吉林辽宁两省18年来的目标设置对突发公共卫生事件应急工作落实情况的关联研究

目的本研究立足于项目组前期研究的成果上，积极探索吉林辽宁两省目标设置水平的差异，并进一步探究受目标设置影响下的工作落实结果情况，探讨产生差异的原因。 方法以系统穷尽的方式收集吉林辽宁两省2000至2017年有关目标与工作落实情况的指标，利用Spearman相关和线性回归分析吉林辽宁两省目标设置对于突发应急工作落实情况的影响。 结果吉林辽宁两省突发应急领域的目标设置水平与工作落实情况总体均呈现上升趋势，截至2017年，吉林目标设置水平与工作落实情况分别为46%与60%，辽宁为60%与53.3%，且目标设置水平与工作落实呈正相关。 结论有公众需要为依据且定量可考的目标设置对于工作落实、推进、完善具有积极的正反馈作用，建立科学量化的突发应急目标设置评价体系是适宜可行的。     

免疫细胞在脓毒血症中的作用及机制研究进展

脓毒血症是由危及生命的感染所引起的宿主炎症反应,伴随着严重的器官功能衰竭和障碍。近年来,尽管医学和医疗技术都取得了巨大进步,脓毒血症的病死率仍高达30%~70%。脓毒血症本质上是机体对感染性因素的反应,初始免疫反应是一种过度炎症状态,随后迅速发展为免疫抑制状态。了解参与脓毒血症期间器官损伤发展中的宿主细胞介导的免疫反应是至关重要的。总结了各类免疫细胞在人和小鼠脓毒血症期间的作用变化及机制研究进展。     

横断面研究能否进行因果推断

基于变量调查(或测量)的共时性、统计学关联及幸存者偏倚等原因,横断面研究被认为不能进行因果推断,这是当前的"共识"。本文基于因果思维,借助因果图,首先明确定义真实截面和测量截面,并识别截面概念仅存在于理论的特性。实际横断面研究中,测量变量的共时性并不存在,而是无一例外地表现为非共时性时序,其实质上相当于测量变量间互为独立性假设,或不存在有差别错分偏倚。类似于累积病例对照研究和历史性队列研究,横断面研究均为暴露和结局已存在或发生后进行的测量,这种测量相当于对变量值的历史重建或"考古"。这类研究进行因果推断的共性前提条件之一是,测量变量与其历史变量间必须存在着因果律。测量变量均为真实变量的替代者,测量变量间的时序在因果推断上并不重要。应加强对横断面研究分析性角色的认识。     

Insulin-like growth factor-1 improves diabetic cardiomyopathy through antioxidative and anti-inflammatory processes along with modulation of Akt/GSK-3β signaling in rats

Diabetic cardiomyopathy (DCM), a serious complication of diabetes mellitus, is associated with changes in myocardial structure and function. This study sought to explore the ability of insulin-like growth factor-1 (IGF-1) to modulate DCM and its related mechanisms. Twenty-four male Wistar rats were injected with streptozotocin (STZ, 60 mg/kg) to mimic diabetes mellitus. Myocardial fibrosis and apoptosis were evaluated by histopathologic analyses, and relevant proteins were analyzed by Western blotting. Inflammatory factors were assessed by ELISA. Markers of oxidative stress were tested by colorimetric analysis. Rats with DCM displayed decreased body weight, metabolic abnormalities, elevated apoptosis (as assessed by the bcl-2/bax ratio and TUNEL assays), increased fibrosis, increased markers of oxidative stress (MDA and SOD) and inflammatory factors (TNF-α and IL-1β), and decreased phosphorylation of Akt and glycogen synthase kinase (GSK-3β). IGF-1 treatment, however, attenuated the metabolic abnormalities and myocardial apoptosis, interstitial fibrosis, oxidative stress and inflammation seen in diabetic rats, while also increasing the phosphorylation levels of Akt and GSK-3β. These findings suggest that IGF-1 ameliorates the pathophysiological progress of DCM along with an activation of the Akt/GSK-3β signaling pathway. Our findings suggest that IGF-1 could be a potential therapeutic choice for controlling DCM.     

老年住院患者反三碘甲腺原氨酸水平与病情及预后的相关性研究

目的分析老年住院患者反三碘甲腺原氨酸(reverse triiodothyronine,rT_2)水平与病情及预后的相关性,为老年住院患者预后的早期评估提供参考指标。方法选取本院2012年5月至2015年5月收治的304例老年住院患者为研究对象,分别检测患者血清甲状腺激素、清蛋白、胆固醇水平,并按照rT_3水平进行分组,比较不同rT_3水平,不同清蛋白、胆固醇水平患者一般资料、死亡率、病情、血清学指标差异,分析rT_3水平与患者病情及预后的相关性。结果304例老年住院患者中,甲状腺功能异常137例(45.07%)。rT_3水平升高87例(28.62%),其余217例(7I.38&%名)患者rT_3水平正常。rT_3水平升高组与rT_3水平正常组患者年龄、性别比例比较差异均无显著性(P>0.05),rT_3水平升高组患者死亡率、急性重症疾病构成比均显著高于rT_3水平正常组,血清清蛋白、胆固醇、游离三碘甲腺原氨酸(FT_3)水平均显著低于rT_3水平正常组(P<0.05)。随着rT_3水平升高程度的增加,患者死亡率显著上升(P<0.05),Pearson相关分析示,rT_3水平与患者死亡率变化呈显著正相关(r=0.719,P<0.05)。低清蛋白、胆固醇水平患者游离甲状腺素(FT_4)、FT_3水平均显著低于高清蛋白、胆固醇水平患者,rT_3水平显著高于高清蛋白、胆固醇水平患者(P<0.05):不同清蛋白、胆固醇表达水平患者血清促甲状腺激素(TSH)水平比较差异具有显著性(P>0.05)。结论血清rT_3水平升高提示老年住院患者营养状态差、病情危重、死亡率较高,应加强对老年住院患者rT_3水平的定期监测,为制订治疗方案与评估预后提供参考。     

25-羟维生素D_3治疗2型糖尿病患者早期肾损害的临床观察

目的观察25-羟维生素D3(Vit D3)对2型糖尿病(T2DM)患者早期肾损害的临床疗效。方法纳入T2DM早期肾损伤患者80例,采用随机数字表法等分为治疗组与对照组,对照组继续原有降糖方案,治疗组在既往用药基础上,肌肉注射Vit D3注射液,疗程均为10个月,治疗结束后进行疗效评价。结果 1与治疗前相比,治疗组糖化血红蛋白(HbA1c)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)水平上调,微量白蛋白(MA)、β2-微球蛋白(β2-M)及肾脏损伤分子-1(KIM-1)水平下调,治疗组低于对照组差异有统计学意义(P<0.05)。2与治疗前相比,治疗组治疗后Vit D3水平上调,治疗组高于对照组差异有统计学意义(P<0.01)。3T2DM患者Vit D3水平与MA(r=-0.432),β2-M(r=-0.615),及KIM-1(r=-0.763)水平均呈负相关(P<0.05)。结论 Vit D3可有效减轻T2DM患者的早期肾损害,对肾脏具有保护作用。     

Safety and diagnostic accuracy of percutaneous CT-guided transthoracic biopsy of small lung nodules (≤20 mm) adjacent to the pericardium or great vessels

PURPOSEWe aimed to evaluate the safety and diagnostic accuracy of computed tomography (CT)-guided transthoracic biopsy of small lung nodules (≤20 mm) adjacent to the pericardium or great vessels.METHODSThis retrospective study examined the safety and diagnostic accuracy of percutaneous CT-guided biopsy for small lung nodules (≤20 mm) located within 10 mm of the pericardium or great vessels. Technical aspects and factors influencing complications were assessed, and diagnostic accuracy was calculated.RESULTSA total of 168 biopsies were performed in 168 patients. The complications were mainly pneumothorax (34.5%; 58 of 168 patients), chest tube insertion (5.3%; 9 of 168 patients), and pulmonary hemorrhage (61.3%; 103 of 168 procedures), with no patient mortality. One patient (0.6%) was admitted because of hemorrhage complications. Significant independent risk factors for pneumothorax were nodules resided in upper or middle lobes and lateral patient position, and for hemorrhage, longer distance from structures and longer needle trajectory through the lung parenchyma. Overall, the sensitivity, accuracy, and specificity were 91.0%, 92.2%, and 100%, respectively.CONCLUSIONPercutaneous CT-guided transthoracic biopsy was highly accurate in small lung nodules (≤20 mm) adjacent to the pericardium or great vessels. Complications are common, but most were minor and self-limited.

In recent years, with wide availability of computed tomography (CT) and the development of low-dose CT screening techniques, more small lung nodules (≤20 mm) have been detected (1–3). Lee et al. (4) reported that small lung nodules were detected at a rate of 44.5%, and that 39.7% of lung cancers were found in small nodules. Accurate histopathological diagnosis is of great importance in management of these nodules, but biopsy via fluoroscopy or ultrasound guidance is technically more difficult, and CT guidance is usually required (5).Percutaneous CT-guided transthoracic lung biopsy is a reasonably safe and accurate approach to the histological diagnosis of primary and secondary lung nodules (4, 6, 7). However, nodule size is the major determinant of diagnostic accuracy, which reached 96.9% for larger nodules (7), but ranged from 52% to 78.8% for small nodules (8, 9).Biopsy of small lung nodules close to proximity to the pericardium or great vessels is particularly challenging, and precise needle placement is essential to avoid complications resulting from non-target tissue injury near vital mediastinal or vascular structures. Hsu et al. (10) suggested that CT-guided lung biopsy should be avoided if the adjacent nodule is within 10 mm of the pericardium.The authors know of no related studies of biopsy of small lung nodules close to the pericardium or great vessels. This study, therefore, was conducted to examine the safety and diagnostic accuracy of CT-guided transthoracic biopsy of small lung nodules (≤20 mm) within 10 mm of the pericardium or great vessels.     

Association between vitiligo and subsequent risk of dementia: A population‐based cohort study

Increasing evidence suggests a positive association between autoimmune disorders and the subsequent risk of dementia, supporting the idea that neuroinflammation is a major contributor to dementia. However, whether or not adults with vitiligo have an increased risk of dementia remains unclear. We aimed to investigate the association between vitiligo and the subsequent risk of dementia. A total of 1320 patients with vitiligo and 5280 matched controls were identified from the Taiwan National Health Insurance Research Database between 1998 and 2011. Dementia was diagnosed by board‐certificated psychiatrists or neurologists in the follow‐up period. Cox proportional hazards models were used to estimate the adjusted hazard ratios (aHR) after controlling for age, sex, income‐related monthly premium, residence and comorbidities associated with dementia. The incidence rate of dementia (per 100 000 person‐years) was 502.8 among patients with vitiligo and 101.9 among the controls. Patients with vitiligo were more likely to develop any type of dementia (aHR, 5.30; 95% confidence interval [CI], 3.30–8.51), Alzheimer’s disease (aHR, 12.22; 95% CI, 3.71–40.28) and vascular dementia (aHR, 3.99; 95% CI, 1.31–12.15) compared with the controls. In conclusion, middle‐aged and old patients with vitiligo are more likely to develop dementia compared with those without vitiligo. This novel finding reminds physicians to be more careful about signs of dementia when managing patients with vitiligo and provides the basis for further investigations that clarify the underlying mechanisms.