Possible pathophysiology of ketamine‐related cystitis and associated treatment strategies

Ketamine‐related cystitis is characterized by ketamine‐induced urinary frequency and bladder pain. It has become a serious problem in recent years. The most typical grossly pathological bladder change with ketamine related cystitis is a contracted bladder and bladder wall thickening. Ulcerative cystitis with an easily bleeding mucosa is a common cystoscopic finding. Microscopically, the urothelium is denuded and is infiltrated by inflammatory cells, such as mast cells and eosinophils. The pathogenesis of ketamine‐related cystitis is complicated and involves many different pathways. Past evidence suggests a direct toxic effect, bladder barrier dysfunction, neurogenic inflammation, immunoglobulin‐E‐mediated inflammation, overexpression of carcinogenic genes, abnormal apoptosis and nitric oxide synthase‐mediated inflammation contribute to the pathogenesis of ketamine‐related cystitis. The first step to managing ketamine‐related cystitis is always asking patients to cease ketamine. Medical treatment might be helpful in patients with early ketamine‐related cystitis and abstinence from ketamine. Several case studies showed that the intravesical installation of hyaluronic acid and intravesical injection of botulinum toxin type A were effective for symptom relief in selected patients. For patients with irreversible pathological change, such as contracted bladder, augmentation enterocystoplasty might be the only solution to increase bladder capacity and relieve intractable bladder pain.     

Nontraumatic posterior atlantooccipital dislocation associated with atlantoaxial instability

Introduction

Nontraumatic posterior atlantooccipital dislocation has only been rarely reported. In the current study, the authors reported an extremely rare case of nontraumatic posterior atlantooccipital dislocation associated with atlantoaxial instability.

Materials and methods

A 47-year-old female was referred with a history of neck pain for 5 years. The patient had no history of trauma. The axial rotation of range of motion of the cervical spine was severely restricted. Posterior atlantooccipital dislocation with atlantoaxial instability was confirmed through conventional radiography, computed tomography and magnetic resonance imaging. We performed realignment of the dislocation and posterior occipitocervical (C0–C2) fusion. After the surgery, the patient’s symptoms improved significantly and she manifested neurological improvement.

Conclusion

To our knowledge, this lesion has not been reported previously. Anomalies of upper cervical spine may have induced this instability.

     

Brain structure links trait creativity to openness to experience

Creativity is crucial to the progression of human civilization and has led to important scientific discoveries. Especially, individuals are more likely to have scientific discoveries if they possess certain personality traits of creativity (trait creativity), including imagination, curiosity, challenge and risk-taking. This study used voxel-based morphometry to identify the brain regions underlying individual differences in trait creativity, as measured by the Williams creativity aptitude test, in a large sample (n = 246). We found that creative individuals had higher gray matter volume in the right posterior middle temporal gyrus (pMTG), which might be related to semantic processing during novelty seeking (e.g. novel association, conceptual integration and metaphor understanding). More importantly, although basic personality factors such as openness to experience, extroversion, conscientiousness and agreeableness (as measured by the NEO Personality Inventory) all contributed to trait creativity, only openness to experience mediated the association between the right pMTG volume and trait creativity. Taken together, our results suggest that the basic personality trait of openness might play an important role in shaping an individual’s trait creativity.     

Postthrombolytic Antiplatelet Use for Patients with Intercerebral Hemorrhage without Extensive Parenchymal Involvement Does Not Worsen Outcome

Background and Purpose

It is unclear whether postthrombolytic antiplatelet (AP) therapy after thrombolytic-related hemorrhage without extensive parenchymal involvement (THEPI) affects the clinical outcome. This study explored whether AP administration in patients with THEPI affects short- and long-term outcomes.

Methods

All of the data for this study were collected from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China) registry. Patients with THEPI were assigned to either the AP (AP therapy should be commenced 24 h after intravenous thrombolysis) or AP-naïve groups. THEPI was defined according to European-Australasian Acute Stroke Study II criteria. The 90-day functional outcome, 7-day National Institutes of Health Stroke Scale (NIHSS) score, and 7-day and 90-day mortalities were compared between the AP and AP-naïve groups. Logistic regression analysis was used to evaluate the effects of AP therapy on the short- and long-term clinical outcomes.

Results

Of the 928 patients enrolled from those in the TIMS-China registry (n=1,440), 89 (9.6%) had nonsymptomatic intracerebral hemorrhage (ICH) within 24-36 h after thrombolysis; 33 (37%) of these patients were given AP therapy (AP group) and 56 (63%) were not (AP-naïve group). No significant differences were found for the risk of 7-day aggravated ICH (p=0.998), 7-day NIHSS score (p=0.5491), 7-day mortality [odds ratio (OR)=3.427; 95% confidence interval (95% CI)=0.344-34.160; p=0.294], 90-day mortality (OR=0.788, 95% CI=0.154-4.040, p=0.775), or modified Rankin score 5 or 6 at 90-days (OR=1.108, 95% CI=0.249-4.928, p=0.893) between the AP and AP-naïve groups after THEPI.

Conclusions

Early administration of postthrombolytic AP therapy after THEPI does not worsen either the short- or long-term outcome. AP therapy may be a reasonable treatment option for patients with THEPI to reduce the risk of ischemic stroke recurrence.     

Regulating emotion to improve physical health through the amygdala

The opinion of mind–body interaction has been increasingly acknowledged in recent years, as exemplified by accumulating evidence indicating that physical health (body) is associated with emotion and emotion regulation (mind). Yet, the neural basis linking emotion regulation with physical health remains largely uninvestigated. Here we used magnetic resonance imaging to investigate the neural basis of this pathway in a large population of healthy young adults. With a systematic study revealing the association of self-reported physical health and emotion traits of personality and general affective experiences, we further demonstrated that, for better physical health, individuals needed to regulate their emotion more effectively. Importantly, individuals who had larger gray matter (GM) volume in the amygdala reported not only a higher ability of emotion regulation but also better physical health. Further, GM volume in the amygdala mediated the correlation between emotion regulation ability and physical health. Our findings suggest that the amygdala plays a critical role in the neural circuit through which emotion regulation may influence physical health. Therefore, our study takes the first step toward exploring the neuroanatomical basis for body–mind interaction and may inform interventions aimed at promoting physical health by augmenting skills of emotion regulation.     

衡阳市社区老年人积极老龄化现状及其影响因素的研究

目的了解社区老年人积极老龄化现状,并分析其影响因素,为社区护理工作者开展健康促进工作,提高社区老年人的健康水平提供参考。方法采用一般问卷调查表、休闲态度量表和积极老龄化量表对衡阳市某国家级示范社区卫生服务中心275名老年人进行问卷调查。结果老年人休闲态度总分为(3.16±0.55)分,积极老龄化总分为(3.24±0.61)分。不同年龄、文化程度、居住情况、休闲类型和身体机能的社区老年人积极老龄化得分比较,差异有统计学意义(均P0.01);社区老年人休闲态度与积极老龄化呈正相关(均P0.01)。回归分析结果表明,身心健康和自我发展是影响积极老龄化的重要因素。结论社区老年人积极老龄化水平和休闲态度水平均待提高,社区护理工作者应采取措施提高社区老年人的休闲态度水平,促进其达到积极老龄化。