微创手术治疗中少量高血压脑出血的临床疗效观察

目的:分析中少量高血压脑出血患者应用微创手术治疗的效果。方法:选取2021年5月—2023年5月太仓市第一人民医院收治的中少量高血压脑出血患者62例为研究对象,按照治疗方式不同分为对照组和观察组,各31例。对照组应用开颅血肿清除术治疗,观察组采用微创手术治疗。观察两组患者血肿清除率、再出血发生率、昏迷情况、神经功能缺损情况、自理能力和日常生活情况。结果:两组患者治疗5 d后,观察组血肿清除率高于对照组,再出血发生率低于对照组,差异有统计学意义(P<0.05)。治疗后1、2、3周,两组患者昏迷、神经功能缺损评分与治疗前比较,差异有统计学意义(P<0.05);且两组治疗后2、3周昏迷评分高于治疗后1周,神经功能缺损评分低于治疗后1周,差异有统计学意义(P<0.05);治疗后3周昏迷评分高于治疗后2周,神经功能缺损评分低于治疗后2周,差异有统计学意义(P<0.05)。观察组患者治疗后1、2、3周昏迷评分高于对照组,神经功能缺损评分低于对照组,差异有统计学意义(P<0.05)。随访1年后,观察组自理能力和日常生活能力评分优于对照组,差异有统计学意义(P<0.05)。结论:对中少量高血压脑出血患者中应用微创手术治疗的血肿清除率高,再出血风险低,患者可尽早恢复,并减少神经功能受损,利于患者远期预后康复。

Importance of oxygen-containing functionalities and pore structures of biochar in catalyzing pyrolysis of homologous poplar

Biochar and bio-oil are produced simultaneously in one pyrolysis process,and they inevitably contact and may interact,influencing the composition of bio-oil and modifying the structure of biochar.In this sense,biochar is an inherent catalyst for pyrolysis.In this study,in order to investigate the influence of functionalities and pore structures of biochar on its capability for catalyzing the conversion of homologous volatiles in bio-oil,three char catalysts(600C,800C,and 800AC)produced via pyrolysis of poplar wood at 600 or 800℃or activated at 800℃,were used for catalyzing pyrolysis of homologous poplar wood at 600℃,respectively.The results indicated that the 600C catalyst was more active than 800C and 800AC for catalyzing cracking of volatiles to form more gas(yield increase by 40.2%)and aromatization of volatiles to form more light or heavy phenolics,due to its abundant oxygen-containing functionalities acting as active sites.The developed pores of the 800AC showed no such catalytic effect but could trap some volatiles and allow their further conversion via sufficient aromatization.Nevertheless,the interaction with the volatiles consumed oxygen on 600C(decrease by 50%),enhancing the aromatic degree and increasing thermal stability.The dominance of deposition of carbonaceous material of a very aromatic nature over 800C and 800AC resulted in net weight gain and blocked micropores but formed additional macropores.The in situ diffuse reflectance infrared Fourier transform spectroscopy characterization of the catalytic pyrolysis indicated superior activity of 600C for removal of -OH,while conversion of the intermediates bearing C=O was enhanced over all the char catalysts.

Steam reforming of acetic acid over Ni/biochar of low metal-loading:Involvement of biochar in tailoring reaction intermediates renders superior catalytic performance

Biochar is a reactive carrier as it may be partially gasified with steam in steam reforming,which could influence the formation of reaction intermediates and modify catalytic behaviors.Herein,the Ni/biochar as well as two comparative catalysts,Ni/Al_(2)O_(3) and Ni/SiO_(2),with low nickel loading(2%(mass))was conducted to probe involvement of the varied carriers in the steam reforming.The results indicated that the Ni/biochar performed excellent catalytic activity than Ni/SiO_(2) and Ni/Al_(2)O_(3),as the biochar carrier facilitated quick conversion of the -OH from dissociation of steam to gasify the oxygen-rich carbonaceous intermediates like C=O and C-O-C,resulting in low coverage while high exposure of nickel species for maintaining the superior catalytic performance.In converse,strong adsorption of aliphatic intermediates over Ni/Al_(2)O_(3) and Ni/SiO_(2) induced serious coking with polymeric coke as the main type(21.5%and 32.1%,respectively),which was significantly higher than that over Ni/biochar(3.9%).The coke over Ni/biochar was mainly aromatic or catalytic type with nanotube morphology and high crystallinity.The high resistivity of Ni/biochar towards coking was due to the balance between formation of coke and gasification of coke and partially biochar with steam,which created developed mesopores in spent Ni/biochar while the coke blocked pores in Ni/Al_(2)O_(3) and Ni/SiO_(2) catalysts.

Thermal pretreatment of willow branches impacts yield and pore development of activated carbon in subsequent activation with ZnCl_(2) via modifying cellulose structure

Development of pore structures of activated carbon(AC)from activation of biomass with ZnCl_(2) relies on content and structure of cellulose/hemicellulose in the feedstock.Thermal pretreatment of biomass could induce dehydration and/or aromatization to change the structure of cellulose/hemicellulose.This might interfere with evolution of structures of AC,which was investigated herein via thermal pretreatment of willow branch(WB)from 200 to 360℃and the subsequent activation with ZnCl_(2) at 550℃.The results showed that thermal pretreatment at 360℃(WB-360)could lead to substantial pyrolysis to form biochar,with a yield of 31.9%,accompanying with nearly complete destruction of cellulose crystals and remarkably enhanced aromatic degree.However,cellulose residual in WB-360 could still be activated to form AC-360 with specific surface area of 1837.9 m~2·g^(-1),which was lower than that in AC from activation of untreated WB(AC-blank,2077.8 m~2·g^(-1)).Nonetheless,the AC-200 from activation of WB-200 had more developed pores(2113.9 m~2·g^(-1))and superior capability for adsorption of phenol,due to increased permeability of ZnCl_(2) to the largely intact cellulose structure in WB-200.The thermal pretreatment did increase diameters of micropores of AC but reduced the overall yield of AC(26.8%for AC-blank versus 18.0%for AC-360),resulting from accelerated cracking but reduced intensity of condensation.In-situ infrared characterization of the activation showed that ZnCl_(2) mainly catalyzed dehydration,dehydrogenation,condensation,and aromatization but not cracking,suppressing the formation of derivatives of cellulose and lignin in bio-oil.The thermal pretreatment formed phenolic-OH and C=O with higher chemical innerness,which changed the reaction network in activation,shifting morphology of fibrous structures in AC-blank to“melting surface”in AC-200 or AC-280.

High-rate lithium-ion battery performance of a ternary sea urchin-shaped CoNiO_(2)@NiP_(6)Mo_(18)/CNTs composites

Bimetallic oxides are attractive anode materials for lithium-ion batteries(LIBs)due to their large theoretical capacity.However,the low conductivity,short cycle life,and poor rate capability are the bottlenecks for their further applications.To overcome above issues,the basket-like polymolybdate(NiP_(6)Mo_(18))and carbon nanotubes(CNTs)were uniformly embedded on the urchin-shaped CoNiO_(2)nanospheres to yield a ternary composites CoNiO_(2)@NiP_(6)Mo_(18)/CNTs via electrostatic adsorption.The multi-level morphology of urchin spinules accelerates the diffusion rate of Li^(+);CNT improves the conductivity and enhances cycle stability of the material;and heteropoly acid contributes more redox activity centres.Thus,CoNiO_(2)@NiP_(6)Mo_(18)/CNTs as an anode of LIBs exhibits a high initial capacity(1396.7 mA h g^(−1)at 0.1 A g^(−1)),long-term cycling stability(750.2 mA h g^(−1)after 300 cycles),and rate performance(450.3 mA h g^(−1)at 2 A g^(−1)),which are superior to reported metallic oxides anode of LIBs.The density functional theory(DFT)and kinetic mechanism suggest that CoNiO_(2)@NiP_(6)Mo_(18)/CNTs delivers an outstanding pseudocapacitance and rapid Li^(+)diffusion behaviors,which is due to the rich surface area of the urchin-like CoNiO_(2)with the uniform embeddedness of NiP_(6)Mo_(18)and CNTs.This study provides a new idea for optimizing the performance of bimetallic oxides and developing high-rate lithium-ion battery composites.

A Localization Method of High Energy Transients for All-sky Gamma-ray Monitor

Fast and reliable localization of high-energy transients is crucial for characterizing the burst properties and guiding the follow-up observations.Localization based on the relative counts of different detectors has been widely used for all-sky gamma-ray monitors.There are two major methods for this count distribution localization:χ^(2)minimization method and the Bayesian method.Here we propose a modified Bayesian method that could take advantage of both the accuracy of the Bayesian method and the simplicity of the χ^(2)method.With comprehensive simulations,we find that our Bayesian method with Poisson likelihood is generally more applicable for various bursts than the χ^(2)method,especially for weak bursts.We further proposed a location-spectrum iteration approach based on the Bayesian inference,which could alleviate the problems caused by the spectral difference between the burst and location templates.Our method is very suitable for scenarios with limited computation resources or timesensitive applications,such as in-flight localization software,and low-latency localization for rapidly follow-up observations.

Searching for the Highest Energy of Pulsation and Critical Luminosity of Swift J0243.6+6124 Observed by Insight-HXMT

Owing to the broad energy coverage of Insight-HXMT in the hard X-ray band,we detected the highest energy of pulsation exceeding 200 keV around the 2017–2018 outburst peak of the first Galactic pulsating ultraluminous X-ray source (PULX) Swift J0243.6+6124,which is the highest energy detected from PULXs to date.We also obtained the highest energy of pulsation of every exposure during the outburst in 2017–2018,and found the highest energy is roughly positively correlated with luminosity.Using our newly developed method,we identified the critical luminosity being 4×10^(38)erg s^(-1) when the main peaks of the low and high energy pulse profiles became aligned,which separates the fan-beam dominated and pencil-beam dominated accretion regimes.Above the critical luminosity,the phase of the main peak shifted gradually from 0.5 to 0.8 until the outburst peak in al energy bands is reached,which is in agreement with the phase shift found previously at low energies.Our result is consistent with what is derived from spectral analysis.

Clinical Analysis of 137 Cases of Fungal Keratitis

Objective: To analyze the epidemiology, clinical diagnosis and treatment of fungal keratitis (FK) in hospitalized patients at the First Affiliated Hospital of Yangtze University in recent years. Methods: A retrospective investigation was conducted on the data of 137 cases of FK in our hospital from January 2019 to December 2022. The epidemiological characteristics, identification results of fungal strains, clinical treatment, and prognosis of the patients were analyzed. Results: Among the 137 FK patients, 89 were males and 48 were females, and the ratio of male to female was 1.85:1, The age of onset was the largest number of patients in 50-59 years old and 60-69 years old. The disease occurred most in autumn, winter and summer farming season (from September to December, January, May, June). 72 cases (52.6%) had a clear history of corneal injury, and 43 cases (31.4%) had a history of plant injury. Other risk factors include eye surface diseases, ophthalmic surgery, and wearing corneal contact lenses. The top three pathogens were fusarium (38.7%), aspergillus (23.3%), and alternaria (17.5%). 101 eyes showed improvement or cure after treatment with medication, 9 eyes underwent corneal stromal injection, 11 eyes were covered with conjunctival flap covering or amniotic membrane transplantation, 12 eyes were covered with corneal transplantation, and enucleation of ocular contents was performed in 4 eyes;Visual acuity was improved or maintained in 123 patients (about 89.8%). Conclusions: The incidence of FK in our hospital was mostly middle-aged and elderly men, mostly caused by corneal injury in the process of agricultural labor. The pathogens were mainly fusarium and aspergillus. The preferred treatment was medication, with severe cases requiring combined surgical treatment. Most patients can maintain or improve their vision after treatment.

糖尿病视网膜病变及糖尿病性黄斑水肿患者血清中CTRP9的表达

目的:探讨C1q/肿瘤坏死因子相关蛋白9(CTRP9)在不同分期糖尿病视网膜病变(DR)及糖尿病性黄斑水肿(DME)患者血清中的表达水平。方法:选取2021-04/2022-04甘肃省人民医院收治的2型糖尿病患者135例作为试验组,根据免散瞳眼底照相结果分为无DR(NDR)组(n=45)、非增殖型DR(NPDR)组(n=45)、增殖型DR(PDR)组(n=45);根据光学相干断层扫描结果将DR患者分为DME组(n=51)、非DME组(n=39);另选取与试验组年龄、性别相匹配的健康体检者45例作为正常对照组。记录并比较各组受试者的临床资料及生化指标检测结果,分析血清CTRP9水平与其他生化指标的相关性,探讨影响DR及DME发生的危险因素。结果:正常对照组、NDR组、NPDR组、PDR组受试者血清CTRP9水平有明显差异(P<0.001),且正常对照组>NDR组>NPDR组>PDR组;DME组与非DME组患者血清CTRP9水平有明显差异(P<0.001),且非DME组>DME组。Spearman秩相关性分析显示,DR患者血清CTRP9水平与糖尿病病程病程呈负相关(r_(s)=-0.251,P<0.05);DME患者血清CTRP9水平与空腹血糖(FBG)(r_(s)=-0.370,P<0.05)、糖化血红蛋白(HbA1c)(r_(s)=-0.421,P<0.05)呈负相关。Logistic多因素回归分析显示,糖尿病病程(OR=1.194,95%CI:1.068~1.335,P=0.002)、血清CTRP9水平(OR=0.936,95%CI:0.907~0.966,P<0.001)是影响DR发生的危险因素;血清CTRP9水平是影响DME发生的危险因素(OR=0.838,95%CI:0.778~0.903,P<0.001)。结论:血清CTRP9水平降低是DR及DME发生的危险因素,可能对二者的风险评估有重要意义。

Maraviroc promotes recovery from traumatic brain injury in mice by suppression of neuroinflammation and activation of neurotoxic reactive astrocytes

Neuroinflammation and the NACHT,LRR,and PYD domains-containing protein 3 inflammasome play crucial roles in secondary tissue damage following an initial insult in patients with traumatic brain injury(TBI).Maraviroc,a C-C chemokine receptor type 5 antagonist,has been viewed as a new therapeutic strategy for many neuroinflammatory diseases.We studied the effect of maraviroc on TBI-induced neuroinflammation.A moderate-TBI mouse model was subjected to a controlled cortical impact device.Maraviroc or vehicle was injected intraperitoneally 1 hour after TBI and then once per day for 3 consecutive days.Western blot,immunohistochemistry,and TUNEL(terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling)analyses were performed to evaluate the molecular mechanisms of maraviroc at 3 days post-TBI.Our results suggest that maraviroc administration reduced NACHT,LRR,and PYD domains-containing protein 3 inflammasome activation,modulated microglial polarization from M1 to M2,decreased neutrophil and macrophage infiltration,and inhibited the release of inflammatory factors after TBI.Moreover,maraviroc treatment decreased the activation of neurotoxic reactive astrocytes,which,in turn,exacerbated neuronal cell death.Additionally,we confirmed the neuroprotective effect of maraviroc using the modified neurological severity score,rotarod test,Morris water maze test,and lesion volume measurements.In summary,our findings indicate that maraviroc might be a desirable pharmacotherapeutic strategy for TBI,and C-C chemokine receptor type 5 might be a promising pharmacotherapeutic target to improve recovery after TBI.

Development and validation of an emergency bloodstream infection score for predicting in-hospital mortality in patients with community-acquired bloodstream infections

BACKGROUND:Community-acquired bloodstream infections(CABSIs)are common in the emergency departments,and some progress to sepsis and even lead to death.However,limited information is available regarding the prediction of patients with high risk of death.METHODS:The Emergency Bloodstream Infection Score(EBS)for CABSIs was developed to visualize the output of a logistic regression model and was validated by the area under the curve(AUC).The Mortality in Emergency Department Sepsis(MEDS),Pitt Bacteremia Score(PBS),Sequential Organ Failure Assessment(SOFA),quick Sequential Organ Failure Assessment(qSOFA),Charlson Comorbidity Index(CCI),and McCabe–Jackson Comorbid Classification(MJCC)for patients with CABSIs were computed to compare them with EBS in terms of the AUC and decision curve analysis(DCA).The net reclassification improvement(NRI)index and integrated discrimination improvement(IDI)index were compared between the SOFA and EBS.RESULTS:A total of 547 patients with CABSIs were included.The AUC(0.853)of the EBS was larger than those of the MEDS,PBS,SOFA,and qSOFA(all P<0.001).The NRI index of EBS in predicting the in-hospital mortality of CABSIs patients was 0.368(P=0.04),and the IDI index was 0.079(P=0.03).DCA showed that when the threshold probability was<0.1,the net benefit of the EBS model was higher than those of the other models.CONCLUSION:The EBS prognostic models were better than the SOFA,qSOFA,MEDS,and PBS models in predicting the in-hospital mortality of patients with CABSIs.

Potential role of microRNA-503 in Icariin-mediated prevention of high glucose-induced endoplasmic reticulum stress

BACKGROUND Dysregulated microRNA(miRNA)is crucial in the progression of diabetic nephropathy(DN).AIM To investigate the potential molecular mechanism of Icariin(ICA)in regulating endoplasmic reticulum(ER)stress-mediated apoptosis in high glucose(HG)-induced primary rat kidney cells(PRKs),with emphasis on the role of miR-503 and sirtuin 4(SIRT4)in this process.METHODS Single intraperitoneal injection of streptozotocin(65 mg/kg)in Sprague-Dawley rats induce DN in the in vivo hyperglycemic model.Glucose-treated PRKs were used as an in vitro HG model.An immunofluorescence assay identified isolated PRKs.Cell Counting Kit-8 and flow cytometry analyzed the effect of ICA treatment on cell viability and apoptosis,respectively.Real-time quantitative polymerase chain reaction and western blot analyzed the levels of ER stressrelated proteins.Dual luciferase analysis of miR-503 binding to downstream SIRT4 was performed.RESULTS ICA treatment alleviated the upregulated miR-503 expression in vivo(DN)and in vitro(HG).Mechanistically,ICA reduced HG-induced miR-503 overexpression,thereby counteracting its function in downregulating SIRT4 levels.ICA regulated the miR-503/SIRT4 axis and subsequent ER stress to alleviate HG-induced PRKs injury.CONCLUSION ICA reduced HG-mediated inhibition of cell viability,promotion of apoptosis,and ER stress in PRKs.These effects involved regulation of the miR-503/SIRT4 axis.These findings indicate the potential of ICA to treat DN,and implicate miR-503 as a viable target for therapeutic interventions in DN.

Two-dimensional nanomaterials confined single atoms: New opportunities for environmental remediation

Two-dimensional(2D)supports confined single-atom catalysts(2D SACs)with unique geometric and electronic structures have been attractive candidates in different catalytic applications,such as energy conversion and storage,value-added chemical synthesis and environmental remediation.However,their environmental appli-cations lack of a comprehensive summary and in-depth discussion.In this review,recent progresses in synthesis routes and advanced characterization techniques for 2D SACs are introduced,and a comprehensive discussion on their applications in environmental remediation is presented.Generally,2D SACs can be effective in catalytic elimination of aqueous and gaseous pollutants via radical or non-radical routes and transformation of toxic pollutants into less poisonous species or highly value-added products,opening a new horizon for the contami-nant treatment.In addition,in-depth reaction mechanisms and potential pathways are systematically discussed,and the relationship between the structure-performance is highlighted.Finally,several critical challenges within this field are presented,and possible directions for further explorations of 2D SACs in environmental remediation are suggested.Although the research of 2D SACs in the environmental application is still in its infancy,this review will provide a timely summary on the emerging field,and would stimulate tremendous interest for designing more attractive 2D SACs and promoting their wide applications.

Extracellular vesicles in the pathogenesis and treatment of acute lung injury

Acute lung injury(ALI)and acute respiratory distress syndrome(ARDS)are common life-threatening lung diseases associated with acute and severe inflammation.Both have high mortality rates,and despite decades of research on clinical ALI/ARDS,there are no effective therapeutic strategies.Disruption of alveolar-capillary barrier integrity or activation of inflammatory responses leads to lung inflammation and injury.Recently,studies on the role of extracellular vesicles(EVs)in regulating normal and pathophysiologic cell activities,including inflammation and injury responses,have attracted attention.Injured and dysfunctional cells often secrete EVs into serum or bronchoalveolar lavage fluid with altered cargoes,which can be used to diagnose and predict the development of ALI/ARDS.EVs secreted by mesenchymal stem cells can also attenuate inflammatory reactions associated with cell dysfunction and injury to preserve or restore cell function,and thereby promote cell proliferation and tissue regeneration.This review focuses on the roles of EVs in the pathogenesis of pulmonary inflammation,particularly ALI/ARDS.

The Nature of Active Sites for Plasmon-Mediated Photothermal Catalysis and Heat-Coupled Photocatalysis in Dry Reforming of Methane

Solar energy-induced catalysis has been attracting intensive interests and its quantum efficiencies in plasmon-mediated photothermal catalysis(P-photothermal catalysis)and external heat-coupled photocatalysis(E-photothermal catalysis)are ultimately determined by the catalyst structure for photo-induced energetic hot carriers.Herein,different catalysts of supported(TiO_(2)-P25 and Al_(2)O_(3))platinum quantum dots are employed in photo,thermal,and photothermal catalytic dry reforming of methane.Integrated experimental and computational results unveil different active sites(hot zones)on the two catalysts for photo,thermal,and photothermal catalysis.The hot zones of P-photothermal catalysis are identified to be the metal-support interface on Pt/P25 and the Pt surface on Pt/Al_(2)O_(3),respectively.However,a change of the active site to the Pt surface on Pt/P25 is for the first time observed in E-photothermal catalysis(external heating temperature of 700℃).The hot zones contribute to the significant enhancements in photothermal catalytic reactivity against thermocatalysis.This study helps to understand the reaction mechanism of photothermal catalysis to exploit efficient catalysts for solar energy utilization and fossil fuels upgrading.

Key Considerations on the Industrial Application of Lignocellulosic Biomass Pyrolysis Toward Carbon Neutrality

1.The importance of biomass in carbon neutrality With the increasing urgency to mitigate climate change,over 100 countries have committed to net-zero carbon emissions by the mid-21st century[1].For example,China has announced that it will reach a carbon peak and carbon neutrality,with the rapid development of renewable energy undoubtedly playing a key role in achieving these goals.Compared with other renewable energy sources,such as wind energy,solar energy.

Localization Method for the Pointing Observation with the Collimated Telescopes of Insight-HXMT

An accurate target source position is sometimes useful for the pointing observation with the collimated telescopes of the Hard X-ray Modulation Telescope(Insight-HXMT),which is determined by the reliability of the instrumental response.Insight-HXMT has the unique design that all three main payloads(LE,ME and HE)consist of detector groups with three fields of views(FOVs)whose orientations differ by 60°.As the point-spread functions are different at different positions in the FOV coordinates,the count rate ratios between the detector groups depend on the position of an X-ray source in the FOVs.Based on the multi-FOV design,we develop a localization method for an X-ray source in the pointing observation of Insight-HXMT.The accuracy of the method is investigated with the pointing observations of the Crab with different exposures.We find that the statistical error decreases with the exposure,and the systematic error is dominant for the exposure>128 s.With the exposure of1024 s,the total error is 0°.015 for the Crab.This method can effectively distinguish the Rapid Burster H 1730–333and Slow Burster GX 354–0,which are only 0°.5 apart and can both contribute to bursts in the light curve obtained by Insight-HXMT.We also apply the pointing observation localization method to locate the X-ray counterpart of FRB 200428 with high precision.The located position is consistent with SGR J1935+2154 within 1σuncertainty of 10′,which provides important evidence that fast radio bursts can originate from magnetars.

Analysis of load status and management strategies of main caregivers of patients with malignant tumors of digestive tract

Caregiver load refers to the subjective and objective negative impact of caregivers in the care of patients,and excessive load will have a serious impact on patients and caregivers themselves and can reduce their quality of life.For the main caregivers,it not only needs to care for the patients in life and daily life,but also needs to pay the cost of treatment for the patients,coupled with the need to carry out their own original work,life,etc.excessive life pressure,economic pressure,work pressure,emotional pressure,etc.lead to heavy load of the main caregivers,which can easily cause caregivers to have different degrees of psychological problems,which will cause serious adverse effects on the caregivers themselves and cancer patients,not conducive to the construction of a harmonious family and society.This article analyzes the current situation of primary caregiver burden in patients with gastrointestinal malignant tumors,analyzes its influencing factors,and specifies specific treatment strategies.It is hoped to provide scientific guidance for later related research and application.

The correlation between the hemoglobin-to-red cell distribution width ratio and all-cause mortality in patients with malignant tumors and sepsis:A retrospective cohort study using the MIMIC-Ⅳdatabase

Objective The aim of the study was to investigate the correlation between the hemoglobin-to-red cell distribution width ratio(HRR)and all-cause mortality in patients with malignant tumors and sepsis.Methods All patients who met the inclusion criteria of the Medical Information Mart for Intensive Care(MIMIC)-Ⅳwere selected and divided into four groups according to the quartile range of HRR distribution.Kaplan-Meier(K-M)analysis was used to plot the 28-day survival curve,and the log-rank test was used to compare the prognosis in each HRR group.A Cox proportional hazards regression model was used to evaluate the prognosis of HRR as both a continuous and categorical variable,and a restricted cubic spline was used to study the effect of HRR,as a continuous variable,on the mortality in patients with malignant tumors and sepsis.Interaction and subgroup analyses were performed to evaluate the consistency of correlations.Results A total of 3926 patients were included in the study,including 934 patients in the HRR≤4.97 group,988 patients in the 4.97<HRR≤6.26 group,1005 patients in the 6.26<HRR≤7.84 group,and 999 patients in the HRR≥7.84 group.According to the K-M analysis,the 28-day survival rate was the lowest in the HRR≤4.97 group(59.53%),and there were significant differences in survival rates among different HRR levels(P<0.001).The Cox proportional hazards regression model found that after adjusting for various potential confounding factors,HRR was negatively correlated with 28-day and 365-day mortality,and the risk of death in the HRR≥7.84 group was significantly lower than that in the HRR≤4.97 group(P=0.030 and P=0.008,respectively).The restricted cubic spline plot revealed a linear and negative relationship between the HRR and the 28-day and 365-day mortality rates.Subgroup analysis revealed an interaction between HRR,blood urea nitrogen,and SAPS II scores(P=0.010 and P=0.048,respectively).Conclusion Low HRR is an independent risk factor for all-cause mortality in patients with malignant tumors and sepsis and could be used as a prognostic indicator for these patients.

县级综合卒中中心应用Solitaire支架机械取栓联合Navien导管抽吸技术治疗急性前循环大血管闭塞的效果分析

目的探讨县级综合卒中中心使用Solitaire支架机械取栓联合Navien导管抽吸技术治疗前循环大血管闭塞的安全性及有效性。方法回顾性连续纳入2018年3—12月太仓市第一人民医院卒中中心收治的前循环大血管闭塞患者17例,均接受了Solitaire支架机械取栓联合Navien导管抽吸技术治疗,其中男10例,女7例;美国国立卫生研究院卒中量表(NIHSS)评分8~22分,平均(14±4)分;大脑中动脉M1段闭塞12例,大脑中动脉分叉部闭塞1例,颈内动脉起始段闭塞4例;醒后卒中4例,院内卒中1例。记录患者年龄、性别、发病至入院时间(ODT)、入院至溶栓时间(DNT)、入院至穿刺时间(DPT)、穿刺至再通时间(PRT),对比术前及术后24 h NIHSS评分的改变,评价血管再通情况[脑梗死溶栓(TICI)分级2b^3级为成功再通]、并发症发生比例和术后90 d预后良好[改良Rankin量表(mRS)评分≤2分]比例。结果17例患者中,静脉溶栓后桥接动脉取栓治疗5例,单纯动脉取栓12例;ODT为1.0~5.5 h,中位时间3.0(2.0,4.7)h;DNT为26~35 min,平均(30±4)min;DPT为79~276 min,平均(152±53)min;PRT为27~134 min,平均(57±33)min;支架取栓次数为1~3次,中位次数1(1,2)次。取栓后即刻行DSA检查,17例患者中,TICI 2a级2例,TICI 2b级5例,TICI 3级10例,血管再通占比为15/17,一次取栓成功占比为11/17。17例患者中,1例患者出现远端栓塞,经再次取栓后血管再通;未发生颅内出血。患者取栓后NIHSS评分2~20分,平均(9±5)分,与术前比较,差异有统计学意义(t=5.759,P<0.05)。术后90 d mRS评分≤2分者12例,预后良好占比为12/17。结论县级综合卒中中心使用Solitaire支架机械取栓联合Navien导管抽吸技术治疗前循环大血管闭塞是安全有效的。