Objective To examine national trends in antibiotic consumption and antimicrobial resistance(AMR)among six WHO-priority bacterial pathogens in China from 2016 to 2022.Methods This ecological study analyzed national and...Objective To examine national trends in antibiotic consumption and antimicrobial resistance(AMR)among six WHO-priority bacterial pathogens in China from 2016 to 2022.Methods This ecological study analyzed national and provincial data from the China Antibacterial Resistance Surveillance System(CARSS)and the National Hospital Information Network.Beta regression models assessed temporal trends,and hierarchical models evaluated associations between antibiotic use and resistance.Results From 2016 to 2022,carbapenem resistance in Acinetobacter baumannii and Pseudomonas aeruginosa,and vancomycin resistance in Enterococcus faecium and E.faecalis significantly declined(β<0,P<0.010),while carbapenem-resistant Klebsiella pneumoniae increased(β=0.081,P<0.001).Nationwide antibiotic consumption rose across 10 major classes.Positive associations were found between carbapenem use and resistance in A.baumannii(z=2.719,P=0.007)and P.aeruginosa(z=3.241,P=0.001),and between vancomycin use and resistance in E.faecium(z=4.510,P=0.001)and E.faecalis(z=3.210,P=0.001).Conclusion Carbapenem-resistant K.pneumoniae increased significantly in China,while other resistant pathogens declined.Resistance patterns were linked to the use of multiple antibiotic classes,underscoring the need for strengthened antibiotic stewardship and surveillance.展开更多
目的:评估超声内镜引导下细针穿刺(endoscopic ultrasound-guided fine needle aspiration,EUS-FNA)在胆管病变中的诊断效能和安全性,并探讨影响其准确性的因素。方法:回顾性分析2021年1月到2023年12月成都市第三人民医院因疑似胆管恶...目的:评估超声内镜引导下细针穿刺(endoscopic ultrasound-guided fine needle aspiration,EUS-FNA)在胆管病变中的诊断效能和安全性,并探讨影响其准确性的因素。方法:回顾性分析2021年1月到2023年12月成都市第三人民医院因疑似胆管恶性狭窄/占位而接受EUS-FNA的41例患者临床资料,其中男性22例,女性19例,平均年龄为65.9(35.0~89.0)岁。评估其诊断效能(敏感性、特异性、阳性预测值、阴性预测值和准确性)及影响因素。结果:EUS-FNA对于胆管病变的总体灵敏性为85%,特异性为100%,阳性预测值为100%,阴性预测值为33%,准确性为86%;25G穿刺针和是否存在实性占位是影响EUS-FNA诊断胆管病变准确性的重要因素,而穿刺部位并未对诊断效能产生影响,参与分析的41例患者在随访期间未发现与EUS-FNA相关不良事件。结论:EUS-FNA在诊断胆管病变时具有较高的准确性和安全性,特别是使用25G穿刺针及存在胆管实性占位时,EUSFNA的诊断准确性更高。展开更多
Objective: To investigate the application and feasibility of PDCA circulation method in the treatment of patients with severe neurological diseases in Internet + smart first aid, with a view to promoting the sustainab...Objective: To investigate the application and feasibility of PDCA circulation method in the treatment of patients with severe neurological diseases in Internet + smart first aid, with a view to promoting the sustainable construction of smart first aid. Methods: A total of 105 patients with severe neurological diseases in Zhuji people’s Hospital and cooperative units were selected, and 52 cases in the research group and 53 cases in the control group were divided according to the single and double number visiting time: In this paper, through reading the literature, the development of Internet + wisdom first aid treatment of patients with severe neurological diseases was investigated, and the common problems were analyzed and summarized, and the research group used the PDCA circulation method to sort out the existing problems, analyze the causes of the problems and improve them. The difference in treatment time between the two groups was compared, and the patient’s satisfaction was evaluated for the time of being transferred to the hospital emergency room by 120 ambulances, the time from emergency admission to surgery (Cath lab), and the satisfaction of the patient. Results: The time from emergency treatment to the operation room (catheter room) in the study group was significantly shortened, and patient satisfaction was significantly improved compared with that in the control group, with a statistically significant difference (P Conclusion: Through the application of PDCA circulation method in the Internet + smart emergency treatment of neurologically severe preoperative patients, the Internet + smart emergency mode can be continuously improved, the treatment process can be significantly optimized, the first aid time can be shortened, and the treatment efficiency of neurocritical ill patients can be improved. Therefore, it has been expected to improve the success rate of treatment and improve the success rate of neurological patients.展开更多
Hemoptysis is a severe complication of pulmonary hypertension (PH) with a low in- cidence of 6%-11%.^([1-4])Although occurring in all forms of PH,it is more commonly seen in pulmonary arterial hypertension (PAH),assoc...Hemoptysis is a severe complication of pulmonary hypertension (PH) with a low in- cidence of 6%-11%.^([1-4])Although occurring in all forms of PH,it is more commonly seen in pulmonary arterial hypertension (PAH),associated with congenital heart disease (PAH-CHD).^([5,6])Since enlarged bronchial arteries are a frequent source of pulmonary bleeding,the primary treatment focuses on bronchial artery embolization (BAE),especially for chronic thromboembolic pulmonary hypertension (CTEPH) patients^([7,8]).However,there is disagreement regarding medical therapy,which has received little attention in the recently published PH guidelines.^([5,6])展开更多
BACKGROUND The clinical application of doxorubicin(DOX)is limited by its potential to cause cardiac cardiotoxicity.AIM To investigate the correlation between calumenin(CALU)and mitochondrial kinetic-related proteins i...BACKGROUND The clinical application of doxorubicin(DOX)is limited by its potential to cause cardiac cardiotoxicity.AIM To investigate the correlation between calumenin(CALU)and mitochondrial kinetic-related proteins in rats with DOX cardiomyopathy.METHODS A rat model of DOX-induced cardiomyopathy was used to evaluate the effects of DOX.We observed the effect of DOX on electrical conduction in cardiomyocytes using the electromapping technique.Masson staining was performed to evaluate myocardium fibrosis.Electron microscopy was used to observe the changes in pathological ultrastructure of the myocardium.Western blotting and ELISAs were performed to detect protein levels and intracellular free Ca^(2+)concentration.RESULTS DOX slowed conduction and increased conduction dispersion in cardiomyocytes.The myocardial pathology in rats treated with DOX exhibited a significant deterioration,as demonstrated by an increase in mitochondrial Ca^(2+)concentration and a decrease in the expression of CALU,optic atrophy-1,and Bcl-2.Additionally,there was an increase in the expression of connexin 43(Cx43)and the mitochondrial mitotic proteins dynamin-related protein 1,CHOP,Cytochrome C,and Bax in DOX rats.Decreased expression of CALU in cardiomyocytes triggered an increase in cytoplasmic free calcium concentration,which would normally be taken up by mitochondria,but decreased expression of mitochondrial outer membrane fusion proteins triggered a decrease in mitochondrial Ca^(2+)uptake,and the increase in cytoplasmic free calcium concentration triggered cell apoptosis.CONCLUSION Increased cytoplasmic free calcium ion concentration induces calcium overload in ventricular myocytes,leading to decreased Cx43 protein,slowed conduction in myocytes,and increased conduction dispersion,resulting in arrhythmias.展开更多
Detecting Alzheimer’s disease is essential for patient care,as an accurate diagnosis influences treatment options.Classifying dementia from non-dementia in brain MRIs is challenging due to features such as hippocampa...Detecting Alzheimer’s disease is essential for patient care,as an accurate diagnosis influences treatment options.Classifying dementia from non-dementia in brain MRIs is challenging due to features such as hippocampal atrophy,while manual diagnosis is susceptible to error.Optimal computer-aided diagnosis(CAD)systems are essential for improving accuracy and reducing misclassification risks.This study proposes an optimized ensemble method(CEOE-Net)that initiates with the selection of pre-trained models,including DenseNet121,ResNet50V2,and ResNet152V2 for unique feature extraction.Each selected model is enhanced with the inclusion of a channel attention(CA)block to improve the feature extraction process.In addition,this study employs the Short Time Fourier transform(STFT)technique with each individual model for hierarchical feature extraction before making final predictions in classifying MRI images of dementia and non-demented individuals,considering them as backbone models for building the ensemble method.STFT highlights subtle differences in brain structure and activity,particularly when combined with CA mechanisms that emphasize relevant features by converting spatial data into the frequency domain.The predictions generated from these models are then processed by the Chaotic Evolution Optimization(CEO)algorithm,which determines the optimal weightage set for each backbone model to maximize their contribution.The CEO optimizer explores weight distribution to ensure the most effective combination of model predictions for enhancing classification accuracy,thus significantly improving overall ensemble performance.This study utilized three datasets for validation:two private clinical brain MRI datasets(OSASIS and ADNI)to test the proposed model’s effectiveness.Image augmentation techniques were also employed to enhance dataset diversity and improve classification performance.The proposed CEOE-Net outperforms conventional baseline models and existing methods by showing its effectiveness as a clinical tool for the accurate classification of dementia and non-dementia MRI brain images,as well as autistic and non-autistic facial features.It achieved consistent accuracies of 93.44%on OSASIS and 81.94%on ADNI.展开更多
<strong>Objective:</strong> To retrospectively analyze the clinical utility of quantitative nursing measures of 10 cases of lower cranial nerves injury after cerebellopontine angle tumors surgery to provid...<strong>Objective:</strong> To retrospectively analyze the clinical utility of quantitative nursing measures of 10 cases of lower cranial nerves injury after cerebellopontine angle tumors surgery to provide the experience for improving the recovery rate and living quality of these patients. <strong>Methods:</strong> The clinical data of 10 cases of lower cranial nerves injury after cerebellopontine angle tumors surgery was analyzed. For problems such as dysphagia and dyspnea of these patients, the nursing care focused on strict monitoring, timely oxygen inhalation nursing, posture nursing, ventilator nursing, swallowing function training, etc. <strong>Results:</strong> After received quantitative care, 10 patients with lower cranial nerves injury after cerebellopontine angle tumors surgery were recovered well, and their symptoms such as dysphagia and dyspnea were gradually improved and safely discharged. <strong>Conclusion:</strong> Lower cranial nerves injury is one of the serious complications after removal of cerebellopontine angle tumors, which impacts the life and health of patients. Caregivers should accurately understand and analyze the symptoms, and quantitative and targeted nursing measures for posterior cranial nerves injury are helpful in the postoperative rehabilitation of patients and improve their living quality.展开更多
Achieving high-efficiency photoluminescence in trivalent lanthanides(Ln^(3+))requires precise crystalfield perturbation to overcome parity-forbidden 4f-transitions and suppress nonradiative decay.However,realizing suc...Achieving high-efficiency photoluminescence in trivalent lanthanides(Ln^(3+))requires precise crystalfield perturbation to overcome parity-forbidden 4f-transitions and suppress nonradiative decay.However,realizing such control remains challenging,even in well-optimized Ln^(3+) -doped nanocrystals.Here,by exploiting the atomically precise structure of metal nanoclusters,we demonstrate symmetry engineering in the Eu_(2)Ti_(4) nanoclusters through stepwise ligand substitution(BA/Phen→FBA/Phen→FBA/Bpy.BA:benzoicacid;Phen:1,10-phenanthroline;FBA:p-fluorobenzoicacid;Bpy:2,2'-bipyridine).The incorporation of FBA effectively suppresses nonradiative relaxation,while the flexible Bpy ligand induces symmetry reduction from D_(2d) to C_(2v) through coordination modulation,yielding a high photoluminescence quantum yield(PLQY)of 91.2%in the Ln^(3+) cluster systems.The transient-absorption,Judd-Ofelt theory,crystal-field analysis,and temperature-dependent photophysical studies elucidated the underlying modulation mechanisms.Furthermore,these clusters exhibit promising potential for optoelectronic applications,offering a new design strategy for high-performance luminescent materials.展开更多
At low-Reynolds-number,the performance of airfoil is known to be greatly affected by the formation and burst of a laminar separation bubble(LSB),which requires a more precise simulation of the delicate flow structures...At low-Reynolds-number,the performance of airfoil is known to be greatly affected by the formation and burst of a laminar separation bubble(LSB),which requires a more precise simulation of the delicate flow structures.A framework based on the interior penalty discontinuous Galerkin method and large eddy simulation approach was adopted in the present study.The performances of various subgrid models,including the Smagorinsky(SM)model,the dynamic Smagorinsky(DSM)model,the wall-adapting local-eddy-viscosity(WALE)model,and the VREMAN model,have been analyzed through flow simulations of the SD7003 airfoil at a Reynolds number of 60000.It turns out that the SM model fails to predict the emergence of LSB,even modified by the Van-Driest damping function.On the contrary,the best agreement is generally achieved by the WALE model in terms of flow separation,reattachment,and transition locations,together with the aerodynamic loads.Furthermore,the influence of numerical dissipation has also been discussed through the comparison of skin friction and resolved Reynolds stresses.As numerical dissipation decreases,the prediction accuracy of the WALE model degrades.Meanwhile,nonlinear variation could be observed from the performances of the DSM model,which could be attributed to the interaction between the numerical dissipation and the subgrid model.展开更多
Harnessing solar energy to enhance the rechargeable zinc-air batteries(RZABs)performance is a promising avenue toward sustainable energy storage and conversion.Simultaneously enhancing light-absorption capacity and ca...Harnessing solar energy to enhance the rechargeable zinc-air batteries(RZABs)performance is a promising avenue toward sustainable energy storage and conversion.Simultaneously enhancing light-absorption capacity and carrier separation efficiency in nanomaterials,as well as improving electrical conductivity and configuration for electrocatalysis,presents a formidable challenge due to inherent trade-offs and interdependencies.Here,we have developed a Janus dual-atom catalyst(JDAC)with bifunctional centers for efficient charge separation and electrocatalytic performance through a bipolar doping strategy.The in situ X-ray absorption near-edge structure and Raman spectroscopy analyses demonstrated that the Ni and Fe centers in JDAC not only function as effective sites for oxygen evolution reaction and oxygen reduction reaction,respectively,but also serve as efficient hole and electron enrichment sites,effectively suppressing photoelectron recombination while enhancing photocurrent generation.As a result,the assembled JDAC-based lightassisted RZABs exhibited extraordinary stability at large current densities.This work delivers pivotal insight to design Janus dual-atom catalysts that efficiently convert solar energy into electric and chemical energy.展开更多
Algal copper uptake(i.e.,Cu bioavailability)in the euphotic zone plays a vital role in algal photosynthesis and respiration,affecting the primary productivity and the source and sink of atmospheric carbon.Algal Cu upt...Algal copper uptake(i.e.,Cu bioavailability)in the euphotic zone plays a vital role in algal photosynthesis and respiration,affecting the primary productivity and the source and sink of atmospheric carbon.Algal Cu uptake is controlled by natural dissolved organic Cu(DOCu)speciation(i.e.,complexed with the dissolved organic matter)that conventionally could be tested by model prediction or molecular-level characterizations in the lab,while DOCu uptake are hardly directly assessed.Thus,the new chemistrybiology insight into the mechanisms of the Cu uptake process in algae is urgent.The DOCu speciation transformation(organic DOCu to free Cu(II)ions),enzymatic reduction-induced valence change(reduction of free Cu(II)to Cu(I)ions),and algal Cu uptake at the algae-water interface are imitated.Herein,an intelligent system with DOCu colorimetric sensor is developed for real-time monitoring of newly generated Cu(I)ions.Deep learning with whole sample image-based characterization and powerful feature extraction capabilities facilitates colorimetric measurement.In this context,the Cu bioavailability with 7 kinds of organic ligands(e.g.,amino acids,organic acids,carbohydrates)can be predicted by the mimetic intelligent biosensor within 15.0min,i.e.,the DOCu uptake and speciation is successfully predicted and streamlined by the biomimetic approach.展开更多
Manganese dioxide(MnO_(2))electrode material possesses the advantages of high energy density,structural diversity and high modification potential.This allows it become one of the important cathodes for aqueous zinc io...Manganese dioxide(MnO_(2))electrode material possesses the advantages of high energy density,structural diversity and high modification potential.This allows it become one of the important cathodes for aqueous zinc ion battery.However,the applications are limited by the poor electrical conductivity,narrow layer spacing and the ease of dissolution.Herein,we prepare MnO_(2)-PVP@0.03GO composites by the co-modification of polyvinylpyrrolidone(PVP)pre-insertion layer and graphene oxide(GO)self-assembly layer.The Zn//MnO_(2)-PVP@0.03GO cells deliver a discharge specific capacity of 442 mAh/g at a current density of 0.2 A/g.It also maintains 100%capacity for 1000 times cycling at 1 A/g.The assembled soft package batteries demonstrate superior flexibility and adaptability under different bending conditions.展开更多
Long-term excessive nitrogen(N)application neither increases nor enhances grain yield and N use efficiency(NUE)of maize,yet the mechanisms involving root morphological and physiological characteristics remain unclear....Long-term excessive nitrogen(N)application neither increases nor enhances grain yield and N use efficiency(NUE)of maize,yet the mechanisms involving root morphological and physiological characteristics remain unclear.This study aimed to elucidate the mechanisms underlying stagnant grain yield under excessive N application by examining root morphological and physiological characteristics.A 10-year N fertilizer trial was conducted in Jilin Province,Northeast China,cultivating maize at three N fertilizer levels(zero N,N0;recommended N,N2;and high N level,N4)from 2019 to 2021.Two widely cultivated maize genotypes,‘Xianyu 335’(XY335)and‘Zhengdan 958’(ZD958),were evaluated.Grain yield,N content,root morphology,and physiological characteristics were analyzed to assess the relationships between N uptake,N utilization,plant growth,and root systems under different N treatments.Compared to N0,root biomass,post-silking N uptake,and grain yield improved significantly with increased N input,while no significant differences emerged between recommended N and high N.High N application enhanced root length and root surface area but decreased root activity(measured by TTC(2,3,5-triphenyltetrazolium chloride)method),nitrate reductase activity,and root activity absorbing area across genotypes.Root length and root to shoot ratio negatively affected N uptake(by-1.2 and-24.6%),while root surface area,root activity,nitrate reductase activity,and root activity absorbing area contributed positively.The interaction between cultivar and N application significantly influenced NUE.XY335 achieved the highest NUE(11.6%)and N recovery efficiency(18.4%)through superior root surface area(23.6%),root activity(12.5%),nitrate reductase activity(8.3%),and root activity absorbing area(6.9%)compared to other treatments.Recommended N application enhanced Post N uptake,NUE,and grain yield through improved root characteristics,while high N application failed to increase or decreased NUE by reducing these parameters.This study demonstrates that root surface area,root activity,nitrate reductase activity,and root activity absorbing area limit NUE increase under high N application.展开更多
Objective: Severe traumatic brain injury (sTBI) is one of the common acute and critical diseases in neurosurgery. So we aim to explore the clinical effectiveness of an intelligent emergency care model in patients with...Objective: Severe traumatic brain injury (sTBI) is one of the common acute and critical diseases in neurosurgery. So we aim to explore the clinical effectiveness of an intelligent emergency care model in patients with severe traumatic brain injury. Methods: Eighty patients with severe traumatic brain injury (sTBI) who were treated in Zhuji People’s Hospital of Zhejiang Province from January 2019 to December 2021 were selected as the study subjects. The patients were divided into an observation group and a control group with 40 patients in each group according to the random number table method. Patients in the control group received conventional first-aid nursing mode intervention, and the intelligent emergency nursing mode was used for the observation group based on the control group. Comparisons were conducted between the two groups on the time of arrival to the emergency room, the time from the emergency room to the operating room, Glasgow Coma Scale (GCS) score before surgery, GCS score when leaving the Intensive Care Unit (ICU), the average length of ICU stay, the average length of hospital stay, the total hospital costs. Results: The time of arrival to the emergency room, the time from the emergency room to the operating room, the average length of ICU stay, the average length of hospital stay, and the total hospital costs in the observation group were significantly lower than those in the control group, and the differences were statistically significant (All P Conclusion: Intelligent emergency nursing mode can shorten the time of sTBI rescue, the length of ICU stay, and the average length of hospital stay, reduce the total hospitalization cost, improve the prognosis, with good efficacy, reduce the total cost of hospitalization, and improve the prognosis with better efficacy.展开更多
OBJECTIVE： To evaluate the efficacy of α-lipoic acid（ALA） plus epalrestat combination therapy in the treatment of diabetic peripheral neuropathy（DPN）. DATA SOURCES： The electronic databases of Pub Med, Medline,...OBJECTIVE： To evaluate the efficacy of α-lipoic acid（ALA） plus epalrestat combination therapy in the treatment of diabetic peripheral neuropathy（DPN）. DATA SOURCES： The electronic databases of Pub Med, Medline, Embase, the Cochrane Library, the Chinese National Knowledge Infrastructure, the Wanfang Database and the Chinese Biomedical Database were used to retrieve relevant studies without language restrictions. The search was conducted from the inception of each database to 7 October 2016. The key terms were（diabetic peripheral neuropathy or diabetic neuropathy or DPN） AND（α-lipoic acid or lipoic acid or thioctic acid） AND epalrestat. DATA SELECTION： All of the eligible studies met the following inclusion criteria：（1） Randomized controlled trials that compared efficacy and safety of epalrestat plus ALA combination therapy versus epalrestat or ALA monotherapy in patients with DPN.（2） The minimum duration of treatment was 2 weeks.（3） The DPN patients were diagnosed using the World Health Organization standardized type 2 diabetes mellitus and DPN criteria.（4） Studies contained at least one measure that could reflect the efficacy of the drug and nerve conduction velocities. Studies in which the control group used epalrestat or ALA combined with other drugs were excluded. Statistical analyses were performed using STATA software for meta-analysis. OUTCOME MEASURES： The primary outcomes were the therapeutic efficacy, median motor nerve conduction velocity（MNCV）, median sensory nerve conduction velocity（SNCV）, peroneal MNCV and peroneal SNCV.RESULTS： Twenty studies with 1894 DPN patients were included, including 864 patients in the ALA plus epalrestat group, 473 in the ALA group and 557 in the epalrestat group. The efficacy of ALA plus epalrestat combination therapy was superior to ALA and epalrestat monotherapies（RR = 1.29, 95% CI： 1.21–1.38; RR = 1.43, 95% CI： 1.34–1.54, respectively）. ALA plus epalrestat combination therapy also significantly improved median MNCV（WMD = 5.41, 95% CI： 2.07–8.75）, median SNCV（WMD = 5.87, 95% CI： 1.52–10.22）, peroneal MNCV（WMD = 5.59, 95% CI： 2.70–8.47） and peroneal SNCV（WMD = 4.57, 95% CI： 2.46–6.68）.CONCLUSION： ALA plus epalrestat combination therapy was superior to ALA and epalrestat monotherapies for clinical efficacy and nerve conduction velocities in patients with DPN.展开更多
基金supported by the Beijing Natural Science Foundation(L242149)Research Project on High Quality Development of Hospital Pharmacy,National Institute of Hospital Administration,NHC,China(NIHAYS2332)+1 种基金National High Level Hospital Clinical Research Funding(BJ-2023-199)Capital Funds for Health Improvement and Research(CFH)(2024-1-4052).
文摘Objective To examine national trends in antibiotic consumption and antimicrobial resistance(AMR)among six WHO-priority bacterial pathogens in China from 2016 to 2022.Methods This ecological study analyzed national and provincial data from the China Antibacterial Resistance Surveillance System(CARSS)and the National Hospital Information Network.Beta regression models assessed temporal trends,and hierarchical models evaluated associations between antibiotic use and resistance.Results From 2016 to 2022,carbapenem resistance in Acinetobacter baumannii and Pseudomonas aeruginosa,and vancomycin resistance in Enterococcus faecium and E.faecalis significantly declined(β<0,P<0.010),while carbapenem-resistant Klebsiella pneumoniae increased(β=0.081,P<0.001).Nationwide antibiotic consumption rose across 10 major classes.Positive associations were found between carbapenem use and resistance in A.baumannii(z=2.719,P=0.007)and P.aeruginosa(z=3.241,P=0.001),and between vancomycin use and resistance in E.faecium(z=4.510,P=0.001)and E.faecalis(z=3.210,P=0.001).Conclusion Carbapenem-resistant K.pneumoniae increased significantly in China,while other resistant pathogens declined.Resistance patterns were linked to the use of multiple antibiotic classes,underscoring the need for strengthened antibiotic stewardship and surveillance.
文摘目的:评估超声内镜引导下细针穿刺(endoscopic ultrasound-guided fine needle aspiration,EUS-FNA)在胆管病变中的诊断效能和安全性,并探讨影响其准确性的因素。方法:回顾性分析2021年1月到2023年12月成都市第三人民医院因疑似胆管恶性狭窄/占位而接受EUS-FNA的41例患者临床资料,其中男性22例,女性19例,平均年龄为65.9(35.0~89.0)岁。评估其诊断效能(敏感性、特异性、阳性预测值、阴性预测值和准确性)及影响因素。结果:EUS-FNA对于胆管病变的总体灵敏性为85%,特异性为100%,阳性预测值为100%,阴性预测值为33%,准确性为86%;25G穿刺针和是否存在实性占位是影响EUS-FNA诊断胆管病变准确性的重要因素,而穿刺部位并未对诊断效能产生影响,参与分析的41例患者在随访期间未发现与EUS-FNA相关不良事件。结论:EUS-FNA在诊断胆管病变时具有较高的准确性和安全性,特别是使用25G穿刺针及存在胆管实性占位时,EUSFNA的诊断准确性更高。
文摘Objective: To investigate the application and feasibility of PDCA circulation method in the treatment of patients with severe neurological diseases in Internet + smart first aid, with a view to promoting the sustainable construction of smart first aid. Methods: A total of 105 patients with severe neurological diseases in Zhuji people’s Hospital and cooperative units were selected, and 52 cases in the research group and 53 cases in the control group were divided according to the single and double number visiting time: In this paper, through reading the literature, the development of Internet + wisdom first aid treatment of patients with severe neurological diseases was investigated, and the common problems were analyzed and summarized, and the research group used the PDCA circulation method to sort out the existing problems, analyze the causes of the problems and improve them. The difference in treatment time between the two groups was compared, and the patient’s satisfaction was evaluated for the time of being transferred to the hospital emergency room by 120 ambulances, the time from emergency admission to surgery (Cath lab), and the satisfaction of the patient. Results: The time from emergency treatment to the operation room (catheter room) in the study group was significantly shortened, and patient satisfaction was significantly improved compared with that in the control group, with a statistically significant difference (P Conclusion: Through the application of PDCA circulation method in the Internet + smart emergency treatment of neurologically severe preoperative patients, the Internet + smart emergency mode can be continuously improved, the treatment process can be significantly optimized, the first aid time can be shortened, and the treatment efficiency of neurocritical ill patients can be improved. Therefore, it has been expected to improve the success rate of treatment and improve the success rate of neurological patients.
基金supported by Liaoning Xingliao Talent Project (Grant No. XLYC2007020)。
文摘Hemoptysis is a severe complication of pulmonary hypertension (PH) with a low in- cidence of 6%-11%.^([1-4])Although occurring in all forms of PH,it is more commonly seen in pulmonary arterial hypertension (PAH),associated with congenital heart disease (PAH-CHD).^([5,6])Since enlarged bronchial arteries are a frequent source of pulmonary bleeding,the primary treatment focuses on bronchial artery embolization (BAE),especially for chronic thromboembolic pulmonary hypertension (CTEPH) patients^([7,8]).However,there is disagreement regarding medical therapy,which has received little attention in the recently published PH guidelines.^([5,6])
基金Supported by Technology Development of Jilin Province,No:20190701069GHNatural Science Foundation of Inner Mongolia Autonomous Region,No:2018MS08036,No:2017MS(LH)0824.
文摘BACKGROUND The clinical application of doxorubicin(DOX)is limited by its potential to cause cardiac cardiotoxicity.AIM To investigate the correlation between calumenin(CALU)and mitochondrial kinetic-related proteins in rats with DOX cardiomyopathy.METHODS A rat model of DOX-induced cardiomyopathy was used to evaluate the effects of DOX.We observed the effect of DOX on electrical conduction in cardiomyocytes using the electromapping technique.Masson staining was performed to evaluate myocardium fibrosis.Electron microscopy was used to observe the changes in pathological ultrastructure of the myocardium.Western blotting and ELISAs were performed to detect protein levels and intracellular free Ca^(2+)concentration.RESULTS DOX slowed conduction and increased conduction dispersion in cardiomyocytes.The myocardial pathology in rats treated with DOX exhibited a significant deterioration,as demonstrated by an increase in mitochondrial Ca^(2+)concentration and a decrease in the expression of CALU,optic atrophy-1,and Bcl-2.Additionally,there was an increase in the expression of connexin 43(Cx43)and the mitochondrial mitotic proteins dynamin-related protein 1,CHOP,Cytochrome C,and Bax in DOX rats.Decreased expression of CALU in cardiomyocytes triggered an increase in cytoplasmic free calcium concentration,which would normally be taken up by mitochondria,but decreased expression of mitochondrial outer membrane fusion proteins triggered a decrease in mitochondrial Ca^(2+)uptake,and the increase in cytoplasmic free calcium concentration triggered cell apoptosis.CONCLUSION Increased cytoplasmic free calcium ion concentration induces calcium overload in ventricular myocytes,leading to decreased Cx43 protein,slowed conduction in myocytes,and increased conduction dispersion,resulting in arrhythmias.
基金supported in part by the Science and Technology Major Special Project Fund of Changsha(No.kh2401010)in part by the High-Performance Computing Center of Central South University+3 种基金supported by the National Natural Science Foundation of China(Grants Nos.82022024,31970572)The Science and Technology Innovation Program of Hunan Province(2021RC4018,2021RC5027)Innovation-Driven Project of Central South University(Grant No.2020CX003)NIH grants U01 MH122591,1U01MH116489,1R01MH110920,R01MH126459.
文摘Detecting Alzheimer’s disease is essential for patient care,as an accurate diagnosis influences treatment options.Classifying dementia from non-dementia in brain MRIs is challenging due to features such as hippocampal atrophy,while manual diagnosis is susceptible to error.Optimal computer-aided diagnosis(CAD)systems are essential for improving accuracy and reducing misclassification risks.This study proposes an optimized ensemble method(CEOE-Net)that initiates with the selection of pre-trained models,including DenseNet121,ResNet50V2,and ResNet152V2 for unique feature extraction.Each selected model is enhanced with the inclusion of a channel attention(CA)block to improve the feature extraction process.In addition,this study employs the Short Time Fourier transform(STFT)technique with each individual model for hierarchical feature extraction before making final predictions in classifying MRI images of dementia and non-demented individuals,considering them as backbone models for building the ensemble method.STFT highlights subtle differences in brain structure and activity,particularly when combined with CA mechanisms that emphasize relevant features by converting spatial data into the frequency domain.The predictions generated from these models are then processed by the Chaotic Evolution Optimization(CEO)algorithm,which determines the optimal weightage set for each backbone model to maximize their contribution.The CEO optimizer explores weight distribution to ensure the most effective combination of model predictions for enhancing classification accuracy,thus significantly improving overall ensemble performance.This study utilized three datasets for validation:two private clinical brain MRI datasets(OSASIS and ADNI)to test the proposed model’s effectiveness.Image augmentation techniques were also employed to enhance dataset diversity and improve classification performance.The proposed CEOE-Net outperforms conventional baseline models and existing methods by showing its effectiveness as a clinical tool for the accurate classification of dementia and non-dementia MRI brain images,as well as autistic and non-autistic facial features.It achieved consistent accuracies of 93.44%on OSASIS and 81.94%on ADNI.
文摘<strong>Objective:</strong> To retrospectively analyze the clinical utility of quantitative nursing measures of 10 cases of lower cranial nerves injury after cerebellopontine angle tumors surgery to provide the experience for improving the recovery rate and living quality of these patients. <strong>Methods:</strong> The clinical data of 10 cases of lower cranial nerves injury after cerebellopontine angle tumors surgery was analyzed. For problems such as dysphagia and dyspnea of these patients, the nursing care focused on strict monitoring, timely oxygen inhalation nursing, posture nursing, ventilator nursing, swallowing function training, etc. <strong>Results:</strong> After received quantitative care, 10 patients with lower cranial nerves injury after cerebellopontine angle tumors surgery were recovered well, and their symptoms such as dysphagia and dyspnea were gradually improved and safely discharged. <strong>Conclusion:</strong> Lower cranial nerves injury is one of the serious complications after removal of cerebellopontine angle tumors, which impacts the life and health of patients. Caregivers should accurately understand and analyze the symptoms, and quantitative and targeted nursing measures for posterior cranial nerves injury are helpful in the postoperative rehabilitation of patients and improve their living quality.
基金Project supported by the National Key Research and Development Program of China(2024YFE0206100)the National Natural Science Foundation of China(T2325015,U21A2068,12174151)。
文摘Achieving high-efficiency photoluminescence in trivalent lanthanides(Ln^(3+))requires precise crystalfield perturbation to overcome parity-forbidden 4f-transitions and suppress nonradiative decay.However,realizing such control remains challenging,even in well-optimized Ln^(3+) -doped nanocrystals.Here,by exploiting the atomically precise structure of metal nanoclusters,we demonstrate symmetry engineering in the Eu_(2)Ti_(4) nanoclusters through stepwise ligand substitution(BA/Phen→FBA/Phen→FBA/Bpy.BA:benzoicacid;Phen:1,10-phenanthroline;FBA:p-fluorobenzoicacid;Bpy:2,2'-bipyridine).The incorporation of FBA effectively suppresses nonradiative relaxation,while the flexible Bpy ligand induces symmetry reduction from D_(2d) to C_(2v) through coordination modulation,yielding a high photoluminescence quantum yield(PLQY)of 91.2%in the Ln^(3+) cluster systems.The transient-absorption,Judd-Ofelt theory,crystal-field analysis,and temperature-dependent photophysical studies elucidated the underlying modulation mechanisms.Furthermore,these clusters exhibit promising potential for optoelectronic applications,offering a new design strategy for high-performance luminescent materials.
基金This work was supported by the National Key R&D Program of China(Grant No.2022YFE0207000)the National Natural Science Foundation of China(Grant Nos.12372289,11972250,and 12102298)+1 种基金the China Postdoctoral Science Foundation(Grant No.2021M702443)Tianjin Natural Science Foundation(Grant No.22JCZDJC00910).
文摘At low-Reynolds-number,the performance of airfoil is known to be greatly affected by the formation and burst of a laminar separation bubble(LSB),which requires a more precise simulation of the delicate flow structures.A framework based on the interior penalty discontinuous Galerkin method and large eddy simulation approach was adopted in the present study.The performances of various subgrid models,including the Smagorinsky(SM)model,the dynamic Smagorinsky(DSM)model,the wall-adapting local-eddy-viscosity(WALE)model,and the VREMAN model,have been analyzed through flow simulations of the SD7003 airfoil at a Reynolds number of 60000.It turns out that the SM model fails to predict the emergence of LSB,even modified by the Van-Driest damping function.On the contrary,the best agreement is generally achieved by the WALE model in terms of flow separation,reattachment,and transition locations,together with the aerodynamic loads.Furthermore,the influence of numerical dissipation has also been discussed through the comparison of skin friction and resolved Reynolds stresses.As numerical dissipation decreases,the prediction accuracy of the WALE model degrades.Meanwhile,nonlinear variation could be observed from the performances of the DSM model,which could be attributed to the interaction between the numerical dissipation and the subgrid model.
基金supported by the National Key R&D Program of China(2024YFB4607600)National Natural Science Foundation of China(NSFC,Grant No.52303359)+1 种基金Basic and Applied Basic Research Foundation of Guangdong Province(2023A1515011511,2022A1515110848,2023B1515040027,Young Top Talents Program 2021QN02C174)Open program of State Key Laboratory of Optoelectronic Materials and Technologies(OEMT-2024-KF-06).
文摘Harnessing solar energy to enhance the rechargeable zinc-air batteries(RZABs)performance is a promising avenue toward sustainable energy storage and conversion.Simultaneously enhancing light-absorption capacity and carrier separation efficiency in nanomaterials,as well as improving electrical conductivity and configuration for electrocatalysis,presents a formidable challenge due to inherent trade-offs and interdependencies.Here,we have developed a Janus dual-atom catalyst(JDAC)with bifunctional centers for efficient charge separation and electrocatalytic performance through a bipolar doping strategy.The in situ X-ray absorption near-edge structure and Raman spectroscopy analyses demonstrated that the Ni and Fe centers in JDAC not only function as effective sites for oxygen evolution reaction and oxygen reduction reaction,respectively,but also serve as efficient hole and electron enrichment sites,effectively suppressing photoelectron recombination while enhancing photocurrent generation.As a result,the assembled JDAC-based lightassisted RZABs exhibited extraordinary stability at large current densities.This work delivers pivotal insight to design Janus dual-atom catalysts that efficiently convert solar energy into electric and chemical energy.
基金supported by the National Natural Science Foundation of China(No.22074058,S.Li).
文摘Algal copper uptake(i.e.,Cu bioavailability)in the euphotic zone plays a vital role in algal photosynthesis and respiration,affecting the primary productivity and the source and sink of atmospheric carbon.Algal Cu uptake is controlled by natural dissolved organic Cu(DOCu)speciation(i.e.,complexed with the dissolved organic matter)that conventionally could be tested by model prediction or molecular-level characterizations in the lab,while DOCu uptake are hardly directly assessed.Thus,the new chemistrybiology insight into the mechanisms of the Cu uptake process in algae is urgent.The DOCu speciation transformation(organic DOCu to free Cu(II)ions),enzymatic reduction-induced valence change(reduction of free Cu(II)to Cu(I)ions),and algal Cu uptake at the algae-water interface are imitated.Herein,an intelligent system with DOCu colorimetric sensor is developed for real-time monitoring of newly generated Cu(I)ions.Deep learning with whole sample image-based characterization and powerful feature extraction capabilities facilitates colorimetric measurement.In this context,the Cu bioavailability with 7 kinds of organic ligands(e.g.,amino acids,organic acids,carbohydrates)can be predicted by the mimetic intelligent biosensor within 15.0min,i.e.,the DOCu uptake and speciation is successfully predicted and streamlined by the biomimetic approach.
基金supported by National Natural Science Foundation of China(No.52172218).
文摘Manganese dioxide(MnO_(2))electrode material possesses the advantages of high energy density,structural diversity and high modification potential.This allows it become one of the important cathodes for aqueous zinc ion battery.However,the applications are limited by the poor electrical conductivity,narrow layer spacing and the ease of dissolution.Herein,we prepare MnO_(2)-PVP@0.03GO composites by the co-modification of polyvinylpyrrolidone(PVP)pre-insertion layer and graphene oxide(GO)self-assembly layer.The Zn//MnO_(2)-PVP@0.03GO cells deliver a discharge specific capacity of 442 mAh/g at a current density of 0.2 A/g.It also maintains 100%capacity for 1000 times cycling at 1 A/g.The assembled soft package batteries demonstrate superior flexibility and adaptability under different bending conditions.
基金supported by the National Key Research and Development Program of China(2023YFD2301702)the earmarked Fund for China Agriculture Research System(CARS-02)the National Natural Science Foundation of China(31971852).
文摘Long-term excessive nitrogen(N)application neither increases nor enhances grain yield and N use efficiency(NUE)of maize,yet the mechanisms involving root morphological and physiological characteristics remain unclear.This study aimed to elucidate the mechanisms underlying stagnant grain yield under excessive N application by examining root morphological and physiological characteristics.A 10-year N fertilizer trial was conducted in Jilin Province,Northeast China,cultivating maize at three N fertilizer levels(zero N,N0;recommended N,N2;and high N level,N4)from 2019 to 2021.Two widely cultivated maize genotypes,‘Xianyu 335’(XY335)and‘Zhengdan 958’(ZD958),were evaluated.Grain yield,N content,root morphology,and physiological characteristics were analyzed to assess the relationships between N uptake,N utilization,plant growth,and root systems under different N treatments.Compared to N0,root biomass,post-silking N uptake,and grain yield improved significantly with increased N input,while no significant differences emerged between recommended N and high N.High N application enhanced root length and root surface area but decreased root activity(measured by TTC(2,3,5-triphenyltetrazolium chloride)method),nitrate reductase activity,and root activity absorbing area across genotypes.Root length and root to shoot ratio negatively affected N uptake(by-1.2 and-24.6%),while root surface area,root activity,nitrate reductase activity,and root activity absorbing area contributed positively.The interaction between cultivar and N application significantly influenced NUE.XY335 achieved the highest NUE(11.6%)and N recovery efficiency(18.4%)through superior root surface area(23.6%),root activity(12.5%),nitrate reductase activity(8.3%),and root activity absorbing area(6.9%)compared to other treatments.Recommended N application enhanced Post N uptake,NUE,and grain yield through improved root characteristics,while high N application failed to increase or decreased NUE by reducing these parameters.This study demonstrates that root surface area,root activity,nitrate reductase activity,and root activity absorbing area limit NUE increase under high N application.
文摘Objective: Severe traumatic brain injury (sTBI) is one of the common acute and critical diseases in neurosurgery. So we aim to explore the clinical effectiveness of an intelligent emergency care model in patients with severe traumatic brain injury. Methods: Eighty patients with severe traumatic brain injury (sTBI) who were treated in Zhuji People’s Hospital of Zhejiang Province from January 2019 to December 2021 were selected as the study subjects. The patients were divided into an observation group and a control group with 40 patients in each group according to the random number table method. Patients in the control group received conventional first-aid nursing mode intervention, and the intelligent emergency nursing mode was used for the observation group based on the control group. Comparisons were conducted between the two groups on the time of arrival to the emergency room, the time from the emergency room to the operating room, Glasgow Coma Scale (GCS) score before surgery, GCS score when leaving the Intensive Care Unit (ICU), the average length of ICU stay, the average length of hospital stay, the total hospital costs. Results: The time of arrival to the emergency room, the time from the emergency room to the operating room, the average length of ICU stay, the average length of hospital stay, and the total hospital costs in the observation group were significantly lower than those in the control group, and the differences were statistically significant (All P Conclusion: Intelligent emergency nursing mode can shorten the time of sTBI rescue, the length of ICU stay, and the average length of hospital stay, reduce the total hospitalization cost, improve the prognosis, with good efficacy, reduce the total cost of hospitalization, and improve the prognosis with better efficacy.
基金supported by the National Natural Science Foundation of China,No.81370165a grant from the Public Benefit Technology and Society Development Program of Zhejiang Province of China,No.2015C33309+2 种基金a grant from the Ningbo Science and Technology Innovation Team Program in China,No.2014B82002,2015B11050a grant from the Ningbo Science and Technology Project in China,No.2015A610217the Fang Runhua Fund of Hong Kong,K.C.Wong Magna Fund in Ningbo University
文摘OBJECTIVE： To evaluate the efficacy of α-lipoic acid（ALA） plus epalrestat combination therapy in the treatment of diabetic peripheral neuropathy（DPN）. DATA SOURCES： The electronic databases of Pub Med, Medline, Embase, the Cochrane Library, the Chinese National Knowledge Infrastructure, the Wanfang Database and the Chinese Biomedical Database were used to retrieve relevant studies without language restrictions. The search was conducted from the inception of each database to 7 October 2016. The key terms were（diabetic peripheral neuropathy or diabetic neuropathy or DPN） AND（α-lipoic acid or lipoic acid or thioctic acid） AND epalrestat. DATA SELECTION： All of the eligible studies met the following inclusion criteria：（1） Randomized controlled trials that compared efficacy and safety of epalrestat plus ALA combination therapy versus epalrestat or ALA monotherapy in patients with DPN.（2） The minimum duration of treatment was 2 weeks.（3） The DPN patients were diagnosed using the World Health Organization standardized type 2 diabetes mellitus and DPN criteria.（4） Studies contained at least one measure that could reflect the efficacy of the drug and nerve conduction velocities. Studies in which the control group used epalrestat or ALA combined with other drugs were excluded. Statistical analyses were performed using STATA software for meta-analysis. OUTCOME MEASURES： The primary outcomes were the therapeutic efficacy, median motor nerve conduction velocity（MNCV）, median sensory nerve conduction velocity（SNCV）, peroneal MNCV and peroneal SNCV.RESULTS： Twenty studies with 1894 DPN patients were included, including 864 patients in the ALA plus epalrestat group, 473 in the ALA group and 557 in the epalrestat group. The efficacy of ALA plus epalrestat combination therapy was superior to ALA and epalrestat monotherapies（RR = 1.29, 95% CI： 1.21–1.38; RR = 1.43, 95% CI： 1.34–1.54, respectively）. ALA plus epalrestat combination therapy also significantly improved median MNCV（WMD = 5.41, 95% CI： 2.07–8.75）, median SNCV（WMD = 5.87, 95% CI： 1.52–10.22）, peroneal MNCV（WMD = 5.59, 95% CI： 2.70–8.47） and peroneal SNCV（WMD = 4.57, 95% CI： 2.46–6.68）.CONCLUSION： ALA plus epalrestat combination therapy was superior to ALA and epalrestat monotherapies for clinical efficacy and nerve conduction velocities in patients with DPN.
