Association of weight-adjusted-waist index with incident hypertension: The Rural Chinese Cohort Study

AimsTo explore the association between WWI and the incidence of HTN in the Rural Chinese Cohort Study.Methods and ResultsWe examined data for 10,338 non-hypertensive participants (39.49% men) aged ≥ 18 years from the Rural Chinese Cohort Study who completed a baseline examination during 2007–2008 and follow-up during 2013–2014. WWI was calculated as waist circumference (cm) divided by the square root of weight (kg). Multiple logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the probability of HTN across four WWI categories. Restricted cubic splines analysis was used to model the dose–response association of WWI and HTN. A total of 2078 participants had HTN during a median follow-up of 6 years. After adjusting for potential confounders, as compared with the lowest WWI category (<9.94 cm/√kg), with WWI 9.94 to 10.42, 10.42 to 10.91 and ≥ 10.91 cm/√kg, the ORs (95% CIs) for HTN were 1.12 (0.93–1.35), 1.40 (1.17–1.69) and 1.50 (1.24–1.82), respectively. Results of the sensitivity analyses were robust. The ORs were generally consistent on subgroup analysis by sex, smoking status, systolic blood pressure and diastolic blood pressure. Multiple logistic regression models with restricted cubic splines showed a non-linear positive association between WWI and HTN (P_nonlinearity < 0.001).ConclusionThe highest WWI category was significantly associated with increased risk of HTN. Our findings may facilitate the development and promotion of obesity prevention strategies aimed at reducing the risk of HTN and provide evidence for healthcare policy in rural China.     

非致残性缺血性脑血管事件患者早期淡漠与情感认知障碍的相关性研究

目的 探究非致残性缺血性脑血管事件（NICE）患者早期淡漠与情感认知障碍的关系。方法 收集2021年6月至2022年12月在上海长海医院收治的NICE患者244例,其中男性156例,女性88例,平均年龄为63.1±9.7岁。根据入院时淡漠评估量表-临床医师版（AES-C）评分分为情感淡漠（≥33分,n=64） 组和非淡漠（＜33分,n=180）组。收集患者的人口学资料、血检验结果以及影像学资料,于发病2周内完善匹兹堡睡眠质量指数量表(PSQI)、蒙特利尔认知评估量表（MoCA）、听觉语词学习测验（AVLT）、数字广度实验（DST）、数字符号转换测验（DSST）、数字连线测验（TMT）、汉密尔顿焦虑、抑郁量表（HAMD、HAMA）等评估。利用t检验或非参数检验比较两组之间资料的差异,多因素Logistic回归分析影响淡漠的因素。结果 NICE后早期淡漠的发生率为26.2%,与非淡漠组相比,淡漠组患者的年龄较高而 BMI和受教育年限较低（所有P<0.05）;两组患者的性别、吸烟、饮酒以及高血压病史无显著性差异（所有P>0.05）。入院时首次血检验结果提示两组患者甲状腺激素水平均无显著性差异（P>0.05）,同时TOAST病因分型未发现两组患者的病因存在差异（P>0.05）。使用Fazekas白质评分对白质损伤进行量化结果提示,淡漠组患者的脑白质损伤明显高于非淡漠组（P=0.004）。认知功能检测结果提示,与非淡漠组相比,淡漠组患者认知障碍发生率（MoCA＜26）明显更高（46% vs 59%, P＜0.05）。淡漠组患者的言语流畅性抽象能力、延迟回忆和定向能力均明显减退（所有P<0.05）,两组之间视空间、执行功能以及命名能力无显著差异（所有P>0.05）。此外,淡漠组PSQI、HAMA、HAMD得分均高于非淡漠组,且睡眠障碍、焦虑和抑郁的发生率显著增加（P<0.05）。Logistic回归分析发现HAMD得分、年龄以及TMT-A用时为卒中后淡漠的危险因素（P<0.05）。结论 早期淡漠的NICE患者认知功能障碍发生率更高,且更易出现睡眠障碍以及焦虑和抑郁状态。HAMD得分、年龄以及TMT-A用时为卒中后淡漠的危险因素。     

凝血功能改变与COVID-19后发生急性缺血性脑卒中相关

[摘要]　目的　比较感染与未感染2019新型冠状病毒的急性缺血性脑卒中患者的临床特点、炎症指标及凝血功能,探讨新型冠状病毒病（COVID-19）后发生急性缺血性脑卒中的作用。方法　采用单中心回顾性研究设计,纳入2022年11月5日至2023年2月5日于我院治疗且完善2019新型冠状病毒核酸检测的急性缺血性脑卒中患者187例,其中合并COVID-19患者75例（COVID-19组）、未发生COVID-19患者112例（无COVID-19组）。分析两组患者的一般临床资料、炎症和凝血功能指标,包括中性粒细胞/淋巴细胞比值（NLR）、D-二聚体、纤维蛋白原（FIB）等。构建多因素logistic回归方程,分析COVID-19后发生急性缺血性脑卒中的独立危险因素。结果　COVID-19组的NLR[3.62（2.31,6.71） vs 2.64（1.87,5.04）,P=0.014]、D-二聚体[0.70（0.32,2.27）mg/L vs 0.37（0.27,0.76）mg/L,P=0.001]、FIB[4.21（3.26,5.17）g/L vs 3.25（2.77,3.87）g/L,P<0.001]和淋巴细胞计数[1.40（1.03,1.71）×109/L vs 1.61（1.09,2.21）×109/L,P<0.05]高于无COVID-19组。多因素logistic回归分析结果表明,既往脑卒中史（OR =15.430,95% CI=(1.538,19.175),P= 0.009)、D-二聚体（OR =1.425,95% CI=(1.104,1.840),P= 0.007）及FIB（OR =2.405,95% CI=(1.683,3.437),P= 0.001）是COVID-19后发生急性缺血性脑卒中的独立危险因素。结论　感染COVID-19后急性缺血性卒中患者的炎症和凝血的血清生物标志物升高,COVID-19后缺血性脑卒中的发病与高凝状态相关。     

海水淹溺性肺损伤机制的研究进展

溺水是重要的公共安全问题,是全球意外死亡三大原因之一。肺损伤是溺水患者最常见的并发症之一,其主要表现为严重的呼吸困难和低氧血症,近1/3的患者最终进展为急性肺损伤或急性呼吸窘迫综合症。肺泡上皮细胞是肺泡-毛细血管屏障重要组成部分,淹溺导致其结构和功能的完整性直接破坏促进了肺水肿的发生,同时肺毛细血管通透性增加,中性粒细胞和单核细胞等大量渗出聚集加剧肺内炎症反应。此外,机体氧化应激、细胞间连接和通讯等肺外机制也可导致肺损伤。本文就海水淹溺性肺损伤的相关机制研究进展进行了综述。     

Prognostic effect of increased postoperative MRI T2WI high signal intensity in degenerative cervical myelopathy

BACKGROUND CONTEXTHigh cord signals (HCS) are common in patients undergoing surgery for degenerative cervical myelopathy (DCM). Few studies have investigated the prognostic effects of postoperative HCS changes.PURPOSETo investigate whether different changes in the postoperative magnetic resonance imaging (MRI) T2-weighted images (T2WIs) signal intensity ratio (SIR) is related to patient outcomes, predictors of unsatisfactory recovery, and the factors associated with changes in postoperative SIR.STUDY DESIGNA retrospective chart review at a single institution.PATIENT SAMPLEThe study population included all consecutive patients who showed HCS in preoperative MRI T2WIs and underwent double-door laminoplasty for DCM from December 2017 to December 2020.OUTCOME MEASURESPatient self-reported measures included the Japanese Orthopedic Association (JOA) score, 36-Item Short Form Survey (SF-36) physical component score, and SF-36 mental component score. Imaging measures included SIR, length of HCS, and canal narrowing ratio (CNR).METHODSWe reviewed patient records and analyzed the statistical associations of MRI T2WI measures with the JOA score, SF-36 physical, and mental component scores.RESULTSFifty-three patients were categorized into three groups based on the postoperative HCS changes, identified from MRI T2WI before and after surgery: reduced (Group A, N=26); unchanged (Group B, N=12); and increased (Group C, N=15). The neurological recovery rates 12 months after surgery were 67.72%±17.45% in Group A, 51.53%±16.00% in Group B, and 13.35%±21.35% in Group C (p<.001). Significant differences across the three groups were found in symptom duration, postoperative SIR and length of HCS, pre- and postoperative CNR, recovery rate, JOA, SF-36 scores, with patients in Group C having the worst outcomes. Longer DCM symptom duration, greater preoperative CNR, and increased postoperative HCS were prognostic factors for a recovery rate<50%. Preoperative CNR, with an optimal threshold of 57.303%, was an independent risk factor for increased postoperative HCS.CONCLUSIONSLess than one-third of DCM patients with preoperative HCS exhibited an increase in HCS after double-door laminoplasty and reported worse outcomes at the 12-month follow-up when compared to patients with decreased or unchanged postoperative HCS.     

Does the asymmetry and extension function of the preoperative cervical paraspinal extensor predict postoperative cervical sagittal deformity in patients who undergo modified laminoplasty?

BACKGROUND CONTEXTA previous study found that the cross-sectional area (CSA) of the preoperative cervical paraspinal extensors (CPEs) was associated with loss of cervical lordosis after laminoplasty, while a recent study found that CPE asymmetry was associated with symptoms of degenerative cervical myelopathy. Whether preoperative CPE asymmetry can predict cervical sagittal deformity (CSD) after laminoplasty is unknown.PURPOSETo assess whether asymmetry, degree of degeneration, and extension function of the CPE can be used as predictors of postoperative CSD in patients who undergo laminoplasty.STUDY DESIGNA retrospective study.PATIENT SAMPLEFrom January 2017 to December 2019, 55 patients with multilevel cord compression and myelopathic symptoms were enrolled.OUTCOME MEASURESThe visual analog scale (VAS), neck disability index (NDI), and modified Japanese Orthopedic Association (mJOA) were used to assess cervical spinal function and quality of life.METHODSFrom January 2017 to December 2019, 55 patients undergoing modified laminoplasty were included. The following parameters were measured preoperatively and 24 months postoperatively on X-ray: (1) C0–C2 Cobb angle; (2) C2–C7 Cobb angle (CL); (3) T1 slope (T1S); (5) C2–C7 sagittal vertical axis (SVA); (6) T1S minus CL; (7) Preoperative extension function: Extension CL minus Neutral CL (EF). Preoperative global alignment parameters: (8) spino cranial angle, (9) C7-S1 sagittal vertical axis (C7 SVA), (10) pelvic incidence, (11) lumbar lordosis, (12) thoracic kyphosis. (13) Preoperative CPE parameters: Summation of bilateral total cross-sectional area (STCSA), summation of bilateral total cross-sectional area ratio (STCSAR), total cross-sectional area asymmetry, summation of bilateral functional cross-sectional area of muscle (SFCSA), summation of bilateral functional cross-sectional area of muscle ratio (FCSAR), and functional cross-sectional area of muscle asymmetry (FCSAA). The VAS, mJOA, and NDI were used to evaluate cervical spine function and quality of life. Patients were divided into the CSD group and the non-deformed group (N-CSD) group postoperatively, and the parameters between the two groups were compared. The Pearson correlation coefficient was used to evaluate the relationship between the parameters, and multiple regression analysis and ROC curve analysis were used to determine the predictors and key values.RESULTSCompared with functional scores, mJOA in the CSD group was significantly lower than that in the N-CSD group, while NDI and VAS were significantly higher. Postoperative CL was significantly correlated with EF, SFCSA/STCSA (C3–C6), SFCSAR (C4 and C6), STCSAR (C6), and FSCAA (C6). T1S minus CL was significantly correlated with EF, SFCSA/STCSA (C3–4 and C6), SFCSAR (C4 and C6), STCSAR (C6) and FSCAA (C6). C2–7 SVA was significantly correlated with EF, SFCSAR (C4 and C6), STCSAR (C6), and FSCAA (C6). Multiple regression analysis showed that FCSAA (C6), SFCSAR (C6), SFCSAR (C4), and EF were significant predictors of postoperative CSD. ROC curve analysis showed that the optimal cutoff points were 18.405, 2.95, 4.47, and 11.96.CONCLUSIONSThe present study found that preoperative extension dysfunction of CPEs, asymmetry at the C6 level cervical extensors, and cervical extensor CSAs without fatty infiltration at the C4 and C6 levels were associated with cervical sagittal imbalance after modified laminoplasty. These factors can be considered when future spine surgeons formulate surgical plans.     

Craniocervical instability in patients with Ehlers-Danlos syndrome: controversies in diagnosis and management

Ehlers-Danlos syndrome (EDS) is a rare hereditary condition that can result in ligamentous laxity and hypermobility of the cervical spine. A subset of patients can develop clinical instability of the craniocervical junction associated with pain and neurological dysfunction, potentially warranting treatment with occipitocervical fixation (OCF). Surgical decision-making in patients with EDS can be complicated by difficulty distinguishing from hypermobility inherent in the disease and true pathological instability necessitating intervention. Here we comprehensively review the available medical literature to critically appraise the evidence behind various proposed definitions of instability in the EDS population, and summarize the available outcomes data after OCF. Several radiographic parameters have been used, including the clivo-axial angle, basion-axial interval, and pB-C2 measurement. Despite increasing recognition of EDS by spine surgeons, there remains a paucity of data supporting proposed radiographic parameters for spinal instability among EDS patients. Furthermore, there is a lack of high-quality evidence concerning the efficacy of surgical treatments for chronic debilitating pain prevalent in this population. More standardized clinical measures and rigorous study methodologies are needed to elucidate the role of surgical intervention in this complex patient population.     

次氯酸冲洗的体外安全性及有效性评估

目的：体外实验评估不同次氯酸冲洗用于预防骨折感染的安全性及抗菌效果性方法：体外不同浓度次氯酸刺激小鼠L929和MC3T3细胞,检测细胞克隆形成、增殖及调亡情况评估次氯酸安全性。小鼠红细胞溶血实验评估次氯酸溶血风险。金黄色葡萄球菌及大肠杆菌增殖和抑菌圈实验评估次氯酸有效性及敏感细菌。结果：体外实验表明低浓度次氯酸对小鼠L929和MC3T3细胞的增殖无影响,小鼠红细胞溶血实验阴性。抗菌实验表明低浓度次氯酸具有与碘伏及双氧水类似的抑菌效果,但与其他消毒剂对比无明显差异。结论：本实验结果为低浓度次氯酸应用于临床治疗骨科感染提供体外研究数据。发现低浓度次氯酸安全性高,对革兰阳性菌引起的骨感染治疗效果好,是潜在的临床治疗感染性骨髓缺损、骨髓炎及开放性骨折的清创冲洗剂。