Endoscopic-retrograde-cholangiopancreatography(ERCP) is now a vital modality with primarily therapeutic and occasionally solely diagnostic utility for numerous biliary/pancreatic disorders. It has a significantly stee...Endoscopic-retrograde-cholangiopancreatography(ERCP) is now a vital modality with primarily therapeutic and occasionally solely diagnostic utility for numerous biliary/pancreatic disorders. It has a significantly steeper learning curve than that for other standard gastrointestinal(GI) endoscopies, such as esophagogastroduodenoscopy or colonoscopy, due to greater technical difficulty and higher risk of complications. Yet, GI fellows have limited exposure to ERCP during standard-three-year-GI-fellowships because ERCP is much less frequently performed than esophagogastroduodenoscopy/colonoscopy. This led to adding an optional year of training in therapeutic endoscopy. Yet many graduates from standard three-year-fellowships without advanced training intensely pursue independent/unsupervised ERCP privileges despite inadequate numbers of performed ERCPs and unacceptably low rates of successful selective cannulation of desired(biliary or pancreatic) duct. Hospital credentialing committees have traditionally performed ERCP credentialing, but this practice has led to widespread flouting of recommended guidelines(e.g., planned privileging of applicant with 20% successful cannulation rate, or after performing only 7 ERCPs);and intense politicking of committee members by applicants, their practice groups, and potential competitors. Consequently, some gastroenterologists upon completing standard fellowships train and learn ERCP 'on the job' during independent/unsupervised practice, which can result in bad outcomes: high rates of failed bile duct cannulation. This severe clinical problem is indicated by publication of ≥ 12 ERCP competency studies/guidelines during last 5 years. However, lack of mandatory, quantitative, ERCP credentialing criteria has permitted neglect of recommended guidelines. This work comprehensively reviews literature on ERCP credentialing;reviews rationales for proposed guidelines;reports problems with current system;and proposes novel criteria for competency. This work advocates for mandatory, national, written,minimum, quantitative, standards, including cognitive skills(possibly assessed by a nationwide examination), and technical skills, assessed by number performed(≥ 200-250 ERCPs), types of ERCPs, success rate(approximately ≥ 90%cannulation of desired duct), and letters of recommendation by program director/ERCP mentor. Mandatory criteria should ideally not be monitored by a hospital committee subjected to intense politicking by applicants, their employers, and sometimes even competitors, but an independent national entity,like the National Board of Medical Examiners/American Board of Internal Medicine.展开更多
The current standards in radiotherapy of high-grade gliomas(HGG) are based on anatomic imaging techniques, usually computed tomography(CT) scanning and magnetic resonance imaging(MRI). The guidelines vary depending on...The current standards in radiotherapy of high-grade gliomas(HGG) are based on anatomic imaging techniques, usually computed tomography(CT) scanning and magnetic resonance imaging(MRI). The guidelines vary depending on whether the HGG is a histological grade 3 anaplastic glioma(AG) or a grade 4 glioblastoma multiforme(GBM). For AG, T2-weighted MRI sequences plus the region of contrast enhancement in T1 are considered for the delineation of the gross tumor volume(GTV), and an isotropic expansion of 15 to 20 mm is recommended for the clinical target volume(CTV). For GBM, the Radiation Therapy Oncology Group favors a two-step technique, with an initial phase(CTV1) including any T2 hyperintensity area(edema) plus a 20 mm margin treated with up to 46 Gy in 23 fractions, followed by a reduction in CTV2 to the contrast enhancement region in T1 with an additional 25 mm margin. The European Organisation of Research and Treatment of Cancer recommends a single-phase technique with a unique GTV, which comprises the T1 contrast enhancement region plus a margin of 20 to 30 mm. A total dose of 60 Gy in 30 fractions is usually delivered for GBM, and a dose of 59.4 Gy in 33 fractions is typically given for AG. As more than 85% of HGGs recur in field, dose-escalation studies have shown that 70 to 75 Gy can be delivered in 6 weeks with relevant toxicities developing in < 10% of the patients. However, the only randomized dose-escalation trial, in which the boost dose was guided by conventional MRI, did not show any survival advantage of this treatment over the reference arm. HGGs are amongst the most infiltrative and heterogeneous tumors, and it was hypothesized that the most highly aggressive areas were missed; thus, better visualization of these high-risk regions for radiation boost could decrease the recurrence rate. Innovations in imaging and linear accelerators(LINAC) could help deliver the right doses of radiation to the right subvolumes according to the dose-painting concept. Advanced imaging techniques provide functional information on cellular density(diffusion MRI), angiogenesis(perfusion MRI), metabolic activity and cellular proliferation [positron emission tomography(PET) and magnetic resonance spectroscopy(MRS)]. All of these non-invasive techniques demonstrated good association between the images and histology, with up to 40% of HGGs functionally presenting a high activity within the non- contrast-enhanced areas in T1. New LINAC technologies, such as intensity-modulated and stereotactic radiotherapy, help to deliver a simultaneous integrated boost(SIB) > 60 Gy. Trials delivering a SIB into a biological GTV showed the feasibility of this treatment, but the final results, in terms of clinical benefits for HGG patients, are still pending. Many issues have been identified: the variety of MRI and PET machines(and amino-acid tracers), the heterogeneity of the protocols used for image acquisition and post-treatment, the geometric distortion and the unreliable algorithms for co-registration of brain anatomy with functional maps, and the semi-quiescent but highly invasive HGG cells. These issues could be solved by the homogenization of the protocols and software applications, the simultaneous acquisition of anatomic and functional images(PET-MRI machines), the combination of complementary imaging tools(perfusion and diffusion MRI), and the concomitant addition of some ad hoc targeted drugs against angiogenesis and invasiveness to chemoradiotherapy. The integration of these hybrid data will construct new synthetic metrics for fully individualized treatments.展开更多
目的运用循证医学方法对腕踝针干预术后疼痛的疗效和安全性进行系统评价和Grade评价。方法计算机检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、Embase、Web of Science、Cochrane Library中关于腕踝针干预术后疼痛的随...目的运用循证医学方法对腕踝针干预术后疼痛的疗效和安全性进行系统评价和Grade评价。方法计算机检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、Embase、Web of Science、Cochrane Library中关于腕踝针干预术后疼痛的随机对照试验,检索时限为建库至2023年10月。采用RevMan 5.4软件进行Meta分析。结果纳入23篇文献,共计1968例患者,Meta分析结果显示,与常规治疗相比,腕踝针能够提高术后疼痛患者的总有效率[OR=4.42,95%CI(2.60,7.50),P<0.001],术后镇痛泵药量使用减少[MD=-9.03,95%CI(-12.09,-5.98),P<0.001],术后疼痛评分降低[MD=-1.39,95%CI(-1.68,-1.09),P<0.001],可减少不良反应发生率[RR=0.40,95%CI(0.32,0.48),P<0.001]以及临床满意度[OR=3.94,95%CI(2.40,6.48),P<0.001]。Grade证据分级结果显示:总有效率、不良反应发生率和临床满意度3项结局指标为中等质量证据,VAS评分指标为低质量证据,镇痛泵药量使用指标为极低质量证据。结论腕踝针可提高总有效率,减少术后镇痛药用量,不良反应少,安全性高,为患者提供了一种安全有效的镇痛方式。展开更多
为了系统评价参芪扶正注射液联合常规治疗作为干预措施对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者的临床疗效和安全性。检索中国国家知识基础设施(China national knowledge infrastructure,CNKI)、PubMed、...为了系统评价参芪扶正注射液联合常规治疗作为干预措施对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者的临床疗效和安全性。检索中国国家知识基础设施(China national knowledge infrastructure,CNKI)、PubMed、万方数据知识服务平台(Wanfang Data)、维普中文科技期刊数据库(Weipu China science and technology journal database,VIP)等数据库,筛选并纳入2023年6月18日以前发表的参芪扶正注射液联合常规疗法治疗COPD患者的随机对照试验(randomized controlled trials,RCT),采用Cochrane风险评价工具及评估、发展和评价建议分级(grading of recommendations assessment,development and evaluation,GRADE)系统进行文献证据质量评价,用RevMan 5.4软件对临床疗效及安全性指标进行Meta分析。结果表明,共纳入16项RCTs,1 486例患者。Meta分析结果显示,参芪扶正注射液辅助治疗可提高患者总有效率和第1秒用力呼气容积/用力肺活量比值(forced expiratory volume in one second/forced vital capacity,FEV1/FVC)指标,与对照组相比具有优势(P<0.000 01、P<0.000 1);不良反应少,无严重不良反应(adverse drug reactions,ADR),两组对比无统计学差异(P=0.32);GRADE评价结果显示,有效率及不良反应指标的证据质量均为中等级,肺功能为低等级。可见参芪扶正注射辅助治疗COPD可以提高患者临床疗效,改善肺功能,且具有良好的安全性。但所纳入研究具有局限性,证据质量不高,仍需结合中药辨证使用特点,规范实验方案,开展更多的高质量RCT研究。展开更多
Background:The Mongolian gerbil is an excellent laboratory animal for preparing the cerebral ischemia model due to its inherent deficiency in the circle of Willis.However,the low incidence and unpredictability of symp...Background:The Mongolian gerbil is an excellent laboratory animal for preparing the cerebral ischemia model due to its inherent deficiency in the circle of Willis.However,the low incidence and unpredictability of symptoms are caused by numerous complex variant types of the circle.Additionally,the lack of an evaluation system for the cer-ebral ischemia/reperfusion(I/R)model of gerbils has shackled the application of this model.Methods:We created a symptom-oriented principle and detailed neurobehavioral scoring criteria.At different time points of reperfusion,we analyzed the alteration in locomotion by rotarod test and grip force score,infarct volume by triphenyltetrazo-lium chloride(TTC)staining,neuron loss using Nissl staining,and histological charac-teristics using hematoxylin-eosin(H&E)straining.Results:With a successful model rate of 56%,32 of the 57 gerbils operated by our method harbored typical features of cerebral I/R injury,and the mortality rate in the male gerbils was significantly higher than that in the female gerbils.The suc-cessfully prepared I/R gerbils demonstrated a significant reduction in motility and grip strength at 1 day after reperfusion;formed obvious infarction;exhibited typi-cal pathological features,such as tissue edema,neuronal atrophy and death,and vacuolated structures;and were partially recovered with the extension of reperfu-sion time.Conclusion:This study developed a new method for the unilateral common carotid artery ligation I/R model of gerbil and established a standardized evaluation system for this model,which could provide a new cerebral I/R model of gerbils with more practical applications.展开更多
目的系统评价补肾方剂改善高龄女性自然妊娠结局的临床疗效和安全性。方法检索中国知网、万方数据库、维普数据库、SinoMed、PubMed、Web of Science、Cochrane Library、Embase等数据库建库至2022年6月收录的补肾方剂改善高龄女性自然...目的系统评价补肾方剂改善高龄女性自然妊娠结局的临床疗效和安全性。方法检索中国知网、万方数据库、维普数据库、SinoMed、PubMed、Web of Science、Cochrane Library、Embase等数据库建库至2022年6月收录的补肾方剂改善高龄女性自然妊娠结局的随机对照研究(RCT)。运用偏倚风险工具进行质量评估,使用RevMan软件进行Meta分析。结果共纳入14篇RCT。Meta分析结果显示:补肾方剂联合西药治疗在提高妊娠率[RR=1.71,95%CI(1.45,2.01),P<0.00001]、降低卵泡刺激素(FSH)水平[SMD=-1.63,95%CI(-2.84,-0.43),P=0.008]、提高雌二醇(E_(2))水平[SMD=3.97,95%CI(1.76,6.17),P=0.0004]、增加排卵期子宫内膜厚度[SMD=2.12,95%CI(1.07,3.18),P<0.0001]方面均优于西药组;且补肾方剂单独使用在提高妊娠率[RR=1.94,95%CI(1.31,2.88),P=0.001]、降低FSH水平[SMD=-0.48,95%CI(-0.74,-0.22),P=0.0003]方面也具有显著疗效。结论与西医治疗比较,补肾方剂可以显著改善高龄女性自然妊娠结局,且不良反应较少,但仍需更多高质量、大样本、多中心的RCT予以验证。展开更多
The Rural Minimum Living Standard Guarantee(Rural Dibao)is an important unconditional cash transfer program to alleviate poverty in rural China.Despite the importance of children’s nutrition in breaking poverty cycle...The Rural Minimum Living Standard Guarantee(Rural Dibao)is an important unconditional cash transfer program to alleviate poverty in rural China.Despite the importance of children’s nutrition in breaking poverty cycles,little is known about the impact of Rural Dibao on child nutrition outcomes.Using China Family Panel Studies(CFPS),this paper examines the effects of Rural Dibao on child nutrition outcomes and investigates potential pathways and heterogeneous effects.We exploit propensity score matching and difference-in-differences techniques to evaluate the effects of the Rural Dibao program on child nutrition outcomes.Our results suggest that Rural Dibao significantly impacts the nutrition outcomes of children up to 15 years of age.Specifically,our results suggest that Rural Dibao improves child height-to-age z-scores by 1.05 standard deviations and lowers the probability of stunting by 11.9 percentage points.Additional analyses suggest that increased protein intake is the main pathway through which Rural Dibao participation contributes to better nutrition outcomes.We also find that the effect of the program is more pronounced among girls,children who are non-left-behind or live with highly educated mothers,and those from low-income families and poor areas.Our findings suggest that Rural Dibao participation helps improve child nutrition outcomes through improving diet quality.展开更多
目的:评价温针灸治疗原发性痛经的有效性和安全性。方法:根据PRISMA指南进行系统综述和荟萃分析。收集PubMed、Web of Science、EMBASE、Cochrane Library、中国知网、维普、万方、中国生物医学数据库自建库至2023年5月的随机对照试验...目的:评价温针灸治疗原发性痛经的有效性和安全性。方法:根据PRISMA指南进行系统综述和荟萃分析。收集PubMed、Web of Science、EMBASE、Cochrane Library、中国知网、维普、万方、中国生物医学数据库自建库至2023年5月的随机对照试验。使用Review Manager 5.4对所有获得的数据进行分析。结果:温针灸治疗原发性痛经在提高临床疗效{风险比(RR)=1.21,95%置信区间(CI)[1.16,1.25],P<0.00001},改善阻力指数(RI){均数差(MD)=-0.14,95%CI[-0.19,-0.08],P<0.00001}、搏动指数(PI)(MD=-0.55,95%CI[-0.69,-0.40],P<0.00001)、β-内啡肽(β-EP){标准化均数差(SMD)=1.36,95%CI[0.90,1.82],P<0.00001}、痛经证候积分(MD=-1.82,95%CI[-2.77,-0.87],P=0.0002)、疼痛视觉模拟评分法(VAS)评分(MD=-1.16,95%CI[-1.48,-0.83],P<0.00001)方面的作用优于单独的常规治疗,并且在不良反应发生率(P=0.01)方面低于对照组。证据质量等级评价结果显示临床疗效为中级,其他多为低级。结论:温针灸治疗原发性痛经的疗效明确,并且具有一定的安全性。展开更多
目的分析PTGD后择期LC治疗对GradeⅡ急性胆囊炎ACTH、MPO及Cor水平的影响。方法选取2021年12月至2023年5月安徽中科庚玖医院收治的急性胆囊炎患者121例,根据治疗方案分为三组,即甲组(急诊行LC治疗,未行PTGD)38例、乙组(PTGD引流管拔出后...目的分析PTGD后择期LC治疗对GradeⅡ急性胆囊炎ACTH、MPO及Cor水平的影响。方法选取2021年12月至2023年5月安徽中科庚玖医院收治的急性胆囊炎患者121例,根据治疗方案分为三组,即甲组(急诊行LC治疗,未行PTGD)38例、乙组(PTGD引流管拔出后72 h后行LC,早期)43例和丙组(PTGD引流管拔出后14~30 d后行LC,晚期)40例。对比三组手术情况、炎症因子、肝功能、ACTH、MP、Cor水平及并发症发生率。结果甲组LC手术时长、术后卧床时长及住院天数均长于丙组、乙组,失血量、中转开腹率高于丙组、乙组,差异有统计学意义(P<0.05);丙组LC手术时长、术后卧床时长及住院天数均长于乙组,差异具有统计学意义(P<0.05)。LC术后1 d hs-CRP、PCT、IL-6、ST、ALT、ALP、ACTH、MPO及Cor:甲组>丙组>乙组,差异有统计学意义(P<0.05)。并发症发生率:甲组>丙组>乙组,差异有统计学意义(P<0.05)。结论PTGD后择期LC治疗对GradeⅡ急性胆囊炎ACTH、MPO及Cor水平影响小,且并发症低;而PTGD后早期行LC能有效改善肝功能、炎症因子,且术后应激反应更低,值得临床推广。展开更多
The induction motor,which converts electrical energy into mechanical energy,has been recognized as the cornerstone of industrialization.The rotor of an induction motor can be either a squirrel cage rotor or a wound-ty...The induction motor,which converts electrical energy into mechanical energy,has been recognized as the cornerstone of industrialization.The rotor of an induction motor can be either a squirrel cage rotor or a wound-type rotor,both existing as magnetless topologies.Three-phase squirrel cage induction motors are frequently utilized in industrial drives because they are dependable,have high starting torque,are selfstarting and affordable.Single-phase induction motors,on the other hand,are commonly used for small loads such as domestic appliances in form of modest fans,pumps and electric power tools.In South Africa,there have been reports of fires and explosions resulting in live and property loss because of induction motors that have not been thoroughly tested or are incorrectly labelled in terms of ratings,electrical safety and performance.The goal of this study is targeted at preventing end-user injuries and failures caused by non-compliant induction motors,by evaluating locally manufactured/imported induction motors based on tests and evaluation from standards(IEC and SANS).The study is conducted using experimental procedures at the Explosion Prevention Technology and Rotating Machines(EPT and RM)laboratory,South African Bureau of Standards(SABS),South Africa.The main finding from the study shows differences in the nameplate characteristics of various induction motors which could have detrimental effects such as production and operational downtime in their end-use industries,at later stages.展开更多
Through equilibrium and non-equilibrium molecular dynamics simulations,we have demonstrated the inhibitory effect of composition graded interface on thermal transport behavior in lateral heterostructures.Specifically,...Through equilibrium and non-equilibrium molecular dynamics simulations,we have demonstrated the inhibitory effect of composition graded interface on thermal transport behavior in lateral heterostructures.Specifically,we investigated the influence of composition gradient length and heterogeneous particles at the silicene/germanene(SIL/GER)heterostructure interface on heat conduction.Our results indicate that composition graded interface at the interface diminishes the thermal conductivity of the heterostructure,with a further reduction observed as the length increases,while the effect of the heterogeneous particles can be considered negligible.To unveil the influence of composition graded interface on thermal transport,we conducted phonon analysis and identified the presence of phonon localization within the interface composition graded region.Through these analyses,we have determined that the decrease in thermal conductivity is correlated with phonon localization within the heterostructure,where a stronger degree of phonon localization signifies poorer thermal conductivity in the material.Our research findings not only contribute to understanding the impact of interface gradient-induced phonon localization on thermal transport but also offer insights into the modulation of thermal conductivity in heterostructures.展开更多
Solar-powered interfacial evaporation is an energy-efficient solution for water scarcity.It requires solar absorbers to facilitate upward water transport and limit the heat to the surface for efficient evaporation.Fur...Solar-powered interfacial evaporation is an energy-efficient solution for water scarcity.It requires solar absorbers to facilitate upward water transport and limit the heat to the surface for efficient evaporation.Furthermore,downward salt ion transport is also desired to prevent salt accumulation.However,achieving simultaneously fast water uptake,downward salt transport,and heat localization is challenging due to highly coupled water,mass,and thermal transport.Here,we develop a structurally graded aerogel inspired by tree transport systems to collectively optimize water,salt,and thermal transport.The arched aerogel features root-like,fan-shaped microchannels for rapid water uptake and downward salt diffusion,and horizontally aligned pores near the surface for heat localization through maximizing solar absorption and minimizing conductive heat loss.These structural characteristics gave rise to consistent evaporation rates of 2.09 kg m^(-2) h^(-1) under one-sun illumination in a 3.5 wt%NaCl solution for 7 days without degradation.Even in a high-salinity solution of 20 wt%NaCl,the evaporation rates maintained stable at 1.94 kg m^(-2) h^(-1) for 8 h without salt crystal formation.This work offers a novel microstructural design to address the complex interplay of water,salt,and thermal transport.展开更多
Background Two studies were designed to determine standard ileal crude protein(CP)and amino acid(AA)digestibility of soybean meal(SBM)from different origins fed to non-pregnant and pregnant sows.Seven solvent-extracte...Background Two studies were designed to determine standard ileal crude protein(CP)and amino acid(AA)digestibility of soybean meal(SBM)from different origins fed to non-pregnant and pregnant sows.Seven solvent-extracted SBMs from soybeans produced in the USA,Brazil,and China were selected.In Exp.1,eight different diets were created:a nitrogen(N)-free diet and 7 experimental diets containing SBM from different origins as the only N source.Eight non-pregnant,multiparous sows were arranged in an 8×8 Latin square design(8 periods and 8 diets).In Exp.2,the diet formula was the same as in Exp.1.Eight gestating sows(parity 3)were assigned to 4 different diets in a replicated 4×3 Youden square design(three periods and four diets)in mid-gestation and again in late-gestation stages.Results When fed to non-pregnant and late-gestating sows,the standardized ileal digestibility(SID)of CP and most AAs from different SBM were not significantly different(P>0.05).When fed to mid-gestating sows,the SID values for Arg,His,Lys,Phe,Cys,Gly,Ser,and Tyr in SBM 1 were lower than in SBM 4 and 5(P<0.05),whereas SID for Leu from SBM 5 was higher than in SBM 1 and 4(P<0.05).SID values for Ile,Ala,and Asp from SBM 4 were lower than in SBM 1 and 5(P<0.05).Sows had significantly greater SID values for Lys,Ala,and Asp during mid-gestation when compared with late-gestation stages(P<0.05).Mid-gestating sows had greater SID value for Val and lower SID value for Tyr when compared with non-pregnant and late-gestating sows(P<0.01),whereas non-pregnant sows had significantly greater SID value for Met when compared with gestating sows(P<0.01).Conclusions When fed to mid-gestating sows,the SID values for most AAs varied among SBM samples.The SID values for Lys,Met,Val,Ala,Asp,and Tyr in SBM were affected by sow gestation stages.Our findings provide a cornerstone for accurate SBM use in sow diets.展开更多
文摘Endoscopic-retrograde-cholangiopancreatography(ERCP) is now a vital modality with primarily therapeutic and occasionally solely diagnostic utility for numerous biliary/pancreatic disorders. It has a significantly steeper learning curve than that for other standard gastrointestinal(GI) endoscopies, such as esophagogastroduodenoscopy or colonoscopy, due to greater technical difficulty and higher risk of complications. Yet, GI fellows have limited exposure to ERCP during standard-three-year-GI-fellowships because ERCP is much less frequently performed than esophagogastroduodenoscopy/colonoscopy. This led to adding an optional year of training in therapeutic endoscopy. Yet many graduates from standard three-year-fellowships without advanced training intensely pursue independent/unsupervised ERCP privileges despite inadequate numbers of performed ERCPs and unacceptably low rates of successful selective cannulation of desired(biliary or pancreatic) duct. Hospital credentialing committees have traditionally performed ERCP credentialing, but this practice has led to widespread flouting of recommended guidelines(e.g., planned privileging of applicant with 20% successful cannulation rate, or after performing only 7 ERCPs);and intense politicking of committee members by applicants, their practice groups, and potential competitors. Consequently, some gastroenterologists upon completing standard fellowships train and learn ERCP 'on the job' during independent/unsupervised practice, which can result in bad outcomes: high rates of failed bile duct cannulation. This severe clinical problem is indicated by publication of ≥ 12 ERCP competency studies/guidelines during last 5 years. However, lack of mandatory, quantitative, ERCP credentialing criteria has permitted neglect of recommended guidelines. This work comprehensively reviews literature on ERCP credentialing;reviews rationales for proposed guidelines;reports problems with current system;and proposes novel criteria for competency. This work advocates for mandatory, national, written,minimum, quantitative, standards, including cognitive skills(possibly assessed by a nationwide examination), and technical skills, assessed by number performed(≥ 200-250 ERCPs), types of ERCPs, success rate(approximately ≥ 90%cannulation of desired duct), and letters of recommendation by program director/ERCP mentor. Mandatory criteria should ideally not be monitored by a hospital committee subjected to intense politicking by applicants, their employers, and sometimes even competitors, but an independent national entity,like the National Board of Medical Examiners/American Board of Internal Medicine.
文摘The current standards in radiotherapy of high-grade gliomas(HGG) are based on anatomic imaging techniques, usually computed tomography(CT) scanning and magnetic resonance imaging(MRI). The guidelines vary depending on whether the HGG is a histological grade 3 anaplastic glioma(AG) or a grade 4 glioblastoma multiforme(GBM). For AG, T2-weighted MRI sequences plus the region of contrast enhancement in T1 are considered for the delineation of the gross tumor volume(GTV), and an isotropic expansion of 15 to 20 mm is recommended for the clinical target volume(CTV). For GBM, the Radiation Therapy Oncology Group favors a two-step technique, with an initial phase(CTV1) including any T2 hyperintensity area(edema) plus a 20 mm margin treated with up to 46 Gy in 23 fractions, followed by a reduction in CTV2 to the contrast enhancement region in T1 with an additional 25 mm margin. The European Organisation of Research and Treatment of Cancer recommends a single-phase technique with a unique GTV, which comprises the T1 contrast enhancement region plus a margin of 20 to 30 mm. A total dose of 60 Gy in 30 fractions is usually delivered for GBM, and a dose of 59.4 Gy in 33 fractions is typically given for AG. As more than 85% of HGGs recur in field, dose-escalation studies have shown that 70 to 75 Gy can be delivered in 6 weeks with relevant toxicities developing in < 10% of the patients. However, the only randomized dose-escalation trial, in which the boost dose was guided by conventional MRI, did not show any survival advantage of this treatment over the reference arm. HGGs are amongst the most infiltrative and heterogeneous tumors, and it was hypothesized that the most highly aggressive areas were missed; thus, better visualization of these high-risk regions for radiation boost could decrease the recurrence rate. Innovations in imaging and linear accelerators(LINAC) could help deliver the right doses of radiation to the right subvolumes according to the dose-painting concept. Advanced imaging techniques provide functional information on cellular density(diffusion MRI), angiogenesis(perfusion MRI), metabolic activity and cellular proliferation [positron emission tomography(PET) and magnetic resonance spectroscopy(MRS)]. All of these non-invasive techniques demonstrated good association between the images and histology, with up to 40% of HGGs functionally presenting a high activity within the non- contrast-enhanced areas in T1. New LINAC technologies, such as intensity-modulated and stereotactic radiotherapy, help to deliver a simultaneous integrated boost(SIB) > 60 Gy. Trials delivering a SIB into a biological GTV showed the feasibility of this treatment, but the final results, in terms of clinical benefits for HGG patients, are still pending. Many issues have been identified: the variety of MRI and PET machines(and amino-acid tracers), the heterogeneity of the protocols used for image acquisition and post-treatment, the geometric distortion and the unreliable algorithms for co-registration of brain anatomy with functional maps, and the semi-quiescent but highly invasive HGG cells. These issues could be solved by the homogenization of the protocols and software applications, the simultaneous acquisition of anatomic and functional images(PET-MRI machines), the combination of complementary imaging tools(perfusion and diffusion MRI), and the concomitant addition of some ad hoc targeted drugs against angiogenesis and invasiveness to chemoradiotherapy. The integration of these hybrid data will construct new synthetic metrics for fully individualized treatments.
文摘目的运用循证医学方法对腕踝针干预术后疼痛的疗效和安全性进行系统评价和Grade评价。方法计算机检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、Embase、Web of Science、Cochrane Library中关于腕踝针干预术后疼痛的随机对照试验,检索时限为建库至2023年10月。采用RevMan 5.4软件进行Meta分析。结果纳入23篇文献,共计1968例患者,Meta分析结果显示,与常规治疗相比,腕踝针能够提高术后疼痛患者的总有效率[OR=4.42,95%CI(2.60,7.50),P<0.001],术后镇痛泵药量使用减少[MD=-9.03,95%CI(-12.09,-5.98),P<0.001],术后疼痛评分降低[MD=-1.39,95%CI(-1.68,-1.09),P<0.001],可减少不良反应发生率[RR=0.40,95%CI(0.32,0.48),P<0.001]以及临床满意度[OR=3.94,95%CI(2.40,6.48),P<0.001]。Grade证据分级结果显示:总有效率、不良反应发生率和临床满意度3项结局指标为中等质量证据,VAS评分指标为低质量证据,镇痛泵药量使用指标为极低质量证据。结论腕踝针可提高总有效率,减少术后镇痛药用量,不良反应少,安全性高,为患者提供了一种安全有效的镇痛方式。
文摘为了系统评价参芪扶正注射液联合常规治疗作为干预措施对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者的临床疗效和安全性。检索中国国家知识基础设施(China national knowledge infrastructure,CNKI)、PubMed、万方数据知识服务平台(Wanfang Data)、维普中文科技期刊数据库(Weipu China science and technology journal database,VIP)等数据库,筛选并纳入2023年6月18日以前发表的参芪扶正注射液联合常规疗法治疗COPD患者的随机对照试验(randomized controlled trials,RCT),采用Cochrane风险评价工具及评估、发展和评价建议分级(grading of recommendations assessment,development and evaluation,GRADE)系统进行文献证据质量评价,用RevMan 5.4软件对临床疗效及安全性指标进行Meta分析。结果表明,共纳入16项RCTs,1 486例患者。Meta分析结果显示,参芪扶正注射液辅助治疗可提高患者总有效率和第1秒用力呼气容积/用力肺活量比值(forced expiratory volume in one second/forced vital capacity,FEV1/FVC)指标,与对照组相比具有优势(P<0.000 01、P<0.000 1);不良反应少,无严重不良反应(adverse drug reactions,ADR),两组对比无统计学差异(P=0.32);GRADE评价结果显示,有效率及不良反应指标的证据质量均为中等级,肺功能为低等级。可见参芪扶正注射辅助治疗COPD可以提高患者临床疗效,改善肺功能,且具有良好的安全性。但所纳入研究具有局限性,证据质量不高,仍需结合中药辨证使用特点,规范实验方案,开展更多的高质量RCT研究。
基金National Key Research and Development Program of China,Grant/Award Number:2021YFF0702402National Natural Science Foundation of China,Grant/Award Number:32070531。
文摘Background:The Mongolian gerbil is an excellent laboratory animal for preparing the cerebral ischemia model due to its inherent deficiency in the circle of Willis.However,the low incidence and unpredictability of symptoms are caused by numerous complex variant types of the circle.Additionally,the lack of an evaluation system for the cer-ebral ischemia/reperfusion(I/R)model of gerbils has shackled the application of this model.Methods:We created a symptom-oriented principle and detailed neurobehavioral scoring criteria.At different time points of reperfusion,we analyzed the alteration in locomotion by rotarod test and grip force score,infarct volume by triphenyltetrazo-lium chloride(TTC)staining,neuron loss using Nissl staining,and histological charac-teristics using hematoxylin-eosin(H&E)straining.Results:With a successful model rate of 56%,32 of the 57 gerbils operated by our method harbored typical features of cerebral I/R injury,and the mortality rate in the male gerbils was significantly higher than that in the female gerbils.The suc-cessfully prepared I/R gerbils demonstrated a significant reduction in motility and grip strength at 1 day after reperfusion;formed obvious infarction;exhibited typi-cal pathological features,such as tissue edema,neuronal atrophy and death,and vacuolated structures;and were partially recovered with the extension of reperfu-sion time.Conclusion:This study developed a new method for the unilateral common carotid artery ligation I/R model of gerbil and established a standardized evaluation system for this model,which could provide a new cerebral I/R model of gerbils with more practical applications.
文摘目的系统评价补肾方剂改善高龄女性自然妊娠结局的临床疗效和安全性。方法检索中国知网、万方数据库、维普数据库、SinoMed、PubMed、Web of Science、Cochrane Library、Embase等数据库建库至2022年6月收录的补肾方剂改善高龄女性自然妊娠结局的随机对照研究(RCT)。运用偏倚风险工具进行质量评估,使用RevMan软件进行Meta分析。结果共纳入14篇RCT。Meta分析结果显示:补肾方剂联合西药治疗在提高妊娠率[RR=1.71,95%CI(1.45,2.01),P<0.00001]、降低卵泡刺激素(FSH)水平[SMD=-1.63,95%CI(-2.84,-0.43),P=0.008]、提高雌二醇(E_(2))水平[SMD=3.97,95%CI(1.76,6.17),P=0.0004]、增加排卵期子宫内膜厚度[SMD=2.12,95%CI(1.07,3.18),P<0.0001]方面均优于西药组;且补肾方剂单独使用在提高妊娠率[RR=1.94,95%CI(1.31,2.88),P=0.001]、降低FSH水平[SMD=-0.48,95%CI(-0.74,-0.22),P=0.0003]方面也具有显著疗效。结论与西医治疗比较,补肾方剂可以显著改善高龄女性自然妊娠结局,且不良反应较少,但仍需更多高质量、大样本、多中心的RCT予以验证。
基金The authors are grateful for support from the National Social Science Fund of China(21AJL015).
文摘The Rural Minimum Living Standard Guarantee(Rural Dibao)is an important unconditional cash transfer program to alleviate poverty in rural China.Despite the importance of children’s nutrition in breaking poverty cycles,little is known about the impact of Rural Dibao on child nutrition outcomes.Using China Family Panel Studies(CFPS),this paper examines the effects of Rural Dibao on child nutrition outcomes and investigates potential pathways and heterogeneous effects.We exploit propensity score matching and difference-in-differences techniques to evaluate the effects of the Rural Dibao program on child nutrition outcomes.Our results suggest that Rural Dibao significantly impacts the nutrition outcomes of children up to 15 years of age.Specifically,our results suggest that Rural Dibao improves child height-to-age z-scores by 1.05 standard deviations and lowers the probability of stunting by 11.9 percentage points.Additional analyses suggest that increased protein intake is the main pathway through which Rural Dibao participation contributes to better nutrition outcomes.We also find that the effect of the program is more pronounced among girls,children who are non-left-behind or live with highly educated mothers,and those from low-income families and poor areas.Our findings suggest that Rural Dibao participation helps improve child nutrition outcomes through improving diet quality.
文摘目的分析PTGD后择期LC治疗对GradeⅡ急性胆囊炎ACTH、MPO及Cor水平的影响。方法选取2021年12月至2023年5月安徽中科庚玖医院收治的急性胆囊炎患者121例,根据治疗方案分为三组,即甲组(急诊行LC治疗,未行PTGD)38例、乙组(PTGD引流管拔出后72 h后行LC,早期)43例和丙组(PTGD引流管拔出后14~30 d后行LC,晚期)40例。对比三组手术情况、炎症因子、肝功能、ACTH、MP、Cor水平及并发症发生率。结果甲组LC手术时长、术后卧床时长及住院天数均长于丙组、乙组,失血量、中转开腹率高于丙组、乙组,差异有统计学意义(P<0.05);丙组LC手术时长、术后卧床时长及住院天数均长于乙组,差异具有统计学意义(P<0.05)。LC术后1 d hs-CRP、PCT、IL-6、ST、ALT、ALP、ACTH、MPO及Cor:甲组>丙组>乙组,差异有统计学意义(P<0.05)。并发症发生率:甲组>丙组>乙组,差异有统计学意义(P<0.05)。结论PTGD后择期LC治疗对GradeⅡ急性胆囊炎ACTH、MPO及Cor水平影响小,且并发症低;而PTGD后早期行LC能有效改善肝功能、炎症因子,且术后应激反应更低,值得临床推广。
基金supported in part by Explosion Prevention Technology and Rotating Machines(EPT&RM)laboratory,South African Bureau of Standards(SABS),Pretoria,South Africa.
文摘The induction motor,which converts electrical energy into mechanical energy,has been recognized as the cornerstone of industrialization.The rotor of an induction motor can be either a squirrel cage rotor or a wound-type rotor,both existing as magnetless topologies.Three-phase squirrel cage induction motors are frequently utilized in industrial drives because they are dependable,have high starting torque,are selfstarting and affordable.Single-phase induction motors,on the other hand,are commonly used for small loads such as domestic appliances in form of modest fans,pumps and electric power tools.In South Africa,there have been reports of fires and explosions resulting in live and property loss because of induction motors that have not been thoroughly tested or are incorrectly labelled in terms of ratings,electrical safety and performance.The goal of this study is targeted at preventing end-user injuries and failures caused by non-compliant induction motors,by evaluating locally manufactured/imported induction motors based on tests and evaluation from standards(IEC and SANS).The study is conducted using experimental procedures at the Explosion Prevention Technology and Rotating Machines(EPT and RM)laboratory,South African Bureau of Standards(SABS),South Africa.The main finding from the study shows differences in the nameplate characteristics of various induction motors which could have detrimental effects such as production and operational downtime in their end-use industries,at later stages.
基金Project supported by the National Natural Science Foundation of China (Grant No.12104291)。
文摘Through equilibrium and non-equilibrium molecular dynamics simulations,we have demonstrated the inhibitory effect of composition graded interface on thermal transport behavior in lateral heterostructures.Specifically,we investigated the influence of composition gradient length and heterogeneous particles at the silicene/germanene(SIL/GER)heterostructure interface on heat conduction.Our results indicate that composition graded interface at the interface diminishes the thermal conductivity of the heterostructure,with a further reduction observed as the length increases,while the effect of the heterogeneous particles can be considered negligible.To unveil the influence of composition graded interface on thermal transport,we conducted phonon analysis and identified the presence of phonon localization within the interface composition graded region.Through these analyses,we have determined that the decrease in thermal conductivity is correlated with phonon localization within the heterostructure,where a stronger degree of phonon localization signifies poorer thermal conductivity in the material.Our research findings not only contribute to understanding the impact of interface gradient-induced phonon localization on thermal transport but also offer insights into the modulation of thermal conductivity in heterostructures.
基金financially supported by the Research Grants Council of Hong Kong SAR(16200720)Environment and Conservation Fund of Hong Kong SAR(Project No.21/2022)+2 种基金Young Scientists Fund of National Natural Science Foundation of China(Grant No.52303106)Research Institute for Advanced Manufucturing(Project No.CD8R)the startup fund for new recruits of PolyU(Project Nos.P0038855 and P0038858)。
文摘Solar-powered interfacial evaporation is an energy-efficient solution for water scarcity.It requires solar absorbers to facilitate upward water transport and limit the heat to the surface for efficient evaporation.Furthermore,downward salt ion transport is also desired to prevent salt accumulation.However,achieving simultaneously fast water uptake,downward salt transport,and heat localization is challenging due to highly coupled water,mass,and thermal transport.Here,we develop a structurally graded aerogel inspired by tree transport systems to collectively optimize water,salt,and thermal transport.The arched aerogel features root-like,fan-shaped microchannels for rapid water uptake and downward salt diffusion,and horizontally aligned pores near the surface for heat localization through maximizing solar absorption and minimizing conductive heat loss.These structural characteristics gave rise to consistent evaporation rates of 2.09 kg m^(-2) h^(-1) under one-sun illumination in a 3.5 wt%NaCl solution for 7 days without degradation.Even in a high-salinity solution of 20 wt%NaCl,the evaporation rates maintained stable at 1.94 kg m^(-2) h^(-1) for 8 h without salt crystal formation.This work offers a novel microstructural design to address the complex interplay of water,salt,and thermal transport.
基金funded by the National Key R&D Program of China(No.2021YFD1300202)the nutritional value evaluation and parameter establishment of protein feedstuffs for sowsthe Ministry of Agriculture and Rural Affairs of the People’s Republic of China(125D0203-16190295)the Major Scientific and Technological Special Project of Sichuan Province(No.2021ZDZX0009)。
文摘Background Two studies were designed to determine standard ileal crude protein(CP)and amino acid(AA)digestibility of soybean meal(SBM)from different origins fed to non-pregnant and pregnant sows.Seven solvent-extracted SBMs from soybeans produced in the USA,Brazil,and China were selected.In Exp.1,eight different diets were created:a nitrogen(N)-free diet and 7 experimental diets containing SBM from different origins as the only N source.Eight non-pregnant,multiparous sows were arranged in an 8×8 Latin square design(8 periods and 8 diets).In Exp.2,the diet formula was the same as in Exp.1.Eight gestating sows(parity 3)were assigned to 4 different diets in a replicated 4×3 Youden square design(three periods and four diets)in mid-gestation and again in late-gestation stages.Results When fed to non-pregnant and late-gestating sows,the standardized ileal digestibility(SID)of CP and most AAs from different SBM were not significantly different(P>0.05).When fed to mid-gestating sows,the SID values for Arg,His,Lys,Phe,Cys,Gly,Ser,and Tyr in SBM 1 were lower than in SBM 4 and 5(P<0.05),whereas SID for Leu from SBM 5 was higher than in SBM 1 and 4(P<0.05).SID values for Ile,Ala,and Asp from SBM 4 were lower than in SBM 1 and 5(P<0.05).Sows had significantly greater SID values for Lys,Ala,and Asp during mid-gestation when compared with late-gestation stages(P<0.05).Mid-gestating sows had greater SID value for Val and lower SID value for Tyr when compared with non-pregnant and late-gestating sows(P<0.01),whereas non-pregnant sows had significantly greater SID value for Met when compared with gestating sows(P<0.01).Conclusions When fed to mid-gestating sows,the SID values for most AAs varied among SBM samples.The SID values for Lys,Met,Val,Ala,Asp,and Tyr in SBM were affected by sow gestation stages.Our findings provide a cornerstone for accurate SBM use in sow diets.
