儿童青少年抑郁症自杀及相关影响因素研究

目的 探讨儿童青少年抑郁症患者中自杀相关影响因素.方法 选取2018年1月至2019年12月就诊于河北省第六人民医院的389例儿童青少年抑郁症患者作为研究对象,其中自杀组171例,非自杀组218例.对两组间的一般情况与临床特征进行比较,并采用Logistic回归方法对青少年儿童抑郁症伴自杀的影响因素进行分析.结果 自杀...     

大量饮酒及乙醇戒断后对大鼠脑内维生素C水平的影响

目的研究大量饮酒4 d及乙醇戒断后大鼠脑脊液中及各重要脑区内维生素C(VC)水平及钠依赖性VC转运体2(SVCT2)蛋白水平的变化。方法30只健康Wistar大鼠随机分为5组,对照组(A组)、大量饮酒4 d(B组)、大量饮酒4 d后戒断1 d(C组)、大量饮酒4 d后戒断2 d(D组)、大量饮酒4 d后戒断7 d(E组),每组6只。B、C、D、E组大鼠大量灌胃给予乙醇4 d,乙醇浓度为25%W/V,每8小时灌胃1次,连续4 d;A组给予等体积蒸馏水。采用Y迷宫实验评价大鼠的空间工作记忆能力;以高效液相-电化学法(HPLC-ECD)检测大鼠脑脊液及前额叶皮质、顶叶皮质、颞叶皮质、海马脑区内细胞内VC含量,免疫印迹法检测大鼠各脑区内SVCT2蛋白水平的变化。结果(1)Y迷宫实验:C、D组大鼠自发交替反应率分别为(24.64±15.11)%和(41.48±13.01)%,均显著低于A组[(75.47±8.61)%];E组大鼠的自发交替反应率恢复接近正常[(61.64±11.51)%],与A组差异无统计学意义(P>0.05)。(2)脑脊液内VC含量:B组大鼠脑脊液内VC含量为(204.54±25.51)μmol/L,显著高于A组[(145.57±18.98)μmol/L],而C、D组大鼠脑脊液内VC水平[分别为(90.24±15.45)、(86.93±14.53)μmol/L]明显低于A、B组,差异均有统计学意义(均P<0.001);E组大鼠脑脊液中VC含量[(135.80±17.16)μmol/L]与A组间差异无统计学意义(P>0.05)。(3)各脑区内VC水平:B组前额叶皮质、顶叶皮质、海马脑区脑组织匀浆(细胞内)VC水平变化趋势相同[分别为(1.18±0.13)、(1.14±0.12)、(1.20±0.20)μmol/g],均显著低于A组[分别为(1.64±0.11)、(1.62±0.13)、(2.06±0.27)μmol/g];C组在乙醇戒断后,前额叶皮质、顶叶皮质、海马脑区细胞内VC水平[分别为(1.20±0.29)、(1.05±0.06)、(1.21±0.15)μmol/g]有所恢复,但仍明显低于A组(均P<0.01);C组大鼠颞叶皮质细胞内VC水平[(1.37±0.04)μmol/g]显著高于顶叶皮质(P<0.05);D组各脑区细胞内VC水平均有回升趋势,前额叶皮质细胞内VC水平显著高于顶叶皮质[(1.63±0.24)μmol/g比(1.26±0.16)μmol/g,P<0.05];E组前额叶皮质、顶叶皮质、颞叶皮质、海马区细胞内VC水平[分别为(1.72±0.19)、(1.43±0.22)、(1.67±0.19)、(1.86±0.22)μmol/g]均较B组显著升高(均P<0.01),逐渐恢复至正常水平,海马区VC水平显著高于顶叶皮质(P<0.05)。(4)Western blot结果显示,与A组比较,B、C、D组大鼠前额叶皮质、顶叶皮质及C、D、E组大鼠海马区的SVCT2蛋白均显著升高(均P<0.05)。结论大量饮酒4 d可致大鼠脑损伤,乙醇干预后大鼠脑脊液中及各脑区脑组织匀浆中VC水平呈现负相关的变化过程,此过程中SVCT2蛋白表达上调,这将有助于脑脊液内的VC被转运至各脑区神经元内发挥抗氧化作用。     

Comprehensive Rehabilitation in Severely Ill Inpatients With COVID-19: A Cohort Study in a Tertiary Hospital

BackgroundThis study aimed to investigate the effects of comprehensive rehabilitation management on functional recovery and examine the correlation between clinical parameters and improvements in functional outcomes in severe-to-critical inpatients with coronavirus disease 2019 (COVID-19) in a tertiary hospital.MethodsPost-acute COVID-19 patients who had a World Health Organization (WHO) ordinal scale of 5–7, underwent intensive care, and received comprehensive rehabilitation management, including exercise programs, nutritional support, dysphagia evaluation, and psychological care were included. The appendicular skeletal muscle mass index (SMI), Medical Research Council sum score, handgrip strength, number of repetitions in the 1-minute sit-to-stand test, gait speed, Berg Balance Scale (BBS), and Functional Ambulation Classification (FAC) were evaluated at hospital stay, discharge, and 1-month follow-up. The correlation between the rehabilitation dose and improvement in each outcome measure was analyzed.ResultsOverall, 37 patients were enrolled, of whom 59.5% and 32.4% had a score of 6 and 7 on the WHO ordinal scale, respectively. Lengths of stay in the intensive care unit and hospital were 33.6 ± 23.9 and 63.8 ± 36.5 days. Outcome measures revealed significant improvements at discharge and 1-month follow-up. The SMI was significantly increased at the 1-month follow-up (6.13 [5.24–7.76]) compared with that during the hospital stay (5.80 [5.39–7.05]). We identified dose-response associations between the rehabilitation dose and FAC (ρ = 0.46) and BBS (ρ = 0.50) scores. Patients with older age, longer hospitalization, longer stay at the intensive care unit, longer duration of mechanical ventilation, tracheostomy, a more depressive mood, and poorer nutritional status revealed poorer improvement in gait speed at the 1-month follow-up.ConclusionComprehensive rehabilitation management effectively improved muscle mass, muscle strength, and physical performance in severe-to-critical COVID-19 patients. Dose-response relationship of rehabilitation and functional improvement emphasizes the importance of intensive post-acute inpatient rehabilitation in COVID-19 survivors.Trial RegistrationClinicalTrials.gov Identifier: {"type":"clinical-trial","attrs":{"text":"NCT05104411","term_id":"NCT05104411"}}NCT05104411     

以“肾占位”起病的类鼻疽脓毒症合并噬血细胞综合征1例

类鼻疽病是由类鼻疽伯克霍尔德菌感染所致的传染性疾病,其临床表现多样,常反复发作及合并脓毒症,且易误诊误治,故病死率较高。本文分析1例类鼻疽脓毒症合并噬血细胞综合征的病例,并结合国内外文献对该病的临床特点、诊治思路等进一步总结,以期降低该病的误诊误治,提升患者存活率。     

超重和肥胖对老年高血压患者心脏结构和功能的影响

目的:探讨超重和肥胖对老年高血压患者心脏结构和功能的影响。方法:收集2014年4月至2018年4月重庆医科大学附属第一医院≥65岁的原发性高血压患者1 183例。收集患者的性别、年龄、体质量、收缩压、舒张压等临床资料。收集左房内径(left atrial diameter,LAD)、室间隔厚度(interventricular septal thickness,IVST)、左室后壁厚度(left ventricular posterior wall thickness,LVPWT)、左室舒张期末内径(left ventricular end-diastolic diameter,LVDd)等患者的心脏超声参数,并计算出左室质量(left ventricular mass,LVM)和左室质量指数(left ventricular mass index,LVMI)。体质指数(body mass index,BMI)<18.5 kg/m²共61例为低体质量组,18.5 kg/m²≤BMI<23 kg/m²共375例...     

重庆市新型冠状病毒肺炎患者并发急性呼吸窘迫综合征风险预测模型的建立

目的:探讨重庆市新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)患者并发急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的危险因素,并构建其风险预测模型。方法:回顾性分析2020年1月16日至3月30日于重庆市4所定点医院收治的225例COVID-19患者临床资料。根据柏林定义标准将患者分为ARDS组和非ARDS组,比较2组患者一般资料、临床症状、实验室检查、影像学特征和预后的差异。采用二分类logistic回归获得独立危险因素,并根据各因素优势比(odds ratios,OR)进行赋值,以建立风险预测模型。应用受试者工作特征(receiver operating characteristic,ROC)曲线评价模型的预测效果。结果:225例患者中,男性141例,女性84例;年龄中位数56岁。62例患者(27.6%)并发ARDS。logistic回归分析显示,年龄≥60岁(OR=5.849,95%CI=2.716～12.593,P=0.000)、淋巴细胞计数≤1.0×10⁹个...     

Prognosis-related classification and dynamic monitoring of immune status in patients with sepsis: A prospective observational study

BACKGROUND: The dynamic monitoring of immune status is crucial to the precise and individualized treatment of sepsis. In this study, we aim to introduce a model to describe and monitor the immune status of sepsis and to explore its prognostic value.     

胸腔镜下肺部手术后发生广泛皮下气肿的临床分析

目的 探讨胸腔镜下肺部手术后发生广泛皮下气肿的影响因素.方法 回顾性分析2015年10月-2020年10月3314例行胸腔镜下肺部手术后发生广泛皮下气肿患者的临床资料,寻找发生广泛皮下气肿的相关因素,分析皮下气肿的治疗效果.结果 术后广泛皮下气肿发生率为1.90％(63/3314).其中,肺减容、胸腔粘连、合并肺气肿和...     

Effect of Volume Fraction of Reinforcement on Microstructure and Mechanical Properties of In Situ (Ti,Nb)B/Ti2AlNb Composites with Tailored Three-Dimensional Network Architecture

The mechanical properties of (Ti, Nb)B/Ti₂AlNb composites were expected to improve further by utilizing spark plasma sintering (SPS) and inducing the novel three-dimensional network architecture. In this study, (Ti, Nb)B/Ti₂AlNb composites with the novel architecture were successfully fabricated by ball milling the LaB₆ and Ti₂AlNb mixed powders and subsequent SPS consolidation. The influence of the (Ti, Nb)B content on the microstructure and mechanical properties of the composites was revealed by using the scanning electron microscope (SEM), transmission electron microscopy (TEM) and electronic universal testing machine. The microstructural characterization demonstrated that the boride crystallized into a B27 structure and the α₂-precipitated amount increased with the (Ti, Nb)B increasing. When the (Ti, Nb)B content reached 4.9 vol%, both the α₂ and reinforcement exhibited a continuous distribution along the prior particle boundaries (PPBs). The tensile test displayed that the tensile strength of the composites presented an increasing trend with the increasing (Ti, Nb)B content followed by a decreasing trend. The composite with a 3.2 vol% reinforcement had the optimal mechanical properties; the yield strengths of the composite at 25 and 650 °C were 998.3 and 774.9 MPa, showing an 11.8% and 9.2% improvement when compared with the Ti₂AlNb-based alloy. Overall, (Ti, Nb)B possessed an excellent strengthening effect and inhibited the strength weakening of the PPBs area at high temperatures; the reinforcement content mainly affected the mechanical properties of the (Ti, Nb)B/Ti₂AlNb composites by altering the α₂-precipitated amount and the morphology of (Ti, Nb)B in the PPBs area. Both the continuous precipitation of the brittle α₂ phase and the agglomeration of the (Ti, Nb)B reinforcement dramatically deteriorated the mechanical properties.