Sleep-wake cycle and melatonin rhythms in adolescents and young adults with mood disorders: Comparison of unipolar and bipolar phenotypes

This study evaluated the potential of circadian measures as early markers of mood disorders subtypes. Patients with bipolar disorders had significantly lower levels and later onset of melatonin secretion than those with unipolar depression. Furthermore, abnormal phase angles between sleep, melatonin and temperature were found in several patients.     

神农香菊自然居群遗传变异评价研究及核心种质筛选＊

目的 本文对神农香菊（Chrysanthemum indicum var. aromaticum）自然居群的遗传多样性、遗传结构及特征代谢产物开展研究，并以此为依据筛选核心种质，为神农香菊的资源保护和应用提供理论依据。方法 利用21对分别来源于基因组和转录组数据的简单重复序列引物（SSR）对我国神农架林区的151份神农香菊样本、41份疑似野菊样本和武汉市洪山区11份野菊对照样本进行居群遗传多样性和遗传结构分析。基于遗传信息，采用高效液相色谱技术（HPLC）对不同遗传分组的代表性纯合样本开展9种代谢物的差异分析，利用最小距离逐步取样策略（LDSS）筛选神农香菊的核心种质。结果 21对引物在所有研究样本中共扩增出202个等位基因，每个位点平均等位基因数为9.619个。神农架5个居群的平均有效基因数（N_e）为2.518，香农多样性指数（I）为1.004，多态性信息含量（PIC）为0.526，杂合度（H）为0.246。居群间具有较低的遗传分化（F_st<0.12）和较高的基因流水平（N_m>1）。遗传结构分析显示，神农架的所有样品可分为三个遗传组。异绿原酸C、蒙花苷、木犀草苷等物质在三个组的样本间有明显的含量差异。基于遗传信息，最终筛选出了来自神农架3个地方居群的45份核心种质。结论 本研究展示了神农香菊自然居群整体存在的中高水平的遗传多样性，同时神农香菊样本与邻（混）生的疑似野菊样本具有清晰的形态差异，但两者间可能存在基因流或遗传混杂。这些信息为研究神农香菊的起源进化和对其资源的开发应用提供了理论和数据支撑。     

右美托咪定经鼻腔黏膜给药对小儿腹腔镜疝修补术围术期血气指标及拔管质量的影响

[摘要]目的：探讨右美托咪定（Dex）经鼻腔黏膜给药对小儿腹腔镜疝修补术围术期血气指标及拔管质量的影响。方法：选取2020年1月至2021年4月我院拟行腹腔镜疝修补术的患儿80例，根据随机数字表法分为 对照组（n=26）、Dex 1组（n=27）和Dex 2组（n=27）。比较三组患儿术前、气腹后5 min以及放气后30 min动脉血氧分压（PaO2）、二氧化碳分压（PaCO2）和pH；比较三组患儿使用Dex前（T0）、Dex用药30 min后（T1）、手术开始3 min（T2）和手术结束3 min（T3）时血氧饱和度（SpO2）、心率（HR）、平均动脉压（MAP）；比较三组患儿苏醒时间、拔管时间、拔管质量、躁动评分和不良反应发生率。结果： 对照组气腹后5 min PaO2、pH、PaCO2分别为（73.16±7.45）mm Hg、7.21±0.06、（45.16±5.96）mm Hg；Dex 1组和Dex 2组气腹后5 min PaO2分别为（78.46±6.64）mm Hg、（79.43±6.51）mm Hg，pH分别为7.38±0.10、7.49±0.08，均较 对照组升高，PaCO2分别为（40.14±4.19）mm Hg、（37.06±4.32）mm Hg，均较 对照组降低（P<0.05）；Dex 2组气腹后5 min pH高于Dex 1组，PaCO2低于Dex 1组（P<0.05）。Dex 1组和Dex 2组T1、T2、T3时HR、MAP降低（P<0.05）；Dex 2组T1、T3时HR低于Dex 1组，T1时MAP低于Dex 1组（P<0.05）；Dex 1组和Dex 2组T1、T2、T3时HR、MAP均较T0时降低（P<0.05）。 对照组拔管评分和躁动评分分别为（4.51±0.95）分、（13.25±2.59）分，Dex 1组拔管评分和躁动评分分别为（2.93±1.03）分、（9.27±2.23）分，Dex 2组拔管评分和躁动评分分别为（2.15±1.14）分、（6.38±2.62）分，与 对照组比较，Dex 1组和Dex 2组拔管评分和躁动评分降低，且Dex 2组低于Dex 1组（P<0.05）。3组患儿苏醒时间、拔管时间、不良反应发生率比较，差异无统计学意义（P>0.05）。结论：经鼻腔黏膜给予Dex，可有效改善行腹腔镜疝修补术患儿围术期呼吸循环功能，减轻拔管应激反应和苏醒期躁动反应，且不延长拔管时间，不增加不良反应发生率，安全可靠。     

Identifying outcomes reported in trials of interventions in venous leg ulceration for a core outcome set development: A scoping review

BackgroundVenous leg ulceration is a chronic, recurring, condition causing significant patient morbidity. Randomised controlled trials evaluating treatments for venous leg ulceration provide evidence for clinical decision-making. For trial findings to be useful, outcomes measured need to be clinically meaningful, and consistently and fully reported across trials.A core outcome set is an agreed and standardised set of outcomes which should be, as a minimum, reported in all trials for a given indication.AimTo identify the outcome domains and outcomes reported in trials of interventions for venous leg ulceration.MethodsA scoping review of the literature was carried out. Randomised controlled trials within Cochrane systematic reviews looking at venous leg ulceration interventions and qualitative studies exploring venous leg ulceration were included.ResultsThe review identified 807 outcomes from randomised controlled trials and 15 outcomes from qualitative studies, and these were grouped into 11 outcome domains: healing, patient reported symptoms, clinician reported symptoms, carer reported symptoms, life impacts, clinical signs, clinical measurement, performance of the intervention, resource use (supplies and clinician time) and adverse events.The outcome domain ‘healing’ included 111 outcomes, ‘symptoms’ 109, ‘life impacts’ 30, ‘clinical signs’ 88, ‘clinical measurement’ 184, ‘performance of the intervention’ 58, ‘resource use’ 52 and ‘adverse events’ 190.ConclusionThe scoping review identified a large number of outcomes (n = 822) across 11 related outcome domains, supporting the need for a core outcome set.     

Preoperative assessment and optimisation for pelvic exenteration in locally advanced and recurrent rectal cancer: A review

The pre-operative phase in planning a pelvic exenteration or extended resections is critical to optimising patient outcomes. This review summarises the key components of preoperative assessment and planning in patients with locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LLRC) being considered for potential curative resection. The preoperative period can be considered in 5 key phases: 1) Multidisciplinary meeting (MDT) review and recommendation for neoadjuvant therapy and surgery, 2) Anaesthetic preoperative assessment of fitness for surgery and quantification of risk, 3) Shared decision making with the patient and the process of informed consent, 4) Prehabilitation and physiological optimisation 5) Technical aspects of surgical planning. This review will focus on patients who have been recommended for surgery by the MDT and have completed neoadjuvant therapy. Other important considerations beyond the scope of this review are the various neoadjuvant strategies employed which in this patient group include Total Neo-adjuvant Therapy and reirradiation. Critical to improving perioperative outcomes is the dual aim of achieving a negative resection margin in a patient fit enough for extended surgery. Advanced, realistic communication is required pre-operatively and should be maintained throughout recovery. Optimising patient's physiological and psychological reserve with a preoperative prehabilitation programme is important, with physiotherapy, psychological and nutritional input. From a surgical perspective, image based technical preoperative planning is important to identify risk points and ensure correct surgical strategy. Careful attention to the entire patient journey through these 5 preoperative phases can optimise outcomes with the accumulation of marginal gains at multiple timepoints.     

Time-dependent fracture probability of bilayer,lithium-disilicate-based,glass–ceramic,molar crowns as a function of core/veneer thickness ratio and load orientation

Recent reports on bilayer ceramic crown prostheses suggest that fractures of the veneering ceramic represent the most common reason for prosthesis failure.     

充气升温毯维持围手术期核心体温有效性的系统评价

目的 系统评价充气升温毯维持患者围手术期核心体温的有效性,为围手术期选择合适的保温方法提供临床依据.方法 计算机检索PubMed、The Cochrane Library、EMbase、Web of Science、CBM、CNKI数据库,全面收集不同保温方法维持围手术期核心体温有效性的随机对照试验(RCT),检索时限均为2000～2012年,并追溯纳入研究的参考文献.由两位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan5.1软件进行Meta分析.结果 纳入11个RCT,共577例患者.Meta分析结果显示:在维持围手术期核心体温方面,充气升温毯加温组分别优于电热毯/垫组[SMD=-0.40,95％CI (-0.73,-0.06)]、循环水温毯组[SMD=-1.10,95％CI(-1.55,-0.66)]和红外线辐射加温组[SMD=-0.69,95％CI(-1.06,-0.32)];在围手术期低体温发生率方面,充气升温毯组低于电热毯/垫加温组[RR=1.76,95％CI(1.15,2.69)],而与红外线辐射加温组相当[RR=l.37,95％CI(0.83,2.27)];在围手术期寒战发生率方面,充气升温毯加温组与电热毯/垫组[RR=0.75,95％CI (0.18,3.21)]和红外线辐射加温组相当[RR=0.8,95％CI(0.19,3.36)].结论 充气升温毯与电热毯/垫、红外线辐射、循环水温毯相比,能够更好地维持围手术期患者核心体温,患者低体温发生率更低.受纳入研究数量和质量所限,上述结论尚需开展更多大样本高质量RCT加以验证.     

Repeat work bouts increase thermal strain for Australian firefighters working in the heat

Background: Firefighters regularly re-enter fire scenes during long duration emergency events with limited rest between work bouts. It is unclear whether this practice is impacting on the safety of firefighters.

Objectives:To evaluate the effects of multiple work bouts on firefighter physiology, strength, and cognitive performance when working in the heat.

Methods: Seventy-seven urban firefighters completed two 20-minute simulated search and rescue tasks in a heat chamber (105?±?5°C), separated by a 10-minute passive recovery. Core and skin temperature, rate of perceived exertion (RPE), thermal sensation (TS), grip strength, and cognitive changes between simulations were evaluated.

Results: Significant increases in core temperature and perceptual responses along with declines in strength were observed following the second simulation. No differences for other measures were observed.

Conclusions: A significant increase in thermal strain was observed when firefighters re-entered a hot working environment. We recommend that longer recovery periods or active cooling methods be employed prior to re-entry.