Khat use and mental illness: a critical review

Khat has been used as a stimulant plant in many parts of Africa and the Arabian Peninsula for centuries. Its current use among particular migrant communities in Europe and elsewhere has caused alarm among policy makers and health care professionals. In the United Kingdom, the debate over the psychiatric and social implications of khat use has led to a demand for stricter legal control of this stimulant plant. This paper (a) provides a historical overview of khat use, and (b) reviews the evidence for the existence of a causal link between khat use and mental illness. To do so, we undertook a detailed search of social and medical science databases for case reports, qualitative and quantitative articles on khat use and mental illness from 1945 to 2006. The validity and reliability of the studies that met our inclusion criteria were examined. Lastly, although highlighting health concerns about khat use we suggest that the debate about this popular drug in migrant populations carries elements of a 'moral panic'. There is a need for improved research on khat use and its possible association with psychiatric disorders.     

解剖型锁定钢板治疗锁骨骨折的疗效

〔摘 要〕 目的：分析对锁骨骨折患者行解剖型锁定钢板治疗方式的临床疗效。方法：选择常州市中医院 2016 年 1 月至 2020 年 1 月期间收治的 50 例锁骨骨折患者,按随机分组法分为观察组（36 例,接受解剖型锁定钢板治疗方式）和对照组 （14 例,接受传统手法复位治疗方式）。比较两组患者治疗效果、创伤愈合情况。结果：观察组患者治疗总有效率为 100.00 %, 高于对照组的 85.71%,差异具有统计学意义（P ＜ 0.05）;观察组患者并发症总发生率为 2.78 %,低于对照组的 21.43 %, 差异具有统计学意义（P ＜ 0.05）;观察组所需康复时间为（1.84 ± 0.54）个月,短于对照组的（2.15 ± 0.61）个月,差异 具有统计学意义（P ＜ 0.05）。结论：对锁骨骨折患者行解剖型锁定钢板治疗方式,可帮助患者骨折处骨骼进行固定,使 其处于较稳定的愈合状态,缩短患者的恢复时间,提升其整体的治疗效果,有效减少骨不连等并发症的发生率,确保患者 外形的美观。     

罗哌卡因和布比卡因腰麻的临床对比研究

目的 对比研究15mg罗哌卡因和10mg布比卡因腰麻临床作用。方法 选择下肢手术患者60例 ,18～75岁 ;ASAI～II级 ,随机分为两组 ,按3:2被认为是等效比率分别给予罗哌卡因15mg和布比卡因10mg,药液和10%GS配成重比重液。在L3、4间隙采用硬膜外腰麻联合穿刺技术行腰麻操作。比较观察两组患者感觉和运动阻滞的起效和恢复上的异同 ,并观察用药后术中和术后不良反应。结果罗哌卡因运动阻滞起效时间慢于布比卡因(p<0.05) ,运动恢复时间快于布比卡因(p<0.01),术中肌松阻滞程度弱于布比卡因(p<0.05或p<0.01)。结论 15mg罗哌卡因腰麻作用弱于10mg布比卡因     

Prevalence of Usutu and West Nile virus antibodies in human sera,Modena, Italy, 2012

A collection of 3069 human sera collected in the area of the municipality of Modena, Emilia Romagna, Italy, was retrospectively investigated for specific antibodies against Usutu (USUV) and West Nile viruses (WNV). All the samples resulting positive using a preliminary screening test were analyzed with the plaque reduction neutralization test. Overall, 24 sera were confirmed as positive for USUV (0.78%) and 13 for WNV (0.42%). The results suggest that in 2012, USUV was circulating more than WNV in North‐eastern Italy.     

中药配合手法复位小夹板外固定治疗桡骨远端骨折疗效观察

目的:探讨中药配合手法复位小夹板外固定治疗桡骨远端骨折的临床疗效。方法:选取2017年4月—2018年3月桡骨远端骨折患者112例,随机分为2组,各56例。对照组采取手法复位小夹板外固定治疗,观察组采取温阳健骨汤+手法复位小夹板外固定治疗,对比2组临床疗效、疼痛程度、疼痛缓解时间、消肿时间及骨折愈合时间。结果:对照组治疗有效率较观察组低,差异有统计学意义;治疗1周、2周及4周后,观察组VAS评分均较对照组低,差异有统计学意义;与对照组相比,观察组疼痛缓解时间、消肿时间及骨折愈合时间更短,差异有统计学意义。结论:桡骨远端骨折患者采用中药配合手法复位小夹板外固定治疗可有效提升临床疗效,减轻患者疼痛,促进骨折愈合。     

Virus inactivation of plasma-derived proteins by pasteurization in the presence of guanidine hydrochloride

BACKGROUND: Viruses, among them parvovirus B19 and other small, nonenveloped viruses, may be present in human blood and may contaminate plasma-derived therapeutics. Efficient inactivation or removal of such viruses, especially parvoviruses, represents a current problem and corresponding technologies are under investigation. In this report, such a technology is described. STUDY DESIGN AND METHODS: A recently developed pasteurization of human apolipoprotein A-I (apoA-I), which is performed at 60 degrees C for 10 hours in the presence of guanidine hydrochloride (GdnHCl), was validated by using a series of model viruses, including members of the families parvoviridae and picornaviridae. The model viruses were spiked into the apoA-I- and GdnHCl-containing solutions, and virus inactivation was evaluated by infectivity assays in cell cultures. The mechanism of virus inactivation was studied by virus sedimentation analysis using the picornavirus model. RESULTS: All viruses tested were inactivated to levels below the limit of detection, although different inactivation kinetics were obtained for the different viruses. The mechanism of virus inactivation by this pasteurization was disassembly of the virus particles into single proteins or small noninfectious viral subunits. CONCLUSION: The pasteurization validated in this report has the potential to inactivate a wide range of transfusion-relevant viruses including parvoviruses and picornaviruses.     

Routine HCV PCR screening of blood donations to identify early HCV infection in blood donors lacking antibodies to HCV

BACKGROUND: Detection of early hepatitis C infection of blood donors is still a major problem for blood transfusion. Common anti-HCV screening assays show differences in sensitivity and specificity. The often mild symptoms of acute hepatitis C also cause difficulties in the identification of early HCV infection. The feasibility and efficacy of routine screening of blood donations for HCV RNA were investigated. STUDY DESIGN AND METHODS: Blood donations (n = 251,737) were screened for HCV RNA over 4 years. RNA extraction, amplification, and detection were done by two commercial HCV PCR kits (HCV Cobas Amplicor and HCV Cobas Amplicor 2.0, Roche Diagnostics). Screening was done by pool testing with a maximum pool size of 40 serum samples. RESULTS: Three donations out of 251,737 were HCV RNA positive and anti-HCV negative. ALT levels of these donations were 271, 32, and 10 U per L. The HCV infection of a fourth HCV RNA-positive donor could not be identified by routine, second-generation HCV EIA (Abbott Diagnostika). In this case, two previous donations were also HCV RNA positive, and three second-generation test systems (Abbott) could not detect anti-HCV, whereas third-generation anti-HCV screening assays detected antibody with different sensitivity. The first HCV RNA-positive donation was identified only by the HCV ELISA 3.0 (Ortho Diagnostic Systems). The results of confirmatory assays like RIBA HCV 3.0 (Ortho) and Matrix (Abbott) indicate a restricted immune response to NS3 only. CONCLUSION: HCV RNA detection by PCR can be carried out routinely in blood donor screening without significant delay of release of the components. The residual risk of transmission can be reduced by identification of early infection, which can lead to an improved safety of blood components. RNA screening can also be advantageous in cases of incomplete or lack of antibody response to HCV.     

Prediction of Mortality in Coronary Artery Disease: Role of Machine Learning and Maximal Exercise Capacity

ObjectiveTo develop a prediction model for survival of patients with coronary artery disease (CAD) using health conditions beyond cardiovascular risk factors, including maximal exercise capacity, through the application of machine learning (ML) techniques.MethodsAnalysis of data from a retrospective cohort linking clinical, administrative, and vital status databases from 1995 to 2016 was performed. Inclusion criteria were age 18 years or older, diagnosis of CAD, referral to a cardiac rehabilitation program, and available baseline exercise test results. Primary outcome was death from any cause. Feature selection was performed using supervised and unsupervised ML techniques. The final prognostic model used the survival tree (ST) algorithm.ResultsFrom the cohort of 13,362 patients (60±11 years; 2400 [18%] women), 1577 died during a median follow-up of 8 years (interquartile range, 4 to 13 years), with an estimated survival of 67% up to 21 years. Feature selection revealed age and peak metabolic equivalents (METs) as the features with the greatest importance for mortality prediction. Using these 2 features, the ST generated a long-term prediction with a C-index of 0.729 by splitting patients in 8 clusters with different survival probabilities (P<.001). The ST root node was split by peak METs of 6.15 or less or more than 6.15, and each patient’s subgroup was further split by age or other peak METs cut points.ConclusionApplying ML techniques, age and maximal exercise capacity accurately predict mortality in patients with CAD and outperform variables commonly used for decision-making in clinical practice. A novel and simple prognostic model was established, and maximal exercise capacity was further suggested to be one of the most powerful predictors of mortality in CAD.     

Risk of an Opioid-Related Emergency Department Visit or Hospitalization Among Older Breast,Colorectal, Lung,and Prostate Cancer Survivors

ObjectiveTo assess whether long-term cancer survivors (≥5 years after diagnosis) are at an increased risk of experiencing an opioid-related emergency department (ED) visit or hospitalization compared with persons without cancer.MethodsA 1:1 matched retrospective cohort study was performed using the Surveillance, Epidemiology, and End Results–Medicare linked data sets. The analysis was conducted from October 2020 to December 2020 in persons who lived 5 years or more after a breast, colorectal, lung, or prostate cancer diagnosis matched to noncancer controls on the basis of age, sex, race, pain conditions, and previous opioid use. Fine-Gray regression models were used to assess the relationship between cancer survivorship status and opioid-related ED visit or hospitalization.ResultsThe incidence of opioid-related ED visits and hospitalizations was 51.2 (95% CI, 43.5 to 59.8) and 62.2 (95% CI, 53.4 to 72.1) per 100,000 person-years among cancer survivors and matched noncancer controls, respectively. No significant association was observed between survivorship and opioid-related adverse event among opioid naive (hazard ratio, 0.79; 95% CI, 0.61 to 1.02) and non-naive (hazard ratio, 1.26; 95% CI, 0.84 to 1.89) cohorts.ConclusionCancer survivors and noncancer controls had a similar risk of an ED visit or inpatient admission. Guidelines and policies should promote nonopioid pain management approaches especially to opioid non-naive older adults, a population at high risk for an opioid-related ED visit or hospitalization.