Beside many efforts to improve outcome, sepsis is still one of the most frequent causes of death in critically ill patients. It is the most common condition with high mortality in intensive care units. The complexity ...Beside many efforts to improve outcome, sepsis is still one of the most frequent causes of death in critically ill patients. It is the most common condition with high mortality in intensive care units. The complexity of the septic syndrome comprises immunological aspects- i.e.,sepsis induced immunosuppression- but is not restricted to this fact in modern concepts. So far, exact mechanisms and variables determining outcome and mortality stay unclear. Since there is no typical risk profile, early diagnosis and risk stratification remain difficult, which hinders rapid and effective treatment initiation. Due to the heterogeneous nature of sepsis, potential therapy options should be adapted to the individual. Biomarkers like C-reactive protein and procalcitonin are routinely used as complementary tools in clinical decision-making. Beyond the acute phase proteins, a wide bunch of promising substances and non-laboratory tools with potential diagnostic and prognostic value is under intensive investigation. So far, clinical decision just based on biomarker assessment is not yet feasible. However, biomarkers should be considered as a complementary approach.展开更多
Bulk rock geochemistry of 169 fine-grained sediment samples of the upper Cretaceous to Paleogene Gosau Group （Northern Calcareous Alps, Austria and Slovakia） fiom borehole and outcrop localities was performed to sep...Bulk rock geochemistry of 169 fine-grained sediment samples of the upper Cretaceous to Paleogene Gosau Group （Northern Calcareous Alps, Austria and Slovakia） fiom borehole and outcrop localities was performed to separate non-marine and marine deposits. Geochemical characteristics of different Gosau depositional systems, basins and sediment provenance using major-, trace-, and rare earth elements were also investigated. Geochemical proxies such as boron concentrations were tested for seeking the possibilities of paleosalinity indicators. Due to the [act that several pelagic sections are represented by extremely low boron contents, B/AI＊ ratios are recognized as more robust and differentiate reliably between marine （mean： 160 ± 34） and non-marine （mean： 133 ± 33） samples. Using statistical factor analysis, hemipelagic to pelagic samples flom the Gieghi_ibl Syncline and Slovakian equivalents can be differentiated from marginal-marine to non-marine samples from the Grtinbach and Glinzendorf Syncline related to terrigenous （SiO2, AI203, K20, Th, Rb, Zr and others） and pelagic indicative elements （CaO, St, TOT/C and B/AI＊）. A clear indication for ophiolitic provenance is traced by high amounts of chromium and nickel. Only non-marine successions of the Glinzendorf Syncline show higher Cr and Ni concentrations （up to 250 and 400 ppm, respectively） and enriched Cr/V and Y/Ni ratios trending to an ultramafic source.展开更多
脓毒症是一种由感染引起的异质性疾病,感染触发了一系列复杂的局部或者全身的免疫炎症反应,引起多器官功能衰竭,发病率和病死率显著升高。由于至今仍然没有诊断脓毒症的金标准,所以脓毒症的临床诊断仍是一个难题。因此,脓毒症的临床诊...脓毒症是一种由感染引起的异质性疾病,感染触发了一系列复杂的局部或者全身的免疫炎症反应,引起多器官功能衰竭,发病率和病死率显著升高。由于至今仍然没有诊断脓毒症的金标准,所以脓毒症的临床诊断仍是一个难题。因此,脓毒症的临床诊断需要不断改变来满足临床和研究的要求。然而,尽管有许多新型的生物标记和筛选工具去预测脓毒症发生的风险,但是这些措施的诊断价值和有效性不足以让人满意,并且没有充分的证据去建议临床使用这些新技术。因此,脓毒症的临床诊断标准需要定期更新去适应不断产生的新证据。这篇综述旨在呈现当前脓毒症的诊断和早期识别方面的最新研究证据。临床运用不同的诊断方法的推荐意见依赖于推荐、评价、发展和评估分级体系(Grades of Recommendation Assessment,Development and Evaluation,GRADE),因为大部分的研究是观察性研究,并没有对这些方法进行可靠评估,采用的是两步推理方法。未来需要更多研究来确认或者反驳某一特殊的指标检测,同时应该直接采用相关病人的结果数据。展开更多
The current World Health Organization classification system of primary brain tumors is solely based on morphologic criteria. However, there is accumulating evidence that tumors with similar histology have distinct mol...The current World Health Organization classification system of primary brain tumors is solely based on morphologic criteria. However, there is accumulating evidence that tumors with similar histology have distinct molecular signatures that significantly impact treatment response and survival. Recent practice-changing clinical trials have defined a role for routine assessment of O-6-methylguanine-DNA methyltransferase(MGMT) promoter methylation in glioblastoma patients, especially in the elderly, and 1p and 19q codeletions in patients with anaplastic glial tumors. Recently discovered molecular alterations including mutations in IDH-1/2, epidermal growth factor receptor(EGFR), and BRAF also have the potential to become targets for future drug development. This article aims to summarize current knowledge on the molecular biology of high-grade gliomas relevant to daily practice.展开更多
Cost effectiveness has been demonstrated for traditional lumbar discectomy, lumbar laminectomy as well as for instrumented and noninstrumented arthrodesis. While emerging evidence suggests that minimally invasive spin...Cost effectiveness has been demonstrated for traditional lumbar discectomy, lumbar laminectomy as well as for instrumented and noninstrumented arthrodesis. While emerging evidence suggests that minimally invasive spine surgery reduces morbidity, duration of hospitalization, and accelerates return to activites of daily living, data regarding cost effectiveness of these novel techniques is limited. The current study analyzes all available data on minimally invasive techniques for lumbar discectomy, decompression, short-segment fusion and deformity surgery. In general, minimallyinvasive spine procedures appear to hold promise in quicker patient recovery times and earlier return to work. Thus, minimally invasive lumbar spine surgery appears to have the potential to be a cost-effective intervention. Moreover, novel less invasive procedures are less destabilizing and may therefore be utilized in certain indications that traditionally required arthrodesis procedures. However, there is a lack of studies analyzing the economic impact of minimally invasive spine surgery. Future studies are necessary to confirm the durability and further define indications for minimally invasive lumbar spine procedures.展开更多
The template-directed assembly of planar pentacene molecules on epitaxial graphene grown on Ru（0001） （G/Ru） has been investigated by means of low-temperature scanning tunneling microscopy （STM） and density funct...The template-directed assembly of planar pentacene molecules on epitaxial graphene grown on Ru（0001） （G/Ru） has been investigated by means of low-temperature scanning tunneling microscopy （STM） and density functional theory （DFT） calculations. STM experiments find that pentacene adopts a highly selective and dispersed growth mode in the initial stage. By using DFT calculations including van der Waals interactions, we find that the configuration with pentacene adsorbed on face-centered cubic （fcc） regions of G/Ru is the most stable one, which accounts for the selective adsorption at low coverage. Moreover, at high coverage, we have successfully controlled the molecular assembly from amorphous, local ordering, to long-range order by optimizing the deposition rate and substrate temperature.展开更多
BACKGROUND Splenic vein thrombosis is a known complication of pancreatitis.It can lead to increased blood flow through mesenteric collaterals.This segmental hypertension may result in the development of colonic varice...BACKGROUND Splenic vein thrombosis is a known complication of pancreatitis.It can lead to increased blood flow through mesenteric collaterals.This segmental hypertension may result in the development of colonic varices(CV)with a high risk of severe gastrointestinal bleeding.While clear guidelines for treatment are lacking,splenectomy or splenic artery embolization are often used to treat bleeding.Splenic vein stenting has been shown to be a safe option.CASE SUMMARY A 45-year-old female patient was admitted due to recurrent gastrointestinal bleeding.She was anemic with a hemoglobin of 8.0 g/dL.As a source of bleeding,CV were identified.Computed tomography scans revealed thrombotic occlusion of the splenic vein,presumably as a result of a severe acute pancreatitis 8 years prior.In a selective angiography,a dilated mesenterial collateral leading from the spleen to enlarged vessels in the right colonic flexure and draining into the superior mesenteric vein could be confirmed.The hepatic venous pressure gradient was within normal range.In an interdisciplinary board,transhepatic recanalization of the splenic vein via balloon dilatation and consecutive stenting,as well as coiling of the aberrant veins was discussed and successfully performed.Consecutive evaluation revealed complete regression of CV and splenomegaly as well as normalization of the red blood cell count during follow-up.CONCLUSION Recanalization and stenting of splenic vein thrombosis might be considered in patients with gastrointestinal bleeding due to CV.However,a multidisciplinary approach with a thorough workup and discussion of individualized therapeutic strategies is crucial in these difficult to treat patients.展开更多
A newly developed microprobe-based methodology(the Flank Method)for Fe^(3+)/RFe quantification has been successfully applied to some natural garnets from the North Qilian eclogites by JEOL JXA-8100microprobe at Peking...A newly developed microprobe-based methodology(the Flank Method)for Fe^(3+)/RFe quantification has been successfully applied to some natural garnets from the North Qilian eclogites by JEOL JXA-8100microprobe at Peking University.The results demonstrated an obvious discrepancy in comparison with the outcomes by conventional stoichiometric calculations.This methodology allows to measure theFe^(3+)/Rmeasurement of Fe^(3+)According to the compositional zonation displayed in the studied eclogitic garnets from North Qilian,a prograde metamorphic°C to 22 kbar,600°C was reconstructed.More interestingly,the measured Fe^(3+)/RFe ratios in garnets decreasing from core to rim may probably imply that the oxygen fugacity(f O_2)declines with the depth of the subduction zone.展开更多
So far no mechanism is known, which could connect the two measurements in an Aspect-type experiment. Here, we suggest such a mechanism, based on the phase of a photon＇s field during propagation. We show that two pola...So far no mechanism is known, which could connect the two measurements in an Aspect-type experiment. Here, we suggest such a mechanism, based on the phase of a photon＇s field during propagation. We show that two polarization measurements are correlated, even if no signal passes from one point of measurement to the other. The non-local connection of a photon pair is the result of its origin at a common source, where the two fields acquire a well defined phase difference. Therefore, it is not actually a non-local effect in any conventional sense. We expect that the model and the detailed analysis it allows will have a major impact on quantum cryptography and quantum computation.展开更多
It has been found that a model of extended electrons is more suited to describe theoretical simula- tions and experimental results obtained via scanning tunnelling microscopes, but while the dynamic properties are eas...It has been found that a model of extended electrons is more suited to describe theoretical simula- tions and experimental results obtained via scanning tunnelling microscopes, but while the dynamic properties are easily incorporated, magnetic properties, and in particular electron spin properties pose a problem due to their conceived isotropy in the absence of measurement. The spin of an electron reacts with a magnetic field and thus has the properties of a vector. However, electron spin is also isotropic, suggesting that it does not have the properties of a vector. This central conflict in the de- scription of an electron＇s spin, we believe, is the root of many of the paradoxical properties measured and postulated for quantum spin particles. Exploiting a model in which the electron spin is described consistently in real three-dimensional space - an extended electron model - we demonstrate that spin may be described by a vector and still maintain its isotropy. In this framework, we re-evaluate the Stern-Gerlach experiments, the Einstein-Podolsky-Rosen experiments, and the effect of consecutive ts and find in all cases a fairly intuitive explanation.展开更多
Background: A 6- year- old girlwith a symmetric linear eruption on both of her legs, clinically and histologically resembling inflammatory linear verrucous epidermal nevus (ILVEN) or linear psoriasis (LP), with concom...Background: A 6- year- old girlwith a symmetric linear eruption on both of her legs, clinically and histologically resembling inflammatory linear verrucous epidermal nevus (ILVEN) or linear psoriasis (LP), with concomitant psoriasis of the guttata type and a positive family history of psoriasis is presented. The questions as to whether LP actually exists and ILVEN represents a distinct entity are still under debate. Objective and Methods: The recent literature concerning case reports of ILVEN and LP is reviewed. Results: Case reports of ILVEN and LP can be subdivided into four different groups:(1) ILVEN with or without concomitant psoriasis, only in part reacting to antipsoriatic treatment, (2) ILVEN without concomitant psoriasis, (3) LP with concomitant psoriasis vulgaris, with both groups 2 and 3 reacting successfully to antipsoriatic treatment, and (4) LP without concomitant psoriasis vulgaris and with no family history of psoriasis (very rarely reported). Conclusion: It is hypothesized that inflammatory linear verrucous eruption besides nevoid psoriasisLP represents a further segmentai type 1type 2 mosaic of psoriasis which, if a (verrucous) epidermal nevus exists, shows a high affinity of occurrence in close context to such a nevus. Heritability is thought to be possible.展开更多
The Adaptive Solar Facade （ASF） is a modular, highly integrated dynamic building facade.The energetic behavior as well as the architectural expression of the facade can be controlled with high spatio-temporal resolu...The Adaptive Solar Facade （ASF） is a modular, highly integrated dynamic building facade.The energetic behavior as well as the architectural expression of the facade can be controlled with high spatio-temporal resolution through individually addressable modules. We present the general design process, the current mechanical design, and simulation results on photovoltaic power production and building energy consumption. We introduce the controller concept and show results on solar tracking as well as user interaction. Lastly, we present our current and planned prototypes.展开更多
Two-dimensional(2D)materials received large amount of studies because of the enormous potential in basic science and industrial applications.Monolayer Pd2Se3 is a fascinating 2D material that was predicted to possess ...Two-dimensional(2D)materials received large amount of studies because of the enormous potential in basic science and industrial applications.Monolayer Pd2Se3 is a fascinating 2D material that was predicted to possess excellent thermoelectric,electronic,transport,and optical properties.However,the fabrication of large-scale and high-quality monolayer Pd2Se3 is still challenging.Here,we report the synthesis of large-scale and high-quality monolayer Pd2Se3 on graphene-SiC(0001)by a two-step epitaxial growth.The atomic structure of Pd2Se3 was investigated by scanning tunneling microscope(STM)and confirmed by non-contact atomic force microscope(nc-AFM).Two subgroups of Se atoms have been identified by nc-AFM image in agreement with the theoretically predicted atomic structure.Scanning tunneling spectroscopy(STS)reveals a bandgap of 1.2 eV,suggesting that monolayer Pd2Se3 can be a candidate for photoelectronic applications.The atomic structure and defect levels of a single Se vacancy were also investigated.The spatial distribution of STS near the Se vacancy reveals a highly anisotropic electronic behavior.The two-step epitaxial synthesis and characterization of Pd2Se3 provide a promising platform for future investigations and applications.展开更多
We show by a statistical analysis of high-resolution scanning tunneling microscopy （STM） exper- iments, that the interpretation of the density of electron charge as a statistical quantity leads to a conflict with th...We show by a statistical analysis of high-resolution scanning tunneling microscopy （STM） exper- iments, that the interpretation of the density of electron charge as a statistical quantity leads to a conflict with the Heisenberg uncertainty principle. Given the precision in these experiments we find that the uncertainty principle would be violated by close to two orders of magnitude, if this interpretation were correct. We are thus forced to conclude that the density of electron charge is a physically real, i.e., in principle precisely measurable quantity.展开更多
Traditional geographic information system models for map representation use superposition of layers to model physical reality,neglecting the integrity of the environment and limiting the ability to express interaction...Traditional geographic information system models for map representation use superposition of layers to model physical reality,neglecting the integrity of the environment and limiting the ability to express interactions between features in complex phenomenon.This results in limitations regarding dynamic simulation and geographic causality reasoning.In this paper,we extend the framework of the geographic scene by formalizing the relationship between geographic processes and events to construct a dynamic data model:the process-event-centred dynamic data model.The key element of this data model is relationships between processes,events,and states of the natural or man-made phenomenon of interest.The identified relationships can be translated into a network of hierarchical,developmental,and causal graphs and realized in the Neo4j graph database.The implementation in the graph database supports spatio-temporal reasoning in geographic scenes and achieves an organizational framework for simulating spatio-temporal dynamics and complex calculations.The example of a 2019 mega-typhoon process is used to demonstrate the introduced process-event-centred model and its implementation in the graph database.A series of queries to the graph database show the capabilities of the data model for spatial reasoning and dynamic modeling.展开更多
Background:Recently the beneficial effect of excimer laser treatment has been reported for patients with vitiligo. The influence of treatment frequency on this effect is not clear. Objectives:To determine the optimal ...Background:Recently the beneficial effect of excimer laser treatment has been reported for patients with vitiligo. The influence of treatment frequency on this effect is not clear. Objectives:To determine the optimal frequency of 308-nm excimer laser therapy for vitiligo. Methods:In this prospective, university-based hospital study over 12 weeks we enrolled 14 patients. Each had at least three stable vitiligo lesions in the same body area. The three stable vitiligo lesions in each subject were randomly assigned to receive excimer laser treatment once (1×), twice (2×) and three times (3×) weekly, respectively. The initial ultraviolet (UV) dose was 50 mJ cm-2 less than the 308-nm minimal erythematous dose in vitiligo skin. The UV dose was increased at each treatment session according to the erythematous response to the previous treatment. Results:Thirteen subjects were treated for at least 6 weeks; seven were treated for all 12 weeks. At 6 weeks, the repigmentation rates for treated lesions were 8%(1/13) after 1×weekly treatment, 23%(3/13) after 2×weekly treatment and 62%(8/13) after 3×weekly treatment (P=0.0134; 3×vs. 1×weekly); at 12 weeks, these rates were 46%(6/13), 62%(8/13) and 69%(9/13), respectively (P=NS;3×vs. 1 ×weekly). Repigmentation initiation correlated with treatment number, regardless of frequency (P=NS). As shown by Kaplan-Meier analysis, repigmentation occurred earliest in the most frequently treated lesions (P=0.0336). At 12 weeks, the projected repigmentation rates for 1×,2×and 3×weekly treatment approached each other (60%, 79%and 82%, respectively); the mean repigmentation grades (on a scale of 0-5) for 1×,2×and 3×weekly treatment were 1.7, 2.4 and 3.3, respectively(P=0.018;3×.vs. 1×weekly). Laser-induced repigmentation persisted in most cases over the entire follow-up of 12 months after the end of treatment. Conclusions:308-nm excimer laser therapy is effective against vitiligo. Although repigmentation occurs fastest with 3×weekly treatment, the ultimate repigmentation initi展开更多
We review the recently dew, loped three-dinmnsional （3D） atom-superposition approach for simulating scanning tunneling microscopy （STM） and spectroscopy （STS） based on ab initio electronic structure data. In the...We review the recently dew, loped three-dinmnsional （3D） atom-superposition approach for simulating scanning tunneling microscopy （STM） and spectroscopy （STS） based on ab initio electronic structure data. In the method, contributions from individual electron tunneling transitions between the tip apex atom and each of the sample surface atoms are summed up assuming tile one-dimensional （1D） Wentzel-Kramers--Brillouin （WKB） approximation in all these transitions. This 3D WKB tun- neling model is extremely suitable to simulate spin-polarized STM and STS on surfaces exhibiting a complex noncollinear magnetic structure, i.e., without a global spin quantization axis, at very low computational cost. The tip electronic structure from first principles can also be incorporated into the model, that is often assumed to be constant in energy in the vast majority of the related literature, which couht lead to a misinterpretation of experimental findings. Using this approach,we highlight some of tile electron tunneling features on a prototype frustrated hexagonal antiferro- magnetic Cr monolayer oil Ag（lll） surface. We obtain useful theoretical insights into tile simulated quantities that is expected to help the correct evaluation of experimental results. By extending the method to incorporate a simple orbital dependent electron tunneling transmission, we reinvestigate the bias voltage- and tip-dependent contrast inversion effect on the W（110） surface. STM images cal- culated using this orbital dependent model agree reasonably well with Tersoff-Hamann and Bardeen results. The computational efficiency of the model is remarkable as the k-point samplings of the surface and tip Brillouin zones do not affect the computational time, in contrast to the Bardeen method. In a certain case we obtain a relative computational time gain of 8500 compared to the Bardeen calculation, without the loss of quality. We discuss the advantages and limitations of tile 3D WKB method, and show further ways to improve and exte展开更多
A novel approach is introduced for the detection of the location and direction of traffic congestion using GPS data from taxis.This approach uses a dynamic model that conceptualizes events,processes,and states.The sta...A novel approach is introduced for the detection of the location and direction of traffic congestion using GPS data from taxis.This approach uses a dynamic model that conceptualizes events,processes,and states.The states are the locations of the taxis,the processes are the motion of taxis,and the events are congestion.The model is implemented as a graph database,which represents the relationships between states,events,processes,and things(such as points of interest and road grid).Algorithms for constructing and updating the relationships and taxi behaviors dynamic retrieval method in Neo4j are presented and are used to demonstrate the capabilities in dynamic expression and reasoning.An implementation of Shanghai in 2015finally demonstrated the ability of congestion direction detection and the cause searching of traffic congestion.展开更多
Background The circle of Willis(COW)is part of the brain collateral system.The absence of COW segments may affect functional outcome in patients with ischaemic stroke undergoing endovascular therapy.Methods In 182 pat...Background The circle of Willis(COW)is part of the brain collateral system.The absence of COW segments may affect functional outcome in patients with ischaemic stroke undergoing endovascular therapy.Methods In 182 patients in the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 Study and the CT Perfusion to Predict Response to Recanalisation in Ischaemic Stroke Project,COW anatomy was evaluated on postinterventional magnetic resonance angiography.The absence of the posterior communicating artery or the first segments of posterior or anterior cerebral arteries ipsilateral to the ischaemic infarction was rated as an incomplete COW.Logistic regression was applied to evaluate an association with the patients’modified Rankin scale(mRS)at 90 days after stroke Results An incomplete ipsilateral COW was not predictive of the patients’mRS at 90 days after stroke.Significant associations were shown for the patients’baseline National Institutes of Health Stroke Scale(NIHSS),age and reperfusion status.The effect size suggests that a significant association of an incomplete COW with the mRS at 90 days may be obtained in cohorts of more than 3000 patients.Conclusions Compared with the established predictors NIHSS,age and reperfusion status,an incomplete COW is not associated with functional outcome after endovascular therapy.展开更多
文摘Beside many efforts to improve outcome, sepsis is still one of the most frequent causes of death in critically ill patients. It is the most common condition with high mortality in intensive care units. The complexity of the septic syndrome comprises immunological aspects- i.e.,sepsis induced immunosuppression- but is not restricted to this fact in modern concepts. So far, exact mechanisms and variables determining outcome and mortality stay unclear. Since there is no typical risk profile, early diagnosis and risk stratification remain difficult, which hinders rapid and effective treatment initiation. Due to the heterogeneous nature of sepsis, potential therapy options should be adapted to the individual. Biomarkers like C-reactive protein and procalcitonin are routinely used as complementary tools in clinical decision-making. Beyond the acute phase proteins, a wide bunch of promising substances and non-laboratory tools with potential diagnostic and prognostic value is under intensive investigation. So far, clinical decision just based on biomarker assessment is not yet feasible. However, biomarkers should be considered as a complementary approach.
基金funded by the OMV AG within a scientific research project at the University of Vienna(University of Vienna Commission No.FA 536004)part of G.Hs PhD thesis which is partly funded by the DOC program of Austrian Academy of Sciences
文摘Bulk rock geochemistry of 169 fine-grained sediment samples of the upper Cretaceous to Paleogene Gosau Group （Northern Calcareous Alps, Austria and Slovakia） fiom borehole and outcrop localities was performed to separate non-marine and marine deposits. Geochemical characteristics of different Gosau depositional systems, basins and sediment provenance using major-, trace-, and rare earth elements were also investigated. Geochemical proxies such as boron concentrations were tested for seeking the possibilities of paleosalinity indicators. Due to the [act that several pelagic sections are represented by extremely low boron contents, B/AI＊ ratios are recognized as more robust and differentiate reliably between marine （mean： 160 ± 34） and non-marine （mean： 133 ± 33） samples. Using statistical factor analysis, hemipelagic to pelagic samples flom the Gieghi_ibl Syncline and Slovakian equivalents can be differentiated from marginal-marine to non-marine samples from the Grtinbach and Glinzendorf Syncline related to terrigenous （SiO2, AI203, K20, Th, Rb, Zr and others） and pelagic indicative elements （CaO, St, TOT/C and B/AI＊）. A clear indication for ophiolitic provenance is traced by high amounts of chromium and nickel. Only non-marine successions of the Glinzendorf Syncline show higher Cr and Ni concentrations （up to 250 and 400 ppm, respectively） and enriched Cr/V and Y/Ni ratios trending to an ultramafic source.
文摘脓毒症是一种由感染引起的异质性疾病,感染触发了一系列复杂的局部或者全身的免疫炎症反应,引起多器官功能衰竭,发病率和病死率显著升高。由于至今仍然没有诊断脓毒症的金标准,所以脓毒症的临床诊断仍是一个难题。因此,脓毒症的临床诊断需要不断改变来满足临床和研究的要求。然而,尽管有许多新型的生物标记和筛选工具去预测脓毒症发生的风险,但是这些措施的诊断价值和有效性不足以让人满意,并且没有充分的证据去建议临床使用这些新技术。因此,脓毒症的临床诊断标准需要定期更新去适应不断产生的新证据。这篇综述旨在呈现当前脓毒症的诊断和早期识别方面的最新研究证据。临床运用不同的诊断方法的推荐意见依赖于推荐、评价、发展和评估分级体系(Grades of Recommendation Assessment,Development and Evaluation,GRADE),因为大部分的研究是观察性研究,并没有对这些方法进行可靠评估,采用的是两步推理方法。未来需要更多研究来确认或者反驳某一特殊的指标检测,同时应该直接采用相关病人的结果数据。
文摘The current World Health Organization classification system of primary brain tumors is solely based on morphologic criteria. However, there is accumulating evidence that tumors with similar histology have distinct molecular signatures that significantly impact treatment response and survival. Recent practice-changing clinical trials have defined a role for routine assessment of O-6-methylguanine-DNA methyltransferase(MGMT) promoter methylation in glioblastoma patients, especially in the elderly, and 1p and 19q codeletions in patients with anaplastic glial tumors. Recently discovered molecular alterations including mutations in IDH-1/2, epidermal growth factor receptor(EGFR), and BRAF also have the potential to become targets for future drug development. This article aims to summarize current knowledge on the molecular biology of high-grade gliomas relevant to daily practice.
文摘Cost effectiveness has been demonstrated for traditional lumbar discectomy, lumbar laminectomy as well as for instrumented and noninstrumented arthrodesis. While emerging evidence suggests that minimally invasive spine surgery reduces morbidity, duration of hospitalization, and accelerates return to activites of daily living, data regarding cost effectiveness of these novel techniques is limited. The current study analyzes all available data on minimally invasive techniques for lumbar discectomy, decompression, short-segment fusion and deformity surgery. In general, minimallyinvasive spine procedures appear to hold promise in quicker patient recovery times and earlier return to work. Thus, minimally invasive lumbar spine surgery appears to have the potential to be a cost-effective intervention. Moreover, novel less invasive procedures are less destabilizing and may therefore be utilized in certain indications that traditionally required arthrodesis procedures. However, there is a lack of studies analyzing the economic impact of minimally invasive spine surgery. Future studies are necessary to confirm the durability and further define indications for minimally invasive lumbar spine procedures.
基金This work was financially supported by the Ministry of Science and Technology （MOST Nos. 2011CB921702 and 2011CB932700）, National Natural Science Foundation of China （NSFC No. 61222112）, Multilevel Molecular Assemblies： Structure, Dynamics, and Functions （TRR61）, Shanghai Supercomputer Center （SSC）, and Chinese Academy of Sciences （CAS） in China. WAH acknowledges support from the UK Car-Parinello consortium, grant No. EP/F037783/1.
文摘The template-directed assembly of planar pentacene molecules on epitaxial graphene grown on Ru（0001） （G/Ru） has been investigated by means of low-temperature scanning tunneling microscopy （STM） and density functional theory （DFT） calculations. STM experiments find that pentacene adopts a highly selective and dispersed growth mode in the initial stage. By using DFT calculations including van der Waals interactions, we find that the configuration with pentacene adsorbed on face-centered cubic （fcc） regions of G/Ru is the most stable one, which accounts for the selective adsorption at low coverage. Moreover, at high coverage, we have successfully controlled the molecular assembly from amorphous, local ordering, to long-range order by optimizing the deposition rate and substrate temperature.
文摘BACKGROUND Splenic vein thrombosis is a known complication of pancreatitis.It can lead to increased blood flow through mesenteric collaterals.This segmental hypertension may result in the development of colonic varices(CV)with a high risk of severe gastrointestinal bleeding.While clear guidelines for treatment are lacking,splenectomy or splenic artery embolization are often used to treat bleeding.Splenic vein stenting has been shown to be a safe option.CASE SUMMARY A 45-year-old female patient was admitted due to recurrent gastrointestinal bleeding.She was anemic with a hemoglobin of 8.0 g/dL.As a source of bleeding,CV were identified.Computed tomography scans revealed thrombotic occlusion of the splenic vein,presumably as a result of a severe acute pancreatitis 8 years prior.In a selective angiography,a dilated mesenterial collateral leading from the spleen to enlarged vessels in the right colonic flexure and draining into the superior mesenteric vein could be confirmed.The hepatic venous pressure gradient was within normal range.In an interdisciplinary board,transhepatic recanalization of the splenic vein via balloon dilatation and consecutive stenting,as well as coiling of the aberrant veins was discussed and successfully performed.Consecutive evaluation revealed complete regression of CV and splenomegaly as well as normalization of the red blood cell count during follow-up.CONCLUSION Recanalization and stenting of splenic vein thrombosis might be considered in patients with gastrointestinal bleeding due to CV.However,a multidisciplinary approach with a thorough workup and discussion of individualized therapeutic strategies is crucial in these difficult to treat patients.
基金financially supported by the National Natural Science Foundation of China(41372060,41330210 and 41202032)
文摘A newly developed microprobe-based methodology(the Flank Method)for Fe^(3+)/RFe quantification has been successfully applied to some natural garnets from the North Qilian eclogites by JEOL JXA-8100microprobe at Peking University.The results demonstrated an obvious discrepancy in comparison with the outcomes by conventional stoichiometric calculations.This methodology allows to measure theFe^(3+)/Rmeasurement of Fe^(3+)According to the compositional zonation displayed in the studied eclogitic garnets from North Qilian,a prograde metamorphic°C to 22 kbar,600°C was reconstructed.More interestingly,the measured Fe^(3+)/RFe ratios in garnets decreasing from core to rim may probably imply that the oxygen fugacity(f O_2)declines with the depth of the subduction zone.
文摘So far no mechanism is known, which could connect the two measurements in an Aspect-type experiment. Here, we suggest such a mechanism, based on the phase of a photon＇s field during propagation. We show that two polarization measurements are correlated, even if no signal passes from one point of measurement to the other. The non-local connection of a photon pair is the result of its origin at a common source, where the two fields acquire a well defined phase difference. Therefore, it is not actually a non-local effect in any conventional sense. We expect that the model and the detailed analysis it allows will have a major impact on quantum cryptography and quantum computation.
文摘It has been found that a model of extended electrons is more suited to describe theoretical simula- tions and experimental results obtained via scanning tunnelling microscopes, but while the dynamic properties are easily incorporated, magnetic properties, and in particular electron spin properties pose a problem due to their conceived isotropy in the absence of measurement. The spin of an electron reacts with a magnetic field and thus has the properties of a vector. However, electron spin is also isotropic, suggesting that it does not have the properties of a vector. This central conflict in the de- scription of an electron＇s spin, we believe, is the root of many of the paradoxical properties measured and postulated for quantum spin particles. Exploiting a model in which the electron spin is described consistently in real three-dimensional space - an extended electron model - we demonstrate that spin may be described by a vector and still maintain its isotropy. In this framework, we re-evaluate the Stern-Gerlach experiments, the Einstein-Podolsky-Rosen experiments, and the effect of consecutive ts and find in all cases a fairly intuitive explanation.
文摘Background: A 6- year- old girlwith a symmetric linear eruption on both of her legs, clinically and histologically resembling inflammatory linear verrucous epidermal nevus (ILVEN) or linear psoriasis (LP), with concomitant psoriasis of the guttata type and a positive family history of psoriasis is presented. The questions as to whether LP actually exists and ILVEN represents a distinct entity are still under debate. Objective and Methods: The recent literature concerning case reports of ILVEN and LP is reviewed. Results: Case reports of ILVEN and LP can be subdivided into four different groups:(1) ILVEN with or without concomitant psoriasis, only in part reacting to antipsoriatic treatment, (2) ILVEN without concomitant psoriasis, (3) LP with concomitant psoriasis vulgaris, with both groups 2 and 3 reacting successfully to antipsoriatic treatment, and (4) LP without concomitant psoriasis vulgaris and with no family history of psoriasis (very rarely reported). Conclusion: It is hypothesized that inflammatory linear verrucous eruption besides nevoid psoriasisLP represents a further segmentai type 1type 2 mosaic of psoriasis which, if a (verrucous) epidermal nevus exists, shows a high affinity of occurrence in close context to such a nevus. Heritability is thought to be possible.
文摘The Adaptive Solar Facade （ASF） is a modular, highly integrated dynamic building facade.The energetic behavior as well as the architectural expression of the facade can be controlled with high spatio-temporal resolution through individually addressable modules. We present the general design process, the current mechanical design, and simulation results on photovoltaic power production and building energy consumption. We introduce the controller concept and show results on solar tracking as well as user interaction. Lastly, we present our current and planned prototypes.
基金Project supported by the National Key Research and Development Program of China(Grant Nos.2016YFA0202300,2018YFA0305800,and 2019YFA0308500)the National Natural Science Foundation of China(Grant Nos.51922011,51872284,and 61888102)+1 种基金the Strategic Priority Research Program of the Chinese Academy of Sciences(Grant Nos.XDB30000000 and XDB28000000)the Science Fund from University of the Chinese Academy of Sciences.
文摘Two-dimensional(2D)materials received large amount of studies because of the enormous potential in basic science and industrial applications.Monolayer Pd2Se3 is a fascinating 2D material that was predicted to possess excellent thermoelectric,electronic,transport,and optical properties.However,the fabrication of large-scale and high-quality monolayer Pd2Se3 is still challenging.Here,we report the synthesis of large-scale and high-quality monolayer Pd2Se3 on graphene-SiC(0001)by a two-step epitaxial growth.The atomic structure of Pd2Se3 was investigated by scanning tunneling microscope(STM)and confirmed by non-contact atomic force microscope(nc-AFM).Two subgroups of Se atoms have been identified by nc-AFM image in agreement with the theoretically predicted atomic structure.Scanning tunneling spectroscopy(STS)reveals a bandgap of 1.2 eV,suggesting that monolayer Pd2Se3 can be a candidate for photoelectronic applications.The atomic structure and defect levels of a single Se vacancy were also investigated.The spatial distribution of STS near the Se vacancy reveals a highly anisotropic electronic behavior.The two-step epitaxial synthesis and characterization of Pd2Se3 provide a promising platform for future investigations and applications.
文摘We show by a statistical analysis of high-resolution scanning tunneling microscopy （STM） exper- iments, that the interpretation of the density of electron charge as a statistical quantity leads to a conflict with the Heisenberg uncertainty principle. Given the precision in these experiments we find that the uncertainty principle would be violated by close to two orders of magnitude, if this interpretation were correct. We are thus forced to conclude that the density of electron charge is a physically real, i.e., in principle precisely measurable quantity.
基金supported by National Natural Science Foundation of China[grant number 41631175,42077003].
文摘Traditional geographic information system models for map representation use superposition of layers to model physical reality,neglecting the integrity of the environment and limiting the ability to express interactions between features in complex phenomenon.This results in limitations regarding dynamic simulation and geographic causality reasoning.In this paper,we extend the framework of the geographic scene by formalizing the relationship between geographic processes and events to construct a dynamic data model:the process-event-centred dynamic data model.The key element of this data model is relationships between processes,events,and states of the natural or man-made phenomenon of interest.The identified relationships can be translated into a network of hierarchical,developmental,and causal graphs and realized in the Neo4j graph database.The implementation in the graph database supports spatio-temporal reasoning in geographic scenes and achieves an organizational framework for simulating spatio-temporal dynamics and complex calculations.The example of a 2019 mega-typhoon process is used to demonstrate the introduced process-event-centred model and its implementation in the graph database.A series of queries to the graph database show the capabilities of the data model for spatial reasoning and dynamic modeling.
文摘Background:Recently the beneficial effect of excimer laser treatment has been reported for patients with vitiligo. The influence of treatment frequency on this effect is not clear. Objectives:To determine the optimal frequency of 308-nm excimer laser therapy for vitiligo. Methods:In this prospective, university-based hospital study over 12 weeks we enrolled 14 patients. Each had at least three stable vitiligo lesions in the same body area. The three stable vitiligo lesions in each subject were randomly assigned to receive excimer laser treatment once (1×), twice (2×) and three times (3×) weekly, respectively. The initial ultraviolet (UV) dose was 50 mJ cm-2 less than the 308-nm minimal erythematous dose in vitiligo skin. The UV dose was increased at each treatment session according to the erythematous response to the previous treatment. Results:Thirteen subjects were treated for at least 6 weeks; seven were treated for all 12 weeks. At 6 weeks, the repigmentation rates for treated lesions were 8%(1/13) after 1×weekly treatment, 23%(3/13) after 2×weekly treatment and 62%(8/13) after 3×weekly treatment (P=0.0134; 3×vs. 1×weekly); at 12 weeks, these rates were 46%(6/13), 62%(8/13) and 69%(9/13), respectively (P=NS;3×vs. 1 ×weekly). Repigmentation initiation correlated with treatment number, regardless of frequency (P=NS). As shown by Kaplan-Meier analysis, repigmentation occurred earliest in the most frequently treated lesions (P=0.0336). At 12 weeks, the projected repigmentation rates for 1×,2×and 3×weekly treatment approached each other (60%, 79%and 82%, respectively); the mean repigmentation grades (on a scale of 0-5) for 1×,2×and 3×weekly treatment were 1.7, 2.4 and 3.3, respectively(P=0.018;3×.vs. 1×weekly). Laser-induced repigmentation persisted in most cases over the entire follow-up of 12 months after the end of treatment. Conclusions:308-nm excimer laser therapy is effective against vitiligo. Although repigmentation occurs fastest with 3×weekly treatment, the ultimate repigmentation initi
文摘We review the recently dew, loped three-dinmnsional （3D） atom-superposition approach for simulating scanning tunneling microscopy （STM） and spectroscopy （STS） based on ab initio electronic structure data. In the method, contributions from individual electron tunneling transitions between the tip apex atom and each of the sample surface atoms are summed up assuming tile one-dimensional （1D） Wentzel-Kramers--Brillouin （WKB） approximation in all these transitions. This 3D WKB tun- neling model is extremely suitable to simulate spin-polarized STM and STS on surfaces exhibiting a complex noncollinear magnetic structure, i.e., without a global spin quantization axis, at very low computational cost. The tip electronic structure from first principles can also be incorporated into the model, that is often assumed to be constant in energy in the vast majority of the related literature, which couht lead to a misinterpretation of experimental findings. Using this approach,we highlight some of tile electron tunneling features on a prototype frustrated hexagonal antiferro- magnetic Cr monolayer oil Ag（lll） surface. We obtain useful theoretical insights into tile simulated quantities that is expected to help the correct evaluation of experimental results. By extending the method to incorporate a simple orbital dependent electron tunneling transmission, we reinvestigate the bias voltage- and tip-dependent contrast inversion effect on the W（110） surface. STM images cal- culated using this orbital dependent model agree reasonably well with Tersoff-Hamann and Bardeen results. The computational efficiency of the model is remarkable as the k-point samplings of the surface and tip Brillouin zones do not affect the computational time, in contrast to the Bardeen method. In a certain case we obtain a relative computational time gain of 8500 compared to the Bardeen calculation, without the loss of quality. We discuss the advantages and limitations of tile 3D WKB method, and show further ways to improve and exte
基金supported by National Natural Science Foundation of China[grant number 42071364 and 41631175].
文摘A novel approach is introduced for the detection of the location and direction of traffic congestion using GPS data from taxis.This approach uses a dynamic model that conceptualizes events,processes,and states.The states are the locations of the taxis,the processes are the motion of taxis,and the events are congestion.The model is implemented as a graph database,which represents the relationships between states,events,processes,and things(such as points of interest and road grid).Algorithms for constructing and updating the relationships and taxi behaviors dynamic retrieval method in Neo4j are presented and are used to demonstrate the capabilities in dynamic expression and reasoning.An implementation of Shanghai in 2015finally demonstrated the ability of congestion direction detection and the cause searching of traffic congestion.
文摘Background The circle of Willis(COW)is part of the brain collateral system.The absence of COW segments may affect functional outcome in patients with ischaemic stroke undergoing endovascular therapy.Methods In 182 patients in the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 Study and the CT Perfusion to Predict Response to Recanalisation in Ischaemic Stroke Project,COW anatomy was evaluated on postinterventional magnetic resonance angiography.The absence of the posterior communicating artery or the first segments of posterior or anterior cerebral arteries ipsilateral to the ischaemic infarction was rated as an incomplete COW.Logistic regression was applied to evaluate an association with the patients’modified Rankin scale(mRS)at 90 days after stroke Results An incomplete ipsilateral COW was not predictive of the patients’mRS at 90 days after stroke.Significant associations were shown for the patients’baseline National Institutes of Health Stroke Scale(NIHSS),age and reperfusion status.The effect size suggests that a significant association of an incomplete COW with the mRS at 90 days may be obtained in cohorts of more than 3000 patients.Conclusions Compared with the established predictors NIHSS,age and reperfusion status,an incomplete COW is not associated with functional outcome after endovascular therapy.
