3D Pd/Co core–shell nanoneedle arrays as a high-performance cathode catalyst layer for AAEMFCs

A novel cathode architecture using vertically aligned Co nanoneedle arrays as an ordered support for application in alkaline anion-exchange membrane fuel cells (AAEMFCs) has been developed. The Co nanoneedle arrays were directly grown on a stainless steel sheet via a hydrothermal reaction and then a Pd layer was deposited on the surface of the Co nanoneedle arrays using a vacuum sputter-deposition method to form Pd/Co nanoneedle arrays. After transferring the Pd/Co nanoneedle arrays to an AAEM, a cathode catalyst layer was formed. Without the use of an alkaline ionomer, the AAEMFC with the prepared cathode catalyst layer showed an enhanced performance with ultra-low Pd loading of down to 33.5 μg cm⁻², which is much higher than the conventionally used cathode electrode with a Pt loading of 100 μg cm⁻². This is the first report where three-dimensional Co nanoneedle arrays have been used as the cathode support in an AAEMFC, which is able to deliver a higher power density without an alkaline ionomer than that of conventional membrane electrode assembly (MEA).

A novel ordered Pd/Co nanoneedle array was used as a cathode in an AAEMFC and delivered a higher power density than that of conventional MEA.     

感染科实施人性化护理的应用效果分析

目的：分析人性化护理在感染科患者中的应用效果。方法随机选取50例感染科患者实施人性化护理,作为试验组;抽取同期50例传染病患者实施常规护理,作为对照组。观察并比较人性化护理在传染病护理中的应用效果。结果试验组患者的抑郁和焦虑状态与对照组相比改善更为明显,而且患者对人性化护理的模式更适应并且非常满意。结论对传染病患者实施人性化护理不仅改善了患者的身体和心理状况,还能帮助患者建立对抗疾病的信心,护理工作也因此能够更顺利地进行。     

基于深度学习的肺腺癌肿瘤突变负荷的预测

肿瘤突变负荷(TMB)与非小细胞肺癌(NSCLC)的免疫治疗疗效呈正相关,并且在近期的相关研究中,肿瘤突变负荷对靶向治疗及化疗的疗效也有一定的预测作用。因此,提出一种融合注意力机制的Inception深度学习模型(CAIM),用于对TCGA数据库中的非小型细胞肺癌中的肺腺癌的病理切片进行识别。首先,对数据样本进行切分,裁剪成小切片;然后送入到深度学习模型中,通过卷积学习图像特征,再与注意力机制结合进一步加强特征的提取;最后通过对小切片预测信息的整合,自动判别肺腺癌病理切片TMB值的高低。数据集由337张肺腺癌病理组织切片组成,其中高TMB值的数据271张,低TMB值的数据实验66张。结果表明,所提方法的性能平均曲线下面积(AUC)为0.82,明显高于图像分类方法残差网络(ResNet)的AUC值0.66。研究结果对临床实践中肿瘤突变负荷的检测和辅助诊断具有重要意义。     

ARCO Consensus on the Pathogenesis of Non-traumatic Osteonecrosis of the Femoral Head

Osteonecrosis of the femoral head (ONFH) is a devastating disease frequently leading to femoral head collapse and hip arthritis. Specifically, non-traumatic ONFH primarily affects young and middle-aged adults. Although compromised local circulation of the femoral head seems to be pathognomonic for the disease, the pathogenesis is perplexing and continues to be an area of scrutiny and research. Comprehension of the pathogenesis is of crucial importance for developing and guiding treatments for the disease. Therefore, we provide an up-to-date consensus on the pathogenesis of non-traumatic ONFH.     

Osteonecrosis of the Femoral Head: an Updated Review of ARCO on Pathogenesis,Staging and Treatment

Non-traumatic osteonecrosis of the femoral head (ONFH) usually affects adults younger than 50 years and frequently leads to femoral head collapse and subsequent arthritis of the hip. It is becoming more prevalent along with increasing use of corticosteroids for the adjuvant therapy of leukemia and other myelogenous diseases as well as management of organ transplantation. This review updated knowledge on the pathogenesis, classification criteria, staging system, and treatment of ONFH.     

基质金属蛋白酶-9和骨桥蛋白在甲状腺癌和腺瘤组织中的表达及其临床意义

目的 探讨基质金属蛋白酶-9 (MMP-9)和骨桥蛋白(OPN)在甲状腺癌及腺瘤组织中的表达和临床意义.方法 应用免疫组织化学法检测MMP-9和OPN在85例甲状腺癌组织、26例甲状腺瘤和15例正常甲状腺组织中的表达水平.结果 MMP-9在正常甲状腺、甲状腺瘤和甲状腺癌组织中的表达率分别为20.00％ (3/15)、53.85％ (14/26)和84.71％ (72/85),两两比较差异有统计学意义(P＜0.05),MMP-9表达水平与甲状腺癌美国肿瘤联合委员会(AJCC)分期、组织分化、颈部淋巴结转移、包膜浸润明显相关(P＜0.05);OPN在正常甲状腺、甲状腺瘤和甲状腺癌组织中的表达率分别为13.33％ (2/15)、46.15％ (12/26)和74.12％ (63/85),两两比较差异有统计学意义(P＜0.05),OPN表达水平与甲状腺癌AJCC分期、颈部淋巴结转移、包膜浸润明显相关(P＜0.05).结论 检测MMP-9和OPN有助于判断甲状腺癌浸润转移潜能.     

新鲜冰冻血浆对脑损伤合并失血性休克大鼠的治疗作用

目的探讨新鲜冰冻血浆对脑损伤合并失血性休克大鼠的治疗作用。方法取25只健康雌性SD大鼠,采用Aghaloo法制备新鲜冰冻血浆。将108只健康成年SD大鼠随机分为3组:sham组18只仅开放颅骨骨窗;vehicle组与FFP组(各45只)采用Feeney改良法制作脑损伤模型与Wiggers改良法制作失血性休克模型,60 min后vehicle组给予3倍失血量的生理盐水复苏,FFP组给予同等失血量FFP进行复苏。伊文氏蓝(EB)染色测定血脑屏障通透性,干湿重法测量脑组织含水量,改良神经功能评分(m NSS)评价大鼠神经功能障碍改善情况,7 d时脑组织切片尼氏染色观察神经元细胞生存情况。结果 1、3、7 d时FFP组脑水肿程度比vehicle组轻(P<0.05);12、24、72 h时各组脑组织EB含量差异有统计学意义(P<0.05),12、24、72 h时FFP组比vehicle组EB含量低(P<0.05);3、7 d时FFP组m NSS神经功能评分比vehicle组低(P<0.05)。结论早期采用新鲜冰冻血浆对脑损伤合并失血性休克大鼠进行治疗可以减轻脑水肿,降低血脑屏障通透性,改善神经功能。     

16例主动脉夹层破裂死亡患者病理特点

目的:分析主动脉夹层(AD)破裂死亡的临床表现及病理特点。方法:对16例AD破裂死亡案例进行回顾性研究。结果:AD破裂死亡多发生于40～60岁,有明显性别差异,发病季节多在冬春季(11月～次年4月),突发性腰背部疼痛及腹痛多为首发症状,常伴有高血压、动脉粥样硬化等病史,以Debakey I型多见,且发病急、死亡快,常为心包填塞死亡。结论:尸检发现AD破裂有助于医疗纠纷的处理及提高临床诊疗水平。     

角膜形态学和生物力学参数对角膜后表面高度影响的研究

目的探讨角膜形态学和生物力学参数对近视眼人群角膜后表面高度异常的影响及其辅助诊断角膜后表面高度异常的可行性。方法病例对照研究。选取2017年12月至2018年10月在青岛眼科医院拟行角膜屈光手术的屈光不正患者144例(227只眼),其中男性90例(139只眼),女性54例(88只眼);年龄(22.8±5.6)岁。所有患者检查最佳矫正视力下的球镜和柱镜度数,并行Pentacam眼前节分析系统和Corvis ST角膜生物力学检查。根据Pentacam参数角膜后表面高度变化值(BD)进行分组,将BD<12μm定为对照组(59例,118只眼);将BD≥12μm定为高BD组(85例,109只眼),其中BD≤16μm者为可疑组(44例,53只眼),>16μm者为异常组(41例,56只眼)。选取Pentacam眼前节分析系统中BD、前表面曲率(ASK)、后表面曲率(PSK)、前表面散光(AAstig)、后表面散光(PAstig)、中央角膜厚度(CCT)、角膜直径(W-W)7个参数及Corvis ST角膜生物力学检测系统中第1次压平时间(AT1)、第1次压平长度(AL1)、第1次压平速度(AV1)、第2次压平时间(AT2)、第2次压平长度(AL2)、第2次压平速度(AV2)、最大压陷时间(HCT)、最大压陷峰距(HC-PD)、最大压陷形变幅度(HC-DA)、最大压陷曲率半径(HC-R)、形变幅度比值(DA Ratio)、综合半径、最薄点厚度/厚度变化率(ARTH)、硬度参数(SPA1)、Corvis生物力学指数(CBI)15个参数纳入研究。采用独立样本t检验、Kruskal-Wallis H检验及Bonferroni法进行组间差异性比较,利用Spearman秩相关分析探讨BD的相关影响因素,并建立多元线性回归模型寻找影响BD的主要因素。结果对照组和高BD组在年龄、球镜度数、柱镜度数差异无统计学意义(t=-3.311,-1.808,-2.359;P=0.071,0.072,0.121);Pentacam测量发现在对照组、可疑组和异常组中,ASK、PSK、PAstig、W-W组间差异有统计学意义(Z=18.492,31.547,10.773,70.167;P<0.05),AAstig、CCT组间差异无统计学意义(Z=2.204,1.108;P>0.05)。其中异常组[43.40(42.20,44.40)]较对照组[42.80(41.98,44.00)]ASK增大(t=-4.292;P<0.05),可疑组[-6.50(-6.60,-6.35)]与异常组[-6.50(-6.70,-6.33)]较对照组[-6.30(-6.50,-6.20)]PSK均增大(t=4.492,4.618;P<0.05);可疑组[0.40(0.30,0.40)]与异常组[0.40(0.30,0.40]较对照组[0.40(0.30,0.50)]PAsting均增大(t=2.796,2.515;P=0.016,0.036);可疑组[11.40(11.00,11.60)]和异常组[11.10(10.90,11.30)]较对照组[11.50(11.40,11.80)]W-W减小,同时异常组较可疑组W-W也明显减小(t=3.235,8.353,4.282;P<0.05);Corvis ST参数在3个组间差异无统计学意义(P>0.05)。将每组患者BD与Pentacam参数进行相关性分析发现,在对照组、可疑组、异常组以及所有患者中,BD与W-W呈低至中度负相关(r=-0.614,-0.304,-0.396,-0.661;P<0.05),BD与其他参数相关性较低或未见明显相关性;将患者BD与Corvis ST参数进行相关性分析发现,仅在可疑组中,BD与AV1、HCT、HC-DA间存在低度正相关(r=0.332,0.361,0.382;P<0.05),BD与Corvis ST其他参数在各组中未见明显相关性。以BD为因变量,选取Pentacam参数与Corvis ST参数建立多元线性回归分析模型:变量W-W、ASK、PSK、HC-PD、SPA1、CCT间不存在共线性(容忍度<0.100),方程检验结果F=37.221,P<0.001,调整r^2=0.504,拟合较好。结论角膜形态学参数中角膜直径、前表面曲率、后表面曲率是影响BD的主要因素,角膜生物力学参数中HC-PD和SPA1也可能对BD产生一定程度影响。角膜形态学和生物力学参数的联合评估有助于角膜后表面高度异常的鉴别诊断。     

Optimizing the performance of the feedback controller for state-based switching bilinear systems

This article is concerned with the design and performance optimization of feedback controllers for state-based switching bilinear systems (SBLSs), where subsystems take the form of bilinear systems in different state space polyhedra. First, by further dividing the subregions into smaller regions and designing region-dependent feedback controllers in the resulting regions, the SBLSs can be transformed into corresponding switching linear systems (SLSs). Then, for these SLSs, by imposing contractility conditions on the Lyapunov functions, an upper bound on the infinite horizon quadratic cost can be obtained. Optimizing this upper bound yields the controller design. The optimization problem is formulated as a linear matrix inequalities optimization problem, which can be solved efficiently. Finally, the stability of the close-loop system under the proposed controller is established step by step through a decreasing overall Lyapunov function.