分类： 医学、药学 >> 临床医学 提交时间： 2025-07-09 合作期刊: 《中国全科医学》
摘要： 背景 慢性阻塞性肺疾病（以下简称慢阻肺病）具有进行性和不可逆性，病程长且反复发作，患者常表现出焦虑/抑郁等心理问题，严重影响患者的生命质量，生命质量量表是测量慢阻肺病患者治疗效果和生命质量最常用的方式，国内外研制了多个慢阻肺病特异性生命质量量表，但不同量表之间的维度、条目和水平差异较大，在应用时需要对不同量表进行对比和分析。目的 对慢阻肺病患者特异性生命质量测量工具进行范围综述。方法 以“慢性阻塞性肺疾病”“生命质量”“心理测量学特性”“chronic obstructive pulmonary disease”“quality oflife”“measurement properties”等为检索词，系统检索 Web of Science、PubMed、Embase、中国知网、万方数据知识服务平台、维普网和中国生物医学文献服务系统共7个数据库，检索时限为建库至 2023-12-31。提取工具原始开发文献的基本特征，对工具涵盖维度以及测量性能指标总体情况进行梳理与汇总。结果 共纳入25个慢阻肺病特异性生命质量测量工具，其中7个为基于中国人群开发量表，18个为国外量表，在国外量表中，共有7个量表在中国人群中得到广泛验证。在各维度中，呼吸道症状（包括呼吸困难、咳嗽、咳痰、胸闷和喘息）、社会交往以及日常生活影响这三个维度的测量频次最高，达到 23 个（92.0%）。在量表信度测评中，主要使用Cronbach'sα系数来评估内部一致性；在量表效度测评中，国内开发和验证的量表主要侧重于内容效度和构念效度，国内验证的国外量表其效标效度的使用频次更高；反应度/灵敏度和最小临床重要差值（MCID）的使用频率均较低。结论 慢阻肺病特异性生命质量测量工具开发或验证研究数量繁多，但缺乏现代测量理论的指导。近些年我国学者对慢阻肺病特异性生命质量测量工具的关注逐渐增多，未来应采取项目反应理论等现代测量方法学进行量表开发或验证，使用国际COSMIN指南对量表测量性能指标进行系统评价。
分类： 医学、药学 >> 临床医学 提交时间： 2025-07-09 合作期刊: 《中国全科医学》
摘要： 背景 类风湿关节炎合并间质性肺疾病（RA-ILD）是类风湿关节炎（RA）的常见并发症，20%~50%的RA患者会继发ILD，使RA患者死亡风险增加。目前临床缺乏安全有效、靶向明确的治疗RA-ILD药物。中医药在RA-ILD治疗中具有一定优势，风湿肺痹方作为常用方剂，其疗效确切，但作用机制尚不明确，需通过实验研究加以验证。目的 探讨FSFBF对肿瘤坏死因子α转基因（TNF-Tg）小鼠RA-ILD的疗效和作用机制。方法 于2024年3月—2025年1月，采用雌性TNF-Tg小鼠作为RA-ILD模型小鼠，将24只2.5月龄TNF-Tg小鼠随机分为模型组（TNF-Tg组）、FSFBF低剂量组（Low组）、FSFBF中剂量组（Middle组）、FSFBF高剂量组（High组），同时随机挑选6只同窝野生型小鼠作为对照组（WT组）。TNF-Tg组给予生理盐水，Low、Middle、High组分别给予5.825、13.65、27.3g·kg-1·d-1 FSFBF灌胃。9周后采集小鼠体质量、踝关节临床评分和前肢抓力数据；取踝关节与肺脏组织进行HE染色、Masson染色、番红固绿染色；使用酶联免疫吸附试验（ELISA）检测小鼠血清炎症因子含量；采用免疫荧光染色标记肺脏巨噬细胞；采用实时荧光定量PCR（RT-qPCR）检测肺脏炎症因子mRNA相对表达量。结果 4.5月龄时，TNF-Tg组体质量低于WT组，Low组、High组高于TNF-Tg组（P<0.05）；TNF-Tg组踝关节临床评分高于WT组，Middle组、High组低于TNF-Tg组（P<0.05）；TNF-Tg组前肢抓力低于WT组，High组高于TNF-Tg组（P<0.05）。病理结果显示：TNF-Tg组踝关节炎症面积、肺脏炎症面积、肺脏I型胶原纤维面积大于WT组，Middle组和High组踝关节炎症面积小于TNF-Tg组，Middle组关节软骨面积大于TNF-Tg组，Low组、Middle组和High组肺脏炎症与肺脏I型胶原纤维面积小于TNF-Tg组（P<0.05）。免疫荧光染色结果显示：TNF-Tg组肺脏M1、M2型巨噬细胞数量大于WT组，Low组、Middle组和High组M1型巨噬细胞数量低于TNF-Tg组，M2型巨噬细胞数量高于TNF-Tg组（P<0.05）。ELISA结果显示：TNF-Tg组血清TNF-α、IL-1β和IL-6水平高于WT组，Low组、Middle组、High组血清TNF-α和IL-1β水平低于TNF-Tg组，High组血清IL-6水平低于TNF-Tg组（P<0.05）。RT-qPCR结果显示：TNF-Tg组小鼠肺脏TNF-α和IL-1β相对表达量高于WT组，High组低于TNF-Tg组（P<0.05）；Middle组和High组肺脏IL-1相对表达量低于TNF-Tg组（P<0.05）；TNF-Tg组小鼠踝关节TNF-α和IL-1β相对表达量高于WT组，Low组、Middle组和High组低于TNF-Tg组（P<0.05）。结论 FSFBF通过调节肺脏巨噬细胞极化，改善TNF-Tg小鼠RA-ILD的症状，减轻关节炎症、软骨破坏、肺脏炎症和肺泡纤维化，FSFBF可能成为临床治疗RA-ILD的新方法。
分类： 医学、药学 >> 临床医学 提交时间： 2025-07-09 合作期刊: 《中国全科医学》
摘要： 背景 肺炎支原体肺炎（MPP）是我国常见的儿童社区获得性肺炎，其临床特征及预后与年龄、影像学进展密切相关，但目前针对年龄分层联合影像学分析的系统研究仍然不足。目的 探讨不同年龄MPP临床特征及发生大叶性肺炎的高危因素，为精准诊疗提供帮助。方法 回顾性纳入湖南省人民医院2023年8月—2024年4月895例住院MPP患儿为研究对象，按年龄分为<5岁组和≥5岁组，按影像学结果进一步分为<5岁非大叶性肺炎亚组、<5岁大叶性肺炎亚组、≥5岁非大叶性肺炎亚组、≥5岁大叶性肺炎亚组，收集患者一般资料、实验室指标、治疗及预后资料，并比较组间差异。采用多重实时荧光定量PCR检测呼吸道病原体核酸，Taqman荧光探针PCR技术检测ＭＰ核酸及耐药突变位点基因。采用多因素Logistic逐步回归分析发生大叶性肺炎的危险因素。结果 895例MPP患儿中，男418例（46.7%），女477例（53.3%），中位年龄为7.09（5.1，8.9）岁。<5岁组218例（24.4%），≥5岁组677例（75.6%）。<5岁非大叶性肺炎亚组164例（18.3%），<5岁大叶性肺炎亚组54例（6.0%），≥5岁非大叶性肺炎亚组304例（34.0%）、≥5岁大叶性肺炎亚组373例（41.7%）。≥5岁组患儿咳嗽、发热、啰音、呼吸音减弱、头痛、头晕、热峰≥39.0℃、咽痛比例及热程、中性粒细胞/淋巴细胞比值（NLR）、血小板计数/淋巴细胞比值（PLR）、D二聚体水平、支原体（MP）耐药率、支气管镜比例、甲泼尼龙治疗、大叶性肺炎比例以及鼻导管吸氧比例高于<5岁组，而喘息、三凹征比率、乳酸脱氢酶（LDH）水平、丙种球蛋白的使用、无创机械通气（CPAP）及入住儿童重症监护室（PICU）比例低于<5岁组，差异有统计学意义（P<0.05）。<5岁大叶性肺炎亚组过敏体质、热峰≥39.0℃、喘息、耐药和氧疗比例低于<5岁非大叶性肺炎亚组，中位年龄、肺部呼吸音减弱比例、WBC和住院时间高于<5岁非大叶性肺炎亚组，差异有统计学意义（P<0.05）；≥5岁大叶性肺炎亚组过敏体质比例、热峰≥39℃、呼吸音减弱比例、D-二聚体、耐药、支气管镜和甲泼尼龙比例、住院时间高于≥5岁非大叶性肺炎亚组，喘息、三凹征和氧疗比例低于≥5岁非大叶性肺炎亚组，差异有统计学意义（P<0.05）。多因素Logistic逐步回归分析显示，年龄≥5岁、过敏体质、热峰≥39.0℃、NLR及MP耐药是发生大叶性肺炎的高危因素（P<0.05）。结论 <5岁年龄组肺部体征更明显，更需氧疗和PICU的支持；而≥5岁组肺外症状更明显，住院时间更长，易进展为大叶性肺炎，且耐药发生率高，需要糖皮质激素和BAL治疗更为常见。年龄≥5岁、过敏体质、热峰≥39.0℃、NLR及耐药是发生大叶性肺炎的高危因素。
分类： 图书馆学、情报学 >> 读者工作 提交时间： 2025-07-09
摘要： 【目的/意义］针对图书馆参考咨询服务存在的智能程度不足、服务模式被动及资源整合低效等问题，探索MCP（ModeIContextProtocol）服务驱动的智能化转型路径，旨在通过标准化协议打通大型语言模型（LLM）与图书馆异构资源系统的壁垒，构建主动化、精准化、个性化的智慧服务新范式，为图书馆智慧化发展提供理论支撑与实践方案。［方法/过程】基于MCP技术特性与图书馆业务逻辑的适配性分析，构建“资源-MCP-LLM-用户”四层交互模型，设计包含MCP服务层、MCP协议层、基座大模型层和用户层的分层服务体系架构。通过协议解析、工具封装与上下文管理机制，实现LLM对多源资源的动态调度与知识整合。[结果/结论］研究发现MCP服务能根据图书馆能力动态扩展智能参考咨询服务边界，为图书馆智能化转型提供了可扩展的理论框架与技术实施指南，推动公共文化服务向主动化、知识化方向演进。
分类： 医学、药学 >> 临床医学 提交时间： 2025-07-09 合作期刊: 《中国全科医学》
摘要： 背景 IgA血管炎肾炎（IgAVN）是儿童时期常见的系统性小血管炎之一，但临床对患儿血液指标和尿蛋白定量之间关系的综合研究较少。目的 探究IgAVN患儿24 h尿蛋白定量的变化规律及与患儿部分血液指标之间的相关性。方法 选取2013年—2023年就诊于河南中医药大学第一附属医院的IgAVN患儿，收集其24 h尿蛋白定量、基本信息及相关实验室检查指标进行回顾性分析。采用Mann-Whitney检验、Kruskal-Wallis检验和Spearman秩相关分析探究24 h尿蛋白定量与患儿血液指标的关系。结果 经数据治理，共纳入IgAVN患儿3 774例，其中男2 230例，发病年龄10.0（7.0，12.0）岁；女1 544例，发病年龄10.0（7.0，12.0）岁。HSPN患儿不同性别，血常规中不同单核细胞百分数（M%）、血红蛋白浓度（MCHC）范围，肝肾功中不同丙氨酸氨基转移酶（ALT）范围，免疫六项中不同C3、C4、免疫球蛋白A（IgA）、免疫球蛋白M（IgM）范围，T细胞亚群中不同CD3%、CD3CD8%、CD4/CD8范围的24 h尿蛋白定量比较，差异均无统计学意义（P>0.05）。Spearman秩相关分析结果显示，24 h尿蛋白定量与年龄呈负相关（rs=-0.179，P<0.001）。24 h尿蛋白定量与血常规中白细胞计数（WBC）、血小板计数（PLT）、中性粒细胞百分数（N%）、红细胞沉降率（ESR），与肝肾功能指标中天冬氨酸氨基转移酶（AST）、尿素氮（BUN）、乳酸脱氢酶（LDH）、三酰甘油（TG）、胆固醇（CHOL），与免疫六项中免疫球蛋白E（IgE），与凝血指标中D2聚体（D2）、凝血酶时间（TT），与T细胞亚群中的CD3、CD3CD4、CD3CD8呈正相关（P<0.05）；与血常规中红细胞计数（RBC）、血红蛋白（Hb）、淋巴细胞百分数（L%）、嗜酸粒细胞百分数（E%），与C反应蛋白（CRP），与肝肾功能中总蛋白（TP）、白蛋白（ALB）、直接胆红素（DBIL）、碱性磷酸酶（ALP）、肌酐（Cr）、尿酸（UA）、钙（Ca），与免疫六项中IgG，与凝血指标中国际标准化比值（INR）、活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、纤维蛋白原（FIB），与T细胞亚群中CD3CD4%呈负相关（P<0.05）。结论 本研究发现IgAVN患儿24 h尿蛋白定量与多系统指标存在显著关联：与肾功能损伤（BUN、LDH）、脂代谢紊乱（TG、CHOL）、Th1免疫极化（CD3CD8+）及高凝状态（D2、TT）呈正相关；与肝合成功能（ALB、TP）、免疫调节（CD3CD4%）及凝血因子（FIB）呈负相关。该发现为临床进一步揭示gAVN的病理机制、构建临床监测预警体系、优化治疗策略提供了一定的临床依据。
分类： 管理学 >> 可持续发展管理 提交时间： 2025-07-08
摘要： Green credit policy is an important tool to promote the green and clean development of the industrial sector.，the transformation effect of the industrial sector directly affects the global climate governance process. To explore how green financial policies will impact coordinated carbon pollution emission reduction, this study uses the double difference model (DID) to evaluate the impact of green financial policies on coordinated carbon pollution emission reduction. Constructing an Empirical Analysis of Provincial Panel Data in China from 2008 to 2021. Results show that the green credit policy significantly inhibited the synergistic emission of carbon pollution, with a coefficient of -0.0278, and had a synergistic and significant effect on the total pollutant emissions. The mechanism test shows that the policy drives emission reduction through the path of technological innovation; however, the mechanism of industrial structure adjustment and energy efficiency has not reached a significant level. Furthermore, the policy effect is more significant in areas with high economic levels, areas with low proportions of secondary industry, and areas with high environmental regulation, revealing the heterogeneity of regional economic structure, industrial dependence, and environmental supervision on policy transmission. Based on this, we proposed some recommendations: to strengthen the regional adaptability of green financial instruments, focus on technological innovation incentives, and break heterogeneous bottlenecks through differentiated policy design to improve the efficiency of collaborative governance of carbon pollution and help promote the synergy of global climate goals and sustainable development agendas.
分类： 交通运输工程 >> 交通运输安全工程 提交时间： 2025-07-08
摘要： In the research and development (RD) and verification and validation (VV) phases of autonomous driving decision-making and planning systems, it is necessary to integrate human factors to achieve decision-making and evaluation that align with human cognition. However, most existing datasets primarily focus on vehicle motion states and trajectories, neglecting human-related information. In addition, current naturalistic driving datasets lack sufficient safety-critical scenarios while simulated datasets suffer from low authenticity. To address these issues, this paper constructs the Risk-Informed Subjective Evaluation and Eye-tracking (RISEE) dataset which specially contains human subjective evaluations and eye-tracking data apart from regular naturalistic driving trajectories. By leveraging the complementary advantages of drone-based (high realism and extensive scenario coverage) and simulation-based (high safety and reproducibility) data collection methods, we first conduct drone-based traffic video recording at a highway ramp merging area. After that, the manually selected highly interactive scenarios are reconstructed in simulation software, and drivers’ first-person view (FPV) videos are generated, which are then viewed and evaluated by recruited participants. During the video viewing process, participants’ eye-tracking data is collected. After data processing and filtering, 3567 valid subjective risk ratings from 101 participants across 179 scenarios are retained, along with 2045 qualified eye-tracking data segments.
分类： 计算机科学 >> 计算机科学技术其他学科 提交时间： 2025-07-08
摘要： We point out that neural networks are not black boxes, and their generalization stems from the ability to dynamically map a dataset to the local extrema of the model function. We further prove that the number of local extrema in a neural network is positively correlated with the number of its parameters, and on this basis, we give a new algorithm that is different from the back-propagation algorithm, which we call the extremum-increment algorithm. Some difficult situations, such as gradient vanishing and overfitting, can be reasonably explained and dealt with in this framework.
分类： 农、林、牧、渔 >> 土壤学 提交时间： 2025-07-07 合作期刊: 《干旱区科学》
Jyotirmay ROY
Dipak Ranjan BISWAS
Biraj Bandhu BASAK
Ranjan BHATTACHARYYA
Shrila DAS
Sunanda BISWAS
Renu SINGH
Avijit GHOSH
摘要： Understanding how different vegetation-based restoration practices alter soil chemical and microbial characteristics is crucial, as restoration practices influence phosphorus (P) transformation and fractions and modify P adsorption behavior during the restoration process of degraded land. This study investigated the impacts of vegetation-based restoration practices on soil chemical and microbial parameters, P fractions, and patterns of P adsorption and desorption, and highlighted the combined influence on P availability. To evaluate the impact of vegetation-based restoration practices on P fractions and adsorption behavior in the semi-arid degraded land in India, this study compared three distinct tree-based restoration systems, including Leucaena leucocephala (Lam.) de Wit-based silviculture system (SCS), Acacia nilotica (L.) Willd. ex Delile-based silvopasture system (SPS), and Emblica officinalis Gaertn-based hortipasture system (HPS), with a natural grassland system (NGS) and a degraded fallow system (FS) as control. The soil samples across various soil depths (0–15, 15–30, and 30–45 cm) were collected. The findings demonstrated that SCS, SPS, and HPS significantly improved soil organic carbon (SOC) and nutrient availability. Moreover, SCS and SPS resulted in increased microbial biomass phosphorus (MBP) content and phosphatase enzyme activity. The P fractionation analysis revealed that ferrum-associated phosphorus (Fe-P) was the major P fraction, followed by aluminum-associated phosphorus (Al-P), reflecting the dominance of ferrum (Fe) and aluminum (Al) oxides in the semi-arid degraded land. Compared with FS, vegetation-based restoration practices significantly increased various P fractions across soil depths. Additionally, P adsorption and desorption analysis indicated a lower adsorption capacity in tree-based restoration systems than in FS, with FS soils adsorbing higher P quantities in the adsorption phase but releasing less P during the desorption phase. This study revealed that degraded soils responded positively to ecological restoration in terms of P fraction and desorption behavior, influencing the resupply of P in restoration systems. Consequently, litter rich N-fixing tree-based restoration systems (i.e., SCS and SPS) increased total phosphorus (TP) stock for plants and sustained the potential for long-term P supply in semi-arid ecosystems. With the widespread adoption of restoration practices across degraded landscapes, SCS and SPS would significantly contribute to soil restoration and improve productivity by maintaining the soil P supply in semi-arid ecosystems in India.
分类： 农、林、牧、渔 >> 农业基础学科 提交时间： 2025-07-07 合作期刊: 《干旱区科学》
摘要： Cotton, as one of important economic crops, is widely planted in the saline-alkaline soil of southern Xinjiang, China. Moreover, in order to control the saline-alkaline content for seed germination and seedlings survive of cotton, farmers always adopt salt leaching during winter and spring seasons. However, excessive amount of salt leaching might result in the waste of water resources and unsuitable irrigation seasons might further increase soil salinization. In this study, a field experiment was conducted in the saline-alkaline soil in 2020 and 2021 to determine the effects of leaching amount and period on water-salinity dynamics and cotton yield. Five leaching amounts (0.0 (W0), 75.0 (W1), 150.0 (W2), 225.0 (W3), and 300.0 (W4) mm) and three leaching periods (seedling stage (P1), seedling and squaring stages (P2), and seedling, squaring, flowering, and boll setting stages (P3)) were used. In addition, a control treatment (CK) with a leaching amount of 300.0 mm in spring was performed. The soil water-salt dynamics, cotton growth, seed cotton yield, water productivity (WP), and irrigation water productivity (WPI) were analyzed. Results showed that leaching significantly decreased soil electrical conductivity (EC), and W3P2 treatment reduced EC by 11.79% in the 0–100 cm soil depth compared with CK. Plant height, stem diameter, leaf area index, and yield under W3 and W4 treatments were greater than those under W1 and W2 treatments. Compared with W3P1 and W3P3 treatments, seed cotton yield under W3P2 treatment significantly enhanced and reached 6621 kg/hm2 in 2020 and 5340 kg/hm2 in 2021. Meanwhile, WP and WPI under W3P2 treatment were significantly higher than those under other leaching treatments. In conclusion, the treatment of 225.0 mm leaching amount and seedling and squaring stages-based leaching period was beneficial for the salt control, efficient water utilization, and yield improvement of cotton in southern Xinjiang, China.
分类： 农、林、牧、渔 >> 土壤学 提交时间： 2025-07-07 合作期刊: 《干旱区科学》
摘要： Artificial cyanobacteria crusts are formed by inoculating soil with cyanobacteria. These crusts help prevent soil erosion and restore soil functionality in degraded croplands. However, how fast the artificial cyanobacteria crusts can be formed is a key issue before their practical application. In addition, the effects of artificial cyanobacteria crusts on soil nutrients and plant growth are not fully explored. This study analyzed the effect of inoculation of cyanobacteria from local biological soil crusts on soil nutrients and Pak-choi (Brassica campestris L. ssp. Chinensis Makino var. communis Tsen et Lee; Chinese cabbage) growth in a cropland, northern China through field experiments by comparing with no fertilizer. The results showed that artificial cyanobacteria crusts were formed on the 18th d after inoculation with a coverage of 56.13%, a thickness of 3.74 mm, and biomass of 22.21 μg chla/cm2. Artificial cyanobacteria crusts significantly improved the soil organic matter (SOM), NO3--N, total nitrogen (TN) contents, and the activities of sucrase, alkaline phosphatase, urease, and catalase enzymes of plants on the 50th d after inoculation. Additionally, artificial cyanobacteria crusts led to an increase in plant biomass, improved root morphology, and raised the phosphorus and potassium contents in the plants. Furthermore, the biomass of plant grown with artificial cyanobacteria crusts was comparable with that of grown with chemical fertilizer. The study suggested that, considering plant biomass and soil nutrients, it is feasible to prevent wind erosion in the cropland of arid and semi-arid areas by inoculating cyanobacteria crusts. This study provides new perspectives for the sustainable development and environmental management of cropland in arid and semi-arid areas.
分类： 地球科学 >> 大气科学 提交时间： 2025-07-07 合作期刊: 《干旱区科学》
摘要： Given that Xinjiang Uygur Autonomous Region of China possesses exceptionally abundant solar radiation resources that can be harnessed to develop clean energy, accurately characterizing their spatiotemporal distribution is crucial. This study investigated the applicability of the Clouds and the Earth’s Radiant Energy System (CERES) Single Scanner Footprint TOA/Surface Fluxes and Clouds (SSF) product downward surface shortwave radiation dataset (DSSRCER) under clear-sky conditions in Xinjiang. By integrating multi-source data and utilizing techniques like multivariate fitting and model simulation, we established a two-layer aerosol model and developed a clear-sky downward surface shortwave radiation (DSSR) retrieval model specific to Xinjiang using the Santa Barbara Discrete Atmospheric Radiative Transfer (SBDART) model. We further explored the spatiotemporal distribution characteristics of DSSR under clear-sky conditions in Xinjiang from 2017 to 2019 based on the localized DSSR retrieval model. Our findings revealed a significant discrepancy in DSSRCER under clear-sky conditions at the Xiaotang station in Xinjiang. By comparing, screening, and correcting core input parameters while incorporating the two-layer aerosol model, we achieved a more accurate SBDART simulated DSSR (DSSRSBD) compared to DSSRCER. The annual mean DSSR exhibited a distinct distribution pattern with high values in mountainous regions such as the Altay Mountains, Kunlun Mountains, and Tianshan Mountains and significantly lower values in adjacent lowland areas, including the Tarim River Basin and Junggar Basin. In the four typical administrative regions in northern Xinjiang, the annual mean DSSR (ranging from 551.60 to 586.09 W/m2) was lower than that in the five typical administrative regions in southern Xinjiang (ranging from 522.10 to 623.62 W/m2). These spatial variations stem from a complex interplay of factors, including latitude, altitude, solar altitude angle, and sunshine duration. The variations in seasonal average DSSR aligned closely with variations in the solar altitude angle, with summer (774.76 W/m2) exhibiting the highest values, followed by spring (684.86 W/m2), autumn (544.76 W/m2), and winter (422.74 W/m2). The monthly average DSSR showed a unimodal distribution, peaking in June (792.94 W/m2) and reaching its lowest level in December (363.06 W/m2). Overall, our study findings enhance the current understanding of the spatiotemporal distribution characteristics of DSSR in Xinjiang and provide certain references for the management of clean energy development in this region.
分类： 农、林、牧、渔 >> 农业基础学科 提交时间： 2025-07-07 合作期刊: 《干旱区科学》
摘要： Integrating sprinkler with deficit irrigation system is a new approach to improve crop water productivity and ensure water and food security in arid areas of India. This study undertook a field experiment of sprinkler-irrigated cumin (variety GC-4) with a mini-lysimeter setup at an experimental research farm in Jodhpur, India during 2019–2022. Four irrigation treatments T1, T2, T3, and T4 were designed at irrigation water/cumulative pan evaporation (IW/CPE) of 1.0, 0.8, 0.6, and 0.4, respectively, with three replications. Daily actual crop evapotranspiration (ETc) was recorded and weekly soil moisture was monitored over the crop growth period. Quantities of applied water and drainage from mini-lysimeters were also measured at every irrigation event. Yield of cumin was recorded at crop maturity. Furthermore, change in farmer’s net income from 1-hm2 land was computed based on the cost of applying irrigation water and considering yield variations among the treatments. Results indicated the highest mean seasonal actual ETc (371.7 mm) and cumin yield (952.47 kg/hm2) under T1 (with full irrigation). Under T2, T3, and T4, the seasonal actual ETc decreased by 10.4%, 27.6%, and 41.3%, respectively, while yield declined by 5.0%, 28.4%, and 50.8%, respectively, as compared to the values under T1. Furthermore, crop water productivity of 0.272 (±0.068) kg/m3 under T2 was found relatively higher in comparison to other irrigation treatments, indicating that T2 can achieve improved water productivity of cumin in arid areas at an optimum level of deficit irrigation. The results of cost-economics indicated that positive change in farmer’s net income from 1-hm2 land was 108.82 USD under T2, while T3 and T4 showed net losses of 5.33 and 209.67 USD, respectively. Moreover, value of yield response factor and ratio of relative yield reductions to relative ETc deficits were found to be less than 1.00 under T2 (0.48), and more than 1.00 under T3 (1.07) and T4 (1.23). This finding further supports that T2 shows the optimized level of deficit irrigation that saves 20.0% of water with sacrificing 5.0% yield in the arid areas of India. Findings of this study provide useful strategies to save irrigation water, bring additional area under irrigation, and improve crop water productivity in India and other similar arid areas in the world.
分类： 医学、药学 >> 临床医学 提交时间： 2025-07-07 合作期刊: 《中国全科医学》
摘要： 背景 多囊卵巢综合征（PCOS）是在育龄期女性中极为普遍的内分泌紊乱疾病，肥胖型PCOS患者常伴有胰岛素抵抗，引起糖脂代谢紊乱、胰岛功能异常，进而引起排卵障碍，并导致不孕。克罗米芬可以改善PCOS患者的排卵功能，但长期应用不良反应较多，容易出现克罗米芬抵抗现象。目前两固汤干预肥胖型PCOS不孕症的临床疗效及不良反应尚不明确。目的 探讨两固汤联合克罗米芬对肥胖型PCOS不孕症患者胰岛素抵抗、卵巢血流动力学及妊娠的影响。方法 选取2022年2月—2023年12月于沧州中西医结合医院生殖医学科就诊的127例肥胖型PCOS不孕症患者为研究对象。根据随机分组方法，将患者分为试验组63例、对照组64例。对照组采用克罗米芬治疗，于月经第5 d开始服用，40 mg/次，2次/d，连续服用5 d。试验组在对照组基础上加用两固汤治疗，两固汤中药材煎煮后取150 mL药汁，2次/d，早晚温服，连续服用14 d。以1个月为治疗周期，两组患者均连续治疗3个周期。比较治疗前后两组空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA-IR）、胰岛β细胞功能指数（HOMA-β）、空腹血糖（FPG）、三酰甘油（TG）、总胆固醇（TC）、身体质量指数（BMI）、卵巢收缩期最大峰值流速（PVS）、阻力指数（RI）、搏动指数（PI）、血清雌激素（E2）、黄体生成素（LH）、睾酮（T）、促卵泡生成素（FSH）等实验检查指标差异。以排卵率、妊娠率及流产率为结局指标，记录临床疗效及不良反应发生率，并比较两组差异。结果 治疗3个周期后，试验组BMI、FPG、TG、TC、FINS、HOMA-IR、RI、血清E2、T、LH、FSH水平低于对照组，HOMA-β、PVS、PI高于对照组，差异均有统计学意义（P0.05）。结论 两固汤联合克罗米芬治疗肥胖型PCOS不孕症效果好，能有效改善患者的胰岛素抵抗、糖脂代谢、性激素水平及卵巢血流动力学，提高妊娠率。
分类： 医学、药学 >> 临床医学 提交时间： 2025-07-07 合作期刊: 《中国全科医学》
摘要： 品牌在社区卫生服务中心管理中扮演着越来越重要的角色，实施品牌战略，社区卫生服务中心可以吸引更多居民“小病不出社区”，对医疗资源合理配置、推进健康中国战略具有重要意义。针对目前社区卫生服务中心品牌战略理论研究不足，操作缺乏系统性、专业性等问题，本文提出以“品牌主意——品牌信号——品牌传播”为理论框架，以“社区居民遇到健康问题的第一选择”为品牌主意，“社区健康服务全程优质体验”为品牌信号，“社区沟通系统”为品牌传播渠道的系统方案，对社区卫生服务中心品牌战略的理念和路径进行探索。
分类： 医学、药学 >> 临床医学 提交时间： 2025-07-07 合作期刊: 《中国全科医学》
摘要： 背景 对于心力衰竭患者尽早评估病情并尽快给予治疗，可预防心脏不良事件的发生，有效的诊断评估工具对于此类患者尤其重要，心音描记技术（ACG）作为一种高效且无创的床旁筛查工具可用于判断心力衰竭患者的病情严重程度。目的 探究可穿戴式心音心电远程监测设备在心力衰竭治疗过程中用于动态监测评估心脏功能的可行性。方法 本研究为前瞻性单臂自身对照研究，采用随机抽样法选取2020年10—12月于昆明医科大学第一附属医院心内科住院治疗的急性心力衰竭患者60例，于入院第1天、第2天、第3天、第5天及出院当天测量患者心音心电指标包括机电激活时间百分比（EMAT%）以及氨基末端脑钠肽前体（NT-proBNP）、体重；于出入院当天测量患者心脏彩超指标，分析各指标随治疗情况改变的趋势及指标间变化的一致性。结果 入选60例患者，其中男性35例，女性25例，平均住院天数（7.9±3.2）d。单组重复测量方差分析结果显示不同时间点的EMAT、EMAT%、NT-proBNP、体重比较，差异均具有统计学意义（FEMAT=6.978，P0.05）。以时间校正重复测量方差分析检验EMAT与NT-proBNP变化是否一致，结果显示在该60例心衰住院患者中，EMAT与NT-proBNP变化一致（入院第1天β=67.724，P<0.01；入院第2天β=56.876，P<0.01；入院第3天β=38.503，P<0.01；入院第5天β=23.969，P<0.01；出院当天β=16.851，P<0.05），随病情好转而改变，差异具有统计学意义（P<0.05）。结论 可穿戴式心音心电远程监测设备与床旁心脏彩超测量LVEF以及检测NT-proBNP等项目相比，具备无创、便捷、经济等特点，所采集的心音、心电学参数可随心衰患者病情变化而改变，该装置或可用于远程评估和监测心力衰竭患者心功能，及时发现患者病情变化。
分类： 医学、药学 >> 临床医学 提交时间： 2025-07-07 合作期刊: 《中国全科医学》
摘要： 脑出血（ICH）是一种高死亡率和致残率的脑卒中类型，铁死亡在ICH后的继发性损伤中扮演重要角色。线粒体作为细胞代谢和能量产生的中心，在铁死亡中具有重要作用，探索线粒体在铁死亡中的作用对治疗ICH后继发性损伤具有重要意义。本文结合ICH后铁死亡过程，从线粒体活性氧（ROS）和线粒体渗透性转换孔（mPTP）、线粒体三羟酸循环（TCA）、线粒体自噬、线粒体脱氧核糖核酸（mtDNA）、线粒体二氢乳清酸脱氢酶（DHODH）等不同方面探讨其在铁死亡中的作用，并结合靶向线粒体治疗铁死亡的研究进展，为 ICH 后继发性损伤的干预提供新思路。
分类： 医学、药学 >> 临床医学 提交时间： 2025-07-07 合作期刊: 《中国全科医学》
摘要： 背景 心血管代谢疾病与抑郁密切相关。基层心血管代谢疾病管理工作已初具规模，但对于患者抑郁等心理问题一方面缺乏关注，另一方面缺乏简单、准确、高效的筛查评估工具。目的 应用单导联可穿戴心电设备构建宁夏基层老年心血管代谢疾病患者抑郁发生风险的列线图预测模型并验证。方法 选取2022年1月—2023年6月宁夏地区5个市的20家基层医疗机构应用单导联可穿戴心电设备采集并上传至云平台的3 121例65岁以上高血压、糖尿病、冠心病等心血管代谢疾病患者的心电图资料及云平台收集的患者社会人口学、生活行为方式、心理健康等资料。采用简单随机抽样方法按3∶1比例分为训练集（2 341例）和验证集（780例）。通过运行RStudio 4.1.1软件，使用LASSO回归分析以及交叉验证筛选最佳预测因子，采用多因素Logistic回归分析构建预测老年心血管代谢疾病患者抑郁发生风险的列线图预测模型，采用受试者工作特征（ROC）曲线、校正曲线及决策曲线评估模型的效能。结果 LASSO回归筛选出10个变量：性别、BMI、城乡、运动、焦虑、冠心病、期前收缩、RR间期平均值标准差（SDANN）、正常相邻窦性RR间期差值均方根（rMSSD）、睡眠效率；多因素Logistic回归分析结果显示，性别（OR=1.747，95%CI=1.258~2.434）、BMI（OR=1.073，95%CI=1.024~1.125）、城乡（OR=1.684，95%CI=1.172~2.456）、运动（OR=0.61，95%CI=0.460~0.799）、焦虑（OR=3.041，95%CI=1.597~5.484）、冠心病（OR=2.743，95%CI=1.971~3.815），期前收缩（OR=4.745，95%CI=1.681~19.977）、SDANN（OR=4.745，95%CI=1.681~19.977）、rMSSD（OR=0.986，95%CI=0.972~0.999）、睡眠效率（OR=0.988，95%CI=0.982~0.995）是老年心血管代谢疾病患者抑郁发生风险的影响因素（P<0.05）。Logistic回归方程Logit（P）=4.322+0.558×性别＋0.071×BMI＋0.521×城乡-0.494×运动＋1.112×焦虑＋1.009×冠心病＋1.557×期前收缩-0.011×SDANN-0.014×rMSSD-0.012×睡眠效率，基于此构建列线图预测模型，在训练集和验证集中预测老年慢病患者抑郁发生风险的曲线下面积分别为0.748（95%CI=0.707~0.786，P<0.001）、0.751（95%CI=0.692~0.809，P<0.001），灵敏度分别为75.2%、76.7%，特异度分别为63.4%、60.6%。临床决策曲线显示，在训练集和验证集中当抑郁风险阈值概率分别在8%~35%、8%~37%之间时，预测老年心血管代谢疾病患者抑郁发生风险的净收益更高。结论 性别、BMI、城乡、运动、焦虑、冠心病、期前收缩、SDANN、rMSSD、睡眠效率均是老年心血管代谢疾病患者抑郁发生风险的影响因素。本研究基于单导联可穿戴心电设备构建基层老年心血管代谢疾病患者抑郁发生风险的列线图模型，有较好预测效能及临床应用价值，不但有助于在基层医疗机构对患者进行抑郁筛查与个体化干预措施的制订、还可助力基层心血管疾病防控工作。
分类： 医学、药学 >> 临床医学 提交时间： 2025-07-07 合作期刊: 《中国全科医学》
摘要： 国家基本公共卫生服务高质量发展面临基层优质资源不足、诊疗水平有限等瓶颈问题。深圳市龙华区根据医防融合工作部署，依托基本公共卫生服务项目，自2022年1月起探索试点“数字化+健康管理”全专协同服务模式，以提升基层高血压和糖尿病健康管理服务能力为核心目标，通过政策引导、体系建设和数字化支撑，实现优质医疗资源有效下沉和高效利用。本文从政策机制、具体措施以及初步成效3个方面探讨数字化赋能全专协同服务的实践经验。初步成效包括（1）患者监测与入库情况：2022—2024年，深圳市龙华区半年内因连续2次血压控制不满意而入库管理的高血压患者比例分别为35.3%、37.5%、36.2%，半年内因连续2次血糖控制不满意而入库管理的糖尿病患者比例分别为55.5%、64.0%、47.5%；（2）专科医生会诊情况：由于2023年底将专科医生会诊及时率纳入了医疗集团绩效考核评价体系，2024年会诊及时率明显上升，较2022年高血压和糖尿病会诊及时率分别提高了46.3%、53.9%；（3）全科医生执行情况：高血压执行及时率从2022年的73.7%上升至2024年的84.3%，糖尿病执行及时率从2022年的73.9%上升至2024年的80.8%；（4）入库患者管理效果：高血压和糖尿病患者2022—2024年平均达标率分别为57.1%和50.9%。试点经验表明，数字化全专协同服务模式有效促进了优质医疗资源的整合与利用效率，提升了基层健康管理水平，在患者血压、血糖控制方面发挥了关键作用。在国家基本公共卫生服务迈向高质量发展的关键阶段，建议尽快制订数字化全专协同服务的实施标准，健全相关政策助推机制，完善基本公共卫生服务评价管理体系，以期实现政策试点的全面推广。
分类： 医学、药学 >> 临床医学 提交时间： 2025-07-07 合作期刊: 《中国全科医学》
摘要： 脑缺血再灌注损伤是指脑血流中断后，恢复脑血流供应的过程中，脑组织因能量代谢紊乱、氧化应激、自由基损伤、炎性反应、血-脑脊液屏障破坏、细胞凋亡和坏死等多种生物学过程，导致缺血脑组织再次发生损伤。脑缺血再灌注损伤不仅会加重神经细胞受损甚至死亡，妨碍患者神经功能的恢复，而且严重影响患者生存质量。因此，脑缺血再灌注损伤的有效防治方案已成为脑血管领域目前研究的焦点。黄芩苷是从中药黄芩中提取的类黄酮化合物，越来越多的证据表明黄芩苷可通过等多种药理机制，有效预防脑缺血再灌注损伤。本文归纳了黄芩苷在各种体内和体外实验脑缺血再灌注损伤模型中的神经保护作用，阐述了黄芩苷通过减轻炎性反应、抗氧化应激、调节线粒体稳态、抑制细胞凋亡和焦亡、保护血-脑脊液屏障、维持星形胶质细胞结构与功能和减轻神经细胞毒性等多靶点、多途径方式防治脑缺血再灌注损伤的具体神经保护机制及药理机制。旨在强调黄芩苷在预防和治疗脑缺血再灌注损伤中的潜在作用，为进一步药物研究和开发提供参考依据，并对未来黄芩苷在脑血管疾病中的应用进行了展望。
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