Optimal Option Research Articles

General Characteristics and Current State of Antibiotic Resistance in Pediatric Urinary Tract Infection-A Single Center Experience.

We analyzed 210 positive urine cultures identified in 141 pediatric patients admitted to the hospital over a 6-month period. The majority of patients were females (57%) with a median age of 5 years (IQR 12), while male patients revealed a median age of 2 (IQR 7). Most patients originated from urban areas (53%). Only 18 patients (12.76%) were identified with underlying Congenital Anomalies of the Kidney and Urinary Tract (CAKUT). Escherichia Coli was the most frequent pathogen. Increased antibiotic resistance was found in commonly-used antibiotics Ampicillin and Trimethoprim/Sulfamethoxazole, and in the case of patients with CAKUT. Suitable antibiotics for treating a Gram-negative UTI are aminoglycosides, Meropenem, third-generation Cephalosporins, and Nitrofurantoin. Vancomycin upholds efficacy in treating a Gram-positive pediatric UTI. Periodical analysis needs to be performed in order to constantly update clinicians on uropathogenic antibiotic resistance and optimal empirical treatment options.

A Bayesian Model Based on Local Phenotypic Resistance Data to Inform Empiric Antibiotic Escalation Decisions.

Clinicians commonly escalate empiric antibiotic therapy due to poor clinical progress without microbiology guidance. When escalating, they should take account of how resistance to an initial antibiotic affects the probability of resistance to subsequent options. The term "escalation antibiogram" (EA) has been coined to describe this concept. One difficulty when applying the EA concept to clinical practice is understanding the uncertainty in results and how this changes for specific patient subgroups. A Bayesian model was developed to estimate antibiotic resistance rates in Gram-negative bloodstream infections based on phenotypic resistance data. The model generates a series of "credible" curves to fit the resistance data, each with the same probability of representing the true rate given the inherent uncertainty. To avoid overfitting, an integrated penalisation term adaptively smooths the curves given the level of evidence. Rates of resistance to empiric first-choice and potential escalation antibiotics were calculated for the whole hospitalised population based on 10,486 individual bloodstream infections, and for a range of specific patient groups, including ICU (intensive care unit), haematolo-oncology, and paediatric patients. The model generated an expected value (posterior mean) with 95% credible interval to illustrate uncertainty, based on the size of the patient subgroup. For example, the posterior means of piperacillin/tazobactam resistance rates in Gram-negative bloodstream infection are different between patients on ICU and the general hospital population: 27.3% (95% CI 18.1-37.2 vs. 13.4% 95% CI 11.0-16.1) respectively. The model can also estimate the probability of inferiority between two antibiotics for a specific patient population. Differences in optimal escalation antibiotic options between specific patient groups were noted. EA analysis informed by our Bayesian model is a useful tool to support empiric antibiotic switches, providing an estimate of local resistance rates, and a comparison of antibiotic options with a measure of the uncertainty in the data. We demonstrate that EAs calculated for the whole hospital population cannot be assumed to apply to specific patient group.

Automatic planning for functional lung avoidance radiotherapy based on function-guided beam angle selection and plan optimization

Objective. This study aims to develop a fully automatic planning framework for functional lung avoidance radiotherapy (AP-FLART). Approach. The AP-FLART integrates a dosimetric score-based beam angle selection method and a meta-optimization-based plan optimization method, both of which incorporate lung function information to guide dose redirection from high functional lung (HFL) to low functional lung (LFL). It is applicable to both contour-based FLART (cFLART) and voxel-based FLART (vFLART) optimization options. A cohort of 18 lung cancer patient cases underwent planning-CT and SPECT perfusion scans were collected. AP-FLART was applied to generate conventional RT (ConvRT), cFLART, and vFLART plans for all cases. We compared automatic against manual ConvRT plans as well as automatic ConvRT against FLART plans, to evaluate the effectiveness of AP-FLART. Ablation studies were performed to evaluate the contribution of function-guided beam angle selection and plan optimization to dose redirection. Main results. Automatic ConvRT plans generated by AP-FLART exhibited similar quality compared to manual counterparts. Furthermore, compared to automatic ConvRT plans, HFL mean dose, V 20, and V 5 were significantly reduced by 1.13 Gy (p < .001), 2.01% (p < .001), and 6.66% (p < .001) respectively for cFLART plans. Besides, vFLART plans showed a decrease in lung functionally weighted mean dose by 0.64 Gy (p < .01), fV 20 by 0.90% (p = 0.099), and fV 5 by 5.07% (p < .01) respectively. Though inferior conformity was observed, all dose constraints were well satisfied. The ablation study results indicated that both function-guided beam angle selection and plan optimization significantly contributed to dose redirection. Significance. AP-FLART can effectively redirect doses from HFL to LFL without severely degrading conventional dose metrics, producing high-quality FLART plans. It has the potential to advance the research and clinical application of FLART by providing labor-free, consistent, and high-quality plans.

Advances in molecular basis of response to immunotherapy for penile cancer: better screening of responders.

Penile cancer is a rare malignant tumor of the male urinary system. The treatment benefit of standard first-line chemotherapy is not ideal for patients with locally advanced or metastatic lymph nodes. Immunotherapy has brought new treatment strategies and opportunities for patients with penile cancer. At present, clinical studies on immunotherapy for penile cancer have been reported, and the results show that it is effective but not conclusive. With the development of immunotherapy and the progress of molecular research technology, we can better screen the immunotherapy response population and explore new combination treatment regimens to evaluate the best combination regimen and obtain the optimal treatment options, which is also an important research direction for the immunotherapy of penile cancer in the future.

Utilization of "Intersection" Methodology for Optimization with Many Objectives in Designed Experiments of Material Processing

Material processing involves many factors, and evaluation of final quality of a product also relates to many indexes from different respects. Thus the optimization of qualities and processing of a product is an optimization problem with many objectives (MOO) inevitably. Although there are some approaches proposed to deal with optimization problem with many objectives in nowadays, the inherent shortcomings in these approaches make them puzzled, which include their missing standpoint and use of additive algorithm containing subjective factors. Currently, an "intersection" methodology for optimization with many objectives is proposed by initiating a novel idea of favorable probability to depict the favorite degree of an alternative in optimal option impersonally, which aims to characterize the concurrent optimization of many objectives in a system in spirits of probability theory and set theory. In this article, some regulations are put forward for performing optimal option of material processing parameters in designed experiments of response surface methodology, orthogonal experiment design and uniform experiment design by means of the total / global favorable probability. In the treatment, the total / global favorable probability of an alternative is the decisive indicator in the optimal option uniquely, which transfers the optimization problem with many objectives into a mono-objective one. The result indicates that the novel approach can be employed to deal with the optimal problem of designed experiments for material processing rationally.

Simultaneous bilateral video-assisted thoracic surgery is safe and feasible for multiple primary lung cancers

BackgroundThe treatment for bilateral synchronous multiple primary lung cancers (MPLC) remains challenging. Simultaneous bilateral video-assisted thoracic surgery (VATS) may be an optimal treatment with curative intent, but its safety and feasibility are controversial.MethodsOne hundred and fifty-eight patients who underwent simultaneous bilateral VATS (simultaneous group) and 79 who underwent two-staged bilateral VATS (two-staged group) were included in this study. Their medical records were retrospectively reviewed and analyzed.ResultsThe majority of patients were female and non-smokers. The most common surgical plan was lobectomy and contralateral wedge resection in both groups. There was no significant difference in the postoperative complication rate between the simultaneous groups and two-staged group (13.3% vs. 11.4%, p = 0.73). Patients who underwent simultaneous bilateral resection had shorter hospital stays, shorter anesthesia time and less chest drainage compared with those who underwent two-staged resection. Advanced TNM stage, complicated surgical plan and aggressive lymph node resection were risk factors for postoperative complications in simultaneous bilateral VATS. Patients in two groups had similar overall survival and disease free survival (p = 0.2).ConclusionsSimultaneous bilateral VATS for bilateral lung nodule resection is as safe and feasible as two-staged bilateral VATS. Patients who underwent simultaneous bilateral resection had similar or even better outcomes compared to that of the two-staged group. Simultaneous bilateral VATS is potentially an optimal treatment option for patients with erarly cTNM stage and good physical condition.

САХАРНОЕ ПЕЧЕНЬЕ И КЕКСЫ, ОБОГАЩЕННЫЕ ПЛОДАМИ ШИПОВНИКА МАЙСКОГО

The purpose of research is to study the effect of different amounts of rosehip powder on the quality of sugar cookies and cakes made from premium wheat flour. Tasks: preparing powder from the pulp of rose hips; setting up a laboratory experiment with different dosages of rosehip powder (RP); a comparative study of its effect on quality and nutritional value using the example of sugar cookies and muffins. RP was added to products in amounts of 3, 6, 9, 12 and 15 % instead of wheat flour in dry matter. The control for the studied variants were products without RP. The object of study is a fine powder of light orange color, with a fruity aroma, sweet and sour, slightly astringent taste. The humidity of the RP was (9.3 ± 0.23) %; titratable acidity – (14.1 ± 0.17) mmol H+/100 g; vitamin C content – 3.66 %; content of polyuronides (pectin substances) – 13.8 %. A tasting assessment of sugar cookies showed the optimal option with the addition of 6 and 9 % RP; For the cake, the optimal option was to add 12 % powder. A further increase in the amount of added RP showed a deterioration in the organoleptic properties due to the appearance, taste and aroma of the products. The moisture content of the products did not depend on the amount of RP and was in the range of 8.8–9.2 % for cookies and 12.5–13.0 % for cake. In the control sample and variants with a dosage of 3 and 6 %, the porosity of the cookies was assessed as good; for options with dosages of 9 and 12 % – average; 15 % is bad. The wetness of cookies decreased with an increase in the amount of added PS. In sugar cookies with 6 % RP, the vitamin C content increases by 121 mg/100 g compared to the control; in the Stolichny cake, when adding 12 % PS, it increases by 241 mg/100 g.

Feasible synergy between hybrid solar PV and wind system for energy supply of a green building in Kota (India): A case study using iHOGA

This research article analyses the optimal feasible synergy options of renewable energy sources combined into a hybrid PV panel and wind energy power producing system to deliver green energy for the Renewable Energy Department building at Rajasthan Technical University Kota, India. The configuration of the modeled system is optimized to be estimated with improved hybrid optimization by genetic algorithm (iHOGA). This study generates operational conditions for this hybrid solar-wind energy system which simulates the energy usage process over one year. The optimal synergy configured between solar and wind hybrid systems provides peak-demand energy to the green office building with little surplus energy. The whole year’s production of energy was 6988 kWh and the energy used by the building was 6759 kWh. The energy loss estimated is 276 kWh/year. The CO2 mitigated by using the integrated renewable energy option is evaluated and observed at 5273.14 kg/year. The other pollutants like SO2 and NOx are also being mitigated by 9601.512 kg/year and NOx 32424.32 kg/year respectively.

The Current State of Coronary Revascularization: Coronary Artery Bypass Graft Surgery Versus Percutaneous Coronary Interventions.

The optimal revascularization strategy for coronary artery disease depends on various factors, such as disease complexity, patient characteristics, and preferences. Including a heart team in complex cases is crucial to ensure optimal outcomes. Decision-making between percutaneous coronary intervention and coronary artery bypass grafting must consider each patient's clinical profile and coronary anatomy. While current practice guidelines offer some insight into the optimal revascularization approach for the various phenotypes of coronary artery disease, the evidence to support either strategy continues to evolve and grow. Given the large amount of contemporary data on revascularization, this review aims to comprehensively summarize the literature on coronary artery bypass grafting and percutaneous coronary intervention in patients across the spectrum of coronary artery disease phenotypes. Contemporary evidence suggests that for patients with triple vessel disease, coronary artery bypass grafting is preferred over percutaneous coronary intervention due to better long-term outcomes, including lower rates of death, myocardial infarction, and target vessel revascularization. Similarly, for patients with left main coronary artery disease, both percutaneous coronary intervention and coronary artery bypass grafting can be considered, as they have shown similar efficacy in terms of major adverse cardiac events, but there may be a slightly higher risk of death with percutaneous coronary intervention. For proximal left anterior descending artery disease, both percutaneous coronary intervention and coronary artery bypass grafting are viable options, but coronary artery bypass grafting has shown lower rates of repeat revascularization and better relief from angina. The Synergy Between PCI with Taxus and Cardiac Surgery score can help in decision-making by predicting the risk of adverse events and guiding the choice between percutaneous coronary intervention and coronary artery bypass grafting. European and American guidelines both agree with including a heart team that can develop and lay out individualized, optimal treatment options with respect for patient preferences. The debate between coronary artery bypass grafting versus percutaneous coronary intervention in multiple different scenarios will continue to develop as technology and techniques improve for both procedures. Risk factors, pre, peri, and post-procedural complications involved in both revascularization strategies will continue to be mitigated to optimize outcomes for those patients for which coronary artery bypass grafting or percutaneous coronary intervention provide ultimate benefit. Methods to avoid unnecessary revascularization continue to develop as well as percutaneous technology that may allow patients to avoid surgical intervention when possible. With such changes, revascularization guidelines for specific patient populations may change in the coming years, which can serve as a limitation of this time-dated review.

КОНЦЕПТУАЛЬНЫЕ ОСНОВЫ УСТОЙЧИВОГО ЭКОНОМИЧЕСКОГО РАЗВИТИЯ ТЕРРИТОРИЙ НА ОСНОВЕ ИННОВАЦИОННЫХ ПРОТОКОЛОВ КОНЦЕНТРАЦИИ ПРОИЗВОДСТВА

In this article, the subject of study is a list of unified procedures, the consistent implementation of which will ensure the achievement of the goal of sustainable economic development of both industries and territories based on innovative production concentration protocols. The purpose of the study is to determine the conceptual foundations of sustainable economic development of territories and optimal innovative options for economic development. The development of concretizing tools and the identification of the technological essence and phasing based on innovative production concentration protocols is an urgent task. The multicomponence of the provisions of the concepts of sustainable economic development of territories based on innovative production concentration protocols lies in the sectoral approach to innovative scaling of the economy, the need to develop an assessment of regional potential in the concept of innovative scaling of the economy to ensure its sustainable development, the development of adequate directions for stimulating innovative development acceptable to any subject of the Federation, the introduction of the resulting block into its structure, including the definition of the expected effects from the implementation of the concept, with the separation of these effects by initiators of innovative scaling. Also in this article, in order to identify the foundations of sustainable economic development and identify the optimal options for their congruence, the structure and content of the concept of sustainable economic development of territories based on innovative production concentration protocols are developed; the logic of developing the concept of sustainable economic development of territories is revealed.

Intraoperative Doppler flowmetry evaluation of humeral head perfusion after proximal humerus fracture

Understanding vascularity and assessing the risk of post-traumatic avascular necrosis are crucial for predicting outcomes and identifying optimal treatment options in proximal humerus fractures (PHFs). Until now, Hertel etal have been the only researchers to evaluate the intraoperative perfusion of the humeral head after fracture using Doppler flowmetry in a central single drill hole within the head. This pilot study aims to standardize the evaluation of intraoperative perfusion measurements in different areas of the humeral head in patients with PHF. In this prospective pilot study, intraoperative semiquantitative Doppler perfusion measurements were conducted during plate osteosynthesis for PHF treatment in our institution between July 2021 and May 2022. The fracture morphology was classified radiologically according to Resch's criteria. Quality of reduction was determined postoperatively to be either anatomical, minor malreduced, or major malreduced according to Peters etal in conventional and computed tomography examinations. Medial hinge integrity and medial metaphyseal extension were assessed radiographically according to Hertel etal. Intraoperatively, after drilling screw holes through the plate, a Doppler probe was inserted through all nine drill holes on the humeral head and at least one on the humeral shaft to successively measure the presence of a pulse to indicate if perfusion is present. A total of ten patients (mean age 59 years, range, 36-83) with a humeral head fracture (2× 2GL, 3× 3G, 2× 4G, 2× 4GL, 1× 5aG according to Resch) were included. Nine of the ten patients showed a pulse signal on the humeral shaft. Overall, pulse-synchronous perfusion was detected using Doppler sonography in at least one hole in the humeral head of all patients. In patients with an intact medial hinge (N=6), pulse-synchronous perfusion could be measured in almost twice as many humeral head holes on average (5.7 vs. 3.0 drill holes) compared to patients with a dislocated medial hinge (N=4). In patients with metaphyseal extension (N=3), pulse-synchronous perfusion was measured in an average of 6.7 humeral head holes compared to 3.7 holes in patients without metaphyseal extension (N=7). Semiquantitative, intraoperative Doppler flowmetry offers a noninvasive and rapid assessment of humeral perfusion which allows an understanding of humeral head perfusion, when used in a standardized fashion to measure flow in different areas of the humeral head.

CFD modeling for predicting imperfections in laser welding and additive manufacturing of aluminum alloys

Aluminum and its alloys are widely used in various applications including e-mobility applications due to their lightweight nature, high corrosion resistance, good electrical conductivity, and excellent processability such as extrusion and forming. However, aluminum and its alloys are difficult to process with a laser beam due to their high thermal conductivity and reflectivity. In this article, the two most used laser processes, i.e., laser welding and laser powder bed fusion (LPBF) additive manufacturing, for processing of aluminum have been studied. There are many common laser-material interaction mechanisms and challenges between the two processes. Deep keyhole mode is a preferred method for welding due to improved productivity, while a heat conduction mode is preferred in LPBF aiming for zero-defect parts. In LPBF, the processing maps are highly desirable to be constructed, which shows the transition zone. Presented numerical modeling provides a more in-depth understanding of porosity formation, and different laser beam movement paths have been tested including circular oscillation paths. High accuracy processing maps can be constructed for LPBF that allows us to minimize tedious and time-consuming experiments. As a result, a modeling framework is a highly viable option for the cost-efficient optimization of process parameters.

How Many Monte Carlo Samples are Needed for Probabilistic Cost-Effectiveness Analyses?

ObjectivesProbabilistic sensitivity analysis (PSA) is conducted to account for the uncertainty in cost and effect of decision options under consideration. PSA involves obtaining a large sample of input parameter values (N) to estimate the expected cost and effect of each alternative in the presence of parameter uncertainty. When the analysis involves using stochastic models (eg, individual-level models), the model is further replicated P times for each sampled parameter set. We study how N and P should be determined. MethodsWe show that PSA could be structured such that P can be an arbitrary number (say, P=1). To determine N, we derive a formula based on Chebyshev’s inequality such that the error in estimating the incremental cost-effectiveness ratio (ICER) of alternatives (or equivalently, the willingness-to-pay value at which the optimal decision option changes) is within a desired level of accuracy. We described 2 methods to confirm, visually and quantitatively, that the N informed by this method results in ICER estimates within the specified level of accuracy. ResultsWhen N is arbitrarily selected, the estimated ICERs could be substantially different from the true ICER (even as P increases), which could lead to misleading conclusions. Using a simple resource allocation model, we demonstrate that the proposed approach can minimize the potential for this error. ConclusionsThe number of parameter samples in probabilistic cost-effectiveness analyses should not be arbitrarily selected. We describe 3 methods to ensure that enough parameter samples are used in probabilistic cost-effectiveness analyses.

Fusion Challenges in Solid Tumors: Shaping the Landscape of Cancer Care in Precision Medicine.

Targeting actionable fusions has emerged as a promising approach to cancer treatment. Next-generation sequencing (NGS)-based techniques have unveiled the landscape of actionable fusions in cancer. However, these approaches remain insufficient to provide optimal treatment options for patients with cancer. This article provides a comprehensive overview of the actionability and clinical development of targeted agents aimed at driver fusions. It also highlights the challenges associated with fusion testing, including the evaluation of patients with cancer who could potentially benefit from testing and devising an effective strategy. The implementation of DNA NGS for all tumor types, combined with RNA sequencing, has the potential to maximize detection while considering cost effectiveness. Herein, we also present a fusion testing strategy aimed at improving outcomes in patients with cancer.

Health Care Discrimination and Immigration Fears: Unpacking COVID-19 Vaccine Hesitancy in Latino Adults.

Objectives. To examine the relationship between health care discrimination and COVID-19 vaccine hesitancy attributed to fears of immigration status complications among unvaccinated Latino adults and to determine whether the association differs among immigrants and US-born individuals. Methods. After universal adult eligibility for the COVID-19 vaccine, a nationally representative sample of 12 887 adults was surveyed using online and mobile random digit dialing from May 7 to June 7, 2021. The analytic sample (n = 881) comprised unvaccinated Latino adults. We examined the association between individual and cumulative health care discrimination measures and COVID-19 vaccine hesitancy assignable to immigration-related fears. Results. Using a cumulative measure of health care discrimination, each additional experience corresponded to a 28% higher odds of reporting vaccine hesitancy Because of immigration-related fears. Findings were consistent across US-born and immigrant Latino adults. Four of the 5 discriminatory experiences were positively associated with vaccine hesitancy, including the absence of optimal treatment options, denial or delayed access to necessary health care, physician communication barriers, and lack of specialist referrals. Conclusions. Findings confirm a positive association between health care discrimination and COVID-19 vaccine hesitancy attributable to immigration-related fears among Latino adults, regardless of immigration status. (Am J Public Health. 2024;114(S6):S505-S509. https://doi.org/10.2105/AJPH.2024.307668) [Formula: see text].

Remote Family Communication as Discounted Compensation: Mobile Use and Psychological Well-Being Among Internal Older Migrants Within China

Among the growing floating population in China, many older people—who migrate along with their adult children to provide family support—have formed a specific social group: lao-piao-zu. This group of older migrants is a population with particular experiences and challenges, which merits more scholarly attention to their well-being. The study first presents a three-dimensional conceptual framework for understanding multimodal mobile phone communication among older migrants. Guided by this framework and based on a face-to-face survey ( N = 376) conducted in China’s first-tier city Shenzhen, the study specifically examined how various forms of mobile communication could affect psychological well-being (PWB) among these older migrants. The results showed that mobile phone use could increase multimodal communication activities. However, only communication with the hometown could reduce loneliness and promote PWB. We argue that mobile communication has limited effects on older migrants’ PWB. It is a promising channel for maintaining remote ties; however, it should be considered more as a form of compensation than as the optimal option for older people who are away from their hometowns.

Neoadjuvant Immunotherapy for Patients With Microsatellite Instability-High or POLE-Mutated Locally Advanced Colorectal Cancer With Bulky Tumors: New Optimization Strategy

ObjectiveTo evaluate the efficacy and safety of neoadjuvant immunotherapy for patients with microsatellite instability-high (MSI-H) or DNA polymerase ε (POLE)-mutated locally advanced colorectal cancer (LACRC) with bulky tumors. PatientsWe retrospectively reviewed 22 consecutive patients with MSI-H or POLE-mutated LACRC with bulky tumors (>8 cm in diameter) who received preoperative programmed death-1 blockade, with or without CapOx chemotherapy. Main Outcome MeasuresPathological complete response (pCR), clinical complete response (cCR), toxicity, R0 resection rate, and complications were evaluated. Survival outcomes were analyzed using the Kaplan-Meier method. Multiplex immunofluorescence analysis were performed before and after treatment. ResultsThe incidence of immune-related adverse events (irAEs) was 36.4% (8/22). Five of 22 patients presented with surgical emergencies, most commonly perforation or obstruction. The 22 patients underwent a median 4 (1-8) cycles. Two patients were evaluated as cCR and underwent a watch and wait strategy. The R0 resection rate was 100.0% (20/20) and pCR rate was 70.0% (14/20). Twelve of 14 cT4b patients (85.7%) avoided multivisceral resection, and 10 of them achieved pCR or cCR. In the two patients with POLE mutations, one each achieved pCR and cCR. No Grade III/IV postoperative complications occurred. The median follow-up was 16.0 months. Two-year event-free and overall survival for the whole cohort was both 100%. ConclusionsPreoperative immunotherapy is the optimal option for MSI-H or POLE-mutated LACRC with bulky tumors, especially cT4b. Preoperative immunotherapy in patients with T4b CRC can reduce multivisceral resection and achieve high CR rate.

Feasibility and efficacy of cell-free and concentrate ascites reinfusion therapy (CART) for advanced pancreatic cancer patients with massive malignant ascites

BackgroundThe management of malignant ascites is critical for treating patients with advanced pancreatic cancer. The purpose of this study was to assess the safety of cell-free and concentrated ascites reinfusion therapy (CART) and its impact on the prognosis of patients with advanced pancreatic cancer who have massive malignant ascites. MethodsThis study analyzed 47 procedures in 29 patients who underwent CART for ascites caused by pancreatic cancer between 2015 and 2022. Among them, 7 patients who received chemotherapy following CART were classified as the chemotherapy group, while 22 patients without chemotherapy after CART were classified as the palliative care group. ResultsAmong the 47 procedures, adverse events (AEs) were observed in 9 procedures (19 %). Grade 2 adverse events were observed only in one procedure, manifested as fever. There were no grade 3 or 4 AEs, nor were there any treatment-related deaths. The median survival time was 4.0 months in the chemotherapy group and 0.7 months in the palliative care group (p = 0.004). The albumin level in the chemotherapy group was significantly higher than that in the palliative care group. ConclusionCART is feasible and might be the optimal option to enable prolonged use of chemotherapy to improve the prognosis for late-stage pancreatic cancer patients.

Numerical study on the effect of high efficient cooling nozzles and varying cooling intensity on metallurgical transport behaviors during the slab continuous casting

In this study, the spray characteristics of the cooling water flux of the traditional single nozzle and novel dual nozzle were innovatively and effectively incorporated into a 3D/2D flow-temperature-concentration segmented model. The model was used to investigate the effects of spray characteristics on the flow, heat distribution, solute transport, solidified shell, and mushy zone of steel in the continuous casting. The results showed that various flow patterns of liquid steel in the turbulent zone significantly affected the temperature and carbon concentration distribution. Until Zone 7, the cooling water fluxes in the six cases remained unchanged. The peak temperatures of cases 1 and 4 in Zone 7 were 1253.11 and 1273.51 K, respectively, indicating that the spray characteristic was the primary cause of the variations in slab surface temperatures. The cooling water fluxes in the six cases change from Zone 8 onward. The six cases had differences of −21.39, 17.87, 46.95, −22.08, 16.86, and 45.68 K between the initial and final temperatures in Zone 8, respectively, meeting the requirement of keeping the maximum temperature recovery rate of slab surface under 100 °C/m. However, the final temperatures for cases 2, 3, and 6 were 1225.62, 1196.50, and 1218.91 K, respectively. These temperatures fall within a realistic plastic temperature range, which must be higher than 1220 K. As a result, the plastic cracking in the slab was possible. The maximum temperature gradient differences of the six cases between feature lines at the end of Zone 8 were 0.793, 0.814, 0.829, 0.185, 0.179, and 0.179 K/mm. These results showed that the optimization effect on the temperature gradient difference was insignificant as the cooling intensity rose. However, the carbon concentration uniformity was marginally improved by increasing the cooling water flux. Finally, a state-owned steel company in China chose case 5 (dual nozzle with moderate cooling intensity at the slab solidified end) as the optimum option for the slab continuous casting caster. The dual nozzle enhanced and promoted the efficient and homogeneous production of the metallurgical process.

Метод оценки критериев оптимизации системы электробезопасности в инфраструктуре села

The article provides an analysis of the state of energy availability and equipment of electric installations for infrastructure facilities in rural settlements. The main type of technogenic hazards is marked – the electrical hazard that occurs in emergency modes of operation of electrical installations. The conditions for solving the safety problem and choosing the optimal variant of the electrical safety system are given. The indicators of the technical efficiency of the electrical safety system are determined, characterized by the likelihood of electrical injury to a person and the likelihood of a fire in electrical installations at facilities. The choice of the most appropriate options for the use of electrical protection equipment, providing for the joint use of automatic switches and protective shutdown devices, was made as a result of comparing the likelihood of electrical injury and fire with a normalized risk level of electrical and fire safety. A method for optimizing the electrical safety system is considered according to two particular criteria representing the average values of the probabilities of electrical injury and fire with the equivalence of their values. The task of optimizing the security system is indicated, which consists in constructing a vector criterion of optimality and converting it into a scalar criterion using the "assignment" method to obtain a normalized partial criterion. The normalized private criteria of electrical and fire safety are determined using a scalar criterion for the selection of electrical protection options for an agricultural facility. An algorithm for evaluating the effectiveness of the electrical safety system in dangerous situations of electrical injuries has been built. The description of the construction of an algorithm for modeling the state of fire safety of the system in the event of fires in electrical installations is given. A comprehensive assessment of the normalized criterion for optimizing the electrical safety system was obtained according to two normalized criteria for electrical and fire safety and the choice of optimal electrical protection options at the studied facility. Keywords: TECHNOGENIC HAZARD, ELECTRICAL INSTALLATION, ACCIDENT, ELECTRICAL INJURY, TECHNICAL EFFICIENCY, EVALUATION CRITERIA, OPTIMIZATION OF ELECTRICAL SAFETY SYSTEM, ELECTRICAL PROTECTION