Incidence and case-fatality rates resulting from the 1998 enterovirus 71 outbreak in Taiwan

In 1998, an epidemic of hand-foot-and-mouth disease and herpangina caused by enterovirus 71 occurred in Taiwan, leaving many fatalities and severely handicapped survivors in its wake. The reasons this rather common pathogen would cause such a large-scale epidemic remain unknown. A seroepidemiological survey to elucidate the epidemiological characteristics of this outbreak, including its incidence and case-fatality rates was undertaken. Microneutralization tests for antibodies against enterovirus 71 were used to screen four collections of serum samples: 1) 202 specimens taken from individuals > or = 4 years old in 1994; 2) 245 specimens collected from individuals of all ages in 1997; 3) 1,258 specimens collected from individuals of all ages in 1999; and 4) sera samples from a birth cohort of 81 children who had yearly blood samples taken from 1988-98. After the maternal antibody had declined, the seropositive rates began to increase with age. Approximately half of all children aged 6 years or older were enterovirus 71 seropositive. Significantly higher seropositive rates were noted in 1999 than in 1997, in children aged 0.5-3 years. The incidence of enterovirus 71 infection during the epidemic was estimated to be 13-22%, with the higher rates in younger children. The case-fatality rate was highest (96.96 per 100,000) in infants aged 6-11 months, and declined in older children. The results showed that enterovirus 71 is endemic in Taiwan. The apparent lack of large-scale enterovirus 71 activity in the 3 years before 1998 might have been the prelude to the epidemic's appearance in 1998, and might suggest that enterovirus 71 infection will reappear every few years. The lack of a protective antibody in younger children may account for the high incidence and case-fatality rate in this age group.     

A case of de novo interstitial deletion of chromosome 9(p12p13)

The present paper describes a girl with a small de novo deletion of chromosome 9(p12p13). This deletion has not been published previously. The deleted fragment is clearly outside the region involved in the so-called deletion 9p syndrome. The patient had mild dysmorphic features and feeding problems during the first weeks of life, but is now developing well. Because of the lack of severe clinical features in this patient, we speculate that the deletion may be prevalent in other patients who have no clinical indication for chromosome investigation.     

持续的躯体形式疼痛障碍患者抑郁症状的特征及治疗

目的：了解躯体形式疼痛障碍患者伴发的抑郁症状的特征，明确氟西汀对抑郁及焦虑症状的作用特点。方法：选取62例符合ICD－10中持续的躯体形式疼痛障碍诊断标准的患者，于治疗前及治疗第2，4，6周末评定HAMD，HAMA。疗效评定以减分率及有效率为评定指标。结果：氟西汀治疗第六周末，有效率为79．03％，治疗前及治疗第6周末的HAMD各项目分均有显著性差异（P值均＜0．01）；氟西汀治疗六周后，HAMD三个因子减分率分别为：迟滞（75．8％），焦虑／躯体性(焦虑（69．4％），体重（45．2％）；HAMA二个因子减分率分别为：精神性焦虑（70．97％），躯体性焦虑（72．58％）。结论：氟西汀对躯体形式疼痛障碍患者的抑郁及焦虑症状均有缓解作用。氟西汀对躯体疼痛障碍患者的动力缺乏亦有较好疗效。     

Prediction and profile of the long-stay population. A nation-wide cohort of first time admitted patients

A nation-wide cohort of 12,737 first admitted patients aged 15 years or more to Danish psychiatric institutions was followed in the Danish Case Register for a 10-year period. Long stay patients were delineated as: 1) patients whose first admission lasted for more than 1 year (new long-stay); or 2) patients who later had an admission lasting for more than 1 year (late long-stay). Together they comprised 420 males and 527 females with an incidence rate of 0.22 males and 0.27 females per 1,000. Up to age 65 males dominated, after 65 females dominated. Thirty-three percent of demential disordered and 24 of schizophrenics became long-stay patients. A multiple contingency analysis showed that the variables "age group", "main diagnosis", "size of municipality of residence" and "marital status" were independently associated with the outcome "long-stay". The two long-stay groups differed. New long-stay patients tended to be females, older, suffering from demential disorders and with a total hospital stay shorter than that of the long-stay population. In a multiple contingency analysis the variables "age group" and "main diagnosis" were independently associated with the outcome "new long-stay" and the variables "age groups", "main diagnosis" and "size of municipality of residence" with the outcome "late long-stay".     

Patterns of coverage of psychiatric emergencies

A massive change in the detection of psychiatric cases in the emergency room was recorded when pattern of coverage was changed from "on-call" basis to "continuous physical presence" of psychiatry residents in the emergency room.     

新型冠状病毒肺炎患者出院后核酸检测阳性临床特征及原因综述

从新型冠状病毒肺炎(coronavirus disease 2019, COVID-19)暴发以来,研究发现COVID-19康复患者在出院后在14 d隔离管理或健康监测期间有样本采集核酸检测再次出现新型冠状病毒阳性(复阳)的情况,国内外相关研究报道越来越多。本研究采用文献查阅综述的方法,旨在综合描述COVID-19复阳者临床人口学特征、可能影响因素以及传播风险,为COVID-19患者出院管理、医疗资源救治分配和传播风险控制提供综合科学的建议。     

Active Case Finding of Current Bornavirus Infections in Human Encephalitis Cases of Unknown Etiology,Germany, 2018–2020

Human bornavirus encephalitis is a severe and often fatal infection caused by variegated squirrel bornavirus 1 (VSBV-1) and Borna disease virus 1 (BoDV-1). We conducted a prospective study of bornavirus etiology of encephalitis cases in Germany during 2018–2020 by using a serologic testing scheme applied along proposed graded case definitions for VSBV-1, BoDV-1, and unspecified bornavirus encephalitis. Of 103 encephalitis cases of unknown etiology, 4 bornavirus infections were detected serologically. One chronic case was caused by VSBV-1 after occupational-related contact of a person with exotic squirrels, and 3 acute cases were caused by BoDV-1 in virus-endemic areas. All 4 case-patients died. Bornavirus etiology could be confirmed by molecular methods. Serologic testing for these cases was virus specific, discriminatory, and a practical diagnostic option for living patients if no brain tissue samples are available. This testing should be guided by clinical and epidemiologic suspicions, such as residence in virus-endemic areas and animal exposure.     

Implementation of Goals of Care Communication Innovation Among Nursing Homes: A Multiple Case Study Design

ObjectiveNursing homes (NHs) provide care to residents with serious illness and related complex health care needs. As such, discussions about end-of-life care between NH staff and residents and families are necessary to ensure residents receive care consistent with their goals. Interventions such as video decision aids have been developed to promote discussions and improve advance care planning, but few studies have examined how NH characteristics may relate to the implementation of these interventions; such information might lead toward more use of successful interventions. The purpose of this study is to understand NH characteristics that are associated with the implementation of the Goals of Care (GOC) intervention, which combined a video decision aid with a structured discussion to guide decision-making in advanced dementia.DesignA multiple case study.Setting and ParticipantsStaff surveys were conducted to examine factors related to implementation effectiveness in 11 NHs in North Carolina that participated in the GOC trial.MethodsQuestions measured the dependent variable of implementation effectiveness: the consistency and quality of use of the GOC intervention. NH organizational characteristics were measured using publicly available data and an administrator survey. The analysis consisted of pattern matching logic.ResultsHigh management support aligned with implementation effectiveness within NHs. In addition, the within case pattern analysis indicated additional characteristics related to implementation effectiveness. Facility size, Medicare beds, residents’ racial composition, and star rating were related to implementation effectiveness across 6 of the 11 NHs. NH financial resources, such as size and number of Medicare beds, may be important factors for successful implementation.Conclusion and ImplicationsNHs seeking to implement advance care planning interventions should focus on within and across NH differences, such as adequate management and financial support prior to implementation to increase the likelihood of implementation effectiveness.     

肥胖低通气综合征致急性呼吸衰竭临床分析

目的：阐明肥胖低通气综合征（OHS）所致急性呼吸衰竭的临床特点。方法：对8例OHS致急性呼吸衰竭患者的临床和实验室检查资料进行分析.结果：7例男性和1例女性患者均表现为肥胖,体重指数（BMI）女性为38．79kg.m^-2,男性平均42．68kg.m^-2,年龄平均62岁。全部患者均表现有呼吸性酸中毒,平均pH7.19,平均动脉血二氧化碳分压（PaCO2)12.35kPa,平均动脉血氧分压（PaO2)5.40kPa.8例肺功能检查显示第1秒用力呼气容积实测值占预计值的百分比（FEV1％）为78．75％,肺活量实测值占预计值的百分比（VC％）为78．80％,经治疗后PaCO2为6．49kPa,PaO2为11．42kPa,结论：OHS导致急性呼吸衰竭发生快,表现多样,肺功能损害轻,治疗及时则预后较好。     

Retrosigmoid Approach in the Supine Position Using ORBEYE: A Consecutive Series of 14 Cases

One of the merits of recently introduced exoscopes, including ORBEYE, is that they are superior to a conventional microscope in terms of ergonomic features. Taking advantage of it, the retrosigmoid approach can be performed in the supine position using ORBEYE. We report a consecutive series of 14 operations through the retrosigmoid approach in the supine position using ORBEYE. Fourteen consecutive patients who underwent surgery through the retrosigmoid approach for cerebellopontine (CP) angle lesions in the supine position using ORBEYE were targeted, and surgical outcomes and complications were examined. We evaluated the posture of the operator and the surgical field during this approach compared with those using a conventional microscope. In all 14 cases, all operative procedures were accomplished only using the ORBEYE. There were no operative complications due to this approach. Using ORBEYE, even when the angle of the operative visual axis was horizontal, the operators could manipulate in a comfortable posture. They were not forced to be in an uncomfortable posture that extended their arms, as is often the case with a conventional microscope. Therefore, they could use shorter surgical instruments. As the cerebellum shifted downward with gravity even using slight retraction during this approach, the working space of the surgical field was easily secured. Through this approach, the operators can perform stable microsurgery of CP angle lesions in a comfortable posture. This approach can reduce the burden on the operator and the patient, leading to a refined surgical procedure.