Prevalence of Congenital Heart Disease at Extremely High Altitudes in Tibet and the Establishment of a New Free Treatment Model

Background: This study aimed to illustrate the prevalence of CHD by screening children in extremely high-altitudeareas (over 4000 m to even 5000 m above sea level) and explore an aid model for early diagnosis and treatmentfor the Tibetan population. Methods: A total of 2242 students from different schools in Ngamring County,Xigaze City, Tibet from September 2019 to September 2020 were selected for screening. The students were examinedthrough the inquiry of their current medical history and family history, cardiac auscultation and a physicalexamination, in order to screen out the suspected cases of CHD, and then the suspected cases were confirmed bycardiac color ultrasound examinations. After that, positive patients were be transferred to Shandong Province forfree treatment. Results: The prevalence of CHD among children in Ngamring County was 3.70% (83 cases),which is the highest incidence rate ever reported. The most common type of CHD was patent ductus arteriosus(PDA), accounting for 55.42% of the total number of cases screened, followed by atrial septal defect (ASD) andventricular septal defect (VSD), accounting for 28.92% and 12.05%, respectively. The prevalence of CHD in childrenat high altitude was significantly higher than that in children at low altitude. The children with CHD weretransferred to Shandong Province for surgery, the operations were successful and their recoveries went well.Conclusions: The results show that high altitude is closely related to the prevalence of CHD, and the incidencein Ngamring County is much higher than that in previous reports.

Concise review: Interferon-free treatment of hepatitis C virus-associated cirrhosis and liver graft infection

Chronic hepatitis C is a major reason for development of cirrhosis and hepatocellular carcinoma and a leading cause for liver transplantation. The development of direct-acting antiviral agents lead to(pegylated) interferon-alfa free antiviral therapy regimens with a remarkable increase in sustained virologic response(SVR) rates and opened therapeutic options for patients with advanced cirrhosis and liver graft recipients. This concise review gives an overview about most current prospective trials and cohort analyses for treatment of patients with liver cirrhosis and liver graft recipients. In patients with compensated cirrhosis Child-Pugh-Turcotte(CTP) class A, all approved agents are safe and SVR rates do not significantly differ from patients without cirrhosis in general. In patients with decompensated cirrhosis CTP class B or C, daclastasvir, ledipasvir, velpatasvir, and sofosbuvir are approved, and SVR rates higher than 90% can be achieved. Especially for patients with a model of end stage liver disease score higher than 15 and therefore eligible for liver transplantation, data is scarce. Reported SVR rates in patients with cirrhosis CTP class C are lower compared to patients with a less severe liver disease. In liver transplant recipients with a maximum of CTP class A, SVR rates are comparable to patients without LT. Patients with decompensated graft cirrhosis should be treated on an individual basis.

Treatment Free Intervals after Subsequent Chemotherapy Lines in Recurrent Ovarian Cancer

Aim: Despite recent advances in the treatment of ovarian cancer, recurrence of the disease is still frequent. This study evaluated whether multiple lines of chemotherapy have impact on overall survival (OS), progression free survival (PFS) or on treatment free intervals (TFIs) after serial chemotherapy lines in recurrent settings. Methods: A total of 189 patients with ovarian cancer (including fallopian tube and primary peritoneal cancer), who were treated in Kuopio University Hospital in Finland during 2009-2014, were enrolled. The medical files of these patients were retrospectively reviewed. Results: Median OS and PFS were significantly higher at the time of the first relapse compared to subsequent relapses (p < 0.001). TFIs shortened significantly after the first relapse (p < 0.001). The differences in TFIs were also seen when comparing platinum sensitive, semi-sensitive and platinum resistant patients. The total amount of TFI times during the whole follow-up time was significantly reduced in those patients that received at least one form of aggressive care at the end of life (p = 0.004). Conclusions: Ovarian cancer patients received often multiple lines of chemotherapy. TFIs after subsequent chemotherapy lines decreased during the disease course. More efforts should be taken to avoid unnecessary and ineffective treatments especially in recurrent phase of the disease.

Chrome free surface treatments for galvanized steels—present and future

As the galvanized steels used for electrical and office appliances has achieved a complete chrome-free production worldwide,surface treatment technologies have entered a new phase of development.Grenter effort will be made in exploring new frontier for future surface treatment technologies.A greater contribution will be made for environmental protection,energy-saving and resource-saving,to prevent globalwarming.

A comparative study between flattening filter-free beams and flattening filter beams in radiotherapy treatment

Flattening filter-free(FFF) beams generated by medical linear particle accelerators(linacs) have recently been used in radiotherapy clinical practice.FFF beams have fundamental physical parameter differences with respect to standard flattening filter(FF) beams,such that the generally used dosimetric parameters and definitions are not always viable.This study investigates dosimetric parameters for use in the quality assurance of FFF beams generated by medical linacs in radiotherapy.The main characteristics of the photon beams are analyzed using specific data generated by a Varian True Beam linac having both FFF and FF beams of 6 and 10 MV(megavolt) energy,respectively.Definitions for dose profile parameters are suggested,starting from the renormalization of the FFF with respect to the corresponding FF beam.From this point,the flatness concept is translated into one of "un-flatness",and other definitions are proposed,maintaining a strict parallelism between FFF and FF parameter concepts.The quality controls used in establishing a quality assurance program when introducing FFF beams into the clinical environment are given,maintaining similarity to those used for standard FF beams,and recommendations for the introduction of FFF beams into clinical radiotherapy application for breast cancer patients are provided as an example for comparison between FFF and FF for dose distribution and coverage for a target volume.Although there are many advantages of using a FFF beam,especially for advanced radiotherapy techniques,there are a few limitations(e.g.,using a relatively higher energy photon beam for stereotactic radiotherapy(SRT),limited speed of current multileaf collimators(MLCs),and off-axis distance-dependent modulation in intensitymodulated radiation therapy(IMRT)) as well as challenges(e.g.,criteria for beam quality evaluation and penumbra,establishment of dosimetry methods,and consequences of photon target burn-up) that need to be addressed for establishing the FFF beam as a viable alternative to the FF beam.

随钻式含油钻屑无害化循环利用技术研究

废弃油基及合成基(气制油)钻井液钻屑资源回收价值高,再生循环利用技术处理含油钻屑,不仅具有经济价值,还具有明显的环境效益。针对含油岩屑特性,基于回收废水和回收基液性能、固体废渣检测和经济性评价,对撬装随钻式含油钻屑热降解循环利用装置进行评价。现场应用研究表明,使用撬装式多回程电磁加热解析技术处理含油钻屑,可以实现含油钻屑减量化、无害化和资源化,从而实现连续生产,解决了随钻含油钻屑处置及资源化利用技术难题。

INFLUENCES OF ACID POST-TREATMENT ON THE MORPHOLOGY OF SOAP-FREE P(MMA-EA-MAA)PARTICLES PREPARED BY SEEDED EMULSION POLYMERIZATION

Soap-free poly（methyl methacrylate-ethyl acrylate-methacrylic acid） latex particles with narrow size distribution were synthesized by seeded emulsion polymerization, and the porous particles were created by a stepwise alkali/acid treatment method. Effects of acid treatment conditions on the particle morphology were investigated. Results show that one to three pores were formed inside most of particles after post-treatment. At pH 7.0, when the treatment temperature was lower than 70℃, the size of particles and the volume of pores remained almost unchanged, and these two values increased significantly when the temperature was higher than 70℃. Both the particle size and the pore volume decreased with the increase of initial pH value and treatment time in the acid treatment. As the pH was below 4.0 and the treatment time was longer than 180 min, the particles shrunk in size.

复方红豆杉胶囊维持治疗气虚痰瘀证晚期非小细胞肺癌的多中心、大样本、前瞻性队列研究

目的:探讨复方红豆杉胶囊维持治疗气虚痰瘀证晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的临床疗效和安全性。方法:采用多中心、大样本、前瞻性队列研究方法,纳入一线化疗4~6周期后疗效评价疾病稳定以上进入维持治疗阶段患者,根据患者意愿分为治疗组160例,对照组109例。对照组根据鳞癌和非鳞癌分别给予吉西他滨和培美曲塞单药化疗维持治疗,治疗组给予复方红豆杉胶囊维持治疗。均以21天为1个疗程,两组干预至少2个疗程,每周期进行生活质量评价,每2疗程进行影像学疗效评价。比较两组疾病无进展生存时间(progression-free survival time,PFS)、生活质量,同时进行药物安全性评价。结果:269例入组患者中,246例患者出现PFS终点事件(91.45%),其中治疗组145例,中位PFS为106天,对照组101例,中位PFS为120天,两组PFS比较差异无统计学意义(P>0.05)。采用美国肺癌生存质量量表(FACT-L4.0版)和欧洲五维健康量表中视觉模拟量表(EQ-5D-VAS)对两组患者生活质量评分进行比较,两种生活质量评价量表均提示治疗组较对照组在提高生活质量方面存在优势(P<0.05)。治疗期间两组共有19例患者出现ADR,治疗组7例(占治疗组人数4.38%),对照组12例(占对照组人数11.01%),ADR发生率在治疗组中更低,尤其表现在骨髓抑制不良反应的发生率方面。结论:在延长PFS方面,复方红豆杉胶囊维持治疗气虚痰瘀证晚期NSCLC的疗效非劣于现代医学单药维持化疗,且在高生活质量、低不良反应方面,复方红豆杉胶囊更具有一定优势。

1例重度牙周炎患者牙周种植联合治疗5年观察

Ⅳ期C级牙周炎是临床上分期分级最严重的牙周炎类型,这类患者常伴有牙列缺损与软硬组织缺损,需要联合多学科针对病情设计个性化治疗方案。本文报道1例广泛型Ⅳ期C级牙周炎患者的序列治疗全过程,包括病情分析、治疗的个性化设计、多学科联合手术过程、支持治疗以及5年随访观察。

丙烯酸酯类无氟防污整理剂的合成及在羊毛织物上的应用

为提升羊毛织物的防污性能,首先采用酸性蛋白酶对织物进行预处理来增加粗糙度,然后以甲基丙烯酰氧丙基三(三甲基硅氧烷基)硅烷(M3T)与甲基丙烯酸十八烷酯(SMA)为功能单体,合成无氟防污整理剂MS,并将其应用于羊毛织物的防污整理。整理后织物的水接触角由118.6°提高为150.5°,花生油润湿时间由4 s提高至3 min,具有良好的防水性能与防油污性能,且整理后织物经20次洗涤后接触角仍有141.7°,经过3000次摩擦后接触角为139.7°,具有良好的耐洗性与耐摩擦性。

头颈癌治疗诱发的淋巴水肿:临床因素和预后分析

目的:探讨头颈部恶性肿瘤患者淋巴水肿的严重程度与其相关临床数据之间的关系。方法:对接受多模式治疗的79例头颈癌患者进行回顾性研究。基于术后6个月以上的磁共振成像结果进行淋巴水肿诊断和分级,通过查阅电子病历和电话随访获取相关信息。采用SPSS 26.0软件包对数据进行统计学分析。结果:随着TNM分期、颈淋巴清扫范围的增加,患者淋巴水肿重度率增加。术前接受药物诱导化疗的患者与未接受化疗的患者相比,淋巴水肿重度率更高。不同严重水肿程度患者无瘤生存期无统计学差异。结论:头颈部淋巴水肿的发生与肿瘤分期、淋巴清扫的程度以及综合治疗方式有一定相关性,仍需进一步关注和研究。

《临证指南医案》以通为用论治风湿痹思想浅析

从风湿痹的定义、病因病机、治法方药等多个方面对《临证指南医案》中诊治风湿痹的医案进行总结分析,认为风湿痹的病因为风湿阻络或夹杂寒、热、瘀等因素,治法主要有通表利湿、散寒通脉、清热通下、祛瘀通经等,强调以通为用、启闭通痹。以通为用思想贯穿于《临证指南医案》的遣方用药之中。

血清游离轻链在单克隆球蛋白血症中的临床意义

目的:探讨血清游离轻链(sFLC)在单克隆免疫球蛋白血症(MG)患者中的表达水平及其临床意义。方法:收集98例MG患者和30例健康志愿者外周血,采用免疫比浊法检测sFLC水平,并分析sFLC对MG患者的诊断、疾病严重程度以及疗效评估的价值。结果:98例MG患者中,男性58例,女性40例;具有肾脏意义的单克隆球蛋白血症(MGRS)45例,意义未明的单克隆球蛋白血症(MGUS)33例,血液系统肿瘤20例;Ig G型58例,Ig A型26例,Ig M型7例,轻链型5例,不分泌型2例;κ型35例,λ型63例;肾功能异常53例,肾功能正常45例。MG患者外周血中sFLC-κ和sFLC-λ表达水平相比对照组均显著升高(P<0.01)。血液系统肿瘤患者sFLC-κ和sFLC-λ表达水平显著高于MGRS和MGUS患者(P<0.05),而MGRS患者又显著高于MGUS患者(P<0.05)。肾功能异常者sFLC-κ和sFLC-λ表达水平显著高于肾功能正常者(P<0.01)。sFLC-κ和sFLC-λ与MG患者的球蛋白(r=0.392,r=0.435)、β2-微球蛋白水平呈正相关(r=0.403,r=0.468),在伴肾功能异常的患者中,与血肌酐水平亦呈正相关(r=0.586,r=0.631),与年龄、性别、白蛋白、乳酸脱氢酶、血钙等指标均未见明显相关性。经过治疗,患者sFLC-κ和sFLC-λ的表达水平均显著下降(P<0.01)。结论:sFLC水平在MG患者中显著升高,是一个可以快速检测、敏感度高,有助于疾病类型诊断、病情严重程度判定和疗效评估的新指标。

“无废城市”理念下的垃圾处理厂景观设计策略研究——以南京玖生渼餐厨垃圾处理厂为例

快速的城市化进程导致城市人口的急速增长,资源浪费与生活垃圾处理等难题日益突出。在此背景下,“无废城市”理念倡导的以减少废弃物产生和实现资源循环利用为目标,对推动城市可持续发展具有重要意义。基于此理念,诸如城市环保型垃圾处理设施开始受到大量的关注并成为建设热点,其景观设计也应契合“无废城市”的循环再生理念。鉴于此,通过厘清国内外“无废城市”的发展脉络,将“无废城市”理念与餐厨垃圾处理厂景观营造进行关联研究,构建垃圾处理厂景观设计体系理论框架。结合南京玖生渼餐厨垃圾处理厂景观营造实践,从融合生态理念和现状资源、结合资源循环和环保创意,以及耦合社会参与和景观营造三个方面提出环保型垃圾厂景观设计的策略,以废弃物再利用为主要设计方法打造“无废花园”景观,以期为同类景观设计提供新的参考和设计思路。

高性能免热处理铝合金HA1-H的特性与一体式压铸实践

HA1-H是自主研发的一款免热处理压铸铝合金,在铸态条件下即可获得优良的综合力学性能,适用于一体式压铸大型薄壁件。本文总结了HA1-H合金的特性,以及压铸生产过程中的问题点及应对措施。

煤气化渣活化过硫酸盐体系氧化去除菲

采用固体废弃物煤气化渣(CGS)作为过硫酸盐(PS)的活化剂,考察CGS/PS对菲的去除性能。使用SEM-EDS、XPS表征了CGS的微观结构和元素组成;通过自由基掩蔽实验和电子顺磁共振(EPR)实验确定自由基种类;考察了CGS质量浓度、PS初始浓度、初始pH、共存离子对CGS/PS体系中菲去除率的影响,探讨了反应机理并推测降解路径,并使用ECOSAR软件评估菲及其产物的毒性。结果表明,CGS中Fe元素质量分数为11.9%,可有效活化PS。在菲质量浓度为1 mg/L、pH=3、CGS质量浓度为0.7 g/L、PS初始浓度为1 mmol/L的条件下,60 min后CGS/PS体系对菲的去除率可达95.34%,PS的利用率为29.18%。菲降解过程符合伪一级动力学模型,CGS/PS体系产生了SO_(4)^(–)•和•OH,且SO_(4)^(–)•在菲降解过程中起主要作用,共存离子HCO_(3)^(–)、NO_(3)^(–)对反应的抑制作用较显著。菲主要通过去羰基、羟基化、脱碳等反应分解为长链酸、酯,最终转化为CO_(2)和H_(2)O。ECOSAR模型评估发现,菲降解的中间产物毒性普遍低于菲。

新型镀锌涂层的无铬钝化工艺研究

本文探究了一种新型镀锌涂层的无铬钝化工艺,利用植酸对镀锌层进行处理,再在植酸处理后的表面钝化一层γ-氨丙基三乙氧基硅烷(γ-APS)膜。对其钝化膜进行了硫酸铜点滴实验、碱浸失重实验,绘制了Tafel极化曲线并做了EIS阻抗实验,对其表面形貌进行了SEM表征。最终得出了植酸前处理的最佳工艺为:植酸浓度为10mol/L,p H值为3,处理时间为2min,处理温度为40℃,然后自然干燥2h。

3种免热处理压铸铝合金对模具钢的侵蚀性研究

通过将模具钢浸入熔融铝合金液中并进行动态旋转熔损试验,研究了3种大型一体压铸用免热处理铝合金材料对2种典型压铸模具钢的侵蚀作用。结果表明:经20 min旋转熔损试验后,1#铝合金液中的模具钢表面侵蚀面积最小、质量损失最小、对模具钢的侵蚀最轻,因此,3种免热处理压铸铝合金中,1#铝合金的粘模倾向最小。应用新型免热处理材料时,应选择与该免热处理材料粘模适配性好的模具材料,以获得最小的侵蚀质量损失,保证模具寿命。

新能源汽车一体压铸现状及前景预判

从人员、设备、材料、工艺和产品设计方面阐述了车身一体化压铸技术目前进展及需要解决的课题;指出对车企而言,目前急需中高端爆款车型的规模效应来支撑一体化压铸的铸造成本;建议随着工艺和技术不断进步,提前谋划和布局该领域的车企,有望在3~5年后获得竞争优势。