经皮椎间孔镜与Quadrant微创通道下治疗腰椎间盘突出症的临床研究

目的比较经皮椎间孔镜(PTED)和Quadrant微创通道下手术治疗腰椎间盘突出症(LDH)的临床疗效。方法将59例单节段LDH患者,随机分为PTED组和Quadrant组。其中,PTED组31例,Quadrant组28例。对两组手术时间、切口长度、失血量、住院天数、返回工作时间及手术并发症进行对比分析。采用视觉疼痛模拟评分(VAS)、日本骨科学会下腰痛评分标准(JOA)、Oswestry功能障碍指数(ODI)及改良Mac Nab标准评价手术疗效。结果 PTED组与Quadrant组相比手术切口小、术中出血量少、住院天数及返回工作时间上明显缩短(P<0.05),术后两组患者的VAS、JOA和ODI评分得到改善(P<0.05);而且术后3天、1和3个月,PTED组VAS腰痛评分低于相应时间Quadrant组评分(P<0.05);两组在术后各随访时间点的JOA和ODI评分无明显差异(P>0.05)。按照改良Mac Nab标准评定,两组间优良率差异无统计学意义(P>0.05)。结论 PTED和Quadrant通道两种微创术式治疗LDH均能取得满意的临床效果,但PTED手术恢复快、创伤更小。

Repeated measurement of growth-differentiation factor-15in Chinese Han patients with post-myocardial infarction chronic heart failure

Background Growth-differentiation factor-15(GDF-15)is a promising prognostic biomarker in patients with chronic heart failure (CHF).Comparatively little is known about the value of repeated measurement of GDF-15with CI-IF in Chinese Han population.This study sought to identify the clinical value of repeated measurement of GDF-15in Chinese Han patients with post-myocardial infarction CHF. Methods In total,232consecutive Chinese Hart patients with post-myocardial infarction CHF were enrolled prospectively from January 2014to June 2016.The plasma concentration of GDF-15was determined on admission and over 12months.Patients were followed up for all-cause death and a composite outcome of major adverse cardiac events (MACE)included all-cause death,myocardial infarction and first heart failure (HF)re-hospitalization.Association with other clinical variables and adverse outcomes of repeated measurement of GDF-15 was explored.Results The median baseline GDF-15level was 2025ng/L.Baseline GDF-15was moderately associated with baseline N-terminal pro-B type nalriuretic peptide (NT-proBNP)(coefficient 0.561,P <0.001).During a median follow-up of 20months,there were 53deaths and 100MACE.GDF-I5remained an independent predictor of all-cause death (adjusted hazard ratio 1.826per 1Ln U,95%CI: 1.037-8.360;P =0.037)and MACE (adjusted hazard ratio 2.243per I Ln U,95%CI:1.181-1.775;P <0.001)adjusted for established risk factors.Repeated measurement of GDF-15was performed in 173survivals over 12months.Increase of GDF-15over 12months was associ- ated with dilatation of left ventricle and acted as an independent predictor of subsequent all-canse death (adjusted HR =3.164,95%CI: 1.245~.041;P =0.015).In the joint model,GDF-15was also shown to be a risk factor for all-cause death (HR =2.749,95%CI: 1.667-3.831;P <0.001)and MACE (FIR =2.434,95%CI:1.425-3.443;P <0.001).Conclusions Repeated measurements of GDF-15 have promising prognostic value of the risk of all-cause death in Chinese Han patients with CI-IF post-myocardial infarction.GDF-15may influence the post-myocardial infarction CI-IF through the path physiological pathway of myocardial remodeling.

Neutrophil-to-lymphocyte ratio compared to N-terminal pro-brain natriuretic peptide as a prognostic marker of adverse events in elderly patients with chronic heart failure

Background The neutrophil-to-lymphocyte （N/L） ratio has been associated with poor prognosis in patients with heart failure, but it has not been compared with N-terminal pro-brain natriuretic peptide （NT-proBNP） in elderly patients with chronic heart failure （CHF）. We sought to make this comparison. Methods A total of 1355 elderly patients with CHF were analyzed. A multivariate logistic regression model was used to analyze the variables associated with atrial fibrillation （AF）. Cox regression analysis was used to assess the multivariable rela- tionship between the N/L ratio, NT-proBNP level, and subsequent major cardiovascular events （MCE）. Results In the multiple logistic regression analysis, the N/L ratio was demonstrated as a risk factor for AF in elderly patients with CHF [odds ratio （OR）： 1.079, 95% confi- dence interval （CI）： 1.027-1.134, P = 0.003]. The median follow-up period was 18 months. In a multivariable model using tertiles of both variables, the highest tertile of the N/L ratio was significantly associated with MCE [hazard ratio （HR）： 1.407, 95% CI： 1.098-1.802, P = 0.007] compared with the lowest tertile. Similarly, the highest NT-proBNP tertile was also significantly associated with MCE （HR： 1.461, 95% CI： 1.104-1.934, P- 0.008）. Conclusions In elderly patients with CHF, the N/L ratio is one of the important risk factors for AF and it is an inexpensive and readily available marker with similar independent prognostic power to NT-proBNP. The risk of MCE increases 1.407-fold when the N/L ratio is elevated to the highest tertile.

Assessing inflammation in Chinese subjects with subtypes of heart failure: an observational study of the Chinese PLA Hospital Heart Failure Registry

Background Inflammation is an important element of the pathophysiological process of heart failure (HF) and is correlated with subtypes of HF. The association between multiple biomarkers of inflammation and HF subtypes in Chinese subjects remains unclear. This study aimed to compare the differences in inflammation biomarkers among Chinese patients with different subtypes of HF who have been identified to date. Methods We included 413 consecutive patients with HF,including 262 with preserved ejection fraction (HFpEF),55 with middle-ranged ejection fraction (HFmrEF) and 96 with reduced ejection fraction (HFrEF). Ten inflammation biomarkers were analyzed and compared according to the HF subtypes. One hundred contemporary non-HF subjects were also recruited as the control group. Moreover,the correlations between the inflammatory biomarkers and left ventricular ejection fraction of the HF subtypes were assessed. Results The mean age of the HF patients was 65.0 ± 12.0 years,65.8% were male. Distinct subtypes of HF demonstrated different inflammation biomarker panels. IL-6,PTX-3,ANGPTL-4 and TNF-α were correlated with HFrEF;IL-1β and PTX-3 were correlated with HFmrEF;and IL-1β and IL-6 were correlated with HFpEF. The multivariable logistic regression showed that IL-1β[relative ratio (RR)= 1.08,95% CI: 1.02–1.15,P = 0.010],IL-6 (RR = 1.03,95% CI: 1.01–1.06,P = 0.016),PTX-3 (RR = 1.31,95% CI: 1.11–1.55,P = 0.001),and ANGPTL-4 (RR = 1.05,95% CI: 1.02–1.07,P < 0.001) were independently associated with HF,while IL-6 (RR = 1.03,95% CI: 1.01–1.04,P = 0.019),PTX-3 (RR = 1.23,95% CI: 1.06–1.43,P = 0.007),and ANGPTL-4 (RR = 1.03,95% CI: 1.01–1.06,P = 0.005) were independently associated with the HF subtype. Conclusions Diverse inflammation biomarkers have multifaceted presentations according to the subtype of HF,which may illustrate the diverse mechanisms of inflammation in Chinese HF patients. IL-6,PTX-3,and ANGPTL-4 were independent inflammation factors associated with HFrEF and HF.

Salubrinal protects against tunicamycin and hypoxia induced cardiomyocyte apoptosis via the PERK-eIF2a signaling pathway

Objectives This study examined the protective effect of salubrinal and the mechanism underlying this protection against tunicamycin （TM）- and hypoxia-induced apoptosis in rat cardiomyocytes. Methods Neonatal rat cardiomyocytes were cultured from the ventricles of l-day-old Wistar rats. Cells were exposed to different concentrations of salubrinal （10, 20, and 40 gmol/L） for 30 min followed by TM treatment or hypoxia for 36 h. Apoptosis was measured by a multiparameter HCS （high content screening） apoptosis assay, TUNEL assay and flow cytometry. The phosphorylation of eukaryotic translation initiation factor 2 subunit alpha （eIF2c0 and the expression of cleaved caspase-12 were determined by Western blotting. C/EBP homologous protein （CHOP） was detected by immunocytochemistry. Results HCS, TUNEL assays and flow cytometry showed that salubrinal protected cardiomyocytes against apoptosis induced by TM or hypoxia. Western blotting showed that salubrinal protected cardiomyocytes against apoptosis by inducing eIF2ct phosphorylation and down-regulating the expression of the endoplasmic reticulum stress-mediated apoptotic proteins, CHOP and cleaved caspase-12. Conclusions Our study suggests that salubrinal protects rat cardiomyocytes against TM- or hypoxia-associated apoptosis via a mechanism involving the inhibition of ER stress-mediated apoptosis.

Hydrogeochemical characteristics and evolution of the aquifer systems of Gonghe Basin,Northern China

We present the first systematic hydrogeological analysis to grain insights on the evolution of the Gonghe Basin in North China. Two hundred and forty seven water samples were collected from the Gonghe East Basin, Gonghe West Basin and Chaka Basin. The three groundwater systems of Gonghe Basin from west to east display different geochemical signatures. Based on Na/Cl ratios and Langelier-Ludwig diagram, it is inferred that the groundwater recharge potential of the Gonghe East Basin is much prosperous than the other areas. The renewability of the aquifers in alluvial-proluvial fan of Wahonghe and Gonghe East Basin margin is much faster than in the other basins. The groundwater quality in Chaka Salt Lake,Shazhuyu and Qiabuqia River Valley plains is low due to strong evaporation and cation exchange. The groundwater quality of the phreatic aquifers in the Qiabuqia River Valley plain is further deteriorated by mixing of high-arsenic and high-mineralization water from the deep fault structures.

A multiple-tissue-specific magnetic resonance imaging model for diagnosing Parkinson’s disease: a brain radiomics study

Brain radiomics can reflect the characteristics of brain pathophysiology.However,the value of T1-weighted images,quantitative susceptibility mapping,and R2*mapping in the diagnosis of Parkinson’s disease(PD)was underestimated in previous studies.In this prospective study to establish a model for PD diagnosis based on brain imaging information,we collected high-resolution T1-weighted images,R2*mapping,and quantitative susceptibility imaging data from 171 patients with PD and 179 healthy controls recruited from August 2014 to August 2019.According to the inclusion time,123 PD patients and 121 healthy controls were assigned to train the diagnostic model,while the remaining 106 subjects were assigned to the external validation dataset.We extracted 1408 radiomics features,and then used data-driven feature selection to identify informative features that were significant for discriminating patients with PD from normal controls on the training dataset.The informative features so identified were then used to construct a diagnostic model for PD.The constructed model contained 36 informative radiomics features,mainly representing abnormal subcortical iron distribution(especially in the substantia nigra),structural disorganization(e.g.,in the inferior temporal,paracentral,precuneus,insula,and precentral gyri),and texture misalignment in the subcortical nuclei(e.g.,caudate,globus pallidus,and thalamus).The predictive accuracy of the established model was 81.1±8.0%in the training dataset.On the external validation dataset,the established model showed predictive accuracy of 78.5±2.1%.In the tests of identifying early and drug-naïve PD patients from healthy controls,the accuracies of the model constructed on the same 36 informative features were 80.3±7.1%and 79.1±6.5%,respectively,while the accuracies were 80.4±6.3%and 82.9±5.8%for diagnosing middle-to-late PD and those receiving drug management,respectively.The accuracies for predicting tremor-dominant and non-tremor-dominant PD were 79.8±6.9%and 79.1±6.5%,respectively.In conclusion,the multiple-tissue-specific brain radiomics model constructed from magnetic resonance imaging has the ability to discriminate PD and exhibits the advantages for improving PD diagnosis.

Analysis on the situation and countermeasures of water resources supply and demand in the cities of small and medium-sized river basins along southeast coast of China-taking Xiamen City as an example

The small and medium-sized river basins along southeast coast of China hold comparatively abundant water resources.However,the rapid resources urbanization in recent years has produced a series of water problems such as deterioration of river water quality,water shortage and exacerbated floods,which have constrained urban economic development.By applying the principle of triple supply-demand equilibrium,this paper focuses on the estimation of levels of water supply and demand in 2030 at different guarantee probabilities,with a case study of Xiamen city.The results show that water shortage and inefficient utilization are main problems in the city,as the future water supply looks daunting,and a water shortage may hit nearly 2×10^(8)m^(3)in an extraordinarily dry year.Based on current water supply-demand gap and its trend,this paper proposes countermeasures and suggestions for developing and utilizing groundwater resources and improving the utilization rate of water resources,which can supply as a reference for other southeast middle-to-small-sized basin cities in terms of sustainable water resources and water environment protection.

Genetic model and exploration target area of geothermal resources in Hongtang Area, Xiamen, China

The geothermal resources in Fujian Province are mainly hydrothermal resources of medium-low temperature.To better understand the whole process and conditions of heat control in the middle and deep crust,this study focuses on the analysis of heat accumulation model in Hongtang Area of Xiamen,and the main conditions of the model such as faults and sags are explored and interpreted in detail by using gravity and wide-field electromagnetic methods.4 main faults(F33,F2,F12 and HT-F1)and 10 secondary faults(HT-F2,HT-F3,HT-F4,HT-F5,HT-F6,HT-F7,HT-F8,HT-F9,HT-F10 and HT-F11)were inferred,and the distribution range of sags was delineated.The convective geothermal system is composed of four components:Heat source,geothermal reservoir,heat-conductive fault and heat retaining cover,which form a quaternary heat accumulation model.According to the model,the intersection of the main faults F12,HTF1 and F33 can be delineated as the primary target area of geothermal exploration,while the intersection of the secondary faults(F12 and HT-F6;F12 and HT-F2;HT-F9,HT-F10 and F12;F12 and HT-F11;F33 and HT-F3;HT-F8 and HT-F3;HT-F2,HT-F10 and HT-F1)can be delineated as the secondary target area.Borehole DR01,which is located in the primary target area,shows that the water temperature increases from fast to slow in the depth range of 0–500 m,and stays at 36℃below 500 m.The reliability of the heat accumulation model and the target area was tested via geothermal boreholes,which is of great significance to the exploitation and utilization of geothermal resources in Hongtang Area of Xiamen.

Influence of Al_(2)0_(3) content on mechanical properties of silica-based ceramic cores prepared by stereolithography

Silica ceramic cores have played an important part in the manufacture of hollow blades due to their excellent chemical stability and moderate high-temperature mechanical properties.In this study,silica-based ceramics were prepared with Al_(2)0_(3) addition by stereolithography,and the influence of Al_(2)0_(3) content on mechanical properties of the silica-based ceramics was investigated.The Al_(2)0_(3) in silica-based ceramics can improve the mechanical properties by playing a role as a seed for the crystallization of fused silica into cristobalite.As a result,with the increase of Al_(2)0_(3) content,the linear shrinkage of the silica-based ceramics first decreased and then increased,while the room-temperature flexural strength and the high-temperature flexural strength first increased and then decreased.As the Al_(2)0_(3) content increased to 1.0 vol%,the linear shrinkage was reduced to 1.64%because of the blocked viscous flow caused by Al_(2)0_(3).Meanwhile,the room-temperature flexural strength and the high-temperature flexural strength were improved to 20.38 and 21.43 MPa with 1.0 vol%Al_(2)0_(3),respectively,due to the increased a-cristobalite and P-cristobalite content.Therefore,using the optimal content of Al_(2)0_(3) in silica-based ceramics can provide excellent mechanical properties,which are suitable for the application of ceramic cores in the manufacturing of hollow blades.

Synthesis of a trimeric lignin model compound composed of a-O-4 and b-O-4 linkages under microwave irradiation

A trimeric lignin model compound composed of α-O-4 and β-O-4 linkages was prepared by the microwave-assisted synthesis, which consisted of three steps： （a） the synthesis of 3-methoxy-4- benzyloxyacetophenone （2） from acetovanillone （1）, （b） the bromination of compound 2 to produce 3- methoxy-4-benzyloxy-α-bromoacetophenone （3）, and （c） followed by a nucleophilic substitution of compound （3） to obtain 3-methoxy-4-benzyloxy-α-（3-methoxy-4-（1-propenyl）phenol）-acetophenone （4）. The target product was characterized by MS, 1H NMR and 13C NMR spectroscopy. It was found that the trimeric compound synthesized can be used as a preferable lignin model compound because it contains guaiacyl structural unit （3-methoxy-4-hydroxy phenyl propane） linked by α-O-4 and β-O-4 linkages. In addition, under the conditions of microwave irradiation, the reaction time of each step is significantly reduced, and the selectivity of target product is greatly improved. The yields of each step and the overall sequence are 95.31%. 87.3%. 90.6% and 75.4% （95.31%× 87.3% × 90.6%）. respectively.