成人Still病诊疗进展

【摘要】 成人Still病是一类病因未明的全身炎症性疾病，临床表现多样，其诊断和治疗存在一定困难。近年来发现，血红素加氧酶1、钙网蛋白、炎症细胞因子、糖基化终末产物等新型标志物可对成人Still病的活动程度和严重程度进行全面评估，而新研发的生物制剂如肿瘤坏死因子抑制剂、白细胞介素1（IL-1）抑制剂、IL-6抑制剂、重组IL-18结合蛋白也有望用于治疗。本文主要综述成人Still病的诊断和治疗进展。     

Graph Convolutional Network Based on Manifold Similarity Learning

In the area of large-scale graph data representation and semi-supervised learning, deep graph-based convolutional neural networks have been widely applied. However, typical graph convolutional network (GCN) aggregates information of neighbor nodes based on binary neighborhood similarity (adjacency matrix). It treats all neighbor nodes of one node equally, which does not suppress the influence of dissimilar neighbor nodes. In this paper, we investigate GCN based on similarity matrix instead of adjacency matrix of graph nodes. Gaussian heat kernel similarity in Euclidean space is first adopted, which is named EGCN. Then biologically inspired manifold similarity is trained in reproducing kernel Hilbert space (RKHS), based on which a manifold GCN (named MGCN) is proposed for graph data representation and semi-supervised learning with four different kernel types. The proposed method is evaluated with extensive experiments on four benchmark document citation network datasets. The objective function of manifold similarity learning converges very quickly on different datasets using various kernel functions. Compared with state-of-the-art methods, our method is very competitive in terms of graph node recognition accuracy. In particular, the recognition rates of MGCN (Gaussian kernel) and MGCN (Polynomial Kernel) outperform that of typical GCN about 3.8% on Cora dataset, 3.5% on Citeseer dataset, 1.3% on Pubmed dataset and 4% on Cora_ML dataset, respectively. Although the proposed MGCN is relatively simple and easy to implement, it can discover local manifold structure by manifold similarity learning and suppress the influence of dissimilar neighbor nodes, which shows the effectiveness of the proposed MGCN.

     

膝骨关节炎患者关节滑液中IL-17水平与疾病严重程度的相关性

目的 探讨膝骨美节炎(KOA)患者美节滑液中IL 17的水平与疾病严重程度的相关性，为临床诊治KOA 提供新思路及新方法。方法 选取2017年1月?2018年12月南充市中心医院康复科收治的15。例膝骨美节炎患者作 为实验组，同时纳入30例健康志愿者作为对照组。实验组釆用视觉模拟量表(VAS)评价膝关节的疼痛程度，采用膝关 节学会评分系统(KSS)评价膝关节的功能及采用Kellgren Lawrence (KL)分级系统评价膝关节X线严重程度，通过 ELISA试验检测两组膝关节滑液中IL17的水平。采用Spearman相关分析KOA患者关节滑液中IL 17水平与膝关节 疼痛程度、膝关节功能及X线严重程度的相关性。结果 实验组关节滑液中IL17的水平明显高于对照组(P <0. 05). IL 17水平在滕美节炎KL分级之间比较，差异无统计学差异(P>0. 05)。IL 17的水平与膝关节VAS评分呈正相关 (P=0. 914,P<0.01),IL 17的水平与KSS呈负相关(P=—0. 847,P<0. 01), IL 17的水平与KL分级无相关性(r = 0.050,P= 0.545)。结论 IL 17可反应膝骨关节炎患者疼痛程度及功能损伤程度，但不能反映疾病的X线严重程度。 IL 17可作为一个生化指标反应膝关节炎疼痛程度及膝关节功能，临床通过减少关节滑液中IL 17,可能会减轻膝骨关 节炎患者的临床症状。     

The Associations of Dietary Inflammatory Potential With Musculoskeletal Health in Chinese Community-Dwelling Older People: The Mr. OS and Ms. OS (Hong Kong) Cohort Study

Inflammation, an important contributory factor of muscle and bone aging, is potentially modulated by diet. This study examined the associations of dietary inflammatory index (DII) score with musculoskeletal parameters and related disease outcomes in 3995 community-dwelling Chinese men and women aged ≥65 years in Hong Kong. DII score at baseline was estimated from a food frequency questionnaire. Bone mineral density (BMD) and muscle mass estimated by dual-energy X-ray absorptiometry (DXA), hand grip strength, gait speed, and chair stand test were measured at baseline, year 4, and year 14. The associations of DII score with the longitudinal changes of musculoskeletal parameters, and incidence of osteoporosis, sarcopenia, and fractures were examined by using general linear model, multinomial logistic regression model, and Cox proportional hazards regression model, respectively. After multiple adjustments, each tertile increase in DII score in men was associated with 0.37 (95% confidence interval [CI], 0.10–0.64) kg loss in grip strength and 0.02 (95% CI, 0.01–0.03) m/s loss in gait speed over 4 years. In men, the highest tertile of DII was associated with a higher risk of incident fractures, with adjusted and competing death adjusted hazard ratio (HR) (95% CI) of 1.56 (1.14–2.14) and 1.40 (1.02–1.91), respectively. In women, DII score was not significantly associated with any muscle-related outcomes or incidence of fracture, but a significant association between higher DII score and risk of osteoporosis at year 14 was observed, with the highest tertile of DII score having adjusted odds ratio (OR) (95% CI) of 1.90 (1.03–3.52). In conclusion, pro-inflammatory diet consumption promoted loss of muscle strength and physical function, and increased risk of fractures in older Chinese men. Pro-inflammatory diets had no significant association with muscle related outcomes but increased the long-term risk of osteoporosis in older Chinese women. © 2022 American Society for Bone and Mineral Research (ASBMR).     

生脉散防治心房纤颤的作用机制及网络药理学分析

目的:基于网络药理学方法探讨生脉散治疗心房纤颤的作用靶点和相关信号通路并探讨其作用机制。方法:运用中药系统药理学成分分析平台(bioinformatics analysis tool for molecular mechanism of TCM,BATMAN-TCM)数据库获取生脉散的化学成分及作用靶标基因,通过GeneCards,OMIM,DisGeNET数据库收集心房纤颤的靶标基因。将两者取交集后得到生脉散-心房纤颤靶基因交集,运用STRING构建蛋白质间相互作用网络,并将结果进行网络可视化展示。将药物-疾病交集基因导入DAVID6.8数据库,进行基因本体(gene ontology,GO)分析和基于京都基因与基因组百科全书(Kyoto Encyclopedia of Genes and Geomes,KEGG)通路富集分析。结果:生脉散干预房颤的有效活性成分159个,药物靶点与疾病靶点交集后获得206个共有靶点,PPI蛋白互作网络分析发现AKT1,TP53,PRKACA,IL-1B,TNF,INS,PPAR,RXR,F2,CACAN1C,PKC等是生脉散治疗房颤的核心靶点。GO富集分析确定了175个条目(P0.05),其中生物过程主要心脏传导调节心率、动作电位时膜去极化等;分子功能主要包括电压门控钙通道、类固醇激素受体活性、肾上腺素结合等,在细胞组成方面,主要包括钠、钾、钙通道复合物等。KEGG通路富集分析确定了100条相关信号通路,主要有cGMP/PKG信号通路,cAMP信号通路,血清素能突触,肾素分泌,钙信号通路等。结论:生脉散治疗心房纤颤具有多途径、多靶点作用的特点。该研究初步探讨了其作用的关键靶点及涉及的生物学过程和信号通路,为生脉散治疗心房纤颤后续的实验研究提供一定的参考。     

后Pilon骨折的诊治现状与进展

后Pilon骨折是一种新近报道的Pilon骨折的特殊模式,其特征是累及后外踝和后内踝.在过去由于后Pilon骨折没有得到充分的认识,常被误诊为后踝骨折,也导致这类患者功能恢复不良.因此是否能作出正确诊断至关重要,只有熟悉后Pilon骨折的各种影像学特征并了解合并损伤的机制,才能及时、准确地诊断后Pilon骨折,并改进这种具有挑战性骨折的术前计划和临床结果.本文着重介绍了后Pilon骨折的损伤机制,现有的分类方案,并讨论了目前使用的各种手术方法.     

2010-2019年揭阳市吸毒人群哨点监测分析

目的 了解广东省揭阳市吸毒人群艾滋病感染情况及其行为变化特征，为相关干预工作及防控措施的制定提供科学依据。方法 按照国家哨点监测工作方案，对2010—2019年揭阳市吸毒人群哨点所有吸毒人员进行问卷调查，了解吸毒人群人口学和行为学特征，并采集血样检测艾滋病抗体。结果 11 908名吸毒人员中，以25岁～组为主、占84.47%，男性多于女性、占93.36%，以初中及以下文化程度为主、占93.16%;2010年发生商业性性行为构成比（35.54%）下降至2019年的9.94%；揭阳市吸毒人群注射毒品构成比2010年最高（37.82%）、2017年最低（22.13%），揭阳市吸毒人群对艾滋病知识知晓率2010年的52.55%上升至2019年的97.51%（χ²=12.890,P<0.05），吸毒人群艾滋病感染率2012年最高（0.33%）、2016和2017年最低（均为0.00%）。结论 揭阳市吸毒人群艾滋病知识知晓率显著上升，艾滋病感染率维持较低水平，但吸食复合型毒品人数显著升高，应继续加强吸毒人群的健康宣传教育和持续监测工作。     

认知行为干预在冠心病患者护理中的应用效果

目的观察认知行为干预在冠心病患者护理中的应用效果。方法选取本院2016年12月～2018年2月期间收治的53例冠心病患者,根据住院号奇偶性情况将其随机分为观察组(n=27)和对照组(n=26),对照组予以常规护理,观察组予以认知行为干预。比较两组患者控制态度评分、心理状况评分、生活质量改善情况及依从性。结果观察组控制态度评分、心理状况评分、生活质量改善情况及依从性与对照组比较,差异有统计学意义(P0.05)。结论在冠心病患者护理中给予认知行为干预应用效果极佳,可作为临床干预首选措施。