自发性脑出血患者流行病学特点与死亡影响因素分析

目的探讨自发性脑出血（SICH）患者的流行病学特点,并分析其死亡的影响因素。 方法回顾性分析解放军联勤保障部队第九〇九医院神经外科自2015年1月至2021年12月收治的2765例SICH患者的流行病学资料,分析流行病学特征,并根据治疗结局将患者分为存活组（2497例）和死亡组（268例）,采用单因素和Logistic多因素回归分析死亡的影响因素。 结果2765例患者中,男女比例2.54∶1,50岁以上患者是20~50岁患者的2.48倍;第四季度发病率分别是一、二、三季度的1.85、1.88、1.61倍;凌晨发病率分别是上午、下午和晚上的1.69、1.65、1.39倍。单因素分析和Logistic多因素分析结果显示沿海地区、脑出血家族史、入院GCS评分、脑干出血、血肿体积、中线移位≥5 mm是预后的独立影响因素。 结论本地区SICH患者中男性比例高于女性,第四季度和凌晨发病率较高,重视沿海地区和脑出血家族史人员,结合入院GCS评分、出血体积和中线移位情况可以判断患者的预后情况。     

国内人工肝支持系统治疗重型肝炎疗效的Meta分析

目的探讨国内应用人工肝支持系统治疗重型肝炎的疗效。方法检索国内1990-2005年公开发表的人工肝治疗重型肝炎相关论文及会议论文，提取其中的生存率或出院时临床好转率等可以反映远期预后的资料，以比值比（OR）为效应量进行异质性检验和统计量合并分析。结果入选的10项研究中，共包含重型肝炎患者1030例，对照组均给予常规内科治疗，治疗组均为常规内科治疗联合人工肝治疗。早期、中期、晚期治疗组和对照组比较，其合并OR值（95％可信区间）分别为3．72（2．03～6．83）、2．79（2．88～4．14）和1．85（0．96～3．56）。结论和常规内科治疗相比，人工肝支持系统可显著改善早期及中期重型肝炎患者的远期预后，而对晚期重型肝炎患者远期预后无明显改善。     

阿托伐他汀对冠心病并慢性心力衰竭及心房纤颤患者的预后研究

目的：研究阿托伐他汀治疗对冠心病并慢性心力衰竭(CHF)及心房纤颤(AF)患者的影响。方法62例冠心病并CHF及AF住院患者随机分成两组,他汀组32例,非他汀组30例,两组患者均常规抗心衰等治疗,而他汀组加用阿托伐他汀(立普妥)20 mg/d,分别随访1年,观察两组出院后不同类型房颤的复发及维持情况,评估随访1年内主要不良心血管事件(心血管死亡、非致死性心肌梗死及卒中)风险及心衰再住院率。结果治疗前两组在性别、年龄、并存疾病、AF类型、NYHA心功能分级、左室射血分数(LVEF)、左房内径(LAD)左室舒张末期内径(LVEDD)方面比较差异均无统计学意义(P>0.05)。随访期间主要心血管不良事件发生率他汀组和非他汀组比较差异无统计学意义(31.3%vs 53.3%,χ2=3.817,P=0.282);而他汀组的心衰再住院率减低(25.0%vs 50.0%,P=0.042);阵发性AF复发率他汀组较之非他汀组降低(28.1%vs 53.3%,P=0.043);但持续性房颤复发率两者差异无统计学意义(18.8%vs 20.0%,P=0.901)。结论阿托伐他汀可减少冠心病并CHF及AF患者的阵发性AF复发、降低心衰再住院率,但对主要心血管不良事件发生率无明显影响。     

Pancreatic and gut hormone responses to mixed meal test in post-chronic pancreatitis diabetes mellitus

ObjectiveMore than one-third of chronic pancreatitis patients will eventually develop diabetes, recently classified as post-chronic pancreatitis diabetes mellitus (PPDM-C). This study was aimed to investigate the pancreatic and gut hormone responses to a mixed meal test in PPDM-C patients, compared with non-diabetic chronic pancreatitis (CP), and type 2 diabetes patients or healthy controls.Design and methodsSixteen patients with PPDM-C, 12 with non-diabetic CP as well as 10 with type 2 diabetes and healthy controls were recruited. All participants underwent mixed meal tests, and blood samples were collected for measurements of blood glucose, C-peptide, insulin, glucagon, pancreatic polypeptide (PP), ghrelin, peptide YY, glucagon like peptide-1 (GLP-1) and gastric inhibitory peptide (GIP). Indices of insulin sensitivity and secretion were calculated. Repeated measures analysis of variance was performed.ResultsParticipants with PPDM-C exhibited decreases in both fasting and postprandial responses of C-peptide (P < 0.001), insulin (P < 0.001), ghrelin (P < 0.001) and PYY (P = 0.006) compared to participants with type 2 diabetes and healthy controls. Patients with CP showed blunted glucagon, PP and incretin reactions, while the responses were increased in patients with PPDM-C compared to controls. The level of insulin sensitivity was higher for PPDM-C than type 2 diabetes (P < 0.01), however the indices for early/late-phase and overall insulin secretion (P < 0.01) were lower.ConclusionsPatients with PPDM-C are characterized by decreased C-peptide, insulin, ghrelin and PYY responses, and similar levels of glucagon, PP, GIP and GLP-1 compared to those with type 2 diabetes. The above findings, when confirmed in a larger population, may prove helpful to establish the diagnosis of PPDM-C, and should promote study on underlying pathophysiological mechanisms.     

女性肺癌易感因素、围术期护理及疗效调查

目的探讨女性肺癌患者易感因素、围术期注意事项及疗效。方法了解女性患肺癌的影响因素,对115例女性肺癌患者及同期手术的123例男性肺癌患者术后近期并发症进行分析,了解哪些因素是围术期护理的重点,电话随访统计5年生存率有无差异。结果女性肺癌患者有其特殊的易感分子因素,术后女性相对男性肺部感染、肺不张并发症较少,切口脂肪液化较男性多见,对疼痛的耐受程度较男性差,女性肺癌患者术后5年生存率高于男性患者。结论女性肺癌和男性肺癌发病有着不同的生物学基础,女性患者围术期护理尤其是术后护理有不同之处,女性肺癌患者术后5年生存率较高。     

急性心肌梗死行冠状动脉内支架术初步探讨

目的评价急诊冠状动脉内支架术治疗急性心肌梗死的疗效及安全性.方法 48例急性心肌梗死患者入院6 h内接受急诊介入治疗,共置入支架58枚,术后行即刻血管造影评价,观察住院及近期临床事件.结果 44例(92%)患者梗死相关动脉(IRA)重建后TIMI-3级血流,全部病例IRA残余狭窄<30%.住院期间1例死亡,无急性再闭塞,急诊搭桥及严重出血发生.随访6个月,无再次心肌梗死、需外科血运重建术、卒中、脏器出血和死亡等重大临床事件.结论急诊支架置入术治疗急性心肌梗死成功率高,住院及近期临床效果好,是抢救急性心肌梗死的安全可靠方法.     

肝衰竭患者合并肺曲霉菌病7例临床分析

目的：探讨肝衰竭患者合并肺曲霉菌病的临床特点。方法：收集东南大学医学院附属第二医院近4年被诊断为肝衰竭合并肺曲霉菌病7例患者的临床资料并进行相关分析。结果：7例患者均有使用广谱抗生素、人工肝治疗;5例激素治疗。临床表现为发热、咳嗽、咳痰、胸闷,血象明显增高,肺部浸润性病变。6例进行抗真菌治疗,1例死亡。行抗真菌治疗的6例病情恶化,放弃治疗,自动出院后随访均死亡。结论：肝衰竭患者合并肺曲霉菌病,大多有使用广谱抗生素、激素和人工肝治疗,处于肝衰竭终末期,病死率高,早期诊断、及时治疗可能改善预后。     

The Reliability and Validity of Post Stroke Depression Scale in Different Type of Post Stroke Depression Patients

ObjectiveA self-rating post stroke depression scale (PSDS) showed a good reliability and validity to assess severity of depressive symptoms among stroke patients. This study aimed to retest the psychometric properties of PSDS in different types of post-stroke depression (PSD).Materials and methodsA total of 170 stroke patients were recruited in the study. 82 and 25 patients were respectively diagnosed as PSD symptoms disorder (PSDSD) and PSD disorder (PSDD) patients according to their respective diagnostic criteria. The PSDS and the 9-item Patient Health Questionnaire (PHQ-9) were used to assess the severity of depression. Cronbach α, Spearman rank coefficient and independent sample t-test were conducted to examine reliability, internal consistency and discriminate validity. Then the receiver operating characteristic curve and Youden index were used to performance evaluation and cut-off value respectively in different subtypes of PSD patients.ResultsThe Cronbach α of PSDS was 0.857, indicting a good reliability. The Spearman correlation coefficient between PSDS and PHQ-9 was 0.942 (P<0.001). The discriminate validity displayed significant difference between PSDSD as well as PSDD and no depression patients (all P<0.001). 5/24 and 10/24 were the cut-off value for PSDSD and PSDD patients.ConclusionsPSDS is a useful screen tool with an acceptable psychometric properties for estimation of different subtypes of PSD patients.     

Neuromagnetic coherence of epileptic activity: An MEG study

PurposeThis study was undertaken to test the hypothesis that patients with epilepsy have abnormal imaginary coherence compared with control subjects.MethodsThirty patients with seizures underwent magnetoencephalography (MEG) recording using a whole cortex MEG system. Conventional equivalent current dipoles (ECDs) and synthetic aperture magnetometry (SAM) were used to analyze MEG data. Neural synchronization was studied using imaginary coherence to analyze resting-state MEG data. The ECDs, SAM, and MEG results were then compared with intra/extra-operative EEG.ResultsAbnormal imaginary coherence was identified in all patients (30/30, 100%). The locations of abnormal imaginary coherence were in agreement with the ECDs locations of spikes in 23 patients (23/30, 76.7%). The ECD locations in 5 patients were scattered or located bilaterally. The locations of abnormal imaginary coherence were in agreement with SAM locations in 26 patients (26/30, 86.7%). One case of imaginary coherence was located in two lobes. The ECDs fit locations were in agreement with SAM locations in 21 patients (21/30, 70.0%). The locations of abnormal imaginary coherence, ECDs, and SAM were in agreement with intra/extra-operative EEG in 23 patients (23/30, 76.7%), 17 patients (17/30, 56.7%), and 20 patients (20/30, 66.7%), respectively. The results of ECDs location, SAM location, imaginary coherence, and intracranial EEG (iEEG) were consistent in 15 patients (15/30, 50%).ConclusionsThe results show that patients with epilepsy have abnormal imaginary coherence, and suggest that the location and coherence of epileptic activity could be quantitatively identified and analyzed using neuromagnetic signals.     

The biomechanical influence of the facet joint orientation and the facet tropism in the lumbar spine

Background contextFacet joint orientation and facet tropism (FT) are presented as the potential anatomical predisposing factors for lumbar degenerative changes that may lead in turn to early degeneration and herniation of the corresponding disc or degenerative spondylolisthesis. However, no biomechanical study of this concept has been reported.PurposeTo investigate the biomechanical influence of the facet orientation and FT on stress on the corresponding segment.Study designFinite element analysis.MethodsThree models, F50, F55, and F60 were simulated with different facet joint orientations (50°, 55°, and 60° relative to coronal plane) at both L2–L3 facet joints. A FT model was also simulated to represent a 50° facet joint angle at the right side and a 60° facet joint angle at the left side in the L2–L3 segment. In each model, the intradiscal pressures were investigated under four pure moments and anterior shear force. Facet contact forces at the L2–L3 segment were also analyzed under extension and torsion moments and anterior shear force. This study was supported by 5000 CHF grant of 2011 AO Spine Research Korea fund. The authors of this study have no topic-specific potential conflicts of interest related to this study.ResultsThe F50, F55, and F60 models did not differ in the intradiscal pressures generated under four pure moments: but under anterior shear force, the F60 and FT models showed increases of intradiscal pressure. The F50 model under extension and the F60 model under torsion each generated an increase in facet contact force. In all conditions tested, the FT model yielded the greatest increase of intradiscal pressure and facet contact force of all the models.ConclusionsThe facet orientation per se did not increase disc stress or facet joint stress prominently at the corresponding level under four pure moments, but FT could make the corresponding segment more vulnerable to external moments or anterior shear force.