糖尿病神经病变的评估和预防

糖尿病神经病变是糖尿病最常见和最复杂的并发症之一,可累及全身神经系统的任何部分,大约发生在近50%的糖尿病患者中.通常在1型糖尿病患者中,它出现较晚,而在2型糖尿病的早期就能发现.     

大学生不安全依恋与拖延的关系：正念与自我控制的作用路径

背景 预防和干预大学生的拖延行为具有重要现实意义。已有研究表明,正念、自我控制、不安全依恋和拖延两两相关,但目前关于不安全依恋对拖延的作用机制仍不清楚,且缺乏二者间作用路径的研究。目的 探讨大学生不安全依恋对拖延的影响以及正念与自我控制的作用路径,以期为大学生拖延问题的干预提供参考。方法 于2023年2月—4月,采用整群随机抽样的方法,选取广东省4所高校的514名在校大学生为研究对象。采用非理性拖延量表（IPS）、成人依恋量表（AAS）、正念注意觉知量表（MAAS）和简式自我控制量表（BSCS）进行调查。使用Pearson相关分析考查各量表评分的相关性,使用Bootstrap法进行中介效应检验。结果 大学生AAS评分与IPS评分呈正相关（r=0.382,P<0.01）,与MAAS和BSCS评分均呈负相关（r=-0.242、-0.353,P均<0.01）;IPS评分与MAAS和BSCS评分均呈负相关（r=-0.314、-0.682,P均<0.01）;MAAS评分与BSCS评分呈正相关（r=0.439,P<0.01）。不安全依恋正向预测拖延（β=0.377,P<0.01）,自我控制是不安全依恋与拖延之间的作用路径,间接效应值为0.163（95% CI：0.105~0.223）,占总效应的43.24%,且正念与自我控制可能是不安全依恋与拖延之间的链式作用路径,间接效应值为0.056（95% CI：0.028~0.089）,占总效应的14.85%。结论 不安全依恋可以直接影响大学生拖延,也可以通过自我控制的独立作用路径及正念与自我控制的链式作用路径影响大学生拖延。     

叙事暴露疗法在儿童和青少年创伤后应激障碍患者中应用效果的Meta分析

背景 叙事暴露疗法（NET）结合叙事疗法和暴露疗法的优点,对缓解创伤后应激障碍（PTSD）症状有效,有助于患者对创伤进行深入的认识,也具有较好的安全性。儿童和青少年是PTSD的高发人群,但NET对该人群干预效果的研究结果存在差异。目的 系统评价NET对儿童和青少年PTSD患者的干预效果,为NET的临床应用提供参考。方法 于2022年8月1日,计算机检索Cochrane Library、PubMed、Web of Science、CINAHL、中国知网（CNKI）、中国生物医学文献数据库（SinoMed）、维普数据库和万方数据库,检索时限为建库至2022年6月。采用主题词与自由词相结合的方式进行检索,收集NET治疗儿童和青少年PTSD的文献。根据Cochrane协作网更新的偏倚风险评估手册中对随机对照试验的真实性评价标准（2011）,评价文献质量。采用RevMan 5.4对纳入的随机对照试验进行Meta分析。结果 纳入9篇文献,共包括394例儿童和青少年PTSD患者。Meta分析结果显示,在PTSD症状缓解程度方面,干预后1~3个月（SMD=0.22,95% CI：-0.84~1.28）以及干预后6个月（SMD=0.21,95% CI：-0.75~1.17）,NET与放松疗法的效果比较,差异无统计学意义;干预后1~3个月（SMD=-0.66,95% CI：-1.04~-0.27）以及干预后6个月（SMD=-0.77,95% CI：-1.36~-0.19）,NET的效果均优于常规治疗,差异均有统计学意义。在抑郁症状缓解程度方面,治疗后1~3个月,NET与常规治疗的效果比较,差异无统计学意义（SMD=-0.39,95% CI：-0.98~0.21）;干预后6个月,NET与常规治疗的效果比较,差异无统计学意义（SMD=-0.74,95% CI：-2.23~0.75）。在心理困扰缓解程度方面,干预后1~3个月,NET与常规治疗的效果比较,差异无统计学意义（SMD=-0.54,95% CI：-2.14~1.07）。在食欲亢进缓解程度方面,NET与常规治疗的效果比较,差异无统计学意义（SMD=-0.17,95% CI：-0.54~0.19）。结论 与常规治疗相比,NET对缓解儿童和青少年PTSD症状的效果更佳,且具有中长期效果,但在改善抑郁症状、心理困扰以及食欲亢进方面无明显优势。     

社区严重精神障碍患者危险行为发生风险预测模型

背景 严重精神障碍患者危险行为发生率较一般人群更高,我国对社区严重精神障碍患者危险行为发生风险的预测研究尚不多见,尤其缺乏除传统预测方法之外的数据挖掘技术预测模型的研究和比较。目的 采用Logistic回归分析及分类决策树构建社区严重精神障碍患者危险行为发生风险的预测模型,检验分类决策树模型是否优于Logistic回归模型。方法 于2023年12月,选取2013年—2022年随访记录完整的11 484名社区严重精神障碍在管患者,按8∶2随机分为训练集（n=9 186）与测试集（n=2 298）。在训练集中,分别使用Logistic回归分析和分类决策树建立预测模型,在测试集评价模型的区分度和校准度。结果 1 115例（9.71%）严重精神障碍患者在随访期间出现危险行为。Logistic回归分析结果显示,城市户籍、贫困、有监护人、精神残疾、危险行为史阳性、自知力不全、自知力缺失、有阳性症状是患者发生危险行为的危险因素（OR=1.778、1.459、2.719、1.483、3.890、1.423、2.528、2.124,P均<0.01）;年龄≥60岁、受过教育、医嘱无需用药以及社会功...     

Berberine inhibits IFN-γ signaling pathway in DSS-induced ulcerative colitis

AimsThe potential signaling pathways and core genes in ulcerative colitis (UC) were investigated in this study. Furthermore, potential mechanisms of BBR in treating UC were also explored.MethodsExpression profiling by array of UC patients were obtained from Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were determined with the differential analysis. The biological functions of DEGs were analyzed through the Database for Annotation, Visualization and Integrated Discovery (DAVID). The Gene Set Enrichment Analysis (GSEA) was applied to analyze the expression differences between two different phenotype sample sets. Dextran sulfate sodium (DSS) was applied to establish UC model of mice and lipopolysaccharide (LPS) was utilized to induce inflammatory damage of NCM460 cells. Therapeutic effects of berberine (BBR) on disease performance, pathologic changes and serum supernatant indices were analyzed in vivo. To further investigate the potential mechanisms of BBR in treating UC, the expression of genes and proteins in vivo and in vitro were examined by RT-qPCR, immunohistochemical staining and western blotting.ResultsImmune-inflammatory genes were identified and up-regulated significantly in UC patients. In addition, IFN-γ signaling pathway and its core genes were significantly up-regulated in the phenotype of UC. All disease performance and the pathologic changes of UC in mice were evidently ameliorated by BBR treatment. The pro-inflammatory cytokines of serum, including CXCL9, CXCL1, IL-17 and TNF-α, in UC mice were significantly reduced by treatment of BBR. In terms of mechanisms of BBR in treating UC, the pro-inflammatory and immune-related genes, encoding IFN-γ, IRF8, NF-κB and TNF-α decreased significantly in UC mice followed by BBR treatment. Meanwhile, the expression of IFN-γ and its initiated targets, including IRF8, Ifit1, Ifit3, IRF1, were suppressed significantly by BBR treatment in vivo. The blocking of IFN-γ in vitro led to the silence of IFN-γ signaling pathway after exposure to BBR. Furthermore, the blocking of IFN-γ in vitro led to the silence of IFN-γ signaling pathway after exposure to BBR.ConclusionBBR holds anti-inflammatory activity and can treat UC effectively. The anti-inflammatory property of BBR is tightly related to the suppression of IFN-γ signaling pathway, which is crucial in immune-inflammatory responses of the colon mucosa.     

Non-diabetic urine glucose in idiopathic membranous nephropathy

This study aims to analyze the characteristics of idiopathic membranous nephropathy (iMN) with nondiabetic urine glucose during the follow-up. We retrospectively analyzed the data of 1313 patients who were diagnosed iMN. The prevalence of nondiabetic urine glucose during follow-up was 10.89%. There were significant differences between the patients with nondiabetic urine glucose and those without urine glucose in gender, hypertension ratio, proteinuria, N-acetyl-β-glucosaminidase, retinol binding protein, serum albumin, serum creatinine (Scr), cholesterol, triglyceride and positive anti-phospholipase A2 receptor antibody ratio, glomerular sclerosis ratio, acute and chronic tubular injury lesion at baseline. To exclude the influence of the baseline proteinuria and Scr, case control sampling of urine glucose negative patients was applied according to gender, baseline proteinuria and Scr. The proteinuria nonremission (NR) ratio was 45.83 versus 12.50% of the urine glucose positive group and case control group. Partial remission (PR) ratio of the two groups was 36.46 versus 23.96% and complete remission (CR) ratio was 19.79% versus 63.54%, respectively. Patients with urine glucose had higher risk of 50% estimated glomerular filtration rate (eGFR) reduction. Cox regression showed that urine glucose and baseline Scr were risk factors of 50% reduction of eGFR. Urine glucose remission ratio of the patients with proteinuria NR, PR, and CR was 13.33, 56.25, and 94.73% (p < 0.005). Patients who got urine glucose remission also had better renal survival. In conclusion, non-diabetic urine glucose was closely related to proteinuria. It could be applied as a tubular injury marker to predict renal function.     

Association between plasma Vitamin B5 levels and all‐cause mortality: A nested case‐control study

We aimed to evaluate the prospective association of vitamin B5 with all‐cause mortality and explore its potential modifiers in Chinese adults with hypertension. A nested, case‐control study was conducted in the China Stroke Primary Prevention Trial, including 505 deaths of all causes and 505 matched controls. The median follow‐up duration was 4.5 years. The primary outcome measure in this investigation was all‐cause mortality, which encompassed deaths for any reason. The mean plasma vitamin B5 concentration for cases (43.7 ng/mL) was higher than that in controls (40.9 ng/mL) (p = .001). When vitamin B5 was further assessed as quintiles, compared with the reference group (Q1: < 33.0 ng/mL), the risk of all‐cause mortality increased by 29% (OR = 1.29, 95% CI: 0.83‐2.01) in Q2, 22% (OR = 1.22, 95% CI: 0.77‐1.94) in Q3, 62% (OR = 1.62, 95% CI: 1.00‐2.62) in Q4, and 77% (OR = 1.77, 95% CI: 1.06‐2.95) in Q5. The trend test was significant (p = .022). When Q4‐Q5 were combined, a significant 41% increment (OR = 1.41, 95% CI: 1.03‐1.95) in all‐cause death risk was found compared with Q1‐Q3. The adverse effects were more pronounced in those with normal folate levels (p‐interaction = .019) and older people (p‐interaction = .037). This study suggests that higher baseline levels of plasma vitamin B5 are a risk factor for all‐cause mortality among Chinese patients with hypertension, especially among older adults and those with adequate folate levels. The findings, if confirmed, may inform novel clinical and nutritional guidelines and interventions to optimize vitamin B5 levels.     

Prognostic factors for acute posterior circulation cerebral infarction patients after endovascular mechanical thrombectomy: A retrospective study

This article was to analyze the factors influencing the prognosis of posterior circulation cerebral infarction (PCCI) patients, retrospectively.One hundred forty five patients diagnosed with PCCI in Nanyang Central Hospital between June 25, 2016 and October 14, 2019 were included and underwent cerebral vascular mechanical thrombectomy. The clinical data of those patients were collected. The patients were followed up for 3 months to observe the prognostic efficacy and explore the influencing factors for poor prognosis. The potential prognostic factors for PCCI patients after emergency endovascular mechanical thrombectomy were analyzed by univariate and multivariable logistic regression. The thermodynamic diagram was drawn to explore the associations between the prognostic factors.The risk of poor prognosis in PCCI patients receiving emergency endovascular mechanical thrombectomy was reduced by 0.552 time with every 1-point increase of the Alberta Stroke Program Early CT in posterior circulation score (odds ratio [OR] = 0.448, 95% confidence interval [CI]: 0.276–0.727). The risk of poor prognosis was increased by 0.827 time for each additional grade in the digital subtraction angiography-American Society of Intervention and Therapeutic Neuroradiology grading (OR = 1.827, 95% CI: 1.221–2.733, P = .003) and increased by 0.288 time for every 1-point increase in National Institutes of Health Stroke scale at 24 hours (OR = 1.288, 95% CI: 1.161–1.429). All P < .05.Alberta Stroke Program Early CT in posterior circulation score, digital subtraction angiography-American Society of Intervention and Therapeutic Neuroradiology grading, National Institutes of Health Stroke scale score at 24 hours were factors affecting the prognosis of PCCI patients undergoing emergency endovascular mechanical thrombectomy, which might provide evidence for endovascular treatment of PCCI.     

Effectiveness of therapeutic hypothermia for mild neonatal encephalopathy: A protocol for systematic review and meta-analysis

Background:Neonates with moderate to severe encephalopathy benefit significantly from therapeutic hypothermia, with reduced risk of death or disability. However, the need for therapeutic hypothermia for mild neonatal encephalopathy (NE) remains unclear. Therefore, we conducted a protocol for systematic review and meta-analysis to provide evidence supporting therapeutic hypothermia for term or near term neonates with mild NE, including findings of recent long-term outcome studies, as well as novel adjunctive therapies to augment neurodevelopmental outcomes for neonates with NE who receive therapeutic hypothermia.Methods:Two independent researchers performed a systematic literature search in different electronic databases including PubMed, the Cochrane Center Controlled Trials Register, EMBASE, Medline, Ovid, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang Database without any restrictions of languages and date. Two reviewers will screen the records and include quality studies according to inclusion criteria independently. Two reviewers will assess the risk of bias of the included studies by the “Risk of Bias Assessment Tool” of the Cochrane Handbook for randomized controlled trials. Statistical analysis will be performed with Review Manager software 5.3.Results:A synthesis of current evidence of therapeutic hypothermia for treating mild NE will be provided in this protocol.Conclusion:The results of this study will provide a theoretical basis for the clinical use of therapeutic hypothermia in mild NE.