国内健康信息研究作者合著网络及研究主题分析

目的分析核心作者、作者合著网络特征,推测国内健康信息研究的发展阶段、主要研究力量及主要研究主题。方法以CNKI期刊库为数据源,以"健康信息"及相关词为主题词,检索2000—2018年的相关文献,基于普莱斯定律及综合指数法确定核心作者,使用数据统计软件Excel及社会网络分析软件Vcinet,利用综合指数以及社会网络分析法计算作者间联系合作紧密度,并离析高产合作子网。结果文献量以较快指数型速率增长。作者合作率较高且信息传输渠道较通畅,2000—2018年国内研究的合著率稳定在80%,但学者的合作关系较为单一,多集中在同一机构或同一师门,阻碍了跨机构学者的交流合作。主要合作团队活跃度较高且核心成员多为研究领域的核心作者,科研产出量较大且被引频次较高。结论国内研究正处于旺盛发展期,但未形成稳定的核心作者群体。学者间因同机构或师门关系产生固定合作,健康信息管理、公众健康行为、健康教育等为核心作者或活跃团队研究的主要主题。     

儿童哮喘与成人慢性阻塞性肺疾病相关性研究进展

儿童哮喘与慢性阻塞性肺疾病(COPD)是儿童期与成人期常见的存在气流受限的慢性气道疾病。研究发现,儿童哮喘会增加成年期罹患COPD的风险,而肺功能变化是预测COPD患病风险的重要指标。针对哮喘患儿建立长期肺功能监测管理,对于评估其成年后存在不可逆气道阻塞的风险有重要意义。文章综述儿童哮喘与COPD相关的研究进展。     

The association between sport-related concussion and musculoskeletal injury in university rugby athletes

ObjectivesThe study aimed to analyse the association between Sports-Related Concussion (SRC) and Subsequent Musculoskeletal Injury (MSK) in United Kingdom university-aged rugby union players whilst considering the effects of sex, athlete playing position and injury location.DesignRetrospective cohort study. A period of 365 days with 0–90, 91–180 and 181–365 days sub-periods was analysed for the following variables; MSK injury incidence, occurrence, severity, injury location, playing position and sex.SettingInjury data was collected from the Sports Development Centre database at Loughborough University.ParticipantsA total of 408 injuries in 181 athletes (55 females and 126 males) were included.ResultsThe MSK injury incidence of SRC group was significantly higher than control and higher post-SRC than pre-SRC period over a 365-day period (p=0.012 and p=0.034, respectively). The odds ratios of MSK injury incidence between groups and between periods were 1.62 (95% CI, 1.10–2.25) and 1.57 (95% CI ,1.08–2.29). A SRC was not associated with a greater time loss from a subsequent MSK injury or a specific MSK injury location.ConclusionsAthletes with a second recorded injury were more likely to sustain a MSK injury if they had experienced SRC, however, there was no indication a SRC resulted in greater time loss from a MSK injury.     

Selecting patients for early interdisciplinary rehabilitation during neurointensive care after moderate to severe traumatic brain injury

Background

Early interdisciplinary rehabilitation (EIR) in neurointensive care is a limited resource reserved for patients with moderate to severe traumatic brain injury (TBI) believed to profit from treatment. We evaluated how key parameters related to injury severity and patient characteristics were predictive of receiving EIR, and whether these parameters changed over time.

Methods

Among 1003 adult patients with moderate to severe TBI admitted over 72 h to neurointensive care unit during four time periods between 2005 and 2020, EIR was given to 578 and standard care to 425 patients. Ten selection criteria thought to best represent injury severity and patient benefit were evaluated (Glasgow Coma Scale, Head Abbreviated Injury Scale, New-Injury-Severity-Scale, intracranial pressure monitoring, neurosurgery, age, employment, Charlson Comorbidity Index, severe psychiatric disease, and chronic substance abuse).

Results

In multivariate regression analysis, patients who were employed (adjOR 1.99 [95% CI 1.41, 2.80]), had no/mild comorbidity (adjOR 3.15 [95% CI 1.72, 5.79]), needed neurosurgery, had increasing injury severity and were admitted by increasing time period were more likely to receive EIR, whereas receiving EIR was less likely with increasing age (adjOR 0.97 [95% CI 0.96, 0.98]) and chronic substance abuse. Overall predictive ability of the model was 71%. Median age and comorbidity increased while employment decreased from 2005 to 2020, indicating patient selection became less restrictive with time.

Conclusion

Injury severity and need for neurosurgery remain important predictors for receiving EIR, but the importance of age, employment, and comorbidity have changed over time. Moderate prediction accuracy using current clinical criteria suggest unrecognized factors are important for patient selection.     

儿童社区获得性肺炎血清维生素A的变化及与免疫功能相关性

目的 研究社区获得性肺炎(community acquired pneumonia,CAP)患儿血清维生素A(vitamin A,VA)水平及与免疫功能的相关性,为肺炎病情评估提供一定参考。方法 以入住新乡医学院第一附属医院PICU的63例重度社区获得性肺炎(severe community acquired pneumonia, SCAP)患儿(SCAP组)、普通儿科病区的30例轻度社区获得性肺炎(mild community acquired pneumonia, MCAP)患儿(MCAP组),以及同期体检的30名健康儿童(对照组)为研究对象,检测其血清中VA和免疫球蛋白(immunoglobulin,Ig)G、IgA、IgM水平,及SCAP组体内T淋巴细胞亚群(总T淋巴细胞、CD4、CD8、CD4/CD8),并对SCAP组体内VA水平及以上指标的相关性进行分析。结果 3组性别和年龄差异无统计学意义;血清中VA的平均含量分别为0.36、0.25和0.19 mg/L,CAP组VA的含量较对照组明显降低,且SCAP组明显低于MCAP组(P<0.05)。根据WHO推荐的VA诊断标准,3组VA临床缺乏/亚临床缺乏率分别为10.00%、36.67%和61.90%,差异有统计学意义(P<0.05)。CAP组血清中Ig水平较对照组明显降低,且SCAP组明显低于MCAP组(P<0.05)。SCAP组血中总T淋巴细胞、CD4、CD8和CD4/CD8的平均水平分别为53.28%、30.26%、20.24%和1.59;分析VA水平与免疫相关指标关系发现VA水平与Ig(IgG、IgA、IgM)水平、总T淋巴细胞、CD4呈正相关,与CD8水平不相关。结论 肺炎患儿血清VA水平与病情严重程度及机体免疫功能相关。     

二维斑点追踪显像技术评估窒息新生儿左心室纵向收缩功能与心肌损害的相关性

【摘要】目的 探讨二维斑点追踪显像技术(2D-STI)评估新生儿窒息合并心肌损害后左心室整体及局部心肌的纵向收缩功能在早期诊断窒息新生儿心肌损害中的临床价值。方法 选择2019年07月至2020年12月期间在右江民族医学院附属医院新生儿科住院的足月窒息新生儿61例，经临床确诊合并心肌损害，根据Apgar评分分为轻度组31例和重度组30例，选择同期住院出生的正常足月新生儿30例作为对照组。检测受检者的血清肌酸激酶同工酶（CK-MB）、肌钙蛋白（cTnT）、左室舒张期前后径（LVDId）、左室射血分数（LVEF）、左室短轴缩短率（LVFS）、辛普森法左室射血分数（Simpson EF）、左室三腔心整体应变（GLS-LAX）、左室四腔心整体应变（GLS-A4C）、左室两腔心整体应变（GLS-A2C）、左室整体应变（GLS-AVG）,分析GLS-AVG和CK-MB、cTnT三者的相关性。结果 三组间CK-MB和cTnT比较差异有统计学意义（P<0.05）。三组间性别、体重、胎龄均无统计学差异（P>0.05）。三组间LVDId、LVEF、LVFS、Simpson EF比较差异无统计学意义（P>0.05）。GLS-AVG与CK-MB呈负性相关（r=-0.515，P=0.000），GLS-AVG与cTnT呈负性相关（r=-0.912，P=0.000）。结论 GLS-AVG与CK-MB、cTnT具有相关性，GLS-AVG可作为窒息新生儿心肌损害早期诊断指标。     

Are risk factors necessary for pretest probability assessment of coronary artery disease? A patient similarity network analysis of the PROMISE trial

BackgroundPretest probability (PTP) calculators utilize epidemiological-level findings to provide patient-level risk assessment of obstructive coronary artery disease (CAD). However, their limited accuracies question whether dissimilarities in risk factors necessarily result in differences in CAD. Using patient similarity network (PSN) analyses, we wished to assess the accuracy of risk factors and imaging markers to identify ≥50% luminal narrowing on coronary CT angiography (CCTA) in stable chest-pain patients.MethodsWe created four PSNs representing: patient characteristics, risk factors, non-coronary imaging markers and calcium score. We used spectral clustering to group individuals with similar risk profiles. We compared PSNs to a contemporary PTP score incorporating calcium score and risk factors to identify ≥50% luminal narrowing on CCTA in the CT-arm of the PROMISE trial. We also conducted subanalyses in different age and sex groups.ResultsIn 3556 individuals, the calcium score PSN significantly outperformed patient characteristic, risk factor, and non-coronary imaging marker PSNs (AUC: 0.81 vs. 0.57, 0.55, 0.54; respectively, p ?< ?0.001 for all). The calcium score PSN significantly outperformed the contemporary PTP score (AUC: 0.81 vs. 0.78, p ?< ?0.001), and using 0, 1–100 and ?> ?100 cut-offs provided comparable results (AUC: 0.81 vs. 0.81, p ?= ?0.06). Similar results were found in all subanalyses.ConclusionCalcium score on its own provides better individualized obstructive CAD prediction than contemporary PTP scores incorporating calcium score and risk factors. Risk factors may not be able to improve the diagnostic accuracy of calcium score to predict ≥50% luminal narrowing on CCTA.     

Multiscale quantification of morphological heterogeneity with creation of a predictor of longer survival in glioblastoma

Intratumor heterogeneity is a main cause of the dismal prognosis of glioblastoma (GBM). Yet, there remains a lack of a uniform assessment of the degree of heterogeneity. With a multiscale approach, we addressed the hypothesis that intratumor heterogeneity exists on different levels comprising traditional regional analyses, but also innovative methods including computer-assisted analysis of tumor morphology combined with epigenomic data. With this aim, 157 biopsies of 37 patients with therapy-naive IDH-wildtype GBM were analyzed regarding the intratumor variance of protein expression of glial marker GFAP, microglia marker Iba1 and proliferation marker Mib1. Hematoxylin and eosin stained slides were evaluated for tumor vascularization. For the estimation of pixel intensity and nuclear profiling, automated analysis was used. Additionally, DNA methylation profiling was conducted separately for the single biopsies. Scoring systems were established to integrate several parameters into one score for the four examined modalities of heterogeneity (regional, cellular, pixel-level and epigenomic). As a result, we could show that heterogeneity was detected in all four modalities. Furthermore, for the regional, cellular and epigenomic level, we confirmed the results of earlier studies stating that a higher degree of heterogeneity is associated with poorer overall survival. To integrate all modalities into one score, we designed a predictor of longer survival, which showed a highly significant separation regarding the OS. In conclusion, multiscale intratumor heterogeneity exists in glioblastoma and its degree has an impact on overall survival. In future studies, the implementation of a broadly feasible heterogeneity index should be considered.     

S100蛋白水平联合Rotterdam-CT评分、GCS评分在TBI病情和预后不良评估中的价值

目的 探讨S100蛋白(S100 protein,S100)水平联合Rotterdam计算机X线断层扫描(Computed tomography,CT)评分、格拉斯哥昏迷评分(Glasgow coma scale,GCS)在创伤性颅脑损伤(Traumatic brain injury,TBI)病情和预后不良评估中的价值。方法 回顾性分析106例TBI患者的临床资料,比较不同病情TBI患者血清S100水平、Rotterdam-CT评分,分析血清S100水平与Rotterdam-CT评分、GCS评分的相关性; 根据患者预后情况分为预后良好组和预后不良组,比较2组性别、年龄、血清S100水平、Rotterdam-CT评分、GCS评分等临床资料,多因素logistic回归分析TBI患者预后不良的相关因素; 分析S100蛋白水平、GCS评分、Rotterdam-CT评分及三者联合应用对TBI患者预后不良的预测价值。结果 轻度组、中度组、重度组血清S100水平、Rotterdam-CT评分逐渐增高(P<0.01),TBI患者血清S100水平与GCS评分(r=0.396,P=0.001)、Rotterdam-CT评分(r=0.289,P=0.002)均呈正相关; 2组血氧饱和度、GCS评分、呼吸频率、Rotterdam-CT评分、S100蛋白水平、入院时昏迷占比等指标有明显差异(P<0.05或P<0.01); 多因素logistic回归分析显示呼吸频率、血氧饱和度、入院时昏迷占比、GCS评分、Rotterdam-CT评分、S100蛋白水平均为TBI患者预后不良的相关危险因素; 受试者工作特征曲线(Receiver operator characteristic curve,ROC)显示S100蛋白水平、GCS评分、Rotterdam-CT评分对TBI患者预后不良均有一定的预测价值,三项指标联合应用曲线下面积(Area of the under curve,AUC)值大于各单项指标预测。结论 S100蛋白水平、GCS评分、Rotterdam-CT评分是TBI患者预后不良的相关危险因素,S100蛋白水平联合GCS评分、Rotterdam-CT评分在TBI患者预后不良评估中具有较高的临床价值。