Guidelines and standards for comprehensive clinical diagnosis and interventional treatment for diabetic foot in China(Issue 7.0)

Diabetic foot(DF)is one of the most common complications of diabetes and is associated with high morbidity,disability,lethality and low cure-rate.The clinical diagnosis and treatment of DF need to be standardized.The Chinese Diabetic Foot Cell and Interventional Therapy Technology Alliance has released six editions of guidelines and standards for clinical diagnosis and interventional treatment of DF,which filled the gap in the domestic DF treatment standard and played an important role in improving the level of diagnosis and treatment in China.In line with the latest developments in diagnosis and treatment,the Alliance,along with other 89 institutions,developed and issued the new edition based on the sixth edition to help standardize the clinical diagnosis and treatment of DF in China.

Quality Diagnosis of BtoC Website Based on Fuzzy Comprehensive Evaluation

A hl-quality website is crucial to a company for a successful e-business. The technique maintainers are always faced with the problem how to locate the prime factors which affect the quality of the websites. In view of the complexity and fuzziness of BtoC webslte, a quality diagnosis method based on the multl-attribute and multi-layer fuzzy comprehensive evaluation model including all the quality factors is proposed. A simple example of diagnosis on a famous domestic BtoC websites shows the specific steps of this method and proves its validity. The process of quality evaluation and diagnosis system is illustrated and the computer program of diagnosis is Oven.

Diagnosis and treatment of acute rejection in the first case of human living-related small bowel transplantation with a long-term survival in China

AIM： To report the comprehensive diagnosis and treatment of acute rejection in the first case of living-related small bowel transplantation with a long-term survival in China. METHODS： A 18-year-old boy with short gut syndrome underwent living-related small bowel transplantation, with the graft taken from his father （44-year old）. A segment of 150-cm distal small bowel was resected from the donor. The ileo-colic artery and vein from the donor were anastomosed to the infrarenal aorta and vena cava of the recipient respectively. The intestinal continuity was restored with an end-to-end anastomosis between the recipient jejunum and donor ileum, and the distal end was fistulized. FK506, MMF and prednisone were initially used for post-transplant immunosuppression. Endoscopic observation and mucosal biopsies of the graft were carried out through the terminal ileum enterostomy; serum was collected to detect the levels of IL-2R, IL-4, IL-6 and IL-8. The change of the graft secretion and absorption was observed. RESULTS： Acute rejection was diagnosed promptly and cured. The patient was in good health, 5 years after living- related small bowel transplantation. CONCLUSION： The correct diagnosis and treatment of acute rejection are the key to the long-term survival after living-related small bowel transplantation.

Comprehensive treatment for primary right renal diffuse large B-cell lymphoma with a renal vein tumor thrombus:A case report

BACKGROUND Renal involvement in lymphoma is commonly associated with widespread nodal or extranodal lymphoma.Primary renal diffuse large B-cell lymphoma is an extremely rare extranodal lymphoma,accounting for fewer than 1%of all renal masses.Interestingly,the patient in this study had a renal vein tumor thrombus that was observed after laparoscopic radical nephrectomy.CASE SUMMARY We report the case of a 56-year-old female patient with primary renal lymphoma and a renal vein tumor thrombus whose first symptom was right pain in the back and gross hematuria.Histopathology revealed primary renal diffuse large B-cell lymphoma.The patient received 8 standard cycles of rituximab with cyclophosphamide,doxorubicin,vincristine,and prednisone chemotherapy after surgery,and no obvious signs of recurrence were observed during the one-year follow-up.CONCLUSION We evaluated comprehensive treatment of primary renal diffuse large B-cell lymphoma and multidisciplinary management of this malignancy.

The Construction of an Intrauterine Diagnosis and Treatment System and Comprehensive Lifecycle Health Service of Congenital Heart Disease:Xinhua Hospital Model

With the growing influence of slow population growth and population aging,China has established the birth policy and issued a series of documents to promote maternal and fetal health and improve the birth rate.With the increase in prevalence of birth defects,timely diagnosis and intervention in utero provide possibilities to reduce unnecessary abortions and offer better prognosis.Congenital heart disease(CHD),as one of the most common congenital birth defects,is the leading cause of mortality in patients aged<5 years,and brings a heavy burden to both the affected families and society.Fetuses with CHD are associated with an increased risk of pregnancy-related complications and premature birth,and children with CHD typically face growth and developmental problems even after the correction of malformation.Therefore,management including diagnosis,treatment,and rehabilitation throughout the fetal period into childhood and even adulthood is essential for children with CHD.Based on the rapid advances in intrauterine and perinatal medicine and an in-depth collaboration among obstetrics and pediatrics,a novel diagnosis and treatment system has been established for the management of CHD in the past 2 decades in Shanghai Xinhua Hospital.This Intrauterine Diagnosis and Treatment System and Comprehensive Lifecycle Health Service of Congenital Heart Disease model provides prenatal diagnosis,intrauterine intervention,delivery room service and neonatal therapies,and postintrauterine rehabilitation for children with CHD.We have developed a four-dimensional spatiotemporal image correlation echocardiography and a three-dimensional cardiac virtual endoscopy system for the intrauterine diagnosis of CHD,dramatically raising the diagnostic utility.Our innovative and independent newborn-intervention technique has effectively reduced the re-intervention rate in patients with pulmonary atresia with intact ventricular septum and critical pulmonary stenosis.In 2018,Xinhua Hospital independently performed the case of fetal aortic valvuloplasty in Asia through a multidepartment collaborative effort.All children treated in this system achieved biventricular circulation and a better long-term postoperative outcome.We also have conducted postoperative rehabilitation therapy to promote the development and health of children with CHD.The practice of Xinhua model has reduced unnecessary abortion of CHD fetuses,reduced the mortality rate associated with critical CHD,and improved the mid-and long-term prognosis in CHD,which is essential to promote the fertility level and children’s health.Furthermore,translational medicine platform and the birth cohort Early Life Plan was constructed to explore the origins of major developmental diseases and establish an early intervention model in CHD.This practice of assessment of the intrauterine system has been expanded to other congenital defects in Xinhua Hospital,and sequential treatment of more than 2,000 cases has been completed to date.Based on practice in intrauterine management of CHD and other diseases,the concept of Intrauterine Pediatrics was proposed as a first to emphasize early prevention and intervention of childhood diseases and promote a comprehensive lifecycle service for children.The development and evolution of this system requires further attention not only from researchers but also from the government and global medical communities.

软件运行时配置研究综述

运行时配置为用户使用软件提供了灵活性和可定制性,但其巨大的规模和复杂的机制也带来了巨大的挑战.大量学者和研究机构针对软件运行时配置展开了研究,以提升软件系统在复杂外部环境中的可用性和适应性.建立运行时配置研究分析框架,从配置分析与理解、配置缺陷检测与故障诊断、配置应用3个阶段对现有研究工作进行归类和分析,总结归纳现有研究的不足和面临的挑战,并对未来的研究趋势进行展望,对下一步研究具有一定的指导意义.

夏热冬冷地区某综合医院分项能耗和环境测试分析

以夏热冬冷地区某典型三级甲等综合医院为例,利用现有能耗计量仪表监测数据,辅以设备法测算,对医院的空调制冷、空调制热、医疗设备、电梯、办公设备及照明、后勤设备等用能系统进行了能耗结构分析,结果显示该医院等效电总能耗为216.0 kW·h/(m^(2)·a)。其中暖通空调系统能耗占比最大,为50.45%;其次为后勤设备能耗占比34.84%;其余依次为办公照明能耗和医疗设备能耗。在制冷期对典型室内环境进行了测试,结果显示该医院室内温度满足II级热舒适度水平,湿度超标,照度普遍不足。为提升建筑室内环境品质,同时节能降耗,提出了节能改造和运行管理建议,并利用Design Builder软件对改造前后的能耗进行了模拟,定量分析了各分项能耗的节能率,预估投资回收期约8年。

Chinese Society of Cardiology guidelines on the diagnosis and treatment of adult fulminant myocarditis

Fulminant myocarditis is an acute diffuse inflammatory disease of myocardium.It is characterized by acute onset,rapid progress and high risk of death.Its pathogenesis involves excessive immune activation of the innate immune system and formation of inflammatory storm.According to China’s practical experience,the adoption of the“life support-based comprehensive treatment regimen”(with mechanical circulation support and immunomodulation therapy as the core)can significantly improve the survival rate and long-term prognosis.Special emphasis is placed on very early identification,very early diagnosis,very early prediction and very early treatment.

基于数字孪生的带式输送机状态综合监测

依据工程图纸建立带式输送机数字孪生模型,利用卷积神经网络(CNN)分析、DS证据决策等技术手段,实现了电流、温振、声音等多维信号的融合分析和设备运行状态综合评价;然后利用语音辨识、遥控等互动技术,实现带式输送机运行状态在实体沙盘上的实时呈现,有利于运维人员从宏观、整体上了解设备运行状态,提高巡检效率,为智慧工厂的建设提供一种有效途径。

基层糖尿病微血管疾病筛查与防治专家共识(2024)

糖尿病微血管疾病(DMiVD)是糖尿病常见的慢性并发症,早期识别及有效干预可以显著提高患者生活质量,改善预后。中国微循环学会糖尿病与微循环专业委员会和中华医学会内分泌学分会基层内分泌代谢病学组组织领域内专家,以2021年版为基础,结合最新研究进展,特别针对基层临床实际需求,修订《基层糖尿病微血管疾病筛查与防治专家共识(2024)》。该共识详尽阐述了DMiVD(糖尿病视网膜病变、糖尿病肾脏病、远端对称性多发性神经病变和糖尿病心肌病)的筛查方法、综合管理及防治策略,明确分级诊疗及转诊流程,强化防治DMiVD重要性,为广大医师特别是基层医生及全科医生提供指导和建议,降低DMiVD的发生率、恶化率以及致残致死率。

基于数据挖掘技术优化DRG临床用药目录

目的 优化疾病诊断相关分组(DRG)的临床用药目录,减少患者药品费用,提高DRG结付率。方法 选取某院神经内科BR23疾病组作为研究对象,应用数据挖掘技术,探索疾病组的用药规律,并利用药品综合评价方法对重点监测药品进行评分,进而优化疾病组的临床用药目录。选取2022年12月入组该疾病组患者的住院信息作为优化前数据,2023年9月入组该疾病组患者的住院信息作为优化后数据,通过比较两组患者的医疗质量及药品费用数据来评价优化目录的实施效果。结果 优化临床用药目录后,该疾病组的结付率由优化前的84.36%上升至104.70%,住院药品费用及住院总费用均显著降低(P<0.05),重点监测药品使用量明显下降。结论 数据挖掘技术有助于探索疾病组临床用药规律;药师可以此为依据,通过有效药学干预手段提高DRG结付率。

糖尿病足介入综合诊治临床指南(第九版)

糖尿病足作为糖尿病血管病常见并发症之一,具有高发病率、高致残率、高致死率和治愈率低的特点,严重影响糖尿病患者的身心健康和生活品质,却一直缺少统一的规范性治疗方法。中国糖尿病足细胞与介入治疗技术联盟曾于2015年制定了糖尿病足介入综合诊治临床指南(第一版),在一定程度上填补了国内糖尿病足规范性治疗的空白,对于提高我国糖尿病足治疗水平起到了支撑作用。近10年来,随着诊断标准和治疗方式的更新,以及国内外相关研究的不断深入,联盟组织国内89家单位在第八版的基础上进行新的修订,并颁布第九版指南,以期进一步规范我国糖尿病足临床诊治工作。本指南较第八版主要增加了糖尿病足下肢动脉狭窄或闭塞的腔内治疗原则,强调血管重建优先重建直线血流的原则,至少建立1支能够从股浅动脉起始端到达足部病变部位的直接供血动脉,对于膝下动脉多支病变治疗时建议遵循“先易后难”的重建原则,先处理容易开通的病变动脉,保证至少有1支血管能够供应到足部。同时本版指南介绍了同济大学“五点法皮温”设备在糖尿病足诊治中的巨大应用价值。

基于机器阅读理解的行车故障诊断知识抽取

行车故障调查单是对行车故障诊断过程的文本记录,基于这些历史记录构建知识图谱可以更好地支持行车故障诊断智能化。由于该语料具有实体嵌套、实体跨度大、关系重叠等特点,传统的命名实体识别和关系抽取模型难以对其进行有效的知识抽取。针对语料中存在的实体嵌套和长实体识别问题,本文提出了一种融合强化学习的机器阅读理解模型,以问答形式进行实体识别,以指针网络进行解码;对于语料中存在的关系重叠问题,将关系抽取分为先识别主体再识别客体的两阶段,将不同实体对的关系抽取进行隔离。实验结果表明,基于机器阅读理解的方法在行车故障诊断领域的知识抽取上具有较好的性能,可以有效支持领域知识图谱构建。

基于关联信息熵和轻量级梯度提升机的油纸绝缘特征优选策略

为了充分挖掘对变压器油纸绝缘综合诊断结果有利的老化特征量,提出一种基于关联信息熵和轻量级梯度提升机(LightGBM)的特征量优选策略。首先,基于不同老化状态的变压器介电响应实测数据,提取不同类别的时域特征量形成初始高维特征空间;其次,引入关联信息熵度量特征子集的相关性及冗余性,再利用轻量级梯度提升机评估特征的重要度,进而得到最优特征空间;最后,对比分析最优特征空间与不同对照组的诊断性能,有效验证了基于所提优选策略确定的最优特征空间的优越性。

机械式汽车变速器综合试验台实验方法及故障诊断

随着机械式汽车变速器在现代交通工具中的广泛应用,其性能的优化和故障诊断技术的发展成为汽车工业中的关键研究领域,机械式变速器因其结构的复杂性及对精确操作的要求,常面临着各种故障和性能退化问题。本文就机械式汽车变速器综合试验台的实验方法及故障诊断进行了系统的展开探讨,以期望为变速器的维护和修复提供科学依据,同时为汽车工程技术的发展贡献实践成果。

贵州中北部一次冰雹和雷暴大风过程综合诊断

2021年5月15日贵州省中北部发生了一次以冰雹和雷暴大风为主的强对流过程,最大瞬时风速达到44.3 m∙s^(−1),最大冰雹直径达到40 mm。基于MICAPS常规气象观测资料、欧洲中心ERA5逐小时再分析资料和多普勒雷达资料,对本次过程的天气系统配置、物理量场和雷达回波特征等进行综合诊断。结果表明:(1)500 hPa高原槽东移,槽后冷平流推动低层切变线南压,配合地面冷锋和辐合线活动,触发了本次强对流天气。(2)过程前后,贵州省中北部呈“上干下湿”和“上冷下暖”的结构特征,中低层西南急流带来充足水汽,K指数、△T(850~500)hPa显示大气层结呈较强不稳定状态,此外还有中等偏强的垂直风切变、适宜的0℃和−20℃层高度,整体表现为有利于冰雹、雷暴大风发生发展的环境。(3)雷达回波特征显示,午后地面辐合线附近多个雷暴单体生成发展,回波由团状变为弓状,高质心、高伸展且50~60 dBZ回波接地,表现出有界弱回波区、回波悬垂和前后向的V型槽口等特征,形成大冰雹和极端雷暴大风;夜间雷暴单体先分裂再弥合,强度减弱,形成层状云和积状云的混合云团,雷暴大风和短时强降水天气发生。

考虑STP与LKJ数据融合的机地综合分析系统

无线调车机车信号和监控系统(STP)和列车运行监控装置(LKJ)系统独立地分析和操作过程,导致在STP系统中对机车制动、卸载等现象的分析耗费大量的时间和精力。为此,在分析STP系统与LKJ各自应用场景与功能差异基础上,设计机地综合分析系统,将STP系统与LKJ数据的调车机动作和地面信号设备变化综合处理,实现信息的诊断分析,设计系统的报警、统计与分析功能。机地综合分析系统能够有效降低分析人员跨专业分析的难度,减轻人员综合劳动强度,提升维护水平。

煤矿带式输送机智能集控系统

针对煤矿运输系统中存在的各个系统独立工作,数据信息不能协同调度的问题,建立了一套煤矿带式输送机智能集控系统。通过在沿线布置可编程控制箱、煤量识别摄像仪、沿线保护装置、故障诊断装置等设备,结合主煤流运输智能控制技术、智能视觉技术、故障诊断技术,使带式输送机智能集控系统具备智能感知、数据分析、自主调速、故障诊断等功能,实现煤矿生产与运行维护一体管控,提升煤矿整体安全水平、提高生产效率、降低能源消耗。

山西省28所三级综合医院基于疾病诊断相关分组的住院医疗服务绩效评价

目的比较山西省28所三级综合医院疾病诊断相关分组(DRG)指标与传统指标在住院医疗服务绩效评价中的差异,为医院综合评价提供一定的应用价值。方法通过山西省医疗服务评价平台收集2023年1月至12月山西省28所三级综合医院住院病案首页数据,采用综合指数法从医疗服务能力、医疗服务效率、医疗服务质量方面分析DRG指标与传统指标在住院医疗服务绩效评价中的差异。结果传统指标的住院医疗服务绩效评价结果显示,医院4综合指数排名第一,为6.44;医疗服务能力综合指数最高的是医院3,为3.44;医疗服务效率综合指数最高的是医院25,为1.85;医疗服务质量综合指数最高的是医院16,为4.33。DRG指标的住院医疗服务绩效评价结果显示,医院1的综合指数排名第一,为4.68;医疗服务能力综合指数最高的是医院1,为2.79;医疗服务效率综合指数最高的是医院4和医院6,为1.43;21所医院的医疗服务质量综合指数为1.00。结论采用传统指标与DRG指标对28所三级综合医院的住院医疗服务绩效进行评价,结果存在差别,各医院在医疗服务能力、医疗服务效率及医疗服务质量方面不同程度地存在一些问题。与传统指标比较,DRG指标能客观、准确地评价医院住院医疗服务水平,有助于医院精细化管理。

一种旋转机械综合故障检测和模式识别模型

针对传统故障诊断方法只关注故障检测部分,而对样本是否存在故障的研究较少的问题,提出了一种基于自适应噪声完备经验模态分解(CEEMDAN)-注意熵(AE)和黏菌算法优化极限学习机(SMA-ELM)的旋转机械综合故障诊断模型。首先,针对正常样本和故障样本的复杂性差异,建立了注意熵阈值,计算旋转机械的AE,并将其与阈值进行了比较,若熵值小于该阈值则表明样本存在故障,反之样本是健康的;然后,利用CEEMDAN对故障样本的振动信号进行了分解,提取前6阶分量的AE值;最后,将故障特征输入至SMA-ELM模型中进行了故障识别,利用3种旋转机械故障数据集对该综合故障诊断模型的可靠性进行了研究。研究结果表明:该阈值设置方法可以100%准确地检测样本是否存在故障,后续的故障诊断模型能够准确地检测出样本的故障类型,识别准确率分别达到了99.44%、100%和98%。该综合故障诊断模型能够避免正常样本被误判为故障样本,为旋转机械的故障检测提供了一种可行的思路。