Abstract ：

Objectives. To analyze the association between blood pressure during vasopressor weaning and in-hospital mortality in patients admitted to an intensive care unit (ICU). Methods. Observational retrospective single-center study including patient data registered in the Medical Information Mart for Intensive Care, version 4. The outcome was in-hospital mortality. We used restricted cubic spline (RCS) functions to analyze the associations between mortality and systolic and diastolic blood pressures and mean arterial pressure (SBP, DBP, and MAP, respectively) during weaning from vasopressors. The data was stratified according to SBP, DBP, and MAP, and sensitivity was assessed with Cox regression analysis. Results. Data for 8294 patients were analyzed. The RCS functions showed that SBP, DBP, and MAP values had nonlinear U-shaped associations with in-hospital mortality. Patients were classified into the following subgroups according to points of intersection of SBP, DBP, and MAP reference values: SBP <110, 110-150, or >150 mmHg; DBP <60, 60-85, or >85 mmHg; and MAP <75, 75-110, or >110 mmHg. In the lowest blood pressure group the hazard ratio was 0.59 (95% CI, 0.52-0.66) for SBP in the 110-150 mmHg range; 0.62 (95% CI, 0.55-0.70) for DBP in the 60.85 mmHg range; and 0.64 (95% CI, 0.57-0.72) for MAP in the 75-110 mmHg range during weaning. The analysis of subgroups also indicated that blood pressures during weaning interacted with cerebral vascular disease and chronic obstructive pulmonary disease. Conclusions. Higher blood pressures during vasopressor weaning are associated with longer in-hospital survival in ICU patients. The optimum pressure ranges are SBP, 110-150 mmHg; DBP, 60-85 mmHg; and MAP, 75-110 mmHg. Blood pressures may behave differently according to diagnosis.

Keyword ：

Blood pressure, management Intensive care unit Vasopressor weaning

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A new material model based on dislocation dynamics was developed specifically for cold spraying (CS) under supersonic impact conditions. It can adequately capture the following four physical phenomena occurring within nanoseconds: (1) strain hardening, (2) normal-range strain rate hardening, (3) ultrahigh-strain-rate hardening, and (4) thermal softening/hardening. The parameters of the new material model for pure Ni were systematically determined by mathematical fitting. Moreover, a cold spray experiment focusing on a single Ni microparticle was carried out and the particle’s deformation was measured, which agreed well with the simulated one, thereby proving the high accuracy of this material model. © 2022 Japan Society for Technology of Plasticity. All rights reserved.

Keyword ：

cold spray; extreme deformation; material model; numerical/experimental analysis; pure Nickel; ultrahigh strain rate

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本教材是我们在编写出版了《Systematic Anatomy》和多本英文解剖学辅导教材的基础上，为了进一步提升教学质量，适应现代医学教育需求编写而成。参编教师均有15年以上的教学经验，大部分有国外工作学习的经历。 教材分为三部分：绪论、解剖基本知识和临床联系、操作和观察。 教材语音精炼、条理清晰、重点突出，临床联系紧密，适当介绍与解剖学相关的新进展或新方法，既重视基本知识和能力的培养，也强调知识的深度和广度。主要用于来华留学生学习，也可作为国内本科生和研究生的参考教材。

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目的: 本研究旨在评估含羟磷灰石（HA）脱敏剂封闭牙本质小管的效果及其对温和型通用型粘接剂粘接性能的影响。方法: 收集完整的第三磨牙，制备冠中部牙本质样本，建立牙本质敏感模型。根据不同的脱敏处理方式随机分为4组，分别进行下述处理：无脱敏处理（对照组）、Biorepair牙膏处理（含HA脱敏牙膏）、Dontodent牙膏处理（含HA脱敏牙膏）和HA糊剂处理。通过扫描电镜（SEM）观察牙本质小管封闭情况，并评估牙本质小管封闭率。分别使用All-Bond Universal、Single Bond Universal和Clearfil Universal Bond以自酸蚀模式应用于脱敏处理后的牙本质。通过接触角测量评估脱敏处理后牙本质表面的润湿性和表面能（SFE）。制备树脂-牙本质粘接试样，测试微拉伸粘接强度，分析脱敏处理方式对于3种通用型粘接剂的牙本质微拉伸粘接强度的影响。结果: SEM显示含HA脱敏牙膏和HA脱敏剂处理后牙本质小管均明显封闭，封闭率HA组>Biorepair组>Dontodent组（P<0.05）。接触角分析表明，含HA脱敏剂对通用型粘接剂的润湿性无显著影响（P>0.05），但脱敏处理后牙本质SFE显著增加（P<0.05）。微拉伸粘接强度测试表明，含HA脱敏牙膏会降低微拉伸粘接强度（P<0.05），而HA组与对照组的微拉伸粘接强度之间差异无统计学意义（P>0.05）。结论: 含HA脱敏牙膏能够形成牙本质小管封闭。在使用温和型通用型粘接剂进行后续树脂修复时，含HA脱敏牙膏降低牙本质粘接强度，而HA糊剂的脱敏处理未对粘接性能产生不利影响。.OBJECTIVES: The purpose of the study was to evaluate the effect of hydroxyapatite (HA)-based desensiti-zing agents and determine their influence on the bonding performance of mild universal adhesives. METHODS: Mid-coronal dentin samples were sectioned from human third molars and prepared for a dentin-sensitive model. According to desensitizing applications, they were randomly divided into four groups for the following treatments: no desensitizing treatment (control), Biorepair toothpaste (HA-based desensitizing toothpaste) treatment, Dontodent toothpaste (HA-based desensitizing toothpaste) treatment, and HA paste treatment. Dentin tubular occlusion and occluded area ratios were evaluated by scanning electron microscopy (SEM). Furthermore, All-Bond Universal, Single Bond Universal, and Clearfil Universal Bond were applied to the desensitized dentin in self-etch mode. The wettability and surface free energy (SFE) of desensitized dentin were evaluated by contact angle measurements. Bonded specimens were sectioned into beams and tested for micro-tensile bond strength to analyze the effect of desensitizing treatment on the bond strength to dentin of universal adhesives. RESULTS: SEM revealed that the dentin tubule was occluded by HA-based desensitizing agents, and the area ratios for the occluded dentin tubules were in the following order: HA group>Biorepair group>Dontodent group (P<0.05). Contact angle analysis demonstrated that HA-based desensitizing agents had no statistically significant influence on the wettability of the universal adhesives (P>0.05). The SFE of dentin significantly increased after treatment by HA-based desensitizing agents (P<0.05). The micro-tensile bond strength test showed that HA-based desensitizing toothpastes always decreased the μTBS values (P<0.05), whereas the HA paste group presented similar bond strength to the control group (P>0.05), irrespective of universal adhesive types. CONCLUSIONS: HA-based desensitizing agents can occlude the exposed dentinal tubules on sensitive dentin. When mild and ultra-mild universal adhesives were used for subsequent resin restoration, the bond strength was reduced by HA-based desensitizing toothpastes, whereas the pure HA paste had no adverse effect on bond strength.

Keyword ：

dentin hypersensitivity; hydroxyapatite; micro-tensile bond strength; self-etch mode; universal adhesive

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In the 1970s, Roland Barthes referred to Japanese Zen as "the Empire of signs," while Chinese culture was described as "the vapidity of signs." Francois Jullien adopted the idea of "vapidity" subsequently in its "non-dualist" sense within the framework of comparative philosophy. Since the post-structuralist and deconstructionist currents, more and more semiotic and philosophical research has dealt with Buddhist studies, whose nodal point is then situated in a parallelism for the benefit of intercultural exchanges. In order to despecialize the jargon of each field, it seems imperative to relate the basic concepts in common. To highlight the contribution of terminological and methodological study, this article begins with philological works on the "translation" of Buddhist texts. The discussion then proceeds to focus on "the duality" from the "reception" of Saussurean exegetics. In concrete terms, this is an embryonic study of the dual jargon "signifier/signified": Saussurean exegetics has spread successfully in China through borrowings from Buddhist terminology (neng/suo), offering a positive perspective for intercultural dialogue. Meanwhile, it could also be possible to translate Buddhist terms through semiotics in view of transdisciplinary osmosis.

Keyword ：

Buddhism Buddhist philology duality methodology neng/suo(sic)/ reception signifier/signified terminology translation

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目的: 轻度脑外伤患者占脑外伤患者的80%以上。多数轻度脑外伤患者在CT检查上未见异常，因此绝大部分患者选择自我调养、恢复而非就医。事实上，轻度脑外伤发生后可能会导致持续性的认知功能下降和神经行为功能障碍，神经化学、代谢和细胞的改变可能会引发脑血流的改变，而脑血流的改变被认为是继发性损伤和脑修复缓慢的原因之一。本研究旨在利用动脉自旋标记(arterial spin labeling，ASL)磁共振成像技术评估轻度脑外伤患者脑血流值随病程进展的变化情况。方法: 采集在温州医科大学附属第二医院门诊或急诊就医的43例轻度脑外伤患者的临床信息，同时纳入年龄、性别和受教育程度匹配的43例健康受试者作为对照组，所有受试者均接受脑部磁共振成像扫描，并进行临床神经心理学评估和认知功能评估。对其中22名轻度脑外伤受试者在急性期、第1个月、第3个月和第12个月进行随访。以对照组为基准，分析轻度脑外伤患者的异常脑血流区域，并以异常区域作为后续的感兴趣区(region of interest，ROI)。分析各ROI中的脑血流值与临床指征、认知功能的相关性以及轻度脑外伤患者在后续随访的各时间点ROI中脑血流值的变化。结果: 与对照组比较，轻度脑外伤组急性期在皮质区域的双侧背外侧额上回和双侧辅助运动区以及在皮下核团的右侧壳核、尾状核、苍白球、旁海马区域的脑血流值显著升高(均P<0.01，TFCE-FWE校正)。脑血流值与神经心理学评分以及各认知域认知量表评分的相关性分析结果显示：轻度脑外伤组全脑(r=0.528，P<0.001)、右侧尾状核(r=0.512，P<0.001)、壳核(r=0.486，P<0.001)和苍白球(r=0.426，P=0.006)脑血流值与评估工作记忆能力的倒背数字广度测验(Backward Digit Span Task，BDST)评分呈正相关，而右侧苍白球脑血流值与创伤后应激障碍评分(Post-Traumatic Stress Disorder Cheeklist-Civilian Version，PCL-C)呈负相关(r=-0.402，P=0.010)。在随访期间，这些区域的异常脑血流改变均未恢复，而在第1个月，3个月和12个月时脑血流值与PCL-C和BDST之间无相关性(均P>0.05)。结论: 脑血流值代谢升高是急性期轻度脑外伤患者脑损伤的应激特征之一；其多个皮层或皮层下区域的脑血流值均存在异常的升高，且这些异常区域的脑血流值在后续随访期间均无明显改变，提示轻度脑外伤患者亟需采取潜在的临床治疗手段。.OBJECTIVES: The patients with mild traumatic brain injury (mTBI) accounts for more than 80% of the patients with brain injury. Most patients with mTBI have no abnormalities in CT examination. Therefore, most patients choose to self-care and recover rather than seeking medical treatment. In fact, mTBI may result in persistent cognitive decline and neurobehavioral dysfunction. In addition, changes occurred in neurochemistry, metabolism, and cells after injury may cause changes in cerebral blood flow (CBF), which is one of the causes of secondary injury and slow brain repair. This study aims to evaluate the changes of CBF with the progression of the disease in patients with mTBI based on arterial spin labeling (ASL) magnetic resonance imaging technology. METHODS: In the outpatient or emergency department of the Second Affiliated Hospital of Wenzhou Medical University, 43 mTBI patients were collected as an mTBI group, and 43 normal subjects with age, gender, and education level matching served as a control group. They all received clinical neuropsychology and cognitive function evaluation and magnetic resonance imaging. In the mTBI group, 22 subjects were followed up at acute phase, 1 month, 3 months, and 12 months. Based on the control group, the abnormal regions of CBF in the whole brain of mTBI patients were analyzed. The abnormal regions were taken as the regions of interest (ROI). The correlation of the values of the CBF in ROIs with clinical indications, cognitive function, and the changes of CBF in ROI at each time point during the follow-up were analyzed. RESULTS: Compared with the control group, the CBF in the bilateral dorsolateral superior frontal gyrus and auxiliary motor areas in the cortical region, as well as the right putamen, caudate nucleus, globus pallidus, and parahippocampus in the subcutaneous regions in the acute phase of the mTBI group were significantly increased (all P<0.01, TFCE-FWE correction). The analysis results of correlation of CBF with neuropsychology and cognitive domain showed that in the mTBI group, whole brain (r=0.528, P<0.001), right caudate nucleus (r=0.512, P<0.001), putamen (r=0.486, P<0.001), and globus pallidus (r=0.426, P=0.006) values of the were positively correlated with Backward Digit Span Test (BDST) score (reflectting working memory ability), and the right globus pallidus CBF was negatively correlated with the Post-Traumatic Stress Disorder Cheeklist-CivilianVersion (PCL-C) score (r=-0.402, P=0.010). Moreover, the follow-up study showed that abnormal CBF in these areas had not been restored. The correlation of CBF was negatively correlated with PCL-C and BDST at 1 months, 3 months, and 12 months (all P>0.05). CONCLUSIONS: The elevated CBF value is one of the stress characteristics of brain injury in the mTBI patients at the acute phase. There is abnormal elevation of CBF values in multiple cortex or subcortical areas. Multi-time point studies show that there is no obvious change of CBF in abnormal areas, suggesting that potential clinical treatment is urgently needed for the mTBI patients.

Keyword ：

arterial spin labeling; cerebral blood flow; magnetic resonance imaging; mild traumatic brain injury

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In the field of transcritical CO2 systems applied research, dedicated mechanical subcooling (DMS) is one of the most recently investigated and promising solutions, especially for space heating. However, this kind of system brings with it an intrinsic complexity, and to pursue effective and efficient operation, it requires suitable control and optimization strategies. The paper considers a combined transcritical CO2 and R134a -based DMS system and depicts the benefits of using a Multi-Input-Single-Output (MIMO) Extremum Seeking Control (ESC) approach. The real-time optimization strategy was obtained through a Computer-Aided Control System Design (CACSD) tool, exploiting an ad hoc Dymola model of the DMS system that has been validated and tested by using experimental data. The performance of the proposed approach has been compared with standard solutions relying on physical correlations. The MISO-ESC strategy always performed better in terms of system Coefficient of Performance (COP), under both fixed and variable ambient temperature conditions. Finally, the influence of the different refrigerants in the combined DMS system was analyzed from both heating capacity and performance points of view. © 2022

Keyword ：

CO2; DMS; Extreme seeking control; Multi-variable; Transcritical

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自然语言处理和医学影像的发展使深度学习模型能够在各种领域和各种数据模态中表现出出色的通用性。这些进步不仅加深了对数据的理解，而且促进了学界对最先进架构及其前景的认识。医学影像研究人员已经认识到仅针对图像研究的不足之处，以及对多模态输入进行综合分析的重要意义。但是，目前相关综述论文的缺乏不利于这个研究方向的发展。本篇综述介绍了自然语言处理和医学图像结合这一领域的背景，并分5个主题回顾现有文献的研究目标、模型架构、目标任务、实验数据和性能指标，还对该领域未来可能的发展方向进行简要描述，旨在为研究人员和医护人员提供现有学术研究的详细总结，提出理性的见解，进而促进未来的研究。.Recent advancement in natural language processing (NLP) and medical imaging empowers the wide applicability of deep learning models. These developments have increased not only data understanding, but also knowledge of state-of-the-art architectures and their real-world potentials. Medical imaging researchers have recognized the limitations of only targeting images, as well as the importance of integrating multimodal inputs into medical image analysis. The lack of comprehensive surveys of the current literature, however, impedes the progress of this domain. Existing research perspectives, as well as the architectures, tasks, datasets, and performance measures examined in the present literature, are reviewed in this work, and we also provide a brief description of possible future directions in the field, aiming to provide researchers and healthcare professionals with a detailed summary of existing academic research and to provide rational insights to facilitate future research.

Keyword ：

deep learning; medical imaging; multimodal input; natural language processing

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The heat transfer capacity of air conditioning outside units is inextricably related to fins and airflow distribution, and research on the combination of the two is lacking. To analyze the fins and fin-and-tube heat exchanger, three-dimensional numerical models of the fins and flow field of the outdoor unit are created in this paper. On the one hand, the heat transfer and fluid flow characteristics of the fins are quantitatively evaluated and analyzed. On the other hand, the resistance coefficients of the porous media are numerically fitted to study the uniformity of the air velocity distribution on the surface of the heat exchanger. Two indexes, the total integrated heat capacity and JF-factor, are applied to evaluate the performance of the fins and fin-and-tube heat exchanger on the overall and specific levels, respectively. The results indicate that slit fins perform better than wave fins at heat transfer, whereas plain fins perform the worst. However, improved heat transfer performance results in increased pressure drop, which has a two-sided effect. It causes both a decrease in air volume flow rate and an increase in air distribution uniformity. Comparing the comprehensive performance of different fins, JF-factors of slit fins and wave fins are on average 20.95% and 14.36% higher than plain fins. In terms of overall performance, slit fins and wave fins have higher integrated heat exchange capacities than plain fins by 18.0% and 9.33%, respectively. © 2022 Elsevier Ltd and IIR

Keyword ：

Air distribution; Fin-and-tube heat exchanger; Heat transfer evaluation; Porous media

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