老年人呼吸机相关性肺炎的危险因素及病原学分析

目的研究老年人呼吸机相关性肺炎（VAP）的病原学和预后情况。方法选择老年科行呼吸机治疗的患者92例,采用回顾性队列研究方法,分析临床资料、病原菌构成、耐药性情况。结果VAP组和无VAP组之间的性别、呼吸末正压,是否服用H：受体阻滞剂、利尿剂、糖皮质激素,是否经口气管插管,是否气管插管后改气管切开等情况均差异无统计学意义（P〉0．05）;而两组患者的年龄、慢性阻塞性肺疾病（COPD）病程、白蛋白、机械通气时间、抗生素连续使用情况、是否昏迷等方面均差异有统计学意义（P〈0．05）。VAP患者的呼吸道分泌物培养分离出109株细菌,其中革兰阴性茵74株（67．89％）,革兰阳性茵22株（20．18％）,真茵13株（11．93％）。氨苄青霉素和头孢唑林对铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯杆菌、大肠埃希菌及葡萄球菌属的耐药率较高,在70％-100％之间;而庆大霉素和丁胺卡那霉素对以上病原菌的耐药率较低,在19％-42％之间;泰能对以上病原菌的耐药率更低,在5％～22％之间。结论年龄、COPD病程、白蛋白、机械通气时间、抗生素连续使用天数、抗生素舍用种类、是否气管切开及是否昏迷均是发生VAP的危险因素,革兰阴性菌是VAP的主要病原茵,合理应用抗生素对VAP具有重要的防治意义。     

心脑血管疾病用药不良反应与药品品种关系的聚类分析

目的寻找心脑血管疾病用药的不良反应与药品品种间聚类关系,促进临床安全合理用药。方法运用数据挖掘技术中的两阶段聚类算法对药品的严重不良反应与药品品种间的关系进行聚类分析。结果由聚类结果可知,在使用心脑血管疾病用药时,出现的严重和新的严重不良反应为肝功能异常、肾功能异常、呼吸困难、横纹肌溶解,导致这些严重不良反应的药物有受体类药物、钙离子拮抗剂、降低胆固醇类药物。结论在选择心脑血管疾病用药时,受体类药物、钙离子拮抗剂、降低胆固醇类药物应慎用、少用,尽量避免严重的不良反应发生。     

The upregulated intestinal folate transporters direct the uptake of ligand-modified nanoparticles for enhanced oral insulin delivery

Transporters are traditionally considered to transport small molecules rather than large-sized nanoparticles due to their small pores. In this study, we demonstrate that the upregulated intestinal transporter (PCFT), which reaches a maximum of 12.3-fold expression in the intestinal epithelial cells of diabetic rats, mediates the uptake of the folic acid-grafted nanoparticles (FNP). Specifically, the upregulated PCFT could exert its function to mediate the endocytosis of FNP and efficiently stimulate the traverse of FNP across enterocytes by the lysosome-evading pathway, Golgi-targeting pathway and basolateral exocytosis, featuring a high oral insulin bioavailability of 14.4% in the diabetic rats. Conversely, in cells with relatively low PCFT expression, the positive surface charge contributes to the cellular uptake of FNP, and FNP are mainly degraded in the lysosomes. Overall, we emphasize that the upregulated intestinal transporters could direct the uptake of ligand-modified nanoparticles by mediating the endocytosis and intracellular trafficking of ligand-modified nanoparticles via the transporter-mediated pathway. This study may also theoretically provide insightful guidelines for the rational design of transporter-targeted nanoparticles to achieve efficient drug delivery in diverse diseases.     

Generative Design and Integrated 3D Printing Manufacture of Cross Joints

The integrated process of design and fabrication is invariably of particular interest and important to improve the quality and reduce the production cycle for structural joints, which are key components for connecting members and transferring loads in structural systems. In this work, using the generative design method, a pioneering idea was successfully realized to attain a reasonable configuration of the cross joints, which was then consecutively manufactured using 3D printing technology. Firstly, the initial model and generation conditions of a cross joint were constructed by the machine learning-based generative design algorithm, and hundreds of models were automatically generated. Then, based on the design objective and cost index of the cross joint, three representative joints were selected for further numerical analysis to verify the advantages of generative design. Finally, 3D printing was utilized to produce generative joints; the influences of printing parameters on the quality of 3D printing are further discussed in this paper. The results show that the cross joints from the generative design method have varied and innovative configurations and the best static behaviors. 3D printing technology can enhance the accuracy of cross joint fabrication. It is viable to utilize the integrated process of generative design and 3D printing to design and manufacture cross joints.     

Strained Lattice Gold-Copper Alloy Nanoparticles for Efficient Carbon Dioxide Electroreduction

Electrocatalytic conversion of carbon dioxide (CO₂) into specific renewable fuels is an attractive way to mitigate the greenhouse effect and solve the energy crisis. Au_nCu_100-n/C alloy nanoparticles (Au_nCu_100−n/C NPs) with tunable compositions, a highly active crystal plane and a strained lattice were synthesized by the thermal solvent co-reduction method. Transmission electron microscopy (TEM) and X-ray diffraction (XRD) results show that Au_nCu_100−n/C catalysts display a subtle lattice strain and dominant (111) crystal plane, which can be adjusted by the alloy composition. Electrochemical results show that Au_nCu_100−n/C alloy catalysts for CO₂ reduction display high catalytic activity; in particular, the Faradaic efficiency of Au₇₅Cu₂₅/C is up to 92.6% for CO at −0.7 V (vs. the reversible hydrogen electrode), which is related to lattice shrinkage and the active facet. This research provides a new strategy with which to design strong and active nanoalloy catalysts with lattice mismatch and main active surfaces for CO₂ reduction reaction.     

Corrosion Behavior of Alx(CrFeNi)1−x HEA under Simulated PWR Primary Water

High-entropy alloys (HEAs) have great potential as accident-tolerant fuel (ATF) cladding. Aluminum-forming duplex (BCC and FCC) stainless-steel (ADSS) is a candidate for ATF cladding, but the multiphase composition is detrimental to its corrosion resistance. In this paper, two single-phase HEAs were prepared by adjusting the content of each element in the ADSS alloy. The two HEAs were designed as Al_0.05(CrFeNi)_0.95(FCC) and Al_0.25(FeCrNi)_0.75(BCC). Their corrosion behavior under simulated pressurized water reactor (PWR) primary water was investigated. The corrosion products and corrosion mechanisms of these two HEAs were explored. The results show that the corrosion resistance of HEA alloys containing FCC is better than that of BCC and ADSS alloys. At the same time, the reason why the BCC structure composed of these four elements is not resistant to corrosion is revealed.     

HCBP6模拟磷酸化重组质粒的构建与亚细胞定位

目的 构建HCBP6及HCBP6不同位点模拟磷酸化的绿色荧光蛋白重组质粒,明确其亚细胞定位。方法 以构建含有570 bp的HCBP6外显子基因的绿色荧光蛋白重组质粒为基础,应用快速定点突变技术构建HCBP6不同位点模拟磷酸化的重组质粒。将重组质粒测序并进行序列比对。利用jetPRIME转染体系将HCBP6及HCBP6不同位点模拟磷酸化的重组质粒转染至细胞中,应用Real-Time PCR技术检测目的基因mRNA的表达,应用Western blot技术检测目的基因蛋白表达,应用荧光显微镜观察HCBP6不同位点磷酸化质粒的亚细胞定位。结果 将测序的重组序列与目的基因进行比对,发现重组序列与目的基因完全一致,说明HCBP6不同位点模拟磷酸化的重组质粒构建成功。RealTime PCR和Western blot表明,与对照组相比,实验组高表达HCBP6及HCBP6不同位点模拟磷酸化的基因。免疫荧光显微镜可见10Ala主要在细胞质表达,WT、10Asp、151Ala、151Asp主要在细胞核表达。结论 构建的HCBP6及HCBP6不同位点模拟磷酸化的重组质粒可成功转染细胞并在细胞中高表达,HCB...     

Machine Learning-Based Prediction of In-Hospital Complications in Elderly Patients Using GLIM-, SGA-, and ESPEN 2015-Diagnosed Malnutrition as a Factor

Background: Malnutrition is prevalent in elderly inpatients and is associated with various adverse outcomes during their hospital stay, but the diagnosis of malnutrition still lacks widely applicable criteria. This study aimed to investigate the association of malnutrition diagnosed with the SGA, ESPEN 2015, and GLIM criteria, respectively, with in-hospital complications in elderly patients. Method: Hospitalized patients over 65 years old who had been assessed with the SGA guideline for malnutrition at admission were retrospectively recruited from a large observational cohort study conducted in 34 level-A tertiary hospitals in 18 cities in China from June to September 2014. Malnutrition was then retrospectively diagnosed using the GLIM and ESPEN 2015 criteria, respectively, for comparison with the results of the SGA scale. The risk factors for malnutrition were analyzed using logistic regression, and the value of the three diagnostic criteria in predicting the in-hospital complications was subsequently explored using multivariate regression and the random forest machine learning algorithm. Results: A total of 2526 subjects who met the inclusion and exclusion criteria of the study were selected from the 7122 patients in the dataset, with an average age of 74.63 ± 7.12 years, 59.2% male, and 94.2% married. According to the GLIM, SGA, and ESPEN 2015 criteria, the detection rates of malnutrition were 37.8% (956 subjects), 32.8% (829 subjects), and 17.0% (429 subjects), respectively. The diagnostic consistency between the GLIM and the SGA criteria is better than that between the ESPEN 2015 and the SGA criteria (Kappa statistics, 0.890 vs. 0.590). Logistic regression showed that the risk of developing complications in the GLIM-defined malnutrition patients is 2.414 times higher than that of normal patients, higher than those of the ESPEN 2015 and SGA criteria (1.786 and 1.745 times, respectively). The random forest classifications show that the GLIM criteria have a higher ability to predict complications in these elderly patients than the SGA and ESPEN 2015 criteria with a mean decrease in accuracy of 12.929, 10.251, and 5.819, respectively, and a mean decrease in Gini of 2.055, 1.817, and 1.614, respectively. Conclusion: The prevalence of malnutrition diagnosed with the GLIM criteria is higher than that of the SGA and the ESPEN 2015 criteria. The GLIM criteria are better than the SGA and the ESPEN 2015 criteria for predicting in-hospital complications in elderly patients.