The surface solar radiation in most parts of the world has undergone a phenomenon known as global dimming and brightening,characterized by an initial decrease followed by an increase.As a result,the sunshine duration(...The surface solar radiation in most parts of the world has undergone a phenomenon known as global dimming and brightening,characterized by an initial decrease followed by an increase.As a result,the sunshine duration(SD)has decreased in the past 60 years.Against the backdrop of global dimming and brightening,SD has decreased to varying degrees in many regions of China.Using the observed data of SD,cloud amount(total cloud amount and low cloud amount,abbreviated as TCA and LCA),precipitation,and relative humidity(RH)from 34 meteorological stations in Chongqing during the period of 1961-2020,along with a digital elevation model(DEM)with a resolution of 90 m,this study analyzed the spatiotemporal variations and influencing factors of SD.The analysis employed methods such as linear regression,Mann-Kendall test,wavelet transformation,and DEM-based possible SD distributed model.The results showed that the annual SD in Chongqing has significantly decreased over the last 60 years,with a decreasing interannual trend rate(ITR)of 40.4 h/10a.Except for no obvious trend in spring,SD decreased significantly in summer,autumn and winter at the ITR of 21.1 h/10a,8.5 h/10a and 7.5 h/10a,respectively.An abrupt decrease in the annual SD was found in 1979.The difference before and after the abrupt decrease was 177.7 h.The difference before and after the abrupt decrease was 177.7 h.The annual SD possessed the oscillation period of 11a.The spatial heterogeneity of the mean annual SD during the last 60 years was obvious.The distribution of SD in Chongqing is high in the northeast and low in the southeast.In addition,about 73%of the total area in Chongqing showed a significant and very significant decreasing trend.The regions with significant changes are mainly concentrated in the regions with altitudes of 200~1000 m.The increasing LCA was the main cause of the decrease of the annual SD in the regions with 200-400 m altitude decreased the most and changed the most.Increasing LCA is the primary cause of the reduction in annual SD,showing a strong negative correlation coefficient of-0.7292.In Chongqing,PM2.5 concentration showed a significant decrease trend in annual,spring,autumn and winter during 2000-2020,but the significant correlation between PM2.5 concentration and SD was only in autumn and reached an extremely significant level.展开更多
目的探讨急性大血管闭塞性卒中患者在成功行早期血管内治疗(EVT)后,收缩压下降幅度(SBPr)与术后90 d临床预后及术后24 h症状性颅内出血(sICH)的关系。方法回顾性、序贯性纳入2015年7月至2023年4月于皖南医学院第一附属医院(弋矶山医院)...目的探讨急性大血管闭塞性卒中患者在成功行早期血管内治疗(EVT)后,收缩压下降幅度(SBPr)与术后90 d临床预后及术后24 h症状性颅内出血(sICH)的关系。方法回顾性、序贯性纳入2015年7月至2023年4月于皖南医学院第一附属医院(弋矶山医院)因前循环急性大血管闭塞行EVT并获得成功再通的患者。收集所有患者的人口学资料、既往史(高血压病、糖尿病)、急性卒中Org 10172治疗试验(TOAST)分型、基线美国国立卫生研究院卒中量表(NIHSS)评分及基线Alberta卒中项目早期CT(ASPECT)评分,收集手术相关参数[包括发病至置鞘时间、发病至再通时间、闭塞部位(颈内动脉、大脑中动脉M1段、大脑中动脉M2段)、脑侧支循环状态(术前闭塞血管造影显示闭塞血管区域软脑膜侧支循环回流范围≥50%定义为侧支循环良好,回流范围<50%定义为侧支循环不良)]、术后即刻再通状态[采用改良脑梗死溶栓(mTICI)分级进行评估,成功再通定义为mTICI分级为2b~3级]、术后24 h sICH、术后90 d预后(以术后90 d改良Rankin量表评分评估,评分≤2分为预后良好,评分>2分为预后不良)。根据EVT后24 h内SBPr,将SBPr分成5类,即SBPr<-10%、-10%~10%、>10%~20%、>20%~30%和>30%。根据术后90 d预后以及术后24 h sICH发生情况,将所有纳入患者分为预后良好组与预后不良组以及sICH组与无sICH组。SBPr与术后90 d临床预后和术后24 h sICH的关系采用二分类多因素Logistic回归分析模型分析。根据有无高血压病史、有无持续静脉降压、基线ASPECT评分(3~5分和6~10分)及侧支循环状态(良好与不良)进行亚组分析。利用限制性立方图描绘SBPr与术后24 h sICH及术后90 d临床预后的关系。结果(1)共纳入731例患者,中位年龄71(62,77)岁,男性患者占58.0%(424/731),中位基线NIHSS评分为14(12,18)分,中位基线ASPECT评分9(7,10)分;405例(55.4%)患者术后90 d预后良好,35例(4.8%)患者术后24 h发生sICH。(2)多因素分析结果显示,年龄越大(OR=1.036,95%CI:1.017~1.056),基线NIHSS评分越高(OR=1.095,95%CI:1.049~1.144),基线ASPECT评分越低(OR=0.704,95%CI:0.636~0.780),患有糖尿病(OR=1.729,95%CI:1.084~2.758),侧支循环不良(侧支循环良好比不良,OR=0.481,95%CI:0.332~0.696)以及SBPr>30%(以SBPr-10%~10%作为参照,OR=2.238,95%CI:1.230~4.071),术后90 d预后不良风险越高(均P<0.05)。持续静脉降压为术后24 h sICH发生的危险因素(OR=2.278,95%CI:1.047~4.953;P=0.038),而SBPr 20%~30%与较低的术后24 h sICH发生风险相关(以SBPr-10%~10%作为参照,OR=0.362,95%CI:0.131~0.998;P=0.049)。(3)限制性立方图显示,EVT后SBPr与术后90 d预后不良存在U形关系,而与sICH的发生存在近线性关系,下降越多,sICH发生率越低。(4)亚组分析显示,在无高血压病病史和良好侧支循环状态亚组中,SBPr>30%较SBPr-10%~10%均具有更高的不良预后风险[OR值及95%CI分别为2.921(1.000~8.528)、2.363(1.078~5.183),P=0.05和P<0.05];在EVT后接受持续静脉降压组和基线ASPECT评分6~10分组,SBPr>30%与术后90 d不良预后相关[以SBPr-10%~10%作为参照,OR值和95%CI分别为2.646(1.168~5.993)、2.481(1.360~4.527),均P<0.05]。SBPr与较低的sICH发生风险的相关性仅存在于不良脑侧支循环状态亚组中(以SBPr-10%~10%为参照,SBPr>20%~30%:OR=0.133,95%CI:0.027~0.652;SBPr>30%:OR=0.104,95%CI:0.013~0.864;均P<0.05)。结论对于急性前循环大血管闭塞性卒中EVT后血管再通患者,术后SBPr可能与术后90 d预后不良及术后24 h sICH发生相关,但这种相关性存在显著的个体化差异。基线ASPECT评分、既往高血压病史、脑侧支循环状态以及EVT后持续静脉降压的使用在EVT后个体化血压管理中需谨慎对待。展开更多
目的:分析针刺治疗中风后痉挛性偏瘫随机对照试验(RCTs)的结局指标应用现状,为针刺治疗中风后痉挛性偏瘫核心结局指标集的研究提供基础。方法:全面检索PubMed、Web of Science、Cochrane Library、CBM和中国知网数据库(CNKI)、万方数据...目的:分析针刺治疗中风后痉挛性偏瘫随机对照试验(RCTs)的结局指标应用现状,为针刺治疗中风后痉挛性偏瘫核心结局指标集的研究提供基础。方法:全面检索PubMed、Web of Science、Cochrane Library、CBM和中国知网数据库(CNKI)、万方数据知识服务平台(Wanfang)、维普中文科技期刊数据库(VIP)与中国临床试验注册中心中针刺治疗中风后痉挛性偏瘫的RCTs,检索时间范围均从2018年1月—2023年1月。使用Cochrane风险偏倚评估工具对纳入的研究进行质量评价,采用定性分析的方法描述纳入研究的结局指标。结果:初步检索纳入相关文献1027篇,最终纳入44篇文献(中文文献43篇,英文文献1篇),共报告了50个结局指标,使用频次为203次,其中症状体征使用频次最高,理化检测次之。结论:针刺治疗中风后痉挛性偏瘫的RCT结局指标现存在命名、参考标准及测量时点不统一、使用频次不均衡、主次结局指标不明确和偏倚风险模糊等问题,国内学者理应参考国际经验,结合针刺的临床研究特点构建规范、统一的核心指标结局指标集。展开更多
基金the National Key R&D Program(Grant No.2019YFE0115200)Natural Science Foundation of China(Grants No.42071217).
文摘The surface solar radiation in most parts of the world has undergone a phenomenon known as global dimming and brightening,characterized by an initial decrease followed by an increase.As a result,the sunshine duration(SD)has decreased in the past 60 years.Against the backdrop of global dimming and brightening,SD has decreased to varying degrees in many regions of China.Using the observed data of SD,cloud amount(total cloud amount and low cloud amount,abbreviated as TCA and LCA),precipitation,and relative humidity(RH)from 34 meteorological stations in Chongqing during the period of 1961-2020,along with a digital elevation model(DEM)with a resolution of 90 m,this study analyzed the spatiotemporal variations and influencing factors of SD.The analysis employed methods such as linear regression,Mann-Kendall test,wavelet transformation,and DEM-based possible SD distributed model.The results showed that the annual SD in Chongqing has significantly decreased over the last 60 years,with a decreasing interannual trend rate(ITR)of 40.4 h/10a.Except for no obvious trend in spring,SD decreased significantly in summer,autumn and winter at the ITR of 21.1 h/10a,8.5 h/10a and 7.5 h/10a,respectively.An abrupt decrease in the annual SD was found in 1979.The difference before and after the abrupt decrease was 177.7 h.The difference before and after the abrupt decrease was 177.7 h.The annual SD possessed the oscillation period of 11a.The spatial heterogeneity of the mean annual SD during the last 60 years was obvious.The distribution of SD in Chongqing is high in the northeast and low in the southeast.In addition,about 73%of the total area in Chongqing showed a significant and very significant decreasing trend.The regions with significant changes are mainly concentrated in the regions with altitudes of 200~1000 m.The increasing LCA was the main cause of the decrease of the annual SD in the regions with 200-400 m altitude decreased the most and changed the most.Increasing LCA is the primary cause of the reduction in annual SD,showing a strong negative correlation coefficient of-0.7292.In Chongqing,PM2.5 concentration showed a significant decrease trend in annual,spring,autumn and winter during 2000-2020,but the significant correlation between PM2.5 concentration and SD was only in autumn and reached an extremely significant level.
文摘目的探讨急性大血管闭塞性卒中患者在成功行早期血管内治疗(EVT)后,收缩压下降幅度(SBPr)与术后90 d临床预后及术后24 h症状性颅内出血(sICH)的关系。方法回顾性、序贯性纳入2015年7月至2023年4月于皖南医学院第一附属医院(弋矶山医院)因前循环急性大血管闭塞行EVT并获得成功再通的患者。收集所有患者的人口学资料、既往史(高血压病、糖尿病)、急性卒中Org 10172治疗试验(TOAST)分型、基线美国国立卫生研究院卒中量表(NIHSS)评分及基线Alberta卒中项目早期CT(ASPECT)评分,收集手术相关参数[包括发病至置鞘时间、发病至再通时间、闭塞部位(颈内动脉、大脑中动脉M1段、大脑中动脉M2段)、脑侧支循环状态(术前闭塞血管造影显示闭塞血管区域软脑膜侧支循环回流范围≥50%定义为侧支循环良好,回流范围<50%定义为侧支循环不良)]、术后即刻再通状态[采用改良脑梗死溶栓(mTICI)分级进行评估,成功再通定义为mTICI分级为2b~3级]、术后24 h sICH、术后90 d预后(以术后90 d改良Rankin量表评分评估,评分≤2分为预后良好,评分>2分为预后不良)。根据EVT后24 h内SBPr,将SBPr分成5类,即SBPr<-10%、-10%~10%、>10%~20%、>20%~30%和>30%。根据术后90 d预后以及术后24 h sICH发生情况,将所有纳入患者分为预后良好组与预后不良组以及sICH组与无sICH组。SBPr与术后90 d临床预后和术后24 h sICH的关系采用二分类多因素Logistic回归分析模型分析。根据有无高血压病史、有无持续静脉降压、基线ASPECT评分(3~5分和6~10分)及侧支循环状态(良好与不良)进行亚组分析。利用限制性立方图描绘SBPr与术后24 h sICH及术后90 d临床预后的关系。结果(1)共纳入731例患者,中位年龄71(62,77)岁,男性患者占58.0%(424/731),中位基线NIHSS评分为14(12,18)分,中位基线ASPECT评分9(7,10)分;405例(55.4%)患者术后90 d预后良好,35例(4.8%)患者术后24 h发生sICH。(2)多因素分析结果显示,年龄越大(OR=1.036,95%CI:1.017~1.056),基线NIHSS评分越高(OR=1.095,95%CI:1.049~1.144),基线ASPECT评分越低(OR=0.704,95%CI:0.636~0.780),患有糖尿病(OR=1.729,95%CI:1.084~2.758),侧支循环不良(侧支循环良好比不良,OR=0.481,95%CI:0.332~0.696)以及SBPr>30%(以SBPr-10%~10%作为参照,OR=2.238,95%CI:1.230~4.071),术后90 d预后不良风险越高(均P<0.05)。持续静脉降压为术后24 h sICH发生的危险因素(OR=2.278,95%CI:1.047~4.953;P=0.038),而SBPr 20%~30%与较低的术后24 h sICH发生风险相关(以SBPr-10%~10%作为参照,OR=0.362,95%CI:0.131~0.998;P=0.049)。(3)限制性立方图显示,EVT后SBPr与术后90 d预后不良存在U形关系,而与sICH的发生存在近线性关系,下降越多,sICH发生率越低。(4)亚组分析显示,在无高血压病病史和良好侧支循环状态亚组中,SBPr>30%较SBPr-10%~10%均具有更高的不良预后风险[OR值及95%CI分别为2.921(1.000~8.528)、2.363(1.078~5.183),P=0.05和P<0.05];在EVT后接受持续静脉降压组和基线ASPECT评分6~10分组,SBPr>30%与术后90 d不良预后相关[以SBPr-10%~10%作为参照,OR值和95%CI分别为2.646(1.168~5.993)、2.481(1.360~4.527),均P<0.05]。SBPr与较低的sICH发生风险的相关性仅存在于不良脑侧支循环状态亚组中(以SBPr-10%~10%为参照,SBPr>20%~30%:OR=0.133,95%CI:0.027~0.652;SBPr>30%:OR=0.104,95%CI:0.013~0.864;均P<0.05)。结论对于急性前循环大血管闭塞性卒中EVT后血管再通患者,术后SBPr可能与术后90 d预后不良及术后24 h sICH发生相关,但这种相关性存在显著的个体化差异。基线ASPECT评分、既往高血压病史、脑侧支循环状态以及EVT后持续静脉降压的使用在EVT后个体化血压管理中需谨慎对待。
文摘目的:分析针刺治疗中风后痉挛性偏瘫随机对照试验(RCTs)的结局指标应用现状,为针刺治疗中风后痉挛性偏瘫核心结局指标集的研究提供基础。方法:全面检索PubMed、Web of Science、Cochrane Library、CBM和中国知网数据库(CNKI)、万方数据知识服务平台(Wanfang)、维普中文科技期刊数据库(VIP)与中国临床试验注册中心中针刺治疗中风后痉挛性偏瘫的RCTs,检索时间范围均从2018年1月—2023年1月。使用Cochrane风险偏倚评估工具对纳入的研究进行质量评价,采用定性分析的方法描述纳入研究的结局指标。结果:初步检索纳入相关文献1027篇,最终纳入44篇文献(中文文献43篇,英文文献1篇),共报告了50个结局指标,使用频次为203次,其中症状体征使用频次最高,理化检测次之。结论:针刺治疗中风后痉挛性偏瘫的RCT结局指标现存在命名、参考标准及测量时点不统一、使用频次不均衡、主次结局指标不明确和偏倚风险模糊等问题,国内学者理应参考国际经验,结合针刺的临床研究特点构建规范、统一的核心指标结局指标集。
