This article reviews research advances in the application of early enteral nutrition(EEN)in elderly patients with severe acute pancreatitis(SAP).Elderly SAP patients are associated with higher mor tality rates due to ...This article reviews research advances in the application of early enteral nutrition(EEN)in elderly patients with severe acute pancreatitis(SAP).Elderly SAP patients are associated with higher mor tality rates due to age-related immune dysfunction,whereas EEN has been demonstrated to improve clinical prognosis,reduce infection and complication rates,and shor ten hospital stays.However,ongoing debates exist regarding the optimal timing,route selection,and complication management of EEN.Through a systematic review of the literature,this study synthesizes current evidence on EEN in elderly SAP populations,critically examines unresolved clinical controversies,and proposes future research priorities to inform evidence-based practice.展开更多
A case of imported severe falciparum malaria with spontaneous splenic rupture was reported in this paper.The patient,an African migrant worker,developed hemolytic anemia,sepsis,thrombocytopenia,coagulation dysfunction...A case of imported severe falciparum malaria with spontaneous splenic rupture was reported in this paper.The patient,an African migrant worker,developed hemolytic anemia,sepsis,thrombocytopenia,coagulation dysfunction,liver failure,renal insufficiency,electrolyte disturbance and other clinical manifestations after returning to the local area.Plasmodium falciparum was found by peripheral blood smearscopy and was diagnosed as severe falciparum malaria.After standardized anti-malaria treatment,plasma exchange+cytokine adsorption therapy,the establishment of“forewarning-forewarning-prevention-emergency”predictive nursing management model,the establishment of an integrated nursing team,the division of medical care is clear,professional knowledge is complementary,after three months of regular follow-up,the patient has no malaria recurrence,no refire,the function of all organs returned to normal.展开更多
Dengue fever is an acute infectious disease caused by the dengue virus and transmitted by mosquito vectors[1].Its clinical manifestations include high fever,headache,muscle and joint pain,and rash.It holds a significa...Dengue fever is an acute infectious disease caused by the dengue virus and transmitted by mosquito vectors[1].Its clinical manifestations include high fever,headache,muscle and joint pain,and rash.It holds a significant position in global public health.In recent years,its incidence has continued to rise worldwide[2],making it one of the major diseases threatening human health.The disease course of dengue fever is divided into three typical phases:the acute febrile phase,the critical phase,and the recovery phase.While most patients experience mild symptoms,some may progress to severe dengue and potentially fatal outcomes if not promptly and effectively treated during the critical phase.展开更多
Severe trauma often involves complex injuries,leading to high disability and fatality rates.Effective treatment requires prompt and coordinated efforts across multiple disciplines to enhance success rates.Time-based c...Severe trauma often involves complex injuries,leading to high disability and fatality rates.Effective treatment requires prompt and coordinated efforts across multiple disciplines to enhance success rates.Time-based chain rescue is crucial in managing severe trauma.A patient with chest and abdominal injuries and hemorrhagic shock was transferred from an ambulance to our hospital.Our trauma team-initiated pre-hospital first aid,utilized an emergency green channel,and conducted rapid ultrasound,collaborating across disciplines.The patient eventually recovered and was discharged.展开更多
Severe acute pancreatitis(SAP)can induce acute respiratory distress syndrome(ARDS)and abdominal compartment syndrome(ACS).Although prone position ventilation(PPV)can improve outcomes in patients with ARDS,there is sig...Severe acute pancreatitis(SAP)can induce acute respiratory distress syndrome(ARDS)and abdominal compartment syndrome(ACS).Although prone position ventilation(PPV)can improve outcomes in patients with ARDS,there is significant controversy regarding its concurrent use with ACS owing to concerns of increased risk of intra-abdominal pressure(IAP).[1]We present a case of successful PPV application without adverse eff ects.展开更多
Background:Humanized mouse models are essential for studying the human immune response and antibody development.However,conventional models show limited B cell maturation and antigen-specific humoral responses.To over...Background:Humanized mouse models are essential for studying the human immune response and antibody development.However,conventional models show limited B cell maturation and antigen-specific humoral responses.To overcome these limitations,we used the NOG-EXL mice expressing human interleukin 3(IL-3)and granulocyte-macrophage colony-stimulating factor(GM-CSF)to enhance myeloid and B-cell lineage differentiation.Methods:Human CD34^(+)hematopoietic stem cells(HSC)were transplanted into NOG-EXL mice to produce humanized immune systems.After immune cell reconstitution was confirmed across 12 weeks,the mice were immunized twice with inactivated severe fever with thrombocytopenia syndrome virus(SFTSV)antigens.Peripheral blood mononuclear cells and splenocytes were analyzed using multicolor flow cytometry to assess human immune cell subsets.Antigen-specific immunoglobulin G(IgG)production was quantified using enzyme-linked immunosorbent assay(ELISA),and virus-specific B cells were isolated using antigen-labeled recombinant protein probes.Results:Twelve weeks after transplantation of HSCs into NOG-EXL mice,they exhibited robust engraftment of human leukocytes,including T,B,and dendritic cells,compared to NOG mice.Unlike NOG mice,humanized NOG-EXL mice exhibited an increase in human IgG levels,indicating the production of human antibody responses to antigens.Humanized NOG-EXL mice were immunized twice every 2 weeks with inactivated SFTSV,and antigen-specific human antibodies against the virus were detected in the mouse sera by ELISA.Sera from SFTSV-immunized humanized mice demonstrated neutralizing activity against SFTSV,confirming the induction of functional virus-specific neutralizing antibodies.Antigen-binding IgG-positive human B cells were isolated from mouse splenocytes using recombinant protein probes.Conclusion:This model provides a valuable platform for evaluating humoral immunity and isolating B cells using high-affinity human monoclonal antibodies without genetic engineering.展开更多
Dengue is an arboviral disease caused by the dengue virus,with 390 million infections reported annually worldwide.It is classified into two categories:dengue without or with warning signs and severe dengue.[1]Given th...Dengue is an arboviral disease caused by the dengue virus,with 390 million infections reported annually worldwide.It is classified into two categories:dengue without or with warning signs and severe dengue.[1]Given the moderate efficacy of the dengue vaccine,[2]there is an urgent necessity to design host-directed therapeutic strategies,such as the repurposing of FDA-approved drugs,to combat dengue virus infection.展开更多
The clinical treatment of severe trauma withsternoclavicular joint injury is challenging,primarilydue to the irregular shape of the bones surrounding thesternoclavicular joint,as well as the posterior clavicle beingcl...The clinical treatment of severe trauma withsternoclavicular joint injury is challenging,primarilydue to the irregular shape of the bones surrounding thesternoclavicular joint,as well as the posterior clavicle beingclose to the aorta and mediastinal organs.^([1])These patientsnot only suffer direct injuries to the sternoclavicularjoint,but also frequently experience severe injuries toother body parts.The systemic physiological disordersand multi-organ dysfunction caused by severe traumaincrease the surgery di?culty and mortality risk.^([2])展开更多
Severe fever with thrombocytopenia syndrome(SFTS)is a novel emerging acute infectious disease caused by severe fever with thrombocytopenia syndrome virus(SFTSV),characterized by high fever and thrombocytopenia.It has ...Severe fever with thrombocytopenia syndrome(SFTS)is a novel emerging acute infectious disease caused by severe fever with thrombocytopenia syndrome virus(SFTSV),characterized by high fever and thrombocytopenia.It has been proved that traditional Chinese medicine(TCM)has displayed definite therapeutic effects on viral hemorrhagic fever,indicating its potential to treat SFTS.In this study,SFTS-relative key targets were predicted via gene ontology(GO)analysis and kyoto encyclopedia of genes and genomes(KEGG)enrichment analysis.Molecular docking was then used to select stable binders.Molecules matched TCMs were identified,and a new prescription,Qingqi Guxue decoction(QQGX),was formulated to clear heat and nourish blood,with a resulting drug composition network.We explored the optimal drug proportion for QQGX.Through an in-depth study of molecular mechanisms,we found that QQGX induces S phase arrest by promoting the degradation of cyclin A2(CCNA2)and cyclin-dependent kinase 2(CDK2),thereby inhibiting SFTSV replication.Finally,we verified the effectiveness and safety of QQGX based on the mouse liver bile duct organoid model infected with SFTSV.In summary,our study prepared a TCM decoction using the method of network pharmacology.This decoction has a significant inhibitory effect on the replication of SFTSV and provides a new treatment strategy for hemorrhagic fever with TCM.展开更多
BACKGROUND:The lack of a stable,easy-to-operate animal model for severe trauma has hindered the research progress.The aim of this study is to develop a mouse model that replicates the pathophysiological conditions of ...BACKGROUND:The lack of a stable,easy-to-operate animal model for severe trauma has hindered the research progress.The aim of this study is to develop a mouse model that replicates the pathophysiological conditions of severe trauma,providing a reliable research tool.METHODS:Male C57BL/6J mice(aged 8-10 weeks and weighting approximately 20 g)were used to establish the severe trauma model.Under anesthesia,a midshaft femoral fracture was created and packed with sterile cotton.A midline incision was made from the inguinal region to the sternum,exposing the abdominal organs for 30 min.The right femoral artery was cannulated to induce controlled blood loss at 30%,35%,40%,and 50%of the total blood volume.Survival rates were monitored for 24 h post-induction.In the mice that experienced 30%blood loss,the mean arterial pressure,body temperature,blood gas parameters,peripheral blood inflammatory markers,and major organ pathological changes were assessed.RESULTS:Mice with femoral fractures,soft tissue injuries,abdominal organ exposure,and 30%blood loss exhibited stable survival rates.Increased blood loss significantly reduced survival rates.Mean arterial pressure decreased initially,recovering within 0-15 min and returning to baseline by 50 min.Similarly,the body temperature decreased initially and gradually recovered to baseline within 50 min.Levels of peripheral blood inflammatory markers remained elevated for 12 h post-injury.Distant organs,including intestines,lungs,liver,spleen and kidneys,displayed varying degrees of injury.CONCLUSION:The established mouse model replicates the pathophysiological responses to severe trauma,indicating stability and reproducibility,which could be an useful tool for further trauma research.展开更多
BACKGROUND Boerhaave syndrome,or spontaneous esophageal rupture,is a rare and lifethreatening emergency,typically caused by a sudden increase in esophageal pressure due to violent coughing or vomiting.Early diagnosis ...BACKGROUND Boerhaave syndrome,or spontaneous esophageal rupture,is a rare and lifethreatening emergency,typically caused by a sudden increase in esophageal pressure due to violent coughing or vomiting.Early diagnosis is challenging as its symptoms often resemble those of other diseases.Understanding its pathological features and treatment strategies is therefore critical for clinical practice.CASE SUMMARY This report describes a case of spontaneous esophageal rupture triggered by violent coughing in a 55-year-old male with a history of smoking and hypertension.Following severe coughing,the patient developed chest pain,vomiting,and respiratory distress.Initial clinical evaluation was inconclusive,with a suspected diagnosis of cardiovascular or gastrointestinal conditions.After further examination,the diagnosis of spontaneous esophageal rupture was confirmed.Chest X-ray,computed tomography,and endoscopy revealed a rupture in the lower esophagus,along with mediastinal abscess and pleural effusion.Laboratory tests showed mild infection markers.The patient underwent surgical repair of the esophageal rupture(approximately 3 cm in length)with mediastinal drainage.Postoperatively,the patient’s temperature normalized within 3 days,respiratory function improved,and pleural effusion significantly decreased.After two weeks of treatment,the patient was discharged without complications and had a favorable prognosis.The study suggests that while violent coughing is a rare trigger,it can lead to severe damage,and imaging techniques play a crucial role in diagnosis.CONCLUSION Spontaneous esophageal rupture presents significant diagnostic and therapeutic challenges.Early recognition and timely intervention are crucial for improving prognosis.This case highlights the importance of imaging and surgical treatment,offering new insights for managing similar cases and providing valuable clinical guidance.展开更多
Objective:To investigate the expression level of interleukin-17D(IL-17D)in the serum of patients with severe pneumonia and its correlation with disease severity.Methods:This study included 50 patients with severe pneu...Objective:To investigate the expression level of interleukin-17D(IL-17D)in the serum of patients with severe pneumonia and its correlation with disease severity.Methods:This study included 50 patients with severe pneumonia who were diagnosed and treated in the hospital from May 2024 to May 2025.The expression level of IL-17D in the serum of all patients was recorded.Patients were divided into severe and mild groups based on their disease severity.Gender,age,disease duration,presence of fever,atelectasis,pneumothorax,interleukin-2(IL-2),interleukin-4(IL-4),interleukin-6(IL-6),and interleukin-17D were selected as independent variables.Statistical software SPSS 22.00 was used for univariate analysis,and variables with statistical significance in the univariate analysis were included in a multivariate logistic regression analysis to determine the correlation between IL-17D and the severity of severe pneumonia.Results:The results of this study showed that the level of IL-17D in patients with severe pneumonia was significantly higher than the normal threshold.Univariate analysis indicated that atelectasis,IL-2,IL-6,and IL-17D were statistically significant(P<0.05)and could be considered as influencing factors for the severity of severe pneumonia.Multivariate logistic regression analysis revealed that atelectasis(OR=2.141,95%CI:1.684–2.391),IL-2(OR=2.884,95%CI:2.240–3.614),IL-6(OR=2.571,95%CI:2.190–2.943),and IL-17D(OR=2.416,95%CI:2.093–2.735)were positively correlated with the severity of severe pneumonia.Conclusion:The expression level of IL-17D in the serum of patients with severe pneumonia is higher than the normal threshold and is positively correlated with disease severity.展开更多
This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias.We retrospectively analyzed the clinical data of patients with severe hypospadi...This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias.We retrospectively analyzed the clinical data of patients with severe hypospadias admitted to the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between October 2012 and October 2022.In total,31 patients underwent the conventional Byars procedure(conventional group),and 45 patients underwent the modified Byars staged procedure(modified group).Our modified strategy was built upon the standard Byars procedure by incorporating glansplasty during the first stage and employing a Y-shaped flap in conjunction with a glandular tunnel for urethroplasty during the second stage.Notably,there were no statistically significant differences in the preoperative baseline characteristics,duration of surgery,amount of blood loss,or occurrence of postoperative complications,including urethral fistula,stricture and diverticulum,or penile curvature,between the conventional and modified groups.However,there was a significantly lower incidence of coronal sulcus fistula(0 vs 16.1%,P=0.02)and glans dehiscence(0 vs 12.9%,P=0.02)in the surgical group than that in the conventional group.In addition,the modified group exhibited a notably greater rate of normotopic urethral opening(100.0%vs 83.9%,P=0.01)and a higher mean score on the Hypospadias Objective Penile Evaluation(HOPE;mean±standard error of mean:8.6±0.2 vs 7.9±0.3,P=0.02)than did the conventional group.In conclusion,the modified Byars staged procedure significantly reduced the risks of glans dehiscence and coronal sulcus fistula.Consequently,it offers a promising approach for achieving favorable penile esthetics,thereby providing a reliable therapeutic option for severe hypospadias.展开更多
Background: Severe acute malnutrition (SAM) is one of the major public health problems associated with increased mortality in under-five children. In low-income countries, renal dysfunction (RD) contributes to about 3...Background: Severe acute malnutrition (SAM) is one of the major public health problems associated with increased mortality in under-five children. In low-income countries, renal dysfunction (RD) contributes to about 34% mortality in under-five children with severe acute malnutrition. This study aimed to determine the impacts of severe acute malnutrition on the kidney among the admitted under-five children. Methods: In this prospective longitudinal observational study, a total of 190 children aged 6 to 59 months were enrolled from Iringa and Dodoma tertiary hospitals. Socio-demographic, clinical and laboratory data were collected using a structured questionnaire. Estimated Glomerular Filtration Rate (eGFR) and urine albumin creatinine ratio (uACR) were used to determine RD. Data analysis was done using SPSS version 26 and statistical significance was assumed for factors with p-value Results: Out of 190 children with severe acute malnutrition, 36 (19%) had renal dysfunction. Factors associated with RD in malnourished children were the history of local herbs used within one week (AOR = 5.85, 95% CI [1.41, 24.319], p = 0.0152), Acute watery diarrhea with severe dehydration (AOR = 2.15, 95% CI [1.033, 4.711], p = 0.0166), and positive urine leukocytes (AOR = 19.91, 95% CI [4.09, 96.989], p = 0.0002). At three months of follow up, out of 36 children with RD, 20 (55.56%) attained full recovery, while 4 (11.11%) developed chronic kidney disease (CKD). Children with RD had prolonged hospital stays for more than 14 days with a mean 12.25 ± 5.00 days compared to those with no RD with a mean 6.29 ± 1.68 days (p Conclusion: Renal dysfunction is common among children with severe acute malnutrition. It is associated with prolonged hospital stays and increased mortality. Further studies which can determine the burden of RD in children with severe acute malnutrition as compared to those with no severe acute malnutrition are needed.展开更多
Background:Currently,there is a deficiency in a strong risk prediction framework for precisely evaluating the likelihood of severe postoperative complications in patients undergoing elective hepato-pancreatobiliary su...Background:Currently,there is a deficiency in a strong risk prediction framework for precisely evaluating the likelihood of severe postoperative complications in patients undergoing elective hepato-pancreatobiliary surgery subsequent to experiencing breakthrough infection of coronavirus disease 2019(COVID-19).This study aimed to find factors predicting postoperative complications and construct an innovative nomogram to pinpoint patients who were susceptible to developing severe complications following breakthrough infection of COVID-19 after undergoing elective hepato-pancreato-biliary surgery.Methods:This multicenter retrospective cohort study included consecutive patients who underwent elective hepato-pancreato-biliary surgeries between January 3 and April 1,2023 from four hospitals in China.All of these patients had experienced breakthrough infection of COVID-19 prior to their surgeries.Additionally,two groups of patients without preoperative COVID-19 infection were included as comparative controls.Surgical complications were meticulously documented and evaluated using the comprehensive complication index(CCI),which ranged from 0(uneventful course)to 100(death).A CCI value of 20.9 was identified as the threshold for defining severe complications.Results:Among 2636 patients who were included in this study,873 were included in the reference group I,941 in the reference group II,389 in the internal cohort,and 433 in the external validation cohort.Multivariate logistic regression analysis revealed that completing a full course of COVID-19 vaccination>6 months before surgery,undergoing surgery within 4 weeks of diagnosis of COVID-19 breakthrough infection,operation duration of 4 h or longer,cancer-related surgery,and major surgical procedures were significantly linked to a CCI>20.9.A nomogram model was constructed utilizing CCI>20.9 in the training cohort[area under the curve(AUC):0.919,95%confidence interval(CI):0.881–0.957],the internal validation cohort(AUC:0.910,95%CI:0.847–0.973),and the external validation cohort(AUC:0.841,95%CI:0.799–0.883).The calibration curve for the probability of CCI>20.9 demonstrated good agreement between the predictions made by the nomogram and the actual observations.Conclusions:The developed model holds significant potential in aiding clinicians with clinical decisionmaking and risk stratification for patients who have experienced breakthrough infection of COVID-19 prior to undergoing elective hepato-pancreato-biliary surgery.展开更多
Objective:To analyze the clinical application and effects of the body restraint reduction program for severe neurological patients.Methods:A total of 206 patients admitted to the neurology department of the hospital f...Objective:To analyze the clinical application and effects of the body restraint reduction program for severe neurological patients.Methods:A total of 206 patients admitted to the neurology department of the hospital from January 2022 to May 2025 were selected as the research subjects.Among them,102 patients from January 2022 to May 2025 were assigned to the observation group,and 104 patients during the same period served as the control group.In practice,the control group received conventional body restraint,while the observation group adopted the reduction program.The incidence of unplanned extubation and restraint-related complications were compared between the two groups.Results:The body restraint rate and complication rate in the observation group were significantly lower(P<0.05).After nurse training,their knowledge mastery and operational ability were significantly higher than before training(P<0.01).Conclusion:The body restraint reduction program for severe neurological patients can effectively reduce the restraint rate and complication incidence,while helping improve nurses’restraint management capabilities,serving as an effective means to enhance overall nursing quality.展开更多
BACKGROUND Early risk stratification in severe acute pancreatitis(SAP)remains challenging with traditional scoring systems overlooking etiological heterogeneity,particularly in hypertriglyceridemic acute pancreatitis(...BACKGROUND Early risk stratification in severe acute pancreatitis(SAP)remains challenging with traditional scoring systems overlooking etiological heterogeneity,particularly in hypertriglyceridemic acute pancreatitis(HTG-AP).AIM To develop and evaluate a machine learning(ML)model combining intraabdominal pressure(IAP)and procalcitonin(PCT)for SAP prognosis and evaluate its clinical impact across different etiologies.METHODS We retrospectively analyzed 245 patients with pancreatitis(98 patients with SAP).An ML model using 24-h peak IAP and PCT levels was used to predict 28-day mortality.Propensity score matching was used to compare IAP-PCT-guided management with conventional management.RESULTS The ML-IAP-PCT model outperformed the Acute Physiology and Chronic Health Evaluation II score(area under the curve:0.853 vs 0.801,P=0.044)and Bedside Index of Severity in Acute Pancreatitis score.IAP-PCT-guided management was associated with lower mortality(15.8%vs 25.0%,P=0.043)and multiple organ dysfunction syndrome(48.7%vs 61.8%,P=0.027)rates.Patients with HTG-AP showed the greatest benefit(multiple organ dysfunction syndrome:39.3%vs 60.7%,P=0.018).CONCLUSION ML-optimized IAP-PCT monitoring provides superior prognostic accuracy and guides management associated with improved outcomes,especially in patients with HTG-AP.Prospective validation is needed to establish causality for this etiology-stratified approach.展开更多
To date,nanostructuring through plastic deformation has rarely been reported in biodegradable zinc(Zn)based alloys that have great potential in load-bearing conditions.Here,typical high-strength Zn-Li-based alloys wer...To date,nanostructuring through plastic deformation has rarely been reported in biodegradable zinc(Zn)based alloys that have great potential in load-bearing conditions.Here,typical high-strength Zn-Li-based alloys were subjected to SPD processes,including equal channel angular pressing(ECAP)and high-pressure torsion(HPT),to achieve nanostructured microstructures.The effects of SPD on the microstructures,mechanical properties,and corrosion behaviors were generally investigated.The two SPD routes resulted in totally different microstructures.ECAPed samples processed at 150℃ exhibited a complicated multilevel structure(nm toμm)with mixed Zn equiaxed grains and lamellar-like eutectoid regions(Zn+α-LiZn_(4)),and HPTed ones(25℃)possessed a fully dynamically recrystallized(DRXed)microstructure with an average grain size below 0.4μm.The tensile strength of the SPD samples could reach 500 MPa.Meanwhile,HPTed samples exhibited extraordinary fracture elongations higher than 100%,because of a different grain boundary sliding deformation mechanism.HPTed samples and ECAPed samples displayed different corrosion patterns,and the former exhibited a much higher corrosion rate in Hank's solution,possibly due to the accelerated corrosion at grain boundaries.In summary,SPD is an efficient way to refine the microstructure of biodegradable Zn-based alloys,possibly improving their performances and clinical applications.展开更多
Objective:To investigate whether the presence or absence of improvement in chronic severe functional constipation(CSFC)at the early stage of treatment with electroacupuncture predicts subsequent response or non-respon...Objective:To investigate whether the presence or absence of improvement in chronic severe functional constipation(CSFC)at the early stage of treatment with electroacupuncture predicts subsequent response or non-response,and to determine the optimal treatment duration for assessing subsequent responses to electroacupuncture.Methods:This is a post hoc analysis using data pooled from two large-scale randomized controlled trials.Patients with CSFC were recruited,and those in the electroacupuncture groups were included in the present study.Early improvement was defined as a weekly increase of≥1 complete spontaneous bowel movement(CSBM)compared to baseline.Three treatment response criteria were evaluated:≥3CSBMs per week,overall CSBM response,and sustained CSBM response.Predictive statistics,including sensitivity,specificity,positive predictive value,and negative predictive value,were calculated at weeks1–4.Receiver operating characteristic curves and accuracy rates were used to determine the optimal timepoint for differentiation between responders and non-responders.Results:Cases from a total of 813 participants who received electroacupuncture were analyzed.The proportion of improvers was 40.34%by week 1,increasing to 52.52%by week 4.After 8 weeks of treatment,the response rates were 30.14%,25.83%and 25.58%according to the three aforementioned criteria,respectively.Early improvement was a strong predictor of treatment response,with week 3 demonstrating the highest predictive accuracy.Conclusion:Early improvement with electroacupuncture,especially at week 3,can predict subsequent outcomes.Our findings suggest that acupuncturists may identify non-responders who might require adjustments to therapeutic strategies early in treatment.展开更多
A gradient nanostructured layer was fabricated on the surface of TA15(Ti-6Al-2Zr-1Mo-1V)alloy(produced by selective laser melting)using severe shot peening(SSP).This study focuses on the evolution of the microstructur...A gradient nanostructured layer was fabricated on the surface of TA15(Ti-6Al-2Zr-1Mo-1V)alloy(produced by selective laser melting)using severe shot peening(SSP).This study focuses on the evolution of the microstructure and the mechanism of grain refinement in TA15 titanium alloy during SSP treatment.Transmission electron microscopyand Rietveld refinement methods were employed.The residual stress and microhardness variations with depth were also characterized.The results show:(1)At the initial stage of deformation,plastic deformation is primarily accommodated through twinning and dislocation slip.(2)As the strain increases,twinning disappears,and dislocations interact to form tangles.Some dislocations annihilate and rearrange into subgrain boundaries,subdividing the original grains into subgrains.(3)With continued dislocation activity,the subgrain size decreases until nanocrystals are formed through the dynamic rotational recrystallization.SSP introduced compressive residual stress(CRS)in the near-surface layer of the material,with the maximum CRS of approximately−1141 MPa observed in the subsurface layer.It also induced work hardening,increasing the surface hardness to approximately 479 HV.However,the surface roughness increases,leading to a slight deterioration in surface quality.展开更多
基金supported by the Scientific Research Project of the Health Commission of Shanxi Province(No.2024003)。
文摘This article reviews research advances in the application of early enteral nutrition(EEN)in elderly patients with severe acute pancreatitis(SAP).Elderly SAP patients are associated with higher mor tality rates due to age-related immune dysfunction,whereas EEN has been demonstrated to improve clinical prognosis,reduce infection and complication rates,and shor ten hospital stays.However,ongoing debates exist regarding the optimal timing,route selection,and complication management of EEN.Through a systematic review of the literature,this study synthesizes current evidence on EEN in elderly SAP populations,critically examines unresolved clinical controversies,and proposes future research priorities to inform evidence-based practice.
基金“Artificial Liver Special Fund”of Beijing Gan Dan Xiang Zhao Public Welfare Foundation(Project No.:iGandanF-1082024-RGG055)。
文摘A case of imported severe falciparum malaria with spontaneous splenic rupture was reported in this paper.The patient,an African migrant worker,developed hemolytic anemia,sepsis,thrombocytopenia,coagulation dysfunction,liver failure,renal insufficiency,electrolyte disturbance and other clinical manifestations after returning to the local area.Plasmodium falciparum was found by peripheral blood smearscopy and was diagnosed as severe falciparum malaria.After standardized anti-malaria treatment,plasma exchange+cytokine adsorption therapy,the establishment of“forewarning-forewarning-prevention-emergency”predictive nursing management model,the establishment of an integrated nursing team,the division of medical care is clear,professional knowledge is complementary,after three months of regular follow-up,the patient has no malaria recurrence,no refire,the function of all organs returned to normal.
文摘Dengue fever is an acute infectious disease caused by the dengue virus and transmitted by mosquito vectors[1].Its clinical manifestations include high fever,headache,muscle and joint pain,and rash.It holds a significant position in global public health.In recent years,its incidence has continued to rise worldwide[2],making it one of the major diseases threatening human health.The disease course of dengue fever is divided into three typical phases:the acute febrile phase,the critical phase,and the recovery phase.While most patients experience mild symptoms,some may progress to severe dengue and potentially fatal outcomes if not promptly and effectively treated during the critical phase.
基金Jiangsu Provincial Hospital Association Hospital Management Innovation Research Fund(Project Ni.:JSYGY-3-2025-267)。
文摘Severe trauma often involves complex injuries,leading to high disability and fatality rates.Effective treatment requires prompt and coordinated efforts across multiple disciplines to enhance success rates.Time-based chain rescue is crucial in managing severe trauma.A patient with chest and abdominal injuries and hemorrhagic shock was transferred from an ambulance to our hospital.Our trauma team-initiated pre-hospital first aid,utilized an emergency green channel,and conducted rapid ultrasound,collaborating across disciplines.The patient eventually recovered and was discharged.
文摘Severe acute pancreatitis(SAP)can induce acute respiratory distress syndrome(ARDS)and abdominal compartment syndrome(ACS).Although prone position ventilation(PPV)can improve outcomes in patients with ARDS,there is significant controversy regarding its concurrent use with ACS owing to concerns of increased risk of intra-abdominal pressure(IAP).[1]We present a case of successful PPV application without adverse eff ects.
基金The Korea Centers for Disease Control and Prevention,Grant/Award Number:2022-ER1701-00,2022-NI-041-02,2024-ER1702-00 and 2025-NI-014-00。
文摘Background:Humanized mouse models are essential for studying the human immune response and antibody development.However,conventional models show limited B cell maturation and antigen-specific humoral responses.To overcome these limitations,we used the NOG-EXL mice expressing human interleukin 3(IL-3)and granulocyte-macrophage colony-stimulating factor(GM-CSF)to enhance myeloid and B-cell lineage differentiation.Methods:Human CD34^(+)hematopoietic stem cells(HSC)were transplanted into NOG-EXL mice to produce humanized immune systems.After immune cell reconstitution was confirmed across 12 weeks,the mice were immunized twice with inactivated severe fever with thrombocytopenia syndrome virus(SFTSV)antigens.Peripheral blood mononuclear cells and splenocytes were analyzed using multicolor flow cytometry to assess human immune cell subsets.Antigen-specific immunoglobulin G(IgG)production was quantified using enzyme-linked immunosorbent assay(ELISA),and virus-specific B cells were isolated using antigen-labeled recombinant protein probes.Results:Twelve weeks after transplantation of HSCs into NOG-EXL mice,they exhibited robust engraftment of human leukocytes,including T,B,and dendritic cells,compared to NOG mice.Unlike NOG mice,humanized NOG-EXL mice exhibited an increase in human IgG levels,indicating the production of human antibody responses to antigens.Humanized NOG-EXL mice were immunized twice every 2 weeks with inactivated SFTSV,and antigen-specific human antibodies against the virus were detected in the mouse sera by ELISA.Sera from SFTSV-immunized humanized mice demonstrated neutralizing activity against SFTSV,confirming the induction of functional virus-specific neutralizing antibodies.Antigen-binding IgG-positive human B cells were isolated from mouse splenocytes using recombinant protein probes.Conclusion:This model provides a valuable platform for evaluating humoral immunity and isolating B cells using high-affinity human monoclonal antibodies without genetic engineering.
基金funded by grants Pronaii 302979A1-S-9005 CONACyT (México) from RMDA。
文摘Dengue is an arboviral disease caused by the dengue virus,with 390 million infections reported annually worldwide.It is classified into two categories:dengue without or with warning signs and severe dengue.[1]Given the moderate efficacy of the dengue vaccine,[2]there is an urgent necessity to design host-directed therapeutic strategies,such as the repurposing of FDA-approved drugs,to combat dengue virus infection.
文摘The clinical treatment of severe trauma withsternoclavicular joint injury is challenging,primarilydue to the irregular shape of the bones surrounding thesternoclavicular joint,as well as the posterior clavicle beingclose to the aorta and mediastinal organs.^([1])These patientsnot only suffer direct injuries to the sternoclavicularjoint,but also frequently experience severe injuries toother body parts.The systemic physiological disordersand multi-organ dysfunction caused by severe traumaincrease the surgery di?culty and mortality risk.^([2])
基金supported by the National Natural Science Foundation of China(32170144 and 32470146).
文摘Severe fever with thrombocytopenia syndrome(SFTS)is a novel emerging acute infectious disease caused by severe fever with thrombocytopenia syndrome virus(SFTSV),characterized by high fever and thrombocytopenia.It has been proved that traditional Chinese medicine(TCM)has displayed definite therapeutic effects on viral hemorrhagic fever,indicating its potential to treat SFTS.In this study,SFTS-relative key targets were predicted via gene ontology(GO)analysis and kyoto encyclopedia of genes and genomes(KEGG)enrichment analysis.Molecular docking was then used to select stable binders.Molecules matched TCMs were identified,and a new prescription,Qingqi Guxue decoction(QQGX),was formulated to clear heat and nourish blood,with a resulting drug composition network.We explored the optimal drug proportion for QQGX.Through an in-depth study of molecular mechanisms,we found that QQGX induces S phase arrest by promoting the degradation of cyclin A2(CCNA2)and cyclin-dependent kinase 2(CDK2),thereby inhibiting SFTSV replication.Finally,we verified the effectiveness and safety of QQGX based on the mouse liver bile duct organoid model infected with SFTSV.In summary,our study prepared a TCM decoction using the method of network pharmacology.This decoction has a significant inhibitory effect on the replication of SFTSV and provides a new treatment strategy for hemorrhagic fever with TCM.
基金supported by the National Natural Science Foundation of China(82102315).
文摘BACKGROUND:The lack of a stable,easy-to-operate animal model for severe trauma has hindered the research progress.The aim of this study is to develop a mouse model that replicates the pathophysiological conditions of severe trauma,providing a reliable research tool.METHODS:Male C57BL/6J mice(aged 8-10 weeks and weighting approximately 20 g)were used to establish the severe trauma model.Under anesthesia,a midshaft femoral fracture was created and packed with sterile cotton.A midline incision was made from the inguinal region to the sternum,exposing the abdominal organs for 30 min.The right femoral artery was cannulated to induce controlled blood loss at 30%,35%,40%,and 50%of the total blood volume.Survival rates were monitored for 24 h post-induction.In the mice that experienced 30%blood loss,the mean arterial pressure,body temperature,blood gas parameters,peripheral blood inflammatory markers,and major organ pathological changes were assessed.RESULTS:Mice with femoral fractures,soft tissue injuries,abdominal organ exposure,and 30%blood loss exhibited stable survival rates.Increased blood loss significantly reduced survival rates.Mean arterial pressure decreased initially,recovering within 0-15 min and returning to baseline by 50 min.Similarly,the body temperature decreased initially and gradually recovered to baseline within 50 min.Levels of peripheral blood inflammatory markers remained elevated for 12 h post-injury.Distant organs,including intestines,lungs,liver,spleen and kidneys,displayed varying degrees of injury.CONCLUSION:The established mouse model replicates the pathophysiological responses to severe trauma,indicating stability and reproducibility,which could be an useful tool for further trauma research.
基金Supported by Guangzhou Municipal Science and Technology Bureau,No.SL2024AD3JD0112.
文摘BACKGROUND Boerhaave syndrome,or spontaneous esophageal rupture,is a rare and lifethreatening emergency,typically caused by a sudden increase in esophageal pressure due to violent coughing or vomiting.Early diagnosis is challenging as its symptoms often resemble those of other diseases.Understanding its pathological features and treatment strategies is therefore critical for clinical practice.CASE SUMMARY This report describes a case of spontaneous esophageal rupture triggered by violent coughing in a 55-year-old male with a history of smoking and hypertension.Following severe coughing,the patient developed chest pain,vomiting,and respiratory distress.Initial clinical evaluation was inconclusive,with a suspected diagnosis of cardiovascular or gastrointestinal conditions.After further examination,the diagnosis of spontaneous esophageal rupture was confirmed.Chest X-ray,computed tomography,and endoscopy revealed a rupture in the lower esophagus,along with mediastinal abscess and pleural effusion.Laboratory tests showed mild infection markers.The patient underwent surgical repair of the esophageal rupture(approximately 3 cm in length)with mediastinal drainage.Postoperatively,the patient’s temperature normalized within 3 days,respiratory function improved,and pleural effusion significantly decreased.After two weeks of treatment,the patient was discharged without complications and had a favorable prognosis.The study suggests that while violent coughing is a rare trigger,it can lead to severe damage,and imaging techniques play a crucial role in diagnosis.CONCLUSION Spontaneous esophageal rupture presents significant diagnostic and therapeutic challenges.Early recognition and timely intervention are crucial for improving prognosis.This case highlights the importance of imaging and surgical treatment,offering new insights for managing similar cases and providing valuable clinical guidance.
基金Chongqing Shapingba District Technology Innovation Project(Project No.:2024046)。
文摘Objective:To investigate the expression level of interleukin-17D(IL-17D)in the serum of patients with severe pneumonia and its correlation with disease severity.Methods:This study included 50 patients with severe pneumonia who were diagnosed and treated in the hospital from May 2024 to May 2025.The expression level of IL-17D in the serum of all patients was recorded.Patients were divided into severe and mild groups based on their disease severity.Gender,age,disease duration,presence of fever,atelectasis,pneumothorax,interleukin-2(IL-2),interleukin-4(IL-4),interleukin-6(IL-6),and interleukin-17D were selected as independent variables.Statistical software SPSS 22.00 was used for univariate analysis,and variables with statistical significance in the univariate analysis were included in a multivariate logistic regression analysis to determine the correlation between IL-17D and the severity of severe pneumonia.Results:The results of this study showed that the level of IL-17D in patients with severe pneumonia was significantly higher than the normal threshold.Univariate analysis indicated that atelectasis,IL-2,IL-6,and IL-17D were statistically significant(P<0.05)and could be considered as influencing factors for the severity of severe pneumonia.Multivariate logistic regression analysis revealed that atelectasis(OR=2.141,95%CI:1.684–2.391),IL-2(OR=2.884,95%CI:2.240–3.614),IL-6(OR=2.571,95%CI:2.190–2.943),and IL-17D(OR=2.416,95%CI:2.093–2.735)were positively correlated with the severity of severe pneumonia.Conclusion:The expression level of IL-17D in the serum of patients with severe pneumonia is higher than the normal threshold and is positively correlated with disease severity.
基金supported by funding from the Medical Research Funding of Guangdong(No.A2022499 to QGX)the National Natural Science Foundation of China(No.82301796 to PL)the Guangdong Province Regional Joint Fund-Youth Fund Project of China(No.2022A1515111201 to PL).
文摘This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias.We retrospectively analyzed the clinical data of patients with severe hypospadias admitted to the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between October 2012 and October 2022.In total,31 patients underwent the conventional Byars procedure(conventional group),and 45 patients underwent the modified Byars staged procedure(modified group).Our modified strategy was built upon the standard Byars procedure by incorporating glansplasty during the first stage and employing a Y-shaped flap in conjunction with a glandular tunnel for urethroplasty during the second stage.Notably,there were no statistically significant differences in the preoperative baseline characteristics,duration of surgery,amount of blood loss,or occurrence of postoperative complications,including urethral fistula,stricture and diverticulum,or penile curvature,between the conventional and modified groups.However,there was a significantly lower incidence of coronal sulcus fistula(0 vs 16.1%,P=0.02)and glans dehiscence(0 vs 12.9%,P=0.02)in the surgical group than that in the conventional group.In addition,the modified group exhibited a notably greater rate of normotopic urethral opening(100.0%vs 83.9%,P=0.01)and a higher mean score on the Hypospadias Objective Penile Evaluation(HOPE;mean±standard error of mean:8.6±0.2 vs 7.9±0.3,P=0.02)than did the conventional group.In conclusion,the modified Byars staged procedure significantly reduced the risks of glans dehiscence and coronal sulcus fistula.Consequently,it offers a promising approach for achieving favorable penile esthetics,thereby providing a reliable therapeutic option for severe hypospadias.
文摘Background: Severe acute malnutrition (SAM) is one of the major public health problems associated with increased mortality in under-five children. In low-income countries, renal dysfunction (RD) contributes to about 34% mortality in under-five children with severe acute malnutrition. This study aimed to determine the impacts of severe acute malnutrition on the kidney among the admitted under-five children. Methods: In this prospective longitudinal observational study, a total of 190 children aged 6 to 59 months were enrolled from Iringa and Dodoma tertiary hospitals. Socio-demographic, clinical and laboratory data were collected using a structured questionnaire. Estimated Glomerular Filtration Rate (eGFR) and urine albumin creatinine ratio (uACR) were used to determine RD. Data analysis was done using SPSS version 26 and statistical significance was assumed for factors with p-value Results: Out of 190 children with severe acute malnutrition, 36 (19%) had renal dysfunction. Factors associated with RD in malnourished children were the history of local herbs used within one week (AOR = 5.85, 95% CI [1.41, 24.319], p = 0.0152), Acute watery diarrhea with severe dehydration (AOR = 2.15, 95% CI [1.033, 4.711], p = 0.0166), and positive urine leukocytes (AOR = 19.91, 95% CI [4.09, 96.989], p = 0.0002). At three months of follow up, out of 36 children with RD, 20 (55.56%) attained full recovery, while 4 (11.11%) developed chronic kidney disease (CKD). Children with RD had prolonged hospital stays for more than 14 days with a mean 12.25 ± 5.00 days compared to those with no RD with a mean 6.29 ± 1.68 days (p Conclusion: Renal dysfunction is common among children with severe acute malnutrition. It is associated with prolonged hospital stays and increased mortality. Further studies which can determine the burden of RD in children with severe acute malnutrition as compared to those with no severe acute malnutrition are needed.
基金supported by grants from the Science Fund for Creative Research Groups of the National Natural Science Founda-tion of China(81521091 and 82073031)the National Natural Sci-ence Foundation of China(92269204)Clinical Research Plan of SHDC(SHDC2020CR5007 and SHDC22020213)。
文摘Background:Currently,there is a deficiency in a strong risk prediction framework for precisely evaluating the likelihood of severe postoperative complications in patients undergoing elective hepato-pancreatobiliary surgery subsequent to experiencing breakthrough infection of coronavirus disease 2019(COVID-19).This study aimed to find factors predicting postoperative complications and construct an innovative nomogram to pinpoint patients who were susceptible to developing severe complications following breakthrough infection of COVID-19 after undergoing elective hepato-pancreato-biliary surgery.Methods:This multicenter retrospective cohort study included consecutive patients who underwent elective hepato-pancreato-biliary surgeries between January 3 and April 1,2023 from four hospitals in China.All of these patients had experienced breakthrough infection of COVID-19 prior to their surgeries.Additionally,two groups of patients without preoperative COVID-19 infection were included as comparative controls.Surgical complications were meticulously documented and evaluated using the comprehensive complication index(CCI),which ranged from 0(uneventful course)to 100(death).A CCI value of 20.9 was identified as the threshold for defining severe complications.Results:Among 2636 patients who were included in this study,873 were included in the reference group I,941 in the reference group II,389 in the internal cohort,and 433 in the external validation cohort.Multivariate logistic regression analysis revealed that completing a full course of COVID-19 vaccination>6 months before surgery,undergoing surgery within 4 weeks of diagnosis of COVID-19 breakthrough infection,operation duration of 4 h or longer,cancer-related surgery,and major surgical procedures were significantly linked to a CCI>20.9.A nomogram model was constructed utilizing CCI>20.9 in the training cohort[area under the curve(AUC):0.919,95%confidence interval(CI):0.881–0.957],the internal validation cohort(AUC:0.910,95%CI:0.847–0.973),and the external validation cohort(AUC:0.841,95%CI:0.799–0.883).The calibration curve for the probability of CCI>20.9 demonstrated good agreement between the predictions made by the nomogram and the actual observations.Conclusions:The developed model holds significant potential in aiding clinicians with clinical decisionmaking and risk stratification for patients who have experienced breakthrough infection of COVID-19 prior to undergoing elective hepato-pancreato-biliary surgery.
文摘Objective:To analyze the clinical application and effects of the body restraint reduction program for severe neurological patients.Methods:A total of 206 patients admitted to the neurology department of the hospital from January 2022 to May 2025 were selected as the research subjects.Among them,102 patients from January 2022 to May 2025 were assigned to the observation group,and 104 patients during the same period served as the control group.In practice,the control group received conventional body restraint,while the observation group adopted the reduction program.The incidence of unplanned extubation and restraint-related complications were compared between the two groups.Results:The body restraint rate and complication rate in the observation group were significantly lower(P<0.05).After nurse training,their knowledge mastery and operational ability were significantly higher than before training(P<0.01).Conclusion:The body restraint reduction program for severe neurological patients can effectively reduce the restraint rate and complication incidence,while helping improve nurses’restraint management capabilities,serving as an effective means to enhance overall nursing quality.
基金Supported by Huzhou Science and Technology Bureau Public Welfare Applied Research Project-General Medical and Health Program,No.2021GY21.
文摘BACKGROUND Early risk stratification in severe acute pancreatitis(SAP)remains challenging with traditional scoring systems overlooking etiological heterogeneity,particularly in hypertriglyceridemic acute pancreatitis(HTG-AP).AIM To develop and evaluate a machine learning(ML)model combining intraabdominal pressure(IAP)and procalcitonin(PCT)for SAP prognosis and evaluate its clinical impact across different etiologies.METHODS We retrospectively analyzed 245 patients with pancreatitis(98 patients with SAP).An ML model using 24-h peak IAP and PCT levels was used to predict 28-day mortality.Propensity score matching was used to compare IAP-PCT-guided management with conventional management.RESULTS The ML-IAP-PCT model outperformed the Acute Physiology and Chronic Health Evaluation II score(area under the curve:0.853 vs 0.801,P=0.044)and Bedside Index of Severity in Acute Pancreatitis score.IAP-PCT-guided management was associated with lower mortality(15.8%vs 25.0%,P=0.043)and multiple organ dysfunction syndrome(48.7%vs 61.8%,P=0.027)rates.Patients with HTG-AP showed the greatest benefit(multiple organ dysfunction syndrome:39.3%vs 60.7%,P=0.018).CONCLUSION ML-optimized IAP-PCT monitoring provides superior prognostic accuracy and guides management associated with improved outcomes,especially in patients with HTG-AP.Prospective validation is needed to establish causality for this etiology-stratified approach.
基金supported by the National Natural Science Foundation of China(Nos.U22A20121,52101283 and 52271243)the NSFC-RGC Joint Research Scheme(No.52361165619)+3 种基金The NSFC-RFBR Joint Research Scheme(No.82361138575)the Science and Technology Planning Project of Guangzhou(No.202201011454)the National Key R&D Program of China(Nos.2021YFC2400700 and 2021YFC2400704)the High-level Hospital Construction Project(No.KJ012019520).
文摘To date,nanostructuring through plastic deformation has rarely been reported in biodegradable zinc(Zn)based alloys that have great potential in load-bearing conditions.Here,typical high-strength Zn-Li-based alloys were subjected to SPD processes,including equal channel angular pressing(ECAP)and high-pressure torsion(HPT),to achieve nanostructured microstructures.The effects of SPD on the microstructures,mechanical properties,and corrosion behaviors were generally investigated.The two SPD routes resulted in totally different microstructures.ECAPed samples processed at 150℃ exhibited a complicated multilevel structure(nm toμm)with mixed Zn equiaxed grains and lamellar-like eutectoid regions(Zn+α-LiZn_(4)),and HPTed ones(25℃)possessed a fully dynamically recrystallized(DRXed)microstructure with an average grain size below 0.4μm.The tensile strength of the SPD samples could reach 500 MPa.Meanwhile,HPTed samples exhibited extraordinary fracture elongations higher than 100%,because of a different grain boundary sliding deformation mechanism.HPTed samples and ECAPed samples displayed different corrosion patterns,and the former exhibited a much higher corrosion rate in Hank's solution,possibly due to the accelerated corrosion at grain boundaries.In summary,SPD is an efficient way to refine the microstructure of biodegradable Zn-based alloys,possibly improving their performances and clinical applications.
基金supported by High-Level Chinese Medical Hospital Promotion ProjectHLCMHPP2023089.
文摘Objective:To investigate whether the presence or absence of improvement in chronic severe functional constipation(CSFC)at the early stage of treatment with electroacupuncture predicts subsequent response or non-response,and to determine the optimal treatment duration for assessing subsequent responses to electroacupuncture.Methods:This is a post hoc analysis using data pooled from two large-scale randomized controlled trials.Patients with CSFC were recruited,and those in the electroacupuncture groups were included in the present study.Early improvement was defined as a weekly increase of≥1 complete spontaneous bowel movement(CSBM)compared to baseline.Three treatment response criteria were evaluated:≥3CSBMs per week,overall CSBM response,and sustained CSBM response.Predictive statistics,including sensitivity,specificity,positive predictive value,and negative predictive value,were calculated at weeks1–4.Receiver operating characteristic curves and accuracy rates were used to determine the optimal timepoint for differentiation between responders and non-responders.Results:Cases from a total of 813 participants who received electroacupuncture were analyzed.The proportion of improvers was 40.34%by week 1,increasing to 52.52%by week 4.After 8 weeks of treatment,the response rates were 30.14%,25.83%and 25.58%according to the three aforementioned criteria,respectively.Early improvement was a strong predictor of treatment response,with week 3 demonstrating the highest predictive accuracy.Conclusion:Early improvement with electroacupuncture,especially at week 3,can predict subsequent outcomes.Our findings suggest that acupuncturists may identify non-responders who might require adjustments to therapeutic strategies early in treatment.
基金financially supported by the National Natural Science Foundation of China(No.12262014).
文摘A gradient nanostructured layer was fabricated on the surface of TA15(Ti-6Al-2Zr-1Mo-1V)alloy(produced by selective laser melting)using severe shot peening(SSP).This study focuses on the evolution of the microstructure and the mechanism of grain refinement in TA15 titanium alloy during SSP treatment.Transmission electron microscopyand Rietveld refinement methods were employed.The residual stress and microhardness variations with depth were also characterized.The results show:(1)At the initial stage of deformation,plastic deformation is primarily accommodated through twinning and dislocation slip.(2)As the strain increases,twinning disappears,and dislocations interact to form tangles.Some dislocations annihilate and rearrange into subgrain boundaries,subdividing the original grains into subgrains.(3)With continued dislocation activity,the subgrain size decreases until nanocrystals are formed through the dynamic rotational recrystallization.SSP introduced compressive residual stress(CRS)in the near-surface layer of the material,with the maximum CRS of approximately−1141 MPa observed in the subsurface layer.It also induced work hardening,increasing the surface hardness to approximately 479 HV.However,the surface roughness increases,leading to a slight deterioration in surface quality.
