乌司他丁对非停跳冠脉搭桥术患者的心肺保护作用研究

目的:探讨乌司他丁对非停跳冠脉搭桥术患者的心肺保护作用。方法:选取2017年12月-2019年4月我院收治的非停跳冠脉搭桥术患者76例,根据使用的药物不同分为两组,对照组应用常规方法,研究组应用乌司他丁,在麻醉之后切皮之前为T1,旁路血管开放时时间点为T2,手术结束为T3,手术之后的8 h为T4。比较两组治疗前后的心肺功能指标、动脉血气分析及血浆炎症因子、氧合指数术后恢复。结果:和T1进行对比时,两组T3、T4中的气道阻力(Air way Resistance,Raw)、呼吸指数(Respiratory Index,RI)、肺泡-动脉血氧分压差P(A-a)DO2均有所升高,在T2、T4中(PVR)有所升高,在T2、T3、T4中肺顺应性(Compliance of Lung,CL)有所降低。和对照组进行对比时,研究组在T3、T4中肺循环阻力(pulmonary vascular resistance, PVR)、RI、P(A-a)DO2有所降低,在T2、T3、T4中通气死腔百分比(VD/VT)有所降低(P0.05),在T2中CL有所升高(P0.05);治疗前,两组BNP、TNF-α、IL-6、IL-8无统计学意义(P0.05),治疗后BNP、肿瘤坏死因子(tumor necrosis factor-α,TNF-α)、白细胞介素-6 (Interleukin-6,IL-6)、白细胞介素-8 (Interleukin-8,IL-8)在T1、T2、T3、T4中低于对照组(P0.05),肌钙蛋白(cardiac troponin,cTnI)在T1中和对照组没有明显差异(P0.05),T2、T3、T4中研究组明显低于对照组(P0.05),研究组氧合指数高于对照组(P0.05);研究组T1、T2、T3、T4时平均动脉压(mean artery pressure,MBP)均高于对照组(P0.05),T1、T2、T3、T4时心率均低于对照组(P0.05);研究组ICU停留时间、ICU带气管插管时间、ICU机械通气时间、肺部并发症均低于对照组(P0.05)。结论:乌司他丁用于非停跳冠脉搭桥术的效果较好,可以保护患者的心肺功能。     

血清同型半胱氨酸、叶酸、维生素B12水平与冠状动脉病变严重程度的相关性分析

摘要 目的：探讨血清同型半胱氨酸(homocysteine, Hcy)、叶酸、维生素B12水平与冠状动脉病变严重程度的相关性。方法：选取经冠脉造影检查确诊的稳定期冠心病患者220例为研究组,并以同期健康查体志愿者100例为对照组。检测和比较两组血清Hcy、叶酸、维生素B12和N -末端脑钠肽前体(N-terminal brain natriuretic peptide precursor,NT-proBNP)水平。研究组根据冠脉造影情况进行SYNTAX评分评价,通过心脏超声检查检测左室射血分数(left ventricular ejection fraction,LVEF),确定冠脉病变严重程度。比较研究组SYNTAX低分组(1～22分)、中分组(23～32分)和高分组(≥33分)患者上述各指标水平,并分析研究组血清Hcy、叶酸、维生素B12水平与其血清NT-proBNP 水平、SYNTAX评分和LVEF的关系。结果：与对照组比较,研究组血清Hcy和NT-proBNP水平升高而血清叶酸、维生素B12水平降低(P＜0.05)。研究组SYNTAX评分和LVEF分别为(28.76±6.58)分和(47.33±8.66)%,SYNTAX中分和高分患者血清Hcy和NT-proBNP水平高于SYNTAX低分患者而血清叶酸、维生素B12水平和LVEF则低于SYNTAX低分患者,SYNTAX高分患者血清Hcy和NT-proBNP水平高于SYNTAX中分患者而血清叶酸、维生素B12水平和LVEF则低于SYNTAX中分患者(P＜0.05)。Pearson线性相关分析结果显示研究组血清Hcy水平与其血清NT-proBNP 水平、SYNTAX评分均呈正相关(r=0.881,0.793,P＜0.05),与其LVEF则呈负相关(r=-0.876,P＜0.05);而其血清叶酸、维生素B12水平与其血清NT-proBNP 水平、SYNTAX评分均呈负相关(叶酸：r=-0.786,-0.825;维生素B12：r=-0.884,-0.818,P＜0.05),与其LVEF则呈正相关(r=0.893,0.859,P＜0.05)。结论：血清Hcy是冠心病的重要危险因素,其水平随着冠状动脉病变程度加重而升高;血清叶酸、维生素B12是冠心病的保护因素,其水平随着冠状动脉病变程度加重而降低。     

1D-CADCapsNet: One dimensional deep capsule networks for coronary artery disease detection using ECG signals

PurposeCardiovascular disease (CVD) is a leading cause of death globally. Electrocardiogram (ECG), which records the electrical activity of the heart, has been used for the diagnosis of CVD. The automated and robust detection of CVD from ECG signals plays a significant role for early and accurate clinical diagnosis. The purpose of this study is to provide automated detection of coronary artery disease (CAD) from ECG signals using capsule networks (CapsNet).MethodsDeep learning-based approaches have become increasingly popular in computer aided diagnosis systems. Capsule networks are one of the new promising approaches in the field of deep learning. In this study, we used 1D version of CapsNet for the automated detection of coronary artery disease (CAD) on two second (95,300) and five second-long (38,120) ECG segments. These segments are obtained from 40 normal and 7 CAD subjects. In the experimental studies, 5-fold cross validation technique is employed to evaluate performance of the model.ResultsThe proposed model, which is named as 1D-CADCapsNet, yielded a promising 5-fold diagnosis accuracy of 99.44% and 98.62% for two- and five-second ECG signal groups, respectively. We have obtained the highest performance results using 2 s ECG segment than the state-of-art studies reported in the literature.Conclusions1D-CADCapsNet model automatically learns the pertinent representations from raw ECG data without using any hand-crafted technique and can be used as a fast and accurate diagnostic tool to help cardiologists.     

Trace and rare earth elements in monofloral and multifloral honeys from Northwestern Italy; A first attempt of characterization by a multi-elemental profile

BackgroundMetals are a minor constituent in honey, but they have been suggested to be a potential tool to characterize honeys according to their botanical or geographical origin.MethodsA total of 40 metals were analyzed by Inductively Coupled Plasma-Mass Spectrometry in monofloral and multifloral honeys from Northwestern Italy. PCA and ANOVA were used to discriminate honeys according to the various floral types.ResultsThe highest levels of trace elements and rare earth elements (REEs) were found in chestnut honey, while the lowest concentrations were recorded in acacia and rhododendron honeys. Rubidium and aluminum were the most represented nonessential elements, while manganese, iron, zinc and copper had the highest values of the essential elements. Potentially toxic elements arsenic, cadmium and lead were close to or below the limit of quantification.ConclusionsThe present study showed significant differences in metal concentrations according to honey floral type, reflecting the strong influence of botanical origin on the chemical composition of this particular food.     

中国黄土高原北部地区新石器-青铜时代农业结构演变及其对区域生态环境的适应

本文分析并测定了从15个位于黄土高原北部的遗址中浮选的炭化植物遗存的年代及数量,讨论了该地区新石器-青铜时代农业结构的变化、发展及自适应。研究表明,该地区粟的占比随着遗址年代的推移呈现出上升趋势,证明了先民的农业技术随时间变化而发展;受季风降水特征影响,东南部灌丛草原区粟的占比随时间变化上升趋势明显,西北部干草原区则变化较弱,证明环境的差异也造成了农业模式的不同;在干旱气候条件限制下,自中全新世以来黄土高原北部地区的主要作物始终为粟和黍,粟作农业奠定了黄土高原乃至中国北方的文明基础。     

肺炎支原体感染对川崎病的影响及机制探讨

目的分析肺炎支原体感染对川崎病的影响及其机制,以期指导临床诊疗。方法回顾性分析2013年8月至2018年8月我科住院的496例川崎病患儿临床资料,其中合并肺炎支原体感染组193例,未合并肺炎支原体感染组303例。应用倾向评分匹配法1∶1校正2组的年龄、性别、是否为不完全型川崎病、是否使用糖皮质激素、丙种球蛋白使用时间、丙种球蛋白使用方法和阿司匹林初始剂量,比较2组患儿的总发热天数、冠状动脉直径、冠状动脉扩张发生率、冠状动脉瘤发生率和丙种球蛋白无反应发生率。结果川崎病合并肺炎支原体感染组男性患儿多,更易发生颈部淋巴结肿大,年龄、中性粒细胞百分比、血沉和低密度脂蛋白高于川崎病未合并肺炎支原体感染组,血钾、血钙、高密度脂蛋白和白蛋白低于川崎病未合并肺炎支原体感染组,差异有统计学意义(均P<0.05)。应用倾向评分匹配法1∶1配对后发现,川崎病合并肺炎支原体感染组患儿总发热时间更长[8(6~10)d vs 7(6~9)d,Z=-2.089,P<0.05),冠状动脉直径值更大[(2.81±0.81)mm vs(2.63±0.45)mm,t=2.532,P<0.05],冠状动脉瘤发生率更高(5.5% vs 1.1%,χ²=5.516,P<0.05)。结论肺炎支原体感染可能引起川崎病患儿脂质代谢及电解质的紊乱,其炎症反应更强,持续时间更长,对冠状动脉损伤更大。     

福州市公园外来入侵植物初步调查与分析

[目的] 了解福州市公园的外来入侵植物种类组成,分析其原产地及入侵等级等情况,能够为福州外来入侵植物的扩散、防控以及生物多样性保护提供参考依据。[方法] 对福州市4个区49个公园的外来入侵植物种类、原产地、生活型、入侵频度、危害程度（入侵等级）等进行调查和分析。[结果] 在调查的福州市所有公园内均有入侵植物分布,目前有入侵植物66种,隶属25科,其中菊科、豆科、苋科3个科为优势科,共计33种（占50.00%）;从来源上看,大多数原产于美洲,其次是非洲、欧洲、亚洲;以草本植物为主,共有55种（占83.30%）;从入侵频度看,入侵频度超过50%的入侵植物有7种,其中小蓬草的频度最高,为87.76%;从入侵等级来看,其中恶性（1级）入侵植物16种,严重（2级）入侵植物14种,局部（3级）入侵植物12种,一般（4级）入侵植物11种,有待观察类（5级）13种。[结论] 当前福州市公园内的外来植物入侵现象比较严重,应当加强该区域的入侵植物监测与预警,防止入侵植物扩散从而造成重大生态危害。     

“Into and Out of” the Qinghai‐Tibet Plateau and the Himalayas: Centers of origin and diversification across five clades of Eurasian montane and alpine passerine birds

Encompassing some of the major hotspots of biodiversity on Earth, large mountain systems have long held the attention of evolutionary biologists. The region of the Qinghai‐Tibet Plateau (QTP) is considered a biogeographic source for multiple colonization events into adjacent areas including the northern Palearctic. The faunal exchange between the QTP and adjacent regions could thus represent a one‐way street (“out of” the QTP). However, immigration into the QTP region has so far received only little attention, despite its potential to shape faunal and floral communities of the QTP. In this study, we investigated centers of origin and dispersal routes between the QTP, its forested margins and adjacent regions for five clades of alpine and montane birds of the passerine superfamily Passeroidea. We performed an ancestral area reconstruction using BioGeoBEARS and inferred a time‐calibrated backbone phylogeny for 279 taxa of Passeroidea. The oldest endemic species of the QTP was dated to the early Miocene (ca. 20 Ma). Several additional QTP endemics evolved in the mid to late Miocene (12–7 Ma). The inferred centers of origin and diversification for some of our target clades matched the “out of Tibet hypothesis’ or the “out of Himalayas hypothesis” for others they matched the “into Tibet hypothesis.” Three radiations included multiple independent Pleistocene colonization events to regions as distant as the Western Palearctic and the Nearctic. We conclude that faunal exchange between the QTP and adjacent regions was bidirectional through time, and the QTP region has thus harbored both centers of diversification and centers of immigration.     

Assessment of risk factors for postoperative cognitive dysfunction after coronary artery bypass surgery: a single-center retrospective cohort study

Aim: To find out risk factors for postoperative cognitive dysfunction (POCD) after coronary artery bypass grafting (CABG), and to provide basis for clinical prevention of POCD. A total of 88 patients who underwent CABG were surveyed with Telephone Questionnaire (TICS-M) for their cognitive impairment after 3, 7, 21, 90, 180 days post-surgery. The occurrence of POCD was diagnosed by Neuropsychological Battery which included Vocabular Learning Test (VLT), Wisconsin Card Sorting Test (WCST), Trail Making Test (TMT) and Symbol Digit Modalities Test (SDMT). The preoperative, intraoperative and postoperative risk factors were assessed by the χ² or t test. Multivariate analysis was used to study the correlation between the risk factors and the occurrence of POCD. Age, aortic plaque, carotid artery stenosis, cerebrovascular disease, anesthesia time, the rate of decline in intraoperative hemoglobin concentration (ΔHb) and systemic inflammatory response syndrome (SIRS) score on postoperative day 2 had statistically significant (P<0.05) influence on the occurrence of POCD. Aortic plaque, carotid artery stenosis, anesthesia time and SIRS score (odds ratio (OR) value > 1, P<0.05) are the risk factors for POCD. The incidence of day-21 and -180 POCD was approximately 26.1 and 22.7%, respectively.