论城市品格的塑造——以镇江为例

城市品格是城市无形层面里最本质的部分。城市品格的塑造需要渗入人文精神和城市特色,这样才能使人们生活得更美好。对镇江而言,要塑造城市品格,就需要立足镇江的历史与现实,结合镇江民众的思考,从功利与超功利的角度进行具体的探索。     

临床流行病学和循证医学的学科建设

临床流行病学是在临床医学领域内引入现代流行病学和统计学方法,从患病个体诊治扩大到患病群体研究,以探讨疾病病因、预防、诊断、治疗、预后等规律的临床基础学科。循证医学的核心思想是通过检索、评价和应用证据,结合医生技术经验和患者的具体情况,经医患共同决策作出符合患者需求的利大于弊的诊疗决定。加拿大McMaster大学的David Sackett及其学生Gorden Guyatt先后对临床流行病学这门学科的建立、完善和传播,对循证医学概念的提出、发展和推动,起到了里程碑式的作用。20世纪80年代初,我国第一批追随David Sackett的医生方法学家引入了临床流行病学的核心思想,即临床研究的设计、测量和评价,90年代又引入了循证医学的理念。30年来,临床流行病学和循证医学在我国生根、发芽、开花、结果,对我国现代医学的发展起到了巨大推动作用。在全面建设"健康中国"的新时代,加强临床流行病学和循证医学的学科建设刻不容缓。     

全自动尿沉渣分析仪的临床应用评价

目的　对一种全自动尿沉渣分析仪的临床应用进行评价，并建立其对尿液有形成分分析的正常参考范围。方法　从仪器精密度、携带污染率、分析测量范围以及与人工镜检的可比性4个方面进行评价，同时建立仪器检测红细胞(red blood cell，RBC)、白细胞(white blood cell，WBC)、鳞状上皮细胞(squamous epithelial cell，EC)及管型的正常参考范围。结果　RBC低值、中值和高值精密度的变异系数分别为129.10%、20.59%和7.80%；WBC低值、中值和高值精密度的变异系数分别为65.73%、14.30%和13.00%；EC中值和高值精密度的变异系数分别为27.01%和21.46%。RBC、WBC和EC的携带污染率均为0；RBC分析测量范围为0⁸3 608个/μl,WBC分析测量范围为083 608个/μl,WBC分析测量范围为0¹5 624个/μl，细菌分析测量范围根据菌种不同而结果有明显差异。仪器与人工镜检相比，RBC、WBC和EC的一致率分别为82.80%、73.82%和57.56%。男性尿液有形成分的参考范围显示，RBC为015 624个/μl，细菌分析测量范围根据菌种不同而结果有明显差异。仪器与人工镜检相比，RBC、WBC和EC的一致率分别为82.80%、73.82%和57.56%。男性尿液有形成分的参考范围显示，RBC为0⁸个/μl，WBC为08个/μl，WBC为0¹2个/μl，EC为012个/μl，EC为0¹3个/μl，管型为013个/μl，管型为0⁴个/μl，结晶为04个/μl，结晶为0³4个/μl；女性尿液有形成分的参考范围显示，RBC为034个/μl；女性尿液有形成分的参考范围显示，RBC为0¹2个/μl，WBC为012个/μl，WBC为0²1个/μl，EC为021个/μl，EC为0⁴2个/μl，管型为042个/μl，管型为0⁴个/μl，结晶为04个/μl，结晶为0²个/μl。 结论　该全自动尿沉渣分析仪对尿中的RBC和WBC有较好的识别性能，对结晶、管型、真菌、异形细胞等难以自动识别的成分，可利用仪器的审核功能进行人工识别，必要时进行人工复检，为临床提供可靠的检验报告。     

不同临床情况患者床旁心脏超声检查的必要性及其对诊治的影响

目的　探讨不同临床情况患者申请床旁心脏超声检查的必要性及其对患者诊断和治疗的影响。方法　连续入组2013年7月1日至30日北京协和医院申请并完成床旁心脏超声检查的所有患者，分析其临床情况，评价床旁超声检查申请的必要性，并比较不同临床情况患者完成心脏超声检查后对诊治的影响。结果　共入组患者58例（男性33例，56.9%），平均年龄（56.4±19.9）岁。急诊科申请37例（63.8%），各重症监护室16例（27.6%），其他科室5例（8.6%）。床旁超声的申请目的中，符合美国心脏超声学会和急诊医师学会共识建议的36例（62.1%）。完成床旁心脏超声检查后达到申请目的者53例（91.4%），根据结果明确了诊断或者对原有诊断作出修正的患者13例（22.4%），对原有诊断更有信心患者40例（69.0%），对诊断没有帮助者5例（8.6%）；床旁心脏超声检查后，需根据心脏情况调整原有治疗方案者16例（27.6%）。完成检查后，经心内科医生判断确实需要进行床旁超声检查者23例（39.7%），不需要进行床旁超声检查者35例（60.3%）。符合共识建议的申请，获得对于诊断有价值信息的可能性显著高于其他申请（P=0.01），且倾向于更能影响患者的治疗方案（P=0.06）；申请符合共识建议检查的必要性显著高于其他申请（P＜0.01）。结论目前床旁心脏超声申请需更为严格把握指征；严格按照相关共识的建议申请床旁心脏超声，更有可能获得对诊断和治疗有价值的信息，从而更为合理有效地利用有限的医疗资源。     

Relations between in-treatment and follow-up abstinence among cocaine-dependent homeless persons in three clinical trials.

Clinical trials with cocaine-dependent outpatients have found a strong relation between in-treatment and follow-up abstinence, and the strength of this relation is constant across treatment conditions with variable efficacy in generating abstinence. The authors conducted secondary analyses of data from 3 clinical trials to determine whether this relation generalizes to cocaine-dependent homeless persons. The 3 trials (total N = 543) were conducted in a community health care facility for homeless people. The 7 treatment arms across the 3 trials were combinations of day treatment, abstinence-contingent housing, and vocational training. Drug use was measured with urine toxicology testing. Consecutive weeks of abstinence during treatment were strongly related to abstinence at the 12-month follow-up, whether or not missing 12-month data were included in the analysis. The treatment arms differed in their efficacy in generating abstinence, but the relation between in-treatment and follow-up abstinence did not differ across treatment arms. These results replicate earlier reports of these relations and extend them to a population of homeless people. The lack of differences between treatment arms in the in-treatment–follow-up abstinence relation implies that that relation is independent of the treatment-specific intervention components that generate group differences in abstinence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

大数据中效用挖掘的快速单阶段算法

现有数据挖掘算法的缺点是在挖掘大数据时会出现大量候选模式,从而造成可伸缩性瓶颈,个别算法虽然不生成候选模式,但是计算代价高昂,缺乏有效剪裁,运行效率存在瓶颈.为此,提出一个全新的单阶段不生成候选模式的数据挖掘算法,其创新性有3点:一是基于前缀生长的模式枚举和基于效用上限值评估的剪裁策略;二是基于稀疏矩阵和虚拟投影的效用信息表达;三是节省存储空间的深度优先搜索方法.大量实验表明,新算法的时间效率比现有算法高5倍以上,并且内存使用量比现有算法少20％～60％,可伸缩性高.     

Clinical Breakpoint of Apramycin to Swine Salmonella and Its Effect on Ileum Flora

The purpose of this study was to establish the clinical breakpoint (CBP) of apramycin (APR) against Salmonella in swine and evaluate its effect on intestinal microbiota. The CBP was established based on three cutoff values of wild-type cutoff value (CO_WT), pharmacokinetic-pharmadynamic (PK/PD) cutoff value (CO_PD) and clinical cutoff value (CO_CL). The effect of the optimized dose regimen based on ex vivo PK/PD study. The evolution of the ileum flora was determined by the 16rRNA gene sequencing and bioinformatics. This study firstly established the CO_WT, CO_PD in ileum, and CO_CL of APR against swine Salmonella, the value of these cutoffs were 32 µg/mL, 32 µg/mL and 8 µg/mL, respectively. According to the guiding principle of the Clinical Laboratory Standards Institute (CLSI), the final CBP in ileum was 32 µg/mL. Our results revealed the main evolution route in the composition of ileum microbiota of diarrheic piglets treated by APR. The change of the abundances of Bacteroidetes and Euryarchaeota was the most obvious during the evolution process. Methanobrevibacter, Prevotella, S24-7 and Ruminococcaceae were obtained as the highest abundance genus. The abundance of Methanobrevibacter increased significantly when APR treatment carried and decreased in cure and withdrawal period groups. The abundance of Prevotella in the tested groups was significantly lower than that in the healthy group. A decreased of abundance in S24-7 was observed after Salmonella infection and increased slightly after cure. Ruminococcaceae increased significantly after Salmonella infection and decreased significantly after APR treatment. In addition, the genera of Methanobrevibacter and Prevotella were defined as the key node. Valine, leucine and isoleucine biosynthesis, D-Glutamine and D-glutamate metabolism, D-Alanine metabolism, Peptidoglycan and amino acids biosynthesis were the top five Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways in the ileum microbiota of piglets during the Salmonella infection and APR treatment process. Our study extended the understanding of dynamic shift of gut microbes during diarrheic piglets treated by APR.     

单独降脂药物及药物联合饮食控制治疗高脂血症疗效观察对比

目的:对比单独降脂药物及药物联合饮食控制治疗高脂血症的临床疗效,以供参考。方法:将牡丹江医院红旗医院院2011年5月—2013年4月收治的高脂血症患者100例纳入本研究,根据随机原则分组。对照组接受单独降脂药物治疗,实验组接受药物联合饮食控制治疗。用药12w后对比两组患者血脂水平的变化和辛伐他汀日使用剂量的差异。结果:与治疗前对比,治疗后患者TC、TG、LDL-C等指标水平均有所下降,HDL-C水平有所上升,其中实验组各指标改善幅度明显大于对照组,组间差异经统计学分析后认为有意义(P0.05)。与对照组对比,实验组患者辛伐他汀日使用剂量明显较低,组间差异经统计学分析后认为有意义(P0.05)。结论:采用药物联合饮食控制治疗高脂血症的降脂效果优于单独药物治疗,同时可减少降脂药物使用剂量,对减少不良反应和降低医疗费用有益。     

Two types of a passive safety containment for a near future BWR with active and passive safety systems

The paper presents two types of a passive safety containment for a near future BWR. They are named Mark S and Mark X containment. One of their common merits is very low peak pressure at severe accidents without venting the containment atmosphere to the environment. The PCV pressure can be moderated within the design pressure. Another merit is the capability to submerge the PCV and the RPV above the core level. The third merit is robustness against external events such as a large commercial airplane crash. Both the containments have a passive cooling core catcher that has radial cooling channels. The Mark S containment is made of reinforced concrete and applicable to a large power BWR up to 1830 MWe. The Mark X containment has the steel secondary containment and can be cooled by natural circulation of outside air. It can accommodate a medium power BWR up to 1380 MWe. In both cases the plants have active and passive safety systems constituting in-depth hybrid safety (IDHS). The IDHS provides not only hardware diversity between active and passive safety systems but also more importantly diversity of the ultimate heat sinks between the atmosphere and the sea water. Although the plant concept discussed in the paper uses well-established technology, plant performance including economy is innovatively and evolutionally improved. Nothing is new in the hardware but everything is new in the performance.     

农业水资源效用评价Ⅱ：方法与应用

本文在农业水资源效用评价理论框架体系下,进一步完善了农业水资源效用综合评价方法体系：提出了评价模型,确定评价方法并构建了评价指标体系.应用提出的评价理论和方法体系,对华北平原井灌区的代表——北京大兴进行了案例研究.评价结果显示,大兴地区农业水资源利用效用综合得分均保持在良好状态区间,其最大的原因在于经济效益持续较好,贡献了总效应得分的50％以上,而环境效益则相对较差,除了有两年处于正常状态外,其余年份均处于警戒状态.评价结果表明大兴地区农业水资源利用存在着比较突出的环境问题,具体表现为水污染严重,水质较差,地下水超采严重.案例研究的结果与专家的研判大致相符证明了该方法体系的科学性和合理性,下一步的重点是如何从区域差异上解决方法的普适性问题.