目的 探讨影响血小板抗体产生的因素及其对临床血小板输注效果的影响。方法 本研究为1项单中心的前瞻性观察性研究,收集了四川大学华西医院2018年10月1日~2019年9月30日血液病患者输注血小板前的血浆标本,对血小板抗体进行检测(均采用...目的 探讨影响血小板抗体产生的因素及其对临床血小板输注效果的影响。方法 本研究为1项单中心的前瞻性观察性研究,收集了四川大学华西医院2018年10月1日~2019年9月30日血液病患者输注血小板前的血浆标本,对血小板抗体进行检测(均采用固相凝集法),根据血小板抗体筛查结果将患者分为血小板抗体阳性组和阴性组,采用t检验及非参数Mann-Whitney U检验比较2组的输注疗效。从HIS6.2.0和临床用血全过程管理系统3.0收集患者的人口学与临床信息、用血数据,包括患者年龄与性别、病种、输注血小板与红细胞量,分析患者年龄及性别、所患疾病(种)对血小板抗体阳性率的影响,以及不同疾病患者的血小板抗体分布情况、血小板抗体阳性率与输血(血小板)史的相关性。同时现场观察血小板输注过程。结果 本组共纳入316名血液病患者,以急性髓细胞白血病为主[59.5%(188/316)];所有患者住院期间共输注血小板1 671 U、[1~17(5.3±3.1)]U/人,红细胞1 896 U、[0~38(7.8±4.6)]U/人;血小板抗体检出(阳性)率26.9%(85/316),不同性别和年龄的血液病患者输注血小板后的血小板抗体阳性率无明显差异(P>0.05),不同疾病的患者血小板抗体分布不同(P<0.05),其中骨髓增生异常综合症最高(57.1%),其次是再生障碍性贫血(36.4%),髓系白血病(27.7%);血小板抗体阳性率与患者既往输注血小板次数呈正相关(P<0.05)。血小板抗体阳性组和阴性组整体输注效果分别为:阳性组输注血小板后的绝对血小板计数增量(8×10~9/L vs 17×10~9/L,P<0.01)及校正血小板计数增量(5.2×10~9/L vs 11.5×10~9/L,P<0.01)比阴性组低;阳性组平均每周输注的血小板单位数(1.7U vs 1.2U,P<0.01)和红细胞单位数(1.5 U vs 1.1 U,P<0.05)比阴性组多,血小板输注间隔比阴性组短(3.1 d vs 3.6 d,P<0.05),2组间红细胞输注间隔无明显差异(3.1 d vs 3.8 d,P>0.05);阳性组住院期间最低Plt(5×10~9/L vs 9×10~9/L,P<0.01)、平均Plt(27×10~9/L vs 40×10~9/L,P<0.01)及平均Hb(71 g/L vs 77 g/L,P<0.05)比阴性组低,最低Hb之间无明显差异(56 g/L vs 59 g/L,P>0.05)。此外,本次研究共现场观察到1 291例次血小板输注过程,共169例次输血小板不良反应,发生率为13%(169/1291)。结论 血小板抗体在血液病患者中分布频率较高,且血小板抗体阳性的患者输血效果比阴性者差。血液病患者输注血小板前常规做血小板抗体检测,输注配合型血小板,有助于提高输注疗效。展开更多
The square-root unscented Kalman filter （SR- UKF） for state estimation probably encounters the problem that Cholesky factor update of the covariance matrices can＇t be implemented when the zero＇th weight of sigm...The square-root unscented Kalman filter （SR- UKF） for state estimation probably encounters the problem that Cholesky factor update of the covariance matrices can＇t be implemented when the zero＇th weight of sigma points is negative or the mnnerical computation error becomes large during the faltering procedure. Consequently the filter becomes invalid. An improved SR-UKF algorithm （ISR- UKF） is presented for state estimation of arbitrary nonlinear systems with linear measurements. It adopts a modified form of predicted covariance matrices, and modifies the Cholesky factor calculation of the updated covariance matrix originating from the square-root covariance filtering method. Discussions have been given on how to avoid the filter invalidation and further error accumulation. The comparison between the ISR-UKF and the SR-UKF by simulation also shows both have the same accuracy for state estimation. Finally the performance of the improved filter is evaluated under the impact of model mismatch. The error behavior shows that the ISR-UKF can overcome the impact of model mismatch to a certain extent and has excellent trace capability.展开更多
The safety most important factor profile is one of the the plasma discharge. For limiter configuration, people usually use the following cylindrical approximation formula to calculate it q（r）=5r^2BT/RIp where r is t...The safety most important factor profile is one of the the plasma discharge. For limiter configuration, people usually use the following cylindrical approximation formula to calculate it q（r）=5r^2BT/RIp where r is the minor radius of the plasma toms, R is the major radius （in m） , BT is the toroidal magnetic field （in T）, Ip is the total toroidal current（in MA）.展开更多
文摘目的 探讨影响血小板抗体产生的因素及其对临床血小板输注效果的影响。方法 本研究为1项单中心的前瞻性观察性研究,收集了四川大学华西医院2018年10月1日~2019年9月30日血液病患者输注血小板前的血浆标本,对血小板抗体进行检测(均采用固相凝集法),根据血小板抗体筛查结果将患者分为血小板抗体阳性组和阴性组,采用t检验及非参数Mann-Whitney U检验比较2组的输注疗效。从HIS6.2.0和临床用血全过程管理系统3.0收集患者的人口学与临床信息、用血数据,包括患者年龄与性别、病种、输注血小板与红细胞量,分析患者年龄及性别、所患疾病(种)对血小板抗体阳性率的影响,以及不同疾病患者的血小板抗体分布情况、血小板抗体阳性率与输血(血小板)史的相关性。同时现场观察血小板输注过程。结果 本组共纳入316名血液病患者,以急性髓细胞白血病为主[59.5%(188/316)];所有患者住院期间共输注血小板1 671 U、[1~17(5.3±3.1)]U/人,红细胞1 896 U、[0~38(7.8±4.6)]U/人;血小板抗体检出(阳性)率26.9%(85/316),不同性别和年龄的血液病患者输注血小板后的血小板抗体阳性率无明显差异(P>0.05),不同疾病的患者血小板抗体分布不同(P<0.05),其中骨髓增生异常综合症最高(57.1%),其次是再生障碍性贫血(36.4%),髓系白血病(27.7%);血小板抗体阳性率与患者既往输注血小板次数呈正相关(P<0.05)。血小板抗体阳性组和阴性组整体输注效果分别为:阳性组输注血小板后的绝对血小板计数增量(8×10~9/L vs 17×10~9/L,P<0.01)及校正血小板计数增量(5.2×10~9/L vs 11.5×10~9/L,P<0.01)比阴性组低;阳性组平均每周输注的血小板单位数(1.7U vs 1.2U,P<0.01)和红细胞单位数(1.5 U vs 1.1 U,P<0.05)比阴性组多,血小板输注间隔比阴性组短(3.1 d vs 3.6 d,P<0.05),2组间红细胞输注间隔无明显差异(3.1 d vs 3.8 d,P>0.05);阳性组住院期间最低Plt(5×10~9/L vs 9×10~9/L,P<0.01)、平均Plt(27×10~9/L vs 40×10~9/L,P<0.01)及平均Hb(71 g/L vs 77 g/L,P<0.05)比阴性组低,最低Hb之间无明显差异(56 g/L vs 59 g/L,P>0.05)。此外,本次研究共现场观察到1 291例次血小板输注过程,共169例次输血小板不良反应,发生率为13%(169/1291)。结论 血小板抗体在血液病患者中分布频率较高,且血小板抗体阳性的患者输血效果比阴性者差。血液病患者输注血小板前常规做血小板抗体检测,输注配合型血小板,有助于提高输注疗效。
基金Shanghai Commission of Science and Technology,China(No.08JC1408200)Shanghai Leading Academic Discipline Project,China(No.B504)
文摘The square-root unscented Kalman filter （SR- UKF） for state estimation probably encounters the problem that Cholesky factor update of the covariance matrices can＇t be implemented when the zero＇th weight of sigma points is negative or the mnnerical computation error becomes large during the faltering procedure. Consequently the filter becomes invalid. An improved SR-UKF algorithm （ISR- UKF） is presented for state estimation of arbitrary nonlinear systems with linear measurements. It adopts a modified form of predicted covariance matrices, and modifies the Cholesky factor calculation of the updated covariance matrix originating from the square-root covariance filtering method. Discussions have been given on how to avoid the filter invalidation and further error accumulation. The comparison between the ISR-UKF and the SR-UKF by simulation also shows both have the same accuracy for state estimation. Finally the performance of the improved filter is evaluated under the impact of model mismatch. The error behavior shows that the ISR-UKF can overcome the impact of model mismatch to a certain extent and has excellent trace capability.
文摘The safety most important factor profile is one of the the plasma discharge. For limiter configuration, people usually use the following cylindrical approximation formula to calculate it q（r）=5r^2BT/RIp where r is the minor radius of the plasma toms, R is the major radius （in m） , BT is the toroidal magnetic field （in T）, Ip is the total toroidal current（in MA）.
