突发公共事件期间病人涌入导致重症医学科(intensive care unit, ICU)救治效率降低。为综合评估病人床位分配策略提升ICU救治效率的效果,采用智能体建模-离散事件仿真(agent-based modeling-discrete event simulation, ABM-DES)方法构...突发公共事件期间病人涌入导致重症医学科(intensive care unit, ICU)救治效率降低。为综合评估病人床位分配策略提升ICU救治效率的效果,采用智能体建模-离散事件仿真(agent-based modeling-discrete event simulation, ABM-DES)方法构建ICU救治系统仿真模型。以武汉大学人民医院综合性ICU为例,引入急诊科分区管理策略设计4种差异化床位分配方案,同时从病人、医护人员、物资和空间多维度出发,采用熵权逼近理想解排序法(technique for order preference by similarity to an ideal solution, TOPSIS)法构建ICU救治效率评价体系对多种病人到达模式下的救治效率进行量化评估,筛选最优床位分配方案。结果表明:病人到达模式显著影响最优床位分配方案;分区管理策略的增效作用仅体现在长期大量病人到达场景。研究结果可为ICU应对突发公共事件提供重要参考。展开更多
Background:Drug-coated balloons(DCBs)are receiving increasing attention in interventional therapy for coronary artery disease.However,evidence regarding their application in acute myocardial infarction(AMI),particular...Background:Drug-coated balloons(DCBs)are receiving increasing attention in interventional therapy for coronary artery disease.However,evidence regarding their application in acute myocardial infarction(AMI),particularly in high-risk AMI patients,is limited,leading to significant clinical concerns.This study aims to compare the efficacy and safety of DCBs versus standard drug-eluting stents(DESs)in AMI patients and explore their efficacy differences in patients with ST-segment elevation myocardial infarction(STEMI),non-ST-segment elevation myocardial infarction(NSTEMI),and different risk stratifications.Methods:A single-center,retrospective cohort study was conducted,involving 86 patients who underwent percutaneous coronary intervention(PCI)for AMI between January 2023 and July 2025.Patients were divided into a DCB group(n=26)and a DES group(n=60)based on the treatment modality.According to the Killip classification of myocardial infarction at admission,patients were categorized into a low-risk group(Killip Class I,n=68)and a high-risk group(Killip Classes II-IV,n=18).The primary efficacy endpoint was targeting lesion restenosis as shown by coronary angiography follow-up(6-12 months).Safety endpoints included acute in-stent thrombosis during hospitalization(ARC criteria)and long-term coronary slow flow.A multivariate logistic regression model was used to evaluate the associations between intervention modality,risk stratification,infarction type,and endpoint events,and to test for interactions.Results:The DCB and DES groups were generally balanced in terms of baseline traditional risk factors.During hospitalization,three cases(5.0%)of acute in-stent thrombosis occurred in the DES group,all requiring urgent re-intervention,while no such events occurred in the DCB group(0%).Acute in-stent thrombosis formation was significantly associated with high-risk stratification(χ2 test,p=0.047).The overall restenosis rate was 22.1%(19/86).Multivariate analysis showed no statistically significant difference in restenosis risk between the intervention modalities(DCB vs.DES)(adjusted odds ratio[OR]=1.07,95%confidence interval[CI]0.27-4.21,p=0.920),and no statistical differences were found in subgroups based on risk stratification(p=0.382)or infarction type(p=0.484).There was a trend toward increased restenosis risk in high-risk patients(OR=12.34),but the difference was not statistically significant(95%CI 0.28-542.75,p=0.193).The incidence of long-term coronary slow flow was significantly higher in the DES group than in the DCB group(16.7%vs.3.8%,Fisher’s exact test,p=0.048),with a statistically significant difference.Conclusion:For AMI patients,DCBs demonstrate similar efficacy to DESs in preventing restenosis.However,DESs are associated with a higher risk of acute thrombosis during hospitalization,especially in high-risk patients,and a higher risk of long-term slow coronary flow.DCBs exhibit superior perioperative and long-term safety compared to DESs.Given the limited sample size,particularly the small number of high-risk patients and those treated with DCBs,the conclusions require validation through larger-scale prospective studies.展开更多
研究潜艇在斜航工况下的水动力特性对潜艇操纵性的影响至关重要。本文使用雷诺平均RANS(Reynolds Average Navier-Stockes)与分离涡DES(Detached-Eddy Simulation)2种数值方法,对Joubert BB2潜艇在斜航工况下水动力性能及周围流场进行...研究潜艇在斜航工况下的水动力特性对潜艇操纵性的影响至关重要。本文使用雷诺平均RANS(Reynolds Average Navier-Stockes)与分离涡DES(Detached-Eddy Simulation)2种数值方法,对Joubert BB2潜艇在斜航工况下水动力性能及周围流场进行数值模拟。分析不同漂角工况下潜艇所受力、力矩及周围流场,重点关注围壳及尾舵附近流场,探寻漂角变化对潜艇受力及流场的影响。结果显示,采用DES方法计算大漂角工况时误差更小同时流场信息捕捉更加精确。研究结果表明,潜艇大漂角工况下采用DES方法能够更加准确地模拟潜艇受力及流场,同时对研究潜艇斜航状态下的流动分离现象具有一定的参考价值。展开更多
文摘突发公共事件期间病人涌入导致重症医学科(intensive care unit, ICU)救治效率降低。为综合评估病人床位分配策略提升ICU救治效率的效果,采用智能体建模-离散事件仿真(agent-based modeling-discrete event simulation, ABM-DES)方法构建ICU救治系统仿真模型。以武汉大学人民医院综合性ICU为例,引入急诊科分区管理策略设计4种差异化床位分配方案,同时从病人、医护人员、物资和空间多维度出发,采用熵权逼近理想解排序法(technique for order preference by similarity to an ideal solution, TOPSIS)法构建ICU救治效率评价体系对多种病人到达模式下的救治效率进行量化评估,筛选最优床位分配方案。结果表明:病人到达模式显著影响最优床位分配方案;分区管理策略的增效作用仅体现在长期大量病人到达场景。研究结果可为ICU应对突发公共事件提供重要参考。
基金Social Development Science and Technology Project of Dongguan Science and Technology Bureau(Project No.:20221800905302)。
文摘Background:Drug-coated balloons(DCBs)are receiving increasing attention in interventional therapy for coronary artery disease.However,evidence regarding their application in acute myocardial infarction(AMI),particularly in high-risk AMI patients,is limited,leading to significant clinical concerns.This study aims to compare the efficacy and safety of DCBs versus standard drug-eluting stents(DESs)in AMI patients and explore their efficacy differences in patients with ST-segment elevation myocardial infarction(STEMI),non-ST-segment elevation myocardial infarction(NSTEMI),and different risk stratifications.Methods:A single-center,retrospective cohort study was conducted,involving 86 patients who underwent percutaneous coronary intervention(PCI)for AMI between January 2023 and July 2025.Patients were divided into a DCB group(n=26)and a DES group(n=60)based on the treatment modality.According to the Killip classification of myocardial infarction at admission,patients were categorized into a low-risk group(Killip Class I,n=68)and a high-risk group(Killip Classes II-IV,n=18).The primary efficacy endpoint was targeting lesion restenosis as shown by coronary angiography follow-up(6-12 months).Safety endpoints included acute in-stent thrombosis during hospitalization(ARC criteria)and long-term coronary slow flow.A multivariate logistic regression model was used to evaluate the associations between intervention modality,risk stratification,infarction type,and endpoint events,and to test for interactions.Results:The DCB and DES groups were generally balanced in terms of baseline traditional risk factors.During hospitalization,three cases(5.0%)of acute in-stent thrombosis occurred in the DES group,all requiring urgent re-intervention,while no such events occurred in the DCB group(0%).Acute in-stent thrombosis formation was significantly associated with high-risk stratification(χ2 test,p=0.047).The overall restenosis rate was 22.1%(19/86).Multivariate analysis showed no statistically significant difference in restenosis risk between the intervention modalities(DCB vs.DES)(adjusted odds ratio[OR]=1.07,95%confidence interval[CI]0.27-4.21,p=0.920),and no statistical differences were found in subgroups based on risk stratification(p=0.382)or infarction type(p=0.484).There was a trend toward increased restenosis risk in high-risk patients(OR=12.34),but the difference was not statistically significant(95%CI 0.28-542.75,p=0.193).The incidence of long-term coronary slow flow was significantly higher in the DES group than in the DCB group(16.7%vs.3.8%,Fisher’s exact test,p=0.048),with a statistically significant difference.Conclusion:For AMI patients,DCBs demonstrate similar efficacy to DESs in preventing restenosis.However,DESs are associated with a higher risk of acute thrombosis during hospitalization,especially in high-risk patients,and a higher risk of long-term slow coronary flow.DCBs exhibit superior perioperative and long-term safety compared to DESs.Given the limited sample size,particularly the small number of high-risk patients and those treated with DCBs,the conclusions require validation through larger-scale prospective studies.
文摘研究潜艇在斜航工况下的水动力特性对潜艇操纵性的影响至关重要。本文使用雷诺平均RANS(Reynolds Average Navier-Stockes)与分离涡DES(Detached-Eddy Simulation)2种数值方法,对Joubert BB2潜艇在斜航工况下水动力性能及周围流场进行数值模拟。分析不同漂角工况下潜艇所受力、力矩及周围流场,重点关注围壳及尾舵附近流场,探寻漂角变化对潜艇受力及流场的影响。结果显示,采用DES方法计算大漂角工况时误差更小同时流场信息捕捉更加精确。研究结果表明,潜艇大漂角工况下采用DES方法能够更加准确地模拟潜艇受力及流场,同时对研究潜艇斜航状态下的流动分离现象具有一定的参考价值。
