初发脑卒中后认知功能障碍的相关因素分析

目的 初步分析初发脑卒中后认知功能障碍发生的相关因素,从而为临床上采取相应的干预方式提供参考.方法 采用中文版简明智能状态检查表(MMSE)对康复医学科住院的364例初发脑卒中患者进行认知功能评定,同时记录患者的年龄、性别、教育程度、婚姻状况、居住地、生活方式等一般情况以及病程、病变侧、脑卒中性质、病变部位、病灶特点、合并症等疾病特征.采用Logistic逐步多元回归分析法进行分析,筛选有意义的影响因素.结果 上述13种相关因素中,仅初发脑卒中的病变部位、病灶特点、有否高同型半胱氨酸血症、病变侧、合并症、教育程度、年龄等7种相关因素可进入回归方程.多元相关系数为0.849,其联合解释变异量为0.721,即表中7个变量能联合预测MMSE量表评定得分72.1%的变异量.结论 大脑前部病变、多部位/大面积病变、有高同型半胱氨酸血症、左侧大脑半球病变、有高血压/糖尿病等合并症、教育程度较低、年龄较大等因素对卒中后认知障碍的发生影响较大.     

Characterization of a model to independently study regression of ventricular hypertrophy

BACKGROUND: Although a host of studies catalogue changes that occur with the development of left ventricular hypertrophy (LVH), there is little information about features related solely to LVH regression. This is due, in part, to a lack of animal models to study this question. While traditional models of aortic banding have provided useful information regarding the development of LVH, a similarly effective model is necessary to study mechanisms associated with LVH regression. MATERIALS AND METHODS: Minimally invasive transverse arch banding was performed in C57BL6 mice using a slipknot technique. Twenty-eight days later, the band was removed. Carotid Doppler velocity gradients were serially measured to assess the degree of aortic constriction. Echocardiography, histology, electron microscopy, and real-time polymerase chain reaction were used to assess functional, structural, and genetic aspects of hypertrophy. RESULTS: Banding of the transverse arch created the expected increase in aortic velocity and gradient between the left and right carotid artery, which normalized with relief of the constriction. Pressure overload resulted in a robust hypertrophic response as assessed by heart weight/body weight ratios, gross and microscopic histology, transthoracic echocardiography, electron microscopy, and hypertrophy gene expression. These markers were reversed within 1 week following debanding and were maintained for up to 4 weeks. Mortality rate for the cumulative procedure was 5% over a 2-month period. CONCLUSIONS: These results demonstrate a safe, effective, and reproducible method of promoting LVH regression-avoiding the need for endotracheal intubation, mechanical ventilation, and a second invasive surgery to remove the constriction. The simplicity of this technique combined with the well-known advantages of using the mouse species makes this model both unique and relevant. Ultimately, this model will facilitate focused study of independent mechanisms involved with LVH regression.     

Interacting genes in lithium prophylaxis: Preliminary results of an exploratory analysis on the role of DGKH and NR1D1 gene polymorphisms in 199 Sardinian bipolar patients

Lithium represents the first-choice and most effective drug in the treatment of bipolar disorder (BD). While its mechanism of action is far from being totally understood, a large amount of evidence pointed to a role of second messengers mediated pathways and elements of the circadian system in modulating its mood stabilizing effect. In the present paper, we tested the possible association and interaction effect of the nuclear receptor subfamily 1, group D, member 1 (NR1D1) gene and the Diacylglycerol kinase eta (DGKH) gene with the therapeutic response to lithium prophylaxis. Single nucleotide polymorphisms (SNPs) rs12941497 and rs939347 at NR1D1 gene and SNPs rs9315885, rs1012053 and rs1170191 at DGKH gene were genotyped in a sample of 199 Sardinian BD patients characterized for the response to lithium therapy. Genotype and allele frequency distributions did not differ significantly between groups of patients Full Responders and partial/not responders to lithium prophylaxis. Moreover, no significant differences were identified between groups of patients when divided considering the improvement in symptoms after lithium treatment. The interaction analysis did not show a significant effect on these outcomes. While negative, our findings do not exclude an involvement of DGKH and NR1D1 in lithium prophylaxis. Moreover, the lack of statistic interaction might not necessarily correspond to a lack of biologic interaction between the genes studied.     

Why “late equals large” does not work

The concept of conservative scaling of mammalian brain subdivision size with respect to brain size is one of the more contentious issues in neuromorphological studies. What is generally less critically discussed is the widely-cited suggestion that a highly conserved neurogenetic sequence during brain development is the reason for this conservative scaling and other processes of mammalian brain evolution. Here I re-visit the data with which the influential notion of conserved neurogenesis and mechanistic relationship between neurogenesis and mammalian brain subdivision scaling was developed. I suggest that neurogenetic sequences in the species available are not particularly conserved, and that brain subdivision sizes do not correspond well with neurogenetic sequence timing. As an alternative, I propose favouring less generalized and more heterochrony-focused approaches of relating timing differences between species to adult morphology.     

Prenatal diagnosis and fetopathological investigation of dorsolumbosacral agenesis

Sacral and lumbosacral spine agenesis, as characteristic signs of a rare congenital malformation – caudal regression syndrome – has been well described. However, dorsolumbosacral agenesis involving the lower thoracic, lumbar, and sacral vertebrae has rarely been reported, and prenatal diagnosis of this severe form has not been published yet.     

Insomnia and long sleep duration are risk factors for later work disability. The Hordaland Health Study

Both insomnia and sleep duration have previously been linked with a range of adverse outcomes, but no studies have explored their relative effect on subsequent work disability. The aim of the present study was to investigate the contribution of insomnia versus sleep duration to later long-term work disability. Using a historical cohort design with 4-year follow-up, data on insomnia, sleep duration and potential confounders were gathered from 6599 working persons (40–45 years). The outcome was award of disability pension, as registered in the National Insurance Administration. After controlling for baseline exposure to disability and sick leave, insomnia was a strong predictor of permanent work disability [odds ratio (OR) = 4.56], and this effect remained significant after controlling for sleep duration, as well as for other possible confounders (OR = 1.88). Short sleep duration was not significantly associated with subsequent work disability, while long sleep duration (>8.5 h) did predict work disability (OR = 2.96), also in the fully adjusted model (OR = 2.14).The present study demonstrates that both insomnia and long sleep duration are strong and independent risk factors for subsequent work disability.     

海洛因依赖稽延性戒断症状的多因素回归分析

目的探讨海洛因依赖稽延性戒断症状的影响因素。方法以一般人口学资料、汉密顿焦虑量表(HAMA)、稽延性戒断症状评定量表(PWSRS)、症状自评量表(SCL-90)、人格诊断问卷(PDQ)、药物成瘾者生命质量量表(QOL-DA)、社会支持评定量表(SSRS)为评估工具,评估120例海洛因依赖者稽延性戒断症状的心理、社会因素;并测定去甲肾上腺素(NE)、多巴胺(DA)、5-羟色胺(5-HT)浓度,进行动态心电图24小时心率变异分析(HRV),评估生物学因素。结果海洛因依赖稽延性戒断症状主要受复吸、SCL-90躯体化、PDQ回避型、动态心电图RR间期的标准差(SDNN)、动态心电图低频功率与高频功率之比(LF/HF)、5-HT的影响,标准回归系数依次为:0.241、0.388、0.109、0.213、0.183、0.077。结论海洛因依赖者稽延性戒断症状受生物、心理、社会三方面的影响,因此治疗需采取综合治疗措施。     

正畸治疗影响成人鼻唇角变化的多元回归分析

目的探索正畸治疗对成人鼻唇角变化的影响。方法挑选125例Ⅰ类和轻度Ⅱ类成人患者,83例拔除第一双尖牙,42例不拔牙治疗,测量治疗前后鼻唇角以及有可能影响鼻唇角的软硬组织测量项目。根据鼻唇角改变值、治疗前上切牙突距大小分组,做多元回归分析,找出影响鼻唇角变化的相关因素。结果鼻唇角的变化与上唇突度改变正相关,治疗前上切牙突距在正常值以外时,其鼻唇角的变化与上切牙唇倾度的改变呈正相关。而正常者,其鼻唇角的改变与上切牙唇倾度无相关性。结论鼻唇角的改变与上唇突度有关,治疗前上切牙位置偏离正常越小,鼻唇角的变化越不明显。     

From the Cover: Deep phenotyping to predict live birth outcomes in in vitro fertilization

Nearly 75% of in vitro fertilization (IVF) treatments do not result in live births and patients are largely guided by a generalized age-based prognostic stratification. We sought to provide personalized and validated prognosis by using available clinical and embryo data from prior, failed treatments to predict live birth probabilities in the subsequent treatment. We generated a boosted tree model, IVF_BT, by training it with IVF outcomes data from 1,676 first cycles (C1s) from 2003–2006, followed by external validation with 634 cycles from 2007–2008, respectively. We tested whether this model could predict the probability of having a live birth in the subsequent treatment (C2). By using nondeterministic methods to identify prognostic factors and their relative nonredundant contribution, we generated a prediction model, IVF_BT, that was superior to the age-based control by providing over 1,000-fold improvement to fit new data (p < 0.05), and increased discrimination by receiver–operative characteristic analysis (area-under-the-curve, 0.80 vs. 0.68 for C1, 0.68 vs. 0.58 for C2). IVF_BT provided predictions that were more accurate for ∼83% of C1 and ∼60% of C2 cycles that were out of the range predicted by age. Over half of those patients were reclassified to have higher live birth probabilities. We showed that data from a prior cycle could be used effectively to provide personalized and validated live birth probabilities in a subsequent cycle. Our approach may be replicated and further validated in other IVF clinics.