Relationship between REM sleep latency and nocturnal cortisol concentrations in depressed patients

SUMMARY  Due to conflicting reports on the possible association between shortening of rapid eye movement (REM) latency and increased cortisol secretion in patients with severe depression, this study examined the relationship between REM sleep latency and nocturnal cortisol concentration in 12 outpatients with major depression. The results showed a significant inverse correlation ( r = —0.71, P <0.01) between REM sleep latency and mean (23.00 hours-03.00 hours) plasma cortisol concentration. Age and severity of depression did not contribute to the inverse relationship. REM activity and density during the first REM period showed no significant correlations with the cortisol measures. A review of the literature suggests that this relationship might be unique to subjects with major depression, and again raises the possibility that these biological disruptions may have a common neurochemical basis.     

Prevention of hypertensive crisis with ATP during anesthesia for pheochromcytoma

In the anesthetic management of five patients undergoing excision of pheochromocytoma, adenosine triphosphate (ATP) was used for the purpose of regulating systemic arterial pressure during the period of tumor manipulation. ATP was administered at doses of 0.05–0.4mg/kg/min. Systemic arterial pressure showed a significant decrease from 162 ± 17/103 ± 11mmHg before manipulation to 136 ± 21/81 ± 10mmHg during the manipulation period. The plasma catecholamine levels showed significant increases in this period. Immediately after excision, the systemic arterial pressure was maintained at normal levels (118 ± 13/75 ± 16mmHg) by fluid replacement and discontinuation of ATP administration, subsequently becoming 129 ± 19/79 ± 16mmHg. The heart rate was very stable and tachycardia did not ocurr during the manipulation period. Only one arrhythmic episode ocurred in one patient. The systemic vascular resistance index was significantly lower during the manipulation period than before it. It was therefore considered that ATP was useful as an agent for controlling arterial pressue during the anesthesia for pheochromocytoma.(Murata K, Sodeyama O, Ikeda K et al.: Prevention of hypertensive crisis with ATP during anesthesia for pheochromocytoma. J Anesth 1: 162–167, 1987)     

Blast Crisis of Chronic Myelogenous Leukemia with Tumor Formation Characterized by T-cell Features--A Case Report

We report a case of chronic myelogenous leukemia (CML) associatedwith pronounced peripheral lymphadenopathy, with the cells havingthe Philadelphia (Phl) chromosome and T-cell features. A 23-year-oldman who was diagnosed as having CML and treated with busulfanwas admitted to our hospital because of increasing hepatosplenomegalyand pronounced lymphadenopathy. An axillary lymph node biopsydisclosed that the malignant cells formed rosettes with neuraminidase-treatedsheep red blood cells (En) (95.0%) and were positive for Leu1 (91.8%). Of the cytochemical reactions, peroxidase was negativeand periodic acid-Shiff, acid -naphthyl acetate esterase andß-glucuronidase were all positive. The karyotype ofthe bone marrow cells was 46 XY Phl positive (22q–), andthat of the lymph node cells was 51 XY Phl positive +8, +9,+18, +19, +21, 22q–. He was treated with various anti-leukemicagents and irradiation. Despite such treatments, he died ofpneumonia. This is a report of a CML patients with blast crisisand tumor formation characterized by T-cell features.     

血府逐瘀汤预防上肢皮瓣术后血管危象的临床研究

〔摘 要〕 目的：观察血府逐瘀汤预防上肢皮瓣术后血管危象的临床疗效。 方法：选取 2022 年 1 月至 2023 年 1 月就诊于 赣州市南康区第一人民医院的 60 例行上肢皮瓣转移术的患者,采用简单数字随机法分为观察组和对照组,各 30 例。术后 对照组患者常规应用 “ 三抗 ” 治疗,观察组患者在 “ 三抗 ” 的基础上加服血府逐瘀汤剂,比较两组患者术后皮瓣的血运情 况、总体疗效。 结果：术后 3 d、7 d,观察组患者皮瓣肿胀程度优于对照组,差异具有统计学意义（Z 分别为 –2.28、–3.46, P ＜ 0.05）;术后 1 d、3 d、7 d,观察组患者毛细血管反应优于对照组,差异具有统计学意义（Z 分别为 –6.89、–6.29、–7.35, P ＜ 0.05）;观察组患者疗效优于对照组,差异具有统计学意义（Z = –3.44,P ＜ 0.05）。 结论：上肢皮瓣术后的患者在常 规 “ 三抗 ” 的基础上,加用血府逐瘀汤可有效减少血管危象的发生,提高皮瓣成活率。     

Increases in Naloxone Administrations by Emergency Medical Services Providers During the COVID-19 Pandemic: Retrospective Time Series Study

BackgroundThe opioid crisis in the United States may be exacerbated by the COVID-19 pandemic. Increases in opioid use, emergency medical services (EMS) runs for opioid-related overdoses, and opioid overdose deaths have been reported. No study has examined changes in multiple naloxone administrations, an indicator of overdose severity, during the COVID-19 pandemic.ObjectiveThis study examines changes in the occurrence of naloxone administrations and multiple naloxone administrations during EMS runs for opioid-related overdoses during the COVID-19 pandemic in Guilford County, North Carolina (NC).MethodsUsing a period-over-period approach, we compared the occurrence of opioid-related EMS runs, naloxone administrations, and multiple naloxone administrations during the 29-week period before (September 1, 2019, to March 9, 2020) and after NC’s COVID-19 state of emergency declaration (ie, the COVID-19 period of March 10 to September 30, 2020). Furthermore, historical data were used to generate a quasi-control distribution of period-over-period changes to compare the occurrence of each outcome during the COVID-19 period to each 29-week period back to January 1, 2014.ResultsAll outcomes increased during the COVID-19 period. Compared to the previous 29 weeks, the COVID-19 period experienced increases in the weekly mean number of opioid-related EMS runs (25.6, SD 5.6 vs 18.6, SD 6.6; P<.001), naloxone administrations (22.3, SD 6.2 vs 14.1, SD 6.0; P<.001), and multiple naloxone administrations (5.0, SD 1.9 vs 2.7, SD 1.9; P<.001), corresponding to proportional increases of 37.4%, 57.8%, and 84.8%, respectively. Additionally, the increases during the COVID-19 period were greater than 91% of all historical 29-week periods analyzed.ConclusionsThe occurrence of EMS runs for opioid-related overdoses, naloxone administrations, and multiple naloxone administrations during EMS runs increased during the COVID-19 pandemic in Guilford County, NC. For a host of reasons that need to be explored, the COVID-19 pandemic appears to have exacerbated the opioid crisis.     

A Local COVID-19 Support Platform for Nursing Homes: Feedback and Perspectives

The COVID-19 pandemic has had a major impact on nursing homes (NHs), which were not prepared to manage infections among their at-risk patient populations. In order to comply with the French government's guidelines, we rapidly set up a local support platform (LSP) to help NHs manage their cases of COVID-19. The LSP comprised multidisciplinary decision support, a specialist phone hotline, mobile geriatric medicine teams, and videoconferences on COVID-19.We first quantified the LSP's interventions in 63 local NHs since the start of the first wave of COVID-19 (March 2020): 9 instances of multidisciplinary decision support, 275 calls to the specialist phone hotline, 84 interventions by mobile geriatric medicine teams, and 16 videoconferences. The LSP had been used during and between the first and second waves of the epidemic, and all had evolved to meet the NHs' needs.     

肾上腺节细胞神经瘤8例的诊断和治疗

目的：回顾分析8例肾上腺节细胞神经瘤的临床资料,以提高其诊断的水平,方法：8例病例行CT平扫肾上腺区,其中4例加行CT增强扫描,2例加做肾区磁共振成像MRI检查,对其影像学特点进行总结。结果：8例经病理证实的肿瘤中,7例CT平扫呈密度均匀,低于肌肉密度的肿块,增强扫描4例呈密度均匀或销不均匀肿块,低于或等于肌肉强化密度,MRI2例在冠状位T1加权像表现为均匀低信号,轴位T2加权介呈不均匀高信号（相对于正常肝脏信号）。结论：（1）CT和MRI检查在肾上腺节细胞神经瘤术前诊断中有重要价值。（2）治疗主要领先外科手术。     

肾上腺偶发瘤18例临床分析

目的：提高肾上腺偶发瘤的诊治水平。方法：报告18例并结合文献讨论其不宜被早期发现的原因,潜在的手术危险性,及需警惕恶性病变等临床特点,结果：采用影像学,细针穿刺活检等方法诊断,除2例肿瘤无法切除外,共余均行手术切除,病理证实：皮质癌4例,其余均为良性病变,结论：对大于3cm的肿瘤需采取外科手术治疗,小于3cm的肿瘤可密切随访,根据其生物学行为采取不同的处理方法。     

人胚胎肾上腺皮质褪黑素受体亚型蛋白的分布

目的：研究褪黑素（Mel)受体亚型在人胚胎肾上腺皮质的分布。方法：应用免疫组化染色检测Ｍel受体亚型的人胚胎肾上腺皮质的分布。结果：在人胚胎肾上腺皮质的球状速、束状带和网状带均存在Ｍel受体mt1(Mella)和ＭＴ２（Ｍellb)亚型蛋白的表达,且主要分布于细胞质。结论：人胚胎肾上腺皮质存在Ｍel受体mt1和ＭＴ２亚型。     

30例肾上腺肿瘤的CT表现特征分析

目的分析肾上腺肿瘤的CT表现特征. 方法回顾性分析30例经手术病理证实的各类肾上腺肿瘤的CT征像,提出诊断与鉴别诊断的要点.结果纤维黄色瘤呈中等度大小,密度不均匀,轻度强化 ;嗜铬细胞瘤肿块较大,密度不匀,强化明显;髓性脂肪瘤CT值呈脂肪密度;囊肿的CT值偏低,囊肿壁可有钙化;醛固酮腺瘤小,密度低;皮质醇腺瘤中等大小,中等密度;皮质腺癌肿块较大且不规则,内有低密度区;肾上腺转移癌肿块较大,密度不均匀.结论认真分析影像学特征,提高肾上腺肿瘤诊断的准确率是可能的.