乳腺癌根治术患者术前焦虑的影响因素分析及其对术后恢复、细胞免疫功能和生命质量的影响

摘要 目的：分析乳腺癌根治术患者术前焦虑的影响因素,并探讨术前焦虑对患者术后恢复、细胞免疫功能和生命质量的影响。方法：选择我院2020年3月~2021年12月期间收治的拟行乳腺癌根治术的120例患者作为研究对象,术前1 d采用焦虑自评量表（SAS）评估所有患者的焦虑状况,根据是否存在焦虑分为焦虑组和无焦虑组,乳腺癌根治术患者术前焦虑的影响因素采用多因素Logistic回归分析。对比焦虑组和无焦虑组的术后恢复、细胞免疫功能和生命质量情况。结果：120例乳腺癌根治术患者中,有31例患者无术前焦虑,89例患者存在焦虑症状,根据是否存在术前焦虑分为焦虑组（n=89）和无焦虑组（n=31）。乳腺癌根治术患者术前焦虑与年龄、文化程度、家庭人均月收入、付费方式、婚姻状况、家庭支持、既往有无全麻史、术前住院时长、定期体检有关（P<0.05）。多因素Logistic回归分析结果表明：年龄＜60岁、文化程度为小学及其以下、家庭人均月收入＜3000元、婚姻状况为未婚、无家庭支持、既往无全麻史、术前住院时长>1 d是乳腺癌根治术患者术前焦虑的危险因素（P<0.05）。焦虑组的术后首次肛门排气时间、首次下床活动时间、术后住院时间均长于无焦虑组（P<0.05）。两组术后1个月CD3⁺、CD4⁺、CD4⁺/CD8⁺水平升高,且无焦虑组高于焦虑组（P<0.05）,两组术后1个月CD8⁺水平下降,且无焦虑组低于焦虑组（P<0.05）。两组术后1个月生理状况、情感状况、社会/家庭状况、功能状况、附加关注评分和总分下降,且无焦虑组低于焦虑组（P<0.05）。结论：乳腺癌根治术患者术前焦虑发生率较高,其发生受到年龄、文化程度、家庭人均月收入、婚姻状况、家庭支持、既往有无全麻史、术前住院时长等多种因素的影响,可导致患者术后恢复时间延长,细胞免疫功能和生命质量降低。     

关节镜下双排缝合桥固定与单排固定治疗肩袖全层撕裂的疗效对比及术后早期再撕裂的危险因素分析

摘要 目的：对比关节镜下双排缝合桥固定和单排固定治疗肩袖全层撕裂的疗效,并分析术后早期再撕裂的危险因素。方法：回顾性分析广州中医药大学附属北碚中医院2018年1月~2021年12月期间收治的200例肩袖全层撕裂患者的临床资料,根据手术方案的不同分为A组（n=97,接受单排固定治疗）和B组（n=103,接受双排缝合桥固定治疗）。对比两组的疼痛、肩关节功能情况、肩关节活动度及术后早期再撕裂发生率。采用单因素和多因素Logistic回归分析肩袖全层撕裂患者术后早期再撕裂的危险因素。结果：术后6个月,B组视觉疼痛模拟评分量表（VAS）评分低于A组,美国加州大学肩关节评分系统（UCLA）评分、美国肩肘外科医师学会（ASES）评分高于A组（P<0.05）。术后6个月,B组前屈、外展、体侧外旋角度大于A组（P<0.05）。B组的术后早期再撕裂总发生率低于A组（P<0.05）。术后早期再撕裂的发生与糖尿病史、撕裂大小、吸烟史、年龄、术前肌肉质量、性别、脂肪浸润、注射皮质类固醇有关（P<0.05）。多因素Logistic回归分析结果显示：年龄≥60岁、性别为男性、吸烟史、糖尿病史、撕裂大小为巨大型再撕裂、脂肪浸润、注射皮质类固醇是术后早期再撕裂发生的危险因素（P<0.05）。结论：关节镜下双排缝合桥固定治疗肩袖全层撕裂,可更好的减轻疼痛症状,改善关节功能和关节活动度。此外,糖尿病史、脂肪浸润、吸烟史、高龄、撕裂大小为巨大型再撕裂、男性、注射皮质类固醇等是肩袖全层撕裂患者术后早期再撕裂的危险因素。     

重症急性胰腺炎合并腹腔感染患者病原菌分布、药物敏感性分析及其院内死亡的危险因素探讨

摘要 目的：观察重症急性胰腺炎（SAP）合并腹腔感染（IAI）患者病原菌分布,分析药物敏感性,同时探讨其院内死亡的危险因素。方法：本研究纳入2017年1月~2022年1月期间来解放军联勤保障部队第九二二医院接受治疗并确诊的SAP合并IAI患者100例,采集患者腹水标本,观察其病原菌分布,分析药物敏感性。入院后收集患者人口学特征、实验室检查等资料,探讨患者院内死亡的危险因素。结果：100例SAP合并IAI患者腹水标本中,分离出186株病原菌,其中革兰阴性菌有108株,占比58.06%。革兰阳性菌51株,占比27.42%。真菌27株,占比14.52%。鲍曼不动杆菌对不同抗菌药物的敏感性均较低,大肠埃希菌对厄他培南、亚胺培南、哌拉西林／他唑巴坦、庆大霉素、美罗培南的敏感性较高,肺炎克雷伯菌对亚胺培南、美罗培南的敏感性较高,葡萄球菌属对替加环素、万古霉素、利奈唑胺的敏感性较高,屎肠球菌对替加环素、利奈唑胺的敏感性较高,粪肠球菌对氨苄西林、万古霉素、环丙沙星、替加环素的敏感性较高。单因素分析显示,SAP合并IAI患者院内死亡与器官障碍数目、膀胱压、入院时急性生理学与慢性健康状况评分（APACHE II）评分、白细胞计数（WBC）、血钙、红细胞压积（HCT）、总胆固醇（TC）、甘油三醋（TG）、降钙素原（PCT）、C反应蛋白（CRP）、动脉二氧化碳分压（PaCO₂）、动脉氧分压（PaO2）有关（P<0.05）。多因素Logistic回归分析结果显示：器官障碍数目偏多、血钙偏低、CRP偏高、APACHE II评分偏高、膀胱压偏高、PaO₂偏低、WBC偏高是导致SAP合并IAI患者院内死亡的危险因素（P<0.05）。结论：SAP合并IAI患者病原菌分布以革兰阴性菌为主,主要的革兰阴性菌、革兰阳性菌耐药率高。此外,器官障碍数目偏多、血钙偏低、CRP偏高、APACHE II评分偏高、膀胱压偏高、PaO₂偏低、WBC偏高是影响SAP合并IAI患者院内死亡的危险因素。     

高危结直肠腺瘤的危险因素及风险预测模型的构建与验证

摘要 目的：探讨高危结直肠腺瘤的影响因素,构建风险预测模型并验证。方法：回顾性分析2021年1月至2021年12月期间在江苏大学附属人民医院进行诊疗的1408例结直肠腺瘤患者的资料,根据病理特征分为高危结直肠腺瘤组（759例）和非高危结直肠腺瘤组（649例）。采用Logistic回归分析筛选高危结直肠腺瘤的独立危险因素并建立风险预测模型,并验证预测模型的应用效能。结果：Logistic回归分析结果显示,病灶部位为直肠、高血压、高脂血症、年龄≥53岁、吸烟是高危结直肠腺瘤的独立危险因素（P＜0.05）。基于以上因素建立预测高危结直肠腺瘤风险的列线图模型,经Hosmer-Lemeshow检验和受试者工作特征曲线（ROC）分析显示,该风险预测模型具有较好的拟合度和预测效能,可以用于高危腺瘤的风险预测。结论：病灶部位为直肠、高血压、高脂血症、年龄≥53岁、吸烟是高危结直肠腺瘤的独立危险因素,临床医生可尽早对高危患者进行预防性干预以减缓高危腺瘤的发生。     

Substance use disorders: a comprehensive update of classification,epidemiology, neurobiology,clinical aspects,treatment and prevention

Substance use disorders (SUDs) are highly prevalent and exact a large toll on individuals’ health, well-being, and social functioning. Long-lasting changes in brain networks involved in reward, executive function, stress reactivity, mood, and self-awareness underlie the intense drive to consume substances and the inability to control this urge in a person who suffers from addiction (moderate or severe SUD). Biological (including genetics and developmental life stages) and social (including adverse childhood experiences) determinants of health are recognized factors that contribute to vulnerability for or resilience against developing a SUD. Consequently, prevention strategies that target social risk factors can improve outcomes and, when deployed in childhood and adolescence, can decrease the risk for these disorders. SUDs are treatable, and evidence of clinically significant benefit exists for medications (in opioid, nicotine and alcohol use disorders), behavioral therapies (in all SUDs), and neuromodulation (in nicotine use disorder). Treatment of SUDs should be considered within the context of a Chronic Care Model, with the intensity of intervention adjusted to the severity of the disorder and with the concomitant treatment of comorbid psychiatric and physical conditions. Involvement of health care providers in detection and management of SUDs, including referral of severe cases to specialized care, offers sustainable models of care that can be further expanded with the use of telehealth. Despite advances in our understanding and management of SUDs, individuals with these conditions continue to be stigmatized and, in some countries, incarcerated, highlighting the need to dismantle policies that perpetuate their criminalization and instead develop policies to ensure support and access to prevention and treatment.     

THE MEASUREMENT OF SELECTION ON QUANTITATIVE TRAITS: BIASES DUE TO ENVIRONMENTAL COVARIANCES BETWEEN TRAITS AND FITNESS

The use of regression techniques for estimating the direction and magnitude of selection from measurements on phenotypes has become widespread in field studies. A potential problem with these techniques is that environmental correlations between fitness and the traits examined may produce biased estimates of selection gradients. This report demonstrates that the phenotypic covariance between fitness and a trait, used as an estimate of the selection differential in estimating selection gradients, has two components: a component induced by selection itself and a component due to the effect of environmental factors on fitness. The second component is shown to be responsible for biases in estimates of selection gradients. The use of regressions involving genotypic and breeding values instead of phenotypic values can yield estimates of selection gradients that are not biased by environmental covariances. Statistical methods for estimating the coefficients of such regressions, and for testing for biases in regressions involving phenotypic values, are described.     

Nitrous oxide emissions from silage maize fields under different mineral nitrogen fertilizer and slurry applications

Intensive dairy farming systems are a large source of emission of the greenhouse gas nitrous oxide (N₂O), because of high nitrogen (N) application rates to grasslands and silage maize fields. The objective of this study was to compare measured N₂O emissions from two different soils to default N₂O emission factors, and to look at alternative emission factors based on (i) the N uptake in the crop and (ii) the N surplus of the system, i.e., N applied minus N uptake by the crop. Twelve N fertilization regimes were implemented on a sandy soil (typic endoaquoll) and a clay soil (typic endoaquept) in the Netherlands, and N₂O emissions were measured throughout the growing season. Highest cumulative fluxes of 1.92 and 6.81 kg N₂O-N ha^–1 for the sandy soil and clay soil were measured at the highest slurry application rate of 250 kg N ha^–1. Background emissions from unfertilized soils were 0.14 and 1.52 kg N₂O-N ha^–1 for the sandy soil and the clay soil, respectively. Emission factors for the sandy soil averaged 0.08, 0.51 and 0.26% of the N applied via fertilizer, slurry, and combinations of both. For the clay soil, these numbers were 1.18, 1.21 and 1.69%, respectively. Surplus N was linearly related to N₂O emission for both the sandy soil (R²=0.60) and the clay soil (R²=0.40), indicating a possible alternative emission factor. We concluded that, in our study, N₂O emission was not linearly related to N application rates, and varied with type and application rate of fertilizer. Finally, the relatively high emission from the clay soil indicates that background emissions might have to be taken into account in N₂O budgets.     

Excess of nutrients results in plant stress and decreased grass miner performance

We studied the relationship between plant stress intensity and herbivore response in the grass miner Chromatomyia milii (Kaltenbach) (Diptera: Agromyzidae) on nutrient stressed plants. We subjected the host grass Holcus lanatus (Poaceae) to a range of nutrient treatments (0%, 25%, 50%, 100%, and 200% Hoagland nutrient solution) and recorded plant stress intensity (plant growth and foliar chlorophyll a and b levels) and offspring performance of C. milii. Plant growth and foliar chlorophyll a and b levels decreased from the 25% treatment to the 200% treatment. The plant stress intensity from the 0% treatment was equal to or only slightly higher than the 25% treatment. Offspring survival of C. milii was lower on the 100% and the 200% treatments than on the other treatments. Offspring development time and pupal mass did not differ between the nutrient treatments. Offspring survival of C. milii showed a monotonic non‐linear increase with decreasing plant stress intensity. These results clearly show that an excess of nutrients may result in plant stress and reduced herbivore performance.     

Spatial dynamics of lions and their prey along an environmental gradient

Establishing the ecological determinants of the spatial dynamics of large African savanna mammals is necessary for understanding the cumulative impacts on the suitability and resilience of their natural habitats, of progressive habitat fragmentation and temporal shifts in climate, fire regimes and elephant browsing. Systematic directional gradients and small‐scale spatial dependence were evident in rainfall, herbivore biomass and lion density in the Masai Mara National Reserve during September 1990 to July 1992. Lion density, the biomass of resident and all herbivore species were autocorrelated within 4.3, 4.1 and 3.3 km, respectively, and peaked in areas of relatively low rainfall but higher microtopographic and vegetation heterogeneity and complexity and more diverse drainage systems. Rainfall influenced herbivore biomass and hence lion density non‐linearly and that influence was apparently modified by forage mineral nutrients, structural habitat complexity, degree of drainage and distance to waterpoints. Lion density was related to the biomass of resident herbivores, even after controlling for rainfall and spatial trends. Persistence of the recent decline in Mara woodlands and increasing human population along the reserve–ranch boundary would likely reduce the reserve's lion population because most lions spent the daytime within the vegetation mosaic fringing drainage lines, away from humans and domestic livestock.     

Comparative seed ecology of the endangered shrub, Pimelea spicata and a threatening weed, Bridal Creeper: Smoke, heat and other fire-related germination cues

Summary Pimelea spicata R. Br. is a nationally listed endangered Australian shrub threatened with extinction by habitat fragmentation and environmental weed invasion. Bridal Creeper (Asparagus asparagoides L. W. Wight) is the primary weed threat to the largest remaining populations of P. spicata in the Cumberland Plain. Fire, as part of an integrated pest management program, offers the potential to stimulate P. spicata populations while controlling Bridal Creeper. It is important, therefore, to understand how the components of fire affect the germination and growth of both species. Using laboratory experiments we investigated the effects of smoke, heat, ash and/or light on the germination of P. spicata and Bridal Creeper. We found a significant promotive effect of smoke and indication of an inhibitory heat shock (90°C for 10 min) effect on the germination of P. spicata seeds. The response of Bridal Creeper seeds to the same factors was complex; while the results of one experiment suggested an inhibitory effect of smoke and a promotive effect of heat, subsequent trials were contradictory, implying that Bridal Creeper, like many weeds, is able to germinate under a wide range of environmental conditions. Other experiments investigated the optimal germination temperature and innate dormancy of P. spicata in the absence of fire‐related germination cues. Of the incubation temperatures investigated, the optimal diurnally fluctuating regime for P. spicata germinations was 10°C and 20°C in the night and day, respectively. The innate dormancy of freshly produced seeds disappeared after 3 months. In contrast to Bridal Creeper, we found a persistent germinable seed bank of about 97 P. spicata seeds/m² located in the top 5 cm of the soil profile. While fire alone is unlikely to kill Bridal Creeper plants, fire may help to manage local infestations of the weed by limiting germination and providing opportunity for herbicide treatment of regrowth.