湖北省农村贫困地区妇女的抑郁症状及相关因素

目的:了解湖北省农村贫困地区妇女的抑郁症状流行现状及相关因素,为农村贫困地区妇女抑郁的三级预防提供理论依据和指导。方法:采用随机整群抽样法在湖北省7个贫困县市的8个村调查1345名妇女(年龄18～64岁),采用简版流调中心用抑郁自评量表(CES-D₁₀)评估抑郁症状。结果:CES-D₁₀平均得分为(5.8±4.5)分,中位数为5.0分。具有抑郁倾向的检出率为19.8%。多因素回归分析结果显示,睡眠质量越差、经济状况差、年龄越大、丧偶以及有异常孕产史妇女的CES-D₁₀得分越高(β=0.40、0.24、0.07、0.06、0.05,P<0.05);经常锻炼身体妇女的CES-D₁₀得分越低(β=-0.06,P<0.05)。结论:本研究发现,经济困难、睡眠质量差、年龄增长、丧偶、异常孕产史和锻炼身体是湖北省农村贫困妇女抑郁症状的相关因素。     

Cohesin ATPase activities regulate DNA binding and coiled-coil configuration

The cohesin complex is required for sister chromatid cohesion and genome compaction. Cohesin coiled coils (CCs) can fold at break sites near midpoints to bring head and hinge domains, located at opposite ends of coiled coils, into proximity. Whether ATPase activities in the head play a role in this conformational change is yet to be known. Here, we dissected functions of cohesin ATPase activities in cohesin dynamics in Schizosaccharomyces pombe. Isolation and characterization of cohesin ATPase temperature-sensitive (ts) mutants indicate that both ATPase domains are required for proper chromosome segregation. Unbiased screening of spontaneous suppressor mutations rescuing the temperature lethality of cohesin ATPase mutants identified several suppressor hotspots in cohesin that located outside of ATPase domains. Then, we performed comprehensive saturation mutagenesis targeted to these suppressor hotspots. Large numbers of the identified suppressor mutations indicated several different ways to compensate for the ATPase mutants: 1) Substitutions to amino acids with smaller side chains in coiled coils at break sites around midpoints may enable folding and extension of coiled coils more easily; 2) substitutions to arginine in the DNA binding region of the head may enhance DNA binding; or 3) substitutions to hydrophobic amino acids in coiled coils, connecting the head and interacting with other subunits, may alter conformation of coiled coils close to the head. These results reflect serial structural changes in cohesin driven by its ATPase activities potentially for packaging DNAs.

The cohesin complex is required for sister chromatid cohesion, DNA damage response, gene expression, and spatial organization of the genome (1, 2). Psm1/SMC1 and Psm3/SMC3 form a stable heterodimer via both hinge–hinge interaction and ATPase heads engagement upon ATP binding (3–5). Cohesin owns two ATPase domains at its globular head. Each ATPase domain contains the Walker A and Walker B consensus sequences found in most ATPases (5, 6) and several other sequence motifs, such as signature motif and D loop (7). Both ATPase domains are required for efficient loading of cohesin (8). Rad21/SCC1, the kleisin subunit with its N-terminal domain, interacts with Psm3/SMC3 coiled coils (CCs) emerging from the head, and its C-terminal domain interacts with Psm1/SMC1 head domain (9–12). Psc3/SCC3 associates with the unstructured region in the middle of Rad21/SCC1 (13–15).Mis4/SCC2/NIPBL functions as the cohesin loader (16, 17). Mis4/SCC2/NIPBL forms a harp-shaped structure (18, 19). Its N-terminal domain binds to Psm3/SMC3 coiled coils close to the head domain and its C-terminal domain binds to Psm1/SMC1 coiled coils close to the head domain (11, 15). Mis4/SCC2/NIPBL also stimulates cohesin’s ATPase activity for efficient cohesin loading (20–22).All coiled coils of SMC complexes (cohesin, condensin, and SMC5-SMC6 complex) are ∼50 nm long and are essential for their functions (23–25). SMC coiled coils contain interruptions (break sites hereafter) that disrupt the characteristic seven-residue amino acid sequence repeats, known as heptad repeats (26, 27). It has been proposed that cohesin folds around the midpoints of its coiled coils to bring the head and hinge domains into proximity (20, 28–30). However, it is still unclear how such molecular architecture of cohesin works to fulfill its function. In this study, we isolated temperature-sensitive (ts) mutants with single amino acid substitutions in the signature motif or D loop of cohesin ATPase domains, which presumably impair ATPase activity of cohesin. Then, screening of suppressor mutations that rescued the lethality caused by ATPase defects identified several hot regions in cohesin SMC subunits, which are involved in DNA binding, interaction with non-SMC subunits, or coiled-coil dynamics around midpoints. Therefore, these results coupled the dynamics of the cohesin complex with ATPase activity.     

Drug hypersensitivity syndrome induced by sulfasalazine: A case report

Introduction:Drug hypersensitivity syndrome (DHS) induced by sulfasalazine is a serious systemic delayed adverse drug reaction, which is associated with significant morbidity and mortality.Patient concerns:A 52-year-old man was hospitalized for developing a rash after 3 weeks of sulfasalazine treatment for ulcerative colitis (UC).Diagnosis:The patient was diagnosed with DHS based on his drug history, clinical manifestations, and laboratory test results.Interventions:The patient was administered intravenous glucocorticoids. The patient’s condition improved after treatment with human immunoglobulin and antihistamines.Outcomes:Combination therapy of glucocorticoid and gamma globulin, the whole-body pruritus disappeared, and no new rash appeared. The whole-body rash subsided or turned dark red.Conclusion:This article describes the diagnosis and treatment process of a case of sulfasalazine-induced DHS and reviews the relevant literature to improve clinician understanding and avoid misdiagnosis and missed diagnosis.     

Effects of 1-stage revascularization and temporary external fixation combined with 2-stage Ilizarov technique in the treatment of bone defects in lower limb destruction injury: A case report

Rationale:To evaluate the clinical effects of 1-stage revascularization, vacuum sealing drainage covering the wound, temporary external fixation and 2-stage Ilizarov bone transport for the treatment limb destruction injury.Patient concerns and diagnosis:Nine patients with limb destruction injury between September 2014 and June 2019 at our institute were evaluated retrospectively. The age of patient was 21 to 51 years with an average of 33 years. The injuries were caused by vehicle accidents in 4 patients, gunshot in 1 patient, and crushing injuries in 4 patients. All of them had vascular injury. The average length of bone defect was 9.5 (8.3–10) cm. Regular follow-up was performed on wound healing, bone transport time, bone healing time, external fixation index, and limb function.Interventions:All patients underwent 1-stage revascularization and temporary external fixation during emergency surgery, and then gradual bone transport by Ilizarov fixator was performed until the broken fracture site was reunited.Outcomes:Nine patients were followed up for 12 to 48 months (average 30 months). Six patients were treated with autogenous cancellous bone graft for the second time, and 2 patients healed spontaneously. The mean wound healing time was 86 (73–90) days. The bone transport time was 97 (88.3–105.3) days, and the bone mineralization time was 164.5 (156.8–181.3) days, and the healing time of the docking sites was 6.8 (6.1–8.3) months. The external fixator time was 14.5 (12.5–17) months with the external fixation index was 1.5 (1.4–1.8) m/cm. At the last follow-up, according to the Association for the Study of the Method of Ilizarov functional scores, excellent functional outcomes were obtained in 5 patients, good in 1 patients, moderate in 2 patients. According to the Association for the Study of the Method of Ilizarov Radiological System, excellent functional outcomes were obtained in 6 cases and good in 2 cases.Lessons:One-stage revascularization and temporary external fixation combined with 2-stage Ilizarov bone transport technique for the treatment of bone defects in limb destruction injury have satisfactory clinical effects and few complications, and can be applied under the condition of strict understanding of surgical indications.     

3D Cube FLAIR plus HyperSense compressed sensing is superior to 2D T2WI FLAIR scanning regarding image quality,spatial resolution,detection rate for cortical microinfarcts

3-dimention (3D) Cube isotropic volumetric magnetic resonance imaging (MRI) facilitates comprehensive recognition of microinfarcts while it takes long scanning time. HyperSense compressed sensing is an emerging technique for accelerating MRI acquisition to reduce scanning time, while its application along with 3D Cube MRI for microinfarcts is seldom reported. Therefore, this study aimed to investigate the efficiency of 3D Cube FLAIR plus HyperSense compressed sensing technique versus conventional 2-dimention (2D) FLAIR scanning in the detection of cortical microinfarcts (CMIs).Totally 59 patients with cerebrovascular disease were enrolled then scanned by 3D Cube FLAIR plus HyperSense compressed sensing and 2D T2WI FLAIR sequences. The image quality scores, signal-to-noise ratio (SNR) for gray matter (GM), SNR for white matter (WM), their contrast-to-noise ratio (WM-to-GM CNR), detected number of CMIs were evaluated.3D Cube FLAIR plus HyperSense showed a dramatically increased scores of uniformity, artifact, degree of lesion displacement, and overall image quality compared to 2D T2WI FLAIR. Meanwhile, it exhibited similar SNRwm and SNRgm, but a higher WM-to-GM contrast-to-noise ratio compared with 2D T2WI FLAIR. Furthermore, the scanning time of 3D Cube FLAIR plus HyperSense and 2D T2WI FLAIR were both set as 2.5 minutes. Encouragingly, 244 CMIs were detected by 3D Cube FLAIR plus HyperSense, which was higher compared to 2D T2WI FLAIR (106 detected CMIs).3D Cube FLAIR plus HyperSense compressed sensing is superior to 2D T2WI FLAIR scanning regarding image quality, spatial resolution, detection rate for CMIs; meanwhile, it does not increase the scanning time. These findings may contribute to early detection and treatment of stroke.     

Effect of IGF-1C domain-modified nanoparticles on renal ischemia–reperfusion injury in mice

Renal ischemia–reperfusion injury (IRI) is a common prerequisite of acute renal injury (AKI) that involves the entire system and induces critical illness. The C domain of insulin-like growth factor-1 (IGF-1C) plays an important role in promoting angiogenesis and enhancing the inflammatory response. However, given the shortcomings of its short half-life and poor stability, the application of IGF-1C is restricted. In the present study, IGF-1C nanoparticles (NP-IGF-1C) were constructed by combining 1,2-distearoyl-sn-glycero-3-phosphoethanolamine-N-[maleimide (polye thyleneglycol)](DSPE-PEG-MAL) and IGF-1C through a Michael addition reaction to evaluate the effects of NP-IGF-1C on preventing IRI. In vitro studies have shown that NP-IGF-1C is not cytotoxic and protects cells from oxidative damage. The renal enrichment and biocompatibility of NP-IGF-1C were determined in vivo by connecting fluorescent molecules to NP-IGF-1C for in vivo imaging and pathological staining of important organs. After IRI, renal function decreased, and inflammatory cell infiltration, oxidative stress and apoptosis increased. As expected, NP-IGF-1C reversed these changes, indicating that NP-IGF-1C played a protective role in the process of IRI, which may be mediated by its antioxidant, anti-inflammatory and antiapoptotic activities.     

Addition of glomerular lesion severity improves the value of anemia status for the prediction of renal outcomes in Chinese patients with type 2 diabetes

We aimed to determine the utility of biopsy data and anemia for the prediction of renal outcomes in Chinese patients with type 2 diabetes. In total, 441 Chinese patients with type 2 diabetes and biopsy-confirmed diabetic nephropathy (DN) were enrolled in a retrospective study. Their renal pathology was assessed using the Renal Pathology Society system. Cox proportional hazards models were used to estimate hazard ratios (HRs) for end-stage renal disease (ESRD), and immunofluorescence staining was used to assess the expression of hypoxia-inducible factor (HIF)-α in patients’ kidneys. We found that glomerular pathology classification was an independent pathological predictor of low hemoglobin concentration, according to linear and logistic regression analyses. Each 1 g/dL decrease in baseline hemoglobin concentration was associated with a 42% higher risk of an adverse renal outcome, after adjustment for clinical and pathologic covariates. In patients with severe glomerular lesions, the risk of progression to ESRD was significantly higher if mild or moderate/severe anemia was present, but in patients with mild glomerular lesions, the risk was only significantly higher in those with moderate or severe anemia than in the absence of anemia. Harrell’s C Concordance was improved, but the Akaike information criterion was worsened by adding the glomerular pathology classification to the use of anemia status and clinical data. Immunofluorescence staining revealed that renal HIF-1α and HIF-2α expression was significantly higher in classes II–IV than class I. Thus, the addition of glomerular pathology classification increases the value of anemia status for the prediction of the progression to ESRD.     

军队人员门(急)诊社会化保障费用影响因素分析

目的:分析远离军队医疗机构人员门(急)诊社会化保障门(急)费用主要影响因素,为卫生事业经费的合理投入提供参考依据。方法:采用分层与整群抽样,收集某战区2003年3月—2004年3月实行门(急)诊社会化保障单位有关数据,用Spss11.0、两部模型等方法进行统计分析。结果:年龄、部队类别、人员类别、地区类别、定点医疗机构级别、有无第二诊断等因素均可影响医疗费用。讨论:经费投入应充分考虑部队类别、人员身份、地区类别、定点医疗机构级别等因素而实施分类保障。