目的:鉴于脓毒症的高发病率和高病死率,早期识别高风险患者并及时干预至关重要,而现有死亡风险预测模型在操作、适用性和预测长期预后等方面均存在不足。本研究旨在探讨脓毒症患者死亡的危险因素,构建近期和远期死亡风险预测模型。方法...目的:鉴于脓毒症的高发病率和高病死率,早期识别高风险患者并及时干预至关重要,而现有死亡风险预测模型在操作、适用性和预测长期预后等方面均存在不足。本研究旨在探讨脓毒症患者死亡的危险因素,构建近期和远期死亡风险预测模型。方法:从美国重症监护医学信息数据库IV(Medical Information Mart for Intensive Care-IV,MIMIC-IV)中选取符合脓毒症3.0诊断标准的人群,按7?3的比例随机分为建模组和验证组,分析患者的基线资料。采用单因素Cox回归分析和全子集回归确定脓毒症患者死亡的危险因素并筛选出构建预测模型的变量。分别用时间依赖性曲线下面积(area under the curve,AUC)、校准曲线和决策曲线评估模型的区分度、校准度和临床实用性。结果:共纳入14240例脓毒症患者,28 d和1年病死率分别为21.45%(3054例)和36.50%(5198例)。高龄、女性、高感染相关器官衰竭评分(sepsis-related organ failure assessment,SOFA)、高简明急性生理学评分(simplified acute physiology score II,SAPS II)、心率快、呼吸频率快、脓毒症休克、充血性心力衰竭、慢性阻塞性肺疾病、肝脏疾病、肾脏疾病、糖尿病、恶性肿瘤、高白细胞计数(white blood cell count,WBC)、长凝血酶原时间(prothrombin time,PT)、高血肌酐(serum creatinine,SCr)水平均为脓毒症死亡的危险因素(均P<0.05)。由PT、呼吸频率、体温、合并恶性肿瘤、合并肝脏疾病、脓毒症休克、SAPS II及年龄8个变量构建的模型,其28 d和1年生存的AUC分别为0.717(95%CI 0.710~0.724)和0.716(95%CI 0.707~0.725)。校准曲线和决策曲线表明该模型具有良好的校准度及较好的临床应用价值。结论:基于MIMIC-IV建立的脓毒症患者近期和远期死亡风险预测模型有较好的识别能力,对患者预后风险评估及干预治疗具有一定的临床参考意义。展开更多
目的探讨良性阵发性位置性眩晕(BPPV)患者SRM-IV眩晕诊疗系统治疗后眩晕残障现状的影响因素。方法采用前瞻性队列研究,选取2022年4月至2023年4月于西宁市第一人民医院进行SRM-IV眩晕诊疗系统治疗的BPPV患者100例为研究对象,分析治疗后...目的探讨良性阵发性位置性眩晕(BPPV)患者SRM-IV眩晕诊疗系统治疗后眩晕残障现状的影响因素。方法采用前瞻性队列研究,选取2022年4月至2023年4月于西宁市第一人民医院进行SRM-IV眩晕诊疗系统治疗的BPPV患者100例为研究对象,分析治疗后患者的眩晕残障现状及相关影响因素。结果与治疗前相比,BPPV患者治疗后眩晕残障程度量表(DHI)评分较低(68.36±13.14 vs 45.29±8.20)分。与治疗有效的BPPV患者相比,治疗无效的BPPV患者治疗后DHI评分较高(43.32±7.01 vs 67.89±14.01)分。单因素分析显示,≥60岁、病程≥3个月、有头部外伤史、有高血压、高血脂、高血糖、半规管轻瘫CP值≥20%、25羟维生素D3[25-(OH)-D3]<30μg/L、同型半胱氨酸(Hcy)≥13μmol/L、嵴帽型、雌二醇(E2)<100 pmol/L的BPPV患者SRM-IV眩晕诊疗系统治疗后DHI评分较高。多因素Logistics回归分析显示,年龄、病程、头部外伤史、高血压、高血脂、高血糖、半规管轻瘫CP值、25-(OH)-D3、Hcy、疾病类型、E2为影响BPPV患者SRM-IV眩晕诊疗系统治疗后眩晕残障现状的主要因素。结论BPPV患者经SRM-IV眩晕诊疗系统治疗后眩晕残障现状改善,合并症、病情严重程度、外伤史等均与眩晕残障现状相关。展开更多
Isosorbide is a multi-purpose chemical that can be produced from renewable resources.Specifically,it has been investigated as a replacement for toxic bisphenol A(BPA)in the production of polycarbonate(PC).In this stud...Isosorbide is a multi-purpose chemical that can be produced from renewable resources.Specifically,it has been investigated as a replacement for toxic bisphenol A(BPA)in the production of polycarbonate(PC).In this study,the synthesis of isosorbide by sorbitol dehydration using a cerium-based catalyst derived from calcined cerium(IV)sulfate(300°C,400°C,450°C,500°C,and 650°C)was investigated.The reaction occurred in a high-pressure reactor containing nitrogen gas.Advanced instrumental techniques were applied to analyze the characteristics of the calcined catalyst.The results showed that the calcined catalysts demonstrated different crystalline structures and sulfate species at different temperatures.However,the acidic properties(strength and amount)of the catalyst did not change with the calcination temperature.The cerium(IV)sulfate calcined at 400°C exhibited the best catalytic performance,achieving the highest isosorbide yield(55.7%)and complete conversion of sorbitol at 180°C,20 bar of N2,and 6 h using CeSO-400.The presence of a sulfate group on the catalyst was the most important factor in determining the catalytic performance of sorbitol dehydration to isosorbide.This work suggests that CeSO-400 catalysts may play an important role in reducing reaction conditions.展开更多
文摘目的:鉴于脓毒症的高发病率和高病死率,早期识别高风险患者并及时干预至关重要,而现有死亡风险预测模型在操作、适用性和预测长期预后等方面均存在不足。本研究旨在探讨脓毒症患者死亡的危险因素,构建近期和远期死亡风险预测模型。方法:从美国重症监护医学信息数据库IV(Medical Information Mart for Intensive Care-IV,MIMIC-IV)中选取符合脓毒症3.0诊断标准的人群,按7?3的比例随机分为建模组和验证组,分析患者的基线资料。采用单因素Cox回归分析和全子集回归确定脓毒症患者死亡的危险因素并筛选出构建预测模型的变量。分别用时间依赖性曲线下面积(area under the curve,AUC)、校准曲线和决策曲线评估模型的区分度、校准度和临床实用性。结果:共纳入14240例脓毒症患者,28 d和1年病死率分别为21.45%(3054例)和36.50%(5198例)。高龄、女性、高感染相关器官衰竭评分(sepsis-related organ failure assessment,SOFA)、高简明急性生理学评分(simplified acute physiology score II,SAPS II)、心率快、呼吸频率快、脓毒症休克、充血性心力衰竭、慢性阻塞性肺疾病、肝脏疾病、肾脏疾病、糖尿病、恶性肿瘤、高白细胞计数(white blood cell count,WBC)、长凝血酶原时间(prothrombin time,PT)、高血肌酐(serum creatinine,SCr)水平均为脓毒症死亡的危险因素(均P<0.05)。由PT、呼吸频率、体温、合并恶性肿瘤、合并肝脏疾病、脓毒症休克、SAPS II及年龄8个变量构建的模型,其28 d和1年生存的AUC分别为0.717(95%CI 0.710~0.724)和0.716(95%CI 0.707~0.725)。校准曲线和决策曲线表明该模型具有良好的校准度及较好的临床应用价值。结论:基于MIMIC-IV建立的脓毒症患者近期和远期死亡风险预测模型有较好的识别能力,对患者预后风险评估及干预治疗具有一定的临床参考意义。
文摘目的探讨良性阵发性位置性眩晕(BPPV)患者SRM-IV眩晕诊疗系统治疗后眩晕残障现状的影响因素。方法采用前瞻性队列研究,选取2022年4月至2023年4月于西宁市第一人民医院进行SRM-IV眩晕诊疗系统治疗的BPPV患者100例为研究对象,分析治疗后患者的眩晕残障现状及相关影响因素。结果与治疗前相比,BPPV患者治疗后眩晕残障程度量表(DHI)评分较低(68.36±13.14 vs 45.29±8.20)分。与治疗有效的BPPV患者相比,治疗无效的BPPV患者治疗后DHI评分较高(43.32±7.01 vs 67.89±14.01)分。单因素分析显示,≥60岁、病程≥3个月、有头部外伤史、有高血压、高血脂、高血糖、半规管轻瘫CP值≥20%、25羟维生素D3[25-(OH)-D3]<30μg/L、同型半胱氨酸(Hcy)≥13μmol/L、嵴帽型、雌二醇(E2)<100 pmol/L的BPPV患者SRM-IV眩晕诊疗系统治疗后DHI评分较高。多因素Logistics回归分析显示,年龄、病程、头部外伤史、高血压、高血脂、高血糖、半规管轻瘫CP值、25-(OH)-D3、Hcy、疾病类型、E2为影响BPPV患者SRM-IV眩晕诊疗系统治疗后眩晕残障现状的主要因素。结论BPPV患者经SRM-IV眩晕诊疗系统治疗后眩晕残障现状改善,合并症、病情严重程度、外伤史等均与眩晕残障现状相关。
基金The authors appreciative and acknowledge the Faculty of Engineering,Khon Kaen University,Thailand,and the Graduate School,Khon Kaen University,Thailand,for supporting the Lecturer in Admitting High Potential Students to Study and Research in His Expert Program Year 2018(Grant No.611JT212)。
文摘Isosorbide is a multi-purpose chemical that can be produced from renewable resources.Specifically,it has been investigated as a replacement for toxic bisphenol A(BPA)in the production of polycarbonate(PC).In this study,the synthesis of isosorbide by sorbitol dehydration using a cerium-based catalyst derived from calcined cerium(IV)sulfate(300°C,400°C,450°C,500°C,and 650°C)was investigated.The reaction occurred in a high-pressure reactor containing nitrogen gas.Advanced instrumental techniques were applied to analyze the characteristics of the calcined catalyst.The results showed that the calcined catalysts demonstrated different crystalline structures and sulfate species at different temperatures.However,the acidic properties(strength and amount)of the catalyst did not change with the calcination temperature.The cerium(IV)sulfate calcined at 400°C exhibited the best catalytic performance,achieving the highest isosorbide yield(55.7%)and complete conversion of sorbitol at 180°C,20 bar of N2,and 6 h using CeSO-400.The presence of a sulfate group on the catalyst was the most important factor in determining the catalytic performance of sorbitol dehydration to isosorbide.This work suggests that CeSO-400 catalysts may play an important role in reducing reaction conditions.
