益肾别浊丸对糖尿病早期肾病患者血清Periostin水平及尿ACR的影响

目的:观察益肾别浊丸对糖尿病早期肾病患者血清Periostin水平及尿ACR的影响。方法:将180例患者随机分为A、B、C三组,在给予基础治疗的同时,A组加益肾别浊丸10 g,3次/d,B组加缬沙坦胶囊80 mg,1次/d,C组患者加中药益肾别浊丸联合缬沙坦胶囊。于治疗前、治疗1个月及治疗3个月时记录3组患者中医证候积分及临床生化指标。结果:各组患者治疗3个月后较治疗前,症状积分、血脂、尿ACR及血清Periostin水平均有较为明显改善(P<0.05),其中A、C组患者在治疗1个月时部分症状、尿ACR及血清Periostin水平改善较B组更为明显(P<0.05)。结论:益肾别浊丸可改善糖尿病早期肾病临床症状,明显降低患者尿ACR及血清Periostin水平。

尿ACR、CN1在早期糖尿病肾病诊断中的价值

目的探讨尿ACR、CN1诊断早期糖尿病肾病(DN)的价值。方法选取90例DN患者为观察组,90例健康人为对照组,比较两组的尿ACR、CN1以及肾功能指标,分析尿ACR、CN1与DN患者肾功能指标的相关性以及对DN的诊断价值。结果观察组的尿ACR、CN1及血清Scr、BUN、AA、CysC水平高于对照组(P<0.05)。尿ACR、CN1与Scr、BUN、AA、Cys C均呈正相关(P<0.05)。尿ACR、CN1联合检测诊断DN的AUC高于ACR、CN1单独检测(P<0.05)。结论尿ACR、CN1在早期DN患者中表达升高并与患者肾功能指标存在相关性,联合检测二者可提高对早期DN的诊断价值。

ACR-TIRADS和C-TIRADS单独及联合BRAF(V600E)基因检测对BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节的诊断效能比较

背景BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节的诊断一直是临床医师面临的挑战,BRAF(V600E)基因检测常用于术前评估,其特异度高,但敏感度低;美国放射学会和中华医学会超声分会分别提出了美国放射学会甲状腺影像报告和数据系统(American College of Radiology Thyroid Imaging Reporting and Data System,ACR-TIRADS)和中国甲状腺影像报告和数据系统(Chinese Thyroid Imaging Reporting and Data System,C-TIRADS);将TIRADS与BRAF(V600E)基因检测相结合,旨在提高BethesdaⅢ/Ⅳ/Ⅴ类结节的诊断率,并避免不必要的手术和穿刺活检。目的比较ACR-TIRADS与C-TIRADS对BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节的诊断效能,并探讨BARF(V600E)检测的附加价值。方法纳入2020年1月—2023年7月于解放军总医院第一医学中心接受细针穿刺活检并行BRAF(V600E)基因检测的484例患者(484个甲状腺结节),以病理组织学为“金标准”,比较ACR-TIRADS、C-TIRADS单独及联合BRAF(V600E)基因检测对BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节的诊断价值。结果两种超声分层系统中甲状腺结节的恶性风险随着分级的升高逐渐增加(趋势χ2检验,P均<0.001),ACR-TIRADS、C-TIRADS的最佳截断值分别为5类、4c类。BRAF(V600E)基因检测在不降低诊断特异度的基础上显著提高了ACR-TIRADS(0.809 vs 0.778,P<0.001)和C-TIRADS(0.815 vs 0.783,P<0.001)对BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节良恶性的诊断效能。ACR-TIRADS与C-TIRADS单独及联合BRAF(V600E)基因检测的曲线下面积(area under the curve,AUC)差异无统计学意义(0.778 vs 0.783,P=0.755;0.809 vs 0.815,P=0.675),但C-TIRADS单独及联合BRAF(V600E)基因检测的敏感度(88.83%vs 83.90%,P<0.001;95.33%vs 90.13%,P<0.001)和准确度(84.50%vs 81.41%,P<0.001;89.67%vs86.36%,P<0.001)高于ACR-TIRADS单独及联合诊断,而ACR-TIRADS单独及联合诊断的特异度相等,均高于C-TIRADS(71.72%vs 67.68%,P<0.001)。结论BRAF(V600E)基因检测可以在不降低特异度的基础上显著提高ACR-TIRADS、C-TIRADS对BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节良恶性的诊断性能,其中C-TIRADS单独及联合整体诊断性能最佳,在临床实践中具有一定的应用潜力。

探讨C-TIRADS分类及ACR-TIRADS分类在诊断桥本甲状腺炎背景下桥本结节和甲状腺乳头状癌中的应用价值

目的:探讨中国甲状腺结节超声恶性危险分层(C-TIRADS)分类及美国放射学会发布的(ACRTIRADS)分类在诊断桥本甲状腺炎背景下桥本结节和甲状腺乳头状癌中的应用价值。方法:选择惠州市第一人民医院2021年1月-2023年1月住院的患者72例,所有患者伴有桥本结节或甲状腺乳头状癌共134个结节,均进行超声检查,并以术后病理检查为金标准,将其划分为HT组(25例,结节数目38个)和PTC组(47例,结节数目96个),对比两组的影像学表现,及C-TIRADS分类、ACR-TIRADS分类对诊断结节良恶性程度的比较。结果:两组患者的超声特征比较,HT多表现为边界不清晰、边缘不规则、高/等回声和无局灶性强回声的结节,PTC多表现为边缘不规则不清晰、低回声、微钙化的结节。其中PTC的纵横比、内部结构比值较HT比较,差异无统计学意义(P>0.05),PTC的边缘、回声、钙化、声晕等比值较HT比值升高,差异有统计学意义(P<0.05);C-TIRADS分类TR3恶性率14.29%、TR4恶性率18.18%、TR5恶性率98.90%,ACR-TIRADS分类4B类恶性率43.33%、4C类恶性率89.19%、5类恶性率98.00%,其对结节恶性性质的比较,差异有统计学意义(P<0.05)。结论:ACR-TIRADS分级方法对桥本结节和甲状腺乳头状癌诊断较为复杂,而C-TIRADS的分级方法更为简便,且更贴近临床。

Seasonal increase in nest defense,but not egg rejection,in a cuckoo host

The interactions between avian brood parasites and their hosts provide an informative and easy-to-handle system for studying coevolution.Avian brood parasitism reduces the reproductive success of hosts,and thus,hosts have evolved anti-parasitic strategies,such as rejecting parasitic eggs and adopting aggressive nest defense strategies,to avoid the cost brought on by brood parasitism.To test whether host anti-parasitic strategies are adjusted with the risk of being parasitized when the breeding seasons of brood parasites and hosts are not synchronous,we conducted a field experiment assessing nest defense and egg recognition behaviors of the Isabelline Shrike(Lanius isabellinus),a host of the Common Cuckoo(Cuculus canorus).In the local area,the host Isabelline Shrike begins to breed in April,whereas the summer migratory Common Cuckoo migrates to the local area in May and begins to lay parasitic eggs.Results showed that nest defense behaviors of the Isabelline Shrike increases significantly after cuckoo arrival,showing higher aggressiveness to cuckoo dummies,with no significant difference in attack rates among cuckoo,sparrowhawk and dove dummies,but their egg rejection did not change significantly.These results imply that Isabelline Shrikes may adjust their nest defense behavior,but not egg rejection behavior,with seasonality.

To analyze the differentially expressed genes in chronic rejection after renal transplantation by bioinformatics

Objective: To use bioinformatics technology to analyse differentially expressed genes in chronic rejection after renal transplantation, we can screen out potential pathogenic targets associated with the development of this disease, providing a theoretical basis for finding new therapeutic targets. Methods: Gene microarray data were downloaded from the Gene Expression Profiling Integrated Database (GEO) and cross-calculated to identify differentially expressed genes (DEGs). Analysis of differentially expressed genes (DEGs) with gene ontology (GO) is a method used to study the differences in gene expression under different conditions as well as their functions and interrelationships, while Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis is a tool used to explore the functions and pathways of genes in specific biological processes. By calculating the distribution of immune cell infiltration, the result of immune infiltration in the rejection group can be analysed as a trait in Weighted Gene Co-Expression Network Analysis (WGCNA) for genes associated with rejection. Then, protein-protein interaction networks (PPI) were constructed using the STRING database and Cytoscape software to identify hub gene markers. Results: A total of 60 integrated DEGs were obtained from 3 datasets (GSE7392, GSE181757, GSE222889). By GO and KEGG analysis, the GEDs were mainly concentrated in the regulation of immune response, defence response, regulation of immune system processes, and stimulation response. The pathways were mainly enriched in antigen processing and presentation, EBV infection, graft-versus-host, allograft rejection, and natural killer cell-mediated cytotoxicity. After further screening using WGCNA and PPI networks, HLA-A, HLA-B, HLA-F, and TYROBP were identified as hub genes (Hub genes). The data GSE21374 with clinical information was selected to construct the diagnostic efficacy and risk prediction model plots of the four hub genes, and the results concluded that all four Hub genes had good diagnostic value (area under the curve in the range of 0.794-0.819). From the inference, it can be concluded that the four genes, HLA-A, HLA-B, HLA-F and TYROBP, may have an important role in the development and progression of chronic rejection after renal transplantation. Conclusion: DEGs play an important role in the study of the pathogenesis of chronic rejection after renal transplantation, and can provide theoretical support for further research on the pathogenesis of chronic rejection after renal transplantation and the discovery of new therapeutic targets through enrichment analysis and pivotal gene screening, as well as inferential analyses of related diagnostic efficacy and disease risk prediction.

Disturbances rejection optimization based on improved two-degree-of-freedom LADRC for permanent magnet synchronous motor systems

Permanent magnet synchronous motor(PMSM)speed control systems with conventional linear active disturbance rejection control(CLADRC)strategy encounter issues regarding the coupling between dynamic response and disturbance suppression and have poor performance in suppressing complex nonlinear disturbances.In order to address these issues,this paper proposes an improved two-degree-of-freedom LADRC(TDOF-LADRC)strategy,which can enhance the disturbance rejection performance of the system while decoupling entirely the system's dynamic and anti-disturbance performance to boost the system robustness and simplify controller parameter tuning.PMSM models that consider total disturbances are developed to design the TDOF-LADRC speed controller accurately.Moreover,to evaluate the control performance of the TDOF-LADRC strategy,its stability is proven,and the influence of each controller parameter on the system control performance is analyzed.Based on it,a comparison is made between the disturbance observation ability and anti-disturbance performance of TDOF-LADRC and CLADRC to prove the superiority of TDOF-LADRC in rejecting disturbances.Finally,experiments are performed on a 750 W PMSM experimental platform,and the results demonstrate that the proposed TDOF-LADRC exhibits the properties of two degrees of freedom and improves the disturbance rejection performance of the PMSM system.

Impact of COVID-19 on liver transplant recipients: A nationwide cohort study evaluating hospitalization, transplant rejection, and inpatient mortality

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has posed a major public health concern worldwide.Patients with comorbid conditions are at risk of adverse outcomes following COVID-19.Solid organ transplant recipients with concurrent immunosuppression and comorbidities are more susceptible to a severe COVID-19 infection.It could lead to higher rates of inpatient complications and mortality in this patient population.However,studies on COVID-19 outcomes in liver transplant(LT)recipients have yielded inconsistent findings.AIM To evaluate the impact of the COVID-19 pandemic on hospital-related outcomes among LT recipients in the United States.METHODS We conducted a retrospective cohort study using the 2019–2020 National Inpatient Sample database.Patients with primary LT hospitalizations and a secondary COVID-19 diagnosis were identified using the International Classi-fication of Diseases,Tenth Revision coding system.The primary outcomes included trends in LT hospitalizations before and during the COVID-19 pandemic.Secondary outcomes included comparative trends in inpatient mortality and transplant rejection in LT recipients.RESULTS A total of 15720 hospitalized LT recipients were included.Approximately 0.8% of patients had a secondary diagnosis of COVID-19 infection.In both cohorts,the median admission age was 57 years.The linear trends for LT hospitalizations did not differ significantly before and during the pandemic(P=0.84).The frequency of in-hospital mortality for LT recipients increased from 1.7% to 4.4% between January 2019 and December 2020.Compared to the pre-pandemic period,a higher association was noted between LT recipients and in-hospital mortality during the pandemic,with an odds ratio(OR)of 1.69[95% confidence interval(CI):1.55-1.84),P<0.001].The frequency of transplant rejections among hospitalized LT recipients increased from 0.2%to 3.6% between January 2019 and December 2020.LT hospitalizations during the COVID-19 pandemic had a higher association with transplant rejection than before the pandemic[OR:1.53(95%CI:1.26-1.85),P<0.001].CONCLUSION The hospitalization rates for LT recipients were comparable before and during the pandemic.Inpatient mortality and transplant rejection rates for hospitalized LT recipients were increased during the COVID-19 pandemic.

老年T2DM患者Hcy、ACR与糖尿病周围血管病变的相关性分析

目的本研究旨在探讨老年2型糖尿病患者血清同型半胱氨酸(Hcy)水平以及尿蛋白与肌酐比值(ACR)与糖尿病所致周围血管病变之间的关联。选择104例2022年3月至2023年1月在甘肃省第二人民医院老年医学科首次确诊为2型糖尿病患者作为研究对象,按照糖尿病周围血管病变诊断标准分为合并周围血管病变和不合并周围血管病变的对照组。两组患者都接受了踝肱指数(ABI)和微量白蛋白尿(MAU)检测。同时尿蛋白排泄率以ACR表示。同时血清中的Hcy、C反应蛋白、糖化血红蛋白、血尿酸、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇检测了两组含量;结果老年糖尿病患者周围血管病变组的年龄、低密度脂蛋白胆固醇(LDL-C)、血尿酸(SUA)、C反应蛋白水平均高于非糖尿病周围血管病变组,男性患者发生周围血管病变的比例明显高于女性患者,差异具有统计学意义(P<0.05)。两组患者在甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、血清Hcy、ACR和糖化血红蛋白方面进行了比较,结果显示差异不具有统计学意义(P>0.05)。在进行多因素logistic回归分析时,将周围血管病变作为因变量,性别、血尿酸、LDL-C、年龄和C反应蛋白作为自变量,结果表明,男性发病率是女性的3.826倍,P<0.05,性别是老年患者发生糖尿病周围血管病变的独立影响因素(OR 3.826);而C反应蛋白、血尿酸、LDL-C和年龄则对糖尿病周围血管病变没有显著影响(P>0.05);结论在老年2型糖尿病患者中,ACR和同型半胱氨酸水平与糖尿病周围血管病变没有明显相关性,而性别、年龄、LDL-C和SUA水平则是影响因素。在这些因素中,性别是老年患者发生糖尿病周围血管病变的独立影响因素。

Temperature Control of Proton Exchange Membrane Fuel Cell Based on Linear Active Disturbance Rejection Control

The performance of proton exchange membrane fuel cells is very sensitive to temperature. The electrochemical reaction results directly in temperature variations in the proton exchange membrane fuel cell. Ensuring effective temperature control is crucial to ensure fuel cell reliability and durability. This paper uses active disturbance rejection control in the thermal management system to maintain the operating temperature and the stack inlet and outlet temperature difference at the set value. First, key cooling system modules such as expansion tanks, coolant circulation pumps and radiators based on Simulink were built. Then, physical modeling and simulation of the fuel cell cooling system was carried out. In order to ensure the effectiveness of the control strategy and reduce the parameter tuning workload, an active disturbance rejection control parameter optimization method using an elite genetic algorithm was proposed. When the optimized control strategy responds to input disturbances, the maximum overshoot of the system is only 1.23% and can reach stability again in 30 s, so the fuel cell temperature can be controlled effectively. Simulation results show that the optimized control strategy can effectively control the stack temperature and coolant temperature difference under the influence of stepped charging current without interference or with interference, and has strong robustness and anti-interference capability.

The Impact of The Three-Dimensional Cultivation Model on the Development of the Suzhou Tea Industry:Estimating Value of Output Per Acre and Diversified Sales Models

This article explores the impact of the three-dimensional cultivation mode on the development of the Suzhou tea industry,focusing on the diversified estimation of the value of output per acre and sales mode.It introduces the history and traditional cultivation practices of tea in Suzhou,as well as the current challenges and problems faced by the industry.An in-depth analysis was conducted on the overview and improvement plans of the three-dimensional cultivation mode,covering relevant technical methods.Based on this analysis,the impact of the three-dimensional cultivation on the value of output per acre was studied and predicted.Its potential and advantages were explored and compared with the effectiveness of traditional cultivation models.Additionally,the impact of the three-dimensional cultivation mode on sales was analyzed,examining its market adaptability and competitiveness,as well as its advantages in expanding sales channels and market coverage.The study also focused on the promoting effect of diversified sales models on the Suzhou tea industry,including direct consumption market development,tea processing product development and promotion,and the integration of tea culture and the tourism industry.To ensure sustainable development,the article evaluates the environmental impact,economic feasibility,social benefits,and farmer benefits of the three-dimensional cultivation model.Finally,the prospects for the development of the Suzhou tea industry were discussed,and the positioning and response strategies of the threedimensional cultivation model were proposed.

生脉散合血府逐瘀汤加减方对气阴两虚、心血瘀阻型慢性心力衰竭患者相关疗效性指标及NT-proBNP、ACR的影响

【目的】探究生脉散合血府逐瘀汤加减方对气阴两虚、心血瘀阻型慢性心力衰竭(CHF)患者的相关疗效性指标及N末端B型脑钠肽(NT–proBNP)、尿白蛋白/肌酐比值(ACR)水平的影响。【方法】将80例气阴两虚、心血瘀阻型CHF患者随机分为对照组和观察组,每组各40例。对照组给予常规西药抗心衰治疗,观察组在对照组的基础上加用生脉散合血府逐瘀汤加减方治疗,疗程为6周。观察2组患者治疗前后心功能指标、血流动力学指标、6 min步行距离、血清NT–proBNP及ACR水平的变化情况。【结果】(1)心功能方面,治疗后,2组患者的左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)等心功能指标均较治疗前改善(P<0.05),且观察组对各项心功能指标的改善作用均明显优于对照组(P<0.01)。(2)血流动力学方面:治疗后,2组患者的平均二尖瓣跨瓣压差(MVPG)、左心房平均压(MLAP)、肺动脉平均压(MPAP)等血流动力学指标均较治疗前改善(P<0.05),且观察组对各项血流动力学指标的改善作用均明显优于对照组(P<0.05或P<0.01)。(3)6 min步行距离方面,治疗后,2组患者的6 min步行距离均较治疗前明显提高(P<0.01),且观察组对6 min步行距离的提高幅度明显优于对照组(P<0.05)。(4)生化指标方面,治疗后,2组患者的血清NT-proBNP、ACR水平均较治疗前明显降低(P<0.05),且观察组对血清NT-proBNP、ACR水平的降低作用均明显优于对照组(P<0.01)。【结论】生脉散合血府逐瘀汤加减方能有效改善气阴两虚、心血瘀阻型CHF患者的各项疗效性指标,降低血清NT–proBNP水平,并可防治CHF患者的早期肾功能损害。

mALB、ACR及β2-MG检测在妊娠期糖尿病早期肾损伤诊断中的效能

目的探讨尿微量白蛋白(mALB)、尿微量白蛋白与尿肌酐比值(ACR)、尿β2-微球蛋白(β2-MG)在妊娠期糖尿病早期肾损伤诊断中的效能。方法以2020年1月至2020年12月本院138例妊娠期糖尿病(GDM)患者为对象视作疾病组,按照患者是否合并早期肾损伤分为GDM肾损伤组、GDM组,另外选取50例健康孕妇为健康组,全部研究对象均接受mALB、ACR及β2-MG检测,分析不同患者检测结果差异,绘制受试者工作曲线(ROC)分析三项指标单一及联合检测对GDM早期肾损伤的诊断效能。结果GDM组、GDM肾损伤组尿mALB、ACR、β2-MG检测阳性率均高于健康组,且GDM肾损伤组阳性率均高于GDM组(P<0.05)。GDM组、GDM肾损伤组尿mALB、ACR、β2-MG水平均高于健康组,且GDM肾损伤组水平均高于GDM组(P<0.05)。mALB阳性诊断GDM肾损伤的敏感性、特异性、准确性分别为80.33%、90.91%、86.23%,ACR诊断分别为75.41%、89.61%、83.33%,β2-MG诊断分别为77.05%、90.91%、84.78%,mALB、ACR、β2-MG联合诊断为93.44%、84.78%、93.48%,三项指标联合检测的敏感性、准确性均高于单一检测(P<0.05),组间特异性差异无统计学意义(P>0.05)。结论mALB、ACR及β2-MG联合检测对妊娠期糖尿病早期肾损伤的诊断效能明显优于各指标单一检测,GDM患者mALB、ACR及β2-MG水平升高提示肾损伤可能,临床应做好监测工作,以保证及早干预。

The Dual Regulatory Roles of Macrophages in Acute Allogeneic Organ Graft Rejection

Innate immune cells are critical for transplant response.As an important cellular component of innate immune cells,macrophages are the predominate infiltrated cells in allografts,and macrophage accumulation in allografts is negatively associated with the short-and long-term outcomes of organ transplantation.Macrophages are functionally heterogeneous and plastic.They participate in organ graft rejection through multiple pathways,including antigen presentation,the expression of costimulatory molecules and cytokines,and direct cytotoxicity and injury ability to allografts.However,some macrophage subpopulations,such as regulatory macrophages,can protect allografts from immune rejection and promote transplant immune tolerance with their immune regulatory properties.Although researchers recognize the potential roles macrophages play in allograft injury,they pay insufficient attention to the diverse roles of macrophages in allograft rejection.We herein briefly summarize the distinctive roles of macrophages in acute transplant immune response and the effect of immunosuppressive drugs on macrophages.Greater attention should be paid to the complex and critical function of macrophages in allograft rejection,and more effort should be put into developing immunosuppressive drugs that specifically target macrophages,which would ultimately improve the long-term survival of organ grafts in patients.

基于ACR TI-RADS对甲状腺髓样癌的诊断价值及诊断方法改良

目的探讨美国放射学会制定的甲状腺影像报告和数据系统(ACR TI-RADS)在甲状腺髓样癌(MTC)中的超声诊断价值,基于ACR TI-RADS提出补充评分模式形成对MTC的改良诊断法。方法回顾性分析我院2012—2018年483例甲状腺结节(MTC 80例、PTC 179例、良性224例)的超声及病理资料,参照ACR TI-RADS以病理为金标准,以结节总得分构建ROC曲线。对分级在1~4级的结节通过二元Logistic回归分析不同特征对MTC诊断影响的OR值。采用加权最小二乘法和确定赋分权重比例,利用组内发生率比值确定权重以构建MTC补充评分模式。收集我院2018—2019年198例甲状腺结节(MTC 14例、PTC 95例、良性89例)的超声及病理资料,验证改良法诊断效果。结果MTC在ACR TI-RADS评分系统下的平均得分为(6.65±3.098)分,依据ROC曲线判断最佳诊断界值为4.5分,灵敏度、特异度和准确度分别为72.5%、67.9%和69.1%。ACR TI-RADS分级为1~4级的结节中内部血流丰富度、回声、位置、大小4个特征P<0.05且OR值较大,以此制定赋分诊断标准。改良后MTC诊断灵敏度90.0%,准确率75.0%,验证组采用改良法,MTC诊断灵敏度85.7%,准确率71.8%。结论ACR TI-RADS在MTC诊断中具有一定的临床价值,但灵敏度不高。采用改良诊断法,有助于提高对MTC诊断的灵敏度和准确度。

ACR TI-RADS与C-TIRADS在评估桥本甲状腺炎背景下甲状腺结节良恶性中的应用

桥本甲状腺炎(HT)是常见的甲状腺特异性自身免疫性疾病,甲状腺发生弥漫性病变和/或局限性病变。随着疾病进展,超声上可表现为腺体回声不均匀性减低、网格样条索状高回声以及类似结节的病变[1],又称为桥本结节或结节样桥本甲状腺炎(NHT)。HT可合并甲状腺癌的各种类型,以甲状腺乳头状癌(PTC)最为常见,滤泡癌、髓样癌少见[2]。超声检查是甲状腺结节首选的影像学检查方法,超声诊断的准确性又高度依赖医生的经验,为了总结,规范、提升超声检查对甲状腺结节的评估,先后提出多个针对甲状腺成像的影像报告与数据系统(TI-RADS)。

Egg recognition and nestling discrimination in the Crested Myna(Acridotheres cristatellus):Size matters

Most studies exploring abilities of hosts to detect brood parasitism are based on detecting colour and/or pattern differences among parasitic and host eggs or nestlings,while only few were focused on size differences.True recognition and recognition by discordancy are used to explain cognitive mechanisms of host egg recognition;however,only a few studies have found that hosts use recognition by discordancy.This study investigated:1)whether egg and nestling recognitions in the Crested Myna(Acridotheres cristatellus) are based on size cues;2)whether the egg cognitive mechanism is recognition by discordancy based on size cues;and 3) whether the longer the experiment time,the higher the egg recognition rate.Our results showed that the Crested Myna uses egg or nestling size as a recognition cue while the egg and nestling colour and patterning are not associated with egg or nestling rejection,thus the cognitive mechanism of egg recognition in the Crested Myna is recognition by discordancy based on egg size cues.Furthermore,there is a rejection delay in time of egg rejection behaviour of the Crested Myna.Therefore,we suggest that the periodicity of egg rejection experiments could be appropriately extended,especially for species with relatively low egg recognition ability.

Robust Consensus Tracking Control of Uncertain Multi-Agent Systems With Local Disturbance Rejection

In this paper,a new distributed consensus tracking protocol incorporating local disturbance rejection is devised for a multi-agent system with heterogeneous dynamic uncertainties and disturbances over a directed graph.It is of two-degree-of-freedom nature.Specifically,a robust distributed controller is designed for consensus tracking,while a local disturbance estimator is designed for each agent without requiring the input channel information of disturbances.The condition for asymptotic disturbance rejection is derived.Moreover,even when the disturbance model is not exactly known,the developed method also provides good disturbance-rejection performance.Then,a robust stabilization condition with less conservativeness is derived for the whole multi-agent system.Further,a design algorithm is given.Finally,comparisons with the conventional one-degree-of-freedombased distributed disturbance-rejection method for mismatched disturbances and the distributed extended-state observer for matched disturbances validate the developed method.

ACR、Cys C、ApoA1水平与慢性心力衰竭患者病情严重程度及预后的相关性分析

目的分析尿微量白蛋白/尿肌酐比值(ACR)、半胱氨酸蛋白酶抑制剂C(Cys C)、载脂蛋白A 1(ApoA1)水平和慢性心力衰竭(CHF)患者病情严重程度及预后的相关性。方法选取2022年1月至2023年1月北京和平里医院收治的CHF患者98例为研究对象,根据美国纽约心脏病学会(NYHA)心功能分级分为Ⅱ级组41例、Ⅲ级组34例、Ⅳ级组23例,收集患者一般资料及心脏超声检查指标,并检测ACR、Cys C及ApoA1水平,比较NYHA不同分级患者的ACR、Cys C及ApoA1水平,分析CHF患者NYHA分级和左心室射血分数(LVEF)与ACR、Cys C、ApoA1的相关性。对CHF患者随访3个月,以是否发生不良心血管事件(MACE)分为预后不良组(29例)和预后良好组(69例),单、多因素分析影响MACE发生的因素,ROC曲线分析ACR、Cys C、ApoA1预测CHF患者发生MACE的应用价值。结果ACR与Cys C水平在NYHA不同分级患者的比较,均为Ⅱ级<Ⅲ级<Ⅳ级(F=47.229、151.515,P<0.05),ApoA1水平比较,为Ⅱ级>Ⅲ级>Ⅳ级(F=36.637,P<0.05),Pearson显示,ACR及Cys C与NYHA分级呈正相关(r=0.413、0.627,P<0.05),与LVEF呈负相关(r=-0.312、-0.531,P<0.05),ApoA1与NYHA分级呈负相关(r=-0.253,P<0.05),与LVEF呈正相关(r=0.417,P<0.05),多因素Logistic分析显示,年龄及ACR、Cys C、ApoA1水平是CHF患者发生MACE的独立影响因素(P<0.05),ROC曲线显示,ACR、Cys C、ApoA1及联合预测CHF患者发生MACE的曲线下面积分别为0.874、0.853、0.862、0.962。结论ACR、Cys C、ApoA1水平会随CHF患者病情变化而改变,联合检测其水平对于预测CHF患者是否发生MACE具有较好的应用价值。

Egg rejection and egg recognition mechanism in a Chinese Azure-winged Magpie(Cyanopica cyanus)population

Recognition and rejection of foreign eggs are effective defense of hosts against brood parasitism.However,brood parasitism can impose various selection pressures on different geographic populations of the same host species.In a multiple cuckoo system in China,Azure-winged Magpies(Cyanopica cyanus)are parasitized by both Indian Cuckoos(Cuculus micropterus)and Asian Koels(Eudynamys scolopaceus).In this study,egg recognition ability and recognition mechanism of the Azure-winged Magpie were investigated using a population in Fusong,southeastern Jilin,China.The results showed that 55.6%(20/36)of the Azure-winged Magpies correctly rejected quail(Coturnix japonica)eggs in their nests,while 13.9%(5/36)of the individuals experienced rejection costs by wrongly rejecting their own eggs.Azure-winged Magpies could accurately reject the experimental eggs when the number of such eggs in the nests was the same as that of the magpie eggs.However,Azure-winged Magpies do not recognize and reject conspecific eggs(0/28).The present study indicates that the Azure-winged Magpie has moderate egg recognition ability toward non-mimetic quail eggs and shows a true recognition mechanism with rejecting foreign eggs by accurately recognizing their own eggs.However,they cannot recognize conspecific eggs.