Editorial Perspective: Psychosis risk in adolescence – outcomes,comorbidity, and antipsychotics

Research on Clinical High-Risk for Psychosis (CHR-P) has led to a vigorous change in the field of early detection in psychiatry and is gradually expanding its focus toward early development. The Annual Research Review on psychosis risk in adolescents (Journal of Child Psychology and Psychiatry, 62, 2020 and 657) offers a wide-angle meta-analytical picture of such emerging trends in all areas relevant to CHR-P Research, that is, detection, prognosis, and intervention. This editorial perspective is meant to expand the clinical and conceptual reach of these meta-analytic findings in relation to (a) the influence of age on transition rate and scalability of the early detection model across the child–adolescent vs adult periods; (b) potential latent heterogeneity of the pathogenetic trajectories leading to CHR-P as suggested by comorbid psychopathologies; (c) controversial (or at least problematic) prognostic significance of antipsychotic exposure in CHR-P subjects, especially in children and adolescents.     

综合护理干预对小儿高热惊厥家属心理状态的影响分析

目的小儿高热惊厥应用综合护理干预措施对家属心理状态的影响。方法选择郑州大学附属儿童医院2016年4月—2017年6月收治的100例小儿高热惊厥患者为研究对象,按照随机数字表法将其分为观察组、对照组,并对比分析患儿基础病情、SAS和SDS评分。结果观察组患儿在护理后退热时间为(26.8±6.4)h、惊厥消失时间为(4.3±0.8) h和住院时间为(6.2±1.2) d均短于对照组患儿(P0.05)。两组患儿在护理后的SAS、SDS评分均优于护理前,且观察组患儿的SAS为(33.10±6.92)分、SDS为(38.23±5.55)分均优于对照组(P0.05)。结论小儿高热惊厥应用综合护理干预措施具有显著的护理效果,能够缩短惊厥消失时间、住院时间与退热时间,同时还可以缓解患儿家属的焦虑与抑郁,改善心理状态,有助于患儿早日恢复。     

老年腹股沟嵌顿疝全身麻醉腹腔镜手术对认知功能的影响

目的探讨腹腔镜微创手术对老年腹股沟嵌顿疝全麻术后认知功能的影响。 方法回顾性分析2015年3月至2018年6月，内江市第二人民医院接受治疗的44例腹股沟嵌顿疝老年患者临床资料，根据手术方式不同分为观察组（24例）和对照组（20例）。对照组采用开放式无张力疝修补术治疗，观察组采用腹腔镜经腹腹膜前疝修补术（TAPP）治疗。比较2组患者手术相关指标、手术前后焦虑、抑郁状态及认知功能及2组术后并发症发生情况。 结果与对照组比较，观察组术后排气时间、进食时间及自主下床活动时间均明显提前，差异有统计学意义（P<0.05）。与术前比较，术后2周2组患者焦虑自评量表、抑郁自评量表评分均明显降低，且观察组明显低于对照组，差异有统计学意义（P<0.05）。与术前比较，术后第2天2组患者即刻记忆力、回忆力、定向力、注意力及语言能力评分均明显降低，且观察组明显高于对照组，差异有统计学意义（P<0.05）。观察组总并发症发生率明显低于对照组，差异有统计学意义（P<0.05）。 结论TAPP配合围手术期精心护理可更有效地缓解腹股沟嵌顿疝老年患者不良心理情绪，对患者术后认知功能的影响更小，并发症少，有利于患者术后恢复，建议临床推广使用。     

两种术式对于胆道结石患者术后胆道压力与胃肠道功能研究

目的探讨微创手术和开腹手术治疗胆道结石患者的临床疗效及对胆道压力和胃肠道功能的影响，分析胆道压力与胃肠功能的相互关系。 方法回顾性分析2016年1月至2018年1月收治的124例胆道结石患者。开腹组60例患者采用开腹手术治疗，微创组64例患者采用腹腔镜下胆道镜内镜联合钬激光碎石术治疗。采用SPSS18.00统计软件分析，术中术后指标、炎性因子检测、术后胆道压测定和胃肠动力指标检测，以均数( ±s)形式录入，采用独立t检验；净石率、术后并发症比较采用χ²检验；胆道压力与胃肠动力指标相关性分析采用Spearman相关分析，以P<0.05表示差异有统计学意义。 结果微创组手术时间、住院天数、住院费用、净石率、并发症率均优于开腹组(P<0.05)；微创组术后3 d、 5 d血清IL－6、 IL－8、 TNF－α浓度、 MTL、 CCK、 VIP水平和胆道压力和均显著低于开腹组(P<0.05)；患者术后胆道压力与胃肠动力指标MTL、 CCK程负相关(r＝－0.632, －0.678; P均<0.05)；VIP水平与胆道压力程正相关(r＝0.712; P<0.05)。 结论腹腔镜下胆道镜内镜联合钬激光碎石术治疗胆道结石临床效果明显，术后机体炎症反、胆道压力、胃肠动力指标更优，且胆道压力与胃肠动力指标具有一定相关性。     

Impact of sampling rate on statistical significance for single subject fMRI connectivity analysis

A typical time series in functional magnetic resonance imaging (fMRI) exhibits autocorrelation, that is, the samples of the time series are dependent. In addition, temporal filtering, one of the crucial steps in preprocessing of functional magnetic resonance images, induces its own autocorrelation. While performing connectivity analysis in fMRI, the impact of the autocorrelation is largely ignored. Recently, autocorrelation has been addressed by variance correction approaches, which are sensitive to the sampling rate. In this article, we aim to investigate the impact of the sampling rate on the variance correction approaches. Toward this end, we first derived a generalized expression for the variance of the sample Pearson correlation coefficient (SPCC) in terms of the sampling rate and the filter cutoff frequency, in addition to the autocorrelation and cross‐covariance functions of the time series. Through simulations, we illustrated the importance of the variance correction for a fixed sampling rate. Using the real resting state fMRI data sets, we demonstrated that the data sets with higher sampling rates were more prone to false positives, in agreement with the existing empirical reports. We further demonstrated with single subject results that for the data sets with higher sampling rates, the variance correction strategy restored the integrity of true connectivity.     

Clermont-Ferrand versus Vectec uterine manipulator for total laparoscopic hysterectomy

Objective: To compare the operation time and performance of two uterine manipulators used for total laparoscopic hysterectomy (TLH).

Material and methods: Design: Retrospective cohort analysis. Design classification: Canadian Task Force Classification II-2. Setting: Tertiary-care university-based teaching hospital and academic affiliated private hospital. Patients: All consecutive patients who underwent for TLH between January 2014 and June 2017. All operations were performed by two expert endoscopic surgeons using one of the following uterine manipulators depending on surgeon preferences: Clermont-Ferrand (CF) or Vectec (VT) MAUT60. Patients were excluded if additional surgeries such as urogynecological procedures were performed, TLH was converted to laparotomy prior to colpotomy, and when their operation records could not be obtained. A total of 169 patients were added to final analysis. Operation time, colpotomy time and the subjective performance of manipulators such as movement of the uterus, visualization of the vaginal fornices, and maintenance of pneumoperitoneum were evaluated by watching un-edited operation videos.

Results: A total of 169 patients (83 patients in CF group; 86 patients in VT group) were included in the final analysis. Patients’ baseline characteristics were comparable between groups. Operation time and time required for colpotomy were significantly shorter in the VT group. Lateral movements of the manipulators and elevation of the uterus were better with VT compared to CF (p?=?.001 for both). Compared to the CF, VT was superior for visualization of the vaginal fornices (p?=?.004) and maintenance of pneumoperitoneum (p?<?.001). Both surgeons had perfect agreement on the performance grading of manipulators (p?<?.001, Kappa values were between 0.86–0.92). There was no difference between groups in estimated blood loss and duration of hospital stay. Reinsertion or the need to change the manipulator was not required in either group. No pelvic or vaginal abscess, cuff cellulitis, dehiscence, or hematoma formations were noted.

Conclusion: Laparoscopic hysterectomy assisted with the VT uterine manipulator is associated with shorter operation and colpotomy time. Furthermore, the movements of uterus, visualization of the vaginal fornices, and maintenance of pneumoperitoneum were significantly better with VT compared to the CF manipulator.     

唤醒状态联合中央沟定位切除脑运动区胶质瘤对患者运动功能保护作用探讨

目的 探究唤醒状态联合中央沟定位对脑运动区胶质瘤切除术患者运动功能的保护作用。方法 选取本院2016年12月—2017年10月期间收治的脑运动区胶质瘤患者70例。所有患者均行唤醒状态联合中央沟定位运动区胶质瘤切除术。观察患者术后复发情况及术后第6、12个月的Kamofsky评分,并记录并发症发生情况。结果 所有患者均成功完成手术,未出现术中大出血、死亡等严重并发症。70例患者中,有40例全切除,26例次全切除,4例大部分切除。术后,感觉减退者有6例,肌力下降者有5例,肌力下降伴感觉减退者有2例,并发症发生率为18.57%(13/70)。6个月后,应用增强MRI显示有4例患者肿瘤灶周围明显强化,进一步使用正电子发射断层显像发现有1例患者肿瘤复发。术前及术后第6、12个月的Kamofsky评分分别为(89.62±11.88)及(80.73±9.91)、(65.82±12.36)。结论 唤醒状态联合中央沟定位能最大限度切除脑运动区胶质瘤,提高患者预后效果。     

两种手术入路行右心房黏液瘤切除手术的临床对照研究

目的 对比采用右胸前外侧微创切口和胸骨正中切口行右心房黏液瘤切除手术的手术效果。方法 选取2005年5月至2019年12月在复旦大学附属中山医院行手术治疗的右心房黏液瘤患者共61例，其中男性25例，女性36例，年龄19~82岁，平均（53.6±13.4）岁，根据手术切口分组，45例采用胸骨正中切口（胸骨组），16例采用右胸前外侧微创切口（微创组）。采用独立样本t检验、秩和检验、Fisher精确检验比较两组手术结果。结果 两组术前资料匹配，无院内死亡患者。两组平均心肺转流时间相似，但与胸骨组相比，微创组平均手术时间、主动脉阻断时间均较短，平均机械通气时间和术后住院时间较短，引流量较少，输血率较低，差异有统计学意义。术后随访3~153个月，随访率95.6%，1例患者随访期间非心源性死亡，余患者恢复良好，随访超声心动图未见肿瘤复发。结论 两种手术入路行右心房黏液瘤切除均安全有效，术后中远期复发率低，采用右胸前外侧微创切口进行手术可缩短手术时间，减少手术创伤。     

Design,synthesis and pharmacological evaluation of 4-(3-chloro-4-(3-cyclopropylthioureido)-2-fluorophenoxy)-7-methoxyquinoline-6-carboxamide (WXFL-152): a novel triple angiokinase inhibitor for cancer therapy

Angiokinases, such as vascular endothelial-, fibroblast- and platelet-derived growth factor receptors (VEGFRs, FGFRs and PDGFRs) play crucial roles in tumor angiogenesis. Anti-angiogenesis therapy using multi-angiokinase inhibitor has achieved great success in recent years. In this study, we presented the design, synthesis, target identification, molecular mechanism, pharmacodynamics (PD) and pharmacokinetics (PK) research of a novel triple-angiokinase inhibitor WXFL-152. WXFL-152, identified from a series of 4-oxyquinoline derivatives based on a structure–activity relationship study, inhibited the proliferation of vascular endothelial cells (ECs) and pericytes by blocking the angiokinase signals VEGF/VEGFR2, FGF/FGFRs and PDGF/PDGFRβ simultaneously in vitro. Significant anticancer effects of WXFL-152 were confirmed in multiple preclinical tumor xenograft models, including a patient-derived tumor xenograft (PDX) model. Pharmacokinetic studies of WXFL-152 demonstrated high favourable bioavailability with single-dose and continuous multi-dose by oral administration in rats and beagles. In conclusion, WXFL-152, which is currently in phase Ib clinical trials, is a novel and effective triple-angiokinase inhibitor with clear PD and PK in tumor therapy.