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目的应用氢质子磁共振波谱成像（1H-MRS）技术,探讨卒中后抑郁（PSD）患者小脑代谢的改变及其与抑郁严重程度的关系。方法以卒中患者作为研究对象,回顾性收集人口学、个人疾病史和生活方式的数据,对40例卒中患者及20例健康志愿者进行自评抑郁量表（SDS）和汉密尔顿抑郁量表（HAMD）评分。根据评分结果,将卒中患者分为卒中后抑郁（PSD）组和卒中后无抑郁（CONT）组。对PSD组、CONT组和正常对照（NORM）组进行T1WI、T2WI、DWI及1H-MRS检查,评估脑梗死体积和脑白质病变部位及严重程度,测定小脑半球N-乙酰天冬氨酸（NAA）/肌酸（Cr）、胆碱复合物（Cho）/Cr、Cho/NAA比值,并分析卒中后小脑代谢改变与HAMD评分间的关系。结果 CONT组双侧小脑NAA/Cr、Cho/Cr、Cho/NAA比值与NORM组比较差异均无统计学意义（P〉0.05）。与NORM组和CONT组比较,PSD组病灶对侧小脑Cho/Cr、Cho/NAA比值均较高（P〈0.05）,病灶同侧小脑Cho/Cr、Cho/NAA比值差异无统计学意义（P〉0.05）,而双侧小脑NAA/Cr比值差异无统计学意义（P〉0.05）。PSD组家庭APGAR问卷评分、ARWMC总分、发病14d时NIHSS评分、病灶对侧小脑Cho/Cr和Cho/NAA比值与CONT组比较差异有统计学意义（P〈0.05）。多重线性回归分析显示,病灶对侧小脑Cho/Cr、Cho/NAA比值与HAMD评分具有相关性（P〈0.05）。结论小脑可能参与了卒中后抑郁的发生。

目的研究非ST段抬高急性冠脉综合征（NSTE-ACS）患者血浆可溶性CD40配体（sCD40L）水平和脂蛋白相关磷脂酶A2（Lp-PLA2）水平对冠心病危险性的评估价值。方法选取2014年9月至2015年3月住院并行冠脉造影确诊的冠心病患者96例,其中稳定型心绞痛（SAP）患者28例,不稳定型心绞痛（UAP）患者38例,急性非ST段抬高心肌梗死（NSTEMI）患者30例;选取同期冠脉造影正常的非冠心病患者（NC）30例作为对照组。采用ELISA法测定各组血浆sCD40L和Lp-PLA2水平,比较不同组间水平的差异;用冠脉Gensini积分评价NSTE-ACS患者冠脉病变严重程度,分析sCD40L、Lp-PLA2水平与冠脉Gensini积分的相关性;同时对NSTE-ACS患者入院时行GRACE危险评分,分析sCD40L、Lp-PLA2水平与GRACE危险评分的相关性。结果 1NSTEMI、UAP组sCD40L水平高于SAP和NC组（P〈0.05）,NSTEMI和UAP两组间差异无统计学意义（P〉0.05）,SAP和NC两组间差异无统计学意义（P〉0.05）;NSTEMI组Lp-PLA2水平高于UAP、SAP和NC组（P〈0.05）,UAP组Lp-PLA2水平高于SAP和NC组（P〈0.05）,差异有统计学意义（P〈0.05）。2冠心病患者血浆sCD40L水平与Lp-PLA2水平明显相关（r=0.284,P〈0.01）,sCD40L水平和Gensini积分、GRACE危险评分明显相关（r=0.213,P〈0.05;r=0.224,P〈0.05）;Lp-PLA2水平与冠脉Gensini积分、GRACE危险评分明显相关（r=0.270,P〈0.05;r=0.323,P〈0.01）。3Logistic回归分析结果显示血浆Lp-PLA2水平是NSTE-ACS独立相关因素（P〈0.05）。结论 NSTE-ACS患者血浆sCD40L和Lp-PLA2水平明显增高,与冠脉病变严重程度相关,并提示冠状动脉粥样硬化斑块的不稳定性,可作为冠心病患者危险评估的预测指标。

目的观察大鼠饮用不同剂量氟水后发生中、重度氟斑牙的下颌切牙超微结构。方法给SD雄性大鼠分别自由饮用0、25、50、100mg/L的含氟水,于不同的时间点用数码相机对大鼠下颌切牙进行唇侧正位照相,将中、重度氟斑牙的左、右侧下颌切牙分别进行扫描电镜及透射电镜的超微结构观察。结果正常鼠切牙的釉质是一层由成釉细胞形成的棕色色素薄层,呈橘黄色、棕黄色;中度氟斑牙表面呈现不同程度棕、白色相间的水平状条纹,透光度降低;重度氟斑牙牙面出现白垩色外观,不透明。扫描电镜显示正常大鼠下颌切牙牙面平整、致密,仅在颈部有小的点窝;中、重度氟斑牙牙面粗糙,点窝在牙冠和牙颈部都明显存在,颈部甚至出现堆积的无釉柱状突起。透射电镜显示随着氟斑牙严重程度加重成釉细胞呈现一系列细胞凋亡的迹象。结论不同程度的氟斑牙分泌期成釉细胞呈现一系列细胞凋亡迹象,且氟斑牙越严重,细胞凋亡的改变越明显。

目的分析双源CT双能量肺灌注成像（DEPI）技术评价急性肺动脉栓塞（APE）严重程度的可行性。方法经双源CT诊断APE24例,采用Lung PBV软件进行数据处理,得到CT肺血管图像（CTPA）和DEPI,分别计算每位患者的灌注缺损指数、栓塞指数及双室短轴最大径比（RV/LV）,依据患者严重程度分为严重APE组（n=9）和非严重APE组（n=15）,比较两组灌注缺损指数、栓塞指数及RV/LV,并进行Spearman等级相关分析。结果严重APE组的灌注缺损指数、栓塞指数及RV/LV中位数分别为32.5%（15.0%62.5%）、45.0%（27.5%75.0%）和1.16（1.041.45）,而非严重APE组分别为12.5%（0%37.5%）、12.5%（2.5%42.5%）和1.03（0.851.41）,严重APE组的各项指标均高于非严重组,两组间差异有统计学意义（P〈0.05）。相关分析显示,灌注缺损指数与RV/LV及栓塞指数均呈正相关（分别为r=0.635,P〈0.05;r=0.790,P〈0.05）。结论采用双源CT双能量肺灌注成像技术评价APE严重程度具有一定可行性。

目的以现行的哮喘病情分级为对照,探讨哮喘日志与肺通气功能对应监测在支气管哮喘（简称哮喘）治疗中的价值。方法入组的137例哮喘患者进行现行分级评估后,进入最少每天5次的哮喘日志和肺通气功能对应监测,对所获得的临床资料进行统计学处理和综合分析。结果完成监测的126例患者中,仅有61例（48.41%）可按《支气管哮喘防治指南》进行分级。发现了症状感知敏感者27例（21.43%）,症状感知迟钝型33例（26.19%）。结论哮喘日志与肺通气功能对应监测不仅可准确地评价哮喘的病情严重程度,还可发现症状感知偏差的哮喘患者。

目的研究惊恐障碍患者童年期创伤经历是否与疾病严重程度相关.方法采用儿童期创伤问卷（CTQ）对在四川省人民医院心身医学科住院患者中,符合《精神障碍诊断与统计手册（第4版）》（DSM-IV）惊恐障碍诊断标准的早年（16岁以前）有过负性经历的90名患者进行调查,采用惊恐障碍严重程度量表（PDSS）评估惊恐障碍严重程度,分析童年期创伤经历与疾病严重程度的关系.结果根据CTQ结果,90名惊恐障碍患者中,情感虐待的检出率为64.8%,躯体虐待检出率为40.7%,性虐待检出率为31.9%,情感忽视检出率为89.0%,躯体忽视检出率为91.2%.CTQ总评分（40.65±11.34）分,PDSS评分（12.75±5.61）分,CTQ总评分及各种创伤经历与惊恐严重程度无线性相关.结论惊恐障碍患者童年期创伤经历与惊恐障碍严重程度无线性相关.

Chemerin is present in various inflammatory sites and is closely involved in tissue inflammation. Recent studies have demonstrated that chemerin treatment can cause either anti-inflammatory or pro-inflammatory effects according to the disease model being investigated. Elevated circulating chemerin was recently found in patients with inflammatory bowel disease （IBD）; however, the role of chemerin in intestinal inflammation remains unknown. In this study, we demonstrated that the administration of exogenous chemerin （aa 17-156） aggravated the severity of dextran sulfate sodium （DSS）-induced colitis, which was characterized by higher clinical scores, extensive mucosal damage and significantly increased local and systemic production of pro-inflammatory cytokines, including IL-6, TNF-a and interferon （IFN-7）. Interestingly, chemerin did not appear to influence the magnitudes of inflammatory infiltrates in the colons, but did result in significantly decreased colonic expression of M2 macrophage-associated genes, including Arginase 1 （Arg-1）, Yml, FIZZ1 and IL-IO, following DSS exposure, suggesting an impaired M2 macrophage skewing in vivo. Furthermore, an in vitro experiment showed that the addition of chemerin directly suppressed M2 macrophage-associated gene expression and STAT6 phosphorylation in IL-4-stimulated macrophages. Significantly elevated chemerin levels were found in colons from DSS-exposed mice and from ulcerative colitis （UC） patients and appeared to positively correlate with disease severity. Moreover, the in vivo administration of neutralizing anti-chemerin antibody significantly improved intestinal inflammation following DSS exposure. Taken together, our findings reveal a pro-inflammatory role for chemerin in DSS-induced colitis and the ability of chemerin to suppress the anti-inflammatory M2 macrophage response. Our study also suggests that upregulated chemerin in inflamed colons may contribute to the pathogenesis of IBD.

Background： Postmastectomy pain syndrome （PM PS） is defined as a chronic （continuing for 3 or more months） neuropathic pain affecting the axilla, medial arm, breast, and chest wall after breast cancer surgery. The prevalence of PMPS has been reported to range from 20% to 68%. In this study, we aimed to determine the prevalence of PMPS among mastectomy patients, the severity of neuropathic pain in these patients, risk factors that contribute to pain becoming chronic, and the effect of PMPS on life quality. Methods： This cross-sectional study was approved by the Sakarya University, Medical Faculty Ethical Council and included 146 patients ranging in age from 18 to 85 years who visited the pain clinic, general surgery clinic, and oncology clinic and had breast surgery between 2012 and 2014. Patients were divided into two groups according to whether they met PMPS criteria： pain at axilla, arm, shoulder, chest wall, scar tissue, or breast at least 3 months after breast surgery. All patients gave informed consent prior to entry into the study. Patient medical records were collected, and pain and quality of life were evaluated by the visual analog scale （VAS） for pain, a short form of the McGill Pain Questiomlaire （SF-MPQ）, douleur neuropathique-4 （DN-4）, and SF-36. Results： Patient mean age was 55.2 ± 11.8 years （33.0-83.0 years）. PMPS prevalence was 36%. Mean scores on the VAS, SF-MPQ, and DN-4 in PMPS patients were 1.76 ±2.38 （0-10）, 1.73 ± 1.54 （0-5）, and 1.64 ± 2.31 （0-8）, respectively. Of these patients, 31 （23.7%） had neuropathic pain characteristics, and 12 （9.2%） had phantom pain according to the DN-4 survey. Patients who had modified radical mastectomy were significantly more likely to develop PMPS than patients who had breast-protective surgery （P = 0.028）. Only 2 （2.4%） of PMPS patients had received proper treatment （anticonvulsants or opioids）. Conclusions： PMPS seriously impacts patients＇ emotional situation, daily activities, and social relationships and is a majior economic burden for health systems. We conclude that the rate of PMPS among patients receiving breast cancer surgery in Turkey is 64.1% and that challenges to the proper treatment of these patients deserve further investigation.

Background: Early adversity (EA) can contribute to the onset, manifestation, and course of various mental disorders. Measuring EA is still conceptually and psychometrically challenging due to issues such as content coverage, item-wording, scaling methods, and validation procedures. Further, despite research demonstrating the importance of the severity of EA, most EA scales solely focused on the 'presence-versus-absence' indicator of adverse events. Objective: To address these potentially relevant gaps, we have developed a 13-item measure of EA, the Youth and Childhood Adversity Scale (YCAS). Beyond a dichotomous assessment of whether a set of adverse events have been experienced, this scale also assesses the respective severity of these events. Methods: We evaluated the YCAS in a sample of 596 adolescent students (ages 16-19) and a second sample of 451 medical students (ages 18-30+). Exploratory factor analysis was used to determine the underlying structure as proposed by the data, which was then tested with confirmatory factor analysis. We psychometrically assessed both factor scores and sum scores. Results: In both samples, a one-factorial solution was found for both responses to dichotomous items and severity items. Item loadings had a broad range, with minimum loadings of .1-.2 and maximum loadings of .7-.9. Irrespective of the response type, this factor exhibited good reliability (omega total, range: .80 − .89) and was associated with a range of mental-health outcomes, self-esteem, and childhood maltreatment. The fit of the model resembling sum scores was not satisfactory, but the sum score reliability (coefficient alpha, range: .78 − .89) was acceptable and most of the associations with the validation measures held. Conclusions: The YCAS allows an efficient, reliable, and valid assessment of EA and its severity. It covers a reasonable breadth of events, whilst simultaneously being parsimonious. We discuss next steps of how to improve this measure to fully capture the complexity of EA. We present the Youth and Childhood Adversity Scale (YCAS), measuring the presence and severity of adversities. Both yes/no and severity ratings had a 1-factor solution of good reliability and validity. Further refinement of the YCAS, eg improved content breadth, is suggested.

Complement 5a （C5a） has been implicated in the pathogenesis of sepsis by inducing the functional impairment of neutrophils; however, the utility of C5a receptors （C5aRs; C5aR and C5L2） as biomarkers for the management of sepsis is uncertain. This study investigated the dynamic expression of C5aR and C5L2 on neutrophits and their effects on neutrophil function. We found that sepsis patients displayed low expression levels of C5aR and C5L2 on neutrophils compared to healthy and systemic inflammatory response syndrome （SIRS） subjects, and this expression pattern was correlated with disease severity. Additionally, the expression levels of C5aR and C5L2 were associated with the survival of sepsis patients. In vitro, the addition of C5a significantly reduced C5aR and C5L2 expression levels and IL-8 production in neutrophils from sepsis patients. Those findings suggest that the reduced expression of C5aRs was associated with the functional impairment of neutrophils and a poor prognosis for sepsis patients. Overall, these findings may help establish C5aRs expression levels as early markers to predict the severity of sepsis.