ObjectiveTo systematically evaluate the correlation between interpersonal stress and suicidal ideation. MethodsThe PubMed, EMbase, Cochrane Library, CBM, WanFang Data and CNKI databases were searched to collect studies on the correlation between interpersonal pressure and suicidal ideation from database inception to April 27, 2022. Two researchers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed using Stata 14.0 software. ResultsA total of 42 studies including 3 cohort studies, and 39 cross-sectional studies, with a total sample size of 193 810 participants were included. Meta-analysis showed that the risk of suicidal ideation was higher in people who had experienced interpersonal pressure than in people who had not (OR=2.11, 95%CI 1.99 to 2.23, P<0.01). Subgroup analysis showed that people in the Americas who had experienced interpersonal pressure were more strongly associated with suicidal ideation than people in other regions of the studied area. Young adults in the study who had experienced interpersonal pressure were more strongly associated with suicidal ideation than other studied age groups; People who had experienced partner pressure were more strongly associated with suicidal ideation than those who had experienced other types of interpersonal pressure. ConclusionThis study shows that people who have experienced interpersonal pressure are at greater risk of suicidal ideation, and there are certain differences among study areas, subjects and types of interpersonal pressure. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo explore the effectiveness of using antibiotic bone cement-coated plates internal fixation technology as a primary treatment for Gustilo type ⅢB tibiofibular open fractures. Methods The clinical data of 24 patients with Gustilo type ⅢB tibiofibular open fractures who were admitted between January 2018 and December 2021 and met the selection criteria was retrospectively analyzed. Among them, there were 18 males and 6 females, aged from 25 to 65 years with an average age of 45.8 years. There were 3 cases of proximal tibial fracture, 6 cases of middle tibial fracture, 15 cases of distal tibial fracture, and 21 cases of fibular fracture. The time from injury to emergency surgery ranged from 3 to 12 hours, with an average of 5.3 hours. All patients had soft tissue defects ranging from 10 cm×5 cm to 32 cm×15 cm. The time from injury to skin flap transplantation for wound coverage ranged from 1 to 7 days, with an average of 4.1 days, and the size of skin flap ranged from 10 cm×5 cm to 33 cm×15 cm. Ten patients had bone defects with length of 2-12 cm (mean, 7.1 cm). After emergency debridement, the tibial fracture end was fixed with antibiotic bone cement-coated plates, and the bone defect area was filled with antibiotic bone cement. Within 7 days, the wound was covered with a free flap, and the bone cement was replaced while performing definitive internal fixation of the fracture. In 10 patients with bone defect, all the bone cement was removed and the bone defect area was grafted after 7-32 weeks (mean, 11.8 weeks). The flap survival, wound healing of the affected limb, complications, and bone healing were observed after operation, and the quality of life was evaluated according to the short-form 36 health survey scale (SF-36 scale) [including physical component summary (PCS) and mental component summary (MCS) scores] at 1 month, 6 months after operation, and at last follow-up. ResultsAll 24 patients were followed up 14-38 months (mean, 21.6 months). All the affected limbs were successfully salvaged and all the transplanted flaps survived. One case had scar hyperplasia in the flap donor site, and 1 case had hypoesthesia (grade S3) of the skin around the scar. There were 2 cases of infection in the recipient area of the leg, one of which was superficial infection after primary flap transplantation and healed after debridement, and the other was sinus formation after secondary bone grafting and was debrided again 3 months later and treated with Ilizarov osteotomy, and healed 8 months later. The bone healing time of the remaining 23 patients ranged from 4 to 9 months, with an average of 6.1 months. The scores of PCS were 44.4±6.5, 68.3±8.3, 80.4±6.9, and the scores of MCS were 59.2±8.2, 79.5±7.8, 90.0±6.6 at 1 month, 6 months after operation, and at last follow-up, respectively. The differences were significant between different time points (P<0.05). ConclusionAntibiotic bone cement-coated plates internal fixation can be used in the primary treatment of Gustilo type ⅢB tibiofibular open fractures, and has the advantages of reduce the risk of infection in fracture fixation, reducing complications, and accelerating the functional recovery of patients.
Objective The ReHo, ALFF, fALFF of resting-state functional magnetic resonance imaging (RS-fMRI) technology were used to study the influencing factors and neural mechanism of cognitive dysfunction in patients with benign epilepsy of childhood with centrotemporal spikes (BECT). Methods Fourteen patients were enrolled (from April 2015 to March 2018) from epilepsy specialist outpatients and Functional Department of Neurosurgery of Tianjin Medical University General Hospital. They underwent the long term VEEG monitoring (one sleep cycle was included at least), the Wechsler Intelligence Scale (China Revised), the head MRI and RS-fMRI examinations. Spike-wave index (SWI), FIQ, VIQ, PIQ scores were calculated. According to full-scale IQ (FIQ), they were divided into two groups: FIQ<90 (scores range from 70 to 89, the average score was 78.3±8.9, 6 cases) and FIQ≥90 (scores range from 90 to 126, the average score was 116.6±12.9, 8 cases). SPSS21.0 statistical software was used to compare the general clinical data and SWI of the two groups, and the correlation between clinical factors and the evaluation results of Wechsler Intelligence Scale was analyzed. The RS-fMRI images were preprocessed and the further data were analysed by two independent samplest-test under the whole brain of regional homogeneity (ReHo), amplitude of low frequency fluctuation (ALFF) and fractional of ALFF (fALFF) methods. The differences of brain activation regions in RS-fMRI between the two groups were observed, and the results of general clinical data, SWI and cognitive function test were compared and analyzed comprehensively. Results The differences of SWI were statistically significant (P<0.05): FIQ<90 group were greater than FIQ≥90 group. The FIQ, VIQ and PIQ of two groups were negatively correlated with SWI (P<0.05). And the FIQ and PIQ were negatively correlated with the total number of seizures (P<0.05). Compared with FIQ≥90 group by two samplet-test based on whole level ReHo, ALFF, fALFF methods, deactivation of brain regions of FIQ<90 group include bilateral precuneus, posterior cingulate and occipital lobe, and enhanced activation of brain regions include left prefrontal cortex, bilateral superior frontal gyrus medial and right precentral gyrus, supplementary motor area, angular gyrus, supramarginal gyrus, middle temporal gyrus, bilateral insular lobe and subcortical gray matter structures. Conclusions Frequent epileptic discharges during slow wave sleep and recurrent clinical episodes were risk factors for cognitive impairment in BECT patients. Repeated clinical seizures and frequent subclinical discharges could cause dysfunction of local brain areas associated with cognition and the default network, resulting in patients with impaired cognitive function.