mlsa-iai-msu-lab/ru_sci_bench_zho_cite_reranking huggingface dataset:
Limits on sequential sharing of nonlocal advantage of quantum coherence

Sequential sharing of nonlocal correlation is inherently related to its application.We address the question as to how many observers can share the nonlocal advantage of quantum coherence (NAQC) in a (d × d)-dimensional state,where d is a prime or a power of a prime.We first analyze the trade-off between disturbance and information gain of the general d-dimensional unsharp measurements.Then in a scenario where multiple Alices perform unsharp measurements on one party of the state sequentially and independently and a single Bob measures coherence of the conditional states on the other party,we show that at most one Alice can demonstrate NAQC with Bob.This limit holds even when considering the weak measurements with optimal pointer states.These results may shed light on the interplay between nonlocal correlations and quantum measurements on high-dimensional systems and the hierarchy of different quantum correlations.
Design and analysis of a dual-stator brushless doubly-fed induction machine with a staggered dual-cage rotor

In this paper,a new dual-stator brushless doubly-fed induction machine with a staggered dual cage rotor is proposed,with emphasis on the general interconnection rule of the conductor bars for the staggered dual cage rotor.Since the squirrel cage rotor offers the merits of robustness,reliable structure,high slot filling factor,and low rotor resistance comparing to the wound rotor,it is introduced to the dual-stator brushless doubly-fed induction machine to solve the problems of high copper loss and unreliable rotor structure for the dual-stator brushless doubly-fed induction machine with a wound rotor.The originality of this article is to investigate the interconnection rule of conductor bars between the inner and outer cages.The constraint condition that is supposed to be satisfied is deduced by using the rotating magneto-motive force theory,based on which diverse slot/pole combinations are investigated.The performance comparison between the existing and proposed machines is conducted.Finally,a prototype is designed and fabricated.The experimental results verify the effectiveness of the proposed topology.
Pathways to peak carbon emissions in China by 2030: An analysis in relation to the economic growth rate

With less than ten years left to meet its pledge to peak carbon dioxide emissions (peak emissions hereafter) by 2030, China has entered a critical emissions reduction stage. How to meet this commitment in a context in which GDP per capita will double from 2020 by 2035 is a major decision-making issue for the Chinese government and people and one which warrants further study. To reveal the relationships between the GDP growth rate, the rate of decrease of carbon intensity and the time to reach peak emissions, this study translates the question as to “when China's carbon emissions peak will occur” into “how can one control the rate of carbon intensity decrease at a given GDP growth rate”. In the light of the results of a random forest algorithm used to identify and project the key drivers of carbon intensity in China, a mathematical model was developed to simulate different scenarios relating to decreases in carbon intensity. The date at which Chinese carbon emissions will peak is predicted by comparing the rate of decrease of carbon intensity with the GDP growth rate. The results show that the time to peak emissions depends on the relationship between the rate of decrease of carbon intensity and the GDP growth rate, where the former depends mainly on the energy structure and policy. If China's annual GDP growth rate were 5.0% during the 15th Five-Year Plan, and if the share of non-fossil energy in total energy consumption were 23.0% or above, China's carbon emissions will peak before 2030. If the share of non-fossil fuels were 20.0% or less, China might not be able to reach its 2030 target. In this latter case an acceleration in the pace of energy restructuring would be required to reach peak emissions before 2030. The projected peak emissions scenarios suggest that the carbon peak will occur between 2025 to 2029, with average peak emissions of 11.2 billion tons and a distribution ranging from a minimum of 10.5 billion and a maximum of 11.9 billion tons. If the GDP growth rate were 4.5%, 5.5% or 6.0% during the 15th Five-year Plan, the share of non-fossil energy must reach 23.0%, 25.0% or 27.0%, respectively, to ensure that emissions peak by 2030. The results of this study provide a series of reference points for China's pursuit of feasible pathways to peak carbon emissions by 2030.
Variations in monsoon precipitation over southwest China during the last 1500 years and possible driving forces

Understanding hydroclimatic patterns and their possible driving mechanisms during distinct climate periods over the last 1500 years—such as the Medieval Warm Period (MWP), the Little Ice Age (LIA), and the Current Warm Period—is crucial for predicting future changes to monsoon precipitation in southwest China under global warming scenarios. In this study, based on ~(210)Pb and ~(137)Cs dating of surface sediments and AMS ~(14)C dating of terrestrial plant residues, we establish a robust age model that covers the last ~1500 years (AD 439–2012) at Lake Yihai in southwest China. We use analyses of multiple geochemical proxy indices, including loss on ignition at 550°C, total organic carbon, total nitrogen, C/N ratios, and stable carbon isotopes of organic matter to reconstruct changes in summer monsoon precipitation at Lake Yihai during the last ~1500 years. The results show that, over southwest China, warm and dry climate conditions prevailed during the MWP (AD 1000–1400) and the past 200 years, whereas conditions during the LIA (AD 1400–1800) were cold and wet. This is consistent with evidence from other geological records over southwest China, such as stalagmite and lake sediment data. Similar hydroclimatic patterns have occurred over the last 1500 years in adjacent tropical/subtropical monsoon regions where the climate is similarly dominated by the Indian summer monsoon (e.g., South China, the South China Sea, Southeast Asia, Northeast India). We suggest that the meridional migration of the mean position of the Inter-tropical Convergence Zone, and El Nino/Southern Oscillation conditions which are linked to tropical Pacific sea surface temperature, are responsible for centennial-scale hydroclimatic patterns over southwest China and adjacent areas during the last 1500 years.
Differences in intestinal microbiome are associated with the mortality of COVID-19 patients in intensive care units

Coronavirus disease 2019(COVID-19), caused by infection with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2), has developed into a global pandemic. In addition to the common respiratory symptoms, a significant proportion of COVID-19 patients experience gastrointestinal symptoms, such as diarrhea, nausea, and vomiting(Parasa et al., 2020). Furthermore, SARS-CoV-2 nucleic acid could be detected in stool samples from COVID-19 patients(Jeong et al., 2020). It is suspected that the gastrointestinal tract might be a site of viral replication and activity. It has been shown that the diversity of the microbiome is significantly reduced in the stools of COVID-19 patients and the taxonomy of the microbiome is also altered significantly(Gu et al., 2020). However, it is unknown whether changes in the composition of the intestinal microflora may be associated with the outcome(survival or death)of critically ill COVID-19 patients.
Photochemical graft of γ-cyclodextrin's interior leading to in-situ charge-transfer complexes with unusual regioselectivity and its application in 3D photo-printing

Photoirradiation of anthraquinone (AQ) derivatives with γ-cyclodextrin (γ-CD) in aqueous solution led to a γ-CD derivative with a 9,10-dihydroxylanthracene grafting unprecedentedly at the 5′-position of one glucoside of γ-CD in high efficiency. Meanwhile, another AQ enters into the remaining space of the 9,10-dihydroxylanthracene-occupied γ-CD cavity to in-situ form a selfincluded quinhydrone charge transfer (CT) complex. The structure of the supramolecular CT complex was unambiguously demonstrated by 1D and 2D NMR (~1H NMR, ~(13)C NMR, DEPT, ~1H-~1H COSY, HSQC, HMBC, TOCSY, and ROESY) spectroscopies, which revealed a highly stereoselective stacking of the quinhydrone pairs in the γ-CD cavity. The supramolecular CT complex showed an unusually high binding affinity and improved oxidation resistance. Polyacrylamides bearing γ-CD or anthraquinone were respectively synthesized by co-polymerization of acrylamide with the corresponding monomer. Photoirradiation of aqueous mixtures containing these two types of polymers led to gelation, which was applied to 3D photo-printing of soft materials.
Reconfiguring perovskite interface via R4NBr addition reaction toward efficient and stable FAPbI3-based solar cells

Defect states in perovskite films restrict the interfacial stability and open-circuit voltage of perovskite solar cells. Here, aiming at superior interfacial passivation, we investigate the reconfiguration of perovskite interface by the interaction between a series of quaternary ammonium bromides (QAB) and lead–halide (Pb–X) octahedrons. Bromide–iodide substitution reaction or R4NBr addition reaction may occur on the perovskite surface, which is related to the steric hindrance of quaternary ammonium cations. On this basis, the perovskite surface morphology, band structure, growth orientation and defect states are reconstructed via the R4NBr addition reaction. This ordered lead–halide adduct could effectively repair the imperfect perovskite/hole transportation layer interface to suppress non-radiative recombination and ion migration toward ultralong carrier lifetime surpassing 10 μs. The resulting perovskite solar cells yield the efficiency of 23.89% with steady-state efficiency of 23.70%. The passivated cells can sustain 86% of initial efficiency after 200-h operation, which is attributed to the passivation effect and hydrophobic characteristics. This work provides an avenue for reconfiguring perovskite surface by QABs.
Circular RNA-VPS13A attenuates diabetes-induced enteric gllia damage by targeting miR-182/GDNF axis

Gastrointestinal (GI) complications of diabetes mellitus (DM) significantly impact on patients' quality of life. Enteric glial cells (EGC) are the key cell type of enteric nervous system (ENS), which contributes to the destruction of gut homeostasis in DM. Circular RNAs (circRNAs) are a novel type of RNAs abundant in the eukaryotic transcriptome, which form covalently closed continuous loops. In this study, the contribution of circRNAs to EGC damage in DM is investigated. Transcriptome sequencing analysis and functional study show that circVPS13A is significantly down-regulated in hyperglycemia-treated EGC, and circVPS13A overexpression attenuates EGC damage in both in vitro and in vivo DM models. In vitro mechanistic study using dual-luciferase reporter assay, affinity-isolation assay, fluorescence in situ hybridization (FISH) and immunostaining analysis identify that circVPS13A exerts its protective effect by sponging miR-182 and then up-regulates glial cell line-derived neurotrophic factor (GDNF) expression. In addition, in vivo study confirms that the circVPS13A-miR-182-GDNF network regulation can attenuate hyperglycemia-induced EGC damage of duodenum in streptozotocine (STZ)-induced DM mice. The findings of this study may provide novel insights into the protective role of circVPS13A in DM-associated EGC damage and clues for the development of new therapeutic approaches for the prevention of Gl complications of DM.
A Self-Powered Optogenetic System for Implantable Blood Glucose Control

Diabetes treatment and rehabilitation are usually a lifetime process.Optogenetic engineered designer cell-therapy holds great promise in regulating blood glucose homeostasis.However,portable,sustainable,and long-term energy supplementation has previously presented a challenge for the use of optogenetic stimulation in vivo.Herein,we purpose a self-powered optogenetic system (SOS) for implantable blood glucose control.The SOS consists of a biocompatible far-red light (FRL) source,FRL-triggered transgene-expressing cells,a power management unit,and a flexible implantable piezoelectric nanogenerator (i-PENG) to supply long-term energy by converting biomechanical energy into electricity.Our results show that this system can harvest energy from body movement and power the FRL source,which then significantly enhanced production of a short variant of human glucagon-like peptide 1 (shGLP-1) in vitro and in vivo.Indeed,diabetic mice equipped with the SOS showed rapid restoration of blood glucose homeostasis,improved glucose,and insulin tolerance.Our results suggest that the SOS is sufficiently effective in self-powering the modulation of therapeutic outputs to control glucose homeostasis and,furthermore,present a new strategy for providing energy in optogenetic-based cell therapy.
Water-induced electrode poisoning and the mitigation strategy for high temperature polymer electrolyte membrane fuel cells

Engineering failure of membrane electrode assembly caused by increasingly fuel poisoning in the high temperature polymer electrolyte membrane fuel cells fed with humidified reformate gases is firstly demonstrated herein this work.Based on the results of the in-situ environmental scanning electron microscope,electrochemical analyses,and limiting current method,a water-induced phosphoric acid invasion model is constructed in the porous electrode to elucidate the failure causations of the hindered hydrogen mass transport and the enhanced carbon monoxide poisoning.To optimize the phosphoric acid distribution under the inevitably humidified circumstance,a facile and effective strategy of constructing acid-proofed electrode is proposed and demonstrates outstanding stability with highly humidified reformate gases as anode fuel.This work discusses a potential defect that was rarely studied previously under practical working circumstance for high temperature polymer electrolyte membrane fuel cells,providing an alternative opinion of electrode design based on the fundamental aspects towards the engineering problems.
Controlled moderative sulfidation-fabricated hierarchical heterogeneous nickel sulfides-based electrocatalyst with tripartite Mo doping for efficient oxygen evolution

An electrocatalyst with heterogeneous nanostructure, especially the hierarchical one, generally shows a more competitive activity than that of its single-component counterparts for oxygen evolution reaction (OER), due to the synergistically enhanced kinetics on enriched active sites and reconfigured electronic band structure. Here this work introduces hierarchical heterostructures into a NiMo@NiS/MoS_2@Ni_3S_2/ MoOx (NiMoS) composite by one-pot controlled moderative sulfidation. The optimal solvent composition and addition of NaOH enable NiMoS to own loose and porous structures, smaller nanoparticle sizes, optimal phase composition and chemical states of elements, improving the OER activity of NiMoS. To achieve current densities of 50 and 100 mA cm~(-2), small overpotentials of 275 and 306 mV are required respectively,together with a minor Tafel slope of 58 mV dec~(-1), which outperforms most reported sulfide catalysts and IrO_2. The synergistic effects in the hierarchical heterostructures expose more active sites,adjust the electronic band structure, and enable the fast charge transfer kinetics, which construct an optimized local coordination environment for high OER electrocatalytic activity. Furthermore, the hierarchical heterostructures suppress the distinct lowering of electrical conductivity and collapse of pristine structures resulted from the metal oxidation and synchronous S leaching during OER, yielding competitive catalytic stability.
In situ transmission electron microscopy and artificial intelligence enabled data analytics for energy materials

Energy materials are vital to energy conversion and storage devices that make renewable resources viable for electrification technologies. In situ transmission electron microscopy (TEM) is a powerful approach to characterize the dynamic evolution of material structure, morphology, and chemistry at the atomic scale in real time and in operando. In this review, recent advancements of in situ TEM techniques for studying energy materials, including catalysts, batteries, photovoltaics, and thermoelectrics, are systematically discussed and summarized. The topics include a broad range of material transformations that are in situ stimulated by heating, biasing, lighting, electron-beam illuminating, and cryocooling under vacuum,liquid, or gas environments within TEM, as well as the mechanistic understanding of the associated solid-solid, solid-liquid, and solid-gas reactions elucidated by in situ TEM examination and operando measurements. Special focus is also put on the emerging progress of artificial intelligence enabled microscopy data analytics, including machine learning enhanced tools for retrieving useful information from massive TEM imaging, diffraction, and spectroscopy datasets, highlighting its merits and potential for automated in situ TEM experimentation and analysis. Finally, the pressing challenges and future perspectives on in situ TEM study for energy-related materials are discussed.
多功能开口器下低温等离子射频切除声门上型喉癌的初步研究

目的探讨经口低温等离子手术切除声门上型喉癌的可行性。方法收集自2019年1月~2022年4月就诊于济宁医学院附属医院13例声门上型喉癌(T1N1M0 4例,T2N1M0 2例,T1N0M0 7例)患者的临床资料,手术采用多功能开口器下低温等离子手术切除联合双侧颈淋巴结清扫,术后随访6~37个月,观察患者手术时间、出血量、吞咽恢复及肿瘤是否复发等情况。结果手术时间(1.5±0.5)h,出血量(50±10)ml,饮食恢复正常时间(9±3)d,13例患者随访至今均无复发,1例患者行气管切开,术后患者呼吸、发音功能均未受到影响。结论经口低温等离子切除声门上型喉癌手术时间短、出血量少、进食时间早、住院天数短、并发症较传统手术有所减少。
性质不明溃疡伴出血合并胃石1例

本文报道1例老年女性患者主因黑便就诊,门诊行胃镜示"1.十二指肠溃疡并出血(ForrestⅠb);2.胃溃疡(ForrestⅡc);3.胃结石"。入院后积极治疗上消化道出血,同时完善相关检查,肿瘤标志物癌胚抗原(CEA)升高,影像学提示胃周散在淋巴结、卵巢占位病变,后病理回报见少许腺体不典型增生。因胃溃疡难以定性,遂于出血停止后予四联抗幽门螺杆菌(Hp)治疗,在患者拟返院复查前4~5 d,嘱其每日饮用苏打水促进胃石崩解。密切随访,1个月后患者返院,复查胃镜示:胃石消失,胃角见2枚红色溃疡瘢痕,球部溃疡范围较前明显缩小,呈环形线状,覆薄白苔。胃角再次行活检后病理排除恶性肿瘤。
18氟-氟代甲基胆碱PET/CT对原发性甲状旁腺功能亢进症定位诊断研究进展

原发性甲状旁腺功能亢进症(PHPT)系由一个或多个功能自主的甲状旁腺组织分泌过多的甲状旁腺激素(PTH),从而引起以钙磷代谢紊乱为特征的全身多器官受累的复杂病症。一般认为:对于有症状患者或某些无症状者均推荐首选手术根治。鉴于本病病因以甲状旁腺腺瘤(85%)常见,其次包含甲状旁腺增生(15%)及腺癌(1%),故目前手术方式主要有2种:双侧颈部探查术(BNE),微创甲状旁腺切除术(MIP),以及由此衍生的视频辅助下微创甲状旁腺切除术、腔镜及机器人辅助甲状旁腺切除术。其中,MIP因其创伤小,手术并发症更少越来越受到临床的重视,而精准的术前影像学定位对于MIP手术的成功至关重要。虽然传统影像方式如甲状旁腺超声(US)与99mTc-甲氧基异丁基异腈(99mTc-MIBI)显像被各国指南推荐为一线的术前定位方法,但越来越多的新型影像学运用于术前定位,包括18氟-氟代甲基胆碱正电子发射断层显像/计算机体层成像(~(18)F-FCH PET/CT)、四维CT(4DCT)等。近年来大量研究表明新型影像方式的术前定位效能显著高于传统影像方法,而且~(18)F-FCH PET/CT较四维CT具有辐射剂量更低,成像时间更短的特点,为此本文将围绕~(18)F-FCH PET/CT在PHPT中术前定位价值做一综述。
成人上肢假肢评价方案

《第二次全国残疾人抽样调查》显示,我国肢体残疾者有2000多万,其中截肢者接近300万[1]。近年来,随着科技的发展,假肢领域出现了感觉反馈型假肢[2]、植入式假肢[3],和利用脑机接口技术控制的假肢[4]。
聚乙二醇干扰素α-2a与恩替卡韦治疗儿童慢性乙型肝炎的疗效和安全性分析

目的探讨慢性乙型肝炎患儿应用聚乙二醇干扰素(polyethylene glycol interferon, PEG-[FN)α-2a和恩替卡韦治疗的效果。方法选取2016年1月至2020年6月在深圳市第三人民医院就诊旳慢性乙型肝炎患儿,根据治疗用药分为PEG-IFNα-2a组和恩替卡韦组,分别比较两组患儿基线,治疗2、24、48周的丙氨酸转氨酶(alanine aminotransferase,ALT)、乙型肝炎病毒(hepatitis B virus,HBV)血清标志物、HBV DNA变化及不良反应。统计学分析采用χ~2检验。结果共纳入54例患儿,其中PEG-IFNα-2a组31例,恩替卡韦组23例。恩替卡韦组治疗48周的ALT复常率达87.0%(20/23),高于PEG-IFNα-2a组的40.0%(12/30),差异有统计学意义(χ~2 =12.00,P = 0.001)。PEG-IFNα-2a组治疗48周的乙型肝炎e抗原(hepatitis B e antigen,HBeAg)转阴率为48.4%( 15/31),HBeAg血清学转换率为45.2%(14/31),乙型肝炎表面抗原(hepatitis B surface antigen, HBsAg)转阴率为35.5%(11/31);恩替卡韦组治疗48周的HBeAg转阴率为47.8%(11/23),HBeAg血清学转换率为43.5%( 10/23), HBsAg转阴率为13.0%(3/23),两组上述指标比较差异均无统计学意义(χ~2 =0.00、0.02、3.46,均P>0.050)。PEG-IFNα-2a组治疗48周时HBsAg血清学转换率为25.8%(8/31),高于恩替卡韦组的4.3%(1/23),差异有统计学意义(χ~2=4.38,P =0.036)。将PEG-IFNα-2a组患儿在治疗12周时根据HBsAg下降水平分为HBsAg < 1 500 IU/mL组和HBsAg≥l 500 IU/mL组,18例HBsAg < 1 500 IU/mL组患儿在治疗24周时7例HBsAg转阴,48周时10例转阴,而13例HBsAg≥1 500 IU/mL组患儿治疗24周时无一例HBsAg转阴,治疗48周时1例转阴,差异均有统计学意义(χ~2=2.56、2.75,均P<0.050)。结论恩替卡韦改善肝脏炎症的效果更明显,短期内抑制病毒复制的能力更强,安全性较好;PEG-IFNα-2a的治疗效果与HBsAg快速下降有关,治疗中HBsAg快速下降(12周HBsAg < 1 500 IU/mL)的患者,治疗24周和48周的HBsAg转阴率更高。
造血干细胞移植治疗急性髓系白血病伴肥大细胞增生症2例

2例患儿因发热起病,经血常规、骨髓穿刺细胞学检查、白血病免疫分型、骨髓染色体核型、分子生物学等检查诊断为急性髓系白血病M2伴肥大细胞增生症,化疗后行造血干细胞移植,治疗后1例肥大细胞呈下降趋势,1例肥大细胞呈波动状态。
慢性阻塞性肺疾病患者居家运动康复的最佳证据总结

目的总结慢性阻塞性肺疾病(COPD)患者居家运动康复的最佳证据,为临床提供理论参考。方法根据循证学方法,检索有关COPD患者居家运动康复的证据资源,包括指南、专家共识、系统评价、证据总结等,采用澳大利亚循证卫生保健中心的文献评价标准及证据分级系统,对文献进行质量评价及证据级别的评定。结果最终纳入文献30篇,其中指南2篇,证据综合1篇,专家共识4篇,系统评价18篇,随机对照试验5篇。从居家运动可行性、不同分级患者运动处方、运动监测、运动安全性及运动效果评价5个方面进行了证据总结,形成了18条最佳证据。结论卫生服务部门需加强对康复师、社区医生等相应专业人员的规范化培训,针对不同分级的患者,制订个性化居家运动处方,提高患者的最大摄氧量和运动耐力,改善生活质量,减少家庭及社会的经济成本支出。
医用纺织品在血管移植物中的应用进展

血管移植物主要包括替换型人工血管和腔内隔绝型血管支架,目前所用的血管移植物难以完全满足临床的理想需求,近年来医用纺织品是新型血管移植物开发的重要方向。本文从医用纺织品角度出发对现阶段医用纺织品在血管移植物中的应用进行了介绍,旨在为医用纺织品在血管外科领域的研发及应用提供一定的理论参考。
肱骨外侧截骨外固定支架与钢板治疗儿童肘内翻的对比研究

目的比较肱骨外侧截骨外固定支架与钢板治疗儿童肘内翻的临床疗效和影像学结果。方法回顾性分析自2014年10月至2018年10月在我院诊治的38例继发于儿童肱骨髁上骨折的肘内翻病例资料。通过外侧入路进行肱骨远端截骨后,根据手术方式不同随机分为钢板组(A组)和外固定支架组(B组)两组,术后2、4、6和12个月分别复查肘关节X线正侧位片,根据截骨端愈合情况决定是否取出外固定支架或钢板。按照Bellemore功能评定标准,结合影像学检查结果评定分析肘关节功能。结果两组患儿术后截骨处均达到骨性愈合,并取得了满意的功能和外观改善,无一例出现骨不连、异位骨化或固定器移位。A组患儿随访时间为36 ~71个月,平均(59.7 ±3.2)个月,手术时间为(60.9 ± 5.8)min,出血量为(41.5±3.8)ml,手术切口长度为(5.2±0.4)cm;B组患儿随访时间为38 ~72个月,平均(60.0 ±4.1)个月,手术时间为(50.8 ±5.6)min,出血量为(25.6 ±3.1)ml,手术切口长度为(3.9 ± 0.4)cm。B组在出血量、手术时间和手术切口长度方面明显少于钢板组,差异有统计学意义(P< 0.05)。两组患儿术后并发症和肘关节Bellemore功能评定差异无统计学意义(P>0.05)。结论肱骨外侧截骨锁定加压钢板和外固定支架两种方式都是治疗儿童肘内翻畸形的有效方法,和锁定加压钢板相比,外固定支架具有手术时间短、出血量少、创伤小等优点,值得临床上推广应用。
超声心动图诊断二尖瓣机械瓣置换术后急性卡瓣自动解除1例

讨论:心脏人工瓣血栓是心脏瓣膜置换术后的严重并发症,发生率约0.3%~1.3%,血栓形成导致人工瓣膜障碍,病死率约10%。人工瓣血栓形成的常见原因有不规则抗凝或抗凝不足引起血栓形成(二尖瓣为主)和瓣膜周围组织过度生长覆盖瓣周或瓣口的瓣膜组织翳(主动脉瓣为主)等,诊断人工瓣功能障碍的方法有X线、CT及心导管检查,但具有放射性,且无法进行快速、实时的诊断。经食管超声心动图(TEE)可明确人工瓣膜功能异常的原因和瓣周病理改变,联合TTE可更清楚地观测机械瓣的位置、瓣叶活动度,通过测算其流速和跨瓣压差判断是否存在机械瓣功能障碍。本例患者因急性左心衰竭、心功能差无法行TEE检查,故采用TTE检查,结果提示二尖瓣机械瓣声影遮挡,二维图像上瓣及瓣周情况显示不清,但CDFI示二尖瓣机械瓣前向血流束变细、偏向,频谱多普勒示二尖瓣V_(max)、PGmean均明显高于正常,间接提示存在机械瓣梗阻。对症处理后患者临床症状消失,复查TTE提示左房内可见血栓样回声,二尖瓣机械瓣梗阻消除,前向血流束增宽、居中。结合病史,分析本例患者血栓形成的原因为自身心脏因素及抗凝治疗不当所致,而梗阻的形成可能与血栓附着于机械瓣或瓣周有关。本病治疗方案的选择取决于有无梗阻及症状的严重程度,当心功能分级达到纽约心脏协会Ⅳ级,血栓较大(直径>5 mm)和左侧机械瓣血栓高危特征时,需行紧急手术。本例患者有急诊手术指征,但拒绝手术治疗,行强心、利尿、扩血管等对症处理后患者临床症状明显缓解,复查TTE示三尖瓣机械瓣梗阻解除,左房内可见血栓样回声,推测梗阻解除可能与二尖瓣机械瓣区域血栓脱落入左房有关。总之,超声心动图能实时、多切面地观察人工瓣瓣叶及瓣周情况,并能通过测量血流动力学相关参数进行定量评估,是目前评价人工机械瓣功能障碍的首要检查手段。
输尿管原发滤泡惰性小B细胞淋巴瘤超声表现1例

讨论:滤泡性淋巴瘤是一种较常见的非霍奇金淋巴瘤,主要累及淋巴结,也可侵犯胃肠道、甲状腺、乳腺及胰腺等结外器官,发生于泌尿系统的淋巴瘤极少见,其中原发于输尿管者罕见。国内外报道的输尿管淋巴瘤主要有弥漫大B细胞淋巴瘤和黏膜相关淋巴瘤,输尿管滤泡惰性小B细胞淋巴瘤目前尚未见报道。文献报道,患有自身免疫性疾病或免疫力低下的患者发生淋巴瘤的风险相对更高。组织病理学作为诊断淋巴瘤或明确淋巴瘤具体分型的"金标准",其主要价值在于术后的定性诊断。影像学检查可在术前辅助诊断输尿管占位性质、大小、与周围组织或器官关系及术后有无复发和远处转移,与CT、MRI相比,超声具有经济、快速、便捷的优势。本例患者超声表现为包裹输尿管下段的连续性"水滴样"不均质团状回声,输尿管膀胱入口处未探及异常回声,且血流信号丰富。随着今后临床病例数量和经验的积累,超声在输尿管淋巴瘤诊断中更具潜在的应用价值。
Exploring predictive frameworks for malaria in Burundi

In Burundi,malaria infection has been increasing in the last decade despite efforts to increase access to health services,and several intervention programs.The use of heterogeneous data can help to build predictive models of malaria cases.We built predictive frameworks:the generalized linear model (GLM),and artificial neural network (ANN),to predict malaria cases in four sub-groups and the overall general population.Descriptive results showed that more than half of malaria infections are observed in pregnant women and children under 5 years,with high burden to children between 12 and 59 months.Modelling results showed that,ANN model performed better in predicting total cases compared to GLM.Both model frameworks showed that education rates and Insecticide Treated Bed Nets (ITNs) had decreasing effects on malaria cases,some other variables had an increasing effect.Thus,malaria control and prevention interventions program are encouraged to understand those variables,and take appropriate measures such as providing ITNs,sensitization in schools and the communities,starting within high dense communities,among others.Early prediction of cases can provide timely information needed to be proactive for intervention strategies,and it can help to mitigate the epidemics and reduce its impact on populations and the economy.