• 【慢性伤口愈合过程中趋化因子和炎性细胞因子的变化。】 复制标题 收藏 收藏
    DOI:10.1046/j.1524-475X.1997.50405.x 复制DOI
    作者列表:Fivenson DP,Faria DT,Nickoloff BJ,Poverini PJ,Kunkel S,Burdick M,Strieter RM
    BACKGROUND & AIMS: :Wound healing is a complex process resulting from an interplay of processes including coagulation, inflammation, angiogenesis, and epithelialization. The chemokine family has been shown to contain members that are potent regulators of many of these pathways. Because we have previously shown that chemokines "pool" in biologic wound dressings, we studied the levels of CXC and CC chemokines, along with key inflammatory mediators, serially from a group of patients undergoing therapy for chronic venous leg ulcers. After 8 weeks, all patients had marked clinical healing of their ulcers (median 63.3% reduction in size) with two of 10 completely healed. Wound fluids extracted from dressings showed high levels of platelet factor-4 and interferon-gamma-inducible protein, with a trend toward increases in the ratio of the sums of the angiogenic versus angiostatic CXC chemokines (p = 0.082) in the tissues collected from the center of the ulcers during wound closure. Neutrophil-activating peptide-2 and interleukin-8 accounted for the most changes in wound fluid angiogenic chemokines, with significant differences both as compared with baseline levels and with patients' plasma level noted at various time points between weeks 0 and 8. The level of angiostatic chemokines, interferon-y inducible protein 10 and platelet-activating-4, fell most significantly between weeks 0 and 3 as compared with plasma levels. The observed shift toward angiogenic CXC chemokines suggests that effective healing in chronic venous insufficiency ulcers appears to "move" the ulcer bed toward a state more conducive to epithelialization,characteristic of the proliferative phase of wound healing. CC chemokines were also elevated at baseline in the wound fluid samples as compared with the patients' plasma levels. Macrophage inflammatory protein-1 (3 and regulated on activation, normal T expressed and secreted (RANTES) levels decreased with healing, whereas there were significant increases in the tissue levels of monocyte chemoattractant protein-1 and macrophage inflammatory protein-1 a over the first 4 weeks of therapy (p< or = 0.05 for both). Coincident with these changes was a steady increase in the ratio of interleukin-1 R/interleukin-1 receptor antagonist protein in the ulcer center tissues, which also correlated with healing (p < 0 .05) as compared with a decreasing ratio at the ulcer edge, and a biphasic response in the wound fluids. These findings suggest that advanced wound care techniques help move the ulcer from a chronic inflammatory state into one more characteristic of the late inflammatory/early proliferative phase of wound healing. Chemokines may play a critical role in the pathogenesis of chronic venous ulcers through their effects on angiogenesis and/or the progression of inflammatory reactions at the site of injury.
    背景与目标: :伤口愈合是一个复杂的过程,是由凝血,炎症,血管生成和上皮形成等过程相互影响而产生的。趋化因子家族已显示其成员是这些途径中许多的有效调节因子。因为我们先前已经证明趋化因子在生物伤口敷料中“聚集”,所以我们从一组接受慢性静脉腿溃疡治疗的患者中连续研究了CXC和CC趋化因子以及关键的炎症介质的水平。 8周后,所有患者的溃疡均得到了明显的临床治愈(中位数减少了63.3%),其中10例中的2例完全治愈。从敷料中提取的伤口液显示出高水平的血小板因子4和干扰素-γ诱导型蛋白,并且在从组织中收集的组织中,血管生成与血管抑制性CXC趋化因子之和的比例有增加的趋势(p = 0.082)。伤口闭合过程中溃疡的中心。中性粒细胞激活肽2和白细胞介素8引起伤口液中血管生成趋化因子的变化最多,与基线水平相比以及在0至8周的各个时间点记录的患者血浆水平均存在显着差异。与血浆水平相比,血管静息趋化因子,γ-干扰素诱导蛋白10和血小板活化因子4在第0周和第3周之间下降最为明显。观察到的向血管生成性CXC趋化因子的转变表明,慢性静脉功能不全溃疡的有效愈合似乎将溃疡床“移”至更有利于上皮化的状态,这是伤口愈合增殖阶段的特征。与患者血浆水平相比,伤口液样本中的CC趋化因子在基线时也升高。巨噬细胞炎性蛋白-1(3和活化受调节,正常T表达和分泌(RANTES)水平随愈合而降低,而单核细胞趋化蛋白-1和巨噬细胞炎性蛋白1a的组织水平在第一时间显着增加治疗4周(二者均p≤0.05)。溃疡中心组织中白细胞介素1 R /白细胞介素1受体拮抗剂蛋白的比例稳定增加,这与这些变化相关,也与愈合相关(p <0 .05),而溃疡边缘的比率降低,伤口液出现双相反应,这些发现表明,先进的伤口护理技术有助于将溃疡从慢性发炎状态转变为晚期发炎的另一特征/伤口愈合的早期增殖阶段。趋化因子可能通过影响血管生成和/或炎症的发展而在慢性静脉溃疡的发病过程中发挥关键作用受伤部位的反应性反应。
  • 【再生大鼠肝脏线粒体H -ATPase活性和F1含量的变化。】 复制标题 收藏 收藏
    DOI:10.1016/0014-5793(85)80400-2 复制DOI
    作者列表:Buckle M,Guerrieri F,Papa S
    BACKGROUND & AIMS: :Submitochondrial particles prepared from rat liver during hepatic regeneration exhibit a depressed ATPase activity which is correlated with a decrease in F1 subunit content as shown by SDS-PAGE. Use of an antibody directed against the F1 portion of the H+-ATPase complex demonstrated that there is a definite decrease in the amount of beta-subunit of F1 in both submitochondrial particles and mitochondria from rat liver 24 h after partial hepatectomy.
    背景与目标: 肝再生过程中,从大鼠肝脏制备的线粒体颗粒显示出较低的ATPase活性,这与FDS亚基含量的降低有关,如SDS-PAGE所示。使用针对H -ATPase复合物的F1部分的抗体证明,部分肝切除术后24小时,来自大鼠肝脏的线粒体颗粒和线粒体中F1的β亚基的含量明显减少。
  • 【腰椎骨矿物质密度分布的纵向变化可能会增加楔形骨折的风险。】 复制标题 收藏 收藏
    DOI:10.1016/j.clinbiomech.2012.10.005 复制DOI
    作者列表:Giambini H,Khosla S,Nassr A,Zhao C,An KN
    BACKGROUND & AIMS: BACKGROUND:Trabecular bone strength diminishes as a result of osteoporosis and altered biomechanical loading at the vertebral and spinal levels. The spine consists of the anterior, middle and posterior columns and the load supported by the anterior and middle columns will differ across different regions of the spine. Stress shielding of the anterior column can contribute to bone loss and increase the risk of wedge fracture. There is a lack of quantitative data related to regional spinal bone mineral density distribution over time. We hypothesize that there is an increase in the posterior-to-anterior vertebral body bone mineral density ratio and a decrease in whole-body bone mineral density over time. METHODS:Bone mineral density was measured in 33 subjects using quantitative computed tomography scans for L1-L3 vertebrae, region (anterior and posterior vertebral body), and time (baseline and 6 years after). FINDINGS:Lumbar bone mineral density decreased significantly (Δ: ~15%) from baseline to the 6th year visit. Individual vertebra differences over time (L1: ~14%, L2: ~14%, L3: ~17%) showed statistical significance. Anterior bone mineral density change was significantly greater than in the posterior vertebral body region (Δ anterior: ~18%; Δ posterior: ~13%). Posterior-to-anterior bone mineral density ratio was significantly greater in the 6th year compared to baseline values (mean (SD), 1.33 (0.2) vs. 1.23 (0.1)). INTERPRETATION:This study provides longitudinal quantitative measurement of bone mineral density in vertebrae as well as regional changes in the anterior and posterior regions. Understanding bone mineral density distribution over time may help to decrease the risk of wedge fractures if interventions can be developed to bring spine loading to its normal state.
    背景与目标: 背景:由于骨质疏松症以及椎体和脊柱水平的生物力学负荷改变,小梁的骨强度降低。脊柱由前,中和后柱组成,由前柱和中柱支撑的载荷在脊柱的不同区域会有所不同。前柱的应力屏蔽可能会导致骨质流失并增加楔形骨折的风险。缺乏与区域脊柱骨矿物质密度随时间分布有关的定量数据。我们假设随着时间的推移,椎体前后骨矿物质密度比增加,而全身骨矿物质密度降低。
    方法:采用定量计算机断层扫描技术对33名受试者的L1-L3椎骨,区域(椎体的前后)和时间(基线及术后6年)进行了骨矿物质密度测量。
    结果:从基线到第6年随访,腰椎骨矿物质密度显着降低(Δ:〜15%)。随时间变化的各个椎骨差异(L1:〜14%,L2:〜14%,L3:〜17%)显示出统计学意义。前骨矿物质密度变化显着大于后椎体区域(Δ前:〜18%;Δ后:〜13%)。与基线值相比,第6年的前后骨矿物质密度比显着更高(平均值(SD)为1.33(0.2)对1.23(0.1))。
    解释:这项研究提供了纵向定量测量椎骨中骨矿物质密度以及前后区域的变化的信息。如果可以采取干预措施使脊柱负荷恢复到正常状态,那么了解随着时间推移的骨矿物质密度分布可能有助于降低楔形骨折的风险。
  • 【痴呆症磁共振成像中的认知和白质变化。】 复制标题 收藏 收藏
    DOI:10.1001/archneur.1990.00530040029015 复制DOI
    作者列表:Kertesz A,Polk M,Carr T
    BACKGROUND & AIMS: :In a prospective magnetic resonance imaging and cognitive study of 38 demented patients and 15 control subjects, 11 of 27 patients with Alzheimer's disease and 8 of 11 patients with vascular dementia had significant periventricular hyperintensities. Memory and language testing in the early investigation of dementia is useful to distinguish patients with or without periventricular hyperintensities on magnetic resonance imaging. Patients without periventricular hyperintensities are worse on memory and conceptualization tests than patients with periventricular hyperintensities, who tend to be worse on comprehension and attention tests. These differences in cognitive pattern are present between patients with different pathogenesis who are otherwise matched for dementia severity. Language and some nonverbal cognitive deficits correlate with the extent of cortical and ventricular atrophy in Alzheimer's disease.
    背景与目标: :在一项针对38名痴呆患者和15名对照受试者的前瞻性磁共振成像和认知研究中,27名阿尔茨海默氏病患者中的11名和11名血管性痴呆患者中的8名出现了明显的脑室高信号。痴呆症早期调查中的记忆和语言测试有助于区分磁共振成像中是否伴有脑室高信号的患者。没有脑室高信号的患者在记忆力和概念化测试方面比脑室高信号的患者在理解和注意力测试方面更差。这些认知模式上的差异存在于具有不同发病机制的患者之间,这些患者在其他方面因痴呆症的严重程度而匹配。语言和一些非语言认知缺陷与阿尔茨海默氏病的皮质和心室萎缩程度有关。
  • 【胆囊体积的改变不会影响胆囊管阻力。】 复制标题 收藏 收藏
    DOI:10.1001/archsurg.1990.01410160046010 复制DOI
    作者列表:Sharp KW,Ross CB,Tillman VN,Williams LF Jr
    BACKGROUND & AIMS: :To our knowledge, the relationship between gallbladder volume and cystic duct function has not been studied. We hypothesized that changes in gallbladder volume would influence cystic duct resistance. The effect of gallbladder volume changes on cystic duct resistance to both prograde (emptying) and retrograde (filling) steady-state flow was tested in 12 dogs under basal cholecystokinin-stimulated conditions utilizing a multiport catheter with a highly compliant balloon placed within the gallbladder fundus. Gallbladder volume was regulated by varying balloon volume from empty to just beyond physiologic distention. Cystic duct resistance was not affected by balloon volume under basal or stimulated conditions or by the direction of perfusate flow. This study demonstrated no relationship between gallbladder volume and cystic duct resistance and did not demonstrate a cystic duct sphincter mechanism at physiologic gallbladder volumes.
    背景与目标: :据我们所知,尚未研究胆囊体积与胆囊管功能之间的关系。我们假设胆囊体积的变化会影响胆囊管阻力。胆囊体积变化对胆囊管抵抗顺行(空)和逆行(充盈)稳态血流的影响在12条经基础胆囊收缩素刺激的狗中使用多端口导管,并在胆囊内放置高度顺应性球囊进行了测试。胆囊体积的调节是通过将气囊体积从空变到生理上的变化来进行的。囊性导管阻力不受基础或刺激条件下的球囊容积或灌注液流向的影响。这项研究表明胆囊体积和胆囊管阻力之间没有关系,并且在生理胆囊体积上也没有证明胆囊括约肌的机制。
  • 【猪心肌梗死模型中心室去极化和复极化变化的特征。】 复制标题 收藏 收藏
    DOI:10.1088/0967-3334/33/12/1975 复制DOI
    作者列表:Romero D,Ringborn M,Demidova M,Koul S,Laguna P,Platonov PG,Pueyo E
    BACKGROUND & AIMS: :In this study, several electrocardiogram (ECG)-derived indices corresponding to both ventricular depolarization and repolarization were evaluated during acute myocardial ischemia in an experimental model of myocardial infarction produced by 40 min coronary balloon inflation in 13 pigs. Significant changes were rapidly observed from minute 4 after the start of coronary occlusion, achieving their maximum values between 11 and 22 min for depolarization and between 9 and 12 min for repolarization indices, respectively. Subsequently, these maximum changes started to decrease during the latter part of the occlusion. Depolarization changes associated with the second half of the QRS complex showed a significant but inverse correlation with the myocardium at risk (MaR) estimated by scintigraphic images. The correlation between MaR and changes of the downward slope of the QRS complex, [Formula: see text], evaluated at the two more relevant peaks observed during the occlusion, was r = -0.75, p < 0.01 and r = -0.79, p < 0.01 for the positive and negative deflections observed in [Formula: see text], temporal evolution, respectively. Repolarization changes, analyzed by evaluation of ST segment elevation at the main observed positive peak, also showed negative, however non-significant correlation with MaR: r = -0.34, p = 0.28. Our results suggest that changes evaluated in the latter part of the depolarization, such as those described by [Formula: see text], which are influenced by R-wave amplitude, QRS width and ST level variations simultaneously, correlate better with the amount of ischemia than other indices evaluated in the earlier part of depolarization or during the ST segment.
    背景与目标: :在这项研究中,在急性心肌缺血期间,在13只猪的40分钟冠状动脉球囊扩张产生的心肌梗塞实验模型中,评估了与心室去极化和复极化同时对应的几个心电图(ECG)衍生指标。从开始进行冠状动脉闭塞后的第4分钟开始迅速观察到显着变化,分别在去极化的11至22分钟和重新极化的9至12分钟之间达到最大值。随后,在咬合的后期,这些最大变化开始减少。与QRS波复杂度的后半部分相关的去极化变化显示与闪烁显像图像估计的危险心肌(MaR)有显着但相反的相关性。在咬合期间观察到的两个相关峰上,MaR与QRS络合物的向下斜率变化之间的相关性为[r = -0.75,p <0.01和r = -0.79,p分别在[公式:参见文本],时间演变中观察到的正挠度和负挠度<0.01。通过评估在主要观察到的正峰处的ST段抬高来分析的复极化变化也显示为负,但与MaR的相关性不显着:r = -0.34,p = 0.28。我们的结果表明,在去极化后期评估的变化(如[公式:请参见文本]所述)受R波幅度,QRS宽度和ST水平变化的同时影响,与缺血量的相关性更好。比在去极化早期或ST段评估的其他指数要高。
  • 【比较“现场”条件下从血清分离器和氟化物/草酸钾血液采集管中采集的成对样本中的葡萄糖浓度。】 复制标题 收藏 收藏
    DOI:10.1016/j.clinbiochem.2012.11.027 复制DOI
    作者列表:Fernandez L,Jee P,Klein MJ,Fischer P,Perkins SL,Brooks SP
    BACKGROUND & AIMS: OBJECTIVES:There are no direct comparisons of blood glucose values in samples collected with barrier serum tubes (SST) and NaF/potassium oxalate (NaF/KOx) plasma tubes. Collection of samples in SST tubes can offer considerable savings and specimen processing advantages for national level surveys. DESIGN AND METHODS:Serum and plasma samples were collected under 'field conditions' from a single draw of 3692 individuals participating in the Canadian Health Measures Survey. The samples were analyzed retrospectively using the VITROS GLU Slide method (glucose oxidase-based). RESULTS:There was a high rate of hemolysis in the NaF/KOx tubes (86.2%) while hemolysis was infrequently observed with the SST tubes (2%). Comparing only blood draws where no hemolysis was observed in both tubes (n=495; paired t-test) showed no effect of tube type on serum/plasma glucose concentrations. This was also observed when data was restricted to cases when only SST samples were not hemolyzed (n=3546; paired t-test). CONCLUSIONS:These data show that both collection tubes can be used under survey collection and processing conditions to measure glucose with our assay system with no difference in reported results.
    背景与目标: 目的:尚无直接比较采用屏障血清试管(SST)和NaF /草酸钾(NaF / KOx)血浆试管收集的样本中血糖值的方法。在SST管中收集样品可以为国家级调查提供大量的节省和样品处理的优势。
    设计与方法:在“现场条件”下从参加加拿大卫生措施调查的3692个人中抽取了血清和血浆样品。使用VITROS GLU Slide方法(基于葡萄糖氧化酶)对样品进行回顾性分析。
    结果:NaF / KOx管的溶血率很高(86.2%),而SST管的溶血率很少(2%)。仅比较在两个试管中均未观察到溶血的抽血情况(n = 495;配对t检验)显示试管类型对血清/血浆葡萄糖浓度无影响。当数据仅限于仅不对SST样品进行溶血的情况时(n = 3546;配对t检验),也可以观察到这一点。
    结论:这些数据表明,在我们的测定系统中,两个收集管均可在调查收集和处理条件下用于测量葡萄糖,报道的结果没有差异。
  • 【客观面部皮肤质量分析后,光老化严重程度的自我认知变化和皮肤癌风险。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Bae YC,Bae EJ,Wang JH,Gilchrest BA
    BACKGROUND & AIMS: :

    Background: Despite public education efforts, many people at risk for skin cancer do not practice safe sun behaviors.

    Objective: To determine whether machine-based evaluation of UV-induced alterations (VISIA scan) changes self-assessment of facial photoaging, skin cancer risk, and willingness to improve sun protective habits. In addition, to determine whether VISIA scan analysis reveals differences between those with versus without a history of skin cancer, men versus women, those older than 50 versus less than 50 years of age, and Fitzpatrick skin types I-III versus IV-VI.

    Methods: Volunteers attending a health expo were recruited and queried about their perceived risk of skin cancer and degree of skin photoaging. All participants underwent facial skin quality analysis of both sides of the face, and then completed a follow-up survey.

    Results: Participants' scored self-perceptions of overall skin aging were all statistically significantly worse after VISIA scan analysis. There was no change in perceived skin cancer risk, but most participants expressed intent to improve their sun protection habits.

    Limitations: Limitations to this study include selection bias, recall-misclassification bias, and social desirability bias.

    Conclusion: Intervention with facial skin analysis can positively affect subjects' stated intent to use sun protection, indicating the importance of appearance in these health decisions.

    J Drugs Dermatol. 2017;16(5):453-459.

    .
    背景与目标:

    背景:尽管进行了公众教育,但许多有皮肤癌风险的人仍未进行安全的日晒行为。

    目的:确定是否对紫外线诱发的变化进行基于机器的评估(VISIA扫描)改变面部光老化的自我评估,皮肤癌的风险以及改善防晒习惯的意愿。此外,为了确定VISIA扫描分析是否能揭示出有或没有皮肤癌病史,男性与女性,年龄大于50岁与小于50岁以及Fitzpatrick I-III和IV-VI皮肤类型之间的差异。

    方法:招募参加健康博览会的志愿者,并询问他们对皮肤癌的感知风险和皮肤光老化程度。所有参与者都进行了面部两面的面部皮肤质量分析,然后完成了一项后续调查。

    结果:在进行VISIA扫描后,参与者对整体皮肤衰老的自我感觉评分在统计学上均显着变差分析。知觉的患皮肤癌风险没有改变,但大多数参与者表示有意改善其防晒习惯。

    局限性:本研究的局限性包括选择偏见,召回分类错误和社会可取性偏见。 / p>

    结论:进行面部皮肤分析的干预可以正面影响受试者陈述的使用防晒的意图,这表明在这些健康决定中外表的重要性。

    J Dermatol。 2017; 16(5):453-459。

  • 【行为不全的大鼠下牙槽神经横断后三叉神经节和丘脑神经元活动的长期变化。】 复制标题 收藏 收藏
    DOI:10.1523/JNEUROSCI.1828-12.2012 复制DOI
    作者列表:Tseng WT,Tsai ML,Iwata K,Yen CT
    BACKGROUND & AIMS: :The transection of the inferior alveolar nerve (IANx) produces allodynia in the whisker pad (V2 division) of rats. Ectopic discharges from injured trigeminal ganglion (TG) neurons and thalamocortical reorganization are possible contributors to the sensitization of uninjured V2 primary and CNS neurons. To test which factor is more important, TG and ventroposterior medial nucleus (VPM) neurons were longitudinally followed before, during, and after IANx for up to 80 d. Spontaneous discharges and mechanical stimulation-evoked responses were recorded in conscious and in anesthetized states. Results show (1) a sequential increase in spontaneous activities, first in the injured TG neurons of the IAN (2-30 d), followed by uninjured V2 ganglion neurons (6-30 d), and then VPM V2 neurons (7-30 d) after IANx; (2) ectopic discharges included burst and regular firing patterns in the IAN and V2 branches of the TG neurons; and (3) the receptive field expanded, the modality shifted, and long-lasting after-discharges occurred only in VPM V2 neurons. All of these changes appeared in the late or maintenance phase (7-30 d) and disappeared during the recovery phase (40-60 d). These observations suggest that ectopic barrages in the injured IAN contribute more to the development of sensitization, whereas the modality shift and evoked after-discharges in the VPM thalamic neurons contribute more to the maintenance phase of allodynia by redirecting tactile information to the cortex as nociceptive.
    背景与目标: :下牙槽神经(IANx)横断会在大鼠的晶须垫(V2分区)中产生异常性疼痛。受损的三叉神经节(TG)神经元的异位放电和丘脑皮质重组可能是未受伤的V2原发神经元和CNS神经元致敏的原因。为了测试哪个因素更重要,在IANx之前,期间和之后,纵向追踪TG和后内侧内侧核(VPM)神经元长达80 d。在有意识和麻醉状态下记录自发放电和机械刺激诱发的反应。结果显示(1)自发活动依次增加,首先在IAN受伤的TG神经元中(2-30 d),其次是未受伤的V2神经节神经元(6-30 d),然后是VPM V2神经元(7-30) d)在IANx之后; (2)异位放电包括TG神经元IAN和V2分支的爆发和规则放电模式; (3)仅在VPM V2神经元中,感受野扩大,模态改变且持续放电。所有这些变化都出现在后期或维护阶段(7-30 d),而在恢复阶段(40-60 d)则消失了。这些观察结果表明,受伤的IAN的异位弹幕对致敏作用的贡献更大,而VPM丘脑神经元的形态改变和诱发的放电后,则通过将触觉信息重定向至伤害性皮层,从而对异常性疼痛的维持阶段做出了更大贡献。
  • 【急性呼吸窘迫综合征:全国范围内23年内发病率,治疗和死亡率的变化。】 复制标题 收藏 收藏
    DOI:10.1111/aas.12001 复制DOI
    作者列表:Sigurdsson MI,Sigvaldason K,Gunnarsson TS,Moller A,Sigurdsson GH
    BACKGROUND & AIMS: INTRODUCTION:The aim of this study was to assess population-based changes in incidence, treatment, and in short- and long-term survival of patients with acute respiratory distress syndrome (ARDS) over 23 years. MATERIALS AND METHODS:Analysis of all patients in Iceland who fulfilled the consensus criteria for ARDS in 1988-2010. Demographic variables, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores and ventilation parameters were collected from hospital charts. RESULTS:The age-standardised incidence of ARDS during the study period was 7.2 cases per 100,000 person-years and was increased by 0.2 cases per year (P < 0.001). The most common causes of ARDS were pneumonia (29%) and sepsis (29%). The use of pressure-controlled ventilation became almost dominant from 1993. The peak inspiratory pressure (PIP) has significantly decreased (-0.5 cmH(2) O/year), but the peak end-expiratory pressure (PEEP) has increased (0.1 cmH(2) O/year) during the study period. The hospital mortality decreased by 1% per year (P = 0.03) during the study period, from 50% in 1988-1992 to 33% in 2006-2010. A multivariable logistic regression model revealed that higher age and APACHE II score increased the odds of hospital mortality, while a higher calendar year of diagnosis reduced the odds of mortality. This was unchanged when dominant respiratory treatment, PIP and PEEP were added to the model. The 10-year survival of ARDS survivors was 68% compared with 90% survival of a reference population (P < 0.001). CONCLUSION:The incidence of ARDS has almost doubled, but hospital mortality has decreased during the 23 years of observation. The 10-year survival of ARDS survivors is poor compared with the reference population.
    背景与目标: 简介:本研究的目的是评估23年来急性呼吸窘迫综合征(ARDS)患者的发病率,治疗以及短期和长期生存的基于人群的变化。
    材料与方法:分析冰岛所有在1988-2010年间符合ARDS共识标准的患者。人口统计学变量,急性生理和慢性健康评估II(APACHE II)得分和通气参数均从医院病历表中收集。
    结果:研究期间ARDS的年龄标准化发病率为每100,000人年7.2例,并且每年增加0.2例(P <0.001)。 ARDS的最常见原因是肺炎(29%)和败血症(29%)。从1993年开始,几乎一直使用压力控制通气。最高吸气压力(PIP)明显降低了(-0.5 cmH(2)O /年),但是最高呼气末压力(PEEP)却增加了(0.1 cmH (2)O /年)。在研究期间,医院死亡率每年下降1%(P = 0.03),从1988-1992年的50%下降到2006-2010年的33%。多变量logistic回归模型显示,较高的年龄和APACHE II评分增加了医院死亡率的可能性,而较高的诊断日历年降低了死亡率的可能性。当将主要呼吸治疗,PIP和PEEP添加到模型中时,情况没有改变。 ARDS幸存者的10年生存率为68%,而参考人群的90%生存(P <0.001)。
    结论:在23年的观察中,ARDS的发病率几乎翻了一番,但医院死亡率却下降了。与参考人群相比,ARDS幸存者的10年生存率很低。
  • 【健康人类中与年龄相关的皮质兴奋性和连接性变化:通过TMS-EEG对感觉运动网络的非侵入性评估。】 复制标题 收藏 收藏
    DOI:10.1016/j.neuroscience.2017.06.014 复制DOI
    作者列表:Ferreri F,Guerra A,Vollero L,Ponzo D,Maatta S,Mervaala E,Iannello G,Di Lazzaro V
    BACKGROUND & AIMS: :The sensorimotor cortical system undergoes structural and functional changes across its lifespan. Some of these changes are physiological and parallel the normal aging process, while others might represent pathophysiological mechanisms underlying neurodegenerative disorders. In the last years, the study of possible age-related modifications in brain sensorimotor functional characteristics has been the focus of several research projects. Here we have used the transcranial magnetic stimulation (TMS)-electroencephalography (EEG) navigated co-registration to investigate the influence of physiological aging on the excitability and connectivity of the human sensorimotor cortical system. To this end, we compared the TMS-evoked EEG potentials (TEPs) collected after stimulating the dominant primary motor cortex (M1) in healthy young subjects (mean age 24.5years) with those collected in healthy older adults (mean age 67.6years). We have shown that, after stimulation of the left motor cortex, TEPs are significantly affected by physiological aging. This phenomenon has a clear spatio-temporal specificity and we speculate that normal aging per se leads to some changes in the excitability of specific cortical neural assemblies whereas other alterations could reflect compensatory mechanisms to such changes.
    背景与目标: :感觉运动皮质系统在其整个生命周期中都会发生结构和功能的变化。这些变化中的一些是生理上的并且与正常衰老过程平行,而其他一些则可能代表了神经退行性疾病的病理生理机制。近年来,对大脑感觉运动功能特征可能与年龄有关的修饰的研究一直是数个研究项目的重点。在这里,我们已经使用了经颅磁刺激(TMS)-脑电图(EEG)导航的共同注册,以研究生理老化对人类感觉运动皮层系统的兴奋性和连通性的影响。为此,我们比较了健康年轻受试者(平均年龄24.5岁)和健康老年人(平均年龄67.6岁)在刺激主要运动皮层(M1)后收集的TMS诱发的脑电势(TEP)。我们已经表明,刺激左运动皮层后,TEP受生理老化的影响很大。这种现象具有明确的时空特异性,我们推测正常衰老本身会导致特定皮层神经组件兴奋性发生某些变化,而其他变化可能反映出这种变化的补偿机制。
  • 【心脏和非心脏结节病患者的超声心动图检查结果随时间变化。】 复制标题 收藏 收藏
    DOI:10.2169/internalmedicine.51.8396 复制DOI
    作者列表:Teramoto K,Shimamoto S,Terasaki F,Kanzaki Y,Tamaya M,Goto I,Ishizaka N
    BACKGROUND & AIMS: OBJECTIVE:Echocardiography is used for the detection of cardiac sarcoid involvement in patients with non-cardiac sarcoidosis. Little information is available regarding temporal changes in left ventricular ejection fraction (LVEF) and left ventricular end-diastolic dimension (LVDd) in non-cardiac sarcoidosis patients. METHODS AND RESULTS:Fifty-four sarcoidosis patients who received periodic follow-up with echocardiography at our institute were enrolled in this study. At the time of initial ultrasonography, 13 patients were diagnosed with cardiac sarcoid involvement. All of the remaining 41 patients with extra-cardiac sarcoidosis only had a LVEF of >50%. During the median follow-up period of 39 months, two (4.9%) of the non-cardiac sarcoidosis patients were diagnosed with cardiac sarcoid involvement; one patient showed a progressive decline in the LVEF over a short period of time. It was also found that two of 41 non-cardiac sarcoidosis patients showed declines in the LVEF of >10% per year; however, they were not diagnosed with cardiac sarcoidosis during the follow-up period. CONCLUSION:Rapid deterioration of left ventricular function may increase the suspicion of sarcoid involvement of the heart in non-cardiac sarcoidosis patients; however, we must be aware that a certain subfraction of patients may not demonstrate significant abnormalities in LVEF or LVDd on periodic echocardiographic follow-up.
    背景与目标: 目的:超声心动图用于检测非心脏结节病患者的心脏结节样病变。关于非心脏结节病患者左心室射血分数(LVEF)和左心室舒张末期尺寸(LVDd)随时间变化的信息很少。
    方法与结果:54例结节病患者在我院接受了定期超声心动图随访。在初次超声检查时,有13例患者被诊断出患有心脏结节样病变。其余所有41例心外结节病患者的LVEF均仅> 50%。在39个月的中位随访期内,有2名(4.9%)非心脏结节病患者被诊断出患有心脏结节病。一名患者在短时间内LVEF逐渐下降。还发现41例非心脏结节病患者中有2例的LVEF下降每年> 10%。但是,在随访期间并未诊断出他们患有心脏结节病。
    结论:非心脏结节病患者左心功能的迅速恶化可能增加对心脏结节累及的怀疑。但是,我们必须意识到,在定期超声心动图随访中,患者的某些亚分类可能未显示LVEF或LVDd的明显异常。
  • 【触觉刺激的体感处理中与年龄相关的变化-fMRI研究。】 复制标题 收藏 收藏
    DOI:10.1016/j.bbr.2012.10.038 复制DOI
    作者列表:Brodoehl S,Klingner C,Stieglitz K,Witte OW
    BACKGROUND & AIMS: :Age-related changes in brain function are complex. Although ageing is associated with a reduction in cerebral blood flow and neuronal activity, task-related processing is often correlated with an enlargement of the corresponding and additionally recruited brain areas. This supplemental employment is considered an attempt to compensate for deficits in the ageing brain. Although there are contradictory reports regarding the role of the primary somatosensory cortex (SI), currently, there is little knowledge about age-related functional changes in other brain areas in the somatosensory network (secondary somatosensory cortex (SII), and insular, anterior (ACC) and posterior cingulate cortices (PCC)). We investigated 16 elderly (age range, 62-71 years) and 18 young subjects (age range, 21-28 years) by determining the current perception threshold (CPT) and applying functional magnetic resonance imaging (fMRI) using a 3.0 Tesla scanner under tactile stimulation of the right hand. CPT was positively correlated with age. fMRI analysis revealed significantly increased activation in the contralateral SI and ipsilateral motor cortex in elderly subjects. Furthermore, we demonstrated age-related reductions in the activity in the SII, ACC, PCC, and dorsal parts of the corpus callosum. Our study revealed dramatic age-related differences in the processing of a simple tactile stimulus in the somatosensory network. Specifically, we detected enhanced activation in the contralateral SI and ipsilateral motor cortex assumingly caused by deficient inhibition and decreased activation in later stages of somatosensory processing (SII, cingulate cortex) in elderly subjects. These results indicate that, in addition to over-activation to compensate for impaired brain functions, there are complex mechanisms of modified inhibition and excitability involved in somatosensory processing in the ageing brain.
    背景与目标: :与年龄相关的脑功能变化非常复杂。尽管衰老与脑血流量和神经元活动的减少有关,但与任务相关的处理过程通常与相应的和额外招募的大脑区域的扩大有关。这种补充性就业被认为是对衰老脑部缺陷的补偿。尽管关于主要体感皮层(SI)的作用有相互矛盾的报道,但目前,关于体感网络(次要体感皮层(SII)和岛状,前侧( ACC)和后扣带回皮质(PCC))。我们通过确定当前知觉阈值(CPT)并使用3.0 Tesla扫描仪应用功能磁共振成像(fMRI)在以下条件下对16位老年人(年龄范围为62-71岁)和18位年轻受试者(年龄范围为21-28岁)进行了调查右手的触觉刺激。 CPT与年龄呈正相关。 fMRI分析显示,老年受试者对侧SI和同侧运动皮层的激活显着增加。此外,我们证明了与年龄有关的SII,ACC,PCC和call体背部活动减少。我们的研究揭示了在体感网络中简单触觉刺激的处理过程中与年龄有关的戏剧性差异。具体而言,我们检测到对侧SI和同侧运动皮层的激活增强,推测是由于抑制作用不足引起的,而在老年受试者的体感处理后期(SII,扣带回皮层)的激活降低。这些结果表明,除了过度激活以补偿受损的脑功能外,衰老的大脑的体感处理还涉及复杂的抑制和兴奋性机制。
  • 14 Changes in cognition following mild stroke. 复制标题 收藏 收藏

    【轻度中风后认知能力的变化。】 复制标题 收藏 收藏
    DOI:10.1080/09602011.2012.748672 复制DOI
    作者列表:Wolf TJ,Rognstad MC
    BACKGROUND & AIMS: :The objective of the study was to determine how performance on cognitive assessments administered in the subacute phase of mild stroke change or remain stable over time. A prospective longitudinal cohort pilot study was used to assess the cognitive status of participants with mild stroke (n = 20) at two time points: (1) within 3 weeks post-discharge from the acute care setting following mild stroke, and (2) approximately 6 months post-mild stroke. Participants were given a battery of cognitive assessments at both time points that included the following measures: (1) Short Blessed Test, (2) California Verbal Learning Test (CVLT), (3) Connor's Continuous Performance Task (CPT), and (4) The Delis-Kaplan Executive Function System (DKEFS) Trail Making subtest. The only significant differences between the test administrations was on the CVLT Short Delay Free Recall (p = .027) and Long Delay Free Recall (p = .002) which was likely due to practice effects associated with this measure. The results of the study show that performance on standardised cognitive testing in the early phases of mild stroke remained stable over a 6 month period. These results help justify the necessity and ability to assess cognition immediately post-mild stroke in order to make accurate and appropriate rehabilitation recommendations.
    背景与目标: :该研究的目的是确定在轻度中风亚急性期进行的认知评估表现如何或随时间保持稳定。前瞻性纵向队列研究用于评估轻度卒中(n = 20)在两个时间点的参与者的认知状况:(1)轻度卒中后急性护理环境出院后3周内,以及(2)轻度卒中后约6个月。在两个时间点都为参与者提供了一系列的认知评估,包括以下措施:(1)短暂祝福测验;(2)加州言语学习测验(CVLT);(3)康纳的持续表现任务(CPT);以及(4) )Delis-Kaplan执行功能系统(DKEFS)跟踪制作子测试。测试管理之间的唯一显着差异在于CVLT短时免费召回(p = .027)和长时长免费召回(p = .002),这可能是由于与此措施相关的实践效果。研究结果表明,轻度中风早期的标准化认知测试表现在6个月内保持稳定。这些结果有助于证明轻度中风后立即评估认知的必要性和能力,以便提出准确而适当的康复建议。
  • 【术中神经监测变化清单的设计,开发和实施。】 复制标题 收藏 收藏
    DOI:10.3171/2012.9.FOCUS12263 复制DOI
    作者列表:Ziewacz JE,Berven SH,Mummaneni VP,Tu TH,Akinbo OC,Lyon R,Mummaneni PV
    BACKGROUND & AIMS: OBJECT:The purpose of this study was to provide an evidence-based algorithm for the design, development, and implementation of a new checklist for the response to an intraoperative neuromonitoring alert during spine surgery. METHODS:The aviation and surgical literature was surveyed for evidence of successful checklist design, development, and implementation. The limitations of checklists and the barriers to their implementation were reviewed. Based on this review, an algorithm for neurosurgical checklist creation and implementation was developed. Using this algorithm, a multidisciplinary team surveyed the literature for the best practices for how to respond to an intraoperative neuromonitoring alert. All stakeholders then reviewed the evidence and came to consensus regarding items for inclusion in the checklist. RESULTS:A checklist for responding to an intraoperative neuromonitoring alert was devised. It highlights the specific roles of the anesthesiologist, surgeon, and neuromonitoring personnel and encourages communication between teams. It focuses on the items critical for identifying and correcting reversible causes of neuromonitoring alerts. Following initial design, the checklist draft was reviewed and amended with stakeholder input. The checklist was then evaluated in a small-scale trial and revised based on usability and feasibility. CONCLUSIONS:The authors have developed an evidence-based algorithm for the design, development, and implementation of checklists in neurosurgery and have used this algorithm to devise a checklist for responding to intraoperative neuromonitoring alerts in spine surgery.
    背景与目标: 目的:本研究的目的是提供一种基于证据的算法,用于设计,开发和实施针对脊柱手术中对术中神经监测警报的反应的新清单。
    方法:对航空和外科文献进行了调查,以获取成功设计,开发和实施清单​​的证据。审查了清单的局限性以及实施清单的障碍。在此基础上,开发了神经外科检查清单创建和实现的算法。使用此算法,一个多学科团队调查了文献,以了解如何对术中神经监测警报做出反应的最佳实践。然后,所有利益相关者都对证据进行了审查,并就列入清单的项目达成了共识。
    结果:设计了对术中神经监测警报反应的清单。它强调了麻醉师,外科医生和神经监测人员的具体作用,并鼓励团队之间的沟通。它着重于对识别和纠正神经监测警报的可逆原因至关重要的项目。在初步设计之后,检查清单草稿经过了利益相关者的意见审查和修订。然后在小规模试验中对清单进行评估,并根据可用性和可行性进行修订。
    结论:作者开发了一种基于证据的算法,用于神经外科检查清单的设计,开发和实施,并已使用该算法设计了对脊柱手术中术中神经监测警报做出反应的检查清单。

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