高海拔对轴流风机性能影响的数值分析

在高海拔地区,大气压强和空气密度降低,对轴流风机的性能产生影响。针对NACA 65(1)-412翼型的轴流风机,采用数值计算的方法,得到了不同安装角在海拔高度为0,1.0,2.0,3.0,4.0,5.0km的全压、轴功率、效率与体积流量之间关系的性能曲线,结合流场分析高海拔对轴流风机性能的影响。结果表明,安装角为30°、40°、50°的轴流风机,其效率随着海拔高度的增加而降低。并且安装角为30°的轴流风机,其效率受海拔高度的影响最大。在相同工况下,在海拔高度0km的效率比5.0km处高43.2%。轴流风机最大效率点所对应的体积流量随着安装角的增加而增加,安装角60°与安装角30°的轴流风机相比,体积流量增加了76%。安装角为60°的轴流风机在海拔高度2.0km处效率最高,这是由于风机出口靠近壁面处的涡流最小,且流场出口处回流现象弱。

融合K-means聚类分割算法与凸壳原理的遮挡苹果目标识别与定位方法

自然场景下苹果目标的精确识别与定位是智慧农业信息感知与获取领域的重要内容。为了解决自然场景下苹果目标识别与定位易受枝叶遮挡的问题,在K-means聚类分割算法的基础上,提出了基于凸壳原理的目标识别算法,并与基于去伪轮廓的目标识别算法和全轮廓拟合目标识别算法作了对比。基于凸壳原理的目标识别算法利用了苹果近似圆形的形状特性,结合K-means算法与最大类间方差算法将果实与背景分离,由凸壳原理得到果实目标的凸壳多边形,对凸壳多边形进行圆拟合,标定出果实位置。为验证算法有效性,对自然场景下的157幅苹果图像进行了测试,基于凸壳原理的目标识别算法、基于去伪轮廓的目标识别方法和全轮廓拟合目标识别方法的重叠率均值分别为83.7%、79.5%和70.3%,假阳性率均值分别为2.9%、1.7%和1.2%,假阴性率均值分别为16.3%、20.5%和29.7%。结果表明,与上面两种对比算法相比较,基于凸壳原理的目标识别算法识别效果更好且无识别错误的情况,该算法可为自然环境下的果实识别与分割问题提供借鉴与参考。

MicroRNAs as potential therapeutics for treating spinal cord injury

MicroRNAs are a class of recently discovered, small non-coding RNAs that have been shown to play essential roles in a vast majority of biological processes. Very little is known about the role of microRNAs during spinal cord injury. This review summarizes the changes in expression levels of microRNAs after spinal cord injury. These aberrant changes suggest that microRNAs play an important role in inflammation, oxidative stress, apoptosis, glial scar formation and axonal regeneration. Given their small size and specificity of action, microRNAs could be potential therapeutics for treating spinal cord injury in the future. There are rapidly developing techniques for manipulating microRNA levels in animals; we review different chemical modification and delivery strategies. These may provide platforms for designing efficient microRNA delivery protocols for use in the clinic.

Confirmed Diagnosis by RT-PCR and Phylogenetic Analysis of Peste des Petits Ruminants Viruses in Tibet, China

This paper reports the confirmed diagnosis by nested RT-PCR of PPR cases in Tibet, China in 2007, and results of phylogenetic analysis. Results showed that the 11 tested samples were PPRV positive by nested RT-PCR, of which 2 samples were genetically close to the X7443 strain (Nigeria 75/1) of lineage I, and 3 samples close to the strain AY560591 (Sungri96) of linage IV with 96.6%、97.3%、97.6% and 98% nucleotide sequence homogeneity respectively, based on partial sequencing of the F gene from 5 samples and complete sequencing of the N/M/F/H genes from one sample. This study suggested that there are at least 2 origins of PPRV in China.

Seroprevalence and evolutionary dynamics of genotype 4 hepatitis E virus in Shandong Province,China

AIM: To investigate the seroprevalence and evolutionary dynamics of hepatitis E virus (HEV) and assess the ancestor of HEVs in China’s Shandong Province.

Substring-searchable attribute-based encryption and its application for IoT devices

With the development of big data and cloud computing technology,more and more users choose to store data on cloud servers,which brings much convenience to their management and use of data,and also the risk of data leakage.A common method to prevent data leakage is to encrypt the data before uploading it,but the traditional encryption method is often not conducive to data sharing and querying.In this paper,a new kind of Attribute-Based Encryption(ABE)scheme,which is called the Sub-String Searchable ABE(SSS-ABE)scheme,is proposed for the sharing and querying of the encrypted data.In the SSS-ABE scheme,the data owner encrypts the data under an access structure,and only the data user who satisfies the access structure can query and decrypt it.The data user can make a substring query on the whole ciphertext without setting keywords in advance.In addition,the outsourcing method is also introduced to reduce the local computation of the decryption process so that the outsourcing SSS-ABE scheme can be applied to IoT devices.

Pyrolysis of Rice Husk in a Fluidized Bed Reactor:Evaluate the Characteristics of Fractional Bio-Oil and Particulate Emission of Carbonaceous Aerosol(CA)

Bio-oil production via pyrolysis is one of promising technologies for renewable energy production from bio-wastes.However,the complicated biooil is still a challenge for high-valued application and during biomass pyrolysis,the emission of non-cleaned aerosol,the potential emission,namely carbonaceous aerosol(CA)increased the difficulty of the commercial promotion.In this study,Rice husk pyrolysis was performed in a semi-continuous fluidized bed reactor coupled with fractional condensers.The effects of pyrolysis and condensation temperature on the properties of bio-oil and emission of CAwere investigated systemically.Results indicated that the in-situ separation of vapors was accomplished via condensers of different temperatures(85℃and−10℃).The bio-oil with different physiochemical properties were obtained in the high content of phenols and lower acids of BO1 and high content of acids and better liquidity.The size distribution of CA was found primarily classified as sub-micrometer grade particles,which have a diameter of less than 1.1μm.In particular,CA existed in three representative forms:bead,granular aggregate,and liquidoid.The results of light absorption of total organic carbon(TOC)and non-volatile organic carbon(NVOC)indicated that the absorption per mass increased in the single temperature with the decrement of wavelength and it improved as the pyrolysis temperature increased at the specified wavelength.The absorption per mass was to maximum value(3.7 m^(2)/g)at 360 nm wavelength and 600℃.TOC demonstrated a strong light absorption and a wide spectral range dependence(AAE:5.08-10.05)which enhanced the light absorption in the ultra-violet and low-visible regions.

Wall shear stress can improve prediction accuracy for transient ischemic attack

BACKGROUND Early prediction of transient ischemic attack (TIA) has important clinical value. To date, systematic studies on clinical, biochemical, and imaging indicators related to carotid atherosclerosis have been carried out to predict the occurrence of TIA. However, their prediction accuracy is limited. AIM To explore the role of combining wall shear stress (WSS) with conventional predictive indicators in improving the accuracy of TIA prediction. METHODS A total of 250 patients with atherosclerosis who underwent carotid ultrasonography at Naval Military Medical University Affiliated Gongli Hospital were recruited. Plaque location, plaque properties, stenosis rate, peak systolic velocity, and end diastolic velocity were measured and recorded. The WSS distribution map of the proximal and distal ends of the plaque shoulder was drawn using the shear stress quantitative analysis software, and the average values of WSS were recorded. The laboratory indicators of the subjects were recorded. The patients were followed for 4 years. Patients with TIA were included in a TIA group and the remaining patients were included in a control group. The clinical data, laboratory indicators, and ultrasound characteristics of the two groups were analyzed. Survival curves were plotted by the Kaplan-Meier method. Receiver operating characteristic curves were established to evaluate the accuracy of potential indicators in predicting TIA. Logistic regression model was used to establish combined prediction, and the accuracy of combined predictive indicators for TIA was explored.RESULTS The intraclass correlation coefficients of the WSS between the proximal and distal ends of the plaque shoulder were 0.976 and 0.993, respectively, which indicated an excellent agreement. At the end of the follow-up, 30 patients suffered TIA (TIA group) and 204 patients did not (control group). Hypertension (P = 0.037), diabetes (P = 0.026), homocysteine (Hcy)(P = 0.022), fasting blood glucose (P = 0.034), plaque properties (P = 0.000), luminal stenosis rate (P = 0.000), and proximal end WSS (P = 0.000) were independent influencing factors for TIA during follow-up. The accuracy of each indicator for predicting TIA individually was not high (area under the curve [AUC]< 0.9). The accuracy of the combined indicator including WSS (AUC = 0.944) was significantly higher than that of the combined indicator without WSS (AUC = 0.856) in predicting TIA (z = 2.177, P = 0.030). The sensitivity and specificity of the combined indicator including WSS were 86.67% and 92.16%, respectively. CONCLUSION WSS at plaque surface combined with hypertension, diabetes, Hcy, blood glucose, plaque properties, and stenosis rate can significantly improve the accuracy of predicting TIA.

The expression of vascular endothelial growth factor(VEGF)/endostatin(ES)and VEGF receptor 2(VEGFR2)/ES is associated with NSCLC prognosis

Objective The aim of our study was to detect the expression of angiogenesis inhibitory proteins and angiogenesis promotive proteins in the postoperative tumor tissue of non-small cell lung cancer(NSCLC)patients.We also investigated the relationship of protein expression with clinical characteristics and prognosis.Methods We examined the expression of vascular endothelial growth factor(VEGF),VEGF receptor 2(VEGFR2),and endostatin(ES)proteins in 255 specimens resected from NSCLC patients,using immune histochemistry(IHC).We then evaluated the relationships between the expression of the three proteins and clinical characteristics such as stage,histological type,differentiation,gender,tobacco use,and age.According to the value of VEGF/ES,we divided the cohort into angiogenesis-promoting group A,angiogenesis-inhibiting group A,and balance group A.The survival differences in the three groups were evaluated to determine the prognostic value of VEGF/ES.Similarly,we tested the prognostic value of VEGFR2/ES.Results VEGF-positive expression was observed in 93 patients(36.4%).VEGF expression was not correlated with the clinical characteristics.VEGFR2-positive expression was observed in 103 patients(40.4%).The expression of VEGFR2 was correlated with the clinical stage(χ^(2)=21.414,P=0.045)and histological type(χ^(2)=26.911,P=0.008).ES-positive expression was observed in 140 patients(54.9%).The expression of ES was correlated with the clinical stage(χ^(2)=26.504,P=0.009).When evaluating the prognostic values of VEGF/ES and VEGFR2/ES,the prognosis of the angiogenesis balance group was similar to that of the angiogenesis-inhibiting group.The minimum survival time was observed in the angiogenesis-promoting group.Conclusion VEGF/ES and VEGFR2/ES in resected tumors have prognostic value in postoperative NSCLC patients.The survival time of the population with predominant angiogenic factors was short.

Artificial simulated saliva,gastric and intestinal digestion and fermentation in vitro by human gut microbiota of intrapolysaccharide from Paecilomyces cicadae TJJ1213

In this study,the in vitro digestion and fermentation of two intra-polysaccharide fractions(IPS1 and IPS2)from Paecilomyces cicadae TJJ1213 were investigated.The constituent monosaccharides of IPS1 and IPS2 were not changed after simulated saliva,gastric and small intestinal digestion.However,they can be hydrolyzed and utilized by gut microbiota,and short-chain fatty acids(SCFAs)level were increased after IPS1 and IPS2 treatments.Furthermore,16 S r RNA sequencing analysis of fermentation samples were performed.Alpha-diversity,beta-diversity and taxonomic composition differences analysis revealed that IPS1 and IPS2 promoted the proliferation of beneficial bacteria and modulated the overall structure of gut microbiota.Taxonomic comparison analysis found that IPS1 increased the relative abundances of beneficial bacteria including Megamonas,Bifidobacterium and Lactobacillus,while IPS2 could increase the abundance of Bacteroides,Parabacteroides and Phascolarctobacterium.In addition,they can also decrease the levels of pathogenic bacteria containing Escherichia-Shigella,Klebsiella and Fusobacterium.These results indicated that IPS from Paecilomyces cicadae TJJ1213 could be used as potential candidates for new functional foods.

Network pharmacology-based prediction and verification of the mechanism for Bushen Chengyun granule on low endometrial receptivity

Objective:Bushen Chengyun granule(BCG)is an empirical treatment for female infertility(FI)caused by low endometrial receptivity(LER)involving a poorly understood mechanism.In this study,network pharmacology was used to explore the potential therapeutic mechanism of BCG on FI caused by LER.Methods:The corresponding herb targets were obtained by conducting a search in the Traditional Chinese Medicine Systems Pharmacology Database and PubMed-reported literature.Disease targets were obtained from the following databases:Comparative Toxicogenomics Database,Human Phenotype Ontology,and Therapeutic Target Database.Treatments for LER using BCG have used target matching(BCG e LER target).Then,the predicted targets were uploaded to the Search Tool for the Retrieval of Interacting Genes/Proteins database for gene ontology enrichment and Kyoto Encyclopedia of Genes and Genomes pathway analyses.Furthermore,triptorelin acetate for injection t menotrophin t chorionic gonadotropin for injection were used to establish a mouse model of blastocyst implantation disorder and to evaluate the in vivo effect of BCG on blastocyst implantation.Results:Overall,156 bioactive chemical components and 1092 targets of BCG were identified.The results indicated that 482 biological processes(FDR<0.01)and 15 pathways(FDR<0.01)related to BCG participated in the complex treatment effects and were associated with the endocrine system,inflammatory responses,metabolism,apoptosis,ovulatory performance,and angiogenesis.Moreover,16 hub nodes of BCG including estrogen receptor(ESR1),estrogen receptor beta(ESR2),progesterone receptor,et al,were recognized as potential treatment targets and might help clarify the underlying therapeutic mechanisms of BCG for female infertility.BCG significantly increased the protein expressions of estrogen receptors and progesterone receptors.Conclusions:These findings reveal the potential therapeutic mechanism of BCG for female infertility involves low endometrial receptivity,which should be evaluated further.

Cisplatin selects for CD133+cells in lung cancer cells

Objective Platinum-based chemotherapy is the first-line treatment for non-small cell lung cancer,but the chemoresistance of tumor cells continues to be a considerable challenge in the management of NSCLCs,leading to recurrence of most patients.CD133(prominin-1)is a five-transmembrane glycoprotein,and recent evidence suggests that CD133+cells are the cause of drug resistance and tumor recurrence.In this study,the correlation between cisplatin and CD133+cells was investigated systematically.Methods Four lung cancer cell lines,including A549,H460,801D and H1299,were treated with different concentrations of cisplatin.Cell viability was determined by MTT assay.Sphere-forming assay was performed to detect the capability of sphere-forming.CD133+cells was detected by BD FACScaliber flow cytometer.Results The results showed that cisplatin could increase the number of CD133+cells in both time-and dose-dependent manner.The enrichment would weaken but the proportion of CD133+cells was still higher than the basic level as incubation time extended after cisplatin was withdrawn.Compared with adherent culture,the proportion of CD133+cells was higher when the cells were maintained suspension culture.The proportion of CD133+cells significantly increased when cisplatin was provided in suspension culture.Conclusion These results revealed that cisplatin induces the enrichment of CD133+cells and CD133 is a new therapeutic target.Our data partially explained drug resistance to second-line chemotherapy in cisplatin-treated patients with NSCLCs.

Comparison between two commercial immunoassays:Dr.Fooke ALLERG-O-LIQ versus Phadia ImmunoCAP~ System in detecting allergen-specific IgE and total IgE values

Objective： Beside patient＇ s history and skin prick testing（SPT） the detection of specific IgE（slgE） represents an important tool of allergy diagnostics. In recent years different technologies for the detection of slgE have been developed. The objective of this study is the comparison of the ALLERG-O-LIQ with the ImmunoCAW System using seven inhalant and four food allergens. Methods： Sera from patients were collected and tested for slgE to inhalant（dl, d2, d5, i6, el, e5 and m3） and food allergens（fl, f2, f24, f24） by ALLERG-O-LIQ（Dr. Fooke Laboratorien GmbH） and by ImmunoCAP System（Phadia）. Further, samples were also tested for total IgE in both systems. Results： Prevalence of positive test results varied between 0/20（f24） and 11/20（e5） for ALLERG-O-LIQ and between 3/18（f23） and ll/20（dl/d5） for ImmunoCAP. The qualitative agreement between both methods was found between 75%（f24） and 100%（d2） depending on the allergen. Overall qualitative agreement for inhalant（n = 140）, food（n = 78） and all allergens（n = 218） tested was 92.1%（kappa = 0.84）, 83.3%（kappa = 0.58）, 89.0%（kappa = 0.77）, respectively. Sensitivity, specificity, positive predictive value （PPV）, negative predictive value（NPV） and diagnostic efficiency（DE） were found at 88.2%, 95.8%, 95.2%, 89.6%, 92.1%（inhalant allergens）, 62.5%, 92.6%, 78.9%, 84.7%, 83.3%（food allergens） and 81.5%, 94.4%, 91.5%, 87.5%, 89.0%（all allergens）. Conclusion： Good to excellent qualitative agreement between ALLERG-O-LIQ and ImmunoCAP for the detection of specific and total IgE could be observed. The degree of agreement depended on the allergen and was higher in the group of inhalant allergens. The ALLERG-O-LIQ System represents a reliable test for the detection of specific and total IgE.

Improvement of human embryonic stem cell-derived retinal pigment epithelium cell adhesion, maturation, and function through coating with truncated recombinant human vitronectin

AIM:To explore an xeno-free and defined coating substrate suitable for the culture of H9 human embryonic stem cell-derived retinal pigment epithelial(hES-RPE)cells in vitro,and compare the behaviors and functions of h ESRPE cells on two culture substrates,laminin521(LN-521)and truncated recombinant human vitronectin(VTN-N).METHODS:hES-RPE cells were used in the experiment.The abilities of LN-521 and VTN-N at different concentrations to adhere to hES-RPE cells were compared with a high-content imaging system.Quantitative real-time polymerase chain reaction was used to evaluate RPE-specific gene expression levels midway(day 10)and at the end(day 20)of the time course.Cell polarity was observed by immunofluorescent staining for apical and basal markers of the RPE.The phagocytic ability of hES-RPE cells was identified by flow cytometry and immunofluorescence.RESULTS:The cell adhesion assay showed that the ability of LN-521 to adhere to hES-RPE cells was dosedependent.With increasing coating concentration,an increasing number of cells attached to the surface of LN-521-coated wells.In contrast,VTN-N presented a strong adhesive ability even at a low concentration.The optimal concentration of LN-521 and VTN-N required to coat and adhesion to hES-RPE cells were 2 and 0.25μg/cm^(2),respectively.Furthermore,both LN-521 and VTN-N could facilitate adoption of the desired cobblestone cellular morphology with tight junction and showed polarity by the hES-RPE cells.However,hES-RPE cells cultivated in VTN-N had a greater phagocytic ability,and it took less time for these hES-RPE cells to mature.CONCLUSION:VTN-N is a more suitable coating substrate for cultivating hES-RPE cells.

Angioimmunoblastic T-cell lymphoma induced hemophagocytic lymphohistiocytosis and disseminated intravascular coagulopathy: A case report

BACKGROUND Angioimmunoblastic T-cell lymphoma(AITL) is a subtype of peripheral T-cell lymphoma, with heterogenous clinical manifestations and poor prognosis. Here,we report a case of AITL induced hemophagocytic lymphohistiocytosis(HLH)and disseminated intravascular coagulopathy(DIC).CASE SUMMARY An 83-year-old man presented with fever and purpura of both lower limbs for one month. Groin lymph node puncture and flow cytometry indicated a diagnosis of AITL. Bone marrow examination and other laboratory related indexes indicated DIC and HLH. The patient rapidly succumbed to gastrointestinal bleeding and septic shock.CONCLUSION This is the first reported case of AITL induced HLH and DIC. AITL is more aggressive in older adults. In addition to male gender, mediastinal lymphadenopathy, anaemia, and sustained high level of neutrophil-to-lymphocyte ratio may indicate a greater risk of death. Early diagnosis, early detection of severe complications, and prompt and effective treatment are vital.

Wenjing Zhitong recipe exhibits potential anti-primary dysmenorrhea properties by inhibiting COX2 and PKC signaling pathway in rats induced by estradiol benzoate and oxytocin

Objective:To explore the effect and mechanism of action of the Wenjing Zhitong recipe(WZR)in primary dysmenorrhea(PD)treatment.Methods:Uterine contractions were induced by estradiol benzoate and oxytocin in a PD model and WZR was administrated.The rate of change in uterine contractility and the writhing test were used to evaluate the effects of WZR.The serum levels of prostaglandin F_(2a)(PGF_(2a))and prostaglandin E_2(PGE_2),and the activity of cyclooxygenase-2(COX2)were detected by enzyme-linked immunosorbent assay(ELISA).The changes in phosphor-phospholipase C(pPLC/PLC),phosphor-protein kinase C(pPKC/PKC),and connexin 43(CX43)expression were detected using immunohistochemistry and western blot.Results:WZR significantly reduced the rate of change in uterine contractility and writhing times in the PD model.WZR treatment inhibited the enzymatic activity of COX2 and reduced the levels of PGF_(2a),PGF_(2a)/PGE2and COX2 in the PD model.WZR also significantly reduced the expression of pPLC/PLC,pPKC/PKC and CX43.Targeting the inhibition of COX2 activity,caffeic acid and 1-acetyl-β-carboline were validated as the active ingredients in WZR responsible for reducing uterine contractions.Conclusion:WZR attenuated PD by inhibiting COX2 activity,downregulating PGF_(2a)/PGE_2 expression,and inhibiting the PKC signaling pathway.

隐性脊柱裂患者的尿流动力学检查以及排尿异常的治疗

目的探讨隐性脊柱裂患者应用不同治疗方法后,对尿流动力学参数变化以及排尿异常表现的影响.方法选取在武汉市中心医院新洲院区接受治疗的21例隐性脊柱裂患者为研究对象,将其随机均分为口服阿莫西林药物的口服药物对比组,泌尿外科手术治疗的泌尿外科手术组;脊索栓系松解手术治疗的脊索栓系松解组,应用计算机断层扫描(CT)以及磁共振成像(MRI)检测的影像资料,对比3组患者治疗前后尿动力学指标以及治疗总有效率.结果经CT以及MRI检测显示,11例患者出现逼尿肌活动低下,6例出现膀胱逼尿肌活动过度,4例患者可见膀胱出口成梗阻;治疗前,3组患者尿动力指标间差异均无统计学意义(P>0.05),治疗后,脊索栓系松解组各尿动力指标水平均明显优于其他两组(P<0.05);脊索栓系松解组总有效率明显高于其他两组,差异有统计学意义(P<0.05).结论隐性脊柱裂患者应用脊索栓系松解术可显著改善尿流动力学各项指标,调节排尿异常.

根治性膀胱切除术后输尿管-回肠膀胱吻合口狭窄的分型及腔内处理的疗效

目的探讨根治性膀胱切除术后输尿管-回肠膀胱吻合口狭窄(UAS)的分型及腔内处理的疗效。方法回顾分析2017年1月至2022年1月同济医院收治的34例根治性膀胱切除术后UAS患者的临床资料。男25例,女9例。年龄(66.3±7.7)岁。发生UAS时间为根治性膀胱切除术后(14.7±6.5)个月。单侧肾盂积水32例,双侧肾盂积水2例。2例在外院已行肾造瘘。3例血常规检查白细胞升高,其中2例伴发热,先行积水侧肾造瘘和抗感染治疗,待血常规检查白细胞正常,且停用抗生素24h无发热后再手术。34例术前肾积水(2.7±0.6)cm。本组34例中,5例经术前留置的肾造瘘管注射亚甲蓝,29例用18G穿刺针于超声引导下穿刺肾盂注射亚甲蓝。用输尿管硬镜于回肠膀胱中观察,4例可见亚甲蓝,依亚甲蓝引导寻及狭窄处并置入超滑导丝,其中3例用5mm输尿管扩张球囊导管扩张,1例用F14软镜鞘扩张,然后留置F6单J管。30例未见亚甲蓝,其中16例顺行经肾造瘘口用输尿管软镜寻及狭窄处,用30W钬激光切开,然后9例行球囊扩张、7例行软镜鞘扩张后留置F6单J管。14例顺行方法无法寻及狭窄处,根据手术时间、患者情况等决定即刻或二期行双镜联合手术,经肾造瘘口用软镜沿超滑导丝进镜至狭窄处,经回肠膀胱用输尿管硬镜观察,借助超滑导丝抖动和内镜光点寻找狭窄处。10例寻及狭窄处,用30W钬激光切开,8例行球囊扩张、2例行软镜鞘扩张后留置F6单J管。4例采用双镜联合方法仍无法准确寻及狭窄处(其中1例为双侧狭窄1侧已解除),继续留置肾造瘘管。本研究成功解除狭窄的定义为输尿管可以置入F6单J管。结果根据术中所见严重程度将UAS分成4型:Ⅰ型,狭窄处管腔较正常输尿管缩窄>50%,但亚甲蓝可以成股通过;Ⅱ型,针尖样狭窄,仅允许亚甲蓝细丝样通过;Ⅲ型,膜状闭锁,狭窄段长1~3mm,亚甲蓝无法通过;Ⅳ型,长段狭窄。本组34例中,Ⅰ型4例,采用逆行方法疏通狭窄段;Ⅱ型16例,采用顺行方法疏通狭窄段;Ⅲ型10例,采用双镜联合方法疏通狭窄段;Ⅳ型4例(其中1例为双侧UAS,一侧Ⅲ型,一侧Ⅳ型,计入Ⅳ型),通过上述方法均未成功疏通。本研究34例中,30例成功解除吻合口狭窄,1例双侧梗阻患者单侧吻合口狭窄解除;余3例因为狭窄段过长,腔内手术风险大,其中2例改行肾造瘘,1例改行开放手术。本组手术成功率为88.2%。所有患者术中、术后均未发生严重并发症。术后随访6~24个月,4例影像学检查提示肾积水加重,肌酐升高(32.5±10.9)μmol/L,需更换单J管;其余26例影像学检查提示肾积水(0.9±0.6)cm,较术前(2.6±0.6)cm差异有统计学意义(P<0.01)。13例为分期手术,术后3个月生活质量评分(1.9±0.6)分,较术前留置肾造瘘管期间(5.2±0.7)分显著改善,差异有统计学意义(P<0.01)。结论采用逆行、顺行、双镜联合3种腔内处理方法治疗根治性膀胱切除术后UAS的成功率高,可使部分患者避免留置外引流管的不便和开放手术的风险。选择合适的手术方法可以用最小的创伤达到治疗狭窄的目的。

左西孟旦在重症患者中应用效果的研究进展

左西孟旦是一种新型钙增敏剂,主要具有正性肌力和扩张血管作用。与传统正性肌力药物相比,左西孟旦主要通过增加肌钙蛋白C对Ca^2+的敏感性而增强心肌细胞收缩力,不会增加细胞内钙负荷及心肌耗氧量,不易导致心律失常和细胞损伤,不延长舒张期时间及损伤心肌舒张功能,是一种更具优势的强心、护心药物。尽管目前左西孟旦尚未广泛用于ICU患者,但越来越多研究表明其对危重症患者心脏、肺脏、肾脏、膈肌功能等具有一定保护作用。本文主要综述了左西孟旦在心脏重症、呼吸重症、困难脱机、脓毒症、肾损伤中的应用效果,以期为重症患者提供更多的治疗思路。

METTL3-mediated m^(6)A modification of HMGA2 mRNA promotes subretinal fibrosis and epithelial-mesenchymal transition

Subretinal fibrosis is a major cause of the poor visual prognosis for patients with neovascular age-related macular degeneration(nAMD).Myofibroblasts originated from retinal pigment epithelial(RPE)cells through epithelial-mesenchymal transition(EMT)contribute to the fibrosis formation.N^(6)-Methyladenosine(m^(6)A)modification has been implicated in the EMT process and multiple fibrotic diseases.The role of m^(6)A modification in EMT-related subretinal fibrosis has not yet been elucidated.In this study,we found that during subretinal fibrosis in the mouse model of laser-induced choroidal neovascularization,METTL3 was upregulated in RPE cells.Through m^(6)A epitranscriptomic microarray and further verification,high-mobility group AT-hook 2(HMGA2)was identified as thekey downstream target of METTL3,subsequently activating potent EMT-inducing transcription factor SNAIL.Finally,by subretinal injections of adeno-associated virus vectors,we confirmed that METTL3 deficiency in RPE cells could efficiently attenuate subretinal fibrosis in vivo.In conclusion,our present research identified an epigenetic mechanism of METTL3-m^(6)A-HMGA2 in subretinal fibrosis and EMT of RPE cells,providing a novel therapeutic target for subretinal fibrosis secondary to nAMD.