Understanding heterogeneity in grey matter research of adults with childhood maltreatment—A meta-analysis and review

Childhood trauma has been associated with long term effects on prefrontal-limbic grey matter. A literature search was conducted to identify structural magnetic resonance imaging studies of adults with a history of childhood trauma. We performed three meta-analyses. Hedges’ g effect sizes were calculated for each study providing hippocampal or amygdala volumes of trauma and non-trauma groups. Seed based differential mapping was utilised to synthesise whole brain voxel based morphometry (VBM) studies. A total of 38 articles (17 hippocampus, 13 amygdala, 19 whole brain VBM) were included in the meta-analyses. Trauma cohorts exhibited smaller hippocampus and amygdala volumes bilaterally. The most robust findings of the whole brain VBM meta-analysis were reduced grey matter in the right dorsolateral prefrontal cortex and right hippocampus amongst adults with a history of childhood trauma. Subgroup analyses and meta-regressions showed results were moderated by age, gender, the cohort’s psychiatric health and the study’s definition of childhood trauma. We provide evidence of abnormal grey matter in prefrontal-limbic brain regions of adults with a history of childhood maltreatment.     

Case series of two patients with Fibrocartilaginous Embolism mimicking Transverse Myelitis of the Spinal Cord

Fibrocartilaginous Embolism (FCE) refers to the extrusion of some of the fibro-cartilaginous nucleus pulposus material from within the inter-vertebral disc to eventually embolize into one of the spinal cord vessels with resultant spinal cord infarction. According to a 2016 review, AbdelRazek et al. (2106) [1] there are 41 pathologically confirmed and 26 clinically suspected cases in the literature till the end of 2015. We add two more clinically diagnosed cases.     

成长环境和儿童期创伤对大学生情绪问题和躯体症状影响的研究

目的探究成长环境的城市化水平、儿童期忽视、躯体虐待和缺乏父母陪伴对大学生情绪问题和躯体症状的影响。方法纳入某综合性大学4620名二年级本科生进行问卷调查。以6条目Kessler心理痛苦量表(the 6-item Kessler psychological distress scale,K6)和患者健康问卷躯体症状群量表(patient health questionnaire-15,PHQ-15)分别评估情绪问题和躯体症状;以自编问卷调查出生地城市化水平及15岁前主要居住地变更情况;以改编自世界精神卫生复合式国际诊断检查(the World Mental Health Composite International Diagnostic Interview,WMH-CIDI)儿童期部分的5条目被抚养人忽视问卷和1项被殴打条目回顾性评估16岁前忽视及躯体虐待情况;以自编问卷调查儿童期缺乏父和(或)母陪伴的经历。结果广义线性模型多因素回归分析显示,情绪问题的影响因素有女性(β=0.894,P0.001)、农村成长(β=0.378,P=0.001)、儿童期忽视(β=0.279,P0.001)和儿童期躯体虐待(β=0.550,P0.001)。躯体症状的影响因素有女性(β=2.638,P0.001)、农村成长(β=0.395,P=0.015)、儿童期忽视(β=0.487,P0.001)和儿童期躯体虐待(β=0.483,P=0.005)。情绪问题和躯体症状之间呈正相关(r=0.545,P0.001)。结论女性、农村成长、儿童期逆境经历可增加大学生情绪问题、躯体症状的症状数目和严重程度。大学生的情绪问题和躯体症状在严重程度上呈正相关。     

Increased methylation of glucocorticoid receptor gene promoter 1F in peripheral blood of patients with generalized anxiety disorder

Previous findings on the dysfunction of hypothalamic-pituitary-adrenal (HPA) axis in generalized anxiety disorder (GAD) are controversial, and the molecular mechanisms underlying such dysfunction remain unclear. We analyzed the methylation status of the NR3C1 1_F promoter and the expression of glucocorticoid receptor-α isoform (GRα) in peripheral blood mononuclear cells (PMBCs), the basal cortisol level in serum, and a functional neuroendocrine marker for GR sensitivity in the PMBCs in 64 patients with current GAD and 85 healthy controls. We found that patients with GAD had significantly elevated levels of morning basal serum cortisol (P < 0.0001) and diminished GR sensitivity in the PBMCs (P < 0.0001) compared with healthy controls. The overall methylation levels across NR3C1 1_F promoter (P < 0.0001) and percent methylation at each of the 5 CpG sites including CpG12, 21, 30, 31, and 32 (P < 0.001) significantly increased. Accordingly, the mRNA levels of GRα significantly decreased (P < 0.0001) in the PBMCs in patients with GAD compared with healthy controls, with the effects specific in patients without childhood traumatic experience. Moreover, both serum basal cortisol levels and GR sensitivity in the PBMCs were negatively correlated with the overall methylation levels of the NR3C1 1_F promoter (P < 0.0001) and positively correlated with GRα mRNA levels (P = 0.007) in the PBMCs. In sum, our study revealed the increased activity of the HPA axis and diminished peripheral glucocorticoid responsiveness of GR underlying episodes of GAD. Furthermore, such dysfunction of the HPA axis is associated with both increased DNA methylation of NR3C1 1_F promoter and decreased GRα expression.     

重症颅脑外伤患者引入以循证为基础的早期营养支持干预的效果分析

目的 探讨重症颅脑外伤患者引入以循证为基础的早期营养支持干预的效果。方法 选择2017年5月-2019年5月本院神经外科收治的重症颅脑外伤患者108例,按随机数字表法分为2组,各54例; 对照组术后行早期常规营养支持干预,观察组术后行以循证为基础的早期营养支持干预; 比较2组肠内营养耐受性、治疗依从性、干预前后NIHSS评分、FMA评分变化及术后并发症发生率。结果 观察组颅脑外伤后第7 d肠内营养最大输注量高于对照组(P<0.05); 观察组治疗依从性优于对照组(P<0.05); 观察组干预后NIHSS评分低于对照组,FMA评分高于对照组(P<0.05); 观察组术后总并发症发生率低于对照组(P<0.05)。结论 重症颅脑外伤患者引入以循证为基础的早期营养支持干预可改善肠内营养耐受性,提高治疗依从性,促进神经功能和运动功能恢复,降低术后并发症发生率。     

多奈哌齐治疗脑外伤后痴呆疗效观察

外伤性痴呆是指脑外伤引起的智能障碍综合征,包括生理、认知、行为、情感方面的障碍,其持续时间长,一般持续数周乃至数月以上.对于初中以上文化脑外伤患者,简易智能量表(mini-mental state examination,MMSE)评分≤23分者,即认为存在程度不等的腩外伤后痴呆.     

B超在腹部闭合性损伤诊断中的应用价值分析

目的探讨B超检查在腹部闭合性损伤中的应用及其重要的临床意义。方法回顾性分析2003年1月—2009年1月6年间收治腹部闭合性损伤患者192例,其B超检查方法,分析其对临床治疗方案的作用。结果192例患者经B超检查,均诊断为：腹部闭合性损伤。其中空腔脏器破裂患者32例,脾破裂86例,肝破裂48例,腹膜后血肿23例,胰腺破裂损伤15例,肾脏破裂23例。其中合并两种及以上损伤患者18例。结论B超检查对腹腔脏器破裂的诊断及其临床分型具有的较高的应用价值。可明确诊断腹腔内脏器损伤的部位、范围或提供为临床进一步检查方向提供线索,B超检查无放射性、操作方便、结果可靠、费用低,能为临床医师选择适当的治疗方案的提供依据。患者做保守治疗时,应强调卧床休息,避免不必要的搬动,床头B超可随时进行复查。为临床医师及时调整治疗方案提供了保障。     

记忆合金肋骨环抱接骨器治疗多发性肋骨骨折的临床观察

总结应用记忆合金肋骨环抱接骨器对10例多发肋骨骨折的临床治疗经验,我们认为该术式操作简单、安全,手术创伤小,疗效可靠,对于多发肋骨骨折,特别适用于伴有胸壁浮动、连枷胸、血气胸等并发症的病人,是一种值得推广的治疗方法。     

胸腰椎损伤分类及损伤程度评分系统的初步评估

目的 评估胸腰椎损伤分类及损伤程度评分系统(TLICS)的可信度(Interobserver reliability)和可重复性(Intraobserv er reproducibility),及其对胸腰椎损伤治疗的指导作用.方法 2006年1月～2007年6月收治脊柱胸腰段骨折48例,均行胸腰椎X线、CT、MRI检查,根据TLICS系统进行评定,3个月后进行再次评估.使用Cohen加权Kappa系数(Unweighted Co hen kappa coefficients)对观察者问一致性和可重复性进行分析.结果 计算TLICS亚类Kappa系数位于中度和较高可靠性之间(0.43～0.72).TLICS系统可重复性的Kappa系数则位于中度和较高度可重复性之间(0.55～0.76).TLICS系统诊断准确率为95.1%,敏感性87.5%,特异性96.8%.结论 TLICS分类系统具有较高的可靠性和可重复性,使用简单,易于掌握,此方法对于胸腰椎损伤的评估较全面和准确,可以作为患者临床治疗选择的依据.     

多发伤早期救治的对策与分析

目的 通过分析采取不同方法处理的90例多发伤患者的治疗结果,探讨早期全面治疗(ETC)与损伤控制治疗(DCS)的合理性.方法 选取2001年6月至2007年6月病情严重程度接近的多发伤患者90例,其中采取DCS方法治疗的患者45例(DCS组),以ETC方法治疗的患者45例作为对照组(ETC组),入选条件为ISS评分25以上、病情严重度评分为创伤极端严重.结果 DCS组的乳酸清除时间、体温恢复时间、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)恢复时间较ETC组短,两组差异有显著性(P<0.05);DCS组比ETC组并发症及病死率低,两组有显著差异(P<0.05);两组在出血量和手术时间方而比较差异无统计学意义(P>0.05).结论 采用DCS方法治疗严重多发伤患者,有利于降低患者的并发症和病死率,在选择DCS方法时,除根据多发伤患者生理指标外,还要结合创伤机制、创伤复杂性等综合分析.