肠内营养液的温度、速度对胃肠道并发症的影响

目的:探讨不同温度、速度肠内营养(enteral nutrition,EN)液输注对患者胃肠道并发症的影响.方法:将240例进行EN的患者根据使用加温营养泵与否,分为观察组与对照组,各120例.同时将观察组再根据营养泵给液速度,分为01、02、03 3组,对照组也根据以上方法,分为C1、C2、C3 3组,每组40例.01、C1组EN泵给液速度为60-70 mL/h,02、C2组EN泵给液速80-100 mL/h,03、C3组EN泵给液速度为110-120 mL/h.观察各组患者胃肠道并发症的发生情况.结果:观察组与对照组在胃肠道并发症发生率、胃潴留发生情况、EN时间方面比较差异有统计学意义;同时,不同的输注速度在上述方面比较差异有统计学意义.结论:通过使用加温营养泵,温度控制在37℃-40℃,且输注速度在80-100 mL/h时可有效减少胃肠道并发症的发生,达到临床满意的效果,值得临床推广应用.     

Do different types of stress differentially alter behavioural and neurobiological outcomes associated with depression in rodent models? A systematic review

Cataloguing the effects of different types of stress on behaviour and physiology in rodent models has not been comprehensively attempted. Here, we systematically review whether chronic exposure to physical stress, psychosocial stress, or both types of stress can induce different behavioural and neurobiological outcomes in male and female rodents. We found that physical stress consistently increased depressive-like behaviour, impaired social interaction and decreased body weight, while psychosocial stress consistently increased both anxiety- and depressive-like behaviour, impaired social interaction and learning and memory, increased HPA axis activity, peripheral inflammation and microglial activation, and decreased hippocampal neurogenesis in male rodents. Moreover, we found that the combined effect of both stress types resulted in a more severe pathological state defined by increased anxiety- and depressive-like behaviour, impaired social interaction and learning and memory, increased HPA axis activity and central inflammation, and reduced hippocampal neurogenesis and neural plasticity in male rodents. Phenotypes for females were less consistent, irrespective of the type of stress exposure, on account of the limited number of studies using females. This review highlights that the type of stress may indeed matter and will help animal researchers to more appropriately choose a stress/depression model that fits their research purposes.     

二甲双胍通过激活AMPK/STAT3通路调控巨噬细胞分化抑制小鼠动脉粥样硬化形成

目的 探究二甲双胍(Met)通过腺苷酸活化蛋白激酶(AMPK)/信号转导及转录激活因子3(STAT3)信号通路调控巨噬细胞表型对小鼠动脉粥样硬化(As)形成的影响。方法 体外培养RAW264.7巨噬细胞,使用脂多糖促进巨噬细胞分化,同时使用Met刺激细胞。流式细胞术检测不同表型(CD86、CD206)巨噬细胞比例。Western blot检测相关信号通路蛋白诱导型一氧化氮合酶(iNOS)、精氨酸酶1(Arg-1)、AMPK、磷酸化AMPK(pAMPK)、STAT3、磷酸化STAT3(pSTAT3)蛋白表达水平。高脂饲料喂养ApoE－/－小鼠构建As模型。实验组(Met组)小鼠予Met灌胃干预,对照组(CTL组)小鼠给予同体积生理盐水灌胃干预。3个月后,提取小鼠大动脉全长(头臂干至双侧髂动脉)及主动脉根部,分别行油红O染色和免疫荧光染色,评价主动脉脂质沉积情况和脂质斑块内巨噬细胞不同表型比例。提取大动脉蛋白,Western blot验证相关信号通路的AMPK、pAMPK、STAT3、pSTAT3蛋白表达水平。结果 细胞实验表明,Met刺激后M1巨噬细胞比例明显减少,M2巨噬细胞比例明显增加(P＜0.05),AMPK活性明显增加,而STAT3活性明显下降。动物实验表明,在造模3个月后,油红O染色示Met组小鼠大动脉全长和主动脉瓣膜处脂质沉积均较CTL组明显减少(P＜0.05)；免疫荧光染色示Met组脂质斑块内M1巨噬细胞比例较CTL组明显减少,而M2巨噬细胞比例较CTL组明显增多(P＜0.05)。Western blot实验显示,与CTL组相比,Met组AMPK活性明显增加,而STAT3活性明显降低(P＜0.05)。结论 Met通过激活AMPK抑制STAT3活性,调控斑块内巨噬细胞表型分化,抑制小鼠As形成。     

Postoperative complications of Goel-Harms C1-C2 screw-rod fixation technique for C1-C2 instability after C2 nerve sacrifice,a prospective study over two years follow up

BackgroundAtlantoaxial instability is mainly caused by trauma. C2 nerve is usually needed to be sacrificed for adequate exposure of the lateral mass and screw insertion.ObjectivesThis study aimed to investigate the clinical outcome of postoperative complications of C1 and C2 screw-rod fixation using the Goel-Harms technique for C1-C2 instability after sacrificing the C2 nerve root.MethodsAmongst forty patients with C1-C2 pathology, twenty-seven cases were enrolled into the study, then variables, including age, sex, primary pathology, operation duration, postoperative pain, paresthesia, anesthesia, and other specific conditions, were documented. Data analyzed by an expert biostatistician. p-value < 0.05 was considered significant.ResultsRegardless of gender, the most postoperative adverse effect was occipital anesthesia (81.5%). Most of the patients (63%) had both occipital pain and anesthesia one-month post-surgery. At 3- and 6-months post-surgery, occipital pain and anesthesia were seen in 40.7% and 14.8%, respectively.ConclusionThe most common postoperative adverse effect of C2 nerve root scarification after C1-C2 fixation is occipital anesthesia followed by occipital paresthesia and pain, which are reduced in severity over time.     

RICE: A method for quantitative mammographic image enhancement

We introduce Region of Interest Contrast Enhancement (RICE) to identify focal densities in mammograms. It aims to help radiologists: 1) enhancing the contrast of mammographic images; and 2) detecting regions of interest (such as focal densities) that are candidate masses potentially masked behind dense parenchyma. Cancer masking is an unsolved issue, particularly in breast density categories BI-RADS C and D. RICE suppresses normal breast parenchyma in order to highlight focal densities. Unlike methods that enhance mammograms by modifying the dynamic range of an image; RICE relies on the actual tissue composition of the breast. It segments Volumetric Breast Density (VBD) maps into smaller regions and then applies a recursive mechanism to estimate the ‘neighbourhood’ for each segment. The method then subtracts and updates the neighbourhood, or the encompassing tissue, from each piecewise constant component of the breast image. This not only enhances the appearance of a candidate mass but also helps in estimating the mass density. In extensive experiments, RICE enhances focal densities in all breast density types including the most challenging category BI-RADS D. Suitably adapted, RICE can be used as a precursor to any computer-aided diagnostics and detection system.     

Genome characteristics and molecular evolution of the human sapovirus variant GII.8

Human sapovirus is regarded as an important viral agent for acute diarrhea worldwide. GII.8, a recently reported genotype, has been detected in a few countries and regions. In this study, we obtained the first genome sequence of a sapovirus GII.8 strain isolated in mainland China, and comprehensively analyzed the genetic diversity and evolutionary process of this genotype. The viral genome of the new GII.8 Guangzhou strain GZ2014-L231 comprised 7433 nucleotides, including two ORFs. Pairwise alignments of the new genome with representative sequences of different genotypes showed inconsistent homology between different protein-encoding regions, of which NS1 and VP2 were found as the variable proteins, and NS3, NS5, and NS6/7 were found as the conserved ones. Compared with other reported GII.8 genomes, the Guangzhou strain introduced 34 new nucleotide changes and one new amino acid change. Phylogenetic analysis based on full-length VP1 sequences demonstrated that 11 GII.8 strains could be divided into 4 clusters A-D, with 88 SNP and 10 SAP spots occurred during their evolutionary process. The Guangzhou strain has higher homology with seven GII.8 strain detected after 2014, especially the US and Peruvian strains of 2015/2016, which have the identical VP1 amino acid sequences. Using a Bayesian coalescent method based on VP1 sequences, GII.8 was predicted to emerge in 2001 with the evolution rate of 1.45 × 10⁻³ nucleotide substitutions/site/year (strict clock). In summary, the data in this study not only provided reference data from mainland China for sapovirus researches in future, but also firstly described the evolutionary process of the GII.8 genotype.     

Social and behavioral determinants of attitudes towards and practices of hepatitis B vaccine birth dose in Vietnam

BackgroundHepatitis B virus (HBV) infection is a significant public health issue in Vietnam. Our goal was to understand the determinants of attitudes towards and practices of hepatitis B vaccine birth dose (HepB-BD) in certain regions of Vietnam.MethodA rapid qualitative assessment was conducted in three geographically diverse provinces that reported low coverage (<50%) of HepB-BD. Using purposive sampling of participants, 29 focus group discussions and 20 in-depth interviews were held with caregivers (n = 96), healthcare providers (n = 75), and healthcare administrators (n = 16). Summary notes from these were translated, and inductive coding was used to derive themes. The SAGE Vaccine Hesitancy Determinants Matrix was used as a theoretical framework to organize barriers and facilitators associated with the themes into three levels of influence.ResultsAt the individual and group level, caregivers who had higher levels of knowledge about HepB-BD sought the vaccine proactively, while others with lower knowledge faced barriers to the vaccine. Some caregivers reported a negative attitude toward health services because of a language barrier or had generalized concerns about HepB-BD due to media reporting of the past adverse events. Distress arising from potential adverse events was equally common among healthcare providers. At the contextual level, the physical environment made it difficult for caregivers to access healthcare facilities and for providers to conduct outreach. Home births posed a challenge for timely administration of HepB-BD, while health facility births facilitated it. Vaccination-specific barriers included misinterpretation of pre-vaccination screening criteria and asking for the consent of caregivers. Inadequate resources for service delivery negatively influenced HepB-BD attitudes and practices.ConclusionGiven the diversity of barriers associated with attitudes towards and practices of HepB-BD in the three provinces, tailored interventions will be necessary for both demand- and supply-side factors. Rural areas, often with more home births and geographic barriers, may require focused attention.     

广州地区急性腹泻患儿粪便中多重耐药及高毒力肺炎克雷伯菌分布检测

目的 了解广州地区急性腹泻患儿粪便中肺炎克雷伯菌的携带情况,以及其中具有多重耐药性和高毒力的肺炎克雷伯菌菌株的分布情况。方法 2015年5~9月,采集广州市某医院门诊腹泻患儿的粪便样本,分离鉴定肺炎克雷伯菌并进行药敏试验,同时筛检产超广谱β-内酰胺酶（extended-spectrum β-lactamases,ESBLs）菌株。采用聚合酶链式反应（polymerase chain reaction,PCR）实验检测产ESBLs菌株中具有耐药基因bla_TEM、bla_SHV和bla_CTX-M的菌株分布情况;用PCR实验检测所有分离菌株中六种常见高毒力荚膜血清型的分布情况。结果 在87份腹泻患儿粪便样本中,肺炎克雷伯菌检出率为66.7%。分离株对青霉素类抗菌药物、第一代头孢菌素和呋喃妥因的耐药率较高;而对二、三、四代头孢类抗菌素、喹诺酮类、氨基糖苷类抗生素耐药性较低,且未检出耐碳青霉烯肺炎克雷伯菌;产ESBLs肺炎克雷伯菌检出率为12.1%（7/58）,其中检出4株bla_CTX-M和2株bla_TEM基因型菌株,未检出含bla_SHV基因型菌株;所有分离株的多重耐药率为27.6%。共检出高毒力肺炎克雷伯菌K2、K20、K54型各1株,未检出K1、K5及K57型。结论 腹泻患儿粪便中肺炎克雷伯菌分离率较高,多重耐药性菌株比例较高,而且存在具有多重耐药同时高毒力的菌株,应引起重视。     

Frailty as a predictor of adverse outcomes in hospitalized older adults: A systematic review and meta-analysis

Frailty syndrome is prevalent among hospitalized older adults as are the occurrence of adverse outcomes. This systematic review and meta-analysis investigated whether frailty in older adults at hospital admission predicts adverse outcomes. Manual (ProQuest, conferences annals and references) and electronic searches (PUBMED, EMBASE, Web of Science, Lilacs, CINAHL, PsycINFO and Google Scholar) were performed. We included prospective studies of hospitalized older adults. Primary outcomes were functional decline at hospital discharge and mortality after discharge. Other data were considered secondary outcomes. Methodological quality was evaluated by the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Twenty-eight papers were included, corresponding to 19 cohorts (5 cohorts for functional decline and 16 for mortality), with moderate to good methodological quality. Being frail [RR: 1.32 (95%CI: 1.04; 1.67)] and pre-frail [RR: 1.51 (95%CI: 1.05; 2.17)] are risk factors for functional decline compared with being nonfrail. Frail individuals had a relative risk for in-hospital mortality and mortality in medium- and long-term compared to nonfrail (in-hospital RR: 8.20, medium RR: 9.49 and long RR: 7.94) and pre-frail (in-hospital RR: 3.19, medium RR: 3.31 and long RR: 3.72). The overall mortality risk in frail individuals is 3.49 and 2.14 times compared to nonfrail and pre-frail, respectively. Length of hospital stay was higher for frail older adults (13.5 days) compared with pre-frail (10.5 days) and nonfrail (8.3 days). Therefore, being frail at hospital admission is a risk factor for in-hospital mortality, long hospital stay, functional decline at hospital discharge, and mortality in the medium- and long-term.