飞行员体重指数与血糖、血脂、血尿酸的调查分析

目的对飞行员血糖、血脂、血尿酸与体重指数进行调查研究,为预防和控制飞行员慢性非传染性疾病提供科学依据。方法飞行员组1 032人,对照组635人,统计血糖、血脂、血尿酸水平以及体质指数并进行分析比较。结果飞行员组超重283例,超重率30.41%;肥胖83例,肥胖率7.8%。对照组635例,超重者240例,占37.8%;肥胖者91例,占14.3%,两组间的超重和肥胖率差异具有统计学意义(P值均为0.000 0)。飞行员组的高血糖、高血脂、高血尿酸发生率低于健康对照组,两组间差异有统计学意义(P0.05)。结论飞行员的超重和肥胖、高血脂发生率较高,应加强飞行员的健康教育和体质量管理,减少慢性疾病的发病危险因素。     

糖皮质激素治疗对急性呼吸窘迫综合征患者预后的影响

目的：探讨早期应用糖皮质激素（GC）治疗对急性呼吸窘迫综合征（ARDS）患者预后的影响。方法回顾性分析成都军区总医院2008年1月至2011年12月收治的所有ARDS病例的临床资料,选择符合2012年柏林ARDS诊断标准的成人患者,根据是否采用过GC治疗将患者分为GC组与非GC组。GC组患者均在ARDS发生48 h内开始静脉使用低剂量GC（＜5 mg·kg-1·d-1,均换算为氢化可的松的剂量）治疗,激素种类为甲泼尼松龙、地塞米松,疗程为7～21 d;而非GC组为ARDS发生后未使用GC治疗。比较两组患者机械通气时间、重症加强治疗病房（ICU）住院时间、总住院时间、医疗费用和28 d生存率的差异。结果共纳入ARDS患者117例,其中GC组56例（占47.86%）,非GC组61例（占52.14%）。与非GC组比较,GC组机械通气时间明显缩短〔d：0（0,2.50）比2.00（0,2.50）,Z＝2.015,P＝0.044〕,28 d生存率明显升高〔71.43%（40/56）比50.82%（31/61）,χ2＝5.198,P＝0.023〕,ICU住院时间〔d：7.50（2.00,11.00）比4.00（1.00,9.00）,Z＝1.879, P＝0.060〕和总住院时间〔d：16.00（10.00,27.75）比15.00（7.00,28.00）,Z＝0.592,P＝0.552〕差异无统计学意义,但非GC组患者的医疗费用显著低于GC组〔万元：3.15（1.51,5.78）比4.39（1.66,10.88）,Z＝2.204,P＝0.028〕。结论早期使用GC治疗ADRS患者可改善预后,特别是28 d生存率。     

Current states of endogenous stem cells in adult spinal cord

New neurons are continuously generated throughout life in the subgranular zone in the dentate gyrus of the mammalian hippocampus and in the subventricular zone of the lateral ventricles. With the aid of new methodologies, significant progress has been made in the characterization of endogenous stem cells (ependymal cells) and their development in the adult spinal cord. Recent studies have shed light on essential extrinsic and intrinsic molecular mechanisms that govern sequential steps of neurogenesis in the adult spinal cord. This review discusses the occurrence, origin, and specific makers of ependymal cells; the factors regulating neurogenesis of multipotent ependymal cells; and the implications of ependymal cells in the repair of spinal cord injuries. © 2014 Wiley Periodicals, Inc.     

A Randomized Comparison of Aripiprazole and Risperidone for the Acute Treatment of First-Episode Schizophrenia and Related Disorders: 3-Month Outcomes

Research findings are particularly important for medication choice for first-episode patients as individual prior medication response to guide treatment decisions is unavailable. We describe the first large-scale double-masked randomized comparison with first-episode patients of aripiprazole and risperidone, 2 commonly used first-episode treatment agents. One hundred ninety-eight participants aged 15–40 years with schizophrenia, schizophreniform disorder, schizoaffective disorder or psychotic disorder Not Otherwise Specified, and who had been treated in their lifetime with antipsychotics for 2 weeks or less were randomly assigned to double-masked aripiprazole (5–30mg/d) or risperidone (1–6mg/d) and followed for 12 weeks. Positive symptom response rates did not differ (62.8% vs 56.8%) nor did time to response. Aripiprazole-treated participants had better negative symptom outcomes but experienced more akathisia. Body mass index change did not differ between treatments but advantages were found for aripiprazole treatment for total and low-density lipoprotein cholesterol, fasting glucose, and prolactin levels. Post hoc analyses suggested advantages for aripiprazole on depressed mood. Overall, if the potential for akathisia is a concern, low-dose risperidone as used in this trial maybe a preferred choice over aripiprazole. Otherwise, aripiprazole would be the preferred choice over risperidone in most situations based upon metabolic outcome advantages and some symptom advantages within the context of similar positive symptom response between medications.Key words: clinical trial, treatment response, negative symptoms, akathisia, metabolic side effects     

Heterogeneity of Structural Brain Changes in Subtypes of Schizophrenia Revealed Using Magnetic Resonance Imaging Pattern Analysis

Background:

Schizophrenia is a multifaceted mental disorder characterized by cognitive, perceptual, and affective symptom dimensions. This heterogeneity at the phenomenological level may be subserved by complex and heterogeneous patterns of structural abnormalities. Thus, delineating such patterns may improve the insight into the variability of disease and facilitate future magnetic resonance imaging-based diagnosis.

Methods:

We aimed to identify structurally complex signatures that directly differentiate patients with predominantly negative (pNEG), positive (pPOS), and disorganized (pDIS) symptoms using Optimally-Discriminative Voxel-Based Analysis (ODVBA). ODVBA is a new analytical framework for group analysis, which showed to have superior sensitivity and specificity over conventional voxel-based morphometric approaches, thus facilitating the identification of subtle neuroanatomical signatures delineating different subgroups.

Results:

pPOS were characterized by pronounced gray matter (GM) volume reductions in the ventromedial prefrontal cortex (vmPFC), which herein is defined to include the orbitofrontal cortex, and in occipitotemporal GM and parts of the lingual gyrus. pNEG was found to have vmPFC reduction but to a lesser degree than pPOS and with a relative sparing of the more medial vmPFC regions, compared to pDIS; it also had significantly less cerebellar GM. pDIS showed relatively highest GM volume preservation among three subtypes.

Conclusions:

Although a common prefronto-perisylvian GM reduction pattern was present at the whole-group level, marked morphometric differences emerged between the three subgroups, including reduced cerebellar GM in pNEG and reduced vmPFC and occipitotemporal GM in pPOS. Besides deepening our insight into the neurobiological underpinnings of clinical heterogeneity, these results also identify important imaging biomarkers that may aid patient stratification.Key words: volume reduction, ODVBA, voxel-based morphometry, patient stratification     

朗格汉斯细胞组织细胞增生症神经变性病研究进展北大核心CSCD

朗格汉斯细胞组织细胞增生症(LCH)是一种罕见的以CD1a+CD207+树突状细胞浸润为特征的髓源性肿瘤疾病, 由于受累器官的部位和多少的不同临床表现差异很大。神经变性病(ND)是LCH中枢神经系统受累的表现之一。LCH-ND发病机制不清, 临床上主要以神经功能学障碍和进行性发展的影像学改变为特征。目前LCH-ND主要的治疗包括静脉注射免疫球蛋白、化疗及靶向治疗等。早期治疗和积极干预可能是延迟LCH-ND进展、稳定中枢神经系统功能和提高生活质量的关键。现就LCH-ND的发病机制、临床表现、诊断、治疗及临床评估作简要综述。