不同病情急性呼吸窘迫综合征患者血清铁蛋白、血管生成素样蛋白4、降钙素原与白蛋白比值的变化及对预后的评估价值

摘要 目的：探讨不同病情急性呼吸窘迫综合征（ARDS）患者血清铁蛋白、血管生成素样蛋白4（ANGPTL4）、降钙素原与白蛋白比值（PAR）的变化及对预后的评估价值。方法：选取2019年3月至2022年6月四川大学华西第四医院重症医学科收治的109例ARDS患者,根据氧合指数（PaO₂/FiO₂）将患者分为轻度组（200 mmHg＜PaO₂/FiO₂≤300 mmHg,38例）、中度组（100 mmHg＜PaO₂/FiO₂≤200 mmHg,42例）、重度组（≤100 mmHg,29例）。检测所有ARDS患者血清铁蛋白、ANGPTL4水平及PAR,根据患者入院后28 d内生存状况将其分为存活组（69例）、死亡组（40例）。多因素Logistic回归分析ARDS患者入院后28 d内死亡的危险因素。受试者工作特征（ROC）曲线分析血清铁蛋白、ANGPTL4、PAR评估ARDS患者预后的预测价值。结果：重度组血清铁蛋白、ANGPTL4、降钙素原及PAR高于中度组和轻度组（P＜0.05）,血清白蛋白水平低于中度组和轻度组（P＜0.05）。死亡组血清铁蛋白、ANGPTL4、降钙素原及PAR高于存活组（P＜0.05）,血清白蛋白水平低于存活组（P＜0.05）。高SOFA评分、高PAR及血清铁蛋白、ANGPTL4水平升高是 ARDS患者入院28 d内死亡的危险因素（P＜0.05）。联合血清铁蛋白、ANGPTL4、PAR三项指标预测ARDS患者预后的曲线下面积为0.867,高于单独指标预测的0.775、0.727、0.776。结论：ARDS患者血清铁蛋白、ANGPTL4水平及PAR增高与病情加重以及预后不良有关,联合检测三项指标在ARDS患者预后评估中具有较高价值。     

血清SAA、YKL-40及SP-A的联合检测对小儿难治性肺炎支原体肺炎的预测价值分析

摘要 目的：探究血清淀粉样蛋白A（SAA）、几丁质酶样蛋白YKL-40和肺表面活性物质相关蛋白-A（SP-A）表达水平对的联合检测对小儿难治性肺炎支原体肺炎（RMPP）的预测价值。方法：纳入2019年11月至2021年12月期间我院收治的60例MPP患儿作为研究对象,依据病情最终转归将其分为RMPP组和普通肺炎支原体肺炎（GMPP）组,另纳入同期于我院行体格检查的60例健康儿童作为对照组。收集所有受试儿童的临床资料、实验室指标及影像学结果,采用酶联免疫吸附法（ELISA）检测血清SAA、YKL-40和SP-A的表达水平,应用受试者工作特征曲线（ROC）判定各指标单项检测和联合检测的预测效能。结果：MPP组患儿和对照组儿童一般资料相比无统计学差异（P＞0.05）。依据病情最终转归,60例MPP患儿中共有23例（38.33 %）进展为RMPP,RMPP组与GMPP组患儿在白介素-6（IL-6）、C-反应蛋白（CRP）、降钙素原（PCT）、D-二聚体（D-D）等实验室指标以及肺不张、胸腔积液等影像学特征方面相比有统计学差异（P＜0.05）。RMPP组和GMPP组血清SAA、YKL-40和SP-A的表达水平显著高于对照组（P＜0.05）,同时RMPP组血清SAA、YKL-40和SP-A的表达水平显著高于GMPP组（P＜0.05）。血清SAA的最佳截断值为39.75 mg/L,预测RMPP发生的ROC曲线下面积为0.894（95%CI：0.861-0.925）,敏感度为78.26 %,特异度为86.67 %;血清YKL-40的最佳截断值为31.85 ng/mL,预测RMPP发生的ROC曲线下面积为0.754（95%CI：0.634-0.873）,敏感度为73.91 %,特异度为67.21 %;血清SP-A的最佳截断值为35.59 ng/mL,预测RMPP发生的ROC曲线下面积为0.761（95%CI：0.640-0.891）,敏感度为73.91 %,特异度为75.00 %;SAA+YKL-40-1+SP-A三者联合检测预测RMPP的AUC为0.914（95%CI：0.871-0.957）,敏感度为91.30 %,特异度为91.66 %。结论：血清SAA、YKL-40和SP-A表达水平的检测可作为预测RMPP发生的重要生物学指标,且三者联合检测的预测效能较高,可为临床尽早诊断RMPP、尽早干预、改善患儿预后提供一定的帮助。     

血清肿瘤标志物与宫颈癌病理特征的关系及对术后复发的预测研究

摘要 目的：探讨血清肿瘤标志物与宫颈癌病理特征的关系及对术后复发的预测研究。方法：选择2015年1月至2017年12月来我院诊治的宫颈癌患者82例作为观察组,选择同期来我院体检的健康女性者50例,两组均使用电化学发光免疫分析法检测血清中的CA125、CA153、CA199、CEA水平,观察组患者随访时间截至2022年12月。对比两组血清CA125、CA153、CA199、CEA水平,分析观察组患者血清CA125、CA153、CA199、CEA水平与临床病理特征的关系,分析观察组患者术后随访复发情况,宫颈癌根治术后患者复发的单因素与多因素Cox回归结果,血清CA125、CA153、CA199、CEA水平对宫颈癌根治术后复发的预测价值。结果：观察组的血清CA125、CA153、CA199、CEA水平明显较对照组高（P<0.05）。宫颈癌患者不同FIGO分期、间质浸润深度及是否存在淋巴结转移间血清CA125、CA153、CA199、CEA水平对比有统计学意义（P<0.05）。82例患者随访时间为13~60个月,中位生存时间为39个月,截止2022年12月末次随访,82例患者术后复发18例（21.95%）。单因素及多因素Cox回归分析表明,FIGO分期在ⅡA期、间质浸润深度≥1/2、有淋巴结转移、CA125≥307.41 U/mL、CA153≥185.89 U/mL、CA199≥153.23 U/mL、CEA≥30.15 ng/mL是影响宫颈癌术后复发的独立危险因素。ROC曲线显示,CA125+CA153+CA199+CEA预测宫颈癌术后复发的AUC明显较CA125、CA153、CA199、CEA单独指标预测价值高（P<0.05）。结论：宫颈癌患者血清CA125、CA153、CA199、CEA高表达,其与间质浸润深度、FIGO 分期、淋巴结转移、术后复发有关,四者联合可作为宫颈癌术后复发的预测指标。     

食管癌患者放射治疗中照射体积和时间与外周血淋巴细胞绝对值的相关性研究

摘要 目的：探究照射体积和时间与食管癌患者外周血淋巴细胞绝对值的相关性。方法：本研究方案将纳入2019年1月~2019年12月蚌埠医学院第一附属医院放疗科收治的放疗或同步放化疗食管癌患者84例,其中单独放疗患者24例,同步放化疗患者60例,采用血液细胞分析仪测定患者放疗期间每周复查外周血白细胞（WBC）、中性粒细胞（N）、淋巴细胞（L）、血红蛋白（HB）及血小板（PLT）计数等指标。Pearson相关性分析照射时间、剂量及体积与外周血指标之间的相关性。结果：食管癌放疗患者,包括同步放化疗及单纯放疗亚组,在治疗1-6周,照射时间与外周血指标均无相关性（P>0.05）。但在放疗第5-6周,患者放疗剂量与WBC、N、L、HB呈负相关（P<0.05）,同步放化疗亚组患者照射剂量与WBC、N、L、HB呈负相关（P<0.05）。在治疗1-4周,不同照射剂量下各梯度照射剂量对应照射体积与外周血指标均无相关性（P>0.05）。但在第5-6周时,患者不同梯度照射剂量下各照射体积与WBC、N呈负相关（P<0.05）,同时在20Gy-60Gy照射剂量,尤其20Gy和30Gy照射剂量下照射体积与L呈负相关（P<0.05）。同步放化疗亚组患者不同照射剂量下各照射体积与WBC、N呈负相关（P<0.05）,同时在20Gy-60Gy照射剂量下照射体积与L呈负相关（P<0.05）,而且在60Gy照射剂量下照射体积与HB呈负相关（P<0.05）。结论：放疗患者特别是同步放化疗亚组患者照射体积、照射剂量与食管癌患者外周血淋巴细胞计数成负相关,基线淋巴细胞与食管癌患者外周血淋巴细胞计数成正相关,而照射时间与食管癌患者外周血淋巴细胞计数无相关性。     

血清ApoB/ApoA1比值、TG/HDL-C比值、LDH及ALP水平与冠心病患者冠状动脉病变严重程度的关系及其预测价值分析

摘要 目的：探讨血清载脂蛋白B（ApoB）/载脂蛋白A1（ApoA1）比值、三酰甘油（TG）/高密度脂蛋白胆固醇（HDL-C）比值、乳酸脱氢酶（LDH）及碱性磷酸酶（ALP）水平与冠心病（CHD）患者冠状动脉病变严重程度的关系及其预测价值。方法：选取2019年1月-2021年12月因胸痛来我院检查并收治的185例患者,根据检查结果是否为CHD分为CHD组（120例）和对照组（65例）,根据Gensini评分将CHD组分为轻度狭窄亚组36例、中度狭窄亚组55例、重度狭窄亚组29例。入院后检测血清ApoB/ApoA1比值、TG/HDL-C比值、LDH及ALP水平。采用Spearman相关系数分析CHD患者血清ApoB/ApoA1比值、TG/HDL-C比值、LDH、ALP水平与Gensini评分的相关性,采用多因素Logistic回归分析CHD的影响因素;受试者工作特征（ROC）曲线分析血清ApoB/ApoA1比值、TG/HDL-C比值、LDH及ALP水平对CHD的预测价值。结果：与对照组比较,CHD组吸烟、饮酒、高血压、糖尿病比例和血清总胆固醇（TC）、TG、低密度脂蛋白胆固醇（LDL-C）、ApoB、ApoB/ApoA1比值、TG/HDL-C比值、LDH、ALP水平升高,HDL-C、ApoA1水平降低（P＜0.05）。轻度、中度、重度狭窄亚组血清ApoB/ApoA1比值、TG/HDL-C比值、LDH及ALP水平依次升高（P＜0.05）。CHD患者血清ApoB/ApoA1比值、TG/HDL-C比值、LDH、ALP水平与Gensini评分呈正相关（P均＜0.001）。多因素Logistic回归分析显示,高血压、血清ApoB/ApoA1比值、TG/HDL-C比值、LDH、ALP水平升高为CHD的独立危险因素（P＜0.05）。ROC曲线分析显示,血清ApoB/ApoA1比值、TG/HDL-C比值、LDH及ALP水平联合预测CHD的曲线下面积大于单独预测（P＜0.05）。结论：血清ApoB/ApoA1比值、TG/HDL-C比值、LDH、ALP水平与CHD患者冠状动脉病变严重程度有关,且联合预测CHD的价值较高。     

Prevalence and trends of common mental disorders from 2007-2009 to 2019-2022: results from the Netherlands Mental Health Survey and Incidence Studies (NEMESIS), including comparison of prevalence rates before vs. during the COVID-19 pandemic

Up-to-date information on the prevalence and trends of common mental disorders is relevant to health care policy and planning, owing to the high burden associated with these disorders. In the first wave of the third Netherlands Mental Health Survey and Incidence Study (NEMESIS-3), a nationally representative sample was interviewed face-to-face from November 2019 to March 2022 (6,194 subjects; 1,576 interviewed before and 4,618 during the COVID-19 pandemic; age range: 18-75 years). A slightly modified version of the Composite International Diagnostic Interview 3.0 was used to assess DSM-IV and DSM-5 diagnoses. Trends in 12-month prevalence rates of DSM-IV mental disorders were examined by comparing these rates between NEMESIS-3 and NEMESIS-2 (6,646 subjects; age range: 18-64 years; interviewed from November 2007 to July 2009). Lifetime DSM-5 prevalence estimates in NEMESIS-3 were 28.6% for anxiety disorders, 27.6% for mood disorders, 16.7% for substance use disorders, and 3.6% for attention-deficit/hyperactivity disorder. Over the last 12 months, prevalence rates were 15.2%, 9.8%, 7.1%, and 3.2%, respectively. No differences in 12-month prevalence rates before vs. during the COVID-19 pandemic were found (26.7% pre-pandemic vs. 25.7% during the pandemic), even after controlling for differences in socio-demographic characteristics of the respondents interviewed in these two periods. This was the case for all four disorder categories. From 2007-2009 to 2019-2022, the 12-month prevalence rate of any DSM-IV disorder significantly increased from 17.4% to 26.1%. A stronger increase in prevalence was found for students, younger adults (18-34 years) and city dwellers. These data suggest that the prevalence of mental disorders has increased in the past decade, but this is not explained by the COVID-19 pandemic. The already high mental disorder risk of young adults has particularly further increased in recent years.     

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.     

Effect of nitrogen application on growth and photosynthetic nitrogen use efficiency in two ecotypes of wild strawberry, Fragaria chiloensis

The relationships between increasing nitrogen fertilization and growth, maximum CO₂ assimilation and the initial slope of the CO₂ response curve were studied in 2 ecotypes of wild strawberry, Fragaria chiloensis (L.) Duchn. Nitrogen accumulation of CA11, an ecotype from a low-nutrient dune site, was greater at all nitrogen concentrations than that of RCP37, an ecotype from a higher-nutrient strand site. Maximum CO₂ assimilation, total Rubisco activity, dry weight, and initiation of leaves and crowns were higher in CAI1 than RCP37 as nitrogen treatment was increased from 0 to 200 mg ^l-1, whereas these parameters were lower in CAl1 when fertilized at 300 mg T¹, but not in RCP37. The mean leaf area of CA11 was greater than RCP37 when grown with no supplemental nitrogen, but mean leaf area of the 2 lines was similar under nitrogen fertilization. Maximum CO₂ assimilation and carboxylation efficiency increased with increasing leaf nitrogen in both clones. At equivalent concentrations of leaf nitrogen, RCP37 had higher CO₂ assimilation and carboxylation efficiency than CA11 and the difference between the 2 clones increased as ieaf nitrogen increased. Thus, RCP37 had a higher photosynthetic nitrogen use efficiency than CA11. However, at a given applied nitrogen level, CA11 allocated more nitrogen to a unit of leaf area so that photosynthetic rates were higher than RCP37, except at the highest application of 300 mg ^l-1. The high nitrogen accumulation capacity and resource allocation to fruiting structures (crowns) in CA11 leads us to suggest that this clone may possess genes that could increase fruit yield in cultivated strawberry.     

Spatial ecology of golden jackal in farmland in the Ethiopian Highlands

The spatial ecology of golden jackal Canis aureus was studied on farmland adjacent to the Bale Mountains National Park in southern Ethiopia during 1998–2000. Three adult and four subadult jackals were captured in leg‐hold traps and radiotagged. The range size of the adult jackals varied from 7.9 to 48.2 km² and the subadults from 24.2 to 64.8 km² . These ranges are the largest recorded for this species. Range overlap of the tagged jackals averaged 54%, which, in conjunction with observations of associations between individuals, suggested that all the tagged jackals belonged to one social group. Tagged jackals were observed alone on 87% of occasions despite the extensive overlap in individual ranges. Pairs consisting of a male and female were the most commonly observed group and larger groups were seen on only five occasions. Jackals in this population appeared less gregarious than observed elsewhere. The jackals used all the habitats available to them, particularly at night when they foraged in Artemesia and Hypericum bush and farmland. During the day they were more frequently found in Hagenia and Juniper woodland and their diurnal resting sites were characterized by thick cover. This is the first detailed study of golden jackals in a human‐modified landscape in Africa and further demonstrates the flexibility in behaviour and ecology exhibited by this species throughout its range.     

Use of Restored Small Wetlands by Breeding Waterfowl in Prince Edward Island, Canada

Abstract Since 1990 under the Eastern Habitat Joint Venture over 100 small wetlands have been restored in Prince Edward Island, Canada. Wetlands were restored by means of dredging accumulated sediment from erosion to emulate pre‐disturbance conditions (i.e., open water and extended hydroperiod). In 1998 and 1999 we compared waterfowl pair and brood use on 22 restored and 24 reference wetlands. More pairs and broods of Ring‐necked Ducks, Gadwall, Green‐winged Teal, and American Black Ducks used restored versus reference wetlands. In restored wetlands waterfowl pair density and species richness were positively correlated with wetland/cattail area, percent cattail cover, and close proximity to freshwater rivers. In addition, a waterfowl reproductive index was positively correlated with percent cattail cover. Green‐winged Teal pair occurrence in restored wetlands was positively correlated with greater amounts of open water and water depths. American Black Duck pairs occurred on most (86%) restored wetlands. Restored small wetlands likely served as stopover points for American Black Duck broods during overland or stream movements, whereas they likely served as a final brood‐rearing destination for Green‐winged Teal broods. We suggest that wetland restoration is a good management tool for increasing populations of Green‐winged Teal and American Black Ducks in Prince Edward Island.