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简介：AbstractPurpose:The injury severity score (ISS) and new injury severity score (NISS) have been widely used in trauma evaluation. However, which scoring system is better in trauma outcome prediction is still disputed. The purpose of this study is to evaluate the value of the two scoring systems in predicting trauma outcomes, including mortality, intensive care unit (ICU) admission and ICU length of stay.Methods:The data were collected retrospectively from three hospitals in Zhejiang province, China. The comparisons of NISS and ISS in predicting outcomes were performed by using receiver operator characteristic (ROC) curves and Hosmer-Lemeshow statistics.Results:A total of 1825 blunt trauma patients were enrolled in our study. Finally, 1243 patients were admitted to ICU, and 215 patients died before discharge. The ISS and NISS were equivalent in predicting mortality (area under ORC curve [AUC]: 0.886 vs. 0.887, p = 0.9113). But for the patients with ISS ≥25, NISS showed better performance in predicting mortality. NISS was also significantly better than ISS in predicting ICU admission and prolonged ICU length of stay.Conclusion:NISS outperforms ISS in predicting the outcomes for severe blunt trauma and can be an essential supplement of ISS. Considering the convenience of NISS in calculation, it is advantageous to promote NISS in China’s primary hospitals.

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简介：目的:研究损伤严重程度感知(ISP)评分法在测试急性挥鞭样损伤患者中的复测可重复性。方法:在基层保健中心连续对急性阶段患急性挥鞭样损伤患者采用ISP评分。ISP是一种通过数字等级进行评分,其测量范围从0到10,受试者被要求指出他们自认为的受伤严重程度。0代表'无损伤',10代表'严重且永久性损伤'。利用ISP问卷对同一批受试者在招募完成时及7天后进行评分。复测可重复性由一致百分率和在两个时间点进行的Kappa分析进行计算。锚定两端分别标记为'没有损伤'(0)和'严重损伤,可能是永久性损伤'(10)。结果:实验包括94名研究对象(34名男性,60名女性,平均年龄为40.6±10.0岁,范围19-60岁),在刚招募时JSP平均得分为4.9±1.7(评分在2-9之间),一周后ISP平均得分为5.1±2.1(评分在2-9之间)。在ISP的两次重复测量中百分比一致率为86%,Kappa系数为0.79。结论:这项研究表明ISP复测可重复性在预后研究中偏倚风险较低。ISP评分法在急性挥鞭样损伤患者的流行病学研究中具有相当高的可靠性。

简介：AbstractPurpose:To establish a severe blast lung injury model of goats and investigate the feasibility of lung ultrasonic score in the evaluation of blast lung injury.Methods:Twenty female healthy goats were randomly divided into three groups by different driving pressures: 4.0 MPa group (n = 4), 4.5 MPa group (n = 12) and 5.0 MPa group (n = 4). The severe blast lung injury model of goats was established using a BST-I bio-shock tube. Vital signs (respiration, heart rate and blood pressure), lung ultrasound score (LUS), PO2/FiO2 and extravascular lung water (EVLW) were measured before injury (0 h) and at 0.5 h, 3 h, 6 h, 9 h, 12 h after injury. Computed tomography scan was performed before injury (0 h) and at 12 h after injury for dynamic monitoring of blast lung injury and measurement of lung volume. The correlation of LUS with PaO2/FiO2, EVLW, and lung injury ratio (lesion volume/total lung volume*100%) was analyzed. All animals were sacrificed at 12 h after injury for gross observation of lung injury and histopathological examination. Statistical analysis was performed by the SPSS 22.0 software. The measurement data were expressed as mean ± standard deviation. The means of two samples were compared using independent-sample t-test. Pearson correlation analysis was conducted.Results:(1) At 12 h after injury, the mortality of goats was 0, 41.67% and 100% in the 4.0 Mpa, 4.5 MPa and 5.0 MPa groups, respectively; the area of pulmonary hemorrhage was 20.00% ± 13.14% in the 4.0 Mpa group and 42.14% ± 15.33% in the 4.5 MPa group. A severe lung shock injury model was established under the driving pressure of 4.5 MPa. (2) The respiratory rate, heart rate, LUS and EVLW were significantly increased, while PaO2/FiO2 was significantly reduced immediately after injury, and then they gradually recovered and became stabilized at 3 h after injury. (3) LUS was positively correlated with EVLW (3 h: r = 0.597, 6 h: r = 0.698, 9 h: r = 0.729; p < 0.05) and lung injury ratio (12 h: r= 0.884, p < 0.05), negatively correlated with PaO2/FiO2 (3 h: r =－0.871, 6 h: r =－0.637, 9 h: r =－0.658; p < 0.05).Conclusion:We established a severe blast lung injury model of goats using the BST-I bio-shock tube under the driving pressure of 4.5 MPa and confirmed that ultrasound can be used for quick evaluation and dynamic monitoring of blast lung injury.

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简介：AbstractBackground:The platelet to lymphocyte ratio (PLR) has recently emerged as a potential inflammatory biomarker and has been shown to be significantly associated with atherosclerotic coronary artery disease (CAD). Therefore, we aimed to explore the association of PLR with in-hospital major adverse cardiovascular events (MACEs) and the severity of CAD assessed by the Gensini score (GS) in patients with acute myocardial infarction (AMI) undergoing coronary angiography.Methods:A total of 502 patients with AMI consecutively treated at the Affiliated Hospital of Qingdao University (Qingdao, China) and underwent coronary angiography from August 2017 to December 2018 were recruited in this study. The demographic, clinical, angiographic characteristics, and laboratory parameters were collected. According to the presence of in-hospital MACEs, the included patients were divided into the MACE group (n = 81) and the non-MACE group (n = 421). Further, according to tertiles of the GS, the patients were classified into three groups: the low GS group (GS ≤32 points, n = 173), medium GS group (32 points < GS ≤ 60 points, n = 169), and high GS group (60 points < GS ≤ 180 points, n = 160). The main statistical methods included Chisquared test, non-parametric Mann-Whitney U test, Kruskal-Wallis H test, logistic regression, and receiver operating characteristic curves.Results:The PLR in the MACE group was significantly higher than that in the non-MACE group (179.43 [132.84, 239.74] vs. 116.11 [87.98, 145.45], Z = -8.109, P < 0.001). Further, there were significant differences in PLR among the tertiles of GS (110.05[84.57, 139.06] vs. 119.78 [98.44, 157.98] vs. 140.00 [102.27, 191.83], H= 19.524, P < 0.001). PLR was demonstrated to be an independent risk factor of in-hospital MACEs (odds ratio [OR]: 1.012, 95% confidential interval [CI]: 1.006-1.018, P < 0.001) and severe CAD assessed by the GS (OR: 1.004, 95% CI: 1.002-1.009, P= 0.042). The cutoff value of PLR for predicting the development of in-hospital MACEs was 151.28 with a sensitivity of 66.7% and a specificity of 78.1% (area under the curve [AUC]: 0.786, 95% CI: 0.730-0.842, P < 0.001), and a PLR of 139.31 was also identified to be an effective cutoff point for detecting a high GS (<60 points) with a sensitivity of 49.4% and a specificity of 69.6% (AUC: 0.611, 95% CI: 0.556-0.666, P < 0.001).Conclusions:PLR as a novel inflammatory marker is significantly and independently associated with the occurrence of in-hospital MACEs and the severity of CAD assessed by the GS in patients with AMI. As an easily available and inexpensive inflammatory indicator, PLR could be widely used as an efficient inflammatory biomarker for identifying high-risk patients and for individualizing targeted therapy to improve the prognosis of AMI.

简介：Theincreaseinneurotrophicfactorsaftercraniocerebralinjuryhasbeenshowntopromotefracturehealing.Moreover,neurotrophicfactorsplayakeyroleintheregenerationandrepairofperipheralnerve.However,whethercraniocerebralinjuryalterstherepairofperipheralnerveinjuriesremainspoorlyunderstood.Ratinjurymodelswereestablishedbytransectingtheleftsciaticnerveandusingafree-falldevicetoinducecraniocerebralinjury.Comparedwithsciaticnerveinjuryaloneafter6–12weeks,ratswithcombinedsciaticandcraniocerebralinjuriesshoweddecreasedsciaticfunctionalindex,increasedrecoveryofgastrocnemiusmusclewetweight,recoveryofsciaticnervegangliaandcorrespondingspinalcordsegmentneuronmorphologies,andincreasednumbersofhorseradishperoxidase-labeledcells.Theseresultsindicatethatcraniocerebralinjurypromotestherepairofperipheralnerveinjury.

简介：score、dozen是一对用法极易混淆的词，下面对它们的用法略加区分。

简介：这研究试图决定血浆睾丸激素是否在经历了选任的冠的angiography的一组803个人与冠的动脉粥样硬化的严厉被联系。睾丸激素层次在根据睾丸激素水平tertiles被分成三个组的803个男病人被测量。所有病人经历了选任的冠的angiography，并且冠的动脉疾病(CAD)的严厉被Gensini分数决定。而且，病人们根据Gensini分数被分类进二个组(20≤；26和20>；26)用是的中部的价值，截止指。血浆睾丸激素层次被一个ELISA工具包测量。睾丸激素的水平否定地与Gensini分数被联系(r=−；0.188；P=0.000)。多重线性回归分析表明那睾丸激素是为Gensini分数的一个独立风险因素(β；=−；0.110；P=0.002)在为使covariates惊讶调整以后。在multivariate逻辑回归模型，CAD的严厉被显示在第三tertile显著地更低(最高)与第一tertile相比的睾丸激素(最低)睾丸激素(机会比率(或)=0.465；95%；信心间隔(CI)：0.327-0.662；P=0.000)。在这研究，有更低的睾丸激素层次的病人在经历了选任的冠的angiography的一组803个人有更高的Gensini分数。另外的研究被需要澄清诱发性和可能的位于\O下面机制的方向。

简介：AIM:Toinvestigatethelatentstructureofanirritablebowelsyndrome(IBS)symptomseverityscaleinapopulationofhealthyadults.METHODS:TheBirminghamIBSsymptomquestionnairewhichconsistsofthreesymptomspecificscales(diarrhea,constipation,pain)wasevaluatedbymeansofstructuralequationmodeling.Wecomparedtheoriginal3-factorsolutiontoageneralfactormodelandabifactorsolutioninalargeinternetsampleofcollegestudents(n=875).Statisticalcomparisonsofcompetingmodelswereconductedbymeansofχ2differencetests.Regardingtheevaluationofmodelfit,weexaminedthecomparativefitindex(CFI)andtheRootMeanSquareErrorofApproximation(RMSEA).RESULTS:ResultsclearlyfavoredabifactormodelofIBSsymptomseverity(CFI=0.99,RMSEA=0.05)whichconsistedofastronggeneralIBSsomatizationfactorandthreesymptomspecificfactors(diarrhea,constipation,pain)basedonthesubscalesoftheBirminghamIBSsymptomquestionnaire.Thefitindicesofthecompetingonefactormodel(CFI=0.85,RMSEA=0.17)andthreefactormodel(CFI=0.97,RMSEA=0.08)wereclearlyinferior.χ2differencetestsshowedthatthedifferencesbetweenthemodelswereindeedsignificantinfavorofthebifactormodel(P<0.001).Correlationsofthefourlatentfactorswithmeasuresofpainsensitivity,somatoformdissociation,fatigueseverity,anddemographicvariablessupportthevalidityofourbifactormodelofIBSspecificsymptomseverity.CONCLUSION:ThefindingssuggestthatIBSsymptomseveritymightbestbeunderstoodasacontinuousandmultidimensionalconstructwhichcanbereliablyandvalidlyassessedwiththeB-IBS.

简介：客观：为了改进痊愈，与由craniocerebral损害复杂的腹的内脏的损害病人评价。方法：由craniocerebral损害复杂的腹的内脏的损害的176个盒子的临床的数据回顾地被分析。结果：在这个系列，44个盒子死了，死亡是25.0%。死亡的主要原因是与吃惊相结合的腹的内脏的损害和严重craniocerebral损害。结论：在早舞台由精确诊断改进痊愈率是必要的。腹的帕拉穿刺术和CT应该即时并且动态地被执行。优先级应该被给life-threateninginjuries的治疗。

简介：1953年，美国总统德怀特·D·艾森豪威尔签署《小型企业法案》，相继成立美国小企业管理局（SBA）。

简介：Givennon-negativeintegersm,n,handkwithm≥h>1andn≥k>1,an(h,k)-bipartitehypertournamentonm+nverticesisatriple(U,V,A),whereUandVaretwosetsofverticeswith|U|=mand|V|=n,andAisasetof(h+k)-tuplesofvertices,calledarcs,withatmosthverticesfromUandatmostkverticesfromV,suchthatforanyh+ksubsetsU_1∪V_1ofU∪V,Acontainsexactlyoneofthe(h+k)!(h+k)-tupleswhoseentriesbelongtoU_1∪V_1.Necessaryandsufficientconditionsforapairofnon-decreasingsequencesofnon-negativeintegerstobethelosingscorelistsorscorelistsofsome(h,k)-bipartitehypertournamentareobtained.

简介：Thephenomenonofischemia/reperfusioninjuryisdescribedintheexperimentalmodelsofacutemyocardialinfarction(AMI),causingadditionalfunctionalandstructuraldamagetotheacutereperfusedmyocardium,andischemicpreconditioningreferstothemyocardialischemiaafteralongperiodofreperfusionbeforeoneorseveralshortoccasionalduplicationofmyocardialischemia/reperfusion1,whichcanincreasemyocardialischemictolerance.ThetherapeuticstrategiesforAMIhavefocusedonmyocardialischemia/reperfusioninjury,whichaccountsforasignificantpartofthefinalinfarctsize.Althoughexperimentsinthelast20yearshavereportedthatpharmacologicalinterventionsatreperfusionmightreducemyocardialreperfusioninjury,thiscouldnotbeconfirmedinhumanstudies.Analternativetochemicalmodifiers,postconditioning(briefrepeatedperiodsofischemiaappliedattheonsetofreperfusion)isanothermethodproventobeefficientinanimalmodelsandtobeconfirmedinrecenthumanstudies.Thissimplemethod,appliedinthefirstminuteofreperfusion,reducesthefinalinfarctsizeby30%-50%.Thisreviewwillfocusonthemechanisms,pharmacologicalpreconditioning,postconditioningtechnique,whichiseasilyapplicableinhumanpatientsinthesettingofAMI.

简介：Thecingulum,theneuraltractconnectingtheorbitofrontalcortexwiththemedialtemporallobe,playsanimportantroleincognition(Bushetal.,2000).Itisalsoimportantinmemorybecauseitprovidescholinergicinnervationstothecerebralcortexafterobtaininginnervationfromthemedialseptalnucleus,the

简介：WesternChinaexperiencedanextremehotsummerin2015,breakinganumberoftemperaturerecords.Thesummermeansurfaceairtemperature(SAT)anomalywastwicetheinterannualvariability.Thehottestdaytimetemperature(TXx)andwarmestnight-timetemperature(TNx)werethehighestinChinasince1964.Thisextremehotsummeroccurredinthecontextofsteadilyincreasingtemperaturesinrecentdecades.Wecarriedoutasetofexperimentstoevaluatetheextenttowhichthechangesinseasurfacetemperature(SST)/seaiceextent(SIE)andanthropogenicforcingdrovetheseverityoftheextremesummerof2015inwesternChina.Ourresultsindicatethatabout65%-72%oftheobservedchangesintheseasonalmeanSATandthedailymaximum(Tmax)anddailyminimum(Tmin)temperaturesoverwesternChinaresultedfromchangesinboundaryforcings,includingtheSST/SIEandanthropogenicforcing.Fortherelativeroleofindividualforcing,thedirectimpactofchangesinanthropogenicforcingexplainabout42%oftheSATwarmingand60%(40%)oftheincreaseinTNxandTmin(TXxandTmax)inthemodelresponse.ThechangesinSST/SIEcontributedtotheremainingsurfacewarmingandtheincreaseinhotextremes,whicharemainlytheresultofchangesintheSSToverthePacificOcean,whereasuperElNi?oeventoccurred.OurstudyindicatesaprominentroleforthedirectimpactofanthropogenicforcingintheseverityoftheextremehotsummerinwesternChinain2015,althoughthechangesinSST/SIE,aswellastheinternalvariabilityoftheatmosphere,alsomadeacontribution.

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简介：BackgroundIncreasedserumleveloflipoprotein(a)(Lp(a))isassociatedwithatherosclerosis.WhetherincreasedLp(a)levelisindependentlyassociatedwiththeseverityofcoronaryarterydisease(CAD)isunclear.MethodsSubjectswereenrolledandreceivedcoronaryangiographytoassessthenumberofstenosedcoronaryartery.ThesubjectswithCADweredividedintonon-significant(<50%stenosis),singleandmultivesselstenosis(≥50%stenosis)groups.Parametersofinterestatbaselinewerecollected.StatisticalanalyseswereperformedtoevaluatetherelationshipbetweenLp(a)levelandCADseverity.ResultsTotally745populationswereenrolledanddiagnosedasCAD(n=605)orwithoutCAD(n=140)onthebasisofangiographyexamination.AscomparedtothesubjectswithoutCAD,serumlevelsofLp(a)andCRP,andthepercentagesofsubjectswithsmokingordiabetesweresignificantlyhigherinsubjectswithCAD.Incontrast,serumlevelsofHDL-CandApo-AweresignificantlylowerinsubjectswithCADascomparedtosubjectswithoutCAD.Incomparisonofsubjectswithnon-significantstenosis(serumLp(a)level,170.0±19.7mg/dL),serumLp(a)levelwassignificantlyhigherinsubjectswithsingle(245.5±22.3mg/dL)ormultiplevesselstenoses(265.8±14.0mg/dL).Withmultivariateregressionanalyses,afteradjustedforage,gender,smoking,familyhistoryandhypertension,therewasstillsignificantassociationbetweenserumLp(a)levelandthenumberofcoronaryarterystenosis.Afteradditionaladjustmentfordiabetes,HbA1c,totalcholesterol,LDL-C,Apo-A,uricacidandCRP,Lp(a)remainedstronglyassociatedwithCADseverity.ConclusionSerumLp(a)levelwassignificantlyassociatedwiththeseverityofcoronaryarterystenosis,whichmayaddthevalueoncardiovascularriskevaluation.