Improved durable pulmonary vein isolation with shorter procedure times and lower energy levels using RF ablation with ablation index and a stringent lesion contiguity

BackgroundThe single procedure success rates of durable pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) varies between 80 and 90%. Ablation index, incorporating contact force, stability, time and power is a more profound parameter of significant lesion size and has been established. Equally important is a stringent contiguity of the lesion set.Methods and resultsA total number of 100 consecutive patients undergoing de-novo catheter ablation for paroxysmal atrial fibrillation (PAF) were analyzed between 2016 and 2019. In the first 50 patients (group A) PVI was performed using a surround flow, contact force catheter (Biosense Webster Thermocool STSF, Biosense Webster, USA) with a drag-and-ablate technique to encircle the PVs. In the following 50 patients (group B), PVI was performed using ablation index and a stringent lesion contiguity with an interlesion distance (ILD) of <5 mm. The baseline characteristics showed no significant differences between both groups. During a mean follow-up of 18 ± 3 months after a single procedure, 36 (72%) patients of group A were free of arrhythmia recurrence versus 43 (86%) patients in group B (p = 0.047). A total of 14 patients (group A: 10 (20%), group B: 4 (8%); underwent a redo-procedure. 7 patients of group A (14%) and 2 patients of group B (4%) showed recovered veins. In 3 patients of group A and 2 patients of group B the PVs were durably isolated. In these patients persistent AF recurrence was caused by extra-PV AF sources. Four patients of group A and three patients of group B had continued paroxysmal or persistent AF but did not undergo redo-procedure. With regard to the procedural data, the procedure time, the total energy and the fluoroscopy time were significantly lower in group B (AI and ILD <5 mm) (128.86 ± 18.19 versus 115.35 ± 15.38; p < 0.05; 1619.16 ± 988.56 versus 1186.26 ± 756.34; p < 0.05; 11.49 ± 3.20 versus 9.66 ± 3.86; p = 0.04). Both procedures were performed with a low number of complications, no pericardial effusion was seen in either group.ConclusionsPVI using ablation index in combination with a stringent lesion contiguity improves clinical outcome after first-time PVI with lower PVI recovery, shorter procedure times, lower total energy and shorter fluoroscopy times and therefore, is more efficient.     

脆弱拟杆菌BF839治疗寻常型银屑病：一项单臂、开放初步临床试验

银屑病被认为是一种T细胞主导的炎症性疾病,其发病与肠道菌群失调密切相关。脆弱拟杆菌 (Bacteroides fragilis,BF) 可通过调节T细胞的细胞因子表达起抗炎作用。目前尚无脆弱拟杆菌用于治疗银屑病的相关报道,文中率先探究脆弱拟杆菌BF839对银屑病的治疗效果。选择2019年4月至2019年10月广州医科大学附属第二医院就诊的27例银屑病患者,维持原治疗不变,口服脆弱拟杆菌BF839 12周,对比治疗前后银屑病皮损面积与严重程度指数 (Psoriasis area and severity index,PASI) 评分,统计治疗12周后药物减停率。结果表明,12周试验完成率为96.3% (26/27),12周PASI30 (PASIN定义为治疗后PASI评分下降≥N%的患者比例) 为65.4%,PASI50为42.3%,PASI75为19.2%;治疗前PASI评分为9.1±5.9,治疗12周后PASI评分为5.8±4.9,具有显著统计学差异 (P<0.01);治疗12周后皮肤瘙痒程度用视觉模拟量表 (Visual analog scale,VAS) 评分有效率为42.3%,治疗前VAS评分为2.9±2.2,治疗12周后VAS评分为2.3±2.1,无显著统计学差异 (P>0.05)。患者治疗12周内不良反应率为3.8% (1/26),其中便秘1例,药物减停率为60.0%。以上结果提示脆弱拟杆菌BF839可能对银屑病治疗有一定疗效,可降低PASI评分及药物使用率,不良反应少,值得进一步研究。     

Plant–plant facilitation increases with reduced phylogenetic relatedness along an elevation gradient

Environmental conditions can modify the intensity and sign of ecological interactions. The stress gradient hypothesis (SGH) predicts that facilitation becomes more important than competition under stressful conditions. To properly test this hypothesis, it is necessary to account for all (not a subset of) interactions occurring in the communities and consider that species do not interact at random but following a specific pattern. We aim to assess elevational changes in facilitation, in terms of species richness, frequency and intensity of the interaction as a function of the evolutionary relatedness between nurses and their associated species. We sampled nurse and their facilitated plant species in two 1000–2000 m. elevation gradients in Mediterranean Chile where low temperature imposes a mortality filter on seedlings. We first estimated the relative importance of facilitation as a mechanism adding new species to communities distributed along these gradients. We then tested whether the frequency and intensity of facilitation increases with elevation, taking into account the evolutionary relatedness of the nurse species and the facilitated species. We found that nurses increase the species richness of the community by up to 35%. Facilitative interactions are more frequent than competitive interactions (56% versus 44%) and facilitation intensity increased with elevation for interactions involving distantly related lineages. Our results highlight the importance of including an evolutionary dimension in the study of facilitation to have a clearer picture of the mechanisms enabling species to coexist and survive under stressful conditions. This knowledge is especially relevant to conserve vulnerable and threatened communities facing new climate scenarios, such as those located in Mediterranean-type ecosystems.     

四川盆地北部山区中华蜜蜂活动气象指数构建及应用

基于四川盆地北部山区(简称四川盆北山区)2个地面气象观测站的气象资料和1个中华蜜蜂核心保护区的产量资料以及中华蜜蜂的生态特征和活动规律,分析了区内中华蜜蜂的气候生态适宜性;并以气温、水分、光照、风力和天气状况为影响指标,参考生活气象指数,构建四川盆北山区中华蜜蜂活动气象指数和年景评价分级计算方法。结果表明: 影响研究区中华蜜蜂活动的主要气象因子有气温、空气相对湿度、日照时数、风力和白天降水累计时长,其中,气温和白天降水累计时长是影响中华蜜蜂活动的主要限制性气象因子。通过这5个指标因子的不同取值组合,构建中华蜜蜂活动气象指数并进行分级评价:当指数＞12时,天气条件好,适宜中华蜜蜂活动;当指数为7～12时,天气条件一般,较适宜中华蜜蜂活动;当指数为1～7时,天气条件较差,中华蜜蜂活动明显减少;当指数≤1时,天气条件差,不适宜中华蜜蜂活动或处于越冬期。运用该指数对中山蜂场进行气候评价,多年(4—10月)平均综合气象指数为129.3(评分60.4),总体气象条件良好,“土蜂蜜”单产与年度综合气象指数显著相关,气象年景评价准确率90%。     

中老铁路经济廊带生态质量及其与人类活动的关系

区域生态质量很大程度上受人类活动强度影响,制约着区域经济可持续发展。以中老铁路经济廊带为对象,重点研究区内人类活动强度对区域生态环境的影响。选取1999、2009、2019年遥感影像计算遥感生态指数(RSEI),采用空间自相关及局域G统计量探测研究区生态质量的时空演变规律,并结合同期人口密度构建地理加权回归模型,定量分析区内人类活动强度引起的生态效应。研究表明: 1999—2019年,区内生态质量经历了先升后降的变化,RSEI均值由1999年的0.645升为2009年的0.738,随后又降为2019年的0.721,中部地区生态质量波动较大;基于地理加权回归模型(GWR)拟合人口密度与生态质量的效果明显好于最小二乘法,基于GWR的不同时期R²均高于0.7且拟合效果稳定,2019年拟合度最好(R²为0.785),1999、2009年R²分别为0.726、0.754;中老铁路沿线南部万象一带的生态质量对人类活动较敏感,以中度敏感区为主。对高、中、低度敏感区而言,人口密度每增长10、100、1000倍将相应导致RSEI均值降低0.2、0.4、0.6。经济廊带发展会导致人口密度增加,在规划布局过程中应控制人类活动,防止潜在敏感区及现有敏感区生态质量进一步恶化。     

1989—2019年西北地区干燥度指数时空变化及其对气候因子的响应

基于西北地区143个气象站点的气象数据,采用FAO-56 Penman-Monteith公式计算潜在蒸发量,并结合降水量计算西北地区1989—2019年干燥度指数(AI),采用Mann-Kendall趋势分析、小波分析、偏微分方程等方法来揭示其变化趋势、变化周期和气候因子对AI的贡献率。结果表明: 1989—2019年,西北地区AI整体呈不显著的减小趋势,其中,青海呈显著减小趋势,新疆呈不显著的上升趋势;研究区AI在2010年发生了突变,AI变化存在1个17年的主周期。西北地区AI呈现出由东南部向中部、西北部向中部增加的空间格局。西北地区AI变化的倾向率为-1.267·(10 a)^-1,其中,甘肃、宁夏、陕西、青海和新疆AI变化的倾向率分别为-1.17、-0.41、-0.49、-1.77和-2.73·(10 a)^-1。青海小灶火、新疆库尔勒、阿克苏和吐鲁番地区干旱风险发生的可能性较高。降水量和实际水汽压是影响甘肃、宁夏、青海、陕西AI变化的主要气侯因子,影响新疆AI变化的主要气侯因子为潜在蒸散、太阳辐射和平均气温。     

河西走廊不同产地‘赤霞珠’酿酒葡萄果实品质评价

为了确定河西走廊地区‘赤霞珠’酿酒葡萄核心品质指标,建立‘赤霞珠’酿酒葡萄品质综合评价模型。从张掖、武威、嘉峪关3个酿酒葡萄主产市的代表性果园采集6份‘赤霞珠’葡萄样品进行品质测定,通过主成分分析和聚类分析法确定‘赤霞珠’葡萄核心品质指标,运用层次分析法确定指标权重并建立‘赤霞珠’葡萄品质综合评价模型。结果表明:(1)不同产地‘赤霞珠’酿酒葡萄品质指标存在明显差异性,张掖市国风葡萄酒庄园的‘赤霞珠’葡萄果糖、蔗糖、草酸、柠檬酸含量均高于其他地区,且可溶性固形物、可溶性糖、总酚、苹果酸含量在各产地中也均保持在最高水平。(2)相关性分析发现,葡萄果实葡萄糖含量与可溶性固形物含量、果糖与可溶性糖含量之间呈极显著正相关,固酸比和糖酸比均与可滴定酸含量呈极显著负相关关系。(3)综合主成分分析、聚类分析和相关性分析结果,确定维生素C(Vc)、单宁、果糖和固酸比是‘赤霞珠’葡萄核心品质指标,应用层次分析法建立了‘赤霞珠’葡萄品质综合评价模型为Y=0.0960×Vc含量+0.1611×单宁含量+0.2771×果糖含量+0.4568×固酸比(各指标含量均经过标准化处理)。研究发现,河西走廊地区‘赤霞珠’葡萄果实品质最佳产地是张掖市,果实Vc、单宁、果糖和固酸比是‘赤霞珠’葡萄的核心品质指标,以其建立的评价模型可用于‘赤霞珠’葡萄品质的综合评价。     

陕西长武玉米降水指数保险设计

天气指数保险能有效规避传统农业保险的弊端。本研究基于陕西长武长序列产量数据和气象数据,采用统计分析的方法进行种植面积、产量、单产、趋势产量、相对气象产量以及玉米生育期需供水的分析;采用基于损失的风险评估方法评价种植风险;采用基于Logistic模型的费率厘定方法进行纯费率厘定;根据降水指数和减产率的相关性,设计降水指数;采用投影寻踪的方法设计降水指数赔付方案。结果表明:长武玉米种植面积、产量、单产、趋势产量以及相对气象产量都呈现出增加趋势;生育期平均需水650 mm,降水434mm,亏缺216 mm;从4月下旬到8月下旬,玉米呈现出水分亏缺的状态,7月中旬抽雄期水分亏缺最多,为33.65 mm;9月出现微弱的水分盈余;1994、1995和1997年为减产年,减产率分别为14%、20%和44%,相应降水距平分别为-42.44%、-47.72%和-29.71%;玉米种植轻、中、重和巨灾的发生概率分别是7.49%、3.40%、1.43%和1%;玉米降水指数保险纯费率为2.92%;生育期内旬降水(阈值为40 mm)累积值指定为玉米降水指数,并以降水指数为变量进行分段赔付。本研究剖析了长武玉米种植状况和干旱灾害,并设计了玉米的降水指数保险产品,为长武玉米农业保险提供了新的选择,对解决农业保险目前的困境具有重要的意义。