Exploration of the coupled lattice Boltzmann model based on a multiphase field model:A study of the solid-liquid-gas interaction mechanism in the solidification process

A multiphase field model coupled with a lattice Boltzmann(PF-LBM)model is proposed to simulate the distribution mechanism of bubbles and solutes at the solid-liquid interface,the interaction between dendrites and bubbles,and the effects of different temperatures,anisotropic strengths and tilting angles on the solidified organization of the SCN-0.24wt.%butanedinitrile alloy during the solidification process.The model adopts a multiphase field model to simulate the growth of dendrites,calculates the growth motions of dendrites based on the interfacial solute equilibrium;and adopts a lattice Boltzmann model(LBM)based on the Shan-Chen multiphase flow to simulate the growth and motions of bubbles in the liquid phase,which includes the interaction between solid-liquid-gas phases.The simulation results show that during the directional growth of columnar dendrites,bubbles first precipitate out slowly at the very bottom of the dendrites,and then rise up due to the different solid-liquid densities and pressure differences.The bubbles will interact with the dendrite in the process of flow migration,such as extrusion,overflow,fusion and disappearance.In the case of wide gaps in the dendrite channels,bubbles will fuse to form larger irregular bubbles,and in the case of dense channels,bubbles will deform due to the extrusion of dendrites.In the simulated region,as the dendrites converge and diverge,the bubbles precipitate out of the dendrites by compression and diffusion,which also causes physical phenomena such as fusion and spillage of the bubbles.These results reveal the physical mechanisms of bubble nucleation,growth and kinematic evolution during solidification and interaction with dendrite growth.

动态增强磁共振成像技术在子宫颈癌临床分期中的应用

目的探讨动态增强磁共振成像(dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)技术在子宫颈癌临床分期中的应用价值。方法对2019年1月至2021年12月在郑州大学第二附属医院行手术治疗的186例子宫颈癌患者进行回顾性分析。所有患者术前均行DCE-MRI技术以协助评估临床分期、宫颈肌层浸润、子宫体浸润、阴道累及、宫旁转移、淋巴结转移等相关参数,以术后病理为金标准进行验证,分析DCE-MRI技术术前评估子宫颈癌分期的准确度、灵敏度及特异度。结果186例子宫颈癌患者临床分期与手术病理分期一致性较好(Kappa=0.862,P<0.001),165例(88.71%)临床分期与手术病理分期一致。DCE-MRI诊断阴道累及的准确度为96.24%、灵敏度为86.96%、特异度为97.55%;诊断淋巴结转移的准确度为97.31%、灵敏度为82.35%、特异度为98.82%;诊断深肌层浸润的准确度为86.56%、灵敏度为90.79%、特异度为83.63%。结论DCE-MRI技术在诊断阴道累及、淋巴结转移、深肌层浸润等方面具有较高的灵敏度与特异度,可为子宫颈癌术前临床分期评估提供参考。

用于环境抗菌的氧稳定W-Ag薄膜

在溅射沉积的钨薄膜中加入氧以降低薄膜的残余应力,进一步添加含量高达14.3%(摩尔分数)的银以进行抗菌功能化。采用SEM-EDX、XPS和XRD分析薄膜。薄膜仅检测到β-W或W_(3)O相的X射线衍射峰。氧和银主要以固溶原子的形式存在于薄膜中。银的加入降低了薄膜的硬度(仍然≥10.3 GPa)和弹性模量。动电位极化实验表明WO膜的腐蚀电流密度低于钨膜,而银改变了膜层的腐蚀行为。薄膜表面的贫银氧化钨层抑制了银离子在水中的释放,WOAg膜对大肠杆菌具有良好的抗菌活性。WOAg薄膜将在环境和其他抗菌应用中发挥作用。

高温反应合成莫来石实现钒渣氯化残渣的无毒高效利用

采用氯化法从钒渣中提取有价元素(Ti、Cr、Fe、Mn和V)后得到的浸出渣主要成分为Al_(2)O_(3)和SiO_(2),还含有少量有害元素Cr和V。为了减少Cr和V对环境的污染,提出一种浸出渣无毒和有效利用的新方法。以浸出渣为原料,加入适量SiO_(2),在1600℃下固相烧结5 h,合成抗压强度为133.345 MPa、密度为3.20 g/cm^(3)的纯莫来石。浸出渣中的微量元素Ti和有害元素V和Cr在高温反应过程中进入莫来石晶格形成固溶体,稳定在莫来石相中。合成的样品采用毒性特性浸出程序(TCLP)和GB5085.3—2007进行检测。结果表明,莫来石符合毒性浸出标准,是一种安全无毒产品。

Analysis of Significant Genes and Pathways in Esophageal Cancer Based on Gene Expression Omnibus Database

Objective To screen antigen targets for immunotherapy by analyzing over-expressed genes,and to identify significant pathways and molecular mechanisms in esophageal cancer by using bioinformatic methods such as enrichment analysis,protein-protein interaction(PPI)network,and survival analysis based on the Gene Expression Omnibus(GEO)database.Methods By screening with highly expressed genes,we mainly analyzed proteins MUC13 and EPCAM with transmembrane domain and antigen epitope from TMHMM and IEDB websites.Significant genes and pathways associated with the pathogenesis of esophageal cancer were identified using enrichment analysis,PPI network,and survival analysis.Several software and platforms including Prism 8,R language,Cytoscape,DAVID,STRING,and GEPIA platform were used in the search and/or figure creation.Results Genes MUC13 and EPCAM were over-expressed with several antigen epitopes in esophageal squamous cell carcinoma(ESCC)tissue.Enrichment analysis revealed that the process of keratinization was focused and a series of genes were related with the development of esophageal cancer.Four genes including ALDH3A1,C2,SLC6A1,and ZBTB7C were screened with significant P value of survival curve.Conclusions Genes MUC13 and EPCAM may be promising antigen targets or biomarkers for esophageal cancer.Keratinization may greatly impact the pathogenesis of esophageal cancer.Genes ALDH3A1,C2,SLC6A1,and ZBTB7C may play important roles in the development of esophageal cancer.

Strain compensated type Ⅱ superlattices grown by molecular beam epitaxy

We investigate a strain compensation method for the growth of complex interband cascade laser structures. For thick In As/Al Sb superlattice clad layers, the sublayer thicknesses were adjusted so that the tensile strain energy in the In As sublayer was equal to the compressive strain energy in the Al Sb sublayer. For the four-constituent active region, as the compressive strain in the Ga0.65In0.35Sb alloy layer was large, a tensile strain was incorporated in the chirped In As/Al Sb superlattice region for strain compensation to the Ga0.65In0.35Sb alloy. A laser structure of thickness 6 μm was grown on the Ga Sb substrate by molecular beam epitaxy. The wafer exhibited good surface morphology and high crystalline quality.

Unexplained hyperammonemia and encephalopathy in the emergency department:Abernethy malformation in elderly patients

Congenital extrahepatic portosystemic shunt(CEPS),also known as Abernethy malformation,is a rare disorder characterized by the partial or complete diversion of portal blood into systemic veins.CEPS is classified into two types:typeⅠis an end-to-side portocaval shunt,whereas typeⅡis a side-to-side shunt,diverting blood from the portal vein to the inferior vena cava(IVC)(Figure 1).[1]

Flat Top Optical Frequency Combs Based on a Single-Core Quantum Cascade Laser at Wavelength of~8.7μm

We present optical frequency combs with a spectral emission of 48 cm-1and an output power of 420 m W based on a single-core quantum cascade laser at λ ~ 8.7μm. A flat top spectrum sustains up to 130 comb modes delivering ~ 3.2 m W of optical power per mode, making it a valuable tool for dual comb spectroscopy. The homogeneous gain medium, relying on a slightly diagonal bound-to-continuum structure, promises to provide a broad and stable gain for comb operating. Remarkably, the dispersion of this device is measured within 300 fs2/mm to ensure stable comb operation over 90% of the total current range. The comb is observed with a narrow beatnote linewidth around 2 k Hz and has weak dependence on the applied current for stable comb operation.

基于SEER数据库的影响早期胃癌风险因素分析

目的探索影响早期胃癌(early gastric cancer,EGC)生存的危险因素.方法选取SEER数据库经手术治疗诊断为T1期胃癌患者,采用COX比例风险模型、卡方检验(单因素分析)、Logistic回归对患者资料进行分析.结果COX比例风险模型分析显示年龄、种族、性别、肿瘤大小、病理类型、分化程度、淋巴结转移情况均为影响EGC患者预后的独立风险因素.在≤60岁EGC患者中,肿瘤大小不是影响预后的独立危险因素.在性别分组中,在种族因素中,男性中亚裔及其他总生存期要优于白人和黑人,但在女性中没有差异.男性中肿瘤大小、病理类型是影响预后的危险因素,但在女性中不是.而女性中,肿瘤分化程度是影响预后的独立风险因素,但在男性中不是.影响淋巴结转移的独立风险因素只有肿瘤大小、病理分型和分化程度.结论年龄和性别也是影响EGC患者预后的独立因素.在不同年龄段和不同性别中影响预后的风险因素也有所差异.因此,了解不同临床特征患者的危险因素对于EGC患者精准治疗提供一定的循证学证据支持.

全身亚低温联合人脐带血间充质干细胞移植改善新生大鼠缺氧缺血性脑损伤后认知障碍和能量衰竭的机制研究

目的探究全身亚低温联合人脐带血间充质干细胞(hCMNCs)移植改善新生大鼠缺氧缺血性脑损伤(HIBD)后认知障碍和能量衰竭的机制。方法7日龄新生SD乳鼠330只。随机分为11组,每组30只。空白对照组(A组)、HIBD常温组(B组)、HIBD亚低温持续72 h组(C组)、HIBD亚低温24 h干细胞移植组(D组)、HIBD亚低温48 h干细胞移植组(E组)、HIBD亚低温72 h移植组(F组)、HIBD亚低温24 h后持续3 d移植干细胞(G组)、HIBD 24 h干细胞移植组(H组)、HIBD 48 h干细胞移植组(I组)、HIBD 72 h干细胞移植组(J组)、HIBD 24 h、48 h、72 h干细胞移植组(K组)。乳鼠生长的第10天、第21天和第35天对其进行称重;通过Morris水迷宫实验检测乳鼠学习和记忆能力,超微电镜观察分析乳鼠脑组织神经元细胞及突触超微结构的变化,苏木精-伊红(HE)染色观察脑组织病理学变化,酶联免疫吸附试验检测乳鼠脑组织炎症因子和干细胞分化标记蛋白含量,免疫荧光染色检测脐带CD24和CD29阳性表达率,荧光显微镜测量线粒体膜电位。结果A、B、C、D、E、F、G、H、I、J、K组乳鼠生长第10天、第21天和第35天体重比较,采用重复测量设计的方差分析,结果:①不同时间点乳鼠体重有差异(F=13.285,P=0.000),各组乳鼠第21天与第35天体重比较,差异有统计学意义(P<0.05);②各组乳鼠体重有差异(F=20.097,P=0.000),B组乳鼠体重较A组降低(P<0.05),C~K组乳鼠体重较B组升高(P<0.05),G、I组乳鼠体重较B、C、D、E、F、H、J、K组均升高(P<0.05),且G组与I组乳鼠体重比较,差异无统计学意义(P>0.05);③各组乳鼠体重变化趋势有差异(F=28.712,P=0.000)。C~F组3种反射(悬崖调转反射、阴性趋地性、步态反射)时间较A组延长(P<0.05),但较B组缩短(P<0.05);C组3种反射时间较A、D~J组延长(P<0.05);G~K组3种反射时间与A组比较,差异无统计学意义(P>0.05);C~F组3种反射时间较G~K组延长(P<0.05)。HE染色结果显示,与A组比较,B~K组乳鼠HIBD模型复制成功后第3天,脑间质水肿,小血管间隙增宽,左侧大脑出现大片坏死,细胞溶解、破坏、消失;皮质海马神经元排列紊乱,核固缩、崩解,细胞浓染,并见小胶质细胞。第21天,B~K组与A组有差异,B~K组脑组织见不同程度的损伤,其中B组可见大的梗塞灶及液化空洞形成。C~K组表现为部分炎症细胞;B组与C~K组比较,脑损伤程度较大。其中G、J、K组脑损伤及炎症程度较C~F、H、I组小。B~K组逃避潜伏期较A组延长(P<0.05),G、J、K组逃避潜伏期较B~F、H组缩短(P<0.05)。B~K组神经元致密区长度较A组变短(P<0.05),厚度较A组变薄(P<0.05),而突触间隙宽度较A组变厚(P<0.05)。C~K组乳鼠神经元致密区长度较B组变长(P<0.05),厚度较B组变厚(P<0.05),突触间隙宽度较B组变薄(P<0.05)。G~J组乳鼠神经元致密区长度较D~F、K组变长(P<0.05),厚度较D~F、K组变厚(P<0.05),突触间隙宽度较D~F、K组变薄(P<0.05)。A、B、C、D、E、F、G、H、I、J、K组乳鼠HIBD模型复制成功后第3天、第8天、第12天的TNF-α、IL-6、Nestin、TUBB、MBP比较,采用重复测量设计的方差分析,结果:①不同时间点TNF-α、IL-6、Nestin、TUBB、MBP有差异(F=39.451、19.754、36.957、16.794和16.958,均P=0.000);②各组乳鼠TNF-α、IL-6、Nestin、TUBB、MBP有差异(F=10.719、10.159、43.271、5.947和11.217,P=0.000、0.000、0.000、0.012和0.000);B~K组TNF-α、IL-6在HIBD模型复制成功第3天、第8天和第12天较A组升高(P<0.05),C~K组TNF-α、IL-6较B组降低(P<0.05)。C~K组Nestin、TUBB和MBP较B组升高(P<0.05)。③各组乳鼠TNF-α、IL-6、Nestin、TUBB、MBP变化趋势有差异(F=22.678、25.483、6.597、20.159和20.154,P=0.000、0.000、0.003、0.000和0.000)。A~C组CD24和CD29阳性表达率较E~K组降低(P<0.05),G、I组较H、J、K组CD24和CD29阳性表达率升高(P<0.05)。B~K组线粒体膜电位较A组降低(P<0.05),C~K组线粒体膜电位较B组升高(P<0.05),G~J组线粒体膜电位较C~F组升高(P<0.05)。结论亚低温联合UCMSCs能改善HIBD乳鼠认知障碍和能量衰竭,对脑神经有保护作用。

原发性青光眼患者焦虑和抑郁及睡眠质量调查研究

目的:探讨原发性闭角型青光眼(PACG)和原发性开角型青光眼(POAG)患者焦虑、抑郁及睡眠状况。方法:回顾性临床研究。采用焦虑自评量表(SAS)、抑郁自评量表(SDS)、匹兹堡睡眠质量指数(PSQI)对2019-06/2020-12期间在我院眼科确诊的原发性青光眼患者60例(30例PACG,30例POAG)和将同期来自我院体检部的30名健康成年人设为对照组进行评估,比较三组受试者SAS、SDS、PSQI得分。结果:PACG组和POAG组SAS、SDS、PSQI得分(48.40±9.302,53.40±8.625,9.57±2.861;42.57±9.684,48.80±10.320,7.23±2.223分)均明显高于对照组(37.03±6.805,38.63±7.881,4.87±2.688分)(P<0.05)。PACG组SAS、PSQI得分较POAG组高(均P<0.05)。以SAS≥45分、SDS≥50分和PSQI>7分为临界,PACG组的焦虑、抑郁和失眠症状阳性率(77%、73%、70%)高于POAG组(43%、40%、37%)和对照组(13%、10%、20%)(P<0.05)。结论:PACG患者比POAG有更严重的焦虑、抑郁及失眠,应给予必要的心理干预。

吡非尼酮对内皮细胞间质转化的抑制作用及机制

目的:建立缺氧诱导内皮细胞的内皮-间质转化(EndoMT)模型,探讨吡非尼酮(PFD)在视网膜下纤维瘢痕形成过程中的抗纤维化作用及机制。方法:原代培养人脐静脉内皮细胞,鉴定后取4~7代用于实验。CoCl2诱导细胞缺氧建立纤维化模型。CCK-8法检测细胞增殖率,筛选药物浓度。将细胞分为对照组(无血清培养基培养)、CoCl2(200μmol/L)模型组、CoCl2+低浓度(0.3mg/mL)PFD组、CoCl2+高浓度(0.6mg/mL)PFD组。Western blot法检测细胞CD31、VE-cadherin、α-SMA、FSP1、p-p38和p38的蛋白表达水平。CD31/α-SMA免疫荧光双染法观察蛋白表达的变化。划痕实验观察细胞迁移能力的改变。q-PCR法检测TGF-β1、SNAI1 mRNA转录水平。结果:与CoCl2模型组相比,PFD能明显提高缺氧细胞的增殖率,抑制细胞的迁移能力(均P<0.05);PFD组细胞标志蛋白CD31、VE-cadherin表达增加,α-SMA、FSP1表达降低(均P<0.05)。免疫荧光检测显示PFD可明显抑制α-SMA和增加CD31的蛋白表达(P<0.05)。内皮细胞EndoMT过程中,p38总蛋白表达不变(P>0.05),但p-p38磷酸化蛋白表达增加、TGF-β1和SNAI mRNA转录水平增高的现象可明显被PFD抑制(均P<0.05)。高低浓度PFD组上述各现象无明显差异。结论:PFD可以抑制内皮细胞纤维化的发生,TGF-β/p38 MAPK通路可能是PFD调控EndoMT过程的机制之一,为视网膜下纤维化的治疗提供了新思路。

Understanding the Unique Characteristics of Suicide in China: National Psychological Autopsy Study

Objective To compare the characteristics of suicides in the four main demographic groups： urban males, urban females, rural males and rural females in order to help clarify the demographic pattern of suicides in China. Methods A detailed psychological autopsy survey instrument was independently administered to 895 suicide victims in family members and close associates from 23 geographically representative locations from around the country. Results Pesticide ingestion accounted for 58% （519） of all suicides and 61% （3181519） of deaths were due to unsuccessful medical resuscitation. A substantial proportion （37%） of suicide victims did not have a mental illness. Among the 563 victims with mental illness, only 13% （76/563） received psychiatric treatment. Compared to other demographic groups, young rural females who died from suicide had the highest rate of pesticide ingestion （79%）, the lowest prevalence of mental illness （39%）, and the highest acute stress from precipitating life events just prior to the suicide. Contusion Many suicides in China are impulsive acts of deliberate self-harm following acute interpersonal crises. Prevention of suicides in China must focus on improving awareness of psychological problems, improving mental health services, providing alternative social support networks for managing acute interpersonal conflicts, limiting access to pesticides, and improving the resuscitation skills of primary care providers.

Role of autophagy in acute myeloid leukemia therapy

Despite its dual role in determining cell fate in a wide array of solid cancer cell lines, autophagy has been robustly shown to suppress or kill acute myeloid leukemia cells via degradation of the oncogenic fusion protein that drives leukemogenesis. However, autophagy also induces the demise of acute leukemia cells that do not express the known fusion protein, though the molecular mechanism remains elusive. Nevertheless, since it can induce cooperation with apoptosis and differentiation in response to autophagic signals, autophagy can be manipulated for a better therapy on acute myeloid leukemia.

Values of endoscopic ultrasonography for diagnosis and treatment of duodenal protruding lesions

Objective： The diagnoses of patients with duodenal protruding lesions are difficult when using conventional examinations such as computed tomography （CT） and conventional endoscope etc. Thus, we investigated the clinical value of endoscopic ultrasonography （PUS） with miniature ultrasonic probes on the diagnosis and treatment of duodenal protruding lesions. Methods： Patients with duodenal protruding lesions who were indicated for PUS were examined by PUS with 12-15 MHz miniature ultrasonic probes and double-cavity electronic endoscope. According to diagnosis of PUS, those patients were indicated for biopsy and treatment received biopsy, endoscopic resection or surgical excision. The postoperative histological results were compared with the preoperative diagnosis of PUS. Those patients without endoscopic resection or surgical excision were periodically followed up with PUS. Results： A total of 169 patients with duodenal protruding lesions were examined by PUS, of which 40 were diagnosed with cysts, 36 with inflammatory protruding or polyp, 25 with Brunner＇s gland adenoma, 19 with ectopic pancreas, 17 with gastrointestinal stromal tumor, 12 with extrinsic compression, 12 with minor papilla, 6 with lipoma, 1 with adenocarcinoma and 1 with lymphoma. After PUS examinations, 75 patients received biopsy, endoscopic resection or surgical excision respectively. The postoperative histological results of 70 patients were completely consistent with the preoperative diagnosis of PUS, with 93.33% diagnostic accuracy. The results of follow-up with PUS indicated that duodenal cyst, Brunner＇s gland adenoma, ectopic pancreas, gastrointestinal stromal tumor and lipoma remained unchanged within 1-3 years. No related complications occurred among all patients that received PUS examinations. Conclusion： PUS is an effective and reliable diagnostic method for duodenal protruding lesions.

Sonographic features of duodenal lipomas in eight clinicopathologically diagnosed patients

AIM:To investigate the sonographic features and diagnostic value of endoscopic ultrasonography (EUS) for duodenal lipomas (DLs).METHODS:A total of eight consecutive patients with DL diagnosed pathologically were included in the study.One EUS expert reviewed the ultrasonic images for all lesions,including the original layer of the duodenal wall,the echo intensity and the echo homogeneity.The size of the lesions and the perifocal structures were also investigated.The diagnosis by EUS was compared with the histological results.RESULTS:Using routine endoscopy,only one case was correctly diagnosed as DL.Four cases were classified as submucosal tumors,and three cases were mistaken for stromal tumors.All tumors appeared as round or oval intensive hyperechoic lesions with distinct anterior borders that originated from the submucosal layer on EUS.Tumors ranged from 8 to 36 mm in size,with an average size of 16 mm.Homogeneous echogenicity was seen in all cases except one that had a tubular structure inside the tumor.Echo attenuation was observed only in the area behind the tumors in five cases,and it was observed both inside and behind the tumors in three cases in which the posterior border was obscure or invisible.Seven (87.5%) cases were correctly diagnosed as DL,and one (12.5%) was mistaken as Brunner's gland adenoma by EUS.Pathologically,all tumors originated from the submucosal layer and consisted of mature fat cells without heteromorphism.Among the fat cells,there was a small amount of thick-wall vessels infiltrating the lymphocytes,and abundant fibrous connective tissues.CONCLUSION:On EUS,DL is featured as an intensive homogeneous hyperechoic submucosal lesion with marked echo attenuation and without involvement of the mucosa.

Recovery and separation of Fe and Mn from simulated chlorinated vanadium slag by molten salt electrolysis

Tailings from the vanadium extraction process are discarded each year as waste,which contain approximately 30 wt%of Fe.In our previous work,we extracted Fe and Mn from vanadium slag,and Fe and Mn existed in the form of FeCl_(2) and MnCl_(2) after chlorination by NH_(4) Cl to achieve effective and green usage of waste containing Fe and Mn.In this work,square wave voltammetry(SWV)and cyclic voltammetry(CV)were applied to investigate the electrochemical behaviors of Fe^(2+)and Mn^(2+)in Na Cl-KCl melt at 800℃.The reduction processes of Fe^(2+)and Mn^(2+)were found to involve one step.The diffusion coefficients of FeCl_(2) and Mn Cl_(2) in molten salt of eutectic mixtures Na Cl-KCl molten salt were measured.The electrodeposition of Fe and Mn were performed using two electrodes at a constant cell voltage.The Mn/Fe mass ratio of the electrodeposited product in Na Cl-KCl-2.13 wt%FeCl_(2)-1.07 wt%Mn Cl_(2) was 0.0625 at 2.3 V.After the electrolysis of NaCl-KCl-2.13 wt%Fe Cl_(2)-1.07 wt%MnCl_(2) melted at 2.3 V,the electrolysis was again started under 3.0 V and the Mn/Fe mass ratio of the electrodeposited product was 36.4.This process provides a novel method to effectively separate Fe and Mn from simulated chlorinated vanadium slag.

社区获得性肺炎患者血清CTRP5水平及与炎症细胞因子的关系

目的探讨社区获得性肺炎(CAP)患者血清补体C1q/肿瘤坏死因子相关蛋白5(CTRP5)水平及与炎症细胞因子水平的关系。方法选取2014年1月-2017年12月诸暨市第三人民医院内科住院治疗的CAP患者80例作为CAP组,同期本院健康体检者80例作为对照组。CAP患者根据病情分为普通CAP组58例和重症CAP组22例。测定血清CTRP5水平和C反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)、肿瘤坏死因子-ɑ(TNF-ɑ)水平。结果CAP组患者治疗前血清CTRP5、CRP、PCT、IL-6、TNF-ɑ水平高于对照组(P<0.05)。重症CAP组血清CTRP5、CRP、PCT、IL-6、TNF-ɑ水平高于普通CAP组(P<0.05)。普通CAP组与重症CAP组患者治疗后血清CTRP5、CRP、PCT、IL-6、TNF-ɑ水平均低于治疗前(P<0.05)。CAP患者治疗前血清CTRP5水平与血清CRP、PCT、IL-6、TNF-ɑ水平均呈正相关(r=0.521、0.625、0.523和0.584,P<0.05)。结论CAP患者血清CTRP5水平升高,其水平高低可反映病情严重程度和炎症反映程度。

Real world effectiveness of PCSK-9 inhibitors combined with statins versus statins-based therapy among patients with very high risk of atherosclerotic cardiovascular disease in China(RWE-PCSK study)

BACKGROUND The efficacy and safety of proprotein convertase subtilisin/kexin type 9(PCSK-9) inhibitors were confirmed by several clinical trials, but its effectiveness in routine clinical practice in China has not been evaluated. This study aims to describe the real world effectiveness of PCSK-9 inhibitors combined with statins compared with statins-based therapy among patients with very high risk of atherosclerotic cardiovascular disease(ASCVD).METHODS This is a multi-center observational study, enrolled patients from 32 hospitals who underwent percutaneous coronary intervention(PCI) from January to June in 2019. There are 453 patients treated with PCSK-9 inhibitors combined with statins in PCSK-9 inhibitor group and 2,610 patients treated with statins-based lipid lowering therapies in statins-based group. The lipid control rate and incidence of major adverse cardiovascular events(MACE) over six months were compared between two groups.A propensity score-matched(PSM) analysis was used to balance two groups on confounding factors. Survival analysis using Kaplan-Meier methods was applied for MACE.RESULTS In a total of 3,063 patients, 89.91% of patients had received moderate or high-intensity statins-based therapy before PCI, but only 9.47% of patients had low-density lipoprotein cholesterol(LDL-C) levels below 1.4 mmol/L at baseline. In the PSM selected patients, LDL-C level was reduced by 42.57% in PCSK-9 inhibitor group and 30.81%(P < 0.001) in statins-based group after six months. The proportion of LDL-C ≤ 1.0 mmol/L increased from 5.29% to 29.26% in PCSK-9 inhibitor group and 0.23% to 6.11% in statins-based group, and the proportion of LDL-C ≤ 1.4 mmol/L increased from 10.36% to 47.69% in PCSK-9 inhibitor group and 2.99% to 18.43% in statins-based group(P < 0.001 for both). There was no significant difference between PCSK-9 inhibitor and statins-based treatment in reducing the risk of MACE(hazard ratio = 2.52, 95% CI: 0.49-12.97, P = 0.250).CONCLUSIONS In the real world, PCSK-9 inhibitors combined with statins could significantly reduce LDL-C levels among patients with very high risk of ASCVD in China. The long-term clinical benefits for patients received PCSK-9 inhibitor to reduce the risk of MACE is still unclear and requires further study.

Feasibility and Diagnostic Accuracy for Assessment of Coronary Artery Stenosis of Prospectively Electrocardiogram-gated High-pitch Spiral Acquisition Mode Dual-source CT Coronary Angiography in Patients with Relatively Higher Heart Rates: in Comparison wit

Objective To prospectively investigate the diagnostic accuracy for coronary artery stenosis of prospectively electrocardiogram-triggered spiral acquisition mode (high pitch mode) dual-source computed tomography coronary angiography (CTCA) in patients with relatively higher heart rates (HR) compared with catheter coronary angiography (CCA). Methods Forty-seven consecutive patients with relatively higher HR (>65 and <100 bpm) (20 male, 27 female; age 55±10 years) who both underwent dual-source CTCA and CCA were prospectively included in this study. All patients were performed CTCA using high pitch mode setting at 20%-30% of the R-R interval for the image acquisition. All coronary segments were evaluated by two blinded and independent observers with regard to image quality on a three-point scale (1: excellent to 3: non-diagnostic) and for the presence of significant coronary stenoses (defined as diameter narrowing exceeding 50%). Considered CCA as the standard of reference, the sensitivity, specificity, positive predictive value and negative predictive value were calculated. Radiation dose values were calculated using the dose-length product. Results Image quality was rated as being score 1 in 92.4% of segments, score 2 in 6.1% of segmentsand score 3 in 1.5% of segments. The average image quality score per segment was 1.064±0.306. The HR variability of patients with image score 1, 2 and 3 were 2.29±1.06 bpm, 5.17±1.37 bpm, 8.88±1.53 bpm, respectively. The average HR variability of patients with different image scores were significantly different (F=170.402, P=0.001). The sensitivity, specificity, positive and negative predictive values were 92.6%, 97.0%, 87.6%, 98.3%, respectively, per segment and 90.0%, 95.2%, 85.3%, 96.9%, respectively, per vessel and 100%, 63.6%, 90.0%, 100%, respectively, per patient. The effective radiation dose was on average 0.86±0.16 mSv. Conclusion In patients with HR more than 65 bpm and below 100 bpm without cardiac arrhythmia, the prospectively electrocardiogram-gated high-pitch spiral acquisition mode with image acquired timing set at 20%-30% of the R-R interval provides a high diagnostic accuracy for the assessment of coronary stenoses combined with a 1.5% of non-diagnostic coronary segments and a radiation dose below 1 mSv.