急性心肌梗死患者PCI治疗后一年内发生不良心血管事件的危险因素及其预测效能

目的 探讨急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后一年内发生不良心血管事件(MACE)的危险因素及其预测效能。方法 AMI患者100例,均行PCI,根据治疗后一年内是否发生MACE分为MACE(+)组(14例)和MACE(-)组(86例),采用单因素分析法、多因素Cox回归分析法分析AMI患者行PCI后一年内发生MACE的影响因素和危险因素,并通过ROC曲线和Kaplan-Meier生存曲线评估危险因素的预测效能。结果 单因素分析显示,两组非经典型单核细胞亚群(NCM)比例、Genisi评分、SYNTAX评分、LVESD比较,P均<0.05。多因素分析显示,NCM比例、Genisi评分是AMI患者行PCI后一年内发生MACE的独立危险因素(P均<0.05)。ROC曲线显示,当NCM比例为9.090%时,约等指数为0.756,其预测AMI患者行PCI后一年内发生MACE的灵敏度为100%,特异度为76.5%,ROC曲线下面积为0.880,95%CI为0.812~0.947,P<0.05;Kaplan-Meier生存曲线显示,以NCM比例的最佳截断值9.090%对AMI患者进行危险分层,NCM比例≥9.090%为低危患者,NCM比例<9.090%为高危患者。结论 AMI患者行经PCI后一年内发生MACE的危险因素是NCM比例,检测此指标有助于AMI患者术后MACE事件发生的预测。

基于关联规则的重症监护室患者气管插管非计划拔管事件特征性因素分析

目的:挖掘重症患者气管插管非计划拔管事件发生的关联因素,为重症监护室气管插管患者非计划拔管的预防与管理提供科学依据。方法:基于关联规则,对温州医科大学附属第一医院2018年1月1日至2021年8月31日上报的109例气管插管非计划拔管事件资料进行数据分析,探讨重症监护室患者气管插管非计划拔管的关联因素。结果:通过条件设定及χ2检验筛选出309条规则,结合护理专业知识,最终得到16条强关联规则。重症监护室患者气管插管非计划拔管事件中的风险因素包括拔管前约束不到位、气管插管持续留置1~2 d、未镇静、夜班、病区护患比<1/3、男性、年龄≥60岁、吸烟史、谵妄筛查低风险、神志清醒、躁动、文化程度小学、手术史、心动过速、体温高、神经系统疾病。结论:通过数据挖掘,获取了重症患者气管插管非计划拔管事件发生的各因素之间的关联规律,为重症监护室气管插管非计划拔管预防和管理体系的构建提供指导,确保气管插管患者的安全。

基于根因分析法的持续质量改进降低神经外科ICU非计划性拔管事件的作用

目的探讨基于根因分析法的持续质量改进降低神经外科ICU非计划性拔管事件(UEE)的作用。方法 2012年1月至2013年12月期间采用常规护理的神经外科ICU置管患者54例作为对照组,2014年1月至2016年1月期间采用常规护理联合基于根因分析法的持续质量改进神经外科ICU置管患者56例作为观察组。比较2组UEX事件发生率、护理舒适度、疼痛程度与护理满意度的差异。结果与对照组比较,观察组UEX发生率明显降低,轻度疼痛率相对增高,重度疼痛率明显降低,护理满意率明显增高,差异有统计学意义(P<0.05)。护理前,2组环境舒适、社会文化舒适、精神心理舒适与生理舒适等四个维度护理舒适度比较差异无统计学意义(P>0.05),护理后,观察组上述指标明显高于对照组,差异有统计学意义(P<0.05)。结论基于根因分析法的持续质量改进有助于显著降低神经外科ICU非计划性拔管事件,提高护理舒适度与护理质量,值得临床推广应用。

基于根因分析法的持续质量改进对神经外科重症患者非计划性拔管事件发生率的影响

目的:探讨基于根因分析法的持续质量改进对神经外科重症患者非计划性拔管事件发生率的影响。方法:选取2014年1月-2016年12月笔者所在医院收治的50例神经外科重症患者作为对照组,给予常规护理;选取2017年1月-2018年6月收治的50例神经外科重症患者作为研究组,给予基于根因分析法的持续质量改进护理。比较两组非计划性拔管事件发生率、疼痛程度、护理舒适度及护理满意度。结果:研究组非计划性拔管事件发生率、轻度疼痛、重度疼痛均优于对照组(P<0.05);两组无痛及中度疼痛比较,差异均无统计学意义(P>0.05);两组干预前护理舒适度各维度评分比较,差异均无统计学意义(P>0.05);两组干预后护理舒适度各维度评分均高于干预前,且研究组均高于对照组,差异均有统计学意义(P<0.05)。研究组护理满意度高于对照组,差异有统计学意义(P<0.05)。结论:基于根因分析法的持续质量改进在神经外科重症患者中应用可显著降低非计划性拔管事件发生率及患者疼痛程度,患者具有较高的护理舒适度及满意度。

基于仿真计算的城市管网爆管事件关阀策略

提出一种区别于广度优先搜索遍历算法的关阀策略。根据管道流体的流体力学性质,利用计算机管网仿真技术,采用基于网络元思想的水力计算方法,通过计算节点处的压力来判断需要关闭的阀门。将该方法与传统遍历算法进行对比发现,该方法计算效率提高了38.8%。提出的关阀策略在某市中压燃气管网的工程实践中得到有效应用。

根因分析法在降低神经外科患者意外拔管发生率中的应用效果研究

目的探讨根因分析法对神经外科患者意外拔管发生率的影响。方法选取2018年1月至2019年12月广西医科大学第十附属医院收治的300例置管的颅脑损伤患者为研究对象,采用随机数字表法分为观察组和对照组,每组各150例。对照组患者接受常规护理干预,观察组在对照组的基础上辅以根因分析法干预,两组患者均于入院后开始干预,出院时停止干预。分别采用视觉模拟评分法和舒适度量表评估两组患者的疼痛程度和舒适度。比较分析两组患者住院期间的非计划性拔管事件(unplanned extubation events,UEE)发生率、干预前后的疼痛情况、舒适度及干预后的护理满意率。结果观察组患者住院期间的UEE发生率为2.00%,对照组患者住院期间的UEE发生率为16.67%,观察组患者住院期间的UEE发生率显著低于对照组(P<0.05)。干预前,两组患者的疼痛程度比较差异无显著性(P>0.05);干预后,两组患者的疼痛程度均显著降低,且观察组患者的疼痛程度显著低于对照组(P<0.05)。干预前,两组患者的舒适度评分比较差异无显著性(P>0.05);干预后,两组患者的舒适度评分均显著升高,且观察组患者的舒适度评分显著高于对照组(P<0.05)。干预后,观察组患者的护理满意率显著高于对照组(P<0.05)。结论基于根因分析法的护理干预可有效降低UEE发生率,减轻患者疼痛程度,提高患者舒适度和护理满意率,值得临床应用。

不同剂量阿托伐他汀对急性心肌梗死患者血浆致动脉硬化指数及预后的影响

目的探讨不同剂量阿托伐他汀对急性心肌梗死（AMI）患者血浆致动脉硬化指数（AIP）及主要不良心血管事件（MACE）的影响。方法选取2015年1月至2016年1月于我院心内科住院主要诊断为AMI并完成随访的患者212例，随机分为标准治疗组（106例）和强化治疗组（106例）。所有患者均予以AMI的常规治疗。标准治疗组患者同时予以阿托伐他汀20mg／d口服，强化治疗组同时予以阿托伐他汀40mg／d口服。随访1年。比较两组患者治疗前后血脂、AIP、脉搏波传导速度（PWV）等指标的变化及MACE的发生。结果AMI患者AIP与PWv呈显著正相关（r=0．801，P〈0．05）。与治疗前比较，两组患者AIP指标均降低（0．22±0．05比0．34±0．06，0．17±0．05比0．33±0．06），强化治疗组患者颈动脉内中膜厚度减少[（1．41±0．18）mm比（1．10±0．17）mm]，差异有统计学意义（P〈0．05）。与标准治疗组比较，强化治疗组AIP指标变化更为显著（0．22±0．05比0．17±0．05），差异有统计学意义（P〈0．05）。两组不良反应发生率比较，差异无统计学意义（P〉0．05）。治疗1年后两组患者总的MACE发生比较（22．64％比11．32％），差异有统计学意义（P〈0．05）。结论阿托伐他汀强化治疗AMI，不仅可进一步降低患者血脂水平，还有更好的抗动脉硬化作用，能降低AMI后MACE的发生，值得临床推广应用。

Influence range of emergency under special events based on CTM

To determine the dynamic influence range of emergencies under special events, the spacial and temporal characteristics of the traffic flow are studied by simulation based on the cell transmission model （CTM）. Based on the traffic management measures used under special events, a semi-dynamic assignment algorithm is proposed, which is combined with an algorithm for logit multi-path traffic assignment and the CTM. In a simple calculation network, the spacial and temporal characteristics of traffic flows which vary with different traffic management schemes are studied, and a method to obtain the influence range of emergency is proposed by computing the jam time of the intersections. By contrasting the average delay of each vehicle, the dissipation effect is studied under two different traffic management schemes. The example shows that the spatial and temporal variety of the traffic flow can be easily simulated and the influence range of emergency can be confirmed by the method based on the CTM. The proposed method provides a new idea for decision-making on traffic management under emergency under special events.

Evaluation model for freeway incident management system

In order to evaluate the general situation and find special problems of the freeway incident management system, an evaluation model is proposed. First, the expert appraisal approach is used to select the primary evaluation index. As a result, 81 indices and the hierarchical structures of the index such as the object layer, the sub-object layer, the criterion layer and the index layer are determined. Then, based on the fuzzy characteristics of each index layer, the analytical hierarchy process（AHP）and the fuzzy comprehensive evaluation are applied to generate the weight and the satisfaction of the index and the criterion layers. When analyzing the relationship between the sub-object layer and the object layer, it is easy to find that the number of sub-objects is too large and sub-objects are significantly redundant. The partial least square （PLS） is proposed to solve the problems. Finally, an application example, whose result has already been accepted and employed as the indication of a new project in improving incident management, is introduced and the result verifies the feasibility and efficiency of the model.

Left atrial area index predicts adverse cardiovascular events in patients with unstable angina pectoris

Background The left atrial size has been considered as a useful marker of adverse cardiovascular outcomes. However, it is not well known whether left atrial area index （LAAI） has predictive value for prognosis in patients with unstable angina pectoris （UAP）. This study was aimed to assess the association between LAAI and outcomes in UAP patients. Methods We enrolled a total of 391 in-hospital patients diag- nosed as UAP. Clinical and echocardiographic data at baseline were collected. The patients were followed for the development of ad- verse cardiovascular （CV） events, including hospital readmission for angina pectoris, acute myocardial infarction （AMI）, congestive heart failure （CHF）, stroke and all-cause mortality. Results During a mean follow-up time of 26.3±8.6 months, 98 adverse CV events occurred （84 hospital readmission for angina pectoris, four AMI, four CHF, one stroke and five all-cause mortality）. In a multivariate Cox model, LAAI [OR： 1.140, 95% CI： 1.01±1.279, P = 0.026], diastolic blood pressure （OR： 0.976, 95% CI： 0.956-0.996, P = 0.020） and pulse pressure （OR 1.020, 95% CI： 1.007-1.034, P = 0.004） were independent predictors for adverse CV events in UAP patients. Conclusions LAAI is a predictor of adverse CV events independent of clinical and other echocardiographic parameters in UAP patients.

Serum uric acid as a prognostic marker in the setting of advanced vascular disease： a prospective study in the elderly

Background Many epidemiological studies analyze the relationship between hyperuricemia and cardiovascular outcomes. This observational prospective study investigates the association of serum uric acid （SUA） levels with adverse cardiovascular events and deaths in an elderly population affected by advanced atherosclerosis. Methods Two hundred and seventy six elderly patients affected by advanced atherosclerosis （217 males and 59 females; aged 71.2 ±7.8 years） were included. All patients were assessed for history of cardiovascular disease, cancer, obesity and traditional risk factors. Patients were followed for approximately 31 ±11 months. Major events were recorded during follow-up, defined as myocardial infarction, cerebral isehemia, myocardial and/or peripheral revascularization and death. Results Mean SUA level was 5.47 ±1.43 mg/dL; then we further divided the population in two groups, according to the median value （5.36 mg/dL）. During a median follow up of 31 months （5 to 49 months）, 66 cardiovascular events, 9 fatal cardiovascular events and 14 cancer-related deaths have occurred. The patients with increased SUA level presented a higher significant incidence of total cardiovascular events （HR： 1.867, P = 0.014, 95% CI： 1.134-3.074）, The same patients showed a significant increased risk of cancer-related death （HR： 4.335, P = 0.025, 95% CI： 1.204-15.606）. Conclusions Increased SUA levels are independently and significantly associated with risk of cardiovascular events and cancer related death in a population of mainly elderly patients affected by peripheral vasculopathy.

Comments to ＂Neutrophil-to-lymphocyte ratio compared to N-terminal pro- brain natriuretic peptide as a prognostic marker of adverse events in elderly patients with chronic heart failure＂

We have read the article which entitled ＂Neutrophil-to- lymphocyte ratio compared to N-terminal pro-brain natri- uretic peptide as a prognostic marker of adverse events in elderly patients with chronic heart failure＂ published in Journal of Geriatric Cardiology with great interest, However, we have some comments regarding this study.

Association between preoperative high sensitive troponin I levels and cardiovascular events after hip fracture surgery in the elderly

Objective Cardiovascular complications contribute to postoperative morbidity and mortality in elderly hip fracture patients. Limited data are available regarding which preoperative risk factors predict cardiovascular course following hip fracture surgery （HFS）. We used high sensitive troponin I （hs-TnI） assays and clinical parameters to identify preoperative risk factors associated with major adverse cardiac events （MACE） in elderly hip frac^u＇e patients. Method From August 2014 to November 2016, 575 patients with hip fracture were enrolled in a retrospective, single-center registry. A total of 262 of these patients underwent HFS and hs-TnI assays. MACE was defined as postoperative all-cause deaths, heart failure （HF）, new-onset atrial fibrillation （AF）, myocardial infarction （MI） and cardiovascular re-hospitalization that occurred within 90 days postoperative. Results Of 262 HFS patients, MACE developed following HFS in 65 （24.8%）. Patients with MACE were older and had higher rates of renal insufficiency, coronary artery disease, prior HF, low left ventricular ejection fraction and use of beta blockers; higher levels of hs-Tnl and N-terminal pro-brain natriuretic peptide （NT-proBNP） and higher revised cardiac risk index. A preoperative hs-TnI≥ 6.5 ng/L was associated with high risk of postoperative HF, new-onset AF and MACE. In multivariable analysis, pre-operative independent predictors for MACE were age 〉 80 years [adjusted hazard ratio （HR）： 1.79, 95% confident interval （CI）： 1.03-3.13, P = 0.04], left ventricular ejection fraction （LVEF） 〈 50% （adjusted HR： 3.17, 95% CI： 1.47-5.82, P 〈 0.01） and hs-TnI 〉 6.5 ng/L （adjusted HR： 3.75, 95% CI： 2.09~5.17, P 〈 0.01）. Conclusion In elderly patients with hip fracture who undergo HFS, a preoperative assessment of hs-TnI may help the risk refinement of cardiovascular complications.

Effects of adjuvant Chinese patent medicine therapy on major adverse cardiovascular events in patients with coronary heart disease angina pectoris:a population-based retrospective cohort study

Objective: This study aimed to explore the effects of Chinese patent medicine(CPM) in reducing the incidence of major adverse cardiovascular events(MACE) in patients with coronary heart disease(CHD) angina pectoris and improving clinical effectiveness and provide evidence for its use as clinical adjuvant therapy.Methods: Twenty-eight thousand five hundred and seventeen patients hospitalized with CHD angina pectoris from 6 hospitals were divided into CPM group(n = 11,374) and non-CPM group(n = 17,143) to evaluate the incidence of MACE, including myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting.Results: The incidence of MACE in the CPM group was lower than that in the non-CPM group. CPM therapy was an independent protective factor that reduced the overall risk of MACE [adjusted hazard ratio = 0.40, 95% confidence interval(0.33;0.49)]. Patients in the CPM group who received one, two, or three types of CPM could benefit from adjuvant treatment with CPM, and taking more types of CPM was associated with a lower risk of MACE. In addition, the male population was better than the female population at taking CPM, and middle-aged people aged 55 to 64 were more suited to take CPM based on Western medicine.Conclusions: The use of CPM as adjuvant therapy can decrease the occurrence of MACE in patients with CHD angina pectoris,especially in men and middle-aged people, and the drug treatment plan should be optimized accordingly. However, this conclusion needs further verification by prospective cohort studies in the future.

Sentiment classification model for bullet screen based on self-attention mechanism

With the development of short video industry,video and bullet screen have become important ways to spread public opinions.Public attitudes can be timely obtained through emotional analysis on bullet screen,which can also reduce difficulties in management of online public opinions.A convolutional neural network model based on multi-head attention is proposed to solve the problem of how to effectively model relations among words and identify key words in emotion classification tasks with short text contents and lack of complete context information.Firstly,encode word positions so that order information of input sequences can be used by the model.Secondly,use a multi-head attention mechanism to obtain semantic expressions in different subspaces,effectively capture internal relevance and enhance dependent relationships among words,as well as highlight emotional weights of key emotional words.Then a dilated convolution is used to increase the receptive field and extract more features.On this basis,the above multi-attention mechanism is combined with a convolutional neural network to model and analyze the seven emotional categories of bullet screens.Testing from perspectives of model and dataset,experimental results can validate effectiveness of our approach.Finally,emotions of bullet screens are visualized to provide data supports for hot event controls and other fields.

Hydrological Processes in the Huaihe River Basin, China： Seasonal Variations, Causes and Implications

Understanding streamflow changes in terms of trends and periodicities and relevant causes is the first step into scientific management of water resources in a changing environment. In this study, monthly streamflow variations were analyzed using Modified Mann-Kendall(MM-K) trend test and Continuous Wavelet Transform(CWT) methods at 9 hydrological stations in the Huaihe River Basin. It was found that: 1) streamflow mainly occurs during May to September, accounting for 70.4% of the annual total streamflowamount with Cv values between 0.16–0.85 and extremum ratio values between 1.70–23.90; 2) decreased streamflow can be observed in the Huaihe River Basin and significant decreased streamflow can be detected during April and May, which should be the results of precipitation change and increased irrigation demand; 3) significant periods of 2–4 yr were detected during the 1960 s, the 1980 s and the 2000 s. Different periods were found at stations concentrated within certain regions implying periods of streamflow were caused by different influencing factors for specific regions; 4) Pacific Decadal Oscillation(PDO) has the most significant impacts on monthly streamflow mainly during June. Besides, Southern Oscillation Index(SOI), North Atlantic Oscillation(NAO) and the Ni?o3.4 Sea Surface Temperature(Ni?o3.4) have impacts on monthly streamflow with three months lags, and was less significant in time lag of six months. Identification of critical climatic factors having impacts on streamflow changes can help to predict monthly streamflow changes using climatic factors as explanatory variables. These findings were well corroborated by results concerning impacts of El Nino-Southern Oscillation(ENSO) regimes on precipitation events across the Huaihe River Basin. The results of this study can provide theoretical background for basin-scale management of water resources and agricultural irrigation.

Influenza vaccination in acute coronary syndromes patients in Thailand： the cost-effectiveness analysis of the prevention for cardiovascular events and pneumonia

Background Influenza vaccination has been clinically shown to reduce adverse cardiovascular outcomes in acute coronary syndrome （ACS） patients, but the economic perspectives can provide important data to make informed decisions. This study aimed to perform the economic evaluation of lifelong annual influenza vaccination for cardiovascular events and well-established pneumonia prevention. Methods Lifetime costs, life-expectancy, and quality-adjusted live years （QALYs） were estimated beyond one-year cycle length of a six-health states Markov model condition on whether a hospitalization for ACS, stroke, heart failure, pneumonia, no hospitalizations occurred, or death. The comparison of three age-groups of 40-49, 50-65, and 〉 65 years scenario was performed. Incremental cost-effectiveness ratio （ICER） and net monetary benefit （NMB） were presented as a societal perspective in 2016. The model robustness was determined by one-way and prob- abilistic sensitivity analyses. Results The influenza vaccination was cost-effective in all age-groups, by dominant ICERs （lower cost with higher effectiveness） which was completely lower than acceptable willingness-to-pay threshold of Thailand [160,000 THB （4,466.8 USD） per QALYs], with a great incremental value of NMB. Especially, the 50-year-old-and- above scenario was shown as the most benefit at 129,092 THB （3,603.9 USD） for each patient. Conclusions The annually additional influenza vaccination to standard treatment in ACS was cost-effective in all age-groups, which should be considered in clinical practice and health-policy making process.

The relationship between neutrophil-to-lymphocyte ratio and major cardiovascular events in elderly patients with chronic heart failure

We have read with great interest a reader＇s letter that ad- dresses several important topics.

South Africa＇s Nuclear Forensics Response Plan Step 1 - in Support of Nuclear Security Investigations

In South Africa, the nuclear forensics approach and its functions hosted and managed by Necsa, in support of any nuclear security investigations, start from the incident scene when the nuclear or radioactive material （that is out of regulatory control） is being handled and handed over to Necsa Emergency Control Centre by the South African law enforcement agencies in the presence of NOMS Department official. The main objective of this approach is to increase the credibility status of the chain of custody on the handling of the material during incident （crime） scene management process （for both nuclear forensics and traditional forensic evidence collection） and its transportation from the scene to the suitable storage facility at Necsa. Aspects to be looked into during the response process include interactions between law enforcement agencies, Necsa relevant departments and the National Nuclear Regulator of South Africa. This paper focuses on the entire whole response process and associated prior arrangements, in order to show and provide a set of requirements attached to the material, the scope of critical relevant technical and law enforcement information that to be acquired by all parties involving and participating in the nuclear/radiological incident or event response process before the material is authorized for storage at a suitably qualified Necsa＇s nuclear forensics, which is dedicated storage facility on Pelindaba site.

Beneficial clinical effects of grape seed proanthocyanidin extract on the progression of carotid atherosclerotic plaques

Background Atherosclerotic plaques indicate the occurrence of ischemia events and it is a difficult task for clinical physicians. Grape seed proanthocyanidin extract （GSPE） has been reported to exert an antiatherogenic effect by inducing regression of atherosclerotic plaques in animal experimental studies. In this study, the antiatherogenic effect of GSPE has been investigated in clinical use. Methods Consecu- tive 287 patients diagnosed with asymptomatic carotid plaques or abnormal plaque free carotid intima-media thickness （CIMT） were ran- domly assigned to the GSPE group （n = 146） or control group （n = 141）. The patients in the GSPE group received GSPE 200 mg per day orally, while patients in the control group were only enrolled in a lifestyle intervention program. Carotid ultrasound examination was per- formed at baseline and 6, 12, 24 months during follow-up. Mean maximum CIMT （MMCIMT）, plaque score, echogenicity of plaques and ischemic vascular events were recorded. Results As anticipated, after treatment, GSPE resulted in significant reduction in MMCIMT pro- gression （4.2% decrease after six months, 4.9% decrease after 12 months and 5.8% decrease after 24 months） and plaque score （10.9% de- crease after six months, 24.1% decrease after 12 months and 33.1% decrease after 24 months） for the primary outcome, while MMCIMT and plaque score were stable and even increased with the time going on in control group. The number of plaques and unstable plaques also de- creased after treatment of GSPE. Furthermore, the carotid plaque can disappear after treatment with GSPE. The incidence rate for transitory ischemic attack （TIA）, arterial revascularization procedure, and hospital readmission for unstable angina in GSPE group were statistically significant lower （P = 0.02, 0.08, 0.002, respectively） compared with the control group. Conclusions GSPE inhibited the progression of MMCIMT and reduced carotid plaque size in GSPE treated patients, and with extended treatment, the superior efficacy on MMCIMT and carotid plaque occurred. Furthermore, the GSPE group showed lower rates of clinical vascular events.