目的:探讨尿液脂阿拉伯甘露聚糖(lipoarabinomannan,LAM)抗原检测对肺外结核患者的诊断价值。方法:连续收集2023年4月至2024年6月于杭州市红十字会医院就诊的92例疑似肺外结核患者的尿液样本进行LAM抗原检测,且对相应病灶部位样本进行Ge...目的:探讨尿液脂阿拉伯甘露聚糖(lipoarabinomannan,LAM)抗原检测对肺外结核患者的诊断价值。方法:连续收集2023年4月至2024年6月于杭州市红十字会医院就诊的92例疑似肺外结核患者的尿液样本进行LAM抗原检测,且对相应病灶部位样本进行GeneXpert MTB/RIF(简称“Xpert”)检测。以临床综合诊断为参考标准,比较两种方法单独及联合检测对肺外结核的诊断效能。结果:以临床综合诊断结果为标准,尿液LAM抗原和Xpert检测肺外结核的敏感度、特异度和受试者工作特征曲线下面积(area under curve,AUC)分别为49.3%(95%CI:36.8%~61.8%)、92.0%(95%CI:74.0%~99.0%)、0.706(95%CI:0.602~0.797)和49.3%(95%CI:36.8%~61.8%)、100.0%(95%CI:86.3%~100.0%)、0.746(95%CI:0.645~0.831)。尿液LAM抗原联合Xpert检测肺外结核的敏感度为73.1%(95%CI:60.9%~83.2%),高于尿液LAM抗原检测和Xpert检测,差异均有统计学意义(χ^(2)=27.672,P<0.001;χ^(2)=17.576,P<0.001);AUC为0.826(95%CI:0.733~0.897),高于尿液LAM抗原检测和Xpert检测,差异均有统计学意义(Z=1.602,P<0.001;Z=4.175,P=0.037)。结论:尿液LAM抗原检测在肺外结核的诊断中具有一定的应用前景,联合Xpert可以提高检测的敏感度,提升在肺外结核诊断中的应用价值。展开更多
To overcome the influence of the nonlinear friction on the gimbaled servo-system of an inertial stabilized platforms(ISPs)with DC motor direct-drive,the methods of modeling and compensation of the nonlinear friction a...To overcome the influence of the nonlinear friction on the gimbaled servo-system of an inertial stabilized platforms(ISPs)with DC motor direct-drive,the methods of modeling and compensation of the nonlinear friction are proposed.Firstly,the inapplicability of LuGre model when trying to interpret the backward angular displacement in the prestiction regime is observed experimentally and the reason is deduced theoretically.Then,based on the dynamic model of direct-drive ISPs,a modified LuGre model is proposed to describe the characteristic of the friction in the prestiction regime.Furthermore,the state switch condition of the three friction regimes including presliding,gross sliding and prestiction is presented.Finally,a composite compensation controller including a nonlinear friction observer and a feedforward compensator based on the novel LuGre model is designed to restrain the nonlinear friction and to improve the control precision.Experimental results indicate that compared with those of the conventional proportion-integrationdifferentiation(PID)control method and the PID plus LuGre model-based friction compensation method,the dwell-time has decreased from 0.2 s to almost 0 s,the position error decreased to 86.7%and the peak-to-peak value of position error decreased to 80%after the novel compensation controller is added.It concludes that the composite compensation controller can greatly improve the control precision of the dynamic sealed ISPs.展开更多
目的分析结核重症监护室（ICU）中胞内分枝杆菌肺病与脓肿分枝杆菌肺病患者的临床特征，为临床诊治提供依据。方法回顾性分析2012年1月至2017年5月杭州市红十字会结核ICU收治的非结核分枝杆菌肺病（NTM）患者74例的临床资料。其中脓肿...目的分析结核重症监护室（ICU）中胞内分枝杆菌肺病与脓肿分枝杆菌肺病患者的临床特征，为临床诊治提供依据。方法回顾性分析2012年1月至2017年5月杭州市红十字会结核ICU收治的非结核分枝杆菌肺病（NTM）患者74例的临床资料。其中脓肿分枝杆菌肺病患者54例，胞内分枝杆菌肺病患者16例，鸟分枝杆菌和堪萨斯分枝杆菌肺病患者各2例。对胞内分枝杆菌及脓肿分枝杆菌肺病复合群感染重症患者的临床特征、影像学表现、治疗与预后等情况进行分析。采用SPSS21．0软件对数据进行分析。采用Graph Pad PrismV5．01进行生存曲线分析。结果74例NTM肺病患者中，脓肿分枝杆菌感染率为72．87％（54／74），胞内分枝杆菌的感染率为21．62％（16／74）。胞内分枝杆菌肺病患者的年龄和入住ICU时间明显低于脓肿分枝杆菌肺病患者（t=-2．729和-6．150，P〈0．05或〈0．01），但两组性别分布、APACHEII评分比较，差异均无统计学意义（P值均〉0．05）。在基础疾病方面，胞内分枝杆菌肺病患者慢性阻塞性肺疾病（COPD）的比例明显低于脓肿分枝杆菌肺病患者（x2=3．902，P〈0．05），而支气管扩张比例明显多于脓肿分枝杆菌肺病患者（x2=23．888，P〈0．01）。在合并症方面，脓肿分枝杆菌肺病患者合并脑卒中后遗症、帕金森症等中枢神经系统疾病（x2=14．872，P〈0．01）及糖尿病（x2=3．902，P〈0．05）的比例显著高于胞内分枝杆菌肺病患者，而合并咯血的比例明显低于胞内分枝杆菌肺病患者（x2=9．717，P〈0．01）。胞内分枝杆菌肺病患者入住ICU主要原因为呼吸衰竭（93．75％）和感染性休克（6．25％），而脓肿分枝杆菌肺病患者为呼吸衰竭（90．74％）、心衰竭（11．11％）和肾衰竭（1．85％），两组患者入住ICU原因比较，差异均无统计学意义（P值均〉0．05）。胞内分枝杆菌肺病组患者在机械通气前分离出NTM的比例明显高于脓肿分枝杆菌肺病组患者（x2=30．366，P〈0．01）。在影像学方面，胞内分枝杆菌肺病组支气管扩张比例明显高于脓肿分枝杆菌肺病组（x2=23．888，P〈0．01）。两组患者28d病死率比较，差异无统计学意义（x2=3．244，P〉0．05），而胞内分枝杆菌肺病组患者120d内生存率明显高于脓肿分枝杆菌肺病组患者（x2=12．780，P〈0．01）。结论当重症患者痰抗酸染色阳性时，须考虑NTM肺病可能。对于长期机械通气的重症患者须首先考虑脓肿分枝杆菌感染。展开更多
This paper addresses double-loop robust tracking controller design of the miniaturized linear motor drive precision stage with mass and damping ratio uncertainties. As an inner-loop, a disturbance observer （DOB） is ...This paper addresses double-loop robust tracking controller design of the miniaturized linear motor drive precision stage with mass and damping ratio uncertainties. As an inner-loop, a disturbance observer （DOB） is employed to suppress exogenous low frequency disturbances such as friction and cutting force. To further eliminate the residual disturbance and to guarantee the robust tracking to the reference input, μ-synthesis outer-loop controller is designed. For eliminating the steady state error, a technique is proposed to design the μ-synthesis outer-loop controller with an integrator. A guideline to select the bandwidth of the Q-filter in the DOB is provided. Simulations using a model of a prototype micro-milling machine indicate that the proposed outer-loop synthesis scheme is superior to the H∞ suboptimal control in disturbance rejection performance and steady state tracking performance. Furthermore, it is shown experimentally that the proposed double-loop robust tracking controller improves the tracking performance of the stage by 29.6% over PID control with a DOB inner-loop.展开更多
文摘目的:探讨尿液脂阿拉伯甘露聚糖(lipoarabinomannan,LAM)抗原检测对肺外结核患者的诊断价值。方法:连续收集2023年4月至2024年6月于杭州市红十字会医院就诊的92例疑似肺外结核患者的尿液样本进行LAM抗原检测,且对相应病灶部位样本进行GeneXpert MTB/RIF(简称“Xpert”)检测。以临床综合诊断为参考标准,比较两种方法单独及联合检测对肺外结核的诊断效能。结果:以临床综合诊断结果为标准,尿液LAM抗原和Xpert检测肺外结核的敏感度、特异度和受试者工作特征曲线下面积(area under curve,AUC)分别为49.3%(95%CI:36.8%~61.8%)、92.0%(95%CI:74.0%~99.0%)、0.706(95%CI:0.602~0.797)和49.3%(95%CI:36.8%~61.8%)、100.0%(95%CI:86.3%~100.0%)、0.746(95%CI:0.645~0.831)。尿液LAM抗原联合Xpert检测肺外结核的敏感度为73.1%(95%CI:60.9%~83.2%),高于尿液LAM抗原检测和Xpert检测,差异均有统计学意义(χ^(2)=27.672,P<0.001;χ^(2)=17.576,P<0.001);AUC为0.826(95%CI:0.733~0.897),高于尿液LAM抗原检测和Xpert检测,差异均有统计学意义(Z=1.602,P<0.001;Z=4.175,P=0.037)。结论:尿液LAM抗原检测在肺外结核的诊断中具有一定的应用前景,联合Xpert可以提高检测的敏感度,提升在肺外结核诊断中的应用价值。
基金co-supported by the National Natural Science Foundation of China(Nos.51135009 and 51105371)
文摘To overcome the influence of the nonlinear friction on the gimbaled servo-system of an inertial stabilized platforms(ISPs)with DC motor direct-drive,the methods of modeling and compensation of the nonlinear friction are proposed.Firstly,the inapplicability of LuGre model when trying to interpret the backward angular displacement in the prestiction regime is observed experimentally and the reason is deduced theoretically.Then,based on the dynamic model of direct-drive ISPs,a modified LuGre model is proposed to describe the characteristic of the friction in the prestiction regime.Furthermore,the state switch condition of the three friction regimes including presliding,gross sliding and prestiction is presented.Finally,a composite compensation controller including a nonlinear friction observer and a feedforward compensator based on the novel LuGre model is designed to restrain the nonlinear friction and to improve the control precision.Experimental results indicate that compared with those of the conventional proportion-integrationdifferentiation(PID)control method and the PID plus LuGre model-based friction compensation method,the dwell-time has decreased from 0.2 s to almost 0 s,the position error decreased to 86.7%and the peak-to-peak value of position error decreased to 80%after the novel compensation controller is added.It concludes that the composite compensation controller can greatly improve the control precision of the dynamic sealed ISPs.
文摘目的分析结核重症监护室（ICU）中胞内分枝杆菌肺病与脓肿分枝杆菌肺病患者的临床特征，为临床诊治提供依据。方法回顾性分析2012年1月至2017年5月杭州市红十字会结核ICU收治的非结核分枝杆菌肺病（NTM）患者74例的临床资料。其中脓肿分枝杆菌肺病患者54例，胞内分枝杆菌肺病患者16例，鸟分枝杆菌和堪萨斯分枝杆菌肺病患者各2例。对胞内分枝杆菌及脓肿分枝杆菌肺病复合群感染重症患者的临床特征、影像学表现、治疗与预后等情况进行分析。采用SPSS21．0软件对数据进行分析。采用Graph Pad PrismV5．01进行生存曲线分析。结果74例NTM肺病患者中，脓肿分枝杆菌感染率为72．87％（54／74），胞内分枝杆菌的感染率为21．62％（16／74）。胞内分枝杆菌肺病患者的年龄和入住ICU时间明显低于脓肿分枝杆菌肺病患者（t=-2．729和-6．150，P〈0．05或〈0．01），但两组性别分布、APACHEII评分比较，差异均无统计学意义（P值均〉0．05）。在基础疾病方面，胞内分枝杆菌肺病患者慢性阻塞性肺疾病（COPD）的比例明显低于脓肿分枝杆菌肺病患者（x2=3．902，P〈0．05），而支气管扩张比例明显多于脓肿分枝杆菌肺病患者（x2=23．888，P〈0．01）。在合并症方面，脓肿分枝杆菌肺病患者合并脑卒中后遗症、帕金森症等中枢神经系统疾病（x2=14．872，P〈0．01）及糖尿病（x2=3．902，P〈0．05）的比例显著高于胞内分枝杆菌肺病患者，而合并咯血的比例明显低于胞内分枝杆菌肺病患者（x2=9．717，P〈0．01）。胞内分枝杆菌肺病患者入住ICU主要原因为呼吸衰竭（93．75％）和感染性休克（6．25％），而脓肿分枝杆菌肺病患者为呼吸衰竭（90．74％）、心衰竭（11．11％）和肾衰竭（1．85％），两组患者入住ICU原因比较，差异均无统计学意义（P值均〉0．05）。胞内分枝杆菌肺病组患者在机械通气前分离出NTM的比例明显高于脓肿分枝杆菌肺病组患者（x2=30．366，P〈0．01）。在影像学方面，胞内分枝杆菌肺病组支气管扩张比例明显高于脓肿分枝杆菌肺病组（x2=23．888，P〈0．01）。两组患者28d病死率比较，差异无统计学意义（x2=3．244，P〉0．05），而胞内分枝杆菌肺病组患者120d内生存率明显高于脓肿分枝杆菌肺病组患者（x2=12．780，P〈0．01）。结论当重症患者痰抗酸染色阳性时，须考虑NTM肺病可能。对于长期机械通气的重症患者须首先考虑脓肿分枝杆菌感染。
基金supported by the Canada Foundation for Innovation (CFI) and the National Natural Science Foundation of China (Grant No.50875257)
文摘This paper addresses double-loop robust tracking controller design of the miniaturized linear motor drive precision stage with mass and damping ratio uncertainties. As an inner-loop, a disturbance observer （DOB） is employed to suppress exogenous low frequency disturbances such as friction and cutting force. To further eliminate the residual disturbance and to guarantee the robust tracking to the reference input, μ-synthesis outer-loop controller is designed. For eliminating the steady state error, a technique is proposed to design the μ-synthesis outer-loop controller with an integrator. A guideline to select the bandwidth of the Q-filter in the DOB is provided. Simulations using a model of a prototype micro-milling machine indicate that the proposed outer-loop synthesis scheme is superior to the H∞ suboptimal control in disturbance rejection performance and steady state tracking performance. Furthermore, it is shown experimentally that the proposed double-loop robust tracking controller improves the tracking performance of the stage by 29.6% over PID control with a DOB inner-loop.
