Formation of phosphatidylethanol in vitro in red blood cells from healthy volunteers and chronic alcoholics

Phosphatidylethanol (PEth) is an abnormal phospholipid, formed only in the presence of ethanol via a transphosphatidylation reaction of phospholipase D (PLD). PEth in blood is a promising new marker of alcohol abuse. Blood PEth is found almost exclusively in red cells. This study was performed to investigate a possible PEth formation in human red cells from alcoholics and healthy individuals, at physiologically relevant ethanol concentrations. Blood was drawn from six healthy volunteers (controls) and six chronic inpatient alcoholics. Hematological analyses were performed, and red blood cells were separated and incubated in plasma with ethanol to study PEth formation. Lipids were extracted and PEth analyzed with high pressure liquid chromatography and evaporative light-scattering detection. Incubation of red cells in 50 mM ethanol yielded detectable PEth after 12 hours. Formation of PEth was concentration dependent at 10 to 50 mM ethanol. In vitro formation of PEth was significantly higher (P <.001) in red cells from alcoholics (5.2 +/- 1.1 micromol/l) compared to controls (2.4 +/- 0.6 micromol/l) (mean +/- SD). A significant correlation (P <.01) was observed between initial mean corpuscular volume and accumulated PEth. This study demonstrates that PEth is formed in human red cells at physiologically relevant ethanol concentrations. Alcoholics accumulate about twice as much PEth than controls. The accumulation rate of PEth is slower in red cells compared to rates reported for other tissues.     

Inducing efficacy of ethanol on hepatic drug metabolizing enzymes in patients

In liver biopsy material of eighty-nine patients with suspected liver disease the drug-metabolizing function was investigated. The capacity of the liver to oxidatively metabolize drugs was assessed by determination of cytochrome P-450 dependent monooxygenase activity in vitro. The biotransformational function of these microsomal enzymes was tested with compounds representing the activity of oxidative drug metabolism (7-ethoxycoumarin, p-nitroanisol and cytochrome c). From the eight-nine patients sixty-one had various liver diseases not related to ethanol and twenty-eight abused ethanol. When both groups were matched for age, sex, smoking, treatment with sedatives, drugs and degree of liver damage the alcoholic group had significantly higher activities of 7-ethoxycoumarin O-deethylase (EOD: 76.9 +/- 31.1 pmol min-1 mg-1 protein, mean +/- SD) than the non-alcoholic liver disease group (42.7 +/- 14.1). The inducing effect of ethanol was most striking on the EOD activity, less for the O-demethylation of p-nitroanisol (PNA) and not present for the NADPH-cytochrome c reductase. The induced patients were analysed in detail to find out which factors were responsible for the observed scatter of enzyme activities within the alcoholic group. Alcoholics with fatty liver (n = 7) had the highest EOD activities (108.9 +/- 25.0), patients with alcoholic hepatitis (n = 10) had significantly less activity (66.0 +/- 1.9) than the former group. However, alcoholics without liver damage (n = 6) had activities not significantly different (46.0 +/- 15.8) from controls (39.4 +/- 9.1). These subgroups among the alcoholics were comparable in terms of sex, age, smoking and drinking habits.(ABSTRACT TRUNCATED AT 250 WORDS)     

The Fc gammaRIIa polymorphism in Turkish children with asthma bronchial and allergic rhinitis

OBJECTIVE: The aim of the present study was to evaluate the Fc gammaRIIa polymorphism in Turkish children with atopic asthma and allergic rhinitis. DESIGN AND METHODS: In this study, 372 atopic children (192 asthma bronchial, 180 allergic rhinitis) between ages of 5 and 16 years old (11.3+/-2.9) who were followed at Aegean University Paediatric Allergy and Pulmonology Outpatient Clinics and 234 healthy subjects as the control group were included. The evaluation of subjects included routine biochemical blood analysis and allergic workup based on the following laboratory determinants. The Fc gammaRIIa polymorphism was determined using the polymerase chain reaction method. RESULTS: Distribution of R131R genotype was significantly different among patient groups compared to controls (for asthmatic children OR: 2.64 95%CI: 1.22-5.79, p=0.006; for allergic rhinitis OR: 2.58 95%CI: 1.18-5.71, p=0.009). Frequency of 131R allele was significantly different among patient groups compared to controls (for asthmatic children OR: 1.66 95%CI: 1.22-2.26, p=0.0007; for allergic rhinitis OR: 1.93 95%CI: 1.42-2.63, p=0.00001). CONCLUSION: This study shows that Fc gammaRIIa gene 131R allele represents an important genetic risk factor for bronchial asthma and allergic rhinitis susceptibility.     

Enalapril effects on alcohol intake and other consummatory behaviors in alcoholics.

Animal studies suggest that angiotensin-converting enzyme inhibitors decrease alcohol intake. In a double-blind crossover study 42 normotensive alcoholics (36 men and six women) aged 24 to 65 years, consuming 8.2 +/- 2.3 (mean +/- SD) standard alcoholic drinks per day, were randomized to enalapril, 10 mg/day (n = 20) or 20 mg/day (n = 22), and placebo for 4 weeks. They monitored their daily alcohol intake and attended biweekly assessments, but no other treatment or advice was given. Compliance and alcohol intake were verified objectively. Mean daily alcoholic drinks were not significantly different during 10 mg/day enalapril (mean +/- SEM, 7.5 +/- 0.5), and its placebo (7.2 +/- 0.5), but both decreased from baseline (8.1 +/- 0.5; both p less than 0.05). Similarly, mean daily drinks during 20 mg/day enalapril (6.8 +/- 0.6) and its placebo (7.2 +/- 0.4) was not significantly different, but both were lower than baseline (8.3 +/- 0.5; both p less than 0.01). Fourteen (64%) of the patients taking 20 mg/day enalapril decreased alcohol intake from placebo by an average of 21% (range, 1.6% to 78.3%). Self-ratings of interest, desire, craving, and liking for alcohol also decreased from baseline during enalapril and placebo treatments, but the effects of both were similar. Plasma renin activity increased, compared with placebo, after 10 mg/day enalapril (from 0.3 +/- 0.2 [mean +/- SD] to 1.9 +/- 1.5 ng/L/sec) and after 20 mg/day enalapril (from 0.4 +/- 0.3 to 2.8 +/- 4.0 ng/L/sec) (both p less than 0.05). Blood pressure decreased within a normotensive range, compared with placebo, with 10 mg/day enalapril (by 6.0 and 8.5 mm Hg systolic and diastolic blood pressures) and 20 mg/day enalapril (by 7.7 and 5.0 mm Hg, respectively). Side effects were few and mild. No patient characteristic or drug effect correlated with changes in alcohol intake. There were no significant variations in nonalcoholic beverages, cigarette smoking, or body weight. These results indicate that enalapril does not alter alcohol intake in normotensive alcoholics with normal plasma renin activity. Studies with higher doses of enalapril in humans may be limited by increased frequency and severity of side effects.     

慢性心力衰竭患者再入院风险因素的Meta分析

目的:通过Meta分析明确慢性心力衰竭患者再入院的相关风险因素。方法:计算机检索PubMed、Cochrane Library、Web of Science、Embase、SinoMed、CNKI、万方数据库和维普数据库,检索时限为建库至2019年12月31日。采用RevMan 5.3软件进行Meta分析。结果:共纳入19篇文献,纳入患者185545例,包括34项相关风险因素。有统计学意义的风险因素包括抑郁情绪(OR=3.87,95%CI:2.87~5.23,P<0.01)、独居(OR=1.12,95%CI:1.01~1.24,P=0.03)、合并高血脂或糖尿病(OR=1.16,95%CI:1.14~1.19,P<0.01)、高盐饮食(OR=3.36,95%CI:2.60~4.35,P<0.01)、肾功能下降(OR=2.00,95%CI:1.95~2.04,P<0.01)、射血分数下降性心力衰竭(OR=2.71,95%CI:1.93~3.73,P<0.01)、贫血(OR=1.43,95%CI:1.27~1.60,P<0.01)、感染(OR=1.12,95%CI:1.00~1.25,P=0.04)。结论:抑郁情绪、独居、合并高血脂或糖尿病、高盐饮食、肾功能下降、射血分数下降性心力衰竭、贫血、感染是慢性心力衰竭患者再入院的相关风险因素。     

ICU患者发生获得性衰弱的危险因素分析

目的分析ICU患者发生获得性衰弱的危险因素。 方法选择2015年6月至2018年9月南充市中心医院ICU收治的280例患者作为研究对象,其中63例患者发生ICU获得性衰弱,217例患者未发生ICU获得性衰弱。根据临床工作经验,将与ICU获得性衰弱有直接或间接尚待求证的因素如性别、年龄、体质量指数（BMI）、入ICU时简化急性生理学评分（SAPS）Ⅱ、急性病生理学和长期健康评价（APACHE）Ⅱ评分、意识障碍、高血压、高血糖、来源科室、弥散性血管内凝血（DIC）、脓毒症、脓毒性休克、多器官功能障碍综合征（MODS）、长期卧床制动、低蛋白血症、机械通气时间、应用糖皮质激素、应用神经肌肉阻滞剂、应用去甲肾上腺素、实施早期康复干预等因素纳入Logistic回归分析,筛选出ICU获得性衰弱的影响因素。 结果单因素Logistic回归分析结果显示,女性[比值比（OR）= 1.514,95%置信区间（CI）（1.074,1.328）,P = 0.042]、年龄≥ 60岁[OR = 1.613,95% CI（1.142,2.002）,P = 0.042]、SAPSⅡ评分≥ 25分[OR = 1.982,95% CI（1.003,2.925）,P = 0.013]、APACHEⅡ评分≥ 8分[OR = 1.770,95%CI（1.192,2.742）,P = 0.014]、高血糖[OR = 1.853,95%CI（1.035,2.214）,P = 0.015]、脓毒症[OR = 2.309,95%CI（1.013,3.063）,P = 0.021]、脓毒性休克[OR = 2.106,95%CI（1.995,4.947）,P = 0.025]、MODS [OR = 3.721,95%CI（1.001,4.980）,P = 0.007]、长期卧床制动[OR = 4.641,95%CI（1.932,5.253）,P < 0.001]、机械通气时间≥ 72 h [OR = 3.367,95%CI（1.635,4.254）,P = 0.005]、应用糖皮质激素[OR = 1.709,95%CI（1.424,2.757）,P = 0.021]、应用神经肌肉阻滞剂[OR = 2.042,95%CI（1.331,4.953）,P = 0.011]以及实施早期康复干预[OR = 0.586,95%CI（0.953,1.472）,P = 0.037]与ICU获得性衰弱相关。将其纳入多因素Logistic回归分析后发现,年龄≥ 60岁[OR =1.576,95%CI（1.095,1.753）,P = 0.038]、SAPSⅡ评分≥ 25分[OR = 1.988,95%CI（1.115,1.803）,P = 0.013]、APACHEⅡ评分≥ 8分[OR = 1.768,95%CI（1.189,2.364）,P = 0.014]、高血糖[OR = 1.680,95%CI（1.033,1.689）,P = 0.015]、脓毒症[OR = 1.842,95%CI（1.011,1.976）,P = 0.010]、长期卧床制动[OR = 4.745,95%CI（1.931,3.470）,P < 0.001]、机械通气时间≥ 72 h[OR = 3.353,95%CI（1.722,4.314）,P = 0.003]、应用神经肌肉阻滞剂[OR = 1.931,95%CI（1.247,2.573）,P = 0.005]是ICU患者发生获得性衰弱的独立危险因素,而实施早期康复干预[OR = 0.598,95%CI（0.978,1.674）,P = 0.037]是其保护因素。 结论ICU获得性衰弱的危险因素复杂,应加强高危患者的早期干预,积极控制好血糖,减少制动时间和机械通气时间,预防ICU获得性衰弱的发生。     

冠状动脉杂交技术对比冠状动脉旁路移植术在冠状动脉再血管化中的meta分析

目的 评价冠状动脉再血管化杂交技术（HCR）与冠状动脉旁路移植术（CABG）在冠心病治疗中的有效性和安全性。方法 检索MEDLINE,EMBASE数据库,中国知网,Corchrane图书馆及二次资源。检索词：杂交技术、冠状动脉旁路移植术、经皮冠状动脉支架置入术、一站式冠状动脉杂交术、分站式冠状动脉杂交术。采用比值比（odd ratio, OR）和95%可信区间（95% confidence interval, CI）作为评价HCR和CABG的主要心脑血管事件发生率（死亡率、卒中发生率、心肌梗死发生率、目标血管再血管化率、主要的心脑血管事件发生率、新发的心房颤动发生率以及红细胞输注率）有无差异的指标;用均数差（median difference,MD）和 95%CI作为评价机械通气时间、ICU时间、总住院时间有无差异的指标。统计学分析应用RevMan 5.2进行异质性检验及Meta分析。结果 在检索到的文献中共有17篇文献满足条件,总计8 608例患者。行HCR的患者和非体外循环CABG的患者比较,在死亡率［OR=0.77, 95%CI（0.42, 1.41）, I2（0%）,P=0.39］、心肌梗死发生率［OR=0.78, 95%CI（0.40,1.52）, I2（0%）,P=0.47］、卒中发生率［OR=0.67, 95%CI（0.34,1.33）, I2（0%）,P＝0.26］、主要的心脑血管事件发生率［OR=0.74, 95%CI（0.53,1.03）, I2（0%）,P=0.07］、目标血管再血管化率［OR=2.41, 95%CI（0.91,6.38）, I2（0%）,P=0.08］以及新发的心房颤动发生率［OR=0.92, 95%CI（0.70,1.22）, I2（29%）,P=0.56］方面差异无统计学意义;在红细胞输注率［OR=-0.16, 95%CI（-0.22,-0.09）, I2（34%）,P＜0.01］方面有所降低;在机械通气时间［OR=-6.25,95%CI（-9.01,-5.32）, I2（22%）,P＜0.01］、ICU时间［OR=-18.58, 95%CI（-23.65,-13.52）, I2（45%）,P＜0.01］、总住院时间［OR=-0.3, 95%CI（-0.46,-0.15）, I2（6%）,P＜0.01］方面,时间均有所缩短。结论 HCR安全可行,且较CABG具有一定优势。     

Diastolic blood pressure is related to urinary sodium excretion in hypertensive Chinese patients

We studied 70 Hong Kong Chinese patients with untreated hypertension and 47 normotensive controls. Blood pressure measurements and 24-h urine collection were performed for each patient, and were repeated 12 weeks later in 14 hypertensive patients who remained untreated. Twenty-two hypertensive patients underwent ambulatory blood pressure monitoring. The primary hypothesis tested was a correlation between diastolic blood pressure and 24-h urinary sodium excretion. In the hypertensive patients, diastolic blood pressure correlated with 24-h urinary sodium excretion (r=0.41, p<0.001), even after adjustment for age, gender, body mass index, ethanol intake and season (r=0.34, p=0.02). In normotensive controls, diastolic blood pressure did not correlate with sodium excretion (r=0.21, p=0.16). A correlation between diastolic blood pressure and sodium excretion was also observed in the patients who underwent ambulatory blood pressure monitoring (r=0.47, p=0.026), and in repeat measurements in untreated patients (r=0.60, p=0.02). Systolic blood pressure did not correlate with sodium excretion, although it increased with patient age (0.6+/-0.1 mmHg/year, p<0.001). In a multiple regression analysis with diastolic blood pressure as the dependent variable, the regression coefficient was 0.06+/-0.02 mmHg/mmol Na. The regression coefficients for ambulatory diastolic blood pressure and diastolic pressure repeated at 12 weeks were 0.07+/-0.03 and 0. 09+/-0.04 mmHg/mmol Na, respectively. Urinary sodium excretion was related to diastolic blood pressure in our hypertensive patients, accounting for 17% of the variance of diastolic blood pressure.     

Serum calcium and phosphorus associate with the occurrence and severity of angiographically documented coronary heart disease, possibly through correlation with atherogenic (apo)lipoproteins.

The associations of serum calcium and phosphorus concentrations as well as other cardiovascular risk factors were investigated in relation to the existence and severity of coronary heart disease (CHD) in 260 clinically stable, angiographically defined CHD patients aged 40-70 years. The subjects were classified as CHD(+) cases if one or more coronary arteries had a significant stenosis (> or =70%) and CHD(-) controls if there was no stenosis (< or =10%) in any artery. The severity of coronary occlusion was scored on the basis of the number and extent of lesions, as normal, mild, moderate or severe. Fasting serum concentrations of electrolytes, lipids and (apo)lipoproteins were determined. The concentrations of serum total calcium (2.41 +/-0.14 vs. 2.33 +/- 0.22 mmol/L, p < or = 0.05), albumin-corrected calcium (2.33 +/- 0.25 vs. 2.23 +/- 0.25 mmol/L, p < or = 0.01), phosphorus (1.32 +/-0.21 vs. 1.25 +/- 0.17 mmol/L, p < or = 0.007) and the ion product of calcium and phosphorus (3.16 +/- 0.58 vs. 2.91 +/- 0.50, p < or =0.0001) were significantly higher in the CHD(+) compared to the CHD(-) group. Patients with CHD compared with controls had increased serum levels of triglyceride, total cholesterol, low-density lipoprotein-cholesterol (LDL-C), apolipoprotein B (apoB), lipoprotein(a) [Lp(a)] and decreased serum levels of high-density lipoprotein (HDL)-C and apoAI. Multiple logistic regression analysis showed strong and significant association between diabetes mellitus (odds ratio, OR = 5.24, p < or = 0.0001), male gender (OR = 8.84, p < or =0.0001), Lp(a) (OR = 1.014, p < or =0.006), hypertension (OR = 2.61, p < or =0.02), apoB (OR = 1.031, p < or =0.001), age (OR = 1.055, p < or =0.003), phosphorus (OR = 2.438, p < or =0.01), albumin-adjusted calcium (OR = 1.532, p < or =0.05), cholesterol (OR = 1.009, p < or =0.05) and the occurrence of CHD. On the basis of bivariate correlation analysis, serum-adjusted calcium was positively correlated with the levels of cholesterol (r = 0.285, p < or =0.0001), LDL-C (r = 0.320, p < or =0.0001), Lp(a) (r = 0.173, p < or = 0.005), apoB (r = 0.237, p < or =0.0001), LDL-C/apoB ratio (r = 0.180, p < or= 0.007), apoAI (r = 0.181, p < or =0.003) and inversely to HDL-C (r = -0.146, p < or =0.02) and HDL-C/apoAI ratio (r = -0.263, p < or =0.0001). Serum phosphorus concentration was a significant correlate of triglyceride (r = 0.199, p < or =0.001) and Lp(a) (r = 0.129, p < or =0.04). The results demonstrated that serum calcium and phosphorus are associated with the prevalence and severity of CHD, probably through correlation with atherogenic lipids and (apo)lipoproteins. Serum calcium and phosphorus and their ion product were also independent risk factors for CHD.     

二维斑点追踪超声心动图联合lncRNA-肺腺癌转移相关转录因子1对脓毒症心肌病的早期诊断价值

目的探讨二维斑点追踪超声心动图（2D-STE）联合长链非编码RNA（lncRNA）-肺腺癌转移相关转录因子1（MALAT1）对脓毒症心肌病（SCM）的诊断价值。 方法选择2019年1月至2021年1月中国科学院大学宁波华美医院急诊重症监护室收治的86例脓毒症患者,根据左心室射血分数（LVEF）将86例脓毒症患者分成SCM组（LVEF<50%,37例）及脓毒症无心肌损伤组（LVEF ≥ 50%,49例）。分析两组患者的临床资料、整体纵向应变（GLS）、整体径向应变（GRS）、整体圆周应变（GCS）、血清lncRNA-MALAT1表达水平。采用二元Logistic回归分析影响SCM患者预后的危险因素,并采用受试者工作特征（ROC）曲线分析GLS、血清lncRNA-MALAT1对SCM的早期诊断价值。 结果SCM组与脓毒症无心肌损伤组患者N末端B型钠尿肽前体（NT-proBNP）[（2 389 ± 2 240）ng/L vs.（1 156 ± 716）ng/L,t = 3.620,P = 0.001]、心肌肌钙蛋白I（cTnI）[（0.60 ± 0.41）μg/L vs.（0.35 ± 0.29）μg/L,t = 3.301,P = 0.001]、GLS[（-18.6 ± 1.6）% vs.（-20.5 ± 2.0）%,t = 4.735,P = 0.001]及lncRNA-MALAT1[（2.4 ± 0.5）vs.（2.0 ± 0.4）,t = 4.219,P = 0.001]比较,差异均有统计学意义。二元Logistic回归分析结果显示,NT-proBNP[比值比（OR）= 0.999,95%置信区间（CI）（0.999,1.000）,P = 0.033]、cTnI[OR = 0.143,95%CI（0.024,0.839）,P = 0.031]、GLS[OR = 0.543,95%CI（0.361,0.817）,P = 0.003]和lncRNA-MALAT1[OR = 0.059,95%CI（0.011,0.309）,P = 0.001]均为SCM的独立危险因素。ROC曲线分析结果显示,NT-proBNP[曲线下面积（AUC）= 0.697,95%CI（0.588,0.791）,P = 0.001]、cTnI[AUC = 0.681,95%CI（0.572,0.778）,P = 0.003]、GLS[AUC = 0.766,95%CI（0.667,0.866）,P < 0.001]、lncRNA-MALAT1[AUC = 0.735,95%CI（0.630,0.840）,P < 0.001]及GLS联合lncRNA-MALAT1[AUC = 0.845,95%CI（0.764,0.926）,P < 0.001]均对SCM具有诊断价值,且GLS联合lncRNA-MALAT1的诊断价值更高。 结论2D-STE联合lncRNA-MALAT1对脓毒症心肌损伤具有一定的诊断意义。     

中国人群脂联素基因启动子区-11377C/G位点多态性与2型糖尿病易感性的Meta 分析

目的 探讨中国人群脂联素基因启动子区-11377C/G位点多态性与2型糖尿病易感的相关性.方法 检索2011年11月前中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方数据库、维普中文科技期刊数据库(VIP)及Medline、Cochrane Library、Embase、Springer、Ovid等数据库,收集有关中国人群脂联素基因-11377C/G多态性与2型糖尿病的相关性研究;评价纳入研究质量,提取有效数据,采用Review Manager5.0软件进行Meta分析.结果 共纳入12组研究中国人群脂联素基因启动子区-11377C/G位点多态性与2型糖尿病的相关性的病例-对照研究,2型糖尿病病例2 598例,对照4 508例.Meta分析发现,脂联素基因启动子区-11377C/G位点C/G多态性与2型糖尿病相关性中G等位基因与C等位基因[OR=1.14,95%CI(1.03,1.25),P=0.009]、基因型(CG+GG)与CC[OR=1.19,95%CI(1.06,1.35),P=0.004]、基因型CG与CC[OR=1.14,95%CI(1.00,1.29),P=0.05]、基因型GG与CC[OR=1.34,95%CI(1.06,1.71),P=0.02]均具有统计学意义差异.结论 中国人群脂联素基因启动子区-11377C/G位点多态性与2型糖尿病易感性存在相关性.     

Grip strength and the metabolic syndrome: findings from the Hertfordshire Cohort Study

INTRODUCTION: Sarcopenia, the loss of muscle mass and strength with age, is significantly associated with type 2 diabetes in older people. AIM: To determine whether there is a relationship between grip strength and features of the metabolic syndrome. DESIGN: Cross-sectional study. METHODS: Data were collected on grip strength, fasting glucose, triglycerides and HDL cholesterol, blood pressure, waist circumference and 2 h glucose after an oral glucose tolerance test, in a population-based sample of 2677 men and women aged 59-73 years. RESULTS: In men and women combined, a standard deviation (SD) decrease in grip strength was significantly associated with higher: fasting triglycerides (0.05 SD unit increase, 95%CI 0.02-0.09, p = 0.006); blood pressure (OR 1.13, 95%CI 1.04-1.24, p = 0.004); waist circumference (0.08 SD unit increase, 95%CI 0.06-0.10, p < 0.001); 2 h glucose (0.07 SD unit increase, 95%CI 0.03-0.11, p = 0.001) and HOMA resistance (0.05 SD unit increase, 95%CI 0.01-0.09, p = 0.008), after adjustment for gender, weight, age, walking speed, social class, smoking habit and alcohol intake. Lower grip strength was also significantly associated with increased odds of having the metabolic syndrome according to both the ATPIII (OR 1.18, 95%CI 1.07-1.30, p < 0.001) and IDF definitions (OR 1.11, 95%CI 1.01-1.22, p = 0.03). DISCUSSION: Our findings suggest that impaired grip strength is associated with the individual features, as well as with the overall summary definitions, of the metabolic syndrome. The potential for grip strength to be used in the clinical setting needs to be explored.     

循证护理在重症急性胰腺炎病人中应用效果的Meta分析

目的:评价循证护理在重症急性胰腺炎病人中的应用效果。方法:通过检索中国知网、维普、万方、中国生物医学文献数据库中发表的关于循证护理对重症急性胰腺炎病人应用的随机对照试验,根据拟定的纳入及排除标准筛选文献并对其进行偏倚风险评估和数据提取,采用Revman 5.3软件进行Meta分析。结果:本次研究最终纳入15项临床研究,共有1240例重症急性胰腺炎病人。Meta分析结果显示,病人住院时间[MD=-5.98,95%CI(-7.05,-4.91),P<0.00001]、并发症发生率[OR=0.21,95%CI(0.15,0.30),P<0.00001]、护理满意度[OR=7.22,95%CI(4.64,11.23),P<0.00001]、病死率[OR=0.09,95%CI(0.02,0.34),P=0.0004]、护理有效率[OR=6.46,95%CI(3.37,12.37),P<0.00001]。各方面均表明,循证护理较常规护理有更好的效果,差异均具有统计学意义。结论:循证护理的整体应用效果优于常规护理,能更好地促进病人康复。     

延续性健康促进模式对老年痴呆患者生活质量干预效果的Meta分析

目的 系统分析延续性健康促进模式对老年痴呆患者生活质量的干预效果。方法 通过检索中国知网、维普、万方及Pubmed、Elsevier等数据库,全面的查阅延续性健康促进影响老年痴呆患者生活质量的相关文献,并运用RevMan 5.3软件对纳入文献进行meta分析。结果 共纳入8篇随机对照实验(randomized controlled trial,RCT)研究,共545例老年痴呆患者。分析发现延续性健康促进模式能改善老年痴呆患者智能状况[WMD=2.28,95%CI(1.60,2.96),P<0.001] ,日常生活能力[WMD=-4.63 ,95%CI(-6.44,-2.81), P<0.001],健康状况[WMD=-8.15,95%CI(-13.49,-2.82),P=0.003],社会活动能力[WMD=2.32,95%CI(0.89,3.75),P=0.001]。 结论 实施积极有效的延续性健康促进有利于提高老年痴呆患者的社会适应能力,改善生活质量。     

脑钠肽和内皮素在冠状动脉旁路移植术中的变化及意义

目的 观察氨基末端B型脑钠肽(Nt-proBNP)和大内皮素(bigET)在冠状动脉旁路移植术(CABG)前后的变化及其对术后近期并发症的预测价值.方法 分析47例常规体外循环冠状动脉旁路移植术(CCABG)和43例非体外循环冠状动脉旁路移植术(OPCAB)患者术前和术后24 h Nt-proBNP、bigET水平变化,及其对术后近期并发症的预测因子.结果 ①术后24 h CCABG和OPCAB两组Nt-pro BNP和bigET均明显升高,CCABG组Nt-proBNP由术前(1 083.5±717.9)pmol/L升到术后24 h(1 579.2±719.7)pmol/L(t=-4.30,P＜0.01),bigET由术前(1.10±1.82)pmol/L升到术后24 h(1.68±1.73)pmol/L(t=-5.35,P＜0.01);OPCAB组Nt-proBNP由术前(999.6±843.6)pmol/L升到术后24 h(1 460.8±830.0)pmol/L(t=-4.20,P＜0.01),bigET由术前(1.35±1.65)pmol/L升到术后24 h(1.73±1.50)pmol/L(t=-2.46,P=0.018).②术前Nt-proBNP水平与左室射血分数(LVEF)呈负相关(r=-0.43,P＜0.001).③经单变量和多变量Logistic回归分析,LVEF[相对比值比(OR)=1.045,95%可信区间(CI)为0.999～1.092,P=0.050]、术后24 h Nt-proBNP(OR=0.990,95%CI为0.999～1.000,P=0.014)水平是术后心力衰竭、低心排、围手术期心肌梗死、死亡、脑梗死的独立预测因子.经受试者工作特征曲线(ROC)分析术后24 hNt-proBNP＞1 174.41 pmol/L时,曲线下面积为0.698,95%CI为0.585～0.811,P＜0.003,敏感性为88.9%,特异性为57.1%,可预测近期并发症.结论 CABG术后Nt-proBNP、bigET明显升高;LVEF、术后24 h Nt-proBNP水平可预测术后近期并发症的发生.     

超声弹性成像技术对精索静脉曲张患者应用价值的Meta分析

目的 采用Meta分析评价超声弹性成像技术对精索静脉曲张(VC)患者的诊断价值。方法 检索PubMed、Embase、web of science、Cochrane图书馆、中国知网(CNKI)、万方以及维普数据库,严格按照纳入及排除标准筛选文献、提取资料并根据NOS量表进行质量评价,运用ＲevMan5.3软件对数据进行Meta分析。结果 最终纳入15篇文献,包含980例左侧VC患者及524名健康对照者,其中7篇文献报道了共计504例左侧VC患者与248名健康对照者在使用SWE检查后的睾丸剪切波速度值SWV,Meta分析汇总结果显示：VC患者睾丸硬度减低[MD=-0.02,95%CI(-0.03,-0.01),P=0.0004],差异具有统计学意义;3篇文献报道了共计160例左侧VC患者和100名健康对照者在使用SE检查后的睾丸应变比SR,Meta分析汇总结果显示：VC患者睾丸硬度减低[MD=-0.01,95%CI(-0.13, 0.12),P=0.92],差异不具有统计学意义;5篇文献报道了共计316例左侧VC患者和176名健康对照者在使用SE检查后的睾丸应变均值Mean,Meta分析汇总结果显示：VC患者睾丸硬度减低[MD=0.36,95%CI(0.12, 0.61),P=0.003],差异具有统计学意义。结论 超声弹性成像技术可能会成为精索静脉曲张患者的重要辅助检查手段。     

经鼻高流量湿化氧疗在成人重症免疫抑制患者应用疗效的meta分析

目的 系统评价经鼻高流量湿化氧疗（HFNC）在成人重症免疫抑制患者的应用疗效。方法 计算机检索PubMed、Embase、Cochrane Library、Ovid、EBSCO、万方、维普、CNKI、CBM,查找HFNC治疗成人重症免疫抑制患者的随机对照试验。检索时限为建库至2019年5月。同时为了避免遗漏,对纳入文献的参考文献进行手工检索。并采用Revman 5.3软件进行meta分析。结果 共纳入8项研究,涉及1 302例患者。Meta分析结果显示,HFNC与传统氧疗相比,能降低患者的插管率［OR=0.77,95%CI（0.60,0.97）,Z=2.19,P=0.03］,但与无创通气相比,在降低插管率上差异无统计学意义［OR=0.43,95%CI（0.17,1.08),Z=1.80,P=0.07］。两个亚组合并结果显示,HFNC较对照氧疗相比,能显著降低重症免疫抑制患者的插管率［合并: OR=0.74,95%CI（0.58,0.93）,Z=2.58,P=0.01］,但对降低病死率、感染率及缩短ICU住院时间差异无统计学意义［病死率：OR=0.84,95%CI（0.66,1.08）,Z=1.34,P=0.18;感染率：OR=0.80,95%CI（0.56,1.15）,Z=1.19,P=0.24;ICU住院时间：OR=-0.19,95%CI（-2.51,2.12）,Z=0.16,P=0.87］。而在进行敏感性分析时发现,HFNC与对照氧疗相比,能显著降低患者的ICU住院时间。结论 HFNC与对照氧疗相比,能显著降低患者的插管率,但不能降低患者的病死率及感染率。     

Oral health and nutritional status in a group of geriatric rehabilitation patients

The aims of this study were to evaluate the oral health status and nutritional status in a group of geriatric rehabilitation patients, and to analyse the relationship between these two parameters. Nurses at the ward performed structured assessments of oral and nutritional status using the Revised Oral Assessment Guide and the Subjective Global Assessment form in 223 newly admitted patients. Most oral health problems were found among patients who stayed longer at the hospital and were more dependent on help as compared with the healthier patients. Thirty-four per cent of the patients were either severely undernourished, at risk or suspected to be undernourished (UN). Oral health problems were more common among UN patients (p < 0.0005) compared with well-nourished patients. The most frequent oral health problem was found on teeth or dentures (48%). Problems related to the tongue and lips were also common among UN patients (56 and 44%, respectively). Oral health status was correlated (r = 0.32) to nutritional status. Problems with swallowing had the strongest association to the nutritional status (OR 6.05; 95% CI 2.41-15.18). This study demonstrated that poor oral health status was related to undernourishment.     

养老机构老人认知障碍影响因素的Meta分析

目的 全面了解空巢老人认知功能障碍危险因素。 方法 检索Ovid Medline、Ovid Embase、Cochrane 图书馆及中国生物医学文献数据库（光盘版）等数据库,检索时间为各数据库建库至2011年12月31日。文献纳入标准：年龄≥60岁或作者指明以老人为研究对象;居住状态包括老人无子女或未与子女同住。两位研究者独立地对符合纳入标准的试验进行质量评价和资料提取。 结果 4篇文献（共1 485例）分析了养老机构老人认知障碍的影响因素,合并分析显示年龄[WMD=2.10岁,95%CI（1.28,2.92）岁,P＜0.000 01]、女性[OR=3.61,95%CI（1.63,8.01）,P=0.002]、失能[SMD=0.78,95%CI （0.36,1.20）,P=0.000 2]、躯体健康[SMD=0.06,95%CI （0.01,0.11）,P=0.02]、未婚/寡居[OR=3.16,95%CI（1.43,6.96）,P＜0.000 01]、文盲[OR=2.94,95%CI（1.06,8.14）,P=0.04]、社会支持差[OR=7.29,95%CI（2.27,23.39）,P=0.000 8]、朋友关系差[OR=2.14,95%CI（1.35,3.39）,P=0.001]、参加活动少[OR=2.11,95%CI（1.36,3.29）,P=0.000 9]及远离子女[OR=5.73,95%CI（3.33,9.87）,P＜0.05]是其危险因素。 结论 养老机构老人认知功能障碍的危险因素包括老年、女性、文盲、未婚/寡居、社交差、与子女距离远、躯体健康水平差及抑郁等。结果仅来源于较少的研究和数量较小的对象,且均为横断面研究,需谨慎看待上述结论。     

联合检测中性粒细胞与白蛋白比值和乳酸对脓毒性休克患者早期预后的评估价值

目的探讨中性粒细胞与白蛋白比值（NAR）和乳酸对脓毒性休克患者28 d死亡的预测价值。 方法回顾性分析2017年10月至2019年10月南京市第一医院ICU收治的118例脓毒性休克患者的临床资料,记录所有患者的年龄、性别、体质量指数（BMI）、急性病生理学和长期健康评价（APACHE）Ⅱ评分、序贯器官衰竭估计（SOFA）评分、C反应蛋白质（CRP）、降钙素原、NAR、白细胞计数、红细胞分布宽度（RDW）、乳酸、住ICU时间、机械通气时间、行连续肾脏替代疗法（CRRT）、肺部感染、腹腔感染、泌尿系感染、血行感染和28 d死亡情况。将上述因素纳入单因素Logistic回归分析,初步筛选出相关的影响因素,再纳入多因素Logistic回归分析,得到影响脓毒性休克患者28 d死亡的独立危险因素;采用受试者工作特征（ROC）曲线分析NAR、乳酸及两者联合对脓毒性休克患者28 d死亡的预测价值,并用Z检验比较曲线下面积（AUC）。 结果经单因素Logistic回归分析,初步筛选出影响脓毒性休克患者28 d死亡的9个因素,包括男性[比值比（OR）= 0.345,95%置信区间（CI）（0.603,3.357）,P = 0.004]、SOFA评分[OR = 1.183,95%CI（1.036,1.350）,P = 0.013]、NAR [OR = 2.849,95%CI（1.487,5.457）,P = 0.002]、乳酸[OR = 1.275,95%CI（1.108,1.467）,P = 0.001]、机械通气时间[OR = 0.254,95%CI（1.025,1.223）,P < 0.001]、行CRRT [OR = 4.585,95%CI（1.737,12.100）,P = 0.002]、存在肺部感染[OR = 0.282,95%CI（0.898,4.732）,P < 0.001]、存在腹腔感染[OR = 0.460,95%CI（0.392,1.989）,P = 0.002]、存在泌尿系感染[OR = 0.464,95%CI（0.201,2.195）,P < 0.001]。将上述影响因素纳入多因素Logistic回归分析,结果显示,NAR [OR = 4.424,95%CI（1.427,13.717）,P = 0.010]、乳酸[OR = 1.267,95%CI（1.008,1.594）,P = 0.043]、机械通气时间[OR = 1.168,95%CI（1.007,1.356）,P = 0.041]、行CRRT [OR = 5.148,95%CI（1.069,24.794）,P = 0.041]是脓毒性休克患者28 d死亡的独立危险因素。ROC曲线分析结果显示,NAR [AUC = 0.676,95%CI（0.572,0.780）,P = 0.001]、乳酸[AUC = 0.696,95%CI（0.592,0.800）,P < 0.001]及NAR和乳酸联合[AUC = 0.759,95%CI（0.699,0.850）,P < 0.001]均对脓毒性休克患者28 d死亡具有预测价值,且NAR和乳酸联合的AUC显著高于NAR（Z = 2.110,P = 0.035）及乳酸（Z = 1.991,P = 0.047）。 结论NAR和乳酸对脓毒性休克患者28 d死亡有一定的预测价值,且两者联合能够提高预测价值。