肾脏叶间动脉阻力指数对Ⅰ型心肾综合征的诊断价值

目的探讨彩色多普勒超声测量肾脏叶间动脉阻力指数(resistance index,RI)对Ⅰ型心肾综合征(cardiorenal syndrome,CRS)的诊断价值。方法选取2017年6月1日至2018年3月1日收住民航总医院急诊综合病房并诊断为Ⅰ型CRS的20例患者作为试验组(CRS组),选取同期诊断为单纯急性心力衰竭的患者20例作为对照组,分析两组患者的临床特征、实验室检查及用药情况,并根据受试者工作特征(receiver operating characteristic,ROC)曲线评价肾动脉RI对Ⅰ型CRS的诊断价值。结果两组患者年龄、左心室射血分数、心功能分级、心率及脉压差差异无统计学意义(P均>0. 05),CRS组患者的氨基末端脑钠尿肽、肌酐水平、呋塞米剂量以及肾动脉RI均高于对照组,而肾小球滤过率低于对照组,差异具有统计学意义(P均<0. 05)。ROC曲线下面积为0. 78,取最佳截点值0. 70时预测Ⅰ型CRS的敏感度为80%,特异度为80%。结论作为一种新的手段,肾动脉RI可与传统方法相互补充,对诊断Ⅰ型心肾综合征患者具有潜在应用价值。     

Development of biodegradable scaffold using polylactic acid and polycaprolactone for cardiovascular application

The limitations of newly synthesized biodegradable stents are low mechanical strength, fracture stiffness, and fast degradability of the polymers. A cylindrical polymeric scaffold was proposed in combination of polylactic acid and polycaprolactone. The tensile strength of the blend was increased twice, though elongation has reduced threefold. The blend illustrated no chemical interaction between polymers. The scaffold was coated with docetaxel, and sustained release profile was observed for 56 days. The degradation of the scaffold was evaluated through change in mechanical properties, weight variation, and morphological studies. The developed hemocompatible polymeric scaffold may be used as for the cardiovascular application.     

Grid Search for Predicting Coronary Heart Disease by Tuning Hyper-Parameters

Diagnosing the cardiovascular disease is one of the biggest medical difficulties in recent years. Coronary cardiovascular (CHD) is a kind of heart and blood vascular disease. Predicting this sort of cardiac illness leads to more precise decisions for cardiac disorders. Implementing Grid Search Optimization (GSO) machine training models is therefore a useful way to forecast the sickness as soon as possible. The state-of-the-art work is the tuning of the hyperparameter together with the selection of the feature by utilizing the model search to minimize the false-negative rate. Three models with a cross-validation approach do the required task. Feature Selection based on the use of statistical and correlation matrices for multivariate analysis. For Random Search and Grid Search models, extensive comparison findings are produced utilizing retrieval, F1 score, and precision measurements. The models are evaluated using the metrics and kappa statistics that illustrate the three models’ comparability. The study effort focuses on optimizing function selection, tweaking hyperparameters to improve model accuracy and the prediction of heart disease by examining Framingham datasets using random forestry classification. Tuning the hyperparameter in the model of grid search thus decreases the erroneous rate achieves global optimization.     

城市干道沿线地区的城市设计实践——以宁波象山县象山港路沿线地区城市设计为例

城市设计并没有标准的理论和固定的模式,城市设计的实践性特征决定了城市设计的内涵。结合宁波象山县象山港路沿线地区的城市设计案例的简析,提出了作为中观层次的城市干道沿线地区城市设计的基本内容和方法。     

Community response to environmental noise and the impact on cardiovascular risk score

Objective

The objective of our study was to investigate and evaluate the relationship between road traffic noise and cardiovascular risk.

Methods

The study sample (n = 659; 36.9% male, 63.1% female university students, mean age 22.83 ± 1.58 years) included a group exposed to road traffic noise (n = 280, L_eq,24 h = 67 ± 2 dB(A)) and a control group (n = 379, L_eq,24 h = 58.7 ± 6 dB(A)). Subjective response was determined by a validated noise annoyance questionnaire. The ten year risk of developing a coronary heart disease event was quantified as an evaluation of cardiovascular risk (SCORE60, Framingham 10-year risk estimation and projection to the age of 60, relative risk SCORE chart).

Results

Cardiovascular risk scores were significantly higher in the exposed group based on the Framingham scores projected to the age of 60, SCORE60 (AOR = 2.72 (95% CI = 1.21-6.15)) and the relative risk SCORE chart (AOR = 2.81 (1.46-5.41)).

Conclusions

These findings highlight the association between road traffic noise and cardiovascular risk.     

Circulating YKL-40 Level,but not CHI3L1 Gene Variants,Is Associated with Atherosclerosis-Related Quantitative Traits and the Risk of Peripheral Artery Disease

YKL-40, a pleotropic cytokine, is emerging as a risk factor and a prognostic predictor of atherosclerotic cardiovascular disease. We attempted to elucidate the genetic, clinical and biochemical correlates of circulating YKL-40 level and, by combining it with CHI3L1 gene variants, with the risk and long-term mortality of peripheral artery disease (PAD). Plasma YKL-40 concentrations were measured in 612 Taiwanese individuals who had no clinically overt systemic disease. Clinical parameters, CHI3L1 gene promoter variants and 18 biomarker levels were analyzed. Eighty-six PAD patients were further enrolled for analysis. Significant associations were found between CHI3L1 genotypes/haplotypes and YKL-40 levels for the health examination subjects (smallest p = 8.36 × 10⁻⁷ for rs4950928 and smallest p = 1.72 × 10⁻¹⁰ for haplotype TGG) and also for PAD patients. For the health examination subjects, circulating YKL-40 level, but not CHI3L1 gene variants, were positively associated with age, smoking, and circulating levels of triglyceride, lipocalin 2 and multiple inflammatory biomarkers and negatively associated with low-density-lipoprotein cholesterol levels. Circulating YKL-40 level is also significantly associated with the risk of PAD (p = 3.3 × 10⁻²³). Circulating YKL40 level, but not CHI3L1 gene promoter variants, is associated with the risk of PAD in Taiwanese. The association of YKL-40 levels with multiple quantitative traits relating to the risk of PAD may provide a molecular basis linking YKL-40 to atherosclerotic cardiovascular disease.     

冠状动脉对称双路移植管中血流动力学的数值模拟

作为对传统单路动脉移植管旁通术的改进,提出了一种新的双路对称移植管旁通术的几何构型.采用有限元法数值模拟了新构型中生理真实的血液流动,得到并分析了1个心动周期内,缝合区附近血流动力学参数,如流形、压力和壁面剪应力等的时空分布情况.计算结果表明,双路对称移植管旁通比单路旁通具有更好的血流动力学特性,流场得到明显的改善,从而可以减小再狭窄的可能性.     

复方七芍降压片对自发性高血压大鼠肠系膜动脉中Ⅰ、Ⅲ型胶原蛋白表达及血压的影响

目的:探究复方七芍降压片对自发性高血压大鼠（SHR）血压及血管重塑的作用机制。方法:SHR大鼠随机分为模型组、厄贝沙坦片组、复方七芍降压片组,每组10只,另设10只WKY大鼠为正常对照组,给药6周,无创血压仪测量各周大鼠血压变化;HE染色观察大鼠肠系膜动脉病理变化并测量管壁厚度、血管中膜厚度及相同位置的管腔直径,比值记为WT;免疫组化法检测肠系膜动脉中基质金属蛋白酶-2（MMP-2）及Ⅰ、Ⅲ型胶原蛋白（COⅠ、COⅢ）表达情况。结果:给药6周后,与正常对照组比较,模型组大鼠各周血压均明显升高（P<0.01）,管壁厚度及WT值增高（P<0.01或P<0.05）,肠系膜动脉中MMP-2及Ⅰ、Ⅲ型胶原蛋白表达均明显升高（P<0.01）;与模型组比较,复方七芍降压片组大鼠各周血压均明显降低（P<0.01）,管壁厚度及WT值降低（P<0.05）,肠系膜动脉中MMP-2及Ⅰ、Ⅲ型胶原蛋白表达均明显降低（P<0.05）,且病理变化得到改善。结论:复方七芍降压片具有降低SHR大鼠血压,改善血管重塑的作用,其机制可能与降低MMP-2表达及Ⅰ、Ⅲ型胶原蛋白沉积有关。     

Endothelial Nitric Oxide Synthase (eNOS) 4b/a Gene Polymorphisms and Coronary Artery Disease: Evidence from a Meta-Analysis

A variety of studies have suggested that the 4b/a polymorphism in the endothelial nitric oxide synthase (eNOS) was associated with coronary artery disease (CAD) risk. However, the data remain conflicting. The aim of the present meta-analysis was to estimate the overall association between risk of CAD and eNOS 4b/a polymorphism. Case-control, cohort or cross-sectional studies evaluating the association between eNOS 4b/a polymorphism and CAD susceptibility were systematically identified in PubMed up to 31 October 2013. Pooled odds ratios (OR) and corresponding 95% confidence intervals (CIs) were calculated to assess the association in overall and subgroup analyses. A total of 10,617 cases and 8302 controls from 37 studies were included in the study. The results of overall analysis revealed significant positive associations between CAD risk and eNOS 4b/a polymorphism in homozygote comparisons (OR = 1.47, 95% CI = 1.16–1.87), heterozygote comparisons (OR = 1.14, 95% CI = 1.02–1.27) and dominant models (OR = 1.18, 95% CI = 1.06–1.33). In subgroup analyses, similar associations were identified in African individuals, as determined using population-based source subgroups and noted in small-and-moderate sample size subgroups (case sample size or control sample size <500). The current meta-analysis revealed that eNOS 4b/a polymorphisms could be a risk factor for developing CAD, particularly in African populations and population-based subgroups.     

髂内动脉栓塞术治疗产后难治性大出血的护理体会

目的：探讨髂内动脉栓塞术治疗产后难治性大出血的护理方法。方法对53例行经皮双髂内动脉栓塞术（IIAE）治疗的产后大出血伴休克产妇的临床资料与护理资料进行回顾性分析。结果53例患者 IIAE 手术均一次性成功,手术耗时0．5～1 h;即刻停止出血者44例,8例出血明显减少,1例24 h 内仍有暗红色血液经阴道排出,至第4 d 完全停止。术后5例出现不同程度臀部或下腹部疼痛,1例患者出现恶心、呕吐症状,对症处理后症状缓解。随访18～37个月,无严重并发症发生。结论IIAE 治疗产后难治性大出血具有操作简单、损伤小、止血快、并发症少的特点;同时做好术前、术后护理及并发症对症处理是保证手术顺利进行及取得满意治疗效果的关键。