Atrial fibrillation after cardiac surgery: A systematic review and meta-analysis

ObjectiveNew-onset postoperative atrial fibrillation (POAF) after cardiac surgery is common, with rates up to 60%. POAF has been associated with early and late stroke, but its association with other cardiovascular outcomes is less known. The objective was to perform a meta-analysis of the studies reporting the association of POAF with perioperative and long-term outcomes in patients with cardiac surgery.MethodsWe performed a systematic review and a meta-analysis of studies that presented outcomes for cardiac surgery on the basis of the presence or absence of POAF. MEDLINE, EMBASE, and the Cochrane Library were assessed; 57 studies (246,340 patients) were selected. Perioperative mortality was the primary outcome. Inverse variance method and random model were performed. Leave-one-out analysis, subgroup analyses, and metaregression were conducted.ResultsPOAF was associated with perioperative mortality (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.58-2.33), perioperative stroke (OR, 2.17; 95% CI, 1.90-2.49), perioperative myocardial infarction (OR, 1.28; 95% CI, 1.06-1.54), perioperative acute renal failure (OR, 2.74; 95% CI, 2.42-3.11), hospital (standardized mean difference, 0.80; 95% CI, 0.53-1.07) and intensive care unit stay (standardized mean difference, 0.55; 95% CI, 0.24-0.86), long-term mortality (incidence rate ratio [IRR], 1.54; 95% CI, 1.40-1.69), long-term stroke (IRR, 1.33; 95% CI, 1.21-1.46), and longstanding persistent atrial fibrillation (IRR, 4.73; 95% CI, 3.36-6.66).ConclusionsThe results suggest that POAF after cardiac surgery is associated with an increased occurrence of most short- and long-term cardiovascular adverse events. However, the causality of this association remains to be established.     

基于自动勾画和快速蒙特卡罗计算的放射治疗全身器官剂量数据库平台的可行性研究

目的:探讨建立一种放射治疗全身器官剂量数据库平台的可行性。方法:使用基于深度学习的自动勾画软件DeepViewer?1例食管癌患者的全身CT上勾画全身器官，然后利用基于GPU加速的蒙特卡罗软件ARCHER计算相应的器官剂量分布，最后利用Lyman-Kutcher-Burman（LKB）模型评估放疗患者正常组织并发症概率（NTCP）。结果:针对该病例，成功建立基于DeepViewer?ARCHER和LKB模型的全身器官剂量数据库，发现距离靶区越近的器官剂量越大，其中心脏与靶区间距离最小，剂量为14.11 Gy，但因其模型参数特殊，通过LKB模型计算的NTCP为0.00%；左、右肺的剂量分别为3.19和1.16 Gy，但是NTCP值却很大，分别为2.13%和1.60%。对于距离靶区较远的头颈部器官（视交叉、视神经和眼）和腹部器官（直肠、膀胱和股骨头）剂量分别约为9和2 mGy，并且NTCP均近似为0.00%。结论:研究结果证明通过自动勾画软件DeepViewer?蒙特卡罗软件ARCHER和LKB模型建立全身器官剂量数据库的可行性。     

Aminotransferases During Treatment Predict Long-Term Survival in Patients With Autoimmune Hepatitis Type 1: A Landmark Analysis

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稽留流产孕早期预测模型的构建与验证

目的构建稽留流产(missed abortion,MA)患者在孕早期流产危险因素列线图。方法纳入2017年2月至2019年10月因稽留流产于中国建筑第二工程局职工医院治疗的孕妇125例为研究组,随机纳入同时期正常孕妇126例为对照组,分析两组患者临床基本资料:年龄、环境因素、动物接触史、叶酸使用、文化程度、流产情况、疾病史、激素水平等。采用Logistic回归分析对孕早期发生稽留流产的危险因素进行分析,应用R软件建立孕早期稽留流产预测列线图,并进行验证。结果研究组孕妇年龄、睾酮(testosterone,T)水平高于对照组,而催乳素(prolactin,PRL)、雌二醇(estradiol,E2)、孕酮(progesterone,P)水平低于对照组,差异均有统计学意义(P<0.05);Logistic回归分析提示孕妇年龄(OR=1.809,P=0.003)、吸烟饮酒(OR=78.120、P=0.044)、职业暴露(OR=61.238,P=0.021)、T水平(OR=5.432,P=0.001)是孕早期发生MA的危险因素。PRL(OR=0.376,P=0.003)、E2(OR=0.258,P=0.016)、P(OR=0.396,P=0.005)是孕早期发生MA的保护因素。预测孕早期MA发生的相关危险因素的C-index为0.912(95%CI:0.874-0.943)。结论列线图中孕妇年龄、环境因素、激素水平能较准确的预测孕早期发生MA的风险。     

miR-200、 miR -155及血管新生因子与复发性流产的相关性分析

目的 研究miR-200、miR-155及血管新生因子与原因不明复发性流产(unexplained recurrent spontaneousabortion,URSA)的相关性分析。 方法 选择2015年3月—2018年1月在青岛市妇女儿童医院妇产科就诊的URSA患者作为URSA组、要求终止妊娠的正常早孕患者作为对照组,检测绒毛组织中微小RNA(microRNA, miR)miR-200、miR-155、血管内皮生长因子(vascular endothelial growth factor,VEGF)、可溶性FMS样酪氨酸激酶1(soluble FMS like tyrosine kinase-1,sFlt-1)的表达量及血清中VEGF、sFlt-1的含量,对miR-200、miR-155靶向结合VEGF、sFlt-1进行生物信息学分析。 结果 URSA组的绒毛组织中miR-200(1.78±0.32 vs. 0.91±0.15)、sFlt-1(1.87±0.35 vs. 1.06±0.21)的相对表达量及血清中sFlt-1的含量[(12.39±2.31)ng/ml vs. (6.51±0.95)ng/ml]均高于对照组,差异有统计学意义(均P<0.05)。绒毛组织中miR-155相对表达量(0.60±0.10 vs. 0.93±0.16)、VEGF mRNA相对表达量(0.59±0.09 vs. 1.02±0.16)及蛋白表达量(0.62±0.07 vs. 1.04±0.18)、血清中VEGF的含量[(601.25±94.39)ng/ml vs. (935.12±132.47)ng/ml]低于对照组,差异有统计学意义(均P<0.05);URSA组患者绒毛组织中miR-200的表达量与血清中VEGF的含量、绒毛组织中VEGF的表达量均呈负相关,绒毛组织中miR-155的表达量与血清中sFlt-1的含量和绒毛组织中sFlt-1的表达量均呈负相关;miR-200、miR-155分别靶向结合VEGF、sFlt-1基因的3’UTR。 结论 miR-200表达增多、miR-155表达减少与URSA发生有关,miR-200靶向VEGF、miR-155靶向sFlt-1是介导该过程的可能机制。     

Effect of UVB 311 nm irradiation on normal human skin

Ultraviolet radiation B (UVB) on the skin induces erythema, inflammation and modifications of the immune system. These changes have been reported after excessive short-term or long-term exposure to broad spectrum UVB. In this study, we examined the effects of local repetitive UVB irradiation of 311 nm wavelength on the skin of seven young volunteers. Skin biopsies were taken before and after UVB irradiation, and we immunohistochemically analyzed the expression of CD1a and HLA-DR antigens of Langerhans cells (LC), the possible infiltration of dermis/epidermis by CD11b macrophages, the modifications or the induction of intercellular adhesion molecule-1 (ICAM-1), E-selectin and vascular cell adhesion molecule-1 (VCAM-1) involved in the binding of leukocytes to the endothelial surface and the development of perivascular infiltrates of LFA-1⁺ mononuclear cells. We also determined the expression of substance P receptors (SPR) using biotinylated substance P (SPB). Exposure of UVB 311 nm induced a drastic reduction of CD1a⁺ cells and a moderate increase of HLA-DR⁺ dendritic cells in the epidermis without infiltration by CD11b macrophages. An increase of the binding of SPB to upper layer epidermal cells was noted in five of seven biopsies. In the dermis, vessel-associated ICAM-1 expression increased and an induction of E-selectin occurred on nearly 20 to 40% of endothelial cells, but VCAM-1 expression remained undetectable. The percentage of LFA-1⁺ cells did not change significantly after irradiation. These observations may be compatible with a selective role of UVB 311 nm on the skin immune response.     

食盐对普通玉米杂交种淀粉糊化性质的影响

采用快速粘度分析仪（RVA）研究了食盐对18种普通玉米杂交种淀粉糊化性质的影响。结果表明：食盐显著降低了所有普通玉米杂交种淀粉的峰值、破损值和回生值;提高了谷值、终粘度、出峰时间和成糊温度。但对不同的普通玉米杂交种淀粉的糊化性质的影响程度有显著差别。随着食盐溶液质量分数的增加,普通玉米杂交种淀粉的谷值、终粘度、出峰时间和成糊温度也逐渐增加,破损值和回生值则显著降低,峰值受食盐溶液质量分数的影响很小。