Evaluation of functional MRI markers in mild cognitive impairment

We aimed to investigate the use of advanced functional MRI (fMRI) techniques such as proton magnetic resonance spectroscopy (¹H-MRS) and the apparent diffusion coefficient (ADC) value in diffusion weighted imaging (DWI), in the diagnosis of mild cognitive impairment (MCI). Multiple indicators were combined in order to improve the early diagnostic value of MRS and ADC. We administered MRS and DWI-ADC to 13 patients with Alzheimer’s disease (AD), 9 patients with MCI, and 13 control patients. Changes in N-acetylaspartate/creatine and phosphocreatine (NAA/Cr), myoinositol/creatine (mI/Cr), and the ADC values in the hippocampus and the temporoparietal region were compared among groups. The sensitivity and specificity of different markers were analyzed individually and combined with others. All participants were evaluated by the mini mental state examination (MMSE), and the correlation between NAA/Cr, MI/Cr, ADC and the score of MMSE were analyzed separately. The NAA/Cr, mI/Cr and ADC values in the hippocampus among AD, MCI patients, and controls were significantly different (p < 0.05). At a fixed specificity of 84.6%, the high sensitivity of 100% and 92.9% in differentiating AD and MCI from normal controls were obtained by combining the three indicators. The receiver operating characteristic plots illustrated that the area under the multimarker curve was the biggest among the all four curves, and the sensitivity of the multimarkers was highest. The best correlation was obtained between ADC and MMSE, rather than between NAA or mI and MMSE. Thus, we found that changes in NAA/Cr, mI/Cr and ADC in the hippocampus and the temporoparietal regions were helpful in the clinical diagnosis of MCI. Furthermore, these changes showed potential in predicting the progression of MCI to AD if the multimarkers were combined.     

某医院战略发展规划基线调查分析

目的对R医院的内、外部环境进行全面调查分析,为制定符合自身发展的战略规划提供翔实的参考依据。方法通过文献查阅、现场调查等方法收集资料,并进行定性和定量分析。结果 R医院卫技人员年龄结构以青年、中年为主,学历结构不断优化。医疗市场占有率有所增加,学科建设和综合实力有了增强。流动比率和速动比率皆较好,资产负债率呈下降趋势。医疗服务质量得到了患者、社区居民的认可。结论 R医院的发展面临着挑战多于机会、优势逊于弱势,需在加强学科建设、人才培养、医院文化建设等方面制定相应的策略。     

The Impact of Delinquency on Young Adult Sexual Risk Behaviors and Sexually Transmitted Infections

PurposeYouth in the juvenile justice system have increased sexual risk behavior and sexually transmitted infections (STI). However, research exploring the effect of self-reported delinquency on sexual risk behavior and STI is limited, and results vary depending on the populations studied. Therefore, we used nationally representative data to examine the longitudinal association between delinquent behavior, sexual risk behavior, and STI among adolescents and young adults.MethodsWe used a sample of 10,828 participants from the National Longitudinal Study of Adolescent and Health. Outcomes included STI and sexual risk behavior from Wave III (17–27-year-olds). Predictors for the generalized linear regression models (stratified by gender) include race, age, education, relationship status at Wave III, and delinquent behavior groups (life-course persistent, adolescence-limited, late-onset and nondelinquency).ResultsNone of the delinquency groups were associated with young adult STI. Only life-course persistent delinquency was associated consistently with sexual risk behavior (except for condom use). The adolescence-limited and late-onset groups had limited effects on sexual risk outcomes.ConclusionsLife-course persistent delinquency influences the expression of young adult sexual risk behavior. However, delinquent behavior does not predict STI in a population-based sample of youth. Programs and interventions that address the sexual health of youth need to consider the role of delinquency in shaping sexual risk behaviors, and future research should explore broader societal and environmental risk factors on STIs.     

关于医疗服务连续性的研究

医疗服务的连续性对维护居民健康是十分必要的。医疗服务连续性内涵深刻,必须进行严密的制度设计,并采取一定的策略措施,以保证居民医疗服务连续性的实现,通过蒙特卡罗模拟对居民医疗服务连续性进行评价。     

深静脉穿刺换针器的研制

目的：研制一种深静脉穿刺换针器,以减少深静脉穿刺并发症。方法：将细针隧道、粗针隧道固定连接在一起,使粗细针通过隧道后能准确相交于一点。结果：该换针器能够保证细针探查后粗针顺利进入深静脉。结论：使用换针器可大大提高临床深静脉穿刺的安全性。     

Endoscopic findings and clinicopathologic characteristics of colonic schistosomiasis:A report of 46 cases

AIM:To make a retrospective analysis of endoscopy findings and clinicopathologic characteristics of colonic schistosomiasis in order to further improve our understanding of the disease and decrease its misdiagnosis. METHODS:Endoscopy findings and clinicopathologic characteristics of 46 intestinal schistosomiasis patients were retrospectively analyzed.All the patients underwent colonoscopy and all biopsy specimens stained with hematoxylin and eosin were observed under a light microscope. RESULTS:Of the 46 co...     

<i>CYP11A1</i>基因单核苷酸多态性与多囊卵巢综合征的关系

目的CYP11A1基因单核苷酸多态性(SNP)与多囊卵巢综合征(PCOS)的关系。 方法选择2005年10月至2010年3月于南京大学医学院附属鼓楼医院妇产科就诊的289例PCOS患者为研究对象,并纳入PCOS组;选择同期于本院参加健康体检的220例健康妇女纳入对照组。采用放射免疫法(RIA)检测患者血清中黄体生成素(LH)、促卵泡生成素(FSH)、雌二醇及睾酮水平等。采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)法对两组受试者CYP11A1基因SNP rs4077582和rs11632698位点进行基因分型,分析两组受试者的等位基因型频率及等位基因频率,并对年龄、人体质量指数(BMI)及血清性激素水平在不同基因型受试者中进行比较。本研究遵循的程序符合南京大学医学院附属鼓楼医院医学伦理委员会制定的伦理学标准,本研究得到该委员会批准,分组征得受试者本人及其家属的知情同意,并与之签署临床研究知情同意书。 结果①两组受试者的年龄、BMI等基本资料和FSH、LH、LH/FSH、雌二醇和睾酮等激素水平比较,差异均有统计学意义(P<0.001)。②CYP11A1基因SNP rs4077582等位基因型(CC、CT和TT)在PCOS组患者中的分布分别为24.9%、49.8%和25.3%,而在对照组中分别为34.5%、46.4%和19.1%,二者比较,差异有统计学意义(χ²＝6.399,P＝0.041)。等位基因T在PCOS组中的频率显著高于对照组(χ²＝6.263,P＝0.012)。而CYP11A1基因SNP rs11632698的等位基因型分布在两组受试者中比较,差异无统计学意义(χ²＝3.416,P＝0.181)。③血清学检测结果显示,PCOS组中,CYP11A1基因SNP rs4077582位点3个不同基因型PCOS患者的年龄、BMI等基本资料和各性激素水平比较,差异均无统计学意义(P>0.05)。而在对照组中,LH与LH/FSH在3个不同基因型受试者(CC、CT、TT)间比较,差异有统计学意义(F＝9.362、21.046,P<0.001)。 结论CYP11A1基因SNP rs4077582位点与PCOS的易感性有关,其作用机制可能是通过调节个体的LH水平最终影响雄激素合成速率,而SNP rs11632698则与PCOS发病无关。     

血清胆红素浓度与急性ST段抬高型心肌梗死患者住院病死率的关系

目的 探讨血清总胆红素(serum total bilirubin,STB)及直接胆红素(serum direct bilirubin,SDB)浓度与急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)术后住院病死率的关系。 方法 收集南京鼓楼医院427例因急性STEMI入院患者的临床资料,分析STB、SDB与其住院病死率的关系。研究分为死亡组和存活组2组,使用SPSS 20.0统计学软件进行差异性检验、ROC曲线分析、COX比例风险回归分析。 结果 PCI术后较高的STB (STB≥19.85 μmol/L)、较高的SDB (SDB≥4.65 μmol/L)均会增加急性STEMI患者住院期间病死率(分别为:HR=2.38,95%CI:1.05～5.40;HR=3.91,95%CI:1.66～9.17)。校正其他混杂因素(性别、吸烟、饮酒、高血压、糖尿病、卒中、心梗部位等)后,较高的STB及较高的SDB仍然是急性STEMI患者住院期间高病死率的独立危险因素(分别为:HR=2.71,95%CI:1.19～6.16;HR=4.49,95%CI:1.90～10.59)。 结论 急性STEMI患者PCI术后较高的STB及较高的SDB浓度可显著增加患者的住院病死率。      

阻塞性睡眠呼吸暂停低通气综合征患者认知功能损害的研究

目的 通过高级神经认知功能量表评估阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的认知功能损害程度,并根据多导睡眠图(PSG)的监测结果分析OSAHS患者认知功能的受损情况。 方法 通过纳入55例OSAHS患者和27例正常对照组的PSG结果,并采集认知功能相关量表,以评估OSAHS患者认知受损情况及其与PSG相关参数之间的相关性,并分析与认知功能受损有关的PSG参数的最佳界值。 结果 (1)两组之间性别、年龄及受教育程度差异无明显统计学意义(P>0.05);(2)两组间呼吸暂停低通气指数(AHI)、呼吸暂停指数、最长呼吸暂停时间、低通气指数、氧减指数(ODI)、夜间平均动脉血氧饱和度(MSaO₂)、夜间最低血氧饱和度(LSaO₂)、睡眠期间血氧饱和度低于90%的时间占总睡眠时间的百分比(TST<0.9)的差异均有统计学意义(均P<0.05);(3)两组睡眠结构结果对照,可见总睡眠时间及睡眠结构的差异无统计学意义(P>0.05);(4)两组简易精神状态量表(MMSE)结果可见两组MMSE评分,及其中定向力的差异有统计学意义(P<0.05);(5)两组高级神经功能量表结果对照,可见两组间Epworth嗜睡量表(ESS)、STOP Bang、逻辑记忆测验(LMT)及延迟回忆(LMT DR)差异有统计学意义(P<0.05);(6)高级神经认知功能量表与PSG有关参数的相关性结果显示AHI及呼吸暂停指数这两个参数与各高级神经功能量表间相关性最强;最长呼吸暂停时间、低通气指数、ODI、TST<0.9、MSaO₂和LSaO₂与各量表存在一定的相关性,而觉醒次数及鼾声指数则无明显相关性;(7)MMSE的筛查效度比较,结果显示ROC曲线下面积(AUC)为0.664,在界值为29.5时,约登指数最高,为0.32,此时MMSE量表灵敏度为76.4%,特异度为55.6%;(8)PSG参数的效度筛查结果显示,呼吸暂停指数的最佳界值为5.15,最长呼吸暂停时间的最佳界值为105 s,低通气指数的最佳界值为0.55,ODI的最佳界值为3.1,TST<0.9的最佳界值为0.27%,MSaO₂的最佳界值为96.5%,LSaO₂的最佳界值为81.5%。 结论 (1)OSAHS患者夜间存在反复呼吸暂停及低通气,引起低氧血症,进而导致认知功能障碍的发生;(2)OSAHS患者夜间总睡眠时间无明显减少,睡眠结构未见明显紊乱;(3)OSAHS患者认知功能存在不同程度的受损,且与疾病严重程度密切相关;(4)OSAHS患者认知功能中定向力、逻辑记忆及回忆能力方面受损明显;(5)呼吸暂停指数>5.15,和(或)最长呼吸暂停时间>105 s,和(或)低通气指数>0.55,和(或)ODI>3.1、和(或)TST<0.9>0.27%、和(或)MSaO₂<96.5%,和(或)LSaO₂<81.5%时,可以快速提示临床医生OSAHS患者可能存在的认知功能受损。     

TNF-α和IL-8在突发性聋患者血清及外周血单个核细胞中的表达及其意义

目的 探讨TNF-α和IL-8在突发性聋患者血清及外周血单个核细胞(PBMC)中的表达及其临床意义。 方法 选择突发性耳聋患者44例作为实验组,健康志愿者32例作为对照组,分别测定血清和PBMC上清液中的TNF-α和IL-8的浓度以及PBMC细胞中TNF-α和IL-8的mRNA表达水平。 结果 TNF-α和IL-8在实验组患者血清中的浓度与对照组比较,差异无统计学意义(P>0.05);TNF-α和IL-8在PBMC上清液中的浓度明显增加,且在PBMC细胞中mRNA表达水平显著提高,差异具有统计学意义(P<0.05)。 结论 TNF-α和IL-8的浓度在突发性聋患者体内升高与内耳的免疫介导机制密切相关,提示炎症反应在突发性聋的发生中起着重要作用,为突发性耳聋的诊断及治疗提供新思路和方法。