小脑参与认知功能机制的研究进展

认知是指人脑为获取和应用知识,将外界信息转化成内在心理活动的复杂过程。自 1998年Schmahmann和Sherman提出“小脑认知-情感综合征”起,小脑认知功能的研究越来越受到关注。 本文通过回顾国内外相关研究,从小脑的解剖与认知功能、小脑的神经网络机制以及交叉性小脑神经 机能联系不能 3 个角度探讨了小脑在认知神经网络中的作用及机制,旨在提高对小脑参与认知功能的 认识。     

抑郁症及抗抑郁药物对疼痛阈值的影响

抑郁症是一种复杂的临床疾病,患者除了自身情绪的改变外,对于疼痛的感知也会发生 变化。临床中,抑郁症患者的疼痛阈值增高常有报道,抗抑郁药物在治疗抑郁症的同时,也会影响疼痛 阈值。由于病理生理的复杂性,目前关于抑郁症及抗抑郁药物对疼痛阈值的影响及机制的结论阐述较 为单一,但疼痛阈值背后的大脑皮层、脑干的神经机制研究的创新层出不穷。本文就抑郁症及抗抑郁 药物对疼痛阈值的不同影响及潜在的作用机制进行综述,从大脑、脑干、脊髓中的受体与递质方面探讨 疼痛传递及调节的潜在神经机制,旨在为抑郁症患者疼痛阈值改变的机制研究及临床治疗提供思路     

精神分裂症认知功能与心血管疾病危险因素相关性的研究进展

精神分裂症患者普遍存在认知功能受损,严重影响其预后及社会功能。认知功能的损害 与多种因素有关,其中导致心血管疾病的风险因素如肥胖、糖尿病、高血压病、血脂异常等代谢综合征, 以及患者普遍存在的不良生活方式均与认知功能下降密切相关,并影响认知功能的发展。本文从精神 分裂症认知功能与心血管疾病危险因素的临床联系、病理研究及干预性研究 3 个层面进行综述,以期为 减轻和延缓精神分裂症患者的认知功能损害提供参考。     

两种术式在缓解恶性输尿管梗阻疗效中的对比研究

目的 探讨恶性输尿管梗阻（malignant ureteral obstruction,MUO）现有的临床治疗方案和经验,讨论恶性输尿管梗阻时使用经皮肾脏穿刺引流（percutaneous nephrostomy,PN）或输尿管支架置入术（ureteral stenting,US）的临床适用范围,明确2种术式在缓解恶性输尿管梗阻时肾功能损伤的有效性。方法 回顾性纳入重庆医科大学附属第一医院泌尿外科2021年1月至2023年5月诊断为恶性输尿管梗阻的患者,严格筛选纳入及排除标准后共有76例患者入组并随机分为PN组（n=22）与US组（n=54）,对患者基本特征及围术期、术后半年随访数据进行病例对照研究以反映肾功能在2组中的差异,采用SPSS 21.0版本对数据进行处理分析。结果 2组患者在性别（P=0.017）、手术侧肾积水程度（P=0.000）的比较,差异有统计学意义。2组患者术前3 d比较尿素氮（P=0.002）、血肌酐（P=0.003）,术后1 d尿素氮（P=0.017）、血肌酐（P=0.005）,差异有统计学意义。术后3 d与术后6个月2组患者在肾功能比较中差异均无统计学意义。结论 恶性输尿管梗阻以宫颈癌多发,其次为位膀胱癌、结直肠癌等。US可选择梗阻或积水较轻、慢性输尿管梗阻、肾功能损伤较轻的患者,可作为缓解输尿管梗阻的首选治疗方案。PN临床常对中至重度肾积水、肾功能损伤较重或者急性肾功能不全的恶性输尿管梗阻患者进行治疗,可作为US失败的替代方案。     

基于探索性因子分析的医学类院校新入职教师胜任力模型构建研究

目的　分析医学类院校新入职教师胜任能力要素并构建胜任力模型。方法　通过文献研究法、半结构化访谈法、专家咨询法,编制医学类院校新入职教师胜任力调查问卷,对12所医学类院校的新入职教师进行问卷调查。运用主成分分析法提取因子。结果　问卷的Cronbach’s α系数为0.95。医学类院校新入职教师胜任力模型包括6个因子：科研水平（38.282%）、教学能力（10.118%）、职业道德（7.150%）、沟通能力（5.707%）、个人特质（4.707%）、自我完善能力（4.218%）。结论　构建医学类院校新入职教师胜任力模型,以期对新入职教师岗前培训模式的优化和相关政策的研究有所帮助。     

Epidemiologic Correlation and Drug Resistance Analysis of Pathogenic Bacteria in Different Open Limb Injury External Conditions

ObjectiveTo study the epidemiological correlation and drug resistance of external factors of infection caused by open injury of limbs to pathogens.MethodsThis experiment is a retrospective study. We took the geographical location and climate of Nanchang, Jiangxi Province, China as the background, analyzed 2017 strains of pathogens from 1589 patients with limb trauma infection in a University Affiliated Hospital from 2012 to 2017. Patients were divided into three groups according to the type of incision: I, In‐hospital infection of clean limb incision, II, In‐hospital infection with open injury, III, Community infection with open injury of the limb. Groups II and Groups III were divided into six subgroups according to the causes of trauma, including: accidents from non‐motor vehicles, machinery, cutting/piercing, pedestrian injuries, struck by/against, pedal cycles, and other injuries. We found eight common pathogens of orthopedic infection, which were mainly divided into Gram‐positive bacteria (G+, mainly including Staphylococcus) and Gram‐negative bacteria (G‐, mainly Enterobacteriaceae). The relationship between main pathogens and damage mechanism, apparent temperature and relative humidity was discussed in this study. SPSS v22.0 was used for statistical analysis of the data. Friedman''s two‐way ANOVA was used to analyze the difference between the injury mechanism and incidence of pathogenic bacteria. Linear regression was used to determine the trend between the incidence of major pathogens and seasonal temperature and humidity. The level of significance was set as P < 0.05.ResultsThere was no significant difference in the distribution of pathogens between Groups II and Groups III (P>0.05). The drug resistance of Groups III was significantly higher than that of Groups II and Groups I. G+ bacteria were resistant to cephalosporin, ceftriaxone and other cephalosporins and erythromycin and other macrolides. They were sensitive to vancomycin and linezolid. G‐ were resistant to the first‐ and the second‐generation cephalosporins, including cefotetan and cefazolin, and ampicillin and other penicillins, while they were sensitive to third‐generation cephalosporins, such as ceftazidime, as well as to levofloxacin and other quinolones, meropenem, and other beta‐lactamases. The correlation between the injury mechanism and infection of pathogenic bacteria was not significant. The monthly average apparent temperature and relative humidity were correlated with the infection rate of pathogenic bacteria.ConclusionIn open injury of extremities, apparent temperature and relative humidity is an important risk factor for infection by pathogenic bacteria and the drug resistance of pathogenic bacteria in out‐of‐hospital infection was lower than that of hospital infection.     

Simplified Chinese Version of the Spinal Instability Neoplastic Score in Evaluating Patients with Metastatic Spinal Tumor: A Cross‐Cultural Adaptation and Validation

ObjectiveTo translate the original English version of the Spinal Instability Neoplastic Score (SINS) into simplified Chinese, adapt it cross‐culturally, validate its psychometric properties in measuring spinal instability in patients with metastatic spinal tumors in the Chinese mainland, examine the reliability and validity to demonstrate its accuracy and applicability in clinical practice.MethodsPatients diagnosed with metastatic spinal disease between January 2016 and January 2020 were recruited. The number of participants was advised to be at least 50 for appropriate analysis of reliability, construct validity, as well as ceiling or floor effects, and recruitment of 100 patients was advised for internal consistency analysis. The study was conducted in two phases: first, the SINS was translated into simplified Chinese; second, the factor structure, internal consistency, test–retest reliability, validity, and floor and ceiling effects of the SC‐SINS were assessed. The internationally recognized cross‐cultural adaptation guidelines were followed. Internal consistency was evaluated with Cronbach''s alpha. Test–retest reliability was examined among the patients with a 4‐week interval. The validity of the Chinese version of SINS (SC‐SINS) was assessed by examining its relationship with Kostuik classification. Principal component analysis was conducted to confirm the factor structure of each subscale.ResultsA total of 160 participants (88 males and 72 females) were enrolled. No major difficulties occurred in the forward and backward translations of SINS. The internal consistency of SC‐SINS was excellent (Cronbach''s α =0.857, ranging from 0.68 to 0.85). Test–retest reliability was also excellent with a value of 0.89, ranging from 0.86 to 0.95. Validity analyses indicated that the SC‐SINS was positively and significantly correlated with Kostuik classification. The correlation between “Posterolateral Involvement of Spinal Elements” and “1‐2 Partial Damage” was the highest with a correlation value of 0.792. The correlation between “Pain” and “1–2 Partial Damage” was the lowest with a value of 0.341. All items showed principal component coefficients greater than 0.4. The values of Factor 1 ranged from 0.523 to 0.681; Factor 2 ranged from 0.591 to 0.731; Factor 3 ranged from 0.613 to 0.754; Factor 4 ranged from 0.461 to 0.711; Factor 5 ranged from 0.513 to 0.701; and Factor 6 ranged from 0.501 to 0.668. In addition, neither floor nor ceiling effects were seen in the SC‐SINS.ConclusionThe SC‐SINS demonstrated high internal consistency and test–retest reliability, which has been proven valid and reliable to measure spinal stability in patients from the Chinese mainland with metastatic spinal tumor.     

单核细胞/淋巴细胞比值与糖尿病足患者下肢动脉病变的相关性研究

目的 探讨单核细胞/淋巴细胞比值（monocytes to lymphocytes ratio,MLR）与糖尿病足患者下肢动脉病变（lower extremity arterial disease,LEAD）的相关性。方法 选取2020年4月至2023年4月于陆军军医大学第一附属医院住院治疗的2 型糖尿病足患者243例,分为下肢动脉病变组（LEAD,n=103）和非下肢动脉病变组（non-lower extremity arterial disease,NLEAD,n=140）,分析MLR与LEAD的相关性。结果 LEAD组MLR显著高于NLEAD组［0.46（0.29,0.63） vs. 0.38（0.26,0.58）（P<0.05）］。logistic回归分析结果显示,MLR、年龄、胆固醇、血肌酐是糖尿病足患者发生下肢血管病变的影响因素（P<0.05）。受试者工作特征曲线分析表明,MLR预测糖尿病足患者下肢血管病变的最佳切点为0.34,敏感度和特异度分别为69.9%和46.4%。结论 MLR与2型糖尿病足患者LEAD的发生相关。     

内皮高表达脂多糖相关因子1通过影响NF-κB信号通路促进糖尿病小鼠皮肤创面愈合的研究

目的 探讨内皮高表达脂多糖相关因子1（endothelial-overexpressed lipopolysaccharide-associated factor 1,EOLA1）对2型糖尿病小鼠皮肤创面促愈合效果及机制。方法 选取SPF级6周龄db/db糖尿病小鼠,构建全层皮肤创面模型,在创口周边注射EOLA1高表达慢病毒。小鼠分为正常对照组、空载体慢病毒组、EOLA1慢病毒组。除正常对照组外,拍照记录不同时期小鼠创口愈合情况,造模第15天取创口及周边皮肤,HE染色观察创面肉芽组织及炎性浸润,Masson染色观察创面胶原纤维沉积,免疫荧光检测ARG1、iNOS观察巨噬细胞分型,Western blot及Real-time PCR检测NF-κB信号通路IκB-α、p-IκB-α、p65蛋白表达和EOLA1、TLR4、TNF-α、IL-1β基因表达水平。结果 与空载慢病毒组相比,EOLA1慢病毒组小鼠皮肤伤口愈合速度加快,肉芽组织及胶原纤维形成增多。EOLA1慢病毒组M2型巨噬细胞标志物ARG1表达升高,M1型巨噬细胞标志物iNOS表达降低。EOLA1慢病毒组IκB-α蛋白表达升高,p-IκB-α蛋白表达降低,TNF-α、IL-1β基因表达水平下调。结论 EOLA1可抑制糖尿病小鼠皮肤创面局部炎症,加速创面愈合,其机制可能为通过上调巨噬细胞内IκB-α表达,封闭p65活性,从而抑制炎症因子TNF-α、IL-1β的释放,巨噬细胞的表型也表现为从促炎症的M1型向促愈合的M2型转变。提示EOLA1在糖尿病创面具有抗炎促愈的潜力。     

Onyx embolization of a spinal epidural hemorrhage caused by thoracic spinal epidural arteriovenous fistula: A case report and literature review

Spinal epidural hemorrhages (SEDH) caused by spinal epidural arteriovenous fistulas (SEAVFs) are rare; thus, their specific pathogenesis has not been explained. Furthermore, the standard treatment for SEAVFs has not yet been defined. Here we report the case of a 36-year-old Chinese man who experienced acute onset chest pain and tightness. His symptoms rapidly aggravated until the lower limbs were unable to support him. Spinal magnetic resonance angiography (MRA) revealed a localized SEAVF and a secondary spinal cord lesion at the T4 level. Digital subtraction angiography (DSA) confirmed the presence of the SEDH/SEAVF at the T3–4 level with the left radicular artery feeding the fistula. Based on DSA and MRA findings, SEDH, local spinal cord infarction, and spinal venous reflux disorder were conditionally diagnosed. Using the arterial route, Onyx-34 was injected into the fistula to embolize the feeding arteries and the venous system. Angiography was performed after the microcatheter was withdrawn, and no residual fistula or anterior spinal artery was observed. The six-week follow-up MRI showed acceptable healing of the SEAVF, and the patient improved neurologically. This case suggests that endovascular treatment with Onyx-34 embolization should be considered a promising treatment strategy for this type of complicated SEAVF.