hs-CRP、CK-MB mass和cTnI联合检测在小儿病毒性心肌炎诊断中的价值

目的:探讨联合检测心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶质量(CK-MB mass)和高敏C反应蛋白(hs-CRP)在小儿病毒性心肌炎诊断中的价值。方法:本研究分为3组,病毒性心肌炎组(VMC)60例,疑似病毒性心肌炎组(NVMC)57例,健康对照组62例。抽取3组儿童静脉血5mL,分别测定各组血清cTnI、CK-MB mass和hs-CRP水平,并进行比较。结果:VMC组hs-CRP、CK-MB mass和cTnI的水平均升高,明显高于NVMC组和对照组(P<0.05);hs-CRP在血清中消失较快,cTnI在血液中存在时间最长;hs-CRP的灵敏度最高(75.0%),cTnI的特异性最好(89.4%),3个指标联合检测的灵敏度为93.3%,特异度为96.5%,准确率为94.9%。结论:联合检测cTnI、CK-MB mass和hs-CRP的血清水平更能准确诊断小儿病毒性心肌炎,对建立更准确的病毒性心肌炎的诊断标准有重要意义。

联合检测cTnI、MYO和CK-MB mass对HIE患儿心肌损伤的诊断研究

目的探讨联合检测心肌肌钙蛋白I(cTnI)、肌红蛋白(MYO)和肌酸激酶同工酶MB质量(CK-MB mass)对新生儿缺氧缺血性脑病(HIE)患者心肌损伤的诊断价值。方法用微粒子化学发光免疫分析法检测148名HIE患儿(轻度61名、中度52名、重度35名)及60名健康对照者cTnI、MYO和CK-MB mass。结果cTnI、MYO和CK-MB mass以HIE重度组最高,分别达(0.75±0.48)μg/L、(305.4±162.1)μg/L和(33.3±17.1)μg/L,中度组其次,分别为(0.33±0.23)μg/L、(178.6±89.3)μg/L和(15.2±8.8)μg/L,均明显高于轻度HIE组和对照组(F=62.96～127.35,P<0.01);轻度HIE患儿MYO明显高于对照组(P<0.01),而cTnI和CK-MB mass两组比较差异均无统计学意义(P>0.05)。轻度、中度和重度HIE患儿出生第1天,3种心肌损伤标志物均以MYO异常率最高。第3天轻度组cTnI、MYO和CK-MB mass异常率分别为6.56%、9.84%、8.20%,中度组分别为42.31%、44.23%、42.31%,重度组分别为77.14%、74.29%、77.14%。3天后,各组HIE患儿MYO均持续下降,而CK-MB mass和cTnI却升至峰值,并维持在较高水平长达1周以上。结论HIE患儿脑损伤与心肌损伤紧密相联——脑损伤越重,心肌损伤也越重。

免疫比浊法CK-MB mass检测诊断急性心肌梗死的价值研究

目的探究免疫比浊法CK-MB mass检测在诊断急性心肌梗死(AMI)中的价值。方法选取我院内科自2019年3月至2020年4月间收治的118例AMI患者和同期于我院体检中心进行体检的64名健康者为研究对象,分别为AMI组和健康组。对两组血清cTnT、CK-MB mass水平进行检测,并对AMI患者给予溶栓治疗,监测病程中血清cTnT、CK-MB mass水平。比较AMI患者发病后2h、6h、12h、1d、2d、4d、7d与健康组的血清cTnT、CK-MB mass水平和cTnT、CK-MB mass的不同时间点阳性率以及诊断效能。结果发病后AMI患者的血清cTnT、CK-MB mass水平较健康组均显著升高(P<0.05),cTnT在发病后2h即显著升高,12h至1d达到峰值,7d后水平仍较高,CK-MB mass在发病后6h明显升高,12h至1d达到峰值,4d后水平显著降低。健康组cTnT、CK-MB mass两指标的阳性率均为0,AMI组cTnT阳性率在发病后2h、6h、12h、1d、2d、4d、7d普遍很高,明显高于CK-MB mass阳性率(P<0.05)。cTnT的灵敏度为0.95,特异度为1.00,约登指数为0.95,CK-MB mass的灵敏度为0.93,特异度为1.00,约登指数为0.93,两者比较无明显差异(P>0.05)。结论免疫比浊法CK-MB mass检测在急性心肌梗死的早期诊断中具有较好的诊断价值,应将其作为常规检测项目以提高临床早期诊断能力。

Anterior mediastinal masses and thymic cysts

Cystic lesions of the anterior mediastinum in children suggest a well-known group of benign lesions that are comparatively frequent.Thymic cysts(TCs)are mostly positioned in the anterior mediastinum and some patients in the neck.Benign TCs classified as congenital intra-thoracic mesothelial cysts are commonly asymptomatic and have slight clinical significance.Multilocular TC,which can mimic another anterior mediastinal cystic tumor and is seen in adults,is more clinically important.It is a sporadic mediastinal lesion thought to arise in the course of acquired inflammation.Congenital mediastinal cysts represent 3%-6%of all mediastinal tumors and 10%-18%of radiologically reported mediastinal masses.Mediastinal TCs are uncommon and it is hard to know their true incidence.About 60%of cases with mediastinal TCs are asymptomatic,and the remainder of patients complains of nonspecific symptoms(e.g.,chest pain,dyspnea,or cough).The literature suggests that most cysts are benign,but an indefinite percentage may have a neoplastic process and result in significant compressive symptoms over time.Clinical symptoms of TCs vary depending on the location.In addition,frequent symptoms at the appearance of enlarged benign thymic and mediastinal cysts generally contain compressive symptoms(e.g.,respiratory distress,thymic pain,and symptoms related to Horner syndrome,hoarseness,dysphonia,dyspnea,orthopnea,wheezing,and fever).Many TCs have cystic density and a neat border and are simple to diagnose with radiological imaging.However,some TCs are hard to identify before surgery and may be misidentified as thymomas depending on their site and computed tomography results.Excision by thoracotomy,median sternotomy,or video-assisted techniques is essential for conclusive diagnosis,management,and abolition of relapse of anterior mediastinal masses and TCs.Histopathologic examination may be required after surgery.Considering the extent of the mass and the preliminary inability to make a definitive diagnosis,en bloc excision of the cyst was thought to be preferred to circumvent likely complications(e.g.,perforation,spillage of the contents,or incomplete excision).

血清Troponin I,CK-MBmass,Myoglobin在急性心肌梗塞诊断中的应用评价

为了解CTnI，CK－MBmass和Mb指标对急性心肌梗塞（AMI）早期诊断、后期监测及预后判断的临床意义，采用微粒子化学发光法，对20例AMI患者、24例不稳定心绞痛（UA）患者、17例骨骼肌损伤（SM）患者和19例健康者（对照组）进行血清CTnI，CK－MBmass和Mb的测定，并对AMI患者胸病发生3～5小时，8～14小时，20～24小时，72小时和7天共五个时段进行了测定。结果：AMI患者发病早期CTnI，CK－MBmass和Mb的阳性检出率分别为65％，70％，70％，CTnI在UA患者组和SM患者组中未检出。CTnI，CK－MBmass和Mb测定值含量在AMI组中明显高于UA组和SM组，AMI患者组CTnI分别是UA组和SM组的84倍和91.63倍，CK－Mbmass分别是该二组的8．82倍和4．67倍，Mb分别是该二组的11．57倍和2．25倍，AMI组与UA组和SM组比较，有显著性差异（P＜0．001）。AMI患者组中该三项指标的动态测定显示，在疾病发生早期（3～5小时）时，CTnI，CK－MBmass和Mb都有显著性升高，随时间延长而逐渐升高，高峰值期均在8～14小时段，72小时时Mb已基本回到正常。7天时血清中仍有CTnI的持续存在，但CK－MBmass已接近正常。以上显示，CTnI，CK－MBmass和Mb在早期诊断AMI时，都具有较高的敏感性，CTnI在AMI患者中的阳性检出率具有心肌特异性。

微动力负压引流对烧伤患者创面愈合及LDH、CK及CK-MB水平的影响

目的 分析微动力负压引流对烧伤患者创面愈合及乳酸脱氢酶(LDH)、肌酸激酶(CK)及肌酸激酶同工酶(CK-MB)水平的影响。方法 采用回顾性、单中心分析2022年5月至2023年1月期间第九〇九医院·厦门大学附属东南医院收治的137例烧伤患者,经纳入、排除标准,剔除36例患者,最后纳入101例患者进行研究,并根据治疗方案不同分为对照组50例(予以传统换药处理)与观察组51例(采用微动力负压引流治疗)。对比两组临床疗效、创面愈合情况、心肌酶谱水平及术后感染发生情况。结果 观察组(96.09%)的总有效率比对照组(84.00%)高,差异有统计学意义(P<0.05);治疗3周后两组创面疼痛度均降低,且观察组低于对照组,差异有统计学意义(P<0.05);观察组创面清洁时间、肉芽组织生长时间、创面愈合时间均短于对照组,差异有统计学意义(P<0.05);治疗3周后,两组LDH、CK-MB、CK水平均降低,且观察组均低于对照组,差异有统计学意义(P<0.05);观察组(5.88%)术后感染总发生率比对照组(20.00%)低,差异有统计学意义(P<0.05)。结论 应用微动力负压引流治疗烧伤患者的临床疗效佳,其有助于创面愈合,改善患者心功能,并有效降低感染的发生率。

Tricuspid mass-curious case of Li-Fraumeni syndrome: A case report

BACKGROUND Li-Fraumeni syndrome(LFS)is a rare autosomal dominant cancer-predisposing syndrome,which can manifest as a polymorphic spectrum of malignancies.LFS is associated with an early onset in life,with the majority of cases occurring prior to the age of 46.Notwithstanding the infrequency of primary cardiac tumors,it behooves clinicians to remain vigilant in considering the differential diagnosis of such tumors in LFS patients who present with a cardiac mass.This is due to the markedly elevated risk for malignancy in this particular population,far surpassing that of the general populace.CASE SUMMARY Herein,we present a case of a 30-year-old female with LFS who was found to have a tricuspid valve leaflet mass.CONCLUSION This case exemplifies valuable learning points in the diagnostic approach for this exceptionally rare patient population.

Evaluation of slope stability through rock mass classification and kinematic analysis of some major slopes along NH-1A from Ramban to Banihal, North Western Himalayas

The network of Himalayan roadways and highways connects some remote regions of valleys or hill slopes,which is vital for India’s socio-economic growth.Due to natural and artificial factors,frequency of slope instabilities along the networks has been increasing over last few decades.Assessment of stability of natural and artificial slopes due to construction of these connecting road networks is significant in safely executing these roads throughout the year.Several rock mass classification methods are generally used to assess the strength and deformability of rock mass.This study assesses slope stability along the NH-1A of Ramban district of North Western Himalayas.Various structurally and non-structurally controlled rock mass classification systems have been applied to assess the stability conditions of 14 slopes.For evaluating the stability of these slopes,kinematic analysis was performed along with geological strength index(GSI),rock mass rating(RMR),continuous slope mass rating(CoSMR),slope mass rating(SMR),and Q-slope in the present study.The SMR gives three slopes as completely unstable while CoSMR suggests four slopes as completely unstable.The stability of all slopes was also analyzed using a design chart under dynamic and static conditions by slope stability rating(SSR)for the factor of safety(FoS)of 1.2 and 1 respectively.Q-slope with probability of failure(PoF)1%gives two slopes as stable slopes.Stable slope angle has been determined based on the Q-slope safe angle equation and SSR design chart based on the FoS.The value ranges given by different empirical classifications were RMR(37-74),GSI(27.3-58.5),SMR(11-59),and CoSMR(3.39-74.56).Good relationship was found among RMR&SSR and RMR&GSI with correlation coefficient(R 2)value of 0.815 and 0.6866,respectively.Lastly,a comparative stability of all these slopes based on the above classification has been performed to identify the most critical slope along this road.

Probabilistic analysis of tunnel face seismic stability in layered rock masses using Polynomial Chaos Kriging metamodel

Face stability is an essential issue in tunnel design and construction.Layered rock masses are typical and ubiquitous;uncertainties in rock properties always exist.In view of this,a comprehensive method,which combines the Upper bound Limit analysis of Tunnel face stability,the Polynomial Chaos Kriging,the Monte-Carlo Simulation and Analysis of Covariance method(ULT-PCK-MA),is proposed to investigate the seismic stability of tunnel faces.A two-dimensional analytical model of ULT is developed to evaluate the virtual support force based on the upper bound limit analysis.An efficient probabilistic analysis method PCK-MA based on the adaptive Polynomial Chaos Kriging metamodel is then implemented to investigate the parameter uncertainty effects.Ten input parameters,including geological strength indices,uniaxial compressive strengths and constants for three rock formations,and the horizontal seismic coefficients,are treated as random variables.The effects of these parameter uncertainties on the failure probability and sensitivity indices are discussed.In addition,the effects of weak layer position,the middle layer thickness and quality,the tunnel diameter,the parameters correlation,and the seismic loadings are investigated,respectively.The results show that the layer distributions significantly influence the tunnel face probabilistic stability,particularly when the weak rock is present in the bottom layer.The efficiency of the proposed ULT-PCK-MA is validated,which is expected to facilitate the engineering design and construction.

血清cTnI、CK-MB及Mb在急性心肌梗死冠脉支架介入患者中的临床意义

目的 分析急性心肌梗死(AMI)冠脉支架介入(PCI)患者肌钙蛋白(cTnI)、肌酸激酶同功酶(CK-MB)及肌红蛋白(Mb)水平变化及临床意义。方法 选取2020年4月至2023年6首都医科大学附属北京世纪坛医院收治的135例AMI患者(观察组)作为研究对象,另选取同期进行体检的健康人群100名为对照组。对比对照组与观察组术前、术后血清cTnI、CK-MB、Mb水平;分析影响AMI患者PCI手术成功的单因素;采用多元Logistic回归分析影响AMI患者PCI手术成功的危险因素;采用Pearson分析AMI患者PCI手术成功率与血清cTnI、CK-MB、Mb水平关系。结果 对照组血清c TnI、CK-MB、Mb水平均低于观察组,观察组术前血清c TnI、CK-MB、Mb水平均低于术后,差异有统计学意义(P<0.05);经影像学检查,有112例患者手术成功(82.96%,手术成功组),有23例患者手术未成功(17.04%,手术未成功组);两组年龄、性别、心功能、高血压病史、糖尿病病史、心绞痛病史、PCI术用时等比较,差异无统计学意义(P>0.05);两组发病至入院时间、发病至PCI术时间、血清cTnI、CK-MB、Mb水平等比较,差异有统计学意义(P<0.05);多元Logistic回归分析显示:发病至入院时间>3 h、发病至PCI术时间≥6 h、cTnI≥0.04 ng/mL、CK-MB>5 ng/mL、Mb>50μg/L是影响AMI患者PCI手术成功的危险因素(P<0.05);根据Pearson相关性分析可得:cTnI、CK-MB、Mb水平与AMI患者PCI手术成功率呈负相关(P<0.05)。结论 在AMI患者PCI手术前后血清cTnI、CK-MB、Mb水平变化可反映PCI治疗的治疗疗效,同时可预判患者的预后,检测三指标具有重要的临床意义。

Stepped-up development of accelerator mass spectrometry method for the detection of ^(60)Fe with the HI-13 tandem accelerator

The Moon provides a unique environment for investigating nearby astrophysical events such as supernovae.Lunar samples retain valuable information from these events,via detectable long-lived“fingerprint”radionuclides such as^(60)Fe.In this work,we stepped up the development of an accelerator mass spectrometry(AMS)method for detecting^(60)Fe using the HI-13tandem accelerator at the China Institute of Atomic Energy(CIAE).Since interferences could not be sufficiently removed solely with the existing magnetic systems of the tandem accelerator and the following Q3D magnetic spectrograph,a Wien filter with a maximum voltage of±60 kV and a maximum magnetic field of 0.3 T was installed after the accelerator magnetic systems to lower the detection background for the low abundance nuclide^(60)Fe.A 1μm thick Si_(3)N_(4) foil was installed in front of the Q3D as an energy degrader.For particle detection,a multi-anode gas ionization chamber was mounted at the center of the focal plane of the spectrograph.Finally,an^(60)Fe sample with an abundance of 1.125×10^(-10)was used to test the new AMS system.These results indicate that^(60)Fe can be clearly distinguished from the isobar^(60)Ni.The sensitivity was assessed to be better than 4.3×10^(-14)based on blank sample measurements lasting 5.8 h,and the sensitivity could,in principle,be expected to be approximately 2.5×10^(-15)when the data were accumulated for 100 h,which is feasible for future lunar sample measurements because the main contaminants were sufficiently separated.

Rock mass quality prediction on tunnel faces with incomplete multi-source dataset via tree-augmented naive Bayesian network

Rock mass quality serves as a vital index for predicting the stability and safety status of rock tunnel faces.In tunneling practice,the rock mass quality is often assessed via a combination of qualitative and quantitative parameters.However,due to the harsh on-site construction conditions,it is rather difficult to obtain some of the evaluation parameters which are essential for the rock mass quality prediction.In this study,a novel improved Swin Transformer is proposed to detect,segment,and quantify rock mass characteristic parameters such as water leakage,fractures,weak interlayers.The site experiment results demonstrate that the improved Swin Transformer achieves optimal segmentation results and achieving accuracies of 92%,81%,and 86%for water leakage,fractures,and weak interlayers,respectively.A multisource rock tunnel face characteristic(RTFC)dataset includes 11 parameters for predicting rock mass quality is established.Considering the limitations in predictive performance of incomplete evaluation parameters exist in this dataset,a novel tree-augmented naive Bayesian network(BN)is proposed to address the challenge of the incomplete dataset and achieved a prediction accuracy of 88%.In comparison with other commonly used Machine Learning models the proposed BN-based approach proved an improved performance on predicting the rock mass quality with the incomplete dataset.By utilizing the established BN,a further sensitivity analysis is conducted to quantitatively evaluate the importance of the various parameters,results indicate that the rock strength and fractures parameter exert the most significant influence on rock mass quality.

Effect of eccentric and inclined loading on the bearing capacity of strip footing placed on rock mass

This paper deals with the bearing capacity determination of strip footing on a rock mass in hilly area by considering the influence of inclined and eccentric loading. Applying the generalized HoekBrown failure criterion, the failure behavior of the rock mass is modeled with the help of the power cone programming in the lower bound finite element limit analysis framework. Using bearing capacity factor(Ns), the change in bearing capacity of the strip footing due to the occurrence of eccentrically inclined loading is presented. The variations of the magnitude of Ns are obtained by examining the effects of the Hoek-Brown rock mass strength parameters(uniaxial compressive strength(sci), disturbance factor(D), rock parameter(mi), and Geological Strength Index(GSI)) in the presence of different magnitudes of eccentricity(e) and inclination angle(λ) with respect to the vertical plane, and presented as design charts. Both the inclined loading modes, i.e., inclination towards the center of strip footing(+λ) and inclination away from the center of strip footing(-λ), are adopted to perform the investigation. In addition, the correlation between the input parameters and the corresponding output is developed by utilizing the artificial neural network(ANN). Additionally, from sensitivity analysis, it is observed that inclination angle(λ) is the most sensitive parameter. For practicing engineers, the obtained design equation and design charts can be beneficial to understand the bearing capacity variation in the existence of eccentrically inclined loading in mountain areas.

Impact of body mass index on adverse kidney events in diabetes mellitus patients: A systematic-review and meta-analysis

BACKGROUND The incidence of chronic kidney disease among patients with diabetes mellitus(DM)remains a global concern.Long-term obesity is known to possibly influence the development of type 2 diabetes mellitus.However,no previous meta-analysis has assessed the effects of body mass index(BMI)on adverse kidney events in patients with DM.AIM To determine the impact of BMI on adverse kidney events in patients with DM.METHODS A systematic literature search was performed on the PubMed,ISI Web of Science,Scopus,Ovid,Google Scholar,EMBASE,and BMJ databases.We included trials with the following characteristics:(1)Type of study:Prospective,retrospective,randomized,and non-randomized in design;(2)participants:Restricted to patients with DM aged≥18 years;(3)intervention:No intervention;and(4)kidney adverse events:Onset of diabetic kidney disease[estimated glomerular filtration rate(eGFR)of<60 mL/min/1.73 m2 and/or microalbuminuria value of≥30 mg/g Cr],serum creatinine increase of more than double the baseline or end-stage renal disease(eGFR<15 mL/min/1.73 m2 or dialysis),or death.RESULTS Overall,11 studies involving 801 patients with DM were included.High BMI(≥25 kg/m2)was significantly associated with higher blood pressure(BP)[systolic BP by 0.20,95%confidence interval(CI):0.15–0.25,P<0.00001;diastolic BP by 0.21 mmHg,95%CI:0.04–0.37,P=0.010],serum albumin,triglycerides[standard mean difference(SMD)=0.35,95%CI:0.29–0.41,P<0.00001],low-density lipoprotein(SMD=0.12,95%CI:0.04–0.20,P=0.030),and lower high-density lipoprotein(SMD=–0.36,95%CI:–0.51 to–0.21,P<0.00001)in patients with DM compared with those with low BMIs(<25 kg/m2).Our analysis showed that high BMI was associated with a higher risk ratio of adverse kidney events than low BMI(RR:1.22,95%CI:1.01–1.43,P=0.036).CONCLUSION The present analysis suggested that high BMI was a risk factor for adverse kidney events in patients with DM.

Clinical nursing value of predictive nursing in reducing complications of pregnant women undergoing short-term massive blood transfusion during cesarean section

BACKGROUND Cesarean hemorrhage is one of the serious complications,and short-term massive blood transfusion can easily cause postoperative infection and physical stress response.However,predictive nursing intervention has important clinical significance for it.AIM To explore the effect of predictive nursing intervention on the stress response and complications of women undergoing short-term mass blood transfusion during cesarean section(CS).METHODS A clinical medical record of 100 pregnant women undergoing rapid mass blood transfusion during sections from June 2019 to June 2021.According to the different nursing methods,patients divided into control group(n=50)and observation group(n=50).Among them,the control group implemented routine nursing,and the observation group implemented predictive nursing intervention based on the control group.Moreover,compared the differences in stress res-ponse,complications,and pain scores before and after the nursing of pregnant women undergoing rapid mass blood transfusion during CS.RESULTS The anxiety and depression scores of pregnant women in the two groups were significantly improved after nursing,and the psychological stress response of the observation group was significantly lower than that of the control group(P<0.05).The heart rate and mean arterial pressure(MAP)of the observation group during delivery were lower than those of the control group,and the MAP at the end of delivery was lower than that of the control group(P<0.05).Moreover,different pain scores improved significantly in both groups,with the observation group considerably less than the control group(P<0.05).After nursing,complications such as skin rash,urinary retention,chills,diarrhea,and anaphylactic shock in the observation group were 18%,which significantly higher than in the control group(4%)(P<0.05).CONCLUSION Predictive nursing intervention can effectively relieve the pain,reduce the incidence of complications,improve mood and stress response,and serve as a reference value for the nursing of women undergoing rapid mass transfusion during CS.

心电图联合CK-MB、cTnI、copeptin在急性心肌梗死诊断中的应用价值

目的:评价心电图联合心肌肌钙蛋白(cTnI)、肌酸激酶同工酶(CK-MB)和肽素(copeptin)检测对早期急性心肌梗死(AMI)的诊断价值。方法:选取我院2019年5月—2022年5月收治的80例疑似AMI患者为观察对象,根据冠状动脉造影结果分为AMI组(n=50)和非AMI组(n=30),检测两组患者血清CK-MB、cTnI、copeptin水平,并进行心电图检测,受试者工作特征曲线(ROC)分析心电图联合CK-MB、cTnI、copeptin诊断AMI的效能。结果:心电图确诊AMI 40例,非AMI 14例,诊断AMI灵敏度为80.00%,特异度为46.67%,AMI组患者血清CK-MB、cTnI、copeptin均明显高于非AMI组(P<0.05),ROC曲线分析显示AMI发作后血清CK-MB、cTnI、copeptin水平的最佳截断值分别为24.23U/L、0.61μg/ml、19.63pg/ml,心电图联合CK-MB、cTnI、copeptin检测诊断AMI的AUC明显高于各指标单独检测(P<0.05),灵敏度、特异度分别为83.70%、96.80%。结论:在AMI诊断中,心电图联合血清CK-MB、cTnI、copeptin有利于提高临床诊断的准确率,为早期临床治疗提供重要的参考依据。

Numerical manifold method for thermo-mechanical coupling simulation of fractured rock mass

As a calculation method based on the Galerkin variation,the numerical manifold method(NMM)adopts a double covering system,which can easily deal with discontinuous deformation problems and has a high calculation accuracy.Aiming at the thermo-mechanical(TM)coupling problem of fractured rock masses,this study uses the NMM to simulate the processes of crack initiation and propagation in a rock mass under the influence of temperature field,deduces related system equations,and proposes a penalty function method to deal with boundary conditions.Numerical examples are employed to confirm the effectiveness and high accuracy of this method.By the thermal stress analysis of a thick-walled cylinder(TWC),the simulation of cracking in the TWC under heating and cooling conditions,and the simulation of thermal cracking of the SwedishÄspöPillar Stability Experiment(APSE)rock column,the thermal stress,and TM coupling are obtained.The numerical simulation results are in good agreement with the test data and other numerical results,thus verifying the effectiveness of the NMM in dealing with thermal stress and crack propagation problems of fractured rock masses.

CK-MB对创伤性颅脑损伤患者预后的影响分析

目的探讨CK-MB对创伤性颅脑损伤患者预后的影响。方法选取2022年1月至2022年11月本院接诊的420例创伤性颅脑损伤患者,根据初诊分为预后良好组(333例)和预后不良组(87例),并收集两组患者血CK-MB值进行比较。应用Logistic二元回归分析方法分析患者预后不良的影响因素,并运用ROC曲线分析CK-MB值在预测患者预后不良情况中的价值。结果预后不良组患者的CK-MB值明显高于预后良好组(P<0.05)。Logistic回归分析显示,CK-MB与颅脑损伤患者预后不良存在相关性(P<0.05)。ROC曲线分析显示,CK-MB预测患者预后不良的AUC为0.773,最佳临界值对应的敏感度、特异度分别为60.9%、88.6%。结论创伤性颅脑损伤患者的CK-MB值水平与预后存在相关性,属于独立危险因素,对预测创伤性颅脑损伤患者预后有重要价值。

Mb、cTnⅠ、CK-MB、BNP联合检测对早期急性心肌梗死的诊断价值

目的探讨肌红蛋白(Myoglobin,Mb)、心肌肌钙蛋白Ⅰ(Cardiac Troponin,cTnⅠ)、肌酸激酶同工酶(Creatine Kinase Isoenzymes-MB,CK-MB)、脑利钠肽(Brain Natriuretic Peptide,BNP)联合检测对诊断早期急性心肌梗死的价值。方法选取2020年1月—2022年12月丹阳市人民医院收治的100例早期急性心肌梗死患者与100名健康体检者为研究对象,分别设为心梗组与健康组,均检测Mb、cTnⅠ、CK-MB、BNP水平,比较两组检测值的差异,另根据临床结果,评估联合检测对急性心肌梗死的诊断效能。结果心梗组Mb(92.84±22.52)ng/mL、cTnⅠ(4.96±0.78)ng/mL、CK-MB(48.91±14.62)U/L、BNP(1510.71±268.40)pg/mL,均高于健康组,差异有统计学意义(t=26.425、63.200、22.761、54.726,P均<0.05)。联合检测诊断准确率95.50%、灵敏度96.00%,高于单独检测值,差异有统计学意义(P均<0.05);联合检测诊断特异度95.00%,与单独检测对比,差异无统计学意义(P均>0.05)。结论早期急性梗死患者Mb、cTnⅠ、CK-MB、BNP水平明显异常,联合检测该4项指标可提高诊断效能。

海上自主水面船舶(MASS)的未来发展思考

为便于解决智能船舶发展过程中存在的问题,对各国在海上自主水面船舶(MASS)领域的发展及实践案例进行梳理,对海上安全委员会(MSC)第98次会议以来有关MASS议题的进展情况进行介绍,并对MASS Code的制定进展进行解读。在此基础上,结合700 TEU自主集装箱运输船展望MASS的研制和功能定义。研究成果可为MASS技术后续发展提供一定参考。