基于DIC评分早期分层抗凝对改善脓毒症预后的有效性和安全性研究

目的 探讨基于弥散性血管内凝血(DIC)评分早期分层抗凝对改善脓毒症预后的有效性和安全性。方法 选取脓毒症患者265例,根据DIC和SIC评分分组,将患者分为DIC组84例、脓毒症凝血病(SIC)组92例和对照组84例(正常凝血状态)。其中DIC组给予常规剂量低分子肝素抗凝治疗,SIC组给予半量低分子肝素治疗,对照组不给予抗凝等治疗。结果 DIC组ICU住院时间、呼吸机使用时间和总住院时间较对照组延长(P<0.05);28天病死率比较,DIC组、SIC组和对照组差异无统计学意义(P>0.05)。DIC组、SIC组治疗后凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)和D二聚体(D-Dimer,D-D)低于治疗前,且DIC组高于SIC和对照组(P<0.05),而血小板和纤维蛋白原(FIB)低于SIC组和对照组(P<0.05)。DIC组、SIC组和对照组治疗后乳酸、BUN和Scr均较治疗前降低,DIC组仍高于SIC组和对照组(P<0.05)。治疗后急性生理及慢性健康状况评分Ⅱ(APACHEⅡ)评分、序贯器官衰竭评分(SOFA)评分均较治疗前降低,SIC组评分低于对照组,DIC组APACHEⅡ评分高于SIC组和对照组(P<0.05)。DIC组、SIC组和对照组出血事件总发生率差异无显著性(P>0.05)。结论 基于脓毒症DIC评分早期分层抗凝在脓毒症治疗中有较好的效果,可减轻患者凝血功能和脏器损功能损害。

老年血液透析患者红细胞体积分布宽度水平及相关影响因素分析

目的:探讨老年血液透析患者红细胞体积分布宽度(red cell distribution width,RDW)水平及其临床意义。方法:前瞻性入选2017年7月至12月在上海市健康医学院附属嘉定区中心医院血液净化中心维持性透析老年患者128例。其中男性48例,女性80例,年龄(69.2±4.5)岁,透析龄(64.3±42.5)个月。所有患者均收集临床病史,并于周中透析前检测血红蛋白、红细胞体积分布宽度、电解质、高敏C反应蛋白、血清白蛋白、铁蛋白、甲状旁腺素等临床指标。应用Pearson相关分析和多元线性逐步回归模型分析各临床指标与RDW的关系。应用曲线拟合模型分析可能与RDW呈非线性相关的临床指标。所有患者临床随访12个月,主要终点为死亡,次要终点为各类型心脑血管事件。应用Kaplan-Meier法分析RDW高值组和低值组患者上述终点事件的差异。应用Cox比例风险模型分析与预后相关的独立预测因子。结果:整组患者RDW为[(16.24±2.22)%,(14.0~20.4)%],中位数15.1%,105(82.1%)例患者RDW水平超过参考值上限。男性患者RDW水平低于女性患者组。Pearson相关分析提示RDW与透析龄、每周促进细胞生成素(EPO)剂量、高敏C反应蛋白、透析间期体质量增加比例显著正相关。RDW与血清白蛋白显著负相关。多元线性逐步回归模型结果提示RDW与血清白蛋白显著负相关(P<0.01),与每周EPO剂量显著正相关(P<0.01)。RDW与血红蛋白呈曲线相关,以二次方程拟合优度最佳(P<0.001)。全部患者均随访12个月,共死亡6例,其中RDW高值组4例,RDW低值组2例,差异无统计学意义。随访期间发生各类心脑血管事件36例,其中RDW高值组26例,RDW低值组10例。Kaplan-Meier分析提示RDW高值组和RDW低值组患者在12个月随访期内心脑血管事件发生率差异有统计学意义(log-rank=16.224,P<0.001)。单因素Cox回归显示RDW水平与12个月内心脑血管事件正相关,血红蛋白、血清白蛋白和12个月内心脑血管事件负相关。多因素Cox回归结果显示RDW(HR=1.231,P=0.015)、血清白蛋白水平(HR=0.964,P<0.001)是老年维持性血液透析患者12个月内心脑血管事件的独立预测因素。结论:老年血液透析患者中RDW水平普遍增高,且与贫血、透析龄、营养水平、炎症状态、心脏功能、EPO剂量及反应等多项临床指标有关;RDW水平增高与老年维持性血液透析患者短期临床心脑血管事件转归相关。

Formation mechanism of the Lidang circular structure in the Guangxi Province

The Lidang circular structure in the center of the Guangxi Province is about 8 km in diameter. This structure appears as an abnormal shallow depression that has disturbed the rather harmonic regional joint systems. Its unique occurrence in the whole region, the circular morphology, negative topography, and the spatial distribution of interior and exterior strata are all consistent with those of impact craters that are formed by asteroidal or cometary collision. To test the impact hypothesis, we carried out both field investigation and remote sensing study of this structure. Regional geological history suggests that if the impact hypothesis were correct, the impact event should have occurred at or after the Early Permian. Field investigation found that the strata inside and outside the crater are dominated by parallel stacks of Lower and Upper Permian limestone that have various thicknesses and different mud contents. The layers of limestone within and outside the circular structure have identical attitudes;no structural disturbances were visible in the outcrops. Field investigations provide conclusive evidence against the impact cratering hypothesis. A high-resolution digital elevation model shows that the spatial distribution of rounded mountains within the structure is controlled by faint but continual extension of joints, suggesting that the crater interior has gone through a much higher degree of erosion. Therefore, regional joints that had once existed within the crater are preserved less well than exterior terrains, forming the abruptly disrupted circular depression. Differential erosion, as the possible formation mechanism of the Lidang structure, is consistent with the different mud contents found between the interior and exterior limestone. The circular outline of this structure may correspond to the shape of the original deposition basin. In conclusion, the Lidang circular structure is a polje formed by karstification, not an astrobleme.

饲料中添加肉桂醛和芽孢杆菌对半滑舌鳎肠道结构的影响

为探讨芽孢杆菌和肉桂醛对半滑舌鳎肠道结构的影响,选取60尾初始平均体重为(112±5)g的健康半滑舌鳎,随机分为饲喂普通饲料组(对照组P1)、饲料中含肉桂醛组(P2)、饲料上喷洒益生菌组(P3)、肉桂醛+益生菌组(P4),每组3个重复,每个重复5尾鱼。以工厂化微水流模式养殖,养殖60天后解剖取半滑舌鳎的前肠,制作石蜡切片并以HE染色,观察肠道结构。研究结果表明:饲喂芽孢杆菌使得前肠绒毛出现末端分支、局部增厚,且绒毛中央乳糜管宽度增加。无论肉桂醛、芽孢杆菌还是两者复合使用,均显著降低了前肠的肌层厚度,部分淋巴细胞聚集在黏膜下层呈现炎性浸润,或者迁移到上皮细胞之间。单独使用芽孢杆菌和肉桂醛联用时降低了前肠杯状细胞密度。

抗肉桂醛益生菌的筛选、鉴定和益生特性评价

为了筛选适合添加于含肉桂醛饲料的水产益生菌,从饲喂肉桂醛的半滑舌鳎肠道中筛选5株芽孢杆菌,同时选用笔者所在实验室保存的35株潜在益生菌,以定性定量法筛选具有高水解酶活性且抗肉桂醛的菌株并鉴定。通过福林-酚法、3,5-二硝基水杨酸法定量测定各菌株的蛋白酶、淀粉酶和纤维素酶活性;进一步以生长抑制法确定各菌株耐受肉桂醛的能力,以16S rDNA序列鉴定优势菌株。结果表明,9种芽孢杆菌具有较强的益生特性,其中菌株1-D的蛋白酶活性最强,为(10.137±0.046)U/mL,菌株8-D的淀粉酶活性最强,为(5.739±0.018)U/mL,菌株9-D的纤维素酶活性最强,为(63.436±0.006)U/mL,且这9株菌分别属于枯草芽孢杆菌和地衣芽孢杆菌,最高能够耐受浓度为2.5μmol/mL的肉桂醛。研究筛选的菌株,有作为益生菌应用于含肉桂醛饲料的潜力。

风力发电机组预制混凝土塔筒施工方法

近几年来,随着能源与环境的矛盾日益凸显,环保节能成为中国电力工业结构调整的重要方向。风力发电作为一种新型的清洁能源越来越受到重视,并且风力发电机组的单台容量有逐年上升的趋势。因此这对风机的塔架高度提出了更高的要求,钢-混凝土混合式风力发电机组塔筒应运而生。这种混合式结构具有制作便捷,施工快捷,结构稳固同时又能降低成本,最重要的是这种结构能够将风机轮毂高度提升至120 m以上,能更好地利用风力资源。本公司承建的张三寨风电项目是平原地区的风电场。地貌单元为黄河冲、洪积平原,地形平坦,地势开阔,采用钢-混凝土式塔筒结构。结合该项目的特点,详细介绍风力发电机组预制混凝土塔筒的施工方法,将施工方法进行规范化。

Non-Impact Origin of the Baisha Structure in Hainan Province, China

The Baisha Structure,with a rim-to-rim diameter of^3.7 km,in the center of the Hainan Province,southern China has been considered to be an impact crater.Field investigation and petrological study are presented in this paper to investigate the impact hypothesis for this structure.The^600-m-thick Lower Cretaceous feldspathic quartz sandstones from the Lumuwan Formation are the major outcrops both within and outside of the structure.The amphitheater-shaped rim of the structure is composed of granite porphyries that are intruded in the Lumuwan Formation.Previously interpreted impact breccia and impact melt rocks are actually granite porphyries different cooling rates and weathering status.Rocks from locations that most likely have recorded shock metamorphic signatures are sampled,but petrographic analyses reveal no indications of shock metamorphism.While subtle structural deformation occurs at the contact boundary between the granite porphyries and the feldspathic quartz sandstones,the feldspathic quartz sandstones exhibit uniformed dipping strata across the crater floor and walls.All the evidence suggests that the Baisha Structure was not formed by impact cratering.It most likely has been shaped by a combination of magmatic intrusion and long-term differential erosion.

ICU气管插管患者应用自制温湿度仪的临床效果探究

目的:探析应用自制温湿度仪对ICU气管插管患者人工气道湿化监测的效果及影响。方法:选取本院近3年收治的60例ICU气管插管患者,将其随机分为对照组与观察组,每组30例。其中对照组患者实施常规监测方式,观察组则在常规监测方式上加以应用自制型温湿度监测仪。之后对比两组患者监测呼吸机效果、湿化效果以及气管总带管时间。结果:观察组在辅用自制温湿度仪后,其呼吸机监测效果及湿化效果显著优于对照组;且观察组患者气管总带管时间显著短于对照组,肺部湿罗音、痰痂形成以及刺激性咳嗽次数均少于对照组,两组相较差异具有显著性(P<0.05)。结论:ICU患者气管插管过程中使用自制温湿度仪,可有效将其人工气道入口端温度控制在36℃左右,有利于患者尽早撤机,并降低气道并发症的发生情况。