浅析OBE理念下的《汽车构造Ⅰ》一流课程建设

为体现以学生为中心、产出导向和持续改进教育理念以及课程的高阶性、创新性以及挑战度,文章以《汽车构造Ⅰ》课程为例,按照线上线下混合式一流课程的建设标准,遵循OBE理念,加强课程总体设计,融入课程思政元素,整合优化教学内容,设计“AEEA”的三阶线上线下混合式教学模式,开展多种教学方法的应用,建立过程化、多元化、混合式的课程考核评价体系,以期为高校专任教师开展一流课程建设与实施应用提供思路。

Time-varying Reliability Analysis of Long-span Continuous Rigid Frame bridge under Cantilever Construction Stage based on the Monitored Strain Data

In general,the material properties,loads,resistance of the prestressed concrete continuous rigid frame bridge in different construction stages are time-varying.So,it is essential to monitor the internal force state when the bridge is in construction.Among them,how to assess the safety is one of the challenges.As the continuous monitoring over a long-term period can increase the reliability of the assessment,so,based on a large number of monitored strain data collected from the structural health monitoring system(SHMS)during construction,a calculation method of the punctiform time-varying reliability is proposed in this paper to evaluate the stress state of this type bridge in cantilever construction stage by using the basic reliability theory.At the same time,the optimal stress distribution function in the bridge mid-span base plate is determined when the bridge is closed.This method can provide basis and direction for the internal force control of this type bridge in construction process.So,it can reduce the bridge safety and quality accidents in construction stages.

Construction of TGP StageⅡWorks

In the construction of Three Gorges Project, the total amount of concrete is about 28 Mm\+3 , and the total amount of metal works and reinforcement is approximately 0.72 Mt . The TGP is constructed in 3 stages . The preparation period together with the first stage is 5 years , the second stage and third stage are both 6 years .In the second stage construction of 6 years (1998～2003) , there are 18.46 Mm\+3 of concrete to be placed and 0.192 Mt of metal works and embedded parts for mechanical and electric equipment to be installed . In 1999, a world record of annual concrete placement of 4.585 Mm\+3 was set . In 2000, it is planned to place 5.4 Mm\+3 of concrete and to install 38 000 t of metal works . Construction equipments and layout of construction site , concrete production and its temperature control, metal works, mechanical and electric equipments in the second stage construction are presented.

Numerical Staged Construction Analysis of Precast Concrete Bridge

The paper discussed about the staged construction analysis of two-span precast-girder bridge considering time dependent effects, namely creep and aging of concrete. Results obtained showed that it is very important to consider construction stage in the analysis of bridge because of stress resultants which are important in design process and very different from those obtained without the consideration of construction stage. This fact is especially important for bridges, because construction period continues along time and loads may change during the construction period and after.

八段锦复合七步法在冠状动脉搭桥术后Ⅰ期心脏康复训练中的应用研究

目的探讨八段锦复合七步法Ⅰ期心脏康复训练对冠状动脉搭桥术(CABG)后患者心肺功能及生活质量的影响。方法选择2022年1月至2023年6月行CABG术后患者86例,采用随机数字表法分为观察组和对照组各43例。两组均给予相同的ICU期间心脏康复训练,对照组同时给予病房七步心脏康复训练,观察组同时给予病房八段锦复合七步法心脏康复训练。出院时,比较两组心肺功能、生活质量、心脏康复训练依从性。结果观察组峰值摄氧量、峰值氧脉搏、峰值功率、无氧阈(AT)功率高于对照组(P<0.05);症状控制、躯体功能、心理社会功能、治疗满意度、不良反应控制、总体生活质量评分均高于对照组(P<0.05);运动依从性(93.02%)、危险因素管理依从性(81.40%)、心理管理依从性(90.70%)高于对照组76.74%、60.47%、74.42%(χ^(2)=4.441、4.568、3.957,P<0.05)。结论八段锦复合七步法能够提高CABG术后患者心脏康复训练依从性,改善心肺功能及生活质量。

分析急诊收治的结直肠癌并发急性梗阻的患者接受Ⅰ期根治性切除吻合手术治疗的临床效果及生存率

目的探讨急诊收治的结直肠癌并发急性梗阻患者行Ⅰ期根治性切除吻合术的效果,以及对生存率的影响。方法回顾性分析2021年1月-2023年1月日照市中心医院治疗的60例结直肠癌并发急性梗阻患者的临床资料,根据治疗方法不同分成基本组(30例,Ⅰ期切除Ⅱ期吻合手术)和研究组(30例,Ⅰ期根治性切除吻合手术)。对比两组患者的手术和住院时间、手术前后血清因子水平、6个月生存率、并发症等情况。结果研究组手术时间和住院时间均短于基本组,血清因子水平低于基本组,差异有统计学意义(P均<0.05);研究组术后并发症发生率(6.67%)低于基本组(26.67%),差异有统计学意义(χ^(2)=4.320,P<0.05);两组术后6个月生存率比较,差异无统计学意义(P>0.05)。结论临床中结直肠癌并发急性梗阻的患者行急诊Ⅰ期根治性切除吻合手术能够有效地减少患者手术与住院的时间,并且改善患者炎性因子的水平,减少术后发生并发症的概率,近期生存率也较高。

Cost Management Strategy of Highway Engineering Construction Stage Using the List Pricing Model

Highway engineering requires higher investment and requires a long time of management compared to other construction projects.There are many factors that affect the project cost during the engineering construction stage of a highway.The effective development of cost management in the construction phase of highway engineering under the list pricing model can avoid unnecessary waste and help control the cost of highway engineering.However,there are still some problems in the development of cost management in the construction phase of highway engineering,which will affect the role of the list-based pricing mode in cost management.This paper explores and analyzes the advantages of the list pricing model and the problems existing in the cost management of the highway engineering construction stage under the list pricing model,and proposes effective management strategies to improve cost management of the highway engineering construction stage.

Decisive Stage of All-round Construction of Well-off Society Is a New Opportunity for China's Human Rights Cause

The p eriod of"The 13th Five-Year Plan"for national socioeconomic development(2016-2020)is a decisive stage of completion of all-round construction of a moderately prosperous society in China,and the year of 2016 is the first annum of this decisive stage.The Central Committee of the Communist Party of China(CPC)headed by General Secretary Xi Jinping has,with a new stance and new ideas,set strategic tasks

塔里木盆地走滑断裂发育演化特征精细解析及其地质意义:以富满油田F_(Ⅰ)17断裂为例

塔里木盆地台盆区走滑断裂具有“控储、控藏、控富”的特点,但因其发育于超深层且活动强度较弱,断裂的精细解析及演化特征分析是目前研究的重点和难点。为深化走滑断裂构造精细解析流程及探讨断裂活动的地质意义,以富满油田F_(Ⅰ)17断裂为例,基于新采集的高精度三维地震资料,结合相干、最大似然及储层振幅变化率等多种地震属性,分析断裂的空间展布规律、活动特征、演化过程,并结合储层发育特征初步分析断裂控储特征。通过恢复研究区前寒武纪基底结构特征,对断裂平面走向偏移的发育机制进行初步分析。研究结果表明,研究区内F_(Ⅰ)17断裂平面发生多次转向,走向由南往北发生逆时针偏转;基于断裂的走向变化特征,可将断裂划分为北(NE8°)、中(NE33°)、南(NE50°)三段。断裂具有垂向分层变形的特征,依据断裂变形特征,可划分为以直立走滑为特征的深部构造变形层(TO_(3)t之下)和发育雁列式正断层的浅部构造变形层(TO_(3)t之上)。断裂在深部构造变形层中具有“分层开花”的特征,垂向上发育多个花状构造,主要分布于上寒武统底面(T∈_(3))及一间房组顶面(TO_(3)t)附近。浅部构造层垂向发育三组雁列式正断层,由下往上分布于TO_(3)t—TS、TS—TC以及TC—TT。断裂的演化具有多期性,演化过程可划分为5个阶段:加里东早期、加里东中期Ⅰ幕、加里东中期Ⅲ幕、加里东晚期—海西早期、海西中—晚期。前寒武纪基底裂谷结构影响了上覆走滑断裂的发育与连接,造成断裂平面走向发生偏移。

Different strategies of treatment for uterine cervical carcinoma stage ⅠB2-ⅡB

Uterine cervical cancer is the second most common gynecological malignancy. It is estimated that over 35% of tumors are diagnosed at locally advanced disease, stage ⅠB2-ⅡB with an estimated 5-year overall survival of 60%. During the last decades, the initial treatment for these women has been debated and largely varies through different countries. Thus, radical concurrent chemoradiation is the standard of care in United Sated and Canada, and neoadjuvant chemotherapy followed by radical surgery is the first line of treatment in some institutions of Europe, Asia and Latin America. Until today, there is no evidence of which strategy is better over the other. This article describe the evidence as well as the advantages and disadvantages of the main strategies of treatment for women affected by uterine cervical cancer stage ⅠB2-ⅡB.

Control and Management of Construction Project Cost

Project cost can control the input in construction project and improve economic benefits of construction enterprises,so it is an important section of construction engineering.Reasonable control and management of project cost is the principle that building units must obey in the whole process of project,particularly in the construction stage,so it is extremely important to control and manage the project cost.This paper first analyzed possible causes for the unreasonable cost of construction projects,and put forward pertinent strategies for the control and management of construction project cost.

A novel recurrence-associated metabolic prognostic model for risk stratification and therapeutic response prediction in patients with stage Ⅰ lung adenocarcinoma

Objective:The proportion of patients with stageⅠlung adenocarcinoma(LUAD)has dramatically increased with the prevalence of low-dose computed tomography use for screening.Up to 30%of patients with stageⅠLUAD experience recurrence within 5 years after curative surgery.A robust risk stratification tool is urgently needed to identify patients who might benefit from adjuvant treatment.Methods:In this first investigation of the relationship between metabolic reprogramming and recurrence in stageⅠLUAD,we developed a recurrence-associated metabolic signature(RAMS).This RAMS was based on metabolism-associated genes to predict cancer relapse and overall prognoses of patients with stageⅠLUAD.The clinical significance and immune landscapes of the signature were comprehensively analyzed.Results:Based on a gene expression profile from the GSE31210 database,functional enrichment analysis revealed a significant difference in metabolic reprogramming that distinguished patients with stageⅠLUAD with relapse from those without relapse.We then identified a metabolic signature(i.e.,RAMS)represented by 2 genes(ACADM and RPS8)significantly related to recurrence-free survival and overall survival times of patients with stageⅠLUAD using transcriptome data analysis of a training set.The training set was well validated in a test set.The discriminatory power of the 2 gene metabolic signature was further validated using protein values in an additional independent cohort.The results indicated a clear association between a high risk score and a very poor patient prognosis.Stratification analysis and multivariate Cox regression analysis showed that the RAMS was an independent prognostic factor.We also found that the risk score was positively correlated with inflammatory response,the antigen-presenting process,and the expression levels of many immunosuppressive checkpoint molecules(e.g.,PD-L1,PD-L2,B7-H3,galectin-9,and FGL-1).These results suggested that high risk patients had immune response suppression.Further analysis revealed that anti-PD-1/PD-L1 immunotherapy did not have significant benefits for high risk patients.However,the patients could respond better to chemotherapy.Conclusions:This study is the first to highlight the relationship between metabolic reprogramming and recurrence in stageⅠLUAD,and is the first to also develop a clinically feasible signature.This signature may be a powerful prognostic tool and help further optimize the cancer therapy paradigm.

Isolated vaginal metastasis from stage Ⅰ colon cancer: A case report

BACKGROUND Distant metastasis occasionally occurs in patients who have been diagnosed with colorectal cancer(CRC), but it occurs in a few patients with stage I CRC. The vagina as a metastasis site has also been reported, albeit rarely. Most reported cases of vaginal metastasis(VM) report their origin from advanced CRC. We encountered a patient who was diagnosed with isolated VM originating from stage I colon cancer(T2N0) and herein present the case of this patient.CASE SUMMARY A 63-year-old woman visited the outpatient clinic because of a positive result from a stool occult blood test. She underwent laparoscopic anterior resection and was pathologically diagnosed with stage I(T2N0) sigmoid colon cancer. Neither lymphovascular invasion nor perineural invasion was observed. Ten months following the surgery, isolated vaginal metastases were detected on gynecologic examination. The examination was performed due to vaginal spotting. A transvaginal wide excision was performed, and no other adjuvant treatment was provided after discussion with a multidisciplinary team and the patient.Subsequently, a new VM was discovered after 33 mo. An additional transvaginal excision was performed. To date, there has been no evidence of further disease progression. From the time of diagnosis of VM, the patient’s overall survival has been 54 mo.CONCLUSION VM can occur as a result of early-stage colorectal cancer. Surgeons should consider the possibility of VM following complaints of gynecologic symptoms following surgery.

Research on Influencing Factors of Reservoir Construction Risk Based on Interpretative Structural Modeling

Reservoir plays an important role in the allocation and rational use of water resources, especially water resources in China are centrally distributed in the western region, and large reservoirs should be built to meet the people’s livelihood needs of each region. The construction of large reservoirs has numerous risks, the clarity of these risks helps us to better plan and make decisions before implementing the project. Search through literature reading and professional information, determined 11 risk factors in the construction phase of the reservoir construction project case, construct a risk influencing factor system under the application of ISM (Interpretative Structural Modeling). Studies have shown that the risks of strategic guidelines and policies and changes in infrastructure planning have the deepest impact on construction risk management. Among them, the strategic policy risk is the root impact, and the impact of the infrastructure planning change risk has a far-reaching impact. Through the above conclusions, providing management countermeasures and suggestions for the risk control of reservoir construction.

Measures to strengthen engineering quality supervision in construction management

With the continuous advancement of China's urbanization process,the demand for construction projects is increasing,which is both an opportunity and a challenge for construction companies.If the enterprises themselves can grasp the background and policy conditions to maintain a high level of construction engineering,then its enterprise benefits and future development prospects will be excellent.However,there are also many companies whose own reputation and actual benefits have been affected for poor engineering quality caused by poor construction management.This is exactly what we must pay attention to.This article will analyse and explore the relevant work to improve the engineering quality of different phases of engineering construction and to guide the management of the construction unit in the future from the perspective of the construction unit to strengthen the project quality supervision.

TITE(e)-U-Keyboard两阶段Ⅰ/Ⅱ期试验设计研究

目的针对肿瘤靶向制剂和细胞免疫疗法治疗效应延迟的问题,基于Ⅰ/Ⅱ期试验设计框架,构建创新试验设计方法TITE(e)-U-Keyboard。方法采用二项近似似然法纳入尚未观测到的有效性结局信息,构建近似分布,辅助决策,并将TITE(e)-U-Keyboard同Ⅰ/Ⅱ期试验设计方法U-BOIN、BOIN12从多个角度进行模拟比较研究。结果模拟结果显示在考虑有效性结局延迟的情况下三种方法的OBD选择准确率及最优剂量分配受试者数相当,但TITE(e)-U-Keyboard所需试验时长最短;敏感性分析表明有效性观察窗会对TITE(e)-U-Keyboard试验时长产生影响,且随着有效性观察窗的增加而增加。结论TITE(e)-U-Keyboard在保持良好试验设计性能的同时显著缩短了试验时长,可以解决Ⅰ/Ⅱ期临床试验中治疗效应延迟的问题,加速临床试验进程。

Macro-decision-making on Phase I Construction of the Three Gorges Project (TGP)

In this paper,the dominance of the national enterprise and current situation of project management are analyzed on the basis of sum of Phase Ⅰ Construction management of the Three Gorges Project.From the start point of idea modification and inner reformation of enterprise,some of concrete suggestions enhancing the project management, are offered in the paper.

胸腔镜手术治疗Ⅰ期非小细胞肺癌的临床疗效

目的研究胸腔镜手术运用于Ⅰ期非小细胞肺癌患者中的效果。方法方便选取2021年1月—2023年5月无锡市锡山人民医院胸外科接诊的86例Ⅰ期非小细胞肺癌患者为研究对象,利用随机数表法分为两组,每组43例。对照组采用常规开胸切除手术,观察组采用胸腔镜手术治疗。比较两组手术相关指标、并发症发生率、免疫指标。结果两组淋巴结清扫数量、手术时间对比,差异无统计学意义(P>0.05)。观察组与对照组相比,观察组术中出血量更低,留置引流管时间、首次下床站立时间、住院时间更短,差异有统计学意义(P<0.05)。两组并发症(肺部感染、切口感染、胸腔积液与其他)发生率相比,观察组(4.65%)低于对照组,差异有统计学意义(χ^(2)=7.340,P<0.05)。治疗后观察组免疫球蛋白G、CD3^(+)、CD4^(+)/CD8^(+)高于对照组,差异有统计学意义(P<0.05)。结论对于Ⅰ期非小细胞肺癌患者的治疗,选用胸腔镜手术治疗的方式效果更好,可推荐开展。

根治性手术结合预防性回肠造口术Ⅰ期开放治疗用于低位直肠癌患者中的效果

目的分析治疗低位直肠癌患者采取根治性手术+预防性回肠造口术Ⅰ期开放治疗的效果。方法选取2020年1月—2023年1月江苏省盱眙县人民医院收治的60例低位直肠癌患者,按随机抽签法分组,各30例。对照组患者另外给予直接低位吻合治疗,观察组患者另外给予预防性回肠造口术Ⅰ期开放治疗,比较两组术后恢复情况、炎性应激指标及免疫功能。结果观察组发热时间、肠功能恢复时间、住院时间、首次进食半流质食物用时均短于对照组,差异有统计学意义(P<0.05)。治疗后,观察组白细胞介素-6、C反应蛋白、肿瘤坏死因子-α水平均低于对照组,差异有统计学意义(P<0.05)。治疗后,观察组免疫球蛋白M、免疫球蛋白A、免疫球蛋白G水平均高于对照组,差异有统计学意义(P<0.05)。结论根治性手术+预防性回肠造口术Ⅰ期开放治疗,对于低位直肠癌患者,可增强其免疫功能,改善炎性应激反应,临床效果显著。

筋膜外全子宫切除联合双侧附件切除术在Ⅰ期子宫内膜癌围术期的应用

目的分析Ⅰ期子宫内膜癌(EC)患者选用筋膜外全子宫切除联合双侧附件切除术的效果。方法选取70例Ⅰ期EC患者,采用抽签法分为试验组与对照组,各35例。对照组实行开腹手术,试验组实行筋膜外全子宫切除联合双侧附件切除术。比较两组临床疗效。结果相比对照组,试验组围术期指标、血清相关指标及肿瘤标志物水平均较低(P<0.05)。试验组总有效率为97.14%,高于对照组的71.43%,差异有统计学意义(P<0.05)。结论针对Ⅰ期EC患者,选择筋膜外全子宫切除联合双侧附件切除术治疗,疗效显著,不仅能改善患者血清、围术期等指标,还能控制炎症状态,且安全性高,值得推广。