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目的探讨脑~(18)F-FDG PET/ CT对MRI阴性难治性癫痫患者术前致痫灶定位的价值。方法回顾性分析2014年1月至2020年6月间于暨南大学附属第一医院接受术前脑~(18)F-FDG PET/ CT-MRI检查的55例[男38例、女17例,年龄(20.0±8.1)岁]MRI阴性癫痫患者的临床资料(550个脑叶)。以立体定向脑电图(SEEG)及术后随访至少1年的结果作为参考标准,分别计算~(18)F-FDG PET/ CT、视频脑电图(VEEG)、PET/ CT+VEEG及PET/ CT-VEEG对致痫灶定位的灵敏度、特异性、准确性、阳性预测值(PPV)及阴性预测值(PPV)。使用χ~2检验对单脑叶、多脑叶及全部患者不同检查方式的效能进行比较。结果PET/ CT对致痫灶的正确定侧率为92.6%(25/27)。PET/ CT对致痫灶定位的灵敏度、特异性、准确性、PPV及NPV分别为65.1%(54/83)、77.9%(364/467)、76.0%(418/ 550)、34.4%(54/157)及92.6%(364/393)。PET/ CT-VEEG对全部及多脑叶癫痫患者致痫灶定位的灵敏度高于单独的VEEG[75.9%(63/83)和45.8%(38/83)、68.6%(35/51)和31.4%(16/51); χ~2值: 15.80、14.16,均P<0.001],PET/ CT+VEEG对全部及单脑叶癫痫患者致痫灶定位的特异性高于单独的VEEG[97.6%(456/467)和94.6%(442/467)、97.9%(282/288)和94.1%(271/288); χ~2值:5.66、 5.48,P值:0.017、0.019]。PET/ CT-VEEG(PET/ CT与VEEG一致)对致痫灶定位的灵敏度高于PET/ CT+VEEG(PET/ CT与VEEG不一致)[8/9和28.4%(21/74); χ~2 =10.40,P =0.001],其特异性及准确性高于PET/ CT-VEEG(PET/ CT与VEEG不一致)[93.4%(57/61)和71.7%(291/406)、92.9%(65/ 70)和72.1%(346/480); χ~2值:13.23、13.96,均P<0.001]。结论~(18)F-FDG PET/ CT能定位定侧MRI阴性癫痫患者的致痫灶。~(18)F-FDG PET/ CT与VEEG的联合应用能提高致痫灶检出的灵敏度、特异性及准确性。~(18)F-FDG PET/ CT与VEEG一致时对致痫灶检出的准确性较高。
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Objective To evaluate the value of ~(18)F-FDG PET/ CT for preoperative localization of epileptogenic foci in refractory epilepsy patients with negative MRI. Methods Clinical data (550 lobes) of 55 epilepsy patients (38 males, 17 females, age (20.0±8.1) years) with negative MRI who underwent preoperative ~(18)F-FDG PET/ CT-MRI between January 2014 and June 2020 at the First Affiliated Hospital of Jinan University were retrospectively analyzed. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of ~(18)F-FDG PET/ CT, video electroencephalogram (VEEG), PET/ CT+VEEG and PET/ CT-VEEG for localizing epileptogenic foci were calculated using stereoelectroencephalography (SEEG) and the outcomes of at least 1 year of postoperative follow-up as reference standards. χ~2 test was used to compare the efficiencies of different examination modalities for unilobar, multilobar and all patients. Results The correct lateralization rate of epileptogenic foci was 92.6%(25/27) using PET/ CT. The sensitivity, specificity, accuracy, PPV and NPV of PET/ CT for localization of epileptogenic foci were 65.1%(54/83), 77.9%(364/467), 76.0%(418/550), 34.4%(54/157) and 92.6%(364/393), respectively. The sensitivities of PET/ CT-VEEG for localization of epileptogenic foci in all patients and patients with multilobar epilepsy were higher than those of VEEG alone (75.9%(63/83) vs 45.8%(38/83), 68.6%(35/51) vs 31.4%(16/51); χ~2 values: 15.80, 14.16, both P<0.001). The specificities of PET/ CT+ VEEG for localization of epileptogenic foci in all patients and patients with unilobar epilepsy were higher than those of VEEG alone (97.6%(456/467) vs 94.6%(442/467), 97.9%(282/288) vs 94.1%(271/ 288); χ~2 values: 5.66, 5.48; P values: 0.017, 0.019). The sensitivity of PET/ CT-VEEG (PET/ CT and VEEG concordance) for localization of epileptogenic foci was higher than that of PET/ CT+VEEG (PET/ CT and VEEG discordance) (8/9 vs 28.4%(21/74); χ~2 =10.40, P =0.001), and its specificity and accuracy were higher than those of PET/ CT-VEEG (PET/ CT and VEEG discordance) (93.4%(57/61) vs 71.7% (291/406), 92.9%(65/70) vs 72.1%(346/480); χ~2 values: 13.23, 13.96; both P<0.001). Conclusions ~(18)F-FDG PET/ CT can localize and lateralize epileptogenic foci in patients with negative MRI. The combination of ~(18)F-FDG PET/ CT and VEEG improves the sensitivity, specificity, and accuracy for epileptogenic foci detection. ~(18)F-FDG PET/ CT is more accurate in detecting epileptogenic foci when it is concordant with VEEG.
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目的探索~(18)F-FDG PET/ MR在难治性癫痫精准定位诊断中的价值。方法回顾性纳入2019年2月至2021年12月在上海交通大学医学院附属瑞金医院确诊为难治性癫痫患者81例[男52例、女29例,年龄(30.0±10.9)岁],所有患者行术前一体化PET/ MR检查,并结合PET/ MR定位定侧的结果进行立体定向脑电图(SEEG)电极植入,记录癫痫发作部位。确定致痫灶后行手术,术后2年随访Engel分级。通过χ~2检验比较MRI与PET/ MR成像对致痫灶的检出率,并比较PET/ MR对颞叶癫痫(TLE)及颞叶外癫痫(ETLE)致痫灶检出率。结果MRI正确定位致痫灶38例,检出率为46.91%(38/81);PET/ MR成像正确定位致痫灶73例,检出率为90.12%(73/81),明显高于MRI (χ~2 =35.05,P<0.001)。TLE共63例,ETLE为18例,PET/ MR对TLE致痫灶的检出率为95.24%(60/ 63),明显高于ETLE(13/18; χ~2 =5.94,P =0.015)。术后2年随访, TLE患者术后有效率(Engel Ⅰ~ Ⅱ级)为76.19%(48/63),ETLE患者为13/18,两者差异无统计学意义(χ~2 =0.12,P =0.731)。结论一体化PET/ MR成像可精准定位致痫灶,特别是对MRI阴性的致痫灶的定位定侧具有良好的应用价值,为手术方案制定提供了分子影像学信息,提高了手术治疗的成功率。
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Objective To analyze the clinical value of ~(18)F-FDG PET/ MR for precise localization of epileptogenic foci in patients with refractory epilepsy. Methods From February 2019 to December 2021, 81 patients (52 males, 29 females; age (30.0±10.9) years) with refractory epilepsy confirmed in Ruijin Hospital Shanghai Jiao Tong University School of Medicine were retrospectively enrolled. All patients underwent preoperative PET/ MR exam, and the possible position of the epileptogenic foci were determined by PET/ MR imaging and pre-surgical evaluation, then the stereoelectroencephalography (SEEG) electrodes were implanted. Surgery was performed, and outcome was assessed by using a modified Engel classification two years after surgery. χ~2 test was used to compare the detection rates of MRI and PET/ MR fusion imaging in localizing epileptogenic foci and the detection rates of epileptogenic foci in temporal lobe epilepsy (TLE) and extratemporal lobe epilepsy (ETLE) by PET/ MR. Results MRI correctly localized seizure foci in 38 patients, with the detection rate of 46.91%(38/81), while PET/ MR detected seizure foci in 73 patients, with the detection rate of 90.12%(73/81; χ~2 = 35.05, P<0.001). There were 63 TLE and 18 ETLE patients. The detection rate of PET/ MR in localizing seizure foci in TLE patients was 95.24%(60/63), which was significantly higher than that in ETLE patients (13/18; χ~2 =5.94, P =0.015). After 2 years follow-up, the postoperative efficacy rate of TLE patients with Engel grades Ⅰ-Ⅱ was 76.19%(48/63), which was 13/18 of ETLE patients (χ~2 =0.12, P =0.731). Conclusion Hybrid PET/ MR imaging can accurately locate epileptogenic foci, especially for MRI negative lesions, which provides precision imaging information for surgical planning and improves surgical success rate.
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目的分析~(18)F-FDG PET在颞叶外癫痫(ETLE)患者术前评估中的应用价值,并探讨提高其定位准确性的改进方法。方法纳入2006年1月至2022年11月间于北京协和医院行手术治疗、最终证实致痫灶位于颞叶外的41例患者[男25例、女16例,年龄(22.7±7.5)岁],采用视觉及半定量方法回顾性分析其术前独立~(18)F-FDG PET显像,以及~(18)F-FDG PET与MRI联合应用对致痫灶检出的准确性,及对治疗决策的影响。采用Fisher确切概率法分析数据。结果41例患者中,独立~(18)F-FDG PET视觉分析发现40例颞叶外脑部代谢异常,其中26例为单一部位的局灶性代谢异常,定位为致痫灶;14例为多灶性代谢异常,其中8例经半定量分析进一步明确致痫灶。有1例PET视觉分析阴性的患者发现其MRI异常信号部位存在微小代谢增高灶。在13例独立MRI阅片结果为阴性的患者中,9例在~(18)F-FDG PET所示代谢减低脑区发现存在微小结构异常。~(18)F-FDG PET帮助18例(43.9%,18/41)患者改善临床决策。73.2%(30/41)的患者术后无癫痫发作,其中局灶性与多灶性~(18)FFDG PET代谢异常患者间预后无明显差异[73.1%(19/26)和10/14,P = 1.000]。结论~(18)F-FDG PET对于ETLE患者是一种有用的术前评估工具。半定量分析有助于在多灶性代谢异常中检出致痫灶。~(18)F-FDG PET和MRI联合评估可提高颞叶外致痫灶定位的准确性。
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Objective To analyze the application value of ~(18)F-FDG PET in the preoperative evaluation of patients with extratemporal lobe epilepsy (ETLE) and explore improved methods to enhance its localization accuracy. Methods A total of 41 patients (25 males, 16 females, age (22.7±7.5) years) who underwent surgery and ultimately confirmed ETLE in Peking Union Medical College Hospital between January 2006 and November 2022 were enrolled. The accuracy of preoperative independent ~(18)F-FDG PET imaging and the combined application of ~(18)F-FDG PET and MRI in detecting epileptogenic foci and their impacts on treatment decisions were retrospectively analyzed by using visual and semi-quantitative methods. Fisher's exact test was used to analyze the data. Results In all 41 patients, 40 cases were found metabolic abnormalities in extratemporal lobe by independent ~(18)F-FDG PET based on visual analysis. Among them, 26 showed unifocal metabolic abnormalities, which were localized as epileptogenic foci. Fourteen patients showed multifocal metabolic abnormalities, and the epileptogenic foci were further verified in 8 cases through semi-quantitative analysis. In 1 case with negative PET visual analysis, a micro-metabolism focus was found at the abnormal MRI signal area. Among 13 patients with negative independent MRI, 9 were found microstructures abnormalities in brain regions with hypometabolism. ~(18)F-FDG PET improved clinical decisionmaking in 18 patients (43.9%, 18/41). There were 30 patients (73.2%, 30/41) with seizure-free postsurgery, and the prognosis was not significantly different between patients with unifocal ~(18)F-FDG PET metabolic pattern and those with multifocal ones (73.1%(19/26) vs 10/14, P =1.000). Conclusions ~(18)F-FDG PET can be a useful diagnostic tool for patients with ETLE. Semi-quantitative analysis helps to detect more epileptogenic foci with multifocal metabolic abnormalities. The combined evaluation of ~(18)F-FDG PET and MRI can improve the accuracy in localizing epileptogenic foci outside the temporal lobe.
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目的探讨~(18)F-FDG PET/ CT显像在癫痫发作且MRI阴性的疑似自身免疫性脑炎(AE)患儿中的诊断价值。方法回顾性分析2019年5月至2022年8月期间在上海交通大学医学院附属新华医院有癫痫发作症状且MRI阴性的94例临床疑似AE患儿(男49例、女45例;年龄1~ 15岁)。所有患儿行~(18)F-FDG PET/ CT脑显像,按临床最终诊断分为AE组与非AE组,并评估其~(18)FFDG PET/ CT视觉诊断的效能。评估所有患儿皮质病灶范围评分(S),测量皮质病灶(L)、基底节(B)和丘脑(T)的SUV_(max)、SUVmean和最小SUV(SUVmin ),获得L/ B、L/ T的各SUV比值(SUVR)。采用两独立样本t检验和Mann-Whitney U检验分析数据,采用二元logistic回归分析确定AE的独立预测因素,并建立诊断模型。通过ROC曲线分析和Delong检验评价诊断效能。结果AE组53例,非AE组41例。~(18)F-FDG PET/ CT视觉分析诊断AE的灵敏度为100%(53/53),特异性为43.9%(18/ 41),准确性为75.5%(71/94)。L_(SUV_(max))、L_(SUV_(mean))、L_(SUV_(min))、L/ B_(SUVR_(max))、L/ B_(SUVR_(mean))、L/ B_(SUVR_(min))、L/ T_(SUVR_(max))、 L/ T_(SUVR_(mean))、L/ T_(SUVR_(min))和S在AE组和非AE组间差异具有统计学意义(z =-6.74,t值:-8.51~ -3.97,均P<0.001)。ROC曲线分析示参数L/ B_(SUVR_(max))的AUC最高(0.914)。Logistic回归分析示,S[比值比(OR)= 11.40,95% CI:2.18~59.52,P=0.004]、L/ B_(SUVR_(max))(OR =13.19,95% CI:2.11~82.51,P =0.006)和L/ T_(SUVR_(max))(OR =9.66,95% CI:1.57~59.55,P = 0.015)是AE的独立影响因素。建立诊断模型:P = 1/(1+e-x ),x =2.433×S+2.580×L/ B_(SUVR_(max)) +2.267×L/ T_(SUVR_(max)) -3.802。该模型的AUC为0.948,其诊断AE的灵敏度、特异性和准确性分别为98.1%(52/53)、90.2%(37/41)和94.7%(89/94);优化后的评分系统诊断效能与优化前的模型一致,且均优于L/ B_(SUVR_(max))(z值:2.01和2.01,P值:0.040和0.040)。结论基于~(18)F-FDG PET/ CT半定量分析建立的诊断模型和评分系统对儿童AE有较好的诊断效能,且优于单独的半定量参数。
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Objective To investigate the value of ~(18)F-FDG PET/ CT imaging in the diagnosis of suspected autoimmune encephalitis (AE) in children with epilepsy and negative MRI. Methods From May 2019 to August 2022, 94 suspected AE children (49 males, 45 females; age 1-15 years) with epilepsy and negative MRI who underwent brain ~(18)F-FDG PET/ CT imaging at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were retrospectively analyzed. All patients were divided into AE and non-AE groups based on clinical final diagnosis. The effectiveness of visual diagnosis was evaluated. The cortical lesion extent score (S), and SUV_(max), SUVmean and minimum of SUV (SUVmin ) of cortical lesions (L), basal ganglia (B) and thalamus (T) were measured and SUV ratios (SUVR) of L/ B or L/ T were obtained. Independent-sample t test or Mann-Whitney U test was used to analyze data. Binary logistic regression analysis was used to screen the diagnostic factors of AE, and a diagnostic model was established. The diagnostic efficiency was evaluated by ROC curve analysis and Delong test. Results There were 53 cases in AE group and 41 cases in non-AE group. Based on visual analysis, the sensitivity, specificity and accuracy of ~(18)F-FDG PET/ CT for AE were 100%(53/53), 43.9%(18/41) and 75.5%(71/94), respectively. Differences of L_(SUV_(max)), L_(SUV_(mean)), L_(SUV_(min)), L/ B_(SUVR_(max)), L/ B_(SUVR_(mean)), L/ B_(SUVR_(min)), L/ T_(SUVR_(max)), L/ T_(SUVR_(mean)), L/ T_(SUVR_(min)) and S between AE and non-AE groups were statistically significant (z =-6.74, t values: from -8.51 to -3.97, all P<0.001). ROC curve analysis showed that the AUC of L/ B_(SUVR_(max)) was the highest (0.914) among visual analysis and semi-quantitative parameters. Logistic regression analysis showed that S (odds ratio (OR)= 11.40, 95% CI: 2.18-59.52, P =0.004), L/ B_(SUVR_(max))(OR =13.19, 95% CI: 2.11-82.51, P =0.006) and L/ T_(SUVR_(max))(OR =9.66, 95% CI: 1.57-59.55, P = 0.015) were independent diagnostic factors for AE. Regression model was established: P=1/ (1+e-x ), x=2.433×S+2.580×L/ B_(SUVR_(max)) +2.267×L/ T_(SUVR_(max)) -3.802. The AUC of this model was 0.948, with the sensitivity, specificity and accuracy of 98.1%(52/53), 90.2%(37/ 41) and 94.7%(89/94), respectively. The diagnostic efficacy of the optimized scoring system was consistent with the pre-optimization model, and were both superior to L/ B_(SUVR_(max))(both z = 2.01, both P = 0.040). Conclusion The diagnostic model and scoring system based on the semi-quantitative analysis of ~(18)F-FDG PET/ CT have better diagnostic efficacy for AE and are superior to semi-quantitative parameters alone.
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目的基于深度残差神经网络(ResNet)分析术前~(18)F-FDG PET影像及患者临床特征,预测难治性颞叶癫痫(TLE)患者术后复发状况。方法回顾性分析2014年1月至2020年6月期间暨南大学附属第一医院诊治的220例难治性TLE患者[男132例、女88例,年龄23.0(20.0,30.2)岁]的术前~(18)F-FDG PET影像及临床资料。采用ResNet对预处理好的PET图像及临床特征进行高通量特征提取,并进行区分TLE患者的术后复发预测任务。评估模型的预测性能,并将其ROC曲线分析所得AUC与经典的生存分析Cox比例风险模型的AUC进行比较(Delong检验)。结果基于PET影像联合临床特征,ResNet预测难治性TLE患者术后12、24、36个月复发的AUC分别为0.895±0.073、 0.861±0.058和0.754±0.111,Cox比例风险回归模型相应AUC依次为0.717±0.093、0.697±0.081和0.645±0.087(z值:-3.00、-2.98、-1.09,P值:0.011、0.018、0.310),其中ResNet对术后12个月内复发事件的预测效果最佳。结论ResNet模型有望在临床实践中用于TLE患者术后随访,帮助对术后患者进行风险分层个体化管理。
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Objective To predict the short-term postoperative recurrence status of patients with refractory temporal lobe epilepsy (TLE) by analyzing preoperative ~(18)F-FDG PET images and patients' clinical characteristics based on deep residual neural network (ResNet). Methods Retrospective analysis was conducted on preoperative ~(18)F-FDG PET images and clinical data of 220 patients with refractory TLE (132 males and 88 females, age 23.0(20.0, 30.2) years)) in the First Affiliated Hospital of Jinan University between January 2014 and June 2020. ResNet was used to perform high-throughput feature extraction on preprocessed PET images and clinical features, and to perform a postoperative recurrence prediction task for differentiating patients with TLE. The predictive performance of ResNet model was evaluated by ROC curve analysis, and the AUC was compared with that of classical Cox proportional risk model using Delong test. Results Based on PET images combined with clinical feature training, AUCs of the ResNet in predicting 12-, 24-, and 36-month postoperative recurrence were 0.895±0.073, 0.861±0.058 and 0.754±0.111, respectively, which were 0.717±0.093, 0.697±0.081 and 0.645±0.087 for Cox proportional hazards model respectively (zvalues: -3.00, -2.98, -1.09, P values: 0.011, 0.018, 0.310). The ResNet showed best predictive effect for recurrence events within 12 months after surgery. Conclusion The ResNet model is expected to be used in clinical practice for postoperative follow-up of patients with TLE, helping for risk stratification and individualized management of postoperative patients.
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目的比较Al18F-1,4,7-三氮杂环壬烷-1,4,7-三乙酸(NOTA)-成纤维细胞激活蛋白抑制剂(FAPI)-04与~(18)F-FDG PET/ CT在初诊胃癌中的应用。方法前瞻性纳入2021年3月至2022年7月间郑州大学第一附属医院初诊胃癌的患者20例(男13例、女7例,年龄:27~77岁),患者均于1周内完成~(18)F-FDG及Al~(18)F-NOTA-FAPI-04 PET/ CT显像。比较2种方法的SUV_(max)、肿瘤与背景比(TBR)和阳性检出率(Wilcoxon符号秩检验、McNemar χ~2检验)。结果Al~(18)F-NOTA-FAPI-04在胃癌原发灶的SUV_(max)及TBR均明显高于~(18)F-FDG[10.2(8.0,13.7)和5.2(3.3,7.7),z =-3.47,P = 0.001;7.6(5.6,10.3)和2.4(1.8,3.0),z =-3.85,P<0.001]。Al~(18)F-NOTA-FAPI-04 PET/ CT对胃癌原发灶的阳性检出率有高于~(18)F-FDG PET/ CT的趋势[95%(19/20)和75%(15/20); χ~2 = 2.25,P = 0.125]。Al~(18)FNOTA-FAPI-04 PET/ CT对转移性淋巴结的检出率高于~(18)F-FDG PET/ CT[78.9%(101/128)与64.8%(83/128); χ~2 =13.47,P<0.001]。Al~(18)F-NOTA-FAPI-04在淋巴结转移灶的SUV_(max)及TBR均高于~(18)FFDG[5.3(3.5,9.2)和2.8(1.8,4.7),z = -7.31,P<0.001;4.6(2.6,6.5)和1.7(1.0,3.0),z = -8.44,P< 0.001]。在检测腹膜转移方面,Al~(18)F-NOTA-FAPI-04显示出比~(18)F-FDG PET/ CT更高的腹膜癌指数(PCI)、SUV_(max)及TBR[PCI:12.0(3.0,29.8)和5.5(0.5,17.5),z = -2.22,P = 0.026;SUV_(max):8.2(4.4, 12.5)和2.7(1.9,4.0),z =-2.52,P = 0.012;TBR:5.1(2.9,13.3)和1.1(0.9,2.0),z =-2.52,P = 0.012]。结论Al~(18)F-NOTA-FAPI-04 PET/ CT在胃癌原发灶和转移灶中的表现优于~(18)F-FDG PET/ CT,是胃癌患者的一种潜在的新型显像方式。
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Objective To compare Al~(18)F-1, 4, 7-trizacyclononane-1, 4, 7-triacetic acid (NOTA)fibroblast activation protein inhibitor (FAPI)-04 PET/ CT with ~(18)F-FDG PET/ CT in the evaluation of patients with initial gastric cancer. Methods Twenty patients (13 males, 7 females, age: 27-77 years) with histologically proven gastric cancer were recruited prospectively between March 2021 and July 2022 in the First Affiliated Hospital of Zhengzhou University. Each patient underwent both ~(18)F-FDG and Al~(18)F-NOTAFAPI-04 PET/ CT within one week. SUV_(max), tumor background ratio (TBR) and positive detection rate of the two methods were compared (Wilcoxon signed rank sum test, McNemar χ~2 test). Results Al~(18)F-NOTAFAPI-04 showed higher SUV_(max) and TBR than those of ~(18)F-FDG in primary tumors (10.2(8.0,13.7) vs 5.2 (3.3,7.7), z =-3.47, P =0.001; 7.6(5.6,10.3) vs 2.4(1.8,3.0), z =-3.85, P<0.001). For the detection of primary gastric cancer, the positive detection rate of Al~(18)F-NOTA-FAPI-04 PET/ CT showed the trend of being higher than that of ~(18)F-FDG PET/ CT (95%(19/20) and 75%(15/20); χ~2 = 2.25, P = 0.125). For assessing lymph node metastasis, the detection rate of Al~(18)F-NOTA-FAPI-04 PET/ CT was higher than that of ~(18)F-FDG PET/ CT (78.9%(101/128) vs 64.8%(83/128); χ~2 =13.47, P<0.001). The SUV_(max) and TBR of Al~(18)F-NOTA-FAPI-04 in lymph node were higher than those of ~(18)F-FDG (5.3(3.5,9.2) vs 2.8(1.8, 4.7), z =-7.31, P<0.001; 4.6(2.6,6.5) vs 1.7(1.0,3.0), z =-8.44, P<0.001). For the detection of peritoneal carcinomatosis, Al~(18)F-NOTA-FAPI-04 PET/ CT showed higher peritoneal cancer index (PCI), SUV_(max), and TBR compared to ~(18)F-FDG PET/ CT (PCI: 12.0(3.0,29.8) vs 5.5(0.5,17.5), z = -2.22, P = 0.026; SUV_(max): 8.2(4.4,12.5) vs 2.7(1.9,4.0); z =-2.52, P =0.012; TBR: 5.1(2.9,13.3) vs 1.1(0.9, 2.0); z =-2.52, P =0.012). Conclusion Al~(18)F-NOTA-FAPI-04 PET/ CT outperforms ~(18)F-FDG PET/ CT in primary and metastatic lesions of gastric cancer and might be a potential novel modality for imaging patients with gastric cancer.
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目的探讨~(99)Tc~m-联肼尼克酰胺(HYNIC)-前列腺特异膜抗原(PSMA)SPECT/ CT显像在前列腺癌(PCa)生化复发中的价值。方法回顾性分析2018年1月至2023年3月间于河南省人民医院行~(99)Tc~m-HYNIC-PSMA SPECT/ CT显像且资料完整的112例PCa生化复发患者[年龄(72.6± 6.1)岁]。根据前列腺特异抗原(PSA)水平分为0.2 μg/ L
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Objective To investigate the value of ~(99)Tc~m-hydrazinonicotinamide (HYNIC)-prostate specific membrane antigen (PSMA) SPECT/ CT imaging in biochemical recurrence of prostate cancer (PCa). Methods From January 2018 to March 2023, 112 patients with biochemical recurrence of PCa (age (72.6±6.1) years) who underwent ~(99)Tc~m-HYNIC-PSMA SPECT/ CT imaging in Henan Provincial People's Hospital were retrospectively analyzed. According to the level of prostate specific antigen (PSA), patients were divided into 0.2 μg/ L<PSA≤1 μg/ L group, 1 μg/ L<PSA≤2 μg/ L group, and PSA>2 μg/ L group. According to the Gleason score, patients were divided into Gleason score≥8 group and Gleason score < 8 group. The detection rate between groups was analyzed by χ~2 test, and the difference of the PSA level between groups was compared by Mann-Whitney U test. Results PSMA imaging was positive in 77 cases and negative in 35 cases, with the detection rate of 68.8%(77/112). The detection rates of local recurrence, lymph node metastasis, bone metastasis and lung metastasis were 8.9%(10/112), 43.8%(49/112), 28.6% (32/112) and 0.9%(1/112), respectively. The detection rates of 0.2 μg/ L<PSA≤1 μg/ L,1 μg/ L<PSA≤ 2 μg/ L and PSA>2 μg/ L groups were 44.7%(21/47), 8/12 and 90.6%(48/53), respectively (χ~2 = 24.44, P<0.001). The detection rates of Gleason score ≥8 group and <8 group were 76.4%(55/72) and 55.0%(22/40) (χ~2 = 5.47, P = 0.032); the PSA level between the two groups was statistically different (3.11(0.75, 5.91) and 0.84(0.44, 2.92) μg/ L; z =-2.99, P =0.003). Of the patients with PSMA positive imaging, 84.4%(65/77) changed their treatment regimen and 15.6%(12/77) continued to observe or maintain the original treatment plan. Of the patients with PSMA negative imaging, 40.0%(14/35) changed the treatment plan, 51.4%(18/35) continued to observe or maintain the original treatment plan, and 8.6% (3/35) discontinued the original treatment because no tumor metastasis was found. Conclusion 99 TcmHYNIC-PSMA SPECT/ CT imaging can provide reference for the lesion detection, treatment decision-making and follow-up observation of biochemical recurrence of PCa.
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心肌纤维化是多种心血管疾病发生发展的重要病理过程,与患者预后密切相关。活化的成纤维细胞(CFs)是其中主要的效应细胞,其表面特异性高表达成纤维细胞激活蛋白(FAP)。核素标记的FAP抑制剂(FAPIs)能与FAP特异性结合,在体可视化活化的CFs,在多种心血管疾病的早期诊断、预后预测及干预指导中表现出初步的临床应用价值。该文就核素标记的FAPIs在心血管疾病显像中的研究进展进行综述。
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Myocardial fibrosis is an important pathological process in the development of cardiovascular diseases, which is closely related to the prognosis of patients. Activated cardiac fibroblasts (CFs) are the main effector cells, whose surface specifically overexpress fibroblast activation protein (FAP). Radionuclide-labeled FAP inhibitors (FAPIs) can specifically bind to FAP to visualize activated CFs in vivo, showing preliminary clinical application in the early diagnosis, prognosis prediction and interventional guidance of various cardiovascular diseases. This article reviews the progress of researches on the application of radionuclide-labeled FAPIs in cardiovascular diseases imaging.
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双显像剂PET显像能够为疾病诊断提供更为全面的临床信息。如何通过单次显像实现双显像剂显像是当前核医学领域研究热点,其核心技术问题是在混合显像剂信号中准确分离出单一显像剂信息。近20年来,不同显像剂的分离方法不断被提出,2种显像剂之间的注射间隔也在不断缩短。该文对近年来提出的双显像剂分离技术进行汇总,介绍了代表性技术的实现手段,总结了各种方法的优势,并展望其发展方向。
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Dual-tracer PET imaging can provide more comprehensive clinical information for disease diagnosis. How to achieve dual-tracer imaging through single imaging session is one of the hot topics in the field of nuclear medicine. The key issues in achieving dual-tracer imaging with a single scan is the accurate separation of single-tracer information from the mixed tracer signal. In the last two decades, separation methods for different tracers have been proposed, and the injection interval between two tracers was reduced. This paper summarizes recent dual-tracer separation methods. The basic principles, features and advantages of separation methods are analyzed. Besides, the outlook on the future development of dual-tracer separation is also discussed in the present review.
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口腔颌面部恶性肿瘤威胁患者生命健康,严重影响患者的吞咽、语言功能和面容。其治疗方法中,~(125)I粒子近距离照射治疗技术因手术创伤小,靶区组织剂量大分布均匀,对周边正常组织损伤小,可以减少医护人员辐射暴露等优点,受到广泛关注。利用~(125)I粒子对口腔颌面部肿瘤进行持续、低剂量的近距离照射治疗,可以有效减小肿瘤体积,延长患者的生存期,治疗效果显著。该文针对~(125)I粒子近距离照射在口腔颌面部恶性肿瘤的临床应用展开综述。
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Oral and maxillofacial malignant tumors threaten the life and health of patients, and seriously affect their swallowing, language function and face. ~(125)I seeds brachytherapy for oral and maxillofacial malignant tumors has been widely concerned and studied because of its advantages such as less surgical trauma, large and uniform dose distribution in the target tissue, little damage to the surrounding normal tissue, and reducing radiation exposure of medical staff. Low-dose brachytherapy with ~(125)I seeds can effectively reduce the tumor volume and prolong the survival time of patients. This article reviews the clinical application of ~(125)I seeds brachytherapy in oral and maxillofacial malignant tumors.
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地表形变危害巨大且深远,利用合成孔径雷达干涉测量(interferometric synthetic aperture radar,InSAR)技术监测地表形变虽已较为成熟,但是超大范围,甚至全国范围的地表形变快速提取仍充满挑战。为快速获取全国地表形变信息,设计了一种基于超算并行计算的广域地表形变快速提取优化方法,并对干涉集基线组合方法、广域相位解缠算法、大气效应改正方法等进行了改进和创新。基于该方法,采用10 157景哨兵1号数据,研制了中国全境2021年度40 m分辨率地表形变速率图,经验证形变速率精度为4.82 mm/a,有效覆盖度为94.6%,图幅间无明显接边差异。同时对国内典型地表形变区域进行了分析。研究为广域地表形变常态化快速提取提供了参考。
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The damage of ground deformation is huge and farreaching. Although it is relatively mature to monitor ground deformation via interferometric synthetic aperture radar (InSAR), challenges still exist in the fast extraction of largescale ground deformation, i. e., across the country. To quickly obtain the national ground deformation information, we design an optimized method for fast extraction of large-scale ground deformation based on supercomputing parallel computing, improve and innovate the baseline combination method of interferometric pairs, large-scale phase unwrapping algorithm, atmospheric effect correction method, etc. Based on this method, we use 10 157 scenes of Sentinel-1 data to develop a 40-meter resolution national ground deformation rate map for the whole territory of China in 2021. The accuracy of the deformation rate is 4.82 mm/a, the effective deformation information coverage is 94.6%, and there is no obvious edge difference between the scenes. At the same time, the typical ground deformation areas in China are analyzed. This research provides a reference for the routinely fast extraction of large-scale ground deformation.
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随着Galileo卫星系统的全面建成,多频Galileo观测值提供了更低噪声和更长波长的观测值组合,从而为Galileo瞬时精密单点定位(precise point positioning,PPP)模糊度固定(ambiguity resolution,AR)提供良好的条件。从三频无电离层组合观测模型出发,重点分析了Galileo各个频点观测值组合的噪声放大因子,并基于15个MGEX(multi-GNSS experiment)测站10天的观测数据评估了不同频率组合的Galileo瞬时PPP-AR定位精度。结果表明:在位置精度衰减因子(position dilution of precision,PDOP)较差时(PDOP= 2.3),采用Galileo E1/E5a/E6频率的瞬时PPP-AR在东、北和天方向的均方根(root mean square,RMS)分别为0.16 m、 0.19 m和0.45 m,与Galileo E1/E5a/E5b瞬时PPP-AR定位解相比,在3个方向分别提高了约40%、38%和32%。以上结果表明,采用Galileo E1/E5a/E6组合对瞬时PPP-AR的定位精度有较大提升,因此当用户的全球导航卫星系统(global navigation satellite system,GNSS)接收机能接收到Galileo E1/E5a/E6频点时,建议采用这三组频点进行定位。
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With the full completion of the Galileo satellite system, the combination of observations with lower noise and longer wavelengths can be provided by multi-frequency Galileo observations. Therefore, it is possible to achieve Galileo instantaneous precision point positioning (PPP) with ambiguity resolution (AR). Based on the triple-frequency ionosphere-free combination observation model, we analyze the noise amplification factors of Galileo observations with different frequencies. Experimenting on the observation data from 15 multi-GNSS experiment (MGEX) stations in 10 days, the positioning performance of Galileo instantaneous PPP-AR is assessed with different frequency combination. When the position dilution of precision (PDOP) is weak (PDOP=2.3), the results indicate that the root mean square (RMS) of Galileo E1/E5a/E6 for east, north and up components are 0.16 m, 0.19 m and 0.45 m, respectively. Compared with the solutions of Galileo E1/E5a/E5b, the Galileo E1/E5a/E6 shows an improvement of approximately 40%, 38% and 32% for east, north and up components, respectively. Therefore, the Galileo E1/E5a/E6 can bring a significant improvement in the instantaneous PPP-AR, and we suggest that these three signals should be used for positioning if the Galileo E1/E5a/E6 can be tracked by the user's global navigation satellite system(GNSS) receiver.
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人工测量夯沉量的方式精度差、效率低且危险性高。针对这些问题,利用单目视觉方法实现了夯沉量的实时高效测量。为验证该方法的有效性,基于夯沉量解算模型,根据误差传播定律建立了夯沉量精度评价模型,并进行了误差敏感性分析,给出了提高夯沉量测量精度的方法和建议。结果表明,对测量精度影响最大的参数为相机俯仰角;特征点识别误差是测量结果误差的主要来源。工程实测结果表明,夯沉量解算均方误差为±28.46 mm,符合工程现场夯沉量测量误差的精度要求,具有推广价值。
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To address the problems of manual measurement of ramming settlement such as poor accuracy, low efficiency and high risk, the monocular vision method is used to realize the real-time and high-efficiency measurement of ramming settlement. To verify the effectiveness of this method, the ramming settlement accuracy evaluation model is established based on the ramming settlement calculation model and the error propagation law. The error sensitivity analysis is carried out, and some suggestions are given to improve the accuracy of ramming settlement measurement. The results show that the parameter which has the greatest impact on the measurement accuracy is the camera pitch angle, and the feature point recognition error is the main source of the measurement error. The engineering results show that the mean square error of the ramming settlement is ±28.46 mm, which meets the accuracy requirements of the measurement error of ramming settlement at the engineering site, and has great promotion value.
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在单目视觉测距系统中,摄像机安装偏差会造成摄像机云台俯仰角与模型俯仰角不一致,从而影响远距离单目测距和定位的精度。针对这一问题,提出了一种基于梯度下降法的俯仰角校正方法。该方法根据单目测距原理和参考点与摄像机的实际距离,构建出梯度下降法的目标函数;对目标函数进行一阶微分,求出目标函数的梯度;迭代计算出使目标函数值小于设定阈值的俯仰角,以此为单目测距模型最优俯仰角。在此基础上,依据单目视觉成像原理构建像素坐标与实际坐标间的函数关系,计算特征点的实际坐标。以球型摄像机为图像采集设备开展实验与应用,结果表明,测距结果的相对误差都在4%以内。这证明该方法能准确校正单目测距俯仰角,确保测距精度,且能有效确定特征点坐标。
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In the monocular vision ranging system, the camera installation deviation will cause the inconsistencies between the camera head's pitch angle and the model's pitch angle, which will affect the accuracy of the long-distance monocular vision ranging and positioning. To solve this problem, we propose a pitch angle correction method based on gradient descent method. According to the principle of monocular vision ranging and the actual distance between the reference point and the camera, the objective function of the gradient descent method is constructed. By differentiating the first order of the objective function, the gradient of the objective function is obtained. The pitch angle that makes the value of the objective function less than the set threshold is calculated iteratively, which is taken as the optimal pitch angle of the monocular vision ranging model. Under these conditions, the function relationship between pixel coordinates and actual coordinates is constructed according to the monocular vision imaging principle, and the actual coordinates of feature points are calculated. The experiment and application of spherical camera as image acquisition equipment show that the relative errors of ranging results are within 4%, which proves that the method can accurately correct the pitch angle of monocular vision ranging, ensure the ranging accuracy, and effectively determine the coordinates of feature points.
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对绝大多数空间目标而言,由于观测条件和观测手段的限制,测轨数据稀疏且精度较低,传统轨道确定时一并解算的大气阻力系数精度稳定性很差。针对这一问题,提出一种基于随机森林的大气阻力系数预测模型。该模型主要利用某个目标的历史大气阻力系数、轨道数据、太阳地磁指数、大气密度等信息预测该目标未来一段时间内的大气阻力系数。仿真GRACE(gravity recovery and climate experiment)A卫星2002年的测轨数据,进行多个时间段的轨道确定与预报模拟实验。结果表明,相比于传统方法,利用所提模型预测大气阻力系数,再将其应用于轨道确定和预报,7天轨道预报最大误差降幅可达60%,有效抑制了最大误差,为稀疏测轨数据条件下改善空间目标轨道确定与预报精度提供了一种技术途径。
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For most space objects, due to the limitations of observation conditions and observation means, tracking data is usually sparse and of low accuracy, and the accuracy of atmospheric drag coefficients solved in the normal orbit determination process, is very unstable. To solve this problem, we propose a predictive model to construct atmospheric drag coefficients based on random forest. It uses historical drag coefficients, orbit data, the solar and geomagnetic activity indices, and the atmospheric density to predict the atmospheric drag coefficient of the object for a future period of time. The orbit determination and prediction simulation experiments are carried out with simulation data of orbit measurement data of gravity recovery and climate experiment (GRACE) A satellite in 2002. The results show that the 7-day maximum orbit prediction errors can be reduced by 60% by using the proposed model to predict the drag coefficient and then applying it to orbit determination and prediction, compared with the normal methods. The proposed model can suppress the maximum errors effectively, thus providing a technical way to improve the orbit determination and prediction accuracy for resident space objects under the sparse data condition.
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星载合成孔径雷达(synthetic aperture radar,SAR)具备强穿透性和不受光照限制等优势,针对在高频波段星载SAR和地面通信时受色散效应影响,产生的信号畸变、失真、幅度起伏和相位起伏问题,提出了一种基于自适应滤波的校正匹配滤波算法,分析了信号失真的特征,对脉冲波形进行校正。实验结果表明,该算法有效补偿了时间延迟和相位畸变,纠正了脉冲信号波形失真。
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Spaceborne synthetic aperture radar (SAR) has the advantages of strong penetrability and no limitation of illumination. Aiming at the problems of signal distortion, signal inaccuracy, amplitude fluctuation and phase fluctuation caused by dispersion effect in high-frequency band during the communication of spaceborne SAR and ground, we propose a corrective matching filtering algorithm based on adaptive filtering, and analyze the characteristics of signal distortion and correct the pulse waveform. The experimental results show that the proposed algorithm can effectively compensate the time delay and phase distortion and correct the pulse signal waveform distortion.
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通过计算机代数系统Mathematica推导出了以地心纬度、归化纬度为变量的卯酉圈曲率半径、子午圈曲率半径和平均曲率半径的直接表达式,该表达式适用于任何椭球参数,具有通用性。并将常规的基于第一偏心率e表示的公式改写为基于第三扁率n表示的公式,以2000国家大地坐标系(China Geodetic Coordinate System 2000,CGCS2000)椭球为例分析了推导出的直接表达式的精确性和可靠性。经分析可得,常用曲率半径展开至e6或n3时,既能满足大地测量学要求的精度,也更为紧凑简练,一定程度上提高了地图投影的计算效率。
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With the computer algebra system Mathematica, the direct calculation formulas of radius of curvature in prime vertical, meridian radius of curvature, mean radius of curvature are derived,which take geocentric latitude and reduced latitude as variables. The expressions can be applied to any ellipsoid parameter for their universality. The conventional formula based on the first eccentricity e is rewritten to the formula based on the third oblate n, and China Geodetic Coordinate System 2000 (CGCS2000) ellipsoid is used to analyze the accuracy and reliability of the derived direct expressions. The analysis result shows that when the curvature radii are expanded to e6 or n3, the accuracy of geodesy can be satisfied, and the calculation efficiency of map projection can be im proved to some extent.
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视觉同步定位与建图(visual simultaneous localization and mapping,VSLAM)技术是近年来机器人和计算机视觉领域的重点研究方向之一,但当前的主流算法主要面向静态环境,当场景中存在运动的物体时,算法的定位精度和稳定性会受到很大影响。为了解决上述问题,提出了一种惯性测量单元(inertial measurement unit,IMU)积分与YOLOv4语义分割结合的VSLAM前端动态特征点剔除算法,通过YOLOv4网络对图像进行语义分割,识别图像中有运动可能的物体;再将IMU积分与语义分割结合,对目标检测框内有运动可能的特征点进行重投影误差的解算,识别并剔除环境中运动的特征点。在TUM Visual-Inertial Dataset上验证该算法,结果表明,在包含运动物体的室内场景下,该算法可以有效剔除环境中的运动物体,显著提升SLAM系统的定位精度和稳定性。
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Visual simultaneous localization and mapping (VSLAM) technology is one of the key research directions in the field of robotics and computer vision in recent years, but the current algorithms are mainly oriented to static environment. When there are moving objects in the scene, the positioning accuracy and stability of the algorithm will be greatly affected. To solve the above problems, we propose a VSLAM algorithm that combines inertial measurement unit (IMU) integration and YOLOv4 semantic segmentation to eliminate front-end dynamic feature points. YOLOv4 network is used to perform semantic segmentation of images and identify objects with possible movement in images. Then IMU integration and semantic segmentation are combined to solve the reprojection error of the feature points with possible movement in the target detection frame, and identify and eliminate the moving feature points in the environment. The TUM Visual- Inertial Dataset is used to verify the proposed algorithm, and the experimental results show that the proposed algorithm can effectively remove the moving objects in the indoor scene containing moving objects, significantly improving the positioning accuracy and stability of SLAM system.
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以单体建筑为对象的属性挂接方法已无法满足城市建筑立体空间多层差异的属性信息挂接需求。因此,提出一种基于倾斜三维数据的建筑物智能楼层提取方法,该方法利用现有二维建筑物矢量边界提取建筑物立面纹理,并在Mask R-CNN模型上增加一个特征增强结构--反向的特征金字塔(feature pyramid network,FPN),充分利用高低层特征信息,提升窗户识别检测率;同时,根据窗户排列规则进行规则化补全,然后进行层高计算、分割楼层。实验证明所提方法容错性较好,即使在窗户识别不全或有遮挡的情况下,经过简单的后处理也能实现楼层的分层。
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The attribute linking method that takes the single building as the object can no longer meet the demand of attribute information linking for the multi-layer difference in 3D space of urban buildings. Therefore, we propose an intelligent method to extract building floors based on oblique photogrammetry 3D data. This method uses the existing 2D vector boundary data of the buildings to extract the facade texture of the buildings, and adds a feature enhancement structure, reverse feature pyramid network (FPN) to Mask R-CNN model to make full use of the feature information of high and low floors to improve the window recognition and detection rate. According to the rules of window arrangement, regular completion is performed, and the floor height is calculated and the floors are divided. The experiment verifies the proposed method has better fault tolerance. Even when the windows are not fully identified or blocked, the floor layering can be achieved through simple post-processing.
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针对现有关键帧提取方法时间复杂度高、漏检率大、忽略视频语义信息等问题,提出一种基于互信息熵和局部聚合描述符向量网络(vector of local aggregated descriptors net,NetVLAD)的视频关键帧提取方法。首先计算视频帧互信息熵,将视频划分为视频子集;然后通过NetVLAD进行视频帧的特征提取与聚类,根据最近邻匹配算法计算帧间距离,提取候选关键帧;最后通过感知哈希减少冗余度,得到关键帧集合。基于UAV-123数据集进行了实验分析,结果表明,该方法高鲁棒地提高了关键帧的提取效率,保证了高保真度的同时降低了关键帧的冗余。
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To solve the problems of existing key frame extraction methods, such as high time complexity, high miss rate and video semantic information neglect, we propose a video keyframe extraction method based on mutual information entropy and vector of local aggregated descriptors net (NetVLAD). First, we calculate the mutual information entropy of video frames and divide the video into video subsets. Then, feature extraction and clustering of video frames are carried out by NetVLAD. The similarity between frames is calculated by the nearest neighbor matching algorithm, and candidate keyframes are extracted. Finally, the redundancy is reduced by perceptual hashing, and the keyframe set is obtained. Experimental analysis based on UAV-123 data set proves that the proposed method improves the extraction efficiency of keyframes with high robustness and reduces the redundancy of key frames with high fidelity.
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使用卷帘快门相机进行移动测量时,由于逐行曝光的特点,影像上会产生果冻效应。而传统的建图与视觉定位方法大多假设影像是全局快门获取,直接处理卷帘快门影像很难得到高精度的结果。针对以上问题,构建基于插值的卷帘快门相机模型,并将其用于卷帘快门影像的高精度建图与视觉定位。建图时使用运动恢复结构算法,利用卷帘快门相机模型对影像特征点进行坐标插值,获取该点的位姿,继而得到对应的投影矩阵,再进行卷帘快门三角化和卷帘快门光束法平差优化,完成高精度建图。在视觉定位环节,利用PnP(perspective-n-point)算法获取影像定位初值,之后使用卷帘快门影像绝对位姿优化算法进行优化。实验结果表明,与传统方法相比,所提方法的建图与视觉定位精度更高。
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Images might suffer rolling shutter effect due to the characteristic of row-by-row exposure if a rolling shutter cam era for movement measurement is used. Traditional methods on mapping and visual positioning typically assume that images are obtained by a global shutter, so, it is difficult to obtain high-precision results when using them to process the rolling shutter images. To solve this problem, we construct a rolling shutter camera model based on interpolation, and use it for high-precision mapping and visual positioning of rolling shutter images. Structure from motion (SfM) algorithm is used for mapping, and rolling shutter camera model is used to obtain the pose of image feature point by coordinate interpolation, and then the corresponding projection matrix is obtained, following by performing rolling shutter triangulation and rolling shutter bundle adjustment to complete high-precision mapping. In visual positioning, perspective-n-point (PnP) algorithm is used to obtain the initial value of image positioning, and then it is optimized by rolling shutter absolute pose optimization algorithm. The experimental results prove that the proposed method can achieve higher mapping and positioning precision than that of traditional global shutter methods.
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以美国航空航天局(National Aeronautics and Space Administration,NASA)、欧洲航天局(European Space Agency,ESA)、加蓬航天局合作的AfriSAR项目中的Lopenp和Mondah为实验区,以L波段的多基线全极化无人驾驶飞行器合成孔径雷达(unmanned aerial vehicle synthetic aperture radar,UAVSAR)数据为数据源,分别采用高度偏差(height variance,VAR)方法、偏心率(eccentricity,ECC)方法和平均相干幅度与分离度乘积(product of average coherence magnitude and separation,PROD)方法、原点到拟合直线距离与分离度乘积(product of fitted line distance from origin and coherence separation,LINE)方法进行基线选择,并基于地面随机体散射模型(random volume on ground,RVoG)三阶段方法反演森林高度,以激光雷达获取的相对高度RH100对两个实验区的森林冠层高度反演结果进行验证。结果表明:在植被高度较小时,利用4种基线选择方法反演的森林冠层高度均比较合理,但森林高度较大时,ECC和VAR方法的低估较为严重;在Lopenp实验区中,采用VAR方法选择基线时,总体反演精度最低,R~2和均方根误差(root mean square error,RMSE)分别为0.36、26.27 m;采用ECC方法选择基线时,总体反演精度优于VAR方法,R~2和RMSE分别为0.50、13.94 m;LINE方法的R~2和RMSE分别为0.72、 8.71 m,PROD方法的R~2和RMSE分别为0.72、8.55 m。 4种基线选择方法中,PROD和LINE方法的总体反演精度明显优于ECC和VAR方法。Mondah实验区结果的规律与Lopenp实验区的一致,说明利用多基线极化合成孔径雷达干涉测量(polarimetric interferometric synthetic aperture radar,PolInSAR)技术反演森林冠层高度时,基线选择方法对反演结果有重要影响。
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In this study, Lopenp and Mondah in the collaborative AfriSAR project between National Aeronautics and Space Administration (NASA), European Space Agency (ESA) and Gabonese Space Agency are used as test areas. Taking the multi-baseline fully polarized unmanned aerial vehicle synthetic aperture radar (UAVSAR) data of L-band as the data source, we use height variance (VAR), eccentricity (ECC), product of average coherence magnitude and separation (PROD), and product of fitted line distance from origin and coherence separation (LINE) methods to select baseline, and use the three-stage method of random volume on ground (RVoG) to retrieve forest height. The forest canopy height inversion results of two test areas are validated by relative height RH100 acquired by LiDAR. The results show that the forest canopy height inversions of the four baseline selection methods are reasonable when the vegetation height is small, but the underestimation of ECC and VAR methods is more serious when the forest height is large. In Lopenp test area, the overall inversion accuracy is the lowest when using VAR method to select baseline, its R~2 and root mean square error (RMSE) are 0.36 and 26.27 m, respectively. When using ECC method to select baseline, its overall inversion accuracy is better than that of VAR method, and its R~2 and RMSE are 0.50 and 13.94 m, respectively. R~2 and RMSE of for LINE method are 0.72 and 8.71 m,respectively. R~2 and RMSE of PROD method are 0.72 and 8.55 m, respectively. Among the four baseline selection methods, PROD and LINE methods have better overall inversion accuracy than ECC and VAR methods. The regularity of the results in Mondah test area is consistent with that of Lopenp test area. It indicates that the baseline selection methods in multi-baseline PolInSAR-based forest canopy height inversion have an important influence on the inversion results.
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遥感影像的云修复是改善影像质量、降低数据成本的一种重要手段。使用Landsat 8影像研究卷积神经网络在云修复中的应用,提出一种影像信息重建的新式网络结构--边缘辅助的门控卷积网络(edge-guided gated convolutional network,EGCN)。该网络以多时相数据作为含云影像上被遮挡信息的辅助数据,主干网络为多时空门控卷积网络(spatial-temporal based gated convolutional network,STGCN),在多尺度特征融合模块引入一种改进的非局部(non-local, NL)模块--门控非局部(gated non-local,GNL)来替代传统的卷积层,并以边缘特征提取网络(edge network,ENet)为分支,从边缘信息层面进行特征引导。实验结果表明, GNL模块和ENet的加入均有助于提升云修复效果。
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Cloud removal of remote sensing images is one of the important technologies to improve data quality and reduce data cost. A novel network structure to reconstruct missing information in images, which is called edge-guided gated convolutional network (EGCN), is put forward via the applications of convolutional neural network in cloud removal task using Landsat 8 images. This network uses multi-temporal data as auxiliary data for padding cloudy images. Spatial-temporal based gated convolutional network (STGCN) is used as the main trunk and an improved non-local (NL) block called gated non-local (GNL) is introduced to replace the traditional convolution layers. Besides, an edge network (ENet) is used as a branch to guide the feature from the edge information level. The experimental results show that GNL and ENet both benefit cloud removal task.
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基于长江中游城市群28个城市的数据,以碳排放为非期望产出,利用超效率松弛变量测度模型计算该城市群2010-2016年的城镇建设用地生态效率,采用社会网络模型分析城市群内建设用地生态效率的空间关联及其影响机制。研究表明,该城市群整体建设用地生态效率水平较低,其网络结构呈南强北弱的格局,空间关联度有待加强。城市经济发展水平和人口规模的差异是其关联性的主要影响因素。因此,进一步提升中心城市人口集聚规模与经济发展水平,统一排放标准,加强城市间产业合作,通过提高城市群内建设用地生态效率的网络关系实现协同减排是城市组团绿色发展的重要途径。
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Based on the data of 28 cities in urban agglomeration in the middle reaches of the Yangtze River, taking carbon emissions as unexpected output, we use super slack based measure model to calculate the eco-efficiency of urban construction land in this urban agglomeration from 2010 to 2016, and use social network model to analyze the spatial correlation and formation mechanism of the eco-efficiency of the urban construction land. The results show that the overall eco-efficiency of this urban agglomeration is low, its network structure is strong in the south and weak in the north, and the spatial correlation needs to be strengthened. The differences of urban economic development level and population size are the main driving factors. Therefore, improving the network relationship of land eco-efficiency of the urban construction land in urban clusters is essential for the green development of urban clusters to further improve the population agglomeration scale and economic development level of core cities, unify emission standards, strengthen industrial cooperation among cities, and achieve collaborative emission reduction.
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鉴于当前较难获取最新高精度长时序遥感城市土地监测图,现有城市扩展空间驱动分析实践识别主要驱动因子时未检验因子集的全局解释性且较少关注空间溢出效应。以东莞为实验对象,集合Landsat影像和MODIS归一化植被指数(normalized differential vegetation index,NDVI)时序产品,构建深度学习分类器,获取高精度土地覆盖分类图,识别城市扩展,使用基于logistic回归的探索性回归识别解释东莞全局城市扩展的最优因子集,进而使用auto logistic回归测度空间溢出效应的影响并进行驱动分析。研究发现:①基于深度学习分类器,融合Landsat光谱、纹理和MODIS NDVI时序变化信息可获取高精度(Kappa>93%)土地覆盖分类图;②基于探索性回归可良好识别解释全局城市扩展的最优因子集,受试者工作特征曲线(receiver operating characteristic curve,ROC)>0.85;③2000-2020年,最优解释东莞全局城市扩展的主要空间驱动因子有城市规划方案、距建成区距离、空间加权城市密度、城市扩展的空间溢出效应,主要限制因子有高程、坡度、1 km~2水体密度和土地可得性。
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Currently, it is difficult to obtain the latest high-accuracy remote sensing urban land monitoring maps over longtime span, while the studies on spatial determinant analysis of urban expansion ignore the globally explanatory ability of determinant sets and pay little attention to spillover effect when identifying major determinants. Taking Dongguan as the experimental area, this study involves Landsat images and MO DIS normalized differential vegetation index(NDVI) time-sequence products, constructs deep-learning classifier to obtain high-accuracy land cover classification maps, and then identifies urban expansion. Subsequently, exploratory regression backed by logistic regression is employed to identify the optimal determinant sets that best explain the urban expansion in Dongguan. Finally, auto logistic regression is used for measuring the impact of spillover effect and spatial determinant analysis. The following conclusions are achieved: First, by employing deep-learning classifier and integrating spectral and context information from Landsat images with NDVI diachronically variation information from MODIS products, high-accuracy (Kappa>93%) land cover classification maps can be obtained. Second, the optimal spatial determinant sets for globally explaining urban expansion can be well identified by exploratory regression, with receiver operating characteristic curve (ROC) over 0.85. Third, the main spatial drivers that optimally explain global urban expansion in Dongguan from 2000 to 2020 include urban planning schemes, distance to build area, spatially weighted urban percentage and spillover effect of urban expansion. In contrast, the main constraining factors include elevation, slope, water percentage within 1 km~2 and land availability.
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中国城市群的飞跃式发展带来空前经济繁荣的同时也引起了发展与保护的严重矛盾,如何协调城市群生态与经济的关系成为关注热点。但目前针对中国城市群协调发展的研究多局限于省(区、市)级单元,较少关注县(市、区)尺度。因此以中国三大城市群之一的京津冀城市群为例,构建生态与经济协调发展评价指标体系,对2000年、2005年、2010年、 2015年、2018年的县(市、区)协调水平进行评价。结果表明: ①城市群经济差异极大且不平衡的趋势加重,经济较为发达的地区主要集中于京津和河北省地级市市辖区,呈现以京津为核心的聚集团状结构和以多个地级市市辖区为散点的点状结构;②城市群整体生态水平“先恶化后优化”,高生态水平县(市、区)前期主要集中于城市群北部,后向南扩张;低生态水平县(市、区)主要位于城市群中东部京津地区和河北省地级市市辖区,在研究中后期数量逐渐减少;③协调度失衡情况严重且未能得到改善,靠近京津中心和冀地级市市辖区的县(市、区)协调水平普遍较高。针对以上问题,提出构建区域协调发展共同体、建立“大中心多组团”的空间结构、合理布局产业分工、强化生态发展模式和生态补偿模式等建议。
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The rapid development of urban agglomeration in China has brought unprecedented economic prosperity, but also caused the serious contradiction between development and protection. How to coordinate ecology and economy of urban agglomeration has become an impending challenge. However, present studies are mainly focused on provinces, regions and municipalities, with few exploring on the county/county-level city/district scale. Taking the Beijing-Tianjin-Hebei urban agglomeration, one of the three major urban agglomerations in China, as an example, we construct an evaluation index system for coordinated development of ecology and economy, and evaluate the coordination level of counties/county-level cities/districts in 2000, 2005, 2010, 2015 and 2018. The results are as follows: First, the economic differences within urban agglomerations are great and the trend of imbalance is increasing. The economically developed regions are mainly concentrated in the prefecture-level municipal districts of Beijing, Tianjin and Hebei, presenting a cluster structure with Beijing and Tianjin as the core and a point structure with several prefecture-level municipal districts as scattered points. Second, the overall ecological level of the urban agglomeration deteriorates first and then optimizes. The high ecological level counties/county-level cities/districts are concentrated in the northern part, and then expand to the south. The low ecological level counties/county-level cities/districts are mainly located in the central and eastern part of Beijing, Tianjin and the prefecture-level municipal districts of Hebei, and the number decreases gradually in the middle and late stage of the study. Third, the imbalance level is severe and has not been im proved, the coordination level of counties/county-level cities/districts near the center of Beijing and Tianjin and the prefecture-level city districts in Hebei is generally high. To solve these problems, the following suggestions are put forward, including building a coordinated regional development mechanism, establishing a spatial structure of“ large center and multiple clusters”, constructing a rational distribution of industrial division, and strengthening ecological development mode and ecological compensation mode.
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对地区的人群活动时空特征进行识别,有利于认识地区空间结构特质,但现有研究对县域及以下层面的关注相对不足,且用于表征县域尺度人群活动的手机信令数据呈现一定的稀疏性,欠缺系统的数据处理方法。为此,以广东省新兴县为例,选取2020年工作日和周末两个特征日的手机信令数据构建时空矩阵,利用非负矩阵分解方法提取隐含的活动模式特征;并基于这些特征,通过k-means聚类算法得出各类功能区在县域的空间分布。研究表明,新兴县周末的夜间经济繁荣、人群活动模式丰富,中心城区的人群活动强度高,但同周边村镇的联系弱;县域内以居住功能为主导,不存在显著的功能分区。研究结果说明了利用非负矩阵分解方法可有效提取稀疏时空矩阵中的模式特征,可为县域国土空间规划编制提供科学的支持和帮助。
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The identification of spatiotemporal characteristics of crowd activity is conducive to the understanding of regional spatial structure characteristics. However, the existing studies have not paid enough attention to the county level and below. Moreover, the mobile signaling data used to characterize the crowd activities at the county level are sparse to a certain extent and systematic data processing methods are lacking. We take Xinxing County in Guangdong Province as an example, select the mobile signaling data of two characteristic days of working day and weekend in 2020 to construct a spatiotemporal matrix, and use the non-negative matrix factorization method to extract the implied activity pattern features. Based on these features, the spatial distribution of various functional areas in this county is obtained by k-means clustering algorithm. The results show that Xinxing County has prosperous economy at night and abundant crowd activity mode on weekends. The intensity of crowd activity in the central city is high, but the connection with the surrounding villages and towns is weak. The county is dominated by residential function, and there is no significant functional partition. The results demonstrate that the non-negative matrix factorization method can effectively extract the pattern features in the sparse spatiotemporal matrix, which can provide scientific support and help for the county land spatial planning.
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在交通与经济联系视角下,以2019年和2020年为时间截面,基于社会网络理论分析粤港澳大湾区城市空间结构与联系网络特征,探究未来大湾区的发展方向与协同模式,以期对大湾区发展规划提供几点建议。结果表明:①粤港澳大湾区存在明显的“东强西弱”空间分异格局,广州、深圳、佛山为湾区城市主要联系方向,形成“广州-佛山”“深圳-东莞”交通极点和“佛山-广州-东莞-深圳-香港”经济联系主线; ②粤港澳大湾区已形成较为明显的以广州、深圳、香港为核心的多中心化网络结构,高位序城市节点表现出较强的虹吸效应,城市间双向联系呈现一定的对称性,但整体网络集聚趋势尚不明显;③粤港澳大湾区正逐步形成以湾区中轴为核心的圈层结构,并通过多个凝聚子群形成以点带面的协同发展格局。
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We analyze the urban spatial structure and connection network's characteristics of Guangdong-Hong Kong-Macao Greater Bay Area from 2019 to 2020 based on social network theory from the perspective of transportation relationship and economic relationship, and explore the development direction and the coordinated mode of the Greater Bay Area in the future, to provide several suggestions for the development planning of the Greater Bay Area. The results are as follows: First, the development of Guangdong-Hong Kong-Macao Greater Bay Area presents a spatial differentiation pattern of “strong in the east and weak in the west”. Guangzhou, Shenzhen and and Foshan are the main contact directions in the Greater Bay Area, forming the traffic pole of “Guangzhou- Foshan”, “Shenzhen-Dongguan” and the main line of economic connection:“Foshan-Guangzhou-Dongguan-Shenzhen- Hong Kong”. Second, a relatively obvious multi-centralized network structure with Guangzhou, Shenzhen and Hong Kong as the core has been formed in Guangdong-Hong Kong- Macao Greater Bay Area. High-ranking cities have shown strong siphon aspect than other cities. The two-way connection between cities presents a certain symmetry, but the overall trend of network agglomeration is not obvious. Third, a circle-like structure is gradually forming with the central axis of the Greater Bay Area as the core, and a coordinated development pattern of point to area is formed through a number of cohesive sub-groups.
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红绿灯位置是道路上行人和车辆的交会点,极大影响着道路结构和交通运行,在城市路网中起着重要的枢纽作用。针对目前红绿灯位置检测方法准确率不够高、覆盖面区域不完整等问题,提出了一种基于轨迹数据的交通灯位置检测方法。该方法基于聚类-合并-分类-合并的四级模型,首先从清理过的轨迹数据中提取隐含的车辆行驶特征,再采用具有噪声的基于密度的聚类(density-based spatial clustering of applications with noise,DBSCAN)方法得到转向和停驻两类聚类中心,对这两类聚类中心进行合并,获得红绿灯位置的候选位置;根据候选位置一定范围内的轨迹点提取该区域的车流行驶特征,然后采用梯度提升决策树(gradient boosting decision tree,GBDT)算法进行分类,最后将候选位置的正样本融合,以检测红绿灯位置。采用成都市浮动车GPS轨迹数据进行实验,检测结果的F1分数为0.947,效果优于常规的机器学习方法。实验结果表明,基于GPS轨迹数据,采用提出的四层模型能有效检测出红绿灯的位置,该模型可被用于城市大范围红绿灯位置信息的快速获取和更新。
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The position of traffic lights is the intersection of pedestrians and vehicles on the road, which greatly affects the structure of the road and the operation of traffic, and it plays an important pivotal role in the urban road networks. In response to the problems of low accuracy and incomplete coverage area of current traffic light position detection methods, we propose a trajectory data-based traffic light position detection method. Based on the four-level model of clustering, merging, classifying and merging, this method extracts the hidden driving characteristics of vehicles from the cleaned trajectory data, and then uses density-based spatial clustering of applications with noise (DBSCAN) method to get the two types of cluster centers (steering and stationary). Then these two types of cluster centers are merged to obtain the candidate positions of the traffic light. According to the trajectory points within a certain range of the candidate positions, the vehicle flow characteristics in this region are extracted. And then gradient boosting decision tree (GBDT) algorithm is used for classification. Finally, the positive samples of candidate positions are fused to detect traffic light positions. We use the floating car GPS trajectory data in Chengdu for experiments. The F1 score of the prediction result is 0.947, which is better than that of conventional machine learning methods. The experimental results show that the proposed four-level model can effectively detect the position of the traffic light according to the GPS trajectory data, and it can be used for the rapid acquisition and update of the city's large-scale traffic light position information.
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描述了一种基于浏览器/服务器(browser/server,B/S)架构的地理信息低代码开发平台的可视化编排设计和实现方法,为组件库、界面层编排、逻辑层编排和数据层编排设计了完善的行为规则。通过该方法实现平台的编排能力,采用拖拽组件和配置参数、逻辑编排、数据编排等方式实现领域地理信息应用软件开发,并用实例证明了该方法能够大幅提高地理信息应用软件开发效率、减少开发成本。
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A visual layout design and implementation method of GIS low-code development platform based on browser/server (B/S) architecture is described to design optimized behavior rules for component library, interface layer arrangement, logic layer arrangement and data layer arrangement. This method can realize the arrangement of the platform, and the geographic information application software in specific field can be developed by dragging components, parameter configuration, logic configuration and data configuration, etc. Examples demonstrate that this method can greatly improve the development efficiency of geographic information application software and reduce the development cost.
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遥感技术属于发达国家对中国采取核心技术封锁和核心元器件禁运的“卡脖子”领域。基于遥感技术发展与城市应用需求,介绍了城市遥感课程教学改革的思路和具体内容,提出了城市遥感课程“以课堂教学为主体、以专题研究为主线,以原理介绍、案例分析、思政案例介绍为教学环节,以分行业需求分析和针对性练习为辅助”的“二三二”教学模式,并对该模式的实施情况进行了介绍。试点教学表明,该模式有效增强了学生学习的主动性,在引导学生构建完善的城市遥感知识体系和激发本科生探索兴趣方面效果良好。 “二三二”教学模式有可能是一种适合中国国情的高校城市遥感课堂教学模式,值得进一步尝试和推广。
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Remote sensing technology is the bottleneck field of core technology blockade and core components embargo im posed by developed countries against China. Based on the development of remote sensing technology and the needs of urban application, we introduce the ideas and specific contents of the teaching reform of Urban Remote Sensing course, and put forward a“ two-three-two” teaching mode for Urban Remote Sensing course. It takes “classroom teaching as the main body, special research as the main line”, principle introduction, case analysis and ideological and political case introduction as the teaching link, and industry demand analysis and targeted exercises as auxiliaries. The pilot teaching shows that this mode effectively enhances students' learning initiative, and has a good effect on guiding students to build a perfect urban remote sensing knowledge system and stimulating undergraduates' interest in exploration. “Two-three-two” teaching mode may be a suitable teaching mode for urban remote sensing in colleges and universities of China, which is worthy of further trial and promotion.
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随着大数据与人工智能时代的到来,发展智能教育,应对新技术浪潮,培养新时代所需的专业人才已成为高校的重要任务。以中国地质大学(武汉)地理空间信息工程(geospatial information engineering,GIE)专业为例,结合专业特色和优势,基于新时代教育的新理念、新机构、新模式探索了GIE专业人才培养模式。围绕创新的“三融合”人才培养理念,开展了跨学科教学平台、专业课程结构、新型教学模式3个方面的人才培养体系设计探索。实践表明,该模式取得了显著的成果,对同类院校设置培养方案具有一定参考意义。
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With the advent of big data and artificial intelligence, it has become an important task for the colleges and universities to develop smart education, in response to the wave of new technologies and train professionals needed in the new era. Taking the geospatial information engineering (GIE) major of China University of Geosciences (Wuhan) as an example, we explore talent training model of GIE based on the new ideas, new institutions, and new models of education in the new era in combination with the characteristics and advantages of the major. Focusing on the talent cultivation concept of“ 3-Integration”, we explore the talent cultivation system in three aspects: interdisciplinary teaching platform, specialized course structure, and new teaching model. Practice shows that this model has achieved remarkable results, and it has certain reference significance for setting up training programs in similar colleges and universities.
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完好性对于全球卫星导航系统(GNSS)来说至关重要,关乎到其能否被放心应用。卫星自主完好性监测(SAIM)技术,是完好性监测技术发展的前沿趋势,国内外卫星导航系统均竞相发展。介绍了北斗三号系统SAIM技术设计与实现的重要意义,从功能设计和实现原理两个方面,阐述了北斗三号SAIM技术体制。针对SAIM实际在轨监测数据的正态分布特性服从程度和长期稳定性等问题,随机选取某一颗中圆轨道(MEO)卫星自2020年7月31日北斗三号系统正式开通服务以来至2021年7月31日连续1年期间的监测数据,得到真实在轨监测数据的分布特性。最后,提出了告警门限优化、分级告警策略设计、星历完好性自主监测等方面的后续发展必要性建议,旨在为北斗系统更好地为全球用户提供更优质的完好性服务提供参考。
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Integrity is very important for the global navigation satellite system(GNSS),which is related to whether it can be safely applied.Satellite autonomous integrity monitoring(SAIM)technology is the frontier trend of the development of integrity monitoring technology,so that all GNSS around the world are competing to develop it.This paper introduces the significance of the design and implementation of BDS-3SAIM technology,and expounds the BDS-3SAIM technology from two aspects of function design and implementation principle.Aiming at the problems of normal distribution characteristics and long-term stability of actual on-orbit monitoring data of SAIM, the monitoring data of a medium Earth orbit(MEO)satellite from July 31,2020to July 31,2021 are randomly selected to obtain the distribution characteristics of real on-orbit monitoring data.Finally,the necessary suggestions for the follow-up development of alarm threshold optimization, hierarchical alarm strategy design and autonomous monitoring of ephemeris integrity are put forward, aiming to provide reference for Beidou system to provide better integrity services for global users.
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近年来,基于信道状态信息(CSI)的无线感知技术在室内定位、活动识别、健康检测等方向有众多探索性研究应用。然而,现有研究获取CSI数据主要依靠自主采集,对CSI开源数据集和数据采集设备/工具的研究现状不够清晰。首先阐述了基于无线保真(WiFi)CSI的无线感知技术,详细介绍了9种CSI数据采集设备/工具,概括了CSI的应用方向及研究现状,并汇总了近5年的CSI开源数据集,分析了现有CSI无线感知研究的局限性与面临的挑战,最后总结全文并对CSI无线感知未来的发展进行展望。
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In recent years,wireless sensing technology based on channel state information(CSI) has been extensively and exploratorily studied and applied in several directions,such as indoor positioning, activity recognition,and health monitoring.However,the current research primarily relies on the independent collection of CSI data,and presenting a lack of clarity towards the research status of CSI open-source dataset and data acquisition devices/tools.Firstly,the wireless sensing technology based on wireless fidelity(WiFi)CSI is described.Secondly,9types of CSI data acquisition devices/tools are introduced in detail and the application directions and research status of CSI are generalized.Thirdly,the CSI open-source datasets of the past five years are aggregated and the limitations and challenges of current research on CSI wireless sensing research are analyzed.Finally,the content of the full text is summarized and the future trend of CSI wireless sensing is prospected.
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全球导航卫星系统(GNSS)超快精密定轨为GNSS实时应用提供了高精度空间基准。基于天地协同定位、导航与授时(PNT)网络服务中心实现了四系统GNSS卫星超快精密定轨,并对定轨结果进行精度评价。介绍了天地协同PNT网络的概念内涵以及网络服务中心部署的超快精密定轨软件架构和详细功能,并针对实时应用需求提出了一种双线程滑动窗口超快精密定轨策略。最后利用重叠弧段比较、与外部轨道产品比较以及卫星激光测距(SLR)检核3种方式对定轨结果进行了精度评价。结果表明,与武汉大学分析中心的最终事后精密轨道产品相比,四系统GNSS MEO卫星预报6h弧段的径向均方根(RMS)误差整体在2~5cm水平,BDS2IGSO卫星最小一维RMS误差在10~15cm水平;GPS和Galileo卫星的SLR检核残差均值在1~3cm水平,标准差在3~6cm水平,能够满足后续厘米级实时应用对空间基准的精度需求。
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Multi-global navigation satellite system(GNSS)ultra-rapid precise orbit determination provides high-precision space reference for GNSS real-time applications.The multi-GNSS ultrarapid precise orbit determination at space-ground collaborative positioning,navigation and timing (PNT)network service center is implemented and the accuracy of the orbit determination results are evaluated.The conceptual essence of the space-ground collaborative PNT network,and the architecture and detailed functions of the ultra-rapid precise orbit determination software deployed on the network service center are introduced.Additionally,a two-thread sliding window ultra-rapid orbit determination strategy is proposed to meet real-time application requirements.Finally,the accuracy of the orbit determination results is evaluated in three ways:through overlapping orbit comparison,comparison with other precise orbit products,and satellite laser ranging(SLR)checking. The results show that the root mean square(RMS)error of multi-GNSS medium-Earth orbiting(MEO)satellites in the radial direction ranges between 2and 5cm during a 6-hour predicted arc,and the minimum one-dimensional RMS error of the BDS2IGSO satellite is at the level of 10~ 15cm,when compared with the final orbit products from the analysis center of Wuhan University. The mean value and standard deviation of SLR residuals for the GPS and Galileo satellites are at 1~3cm and 3~6cm,respectively.The results meet the accuracy requirements of the space reference for centimeter-level real-time applications.
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基于LT-01A卫星星载BDS-3/GPS观测值进行了星载实时精密定轨研究,并重点分析了广播星历旋转误差对实时定轨精度的影响。通过赫尔默特转换评估了所选时段内GPS和BDS-3广播星历轨道旋转误差,显示BDS-3广播星历旋转误差可达-8.7mas,平均量级较GPS大约2.5倍。BDS-3广播星历经旋转改正后,轨道切向、法向均方根(RMS)误差从25cm左右提升至10cm量级,提升幅度超过50%。因此,基于星载BDS-3以及BDS-3/GPS联合的实时定轨精度受BDS-3星历旋转误差影响严重,且主要作用于切向和法向。经过旋转改正后,单独BDS-3实时定轨在切向、法向、径向RMS分别为21.0cm、10.7cm及11.2cm,其切向和法向精度比改正前分别提升15.0%和31.8%;BDS-3与GPS联合定轨进一步提升切向精度至19.4cm。得益于BDS-3广播星历较高的精度,单BDS-3以及BDS-3/GPS联合的实时定轨在旋转改正前的三维RMS分别为31.9cm和29.2cm,较单GPS实时定轨分别提升9.1%和16.8%;添加旋转改正后,其定轨精度分别提升至26.7cm和25.0cm,较单GPS实时定轨分别提升22.6%和27.5%。
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The real-time orbit determination(RTOD)performance with onboard BDS-3and GPS observations from a Chinese low Earth orbit satellite,LT-01A,is analyzed,with a focus on the impact of broadcast ephemeris rotation error on RTOD accuracy.The orbit rotation errors of GPS and BDS-3broadcast ephemeris are evaluated by Helmert transformation with respect to post precise orbit product.BDS-3broadcast ephemeris reveals rotation errors reaching up to-8.7mas, and indicates an average rotation error about 2.5times larger than that of GPS.After the rotation correction of BDS-3broadcast ephemeris,the root mean square(RMS)errors in the along-track and cross-track components of BDS-3broadcast ephemeris show significant reductions from about 25cm to a level around 10cm,manifesting an improvement by more than 50%.Therefore,the RTOD accuracy based on spaceborne BDS-3and BDS-3/GPS combination are significantly affected by the rotation error of BDS-3ephemeris,which mainly degrades the along-track and cross-track components.For BDS-3only RTOD,the along-track,cross-track,and radial RMS errors with rotation correction are 21.0cm,10.7cm,and 11.2cm,respectively;the along-track and crosstrack accuracies present improvements by 15.0%and 31.8%,respectively.By combining BDS-3 and GPS observations,the RTOD errors at the along-track components are further improved to 19.4cm.Thanks to the high accuracy of BDS-3broadcast ephemeris,the three-dimensional RMS errors of independent BDS-3and combined BDS-3/GPS RTOD are 31.9cm and 29.2cm,respectively, which are 9.1%and 16.8%smaller than GPS-only RTOD errors,respectively.With rotation correction,the orbit determination accuracies are improved to 26.7cm and 25.0cm,respectively, which is 22.6%and 27.5%smaller than those of single GPS real-time orbit determination.
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针对密林中卫星信号遮挡难以实现快速高精度定位的问题,提出了一种密林环境空地协同全球卫星导航系统/超宽带(GNSS/UWB)高精度定位方法。该方法综合考虑无人机平台在空旷环境快速运动与超宽带的强穿透性测量等特征,通过无人机携带GNSS/UWB集成化载荷,以移动单基站模拟多基站,配合密林中UWB标签组网测距,完成密林中UWB标签定位。对基站布设方案展开研究,为密林环境下空地协同GNSS/UWB快速高精度定位技术应用提供基站布设指导和依据,并且利用密林环境下实测测距实验+仿真定位实验对提出的方法进行验证。结果表明,所述方法可有效实现密林环境下的快速高精度定位,精度达到分米级,并且通过优选基站布设网型、范围及高度可有效提高定位精度,为密林环境下快速高精度定位方法提供了理论支撑。
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An air-ground collaborative GNSS/UWB high-precision positioning method for dense forest environments is proposed,aiming to address the challenges of satellite signal obstruction, and achieve fast and accurate positioning.The method takes into consideration the characteristics of unmanned aerial vehicle(UAV)platforms in open environments with rapid movements and the strong penetration capabilities of ultra-wideband (UWB)measurements.It utilizes a UAV equipped with an integrated GNSS/UWB payload to simulate multiple base stations,combined with UWB tag network ranging in the dense forest to achieve UWB tag positioning.Research on the base station deployment scheme is conducted,providing guidance and basis for the application of GNSS/UWB cooperative positioning technology in dense forest environments.It verifies the proposed method through field ranging experiments and simulation positioning experiments in dense forest environments.The simulation results demonstrate that the proposed method can effectively achieve fast and high-precision positioning in dense forest environments,with an accuracy of decimeter level.By optimizing the network type,coverage range,and height of the base station deployment, the positioning accuracy can be effectively improved,thus providing theoretical support for fast and high-precision positioning methods in dense forest environments.
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当前大部分城市为保护卫星连续运行参考站(CORS)系统基准站天线安装了整流罩,但天线整流罩对观测值以及基准站坐标影响的研究仍显不足。为解决基于广州CORS(GZCORS)的网络RTK高程测量存在较大偏差的问题,基于2016-2021年观测站数据,以及拆除基准站天线罩前后的观测数据质量与定位效果相关分析,对天线整流罩对GNSS观测值与高程定位精度的影响进行了深入探究,并分别进行了静态仿动态和城市车载动态定位测试验证。研究结果显示,天线整流罩在一定程度上会增加原始观测值的多路径效应影响,降低约10%的数据可用率,并对基准站高程定位结果产生1~14cm的系统性偏差,进而影响用户RTK高程定位效果。定位结果显示,拆除基准站天线罩后,基于GZCORS的RTK水平定位均方根误差(RMS)为1cm左右,高程定位精度RMS为2cm左右;城市场景下车辆动态定位精度RMS为15~20cm,满足车道级定位性能。
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Currently,most reference stations of the satellite continuous operation reference station (CORS)system in cities have installed radomes to protect the antenna.However,the research on the impact of radomes on the observations and reference station coordinates is relatively insufficient. To solve the problem of significant deviation in the network RTK elevation measurement based on Guangzhou CORS(GZCORS),on the basis of the observation station data from 2016to 2021,as well as the analysis of the observation data quality and positioning effect before and after the removal of the reference station antenna radomes,the impact of antenna radome on GNSS observation values and elevation positioning accuracy is well-studied,and static station RTK positioning and urban vehicle kinematic positioning tests are conducted to verify.The results show that the antenna radome can increase the multi-path effect of the original observation values to a certain extent,reduce the data availability by about 10%,and produce a systematic deviation of 1~14cm in the elevation positioning results of the reference station,thereby affecting the user's RTK elevation positioning effect.The positioning results show that after removing the reference station antenna cover,the horizontal positioning accuracy root mean square(RMS)error of RTK based on GZCORS is about 1cm,and the elevation positioning accuracy RMS is about 2cm.The RMS of vehicle kinematic positioning accuracy in urban scenes is 15~20cm,meeting the lane level positioning performance.
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由于高轨空间超出北斗卫星导航系统的正常服务区域,导航信号微弱、可见性差,难以实现高轨飞行器全程稳定可靠的导航定位服务。提出了以空间卫星为时空基准传递平台,向高轨空间区域发射导航信号,从而提高高轨飞行器导航性能的方法,并展开面向高轨空间的北斗导航性能增强星座选型研究。基于卫星可见性、精度衰减因子(DOP)、信号接收门限和所需增强卫星数目等评估指标,仿真分析了基于LEO星座、MEO星座和HEO星座的北斗导航增强性能。
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As in the high-orbit space which exceeds the normal service area of the BeiDou navigation satellite system,the navigation signal is weak and the visibility is poor,and it is difficult to achieve stable and reliable navigation and positioning services for high-orbit aircraft.A method for improving the navigation performance of high-orbit vehicles is proposed by using space satellites as a space-time reference transmission platform to transmit navigation signals to high-orbit space areas,and the selection of BeiDou navigation performance enhancement constellation for high-orbit space is carried out.Based on the evaluation indicators of satellite visibility,dilution of precision(DOP),signal reception threshold and number of required enhanced satellites,the enhanced performance of BeiDou navigation based on LEO constellation,MEO constellation and HEO constellation is simulated and analyzed.
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通常使用无电离层(IF)线性组合(LC)消除低地球轨道(LEO)卫星简化动力学精密定轨(POD)一阶电离层延迟误差,忽略了高阶电离层(HOI)延迟误差。随着LEO卫星POD技术的发展,计算不同轨道高度的HOI延迟并探索其变化已成为进一步提高POD精度的重要手段。首先,使用国际参考电离层-2016(IRI-2016)和国际地磁参考场第13代(IGRF-13)模型,计算电离层穿刺点(IPP)位置和地磁场强度。其次,使用平滑星载GNSS数据计算电离层斜路径总电子含量(STEC)。然后,分别计算GOCE、GRACE-A和SWARM-A/B卫星的二阶和三阶电离层延迟。最后,评估了HOI延迟对LEO卫星重叠轨道分析、卫星激光测距(SLR)检核和精密科学轨道(PSO)比较结果的影响。实验结果表明:HOI延迟对LEO卫星简化动力学POD的影响大约在毫米至厘米的数量级上;HOI延迟对LEO卫星简化动力学POD外符合精度的影响分别达到0.92, 0.22,0.21和0.18mm;随着LEO卫星轨道高度的增加,HOI延迟对LEO卫星简化动力学POD的影响减小。
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Ionospheric-free(IF)linear combination(LC)is usually used to eliminate the first-order ionospheric delay error of low Earth orbit(LEO)satellite reduced-dynamic precision orbit determination(POD),ignoring the high-order ionospheric(HOI)delay error.With the development of LEO satellite POD technology,calculating the HOI delay at different orbital altitude and exploring its changes has become an important means to further improve POD accuracy.Firstly,using the international reference ionosphere-2016(IRI-2016)and international geomagnetic reference field: the 13th generation(IGRF-13)models,the ionospheric pierce point(IPP)position and geomagnetic field intensity are calculated.Secondly,the ionospheric slant total electron content (STEC)is calculated using smooth satellite-borne GNSS data.Then,the second-order and thirdorder ionospheric delay of GOCE,GRACE-A,and SWARM-A/B satellites are calculated,respectively. Finally,the effects of HOI delay on LEO satellite overlapping orbit analysis,satellite laser ranging(SLR)verification,and precision science orbit(PSO)comparison results are evaluated. The experimental results show that the effects of HOI delay on the reduced-dynamic POD of LEO satellites is approximately on the order of millimeters to centimeter level;the effects of HOI delay on the accuracy of reduced-dynamic POD for LEO satellites is 0.92,0.22,0.21,and 0.18mm, respectively;as the orbital altitude of LEO satellites increases,the effects of HOI delay on the reduced- dynamic POD of LEO satellites decreases.
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欺骗干扰已经成为北斗卫星导航系统安全性的一个严重威胁。针对北斗系统面临的欺骗干扰问题,建立二元假设检验模型。由于施加单一天线发射的欺骗干扰后,当前观测频点下各高俯仰角可见星的载噪比值会产生相同的变化趋势,所以基于此变化规律提出了一种利用K-means聚类算法进行分析的北斗卫星信号欺骗干扰检测方法,并给出了施加欺骗载噪比变化域的定义。最后通过在外场搭建实验环境,对实采数据进行了实验验证。实验结果表明,本方法对于欺骗功率优势≥6dBm的大功率优势欺骗信号的检测概率可以达到95%以上,为提高接收机抗干扰能力提供了有益参考。
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Spoofing has become a severe threat to the security of the Beidou navigation satellite system. Aiming at spoofing and interference issues faced by the Beidou system,a binary hypothesis testing model is established.Since the carrier-to-noise ratio of visible stars with high pitch angle at the current observation frequency will have the same variation trend after the spoofing interference transmitted by a single antenna is applied,a detection method of Beidou satellite signal spoofing interference by using K-means clustering algorithm is proposed based on this variation rule,and the definition of the variation domain of carrier-to-noise ratio after spoofing is given.Finally,by setting up the test environment in the field,the actual data are verified by experiment.The experimental results show that the detection probability of high-power advantage spoofing signals with a spoofing power advantage of no less than 6dBm can reach over 95%,providing an useful reference for improving the anti-interference ability of the receiver.
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针对栅格算法易受邻域星点影响导致误匹配的问题,提出了一种结合角距特征的改进栅格星图识别算法。首先介绍了改进栅格算法的原理,其次设计了融合栅格识别模式和星角距识别模式的算法实现流程,最后开展了基于不同视角下的大视场仿真星图的算法试验验证和性能分析。结果表明,由于角距特征具有旋转不变性和不易受观测星邻域星点分布影响等特点,结合角距特征对失效观测星进行再匹配的改进栅格算法,在兼顾存储量需求小、运行速度快等优势的同时,识别率和鲁棒性也得到了提升,最高识别率可达98.88%,在位置噪声干扰以及缺失星干扰下,改进算法的识别率仍可保持在95%,说明算法鲁棒性强,具有较好的应用前景。
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In order to solve the problem that grid algorithm is easily affected by stars in the neighborhood, which leads to the mismatching problem,an improved grid algorithm based on angular distance feature is proposed.Firstly,the principle of the improved grid algorithm is introduced. Then the algorithm flow of combining grid recognition pattern with star angular distance recognition pattern is designed.Finally,the improved algorithm is tested and verified on the simulation star map of the sensor with large field of view (FOV)in different directions.The results show that the angular distance feature is rotational invariance and not easily affected by the distribution of stars in the vicinity of the observed star,the improved grid algorithm combined with angular distance feature to make mismatching stars match again,which can improve the recognition rate and robustness while taking into account the advantages of small memory requirement and fast running speed,the highest recognition rate is 98.88%,and the recognition rate is still 95%under the interference of position noise and missing stars,indicating that the algorithm is robust and has good application prospects.
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针对行人惯性导航系统误差随时间累积致使定位精度严重下降的问题,提出了一种基于足间距信息辅助的行人三维惯性定位算法。该算法在零速修正算法的基础上,利用足部安装的超声波测距模块实时测量行人双足相对距离,构建了基于超声测距的足间距约束模型,通过随机森林算法实现行人运动模式识别,并针对上下楼梯场景,利用台阶高度和足间距信息进行高度解算,最终实现行人三维惯性定位。在实际路线上开展了三维定位实验,数据显示,所提算法平面闭环误差为总路程的0.64%,与零速修正算法相比下降了55.56%,高度误差为0.06m,与零速修正和气压计联合算法相比下降了64.70%,能够实现导航误差在总路程的0.50%以内的三维定位。实验结果表明,所提算法具有良好的工程应用价值。
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To solve the problem of the severe decrease in positioning accuracy caused by the accumulation of errors in the pedestrian inertial navigation system over time,a three-dimensional(3D) pedestrian inertial positioning algorithm based on the auxiliary information of inter-foot distance is proposed.Based on zero velocity update(ZUPT),the algorithm utilizes an ultrasonic ranging module installed on the feet to measure the relative distance between the pedestrian's feet in realtime, constructing a constraint model based on ultrasonic ranging for inter-foot distance.In addition, the random forest algorithm is used to recognize pedestrian motion patterns.For stairway scenarios,the height is calculated based on the step height and inter-foot distance,ultimately achieving 3Dpedestrian inertial positioning.The 3Dpositioning experiment is carried out on the actual route.The data show that the plane closed-loop error of the proposed algorithm is 0.64%of the total distance,which is decreased by 55.56% compared with the ZUPT algorithm,and the height error is 0.06m,which is decreased by 64.70%compared with the ZUPT combined with barometer algorithm.In general,the 3Dpositioning with navigation error within 0.50%of the total distance can be achieved.These results demonstrate the practical engineering value of the proposed algorithm.
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精密单点定位(PPP)时间传递技术是国际时间比对的重要手段之一,为协调世界时的计算做出巨大贡献。为探究多系统融合PPP时间频率传递性能,选取3个国际授时实验室的测站数据组成2条链路,采用8种实验模式对比分析单系统、双系统、三系统和四系统PPP时间频率传递性能。实验结果表明:各多系统组合较单GPS系统在可见星数上均有较大提升,且极大改善了钟差精度因子,增加了时间比对结果的稳健性和可靠性。在时间传递稳定性方面:对于453.4km的PTBB-BRUX链路,较单GPS系统,双系统中GPS/BDS组合提升效果最优,提升率约为10.39%,三系统中GPS/GLONASS/BDS组合提升率最优,约为11.86%,四系统组合提升率为11.98%,可从0.046 7ns提升至0.041 1ns;对于8 031.8km的PTBB-NIST链路,GPS/BDS组合提升率约为4.89%,GPS/GLONASS/BDS组合提升率约为5.49%,四系统组合提升率为5.79%,可从0.114 0ns提升至0.107 4ns。在频率传递稳定度方面:在前10 000s内双系统组合平均提升17.6%,三系统组合平均提升20.5%,四系统组合提升21.6%。
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Precise point positioning(PPP)time transfer technology is one of the important means of international time comparison and has made great contribution to the calculation of coordinated universal time(UTC).In order to investigate the performance of multi-system PPP time and frequency transfers,the station data from three international timing laboratories are selected to form two links,and eight experimental modes are used to compare and analyze the performance of single system,dual system,triple system and quadruple system PPP time and frequency transfers.The experimental results show that each multi-system combination has a greater improvement in the number of visible satellites than the single GPS system,and greatly improves the time dilution of precision(TDOP),which increases the robustness and reliability of the time comparison results.In terms of time transfer stability,for the PTBB-BRUX time link with a geodetic distance of 453.4km, compared with the single GPS system,the GPS/BDS combination in the dual system has an excellent enhancement effect,with an enhancement rate of about 10.39%,the GPS/GLONASS/BDS combination in the triple system has an optimal enhancement rate of about 11.86%,and the quadruple system has an enhancement rate of 11.98%,which can be improved from 0.046 7ns to 0.041 1ns;for the PTBB-NIST time link with a geodetic distance of 8 031.8km,the GPS/BDS combination enhancement rate is about 4.89%,the GPS/GLONASS/BDS combination enhancement rate is about 5.49%,and the quadruple system combination enhancement rate is 5.79%, which can be improved from 0.114 0ns to 0.107 4ns.In terms of frequency transfer stability,the average improvement within the first 10 000sis 17.6%for dual system combinations,20.5%for triple system combinations,and 21.6%for quadruple system combinations.
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Y波导集成光学器件(以下简称Y波导)作为光纤陀螺的核心部件,其可靠性对光纤陀螺整体的可靠性有很大影响。为了快速作出Y波导的可靠性及寿命估计,使用高加速寿命试验(HALT)的方法开展Y波导可靠性和寿命估计的研究,研究环境因素(高温、快速温变以及高湿等)对Y波导性能的影响,结果表明高温会显著影响Y波导性能,且Y波导的高温破坏极限为150℃,工作极限为130℃,主要影响的参数是插入损耗和分束比。使用120℃的条件进行Y波导的高加速寿命试验,得到Y波导在120℃的寿命约为1 120h,等效于25℃的93年寿命,并根据失效数量随时间的变化绘制出了可靠性浴盆曲线。完成了对Y波导的可靠性评估和寿命估计。
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Y waveguide integrated optical device(hereinafter referred to as Y waveguide)serves as the core component of fiber optic gyroscope(FOG),its reliability significantly effects the overall reliability of FOG.To quickly explore the reliability and life estimation of Y waveguide,highly accelerated life test (HALT)is used,and the influence of environmental factors(high temperature,rapid temperature changes, high humidity)on Y waveguide performance is studied.The result shows that the high temperature will significantly affect the performance of Y waveguide.Y waveguide's upper operating temperature limit (UOTL)is 150℃and upper damaging temperature limit(UDTL)is 130℃,insertion loss(IL)and splitting ratio are mainly effected factors.Y waveguide is placed at 120 ℃for HALT,the life of Y waveguide is 1 120hat 120℃,it is equivalent to 93years at 25℃.According to the number of failure over time,reliability bath curve is plotted.Reliability assessment and life estimation of Y waveguide are completed.
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使用DP83640IEEE 1588精密时间协议(PTP)收发芯片设计实现了一款秒脉冲精密移相器,它能与外部的标准秒脉冲(1PPS)进行同步并进行精密相位微调,可应用于高精度相位微跃器。秒脉冲移相器采用DP83640芯片进行级联实现秒脉冲精密移相:利用ARM微处理器控制第二级DP83640实现与外部标准秒脉冲的相位粗调,控制第一级DP83640实现相位微调。相位调整时将外部输入的相位偏移量换算为8ns整周期倍数的相位粗调值,以及不同时间长度档位的相位微调值,分别写入第二级和第一级DP83640共同实现高精度相位微跃。由于硬件电路特性和器件综合噪声的影响,经测试平均相位微跃准确度可以达到0.1fs。
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The DP83640IEEE 1588precise time protocol(PTP)transceiver chip is used to design a pulse-per-second precision phase shifter,which is synchronized with the external standard pulse per second(one pulse per second,1PPS)and perform precise phase adjustment,and can be applied to high-precision frequency and phase offset generator.It uses the DP83640chip cascade to realize 1PPS precision phase shift.The ARM microprocessor controls the second-stage DP83640 to realize the approximate adjustment of the phase with the external standard second pulse,and controls the first-stage DP83640to realize the precise phase adjustment.For phase adjustment, the externally inputted phase offset is converted into a phase approximate adjustment value in multiples of 8ns,and phase precision adjustment values for different time lengths.The phase approximate adjustment value and the precision adjustment value are written to the second stage and the first stage DP83640together to realize high-precision phase adjustment.Due to the influence of hardware circuit characteristics and device comprehensive noise,the average frequency and phase offset precision can reach 0.1fs after testing.
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骨质疏松症(OP)是一种以增龄性骨量降低,骨微结构破坏,骨脆性增加且易骨折的代谢性骨病。该病好发于绝经后女性和中老年男性,起病隐匿,多数患者在骨折后才被确诊,造成了大量的医疗资源消耗。浙江中医药大学附属第三医院姚新苗教授研究团队基于"肾主骨""肾气虚损"等基础理论,创新性提出了OP"亏瘀致痿"的致病理论,认为OP的病机是亏虚瘀互结、夹杂致痿。在该理论指导下,认为应采用"补肾健脾活血法"对OP患者进行辨证论治。补肾健脾活血法主要包括虚瘀同治;补肾为本、健脾为要;筋骨并重3个方面。该研究团队开展了一系列临床与基础研究,从不同角度阐释"亏瘀致痿"理论指导下OP康复策略的科学内涵。
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Osteoporosis (OP) is a metabolic bone disease characterized by an age-related loss of bone mass, destruction of bone microstructure, increased bone fragility and susceptibility to fracture. It is prevalent in postmenopausal women and middle-aged and elderly men and has an insidious onset. Most patients are diagnosed only after fracture, resulting in a significant consumption of medical resources. Based on the basic theories such as "kidney governing bone" and "kidney Qi deficiency", YAO Xinmiao's team in the Third Affiliated Hospital of Zhejiang Chinese Medical University innovatively puts forward the pathogenic theory of "flaccidity caused by deficiency and congestion" in OP, which holds that the pathogenesis of OP is the coexistence of deficiency and blood stasis, mixed with impotence. Under the guidance of this theory, it is believed that the "tonifying kidney, invigorating spleen and activating blood circulation" method should be used to treat patients with OP based on syndrome differentiation. This method consists of three main aspects, including the simultaneous treatment of deficiency and blood stasis; tonifying kidney and invigorating spleen; strengthening both tendons and bones. The research team conducted a series of clinical and basic studies to explain the scientific connotation of the OP rehabilitation strategy under the guidance of the theory of "flaccidity caused by deficiency and congestion" from different perspectives.
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目的观察高频重复经颅磁刺激(rTMS)对脑卒中后认知障碍合并抑郁(PSCCID)患者的临床疗效。方法选取2018年1月-2020年12月在四川省医学科学院·四川省人民医院康复科住院的PSCCID患者30例,采用随机数字表法分为对照组和观察组,每组15例。对照组接受常规药物治疗和常规康复治疗,包括运动治疗(40 min/次,1次/d,5 d/周)、作业治疗(30 min/次,1次/d,5 d/周)、认知功能训练(30 min/次,1次/d, 5 d/周),持续治疗4周。观察组在对照组基础上进行高频rTMS治疗(刺激左侧前额叶背外侧皮质,10 Hz, 100%静息运动阈值,20 min/次,1次/d,5 d/周),持续治疗4周。分别在治疗前后采用蒙特利尔认知评估量表(MoCA)和简易智力精神状态检查(MMSE)量表评估患者认知功能;采用汉密尔顿抑郁量表17项(HAMD-17)评估患者抑郁状态;采用3.0T磁共振成像系统对患者大脑进行MRI成像扫描,基于体素形态学分析方法分析大脑局部区域灰质密度的变化。结果与治疗前比较,2组治疗后MMSE评分、MoCA评分均明显升高,HAMD-17评分明显降低,差异均具有统计学意义(P<0.05)。与对照组比较,观察组治疗后MMSE评分、MoCA评分均明显更高,HAMD-17评分明显更低,差异均具有统计学意义(P<0.05)。与对照组比较,观察组治疗后左侧中央前回头面区、左侧颞中回尾侧灰质密度明显升高,左侧腹中部枕叶皮质、右侧额中回灰质密度明显降低,差异具有统计学意义(P<0.05)。结论高频rTMS可改善PSCCID患者认知功能和抑郁情绪,其机制可能与改善大脑局部区域灰质密度有关。
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Objective To observe the effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) on patients with post-stroke comorbid cognitive impairment and depression (PSCCID). Methods A total of 30 patients with PSCCID were treated in the department of rehabilitation medicine of Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital from January 2018 to December 2020 were randomly divided into control group and observation group, with 15 cases in each group. The control group received routine medication treatment and routine rehabilitation, including exercise therapy (40 minutes a time, once a day, five days a week), occupational therapy (30 minutes a time, once a day, five days a week), and cognitive training (30 minutes a time, once a day, five days a week), for four weeks. The observation group received high-frequency rTMS treatment (stimulation of the left dorsolateral prefrontal cortex, 10 Hz, 100% resting motion threshold, 20 minutes a time, once a day, five days a week) for four weeks, in addition to the treatment received by the control group. Before and after treatment, the Montreal cognitive assessment (MoCA) and the mini-mental state examination (MMSE) scores were used to assess cognitive function. The 17-item Hamilton depression rating scale (HAMD-17) was used to assess depression. The 3.0T magnetic resonance imaging system was used to scan the patient's brain, and voxel-based morphological analysis was used to analyze the changes of gray matter density in local brain areas. Results Compared with those before treatment, the MMSE and MoCA scores were higher and the HAMD-17 score was lower in both groups after treatment, and the differences were statistically significant (P<0.05). Compared with the control group, the MMSE and MoCA scores were higher in the observation group after treatment, and the HAMD-17 score were lower, and the differences were statistically significant (P<0.05). Compared with the control group, gray matter density in the left head and face regions of precentral gyrus, and the left caudal area of middle temporal gyrus of the observation group were higher, while gray matter density in the left medioventral occipital cortex and right middle frontal gyrus were lower, and the difference was statistically significant (P<0.05). Conclusion High-frequency rTMS can improve cognitive function and depression of patients with PSCCID, and the mechanism may be related to the increase of the gray matter density in local brain regions.
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目的观察高精度经颅直流电刺激(HD-tDCS)联合悬吊运动训练对脑卒中患者下肢运动功能的影响。方法选择2022年1月-2023年2月在山东大学附属山东省立第三医院康复医学部住院治疗的脑卒中患者120例,按照随机数字表法分为对照组、HD-tDCS组、悬吊组和联合治疗组,每组30例。治疗过程中有4例因中途出院无法继续接受治疗而脱落,其中对照组3例,HD-tDCS组1例,最终对照组、HD-tDCS组、悬吊组和联合治疗组分别纳入27、29、30、30例。对照组接受运动疗法和神经肌肉电刺激等常规康复治疗, 25 min/d,1次/d,5 d/周,持续治疗8周;HD-tDCS组在对照组基础上接受HD-tDCS治疗,主要刺激电极置于偏瘫侧脑初级运动皮层M1区(C3/C4),4个接受极分别置于M1区四周约3.5 cm处的C1/C2、C5/C6、 FC3/FC4、CP3/CP4区,电流恒定强度2 mA,电流起伏时间30 s,20 min/次,1次/d,5 d/周,持续治疗8周;悬吊组在对照组基础上接受偏瘫侧下肢分离组合运动、动态闭链稳定运动、骨盆摆动和放松运动等悬吊运动训练,25 min/次,1次/d,5 d/周,持续治疗8周;联合治疗组在对照组基础上接受HD-tDCS联合悬吊运动训练。分别于治疗前和治疗4、8周后,采用Fugl-Meyer运动功能量表下肢部分(FMA-LE)评定患者下肢运动功能;采用Berg平衡量表(BBS)评定患者平衡功能;采用功能性步行能力量表(FAC)评定患者功能性步行能力;采用视频步态分析系统评定患者步态时空参数(步频、步速、步长和步行周期)。结果与治疗前比较,4组治疗4、8周后FMA-LE评分、BBS评分、FAC等级及步态时空参数(步频、步速、步长和步行周期)均明显提高,差异具有统计学意义(P<0.05)。与对照组、HD-tDCS组、悬吊组同一时间点比较,联合治疗组治疗4、8周后FMA-LE、BBS评分均明显更高,治疗8周后FAC等级及步态时空参数(步频、步速、步长及步行周期)均明显更高,差异具有统计学意义(P<0.05)。结论HD-tDCS联合悬吊运动训练可有效提高脑卒中患者下肢运动功能、平衡能力和步行能力,值得临床推广应用。
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Objective To observe the effect of high-definition transcranial direct current stimulation combined with suspension exercise training on lower limb motor function of stroke patients. Methods A total of 120 stroke patients treated in the department of rehabilitation medicine of the Shandong Provincial Third Hospital, Shandong University from January 2022 to February 2023 were randomly divided into control group, HD-tDCS group, suspension group and combined treatment group, with 30 cases in each group. During the course of the treatment, 4 cases dropped out because the patients were discharged from hospital and could not continue to receive treatment, including 3 cases in the control group and 1 case in the HD-tDCS group, and finally 27 cases were included in the control group, 29 cases in the HD-tDCS group, 30 cases in the suspension group and 30 cases in the combined treatment group, respectively. The control group received conventional rehabilitation treatments such as exercise therapy and neuromuscular electrical stimulation, 25 minutes a day, once a day, 5 days a week for 8 weeks. In addition to the treatment received by the control group, the HD-tDCS group received HD-tDCS treatment, in which the primary stimulation electrodes were placed at the primary motor cortex of the hemiplegic side of the brain in the M1 area (C3/C4), and the four acceptor electrodes were placed at C1/C2, C5/ C6, FC3/FC4 and CP3/CP4 area about 3.5 cm around the M1 area, respectively, with a constant current intensity of 2 mA, and a current rise and fall of 30 s, 20 minutes a time, once a day, 5 days a week for 8 weeks. The suspension group received suspension exercise training based on the treatment in the control group, such as separated and combined exercise of the lower limbs on the hemiplegic side, dynamic closed-chain stabilization exercise, pelvic swing and relaxation exercise, 25 minutes a time, once a day, five days a week for eight weeks. The combined treatment group received HD-tDCS combined with suspension exercise training based on the treatment in the control group. Before treatment and after 4 and 8 weeks of treatment, the Fugl-Meyer assessment lower extremity (FMA-LE) was used to assess lower limb motor function. Berg balance scale (BBS) was used to assess balance function, functional ambulation category (FAC) scale was used to assess functional walking ability. A video gait system was used to assess gait spatialtemporal parameters (stride frequency, stride speed, stride length, and walking cycle). Results Compared with that before treatment, FMA-LE, BBS, FAC scores and gait spatial-temporal parameters (stride frequency, stride speed, stride length, and walking cycle) of the four groups after 4 and 8 weeks of treatment improved, and the differences were statistically significant (P<0.05). Compared with the control group, the HD-tDCS group and the suspension group at 4 and 8 weeks of treatment, FMA-LE, BBS scores of the combined treatment group were significantly higher, and FAC level and gait spatial-temporal parameters of the combined treatment group after 8 weeks of treatment improved, and the differences were statistically significant (P<0.05). Conclusion HD-tDCS combined with suspension exercise training can effectively improve lower limb motor function, balance ability and walking ability of stroke patients, which is recommended for clinical application.
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目的观察MOTOmed智能运动反馈训练联合精细化康复训练对脑梗死后偏瘫患者神经功能、平衡功能、肢体运动功能和生活质量的影响。方法选择2022年1-10月在南通市第三人民医院康复中心住院治疗的148例脑梗死后偏瘫患者,采用随机数字表法分为对照组和观察组,每组74例。对照组在常规治疗基础上接受精细化康复训练。根据脑梗死患者(卧床患者、可坐立患者、借助辅具可站立患者和无辅具可挺直站立患者)肢体运动功能障碍程度给予相应的运动康复训练(如肢体关节训练、身体转移训练、平衡训练和步行训练等),5 d/周,持续治疗12周。观察组在对照组基础上联合MOTOmed智能运动反馈训练(被动运动模式、有助力运动模式和主动训练模式的上肢/下肢运动康复训练),1次/d,45 min/次,5 d/周,持续治疗12周。分别于治疗前后采用美国国立卫生研究院脑卒中量表(NIHSS)评分评估患者神经功能缺损情况;采用Berg平衡量表(BBS)评分评估患者平衡功能;采用Fugl-Meyer运动功能评定量表(FMA)评分评估患者肢体运动功能;采用改良Barthel指数量表(MBI)评分评估患者日常生活活动能力;采用世界卫生组织生活质量测定量表简表(WHOQOL-BREF)评分评估患者生活质量;比较患者大脑中动脉(MCA)、大脑前动脉(ACA)血流速度变化和血清神经生长因子(NGF)、脑源性神经营养因子(BDNF)水平。结果与治疗前比较,2组治疗后NIHSS评分均明显降低,上肢/下肢FMA评分、BBS评分、MBI评分、WHOQOL-BREF评分、 MAC和ACA血流速度、血清NGF和BDNF水平均明显升高,差异均具有统计学意义(P<0.05)。与对照组比较,观察组治疗后NIHSS评分明显降低,上肢/下肢FMA评分、BBS评分、MBI评分、WHOQOL-BREF评分、MAC和ACA血流速度、血清NGF和BDNF水平均明显升高,差异均具有统计学意义(P<0.05)。结论MOTOmed智能运动反馈训练联合精细化康复训练可改善脑梗死后偏瘫患者神经功能、平衡功能、肢体运动功能和生活质量,值得临床推广。
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Objective To observe the clinical effect of MOTOmed intelligent motion feedback training combined with refined rehabilitation training on neurological function, balance function, limb motor function and quality of life of patients with hemiplegia after cerebral infarction. Methods A total of 148 patients with hemiplegia after cerebral infarction in the rehabilitation center of Nantong Third People's Hospital from January to October 2022 were randomly divided into control group and observation group, with 74 cases in each group. The control group received refined rehabilitation training in addition to the routine treatment. According to the degree of limb motor dysfunction (bedridden, sit upright, stand upright with assistive devices, and stand upright without assistive devices), the patients with hemiplegia after cerebral infarction were provided with corresponding exercise rehabilitation training (such as limb joint training, body transfer training, balance training and walking training) five days a week for 12 weeks. The observation group received MOTOmed intelligent motion feedback training in addition to the training of the control group (upper/lower limb motor rehabilitation training with passive movement, assistive movement and active training modes), once a day, 45 minutes a time, five days a week for 12 weeks. Before and after treatment, the National Institutes of Health stroke scale (NIHSS) score was used to evaluate the neurological deficits. Berg balance scale (BBS) was used to evaluate balance function. Fugl-Meyer assessment (FMA) scale was used to evaluate limb motor function; modified Barthel index (MBI) was used to evaluate activities of daily living. The world health organization quality of life-BREF (WHOQOL-BREF) scale was used to evaluate quality of life. Blood flow velocity changes of the middle cerebral artery (MCA) and anterior cerebral artery (ACA), levels of serum nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) were compared. Results Compared with that before treatment, NIHSS score of the control group and the observation group after treatment decreased significantly, while FMA score of the upper or lower limbs, BBS score, MBI score, WHOQOL-BREF score, MAC and ACA blood flow velocity and serum NGF and BDNF level increased significantly, and the differences were statistically significant (P<0.05). Compared with the control group, NIHSS score of the observation group after treatment was lower, while FMA score of the upper or lower limbs, BBS score, MBI score, WHOQOL-BREF score, MAC and ACA blood flow velocity and serum NGF and BDNF level were higher, and the differences were statistically significant (P<0.05). Conclusion MOTOmed intelligent motion feedback training combined with refined rehabilitation training can improve neurological function, balance function, limb motor function and quality of life of patients with hemiplegia after cerebral infarction, which is recommended for clinical application.
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目的观察针刺百会、曲鬓穴对急性期脑出血(ICH)大鼠白细胞分化抗原36(CD36)、Toll样受体4 (TLR4)表达的影响,探讨针刺治疗脑出血的作用机制。方法选择144只Wistar雄性大鼠,采用随机数字表法分为假手术组、模型组、针刺组、抑制剂组4组,每组36只,每组按1、3、7 d时间点再分为3个亚组,每组12只。采用立体定位自体血注入法建立ICH大鼠模型。模型组仅接受ICH模型制备,不进行任何治疗;假手术组接受类似模型组各项手术操作,但不进行注血制作;抑制剂组造模后6 h,腹腔注射TLR4抑制剂TAK242, 3 mg/kg,1次/d,连续5 d;造模12 h后,针刺组各亚组开始接受针刺治疗,穴位选择百会穴(顶骨正中)、右侧曲鬓穴,采用透刺方法,进针深度20 mm,以100 r/min小幅度捻转,持续捻转2 min,每间隔5 min捻针1次,共留针30 min,期间捻转3次,1次/d,针刺组各亚组分别治疗1、3、7 d。分别于治疗后第1、3、7天,采用改良神经功能缺损评分(mNSS)评估大鼠神经功能;检测脑组织血肿体积;采用Western blot法检测脑组织CD36、TLR4蛋白表达水平;采用免疫荧光法观察CD36、TLR4在星形胶质细胞中的表达。结果① mNSS评分:与假手术组同一时间点比较,模型组、针刺组、抑制剂组治疗后1、3、7 d mNSS评分均明显升高(P< 0.05);与模型组同一时间点比较,针刺组、抑制剂组治疗后1、3、7 d mNSS评分均明显降低(P<0.05);与针刺组同一时间点比较,抑制剂组治疗后1 d mNSS评分明显降低(P<0.05)。②血肿体积:与模型组同一时间点比较,针刺组、抑制剂组治疗后3、7 d脑血肿体积均明显降低,抑制剂组治疗后1、3、7 d脑血肿体积明显降低(P<0.05);与针刺组同一时间点比较,抑制剂组治疗后1、3、7 d脑血肿体积明显降低(P<0.05)。 ③ CD36、TLR4蛋白表达水平:与假手术组同一时间点比较,模型组、针刺组、抑制剂组治疗后1、3、7 d CD36、TLR4蛋白表达水平均明显升高(P<0.05);与模型组同一时间点比较,针刺组、抑制剂组治疗后1、3、 7 d CD36蛋白表达水平均明显升高(P<0.05),针刺组、抑制剂组治疗后3、7 d TLR4蛋白表达水平均明显降低(P<0.05);与针刺组比较,抑制剂组治疗后1、3、7 d CD36蛋白表达水平均明显升高,TLR4蛋白表达水平均明显降低(P<0.05)。④ CD36、TLR4在GFAP中的表达水平:假手术组大鼠脑组织内可见少量CD36、 TLR4表达。与假手术组同一时间点比较,模型组治疗后1、3、7 d CD36、TLR4在GFAP表达均明显增加(P< 0.05);与模型组同一时间点比较,抑制剂组、针刺组治疗后1、3、7 d CD36在GFAP表达明显增加,TLR4在GFAP表达明显降低(P<0.05)。结论针刺百会、曲鬓穴可以改善急性期ICH大鼠神经功能,减轻脑出血血肿体积,可能与促进CD36蛋白表达、抑制TLR4蛋白表达有关。
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Objective To investigate the interventional effect of acupuncture at Baihui (GV 20) and Qubin (GB 7) acupoints on the expression of recombinant cluster of differentiation 36 (CD36) and Toll-like receptor 4 (TLR4) in rats with acute cerebral hemorrhage (ICH), and to explore the mechanism of acupuncture treatment for ICH. Methods A total of 144 male Wistar rats were randomly divided into sham operation group, model group, acupuncture group and inhibitor group, with 36 cases in each group, and then each group was divided into three subgroups at the 1st, 3rd and 7th day, with 12 cases in each subgroup. The stereotaxic autologous blood injection method was used to establish a rat model of ICH. The model group only received ICH model preparation without any treatment. The sham operation group received various operations similar to the model group, but without blood injection. The inhibitor group received an intraperitoneal injection of the TLR4 inhibitor TAK242 at 6 hours after modeling, and the dose was 3 mg/kg, once daily for 5 days. At 12 hours after model establishment, all subgroups of the acupuncture group received penetrative needling at Baihui (GV 20) and Qubin (GV 25) acupoints. The needle was retained at a depth of 20 mm and twisted at a frequency of 100 r/min for three sessions of 2 min each at an interval of 5 min during the 30-min needle retention period. Acupuncture was given once a day and lasted for 1, 3, and 7 days in the three acupuncture subgroups, respectively. At the 1st, 3rd and 7th day after treatment, modified neurological severity score (mNSS) was used to assess neurological function. The volume of hematoma in brain tissue was detected. Western blot was used to detect the protein expression level of CD36 and TLR4 in brain tissue. Immunofluorescence method was used to detect the expression of CD36 and TLR4 in astrocytes. Results (1) mNSS score: compared with the sham operation group at the same time, mNSS score of the model group, the acupuncture group and the inhibitor group at 1, 3, 7 days after treatment increased significantly (P<0.05); compared with the model group at the same time, mNSS score of the acupuncture group and the inhibitor group at 1, 3, 7 days after treatment decreased significantly (P<0.05); compared with the acupuncture group at the same time, mNSS score in the inhibitor group at 1 day after treatment decreased significantly (P<0.05). (2) Hematoma volume: compared with the model group at the same time, hematoma volume in the acupuncture group and the inhibitor group at 3, 7 days after treatment decreased significantly, and hematoma volume in the inhibitor group at 1, 3, 7 days after treatment decreased significantly (P<0.05); compared with the acupuncture group at the same time, hematoma volume in the inhibitor group decreased significantly at 1, 3, 7 days after treatment decreased significantly (P<0.05). (3) Protein expression level of CD36 and TLR4: compared with the sham operation group at the same time, the protein expression level of CD36 and TLR4 in the model group, the acupuncture group and the inhibitor group at 1, 3, 7 days after treatment increased significantly (P<0.05); compared with the model group at the same time, the expression level of CD36 protein in the acupuncture group and the inhibitor group at 1, 3, 7 days after treatment increased significantly (P<0.05), and the expression level of TLR4 protein in the acupuncture group and the inhibitor group at 3, 7 days after treatment decreased significantly (P<0.05); compared with the acupuncture group, the expression level of CD36 protein in the inhibitor group at 1, 3, 7 days after treatment increased significantly, and the expression level of TLR4 protein decreased significantly (P<0.05).
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目的观察电针患侧曲池、阳陵泉穴对脑梗死后肢体痉挛(PSS)大鼠皮质损伤及血清炎性因子[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、谷氨酸(Glu)、丙二醛(MDA)、核黄素激酶(RFK)和还原性辅酶氧化酶2(NOX2)表达的影响,探讨电针治疗缺血性脑卒中后脑损伤的机制。方法选择SPF级健康成年SD雄性大鼠30只,采用随机数字表法分为假手术组与造模组,每组10、20只。造模组采用Zea-Longa线栓法联合内囊注射N-甲基-D-天冬氨酸(NMDA)制备PSS大鼠模型。造模成功后,造模组按随机数字表法分为模型组、电针组,每组10只。模型组采用鼠板固定大鼠,但不进行干预;电针组接受电针干预,穴位选择患侧阳陵泉穴(左)、曲池穴(左),每穴直刺1针,电针波型:密波;频率:100 Hz,强度以大鼠肢体轻微抖动为度,30 min/次,1次/d,连续治疗7 d。分别于造模第1天和治疗第7天采用Zea-Longa神经功能评分评估大鼠神经功能受损程度;分别于造模第2天和治疗第7天采用改良Ashworth量表(MAS)评分评估大鼠患侧肢体肌张力;采用HE染色观察大脑皮质的病理学改变;行为学测试完毕后,采用酶联免疫吸附法(ELISA法)检测MDA、Glu含量和大脑皮质中IL-6、TNF-α含量;采用Western blot法分析RFK、NOX2蛋白表达水平;采用RT-PCR法分析RFK、NOX2 mRNA转录水平。结果 ① Zea-Longa神经功能、MAS评分:与治疗前比较,电针组治疗后Zea-Longa神经功能、MAS评分均明显降低(P<0.05)。与假手术组比较,模型组、电针组治疗前Zea-Longa神经功能、MAS评分均明显升高(P<0.05);与模型组比较,电针组治疗后Zea-longa神经功能、MAS评分均明显降低(P<0.05)。②脑组织病理学改变:模型组可见脑组织水肿,胞核深染,形态不规则、固缩、空泡变性,炎性细胞浸润等病理学改变;与模型组比较,电针组脑组织病变改善,神经元损伤程度减轻,可见较多正常细胞,细胞轮廓清晰,炎性细胞数量减少。③缺血侧皮质TNF-α、IL-6、 Glu、MDA含量:与假手术组比较,模型组、电针组TNF-α、IL-6、Glu、MDA含量明显升高(P<0.05);与模型组比较,电针组TNF-α、IL-6、Glu、MDA含量明显降低(P<0.05)。④ RFK、NOX2蛋白表达水平和RFK、NOX2 mRNA转录水平:与假手术组比较,模型组RFK、NOX2蛋白表达水平和RFK、NOX2 mRNA转录水平明显升高(P<0.05);与模型组比较,电针组干预后RFK、NOX2蛋白表达水平和RFK、NOX2 mRNA转录水平明显降低(P<0.05)。结论电针可以改善PSS大鼠神经功能损伤和肢体痉挛状态,其作用机制可能与下调皮质Glu含量,减少炎症因子TNF-α、IL-6分泌,抑制RFK、NOX2表达,降低氧化应激水平有关。
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Objective To observe the effect of electroacupuncture at the affected side of Quchi (LI 11) and Yanglingquan (GB 34) acupoints on cortical injury and serum inflammatory factors [interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α)], glutamate (Glu), malondialdehyde (MDA), riboflavin kinase (RFK) and NADPH oxidase 2 (NOX2) in rats with post-stroke spasticity (PSS), and to investigate the mechanism of electroacupuncture in alleviating brain injury after ischemic stroke. Methods A total of 30 SPF healthy adult male SD rats were randomly divided into sham operation group and model group, with 10 and 20 rats in each group. The PSS rat model was prepared by Zea-Longa suture method combined with internal capsule injection of N-methyl-D-aspartate (NMDA). After successful modeling, the model group was randomly divided into model group and electroacupuncture group, with 10 cases in each group. The rats in the model group were fixed with the rat plate without intervention, while those in the electroacupuncture group were subjected to electroacupuncture intervention. Yanglingquan (GB34, left) and Quchi (LI 11, left) acupoints on the affected side were selected, and each acupoint was directly punctured with one needle, dense wave pattern, the frequency at 100 Hz, and the intensity based on the slight shaking of rat limbs, 30 minutes a time, once a day, and the treatment lasted for 7 days. At the 1st day of modeling and the 7th day of the treatment, Zea-Longa neurological deficit score was used to assess the degree of neurological impairment. At the 2nd day of modeling and the 1st, 7th day of intervention, modified Ashworth scale (MAS) was used to assess muscle tension of the affected limbs. Hematoxylin-eosin (HE) staining was used to assess pathological changes of cerebral cortex. Enzyme-linked immunosorbent assay (ELISA) was used to detect the contents of MDA, Glu and IL-6, TNF-α in the cerebral cortex after the behavioral tests were completed. Western blot was used to analyze the protein expression level of RFK and NOX2. RT-PCR was used to analyze mRNA transcription levels of RFK and NOX2 mRNA. Results (1) Zea-Longa neurological deficit score and MAS score: compared with that before treatment, Zea-Longa neurological deficit score and MAS score of the electroacupuncture group decreased significantly after treatment (P<0.05). Compared with the sham operation group, Zea-Longa neurological deficit score and MAS score of the model group and the electroacupuncture group increased significantly after treatment (P<0.05). Compared with the model group, Zea-Longa neurological deficit score and MAS score of the electroacupuncture group decreased significantly after treatment (P<0.05). (2) Pathological changes of brain: some pathological changes(edema, hyperchromatic nuclei, irregular morphology, pyknosis, vacuolar degeneration and inflammatory cell infiltration) were observed in the model group. Compared with the model group, the pathological changes of brain tissue in the electroacupuncture group improved, the degree of neuronal injury was reduced, more normal cells were observed, the cell contour was clear, and the number of inflammatory cells decreased. (3) Contents of TNF-α, IL-6, Glu and MDA in the ischemic cortex: compared with the sham operation group, the contents of TNF- α, IL-6, Glu and MDA in the model group and the electroacupuncture group significantly increased (P<0.05). Compared with the model group, the contents of TNF-α, IL-6, Glu and MDA in the electroacupuncture group decreased significantly (P<0.05). (4) Expression level of RFK and NOX2 protein and the transcription level of RFK and NOX2 mRNA: compared with the sham operation group, expression level of RFK and NOX2 protein and the transcription level of RFK and NOX2 mRNA in the model group increased significantly after treatment (P<0.05).
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目的观察关刺法联合本体感觉训练治疗膝骨关节炎(KOA)的临床疗效。方法选择2021年2月- 2022年10月在广州中医药大学附属佛山中医院住院治疗的KOA患者90例,按随机数字表法分为对照组和观察组,每组45例。对照组接受牵伸疗法、关节松动、肌力训练及中频治疗等常规治疗,每项10 min/次, 1次/d,6 d/周,连续治疗4周。观察组在对照组基础上接受关刺法联合本体感觉训练,其中关刺法20 min/次, 1次/d,6 d/周,连续治疗4周;本体感觉训练10 min/次,1次/d,6 d/周,连续治疗4周。分别于治疗前后采用视觉模拟评分法(VAS)评价患者膝关节疼痛程度;采用西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评价患者膝关节功能;采用患肢平均轨迹误差及Berg平衡量表(BBS)评分评估患者下肢平衡功能。结果与治疗前比较,2组治疗后VAS评分、WOMAC评分、患肢平均轨迹误差均明显降低,BBS评分明显升高,差异具有统计学意义(P<0.05)。与对照组比较,观察组治疗后VAS评分、WOMAC评分、患肢平均轨迹误差均明显更低,BBS评分明显更高,差异具有统计学意义(P<0.05)。结论关刺法联合本体感觉训练可有效改善KOA患者膝关节疼痛、膝关节功能和下肢平衡功能。
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Objective To observe the clinical effect of articular needling therapy combined with proprioceptive training on patients with knee osteoarthritis (KOA). Methods A total of 90 patients with KOA in the Foshan Traditional Chinese Medicine Hospital Affiliated to Guangzhou University of Chinese Medicine from February 2021 to October 2022 were randomly divided into control group and observation group, with 45 cases in each group. The control group received routine treatments such as stretching therapy, joint mobilization, muscle strength training and intermediate frequency therapy, with each item treated for 10 minutes a time, once a day, six days a week for four weeks. The observation group received articular needling therapy combined with proprioceptive training based on the treatment of the control group, including articular needling therapy 20 minutes a time, once a day, six days a week for four weeks and proprioceptive training 10 minutes a time, once a day, six days a week for four weeks. Before and after treatment, visual analog scale (VAS) score was used to assess knee joint pain level. Western Ontario and McMaster University osteoarthritis index (WOMAC) was used to assess knee joint function. The average trajectory error of the affected limb and Berg balance scale (BBS) were used to assess the balance function of lower limb. Results Compared with that before treatment, VAS score, WOMAC score and average trajectory error of the affected limb of both groups decreased significantly after treatment, while BBS score increased significantly, and the differences were statistically significant (P<0.05). Compared with the control group, VAS score, WOMAC score and average trajectory error of the affected limb of the observation group were lower after treatment, while BBS score of the observation group was significantly higher, and the differences were statistically significant (P<0.05). Conclusion Articular needling therapy combined with proprioceptive training can effectively improve pain of knee joint, knee joint function, and balance function of lower limb in patients with KOA.
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目的观察重复经颅磁刺激(rTMS)联合社交康复训练对注意缺陷多动障碍(ADHD)儿童的影响。方法选择2019年3月-2022年6月在南京医科大学附属儿童医院治疗的ADHD儿童60例,采用随机数字表法分为对照组与观察组,每组30例。对照组接受常规药物治疗,1次/d,持续治疗12周。观察组在常规药物治疗基础上接受rTMS联合社交技能教育和提升项目(PEERS)社交康复训练,其中rTMS治疗15 min/次, 2次/周,持续治疗12周;PEERS社交康复训练课程包含沟通、信息交互、游戏启动、自我倡议、分歧解决、社会语用学6个部分,共12次课,50 min/次,1次/周,持续12周。分别于治疗前后采用注意缺陷多动障碍筛查量表(SNAP-Ⅳ)评分评价患儿注意力不集中及多动/冲动情况;采用Weiss功能性缺陷程度评定量表(父母版)(WFIRS-P)评价患儿社会功能领域功能缺陷情况;采用儿童社交焦虑量表(SASC)评价患儿焦虑情绪;采用儿童抑郁障碍自评量表(DSRSC)评价患儿抑郁情绪;并分析WFIRS-P家庭评分、社会活动评分与SNAP- Ⅳ评分、SASC评分和DSRSC评分的相关性。结果 ① SNAP-Ⅳ评分:与治疗前比较,2组治疗后SNAP- Ⅳ注意缺陷、多动/冲动、对立违抗评分均明显降低(P<0.05)。与对照组比较,观察组治疗后SNAP-Ⅳ注意缺陷、多动/冲动、对立违抗评分均明显更低(P<0.05)。② WFIRS-P评分:与治疗前比较,2组治疗后WFIRS-P家庭、学习/学校、生活技能、自我观念、社会活动和冒险活动评分均明显降低(P<0.05)。与对照组比较,观察组治疗后WFIRS-P家庭和社会活动评分均明显更低(P<0.05)。③ SASC、DSRSC评分:与治疗前比较,2组治疗后SASC、DSRSC评分均明显降低(P<0.05)。与对照组比较,观察组治疗后SASC、 DSRSC评分均明显更低(P<0.05)。④相关性分析:WFIRS-P家庭评分与SNAP-Ⅳ多动/冲动及对立违抗评分呈正相关关系(r=0.357,P=0.005;r=0.284,P=0.028),与SASC评分(r=0.352,P=0.006)和DSRSC评分(r=0.353,P=0.006)均呈正相关关系。WFIRS-P社会活动评分与SNAP-Ⅳ对立违抗评分呈正相关关系(r=0.293,P=0.023),与DSRSC评分(r=0.347,P=0.007)呈正相关关系。结论rTMS联合社交康复训练可有效改善ADHD儿童注意缺陷多动障碍和焦虑、抑郁情绪,提高家庭及社会活动功能。
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Objective To observe the effect of repetitive transcranial magnetic stimulation (rTMS) combined with social rehabilitation training on children with attention deficit hyperactivity disorder (ADHD). Methods A total of 60 children diagnosed with ADHD in the Children's Hospital of Nanjing Medical University from March 2019 to June 2022 were randomly divided into control group and observation group, with 30 cases in each group. The control group received routine medication, once a day for 12 weeks. The observation group received rTMS combined with the program for the education and enrichment of relational skills (PEERS) social rehabilitation training in addition to the routine medication, including 15 minutes rTMS treatment a time, twice a week for 12 weeks. The PEERS social rehabilitation training course consisted of 6 parts: communication, information interaction, game initiation, self-initiative, disagreement resolution and social pragmatics, which had 12 classes, 50 minutes per session, once a week, for 12 weeks. Before and after treatment, Swanson, Nolan and Pelham-Ⅳ rating scale (SNAP-Ⅳ) was used to evaluate attention deficit and hyperactivity/impulsivity. Weiss functional impairment rating scale-parent form (WFIRS-P) was used to evaluate social functional behavior. Social anxiety scale for children (SASC) was used to evaluate anxiety. Depression self-rating scale for children (DSRSC) was used to evaluate depression. The correlations of WFIRS-P family score and social activity score with SNAP-Ⅳ score, SASC score and DSRSC score were analyzed. Results (1) SNAP-Ⅳ scores: compared with that before treatment, attention deficit, hyperactivity/impulsivity, opposition and defiance scores in SNAP-Ⅳ of both groups decreased significantly after treatment (P< 0.05). Compared with the control group, attention deficit, hyperactivity/impulsivity and opposition defiance scores in SNAP-Ⅳ of the observation group were lower after treatment (P<0.05). (2) WFIRS-P scores: compared with that before treatment, the family, learning/ school, life skill, self-concept, social activity and adventure activity scores in WFIRS-P of both groups decreased significantly after treatment (P<0.05). Compared with the control group, the family and social activity scores in WFIRS-P of the observation group were lower after treatment (P<0.05). (3) SASC and DSRSC scores: compared with that before treatment, the SASC and DSRSC scores of both groups decreased significantly after treatment (P<0.05). Compared with the control group, SASC and DSRSC scores of the observation group were lower after treatment (P<0.05). (4) Correlation analysis: the family score in WFIRS-P was positively correlated with hyperactivity/impulsivity, opposition and defiance scores in SNAP-Ⅳ (r=0.357, P=0.005; r=0.284, P=0.028), the SASC score (r=0.352, P=0.006) and the DSRSC score (r=0.353, P=0.006). The social activity score in WFIRS-P was positively correlated with opposition and defiance score in SNAP-Ⅳ (r=0.293, P=0.023), as well as the DSRSC score (r=0.347, P=0.007). Conclusion rTMS combined with social rehabilitation training can effectively improve attention deficit hyperactivity disorder, anxiety and depression of children with ADHD, and enhance their family and social activity functions.
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目的观察基于心肺运动试验(CPET)的心脏运动康复方案对稳定性冠心病合并高血压患者的影响。方法选择徐州市中心医院2023年2-9月收治的稳定性冠心病合并高血压患者80例,按随机数字表方法分为对照组和观察组,每组40例。对照组接受常规药物治疗,共持续12周;观察组在对照组基础上接受基于CPET的心脏康复运动训练,包括有氧运动和抗阻训练,隔天训练1次,3次/周,共持续12周。分别于治疗前后采用CPET评估患者心脏自主神经功能[主要包括静息心率(HR_(rest))、静息收缩压(SBP_(rest))、静息舒张压(DBP_(rest))、峰值心率(HR_(peak))、峰值收缩压(SBP_(peak))、峰值舒张压(DBP_(peak))、第1~6 min心率恢复值(HRR_t);采用CPET评估患者心肺功能及运动能力[峰值代谢当量(METs_(peak))、峰值负荷(Work_(peak))、最大氧脉搏(VO_2/HR_(peak))、峰值摄氧量(VO_(2 peak))、无氧阈(AT)、CO_2通气当量斜率(VE/VCO_(2 slope));采用36项简明健康状况调查表(SF-36)评估患者生活质量;采用匹兹堡睡眠质量指标(PSQI)评估患者睡眠质量。结果与治疗前比较,观察组治疗后SBP_(rest)、DBP_(peak)、HR_(rest)、HR_(peak)、VE/VCO_(2 slope)均明显降低,HRR_1~HRR_6、VO_(2 peak)、 AT、VO_2/HR_(peak)、METs_(peak)、Work_(peak)、SF-36评分(生理机能、生理职能、躯体疼痛、一般健康、社会职能、精神健康)均明显升高(P<0.05),PSQI评分明显更低(P<0.05)。与对照组比较,观察组治疗后SBP_(rest)、DBP_(peak)、 HR_(rest)、VE/VCO_(2 slope)均明显更低,HRR_1~HRR4、VO_(2 peak)、AT、VO_2/HR_(peak)、METs_(peak)、Work_(peak)、SF-36评分(生理机能、生理职能、一般健康、社会职能、精神健康)均明显更高(P<0.05),PSQI评分明显更低(P<0.05)。结论基于CPET的心脏运动康复可提高稳定性冠心病合并高血压患者心脏自主神经功能、心肺功能、运动能力、睡眠和生活质量,值得临床推广应用。
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Objective To observe the effect of cardiac exercise rehabilitation program based on cardiopulmonary exercise testing (CPET) on patients with stable coronary heart disease complicated with hypertension. Methods A total of 80 patients with stable coronary artery disease complicated with hypertension in the Xuzhou Central Hospital from February to September 2023 were randomly divided into control group and observation group, with 40 cases in each group. The control group received routine medication for 12 weeks. The observation group received cardiac exercise rehabilitation program based on CPET in addition to the treatment of the control group, including aerobic exercise and resistance training, once every other day, 3 times a week for 12 weeks. Before and after treatment, CPET was used to evaluate cardiac autonomic function [such as rest heart rate (HR_(rest)), rest systolic blood pressure (SBP_(rest)), rest diastolic blood pressure (DBP_(rest)), peak heart rate (HR_(peak)), peak systolic blood pressure (SBP_(peak)), peak diastolic blood pressure (DBP_(peak)), heart rate recovery from the 1st to 6th min (HRR_t)]. CPET was used to evaluate cardiopulmonary function and exercise ability [peak metabolic equivalent (METs_(peak)), peak work (Work_(peak)), peak oxygen pulse (VO_2/HR_(peak)), peak oxygen uptake (VO_(2 peak)), anaerobic threshold (AT) and carbon dioxide ventilation equivalents slope (VE/VCO_(2 slope))]. The 36-item short-form health survey (SF-36) was used to evaluate quality of life. Pittsburgh sleep quality index (PSQI) was used to evaluate sleep quality. Results Compared with that before treatment, SBP_(rest), DBP_(peak), HR_(rest), HR_(peak) and VE/VCO_(2 slope) in the observation group decreased significantly after treatment, HRR_1-HRR_6, VO_(2 peak), AT, VO_2/HR_(peak), METs_(peak), Work_(peak), SF-36 scores (physical functioning, role physical, bodily pain, general health, social functioning and mental health) increased significantly, PSQI score decreased significantly (P< 0.05). Compared with the control group, SBP_(rest), DBP_(peak), HR_(rest) and VE/VCO_(2 slope) in the observation group were significantly lower after treatment, HRR_1-HRR4, VO_(2 peak), AT, VO_2/HR_(peak), METs_(peak), Work_(peak), SF-36 scores (physical functioning, role physical, bodily pain, general health, social functioning and mental health) were significantly higher after treatment (P<0.05), PSQI score decreased significantly (P<0.05). Conclusion The cardiac exercise rehabilitation program based on CPET can improve cardiac autonomic function, cardiopulmonary function, exercise ability, sleep and quality of life of patients with stable coronary heart disease complicated with hypertension, which is recommended for clinical application.
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目的分析汉语母语孤独症谱系障碍(ASD)"日历计算专家"(SCC)认知加工特征,并结合头颅磁共振成像(MRI)分析相关脑机制。方法对1例具有SCC特征的汉语母语ASD患者进行随机正常日历计算测试、调整新日历强记能力测试、数字计算能力测试、线方向判断(JLO)测试、失用症检查(口面失用、言语失用和意念运动性失用检查)、额叶功能(FAB)测试和蒙特利尔认知功能评估(MoCA)。采用MRI头颅检查SCC患者,并与健康受试者比较,探讨其脑器质性损伤情况。结果①日历计算能力测试:SCC患者"随机正常日历计算"正确率为80%,平均每题答题时间11.8 s,而健康受试者"随机正常日历计算"平均正确率仅为16%。②日历强记能力测试:SCC患者"调整新日历计算"正确率仅为20%。③数字计算能力:SCC患者加法和除法计算正确率均为100%,平均耗时分别为10.67 s和58.19 s;减法和乘法计算正确率均为93.8%,平均耗时分别23.51 s和34.88 s。④ JLO测试:SCC患者JLO测试得分为27分。⑤失用症检查:部分口面失用,言语失用检查基本正常,但存在意念运动性失用(得分32分)。⑥ FAB和MoCA评分:SCC患者FAB评分13分,主要表现为相似性测验和言语流畅度等方面功能受损。MoCA评分17分,主要表现为认知功能障碍,抽象、语言功能缺失明显。⑦ MRI检查:与健康受试者比较,SCC患者左侧颞叶前方蛛网膜囊肿,两侧海马体积小,以左侧更为明显,左侧顶枕叶皮质萎缩伴皮质下白质胶质增生。结论该汉语母语孤独症谱系障碍存在"日历计算专家"能力,除视空间能力较好外,额叶功能、左顶叶功能(数字计算能力降低、意念运动性失用)均受损;"日历计算专家"能力可能与左侧颞叶蛛网膜囊肿后右侧顶叶的功能性代偿有关。
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Objective To analyze the cognitive processing characteristics of a native Chinese-speaking savant calendar calculator (SCC) with autism spectrum disorder (ASD) and to investigate the related brain mechanisms with cranial magnetic resonance imaging (MRI). Methods One native Chinese-speaking ASD patient with SCC features was assessed with the randomized calendar calculation test, the adjusted new calendar memory ability test, the numerical calculation ability test, the judgement of line orientation (JLO) test, the apraxia examination (orofacial apraxia, speech apraxia, and ideomotor apraxia examination), the frontal assessment battery (FAB), and the Montreal cognitive assessment (MoCA). The patient with SCC was examined with crainial MRI and compared with healthy subjects to explore the organic brain damage. Results (1) Calendar calculation ability test: the correct rate of random normal calendar calculation in the SCC patient was 80%, and the average time of answering each question was 11.8 s, while the average correct rate of random normal calendar calculation in the healthy subjects was only 16%. (2) Calendar memorizing ability test: the correct rate of the adjusted new calendar calculation in the SCC patient was only 20%. (3) Numerical calculation ability: the correct rate of addition and division in the SCC patient was 100%, and the average time was 10.67 s and 58.19 s respectively. The correct rate of subtraction and multiplication was 93.8%, and the average time was 23.51 s and 34.88 s, respectively. (4) JLO test: the score of JLO test in the SCC patient was 27. (5) Examination of apraxia: the patient showed partial orofacial apraxia and no speech apraxia, but the patient had ideomotor aphasia (score=32). (6) Scores of FAB and MoCA: the FAB score of the patient was 13, and mainly indicated impairment in similarity test and verbal fluency. The MoCA score was 17, mainly characterized as cognitive dysfunction and obvious abstract and language function loss. (7) MRI examination: compared with the healthy subjects, the SCC patient had arachnoid cysts in the left anterior temporal lobe, small bilateral hippocampal volume, especially on the left side, and left parietal-occipital cortex atrophy with subcortical white matter gliosis was observed. Conclusion The native Chinese patient with autism spectrum disorder has the ability of SCC, and the frontal lobe function and left parietal lobe function (reduced numerical calculation ability and ideomotor dysfunction) are impaired, except for good visuospatial ability. The ability to be a SCC may be related to functional compensation in the right parietal lobe following a left temporal lobe arachnoid cyst.
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目的通过Meta分析探讨软式康复机器人手套(SRG)对脑卒中后患者上肢-手运动功能的影响。方法计算机检索PubMed、Web of Science、The Cochrane Library、Embase、中国知网(CNKI)、万方数据库(Wanfang Data)、中国生物医学文献服务系统(CBMdisc)、维普中文科技期刊数据库(VIP)等数据库有关SRG干预脑卒中后上肢-手运动功能障碍患者的临床随机对照试验(RCTs),检索时限为建库至2023年8月。主要结局指标包括Fugl-Meyer评定量表上肢部分(FMA-UE)评分、改良Barthel指数(MBI)评分、Wolf运动功能(WMFT)评分、握力、箱盒测试(BBT)评分、上肢动作研究量表(ARAT)评分。数据提取和文献质量评价由2名研究员独立进行,采用RevMan 5.4软件进行Meta分析。连续性变量采用均数差(MD)或标准化均数差(SMD)表示,计算其95%置信区间(CI)。根据I~2值判断异质性大小,若P≥0.10,I~2≤50%,各研究间不存在异质性或异质性较小,采用固定效应模型;若P<0.1,I~2>50%,各研究间异质性较大,采用随机效应模型。结果本研究共纳入13篇文献,共计653例患者。Meta分析结果显示,与对照组比较,试验组FMAUE评分明显更高[MD=8.05,95% CI(7.01,9.09),Z=15.20,P<0.000 01],MBI评分明显更高[MD=9.91, 95% CI(2.65,17.17),Z=2.68,P=0.007],WMFT评分明显更高[MD=8.39,95% CI(6.99,9.78),Z=11.81, P<0.000 01],握力明显更高[SMD=0.39,95% CI(0.11,0.67),Z=2.75,P=0.006],ARAT评分明显更高[MD=11.18,95% CI(9.10,13.26),Z=10.53,P<0.000 01],BBT评分差异无统计学意义[(MD=0.53,95% CI(-1.47,2.53),Z=0.52,P=0.60)]。结论SRG可以提高脑卒中患者上肢-手运动功能和日常生活活动能力,但今后仍需纳入更多大样本、高质量的RCTs以进一步验证其疗效。
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Objective To evaluate the effect of soft rehabilitation robot gloves (SRG) on upper limb, hand motor function and activities of daily living of stroke patients by meta-analysis. Methods Data were searched and retrieved from the PubMed, Web of Science, The Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Data, Chinese Biomedical Literature Service System (CBMdisc), Chinese Science and Technology Periodical Database (VIP). The randomized controlled trials (RCTs) of SRG intervention for patients with upper limb and hand motor dysfunction after stroke were included, and the retrieval time was from the database inception to August 2023.The primary outcome measures included Fugl-Meyer assessment of the upper extremity (FMA-UE), modified Barthel index (MBI), Wolf motor function test (WMFT), grip strength, box and block test (BBT) and action research arm test (ARAT). Two researchers independently completed data extraction and literature quality assessment, and meta-analysis was performed using RevMan 5.4 software. Continuous variables were expressed by mean difference (MD) or standardized mean difference (SMD) with 95% confidence interval (CI). The heterogeneity was determined according to the P value and I2 value. If P≥0.10 and I2≤50%, there was no heterogeneity or small heterogeneity among the studies, and a fixed effects model would be used, if P<0.1 and I2>50%, a random effects model would be used. Results A total of 13 RCTs with 653 patients were included. Meta-analysis results showed that, compared with the control group, FMA-UE score [MD=8.05, 95% CI (7.01, 9.09), Z= 15.20, P<0.000 01], MBI score [MD=9.91, 95% CI (2.65,17.17), Z=2.68, P=0.007], WMFT score [MD=8.39, 95% CI (6.99,9.78), Z= 11.81,P<0.000 01], grip strength [SMD=0.39, 95% CI (0.11,0.67), Z=2.75, P=0.006], and ARAT score [MD=11.18, 95% CI (9.10, 13.26), Z=10.53, P<0.000 01] were significantly higher in the experimental group, but there was no significant difference in BBT score between two groups [MD=0.53, 95% CI (-1.47, 2.53), Z=0.52, P=0.60]. Conclusion SRG can improve the upper limb and hand motor function and activities of daily living of stroke patients, but more large-sample and high-quality RCTs would be needed to further verify its efficacy.
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目的通过Meta分析评价重复经颅磁刺激(rTMS)联合认知训练治疗脑卒中后认知障碍(PSCI)患者的疗效。方法计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国知网(CNKI)、万方数据库(Wangfang Data)、维普中文期刊全文数据库(VIP)等数据库中有关rTMS联合认知训练治疗PSCI患者的临床随机对照试验(RCTs),检索时间为建库至2023年6月。主要结局指标包括蒙特利尔认知评估量表(MoCA)、简易智力状态检查量表(MMSE)、日常生活活动能力量表(ADL)、行为记忆测验法(RBMT)评分。由2名评审员使用Cochrane偏倚风险评估工具评估文献质量,使用RevMan 5.4软件进行Meta分析。计数资料采用比值比(OR)或相对风险比(RR)表示;计量资料采用均数差(MD)或标准化均数差(SMD)表示,并计算其95%置信区间(CI)。根据I 2和P值大小判断异质性,若P≥0.10,I 2≤50%,使用固定效应模型;若P< 0.10,I 2>50%,则使用随机效应模型。结果共纳入23项研究,1 788例患者,其中对照组895例、试验组893例。① MoCA评分:按对照组不同治疗方法进行亚组分析结果显示,试验组MoCA评分均明显高于对照组[MD=1.78,95% CI(1.18,2.38),P<0.000 1;MD=3.30,95% CI(3.01,3.58),P<0.000 01];按刺激频率进行亚组分析结果显示,试验组MoCA评分均高于对照组[MD=3.49,95% CI(3.40,3.57),P<0.000 01; MD=3.16,95% CI(2.79,3.53),P<0.000 01]。② MMSE评分:试验组MMSE评分均高于对照组[MD= 2.14,95% CI(1.14,3.15),P<0.000 1;MD=3.16,95% CI(2.71,3.60),P<0.000 01]。③ ADL评分:试验组ADL评分均明显高于对照组[MD=10.78,95% CI(9.18,12.38),P<0.000 01;MD=8.23,95% CI(7.04,9.41), P<0.000 01]。④ RBMT评分:试验组RBMT评分高于对照组[MD=2.00,95% CI(1.37,2.63),P<0.000 01]。结论rTMS联合认知训练可改善脑卒中患者认知功能、智力状态、行为记忆能力及日常生活活动能力,值得临床推广。
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Objective To evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) combined with cognitive training on patients with post stroke cognitive impairment (PSCI) by Meta-analysis. Methods Data were searched and retrieved from the databases of PubMed, Embase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data, and Chinese Science and Technology Periodical Database (VIP). The randomized controlled trials (RCTs) of rTMS combined with cognitive training for the treatment of patients with PSCI were included, and the retrieval time was from database inception to June 2023. The primary outcome measures included Montreal cognitive assessment (MoCA), mini-mental state examination (MMSE), activities of daily living (ADL) scale and Rivermead behavioural memory test (RBMT). The quality of the literature was assessed by two investigators using the Cochrane risk of bias assessment tool, and Meta-analysis was performed using Rev- Man 5.3 software. Enumeration data were expressed as odds ratio (OR) or relative risk ratio (RR). Measurement data were expressed as mean difference (MD) or standardized mean difference (SMD), with 95% confidence interval (CI). The heterogeneity was determined according to the P value and I2 value. If P≥0.10 and I2≤50%, a fixed effects model would be used, and if P<0.10 and I2>50%, a random effects model would be used. Results A total of 23 RCTs with 1 788 patients were included, 895 patients in the control group and 893 patients in the experimental group. (1) MoCA scores: subgroup analyses by different treatments in the control group showed that MoCA scores in the experimental group were significantly higher than those in the control group [MD=1.78, 95% CI (1.18, 2.38), P<0.000 1; MD=3.30, 95% CI (3.01,3.58), P<0.000 01]; subgroup analyses by stimulation frequency showed that Mo- CA scores in the experimental group were significantly higher than those in the control group [MD=3.49, 95% CI (3.40, 3.57), P< 0.000 01; MD=3.16, 95% CI (2.79, 3.53), P<0.000 01]. (2) MMSE score: compared with the control group, MMSE score in the experimental group was higher [MD=2.14, 95% CI (1.14, 3.15), P<0.000 1; MD=3.16, 95% CI (2.71, 3.60), P<0.000 01]. (3) ADL score: compared with the control group, ADL score in the experimental group was higher [MD=10.78, 95% CI (9.18, 12.38), P< 0.000 01; MD=8.23, 95% CI (7.04, 9.41), P<0.000 01]. (4) RBMT score: compared with the control group, RBMT score in the experimental group was higher [MD=2.00, 95% CI (1.37, 2.63), P<0.000 01]. Conclusion rTMS combined with cognitive training can improve cognitive function, intelligence state, behavioral memory ability and activities of daily living of stroke patients, which is recommended for clinical application.
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脑卒中后睡眠障碍分为睡眠呼吸障碍(SDB)、失眠、日间嗜睡(EDS)与不宁腿综合征(RLS),对脑卒中患者认知、运动等功能预后及生活质量影响较大,应尽早针对脑卒中患者的睡眠障碍开展康复治疗。本研究对脑卒中后睡眠障碍的发病机制与康复治疗研究现状进行综述,其中脑卒中后睡眠障碍发病机制研究主要包括脑卒中后SDB[阻塞性睡眠呼吸暂停综合征(OSAS)、中枢性睡眠呼吸暂停综合征(CSAS)与混合型睡眠呼吸暂停综合征(MSAS)]发病机制;脑卒中后失眠发病机制;脑卒中后EDS发病机制;脑卒中后RLS发病机制。脑卒中后睡眠障碍康复治疗主要包括脑卒中后SDB康复治疗[持续气道正压通气(CPAP)、体位治疗、口咽肌训练];脑卒中后失眠康复治疗[认知行为疗法(CBT)、针刺疗法、无创性经颅神经调控技术(低频重复经颅磁刺激和经颅直流电刺激)和光照疗法];脑卒中后EDS康复治疗(CPAP和光照疗法);脑卒中后RLS康复治疗(针刺)。但脑卒中后睡眠障碍的发病机制尚未完全明确,其基础研究仍处于表型确定阶段;康复治疗仍存在治疗依从性、安全性、精准度等方面的问题,且脑卒中后EDS和RLS的康复研究较少。下一步研究需要探索适合脑卒中后睡眠障碍研究的实验动物模型,为开展基础性研究提供支撑;同时,开展更多高质量、大样本、多中心的临床随机对照试验,为脑卒中后睡眠障碍的康复治疗提供参考。
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Sleep disorder after stroke are classified into sleep-disordered breathing (SDB), insomnia, excessive daytime sleepiness (EDS) and restless legs syndrome (RLS), which have a great impact on the prognosis of cognitive and motor functions and the quality of life of stroke patients. Rehabilitation treatment for sleep disorder in stroke patients should be initiated as early as possible. This study provides an overview of the pathogenesis and rehabilitation treatment of sleep disorder after stroke. The pathogenesis research of post-stroke sleep disorder mainly includes the pathogenesis of SDB [obstructive sleep apnea syndrome (OSAS), central sleep apnea syndrome (CSAS) and mixed sleep apnea syndrome (MSAS)], insomnia, EDS and RLS. Research on rehabilitation treatments for post-stroke sleep disorder mainly includes rehabilitation treatments for SDB [continuous positive airway pressure (CPAP), body positioning therapy, and oropharyngeal muscle training], insomnia [cognitive behavioral therapy (CBT), acupuncture, non-invasive transcranial neuromodulation techniques (low-frequency repetitive transcranial magnetic stimulation and transcranial direct current stimulation), and light therapy], EDS (CPAP and light therapy) and RLS (acupuncture). However, the pathogenesis of poststroke sleep disorder is not yet fully clarified, and its basic research is still at the phenotypic determination stage. Issues such as treatment compliance, safety, and accuracy remain in rehabilitation treatment, and there is limited research on the rehabilitation of poststroke EDS and RLS. Future explorations are needed on experimental animal models suitable for the basic research on post-stroke sleep disorder. In addition, more high-quality, large-sample, multicenter clinical randomized controlled trials are needed to provide references for the rehabilitation treatment of post-stroke sleep disorder.
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创面再生修复是烧伤与创面修复外科主要的研究领域之一。近年来,随着康复治疗理念和技术的不断进步,康复治疗与创面再生修复的联系更加紧密,并由此催生出“再生康复”理念。该文对再生康复概念的形成和发展现状以及再生康复领域未来的发展和引领价值进行探讨。
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Wound regeneration and repair is one of the primary research fields in burn and wound repair surgery. In recent years, with the continuous advancement of treatment concept and technologies in the field of rehabilitation, the connection between rehabilitation treatment and wound regeneration and repair has become closer, forming a new concept "regenerative rehabilitation". This article discussed the concept formation and development status of regenerative rehabilitation, and the future development and potential leading value of regenerative rehabilitation field.
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近年来,随着对光生物调节作用分子生物学机制研究的深入,光生物调节已被逐步应用于临床,为各类疾病提供了有效的治疗手段和方法。相较于传统的光热治疗,光生物调节具有疗效好、几乎无不良反应、操作简便等特点,且临床疗效日益显著。该文就光生物调节的机制及其在创伤修复、医学美容等领域中的应用特点及发展趋势进行详细阐述,以期为该疗法在临床中的广泛应用提供理论基础。
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In recent years, with the deepening of researches on the molecular biological mechanisms of photobiomodulation (PBM), PBM has gradually been applied in clinical practice, providing effective treatment methods and approaches for various diseases. Compared with traditional photothermal therapy, PBM has the characteristics of good therapeutic effect, almost no adverse reaction, and simple operation, and its clinical efficacy is becoming increasingly significant. This article provides a detailed explanation on the mechanism of PBM, its application characteristics and development trends in trauma repair and medical aesthetics, in order to provide a theoretical basis for the extensively clinical application of this therapy.
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目的探讨通过创面局部涂抹、创缘皮下注射和尾静脉注射人脐带间充质干细胞(hUCMSC)外泌体治疗小鼠全层皮肤缺损创面的效果,探究应用hUCMSC外泌体治疗创面的最佳给药途径。方法该研究为实验研究。从3名25~35岁于内蒙古包钢医院妇产科正常分娩产妇弃用脐带组织中提取hUCMSC外泌体并成功鉴定。选用120只6~8周龄雄性BALB/c小鼠,于其背部制备全层皮肤缺损创面后,按随机数字表法分为对照组(不进行给药处理)、创面局部涂抹组、创缘皮下注射组、尾静脉注射组(每组30只小鼠),分别通过创面局部涂抹、创缘皮下注射、尾静脉注射给予后3组小鼠0.2 mL含200 μg hUCMSC外泌体的磷酸盐缓冲液。伤后7、14、21 d,观察创面的大体情况并计算创面愈合率;采集创面组织,分别通过苏木精-伊红和Masson染色观测病理学变化和胶原纤维情况,行CD31免疫组织化学染色观测新生微血管数量,采用酶联免疫吸附测定法检测肿瘤坏死因子α(TNF-α)和白细胞介素6(IL-6)的含量。各组各时间点样本数均为10。结果伤后7、14、21 d,4组小鼠创面均逐步愈合,其中创缘皮下注射组小鼠创面愈合情况最佳;3个给药组小鼠创面愈合率均显著高于对照组(P<0.05),创缘皮下注射组及尾静脉注射组小鼠创面愈合率均显著高于创面局部涂抹组(P<0.05),创缘皮下注射组小鼠创面愈合率均显著高于尾静脉注射组(P<0.05)。伤后7、14、21 d,与对照组比较,3个给药组小鼠创面组织生长、上皮化的速度显著加快,创面胶原纤维生成数量更多且排列更整齐。伤后7、14、21 d,在每200倍视野下,创面局部涂抹组小鼠创面组织新生微血管数量分别为(24.1±2.5)、(50.7±4.1)、(44.2±2.3)根,创缘皮下注射组小鼠创面组织新生微血管数量分别为(32.2±2.9)、(67.5±4.9)、(53.6±3.7)根,尾静脉注射组小鼠创面组织新生微血管数量分别为(27.8±2.4)、(59.1±3.7)、(49.6±2.6)根,均显著多于对照组的(20.6±1.7)、(46.7±3.4)、(40.9±2.8)根(P<0.05);创缘皮下注射组及尾静脉注射组小鼠创面组织中新生微血管数量均显著多于创面局部涂抹组(P<0.05);创缘皮下注射组小鼠创面组织中新生微血管数量均显著多于尾静脉注射组(P<0.05)。伤后7、14、21 d,3个给药组小鼠创面组织中TNF-α和IL-6的含量均较对照组显著减少(P<0.05),创缘皮下注射组及尾静脉注射组小鼠创面组织中TNF-α和IL-6的含量均显著少于创面局部涂抹组(P<0.05),创缘皮下注射组小鼠创面组织中TNF-α和IL-6的含量均显著少于尾静脉注射组(P<0.05)。结论创面局部涂抹、创缘皮下注射及尾静脉注射hUCMSC外泌体均可通过减轻过度炎症反应、促进血管新生发挥促进小鼠全层皮肤缺损创面愈合的作用,其中,创缘皮下注射具有更好的治疗效果,即创缘皮下注射是采用hUCMSC外泌体治疗创面的最佳给药途径。
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Objective To investigate the effects of human umbilical cord mesenchymal stem cell (hUCMSC) exosomes in the treatment of full-thickness skin defect wounds in mice through local wound application, subcutaneous injection at the wound margin, and tail vein injection, and to explore the optimal administration route of hUCMSC exosomes for wound treatment. Methods This study was an experimental study. hUCMSC exosomes were extracted from the discarded umbilical cord tissue of three normal delivery women aged 25-35 years in the Department of Obstetrics and Gynecology of Baogang Hospital of Inner Mongolia and successfully identified. Totally 120 male BALB/c mice aged 6-8 weeks were selected, and full-thickness skin defect wounds were prepared on the back of them. According to the random number table, the injured mice were divided into control group (without drug administration), local wound application group, wound margin subcutaneous injection group, and tail vein injection group (with 30 mice in each group). Mice in the latter three groups were given 0.2 mL phosphate buffer solution containing 200 μg hUCMSC exosomes by local wound application, subcutaneous injection at the wound margin, and tail vein injection, respectively. On post injury day (PID) 7, 14, and 21, the general condition of the wound was observed, and the wound healing rate was calculated; the wound tissue was collected, the pathological changes and collagen fibers were observed respectively by hematoxylin-eosin staining and Masson staining, the number of new microvessels was observed by CD31 immunohistochemical staining, and the content of tumor necrosis factor α (TNF-α) and interleukin-6 (IL-6) was detected by enzyme-linked immunosorbent assay. The sample number was 10 in each group at each time point. Results On PID 7, 14, and 21, the wounds of mice in the 4 groups all healed gradually, and the wound healing of the mice in wound margin subcutaneous injection group was the best; the wound healing rates of mice in the three administration groups were significantly higher than those in control group (P<0.05), the wound healing rates of mice in wound margin subcutaneous injection group and tail vein injection group were significantly higher than those in local wound application group (P<0.05), and the wound healing rates of mice in wound margin subcutaneous injection group were significantly higher than those in tail vein injection group (P<0.05). On PID 7, 14, and 21, the growth and epithelialization speed of the wound tissue of mice in the three administration groups were significantly accelerated, and the collagen fibers in the wounds of mice in the three administration groups were larger in number and more neatly arranged in comparison with the control group. On PID 7, 14, and 21, under every 200-fold visual field, the number of new microvessels in the wound tissue of mice in local wound application group was 24.1±2.5, 50.7±4.1, and 44.2±2.3, respectively, the number of new microvessels in the wound tissue of mice in wound margin subcutaneous injection group was 32.2±2.9, 67.5±4.9, and 53.6±3.7, respectively, and the number of new microvessels in the wound tissue of mice in tail vein injection group was 27.8±2.4, 59.1±3.7, and 49.6±2.6, respectively, which was significantly more than 20.6±1.7, 46.7±3.4, and 40.9±2.8 in control group (P<0.05); the number of new microvessels in the wound tissue of mice in wound margin subcutaneous injection group and tail vein injection group was significantly more than that in local wound application group (P<0.05); the number of new microvessels in the wound tissue of mice in wound margin subcutaneous injection group was significantly more than that in tail vein injection group (P<0.05).
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目的探究负载人脐带间充质干细胞来源的小细胞外囊泡(hUCMSC-sEV)的甲基丙烯酸酐化明胶(GelMA)水凝胶治疗小鼠全层皮肤缺损创面的效果。方法该研究为实验研究。采用超速离心法提取hUCMSC-sEV,通过透射电子显微镜观察其形貌,采用蛋白质印迹法检测CD9、CD63、肿瘤易感基因101(TSG101)及钙联蛋白的表达。将人脐静脉内皮细胞(HUVEC)及第3、4代人表皮角质形成细胞(HEK)、人真皮成纤维细胞(HDF)均分为常规培养的空白对照组和在细胞培养液中加入hUCMSC-sEV培养的hUCMSC-sEV组,行细胞划痕试验并计算划痕后6、12、24 h的细胞迁移率,行细胞Transwell试验并计算培养12 h细胞迁移数量,行5-乙炔基-2'-脱氧尿嘧啶核苷、Hoechst染色检测培养24 h增殖细胞比例,样本数均为3。制备单纯GelMA水凝胶及负载hUCMSC-sEV的GelMA水凝胶(以下简称hUCMSC-sEV/GelMA水凝胶),通过扫描电子显微镜观察2种水凝胶微观形貌,通过激光扫描共聚焦显微镜观察hUCMSC-sEV的分布情况,采用蛋白质比色定量法测定并计算hUCMSC-sEV/GelMA水凝胶在磷酸盐缓冲液(PBS)中浸泡0(即刻)、2、4、6、8、10、12 d时hUCMSC-sEV累积释放率(样本数为3)。将24只6周龄雄性C57BL/6J小鼠按随机数字表法分为PBS组、单纯hUCMSC-sEV组、单纯GelMA水凝胶组和hUCMSC-sEV/GelMA水凝胶组(每组6只),于小鼠背部制备全层皮肤缺损创面后分别行PBS注射、hUCMSC-sEV悬液注射、单纯GelMA水凝胶覆盖、hUCMSC-sEV/GelMA水凝胶覆盖。于伤后0(即刻)、4、8、12 d观察创面愈合情况并统计伤后4、8、12 d创面愈合率,于伤后12 d取创面组织行苏木精-伊红染色后观察创面新生组织结构,样本数均为6。结果提取的hUCMSC-sEV呈杯状结构,表达CD9、CD63和TSG101,几乎不表达钙联蛋白。划痕后6、12、24 h,hUCMSC-sEV组HEK(t值分别为25.94、20.98、20.04)、HDF(t值分别为3.18、5.68、4.28)、HUVEC(t值分别为4.32、19.33、4.00)的迁移率均明显高于空白对照组(P<0.05)。培养12 h,hUCMSC-sEV组HEK、HDF及HUVEC迁移数量分别为(550±23)、(235±9)、(856±35)个,均明显多于空白对照组的(188±14)、(97±6)、(370±32)个(t值分别为22.95、23.13、17.84,P<0.05)。培养24 h,hUCMSC-sEV组HEK、HDF及HUVEC增殖细胞比例均明显高于空白对照组(t值分别为22.00、13.82、32.32,P<0.05)。单纯GelMA水凝胶内部呈疏松多孔的海绵状结构且其中未见hUCMSC-sEV,hUCMSC-sEV/GelMA水凝胶具有相同海绵状结构且其中可见hUCMSC-sEV呈团块状均匀分布。hUCMSC-sEV/GelMA水凝胶浸泡2 d后hUCMSC-sEV累积释放率曲线趋于平缓,浸泡12 d时hUCMSC-sEV累积释放率为(59.2±1.8)%。伤后0~12 d,4组小鼠创面均不断缩小。伤后4、8、12 d,hUCMSC-sEV/GelMA水凝胶组小鼠创面愈合率均明显高于其余3组(P<0.05),单纯GelMA水凝胶组、单纯hUCMSC-sEV组小鼠创面愈合率均明显高于PBS组(P<0.05);伤后8、12 d,单纯hUCMSC-sEV组小鼠创面愈合率均明显高于单纯GelMA水凝胶组(P<0.05)。伤后12 d,hUCMSC-sEV/GelMA水凝胶组小鼠创面上皮化程度最佳,真皮胶原排列松散有序,炎症细胞数量最少;其余3组小鼠创面均可见真皮胶原排列致密且存在不同程度的炎症细胞浸润。结论hUCMSC-sEV能够促进皮肤创面愈合相关细胞HEK、HDF与HUVEC迁移与增殖,并可在GelMA水凝胶内缓慢释放。hUCMSC-sEV/GelMA水凝胶作为创面敷料能够显著提高小鼠全层皮肤缺损创面愈合速度。
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Objective To investigate the effects of gelatin methacrylate anhydride (GelMA) hydrogel loaded with small extracellular vesicles derived from human umbilical cord mesenchymal stem cells (hUCMSCs-sEVs) in the treatment of full-thickness skin defect wounds in mice. Methods This study was an experimental study. hUCMSCs-sEVs were extracted by ultracentrifugation, their morphology was observed through transmission electron microscope, and the expression of CD9, CD63, tumor susceptibility gene 101 (TSG101), and calnexin was detected by Western blotting. The human umbilical vein endothelial cells (HUVECs), the 3~(rd) and 4~(th) passages of human epidermal keratinocytes (HEKs) and human dermal fibroblasts (HDFs) were all divided into blank control group (routinely cultured) and hUCMSC-sEV group (cultured with the cell supernatant containing hUCMSCs-sEVs). The cell scratch test was performed and the cell migration rates at 6, 12, and 24 h after scratching were calculated, the cell Transwell assay was performed and the number of migration cells at 12 h after culture was calculated, and the proportion of proliferating cells was detected by 5-acetylidene-2'-deoxyuridine and Hoechst staining at 24 h after culture, with sample numbers being all 3. The simple GelMA hydrogel and the GelMA hydrogel loaded with hUCMSCs-sEVs (hereinafter referred to as hUCMSC-sEV/GelMA hydrogel) were prepared. Then the micromorphology of 2 kinds of hydrogels was observed under scanning electron microscope, the distribution of hUCMSCs-sEVs was observed by laser scanning confocal microscope, and the cumulative release rates of hUCMSCs-sEVs at 0 (immediately), 2, 4, 6, 8, 10, and 12 d after soaking hUCMSC-sEV/GelMA hydrogel in phosphate buffer solution (PBS) were measured and calculated by protein colorimetric quantification (n=3). Twenty-four 6-week-old male C57BL/6J mice were divided into PBS group, hUCMSC-sEV alone group, GelMA hydrogel alone group, and hUCMSC-sEV/GelMA hydrogel group according to the random number table, with 6 mice in each group, and after the full-thickness skin defect wounds on the back of mice in each group were produced, the wounds were performed with PBS injection, hUCMSC-sEV suspenson injection, simple GelMA coverage, and hUCMSC-sEV/GelMA hydrogel coverage, respectively. Wound healing was observed on post injury day (PID) 0 (immediately), 4, 8, and 12, and the wound healing rates on PID 4, 8, and 12 were calculated, and the wound tissue was collected on PID 12 for hematoxylin-eosin staining to observe the structure of new tissue, with sample numbers being both 6. Results The extracted hUCMSCs-sEVs showed a cup-shaped structure and expressed CD9, CD63, and TSG101, but barely expressed calnexin. At 6, 12, and 24 h after scratching, the migration rates of HEKs (with t values of 25.94, 20.98, and 20.04, respectively), HDFs (with t values of 3.18, 5.68, and 4.28, respectively), and HUVECs (with t values of 4.32, 19.33, and 4.00, respectively) in hUCMSC-sEV group were significantly higher than those in blank control group (P<0.05). At 12 h after culture, the numbers of migrated HEKs, HDFs, and HUVECs in hUCMSC-sEV group were 550±23, 235±9, and 856±35, respectively, which were significantly higher than 188±14, 97±6, and 370±32 in blank control group (with t values of 22.95, 23.13, and 17.84, respectively, P<0.05). At 24 h after culture, the proportions of proliferating cells of HEKs, HDFs, and HUVECs in hUCMSC-sEV group were significantly higher than those in blank control group (with t values of 22.00, 13.82, and 32.32, respectively, P<0.05). The inside of simple GelMA hydrogel showed a loose and porous sponge-like structure, and hUCMSCs-sEVs was not observed in it. The hUCMSC-sEV/GelMA hydrogel had the same sponge-like structure, and hUCMSCs-sEVs were uniformly distributed in clumps.
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目的探究人肠道菌群与增生性瘢痕(HS)之间的因果关系。方法该研究为基于双样本孟德尔随机化(TSMR)分析的研究。从全基因组关联分析数据库获得人肠道菌群(18 473个样本)和HS(208 248个样本)的数据。提取已知肠道菌群门、纲、目、科和属5个水平的遗传变异基因,即单核苷酸多态性(SNP)作为工具变量,并进行连锁不平衡(LD)分析。使用PhenoScanner V2数据库进行人类基因型-表型关联分析,排除与HS不相关的肠道菌群SNP并分析获得的SNP是否为弱工具变量。采用TSMR分析的4种方法,即逆方差加权(IVW)、MR-Egger回归、加权中位数和加权模式,对肠道菌群SNP与HS之间的因果关系进行分析。绘制前述4种分析方法得出重要结果的散布图,分析肠道菌群SNP与HS的相关性。采用IVW检验和MR-Egger回归检验评估肠道菌群SNP的异质性,采用MR-Egger回归检验和MR-PRESSO离群值检验评估肠道菌群SNP的水平多效性,采用留一敏感性分析确定HS是否由肠道菌群中的单个SNP引起。对HS SNP与肠杆菌属或HS SNP与瘤胃球菌2属分别进行逆向TSMR分析,检测它们之间是否存在反向因果关系。结果共获得196个已知肠道菌群,属于9门、16纲、20目、32科、119属,从每个菌群中均获得多个SNP作为工具变量。LD分析显示,除rs1000888、rs12566247、rs994794外,其余肠道菌群SNP均符合遗传变异与暴露因素密切相关的假设。人类基因型-表型关联分析显示,经LD分析后获得的SNP均未被排除且均不是弱工具变量。IVW、MR-Egger回归、加权中位数和加权模式的TSMR分析显示,肠杆菌属及瘤胃球菌2属均与HS存在因果关系。其中,IVW和MR-Egger回归的森林图分析还显示,肠杆菌属的16个SNP(该菌属SNP个数下同)和瘤胃球菌2属的15个SNP(该菌属SNP个数下同)均为HS的保护因素。进一步地,IVW分析显示肠杆菌属SNP(比值比为0.62,95%置信区间为0.41~0.93,P<0.05)和瘤胃球菌2属SNP(比值比为0.62,95%置信区间为0.40~0.97,P<0.05)均与HS发生风险呈负相关。散布图显示,肠杆菌属和瘤胃球菌2属的SNP均是HS的保护因素。IVW检验和MR-Egger回归检验均显示,肠杆菌属SNP(Q值分别为5.73、5.76,P>0.05)和瘤胃球菌2属SNP(Q值分别为13.67、15.61,P>0.05)均无异质性。MR-Egger回归检验显示,肠杆菌属和瘤胃球菌2属的SNP均无水平多效性(截距分别为0.01、0.06,P>0.05);MR-PRESSO离群值检验显示,肠杆菌属和瘤胃球菌2属的SNP均无水平多效性(P>0.05)。留一敏感性分析显示,无单个肠道菌群SNP驱动HS的发生。逆向TSMR分析显示,HS SNP与肠杆菌属之间、HS SNP与瘤胃球菌2属之间均不存在任何反向因果关系(比值比分别为1.01、0.99,95%置信区间分别为0.97~1.06、0.96~1.04,P>0.05)。结论人肠道菌群与HS之间存在一定因果关系,肠杆菌属及瘤胃球菌2属对抑制HS有一定作用。
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Objective To investigate the causality between intestinal flora and hypertrophic scars (HS) of human. Methods This study was a study based on two-sample Mendelian randomization (TSMR) analysis. The data on intestinal flora (n=18 473) and HS (n=208 248) of human were obtained from the genome-wide association study database. Genetically variable genes at five levels (phylum, class, order, family, and genus) of known intestinal flora, i.e., single nucleotide polymorphisms (SNPs), were extracted as instrumental variables for linkage disequilibrium (LD) analysis. Human genotype-phenotype association analysis was performed using PhenoScanner V2 database to exclude SNPs unrelated to HS in intestinal flora and analyze whether the selected SNPs were weak instrumental variables. The causal relationship between intestinal flora SNPs and HS was analyzed through four methods of TSMR analysis, namely inverse variance weighted (IVW), MR-Egger regression, weighted median, and weighted mode. Scatter plots of significant results from the four aforementioned analysis methods were plotted to analyze the correlation between intestinal flora SNPs and HS. Both IVW test and MR-Egger regression test were used to assess the heterogeneity of intestinal flora SNPs, MR-Egger regression test and MR-PRESSO outlier test were used to assess the horizontal multiplicity of intestinal flora SNPs, and leave-one-out sensitivity analysis was used to determine whether HS was caused by a single SNP in the intestinal flora. Reverse TSMR analyses were performed for HS SNPs and genus Intestinimonas or genus Ruminococcus2, respectively, to detect whether there was reverse causality between them. Results A total of 196 known intestinal flora, belonging to 9 phyla, 16 classes, 20 orders, 32 families, and 119 genera, were obtained, and multiple SNPs were obtained from each flora as instrumental variables. LD analysis showed that the SNPs of the intestinal flora were consistent with the hypothesis that genetic variation was strongly associated with exposure factors, except for rs1000888, rs12566247, and rs994794. Human genotype-phenotype association analysis showed that none of the selected SNPs after LD analysis was excluded and there were no weak instrumental variables. IVW, MR-Egger regression, weighted median, and weighted mode of TSMR analysis showed that both genus Intestinimonas and genus Ruminococcus2 were causally associated with HS. Among them, forest plots of IVW and MR-Egger regression analyses also showed that 16 SNPs (the same SNPs number of this genus below) of genus Intestinimonas and 15 SNPs (the same SNPs number of this genus below) of genus Ruminococcus2 were protective factors for HS. Further, IVW analysis showed that genus Intestinimonas SNPs (with odds ratio of 0.62, 95% confidence interval of 0.41-0.93, P<0.05) and genus Ruminococcus2 SNPs (with odds ratio of 0.62, 95% confidence interval of 0.40-0.97, P<0.05) were negatively correlated with the risk of HS. Scatter plots showed that SNPs of genus Intestinimonas and genus Ruminococcus2 were protective factors of HS. Both IVW test and MR-Egger regression test showed that SNPs of genus Intestinimonas (with Q values of 5.73 and 5.76, respectively, P>0.05) and genus Ruminococcus2 (with Q values of 13.67 and 15.61, respectively, P>0.05) were not heterogeneous. MR-Egger regression test showed that the SNPs of genus Intestinimonas and genus Ruminococcus2 had no horizontal multiplicity (with intercepts of 0.01 and 0.06, respectively, P>0.05); MR-PRESSO outlier test showed that the SNPs of genus Intestinimonas and genus Ruminococcus2 had no horizontal multiplicity (P>0.05). Leave-one-out sensitivity analysis showed that no single intestinal flora SNP drove the occurrence of HS.
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