慢加急性肝衰竭分型新视点:基于临床转归的动态分型新标准

目的分析慢加急性肝衰竭(ACLF)的疾病进程特点,探索新型判断慢加急性肝衰竭预后的分型标准,为制定更为精准化的治疗方案提供依据。方法纳入两所三甲医院确诊ACLF患者388例,收集患者人口学特征、临床检查信息、诊疗经过等信息,收集自诊断ACLF起第1、3、7、14、21、28 d和第12周或好转出院前、肝移植或病死前24 h的实验室检查数据,根据患者凝血酶原活动度(PTA)变化趋势,将其在4周内以及12周内的变化情况分为:升高至>40%,升高但仍≤40%,进行性下降或持续不升;而总胆红素(TBil)变化趋势分为:下降程度≥50%,下降程度<50%,进行性升高或者持续不降;筛选符合动态分型要求的患者,综合每个患者在第4、12周PTA、TBil变化趋势以及其预后情况,制定转归动态分型,采用χ2检验分析各分型ACLF患者临床特点。结果经过筛选,共262例患者入组,在病程第4周,有45%的患者PTA升高至>40%,40.8%的患者TBil下降50%,病程进展至12周时,累计有65.3%患者PTA升高至>40%,63.4%患者TBil下降50%;结合患者在第4、12周的预后情况,将患者病情演变过程分成5种类型:A型:快速进展型60例(22.9%);B型:快速恢复型82例(31.3%);C型:缓慢进展型48例(18.3%);D型:缓慢恢复型43例(16.4%);E型:缓慢持续型29例(11.1%)。快速进展型患者中合并上消化道出血、肝性脑病、急性肾损伤的比例分别为16.7%、33.3%、33.3%;而上述并发症在快速恢复型中仅占3.7%、7.3%、12.2%,χ2值分别为14.411、20.060、12.140,P值均<0.05,差异均有统计学意义。真菌感染率在病死或肝移植患者(即快速进展型与缓慢进展型患者)中分别为21.7%、10.4%,在快速恢复型、缓慢恢复型和缓慢持续型患者中分别为1.2%、14%、6.9%,快速进展型与快速恢复型之间差异有统计学意义,χ2=18.925,P<0.05。结论ACLF患者的病情发展过程可分为快速进展型、快速恢复型、缓慢进展型、缓慢恢复型、缓慢持续型,肝病基础、伴有真菌感染、消化道出血、肝性脑病、急性肾损伤均可影响ACLF病情发展。

3.0T MRI动态增强曲线半定量分型法对乳腺病变的诊断应用

目的探讨3.0T MRI动态增强曲线半定量分型法对乳腺病变的诊断价值。方法统计分析2012年11月至2014年10月我院收治的女性乳腺疾病患者90例(101个病灶)的临床资料。结果临界值为每秒平均流出斜率的0.03%的动态增强曲线半定量分型对乳腺良恶性病变的诊断水平显著高于0.06%/s、5%、10%(P<0.05);临界值为每秒平均流出斜率的0.03%的动态增强曲线联合ER对乳腺良恶性病变的诊断水平显著高于0.06%/s、5%、10%(P<0.05)。结论3.0T MRI动态增强曲线半定量分型法的对乳腺良恶性病变具有较高的诊断价值,临界值为每秒平均流出斜率的0.03%时对曲线类型进行划分具有显著的优越性,值得在临床推广使用。

以病人为中心 构建病例质控平台——重点病人安全 一般病人满意的质控艺术

探寻质控单元是医院与主管部门长期以来关心的课题。以病人为中心改进服务,要求以病例为质控单元。通过多角度分型,识别病人的需要,抓住重点病人。要制订分型标准,由粗到细,不断完善。要建立两点一线动态分型流程,住院全程分型,全程质控。要进行病例质量评价,激励医生护士管好分管的每一位病人。

全腹内脏、下躯、下肢缺血/再灌注损伤动物实验研究

目的 探讨全腹内脏、下躯、下肢缺血 /再灌注损伤的病理生理学之动态变化规律。方法 ① 36犬随机分成 6组 ,分别于全腹内脏、下躯、下肢缺血 /再灌注损伤 0min、15min、2 5min、35min、45min和 6 0min获取同步血流动力学、血液生化、血气酸碱、血凝状态等指标以及EEG、RG与ECG指标 ,分析缺血 /再灌注损伤后各阶段多系统功能变化 ;② 12犬分别与全腹内脏、下躯、下肢缺血 /再灌注损伤 0min、15min、2 5min、35min、45min、6 0min后 ,获取心输出量、总外周阻力、右颈总及右股动脉血流量等指标 ,分析缺血 /再灌注损伤之后各阶段心血管系统功能变化 ;③从实验 1各组取 3犬获取肝、肾、胰、肠组织 ,另选 18犬随机分成 6组 ,取脑、肺、脊髓组织。分析缺血 /再灌注损伤之后各阶段多系统结构变化。结果 全腹内脏、下躯、下肢缺血 /再灌注损伤之模型可通过腹主动脉阻断方式制成。全腹内脏、下躯、下肢缺血 /再灌注损伤的全过程 ,按其血流动力学变化 ,可以分成低排高阻、高排低阻和低排低阻三期 ,该缺血 /再灌注损伤可造成多器官危象。结论 全腹内脏、下躯、下肢缺血再灌注损伤的发病机制主要与缺血 -应激、缺氧 -酸中毒、DIC -细胞毛细血管障碍三阶段有关。本实验尚提供了一个缺血

广西6月区域性暴雨过程的延伸预测试验

应用NCEP/NCAR的1958—2008年3-6月的逐日20时SLP、850 hPa、700 hPa、500 hPa环流场再分析资料,选取覆盖广西区域的16个格点进行Lamb环流分型,分析造成广西区域性暴雨的主导系统。利用动态相似集成预测方法,制作延伸期内区域性暴雨过程预测。2003—2008年6月的实际预测结果检验表明,预测准确率可达70%,为短期气候过程预测提出了一个新的方法。

Studies on stand dynamic growth model for larch in Jilin in China

The stand growth and yield dynamic models for Larch in Jilin Province were developed based on the forest growth theories with the forest continuous inventory data. The results indicated that the developed models had high precision, and they could be used for the updating data of inventory of planning and designing and optimal decision of forest management.

Finite difference method for dynamic response analysis of anchorage system

Based on some assumptions, the dynamic analysis model of anchorage system is established. The dynamic governing equation is expressed as finite difference format and programmed by using MATLAB language. Compared with theoretical method, the finite difference method has been verified to be feasible by a case study. It is found that under seismic loading, the dynamic response of anchorage system is synchronously fluctuated with the seismic vibration. The change of displacement amplitude of material points is slight, and comparatively speaking, the displacement amplitude of the outside point is a little larger than that of the inside point, which shows amplification effect of surface. While the axial force amplitude transforms considerably from the inside to the outside. It increases first and reaches the peak value in the intersection between the anchoring section and free section, then decreases slowly in the free section. When considering damping effect of anchorage system, the finite difference method can reflect the time attenuation characteristic better, and the calculating result would be safer and more reasonable than the dynamic steady-state theoretical method. What is more, the finite difference method can be applied to the dynamic response analysis of harmonic and seismic random vibration for all kinds of anchor, and hence has a broad application prospect.

FEM modeling for 3D dynamic analysis of deep-ocean mining pipeline and its experimental verification

3D dynamic analysis models of 1000 m deep-ocean mining pipeline, including steel lift pipe, pump, buffer and flexible hose, were established by finite element method (FEM). The coupling effect of steel lift pipe and flexible hose, and main external loads of pipeline were considered in the models, such as gravity, buoyancy, hydrodynamic forces, internal and external fluid pressures, concentrated suspension buoyancy on the flexible hose, torsional moment and axial force induced by pump working. Some relevant FEM models and solution techniques were developed, according to various 3D transient behaviors of integrated deep-ocean mining pipeline, including towing motions of track-keeping operation and launch process of pipeline. Meanwhile, an experimental verification system in towing water tank that had similar characteristics of designed mining pipeline was developed to verify the accuracy of the FEM models and dynamic simulation. The experiment results show that the experimental records and simulation results of stress of pipe are coincided. Based on the further simulations of 1 000 m deep-ocean mining pipeline, the simulation results show that, to form configuration of a saddle shape, the total concentrated suspension buoyancy of flexible hose should be 95%?105% of the gravity of flexible hose in water, the first suspension point occupies 1/3 of the total buoyancy, and the second suspension point occupies 2/3 of the total buoyancy. When towing velocity of mining system is less than 0.5 m/s, the towing track of buffer is coincided with the setting route of ship on the whole and the configuration of flexible hose is also kept well.

Research on identifying the dynamic error model of strapdown gyro on 3-axis turntable

The dynamic errors of gyros are the important error sources of a strapdown inertial navigation system. In order to identify the dynamic error model coefficients accurately, the static error model coefficients which lay a foundation for compensating while identifying the dynamic error model are identified in the gravity acceleration fields by using angular position function of the three-axis turntable. The angular acceleration and angular velocity are excited on the input, output and spin axis of the gyros when the outer axis and the middle axis of a three-axis turntable are in the uniform angular velocity state simultaneously, while the inner axis of the turntable is in different static angular positions. 8 groups of data are sampled when the inner axis is in 8 different angular positions. These data are the function of the middle axis positions and the inner axis positions. For these data, harmonic analysis method is applied two times versus the middle axis positions and inner axis positions respectively so that the dynamic error model coefficients are finally identified through the least square method. In the meantime the optimal angular velocity of the outer axis and the middle axis are selected by computing the determination value of the information matrix.

Dynamics of phytoplankton communities in the Jiangdong Reservoir of Jiulong River,Fujian,South China

Phytoplankton blooms occurring in the Jiangdong Reservoir of Jiulong River,Fujian Province,South China,are a potential source of contamination of the drinking water of Xiamen(Amoy)City.To understand the main factors governing phytoplankton composition and succession,we sampled phytoplankton and measured environmental parameters in the reservoir,weekly or biweekly from Jan.2010 to Feb.2012.We identifi ed 123 species of phytoplankton from 7 phyla and 74 genera.The major phyla were Chlorophyta,Bacillariophyta,Cryptophyta,Cyanophyta,and Dinophyta.The main trend in the succession of phytoplankton was from prevalence of Cryptophyta-Bacillariophyta communities to those of Chlorophyta-Cyanophyta.High cell concentrations of Cryptophyta,predominantly Komma caudate,Cryptomonas marssonii,and Cryptomonas erosa,were present in winter,associated with low river discharge and cold water.Bacillariophyta,primarily Cyclotella meneghiniana,Aulacoseira granulata,and Aulacoseira granulata var.angustissima,dominated in early spring,coinciding with high turbulence and low irradiance.During early summer and autumn,Chlorophyta,comprising Scenedesmus quadricauda,Dictyosphaerium ehrenbergianum,and Pandorina sp.were prevalent during conditions of warmer water temperatures and low turbulence.Cyanophyta,with dominance of Pseudanabaena mucicola,Merismopedia tenuissima and Raphidiopsis sp.increased throughout the summer,coinciding with higher water temperatures and lower nutrient concentrations.Dinophyta content was occasionally high during winter and summer.Peridiniopsis penardii(Dinophyta)bloomed during winter 2009,with a persistently high biomass recorded into early spring.Canonical correspondence analysis indicated that phytoplankton communities were infl uenced by river discharge,irradiance,water temperature,and nutrient concentrations.

Violent Transient Sloshing-Wave Interaction with a Baffle in a Three-Dimensional Numerical Tank

A finite difference model for solving Navier Stokes viscous liquid sloshing-wave interaction with baffles in a tank. equations with turbulence taken into accotmt is used to investigate The volume-of-fluid and virtual boundary force methods are employed to simulate free surface flow interaction with structures. A liquid sloshing experimental apparatus was established to evaluate the accuracy of the proposed model, as well as to study nonlinear sloshing in a prismatic tank with the baffles. Damping effects of sloshing in a rectangular tank with bottom-mounted vertical baffles and vertical baffles touching the free surface are studied numerically and experimentally. Good agreement is obtained between the present numerical results and experimental data. The numerical results match well with the current experimental data for strong nonlinear sloshing with large free surface slopes. The reduction in sloshing-wave elevation and impact pressure induced by the bottom-mounted vertical baffle and the vertical baffle touching the free surface is estimated by varying the external excitation frequency and the location and height of the vertical baffle under horizontal excitation.

Decomposable Algorithm for Large Dynamic Programming

An approach about large dynamic programming based on discrete linear system with a quadratic index function is proposed by importing two Lagrange multipliers.

Study on dynamic response of embedded long span corrugated steel culverts using scaled model shaking table tests and numerical analyses

A series of scaled-model shaking table tests and its simulation analyses using dynamic finite element method were performed to clarify the dynamic behaviors and the seismic stability of embedded corrugated steel culverts due to strong earth-quakes like the 1995 Hyogoken-nanbu earthquake. The dynamic strains of the embedded culvert models and the seismic soil pressure acting on the models due to sinusoidal and random strong motions were investigated. This study verified that the cor-rugated culvert model was subjected to dynamic horizontal forces (lateral seismic soil pressure) from the surrounding ground, which caused the large bending strains on the structure; and that the structures do not exceed the allowable plastic deformation and do not collapse completely during strong earthquake like Hyogoken-nanbu earthquake. The results obtained are useful for design and construction of embedded long span corrugated steel culverts in seismic regions.

Spatiotemporal distribution model for zinc electrowinning process and its parameter estimation

This paper focuses on the distributed parameter modeling of the zinc electrowinning process(ZEWP)to reveal the spatiotemporal distribution of concentration of zinc ions(CZI)and sulfuric acid(CSA)in the electrolyte.Considering the inverse diffusion of such ions in the electrolyte,the dynamic distribution of ions is described by the axial dispersion model.A parameter estimation strategy based on orthogonal approximation has been proposed to estimate the unknown parameters in the process model.Different industrial data sets are used to test the effectiveness of the spatiotemporal distribution model and the proposed parameter estimation approach.The results demonstrate that the analytical model can effectively capture the trends of the electrolysis reaction in time and thus has the potential to implement further optimization and control in the ZEWP.

A Dynamic Model for Simulating Atmospheric, Surface and Soil Water interactions in Hillslope of Loess Area Under Natural Conditions and Its Application

The mechanism of atmospheric, surface and soil water interactions (water transformation) in hillslope under natural conditions was analyzed, and a dynamic model was developed to simulate infiltration, overland flow and soil water movement during natural rainfall in hillslope, by bringing forward concepts such. as rainfall intensity on slope and a correction coefficient of saturated soil water content for soil surface seal. Some factors, including slope angle, slope orientation and raindrop inclination, which affect the rainfall amount on slope, were taken into account while developing the dynamic model. The effect of surface seal on infiltration and water balance under a boundary condition of the second kind was also considered. Application of the model in a field experiment showed that the model simulated precisely the infiltration, overland flow and soil water movement in hillslope under natural rainfall conditions.

Dynamic Distribution Model with Prime Granularity for Parallel Computing

Dynamic distribution model is one of the best schemes for parallel volume rendering. How- ever, in homogeneous cluster system.since the granularity is traditionally identical, all processors communicate almost simultaneously and computation load may lose balance. Due to problems above, a dynamic distribution model with prime granularity for parallel computing is presented. Granularities of each processor are relatively prime, and related theories are introduced. A high parallel performance can be achieved by minimizing network competition and using a load balancing strategy that ensures all processors finish almost simultaneously. Based on Master-Slave-Gleaner ( MSG) scheme, the parallel Splatting Algorithm for volume rendering is used to test the model on IBM Cluster 1350 system. The experimental results show that the model can bring a considerable improvement in performance, including computation efficiency, total execution time, speed, and load balancing.

The Dynamic Model of Allocation Control in Venture Capital

The allocation of control and stock in venture capital is the key point of the venture capital project.This paper develops a dynamic model of control and stock and profoundly analyses how to allocate the control between the entrepreneur and the venture capitalist.The model reveals the relationship of control and stock's structure,the time and the degree of imparting the control to the entrepreneur or the venture capitalist,the condition of retracting the control and compensation accordingly.

Simulation and modal analysis of the uplift device of a sugarcane harvester using virtual prototype technology

A three-dimensional model of the uplift device of a sugarcane harvester was built up in Pro/Engineer. Simulation and evaluation of its motional and dynamic performance were performed with the automatic dynamic analysis of mechanical system (ADAMS). ANSYS program was applied to the structural analysis of the model. A finite element analytic model was built up with the bottom-up methodology and was meshed. The default Block Lanczos method was used to work out the native frequency. The results indicate that the five lower modes-the transpotaion wheel, the left holding device, the right holding device, the left cutter disk, and the right cutter disk- and displacement of vibratory type only slightly affect the process of sugarcane harvester and harvesting quality. So it is advisable that the optimization of the static intensity other than the dynamic stiffness of uplift device be executed.