Factores de riesgo asociados a fallecimiento por la variante ómicron de COVID-19: análisis retrospectivo con personas mayores de Canarias

Background and aimsSince the beginning of the COVID-19 pandemic, the elderly population has had the highest rates of complications and mortality. This study aimed to determine the influence of different risk factors on deaths due to the Omicron variant in the Canary Islands.Materials and methodsA retrospective observational study of 16,998 cases of COVID-19 over 40 years of age was conducted in the Canary Islands between August 1, 2022, and January 31, 2023. We extracted sociodemographic data (age and sex) and clinical data (death, vaccination history, hospital admission, previous diseases, and treatments).ResultsAmong the deaths, there was a higher proportion of males aged over 70 years, with diabetes, cardiovascular, renal, respiratory, and systemic diseases, and nursing home residents. Significant differences were observed in the number of doses of the vaccine. The multiple regression model showed that male sex (OR [95% CI] = 1.92 [1.42–2.58]), age (70–79 years, 9.11 [4.27–19.43]; 80–89 years, 21.72 [10.40–45.36]; 90–99 years, 66.24 [31.03–141.38]; 100 years or older, 69.22 [12.97–369.33]), being unvaccinated (6.96, [4.01–12.08]), or having the last dose administered at least 12 months before the diagnosis (2.38, [1.48–3.81]) were significantly associated with mortality.ConclusionsMultiple factors may increase the risk of mortality due to COVID-19 in the elderly population. In our study, we found that only three predictors can effectively explain the variability: older age, male sex, and not being vaccinated or last vaccination date prior to one year.     

Utilidad y seguridad de los ingresos directos a una unidad hospitalaria de agudos de un servicio de geriatría valorados por atención geriátrica en residencias

Background and objectiveMore than half of institutionalized older people need a emergency department visit annually, with high resources consumption and higher risk of adverse events, due to high complexity. Direct admission to Acute Geriatric Unit (AGU), after geriatric consultant and nursing home medical team assessment, could be a safety and effective alternative to emergency department (ED) admission.MethodsRetrospective observational study of AGU patients admitted by Nursing Home Geriatric Team between January, 1st and December, 31st, 2021. Planned admissions and SARS-CoV-2 positive patients were excluded. Medical (sociodemographic, clinical, functional and cognitive) records and outcomes data (inpatient mortality, hospital and ED lenght of stay, transfer to ED and delirium within 48 h after admission, hospital discharge location) were collected.ResultsTwo hundred and six patients directly admitted, 101 through ED (N 307). 62.5% with Barthel index <40, 65% with dementia, 56.4% with Charlson index ≥3. Inpatient mortality was 14.6% in direct admission, 20.8% in ED referral group, p = 0.14. Hospital lenght of stay was 9.61 ± 6.01 days in direct admission, 11.22 ± 5.36 days in ED group, p = 0.02. 27.7% of patients with delirium in direct admission and 36.6% in ED group; only one patient was transferred to ED, within 48 h after admission.ConclusionsDirect admission is a safety and effective alternative to ED referral in institutionalized older people after geriatric assessment, due to no increased mortality, shorter length of stay and hospital cost reduction.     

肠道菌群在脊髓损伤后胃肠道炎症反应中的研究进展

脊髓损伤(spinal cord injury, SCI)目前尚无有效的治疗手段。脊髓损伤后,患者常伴有严重的胃肠功能障碍,严重影响患者的生活质量。研究发现,脊髓损伤后肠道菌群的紊乱和脊髓损伤后的胃肠道功能障碍密切相关。因此,本文围绕脊髓损伤后肠道菌群的变化,探讨肠道菌群在迷走神经、下丘脑-垂体-肾上腺和肠道菌群代谢物3个途径中发挥的作用,及与胃肠道炎症反应相关的研究进展。     

Carbohydrate distribution and cellular injuries in acid rain and cold-treated spruce needles

Summary The cellular structures of acid rain-irrigated needles of several provenances of Norway spruce (Picea abies L. Karst) seedlings were studied after winter experimental freezing. Frost injuries and recovery were characterized by visual damage scoring and classification of mesophyll cell alterations, also using histochemical methods for carbohydrate fluorescent staining. The treatment with-30° C during the late dormancy period was sufficient to cause significant injuries and intracellular degradation in the tissues of the green needles. The most affected seedlings in terms of visual injury scoring were found among those treated with clean water or at pH 3, while freezing injury, defined as an occlusion of phenolic substances in the central vacuole of the mesophyll cells, was most abundant in the needles from spruces irrigated either with clean water or at pH 4 or pH 3. Electron microscopy revealed the details of the injury, e. g. thinning out of the cytoplasm and chloroplast stroma, darkening of the chloroplasts and eventually swelling of the chloroplasts and protoplast. PAS and ConA reactions in the needle tissue revealed intense starch accumulation in the mesophyll and transfusion tissues as early as in March, with a tendency to increase, especially in the untreated needles during the recovery period. Plasma membrane disturbances were indicated by histochemical identification of callose deposits in the mesophyll cell walls, these being most abundant in the acid rain-treated needles. All these findings suggest that freezing at –30° C was more deleterious to the seedlings pretreated with acid or clean water than to those not given additional irrigation.     

细胞外基质刚度调控压电型机械敏感离子通道组件1对神经干细胞分化的影响

目的 本研究旨在探讨细胞外基质刚度变化对神经干细胞（neural stem cells,NSCs）分化的影响及其作用机制。方法 本研究基于成功构建脊髓损伤大鼠模型,并制备不同刚度（0.7 kPa、40 kPa）的聚丙烯酰胺凝胶基底,将大鼠原代NSCs于不同刚度基底上培养。压电型机械敏感离子通道组件1（piezo type mechanosensitive ion channel component 1,Piezo1）shRNA质粒转染NSCs细胞。免疫荧光染色检测神经元标志物双皮质醇（doublecortion,DCX）和星形胶质细胞标志物胶质纤维酸性蛋白（glial fibrillary acidic protein,GFAP）阳性细胞百分比。免疫组织化学及蛋白质免疫印迹（Western blot）法检测损伤组织及NSCs细胞中Piezo1蛋白的表达水平。结果 与0.7 kPa基质刚度组相比,40 kPa基质刚度组中DCX阳性细胞数增加,而GFAP阳性细胞数减少,Piezo1蛋白表达量上升。脊髓损伤大鼠损伤组织Piezo1蛋白表达显著高于空白对照（sham）组。40 kPa基质刚度条件下沉默Piezo1后,DCX阳性细胞数减少,而GFAP阳性细胞数增加,差异具有统计学意义（P<0.05）。机制研究发现,沉默Piezo1导致IV型胶原及纤连蛋白表达下降。重组纤连蛋白逆转了Piezo1 shRNA对NSCs分化的影响,即DCX阳性细胞数增加,而GFAP阳性细胞数减少。结论 综上可见,硬基底刚度通过促进Piezo1蛋白表达,上调IV型胶原及纤连蛋白表达,从而调控NSCs细胞分化。本研究为基于生物材料治疗脊髓损伤提供了新的视角。     

钙对臭氧伤害小麦的防护作用

春小麦分别用0、1‰、3‰、5‰浓度的CaCl_2溶液浸种及培养,9天后,用0.3—0.7ppm浓度的臭氧(O_3)对幼苗熏气0、4、8、12h,观测到来经Ca~(2+)处理材料的叶片,其外渗液紫外吸收值和电导率随O_3处理时间延长都有不同程度的升高,而叶内可溶性糖和叶绿素含量都明显降低,经过3‰Ca~(2+)处理O_3熏气4—12h的材料,其外渗液紫外吸值、电导率、外渗糖、蒸腾强度都低于对照,其叶内可溶性糖及叶绿素含量均高于对照,证收明在一定O_3浓度范围内,3‰CaCl_2对O_3侵害小麦有明显的防护作用。     

冷害条件下凤眼莲某些生理特性变化的研究

研究了凤眼莲在冷害条件下细胞膜透性、体内生理代谢过程中一些大分子物质的变化。①０℃条件下细胞内大量电解质外渗,质膜性明显增加。此时,植株外部已发生了严重的伤害症状,②低温处理后,叶片内可溶性糖和游离脯氨酸累积,可溶性蛋白质含量基本不变。③过氧化物酶活性在低温下减弱,其同工酶谱带增加１－４条。过氧化氢酶活性明显增加,其同工酶谱带增加１－２条。ＳＯＤ活性有所降低,其同工酶谱带在０℃、３６小时后增加了１     

Current status and prospects of basic research and clinical application of mesenchymal stem cells in acute respiratory distress syndrome

Acute respiratory distress syndrome (ARDS) is a common and clinically devastating disease that causes respiratory failure. Morbidity and mortality of patients in intensive care units are stubbornly high, and various complications severely affect the quality of life of survivors. The pathophysiology of ARDS includes increased alveolar–capillary membrane permeability, an influx of protein-rich pulmonary edema fluid, and surfactant dysfunction leading to severe hypoxemia. At present, the main treatment for ARDS is mechanical treatment combined with diuretics to reduce pulmonary edema, which primarily improves symptoms, but the prognosis of patients with ARDS is still very poor. Mesenchymal stem cells (MSCs) are stromal cells that possess the capacity to self-renew and also exhibit multilineage differentiation. MSCs can be isolated from a variety of tissues, such as the umbilical cord, endometrial polyps, menstrual blood, bone marrow, and adipose tissues. Studies have confirmed the critical healing and immunomodulatory properties of MSCs in the treatment of a variety of diseases. Recently, the potential of stem cells in treating ARDS has been explored via basic research and clinical trials. The efficacy of MSCs has been shown in a variety of in vivo models of ARDS, reducing bacterial pneumonia and ischemia-reperfusion injury while promoting the repair of ventilator-induced lung injury. This article reviews the current basic research findings and clinical applications of MSCs in the treatment of ARDS in order to emphasize the clinical prospects of MSCs.     

qSOFA评分、血乳酸及红细胞分布宽度与急性上消化道出血病情严重程度的关系及其预测患者预后的效能分析

摘要 目的：探讨快速序贯器官功能衰竭评估（qSOFA）评分、血乳酸（Lac）及红细胞分布宽度（RDW）与急性上消化道出血（AUGIB）病情严重程度的关系及其预测患者预后的效能。方法：选取2017年6月～2022年6月我院收治的230例AUGIB患者为研究对象,根据病情严重程度分为低危组44例、中危组140例、高危组36例、极高危组10例,且根据其入院28 d内生存情况分为死亡组（n=31）和存活组（n=199）。收集AUGIB患者临床资料,检测血Lac、RDW水平并计算qSOFA评分。采用多因素Logistic回归分析AUGIB患者预后不良的影响因素,受试者工作特征（ROC）曲线分析qSOFA评分和血Lac、RDW对AUGIB患者预后不良的预测价值。结果：低危组、中危组、高危组、极高危组qSOFA评分和血Lac、RDW水平依次升高（P＜0.05）。230例AUGIB患者入院28 d内死亡率为13.48％（31/230）。多因素Logistic回归分析显示,年龄增加、GBS评分≥6分及休克指数、qSOFA评分、血尿素氮、血Lac、RDW水平升高为AUGIB患者预后不良的独立危险因素（P＜0.05）。ROC曲线分析显示,qSOFA评分、血Lac及RDW联合预测AUGIB患者预后不良的曲线下面积大于qSOFA评分、血Lac及RDW单独预测。结论：AUGIB患者qSOFA评分、血Lac及RDW水平升高与病情加重和预后不良密切相关,qSOFA评分、血Lac及RDW联合预测AUGIB患者预后不良的效能较高。     

尿铜蓝蛋白、肾损伤因子1与糖尿病肾病患者肾功能的关系及对预后不良的预测价值研究

摘要 目的：探讨尿铜蓝蛋白（CP）、肾损伤因子1（KIM-1）与糖尿病肾病（DKD）患者肾功能的关系及对预后不良的预测价值。方法：回顾性分析2017年1月～2019年1月陆军第八十二集团军医院肾内科收治的160例DKD患者（DKD组）的临床资料,随访3年,根据是否发展为终末期肾脏疾病（ESRD）分为预后不良组42例和预后良好组118例,另选取同期56例单纯2型糖尿病（T2DM）患者作为T2DM组和47例体检健康者作为对照组。采用微量法和酶联免疫吸附试验法检测尿CP、KIM-1水平,并计算尿白蛋白/肌酐比值（UACR）和估算肾小球滤过率（eGFR）。通过Spearman相关性分析DKD患者尿CP、KIM-1与UACR、eGFR的相关性,单因素和多因素Logistic回归分析DKD患者预后不良的影响因素,受试者工作特征（ROC）曲线分析尿CP、KIM-1对DKD患者预后不良的预测价值。结果：随访3年,160例DKD患者有42例发展为ESRD,预后不良发生率为26.25％（42/160）。DKD组尿CP、KIM-1、UACR高于T2DM组、对照组,eGFR低于T2DM组、对照组（P＜0.05）;T2DM组尿CP、KIM-1、UACR高于对照组,eGFR低于对照组（P＜0.05）。Spearman相关性分析显示,DKD患者尿CP、KIM-1与UACR呈正相关（P均＜0.001）,与eGFR呈负相关（P均＜0.001）。多因素Logistic回归分析显示,高血压、DKD分期4期和糖化血红蛋白（HbA1c）（较高）、低密度脂蛋白胆固醇（LDL-C）（较高）、UACR（较高）、尿CP（较高）、尿KIM-1（较高）为DKD患者预后不良的独立危险因素（P＜0.05）,eGFR（较高）为独立保护因素（P＜0.05）。ROC曲线分析显示,尿CP、KIM-1联合预测DKD患者预后不良的曲线下面积大于各指标单独预测。结论：DKD患者尿CP、KIM-1升高与肾功能降低和预后不良密切相关,尿CP、KIM-1联合预测DKD患者预后不良的价值较高。