Benefit of cardiac rehabilitation in acute heart failure patients with cognitive impairment.

Aims: This study aimed to evaluate the prevalence of cognitive impairment among patients with acute heart failure (AHF), its prognosis, and the effects of cardiac rehabilitation (CR) on these patients' outcomes. Methods: Overall, 247 consecutive AHF patients (median age, 60 years; males, 78.5 %) were evaluated from March 2015 to May 2021. Patients received an AHF disease management program coordinated by an HF specialist nurse and underwent a Luria-Nebraska Neuropsychological battery-screening test (LNNB-S) assessment during admission. Cognitive impairment was defined as an LNNB-S score ≥10. Patients who underwent at least one session of phase II CR and continued with the home-based exercise program were considered to have received CR. The primary endpoint was composite all-cause mortality or readmission after a 3.30-year follow-up (interquartile range, 1.69-5.09 years). Results: Cognitive impairment occurred in 53.0 % and was associated with significantly higher composite endpoint, all-cause mortality, and readmission rates (p=<0.001, 0.001, and 0.015, respectively). In the total cohort, 40.9 % of patients experienced the composite endpoint. Multivariate analysis showed that the peak VO2 was a significant predictor of the composite endpoint. After adjustment, CR significantly decreased the event rate of the composite endpoint and the all-cause mortality in patients with cognitive impairment (log-rank p = 0.024 and 0.009, respectively). However, CR did not have a significant benefit on the composite endpoint and the all-cause mortality in patients without cognitive impairment (log-rank p = 0.682 and 0.701, respectively). Conclusion: Cognitive impairment is common in AHF patients and can lead to poor outcomes. CR is a standard treatment to improve prognosis.

Utilizing Nearest-Neighbor Clustering for Addressing Imbalanced Datasets in Bioengineering.

Imbalance classification is common in scenarios like fault diagnosis, intrusion detection, and medical diagnosis, where obtaining abnormal data is difficult. This article addresses a one-class problem, implementing and refining the One-Class Nearest-Neighbor (OCNN) algorithm. The original inter-quartile range mechanism is replaced with the K-means with outlier removal (KMOR) algorithm for efficient outlier identification in the target class. Parameters are optimized by treating these outliers as non-target-class samples. A new algorithm, the Location-based Nearest-Neighbor (LBNN) algorithm, clusters one-class training data using KMOR and calculates the farthest distance and percentile for each test data point to determine if it belongs to the target class. Experiments cover parameter studies, validation on eight standard imbalanced datasets from KEEL, and three applications on real medical imbalanced datasets. Results show superior performance in precision, recall, and G-means compared to traditional classification models, making it effective for handling imbalanced data challenges.

Investigation and Application of High-Efficiency Network Fracturing Technology for Deep Shale Gas in the Southern Sichuan Basin.

The Longmaxi Formations in the Luzhou block located in the Southern Sichuan Basin exhibit thick shale formations and huge shale gas resources and have become one of the significant blocks for large-scale production of shale gas. However, due to the natural fractures and high in situ stress and horizontal stress differences, proppants are broken and embedded severely, and complex network fractures are difficult to form, so traditional hydraulic fracturing technology cannot meet the need for profitable development of deep shale gas. In order to increase the stimulated reservoir volume and improve fracture complexity, large-scale hydraulic fracturing experiments and fracture propagation numerical simulations have been conducted based on the geology and engineering treatment difficulty of the Luzhou block to discuss the main factors influencing fracturing effectiveness. Meanwhile, two round field tests were conducted to evaluate the fracturing effectiveness, and the following study results were obtained. First, in situ stress and horizontal stress differences are the main mechanical factors, while cluster spacing and proppant injection intensity are the main fracturing parameters. Therefore, multi-cluster perforation, high-intensity proppant injection, and diversion are employed to improve fracture complexity and conductivity, thus increasing effective fracture volume. Furthermore, the second round of field tests gained remarkable results. The "short-cluster spacing + high proppant amount + variable viscosity slick water + diversion" high-efficiency fracturing technology was formed, and the average test production got to 28.6 × 104 m3/d, which represented a 64% increase over the first round. It concludes that the high-efficiency hydraulic fracturing technology contributes to increasing shale gas production, notably in the Luzhou block for deep shale gas, and provides reliable technology support and study direction for further technical optimization in this block.

Cutting Balloon Combined with Drug-Coated Balloon Angioplasty for the Treatment of In-Stent Restenosis.

Drug-coated balloon (DCB) has emerged as an alternative therapeutic choice for in-stent restenosis (ISR) lesions. Cutting balloon angioplasty (CBA) is also a strategy utilized to treat tight stenotic lesions or ISR lesions. Few studies have focused on whether CBA plus DCB could achieve a better result in lowering the incidence of recurrent ISR. This study aimed to evaluate the efficacy of CBA plus DCB for ISR lesions.Between August 2011 and December 2017, 681 patients (937 lesions) were diagnosed with ISR and treated with DCBs in our hospital. The CBA plus DCB group comprised 90 patients who underwent PCI with further CBA plus DCB, and the DCB alone group comprised 591 patients who underwent percutaneous coronary intervention (PCI) with DCB alone.Baseline characteristics, the types of previous stents, lesion type, prevalence of ostial lesion and left main lesion, and pre-PCI and post-PCI stenotic percentage showed no significant difference between the two groups. Only post-PCI reference luminal diameter and size of DCB were larger in the CBA plus DCB group. During the one-year follow-up period, late loss and clinical outcomes did not differ between the two groups before and after propensity score matching. The incidence of subtotal/total occlusion with delay flow was lower in the CBA plus DCB group after propensity score matching (4.1% versus 10.9%; P = 0.030).In these patients with ISR lesions, the clinical outcomes and the incidence of repeat target lesion revascularization were similar after treatment with CBA plus DCB versus DCB alone. Further study is warranted, including prospective, randomized comparisons.

Characterization of the Pore Structure of Well Cement under Carbon Capture and Storage Conditions by an Image-Based Method with a Combination of Metal Intrusion.

To more quantitatively and subtly analyze effects of carbonation on the pore structure of well cement by supercritical CO2 under carbon capture and storage (CCS) conditions, a digital scanning electron microscopy-backscattered electron (SEM-BSE) image analysis with a combination of nontoxic low-melting point metal intrusion is used to characterize the exposed cements to humid supercritical CO2 for 10 and 20 days. The porous area fraction (PAF) and pore size distribution (PSD) profiles obtained by slicing operation are used to describe the pore structure variation along the corrosion direction in a two-dimensional (2D) plane. The results show that the image-based method with the combination of metal intrusion is an effective method for characterizing the layer structure of exposed cement and getting quantitative information about the pore structure. From the surface to the core, the main altered layers in exposed cement for 10 days include the partially leached layer, the carbonated layer, and the calcium hydroxide (CH)-dissolved layer. For the exposed cement for 20 days, the main altered layers include the porous leached layer, the partially leached layer, the carbonated layer, and the carbonated transition layer. The nonporous carbonated layer can effectively block the flow parallel to the corrosion direction, while the porous leached layer can facilitate the flow perpendicular to the corrosion direction. Findings from this study will provide valuable information for understanding the effects of carbonation on the pore structure of well cement under CCS conditions.

[One family investigation and risk factors analysis of developmental dysplasia of the hip].

OBJECTIVE: To investigate the clinical manifestations and risk factors of the patients from developmental dysplasia of the hip(DDH) family. METHODS: Detailed epidemiology investigation, physical examination, functional movement assessment, lab test and X-ray examination were applied to the whole members of a DDH family. RESULTS: In the family with 9 generations and 218 persons, the incidence of DDH was 31.03% in 145 survivors. Patients mainly manifested bilateral knee and hip joint pain, flexion contracture of hip, limitation in internal and external rotation of hip; a few had arthritic functional disorder, deformation, and limp. The radiography illustrated shallow acetabulum with increased inclination, which encompassed the femoral head badly. Deformation of the femoral head, narrow joint space and osteophyte were also found by X-ray examination. The main risk factors of DDH were genetic factors, gender, birth season etc. The son or daughter with one or two DDH parents had a higher risk for developing DDH than those with no DDH parents. Furthermore, first-degree relatives of the DDH patients also had a greater chance to develop DDH than second-degree relatives and third-degree relatives. The incidence among females was higher than males, and the family member who was given birth in winter had a highest risk for developing DDH. However, there was no difference between incidence of DDH in children and youths and in adults; the incidence of DDH in the immigrants with no blood relationship also did not differ from the incidence of DDH in the family member. CONCLUSION: The genetic factors play an important role in the development of DDH, so do the environmental factors.