rTMS及CBT-I对慢性失眠障碍患者治疗效果的随机对照研究

背景 目前,药物疗法是失眠障碍的一线治疗手段,但仍然存在着一定的不良反应。与药物治疗相比,重复经颅磁刺激（rTMS）和失眠的认知行为治疗（CBT-I）的不良反应较少、患者耐受性较好。目的 探讨rTMS与CBT-I治疗慢性失眠障碍的效果,以期为慢性失眠障碍患者提供更优的治疗方案。方法 选取2020年9月21日—2021年12月16日在内蒙古自治区精神卫生中心门诊或社区医院就诊的、符合《国际睡眠障碍分类第三版》（ICSD-3）诊断标准的慢性失眠障碍患者（n=50）,同期在社区招募与患者组年龄和性别相匹配的健康人作为对照组（n=16）。采用随机数字表法将慢性失眠障碍患者分为rTMS组与CBT-I组各25例,分别接受为期6周的rTMS或CBT-I干预。于干预前和干预后,慢性失眠障碍患者接受多导睡眠监测（PSG）以及匹兹堡睡眠质量指数量表（PSQI）、失眠严重程度指数量表（ISI）、重复性成套神经心理状态测验（RBANS）评定。对患者组和对照组进行静息态磁共振成像（rs-fMRI）扫描,并进行静息态低频振幅（ALFF）分析。将患者组和对照组ALFF值差异有统计学意义的脑区作为感兴趣区域（ROI）,将其作为种子点与患者全脑进行功能连接分析。结果 rTMS组和CBT-I组的PSQI评分、ISI评分以及RBANS中的即刻记忆、言语功能、延时记忆维度评分的时间效应均有统计学意义（F=41.160、69.615、47.923、12.090、28.193,P均<0.05）;两组总睡眠时间的时间效应、睡眠效率的时间效应和组别效应以及N1%的时间效应均有统计学意义（F=8.995、12.414、4.342、7.806,P均<0.05）。干预后,CBT-I组睡眠效率高于干预前（t=-2.785,P<0.05）。rTMS组眶部额上回与左侧豆状壳核（t=4.991,P<0.05）、右内侧和旁扣带回（t=4.471,P<0.05）和右侧中央后回（t=4.922,P<0.05）之间的功能连接增强,CBT-I组眶部额上回与左侧额中回之间的功能连接增强（t=6.586,P<0.05）。结论 rTMS及CBT-I可能有助于改善慢性失眠障碍患者的失眠情况和认知功能。     

Association between Geriatric Nutritional Risk Index and Depression after Ischemic Stroke

Background: Malnutrition is associated with poor outcomes after stroke. However, the association between malnutrition and post-stroke depression (PSD) remains unelucidated. We aimed to explore the association between geriatric nutritional risk index (GNRI) and depression after ischemic stroke. Methods: In total, 344 patients with ischemic stroke were included in this analysis. The GNRI was calculated from serum albumin level, weight, and height at admission. Malnutrition was defined using the GNRI cutoff points. A lower GNRI score indicates an elevated nutritional risk. The outcome was depression, measured 14 days after ischemic stroke. Logistic regression models were used to estimate the association between the GNRI and risk of PSD. Results: A total of 22.9% developed PSD 14 days after stroke. The mean GNRI was 99.3 ± 6.0, and 53.8% of the patients had malnutrition. After adjusting for covariates, baseline malnutrition was not associated with risk of PSD (OR, 0.670; 95%CI, 0.370–1.213; p = 0.186). The restricted cubic splines revealed a U-shaped association between the GNRI and PSD. Compared to moderate GNRI, higher GNRI (OR, 2.368; 95%CI, 0.983–5.701; p = 0.085) or lower GNRI (OR, 2.226; 95%CI, 0.890–5.563; p = 0.087) did not significantly increase the risk of PSD. Conclusion: A low GNRI was not associated with an increased risk of depression after ischemic stroke.     

Effects of Processing Parameters on the Microstructure and Mechanical Properties of Nanoscaled WC-10Co Cemented Carbide

This work was mainly focused on the processing-parameter-related microstructure and properties of ultrafine WC-10Co-0.4VC-0.5Cr₃C₂ cemented carbide. The samples were prepared via a spark plasma sintering (SPS) technique using nano WC and Co powders and the corresponding inhibitor VC and Cr₃C₂ powders. The influence of the processing process on the microstructure and mechanical properties of ultrafine-grained cemented carbide was investigated under different ball-milling times and sintering temperatures. The results showed that the grain size of WC decreased with increasing ball-milling time and decreasing sintering temperature and that the specific gravity of ε-Co increased with increasing ball-milling time. The hardness of cemented carbide increased with increasing ball-milling time and decreased with increasing sintering temperature due to the corresponding variation in grain size and the relative density of samples. The transverse fracture strength (TRS) was mainly affected by ball-milling time. The increase in ball-milling time led to decreased TRS values, mainly ascribed to the formation of WC particle agglomeration and the decreased WC-Co eutectic temperature. In addition, temperature changes were found to have little effect on TRS. The samples sintered at 1250 °C with a ball-milling time of 60 h had comprehensive mechanical properties. Their average grain size, relative density, hardness, and TRS were 355.5 nm, 95.79%, 2035.5 kg/mm², and 2155.99 MPa, respectively.     

漂浮导管对重症急性胰腺炎继发脓毒血症患者临床治疗的价值研究

目的探讨分析漂浮导管技术对指导重症急性胰腺炎继发脓毒血症患者临床治疗的价值研究。方法选取2017年1月至2019年4月我院收治的重症急性胰腺炎继发脓毒血症患者60例,跟踪病情变化,其中病情好转患者40例（A组）,病情恶化患者20例（B组）。对比观察两组患者的治疗前后48 h的中心静脉压（CVP）、平均肺动脉压（MPAP）、肺毛细血管楔压（PCWP）、心率（HR）、心脏指数（CI）、外周血管阻力指数（SVRI）等指标的血流动力学变化,同时观察记录病情好转组治疗后1～6 d的血流动力学改变。结果相比于治疗前,A组患者治疗48 h后CVP、CI指标明显下降（P<0.05）,SVRI、HR、PCWP、MPAP指标明显升高（P<0.05）; B组患者治疗前后血流动力学指标差异均无统计学意义（P>0.05）。与对照值相比,A组患者治疗后1～3 d CI、CVP明显降低（P<0.05）,PCWP、SVRI明显升高（P<0.05）;治疗后4～6 d内SVRI明显降低（P<0.05）;治疗后6 d内MPAP和HR明显升高（P<0.05）。结论漂浮导管技术应用于重症急性胰腺炎继发脓毒血症患者,能够及时检测外周血管扩张和低血容量的问题,评估病情,在临床治疗的监测指导和预后评估有着重要价值     

Oral Health,Diabetes, and Inflammation: Effects of Oral Hygiene Behaviour

IntroductionThe aim of this research was to assess the association between inflammation and oral health and diabetes, as well as the mediating role of oral hygiene practice in this association.MethodsData were from the 2009–2010 National Health and Nutrition Examination Survey. The analytical sample consisted of 2,191 respondents aged 50 and older. Poor oral health was clinically defined by significant tooth loss (STL) and periodontal disease (PD). Diabetes mellitus (DM) was determined by glycemic levels. The outcome variable was serum C-reactive protein (CRP) level, dichotomised as ≥1 mg/dL (elevated CRP) vs <1 mg/dL (not elevated CRP). Two path models, one using STL and DM as the independent variable, the other using PD and DM as the independent variable, were estimated to assess the direct effects of having poor oral health and DM on elevated CRP and the mediating effects of dental flossing.ResultsIn path model 1, individuals having both STL and DM (adjusted odds ratio [AOR], 1.92; 95% confidence interval [CI], 1.30–2.82) or having STL alone (AOR, 2.30; 95% CI, 1.68–3.15) were more likely to have elevated CRP than those with neither STL nor DM; dental flossing (AOR, 0.92, 95% CI, 0.88–0.96) was associated with lower risk of elevated CRP. In path model 2, no significant association was found between having both PD and DM and elevated CRP; dental flossing (AOR, 0.91; 95% CI:, 0.86–0.94) was associated with lower risk of elevated CRP.ConclusionsFindings from this study highlight the importance of improving oral health and oral hygiene practice to mitigate inflammation. Further research is needed to assess the longer-term effects of reducing inflammation.Key words: Tooth loss, Periodontal disease, Diabetes, Inflammation     

Neoadjuvant chemotherapy endows CD9 with prognostic value that differs between tumor and stromal areas in patients with pancreatic cancer

BackgroundThe selective pressure imposed by chemotherapy creates a barrier to tumor eradication and an opportunity for metastasis and recurrence. As a newly discovered stemness marker of pancreatic ductal adenocarcinoma (PDAC), the impact of CD9 on tumor progression and patient''s prognosis remain controversial.MethodsA total of 179 and 211 PDAC patients who underwent surgical resection with or without neoadjuvant chemotherapy, respectively, were recruited for immunohistochemical analyses of CD9 expression in both tumor and stromal areas prior to statistical analyses to determine the prognostic impact and predictive accuracy of CD9.ResultsThe relationship between CD9 and prognostic indicators was not significant in the non‐neoadjuvant group. Nevertheless, CD9 expression in both tumor (T‐CD9) and stromal areas (S‐CD9) was significantly correlated with the clinicopathological features in the neoadjuvant group. High levels of T‐CD9 were significantly associated with worse OS (p = 0.005) and RFS (p = 0.007), while positive S‐CD9 showed the opposite results (OS: p = 0.024; RFS: p = 0.008). Cox regression analyses identified CD9 in both areas as an independent prognostic factor. The T&S‐CD9 risk‐level system was used to stratify patients with different survival levels. The combination of T&S‐CD9 risk level and TNM stage were accurate predictors of OS (C‐index: 0.676; AIC: 512.51) and RFS (C‐index: 0.680; AIC: 519.53). The calibration curve of the nomogram composed of the combined parameters showed excellent predictive consistency for 1‐year RFS. These results were verified using a validation cohort.ConclusionNeoadjuvant chemotherapy endows CD9 with a significant prognostic value that differs between tumor and stromal areas in patients with pancreatic cancer.     

骨整合义耳修复创伤性全耳廓缺损

目的探讨骨整合义耳修复创伤性全耳廓缺损的可行性和临床效果。方法回顾性分析19例创伤性全耳廓缺损采用骨整合义耳修复患者。其中先天性小耳畸形全耳再造失败者12例,硫酸烧伤1例,高温铝水烫伤1例,车祸所致4例,刀砍伤1例。所有病例得到随诊,时间3～5年。结果所有患者均1次治愈,有一个形态逼真、色泽自然的外观,用骨整合方法固位的义耳配戴稳定,对日常生活无影响。结论骨整合义耳修复方法简便、创伤小、治疗周期短,无并发症,效果满意。对全耳再造失败者是一有效的治疗补救,对耳廓连同周围组织大面积缺损后瘢痕愈合者是可优先选择的方法。     

Hand-assisted laparoscopic versus laparoscopic-assisted radical gastrectomy in the treatment of advanced distal gastric cancer: final results of a single-center randomized study

ObjectiveTo compare the results and 5- and 8-year overall survival (OS) and disease-free survival (DFS) of hand-assisted laparoscopic surgery (HALS) and laparoscopic-assisted surgery (LAS) in radical gastrectomy for advanced distal gastric cancer.MethodsA total of 124 patients admitted to our institution from May 2009 to April 2013 were randomly divided into a HALS group (n = 62) and a LAS group (n = 62). Postoperatively, 110 patients were followed for 5 and 8 years, and 14 patients were lost to follow-up. The 5- and 8-year OS and DFS rates of the groups were compared and analyzed.ResultsThe 5- and 8-year OS rates, respectively, were 38.8% and 19.4% in the HALS group and 38.3% and 15.3% in the LAS group (log-rank test, χ² = 0.250). The 5- and 8-year DFS rates, respectively, were 23.1% and 10.6% in the HALS group and 19.3% and 11.6% in the LAS group (log-rank test, χ² = 0.109). No significant differences were found.ConclusionCompared with LAS, HALS radical gastrectomy for advanced distal gastric cancer had a lower conversion rate to open surgery, shorter surgical duration, and more thorough dissection of lymph nodes; 5- and 8-year OS and DFS rates were similar to those with LAS.     

Avian IRF1 and IRF7 Play Overlapping and Distinct Roles in Regulating IFN-Dependent and -Independent Antiviral Responses to Duck Tembusu Virus Infection

Avian interferon regulatory factors 1 and 7 (IRF1 and IRF7) play important roles in the host’s innate immunity against viral infection. Our previous study revealed that duck tembusu virus (DTMUV) infection of chicken fibroblasts (DF1) and duck embryo fibroblasts (DEFs) induced the expression of a variety of IFN-stimulated genes (ISGs), including VIPERIN, IFIT5, CMPK2, IRF1, and IRF7. IRF1 was further shown to play a significant role in regulating the up-expression of VIPERIN, IFIT5, and CMPK2 and inhibiting DTMUV replication. In this study, we confirm, through overexpression and knockout approaches, that both IRF1 and IRF7 inhibit DTMUV replication, mainly via regulation of type I IFN expression, as well as the induction of IRF1, VIPERIN, IFIT5, CMPK2, and MX1. In addition, IRF1 directly promoted the expression of VIPERIN and CMPK2 in an IFN-independent manner when IRF7 and type I IFN signaling were undermined. We also found that non-structural protein 2B (NS2B) of DTMUV was able to inhibit the induction of IFN-β mRNA triggered by Newcastle disease virus (NDV) infection or poly(I:C) treatment, revealing a strategy employed by DTMUV to evade host’s immunosurveillance. This study demonstrates that avian IRF7 and IRF1 play distinct roles in the regulation of type I IFN response during DTMUV infection.     

脂蛋白脂酶活化剂NO-1886抑制糖尿病兔动脉粥样硬化的形成

目的　合成化合物NO 1886 ,一种脂蛋白脂酶活化观察脂蛋白脂酶活化剂是否降低高脂 /高蔗糖饲料诱发的糖尿病新西兰兔的血浆葡萄糖并减轻其动脉粥样硬化。方法　给予高脂 /高蔗糖饲料升高新西兰兔血浆总胆固醇 ,甘油三酯和葡萄糖及降低高密度脂蛋白胆固醇而导致动脉粥样硬化。饲料中加入 1 0 %NO 1886进行治疗观察。分别在 0、4、8、12、16、2 0及 2 4wk从禁食过夜的兔耳静脉抽取血样测定葡萄糖和脂质水平。第 2 4周末 ,处死动物 ,分离主动脉 ,经苏丹Ⅳ染色固定脂质后 ,计算脂纹病变面积。结果　应用NO 1886后 ,实验动物血浆葡萄糖 ,总胆固醇和甘油三酯降低 ,高密度脂蛋白胆固醇增加。对动脉粥样硬化的发展具有抑制作用。结论　NO 1886不仅可改善脂质紊乱 ,而且可降低血浆葡萄糖 ,减轻糖尿病兔动脉粥样硬化