重症监护病房老年病人脓毒症相关谵妄的危险因素分析

目的 探讨ICU老年病人脓毒症相关谵妄(SAD)的危险因素,为SAD临床诊治和预防提供参考。方法 回顾性选择2017年2月至2022年2月我院收治的352例老年脓毒症病人,根据混淆评定方法-ICU-7(CAM-ICU-7)评分将病人分为SAD组(158例)和非SAD组(194例)。收集2组临床资料和实验室指标,采用多因素Logistic回归分析SAD的影响因素。结果 SAD组年龄大于非SAD组,序贯器官衰竭评估(SOFA)评分、APACHEⅡ评分,脓毒症休克、机械通气、使用镇静剂、合并高血糖、合并高碳酸血症比例,血清IL-6、TNF-α、CRP和S-100β蛋白水平高于非SAD组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,高龄、合并高血糖、合并高碳酸血症、使用镇静剂,高IL-6、S-100β水平,高SOFA、APACHEⅡ评分是SAD发病的危险因素。结论 ICU老年病人发生SAD受很多因素的影响,积极评估这些指标有助于早期识别谵妄。

2个中国汉族假肥大型进行性肌营养不良家系分析

目的·通过分析2个中国汉族假肥大型进行性肌营养不良家系的基因变异,提高对本病的认识。方法·回顾性分析2个假肥大型进行性肌营养不良家系中先证者的临床特征,以及先证者及其亲属的多重连接探针扩增(multiplex ligation-dependent probe amplification,MLPA)检测结果。结果·3个携带抗肌萎缩蛋白基因(dystrophin gene,DMD基因)变异的假肥大型进行性肌营养不良先证者均有血清肌酸激酶异常升高,家系1中异卵双生的兄弟2人均为DMD基因8～9号外显子缺失,其母该位点未见异常。家系2中异卵双生之弟为DMD基因48～51号外显子重复,其母为该位点的杂合变异。结论·(1)异卵双胎存在相同DMD基因突变的家系,若其母亲外周血基因检测正常,则提示其母亲可能为该突变的生殖腺嵌合体,再次生育时须进行产前基因诊断来降低后代患假肥大型进行性肌营养不良的风险。(2) DMD基因48～51号外显子重复为致病突变。

Effect of Tangweian Jianji on upper gastrointestinal remodeling in streptozotocin-induced diabetic rats

AIM： To investigate the effect of Tangweian Jianji （TWAJJ） on the biomechanical and morphometrical remodeling of the upper gastrointestinal tract in diabetic rats. METHODS： Diabetes was induced in 27 rats by in- jecting streptozotocin （40 mg/kg body weight）, the animals were then divided into three groups （n = 9 in each group）, i.e., diabetic control （DM）; high dose （10 g/kg, T1） and low dose （5 g/kg, T2）. Another 10 rats acted as normal controls （Control）. TWAJJ was admin- istered by gavage once daily. Blood glucose and serum insulin levels were measured. Circumferential length, wall thickness and opening angle were measured from esophageal, duodenal, jejunal and ileal ring segments. The residual strain was calculated from the morpho- metric data. Step-wise distension was carried out on esophageal and jejunal segments. The obtained data on the length, diameter and pressure changes were then used to calculate the circumferential and longitu- dinal stresses and strains. Real-time reverse transcrip- tion polymerase chain reaction was used to detect the receptor of advanced glycation end-products （RAGE） mRNA level in jejunal tissues. RESULTS： At the end of the experiment, the blood glucose level was significantly higher and the serum insulin level was significantly lower in DM, T1 and T2 groups than in the control group （Glucose： 30.23 ± 0.41 mmol/L, 27.48 ± 0.27 mmol/L and 27.84 ± 0.29 mmol/ L vs 5.05 ± 0.04 mmol/L, P = 1.65 x 10-16, P = 5.89 x 1019 and P = 1.63 x 10-Is, respectively; Insulin： 1.47 ± 0.32 °tg/L, 2.66 ± 0.44 pg/L, 2.03 ± 0.29 pg/L and 4.17 ± 0.54 pg/L, P = 0.0001, P = 0.029 and P = 0.025, re- spectively）. However, these levels did not differ among the DM, T1 and T2 groups. The wet weight per unit length, wall thickness and opening angle of esophageal and intestinal segments in the DM group were signifi- cantly higher than those in the control group （from P = 0.009 to P = 0.004）. These parameters in the T1 group were significantly lower than those in the DM group （wet weight, duodenum： 0.147 ± 0.003 g/cm vs 0.158 ± 0.001 g/cm, P = 0.047; jejunum, 0.127 ± 0.003 g/cm vs 0.151：1：0.002 g/cm, P = 0.017; ileum, 0.127 ± 0.004 g/cm vs 0.139 ± 0.003 g/cm, P = 0.046; wall thickness, esophagus： 0.84±0.03 mm vs 0.94 ± 0.02 ram, P = 0.014; duodenum： 1.27 ± 0.06 mm vs 1.39 ± 0.05 ram, P = 0.031; jejunum： 1.19 ± 0.07 mm vs 1.34 ± 0.04 mm, P = 0.047; ileum： 1.09 ± 0.04 mm vs 1.15 ± 0.03 mm, P = 0.049; opening angle, esophagus： 112.2 ± 13.2° vs 134.7 ± 14.7°, P = 0.027; duodenum： 105.9 ± 12.3° vs 123.1 ± 13.1°, P = 0.046; jejunum： 90.1 ± 15.4° vs 115.5 ± 13.3°, P = 0.044; ileum： 112.9 ± 13.4° vs 136.1 ± 17.1°, P = 0.035）. In the esophageal and jejunal segments, the inner residual stain was significantly smaller and the outer residual strain was larger in the DN group than in the control group （P = 0.022 and P = 0.035）. T1 treatment significantly restored this biomechanical alteration （P = 0.011 and P = 0.019）, but T2 treatment did not. Fur- thermore, the circumferential and longitudinal stiffness of the esophageal and jejunal wall increased in the DM group compared with those in the control group. T1, but not T2 treatment, significantly decreased the cir- cumferential wall stiffness in the jejunal segment （P = 0.012） and longitudinal wall stiffness in the esophageal segment （P = 0.023）. The mRNA level of RAGE was significantly decreased in the T1 group compared to that in the DN group （P = 0.0069）. CONCLUSION： TWAJJ （high dose） treatment partly restored the morphometric and biomechanical remodel- ing of the upper gastrointestinal tract in diabetic rats.

Effect of Kaiyu Qingwei Jianji on the morphometry and residual strain distribution of small intestine in experimental diabetic rats

AIM： To investigate the effect of a Chinese medicine, Kaiyu Qingwei Jianji （KYQWJJ） used for diabetic treatment, on the morphometry and residual strain distribution of the small intestine in streptozotocin （STZ） -induced diabetic rats. Correlation analysis was also performed between the opening angle and residual strain with the blood glucose level. METHODS： Forty-two male Wistar rats weighing 220-240 g were included in this study. Thirty-two STZ- induced diabetic rats were subdivided into four groups （n = 8 in each group）, i.e. diabetic control group （DM）; high dose of KYQWJJ （T1, 36g/kg per day）; low dose of KYQWJJ （T2, 17 g/kg per day） and Gliclazide （T3, 50 mg/kg per day）. Another ten rats were used as nondiabetic control （CON）. The medicines were poured directly into stomach lumen by gastric lavage twice daily. The rats of CON and DM groups were only poured the physiological saline. Blood glucose and plasma insulin levels were measured. Experimental period was 35 d. At the end of experiment, three 5-cm long segments were harvested from the duodenum, jejunum and ileum. Three rings of 1-2 mm in length for no-load and zero-stress state tests were cut from the middle of different segments. The morphometric data, such as the circumferential length, the wall thickness and the opening angle were measured from the digitized images of intestinal segments in the no-load state and zerostress state. The residual strain was computed from the morphometry data. Furthermore, the linear regression analysis was performed between blood glucose level with morphometric and biomechanical data in the different intestinal segments. RESULTS： The blood glucose level of DM group was consistent 4-fold to 5-fold higher than those in CON group during the experiment （16.89 ± 1.11 vs 3.44 ± 0.15 mmol/L, P 〈 0.001）. The blood glucose level in the T1 （16.89 ± 1.11 vs 11.08 ± 2.67 mmol/L, P 〈 0.01） and T3 groups （16.89 ± 1.11 vs 13.54 ± 1.73 mmol/L, P 〈 0.05）, but not in T2 group （P 〉 0.05） was significantly lower than those in DM group. The plasma insulin levels of DM, T1, T2 and T3 groups were significantly lower than those in CON group （10.98 ± 1.02, 12.52 ± 1.42,13.54 ± 1.56,10.96 ± 0.96 vs 17.84 ± 2.34 pmol/L respectively, P 〈 0.05）, but no significantly difference among the groups with exception of CON group. The wet weight/cm and total wall thickness of duodenum, jejunum and ileum in DM group were significantly higher than those in CON group （wet weight （g/cm）： duodenum 0.209 ± 0.012 vs 0.166 ± 0.010, jejunum 0.149 ± 0.008 vs 0.121 ± 0.004, ileum 0.134 ± 0.013 vs 0.112 ± 0.007; Wall thickness （mm）： duodenum 0.849 ± 0.027 vs 0.710 ± 0.026, jejunum 0.7259 ± 0.034 vs 0.627 ± 0.025, ileum 0.532 ± 0.023 vs 0.470 ± 0.010, all P 〈 0.05）, T1 and T3 treatment could partly restore change of wall thickness, but T2 could not. The opening angle and absolute value of inner and outer residual stain were significantly smaller in duodenal segment （188 ± 11 degrees, -0.31 ± 0.02 and 0.35 ± 0.03 vs 259 ± 15 degrees, -0.40 ± 0.02 and 0.43 ± 0.05） and larger in jejunal （215 ± 20 degrees, -0.30 ± 0.03 and 0.36 ± 0.06 vs 172 ± 19 degrees, -0.25 ± 0.02 and 0.27 ± 0.02） and ileal segments （183 ± 20 degrees, -0.28 ± 0.01 and 0.34 ± 0.05 vs 153 ± 14 degrees, -0.23 ± 0.03 and 0.29 ± 0.04） in DM group than in CON group （P 〈 0.01）. TI and T3 treatment could partly restore this biomechanical alteration, but strong effect was found in T1 treatment （duodenum 243 ± 14 degrees, -0.36 ± 0.02 and 0.42 ± 0.06, jejunum 180 ± 15 degrees, -0.26 ± 0.03 and 0.30 ± 0.06 and ileum 163 ± 17 degrees, -0.23 ± 0.03 and 0.30 ± 0.05, compared with DM, P 〈 0.05）. The linear association was found between the glucose level with most morphometric and biomechanical data. CONCLUSION： KYQWJJ （high dose） treatment could partly restore the changes of blood glucose level and the remodeling of morphometry and residual strain of small intestine in diabetic rats. The linear regression analysis demonstrated that the effect of KYQWJJ on intestinal opening angle and residual strain is partially through its effect on the blood glucose level.

Electrical bioimpedance gastric motility measurement based on an electrical-mechanical composite mechanism

AIM： To introduce a bioimpedance gastric motility mea- surement method based on an electrical-mechanical composite concept and a preliminary clinical application. METHODS： A noninvasive gastric motility measure- ment method combining electrogastrograrn （EGG） and impedance gastric motility （IGM） test was used. Prelim- inary clinical application studies of patients with func- tional dyspepsia （FD） and gastritis, as well as healthy controls, were carried out. Twenty-eight FD patients （mean age 40.9±9.7 years） and 40 healthy volun- teers （mean age 30.9±7.9 years） were involved. IGM spectrum was measured for both the healthy subjects and FD patients, and outcomes were compared in the FD patients before treatment and 1 wk and 3 wk after treatment. IGM parameters were obtained from 30 erosive gastritis patients （mean age 50.5±13.0 years） and 40 healthy adults, and IGM and EGG results were compared in the gastritis patients before treatment and 1 wk after treatment.RESULTS： There were significant differences in the IGM parameters between the FD patients and healthy subjects, and FD patients had a poorer gastric motility [percentage of normal frequency （PNF） 70.8±25.5 in healthy subjects and 28.3 =t= 16.9 in FD patients, P 〈 0.01]. After 1 wk administration of domperidone 10 mg, tid, the gastric motility of FD patients was not im- proved, although the EGG of the patients had returned to normal. After 3 wk of treatment, the IGM rhythm of the FD patients became normal. There was a significant difference in IGM parameters between the two groups （PNF 70.4：1：25.5 for healthy subjects and 36.1 4- 21.8 for gastritis patients, P 〈 0.05）. The EGG rhythm of the gastritis patients returned to normal （frequency insta- bility coefficient 2.22±0.43 before treatment and 1.77 ：t： 0.19 one wk after treatment, P 〈 0.05） after 1 wk of treatment with sodium rabeprazole tablets, 10 mg, qd, po, qm, while some IGM parameters showed a tenden- cy toward improvement but had not reached statistical significance. CONCLUSION： The electrical-mechanical composite measurement method showed an attractive clinical appli- cation prospect in gastric motility research and evaluation.

低温与卒中发病风险

年多研究显示气象因素与卒中风险相关，特别是低温。文章对低温对卒中发病的影响进行了综述。

Gastric motility functional study based on electrical bioimpedance measurements and simultaneous electrogastrography

For some time now,the research on gastric motility and function has fallen behind in the amount of research on gastric endocrine,exocrine secretion,and gastric morphology.In this paper,a noninvasive method to study gastric motility was developed,taking bioimpedance measurements over the gastric area simultaneously with the electrogastrography(EGG).This is based on the concept of observing and analyzing simultaneously the intrinsic electrical gastric activity(basic electric rhythm) and the mechanical gastric activity.Additionally,preliminary clinical studies of healthy subjects and subjects with functional dyspepsia(FD) and gastritis were carried out.The impedance gastric motility(IGM) measurements of the healthy and FD subjects were compared,along with the studies of the FD subjects before treatment and after one week and three weeks of treatment.We also compared IGM measurements of healthy subjects and subjects with erosive gastritis,along with the studies of the subjects with erosive gastritis before treatment and after one week of treatment.Results show that FD subjects have poor gastric motility(P<0.01).After a week of treatment,the gastric motility of FD subjects was not yet improved although the EGG had returned to normal by this time.By three weeks of treatment,the regular IGM rhythm returned in FD subjects.There was a significant difference of IGM parameters between the gastritis and healthy subjects(P<0.05).The EGG rhythm of the gastritis subjects returned to normal at one week post-treatment,while IGM parameters showed a trend to improvement(P>0.05),These results suggest the possibility of clinic application of the proposed method.