重性抑郁障碍患者躯体症状与脑源性神经营养因子和炎性因子的相关性研究

背景 大量证据表明抑郁障碍患者的躯体症状的风险比正常人高,但躯体易感性的机制尚不明确。部分研究认为前者脑源性神经营养因子前体(ProBDNF)、炎性因子水平比正常人高,而这是否与伴随的躯体症状有关还没有明确的结论。目的 探讨重性抑郁障碍(MDD)患者躯体症状与脑源性神经营养因子(BDNF)、炎性因子的特征及其相关性。方法 选取2019年2月至2020年12月山西医科大学第一医院精神卫生科门诊或住院部MDD患者59例与同期社区招募的健康志愿者32例作为研究对象。根据躯体化症状自评量表(SSS)将MDD患者分为伴躯体症状抑郁障碍(SD)组37例(SSS总分>36分)和不伴躯体症状抑郁障碍(NSD)组22例(SSS总分≤36分),32例健康志愿者为健康对照组(HC组)。收集临床资料,包括性别、年龄、受教育年限、17项汉密尔顿抑郁量表(HAMD-17)评分、SSS评分、BDNF、ProBDNF与炎性因子[C反应蛋白(CRP)、白介素4(IL-4)、白介素6(IL-6)、白介素10(IL-10)、白介素18(IL-18)、白介素23a(IL-23a)、高迁移率族蛋白B1(HMGB1)、肿瘤...     

Safety and efficacy of oral nemonoxacin versus levofloxacin in treatment of community-acquired pneumonia: A phase 3, multicenter,randomized, double-blind,double-dummy,active-controlled,non-inferiority trial

Background/Purpose

Nemonoxacin is a novel nonfluorinated quinolone with excellent in vitro activity against most pathogens in community-acquired pneumonia (CAP), especially Gram-positive isolates. The purpose of this study was to assess the efficacy and safety of nemonoxacin compared with levofloxacin in patients with CAP.

丙型肝炎病毒基因分型及其与干扰素治疗应答的关系

目的为了解山西省丙型肝炎病毒的基因型和基因型对干扰素疗效的预示价值。方法用ＨＣＶ５’ＮＣ区酶切分型方法对９４例丙型肝炎病人进行基因分型，并观察其中４５例患者对干扰素α１ｂ治疗的应答。结果显示ＨＣＶⅠ组（Ⅰ、Ⅱ型）感染８０例（８５１％），ＨＣＶⅡ组（Ⅲ、Ⅳ型）感染１２例（１２８％），ＨＣＶⅠ／Ⅱ组混合感染２例（２１％）。在接受干扰素治疗的病例中，ＨＣＶⅠ组感染（３５例）的应答率为３７１％，持续应答率为１７１％，而Ⅱ组感染（１０例）的应答率为８０％，持续应答率为６０％，两组相比，有显著性差异（Ｐ＜００５，Ｐ＜００２５）。结论表明山西省以ＨＣＶⅠ组感染为主，干扰素对ＨＣＶⅡ组感染的疗效优于ＨＣＶⅠ组感染，ＨＣＶ基因型有预测干扰素疗效的意义。     

分娩前静脉血铬水平与子痫前期的病例对照研究

  目的  探讨分娩前静脉血铬(chromium, Cr)水平与孕妇子痫前期(preeclampsia, PE)及其临床亚型的发生风险的关系。  方法  研究对象为2012年3月―2016年9月在山西医科大学第一医院产科住院分娩的孕妇,从中随机选取442例PE病例[195例早发型子痫前期(early-onset PE, EOPE)和247例晚发型子痫前期(late-onset PE, LOPE)]和1 745例正常妊娠孕妇。收集其一般人口学特征、疾病史、家族史等,以及检测其全血中的重金属Cr浓度。经非条件Logistic回归分析模型分析Cr暴露对PE及其临床亚型的发生风险的影响。  结果  PE组孕妇全血Cr暴露水平为[9.54(3.40, 39.26)]μg/L,其中EOPE组为[9.75(3.56, 55.38)] μg/L,LOPE组为[9.36(3.21, 39.24)] μg/L,均高于与正常妊娠孕妇的[7.02(0.10, 30.05)] μg/L(均有P＜0.05)。经非条件Logistic回归分析,调整孕妇年龄、文化程度、家庭人均月收入等混杂因素后,Cr暴露与PE及其临床亚型的发生风险均有关,且对EOPE影响更大。  结论  妊娠Cr暴露与PE的发生风险有关,并与EOPE的发病风险关联更大。     

Risk factors for sleep disturbance in patients with cervical myelopathy and its clinical significance: a cross-sectional study

BACKGROUND CONTEXTSleep disturbance is highly prevalent in patients with spinal cord injury and is one of the most important clinical issues affecting their quality of life. However, it has not been properly measured or treated in patients with cervical myelopathy (CM), although most typical or atypical symptoms of CM are known to be risk factors for sleep disturbance. In addition, previous studies identified that the presence of sleep disturbance is unintentionally missed under the current evaluation process for degenerative spinal disease without direct investigation using validated tools for sleep. Therefore, studies about sleep disturbances in patients with CM are essential.PURPOSEThe purpose of this study was to investigate the prevalence of sleep disturbance in patients with CM using validated tools and to understand its mechanism by identifying high-risk patients.STUDY DESIGN/SETTINGCross-sectional study.PATIENT SAMPLEConsecutive patients diagnosed with CM.OUTCOME MEASURESPittsburgh sleep quality index.METHODSThis study was performed on patients diagnosed with CM. Sleep disturbance was determined using the Pittsburgh sleep quality index. Variables associated with sleep disturbance including demographics, lifestyle, medical history, and radiologic parameters were investigated. Independent risk factors related to sleep disturbance were identified using multivariate logistic regression analysis.RESULTSA total of 203 patients with CM were included in our study. Among them, 126 patients (62.1%) were men, and the mean age was 63.0 years. Despite male predominance, sleep disturbance was identified in 71.4% of patients (145 of 203). Multivariate analysis identified a worse depression scale score, a lower modified Japanese Orthopedic Association score, chronic shoulder joint pain, smaller spinal cord area, and decreased cervical range of motion as independent risk factors for sleep disturbance.CONCLUSIONSIn patients with CM, sleep disturbance was associated with a more severe type of myelopathy. Further studies including polysomnography and measurement of melatonin will be helpful to identify the mechanisms of the sleep disturbance in patients with CM and to improve their quality of life and clinical outcomes.     

基于纳米材料的肿瘤消融联合免疫治疗研究进展

影像学引导消融治疗已逐渐成为治疗不可切除实体肿瘤的重要方式,但消融治疗后存在肿瘤局部复发及全身转移风险。免疫治疗可通过增强机体自身免疫细胞功能间接清除肿瘤细胞,但多数实体肿瘤对免疫治疗的反应率较低。近年来,基于纳米材料的肿瘤消融技术发展迅速,为增强局部消融效果及提高系统免疫应答提供了新的可能。本文对基于纳米材料的消融联合免疫治疗肿瘤研究进展进行综述。     

维生素D受体基因多态性与妊娠期糖尿病关系的病例对照研究

目的 探讨维生素D受体（VDR）基因多态性与妊娠期糖尿病（GDM）之间的关系,为GDM的机制研究提供线索与依据。方法 采用病例对照研究设计,以2012年3月1日至2014年7月30日在山西医科大学第一医院产科分娩的孕妇为研究对象,其中334例被诊断为GDM,按年龄、妊娠时间及居住地1∶1匹配相应健康对照。对研究对象进行DNA基因分型,剔除基因分型缺失率>10%者,最终323例病例和320例对照纳入研究。在共显性、显性、隐性和等位基因遗传模型下,通过非条件logistic回归分析VDR基因位点多态性和GDM之间的关系,并采用Haploview软件分析单倍型与GDM之间的关系。结果 在基因水平上,VDR基因与GDM发病风险有关（P<0.05）。在调整孕前BMI、糖尿病家族史后,rs7967152位点在共显性（AC vs. AA,OR=1.58,95%CI：1.13~2.21）、显性（AC+CC vs. AA,OR=1.58,95%CI：1.15~2.18）和等位基因（C vs. A,OR=1.41,95%CI：1.10~1.82）遗传模型下与GDM风险升高有关;rs2238140位点在共显性（AA vs. GG,OR=2.24,95%CI：1.19~4.20）、显性（GA+AA vs. GG,OR=1.48,95%CI：1.07~2.03）和等位基因（A vs. G,OR=1.43,95%CI：1.11~1.83）遗传模型下与GDM风险升高有关。在共显性和显性遗传模型下,孕妇携带rs2853564位点AG基因型、AG+GG基因型（OR=1.46,95%CI：1.04~2.05;OR=1.45,95%CI：1.05~2.00）与携带AA基因型相比,是GDM的危险因素;孕妇携带rs2853566位点AG基因型、AG+GG基因型（OR=1.43,95%CI：1.03~2.00;OR=1.41,95%CI：1.02~1.94）与携带AA基因型相比,是GDM的危险因素。在VDR基因内由rs1544410、rs7967152组成的单倍型区块,其GC单倍型与是GDM的危险因素（OR=1.50,95%CI：1.15~1.97）。结论 VDR基因rs7967152、rs2238140、rs2853564、rs2853566位点多态性和区块（rs1544410、rs7967152）GC单倍型与GDM的发病风险升高有关。     

Long-term persistent immunogenicity after successful standard and triple-dosed hepatitis B vaccine in hemodialysis patients: A 3-year follow-up study in China

BackgroundAlthough the efficacy of hepatitis B vaccines among hemodialysis patients has been documented, the long-term persistence of immunogenicity in this population remains largely unknown. We explored the long-term persistence of immunogenicity induced by different hepatitis B vaccine regimens in hemodialysis patients.MethodsIn initial study, we conducted a randomized, multicenter, double-blind, parallel-controlled trial among hemodialysis patients in 13 hospitals in Shanxi Province, China. A total of 352 hemodialysis patients were allocated to receive 3-dose 20 μg (IM20 group) and 3-dose 60 μg (IM60 group) recombinant hepatitis B vaccine at months 0, 1, and 6. Vaccine-induced immune responses were measured at month 7. In this study, the responders (anti-HBs ≥ 10 mIU/mL) were followed up at months 18, 24, 30, 36 and 42, respectively. We used the generalized log-rank test and generalized estimating equations (GEE) to analyze the long-term durability of responses and the kinetics of anti-HBs levels, respectively.ResultsA total of 284 patients were involved in the extended follow-up period. The duration of vaccine-induced response with 75% of patients maintained protective antibody were 12 months and 18 months in the IM20 group and IM60 group, respectively (P = 0.291). The long-term persistent immunogenicity induced by 3-dose 60 μg was more satisfactory than that by 3-dose 20 μg hepatitis B vaccine in patients with hemodialysis duration ≥ five years (P = 0.023). The peak anti-HBs levels in 100–1000 mIU/mL or ≥ 1000 mIU/mL were more likely to maintain long-term protective antibody compared to anti-HBs levels in 10–100 mIU/mL (P ＜ 0.05). The kinetic profile was similar between the two groups (P = 0.334).ConclusionHigh-dose 60 μg hepatitis B vaccine could lead a satisfactory long-term durability of immunogenicity among patients with hemodialysis duration of five years or more. Peak anti-HBs level after vaccination was associated with the long-term persistence of immunogenicity.     

联带运动性耳鸣

目的：探讨联带运动性鸣的发生机制,临床表现及治疗。