CHF贫血患者血清sFas/Apo-1、sFas和FasL水平变化及干预研究

目的:研究慢性充血性心力衰竭(CHF)贫血患者血清sFas/Apo-1、sFas和FasL水平变化及干预。方法:检测入选的319例CHF患者的血红蛋白、血清sFas/Apo-1、sFas和FasL水平,按血红蛋白水平分为CHF贫血组和非贫血组。结果:随着CHF患者心功能的恶化,其血红蛋白水平逐渐降低,而血清sFas/Apo-1、sFas和FasL水平则逐渐升高;CHF贫血组的血清sFas/Apo-1、sFas和FasL水平均明显高于CHF非贫血组(均为P<0.01);CHF患者血红蛋白水平与血清sFas/Apo-1、sFas和FasL水平呈负相关(P<0.01)。治疗后的结果显示,CHF贫血患者在贫血纠正后,血清sFas/Apo-1、sFas和FasL水平恢复到非贫血组患者水平。结论:CHF患者sFas/Apo-1、sFas和FasL水平的升高参与了CHF发生发展的病理生理过程,纠正贫血,规范治疗可显著降低血清sFas/Apo-1、sFas和FasL水平,抑制细胞凋亡,从而改善CHF患者心脏功能和预后。     

The effect of perceived spatial separation on informational masking of Chinese speech

The effect of perceived spatial separation, induced by the precedence effect, on release from noise or speech masking was investigated. Listeners were asked to orally repeat Chinese nonsense sentences, which were spoken by a female talker and presented by both the left (-45 degrees) and right (+45 degrees) loudspeakers, when maskers, which were either speech-spectrum noise sounds or Chinese nonsense sentences spoken by two other female talkers, were presented by the same two loudspeakers. Delays between identical sounds presented over the two loudspeakers were used to control the perceived locations of the target (right only) and masker (right, center, or left). The results show that perceived 45 degrees and 90 degrees separations of target speech from masking speech led to equivalently marked improvement in speech recognition, even though the degree of improvement was smaller than that reported in [J. Acoust. Soc. Am. 106 (1999) 3578 (using English nonsense speech)]. When the masker was noise, however, perceived separation only marginally improved speech recognition. These results indicate that release from informational masking, due to perceived target/masker spatial separation induced by the precedence effect, also occurs for tonal Chinese speech. Compared to the 45 degrees perceived within-hemifield separation, the 90 degrees perceived cross-hemifield separation does not produce further unmasking.     

精神康复治疗对精神分裂症患者生活质量的影响探讨

目的探讨并研究精神康复治疗对精神分裂症患者生活质量的影响。方法抽取本院2018年1月—12月接收的440例精神分裂症患者作为研究对象,440例患者均接受精神康复治疗,分析精神康复治疗对精神分裂症患者生活质量的影响。结果治疗后,患者精神康复作业治疗效果评分高于治疗前;精神康复松弛治疗效果评分高于治疗前;简单精神状态检查量表(mini-mental state examination,MMSE)评分高于治疗前;社会功能缺陷筛选量表(sloan digital sky survey,SDSS)评分均低于治疗前;治疗前后各项指标比较差异有统计学意义(P<0.05)。结论精神康复治疗能提高精神康复作业治疗效果和精神康复松弛治疗效果,改善患者的精神状态与社会功能,进而有效改善患者的生活质量。     

血浆脑钠肽前体检测对心源性脑栓塞的诊断价值

目的:探讨血浆脑钠肽前体(Pro-brain natriuretic peptide,Pro-BNP)检测对心源性脑栓塞(Cardioembolic,CE)诊断价值。方法:连续登记2013年10月~2014年1月我院神经内科收住的92例急性脑梗死(Cerebral infarction,CI)患者,检测患者血浆Pro-BNP水平,根据TOAST诊断标准分为CE组(n=38)和非CE组(n=54),比较两组血浆Pro-BNP水平差异性。结果:CI组患者血浆Pro-BNP水平明显高于正常对照组(中位数413.1 vs 68.06,P<0.01);CE组血浆Pro-BNP水平明显高于非CE组(中位数1 618 vs 121.9,P<0.01)。结论:血浆Pro-BNP水平检测有助于脑梗死病因学分型,有利于早期开展脑梗死二级预防治疗。     

肺移植营养不良患者多学科营养管理方案的构建与应用

目的 构建肺移植营养不良患者多学科营养管理方案,探讨该方案对术前营养不良患者肺移植术后营养状态及康复效果的影响.方法 按照住院时间将肺移植前营养不良患者分为对照组49例和干预组50例.对照组采用常规营养管理方案,干预组构建并实施包括运动处方、营养处方、药物治疗、心理管理等方面的多学科营养管理方案.结果 移植后1个月,干预组患者总白蛋白、白蛋白、竖脊肌横截面积、6分钟步行距离、呼吸困难评分显著优于对照组,术后住院时间显著短于对照组(P＜0.05,P＜0.01).结论 多学科营养管理有利于改善术前营养不良肺移植患者的术后营养状态,促进康复.     

Synergistic interaction of hypertension and hyperhomocysteinemia on chronic kidney disease: Findings from the National Health and Nutrition Examination Survey 1999‐2006

Hypertension and hyperhomocysteinemia are two independent risk factors of chronic kidney disease (CKD). Our study aimed to evaluate whether hypertension and hyperhomocysteinemia act synergistically toward renal injury. Our analysis included 13 693 subjects from the National Health and Nutritional Survey (NHANES) 1999‐2006. Association was assessed by multivariate logistic regressions. The interaction was investigated on both additive and multiplicative scales. CKD had a prevalence of 17.62% in the NHANES population. After adjusting for age, sex, race, education, physical activity, drinking frequency, current smoking status, poverty‐to‐income ratio, Total cholesterol, high‐density lipoprotein cholesterol, serum folate, vitamin B12, body mass index, waist circumference, and diabetes mellitus, patients with both hypertension and hyperhomocysteinemia had a 5.072 (3.967‐6.486) times risk of CKD than their healthy compartments, higher than that in patients with only hypertension or hyperhomocysteinemia. Moreover, additive interaction of hypertension and hyperhomocysteinemia was significant (relative excess risk due to interaction: 2.107, 95% CI: 1.071‐3.143; the attributable proportion due to interaction: 0.415, 95% CI: 0.270‐0.561; synergy index: 2.072, 95% CI: 1.449‐2.962). Finally, subgroup analyses elucidated the interaction was robust in those with only reduced estimated glomerular filtration rate or albuminuria, and stratification analyses based on gender showed consistency with the main results. Hypertension and hyperhomocysteinemia may act synergistically toward a greater renal injury than the sum of their independent effects. Our findings suggest the coexistence itself also correlates with a deteriorative impact on renal function in addition to the effects of hypertension and diabetes themselves. The results may support the rationality and value of simultaneous tight control of hypertension and hyperhomocysteinemia to prevent CKD.     

血浆同型半胱氨酸水平与轻度认知功能障碍对老年2型糖尿病患者的影响

目的 分析血浆同型半胱氨酸（Hcy）水平与认知功能障碍对2型糖尿病患者的影响,并探讨影响认知功能的其他因素.方法 2型糖尿病患者80例,根据简易精神状态量表（MMSE）评分将2型糖尿病患者分为认知障碍组（38例）、非认知障碍组（42例）,选择健康对照者30名作为正常对照组.测定3组血浆Hcy、糖化血红蛋白、血脂、尿酸、24 h尿微量白蛋白等指标.结果 糖尿病认知障碍组、糖尿病非认知障碍组、正常对照组血浆Hcy浓度分别为（19.56±5.23）、（16.21 ±3.27）、（14.67 ±4.27）μmol/L,3组差异有统计学意义（F=3.76,P＜0.05）,且糖尿病认知障碍组血浆Hcy水平高于糖尿病非认知障碍组（P＜0.05）与正常对照组（P＜0.01）,糖尿病非认知障碍组高于正常对照组（P＜0.05）;影响患者认知功能的其他因素包括年龄、糖化血红蛋白、体质量指数、糖尿病病程及血浆Hcy水平,与患者MMSE评分呈负相关（r值分别为-0.336、-0.285、-0.226、-0.392、-0.312,P均＜0.05）.结论 年龄、糖尿病病程、糖化血红蛋白、体质量指数均可影响患者的认知功能,Hcy水平升高是2型糖尿病患者认知障碍的一个危险因素.     

The efficacy of internet-based cognitive behavioural therapy for social anxiety disorder: A systematic review and meta-analysis

Social anxiety disorder (SAD) is one of the most common lifelong anxiety disorders. Although cognitive behavioural therapy (CBT) has proven to be effective in treating people with SAD, it may not be available for a considerable proportion of patients. Internet-based CBT (ICBT) is more accessible than face-to-face treatment. This meta-analysis evaluated the efficacy of ICBT in patients with SAD. We searched five databases, PubMed, Cochrane Central Register of Controlled Trials, Health Management Information Consortium, Ovid MEDLINE and EMBASE, and identified 20 eligible randomized controlled trials published from inception to 25 July 2020, with the outcome data from 1,743 participants. The results indicated that ICBT had a significant positive effect on patients with SAD compared with the control groups (g = −0.55). A subgroup analysis revealed that ICBT and CBT had an equal effect on treating patients with SAD (g = −0.18). There was also no difference between ICBT and ICBT plus other therapies in the treatment of patients with SAD (g = −0.07). The effect size of ICBT on patients with SAD was maintained at the 6-month follow-up (g = −0.08) and at the 12-month follow-up (g = −0.17). The findings of this review demonstrated that ICBT can significantly reduce SAD symptoms and that ICBT and face-to-face CBT produce equivalent effects. The results of this meta-analysis contributed to the literature on ICBT for the treatment of patients with SAD, although numerous aspects of ICBT were identified for future investigations.     

Alterations of brain activity and functional connectivity in transition from acute to chronic tinnitus

The objective of this study was to investigate alterations to brain activity and functional connectivity in patients with tinnitus, exploring neural features in the transition from acute to chronic phantom perception. Twenty‐four patients with acute tinnitus, 23 patients with chronic tinnitus, and 32 healthy controls were recruited. High‐density electroencephalography (EEG) was used to explore changes in brain areas and functional connectivity in different groups. When compared with healthy subjects, acute tinnitus patients had a significant reduction in superior frontal cortex activity across all frequency bands, whereas chronic tinnitus patients had a significant reduction in the superior frontal cortex at beta 3 and gamma frequency bands as well as a significant increase in the inferior frontal cortex at delta‐band and superior temporal cortex at alpha 1 frequency band. When compared to the chronic tinnitus group, the acute tinnitus group activity was significantly increased in the middle frontal and parietal gyrus at the gamma‐band. Functional connectivity analysis showed that the chronic tinnitus group had increased connections between the parahippocampus gyrus, posterior cingulate cortex, and precuneus when compared with the healthy group. Alterations of local brain activity and connections between the parahippocampus gyrus and other nonauditory areas appeared in the transition from acute to chronic tinnitus. This indicates that the appearance and development of tinnitus is a dynamic process involving aberrant local neural activity and abnormal connectivity in multifunctional brain networks.