机器学习模型预测开放手术修复腹主动脉瘤后急性肾损伤的发生

目的:腹主动脉瘤是指腹主动脉扩张超过3.0 cm的一种病理状态,手术治疗方式包括开放手术(open surgical repair,OSR)和腔内修复(endovascular aneurysm repair,EVAR)。预测腹主动脉瘤患者OSR后急性肾损伤(acute kidney injury,AKI)的发生有助于术后临床决策。为找到一种更有效的预测方法,本研究对不同机器学习预测模型的效能进行测试。方法:回顾性收集2009年1月至2021年12月中南大学湘雅医院80例OSR患者的围手术期数据,手术均由血管外科医师实施。选择logistic回归、线性核支持向量机、高斯核支持向量机、随机森林4种常用的机器学习分类模型来实施预测。通过五重交叉验证来分析模型的性能。结果:33名患者出现AKI,4种分类模型的五重交叉验证结果表明:随机森林是预测AKI最精确的模型,曲线下面积为0.90±0.12。结论:机器学习模型可以精确预测术后AKI的发生,从而使血管外科医生能更早地处理并发症,并且可能有助于提高腹主动脉瘤OSR的临床疗效。

Values of Donor Serum Lipids and Calcium in Predicting Graft Function after Kidney Transplantation:A Retrospective Study

Objective Delayed graft function(DGF)and early graft loss of renal grafts are determined by the quality of the kidneys from the deceased donor.As“non-traditional”risk factors,serum biomarkers of donors,such as lipids and electrolytes,have drawn increasing attention due to their effects on the postoperative outcomes of renal grafts.This study aimed to examine the value of these serum biomarkers for prediction of renal graft function.Methods The present study consecutively collected 306 patients who underwent their first single kidney transplantation(KT)from adult deceased donors in our center from January 1,2018 to December 31,2019.The correlation between postoperative outcomes[DGF and abnormal serum creatinine(SCr)after 6 and 12 months]and risk factors of donors,including gender,age,body mass index(BMI),past histories,serum lipid biomarkers[cholesterol,triglyceride,high-density lipoprotein(HDL)and low-density lipoprotein(DL)],and serum electrolytes(calcium and sodium)were analyzed and evaluated.Results(1)Donor age and pre-existing hypertension were significantly correlated with the incidence rate of DGF and high SCr level(≥2 mg/dL)at 6 and 12 months after KT(P<0.05);(2)The donor’s BMI was significantly correlated with the incidence rate of DGF after KT(P<0.05);(3)For serum lipids,merely the low level of serum HDL of the donor was correlated with the reduced incidence rate of high SCr level at 12 months after KT[P<0.05,OR(95%CI):0.425(0.202–0.97)];(4)The serum calcium of the donor was associated with the reduced incidence rate of high SCr level at 6 and 12 months after KT[P<0.05,OR(95%CI):0.184(0.045–0.747)and P<0.05,OR(95%CI):0.114(0.014–0.948),respectively].Conclusion The serum HDL and calcium of the donor may serve as predictive factors for the postoperative outcomes of renal grafts after KT,in addition to the donor’s age,BMI and pre-existing hypertension.

基于BIM技术的装配式建筑施工课程教学改革与实践

装配式施工是现代化建筑业持续健康发展的必然趋势,为进一步深化高职院校土建类专业教育教学改革和更好地培养装配式建筑施工人才,对目前装配式建筑施工课程教学现状进行了分析,按建筑工业化和信息化的发展需求,并结合BIM技术特点,从专业层面重构装配式建筑课程体系,并从课程出发改革装配式建筑施工课程的教学内容和教学模式。综合考虑BIM技术和装配式建筑施工课程特点,就BIM技术的直接应用、教学辅助、综合应用等入课方式进行教学实践,实践效果良好。

地铁隧道施工对近接建筑影响的数值分析

以某市地铁一号线隧道洞室的开挖工程为背景,采用FLAC3D软件,通过模拟研究隧道洞室开挖施工对相邻建筑地基基础的影响,并根据现场测量数据及数值模拟计算结果,回归得到一合适的测压系数。结果表明:当测压系数取值为0.25时,采用FLAC软件进行数值模拟能较好地符合现场实际情况;采用混凝土支护桩和预应力锚索组合防护措施,能显著降低隧道洞室施工对相邻建筑地基的影响。

输尿管镜手术相关输尿管全长离断的急诊原位再植修复4例报告

目的探讨原位再植修复用于输尿管镜相关输尿管全长离断急诊修复的临床疗效,为此类严重并发症的治疗提供借鉴。方法回顾性分析上海4家综合性医院近5年诊治的输尿管镜相关输尿管全长离断行急诊原位再植修复的4例患者的临床资料,术式均采用近端输尿管端端吻合+远端输尿管膀胱再植术,统计分析4例患者的围手术期及随访的相关指标。结果4例患者平均手术时间为(4.75±0.65)(4.0~5.5)h,术中行大网膜包绕3例(75%),术中行经皮肾造瘘2例(50%),中位随访时间为24(6~54)个月,双J管平均留置时间为(6.75±1.89)(4~8)个月,肾造瘘管平均留置时间为(7.25±11.41)(0~24)个月,围手术期及随访肾功能及肾积水程度总体稳定。结论对于输尿管镜相关输尿管全长离断,实施以输尿管端端吻合+输尿管膀胱再植术为基础的急诊原位再植修复能够恢复输尿管的自然结构与生理功能、有效保护肾功能,有望成为同等条件下的首选急诊修复方法。

基于DSP的旋转磁场电磁跟踪系统设计

该文实现了一种基于电控旋转磁场的电磁跟踪系统。设计了以数字信号处理器(Digital Signal Processor,DSP)作为控制处理装置,并且包括一个可控恒流源模块、一个磁场源模块、一个三轴磁传感器及ADC接口电路的电磁跟踪系统。初步的实验测试结果表明系统每次都能稳定实现定位,平均位置误差为0.282 cm,平均姿态误差为0.696°,定位时间为1.572 s。通过标定、校准以及硬件电路的进一步改进,该系统的性能有望进一步提高。

隐睾并发睾丸网腺癌1例报告并文献复习

目的:探讨1例隐睾并发睾丸网腺癌的临床病理学特征及诊治要点。方法:收集1例隐睾并发睾丸网腺癌患者的临床及影像学、观察期病理学形态及免疫表型,并复习相关文献,探讨其病理诊断和诊治要点。结果:患者老年男性,因右侧腹股沟肿痛一周入院。查体右侧腹股沟区触及实性肿块,压痛、质地较硬,右侧阴囊空虚。CT显示右侧腹股沟睾丸样肿块合并积液、腹膜转移增厚、腹水形成。病理组织学检查显示有乳头状结构,伴有腺体和小管,基质富含胶原,以实性病变为主。肿瘤细胞呈中度核异型性和频繁的核分裂。显微镜下可见曲细精管、精原细胞减少,基底膜增厚。肿瘤细胞免疫组化CEA^+、CA199^+、HBME-1^-、EMA^+、Calectin^-、CK5/6^-。结论:睾丸网腺癌临床罕见,病因不明,临床表现无特异性,确诊易延误。基本治疗是根治性睾丸切除术辅以根治性腹膜后淋巴结清扫术,转移性睾丸网腺癌予以化疗,放疗效果不佳。

Surgical treatment of giant esophageal leiomyoma

AIM: To summarize the operative experiences for giant leiomyoma of esophagus.METHODS: Eight cases of giant esophageal leiomyoma (GEL) whose tumors were bigger than 10 cm were treated surgically in our department from June 1980 to March 2004.and esophagoscopy. Leiomyoma located in upper thirds of the esophagus in one case, middle thirds of the esophagus in five cases, lower thirds of the esophagus in two cases. Resection of tumors was performed successfully in all of these cases. Operative methods included transthoracic extramucosal enucleation and buttressing the muscular defect with pedicled great omental flap (one case), esophagectomy and esophagogastrostomy above the arch of aorta (three cases), total esophagectomy and esophageal replacement with colon (four cases). Histological examination confirmed that all of these cases were leiomyoma.RESULTS: All of the eight patients recovered approvingly with no mortality and resumed normal diet after operation. Vomiting during meals occurred in one patient with esophagogastrostomy, and remained 1 mo. Reflux esophagitis occurred in one patient with esophagogastrostomy and was alleviated with medication. Thoracic colon syndrome (TCS) occurred in one patient with colon replacement at 15 mo postoperatively. No recurrence occurred in follow-up from 6 mo to 8 years.CONCLUSION: Surgical treatment for GEL is both safe and effective. The choices of operative methods mainly depend on the location and range of lesions. We prefer to treat GEL via esophagectomy combined with esophagogastrostomy or esophagus replacement with colon. The long-time quality of life is better in the latter.

A 12-bit 30-MS/s VCO-based SAR ADC with NOC-assisted multiple adaptive bypass windows

This paper proposes a technique that uses the number of oscillation cycles(NOC)of a VCO-based comparator to set multiple adaptive bypass windows in a 12-bit successive approximation register(SAR)analog-to-digital converter(ADC).The analysis of the number of bit cycles,power and static performance shows that three adaptive bypass windows reduce power consumption,and decrease DNL and have similar INL,compared with the SAR ADC without bypass windows.In addition,a 1-bit split-and-recombination redundancy technique and a general bypass logic digital error correction method are proposed to address the settling issues and optimize the size of the bypass window.This design is implemented in 40 nm CMOS technology.The conversion frequency of the ADC reaches up to 30 MS/s.The ADC achieves an SFDR of 85.35 dB and 11.12-bit ENOB with Nyquist input,consuming 380μW,down from 427μW without multiple adaptive bypass windows,at a 1.1 V supply,resulting in a figure of merit(FoM)of 5.69 fJ/conversion-step.

Infective Artery Rupture of Renal Allografts:A Single-Center Retrospective Study in China

Objective:This study investigated the composition of pathogenic microorganisms,clinical features,and therapeutic strategies of infective artery rupture of renal allografts in recipients receiving deceased donor(DD)kidneys.Methods:We retrospectively studied the clinical data of the DD kidney transplant recipients with donor-associated infection at Tongji Hospital,Wuhan,China from January 1,2015 to December 31,2018,related recipients and corresponding donors.We collected the entire results of pathogenic microorganisms cultured from these related ruptured kidneys and then analyzed their distribution and differences.Results:A total of 1440 kidney transplants from DD were performed in our center.The total incidence of infective artery rupture in kidney transplants was about 0.76%(11/1440),and the annual incidence ranged from 0.25%to 1.03%.The microbial culture results revealed that 11 recipients suffered from infective artery rupture and 3 recipients who accepted the kidney from same donor had the donor-associated pathogens,including 9 fungal strains(28.1%)and 23 bacterial strains(71.9%).There were 4 recipients infected with multi-drug-resistant Staphylococcus and Klebsiella pneumoniae from the above 11 recipients,of which,10 recipients underwent graft loss,and one died of septic shock.The microbial cultures of the remaining 3 recipients who received appropriate anti-infective regimens turned negative eventually,and the patients were discharged successfully without significant complications.Conclusion:Renal recipients with infections derived from DDs were at high risk of artery rupture,graft loss,or even death.Appropriate anti-infective treatment is essential to reduce the incidence of artery rupture and mortality.

Thermodynamic Analysis and Synthesis Gas Generation by Chemical-Looping Gasification of Biomass with Nature Hematite as Oxygen Carriers

Thermodynamic parameters of chemical reactions in the system were carried out through thermodynamic analysis. According to the Gibbs free energy minimization principle of the system, equilibrium composition of the reactions of chemical-looping gasification (CLG) of biomass with natural hematite (Fe2O3) as oxygen carrier were analyzed using commercial software of HSC Chemistry 5.1. The feasibility of the CLG of biomass with hematite was experimental verified in a lab-scale bubbling fluidized bed reactor using argon as fluidizing gas. It was indicated the experimental results were consistent with the theoretical analysis. The presence of oxygen carrier gave a significant effect on the biomass conversion and improved the synthesis gas yield obviously. It was observed that the gas content of CO and H2 was over 70% in CLG of biomass. The reduced hematite particles mainly existed in form of FeO. It was showed that the reduction of natural hematite with biomass proceeds in a stepwise manner from Fe2O3 →Fe3O4→ FeO. Reduction product of natural hematite can be restored the lattice oxygen by oxidation with air.

火山岩底水油藏水平井产能合理参数研究

以某实际油藏地质特征、开发动态为基础,采用油藏工程法,从水平段长度、水平段纵向位置、油层厚度、裂缝水平垂直渗透率比等参数出发,对影响水平井开发效果的各参数进行研究,发现当考虑井筒摩阻时,水平井产量的增幅随水平段长度的增加而减小。最优水平段长度为1500m。在相同条件下当无因次避水高度为0.9时,水平井开发效果最好。当上产压差相同时,随着油层厚度的增加,水平井的产量不断增加,当油层厚度达到40m时,水平井产量随油层厚度的增加幅度变得平缓。并利用正交设计确定各影响参数的主次顺序为:工作制度>水平段长度>油层厚度>避水高度>裂缝垂直水平渗透率比。

Anaerobic Membrane Bioreactors (AnMBR) for Wastewater Treatment

This paper focuses on the recent research in the development of anaerobic membrane bioreactors in wastewater treatment. Anaerobic wastewater treatment technology is gaining increasing attention due to its capacity to convert wastewater BODs to usable biogas with relatively low energy consumption. The anaerobic membrane bioreactor (AnMBR), which is a combination of the anaerobic biological wastewater treatment process and membrane filtration, represents a recent development in the high-rate anaerobic bioreactors. This paper reviews applications and performances of AnMBR and the membrane filtration behaviour in AnMBRs.

Relationship of Transforming Growth Factor-β1 and Arginase-1 Levels with Long-term Survival after Kidney Transplantation

In this study, we compared the serum levels of transforming growth factor-β1 （TGF-β1）, interleukin-10 （IL-10）, and arginase-1 in long-term survival kidney transplant recipients （LTSKTRs） with those in short-term survival kidney transplant recipients （STSKTRs）. We then evaluated the relationship between these levels and graft function. Blood samples were collected from 50 adult LTSKTRs and 20 STSKTRs （graft survival approximately 1-3 years post-transplantation）. All patients had stable kidney function. The samples were collected at our institution during the patients＇ follow-up examinations between March 2017 and September 2017. The plasma levels of TGF-β1, IL- 10, and arginase- 1 were analyzed using enzyme-linked immunosorbent assays （ELISA）. The levels of TGF-β1 and arginase-1 were significantly higher in the LTSKTRs than in the STSKTRs. The time elapsed since transplantation was positively correlated with the levels of TGF-β1 and arginase-1 in the LTSKTRs. The estimated glomerular filtration rate was positively correlated with the TGF-β1 level, and the serum creatinine level was negatively correlated with the TGF-β1 level. Higher serum levels of TGF-β1 and arginase-1 were found in LTSKTRs than in STSKTRs, and we found that TGF-β1 was positively correlated with long-term graft survival and function. Additionally, TGF-β1 and arginase-1 levels were positively correlated with the time elapsed since transplantation. On the basis of these findings, TGF-β1 and arginase- 1 may play important roles in determining long-term graft survival. Thus, we propose that TGF-β1 and arginase-1 may potentially be used as predictive markers for evaluating long-term graft survival.

Degradation behaviors of Nabumetone and its metabolite during UV/monochloramine process:Experimental and theoretical study

This study investigated degradation behaviors of a nonsteroidal anti-inflammatory drug Nabumetone(NMT)and its major metabolite 6-methoxy-2-naphthylacetic acid(MNA)in the coupling process of ultraviolet and monochloramine(UV/NH2Cl).The second-order rate constants of the contaminants reacting with reactive radicals(HO·,Cl·,Cl_(2)·-,and CO_(3)·^(-))were determined by laser flash photolysis experiments.HO·and Cl·contributed predominantly with 52.3%and 21.7%for NMT degradation and 60.8%and 22.3%for MNA degradation.The presence of chlorides retarded the degradation of NMT,while promoted the destruction of MNA,which was ascribed to the photosensitization effects of MNA under UV irradiation.Density functional theory(DFT)calculations revealed that radical adduct formation(RAF)was dominant pathway for both HO·and Cl·reacting with the contaminants,and hydrogen atom transfer(HAT)preferred to occur on side chains of NMT and MNA.NMT reacted with NO_(2)·through single electron transfer(SET)with the second-order rate constant calculated to be 5.35×10^(7)(mol/L)^(-1)sec^(-1),and the contribution of NO_(2)·was predicted to be 13.0%of the total rate constant of NMT in pure water,which indicated that NO_(2)·played a nonnegligible role in the degradation of NMT.The acute toxicity and developmental toxicity of NMT were enhanced after UV/NH_(2)Cl treatment,while those of MNA were alleviated.The transformation products of both NMT and MNA exhibited higher mutagenicity than their parent compounds.This study provides a deep understanding of the mechanism of radical degradation of NMT and MNA in the treatment of UV/NH2Cl.

欧洲血管外科学会2023版《血管疾病抗血栓治疗临床实践指南》解读——下肢动脉硬化性疾病

欧洲血管外科学会(ESVS)首次发布了2023版《血管疾病抗血栓治疗临床实践指南》,对下肢动脉硬化性疾病(LEAD)的抗血栓策略进行了详细的介绍和更新,并给出了21条具体的推荐。LEAD患病率和相关的公共卫生费用都在不断增加,抗血栓治疗是LEAD患者的治疗基石。因此,笔者根据指南的循证医学证据,结合临床实际,重点对LEAD的抗血栓策略进行解读,希望能够帮助医务工作者更好地理解和遵循指南。

普通外科恶性肿瘤患者术后下肢深静脉血栓形成预测模型的构建

背景与目的:下肢深静脉血栓形成(LDVT)是普通外科恶性肿瘤患者术后常见的并发症之一,严重影响患者的术后康复。目前的评估工具无法对LDVT患者进行更加细致的风险分层。因此,本研究探讨普通外科恶性肿瘤患者术后发生LDVT的影响因素,并建立可靠的预测工具,从而为LDVT的诊断和防治提供帮助。方法:回顾性分析2021年1月1日—2022年10月31日中南大学湘雅医院普通外科手术治疗恶性肿瘤患者的临床资料,根据良好设计的纳入、排除标准对病例进行严格的质量控制。使用已经较明确的LDVT的影响因素和一些重要临床特征作为分析变量,单变量分析和多变量分析用以评估LDVT的影响因素以及筛选模型的预测因子。应用编程软件制作基于Logistic回归的列线图并通过受试者工作特征曲线(ROC)评估列线图的预测性能,校准曲线用以评估预测模型与数据的拟合程度。使用决策曲线分析(DCA)比较预测模型与其他单一指标临床应用价值的差异。结果:本研究共纳入342例患者,其中LDVT组167例,对照组175例。单变量分析显示,1个月内有手术创伤史、高血压史、吸烟史、饮酒史、放疗史、ICU住院时间、红细胞(RBC)、血红蛋白(Hb)、纤维蛋白原降解产物(FDP)、D-二聚体、凝血时间、手术时间、术中输注RBC、术中输注血浆、手术方式与LDVT的发生有关(均P<0.05)。多变量分析显示,1个月内有手术创伤史、FDP、凝血时间、手术时间、术中输注RBC、术中输注血浆是术后LDVT的独立影响因素(均P<0.05)。将独立影响因素作为预测因子建立模型,预测术后2周LDVT风险列线图的ROC曲线的曲线下面积(AUC)为0.830 (95%CI=0.787~0.874,P<0.001)。校准曲线中的Hosmer-Lemeshow检验统计量为0.973;DCA分析显示了列线图比单一指标有更好的净效益。结论:本研究构建的预测模型具有良好的鉴别能力和临床应用价值,有助于临床医生在LDVT高危人群中进行风险再分层,从而制定个性化有效的防治措施。为了检验和提高模型的外部效度,未来还需要对预测模型进行多中心、前瞻性、智能算法设计的研究。

A general quantum minimum searching algorithm with high success rate and its implementation

Finding a minimum is a fundamental calculation in many quantum algorithms.However,challenges are faced in demonstrating it effectively in real quantum computers.In practice,the number of solutions is unknown,and there is no universal encoding method.Besides that,current quantum computers have limited resources.To alleviate these problems,this paper proposes a general quantum minimum searching algorithm.An adaptive estimation method is adopted to calculate the number of solutions,and a quantum encoding circuit for arbitrary databases is presented for the first time,which improves the universality of the algorithm and helps it achieve a nearly 100%success rate in a series of random databases.Moreover,gate complexity is reduced by our simplified Oracle,and the realizability of the algorithm is verified on a superconducting quantum computer.Our algorithm can serve as a subroutine for various quantum algorithms to promote their implementation in the Noisy IntermediateScale Quantum era.

A novel multiscale simulation framework for low-dimensional memristors

In recent years,the memristor has been widely considered an emerging device,but it has rarely been simulated.An obstacle is the change in the intrinsic atomic level when it works.Using the density functional theory(DFT),this atomic level change in structure cannot be demonstrated.Using molecular dynamics(MD),memristor electronic transport properties cannot be calculated.In this study,we propose a novel multiscale simulation framework merging MD,DFT,and the nonequilibrium Green’s function method,which can reveal not only a memristor’s basic working mechanism but also its transport character.To verify our framework’s availability in guiding innovative memristor design,a new type of memristor,a planar monolayer MoS_(2)-based memristor,is simulated for the first time.The popped S atoms’effect on its carrier transport is revealed,which clarifies the working mechanism of the planar monolayer MoS_(2)-based memory device.We hope that this framework can shed light on the analysis and design of low-dimensional memristors.

Distribution characteristics of poly-and perfluoroalkyl substances in the Yangtze River Delta

In this work, a method was developed and optimized for the analysis of polyfluoroalkyl and/or perfluoroalkyl substances（PFASs） content in surface water and sediment samples with high instrumental response and good separation. Surface water and sediment samples were collected from the Yangtze River Delta（YRD） to analyze the distribution characteristics of perfluoroalkyl carboxylic acids（PFCAs）, perfluoroalkane sulfonic acids（PFSAs）, perfluoroalkyl phosphonic acids（PFPAs）, perfluoroalkyl phosphinic acids（PFPiAs）, and polyfluoroalkyl phosphoric acid diesters（di PAPs）. The results showed that the total concentrations of PFCAs and PFSAs in YRD varied from 31 to 902 ng/L. PFCAs（≥ 11 carbons） and PFSAs（≥ 10 carbons atoms） were not detected in any surface water samples. The mean concentrations of all PFCAs and PFSAs in surface water from the sampling areas decreased in the following order：Yangtze river（191 ng/L） ≈ Taihu lake（189 ng/L） 〉 Huangpu river（122 ng/L） ≈ Qiantang river（120 ng/L） 〉 Jiaxing urban river（100 ng/L）. Strong significant（p 〈 0.05） correlations between the concentrations of many of the compounds were found in the sampling areas, suggesting a common source for these compounds. Only perfluorooctanoic acid（PFOA） was observed in all sediment samples, at concentrations varying from 0.02 to 1.35 ng/g. Finally, detection rates of two di PAPs were only 8% and 10%, respectively and the concentration of di PAPs was two to three times lower compared to PFCAs and PFSAs.