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In this paper, we develop a mixed stochastic approximation expectation-maximization (MSAEM) algorithm coupled with a Gibbs sampler to compute the marginalized maximum a posteriori estimate (MMAPE) of a confirmatory multidimensional four-parameter normal ogive (M4PNO) model. The proposed MSAEM algorithm not only has the computational advantages of the stochastic approximation expectation-maximization (SAEM) algorithm for multidimensional data, but it also alleviates the potential instability caused by label-switching, and then improved the estimation accuracy. Simulation studies are conducted to illustrate the good performance of the proposed MSAEM method, where MSAEM consistently performs better than SAEM and some other existing methods in multidimensional item response theory. Moreover, the proposed method is applied to a real data set from the 2018 Programme for International Student Assessment (PISA) to demonstrate the usefulness of the 4PNO model as well as MSAEM in practice.

BackgroundThe mpox pandemic has caused widespread public concern around the world. The spread of misinformation through the internet and social media could lead to an infodemic that poses challenges to mpox control. ObjectiveThis review aims to summarize mpox-related infodemiology studies to determine the characteristics, influence, prevention, and control measures of the mpox infodemic and propose prospects for future research. MethodsThe scoping review was conducted based on a structured 5-step methodological framework. A comprehensive search for mpox-related infodemiology studies was performed using PubMed, Web of Science, Embase, and Scopus, with searches completed by April 30, 2024. After study selection and data extraction, the main topics of the mpox infodemic were categorized and summarized in 4 aspects, including a trend analysis of online information search volume, content topics of mpox-related online posts and comments, emotional and sentiment characteristics of online content, and prevention and control measures for the mpox infodemic. ResultsA total of 1607 articles were retrieved from the databases according to the keywords, and 61 studies were included in the final analysis. After the World Health Organization’s declaration of an mpox public health emergency of international concern in July 2022, the number of related studies began growing rapidly. Google was the most widely used search engine platform (9/61, 15%), and Twitter was the most used social media app (32/61, 52%) for researchers. Researchers from 33 countries were concerned about mpox infodemic–related topics. Among them, the top 3 countries for article publication were the United States (27 studies), India (9 studies), and the United Kingdom (7 studies). Studies of online information search trends showed that mpox-related online search volume skyrocketed at the beginning of the mpox outbreak, especially when the World Health Organization provided important declarations. There was a large amount of misinformation with negative sentiment and discriminatory and hostile content against gay, bisexual, and other men who have sex with men. Given the characteristics of the mpox infodemic, the studies provided several positive prevention and control measures, including the timely and active publishing of professional, high-quality, and easy-to-understand information online; strengthening surveillance and early warning for the infodemic based on internet data; and taking measures to protect key populations from the harm of the mpox infodemic. ConclusionsThis comprehensive summary of evidence from previous mpox infodemiology studies is valuable for understanding the characteristics of the mpox infodemic and for formulating prevention and control measures. It is essential for researchers and policy makers to establish prediction and early warning approaches and targeted intervention methods for dealing with the mpox infodemic in the future.

Summary: This study systematically reviewed the application of large language models (LLMs) in medicine, analyzing 550 selected studies from a vast literature search. LLMs like ChatGPT transformed healthcare by enhancing diagnostics, medical writing, education, and project management. They assisted in drafting medical documents, creating training simulations, and streamlining research processes. Despite their growing utility in assisted diagnosis and improving doctor-patient communication, challenges persisted, including limitations in contextual understanding and the risk of over-reliance. The surge in LLM-related research indicated a focus on medical writing, diagnostics, and patient communication, but highlighted the need for careful integration, considering validation, ethical concerns, and the balance with traditional medical practice. Future research directions suggested a focus on multimodal LLMs, deeper algorithmic understanding, and ensuring responsible, effective use in healthcare.

Abstract Background The impact of insulin resistance on the prognosis of heart failure with preserved ejection fraction (HFpEF) remains unknown. This study aimed to investigate the association between the triglyceride-glucose (TyG) index, an easily calculated marker of insulin resistance, and the long-term prognosis of HFpEF. Methods A total of 823 patients with HFpEF were enrolled in the study. The TyG index was determined using the formula ln(fasting triglycerides [mg/dL] × fasting glucose [mg/dL]/2). The primary endpoint was all-cause death. The secondary endpoints were cardiovascular (CV) death and heart failure (HF) rehospitalization. Restricted cubic spline, multivariate Cox proportional hazard models, and competing risk models were used for analyses. Results During a median follow-up period of 3.16 years, 147 (17.8%) all-cause deaths, 139 (16.8%) CV deaths, and 222 (27.0%) HF rehospitalizations occurred. Restricted cubic spline analysis revealed a J-shaped association between the TyG index and the mortality and rehospitalization rates. In the multivariate Cox proportional hazard models, compared with those in the lowest TyG index tertile, patients in the highest tertile exhibited the greatest susceptibility to all-cause death (HR 1.53, 95% CI 1.19–1.98) and CV death (HR 1.52, 95% CI 1.19–1.96). In the competing risk model, a significant association between the TyG index and HF rehospitalization was observed (HR 1.31, 95% CI, 1.07–1.61). Conclusion A high TyG index is associated with an increased risk of mortality and rehospitalization in patients with HFpEF. The TyG index may serve as a promising prognostic marker for patients with HFpEF.

Abstract The hard roof in coal mines will induce strong pressure problems for the working face and the lanes, which will seriously affect the safe and efficient production of the mine. For these issues, our team developed a new technology of cutting hard roof by composite blasting. With the new technology, a penetrating process is key to the directionally cut roof. Thus, an arbitrary Lagrange–Euler method is proposed to calculate the penetrating process. In this method, it was taken that the Jones–Wilkins–Lee constitutive model, Johnson–Cook constitutive model, and Holmquist–Johnson–Cook constitutive model to build a numerical model, by LS‐DYNA software, of the process of the penetrating the hard roof. Finally, the following conclusions were obtained: (1) The velocity variation law of metal liner from head to tail is revealed. The speeds of the metal liner's head and tail are 3500 and 450 m/s, respectively. (2) The shape of the channel formed by shaped charge jets is like a funnel, whose mouth's depth and diameter are 33 and 49 mm, respectively. The funnel's narrow diameter is 7.5 mm. (3) With the increase of the channel depth, the rock damage area changes in three different states: slow increase, rapid increase, and linear increase. Then, a shovel‐shaped geometric model of rock damage zone is established, whose key size parameters in the model are given.

ObjectiveThis study utilized computed tomography angiography (CTA) to assess the risk of acute type A aortic dissection (ATAAD) by analyzing the imaging morphology indicators of the ascending aorta, along with the relevant risk factors associated with aortic dissection.MethodsThe study utilized a retrospective observational research design. The population consisted of 172 patients who received treatment in the Department of Cardiothoracic Surgery at Qilu Hospital, Shandong University, from January 2018 to December 2022. The patients were divided into two groups: the ATAAD group (n = 97) and the thoracic aortic aneurysm group (TAA, n = 75). Demographic data and ascending aorta CTA measurements were collected from all patients. Single factor and multivariate logistic regression were employed to analyze the statistical differences in clinical data and ascending aorta CTA imaging morphology indicators between the two groups.ResultsThe variables were included in logistic multivariate analysis for further screening, indicating that the length of the ascending aorta (LAA) before ATAAD (OR = 3.365; 95% CI :1.742–6.500, P

Conclusions: These findings indicate that G1 treatment is influenced by a high-fat diet, potentially disrupting glucolipid metabolism and promoting insulin resistance alongside its antiobesity effects. Consequently, further investigation is imperative to thoroughly explore this potential toxic side effect of G1 therapy.

The utilization of digital statistical processes in images and videos can effectively tackle numerous challenges encountered in optical sensors. This research endeavors to overcome the limitations inherent in traditional focus models, particularly their inadequate accuracy. It aims to bolster the precision of real-time perception and dynamic control by employing enhanced data fusion methodologies. The ultimate objective is to facilitate information services that enable seamless interaction and profound integration between computational and physical processes within an open environment. To achieve this, an enhanced sum-modulus difference (SMD) evaluation function has been proposed. This innovation is founded on the concept of threshold value evaluation, aimed at rectifying the accuracy shortcomings of traditional focusing models. Through the computation of each gray value after threshold segmentation, the method identifies the most suitable threshold for image segmentation. This identified threshold is then applied to the focus search strategy employing the radial basis function (RBF) algorithm. Furthermore, an intelligent focusing system has been developed on the Zynq development platform, encompassing both hardware design and software program development. The test results affirm that the focusing model based on the improved SMD evaluation function rapidly identifies the peak point of the gray variance curve, ascertains the optimal focal plane position, and notably enhances the sensitivity of the focusing model.

Abstract Objective This study aimed to investigate the relationship between the TyG (Triglyceride-glucose index) and the prognosis of patients with HOCM (hypertrophic obstructive cardiomyopathy) without diabetes. Research design and methods A total of 713 eligible patients with HOCM were enrolled in this study and divided into two groups based on treatment: an invasive treatment group (n = 461) and a non-invasive treatment group (n = 252). The patients in both two groups were then divided into three groups based on their TyG index levels. The primary endpoints of this study were Cardiogenic death during long-term follow-up. Kaplan–Meier analysis was used to study the cumulative survival of different groups. Restricted cubic spline was used to model nonlinear relationships between the TyG index and primary endpoints. Myocardial perfusion imaging/Myocardial metabolic imaging examinations were performed to assess glucose metabolism in the ventricular septum of the HOCM patients. Results The follow-up time of this study was 41.47 ± 17.63 months. The results showed that patients with higher TyG index levels had better clinical outcomes (HR, 0.215; 95% CI 0.051,0.902; P = 0.036, invasive treatment group; HR, 0.179; 95% CI 0.063,0.508; P = 0.001, non-invasive treatment group). Further analysis showed that glucose metabolism in the ventricular septum was enhanced in HOCM patients. Conclusions The findings of this study suggest that the TyG index may serve as a potential protective factor for patients with HOCM without diabetes. The enhanced glucose metabolism in the ventricular septum of HOCM patients may provide a potential explanation for the relationship between the TyG index and HOCM prognosis.

Abstract Background The prognostic implication of liver fibrosis in acute coronary syndrome (ACS) patients are scarce. We sought to evaluate whether liver fibrosis scores (LFS) were associated with thrombotic or bleeding events in patients with acute coronary syndrome. Methods We included 6386 ACS patients who underwent percutaneous coronary intervention (PCI). This study determined liver fibrosis with aspartate aminotransferase to platelet ratio index (APRI), aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT ratio), Forns score, and nonalcoholic fatty liver disease fibrosis score (NFS). The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause mortality (ACM), myocardial infarction (MI), and ischemic stroke (IS). Results During the follow-up, 259 (4.06%) MACCE and 190 (2.98%) bleeding events were recorded. As a continuous variable or a categorical variable stratified by the literature-based cutoff, LFS was positively associated with MACCE (p > 0.05) but not with bleeding events. Compared with subjects with low APRI scores, AST/ALT ratio scores, Forns scores, and NFS scores, subjects with high scores had a 1.57- to 3.73-fold increase risk of MACCE after adjustment (all p

Abstract Aims Recent studies suggested that both left ventricular ejection fraction (LVEF) lower than 60% or higher than 65% were associated with an increased mortality in the general population. Uncertainty remains regarding adverse outcomes across LVEF in coronary artery disease (CAD). The common understanding was that LVEF 40%. We aimed to evaluate the relationship between LVEF and mortality or adverse events in CAD patients undergoing percutaneous coronary intervention (PCI). Methods and results A total of 10 252 CAD patients undergoing PCI from an observational cohort were studied. All‐cause mortality and major adverse cardiovascular and cerebrovascular events (MACCE) were set as outcomes. Kaplan–Meier curves, adjusted Cox regression models, and restricted cubic spline analyses were used for evaluation. A total of 137 (1.3%) patients had all‐cause mortality, and 816 (8.0%) patients had MACCE during a median of 2.4 years of follow‐up. The median LVEF was 64%. All‐cause mortality and MACCE rates changed substantially across LVEF categories, and a linear inverse relationship of LVEF with all‐cause mortality and MACCE risk was observed. All‐cause mortality or MACCE risk increased significantly below an LVEF of 55 or 65%, respectively. Patients with LVEF

ObjectiveThe main purpose of this study was to evaluate the safety and efficacy of Castor single-branched stent-graft combined with fenestrated technique in treatment of thoracic aortic disease (TAD) with unfavorable proximal landing area (PLZ) and isolated left vertebral artery (ILVA).MethodsFrom January 2018 to March 2022, 8 patients with TAD (6 patients with type B aortic dissections, 1 patient with type B intramural hematomas, and 1 patient with thoracic aortic aneurysm) underwent thoracic endovascular aortic repair with fenestrated Castor stent-graft due to the existence of ILVA and unfavorable PLZ. Demographic characteristics, surgical details, postoperative complications, follow-up and postoperative CTA imaging results were collected and analyzed.ResultsThe primary technical success rate was 100%. The mean operation time was 115 min (range, 70–180 min). All the left subclavian arteries (LSAs) and ILVAs of the eight patients were revascularized by fenestrated Castor stent-grafts. During the follow-up period, no deaths and complications were observed. No internal leakage, aortic rupture, retrograde type A dissection were found on computed tomography angiography. All of the LSAs and ILVAs maintained patency without stenosis.ConclusionCastor single-branched stent-graft implantation combined with fenestration technique may be safe and feasible for TAD patients with ILVA and unfavorable PLZ.

Ultra-short-term power load forecasting (USTPLF) can provide strong support and guarantee the decisions on unit start-up, shutdown, and power adjustment. The ultra-short-term power load (USTPL) has strong non-smoothness and nonlinearity, and the time-series characteristics of the load data themselves are difficult to explore. Therefore, to fully exploit the intrinsic features of the USTPL, a stochastic configuration networks (SCNs) USTPLF method based on K-means clustering (K-means) and empirical mode decomposition (EMD) is proposed. First, the load data are decomposed into several intrinsic mode functions (i.e., IMFs) and residuals (i.e., Res) by EMD. Second, the IMFs are classified by K-means, and the IMF components of the same class are summed. Third, the SCNs is used to forecast the electric load on the basis of the classified data. Lastly, on the basis of the real load of Shenzhen City, the proposed method is applied for emulation authentication. The result verifies the efficiency of the proposed measure.

ObjectivesThis observational study aims to explore the predictive role of postoperative arterial lactate in off-pump coronary artery bypass grafting (CABG)-associated acute kidney injury (AKI).Materials and methodsA total of 500 consecutive patients who underwent off-pump CABG from August 2020 to August 2021 at the Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, were included. Logistic regression analysis was used to confirm the independent risk factors of off-pump CABG-associated AKI. Receiver operating characteristic (ROC) curve was performed to evaluate the discrimination ability and Hosmer–Lemeshow goodness of fit test was performed to evaluate the calibration ability.ResultsThe incidence of off-pump CABG-associated AKI was 20.6%. Female gender, preoperative albumin, baseline serum creatinine, 12 h postoperative arterial lactate and duration of mechanical ventilation were independent risk factors. The area under the ROC curve (AUC) of 12 h postoperative arterial lactate for predicting off-pump CABG-associated AKI was 0.756 and the cutoff value was 1.85. The prediction model that incorporated independent risk factors showed reliable predictive ability (AUC = 0.846). Total hospital stay, intensive care unit stay, occurrence of other postoperative complications, and 28-day mortality were all significantly higher in AKI group compared to non-AKI group.Conclusion12 h postoperative arterial lactate was a validated predictive biomarker for off-pump CABG-associated AKI. We constructed a predictive model that facilitates the early recognition and management of off-pump CABG-associated AKI.

This study focuses on the measurement of mathematical ability in the Chinese Compulsory Education Qualification Monitoring (CCEQM) framework using bifactor theory. First, we propose a full-information item bifactor (FIBF) model for the measurement of mathematical ability. Second, the performance of the FIBF model is empirically studied using a data set from three representative provinces were selected from CCEQM 2015–2017. Finally, Monte Carlo simulations are conducted to demonstrate the accuracy of the model evaluation indices and parameter estimation methods used in the empirical study. The obtained results are as follows: (1) The results for the four used model selection indices (AIC, SABIC, HQ, BIC) consistently showed that the fit of the FIBF model is better than that of the UIRT; (2) All of the estimated general and domain-specific abilities of the FIBF model have reasonable interpretations; (3) The model evaluation indices and parameter estimation methods exhibit excellent accuracy, indicating that the application of the FIBF model is technically feasible in large-scale testing projects.

In the estimation of item response models, the normality of latent traits is frequently assumed. However, this assumption may be untenable in real testing. In contrast to the conventional three-parameter normal ogive (3PNO) model, a 3PNO model incorporating Ramsay-curve item response theory (RC-IRT), denoted as the RC-3PNO model, allows for flexible latent trait distributions. We propose a stochastic approximation expectation maximization (SAEM) algorithm to estimate the RC-3PNO model with non-normal latent trait distributions. The simulation studies of this work reveal that the SAEM algorithm produces more accurate item parameters for the RC-3PNO model than those of the 3PNO model, especially when the latent density is not normal, such as in the cases of a skewed or bimodal distribution. Three model selection criteria are used to select the optimal number of knots and the degree of the B-spline functions in the RC-3PNO model. A real data set from the PISA 2018 test is used to demonstrate the application of the proposed algorithm.

ObjectivesThis study aims to investigate whether the ratios of cell types in peripheral blood could be used as reliable predictors of off-pump coronary artery bypass grafting (CABG)-associated acute kidney injury (AKI).Materials and methodsWe retrospectively reviewed patients (n = 420) undergoing off-pump CABG from January 1, 2021 to January 1, 2022 in Qilu Hospital of Shandong University. We used logistic regression analysis to identify the potential predictors of off-pump CABG-associated AKI and construct a predictive model. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive ability of predictors and prediction models.ResultsThe prevalence of AKI associated with off-pump CABG was 20.95%. Patients in the AKI group had significantly higher ratios of peripheral blood cells on postoperative day (POD)1 than patients in the non-AKI group (P

ObjectiveTo explore the correlation between the incidence of atrial fibrillation (AF) and thyroid dysfunction in patients with hypertrophic obstructive cardiomyopathy (HOCM).MethodsThyroid function testing in 755 consecutive patients with HOCM were examined at the National Center for Cardiovascular Diseases (China) from October 2009 to December 2013. Patients were divided into four groups according to the TSH levels: TSH10.00mIU/L(n=17).ResultsA total of 107 patients were diagnosed with AF (14%).(1) Compared to HOCM patients without AF,HOCM patients with AF have older age (P

Abstract MicroRNAs have emerged as key regulators in vascular diseases and are involved in the formation of atherosclerotic lesions. However, the atherosclerotic-specific MicroRNAs and their functional roles in atherosclerosis are unclear. Here, we report that miR-378c protects against atherosclerosis by directly targeting Sterile Alpha Motif Domain Containing 1 (Samd1), a predicted transcriptional repressor. miR-378c was strikingly reduced in atherosclerotic plaques and blood of acute coronary syndrome (ACS) patients relative to healthy controls. Suppression of miR-378c promoted vascular smooth muscle cells (VSMCs) phenotypic transition during atherosclerosis. We also reported for the first time that Samd1 prolonged immobilization of LDL on the VSMCs, thus facilitated LDL oxidation and subsequently foam cell formation. Further, we found that Samd1 contains predicted DNA binding domain and directly binds to DNA regions as a transcriptional repressor. Together, we uncovered a novel mechanism whereby miR-378c-Samd1 circuit participates in two key elements of atherosclerosis, VSMCs phenotypic transition and LDL oxidation. Our results provided a better understanding of atherosclerosis pathophysiology and potential therapeutic management by targeting miR-378c-Samd1 circuit.

ObjectivesThe aim of this study was to analyze long-term outcomes of Chinese coronary artery disease (CAD) patients with (and without) chronic obstructive pulmonary disease (COPD) after percutaneous coronary intervention (PCI).BackgroundChronic obstructive pulmonary disease is a chronic condition which often develops in conjunction with CAD. PCI is a core therapy for CAD, although we still need to understand CAD-COPD outcomes and to identify factors that influence prognoses, across ethnicities.MethodsThis double-cohort study involved 12,343 Chinese CAD patients who received PCI. Baseline characteristics were collected in two independent, specialty centers. Propensity-score matching was performed to control confounding factors, using a nearest neighbor matching method within a 0.02 caliper and on a propensity score scale of 0.1 for each center. Comorbid CAD-COPD cases were compared to non-COPD patients in terms of major adverse cardiac events (MACEs).ResultsPatients with COPD were generally older than those without COPD (65.4 ± 9.2 vs. 58.2 ± 10.3, p < 0.001). There were no significant differences in the end points between COPD and non-COPD groups after PCI (All p > 0.05); however, the incidence of MACEs increased after 450 days. Further subgroup analysis suggests that COPD is approximately four times more prevalent among those aged over 75 years (HR, 3.818; 95%CI, 1.10–13.29; p = 0.027) and those aged below 55 years (HR = 4.254; 95% CI, 1.55–11.72; p = 0.003).ConclusionHaving COPD does not appear to have a significant impact on CAD outcomes 2 years after PCI, and beyond. However, an increasing number of MACEs was observed after 450 days, which suggests that there may be a double-stage effect of COPD on PCI prognosis. There is a need for focused comorbidity management, specifically for those aged below 55 years and above 75 years.

BackgroundObservational studies have shown an association between early age at menarche (AAM) and myocardial infarction (MI) with recorded cases. In this Mendelian randomization (MR) study, we used large amounts of summary data from genome-wide association studies (GWASs) to further estimate the association of genetically predicted AAM with genetically predicated risk of MI and investigate to what extent this association is mediated by genetically determined lifestyles, cardiometabolic factors, and estrogen exposure.MethodsA two-step, two-sample MR study was performed by mediation analysis. Genetic variants identified by GWAS meta-analysis of reproductive genetics consortium (n = 182,416) were selected for genetically predicted AAM. Genetic variants identified by the Coronary ARtery DIsease Genome-wide Replication and Meta-analysis plus The Coronary Artery Disease Genetics Consortium (n = 184,305) were selected for genetically predicted risk of MI. Genetic variants from other international GWAS summary data were selected for genetically determined mediators.ResultsThis MR study showed that increase in genetically predicted AAM was associated with lower risk of genetically predicted MI (odds ratio 0.91, 95% confidence interval 0.84–0.98). Inverse variance weighted (IVW) MR analysis also showed that decrease in genetically predicted AAM was associated with higher genetically predicted alcohol intake frequency, current smoking behavior, higher waist-to-hip ratio, and higher levels of systolic blood pressure (SBP), fasting blood glucose, hemoglobin A1c (HbA1c), and triglycerides (TGs). Furthermore, increase in genetically predicted AAM was associated with genetically predicted longer sleep duration, higher levels of high-density lipoproteins, and older age at which hormone replacement therapy was started. The most essential mediators identified were genetically predicted current smoking behavior and levels of HbA1c, SBP, and TGs, which were estimated to genetically mediate 13.9, 12.2, 10.5, and 9.2%, respectively, with a combined mediation proportion of 37.5% in the association of genetically predicted AAM with genetically predicted increased risk of MI in an MR framework.ConclusionOur MR analysis showed that increase in genetically predicted AAM was associated with lower genetically predicted risk of MI, which was substantially mediated by genetically determined current smoking behavior and levels of HbA1c, SBP, and TGs. Intervening on the above mediators may reduce the risk of MI.

Objective: The purpose of this study was to determine the effects of surgical resection of muscle layer on the long-term survival of patients with hypertrophic obstructive cardiomyopathy (HOCM). Methods: The original study cohort consisted of 552 patients with hypertrophic cardiomyopathy (HCM), including 380 patients with HOCM and 172 patients with nonobstructive HCM. All these patients had a definite diagnosis in our center from October 1, 2009, to December 31, 2012. They were divided into three groups, viz., HOCM with myectomy group (n=194), nonoperated HOCM group (n=186), and nonobstructive HCM group (n=172). Median follow-up duration was 57.57+-13.71 months, and the primary end point was a combination of mortality from all causes. Results: In this survival study, we compared the prognoses of patients with HOCM after myectomy, patients with nonoperated HOCM, and patients with nonobstructive HCM. Among the three groups, the myectomy group showed a lower rate of reaching the all-cause mortality with statistically indistinguishable overall survival compared with patients with nonobstructive HCM (p=0.514). Among patients with left ventricular outflow tract (LVOT) obstruction, the overall survival in the myectomy group was noticeably better than that in the nonoperated HOCM group (log-rank p

Abstract Aiming at serious deformation and failure of large‐section coal roadway under mined zones in ultra‐thick coal seam, its deformation and failure characteristics are analyzed based on the field measurement. This paper reveals the mechanism of roadway roof separation, roof leakage, and right rib extrusion. Based on the mechanism, two kinds of secondary support schemes are proposed, that is, “grouting + I‐steel support + bolt” (scheme I) and “grouting + U steel support + anchor + anchor cable” (scheme II). The industrial experiment is carried out at 1070 auxiliary transportation roadway in Tashan Coal Mine. The measured results show that the roadway roof separations of the secondary support scheme I and II are only 1/11 and 1/46 of the original support scheme, respectively, while the lateral displacements of the roadway are only 1/7 and 1/44 of the original support scheme. It could be seen that the deformation and failure of the roadway surrounding rock have been well controlled.

Introduction and ObjectivesThe risk of ventricular arrhythmia and heart failure in patients with hypertrophic obstructive cardiomyopathy (HOCM) is much higher than that in the general population. More and more pieces of evidence showed that HOCM is the leading cause of sudden cardiac death in young people. We reported our experience in a study, comparing surgical myectomy, alcohol septal ablation (ASA), and medical therapy.MethodsThe original cohort included 965 consecutive patients with HOCM. The patients were divided into three groups according to treatment strategies: myectomy group (n = 502), ASA group (n = 138), and medical treatment group (n = 325). The median follow-up duration was 42.99 ± 18.32 months, and the primary endpoints were all-cause mortality and heart transplantation.ResultsBoth in short- and long-term observations, surgical myectomy reduced the left ventricular outflow tract (LVOT) gradients more effectively (7 days, 16.15 ± 12.07 mmHg vs. 42.33 ± 27.76 mmHg, p < 0.05; 1 year, 14.65 ± 13.18 mmHg vs. 41.17 ± 30.76 mmHg, p < 0.05). Among the three groups, the patients in the medical treatment group were at a higher risk of mortality and cardiac transplantation (vs. the myectomy group, p < 0.001 by log-rank test; vs. the alcohol septal ablation group, p = 0.017 by log-rank test), and the myectomy group shows a lower risk of reaching the primary endpoint than the two other groups. In the multivariate Cox regression analysis, previous atrial fibrillation (AF), N terminal pro B type natriuretic peptide (NT-pro-BNP), and surgical myectomy predicted an HOCM prognosis. However, the impact of surgical myectomy on HOCM prognosis seems to be limited to the

At present, the calculation method of ice load on surface navigation ships has been very mature, but the calculation method of submarine ice load is very few. The reasonable evaluation of submarine ice load has become an urgent problem to be solved. In this paper, the mechanical characteristics of the submarine surfacing ice-breaking process are systematically analyzed. Based on the theory of plate and shell, the theoretical calculation models of ice-breaking resistance of the submarine command tower and hull are established, respectively, and the ice load calculation method of the command tower and the hull is obtained. Then, the submarine model SUBOFF is used to perform the numerical simulation of the submarine’s ice-breaking and surfacing process. The numerical result is compared with the ice-breaking resistance calculation model. The results show that the ice-breaking resistance calculation model proposed in this paper is consistent with the numerical simulation results, and the influence of parameters such as ice mechanical properties, the upper area of the command tower, and initial crack length on ice-breaking resistance is established. The calculation model in this paper can provide a theoretical reference for the optimization design of polar submarine structures.

The recycling of construction waste and the use of a new sintering process in the field of sintered bricks can greatly solve the problems of clay resource depletion, soil structure destruction, and high CO2 emissions that always limit the development of the sintered brick field. The study was carried out using an orthogonal experiment to derive the optimal mix ratio for the preparation of sintered bricks, and subsequently, the sintered bricks were prepared using the optimal mix ratio. The experimental results show that the maximum compressive strength of construction waste sintered brick (MRB sintered brick) prepared using high-temperature sintering is 8.1 MPa, and the water absorption is 11. When the waste glass slag is mixed with 10%, it can show a better fluxing effect in the preparation of sintered bricks by mixing construction waste with waste glass slag (MGB sintered bricks), so that the MGB sintered bricks have a higher densification. The compressive strength is 32.9% higher and the water absorption is 3.5% lower than that of MRB sintered brick. MGS sintered bricks were prepared by mixing Yellow River sedimentary sand into MGB sintered bricks. The strength of MGS sintered bricks increased with the replacement rate of Yellow River sedimentary sand, and when the replacement rate of Yellow River sedimentary sand reached 16%, the strength of the MGS sintered bricks increased by 88.9%, and the water absorption rate was reduced by 4.6% compared with the MGB sintered bricks. The sintering mechanism had significant effects on the compressive strength, weathering resistance, and frost resistance of the sintered brick. The microwave sintering process has the characteristics of high efficiency, uniform heating, selective heating, and low thermal inertia, which can increase the compressive strength of MGS sintered brick by 4.6%, reduce the water absorption by 12.9%, shorten the sintering time by 43.6%, and improve the frost resistance.

BackgroundThe triglyceride-glucose index (TyG index) is a valuable marker for predicting adverse cardiovascular events in diabetic patients. However, for nondiabetic patients, whether the TyG index is independently related to poor prognosis remains unclear. This cohort study assessed the association of the TyG index with future cardiovascular risk in nondiabetic subjects who received percutaneous coronary intervention (PCI).MethodsWe consecutively enrolled 5,489 nondiabetic patients who underwent PCI. All experimental subjects were divided into three groups based on their TyG index, which was determined by the equation ln (fasting triglyceride (mg/dl) × fasting blood glucose (mg/dl)/2). The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including all-cause death, nonfatal myocardial infarction (MI), nonfatal stroke, and target vessel revascularization (TVR).ResultsA total of 386 MACCE were documented during a median 29-month follow-up. The Kaplan–Meier survival results indicated that among the three groups, there was no obvious difference in any endpoints. Further Cox regression analyses suggested that the TyG index was not independently related to adverse cardiovascular outcomes for nondiabetic patients who underwent PCI (HR: 0.77, 95% CI 0.56–1.16, P = 0.210 for MACCE). Subgroup analysis suggested that the TyG index was independently relevant to MACCE for patients with low-density lipoprotein cholesterol (LDL-C) lower than 1.8 mmol/L.ConclusionThe TyG index is not an effective predictive factor for adverse cardiovascular prognosis in nondiabetic patients who underwent PCI. However, in subjects with LDL-C lower than 1.8mmol/L, it may predict future cardiovascular risk.

The occurrence of overlying coal pillar (OCP) exerts a strong effect on the stress and strain distribution of the surrounding rock in the stope. In this paper, the stress distribution characteristics are analyzed via the numerical calculation with the account of OCP presence or absence. In addition, this study revealed the joint effect of side pressure relief area of the goaf and stress concentration in OCP on the final stress distribution. Furthermore, the rules of abutment stress distribution affected by three influencing factors, namely horizontal-vertical distances between OCP and working face and buried depth of OCP, are analyzed. The functional model linking the peak stress of surrounding rock with the above influencing factors is developed. The field application of the above results proved that the rib spalling and deformation of a 2.95 m-high and 5.66 m-wide roadway could be efficiently controlled by rationally adjusting working states of the support, and adopting the hydraulic prop coordinated with the π type metal beam and anchor cable to strengthen the surrounding rock of working face and roadway, respectively. The proposed measures are considered appropriate to satisfy the safe operation requirements. Keywords: Overlying coal pillar (OCP), Stress distribution, Influencing factors, Surrounding rock control

Atrial fibrillation (AF) is a form of sustained cardiac arrhythmia and microRNAs (miRs) play crucial roles in the pathophysiology of AF. To identify novel miR–mRNA pairs, we performed RNA-seq from atrial biopsies of persistent AF patients and non-AF patients with normal sinus rhythm (SR). Differentially expressed miRs (11 down and 9 up) and mRNAs (95 up and 82 down) were identified and hierarchically clustered in a heat map. Subsequently, GO, KEGG, and GSEA analyses were run to identify deregulated pathways. Then, miR targets were predicted in the miRDB database, and a regulatory network of negatively correlated miR–mRNA pairs was constructed using Cytoscape. To select potential candidate genes from GSEA analysis, the top-50 enriched genes in GSEA were overlaid with predicted targets of differentially deregulated miRs. Further, the protein–protein interaction (PPI) network of enriched genes in GSEA was constructed, and subsequently, GO and canonical pathway analyses were run for genes in the PPI network. Our analyses showed that TNF-α, p53, EMT, and SYDECAN1 signaling were among the highly affected pathways in AF samples. SDC-1 (SYNDECAN-1) was the top-enriched gene in p53, EMT, and SYDECAN1 signaling. Consistently, SDC-1 mRNA and protein levels were significantly higher in atrial samples of AF patients. Among negatively correlated miRs, miR-302b-3p was experimentally validated to suppress SDC-1 transcript levels. Overall, our results suggested that the miR-302b-3p/SDC-1 axis may be involved in the pathogenesis of AF.

In fully mechanized caving mining of extra-thick coal seams, the movement range of overburden is wide, resulting in the breakage of multilayer hard roofs in overlying large spaces. However, the characteristics, morphology and impact effect of hard roofs at different levels are different and unclear. In this study, a secondary development was used in the numerical simulation software ABAQUS, and the caving of rock strata in the finite-element software was realized. The bearing stress distribution, fracturing morphology and impact energy characteristics of hard roofs at different levels were studied to reflect the action and difference of hard roof failure on the working face; thus, revealing the mechanism of the strong ground pressure in stopes, and providing a theoretical basis for the safe and efficient mining of extra-thick coal seams with hard roofs.

Purpose: To determine the effect of competitive flow and diltiazem on postoperative hemodynamics and long-term patency rate in patients undergoing coronary artery bypass grafting (CABG). Methods: A retrospective analysis was performed on the clinical records of 98 patients who underwent CABG at Qilu Hospital of Shandong University from March 2018 to September 2020. Among them, 47 patients who underwent CABG alone were assigned to control group, while 51 patients who received additional diltiazem were assigned to study group. The severity of coronary artery stenosis (CAS) was evaluated through preoperative coronary angiography, and bridge vessel flow compared between severe stenosis and non-severe stenosis groups. Changes in hemodynamic parameters between two groups were compared before surgery, as well as 12 and 24 h after surgery. Results: A significantly higher bridge vessel blood flow was found in severe stenosis group compared to non-severe stenosis group (p < 0.05). The CAS severity and bridge vessel blood flow revealed an inverse relationship (r = - 0.792, p < 0.001). At 12 and 24 h post-surgery, the study group exhibited significantly lower central venous pressure (CVP), heart rate (HR) and mean arterial pressure (MAP) than the control group (p < 0.05). There was no significant difference in adverse cardiovascular effects (ACEs), between the two groups after 12 months (p > 0.05). Similarly, there was no significant difference in graft patency rate, mild stenosis rate, severe stenosis rate, complete occlusion rate, and linear signs rate 12 months post-operation (p > 0.05). However, the patency rate was significantly higher in cases with severe stenosis (p < 0.05). Conclusion: Postoperative administration of diltiazem in patients undergoing CABG improves systemic hemodynamic parameters. However, competitive blood flow may potentially decrease the long-term patency rate of bridge vessels in patients. [ABSTRACT FROM AUTHOR]

There are many factors involved in the layout optimization of cabin equipment, and human factors should be considered in the early stage of layout design. Human reliability is an effective index to evaluate the probability of success of the human completion of tasks. In order to put forward the method of human reliability which is more suitable for the layout optimization of cabin equipment, the existing methods of human reliability analysis (HRA) are systematically studied. At the same time, taking HRA, equipment correlation and cabin balance as objective functions, the optimization problem of cabin equipment layout was quantified into a mathematical model. When solving the model, the visibility graph method was used to model the cabin path planning, and a solution platform for the optimization of cabin equipment layout was developed on the basis of a genetic algorithm. Finally, the developed platform was applied with a ship example, and the results before and after the layout optimization were displayed through a three-dimensional model. At the same time, equipment layout evaluation software was used to simulate the experimental results so as to compare the improvement of important parameters before and after the layout optimization.

Stable maximum likelihood estimation (MLE) of item parameters in 3PLM with a modest sample size remains a challenge. The current study presents a mixture-modeling approach to 3PLM based on which a feasible Expectation-Maximization-Maximization (EMM) MLE algorithm is proposed. The simulation study indicates that EMM is comparable to the Bayesian EM in terms of bias and RMSE. EMM also produces smaller standard errors (SEs) than MMLE/EM. In order to further demonstrate the feasibility, the method has also been applied to two real-world data sets. The point estimates in EMM are close to those from the commercial programs, BILOG-MG and flexMIRT, but the SEs are smaller.