颈椎Modic改变与颈椎退行性疾病的关系

目的探讨颈椎Modic改变与颈椎退行性疾病之间的关系。方法对78例Modic改变患者的颈椎退行性疾病进行统计,分析其与Modic改变之间的关系。结果 78例患者中30例(38.5%)诊断为轻度颈椎退行性疾病,26例(33.3%)诊断为中度颈椎退行性疾病,22例(28.2%)诊断为重度颈椎退行性疾病。结论颈椎Modic改变好发于老年患者,以Ⅱ型改变居多,多发生于C5~6、C6~7节段,与颈椎退行性疾病的程度无明显关系。     

The Mediating Effect of Body Dissatisfaction in Association between Obesity and Dietary Behavior Changes for Weight Loss in Chinese Children

Objective The aim of this study was to analyze the mediating effect of body dissatisfaction in correlation between obesity and dietary behavior changes for weight loss(DBCWL).Methods A total of 680 primary and middle school students were included in this study. Their body height, weight, and waistline were effectively measured, and they were also evaluated to assess their body dissatisfaction, perception of dietary behaviors, and DBCWL. The correlation among these factors was analyzed using mediating effect models.Results The prevalence of overweight/obesity and abdominal obesity was significantly higher in males than in females(P 0.05). Overweight/obesity, abdominal obesity, and body dissatisfaction significantly increased the risk for DBCWL(OR = 2.57, 2.77, and 1.95, respectively). Overweight/obesity and abdominal obesity significantly increased the risk for body dissatisfaction(OR = 6.00 and 4.70,respectively). Significant mediating effects of body dissatisfaction were observed in correlation between overweight/obesity and DBCWL and between abdominal obesity and DBCWL(OR = 2.20 and 1.92,respectively; P 0.05), and the proportions of mediating effects among the total effects were 48.89% and 46.60%, respectively.Conclusion Body dissatisfaction might play an important mediating effect in association between DBCWL and obesity, which indicates that guiding children to correctly recognize their body might be more conducive than promoting obese children toward weight loss through dietary behavior changes.     

我国慢性非传染性疾病流行态势研究

阐述我国近几十年来慢性非传染性疾病谱演变以及疾病主要危险因素构成情况,分析和总结心血管疾病、恶性肿瘤、呼吸系统疾病等我国主要慢性非传染性疾病流行情况,探讨针对慢性非传染性疾病防控措施的有效建议。     

脓毒症患者T淋巴细胞亚群变化及与炎症状态的关系研究

目的 研究脓毒症患者的T淋巴细胞亚群变化及与炎症状态的关系。方法 选取2015年3月— 2018年10月浙江大学医学院附属杭州市第一人民医院脓毒症患者126例作为观察组,另选取同期健康体检者60例作为对照组。检测并比较两组的T淋巴细胞亚群（CD4+、CD8+、CD4+/CD8+）和炎症因子[血沉（ESR）、降钙素原（PCT）、C反应蛋白（CRP）、白细胞介素-6（IL-6）、白细胞介素-10（IL-10）、肿瘤坏死因子α （TNF-α）、高迁移率族蛋白B1（HMGB-1）],采用Pearson检验T淋巴细胞亚群与炎症指标的相关性。结果 观察组入院时CD8+及血清PCT、CRP、IL-6、TNF-α、IL-10、HMGB-1水平高于对照组（P?<0.05）,而CD4+、CD4+/CD8+低于对照组（P?<0.05）。PCT、CRP、IL-6、IL-10、TNF-α在入院6?h达到峰值;严重脓毒症组和脓毒症休克组各个时间点的CD4+、CD4+/CD8+低于脓毒症组,CD8+、PCT、CRP、IL-6、IL-10、TNF-α高于脓毒症组,ESR在入院5?d时高于脓毒症组,而HMGB-1在入院7?d时高于脓毒症组,差异有统计学意义（P?<0.05）,且严重脓毒症组与脓毒症休克组比较,差异有统计学意义（P?<0.05）。脓毒症患者的CD4+、CD8+、CD4+/CD8+与血清PCT、CRP、IL-6、IL-10、TNF-α和HMGB-1均呈线性相关（P?<0.05）。结论 脓毒症患者存在明显的T淋巴细胞紊乱和促炎/抗炎失衡,且病情越重其免疫-炎症紊乱越明显,动态监测T淋巴细胞亚群及炎症因子水平可为病情评估及治疗决策提供参考。     

血清降钙素原及其动态变化对于脓毒症病情严重程度的评估价值

目的 探讨住院早期降钙素原(PCT)及其动态变化对于脓毒症、脓毒性休克患者的评估价值。方法 回顾性分析山西省人民医院2020年5月—2022年2月因感染或可疑感染就诊,最终诊断为“脓毒症”或“脓毒性休克”的135例患者。根据最终诊断,将135例患者分为脓毒症组(n=70)和脓毒性休克组(n=65)。记录并比较两组患者入院时一般资料、入院后24 h内首次检测的血降钙素原(PCT₁)、入院后经积极诊疗后(早期抗生素暴露及液体复苏等治疗措施)48 h检测的降钙素原(PCT₂)等院内数据,将有意义的数据进行多因素Logistic回归分析筛选独立危险因素,利用受试者工作特征曲线分析相关指标对脓毒性休克的评估价值。结果 共纳入135例患者,男性88例,女性47例,中位年龄67(56,75)岁。脓毒性休克组PCT₁、PCT₂、乳酸(Lac)均较脓毒症组高(P<0.05)。多因素Logistic回归分析显示,PCT₂和Lac是影响脓毒症病情严重程度的危险因素。ROC曲线分析显示,PCT<...     

基于数字眼底照相的脑小血管病临床初筛的应用探讨

目的 探讨数字眼底照相技术在脑小血管病临床初筛中的应用价值,为脑小血管病在基层社区临床 初筛提供依据。 方法 选取脑小血管病患者36例（72眼）为观察组,另选取30例（60眼）同期同年龄层非脑小血管病 的志愿者为对照组。比较两组一般资料、眼底血管改变和颈动脉斑块等情况。 结果 观察组眼底动静脉交叉征率（77.78% vs 23.33%）、眼底血管改变总发生率（88.89% vs 56.67%）、眼底动脉硬化3级比例（30.56% vs 0）均高于对照组（P <0.001,P =0.003,P =0.002）。 Logistic多元回归分析提示眼底动静脉交叉征是脑小血管病的重要危险因素[比值比（odds ratio,OR） 10.678,95%可信区间（confidence interval,CI ）2.943～38.742,P <0.001]。观察组中有眼底血管改变者 32例,无眼底血管改变者4例,有眼底血管改变者的颈动脉斑块发生率、颈动脉斑块数均较无眼底 血管改变者高（P =0.010,P =0.013）。 结论 本研究中半数以上脑小血管病患者出现眼底动静脉交叉征,数字眼底照相技术或可作为脑小 血管病在基层社区临床初筛常规手段之一。     

发作性睡病患者自发性体动及体温昼夜特征分析

目的探讨发作性睡病患者自发性体动及深部体温昼夜节律特点。方法共14例发作性睡病患者和14例性别、年龄相匹配的正常对照者,行夜间多导睡眠图监测和次日多次睡眠潜伏期试验(MSLT),体动记录仪连续监测自发性体动1~2周并每日记录睡眠日记,于昼夜20个时间点测量深部体温。结果与对照组相比,发作性睡病组患者夜间卧床时间增加(P=0.008),睡眠效率降低(P=0.001),入睡后觉醒次数增加(P=0.000)、觉醒时间延长(P=0.000),易出现睡眠始发的快速眼动睡眠(SOREMP,P=0.002);MSLT试验中平均睡眠潜伏期缩短(P=0.000),SOREMPs次数增加(P=0.000);夜间总活动量和活动度增加(均P=0.000),白天总活动量和活动度减少(均P=0.000),夜间与白天总活动量和活动度比值升高(均P=0.000)。两组受试者深部体温呈现明显昼夜节律变化,其中值、振幅和峰值相位差异均无统计学意义(P=0.177,0.730,0.488)。结论尽管发作性睡病患者存在明显的睡眠-觉醒节律和自发性体动的昼夜节律紊乱,但其对深部体温的影响并不显著,提示发作性睡病患者体温中枢的调节能力相对保留。     

Functional MR imaging of kidneys in patients with lupus nephritis

Objective To evaluate the functional magnetic resonance (MR) imaging in the assessment of renal involvement and pathological changes in patients with lupus nephritis (LN). Methods Seventeen patients with LN and 10 healthy controls underwent coronal echo?planar diffusion?weighted (DW) MR imaging and blood oxygen level dependent (BOLD) MR imaging of the kidneys with a single breath?hold time of 16 s. The apparent diffusion coefficient (ADC) and R2* value of the kidneys were calculated with high b values (b=500 s/mm2). The correlation between the renal injury variables and the ADCs or R2* values was evaluated. Results The mean ADC value of kidneys in patients with LN was (2.43±0.24)×10-3 mm2/s, the mean R2* values of the renal cortex and medulla were (11.72±2.35)/s and (13.07±2.35)/s respectively, which were all significantly lower than those in volunteers (P=0.045,P=0.048 and P=0.001, respectively). In the patients with LN, the mean ADC values were positively correlated with estimated glomerular filtration rate (eGFR) (r=0.558, P<0.05). There was a negative correlation between the ADC values of the right kidneys and pathological chronic indexes (r=-0.493, P<0.05). Moreover, the R2*values of the renal medulla were negatively correlated with 24 hours proteinuria, serum creatinine, pathological active indexes. The patients were assigned to group A (class Ⅲ, Ⅳ, Ⅴ, n=8) and group B (class Ⅴ+Ⅲ and Ⅴ+Ⅳ, n=9). The tubulointerstitial lesions in group B were more severe than those in group A, while the mean ADC values and R2* values of the renal cortex in group B were lower as compared to group A. Conclusion DW MR imaging and BOLD MR imaging may be used to non?invasively monitor the disease activity and evaluate the efficacy in lupus nephritis.     

Reduced quality of life in living kidney donors: association with fatigue, societal participation and pre-donation variables

Health related quality of life (HRQoL) of living kidney donors on average is good, but some donors experience a low HRQoL after donation. This study assessed the prevalence of reduced HRQoL and explored associations with pre‐ and post‐donation variables. 316 donors (response rate 74%) who donated a kidney between 1997 and 2009 filled in a questionnaire. HRQoL was measured using the Short‐Form 36; fatigue using the Multidimensional Fatigue Inventory; societal participation using the Utrecht Scale for Evaluation of Rehabilitation‐Participation. Donors on average had better HRQoL than the general population. However, 12% had a reduced physical (PCS) and 18% a reduced mental (MCS) HRQoL. Donors with reduced HRQoL reported greater fatigue (P < 0.01), lower societal participation (P < 0.01) and showed a trend towards statistical significance in experiencing more donor–recipient relationship changes (P = 0.07). Prior to donation, donors with reduced PCS had a higher BMI (P < 0.05) and more often smoked (P < 0.05). Donors with reduced MCS had higher expectations (P < 0.05). Reduced HRQoL is associated with higher BMI, smoking and higher expectations prior to donation. These results may be used to develop a screening instrument to select donors at high risk for reduced HRQoL.     

Histopathological perspective on bone marrow oedema, reactive bone change and haemorrhage

This article presents a systematic review of the current biomedical literature surrounding the aetiopathogenesis and histopathological features of bone marrow oedema, reactive bone change and haemorrhage. Bone marrow oedema is generally demonstrated as a non-specific finding on magnetic resonance imaging in association with infections, tumours and avascular necrosis. When it occurs in isolation as a primary event not triggered by any obvious bony pathology in the clinical setting of debilitating joint pain, it constitutes the "bone marrow oedema syndrome". Although the latter diagnosis is based on magnetic resonance (MR) imaging, showing the lesion as areas of signal hyperintensity within the marrow, recent radiology-histology correlational studies have shown variably interstitial marrow oedema, necrosis, fibrosis and trabecular bone abnormalities. In light of these facts, the use of the term bone marrow oedema syndrome in a radiological context might be considered questionable, but histopathological techniques are not sensitive in detecting increased extracellular fluid. Reactive bone changes may be focal or diffuse and usually amount to increased bone formation. Bone marrow haemorrhage, due to trauma, results in bone bruising, a condition in which the size of the bruise and associated osteochondral injury determines the outcome, although the natural history of these lesions is still being researched.