Aspirin platelet reactivity on platelet function and clinical outcome in minor stroke or transient ischemic attack

ObjectiveWhether aspirin platelet reactivity affects platelet function and clinical outcomes with different antiplatelet therapies in patients with mild stroke or transient ischemic attack (TIA) remains unclear. We conducted a subgroup analysis of the PRINCE trial.Materials and methodsPatients with mild stroke or TIA were randomized into aspirin+ticagrelor, or aspirin+clopidogrel groups; aspirin reaction units (ARU) were measured at the baseline and after 7 ± 2 days to assess response to treatment. High on-treatment platelet reactivity (HPR) was defined as ≥550 ARU (poor response to aspirin). The platelet functions of ticagrelor and clopidogrel were measured using the VerifyNow P2Y₁₂ assay for P2Y₁₂ reaction units (PRU); HPR to P2Y₁₂ was defined as >208 PRU (poor response to P2Y₁₂). Clinical outcomes included stroke and clinical vascular and bleeding events after 90 days.ResultsAmong 628 enrolled patients, 69 (11%) were poor aspirin responders. After 7 ± 2 days, the proportion of poor P2Y₁₂ responders for ticagrelor versus clopidogrel significantly reduced in poor (2.6% versus 27.4%) and good (14.3% versus 29.4%) aspirin responders. There were significant interactions between treatment groups, and between treatment groups and aspirin platelet reactivity for poor P2Y₁₂ responders (P = 0.01). After 90 ± 7 days, there were no significant interactions between treatment groups and aspirin platelet reactivity for new stroke risk (good aspirin responders: 5.5% versus 8.8%, hazard ratio [HR]: 0.61; 95% confidence interval [CI], 0.32 to 1.16; P = 0.13; poor aspirin responders: 8.6% versus 8.8%, HR: 0.97, 95% CI: 0.20–4.81; P = 0.97; P for interaction = 0.60). Major bleeding was less frequent in poor than good aspirin responders (ticagrelor/aspirin: 0.4%/0%; clopidogrel/aspirin: 1.4%/0%).ConclusionsIn patients with minor stroke or TIA, clopidogrel, and particularly ticagrelor, decreased platelet function in poor versus good aspirin responders. The poor platelet reactivity of aspirin could not sufficiently reduce the risk of recurrent stroke with ticagrelor or clopidogrel; however, HPR (poor aspirin response) may have a protective effect on clinically relevant major bleeding.     

磁惊厥治疗与无抽搐电痉挛治疗抑郁发作的早期疗效及对认知功能的影响

目的 比较磁惊厥治疗(magnetic seizure therapy, MST)与无抽搐电休克治疗(modified electroconvulsive therapy, MECT)对抑郁发作早期的疗效及对认知功能的影响。方法 入组45例抑郁发作患者,分别接受MST和MECT治疗。采用汉密尔顿抑郁量表-17项(Hamilton Depression Scale-17 Item, HAMD-17),汉密尔顿焦虑量表(Hamilton Anxiety Scale, HAMA),临床总体印象量表(Clinical Global Impression Scale,CGI)进行临床症状评估,采用重复成套神经心理状态测验(the Repeatable Battery for the Assessment of Neuropsychological Status, RBANS)及简易智力状态检查量表(Mini-mental State Examination, MMSE)进行认知功能评估。评估时间点包括基线、治疗3次后、治疗6次后。结果 双因素重复测量方差分析显示,两组间治疗前后HAMD-17、HAMA、CGI-S、CGI-I评分差异均无统计学意义(P_组间>0.05),其中HAMD-17、HAMA、CGI-S评分均随治疗时间的延长逐渐降低(P_时间<0.05)。两组RBANS总分,均随治疗时间延长逐渐升高(P_时间<0.05);各时点,MST组RBANS总分高于MECT组,组间比较差异有统计学意义(P_组间<0.05),且随时间延长,MST的治疗效应组间增大(P_交互<0.05)。治疗3次和治疗6次后,HAMD减分率两组间比较差异无统计学意义。结论 MST治疗抑郁发作早期治疗疗效果与MECT相当,MST治疗6次后可改善患者的部分认知功能。     

Electroconvulsive therapy is associated with lower readmission rates in patients with schizophrenia

BackgroundElectroconvulsive therapy is an important somatic treatment for severe mental disorders with established efficacy and safety. However, data on the relationship between ECT and the readmission rate of patients with schizophrenia are scarce. This study will explore the association between the administration of ECT and readmission rates using a machine learning method.MethodsInpatient medical records from the year of 2016 in one large psychiatric hospital in Beijing, China, were analyzed using a machine learning algorithm to determine the most important variables affecting readmission of patients with schizophrenia.ResultsThe medical records of 2131 inpatients with schizophrenia were reviewed. 1099 patients were followed up within 3 months of their index admission (642 ECT cases and 457 non-ECT cases) and 1032 patients were followed up within 6 months (596 ECT cases and 436 non-ECT cases) after discharge. The 3- and 6-month readmission rates in the ECT group (11.37% and 17.94%, respectively) were significantly lower than that of the patients who did not receive ECT (18.79% and 29.36%, respectively, both p < 0.001). The risk of readmission was significantly associated with male sex, older age, being married, having a lower income, a shorter inpatient length of stay, and receiving specific antipsychotic medications including olanzapine, paliperidone, clozapine, and haloperidol during the index admission. In the ECT group, patients who received 9 or more treatments were significantly less likely to be readmitted.ConclusionReceiving ECT may be associated with a lower risk of readmission in patients with schizophrenia.     

石珍安神颗粒改善精神分裂症前驱期患者认知损害的临床观察

目的 研究石珍安神颗粒治疗对精神分裂症前驱期患者认知功能的改善作用。方法 纳入 60 例受试者采用数字法随机分为治疗组和对照组,治疗组予石珍安神颗粒和阿立哌唑安慰剂,对照组予阿立哌唑和石珍安神颗粒安慰剂。所有受试者在治疗前和治疗28 d后进行认知功能评估,包括连线测验(Trail Making Test A, TMTA)、霍普金斯词语学习测验-修订版(Hopkins Verbal Learning Test-revised, HVLT-R)、简易视觉空间记忆测验-修订版 (Brief Visuospatial Memory Test Revised, BVMT-R) 、Stroop 色词测验(Stroop Color-word Test ,SCWT)和持续操作测验(Continuous Performance Test, CPT),并进行统计分析。结果 两组在所有认知功能评价指标的组间主效应差异均无统计学意义(P＞0.05),两组在TMTA、HVLT-R、BVMT-R、Stroop词测验、SCWT和CPT的时间主效应差异均有统计学意义(P＜0.05),两组仅在SCWT和CPT上存在时间与组间的交互作用(P＜0.05)。治疗组在所有认知功能评价指标上治疗后与治疗前相比,差异均有统计学意义(P＜0.05);对照组仅在HVLT-R、BVMT-R、SCWT和CPT上治疗后与治疗前相比,差异有统计学意义(P＜0.05)。结论 石珍安神颗粒在改善精神分裂前驱期的认知损害方面与阿立哌唑作用相似,但治疗前后多数指标的变化程度相对优于阿立哌唑。     

2014—2023年首都医科大学附属北京安定医院喹硫平致心血管系统不良反应分析

目的 调查分析首都医科大学附属北京安定医院喹硫平导致心血管系统药品不良反应的特点。方法 选取2014—2023年首都医科大学附属北京安定医院上报国家不良反应中心的121例喹硫平致心血管系统不良反应的病例,分析患者的不良反应及药物治疗情况,治疗措施及转归等方面,探讨喹硫平导致心血管系统不良反应的临床特点。结果 121例患者中,女性占比（61.98%）较大。原患疾病以双相情感障碍为主,为51例（42.15%）。发生不良反应时,用药剂量均较低,仅12例患者剂量超过700mg/d。不良反应以直立性低血压为主（42.98%）。不良反应多发生在用药初期,大部分在用药10d内出现症状。不良反应的临床表现方面,直立性低血压患者收缩压和舒张压呈不同程度的降低。患者出现不良反应后,及时处理并密切观察不良反应情况,症状均缓解或恢复正常。结论 喹硫平在较小日剂量使用时,仍有导致心血管不良反应的风险。喹硫平还可引起罕见的不良反应,包括心悸、高血压、QT间期延长、心动过缓等。其中QT间期延长是较为严重的不良反应,可能导致更严重的不良反应发生,如心源性猝死。对于存在先天性长QT综合征、心衰、女性、老年等危险因素时,...     

Electrocortical and behavioral responses produced by acute electrical stimulation of the human centromedian thalamic nucleus

Incremental, desynchronizing and spike-wave electrocortical responses and concomitant symptoms to acute electrical stimulation of the centromedian thalamic nucleus (CM) were studied in 12 patients with intractable complex partial and tonic-clonic generalized seizures. Low-frequency (6/s), 320–800 μA stimulation of the caudal-basal and central portions of CM elicited incremental recruiting and augmenting-like responses with a bilateral regional scalp distribution, with emphasis at the ipsilateral frontal (recruiting) and central (augmenting) regions, while ventral-basal CM stimulation elicited primary-like responses with a focal distribution at the ipsilateral parietal region. High-frequency (60/s), 320–800 μA stimulation of caudal-basal and central, but not ventral-basal CM, elicited EEG desynchronization and a slow negative shift of the EEG baseline with scalp distribution similar to that showed by recruiting- and augmenting-like responses. Neither incremental nor desynchronization EEG responses were accompanied by evident patient sensory or motor responses. Low-frequency (3/s), high-intensity (30 V = 2400 μA) combined stimulation of the right CM and left non-specific mesencephalic ascending pathways elicited a response similar to the typical absence attack with all EEG and clinical ingredients: S1, S2, P1 and W components of the individual spike-wave complex and generalized spike-wave discharges followed by sleep spindle EEG afterdischarges, accompanied by motionless stare, 3/s eye blinking, lip smacking and total failure to respond to visual stimuli in patients under a simple responding task.     

Focus group interviews with risk-taking gay men: appraisal of AIDS prevention activities,explanations for sexual risk-taking,and needs for support

Recently, several findings demonstrated an increase in high-risk sexual behaviour among gay men. This study conducted focus groups with gay men who engaged in'risk-taking behaviour with casual partners. Three issues were addressed: appraisal of current AIDS prevention activities, explanations for sexual risk-taking, and needs for support. The results show that participants criticize current prevention efforts. The explanations for risk-taking behaviour contribute to a better understanding of the underlying processes related to sexual risk-taking. Participants' needs include unequivocal information on HIV and AIDS, more insight into the rationality behind safe sex directives, and more opportunities to discuss their difficulties regarding safe sex behaviour with peers.