晚期肺癌化疗患者家庭韧性与希望水平、生活质量的关系研究

目的 分析晚期肺癌化疗患者家庭韧性的现状及其与希望水平、生活质量的相关性。方法 选取2020年8月至11月在某省级三级甲等肿瘤专科医院就诊的144例晚期肺癌化疗患者,采用一般资料调查表、家庭韧性评定量表中文简化版、Herth希望量表以及肺癌治疗功能评定量表对其进行调查。结果 晚期肺癌化疗患者家庭韧性总分为（89.90±8.11）分、希望水平总分为（31.89±4.01）分、生活质量总分为（88.85±11.69）分。工作状况、家庭人均月收入、希望水平及生活质量是晚期肺癌化疗患者家庭韧性的影响因素（P<0.01或P<0.05）。结论 晚期肺癌化疗患者家庭韧性、希望水平处于中等水平,生活质量较低,均有待提高。临床医护工作者应加强对患者家庭经济情况的关注,积极探索提高其希望水平及生活质量的护理干预措施,从而提高家庭韧性水平。     

Attitudes Toward the Global Allocation of Chinese COVID-19 Vaccines: Cross-sectional Online Survey of Adults Living in China

BackgroundCOVID-19 vaccines are in short supply worldwide. China was among the first countries to pledge supplies of the COVID-19 vaccine as a global public product, and to date, the country has provided more than 600 million vaccines to more than 200 countries and regions with low COVID-19 vaccination rates. Understanding the public’s attitude in China toward the global distribution of COVID-19 vaccines could inform global and national decisions, policies, and debates.ObjectiveThe aim of this study was to determine the attitudes of adults living in China regarding the global allocation of COVID-19 vaccines developed in China and how these attitudes vary across provinces and by sociodemographic characteristics.MethodsWe conducted a cross-sectional online survey among adults registered with the survey company KuRunData. The survey asked participants 31 questions about their attitudes regarding the global allocation of COVID-19 vaccines developed in China. We disaggregated responses by province and sociodemographic characteristics. All analyses used survey sampling weights.ResultsA total of 10,000 participants completed the questionnaire. Participants generally favored providing COVID-19 vaccines to foreign countries before fulfilling domestic needs (75.6%, 95% CI 74.6%-76.5%). Women (3778/4921, 76.8%; odds ratio 1.18, 95% CI 1.07-1.32; P=.002) and those living in rural areas (3123/4065, 76.8%; odds ratio 1.13, 95% CI 1.01-1.27; P=.03) were especially likely to hold this opinion. Most respondents preferred providing financial support through international platforms rather than directly offering support to individual countries (72.1%, 95% CI 71%-73.1%), while for vaccine products they preferred direct provision to relevant countries instead of via a delivery platform such as COVAX (77.3%, 95% CI 76.3%-78.2%).ConclusionsAmong our survey sample, we found that adults are generally supportive of the international distribution of COVID-19 vaccines, which may encourage policy makers to support and implement the distribution of COVID-19 vaccines developed in China worldwide. Conducting similar surveys in other countries could help align policy makers’ actions on COVID-19 vaccine distribution with the preferences of their constituencies.     

Predictions and Experiments on the Distortion of the 20Cr2Ni4A C-ring during Carburizing and Quenching Process

This paper focuses on the effect of gear steel on distortion due to phase transformation in carburizing and quenching. The carburizing and quenching process of C-rings under suspension was studied by using the finite element method based on the thermo-mechanical theory, considering phase transformation. The phase transformation kinetics parameters, depending on different carbon contents, were measured by Gleeble-3500. The distortion behavior of the carburized C-ring during the cooling stage was analyzed, as well as the carbon concentration distribution and martensite volume fractions. The accuracy of the simulation was also verified by comparing the experimental data with the simulated result of the distortion and microstructure. A reliable basis is provided for predicting the distortion mechanism of gear steels in carburizing and quenching.     

梁苹茂治疗痤疮经验

痤疮是临床常见疾病,梁苹茂教授根据多年临床经验,采用中药汤剂内服辨证治疗,每获良效。     

Analysis of the tumor microenvironment and mutation burden identifies prognostic features in thymic epithelial tumors

Thymic epithelial tumors (TETs) are one of the rarest adult malignancies in the anterior mediastinum. Thymic carcinomas (TCs) are less prevalent among TETs, but they are more clinically aggressive. Immunotherapy has emerged as a promising therapeutic approach for refractory TETs, even though chemotherapy remains the conventional treatment for the advanced disease. However, limited attention has been paid to the features of the tumor microenvironment (TME) which might provide clinically relevant information and guide treatment regimen design. Especially, to date, there have been only a few studies focusing on the differences between the TME and genomic features preserved by TETs and TCs. We analyzed the TME and genomic characteristics of TETs using RNA sequencing and whole-exome sequencing, finding that distinct characteristics of TME in different pathogenic subtypes of TETs. According to those findings, we found that thymic carcinomas had significantly lower expression of HMGB1, a pro-inflammatory cytokine-related gene, than thymomas, and low HMGB1 expression was linked to a poor prognosis. Additionally, higher mutation burdens were significantly associated with the later stage and more advanced pathological types. Thymoma patients with lower mutation burdens tended to relapse within 3 years. In summary, different characteristics of TME and genomic features between thymoma and thymic carcinoma were associated with clinical outcomes of TETs and presented promisingly predictive value for efficacy and toxicity of immunotherapy.     

Wear Mechanisms and Notch Formation of Whisker-Reinforced Alumina and Sialon Ceramic Tools during High-Speed Turning of Inconel 718

Nickel-based alloys, referred to as the most difficult-to-cut materials, pose a great challenge to cutting tool materials due to their excellent high-temperature properties. Ceramic tools have the potential to improve the machinability of these alloys with the advance of toughening mechanisms. In this work, the wear mechanisms of SiC whisker-reinforced alumina and Sialon when high-speed turning Inconel 718 alloy under dry cutting condition were investigated. The results showed that the wear process of Al₂O₃-SiC_w WG300 was dominated by the notch wear, while the flank wear characterized by ridges and grooves perpendicular to the cutting edge was the main wear mode for Sialon SX9. A Ti−enriched belt was found at the boundary of the wear band for both ceramic tools. The SEM inspection and EDS analysis for this belt suggested the trace of diffusion between the workpiece material and tool matrix. As for the notch formation, the periodically adhesive action of the workpiece material at the depth-of-cut line combined with the thermal shock resistance of ceramic tools were considered to account for its formation. In addition, the oxidation of the workpiece material at the depth-of-cut line played a positive role in reducing the adhesive affinity and consequent notch wear.     

Numerical Investigation of the Influence of Ultimate-Strength Heterogeneity on Crack Propagation and Fracture Toughness in Welded Joints

The mechanical properties of dissimilar metal-welded joint materials are heterogeneous, which is an obstacle to the safety evaluation of key welded structures. The variation of stress–strain conditions at the crack tip caused by mismatch of material mechanical properties in dissimilar metal-welded joints is an important factor affecting crack propagation behavior. To understand the influence of uneven distribution of ultimate strength of the base metal and the welded metal on the crack propagation path, fracture toughness, as well as the mechanical field at the crack tip in the small-scale yield range, the user-defined field variable subroutine method is used to express continuous variation characteristics of welded joint ultimate strength in finite element software. In addition, the J-integral during crack propagation is calculated, and the effect of the ultimate strength on the J-integral and the stress field at the crack tip are analyzed. The results show that as the crack propagation direction is perpendicular to the direction of ultimate strength, the gradient of ultimate strength increases from |G_y|= 50 to |G_y|= 100 MPa/mm, the crack deflection angle increases by 0.018%, and the crack length increases by 1.46%. The fracture toughness of the material decreased slightly during crack propagation. Under the condition that the crack propagation direction is the same as the direction of ultimate strength, the crack propagation path is a straight line. As the gradient of ultimate strength increases from G_x = 50 to G_x = 100 MPa/mm, the crack propagation length decreases by 5.17%, and the slope of fracture toughness curve increases by 51.63%. On the contrary, as the crack propagates to the low ultimate strength side, the crack propagation resistance decreases, the ultimate strength gradient increases from G_x = −100 to G_x = −50 MPa/mm, and the slope of the fracture toughness curve decreases by 51.01%. It is suggested to consider the relationship between crack growth behavior and ultimate strength when designing and evaluating the structural integrity of cracks at the material interface of dissimilar metal-welded joints.     

Exposure to Per- and Polyfluoroalkyl Substances and Mortality in U.S. Adults: A Population-Based Cohort Study

Background: Per- and polyfluoroalkyl substances (PFAS) are widespread environmental contaminants associated with diseases such as cancer and dyslipidemia. However, few studies have investigated the association between PFAS mixture exposure and mortality in general populations.Objectives: This study aimed to explore the association between PFAS mixture, perfluorooctanoic acid (PFOA), and perfluorooctane sulfonic acid (PFOS) and mortality in U.S. adults by a nationally representative cohort.Methods: Adults ≥18 years of age who were enrolled in the National Health and Nutrition Examination Survey (NHANES) (1999–2014) were included in our study. Baseline serum concentrations of seven PFAS were measured and individuals were followed up to 31 December 2015. Hazard ratios (HRs) and confidence intervals (CIs) were estimated using Cox proportional hazards models. Association between PFAS mixture exposure and mortality was analyzed using the k-means method by clustering PFAS mixtures into subgroups. Association between PFOA/PFOS exposure and mortality was subsequently analyzed in both continuous and categorical models.Results: During the follow-up period, 1,251 participants died. In the mixture analysis, the k-means algorithm clustered participants into low-, medium-, and high-exposure groups. Compared with the low-exposure group, participants in the high-exposure group showed significantly higher risks for all-cause mortality (HR=1.38; 95% CI: 1.07, 1.80), heart disease mortality (HR=1.58; 95% CI: 1.05, 2.51), and cancer mortality (HR=1.70; 95% CI: 1.08, 2.84). In single PFAS analysis, PFOS was found to be positively associated with all-cause mortality (third vs. first tertile HR=1.57; 95% CI: 1.22, 2.07), heart disease mortality (third vs. first tertile HR=1.65; 95% CI: 1.09, 2.57), and cancer mortality (third vs. first tertile HR=1.75; 95% CI: 1.10, 2.83), whereas PFOA exposure had no significant association with mortality. Assuming the observed association is causal, the number of deaths associated with PFOS exposure (≥17.1 vs. <7.9 ng/mL) was ∼382,000 (95% CI: 176,000, 588,000) annually between 1999 and 2015, and it decreased to 69,000 (95% CI: 28,000, 119,000) annually between 2015 and 2018. The association between PFOS and mortality was stronger among women and people without diabetes.Discussion: We observed a positive association between PFAS mixture exposure and mortality among U.S. adults. Limitations of this study include the potential for unmeasured confounding, selection bias, a relatively small number of deaths, and only measuring PFAS at one point in time. Further studies with serial measures of PFAS concentrations and longer follow-ups are necessary to elucidate the association between PFAS and mortality from specific causes. https://doi.org/10.1289/EHP10393     

辛伐他汀治疗无症状性颈动脉粥样硬化的疗效观察

目的采用颈动脉超声观察辛伐他汀治疗无症状性颈动脉粥样硬化的疗效。方法对参加我院健康体检时经彩超检查发现有颈动脉斑块的观察病例68例，每晚服用辛伐他汀，连续4月，观察颈动脉斑块的面积变化以及血脂的动态改变。结果68例观察者共发现斑块112个，服药4月后发现低回声斑块面积消退幅度达32％，混合性斑块达25％，高回声斑块只有9％，平均消退幅度22％，除高回声斑块外，其他均有明显统计学意义（P〈0．05）。患者的TC下降与治疗前比较有显著差异（P〈0．01），TG、LDL的下降与治疗前比较有明显差异（P〈0．05），HDL有所升高，但无统计学意义。结论通过观察服用辛伐他汀4月后斑块的面积变化以及血脂的改变结果表明，坚持服用他汀类药物，可以达到稳定与消退斑块的作用。