肝细胞癌伴“结中结”的肝胆期影像表现分型及其病理学特征

目的分析肝细胞癌伴“结中结”(NIN-HCC)的肝胆期(HBP)影像表现分型及其病理学特征。方法回顾性连续纳入2015年7月至2022年11月于南通大学附属南通第三医院经手术病理证实为NIN-HCC,术前进行过钆塞酸二钠增强MRI检查的25例(27个病灶)肝硬化患者。分析并记录NIN-HCC中内、外结节的大小、信号强度、强化方式及其病理学特征,并根据2018版肝脏影像报告与数据系统(LI-RADS)分类标准对病灶进行评分。根据内、外结节的HBP不同信号强度,将NIN-HCC进行分组、分型。采用独立样本t检验、Mann-Whitney U检验或Fisher确切概率法比较组间的影像特征及LI-RADS评分的差异。采用Spearman相关系数评估内、外结节的病理分化程度与HBP信号强度之间的相关性。采用Kaplan-Meier曲线分析NIN-HCC术后无复发生存(RFS)。结果27个NIN-HCC中,内结节动脉期均呈富血供改变,最大径(13.2±5.5)mm,51.9%(14/27)呈“快进快出”强化,48.1%(13/27)呈“快进慢出”强化。外结节动脉期均呈乏血供改变,最大径(25.7±7.3)mm,13个(48.1%)伴廓清表现。以背景肝实质信号强度作为参照,根据外结节HBP的信号强度,将NIN-HCC分为2组:低信号组(n=17,63.0%)及等信号组(n=10,37.0%)。以外结节信号强度作为参照,根据内结节低、等、高信号,将低信号组、等信号组依次分为A~C型、D~F型,共6型。低信号组中,7.4%(2/27)内结节呈更低信号(A型),37.0%(10/27)呈等信号(B型),18.5%(5/27)呈高信号(C型)。等信号组中,29.6%(8/27)内结节呈低信号(D型),7.4%(2/27)呈等信号(E型),无一例高信号(F型)。40.7%(11/27)病灶LI-RADS评分为LR-4类,59.3%(16/27)为LR-5类。低信号组与等信号组间,内、外结节最大径、强化方式及病灶LI-RADS评分差异均无统计学意义(P值均>0.05)。组织学上,NIN-HCC呈细梁/假腺管型,无微血管侵犯,其中内结节以中分化HCC为主,外结节以高分化HCC为主。内、外结节的分化程度与HBP信号强度差异无统计学意义(r=0.290,P=0.143;r=0.079,P=0.697)。NIN-HCC根治性切除术后中位RFS随访时间为31.7个月,1、3、5年累积RFS率分别为96.0%、76.0%和64.0%。结论NIN-HCC可作为HCC多步癌演变早期诊断的形态学标志物,影像及病理学具有一定特征性,HBP影像学分型有助于进一步提高HCC伴“结中结”影像征象的了解。

Evidence-based Clinical Chinese Medicine:What Has Changed Over the Past 20 Years

Chinese medicine has been used for centuries to treat a range of health conditions.This history has produced a wealth of classical literature,case studies and clinical research data detailing its use and effectiveness.However,high-quality and conclusive evidence that meets modern requirements for clinical decision support is lacking.This evidence gap limits the integration of Chinese medicine with contemporary medicine,which in turn limits global access and acceptance of Chinese medicine as a form of safe and effective health care.Over the past 20 years,researchers and organisations around the world,including the World Health Organization(WHO)and United Nations,have worked to support the integration of traditional medicines,such as Chinese medicine,with conventional medicines to improve global health care.This paper provides an overview of Chinese medicine studies published in the top four general medical journals(BMJ,JAMA,Lancet and New England Journal of Medicine)from February 2005 to February 2024 in the past 20 years to highlight the progress in the development of this evidence base.It also highlights key actions taken to promote evidence-based clinical Chinese medicine,including product and practitioner regulation,formalising education standards,and international collaborations.Research conducted at the China-Australia International Research Centre for Chinese Medicine demonstrates the benefits of such a collaboration.Through development of its unique and inclusive‘whole-evidence’approach,plus clinical studies and systematic reviews,the Centre has significantly contributed to the evidence base for clinical Chinese medicine.In addition,its high-impact papers and groundbreaking monographs have been cited in international conventional medicine guidelines.While progress has certainly been made during the past 20 years to build a stronger evidence base for clinical Chinese medicine,there is still a considerable gap that limits its integration with conventional medicine.Future funding and research are needed to continue this work and achieve to safe,effective and accessible traditional medicine as part of the WHO’s Universal Health Coverage strategy.

Gd-EOB-DTPA增强MRI肝胆期高信号HCC的影像学表现及病理对照分析

目的探讨普美显(Gd-EOB-DTPA)增强MRI肝胆期(HBP)高信号肝细胞癌(HCC)影像学表现及病理对照分析。方法回顾性分析南通第三人民医院自2018年12月至2022年10月经手术病理证实的29例Gd-EOB-DTPA增强MRI检查HBP高信号HCC患者的影像学及病理资料,观察肿瘤的影像特征(包括病灶大小、MRI平扫、动态增强模式及HBP表现),并与病理结果进行对照分析。结果29例均为单发病灶,最大径3.0(2.2,4.2)cm,主要表现为T1WI低信号、T2WI高信号,19例DWI、ADC均呈稍高信号,2例为病变内含脂。动态强化模式以快进慢出型为主(58.6%,17/29),其次是快进快出型(41.4%,12/29)。肝胆期,51.7%(15/29)表现为HBP低信号环、44.8%(13/29)表现为对比剂局灶性未摄取、27.6%(8/29)表现为“结中结”表现。根据HCC Edmondson病理分级,高分化3例(Ⅰ级1例,Ⅰ/Ⅱ级2例)、中分化(Ⅱ级)19例、低分化(Ⅱ/Ⅲ级5例,Ⅲ级2例)7例。高中分化组与低分化组高信号HCC在ADC图信号、动态强化模式上具有统计学差异(P=0.030,P=0.011)。影像与病理对照发现,HBP低信号环与肿瘤纤维包膜相对应,对比剂局灶性未摄取与肿瘤囊变、坏死或去分化区相一致,“结中结”表现与肿瘤异质性分化密切相关。结论HBP高信号HCC病理上以高中分化为主,ADC图信号、动态强化模式与肿瘤分化程度有关,HBP低信号环、对比剂局灶性未摄取、“结中结”表现有助于其诊断。

Security Assurance for One-stage Resection of Left Colon Cancer with Acute Obstruction—Thorough and Prompt Enteral Decompression without Contamination

Objective: Thorough, prompt enteral decompression technique without contamination was de- veloped to ensure safety for emergent colon resection and primary anastomosis. Methods: After isolating the mesentery, the “to be resected colon segment” was cut at its lower end, then the proximal cut end was put into a plastic bag which was adhered to one side of the operating table. After releasing the clamp, the content could ?ow into this bag. The operator could squeeze the bowel with two hands by turns, from proximal to farness, and from small bowel to large bowel, until the entire bowel content was fully discharged. Then the upper end of this “to be resected colon segment” was cut, and was removed together with the plastic bag. Results: 31 cases of left colon cancer with acute obstruction were decompressed with this technique. They all recovered smoothly, without anastomosis ?stula. Another 6 cases of hepatic seg- mentectomy with incidental colonectomy were decompressed with this technique and had the same results. This technique was also used in di?erent kinds of acute small intestinal obstruction and gained satisfactory results. Conclusion: This technique could be considered as the preferable choice for intraoperative enteral decompression.

Sanders＇ Mid-long Cylindrical Shell Theory and its Application to Ocean Engineering Structures

The cylindrical shell is one of the main structural parts in ocean engineering structures.These cylinders are mostly of medium length,which means that the radius of the cross section is significantly smaller than the length of the cylindrical shell.From the viewpoint of the shell theory,they belong to the mid-long cylindrical shell category.To solve mechanical problems on this kind of structure,especially a cracked cylindrical shell,analysis based on shell theory is necessary.At present the generally used solving system for the mid-long cylindrical shell is too complicated,difficult to solve,and inapplicable to engineering.This paper introduced the Sanders' mid-long cylindrical shell theory which reduces the difficulty of the solution process,and will be suitable for solving problems with complicated boundary conditions.On this basis,the engineering applications of this theory were discussed in conjunction with the problem of a mid-long cylindrical shell having a circumferential crack.The solution process is simple,and the closed form solution can usually be found.In practical engineering applications,it gives satisfactory precision.

Examining advanced nursing practice in Hong Kong and Guangzhou

Objective:There were studies evaluating advanced nursing practice independently in the mainland and Hong Kong Special Administrative Region of China,but there was no attempt to make a comparison of practice between them.This study employed a case study method to examine and compare advanced nursing practice in Hong Kong and Guangzhou.Method:Purposive sampling method was used to recruit 24 advanced practice nurses(APN)who came from the specialty of medical,surgical and pediatric in Hong Kong and Guangzhou.A questionnaire survey and semi-structured interview were conducted to solicit quantitative and qualitative data for exploring the structure-process-outcome of advanced nursing practice.The structure component explored the factors influencing advanced nursing practice.The process part examined APN role components and illustrations of exemplary advanced nursing practice.The outcomes described outcome indicators that best reflected advanced nursing practice.Findings:Findings revealed that in the structure domain,APN education and career development,team approach in healthcare,and support from management,physicians and professional associations were important contextual factors for APN development in both cities.For the process domain,participants had at least 80%of their time practicing independently/interdependently and were engaged in APN activities including direct/indirect patient care,research/project work,initiation of staff and patient protocols.All participants demonstrated competencies with impacts on patient,service and profession in their description of exemplary practice.Participants from both cities ranked patient-related outcomes as top indicators for their advanced nursing practice.Conclusion:This study has revealed that APNs in Guangzhou and Hong Kong shared similar work involvement and impacts and their demonstrated competencies were on par with international counterparts.Continued efforts need to be put in establishing formal APN education,clear clinical career pathway and title protection to empower nurses to provide optimal care to the fullest extent that they are prepared for.

Formation Mechanism and Binding Energy for Body-Centered Cubic Structure of He^＋9 Cluster

The formation mechanism for the body-centered cubic structure of cluster is proposed and its total energy curve is calculated by the method of a Modified Arrangement Channel Quantum Mechanics. The energy is the function of separation R between the nuclei at the center and an apex of the body-centered cubic structure. The result of the calculation shows that the curve has a minimal energy . The binding energy of with respect to was calculated to be 0.8857 a.u. This means that the cluster ofmay be formed in the body-centered cubic structure of .

Reexamining China＇s Demographic Transition and Age Structure

This paper discusses the shortcomings of Western theories on demographic transition by comparing transitions in demographic structure for Europe and China. This paper further proposes several criteria for judging the direction of demographic transition and whether or not it has finished. Apart from establishing new theories of demographic transition and the trasition of demographic structure, this paper differentiates the concepts of ＂relative surplus population＂ and ＂relative suitable population,＂ and ＂relative insufficient population＂ and identifies key demographic differences along the way. In doing so, this paper argues that China＇s demographic strueture is undergoing a process of rebalancing.

Increasing prevalence of advanced colonic polyps in young patients undergoing colonoscopy in a referral academic hospital in Hong Kong

AIM： To investigate the distribution and frequency of advanced polyps over eight years.METHODS：6424 colonoscopies were reviewea aunng the study period 1998 to 2005. The study period was subdivided into period I ： 1998 to 2001 and period 11： 2002-2005. RESULTS： 1856 polyps （33% advanced polyps） and 328 CRCs were detected. The mean ages of the patients with advanced polyps and cancer were 69.2 ± 12.0 and 71.6± 13.8 years, respectively. Advanced polyps were mainly lerc sided （59.5%）. Advanced polyps were found in patients ≤60 years from 17.7% in period Ⅰto 26.3% in period Ⅱ（P 〈 0.05）, especially in male subjects ≤60 years （21.6% vs 31.6%, P 〈 0.05）. Advanced tubuloviUous polyps rose from 21.5% in period I to 29.5% in period Ⅱ （P 〈 0.05）. Whereas cancers in male patients ≤ 60 years were similar in both periods： 23.2% vs 16.5% （P 〉 0.05）.CONCLUSION： Advanced polyps increased significantly in the younger male group in the most recent period and there seems to be a shiE towards a proximal location.

Seven-Decade Structural Transformation of China’s Industrial Economy

Over the past seven decades since the founding of the People's Republic of China in 1949,China's industrial structure has experienced transformations in various stages,which is consistent with the general pattern of industrialization and China's domestic and international situations.These changes also have to do with China's reforms in building the socialist market economic system.China's seven-decade industrial structural transformation offers valuable experiences:In promoting its industrial development,China has persistently carried out economic reforms,kept pace with changing factor and demand structures,invested in technology importation and innovation,leveraged global resources and markets,and formulated development policies in line with specific industrial development stages.Despite industrial structural problems,China has set the stage for innovation-driven development,further opening up,and balanced regional development.China's industrial structure will keep evolving amid its transition toward a competitive industrial nation.

Agricultural Structure in Western China by Comparing with before and after CFFG Based on Shift-share Method

Based on shift-share method,this article employs regional share,structural shift and competitive shift to analyze the structural benefit and competitive position of agricultural structure in western China by comparing with agriculture,foresting,stockbreeding and fishing before and after Conversion of Farmland to Forest and Grassland(CFFG) .Then authors draw following conclusion:while CFFG program has been put in practice,the agricultural structure in western China has some typical characteristics,such as growth faster,structural predominance obvious and more competitive.But the contributiveness from the competition is not too much yet,and the structural benefit of forest estate and stockbreeding are restrained.

Why Does China＇s Labor Income Share Tend to Decline？- From the Perspective of Population Age Structure Change

Using a theoretical model, this article concludes that age structures influence people＇s propensity to save and thereby influence their capital intensity. In the context that capital and labor are in a substitutional relation, increased capital intensity may lead to a drop of labor income share. We perform empirical research with provincial-level data from 1990 to 2007 and have proved that the rising of the old dependency ratio and the decrease of the children dependency rate both contribute to the fall of labor income share. This assumption still holds true after the authors control the influences of other potential factors that may influence labor income share

Research on the Current Situation of the capital structure of SMEs

SMEs are in a rapid growth, it has become a new economic growth point. It is critical for SMEs to healthy and sustainable growth, and the capital structure is an important factor in its development. Therefore, the paper has a research on the current situation of SMEs capital structure is important.

Mechanism of Structural Transformation of China＇s Technology Export

Extending Long＇s （2001） two-sector model into a three-sector model, this paper constructs a new framework for analysing the evolution mechanism of the structure of technology exports. The authors also have applied an adjusted Hausman model to measure the structure of exported technology at China＇s provincial level regions. Upon this foundation, approaching the subject from its domestic and international impact factors, this paper empirically tests the motives driving the structural transformation of China＇s technology export. The conclusions are： （1） the structure of China＇s technology export has improved significantly in recent years, but not as highly as measured by Rodrik （2006） et al. （2） The dynamic mechanism of the structure of China＇s technology export differs from that of the other developing countries. At national and regional levels, the mounting physical capital stock is the fundamental driving force, but with obvious decreasing marginal utility. （3） Excessive unskilled labor in the capital production sector in the central and western regions, and excessively low export prices in the eastern regions have caused negative effects of the skilled labor in the western region and unskilled labor in the eastern region on local structure of technology export.

Hollow and substrate-supported Prussian blue,its analogs,and their derivatives for green water splitting

To meet the current energy needs of society,the highly efficient and continuous production of clean energy is required.One of the key issues facing the green hydrogen evolution is the construction of efficient,low-cost electrocatalysts.Prussian blue(PB),Prussian blue analogs(PBAs),and their derivatives have tunable metal centers and have attracted significant interest as novel photo-and electrochemical catalysts.In this review,recent research progress into PB/PBA-based hollow structures,substrate-supported nanostructures,and their derivatives for green water splitting is discussed and summarized.First,several remarkable examples of nanostructured PB/PBAs supported on substrates(copper foil,carbon cloth,and nickel foam)and hollow structures(such as single-shelled hollow boxes,open hollow cages,and intricate hollow structures(multi-shell and yolk-shell))are discussed in detail,including their synthesis and formation mechanisms.Subsequently,the applications of PB/PBA derivatives((hydr)oxides,phosphides,chalcogenides,and carbides)for water splitting are discussed.Finally,the limitations in this research area and the most urgent challenges are summarized.We hope that this review will stimulate more researchers to develop technologies based on these intricate PB/PBA structures and their derivatives for highly efficient,green water splitting.

Mesoscale structure of the central South China Sea detected by SCSMEX Buoy and Argo float

We addressed the mesoscale structure variation of the central South China Sea （SCS） with the measurements by a long-lived Argo float and a high-resolution ATLAS buoy during 1998-2002. T-S diagram indicates cooling and freshening events in 2000 and 2001 with lower salinity （0.5-0.8） and lower temperature （1-1.7℃）. Significant decrease in the net heat flux and increase in the precipitation suggest that the cooling and freshening is due to extra forcing by the atmosphere. Additional to large year-to-year changes, intraseasonal variability is moderate in the research area. The axis of the maximum intraseasonal temperature and salinity signals are mainly located on the thermocline, Typically, amplitude and period of intraseasonal temperature is about 2℃ and 40-60 days, and that of salinity is 0.34）.5 and 35-60 days. Rapidly-changing winds, heat flux, and precipitation are critical in controlling the intraseasonal fluctuations of the mixed layer of the area. Studies on heat and freshwater balance in the mixed-layer further suggest that horizontal advection plays an important role in intraseasonal fluctuation in the upper ocean. In addition, the energetic mesoscale propagation radiated from the east boundary is linked to the intraseasonal variability in winter.

Evolution Rules of Urban-rural Development and Inspiration for China's Agriculture

Based on urban-rural contrast coefficient,this article designs the agriculture relative development index(ARDI) as indicators measuring the intensity of urban-rural dual structure which is comparable among the countries of the world.This article calculates ARDI of 40 countries from 1980 to 2004.The result shows that ARDI in the developed countries and most of the middle-income countries are rising and yet there are declines in most of the low-income countries.The result also showed that most countries' ARDI will see a decline at the earlier stage of industrialization,so their dual economic structure will also aggravate and urban-rural gap will widen.With the economic development,the tendency will change and ARDI presents a U-shape change overall.The turning point is when a country becomes a middle-income one.

Microstructure and Mechanical Properties of Calcium Phosphate Cement/gelatine Composite Scaffold with Oriented Pore Structure for Bone Tissue Engineering

In this study,the macroporous calcium phosphate cement with oriented pore structure was prepared by freeze casting.SEM observation showed that the macropores in the porous calcium phosphate cement were interconnected aligned along the ice growth direction.The porosity of the as-prepared porous CPC was measured to be 87.6% by Archimede's principle.XRD patterns of specimens showed that poorly crystallized hydroxyapatite was the main phase present in the hydrated porous calcium phosphate cement.To improve the mechanical properties of the CPC scaffold,the 15% gelatine solution was infiltrated into the pores under vacuum and then the samples were freeze dried to form the CPC/gelatine composite scaffolds.After reinforced with gelatine,the compressive strength of CPC/gelatin composite increased to 5.12 MPa,around 50 times greater than that of the unreinforced macroporous CPC scaffold,which was only 0.1 MPa.And the toughness of the scaffold has been greatly improved via the gelatine reinforcement with a much greater fracture strain.SEM examination of the specimens indicated good bonding between the cement and gelatine.In conclusion,the calcium phosphate cement/gelatine composite with oriented pore structure prepared in this study might be a potential scaffold for bone tissue engineering.

China’s Imports Technology Structure and Its Relationship with Trade Partners:1995-2011

This paper uses the latest data to analyze the historical patterns and the current situation of the technology structure of China＇ commodities imports, the structure of China＇s commodities imports from 19 countries and regions, and China＇s interdependent relationship with its trade partners on the basis of studying 230 kinds of manufactured products categorized by their technological intensity. The results show that during the period of 1995-2011, the share of low technology （low-tech） products and medium technology （medium-tech） products declined,＂ the share of primary products, resource- based products, and high technology （high-tech） products increased; high-tech products had taken the largest share, bypassing low-tech and medium-tech products, as early as 2000; different types of countries exported different kinds of commodities to China and had different positions in China＇s imports; China had relatively high interdependent relations with Japan, South Korea and China＇s Taiwan; China had relatively low interdependent relations with the United States, Germany, France and the Netherlands; China＇s import dependence on major developing countries and emerging developing countries was less than these countries＇ export dependence on China; China was the leading export destination for major developing countries and emerging developing countries. Generally speaking, the development of China＇s import trade is inclusive, and China shares its growth with other countries. It not only promotes developing countries＇exports but also enhances developed countries＇ exports.

Physical and numerical investigation on transient cavitating flows

The objective of this paper is to investigate transient cavitating flows around a hydrofoil via combined physical and numerical studies. The aims are to 1) investigate the periodic formation, breakup, shedding, and collapse of the sheet/cloud cavities, 2) provide a better insight in the physical mechanism that governs the dynamics and structures of the sheet/cloud cavitation, 3) quantify the influence of cavitation on the surrounding flow structures. Results are presented for a Clark-Y hydrofoil fixed at an angle of attack of a=8° at a moderate Reynolds number, Re=7×105 , for sheet/cloud cavitating conditions. The experimental studies were conducted in a cavitation tunnel at Beijing Institute of Technology, China. The numerical simulations are performed by solving the incompressible, multiphase unsteady Reynolds-averaged Navier-Stokes (URANS) equations via the commercial code CFX using a transport equation-based cavitation model; a filter-based density corrected model (FBDCM) is used to regulate the turbulent eddy viscosity in both the cavitation regions near the foil and in the wake. The results show that numerical predictions are capable of capturing the initiation of the cavity, growth toward the trailing edge, and subsequent shedding in accordance with the quantitative features observed in the experiment. Regarding vapor shedding in the cavitating flow around the three-dimensional foil, it is primarily attributed to the effect of the re-entrant flow, which is formed due to the strong adverse pressure gradient. The results show strong correlation between the cavity and vorticity structures, demonstrating that the inception, growth, shedding, and collapse of sheet/cloud cavities are important mechanisms for vorticity production and modification.