Psychological Status and Warfarin Therapy in Patients after Valve Replacement during the COVID-19 Pandemic:A Cross-sectional Study

Objective The standardization of warfarin anticoagulant therapy is the key to lifelong treatment for patients after heart valve replacement.The present study explored the possible risk factors for anxiety and depression during the coronavirus disease 2019(COVID-19)pandemic and analyzed the influence of psychological state on medication safety.Methods Eligible patients received a web-based questionnaire survey via the Wenjuanxing platform during outpatient visits.Depression was evaluated by the Self-Rating Depression Scale(SDS).Anxiety was evaluated by the Self-Rating Anxiety Scale(SAS).Medication adherence was evaluated by the Morisky scale.Results A total of 309 patients(aged 52.2±11.4 years)were included in the present study.The SDS score of all included patients was 36.9±9.4 points,of which 11(3.6%)patients were diagnosed as having depression.The SAS score of all included patients was 43.1±9.3 points,of which 71(23%)patients were diagnosed as having anxiety.Seven patients(2.3%)had both anxiety and depression.Logistic regression analysis revealed that only monthly income was an independent influencing factor for depression.Regarding anxiety,patients who underwent repeated operations had a 2.264-fold greater risk,and patients who received combination medication had a 2.140-fold greater risk.More bleeding events and coagulation disorders could be observed in patients with anxiety,depression or both.When anxiety occurred,patients showed worse medication adherence.However,depression had no significant effect on medication adherence.Conclusion During the COVID-19 pandemic,the detection rate of mental illnesses such as anxiety and depression was high,which seriously affected the medication safety of warfarin.Analysis of its influencing factors will provide a reference for further standardized regulation of warfarin anticoagulant therapy after valve replacement.

Simultaneously improved the strength and ductility of laser powder bed fused Al-Cr-Fe-Ni-V high-entropy alloy by hot isostatic pressing:Microcrack closure and precipitation strengthening

Hot isostatic pressing(HIP)is usually applied to reduce the defects including cracks and pores in the materials prepared by laser powder bed fusion(LPBF).In the present research,in order to improve the relative density and mechanical property,HIP was employed on the LPBF-processed Al-Cr-Fe-Ni-V high-entropy alloy(HEA)with microcracks and pores.The microstructure evolution and property improvement induced by HIP were investigated.In the LPBF-processed HEA,the microcracks were caused by residual stress and element segregation,and these microcracks as well as the pores reduced significantly after HIP treatments.Remarkably,HIP temperature has a more critical effect on the microcrack closure than the holding time,thus,microcracks and pores still existed after HIP-1 treatment(1273 K,8 h),while HIP-2 treatment(1473 K,4 h)could close the microcracks significantly.The crack closure was attributed to the interfacial diffusion of the alloying element under high temperature accompanied by high pressure,and the degree of element diffusion at both interfaces of the cracks determined the bonding strength after crack closure.Higher temperatures at high pressure induced more adequate element diffusion and higher bonding strength.The above high temperature and high pressure also induced the growth of the L1_(2) phase and the precipitation of the B2 phase in HEA.Consequently,the tensile strength and elonga-tion of the LPBF-processed HEA after HIP-2 treatment were simultaneously enhanced(80.7%and 222.5%higher than that of LPBF-processed HEA,respectively).This could be attributed to the combined effect of microcrack/pore closure and precipitation strengthening.The strengthening effect of the B2 phase and L1_(2) phase accounted for 53%(dislocation by-pass mechanism)and 47%(dislocation shearing mechanism)of the total precipitation strengthening,respectively.

多学科综合治疗71例儿童横纹肌肉瘤的效果评估

目的:评价横纹肌肉瘤(rhabdomyosarcoma,RMS)多学科诊疗草案重庆方案(CQ-RMS-2009)多学科综合治疗(multidisci-plinary treatment,MDT)儿童RMS的有效性,探讨RMS预后因素。方法:回顾性分析2006年5月至2016年4月于上海交通大学医学院附属新华医院治疗、年龄<14岁RMS患儿临床资料。比较不同因素对RMS患儿长期生存的影响。结果:71例RMS患儿纳入研究,男女比例1.84:1;中位诊断年龄为47(2~166)个月,中位随访时间52(15~165)个月。5年总体生存率(5-year overall sur-vival,5y-OS)和5年无事件生存率(5-year event free survival,5y-EFS)分别为(61.9±5.1)%和(56.1±4.2)%。2006年5月至2009年12月收治的患儿5y-OS为(48.1±12.1)%,2010年1月至2016年4月收治患儿的5-OS为(73.3±7.9)%,差异具有统计学意义(P=0.042);5y-EFS分别为(35.9±11.7)%和(69.8±8.7)%,差异无统计学意义(P=0.064)。单因素分析显示,病理类型、术后临床分组、治疗模式、危险度分组是影响RMS患儿总体生存率(overall survival,OS)的重要因素(均P<0.05)。多因素分析显示,术后临床分组及治疗模式是影响患儿预后的独立因素(均P<0.05)。结论:当RMS确诊时,多数患儿处于中晚期,OS偏低,MDT模式可有效改善RMS患儿的预后,降低晚期患儿复发/疾病进展率,对于疾病复发/进展后的局部控制同样有明显效果。

冠状动脉粥样硬化性心脏病患者血清LP-PLA2、NEFA水平变化及其临床意义

目的探讨冠状动脉粥样硬化性心脏病(以下简称冠心病)患者血清脂蛋白相关磷脂酶A2(LPPLA2)、游离脂肪酸(NEFA)水平变化并分析其临床意义。方法选取2015年3月-2016年4月遂宁市中心医院心血管中心收治的冠心病患者138例作为研究组,根据Gensini总积分分为轻度病变组42例,中度病变组47例和重度病变组49例;根据病变支数分为单支病变组40例,双支病变组49例和三支病变组49组。选取同期该院的健康体检者46例作为对照组。比较各组血清LP-PLA2、NEFA水平,并分析血清LP-PLA2、NEFA水平与冠心病患者冠状动脉病变程度的关系及对随访3年发生心血管事件的影响。结果不同病变组患者的性别、年龄、LP-PLA2、NEFA、伴随糖尿病及高血压比较,差异有统计学意义(P <0.05),体重指数、吸烟、喝酒、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、同型半胱氨酸(Hcy)、C反应蛋白(CRP)和左室射血分数(LVEF)比较,差异无统计学意义(P>0.05)。随访至2019年4月,46例健康体检者未出现心血管事件,138例冠心病患者发生心血管事件57例,心血管事件发生率为41.30%。二元Logistic回归分析,结果显示,不同病变程度[O^R=2.546(95%CI:2.001,4.013)]、不同病变支数[O^R=2.453(95%CI:2.000,4.014)]、血清LP-PLA2 [O^R=2.453(95%CI:2.758,5.346)]和NEFA [O^R=4.034(95%CI:2.014,5.896)]为冠心病患者3年随访期间发生心血管事件的危险因素(P <0.05)。结论冠心病患者血清LP-PLA2、NEFA高表达,其水平与冠状动脉病变严重程度密切相关,并影响患者预后。

Abdominal paracentesis drainage ameliorates myocardial injury in severe experimental pancreatitis rats through suppressing oxidative stress

BACKGROUND Abdominal paracentesis drainage(APD)is a safe and effective strategy for severe acute pancreatitis(SAP)patients.However,the effects of APD treatment on SAPassociated cardiac injury remain unknown.AIM To investigate the protective effects of APD on SAP-associated cardiac injury and the underlying mechanisms.METHODS SAP was induced by 5%sodium taurocholate retrograde injection in Sprague-Dawley rats.APD was performed by inserting a drainage tube with a vacuum ball into the lower right abdomen of the rats immediately after SAP induction.Morphological staining,serum amylase and inflammatory mediators,serum and ascites high mobility group box(HMGB)1,cardiac-related enzymes indexes and cardiac function,oxidative stress markers and apoptosis and associated proteins were assessed in the myocardium in SAP rats.Nicotinamide adenine dinucleotide phosphate oxidase activity and mRNA and protein expression were also examined.RESULTS APD treatment improved cardiac morphological changes,inhibited cardiac dysfunction,decreased cardiac enzymes and reduced cardiomyocyte apoptosis,proapoptotic Bax and cleaved caspase-3 protein levels.APD significantly decreased serum levels of HMGB1,inhibited nicotinamide adenine dinucleotide phosphate oxidase expression and ultimately alleviated cardiac oxidative injury.Furthermore,the activation of cardiac nicotinamide adenine dinucleotide phosphate oxidase by pancreatitis-associated ascitic fluid intraperitoneal injection was effectively inhibited by adding anti-HMGB1 neutralizing antibody in rats with mild acute pancreatitis.CONCLUSION APD treatment could exert cardioprotective effects on SAP-associated cardiac injury through suppressing HMGB1-mediated oxidative stress,which may be a novel mechanism behind the effectiveness of APD on SAP.

Microstructure evolution of Al_(0.6)CoCrFeNi high entropy alloy powder prepared by high pressure gas atomization

The influence of cooling rate on the microstructure of Al0.6CoCrFeNi high entropy alloy（HEA） powders was investigated. The spherical HEA powders（D50≈78.65 μm） were prepared by high pressure gas atomization. The different cooling rates were achieved by adjusting the powder diameter. Based on the solidification model, the relationship between the cooling rate and the powder diameter was developed. The FCC phase gradually disappears as particle size decreases. Further analysis reveals that the phase structure gradually changes from FCC＋BCC dual-phase to a single BCC phase with the increase of the cooling rate. The microstructure evolves from planar crystal to equiaxed grain with the cooling rate increasing from 3.19×10^4 to 1.11×10^6 K/s.

Electrical properties of m×n cylindrical network

We consider the problem of electrical properties of an m×n cylindrical network with two arbitrary boundaries,which contains multiple topological network models such as the regular cylindrical network,cobweb network,globe network,and so on.We deduce three new and concise analytical formulae of potential and equivalent resistance for the complex network of cylinders by using the RT-V method(a recursion-transform method based on node potentials).To illustrate the multiplicity of the results we give a series of special cases.Interestingly,the results obtained from the resistance formulas of cobweb network and globe network obtained are different from the results of previous studies,which indicates that our research work creates new research ideas and techniques.As a byproduct of the study,a new mathematical identity is discovered in the comparative study.

带模具约束的两台同型机排序问题的改进算法

研究带模具约束的两台同型机排序问题,针对极小化工件最大完工时间的目标函数,与已有的3/2近似算法相比,增加对最大工件集的处理,得到改进算法的近似比为4/3,并给出了紧例。

Treatment results of childhood extracranial malignant germ cell tumors and the salvage approach for recurrent and refractory cases: a single-center report

Objective The aim of this study is to report the treatment result of childhood excranial malignant germ cell tumors and discuss the experience for recurrent and refractory cases treatment from our center.Methods We have retrospectively analyzed 58 extracranial malignant germ cell tumor patients treated with surgery and chemotherapy from our center over a 9-year period.Another 14 recurrent and refractory cases referred from other centers were added to the study for salvage approach.We evaluated the treatment results for primary cases and relapsed cases with a median follow-up of 61.5 months.Several factors were analysed to evaluate their power to the outcome of these cases.Results The 5-year event-free and overall survival for primary cases were 74.1±5.7%and 86.2±4.5%,respectively.25 recurrent or refractory cases entered the salvage approach study,and 17 patients were alive till the end of follow-up.We demonstrated superior survival outcome for those with successful local control through pre-operative and post-operative radiotherapy,second-look surgery and multi-drug secondline chemotherapies.Conclusion The outcome for childhood extracranial malignant germ cell tumors is generally favorable.For recurrent and refractory cases,multi-modality treatment approaches including radiotherapy,salvage chemotherapy and secondlook surgery are important for better local control.

Heteromaterial-gate line tunnel field-effect transistor based on Si/Ge heterojunction

A Si/Ge heterojunction line tunnel field-effect transistor （LTFET） with a symmetric heteromaterial gate is proposed. Compared to single-material-gate LTFETs, the heteromaterial gate LTFET shows an off-state leakage current that is three orders of magnitude lower, and steeper subthreshold characteristics, without degradation in the on-state current. We reveal that these improvements are due to the induced local potential barrier, which arises from the energy-band profile modulation effect. Based on this novel structure, the impacts of the physical parameters of the gap region between the pocket and the drain, including the work-function mismatch between the pocket gate and the gap gate, the type of dopant, and the doping concentration, on the device performance are investigated. Simulation and theoretical calculation results indicate that the gap gate material and n-type doping level in the gap region should be optimized simultaneously to make this region fully depleted for further suppression of the off-state leakage current.

Effect of bifidobacterium enteral nutrition on intestinal flora and systemic inflammatory stress in patients with severe stroke

Objective:To study the effect of bifidobacterium enteral nutrition on intestinal flora and systemic inflammatory stress in patients with severe stroke.Methods: Patients with severe stroke who were treated in our hospital between March 2015 and July 2017 were selected and randomly divided into the observation group who accepted bifidobacterium enteral nutrition and the control group who accepted conventional enteral nutrition, and the contents of intestinal flora in feces as well as the contents of intestinal mucosal barrier markers, inflammatory response indexes, stress response indexes in serum were determined.Results: D-lactic acid, DAO, PCT, Claudin-4, TNF-α, IL-1β, Hcy, sICAM1, NE, Cor and MDA contents in serum of both groups 14 days after treatment were lower than those before treatment whereas T-AOC contents were higher than those before treatment, and bifidobacterium, lactobacillus and bacteroides contents in feces as well as T-AOC content in serum of observation group 14 d after treatment were higher than those of control group whereas enterococcus and enterobacter contents in feces as well as D-lactic acid, DAO, PCT, Claudin-4, TNF-α, IL-1β, Hcy, sICAM1, NE, Cor and MDA contents in serum were lower than those of control group. Conclusion: Bifidobacterium enteral nutrition is able to improve the intestinal flora and inhibit the systemic inflammatory stress in patients with severe stroke.

ELECTROCHEMICAL DIMERIZATION OF FLAVONE

Electrochemical reduction of flavone 1 in ethanol-sulphuric acid solution with lead electrode gave, flavanone 3 and 2-2 ' coupled biflavanones: 2a (racemate) and 2b (meso) The configuration of 2a was determined by X-ray crystallography.

Electrical Properties of an m × n Hammock Network

Electrical property is an important problem in the field of natural science and physics, which usually involves potential, current and resistance in the electric circuit. We investigate the electrical properties of an arbitrary hammock network, which has not been resolved before, and propose the exact potential formula of an arbitrary m × n hammock network by means of the Recursion-Transform method with current parameters(RT-I) pioneered by one of us [Z. Z. Tan, Phys. Rev. E 91(2015) 052122], and the branch currents and equivalent resistance of the network are derived naturally. Our key technique is to setting up matrix equations and making matrix transformation, the potential formula derived is a meaningful discovery, which deduces many novel applications. The discovery of potential formula of the hammock network provides new theoretical tools and techniques for related scientific research.

Communications in Theoretical Physics

The unified processing and research of multiple network models are implemented,and a new theoretical advance has been made,which sets up two new theorems on evaluating the exact electrical characteristics(potential and resistance)of the complex m×n resistor networks by the recursion-transform method with potential parameters,and applies to a variety of different types of lattice structure with arbitrary boundaries such as the nonregular m×n rectangular networks and the nonregular m×n cylindrical networks.Our research gives the analytical solutions of electrical characteristics of the complex networks(finite,semi-infinite and infinite),which has not been solved before.As applications of the theorems,a series of analytical solutions of potential and resistance of the complex resistor networks are discovered.

A new path planning method for bevel-tip flexible needle insertion in 3D space with multiple targets and obstacles

In this paper,a new bevel-tip flexible needle path planning method based on the bee-foraging learning particle swarm optimization(BFL-PSO)algorithm and the needle retraction strategy in 3D space is proposed to improve the puncture accuracy and shorten the puncture distance in the case of multiple puncture targets.First,the movement of the needle after penetrating the human body is analyzed,and the objective function which includes puncture path error,puncture path length,and collision function is established.Then,the BFL-PSO algorithm and the needle retraction strategy are analyzed.Finally,medical images of the tissue to be punctured are obtained by medical imaging instruments,i.e.,magnetic resonance(MR),and the 3D model of the punctured environment is constructed by 3D Slicer to obtain the environment information on targets and obstacles,and the path of flexible needle is carried out based on the BFL-PSO optimization algorithm and the needle retraction strategy.The simulation results show that,compared with other path planning methods in the related literature,the new path planning method proposed in this paper has higher path planning accuracy,shorter puncture distance,and good adaptability to multi-target path planning problems.

Structural Modification of Al65Cu16.5Ti18.5 Amorphous Powder through Annealing and Post Milling： Improving Thermal Stability

To improve thermal stability of the Al65Cu16.5Ti18.5 amorphous powder,structural modification of the amorphous powder was performed through annealing and post milling.Annealing above the crystallization temperature（Tx） not only induced nanoscale intermetallics to precipitate in the amorphous powder,but also increased Cu atomic percentage within the residual amorphous phase.Post milling induced the amorphization of the nanocrystal intermetallics and the formation of Cu9Al4 from the residual amorphous phase.Thus,a mixed structure consisting of amorphous phase and Cu9Al4 was obtained in the powder after annealing and post milling（the APMed powder）.The phase constituent in the APMed powder did not change during the post annealing,which exhibited significantly improved thermal stability in comparison with the as-milled amorphous powder.