ABSTRACT
Post-amputation pain causes great suffering to amputees, but still no effective drugs are available due to its elusive mechanisms. Our previous clinical studies found that surgical removal or radiofrequency treatment of the neuroma at the axotomized nerve stump effectively relieves the phantom pain afflicting patients after amputation. This indicated an essential role of the residual nerve stump in the formation of chronic post-amputation pain (CPAP). However, the molecular mechanism by which the residual nerve stump or neuroma is involved and regulates CPAP is still a mystery. In this study, we found that nociceptors expressed the mechanosensitive ion channel TMEM63A and macrophages infiltrated into the dorsal root ganglion (DRG) neurons worked synergistically to promote CPAP. Histology and qRT-PCR showed that TMEM63A was mainly expressed in mechanical pain-producing non-peptidergic nociceptors in the DRG, and the expression of TMEM63A increased significantly both in the neuroma from amputated patients and the DRG in a mouse model of tibial nerve transfer (TNT). Behavioral tests showed that the mechanical, heat, and cold sensitivity were not affected in the Tmem63a-/- mice in the naïve state, suggesting the basal pain was not affected. In the inflammatory and post-amputation state, the mechanical allodynia but not the heat hyperalgesia or cold allodynia was significantly decreased in Tmem63a-/- mice. Further study showed that there was severe neuronal injury and macrophage infiltration in the DRG, tibial nerve, residual stump, and the neuroma-like structure of the TNT mouse model, Consistent with this, expression of the pro-inflammatory cytokines TNF-α, IL-6, and IL-1β all increased dramatically in the DRG. Interestingly, the deletion of Tmem63a significantly reduced the macrophage infiltration in the DRG but not in the tibial nerve stump. Furthermore, the ablation of macrophages significantly reduced both the expression of Tmem63a and the mechanical allodynia in the TNT mouse model, indicating an interaction between nociceptors and macrophages, and that these two factors gang up together to regulate the formation of CPAP. This provides a new insight into the mechanisms underlying CPAP and potential drug targets its treatment.
Subject(s)
Animals , Mice , Amputation, Surgical , Chronic Pain/pathology , Disease Models, Animal , Ganglia, Spinal/pathology , Hyperalgesia/etiology , Ion Channels/metabolism , Macrophages , Neuroma/pathologyABSTRACT
Compared with single therapy, radiotherapy combined with chemotherapy, endocrine therapy, molecular targeted therapy and immunological therapy can not only shorten the treatment cycle, but also improve the local control rate and prolong the survival of patients. However, the safety of combined therapy still needs to be further clarified to comprehensively evaluate the feasibility. Therefore, exploring the efficacy and safety of radiotherapy combined with systematic therapy will provide evidence for clinical benefits.
ABSTRACT
To further standardize the sedation and analgesia treatment for neurocritical care patients, the National Center for Healthcare Quality Management in Neurological Diseases and Chinese Society of Critical Care Medicine organized national experts in this fields to form Working group of the Expert consensus on sedation and analgesia for neurocritical care patients in order to update the Expert consensus on sedation and analgesia for patients with severe brain injury (2013) based on evidence-based medicine. This update aims to provide scientific guidance for the clinical diagnosis and treatment of neurocritical care patients. The working group followed the definition of clinical practice guidelines by the Institution of Medicine (IOM) and the World Health Organization guidelines development handbook and Guidelines for the formulation/revision of clinical guidelines in China (2022) to register and draft the Expert consensus on sedation and analgesia for neurocritical care patients. The working group will strictly adhere to the consensus development process to formulate and publish the Expert consensus on sedation and analgesia for neurocritical care patients (2023). This protocol primarily introduces the development methodology and process of the Expert consensus on sedation and analgesia for neurocritical care patients (2023), including the purpose of the update, the target population, the composition of the consensus development working group, the presentation and collection of clinical questions, evidence evaluation and summarization, and the generation of recommended opinions. This will make the consensus development process more standardized and transparent.
Subject(s)
Humans , Consensus , Analgesia , Analgesics/therapeutic use , Pain Management , Critical CareABSTRACT
【Objective】 To explore the efficacy of Mathieu combined with tongue-shaped flap covering in children with distal hypospadias and micropenis head deformity. 【Methods】 The clinical data of 72 patients with distal hypospadias complicated with micropenis treated during Jan.2018 and Jun.2021 were retrospectively analyzed, including 35 patients who underwent modified Mathieu combined with tongue-shaped flap and external urethral orificium (study group), and 37 patients who underwent traditional Mathieu (control group). Urethral stricture, urethral fistula, urethral diverticulum and penile head cleft were compared between the two groups. 【Results】 Urinary fistula occurred in 2 cases (5.27%) and 9 cases (24.32%) in the study group and control group, respectively, the incidence being much lower in the study group (P=0.028). Urethral stricture occurred in 1 case (2.86%) and 1 case (2.70%) in the study group and control group, respectively; penile head dehiscence in 1 case (2.86%) and 3 cases (8.11%); urethral diverticulum in 0 case (0%) and 2 cases (5.41%). There were no significant differences between the two groups in the incidence of urethral stricture, urethral dehiscence and urethral diverticulum (P>0.05). 【Conclusion】 Mathieu combined with tongue-shaped flap covering to treat children with distal hypospadias with micropenis head deformity can reduce the incidence of postoperative complications, achieve high surgical satisfaction and appearance satisfaction in the first phase, reduce harm caused by surgery, and promote patients’ psychological health.
ABSTRACT
【Objective】 To investigate the predictive value of high preoperative neutrophile-lymphocyte ratio (NLR) for the prognosis of nonurothelial carcinoma of the bladder (NUBC) after radical cystectomy (RC). 【Methods】 Clinical and follow-up data of NUBC patients undergoing RC during Jan.2005 and Dec.2020 were collected. The optimal cut-off value of NLR was determined with the receiver operating characteristic (ROC) curve. The survival curve was drawn with Kaplan-Meier method to compare the differences in cancer specific survival (CSS) and overall survival (OS) between the high-NLR and low-NLR groups. The independent risk factors of CSS and OS were screened with Cox proportional hazard regression model. 【Results】 Of the 62 eligible cases,34 (54.8%) were diagnosed with adenocarcinoma,17 (27.4%) with squamous cell carcinoma, 6 (9.7%) with small cell carcinoma and 5 (8.1%) with sarcoma. Kaplan-Meier analysis results showed high NLR was associated with poor CSS (P=0.001) and OS (P<0.001). Cox regression results indicated that high NLR (HR=2.42, 95%CI: 1.12-5.23, P=0.025) and advanced pathologic tumor stage (HR=3.21, 95%CI:1.53-6.74,P=0.002) were independent risk factors of unfavorable CSS. Similarly, high NLR (HR=2.75, 95%CI: 1.35-5.56, P=0.005) and advanced pathologic tumor stage (HR=2.81, 95%CI:1.43-5.57, P=0.003) were independent risk factors of unfavorable OS. 【Conclusion】 As an independent risk factor of unfavorable CSS and OS in NUBC patients undergoing RC, high preoperative NLR is of great value in the prediction of long-term prognosis and may help to optimize individualized treatment.
ABSTRACT
Objective:To survey the knowledge,attitude and practice (KAP) for diabetic retinopathy (DR) among diabetic patients in Shanghai suburb, and to analyze the related influencing factors.Methods:A cross-sectional survey on KAP for diabetic retinopathy was conducted from January to January 2022,a total of 260 diabetic patients were selected from Huacao Town of Shanghai Minhang District by stratified cluster random sampling method as the investigation subjects. The gender, age, height, weight, education level, occupation, frequency of exercise or outdoor sports, medical insurance status, comorbid chronic diseases, diabetic retinopathy in direct relatives were documented;the KAP of diabetes retinopathy prevention and treatment was investigated by a self-designed questionnaire. The influencing factors were analyzed by univariate and multivariate regression analysis.Results:A total of 260 valid questionnaires were received with a recovery rate of 100.0%. The survey showed that the knowledge awareness rate, attitude positive rate and behavior execution rate were 25.38% (66/260), 50.76% (132/260) and 14.61% (38/260), respectively; scores of knowledge,attitude,behavior and medication compliance of the subjects were 13.74±4.55, 10.40±3.23 and 14.92±4.51, respectively. Univariate analysis showed that the knowledge was significantly related to occupations,frequency of exercise or outdoor exercise,chronic disease, direct relatives with DR( F=5.03, 8.77, 5.08, 32.37,all P<0.05);the attitude was significantly related to age, education level, chronic disease, direct relatives with DR and awareness level of DR( F=2.12, 2.09, 2.75, 3.28,all P<0.05); the behavior was significantly related to age, frequency of exercise or outdoor exercise, direct relatives with DR( F=2.30, 2.70, 3.11,all P<0.05). Multiple stepwise linear regression analysis showed that the knowledge awareness score was significantly associated with age,education levels,direct relatives with DR( t=2.83, 2.46, 6.24,all P<0.05),and the age, chronic disease, awareness score were significantly associated with the attitude toward DR prevention and treatment ( t=3.70, 3.42, 6.03,all P<0.05).Patients with insufficient awareness had worse behavior of DR prevention and treatment( t=11.00, P<0.05). Conclusions:The KAP status of DR prevention and treatment in diabetes patients in Huacao Town is less satisfactory. In order to prevent the occurrence of diabetic retinopathy, it is necessary to strengthen health education, improve self-management ability, enhance lifestyle intervention, and increase the frequency of exercise or outdoor exercise in diabetic patients.
ABSTRACT
Radical pelvic surgery is a surgical method mainly used to treat tumors in the pelvic cavity, and erectile dysfunction (ED) is a common sexual dysfunction after surgery. The incidence of ED after radical pelvic surgery is not uniformly understood due to differences in surgical approaches and methods of investigation. The main causes of postoperative ED include intraoperative neurovascular injury, psychosomatic factors and preoperative patient characteristics, with intraoperative injury to the neurovascular bundle being the most common. Studies have shown that the occurrence of postoperative ED can be prevented by active intervention, but still lack of effective treatment measures. This article reviews and summarizes the clinical epidemiological features and research progress in recent years on ED after radical pelvic surgery, and discusses specific measures for the prevention and treatment of postoperative ED.
ABSTRACT
@#AIM: To compare the consistency of angle Kappa and angle Alpha in age-related cataract eyes with three different instruments. <p>METHODS: Prospective study. Totally 60 eyes of 30 patients with age-related cataract from December 1 to December 30, 2020 were collected. After adapting to 10min in the darkroom before operation, the angle Kappa and angle Alpha were measured with iTrace, Lenstar 900 and IOL Master 700 biometric instruments, respectively. The difference and consistency of the three instruments were analyzed.<p>RESULTS: The results of angle Kappa measurement of iTrace, Lenstar 900 and IOL Master 700 were 0.25±0.13, 0.19±0.11, 0.21±0.11mm(F=1.903, P=0.155). The results of angle Alpha measurement of the three instruments were 0.31±0.11, 0.36±0.16, 0.36±0.14mm(F=2.999, P=0.052). The proportion of angle Kappa of the three instruments greater than 0.5mm is 3%, 2% and 2%, and the proportion of angle Alpha greater than 0.5mm is 5%, 15% and 22%. The distribution of angle Kappa and angle Alpha is mainly in the temporal side of both eyes. Compared with the angle Kappa distribution of both eyes, the temporal distribution ratio of angle Alpha is higher, and the distribution of angle Alpha measured by iTrace is closer than that of Lenstar 900 and IOL Master 700 along the horizontal line. There was a positive correlation between angle Alpha and angle Kappa measured by each instrument(r=0.2941, 0.4082, 0.5137; P=0.0226, P=0.0012, P<0.0001). The consistency of angle Kappa measurement results of three kinds of instruments was good, while that of angle Alpha measurement results was poor.<p>CONCLUSION: When making the decision of multifocal intraocular lens implantation before cataract surgery, the consistency of angle Alpha measured by Lenstar 900, IOL Master 700 and iTrace is poor, so it is necessary to compare and refer to the results of various instruments in clinical application. When the data of angle Alpha could not be obtained before cataract surgery, the angle Kappa measured with the three instruments could provide useful information for multifocal IOL implantation decision.
ABSTRACT
Objective:To investigate the compassion fatigue of medical staff working in centralized quarantine sites and its influencing factors during the COVID-19 epidemic.Methods:From September 2020 to October 2020, a cross-sectional study was conducted on 213 medical staff working in 13 quarantine centers in two districts of Shanghai. A self-made general information questionnaire, professional quality of life scale, general self-efficacy scale and perceived social support scale were used in the study.Results:The score of empathy satisfaction was 33.00(28.25, 37.75), and there were 141 cases (66.20%) with supercritical value. The score of job burnout was 26.00(21.50, 30.50), and 96 cases (45.07%) exceeded the critical value. The score of secondary traumatic stress was 25.00(20.50, 29.50), and 192 cases (90.14%) exceeded the critical value. Multivariate logistic regression analysis showed that average daily working hours, job satisfaction, self-evaluation of work pressure, general self-efficacy and perceived social support were the influencing factors of compassion fatigue among medical staff. Compared with those who worked for 0 h in the polluted area, those who worked for more than 8 h had a higher degree of compassion fatigue ( OR=7.787, 95 %CI: 1.127-53.820);compared with those who were more satisfied with their work, those who were less satisfied with their work had a higher degree of compassion fatigue ( OR=6.209,95 %CI:1.474-26.157); compared with those with no or low stress, those with high stress had higher degree of compassion fatigue ( OR=2.567, 95 %CI: 1.228-5.366); compared with those with high self-confidence, those with low self-confidence or moderate self-confidence had higher degree of compassion fatigue ( OR=13.519, 95 %CI: 3.394-53.848; OR=3.462, 95 %CI: 1.038-11.548); compared with those with high perceived social support, those with low perceived social support had higher degree of compassion fatigue ( OR=2.071, 95 %CI: 1.027-4.175) (all P<0.05). Conclusion:The status of compassion fatigue of medical staff working in the centralized quarantine sites need to be improved. We should pay more attention to the those medical staff having long daily working hours in the polluted area, those with low job satisfaction, poor self-evaluation of work pressure, poor general self-efficacy and low perceived social support.
ABSTRACT
Objective:To evaluate the effect of long-term intake of ω-3 polyunsaturated fatty acids (ω-3 PUFAs) on the activation of hippocampal microglia in a mouse model of postoperative cognitive dysfunction (POCD).Methods:Ninety-six clean-grade healthy male C57BL/6 mice, aged 8 weeks, weighing 18-24 g, were stratified according to body weight and divided into 4 groups ( n=24 each) by a random number table method: control diet group (group C), ω-3 PUFAs group (group ω), control diet plus POCD group (group C+ P) and ω-3 PUFAs plus POCD group (group ω+ P). Mice were fed a special ω-3 PUFAs diet (DHA 0.14 g/100 g, EPA 0.03 g/100 g) for 12 weeks in group ω and group ω+ P, while mice were fed with a control diet for 12 weeks in group C and group C+ P.Tibial fracture procedures were performed under isoflurane anesthesia to develop the POCD model after 12 weeks of feeding.The fear conditioning test and Y maze test were performed on 1st and 3rd days after developing the model.The mice were sacrificed after behavioral tests, and the hippocampal tissues were removed for determination of the contents of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) (by gas chromatography-mass spectroscopy), density of Iba-1 positive microglia (by immunofluorescence staining), and expression of mature brain-derived neurotrophic factor (mBDNF) and precursor brain-derived neurotrophic factor (pro-BDNF) (by Western blot), and contents of interleukin-1beta (IL-1β) and interleukin-6 (IL-6) (by enzyme-linked immunosorbent assay). Results:Compared with group C, the contents of DHA and EPA were significantly increased, the percentage of freezing time in the contextual test was increased, mBDNF/pro-BDNF ratio was increased ( P<0.05), no significant change was found in the rotation accuracy in Y maze test, density of Iba-1 positive microglia and contents of IL-1β and IL-6 in hippocampus ( P>0.05) in group ω ( P<0.05), and no significant change was found in the contents of DHA and EPA ( P>0.05), the percentage of freezing time in the contextual test and accuracy of rotation in Y maze test were decreased on 1st and 3rd days after operation, the density of Iba-1 positive microglia and contents of IL-1β and IL-6 were increased, and mBDNF/pro-BDNF ratio was decreased in group C+ P ( P<0.05). Compared with group C+ P, the contents of DHA and EPA were significantly increased, the percentage of freezing time in the contextual test and accuracy of rotation in Y maze test were increased on 1st and 3rd days after operation, the density of Iba-1 positive microglia and contents of IL-1β and IL-6 were decreased, and mBDNF/pro-BDNF ratio was increased in group ω+ P ( P<0.05). Conclusions:Long-term intake of ω-3 PUFAs can improve cognitive function in a mouse model of POCD, and the mechanism may be related to inhibition of activation of hippocampal microglia, reduction of inflammatory responses, and thus increasing the mBDNF/Pro-BDNF ratio.
ABSTRACT
Dementia with Lewy bodies(DLB)is the second most common neurodegenerative dementia after Alzheimer's Disease(AD). This article will mainly elaborate the relationship between DLB and blood-brain barrier(BBB)from the following five aspects: (1)The structure and function of BBB; (2)In vivo assessment methods for the blood-brain barrier damage; (3)Evidence for the damage of blood-brain barrier in DLB; (4)The relationship between α-synuclein and the blood-brain barrier; (5)The relationship between APOE and the blood-brain barrier.Future research should focus on the pathogenesis of BBB damage in DLB patients, by which new drug targets for disease diagnosis and treatment may be found.
ABSTRACT
Under the background that the family doctor teams undertake the evaluation function of long-term care insurance for the elderlies living at home, it is imperative to further improve the efficiency of its integrated aging-medical care by strengthening the management. The Huacao community health service center and Hongqiao community health service center in Minhang District of Shanghai explored the construction of a family doctor′s home-based aging care management path, a practice launched since February 2021. This path was mainly designed with the entry criteria, management requirements for various services and evaluation indicators, with a service path form formulated on such basis. The form covered three stages: that before the on-site service, that on the day of the on-site service and that after the on-site service. Each stage was subdivided into three dimensions: the work content of the main aging-medical care, the key works of family doctors and the key works of assistant nurses. The implementation of this management path can enable such teams to provide further refined, standardized and procedural aging-medical care services, avoid service delays, improve service quality and management efficiency, and improve the utilization efficiency of health resources.
ABSTRACT
Schizophrenia is a serious mental disease. The diagnosis of schizophrenia so far relies heavily on subjective evidence, including self-reported experiences by patients, manifestations described by relatives, and abnormal behaviors assessed by psychiatrists. The diagnosis, monitoring of the disease progression and therapy efficacy assessment are challenging due to the lack of established laboratory biomarkers. Based on the current literature, clinical consensus, guidelines, and expert recommendations, this review highlighted evidence-based potential laboratory biomarkers for the diagnosis of schizophrenia, including genetic biomarkers, neurotransmitters, neurodevelopmental-related proteins, and intestinal flora, and discussed the potential future directions for the application of these biomarkers in this field, aiming to provide an objective basis for the use of these biomarkers in the early and accurate diagnosis, treatment, and prognosis and rehabilitation assessment of schizophrenia.
ABSTRACT
Objective:To investigate the changes of disease constitution in general practice outpatients before and after COVID-19 pandemic.Methods:Rank-sum ratio (RSR)method and Pareto method were used to comprehensively analyze the disease composition of patients in general practice outpatients in Huacao Community Health Service Center of Shanghai from January 2019 to December 2021.Results:The number of visits to general practice clinic decreased from 2019 to 2021. The top five diseases in RSR were circulatory system, endocrine, nutrition and metabolism, respiratory system, digestive system, and nervous system(RSR=1.000,0.917,0.896,0.813 and 0.750), all of which were classified as Class A factors, with a cumulative composition ratio of 80.45%. Taking the above 5 categories as the main diseases, and consistency analysis was performed for the annual changes. The coefficient of concordance of the top five diseases was poor, and not statistically significant ( WR=0.956, χ 2=11.47, P>0.01), suggesting that the disease spectrum was changed. The visits of patients with respiratory diseases dropped from the 2nd place to the 3rd after COVID-19 pandemic, with an average annual change rate of-14.31%, the lowest among all diseases. Among the top five diseases, nervous system disease had the highest annual change rate (7.68%). Among the factors affecting health status and contact with health care institutions, eye and appendage diseases ranked the first with the annual change rate of 12.97% and 10.35%,respectively. Conclusions:After the outbreak of COVID-19 pandemic, the disease spectrum in general practice clinics has changed. Measures must be taken in time to meet the needs for medical care.
ABSTRACT
In September 2020, a child with open wrist fracture and severe soft tissue injury was admitted in the Department of Hand and Foot Microsurgery, Xi'an Fengcheng Hospital. In the emergency surgery, the fracture was fixed, the vascular, nerve and tendon were repaired, and Flow-through chimeric anterolateral thigh perforator tissue flap was used to cover the wound. The chimeric tissue flap and the wrist survived in first stage as well as the wound healing. At 1 year of follow-up, the flap was not bloated and the protective sensation was restored. The flexion and extension and the rotation of left wrist were good. The pinch, flexion and extension of all digits of the left hand recovered well.
ABSTRACT
Objective:To assess the practical value of visual scores of magnetic resonance imaging(MRI)features in the diagnosis and classification of dementia with Lewy bodies(DLB).Methods:In this study, 102 DLB patients were prospectively recruited, with 102 cognitively normal elderly people as the normal control group(NC).All included subjects underwent MRI examinations and neuropsychological assessments.Based on the clinical dementia rating(CDR)scale, DLB patients were divided into a mild(CDR=1.0), a moderate(CDR=2.0)and a severe(CDR=3.0)group.The results of MRI were scored visually and the rating scales included medial temporal lobe atrophy(MTA), global cortical atrophy-frontal subscale(GCA-F), posterior cortical atrophy(PCA), white matter lesions(the Fazekas scale), cerebral microbleeds(CMBs), and the Evans Index(EI).Statistical differences were compared between the DLB and NC groups and between DLB patients with different degrees of cognitive impairment.Results:In terms of neuropsychology, the Mini-Mental State Examination(MMSE) score of the DLB group[16.0(11.0, 21.0)]was statistically significantly lower than that of the NC group[29.0(28.0, 30.0)]( Z=-12.31, P<0.001), the Montreal Cognitive Assessment(MoCA)score of the DLB group[9.5(6.0, 15.0)]was statistically significantly lower than that of the NC group[28.0(27.0, 29.0)]( Z=-12.40, P<0.001), and the Activities of Daily Living(ADL)score of the DLB group[32.0(23.8, 40.0)]was statistically significantly higher than that of the NC group[20.0(20.0, 20.0)]( Z=-11.98, P<0.001).The scores of all MRI visual assessment scales in DLB patients were statistically significantly higher than those in the NC group( P<0.001).There were significant differences in MTA scores between DLB patients with different degrees of cognitive impairment( P0<0.001).The MTA score of the mild group[1.0(1.0, 1.0)]was statistically significantly lower than that of the moderate group[2.0(1.0, 2.0)]( P1<0.001, P2<0.001); The MTA score of the moderate group[2.0(1.0, 2.0)]was statistically significantly lower than that of the severe group[2.0(2.0, 3.0)]( P1=0.003, P2=0.010). Conclusions:This study has for the first time after comprehensively evaluated the value of various visual scores in DLB diagnosis, MTA can be used to help diagnose DLB and distinguish the severity of DLB, providing a new supplemental tool for clinical diagnosis.
ABSTRACT
Objective:To analyze the prevalence of epilepsy and its clinical features in patients with Alzheimer's disease(AD).Methods:Clinical data of patients with AD from a separate database of Tianjin Huanhu Hospital for dementia and degenerative diseases from January 2010 to January 2019 were retrospectively examined.The prevalence of AD combined with epilepsy was analyzed.The characteristics from neuropsychological assessment, clinical manifestations of epileptic attacks, electroencephalogic patterns and other features were analyzed and compared with those of AD patients without epilepsy.Results:Of 376 AD patients, 11.4% had epilepsy, with 4.0% showing non-induced seizures before AD diagnosis and 7.5% after AD diagnosis.The average age of AD patients at first onset of epilepsy was 59.8±19.9 years, and the average age of patients at initial diagnosis with AD was 62.8±6.6 years.The most common type was focal seizures(65.1%), and EEG showed mostly focal slow waves(69.8%)and focal epileptiform discharges(23.3%). The AD diagnosis for patients with epilepsy was 8 years earlier than those without epilepsy.Conclusions:Epilepsy has a high prevalence in AD patients, and seizures may be a risk factor for progression from cognitive impairment to AD.Early identification of seizures and cognitive impairment may have a positive effect on delaying the progression of dementia.
ABSTRACT
Objective:To explore the difference of brain structure between patients with early-onset depression with and without suicidal ideation and its relationship with the severity of depression.Methods:Totally 37 patients with early-onset depressive disorder with suicidal ideation and 23 patients with early-onset depressive disorder without suicidal ideation were examined by psychological assessment and magnetic resonance imaging(MRI)from 2019 to 2020.Voxel-based morphometry (VBM) technology was used to compare the differences in brain structure between the two groups of subjects, and further analyze the relationship between the gray matter volume of the different brain areas and the severity of depression. The demographic and clinical data were analyzed by SPSS 24.0 statistical software package. The comparison between the two groups was performed by double sample t-test and chi square test. SPM8 software was used for VBM statistical analysis, and double sample t test was used for image analysis and comparison between the two groups. Pearson correlation analysis was performed between the mean gray matter volume of the two groups and the scores of HAMD-17 and Beck scale for suicide ideation(BSI). Results:Compared with the group without suicide ideation, the volume of gray matter in the right middle frontal gyrus(MNI: x, y, z=28.5, 33.0, 43.5, FWE correction for mass level, P<0.05)and left angular gyrus of the suicide idea group increased(MNI: x, y, z=-37.5, -73.5, 48.0, FWE correction for mass level, P<0.05). There was no significant correlation between the gray matter volume of the right middle frontal gyrus and the HAMD-17 scale, BSI scale in patients with early-onset depression ( r=0.073, r=-0.153, both P>0.05). Conclusion:There are structural differences in the right middle frontal gyrus and left angular gyrus between patients with early-onset depression with suicidal ideation and patients with early-onset depression without suicidal ideation, and there was no significant correlation between gray matter volume and depression severity.
ABSTRACT
Objective:To investigate the quality of life of diabetes patients managed by the“1+1+1”contracted family physician services and to analyze the influencing factors.Methods:A survey on quality of life of diabetic patients in the community was conducted in Shanghai Huacao township from July 2018 to September 2018. A total of 413 residents managed by the contracted family physician services in 3 villages of Huacao township were selected by stratified cluster random sampling as study subjects, including 203 diabetes patients and the 210 healthy subjects (control group). The self-prepared questionnaire was applied for survey of general information and the quality of life was evaluated with the MOS 36-item short form health survey (SF-36) in two groups. The linear stepwise regression model was deployed to analyze the factors related to the quality of life of diabetes patients.Results:The total scores of SF-36 were (711.36±103.40) and (736.72±85.42) in diabetic group and control group, respectively. The total score and the scores of reported health transition, physical function, general health, physiological contents in diabetic group were significantly lower than those of control group ( t=-2.712, -2.326, -4.872, -5.509, -3.504, P<0.05); however, there were no significant differences in role-physical, bodily pain, role-emotional, mental health, vitality, social function, and psychological contents between the two groups ( P>0.05). The univariate regression analysis indicates that age, educational degree, score on the quality of sleep, stressful life event, usual mental state, and the years of contracted family doctor service were associated with the quality of life of diabetes patients ( t/ F=3.373, 3.216, 5.716, 58.146, 28.325, 14.450, P<0.05). Stepwise multiple linear regression analysis showed that stressful life event, usual mental state, and the years of contracted family doctor service were the independent factors related to the quality of life in diabetes patients ( t=7.157, 4.741, -2.779, 2.129, P<0.05). Conclusion:Under the“1+1+1”contracted family doctor service mode, the quality of life of diabetes patients in the community is very close to that of the healthy population in several dimensions. The study has also revealed that the duration of contracted family physician service and other factors can influence the quality of life of diabetic patients.
ABSTRACT
Objective:To observe the effect of exercise on cognitive function and the expression of NeuN and SynapsinI in prefrontal cortex of rats after cerebral ischemia-reperfusion. Methods:Forty health male Sprague-Dawley rats were randomly divided into sham group (S group, n = 10), model group (M group, n = 10), sham & exercise group (SE group, n = 10) and model & exercise group (ME group, n = 10). The left middle cerebral artery was occluded for one hour and reperfused. SE and ME groups accepted treadmill training, for 14 days. The cognitive function of rats was evaluated with open field experiment and new object recognition experiment. The number and distribution of nerve cells in rat brain were observed with Nissl staining and immunofluorescence staining. The SynapsinI expression in serum was detected with ELISA. Results:Compared with S group, the activity, times of crossing, length and activity time in central area of open field experiment decreased in M group, as well as the cognitive index and length of new object recognition experiment (P < 0.05). Compared with M group, all the indexes increased in ME group (P < 0.05). The number of Nissl bodies decreased in M group (P < 0.05) and the arrangement was disordered, while the number of Nissl bodies increased in ME group (P < 0.05) compared with M group. The NeuN positive cells was more in S group than in M group (P < 0.05), and it was more in ME group than in M group (P < 0.05); as well as that of SynapsinI. The expression of SynapsinI decreased in M group (P < 0.05), and increased in ME group (P < 0.05). Most results of behavioral experiments positively correlated with the expression of Nissl, NeuN and SynapsinI (r > 0.221, P < 0.05). Conclusion:Cerebral ischemia-reperfusion can cause cognitive impairment in rats. Exercise can alleviate nerve injury and improve cognitive function, which may relate to promoting the expression of NeuN and SynapsinI in prefrontal cortex, to increase the number of neurons and synapses.