天津市一起停乳链球菌似马亚种感染引起的聚集性发热事件的调查分析

目的 调查一起疑似停乳链球菌似马亚种（Streptococcus dysgalactiae subsp. Equisimilis, SDSE）引起的发聚集性发热事件,为今后处理类似事件积累经验。方法 2020年5月22日天津市某公司内出现不明原因聚集性发热病例,采集24例患者咽拭子标本,采用荧光定量PCR技术、微流体芯片技术、基因测序技术、细菌培养、药敏试验等方法进行病毒、细菌等相关病原体检测。现场采集90份环境样本进行细菌检测。结果 24份咽拭子标本中,9份标本检出溶β-溶血性链球菌,经VITEK2生化鉴定系统及质谱鉴定仪确认为停乳链球菌似马亚种。药敏试验结果显示对万古霉素、氨苄西林、氯霉素、左氧氟沙星、头孢唑林、头孢曲松、青霉素100%敏感,对庆大霉素、红霉素、阿奇霉素、克林霉素、克拉霉素100%耐药,对复方新诺明中度耐药（耐药率为55.6%）,对四环素的耐药率为77.8%,基因组测序结果显示66 666个reads为停乳链球菌似马亚种的基因片段,覆盖基因组长度为2 179 445 bp,覆盖度达到60%。环境样本各项细菌检测指标均合格,未检出β-溶血性链球菌和嗜肺军团菌。结论 这是一起疑似由停乳链球菌似马亚种引起的聚集性发热事件,在天津地区尚属首次。SDSE引起的暴发感染在国内非常罕见,迅速对病原体进行分离鉴定是确定疫情爆发原因的关键。     

核转录因子红系 2相关因子 2和 p62在宫颈鳞状细胞癌和上皮内病变中的表达及诊断价值

目的探讨核转录因子红系 2相关因子 2(Nrf2)与选择性自噬接头蛋白 p62/Sequestosome1(SQSTM1)在诊断宫颈癌和上皮内病变中的价值,并且分析二者在不同宫颈病变中的相关性。方法收集 2008年 1月至 2021年 12月南通市肿瘤医院 120例宫颈鳞状细胞癌(SCC)102例低级别鳞状上皮内病变(LSIL)和 101例高级别鳞状上皮内病变(HSIL)病人及 49例宫颈良性/反应性鳞状上皮病人的石蜡、标本,免疫组织化学方法检测其中 Nrf2和 p62的表达,并分析二者在不同宫颈病变中的相关性及评估二者在诊断中的价值。结果 Nrf2和 p62在 LSIL、HSIL和 SCC中表达明显高于良性 /反应性宫颈鳞状上皮(均 P<0.05), Nrf2和 p62在 HSIL和 SCC中表达明显高于 LSIL(均 P<0.05),p62在 SCC中表达明显高于 HSIL(P<0.05),而 Nrf2在 HSIL中表达稍低于 SCC(P<0.05)。 Nrf2和 p62在良性 /反应性宫颈鳞状上皮、 LSIL、HSIL和 SCC中均具有正相关性,相关系数分别为 0.63、 0.58、0.69和 0.38(均 P<0.05)。 ROC曲线结果显示,除 Nrf2在诊断 HSIL与 SCC中差异无统计学意义外, Nrf2、p62以及联合 Nrf2和 p62在诊断良性 /反应性鳞状上皮与 LSIL、良性 /反应性鳞状上皮与 HSIL、良性 /反应性鳞状上皮与 SCC、LSIL与 HSIL、LSIL与 SCC、HSIL与 SCC各个组别中均差异有统计学意义(均 P<0.05)。结论 Nrf2和 p62在良性 /反应性鳞状上皮中不表达或低表达, LSIL中表达有所增高, HSIL和 SCC中表达最高,二者在不同宫颈病变中均具有正相关性,而且单独使用 Nrf2或 p62就能够有效诊断不同的宫颈病变,二者联用诊断效果更佳。     

A New Approach to the Characterization of Subtle Errors in Everyday Action: Implications for Mild Cognitive Impairment

Mild functional difficulties have been associated with early cognitive decline in older adults and increased risk for conversion to dementia in mild cognitive impairment, but our understanding of this decline has been limited by a dearth of objective methods. This study evaluated the reliability and validity of a new system to code subtle errors on an established performance-based measure of everyday action and described preliminary findings within the context of a theoretical model of action disruption. Here 45 older adults completed the Naturalistic Action Test (NAT) and neuropsychological measures. NAT performance was coded for overt errors, and subtle action difficulties were scored using a novel coding system. An inter-rater reliability coefficient was calculated. Validity of the coding system was assessed using a repeated-measures ANOVA with NAT task (simple versus complex) and error type (overt versus subtle) as within-group factors. Correlation/regression analyses were conducted among overt NAT errors, subtle NAT errors, and neuropsychological variables. The coding of subtle action errors was reliable and valid, and episodic memory breakdown predicted subtle action disruption. Results suggest that the NAT can be useful in objectively assessing subtle functional decline. Treatments targeting episodic memory may be most effective in addressing early functional impairment in older age.     

Application of a Multidisciplinary Model to a Case Example of Presurgical Epilepsy Planning

This article presents a case example which illustrates the multidisciplinary model for presurgical assessment for epilepsy patients. Nearly three million people in the United States are diagnosed with epilepsy and more than one third of this population is refractory to pharmacological treatment. Poor seizure control is associated with additional impairment in quality of life and cognitive and social functioning, and even with premature death. In accordance with these concerns, surgical intervention is increasingly recognized as a viable treatment option, which should be considered soon after drug resistance becomes apparent. Despite the widespread evidence of effectiveness surgery is often delayed, in part because of the necessity, and difficulties, of correctly applying a multidisciplinary approach to presurgical assessment. And yet, a multidisciplinary team is crucial in the evaluation of risks and benefits of possible surgical intervention and in guiding the surgical procedure to maximize seizure control and minimize risk to eloquent cortex. In the model and complex case presented, the neuropsychologist has a critical role in the presurgical evaluation, as well as in the postsurgical evaluation of outcome.     

Accuracy of the Modified Somatic Perception Questionnaire and Pain Disability Index in the Detection of Malingered Pain-Related Disability in Chronic Pain

The Modified Somatic Perception Questionnaire (MSPQ) and the Pain Disability Index (PDI) are both popular clinical screening instruments in general orthopedic, rheumatologic, and neurosurgical clinics and are useful for identifying pain patients whose physical symptom presentations and disability may be non-organic. Previous studies found both to accurately detect malingered pain presentations; however, the generalizability of these results is not clear. This study used a criterion groups validation design (retrospective cohort of patients with chronic pain, n = 328) with a simulator group (college students, n = 98) to determine the accuracy of the MSPQ and PDI in detecting Malingered Pain Related Disability. Patients were grouped based on independent psychometric evidence of MPRD. Results showed that MSPQ and PDI scores were not associated with objective medical pathology. However, they accurately differentiated Not-MPRD from MPRD cases. Diagnostic statistics associated with a range of scores are presented for application to individual cases. Data from this study can inform the clinical management of chronic pain patients by screening for psychological overlay and malingering, thus alerting clinicians to the possible presence of psychosocial obstacles to effective treatment and triggering further psychological assessment and/or treatment.     

Cognitive Impairment and Memory Loss Associated With Histoplasmosis: A Case Study

Histoplasmosis is a rare disease caused by inhalation of the fungus Histoplasma capsulatum. It can spread via cerebral circulation to the central nervous system as a manifestation of a disseminated infection; particularly in patients with immune suppression, which can result in isolated ring-enhancing lesions and inflammation in the brain. Of the reported disseminated histoplasmosis cases (approximately 1 in 2000 per year), only 5–20% have evidence of central nervous system involvement. This paper reviews a single case study of a 57-year-old female diagnosed with disseminated CNS histoplasmosis. Patient’s complaints included reduced short-term memory, word-finding problems, and difficulty organizing, making decisions, getting lost while driving, recalling names, retaining information while reading, and slowed processing speed. There was also a history of mild depression and anxiety. Direct testing revealed deficits in multiple cognitive domains including complex attention, processing speed, semantic fluency, visual scanning, motor speed, set-shifting, naming, nonverbal memory, and verbal memory. Neuropsychological deficits suggest cortical and subcortical brain dysfunction, including anterior, temporal, and mesial-temporal regions. This case illustrates the need for neuropsychologists to understand histoplasmosis, the related pathophysiology, and the neuropsychological impact; particularly with the potential for delayed progression.     

An Examination of the Frequency of Invalid Forgetting on the Test of Memory Malingering

The Test of Memory Malingering (TOMM) is the most used performance validity test in neuropsychology, but does not measure response consistency, which is central in the measurement of credible presentation. Gunner, Miele, Lynch, and McCaffrey (2012 Gunner, J. H., Miele, A. S., Lynch, J. K., & McCaffrey, R. J. (2012). The Albany Consistency Index for the Test of Memory Malingering. Archives of Clinical Neuropsychology, 27(1), 1–9. doi:10.1093/arclin/acr089.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) developed the Albany Consistency Index (ACI) to address this need. The ACI consistency measurement, however, may penalize examinees, resulting in suboptimal accuracy. The Invalid Forgetting Frequency Index (IFFI), created for the present study, utilizes an algorithm to identify and differentiate learning and inconsistent response patterns across TOMM trials. The purpose of this study was to assess the diagnostic accuracy of the ACI and IFFI against a reference test (Malingered Neurocognitive Dysfunction criteria), and to compare both to the standard TOMM indexes. This retrospective case-control study used 59 forensic cases from an outpatient clinic in Southern Kansas. Results indicated that sensitivity, negative predictive value, and overall accuracy of the IFFI were superior to both the TOMM indexes and ACI. Logistic regression odds ratios were similar for TOMM Trial 2, Retention, and IFFI (1.25, 1.24, 1.25, respectively), with the ACI somewhat lower (1.18). The IFFI had the highest rate of group membership predictions (79.7%). Implications and limitations of the present study are discussed.     

Diagnostic accuracy of the Phototest for cognitive impairment and dementia in Argentina

Phototest is a simple, easy and very brief test with theoretical advantages over available dementia screening tests in Spain. The objective of this study was to estimate the diagnostic accuracy of the Phototest for cognitive impairment and dementia and to compare it with that of the MMSE and the Clock Drawing Test (CDT) in an Argentine population. A phase II cross-sectional study of diagnostic tests evaluation was performed in a sample of 30 controls, 61 with amnestic mild cognitive impairment (a-MCI), and 56 with mild Alzheimer type dementia (DAT). The diagnostic accuracy (DA) was assessed in relation to the clinical diagnosis by calculating the area under the ROC curve (UAC), Sensitivity (Sn), and Specificity (Sp).The DA of the Phototest for a-MCI and DAT (0.93 and 0.97 [UAC]) was higher than that of the MMSE and the CDT. The cut-off points of 27/28 for DAT (Sn = 89.29 [78.1–96.0], Sp = 96.67 [82.8–99.9]) and 30/31 for a-MCI (Sn = 85.25 [73.8–93.0], Sp = 90.00 [73.5–97.9]) maximized the sum of Sn and Sp. Phototest correlates significantly with MMSE and CDT. The Phototest is an efficient instrument for the detection of mild dementia or MCI, with good accuracy and good correlation with tests measuring overall cognitive impairment.     

Why Don’t Neurosurgery Patients Return for Neuropsychological Follow-Up? Predictors for Voluntary Appointment Keeping and Reasons for Cancellation

Neuropsychological follow-up appointments are important for patients who have had intracranial surgery because cognitive deficits are common in this population and prognosis is not always optimistic. Unfortunately some patients cancel or do not show up. The current study attempted to identify predictors of non-attendance in this population. A total of 428 patients recruited over 2 years with a scheduled neuropsychological follow-up appointment after intracranial surgery in the St. Elisabeth Hospital, Tilburg, The Netherlands were included. Demographic, clinical, and other miscellaneous variables were extracted from medical records. Of this total population, 42% were non-attenders. The predictors of non-attendance were as follows: patients who had subdural hematomas and/or malignant tumors (compared to those who had other diagnoses prior to intracranial surgery); those who had been transferred to another hospital (compared to those sent home); those who had been referred for further medical treatment before the appointment; a shorter time interval between discharge and follow-up appointment; and finally, if the patient’s home was further away from the hospital. Patients who undergo intracranial surgery are a very heterogeneous group with different needs. Neuropsychological follow-up after surgery may be important for some patients (the better-functioning and/or those with cognitive complaints) but perhaps not for others (those with more severe prognoses and/or no complaints). We provide suggestions which should increase attendance in those who could benefit from follow-up neuropsychological assessment.     

1 year test–retest reliability of ImPACT in professional ice hockey players

The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) battery is widely used to assess neurocognitive outcomes following sports-related concussion. The purpose of this study was to examine the 1 year test–retest reliability of ImPACT in a multilingual sample of professional hockey players. A total of 305 professional hockey players were tested 1 year apart using ImPACT. Reliable change confidence intervals were calculated and test–retest reliability was measured using Pearson and Intraclass correlation coefficients. Results indicated that the 1-year test–retest reliabilities for the Visual Motor and Reaction Time Composites ranged from low to high (.52 to .81). In contrast, 1-year test–retest reliabilities for the Verbal and Visual Memory Composites were low (.22 to .58). The 1-year test–retest results provided mixed support for the use of Visual Motor and Reaction Time Composites in select samples; in contrast, the Verbal and Visual Memory Composites may not be sensitive to clinical change.