丽水市558例毒蛇咬伤流行病学分析

目的分析浙江省丽水市我院2018—2020年住院的毒蛇咬伤就诊病例基本特征和流行病学特征,为临床诊疗、疾病防控及临床诊疗提供依据参考。方法采集浙江省丽水市中心医院2018—2020年558例毒蛇咬伤病例临床流行病学资料进行回顾性分析,包括毒蛇种类、患者性别与年龄、咬伤月份及具体时间、部位、局部症状及严重程度等。结果558例病例中,五步蛇194例(34.77%),竹叶青108例(19.35%),烙铁头53例(9.50%),眼镜蛇67例(12.01%),银环蛇11例(1.97%),不详120例(21.51%)。其中男、女性别比为2.47∶1;以农民为主,有433例,占77.60%;伤害高发年龄为51~70岁,占55.56%;受伤部位以四肢为主,重度蛇伤患者110例,其中五步蛇咬伤64例(58.18%),疾病负担相对更重。伤害时间以夏秋季节为主,占90.5%;经过规范救治后,所有患者中治愈出院500例(占89.60%),好转出院34例(占6.09%),致残24例(4.31%),死亡0例(0)。结论丽水市毒蛇咬伤高发于夏秋季节,以五步蛇为主,眼镜蛇和竹叶青次之;其中重度蛇伤患者多为五步蛇咬伤,蛇伤部位多见于四肢。

On-chip ultrafast stackable dielectric laser positron accelerator

We present a first on-chip positron accelerator based on dielectric laser acceleration.This innovative approach significantly reduces the physical dimensions of the positron acceleration apparatus,enhancing its feasibility for diverse applications.By utilizing a stacked acceleration structure and far-infrared laser technology,we are able to achieve a seven-stage acceleration structure that surpasses the distance and energy gain of using the previous dielectric laser acceleration methods.Additionally,we are able to compress the positron beam to an ultrafast sub-femtosecond scale during the acceleration process,compared with the traditional methods,the positron beam is compressed to a greater extent.We also demonstrate the robustness of the stacked acceleration structure through the successful acceleration of the positron beam.

Butyl ether as Co-diluent in medium-concentrated electrolyte for Li-S battery

1. Introduction The Lithium-sulfur battery(LSB) shows promise as a highdensity energy source, with a theoretical energy density of approximately 2600 W h kg^(-1)[1]. However, practical application of the LSB has been hindered by the “shuttle effect” and Li anode corrosion [2,3]. Highly concentrated electrolytes(HCEs) have been proposed as a solution, as they can inhibit the dissolution of lithium polysulfide and promote homogeneous lithium deposition [4].

Structure and material study of dielectric laser accelerators based on the inverse Cherenkov effect

Dielectric laser accelerators(DLAs)are considered promising candidates for on-chip particle accelerators that can achieve high acceleration gradients.This study explores various combinations of dielectric materials and accelerated structures based on the inverse Cherenkov effect.The designs utilize conventional processing methods and laser parameters currently in use.We optimize the structural model to enhance the gradient of acceleration and the electron energy gain.To achieve higher acceleration gradients and energy gains,the selection of materials and structures should be based on the initial electron energy.Furthermore,we observed that the variation of the acceleration gradient of the material is different at different initial electron energies.These findings suggest that on-chip accelerators are feasible with the help of these structures and materials.

低频重复经颅磁刺激治疗癫痫的疗效和安全性

目的探讨低频重复经颅磁刺激治疗癫痫的疗效和安全性。方法选取2020年4—11月符合标准的武汉市第一医院神经内科86例癫痫患者,分为AEDs组(原有AEDs治疗)和低频rTMS联合AEDs组(低频rTMS联合原有AEDs治疗),持续治疗4周后,随访3个月,观察患者治疗前后发作次数、视频脑电图检查及不良反应。结果低频rTMS联合AEDs组的总有效率高于AEDs组(P<0.05)。低频rTMS联合AEDs组癫痫发作次数减少到50%用时短于AEDs组(P<0.05)。癫痫持续状态与部分发作的显效率在低频rTMS联合AEDs组明显高于AEDs组(P<0.05);低频rTMS联合AEDs组治疗后EEG与AEDs组相比异常程度明显减轻(P<0.05)。两组不良反应发生率差异无统计学意义(P>0.05)。结论低频重复经颅磁刺激联合抗癫痫药物治疗可提高治疗效果,减少发作次数,且安全性高。

基于协整和向量误差修正的轴承剩余寿命预测

针对传统机器学习出现"伪回归"问题,忽视非平稳序列间的长期依赖关系,提出协整理论和向量误差修正模型预测滚动轴承的性能退化趋势,进而预测其剩余使用寿命(RUL)。首先从振动信号中提取峭度值、峰峰值和均方根值,并分析其平稳性。然后检验3种时域特征的协整关系,根据检验结果来建立向量误差修正模型,并对模型进行残差分析,分析结果接近于高斯白噪声分布,表明模型良好。最后利用该模型预测轴承性能退化趋势和RUL,并使用均方根误差(RMSE)、平均百分比误差(MPE)、平均绝对百分比误差(MAPE)和Theil不等系数来定量评估预测结果。实验结果表明,提出的向量误差修正模型相比于差分平均移动自回归-卡尔曼滤波模型,具有更高的预测精度,并简化了建模过程。

In situ self-assembled organoid for osteochondral tissue regeneration with dual functional units

The regeneration of hierarchical osteochondral units is challenging due to difficulties in inducing spatial,directional and controllable differentiation of mesenchymal stem cells(MSCs)into cartilage and bone compartments.Emerging organoid technology offers new opportunities for osteochondral regeneration.In this study,we developed gelatin-based microcryogels customized using hyaluronic acid(HA)and hydroxyapatite(HYP),respectively for inducing cartilage and bone regeneration(denoted as CH-Microcryogels and OS-Microcryogels)through in vivo self-assembly into osteochondral organoids.The customized microcryogels showed good cytocompatibility and induced chondrogenic and osteogenic differentiation of MSCs,while also demonstrating the ability to self-assemble into osteochondral organoids with no delamination in the biphasic cartilage-bone structure.Analysis by mRNA-seq showed that CH-Microcryogels promoted chondrogenic differentiation and inhibited inflammation,while OS-Microcryogels facilitated osteogenic differentiation and suppressed the immune response,by regulating specific signaling pathways.Finally,the in vivo engraftment of pre-differentiated customized microcryogels into canine osteochondral defects resulted in the spontaneous assembly of an osteochondral unit,inducing simultaneous regeneration of both articular cartilage and subchondral bone.In conclusion,this novel approach for generating self-assembling osteochondral organoids utilizing tailor-made microcryogels presents a highly promising avenue for advancing the field of tissue engineering.

4例以痫性发作为表现的急性脑梗死患者的临床特点分析

目的首次以痫性发作就诊,头颅普通CT未见明显异常,仍需完善急性脑梗死的筛查,排除卒中后痫性发作。方法收集武汉市第一医院神经内科2019年11月至2020年11月4例以痫性发作为表现的急性脑梗死患者的资料,均完善常规影像学、血管评估、实验室检查及视频脑电图监测。结果4例头颅CTA、CTP均可见大血管重度狭窄或闭塞,伴有局部低灌注表现,3例头颅DSA提示同CTA一致的血管中-重度狭窄,1例未行头颅DSA检查,4例头颅DWI均未见明显异常或轻度异常;4例脑电图均提示中-重度异常于成人脑电图。实验室检查无明显异常。积极给予卒中后血管内干预治疗,发作严重者给予短期抗癫痫治疗,癫痫发作得以控制,追踪随访未再出现痫性发作。结论以痫性发作为主要表现,头颅普通CT未见明显异常,仍需完善急性脑梗死筛查,排除以痫性发作为表现的急性脑梗死,以免误诊、漏诊而延误最佳的治疗时机。

沈阳故宫博物院凤凰楼圣容像存贮探微

沈阳故宫博物院凤凰楼是清朝在盛京皇宫尊藏历代皇帝圣容像之所。自乾隆十五年“五代圣容”入藏凤凰楼后,清朝历代皇帝都会将先帝圣容像移至凤凰楼尊藏。但光绪二年因凤凰楼需要修缮,一应陈设品均移贮敬典阁,后再未移回。本文根据《实录》、档案、近代报刊等资料,探究了圣容像在留都盛京的入藏和流转情况,并尝试还原凤凰楼部分旧藏。

Dynamic multifunctional metasurfaces:an inverse design deep learning approach

Optical metasurfaces(OMs)offer unprecedented control over electromagnetic waves,enabling advanced optical multiplexing.The emergence of deep learning has opened new avenues for designing OMs.However,existing deep learning methods for OMs primarily focus on forward design,which limits their design capabilities,lacks global optimization,and relies on prior knowledge.Additionally,most OMs are static,with fixed functionalities once processed.To overcome these limitations,we propose an inverse design deep learning method for dynamic OMs.Our approach comprises a forward prediction network and an inverse retrieval network.The forward prediction network establishes a mapping between meta-unit structure parameters and reflectance spectra.The inverse retrieval network generates a library of meta-unit structure parameters based on target requirements,enabling end-to-end design of OMs.By incorporating the dynamic tunability of the phase change material Sb2Te3with inverse design deep learning,we achieve the design and verification of dynamic multifunctional OMs.Our results demonstrate OMs with multiple information channels and encryption capabilities that can realize multiple physical field optical modulation functions.When Sb2Te3is in the amorphous state,near-field nano-printing based on meta-unit amplitude modulation is achieved for X-polarized incident light,while holographic imaging based on meta-unit phase modulation is realized for circularly polarized light.In the crystalline state,the encrypted information remains secure even with the correct polarization input,achieving double encryption.This research points towards ultra-compact,high-capacity,and highly secure information storage approaches.

The development of laser-produced plasma EUV light source

Extreme ultraviolet lithography(EUVL)has been demonstrated to meet the industrial requirements of new-generation semiconductor fabrication.The development of high-power EUV sources is a long-term critical challenge to the implementation of EUVL in high-volume manufacturing(HVM),together with other technologies such as photoresist and mask.Historically,both theoretical studies and experiments have clearly indicated that the CO 2 laser-produced plasma(LPP)system is a promising solution for EUVL source,able to realize high conversion efficiency(CE)and output power.Currently,ASML’s NXE:3400B EUV scanner configuring CO_(2) LPP source sys-tem has been installed and operated at chipmaker customers.Mean-while,other research teams have made different progresses in the development of LPP EUV sources.However,in their technologies,some critical areas need to be further improved to meet the requirements of 5 nm node and below.Critically needed improvements include higher laser power,stable droplet generation system and longer collector life-time.In this paper,we describe the performance characteristics of the laser system,droplet generator and mirror collector for different EUV sources,and also the new development results.

6例由假残托鹅膏引起的中毒病例临床调查及毒物鉴定研究

目的调查2021年4月浙江省丽水市发生的一起误食野生蘑菇引起神经精神型中毒事件,鉴定毒蘑菇种类,了解中毒症状和救治措施。方法开展中毒病例的流行病学调查、临床救治分析,毒蘑菇样本现场采集并结合形态学与分子生物学方法鉴定物种。结果6例患者食用了自己采集并煮汤的蘑菇,于食用后30 min~2 h出现中毒症状,轻症患者恶心呕吐、头晕,重症患者有意识模糊、四肢不自主抽动等症状。轻症患者经过支持性治疗当天痊愈出院,重症患者经过住院治疗顺利恢复。毒蘑菇样本经过形态学结合分子生物学方法鉴定为假残托鹅膏(Amanita pseudosychnopyramis)。结论该起中毒事件是一起由假残托鹅膏导致的食物中毒事件,国内外文献未见报道。

“名实分离”：雍正帝对大学士选任制度的改革——兼谈阁权的“变异”

雍正帝在大学士选任制度上进行了一系列新尝试。其举措出现了外任大学士、协办大学士、额外大学士等多种形式,他一方面通过提高大学士品级巩固大学士文臣首领的地位;另一方面,也通过"名实分离"的方式虚化和拆解阁权,使原本单一的"阁权"发生变异。

Ultrafast imaging for uncovering laser–material interaction dynamics

The physical mechanism of the dynamics in laser–material interaction has been an important research area.In addition to theoretical analysis,direct imaging‐based observation of ultrafast dynamic processes is an important approach to understand many fundamental issues in laser–material interaction such as inertial confinement fusion(ICF),laser accelerator construction,and advanced laser production.In this review,the principles and applications of three types of commonly used ultrafast imaging methods are introduced,including the pump–probe,X‐ray diagnosis,and single‐shot optical burst imaging.We focus on the technical features such as the spatial and temporal resolution for each technique,and present several conventional applications.

康熙朝起居注官侍直制度略探

侍直制度是康熙朝起居注制度的重要组成部分,本文主要通过《康熙起居注》和会典记载,考察起居注官的侍直人数、满汉差异、宫内和扈从记注情况,梳理侍直制度的发展脉络。康熙朝处于侍直制度的形成、探索期,始终保持较高的随意性、灵活性和实用性。侍直安排具有制度化倾向,并遵循实际需要进行调整。尽管汉记注官人数占优,但满记注官侍直的机会更多,也更受皇帝信任,满汉之别在侍直方面呈现不断扩大的趋势。

康亁时期汉大臣的「赐第」

清前期的汉官多居于北京南城,汉阁臣获内城赐第始于雍正皇帝。到乾隆朝,这一现象更为普遍,阁臣之外,尚书和军机大臣也有机会获得赐第。汉臣的「赐第」,作为一种特殊赏赐形式,始终被皇帝控制在很小的范围内,旨在保持满臣优越感的同时,极大提升汉臣的积极性。这于皇帝而言,可谓用较小的代价,获得了多方面收益。

浙江省丽水市6471例狂犬病暴露者流行病学特征分析

目的了解丽水市中心医院动物致伤门诊接诊的狂犬病暴露预防处置人群的流行病学特征及暴露后处置情况,为本地区狂犬病防控提供参考。方法回顾性分析丽水市中心医院2021-2023年6471例狂犬病暴露者流行病学资料,包括暴露人群性别与年龄、致伤月份及部位、致伤动物种类、暴露等级、狂犬病疫苗接种情况、狂犬病被动免疫制剂注射等。结果2021-2023年丽水市中心医院动物致伤门诊收治狂犬病暴露者共计6471例,2021-2023年分别接诊1133例、2135例和3203例,4~11月为暴露的高峰期,其中年龄21~30岁人群就诊率最高,达27.79%(1798/6471),为暴露的高危人群,3年间狂犬病暴露年龄构成比差异具有统计学意义(χ^(2)=43.82,P<0.001);男、女性别比为1∶1.14(χ^(2)=1.63,P=0.442);其中猫致伤3317例(51.26%,3317/6471),犬致伤2614例(42.16%,2614/6471),猫和犬为主要致伤动物(χ^(2)=18.63,P=0.098)。暴露部位以上肢(4131/6471,63.84%)和下肢(1848/6471,28.56%)居多,3年间各部位的暴露构成比差异具有统计学意义(χ^(2)=105.79,P<0.001);其中Ⅱ级暴露占31.79%(2057/6471),Ⅲ级暴露占62.31%(4032/6471),Ⅲ级暴露者中应用被动免疫制剂者占55.13%(2232/4032)。结论丽水市中心医院动物致伤门诊狂犬病暴露者就诊数量逐年增高,就诊人群被猫和犬致伤的情况较突出,Ⅲ级暴露者被动免疫制剂使用率仍然有待继续提高。