一项新研究发现，暴露在空气污染中可能会加速大脑衰老。

这项研究的对象为1403名未患痴呆症的女性，她们曾在1996年至1998年间参与过另一项大型健康研究。在2005年和2006年，研究人员用磁共振成像扫描的方式，测量了这些年纪在71岁至89岁之间的女性的脑容量。

研究人员利用居住记录和空气污染数据，对她们从1999年到2006年暴露在空气污染中的情况进行了估算。他们使用了监测PM 2.5的站点记录的数据。PM 2.5是一种容易进入肺中的微粒物。

每立方厘米中累积污染物每增加3.49微克，脑白质就会减少6.23立方厘米，相当于大脑衰老一到两年。根据多个变量进行了调整后，这种相关性依然存在。

罗斯央行金融稳定部门负责人Sergey Moiseev周二称，央行希望俄罗斯的主权债务评级能够在12个月内从垃圾级被上调。
Moiseev在呈交2014年第四季度和2015年第一季度央行金融稳定报告时称，俄罗斯的偿债能力正在改善，有关低通胀和经济复苏的预期可以成为上调评级的理由。

Moiseev称，俄罗斯经济显然正在复苏，评级将被修正，预计未来12个月内主权评级将被上调。

西方因乌克兰危机对俄罗斯实施制裁后，标准普尔(Standard & Poor's)和穆迪投资者服务(Moody's Investors Service)于2015年初将俄罗斯的主权外汇评级下调至垃圾级，这是10多年来的首次。

二季度末前欧元区经济复苏，尽管希腊可能出现债务违约及退出欧元区，对采购经理人的调查显示企业活动经过两个月的放缓后在6月份升温。
对采购经理人进行调查的数据公司Markit的首席经济学家威廉森(Chris Williamson)称，至少目前，欧元区经济正在相对安好地度过希腊风暴。

Markit周二表示，6月份综合采购经理人指数(PMI)从5月份的53.6上升至54.1，超过经济学家的预期，达到逾四年来的最高水平。此前经济学家预计综合PMI持平。PMI低于50表示活动下滑，高于50表示活动增加。Markit对欧元区的逾5,000家企业进行了调查。

1. 洗手，没事就洗手。

2. 抓到笔就往口袋塞，因为笔随时会不见了。

3. 口袋有黑笔红笔记号笔叩诊锤小手电。如果几个功能都有的工具，上面一般都有写着自己名字的胶布。

4. 对刀具的朝向很在意，厨房乱放刀具会很嫌弃。

5. 喜欢盯着别人的手看，找静脉，如果形态比较好的会摸一摸。护士更是如此。

6. 看人从头到脚扫一遍，重点找不对劲的地方。（整过容的吃饭的时候最好离医生远点，他老盯着你看不是因为你很美，是因为他在找你手术的破绽。）

7. 用屁股和手肘开门。

8. 鄙视一切国产医疗剧。

9. 有意无意的把身边分为脏，相对干净，绝对干净这几个区域。

10. 和人聊天不喜欢重复说过的话，如果能以查房的格式相互问答心情会很愉悦。外科医生更是如此。

11. 指甲永远是最短的，不能忍受甲缝污垢和长指甲。

美国波士顿大学医学院呼吸中心 Heckman 医学博士等由一病例引出，就肺功能检查结果的解读撰写文章，发表在近期出版的 JAMA 上。

病例介绍

患者，男性，67 岁，有 45 包/年的吸烟史，近期出现进行性加重的呼吸困难。患者静息氧饱和度为 94%，步行 60 分钟后下降为 86%。肺部体检提示两肺基底部存在吸气相湿罗音，肺尖部呼吸音消失。心血管检查正常，无外周水肿。胸部 X 线检查提示肺纹理增多，肺过度通气。肺功能检查结果如下（见图和表）。

表. 肺功能检查结果

                                                                                        患者数值

测量值
预测值
预测%
LLN
FVC,L
3.84
5.02
76
4.01
FEV1,L        2.30
3.73
62
2.88
FEV1/FVC        0.60
0.74

0.65
FEF25%-75%,L/S
0.98
2.89
34
1.1.6
TLC,L
5.21
7.70
68
6.55
RV,L
1.22
2.67
46
2.00
FRC,L
3.17
3.85
82
2.87
DLCO,mL/mm(Hg/min)
8.9
30.16
30
23.24
VA,L
4.46
7.70
58
6.55
DLCO/VA,mL/mm(Hg/min/L)
1.99
3.92
51

缩写：DLCO/VA：一氧化碳弥散量/肺泡通气量，FEF25%-75%：根据用力肺活量曲线而计算得出用力呼出 25%-75% 的平均流量，FEV1/FVC：第一秒用力呼气量/用力肺活量，FRC：功能残气量，LLN：正常下限，RV：残气量，TLC：肺总量，VA：肺泡通气量

Picture1.jpg
图. 流量容积曲线

肺功能检查结果如何？

A、限制性通气功能障碍

B、 阻塞性通气功能障碍合并「假」限制性通气功能障碍

C 、混合性通气功能障碍（限制性合并阻塞性通气功能障碍）

D、由于患者存在限制性通气功能障碍，肺功能检查不能判断患者有无阻塞性通气功能障碍

答案

C 、混合性通气功能障碍（限制性合并阻塞性通气功能障碍）

肺功能检查特点

肺功能检查可用于诊断肺部疾病及判断该疾病的严重程度。肺功能检查可测定用力肺活量（FVC，尽力最大吸气后尽力尽快所能呼出的最大气量）和第一秒用力呼气量（FEV1，尽力最大吸气后第一秒内尽力尽快呼出的气量）。

FEV1/FVC 比值下降提示存在阻塞性通气功能障碍，比值正常提示肺功能正常或存在限制性通气功能障碍。轻度阻塞性通气功能障碍时，FEV1/FVC 往往正常，但最大呼气中段流量（MMEF 或 FEF25%-75%）下降，流量-容积曲线（FVL）呼气支凹陷。

限制性通气功能障碍时，FVC 和 FEV1 下降，但 FEV1/FVC 比值正常或升高。且限制性通气功能障碍需结合肺容积数值才能得以明确诊断。

支气管舒张试验比较了吸入短效支气管扩张剂前后肺功能的变化情况。吸入支气管扩张剂后，气道阻塞完全可逆则提示为哮喘，不考虑为慢性阻塞性肺部疾病。但是吸入支气管扩张剂后，气道阻塞无改善，则不能除外哮喘可能，也不能认为该患者不能从支气管扩张剂治疗中获益。

FVL 为受试者在作最大用力呼气过程中，将呼出的气体容积与相应的呼气流量所记录的曲线。通过 FVL 形态，可判断受试者肺功能情况、有无阻塞性通气功能障碍或中枢性气道阻塞病变。

肺容积测量，最理想情况是通过容积描记法进行，可以估算出肺总量（TLC，肺所能容纳的最大气量）、功能残气量（FRC，平静呼气末尚残留于肺内的气量）和残气量（RV，最大呼气末尚存留于肺内不能再呼出的气量）。

TLC 下降提示存在限制性通气功能障碍。TLC 和 RV 升高分别提示过度通气和气体潴留，说明可能存在阻塞性通气功能障碍。「假」限制性通气功能障碍表现为因显著气体潴留导致的 RV 水平升高，TLC 正常或轻度升高，FVC 水平下降。

一氧化碳弥散量（DLCO）测定中受试者需吸入含有低浓度一氧化碳的测试气体，该测定可以反映出气体分布情况。当肺气肿、间质性肺部疾病、肺血管疾病、贫血时，DLCO 水平下降。

DLCO/肺泡通气量（VA）比值可以区分不同原因所致的低 DLCO，如气体交换异常所致的 DLCO 和肺容量下降所致的 DLCO，虽然这一方法并不能达到 100% 的准确率。目前肺活量的医保费用为 36.18 美元，完整肺功能测试的医保费用为 168.73 美元。

肺功能检查的结果与患者呼吸动作密切相关。患者的性别、年龄、种族和体重都会影响肺功能的正常范围。因此需根据患者的个体特点来解读肺功能检查结果（预测值和正常下限）。

FEV1/FVC 比值<0.7 往往提示存在气流受限，但是随着年龄上升这一比值会逐渐下降。且目前不少学者也指出当该比值低于正常下限时即存在气流受限。

患者肺功能检查结果解读

FVL 中，呼气降支凹向肺容积轴，提示存在阻塞性肺部疾病，但是也不能除外合并限制性肺通气功能障碍可能。FEV1/FVC 比值低于正常下限。当存在气流受限时，FEV1 占预测值百分比可提示气流受限的严重程度。这名患者的 FEV1% 预计值为 62%，这提示存在中度气流受限。

这名患者的 FEV1/FVC 比值降低，FVC 低于正常下限；这提示这名患者要么存在混合性通气功能障碍（限制性合并阻塞性）要么存在「假」阻塞性通气功能障碍。这名患者的 TLC 也低于正常下限，这说明他确实存在阻塞性通气功能障碍。

可通过肺功能检查来明确 DLCO 下降的原因。这名患者 DLCO 和 DLCO/VA 比值下降明显，且合并阻塞性通气功能障碍（肺气肿）和限制性通气功能障碍（间质性肺部疾病）。

是否还有其他的诊断性检查方法？

肺功能检查是诊断阻塞性和限制性肺部疾病的标准诊断方法。可通过氧饱和度测试和动脉血气分析来了解气体交换情况。

患者转归

计算机断层扫描（CT）证实患者存在肺气肿和间质性纤维化，这与肺功能检查结果一致。最终，这名患者被诊断为特发性肺纤维化。右心导管提示存在肺动脉高压，这可能是导致 DLCO 下降的原因。这名患者考虑接受肺移植。

临床结语

肺功能检查的解读需基于患者年龄、性别、种族等特征。

肺功能检查可以证实阻塞性通气功能障碍，提示限制性通气功能障碍。结合肺容量检查可确诊。

气体交换（DLCO）减少是非特异性的，提示存在实质性肺部疾病、肺血管疾病或贫血。

从今年5月20日开始至今，41岁的衢州男子余益飞自己给自己动手术割嘴里的恶性肿瘤已经十多次了。手术工具是医院买的手术剪、手术刀和镊子。“我这是在挑战生命。”余益飞一家生活拮据，被查出癌细胞转移后，拒绝了医生的手术建议。

BBC日前宣布，他们已研究出可用脑电波控制调台的头戴设备。据介绍，将“意念头盔”戴在头上，贴近额头和夹在耳垂上的传感器便会读取脑电波并传输到电视上的相应 app 上。用户可以选择“注意力集中程度”或“思考程度”作为衡量标准，当头戴设备监测到“注意力集中程度”或“思考程度”达到一定数值时， iPlayer 就会认为你想看这档节目，接着便会直接进入节目播放模式。反之，节目就会停留在预览阶段，供用户选择。

长和主席李嘉诚于股东会后坦言，对于政改方案未能获通过感到非常失望。被问到会否认为梁振英能连任，他指，社会上已有很多关注，拒绝评论。至于营商环境有否转差，李嘉诚则认为本港仍有很多机会。

Intel中国研究院首席工程师吴甘沙在一次报告中透露：所谓“啤酒加尿布”的数据挖掘经典案例，其实是Teradata公司一位经理编出来的“故事”，历史上并没有发生过！我靠！所有讲大数据应用的都讲这个经典案例，要求大家多研究“相关性”，少研究因果关系！敢情是编的故事啊！

“真正失败的人，就是那种特别害怕不能成功，怕死了，连试都不敢试的人。”

Dmitri P. Bertsekas, "Convex Optimization Algorithms"
2015 | ISBN-10: 1886529280 | 576 pages | Djvu | 15 MB

Arrigo Cellina, Ivar Ekeland, Paolo Marcellini, "Methods of Nonconvex Analysis"
1990 | pages: 214 | ISBN: 3540531203 | DJVU | 1,6 mb

Self-Organization: Theories and Methods By Wenjun Zhang (editor)
2013 | 260 Pages | ISBN: 1626188653 | PDF | 23 MB

Frontiers in Interpolation and Approximation (Pure and Applied Mathematics) by N. K. Govil
English | July 20, 2006 | ISBN: 1584886366 | 476 Pages | PDF | 7 MB

Norman Matloff, "Parallel Computing for Data Science: With Examples in R, C++ and CUDA"
English | 2015 | ISBN: 1466587016 | 328 pages | PDF | 2 MB

6.51pm ET

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