血液透析患者颈-股动脉脉搏波速度改变及其影响因素

背景：维持性血液透析患者颈-股动脉脉搏波速度改变受多种因素影响。 目的：探讨维持性血液透析患者颈-股动脉脉搏波速度改变及其相关因素分析。 设计、时间及地点：相关性分析,交叉对照实验,于2006-01/08北京大学第三医院肾脏内科完成。 对象：北京大学第三医院临床情况稳定的66例维持性血液透析患者。 方法：收集患者一般情况、生化学指标、颈-股动脉脉搏波速度和主观综合营养状态的评估等4个方面资料。根据SGA营养评分将患者分为营养正常组49例、营养不良组17例。比较两组脉搏波速度的差异,采用单因素相关和多因素回归分析探讨脉搏波速度的相关因素。 主要观察指标：患者颈-股动脉脉搏波速度,血白蛋白和甲状旁腺激素。 结果：血液透析患者颈-股动脉脉搏波速度与年龄(r=0.284,P=0.021)、收缩压(r=0.468,P < 0.001)、脉压(r=0.451,P < 0.001)存在显著正相关,与透前血清肌酐(r=-0.347,P=0.004)、转铁蛋白(r=-0.284,P < 0.05)、血前蛋白 (r=-0.318,P < 0.05)、血浆白蛋白(r=-0.263,P < 0.05)和甲状旁腺激素(r=-0.167,P < 0.05)存在负相关。多元逐步回归分析显示脉压和甲状旁腺激素是颈-股动脉脉搏波速度的独立影响因素。采用SGA营养评估营养状态,营养不良组颈-股动脉脉搏波速度明显增快,与营养正常组比较差异有显著性意义(P < 0.05)。 结论：脉压是维持性血液透析患者颈-股动脉脉搏波速度独立的影响因素。营养不良与动脉粥样硬化是维持性血液透析常见的并发症,两者关系密切,营养不良者脉搏波速度值增高。     

阿尔茨海默病相关认知障碍患者营养不良影响因素初步分析

目的分析阿尔茨海默病相关认知障碍患者营养风险/不良的影响因素, 并进一步分析此类患者营养状况与痴呆精神行为症状(BPSD)严重程度的相关性。方法连续性收集2021年6月1日至2022年8月31日首都医科大学附属北京天坛医院阿尔茨海默病生物标志物与生活方式研究队列中的247例阿尔茨海默病相关认知障碍患者的临床资料。根据微型营养评定量表(MNA)评分将患者分为营养良好组(128例)和营养不良组(119例)。采用假设检验和单因素Logistic回归分析比较2组患者在性别、入组年龄、体重指数、腰臀比、受教育年限、是否有嗅觉减退、是否合并≥2种慢性疾病、胃肠道疾病史、是否有BPSD以及在简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、神经精神问卷(NPI)、日常生活活动能力评定量表(ADL)、照料者负担量表(CBI)评分和膳食多样化评分(DDS)得分上的差异。将单因素分析中差异有统计学意义的指标纳入多因素Logistic回归分析, 进一步分析阿尔茨海默病相关认知障碍患者营养不良的独立影响因素。采用Spearman相关分析检验NPI评分与MNA评分的相关性。结果与营养良好组相比...     

延髓性麻痹患者营养评估对鼻饲的指导意义

目的 探讨早期营养评估对脑卒中延髓性麻痹患者鼻饲的指导意义.方法 用体重指数(BMI)、血清白蛋白(ALB)指标将患者分为营养正常组和营养不良组.每组各设治疗组和对照组,观察各组患者治疗前后神经功能缺损评分及常见并发症的发生率.结果 经10d治疗后,营养正常组中治疗组与对照组的神经功能缺损评分及肺部感染、压疮等并发症的发生率相比无明显改善(P＞0.05),而水电解质紊乱发生率明显下降(P＜0.05).营养不良组中治疗组神经功能缺损评分相比对照组有明显改善(P＜0.05),且肺部感染、水电解质紊乱、压疮等并发症的发生率明显降低(P＜0.05).结论 早期对患者进行营养评估,如营养不良应尽早予鼻饲加强支持治疗;如营养正常可不予鼻饲,但需监测水电解质情况,及时纠正水电解质紊乱.     

抑郁情绪对慢性鼻窦炎内镜术后患者症状改善的影响

目的 探讨抑郁情绪对慢性鼻窦炎(CRS)内镜术后患者症状改善的影响.方法 选择本院2018年1月～2020年6月120例CRS内镜术后患者作为研究对象,根据术后汉密尔顿抑郁量表(The Hamilton Depression Scale,HAMD)分数,设为抑郁组(45例)与非抑郁组(75例),采用视觉模拟评分(Visual analog scale,VAS)评估鼻塞、头昏/头痛、嗅觉障碍、鼻分泌物、面部疼痛、鼻后滴漏等CRS主观症状,以及Lund-Mackay内镜评分评估黏膜炎症状态、黏液性分泌物、脓性分泌物等客观症状,分析HAMD评分与主观症状、客观症状评分的关系.结果 抑郁组鼻塞、头昏/头痛、嗅觉障碍、鼻分泌物、面部疼痛、鼻后滴漏等CRS主观症状VAS评分均显著高于非抑郁组(P＜0.05);抑郁组黏膜炎症状态、黏液性分泌物、脓性分泌物等Lund-Mackay内镜评分均显著高于非抑郁组(P＜0.05);HAMD评分与主观症状、客观症状评分均呈显著正相关关系(P＜0.05).结论 抑郁情绪会影响CRS内镜术后症状改善,临床宜根据患者实际情况进行针对性心理干预,以促进术后症状改善.     

无基础代谢性疾病急性缺血性卒中患者短期营养不良预测模型构建与验证

目的 分析无基础代谢性疾病急性缺血性卒中（acute ischemic stroke,AIS）患者短期营养不良的影响因素,并构建AIS短期营养不良的临床预测模型。方法 回顾性选取2019年3月—2021年6月在苏州市第九人民医院神经内科治疗的无基础代谢性疾病AIS患者作为建模队列,以患者入院2周时微型营养评定简表（mini-nutritional assessment short-form,MNA-SF）、BMI和白蛋白（albumin,Alb）指标作为综合评估,即MNA-SF评分＜8分且BMI＜18.5 kg/m2、Alb＜35.0 g/L为营养不良,以此为依据划分营养不良组和无营养不良组。比较两组的人口学特征及入院时临床资料,将单因素分析具有统计学意义的变量纳入多因素logistic回归分析,基于多因素分析出的影响指标构建预测模型。用ROC曲线评价其区分度,用拟合优度检验评价其校准度。以2021年8月—2022年6月在苏州市第九人民医院神经内科治疗的无基础代谢性疾病AIS患者作为验证队列验证模型的效能。 结果 建模队列共纳入924例无基础代谢性疾病AIS患者,平均（55.0±14.3）岁,男性544例（58.9%）。入院2周时的营养评估发现72例（7.8%）营养不良。多因素分析显示,高龄（OR 2.059,95%CI 1.132～3.743,P=0.018）、饮酒史（OR 1.747,95%CI 1.076～2.835,P=0.024）、入院时有营养风险（OR 2.951,95%CI 1.485～5.859,P=0.002）、院内无营养支持（OR 1.870,95%CI 1.065～3.284,P=0.029）、入院才藤氏分级低（OR 0.226,95%CI 0.079～0.652,P=0.006）、入院NIHSS评分高（OR 1.556,95%CI 1.057～2.289,P=0.025）均为无基础代谢性疾病AIS患者短期营养不良的独立影响因素。根据影响因素得出预测模型方程：logit（P）=0.722×年龄+0.558×饮酒史+1.082×入院时营养风险+0.626×院内无营养支持-1.483×才藤氏分级+0.442×NIHSS评分+0.479-31.187。该模型预测患者短期营养不良的AUC为0.863（95%CI 0.811～0.914）,最大约登指数（0.703）对应的灵敏度和特异度分别为87.50%、83.90%;拟合优度检验χ2=2.754,P=0.498。验证队列共纳入126例无基础代谢性疾病AIS患者,采用模型对其营养不良进行预测得出的灵敏度为86.96%、特异度为83.50%、准确率为84.13%。结论 高龄、饮酒史、入院时有营养风险、院内无营养支持、才藤氏分级低和入院NIHSS评分高是无基础代谢性疾病AIS患者短期营养不良的影响因素,经验证基于上述指标构建临床预测模型具有良好的预测效能。     

急性脑卒中患者的营养状况及营养支持

目的探讨急性脑卒中住院患者的营养状态及合理的营养支持措施。方法根据能否安全进食将61例急性脑卒中患者分为正常进食组(A组)和管饲组(B组),后者又分为持续营养液组(B1组)和分次普通流质饮食组(B2组)比较入院时一般情况、Glasgow昏迷评分和欧洲脑卒中评分(ESS)。患者入院时和2周后分别测量上臂周径(MC)、三头肌皮褶厚度(TSF)并计算上臂肌肉周径(MAMC),其正常值由年龄匹配的60名健康人获得;检测血红蛋白、总蛋白、白蛋白和转铁蛋白,将以上各组结果进行比较分析。3个月后评估Barthel生活指数(BI)。结果60例健康人的MC、TSF和MAMC的正常值范围分别为(24．99～30．55)cm、(13．29～16．25)mm和(20．83～25．45)cm。61例急性脑卒中患者入院时3个躯体营养指标明显低于健康人群。入院时和2周后营养不良发生率分别为11．48%和24．6%,两者间差别均有显著性意义(P＜0．001)。高龄、入院时营养不良和吞咽困难是2周后发生营养不良的独立危险因素,相对危险度(RR)分别为1．08[95%CI为(1．01～1．16)]、7．64[95%CI为(0．94～61．86)]和4．38[95%CI为(1．94～16．09)]。入院时ESS和营养不良是影响患者3个月后BI的独立危险因素,RR分别为0．78[95%CI为(0．66～0．92)]和1．71[95％CI为(1．56～1．91)]。营养支持后,A组患者的躯体营养指标和实验室指标均明显低于入院时;B1组改变无统计学差异;B2组除血红蛋白和白蛋白外其他指标均显著下降。A组BI分别高于B1组与B2组,B1组患者的BI高于B2组患者。A组3个月内无死亡, B1组和B2组3个月内病死率分别为10．0%和29．4%,但两者间差别无显著性意义(P＞0．05)。入院时低ESS和营养不良是影响患者顸后的独立危险因素。结论急性脑卒中患者入院时常有营养不良,并随住院时间延长而恶化,合理的营养支持可以改善营养状况和预后,持续肠内滴注营养液可能是有效的营养支持方式。     

失眠患者与健康人睡眠感知水平的对比分析

目的 研究失眠患者与健康人之间对睡眠状况主观感知和客观评估的差异,进一步探讨失眠患者主观睡眠感知的特点.方法 通过睡眠日记晨间评估项目和多导睡眠图监测获取受试者的睡眠自我评估参数及客观睡眠参数.采用失眠严重程度指数.焦虑自评量表和抑郁自评量表等描述失眠程度并进行初步相关分析.结果 与正常对照组相比,失眠组受试者的睡眠自我评估参数和多导睡眠图监测参数均显示睡眠潜伏期和觉醒时间延长,睡眠效率下降和总睡眠时间减少,组间差异有统计学意义(均P<0.01).组内比较,两组受试者睡眠自我评估参数与多导睡眠图监测参数之间差异有统计学意义(均P<0.05),但失眠组这种差异较对照组更为显著(P<0.05).尤其足对睡眠潜伏期的评估误差.失眠组受试者睡眠自我评估误差呈现双向性.失眠组受试者焦虑自评量表评分和抑郁自评量表评分高于对照组(P<0.01),并与失眠严重程度指数呈正相关(P<0.01),焦虑自评量表评分与睡眠自我评估参数中的睡眠潜伏期呈正相关(P<0.01).结论 失眠患者睡眠质量下降,其对睡眠状态的自我评估误差显著高于健康受试者,且具有双向误差之特点,包括对睡眠状态的低估(夸大睡眠障碍)和对睡眠状态的高估(忽视夜间的睡眠缺失).焦虑情绪可能与睡眠潜伏期感知误差具有直接相关性.     

社区脑卒中后患者营养现状的流行病学调查

目的 调查上海市虹口区社区医院住院的卒中后患者吞咽障碍、低白蛋白血症和营养不良的检出率以及进食情况.方法 采用横断面研究,以438例在社区医院住院的卒中后患者为研究对象,记录其人口学特征、洼田饮水试验评估结果、营养学指标(包括人体测量学指标和生化指标)和进食情况.结果 438例卒中后患者吞咽障碍、低白蛋白血症和营养不良的检出率分别为18.6%、42.7%和52.7%;376例患者经口进食,61例鼻饲肠内喂养,1例经皮内窥镜胃造瘘术.其中376例经口进食患者中32%进食量恢复正常,60%进食量为正常状态的一半以上,8%为正常状态的一半以下;62例肠内营养患者中46例能量需要量未按照"肠内肠外营养临床指南(2006版)"推荐的标准实施.结论 社区医院住院的卒中后患者中仍有相当大比例的患者存在吞咽障碍,低白蛋白血症及营养不良的检出率高;患者进食缺乏统一管理,饮食内容随意无序,进食缺乏监控;临床医生应关注卒中后患者的营养现状.     

脑卒中后患者营养不良与预后的相关性研究

目的调查脑卒中后患者营养不良的发生率;探讨卒中后患者营养不良与神经功能缺损程度、残障程度、日常生活能力、感染和并发症发生率之间的关系。方法采用横断面研究,研究对象为438例在社区医院住院的卒中后患者,记录其人口学特征、营养学评定指标、神经功能缺损评分（NIH—SS）、mRS评分、Barthel指数、感染和并发症的发生情况。结果脑卒中后患者营养不良的发生率达52．7％;卒中后营养不良的患者中中重度神经功能缺损（NIHSS〉4分）的占77．1％,重度残障（mRS评分4～5分）的占70．1％,日常生活重度依赖及完全依赖（Barthel指数0～45分）的占69．7％,感染发生率为34．6％。并发症发生率为55．4％;而正常营养状态患者,相应的比例分别为24．2％、21．3％、19．8％、11．6％和18．8％。结论卒中后患者营养不良的发生率高,营养不良与神经功能缺损程度、残障程度,日常生活能力,感染和并发症发生率具有相关性（P〈0．0001）,营养不良的患者神经功能缺损程度、残障程度严重,日常生活能力低下,感染和并发症发生率高,关注卒中后患者营养不良对改善卒中预后有积极作用。     

卒中后抑郁患者匹兹堡睡眠量表与多道睡眠图研究

目的 探讨卒中后抑郁（PSD）患者的主观睡眠和客观睡眠情况,比较两种评估结果是否一致.方法 使用匹兹堡睡眠量表指数（PSQI）对PSD组和对照组患者的主观睡眠状况进行评估,并应用多道睡眠仪（PSG）对PSD组患者的客观睡眠状况进行记录,比较PSD组主客观睡眠的各项指标.结果 PSD组与对照组比较,PSQI各因子分及总分值偏高,差异有显著性;PSD组患者主观睡眠比客观睡眠障碍更加严重,差异有显著性.结论 PSD患者存在睡眠障碍,且PSD患者主观睡眠障碍比客观睡眠障碍更加严重.     

Auditory gamma oscillations predict global symptomatic outcome in the early stages of psychosis: A longitudinal investigation

Objectives

The gamma-band auditory steady-state response (ASSR) is thought to reflect the function of parvalbumin-positive γ-aminobutyric acid (GABA)-ergic interneurons and may be a candidate biomarker in early psychosis. Although previous cross-sectional studies have shown that gamma-band ASSR is reduced in early psychosis, whether reduced gamma-band ASSR could be a predictor of the long-term prognosis remains unknown.

Is transient global amnesia a risk factor for amnestic mild cognitive impairment?

Abstract. Transient Global Amnesia (TGA) is a common condition of unknown aetiology characterised by the abrupt onset of severe anterograde amnesia, which lasts less than 24 hours. Some authors have suggested that subclinical impairment of memory functions may persist for much longer, but neuropsychological assessment lasting years after TGA attack has not been performed so far. The aim of this study was to evaluate longterm cognitive functions in patients with a previous TGA episode. Fifty-five patients underwent a standardised neuropsychological assessment after at least one-year from the TGA attack, and were compared with 80 age-matched controls. TGA patients showed worse performances on tests evaluating verbal and nonverbal long-term memory and attention, with comparable global cognitive functions. By applying current criteria for amnestic Mild Cognitive Impairment (MCI-a) on TGA subjects, a group consisting of 18/55 (32.7%) MCI-a subjects was identified. There was no association between the presence of MCIa and demographic variables, vascular risk factors, years since the TGA episode, or ApoE genotype. This study demonstrates that TGA appears to be a relatively benign syndrome although objective memory deficits fulfilling MCI-a criteria persist over time, as detected by multidimensional neuropsychological tasks performed at long-term follow-up.     

Aortic dissection as a possible cause of pure transient global amnesia: a case report and literature review

A 55-year-old man suddenly developed anterograde and retrograde amnesia. His colleagues witnessed the onset of the episode and reported that 2 h before the onset of the amnesic attack the patient transiently became pale. Physical examination was unremarkable and neurological examination revealed no focal neurological sign although a laboratory investigation revealed leukocytosis. Pure transient global amnesia (TGA) was diagnosed. The anterograde amnesia resolved 20 h after onset, but the causes of his transient paleness precedent to TGA and leukocytosis were unclear. Thirty-four hours after onset, the patient complained of sudden back pain and radiological studies revealed aortic dissection (AD; Stanford type B). We emphasize AD as a rare cause of pure TGA, because TGA in itself often has a benign natural history, but AD can be life-threatening if undiagnosed. The precedent pain, transient systemic symptoms, and leukocytosis can be red flags suggesting AD as an etiology of TGA.     

Predicting Adolescents' Global Functioning from Personality Typologies

This study examined the utility of three personality typologies in predicting global functioning in a non-clinic sample of adolescents. Participants were 140 students from middle class suburban public high schools (74 girls; mean age = 16.0 ± 1.2; 70.7% Caucasian, 11.4% African American, 7.1% Asian, 7.1% Hispanic, and 3.6% other) who completed psychometrically sound standardized measures of personality. They were combined into three four quadrant personality typologies. Global Assessment of Functioning (GAF) ratings were based on clinical interviews utilizing DSM criteria and were obtained by raters blind to self-report results. All three systems overlapped modestly but significantly. Each model detected significant GAF differences among quadrants. There was no gender difference in representation among the quadrants of the three systems. Results suggest that compared with unitary dimensions of personality, typologies concurrently utilizing two dimensions of personality functioning better capture individual differences on a complex psychological construct such as global functioning. Further research is warranted to examine the utility of these typological systems in predicting global functioning across a variety of clinical and nonclinical adolescent populations, and to determine how other aspects of global functioning may influence or interact with personality typologies.     

抗精神病药单用与结合心理社会干预对非慢性精神分裂症患者一年结局的影响

目的 比较抗精神病药单用与结合心理社会干预对非慢性精神分裂症患者1年结局的影响.方法 多中心随机对照研究,将1239例病程≤5年、稳定期的精神分裂症患者随机分为单纯药物治疗组(以下简称药物组,635例)和药物结合心理社会干预组(以下简称干预组,604例)治疗随访1年.心理社会干预包括健康教育、家庭干预、技能训练及认知行为治疗.主要结局指标为各种原因造成的治疗中断率、疾病复发率和再入院率;次要结局指标为自知力与治疗态度问卷(ITAQ)、健康状况问卷(SF-36)、大体评定量表(GAS)和社会功能缺陷筛选量表(SDSS)评分的变化.结果 (1)干预组和药物组总的治疗中断率分别为32.8%和46.8%[相对危险度(RR)=1.61],复发率分别为13.8%和21.3%(RR=1.76),再入院率分别为6.5%和11.2%(RR=1.99),差异均有统计学意义(P均<0.01～0.05).(2)干预组ITAQ总分变化值[(4.7±0.1)分]、6项SF-36因子分改善值、GAS总分变化值[(6.9±0.2)分]、SDSS总分变化值[(1.5±0.1)分]均明显高于药物组[分别为(1.5±0.1)分、(3.7±0.2)分、(1.0±0.1)分;P均<0.01～0.05].结论 抗精神病药结合心理社会干预治疗非慢性精神分裂症患者,中断率、复发率和再入院率均低于单用抗精神病药患者,自知力、治疗依从性、生活质量、社会功能的改善优于单用抗精神病药患者.     

Cortical sources of resting state electroencephalographic rhythms probe brain function in naïve HIV individuals

Objective

Here we evaluated the hypothesis that resting state electroencephalographic (EEG) cortical sources correlated with cognitive functions and discriminated asymptomatic treatment-naïve HIV subjects (no AIDS).

Comparing retrospective reports to real-time/real-place mobile assessments in individuals with schizophrenia and a nonclinical comparison group

Retrospective reports are often used as the primary source of information for important diagnostic decisions, treatment, and clinical research. Whether such reports accurately represent individuals' past experiences in the context of a serious mental illness such as schizophrenia is unclear. In the current study, 24 individuals with schizophrenia and 26 nonclinical participants used a mobile device to complete multiple real-time/real-place assessments daily, over 7 consecutive days. At the end of the week, participants were also asked to provide a retrospective report summarizing the same period. Comparison of the data captured by the 2 methods showed that participants from both groups retrospectively overestimated the intensity of negative and positive daily experiences. In the clinical group, overestimations for affect were greater than for psychotic symptoms, which were relatively comparable to their retrospective reports. In both samples, retrospective reports were more closely associated with the week's average than the most intense or most recent ratings captured with a mobile device. Multilevel modeling revealed that much of the variability in weekly assessments was not explained by between-person differences and could not be captured by a single retrospective estimate. Based on the findings of this study, clinicians and researchers should be aware that while retrospective summary reports of the severity of certain symptoms compare relatively well with average momentary ratings, they are limited in their ability to capture variability in one's affective or psychotic experiences over time.