Effectiveness of Histopathological Examination of Ultrasound-guided Puncture Biopsy Samples for Diagnosis of Extrapulmonary Tuberculosis

Objective To evaluate the diagnostic value of histopathological examination of ultrasound-guided puncture biopsy samples in extrapulmonary tuberculosis(EPTB).Methods This study was conducted at the Shanghai Public Health Clinical Center.A total of 115patients underwent ultrasound-guided puncture biopsy,followed by MGIT 960 culture(culture),smear,Gene Xpert MTB/RIF(Xpert),and histopathological examination.These assays were performed to evaluate their effectiveness in diagnosing EPTB in comparison to two different diagnostic criteria:liquid culture and composite reference standard(CRS).Results When CRS was used as the reference standard,the sensitivity and specificity of culture,smear,Xpert,and histopathological examination were(44.83%,89.29%),(51.72%,89.29%),(70.11%,96.43%),and(85.06%,82.14%),respectively.Based on liquid culture tests,the sensitivity and specificity of smear,Xpert,and pathological examination were(66.67%,72.60%),(83.33%,63.01%),and(92.86%,45.21%),respectively.Histopathological examination showed the highest sensitivity but lowest specificity.Further,we found that the combination of Xpert and histopathological examination showed a sensitivity of 90.80%and a specificity of 89.29%.Conclusion Ultrasound-guided puncture sampling is safe and effective for the diagnosis of EPTB.Compared with culture,smear,and Xpert,histopathological examination showed higher sensitivity but lower specificity.The combination of histopathology with Xpert showed the best performance characteristics.

An Empirical Study of the Socratic Method in Nongraded English Teaching in Senior High School Under the Background of the New National College Entrance Examination

With the reform of the New National College Entrance Examination(Gaokao),the nongraded education will become an inevitable trend.In senior high school,the traditional test-oriented education is popular.The knowledge is mainly taught by the teachers,and the students passively absorb it.This study examines a problem-oriented Socratic experiment in nongraded English teaching in senior high school.The teachers seek output from students,who respond by interpreting questions,fostering critical thinking,and enhancing problem-solving skills.This teaching experiment indicates that the Socratic method has a significant positive effect on cultivating nongraded senior high English students’critical thinking under the New National College Entrance Examination.

Research on the Evaluation of the Implementation Effect of Curriculum Examination Reform: Taking the Course of “Introduction to Language” as an Example

“Introduction to Language,”as the core course of the English major,mainly reveals the basic laws of language,enabling the students to have the ability to apply linguistic theories to explain language phenomena and solve specific language problems.This course is highly theoretical and has a certain degree of difficulty.The evaluation of student grades has always been based on examination reform,but several problems have been encountered during the implementation process.This article analyzes the current situation of the reform and implementation of the“Introduction to Language”course examination in applied universities and puts forth suggestions and specific measures to improve the assessment of the course,aiming to enhance the teaching effectiveness of the course and scientifically and comprehensively evaluate students’abilities.

A Holistic Approach to Enhance FRCS General Surgery Examination Training Using Adult Learning Model: A Non-Profit Initiative

Objectives: To evaluate the impact of adult learning and simulation-based learning (SBL) on surgical trainees’ learning experiences and Fellowship of the Royal College of Surgeons (FRCS) Section 2 General Surgery examination pass rate. Methods: This was a cross-sequential study involving 148 surgical candidates (72 UK trainees, 75 non-UK trainees) who had attended our revision course (Phoenix FRCS Course) from June 2017 until 2023. Each course comprised a two-day weekend preparation with dedicated sections for clinical, viva, and academic reading, incorporating SBL as its key learning style. We maintained a prospective database of candidate and course details, examination results, and feedback since the course inception. Results: We found that 97% of candidates passed the FRCS examination after their first attempt. The course was attended once by 89% of candidates, and only 3 of the 148 candidates exhausted all four attempts at the examination. Candidate feedback for the course and its style of learning was positive, with simulation-based table viva sessions and virtual clinical sessions proving the most popular learning sessions (95% and 80% of candidates attending courses run in December 2017, April 2018, and May 2021 rated them “Excellent” respectively). Conclusions: The course is centered around shared adult learning and mindfulness tools to encourage candidates to learn from each other and develop confidence and mastery in all domains of surgical practice. These methods have been shown to be effective in achieving high success rates in the Intercollegiate and International FRCS examinations for UK and overseas surgeons.

The Infection Control Measures Taken in MRI Examination During the COVID-19 Pandemic Prevention and Control Period

Objective:To optimize the magnetic resonance imaging(MRI)detection process in view of the COVID-19 pandemic,standardize and strengthen the infection control and management MRI rooms.Methods:According to the Technical Guide for COVID-19 Prevention and Control in Medical Institutions(3rd Edition),with reference to the current COVID-19 infection control plan,there are three aspects involved in the planning of MRI examination:MRI room management,medical staff management and protection,and patient management,especially the use of full plastic nose strip medical masks.Infection prevention measures are formulated,scientific prevention and control are made,and accurate policies are implemented.Results:MRI examination was carried out according to the infection control and management of MRI room plan during the epidemic,so as to ensure the safety of examination,the safety of patients and the safety of medical staff and no cross infection in hospital.Conclusion:The implementation of proper infection prevention measures during MRI examination in light of COVID-19 ensures that patients wear medical surgical masks with full plastic nose strips throughout the process to avoid cross-infection,ensure the safety of doctors and patients,and maintain the health of the population.

The IOMT-Based Risk-Free Approach to Lung Disorders Detection from Exhaled Breath Examination

The lungs are the main fundamental part of the human respiratory system and are among the major organs of the human body.Lung disorders,including Coronavirus(Covid-19),are among the world’s deadliest and most life-threatening diseases.Early and social distance-based detection and treatment can save lives as well as protect the rest of humanity.Even though X-rays or Computed Tomography(CT)scans are the imaging techniques to analyze lung-related disorders,medical practitioners still find it challenging to analyze and identify lung cancer from scanned images.unless COVID-19 reaches the lungs,it is unable to be diagnosed.through these modalities.So,the Internet of Medical Things(IoMT)and machine learning-based computer-assisted approaches have been developed and applied to automate these diagnostic procedures.This study also aims at investigating an automated approach for the detection of COVID-19 and lung disorders other than COVID-19 infection in a non-invasive manner at their early stages through the analysis of human breath.Human breath contains several volatile organic compounds,i.e.,water vapor(5.0%–6.3%),nitrogen(79%),oxygen(13.6%–16.0%),carbon dioxide(4.0%–5.3%),argon(1%),hydro-gen(1 ppm)(parts per million),carbon monoxide(1%),proteins(1%),isoprene(1%),acetone(1%),and ammonia(1%).Beyond these limits,the presence of a certain volatile organic compound(VOC)may indicate a disease.The proposed research not only aims to increase the accuracy of lung disorder detection from breath analysis but also to deploy the model in a real-time environment as a home appliance.Different sensors detect VOC;microcontrollers and machine learning models have been used to detect these lung disorders.Overall,the suggested methodology is accurate,efficient,and non-invasive.The proposed method obtained an accuracy of 93.59%,a sensitivity of 89.59%,a specificity of 94.87%,and an AUC-Value of 0.96.

The Association of Mercury and ALT with Obesity in Korean Adults Using Data from the Korea National Health and Nutrition Examination Survey for 11 Years(KNHANES 2005,2008-2017)

The association between heavy metals in the blood and obesity has been examined in many studies.However,inconsistencies have been observed in the results of these studies.The present study was conducted using data from 119,181 participants of the Korea National Health and Nutrition Examination Survey(KNHANES)for 11 years in 2005 and between 2008 and 2017.The subjects with missing heavy metal blood tests,health interview data,and health examination data were excluded from the study.The study population comprised 1,844 individuals(972 men,and 872 women)who were eligible for inclusion.It was found that obesity and abdominal obesity were associated with an increase in both blood mercury(P<0.001)and alanine aminotransferase(ALT)(P<0.001).After adjusting the confounding factors,those with concurrent high levels of ALT and the highest tertile of mercury showed an increased risk of obesity(odds ratio 4.46,95%confidence interval 2.23-8.90,P<0.001)as well as abdominal obesity(odds ratio 5.36,95%confidence interval 2.57-11.17,P<0.001).The interrelationship of mercury and ALT with the parameters of body mass index(P for interaction=0.009)and waist circumference(P for interaction=0.012),respectively,have been observed to be significant,suggesting that the reciprocal relationship could contribute to obesity and abdominal obesity.

Breast Self-Examination (BSE): Association between “Belief in BSE” and “Awareness of BSE” among University Female Students in Uganda

Background: Regular breast self-examination (BSE) has been known to effectively detect breast cancer occurrence early. Are Women who consider BSE effective in detecting breast cancer more likely to be aware of BSE, or vice versa? The present study was an attempt to answer this question. Methods: A cross-sectional study was performed for 259 female University students in Kampala, Uganda. Data were analyzed using SPSS. Univariate and bivariate analyses were carried out. Results: The majority (64.1%) were aware of the BSE technique. Women considering BSE to be effective for early cancer detection were significantly more likely to be aware of the BSE technique. Conclusions: University students who believed in the benefits of BSE were more likely to be aware of BSE than those who did not. More emphasis should be placed on health education for women of younger ages to increase the knowledge of the practice of BSE.

水资源-能源-粮食-生态系统耦合协调及驱动力分析

为加深对我国水资源、能源、粮食、生态系统协同演变趋势的认识,构建水资源-能源-粮食-生态多维系统指标体系,运用耦合协调度模型对我国2005—2020年水资源-能源-粮食-生态系统耦合协调度进行评价,并采用多因素归因分析法进行驱动力分析。结果表明:我国水资源-能源-粮食-生态系统耦合协调度从2005年的0.55增长到2020年的0.84,各地区耦合协调度从勉强协调发展水平过渡到中级协调发展水平,各子系统对耦合协调度上升的驱动分别经历了由粮食子系统到生态子系统再到水资源子系统主导的过程;能源子系统的贡献率虽然比较小,但是未来可能是各地区提升水资源-能源-粮食-生态系统多维系统协调发展水平的突破口。

基于DEMATEL-ISM的水利工程EPC项目价值增值机理研究

采用设计-采购-施工(engineering-procurement-construction,EPC)总承包模式的水利工程项目日益增多,研究其价值增值机理有利于总承包方做好项目的价值管理。从水利工程EPC项目的价值链分析入手,基于文献和专家访谈得到23个价值增值影响因素。采用问卷调查方式得到各因素间的影响程度评分,用决策实验和评估实验(decision-making trial and evaluation laboratory,DEMATEL)法计算了各因素的中心度和原因度,结合解释结构模型(interpretative structural modeling,ISM)对数据进行分析,将价值增值因素划分为6类,构建了水利工程EPC项目价值增值的递阶模型,探究和揭示了项目价值增值的路径和机理。研究结果对水利工程EPC总承包方制订管理策略有一定启示作用。

二氧化碳-水-岩作用机理及微观模拟方法研究进展

系统综述CO_(2)-水-岩复杂作用机理、多孔介质反应输运(溶解、沉淀及沉淀运移)微观模拟、CO_(2)-水-岩系统微观模拟3个方面的研究进展,指出目前研究存在的主要问题并提出了关于未来研究方向的建议。CO_(2)注入储集层后,不仅存在常规渗流体系的流动和传质作用,还会产生溶解、沉淀及沉淀运移等特殊物理化学现象,其耦合作用导致多孔介质的孔渗参数变化规律复杂。孔隙尺度的微观渗流模拟,可以得到孔喉三维空间内的详细信息,且能显性观察到多孔介质流-固界面随反应的变化。目前研究主要在复杂作用机理解耦合、多矿物差异性反应表征、沉淀生成机理及表征(晶体成核和矿物脱落)、沉淀-流体相互作用模拟方法、多物理化学过程耦合渗流机制等方面存在局限。未来研究中,需要创新实验方法对“溶解—沉淀—沉淀运移”解耦合,提高矿物地球化学反应相关参数实验测试的准确度,在不同沉淀机理可靠表征的基础上,建立沉淀-流体相互作用模拟方法,并有机耦合各个物理化学过程,最终实现对CO_(2)-水-岩系统中“溶解—沉淀—沉淀运移”的耦合渗流模拟。

基于GC-IMS和GC-MS技术结合化学计量法分析干燥方式对香椿挥发性成分的影响

为研究干燥方式对香椿挥发性风味物质的影响,利用气相色谱-离子迁移谱技术(gaschromatography-ion mobility spectrometry,GC-IMS)和气相色谱-质谱联用技术(gas chromatography-mass spectrometry,GC-MS)、相对香气活性值(relative odor activity value,ROAV)对真空冷冻干燥、热泵干燥、热风干燥、微波真空干燥的香椿样品进行挥发性成分分析,并进一步结合化学计量方法主成分分析(principal component analysis,PCA)和偏最小二乘判别分析(partial least squares-discriminant analysis,PLS-DA),探究样品间挥发性成分的差异性。结果表明,通过GC-IMS检测到78个峰,鉴定出59种化合物。通过GC-MS鉴定出94种挥发性化合物,主要挥发性成分是硫化物、烯烃类和醛类。经过干燥后总挥发性化合物的含量显著降低。通过ROAV法确定了(E,Z)-二-1-丙烯基二硫化物、2-巯基-3,4-二甲基-2,3-二氢噻吩、正己醛、2-己烯醛、丁香酚等为香椿样品中关键香气化合物。PCA和PLS-DA结果表明,不同干燥方式的样品与新鲜样品有明显的分离,彼此之间也有明显的区别。鲜样和真空冷冻干燥样品为一组,其他3个干燥香椿样品为一组。根据变量投影重要性(variable importance in projection,VIP)得分共筛选出10种(VIP>1)标志挥发性化合物。干燥方式对香椿风味特性影响显著,真空冷冻干燥组与鲜样最为接近,考虑实际应用热泵干燥为香椿最适宜的脱水方式。本研究为热加工过程中风味品质控制提供一定的理论参考。

基于CFD-DEM的流-固耦合数值建模方法研究进展

随着土体渗流侵蚀研究的逐渐深入,对土颗粒流失和变形破坏机理的研究方法呈现出多尺度的特点。其中,计算流体力学-离散元耦合方法(CFD-DEM)为在细观尺度上研究流-固耦合相互作用对土体宏观力学特性的影响提供了一种行之有效的方法。针对CFD-DEM耦合方法在岩土工程领域应用现状,本文系统总结现有流-固耦合计算方法的优缺点,重点论述CFD-DEM耦合方法的建模策略,包括固相颗粒形状建模与粒间接触模型、流体相控制方程及参数计算方法,以及CFD-DEM耦合计算,并就相关问题进行深入探讨,最后提出了CFD-DEM耦合方法未来的发展方向。

老年急性脑梗死患者血清Del-1和IL-17水平变化及与梗死面积和预后的关系

目的 探究老年急性脑梗死(ACI)患者血清内皮发育调节基因-1(Del-1)、白细胞介素-17(IL-17)水平与脑梗死面积、病情严重程度及预后的关系。方法 回顾性收集2019-01-2021-12厦门大学附属东南医院收治的126例老年ACI患者(病例组)及105名健康体检者(对照组)的临床资料,根据脑梗死面积将病例组患者分为大面积梗死组(梗死最大直径>5 cm,n=14)、中面积梗死组(梗死最大直径3~5 cm,n=53)和小面积梗死组(梗死最大直径<3 cm,n=59);根据NIHSS评分分为重症组(NIHSS评分≥16分,n=13)、中症组(5分<NIHSS评分<15分,n=58)和轻症组(NIHSS评分≤5分,n=55);根据m RS评分分为预后良好组(mRS评分≤2分,n=81)和预后不良组(mRS评分>2分,n=45)。采用荧光免疫法检测血清Del-1、IL-17水平,受试者工作特征(ROC)曲线评估血清Del-1、IL-17水平预测老年ACI患者预后的价值。结果 病例组吸烟史比例、收缩压、舒张压、糖化血红蛋白、血清IL-17水平均高于对照组,血清Del-1水平低于对照组(P<0.05)。不同脑梗死面积患者血清Del-1水平比较,小面积梗死组>中面积梗死组>大面积梗死组;血清IL-17水平比较,小面积梗死组<中面积梗死组<大面积梗死组(P<0.05)。轻症组血清Del-1水平高于中症组、重症组(P<0.05),不同病情严重程度患者血清IL-17水平比较,重症组>中症组>轻症组(P<0.05)。预后良好组患者血清Del-1水平高于预后不良组,血清IL-17水平低于预后不良组(P<0.05)。ROC曲线分析显示,血清Del-1、IL-17预测ACI患者预后的AUC值分别为0.763、0.747(P<0.05)。结论 老年ACI患者血清Del-1水平较低,IL-17水平较高,二者与患者脑梗死面积、病情严重程度和预后关系密切,可作为预测老年ACI患者预后的可靠指标。

基于混合式教学的“教-学-评”一体化实验教学体系探索

实验能力是医学专业研究生的重要科研能力,实验能力的培养与实验教学的方法与质量密切相关。文章针对传统实验教学受到时间和空间限制且评价指标较为单一的现状,提出构建基于线上自主学习和现场实践相结合的“教-学-评”一体化实验教学体系,建立覆盖课前线上自主学习、课堂现场实践、课后作业提交与考核教学全过程的评价体系,以评促学,以评促教,通过评价反馈激发学生的学习热情,改进教学内容和方法,不断探索与完善实验教学体系,提高实验教学质量,以期为培养具有实践能力与创新精神的医学科研人才发挥积极作用。

健脾益肠散对溃疡性结肠炎大鼠NLRP3信号通路IL-1β、IL-18表达的影响

目的探讨健脾益肠散对溃疡性结肠炎(UC)模型大鼠NLRP3信号通路白细胞介素(IL)-1β、IL-18表达的影响。方法从40只SD大鼠随机选取10只作为正常组,其余大鼠自由饮用5%硫酸葡聚糖溶液7 d制备UC大鼠模型,将成模大鼠随机分为模型组、柳氮磺吡啶组和健脾益肠散组,每组10只。健脾益肠散组和柳氮磺吡啶组予相应药液灌胃,正常组和模型组予等体积蒸馏水灌胃,连续14 d。观察大鼠一般状况,并进行疾病活动指数(DAI)评分,ELISA检测大鼠血清核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)、凋亡相关斑点样蛋白(ASC)、胱天蛋白酶1(Caspase-l)含量,免疫组化染色、Western blot和RT-PCR检测结肠组织IL-1β、IL-18蛋白及mRNA表达。结果与正常组比较,模型组大鼠一般状况较差,DAI评分显著升高(P<0.01),血清NLRP3、ASC、Caspase-l含量显著增加(P<0.01),结肠组织IL-1β、IL-18蛋白和mRNA表达均显著升高(P<0.01);与模型组比较,健脾益肠散组和柳氮磺嘧啶组大鼠一般状况明显好转,DAI评分显著降低(P<0.01),血清NLRP3、ASC、Caspase-l含量明显减少(P<0.05,P<0.01),结肠组织IL-1β、IL-18蛋白和mRNA表达均明显降低(P<0.05,P<0.01)。结论健脾益肠散可抑制NLRP3信号通路IL-1β、IL-18表达,改善结肠免疫炎症损伤,发挥治疗UC作用。

自身免疫疾病应用肿瘤坏死因子-α抑制剂后并发结核病33例临床特征分析

目的探讨自身免疫疾病患者应用肿瘤坏死因子-α抑制剂后并发结核病的临床特点、治疗及预后。方法收集2019年1月至2023年3月期间广州市胸科医院收治的33例应用生物制剂(肿瘤坏死因子-α抑制剂)后并发结核病患者的临床资料,其中男性25例,女性8例,中位年龄32岁,回顾性分析其临床症状、实验室检查结果、影像学及气管镜特征、病理特点、治疗及转归进行综合分析。结果常见临床表现为咳嗽(26/33)、咳痰(23/33)、发热(17/33)。发病多见于肺结核(32/33)、支气管结核(15/33)、纵隔及肺门淋巴结结核(11/33)。结核菌双侧全肺播散(21/33),结核菌肺内组织(支气管、纵隔肺门淋巴结、胸膜)播散(19/33),肺外结核(18/33),肺结核伴肺内组织或肺外结核(26/33)。血CD4+T淋巴细胞检测正常(23/33),血IGRA检测阳性(27/33)。肺部影像学粟粒性结节(8/33)。淋巴结组织病理为不典型肉芽肿结节。抗结核治疗疗程8~32个月。死亡1例。结论自身免疫疾病应用肿瘤坏死因子-α抑制剂后并发结核病患者以双肺病灶多见,易播散到肺内组织及全身多个器官,免疫功能下降,多需延长治疗疗程,经综合治疗多预后良好。

小流域生态-岩土协同减灾原理与方法初探

随着全球变暖,极端降雨事件增多,导致山区小流域灾害频发,严重威胁人民生命财产安全。小流域防灾减灾形式多样,其中生态工程措施与岩土工程措施相结合协同减灾的方式,不仅能够充分发挥两种措施在不同时间段的减灾作用,而且能够增加整体减灾功效。目前,受限于生态工程措施与岩土工程措施协同减灾原理不明,评估方法缺乏,导致二者无法有机结合并开展综合减灾效益评估。本文在基于自然解决方案的基础上,提出了山区小流域生态-岩土措施协同减灾的原理,即利用生态工程与岩土工程协作,通过坡面防护和沟道调控,形成稳定阶梯-深潭结构的生态工程-岩土工程措施协同减灾原理。在此基础上,结合地理信息系统和最优化原理,给出基于能量消减的小流域生态工程-岩土工程协同减灾功效的定量化评价方法,为规划、设计、物种选择以及生态工程与岩土工程对策的结合提供依据。

基于“马赛克战”的水下有人-无人作战使用探讨

通过对“马赛克战”概念的背景和特点进行分析,提出基于马赛克的水下攻防作战运用构想,构建基于马赛克的水下有人-无人作战网络,分析多域背景下水下OODA作战网络的构成,利用OODA作战环理论对水下马赛克作战网络作战能力进行分析,并提出水下马赛克作战网络对抗单个平台和对抗作战网络的使用方法。最后,从通信组网、集群使用、人工智能、察打一体等4个方面对“马赛克战”概念下水下无人航行器装备使用提出建议。

适用于规划-运行两阶段的配电网可靠性等级划分及评估方法

新型电力系统的快速建设与发展对配电网的可靠性评估提出了更高的要求。综合考虑配电网中终端用户差异化的可靠性需求和电网规划、运行两阶段的不同特点,提出了配电网可靠性等级划分方法和适用于规划-运行两阶段的配电网可靠性评估方法。首先,考虑用电性质、用户侧负荷特性等多方面因素,计及可靠性电价的影响,从系统侧、用户侧和供用电交互侧出发,建立了配电网供电可靠性评估指标体系;然后考虑终端用户用电需求的差异性,进行了配电网可靠性等级的划分;在此基础上,基于终端用户的差异化可靠性需求,提出了适用于规划-运行两阶段的配电网可靠性评估方法。最后进行算例分析,验证了所提划分方法的合理性和评估方法的有效性。