Update in lean metabolic dysfunction-associated steatotic liver disease

BACKGROUND A new nomenclature consensus has emerged for liver diseases that were previously known as non-alcoholic fatty liver disease(NAFLD)and metabolic dysfunction-associated fatty liver disease(MAFLD).They are now defined as metabolic dysfunction-associated steatotic liver disease(MASLD),which includes cardiometabolic criteria in adults.This condition,extensively studied in obese or overweight patients,constitutes around 30%of the population,with a steady increase worldwide.Lean patients account for approximately 10%-15%of the MASLD population.However,the pathogenesis is complex and is not well understood.AIM To systematically review the literature on the diagnosis,pathogenesis,characteristics,and prognosis in lean MASLD patients and provide an interpretation of these new criteria.METHODS We conducted a comprehensive database search on PubMed and Google Scholar between January 2012 and September 2023,specifically focusing on lean NAFLD,MAFLD,or MASLD patients.We include original articles with patients aged 18 years or older,with a lean body mass index categorized according to the World Health Organization criteria,using a cutoff of 25 kg/m2 for the general population and 23 kg/m2 for the Asian population.RESULTS We include 85 studies in our analysis.Our findings revealed that,for lean NAFLD patients,the prevalence rate varied widely,ranging from 3.8%to 34.1%.The precise pathogenesis mechanism remained elusive,with associations found in genetic variants,epigenetic modifications,and adaptative metabolic response.Common risk factors included metabolic syndrome,hypertension,and type 2 diabetes mellitus,but their prevalence varied based on the comparison group involving lean patients.Regarding non-invasive tools,Fibrosis-4 index outperformed the NAFLD fibrosis score in lean patients.Lifestyle modifications aided in reducing hepatic steatosis and improving cardiometabolic profiles,with some medications showing efficacy to a lesser extent.However,lean NAFLD patients exhibited a worse prognosis compared to the obese or overweight counterpart.CONCLUSION MASLD is a complex disease comprising epigenetic,genetic,and metabolic factors in its pathogenesis.Results vary across populations,gender,and age.Limited data exists on clinical practice guidelines for lean patients.Future studies employing this new nomenclature can contribute to standardizing and generalizing results among lean patients with steatotic liver disease.

Heterostructured nickel-cobalt metal alloy and metal oxide nanoparticles as a polysulfide mediator for stable lithium-sulfur full batteries with lean electrolyte

Batteries that utilize low-cost elemental sulfur and light metallic lithium as electrodes have great potential in achieving high energy density.However,building a lithium-sulfur(Li-S)full battery by controlling the electrolyte volume generally produces low practical energy because of the limited electrochemical Li-S redox.Herein,the high energy/high performance of a Li-S full battery with practical sulfur loading and minimum electrolyte volume is reported.A unique hybrid architecture configured with Ni-Co metal alloy(NiCo)and metal oxide(NiCoO_(2))nanoparticles heterogeneously anchored in carbon nanotube-embedded selfstanding carbon matrix is fabricated as a host for sulfur.This work demonstrates the considerable improvement that the hybrid structure's high conductivity and satisfactory porosity promote the transport of electrons and lithium ions in Li-S batteries.Through experimental and theoretical validations,the function of NiCo and NiCoO_(2) nanoparticles as an efficient polysulfide mediator is established.These particles afford polysulfide anchoring and catalytic sites for Li-S redox reaction,thus improving the redox conversion reversibility.Even at high sulfur loading,the nanostructured Ni-Co metal alloy and metal oxide enable to have stable cycling performance under lean electrolyte conditions both in half-cell and full-cell batteries using a graphite anode.

Metal-free two-dimensional phosphorene-based electrocatalyst with covalent P-N heterointerfacial reconstruction for electrolyte-lean lithium-sulfur batteries

The use of lithium-sulfur batteries under high sulfur loading and low electrolyte concentrations is severely restricted by the detrimental shuttling behavior of polysulfides and the sluggish kinetics in redox processes.Two-dimensional(2D)few layered black phosphorus with fully exposed atoms and high sulfur affinity can be potential lithium-sulfur battery electrocatalysts,which,however,have limitations of restricted catalytic activity and poor electrochemical/chemical stability.To resolve these issues,we developed a multifunctional metal-free catalyst by covalently bonding few layered black phosphorus nanosheets with nitrogen-doped carbon-coated multiwalled carbon nanotubes(denoted c-FBP-NC).The experimental characterizations and theoretical calculations show that the formed polarized P-N covalent bonds in c-FBP-NC can efficiently regulate electron transfer from NC to FBP and significantly promote the capture and catalysis of lithium polysulfides,thus alleviating the shuttle effect.Meanwhile,the robust 1D-2D interwoven structure with large surface area and high porosity allows strong physical confinement and fast mass transfer.Impressively,with c-FBP-NC as the sulfur host,the battery shows a high areal capacity of 7.69 mAh cm^(−2) under high sulfur loading of 8.74 mg cm^(−2) and a low electrolyte/sulfur ratio of 5.7μL mg^(−1).Moreover,the assembled pouch cell with sulfur loading of 4 mg cm^(−2) and an electrolyte/sulfur ratio of 3.5μL mg^(−1) shows good rate capability and outstanding cyclability.This work proposes an interfacial and electronic structure engineering strategy for fast and durable sulfur electrochemistry,demonstrating great potential in lithium-sulfur batteries.

Effect of nano-CaO particle on the microstructure,mechanical properties and corrosion behavior of lean Mg-1Zn alloy

The effects of nano-CaO contents on the microstructure,mechanical properties and corrosion resistance of lean Mg-1Zn alloy were investigated.The results showed that the addition of nano-CaO significantly refined the grain size and improved mechanical properties of the Mg-1Zn alloy.At the same time,CaO reacted with molten Mg in situ to form nano-MgO,whose corrosion product in SBF solution was the same with the degradation product of Mg matrix,resulting in the enhanced compactness of the Mg(OH)_(2) layer and reduced corrosion rate of matrix.The Mg-1Zn alloy had lower corrosion resistance due to excessively large grain size and shedding of corrosion products.The composite with 0.5 wt.%CaO had the best corrosion resistance with a weight loss of 9.875 mg·y^(-1)·mm^(-2)due to the small number of Ca_(2)Mg_(6)Zn_(3) phase and suitable grain size.While for composites with high content of CaO(0.7 wt.%and 1.0 wt.%),they had lower corrosion resistance due to the coexistence of large number of Ca_(2)Mg_(6)Zn_(3) and Mg_(2)Ca at grain boundaries,especially for 1.0 wt.%CaO composite,resulting from the strong micro-galvanic corrosion.

Design Strategies for Leaning-Type Arch Bridges

This paper presents a study on the design strategy of leaning-type arch bridges.The main characteristics of leaning-type arch bridges are first introduced;Kunshan Yufeng Bridge is taken as an example to discuss different aspects of a design strategy,which includes self-system optimization,selection of beam length and bridge deck position,and other aspects.This paper can be used as a reference to further improve and develop bridge design.

Overview of the Theoretical Exploration and Application of Lean Six Sigma

In contemporary contexts,Lean Six Sigma(LSS)is extensively utilized and has evolved across various sectors due to its substantial benefits.This paper aims to explore the definition,origin,and development of LSS,as well as its key tools,methods,theoretical research,and future prospects.Furthermore,it analyzes the theoretical foundations and practical applications of LSS in-depth,with an emphasis on anticipating future development trends.The goal is to provide readers with a comprehensive overview of LSS and offer insights for enterprises seeking to implement LSS for process improvement and innovation.

基于E-leaning的体育课程网络化教学改革

E-leaning可以优化教育资源、提高学习效率、降低学习成本,对于体育课程教学而言,其灵活便捷的教学方式能够解决"学训矛盾",方便学生自主学习。学习过程记录方便、教学管理和课程资源及时有效的更新,既方便了教学管理,也为体育远程教育创造了条件。E-leaning借助网络跨越了校园空间的限制,给学习者提供了一个全新的学习环境,促使了学校与学习者之间距离的缩短,让学校教育向更广泛的地区辐射。借助E-leaning进行体育精品课程和网络课程整合,开展体育远程教育有助于现有体育精品课程和网络课程的可持续发展,有利于体育教育资源共享,是未来学校体育教育和终身体育教育的重要途径。

《Leaning to do》的启示:把价值观教育与TVET结合起来

这几个模块相关联的核心价值是健康,与自然和谐,达到人的身体、智力、情感、社会和精神的全面发展,实现一种人与人、人与自然环境和谐的状态.要对自身健康负责,对所有形态的生命关爱,成为一个环境的看护者.

新时代学习方法的主流——M-Leaning

在现今知识信息的新时代,随着学习需求的与日俱增,现有的教育体系、模式与人们对教育的需求之间的矛盾也逐渐暴露出来,人们渴望更新、更灵活的学习模式的出现。因此,在任何时间(Anytime)和任何地点(Anywhere)利用手持的、无线移动通讯设备(如手机、PDA)学习任何内容(Anything)的M-leaning的出现是一种必然趋势。

Boosting Lean Electrolyte Lithium-Sulfur Battery Performance with Transition Metals: A Comprehensive Review

Lithium–sulfur(Li–S) batteries have received widespread attention, and lean electrolyte Li–S batteries have attracted additional interest because of their higher energy densities. This review systematically analyzes the effect of the electrolyte-to-sulfur(E/S) ratios on battery energy density and the challenges for sulfur reduction reactions(SRR) under lean electrolyte conditions. Accordingly, we review the use of various polar transition metal sulfur hosts as corresponding solutions to facilitate SRR kinetics at low E/S ratios(< 10 μL mg~(-1)), and the strengths and limitations of different transition metal compounds are presented and discussed from a fundamental perspective. Subsequently, three promising strategies for sulfur hosts that act as anchors and catalysts are proposed to boost lean electrolyte Li–S battery performance. Finally, an outlook is provided to guide future research on high energy density Li–S batteries.

基于Lean管理理念的门诊医疗服务质量提升研究

目的分析在Lean管理理念基础上实施门诊护理管理对门诊医疗服务质量提升的影响。方法选取2021年1月—2022年12月在南京医科大学附属逸夫医院门诊工作的34名护理人员作为研究对象,2021年1—12月实施常规管理(实施前组),2022年1—12月实施Lean管理理念(实施后组)。比较实施前后护理质量、不良事件发生率及交接班质量评分。结果实施后组护理质量评分高于实施前组,差异有统计学意义(P<0.05)。实施后组护理差错、缺陷、纠纷发生率均低于实施前组,差异有统计学意义(P均<0.05)。实施后组护理人员交接班质量评分高于实施后组,差异有统计学意义(P<0.05)。结论Lean管理理念在门诊护理管理中的应用能有效提升护理质量,降低护理差错发生率,减少护患纠纷和投诉发生率,对提升门诊医疗服务质量具有积极意义。

成果导向下“精益”教学资源库建设模式的构建与实践

针对高职专业教学资源库建设中资源与岗位对接度不够、资源利用率不高、学习达成度评价体系不全等问题,提出了一种成果导向下的“精益”建设模式。“精益”建设模式以成果为导向,反向设计资源模块,项目式串联建设可复用颗粒化资源,精准化设置学习目标达成评价体系,教师可以基于学情数据,利用资源库资源搭建在线课程,满足不同学习者的学习需求,实现分层次差异化教学。实践表明该模式能有效服务于专业人才培养需求,高效益建设资源库资源,提高学生学习达成度,更好的服务于教师的教学需求,为职业教育资源库提供了一种参考模式。

DIP医保支付方式改革下医院多维联动精益运营管理研究

按病种分值付费(Diagnosis-Intervention Packet,DIP)医保支付方式改革的实施与落地对医院运营管理模式造成深远影响,使得医院的运营方式和管理内涵急需适配与优化。深度剖析DIP医保支付方式对于医院运营管理造成的影响,分别从病种分值政策的实施、医保成本核算控制、医疗服务质量提升、医保事后分析、病种管理等多个维度,对全生命周期视角DIP医保支付方式改革下医院运营管理模式的构建策略进行有力探索,以期更好地促进医院健康持续发展。

回流区稳定燃烧的近熄火特性理论分析

基于火焰稳定在回流区剪切层中的假设,建立了预混火焰近贫燃熄火极限特性的理论分析模型.一旦火焰稳定在剪切层中,由于剪切层同时从两侧卷吸流体,所以进入火焰的流体将是自由流与回流区流体的混合物.如果是贫燃火焰,回流区流体由燃烧产物和多余的氧化剂组成而没有燃料,因此进入剪切层火焰的混合物当量比将低于自由流的当量比.如此一来,即使自由来流是可燃的,剪切层中混合物的当量比也可能超出可燃极限.分析表明,对于回流区稳定的贫燃火焰,进入剪切层火焰的混合物有效当量比将低于自由来流的当量比.根据理论分析建立了近贫燃熄火极限的回流区稳定燃烧模式图,其中涉及4个参数:自由来流当量比、剪切层卷吸比、吹熄极限和再点火极限.分析揭示出4种可能的燃烧模式:超稳定火焰、亚稳定火焰、振荡火焰和熄火.特别地,在参数空间发现了一个振荡区,它可能为近吹熄火焰引入一种新的固有不稳定性机制.在这种机制中,剪切层中的当量比振荡实际上是由燃烧过程本身驱动的,因为火焰的位置/振荡影响着进入回流区的流体成分进而影响剪切层中的当量比.因此,当量比振荡与燃烧过程之间的反馈循环由于周期性的火焰吹熄和闪回/再稳定而得以封闭.

企业—用户互动、敏捷开发与数字产品创新绩效

数字技术的可重新编程性、开放性等特征增强了市场需求的不确定性,企业通过与用户互动进行敏捷开发以提升数字产品创新绩效,成为获取竞争优势的关键。基于精益创业理论和利益相关者理论,深入分析企业—用户互动、敏捷开发与数字产品创新绩效间的作用机理。结果表明:企业—用户互动通过敏捷开发积极影响数字产品创新绩效,且组织创新氛围将增强三者间的作用关系。研究有助于丰富对于数字情境下企业—用户互动创新的理解,推动敏捷开发研究的发展,为解释数字产品创新绩效差异化提供有价值的研究思路,也为数字产品创新绩效的提升提供重要的管理启示。

基于Damköhler数的支板稳定器贫油熄火分析方法研究

稳定器的贫油熄火边界预测对于燃烧室的设计具有重要意义。本文开展了支板稳定器的贫油熄火试验,得到了来流温度473~623 K,空气流速在60~130 m/s下的贫油熄火边界。通过数值模拟得到燃烧室的反应场和流场分布,分析了近熄火和稳定燃烧工况时Damköhler数的分布特性。结果表明,流动时间尺度在不同燃油流量下变化不大,化学时间尺度随燃油流量的降低而增大,在近熄火时,Damköhler数大于1的区域为两条明显的带状分布,仅在剪切层保持较高水平,回流区难以加热剪切层的新鲜混气,导致最终熄火;基于CO质量分数确定的关键反应区与实际火焰具有较好的一致性。不同熄火工况下反应区内的平均Damköhler数在1左右波动,最大误差22%,证明基于Damköhler数的贫油熄火分析方法能够揭示贫熄特征,为解决实际熄火预测提供基础。

绿色低碳型印染企业生产成本有效控制探讨

进入低碳时代,印染行业更需要进行成本控制,文中从节能减排、劳动力成本、染料与助剂成本、化验室成本、管理成本这5个方面逐一进行分析。指出改进印染设备运行及对中水进行回用,可达到节能减排的目的;印染生产全过程推行全自动化控制可减少劳动力成本;针对面料的不同以及客户要求的差别化,合理选择染料与助剂,可降低染化料成本;化验室技术人员精心控制工艺配方的成本,不断对工艺流程进行改革创新,并应用计算机信息技术提高综合业务水平,可有效降低生产成本;生产管理者采用精益管理方式,可降低管理成本。

基于DMAIC模型的妊娠合并脑血管病急诊就诊流程优化研究

目的利用精益六西格玛(lean six sigma,LSS)管理中的界定、测量、分析、改进和控制(define,measure,analyze,improve,control;DMAIC)模型,优化妊娠合并脑血管病患者就医流程,提高患者就医效率,保障母婴安全。方法2021年12月,首都医科大学附属北京天坛医院根据DMAIC模型,对危重孕产妇的就诊流程进行优化:梳理就诊流程,明确到院—医嘱开立、采血—送检、医嘱开立—影像学检查为院内延误的关键环节,对上述环节进行流程跟踪及分析,找出延误原因,并采取改进措施,优化流程。本研究回顾性纳入流程优化前(2019年1月—2021年12月)的妊娠合并脑血管病患者为优化前组,流程优化后(2022年1月—2023年12月)的患者为优化后组。比较两组患者就诊流程中的到院—医嘱开立、采血—送检、医嘱开立—影像学检查、到院—办理住院的时间。结果急诊就诊流程优化后,妊娠合并脑血管病患者的总体就诊效率提高。到院—医嘱开立[24.0(13.5~38.5)min vs.39.0(17.5~98.0)min,P=0.027]、医嘱开立—影像学检查[48.0(10.0~73.0)min vs.65.5(22.7~90.7)min,P=0.025]以及到院—办理入院总时间[120.0(93.0~149.0)min vs.218.0(123.0~382.7)mi n,P<0.001]均较优化前缩短,差异有统计学意义;采血—送检时间有缩短趋势,但优化前后差异无统计学意义。结论使用DMAIC模型能够明确流程优化的关键环节,优化妊娠合并脑血管病患者的急诊就诊流程。

Pd(111)与Pt(111)上NO氧化的第一性原理研究

随着排放法规的日益严格,发动机的氮氧化物(NO_(x))后处理已成为当今研究的重点问题.针对目前可有效降低稀燃汽油机NO_(x)的稀燃氮氧化物捕集器中铂(Pt)和钯(Pd)两种贵金属之间的替换问题,进行了密度泛函理论(density functional theory,DFT)计算研究.首先,对一氧化氮(NO)、氧气(O_(2))、二氧化氮(NO_(2))在两种催化剂(111)表面的吸附进行了研究,之后,在两催化剂表面对比研究了氧化过程中涉及的O_(2)解离与NO氧化两反应过程,揭示了NO在Pd与Pt催化剂上的氧化机理.结果显示:3种物质在催化剂表面的吸附强度为NO>O_(2)>NO_(2).氧覆盖度将会改变氮氧化物的最佳吸附构型,随着表面氧原子的增加NO会由三重空位式吸附转变为顶点吸附,NO_(2)会由μ-N,O-亚硝基吸附转变为硝基吸附.在O_(2)解离过程中Pt的催化能力优于Pd,但是两者对NO氧化的催化能力接近.在Pd和Pt表面反应限速步骤都是O_(2)的解离,Pd对O_(2)较弱的解离能力导致了其NO的转化效率低于Pt.氧覆盖度对氧化过程存在影响,通过电子结构分析发现,氧覆盖度的提升使催化剂与吸附物质之间的吸附能下降,这导致了反应由吸热变为放热,使催化可以自发进行.反应生成的NO_(2)需要1.00 eV以上的能量完成脱附,这在原子层面解释了NO_(2)对NO氧化反应的抑制作用.

集中管理模式下精益六西格玛管理法对优化医疗设备维修管理的价值研究

目的研究集中管理模式下精益六西格玛(lean six sigma,LSS)管理法在优化生命支持类医疗设备维修管理流程方面的应用价值。方法以输液泵和注射泵为例,运用LSS管理方法中的界定、测量、分析、改进和控制5个阶段流程对生命支持类医疗设备维修管理难点进行分析,采用组织系统模型流程管理及鱼骨图等方法,分析影响设备维修管理的关键环节,提出在集中管理模式中简化维修审批流程、建立集中管理设备维修和质量控制运行机制、规范设备消毒和检测制度等改进方案,对LSS管理方法实施前后输液泵和注射泵实际维修周期和维修费用进行比较。结果LSS管理方法实施后,输液泵和注射泵设备实际维修时长分别缩短至(6.75±1.81)d和(5.89±1.25)d,维修周期分别缩短26.87%和20.19%,差异有统计学意义(P<0.05);输液泵和注射泵每月单次维修费用分别降低至232.10[32.50,291.00]元和164.40[32.80,183.40]元,差异有统计学意义(P<0.05);月均维修费用分别降低至1217.00元和1426.75元,分别降低了16.54%和28.20%,达到了LSS管理方法的工作目标。结论本研究提出的LSS管理方法可以有效分析医疗设备维修管理中的难点,从而在集中管理模式下针对性优化管理流程,可有效提升设备维修效率,降低维修成本。