Baseline metabolites could predict responders with hepatitis B virus-related liver fibrosis for entecavir or combined with FuzhengHuayu tablet

BACKGROUND After receiving entecavir or combined with FuzhengHuayu tablet(FZHY)treatment,some sufferers with hepatitis B virus(HBV)-related liver fibrosis could achieve a histological improvement while the others may fail to improve even worsen.Serum metabolomics at baseline in these patients who were effective in treatment remain unclear.AIM To explore baseline serum metabolites characteristics in responders.METHODS A total of 132 patients with HBV-related liver fibrosis and 18 volunteers as healthy controls were recruited.First,all subjects were divided into training set and validation set.Second,the included patients were subdivided into entecavir responders(E-R),entecavir no-responders(E-N),FZHY+entecavir responders(FR),and FZHY+entecavir no-responders(F-N)following the pathological histological changes after 48 wk’treatments.Then,Serum samples of all subjects before treatment were tested by high performance liquid chromatographytandem mass spectrometry(LC-MS)high-performance LC-MS.Data processing was conducted using multivariate principal component analysis and orthogonal partial least squares discriminant analysis.Diagnostic tests of selected differential metabolites were used for Boruta analyses and logistic regression.RESULTS As for the intersection about differential metabolic pathways between the groups E-R vs E-N and F-R vs F-N,results showed that 4 pathways including linoleic acid metabolism,aminoacyl-tRNA biosynthesis,cyanoamino acid metabolism,alanine,aspartate and glutamate metabolism were screened out.As for the differential metabolites,these 7 intersected metabolites including hydroxypropionic acid,tyrosine,citric acid,taurochenodeoxycholic acid,benzoic acid,2-Furoic acid,and propionic acid were selected.CONCLUSION Our findings showed that 4 metabolic pathways and 7 differential metabolites had potential usefulness in clinical prediction of the response of entecavir or combined with FZHY on HBV fibrotic liver.

A novel multi-channel porous structure facilitating mass transport towards highly efficient alkaline water electrolysis

An advantageous porous architecture of electrodes is pivotal in significantly enhancing alkaline water electrolysis(AWE)efficiency by optimizing the mass transport mechanisms.This effect becomes even more pronounced when aiming to achieve elevated current densities.Herein,we employed a rapid and scalable laser texturing process to craft novel multi-channel porous electrodes.Particularly,the obtained electrodes exhibit the lowest Tafel slope of 79 mV dec^(-1)(HER)and 49 mV dec^(-1)(OER).As anticipated,the alkaline electrolyzer(AEL)cell incorporating multi-channel porous electrodes(NP-LT30)exhibited a remarkable improvement in cell efficiency,with voltage drops(from 2.28 to 1.97 V)exceeding 300 mV under 1 A cm^(-1),compared to conventional perforated Ni plate electrodes.This enhancement mainly stemmed from the employed multi-channel porous structure,facilitating mass transport and bubble dynamics through an innovative convection mode,surpassing the traditional convection mode.Furthermore,the NP-LT30-based AEL cell demonstrated exceptional durability for 300 h under 1.0 A cm^(-2).This study underscores the capability of the novel multi-channel porous electrodes to expedite mass transport in practical AWE applications.

Design of Cold-Junction Compensation and Disconnection Detection Circuits of Various Thermocouples and Implementation of Multi-Channel Interfaces Using Them-A Secondary Publication

Cold-junction compensation(CJC)and disconnection detection circuit design of various thermocouples(TC)and multi-channel TC interface circuits were designed.The CJC and disconnection detection circuit consists of a CJC semiconductor device,an instrumentation amplifier(IA),two resistors,and a diode for disconnection detection.Based on the basic circuit,a multi-channel interface circuit was also implemented.The CJC was implemented using compensation semiconductor and IA,and disconnection detection was detected by using two resistors and a diode so that IA input voltage became-0.42 V.As a result of the experiment using R-type TC,the error of the designed circuit was reduced from 0.14 mV to 3μV after CJC in the temperature range of 0°C to 1400°C.In addition,it was confirmed that the output voltage of IA was saturated from 88 mV to-14.2 V when TC was disconnected from normal.The output voltage of the designed circuit was 0 V to 10 V in the temperature range of 0°C to 1400°C.The results of the 4-channel interface experiment using R-type TC were almost identical to the CJC and disconnection detection results for each channel.The implemented multi-channel interface has a feature that can be applied equally to E,J,K,T,R,and S-type TCs by changing the terminals of CJC semiconductor devices and adjusting the IA gain.

Clinical characteristics of null responders to Peg-IFNα2b/ ribavirin therapy for chronic hepatitis C

AIM: To predict which chronic hepatitis C patients are likely to be late-responders, we herein investigated the clinical characteristics of null-responders at 36 wk with hepatitis C virus (HCV) genotype Ib and a high viral load during the course of pegylated interferon (Peg-IFN)/ ribavirin ther apy. METHODS: One hundred forty-two patients with genotype Ib HCV and a high viral load were included in this study. Peg-IFNα2b (1.5 μg/kg once a week) and ribavirin (600-1000 mg per day according to body weight) were administered for 48 wk. We def ined nullresponders as the cases that never cleared serum HCV RNA as determined using RT-PCR until 36 wk. Other patients were def ined as responders. We compared the clinical characteristics (age, gender, body mass index, previous treatment) and HCV RNA titer during the therapy between null-responders and responders.RESULTS: The HCV RNA clearance rate was 17.9% (24/134), 46.3% (62/134), 60.6% (86/142), 86.6% (123/142), and 88.0% (125/142) at 4, 8, 12, 24, and 36 wk, respectively. There were 17 patients (12.0%) who were still null-responders at 36 wk. There were no differences in the clinical characteristics between the responders and null-responders except for the titer and decline rates of HCV RNA at 1 wk and 4 wk. The HCV RNA titers at 1 wk and after 4 wk of treatment were significantly higher in the null-responders in comp arison to the responders (P <0.01). The serum HCV RNA titers of the responders decreased by 1.3 log after 1 wk of treatment, and 1.6 log after 4 wk of treatm ent, respectively. On the other hand, the titers of the null responders decreased by only 0.5 log after 1 wk, and 0.7 log after 4 wk of treatment, respectively. The decrease rates of HCV RNA after 1 and 4 wk of treatm ent were signif icantly worse for null responders than for the responders (P <0.01). CONCLUSION: The HCV RNA titer at 1 wk and 4 wk after initiating treatment may be useful for predicting null-responders to Peg-IFNα2b/ribavirin therapy. However, further investigation is needed to determine the optimal time at which the decision to discontinue the Peg-IFNα2b/ribavirin therapy for null-responders can be made.

Cumulative Live Birth Rate after Three Ovarian Stimulation IVF Cycles for Poor Ovarian Responders According to the Bologna Criteria

Summary： This study explored the cumulative live birth rate after three ovarian stimulation in vitro fer- tilization （IVF） cycles for poor ovarian responders according to the Bologna criteria. In this retrospec- tive cohort study, 479 poor ovarian responders according to the Bologna criteria in the first ovarian stimulation IVF cycle between July 2006 and January 2012 in our IVF centre were included. The cu- mulative live birth rate was calculated by optimistic and pessimistic methods. The cumulative live birth rate after three ovarian stimulation IVF cycles for poor ovarian responders according to the Bologna criteria was 12.7%-20.5%. The three-cycle cumulative live birth rate was 18.5%--24.5%, 13.2%-27.4% and 8.6%-14.9% for poor responders aged ≤35 years, 36-39 years and 〉40 years, re- spectively. In conclusion, poor responders according to the Bologna criteria can receive an acceptable cumulative live birth, rate after three ovarian stimulation IVF cycles, especially poor responders aged 〈40 years.

Recent advances in vaccination of non-responders to standard dose hepatitis B virus vaccine

Hepatitis B virus(HBV) infection is a global health problem. It is estimated there are more than 2 billion individuals exposed to the virus and 250 million are chronically infected. Hepatitis B is the cause of more than 600000 annual deaths due to cirrhosis and hepatocellular carcinoma. An effective vaccine exists and preventative initiatives center around universal vaccination especially in those at highest risk. Effective vaccination algorithms have led to a significant decline in the development of new infections and its devastating consequences. The vaccine is administered intramuscularly in three doses, with 95% showing long lasting serologic immunity. An additional fourth dose or a repeated higher dose three course regimen is given to those that fail to show immunity. Despite these additional regimens, some remain vulnerable to hepatitis B and are deemed nonresponders. Individuals with chronic disease states such as kidney disease, liver disease, diabetes mellitus, as well as those with a genetic predisposition, and those on immunomodulation therapy, have the highest likelihood of non-response. Various strategies have been developed to elicit an immune response in these individuals. These include increased vaccination dose, intradermal administration, alternative adjuvants, alternative routes of administration, co-administration with other vaccines, and other novel therapies. These alternative strategies can show improved response and lasting immunity. In summary, HBV vaccination is a major advance of modern medicine and all individuals at risk should be sought and vaccinated with subsequent adequate titers demonstrated.

Hepatitis B vaccine by intradermal route in non responder patients:An update

Vaccination is the main prophylactic measure to reduce the mortality caused by hepatitis B virus(HBV)infection in healthy subjects since the immune response to hepatitis B recombinant vaccination occurs in over 90%of general population.Individuals who develop an antiHBs titer less than 10 mIU/mL after primary vaccination cycle are defined"no responders".Many factors could cause a non response to the HBV vaccination,such as administration of the vaccine in buttocks,impaired vaccine storage conditions,drug abuse,smoking,infections and obesity.Moreover there are some diseases,like chronic kidney disease,human immunodeficiency virus infection,chronic liver disease,celiac disease,thalassaemia,typeⅠdiabetes mellitus,down’s syndrome and other forms of mental retardation that are characterized by a poorer response to HBV vaccination than healthy subjects.To date it is still unclear how to treat this group of patients at high risk of hepatitis B infection.Recent studies seem to indicate that the administration of HBV recombinant vaccine by the intradermal route is very effective and could represent a more useful strategy than intramuscular route.This review focuses on the use of anti hepatitis B vaccine by intradermal route as alternative to conventional intramuscular vaccine in all non responder patients.A comprehensive review of the literature using PubMed database,with appropriate terms,was undertaken for articles in English published since 1983.The literature search was undertaken in September 2013.

Does ‘super-responder’ patients to cardiac resynchronization therapy still have indications for neuro-hormonal antagonists? Evidence from long-term follow-up in a single center

Background Whether cardiac resynchronization therapy super-responders (CRT-SRs) still have indications for neuro-hormonal antagonists or not remains uninvestigated.Methods We reviewed clinical data from 376 patients who underwent CRT implantation in Fuwai Hospital from 2009 to 2015 and followed up to 2017.CRT-SRs were defined by an improvement of the New York Heart Association functional class and left ventricular ejection fraction to ≥ 50% in absolute values at 6-month follow-up.All CRT-SRs were assigned into two groups on the basis of whether persistently receiving neuro-hormonal antagonists (NHA)(defined as angiotensin-converting enzyme inhibitors/ angiotensin receptor blockers and β-blockers) after 6-month follow-up and then we compared long-term outcome.Results A total of 60 patients met criteria for super-response.One of thirteen (7.7%) CRT-SRs without NHA had all-cause death,which also occurred in 2 of 47 (4.3%) in CRT-SRs with NHA (P = 0.526).However,3 of 13 (23.1%) CRT-SRs without NHA had heart failure (HF) hospitalization,1 of 47 (2.1%) CRT-SRs with NHA had this endpoint (P = 0.040).Besides,subgroup analysis indicated that,for ischemic etiology group,CRT-SRs receiving NHA had considerably lower incidence of HF hospitalization than those without NHA (0 vs.75%,P = 0.014),which was not observed in non-ischemic etiology group (2.6% vs.0,P = 1.000) during long-term follow-up.Conclusions Our study found that for ischemic etiology,compared with CRT-SRs with NHA,CRT-SRs without NHA were associated with a higher risk of HF hospitalization.However,for non-ischemic etiology,we found that CRT-SRs with NHA or without NHA at follow-up were associated with similar outcomes,which needed further investigation by prospective trials.

Aromatase Inhibitors for IVF Poor Responders

Objective To evaluate whether letrozole enhanced follicular recruitment, embryo numbers, and pregnancy rates in poor responders undergoing IVF. Methods We reviewed all IVF cycles between January 2002 and September 2003 using letrozole at Stanford University Medical Center. The entry criteria were the requirement of at least 450 IU/d of injectable gonadotropins in a prior failed cycle, which was used as a control. Results A total of 27 charts were reviewed revealing information on 54 cycles. The number of oocytes retrieved, fertilization, embryo quality and embryos transferred yielded no statistical significance, although there appeared to be a trend toward higher numbers of each in the letrozole group. The clinical pregnancy rate was 9/27 （33.3%, P〈0.001） with a viable pregnancy rate of 7/27 （25.9%, P=0. 002） in the Ietrozole cycle. Conclusion Our study is one of the first to evaluate letrozole with in vitro fertilization. Although this study showed no difference in number of oocytes or embryos, 25.9% of these ＂poor responding＂ patients achieved a pregnancy after a failed cycle at our center.

GnRH Antagonist Protocol: Is It Effective for Expected Poor Ovarian Responders with Tubal Factor Undergoing IVF?

Background: This study aimed to determine if the gonadotropin releasing hormone (GnRH) antagonist protocol is optimal for expected poor ovarian responders with tubal factor undergoing in vitro fertilization-embryo transfer (IVF-ET). Methods: A total of 341 IVF-ET cycles were retrospectively identified. The following inclusion criteria were applied: age ≥ 40 years and patients with tubal factors. The cycles were divided into two groups: a GnRH antagonist group (157 cycles) and a GnRH agonist group (184 cycles). Results: The duration of stimulation and the total doses of gonadotropin in the GnRH agonist group were significantly more than those in the GnRH antagonist group (P < 0.05). There were significant differences in LH and P values on the hCG measurement days between the two groups (0.91 ± 1.17 vs. 4.82 ± 4.69 U/L and 0.69 ± 0.42 vs. 1.03 ± 0.50 ng/mL, P < 0.05). The implantation rate of the GnRH antagonist group was 12.24%, which was slightly higher than that of the GnRH agonist group (10.10%, P = 0.437). The clinical pregnancy rate of the two groups showed no statistical differences (23.36% vs. 23.03%, P = 1.000). Conclusion: For expected poor ovarian responders, the GnRH antagonist protocol was, to some extent, superior to the GnRH agonist protocol in terms of the implantation and clinical pregnancy rates.

The Challenge of Improving IVF Results in Normogonadotrophic (Unexpected) Young Poor Ovarian Responders: The Predictive Value of a Flexible Treatment Protocol Based on the “Biophysical Profile of the Uterus”

Objective: To study whether the unexpected poor ovarian responders optimization of uterine receptivity with a flexible controlled ovarian hyper stimulation protocol based on the Biophysical Profile of the Uterus, has an impact on their reproductive performance. Design: Observational Prospective study. Setting(s): i) General hospital-IVF and Infertility Centre;ii) University hospital. Patient(s): 44 normogonadotrophic young women (26 - 38 yrs) with previous “unexpected” poor ovarian response underwent IVF/ICSI treatment on a protocol based on the Biophysical Profile of their uterus (Group A). The same patients were used as controls in a preceded IVF cycle on the conventional stimulation protocol. Intervention(s): None. Main outcome measure(s): Pregnancy, miscarriage and home take baby rates, amount and duration of gonadotropins required, number and quality of embryos resulted, Biophysical Profile of the Uterus score. Result(s). Treatment in Group A in comparison to Group B resulted in significantly larger number of eggs retrieved per patient, and improved fertilization rates and higher number of embryos/ET (p = 0.011, 0.010 and 0.034 respectively). Group A also demonstrated a trend for higher rates of clinical pregnancy (29.5% v.s. 15.9%), viable stage pregnancies ≥ 24 weeks (33.3% v.s. 20%) and home take babies (26.6% v.s. 16%). The amount of gonadotropins used per patient (IU) was similar in the two groups (p = 0.264). Cancellation, implantation and miscarriage rates as well as embryos quality, although superior in the treatment Group A, showed no significant difference. The number of pregnancies achieved in Group A, were directly related with the score in the Biophysical Profile of the Uterus 12 point scale. Conclusion(s): Unexpected Poor Ovarian Responders on the flexible IVF/ICSI protocol (Group A), adjusting the management according to the Biophysical Profile of their uterus (duration of stimulation, day of HCG and day of embryo transfer), had a significantly better performance in comparison to the Group B managed on the conventional protocol in this difficult to manage and so far, rather understudied population.

Preliminary Results of DHEA in Poor Responders in IVF

Objective: Dehydroepiandrosterone (DHEA) has been previously reported to improve ovarian response in IVF for poor responders. Its effect remains uncertain. The purpose of this study was to evaluate the effect of DHEA given during two years in our unit, in order to build hypothesis for a future randomized controlled trial. Design: Cohort of exposed and non-exposed DHEA study. Patient(s): 224 patients with AMH under 1.6 ng/ml undergoing IVF with a short antagonist protocol adding FSH and LH rec were enrolled for 327 IVF cycles. 176 patients had been treated with DHEA before IVF, and 151 had not. Intervention(s): None. Main Outcome Measure(s): Cancellation cycle rate, amount of gonadotrophins used, estradiol level on day six of stimulation, number of oocytes retrieved, metaphase II oocytes, blastocysts and frozen embryos, clinical pregnancy rate and miscarriage rate. Results: The cancellation rate was significantly higher in the group without DHEA (29.8% versus 13.1%, p = 0.002). The amount of gonadotrophins used for stimulation, the estradiol level on day six of stimulation, the number of oocytes retrieved, metaphase II oocytes, blastocysts, frozen embryos and miscarriage rate were not different in both groups. The clinical pregnancy rate per included patient in the DHEA group was 17.1% versus 8.6% in the non-treated group (p = 0.02). Conclusion: DHEA appears to improve clinical pregnancy rate by decreasing the cancellation rate.

INTRAMUSCULAR VERSUS INTRADERMAL HEPATITIS B REVACCINATIONIN HEALTHY NON-RESPONDER CHILDREN: A 5-YEAR PROSPECTIVE RANDOMIZED STUDY

Objective With the same times of injection to compare low-dose intradermal regimen with routine-dose intramuscular inoculation in revaccination of non-responders to hepatitis B vaccine. Methods 40 healthy non-responder children collected by screening were administrated a three-dose revaccination randomly by intramuscular or intradermal route (10vs 2g per dose), and regularly tested for serologic markers up to five years. By the end of follow-up, a booster dose (5μg) was given to those who had lost anti-HBs of ≥10mIU/mL (seroprotection) and anamnestic response was estimated thereafter. Results All 17 intramuscular and 22 of 23 intradermal children effected seroprotection after revaccination. Intradermal children lost seroprotection over time significantly rapider compared with intramuscular children (Log Rank test, P= 0.029). In year 5, 50% of intramuscular but only 18.2% of intradermal children still maintained seroprotection (P=0.075). 12-14 days after the booster dose, all the eight intramuscular children developed an anamnestic response with anti-HBs titer increasing greater, but two of the 18 intradermal children failed to mount seroprotective level. Conclusion Three-routine-dose intramuscular revaccination was significantly effective than low-dose intradermal one with the same times of injection, especially in long-term immunity. We recommend routine-dose intramuscular protocol in revaccination of non-responders.

Multi-channel terahertz focused beam generator based on shared-aperture metasurface

Most of existing metasurfaces usually have limited channel behavior,which seriouslyhinders their development and application.In this paper,we propose a multi-channel terahertz focused beam generator based on shared-aperture metasurface,and the generator consists of a top square metal strip,a middle layer of silica and a metal bottom plate.By changing the position and size of the shared-aperture array,the designed metasurface can generate any number of multi-channel focusing beams at different predicted positions.In addition,the energy intensity of focusing beams can be controlled.The full-wave simulation results show that the metasurface achieves four-channel vortex focused beam generation with different topological charges,and five-,six-,eight-channel focused beam generation with different energy intensities at a frequency of 1 THz,which are in good agreement with the theoretically calculated predictions.This work can provide a new idea for designing the terahertz multichannel devices.

Fast pre-stack multi-channel inversion constrained by seismic reflection features

Classical multi-channel technology can significantly reduce the pre-stack seismic inversion uncertainty, especially for complex geology such as high dipping structures. However, due to the consideration of complex structure or reflection features, the existing multi-channel inversion methods have to adopt the highly time-consuming strategy of arranging seismic data trace-by-trace, limiting its wide application in pre-stack inversion. A fast pre-stack multi-channel inversion constrained by seismic reflection features has been proposed to address this issue. The key to our method is to re-characterize the reflection features to directly constrain the pre-stack inversion through a Hadamard product operator without rearranging the seismic data. The seismic reflection features can reflect the distribution of the stratum reflection interface, and we obtained them from the post-stack profile by searching the shortest local Euclidean distance between adjacent seismic traces. Instead of directly constructing a large-size reflection features constraint operator advocated by the conventional methods, through decomposing the reflection features along the vertical and horizontal direction at a particular sampling point, we have constructed a computationally well-behaved constraint operator represented by the vertical and horizontal partial derivatives. Based on the Alternating Direction Method of Multipliers (ADMM) optimization, we have derived a fast algorithm for solving the objective function, including Hadamard product operators. Compared with the conventional reflection features constrained inversion, the proposed method is more efficient and accurate, proved on the Overthrust model and a field data set.

Ribavirin monotherapy increases sustained response rate in relapsers of end treatment virologic responders

AIM: To assess the efficacy of ribavirin monotherapy in patients with biochemical relapse after combination therapy.METHODS: Twenty-four weeks of ribavirin monotherapy was given to biochemical relapsers of end treatment biochemical responders within 6 mo after combination therapy, including non-responders with HCV-RNA level ≤0.2 Meq/mL and end treatment virologic responders (ETVRs) with or without reappearance of HCV-RNA.RESULTS: Sixty-two chronic HCV-infected patients completed 24 wk of interferon-α plus ribavirin combination therapy. Fifty patients (80%) achieved end treatment biochemical response including 16 non-responders and 34 of 36 ETVRs. Twenty-six patients (41.9%) were nonresponders. Ribavirin monotherapy was given to 20biochemical relapsers including 12 non-responders with HCV-RNA levels ≤0.2 Meq/mL, four of eight HCV-RNA reappearing ETVRs, and four HCV-RNA negative ETVRs.After 24 wk of ribavirin monotherapy, one of 12 nonresponders, two of four HCV-RNA reappearing ETVRs and all four RNA-negative biochemical relapsers of ETVRs showed sustained virologic response. Two of 12monotherapy treated non-responders showed persistent normalization of liver function test. In total, 50% (31/62)of patients achieved sustained virologic response.CONCLUSION: Resumption of ribavirin monotherapy in ETVRs at signs of viral rebound and recurrent biochemical abnormalities rather than continuation of monotherapy appears to be the key to success of ribavirin monotherapy after interferon-related combination therapy.

Opportunistic Routing with Multi-Channel Cooperative Neighbour Discovery

Due to the scattered nature of the network,data transmission in a dis-tributed Mobile Ad-hoc Network(MANET)consumes more energy resources(ER)than in a centralized network,resulting in a shorter network lifespan(NL).As a result,we build an Enhanced Opportunistic Routing(EORP)protocol architecture in order to address the issues raised before.This proposed routing protocol goal is to manage the routing cost by employing power,load,and delay to manage the routing energy consumption based on theflooding of control pack-ets from the target node.According to the goal of the proposed protocol techni-que,it is possible to manage the routing cost by applying power,load,and delay.The proposed technique also manage the routing energy consumption based on theflooding of control packets from the destination node in order to reduce the routing cost.Control packet exchange between the target and all the nodes,on the other hand,is capable of having an influence on the overall efficiency of the system.The EORP protocol and the Multi-channel Cooperative Neighbour Discovery(MCCND)protocol have been designed to detect the cooperative adja-cent nodes for each node in the routing route as part of the routing path discovery process,which occurs during control packet transmission.While control packet transmission is taking place during the routing path discovery process,the EORP protocol and the Multi-channel Cooperative Neighbour Discovery(MCCND)protocol have been designed to detect the cooperative adjacent nodes for each node in the routing.Also included is a simulation of these protocols in order to evaluate their performance across a wide range of packet speeds using Constant Bit Rate(CBR).When the packet rate of the CBR is 20 packets per second,the results reveal that the EORP-MCCND is 0.6 s quicker than the state-of-the-art protocols,according to thefindings.Assuming that the CBR packet rate is 20 packets per second,the EORP-MCCND achieves 0.6 s of End 2 End Delay,0.05 s of Routing Overhead Delay,120 s of Network Lifetime,and 20 J of Energy Consumption efficiency,which is much better than that of the state-of-the-art protocols.

基于“亢害承制”理论探讨巨噬细胞外泌体在慢性心力衰竭发展中的作用

巨噬细胞外泌体影响心脏炎症微环境,在慢性心力衰竭病程中发挥了关键作用。“亢害承制”理论是中医认识人体生克制化、病理失衡及指导辨证施治的重要法则。本文基于“亢害承制”理论,从理论依据、发病机制、病理生理联系及现代研究方面阐述巨噬细胞外泌体在慢性心力衰竭发展中的作用,提出运用“扶正调平,祛邪除亢”法治疗慢性心力衰竭,通过调控巨噬细胞外泌体减轻心脏炎症反应,以期为慢性心力衰竭的诊治提供新思路。

第一目击者急救知识技能导师培训模式探讨与实践

目的 分析2018—2022年湖南省第一目击者急救知识技能导师培训的情况,探讨适合我国第一目击者导师培训的特点及模式。方法 通过规范第一目击者急救知识技能导师培训的课程设计、信息化平台建设及质量管理控制,总结导师培训的特征及考核评价效果。结果 2018—2022年湖南省共培训第一目击者急救知识技能导师4 504名,主要由医护人员组成,占98.8%;83.42%为中级及以上职称。设计第一目击者急救知识技能导师培训课程和考核方式,导师经培训后考核,理论成绩为(96.11±3.61)分,心肺复苏操作评分为(90.49±2.90)分,AED使用评分为(90.37±3.09)分,创伤四项操作评分为(88.90±3.37)分。导师在理论课程、心肺复苏操作、AED使用、创伤四项操作四方面的掌握程度同质性较好。结论 第一目击者急救知识技能导师培训的模式具有科学性与合理性,值得进一步推广。

复杂信息环境下的情报快速反应机制研究

在科技飞速发展和大国博弈日益白热化的背景下,情报成为抢占国家发展先机的重要工具之一。在复杂信息环境的情报生产新环境和决策新要求下,本文以如何实现情报支撑国家战略决策为研究问题,通过文献调研与案例分析等方法,在总结梳理相关理论和实践经验的基础上,对情报快速反应机制的内涵、特征和决策支撑场景进行深入探究。本文创新性地提出一套适用于复杂信息环境下的“3+5+9情报快速反应机制”,以“早发现、早预判、早报告、早决策、早应对”为五大核心目标,以“联动协调、信息监测、信息资源、情报分析、应急处置、技术支撑、专家协作、组织保障、跟踪评估监督”为九大支撑子体系,适用于常态化监测、回应关切和突发应急三类重要决策支撑场景的情报工作机制,以期为未来相关实践提供较为扎实的理论基础。