Network-based forecasting of climate phenomena

Network theory, as emerging from complex systems science, can provide critical predictive power for mitigating the global warming crisis and other societal challenges. Here we discuss the main differences of this approach to classical numerical modeling and highlight several cases where the network approach substantially improved the prediction of high-impact phenomena: 1) El Niño events, 2) droughts in the central Amazon, 3) extreme rainfall in the eastern Central Andes, 4) the Indian summer monsoon, and 5) extreme stratospheric polar vortex states that influence the occurrence of wintertime cold spells in northern Eurasia. In this perspective, we argue that network-based approaches can gainfully complement numerical modeling.     

Chronic BMY7378 treatment alters behavioral circadian rhythms

The mammalian circadian clock is synchronized to the day : night cycle by light. Serotonin modulates the circadian effects of light, with agonists inhibiting response to light and antagonists enhancing responses to light. A special class of serotonergic compounds, the mixed 5‐HT_1A agonist/antagonists, potentiates light‐induced phase advances by up to 400% when administered acutely. In this study, we examine the effects of one of these mixed 5‐HT_1A agonist/antagonists, BMY7378, when administered chronically. Thirty adult male hamsters were administered either vehicle or BMY7378 via surgically implanted osmotic mini pumps over a period of 28 days. In a light : dark cycle, chronic BMY7378 advanced the phase angle of entrainment, prolonged the duration of the active phase and attenuated the amplitude of the wheel‐running rhythm during the early night. In constant darkness, chronic treatment with BMY7378 significantly attenuated light‐induced phase advances, but had no significant effect on light‐induced phase delays. Non‐photic phase shifts to daytime administration of a 5‐HT_1A/7 agonist were also attenuated by chronic BMY7378 treatment. qRT‐PCR analysis revealed that chronic BMY7378 treatment upregulated mRNA for 5‐HT_1A and 5‐HT_1B receptors in the hypothalamus and downregulated mRNA for 5‐HT_1A and monoamine oxidase‐A in the brainstem. These results highlight adaptive changes of serotonin receptors in the brain to chronic treatment with BMY7378 and link such up‐ and downregulation to changes in important circadian parameters. Such long‐term changes to the circadian system should be considered when patients are treated chronically with drugs that alter serotonergic function.     

Visually evoked startle response in a patient with epilepsy: a case report and review of the literature

Both symptomatic and genetic, cases with hyperekplexia or startle seizures induced by acoustic stimuli, are previously reported. By contrast, startle response induced by visual stimuli is rare. While visual stimuli are more commonly associated with startle seizures, here we present an 11-year-old girl with epilepsy, motor-mental retardation, and spastic tetraparesis, who had repetitive startle responses by photic stimulation during the electroencephalogram recording, without any spike-and-wave discharges associated with the startles. We report this unique case with startle responses induced both by acoustic and photic stimuli and review the literature related to this exceptionally rare combination of symptoms.     

硫酸镁、利多卡因对冠心病患者全麻诱导期间血液动力学的影响

 目的 比较不同剂量舒芬太尼及复合使用利多卡因或硫酸镁对冠心病患者全麻诱导期间血液动力学的影响,以探讨更加适合冠心病患者全麻诱导的药物组合。方法 择期行非体外循环冠脉旁路移植术患者80例,年龄52~76岁,体重49~87 kg,美国麻醉医师协会（ASA Ⅱ级或Ⅲ级,左室射血分数≥45%。根据麻醉诱导用药情况分为4组：复合硫酸镁组（MS组、复合利多卡因组（LS组、小剂量舒芬太尼组（S1组和大剂量舒芬太尼组（S2组。MS组和LS组在静注总量（0.08 mg·kg-11/3的咪达唑仑后分别缓慢静注硫酸镁20 mg·kg-1和利多卡因1.5 mg·kg-1,然后静注余量的咪达唑仑和舒芬太尼0.6 μg·kg-1;S1组和S2组在静注总量（0.08 mg·kg-11/3的咪达唑仑后分别缓慢注射舒芬太尼0.6和0.9 μg·kg-1,然后静注余量的咪达唑仑,当脑电双频谱指数（BIS降至75时给予哌库溴铵,经面罩加压供氧3 min行气管插管。记录病人入室麻醉前（基础值、麻醉用药后气管插管前、气管插管后即刻、1、3、5、8 min的收缩压（SBP、舒张压（DBP、平均动脉压（MAP和心率（HR。并记录各组心血管不良事件的发生情况和需要药物干预的病例数。结果 与基础值相比,在麻醉诱导后气管插管前4组血压均明显降低,S2组降低幅度最大。气管插管后4组血压均回升,其中S1组增加明显（P<0.05,且与另外3组相比差异显著（P<0.05。插管后3至8 min所有病人血压逐渐回降,MS、ML和S1组的血压低于基础值,但仍在临床允许范围,而S2组下降显著,尤其在插管后8 min,与另外3组比较差异显著（P<0.05,P<0.01。除S2组以外,另外3组插管前心率下降不明显,插管后即刻至1 min仅S1组心率显著增加（P<0.05,在插管5 min后S2组心率继续下降（P<0.05。气管插管前S2组发生低血压和心动过缓的病例明显多于另外3组,插管后S1组高血压和心动过速的病例则明显多于MS、LS和S2组。结论 以较小剂量舒芬太尼（0.6 μg·kg-1复合硫酸镁（20 mg·kg-1或利多卡因（1.5 mg·kg-1可明显缓和冠心病患者插管前低血压,并减少插管刺激引起的高血压和心动过速,有利于血液动力学的稳定。     

肺复张治疗肺外源性急性呼吸窘迫综合征的效果评价

目的 观察肺复张对肺外源性急性呼吸窘迫综合征(ARDS)患者氧合指数[氧分压(PaO2)/吸入氧气浓度(FiO2)]、呼吸力学及血流动力学的影响.方法 14例肺外源性ARDS患者行保护性肺通气,稳定后开始肺复张治疗.实施控制性肺膨胀(SI)进行肺复张,每8小时进行1次,共3天,纪录每天第1次患者治疗前及治疗后1小时的血气指标、呼吸机参数及肺复张前后的血流动力学指标.结果 1、2、3天肺复张治疗后1小时患者PaO2/FiO2较治疗前均有上升,(162.6±19.80)mmHg vs(220.93±34.10)mmHg,(195.6±24.40) mmHg vs (243.3±34.60)mmHg,(222.57±27.40) mmHg vs(254.71±38.90)mmHg(P＜0.05或＜0.0l);气道峰压[PIP:(35.64±2.71)cmH2O vs(34.07±2.58)cmH2O,(32.86±3.30)cmH2O vs(30.93±3.15)cmH2O,(30.14±2.66)cmH2O vs (28.07±3.27)cmH2O,P＜0.01]、气道平台压[Pplat:(31.29±2.49)cmH2O vs (28.93±2.63) cmH2O,(28.79±3.02) cmH2O vs(26.86±3.13)cmH2O,(25.71±2.09)cmH2O vs(23.57±2.34)cmH2O,P＜0.01]在肺复张治疗后均下降,呼吸系统静态顺应性(Cst)在肺复张治疗后改善,且整体呈升高趋势[(26.21±3.26)ml/cmH2O vs (30.14±3.70) ml/cmH2O,(29.36±4.25) ml/cmH2O vs (33.64±5.30) ml/cmH2O,(32.14±5.05) ml/cmH2O vs (35.57±5.57)ml/cmH2O,P＜0.01)];14例患者中有9例在肺复张过程中心率升高、血压下降,但均能于复张后3分钟恢复至复张前水平,余患者肺复张过程中心率、血压未见明显波动,14例患者均无心律失常发生.结论 对于肺外源性ARDS,肺复张可明显改善氧合,改善呼吸系统顺应性,对血流动力学影响轻徽.     

中波紫外线对角质形成细胞MMP-9及TIMP-1的影响

【摘要】目的：研究中波紫外线(UVB)照射对HaCaT细胞中基质金属蛋白酶-9（MMP-9）和基质金属蛋白酶抑制剂-1（TIMP-1）mRNA表达的影响。方法：培养HaCaT细胞,绘制细胞生长曲线,经不同剂量（0、30、60、90 mJ/cm2）UVB照射;用MTT方法测定UVB照射后细胞的增殖活性,反转录-聚合酶链反应（RT-PCR）方法测定UVB照射后HaCaT细胞中MMP-9 mRNA 和 TIMP-1 mRNA的表达。结果：随着照光剂量的增大,细胞的增殖活性逐渐降低,而细胞的增殖抑制率逐渐增加,不同照射剂量各组间OD值差异有统计学意义（P<0.05）;随着照光剂量的增大,MMP-9 mRNA的表达逐渐增加,各组之间比较差异均有统计学意义（P<0.05）;TIMP-1mRNA的表达逐渐降低,与0 mJ/cm2比较差异具有统计学意义（P<0.05）。结论：UVB照射可诱导HaCaT细胞损伤和细胞凋亡,MMP-9和TIMP-1可能与光老化的发生有一定关系。     

儿童疫苗接种常见不良反应及处理

疫苗接种是消除感染性疾病的重要措施。然而,疫苗接种不可避免地会引起各种不良反应,需引起儿科医师重视并给予及时适当处理。临床医生应了解儿童疫苗接种不良反应常见临床类型（疫苗接种后一般反应、异常反应、疫苗接种后现象等）及基本处理方法。