串联质谱检测氨基酸和酰基肉碱的室间质量评价

目的调查我国部分新生儿筛查实验室串联质谱检测氨基酸和酰基肉碱的水平和现状。方法向19家新生儿筛查实验室发放5个批号（201211、201212、201213、201214、201215）的血斑质控品,收集实验室回报的氨基酸和酰基肉碱检测值,对回报的结果按照方法分组进行统计分析,并评价其检测水平。结果 18家实验室回报了检测结果,回报率为94.7%。回报结果的18家实验室中有14家实验室采用衍生非配套的试剂检测氨基酸和酰基肉碱,有3家实验室采用衍生配套的试剂检测氨基酸和酰基肉碱,有1家实验室采用非衍生的方法检测氨基酸和酰基肉碱。按照方法学分组同时考虑是否使用配套试剂计算各组及格率,其中,瓜氨酸项目及格率为71.4%～100.0%,亮氨酸项目的及格率为71.4%～100.0%,甲硫氨酸项目的及格率为42.5%～100.0%,苯丙氨酸项目及格率为71.4%～100.0%,酪氨酸项目及格率为71.4%～100.0%,缬氨酸项目的及格率为66.7%～100.0%,游离肉碱项目的及格率为42.9%～100.0%,丙酰肉碱项目的及格率为28.6%～100.0%,异戊酰肉碱项目的及格率为33.3%～92.9%,辛酰肉碱项目的及格率为28.6%～100.0%,月桂酰肉碱项目的及格率为46.2%～100.0%,棕榈酰肉碱项目的及格率为64.3%～100.0%,十八碳酰肉碱项目的及格率为71.4%～100.0%。结论目前串联质谱检测氨基酸和酰基肉碱的质量水平差异较大,开展室间质评项目计划有利于提高我国遗传代谢病的检测领域整体水平。     

痰瘀证的血清蛋白质指纹图谱的临床研究

[目的]分析痰瘀证患者血清蛋白质指纹图谱,探讨痰瘀证患者血清多肽蛋白表达的差异性。[方法]应用表面增强激光解析离子化飞行时间质谱(SELDI-TOF-MS)及弱阳离子交换蛋白质芯片(weak cationic exchanger protein chip)技术检测14例痰瘀证患者和16例性别、年龄匹配的正常对照组血清,获得血清蛋白质指纹图谱。[结果]痰瘀证组与正常对照组之间检测到18种差异蛋白(P0.05)。[结论]痰瘀证患者血清中存在一些差异表达蛋白质。     

培养创新型临床医学人才的思考

文章从创新及创新型人才的概念入手，通过调研指出，目前临床医学人才培养存在的主要问题，提出在新时期要转变教育教学观念、强化创新意识教育、增强创新思维训练、着力创新人格塑造，以培养创新型临床医学人才。     

基于拟Laplace谱的形状表示与聚类

基于谱图理论的形状表示与聚类是计算机视觉和模式识别领域的重要研究方向。针对不同形状的结构特征,通过对形状骨架点所构完全图的拟Laplace矩阵进行奇异值分解,将得到的高维数据投影至低维空间中,进而分析该数据在低维空间中的分布情况实现聚类。针对公共数据集的对比实验验证了该算法的有效性。     

红外光谱自动分析系统在尿路结石成分分析中的应用

目的评价红外光谱自动分析系统检测尿路结石成分的临床应用价值。方法应用LIIR型红外光谱自动分析系统对110例尿路结石的结石标本进行成分分析。结石标本分别取自患者自排、冲击波碎石、输尿管镜取石和经皮肾镜碎石。在结石患者中,男性71例,女性39例,男：女：2．6：1。结果在结石的构成比中,草酸钙结石最多,其次是碳酸磷灰石,再次为尿酸类结石;感染石少见。在构成比中,碳酸磷灰石存在性别差异（P〈0．05）。在不同成分的检出率中,男性依次是一水草酸钙、碳酸磷灰石、二水草酸钙、尿酸和六水磷酸铵镁;女性依次是碳酸磷灰石、一水草酸钙、二水草酸钙和六水磷酸铵镁。在不同成分的检出率中碳酸磷灰石存在性别差异（P〈0．05）。此外,在110例结石中,单一结石成分占26．36％（29／110）;二种结石成分占43．36％（48／110）;三种石成分占30．00％（33／110）。最常见的混合性结石成分为-水草酸钙＋二水草酸钙＋碳酸磷灰石。结论红外光谱自动分析系统在临床使用过程中具有自动、准确、快捷、方便等诸多优点．值得临床推广使用。     

宝石能谱CT物质定量分析对肝硬化结节与癌性结节鉴别诊断的临床价值

目的：探讨宝石能谱CT物质定量分析对肝硬化再生结节与癌性结节鉴别的临床价值。方法：搜集2014年2-6月在本院行能谱CT三期增强扫描并经病理证实的肝占位患者33例,其中肝硬化再生结节22例,癌性结节11例,对比两组病例的能谱图像,算出不同能量时病灶与肝实质对比噪声比（CNR）、标准化碘浓度（NIC）、病灶与正常肝实质含碘浓度比值（LNR）、病灶动脉期和门脉期碘浓度差异（ICD）。结果：肝硬化再生结节与癌性结节在不同能量下病灶-肝脏对比噪声比有一定规律,随着能量的增加,病灶-肝脏对比噪声比减少（P〈0.05）。癌性结节动脉期和门静脉期的标准化碘浓度、碘浓度比值和碘浓度的差异值均低于肝硬化再生结节。动脉期病灶与正常肝实质含碘浓度比值鉴别肝硬化再生结节与癌性结节的敏感性和特异性均为100%。结论：能谱CT物质定量分析对肝硬化再生结节与癌性结节的鉴别诊断有巨大临床价值,能提高诊断准确性。     

Self-adaptive integration of photothermal and radiative cooling for continuous energy harvesting from the sun and outer space

The sun (∼6,000 K) and outer space (∼3 K) are two significant renewable thermodynamic resources for human beings on Earth. The solar thermal conversion by photothermal (PT) and harvesting the coldness of outer space by radiative cooling (RC) have already attracted tremendous interest. However, most of the PT and RC approaches are static and monofunctional, which can only provide heating or cooling respectively under sunlight or darkness. Herein, a spectrally self-adaptive absorber/emitter (SSA/E) with strong solar absorption and switchable emissivity within the atmospheric window (i.e., 8 to 13 μm) was developed for the dynamic combination of PT and RC, corresponding to continuously efficient energy harvesting from the sun and rejecting energy to the universe. The as-fabricated SSA/E not only can be heated to ∼170 °C above ambient temperature under sunshine but also be cooled to 20 °C below ambient temperature, and thermal modeling captures the high energy harvesting efficiency of the SSA/E, enabling new technological capabilities.

Heating and cooling are two kinds of significant end uses of thermal energy in society, which exist in various conditions (e.g., space/water heating, space cooling, and industrial processes) and account for 51% of the total final energy consumption (1). For example, the heating and cooling of buildings are responsible for nearly 48% of the building energy consumption, increasing to be the largest individual energy expense (2). Therefore, heat and cool harvesting relying on clean techniques from renewable energy resources has drawn remarkable attention from fields of engineering to material science because it has considerable potential for global energy conservation and greenhouse emission reduction. Thermodynamically, any heat transportation and work-generation process requires a temperature gradient. The hot sun (∼6,000 K) and cold outer space (∼3 K) are the ultimate heat source and heat sink for the Earth. Theoretical analysis reveals that maximal output work can be extracted from nonreciprocal systems based on the temperature difference between the sun and Earth (∼300 K) with an ultimate solar energy harvesting efficiency limit of 93.3%, while a maximal work of 153.1 W·m⁻² can also be obtained on the basis of temperature difference between the Earth and outer space (3, 4). Thus, the sun and outer space are two significant renewable thermodynamic resources for the Earth, which can be effectively utilized for clean heat and cool collection.Photothermal (PT) is a widely used solar thermal collection method that employs solar absorbers to capture solar photons and convert them to heat. Thermal analysis reveals that a good candidate for a solar absorber should have high solar absorptivity and low thermal emissivity simultaneously for efficient solar thermal collection. Various materials, including multilayer metal/ceramic films (5, 6), photonic crystals (7, 8), and metamaterials (9, 10), have been developed for spectrally selective solar absorbers and have been used for real-world applications. Meanwhile, radiative cooling (RC) has re-elicited considerable interest in recent years because it can passively provide clean cooling without any extra energy input (11–14). The waste heat of terrestrial objects can be continuously pumped into the cold outer space, relying on the transparent atmospheric window (i.e., 8 to 13 μm). So, high emissivity within the atmospheric window of materials is necessary for efficient RC, and excellent solar reflection is also important for RC under sunshine. Thus, different materials with the tailored spectrum, such as photonic structures (15–17), structure materials (18), energy-saving paints (19–21), and even metamaterials (22–24), have been reported for passive cooling. On the potential application level, RC implementations also span a range of fields, including passive cooling of buildings (25–27), thermal management of textiles and color surfaces (28–30), atmospheric water harvesting (31), and thermoelectric generation (32, 33). Although the reported PT and RC can generate heat and cold with high efficiency through different spectrally selective materials, most of the approaches are static and monofunctional, which can only provide heating or cooling under sunlight or darkness. Therefore, the dynamical integration of PT and RC for continuously efficient heat and cool harvesting is a new topic for the energy exploitation of the sun and outer space. The tunable combination of PT and RC hybrid utilization has been recently proposed, but mechanical methods such as switching (e.g., flip action) a PT absorber and an RC emitter manually (34) or changing the optical properties of the materials through extra force stimuli (35) are preferred.Herein, a smart strategy for the dynamic combination of daytime PT and nighttime RC is proposed, corresponding to continuously efficient energy harvesting from the sun and rejecting energy to the universe. A spectrally self-adaptive absorber/emitter (SSA/E) with solar absorption of over 0.8 and emissivity modulation capability of regulating from broadband emissivity of 0.25 within the mid-infrared (MIR) region to the selective high emissivity of 0.75 within the atmospheric window is designed and fabricated for the proof of the concept. Outdoor thermal experimental results demonstrate that the SSA/E can be heated to ∼170 °C above ambient temperature in the daytime PT mode and passively cooled to ∼20 °C below ambient temperature in the nighttime RC mode. Moreover, the heat and cool energy gains of the SSA/E system are respectively predicted to be 78% and 103% larger than those of the reference system that combines static and monofunctional PT absorber and RC emitter.     

经典名方真武汤的物质基准量值传递分析

通过制备15批真武汤物质基准,测定其特征图谱、指标成分含量及出膏率,明确其特征图谱的峰归属、相似度范围、出膏率范围、芍药苷和6-姜辣素的含量范围以及转移率范围.结果 表明,物质基准特征图谱与15批物质基准生成的对照图谱R的相似度大于0.970;共归属19个特征峰,进一步汇总特征峰信息可知,茯苓有3个特征峰,白芍有10个...     

猪眼LASIK术后角膜的应力松弛和连续松弛谱

目的:探讨猪眼LASIK术后角膜的应力松弛特征方法:新鲜猪眼,经视神经灌注维持眼压恒定,行常规LASIK手术,基质床分别切削30%,50%,70%整体角膜厚度,用自制的模具尺,切取哑铃型试件,200mL/L人血白蛋白液浸泡,冰箱4℃过夜保存.将试样吸干蛋白液,置于自制夹具固定,于美国Tytron250力学实验机做应力松弛实验.应力松弛突加载荷的加载速率为385mm/min,伸长比为1.5,松弛时间1 000s,计算机自动采集数据.结果:LASIK手术中,单纯切开角膜瓣即导致了角膜的应力松弛程度降低,P＜0.05(P=0.49),但是程度不大,可能角膜依然保持其粘弹特性.当激光消融30%角膜整体厚度及大于此值时,角膜的应力松弛程度几乎下降了一倍,P＜0.01.在LASIK手术中角膜的纵向应力松弛程度不如横向的变化明显,尤其是在70%切削深度条件下,角膜的横向应力松弛程度小于纵向应力松弛程度,有显著的统计学差异(P＜0.001).结论:猪眼角膜在横向上的应力松弛程度与纵轴方向的应力松弛程度相似,猪眼角膜LASIK手术后,角膜横轴方向的应力松弛程度小于纵轴方向应力松弛程度,在70%角膜厚度的切削深度时,差异有显著性意义.猪眼LASIK手术中,切削深度越深,角膜的应力松弛程度越差,也就越容易引起角膜的形变和蠕变.     

兰州市2014年住院患者呼吸系统疾病谱分析

目的了解兰州市居民就医住院患者呼吸系统疾病谱的发生状况、分布和变化规律,为制定兰州市呼吸系统疾病防治策略提供科学依据。方法对兰州市一级及以上医疗机构依据《甘肃省卫生系统疾控机构进医院信息平台》收集的呼吸系统疾病数据进行核对,按照ICD-10标准进行编码,然后由兰州市CDC进行分类汇总和统计分析。结果兰州市一级以上医疗机构2014年住院所有病例中呼吸系统疾病排序第3位,重点防范的疾病以上呼吸道感染、急性支气管炎、喘息性支气管肺炎、支气管肺炎及肺炎为主,呼吸系统疾病单病种中上呼吸道感染在男女住院病例中均占据首位,构成比分别为8.49%、11.35%;各年龄组排序首位病种均不相同,婴儿组和老年组排序第一位的分别为喘息性支气管肺炎及慢性支气管炎急性发作,构成比分别为20.45%、13.27%;全年4个季节都易发生呼吸系统疾病,全年重点防范在冬春季;呼吸系统疾病恶性肿瘤发病以支气管或肺恶性肿瘤最高,男性和女性构成比分别为46.94%、41.53%,居民呼吸系统疾病住院病例中所承担的就医费用以支气管或肺恶性肿瘤最高,为998.71万元占7.33%。结论上呼吸道感染、急性支气管炎、喘息性支气管肺炎、支气管肺炎及肺炎是居民就医住院病例的重点呼吸系统疾病病种,应加以重点防范与研究;重视支气管或肺恶性肿瘤、慢性支气管炎及肺炎等疾病危险因素的预防、控制,减少居民就医所承担的就医费用。