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。

Gastroesophageal reflux following per-oral endoscopic myotomy:Can we improve outcomes?

This editorial is an analysis the review article by Nabi et al recently published in this journal.Achalasia Cardia is a disease whose pathophysiology is still unclear.It is known that there is inflammation of unknown aetiology leading to loss of ganglion cells in the muscularis propria.The end result is lower oesophageal sphincter spasm,loss of receptive relaxation,decreased oesophageal peristalsis,all leading on to varying degrees of dysphagia.The treatment of this condition is palliative in nature,performed by myotomy of the lower oesophagus either surgically or endoscopically.Gastroesophageal reflux disease(GERD)has been associated with the myotomy performed,particularly with the Peroral Endoscopic Myotomy(POEM)procedure.Nabi et al have provided an excellent overview of the latest developments in predicting,preventing,evaluating,and managing GERD subsequent to POEM.Based on this theme,this review article explores the concept of using histology of the oesophageal muscle layer,to grade the disease and thereby help tailoring the length/type of myotomy performed during the POEM procedure.In the future,will a histology based algorithm available preoperatively,help modify the POEM procedure,thereby decreasing the incidence of GERD associated with POEM?

Barrett's esophagus with high grade dysplasia is associated with non-esophageal cancer

AIM To study factors associated with esophageal and nonesophageal cancer morbidity among Barrett's esophagus(BE) patients. METHODS A cohort study within a single tertiary center included 386 consecutive patients with biopsy proven BE, who were recruited between 2004-2014. Endoscopic and histologic data were prospectively recorded. Cancer morbidity was obtained from the national cancer registry. Main outcomes were BE related(defined as esophagus and cardia) and non-BE related cancers(all other cancers). Cancer incidence and all-causemortality were compared between patients with highgrade dysplasia(HGD) and with low-grade or no dysplasia(non-HGD) using Kaplan-Meier curves and cox regression models.RESULTS Of the 386 patients, 12 had HGD, 7 had a BE related cancer. There were 75(19.4%) patients with 86 cases of lifetime cancers, 76 of these cases were non-BE cancers. Seven(1.8%) and 18(4.7%) patients had BE and non-BE incident cancers, respectively. Twelve(3.1%) patients had HGD as worst histologic result. Two(16.7%) and 16(4.4%) incident non-BE cancers occurred in the HGD and non-HGD group, respectively. Ten-year any cancer and non-BE cancer free survival was 63% and 82% in the HGD group compared to 93% and 95% at the non-HGD group, respectively. Log-rank test for patients with more than one endoscopy, assuring longer follow up, showed a significant difference(P < 0.001 and P = 0.017 respectively). All-cause mortality was not significantly associated with BE HGD.CONCLUSION Patients with BE and HGD, may have a higher risk for all-cause cancer morbidity. The implications on cancer prevention recommendations should be further studied.

Effects of slip, viscous dissipation and Joule heating on the MHD flow and heat transfer of a second grade fluid past a radially stretching sheet

The flow and heat transfer of an electrically conducting non-Newtonian second grade fluid due to a radially stretching surface with partial slip is considered. The partial slip is controlled by a dimensionless slip factor, which varies between zero （total adhesion） and infinity （full slip）. Suitable similarity transformations are used to reduce the resulting highly nonlinear partial differential equations into ordinary differential equations. The issue of paucity of boundary conditions is addressed and an effective numerical scheme is adopted to solve the obtained differential equations even without augmenting any extra boundary conditions. The important findings in this communication are the combined effects of the partial slip, magnetic interaction parameter and the second grade fluid parameter on the velocity and temperature fields. It is interesting to find that the slip increases the momentum and thermal boundary layer thickness. As the slip increases in magnitude, permitting more fluid to slip past the sheet, the skin friction coefficient decreases in magnitude and approaches zero for higher values of the slip parameter, i.e., the fluid behaves as though it were inviscid. The presence of a magnetic field has also substantial effects on velocity and temperature fields.

Low grade dysplasia in Barrett's esophagus:Should we worry?

The optimal management for low-grade dysplasia(LGD)in Barrett’s esophagus is unclear.In this article the importance of LGD is discussed,including the significant risk of progression to esophageal adenocarcinoma.Endoscopic surveillance is a management option but is plagued by sampling error and issues of suboptimal endoscopy.Furthermore endoscopic surveillance has not been demonstrated to be cost-effective or to reduce cancer mortality.The emergence of endoluminal therapy over the past decade has resulted in a paradigm shift in the management of LGD.Ablative therapy,including radiofrequency ablation,has demonstrated promising results in the management of LGD with regards to safety,cost-effectiveness,durability and reduction in cancer risk.It is,however,vital that a shareddecision making process occurs between the physician and the patient as to the preferred management of LGD.As such the management of LGD should be"individualised."

Nonlinear oscillations of sigmoid functionally graded material plates moving in longitudinal direction

Geometrically nonlinear oscillations are investigated on sigmoid functionally graded material （S-FGM） plates with a longitudinal speed. The material properties of the plates obey a sigmoid distribution rule along the thickness direction. Based on the D＇Alembert＇s principle, a nonlinear equation of motion is derived for the moving S-FGM plates, where the von K^rm^n nonlinear plate theory is adopted. Utilizing the Galerkin method, the equation of motion is discretized and solved via the method of harmonic bal- ance. The approximate analytical solutions are validated through the adaptive step-size fourth-order Runge-Kutta method. Besides, the stability of the steady-state solutions is examined. The results reveal that the mode interaction behavior can happen between the first two modes of the moving S-FGM plates, leading to a complex nonlinear frequency response. It is further found that the power-law index, the longitudinal speed, the exci- tation amplitude, and the in-plane pretension force can significantly affect the nonlinear frequency-response characteristics of longitudinally traveling S-FGM plates.

Characterization of functionally graded ZrO_2 thermal barrier coatings sprayed by supersonic plasma spray with dual powder feed ports

The functionally graded thermal barrier coatings （FG-TBCs） with 80%ZrO2-13%CeO2-7%Y2O3 （C-YSZ）/NiCoCrAlY were prepared using a recently developed supersonic plasma spraying（S-PS） with dual powder feed ports system. The thermal shock experiment of FG-TBCs specimens was carried out by means of the automatic thermal cycle device, in which the samples were heated to 1200℃ by oxygen-acetylene flame jet then water-quenched to ambient temperature. The temperature—time curves of specimens and photographs can be watched on-line and recorded by a computer during the test. The results show that the totally 1mm-thick FG-TBCs have excellent thermal shock resistance due to the fact that the coatings have no any peeling-off after 200 thermal cycles. The microstructures and morphologies of FG-TBCs were characterized and analyzed by SEM.

Progression from low-grade dysplasia to malignancy in patients with Barrett's esophagus diagnosed by two or more pathologists

AIM To evaluate annual incidence of low grade dysplasia(LGD) progression to high grade dysplasia(HGD) and/or esophageal adenocarcinoma(EAC) when diagnosis was made by two or more expert pathologists.METHODS Studies evaluating the progression of LGD to HGD or EAC were included. The diagnosis of LGD must be made by consensus of two or more expert gastrointestinal pathologists. Articles were searched in Medline, Pubmed, and Embase. Pooled proportions were calculated using fixed and random effects model. Heterogeneity among studies was assessed using the I2 statistic. RESULTS Initial search identified 721 reference articles, of which 53 were selected and reviewed. Twelve studies(n = 971) that met the inclusion criteria were included in this analysis. Among the total original LGD diagnoses in the included studies, only 37.49% reached the consensus LGD diagnosis after review by two or more expert pathologists. Total follow up period was 1532 patient-years. In the pooled consensus LGD patients, the annual incidence rate(AIR) of progression to HGD and or EAC was 10.35%(95%CI: 7.56-13.13) and progression to EAC was 5.18%(95%CI: 3.43-6.92). Among the patients down staged from original LGD diagnosis to No-dysplasia Barrett's esophagus, the AIR of progression to HGD and EAC was 0.65%(95%CI: 0.49-0.80). Among the patients down staged to Indefinite for dysplasia, the AIR of progression to HGD and EAC was 1.42%(95%CI: 1.19-1.65). In patients with consensus HGD diagnosis, the AIR of progression to EAC was 28.63%(95%CI: 13.98-43.27). CONCLUSION When LGD is diagnosed by consensus agreement of two or more expert pathologists, its progression towards malignancy seems to be at least three times the current estimates, however it could be up to 20 times the current estimates. Biopsies of all Barrett's esophagus patients with LGD should be reviewed by two expert gastroenterology pathologists. Follow-up strict surveillance programs should be in place for these patients.

Asymmetric Green's functions for exponentially graded transversely isotropic substrate–coating system

By virtue of a complete set of two displacement potentials,an analytical derivation of the elastostatic Green’s functions of an exponentially graded transversely isotropic substrate–coating system is presented.Three-dimensional point–load and patch–load Green’s functions for stresses and displacements are given in line-integral representations.The formulation includes a complete set of transformed stress–potential and displacement–potential relations,with utilizing Fourier series and Hankel transforms.As illustrations,the present Green’s functions are degenerated to the special cases such as an exponentially graded half-space and a homogeneous two-layered half-space Green’s functions.Because of complicated integrand functions,the integrals are evaluated numerically and for numerical computation of the integrals,a robust and effective methodology is laid out which gives the necessary account of the presence of singularities of integration.Comparisons of the existing numerical solutions for homogeneous two-layered isotropic and transversely isotropic half-spaces are made to confirm the accuracy of the present solutions.Some typical numerical examples are also given to show the general features of the exponentially graded two-layered half-space Green’s functions that the effect of degree of variation of material properties will be recognized.

Higher-order crack tip fields for functionally graded material plate with transverse shear deformation

The crack tip fields are investigated for a cracked functionally graded material （FGM） plate by Reissner＇s linear plate theory with the consideration of the transverse shear deformation generated by bending. The elastic modulus and Poisson＇s ratio of the functionally graded plates are assumed to vary continuously through the coordinate y, according to a linear law and a constant, respectively. The governing equations, i.e., the 6th-order partial differential equations with variable coefficients, are derived in the polar coordinate system based on Reissner＇s plate theory. Furthermore, the generalized displacements are treated in a separation-of-variable form, and the higher-order crack tip fields of the cracked FGM plate are obtained by the eigen-expansion method. It is found that the analytic solutions degenerate to the corresponding fields of the isotropic homogeneous plate with Reissner＇s effect when the in-homogeneity parameter approaches zero.

Quantitative Study on the Grade of Forest Combustibles Based on "3S" Technology

Based on a comprehensive and systematic analysis of the temporal and spatial distribution,periodic changes,and influencing factors of forest fires in Inner Mongolia,through fixed-point observations and experiments on the ground,forest combustibles are divided into the ground litter layer,ground standing litter,and living plants.The combustibles are divided into various grades according to their load,dryness and combustibility.By determining the influencing factors of each combustible grade,a forecast model of the combustibility grade of combustibles is established.The forecast model has been widely used in the mid-and long-term forecast model of fire danger grade,and the accuracy rate of the fall area forecast through back-generation fitting verification is above 88.43%.

Low Dose Total Body Irradiation for Relapsed Low Grade Non-Hodgkin’s Lymphoma: Experience of National Cancer Institute, Cairo

Background and Purpose: The relapsed low grade non-Hodgkin’s lymphoma (LG-NHL) is currently?incurable disease and the optimal treatment regimen has not determined yet. Low dose total body irradiation (LTBI) provides an alternative mechanism of action against cancer cells rather than direct cell kill. The mode of action of LTBI is immune-modulatory effect, induction of apoptosis and?hypersensitivity to low radiation doses. The aim of our study is to evaluate the effect of LTBI on relapsed?LG-NHL and reporting our experience at National Cancer Institute, Cairo (NCI, Cairo). Material and Methods: Fifty eight patients with relapsed LG-NHL and received LTBI studied retrospectively.?LTBI dose was 1.6 Gy/8 fractions divided on 2 courses;each course 4 fractions treated over 4 days with 2 weeks rest between the 2 courses. Results: The median age is 54 years;65% of the patients are men. Forty (69%) patients had performance status of 2 or more. Twenty seven patients were stage II/III and 31 patients (53%) had stage IV disease. Twenty six (45%) patients had bulky disease more than 10 cm and 22 (38%) patients had B symptoms at the time of relapse. The?extranodal disease was present in 17 patients (29%) and 78% of the patients received?>3 regimens of chemotherapy before referral to LTBI. Twenty three patients received IFRT (mean dose 32 ± 4 Gy) to initially bulky sites after LTBI. Fourteen patients (24%) achieved complete remission (CR) while 45%, 21% and 10% had partial remission (PR), stable disease (SD) and progressive disease (PD) respectively. The median PFS duration was 14 months and the median OS duration?was 39 months. Stage VI,?>3 regimen of chemotherapy and bad response to LTBI (SD) affected?progression duration adversely (0.03, 0.05 and 0.01 respectively). The response to LTBI is the only factor affected the OS duration significantly. The 3-year PFS was 19% ± 9%, and 3-year OS was 45% ± 8%. Stage IV was the only factor affected the 3-year PFS significantly with p value 0.03. The hematological toxicity was the main side effect of LTBI. Eleven patients developed G3/4 anemia while 8 patients only developed G3/4 thrombocytopenia and 13 patients developed G3/4 leucopenia. Conclusion: The use of LTBI in patients with relapsed low grade NHL is a feasible, effective and tolerable treatment that is worthy of testing in a future with chemotherapy and Rituximab maintenance.

Single-pulse chaotic dynamics of functionally graded materials plate

Single-pulse chaos are studied for a functionally graded materials rectangular plate. By means of the global perturbation method, explicit conditions for the existence of a SiZnikov-type homoclinic orbit are obtained for this sys- tem, which suggests that chaos are likely to take place. Then, numerical simulations are given to test the analytical predic- tions. And from our analysis, when the chaotic motion oc- curs, there are a quasi-period motion in a two-dimensional subspace and chaos in another two-dimensional supplemen- tary subspace.

压电集成石墨烯增强功能梯度多孔板的等几何建模与分析

基于等几何分析方法和一种仅含有4自由度的简化一阶剪切变形理论(simple first-order shear deformation theory,S-FSDT)建立了压电集成石墨烯增强功能梯度多孔(piezoelectric integrated graphene platelets reinforced functionally graded porous,P-GPLs-FGP)板的数值分析模型。利用Halpin-Tsai微观力学模型、闭胞体高斯随机场理论和混合定律得到了石墨烯增强功能梯度多孔板的有效材料属性;基于等几何分析方法、S-FSDT和哈密顿原理推导了P-GPLs-FGP板的运动控制方程,并通过与已有算例对比验证了模型的准确性和有效性;利用所建模型分析了孔隙分布形式、孔隙系数、石墨烯分布形式、石墨烯质量分数、边界条件和宽厚比对P-GPLs-FGP板固有频率和机-电载荷作用下静态弯曲响应的影响。研究结果表明:板的刚度与孔隙系数成反比,而在基体材料中添加少量的石墨烯可以有效地增强结构的刚度;与其他组合形式相比,板的刚度在孔隙PD-S分布和石墨烯GPL-S分布时最大。

基于D-S证据理论的决策级多特征融合苹果分级方法

针对单特征苹果分级的不确定性和低正确率,通过图像处理提取大小、形状、颜色和缺陷4类能反映苹果外观品质的主要特征,引入信息融合的思想,以单特征初步分级的结果作为证据,用D-S证据理论的方法进行决策级融合处理,实现苹果的多特征综合分级,进一步提高可靠性和分级正确率。80个测试样本的分级试验表明,苹果分级正确率达92.5%,与单特征分级相比,此方法正确识别率高、稳定性好、效果显著。

某高硫低品位铜矿浮选试验研究

安徽某高硫低品位铜矿硫品位41.30%、铜品位0.53%,易氧化,选矿指标不稳定。为了改善铜硫分离效果,研究了磨矿细度、药剂种类和药剂用量等对浮选指标的影响。结果表明,磨矿细度-0.074 mm粒级占83.88%,采用一粗二精二扫闭路浮选流程,以CaO+Na_(2)S为组合抑制剂、Z-200为捕收剂、2#油为起泡剂,获得了铜品位15.27%、回收率80.96%的技术指标。试验结果可为高硫低品位铜矿浮选回收铜提供参考。

基于B/S结构的等级考试管理系统

以校园网构建为基础,利用ASP.NET技术开发的网站高校等级考试管理系统,着重研究了基于B/S模式的高校等级考试管理系统的开发原理、系统的功能特点和设计方案,探讨了校园网系统中各类型用户通过浏览器访数据的过程。并实现了网站新闻的动态管理,使得对信息的管理更加及时、高效,提高了工作效率。

非活动性HBsAg携带者临床病理分析

目的了解非活动性HBsAg携带者临床病理特点。方法对80例患者进行生化、病毒标志物及病毒定量检测,并和肝脏病理进行相关性分析。结果光镜下见肝组织基本正常者1例,病理诊断为慢性肝炎轻度者48例,中度以上者19例,占23.75%,活动性肝硬化者12例,占15%;抗HBe阴性组纤维化程度要重于抗HBe阳性组,其中大于S3的抗HBe阴性组患者占总数的60%,阳性组为26%,但肝脏炎症程度与抗HBe水平无关;血小板和胆碱酯酶对于代偿期肝硬化的诊断具有辅助价值。结论对于非活动性HBsAg携带者应尽可能进行肝脏病理检查以明确诊断,并指导治疗。

七氟烷麻醉用于颅内动脉瘤夹闭术的临床观察和对血浆S-100B蛋白浓度的影响

目的观察七氟烷用于颅内动脉瘤夹闭术的临床效果及其对血浆S-100B蛋白浓度的影响。方法择期全麻下行颅内动脉瘤夹闭术的患者34例,ASAⅡ级或Ⅲ级,随机分为两组:丙泊酚(n=17)及七氟烷组(n=17),二组分别以丙泊酚和七氟烷诱导和维持。观察评价患者手术条件、苏醒质量、定向及记忆能力、血动力学参数,及出院时神经功能转归,测定不同时点血浆中S-100B蛋白含量。结果颅内动脉瘤夹闭术中使用七氟烷和丙泊酚在手术条件上、出院转归情况等方面差异无统计学意义(p>0.05),术后苏醒即刻的认知功能评分丙泊酚组(18.3±5.1)较七氟烷组(20.1±3.9)稍低(p<0.05)。两组患者手术后血浆S-100B蛋白浓度均有所升高,但组间比较差异无统计学意义(p>0.05),结论在颅内动脉瘤夹闭术中七氟烷具有与丙泊酚同样的特点,作用时间短、苏醒快速,血液动力学稳定,术野清晰,脑组织顺应性好,并且在术后神经功能评分上具有一定优势。

S-CIELAB及颜色分级应用

根据人眼视觉特性 ,给出了Spatial CIELAB系统分析方法 .该方法首先利用由人类视觉空间响应特性确定的卷积核进行空间滤波 ,然后进行CIELAB处理 .实验结果表明 。