Ácido Gálico/química , Cobre/química , Fármacos Fotossensibilizantes/química , Fármacos Fotossensibilizantes/farmacologia , Catálise , Humanos , Ferro/química , Estruturas Metalorgânicas/química , Fotoquimioterapia , Ligantes , Nanomedicina Teranóstica , Nanopartículas/química , Tamanho da Partícula , Propriedades de SuperfícieRESUMO
BACKGROUND: Bone marrow fibrosis (BMF) severely impacts both the quality of life and the efficacy of diagnostic procedures. However, the correlation between BMF and clinicopathological features, cytogenetic changes, and prognosis of newly diagnosed multiple myeloma (NDMM) remains unclear. This study determined the incidence, patient characteristics, and clinical outcomes of patients with NDMM with BMF. METHODS: The clinical data, histological features, and clinical outcomes of patients with NDMM were collected. Reticular fiber staining was performed on the enrolled cases, and the degree of reticular fiber overgrowth was graded. Patients with MF-2 and MF-3 were classified as the BMF+ group, and those with MF-0 and MF-1 were classified as the BMF- group, and BMF incidence was calculated. The differences in clinical data, histological features, and clinical outcomes between the BMF+ group and the BMF- group were compared. RESULTS: A consecutive series of 146 patients with NDMM were included. The incidence of MF-0, MF-1, MF-2, and MF-3 was 7.53% (11/146), 34.93% (51/146), 51.37% (75/146), and 6.16% (9/146), respectively. The incidence of BMF-MF-2 and MF-3-was 57.53% (84/146). A significant correlation was identified between the pattern of infiltration and BMF (P < 0.001). In the BMF- group, the distribution of cases with interstitial, nodular, and diffuse infiltration of plasma cells was 16 (25.8%), 21 (33.9%), and 25 (40.3%), respectively. Conversely, in the BMF+ group, these values for interstitial, nodular, and diffuse tumor cells were 9 (10.7%), 15 (17.9%), and 60 (71.4%). Furthermore, BMF was associated with a diffuse infiltration pattern. The overall survival (OS) of the BMF+ group (39.1 months; 95% confidence interval [CI]: 34.0-44.3) was lower than that of the BMF- group (45.4 months; 95% CI: 39.5-51.3), but there was no significant difference between the two groups (P = 0.221). Univariate and multivariate analyses showed that the BMF+ status was not associated with OS in patients with NDMM (P = 0.381 and P = 0.748, respectively). CONCLUSIONS: Our findings suggest that BMF is linked to a diffuse infiltration pattern, and its occurrence is not related to the prognosis of patients with NDMM, providing a basis for further exploring the BMF value in NDMM diagnosis and treatment.
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Medula Óssea , Mieloma Múltiplo , Mielofibrose Primária , Humanos , Mieloma Múltiplo/patologia , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/mortalidade , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Mielofibrose Primária/patologia , Mielofibrose Primária/diagnóstico , Medula Óssea/patologia , Adulto , Prognóstico , Idoso de 80 Anos ou mais , Estudos Retrospectivos , Incidência , FibroseRESUMO
Autoimmune hepatitis (AIH) is a T-cell-mediated liver disease characterized by elevated transaminases, circulating autoantibodies, hypergammaglobulinemia, and interface hepatitis. A 66-year-old female patient visited our department due to recurrent episodes of altered consciousness, sleep-wake inversion, and asterixis, indicating hepatic encephalopathy (HE). Her liver biopsy results clearly demonstrated interface hepatitis. The patient's severe HE does not parallel her relatively stable liver function and was attributed to a wide retroperitoneal collateral vein shunting blood directly into the inferior vena cava, bypassing the liver, and allowing excess neurotoxins to enter the central nervous system. Due to the unfavorable benefit-risk ratio of embolization and the patient's stable liver function, non-invasive treatments were adopted, and prednisolone was discontinued. The patient experienced no further episodes of HE thereafter. To the best of our knowledge, this is the first AIH case with a spontaneous portosystemic shunt directly shunting blood into the inferior vena cava. A crucial lesson from this case is that when HE cannot be fully explained by liver dysfunction, abdominal CT scans should be carefully inspected for possible anatomical variations. This case also underscores the importance of a multidisciplinary approach in managing AIH in elderly patients, who may benefit more from a tailored treatment regimen rather than strictly following standard treatment guidelines.
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In the realm of special equipment, significant advancements have been achieved in fault detection. Nonetheless, faults originating in the equipment manifest with diverse morphological characteristics and varying scales. Certain faults necessitate the extrapolation from global information owing to their occurrence in localized areas. Simultaneously, the intricacies of the inspection area's background easily interfere with the intelligent detection processes. Hence, a refined YOLOv8 algorithm leveraging the Swin Transformer is proposed, tailored for detecting faults in special equipment. The Swin Transformer serves as the foundational network of the YOLOv8 framework, amplifying its capability to concentrate on comprehensive features during the feature extraction, crucial for fault analysis. A multi-head self-attention mechanism regulated by a sliding window is utilized to expand the observation window's scope. Moreover, an asymptotic feature pyramid network is introduced to augment spatial feature extraction for smaller targets. Within this network architecture, adjacent low-level features are merged, while high-level features are gradually integrated into the fusion process. This prevents loss or degradation of feature information during transmission and interaction, enabling accurate localization of smaller targets. Drawing from wheel-rail faults of lifting equipment as an illustration, the proposed method is employed to diagnose an expanded fault dataset generated through transfer learning. Experimental findings substantiate that the proposed method in adeptly addressing numerous challenges encountered in the intelligent fault detection of special equipment. Moreover, it outperforms mainstream target detection models, achieving real-time detection capabilities.