Gray matter atrophy and corresponding impairments in connectivity in patients with anti-N-methyl-D-aspartate receptor encephalitis

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a severe autoimmune disease that is commonly accompanied by cognitive impairment and various neurological and psychiatric symptoms, advanced image analyses help explore the pathogenesis of this disease. Therefore, this study aimed to explore specific structural and functional alterations and their relationship with the clinical symptoms of anti-NMDAR encephalitis. In this study, twenty-two patients with anti-NMDAR encephalitis after the acute stage and 29 controls received cognitive assessments and magnetic resonance imaging. Grey matter atrophy was measured using voxel-based morphometry, and functional alterations in abnormal regions were subsequently investigated using resting state functional connectivity (RSFC). Finally, correlation analyses were performed to explore the associations between imaging alterations and cognitive assessments. The patients demonstrated significant gray matter atrophy in the bilateral triangle part of the inferior frontal gyrus (triIFG.L and triIFG.R) and right precuneus, decreased RSFC between triIFG.L and bilateral Heschl gyrus (HES), decreased RSFC between triIFG.R and HES.R, decreased RSFC between right precuneus and left cerebellum, and increased RSFC between triIFG.R and left superior frontal gyrus. Further correlation analyses showed that the gray matter volume in triIFG.R and decreased RSFC between triIFG.L and HES.R were associated with decreased memory scores, whereas decreased RSFC between triIFG.R and HES.R was marginally correlated with the disease course in patients. In conclusion, this study suggests that cognitive impairments in patients with anti-NMDAR encephalitis may be mainly associated with gray matter atrophy and abnormal RSFC in the triIFG. These findings provide new insights into anti-NMDAR encephalitis pathogenesis and help explore potential treatments.

     

基于互联网医院的医护上门多系统集成平台研发及应用

目的 基于互联网医院构建一站式医护上门多系统集成平台,并评价其应用效果。方法 设计开发“医护上门”服务平台,实施患者居家护理服务。统计应用前6个月(采用电话预约方式实施居家服务)与应用后6个月服务患者的情况,比较患者满意度及护士认可度。结果 应用前开展项目12项,接受服务63例;应用后开展项目28项,接受服务299例。应用后患者满意度评分及护士认可度评分显著高于应用前(均P<0.01)。结论 医护上门平台实现了多系统、多学科的有效融合,可为患者提供专业、高效、便捷的居家护理服务,促进了居家护理服务业态的持续发展。     

口腔癌患者围术期个案管理模式的应用

目的探讨个案管理模式在口腔癌患者围术期的干预效果。方法将口腔癌手术患者按照入院时间分为对照组90例和观察组112例。对照组实施口腔癌围术期常规护理及术后随访,观察组由多学科个案管理团队实施个案管理。结果干预后,观察组各项营养相关指标及生活质量得分显著高于对照组,焦虑评分显著低于对照组(均P<0.01)。结论个案管理模式较常规护理可改善口腔癌患者围术期营养状况、焦虑水平和生活质量。     

院内外团队协作入户对产妇实施母乳喂养与产褥期照护支持研究

目的 通过实施院内外联动母乳喂养与产褥期照护支持,了解母婴产褥期健康问题,总结入户访视经验,为完善产褥期健康管理提供依据。方法由医院指导团队对社区入户指导团队4名成员进行培训和一对一对接指导,协助制订入户照护方案,由入户指导团队对102名存在母乳喂养问题的产妇行入户访视服务,包括母乳喂养与产褥期照护支持。结果共完成118人次入户访视服务。最常见的产妇问题为哺乳姿势问题,占73.7%;最常见的婴儿问题为喂养遇到的难题,占65.2%。产妇对访视服务的满意度为100%,未发生事故和投诉。结论院内外团队协作入户对产妇行母乳喂养与产褥期照护支持,能帮助产妇解决母乳喂养遇到的问题,提高产妇满意度。在实施前应构建访视团队以及相应的指导团队,加强入户指导质量把控,提高院内外联动性、对指导者进行一对一指导以提高服务质量。     

情绪诱发在护理本科生心肺复苏技能教学中的应用

目的 探讨情绪诱发在护理本科生心肺复苏技能教学中的应用效果。 方法 将2018级35名和2019级31名护理本科生分别设为对照组和观察组。对照组在心肺复苏技能教学中采用教师演示、学生练习、教师指导的传统教学模式,观察组在传统教学模式的基础上融入不同主题的情绪诱发内容。 结果 课程结束后即刻、3个月和6个月观察组心肺复苏技能及心肺复苏施救自我效能得分显著优于对照组（均P＜0.05）,随着时间的推移心肺复苏技能得分无显著下降。 结论 情绪诱发融入式教学可有效提高护理本科生的学习投入度,从而提高学习效果,促进心肺复苏技能、心肺复苏施救自我效能的保留。     

角膜形态学和生物力学参数对角膜后表面高度影响的研究

目的探讨角膜形态学和生物力学参数对近视眼人群角膜后表面高度异常的影响及其辅助诊断角膜后表面高度异常的可行性。方法病例对照研究。选取2017年12月至2018年10月在青岛眼科医院拟行角膜屈光手术的屈光不正患者144例(227只眼),其中男性90例(139只眼),女性54例(88只眼);年龄(22.8±5.6)岁。所有患者检查最佳矫正视力下的球镜和柱镜度数,并行Pentacam眼前节分析系统和Corvis ST角膜生物力学检查。根据Pentacam参数角膜后表面高度变化值(BD)进行分组,将BD<12μm定为对照组(59例,118只眼);将BD≥12μm定为高BD组(85例,109只眼),其中BD≤16μm者为可疑组(44例,53只眼),>16μm者为异常组(41例,56只眼)。选取Pentacam眼前节分析系统中BD、前表面曲率(ASK)、后表面曲率(PSK)、前表面散光(AAstig)、后表面散光(PAstig)、中央角膜厚度(CCT)、角膜直径(W-W)7个参数及Corvis ST角膜生物力学检测系统中第1次压平时间(AT1)、第1次压平长度(AL1)、第1次压平速度(AV1)、第2次压平时间(AT2)、第2次压平长度(AL2)、第2次压平速度(AV2)、最大压陷时间(HCT)、最大压陷峰距(HC-PD)、最大压陷形变幅度(HC-DA)、最大压陷曲率半径(HC-R)、形变幅度比值(DA Ratio)、综合半径、最薄点厚度/厚度变化率(ARTH)、硬度参数(SPA1)、Corvis生物力学指数(CBI)15个参数纳入研究。采用独立样本t检验、Kruskal-Wallis H检验及Bonferroni法进行组间差异性比较,利用Spearman秩相关分析探讨BD的相关影响因素,并建立多元线性回归模型寻找影响BD的主要因素。结果对照组和高BD组在年龄、球镜度数、柱镜度数差异无统计学意义(t=-3.311,-1.808,-2.359;P=0.071,0.072,0.121);Pentacam测量发现在对照组、可疑组和异常组中,ASK、PSK、PAstig、W-W组间差异有统计学意义(Z=18.492,31.547,10.773,70.167;P<0.05),AAstig、CCT组间差异无统计学意义(Z=2.204,1.108;P>0.05)。其中异常组[43.40(42.20,44.40)]较对照组[42.80(41.98,44.00)]ASK增大(t=-4.292;P<0.05),可疑组[-6.50(-6.60,-6.35)]与异常组[-6.50(-6.70,-6.33)]较对照组[-6.30(-6.50,-6.20)]PSK均增大(t=4.492,4.618;P<0.05);可疑组[0.40(0.30,0.40)]与异常组[0.40(0.30,0.40]较对照组[0.40(0.30,0.50)]PAsting均增大(t=2.796,2.515;P=0.016,0.036);可疑组[11.40(11.00,11.60)]和异常组[11.10(10.90,11.30)]较对照组[11.50(11.40,11.80)]W-W减小,同时异常组较可疑组W-W也明显减小(t=3.235,8.353,4.282;P<0.05);Corvis ST参数在3个组间差异无统计学意义(P>0.05)。将每组患者BD与Pentacam参数进行相关性分析发现,在对照组、可疑组、异常组以及所有患者中,BD与W-W呈低至中度负相关(r=-0.614,-0.304,-0.396,-0.661;P<0.05),BD与其他参数相关性较低或未见明显相关性;将患者BD与Corvis ST参数进行相关性分析发现,仅在可疑组中,BD与AV1、HCT、HC-DA间存在低度正相关(r=0.332,0.361,0.382;P<0.05),BD与Corvis ST其他参数在各组中未见明显相关性。以BD为因变量,选取Pentacam参数与Corvis ST参数建立多元线性回归分析模型:变量W-W、ASK、PSK、HC-PD、SPA1、CCT间不存在共线性(容忍度<0.100),方程检验结果F=37.221,P<0.001,调整r^2=0.504,拟合较好。结论角膜形态学参数中角膜直径、前表面曲率、后表面曲率是影响BD的主要因素,角膜生物力学参数中HC-PD和SPA1也可能对BD产生一定程度影响。角膜形态学和生物力学参数的联合评估有助于角膜后表面高度异常的鉴别诊断。     

急性进展性后部型早产儿视网膜病变的治疗研究进展

急性进展性后部型早产儿视网膜病变(aggressive posterior retinopathy of prematurity,AP-ROP)是一种少见且进展很快的严重性早产儿视网膜病变,可不遵循1~3期的经典病程,而迅速进展为5期病变,最终导致不可逆的视力丧失。目前常用的治疗方式有激光光凝、玻璃体腔内注射抗血管内皮生长因子(VEGF)、玻璃体切除术。本文将从以上三个方面入手,对AP-ROP的治疗方式进行综述。     

骨形态发生蛋白2、血管内皮生长因子165双基因转染小鼠骨髓基质干细胞的体内诱导成骨

目的：观察骨形态发生蛋白2、血管内皮生长因子。双基因转染的小鼠骨髓基质干细胞是否具有异位诱导成骨能力。方法：脂质体介导下将pIRES-BMP2-VEGF165导入小鼠骨髓基质干细胞，用RT-PCR和免疫组织化学法观察骨形态发生蛋白2和血管内皮生长因子165双基因在小鼠骨髓基质干细胞内的表达：将转染双基因的小鼠骨髓基质干细胞植入裸鼠大腿后群肌袋内，4周后用影像学和组织学方法观察体内诱导成骨效果。结果：转染pIRES-BMP2-VEGF165的小鼠骨髓基质干细胞扩增出1．2kb及590bp两条带，胞浆中有棕黄色颗粒阳性信号。该细胞植入裸鼠大腿后群肌袋4周后有大量异位骨形成。结论：转染骨形态发生蛋白2和血管内皮生长因子165双基因的小鼠骨髓基质干细胞具有较强诱导异位成骨能力。     

Evaluation of cardiac global function using the myocardial performance index by tissue Doppler echocardiography in patients with uremia.

OBJECTIVE: The purpose of this study was to assess global ventricular function in patients with uremia by means of the myocardial performance index (MPI) derived from tissue Doppler echocardiography. METHODS: According to the left ventricular mass index and pericardial effusion, 45 patients with uremia were classified into 2 groups: a uremia group and a uremia with pericardial effusion group. To calculate left ventricular MPI (LVMPI) and right ventricular MPI (RVMPI) by tissue Doppler echocardiography, the isovolumic contraction time (ICT), isovolumic relaxation time (IRT), and ejection time (ET) were measured at different sites in the mitral and tricuspid annuli. RESULTS: The mean ICT and IRT were longer, the ET was shorter, and the LVMPI and RVMPI were higher in the 2 disease groups than in a control group, and the indices were higher in the uremia with pericardial effusion group than in the uremia group. The increase of the LVMPI was more obvious than that of the RVMPI. There was a significant difference in the mean LVMPI and RVMPI among the 3 groups (P<.01). The MPI was positively correlated with the IRT and the sum of the ICT and IRT and negatively correlated with the ET. CONCLUSIONS: Both left and right ventricular systolic and diastolic function are impaired in patients with uremia. The MPI could be measured by tissue Doppler echocardiography, and we suggest that this index provides a novel, noninvasive method for clinical research on global myocardial performance in patients with uremia.     

激光光镊对生物细胞操纵的研究

目的：利用光镊实现对生物微粒的操作。方法：利用激光陷阱技术，用激光器、生物显微镜、CCD传感器和计算机图像处理系统构成一套光镊来进行操纵，结果：利用制作的装置成功地对多种细胞进行了捕获和操纵，结论：激光束陷阱能够方便地捕获和操纵生物微粒。