胆总管结石中西医结合介入治疗专家共识

胆总管结石是一种常见疾病,十二指肠乳头肌扩张顺行排石术(Percutaneous Transhepatic Papillary Balloon Dilation,PTPBD)治疗该病是国内新近兴起的一种介入治疗新方法,与现有治疗手段相比,已被证实具有一定的优势。中医药在胆总管结石的治疗方面具有疗效可靠、副作用小、复发率低的优点。为适应临床工作需要,推广PTPBD技术在胆总管结石中的应用,提高胆总管结石中西医诊治水平,中国医师协会介入医师分会组织国内胆总管结石治疗领域的多学科专家讨论、制定了本规范,旨在规范PTPBD技术的适应证、禁忌证、操作流程和中西医结合诊治方案。

Edge Computing Task Scheduling with Joint Blockchain and Task Caching in Industrial Internet

Deploying task caching at edge servers has become an effectiveway to handle compute-intensive and latency-sensitive tasks on the industrialinternet. However, how to select the task scheduling location to reduce taskdelay and cost while ensuring the data security and reliable communicationof edge computing remains a challenge. To solve this problem, this paperestablishes a task scheduling model with joint blockchain and task cachingin the industrial internet and designs a novel blockchain-assisted cachingmechanism to enhance system security. In this paper, the task schedulingproblem, which couples the task scheduling decision, task caching decision,and blockchain reward, is formulated as the minimum weighted cost problemunder delay constraints. This is a mixed integer nonlinear problem, which isproved to be nonconvex and NP-hard. To solve the optimal solution, thispaper proposes a task scheduling strategy algorithm based on an improvedgenetic algorithm (IGA-TSPA) by improving the genetic algorithm initializationand mutation operations to reduce the size of the initial solutionspace and enhance the optimal solution convergence speed. In addition,an Improved Least Frequently Used algorithm is proposed to improve thecontent hit rate. Simulation results show that IGA-TSPA has a faster optimalsolution-solving ability and shorter running time compared with the existingedge computing scheduling algorithms. The established task scheduling modelnot only saves 62.19% of system overhead consumption in comparison withlocal computing but also has great significance in protecting data security,reducing task processing delay, and reducing system cost.

热消融治疗肺部亚实性结节专家共识(2021年版)

局部热消融技术在肺部结节治疗领域正处在起步与发展阶段,为了肺结节热消融治疗的临床实践和规范发展,由"中国医师协会肿瘤消融治疗技术专家组""中国医师协会介入医师分会肿瘤消融专业委员会""中国抗癌协会肿瘤消融治疗专业委员会""中国临床肿瘤学会消融专家委员会"组织多学科国内有关专家,讨论制定了"热消融治疗肺部亚实性结节专家共识(2021年版)"。主要内容包括:(1)肺部亚实性结节的临床评估;(2)热消融治疗肺部亚实性结节技术操作规程、适应证、禁忌证、疗效评价和相关并发症;(3)存在的问题和未来发展方向。

Recent Advances on Preparation Method of Ti-Based Hydrogen Storage Alloy

Ti-based hydrogen storage alloy is one of the most common solid-state hydrogen storage materials due to its high hydrogen absorption capacity, low dehydrogenation temperature and rich resources. This paper mainly presents the influence of several different preparation methods of Ti-based hydrogen storage alloys on the hydrogen storage performance including traditional preparation methods (smelting, rapid quenching and mechanical alloying) and novel methods by plastic deformation (cold rolling, equal channel angular pressing and high-pressure torsion). The microstructure analysis and hydrogen storage properties of Ti-based alloy are summarized thoroughly corresponding with the preparation processes mentioned above. It was found that slight introduction of lattice defects including dislocation, grain boundary, sub-grain boundary and cracks by severe plastic deformation (SPD) was beneficial to improve the hydriding/dehydriding kinetic characteristic. However, the nonuniform composition and residual stress of the alloy may be caused by SPD, which is not conducive to the improvement of hydrogen storage capacity. In the future, it would be expected that new methods and technologies combined with dopant and modification are applied to Ti-based hydrogen storage alloys to make breakthroughs in practical application.

A systematic review and meta-analysis of the safety and efficacy of uterine artery embolization vs. surgery for symptomatic uterine fibroids

Purpose: The aim of this study was to systematically review the safety and efficacy of uterine artery embolization(UAE) versus surgery for symptomatic uterine fibroids. Materials and Methods: An electronic search of the Cochrane Library, PubMed, Embase and Web of Science databases was conducted from their inception to May 2017 for randomized controlled trials(RCTs) that assessed UAE versus surgery for the treatment of symptomatic uterine fibroids. The references of the included studies were also retrieved. Two reviewers independently screened the studies based on the inclusion and exclusion criteria, extracted the data, and assessed the methodological quality. The meta-analysis was conducted using RevMan 5.3 software. Results: A total of seven RCTs involving 859 patients were included. The results of the meta-analysis showed a shorter hospital stay and recovery time for UAE as compared to surgery. Surgery was not reported to be better for improving health-related quality of life in any of the included studies. There were no significant differences in patient satisfaction(1-2 and 5 years), and intra-procedural complications or major complications(1 year). However, the rates of minor complications(1 year) and further interventions(2 and 5 years) were significantly higher in patients who underwent UAE rather than surgery. The rates of pregnancy and live births were significantly lower among patients who underwent UAE than surgery. Conclusion: UAE is safe and effective, and has the advantages of shorter hospital stay and recovery time as compared to surgery. However, UAE has the risk of re-intervention, and lower pregnancy and live birth rates.

Boosted Storage Kinetics in Thick Hierarchical Micro-Nano Carbon Architectures for High Areal Capacity Li-Ion Batteries

A practical and effective approach to increase the energy storage capacity of lithium ion batteries(LIBs)is to boost their areal capacity.Developing thick electrodes is one of the most crucial ways to achieve high areal capacity but limited by sluggish ion/electron transport,poor mechanical stability,and high-cost manufacturing strategies.Here we address these constraints by engineering a unique hierarchical-networked 10 mm thick all-carbon electrode,providing a scalable strategy to produce high areal capacity LIB electrodes.The hierarchical-networked structure utilizes micrometer-sized carbon fibers(MCFs)as building blocks,nano-sized carbon nanotubes(CNTs)as good continuous network with excellent electrical conductivity,and pyrolytic carbon as the binder and active material with excellent storage capacity.The combination of the above features endows our HNT-MCF/CNT/PC electrode with excellent performance including high reversible capacity of 15.44 mAh cm^(-2) at 2.0 mA cm^(-2) and exhibits excellent rate capability of 2.50 mAh cm^(-2) under 10.0 mA cm^(-2) current density.The Li-ion storage mechanism in HNT-MCF/CNT/PC involves dual-storage mechanism including intercalation and surface adsorption(pseudocapacitance)confirmed by the cyclic voltammetry and symmetric cell analysis.This work provides insights into the construction of high mechanical stability thick electrode for the next generation high areal capacity LIBs and beyond.

Transverse Vibration and Stability Analysis of Circular Plate Subjected to Follower Force and Thermal Load

Transverse vibration and stability analysis of circular plate subjected to follower force and thermal load are analyzed.Based on the thin plate theory in involving the variable temperature,the differential equation of transverse vibration for the axisymmetric circular plate subjected to follower force and thermal load is established.Then,the differential equation of vibration and corresponding boundary conditions are discretized by the differential quadrature method.Meanwhile,the generalized eigenvalue under three different boundary conditions are calculated.In this case,the change curve of the first order dimensionless complex frequency of the circular plate subjected to the follower force in the different conditions with the variable temperature coefficient and temperature load is analyzed.The stability and corresponding critical loads of the circular plate subjected to follower force and thermal load with simply supported edge,clamped edge and free edge are discussed.The results provide theoretical basis for improving the dynamic stability of the circular plate.

Arterial stimulation with simultaneous venous sampling for localizing insulinomas

Purpose: The present study aimed to assess the accuracies of arterial stimulation with simultaneous venous sampling(ASVS) in preoperative localization of insulinomas. Materials and Methods: A cohort consisting of 6 males and 14 females(median age, 48.5y; range, 28–62y) with pathologically proven insulinomas were included in this study. Selective angiographies were performed with the superior mesenteric artery(SMA), gastroduodenal artery(GDA), proximal splenic artery, and midsplenic artery in all individuals. Then ASVS procedures were followed after angiographies for these arteries. Clinical characteristics of the patient and the tumor number, location, and size were recorded. The accuracy of preoperative localization of insulinomas was tested. Results: A total of 22 tumors were identified by histopathological diagnosis. The mean size of the tumor was 1.40±0.60 cm. Five tumors were in the head/neck region and 17 in the body/tail region. ASVS accurately localized 17/20(85%) cases with only biochemical data and 19/20(95%) cases with biochemical data and angiography images. Variant pancreatic arterial anatomy was revealed in 2 false cases with inferior pancreatic artery replaced by the superior mesenteric artery. Conclusion: ASVS was highly accurate in localizing insulinomas and should be performed in most of the patients with suspected insulinomas before the operation.

Balloon-occluded retrograde transvenous obliteration with lauromacrogol sclerosant foam for gastric varices

Objectives:To evaluate the safety and efficacy of balloon-occluded retrograde transvenous obliteration(BRTO)using lauromacrogol sclerosant foam for gastric varices(GVs)with gastrorenal venous shunts.Methods:Data of GV patients treated with BRTO using lauromacrogol sclerosant foam in 2016–2020 were retrospectively analyzed along with procedural success rate,complications,and follow-up efficacy.Results:A total of 31 patients were treated with BRTO.The sclerosant foam was prepared by mixing iodinated oil,lauromacrogol,and air at a 1:2:3 ratio.The BRTO procedure was successfully completed in 93.5%of patients.One patient was allergic to the lauromacrogol injection.A mild postoperative fever occurred in three patients.One patient experienced grand mal seizures after the procedure.There was no significant difference in the median Child-Turcotte-Pugh scores before versus after BRTO.Complete GV resolution was observed in 93.1%of patients.One patient underwent endoscopic treatment for the development of high-risk esophageal varices.Another patient underwent transjugular intrahepatic portosystemic shunt placement for the aggravation of ascites.Conclusions:Lauromacrogol sclerosant foam is safe and effective in patients undergoing BRTO for GV.

Irreversible electroporation treatment of pheochromocytoma at a complex site: A case report

A 24-year-old man was seen 2 years prior for hematuria,hypertension(165/120 mmHg),and palpitations.The plasma normetanephrine(NMN)level was elevated(9812.4 pg/mL).Computed tomography(CT)showed bilateral adrenal tumors(Fig.1).Of the two tumors on the left adrenal gland,the lesion on the head aspect was relatively large,while that on the feet aspect(arrow)was relatively small and adjacent to the left renal artery.There was one lesion on the right adrenal gland.Positron emission tomography(PET)-CT showed increased radioactive tracer uptake in the regions of the bilateral adrenal tumors(Fig.2).The clinical diagnosis was pheochromocytoma.

Design and Implementation of a New Chinese Word Segmentation Dictionary for the Personalized Mobile Search

Chinese word segmentation is the basis of natural language processing. The dictionary mechanism significantly influences the efficiency of word segmentation and the understanding of the user’s intention which is implied in the user’s query. As the traditional dictionary mechanisms can't meet the present situation of personalized mobile search, this paper presents a new dictionary mechanism which contains the word classification information. This paper, furthermore, puts forward an approach for improving the traditional word bank structure, and proposes an improved FMM segmentation algorithm. The results show that the new dictionary mechanism has made a significant increase on the query efficiency and met the user’s individual requirements better.

Wireless Distributed Monitoring Terminal Used for On-Line Application

A wireless distributed monitoring terminal was designed with embedded Linux used on the basis of ARM board, and an application program was developed for data collection, processing and transmission. Data were collected from the surrounding environment and transmitted to a server via WLAN in the form of Extensible Markup Language (XML) stream, so the terminal had good flexibility to be compatible with different sensors, network devices and information systems from multiple manufacturers.

Penpulimab,an anti-PD-1 antibody,for heavily pretreated metastatic nasopharyngeal carcinoma:a single-arm phase II study

Penpulimab is an anti-programmed cell death-1(PD-1)IgG1 antibody with no Fc gamma receptor(FcγR)binding activity,and thus theoretically reduced immune-related adverse events(irAEs)while maintaining efficacy.This single-arm,phase II trial conducted across 20 tertiary care centers in China enrolled adult patients with metastatic nasopharyngeal carcinoma(NPC)who had failed two or more lines of previous systemic chemotherapy.Patients received 200-mg penpulimab intravenously every 2 weeks(4 weeks per cycle)until disease progression or intolerable toxicities.The primary endpoint was objective response rate(ORR)per RECIST(version 1.1),as assessed by an independent radiological review committee.The secondary endpoints included progression-free survival(PFS)and overall survival(OS).One hundred thirty patients were enrolled and 125 were efficacy evaluable.At the data cutoff date(September 28,2022),1 patient achieved complete response and 34 patients attained partial response.The ORR was 28.0%(95%CI 20.3–36.7%).The response was durable,with 66.8%still in response at 9 months.Thirty-three patients(26.4%)were still on treatment.The median PFS and OS were 3.6 months(95%CI=1.9–7.3 months)and 22.8 months(95%CI=17.1 months to not reached),respectively.Ten(7.6%)patients experienced grade 3 or higher irAEs.Penpulimab has promising anti-tumor activities and acceptable toxicities in heavily pretreated metastatic NPC patients,supporting further clinical development as third-line treatment of metastatic NPC.

Three-dimensional （3D） interconnected networks fabricated via in-situ growth of N-doped graphene/ carbon nanotubes on Co-containing carbon nanofibers for enhanced oxygen reduction

The strategy of combining highly conductive frameworks with abundant active sites is desirable in the preparation of alternative catalysts to commercial Pt/C for the oxygen reduction reaction （ORR）. In this study, N-doped graphene （NG） and carbon nanotubes （CNT） were grown in-situ on Co-containing carbon nanofibers （CNF） to form three-dimensional （3D） interconnected networks. The NG and CNT bound the interlaced CNF together, facilitating electron transfer and providing additional active sites. The 3D interconnected fiber networks exhibited excellent ORR catalytic behavior with an onset potential of 0.924 V （vs. reversible hydrogen electrode） and a higher current density than Pt/C beyond 0.720 V. In addition, the hybrid system exhibited superior stability and methanol tolerance to Pt/C in alkaline media. This method can be extended to the design of other 3D interconnected network architectures for energy storage and conversion applications.

Effects of Sm-doping on microstructure,magnetic and microwave absorption properties of BiFeO_(3)

In this paper,polycrystalline samples of Bi_(1-x)Sm_(x)FeO_(3)(x=0,0.05,0.1,0.15) were successfully synthesized by sol-gel method.The effects of Sm concentration on the crystal structure,morphology,chemical states,magnetic properties and microwave absorption performance were studied by X-ray diffraction(XRD),scanning electron microscopy(SEM),transmission electron microscopy(TEM),X-ray photoelectron spectroscopy(XPS),a vibrating sample magnetometer(VSM) and a Vector network analyzer(VNA),respectively.The results show that the rare earth Sm doping causes the crystal structure to change.When x≤0.1,Bi_(1-x)Sm_(x)FeO_(3) is the distorted rhombohedral structure with space group R3c.With the increase of Sm doping amount to x=0.15,the phase structure of Bi_(1-x)Sm_(x)FeO_(3) changes from rhombohedral structure to cubic structure with the space group Pm3 m.The particle size decreases with the increase of the Sm doping amount.The analysis results show that Sm doping can effectively reduce the oxygen vacancies and significantly improve its magnetic properties.The results exhibit that moderately doped rare earth Sm element can effectively improve microwave absorption properties of Bi_(1-x)Sm_(x)FeO_(3) powders.When Sm doping amount of x is 0.1,the Bi_(0.9)Sm_(0.1)FeO_(3) compound has good microwave absorption performance,and the minimum reflection loss value of Bi_(0.9)Sm_(0.1)FeO_(3) powder reaches about-32.9 dB at11.7 GHz,and its effective absorption bandwidth(RL <-10 dB) is 2.6 GHz with the optimal matching thickness of 2.0 mm.

Preparation and application of iron oxide/persimmon tannin/graphene oxide nanocomposites for efficient adsorption of erbium from aqueous solution

Rare earth elements(REEs)are used for the developme nt of new energy materials owing to their intrinsic physicochemical property.However,excess REEs in water threaten the safety of animals,plants and humans.An efficient way to separate REEs from the water is therefore needed.In this study,a biosorbent consisting of iron oxide(Fe3 O4),persimmon tannin(PT),and graphene oxide(GO)as Fe3 O4/PT/GO was prepared,and the adsorption of trivalent erbium(Er3+)ions from aqueous solution was investigated.The adsorption process for Er3+ions conforms to pseudo-second order kinetic and the Langmuir isotherm model behavior.Thermodynamic studies indicate that the adsorption process is spontaneous and endothermic.Scanning electron microscopy(SEM),X-ray photoelectron spectroscopy(XPS),X-ray diffraction(XRD),thermogravimetric analysis(TGA).Fourier-transform infrared(FT-IR)spectroscopy;Brunauer-Emmett-Teller(BET)analysis,and vibrating sample magnetometer(VSM)were used to assess the adsorption mechanism of Er3+ions onto the Fe3 O4/PT/GO biosorbent.A combination of electrostatic interactions,redox reactivity and chelation are responsible for adsorption of Er3+ions on the Fe3 O4/PT/GO biosorbent,The magnetic Fe3 O4/PT/GO biosorbent can be easily separated under the magnetic field for effective recycle of Er3+ions from aqueous solution.Therefore,this new biomass composite holds great promise for wastewater treatment.

医院知识管理平台的构建及应用

医学知识平台建设是电子病历智能化建设的核心, 全院级别的医院知识库构建涵盖内容广泛, 包含用药、检验、检查、手术、输血及护理等多个业务场景。江苏省人民医院利用知识图谱和规则引擎两类核心技术构建医院知识管理平台, 实现知识型知识库和非知识型知识库的融合, 并将临床诊疗规则嵌入到信息系统, 供不同的应用场景和应用系统灵活调用。最终形成多维知识库, 实现全院统一的信息集成, 为各部门提供集成展示和决策支持, 在临床诊疗和医院管理各个环节实现实时数据核查、提示与管控。

Resonance-assisted light–control–light characteristics of SnS_2 on a microfiber knot resonator with fast response

An all-optical light–control–light functionality with the structure of a microfiber knot resonator (MKR) coated with tin disulfide (SnS_2) nanosheets is experimentally demonstrated. The evanescent light in the MKR [with a resonance Q of ～59,000 and an extinction ratio (ER) of ～26 dB] is exploited to enhance light–matter interaction by coating a two-dimensional material SnS_2 nanosheet onto it. Thanks to the enhanced light–matter interaction and the strong absorption property of SnS_2, the transmitted optical power can be tuned quasi-linearly with an external violet pump light power, where a transmitted optical power variation rate ΔT with respect to the violet light power of ～0.22 dB∕mW is obtained. In addition, the MKR structure possessing multiple resonances enables a direct experimental demonstration of the relationship between resonance properties (such as Q and ER), and the obtained ΔT variation rate with respect to the violet light power. It verifies experimentally that a higher resonance Q and a larger ER can lead to a higher ΔT variation rate. In terms of the operating speed, this device runs as fast as ～3.2 ms. This kind of all-optical light–control–light functional structure may find applications in future all-optical circuitry, handheld fiber sensors, etc.