Background
To evaluate the benefit of neoadjuvant chemotherapy (NAC) for survival in high-grade upper tract urothelial carcinoma (UTUC), a propensity score-based analysis was performed with ...high-grade UTUC patients from multiple urologic centers.
Methods
From three urologic centers, 48 high-grade UTUC patients who received chemotherapy followed by surgery (NAC group) and 72 high-grade UTUC patients who underwent initial surgery (no-NAC group) were involved in a propensity score-based analysis. After propensity score-based (1:1) matching, 37 patients receiving NAC and 37 patients not receiving NAC were followed.
Results
The patients who received NAC had improved disease-free survival (DFS) and overall survival (OS), with a 3-year DFS rate of 78.4% and an OS rate of 86.5% versus a 3-year DFS rate of 51.4% and an OS rate of 62.2% for those treated with initial surgery (
P
= 0.018 and
P
= 0.02, respectively). In the multivariate analysis, the NAC group had a lower risk for mortality DFS hazard ratio (HR) 0.25; 95% confidence interval (CI) 0.10–0.62;
P
= 0.003; OS HR 0.22; 95% CI 0.085–0.57;
P
= 0.002. The analysis of patient survival in matched subgroups showed that NAC was beneficial in terms of the 3-year DFS for the group with a cT of 3 or higher (DFS HR 0.37; 95% CI 0.14–0.94;
P
= 0.036) and the group that had tumor with hydronephrosis (DFS HR 0.31; 95% CI 0.11–0.87;
P
= 0.026).
Conclusion
The study showed that NAC may be considered as an effective addition to surgery for the treatment in high-grade UTUC patients.
Supercritical carbon dioxide (SCO2) jets are a promising method to assist drilling, enhance oil–gas production, and reduce greenhouse gas emissions. To further improve the drilling efficiency of SCO2 ...jet-assisted drilling, organ-pipe nozzles were applied to generate a self-excited oscillation SCO2 jet (SEOSJ). The impact pressure oscillation and rock erosion capability of SEOSJs under both supercritical and gaseous CO2 (GCO2) ambient conditions were experimentally investigated. It was found that the impact pressure oscillation characteristics of SEOSJs produced by organ-pipe nozzles are dramatically affected by the oscillation chamber length. The optimum range of the dimensionless chamber length to generate the highest impact pressure peak and the strongest pressure oscillation is within 7–9. The dimensionless pressure peak and the pressure ratio decreases gradually with increasing pressure difference, whereas the pressure oscillation intensity increases with increasing pressure difference and the increasing rate decreases gradually. The dominant frequency was observed to decrease monotonically with increasing chamber length but increases with the increase of pressure difference. Moreover, the comparison of impingement characteristics of SEOSJs under different ambient conditions showed that the values of dimensionless peak impact pressure are similar under the two ambient conditions, and the SEOSJ achieves higher pressure oscillation intensity and dominant frequency in SCO2 at the same pressure difference. The rock breaking ability of the SEOSJ is closely related to its axial impact pressure. The erosion depth and mass loss of sandstone caused by the organ-pipe nozzle with the best impact pressure performance is higher than those produced by other nozzles. The SEOSJ results in a deeper and narrower crater in SCO2 than in GCO2 under the same pressure difference. The reported results provide guidance for SEOSJ applications and the design of an organ-pipe nozzle used for jet-assisted drilling.
Resting-state brain network with physiological and pathological basis has always been the ideal data for intelligent diagnosis of major depression disease (MDD). Brain networks are divided into ...low-order networks and high-order networks. Most of the studies only use a single-level network to classify while ignoring that the brain works cooperatively with different levels of networks. This study hopes to find out whether varying levels of networks will provide complementary information in the process of intelligent diagnosis and what impact will be made on the final classification results by combining the characteristics of different networks.
Our data are from the REST-meta-MDD project. After the screening, 1,160 subjects from ten sites were included in this study (597 MDD and 563 normal controls). For each subject, we constructed three different levels of networks according to the brain atlas: the traditional low-order network based on Pearson's correlation (low-order functional connectivity, LOFC), the high-order network based on topographical profile similarity (topographical information-based high-order functional connectivity, tHOFC) and the associated network between them (aHOFC). Two sample
-test is used for feature selection, and then features from different sources are fused. Finally, the classifier is trained by a multi-layer perceptron or support vector machine. The performance of the classifier was evaluated using the leave-one-site cross-validation method.
The classification ability of LOFC is the highest among the three networks. The classification accuracy of the three networks combined is similar to the LOFC network. These are seven features chosen in all networks. In the aHOFC classification, six features were selected in each round but not seen in other classifications. In the tHOFC classification, five features were selected in each round but were unique. These new features have crucial pathological significance and are essential supplements to LOFC.
A high-order network can provide auxiliary information for low-order networks but cannot improve classification accuracy.
Experiments were conducted to investigate the cavitation behavior of Helmholtz self-sustained oscillation jets. In this paper, highspeed photographic technology was used to capture the flow details ...of cavitation with various nozzle structures and operating pressures from 1.0 MPa to 3.0 MPa. Furthermore, an in-house code based on a matrix approach that processes gray values with various statistical methods was used to quantitatively evaluate the cavitation jet of waters generated by Helmholtz nozzles. The mean values of the normalized gray levels of the images were used as a metric to measure the lengths of the cavitation clouds. When the original data were smoothed by a 15th lowess filter to exclude the noise of the images, the periods of cavitation cloud shedding were obtained accordingly, and the average period had a magnitude of 10
-4
. All of the smoothed results of the original data captured a two-peak shape that comprises a large peak and a mild hump. Image processing results showed that the Helmholtz nozzle produced greater cavitation intensity than a traditional conical nozzle. The shear-layer instability waves disappeared within 10
d
1
downstream from the injector exit. The cavitation clouds propagated a distance of approximately 1–10
d
1
at various pressure ratios, and the clouds were continuous within this distance. The geometry of the nozzle strongly affected the length and shedding period of the cavitation cloud. As described in the discussion section of this paper, when the cavity length was doubled, the length of the cavitation cloud decreased approximately 26.5 %; however, the period of the cavitation cloud shedding increased approximately 10 %. The longest cavitation cloud appeared when the ratio of the cavity diameter and the upper nozzle diameter was eight. Excessively small or large diameters were not conducive to the development of cavitation, whereas the effect of the pressure ratio on the cavitation cloud length was positive. When other conditions remained unchanged, the lump shedding period decreased as the pressure ratio was increased to 25. When the pressure ratio exceeded 25, the cavitation cloud shedding period remained constant.
Pulsed waterjet can break rocks effectively by taking advantage of the water hammer effect, and is thus widely used in mining, petroleum, and natural gas fields. With the aim to further clarify the ...flow field characteristics of pulsed jets induced by a Helmholtz oscillator, large eddy simulation was conducted under different operating pressures. The velocity distribution, mean flow field, and the coherent structure were examined using the oscillators of different cavity lengths and diameters. The results clearly showed that the major frequency of jet pulsation gradually increased with the increase of operating pressure. A stable periodic velocity core was formed at the outlet of the Helmholtz oscillator, while the external flow field was subjected to periodic impact. As a result, the ambient fluid was strongly entrained into the jet beam. With the increase of the cavity length, the length of the core segment decreased while the energy loss caused by the cavity increased, which was also accompanied by a rapid attenuation of the axial velocity at the jet outlet. The coherent structure of the jet in the oscillator with small cavity diameter was more disordered near the nozzle outlet, and the vortex scale was larger. The effect of cavity diameter can be reflected in the feedback modulation of the jet in the cavity. Compared with the conical nozzle, the length of the core section of the jet was shorter, but the jet had better bunching, a smaller diffusion angle, and better mixing performance. These results provide a further understanding of the characteristics of pulsed water jet for better utilizations in the fields of energy exploitation.
The efficacy and safety of low-pressure balloon pre-dilatation before intracoronary pro-urokinase (pro-UK) in preventing no-reflow during percutaneous coronary intervention (PCI) remains unknown. ...This study aimed to evaluate the clinical outcomes of intracoronary pro-UK combined with low-pressure balloon pre-dilatation in patients with anterior ST-segment-elevation myocardial infarction (STEMI).
This was a randomized, single-blind, investigator-initiated trial that included 179 patients diagnosed with acute anterior STEMI. All patients were eligible for PCI and were randomized into two groups: intracoronary pro-UK combined with (ICPpD group, n = 90) or without (ICP group, n = 89) low-pressure balloon pre-dilatation. The main efficacy endpoint was complete epicardial and myocardial reperfusion. The safety endpoints were major adverse cardiovascular events (MACEs), which were analyzed at 12 months follow-up.
Patients in the ICPpD group presented significantly higher TIMI myocardial perfusion grade 3 (TMPG3) compared to those in the ICP group (77.78% versus 68.54%, P = 0.013), and STR ≥ 70% after PCI 30 min (34.44% versus 26.97%, P = 0.047) or after PCI 90 min (40.0% versus 31.46%, P = 0.044). MACEs occurred in 23 patients (25.56%) in the ICPpD group and in 32 patients (35.96%) in the ICP group. There was no difference in hemorrhagic complications during hospitalization between the groups.
Patients with acute anterior STEMI presented more complete epicardial and myocardial reperfusion with adjunctive low-pressure balloon pre-dilatation before intracoronary pro-UK during PCI.
2019xkj213.
Self-resonating waterjets (SRWJs) are being widely used in the fields of energy exploitation, due to the significantly increased penetration rate of roller bits in deep-hole drilling. To further ...improve the impact and erosion abilities of SRWJs, the effects of the downstream contraction ratio of organ-pipe nozzle on the axial pressure oscillations were experimentally studied. The axial pressure oscillation peak and amplitude were used to evaluate the effects under two inlet pressures and various standoff distances. The results show that the downstream contraction ratio can affect the development trends of the pressure oscillations and determines the values of the peaks and amplitudes. Under the experimental conditions, 2.5 is the ratio that leads to the maximum peaks and amplitudes at almost all the testing standoff distances, while the ratio of 2 always results in the minimum ones. The development trend of the pressure oscillation peak for the ratio of 3.5 has a great change at an inlet pressure of 20 MPa. Generally, the relative pressure oscillations are more violent at an inlet pressure of 10 MPa, which is regardless of the contraction ratio. This study helps provide a guideline for determining the physical parameters required in the fabrication of organ-pipe nozzles used for deep-hole drilling.
Alcohol-related liver fibrosis (ALF) is a form of alcohol-related liver disease (ALD) that generally occurs in response to heavy long-term drinking. Ecto-5′-nucleotidase (NT5E), also known as CD73, ...is a cytomembrane protein linked to the cell membrane
via
a GPI anchor that regulates the conversion of extracellular ATP to adenosine. Adenosine and its receptors are important regulators of the cellular response. Previous studies showed that CD73 and adenosine A1 receptor (A
1
R) were important in alcohol-related liver disease, however the exact mechanism is unclear. The aim of this study was to elucidate the role and mechanism of the CD73-A
1
R axis in both a murine model of alcohol and carbon tetrachloride (CCl
4
) induced ALF and in an
in vitro
model of fibrosis induced by acetaldehyde. The degree of liver injury was determined by measuring serum AST and ALT levels, H & E staining, and Masson’s trichrome staining. The expression levels of fibrosis indicators and PLC-IP
3
-Ca
2+
/DAG-PKC signaling pathway were detected by quantitative real-time PCR, western blotting, ELISA, and calcium assay. Hepatic stellate cell (HSC) apoptosis was detected using the Annexin V-FITC/PI cell apoptosis detection kit. Knockdown of CD73 significantly attenuated the accumulation of α-SMA and COL1a1 damaged the histological architecture of the mouse liver induced by alcohol and CCl
4
.
In vitro
, CD73 inhibition attenuated acetaldehyde-induced fibrosis and downregulated A
1
R expression in HSC-T6 cells. Inhibition of CD73/A
1
R downregulated the expression of the PLC-IP
3
-Ca
2+
/DAG-PKC signaling pathway. In addition, silencing of CD73/A
1
R promoted apoptosis in HSC-T6 cells. In conclusion, the CD73-A
1
R axis can regulate the activation and apoptosis of HSCs through the PLC-IP
3
-Ca
2+
/DAG-PKC signaling pathway.
Pulsed waterjets are widely used in exploitation of fossil fuels for their high efficiency. With the aim to further clarify the impact performance of Helmholtz self-excited oscillation waterjets ...(HSEOW), numerical and experimental studies were conducted. The morphological characteristics of the erosion surfaces between conical and HSEOW nozzles were compared and the cavitation evolution was obtained. Results show that the cavitation damage caused by the HSEOW nozzle on the specimen was mainly caused by the jet cavitation cloud under submerged conditions. The cavitation effect produced by the HSEOW nozzle had a much greater destructive effect than that of a conical nozzle. The mass loss caused by HSEOW nozzles increased first with the increase of standoff distance, then decreased rapidly after reaching the maximum value. Moreover, the density of holes and the damage intensity weakened with the increase of radial distance. A dimensionless cavity length of 2 and a dimensionless cavity diameter of 8 was the optimal structure that led to maximum mass loss. These results provide a further understanding of cavitation mechanism which leads to the impact performance of pulsed water jets and optimal working parameters in the field of energy exploitation.
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