Lithium-Ion Charged Polymer Channels Flattening Lithium Metal Anode

The concentration difference in the near-surface region of lithium metal is the main cause of lithium dendrite growth.Resolving this issue will be key to achieving high-performance lithium metal batteries(LMBs).Herein,we construct a lithium nitrate(LiNO_(3))-implanted electroactiveβphase polyvinylidene fluoride-co-hexafluoropropylene(PVDF-HFP)crystalline polymorph layer(PHL).The electronegatively charged polymer chains attain lithium ions on the surface to form lithium-ion charged channels.These channels act as reservoirs to sustainably release Li ions to recompense the ionic flux of electrolytes,decreasing the growth of lithium dendrites.The stretched molecular channels can also accelerate the transport of Li ions.The combined effects enable a high Coulombic efficiency of 97.0%for 250 cycles in lithium(Li)||copper(Cu)cell and a stable symmetric plating/stripping behavior over 2000 h at 3 mA cm^(-2)with ultrahigh Li utilization of 50%.Furthermore,the full cell coupled with PHL-Cu@Li anode and Li Fe PO_(4) cathode exhibits long-term cycle stability with high-capacity retention of 95.9%after 900 cycles.Impressively,the full cell paired with LiNi_(0.87)Co_(0.1)Mn_(0.03)O_(2)maintains a discharge capacity of 170.0 mAh g^(-1)with a capacity retention of 84.3%after 100 cycles even under harsh condition of ultralow N/P ratio of 0.83.This facile strategy will widen the potential application of LiNO_(3)in ester-based electrolyte for practical high-voltage LMBs.

循证骨科学定义的系统评价及循证骨科学文献的可视化分析

目的系统检索国内外循证骨科学文献,评价循证骨科学定义,分析当前研究现状。方法计算机检索PubMed、Web of Scinence、EMbase、CNKI、VIP、CBM数据库,及百度、Google,搜集循证骨科学文献,提取循证骨科学定义和相关信息,并采用CiteSpace软件可视化分析。结果循证骨科学定义方面,共检索获得6个循证骨科学定义,来源分别为中文文献(1个)、英文文献(3个)、中文书籍(1个)、英文书籍(1个);循证骨科学文献方面,纳入中文文献462篇和英文文献583篇,中英文文献年发文量均呈现先上升后下降的变化趋势。Bhandari Mohit教授为该领域最突出专家。发文量最多的国内机构是四川大学华西医院,国外机构是哈佛大学(Harvard University)、多伦多大学(University of Toronto)和麦克马斯特大学(McMaster University)。美国和加拿大在该领域发文量较多。中文文献关键词集中在循证护理、临床教学和诊疗方面;英文关键词集中在随访和诊疗方面。结论循证骨科学定义存在较大差异,难以完整准确地表述循证骨科学的内涵。循证骨科学研究不充分,亟需加强循证骨科学理论研究与骨科领域的循证研究。

面向真实世界的知识挖掘与知识图谱补全研究(二):非结构化电子病历信息抽取方法及进展

随着信息技术的普及和推广,健康医疗大数据呈指数级增长,基于健康医疗大数据的临床真实世界研究日益受到关注。医院电子病历记录了真实世界下患者的诊疗全过程,是最能为临床决策提供支持的数据源之一。但电子病历数据中大量非结构化文本数据的存在,增加了数据处理难度,制约了基于电子病历数据研究的开展。急需将信息技术、人工智能等先进的方法用于非结构化电子病历数据的处理,以加速数据价值转化。本文总结了当前非结构化医学数据处理的常用方法,包括基于词典和规则的方法、基于传统机器学习和深度学习的方法和以本体为代表的基于认知模型的方法,探讨了非结构化电子病历数据处理时的标准化问题及透明化报告问题,展望了相关发展。

面向真实世界的知识挖掘与知识图谱补全研究(一):真实世界数据与知识图谱概述

来源于真实的医疗环境的真实世界数据能够真实反映患者的健康情况和临床诊疗过程,是重要的知识和证据来源。知识图谱作为一种语义网络,可用于组织、呈现和推理医学知识。真实世界数据与知识图谱结合应用能够更好地对医疗知识进行补充、展示和利用。目前,利用真实世界数据构建医学知识图谱,或使用真实世界数据对医学知识图谱进行补全是两者结合应用的主要方式。在开展真实世界数据与医学知识图谱结合应用研究时,需注意多学科团队协作、患者隐私保护及数据治理标准化等问题。

以临床问题解决效果为核心的骨科循证研究质量评价指标体系构建

目的构建以临床问题解决效果为核心的骨科循证研究质量评价指标体系。方法应用结构-过程-结果理论,通过文献分析法、半结构访谈法和两轮德尔菲专家函询法,结合层次分析法构建以临床问题解决效果为核心的骨科循证研究质量评价指标体系,确定指标权重并进行初步验证。结果15名专家完成两轮德尔菲专家咨询,结果显示专家权威性评分高、意见协调性好。最终构建4个一级指标、14个二级指标、2个三级指标、5个四级指标。层次分析法结果显示随机一致性指标(random index,RI)为0.882,一致性比率(consistent ratio,CR)为0.006。初步验证结果显示量表信度一致性较好、区分度较高。结论以临床问题解决效果为核心的骨科循证研究质量评价指标体系能够快速、客观地评价骨科循证研究,发现并解决骨科临床问题,从而为提升骨科循证研究质量奠定基础。

“互联网+”新型教学模式形成性评价体系构建及其应用于循证医学课程的思考

“互联网+”给医学教育带来巨大挑战,融入信息技术的新型教学活动应用日益广泛,它们具有较强的开放性、自主性和灵活性,如何强化对课程教学过程的监督、管理和评估,已成为推动教学改革的难点。作为课程教学评价的重要方式之一,形成性评价在“教学-反馈-改进”过程中起着重要作用。本文分析了医学教育领域“互联网+”教学模式及其形成性评价体系特点,提出了评价体系的建设方向及改革着力点,结合武汉大学循证医学混合式教学的授课经验,以该课程为例提出了形成性评价体系建设思路。期望能与同行相互探讨,共同推动信息技术与循证医学类课程的深度融合,充分发挥其在医学生循证医学能力培养中的作用。

循证医学课程体系的建设与实践--以武汉大学为例

循证医学教育是国际及我国医学教育的基本要求内容,其目的在于培养具备解决临床实际问题能力、批判性思维能力、创新能力等的医学人才。武汉大学自2004年首次开设循证医学课程至今,进行了全方位、系统性的探索与实践,完成了教研室的创建、师资力量的构建、课程体系的打造,实现了医学专业学生全覆盖,有效地将循证医学教育特色融入新时代医学生培养进程中。本文对武汉大学循证医学课程体系定位及建设思路进行介绍,特别是对创新“1+4”的课程教学模式、建立全过程“教”与“学”的评价、创新师资力量的培养与传承三大具体措施进行了总结,以期为我国循证医学教育及其教学改革提供参考,服务于培养符合时代需求的医学人才。

医学生对循证医学课程思政认知与态度的横断面研究

目的调查医学生对课程思政的态度和思政元素的需求,贯彻三全育人理念,为医学类课程思政设计和教学改革提供参考。方法选择武汉大学第二临床学院2021-2022学年第一学期选修循证医学的研究生,设计“课程思政认知与态度”问卷,就学生对思政内容的要求和评价进行调查,利用SPSS 22.0软件进行数据录入与分析。结果共纳入138名学生,其中83.33%的学生对课程思政融入循证医学专业课感兴趣,学生对专业课中思政内容的兴趣越大,越认可授课教师在理想信念(r=0.33,P<0.001)、仁爱之心(r=0.28,P<0.001)、道德情操(r=0.24,P=0.005)和扎实学识(r=0.21,P=0.020)方面对自己的影响。学生主要关注的课程思政元素是专业知识与思政相结合的内容(51.45%),并希望思政内容能有机融入、不要太“刻意”(84.06%)。结论大部分医学生对课程思政融于专业课持肯定态度。自然、适度、适时地融入思政元素并采用创新的教学方法,可获得更好的效果。

临床实践指南实施性促进研究之一:实施性现状与促进策略

临床实践指南的实施是证据转化的重要形式,是缩小研究成果与临床实践差距的主要方式,采取有效措施提高指南的实施性成为促进临床实践指南推广应用的重要举措。受到可操作性低、传播应用形式单一、更新不及时,以及实施工具和实施性评价工具缺乏等因素影响,临床实践指南在临床实践中的依从性不高,实施应用仍存在不足。结合证据生态系统框架、构建指南实施性评价工具、利用知识图谱等人工智能技术为指南实施分别提供理论支撑、效果评价工具、技术路径,是促进临床实践指南实施的有效方法。

A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV) infected pneumonia(standard version)

In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.

MiRNA profile in esophageal squamous cell carcinoma:Downregulation of miR-143 and miR-145

AIM:To investigate the expression profile of miRNA in esophageal squamous cell carcinoma(ESCC).METHODS:The expression profile of miRNA in ESCC tissues was analyzed by miRNA microarray.The expression levels of miR-143 and miR-145 in 86 ESCC patients were determined by real-time polymerase chain reaction(PCR) using TaqMan assay.The mobility effect was estimated by wound-healing using esophageal carcinoma cells transfected with miRNA expression plasmids.RESULTS:A set of miRNAs was found to be deregulated in the ESCC tissues,and the expression levels of miR-143 and-145 were significantly decreased in most of the ESCC tissues examined.Both miR-143 and miR-145 expression correlated with tumor invasion depth.The transfection of human esophageal carcinoma cells with miR-143 and miR-145 expression plasmids resulted in a greater inhibition of cell mobility,however,the protein level of the previously reported target of miR-145,FSCN1,did not show any significant downregulation.CONCLUSION:These findings suggest that the deregulation of miRNAs plays an important role in the progression of ESCC.Both miR-143 and miR-145 might act as anti-oncomirs common to ESCC.

临床实践指南实施性促进研究之四:中医/中西医结合指南知识图谱知识抽取、存储与实例展示

本研究基于中医诊疗特点和中医临床指南特点,以《冠心病稳定型心绞痛中医诊疗指南》为例构建中医/中西医临床指南知识图谱,进一步检验知识图谱技术应用于中医/中西医指南领域的可操作性和合理性。构建流程主要包括:根据概念层及数据层设计,从指南中抽取实体与关系、整理成实体库与三元组关系库进行知识导入、利用Neo4j进行知识存储,并检索验证知识图谱的正确性,完成可视化展示。该临床指南知识图谱的构建思路也可为其他疾病中医/中西医结合临床指南的知识图谱建构提供参考。

临床实践指南实施性促进研究之三:中医/中西医结合指南知识图谱框架设计

临床实践指南存在的意义在于它的实施性。然而,目前指南的实施存在诸多问题,临床证据转化存在瓶颈。知识图谱技术的引入为指南智能化提供了坚实的基础,为解决指南实施问题提供了良好的手段。中医/中西医结合体现了我国医疗体系的特色。本研究基于心血管疾病中医/中西医结合诊疗现状及相关指南实施存在的问题,明确心血管疾病中医/中西医结合诊疗临床指南的知识图谱构建目标,据此设计符合专业认知与实际应用需求的知识图谱框架,包括解析指南内容范围、梳理指南内容模块、归纳指南知识结构、设计概念结构表和实体语义关系表。本文提出的中医/中西医指南知识图谱框架设计为指南数字化、智能化提供了基础,有利于推动指南的实施与传播。

Perceived infection transmission routes, infection control practices, psychosocial changes, and management of COVID-19 infected healthcare workers in a tertiary acute care hospital in Wuhan: a cross-sectional survey

Background:Many healthcare workers were infected by coronavirus disease 2019(COVID-19)early in the epidemic posing a big challenge for epidemic control.Hence,this study aims to explore perceived infection routes,influencing factors,psychosocial changes,and management procedures for COVID-19 infected healthcare workers.Methods:This is a cross-sectional,single hospital-based study.We recruited all 105 confirmed COVID-19 healthcare workers in the Zhongnan Hospital of Wuhan University from February 15 to 29,2020.All participants completed a validated questionnaire.Electronic consent was obtained from all participants.Perceived causes of infection,infection prevention,control knowledge and behaviour,psychological changes,symptoms and treatment were measured.Results:Finally,103 professional staff with COVID-19 finished the questionnaire and was included(response rate:98.1%).Of them,87 cases(84.5%)thought they were infected in working environment in hospital,one(1.0%)thought their infection was due to the laboratory environment,and 5(4.9%)thought they were infected in daily life or community environment.Swab of throat collection and physical examination were the procedures perceived as most likely causing their infection by nurses and doctors respectively.Forty-three(41.8%)thought their infection was related to protective equipment,utilization of common equipment(masks and gloves).The top three first symptoms displayed before diagnosis were fever(41.8%),lethargy(33.0%)and muscle aches(30.1%).After diagnosis,88.3%staff experienced psychological stress or emotional changes during their isolation period,only 11.7%had almost no emotional changes.Arbidol(Umifenovir;an anti-influza drug;69.2%)was the drug most commonly used to target infection in mild and moderate symptoms.Conclusion:The main perceived mode of transmission was not maintaining protection when working at a close distance and having intimate contact with infected cases.Positive psychological intervention is necessary.

Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19: An evidence-based clinical practice guideline(updated version)

The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the cause of a rapidly spreading illness,coronavirus disease 2019(COVID-19),affecting more than seventeen million people around the world.Diagnosis and treatment guidelines for clinicians caring for patients are needed.In the early stage,we have issued"A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infected pneumonia(standard version)";now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline.We formed a working group of clinical experts and methodologists.The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas:chemoprophylaxis,diagnosis,treatments,and discharge management.We searched the literature for direct evidence on the management of COVID-19,and assessed its certainty generated recommendations using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach.Recommendations were either strong or weak,or in the form of ungraded consensus-based statement.Finally,we issued 34 statements.Among them,6 were strong recommendations for,14 were weak recommendations for,3 were weak recommendations against and 11 were ungraded consensus-based statement.They covered topics of chemoprophylaxis(including agents and Traditional Chinese Medicine(TCM)agents),diagnosis(including clinical manifestations,reverse transcription-polymerase chain reaction(RT-PCR),respiratory tract specimens,IgM and IgG antibody tests,chest computed tomography,chest X-ray,and CT features of asymptomatic infections),treatments(including lopinavirritonavir,umifenovir,favipiravir,interferon,remdesivir,combination of antiviral drugs,hydroxychloroquine/chloroquine,interleukin-6 inhibitors,interleukin-1 inhibitors,glucocorticoid,qingfei paidu decoction,lianhua qingwen granules/capsules,convalescent plasma,lung transplantation,invasive or noninvasive ventilation,and extracorporeal membrane oxygenation(ECMO)),and discharge management(including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge).We also created two figures of these recommendations for the implementation purpose.We hope these recommendations can help support healthcare workers caring for COVID-19 patients.

Epidemiological trends of urinary tract infections,urolithiasis and benign prostatic hyperplasia in 203 countries and territories from 1990 to 2019

Background:Urinary tract infections(UTI),urolithiasis,and benign prostatic hyperplasia(BPH)are three of the most common nonmalignant conditions in urology.However,there is still a lack of comprehensive and updated epidemiological data.This study aimed to investigate the disease burden of UTI,urolithiasis,and BPH in 203 countries and territories from 1990 to 2019.Methods:Data were extracted from the Global Burden of Disease 2019,including incident cases,deaths,disabilityadjusted life-years(DALYs)and corresponding age-standardized rate(ASR)from 1990 to 2019.Estimated annual percentage changes(EAPC)were calculated to evaluate the trends of ASR.The associations between disease burden and social development degrees were analyzed using a sociodemographic index(SDI).Results:Compared with 1990,the incident cases of UTI,urolithiasis,and BPH increased by 60.40%,48.57%,and 105.70%in 2019,respectively.The age-standardized incidence rate(ASIR)of UTI increased(EAPC=0.08),while urolithiasis(EAPC=–0.83)and BPH(EAPC=–0.03)decreased from 1990 to 2019.In 2019,the age-standardized mortality rate(ASMR)of UTI and urolithiasis were 3.13/100,000 and 0.17/100,000,respectively.BPH had the largest increase(110.56%)in DALYs in the past three decades,followed by UTI(68.89%)and urolithiasis(16.95%).The burden of UTI was mainly concentrated in South Asia and Tropical Latin America,while the burden of urolithiasis and BPH was recorded in Asia and Eastern Europe.Moreover,the ASIR and SDI of urolithiasis in high-SDI regions from 1990to 2019 were negatively correlated,while the opposite trend was seen in low-SDI regions.In 2019,the ASIR of UTI in females was 3.59 times that of males,while the ASIR of urolithiasis in males was 1.96 times higher than that in females.The incidence was highest in the 30–34,55–59,and 65–69 age groups among the UTI,urolithiasis,and BPH groups,respectively.Conclusions:Over the past three decades,the disease burden has increased for UTI but decreased for urolithiasis and BPH.The allocation of medical resources should be based more on the epidemiological characteristics and geographical distribution of diseases.

临床实践指南实施性促进研究之二:基于非肌层浸润性膀胱癌指南的知识图谱框架设计

指南的转化和应用是医学科技成果转化的关键环节。但是,目前指南在临床决策和实践可操作性方面仍存在较多不足。知识图谱技术的引入为指南智能化提供了坚实的基础,为解决指南实施问题提供了良好的手段。非肌层浸润性膀胱癌(non-muscle invasive bladder cancer,NMIBC)是泌尿系统常见的恶性肿瘤,随着新的诊疗手段不断涌现,NMIBC临床指南存在查阅费时、更新频繁等问题。鉴于临床医生迫切需要学习和使用指南知识、梳理指南更新内容,本研究基于NMIBC疾病特征和临床指南特点,提出并构建NMIBC临床指南知识图谱框架,包括解析指南内容范围、梳理指南内容模块、归纳指南知识结构等,参考OMAHA Schema,根据二级概念层及概念实例设计概念结构表,设计并调整概念间的关系结构,改进并完善实体与实体间的关系,并请专家对知识图谱的科学性和方法有效性进行审核与评估。基于NMIBC指南的知识图谱框架设计为指南数字化、智能化提供了基础,有利于推动指南的实施与传播。

Luminal型与Basal-like型乳腺癌差异miRNAs的表达与预后分析

目的分析Luminal型和Basal-like型乳腺癌之间差异表达的microRNAs(miRNAs),探讨其表达水平与Luminal型和Basal-like型乳腺癌预后的关系。方法从基因表达综合数据库(GEO)中下载包含Luminal和Basal-like乳腺癌患者相关的miRNAs微阵列数据集GSE81000与GSE40267,利用GEO2R在线分析工具筛选Luminal和Basal-like乳腺癌之间差异表达的miRNAs。通过mirDIP数据库预测其靶基因,并采用实时荧光定量PCR(quantitative real-time PCR,qRT-PCR)在人乳腺癌细胞MCF-7和MDA-MB-468中验证miRNAs的差异表达。利用METABRIC数据库,采用KaplanMeier Plotter在线工具分析miR-199a-5p和miR-199b-5p表达水平与Luminal型和Basal-like型乳腺癌预后的关系。结果筛选出了35种在Luminal型和Basal-like型乳腺癌中差异表达的miRNAs。相较于Luminal型,18种miRNAs在Basal-like型中表达下调,17种表达上调。靶基因预测结果显示,35种差异表达miRNAs的潜在靶基因共4180个,其中最相关的靶基因有19个,对应的差异miRNAs为miR-199a-5p、miR-199b-5p。相较于Luminal型乳腺癌,miR-199a-5p和miR-199b-5p在Basal-like型乳腺癌中表达下调。qRT-PCR检测结果表明,miR-199a-5p和miR-199b-5p在MCF-7(Luminal型)和MDA-MB-468(Basal-like型)细胞中的表达水平与GEO2R分析结果趋势一致。生存分析结果表明,miR-199a-5p与miR-199b-5p低表达与Luminal A型乳腺癌患者的总生存率降低显著相关。结论共筛选出35个在Luminal型和Basal-like型乳腺癌中差异表达的miRNAs。其中,miR-199a-5p、miR-199b-5p与乳腺癌的预后相关,有望成为治疗的新靶点。

Anomaly Detection Algorithm for Stay Cable Monitoring Data Based on Data Fusion

In order to improve the accuracy and consistency of data in health monitoring system,an anomaly detection algorithm for stay cables based on data fusion is proposed.The monitoring data of Nanjing No.3 Yangtze River Bridge is used as the basis of study.Firstly,an adaptive processing framework with feedback control is established based on the concept of data fusion.The data processing contains four steps:data specification,data cleaning,data conversion and data fusion.Data processing information offers feedback to the original data system,which further gives guidance for the sensor maintenance or replacement.Subsequently,the algorithm steps based on the continuous data distortion is investigated,which integrates the inspection data and the distribution test method.Finally,a group of cable force data is utilized as an example to verify the established framework and algorithm.Experimental results show that the proposed algorithm can achieve high detection accuracy,providing a valuable reference for other monitoring data processing.

Clinical Observation on Treatment of Moderate and Severe Periodical Mastalgia with TCM Hot-wet Compress Therapy

[Objectives] To observe the clinical therapeutic efficacy of local hot-wet compress therapy of digestion ointment prescription on the patients with moderate and severe mastalgia. [Methods] Firstly,60 patients with mastalgia were selected,and divided into the experimental group and control group( 30 cases for each group). The control group was treated with acupuncture at distal point,and the experimental group was treated with TCM local hot-wet compress therapy combined with acupuncture at distal point. Then,the clinical therapeutic efficacy of two groups was compared. [Results]The experimental group was superior to the control group in relieving the breast pain,improving emotional integral,reducing breast lumps,improving lump texture,and improving TCM syndrome integral( P < 0. 05). [Conclusions]The digestion ointment prescription local hot-wet compress therapy has a significant therapeutic effect on treatment of mastalgia and can significantly improve the breast pain symptom of patients.