Resultados preliminares de un trabajo multicéntrico a nivel nacional para el tratamiento de STUI secundario a hiperplasia benigna de próstata mediante el sistema con vapor de agua Rezūm®

Introduction and objectiveRezūm® system is a minimally invasive transurethral therapy that uses convective water vapor energy to ablate prostatic tissue. The objective is to report 1-year functional and security outcomes obtained by using this technique in real clinical practice.Material and methodsProspective study conducted in 5 Spanish hospitals for the treatment of LUTS secondary to BPH using the Rezūm® system. Patients with prostatic medium lobe (ML) and urethral catheter carriers were also included. Pre- and post-operative data were collected using IPSS, IIEF-5 and QoL questionnaires, flowmetry and post-void residual volume. Complications and retreatment rate at one-year follow-up were also reported.Results137 patients, including 64 with ML and 10 patients with urinary retention were treated. Median prostate volume was 50 cm³ (15-131). At 3 months follow-up, significant improvement was observed in IPSS (?6,37 points), Qmax (+4,95 mL/s) and QoL (?1,29); and was maintained until 12 months: ?10,78 points, +4,62 mL/s and ?2,73 respectively (p < 0.001). No significant changes were observed in the sexual sphere. All complications were mild (≤ Clavien II). Retreatment rate at one year was 4%.ConclusionShort-term results of this technique are promising, showing improvement in terms of functional outcomes, with no impact on the sexual sphere or complications. Longer term follow-up should include treatment durability and comparison to standard BPH treatments.     

The late stage of Parkinson's –results of a large multinational study on motor and non-motor complications

IntroductionThere is little information on the late stages of parkinsonism.MethodsWe conducted a multicentre study in 692 patients with late stage parkinsonism in six European countries. Inclusion criteria were disease duration of ≥7 years and either Hoehn and Yahr stage ≥4 or Schwab and England score of 50 or less.ResultsAverage disease duration was 15.4 (SD 7.7) years and mean total UPDRS score was 82.7 (SD 22.4). Dementia according to MDS-criteria was present in 37% of patients. Mean levodopa equivalence dose was 874.1 (SD 591.1) mg/d. Eighty two percent of patients reported falls, related to freezing (16%) or unrelated to freezing (21% of patients) or occurring both related and unrelated to freezing (45%), and were frequent in 26%. Moderate-severe difficulties were reported for turning in bed by 51%, speech by 43%, swallowing by 16% and tremor by 11%. Off-periods occurred in 68% and were present at least 50% of the day in 13%, with morning dystonia occurring in 35%. Dyskinesias were reported by 45% but were moderate or severe only in 7%. Moderate-severe fatigue, constipation, urinary symptoms and nocturia, concentration and memory problems were encountered by more than half of participants. Hallucinations (44%) or delusions (25%) were present in 63% and were moderate-severe in 15%. The association with overall disability was strongest for severity of falls/postural instability, bradykinesia, cognitive score and speech impairment.ConclusionThese data suggest that current treatment of late stage parkinsonism in the community remains insufficiently effective to alleviate disabling symptoms in many patients.     

Prevalence and correlates of depressive symptoms in secondary school children in Dhaka city,Bangladesh

ABSTRACT

Objectives: Depression is a leading contributor to the global burden of disease, and often starts at a young age. Depression in young people can increase the risk of unhealthy lifestyle behaviour and can lead to substantial disability, social problems, poor health, and suicide. Other research has examined depressive symptoms among adult populations in Bangladesh, but little is known about other age groups. The aim of this study was to assess the prevalence and socio-demographic correlates of depressive symptoms among secondary school children of Dhaka city, Bangladesh.

Design: A self-completed questionnaire was administered to 898 students from eight secondary schools of Dhaka, the capital City of Bangladesh. Of the respondents, 755 (372 males, 383 females; average age 14.26 years; SD 1.15) completed the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). A score of 10 or more was used to indicate depressive symptoms. Parents completed a separate questionnaire to provide individual and household/family-level data. Generalized Estimating Equations (GEE) was used to assess sociodemographic and lifestyle factors associated with adolescent depressive symptoms.

Results: Among the responding adolescents, 25% reported depressive symptoms with prevalence more common among females than males (30% vs. 19%). Factors significantly associated with symptoms of depression included being female, aged 15–16 years, self-perception of non-normal weight, feeling unsafe at school, sleep disturbance, low life satisfaction, high intake of sugary drinks, and regularly skipping breakfast.

Conclusion: Depressive symptoms are prevalent among secondary school children in urban Bangladesh. Interventions for adolescents with depressive symptoms could focus on lifestyle practices such as weight management, personal safety, sleep hygiene and healthy eating.     

A physical therapy programme for functional motor symptoms: A telemedicine pilot study

Introductionfor a proportion of patients with functional motor symptoms (FMS), specific physiotherapy has recently emerged as a promising treatment. Aim of the present study was to assess in a sample of patients with FMS the efficacy of a physical therapy-based telemedicine programme on the motor symptoms themselves and on some psychological variables such as anxiety, depression, alexithymia and quality of life.Materials and methodseighteen patients were recruited. The programme consisted of 24 sessions: three face-to-face sessions (at week 0 (T0), 12 (T1) and 24 (T2)) and 21 tele-sessions. Each session included education, movement retraining exercises and development of a management plan. All patients underwent the following assessment at T0, T1 and T2: Psychogenic movement disorders rating scale (PMDRS), assessment of depression, anxiety, alexithymia and quality of life. Self-assessment of outcome (CGI) was recorded at T1 and T2.ResultsOn the CGI improvement was reported by 66,7% of patients at T1 and 77,8% at T2. A significant improvement over the three time points was shown for PMDRS and for the following domains of the SF-36: general health, vitality, social functioning and mental health.Conclusionthe use of two innovative approaches for FMS (physiotherapy and telemedicine), combined together, might have a valuable role in the treatment of this neuropsychiatric condition.     

儿童肥胖症机理与少儿推拿综合调理

儿童单纯性肥胖症是以儿童过度营养、运动不足和行为异常为特征的全身脂肪组织过度增生性疾病,不仅影响少儿身心健康,还为成年后多种疾病埋下隐患。单纯性肥胖已成为21世纪威胁儿童健康的头号杀手,也是人们关注的严重公共卫生问题之一。通过中西医对儿童肥胖症机理的不同认识,特别是中医对儿童肥胖症的病因病机进行分析,提出儿童肥胖症的治疗要根据肥胖症患儿临床表现辨证施术,以少儿推拿为主的综合治疗调理方法,配合中药、针灸、拔罐、刮痧等疏通经脉、调和气血、平衡阴阳,调整脏腑功能,辅助心理治疗及行为矫正,在瘦身、强身的同时亦关注少儿心理健康。     

激素受体阳性乳腺癌患者在不同内分泌治疗用药时间的类更年期症状及生命质量

目的探讨激素受体阳性(HR+)乳腺癌患者在不同内分泌治疗时间的类更年期症状和生命质量状况。方法采用横断面研究设计,收集2011—2017年就诊于四川省肿瘤医院经病理确诊的167例HR+乳腺癌患者,按内分泌治疗时间分为<12个月组、12~36个月组、>36个月组。应用改良Kupperman量表和乳腺癌生命质量测定量表(FACT-B)测量类更年期症状和生命质量。采用方差分析及χ2检验比较不同用药时间及用药类型患者的类更年期症状差异,采用协方差分析和多重线性回归分析不同用药时间患者的生命质量得分差异和类更年期症状对生命质量的影响。结果167例乳腺癌患者的类更年期症状得分为(14.5±7.6)分,现患率为87.4%(146/167),以失眠率最高(73.7%,123/167)。除失眠易激动外,选择性雌激素受体调节剂(SERM)使用者以潮热症状最多(64.8%,79/122),芳香化酶抑制剂使用者以骨关节痛症状最多(62.2%,28/45)。患者的FACT-B总得分为(104.5±15.5)分,达标率高达89.8%(150/167),但各维度状况参差不齐,以社会家庭及功能维度达标率最低,分别为73.0%(122/167)和50.9%(85/167)。<12个月组、12~36个月组和>36个月组患者的Kupperman总分分别为(15.0±1.3)分、(14.0±6.9)分和(14.5±7.4)分;FACT-B总得分分别为(102.7±17.8)分、(105.0±12.9)分和(105.6±16.7)分,差异均无统计学意义(均P>0.05)。多重线性回归分析结果显示,患者服用SERM类药物期间类更年期症状对生命质量存在负向影响,<12个月组、12~36个月组和>36个月组患者的标准偏回归系数分别为-0.67、-0.30和-0.50,影响程度在12~36个月组中最小。结论HR+乳腺癌患者回归社会、家庭和功能恢复情况较差,应重点关注。类更年期症状在内分泌治疗期间普遍存在,应积极处理以改善生命质量。     

Parkinson's disease may reduce sensitivity to visual-tactile asynchrony irrespective of dopaminergic treatment: Evidence from the rubber hand illusion

BackgroundThe feeling of body ownership relies on the binding of multisensory body-related signals. Various sensory abnormalities have been described in Parkinson's disease (PD).ObjectiveTo assess the rubber hand illusion (RHI) in patients with PD (PwPD) and age-matched healthy controls (CTRL). To evaluate the influence of the dopaminergic system in a PwPD subgroup OFF medication.MethodsThe RHI paradigm was applied to 42 PwPD and 48 CTRL. In this experimental setup, stroking a visible plastic hand simultaneously with the covered real hand elicits the feeling of ownership over the seen hand. Asynchronous stroking served as a control condition. Proprioceptive bias and an illusion score based on a questionnaire were used as measures of the RHI. Seventeen PwPD additionally underwent the experiments “OFF medication”.ResultsCompared to CTRL, PwPD showed higher proprioceptive bias independent of the stroking condition (p = 0.015), and had higher illusion scores in the asynchronous condition (p < 0.05). In PwPD, there were no significant differences between ON- and OFF-medication state.ConclusionIn PwPD, responses to the RHI are less specific with respect to the degree of synchronicity of brushstrokes. This might be attributed to a less stable body representation, internal “noise” during multisensory integration, or a blur of temporal discrimination in PD. The fact that RHI measures did not differ between ON- and OFF-medication states indicates an involvement of non-dopaminergic transmitter systems in this finding.     

丙卡特罗、孟鲁司特对支气管哮喘疗效的影响

目的探讨丙卡特罗口服液联合孟鲁司特对支气管哮喘的疗效、对肺功能、日间及夜间症状评分。方法选取本院支气管哮喘患者98例,随机数字表分为观察组和对照组,各49例。观察组采用丙卡特罗口服液、孟鲁司特进行治疗,对照组采用孟鲁司特进行指标,比较两组患者的1s用力呼气容积(FEV1)、呼气高峰流量(PEFR)、呼气峰流速值(PEF)、用力呼气量/用力肺活量(FEV1/FVC),日间及夜间症状评分。结果观察组总有效率高于对照组(P<0.05)。治疗前两组FEV11、PEFR、PEF、FEV1/FVC差异均无统计学意义(P>0.05);治疗后两组FEV1、PEFR、PEF、FEV1/FVC均增高,且观察FEV1、PEFR、PEF、FEV1/FVC均高于对照组,差异有统计学意义(P<0.05)。治疗前两组日间和夜间症状评分差异均无统计学意义(P>0.05);治疗后两组间和夜间症状评分均下降,且观察组日间和夜间症状评分均低于对照组,差异有统计学意义(P<0.05)。结论丙卡特罗口服液联合孟鲁司特对支气管哮喘疗效较好,明显提高患者的肺功能,改善患者日间和夜间的症状。