人体动脉血气波浪式变化特点的实验证据—同时间动、静脉血波浪式变化幅度的不同*

目的: 人动脉血来源是右心系统并在肺脏进行气体交换的静脉血,右心系统的静脉血是否存在波浪式信号目前尚没有证据支持,本研究旨在对比同时间动、静脉血中信号的连续变化特点。方法: 选择心功能正常,需要连续监测动脉血流动力学变化的患者6 例,4男2女,年龄（59.00±16.64） 岁,体质量（71.67±10.37）kg,左心射血分数（LVEF）（61.33±2.16)%。患者签署知情同意书后,选择心功能正常需要监测动、静脉血流动力学变化的患者6 例,连续同时桡动脉、颈内静脉逐搏取血,测定PaO₂。选取2个典型呼吸周期,用于分析同时段动、静脉血气的波浪式变化。分别比较患者血氧分压最高和最低值,以验证同时段动、静脉血气是否都存在周期性波浪式信号变化。此外,将患者动脉、静脉血气周期性波浪式信号的变化幅度进行统计学t 检验分析,比较有无差异。结果: 共6例患者,抽取动、静脉血液充满肝素化细长塑化管需要15~16次心跳,即取血需要15~16次心跳,全部覆盖超过2个呼吸周期。所有患者动脉血气中PaO₂均呈现明显的波浪式变化（P<0.05）,幅度是（9.96±5.18）mmHg,是均值的（8.09±2.43）%。患者静脉血气中PaO₂波动幅度并不明显,为（1.63±0.41）mmHg,是均值的（3.91±1.22）%,与动脉血气组相比有明显统计学差异（P<0.05）。结论: 采用同时连续逐搏动、静脉取血血气分析法证实,患者自主呼吸时动脉血气有明显的周期性波浪式变化信号,而静脉血气几乎没有周期性波浪式变化信号（很弱）,说明动脉血气波浪式信号主要是由于肺通气过程中吸气和呼气期产生肺泡中氧分压规律性上升和下降,通过离开肺毛细血管与肺泡氧气压力平衡的动脉化血液,经过左心室搏血进入动脉血管系统所致。     

Max试验验证症状限制心肺运动试验为最大极限运动进一步临床研究*

目的: 验证临床受试者所完成的心肺运动试验（CPET）为最大极限运动,进一步设计完善Max试验验证CPET结果客观定量功能评估的准确性及以某特定指标的特定数值作为停止运动的标准是否可行。方法: 选择2017年9月至2019年1月在阜外医院签署知情同意书后进行CPET和Max试验受试者216例。其中正常受试者41例,因CPET峰值呼吸交换率（RER）≤1.10,或运动中心率和血压不上升,对CPET极限运动结果存在质疑的临床患者175例进行研究。其中60例已初步报告,本研究进一步扩大研究。Max试验方法：完成CPET测试后,先蹬车≥60 r/min,再施加130%峰值功率的恒定功率,鼓励受试者运动至不能坚持的极限状态。计算分析Max试验30 s的最大心率和最大摄氧量、及其与峰值心率和峰值摄氧量之间的差值和百分差值。百分差值=（Max值-峰值值）/Max值× 100%。评测标准：①若心率和摄氧量任一指标的差值百分比≤-10%（Max测试的数值低于CPET峰值数据）则定义Max试验操作失败,否则为成功;2若心率和摄氧量的差值百分比均在-10%~10%,则Max试验操作成功,证明CPET数据为极限运动,CPET 峰值相关数据较为准确;③若心率和摄氧量差值任一指标差值百分比≥10%时,则Max试验操作成功,证明CPET结果为非极限运动。结果: 病例组峰值摄氧量（L/min、ml/（min·kg）、%pred）、无氧阈（L/min、ml/（min·kg）、%pred）、峰值氧脉搏（ml/beat、%pred）、峰值RER、峰值收缩压（mmHg）、峰值运动负荷（W/min）、峰值心率（bpm）、摄氧有效性峰值平台（OUEP）（比值、%pred）低于正常组,二氧化碳通气有效性平均90 s最低值（Lowest Ve/VCO₂）（比值、%pred）、二氧化碳通气效率斜率（Ve/VCO₂ Slope）（比值、%pred）高于正常组（P<0.05）。所有正常组与病例组均安全无任何事件完成CPET和Max试验。216例受试者中,Max试验成功198例（91.7%）,其中证明CPET为极限运动182例,为非极限运动16例;失败18例（8.3%）。结论: 在临床检查中,若对CPET结果是否为最大极限存在质疑,利用Max试验可验证CPET是否为极限运动。Max试验方法安全可行,值得进一步深入研究和临床推广应用。     

新生儿首次呼吸前后脐带动静脉血液氧和二氧化碳变化探索呼吸调控机制的初步报告II—同一个新生儿同一时间的脐带动静脉血液氧和二氧化碳分压差值个体化分析*

目的: 为探讨新生儿自主呼吸产生机制,前文已对新生儿出生后自主呼吸开始前脐带动静脉氧气和二氧化碳差值进行了人群组间分析;而本部分则对相关信息进行个体化分析。方法: 在产前经所有胎儿父母签署知情同意书,新生儿出生后还没有呼吸之前在脐带动脉和脐带静脉分别连续逐搏取血,仅有3例同时采集到Pua和Puv血液样本进行血气分析测定,计算分析脐带静脉和脐带动脉的异同和动态变化。结果: 虽然准备了数十产妇,但仅有3例同时采集到Pua和Puv血液样本,同一时间的PuvO₂显著高于PuaO₂（P均<0.01）,平均相差（24.17±7.09） mmHg;而PuvCO₂显著低于PuaCO₂（P均<0.01）,平均相差（-7.67±3.70） mmHg。在同一时间的Puv-uaO₂显著高于Puv-uaCO₂（P<0.05）。结论: 新生儿出生后自主呼吸前,全部氧气供应由脐带静脉运输,只要胎盘开始剥离则新生儿的PuaO₂随时间（心跳次数）逐渐降低,当PuaO₂达到触发呼吸阈值（最低值）诱发第一次吸气开始其自主呼吸。     

存在睡眠呼吸异常的慢病患者呼吸影响心率变异性的初步分析*

目的: 基于整体整合生理学医学理论提出的呼吸引起循环指标变异的假说,分析研究存在睡眠呼吸异常的慢病患者睡眠期间呼吸和心率变异之间的相关关系。方法: 纳入存在睡眠呼吸异常且呼吸暂停低通气指数（AHI）≥15次/小时的慢病患者11例,签署知情同意书后完成标准化症状限制性极限运动的心肺运动试验（CPET）和睡眠呼吸监测,计算分析病人睡眠期间波浪式呼吸（OB）期与正常平稳呼吸期的呼吸鼻气流、心电图R-R间期心率变异的规律。结果: 存在睡眠呼吸异常的慢病患者CPET峰值摄氧量（Peak VO₂）和无氧阈（AT）为（70.8±13.6）%pred和（71.2±6.1）%pred;CPET有5例存在运动诱发的波浪式呼吸（EIOB）,6例为呼吸不稳定,提示整体功能状态低于正常人。本组慢病患者AHI为每小时（28.8±10.0）次,睡眠呼吸异常总时间占睡眠总时间的比值为（0.38±0.25）;OB周期的平均时间长度为（51.1±14.4）s。本组慢病患者正常平稳呼吸期的呼吸周期数与心率变异周期数的比值（B-n/HRV-B-n）为1.00±0.04,每个呼吸周期节律的心率变异平均幅度（HRV-B-M）为（2.64±1.59） bpm,虽然低于正常人（P<0.05）,但却与无睡眠呼吸异常的慢病患者相似（P>0.05）;HRV-B-M的变异度CV（HRV-B-M的SD/x）为( 0.33±0.11）,期间血氧饱和度（SpO₂）虽略低,但并无明显规律性下降与上升。本组慢病患者的OB期间呼吸周期数与心率变异周期数（OB-B-n/OB-HRV-B-n）比值为（1.22±0.18）,OB期每个呼吸周期节律的心率变异平均幅度（OB-HRV-B-M）为（3.56±1.57）bpm及其变异度（OB-CV =OB-HRV-B-M的SD/x）为（0.59±0.28）,每个OB周期节律的心率变异平均幅度（OB-HRV-OB-M）为（13.75±4.25）bpm,OB期间低通气时SpO₂出现明显的下降,OB期间SpO₂平均变异幅度（OB-SpO₂-OB-M）为（4.79±1.39）%,OB期的OB-B-n/OB-HRV-B-n比值、OB-HRV-OB-M比其正常平稳呼吸期对应指标显著增大（P<0.01）。OB-HRV-B-M虽然与正常平稳呼吸期HRV-B-M相比差异无统计学意义（P>0.05）,但其变异度OB-CV却显著增大（P<0.01）。结论: 睡眠呼吸异常的慢病患者OB期的心率变异幅度大于其正常平稳呼吸期,当呼吸模式发生改变时心率变异也发生明显改变,其平稳呼吸期的呼吸周期数与心率变异周期数的比值与正常人以及无睡眠呼吸异常的慢病患者相同,证实心率变异为呼吸源性;而其OB期间心率变异周期数相对于呼吸周期减少直接源于此时的低通气或者呼吸暂停,心率变异也是呼吸源性。     

SHED aggregate exosomes shuttled miR‐26a promote angiogenesis in pulp regeneration via TGF‐β/SMAD2/3 signalling

ObjectivesPulp regeneration brings big challenges for clinicians, and vascularization is considered as its determining factor. We previously accomplished pulp regeneration with autologous stem cells from deciduous teeth (SHED) aggregates implantation in teenager patients, however, the underlying mechanism needs to be clarified for regenerating pulp in adults. Serving as an important effector of mesenchymal stem cells (MSCs), exosomes have been reported to promote angiogenesis and tissue regeneration effectively. Here, we aimed to investigate the role of SHED aggregate‐derived exosomes (SA‐Exo) in the angiogenesis of pulp regeneration.Materials and MethodsWe extracted exosomes from SHED aggregates and utilized them in the pulp regeneration animal model. The pro‐angiogenetic effects of SA‐Exo on SHED and human umbilical vein endothelial cells (HUVECs) were evaluated. The related mechanisms were further investigated.ResultsWe firstly found that SA‐Exo significantly improved pulp tissue regeneration and angiogenesis in vivo. Next, we found that SA‐Exo promoted SHED endothelial differentiation and enhanced the angiogenic ability of HUVECs, as indicated by the in vitro tube formation assay. Mechanistically, miR‐26a, which is enriched in SA‐Exo, improved angiogenesis both in SHED and HUVECs via regulating TGF‐β/SMAD2/3 signalling.ConclusionsIn summary, these data reveal that SA‐Exo shuttled miR‐26a promotes angiogenesis via TGF‐β/SMAD2/3 signalling contributing to SHED aggregate‐based pulp tissue regeneration. These novel insights into SA‐Exo may facilitate the development of new strategies for pulp regeneration.     

Crumbs proteins stabilize the cone mosaics of photoreceptors and improve vision in zebrafish

Although the unique organization of vertebrate cone mosaics was first described long ago,both their underlying molecular basis and physiological significance are largely unknown.Here,we demonstrate that Crumbs proteins,the key regulators of epithelial apical polarity,establish the planar cellular polarity of photoreceptors in zebrafish.Via heterophilic Crb2a-Crb2b interactions,the apicobasal polarity protein Crb2b restricts the asymmetric planar distribution of Crb2a in photoreceptors.The planar polarized Crumbs proteins thus balance intercellular adhesions and tension between photoreceptors,thereby stabilizing the geometric organization of cone mosaics.Notably,loss of Crb2b in zebrafish induces a nearsightedness-like phenotype in zebrafish accompanied by an elongated eye axis and impairs zebrafish visual perception for predation.These data reveal a detailed mechanism for cone mosaic homeostasis via previously undiscovered apical-planar polarity coordination and propose a pathogenic mechanism for nearsightedness.     

A new Illumina MiSeq high-throughput sequencing-based method for evaluating the composition of the Bacteroides community in the intestine using the rpsD gene sequence

Bacteroides is a bacterial genus that is known to closely interact with the host. The potential role of this genus is associated with its ecological status and distribution in the intestine. However, the current 16S V3–V4 region sequencing method can only detect the abundance of this genus, revealing a need for a novel sequencing method that can elucidate the composition of Bacteroides in the human gut microbiota. In this study, a core gene, rpsD, was selected as a template for the design of a Bacteroides-specific primer set. We used this primer set to develop a novel assay based on the Illumina MiSeq sequencing platform that enabled an accurate assessment of the Bacteroides compositions in complex samples. Known amounts of genomic DNA from 10 Bacteroides species were mixed with a complex sample and used to evaluate the performance and detection limit of our assay. The results were highly consistent with those of direct sequencing with a low Bacteroides DNA detection threshold (0.01 ng), supporting the reliability of our assay. In addition, the assay could detect all the known Bacteroides species within the faecal sample. In summary, we provide a sensitive and specific approach to determining the Bacteroides species in complex samples.     

Effects of growth-promoting rhizobacteria on maize growth and rhizosphere microbial community under conservation tillage in Northeast China

Conservation tillage in conjunction with straw mulching is a sustainable agricultural approach. However, straw mulching reduces the soil temperature, inhibits early maize growth and reduces grain yield in cold regions. To address this problem, we investigated the effects of inoculation of plant growth-promoting rhizobacteria (PGPR) on maize growth and rhizosphere microbial communities under conservation tillage in Northeast China. The PGPR strains Sinorhizobium sp. A15, Bacillus sp. A28, Sphingomonas sp. A55 and Enterobacter sp. P24 were isolated from the maize rhizosphere in the same area and inoculated separately. Inoculation of these strains significantly enhanced maize growth, and the strains A15, A28 and A55 significantly increased grain yield by as much as 22%–29%. Real-time quantitative PCR and high-throughput sequencing showed that separate inoculation with the four strains increased the abundance and species richness of bacteria in the maize rhizosphere. Notably, the relative abundance of Acidobacteria_Subgroup_6, Chloroflexi_KD4-96, and Verrucomicrobiae at the class level and Mucilaginibacter at the genus level were positively correlated with maize biomass and yield. Inoculation with PGPR shows potential for improvement of maize production under conservation tillage in cold regions by regulating the rhizosphere bacterial community structure and by direct stimulation of plant growth.     

Base editing with high efficiency in allotetraploid oilseed rape by A3A‐PBE system

CRISPR/Cas‐base editing is an emerging technology that could convert a nucleotide to another type at the target site. In this study, A3A‐PBE system consisting of human A3A cytidine deaminase fused with a Cas9 nickase and uracil glycosylase inhibitor was established and developed in allotetraploid Brassica napus. We designed three sgRNAs to target ALS, RGA and IAA7 genes, respectively. Base‐editing efficiency was demonstrated to be more than 20% for all the three target genes. Target sequencing results revealed that the editing window ranged from C1 to C10 of the PAM sequence. Base‐edited plants of ALS conferred high herbicide resistance, while base‐edited plants of RGA or IAA7 exhibited decreased plant height. All the base editing could be genetically inherited from T₀ to T₁ generation. Several Indel mutations were confirmed at the target sites for all the three sgRNAs. Furthermore, though no C to T substitution was detected at the most potential off‐target sites, large‐scale SNP variations were determined through whole‐genome sequencing between some base‐edited and wild‐type plants. These results revealed that A3A‐PBE base‐editing system could effectively convert C to T substitution with high‐editing efficiency and broadened editing window in oilseed rape. Mutants for ALS, IAA7 and RGA genes could be potentially applied to confer herbicide resistance for weed control or with better plant architecture suitable for mechanic harvesting.