个体化PEEP通气策略对围手术期肺保护、肺不张及血流动力学的影响:系统性评价及荟萃分析

目的 在全麻患者术中使用不同的方法(电阻抗断层成像、肺部超声、动/静态肺顺应性、驱动压、跨肺压)确定个体化呼吸末正压(PEEP),与传统的固定PEEP相比是否引起肺损伤、肺不张及血流动力学不稳定。方法 计算机检索PubMed、clinicaltrials.gov、Web of Science、Cochrane Library及中国知网,并筛选所有选定文章的参考列表和类似文献,搜索截至2023年1月的所有中英文出版物,使用Revman 5.3软件进行Meta分析。结果 研究了45篇文献,共3 767患者。Meta分析显示个体化PEEP组CC-16浓度、肺部超声评分及肺部并发症发生率与传统PEEP组相比明显降低(P<0.05)。个体化PEEP与术中更高的动态肺顺应性和更低的驱动压有关(P<0.000 01)。同时,个体化PEEP组相较于传统PEEP组对MAP(P=0.13)和HR(P=0.94)差异无统计学意义。结论 与传统PEEP相比,术中使用个体化PEEP增加了患者围手术期肺保护效应,降低了围手术期肺不张的发生率和严重程度。同时,并不引起围手术期血流动力学紊乱。

Efficacy and predictive factors of transarterial chemoembolization combined with lenvatinib plus programmed cell death protein-1 inhibition for unresectable hepatocellular carcinoma

BACKGROUND The efficacy and safety of transarterial chemoembolization(TACE)combined with lenvatinib plus programmed cell death protein-1(PD-1)for unresectable hepato-cellular carcinoma(HCC)have rarely been evaluated and it is unknown which factors are related to efficacy.AIM To evaluate the efficacy and independent predictive factors of TACE combined with lenvatinib plus PD-1 inhibitors for unresectable HCC.METHODS This study retrospectively enrolled patients with unresectable HCC who received TACE/lenvatinib/PD-1 treatment between March 2019 and April 2022.Overall survival(OS)and progression-free survival(PFS)were determined.The objective response rate(ORR)and disease control rate(DCR)were evaluated in accordance with the modified Response Evaluation Criteria in Solid Tumors.Additionally,the prognostic factors affecting the clinical outcome were assessed.RESULTS One hundred and two patients were enrolled with a median follow-up duration of 12.63 months.The median OS was 26.43 months(95%CI:17.00-35.87),and the median PFS was 10.07 months(95%CI:8.50-11.65).The ORR and DCR were 61.76%and 81.37%,respectively.The patients with Barcelona Clinic Liver Cancer Classification(BCLC)B stage,early neutrophil-to-lymphocyte ratio(NLR)response(decrease),or early alpha-fetoprotein(AFP)response(decrease>20%)had superior OS and PFS than their counterparts.CONCLUSION This study showed that TACE/lenvatinib/PD-1 treatment was well tolerated with encouraging efficacy in patients with unresectable HCC.The patients with BCLC B-stage disease with early NLR response(decrease)and early AFP response(decrease>20%)may achieve better clinical outcomes with this triple therapy.

基于改进WOA-BP神经网络的网格化空气质量监测仪数据修正

空气污染严重威胁人类健康,近年来逐渐兴起的基于传感器技术的微型空气监测仪(简称微型站)具有体积小、造价低的优点,符合当前网格化、精细化的空气质量管理模式。但微型站中使用的电化学传感器存在复杂的气体交叉干扰,影响设备的准确性。针对交叉干扰非线性,难以用明确的数学表达式描述的问题,提出将改进鲸鱼算法优化的反向传播(CIWOA-BP)神经网络应用于微型站数据的修正。CIWOA-BP算法结合了BP神经网络善于处理非线性黑箱问题的优势以及CIWOA全局寻优的能力。结果表明:经过CIWOA-BP修正后的微型站可以实现对混合气体中的NO_(2)、CO、O_(3)和SO_(2)的准确定量分析,4种气体的计算值和实际值之间的拟合优度(R^(2))均超过了0.97,效果优于一元、多元线性回归和传统的BP神经网络,可以很好地提升设备对空气污染物的监测精度。

网格化空气质量监测仪中气体干扰模型的建立

网格化空气质量监测仪(简称微型站)利用内部集成的电化学气体传感器检测NO2、SO_(2)、CO和O_(3)等空气污染物,具有成本低、体积小等优点,但电化学传感器自身存在的气体交叉干扰问题极大地影响了监测结果的准确性。通过一元、多元线性和多元非线性回归分析的方法研究了微型站内的4种传感器的交叉干扰模型。结果表明:NO_(2)、CO传感器符合一元线性模型,拟合优度(R^(2)值)分别为0.9778和0.9898;而多元线性模型更适用于O_(3)和SO_(2)传感器,R^(2)值分别为0.9773和0.8901。在此基础上,通过进一步引入气体浓度交叉项进行优化,可以使SO2传感器的R2值提升至0.9294。气体交叉干扰模型的建立和优化有助于提高微型站对空气污染物的监测能力,同时为厂家设计和改良仪器提供参考。

Current status of yttrium-90 microspheres radioembolization in primary and metastatic liver cancer

Liver malignancy,including primary liver cancer and metastatic liver cancer has become one of the most common causes of cancer-related death worldwide due to the high malignant degree and limited systematic treatment strategy.Radioembolization with yttrium-90(^(90)Y)-loaded microspheres is a relatively novel technology that has made significant progress in the local treatment of liver malignancy.The different steps in the extensive work-up of radioembolization for patients with an indication for treatment with^(90)Y microspheres,from patient selection to follow up,both technically and clinically,are discussed in this paper.It describes the application and development of^(90)Y microspheres in the treatment of liver cancer.

化学需氧量和总有机碳在水质在线监测中的比较

化学需氧量(COD)和总有机碳(TOC)是定量表示水体受有机物污染的2个重要代表性指标。传统的COD在线监测方法在监测有机污染物方面存在一定的挑战,系统比较了COD和TOC在线监测方法在特殊水质中的应用。结果显示:TOC对难氧化有机物的氧化效率高达98%,高氯离子和无机还原性离子对TOC测量误差影响分别约为10%和7%。TOC可更直接、更准确地反映出水体受有机物污染的情况,最后对TOC指标在水质在线监测中的推广应用提出建议。

浅谈水质生物毒性自动监测研究进展

《“十四五”生态环境监测规划》明确提出要推进生物毒性自动监测的试点。文章梳理了水质生物毒性监测的主要方法和相关设备研发的应用进展,分析了我国生物毒性自动监测设备在推广应用中存在的问题,并提出了相关的建议。

Transcatheter arterial chemoembolization followed by immediate radiofrequency ablation for large solitary hepatocellular carcinomas

AIM: To assess the technical safety and efficacy of transcatheter arterial chemoembolization (TACE) combined with immediate radiofrequency ablation (RFA) for large hepatocellular carcinomas (HCC) (maximum diameter ≥ 5 cm). METHODS: Individual lesions in 18 patients with HCCs (mean maximum diameter: 7.5 cm; range: 5.1-15.5 cm) were treated by TACE combined with percutaneous RFA between January 2010 and June 2012. All of the patients had previously undergone one to four cycles of TACE treatment. Regular imaging and laboratory tests were performed to evaluate the rate of technical success, technique-related complications, local-regional tumor responses, recurrence-free survival time and survival rate after treatment.RESULTS: Technical success was achieved for all 18 visible HCCs. Complete response (CR) was observed in 17 cases, and partial response was observed in 1 case 1 mo after intervention. The CR rate was 94.4%. Local tumors were mainly characterized by coagulative necrosis. During follow-up (2-29 mo), the mean recurrencefree survival time was 16.8 ± 4.0 mo in 17 cases of CR. The estimated overall survival rate at 6, 12, and 18 mo was 100%. No major complications were observed. Levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the blood of 17 patients transiently increased on the third day after treatment (ALT 200.4 ± 63.4 U/L vs 24.7 ± 9.3 U/L, P < 0.05; AST 228.1 ± 25.4 U/L vs 32.7 ± 6.8 U/L, P < 0.05). Severe pain occurred in three patients, which was controlled with morphine and fentanyl. CONCLUSION: TACE combined with immediate RFA is a safe and effective treatment for large solitary HCCs. Severe pain is a major side effect, but can be controlled by morphine.

Management of surgical splenorenal shunt-related hepatic myelopathy with endovascular interventional techniques

We present a case with hepatic myelopathy(HM) due to a surgical splenorenal shunt that was successfully treated by endovascular interventional techniques.A 39-year-old man presented with progressive spastic paraparesis of his lower limbs 14 mo after a splenorenal shunt.A portal venogram identified a widened patent splenorenal shunt.We used an occlusion balloon catheter initially to occlude the shunt.Further monitoring of the patient revealed a decrease in his serum ammonia level and an improvement in leg strength.We then used an Amplatzer vascular plug(AVP) to enable closure of the shunt.During the follow up period of 7 mo,the patient experienced significant clinical improvement and normalization of blood ammonia,without any complications.Occlusion of a surgically created splenorenal shunt with AVP represents an alternative therapy to surgery or coil embolization that can help to relieve shunt-induced HM symptoms.

Role of prophylactic hyperthermic intraperitoneal chemotherapy in patients with locally advanced gastric cancer

BACKGROUND Gastric cancer is the second most common malignant tumor in China,ranking third among all malignant tumor mortality rates.Hyperthermic intraperitoneal chemotherapy(HIPEC)has been shown to increase significantly the effectiveness of intraperitoneal chemotherapeutic drugs,prolong the action time of these drugs on intraperitoneal tumor cells,and enhance their diffusion in tumor tissues.HIPEC may be one of the best choices for the eradication of residual cancer cells in the abdominal cavity.AIM The aim of this study was to study the role of preventive HIPEC after radical gastrectomy.METHODS A prospective analysis was performed with patients with c T4 N0-3 M0 gastric cancer to compare the effects of postoperative prophylactic HIPEC plus intravenous chemotherapy with those of routine adjuvant chemotherapy.Patients’medical records were analyzed,and differences in the peritoneal recurrence rate,diseasefree survival time,and total survival time between groups were examined.RESULTS The first site of tumor recurrence was the peritoneum in 11 cases in the conventional adjuvant chemotherapy group and in 2 cases in the HIPEC group(P=0.020).The 1-year and 3-year disease-free survival rates were 91.9%and 60.4%,respectively,in the conventional adjuvant chemotherapy group and 92.1%and 63.0%,respectively,in the HIPEC group.The 1-year and 3-year overall survival rates were 95.2%and 66.3%,respectively,in the conventional adjuvant chemotherapy group and 96.1%and 68.6%,respectively,in the HIPEC group.No significant difference in postoperative or chemotherapy complications was observed between groups.CONCLUSION In patients with c T4 N0-3 M0 gastric cancer,prophylactic HIPEC after radical tumor surgery is beneficial to reduce peritoneal tumor recurrence and prolong survival.

Feasibility of terahertz imaging for discrimination of human hepatocellular carcinoma

BACKGROUND Hepatocellular carcinoma(HCC) is one of the most common malignant tumors worldwide, and novel methods for early/rapid diagnosis of HCC are needed.Terahertz(THz) spectroscopy is considered to have the potential to distinguish between normal liver tissue and HCC tissue; however, there are few reports on it.We conduct this observational study to explore the feasibility of THz imaging for the diagnosis of HCC.AIM To evaluate the feasibility of THz for discriminating between HCC and normal liver tissues using fresh tissue specimens obtained from HCC patients who had undergone surgery.METHODS Normal liver tissue and HCC tissue were cryosectioned into 50 μm-thick slicesand placed on cover glass. Two adjacent tissue sections were separated subjected to histopathological examination by hematoxylin and eosin staining or THz transmission examination, and THz images were compared with pathologically mapped images. We determined the typical tumor and normal liver tissue regions by pathological examination; the corresponding areas of adjacent sections were examined by THz transmission.RESULTS The transmission rate of HCC tissue was 0.15-0.25, and the transmission rate of typical HCC tissue was about 0.2. THz transmittance in normal liver tissue is slightly higher than 0.4, but there were many influencing factors, including the degree of liver cirrhosis, fat components, ice crystals in frozen sections, and apoptosis.CONCLUSION In conclusion, this study shows that THz imaging can detect HCC tissue. Further research will yield more detailed data of the THz transmission rates of HCC tissue with different degrees of differentiation.

Dissolution-precipitation mechanism of self-propagating high-temperature synthesis of TiC-Cu cermets

The mechanism of self-propagating high-temperature synthesis （SHS） of TiC-Cu cermets was studied using a combustion front quenching method. Microstructural evolution in the quenched sample was observed using scanning electron microscope （SEM） with energy dispersive X-ray （EDX） spectrometry, and the combustion temperature was measured. The results showed that the combustion reaction started with local formation of Ti-Cu melt and could be described with the dissolution-precipitation mechanism, namely, Ti, Cu, and C particles dissolved into the Ti-Cu solution and TiC particles precipitated in the saturated Ti-Cu-C liquid solution. The local formation of Ti-Cu melt resulted from the solid diffusion between Ti and Cu particles.

Prostatic artery embolization: Progress and prospect

Prostate artery embolization is a well-known and promising treatment for benign prostatic hyperplasia, with the quantum leaps of research in medicine. We aim to provide an up-to-date review of the novel technique, including large retrospective studies and randomized control trials, ends with discussions of advantages and disadvantages of this minimally invasive technique.

Neurological functional evaluation based on accurate motions in big animals with traumatic brain injury

An accurate and effective neurological evaluation is indispensable in the treatment and rehabilitation of traumatic brain injury. However,most of the existing evaluation methods in basic research and clinical practice are not objective or intuitive for assessing the neurological function of big animals, and are also difficult to use to qualify the extent of damage and recovery. In the present study, we established a big animal model of traumatic brain injury by impacting the cortical motor region of beagles. At 2 weeks after successful modeling, we detected neurological deficiencies in the animal model using a series of techniques, including three-dimensional motion capture, electromyogram and ground reaction force. These novel technologies may play an increasingly important role in the field of traumatic brain injury diagnosis and rehabilitation in the future. The experimental protocol was approved by the Animal Care and Use Committee of Logistics University of People's Armed Police Force(approval No. 2017-0006.2).

Feasibility of hyperspectral analysis for discrimination of rabbit liver VX2 tumor

BACKGROUND Hepatocellular carcinoma is one of the most common malignant tumors worldwide. Currently, the most accurate diagnosis imaging modality for hepatocellular carcinoma is enhanced magnetic resonance imaging. However, it is still difficult to distinguish cirrhosis lesions, and novel diagnosis modalities are still needed.AIM To investigate the feasibility of hyperspectral analysis for discrimination of rabbit liver VX2 tumor.METHODS In this study, a rabbit liver VX2 tumor model was established. After laparotomy,under direct view, VX2 tumor tissue and normal liver tissue were subjected to hyperspectral analysis.RESULTS The spectral signature of the liver tumor was clearly distinguishable from that of the normal tissue, simply from the original spectral curves. Specifically, two absorption peaks at 600-900 nm wavelength in normal tissue disappeared but a new reflection peak appeared in the tumor. The average optical reflection at the whole waveband of 400-1800 nm in liver tumor was higher than that of the normal tissue.CONCLUSION Hyperspectral analysis can differentiate rabbit VX2 tumors. Further research will continue to perform hyperspectral imaging to obtain more information for differentiation of liver cancer from normal tissue.

Simultaneous transarterial chemoembolization and radiofrequency ablation for large hepatocellular carcinoma

BACKGROUND Hepatocellular carcinoma(HCC)is a common cancer and a leading cause of tumor-related death.Patients with large HCC(≥8 cm)are at an advanced stage and have poor prognosis,and hepatic resection may not be suitable,and the incidence of postoperative recurrence is high.AIM To evaluate recurrence and mid-term survival of patients with large HCC treated by transcatheter arterial chemoembolization(TACE)and radiofrequency ablation(RFA).METHODS This was a retrospective study.From 2010 to 2013,46 consecutive patients with large HCC were treated with simultaneous TACE and RFA.Thirty-five of 46 patients had a single tumor.Progression-free survival(PFS)and overall survival(OS)were analyzed at 2 years and 3 years,respectively.RESULTS Forty-six patients treated by simultaneous TACE and RFA had no significant complications and treatment was successful.After 3 years,median PFS and OS were 10.21±1.58 mo and 26.44±2.26 mo,retrospectively.The survival rate was 67.5%after 2 years and 55.67%after 3 years.CONCLUSION These preliminary data show that simultaneous TACE and RFA are safe and effective for large HCC.

Microstructures of GaN Buffer Layers Grown on Si(111) Using Rapic Thermal Process Low-Pressure Metalorganic Chemical Vapor Deposition

Microstructures of GaN buffer layers grown on Si(111)substrates using rapid thermal process low-pressure metalorganic chemical vapor deposition are investigated by an atomic force microscope(AFM)and a high-resolution transmission electron microscope(HBTEM).AFM images show that the islands appear in the GaN buffer layer after annealing at high temperature.Cross-sectional HBTEM micrographs of the buffer region of these samples indicate that there are bunched steps on the surface of the Si substrate and a lot of domains in GaN misorienting each other with small angles.The boundaries of those domains locate near the bunched steps,and the regions of the Him on a terrace between steps have the same crystal orientation.An amorphous-like layer,about 3nm thick,can also be observed between the GaN buffer layer and the Si substrate.

Continuous-Wave Self-Focusing and Self-phase Modulation in C_(60)-Benzene Solution

C_(60)-benzene solutions are used as a new type of nonlinear Medium for observing cw self-focusing of laser beams.Self-phase modulation of much low power laser beam has been observed.The response time of C_(60)-benzene solution has been measured.

OPTICAL DIFFRACTION ON SIERPINSKI CARPET

An experimental study of the optical diffraction on SierpiAski carpet is performed.The theoretical formula for diffraction intensity is derived and computer Simulation is carried out in order to compare with experimentally observed diffraction pattern.The results show that the pattern of the Fourier transform of a fractai grating is also selfsimilar and the fractal dimension may be determined with optical measurement.

Early- and intermediate-term outcome of transarterial embolization for symptomatic hepatic focal nodular hyperplasia

Purpose: To evaluate the early-and intermediate-term outcome in patients with symptomatic hepatic focal nodular hyperplasia(FNH) treated with transarterial embolization using bleomycin-iodinated oil and polyvinyl alcohol(PVA) particles. Materials and methods: In this two-center retrospective study between January 2005 and December 2013, 27 consecutive patients with symptomatic hepatic FNH underwent superselective catheterization by microcatheter techniques and embolization using bleomycin-iodinated oil combined with PVA. Early-term(3–41 months) follow-up of TAE was performed in terms of symptom control, changes in lesion size, and complications. Intermediate-term(45–112 months) follow-up was carried out to assess symptom control and reinterventions for recurrence. Results: Embolization was performed in 27 patients with 31 lesions. Technical success was achieved in all cases. The follow-up period ranged from three to 112 months. At early-term follow-up, mean lesion diameters were decreased significantly from 6.4±2.7 cm pre-intervention to 3.6±1.8 cm at 3-9 months after embolization(P<0.001). A total of 7 lesions had complete resolution during the whole follow-up period. At intermediate-term follow-up, local recurrence was found in 1 treated lesion at 54-months. Contrast-enhanced scans showed complete lack of residual arterial blood supply in the majority of lesions during the follow-up period. There was no major complication associated with the procedure. Conclusion: Transarterial embolization using bleomycin-iodinated oil and PVA is a feasible, safe and effective alternative in both early-and intermediate-terms for the treatment of symptomatic hepatic FNH.