The bearings of reactor coolant pumps play a vital role in ensuring the smooth operation of the spindle, and the oil film thickness is an important indicator reflecting the operating condition of the bearing. However, the internal environment of the reactor coolant pump is characterized by high temperature, high pressure, and strong corrosion, making it difficult to install high-precision sensors to monitor the oil film thickness of the bearings in real time. To address this issue, a noise-adaptive soft-sensing framework is proposed, introducing a robust stochastic configuration network with a mixture of Gaussian (RSCN-MoG) to overcome the limitations of conventional soft sensors. The RSCN-MoG model employs an adjusted objective function combined with the expectation–maximization (EM) algorithm to adapt to any continuously distributed noise, representing a novel mechanism for handling mixed Gaussian and non-Gaussian disturbances in industrial measurement. Comprehensive experiments on benchmark datasets and a nuclear pump testbed demonstrate that the proposed RSCN-MoG model achieves a root mean squared error (RMSE) improvement of approximately 7.443

The traditional experiment projects of circuits fundamentals and analog circuits are often isolated, focusing on individual knowledge points with little correlation between them. These experiments mainly involve circuit validation, lacking innovative project design. As a result, students often struggle to develop a meaningful understanding of the course's professional applications, as well as the practical use of knowledge and technology, even after completing these experiments. The electric trolley, a high-tech system integrating electronic circuits, sensors, and mechanical structures, serves as a comprehensive platform for environmental awareness, planning and decision-making, and autonomous driving. We exploit this system as a foundation to reform circuit and analog electronics courses through project-based and experimental teaching. First, aligned with the curriculum and knowledge framework of circuit fundamentals and analog circuit theory, we design an experimental project focusing on black-and-white lane detection for the electric trolley. Then, we develop a problem-oriented, step-by-step approach to guide the implementation of these experiments, progressively introducing more complex engineering challenges that reflect real-world design problems. Finally, we integrate experimental results with theoretical knowledge and align the experimental content with actual industry demands, fostering a seamless connection between education and industrial applications. Classroom surveys and assessment results indicate that the experimental content is both challenging and engaging for students.

Objective:To investigate the current situation of cardiopulmonary bypass(CPB) in China and analyze the causes, to guide the formulation and implementation of technology standard.Methods:The survey task force sent out a nationwide survey to obtain up-to-date information on perfusion practice by ChSECC(Chinese Society of Extracorporeal Circulation). The unit of analysis for the survey was the medical center performs CPB. The survey consisted 48 questions covering four topics of qualifications, including certification and education, policies and practices, device and equipment, techniques used.Results:There were 540 of the 714 centers for an overall response rate of 76%. According to the annual number of CPB, they were divided into 4 groups: group A(≤50 cases/year), group B(50-100 cases/year), group C(100-500 cases/year) and group D(≥500 cases/year). The response rate of center with more than group D last year was 100%. Most of the perfusionists had certification issued by ChSECC. Although there were more than 80% of group D performed regular training and assessment of perfusionist, the result was still not ideal enough. Low utilization of safety equipment was not depend on the annual operation volume in most of responding centers. Ultrafiltration and blood protection technology had high application rate in group D compared with group A and B.Conclusion:The certification rate of perfusionists are high. Lower the number of annual CPB cases, lower the proportion of regular evaluation and training, and lower rate of standards performance. No matter the amount of CPB, the application rate of safety equipment is not ideal. Higher the number of CPB cases, higher the utilization rate of CPB related technologies.

自2022年3月以来,因新型冠状病毒(新冠)奥密克戎毒株传播快、潜伏期短、隐匿性强致上海市短时间内多点出现疫情,感染人数显著增加.我院作为上海市新冠肺炎后备定点医院承担特殊时期新冠感染患者的救治任务.本研究基于全面质量管理理论"4M1E"法制定的整建制转化方案,使医院在接到上级指令后,迅速、高效完成整体转化,有序收治患者.现将整建制转化方案及实践经验报道以供参考.

目的 评估先天性心脏病患儿术前的神经发育状况,并分析相关的影响因素.方法 选取2019年12月至2020年12月在上海交通大学医学院附属上海儿童医学中心就诊的476例先天性心脏病患儿,应用《年龄与发育进程问卷(第3版)》(ASQ-C)量表对其进行神经发育评估,了解先天性心脏病患儿术前的神经发育现状,并进一步分析其影响因素.结果 先天性心脏病患儿术前的神经发育异常检出率为29.2％,其中粗大动作能区异常率最高(14.9％).多因素Logistic回归分析显示,家庭月收入高是沟通能区的保护因素(OR=0.579,95％C I:0.363～0.924,P=0.022),复杂先天性心脏病是粗大动作能区的危险因素(OR=2.092,95％C I:1.124～3.893,P=0.020),父母文化程度高是精细动作能区(OR=0.581,95％C I:0.397～0.850,P=0.005)、解决问题能区(OR=0.588,95％CI:0.374～0.923,P=0.021)及个人-社会能区(OR=0.677,95％CI:0.486～0.944,P=0.021)的保护因素.结论 先天性心脏病患儿术前的神经发育现状不容乐观,尤其是粗大动作能区异常率较高;家庭月收入、疾病复杂程度和家长文化程度是其神经发育的影响因素,因此应予以重点关注,早发现、早干预,以降低因神经发育迟缓带来的负面影响.

Objective: To investigate the gut microbiota distribution and antibiotic resistant genes (ARGs) carrying- status in the girls with precocious puberty (PP). Methods: A total of 29 girls were enrolled in the study, including 21 girls with precocious puberty (PP) [11 girls with central precocious puberty (CPP group), 10 girls with premature thelarche (PT group)], and 8 age-matched healthy girls (NC group). The fecal samples were analyzed to explore difference in composition of gut microbiota and ARGs numbers between the PP (CPP+PT) and NC groups using shotgun metagenomic sequencing. Results: The composition and abundance of gut microbiota in the PP girls were different from the NC girls. The relative abundances of top three gut microbiota in CPP, PT and NC girls were 50.03%, 37.73% and 67.61% for Firmicutes, 33.00%, 43.26% and 10.32% for Bacteroidetes, and 4.26%, 4.22% and 11.16% for Actinobacteria. Compared with the NC girls, the PP girls had a significantly higher abundance of Bacteroidetes (P=0.034) and much lower abundance of Firmicutes (P=0.006) and Actinobacteria (P<0.000 1). It revealed that there were 257, 273 and 240 species of ARGs identified in the CPP, PT and NC girls, respectively. The PP girls had more ARGs types and higher abundance of tetracyclines and macrolide ARGs than the NC girls. Conclusions: Compared with the NC girls, the PP girls have a different distribution of gut microbiota and more species of ARGs enriching in tetracyclines and macrolides. It indicates that the dietary and environmental antibiotic exposure may influence the gut microbiota distribution in children, which may be associated with the pathogenesis of PP.

Objective:To explore the role of extracorporeal membrane oxygenation (ECMO) support in children with complicated congenital heart disease (CHD).Methods:From January 2017 to December 2020, the relevant clinical were retrospectively reviewed for 133 children (76 boys and 57 girls aged 0-18 years) with complex congenital heart disease receiving ECMO-assisted support. The average age at the time of ECMO-assisted support was 4.2 months, the average height (71.33±28.53) cm and the average weight (9.06±11.38) kg. Complex congenital heart diseases requiring ECMO-assisted support included transposition of great arteries (17.29%, 23/133) ,double outlet right ventricle (9.77 %, 13/133) ,pulmonary atresia (9.02 %, 12/133) , valvular disease (8.27 %, 11 /133) and aortic arch interruption & constriction (7.51%, 10/133). G eneral profiles, diagnosis, treatment and examinations were recorded and treatment protocols and outcomes analyzed.Results:Intraoperative cardiopulmonary bypass time was (221.00±161.78) min, blocking duration (100.31±68.09) min, ECMO bypass time (114.87±84.39) h, overall weaning rate of ECMO 63.91 % (85/133) and survival rate of 49.62 % (66/133 ) . Forty-two children underwent extracorporeal cardiopulmonary resuscitation (ECPR) with a weaning rate of 54.76% (23/42) and a survival rate of 40.48% (17/42) . And 48.87% (65/133) of them had ECMO assistance days of 3 to 5 days and the survival rate with this assistance day was 64.62% (42/65) . It was higher than survival rate of those with ECMO support assistance days < 3 days and > 5 days [64.62% (42/65) vs. 22.7(5/22) , 64.62% (42/65) vs. 41.30% (19/46) ] and a difference of 3% had statistical significance ( P<0.05) . Lactate values at 24 h after ECMO showed a relevant trend with weaning ( P=0.036) and survival ( P=0.051) . Common perioperative complications included intracranial hemorrhage and gastrointestinal hemorrhage. Neonatal period was a risk factor for intracranial hemorrhage ( P=0.018) while gastrointestinal hemorrhage was associated with lactate level before assistance ( P=0.013) . Conclusions:ECMO may facilitate the recovery of cardiopulmonary function in postoperative children with complicated CHD. Those with a duration of ECMO 3-5 days have the best overall prognosis. Intracranial hemorrhage is likely to occur with ECMO support during neonatal period. And the pre-ECMO level of lactate is correlated with the occurrence of gastrointestinal hemorrhage.

目的 观察老年脓毒症患者D-二聚体(D-dimer)、血清白蛋白(ALB)的变化,评估两者对老年脓毒症患者预后的临床预测价值.方法 采用回顾性研究,收集2019年1月至2020年11月上海交通大学医学院附属第九人民医院急诊科收治的老年脓毒症(根据脓毒症-3标准定义)患者103例,根据出院时的预后分为存活组(78例)和死亡组(25例),使用独立样本t检验比较两组患者入院24 h内血白细胞(WBC)、血小板(PLT)、C反应蛋白(CRP)、D-dimer和ALB的水平.通过logistic回归分析影响患者预后的独立危险因素.应用ROC曲线和曲线下面积(AUG)评价D-dimer、ALB、及以D-dimer和ALB联合预测因子(D-dimer/ALB)对老年脓毒症患者预后的评估价值.结果 死亡组D-dimer水平[(9.39±7.74) mg/L比(2.08±1.71) mg/L]显著高于存活组(P＜0.01),死亡组ALB水平[(29.84±4.24) g/L比(32.54±4.89) g/L]显著低于存活组(P=0.011).多因素logistic回归分析显示,D-dimer(OR=1.589,P＜0.01)、ALB(OR =0.816,P＜0.05)与脓毒症患者死亡发生风险增加相关.ROC曲线分析显示,D-dimer水平对脓毒症老年患者的院内死亡率具有出色的预测能力(AUC=0.863,P＜0.001).单独检测D-dimer与ALB判断老年脓毒症患者预后的AUC差异有统计学意义(0.863比0.669,P=0.0095),而联合指标D-dimer/ALB与D-dimer单独检测的AUC比较,差异无统计学意义(0.874比0.863,P=0.1110).D-dimer的最佳截断点为2.70 mg/L,此时预测老年脓毒症患者的敏感度为92.00％,特异度为70.50％,对预测预后具有较好的准确度.结论 D-dimer、ALB以及D-dimer/ALB与老年脓毒症患者的预后密切相关,其中D-dimer预测老年脓毒症患者预后的价值较高.

胰腺少见囊肿发生率低，影像诊断困难，与其他常见的胰腺囊性肿瘤，尤其是与具有潜在恶性的胰腺囊性病灶鉴别困难，常常造成不必要的手术干预。本文报道脉管瘤、纤毛前肠囊肿、副脾囊肿、淋巴上皮囊肿4种少见的胰腺囊肿类型，介绍其临床特征、放射影像和超声胃镜影像的表现，并进行文献复习。

目的 探索石杉碱甲在中国老年受试者体内的药动学特点和安全性.方法 14例无认知功能障碍的中国老年受试者(年龄60～80岁)接受单次口服石杉碱甲0.1 mg,在给药后48 h内收集血液和尿液样本.采用液相色谱-串联质谱(LC-MS/MS)法测定生物样品中药物浓度,以获得药动学参数.在整个研究过程中,对受试者进行安全性指标和不良事件监测.结果 老年受试者单次口服石杉碱甲0.1 mg后主要药动学参数:峰浓度(Cmax)(0.92±0.28)ng·mL-1,峰时间(tmax)(2.61±1.67)h,血浆浓度-时间曲线下面积(AUC(0-72h))(15.12±4.73)ng·h·mL-1,AUC(0-∞)(16.99±4.92)ng·h·mL-1,消除半衰期(t1/2)(14.38±3.87)h,48 h累计尿液药物排泄率为34.76％.1例受试者(7.1％)发生与研究药物可能无关的轻度不良事件.结论 石杉碱甲在中国老年受试者中有良好的耐受性.相比非老年健康受试者,老年受试者中石杉碱甲的吸收和消除过程相对更缓慢,暴露程度更高.

Foreign body reactions (FBR) to implants seriously impair tissue-implant integration and postoperative adhesion. The macrophage, owing to its phenotypic plasticity, is a major regulator in the formation of the inflammatory microenvironment; NF-κB signaling also plays a vital role in the process. It is hypothesized that NF-κB phosphorylation exerts a proinflammatory regulator in FBR to polylactide membranes (PLA-M) and adhesion. First, in vitro and in vivo experiments show that PLA-M induces NF-κB phosphorylation in macrophages, leading to M1 polarization and release of inflammatory factors. The inflammatory microenvironment formed due to PLA-M accelerates myofibroblast differentiation and release of collagen III and MMP2, jointly resulting in peritendinous adhesion. Therefore, JSH-23 (a selective NF-κB inhibitor)-loaded PLA membrane (JSH-23/PLA-M) is fabricated by blend electrospinning to regulate the associated M1 polarization for peritendinous anti-adhesion. JSH-23/PLA-M specifically inhibits NF-κB phosphorylation in macrophages and exhibits anti-inflammatory and anti-adhesion properties. The findings demonstrate that NF-κB phosphorylation has a critical role in PLA-induced M1 polarization and aggravating FBR to PLA-M. Additionally, JSH-23/PLA-M precisely targets modulation of NF-κB phosphorylation in FBR to break the vicious cycle in peritendinous adhesion therapy.

体外膜氧合技术( extracorporeal membrane oxy?genation, ECMO)对医学界而言并不是一个全新的技术,在国际上最早1971年就有成功案例,在国内也是在本世纪初就开始临床使用的.但由于其总体治疗病例数少,使用的单位也并不多,宣传也不广泛,因此大众对其熟悉程度较低,甚至于有些医护人员也不知其为何物.今年,由于新冠疫情的爆发,部分危重病例必须采用这一技术方能挽救生命,该技术也被媒体多次报道,因此,ECMO技术被大众所熟悉,受到了广泛的关注,被称之为"生命的最后一道防线"[1].不过由于新冠病毒感染的儿童病例较少,危重程度也远较成人为轻,因此,由于新冠感染而需要使用ECMO的儿童病例并不多,但是,ECMO在儿童危重病例中的作用也受到了人们的普遍关注.本文对儿童使用ECMO技术的情况做一简述,并展望其未来的可能发展趋势.

目的 探讨重症急性胰腺炎(SAP)患者外周血miR-21-3p、miR-22-3p与并发肺损伤(ALI)的相关性.方法 选择2017年7月～2020年2月本院收治的124例SAP患者作为研究对象,按照是否合并ALI分为单纯SAP组(78例)、SAP合并ALI组(46例);另选择同期体检的50例健康志愿者作为对照组.采集患者外周静脉血,采用实时荧光反转录定量聚合酶链式反应检测miR-21-3p、miR-22-3p表达,收集SAP患者临床资料.结果 单纯SAP组、SAP合并ALI组患者外周血miR-21-3p、miR-22-3p显著高于对照组(P＜0.05);SAP合并ALI组高于单纯SAP组(P＜0.05).不同CT分级、伴有胸水与否、急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分患者外周血miR-21-3p、miR-22-3p水平比较差异具统计学意义(P＜0.05);CT分级为E级、合并胸水、APACHEⅡ评分≥15分患者外周血miR-21-3p、miR-22-3p水平高于CT分级为D级、无胸水、APACHEⅡ评分＜15分的患者(P＜0.05).Logistic回归分析显示,CT分级、胸水、外周血miR-21-3p、miR-22-3p表达水平与SAP患者并发ALI相关(P＜0.05).外周血miR-21-3p、miR-22-3p诊断ALI曲线下面积(AUC)为0.770、0.812,当截点值为2.668、1.815时,约登指数最大;两者联合诊断AUC为0.869.结论 SAP患者外周血miR-21-3p、miR-22-3p与ALI并发密切相关,临床可检测其水平明确SAP程度及是否发生ALI,对指导临床治疗具有重要价值.

目的 分析体外膜氧合(ECMO)模拟课程用于心血管重症监护室(CICU)护士培训的效果,发现存在的问题,探讨更好开展培训的方法.方法 对58名接受ECMO模拟培训的CICU护士进行测试.运用配对t检验的方法分析培训前后理论成绩的差异,运用多元线性回归的方法分析影响培训后理论成绩的主要因素,并描述性分析了学员对模拟课程的态度.结果 经过培训,学员理论成绩得到了提高,"学历"、"接受过ECMO培训"是影响培训后理论成绩的主要因素,学员对模拟课程的评价较高.结论 相关部门和临床科室应该结合自身需求设计多样化的ECMO模拟培训课程,用以提高相关护理人员关键知识水平和综合能力水平.

168例胰腺钙化涵盖了6个病种，其中慢性胰腺炎(CP)钙化者占73.2%。胰腺导管内乳头状黏液性肿瘤(IPMN)恶变病例中的钙化比例高于无恶变病例中比例(8.3%比0.7%)。CP癌变风险较高的独立风险因素为胰腺肿块以及胰腺实质萎缩、年龄>55岁、体重指数(BMI)>24 kg/m 2、胰腺钙化。肿块型CP的癌变主要独立风险因素为胰腺钙化。

目前肝门胆管癌手术方式是在肝十二指肠韧带淋巴结缔组织廓清的基础上,依据Bismuth分型,根据肿瘤侵犯肝门胆管的位置与范围,选择肝外胆管局部切除、半肝或扩大半肝联合尾状叶切除或肝移植,其中半肝联合尾状叶切除是主流术式.为减少无辜肝脏的牺牲,尽量保留余肝体积与功能,有学者提出了各种小范围肝切除.如何合理选择肝切除范围是值得深入探讨的问题.

糖原累积病(glycogen storage diseases,GSD)是由糖原代谢过程中酶的缺乏以及蛋白转运障碍所引起,以各组织中糖原累积为特点,尤以肝脏和肌肉为主的一组异质性的遗传性疾病.本文报告1例以间断便血为首发表现的1例GSD患儿资料.

1引言 自2019年年末以来,新型冠状病毒(COVID-19,也称2019-nCoV)在武汉感染流行并迅速蔓延全国各地,根据国家整体防控方案各地进行隔离等措施,全国各医疗部门共抗疫情[1].然而部分感染患者进行相关手术仍需体外循环支持.为规范管理、准化流程,现制定疑似及确诊COVID-19感染患者的体外循环工作原则及流程,供广大同道参考.同时也会根据疫情的变化适时更新该规范.

目的 探讨氯化铯对人诱导多能干细胞来源心肌细胞自发动作电位以及起搏电流的影响.方法 利用CHIR99021和IWP-2小分子在体外将人诱导多能干细胞分化为心肌细胞.通过免疫荧光和动作电位测定对转化心肌细胞进行形态学和电生理鉴定.利用膜片钳系统记录氯化铯对培养60 d人诱导多能干细胞来源心肌细胞自发动作电位及起搏电流的影响.结果 免疫荧光显示人诱导多能干细胞来源心肌细胞高表达心肌肌钙蛋白T(cardiac troponin T,cTnT)心肌标志物,电生理鉴定提示其具有自发动作电位,2 mM氯化铯增快自发动作电位的频率(P=0.003,n=5).2mM氯化铯提高动作电位的静息电位(P＜0.001,n=5),提高动作电位的阈电位(P＜0.001,n=5),降低动作电位的振幅(P=0.002,n=5),缩短动作电位复极90％(APD90)的时间(P＜0.001,n=5).2 mM氯化铯抑制人诱导多能干细胞来源心肌细胞起搏电流的平台期电流以及尾电流有统计学意义(P＜0.05,n=5).结论 氯化铯增加人诱导多能干细胞来源心肌细胞自发动作电位的自发节律性,并抑制其起搏电流.

目的:探讨肠道菌群在小于胎龄(small for gestational age,SGA)大鼠生长追赶中的作用,并进一步研究肠道菌群介导SGA生长追赶(catch-up growth,CUG)的可能机制.方法:用孕鼠全程半限制饮食法诱导建立4周龄的SGA大鼠模型,共收集54只大鼠幼鼠,满4周龄时,其中30只(55.6％)实现CUG,作为有CUG的SGA大鼠幼鼠组(CUG-SGA组),另24只(44.4％)无生长追赶(non-catch-up growth,NCUG)的SGA大鼠幼鼠作为NCUG-SGA组.用酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)法检测其血清胰岛素样生长因子1(insulin-like growth factor 1,IGF-1)水平;用16S rRNA高通量测序分析幼鼠粪便中的肠道菌群;用气相色谱-质谱法检测其肠道粪便中的短链脂肪酸(short chain fatty acid,SCFA),分析比较2组间的差异.结果:CUG-SGA组幼鼠的血IGF-1水平为(250.41±85.66)μg/L,显著高于NCUG-SGA组的(112.29±32.26)μg/L(P<0.05);CUG-SGA组幼鼠的肠道菌群多样性Simpson指数(0.99)显著高于NCUG-SGA组(0.97)(P<0.05);CUG-SGA组幼鼠肠道粪便中的SCFA各组分水平均高于NCUG组(P<0.05).SGA幼鼠肠道粪便中的SCFA水平与11种差异表达的菌属相对丰度间存在相关性(|r|均>0.6,P<0.05),其中丙酸、丁酸、异丁酸、戊酸浓度与幼鼠的体重、身长及其血IGF-1水平间均呈显著正相关(r均>0.6,P<0.05).结论:肠道菌群在SGA大鼠的CUG中发挥一定作用,这种作用可能是通过菌群代谢产物SCFA调节机体能量代谢和吸收来实现的.