目的 探讨“5.12”地震后北川羌族人群中类风湿关节炎（RA）患者外周血 T细胞亚群的表达情况并分析创伤后应激障碍（PTSD）对RA患者细胞免疫之间的影响。 方法 2009年3月－2010年3月，对98例北川羌族RA患者、112例健康对照，以及同期绵阳郊区84例RA患者、120例健康对照进行分析。用流式细胞仪分别检测CD3+、CD3+CD4+、CD3+ CD8+ T淋巴细胞数及CD4/+CD8+比值， RA疾病活动性采用DAS28测定，应用美国精神障碍诊断与统计手册第4版（DSM-Ⅳ）诊断标准调查RA人群中的PTSD患者，应用PTSD检查表平时版（PCL-C）检查对PTSD患者进行分析。 结果 北川羌族与绵阳郊区RA活动组患者（分别为58例、39例）与健康对照组比较，CD8+ T淋巴细胞数降低，CD+4/CD8+比值增高，差异有统计学意义（P＜0.05）；北川羌族RA活动组与绵阳郊区RA活动组比较，CD3+ T淋巴细胞数降低，差异有统计学意义（P＜0.05）。北川RA患者中PTSD者（38例）与非PTSD者（60例）比较，PTSD组CD3+ T淋巴细胞数和CD4+/CD+8比值均明显低于PTSD组，差异有统计学意义（P＜0.05）；PCL-C对北川RA患者中PTSD的测定发现，PCL高分组CD3+ T淋巴细胞数显著低于PCL低分组（P＜0.05）。 结论 “5.12”地震后一部分RA患者出现T细胞免疫功能异常，且免疫功能异常与PTSD有关，对合并有PTSD的进行RA患者早期心理干预及药物治疗，改善患者生存质量。
Objective To investigate the status and influencing factors of psychosis-related post-traumatic stress disorder (PR-PTSD) in hospitalized patients with schizophrenia. Methods A questionnaire survey was conducted among the hospitalized patients with schizophrenia in three grade Ⅱ or above psychiatric hospitals in Chengdu between March and July, 2022, using the convenient sampling method. Questionnaires included the General Information Questionnaire, Impact of Event Scale-revised (IES-R), Self-rating Depression Scales, Simplified Coping Style Questionnaire, and Intolerance of Uncertainty Scale. If the score showed skewed distribution, it was expressed by the median (lower quartile, upper quartile). According to IES-R score, the patients included were divided into 2 groups. The patients whose score ≥33 were divided into PR-PTSD group, and <33 were divided into non-PR-PTSD group. The general information of the two groups of patients were compared. The correlation between PR-PTSD and depression, coping style and intolerance of uncertainty of the included patients were analyzed. The factors affecting the PR-PTSD of hospitalized patients with schizophrenia were analyzed by multivariate binary logistic regression analysis. Results A total of 388 patients were included. Among them, there were 282 cases in the non-PR-PTSD group and 106 cases in the PR-PTSD group. The IES-R score was 23.00 (15.00, 33.00), the depression score was 45.00 (38.00, 53.00), the negative coping style score was 11.00 (8.00, 14.75), the positive coping style score was 20.00 (16.00, 25.00), and the intolerance of uncertainty score was 28.00 (22.25, 33.00). IES-R was positively correlated with depression (r=0.370, P<0.001), negative coping style (r=0.396, P<0.001), positive coping style (r=0.111, P=0.029) and intolerance of uncertainty (r=0.467, P<0.001). Regression analysis showed that depression [(odds ratio, OR)=1.073, 95% confidence interval (CI) (1.043, 1.105), P<0.001)], negative coping style [OR=1.121, 95%CI (1.040, 1.208), P=0.003], intolerance of uncertainty [OR=1.081, 95%CI (1.045, 1.118), P<0.001] were the influencing factors of PR-PTSD in hospitalized patients with schizophrenia. Conclusions The prevalence of PR-PTSD in hospitalized patients with schizophrenia is high. Depression, negative coping style and intolerance of uncertainty are the risk factors for PR-PTSD in hospitalized schizophrenia patients.
ObjectiveTo evaluate the treatment results of Ilizarov microcirculation reconstruction technique for chronic wounds in the post-traumatic ischemia limbs.MethodsBetween January 2016 and July 2019, 7 cases of chronic wounds in the post-traumatic ischemia limbs were treated. There were 5 males and 2 females, with an average age of 42.4 years (range, 29-66 years). The duration of the wound ranged from 1 month to 2 years (mean, 7.7 months). The wounds located in the leg (3 cases) or in the foot and ankle (4 cases). The wound sizes ranged from 4.0 cm×2.2 cm to 12.0 cm×7.1 cm. There were 1 case of tibial varus, 3 cases of equinovarus, 1 case of scleroderma, and 2 cases of Volkmann’s ischemic contracture. After debridement, external fixators were used for tibial transverse transport, or correction of tibial varus and correction of equinovarus.ResultsAll patients were followed up 8-20 months, with an average of 13 months. The infection of wound surface was all controlled in 7 cases and the granulation tissue grew well; the wound surface healed directly in 5 cases and healed after skin grafting in 2 cases, and the wound healing time was 1-3 months (mean, 1.7 months). During the follow-up, there was no recurrence of the wound. Six cases of limb deformity were corrected.ConclusionFor the chronic wounds in the post-traumatic ischemia limbs, Ilizarov microcirculation reconstruction technique can effectively improve local circulation and facilitate the fresh granule growth and wound healing.
目的 调查极重灾区某中学学生的创伤后应激障碍（PTSD）症状检出率及影响因素，为进一步开展灾后心理卫生服务提供依据。 方法 2008年9月下旬，对汶川地震的极重灾区都江堰某镇中学1 500名同学进行调查，获有效问卷1 498份。采用一般情况调查问卷、儿童事件影响量表（CRIES-13）中文版进行集体施测。 结果 某镇中学学生灾后4个月PTSD症状检出率29.71%（445/1 498）。经非条件逐步logistic回归筛选PTSD症状的影响因素有：地震时是否受伤（OR=1.995，P=0.000）、性别（OR=1.785，P=0.000）、绝望感（OR=1.597，P=0.000）、是否目睹死亡（OR=1.344，P=0.000）、年龄（OR=1.308，P=0.000）、是否目睹受伤（OR=1.262，P=0.000）、地震时是否被困（OR=1.209，P=0.011）、震后居住地点（OR=1.182，P=0.000）、是否目睹垮塌（OR=1.176，P=0.000）、家人情况（OR=1.104，P=0.000）、地震后是否住院（OR=0.828，P=0.041）12个因素。 结论 在灾后重建过程中，该中学的学生PTSD症状检出率较高，其与地震时是否受伤、性别、绝望感、是否目睹死亡、年龄、是否目睹受伤、地震时是否被困、震后居住地点、是否目睹垮塌、家人情况、地震后是否住院呈显著相关。
Objective To summarize and analyze the characteristics and treatment strategies of post-traumatic lower limb deformity based on QIN Sihe Orthopaedic Surgery Database. Methods A clinical data of 837 patients with post-traumatic lower limb deformities treated by orthopaedic surgery between May 25, 1978 and December 31, 2020 in QIN Sihe Orthopaedic Surgery Database were analyzed retrospectively. The information of the patient’s gender, age at the time of surgery, region of origin, cause of trauma, deformity side, orthopedic surgery related information (operation time, location, type, and fixation method after operation) were summarized and analyzed. ResultsAll patients came from 32 provinces, municipalities, autonomous regions, and Taiwan in China. Among them, 551 cases (65.83%) were male and 286 cases (34.17%) were female. The age of the patients at the time of surgery was 3-84 years old, with an average of 27.6 years old, and the most patients were 16-45 years old (559 cases, 66.78%). The main cause of trauma was traffic accident injury (639 cases, 76.34%). The deformity mainly involved unilateral limbs, including 394 cases (47.07%) on the left side and 376 cases (44.92%) on the right side. The most patients were admitted between 2008 and 2017, accounting for 53.05% (444/837). All patients were operated on one or more sites (1 048 sites), among which ankle and toe surgery were the most, accounting for 48.38% (507/1 048). The patients received 1204 surgeries including tendon lengthening and soft tissue contracture release, et al. Orthopedic surgery combined with bone external fixation was used in 624 cases (467 cases of Ilizarov external fixation and 157 cases of combined external fixation), and plaster or brace external fixation was used in 213 cases. Conclusion Post-traumatic lower extremity deformity patients have a large proportion of males, with a wide geographical distribution, involving various parts of the lower extremities, and most commonly in the foot and ankle. Orthopedic surgery combined with bone external fixation (Ilizarov technique) is the main methods for correction and functional reconstruction of post-traumatic lower limb deformity.
ObjectiveTo systematically review the efficacy of ICU diaries on psychological outcomes, cognition and health-related quality of life in both patients and their relatives. MethodsThe PubMed, Embase, Web of Science, Cochrane Library, PsycINFO, CNKI, WanFang Data and VIP database were electronically searched to collect trails related to the objective from inception to August 2023. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.3 software. ResultsA total of 17 studies involving 2 093 patients and 786 relatives were included. The results of meta-analysis showed that compared with the control group, ICU diaries could improve patients’ post-traumatic stress disorder (PTSD) (RR=0.64, 95%CI 0.50 to 0.83, P<0.01), depression (RR=0.65, 95%CI 0.48 to 0.89, P<0.01) and quality of life (MD=7.78, 95%CI 4.37 to 11.18, P<0.01) significantly. However, there were no significant differences in patients’ anxiety, memory and relatives’ psychological outcomes. ConclusionCurrent evidence shows that the use of ICU diaries can reduce the incidence rate of patients’ PTSD, depression and improve their quality of life, but other effects are unclear. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
目的:探讨5·12 四川汶川大地震对系统性红斑狼疮(SLE)病情活动性的影响,以及因地震造成的停药、感染、居住环境恶劣(长期紫外线照射)和创伤后应激障碍(posttraumatic stress disease,PTSD)与病情活动性的相关性。方法:分析41例重灾区(北川、平武、江油、安县)SLE患者地震前后实验室指标和临床表现变化情况,采用Logistic回归分析地震造成停药、感染、居住环境恶劣和PTSD四种因素对SLE病情活动性的影响。结果:41例SLE患者地震后有18例病情活动,其中有27%患者出现关节痛,24%出现颜面红斑,19.5%出现发热,22%合并狼疮肾炎，震后C3水平显著低于震前。震后6例患者感染,13例患者停药,16例患者长期居住于恶劣环境中,11例患者患PTSD。通过Logistic回归分析发现PTSD、停药、居住条件恶劣与地震后SLE患者病情活动相关。结论:地震可使一部分重灾区SLE患者病情出现活动,PTSD、停药、居住条件恶劣与SLE病情活动具有相关性。