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Abstract Background To evaluate a novel intraoperative localization technique utilizing temporary pulmonary arteriovenous occlusion for enhancing the precision of sublobar resections in early‐stage NSCLC. Methods Conducted from January to November 2023, this study involved 140 patients. During the surgery, key pulmonary vessels were identified using preoperative three‐dimensional (3D) imaging and temporarily occluded with noninvasive clamps to isolate the target lung segment. Following vascular occlusion, indocyanine green (ICG) was administered intravenously to precisely delineate the resection margins. After visually confirming the marked areas, the clamps were released, and a targeted partial resection was performed on the delineated segment. Surgical data, including operation times, surgical margins, and hospitalization costs, were collected and compared with those from a historical control group of 110 patients who underwent traditional pulmonary wedge resections. Results In the study group, the median surgical margin achieved was 16 mm, which was statistically significant compared to 15 mm in the control group (p

Abstract Objective To evaluate the early and mid-term outcomes of open repair in patients with thoracoabdominal aortic aneurysm (TAAA) after thoracic endovascular aortic repair (TEVAR). Methods This was a retrospective single center study. Data were retrospectively collected and analyzed for consecutive patients undergoing open TAAA repair (TAAAR) after TEVAR from November 2016 to June 2021. Indications for TAAAR included aneurysm progression due to endoleak, persisted false lumen perfusion, proximal/distal disease progression, and aorta rupture. The risk factor of operative mortality was analyzed by multivariable logistic regression model and the survival was evaluated by Kaplan–Meier. Results Sixty-three patients who met the inclusion criteria for the study were identified. The mean age at TAAAR was 41 ± 12 years and 43 (68.3%) were male. Marfan syndrome (MFS) was presented in 39 patients (61.9%). 60 (95.2%) patients presented with post-dissection aneurysm and 3 (4.8%) patients with degenerative aneurysm. The extent of TAAA was Crawford I in 9 (14.3%), II in 22 (34.9%), III in 23 (36.5%), and IV in 9 (14.3%). Emergent TAAAR was done in 10 (15.9%) patients, and deep hypothermic circulatory arrest was used in 22 (34.6%). Endograft was explanted in 31 (49.2%). Operative mortality was 11 (17.5%). Stroke, paraplegia, and acute kidney failure occurred in 5 (7.9%), 7 (11.1%), and 6 (9.5%) patients, respectively. Pulmonary complications occurred in 19 (30.2%) patients. The estimated survival was 74.8 ± 4.9% at 5 years. Late reoperations were performed in 2 patients at 2.5 years and 1.3 years, respectively. Conclusions In this series of TAAA after TEVAR, TAAAR was related with a high risk of operative mortality and morbidity and the midterm outcomes represented a durable treatment and were respectable.

The aim of this study is to explore innovative non-linear programming (NLP) models utilizing the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) method, tailored for resolving decision-making challenges within the framework of cubic $p,q-$ quasirung orthopair fuzzy sets $({\mathrm {C}_{\mathrm {(p,q)}}}\mathrm {QOFSs})$ . In prior research, data pertaining to an element has typically been gathered in the form of either interval-valued $p,q-$ quasirung orthopair fuzzy sets $({\mathrm {IV}_{\mathrm {(p,q)}}}\mathrm {QOFSs})$ or $p,q-$ quasi orthopair fuzzy sets ( $p,q-$ QOFSs) information. As an alternative approach, ${\mathrm {C}_{\mathrm {(p,q)}}}\mathrm {QOFSs}$ emerges as an extension of these sets, wherein information is compiled by simultaneously considering both ${\mathrm {IV}_{\mathrm {(p,q)}}}\mathrm {QOFSs}$ and $p,q-$ QOFSs. Driven by this motivation, we constructed the NLP models incorporating interval weights and integrating the relative closeness coefficient concept alongside weighted distance measures. Furthermore, we scrutinized some notable characteristics (RCC) of these models. Additionally, we introduce an innovative multicriteria decision-making (MCDM) technique and illustrate its application with a real-world case study related to green supplier selection. A comparative analysis is also performed to validate the effectiveness and rationality of the method.

Ultrasonic focusing transducers have broad prospects in advanced ultrasonic non-destructive testing fields. However, conventional focusing methods that use acoustic concave lenses can disrupt the acoustic impedance matching condition, thereby adversely affecting the sensitivity of the transducers. In this paper, an active focusing planar ultrasonic transducer is designed and presented to achieve a focusing effect with a higher sensitivity. An electrode pattern consisting of multiple concentric rings is designed, which is inspired by the structure of Fresnel Zone Plates (FZP). The structural parameters are optimized using finite element simulation methods. A prototype of the transducer is manufactured with electrode patterns made of conductive silver paste using silk screen-printing technology. Conventional focusing transducers using an acoustic lens and an FZP baffle are also manufactured, and their focusing performances are comparatively tested. The experimental results show that our novel transducer has a focal length of 16 mm and a center frequency of 1.16 MHz, and that the sensitivity is improved by 23.3% compared with the conventional focusing transducers. This research provides a new approach for the design of focusing transducers.

Background: Lung adenocarcinoma (LUAD) is the most common variant of non–small cell lung cancer (NSCLC) across the world. Recently, the rapid development of immunotherapy has brought a new dawn for LUAD patients. Closely related to the tumor immune microenvironment and immune cell functions, more and more new immune checkpoints have been discovered, and various cancer treatment studies targeting these novel immune checkpoints are currently in full swing. However, studies on the phenotype and clinical significance of novel immune checkpoints in LUAD are still limited, and only a minority of patients with LUAD can benefit from immunotherapy.Methods: The LUAD datasets were downloaded from The Cancer Genome Atlas (TCGA) and the Gene Expression Omnibus (GEO) databases, and the immune checkpoints score of each sample were calculated based on the expression of the 82 immune checkpoints-related genes (ICGs). The weighted gene co-expression network analysis (WGCNA) was used to obtain the gene modules closely related to the score and two different LUAD clusters were identified based on these module genes by the Non-negative Matrix Factorization (NMF) Algorithm. The differentially expressed genes between the two clusters were further used to construct a predictive signature for prognosis, immune features, and the response to immunotherapy for LUAD patients through a series of regression analyses.Results: A new immune checkpoints-related signature was finally established according to the expression of 7 genes (FCER2, CD200R1, RHOV, TNNT2, WT1, AHSG, and KRTAP5-8). This signature can stratify patients into high-risk and low-risk groups with different survival outcomes and sensitivity to immunotherapy, and the signature has been well validated in different clinical subgroups and validation cohorts.Conclusion: We constructed a novel immune checkpoints-related LUAD risk assessment system, which has a good predictive ability and significance for guiding immunotherapy. We believe that these findings will not only aid in the clinical management of LUAD patients but also provide some insights into screening appropriate patients for immunotherapy.

This study successfully deposited CrN, CrAlN, and TiAlN coatings on the surface of Cr12MoV substrate using multi-arc ion plating (MAIP). The influence of phase composition and surface morphology on the hardness, adhesion strength, friction performance, and wear mechanisms of these coatings was investigated, with a comparative analysis of their wear resistance. Nanoindentation results revealed that the hardness ( H ) of CrN, CrAlN, and TiAlN coatings increased by 70.37%, 74.97%, and 75.64%, respectively, compared to the substrate. The hardness ( H ) and elastic modulus ( E ) were found to be positively correlated. CrAlN demonstrated superior resistance to deformation, reflected in its higher H/E and H ^3 /E ^2 radios compared to the CrN and TiAlN. Adhesion tests showed that CrAlN had the strongest adhesion strength to the substrate, with an adhesion force of 81.55 N, representing a 14.78% and 8.46% improvement over CrN and TiAlN, respectively. Friction and wear tests identified CrAlN as having the lowest friction coefficient (0.389), attributed to its high hardness and strong adhesion. The wear mechanisms of CrAlN observed were primarily mild abrasive wear, oxidative wear, and adhesive wear. In comparison, CrN and TiAlN coatings exhibited higher friction coefficients of 0.424 and 0.391, respectively, due to their lower hardness and adhesion, which led to more severe oxidative and abrasive wear. Additionally, the TiAlN coating showed signs of brittle failure in wear scars, likely due to the formation of Al _2 O _3 oxides during wear.

Abstract Background This study was designed to compare early outcomes associated with coronary artery bypass grafting for multi-vessel disease conducted using either minimally invasive or conventional off-pump techniques. Methods From January 2017 through January 2021, 582 patients with multi-vessel lesion coronary artery disease underwent either minimally invasive cardiac surgery coronary artery bypass grafting (MICS CABG) or conventional off-pump coronary artery bypass grafting (OPCABG) treatment by our team at Anzhen Hospital. Patients in the MICS CABG group were propensity score-matched with those in the OPCABG at a 1:1 ratio (MICS CABG = 172; OPCABG = 172), using epidemiological data, preoperative clinical characteristics, and SYNTAX score as covariates. Perioperative outcomes and 6-month computed tomography angiography findings were compared between these groups. Results No significant differences between groups were observed with respect to 30-day postoperative mortality, myocardial infarction, and stroke incidence. Surgical data indicated that the MICS CABG procedure was able to cover all three main arterial territories with a relatively low need for circulatory assistance. The MICS CABG procedure was associated with a longer operative duration, but was also associated with higher postoperative hemoglobin and activities of daily living index values as well as a shorter duration of postoperative hospitalization (P

Liturgical practice and its theological interpretation are not only very important to the Chinese inculturation of Catholicism in particular and Christianity in general but also of great significance in the establishment of an indigenized Christian faith and system of life. This paper will analyze the methodological approaches and historical inspirations for the inculturation of Christian liturgical theology through Giulio Aleni’s (1582–1649) Explication of the Mass (Misa Jiyi, 弥撒祭义), the first book to utilize Chinese cultural resources to systematically interpret the Mass (Eucharist). Continuing the general Jesuit accommodation initiated by Matteo Ricci, Aleni established an indigenized liturgical system of theology through intercultural learning, borrowing, and creative construction. Three of his contributions especially stand out. First, Aleni explained the significance of the Mass in terms of the Chinese philosophical–ethical concepts of “repaying the roots” (baoben, 报本) and “giving thanks” (gan’en, 感恩). Second, he elaborated on communion with the Trinitarian God in the Mass through Jesus Christ by drawing on the ancient Chinese teachings of repaying (chou, 酬), commemoration (shi, 示), and hope (wang, 望), which Aleni related to “giving thanks to the Father,” “commemorating Jesus,” and “invoking the Holy Spirit.” Finally, he provided a deep spiritual explanation of the Mass, using the traditional Confucian concepts of “self-restraint” (keji, 克己), “self-reflection” (fanji, 反己), and “spiritual meditation” (chouyi, 抽绎) to help believers understand the activities of repentance, commemoration, and prayer in the Mass. Overall, Aleni emphasized that the essence of the Mass was to achieve “communion with the heart of heavenly Lord” (xihe tianzhuzhixin, 翕合天主之心), which, as a pivot of faith, could be extended into daily life through its spiritual practice. Aleni, therefore, established a comprehensive system of “liturgy-spirituality-life” for Chinese Christians by indigenizing Christian liturgical theology through intercultural learning. His creative synthesis yielded a dynamic balance between Christian and Chinese traditions, absorbing Confucian resources to imaginatively enrich and expand the Christian tradition, while encouraging the creative transformation of the Christian tradition into the Chinese cultural community.

BackgroundMitral valve surgery (MVS) is an effective treatment for mitral valve diseases. There is a lack of reliable personalized risk prediction models for mortality in patients undergoing mitral valve surgery. Our aim was to develop a risk stratification system to predict all-cause mortality in patients after mitral valve surgery.MethodsDifferent machine learning models for the prediction of all-cause mortality were trained on a derivation cohort of 1,883 patients undergoing mitral valve surgery [split into a training cohort (70%) and internal validation cohort (30%)] to predict all-cause mortality. Forty-five clinical variables routinely evaluated at discharge were used to train the models. The best performance model (PRIME score) was tested in an externally validated cohort of 220 patients undergoing mitral valve surgery. The model performance was evaluated according to the area under the curve (AUC). Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were compared with existing risk strategies.ResultsAfter a median follow-up of 2 years, there were 133 (7.063%) deaths in the derivation cohort and 17 (7.727%) deaths in the validation cohort. The PRIME score showed an AUC of 0.902 (95% confidence interval [CI], 0.849–0.956) in the internal validation cohort and 0.873 (95% CI: 0.769–0.977) in the external validation cohort. In the external validation cohort, the performance of the PRIME score was significantly improved compared with that of the existing EuroSCORE II (NRI = 0.550, [95% CI 0.001–1.099], P = 0.049, IDI = 0.485, [95% CI 0.230–0.741], P < 0.001).ConclusionMachine learning-based model (the PRIME score) that integrate clinical, demographic, imaging, and laboratory features demonstrated superior performance for the prediction of mortality patients after mitral valve surgery compared with the traditional risk model EuroSCORE II.Clinical Trial Registration[http://www.clinicaltrials.gov], identifier [NCT05141292].

Renewable energy based wireless power transfer is challenging. Here the authors show a resonant-coupled triboelectric nanogenerator as a wireless power source and have further utilized this system to explore two fully self-powered wireless chipless sensors.

Artificial intelligence (AI) based on deep learning, convolutional neural networks and big data has been increasingly effective in the diagnosis and treatment of multiple primary pulmonary nodules. In comparison to previous imaging systems, AI measures more objective parameters such as three‐dimensional (3D) volume, probability of malignant nodules, and possible pathological patterns, making the access to the properties of nodules more objective. In our retrospective study, a total of 53 patients with synchronous and metachronous multiple pulmonary nodules were enrolled of which 33 patients were confirmed by pathological tests to have primary binodules, and nine to have primary trinodules. A total of 15 patients had only one focus removed. The statistical results showed that the agreement in the AI diagnosis and postoperative pathological tests was 88.8% in identifying benign or malignant lesions. In addition, the probability of malignancy of benign lesions, preinvasive lesions (AAH, AIS) and invasive lesions (MIA, IA) was totally different (49.40±38.41% vs 80.22±13.55% vs 88.17±17.31%). The purpose of our study was to provide references for the future application of AI in the diagnosis and follow‐up of multiple pulmonary nodules. AI may represent a relevant diagnostic aid that shows more accurate and objective results in the diagnosis of multiple pulmonary nodules, reducing the time required for interpretation of results by directly displaying visual information to doctors and patients and together with the clinical conditions of MPLC patients, offering plans for follow‐up and treatment that may be more beneficial and reasonable for patients. Despite the great application potential in pneumosurgery, further research is needed to verify the accuracy and range of the application of AI.

This article presents a novel wideband bandpass filter based on the integration of a substrate integrated waveguide (SIW) and a spoof surface plasmon polariton (SSPP). An SIW cavity with periodic arrays of meander-slot units is etched on the top metallic layer to achieve the characteristics of a multi-order filter with good performance. The passbands can be flexibly selected by varying the geometric parameters of the SIW and SSPP to adjust the lower and upper sidebands independently. Using a redistribution layer (RDL) process, a novel 3D capacitive interconnection called a through-dielectric capacitor (TDC) is proposed and collaboratively designed with an interdigital capacitor to achieve capacitive source-load cross-coupling. The proposed filter has a center frequency of 60 GHz, with a wide 3-dB fractional bandwidth of about 45.8%. The improved simulated sideband suppression has a 30 dB rejection at 40 GHz and 75.4 GHz, corresponding to a 30-dB rectangular coefficient of 1.28.

Objectives. Minimally invasive coronary artery bypass grafting (MICS CABG) has emerged as an alternative treatment for patients with multi-vessel coronary artery disease, but there are certain surgical challenges inherent in the adoption of this approach. The present study was conducted to provide insight regarding the outcomes associated with our first 118 cases, to discuss the surgical difficulties encountered in these patients, and to outline the potential countermeasures. Methods. Between January 2017 and January 2020, 118 patients underwent multi-vessel MICS CABG. These patients were stratified into two groups based upon whether they did or did not experience surgical challenges, and early clinical outcomes were compared between these groups to assess the incidence of technical difficulties and associated factors. Results. Surgical challenges arose in 38 of the 118 cases in this study, including 13 cases of exposure-related difficulties, 11 cases of proximal anastomosis-related difficulties, 15 cases of distal anastomosis-related difficulties, 4 cases of LITA-related difficulties, and 3 cases of lung-related difficulties. Relative to the other 80 patients, those patients for whom intraoperative technical challenges arose experience significant increases in operative duration (4.94 ± 0.89 vs. 5.59 ± 1.11 h, P=0.001), intraoperative blood loss (667 ± 313 vs. 892 ± 532 mL, P=0.005), length of the ICU admission (17.59 ± 3.51 vs. 22.59 ± 17.31 h, P=0.015), and the duration of postoperative hospitalization (5.96 ± 1.23 vs. 6.71 ± 1.92 days, P=0.012). There were no significant differences between these groups with respect to the mean graft number, major complications such as stroke or organ dysfunction, or one-year graft patency. Conclusions. There is a substantial learning curve associated with performing off-pump MICS CABG to treat multi-vessel disease. Surgical challenges encountered during this procedure may increase the operative duration, intraoperative blood loss, ICU admission, and the duration of postoperative hospitalization. However, these issues do not appear to compromise the efficacy of complete revascularization, and early clinical outcomes associated with this procedure remain acceptable.

Anterior ischemic optic neuropathy( AION )is the most common acute optic neuropathy in people over 50 years old, which often causes unilateral acute painless visual loss. Non-arteritis anterior ischemic optic neuropathy(NAION)is the most common type and one of the main causes of blindness or severe visual impairment in the middle-aged and elderly. But at present, because of insufficient understanding of the pathogenesis of this disease, there is still no effective treatment method in clinic. Therefore, it is very important to find a standard and effective treatment method in order to control the disease development and reduce blindness.

For achieving tunable saturation magnetization and line width, different cations were doped into the YIG-based garnets, which the standard molecular formula could be expressed as A _3 [Fe _2−x M _x ](Fe _3−y N _y )O _12 . Most researchers have reported a single rule of one element doping (x or y) on its magnetic properties. However, the cooperation effect of x + y to the magnetic contribution was not clearly clarified. In this work, multi-doped bismuth-iron garnets {Bi _0.84 Ca _2.16 }[Fe _2−x In _x ](Fe _3−y V _y )O _12 (x = 0.72–0.14 and y = 1.24–1.38) with low saturation magnetizations (4 πM _s = 200–600 Gs at 298 K) were prepared by a conventional fluxing agent method. The cooperation effect of In ^3+ and V ^5+ co-doped into bismuth-iron garnets (BIG) on their structures and magnetic properties were systematically investigated using XPS, TEM and VSM. It could be found that the total doped concentration (x + y) was decreasing regardless of the increasing V concentration (y) and decreasing In concentration (x). As-synthesized BIG presented a well single-crystal structure, and the lattice spacing was decreasing with the decrease of x + y in accompanying with the transition of dislocations from point defects to edge dislocations. Both linear increase of Curie temperature and 4 πM _s with the decrease of x + y was revealed. The mechanism could be attributed that the doped non-magnetic ions could reduce the average nearest-neighbor coordination irons for oxygen ions and weaken the anti-ferromagnetic super-exchange interactions among the magnetic ions within the structure, namely dilution effect. By comparison, the total concentraions were higher than that of previous works, which the tailorable 4 πM _s of ferrite was not reported. Here we revealed the controllable 4 πM _s with higher total concentrations (x + y ≥ 1.52). These findings will be provided more opportunities for applications in microwave devices.

From the perspective of comparative scripture, this paper is using the Shen si lu (Meditations) by Catholic Literati Li Jiugong as a case study to investigate the dialogue and interaction between Confucianism and Christianity in the late-Ming period. Li’s theology, incorporating the three aspects of being in harmony with Heaven, other people, and oneself, is expressed in Confucian terminology. It represents the late-Ming Chinese theological understanding of God, human nature, and society. The paper analyses Li’s strategy of comparative scripture by which Confucian scriptural resources were reinterpreted, appropriated, and intertwined with the Christian meaning system. Finally, the paper also discusses the significance of using the methodology of comparative scripture in interreligious dialogue and in furthering the indigenization of Christianity in China.

A new ultrahigh frequency radio frequency identification (UHF RFID) reader’s front-end circuit which is based on zero-IF, single antenna structure and composed of discrete components has been designed. The proposed design brings a significant improvement of the reading performance by adopting a carrier leakage suppression (CLS) circuit instead of a circulator which is utilized by most of the conventional RF front-end circuit. Experimental results show that the proposed design improves both the sensitivity and detection range compared to the conventional designs.

At present, more and more electronic tags are used in Antitheft system; it is important to examine the performance of electronic tags. The traditional single-transmitter-coil antenna (STC antenna) of the electronic tags tester has some serious drawbacks. So a novel double-transmitter-coil antenna (DTC antenna) is presented in this paper. Compared to the traditional STC antenna, this new antenna has a more excellent performance in the tag test systems, especially when it is used for testing the quality factor of tags.

The structure of each part of a diagonal compressor directly affects its overall performance and internal flow. We introduce the Reynolds-averaged Navier-Stokes flow simulation for unit calculation on the whole system including a diagonal impeller, a vaneless diffuser and a volute. By analyzing different flow chromatograms of specific sections, we can compare the configuration of three types of diffusers and volutes and the meridian flow status of the corresponding diagonal compressors which serves as a basis for the impeller flow path as well as for its matching designs. Considering the interference between the rotor and the upstream and downstream stillness body, this thesis analyzes how the vaneless diffuser meridian flow path, the volute flow path and its section secondary flow affect the upstream rotor flow. Both the calculation and experimental data on the rotor outlet are compared, as well as the calculated numerical value of the meridian plane streamline distribution and the diffuser velocity distribution, upstream and downstream, coincides with the designed numerical value. Without changing the conventional quasi-three-dimensional design system, the thesis applies the annulus wall boundary layer theory and the velocity distribution diagram to sweep and skew the leading edge of the airfoil. A performance test shows that the leading edge skewed-swept diagonal rotor can better improve the stall characteristic in a low flow rate area and expand the surge margin, compared with conventional diagonal rotor. It can also efficiently restrain the low momentum fluid conglomeration near the wall region and reduce the secondary flow loss by sweeping and skewing the blade properly. The purpose of the thesis is to make a contribution to optimizing the overall structure design of diagonal compressors and to study further the complex internal flow between the leading edge skewed-swept diagonal rotor and the cover.

Background: Organizational readiness for change, defined as the collective preparedness of organization members to enact changes, remains understudied in implementing sepsis survivor transition-in-care protocols. Effective implementation relies on collaboration between hospital and post-acute care informants, including those who are leaders and staff. Therefore, our cross-sectional study compared organizational readiness for change among hospital and post-acute care informants. Methods: We invited informants from 16 hospitals and five affiliated HHC agencies involved in implementing a sepsis survivor transition-in-care protocol to complete a pre-implementation survey, where organizational readiness for change was measured via the Organizational Readiness to Implement Change (ORIC) scale (range 12-60). We also collected their demographic and job area information. Mann-Whitney U-tests and linear regressions, adjusting for leadership status, were used to compare organizational readiness of change between hospital and post-acute care informants. Results: Eighty-four informants, 51 from hospitals and 33 from post-acute care, completed the survey. Hospital and post-acute care informants had a median ORIC score of 52 and 57 respectively. Post-acute care informants had a mean 4.39-unit higher ORIC score compared to hospital informants (p = 0.03). Conclusions: Post-acute care informants had higher organizational readiness of change than hospital informants, potentially attributed to differences in health policies, expertise, organizational structure, and priorities. These findings and potential inferences may inform sepsis survivor transition-in-care protocol implementation. Future research should confirm, expand, and examine underlying factors related to these findings with a larger and more diverse sample. Additional studiesmay assess the predictive validity of ORIC towards implementation success. [ABSTRACT FROM AUTHOR]