麦吉尔布里斯班症状评分对胰头癌预后预测价值的临床研究

目的探讨麦吉尔布里斯班症状评分(McGill Brisbane symptom score,MBSS)对胰头癌预后的预测价值。方法回顾性地收集于2006年6月至2015年6月就诊并接受手术治疗的83例胰头癌病人的临床资料。记录病人的性别、年龄、合并基础疾病、入院近期的体重改变情况、是否腹痛、黄疽、吸烟史、手术情况(R0、非R0)、是否合并淋巴结、局部神经和血管侵犯、随访2年时的生存率等指标。单因素分析法比较组间上述指标的差异,进一步选取单因素分析结果中的组间差异指标进行多因素分析,以确定胰头癌病人术后预后不良的相关危险因素。结果本组83例病人共分为低MBSS组37例,高MBSS组46例,病人平均年龄、性别构成、合并基础疾病情况、肿瘤分化程度、周围神经、血管及淋巴结侵犯情况相比,组间差异无统计学意义(P0.05);而高MBSS组病人肿瘤相对较大,分期相对较晚,非R0切除率及平均MBSS评分较高,组间差异有统计学意义(P0.05);肿瘤大小、分期、手术方式及MBSS评分4项指标均为胰腺癌病人术后早期预后不良的独立危险因子(OR均1.0,P值均0.05);MBSS=9.0时,其预测病人术后早期预后不良的敏感性、特异性分别为80.44%和85.23%。结论 MBSS与胰头癌病人术后预后有关,高MBSS评分是胰头癌病人术后预后不良的独立危险因子,MBSS评分9时,其预测胰头癌病人术后早期预后不良的敏感性和特异性均较高,值得临床进一步深入研究。     

Psychological Factors in Gastroesophageal Reflux Disease Measured by SCL-90-R Questionnaire

Background An association between psychological factors and gastroesophageal reflux disease has been recognized. Psychological distress can influence the outcomes of the disease. Aims To determine the existence of psychological factors in our gastroesophageal reflux disease sample, as well as determine their influence on the outcome of the disease and treatment response. Methods A cross-sectional study was performed from February 2006 to December 2007. Patients referred to gastrointestinal specialists who reported symptoms of gastroesophageal reflux were asked to fill out the SCL-90-R questionnaire. All underwent endoscopy and pH-metry studies. Results Fifty-five patients with gastroesophageal reflux disease were analyzed. Subjects with reflux symptoms had higher scores compared to healthy controls on sommatization, obsessiveness, interpersonal sensitivity, being phobic, being psychotic, and the global index (P < 0.05). Patients with high frequency of symptoms and long duration of disease have increased psychological distress. There was no relationship among pH-metry results, endoscopy findings, and SCL-90-R scores. Conclusions Psychosocial factors can predispose to gastroesophageal reflux disease. The SCL-90-R questionnaire can be useful in investigating psychological factors in those patients with unsuccessful outcome of the symptoms despite correct management.     

A large single ethnicity study of prepulse inhibition in schizophrenia: Separate analysis by sex focusing on effect of symptoms

Deficits in sensorimotor gating, as measured with prepulse inhibition (PPI), have been considered an endophenotype of schizophrenia. However, the question remains whether these deficits are related to current symptoms. This single site study aimed to explore clinical features related to the modulation of startle reflex in a large sample of Japanese patients with schizophrenia (DSM-IV). The subjects comprised 181 patients and 250 healthy controls matched for age and sex. Schizophrenia symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Startle reflex to acoustic stimuli was recorded using a startle stimulus of 115 dB and a prepulse of four different conditions (intensity: 86 dB or 90 dB; lead interval: 60 ms or 120 ms). Patients exhibited significantly reduced startle magnitude (p < 0.001), habituation (p = 0.001), and PPI (90 dB, 60 ms, p = 0.016; 90 dB, 120 ms, p = 0.001) compared with controls. Patients of both sexes exhibited significantly lower habituation and PPI (90 dB, 120 ms) compared with the same sex controls. We could not detect a significant correlation with any clinical variable in the entire patients, however, when men and women were examined separately, there was a negative correlation with the PANSS cognitive domain (ρ = −0.33, p = 0.008) in men, but not in women. Moreover, when patients were subdivided into four clusters, two clusters with high positive symptoms showed significant PPI deficits in men. Our results suggest that sensorimotor gating is impaired in schizophrenia of both sexes, and PPI deficits may be related to thought disturbance and disorganization in male patients with schizophrenia.     

Using neuroscience as an outcome measure for behavioral interventions in Autism spectrum disorders (ASD): A review

Though medications have proven effective in improving associated symptoms of autism spectrum disorder (ASD), behavioral interventions remain the most effective method of improving core symptoms (e.g. social communication, restricted and repetitive behaviors) in this population. Although the cause remains unknown, research provides evidence that ASD is a neurologically based disorder, with differences in brain activity contributing to observed social difficulties. Given the above, along with recent publications underscoring the importance of utilizing neuroscience to measure changes associated with intervention in ASD, it is surprising that studies that measure neurological changes in response to behavioral interventions remain quite rare. Using systematic searches of the PsychINFO and MEDLINE databases, the current review summarizes the extant literature on neural changes in response to behavioral interventions in ASD, and compares the state of the literature in ASD with other disorders such as anxiety, depression, and schizophrenia. We conclude that research utilizing neuroscience to measure changes in response to behavioral interventions in ASD is lacking, and suggest that future research make integrating these two lines of research a priority.     

International Prostate Symptom Score Should Be Considered a Complement Rather Than a Substitute to Generic Preference‐Based Measures for Measuring Lower Urinary Tract Symptoms Within Economic Evaluation

Objective

To determine the suitability of using the International Prostate Symptom Score (IPSS), a condition‐specific instrument, within economic evaluation of lower urinary tract symptom (LUTS) interventions.

Methods

Data were obtained from a cohort of 2236 community‐dwelling Australian men. Using correlations and a modified Bland–Altman plot, we investigated the convergent validity of the IPSS with two generic quality of life (GQol) instruments: the Assessment of Quality of L ife 4 Dimensions (AQoL‐4D) and the Short‐Form 36 (SF‐36). Discriminant validity was investigated using Wilcoxon–Mann–Whitney and Kruskal–Wallis tests, comparing instrument scores and utilities between subgroups varying in age, marital status, history of illness, smoking status and self‐assessed general health.

Results

Discriminant validity was confirmed for all instruments by finding statistically significant differences in summary scores and utilities between nearly all subgroups. Convergent validity between the summary scores/utilities of the IPSS and the GQoL instruments was weak (absolute correlation value range, 0.11–0.23) but differed considerably between dimensions of the instruments (absolute correlation value range, 0.01–0.24). Weak to moderate correlation between the GQoL instruments was seen (absolute correlation value range, 0.01–0.49).

Conclusion

Our findings suggest that the IPSS has comparable discriminant validity to the GQoL instruments and therefore useful for assessing subgroup differences related to urinary symptoms. The weak convergence between the IPSS and the GQoL instruments however suggests that, within economic evaluation, the IPSS should be viewed as a complement rather than a substitute to the GQoL instruments because it captures different quality of life constructs.     

Novel Interdisciplinary Approach to GERD: Concomitant Laparoscopic Hiatal Hernia Repair with Transoral Incisionless Fundoplication

1. Download : Download high-res image (395KB)
2. Download : Download full-size image

     

Measuring maternal mental health using the Dutch Four-Dimensional Symptom Questionnaire (4DSQ): Pregnancy-related item bias across the perinatal period

Objectivethe Four-Dimensional Symptom Questionnaire (4DSQ) measures four dimensions of common psychopathology: distress, depression, anxiety and somatization. The instrument is developed and validated for general practice. A previous validation study of the 4DSQ for midwifery practice indicated that pregnant women respond differently to the items of the 4DSQ. This phenomenon is called item bias. The present study is a followup validation study in which pregnant women were followed up until one year post partum, to assess pregnancy-related item bias.Designcohort study with repeated measurements.Setting and participantsthe research group consisted of participants of the Mom@Work study, a study concerning mental health in a group of 574 working pregnant women and young mothers, recruited between 2004 and 2006. Measurements in the research group took place at 33 weeks of pregnancy and post partum at 7, 13, 25 and 52 weeks. The comparison group consisted of female general practice patients, matched for age (N=835).Measurements and findingspregnancy-related item bias was assessed by two methods of differential item functioning (DIF) analysis: ordinal logistic regression (OLR) and the Mantel-Haenszel (MH) method. The impact of item bias on total scale scores was estimated by linear regression. Impact of item bias was found in the somatization-, distress- and anxiety scales of the 4DSQ across the perinatal period up until 13 weeks post partum. The depression scale remained free of item bias.Key conclusions and implications for practicepregnant and postpartum women responded differently to the 4DSQ than the women in the comparison group up until 13 weeks post partum. Pregnancy-related item bias lead to overestimation of distress and underestimation of somatization and anxiety. The depression scale was free of bias. The 4DSQ is a valid tool for case-finding and assessment of psychological conditions in the perinatal period, provided cut-off points are adapted up until 13 weeks post partum. Validation of generic questionnaires is recommended before using them in the perinatal period.     

浅析中医思辨之门径

河图易经是中医思辨的起源,天人合一是中医思辨的基础,辨证论治是学习和理解中医的方便之道,但如果过分强调辨证论治则有可能陷入机械唯物主义辩证观。中医思辨的归处是恢复常态,而非思辨本身。当代人的知识体系更加分化,很多人已难以直接接受阴阳五行这一世界观宇宙观,因而辨证论治成为了解中医的方便法门,但若仅止于辨证论治而忘记了中医思辨的渊源——河图易经,忽视了中医思辨的基础——天人合一,看不到中医思辨的核心——阴阳五行动态演变规律,就可能会一叶障目,达不到中医治疗应有的效果。所幸近几年来西方天文学逐渐发展,物理学发展到量子力学的水平,对宇宙真相有所窥见,相信将来有一天科学会追上中华民族的先祖,印证河图易经的正确。