Objectives This systematic review aimed to identify effective and cost-effective digital health interventions to improve self-management behaviors,blood pressure control,and cardiovascular risk reduction.Methods A sea...Objectives This systematic review aimed to identify effective and cost-effective digital health interventions to improve self-management behaviors,blood pressure control,and cardiovascular risk reduction.Methods A search for randomized and non-randomized control trials of digital health interventions among patients with uncontrolled hypertension was conducted from the databases of Embase,PubMed,Scopus,CINAHL,Web of Science,PsycINFO,Thai Journal Online(ThaiJO),the Faculty of Nursing Mahidol University(FON-MU)Nursing Research Database,and gray literature.After conducting the literature screening,the authors completed data extraction,and the risk of bias was assessed using the Joanna Briggs Institute randomized controlled trial checklist and the Joanna Briggs Institute critical appraisal checklist for quasi-experimental studies.Results The study included 22 articles,comprising 30 to 4,118 patients with uncontrolled hypertension.This review classified and summarized the components of digital health interventions and their effects on hypertensive outcomes.It was found that the key elements of digital health interventions include health education,reminders,self-monitoring,feedback and consultation,and instrumental support.Moreover,approximately 81.81%(n=18)of the digital health interventions involved healthcare providers participating in feedback and consultation.Additionally,digital health interventions effectively improve hypertensive outcomes such as self-management behaviors,blood pressure control,and cardiovascular risk reduction,providing cost-effectiveness.Conclusion Based on the available literature,digital health interventions have been shown to effectively enhance behavioral,clinical,and economic outcomes for individuals with uncontrolled hypertension.Moreover,the combination of digital health interventions and healthcare providers’interventions can potentially help patients with uncontrolled hypertension improve adherence to self-management when compared to stand-alone digital health interventions.Digital health interventions to support self-management interventions should be developed for patients by healthcare providers.展开更多
Pheochromocytoma (PHEO) is a rare endocrine tumor from the chromaffin cells in the adrenomedullary gland and sympathetic/parasympathetic ganglia, secreting one or more catecholamines. It is frequently associated with ...Pheochromocytoma (PHEO) is a rare endocrine tumor from the chromaffin cells in the adrenomedullary gland and sympathetic/parasympathetic ganglia, secreting one or more catecholamines. It is frequently associated with hypertension and described in the literature as a cause of secondary diabetes mellitus. In patients with known persistent uncontrolled diabetes, PHEO is rarely mentioned as the cause of uncontrolled diabetes. The authors report a rare case of PHEO diagnosed in a 64-year-old female patient treated for 10 years with type 2 diabetes mellitus and hypertension. She was treated using a combination of insulin (2 injections) and Metformin 1000 mg twice a day. The glycemic control was poor (HbA1c-11%), and persistent High Blood Pressure (HBP). She presented with unexplained weight loss associated with permanent hyperhidrosis (sweating), affecting her quality of life and diffuse abdominal pain. The investigations confirmed the diagnosis of PHEO, which resection led to improvement of glycemic control and hypertension.展开更多
AIM:To systematically review the current evidence based on the efficacy and cost of Ex-PRESS implantation and trabeculectomy(Trab)for uncontrolled glaucoma.·METHODS:Clinical trials were identified by electron...AIM:To systematically review the current evidence based on the efficacy and cost of Ex-PRESS implantation and trabeculectomy(Trab)for uncontrolled glaucoma.·METHODS:Clinical trials were identified by electronic databases(Pub Med,EMBASE,ISI Web of science and Cochrane library),and data,such as intraocular pressure(IOP),the complete and qualified success rate,the postoperative complications and the cost,were exacted from these relevant studies.Weighted mean difference(WMD),odds ratio(OR)and 95%confidence intervals(CIs)were calculated and were pooled using a randomeffects model.·RESULTS:Eleven relevant publications and two abstracts met the inclusion criteria.The efficacy of ExPRESS was similar to that of Trab in the percentage of IOP reduction(IOPR%)at 1,2y(WMD:-2.01;95%CI:-7.92-3.90;=0.50 and WMD:2.89;95%CI:-8.05-13.83;=0.60,respectively).Ex-PRESS possessed a significant higher complete and qualified success rate(OR:1.59;95%CI:1.07-2.35;=0.02 and OR:1.74;95%CI:1.06-2.86;=0.03,respectively).Moreover,Ex-PRESS exerted a significantly lower frequency of hypotony and hyphema than Trab(OR:0.39;95%CI:0.21-0.72;=0.003 and OR:0.27;95%CI:0.10-0.69;=0.003,respectively).However,there was no consistent result on the cost between the two groups according to the previous three studies.·C ONCLUSION:Both Trab and Ex-PRESS have equivalent efficacy in lowering IOP,yet Ex-PRESS had a lower risk of hypotony and hyphema than Trab.Nevertheless,whether the cost of Ex-PRESS was less than that of Trab should be further investigated to ensure evidence-based conclusion in the long run.展开更多
Gas blowout occurred during drilling may cause catastrophic environmental hazards and economic losses.It is thus one of the important tasks to accurately determine the gas blowout volume so that an effective rescue pl...Gas blowout occurred during drilling may cause catastrophic environmental hazards and economic losses.It is thus one of the important tasks to accurately determine the gas blowout volume so that an effective rescue plan can be worked out in case of gas blowout.In this paper,a numerical method for estimating the gas blowout volume was presented based on the Bernoulli Equation and the corresponding software was programmed.In the process of numerical estimation,the velocity distribution of the blowoutflame characterized by the axisymmetric laminarflow was investigated through an analysis of the dynamicflowing features of the gas gusher,and the relationship between the gas production of a well and the height of the blowoutflame was then analyzed with the Bernoulli Equation to obtain the numerical results of the gas blowout volume.The results were then compared with those laboratory measurements,and the software was revised based on the comparisons.Some conclusions were drawn.First,when the spout shape of a gusher is constant,the gas production is proportional to the height of the blowoutflame,and inversely proportional to the gas kinematic viscosity,the stoichiometric ratio factor and the oxygen concentration.Second,the errors be-tween the results estimated using the revised software and the laboratory measurements are within the allowable range,and the software can automatically generate a report.In a word,the method and software presented in this paper can be an effective technique for preparing a sound and safe rescue plan in case of gas blowout,and is of great significance in relieving the hazards of a well with uncontrolled blowout.展开更多
Explicit traffic control measures are absent in uncontrolled intersections which make them susceptible to frequent conflicts and resulting collisions between vehicles. In developing countries like India, drivers at su...Explicit traffic control measures are absent in uncontrolled intersections which make them susceptible to frequent conflicts and resulting collisions between vehicles. In developing countries like India, drivers at such intersections do not yield to higher priority movements which cause more crashes between vehicles. The objective of this study is to analyze and model the gap acceptance behavior of minor street drivers at uncontrolled T-intersections considering their aggressive nature. Three intersections in the northeast region of India have been selected as the case study area. Preliminary analysis of the data revealed that drivers behave aggressively, not because they have to wait for a long time at the stop line, but because of their lack of respect for traffic rules. Binary logit models are developed for minor road right turning vehicles which show that gap acceptance behavior is influenced by gap duration, clearing time and aggressive nature of drivers. The equations obtained were used to estimate the critical gaps for aggressive and non-aggressive drivers. Critical gaps are also calculated using an existing method called clearing behavior approach. It is also shown that the estimation of critical gap is more realistic if clearing time and aggressive behavior of drivers are considered.展开更多
The most visible uncontrolled landfill sites were selected in the western and eastern parts of the territory of Georgia. Particularly, in eastern Georgia the regions of Mtskheta-Mtianeti and Kvemo Kartli have been res...The most visible uncontrolled landfill sites were selected in the western and eastern parts of the territory of Georgia. Particularly, in eastern Georgia the regions of Mtskheta-Mtianeti and Kvemo Kartli have been researched;and in western Georgia Imereti and Samtskhe-Javakheti correspondingly. Both chemical and microbiological analyses were conducted in the samples taken from their adjacent territories. In case the landfill site is located near the river, during field works using portable equipment main physical-chemical indicators of surface waters were determined. After processing of the obtained results the corresponding estimations were provided. The risks due to the environmental pollution and negative impacts on population health were assessed.展开更多
Objective To preliminarily evaluate the efficacy and safety of a domestically developed bilateral interventional ultrasound renal denervation (RDN) system in patients with uncontrolled hypertension despite antihyperte...Objective To preliminarily evaluate the efficacy and safety of a domestically developed bilateral interventional ultrasound renal denervation (RDN) system in patients with uncontrolled hypertension despite antihypertensive medication.Methods A multicenter,single-arm trial was conducted.Patients with uncontrolled hypertension(≥2 antihypertensive drugs) were enrolled from April2023 to April 2024 at the Second Affiliated Hospital of Chongqing Medical University,West China Hospital of Sichuan University,and the Second Affiliated Hospital of Harbin Medical University.展开更多
Effectively controlling deep non-compressible bleeding remains a major challenge.In this study,by mimicking nanofiber structure and netting blood cells function of fibrin network in blood clots,we develop a novel bioi...Effectively controlling deep non-compressible bleeding remains a major challenge.In this study,by mimicking nanofiber structure and netting blood cells function of fibrin network in blood clots,we develop a novel bioinspired quaternized chitosan nanofiber sponge with distinct blood cells filtration and blood plasma absorption bifunction for rapid hemostasis.The quaternized chitosan nanofiber sponge possesses a unique gradient pore structure with small pores on the outer surface and large pores in the inner part.The outer small pores effectively capture blood cells with a filtration efficiency as high as 91.7%,while the inner large pores endow with an ultrahigh liquid absorption capacity(93 g/g),surpassing previously reported literature records.The quaternized chitosan nanofiber sponge demonstrates a hemostasis time 2.5 times faster than that of the commercial gelatin®hemostatic sponge when treating the rat liver defect bleeding(noncompressible hemorrhage model).When applied to the rabbit arterial injury bleeding(lethal arterial hemorrhage model),the bioinspired nanofiber sponge achieves bleeding control within only 61.6 s,while both commercial gelatin®hemostatic sponge and commercial collagen®hemostatic sponge fail to stop bleeding even after 240 s.This bioinspired nanofiber sponge derived from the physiological coagulation process may hold great potential for pre-hospital and battlefield first aid.展开更多
Tumors are defined by uncontrolled cell proliferation(Hariharan and Bilder,2006).Benign tumors are typically slow-growing and localized,while malignant ones are invasive and aggressive.The nuclear receptor Eip75B(E75)...Tumors are defined by uncontrolled cell proliferation(Hariharan and Bilder,2006).Benign tumors are typically slow-growing and localized,while malignant ones are invasive and aggressive.The nuclear receptor Eip75B(E75),a heme-binding protein responsive to ecdysone signaling,encodes three major isoforms,E75A,E75B,and E75C(Bialecki et al.,2002),among them,only E75A and E75C contain zinc finger domains that enable DNA binding.展开更多
Background Impaired coronary flow reserve(CFR)in patients with hypertension may be caused by epicardial coronary stenosis or microvascular dysfunction.Antihypertensive treatment has been shown to improve coronary micr...Background Impaired coronary flow reserve(CFR)in patients with hypertension may be caused by epicardial coronary stenosis or microvascular dysfunction.Antihypertensive treatment has been shown to improve coronary microvascular dysfunction.The aim of this study was to evaluate the impact of uncontrolled blood pressure(BP)on diagnostic accuracy of CFR for detecting significant coronary stenosis.Methods A total of 98 hypertensive patients scheduled for coronary angiography(CAG)due to chest pain were studied.Of them,45 patients had uncontrolled BP(defined as the office BP〉140/90 mmHg(1 mmHg=0.133 kPa)in general hypertensive patients,or≥130/80 mmHg in hypertensive individuals with diabetes mellitus),and the remaining 53 patients had well-controlled BP.CFR was measured in the left anterior descending coronary artery(LAD)during adenosine triphosphate-induced hyperemia by non-invasive transthoracic Doppler echocardiography(TTDE)within 48 hours prior to CAG.Significant LAD stenosis was defined as〉70%luminal narrowing.Diagnostic accuracy of CFR for detecting significant coronary stenosis was analyzed with a receiver operating characteristic analysis.Results CFR was significantly lower in patients with uncontrolled BP than in those with well-controlled BP(2.1±0.6 vs.2.6±0.9,P〈0.01).Multivariate linear regression analysis of the study showed that the value of CFR was independently associated with the angiographically determined degree of LAD stenosis(β=-0.445,P〈0.0001)and the presence of uncontrolled BP(β=-0.272,P=0.014).With a receiver operating characteristic analysis,CFR〈2.2 was the optimal cut-off value for detecting LAD stenosis in all hypertensive patients(AUC 0.83,95%CI 0.75-0.91)with a sensitivity of 75%,a specificity of 78%,and an accuracy of 77%.A significant reduction of diagnostic specificity was observed in patients with uncontrolled BP compared with those with well-controlled BP(67%vs.93%,P=0.031).Conclusions CFR measurement by TTDE is valuable in the diagnosis of significant coronary stenosis in hypertensive patients.However,the diagnostic specificity is reduced in patients with uncontrolled BP.展开更多
Purpose-In order to solve the problem that the performance of the existing local feature descriptors in uncontrolled environment is greatly affected by illumination,background,occlusion and other factors,we propose a ...Purpose-In order to solve the problem that the performance of the existing local feature descriptors in uncontrolled environment is greatly affected by illumination,background,occlusion and other factors,we propose a novel face recognition algorithm in uncontrolled environment which combines the block central symmetry local binary pattern(CS-LBP)and deep residual network(DRN)model.Design/methodology/approach-The algorithm first extracts the block CSP-LBP features of the face image,then incorporates the extracted features into the DRN model,and gives the face recognition results by using a well-trained DRN model.The features obtained by the proposed algorithm have the characteristics of both local texture features and deep features that robust to illumination.Findings-Compared with the direct usage of the original image,the usage of local texture features of the image as the input of DRN model significantly improves the computation efficiency.Experimental results on the face datasets of FERET,YALE-B and CMU-PIE have shown that the recognition rate of the proposed algorithm is significantly higher than that of other compared algorithms.Originality/value-The proposed algorithm fundamentally solves the problem of face identity recognition in uncontrolled environment,and it is particularly robust to the change of illumination,which proves its superiority.展开更多
Pelvic fractures carry a considerable risk for morbidity and mortality.Half or more of the early deaths in these patients have been attributed directly to haemorrhage.The transfusional requirements are four times high...Pelvic fractures carry a considerable risk for morbidity and mortality.Half or more of the early deaths in these patients have been attributed directly to haemorrhage.The transfusional requirements are four times higher for open pelvic fractures compared with a similar group of closed pelvic fractures.The loss of the tamponade effect by disruption of the pelvic soft tissues and the energy imparted play a central role in this potentially life threatening situation.We reported a case of open pelvic fracture in which persistent haemorrhage was stopped by giving recombinant activated coagulation factor Vlla as our last resort.展开更多
Chronic uncontrolled inflammation is a major risk factor driving the occurrence of hepatocellular carcinoma(HCC),with over half of global cases attributed to hepatitis B virus(HBV)infection.Persistent inflammation fre...Chronic uncontrolled inflammation is a major risk factor driving the occurrence of hepatocellular carcinoma(HCC),with over half of global cases attributed to hepatitis B virus(HBV)infection.Persistent inflammation frequently progresses to cirrhosis and,ultimately,malignancy[1].Monitoring the key risk factors involved in the inflammatory-to-cancerous transformation in HCC is crucial for enabling timely intervention and improving patient survival rates.To address this challenge,we analyzed plasma samples collected from healthy volunteers and patients at various stages of HCC progression,including hepatitis,cirrhosis,and HCC(Approval No.:2021-IRBQYYS-021)(Tables S1–S5).展开更多
We investigated migration of pollutant at the base of the Suzhou landfill after it had been operated for 13 years.The investigation was carried out by performing chemical analyses on the soil samples taken from the si...We investigated migration of pollutant at the base of the Suzhou landfill after it had been operated for 13 years.The investigation was carried out by performing chemical analyses on the soil samples taken from the silty clay deposit.Concentrations of chloride,chemical oxygen demand(COD)and the heavy metals in the soil samples were determined using the standard methods.The experimental data showed that the maximum migration depth of chloride was more than 10 m,while the maximum migration depth of COD varied between 1 and 3.5 m.It is believed that the difference is attributed to the variation in diffusion rate and leachate-soil interaction.The chloride profiles also indicated that adveetion may be the dominant contaminant transport mechanism at this site.The total contents ofCu,Pb and Cr are very close to the background levels and the concentration values of these metals mainly are lower than the threshold values specified by the Chinese soil quality standard and the European one.The water-extractable concentrations of COD in the surface of the silty clay generally exceed the limit value specified by the Chinese standard.The concentrations of copper and chromium in pore water are 1-2 orders of magnitude less than the total concentrations of these heavy metals within the soils,implying that heavy metals are mainly adsorbed by the soil particles.Finally,remediation methods were suggested for this landfill site.展开更多
This paper presents a large gathering dataset of images extracted from publicly filmed videos by 24 cameras installed on the premises of Masjid Al-Nabvi,Madinah,Saudi Arabia.This dataset consists of raw and processed ...This paper presents a large gathering dataset of images extracted from publicly filmed videos by 24 cameras installed on the premises of Masjid Al-Nabvi,Madinah,Saudi Arabia.This dataset consists of raw and processed images reflecting a highly challenging and unconstraint environment.The methodology for building the dataset consists of four core phases;that include acquisition of videos,extraction of frames,localization of face regions,and cropping and resizing of detected face regions.The raw images in the dataset consist of a total of 4613 frames obtained fromvideo sequences.The processed images in the dataset consist of the face regions of 250 persons extracted from raw data images to ensure the authenticity of the presented data.The dataset further consists of 8 images corresponding to each of the 250 subjects(persons)for a total of 2000 images.It portrays a highly unconstrained and challenging environment with human faces of varying sizes and pixel quality(resolution).Since the face regions in video sequences are severely degraded due to various unavoidable factors,it can be used as a benchmark to test and evaluate face detection and recognition algorithms for research purposes.We have also gathered and displayed records of the presence of subjects who appear in presented frames;in a temporal context.This can also be used as a temporal benchmark for tracking,finding persons,activity monitoring,and crowd counting in large crowd scenarios.展开更多
Objective To assess antihypertensive management of older patients with poor blood pressure(BP)control.Methods Physicians,voluntary participating in the study,included six consecutive hypertensive patients during routi...Objective To assess antihypertensive management of older patients with poor blood pressure(BP)control.Methods Physicians,voluntary participating in the study,included six consecutive hypertensive patients during routine visits.Hypertension had to have been previously recognized and averaged office BP was>140 and/or>90 mmHg in spite of>6 weeks of antihypertensive therapy.The physicians completed a questionnaire on patients'history of cardiovascular(CV)risk factors,comorbidities,home BP monitoring,anthropometric data and the pharmacotherapy.Results Mean age of the 6462 patients was 61 years,7%were>80 years,51%were female.Mean士SD office BP values were 158士13/92土10 mmHg.The most commonly prescribed antihypertensive drugs were:diuretics(67%),ACE inhibitors(64%),calcium channel blockers(58%)and卩-blockers(54%),and their use increased with age.On monotherapy or dual therapy,43%of the patients and 40%had their latest treatment modification within six months.Home BP monitoring was a factor that accelerated the modification of the therapy.Older patients had to have less chance on faster modification of antihypertensive therapy in spite of presence of diabetes and higher systolic BP.Conclusions Our study suggests that a large number of outpatients with poor BP control receive suboptimal antihypertensive therapy,especially in primary care.In older patients,higher BP values in the office settings are more frequently accepted by physicians even in case of higher CV risk.Regular home BP monitoring hastens the decision to intensify of antihypertensive treatment.展开更多
In India, traffic flow on roads is highly mixed in nature with wide variations in the static and dynamic characteristics of vehicles. At unsignalized intersections, vehicles generally do not follow lane discipline and...In India, traffic flow on roads is highly mixed in nature with wide variations in the static and dynamic characteristics of vehicles. At unsignalized intersections, vehicles generally do not follow lane discipline and ignore the rules of priority. Drivers generally become more aggressive and tend to cross the uncontrolled intersections without considering the conflicting traffic. All these conditions cause a very complex traffic situation at unsignal- ized intersections which have a great impact on the capacity and performance of traffic intersections. A new method called additive conflict flow (ACF) method is suitable to determine the capacity of unsignalized inter- sections in non-lane-based mixed traffic conditions as prevailing in India. Occupation time is the key parameter for ACF method, which is defined as the time spent by a vehicle in the conflict area at the intersection. Data for this study were collected at two three-legged unsignalized intersections (one is uncontrolled and other one is semi- controlled) in Mangalore city, India using video-graphic technique during peak periods on three consecutive week days. The occupation time of vehicles at these intersections were studied and compared. The data on conflicting traffic volume and occupation time by each subject vehicle at the conflict area were extracted from the videos using image processing software. The subject vehicles were divided into three categories: two wheelers,cars, and auto-rickshaws. Mathematical relationships were developed to relate the occupation time of different cate- gories of vehicles with the conflicting flow of vehicles for various movements at both the intersections. It was found that occupation time increases with the increasing con- flicting traffic and observed to be higher at the uncontrolled intersection compared to the semicontrolled intersec- tion. The segregated turning movements and the presence of mini roundabout at the semicontrolled intersection reduces the conflicts of vehicular movements, which ulti- mately reduces the occupation time. The proposed methodology will be useful to determine the occupation time for various movements at unsignalized intersections. The models developed in the study can be used by practitioners and traffic engineers to estimate the capacity of unsignalized intersections in non-lane-based discipline and mixed traffic conditions.展开更多
The Casablanca landfill is one among many uncontrolled dumping sites in Morocco with no bottom liner. About 4000 tons/day of solid wastes from mixed urban and industrial origins are placed directly on the fifteen old ...The Casablanca landfill is one among many uncontrolled dumping sites in Morocco with no bottom liner. About 4000 tons/day of solid wastes from mixed urban and industrial origins are placed directly on the fifteen old sandstone quarries. At the site of this landfill, the groundwaters circulate deeply (10 m) in the fractured aquiferous quartzites, the site has never been sealed before its opening. The aim of this study is the characterization the groundwater quality around the landfill, to delimit the contaminated zone and the factors controlling the extent of groundwater contamination. To evaluate groundwater pollution due to this landfill, piezometric level and geochemical analyses have been carried out on 19 wells. The results of geochemical analyses show an important qualitative degradation of the groundwater, especially in the parts situated in the down gradient area and in direct proximity to the landfill. In these polluted zones, we have observed the following values: higher than 11 mS/cm in electric conductivity, 1400 mg/L in bicarbonates, 275 mg/L in chemical oxygen demand, 2616 and 100 mg/L respectively in chlorides and sulfate, 269.5 mg/L in nitrates, 50 - 100 mg/L in cadmium, and 40 - 230 μg/L in chromium. These concentrations widely exceed the standard values for potable and irrigation water. Several determining factors in the evolution of groundwater contamination have been highlighted, such as: depth of the water table, permeability of unsaturated zone and lineaments, effective infiltration, absence of a system for leachate drainage. So, to reduce the pollution risks of the groundwater, it is necessary to set a system of collection, drainage and treatment of landfill leachates and to emplace an impermeable surface at the site of landfill, in order to limit the infiltration of leachate.展开更多
Background:Occupational burnout is associated with diminished psychological flexibility and higher emotional(EE)and uncontrolled eating(UE).Psychological flexibility could be a mediating factor between burnout and eat...Background:Occupational burnout is associated with diminished psychological flexibility and higher emotional(EE)and uncontrolled eating(UE).Psychological flexibility could be a mediating factor between burnout and eating behaviour.Objectives:To investigate differences in eating behaviour between those with different levels of psychological flexibility,and the association of the interaction between psychological flexibility and occupational burnout with eating behaviour.Design:The participants were working women(n=263),who took part in the randomized controlled health intervention trial.Analyses were performed in a cross-sectional setting at baseline.Methods:Eating behaviour was measured using the Three Factor Eating Behaviour Questionnaire-18[which evaluates EE,UE and cognitive restraint(CR)],psychological flexibility using Acceptance and Action Questionnaire-II and occupational burnout using Bergen Burnout Indicator-15.Participants were divided into four groups based on the quartile points of psychological flexibility.Results:The EE of those who were inflexible was higher than that of those whose flexibility was high moderate(p=0.013)and who were flexible(p=0.001).The UE of those who were inflexible was higher than the UE in the other groups with higher flexibility[low moderate(p=0.034),high moderate(p een occupational burnout and EE and UE.Multivariate analysis of variances revealed that the combination of psychological flexibility and burnout had a stronger association with the variances of EE and UE than psychological flexibility alone.Conclusions:Persons who are psychologically inflexible have higher EE and UE.Future studies should investigate if increasing psychological flexibility helps decrease EE and UE.展开更多
The chaotic dynamics of the transport equation for the L-mode to H-mode near the plasma in a tokamak is studied in detail with the Melnikov method. The transport equations represent a system with external and parametr...The chaotic dynamics of the transport equation for the L-mode to H-mode near the plasma in a tokamak is studied in detail with the Melnikov method. The transport equations represent a system with external and parametric excitation. The critical curves separating the chaotic regions and nonchaotic regions are presented for the system with periodically external excitation and linear parametric excitation, or cubic parametric excitation, respectively. The results obtained here show that there exist uncontrollable regions in which chaos always take place via heteroclinic bifurcation for the system with linear or cubic parametric excitation. Especially, there exists a controllable frequency, excited at which chaos does not occur via homoclinic bifurcation no matter how large the excitation amplitude is for the system with cubic parametric excitation. Some complicated dynamical behaviors are obtained for this class of systems.展开更多
基金the support provided by the 2D43 TW009883 D43 Post-Doctoral Program at the School of Nursing,University of Michigan,USA。
摘要Objectives This systematic review aimed to identify effective and cost-effective digital health interventions to improve self-management behaviors,blood pressure control,and cardiovascular risk reduction.Methods A search for randomized and non-randomized control trials of digital health interventions among patients with uncontrolled hypertension was conducted from the databases of Embase,PubMed,Scopus,CINAHL,Web of Science,PsycINFO,Thai Journal Online(ThaiJO),the Faculty of Nursing Mahidol University(FON-MU)Nursing Research Database,and gray literature.After conducting the literature screening,the authors completed data extraction,and the risk of bias was assessed using the Joanna Briggs Institute randomized controlled trial checklist and the Joanna Briggs Institute critical appraisal checklist for quasi-experimental studies.Results The study included 22 articles,comprising 30 to 4,118 patients with uncontrolled hypertension.This review classified and summarized the components of digital health interventions and their effects on hypertensive outcomes.It was found that the key elements of digital health interventions include health education,reminders,self-monitoring,feedback and consultation,and instrumental support.Moreover,approximately 81.81%(n=18)of the digital health interventions involved healthcare providers participating in feedback and consultation.Additionally,digital health interventions effectively improve hypertensive outcomes such as self-management behaviors,blood pressure control,and cardiovascular risk reduction,providing cost-effectiveness.Conclusion Based on the available literature,digital health interventions have been shown to effectively enhance behavioral,clinical,and economic outcomes for individuals with uncontrolled hypertension.Moreover,the combination of digital health interventions and healthcare providers’interventions can potentially help patients with uncontrolled hypertension improve adherence to self-management when compared to stand-alone digital health interventions.Digital health interventions to support self-management interventions should be developed for patients by healthcare providers.
摘要Pheochromocytoma (PHEO) is a rare endocrine tumor from the chromaffin cells in the adrenomedullary gland and sympathetic/parasympathetic ganglia, secreting one or more catecholamines. It is frequently associated with hypertension and described in the literature as a cause of secondary diabetes mellitus. In patients with known persistent uncontrolled diabetes, PHEO is rarely mentioned as the cause of uncontrolled diabetes. The authors report a rare case of PHEO diagnosed in a 64-year-old female patient treated for 10 years with type 2 diabetes mellitus and hypertension. She was treated using a combination of insulin (2 injections) and Metformin 1000 mg twice a day. The glycemic control was poor (HbA1c-11%), and persistent High Blood Pressure (HBP). She presented with unexplained weight loss associated with permanent hyperhidrosis (sweating), affecting her quality of life and diffuse abdominal pain. The investigations confirmed the diagnosis of PHEO, which resection led to improvement of glycemic control and hypertension.
基金Supported by the National Natural Science Foundation of China(No.81373826)
摘要AIM:To systematically review the current evidence based on the efficacy and cost of Ex-PRESS implantation and trabeculectomy(Trab)for uncontrolled glaucoma.·METHODS:Clinical trials were identified by electronic databases(Pub Med,EMBASE,ISI Web of science and Cochrane library),and data,such as intraocular pressure(IOP),the complete and qualified success rate,the postoperative complications and the cost,were exacted from these relevant studies.Weighted mean difference(WMD),odds ratio(OR)and 95%confidence intervals(CIs)were calculated and were pooled using a randomeffects model.·RESULTS:Eleven relevant publications and two abstracts met the inclusion criteria.The efficacy of ExPRESS was similar to that of Trab in the percentage of IOP reduction(IOPR%)at 1,2y(WMD:-2.01;95%CI:-7.92-3.90;=0.50 and WMD:2.89;95%CI:-8.05-13.83;=0.60,respectively).Ex-PRESS possessed a significant higher complete and qualified success rate(OR:1.59;95%CI:1.07-2.35;=0.02 and OR:1.74;95%CI:1.06-2.86;=0.03,respectively).Moreover,Ex-PRESS exerted a significantly lower frequency of hypotony and hyphema than Trab(OR:0.39;95%CI:0.21-0.72;=0.003 and OR:0.27;95%CI:0.10-0.69;=0.003,respectively).However,there was no consistent result on the cost between the two groups according to the previous three studies.·C ONCLUSION:Both Trab and Ex-PRESS have equivalent efficacy in lowering IOP,yet Ex-PRESS had a lower risk of hypotony and hyphema than Trab.Nevertheless,whether the cost of Ex-PRESS was less than that of Trab should be further investigated to ensure evidence-based conclusion in the long run.
摘要Gas blowout occurred during drilling may cause catastrophic environmental hazards and economic losses.It is thus one of the important tasks to accurately determine the gas blowout volume so that an effective rescue plan can be worked out in case of gas blowout.In this paper,a numerical method for estimating the gas blowout volume was presented based on the Bernoulli Equation and the corresponding software was programmed.In the process of numerical estimation,the velocity distribution of the blowoutflame characterized by the axisymmetric laminarflow was investigated through an analysis of the dynamicflowing features of the gas gusher,and the relationship between the gas production of a well and the height of the blowoutflame was then analyzed with the Bernoulli Equation to obtain the numerical results of the gas blowout volume.The results were then compared with those laboratory measurements,and the software was revised based on the comparisons.Some conclusions were drawn.First,when the spout shape of a gusher is constant,the gas production is proportional to the height of the blowoutflame,and inversely proportional to the gas kinematic viscosity,the stoichiometric ratio factor and the oxygen concentration.Second,the errors be-tween the results estimated using the revised software and the laboratory measurements are within the allowable range,and the software can automatically generate a report.In a word,the method and software presented in this paper can be an effective technique for preparing a sound and safe rescue plan in case of gas blowout,and is of great significance in relieving the hazards of a well with uncontrolled blowout.
摘要Explicit traffic control measures are absent in uncontrolled intersections which make them susceptible to frequent conflicts and resulting collisions between vehicles. In developing countries like India, drivers at such intersections do not yield to higher priority movements which cause more crashes between vehicles. The objective of this study is to analyze and model the gap acceptance behavior of minor street drivers at uncontrolled T-intersections considering their aggressive nature. Three intersections in the northeast region of India have been selected as the case study area. Preliminary analysis of the data revealed that drivers behave aggressively, not because they have to wait for a long time at the stop line, but because of their lack of respect for traffic rules. Binary logit models are developed for minor road right turning vehicles which show that gap acceptance behavior is influenced by gap duration, clearing time and aggressive nature of drivers. The equations obtained were used to estimate the critical gaps for aggressive and non-aggressive drivers. Critical gaps are also calculated using an existing method called clearing behavior approach. It is also shown that the estimation of critical gap is more realistic if clearing time and aggressive behavior of drivers are considered.
摘要The most visible uncontrolled landfill sites were selected in the western and eastern parts of the territory of Georgia. Particularly, in eastern Georgia the regions of Mtskheta-Mtianeti and Kvemo Kartli have been researched;and in western Georgia Imereti and Samtskhe-Javakheti correspondingly. Both chemical and microbiological analyses were conducted in the samples taken from their adjacent territories. In case the landfill site is located near the river, during field works using portable equipment main physical-chemical indicators of surface waters were determined. After processing of the obtained results the corresponding estimations were provided. The risks due to the environmental pollution and negative impacts on population health were assessed.
摘要Objective To preliminarily evaluate the efficacy and safety of a domestically developed bilateral interventional ultrasound renal denervation (RDN) system in patients with uncontrolled hypertension despite antihypertensive medication.Methods A multicenter,single-arm trial was conducted.Patients with uncontrolled hypertension(≥2 antihypertensive drugs) were enrolled from April2023 to April 2024 at the Second Affiliated Hospital of Chongqing Medical University,West China Hospital of Sichuan University,and the Second Affiliated Hospital of Harbin Medical University.
基金Natural Science Basic Research Plan in Shaanxi Province,Grant/Award Number:2024JC-YBMS-399The Key Research and Development Plan of Shaanxi Province,Grant/Award Number:2023-YBGY-168+1 种基金The Basic Research Program for Natural Science of Shaanxi Province,Grant/Award Number:2022JZ-50The Independent Research Project of the State Key Laboratory of Oral and Maxill of acial Reconstruction and Regeneration,Grant/Award Number:2021ZA05。
摘要Effectively controlling deep non-compressible bleeding remains a major challenge.In this study,by mimicking nanofiber structure and netting blood cells function of fibrin network in blood clots,we develop a novel bioinspired quaternized chitosan nanofiber sponge with distinct blood cells filtration and blood plasma absorption bifunction for rapid hemostasis.The quaternized chitosan nanofiber sponge possesses a unique gradient pore structure with small pores on the outer surface and large pores in the inner part.The outer small pores effectively capture blood cells with a filtration efficiency as high as 91.7%,while the inner large pores endow with an ultrahigh liquid absorption capacity(93 g/g),surpassing previously reported literature records.The quaternized chitosan nanofiber sponge demonstrates a hemostasis time 2.5 times faster than that of the commercial gelatin®hemostatic sponge when treating the rat liver defect bleeding(noncompressible hemorrhage model).When applied to the rabbit arterial injury bleeding(lethal arterial hemorrhage model),the bioinspired nanofiber sponge achieves bleeding control within only 61.6 s,while both commercial gelatin®hemostatic sponge and commercial collagen®hemostatic sponge fail to stop bleeding even after 240 s.This bioinspired nanofiber sponge derived from the physiological coagulation process may hold great potential for pre-hospital and battlefield first aid.
基金supported by the National Natural Science Foundation of China(32170824 and 32322027 to X.M.)HRHI program of Westlake Laboratory of Life Sciences and Biomedicine(1011103360222B1 to X.M.)+1 种基金"Pioneer"and"Leading Goose"R&D Program of Zhejiang(2024SSYS0034)State Key Laboratory of Gene Expression.
摘要Tumors are defined by uncontrolled cell proliferation(Hariharan and Bilder,2006).Benign tumors are typically slow-growing and localized,while malignant ones are invasive and aggressive.The nuclear receptor Eip75B(E75),a heme-binding protein responsive to ecdysone signaling,encodes three major isoforms,E75A,E75B,and E75C(Bialecki et al.,2002),among them,only E75A and E75C contain zinc finger domains that enable DNA binding.
摘要Background Impaired coronary flow reserve(CFR)in patients with hypertension may be caused by epicardial coronary stenosis or microvascular dysfunction.Antihypertensive treatment has been shown to improve coronary microvascular dysfunction.The aim of this study was to evaluate the impact of uncontrolled blood pressure(BP)on diagnostic accuracy of CFR for detecting significant coronary stenosis.Methods A total of 98 hypertensive patients scheduled for coronary angiography(CAG)due to chest pain were studied.Of them,45 patients had uncontrolled BP(defined as the office BP〉140/90 mmHg(1 mmHg=0.133 kPa)in general hypertensive patients,or≥130/80 mmHg in hypertensive individuals with diabetes mellitus),and the remaining 53 patients had well-controlled BP.CFR was measured in the left anterior descending coronary artery(LAD)during adenosine triphosphate-induced hyperemia by non-invasive transthoracic Doppler echocardiography(TTDE)within 48 hours prior to CAG.Significant LAD stenosis was defined as〉70%luminal narrowing.Diagnostic accuracy of CFR for detecting significant coronary stenosis was analyzed with a receiver operating characteristic analysis.Results CFR was significantly lower in patients with uncontrolled BP than in those with well-controlled BP(2.1±0.6 vs.2.6±0.9,P〈0.01).Multivariate linear regression analysis of the study showed that the value of CFR was independently associated with the angiographically determined degree of LAD stenosis(β=-0.445,P〈0.0001)and the presence of uncontrolled BP(β=-0.272,P=0.014).With a receiver operating characteristic analysis,CFR〈2.2 was the optimal cut-off value for detecting LAD stenosis in all hypertensive patients(AUC 0.83,95%CI 0.75-0.91)with a sensitivity of 75%,a specificity of 78%,and an accuracy of 77%.A significant reduction of diagnostic specificity was observed in patients with uncontrolled BP compared with those with well-controlled BP(67%vs.93%,P=0.031).Conclusions CFR measurement by TTDE is valuable in the diagnosis of significant coronary stenosis in hypertensive patients.However,the diagnostic specificity is reduced in patients with uncontrolled BP.
基金The education and scientific research project of young and middle-aged teachers of Fujian Provincial Department of education(No.JAT171070).
摘要Purpose-In order to solve the problem that the performance of the existing local feature descriptors in uncontrolled environment is greatly affected by illumination,background,occlusion and other factors,we propose a novel face recognition algorithm in uncontrolled environment which combines the block central symmetry local binary pattern(CS-LBP)and deep residual network(DRN)model.Design/methodology/approach-The algorithm first extracts the block CSP-LBP features of the face image,then incorporates the extracted features into the DRN model,and gives the face recognition results by using a well-trained DRN model.The features obtained by the proposed algorithm have the characteristics of both local texture features and deep features that robust to illumination.Findings-Compared with the direct usage of the original image,the usage of local texture features of the image as the input of DRN model significantly improves the computation efficiency.Experimental results on the face datasets of FERET,YALE-B and CMU-PIE have shown that the recognition rate of the proposed algorithm is significantly higher than that of other compared algorithms.Originality/value-The proposed algorithm fundamentally solves the problem of face identity recognition in uncontrolled environment,and it is particularly robust to the change of illumination,which proves its superiority.
摘要Pelvic fractures carry a considerable risk for morbidity and mortality.Half or more of the early deaths in these patients have been attributed directly to haemorrhage.The transfusional requirements are four times higher for open pelvic fractures compared with a similar group of closed pelvic fractures.The loss of the tamponade effect by disruption of the pelvic soft tissues and the energy imparted play a central role in this potentially life threatening situation.We reported a case of open pelvic fracture in which persistent haemorrhage was stopped by giving recombinant activated coagulation factor Vlla as our last resort.
基金supported by Liaoning Province Science and Technology Plan Project,China(Grant No.:2022JH2/101300038)Liaoning Provincial Applied Basic Research Project,China(Grant No.:2022020255-JH2/1013)+6 种基金the National Natural Science Foundation of China of China(Grant Nos.:82104379/H3203 and 82104126/H3410)Liaoning Distinguished Professor Project(2017)Liaoning BaiQianWan Talents Program in 2019(A-37),ChinaLiaoning key Research and Development Program(2018),Chinathe Natural Science Funds of Liaoning Province,China(Grant No.:2021JH2/10300068)the Basic Scientific Research Project of Higher Education Department of Liaoning Province,China(Grant No.:LJ212410163036)Educational Commission of Liaoning Province of China,China(Grant No.:LJ212410163026).
摘要Chronic uncontrolled inflammation is a major risk factor driving the occurrence of hepatocellular carcinoma(HCC),with over half of global cases attributed to hepatitis B virus(HBV)infection.Persistent inflammation frequently progresses to cirrhosis and,ultimately,malignancy[1].Monitoring the key risk factors involved in the inflammatory-to-cancerous transformation in HCC is crucial for enabling timely intervention and improving patient survival rates.To address this challenge,we analyzed plasma samples collected from healthy volunteers and patients at various stages of HCC progression,including hepatitis,cirrhosis,and HCC(Approval No.:2021-IRBQYYS-021)(Tables S1–S5).
基金supported by the National Natural Science Foundation of China(No.50538080)the National Science Fund for Distinguished Young Scholars(No.50425825),China
摘要We investigated migration of pollutant at the base of the Suzhou landfill after it had been operated for 13 years.The investigation was carried out by performing chemical analyses on the soil samples taken from the silty clay deposit.Concentrations of chloride,chemical oxygen demand(COD)and the heavy metals in the soil samples were determined using the standard methods.The experimental data showed that the maximum migration depth of chloride was more than 10 m,while the maximum migration depth of COD varied between 1 and 3.5 m.It is believed that the difference is attributed to the variation in diffusion rate and leachate-soil interaction.The chloride profiles also indicated that adveetion may be the dominant contaminant transport mechanism at this site.The total contents ofCu,Pb and Cr are very close to the background levels and the concentration values of these metals mainly are lower than the threshold values specified by the Chinese soil quality standard and the European one.The water-extractable concentrations of COD in the surface of the silty clay generally exceed the limit value specified by the Chinese standard.The concentrations of copper and chromium in pore water are 1-2 orders of magnitude less than the total concentrations of these heavy metals within the soils,implying that heavy metals are mainly adsorbed by the soil particles.Finally,remediation methods were suggested for this landfill site.
基金This research was supported by the Deanship of Scientific Research,Islamic University of Madinah,Madinah(KSA),under Tammayuz program Grant Number 1442/505.
摘要This paper presents a large gathering dataset of images extracted from publicly filmed videos by 24 cameras installed on the premises of Masjid Al-Nabvi,Madinah,Saudi Arabia.This dataset consists of raw and processed images reflecting a highly challenging and unconstraint environment.The methodology for building the dataset consists of four core phases;that include acquisition of videos,extraction of frames,localization of face regions,and cropping and resizing of detected face regions.The raw images in the dataset consist of a total of 4613 frames obtained fromvideo sequences.The processed images in the dataset consist of the face regions of 250 persons extracted from raw data images to ensure the authenticity of the presented data.The dataset further consists of 8 images corresponding to each of the 250 subjects(persons)for a total of 2000 images.It portrays a highly unconstrained and challenging environment with human faces of varying sizes and pixel quality(resolution).Since the face regions in video sequences are severely degraded due to various unavoidable factors,it can be used as a benchmark to test and evaluate face detection and recognition algorithms for research purposes.We have also gathered and displayed records of the presence of subjects who appear in presented frames;in a temporal context.This can also be used as a temporal benchmark for tracking,finding persons,activity monitoring,and crowd counting in large crowd scenarios.
基金conducted under unrestricted educational grant of Servier Poland
摘要Objective To assess antihypertensive management of older patients with poor blood pressure(BP)control.Methods Physicians,voluntary participating in the study,included six consecutive hypertensive patients during routine visits.Hypertension had to have been previously recognized and averaged office BP was>140 and/or>90 mmHg in spite of>6 weeks of antihypertensive therapy.The physicians completed a questionnaire on patients'history of cardiovascular(CV)risk factors,comorbidities,home BP monitoring,anthropometric data and the pharmacotherapy.Results Mean age of the 6462 patients was 61 years,7%were>80 years,51%were female.Mean士SD office BP values were 158士13/92土10 mmHg.The most commonly prescribed antihypertensive drugs were:diuretics(67%),ACE inhibitors(64%),calcium channel blockers(58%)and卩-blockers(54%),and their use increased with age.On monotherapy or dual therapy,43%of the patients and 40%had their latest treatment modification within six months.Home BP monitoring was a factor that accelerated the modification of the therapy.Older patients had to have less chance on faster modification of antihypertensive therapy in spite of presence of diabetes and higher systolic BP.Conclusions Our study suggests that a large number of outpatients with poor BP control receive suboptimal antihypertensive therapy,especially in primary care.In older patients,higher BP values in the office settings are more frequently accepted by physicians even in case of higher CV risk.Regular home BP monitoring hastens the decision to intensify of antihypertensive treatment.
摘要In India, traffic flow on roads is highly mixed in nature with wide variations in the static and dynamic characteristics of vehicles. At unsignalized intersections, vehicles generally do not follow lane discipline and ignore the rules of priority. Drivers generally become more aggressive and tend to cross the uncontrolled intersections without considering the conflicting traffic. All these conditions cause a very complex traffic situation at unsignal- ized intersections which have a great impact on the capacity and performance of traffic intersections. A new method called additive conflict flow (ACF) method is suitable to determine the capacity of unsignalized inter- sections in non-lane-based mixed traffic conditions as prevailing in India. Occupation time is the key parameter for ACF method, which is defined as the time spent by a vehicle in the conflict area at the intersection. Data for this study were collected at two three-legged unsignalized intersections (one is uncontrolled and other one is semi- controlled) in Mangalore city, India using video-graphic technique during peak periods on three consecutive week days. The occupation time of vehicles at these intersections were studied and compared. The data on conflicting traffic volume and occupation time by each subject vehicle at the conflict area were extracted from the videos using image processing software. The subject vehicles were divided into three categories: two wheelers,cars, and auto-rickshaws. Mathematical relationships were developed to relate the occupation time of different cate- gories of vehicles with the conflicting flow of vehicles for various movements at both the intersections. It was found that occupation time increases with the increasing con- flicting traffic and observed to be higher at the uncontrolled intersection compared to the semicontrolled intersec- tion. The segregated turning movements and the presence of mini roundabout at the semicontrolled intersection reduces the conflicts of vehicular movements, which ulti- mately reduces the occupation time. The proposed methodology will be useful to determine the occupation time for various movements at unsignalized intersections. The models developed in the study can be used by practitioners and traffic engineers to estimate the capacity of unsignalized intersections in non-lane-based discipline and mixed traffic conditions.
摘要The Casablanca landfill is one among many uncontrolled dumping sites in Morocco with no bottom liner. About 4000 tons/day of solid wastes from mixed urban and industrial origins are placed directly on the fifteen old sandstone quarries. At the site of this landfill, the groundwaters circulate deeply (10 m) in the fractured aquiferous quartzites, the site has never been sealed before its opening. The aim of this study is the characterization the groundwater quality around the landfill, to delimit the contaminated zone and the factors controlling the extent of groundwater contamination. To evaluate groundwater pollution due to this landfill, piezometric level and geochemical analyses have been carried out on 19 wells. The results of geochemical analyses show an important qualitative degradation of the groundwater, especially in the parts situated in the down gradient area and in direct proximity to the landfill. In these polluted zones, we have observed the following values: higher than 11 mS/cm in electric conductivity, 1400 mg/L in bicarbonates, 275 mg/L in chemical oxygen demand, 2616 and 100 mg/L respectively in chlorides and sulfate, 269.5 mg/L in nitrates, 50 - 100 mg/L in cadmium, and 40 - 230 μg/L in chromium. These concentrations widely exceed the standard values for potable and irrigation water. Several determining factors in the evolution of groundwater contamination have been highlighted, such as: depth of the water table, permeability of unsaturated zone and lineaments, effective infiltration, absence of a system for leachate drainage. So, to reduce the pollution risks of the groundwater, it is necessary to set a system of collection, drainage and treatment of landfill leachates and to emplace an impermeable surface at the site of landfill, in order to limit the infiltration of leachate.
摘要Background:Occupational burnout is associated with diminished psychological flexibility and higher emotional(EE)and uncontrolled eating(UE).Psychological flexibility could be a mediating factor between burnout and eating behaviour.Objectives:To investigate differences in eating behaviour between those with different levels of psychological flexibility,and the association of the interaction between psychological flexibility and occupational burnout with eating behaviour.Design:The participants were working women(n=263),who took part in the randomized controlled health intervention trial.Analyses were performed in a cross-sectional setting at baseline.Methods:Eating behaviour was measured using the Three Factor Eating Behaviour Questionnaire-18[which evaluates EE,UE and cognitive restraint(CR)],psychological flexibility using Acceptance and Action Questionnaire-II and occupational burnout using Bergen Burnout Indicator-15.Participants were divided into four groups based on the quartile points of psychological flexibility.Results:The EE of those who were inflexible was higher than that of those whose flexibility was high moderate(p=0.013)and who were flexible(p=0.001).The UE of those who were inflexible was higher than the UE in the other groups with higher flexibility[low moderate(p=0.034),high moderate(p een occupational burnout and EE and UE.Multivariate analysis of variances revealed that the combination of psychological flexibility and burnout had a stronger association with the variances of EE and UE than psychological flexibility alone.Conclusions:Persons who are psychologically inflexible have higher EE and UE.Future studies should investigate if increasing psychological flexibility helps decrease EE and UE.
基金supported by the Natural Science Foundation of Tianjin (No.09JCZDJC26800)the National Natural Science Foundation of China (No.10632040)
摘要The chaotic dynamics of the transport equation for the L-mode to H-mode near the plasma in a tokamak is studied in detail with the Melnikov method. The transport equations represent a system with external and parametric excitation. The critical curves separating the chaotic regions and nonchaotic regions are presented for the system with periodically external excitation and linear parametric excitation, or cubic parametric excitation, respectively. The results obtained here show that there exist uncontrollable regions in which chaos always take place via heteroclinic bifurcation for the system with linear or cubic parametric excitation. Especially, there exists a controllable frequency, excited at which chaos does not occur via homoclinic bifurcation no matter how large the excitation amplitude is for the system with cubic parametric excitation. Some complicated dynamical behaviors are obtained for this class of systems.