首发精神障碍家庭照顾者经历的系统评价

目的：系统评价首发精神障碍家庭照顾者的经历，为患者早期康复及照顾者心理健康问题的干预提供循证依据。方法：计算机检索The Cochrane Library、Ovid 、PubMed、Embase、Web of Science、CBM、CNKI、VIP和WANFANG DATE 数据库，检索时限均从建库至2021年7月31日，使用“JBI循证卫生保健中心质性研究质量评价标准”评价符合纳入标准的文献，并采用汇集性整合法对研究结果进行整合。结果：纳入12篇文献，提炼出60个研究结果，整理成8个类别，得出3个整合结果。分别是多维度的挑战、成长或缺如的角色结局、急需的社会支持。结论：亟需提高全民心理健康素质及去精神障碍疾病污名化，营造患者及家属无障碍化就医环境；关注家庭照顾者早期心理健康的干预，满足其社会支持的需要，提高该类人群应激应对能力，促进照顾者心理康复。     

进食障碍患者家庭顺应量表的汉化及信效度检验

目的 汉化进食障碍患者家庭顺应量表，并检验其信效度。方法 根据Brislin翻译模式将量表翻译成中文，通过专家函询和预调查对量表进行文化调适和修订。将量表应用于300例进食障碍患者照顾者检验信效度。结果 中文版进食障碍患者家庭顺应量表的量表水平内容效度指数为0.918。探索性因子分析结果显示5个因子可解释总变异量的49.862%。量表的各维度得分与量表总分呈中高度相关，各维度得分之间呈中低度相关或不相关。量表总Cronbach′s α为0.877，重测信度为0.883。结论 中文版进食障碍患者家庭顺应量表具有较好的信效度，可用于测量进食障碍患者的家庭顺应情况。     

Parenchymal calcification is associated with the neurological prognosis in patients with congenital rubella syndrome

Congenital rubella syndrome (CRS) results from maternal rubella virus infection in early pregnancy. Abnormal neuroimaging findings have been analyzed in a small number of CRS patients in the past; however, their clinical significance has been poorly addressed. Therefore, we have investigated the neuroimaging findings of 31 patients with CRS from previous studies. The most common finding was parenchymal calcification, which was observed in 18 of 31 patients (58.1%). A multivariable logistic regression model showed that it was associated with psychomotor or mental retardation (p = 0.018), suggesting that parenchymal calcification in CRS could be a prognostic factor.     

基于功能磁共振成像的肝豆状核变性患者纹状体亚区损害及临床分析

目的基于功能磁共振成像分析肝豆状核变性（Wilson disease, WD）患者纹状体亚区神经功能损害及其与临床相关分析，探讨其神经心理学症状可能的致病机制。方法收集WD患者29例和健康志愿者30例，进行3.0 T磁共振功能磁共振成像及临床量表测试，采用mICA工具箱的group ICA功能将壳核和尾状核分成8个亚区，做全脑功能连接，提取功能连接异常区域的值与临床量表测试结果做相关性分析。结果与对照组相比，WD患者左侧尾状核中部与全脑未发现功能增强或减弱区域，余感兴趣区与全脑功能连接不同程度减弱。左侧尾状核前部（ROI5）-中扣带回功能连接值与简易智能状态量表（MMSE）值呈显著负相关（r=-0.47，P=0.009）；右侧尾状核前部（ROI6）-中扣带回功能连接值与MMSE值呈显著负相关（r=-0.46，P=0.011）；右侧尾状核中部（ROI8）-右侧岛叶功能连接值与MMSE值呈显著负相关（r=-0.38，P=0.041）。结论右侧尾状核前中部与背外侧前额叶功能连接减弱，双侧壳核前部与丘脑功能连接减弱，可能破坏皮质-纹状体-丘脑回路引起认知功能损害；参与记忆及动作相关认知的突显网络、默认模式网络的通路连接受阻则可能是WD患者认知障碍的神经病理机制。     

Cancer Stem Cells and Circulatory Tumor Cells Promote Breast Cancer Metastasis

Breast cancer (BC) is a highly metastatic, pathological cancer that significantly affects women worldwide. The mortality rate of BC is related to its heterogeneity, aggressive phenotype, and metastasis. Recent studies have highlighted that the tumor microenvironment (TME) is critical for the interplay between metastasis mediators in BC. BC stem cells, tumor-derived exosomes, circulatory tumor cells (CTCs), and signaling pathways dynamically remodel the TME and promote metastasis. This review examines the cellular and molecular mechanisms governing the epithelial to mesenchymal transition (EMT) that facilitate metastasis. This review also discusses the role of cancer stem cells (CSCs), tumor-derived exosomes, and CTs in promoting BC metastasis. Furthermore, the review emphasizes major signaling pathways that mediate metastasis in BC. Finally, the interplay among CSCs, exosomes, and CTCs in mediating metastasis have been highlighted. Therefore, understanding the molecular cues that mediate the association of CSCs, exosomes, and CTCs in TME helps to optimize systemic therapy to target metastatic BC.     

Validity and Reliability of the Modified Attitudes About Drug Use in Pregnancy Scale

ObjectiveTo contemporize the Attitudes About Drug Abuse in Pregnancy questionnaire, keep the length of the modified scale brief to promote use, and test the psychometric properties of the modified scale among perinatal nurses.DesignCross-sectional survey.SettingFour hospitals in the Midwestern United States.ParticipantsRegistered nurses who worked in perinatal units (N = 440).MethodsWe collected data from participants using survey methods. Seven experts in perinatal substance use research and clinical care informed scale modifications. We used a split-sample design involving maternal–newborn units (labor, postpartum) and newborn-focused units (NICU, pediatrics). We evaluated construct validity using factor analysis and reliability using Cronbach’s alpha. We tested for differences between units using analysis of variance and Tukey’s post hoc honest significant difference test of pairwise differences.ResultsThe final modified scale included 13 items that loaded on one factor and showed internal consistency reliability in both samples (α = .88?.91). We found a statistically significant difference in mean score between NICU and pediatric units; however, the absolute difference was small and likely not clinically significant.ConclusionsThe Modified Attitudes About Drug Use in Pregnancy scale has initial evidence for validity and reliability, was updated to reflect current terminology in the field, and is a pragmatic tool for use in research.     

Valvuloplasty of fetal pulmonary atresia with intact ventricular septum and hypoplastic right heart: Mid-term follow-up results

ObjectiveThis study aimed to analyze and evaluate the results of mid-term follow-up after fetal pulmonary valvuloplasty (FPV) in fetuses with pulmonary atresia with intact ventricular septum (PA/IVS).MethodsFrom August 31, 2018, to May 31, 2019, seven fetuses with PA/IVS and hypoplastic right heart were included in this study. All underwent echocardiography by the same specialist and were operated on by the same team. Intervention and echocardiography data were collected, and changes in the associated indices noted during follow-up were analyzed.ResultsAll seven fetuses successfully underwent FPV. The median gestational age at FPV was 27.54 weeks. The average FPV procedural time was 6 ?min. Persistent bradycardia requiring treatment occurred in 4/7 procedures. Finally, five pregnancies were successfully delivered, and the other two were aborted. Compared to data before fetal cardiac interventions (FCI), tricuspid valve annulus diameter/mitral valve annulus diameter (TV/MV) and right ventricle diameter/left ventricle diameter (RV/LV) of all fetuses had progressively improved. The maximum tricuspid regurgitation velocity decreased from 4.60 ?m/s to 3.64 ?m/s. The average follow-up time was 30.40 ?± ?2.05 months. During the follow-up period, the diameter of the tricuspid valve ring in five children continued to improve, and the development rate of the tricuspid valve was relatively obvious from 6 months to 1 year after birth. However, the development of the right ventricle after birth was relatively slow. It was discovered that there were individual variations in the development of the right ventricle during follow-up.ConclusionThe findings support the potential for the development of the right ventricle and tricuspid valve in fetuses with PA/IVS who underwent FCI. Development of the right ventricle and tricuspid valve does not occur synchronously during pregnancy. The right ventricle develops rapidly in utero, but the development of tricuspid valve is more apparent after birth than in utero.     

Diagnostic approaches to respiratory abnormalities in craniofacial syndromes

Craniofacial syndromes are a complex cluster of genetic conditions characterized by embryonic perturbations in the developmental trajectory of the upper airway and related structures. The presence of reduced airway size and maladaptive neuromuscular responses, particularly during sleep, leads to significant alterations in sleep architecture and overall detrimental gas exchange abnormalities that can be life-threatening. The common need for multi-stage therapeutic interventions for these craniofacial problems requires careful titration of anatomy and function, and the latter is currently evaluated by overnight polysomnography in sleep laboratories. The cost, inconvenience, and scarcity of pediatric sleep laboratories preclude the frequent evaluations that could optimize the overall process of treatment and corresponding outcomes. Here, we critically examine reductionist approaches to polysomnography in children to establish the parallel approximation of such techniques to infant with craniofacial disorders. The need for prospective longitudinal multicenter studies with side-by-side comparisons aimed at identifying an optimal diagnostic and long-term monitoring paradigm for these potentially life-threatening conditions is emphasized.