雅安市精神障碍患者就诊情况及影响因素

目的 了解雅安市精神障碍患者就诊情况及影响因素，提高雅安市精神卫生服务利用质量。方法 采用分层整群随机抽样方法抽取雅安市6县2区9 000名居民作为调查对象，实际共8 876名完成调查。其中符合《精神障碍诊断与统计手册（第5版）》（DSM-5）诊断标准共1 106例，使用精神卫生服务利用调查表对精神障碍患者的就诊情况进行调查。采用χ²检验及Logistic二元回归对患者就诊情况的影响因素进行分析。结果 1 106例精神障碍患者中，曾到精神卫生专业机构就诊共173例，就诊率为15.64%（标化就诊率为15.62%）。就诊率排名后三位的病种为：物质相关及成瘾障碍（7.92%）、创伤及应激相关障碍（6.12%）、强迫及相关障碍（0.00%）。未就诊而采用自助方式者（求神拜佛、咨询亲友）共42例，其中汉族28例，少数民族14例。居住地为城市（OR=2.36，P<0.01）对精神障碍患者就诊有正向影响，家族史阴性（OR=0.49，P<0.01）、无就诊意愿（OR=0.07，P<0.01）对精神障碍患者就诊有负向影响。结论 雅安市精神障碍患者就诊率偏低，就诊方式以精神科住院及门诊就诊为主，居住地、家族史和就诊意愿影响精神障碍患者的就诊。     

Efficacy and safety of selective internal radiotherapy versus sorafenib for intermediate-locally advanced hepatocellular carcinoma: a systematic review and meta-analysis

Background: Sorafenib (SOR) is recommended for locally advanced and metastatic hepatocellular carcinoma (HCC), but the tolerability of SOR is unsatisfactory. Selective internal radiotherapy (SIRT) has shown efficacy in intermediate-locally advanced HCC patients. This meta-analysis aimed to compare the efficacy and safety of SIRT and SOR in the treatment of intermediate-locally advanced HCC.

Methods: We systematically searched the PubMed, Embase, Cochrane Library and Web of Science databases for eligible studies. The endpoints evaluated included the overall survival (OS), disease control rate (DCR), objective response rate (ORR) and grade≥3 adverse events (AEs).

Results: Six studies were included in this analysis. The OS was similar between the two groups (HR 1.06, 95%CI 0.93–1.20; P = 0.40). There was no difference in the DCR between the two groups (RR 1.13, 95%CI 0.87–1.46; P = 0.35). However, the ORR in the SIRT group was significantly higher than that in the SOR group (RR 4.10, 95%CI 1.92-8.76; P = 0.0003). The incidence rate of grade≥3 AEs was higher in the SOR group.

Conclusions: In patients with intermediate-locally advanced HCC, SIRT and SOR result in similar survival rates. The improved toxicity profile of SIRT may help when choosing between the two treatments.     

Characterization of viral genomic mutations in novel influenza A (H7N9)-infected patients: the association between oseltamivir-resistant variants and viral shedding duration

Since February 2013, human infections with the novel influenza A H7N9 virus have occurred in eastern China. It is important to detect mutations in viral genes and analyze the clinical features of patients and viral shedding duration related to neuraminidase inhibitor (NAI) resistance. We collected clinical specimens from 31 hospitalized H7N9 patients and sequenced NA, PB2, HA, and M gene fragments. Of the 31 identified patients, 7 (22.6%) carried the R292K substitution in NA, 30 (96.8%), 3 (9.7%), and 5 (16.1%) carried E627K, Q591K, and D701N mutations in PB2, respectively, and 2 (6.5%) carried both E627K and D701N mutations in PB2. All 26 identified patients harbored Q226L mutations and possessed only a single arginine (R) at cleavage sites in the HA and a S31N mutation in M2. Among 7 NA-R292K mutated patients, 3 died and 4 were discharged. There was no significant difference in the days that patients started oseltamivir treatment after symptom onset between NA-R292K mutant and NA-R292 wild-type patients (median days, 7 vs 6, P?=?0.374). NA-R292K mutant patients had a significantly longer duration of viral shedding than NA-R292 wild-type patients after oseltamivir treatment (median days, 10 vs 5, P?=?0.022). The mutation of R292K in NA conferring the potential ability of oseltamivir resistance resulted in prolonged viral duration and poor outcome and should be taken into consideration in the clinical management of infected patients.

     

《皮肤科学（非肿瘤性皮肤病）中皮肤镜术语和基本参数的标准化：国际皮肤镜协会专家共识》解读

【摘要】 为规范非肿瘤性皮肤病的皮肤镜检查标准，国际皮肤镜协会组织专家制定了《皮肤科学（非肿瘤性皮肤病）中皮肤镜术语和基本参数的标准化：国际皮肤镜协会专家共识》，该共识确定了5个标准化基本参数及31个子项，包括血管（形态和分布）、鳞屑（颜色和分布）、毛囊改变、其他结构（颜色和形态）、特异线索，并总结了它们的曾用名、组织病理学对应关系和主要涉及的疾病。本文通过介绍该共识，为未来相关中文皮肤镜术语及参数规范的制定提供参考，以期更好地规范皮肤镜在皮肤科学中的应用。     

缺血性脑卒中再发相关危险因素分析

目的探讨包括脑白质疏松(LA)在内的相关危险因素与缺血性脑卒中再发的关系。方法连续收集2010年1月至2014年12月在我院保健科、神经内科发病72 h内住院首发急性缺血性卒中患者751例,随访3年,入选患者701例,随访中再发患者124例为再发组;首发缺血性卒中患者577例为未再发组,比较分析两组患者危险因素。结果再发组患者LA程度高于未再发组(Z=-2.307,P=0.021);再发组血糖、血压、血脂控制达标率低于未再发组(均P<0.05)。Spearson相关分析与缺血性卒中再发患者呈正相关的因素为LA(r=0.451,P=0.007)、年龄(r=0.334,P=0.015)、血压(r=0.812,P=0.001)、血糖(r=0.637,P=0.002)、低密度脂蛋白胆固醇(LDL-C)(r=0.674,P=0.000)、总胆固醇(r=0.748,P=0.003)、三酰甘油(r=0.878,P=0.004)、吸烟(r=0.380,P=0.008);与脑卒中再发无明显相关的因素为性别(r=0.032,P=0.115)。二分类Logistics回归与缺血性卒中再发呈正相关因素为年龄(B=0.142,P=0.000)、血压(B=0.135,P=0.000)、LDL-C(B=1.141,P=0.001)、三酰甘油(B=0.367,P=0.036)、血糖(B=0.385,P=0.000);与缺血性卒中再发无相关的因素为LA(B=22.221,P=0.997)、总胆固醇(B=0.081,P=0.867)、吸烟(B=21.434,P=0.995)。结论年龄、高血糖、高血压、三酰甘油是缺血性卒中患者复发的独立危险因素,LA、总胆固醇、吸烟是缺血性卒中复发的混杂因素。进行积极危险因素干预治疗,对预防缺血性卒中复发有重要意义。     

胸水及血清中透明质酸水平在肺癌与肺良性疾病中的鉴别诊断意义

目的分析胸水及血清透明质酸(HA)水平在肺癌与肺良性疾病中的鉴别诊断意义。 方法选取我院2019年5月至2021年9月收治的37例肺癌患者为观察组，选取我院同期住院治疗的32例肺部良性病变为对照组。入院24 h内采集胸水及血液标本分别检HA水平；以磁微粒化学发光法检测血清鳞状上皮细胞癌抗原(SCC)、糖类抗原125(CA125)、神经元特异性烯醇化酶(NSE)、癌胚抗原(CEA)及细胞角蛋白19片段抗原21-1(CYFRA21-1)。比较两组胸水及血清中HA水平。 结果观察组胸水及血清HA水平高于对照组(P<0.05)。观察组胸水CEA、ADA高于对照组(P<0.05)。胸水CEA及ADA水平、胸水及血清HA、肿瘤标志物表达高，为影响肺癌患者发生的相关因素(P<0.05)。 结论肺癌患者胸水CEA及ADA水平、胸水及血清HA、肿瘤标志物五项SCC、CA125、NSE、CEA、CYFRA21-1水平呈异常表达，对肺癌具有鉴别诊断意义。     

Clinical and Contrast-enhanced Ultrasound Characteristics of Epithelioid and Classic Hepatic Angiomyolipoma: Comparison With Alpha-fetoprotein–negative Hepatocellular Carcinoma

Hepatic angiomyolipoma (HAML) comprises epithelioid angiomyolipoma (EAML) and classic hepatic angiomyolipoma (CAML). The imaging appearance of HAML varies widely, and EAML is more easily misdiagnosed as hepatocellular carcinoma (HCC) than as CAML. The clinical and contrast-enhanced ultrasound (CEUS) features of CAML, EAML and HCC with negative alpha-fetoprotein protein expression (HCC[AFP–]) were retrospectively reviewed. The hyper-vascular type was more commonly found in CAML and EAML lesions than in HCC lesions. Most lesions were hyper-enhanced in the arterial phase. CAMLs showed prolonged hyper-enhancement or iso-enhancement during the portal and late phases on CEUS, making them easily distinguishable from HCC(AFP–). Some EAML lesions (41.7%) were hypo-echoic, similar to HCC(AFP–). However, the hypo-enhancement of EAML lesions occurred later than that of HCC(AFP–) lesions. Thus, our findings may be useful in distinguishing among these lesions to improve diagnostic accuracy.     

The Acute Effects of Aerobic Dance Exercise with and without Face Mask Use on Attention,Perceived Exertion and Mood States

The present study aimed to determine the effect of wearing a face mask during aerobic dance exercise on cognitive function, more specifically on attention, as well as on perceived exertion and mood states. Thirteen healthy college students (9 males and 4 females: mean age = 17.5 years, height = 1.72 m, weight = 71.00 kg) volunteered to participate in this study. They were randomized to perform aerobic dance exercise while wearing a cloth face mask or no mask or a control condition (sitting on a comfortable chair and reading information about the health benefits of aerobic dance exercise) on three separate occasions (with at least one week of interval). Rate of perceived exertion (RPE), the Brunel Mood Scale (BRUMS) and d2 Attention assessment were assessed before and immediately after each condition. The results demonstrated higher concentration performance for the aerobic dance exercise without face mask than the control condition (p = 0.05). Post RPE and BRUMS fatigue subscale values were significantly higher in the aerobic dance exercise with face mask as compared to the aerobic dance exercise without face mask and control condition (all, p < 0.05). BRUMS vigor subscale value significantly differed across conditions (F = 113.84, p < 0.001, ES = 0.86) and was significantly higher in the aerobic dance exercise group without face mask as compared to the aerobic dance exercise with face mask and the control conditions (both, p < 0.001). This study suggests that face mask use during aerobic dance exercise with moderate intensity did not affect attention. Practitioners, students and athletes should avoid wearing face mask while practicing physical activity or aerobic dance exercise with moderate intensity to improve its acute effect on cognitive function.     

Turning duration and steps predict future falls in poststroke hemiplegic individuals: A preliminary cohort study

ABSTRACT

Introduction: Turning was reported as one of the activities that most frequently leads to falling among stroke patients. This study investigated whether the duration and steps of a 180° turn while walking can distinguish retrospective fallers from non-fallers and predict future falls in a 1-year period in patients with poststroke hemiplegia.

Methods: Thirty stroke patients were recruited. They were instructed to get up from a chair, walk straight 3 m, turn around, and return to seated position to assess the 180° walking-turn task. Turning performance was measured by two inertial sensor units of Physilog. Turn duration and steps were recorded for analysis. The numbers of retrospective and prospective falls were also obtained.

Results: No significant difference was observed between retrospective stroke fallers and non-fallers in turn duration and steps. Turn duration and steps were significantly greater in prospective stroke fallers than in non-fallers. The cutoff turn duration of 4 s (area under the curve 0.75, 95% CI: 0.56–0.93, sensitivity 67%, specificity 80%, p =.04) and turn step of 7 steps (area under the curve 0.73, 95% CI: 0.51–0.94, sensitivity 56%, specificity 85%, p =.05) were found to most accurately predict prospective stroke fallers from non-fallers.

Conclusions: Turn duration and steps were unable to discriminate between retrospective fallers and non-fallers but could predict prospective falls in patients with stroke. More than 4 s or 7 steps to complete a 180° turn while walking can be a predictor for patients with stroke at an increased risk of falling.     

TWEAK/Fn14 activation induces keratinocyte proliferation under psoriatic inflammation

Tumor necrosis factor (TNF)‐like weak inducer of apoptosis (TWEAK) has been reported to induce keratinocyte apoptosis in vitro by engaging its sole receptor of fibroblast growth factor‐inducible 14 (Fn14). In this study, we explored the role of TWEAK/Fn14 pathway in the growth of psoriatic keratinocytes that is, however, characterized by suppressed apoptotic cell death. Skin tissues from the patients with psoriasis or healthy donors were determined for TWEAK and Fn14 expression, and primary keratinocytes were evaluated under the stimulation of psoriatic proinflammatory cytokines or plus TWEAK. The results showed that both TWEAK and Fn14 were highly expressed in psoriatic skins. Moreover, the stimulation of psoriatic cytokines enhanced Fn14 expression by keratinocytes in vitro, which expressed TNF receptor 2 predominantly and proliferated increasingly with the addition of TWEAK. Furthermore, TWEAK stimulation enhanced the synthesis of survivin, inhibitor of apoptosis protein 2 and cellular FLICE‐inhibitory protein in lesional keratinocytes. Therefore, TWEAK/Fn14 interaction prefers to enhance proliferation but not apoptosis of keratinocytes under psoriatic inflammation. The activation of nuclear factor‐κB signalling‐dependent anti‐apoptotic proteins and biased expression of TNF receptors may be responsible for such a novel principle in keratinocytes under psoriatic inflammation.