End-stage liver disease score and future liver remnant volume predict post-hepatectomy liver failure in hepatocellular carcinoma

BACKGROUND Hepatocellular carcinoma(HCC)is the world’s sixth most common malignant tumor and the third cause of cancer death.Although great progress has been made in hepatectomy,it is still associated with a certain degree of risk of posthepatectomy liver failure(PHLF),which extends the length of hospital stay and remains the leading cause of postoperative death.Studies have shown that assessment of hepatic functional reserve before hepatectomy is beneficial for reducing the incidence of PHLF.AIM To assess the value of model for end-stage liver disease(MELD)score combined with standardized future liver remnant(sFLR)volume in predicting PHLF in patients undergoing hepatectomy for HCC.METHODS This study was attended by 238 patients with HCC who underwent hepatectomy between January 2015 and January 2018.Discrimination of sFLR volume,MELD score,and sFLR/MELD ratio to predict PHLF was evaluated according to the area under the receiver operating characteristic curve.RESULTS The patients were divided into two groups according to whether PHLF occurred after hepatectomy.The incidence of PHLF was 8.4%in our research.The incidence of PHLF increased with the decrease in sFLR volume and the increase in MELD score.Both sFLR volume and MELD score were considered independent predictive factors for PHLF.Moreover,the cut-off value of the sFLR/MELD score to predict PHLF was 0.078(P<0.001).This suggests that an sFLR/MELD≥0.078 indicates a higher incidence of PHLF than an sFLR/MELD<0.078.CONCLUSION MELD combined with sFLR is a reliable and effective PHLF predictor,which is superior to MELD score or sFLR volume alone.

Progress in hepatitis B virus-related acute-on-chronic liver failure treatment in China:A large,multicenter,retrospective cohort study using a propensity score matching analysis

Background:Hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)has a high short-term mortality.However,the treatment progression for HBV-ACLF in China in the past decade has not been well characterized.The present study aimed to determine whether the HBV-ACLF treatment has significantly improved during the past decade.Methods:This study retrospectively compared short-term(28/56 days)survival rates of two different nationwide cohorts(cohort I:2008-2011 and cohort II:2012-2015).Eligible HBV-ACLF patients were enrolled retrospectively.Patients in the cohorts I and II were assigned either to the standard medical therapy(SMT)group(cohort I-SMT,cohort II-SMT)or artificial liver support system(ALSS)group(cohort IALSS,cohort II-ALSS).Propensity score matching analysis was conducted to eliminate baseline differences,and multivariate logistic regression analysis was used to explore the independent factors for 28-day survival.Results:Short-term(28/56 days)survival rates were significantly higher in the ALSS group than those in the SMT group(P<0.05)and were higher in the cohort II than those in the cohort I(P<0.001).After propensity score matching,short-term(28/56 days)survival rates were higher in the cohort II than those in the cohort I for both SMT(60.7%vs.53.0%,50.0%vs.39.8%,P<0.05)and ALSS(66.1%vs.56.5%,53.0%vs.44.4%,P<0.05)treatments.The 28-day survival rate was higher in patients treated with nucleos(t)ide analogs than in patients without such treatments(P=0.046).Multivariate logistic regression analysis revealed that ALSS(OR=0.962,95%CI:0.951-0.973,P=0.038),nucleos(t)ide analogs(OR=0.927,95%CI:0.871-0.983,P=0.046),old age(OR=1.028,95%CI:1.015-1.041,P<0.001),total bilirubin(OR=1.002,95%CI:1.001-1.003,P=0.004),INR(OR=1.569,95%CI:1.044-2.358,P<0.001),COSSH-ACLF grade(OR=2.683,95%CI:1.792-4.017,P<0.001),and albumin(OR=0.952,95%CI:0.924-0.982,P=0.002)were independent factors for 28-day mortality.Conclusions:The treatment for patients with HBV-ACLF has improved in the past decade.

Failure Assessment of Aero-engine Support Structure due to Blade-off

Aero-engine blade-off event could cause serious malfunction and endanger flight safety,which is an important issue widely concerned for a long period.This paper presents a comprehensive review on the regulation requirements,the major research methods and status at home and abroad.Firstly,the relevant certification regulations and standards about aero-engine structure safety due to blade-off event were overviewed and the research gaps between the abroad and the domestic were compared.Then,the simulation and experimental methodologies on aero-engine supporting structures undertake abnormal load due to blade-off event were discussed as major issue.Finally,the safety certification verification technology system for aero-engine support structures during blade-off event was proposed.

Evaluation of the Reliability Performance of Failure Criteria for Composite Structures

Evolution of materials, following the design requirements of special structures, has shifted interest towards development of composite members able to meet strength requirements “tailored” to specific applications. These members can provide appropriate, more cost effective structures, however absence of generic design guidelines raise constraints towards derivation of optimized structures. Reliability-based assessment can overcome this limitation by ensuring that acceptable levels of target reliability are achieved throughout their service life. This paper presents a methodology for reliability assessment of composite members based on appropriate limit state functions derived according to fundamental failure criteria, Tsai-Hill and Tsai-Wu, applicable to composite materials. The methodology that is proposed employs a Stochastic Response Surface Method (SRSM) which combines in discrete steps FEA modelling, numerical simulations and analytical probabilistic assessment techniques, allowing use of commercial and custom developed specialized numerical tools. Application of the proposed methodology on a complex composite structural geometry will illustrate its efficiency and evaluate the reliability performance of the limit states derived and examined.

Calibration of Four Nonlinear Failure Envelopes from Triaxial Test Data and Influence of Nonlinearity on Geotechnical Computations

It is now recognized that many geomaterials have nonlinear failure envelopes. This non-linearity is most marked at lower stress levels, the failure envelope being of quasi-parabolic shape. It is not easy to calibrate these nonlinear failure envelopes from triaxial test data. Currently only the power-type failure envelope has been studied with an established formal procedure for its determination from triaxial test data. In this paper, a simplified procedure is evolved for the development of four different types of nonlinear envelopes. These are of invaluable assistance in the evaluation of true factors of safety in problems of slope stability and correct computation of lateral earth pressure and bearing capacity. The use of the Mohr-Coulomb failure envelopes leads to an overestimation of the factors of safety and other geotechnical quantities.

集成电路固有失效机理的可靠性评价综述

ULSI/VLSI集成电路芯片的可靠性既与设计有关,也与工艺加工过程有关,即芯片的可靠性是设计进去、制造出来。设计是集成电路芯片可靠性的基础,工艺制造是集成电路芯片可靠性的实现。要使超大规模集成电路在特定的寿命期间内能够稳定地工作,必须对影响集成电路芯片可靠性的固有失效机理进行评价。评价的目的是确定磨损失效的机理,通过改进设计和工艺加工水平确保集成电路芯片在整个产品寿命期间有良好的可靠性。本文梳理了国内外集成电路芯片固有失效机理的可靠性评价标准,阐述了这些固有失效机理的产生机制,总结了不同固有失效机理的试验方法,提出了固有失效机理的可靠性评价要求。这些标准、方法和可靠性评价要求具有很强的时效性,集成电路芯片固有失效机理的可靠性评价将在工艺开发、建库及工程服务中发挥作用,并有助于推动国内合格生产线认证的开展。

左西孟旦在急性心肌梗死合并心力衰竭患者中的应用

目的 分析左西孟旦在急性心肌梗死(AMI)合并心力衰竭患者中的应用效果。方法 选取2018年1月至2022年11月北京市大兴区人民医院收治的106例AMI合并心力衰竭患者作为研究对象,按照随机数字表法将其分为两组,各53例。对照组采用标准化治疗,观察组同时联合左西孟旦治疗。比较两组治疗前后血清炎症因子[超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、血流动力学水平[心指数(CI)、全心舒张末容积指数(GEDVI)、全身血管阻力指数(SVRI)]、心功能指标[左室射血分数(LVEF)、每搏输出量(SV)、B型尿钠肽(BNP)],及临床疗效和不良反应总发生率。结果 治疗后,两组hs-CRP、IL-6、TNF-α、GEDI、SVRI、BNP水平均低于治疗前,且观察组低于对照组(P<0.05);治疗后,两组CI、LVEF、SV水平均高于治疗前,且观察组高于对照组(P<0.05)。观察组临床疗效高于对照组(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论 标准化治疗基础上联合左西孟旦治疗AMI合并心力衰竭能够有效缓解患者的炎症反应,稳定血流动力学,改善心功能和临床疗效,且无明显不良反应。

中医药防治射血分数保留心力衰竭的研究范式思考

射血分数保留的心力衰竭(heart failure with preserved ejection fraction,HFpEF)发病率逐年递增,患病人数庞大,如何发挥中医药防治HFpEF优势、提升中医药防治HFpEF能力成为关键。针对HFpEF自身发病特点和目前存在的问题,本文对中医药防治HFpEF的研究范式进行了探讨:(1)建立HFpEF病名、诊断、疗效评价于一体的标准化体系,从顶层设计确保研究的可比性,促进中医药研究走向国际化;(2)立足于规模化群防群治,在病证结合思路指导下分疾病阶段、抓核心病机形成核心方进行序贯治疗,在规模化防治中总结和提升疗效;(3)多学科交叉合作,对不同亚型的HFpEF诊治方案和临床转归做出精准决策;(4)在健康中国战略思维指导下,着眼长期可持续性发展,从“以预防为主,防治结合,中西医并重”的治疗理念逐渐发展到“以健康为中心”的治未病理念,从治疗HFpEF到关注HFpEF患者,再到从全局关注全生命周期的健康逐步转变。

达格列净结合标准抗心衰及降糖方案治疗老年慢性心力衰竭合并T2DM及高尿酸血症的临床分析

目的探究对老年慢性心力衰竭合并2型糖尿病(Diabetes Mellitus Type 2,T2DM)及高尿酸血症患者采用达格列净和标准抗心衰及降糖方案结合治疗后效果。方法随机选取2021年6月—2022年6月广州市花都区人民医院收治的心力衰竭合并T2DM及高尿酸血症患者120例为研究对象,采用随机数表法分成对照组(60例)、观察组(60例)。对照组采取标准抗心衰及降糖方案,观察组在对照组基础上采取达格列净,对比临床效果。结果观察组氨基末端脑钠肽前体(N Terminal Pro B Type Natriuretic Peptide,NT-proBNP)为(519.36±107.52)ng/L、血尿酸为(346.17±42.15)μmol/L低于对照组,差异有统计学意义(t=2.020、4.245,P<0.05)。观察组血脂改善更好,左室舒张末容积、左室收缩末容积、舒张早期二尖瓣血流速度/二尖瓣环运动速度(the Ratio of Early Diastolic Transmitral Flow Velocity to Mitral Annular Velocity,E/e’)低于对照组,左室射血分数高于对照组,差异有统计学意义(P<0.05)。观察组主要终点事件、次要终点事件、痛风发作率低于对照组,差异有统计学意义(P<0.05)。两组药物不良反应率对比,差异无统计学意义(P>0.05)。结论针对老年慢性心力衰竭合并T2DM及高尿酸血症患者,采用达格列净联合标准抗心衰及降糖方案,能改善血脂、心功能等指标水平,预后效果以及安全性较高。

一种抑制后续换相失败的电流偏差控制参数整定方法

电网换相换流器型高压直流输电(line commutated converter-based high voltage direct current,LCC-HVDC)系统若发生后续换相失败,将严重影响交直流混联电网的安全稳定运行。文中首先针对LCC-HVDC系统故障恢复过程中电流偏差控制作用阶段易再次发生换相失败的问题,对电流偏差控制参数与换相失败之间的关系进行理论分析,发现此阶段系统若不发生换相失败,逆变侧LCC直流电压和交流换相电压须满足一定的约束关系,且该约束关系受电流偏差控制参数的直接影响。然后,基于理论分析结果,提出一种电流偏差控制参数整定方法,可改善系统故障恢复过程中对直流电压恢复速度和程度的控制要求,使系统更易满足直流电压与交流换相电压稳定运行约束关系,以降低后续换相失败概率。最后,利用PSCAD/EMTDC仿真平台CIGRE标准测试模型验证了理论分析的正确性以及参数整定方法的有效性。

经鼻高流量湿化氧疗在呼吸衰竭低氧血症患者中的应用及规范化护理研究

目的:经鼻高流量湿化氧疗在呼吸衰竭低氧血症患者中的应用及规范化护理效果研究。方法:本次研究从山东大学齐鲁医院2022年1月到2023年6月收入的呼吸衰竭低氧血症患者中随机抽取76例,按照随机数表法将其分为了对照组和观察组两组。对照组接受常规治疗和护理,观察组接受经鼻高流量湿化氧疗以及规范化护理。结果:对照组综合满意29例(76.32%),观察组综合满意36例(94.74%),观察组综合护理满意率显著高于对照组,差异有统计学意义,(P<0.05);治疗后观察组的血气指标结果优于对照组,(P<0.05),有统计学意义;对照组并发症10例(26.32%),观察组并发症3例(7.89%),观察组并发症显著低于对照组,差异有统计学意义,(P<0.05)。结论:经鼻高流量湿化氧疗联合规范化护理方式可以稳定呼吸衰竭患者的临床体征,改善血气指标,降低并发症发生率,可推广。

医疗失效模式与效应分析管理模式在降低急性脑卒中患者肺部感染中的应用研究

目的探讨医疗失效模式与效应分析(HFMEA)管理模式降低急性脑卒中患者肺部感染率的应用效果。方法选择2023年1-7月我院神经内科收治的114例急性脑卒中患者为研究对象。将2023年1-3月HFMEA实施前的57例患者为对照组;2023年4-7月HFMEA实施后的57例患者作为观察组。应用HFMEA评估工具,对引发肺部感染的潜在风险因素及风险环节进行分析,计算风险优先指数(RPN),对RPN>125分项目制定改进措施并评价其应用效果。结果应用HFMEA管理模式后,观察组6项失效模式的RPN值均低于对照组(P<0.05),监管其过程3项标准预防的合格率及3项护理流程合格率均高于对照组(P<0.05)。观察组患者肺部感染率、平均住院时间、平均住院费用均低于对照组(P<0.05)。结论应用HFMEA管理模式后,临床护士针对医院感染风险因素及环节,落实专科感控技术标准预防措施,规范关键环节护理流程,联合督导核查及感控技术得以持续质量改进,可降低急性脑卒中患者肺部感染发生率,缩短住院时间,降低住院费用。

标准化护理流程联合PDCA循环管理在重症监护室心力衰竭患者中的应用

目的:探讨标准化护理流程联合PDCA循环管理在重症监护室(intensive care unit,ICU)心力衰竭患者中的应用。方法:选取2022年1月—2023年12月清华大学附属北京清华长庚医院收治的110例ICU心力衰竭患者。根据随机数表法将其分为对照组(n=54)和观察组(n=56)。对照组采用常规护理,观察组采用标准化护理流程联合PDCA循环管理。比较两组护理前后生命体征、生活质量,时间指标,护理满意度。结果:护理后,两组收缩压、舒张压均升高,心率降低,观察组收缩压、舒张压均高于对照组,心率低于对照组,差异有统计学意义(P<0.05)。观察组住ICU时间、总住院时间均短于对照组,差异有统计学意义(P<0.05)。护理后,两组生理功能、生理职能、躯体疼痛、总体健康、活力、社会功能、情感职能、精神健康评分均升高,观察组生理功能、生理职能、躯体疼痛、总体健康、活力、社会功能、情感职能、精神健康评分均高于对照组,差异有统计学意义(P<0.05)。观察组护理总满意度为96.43%,高于对照组的83.33%,差异有统计学意义(P<0.05)。结论:标准化护理流程联合PDCA循环管理能维持ICU心力衰竭患者生命体征稳定,缩短住院时间,有效改善患者生活质量,且护理满意度更高。

标准化护理在EICU心力衰竭患者中的应用效果

目的:分析对急诊重症监护室(EICU)中的心力衰竭患者实施标准化护理的应用效果。方法:选择山东大学齐鲁医院于2021年11月至2023年10月EICU收治的76例心力衰竭患者,将2021年11月至2022年10月收治的患者设为对照组(38例),采用常规护理,2022年11月至2023年10月收治的患者设为观察组(38例),采用标准化护理,对比两组的干预效果。结果:观察组院内反应时间、急救反应时间、致残率、HAMA焦虑评分、HAMD抑郁评分、血压、心率、并发症发生率均明显低于对照组,观察组舒适度GCQ评分明显高于对照组,差异显著(P<0.05)。结论:标准化护理可显著提高EICU心力衰竭患者干预效果,显著缓解患者不良情绪,有效改善心功能,促进血压、心率恢复,减少并发症发生,从而提高舒适度,有较高应用价值。

慢性肾衰中医诊疗标准现状研究述评

中医药治疗慢性肾衰具有一定的临床优势,现有的慢性肾衰指南更多的是较为完善的中西医结合指南,虽内容不断充实,但缺少中医药特色。通过对既往发布的慢性肾衰中医和中西医结合行业学会标准进行梳理和分析,发现其中存在局限性,建议完善慢性肾衰的病因病机,规范辨证分型体系,增加证据等级推荐,完善疗效评价及非药物治疗和中医综合治疗标准化流程,增加辨证运动,补充合并症/并发症和慢性肾脏疾病(CKD)5期透析患者的中医药治疗指导,为建立更加完善慢性肾衰中医诊疗标准提供思路。

标准化护理程序对重症监护室心衰患者血压的影响研究

目的:探究标准化护理程序对重症监护室心衰患者血压的影响。方法:从南京市中医院重症监护室收治的心衰患者中选取病例参与研究,时间范围为2023年1月至12月,样本容量为58例。随机分组后,对照组(n=29)给予常规护理,观察组(n=29)给予标准化护理,对比两组护理效果。结果:护理前,两组患者血压差异无统计学意义(P>0.05),护理后,观察组患者收缩压、舒张压均低于对照组(P<0.05)。结论:在重症监护室心衰患者的临床治疗中,标准化护理模式的运用确有成效,能够改善血压水平,提升患者满意度,可以加强研究应用。

标准化护理干预对老年慢性心力衰竭患者自我管理和心功能的影响

目的:讨论临床护理老年慢性心力衰竭患者时标准化护理的干预效果,以及对患者心功能与自我管理能力的影响。方法:选择2022年10月至2023年10月期间南京医科大学附属南京医院收治的98例老年慢性心力衰竭患者作为研究对象,由随机数字表开展分组讨论,对照组49例、试验组49例,分别实施常规干预、标准化护理流程干预,针对组间心功能、自我管理能力及满意度展开分析。结果:干预前,试验组及对照组的心功能比较差异不突出(P﹥0.05),试验组干预后的心功能指标均小于对照组,左心射血分数大于对照组(P﹤0.05)。试验组干预之后的自我管理能力评估得分较对照组更高(P﹤0.05)。试验组患者护理满意度95.92%高于对照组79.59%(P﹤0.05)。结论:对老年慢性心力衰竭患者给予标准化护理干预,可明显改善患者心功能,提高患者自我管理能力,护理满意度较高。

Predicting liver function after hemihepatectomy in patients with hepatocellular carcinoma using different modalities

In response to Dr.Yue et al's study on prognostic factors for post-hemihep-atectomy outcomes in hepatocellular carcinoma(HCC)patients,this critical review identifies methodological limitations and proposes enhancements for future research.While the study identifies liver stiffness measure and standard residual liver volume as potential predictors,concerns regarding small sample size,reliance on biochemical markers for safety assessment,and inadequate ad-justment for confounding variables are raised.Recommendations for rigorous methodology,including robust statistical analysis,consideration of confounding factors,and selection of outcome measures with clinical components,are proposed to strengthen prognostic assessments.Furthermore,validation of novel evaluation models is crucial for enhancing clinical applicability and advancing understanding of postoperative outcomes in patients with HCC undergoing hem-ihepatectomy.

自动变速器清洁度综述及失效影响

零件清洁度是用来表示零件清洁水平的指标,是指清洗后在零件或产品一定表面上残留的污染物的限量值,涉及颗粒物的种类、大小、数量和质量等特征。对于自动变速器,清洁度要求相较于手动变速器更高,因此,清洁度的深入研究对自动变速器的研发过程及质量管理过程至关重要。文章针对自动变速器产品,通过研究国外主流变速器厂家清洁度的推行现状,从清洁度标准、检测、过程控制及失效影响四个维度分别进行总结介绍,为国内自主变速器厂家清洁度管控提供参考。

石油天然气工业微生物腐蚀的标准化现状

在油气田注水、水力压裂、油气集输与污水处理中,微生物腐蚀已经成为导致石油管材和设备腐蚀失效的主要原因之一。与常见的CO_(2)、H_(2)S和O_(2)等所造成的电化学腐蚀相比,微生物腐蚀具有独特性,它涉及到微生物的生命活动或代谢产物与金属的相互作用。从微生物来源、微生物腐蚀失效和微生物腐蚀标准化3个方面系统综述了石油天然气工业中微生物腐蚀的标准化现状。现有的微生物分析和杀菌剂评价方法和传统的腐蚀试验方法已然不能满足油气行业中微生物腐蚀控制的需求。在微生物及其生物作用的精准识别、微生物腐蚀试验流程的统一和杀菌剂对生物膜的使用效能评价方面存在较多问题。因此,建立微生物腐蚀失效分析程序和微生物腐蚀试验方法、开发微生物腐蚀控制用杀菌剂产品及其效能评价方法是石油天然气工业微生物腐蚀标准化的主要研究方向。