目的 探讨创伤中心严重多发伤患者谵妄的发生情况及其危险因素.方法 选取2021年6月-2022年1月收治的168例严重多发伤患者,采用意识模糊评估量表(CAM)评估患者谵妄发生情况,并根据是否发生谵妄,分为谵妄组(n=65)和非谵妄组(n=103).收集患者资料并分析其发生谵妄的危险因素.结果 共收集168例创伤中心严重多发伤患者临床资料,其中发生谵妄患者为65例,发生率为38.69％.2组患者在年龄、机械通气、低氧血症(动脉血氧分压＜60 mmHg)、由ICU转出至创伤中心、创伤时发生昏迷、合并高血压病史、合并脑外伤、有创操作、疾病严重程度方面比较,差异均有统计学意义(P＜0.05).多因素Logistic回归分析显示,年龄＞60岁、机械通气、低氧血症(动脉血氧分压＜60 mmHg)、由ICU转出至创伤中心、创伤时发生昏迷、合并高血压病史、合并脑外伤、有创操作、疾病严重程度高[急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分＞21分]是创伤中心严重多发伤患者并发谵妄的独立危险因素.结论 创伤中心严重多发伤患者的谵妄发生率较高,其并发谵妄的独立危险因素较多且涉及范围广泛,应及时发现并处理.

目的 通过有限元分析比较3种内固定方式治疗髋臼后壁骨折的生物力学性能,评估不同内固定方式的稳定性.方法 建立包括骨盆主要韧带及股骨上1/3的骨盆三维有限元模型,模拟骨折面积＞50％的髋臼后壁骨折,髋臼后壁骨折采用后柱钢板+空心钉(空心钉组)、后柱钢板+弹簧板(弹簧板组)、后柱钢板+弹簧板+空心钉(弹簧板+空心钉组)内固定,统一用后柱钢板压住骨折块.加载不同负荷模拟站立、前屈、侧弯三种运动状态,比较分析3组骨盆各部件与内固定物的应力分布及垂直位移.结果 骨盆模型生物力学传递途径与既往研究高度一致,表明模型的可靠性与内固定治疗的有效性.相同载荷下空心钉组骨盆和内固定物的应力最大.空心钉组骨折区域的最大应力、垂直位移、内固定物与骨折区域应力差值均大于弹簧板组与弹簧板+空心钉组,而弹簧板+空心钉组最小.结论 上述3种内固定方式治疗髋臼后壁骨折均能取得良好的生物力学稳定性,但后柱钢板+弹簧板+空心钉内固定能改善整体的应力分布,降低再骨折和内固定断裂的风险,同时能促进骨折愈合,表现出更好的生物力学相容性.

目的 分析德尔塔病毒疫情暴发期间医院急诊患者的特点及医院救治策略.方法 通过医院病历系统调取2021年8月、2020年8月、2019年8月的急诊就诊患者病历信息以及医院缓冲病房收治的患者病历信息,分析急诊就诊患者的特点,评价医院救治策略的效果.结果 2019年8月就诊患者数量总计19490例次,其中男性10182例次,女性9308例次.2020年8月就诊患者数量总计16872例次,其中男性8903例次,女性7969例次.2021年8月就诊患者数量总计12263例次,其中男性6544例次,女性5719例次.2021年8月急诊就诊患者的性别分布与2019年8月以及2020年8月比较,差异均无统计学意义(P＞0.05).2021年8月急诊外科就诊原因与2019年8月以及2020年8月比较,因外伤就诊比率下降,因泌尿系结石就诊比率增高,差异有统计学意义(P＜0.05).设立的缓冲病房在2021年8月期间共收治患者277例,所有患者连续3次核酸检测阴性后安全转入专科病房.结论 2021年8月德尔塔病毒疫情暴发期间,急诊各科室就诊患者数量较2019年、2020年同期均减少.医院在急诊前端要严格遵守规范的预检分诊流程,在急诊后端建立缓冲病房,将新型冠状病毒肺炎的院内感染风险降至最低.

OBJECTIVE:This research was designed to probe into the effects of unilateral and bilateral pedicle screw fixation on the VAS scores of low back pain, leg pain, ODI indexes and JOA scores in patients with lumbar degenerative diseases. METHODS:Totally 113 patients with lumbar degenerative diseases admitted in our hospital from February 2016 to December 2018 were collected as the research objects. Among them, 52 received bilateral pedicle screw fixation (BPSF) and 61 were treated by unilateral pedicle screw fixation (UPSF). The intraoperative blood loss, time of operation and hospitalization, and incidence of perioperative complications of the two groups were compared. The VAS scores, ODI indexes and JOA scores were assessed before operation and 6 and 12 months after treatment. The intervertebral fusion rates were compared, and the quality of life was evaluated by SF-36. RESULTS:The intraoperative blood loss in the observation group (OG) was higher than that in the control group (CG) (P<0.05), while the time of operation and hospital stay were obviously shorter (P<0.05). There was no marked difference in the incidence of perioperative complications (P>0.05). Before treatment, there was no remarkable difference in the VAS scores of low back pain, leg pain, ODI indexes and JOA scores (P>0.05). At 6 and 12 months after treatment, the first two parameters were remarkably lower than those before treatment, but the rest of the parameters were dramatically higher (P<0.05). The VAS scores and ODI indexes of the OG were markedly lower than those of the CG, while the JOA scores, fusion rates and quality of life were obviously higher (P<0.05). CONCLUSION:Bilateral pedicle screw fixation is valid and safe on lumbar degenerative diseases, which can improve patients' quality of life.

Objective:Through TTC staining, immunohistochemical analysis, RT-PCR and hind limb motor function evaluation and other experimental methods, to explore the regulatory mechanism of metformin on anti-apoptosis in rats with spinal cord injury (SCI).Methods:Establish a rat spinal cord injury model. Through Basso-Beattie -Bresnahan locomotor rating scale (BBB) and cant test to evaluate the recovery of hindlimb motor function in rats. The changes of necrotic area of spinal cord tissue were compared by TTC staining. Extraction of rat spinal cord tissue, by Dot blot analysis and immunohistochemical detection of the hydroxyl of DNA methylation level. By qPCR, Western Blot detection TET2mRNA and protein expression level, and the changes in the scope of spinal cord injury were detected by inhibiting the expression of TET2. The interaction between TET2 and Foxo3a was detected by immunoblotting and immunoprecipitation. Through RT-PCR assay Foxo3a downstream related changes in the level of gene expression.Results:Compared with the SCI+NS group, the necrotic area of the spinal cord tissue was reduced after metformin treatment, and the BBB score and the incline test score were higher ( P<0.05). At the same time, we found that the levels of TET2mRNA and protein increased significantly after SCI at 24 h, and the 5-hmC level of DNA increased. The levels of TET2mRNA and protein and 5-hmC increased further after the use of metformin. After using SC-1, compared with the SCI+MET group, the level of 5-hmC decreased and the area of infarction increased. After SCI, the mRNA levels of downstream genes Bim, P27kip, Bax increased significantly. After metformin treatment, the mRNA levels of Bim and Bax were lower than those in the SCI+NS group ( P<0.05). After SCI, the 5-hmC levels of downstream genes Bim, P27kip, Bax increased significantly. After metformin treatment, the 5-hmC levels of Bim and Bax were lower than those in the SCI+NS group ( P<0.05). Conclusion:Metformin can promote the interaction between TET2 and Foxo3a, increase the 5-hmC level of the overall DNA, and inhibit the activation of related apoptosis genes, thereby improving tissue damage and nerve function recovery after spinal cord injury.

目的 探讨Nogo-A启动子的地塞米松结合区域以及相关的转录因子.方法 构建不同长度的Nogo-A启动子并插入pGL3基本载体中,然后将其转染到SGC-7901细胞中.采用不同剂量的地塞米松处理转染细胞.通过荧光分析探讨Nogo-A启动子的地塞米松结合区域.利用生物信息学方法对此段序列转录因子结合位点进行分析.结果 Nogo-A启动子的地塞米松结合区域在-1 218～-833碱基对(bp)区间.目标区域有90种可能的转录因子.Nogo-A启动子区域无CpG岛存在.结论 地塞米松可能通过转录因子c-Jun与Nogo-A启动子上游-1218～-833 bp区域结合来调控Nogo-A.

目的 采用同位素相对标记与绝对定量技术(iTRAQ技术)分析骨质疏松症患者和健康人的血清样本中的差异蛋白定量结果,从中筛选并鉴定出骨质疏松症早期诊断的特异性血清蛋白标志物.方法 抽取符合入组条件的健康人群和老年性骨质疏松症人群的血清样本各24份,采用iTRAQ技术对各组样本进行蛋白定量定性分析,对比各组样本中蛋白质组的差异性,筛选出存在显著差异(差异倍数＞1.2,P＜0.01)的特异性蛋白.经查阅uniport数据库及相关文献,分析特异性蛋白的特性及其与骨质疏松症的相关性,以初步鉴定出骨质疏松症早期诊断的特异性血清蛋白标志物.结果 通过iTRAQ技术共筛选出31个骨质疏松症相关差异蛋白,其中8个上调,23个下调.筛选出Ephrin A型受体4(EphA4)、角蛋白(KRT)、破骨细胞刺激因子1(OSTF1)作为骨质疏松症患者潜在的生物标志物.结论 根据生物通路分析(IPA)结果及各差异蛋白生物生理功能,进一步筛选出EphA4、KRT、OSTF1共3个差异蛋白,初步认定为骨质疏松症早期诊断的潜在蛋白标志物.