目的:系统评价培土生金中药联合西医常规疗法治疗支气管哮喘缓解期肺脾两虚证的疗效以及证据质量,为临床决策及疾病指南制订提供循证依据。方法:检索中国知网(CNKI)、万方数据库(Wangfang)、Pubmed、Web of Science等8大中英文数据库,由...目的:系统评价培土生金中药联合西医常规疗法治疗支气管哮喘缓解期肺脾两虚证的疗效以及证据质量,为临床决策及疾病指南制订提供循证依据。方法:检索中国知网(CNKI)、万方数据库(Wangfang)、Pubmed、Web of Science等8大中英文数据库,由2名研究者独立进行文献筛选、信息提取、偏倚风险评估及方法学质量评价,并对纳入研究的总有效率、中医证候积分、第一秒用力呼气容积(FEV1)、第一秒用力呼气容积/用力肺活量(FEV1/FVC)、哮喘控制测试(ACT)评分等结局指标进行Meta分析,最终依照GRADE评估证据质量。结果:共纳入14项研究,合计1263例患者。结果显示:(1)培土生金中药联合常规西医疗法可有效改善患者总有效率,降低患者中医证候积分,改善患者FEV1水平、FEV1/FVC及ACT评分。(2)总有效率证据质量较优,可信度高,其余指标证据质量较低,尚待更多高质量的研究支持以提升证据级别。结论:培土生金中药联合西医常规疗法治疗支气管哮喘缓解期肺脾两虚证优于单用西医常规治疗,且在总有效率上证据质量较高,具有一定的循证学意义。展开更多
Functionally graded cellular structures(FGCSs)have a multitude of applications to a wide range of industries.Utilising the ever-progressing technology of additive manufacturing(AM),FGCSs can be applied to control mate...Functionally graded cellular structures(FGCSs)have a multitude of applications to a wide range of industries.Utilising the ever-progressing technology of additive manufacturing(AM),FGCSs can be applied to control material grading and achieve the desired mechanical properties.The current study explores the design and optimisation of FGCSs for AM,with a focus on improving the compression and impact performance of below knee(BK)prosthetic limbs made of thermoplastic polyurethane(TPU).A multiscale research methodology integrating topology optimization(TO),finite element analysis(FEA),and design of experiments(Do E)was adopted to optimise lattice structures in terms of stiffness and lightweight properties.Two-unit cell designs were considered in the study:Schwarz P gyroid and body-centered cubic(BCC).Response surface methodology(RSM)was implemented to analyse the effect of minimum and maximum cell wall thickness,cell size,and unit cell type on the mechanical performance of TPU FGCS structures.The results indicated that a Schwarz P FGCS structure with cell size,minimum and maximum cell wall thickness of 6,0.9 and 2.8 mm,respectively,could be optimal for a compromise between performance and weight.In this optimized case,stiffness and volume fraction values of 684 N/mm and 0.64 were obtained,respectively.The study also presents a proof-of-concept design for a BK prosthetic damper,highlighting the potential of FGCSs to enhance patient comfort,reduce manufacturing costs,and enable personalised designs through 3D scanning and AM.The obtained results could be a step forward towards the incorporation of AM technologies in prosthetics,offering a pathway to lightweight,cost-effective,and functionally tailored solutions.展开更多
We performed this study to investigate pathological upgrading from biopsy to prostatectomy and clinicopathological factors associated with grade group(GG)upgrading in patients with International Society of Urological ...We performed this study to investigate pathological upgrading from biopsy to prostatectomy and clinicopathological factors associated with grade group(GG)upgrading in patients with International Society of Urological Pathology(ISUP)GG 1 and 2 prostate cancer(PCa)in a Chinese cohort.We included patients diagnosed with PCa with ISUP GG 1 and 2 at biopsy,who underwent RP at our institution.Pre-and postoperative clinical variables were examined.Univariate and multivariate logistic regression analyses were conducted to identify independent factors associated with GG upgrading.Patients in GG upgraded group had higher total prostatespecific antigen(tPSA;median:14.43 ng ml^(−1) vs 10.52 ng ml^(−1),P=0.001)and PSA density(PSAD;median:0.45 ng ml^(−2) vs 0.27 ng ml^(−2),P<0.001)than those in GG nonupgraded group.Patients in upgraded group had a higher ratio for Prostate ImagingReporting and Data System(PI-RADS)score>3(86.4%vs 67.9%,P<0.001).Those with GG 1 in biopsy were more likely to experience GG upgrading after RP than those with GG 2(71 vs 54,P=0.016).Independent preoperative factors predicting GG upgrading were PI-RADS score>3(odds ratio[OR]:2.471,95%confidence interval[CI]:1.132–5.393;P=0.023),higher PSAD(P=0.001),and GG in biopsy(OR:0.241,95%CI:0.123–0.471;P<0.001).The histopathological analyses of RP specimens revealed that perineural invasion(PNI;OR:1.839,95%CI:1.027–3.490;P=0.041)was identified as an independent factor associated with GG upgrading.Our results revealed that GG in the biopsy,PSAD,PI-RADS score>3,and PNI were independent factors of GG upgrading.These factors should be considered for patients with ISUP grade≤2 PCa.展开更多
目的:基于推荐分级的评估、制订和评价系统(grading of recommendations assessment,development and e valuation,GRADE)与整合证据链法(integrated evidence chain-based efficacy evaluation of traditional Chinese medicine,i EC-E...目的:基于推荐分级的评估、制订和评价系统(grading of recommendations assessment,development and e valuation,GRADE)与整合证据链法(integrated evidence chain-based efficacy evaluation of traditional Chinese medicine,i EC-Eff),评价电针治疗痛风性关节炎(gouty arthritis,GA)的证据质量。方法:计算机检索PubMed、Web of Science、Cochrane Library、Embase、中国知网、中文科技期刊数据库、万方医学期刊数据库、中国生物医学文献数据库等数据库,检索时限为建库至2025年4月,纳入电针治疗GA的随机对照试验(randomized controlled trial,RCT)、实验研究及临床经验文献,采用Cochrane偏倚风险工具以及针刺临床试验干预措施报告标准(standards for reportlng interventions in clinical trials of acupuncture,STRICTA)评估RCT质量,采用Stata 18软件进行Meta分析,采用GRADE工具对结局指标进行证据质量评级,通过i EC-Eff整合多维度证据。结果:GRADE评价中,单一电针干预血尿酸、疼痛视觉模拟评分(visual analogue scale,VAS)等指标证据为C级(低质量证据),针药结合降低血尿酸、改善炎症指标C反应蛋白(C-reactive protein,CRP)和红细胞沉降率(erythrocyte sedimentation reaction,ESR)为B级(中等质量证据),细胞因子等指标证据为C级(低质量证据)。i EC-Eff评价中,临床经验证据为B级,实验研究证据为A级,临床试验证据为B级,综合评定为BAB(中级证据)。GRADE与i EC-Eff评价体系差异源于前者对研究设计严谨性要求高,后者契合中医药整体模式。电针联合西药在降尿酸、抗炎方面具有优势,但需高质量RCT验证。结论:电针治疗GA可以改善关节红肿热痛症状、降低血尿酸水平、减轻关节炎症反应(如ESR、CRP等指标)等,证据质量较高,具有较好的临床应用前景。GRADE与i EC-Eff在电针治疗GA的证据评价方面各有优势,未来需将二者结合起来优化中医药疗效评价体系,推动电针治疗GA的循证医学证据积累与国际化认可。展开更多
动物实验是生物医学研究中的重要手段,是连接基础研究与临床试验的桥梁。动物实验的系统评价/Meta分析(systematic review/meta-analysis,SRs/MAs)是整合动物实验证据的重要手段,能够促进成果向临床研究转化,降低转化风险,并推动基础研...动物实验是生物医学研究中的重要手段,是连接基础研究与临床试验的桥梁。动物实验的系统评价/Meta分析(systematic review/meta-analysis,SRs/MAs)是整合动物实验证据的重要手段,能够促进成果向临床研究转化,降低转化风险,并推动基础研究的资源整合。随着证据推荐分级的评估、制订与评价(grading of recommendations assessment,development and evaluation,GRADE)方法的不断发展,其在动物实验SRs/MAs中的应用受到了越来越多的关注。本文首先阐述了GRADE方法在动物实验SRs/MAs中的应用原理及具体应用类型,包括定性描述的系统评价、Meta分析及网状Meta分析;接着深入分析了GRADE方法在实际应用中的误用情况,主要包括未正确进行证据体分级、证据体分级不当、误用于定性系统评价、升降级过程记录与结果不一致,以及误用于提供推荐意见;此外,还全面探讨了GRADE方法在动物实验SRs/MAs中的证据确信度升降级因素,包括偏倚风险、间接性、不一致性、不精确性和发表偏倚对证据降级的影响,以及大效应量和跨物种一致性对证据升级的作用;最后,针对上述问题提出了改进策略,包括进一步研究与优化GRADE方法在动物实验SRs/MAs中的应用细节、制定符合动物实验研究特点的SRs/MAs报告规范,以及加强研究人员在GRADE方法上的专业培训等。本文旨在通过提升动物实验SRs/MAs的证据质量,增强其在临床决策中的可靠性,促进动物实验研究成果更高效地转化为临床实践。展开更多
应用推荐分级的评估、制订和评价(grading of recommendations assessment,development and evaluation,GRADE)系统与中药有效性评价整合证据链法(integrated evidence chain-based effectiveness evaluation of traditional Chinese me...应用推荐分级的评估、制订和评价(grading of recommendations assessment,development and evaluation,GRADE)系统与中药有效性评价整合证据链法(integrated evidence chain-based effectiveness evaluation of traditional Chinese medicine,Eff-iEC)对指南或专家共识推荐频次较高的12种治疗骨质疏松症的常用中成药进行了证据评价。结果显示,仙灵骨葆胶囊/片根据GRADE系统评价为C级(低级证据),根据Eff-iEC体系评价为BA+B^(+)(中级证据);金天格胶囊根据GRADE系统评价为C级(低级证据),根据Eff-iEC体系评价为AA+B(高级证据);骨疏康颗粒/胶囊根据GRADE系统评价为C级(低级证据),根据Eff-iEC体系评价为BA+B^(+)(中级证据);左归丸根据GRADE系统评价为C级(低级证据),根据Eff-iEC体系评价为AA^(++)B^(+)(高级证据);强骨胶囊根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为AA+B^(+)(高级证据);壮骨止痛胶囊根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为BA+B(中级证据);金匮肾气丸根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为AA+B(高级证据);全杜仲胶囊根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为AD+B^(+)(低级证据);淫羊藿总黄酮胶囊根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为AAB^(+)(高级证据);右归丸根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为AA^(++)B^(+)(高级证据);芪骨胶囊根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为BB^(+)B(中级证据);六味地黄丸根据GRADE系统评价为C级(低级证据),根据Eff-iEC体系评价为AA^(++)B^(+)(高级证据)。整体而言,Eff-iEC评价体系较GRADE系统能更全面地评价中医药的有效性证据,但仍有不够完善之处,制约其推广应用。在临床证据评价方面,Eff-iEC评价体系与GRADE系统均反映出当前中成药治疗骨质疏松症的临床研究质量普遍较低,未来尚需开展高质量临床试验,进一步验证临床疗效。展开更多
The good combination of mechanical and wear properties for cemented carbides is crucial.In this work,the wear behavior of functionally graded cemented carbide(FGCC)and non-graded cemented carbide(CC),with CoNiFeCr mul...The good combination of mechanical and wear properties for cemented carbides is crucial.In this work,the wear behavior of functionally graded cemented carbide(FGCC)and non-graded cemented carbide(CC),with CoNiFeCr multi-principal-element alloy(MPEA)binder,has been investigated by performing sliding wear tests and composition characterization.The results showed that compared with CC,FGCC had higher hardness,stronger fracture toughness,better wear performance,and similar TRS.FGCCs exhibited lower wear rates(3.44×10^(−7)–6.95×10^(−6)mm^(3)/(N m))and coefficients of friction(COFs)(0.27–0.39)than CCs from RT to 600℃due to mitigation of multiple risks caused by binder removal,fragmentation and pull-out of WC grains,high-temperature oxidation and softening.In the low-temperature wear stage,the MPEA binder underwent dynamic recrystallization(DRX)and twinning deformation before removing from the surface.The binder removal caused dislocation pile-ups and stacking faults(SFs)to form under high stress,resulting in fragmentation and pull-out of WC grains.The low-temperature wear was dominated by abrasive wear and adhesive wear,with a low wear rate and a high and unstable COF.In the high-temperature wear stage,initial pitting oxidation of WC grains generated many subgrain boundaries,reducing heat transfer and exacerbating oxidation,resulting in an oxide layer enriched with WO3,Mx Oy,and MWO4.High-temperature wear was dominated by oxidation wear and high-temperature softening,with a high wear rate and a low and smooth COF.The results from the present study do not only provide theoretical guidance for an understanding of the antiwear mechanism of WC-CoNiFeCr,but also a new approach for the preparation of cemented carbides with high wear resistance.展开更多
It is important to analyze the damage evolution process of surrounding rock under different water content for the stability of engineering rock mass.Based on digital speckle correlation(DSCM),acoustic emission(AE)and ...It is important to analyze the damage evolution process of surrounding rock under different water content for the stability of engineering rock mass.Based on digital speckle correlation(DSCM),acoustic emission(AE)and electromagnetic radiation(EMR),uniaxial hierarchical cyclic loading and unloading tests were carried out on sandstones with different fracture numbers under dry,natural and saturated water content,to explore the fracture propagation,failure precursor characteristics and damage response mechanism under the influence of water content effect.The results show that with the increase of water content,the peak stress and crack initiation stress decrease gradually,and the decreases are 15.28%-21.11%and 17.64%-23.04%,respectively.The peak strain and crack initiation strain increase gradually,and the increases are 19.85%-44.53%and 19.15%-41.94%,respectively.The precracked rock with different water content is mainly characterized by tensile failure at different loading stages.However,with the increase of water content,the proportion of shear cracks gradually increases,while acoustic emission events gradually decrease,the dissipative energy and energy storage limits of the rock under peak load gradually decrease,and the charge signal increases significantly,which is because the lubrication effect of water reduces the friction coefficient between crack surfaces.展开更多
The graded density impactor(GDI)dynamic loading technique is crucial for acquiring the dynamic physical property parameters of materials used in weapons.The accuracy and timeliness of GDI structural design are key to ...The graded density impactor(GDI)dynamic loading technique is crucial for acquiring the dynamic physical property parameters of materials used in weapons.The accuracy and timeliness of GDI structural design are key to achieving controllable stress-strain rate loading.In this study,we have,for the first time,combined one-dimensional fluid computational software with machine learning methods.We first elucidated the mechanisms by which GDI structures control stress and strain rates.Subsequently,we constructed a machine learning model to create a structure-property response surface.The results show that altering the loading velocity and interlayer thickness has a pronounced regulatory effect on stress and strain rates.In contrast,the impedance distribution index and target thickness have less significant effects on stress regulation,although there is a matching relationship between target thickness and interlayer thickness.Compared with traditional design methods,the machine learning approach offers a10^(4)—10^(5)times increase in efficiency and the potential to achieve a global optimum,holding promise for guiding the design of GDI.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)has become a widely accepted,minimally invasive treatment for gastrointestinal submucosal tumors.It has been reported that humanistic nursing care with graded psychologi...BACKGROUND Endoscopic submucosal dissection(ESD)has become a widely accepted,minimally invasive treatment for gastrointestinal submucosal tumors.It has been reported that humanistic nursing care with graded psychological interventions can effectively enhance patients’physical activity in patients,reduce postoperative complications,and improve their postoperative quality of life.AIM To investigate the effects of combining humanistic care with graded psychological support on nursing satisfaction and quality of life in patients undergoing ESD for gastrointestinal submucosal tumors.METHODS A retrospective analysis was conducted on the clinical data of 180 patients who underwent ESD surgery for gastrointestinal submucosal tumors at our hospital between March 2021 and February 2023.Patients were allocated into groups based on the nursing care they received:The control group,which received routine care(n=90),and the observation group,which was subjected to humanistic nursing care in combination with graded psychological support(n=90).Patient anxiety and depression were assessed using the self-rating anxiety scale(SAS)and self-rating depression scale(SDS).Quality of life was evaluated using the shortform 36 health survey,and additional indications such as time to first food intake,surgery duration,length of hospital stay,nursing satisfaction,and adverse reactions were also recorded.Data was analyzed using SPSS22.0,with t-tests employed for continuous variables andχ2 tests for categorical data.RESULTS Patients in the observation group experienced significantly shorter times to first postoperative meal,surgery,and hospital stay compared to the control group.After the intervention,the SAS score of the observation group was 43.17±5.68,and the SDS score was 41.57±6.52,both significantly lower than those of the control group,with SAS score of 52.38±5.21 and SDS score of 51.23±8.25.In addition,the observation group scored significantly higher in daily living,physical function,psychological well-being,and social functioning(80.01±6.39,83.59±6.89,81.69±5.34,and 85.23±6.05,respectively).Moreover,the observation group also exhibited higher satisfaction and selfefficacy scores and a lower incidence of adverse reactions compared to the control group(P<0.05).CONCLUSION For patients undergoing ESD for gastrointestinal submucosal tumors,humanistic nursing care in combination with graded psychological nursing care significantly shorten the times to first postoperative meal,surgery,and hospital stay,effectively alleviates anxiety and depression,improves quality of life and nursing satisfaction,and mitigate the incidence of adverse reactions.展开更多
Fe-Mo functionally graded materials(FGMs)with different composition-change rates from 100%304 stainless steel to 100%Mo along the composition gradient direction were prepared by electron beam-directed energy depositio...Fe-Mo functionally graded materials(FGMs)with different composition-change rates from 100%304 stainless steel to 100%Mo along the composition gradient direction were prepared by electron beam-directed energy deposition(EB-DED)technique,including three samples with composition mutation of 100%,composition change rate of 10%and 30%.Results show that the composition-change rate significantly affects the microstructure and mechanical properties of the samples.In the sample with abrupt change of composition,the sharp shift in composition between 304 stainless steel and Mo leads to a great difference in the microstructure and hardness near the interface between the two materials.With the increase in the number of gradient layers,the composition changes continuously along the direction of deposition height,and the microstructure morphology shows a smooth transition from 304 stainless steel to Mo,which is gradually transformed from columnar crystal to dendritic crystal.Elements Fe,Mo,and other major elements transform linearly along the gradient direction,with sufficient interlayer diffusion between the deposited layers,leading to good metallurgical bonding.The smaller the change in composition gradient,the greater the microhardness value along the deposition direction.When the composition gradient is 10%,the gradient layer exhibits higher hardness(940 HV)and excellent resistance to surface abrasion,and the overall compressive properties of the samples are better,with the compressive fracture stress in the top region reaching 750.05±14 MPa.展开更多
文摘目的:系统评价培土生金中药联合西医常规疗法治疗支气管哮喘缓解期肺脾两虚证的疗效以及证据质量,为临床决策及疾病指南制订提供循证依据。方法:检索中国知网(CNKI)、万方数据库(Wangfang)、Pubmed、Web of Science等8大中英文数据库,由2名研究者独立进行文献筛选、信息提取、偏倚风险评估及方法学质量评价,并对纳入研究的总有效率、中医证候积分、第一秒用力呼气容积(FEV1)、第一秒用力呼气容积/用力肺活量(FEV1/FVC)、哮喘控制测试(ACT)评分等结局指标进行Meta分析,最终依照GRADE评估证据质量。结果:共纳入14项研究,合计1263例患者。结果显示:(1)培土生金中药联合常规西医疗法可有效改善患者总有效率,降低患者中医证候积分,改善患者FEV1水平、FEV1/FVC及ACT评分。(2)总有效率证据质量较优,可信度高,其余指标证据质量较低,尚待更多高质量的研究支持以提升证据级别。结论:培土生金中药联合西医常规疗法治疗支气管哮喘缓解期肺脾两虚证优于单用西医常规治疗,且在总有效率上证据质量较高,具有一定的循证学意义。
基金financially supported and funded by the Deanship of Scientific Research at Imam Mohammad Ibn Saud Islamic University(IMSIU)(No.IMSIU-DDRSP2503)。
文摘Functionally graded cellular structures(FGCSs)have a multitude of applications to a wide range of industries.Utilising the ever-progressing technology of additive manufacturing(AM),FGCSs can be applied to control material grading and achieve the desired mechanical properties.The current study explores the design and optimisation of FGCSs for AM,with a focus on improving the compression and impact performance of below knee(BK)prosthetic limbs made of thermoplastic polyurethane(TPU).A multiscale research methodology integrating topology optimization(TO),finite element analysis(FEA),and design of experiments(Do E)was adopted to optimise lattice structures in terms of stiffness and lightweight properties.Two-unit cell designs were considered in the study:Schwarz P gyroid and body-centered cubic(BCC).Response surface methodology(RSM)was implemented to analyse the effect of minimum and maximum cell wall thickness,cell size,and unit cell type on the mechanical performance of TPU FGCS structures.The results indicated that a Schwarz P FGCS structure with cell size,minimum and maximum cell wall thickness of 6,0.9 and 2.8 mm,respectively,could be optimal for a compromise between performance and weight.In this optimized case,stiffness and volume fraction values of 684 N/mm and 0.64 were obtained,respectively.The study also presents a proof-of-concept design for a BK prosthetic damper,highlighting the potential of FGCSs to enhance patient comfort,reduce manufacturing costs,and enable personalised designs through 3D scanning and AM.The obtained results could be a step forward towards the incorporation of AM technologies in prosthetics,offering a pathway to lightweight,cost-effective,and functionally tailored solutions.
文摘We performed this study to investigate pathological upgrading from biopsy to prostatectomy and clinicopathological factors associated with grade group(GG)upgrading in patients with International Society of Urological Pathology(ISUP)GG 1 and 2 prostate cancer(PCa)in a Chinese cohort.We included patients diagnosed with PCa with ISUP GG 1 and 2 at biopsy,who underwent RP at our institution.Pre-and postoperative clinical variables were examined.Univariate and multivariate logistic regression analyses were conducted to identify independent factors associated with GG upgrading.Patients in GG upgraded group had higher total prostatespecific antigen(tPSA;median:14.43 ng ml^(−1) vs 10.52 ng ml^(−1),P=0.001)and PSA density(PSAD;median:0.45 ng ml^(−2) vs 0.27 ng ml^(−2),P<0.001)than those in GG nonupgraded group.Patients in upgraded group had a higher ratio for Prostate ImagingReporting and Data System(PI-RADS)score>3(86.4%vs 67.9%,P<0.001).Those with GG 1 in biopsy were more likely to experience GG upgrading after RP than those with GG 2(71 vs 54,P=0.016).Independent preoperative factors predicting GG upgrading were PI-RADS score>3(odds ratio[OR]:2.471,95%confidence interval[CI]:1.132–5.393;P=0.023),higher PSAD(P=0.001),and GG in biopsy(OR:0.241,95%CI:0.123–0.471;P<0.001).The histopathological analyses of RP specimens revealed that perineural invasion(PNI;OR:1.839,95%CI:1.027–3.490;P=0.041)was identified as an independent factor associated with GG upgrading.Our results revealed that GG in the biopsy,PSAD,PI-RADS score>3,and PNI were independent factors of GG upgrading.These factors should be considered for patients with ISUP grade≤2 PCa.
文摘目的:基于推荐分级的评估、制订和评价系统(grading of recommendations assessment,development and e valuation,GRADE)与整合证据链法(integrated evidence chain-based efficacy evaluation of traditional Chinese medicine,i EC-Eff),评价电针治疗痛风性关节炎(gouty arthritis,GA)的证据质量。方法:计算机检索PubMed、Web of Science、Cochrane Library、Embase、中国知网、中文科技期刊数据库、万方医学期刊数据库、中国生物医学文献数据库等数据库,检索时限为建库至2025年4月,纳入电针治疗GA的随机对照试验(randomized controlled trial,RCT)、实验研究及临床经验文献,采用Cochrane偏倚风险工具以及针刺临床试验干预措施报告标准(standards for reportlng interventions in clinical trials of acupuncture,STRICTA)评估RCT质量,采用Stata 18软件进行Meta分析,采用GRADE工具对结局指标进行证据质量评级,通过i EC-Eff整合多维度证据。结果:GRADE评价中,单一电针干预血尿酸、疼痛视觉模拟评分(visual analogue scale,VAS)等指标证据为C级(低质量证据),针药结合降低血尿酸、改善炎症指标C反应蛋白(C-reactive protein,CRP)和红细胞沉降率(erythrocyte sedimentation reaction,ESR)为B级(中等质量证据),细胞因子等指标证据为C级(低质量证据)。i EC-Eff评价中,临床经验证据为B级,实验研究证据为A级,临床试验证据为B级,综合评定为BAB(中级证据)。GRADE与i EC-Eff评价体系差异源于前者对研究设计严谨性要求高,后者契合中医药整体模式。电针联合西药在降尿酸、抗炎方面具有优势,但需高质量RCT验证。结论:电针治疗GA可以改善关节红肿热痛症状、降低血尿酸水平、减轻关节炎症反应(如ESR、CRP等指标)等,证据质量较高,具有较好的临床应用前景。GRADE与i EC-Eff在电针治疗GA的证据评价方面各有优势,未来需将二者结合起来优化中医药疗效评价体系,推动电针治疗GA的循证医学证据积累与国际化认可。
文摘动物实验是生物医学研究中的重要手段,是连接基础研究与临床试验的桥梁。动物实验的系统评价/Meta分析(systematic review/meta-analysis,SRs/MAs)是整合动物实验证据的重要手段,能够促进成果向临床研究转化,降低转化风险,并推动基础研究的资源整合。随着证据推荐分级的评估、制订与评价(grading of recommendations assessment,development and evaluation,GRADE)方法的不断发展,其在动物实验SRs/MAs中的应用受到了越来越多的关注。本文首先阐述了GRADE方法在动物实验SRs/MAs中的应用原理及具体应用类型,包括定性描述的系统评价、Meta分析及网状Meta分析;接着深入分析了GRADE方法在实际应用中的误用情况,主要包括未正确进行证据体分级、证据体分级不当、误用于定性系统评价、升降级过程记录与结果不一致,以及误用于提供推荐意见;此外,还全面探讨了GRADE方法在动物实验SRs/MAs中的证据确信度升降级因素,包括偏倚风险、间接性、不一致性、不精确性和发表偏倚对证据降级的影响,以及大效应量和跨物种一致性对证据升级的作用;最后,针对上述问题提出了改进策略,包括进一步研究与优化GRADE方法在动物实验SRs/MAs中的应用细节、制定符合动物实验研究特点的SRs/MAs报告规范,以及加强研究人员在GRADE方法上的专业培训等。本文旨在通过提升动物实验SRs/MAs的证据质量,增强其在临床决策中的可靠性,促进动物实验研究成果更高效地转化为临床实践。
文摘应用推荐分级的评估、制订和评价(grading of recommendations assessment,development and evaluation,GRADE)系统与中药有效性评价整合证据链法(integrated evidence chain-based effectiveness evaluation of traditional Chinese medicine,Eff-iEC)对指南或专家共识推荐频次较高的12种治疗骨质疏松症的常用中成药进行了证据评价。结果显示,仙灵骨葆胶囊/片根据GRADE系统评价为C级(低级证据),根据Eff-iEC体系评价为BA+B^(+)(中级证据);金天格胶囊根据GRADE系统评价为C级(低级证据),根据Eff-iEC体系评价为AA+B(高级证据);骨疏康颗粒/胶囊根据GRADE系统评价为C级(低级证据),根据Eff-iEC体系评价为BA+B^(+)(中级证据);左归丸根据GRADE系统评价为C级(低级证据),根据Eff-iEC体系评价为AA^(++)B^(+)(高级证据);强骨胶囊根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为AA+B^(+)(高级证据);壮骨止痛胶囊根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为BA+B(中级证据);金匮肾气丸根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为AA+B(高级证据);全杜仲胶囊根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为AD+B^(+)(低级证据);淫羊藿总黄酮胶囊根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为AAB^(+)(高级证据);右归丸根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为AA^(++)B^(+)(高级证据);芪骨胶囊根据GRADE系统评价为D级(极低级证据),根据Eff-iEC体系评价为BB^(+)B(中级证据);六味地黄丸根据GRADE系统评价为C级(低级证据),根据Eff-iEC体系评价为AA^(++)B^(+)(高级证据)。整体而言,Eff-iEC评价体系较GRADE系统能更全面地评价中医药的有效性证据,但仍有不够完善之处,制约其推广应用。在临床证据评价方面,Eff-iEC评价体系与GRADE系统均反映出当前中成药治疗骨质疏松症的临床研究质量普遍较低,未来尚需开展高质量临床试验,进一步验证临床疗效。
基金financially supported by the National Key Research and Development Program of China(No.2021YFB3701800)Special funding support for the Yuelu Mountain National University Science and Technology City“Ranking the Top of the List”Research Project:(Tunnel Boring Machine High-performance Long-life Cutting Tools)the State Key Laboratory of Powder Metallurgy,Central South University,Changsha,China.
文摘The good combination of mechanical and wear properties for cemented carbides is crucial.In this work,the wear behavior of functionally graded cemented carbide(FGCC)and non-graded cemented carbide(CC),with CoNiFeCr multi-principal-element alloy(MPEA)binder,has been investigated by performing sliding wear tests and composition characterization.The results showed that compared with CC,FGCC had higher hardness,stronger fracture toughness,better wear performance,and similar TRS.FGCCs exhibited lower wear rates(3.44×10^(−7)–6.95×10^(−6)mm^(3)/(N m))and coefficients of friction(COFs)(0.27–0.39)than CCs from RT to 600℃due to mitigation of multiple risks caused by binder removal,fragmentation and pull-out of WC grains,high-temperature oxidation and softening.In the low-temperature wear stage,the MPEA binder underwent dynamic recrystallization(DRX)and twinning deformation before removing from the surface.The binder removal caused dislocation pile-ups and stacking faults(SFs)to form under high stress,resulting in fragmentation and pull-out of WC grains.The low-temperature wear was dominated by abrasive wear and adhesive wear,with a low wear rate and a high and unstable COF.In the high-temperature wear stage,initial pitting oxidation of WC grains generated many subgrain boundaries,reducing heat transfer and exacerbating oxidation,resulting in an oxide layer enriched with WO3,Mx Oy,and MWO4.High-temperature wear was dominated by oxidation wear and high-temperature softening,with a high wear rate and a low and smooth COF.The results from the present study do not only provide theoretical guidance for an understanding of the antiwear mechanism of WC-CoNiFeCr,but also a new approach for the preparation of cemented carbides with high wear resistance.
基金financially supported by National Natural Science Foundation of China(No.52304136)Young Talent of Lifting Engineering for Science and Technology in Shandong,China(No.SDAST2024QTA060)Key Project of Research and Development in Liaocheng(No.2023YD02)。
文摘It is important to analyze the damage evolution process of surrounding rock under different water content for the stability of engineering rock mass.Based on digital speckle correlation(DSCM),acoustic emission(AE)and electromagnetic radiation(EMR),uniaxial hierarchical cyclic loading and unloading tests were carried out on sandstones with different fracture numbers under dry,natural and saturated water content,to explore the fracture propagation,failure precursor characteristics and damage response mechanism under the influence of water content effect.The results show that with the increase of water content,the peak stress and crack initiation stress decrease gradually,and the decreases are 15.28%-21.11%and 17.64%-23.04%,respectively.The peak strain and crack initiation strain increase gradually,and the increases are 19.85%-44.53%and 19.15%-41.94%,respectively.The precracked rock with different water content is mainly characterized by tensile failure at different loading stages.However,with the increase of water content,the proportion of shear cracks gradually increases,while acoustic emission events gradually decrease,the dissipative energy and energy storage limits of the rock under peak load gradually decrease,and the charge signal increases significantly,which is because the lubrication effect of water reduces the friction coefficient between crack surfaces.
基金supported by the Guangdong Major Project of Basic and Applied Basic Research(Grant No.2021B0301030001)the National Key Research and Development Program of China(Grant No.2021YFB3802300)the Foundation of National Key Laboratory of Shock Wave and Detonation Physics(Grant No.JCKYS2022212004)。
文摘The graded density impactor(GDI)dynamic loading technique is crucial for acquiring the dynamic physical property parameters of materials used in weapons.The accuracy and timeliness of GDI structural design are key to achieving controllable stress-strain rate loading.In this study,we have,for the first time,combined one-dimensional fluid computational software with machine learning methods.We first elucidated the mechanisms by which GDI structures control stress and strain rates.Subsequently,we constructed a machine learning model to create a structure-property response surface.The results show that altering the loading velocity and interlayer thickness has a pronounced regulatory effect on stress and strain rates.In contrast,the impedance distribution index and target thickness have less significant effects on stress regulation,although there is a matching relationship between target thickness and interlayer thickness.Compared with traditional design methods,the machine learning approach offers a10^(4)—10^(5)times increase in efficiency and the potential to achieve a global optimum,holding promise for guiding the design of GDI.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)has become a widely accepted,minimally invasive treatment for gastrointestinal submucosal tumors.It has been reported that humanistic nursing care with graded psychological interventions can effectively enhance patients’physical activity in patients,reduce postoperative complications,and improve their postoperative quality of life.AIM To investigate the effects of combining humanistic care with graded psychological support on nursing satisfaction and quality of life in patients undergoing ESD for gastrointestinal submucosal tumors.METHODS A retrospective analysis was conducted on the clinical data of 180 patients who underwent ESD surgery for gastrointestinal submucosal tumors at our hospital between March 2021 and February 2023.Patients were allocated into groups based on the nursing care they received:The control group,which received routine care(n=90),and the observation group,which was subjected to humanistic nursing care in combination with graded psychological support(n=90).Patient anxiety and depression were assessed using the self-rating anxiety scale(SAS)and self-rating depression scale(SDS).Quality of life was evaluated using the shortform 36 health survey,and additional indications such as time to first food intake,surgery duration,length of hospital stay,nursing satisfaction,and adverse reactions were also recorded.Data was analyzed using SPSS22.0,with t-tests employed for continuous variables andχ2 tests for categorical data.RESULTS Patients in the observation group experienced significantly shorter times to first postoperative meal,surgery,and hospital stay compared to the control group.After the intervention,the SAS score of the observation group was 43.17±5.68,and the SDS score was 41.57±6.52,both significantly lower than those of the control group,with SAS score of 52.38±5.21 and SDS score of 51.23±8.25.In addition,the observation group scored significantly higher in daily living,physical function,psychological well-being,and social functioning(80.01±6.39,83.59±6.89,81.69±5.34,and 85.23±6.05,respectively).Moreover,the observation group also exhibited higher satisfaction and selfefficacy scores and a lower incidence of adverse reactions compared to the control group(P<0.05).CONCLUSION For patients undergoing ESD for gastrointestinal submucosal tumors,humanistic nursing care in combination with graded psychological nursing care significantly shorten the times to first postoperative meal,surgery,and hospital stay,effectively alleviates anxiety and depression,improves quality of life and nursing satisfaction,and mitigate the incidence of adverse reactions.
基金National Natural Science Foundation of China(51975286)。
文摘Fe-Mo functionally graded materials(FGMs)with different composition-change rates from 100%304 stainless steel to 100%Mo along the composition gradient direction were prepared by electron beam-directed energy deposition(EB-DED)technique,including three samples with composition mutation of 100%,composition change rate of 10%and 30%.Results show that the composition-change rate significantly affects the microstructure and mechanical properties of the samples.In the sample with abrupt change of composition,the sharp shift in composition between 304 stainless steel and Mo leads to a great difference in the microstructure and hardness near the interface between the two materials.With the increase in the number of gradient layers,the composition changes continuously along the direction of deposition height,and the microstructure morphology shows a smooth transition from 304 stainless steel to Mo,which is gradually transformed from columnar crystal to dendritic crystal.Elements Fe,Mo,and other major elements transform linearly along the gradient direction,with sufficient interlayer diffusion between the deposited layers,leading to good metallurgical bonding.The smaller the change in composition gradient,the greater the microhardness value along the deposition direction.When the composition gradient is 10%,the gradient layer exhibits higher hardness(940 HV)and excellent resistance to surface abrasion,and the overall compressive properties of the samples are better,with the compressive fracture stress in the top region reaching 750.05±14 MPa.
