目的构建老年胃肠镜检查患者苏醒延迟风险预测模型,并验证模型临床应用价值。方法本研究选取2020年1月—2025年1月首都医科大学附属北京友谊医院收治的450例拟行胃肠镜检查的老年患者为研究对象,按照7∶3比例分别纳入训练集(n=315)、验...目的构建老年胃肠镜检查患者苏醒延迟风险预测模型,并验证模型临床应用价值。方法本研究选取2020年1月—2025年1月首都医科大学附属北京友谊医院收治的450例拟行胃肠镜检查的老年患者为研究对象,按照7∶3比例分别纳入训练集(n=315)、验证集(n=135)。按照训练集患者苏醒延迟情况,将其分别纳入延迟组、非延迟组,比较2组患者临床资料。使用logistic多因素回归模型分析影响老年胃肠镜检查患者苏醒延迟的相关因素。基于相关因素构建风险预测Nomogram图,使用受试者工作特征(ROC)曲线评估模型区分效能,使用校准曲线和Hosmer-Lemeshow拟合优度检验评估模型一致性,使用决策曲线分析评估模型临床净收益。结果老年胃肠镜检查患者中共有81例发生苏醒延迟,发生率为18.00%。其中,训练集中57例患者发生苏醒延迟,验证集中24例患者发生苏醒延迟,发生率分别为18.10%、17.78%。多因素logistic回归分析显示,年龄≥75岁(OR=3.152,95%CI:1.667~5.960)、麻醉时长≥45 min(OR=4.011,95%CI:2.223~7.235)、术中输液量≥1500 m L(OR=2.532,95%CI:1.393~4.603)、美国麻醉师协会(ASA)分级Ⅲ级(OR=2.875,95%CI:1.526~5.414)、术中低体温(OR=2.790,95%CI:1.514~5.142)是老年胃肠镜检查患者苏醒延迟的独立危险因素(P<0.05)。基于影响因素建立的列线图模型内部验证结果显示,训练集、验证集曲线下面积(AUC)分别为0.892(95%CI:0.851~0.933)、0.878(95%CI:0.817~0.939)。校准曲线显示预测概率与实际发生概率具有良好的一致性。Hosmer-Lemeshow拟合优度检验在训练集(χ^(2)=8.150,P=0.419)和验证集(χ^(2)=6.980,P=0.539)中均表明模型校准度良好。决策曲线分析显示,当风险阈值概率在0.10~0.75时,使用该模型进行干预决策的净收益高于“全员干预”或“全员不干预”策略。结论老年胃肠镜检查患者苏醒延迟风险较高,且受年龄、麻醉时长、术中输液量、ASA分级、术中低体温等多种因素影响,基于上述因素建立的风险预测模型能够为高危个体的识别提供可靠参考依据。展开更多
目的了解国际医疗护理员的研究现状,探讨主题领域内热点趋势,为我国医疗护理员领域的研究提供参考。方法检索Web of Science核心合集数据库中医疗护理员为主题的相关文献,采用Co-Occurrence14.5提取高频关键词生成词篇矩阵,应用gCluto2....目的了解国际医疗护理员的研究现状,探讨主题领域内热点趋势,为我国医疗护理员领域的研究提供参考。方法检索Web of Science核心合集数据库中医疗护理员为主题的相关文献,采用Co-Occurrence14.5提取高频关键词生成词篇矩阵,应用gCluto2.0聚类工具包进行双聚类分析。结果共纳入文献10429篇,年发文量整体呈上升趋势,美国、日本、英国位居发文总量前3位。共提取30个高频主题词,形成医疗护理员的专业发展及护理质量的提升研究、医疗护理员在重点人群的健康干预研究、医疗护理员与特定健康领域的研究、医疗护理员护理质量与健康结局的关联性研究4个聚类。结论国际医疗护理员相关研究已形成以护理质量与健康结局关联性为核心的热点聚类,并呈现出体系化、专业化的发展趋势。我国可结合人口结构变化和医疗卫生体系特点,深入开展符合国情的实证研究,推动我国医疗护理员群体的科学化、可持续发展。展开更多
Deformations in high fill foundations comprising soil–stone mixtures must be accurately predicted to ensure construction quality and long-term operational safety.However,existing computational and analytical methods ...Deformations in high fill foundations comprising soil–stone mixtures must be accurately predicted to ensure construction quality and long-term operational safety.However,existing computational and analytical methods inadequately capture their complex mechanical behavior.We conducted a series of triaxial tests on unsaturated soil samples collected from a high fill project site in northwestern China under three stress paths.The incremental nonlinear and elastoplastic constitutive models for unsaturated soils were modified,and a calculation method was developed for the vertical and lateral deformations of high fill foundations using the layered summation approach.The results indicate that for soil samples with the same mixing ratio(m)and compaction coefficient(n),the strength of the sample and its tendency to exhibit shear dilation increase with the net confining pressure or matric suction.Additionally,the stress–strain curve of the soil sample gradually changes from the strain-hardening type to the ideal elastoplastic type as the compaction coefficient increases.Moreover,the compaction coefficient is an important factor influencing the magnitude of yield stress and yield suction in soil samples,and the yield points of both are similar in shape to the loadingcollapse(LC)and suction increase(SI)yield lines obtained using the Barcelona model in the net mean stress-generalized shear stress(p-s)plane,respectively.The modified incremental nonlinear instantaneous model simultaneously considers the effects of the compaction coefficient,suction and mixing ratio,and the model parameter can be simplified to the tangential modulus expression in the Duncan-Chang model when the suction is zero.Furthermore,the modified elastoplastic constitutive model,which considers the effects of the net mean stress,suction and partial stress,can be simplified to the elastoplastic constitutive relationship of saturated soil when the suction is zero.The proposed deformation calculation method,based on the layered summation theory,is applicable to both elastic and elastoplastic foundation states,as confirmed through numerical simulations.Our work can be used as a reference for the calculation of foundation deformation in similar mixed material high fill projects.展开更多
目的探究磁珠富集联合高通量酶联免疫吸附试验对血站血液质量控制的应用价值,为血站血液传染病筛查提供更优的检测方案。方法将2023年1月—2025年1月血站采取的100份血液标本作为观察对象,按检测方法分为对照组与观察组,各50份。对照组...目的探究磁珠富集联合高通量酶联免疫吸附试验对血站血液质量控制的应用价值,为血站血液传染病筛查提供更优的检测方案。方法将2023年1月—2025年1月血站采取的100份血液标本作为观察对象,按检测方法分为对照组与观察组,各50份。对照组采用单纯高通量酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)检测,观察组采用磁珠富集联合高通量ELISA检测,分析其对人类获得性免疫缺陷病毒(human acquired immunodeficiency virus,HIV)抗体、丙型肝炎病毒(hepatitis C virus,HCV)抗体、梅毒螺旋体(treponema pallidum,TP)抗体、乙型肝炎病毒(hepatitis B virus,HBV)乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)的检测结果,比较2种检查方法的安全性、阳性检出率、灵敏度、特异度、诊断符合率、约登指数诊断效能指标及检验失误率。结果100份血液标本中,使用蛋白印迹法检出阳性11份、阴性89份,观察组阳性检出率、特异度分别为100%、94.87%,高于对照组的72.73%、83.33%,差异无统计学意义(P>0.05)。观察组灵敏度、诊断符合率分别为81.82%、36.36%,高于对照组的36.36%、78.00%,差异有统计学意义(P<0.05)。观察组各检测环节失误率均为0,总失误率为0,低于对照组的6.00%,差异有统计学意义(P<0.05)。2组在检测过程均无生物安全隐患。结论磁珠富集联合高通量ELISA检验法可进一步提升血站血液传染病的检出率与诊断准确率,降低检验失误率,相较于单纯高通量ELISA更具检测优势,对血站血液质量控制和标准化实验室建设具有更高的实践意义。展开更多
文摘目的构建老年胃肠镜检查患者苏醒延迟风险预测模型,并验证模型临床应用价值。方法本研究选取2020年1月—2025年1月首都医科大学附属北京友谊医院收治的450例拟行胃肠镜检查的老年患者为研究对象,按照7∶3比例分别纳入训练集(n=315)、验证集(n=135)。按照训练集患者苏醒延迟情况,将其分别纳入延迟组、非延迟组,比较2组患者临床资料。使用logistic多因素回归模型分析影响老年胃肠镜检查患者苏醒延迟的相关因素。基于相关因素构建风险预测Nomogram图,使用受试者工作特征(ROC)曲线评估模型区分效能,使用校准曲线和Hosmer-Lemeshow拟合优度检验评估模型一致性,使用决策曲线分析评估模型临床净收益。结果老年胃肠镜检查患者中共有81例发生苏醒延迟,发生率为18.00%。其中,训练集中57例患者发生苏醒延迟,验证集中24例患者发生苏醒延迟,发生率分别为18.10%、17.78%。多因素logistic回归分析显示,年龄≥75岁(OR=3.152,95%CI:1.667~5.960)、麻醉时长≥45 min(OR=4.011,95%CI:2.223~7.235)、术中输液量≥1500 m L(OR=2.532,95%CI:1.393~4.603)、美国麻醉师协会(ASA)分级Ⅲ级(OR=2.875,95%CI:1.526~5.414)、术中低体温(OR=2.790,95%CI:1.514~5.142)是老年胃肠镜检查患者苏醒延迟的独立危险因素(P<0.05)。基于影响因素建立的列线图模型内部验证结果显示,训练集、验证集曲线下面积(AUC)分别为0.892(95%CI:0.851~0.933)、0.878(95%CI:0.817~0.939)。校准曲线显示预测概率与实际发生概率具有良好的一致性。Hosmer-Lemeshow拟合优度检验在训练集(χ^(2)=8.150,P=0.419)和验证集(χ^(2)=6.980,P=0.539)中均表明模型校准度良好。决策曲线分析显示,当风险阈值概率在0.10~0.75时,使用该模型进行干预决策的净收益高于“全员干预”或“全员不干预”策略。结论老年胃肠镜检查患者苏醒延迟风险较高,且受年龄、麻醉时长、术中输液量、ASA分级、术中低体温等多种因素影响,基于上述因素建立的风险预测模型能够为高危个体的识别提供可靠参考依据。
文摘目的了解国际医疗护理员的研究现状,探讨主题领域内热点趋势,为我国医疗护理员领域的研究提供参考。方法检索Web of Science核心合集数据库中医疗护理员为主题的相关文献,采用Co-Occurrence14.5提取高频关键词生成词篇矩阵,应用gCluto2.0聚类工具包进行双聚类分析。结果共纳入文献10429篇,年发文量整体呈上升趋势,美国、日本、英国位居发文总量前3位。共提取30个高频主题词,形成医疗护理员的专业发展及护理质量的提升研究、医疗护理员在重点人群的健康干预研究、医疗护理员与特定健康领域的研究、医疗护理员护理质量与健康结局的关联性研究4个聚类。结论国际医疗护理员相关研究已形成以护理质量与健康结局关联性为核心的热点聚类,并呈现出体系化、专业化的发展趋势。我国可结合人口结构变化和医疗卫生体系特点,深入开展符合国情的实证研究,推动我国医疗护理员群体的科学化、可持续发展。
基金funded by the National Natural Science Foundation of China(Grant Nos.52368049,52168051,and 42462028)Lanzhou Young Scientific and Technological Talents Innovation Project(Grant Nos.2023-QN-27 and 2023-QN-52)Major Project of the Joint Scientific Research Fund of Gansu Province(Grant No.25JRRL007)。
文摘Deformations in high fill foundations comprising soil–stone mixtures must be accurately predicted to ensure construction quality and long-term operational safety.However,existing computational and analytical methods inadequately capture their complex mechanical behavior.We conducted a series of triaxial tests on unsaturated soil samples collected from a high fill project site in northwestern China under three stress paths.The incremental nonlinear and elastoplastic constitutive models for unsaturated soils were modified,and a calculation method was developed for the vertical and lateral deformations of high fill foundations using the layered summation approach.The results indicate that for soil samples with the same mixing ratio(m)and compaction coefficient(n),the strength of the sample and its tendency to exhibit shear dilation increase with the net confining pressure or matric suction.Additionally,the stress–strain curve of the soil sample gradually changes from the strain-hardening type to the ideal elastoplastic type as the compaction coefficient increases.Moreover,the compaction coefficient is an important factor influencing the magnitude of yield stress and yield suction in soil samples,and the yield points of both are similar in shape to the loadingcollapse(LC)and suction increase(SI)yield lines obtained using the Barcelona model in the net mean stress-generalized shear stress(p-s)plane,respectively.The modified incremental nonlinear instantaneous model simultaneously considers the effects of the compaction coefficient,suction and mixing ratio,and the model parameter can be simplified to the tangential modulus expression in the Duncan-Chang model when the suction is zero.Furthermore,the modified elastoplastic constitutive model,which considers the effects of the net mean stress,suction and partial stress,can be simplified to the elastoplastic constitutive relationship of saturated soil when the suction is zero.The proposed deformation calculation method,based on the layered summation theory,is applicable to both elastic and elastoplastic foundation states,as confirmed through numerical simulations.Our work can be used as a reference for the calculation of foundation deformation in similar mixed material high fill projects.
文摘目的探究磁珠富集联合高通量酶联免疫吸附试验对血站血液质量控制的应用价值,为血站血液传染病筛查提供更优的检测方案。方法将2023年1月—2025年1月血站采取的100份血液标本作为观察对象,按检测方法分为对照组与观察组,各50份。对照组采用单纯高通量酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)检测,观察组采用磁珠富集联合高通量ELISA检测,分析其对人类获得性免疫缺陷病毒(human acquired immunodeficiency virus,HIV)抗体、丙型肝炎病毒(hepatitis C virus,HCV)抗体、梅毒螺旋体(treponema pallidum,TP)抗体、乙型肝炎病毒(hepatitis B virus,HBV)乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)的检测结果,比较2种检查方法的安全性、阳性检出率、灵敏度、特异度、诊断符合率、约登指数诊断效能指标及检验失误率。结果100份血液标本中,使用蛋白印迹法检出阳性11份、阴性89份,观察组阳性检出率、特异度分别为100%、94.87%,高于对照组的72.73%、83.33%,差异无统计学意义(P>0.05)。观察组灵敏度、诊断符合率分别为81.82%、36.36%,高于对照组的36.36%、78.00%,差异有统计学意义(P<0.05)。观察组各检测环节失误率均为0,总失误率为0,低于对照组的6.00%,差异有统计学意义(P<0.05)。2组在检测过程均无生物安全隐患。结论磁珠富集联合高通量ELISA检验法可进一步提升血站血液传染病的检出率与诊断准确率,降低检验失误率,相较于单纯高通量ELISA更具检测优势,对血站血液质量控制和标准化实验室建设具有更高的实践意义。
