Modeling defensive resource allocation in multilayered systems under probabilistic and strategic risks.

Confronting the continuing risk of an attack, security systems have adopted target-hardening strategies through the allocation of security measures. Most previous work on defensive resource allocation considers the security system as a monolithic architecture. However, systems such as schools are typically characterized by multiple layers, where each layer is interconnected to help prevent single points of failure. In this paper, we study the defensive resource allocation problem in a multilayered system. We develop two new resource allocation models accounting for probabilistic and strategic risks, and provide analytical solutions and illustrative examples. We use real data for school shootings to illustrate the performance of the models, where the optimal investment strategies and sensitivity analysis are presented. We show that the defender would invest more in defending outer layers over inner layers in the face of probabilistic risks. While countering strategic risks, the defender would split resources in each layer to make the attacker feel indifferent between any individual layer. This paper provides new insights on resource allocation in layered systems to better enhance the overall security of the system.

Development of a major amputation prediction model and nomogram in patients with diabetic foot.

BACKGROUND: Diabetes mellitus, as one of the world's fastest-growing diseases, is a chronic metabolic disease that has now become a public health problem worldwide. The purpose of this research was to develop a predictive nomogram model to demonstrate the risk of major amputation in patients with diabetic foot. METHODS: A total of 634 Type 2 Diabetes Mellitus (T2DM) patients with diabetic foot ulcer hospitalized at the Air Force Medical Center between January 2018 and December 2023 were included in our retrospective study. There were 468 males (73.82%) and 166 females (26.18%) with an average age of 61.64 ± 11.27 years and average body mass index of 24.45 ± 3.56 kg/m2. The predictive factors were evaluated by single factor logistic regression and multiple logistic regression and the predictive nomogram was established with these features. Receiver operating characteristic (subject working characteristic curve) and their area under the curve, calibration curve, and decision curve analysis of this major amputation nomogram were assessed. Model validation was performed by the internal validation set, and the receiver operating characteristic curve, calibration curve, and decision curve analysis were used to further evaluate the nomogram model performance and clinical usefulness. RESULTS: Predictors contained in this predictive model included body mass index, ulcer sites, hemoglobin, neutrophil-to-lymphocyte ratio, blood uric acid (BUA), and ejection fraction. Good discrimination with a C-index of 0.957 (95% CI, 0.931-0.983) in the training group and a C-index of 0.987 (95% CI, 0.969-1.000) in the validation cohort were showed with this predictive model. Good calibration were displayed. The decision curve analysis showed that using the nomogram prediction model in the training cohort and validation cohort would respectively have clinical benefits. CONCLUSION: This new nomogram incorporating body mass index, ulcer sites, hemoglobin, neutrophil-to-lymphocyte ratio, BUA, and ejection fraction has good accuracy and good predictive value for predicting the risk of major amputation in patients with diabetic foot.

Light and gas dual-function detection and mutual enhancement based on hyperdoped black silicon.

We introduce a unique dual-function detector with an asymmetric light illumination based on the black silicon co-hyperdoped with sulfur and nitrogen for light and gas detection, and the properties in NO2 gas sensing and photoelectric detection are studied under various light and gas environments, respectively. Enhanced performance of the device under certain light and gas conditions is observed. When illuminated at the optimal wavelength, the gas sensors' responsivity to NO2 can be enhanced by approximately 5 to 200 times over 730 nm illumination, respectively. The photodetectors' photoresponsivity increases 15 to 200 times in a 300 ppm NO2 gas environment compared to air. Such mutual enhancement achieved through the clever combination of light and gas implies a novel approach to improve the performance of the black silicon detectors in both gas sensing and photoelectric detection.

Evaluation of postoperative complications of hypospadias using high-frequency ultrasound imaging.

PURPOSE: Various complications following hypospadias surgery present distinct manifestations when examined with ultrasound. Utilizing high-frequency ultrasound, clinicians can promptly identify these complications and initiate appropriate treatment. The aim of this study is to catalogue the ultrasonographic presentations of various postoperative complications following hypospadias surgery, thereby providing a reference for ultrasonographic diagnosis. METHODS: Ultrasonic images of post-hypospadias surgery from October 1, 2015, to June 30, 2023, recorded at the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences, serve as the basis for this investigation. Drawing on patient clinical diagnoses, this study compiles and selects representative ultrasound images of diverse complications. RESULTS: The study encompassed a total of 121 subjects; 26 demonstrated urethral stricture on ultrasonic images, two presented local urethral dilation, six showed intraurethral hair-like structures, 17 revealed intraurethral septum, two exhibited intraurethral fold, one had urethral calculus, one displayed urethral calcification, 12 indicated intraurethral urine accumulation, and two showed urethral diverticulum. CONCLUSION: Ultrasound examination is helpful for postoperative diagnosis following hypospadias, detecting complications such as urethral stricture, urethral hair growth, and urethral diverticulum, which can help doctors choose appropriate clinical treatment strategies.

Evaluation of the effect of chin prosthesis implantation on mentalis muscles based on three-dimensional imaging technology.

BACKGROUND: Chin prosthesis implantation, a cosmetic procedure to correct chin asymmetry, depression, or retraction, is generally safe and simple. However, its long-term effects on surrounding tissues are a concern. This study aimed to use three-dimensional (3D) scanning to classify the mentalis muscle shapes and assess the impact of prosthesis implantation on these muscles. METHOD: This study evaluated 450 eligible female participants. Using three-dimensional imaging, data on the types, thickness, width, and length of the left and right mentalis muscles were collected and summarized. The impact of chin prosthesis on these muscle dimensions was assessed using analysis of variance, and the effect on muscle type was determined using χ2 test. RESULTS: Chin implant placement affected the mentalis muscles, resulting in increased length, thickness, and width. The subjects' mentalis muscles were categorized into 3 types and divided into 7 subtypes. χ2 test results indicated that implantation influences the classification of these muscles. CONCLUSION: Recognizing how implant placement affects the mentalis muscle can guide the development of treatments to mitigate these changes. Additionally, understanding the muscle's morphology enables more precise treatment approaches for patients.

Successful Treatment Without Using Dantrolene Sodium on a Child Occurring Malignant Hyperthermia During Induction of General Anesthesia: A Case Report.

Malignant hyperthermia (MH) is a fatal hyperthermia with a high mortality, which usually occurs during induction of general anesthesia. Dantrolene sodium is a wonder drug currently used for treating malignant hyperthermia. However, preparing, storing, and maintaining dantrolene sodium are crucially expensive, thus making it financially unsatisfactory and difficult for clinicians to acquire in time. Monitoring patients' condition closely and intervening promptly when early signs of malignant hyperthermia occur can effectively prevent the condition from worsening and win over time for the arrival of dantraline sodium. This article is to report a case in which we successfully rescued a child occurring malignant hyperthermia without using dantrolene sodium.

Mild Allergic Reactions after Botulinum Toxin Injection: A Case Series and Literature Review.

Background: Botulinum toxin type A (BTA) is becoming more and more prevalent as an injection agent in cosmetic surgery. However, there is an increasing amount of cases reporting unexpected adverse reactions related to BTA injection. BTA can invoke many kinds of hypersensitive reactions, some of which can be delayed-type or even fatal; hence, it is of crucial importance to pay close attention to atypical and early symptoms that may indicate the presence of BTA allergy in patients. Methods: In this study, we reported three cases of mild and unexpected BTA-related hypersensitive reaction with a symptom of nonpruritic erythema on the chest that happened after BTA treatment of upper facial wrinkles and proposed several suggestions based on our practical experience and literature review. Results: Two patients' symptoms were alleviated spontaneously, and one patient's were alleviated after taking oral corticosteroid. According to our literature review, we believe that these incidences indicate a kind of unreported allergic reaction relevant to botulinum toxin. Conclusions: We suggest clinicians consider warily patients' subsequent BTA injection schedule if any suspicious reaction occurs after treatment. We suggest that patients who experience nonpruritic erythema after botulinum toxin injection should suspend subsequent injection plans for at least 3 months to prevent more severe consequences.

A data-driven and cost-oriented FMEA-MCDM approach to risk assessment and ranking in a fuzzy environment: A hydraulic pump factory case study.

In today's highly competitive business environment, firms strive to maximize profitability by minimizing or eliminating disruptions and failures to maintain a competitive edge. This study focuses on evaluating risks in a hydraulic pump factory as a means to achieve sustainable growth. To accomplish this, a team of experts was formed to identify potential errors, utilizing a combination of risk priority number criteria weighted by Fuzzy Shannon's entropy and a fusion of multi-criteria decision-making and failure mode and effects analysis for evaluating and ranking failures. Moreover, the study emphasizes the importance of considering the interaction among risk assessment indicators, the inclusion of cost of failure, and modeling under fuzzy uncertainty circumstances, as they have a notable impact on the final ranking of failures to be processed for risk mitigation action planning. This research brings a new dimension to enhance the overall effectiveness of risk assessment by aggregation, as evidenced by a novel use of data classification in machine learning and correlation in statistics. The findings indicate that the aggregated ranking data series is best matched and most influenced by the weighted aggregated sum product assessment method, with the highest rate of recall and precision accomplished.

Application of High-Frequency Ultrasound to Evaluate Forehead Filling Materials.

BACKGROUND: In recent years, soft tissue materials have been applied as forehead fillers. Some filling materials need to be removed or refilled in a timely manner in certain situations; therefore, it is important to develop a method to identify the location and type of filling materials. This study summarizes the imaging findings of different filling materials under high-frequency ultrasound, providing a reference for clinical treatment. METHODS: We screened facial ultrasound images performed at the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences from April 2015 to July 2023 and classified and summarized the types of frontal filling materials and their imaging results. RESULTS: This study included ultrasound imaging results from 114 patients, including 39 with hyaluronic acid (HA) filling, 45 with polyacrylamide hydrogel (PAG) filling, 14 who received autologous fat transplantation, 2 who received prosthesis implantation, 2 who received both HA and PAG filling, and 12 who received silicone oil filling. HA mainly manifests as an anechoic zone on ultrasonography, with images divisible into four types. PAG primarily presents as fine punctate echoes, divisible into five types. Fat transplantation presents as a low-echo area with uneven density, divisible into five types. Finally, the silicone oil-filling material appears as a cloud-like high echo on the forehead, visible throughout the entire skin layer, and unclear imaging in deep tissues. CONCLUSION: High-frequency ultrasound is a safe and reliable method to evaluate the type and position of forehead filling materials, which can be easily applied in clinical practice. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Assessment of prolonged proteasome inhibition through ixazomib-based oral regimen on newly diagnosed and first-relapsed multiple myeloma: A real-world Chinese cohort study.

OBJECTIVE: To evaluate the effectiveness, safety, and convenience of in-class transition (iCT) from intravenous bortezomib-based induction to ixazomib-based oral regimens. METHODS: This retrospective real-world study was conducted in 16 Chinese hospitals between October 2017 and April 2023 and analyzed newly diagnosed (NDMM) and first-line relapsed multiple myeloma (FRMM) patients who attained at least a partial response from bortezomib-based induction therapy, followed by an ixazomib-based oral regimen for 2 year or until disease progression or intolerable toxicity. RESULTS: The study enrolled 199 patients, median age: 63 years old, male 55.4%, 53% as high risk (HR), and 47% as standard risk. Cytogenetic risk stratification by metaphase fluorescence in situ hybridization (M-FISH), based on the Mayo Clinic risk stratification system. The median duration of total PI therapy was 11 months, with ixazomib-based treatment spanning 6 months. At the 20-month median follow-up, 53% of patients remained on therapy. The 24-month PFS rate was 84.3% from the initiation of bortezomib-based induction and 83.4% from the start of ixazomib-based treatment. Overall response rate (ORR) was 100% post-bortezomib induction and 90% following 6 cycles of the ixazomib-based regimen. Based on the Sankey diagrams, 89.51% of patients maintained or improved their disease response after 2 cycles of iCT, 6 cycles (90.14%), and 12 cycles (80%). The HR level of Mayo was found to be a significant independent factor in a worse remission (hazard ratio (HR) 2.55; p = 0.033). Ixazomib's safety profile aligned with previous clinical trial data, with 49% of patients experiencing at least one AE of any grade. The most common AEs included peripheral neuropathy, nausea and vomiting, diarrhea, thrombocytopenia, and granulocytopenia. CONCLUSION: In the real-world Chinese MM population, NDMM and FRMM patients responded favorably to PI-based continuous therapy, demonstrating substantial response rates. The ixazomib-based iCT allows for sustained PI-based treatment, offering promising efficacy and tolerable AEs.

Trigeminal Neuralgia after Hyaluronic Acid and Botox Injection.

A rare case of trigeminal neuralgia following injections of Hyaluronic Acid and Botox was documented. In addressing the severe pain and swelling caused by the injection, a novel combination therapy was employed, notably including 5-fluorouracil. The significant improvement observed in this case not only provided clinical insights but also spurred further investigation into the underlying mechanisms linking trigeminal nerve damage to local dermal filler injections. The aim was to glean new medical perspectives and develop practical preventive strategies to mitigate such complications in future cases. This approach highlights the importance of understanding and addressing the potential neurological impacts of cosmetic procedures. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266 .

Ultra-Confined Phonon Polaritons and Strongly Coupled Microcavity Exciton Polaritons in Monolayer MoSi2N4 and WSi2N4.

The 2D semiconductors are an ideal platform for exploration of bosonic fluids composed of coupled photons and collective excitations of atoms or excitons, primarily due to large excitonic binding energies and strong light-matter interaction. Based on first-principles calculations, it is demonstrated that the phonon polaritons formed by two infrared-active phonon modes in monolayer MoSi2N4 and WSi2N4 possess ultra-high confinement factors of around ≈105 and 103, surpassing those of conventional polaritonic thin-film materials by two orders of magnitude. It is observed that the first bright exciton possesses a substantial binding energies of 750 and 740 meV in these two monolayers, with the radiative recombination lifetimes as long as 25 and 188 ns, and the Rabi splitting of the formed cavity-exciton polaritons reaching 373 and 321 meV, respectively. The effective masses of the cavity exciton polaritons are approximately 10-5me, providing the potential for high-temperature quantum condensation. The ultra-confined and ultra-low-loss phonon polaritons, as well as strongly-coupled cavity exciton polaritons with ultra-small polaritonic effective masses in these two monolayers, offering the flexible control of light at the nanoscale, probably leading to practical applications in nanophotonics, meta-optics, and quantum materials.

Botulinum Toxin Injection Technique for Reducing the Masseter Size and Enhancing the Jawline.

BACKGROUND: The injection of botulinum toxin into the masseter muscle is an important method for improving hypertrophy. However, some patients may experience adverse reactions, such as sagging of the lower jaw. Therefore, we proposed a method of injecting botulinum toxin into the masseter and platysma muscles that would reduce masseter size and enhance the jawline. OBJECTIVES: The aim of this study was to reduce the masseter size while enhancing the jawline. METHODS: Twenty patients received botulinum toxin injections into the masseter and platysma muscles. Pain levels were evaluated with the visual analog scale. All patients were photographed before and 6 months after treatment. Evaluations were performed based on standardized criteria. The lift index, reduction index, and symmetry index were performed to assess the degree of jawline elevation, masseter size reduction, and jawline symmetry before and after treatment. RESULTS: The mean visual analog scale score of the 20 patients was 2.80 (±1.24). The mean lift index score decreased from 4.93 (±0.34) to 4.53 (±0.37), P < .05. The mean reduction index score decreased from 3.13 (±0.27) to 2.74 (±0.27), P < .05. The mean symmetry index score changed from 0.0393 (±0.0296) to 0.0257 (±0.0246), P < .05. CONCLUSIONS: Botulinum toxin injections into the masseter and platysma muscles through nerve block reduced the masseter size, elevated the jawline, and improved symmetry.

Application of System Nursing in the Prevention of Postoperative Nonstructural Scoliosis in Patients With Ear Reconstruction.

OBJECTIVE: To evaluate whether early systematic nursing can reduce the occurrence of postoperative nonstructural scoliosis in patients undergoing ear reconstruction. METHODS: A total of 136 patients with congenital microtia who underwent ear reconstruction surgery at the Department of Plastic Surgery, Chinese Academy of Medical Sciences from, January 2022 to July 2022 were included as study subjects. They were randomly divided into a routine nursing group and a systematic nursing group. After preoperative and postoperative education, as well as continuous follow-up intervention after surgery, spinal CT three-dimensional imaging examination was performed 6 months later to measure the Cobb angle and observe the occurrence of spinal scoliosis. RESULTS: Compared with the routine nursing group, the incidence and severity of postoperative nonstructural scoliosis were significantly reduced in patients who received systematic nursing. CONCLUSIONS: Systematic nursing intervention for patients undergoing ear reconstruction can help prevent the occurrence of postoperative nonstructural scoliosis and has a positive effect on improving patient prognosis. It is worth promoting in clinical treatment.

What Factors Can Affect the Occurrence of Vertigo in Patients After Craniofacial Surgery in China?

Vertigo is a complication of craniomaxillofacial contour plastic surgery characterized by dizziness from hypovolemia in the cerebral hemispheres and brainstem. The authors analyzed the current status and influencing factors of postoperative vertigo in patients who undergo craniomaxillofacial contouring and discussed improvements in nursing strategies. The authors investigated 418 patients admitted to the authors' hospital who underwent craniomaxillofacial contouring between November 2020 and October 2023 and divided them into asymptomatic and symptomatic groups based on syncopal precursors or vertigo. The authors screened the current status of vertigo in patients after craniomaxillofacial contouring and the factors affecting vertigo and determined nursing improvement strategies. After craniomaxillofacial contouring, 125 patients had vertigo symptoms. Postcraniomaxillofacial contouring syncope or vertigo was associated with age, patient vertigo history, family history, depression, weight loss, blood pressure at admission, feeding before getting out of bed, and the level of intraoperative hemorrhage Multifactorial logistic regression analysis revealed the association between postcraniomaxillofacial contouring syncope or vertigo and vertigo history, depression, weight loss, feeding before getting out of bed, and intraoperative bleeding volume. Vertigo precursor incidence after craniomaxillofacial contouring surgery is 29.90%. Its influencing factors are complex, suggesting that nurses need to improve the perioperative health education of craniomaxillofacial contouring surgery and optimize the nursing care, encourage patients to have a reasonable diet or provide parenteral nutritional support preoperatively, help patients get out of bed early postoperatively, encourage them to have multiple meals in little quantity before getting out of bed, and control the intraoperative bleeding, to ensure patient safety postoperatively.

Ixazomib-based frontline therapy followed by ixazomib maintenance in frail elderly newly diagnosed with multiple myeloma: a prospective multicenter study.

Background: Frail elderly patients with newly diagnosed multiple myeloma (NDMM) have inferior survival and less benefit from high-dose therapies. This prospective study aimed to investigate the efficacy, safety, and quality of life (QoL) of induction treatment of ixazomib/lenalidomide/dexamethasone (IRd) and ixazomib/pegylated liposomal doxorubicin/dexamethasone (IDd) followed by ixazomib/dexamethasone (Id) maintenance therapy in frail, elderly patients with NDMM. Methods: From July 2019 to December 2021, this non-randomized concurrent controlled clinical study enrolled 120 NDMM patients aged ≥65 years with frailty defined by the International Myeloma Working Group (IMWG) frailty score or Mayo geriatric scoring system. The enrolled patients received 6-8 cycles of IRd or IDd followed by Id maintenance therapy for a minimum of 2 years at the discretion of physicians based on patient's clinical characteristics (chiCTR1900024917). Findings: The median age was 71 years and 55% of the patients were males. The overall response rate (ORR) was 82% and 77%, complete response (CR) rate was 25% and 12% for IRd and IDd groups, respectively. The difference in ORR of the Idd group minus the IRd group was -5.36% (95% CI: -18.9% to 8.19%), indicating that the ORR of the IDd group was neither inferior nor non-inferior to the IRd group. After a median follow-up of 34.3 months, the median progression-free survival (PFS) was 21.6 and 13.9 months, OS was not reached and 29.2 months in IRd and IDd groups, respectively. 28 and 33 patients discontinued induction therapy, 20 and 19 discontinued maintenance therapy in IRd and IDd groups, respectively. Cumulative Grade 3 or higher hematological adverse events (AEs) occurred in 10 of the 60 patients (17%) and non-hematological AEs occurred in 15 of the 60 patients (25%) in the IRd group, while 13 of the 60 patients (22%) and 21 of the 60 patients (35%) in the IDd group. Patients were observed with clinically significant improvement in QoL when compared with that at baseline in both IRd and IDd groups by evaluation per cycle (P < 0.0001). Interpretation: The results demonstrated that compared with IRd regimen, IDd regimen showed no significant advantage, but the survival of the IDd group was shorter than that of the IRd group, indicating an all-oral outpatient triplet regimen with IRd, which has low toxicity and has improved QoL, could be the viable first-line treatment option for frail NDMM patients. Funding: The Young Elite Scientist sponsorship program by bast of Beijing Association for Science and Technology (No. BYESS2023116) and Beijing Medical Award Foundation (No. YXJL-2018-0539-0073).

Localization of the Submandibular Glands Using High-Frequency Ultrasound.

BACKGROUND: Injecting botulinum toxin (BTX) into the submandibular glands (SMGs) can treat drooling symptoms in neurological diseases and improve the aesthetics of SMG hypertrophy and ptotic SMGs. OBJECTIVES: This study aimed to define the size and position of the SMGs by high-frequency ultrasound, and to perform statistical analysis to improve the safety and accuracy of BTX injection therapy. METHODS: Neck ultrasonography with high-frequency ultrasound was performed on 214 volunteers. The length, height, and thickness of the SMGs, and the distance between the SMGs and the midline, the anterior border of the sternocleidomastoid, the mandible, and the surface were measured. RESULTS: The SMGs were almond-shaped with a mean [standard deviation] length of 33.7 [4.7] mm, a thickness of 13.3 [2.9] mm, and a height of 27.6 [6.0] mm. The length and height were significantly different between underage and youth groups. The size of the SMGs did not show any notable differences with increasing BMI; however, their depth, and the distance from the mandible, midline, and anterior border of the sternocleidomastoid increased. No significant differences were observed between the affected and healthy sides in patients with microtia, hemifacial microsomia, or cleft lip and palate. CONCLUSIONS: Ultrasound provides more comprehensive information regarding the size and position of the SMGs, which can serve as a reference in BTX therapy and in the diagnosis of SMG diseases involving size alterations.

The rice LATE ELONGATED HYPOCOTYL enhances salt tolerance by regulating Na+/K+ homeostasis and ABA signalling.

The circadian clock plays multiple functions in the regulation of plant growth, development and response to various abiotic stress. Here, we showed that the core oscillator component late elongated hypocotyl (LHY) was involved in rice response to salt stress. The mutations of OsLHY gene led to reduced salt tolerance in rice. Transcriptomic analyses revealed that the OsLHY gene regulates the expression of genes related to ion homeostasis and the abscisic acid (ABA) signalling pathway, including genes encoded High-affinity K+ transporters (OsHKTs) and the stress-activated protein kinases (OsSAPKs). We demonstrated that OsLHY directly binds the promoters of OsHKT1;1, OsHKT1;4 and OsSAPK9 to regulate their expression. Moreover, the ossapk9 mutants exhibited salt tolerance under salt stress. Taken together, our findings revealed that OsLHY integrates ion homeostasis and the ABA pathway to regulate salt tolerance in rice, providing insights into our understanding of how the circadian clock controls rice response to salt stress.