2018年3月8?9日,中国临床肿瘤学会(Chinese Society of Clinical Oncology,CSCO)和中国抗癌协会肺癌专业委员会联合主办了第15届“中国肺癌高峰论坛”。本次论坛的主题为“聚焦中枢神经系统转移:精确诊断,精准治疗”。晚期肺癌患者往往...2018年3月8?9日,中国临床肿瘤学会(Chinese Society of Clinical Oncology,CSCO)和中国抗癌协会肺癌专业委员会联合主办了第15届“中国肺癌高峰论坛”。本次论坛的主题为“聚焦中枢神经系统转移:精确诊断,精准治疗”。晚期肺癌患者往往合并脑转移,在1 000多例的肺癌尸检结果中,肺癌脑转移发生率23%~36%,是脑转移性肿瘤中最常见的类型,且通常预后较差[1]。目前肺癌脑(膜)转移的综合治疗管理和治疗结果,仍不令人满意,治疗效果不佳,中位总生存时间16个月,其中脑膜转移的患者则仅为4.5个月左右[2?5]。近10年肺癌的治疗出现了革命性的改变,但肺癌脑转移的诊断和治疗成了提高肺癌长期生存率的瓶颈。临床医师及科研工作者,应如何对脑转移进行准确及时的诊断?在众多的分型分类体系中,又该如何参考应用?如何全面地对脑转移患者的颅内/颅外病灶进行合理评估?对于伴有驱动基因敏感突变的脑转移患者群体,应怎样对待酪氨酸激酶抑制剂(tyrosine kinase inhibitor,TKI)治疗的定位和应用时机?随着血管生成抑制剂和免疫检查点Checkpoint抑制剂的应用发展,新的治疗选择在肺癌脑转移治疗应用中又该如何管理?以上都是肺癌脑转移综合管理中的疑点和难点,急需解答和形成共识以指导临床实践。本次肺癌高峰论坛,综合近年来发表的前瞻性及回顾性重要研究结果、结合我国肺癌脑转移治疗管理的实际情况,与会专家们就肺癌脑转移的综合管理进行了详细的讨论和各抒己见的争辩,最后达成了以下四点共识。展开更多
为比较抗核糖体P蛋白抗体(anti-ribosomal P protein antibody,anti-P)、抗Smith抗体(anti-Smith antibody,anti-Sm)、抗dsDNA抗体(anti-dsDNA)、抗核小体抗体(anti-nucleosome antibody,ANuA)和抗组蛋白抗体(anti-histone antibody,AHA...为比较抗核糖体P蛋白抗体(anti-ribosomal P protein antibody,anti-P)、抗Smith抗体(anti-Smith antibody,anti-Sm)、抗dsDNA抗体(anti-dsDNA)、抗核小体抗体(anti-nucleosome antibody,ANuA)和抗组蛋白抗体(anti-histone antibody,AHA)对系统性红斑狼疮(systemic lupus erythematosus,SLE)的诊断价值,探讨它们与SLE临床特征及疾病活动度的关系,回顾性分析351例SLE患者,200例非SLE自身免疫性疾病患者和100例健康对照者临床资料,计算anti-P、anti-Sm、anti-dsDNA、ANuA和AHA诊断SLE的灵敏度、特异度、阴/阳性预测值及准确度,再进一步比较各抗体阳性组和阴性组SLE患者在临床特征、SLEDAI及C3、C4水平上差异是否显著。结果显示,anti-P、anti-Sm、anti-dsDNA、ANuA和AHA诊断SLE的灵敏度分别为31.9%、20.8%、45.3%、26.5%和18.2%,特异度分别为99.0%、99.3%、99.0%、98.3%和96.0%;5种抗体单阳性者占总阳性数的百分比分别为26.8%、31.5%、20.8%、8.6%和7.8%。其中,anti-P、anti-Sm、anti-dsDNA和AHA阳性组和阴性组在SLE发病年龄上差异有统计学意义(均P<0.05);anti-P阳性组皮肤红斑发生率较高,ANuA阳性组脱发发生率较高,anti-dsDNA、ANuA和AHA阳性组狼疮肾炎(lupus nephritis,LN)的发生率更高,与阴性组相比差异有统计学意义(均P<0.05);anti-P、anti-dsDNA、ANuA和AHA阳性组与阴性组在SLEDAI上差异有统计学意义(有P<0.05);补体C3、C4水平在5个抗体阳性和阴性组间差异均有统计学意义(均P<0.01)。Spearman相关性分析显示SLEDAI与C3、C4水平呈显著负相关(r=-0.395、-0.314)。由此,anti-P、anti-Sm、anti-dsDNA、ANuA和AHA对SLE的诊断具有较高的特异度,但灵敏度较差,联合检测可大大提高SLE的诊断率。anti-P、anti-Sm、anti-dsDNA和AHA阳性患者的发病年龄更小,anti-P阳性与SLE皮肤红斑发生率有关,ANuA阳性与患者脱发可能存在一定关联,而anti-dsDNA、ANuA和AHA阳性时LN的发生率更高。anti-P、anti-dsDNA、ANuA和AHA都与SLE疾病�展开更多
Based on turbulent theory, a 3D coupled model of fluid flow and solidification was built using finite difference method and used to study the influence of superheating degree and casting speed on fluid flow and solidi...Based on turbulent theory, a 3D coupled model of fluid flow and solidification was built using finite difference method and used to study the influence of superheating degree and casting speed on fluid flow and solidification, analyze the interaction between shell and molten steel, and compare the temperature distribution under different technological conditions. The results indicate that high superheating degree can lengthen the liquid-core depth and make the crack and breakout possible, so suitable superheating should be controlled within 35℃ according to the simulation results. Casting speed which is one of the most important technological parameters of improving production rate, should be controlled between 0. 85 m/min and 1.05 m/min and the caster has great potential in the improvement of blank quality.展开更多
BACKGROUND The incidence of acute kidney injury(AKI)in patients with sepsis is high,and the prognosis of patients with septic AKI is poor.The early diagnosis and treatment of septic AKI is of great significance in imp...BACKGROUND The incidence of acute kidney injury(AKI)in patients with sepsis is high,and the prognosis of patients with septic AKI is poor.The early diagnosis and treatment of septic AKI is of great significance in improving the prognosis of patients with sepsis.AIM To explore the value of contrast-enhanced ultrasound(CEUS),serum creatinine(Scr),and other indicators in the early diagnosis of septic AKI.METHODS Ninety patients with sepsis during hospitalization at Tongji Hospital of Tongji University were recruited as subjects.Each patient was recorded with relevant basic data,clinical indicators,and CEUS results.The patients were divided into AKI group and non-AKI group according to the results of renal function diagnosis after 48 h.On the 7th day,the renal function of the non-AKI group was re-evaluated and the patients were further divided into AKI subgroup and non-AKI subgroup.The differences of the indicators in different groups were compared,and the diagnostic value of each indicator and their combination for septic AKI was analyzed.RESULTS Systemic inflammatory response score(2.58±0.75),blood lactic acid(3.01±1.33 mmol/L),Scr(141.82±27.19μmol/L),blood urea nitrogen(4.41±0.81mmol/L),and rise time(10.23±2.63 s)in the AKI group were higher than those in the non-AKI group.Peak intensity(PI)(10.78±3.98 dB)and wash in slope(WIS)(1.07±0.53 dB/s)were lower than those in the non-AKI group.The differences were statistically significant(P<0.05).The PI(12.83±3.77 dB)and WIS(1.22±0.68 dB/s)in the AKI subgroup were lower than those in the non-AKI subgroup,and the differences were statistically significant(P<0.05).The area under curve(AUC)of Scr for the diagnosis of septic AKI was 0.825 with a sensitivity of 56.76% and a specificity of 100%.The AUCs of WIS and PI(0.928 and 0.912)were higher than those of Scr.Their sensitivities were 100%,but the specificities were 71.70% and 75.47%.The AUC of the combination of three indicators for the diagnosis of septic AKI was 0.943,which was significantly higher than the AUC d展开更多
文摘2018年3月8?9日,中国临床肿瘤学会(Chinese Society of Clinical Oncology,CSCO)和中国抗癌协会肺癌专业委员会联合主办了第15届“中国肺癌高峰论坛”。本次论坛的主题为“聚焦中枢神经系统转移:精确诊断,精准治疗”。晚期肺癌患者往往合并脑转移,在1 000多例的肺癌尸检结果中,肺癌脑转移发生率23%~36%,是脑转移性肿瘤中最常见的类型,且通常预后较差[1]。目前肺癌脑(膜)转移的综合治疗管理和治疗结果,仍不令人满意,治疗效果不佳,中位总生存时间16个月,其中脑膜转移的患者则仅为4.5个月左右[2?5]。近10年肺癌的治疗出现了革命性的改变,但肺癌脑转移的诊断和治疗成了提高肺癌长期生存率的瓶颈。临床医师及科研工作者,应如何对脑转移进行准确及时的诊断?在众多的分型分类体系中,又该如何参考应用?如何全面地对脑转移患者的颅内/颅外病灶进行合理评估?对于伴有驱动基因敏感突变的脑转移患者群体,应怎样对待酪氨酸激酶抑制剂(tyrosine kinase inhibitor,TKI)治疗的定位和应用时机?随着血管生成抑制剂和免疫检查点Checkpoint抑制剂的应用发展,新的治疗选择在肺癌脑转移治疗应用中又该如何管理?以上都是肺癌脑转移综合管理中的疑点和难点,急需解答和形成共识以指导临床实践。本次肺癌高峰论坛,综合近年来发表的前瞻性及回顾性重要研究结果、结合我国肺癌脑转移治疗管理的实际情况,与会专家们就肺癌脑转移的综合管理进行了详细的讨论和各抒己见的争辩,最后达成了以下四点共识。
文摘为比较抗核糖体P蛋白抗体(anti-ribosomal P protein antibody,anti-P)、抗Smith抗体(anti-Smith antibody,anti-Sm)、抗dsDNA抗体(anti-dsDNA)、抗核小体抗体(anti-nucleosome antibody,ANuA)和抗组蛋白抗体(anti-histone antibody,AHA)对系统性红斑狼疮(systemic lupus erythematosus,SLE)的诊断价值,探讨它们与SLE临床特征及疾病活动度的关系,回顾性分析351例SLE患者,200例非SLE自身免疫性疾病患者和100例健康对照者临床资料,计算anti-P、anti-Sm、anti-dsDNA、ANuA和AHA诊断SLE的灵敏度、特异度、阴/阳性预测值及准确度,再进一步比较各抗体阳性组和阴性组SLE患者在临床特征、SLEDAI及C3、C4水平上差异是否显著。结果显示,anti-P、anti-Sm、anti-dsDNA、ANuA和AHA诊断SLE的灵敏度分别为31.9%、20.8%、45.3%、26.5%和18.2%,特异度分别为99.0%、99.3%、99.0%、98.3%和96.0%;5种抗体单阳性者占总阳性数的百分比分别为26.8%、31.5%、20.8%、8.6%和7.8%。其中,anti-P、anti-Sm、anti-dsDNA和AHA阳性组和阴性组在SLE发病年龄上差异有统计学意义(均P<0.05);anti-P阳性组皮肤红斑发生率较高,ANuA阳性组脱发发生率较高,anti-dsDNA、ANuA和AHA阳性组狼疮肾炎(lupus nephritis,LN)的发生率更高,与阴性组相比差异有统计学意义(均P<0.05);anti-P、anti-dsDNA、ANuA和AHA阳性组与阴性组在SLEDAI上差异有统计学意义(有P<0.05);补体C3、C4水平在5个抗体阳性和阴性组间差异均有统计学意义(均P<0.01)。Spearman相关性分析显示SLEDAI与C3、C4水平呈显著负相关(r=-0.395、-0.314)。由此,anti-P、anti-Sm、anti-dsDNA、ANuA和AHA对SLE的诊断具有较高的特异度,但灵敏度较差,联合检测可大大提高SLE的诊断率。anti-P、anti-Sm、anti-dsDNA和AHA阳性患者的发病年龄更小,anti-P阳性与SLE皮肤红斑发生率有关,ANuA阳性与患者脱发可能存在一定关联,而anti-dsDNA、ANuA和AHA阳性时LN的发生率更高。anti-P、anti-dsDNA、ANuA和AHA都与SLE疾病�
文摘Based on turbulent theory, a 3D coupled model of fluid flow and solidification was built using finite difference method and used to study the influence of superheating degree and casting speed on fluid flow and solidification, analyze the interaction between shell and molten steel, and compare the temperature distribution under different technological conditions. The results indicate that high superheating degree can lengthen the liquid-core depth and make the crack and breakout possible, so suitable superheating should be controlled within 35℃ according to the simulation results. Casting speed which is one of the most important technological parameters of improving production rate, should be controlled between 0. 85 m/min and 1.05 m/min and the caster has great potential in the improvement of blank quality.
基金National Natural Science Foundation of China,No.81873609
文摘BACKGROUND The incidence of acute kidney injury(AKI)in patients with sepsis is high,and the prognosis of patients with septic AKI is poor.The early diagnosis and treatment of septic AKI is of great significance in improving the prognosis of patients with sepsis.AIM To explore the value of contrast-enhanced ultrasound(CEUS),serum creatinine(Scr),and other indicators in the early diagnosis of septic AKI.METHODS Ninety patients with sepsis during hospitalization at Tongji Hospital of Tongji University were recruited as subjects.Each patient was recorded with relevant basic data,clinical indicators,and CEUS results.The patients were divided into AKI group and non-AKI group according to the results of renal function diagnosis after 48 h.On the 7th day,the renal function of the non-AKI group was re-evaluated and the patients were further divided into AKI subgroup and non-AKI subgroup.The differences of the indicators in different groups were compared,and the diagnostic value of each indicator and their combination for septic AKI was analyzed.RESULTS Systemic inflammatory response score(2.58±0.75),blood lactic acid(3.01±1.33 mmol/L),Scr(141.82±27.19μmol/L),blood urea nitrogen(4.41±0.81mmol/L),and rise time(10.23±2.63 s)in the AKI group were higher than those in the non-AKI group.Peak intensity(PI)(10.78±3.98 dB)and wash in slope(WIS)(1.07±0.53 dB/s)were lower than those in the non-AKI group.The differences were statistically significant(P<0.05).The PI(12.83±3.77 dB)and WIS(1.22±0.68 dB/s)in the AKI subgroup were lower than those in the non-AKI subgroup,and the differences were statistically significant(P<0.05).The area under curve(AUC)of Scr for the diagnosis of septic AKI was 0.825 with a sensitivity of 56.76% and a specificity of 100%.The AUCs of WIS and PI(0.928 and 0.912)were higher than those of Scr.Their sensitivities were 100%,but the specificities were 71.70% and 75.47%.The AUC of the combination of three indicators for the diagnosis of septic AKI was 0.943,which was significantly higher than the AUC d
