抗结核药物超敏反应综合征致暴发性1型糖尿病1例并文献复习

目的探讨抗结核治疗中抗结核药物超敏反应综合征(DIHS)致暴发性1型糖尿病(FT1DM)的诊疗经验。方法回顾性分析1例抗结核药物(ATD)引起DIHS致FT1DM患者的病情变化,结合治疗经过等临床资料,总结诊疗方法。结果病例在使用抗结核药物后出现皮疹、肝功能受损,治疗过程中突然出现糖尿病酮症酸中毒,完善胰岛功能、胰岛素相关抗体、糖化血红蛋白等相关检查后确诊为FT1DM,经积极治疗后患者症状、检验指标改善。结论ATD引起的DIHS可导致FT1DM的发生,出现DIHS时,应注意临床特征变化,完善相关检查,及早诊治。

悬吊式重力卸荷系统的主动式缓冲控制

针对索驱悬吊式重力卸荷系统被动缓冲器带来的欠驱动问题,提出了基于气动人工肌肉(Pneumatic Artificial Muscle,PAM)主动式缓冲器控制方法。首先,分析用于地面微/低重力模拟的悬吊式重力卸荷系统,为了克服PAM高度非线性特性,提出基于块结构的非线性神经网络建模方法,其次分析吊索与航天器相互作用过程中挠性引起的力扰动,最后采用非线性模型预测跟踪控制。相比传统PID控制方法,该方法具有参数调节简单,实时跟随性能好,以及对卸荷系统目标惯性参数的摄动具有控制性能不变性等优势。实验结果表明,设置不同扰动情况跟随力误差都能保证在3%以内,实验证明了基于PAM主动缓冲器的可行性,所提出的控制方法能够在挠性不确定性的情况下实现力跟随控制。

含利奈唑胺方案治疗耐多药肺结核患者的疗效观察及不良结局预测模型的构建与评价

目的观察含利奈唑胺方案治疗耐多药肺结核患者的临床疗效,并构建不良结局的预测模型。方法选取广州市胸科医院耐药结核科2019年7月至2022年9月纳入治疗的113例耐多药或利福平耐药肺结核患者,所有患者治疗方案的制定参照指南的治疗原则,住院2周以上,出院转耐多药专科门诊全程治疗管理,记录年龄、性别、治疗史、基础疾病、肺部病灶、痰菌检测结果等临床特征。采用χ^(2)检验进行组间比较分析治疗成功组和不良结局组的临床特征。将纳入病例的临床特征作为自变量,以治疗成功(治愈、完成治疗)及不良结局(失败、丢失、死亡)为因变量,对可能影响不良结局的因素采用Logistic回归分析,计算各因素的P值、比值比(OR)及其95%可信区间(95%CI)。结果纳入的113例含利奈唑胺方案治疗的MDR/RR-TB患者中治疗成功率为79.65%,不良结局发生率为20.35%,肺部病灶吸收有效率为88.35%,空洞变化有效率为73.24%,治疗2个月及6个月痰菌阴转率分别为:47.79%、87.61%。Logistic回归分析显示:复治(OR=3.987,95%CI:1.089~14.590,P=0.037)、合并空洞(OR=15.760,95%CI:1.518~163.667,P=0.021)、年龄≥65岁(OR=9.438,95%CI:1.136~78.396,P=0.038)可能是影响患者发生不良结局的危险因素。预测模型ROC曲线下面积AUC为0.772,当约登指数为0.448时,其敏感度为0.870,特异度为0.578,截断值为0.156。结论利奈唑胺治疗耐多药肺结核疗效可观,但仍存在一定比例的不良结局发生率,临床治疗及随访中可使用该模型对患者进行不良转归风险分类,通过对合并复治、空洞、年龄≥65岁的人群重点管治、加强督导,并采取有针对性的、有效的方案,从而提高治疗成功率。

2型糖尿病合并初治菌阳肺结核患者肺部广泛病灶和空洞发生的危险因素分析

目的:探讨2型糖尿病合并初治菌阳肺结核患者肺部广泛病灶和空洞发生的危险因素,为慢性病的治疗管理提供参考。方法:采用回顾性研究方法,收集2013年1月至2018年1月在广州市胸科医院首次住院的2型糖尿病合并初治菌阳肺结核患者,筛选出符合研究条件的955例患者,通过电子病历和医院信息管理系统采集患者的年龄、性别、糖尿病病程、肺部病灶范围、肺部空洞、糖化血红蛋白、淋巴细胞、中性粒细胞/淋巴细胞比值(NLR)、二甲双胍是否在近3个月连续稳定使用等。分别以肺部广泛病灶(影像学检查证实肺部病灶≥3个肺野)和肺部空洞为因变量,上述其他因素为自变量进行单因素和多因素logistic回归分析。结果:955例患者中,病灶广泛者753例(78.8%),出现空洞者659例(69.0%)。多因素logistic回归分析结果显示,二甲双胍使用史(OR=0.656,95%CI:0.449~0.957)及淋巴细胞水平高(OR=0.608,95%CI:0.404~0.915)为两病合并时肺部病灶广泛的保护因素,出现空洞(OR=2.094,95%CI:1.498~2.926)、NLR水平高(OR=2.681,95%CI:1.860~3.864)为肺部广泛病灶的危险因素;肺部病灶广泛(OR=1.945,95%CI:1.390~2.719)、糖化血红蛋白水平高(OR=1.206,95%CI:1.078~1.350)及NLR水平高(OR=1.390,95%CI:1.012~1.991)为发生空洞的危险因素。结论:2型糖尿病合并初治菌阳肺结核患者肺部常出现广泛病灶和空洞,两者互为危险因素。对于2型糖尿病患者,可首选含二甲双胍降糖干预的方案,并积极进行糖化血红蛋白、淋巴细胞及NLR指标的监测和管理,以减轻并发肺结核时的病情。

二甲双胍降糖治疗2型糖尿病合并肺结核的临床特点

目的探讨二甲双胍(MET)治疗的2型糖尿病(T2DM)患者在合并肺结核时(PTB)的临床特点,为临床治疗策略提供参考。方法收集2013年1月至2018年1月首次在本院住院治疗的T2DM合并初治菌阳PTB患者临床资料。以T2DM患者在首次确诊PTB前3个月以上连续使用MET降糖治疗的为观察组(MET组)206例,以同期在首次确诊PTB前3个月未使用MET治疗的为对照组(N-MET组)749例。结果MET组和N-MET组HbA1c达标率均较低(P=0.703)。两组患者继发感染发生率差异无统计学意义(P=0.703),MET组患者中性粒细胞/淋巴细胞比值(NLR)、肺部病灶广泛程度及空洞发生均较N-MET组低,差异有统计学意义(P=0.021、0.045、0.039)。在HbA1c<7%患者合并肺部空洞发生较少(P<0.001),MET组病灶范围广泛程度较少(P=0.042)。结论MET治疗T2DM患者合并PTB时,NLR水平较低,病灶范围及空洞发生较少。HbA1c<7%的患者并发肺结核时病灶较少。

Design and application of single-antenna GPS/accelerometers attitude determination system

In view of the problem that the current single-antenna GPS attitude determination system can only determine the body attitude when the sideslip angle is zero and the multiantenna GPS/SINS integrated navigation system is of large volume, high cost, and complex structure, this approach is presented to determine the attitude based on vector space with single-antenna GPS and accelerometers in the micro inertial measurement unit （MIMU）. It can provide real-time and accurate attitude information. Subsequently, the single-antenna GPS/SINS integrated navigation system is designed based on the combination of position, velocity, and attitude. Finally the semi- physical simulations of single-antenna GPS attitude determination system and single-antenna GPS/SINS integrated navigation system are carried out. The simulation results, based on measured data, show that the single-antenna GPS/SINS system can provide more accurate navigation information compared to the GPS/SINS system, based on the combination of position and velocity. Furthermore, the single-antenna GPS/SINS system is characteristic of lower cost and simpler structure. It provides the basis for the application of a single-antenna GPS/SINS integrated navigation system in a micro aerial vehicle （MAV）.

Analysis of one dimensional and two dimensional fuzzy controllers

The analytical structures and the corresponding mathematical properties of the one dimensional and two dimensional fuzzy controllers are first investigated in detail. The nature of these two kinds of fuzzy controllers is next probed from the perspective of control engineering. For the one dimensional fuzzy controller, it is concluded that this controller is a combination of a saturation element and a nonlinear proportional controller, and the system that employs the one dimensional fuzzy controller is the combination of an open-loop control system and a closedloop control system. For the latter case, it is concluded that it is a hybrid controller, which comprises the saturation part, zero-output part, nonlinear derivative part, nonlinear proportional part, as well as nonlinear proportional-derivative part, and the two dimensional fuzzy controller-based control system is a loop-varying system with varying number of control loops.

Stability analysis of the simplest Takagi-Sugeno fuzzy control system using circle criterion

A frequency-domain-based sufficient condition is derived to guarantee the globally asymptotic stability of the simplest Takagi-Sugeno （T-S） fuzzy control system by using the circle criterion. The analysis is performed in the frequency domain, and hence the condition is of great significance when the frequency-response method, which is widely used in the linear control theory and practice, is employed to synthesize the simplest T-S fuzzy controller. Besides, this sufficient condition is featured by a graphical interpretation, which makes the condition straightforward to be used. Comparisons are drawn between the performance of the simplest T-S fuzzy controller and that of the linear compensator. Two numerical examples are presented to demonstrate how this sufficient condition can be applied to both stable and unstable plants.

An LMI-based decoupling control for electromagnetic formation flight

Electromagnetic formation flight （EMFF） leverages electromagnetic force to control the relative position of satellites. EMFF offers a promising alternative to traditional propellant-based spacecraft flight formation. This novel strategy is very attractive since it does not consume fuel. Due to the highly coupled nonlinearity of electromagnetic force, it is difficult to individually design a controller for one satellite without considering others, which poses challenges to communications. This paper is devoted to decoupling control of EMFF, including regulations, constraints and con- troller design. A learning-based adaptive sliding mode decoupling controller is analyzed to illustrate the problem of existing results, and input rate saturation is introduced to guarantee the validity of frequency division technique. Through transformation, the imposed input rate saturation is con- verted to state and input constraints. A linear matrix inequalities （LMI）-based robust optimal con- trol method can then be used and improved to solve the transformed problem. Simulation results are presented to demonstrate the effectiveness of the proposed decoupling control.