血浆NLR联合NIHSS评分对老年急性脑梗死静脉溶栓后预后的预测价值

目的 探讨中性粒细胞/淋巴细胞值(neutrophil to lymphocyte ratio, NLR)联合NIHSS评分对老年急性脑梗死(cute cerebral infarction, ACI)静脉溶栓患者预后的评估价值。方法 选取151例接受静脉溶栓治疗的患者,收集实验室及临床相关资料,统计溶栓前血浆NLR和NIHSS评分。根据发病90d后改良Rankin量表(mRS)评分将患者分为预后不良组(93例)和预后良好组(58例)。采用二元logistic回归分析比较两组临床资料结果,用ROC曲线分析NLR、NIHSS评分与老年患者预后不良的关系及其预测预后不良的价值。结果 预后不良组溶栓前NIHSS评分及NLR均高于预后良好组。二元logistic回归分析显示,溶栓前血浆NLR及溶栓前NIHSS评分是急性脑梗死的独立危险因素(P<0.05),溶栓前血浆NLR及NIHSS评分预测急性脑梗死患者静脉溶栓后预后不良的ROC曲线下面积分别是0.720(95%CI 0.639～0.800,P=0.001),0.761(95%CI 0.683～0.840,P=0.001)。结论 溶栓前...     

老年颅脑外伤患者术后切口早期愈合不良的影响因素

目的观察老年颅脑外伤患者术后切口早期愈合情况,分析术后切口早期愈合不良的影响因素。方法回顾性分析接受手术治疗的107例颅脑外伤患者,根据术后3 w切口愈合情况,分为愈合组76例和愈合不良组31例,将愈合不良组分为感染组和非感染组。记录患者年龄、性别、体重指数(BMI)、合并基础病(糖尿病、高血压、冠心病、慢性呼吸系统疾病)、吸烟史、手术切口清洁程度、手术时间、术中出血量、是否留置引流管、住院时间;Logistic回归分析术后切口早期愈合不良的影响因素。结果术后切口早期愈合76例(71.03%),愈合不良31例(28.97%),其中切口积液15例,切口裂开6例,切口感染10例;老年颅脑外伤患者术后切口愈合不良与糖尿病、吸烟史、手术时间和留置引流管有关,合并糖尿病(OR=1.956,P=0.033)和手术时间4 h(OR=1.978,P=0.029)为影响老年颅脑外伤患者术后切口愈合不良的独立危险因素;感染组合并糖尿病、手术时间4 h所占比例明显高于非感染组。结论为降低老年颅脑外伤患者术后早期愈合不良的发生,临床需重点关注合并糖尿病、手术时间4 h的患者。     

老年急性冠状动脉综合征患者介入术后1年内主要不良心血管事件诺莫图的构建与评估

目的 构建老年急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术后1年内主要不良心血管事件(MACE)的诺莫图预测模型。方法 回顾性收集2020年1月1日至2022年4月1日解放军空军特色医学中心确诊ACS并接受PCI的患者551例,根据1年内随访是否发生MACE分为MACE组176例和非MACE组375例。采用单因素及多因素logistic回归分析老年ACS患者PCI术后1年内发生MACE的危险因素,构建诺莫图预测模型,并采用ROC曲线下面积(AUC)评估该模型的预测效果。结果 MACE组Gensini评分、全身免疫炎症指数、全球急性冠状动脉事件注册评分明显高于非MACE组,预后营养指数明显低于非MACE组(P<0.01)。多因素logistic回归分析显示,近期吸烟(OR=2.222,95%CI:1.361～3.628,P=0.010)、高脂血症(OR=1.881,95%CI:1.145～3.089,P=0.013)、预后营养指数(OR=4.645,95%CI:2.788～7.739,P=0.001)、左心室射血分数(OR=5.177,95%CI:3.160～8...     

糖尿病视网膜病变合并糖尿病肾病的危险因素及其预测价值

目的探讨糖尿病视网膜病变(DR)合并糖尿病肾病(DN)的危险因素及预测价值。方法回顾性分析2017年5月至2018年5月南京医科大学附属无锡市人民医院内分泌科收治的2型糖尿病(T2DM)患者1 969例,其中糖尿病视网膜病变(DR)合并糖尿病肾病(DN)患者609例,单纯DR患者746例,未并发DN和DR患者614例,比较3组患者的血糖、血压、肝功能和肾功能指标水平,分析DR合并DN的危险因素及预测价值。采用SPSS 18.0统计软件对数据进行分析。组间比较采用单因素方差分析或χ~2检验。多因素logistic回归分析DR合并DN的危险因素。受试者工作特征(ROC)曲线分析因素预测DR合并DN的价值。结果除高密度脂蛋白胆固醇(HDL-C)水平和左侧颈动脉内膜中层厚度(IMT)外,3组患者其余指标差异均具有统计学意义(P0.05)。多因素logistic回归分析结果显示年龄(OR=0.966,95%CI 0.932～1.000; P=0.049)、白蛋白(ALB)(OR=0.872,95%CI 0.837～0.908; P0.001)、服用他汀类药物(OR=0.400,95%CI 0.265～0.606; P0.001)是DR合并DN的保护因素,高血压病程(OR=1.021,95%CI 1.005～1.037; P=0.011)、收缩压(OR=1.018,95%CI 1.007～1.029; P=0.002)、空腹血糖(OR=1.054,95%CI 1.002～1.108; P=0.040)、甘油三酯(OR=1.133,95%CI 1.021～1.256;P=0.019)、低密度脂蛋白胆固醇(OR=1.355,95%CI 1.017～1.805; P=0.038)、血尿酸(OR=1.124,95%CI 1.016～1.244;P=0.023)、胱抑素C(OR=2.466,95%CI 1.495～4.068; P0.001)、眼底评分(OR=1.275,95%CI 1.088～1.494; P=0.003)、左室后壁厚度(OR=1.306,95%CI 1.051～1.622; P=0.016)和颈动脉粥样斑块形成(OR=1.578,95%CI 1.051～2.370;P=0.028)为危险因素。ROC曲线分析结果表明胱抑素C预测DR合并DN价值最高,AUC为0.677。结论 T2DM患者DR合并DN的患病率较高,其发生与多种因素相关,其中,胱抑素C预测DR合并DN价值最高。     

兰州高原地区重型创伤性脑损伤患者基线血清电解质水平对不良预后风险的预测价值

目的 探讨兰州高原地区重型创伤性脑损伤(sTBI)患者基线血清电解质水平对不良预后风险的预测价值。方法 回顾性选取解放军联勤保障部队第九四〇医院收治的210例兰州高原地区sTBI患者作为研究对象,根据预后情况分为预后良好组(91例)和预后不良组(119例)。对比2组患者临床资料、血清电解质水平,用多因素logistic回归分析预后不良的影响因素,绘制ROC曲线分析预测价值。结果 2组患者糖尿病、GCS、血清钙及血清镁水平比较有显著差异(P<0.05,P<0.01)。多因素logistic回归分析显示,糖尿病(OR=3.483,95%CI:1.452～8.357,P=0.005)、GCS(OR=0.464,95%CI:0.363～0.594,P=0.000)、低钙血症(OR=6.243、95%CI:3.353～11.626,P=0.000)和高镁血症(OR=9.985,95%CI:1.251～19.701,P=0.030)是高原sTBI患者不良预后的影响因素。ROC曲线分析显示,低钙血症曲线下面积为0.702(95%CI:0.635～0.763),高镁血症曲线下面积为0.56...     

老年早期肺腺癌患者术后切口愈合不良预测模型的建立全文替换

目的 建立出老年早期肺腺癌患者的术后切口愈合不良的风险预测模型。方法 回顾性分析2019年1月—2021年12月期间南京医科大学附属苏州市立医院胸外科收治的140例施行VATS手术的老年早期LUAD患者的资料。根据老年早期肺腺癌患者是否存在术后切口愈合不良，将其分为病例组共26例和对照组共114例。针对本研究中12项影响因素(包括：性别、年龄、营养状况、高血压、糖尿病、手术径路、手术方式、手术时间、术中出血量、术后肺炎、拔除胸管时间、 TNM分期等)分别进行单因素分析、 Logistic回归分析。结果 单因素分析的结果：年龄、营养状况、糖尿病、手术径路、术后肺炎以及拔除胸管时间等6项观察指标与手术切口愈合不良存在相关性(P<0.05)。Logistic回归分析的结果：年龄(OR=11.378, 95%CI:2.417～55.554,P=0.002),营养状况(OR=11.649,95%CI:2.802～48.431,P=0.001),糖尿病(OR=6.179, 95%CI:1.662～22.968,P=0.007),手术径路(OR=5.377, 95%CI:1.117～25.89...     

C-反应蛋白与白蛋白比值对老年髋部骨折患者短期预后的影响

目的探讨老年髋部骨折患者术前血清C-反应蛋白与白蛋白比值(CRP/Alb)在预测老年髋部骨折患者术后1年内死亡的临床价值。方法回顾性分析2015年1月至2017年8月,在中国人民解放军中部战区总医院骨科接受手术治疗的老年髋部骨折患者临床资料。根据患者术后1年内是否死亡分为存活组和死亡组。采用多元logistic回归分析筛选出老年髋部骨折患者术后1年内死亡的独立危险因素;并采用受试者工作特征(ROC)曲线和Kaplan-Meier法分析CRP/Alb对老年髋部骨折患者不良预后的评估价值。结果共165例患者纳入最终研究,术后1年内累计死亡率为20.61%。单因素分析结果显示,死亡组年龄、红细胞分布宽度、CRP、CRP/Alb、合并慢性肺部疾病比例和ASA分级均明显高于存活组,Alb明显低于存活组,差异均具有统计学意义(P0.05)。多因素分析结果显示CRP/Alb(OR=2.472,95%CI 1.100～5.554)是老年髋部骨折患者术后1年内死亡的重要危险因素。CRP/Alb预测老年髋部骨折不良预后的曲线下面积(AUC)为0.949(95%CI 0.915～0.984,P0.001),均明显高于CRP或Alb单指标预测。当CRP/Alb取3.05为最佳截断点时,将患者分为CRP/Alb高比值组(n=37)和低比值组(n=128),CRP/Alb高比值组患者生存期明显低于低比值组,差异具有统计学意义(χ~2=48.607,P0.001)。结论 CRP/Alb是老年髋部骨折患者术后1年内死亡的独立危险因素,CRP/Alb比值可作为预测不良临床结局的有效指标。     

脂蛋白相关磷脂酶A2与老年急性ST段抬高型心肌梗死患者冠状动脉高血栓负荷相关性

目的探讨血浆脂蛋白相关磷脂酶A2(Lp-PLA2)与急性ST段抬高型心肌梗死(STEMI)患者高血栓负荷的相关性。方法连续入选2016年8～12月于我院就诊的STEMI并行急诊PCI患者110例,根据患者冠状动脉造影确定血栓负荷程度分为低血栓负荷组68例和高血栓负荷组42例。采用多因素logistic回归分析冠状动脉高血栓负荷危险因素,用ROC曲线评估Lp-PLA2的预测价值。结果高血栓负荷组Lp-PLA2水平高于低血栓负荷组[(254.63±69.63)μmol/L vs(211.76±60.92)μmol/L,P=0.001]。多因素logistic回归分析显示,Lp-PLA2是高血栓负荷发生的独立危险因素(OR=1.008,95%CI:1.001～1.015,P=0.024)。ROC曲线分析显示,Lp-PLA2预测STEMI患者冠状动脉高血栓负荷程度曲线下面积为0.686(95%CI:0.583～0.788,P0.01)。结论 Lp-PLA2对STEMI患者冠状动脉高血栓负荷具有一定预测价值。     

慢性乙型肝炎免疫耐受期患者显著肝损伤的列线图模型及其预测价值分析

目的分析慢性HBV感染免疫耐受期(IT-CHB)患者显著肝损伤的高危因素并建立列线图预测模型。方法回顾性分析2002年8月—2017年12月在解放军总医院第五医学中心接受肝活检的382例慢性HBV感染者的资料,按照肝组织是否存在显著肝损伤分为2组,显著肝损伤组(≥G2或S2,n=82)和非显著肝损伤组(n=300)。正态分布的计量数据2组间比较采用独立样本t检验;非正态分布数据2组间比较采用Mann-Whitney U检验;多组比较采用Kruskal-Wallis H检验;计数资料2组间比较采用χ~2检验。相关性分析采用Spearman秩相关。采用单/多因素logistic回归方法筛选高危因素,并建立列线图模型,用C-指数、ROC曲线、校准曲线以及Bootstrap法来评价列线图的区分度及校准度。结果 2组年龄、HBV DNA载量、ALT、AST、PLT比较差异均有统计学意义(t=-7.071,Z值别为-4.924、-3.693、-6.945、-0.585、-5.723,P值均0.001)。Logistic回归分析显示年龄(OR=1.074,95%CI:1.043～1.107,P 0.001),HBV DNA载量(OR=0.442,95%CI:0.314～0.624,P 0.001),AST(OR=1.096,95%CI:1.051～1.142,P 0.001),PLT(OR=0.992,95%CI:0.986～0.998,P=0.006)是显著肝损伤的高危因素。基于以上因素建立列线图模型,预测显著肝损伤的C-指数为0.845,并且有拟合度高的校正曲线,其ROC曲线下面积(AUC)为0.845(95%CI:0.795～0.895),显著优于APRI(AUC=0.781,95%CI:0.723～0.840)以及FIB-4 (AUC=0.802,95%CI:0.746～0.859)。结论免疫耐受期具有显著肝损伤的患者比例并不少见,基于年龄、HBV DNA、AST、PLT构建的列线图模型具有良好的预测准确性,可用于个体化预测IT-CHB患者的显著肝损伤,减少肝活检,为抗病毒的精准治疗提供参考。     

国产自膨式经导管主动脉瓣置换术后严重传导损伤相关因素分析

目的 分析应用国产自膨式瓣膜行经导管主动脉瓣置换术(TAVR)后严重传导损伤的相关因素并评估其预测效能。方法 回顾性纳入2016年12月至2022年10月于中国人民解放军总医院第一医学中心应用国产自膨式主动脉瓣膜行TAVR患者。根据术后结果分为正常组和传导损伤组,采用logistic回归分析筛选相关因素。绘制受试者工作特征(ROC)曲线,计算预测效能并评估效能差异。采用SPSS 26.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、U检验及χ²检验。结果 纳入患者84例,其中正常组60例,传导损伤组24例。2组间左室流出道(LVOT)面积、LVOT面积/瓣环面积、室间隔膜部长度、室间隔膜部长度和植入深度的差值(ΔMSID)比较,差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,LVOT面积/瓣环面积(OR=0.874,95%CI 0.797～0.959,P=0.004)、ΔMSID(OR=0.660,95%CI 0.515～0.846,P=0.001)是TAVR术后严重传导损伤的独立危险因素。ROC曲线示LVOT面积/瓣环面...     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.