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Experience of treating severe cases of 2019 novel coronavirus pneumonia in Changde area

中华危重病急救医学 2020年第1期32卷 10-12页

作者： Jin Xin Fang Yimin Huang Shaohua Luo Lin qin yunjian Zhou Rui Peng Yue Yang Mingshi Ai Yuhang Department of Critical Medicine Xiangya Third Hospital Central South University Changsha 410000 Hunan China

Since the cluster of the 2019 novel coronavirus (2019-nCoV) pneumonia, a large number of patients gathered, the mortality of critical patients has remained high and the treatment was unclear. In this outbreak, Hunan Changde region immediately set up a hospital and intensive care unit. The patients relieved through respiratory support, hemodynamics management, nutritional support, the application of antiviral drugs, analgesic and sedation. The treatment experience in severe cases of 2019-nCov pneumonia patients were summarized as follows: in terms of respiratory support, we needed to pay attention to the advantages of high-flow nasal cannula oxygen therapy (HFNC) and the intervention of mechanical ventilation, pay attention to the ventilator parameters, and adopt prone position timely. In the aspects of fluid resuscitation and volume management, we should pay attention to the characteristics of severe patients'' volume status, perform early evaluation, and clinicians should focused on hemodynamic management beside the bed. In the aspect of nutritional support and evaluation and maintenance of intestinal function, early enteral nutrition should be adopted in time. However, the trade-off between the risk of intestinal function and nutritional support in patients with mechanical ventilation and the antiviral benefits of Kaletra needed to be reevaluated, the optimized way of analgesia and sedation was adopted, at the same time, the usage and side effects of antiviral drugs should be paid attention to. We should grasp the opportunity of transportation for severe patients. It is suggested that some warning scores should be used to facilitate early recognition of patients with severe infection and then they should be earlier transferred to the designated hospital for intensive care.

关键词： 2019 Novel coronavirus pneumonia Critical case Treatment experience

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异食王:从喝汽油柴油到吃剧毒农药

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全科护理 2007年第16期5卷 12-15页

作者：大林人湖南省常德市第一人民医院 415000

一个中年妇女,每天都要喝汽油或柴油。十来年,她喝下了上吨的汽油和柴油。后来,她改掉了喝油的习惯,却吃掉了上百千克的剧毒农药“六六六粉”,她现在的状况如何呢?

关键词：六六粉树梅汽油燃料油柴油石油燃料程树

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基于预防重症患者谵妄发生的最佳疼痛控制目标研究

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中华危重病急救医学 2021年第1期33卷 84-88页

作者：秦运俭李颖陈剑琴曾凤华张红霞常德市第一人民医院重症医学科湖南常德415000

目的探讨预防重症患者发生谵妄的最佳疼痛控制目标。方法采用前瞻性队列研究方法,选择2017年1月至2019年12月入住常德市第一人民医院普通科室,并因病情危重转入重症监护病房(ICU)治疗的患者作为研究对象。患者入院后48 h内收集一般资料... 详细信息

目的探讨预防重症患者发生谵妄的最佳疼痛控制目标。方法采用前瞻性队列研究方法,选择2017年1月至2019年12月入住常德市第一人民医院普通科室,并因病情危重转入重症监护病房(ICU)治疗的患者作为研究对象。患者入院后48 h内收集一般资料;患者入住ICU后由管床护士应用重症监护疼痛观察工具(CPOT)每8 h评估1次疼痛程度,由护理组长在不知晓患者疼痛程度的情况下应用ICU意识模糊评估法(CAM-ICU)每8 h评估1次是否发生谵妄,直至患者转出ICU。绘制受试者工作特征曲线(ROC曲线),以是否发生谵妄为参考标准分析ROC曲线下面积(AUC)和最佳阈值;根据最佳阈值,采用多因素Logistic回归分析评价CPOT评分与谵妄发生的相关性。结果研究期间入住参与研究科室且根据纳入和排除标准通过初筛者575例,因资料不完整而剔除34例,最终541例患者纳入分析,其中谵妄组149例,非谵妄组392例。两组患者性别、年龄、患者来源、文化程度、吸烟史、饮酒史、家族精神病史及急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)等一般资料比较差异均无统计学意义;谵妄组有10.1%(15/149)的患者使用过阿片类药物,明显高于非谵妄组的4.3%(17/392),差异有统计学意义(P65岁),分析结果与整体分析结果一致。ROC曲线分析显示,CPOT评分预测谵妄发生的AUC为0.719;当CPOT评分最佳阈值为2.5分时,敏感度为91.3%,特异度为49.0%,阳性预测值为40.5%,阴性预测值为93.7%。多因素Logistic回归分析显示,以CPOT评分3分为界值,ICU患者CPOT评分≥3分时,其谵妄发生风险是<3分者的10.043倍〔优势比(OR)=10.043,95%可信区间(95%CI)为5.498~18.345,P<0.001〕;调整患者的性别、年龄、APACHEⅡ评分、吸烟史、饮酒史、阿片类药物使用情况等因素后,CPOT评分≥3分患者谵妄的发生风险是<3分者的10.719倍(OR=10.719,95%CI为5.689~20.196,P<0.001),调整前后风险差异不大。结论以预防ICU患者发生谵妄为目标的最佳疼痛控制目标为CPOT评分3分以下。

关键词：重症监护疼痛观察工具谵妄重症监护病房意识模糊评估法受试者工作特征曲线重症护理

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被动与主动湿化器对人工气道湿化效果的Meta分析

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中华现代护理杂志 2015年第11期21卷 1283-1286页

作者：李颖秦运俭湖南省常德市第一人民医院重症医学科 415000

目的比较被动湿化器和主动湿化器用于人工气道的湿化效果。方法计算机检索和手工检索中国知网、万方医学、维普VIP数据库，收集研究分别以被动及主动湿化器作为人工气道湿化装置，将气道湿化效果、堵管率、肺部感染率等作为结局指标的... 详细信息

目的比较被动湿化器和主动湿化器用于人工气道的湿化效果。方法计算机检索和手工检索中国知网、万方医学、维普VIP数据库，收集研究分别以被动及主动湿化器作为人工气道湿化装置，将气道湿化效果、堵管率、肺部感染率等作为结局指标的随机对照试验（RCTs），采用Cochrane协作网RevMen5．2软件进行统计分析。结果共纳入国内符合本研究标准的11个RCTs，包括1531例患者。被动与主动湿化器用于人工气道时湿化过度，湿化满意，湿化不足效果的95％可信区间分别为0．47（0．3～0．73。P=0．0009），1．32（1．01～1．73，P=0．04）与0．88（0．43～1．78，P=0．71）；堵管率的95％可信区间0．88（0．43～1．78，P=0．71）；肺部感染发生率的95％可信区间0．57（0．50～0．90，P=0．008）。结论基于中国目前的RCTs研究发现，将被动湿化器作为人工气道的湿化装置能明显提高气道湿化满意度，防止湿化过度，减少肺部感染的发生。但此分析受限于儿科、新生儿患者、呼吸储备功能差及堵管高发人群，更加完善的RCT有必要去验证HME使用的广泛性。

关键词：人工鼻加热湿化器湿化效果 Meta分析

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Sliding mode control for consensus tracking of second-order nonlinear multi-agent systems driven by Brownian motion

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Science China(Information Sciences) 2018年第7期61卷 172-179页

作者： Birong ZHAO yunjian PENG Yanan SONG Ruwen qin School of Mathematics and Information Science Guangzhou University School of Automation South China University of Technology College of Automation Guangdong University of Technology Department of Engineering Management and Systems Engineering Missouri University of Science and Technology

The consensus tracking problem of nonlinear stochastic multi-agent systems with directed topologies is investigated in this study. To solve the consensus tracking problem, first, an innovative concept of sub-reachability is introduced, and then, the specified sliding hyperplane is designed. A novel consensus tracking protocol is then proposed by using sliding mode techniques. With the help of It?o integral techniques and stochastic Lyapunov method, the sub-reachability of sliding motion and consensus tracking are proved;that is, the sliding mode variable structure control protocol steers the consensus errors to the given sliding surface in a finite time, and the sliding motion is exponentially stable in the sense of mean square. The efficacy of the proposed method is tested by a numerical case.

关键词： stochastic nonlinear multi-agent systems sub-reachability sliding hyperplane sliding mode variable structure control protocol it?o integral techniques consensus tracking errors

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Dynamics of non-metal-regulated FeCo bimetal microenvironment on oxygen reduction reaction activity and intrinsic mechanism

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Nano Research 2023年第2期16卷 2199-2208页

作者： Hong Cui Tong Liu yunjian Chen Pengyue Shan Qi Jiang Xue Bai Yazhou Wang Zhiyong Liang Rong Feng qin Kang Hongkuan Yuan School of Mechanical Engineering Shaanxi University of TechnologyHanzhong 723001China Shaanxi Key Laboratory of Industrial Automation Shaanxi University of TechnologyHanzhong 723001China School of Physical Science and Technology Southwest UniversityChongqing 400715China

The change in the coordination environment of the active sites of a fuel cell cathode catalyst provides a new modulation strategy for stimulating the catalyst’s oxygen reduction reaction *** thermodynamic and electronic properties of the FeCoN5A and FeCoN6A catalyst structures with nonmetallic A-doped(A=B,N,O,P,and S)coordination were calculated and analyzed based on density functional *** modulation order of G*OH by different A-doped FeCo bimetal pairs(BMPs)was as follows:S>P>O>N/C>*** was a dynamic distribution of charges in the coordination environment during the adsorption of OH,which resulted in inversely proportional relationship with the charge transfer between the adsorbate OH,active site,first coordination layer,and second coordination layer in *** of the orbital energy levels of neighboring nonmetal atoms were constructed based on the p-electron number and electronegativity of the doped nonmetal *** change of the orbital energy levels of the first coordination atom during the adsorption process caused the structure to exhibit different adsorption *** study provides new insights on the non-metallic modulation of the M-N-C coordination environment to improve the oxygen reduction reaction activity.

关键词： dynamic distribution of charges coordination environment charge transfer orbital energy levels

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Recent advances in flexible alkaline zinc-based batteries:Materials,structures,and perspectives

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Journal of Energy Chemistry 2023年第12期87卷 61-88,I0004页

作者： Yanzhe Zhu Peiyuan Guan Renbo Zhu Shuo Zhang Ziheng Feng Mengyao Li Tao Wan Long Hu yunjian Liu qin Li Juan Yu Dewei Chu School of Materials Science and Engineering The University of New South WalesSydneyNSW 2052Australia School of Material Science and Engineering Jiangsu UniversityZhenjiang 212013JiangsuChina Queensland Micro-and Nanotechnology Centre School of Engineering and Built Environment Griffith UniversityBrisbane QLD 4111Australia School of Metallurgical Engineering Xi’an University of Architecture and TechnologyXi’an 710055ShaanxiChina

The development of wearable electronic systems has generated increasing demand for flexible power *** zinc(Zn)-based batteries,as one of the most mature energy storage technologies,have been considered as a promising power source owing to their exceptional safety,low costs,and outstanding electrochemical ***,the conventional alkaline Zn-based battery systems face many challenges associated with electrodes and electrolytes,causing low capacity,poor cycle life,and inferior mechanical *** advances in materials and structure design have enabled the revisitation of the alkaline Zn-based battery technology for applications in flexible ***,we summarize the up-to-date works in flexible alkaline Zn-based batteries and analyze the strategies employed to improve battery ***,we introduce the three most reported cathode materials(including Ag-based,Ni-based,and Co-based materials)for flexible alkaline Zn-based ***,challenges and modifications in battery anodes are ***,the recently advanced gel electrolytes are introduced from their properties,functions as well as advanced ***,recent works and the advantages of sandwich-type,fiber-type and thin film-type flexible batteries are summarized and *** review provides insights and guidance for the design of high-performance flexible Zn-based batteries for next-generation electronics.

关键词： Alkaline zinc-based batteries Cathode materials Anodeissue Gel electrolytes Flexibility Design strategy

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不同时间点静脉泵注前列地尔对行肝移植手术治疗的终末期肝病患儿血浆Clara细胞分泌蛋白及动脉血气分析指标的影响

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广西医学 2023年第8期45卷 885-890页

作者：莫少娥梁胜凤周斌先秦鋆建罗金辉李青倩陶春辉蓝雨雁广西医科大学第一附属医院麻醉科广西南宁市530021 广西壮族自治区人民医院麻醉科广西南宁市530021

目的观察不同时间点静脉泵注前列地尔对行肝移植手术治疗的终末期肝病患儿血浆Clara细胞分泌蛋白(CCSP)及动脉血气分析指标的影响。方法将择期行肝移植手术治疗的44例终末期肝病患儿随机分为C组20例与K组24例。C组患儿在新肝期开始静脉... 详细信息

目的观察不同时间点静脉泵注前列地尔对行肝移植手术治疗的终末期肝病患儿血浆Clara细胞分泌蛋白(CCSP)及动脉血气分析指标的影响。方法将择期行肝移植手术治疗的44例终末期肝病患儿随机分为C组20例与K组24例。C组患儿在新肝期开始静脉泵注0.5 ng/(kg·min)前列地尔至术毕,K组患儿手术开始后立即静脉泵注0.5 ng/(kg·min)前列地尔至术毕。比较两组患儿切皮前(T_(0))、无肝期30 min时(T_(1))、新肝期30 min时(T_(2))、手术结束时(T_(3))、术后12 h(T_(4))、术后24 h(T_(5))、术后48 h(T_(6))的血浆CCSP含量及动脉血气分析指标,以及术后儿科ICU住院时间、机械通气时间及肺部感染发生率。结果在T_(2)、T_(3)、T_(4)、T_(5)、T_(6)时,K组血浆CCSP含量均低于C组(均P0.05),但两组上述指标均有随时间变化的趋势(均P0.05)。结论肝移植手术开始后立即静脉泵注前列地尔可降低终末期肝病患儿血浆CCSP含量,缩短患儿术后机械通气时间和儿科ICU停留时间,安全性良好。

关键词：肝移植终末期肝病前列地尔 Clara细胞分泌蛋白肺功能动脉血气分析儿童

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Counteracting lineage-specific transcription factor network finely tunes lung adeno-to-squamous transdifferentiation through remodeling tumor immune microenvironment

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National Science Review 2023年第4期10卷 37-55页

作者： Shijie Tang Yun Xue Zhen qin Zhaoyuan Fang Yihua Sun Chongzhe Yuan yunjian Pan Yue Zhao Xinyuan Tong Jian Zhang Hsinyi Huang Yuting Chen Liang Hu Dasong Huang Ruiqi Wang Weiguo Zou Yuan Li Roman K.Thomas Andrea Ventura Kwok-Kin Wong Haiquan Chen Luonan Chen Hongbin Ji State Key Laboratory of Cell Biology Shanghai Institute of Biochemistry and Cell BiologyCenter for Excellence in Molecular Cell ScienceChinese Academy of Sciences College of Life Sciences University of Chinese Academy of Sciences Zhejiang University-University of Edinburgh Institute Zhejiang University School of Medicine The Second Affiliated Hospital Zhejiang University School of Medicine Department of Thoracic Surgery Fudan University Shanghai Cancer Center Department of Oncology Shanghai Medical CollegeFudan University School of Life Science and Technology Shanghai Tech University Department of Mathematics Shanghai University Department of Translational Genomics Center of Integrated Oncology Cologne-BonnMedical FacultyUniversity of Cologne Department of Pathology University Hospital Cologne Cancer Biology and Genetics Program Memorial Sloan Kettering Cancer Center Laura and Isaac Perlmutter Cancer Center New York University Langone Medical Center Key Laboratory of Systems Biology Shanghai Institutes for Biological SciencesChinese Academy of Sciences School of Life Science Hangzhou Institute for Advanced StudyUniversity of Chinese Academy of SciencesChinese Academy of Sciences

Human lung adenosquamous cell carcinoma(LUAS), containing both adenomatous and squamous pathologies, harbors strong plasticity and is significantly associated with poor prognosis. We established an up-to-date comprehensive genomic and transcriptomic landscape of LUAS in 109 Chinese specimens and demonstrated LUAS development via adeno-to-squamous transdifferentiation. Unsupervised transcriptomic clustering and dynamic network biomarker analysis identified an inflammatory subtype as the critical transition stage during LUAS development. Dynamic dysregulation of the counteracting lineage-specific transcription factors(TFs), containing adenomatous TFs NKX2-1 and FOXA2, and squamous TFs TP63 and SOX2, finely tuned the lineage transition via promoting CXCL3/5-mediated neutrophil infiltration. Genomic clustering identified the most malignant subtype featured with STK11-inactivation, and targeting LSD1 through genetic deletion or pharmacological inhibition almost eradicated STK11-deficient lung tumors. These data collectively uncover the comprehensive molecular landscape, oncogenic driver spectrum and therapeutic vulnerability of Chinese LUAS.

关键词： LUAS ALK fusion counteracting TF regulatory network CXCL3/CXCL5 LSD1

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应用非一致性网格和高阶有限元的井地电磁三维各向异性正演算法

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石油地球物理勘探 2024年第6期59卷 1410-1419页

作者：秦策付文亮王绪本米晓利杨云见赵宁河南理工大学物理与电子信息学院河南焦作454003 成都理工大学地球物理学院四川成都610059 东方地球物理公司综合物化探经理部河北涿州072751

地下介质通常表现为电各向异性,增加了井地电磁法响应的复杂性。因此,针对各向异性介质模型进行正演模拟并总结规律,对于正确解释电磁勘探的观测数据至关重要。目前,对复杂三维地质模型进行精确建模是正演中的难点之一。本文使用一种基... 详细信息

地下介质通常表现为电各向异性,增加了井地电磁法响应的复杂性。因此,针对各向异性介质模型进行正演模拟并总结规律,对于正确解释电磁勘探的观测数据至关重要。目前,对复杂三维地质模型进行精确建模是正演中的难点之一。本文使用一种基于八叉树网格的高精度建模方法,通过将六面体单元划分为八个较小的单元来局部细化网格,能够使用较少数量单元的同时保证建模的精度,从而降低计算成本。此外,为提高数值解的精度,在计算时使用高阶形函数。结合八叉树网格和高阶形函数实现了井地电磁法三维各向异性正演方法。通过对比各向异性层状模型的数值解与解析解,验证了算法的正确性。使用八叉树网格实现复杂各向异性油气模型精确建模,将异常体设置不同的水平和垂直电阻率,计算结果表明垂直电阻率对响应的影响大于水平电阻率。研究成果对实际的野外施工具有一定的指导作用,为进一步进行各向异性介质的三维反演打下基础。

关键词：各向异性八叉树有限单元法高阶形函数

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