GIDS在老年AECOPD呼吸衰竭患者病情及预后评估中的应用

目的 探讨胃肠道功能障碍评分(GIDS)与老年慢性阻塞性肺疾病急性加重期(AECOPD)呼吸衰竭患者疾病严重程度的相关性及对预后的预测价值,为疾病严重程度和预后评估提供参考依据。方法 收集2020年1月至2023年8月于该院ICU治疗的264例老年AECOPD呼吸衰竭患者作为研究对象。根据患者GIDS,将患者分为低GIDS组(0~1分)和高GIDS组(2~4分)。比较不同GIDS组患者急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分和序贯器官衰竭评估(SOFA)评分,以及患者住院结局指标,包括机械通气时间、ICU入住时间和预后情况。采用Spearman相关分析GIDS与APACHEⅡ评分、SOFA评分的相关性。采用受试者工作特征(ROC)曲线分析GIDS对预后的预测价值。结果 264例老年AECOPD呼吸衰竭患者GIDS为2.00(1.00,3.00)分,其中0分53例(20.1%),1分65例(24.6%),2分53例(20.1%),3分45例(17.0%),4分48例(18.2%)。高GIDS组APACHEⅡ评分和SOFA评分高于低GIDS组(P<0.05)。Spearman相关性分析结果显示,GIDS与APACHEⅡ评分、SOFA评分均呈正相关(r=0.458、0.392,P<0.05)。高GIDS组机械通气时间、ICU入住时间长于低GIDS组,预后不良发生率高于低GIDS组,差异均有统计学意义(P<0.05)。ROC曲线结果显示,GIDS预测老年AECOPD呼吸衰竭患者预后不良的曲线下面积为0.823,灵敏度和特异度分别为93.4%和60.1%。结论 老年AECOPD呼吸衰竭患者GIDS与疾病严重程度密切相关,该评分对患者预后不良具有良好的预测价值。

Plant Disease Severity Assessment Based on Machine Learning and Deep Learning: A Survey

The world’s agricultural production suffers huge losses estimated between 20% and 40% annually. 40% to 50% of such losses are due to pest and diseases which cause significant economic losses every year. Precise assessment of severity is crucial for suitable management of crop diseases. It helps famers to avoid yield losses, reduce production costs, ensure good disease management and so on. This paper is a review of plant diseases severity estimation solutions proposed by researchers the last few years and based on Image Processing Techniques (IPT), classical Machine Learning (ML) and Deep Learning (DL) algorithms. The analysis of these solutions has allowed us to identify their limitations and potential challenges in plant disease severity assessment.

老年重症肺炎并发ARDS患者血清miR-27a、FOXO3与疾病严重程度及预后的关系

目的分析老年重症肺炎并发急性呼吸窘迫综合征(ARDS)患者血清微小核糖核酸(miRNA)-27a、叉头框蛋白O3(FOXO3)与疾病严重程度及预后的关系。方法选取2022年10月—2023年9月上海市静安区中心医院重症医学科收治老年重症肺炎并发ARDS患者108例(ARDS组)和老年重症肺炎未并发ARDS患者72例(非ARDS组),ARDS组患者再根据氧合指数分为轻度亚组26例、中度亚组34例、重度亚组48例,并根据28 d预后情况分为死亡亚组33例、存活亚组75例;另选取同期体检健康志愿者60例为健康对照组。采用实时荧光定量聚合酶链式反应检测血清miR-27a、FOXO3水平,TargetScan数据库预测miR-27a与FOXO3的结合位点。通过Pearson/Spearman相关性分析血清miR-27a与FOXO3 mRNA水平的相关性,多因素Logistic回归分析老年重症肺炎并发ARDS患者预后的影响因素,受试者工作特征(ROC)曲线分析血清miR-27a、FOXO3 mRNA水平对老年重症肺炎并发ARDS患者死亡的预测价值。结果健康对照组、非ARDS组、ARDS组血清miR-27a水平依次降低,FOXO3 mRNA水平依次升高(F/P=77.352/<0.001、62.956/<0.001);轻度亚组、中度亚组、重度亚组血清miR-27a水平依次降低,FOXO3 mRNA水平依次升高(F/P=83.597/<0.001、111.833/<0.001);miR-27a与FOXO3的3’-非翻译区3257~3264处存在结合位点。老年重症肺炎并发ARDS患者血清miR-27a与FOXO3 mRNA水平呈负相关(r/P=-0.736/<0.001),氧合指数与血清miR-27a水平呈正相关,与FOXO3 mRNA水平呈负相关(r/P=0.751/<0.001、-0.785/<0.001)。老年重症肺炎并发ARDS患者28 d死亡率为30.56%(33/108)。年龄增加、机械通气时间延长、FOXO3 mRNA升高为影响老年重症肺炎并发ARDS患者预后的独立危险因素[OR(95%CI)=1.199(1.033~1.393)、1.547(1.009~2.373)、1.108(1.040~1.180)],氧合指数升高、miR-27a升高为独立保护因素[OR(95%CI)=0.973(0.958~0.989)、0.903(0.844~0.965)];血清miR-27a、FOXO3 mRNA水平及二者联合预测老年重症肺炎并发ARDS患者死亡的曲线下面积分别为0.784、0.786、0.879,二者联合的AUC大于血清miR-27a、FOXO3 mRNA水平单独预测(Z/P=2.550/0.011、2.963/0.003)。结论老年重症肺炎并发ARDS患者血清miR-27a水平降低,FOXO3 mRNA水平升高,与疾病加重和预后不良密切相关,二者联合预测老年重症肺炎并发ARDS患者死亡的价值较高。

Relationship between nutritional therapy and beneficial bacteria ratio in severe disease

Objective:To evaluate relationship between changes in the beneficial bacteria in intensive care unit(ICU)patients and nutritional therapy type.Methods:Ten patients aged≥18 years admitted to the ICU between January and December 2020,were included.Good enteral nutrition was defined as early achievement of target calorie intake through enteral feeding.The ratio of beneficial bacteria at the first and second bowel movements after each patient’s admission was calculated and the patients were classified into the increase or decrease group.Among all patients,five each were in the increase and decrease groups.We investigated patient background,changes in sequential organ failure assessment(SOFA)and acute physiology and chronic health evaluation(APACHE)Ⅱscores,nutritional doses or methods,and clinical outcomes.Results:No relationship was found between changes in the ratio of beneficial bacteria and changes in SOFA/APACHEⅡscores at the time of admission.The rate of good enteral nutrition was significantly higher in the increase group than in the decrease group(4/5 vs.0/5,P=0.01).Conclusions:An increase in beneficial bacteria may be significantly related to the early establishment of enteral nutrition.In the future,accumulating cases may make it possible to establish a new nutritional strategy for critically ill patients from an intestinal microbiota perspective.

Determination of serum inflammatory factors in different pathogenic bloodstream infections and judgment value on the degree of disease severity and prognosis

Objective: To investigate the serum inflammatory cytokines expression in different pathogens and to explore the value of serum inflammatory cytokines in judging the severity of disease and assessing prognosis. Methods: We retrospectively analyzed 90 cases of bloodstream infections admitted to our hospital from October 2016 to November 2017 and regarded it as observation group, while the control group was 80 patients with negative blood cultures over the same period. Serum inflammatory factors PCT, C-reactive protein (CRP), white blood cell count (WBC), neutrophil percentage (NEUT) and Endotoxin levels were compared between the two groups.The levels of serum inflammatory factors PCT, CRP, WBC, NEUT and Endotoxin in patients with Gram-positive(G+), Gram-negative (G-), treatment improvement and treatment ineffective group were compared. Result: The levels of PCT, CRP, WBC, NEUT and Endotoxin in patients with positive blood flow culture were significantly higher than those with negative blood culture. Compared with the G+ group, the levels of PCT, CRP, WBC and Endotoxin in the G- group were significantly higher. There was no significant difference in the level of NEUT in two groups. Compared with the treatment-ineffective group, the therapeutic improvement group PCT, CRP, WBC, NEUT and Endotoxin levels decreased significantly. The levels of PCT, CRP, WBC,NEUT and endotoxin in patients with moderate and severe bloodstream infections were significantly higher than those with mild infections;the levels of PCT, CRP, WBC, NEUT and endotoxin in patients with moderate infection were significantly higher than those with mild infections, and all has statistical significance. Conclusion:PCT, CRP, WBC, NEUT and Endotoxin can be used as auxiliary diagnostic indicators of bloodstream infections, which can be used to judge the severity of bloodstream infection and evaluate the prognosis.

Predictors of disease severity in ulcerative colitis patients from Southwestern Ontario

AIM:To understand the demographic characteristics of patients in Southwestern Ontario,Canada with ulcerative colitis(UC)in order to predict disease severity. METHODS:Records from 1996 to 2001 were exam- ined to create a database of UC patients seen in the London Health Sciences Centre South Street Hospital Inflammatory Bowel Disease Clinic.To be included, patients'charts were required to have information of their disease presentation and a minimum of 5 years of follow-up.Charts were reviewed using standardized data collection forms.Disease severity was generated during the chart review process,and non-endoscopic Mayo Score criteria were collected into a composite. RESULTS:One hundred and two consecutive patients'data were entered into the database.Demographic analyses revealed that 51%of the patients were male, the mean age at diagnosis was 39 years,13.7%had a first degree relative with inflammatory bowel disease (IBD),61.8%were nonsmokers and 24.5%were ex-smokers.In 22.5%of patients the disease was limited to the rectum,in 21.6%disease was limited to the sigmoid colon,in 22.5%disease was limited to the left colon,and 32.4%of patients had pancolitis. Standard multiple regression analysis which regressed a composite of physician global assessment of disease severity,average number of bowel movements,and average amount of blood in bowel movements on year of diagnosis and age at time of diagnosis was significant,R 2=0.306,F(7,74)=4.66,P<0.01. Delay from symptoms to diagnosis of UC,gender, family history of IBD,smoking status and disease severity at the time of diagnosis didnot significantly predict the composite measure. CONCLUSION:UC severity is associated with younger age at diagnosis and year of diagnosis in a longitudinal cohort of UC patients,and may identify prognostic UC indicators.

Quantitative computed tomography analysis for stratifying the severity of Coronavirus Disease 2019

To examine the feasibility of using a computer tool for stratifying the severity of Coronavirus Disease 2019(COVID-19)based on computed tomography(CT)images.We retrospectively examined 44 confirmed COVID-19 cases.All cases were evaluated separately by radiologists(visually)and through an in-house computer software.The degree of lesions was visually scored by the radiologist,as follows,for each of the 5 lung lobes:0,no lesion present;1,<1/3 involvement;2,>1/3 and<2/3 involvement;and 3,>2/3 involvement.Lesion density was assessed based on the proportion of ground-glass opacity(GGO),consolidation and fibrosis of the lesions.The parameters obtained using the computer tool included lung volume(mL),lesion volume(mL),lesion percentage(%),and mean lesion density(HU)of the whole lung,right lung,left lung,and each lobe.The scores obtained by the radiologists and quantitative results generated by the computer software were tested for correlation.A Chi-square test was used to test the consistency of radiologist-and computer-derived lesion percentage in the right/left lung,upper/lower lobe,and each of the 5 lobes.The results showed a strong to moderate correlation between lesion percentage scores obtained by radiologists and the computer software(r ranged from 0.7679 to 0.8373,P<0.05),and a moderate correlation between the proportion of GGO and mean lesion density(r=-0.5894,P<0.05),and proportion of consolidation and mean lesion density(r=0.6282,P<0.05).Computer-aided quantification showed a statistical significant higher lesion percentage for lower lobes than that assessed by the radiologists(x^2=8.160,P=0.004).Our experiments demonstrated that the computer tool could reliably and accurately assess the severity and distribution of pneumonia on CT scans.

Relationship between high sensitivity C-reactive protein and angiographic severity of coronary artery disease

Background Coronary artery disease(CAD)remains a leading cause of morbidity and mortality.Cytokines play a potential role in atherosclerosis pathogenesis and progression.We investigated the association between high sensitive C-reactive protein(hs CRP)and severity of CAD.Methods CAD patients were stratified according to hs CRP cut-off value into high levels hs CRP group(≥8.4 mg/L)and low levels hs CRP group(<8.4 mg/L).Severity of CAD was assessed according to artery stenosis degree and the number of vessel involved.Statistical analysis was performed using Statistical Package for the Social Sciences(SPSS,version 23.0).Results The mean age was 60.3±11.0 years.The level of hs CRP was increased and ranged from 0.2 to 1020.0 mg/L.Biochemical risk factors and severity of CAD didn’t show significant differences between the two groups.In multivariate linear analysis,cardiac troponin I(c Tn I)and serum amyloid A(SAA)were predictors of hs CRP.As shown in receiver operating characteristic(ROC)curve analysis performed in patients with ST-segment elevation myocardial infarction(STEMI)and compared to myonecrosis biomarkers,hs CRP(area under the curve(AUC):0.905;95%CI:0.844-0.966;P<0.001)could be a powerful predictor marker in evaluating the infarct size after myocardial infarction but not better than c Tn I.Conclusions Hs CRP levels were not associated with the severity of CAD but could be useful in the evaluation of myocardial necrosis in patients with STEMI.

Characterizing and Estimating Fungal Disease Severity of Rice Brown Spot with Hyperspectral Reflectance Data

Large-scale farming of agriculture crops requires real-time detection of disease for field pest management. Hyperspectral remote sensing data generally have high spectral resolution, which could be very useful for detecting disease stress in green vegetation at the leaf and canopy levels. In this study, hyperspectral reflectances of rice in the laboratory and field were measured to characterize the spectral regions and wavebands, which were the most sensitive to rice brown spot infected by Bipolaris oryzae （Helminthosporium oryzae Breda. de Hann）. Leaf reflectance increased at the ranges of 450 to 500 nm and 630 to 680 nm with the increasing percentage of infected leaf surface, and decreased at the ranges of 520 to 580 nm, 760 to 790 nm, 1550 to 1750 nm, and 2080 to 2350 nm with the increasing percentage of infected leaf surface respectively. The sensitivity analysis and derivative technique were used to select the sensitive wavebands for the detection of rice brown spot infected by B. oryzae. Ratios of rice leaf reflectance were evaluated as indicators of brown spot. R669/R746 （the reflectance at 669 nm divided by the reflectance at 746 nm, the following ratios may be deduced by analogy）, R702/R718, R692/R530, R692/R732, R535/R746, R521/R718, and R569/R718 increased significantly as the incidence of rice brown spot increased regardless of whether it＇s at the leaf or canopy level. R702/R718, R692/R530, R692/R732 were the best three ratios for estimating the disease severity of rice brown spot at the leaf and canopy levels. This result not only confirms the capability of hyperspectral remote sensing data in characterizing crop disease for precision pest management in the real world, but also testifies that the ratios of crop reflectance is a useful method to estimate crop disease severity.

Magnetic resonance imaging and Crohn's disease endoscopic index of severity: Correlations and concordance

AIM To examine the correlation between magnetic resonance imaging(MRI) and endoscopic index of severity(CDEIS) in patients with Crohn's disease(CD).METHODS This was a retrospective study of 104 patients with CD that were treated at the Ruijin Hospital between March 2015 and May 2016. Among them, 61 patients with active CD were evaluated before/after treatment. MRI and endoscopy were performed within 7 d. CDEIS was evaluated. MRI parameters included Ma RIA scores, total relative contrast enhancement(tRCE), arterialRCE(aRCE), portalRCE(pRCE), delay phaseRCE(dRCE), and apparent diffusion coefficient. The correlation and concordance between multiple MRI findings and CDEIS changes before and after CD treatment were examined.RESULTS Among the 104 patients, 61 patients were classified as active CD and 43 patients as inactive CD. Gender, age, disease duration, and disease location were not significantly different between the two groups(all P > 0.05). CRP levels were higher in the active group than in the inactive group(25.12 ± 4.12 vs 5.14 ± 0.98 mg/L, P < 0.001). Before treatment, the correlations between CDEIS and MaRIAs in all patients were r = 0.772 for tRCE, r = 0.754 for aRCE, r = 0.738 for pRCE, and r = 0.712 for dRCE(all MaRIAs, P < 0.001), followed by MRI single indexes. Among the active CD patients, 44 cases were remitted to inactive CD after treatment. The correlations between CDEIS and MaRIAs were r = 0.712 for aRCE, r = 0.705 for tRCE, r = 0.685 for pRCE, and r = 0.634 for dRCE(all MaRIAs, P < 0.001).CONCLUSION Arterial Ma RIA should be an indicator for CD follow-up and dynamic assessment. CD treatment assessment was not completely concordant between CDEIS and MRI.

Quantification of Tc-99m-ethyl cysteinate dimer brain single photon emission computed tomography images using statistical probabilistic brain atlas in depressive end-stage renal disease patients:Correlation with disease severity and symptom factors

This study adapted a statistical probabilistic anatomical map of the brain for single photon emission computed tomography images of depressive end-stage renal disease patients. This research aimed to investigate the relationship between symptom clusters, disease severity, and cerebral blood flow. Twenty-seven patients （16 males, 11 females） with stages 4 and 5 end-stage renal disease were enrolled, along with 25 healthy controls. All patients underwent depressive mood assessment and brain single photon emission computed tomography. The statistical probabilistic anatomical map images were used to calculate the brain single photon emission computed tomography counts. Asymmetric index was acquired and Pearson correlation analysis was performed to analyze the correlation between symptom factors, severity, and regional cerebral blood flow. The depression factors of the Hamilton Depression Rating Scale showed a negative correlation with cerebral blood flow in the left amygdale. The insomnia factor showed negative correlations with cerebral blood flow in the left amygdala, right superior frontal gyrus, right middle frontal gyrus, and left middle frontal gyrus. The anxiety factor showed a positive correlation with cerebral glucose metabolism in the cerebellar vermis and a negative correlation with cerebral glucose metabolism in the left globus pailidus, right inferior frontal gyrus, both temporal poles, and left parahippocampus. The overall depression severity （total scores of Hamilton Depression Rating Scale） was negatively correlated with the statistical probabilistic anatomical map results in the left amygdala and right inferior frontal gyrus. In conclusion, our results demonstrated that the disease severity and extent of cerebral blood flow quantified by a probabilistic brain atlas was related to various brain areas in terms of the overall severity and symptom factors in end-stage renal disease patients.

miR-125b, miR-200c Are Correlated with the Severity of Interstitial Lung Disease in Dermatomyositis/Polymyositis

Objective: To explore the correlations between miR-125b, miR-200c, and the severity of interstitial lung disease associated with dermatomyositis/polymyositis (DM/PM-ILD). Methods: 30 consecutive patients with DM/PM and 23 healthy controls were recruited into current study. Anti-JO-1, anti-SSA, muscle enzymes, the data of chest HRCT and pulmonary function test were collected. 9 consecutive DM/PM-ILD patients underwent bronchoalveolar lavage (BAL). TGF-β1 and surfactant protein D (SP-D) in BAL fluid (BALF) and plasma were detected by ELISA. miR-125b and miR-200c in PBMCs and bronchoalveolar cells were detected by QRT-PCR. All patients were classified into three groups: Mild or non-ILD group, moderate ILD group, and severe ILD group. The correlations between miRNAs and the severity of ILD, the lung damage markers, auto-antibodies, were analyzed. Results: The levels of miR-125b and miR-200c in bronchoalveolar cells were higher than in PBMCs, and the levels of TGF-β1 and SP-D were higher in BALF than in plasma in DM/PM-ILD patients. There were positive correlations between miR-125b, miR-200c in bronchoalveolar cells and SP-D in BALF. The levels of miR-125b and miR-200c in severe ILD group were higher than in mild or non-ILD and moderate ILD groups. There were negative correlations between miR-125b, miR-200c, and FEV1, and between miR-200c and DLCO. The patients with anti-JO-1 antibody had higher levels of miR-125b and miR-200c, and had more severe condition of ILD. Conclusion: miR-125b and miR-200c were positively correlated with the lung damage and severity of ILD in DM/PM, which could be important markers for judgement of disease condition in clinic.

Histone H1/MBP hydrolysing antibodies - novel potential marker in diagnosis of disease severity in systematic lupus erythematosus patients

Recently we have shown the presence of catalytically active IgGs, capable to cleave histone H1 and bovine myelin basic protein (MBP), in blood serum of SLE patients. Here we present data that demonstrate the correlation between a) proteolytic activity towards histone H1 and MBP of IgG-antibodies from blood serum of SLE patients and b) disease severity level in these patients. IgGs were isolated from blood serum by chromatography on protein G-sepharose. Commercial preparations of bovine myelin basic proteins (MBP) and calf thymus histone H1 were used as substrates. Analysis of the proteolytic activity showed that 16 of 38 lgG-preparations (42,1%) obtained from blood serum of SLE patients were capable of cleaving both histone H1 and MBP with different efficiency. It was revealed that the presence in blood serum of lgGs possessing proteolytic activity towards both histone H1 and bMBP closely correlates with manifestation of the disease severity in SLE patients.

Circulating miR-125a but not miR-125b is decreased in active disease status and negatively correlates with disease severity as well as inflammatory cytokines in patients with Crohn's disease

AIM To determine the association of circulating mi R-125 a/b expression with the risk and disease severity of Crohn's disease(CD), and with inflammatory cytokines.METHODS Plasma samples were collected from patients with active CD(A-CD), or CD in remission(R-CD) and from healthy controls(HCs). The levels of the inflammatory cytokines interleukin-17(IL-17), tumour necrosis factor-α(TNF-α), and interferon-γ(IFN-γ) were measured by enzyme-linked immunosorbent assay. The expression of mi R-125 a/b was assessed by quantitative polymerase chain reaction(q PCR).RESULTS Twenty-nine A-CD patients, 37 R-CD patients, and 37 HCs were included in the study. Plasma mi R-125 a expression was decreased in A-CD patients comparedwith that in R-CD patients(P < 0.001) and HCs(P < 0.001). mi R-125 a expression levels enabled the differentiation of A-CD from R-CD patients [area under curve(AUC) = 0.854] and from HCs(AUC = 0.780), whereas mi R-125 b expression did not. mi R-125 a was negatively correlated with C-reaction protein(CRP)(P = 0.017), erythrocyte sedimentation rate(ESR)(P = 0.026), Crohn's disease activity index(CDAI)(P = 0.003), IL-17(P = 0.015), and TNF-α(P = 0.004) in A-CD patients. Furthermore, mi R-125 a was negatively associated with CRP(P = 0.038) and CDAI(P = 0.021) in R-CD patients. Regarding mi R-125 b, no association with CRP, CDAI, IL-17, TNF-α, or IFN-γ was found in A-CD or in R-CD patients. mi R-125 a levels gradually increased in A-CD patients who achieved clinical remission(P = 0.009) after 3-mo treatment, whereas they remained unchanged among patients who failed to achieve remission. No changes in mi R-125 b expression were detected in remission or non-remission patients after treatment. CONCLUSION Circulating mi R-125 a but not mi R-125 b is decreased in patients with active disease status and negatively correlates with disease severity and inflammatory cytokines in patients with CD.

Coronavirus disease 2019 severity in obesity:Metabolic dysfunctionassociated fatty liver disease in the spotlight

The coronavirus disease 2019(COVID-19)outbreak has drawn the scientific community's attention to pre-existing metabolic conditions that could aggravate the infection,causing extended viral shedding,prolonged hospitalization,and high death rates.Metabolic dysfunction-associated fatty liver disease(MAFLD)emerges as a surrogate for COVID-19 severity due to the constellation of metabolic alterations it entails.This review outlines the impact MAFLD exerts on COVID-19 severity in obese subjects,besides the possible mechanistic links to the poor outcomes.The data collected showed that MAFLD patients had poorer COVID-19 outcomes than non-MAFLD obese subjects.MAFLD is generally accompanied by impaired glycemic control and systemic arterial hypertension,both of which can decompensate during the COVID-19 clinical course.Also,MAFLD subjects had higher plasma inflammatory marker concentrations than non-MAFLD subjects,which might be related to an intensified cytokine storm syndrome frequently associated with the need for mechanical ventilation and death.In conclusion,MAFLD represents a higher risk than obesity for COVID-19 severity,resulting in poor outcomes and even progression to non-alcoholic steatohepatitis.Hepatologists should include MAFLD subjects in the high-risk group,intensify preventive measurements,and prioritize their vaccination.

Correlation between severity of endoscopic findings and apnea-hypopnea index in patients with gastroesophageal reflux disease and obstructive sleep apnea

AIM: To assess the relationship between severity of gastroesophageal reflux disease and apnea-hypopnea index (AHI) as an indicator of the severity of obstructive sleep apnea.METHODS: Data of 57 patients with proven obstructive sleep apnea and gastroesophageal reflux disease were analyzed. Patients were divided into two groups according to severity of the sleep apnea: 'mild-moderate' (A)-AHI ≥5-30, n = 27, 'severe' (B)-AHI ＞30, n = 30. All patients underwent apnea monitoring during the night, upper panendoscopy and were asked about typical reflux symptoms.RESULTS: All examined patients in both groups showed a significant overweight and there was a positive correlation between body mass index and the degree of sleep apnea (P = 0.0002). The occurence of erosive reflux disease was significantly higher in 'severe' group (P = 0.0001).Using a logistic regression analysis a positive correlation was found between the endoscopic severity of reflux disease and the AHI (P = 0.016). Forty-nine point five percent of the patients experienced the typical symptoms of reflux disease at least three times a week and there was no significant difference between the two groups.CONCLUSION: A positive correlation can be found between the severity of gastroesophageal reflux disease and obstructive sleep apnea.

TCCD技术诊断急性缺血性脑卒中颈动脉狭窄与DSA一致性及其参数评估病情价值分析

目的 探究经颅彩色多普勒超声(TCCD)技术诊断急性缺血性脑卒中(AIS)颈动脉狭窄与数字减影血管造影(DSA)一致性及其参数评估病情价值。方法 选取成都市第六人民医院2019年10月—2021年8月80例AIS患者,均行TCCD检查,以DSA为金标准,分析其诊断颈动脉狭窄与DSA一致性,并评价其参数[舒张末期血流速度(EDV)、收缩期峰值流速(PSV)、平均血流速度(MV)、搏动指数(PI)]对病情的评估价值。结果 经DSA检查证实,颈动脉轻度狭窄19例,中度狭窄28例,重度狭窄30例,闭塞3例;TCCD检查显示,颈动脉轻度狭窄20例,中度狭窄30例,重度狭窄27例,闭塞3例。一致性分析,TCCD诊断AIS患者颈动脉狭窄与DSA一致性较高(Kappa值=0.872,95%CI:0.726~1.017,P<0.001);重度损伤患者EDV、PSV、MV低于中度、轻度损伤患者,中度损伤患者低于轻度损伤患者;重度损伤患者PI高于中度、轻度损伤患者,中度损伤患者高于轻度损伤患者(P<0.05)。Perason相关性分析显示,EDV、PSV、MV与病情程度呈负相关,PI与病情程度呈正相关(P<0.05);ROC曲线分析,EDV、PSV、MV、PI联合鉴别AIS轻度与中度损伤的曲线下面积(AUC)为0.889,95%CI为0.773~0.959,敏感度为87.10%,特异度为77.27%;联合评估重度损伤的AUC为0.886,95%CI为0.795~0.946,敏感度为77.78%,特异度为94.34%,均优于各指标单独鉴别、评估价值。结论 TCCD技术对AIS患者颈动脉狭窄有较好诊断价值,与DSA一致性较高,其参数EDV、PSV、MV、PI联合测定可作为临床评估病情的重要途径。

Ultrasound features of carotid atherosclerosis in patients with coronary heart disease and their correlation with disease severity

Objective:To study the ultrasound features of carotid atherosclerosis in patients with coronary heart disease and their correlation with disease severity. Methods:180 patients with coronary heart disease treated in our hospital between December 2010 and December 2015 were collected as observation group and divided into single-vessel disease group (n=50), double-vessel disease group (n=72) and triple-vessel disease group (n=58) according to the degree of coronary artery stenosis;50 healthy subjects receiving physical examination in our hospital during the same period were selected as control group. Carotid ultrasound was used to measure carotid atherosclerosis parameters, cardiac color Doppler ultrasound was used to detect cardiac function parameters, enzyme-linked immunosorbent assay (ELISA) was used to detect serum endothelial function indexes, and Pearson test was used to analyze the correlation between carotid ultrasound parameters and the cardiac function as well as endothelial function. Results:Carotid ultrasound parameters stiffness (β), elastic modulus (Ep), arterial compliance (AC) and pulse wave velocity (PWVβ) value of observation group were higher than those of control group, and with the increase of coronary artery lesion severity, the changes ofβ, Ep, AC and PWVβvalue increased (P<0.05);cardiac function parameters left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) value of observation group were higher than those of control group while left ventricular ejection fraction (LVEF) value was lower than that of control group, and with the increase of coronary artery lesion severity, the changes of LVEDD, LVESD and LVEF value increased (P<0.05);endothelial function indexes endothelin-1 (ET-1) and von willebrand factor (vWF) levels of observation group were higher than those of control group while nitric oxide (NO) level was lower than that of control group, and with the increase of coronary artery lesion severity, the changes of ET-1, vWF and NO levels increased (P<0.05). Carotid ultrasound parameterβ, Ep, AC and PWVβvalue in patients with coronary heart disease were directly correlated with the levels of cardiac function parameters and endothelial function indexes. Conclusions:The ultrasound parameter levels of carotid atherosclerosis in patients with coronary heart disease are directly correlated with the disease severity and can be used as the noninvasive and reliable means for early judgment of the disease.

Association Between Knee Alignment,Disease Severity and Subchondral Trabecular Bone Microarchitecture in Patients with Knee Osteoarthritis

Objective Most patients with knee osteoarthritis(OA)have alignment deformity with the change of Hip-knee-ankle(HKA)angle.The knee alignment influences load distribution at the tibial plateau.Meanwhile,change of subchondral trabecular bone microstructure is related to load bearing and OA progression.However,the relationship between knee alignment on the changes of subchondral trabecular bone microstructure and OA severity have been poorly investigated.The main goal of this work was to investigate variation in tibial plateaus subchondral trabecular bone microstructure in knee OA patients and their association with the severity of OA with the change of knee alignment.Methods Seventy-one knee OA patients planning to undergo total knee arthroplasty were enrolled in this study.The HKA angle and OA disease severity(OARSI score,compartment-specific Kellgren-Lawrence(K-L)grade and OARSI Atlas grade)based on full-leg standing posteroanterior radiographs were evaluated preoperatively in all patients.The tibial plateau collected during surgery was first used for micro-computed tomography(μCT)to analyze the subchondral trabecular bone microstructures,and then used for pathological sections to analyze cartilage degeneration(OARSI score).Pearson and spearman correlations were used to examine linear relationships between knee alignment,OA disease severity and subchondral trabecular bone microstructure.Patients were then divided into group I(HKA angle exceeds 0°in the valgus direction),group II(varus angle<10°)and group III(varus angle≥10°).The differences in subchondral trabecular bone microstructural parameters between the three groups were analyzed by the one-way ANOVA with a post hoc Tukey test.Results HKA angle was significantly correlated with all tibial plateau subchondral trabecular bone microstructure parameters.Regardless of the medial or lateral tibia,HKA angle was most strongly correlated with bone volume fraction(BV/TV),M:(r=0. 613,P<0.01);L:(r=-0.490,P<0.01).In addition,for the media-to-lateral ratios(M:L)of the subchondral trabecular bone microstructure parameters,the HKA angle is positively correlated with M:L BV/TV(r=0.658,P<0.01),M:L trabecular number(Tb.N)(r=0.525,,P<0.01),M:L trabecular thickness(Tb.Th)(r=0.636,P<0.01),and negatively correlated with M:L trabecular separation(Tb.Sp)(r=-0.636,P<0.01)and M:L Specific Bone Surface(BS/BV)(r=-0.792,P<0.01).The BV/TV,Tb.N,and Tb.Th of the medial tibia were sequentially incremented in the order of groupⅠ,Ⅱ,Ⅲof knee alignment,while the Tb.Sp and BS/BV were decreased in this order.The lateral tibia is the opposite.In addition,most of the severity indices of OA are associated with subchondral trabecular bone microstructures,of which OARSI score and BV/TV in medial tibia are the most relevant(r=0.787,P<0.01).HKA angle is significantly correlated with all OA severity grades in medial compartment,but only with OARSI score and Bone sclerosis grade in lateral compartment.Conclusions Tibial plateau subchondral trabecular bone microarchitecture is associated with the HKA angle and OA severity.With the increase of varus angle and the severity of OA,the subchondral trabecular bone in medial tibia has more obvious sclerosis changes and vice versa,suggesting that knee malalignment may promote abnormal subchondral trabecular bone remodeling by altering joint load distribution,thereby affecting the progression of OA.

Fixed-point Monitoring of Vaccine Immune Effects on Severe Animal Diseases in Livestock and Poultry Breeding Fields

In order to reveal the immune antibody levels and immune effect of livestock and poultry in the locality,we performed antibody surveillance on severe animal diseases in 17 livestock and poultry fields in six administrative districts of Wuhan City. The results showed that the vaccines had a good protective efficacy on highly pathogenic avian influenza( HPAI) and Newcastle disease( ND) in Wuhan City. The whole antibody levels kept above the ministerial standard( 】 70%).However,the vaccine immunity of porcine reproductive and respiratory syndrome( PRRS),swine fever( SF) and foot and mouth disease( FMD) was still poorly protective. The data indicated that the vaccines are protecting the severe animal diseases well,but there are still some potential security holes in some administrative districts.