70例免疫球蛋白辅助治疗老年脓毒症患者效果的研究

目的 探讨免疫球蛋白辅助治疗老年脓毒症患者的疗效,研究死亡患者的临床特征,分析临床指标对患者预后的预测价值。方法 选取2017年1月-2020年5月解放军总医院第六医学中心诊治的140例老年脓毒症患者,常规治疗+免疫球蛋白治疗70例为研究组,常规治疗70例为对照组,评估免疫球蛋白治疗效果及治疗前后临床指标情况。根据患者28 d预后情况分为存活及死亡两亚组,采用受试者工作曲线 (ROC)评价临床指标对患者预后的预测价值。结果 研究组与对照组患者一般情况差异无统计学意义（P>0.05）;研究组28 d死亡率下降,但与对照组比较差异无统计学意义（P>0.05）;免疫球蛋白辅助治疗能更好的降低C反应蛋白（CRP）等炎性指标,差异有统计学意义（P<0.05）;存活和死亡亚组患者临床指标单因素分析,结果示SOFA、APACHEⅡ、乳酸（Lac）、降钙素原（PCT）和血小板差异有统计学意义（P<0.05）;多因素logistic分析示SOFA、APACHEⅡ和Lac是影响预后的独立危险因素;将预测值纳入受试者工作曲线（ROC）,结果显示曲线下面积（AUC）为0.854,95%置信区间为（0.789～0.919）。结论 免疫球蛋白辅助治疗老年脓毒症患者的死亡率下降,但差异无统计学意义;SOFA、APACHEⅡ和Lac对患者预后预测效能较好。     

术前罗哌卡因联合右美托咪定和地塞米松髂筋膜间隙阻滞在高龄患者半髋关节置换术中的应用及对患者应激反应的影响

目的 探讨术前罗哌卡因联合右美托咪定和地塞米松行髂筋膜间隙阻滞对高龄患者半髋关节置换术后镇痛效果和应激反应的影响。方法 选取2020年01月至2021年10月入住中国人民解放军总医院第六医学中心拟行半髋关节置换术的高龄患者90例并随机分成两组,每组患者均于术前24 h及手术当日麻醉前30 min行骨折侧超声引导下腹股沟韧带上髂筋膜间隙阻滞,对照组患者使用0.375%罗哌卡因30 mL,观察组患者使用0.375%罗哌卡因联合0.5 μg/kg右美托咪定和0.1mg/kg地塞米松共30 mL,术后两组患者均连接静脉自控镇痛泵。比较两组患者入院后即刻（T0）、术前实施神经阻滞后12 h（T1）、入室时（T2）、术后12 h（T3）、24 h（T4）和48 h（T5）的静息视觉模拟评分（visual analogue scores, VAS）及T3~T5时刻的运动VAS评分;并记录两组患者术后镇痛泵的首次按压时间,镇痛药的使用剂量和不良反应的发生率;同时比较两组患者术前和术后1 d血清白细胞介素-6（interleukin-6, IL-6）、C反应蛋白（c reactive protein, CRP）、皮质醇（cortisol, Cor）、去甲肾上腺素（norepinephrine, NE）和肾上腺素（epinephrine, E）水平。结果 与对照组比较,观察组患者T2和T4时刻的静息VAS评分以及T3~T5时刻的运动VAS评分均降低（P<0.05）,且术后镇痛泵的首次使用时间推迟,镇痛药的使用剂量减少（P<0.05）。术后1 d,观察组血清IL-6、CRP、Cor、NE和E的水平明显低于对照组（P<0.05）,但两组患者术后并发症和不良反应的发生率比较,差异无统计学意义（P>0.05）。结论 术前罗哌卡因联合右美托咪定和地塞米松行髂筋膜间隙阻滞可有效减轻高龄患者半髋关节置换术后的疼痛程度、延长镇痛时间、减轻术后炎症和应激反应,且安全可靠。     

MicroRNA-21* regulates the prosurvival effect of GM-CSF on human eosinophils

Eosinophils are the principal effector cells of allergic inflammation, and hematopoietic cytokine granulocyte macrophage colony-stimulating factor (GM-CSF) is the primary cytokine that activates and prolongs the survival of eosinophils in local inflammatory sites by mediating anti-apoptotic activity in allergic inflammation. To investigate the immunopathological role of microRNA (miRNA) in allergic inflammation, we elucidated the regulatory mechanisms of miRNA on the GM-CSF-mediated in vitro survival in eosinophils. Eosinophils were purified from fresh human peripheral blood buffy coat fraction obtained from adult volunteer using microbead magnetic cell sorting. The apoptosis, viability and phosphorylation of extracellular signal-regulated kinase (ERK) were assessed by flow cytometry, and the expression of miRNA was analyzed using Agilent Human miRNA Microarray with Human miRNA Microarray Version 3 and real time RT-PCR. We have confirmed the increased in vitro viability of GM-CSF-treated eosinophils and upregulated expression of miRNA-21* (miR-21*), a complementary miRNA of miR-21, in GM-CSF-treated eosinophils. The transfection of pre-miR miR-21* precursor molecule could up-regulate the miR-21* expression, subsequently enhance the GM-CSF-activated ERK pathway and reverse the apoptosis of eosinophils, while anti-miR-21* inhibitor could down-regulate the miR-21* expression, suppress the GM-CSF-activated ERK pathway and enhance the apoptosis. Our results should shed light on the potential immunopathological role of miRNA-21* regulating the in vitro apoptosis of eosinophils and development of novel molecular treatment of allergic inflammation.     

Mental Health Multimorbidity among Caregivers of Older Adults During the COVID-19 Epidemic

ObjectiveTo investigate mental health status and associated factors among caregivers of older adults during the COVID-19 epidemic in China.MethodsFrom March 1 to 31, 2020, 916 caregivers of older adults participated in an online cross-sectional survey on the prevalence of anxiety, depression, and sleep problems. The seven-item Generalized Anxiety Disorder Scale (GAD-7) was administered to measure anxiety symptoms, the two-item Patient Health Questionnaire (PHQ-2) was used to assess depressive symptoms, and a self-developed questionnaire was used to assess sleep quality and duration. Six questions about COVID-19-related experiences were used to assess community-level infection contact and the level of exposure to media information. The prevalence rates of anxiety, depression and sleep problems were computed. The Wald χ² were applied to compare the differences between subgroups. Multiple logistic regression analyses were performed to investigate factors associated with anxiety, depression, sleep problems, and multimorbidity.ResultsThe prevalence rates of anxiety, depression, and sleep problems were 46.8%, 29.8%, and 10.8%, respectively. Approximately 263 participants (28.7%) presented with two or more mental health problems. Being female (OR, 2.254; 95% CI, 1.510–3.363), having community-level COVID-19 contact (OR, 1.856; 95% CI, 1.189–2.898), and having a mental disorder (OR, 3.610; 95% CI, 1.644–7.930) were associated with increased risk of multimorbidity among caregivers. Caregivers who preferred positive information (OR, 0.652; 95% CI, 0.472–0.899) had reduced risk of multimorbidity.ConclusionAnxiety and depression were common among caregivers of older adults during the COVID-19 epidemic. Being female and having community-level COVID-19 contact were independent risk factors for experiencing multiple mental health problems. Preexisting mental disorders increased the risk of multimorbidity among caregivers, while enhanced access to positive media information decreased the risk of multimorbidity.     

针灸预处理对心脏手术患者预后影响的Meta分析

 目的 采用Meta分析的方法评价针灸预处理对心脏手术患者预后的影响。方法 系统检索PubMed,Cochrane Library, Web of Science,EMBASE,中国期刊全文数据库,万方数据库,中文科技期刊全文数据库中关于针灸预处理对心脏手术患者预后影响的文献,利用RevMan 5.3软件对符合要求的纳入研究结果进行Meta分析。结果 共纳入13个随机对照试验研究,979例Meta分析结果显示,与对照组相比,针灸预处理可显著缩短心脏术后患者机械通气时间[MD=1.73, 95% CI (1.41, 2.05), P< 0.00001],减少体外循环后患者ICU停留时间[MD=9.01, 95% CI (2.87, 15.14), P= 0.004]和住院时间[MD=2.00, 95% CI (1.01, 2.98), P< 0.0001],减少心脏手术患者术后3 d认知功能障碍发生率[RR=0.24, 95% CI (0.12, 0.48), P< 0.0001]和术后24 h恶心呕吐的发生率[RR=0.52, 95% CI (0.36, 0.74), P= 0.0003],减轻患者术后疼痛评分[MD=0.39, 95% CI (0.19,0.58), P< 0.0001]。结论 针灸预处理可改善心脏手术患者预后,减少术后不良反应的发生。     

G蛋白β3亚单位C825T基因多态性与富马酸比索洛尔降压疗效的相关性

 目的 探讨G蛋白β₃亚单位C825T基因多态性与富马酸比索洛尔降压疗效的相关性。方法 选择2018-10至2020-10在解放军总医院第一医学中心心内科住院或门诊就诊的轻、中度原发性高血压患者,均口服5 mg/d比索洛尔,进行GNβ₃-C825T基因型测定,依据基因型分为3组:CC组、CT组、TT组,每组150例,在3组受试者治疗7 d,1、3、6个月后进行随访,测定患者的富马酸比索洛尔药物代谢血药浓度;治疗前、治疗7 d,1、3、6个月后进行24 h动态血压监测,比较患者静息状态下收缩压及舒张压(SBP、DBP),24 h收缩压均数(24 h SBP)、24 h舒张压均数(24 h DBP)、白天收缩压均数(d SBP)、白天舒张压均数(d DBP)、夜间收缩压均数(n SBP)、夜间舒张压均数(n DBP)的组间差异;进行24 h动态心电图监测,比较24 h平均心率、窦性心律震荡水平。结果 治疗7 d,随访1、3、6个月TT组富马酸比索洛尔血药浓度均高于CC组及CT组,差异均有统计学意义(P＜0.05),CC组与CT组无统计学差异,3组组内不同时间血药浓度变化均无统计学差异;应用富马酸比索洛尔后,3组患者血压均有下降趋势,其中TT组降压效果＞CT组＞CC组,3组间血压下降水平有统计学差异(P＜0.05);治疗7 d后,动态心电图显示:3组患者心率有下降趋势,TT组＞CT组＞CC组,其中TT组与CT组、CC组比较有统计学差异(P＜0.05),CT组与CC组心率下降无统计学差异;TT组窦性心律震荡水平优于CT组、CC组。结论 G蛋白β₃亚单位C825T基因多态性与富马酸比索洛尔降压疗效之间具有相关性。     

老年非酒精性脂肪肝患者25(OH)D3水平与胰岛素抵抗、氧化应激的相关性

 目的 探究老年非酒精性脂肪肝(non-alcoholic fatty liver disease,NAFLD)患者血清25-羟维生素D₃[25(OH)D₃]水平的变化及与胰岛素抵抗、氧化应激之间的关系。方法 选取2018-01至2020-04在我院诊治的125例老年NAFLD患者作为观察组,按血清25(OH)D₃水平分为维生素D缺乏组、维生素D不足组和维生素D正常组三个亚组;另选取同期老年健康体检者30例作为对照组。比较观察组与对照组血清25(OH)D₃水平差异;对比观察组三个亚组体质量(BMI)、血脂、肝功能、空腹血糖(FBG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)等各指标差异;分析观察组血清25(OH)D₃水平与以上指标的相关性。结果 与对照组相比,观察组25(OH)D₃、SOD、GSH-Px水平显著下降,BMI、FINS、HOMA-IR、MDA水平显著升高(P<0.05)。与维生素D正常组相比,维生素D缺乏组和维生素D不足组FINS、HOMA-IR、MDA水平显著升高,SOD、GSH-Px水平显著降低(P<0.05);其中维生素D缺乏组各指标水平高于或低于维生素D不足组(P<0.05)。观察组25(OH)D₃水平与HOMA-IR、MDA呈显著负相关(r=-0.395,r=-0.328,P均<0.05);与SOD、GSH-Px呈显著正相关(r=0.388,r=0.376,P均<0.05)。结论 老年NAFLD患者血清25(OH)D₃水平明显下降,血清25(OH)D3缺乏与胰岛素抵抗及氧化应激密切相关。     

T-Cell Immunoglobulin- and Mucin-Domain-Containing Molecule 3 Genetic Variants and HIV+ Non-Hodgkin Lymphomas

T cell immunoglobulin- and mucin-domain-containing molecule 3 (TIM-3) has been established as a negative regulatory molecule and plays a critical role in inflammatory diseases such as rheumatoid arthritis, hepatitis B and C, and human immunodeficiency virus (HIV)-related inflammation. Recent studies have shown that chronic inflammation may greatly affect the pathogenesis of non-Hodgkin lymphomas (NHL). The aim of this study was to investigate whether polymorphisms in the TIM-3 gene were associated with susceptibility to non-NHL and HIV-related NHL. Three polymorphisms in TIM-3 gene (?1516G/T, ?574G/T, and +4259T/G) were identified by polymerase chain reaction-restriction fragment length polymorphism in 434 NHL patients, 62 HIV-related NHL cases, and 512 healthy controls. Results showed that the prevalence of ?574GT genotype and +4259TG genotype were significantly increased in the NHL cases than in controls (odds ratio (OR)?=?2.72, 95 % confidence interval (CI)?=?1.50–4.92, p?=?0.0006 and OR?=?2.59, 95 % CI?=?1.49–4.49, p?=?0.0005, respectively). The ?1516G/T polymorphism did not reveal significant difference between patients and healthy controls. When analyzing the TIM-3 polymorphisms in HIV-related NHL patients, data showed that HIV+ NHL patients had higher prevalence of ?574GT or +4259TG genotypes than those cases without HIV infection (OR?=?3.48, 95 % CI?=?1.67–7.28, p?=?0.0005 and OR?=?2.92, 95 % CI?=?1.42–6.01, p?=?0.0026, respectively). These results suggested polymorphisms in TIM-3 gene could be new risk factors for NHL as well as HIV-related NHL and suggested a possible role of the inflammatory factor in these diseases.     

新冠肺炎流行期中学生从医意愿及相关因素

目的:了解中学生在新冠肺炎流行期间的从医意愿及其相关因素。方法:在2020年3月8日-15日对全国8078名12~18岁的中学生进行在线问卷调查。采用自编调查表进行从医意愿及原因调查,患者健康问卷(PHQ-9)用于抑郁症状的筛查,广泛性焦虑量表(GAD-7)用于焦虑症状的筛查,社会支持评定量表(SSRS)用于评估个体的社会支持水平。结果:新冠疫情期间中学生有从医意愿者比率为55.1%,前3位原因分别为职业价值高、对医学感兴趣、职业受人尊重,其中29.8%的中学生在疫情爆发后由无从医意愿转为有从医意愿。无从医意愿前3位原因分别为对医学不感兴趣、工作压力大、工作忙而休息时间少。Logistic回归分析显示,女性(OR=1.31,P<0.001)、居住在城市(OR=1.14,P<0.05)、高(OR=2.70,P<0.001)或中(OR=1.48,P<0.001)社会支持水平与中学生较高的从医意愿关联;高中(OR=0.60,P<0.001)、抑郁症状(OR=0.74,P<0.001)与中学生较低的从医意愿关联。结论:新冠肺炎流行期间,中学生有从医意愿的占比超过半数,女性、居住在城市、社会支持水平较高的中学生从医意愿较高,高中生、伴有抑郁症状的中学生从医意愿较低。