来那度胺联合自体造血干细胞移植治疗POEMS综合征1例及文献复习

POEMS综合征(POEMS syndrome)是一种罕见的克隆性浆细胞病,Bardwick等[1]于1980年根据该疾病主要症状的首字母:多发性神经病(polyneuropathy)、脏器肿大(organmegaly)、内分泌异常(endocrinopathy)、M蛋白(mprotein)、皮肤改变(skin changes),提出了POEMS综合征的命名方式。POEMS综合征的临床表现复杂,涉及多个学科,并且没有特定的检查方法,所以POEMS综合征早期容易漏诊或误诊。该病发病机制尚不清,可能与细胞因子失衡相关。

变异型POEMS综合征1例并文献复习

POEMS综合征是一种罕见的综合征,1980年由Bardwick及其同事首次提出。近期,青海大学附属医院血液科诊断变异型POEMS综合征1例,现报告如下1病例资料患者,男,53岁,于1年前无明显诱因发现双侧乳房大小略增,体毛增多变硬,性功能减退.

不典型POEMS综合征1例报告并文献复习

POEMS综合征是一种罕见的由单克隆浆细胞异常增殖导致的副肿瘤综合征,主要表现为脱髓鞘性周围神经病及多系统受累。Bardwick等于1980年根据该疾病主要症状的首字母:多发性神经病、脏器肿大、内分泌异常、M蛋白、皮肤改变,提出了POEMS综合征的命名方式[1-2]。日本在2003年的全国范围调查,其发病率大约为0.3/100000[3]。其发病率低,已被列入我国首批罕见病目录。由于其罕见性、多系统受累和临床高度异质性,有着较高的误诊率和漏诊率,从发病至诊断中位时间约为12个月[4-5]。POEMS综合征患者临床症状不典型国内少有相关文献报道,本研究报道1例POEMS综合征患者资料(患者及家属表示知情同意),同时对该病文献进行复习学习,以期为POEMS综合征患者的治疗提供临床指导和参考。

达雷妥尤单抗联合方案治疗POEMS综合征1例并文献复习

POEMS(polyneuropathy,organomegaly,endocrinopathy,M-protein and skin changes)综合征是一种单克隆浆细胞异常增殖的副肿瘤综合征,患病率约为0.3/10万[1]。该病累积神经、内分泌、骨骼、免疫及造血等系统,临床上诊断需要2个基本要素:多发性周围神经病和单克隆浆细胞病[2]。周围神经病变是超过60%的POEMS综合征患者的首发症状,不少患者早期就诊于神经内科并被误诊为慢性炎性脱髓鞘性多发性神经根神经病(chronic inflammatory demyelinating polyneuropathy,CIDP)等原发性神经系统疾病[3]。由于神经病变进展缓慢、致残率高,多数患者就诊时症状严重且已造成神经不可逆性损伤,给患者生活带来极大不便,因此早识别、早诊断、及时治疗至关重要。本文报告1例采用达雷妥尤单抗(Daratumumab,Dara)联合方案治疗伴有严重周围神经病变的POEMS综合征,分析了神经病变的发病机制,并强调了POEMS综合征诊断的复杂性以及Daratumumab作为新一代药物在治疗中的潜在优势。

UpToDate临床顾问在疑难病诊断中的应用--以POEMS综合征为例

以一例POEMS综合征为例,展示如何使用UpToDate临床顾问辅助疑难病的诊断。详细描述一位54岁女性患者的临床资料、检查结果和治疗过程,根据病例特点,借助UpToDate临床顾问梳理包括糖尿病性多发性神经病的筛查、库欣综合征确诊、低促性腺激素性性腺功能减退症病因、慢性炎症性脱髓鞘性多发性神经病的诊断等专业知识和临床诊断思路,在多学科合作基础上,逐渐明晰诊断证据,并通过UpToDate临床顾问和PubMed数据库的互补合用,实现对临床病情全面解读。

以肾上腺功能减退为首发表现的POEMS综合征1例报道并文献复习

老年男性患者,无明显诱因出现乏力、纳差,并进行性加重,伴双下肢水肿,入院检查存在多发性神经病,缺乏单克隆浆细胞证据,存在Castleman病及VEGF升高,有淋巴结增大、皮肤色素沉积、浆膜腔积液及肾上腺皮质功能减退,可诊断为变异型POEMS综合征。这个患者以肾上腺皮质功能减退为首发及突出表现,较少见,故对POEMS综合征的内分泌病变发病机制进行文献复习。

POEMS综合征1例报道并文献复习

目的对POEMS综合征的临床特征及治疗进行总结,以提高临床对该病的诊疗能力。方法对广东医科大学附属医院收治的1例POEMS综合征患者的临床表现、相关辅助检查结合既往文献复习进行分析。结果本例患者以四肢麻木、无力起病,逐渐出现肢体水肿、器官肿大、皮肤色素沉着等症状,曾查M蛋白阴性,历时5 a方确诊。结论POEMS综合征临床表现多样,早期极易误诊,临床应提高对该病的认识,从而降低误诊率及漏诊率。

Reference-frame-independent quantum key distribution with two-way classical communication

The data post-processing scheme based on two-way classical communication(TWCC)can improve the tolerable bit error rate and extend the maximal transmission distance when used in a quantum key distribution(QKD)system.In this study,we apply the TWCC method to improve the performance of reference-frame-independent quantum key distribution(RFI-QKD),and analyze the influence of the TWCC method on the performance of decoy-state RFI-QKD in both asymptotic and non-asymptotic cases.Our numerical simulation results show that the TWCC method is able to extend the maximal transmission distance from 175 km to 198 km and improve the tolerable bit error rate from 10.48%to 16.75%.At the same time,the performance of RFI-QKD in terms of the secret key rate and maximum transmission distance are still greatly improved when statistical fluctuations are considered.We conclude that RFI-QKD with the TWCC method is of practical interest.

Structure-preserving algorithms for guiding center dynamics based on the slow manifold of classical Pauli particle

The classical Pauli particle(CPP) serves as a slow manifold, substituting the conventional guiding center dynamics. Based on the CPP, we utilize the averaged vector field(AVF) method in the computations of drift orbits. Demonstrating significantly higher efficiency, this advanced method is capable of accomplishing the simulation in less than one-third of the time of directly computing the guiding center motion. In contrast to the CPP-based Boris algorithm, this approach inherits the advantages of the AVF method, yielding stable trajectories even achieved with a tenfold time step and reducing the energy error by two orders of magnitude. By comparing these two CPP algorithms with the traditional RK4 method, the numerical results indicate a remarkable performance in terms of both the computational efficiency and error elimination. Moreover, we verify the properties of slow manifold integrators and successfully observe the bounce on both sides of the limiting slow manifold with deliberately chosen perturbed initial conditions. To evaluate the practical value of the methods, we conduct simulations in non-axisymmetric perturbation magnetic fields as part of the experiments,demonstrating that our CPP-based AVF method can handle simulations under complex magnetic field configurations with high accuracy, which the CPP-based Boris algorithm lacks. Through numerical experiments, we demonstrate that the CPP can replace guiding center dynamics in using energy-preserving algorithms for computations, providing a new, efficient, as well as stable approach for applying structure-preserving algorithms in plasma simulations.

Evaluation of the famous classic formula Sanhua decoction based on network pharmacology and multi-component quantitative analysis

Background:Sanhua decoction has significant effects in the treatment of stroke.The study of the Sanhua decoction material benchmark was carried out to analyze the value transfer relationship between the Chinese herbal pieces and the substance benchmark.Methods:Network pharmacology was employed to investigate the potential active components and molecular mechanisms of Sanhua decoction in the treatment of stroke.15 batches of Sanhua decoction lyophilized powder were prepared using traditional formulas and subjected to high-performance liquid chromatography analysis to generate fingerprints of the Sanhua decoction substance benchmarks.Then,a multi-component quantitative analysis method was established,allowing for the simultaneous determination of ten components,to study the transfer of quantity values between pieces and substance benchmarks.Results:60 active ingredients were screened from Sanhua decoction by network pharmacology,of which gallic acid,magnolol honokiol,physcion,and aloe-emodin may have a greater effect than other active components.63 key targets and 134 pathways were predicted as the potential mechanism of Sanhua decoction in treating stroke.The fingerprint similarity of the Sanhua decoction substance benchmarks was found to be good among the 15 batches,confirming the 19 common peaks.The content of the 10 components was basically consistent.The components’transfer rates were within 30%of their respective means.Conclusions:This study provided a comprehensive and reliable strategy for the quality evaluation of Sanhua decoction substance benchmarks and held significant importance in improving its application value.

Tailoring Classical Conditioning Behavior in TiO_(2) Nanowires:ZnO QDs-Based Optoelectronic Memristors for Neuromorphic Hardware

Neuromorphic hardware equipped with associative learn-ing capabilities presents fascinating applications in the next generation of artificial intelligence.However,research into synaptic devices exhibiting complex associative learning behaviors is still nascent.Here,an optoelec-tronic memristor based on Ag/TiO_(2) Nanowires:ZnO Quantum dots/FTO was proposed and constructed to emulate the biological associative learning behaviors.Effective implementation of synaptic behaviors,including long and short-term plasticity,and learning-forgetting-relearning behaviors,were achieved in the device through the application of light and electrical stimuli.Leveraging the optoelectronic co-modulated characteristics,a simulation of neuromorphic computing was conducted,resulting in a handwriting digit recognition accuracy of 88.9%.Furthermore,a 3×7 memristor array was constructed,confirming its application in artificial visual memory.Most importantly,complex biological associative learning behaviors were emulated by mapping the light and electrical stimuli into conditioned and unconditioned stimuli,respectively.After training through associative pairs,reflexes could be triggered solely using light stimuli.Comprehen-sively,under specific optoelectronic signal applications,the four features of classical conditioning,namely acquisition,extinction,recovery,and generalization,were elegantly emulated.This work provides an optoelectronic memristor with associative behavior capabilities,offering a pathway for advancing brain-machine interfaces,autonomous robots,and machine self-learning in the future.

^(18)F-FDG PET/CT显像及血管内皮生长因子对POEMS综合征放化疗联合自体干细胞移植的疗效

目的探讨^(18)F-FDG PET/CT显像、血管内皮生长因子(VEGF)在POEMS综合征放化疗联合自体干细胞移植治疗中的价值。方法回顾性分析2012年6月~2022年12月本院123例临床高度怀疑POEMS综合征患者临床及影像资料,最终纳入25例患者,经临床及病理确诊POEMS综合征21例,惰性淋巴瘤1例,多发性骨髓瘤3例。21例POEMS综合征患者分为单纯放化疗组(n=12)和放化疗联合自体干细胞移植治疗组(n=9),分析两组患者PET/CT影像特点、最大标准化摄取值(SUV_(max))、VEGF、白细胞介素6(IL-6)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)水平,随访观察两组患者的治疗效果。结果21例POEMS综合征患者均伴有不同程度的多发性神经病变与单克隆浆细胞增殖性改变,皮肤病变10例。^(18)F-FDG PET/CT显像21例患者94个部位形态或代谢异常,SUV_(max)与VEGF水平呈正相关性(r=0.590,P=0.005),而SUV_(max)与FT3、FT4、TSH、IL-6水平均无相关性(P>0.05)。随访55.5±17.6月,治疗后VEGF水平较治疗前基线水平降低(1670.7±309.1 pg/mL vs2051.0±458.8 pg/mL,P<0.05);放化疗联合自体干细胞治疗组中位生存期与单纯放化疗组的差异无统计学意义(P=0.612)。结论PET/CT显像联合血清VEGF水平检测可作为POEMS综合征诊断、活动度监测及预后评估的无创方法,自体干细胞联合放化疗未明显延长POEMS综合征的中位生存期。

Clinical research report on traditional Chinese patent medicines and traditional Chinese classic famous prescriptions(2022)

Objective:The paper is to comprehensively summarize and analyze the basic situation and methodological quality of clinical randomized controlled trials(RCTs)of traditional Chinese patent medicines and traditional Chinese classic famous prescriptions published in 2022,to provide evidence and reasonable suggestions for the advancement of clinical research and the formulation of policies and guidelines.Methods:The Evidence Database System of clinical evidence-based evaluation of traditional Chinese medicine was searched,and data from China National Knowledge Infrastructure(CNKI),PubMed,and other databases were supplemented.The search duration was from January 1,2022,to December 31,2022.RCTs of traditional Chinese patent medicines and traditional Chinese classic famous prescriptions were included as the source of clinical evidence,and published information,sample size,intervention,control measures,treatment course,methodological quality,and key link report were analyzed and evaluated.Results:A total of 1,464 RCTs of traditional Chinese patent medicines were included,which comprised 667 types of traditional Chinese patent medicines;“traditional Chinese patent medicines+Western medicine vs.Western medicine”was the most widely used intervention and control setting,involving 417 RCTs(28.48%).A total of 245 RCTs of traditional Chinese classic famous prescriptions were included,comprising 55 types of traditional Chinese classic famous prescriptions.“Decoction+conventional treatment vs.conventional treatment”was the most widely used intervention and control setting,with 87 RCTs(35.51%).Published RCTs on traditional Chinese patent medicines and traditional Chinese classic famous prescriptions were limited by the study design and implementation.Most“allocation concealment”and“blinding of patients and personnel”were rated as medium to high risk.There are insufficient reports on key research links such as experimental registration and ethical approval.Conclusions:The number of RCTs on traditional Chinese patent medicines has decreased in 2022,but there has been a slight improvement in the research quality and impact.There are relatively few studies on traditional Chinese classic famous prescriptions.Measures must be taken to improve clinical trial design,implementation,and reporting.Methodological experts should be invited to provide professional technical guidance on the trial design.In the research implementation process,attention should be paid to quality control,particularly the standardization of the randomized execution.

Guidance and Application of Chinese Classical Gardens in Modern Gardens

As a representative of Eastern gardens,Chinese classical gardens have always held an extremely important position in world gardens.They not only carry the profound cultural and ideological connotations of China,but also have great aesthetic achievements that are worth exploring.In the process of urbanization,the construction of urban gardens is also progressing rapidly with the development of the city,and modern gardens are reflected more.Gradually,people began to realize that the aesthetics of Chinese classical gardens can collide with the design concepts of modern gardens,in order to conform to the current development trend of the new era.This paper compares and analyzes the differences and connections between Chinese classical gardens and modern gardens from three aspects:gardening concepts,gardening elements,and gardening techniques.Combined with relevant cases,it studies the practical application of Chinese classical garden design techniques in modern gardens,and explores and promotes the art of Chinese classical garden design.

A Preliminary Exploration of Zong Baihua’s Aesthetic Character and the Creative Philosophy of Small Poems

Zong Baihua’s aesthetic character and the creative philosophy of small poems are integrated and intertwined with each other,with distinctive aesthetic characteristics and unique artistic concepts.Whether it is his“rounded and integrated aesthetics centered on Chinese art”,“vivid and charming natural cosmology”,or“personality aesthetics that mutually mirrors with the nature universe”,they all have extraordinary inspirations and guidance for us today to explore the reform of new literature and art,the reform of new poems,and even the contemplation of the cosmos,society,and life,with positive and profound significance.

Classical Correlations vs Quantum Correlations—Similarities, Differences, Opportunities

Classical Correlations were founded in 1900 by Karl Pearson and have since been applied as a statistical tool in virtually all sciences. Quantum correlations go back to Albert Einstein et al. in 1935 and Erwin Schrödinger’s responses shortly after. In this paper, we contrast classical with quantum correlations. We find that classical correlations are weaker than quantum correlations in the CHSH framework. With respect to correlation matrices, the trace of classical correlation matrices is dissimilar to quantum density matrices. However, the off-diagonal terms have equivalent interpretations. We contrast classical dynamic (i.e., time evolving) stochastic correlation with dynamic quantum density matrices and find that the off-diagonal elements, while different in nature, have similar interpretations. So far, due to the laws of quantum physics, no classical correlations are applied to the quantum spectrum. However, conversely, quantum correlations are applied in classical environments such as quantum computing, cryptography, metrology, teleportation, medical imaging, laser technology, the quantum Internet and more.

Chinese Culture,Classical Philosophy,and the Cultivation of Life

This paper explores the intricate relationship between Chinese culture and the nation’s rise,emphasizing the indispensable role of cultural education in fostering a robust national spirit and civilization.Drawing from classical Chinese texts and contemporary philosophical insights,the study examines how cultural virtues and educational practices can lead to societal harmony,national rejuvenation,and global contributions.The analysis highlights the enduring relevance of Confucian principles and their potential to address modern challenges,advocating for a renewed focus on cultural education to achieve a prosperous and peaceful world.Additionally,it underscores the necessity of integrating traditional values with modern educational practices to create a holistic approach that fosters ethical leadership and global cooperation.

Comparative Analysis of Differences among Northern,Jiangnan,and Lingnan Classical Private Gardens Using Principal Component Cluster Method

This paper investigates the design essence of Chinese classical private gardens,integrating their design elements and fundamental principles.It systematically analyzes the unique characteristics and differences among classical private gardens in the Northern,Jiangnan,and Lingnan regions.The study examines nine classical private gardens from Northern China,Jiangnan,and Lingnan by utilizing the advanced tool of principal component cluster analysis.Based on literature analysis and field research,273 variables were selected for principal component analysis,from which four components with higher contribution rates were chosen for further study.Subsequently,we employed clustering analysis techniques to compare the differences among the three types of gardens.The results reveal that the first principal component effectively highlights the differences between Jiangnan and Lingnan private gardens.The second principal component serves as the key to defining the types of Northern private gardens and distinguishing them from the other two types,and the third principal component indicates that Lingnan private gardens can be categorized into two distinct types as well.

A Study on Extracurricular Literary Classics Reading in High School English Based on Core Literacy

Reading teaching is the core content of high school English teaching,and extracurricular literary classics reading is a supplement to in-class reading,which can deepen students’understanding and memorization of English-related knowledge,and cultivate students’core literacy.This paper outlines the problems in high school English reading teaching,analyzes the significance of extracurricular literary classics reading in high school English,and explores the teaching strategies of extracurricular literary classics reading in high school English based on core literacy,with a view to providing valuable reference information for teachers.

Research on the Progress of Treating Gastroesophageal Reflux Disease with Modified Classic Traditional Chinese Medicine Prescription

Gastroesophageal reflux disease (GERD) is a high-incidence digestive system disease. Western medicine mainly uses drugs such as proton pump inhibitors to inhibit gastric acid secretion, but some patients are accompanied by symptoms such as non-acid reflux and gas reflux, which cannot effectively treat the disease. It is necessary to actively explore other treatment schemes. Traditional Chinese medicine (TCM) has a long history of research on gastroesophageal reflux disease, which emphasizes the treatment based on syndrome differentiation as a whole. Through the treatment of various and multi-component TCM prescriptions, the patient’s body condition can be adjusted, and the treatment effect on gastroesophageal reflux disease is reliable, which has obvious therapeutic advantages. To further clarify the treatment of gastroesophageal reflux disease, this study reviewed and analyzed the research progress of the treatment of liver disease with modified prescriptions, and the report is as follows.