儿童与成人阻塞型睡眠呼吸暂停低通气综合征代谢异常特征的比较

目的：探讨儿童及成人阻塞型睡眠呼吸暂停低通气综合症（OSAHS）发病原因、睡眠呼吸紊乱严重程度及合并代谢异常程度的差别。方法：对我院2003年1月1日至20]0年7月1日71例诊断为OSAHS住院患者进行回顾性调查,登记年龄、性男日、发病原因、血压、白细胞计数、中性粒细胞比率、淋巴细胞比率、呼吸暂停低通气指数（AHI）、夜间最低血氧饱和度、微觉醒指数。根据年龄进行分组,年龄〈18岁者为A组,年龄≥18岁者为B组。比较两组发病原因、睡眠呼吸紊乱及合并代谢异常程度的差剐。结果：1．A组慢性扁桃体炎和（或）腺样体肥大发生率明显高于B组（P〈O．01）,鼻中隔偏曲发生率明显低于B组（P〈0．01）。2．与B组比较,A组AHI及微觉醒指数降低,夜间最低血氧饱和度升高（P〈0．01）;3．与B组比较,A组高血压、中性粒细胞比率、谷丙转氨酶比例降低（P〈0．05）。结论：A组睡眠呼吸紊乱程度及代谢异常较B组程度轻,更需关注成人阻塞型睡眠呼吸暂停低通气综合症的综合治疗。     

CPAP治疗对OSAHS患者血浆TNF-α水平的影响及临床意义的研究

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血浆TNF-α水平的变化,以及CPAP治疗的影响和临床意义.方法:48例多导睡眠图确诊的男性OSAHS患者,按照呼吸暂停低通气指数(AHI)分为轻度OSAHS 组(n=15),中度OSAHS组(n=16),重度OSAHS组(n=17).16例年龄和体重指数(BMI)匹配的健康男性作为对照组,其中13例中重度OSAHS患者进行持续气道正压通气(CPAP)治疗.ELISA法测定血浆ZNF-α浓度.对OSAHS患者血浆TNF-α与睡眠期AHI和最低脉氧饱和度(miniSpO2)进行Pearson相关性分析.结果:轻度、中度和重度OSAHS组TNF-α浓度分别为(11.49±1.32 pg/ml)、(13.29±1.73pg/ml)、(14.74±2.72pg/ml),均显著高于正常对照组(9.29±1.74pg/ml).TNF-α水平随OSAHS程度加重而增高.Pearson相关性分析显示OSAHS患者TNF-α浓度与呼吸暂停低通气指数(AHI)呈显著正相关(r=0.714,P<0.001),与miniSpO2间呈显著负相关(r=0.601,P<0.001).CPAP治疗后OSAHS患者血浆TNF-α水平显著降低(P<0.001).结论:CPAP治疗可降低或防止OSAHS患者的动脉硬化进展.     

儿童阻塞性睡眠呼吸暂停低通气综合征与肥胖的相关性研究

目的:探讨儿童阻塞性睡眠呼吸暂停/低通气综合征(OSAHS)与肥胖的相关性。方法:收集单纯性肥胖儿童120例和体重正常儿童110例作为研究对象,进行统一的体格检查和专科检查,并进行多导睡眠监测记录阻塞性呼吸暂停指数(OAI)、呼吸暂停/低通气指数(AHI)、中枢性呼吸暂停指数(CAI)、最低血氧饱和度(LSa O2)和睡眠效率。结果:肥胖组OSAHS患病率为58.33%显著高于对照组的31.82%,差异有统计学意义(P0.05);OAI、AHI、CAI均显著高于对照组,而LSa O2、睡眠效率指标显著低于对照组,差异均有统计学意义(均P0.05);多因素回归分析显示,肥胖、扁桃体增生、腺样体增生是导致OSAHS的独立危险因素,差异有统计学意义(均P0.05)。结论:肥胖是儿童OSAHS发病的重要影响因素,特别是合并扁桃体肿大或腺样体肿大的患儿应注意预防OSAHS的发生。     

手术治疗儿童阻塞性睡眠呼吸暂停低通气综合征临床疗效观察

目的:观察手术治疗儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的手术治疗方法及临床效果,为临床治疗提供依据。方法:选取我院2010年2月~2013年1月期间收治的儿童阻塞性睡眠呼吸暂停低通气综合征患者56例做研究对象,对患儿的手术治疗方法及手术前后呼吸暂停指数、最低血氧饱和度及呼吸暂停低通气指数平均值进行记录和分析,比较其临床疗效情况。结果:三组患儿术后呼吸暂停指数、伴最低血氧饱和度、呼吸暂停低通气指数与术前比较,差异明显具有统计学意义,术后优于术前。中、重度鼻咽气道狭窄程度比较,术后较术前疗效显著,差异明显具有统计学意义(P0.05)。结论:儿童阻塞性睡眠呼吸暂停低通气综合征手术后呼吸暂停指数、伴最低血氧饱和度、呼吸暂停低通气指数得到显著改善,是治疗最佳方案,建议推广应用。     

睡眠呼吸暂停综合征患者血脂水平的研究

目的:了解阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血浆脂质代谢情况。方法:分别检测健康对照组、睡眠呼吸暂停综合征患者组甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、载脂蛋白A、载脂蛋白B、脂蛋白a、载脂蛋白E含量。进行统计学对比及分析。结果:睡眠呼吸暂停综合征患者的甘油三酯、总胆固醇、高密度脂蛋白、总胆固醇/高密度脂蛋白、载脂蛋白A、载脂蛋白B及载脂蛋白E与健康对照组比较有显著差异,且与其睡眠监测指标有明显相关。结论:OSAHS可导致血浆脂质代谢紊乱,与动脉粥样硬化发生及发展的存在重要的相关性,是独立于年龄、体重、饮食、遗传等原因的冠心病、高血压、脑卒中等心脑血管疾病的发病因素之一。因此,提高对OSAHS的警惕是非常重要的。     

中老年男性缺血性脑血管病与阻塞性睡眠呼吸暂停综合症的临床相关性分析

目的:对中老年男性缺血性脑血管病合并阻塞性睡眠呼吸暂停综合症(obstructive sleep apnea,OSA)的相关性及其危险因素进行临床分析。方法:选择中老年男性急性脑梗死患者(acute cerebral infarction,ACI)40例,短暂性脑缺血发作患者(transient ischemic attack,TIA)36例及健康对照组患者36例用多导睡眠呼吸监测仪进行监测,对患有OSA的患者根据睡眠呼吸暂停低通气指数(apnea hypopnea index,AHI)分成轻中重三组,并对其临床指标及危险因素进行分析。结果:ACI组(15.3±12.3)和TIA组(14.7±10.4)患者AHI显著高于对照组(8.2±6.6,P0.01)。OSA在各组中的发病率分别为60.0%,52.8%和22.2%,与对照组有显著差异。缺血性脑血管病患者的体重指数(BMI),血糖,纤维蛋白原(FIB),胆固醇水平(CHOL),高密度脂蛋白(HDL)以及烟酒等不良嗜好与OSA呈正相关。中重度OSA患者缺血性脑血管病的发病率显著高于轻症患者(P0.01)。结论:OSA是影响老年男性缺血性脑血管病发病的重要因素,其严重程度可能与缺血性脑血管病成正相关。     

血清IL-6、CRP在阻塞型睡眠呼吸暂停低通气综合征并发冠心病患者发病中的作用

目的:探讨血清白细胞介素-6(IL-6)和C反应蛋白(CRP)在阻塞型睡眠呼吸暂停低通气综合征(OSAHS)并发冠心病(CHD)患者发病中的作用。方法:选取2013年12月~2015年2月我院的健康人群(正常组)、单纯OSAHS患者(OSAHS组)、OSAHS合并CHD患者(OSAHS+CHD组)作为研究对象,对比三组的睡眠呼吸指标、血清IL-6、CRP水平,并分析患者中三者的相关性分析。结果:正常组的血清IL-6和CRP水平均显著低于单纯OSAHS组与OSAHS+CHD组(P0.05),且OSAHS+CHD组高于单纯OSAHS组(P0.05);单纯OSAHS组与OSAHS+CHD组在睡眠呼吸暂停低通气指数(AHI)、平均Sa O2、最低Sa O2、呼吸暂停时间百分比上具有显著差异(P0.05);单纯OSAHS组和OSAHS+CHD组患者血清IL-6与CRP均为正相关关系(P0.05);单纯OSAHS组与OSAHS+CHD组血清IL-6和CRP均与AHI、呼吸暂停时间百分比呈正相关(P0.05),与最低Sa O2呈负相关(P0.05)。结论:IL-6、CRP和OSAHS合并CHD有密切关联性,为临床研究探讨炎性过程在OSAHS并CHD中的作用机制,以及心血管事件的防治等方向提供了依据。     

药物干预和手术切除治疗儿童阻塞性睡眠呼吸暂停低通气综合征的疗效评估

目的:对比分析药物干预和手术切除治疗儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的临床疗效。方法:应用随机数字表法将2015年2月至2017年11月经本院确诊的100例OSAHS患儿分为药物组、手术组,每组50例。药物组采用孟鲁司特钠治疗6个月,手术组行腺样体和扁桃体切除术。6个月后比较两组患儿多导睡眠图监(PSG)的监测结果和生活质量情况,比较两组疗效评定情况,记录手术组无效及并发症的原因。结果:6个月后,药物组、手术组患儿呼吸暂停低通气指数(AHI)、阻塞性呼吸暂停指数(OAI)、微觉醒指数(MAI)和睡眠呼吸紊乱指数(RDI)较治疗前降低,且手术组患儿AHI低于药物(P0.05)。手术组患儿6个月后睡眠障碍、对监护人的影响、身体症状评分较治疗前降低,且低于药物组(P0.05),而药物组治疗前后OSA-18评分各指标比较差异无统计学意义(P0.05)。手术组患儿总有效率为90.00%(45/50),高于药物组的50.00%(25/50),差异有统计学意义(P0.05)。手术组患儿有出血现象的4例、伴舌后坠2例、上呼吸反复道感染6例和鼻炎5例,无效的5例患儿为伴有肥胖的重度OSAHS。结论:对于OSAHS患儿,药物干预和手术切除均可改善患儿PSG指标水平,但手术切除治疗可提高患儿生活质量和治疗有效率。     

OSAHS患者腭咽组织中COX-2、VEGF的表达及其与新生血管生成的关系

目的：探讨阻塞性睡眠呼吸暂停低通气综合症（OSAHS）患者腭咽组织中环氧化酶-2（COX-2）、血管内皮生长因子（VEGF）的表达及其与新生血管生成的关系及意义。方法：经多导睡眠监测仪（PSG）确诊的40例OSAHS患者（其中轻度组7例,中度12例,重度21例）及6例无鼾症患者的软腭组织,采用HE染色光镜观察腭咽部组织的病理组织学改变,免疫组化技术检测COX-2,VEGF及微血管密度（MVD）的表达情况。结果：COX-2、VEGF主要表达于OSAHS患者软腭组织的黏膜鳞状上皮和导管腺上皮,中、重度OSAHS组与对照组比较,COX-2,VEGF,MVD表达均有显著差异（P〈0.01）,OSAHS组明显高于对照组,轻度组与对照组差别无统计学意义（P〉0.05）;COX-2、VEGF均与MVD的表达呈正相关（P〈0.01）,COX-2与VEGF的表达呈正相关（P〈0.01）,COX-2,VEGF,MVD均与睡眠呼吸暂停低通气指数（AHI）呈正相关（P〈0.01）,与夜间最低氧饱和度呈负相关（P〈0.01）。结论：OSAHS患者腭咽部存在新生血管增生,与缺氧程度有关,COX-2及VEGF在其发生发展过程中可能起到重要作用。     

H型高血压合并阻塞性睡眠呼吸暂停低通气综合征的观察

目的:探讨H型高血压与阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的相互关系。方法:选择2013年10月至2014年8月在上海市浦南医院心内科就诊的78例高血压住院患者,血浆同型半胱氨酸(Hcy)水平≥10μmol/L为H型高血压、血浆Hcy水平10μmol/L为单纯性高血压。两者分别用便携式睡眠监测仪(PMD)检测,比较两组结果的差异。结果:H型高血压组的呼吸暂停低通气指数(AHI)高于单纯性高血压组(P0.05),H型高血压组的OSAHS发病率与单纯组无差异(P0.05),在有OSAHS的高血压病人中,H型高血压组有较高的中重度OSAHS的发病率(P0.01)。结论:在高血压患者中,没有发现血浆Hcy水平与OSAHS相关。但是一旦存在OSAHS,则合并H型高血压患者中出现中重度OSAHS的概率较高。     

新疆石河子农耕区不同植被类型昆虫群落结构特征

2006年7～9月,用五点抽样法对新疆石河子农耕区不同植被类型中的昆虫群落结构进行调查,共采集到昆虫68种,隶属10目34科,共计6727头,其中叶蝉和蚜虫是主要害虫,瓢虫和草蛉是主要天敌昆虫。群落结构分析表明:在不同植被类型中昆虫群落多样性显著不同,以苗圃的多样性指数最高(2.5739),玉米的最低(1.0189),果木类的高于农作物的,间作的高于单纯植物的。     

干旱指标研究进展

干旱作为全球最为常见的自然灾害之一,已经对我国的农业生产造成了严重影响。为更好地预测影响作物的干旱并及时采取应对措施,综述了国内外广泛应用的各类干旱指标,包括气象指标、土壤墒情指标、作物生理生态指标及其它综合监测指标等,评述了各类干旱指标的优缺点以及在农业上的适用性,探讨了未来以作物干旱为核心的干旱指标研究拟重视的方面,以为减缓和预防干旱对农业的不良影响及制订科学的政策提供依据。     

Plan evaluation indices: A journey of evolution

AimA systemic review and analysis of evolution journey of indices, such as conformity index (CI), homogeneity index (HI) and gradient index (GI), described in the literature.BackgroundModern radiotherapy techniques like VMAT, SRS and SBRT produce highly conformal plans and provide better critical structure and normal tissue sparing. These treatment techniques can generate a number of competitive plans for the same patients with different dose distributions. Therefore, indices like CI, HI and GI serve as complementary tools in addition to visual slice by slice isodose verification while plan evaluation. Reliability and accuracy of these indices have been tested in the past and found shortcomings and benefits when compared to one another.Material and methodsPotentially relevant studies published after 1993 were identified through a pubmed and web of science search using words “conformity index”, “Homogeneity index”, “Gradient index”,” Stereotactic radiosurgery”,” stereotactic Body radiotherapy” “complexity metrics” and “plan evaluation index”. Combinations of words “plan evaluation index conformity index” were also searched as were bibliographies of downloaded papers.Results and conclusionsMathematical definitions of plan evaluation indices modified with time. CI definitions presented by various authors tested at their own and could not be generalized. Those mathematical definitions of CI which take into account OAR sparing grant more confidence in plan evaluation. Gradient index emerged as a significant plan evaluation index in addition to CI whereas homogeneity index losing its credibility. Biological index base plan evaluation is becoming popular and may replace or alter the role of dosimetrical indices.     

Fungal diversity in pigeonpea (Cajanus cajan (L.) Millspaugh) cropping system of calcareous soil

Soil mycofloral diversity plays a pivotal role in crop production and is an integral part of any ecosystem. Pigeonpea cropping system provides a congenial environment to soil microbes by fixing nitrogen and solubilizing phosphorus which in turn provides sufficient nutrients for their prolific growth. The present study was undertaken to know the fungal diversity in calcareous soil of Bihar region in India, which are not supportive to growth of many fungi owing to high calcium content. Soil samples were collected from pigeonpea cropping system treated with native and commercial isolates of phosphorus solubilizing bacteria (PSB) and plant growth promoting rhizobacteria (PGPR) along with Rhizobium. Thirty-seven species belonging to seven genera and a group of unidentified species were isolated. Aspergillus and Penicillium were the dominant genera in all the treatments. Absidia and Cunnighmella were distributed only once as rare genera. Though single species of Pythium, Rhizopus, Periconia, Geotrichum and Gliocladium genera were recorded but their occurrence was even in all the treatments. The diversity and equitability index were not varied much in different treatments except one. The deuteromucetous fungi occupied the highest space followed by zygomycetous, mycelia sterilia and mastigomycetous fungi.     

Wheat genotypic variability in grain yield and carbon isotope discrimination under Mediterranean conditions assessed by spectral reflectance

A collection of 368 advanced lines and cultivars of spring wheat(Triticum aestivum L.) from Chile, Uruguay, and CIMMYT(Centro Internacional de Mejoramiento de Maíz y Trigo), with good agronomic characteristics were evaluated under the Mediterranean conditions of central Chile. Three different water regimes were assayed: severe water stress(SWS, rain fed), mild water stress(MWS; one irrigation around booting), and full irrigation(FI; four irrigations: at tillering,flag leaf appearance, heading, and middle grain filling). Traits evaluated were grain yield(GY), agronomical yield components,days from sowing to heading, carbon isotope discrimination(D13C) in kernels, and canopy spectral reflectance. Correlation analyses were performed for 70 spectral reflectance indices(SRI) and the other traits evaluated in the three trials. GY and D13C were the traits best correlated with SRI, particularly when these indices were measured during grain filling. However,only GY could be predicted using a single regression, with ResearchNormalized Difference Moisture Index(NDMI2: 2,200; 1,100)having the best fit to the data for the three trials. For D13C, only individual regressions could be forecast under FI(r2: 0.25–0.37)and MWS(r2: 0.45–0.59) but not under SWS(r2: 0.03–0.09).NIR‐based SRI proved to be better predictors than those that combine visible and NIR wavelengths.     

Wheat genotypic variability in grain yield and carbon isotope discrimination under Mediterranean conditions assessed by spectral reflectance

A collection of 368 advanced lines and cultivars of spring wheat（Triticum aestivum L.） from Chile, Uruguay, and CIMMYT（Centro Internacional de Mejoramiento de Maíz y Trigo）, with good agronomic characteristics were evaluated under the Mediterranean conditions of central Chile. Three different water regimes were assayed： severe water stress（SWS, rain fed）, mild water stress（MWS; one irrigation around booting）, and full irrigation（FI; four irrigations： at tillering,flag leaf appearance, heading, and middle grain filling）. Traits evaluated were grain yield（GY）, agronomical yield components,days from sowing to heading, carbon isotope discrimination（△^13C） in kernels, and canopy spectral reflectance. Correlation analyses were performed for 70 spectral reflectance indices（SRI） and the other traits evaluated in the three trials. GY and △^13C were the traits best correlated with SRI, particularly when these indices were measured during grain filling. However,only GY could be predicted using a single regression, with ResearchNormalized Difference Moisture Index（NDMI2： 2,200; 1,100）having the best fit to the data for the three trials. For △^13C, only individual regressions could be forecast under FI（r^2： 0.25–0.37）and MWS（r^2： 0.45–0.59） but not under SWS（r^2： 0.03–0.09）.NIR‐based SRI proved to be better predictors than those that combine visible and NIR wavelengths.     

Ponderal indices at birth

At birth, the index weight/height is the highest correlated with weight, height and cephalic perimeter, for the index of Quételet (BMI) the correlations are also significant although lower. In both cases, the variation with age is significant. For the Rohrer index, the situation is different, the changes with age being almost absent. In front of these results, can we decide which index would be adequate to establish the nutritional status at birth? For Cole (1986), for such a ponderal index the correlation with height would have to be absent. Rolland-Cachera (1982) proposed also that the correlations with height would be absent but would be high with weight. In the case of the newborns of our study the only index being not correlated to height is the Rohrer index with low correlation also with the cephalic perimeter and high correlation with weight (although here the correlation is even higher with BMI and W/H). During the utero-placentary disfunction the foetal weight is affected but not height and cephalic perimeter: in this case, the advantage is also to an index correlated with weight but not with height.     

Genetic Group Index on Multiple Traits for Homogeneous Covariance Structure

A multi-trait index for ranking different genetic groups/populations with homogeneous covariance structure is developed and illustrated with live data.     

近50年京津冀气候舒适度的区域时空特征分析

受气候变化影响,区域气候舒适期势必会发生不同程度的变化。从气候舒适性的视角出发,利用京津冀地区1966—2015年的170个观测站点50年逐日气象资料,以温湿指数、风效指数、着衣指数及其综合指数为气候舒适性的评价指标,统计分析区域气候舒适期的起止日期、天数及其年际间变化规律,揭示京津冀区域气候舒适度的时空变化特征,为区域人口合理分布和气候资源评价提供科学依据。此外,以日为时间尺度进行气候舒适期分析,有利于气候变化背景下区域间横向和区域内纵向的比较研究。结果显示:(1)京津冀气候舒适度指数近50年来的变化趋势基本相同,综合指数呈显著增加趋势;但各地间变幅存在一定差异,其中天津气候舒适度指数变化幅度最为明显,北京变化相对平稳。(2)从气候舒适度综合指数来看,京津冀地区气候舒适期年内分布呈"M"型,舒适期相对集中在4—5月、9—10月,舒适和较舒适等级的月累计日数均达到28 d以上,其中5月气候最为舒适,舒适等级日数最多,达到24—26 d;北京年平均舒适天数最多(100 d),天津最少(91 d)。(3)从单一气候舒适度指数来看,京津冀舒适和较舒适等级的初始日期大多呈显著的提前趋势;终止日期和天数大多略有增加,但变化趋势不显著。而综合指数显示,1966—2015年较舒适等级的初始日期变化最为显著,大约每10年提前3—4 d;天津和河北终止日期变化也达到显著水平,大约每10年推迟1—2 d,北京增加趋势不明显。(4)京津冀气候舒适期的空间分布显示,舒适等级的日数从西北向东南地区呈减少特征,河北北部舒适等级的年平均日数最多达115—120 d,东南部最少,不足90 d。     

甲真菌病患者分离真菌多样性分析

为了探寻甲真菌病患者病甲部位的真菌多样性,以期对临床治疗提供参考,结合菌种培养的形态学研究和rDNA ITS序列分析的方法,对临床拟诊为甲真菌病患者的病甲分离培养菌株进行物种鉴定,并以丰富性指数(Ma)、多样性指数(H′)、均匀度指数(J)等指标分析指甲和趾甲分离真菌的多样性。2010年2月至9月在北京大学第三医院皮肤科的1 568例拟诊甲真菌病患者中,641例培养阳性,包括趾甲561例和指甲80例。检测到的皮肤癣菌占59.13%(其中红色毛癣菌为96.04%),酵母菌17.00%,其他真菌23.87%。分离自趾甲的Candida galli、Lewia infectoria和Paraconiothyrium hawaiiense,以及分离自指甲的Cyberlindnera jadinii确定为中国新记录种。趾甲分离菌的物种多样性指数H′、丰富度指数Ma和均匀度指数J均高于指甲分离菌。研究结果表明,该医院就诊甲真菌病患者可分离培养的真菌以皮肤癣菌的红色毛癣菌为主要物种,且趾甲分离菌的菌种多样性较指甲的更为明显。