甜梦胶囊(口服液)治疗睡眠障碍的Meta分析及GRADE评价

目的 系统评价甜梦胶囊(口服液)治疗睡眠障碍的有效性与安全性。方法 通过计算机检索中国期刊全文数据库(CNKI)、万方数据知识服务平台(Wanfang)、维普中文科技期刊数据库(VIP)、中国生物医学文献数据库(CBM)、PubMed、Embase、EBSCO、Cochrane Library数据库,检索时间均为建库至2021年3月,收集采用甜梦胶囊(口服液)治疗睡眠障碍的随机对照试验(RCT)。使用Cochrane偏倚风险评估工具评估纳入研究的质量。采用RevMan5.4及Stata14.0进行Meta分析,并使用GRADE profiler评价证据质量。结果 共纳入17篇文献,涉及1 396例患者。Meta分析结果显示,试验组的治疗有效率显著高于对照组(P<0.00001)。治疗后,试验组的匹兹堡睡眠质量指数(PSQI)评分显著低于对照组(P<0.00001)。治疗后,试验组的多导睡眠图(PSG)睡眠效率显著高于对照组(P<0.00001)。试验组的不良反应发生率低于对照组(P=0.03)。根据GRADE标准,有效率、PSQI评分、PSG睡眠效率为低质量证据,不良反应发生率为中等质量证据。结论 现有证据表明,甜梦胶囊(口服液)能有效提高睡眠效率,减少不良反应的发生,但上述结论尚需更多更高质量研究进一步验证。

Abrasive wear behavior of functionally graded Al_(3)Ti reinforced aluminum matrix composite

Aluminum alloys are widely used in industry due to their light weight.These alloys are generally exposed to abrasive wear,which diminishes their effective lifespan.The wear resistance of these alloys is enhanced by adding various reinforcements,however,this enhancement comes at the cost of reduced fracture toughness.This paradox of increased wear resistance versus decreased fracture toughness in aluminum alloys can be resolved by using functionally graded materials (FGMs).This study focuses on the abrasive wear behavior of functional graded aluminum matrix composites reinforced with Al_(3)Ti particles.The wear properties of the composites were investigated by considering the characteristics of the composite such as matrix type and various composite zones,as well as the wear parameters such as abrasive particle diameter,load,sliding speed and distance.Taguchi method was used in the abrasive wear tests in order to get more reliable results in a timeefficient manner.Experiment recipes were created based on the L_(27)(3^(6)) orthogonal series.As a result of the study,it is observed that the wear resistance of the composites increases with an increase in Al_(3)Ti reinforcement content and hardness of the matrix.In addition,the size of abrasive particles and the applied load are significant factors affecting abrasive wear.

Humanistic and graded psychological nursing care for patients undergoing endoscopic submucosal dissection of gastrointestinal tumors

BACKGROUND Endoscopic submucosal dissection(ESD)has become a widely accepted,minimally invasive treatment for gastrointestinal submucosal tumors.It has been reported that humanistic nursing care with graded psychological interventions can effectively enhance patients’physical activity in patients,reduce postoperative complications,and improve their postoperative quality of life.AIM To investigate the effects of combining humanistic care with graded psychological support on nursing satisfaction and quality of life in patients undergoing ESD for gastrointestinal submucosal tumors.METHODS A retrospective analysis was conducted on the clinical data of 180 patients who underwent ESD surgery for gastrointestinal submucosal tumors at our hospital between March 2021 and February 2023.Patients were allocated into groups based on the nursing care they received:The control group,which received routine care(n=90),and the observation group,which was subjected to humanistic nursing care in combination with graded psychological support(n=90).Patient anxiety and depression were assessed using the self-rating anxiety scale(SAS)and self-rating depression scale(SDS).Quality of life was evaluated using the shortform 36 health survey,and additional indications such as time to first food intake,surgery duration,length of hospital stay,nursing satisfaction,and adverse reactions were also recorded.Data was analyzed using SPSS22.0,with t-tests employed for continuous variables andχ2 tests for categorical data.RESULTS Patients in the observation group experienced significantly shorter times to first postoperative meal,surgery,and hospital stay compared to the control group.After the intervention,the SAS score of the observation group was 43.17±5.68,and the SDS score was 41.57±6.52,both significantly lower than those of the control group,with SAS score of 52.38±5.21 and SDS score of 51.23±8.25.In addition,the observation group scored significantly higher in daily living,physical function,psychological well-being,and social functioning(80.01±6.39,83.59±6.89,81.69±5.34,and 85.23±6.05,respectively).Moreover,the observation group also exhibited higher satisfaction and selfefficacy scores and a lower incidence of adverse reactions compared to the control group(P<0.05).CONCLUSION For patients undergoing ESD for gastrointestinal submucosal tumors,humanistic nursing care in combination with graded psychological nursing care significantly shorten the times to first postoperative meal,surgery,and hospital stay,effectively alleviates anxiety and depression,improves quality of life and nursing satisfaction,and mitigate the incidence of adverse reactions.

热敏灸治疗颈型颈椎病的Meta分析及GRADE证据等级评价

目的系统评价热敏灸及其综合疗法用于颈型颈椎病的临床效果,为热敏灸治疗颈型颈椎病提供更好的证据来源。方法收集国内外各大数据库热敏灸及其综合疗法用于颈型颈椎病的随机对照试验(RCT),通过Revman 5.3软件进行Meta分析,按照GRADE标准对结局指标进行证据质量评价。结果纳入9篇文献共855例患者,Meta分析结果提示:热敏灸及其综合疗法组在提高总有效率(RR=1.19,P<0.01)和治愈率(RR=1.73,P<0.01)、降低视觉模拟量表(VAS)评分(SMD=-0.73,P<0.01)、简化McGill疼痛问卷(SF-MPQ)评分(SMD=-1.28,P<0.05)以及NPQ颈痛量表评分(SMD=-0.81,P<0.05)方面都优于对照组;GRADE证据等级评价提示:前三者为低质量证据,后二者为极低质量证据。结论热敏灸及其综合疗法用于颈型颈椎病在提高临床效果、镇痛以及改善患者生活质量方面更具优势。

刮痧改善腰椎间盘突出疼痛症状的系统评价及GRADE证据质量评价

目的系统评价刮痧干预腰椎间盘突出疼痛症状的疗效与安全性,为其临床治疗提供循证依据。方法计算机检索自建库到2022年8月29日前公开发表在中国知网、万方、维普、中国生物医学文献服务系统、PubMed、Embase、Web of Science、The Cochrane Library数据库,收集关于刮痧干预腰椎间盘突出的随机对照试验(Randomized controlled trial,RCT)。文章由两名研究者独立筛选,根据Cochrane Reviewers Handbook 6.2的偏倚风险评估工具对纳入文献进行质量评价,应用RevMan 5.4软件对纳入文献的结局指标进行Meta分析,并采用GRADE系统对结局指标进行证据质量等级评价。结果最终纳入10篇RCT,共1087例患者。Meta分析结果显示:刮痧试验组治疗腰椎间盘突出患者在疼痛VAS评分[MD=-1.11,95%CI(-1.58,-0.64),P<0.00001]、日本骨科协会(JOA)评分[MD=4.47,95%CI(3.76,5.17),P<0.00001]、临床有效率[relative risk(RR)=1.13,95%CI(1.08,1.19),P<0.00001]和护理满意度[RR=1.21,95%CI(1.09,1.34),P=0.0005]方面,明显优于对照组,差异均有统计学意义(P<0.00001)。本文结局指标的证据质量为极低。结论当前证据表明,刮痧治疗腰椎间盘突出患者的疼痛症状具有良好临床疗效,并有助于提高临床护理满意度。由于部分结局证据质量较低,有待严谨的多中心、大样本随机对照试验来进一步验证其有效性,提升临床证据。

穴位埋线治疗功能性便秘疗效与安全性Meta分析及GRADE评价

目的:系统评价穴位埋线治疗功能性便秘(FC)的疗效和安全性及纳入证据的质量,以期为临床决策提供循证医学证据。方法:检索中国知网(CNKI)、万方知识服务平台(WANFANG)、维普中文期刊数据库(VIP)、中国生物医学文献服务系统(SinoMed)、Embase、PubMed和Cochrane Library数据库,搜集穴位埋线治疗FC的随机对照试验(RCT),检索时间均从建库至2023年10月16日。由2名研究者独立完成文献筛选、资料提取及偏倚风险评估,采用RevMan 5.4软件进行Meta分析,并采用GRADE评价方法对各项结局指标进行证据质量评价。结果:最终共纳入19项RCT,包括1673例患者。Meta分析结果显示,与对照组比较,穴位埋线治疗FC可提高总有效率[RR=1.23,95%CI=(1.17,1.29),P<0.00001],增加完全自发排便(CSBM)次数[MD=0.61,95%CI=(0.11,1.10),P=0.02],改善粪便性状[MD=0.53,95%CI=(0.31,0.76),P<0.00001]及排便困难[MD=-0.71,95%CI=(-1.03,-0.40),P<0.00001],缩短排便时间[MD=-0.50,95%CI=(-0.72,-0.29),P<0.00001],改善便秘生活质量评估量表(PAC-QOL)评分[MD=-7.72,95%CI=(-12.83,-2.61),P<0.003];两组不良反应发生率比较,差异无统计学意义[RR=0.37,95%CI=(0.10,1.38),P=0.14]。GRADE证据级别评价结果显示:总有效率为中级别证据质量,不良反应发生率、粪便性状评分、排便困难评分为低级别证据质量,CSBM次数、排便时间、PACQOL评分为极低级别证据质量。结论:穴位埋线治疗FC具有一定的疗效,可改善便秘相关症状,且未增加不良反应发生率。但纳入研究质量总体偏低,上述结论尚需开展更多高质量的研究予以验证。

腕踝针干预术后疼痛疗效的Meta分析和Grade评价

目的运用循证医学方法对腕踝针干预术后疼痛的疗效和安全性进行系统评价和Grade评价。方法计算机检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、Embase、Web of Science、Cochrane Library中关于腕踝针干预术后疼痛的随机对照试验,检索时限为建库至2023年10月。采用RevMan 5.4软件进行Meta分析。结果纳入23篇文献,共计1968例患者,Meta分析结果显示,与常规治疗相比,腕踝针能够提高术后疼痛患者的总有效率[OR=4.42,95%CI(2.60,7.50),P<0.001],术后镇痛泵药量使用减少[MD=-9.03,95%CI(-12.09,-5.98),P<0.001],术后疼痛评分降低[MD=-1.39,95%CI(-1.68,-1.09),P<0.001],可减少不良反应发生率[RR=0.40,95%CI(0.32,0.48),P<0.001]以及临床满意度[OR=3.94,95%CI(2.40,6.48),P<0.001]。Grade证据分级结果显示:总有效率、不良反应发生率和临床满意度3项结局指标为中等质量证据,VAS评分指标为低质量证据,镇痛泵药量使用指标为极低质量证据。结论腕踝针可提高总有效率,减少术后镇痛药用量,不良反应少,安全性高,为患者提供了一种安全有效的镇痛方式。

乌梅丸加减治疗帕金森病的Meta分析及GRADE评价

目的 系统评估乌梅丸加减治疗帕金森病(parkinson's disease, PD)的疗效和安全性。方法 计算机检索Cochrane Library、EMBASE、Web of Science、PubMed、CNKI、CBM等中英文数据库及临床试验中心,关于乌梅丸治疗PD的临床随机对照试验(randomized controlled trial, RCT),检索时限从建库至2023年4月。进行资料整理及数据提取等工作后,最终纳入8项研究,治疗组(乌梅丸)和对照组分别纳入226例。使用RevMan 5.3及stata14软件进行荟萃分析,使用GRADEpro GDT评估各项结局指标的证据质量。结果 治疗组降低PD统一评分量表(unified Parkinson's disease rating scale, UPDRS)的各项量表积分较对照组明显,其中在改善UPDRS Ⅰ、Ⅲ、Ⅳ方面具有统计学意义,结果分别为[MD=-0.769,95%CI(-1.213~-0.324),P=0.001]、[MD=-2.211,95%CI(-2.713~-1.708),P=0]、[MD=-0.526,95%CI(-1.041~-0.012),P=0.045]。2组在改善UPDRS总分方面差异无统计学意义[MD=3.964,95%CI(-9.465~17.392),P=0.563]。治疗组能显著提高治疗有效率,差异具有统计学意义[RR=1.709,95%CI(1.361~2.145),P=0]。各项研究均未发现不良事件发生及与治疗有关的检验指标异常。GRADE证据质量分级结果为UPDRS Ⅰ、UPDRS Ⅲ、UPDRS Ⅳ及有效率方面均为中等级别,UPDRS Ⅱ为低等级,UPDRS总分为非常低。结论 乌梅丸加减的应用对PD的治疗有一定效果,且具有良好的安全性。

医院药学指南制定中的证据与推荐意见GRADE系统评级方法及应用

目前,国际上存在多种证据与推荐意见分级系统,对临床医务工作者阅读指南证据和推荐意见造成困扰。证据推荐分级的评估、制定与评价(GRADE)系统目前是全球使用最为广泛的证据与推荐意见分级系统,本文简单地介绍GRADE系统证据质量评级及影响推荐意见形成的4个主要因素,并结合中国医院药学界发起制定的、在国际上发表的几部药学指南举例阐述,以帮助临床医务工作者了解GRADE系统,以批判性思维运用指南证据和推荐意见指导临床实践行为。

火针治疗神经性皮炎的Meta分析及GRADE证据质量评价

目的:运用Meta分析系统评价火针治疗神经性皮炎的临床疗效。方法:计算机检索中国期刊全文数据库(CNKI)、重庆维普(VIP)、万方数据库(WanFang)、中国生物医学文献数据库(CBM)及Pubmed、Cochrane library等中英文数据库,时限设定为建库-2023年2月28日,检索火针治疗神经性皮炎的随机对照试验(Randomized controlled,RCT)相关文献。运用Cochrane风险偏倚评估工具对纳入研究的文献质量评估,再运用Revman5.4软件进行Meta分析,运用TSA0.9.5.10软件进行试验序贯分析,使用GRADE软件对主要结局指标的证据进行证据质量评级。结果:①共纳入18篇研究,1 662例患者,火针组840例,对照组822例;②Meta分析结果显示:火针组的临床有效率[OR=3.99,95%CI(2.81,5.68),Z=7.71,P<0.00 001]、复发率[OR=0.27,95%CI(0.11,0.68),Z=2.79,P=0.005)]均优于对照组;症状积分[MD=-1.49,95%CI(-2.25,-0.73),Z=3.85,P=0.0 001]、TNF-α水平[MD=-4.26,95%CI(-7.01,-1.51),Z=3.03,P=0.002]、IL-6水平[MD=-7.39,95%CI(-14.36,-0.42),Z=2.08,P=0.04]、IL-4水平[MD=-1.50,95%CI(-1.94,-1.06),Z=6.69,P<0.00 001]方面火针组均低于对照组;③火针组不良反应率整体低于对照组;④试验序贯分析显示:累计Z值穿过了传统界值和TSA界值,表示虽然累计的信息量未达到期望值,但不需要更多的试验,提前得到肯定的结论,结果较为可靠。结论:火针治疗神经性皮炎的具有明确的疗效,在症状积分和TNF-α、IL-6、IL-4水平表达等方面效果均优于对照组,安全性也较高,可为中医外治法治疗神经性皮炎的有效性提供相关证据。但因GRADE证据质量评级显示证据质量不理想,建议后续医务工作者可减少开展火针治疗神经性皮炎相关低质量试验,开展一些多中心、高质量的研究对结果加以佐证,从而避免科研和医疗资源的浪费。

参芪扶正注射液辅助治疗慢性阻塞性肺疾病的Meta分析与GRADE评价

为了系统评价参芪扶正注射液联合常规治疗作为干预措施对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者的临床疗效和安全性。检索中国国家知识基础设施(China national knowledge infrastructure,CNKI)、PubMed、万方数据知识服务平台(Wanfang Data)、维普中文科技期刊数据库(Weipu China science and technology journal database,VIP)等数据库,筛选并纳入2023年6月18日以前发表的参芪扶正注射液联合常规疗法治疗COPD患者的随机对照试验(randomized controlled trials,RCT),采用Cochrane风险评价工具及评估、发展和评价建议分级(grading of recommendations assessment,development and evaluation,GRADE)系统进行文献证据质量评价,用RevMan 5.4软件对临床疗效及安全性指标进行Meta分析。结果表明,共纳入16项RCTs,1 486例患者。Meta分析结果显示,参芪扶正注射液辅助治疗可提高患者总有效率和第1秒用力呼气容积/用力肺活量比值(forced expiratory volume in one second/forced vital capacity,FEV1/FVC)指标,与对照组相比具有优势(P<0.000 01、P<0.000 1);不良反应少,无严重不良反应(adverse drug reactions,ADR),两组对比无统计学差异(P=0.32);GRADE评价结果显示,有效率及不良反应指标的证据质量均为中等级,肺功能为低等级。可见参芪扶正注射辅助治疗COPD可以提高患者临床疗效,改善肺功能,且具有良好的安全性。但所纳入研究具有局限性,证据质量不高,仍需结合中药辨证使用特点,规范实验方案,开展更多的高质量RCT研究。

补肾方剂改善高龄女性自然妊娠结局的Meta分析及GRADE质量评价

目的系统评价补肾方剂改善高龄女性自然妊娠结局的临床疗效和安全性。方法检索中国知网、万方数据库、维普数据库、SinoMed、PubMed、Web of Science、Cochrane Library、Embase等数据库建库至2022年6月收录的补肾方剂改善高龄女性自然妊娠结局的随机对照研究(RCT)。运用偏倚风险工具进行质量评估,使用RevMan软件进行Meta分析。结果共纳入14篇RCT。Meta分析结果显示:补肾方剂联合西药治疗在提高妊娠率[RR=1.71,95%CI(1.45,2.01),P<0.00001]、降低卵泡刺激素(FSH)水平[SMD=-1.63,95%CI(-2.84,-0.43),P=0.008]、提高雌二醇(E_(2))水平[SMD=3.97,95%CI(1.76,6.17),P=0.0004]、增加排卵期子宫内膜厚度[SMD=2.12,95%CI(1.07,3.18),P<0.0001]方面均优于西药组;且补肾方剂单独使用在提高妊娠率[RR=1.94,95%CI(1.31,2.88),P=0.001]、降低FSH水平[SMD=-0.48,95%CI(-0.74,-0.22),P=0.0003]方面也具有显著疗效。结论与西医治疗比较,补肾方剂可以显著改善高龄女性自然妊娠结局,且不良反应较少,但仍需更多高质量、大样本、多中心的RCT予以验证。

温针灸治疗原发性痛经有效性和安全性的系统评价及GRADE评价

目的:评价温针灸治疗原发性痛经的有效性和安全性。方法:根据PRISMA指南进行系统综述和荟萃分析。收集PubMed、Web of Science、EMBASE、Cochrane Library、中国知网、维普、万方、中国生物医学数据库自建库至2023年5月的随机对照试验。使用Review Manager 5.4对所有获得的数据进行分析。结果:温针灸治疗原发性痛经在提高临床疗效{风险比(RR)=1.21,95%置信区间(CI)[1.16,1.25],P<0.00001},改善阻力指数(RI){均数差(MD)=-0.14,95%CI[-0.19,-0.08],P<0.00001}、搏动指数(PI)(MD=-0.55,95%CI[-0.69,-0.40],P<0.00001)、β-内啡肽(β-EP){标准化均数差(SMD)=1.36,95%CI[0.90,1.82],P<0.00001}、痛经证候积分(MD=-1.82,95%CI[-2.77,-0.87],P=0.0002)、疼痛视觉模拟评分法(VAS)评分(MD=-1.16,95%CI[-1.48,-0.83],P<0.00001)方面的作用优于单独的常规治疗,并且在不良反应发生率(P=0.01)方面低于对照组。证据质量等级评价结果显示临床疗效为中级,其他多为低级。结论:温针灸治疗原发性痛经的疗效明确,并且具有一定的安全性。

基于GRADE证据质量评级的小青龙汤治疗过敏性鼻炎系统评价与试验序贯分析

目的:系统评价小青龙汤治疗过敏性鼻炎的临床疗效和安全性,分析证据质量,验证研究结果的可信度。方法:检索中国知网、万方数据库、维普中文期刊服务平台、中国生物医学文献数据库、PubMed、Web of Science、The Cochrane Library等数据库中从建库至2023年7月31日小青龙汤治疗过敏性鼻炎的文献。对所得文献进行筛选、资料提取和评估,使用RevMan5.3软件进行Meta分析,使用Stata 16.0软件进行敏感性分析,使用TSA V0.9软件进行试验序贯分析,使用GRADEpro软件对结局指标进行证据质量评级。结果:纳入20篇随机对照试验(Randomized Controlled Trial,RCT),患者1 723例。Meta分析结果显示,试验组比对照组有更好的临床疗效[相对危险度(RR)=1.19,95%置信区间(CI)(1.14,1.25),P <0.000 01]。试验组在降低半年复发率[RR=0.50, 95%CI (0.32,0.78),P=0.002],降低鼻塞[加权均数差(WMD)=-0.20,95%CI(-0.26,-0.13),P <0.000 01]、流涕[WMD=-0.09,95%CI(-0.15,-0.03),P=0.004]、喷嚏[WMD=-0.21,95%CI(-0.28,-0.13),P <0.000 01]等症状积分及体征积分[WMD=-0.25,95%CI(-0.37,-0.14),P <0.000 1]和血清白细胞介素-4水平[WMD=-4.23,95%CI(-7.22,-1.23),P=0.006]方面均优于对照组。试验序贯分析进一步肯定了小青龙汤治疗过敏性鼻炎的疗效。GRADE证据质量分级显示,临床有效率、不良反应发生率、鼻痒积分为低质量证据,其余均为极低质量证据。结论:小青龙汤治疗过敏性鼻炎安全有效,但需要纳入更高质量的临床研究进一步验证。

PTGD后择期腹腔镜胆囊切除治疗对GradeⅡ急性胆囊炎ACTH、MPO及Cor水平的影响

目的分析PTGD后择期LC治疗对GradeⅡ急性胆囊炎ACTH、MPO及Cor水平的影响。方法选取2021年12月至2023年5月安徽中科庚玖医院收治的急性胆囊炎患者121例,根据治疗方案分为三组,即甲组(急诊行LC治疗,未行PTGD)38例、乙组(PTGD引流管拔出后72 h后行LC,早期)43例和丙组(PTGD引流管拔出后14~30 d后行LC,晚期)40例。对比三组手术情况、炎症因子、肝功能、ACTH、MP、Cor水平及并发症发生率。结果甲组LC手术时长、术后卧床时长及住院天数均长于丙组、乙组,失血量、中转开腹率高于丙组、乙组,差异有统计学意义(P<0.05);丙组LC手术时长、术后卧床时长及住院天数均长于乙组,差异具有统计学意义(P<0.05)。LC术后1 d hs-CRP、PCT、IL-6、ST、ALT、ALP、ACTH、MPO及Cor:甲组>丙组>乙组,差异有统计学意义(P<0.05)。并发症发生率:甲组>丙组>乙组,差异有统计学意义(P<0.05)。结论PTGD后择期LC治疗对GradeⅡ急性胆囊炎ACTH、MPO及Cor水平影响小,且并发症低;而PTGD后早期行LC能有效改善肝功能、炎症因子,且术后应激反应更低,值得临床推广。

Thermal transport in composition graded silicene/germanene heterostructures

Through equilibrium and non-equilibrium molecular dynamics simulations,we have demonstrated the inhibitory effect of composition graded interface on thermal transport behavior in lateral heterostructures.Specifically,we investigated the influence of composition gradient length and heterogeneous particles at the silicene/germanene(SIL/GER)heterostructure interface on heat conduction.Our results indicate that composition graded interface at the interface diminishes the thermal conductivity of the heterostructure,with a further reduction observed as the length increases,while the effect of the heterogeneous particles can be considered negligible.To unveil the influence of composition graded interface on thermal transport,we conducted phonon analysis and identified the presence of phonon localization within the interface composition graded region.Through these analyses,we have determined that the decrease in thermal conductivity is correlated with phonon localization within the heterostructure,where a stronger degree of phonon localization signifies poorer thermal conductivity in the material.Our research findings not only contribute to understanding the impact of interface gradient-induced phonon localization on thermal transport but also offer insights into the modulation of thermal conductivity in heterostructures.

Tree‑Inspired Structurally Graded Aerogel with Synergistic Water,Salt,and Thermal Transport for High‑Salinity Solar‑Powered Evaporation

Solar-powered interfacial evaporation is an energy-efficient solution for water scarcity.It requires solar absorbers to facilitate upward water transport and limit the heat to the surface for efficient evaporation.Furthermore,downward salt ion transport is also desired to prevent salt accumulation.However,achieving simultaneously fast water uptake,downward salt transport,and heat localization is challenging due to highly coupled water,mass,and thermal transport.Here,we develop a structurally graded aerogel inspired by tree transport systems to collectively optimize water,salt,and thermal transport.The arched aerogel features root-like,fan-shaped microchannels for rapid water uptake and downward salt diffusion,and horizontally aligned pores near the surface for heat localization through maximizing solar absorption and minimizing conductive heat loss.These structural characteristics gave rise to consistent evaporation rates of 2.09 kg m^(-2) h^(-1) under one-sun illumination in a 3.5 wt%NaCl solution for 7 days without degradation.Even in a high-salinity solution of 20 wt%NaCl,the evaporation rates maintained stable at 1.94 kg m^(-2) h^(-1) for 8 h without salt crystal formation.This work offers a novel microstructural design to address the complex interplay of water,salt,and thermal transport.

Numerical Analysis of Permeability of Functionally Graded Scaffolds

In this work,we numerically study the hydrodynamic permeability of new-generation artificial porous materials used as scaffolds for cell growth in a perfusion bioreactor.We consider two popular solid matrix designs based on triply periodic minimal surfaces,the Schwarz P(primitive)and D(diamond)surfaces,which enable the creation of materials with controlled porosity gradients.The latter property is crucial for regulating the shear stress field in the pores of the scaffold,which makes it possible to control the intensity of cell growth.The permeability of functionally graded materials is studied within the framework of both a microscopic approach based on the Navier-Stokes equation and an averaged description of the liquid filtration through a porous medium based on the equations of the Darcy or Forchheimer models.We calculate the permeability coefficients for both types of solid matrices formed by Schwarz surfaces,study their properties concerning forward and reverse fluid flows,and determine the ranges of Reynolds number for which the description within the Darcy or Forchheimer model is applicable.Finally,we obtain a shear stress field that varies along the sample,demonstrating the ability to tune spatially the rate of tissue growth.

Parametric resonance of axially functionally graded pipes conveying pulsating fluid

Based on the generalized Hamilton's principle,the nonlinear governing equation of an axially functionally graded(AFG)pipe is established.The non-trivial equilibrium configuration is superposed by the modal functions of a simply supported beam.Via the direct multi-scale method,the response and stability boundary to the pulsating fluid velocity are solved analytically and verified by the differential quadrature element method(DQEM).The influence of Young's modulus gradient on the parametric resonance is investigated in the subcritical and supercritical regions.In general,the pipe in the supercritical region is more sensitive to the pulsating excitation.The nonlinearity changes from hard to soft,and the non-trivial equilibrium configuration introduces more frequency components to the vibration.Besides,the increasing Young's modulus gradient improves the critical pulsating flow velocity of the parametric resonance,and further enhances the stability of the system.In addition,when the temperature increases along the axial direction,reducing the gradient parameter can enhance the response asymmetry.This work further complements the theoretical analysis of pipes conveying pulsating fluid.

Observation of Curative Effect of Surgical Nursing in Patients with Grade III Hand-Foot Syndrome

Objective: To investigate the effect of surgical nursing on grade III Hand-Foot Syndrome (HFS) induced by Doxorubicin hydrochloride liposome chemotherapy after breast cancer surgery. Method: From January 2019 to December 2019, 10 patients with HFS grade III caused by Doxorubicin hydrochloride liposome chemotherapy after breast cancer surgery in the Breast Department of Cancer Prevention and Treatment Center of Sun Yat-sen University were selected, and surgical nursing methods were used to intervene and observe the therapeutic effects of the patients. Results: One patient was cured within 7 days, the cure rate was 10% in 7 days, 8 patients were cured within 10 days, the cure rate was 80% in 10 days, 10 patients were cured within 15 days, the cure rate was 100% in 15 days. Conclusion: The surgical nursing method is effective for patients with grade III HFS caused by Doxorubicin hydrochloride liposome chemotherapy after breast cancer surgery, shortening the treatment time of HFS, and is worthy of clinical promotion.