Depression in Primary Care

Depression is a heterogeneous disorder with a wide range of presentations. Most patients with depression are seen in primary care, where it is often unrecognized; thus, screening for depression is important. Medical conditions can mimic depression and vice versa. For mild cases of depression, symptom monitoring and nonpharmacologic strategies are generally recommended initially, whereas psychotherapy and antidepressant drugs are first-line treatment for moderate to severe cases. Patients with depression often experience relapse, recurrence, or both, and multiple options are available. Primary care providers are central to screening, diagnosing, and subsequently treating or referring these patients.     

PBL联合微信教学模式在住培医师临床实践中的应用

目的探讨基于问题学习(Problem-based learning,PBL)联合微信的教学方法应用于住培医师的临床实践。方法选择2017年1月—2019年12月在产科学习的46名住院医师规范化培训二年级学员作为研究对象,将其随机分成PBL组(A组,n=23),PBL联合微信组(B组,n=23),结合电子问卷,分析两组学员的理论考试、病历书写、技能操作、病例分析成绩在两种教学质量上的差异。结果在理论考试成绩及病历书写上比,A组与B组,差异无统计学意义(P>0.05);在技能操作成绩及病例分析成绩上比,B组优于A组,差异有统计学意义(P<0.05)。结论PBL联合微信教学模式,可以弥补单纯PBL教学模式的不足,对产科住培医师临床实践有较大的帮助,可以提高住培医师的带教质量。     

Preoperative tendon retraction,not smoking,is a risk factor for failure with continuity after rotator cuff repair

BackgroundSmoking is a poor prognostic factor for healing after rotator cuff repair and is associated with inferior results. We hypothesized that smokers would have higher recurrent tear rates and more postoperative myotendinous junction (MTJ) retraction in healed repairs than nonsmokers three months postoperatively.MethodsRotator cuff repairs (RCRs) were retrospectively reviewed over a 2-year period. Patients underwent magnetic resonance imaging (MRI) within 6 months prior to surgery and again at 3 months postoperatively. Seventy-nine patients were included and stratified by smokers versus nonsmokers. Baseline patient demographics, tear characteristics, and surgical factors were collected. Preoperative and postoperative MRIs were assessed to quantify the MTJ position and to establish the recurrent tear rate.ResultsFor the total cohort (nonsmokers, n = 56; smokers, n = 23), significant differences in age, race, and traumatic onset of injury existed between groups. There were no significant differences in recurrent tear between smokers (26%) and nonsmokers (27%), but nonsmokers were more satisfied. For patients with healed RCRs (nonsmokers, n = 41; smokers, n = 17), there were significant differences in race. On univariate analysis, nonsmokers had a significantly more lateral MTJ postoperatively (P = 0.05). On multivariable regression analysis, medialized postoperative MTJ position in healed cuffs was driven only by greater preoperative rotator cuff retraction preoperatively. There were no significant differences in MTJ position based on smoking status for patients with healed RCRs.ConclusionSmoking does not appear to be an independent risk factor for postoperative MTJ retraction in healed RCRs, also known as failure in continuity. Preoperative tear size and retraction play the biggest roles in predicting postoperative MTJ position, regardless of smoking status. There are no significant differences in patient-reported outcomes for patients with healed RCRs, but nonsmokers had more satisfaction following RCR in the total cohort.Level of EvidenceLevel III; Retrospective cohort study; Diagnostic study     

The veiled intimacy between neurology and Vincent van Gogh

Vincent van Gogh (1853–1890) is one of the most important painters of our history. Celebrating 130 years since the death of this genius, this article unveils the surprising relationship between van Gogh and neurology. Besides all his eternal artistic output, Vincent also suffered all his life from a neurological disease. Many articles have already investigated his illness and epilepsy appears to be one of the most reasonable diagnosis. There is much evidence that van Gogh's work was influenced by his neurological condition in several ways. Besides, the analysis of Vincent's life can provide several valuable teachings to neurologists.     

Acute effects of brain-responsive neurostimulation in drug-resistant partial onset epilepsy

ObjectiveUnderstanding the acute effects of responsive stimulation (AERS) based on intracranial EEG (iEEG) recordings in ambulatory patients with drug-resistant partial epilepsy, and correlating these with changes in clinical seizure frequency, may help clinicians more efficiently optimize responsive stimulation settings.MethodsIn patients implanted with the NeuroPace® RNS® System, acute changes in iEEG spectral power following active and sham stimulation periods were quantified and compared within individual iEEG channels. Additionally, acute stimulation-induced acute iEEG changes were compared within iEEG channels before and after patients experienced substantial reductions in clinical seizure frequency.ResultsResponsive stimulation resulted in a 20.7% relative decrease in spectral power in the 2–4 second window following active stimulation, compared to sham stimulation. On several detection channels, the AERS features changed when clinical outcomes improved but were relatively stable otherwise. AERS change direction associated with clinical improvement was generally consistent within detection channels.ConclusionsIn this retrospective analysis, patients with drug-resistant partial epilepsy treated with direct brain-responsive neurostimulation showed an acute stimulation related reduction in iEEG spectral power that was associated with reductions in clinical seizure frequency.SignificanceIdentifying favorable stimulation related changes in iEEG activity could help physicians to more rapidly optimize stimulation settings for each patient.     

颅内动脉瘤心动周期内膨胀率与其破裂的相关性研究

目的 基于四维计算机X线断层扫描(Computed tomography,CT)血管成像(Dynamic four-dimensional CTA,4D-CTA)测量,计算颅内动脉瘤心动周期内膨胀率,探讨颅内动脉瘤破裂与膨胀率的相关性。方法 回顾性分析2018年5月-2020年5月就诊于哈尔滨医科大学附属第四医院微创神经外科一病区64例(其中未破裂动脉瘤24个,破裂动脉瘤40个)患者的完整资料; 所有患者均行4D-CTA扫描并重建图像; 依据动脉瘤破裂与否,患者分为未破裂组、破裂组; 将1个心动周期的图像数据分成20个阶段,判断动脉瘤是否存在异常搏动点; 同时记录和量化每个阶段动脉瘤的形态特征,计算其体积变化率(膨胀率); 分析动脉瘤破裂相关的危险因素。结果 未破裂组中男女患者比例差异不大; 破裂组女性患者则占70%,女性患者比例显著高于男性; 破裂组吸烟史的比例明显高于未破裂组; 破裂组瘤高(4.63±1.56)mm,瘤宽(4.72±3.68)mm,瘤颈宽(3.86±1.69)mm均大于未破裂组; 破裂组异常搏动点有29个(占72.5%)、膨胀率(14.56±6.25)%; 未破裂组异常搏动点13个(占54.2%)、膨胀率(10.21±3.26)%; 2组有明显差异(P<0.05)。此外,多因素Logistic回归分析显示动脉瘤破裂与吸烟史、纵横比、异常搏动点、膨胀率有关(P<0.05)。ROC分析中纵横比临界值为1.145(P=0.002),灵敏度为77.5%,特异性为58.3%; 存在异常搏动点与否的阈值为0.5(P=0.032),灵敏度为72.5%、特异性为45.8%; 膨胀率的临界值为9.775%(P=0.001),灵敏度为85.0%、特异性为54.2%。结论 借助4D-CTA能观察心动周期内颅内动脉瘤动态变化; 本研究成功量化了动脉瘤膨胀率,颅内动脉瘤破裂与膨胀率有关; 当膨胀率>9.775%,或纵横比>1.145,或存在异常搏动点时动脉瘤破裂风险将进一步增加。     

A pilot randomized controlled trial examining the benefits of an adjuvant psycho-behavioural intervention in comparison to a health education program,on psychological well-being and freezing-of-gait in patients with Parkinson's disease

This study investigated the effectiveness of a psycho-behavioural intervention (PBI) for freezing of gait (FOG) management in people with Parkinson's disease, through a double-blind randomized controlled pilot trial conducted with nineteen participants. Though no significant between-group differences were found, PBI was feasible, well-tolerated by participants, and exhibited a trend towards improvement for FOG and depression, thereby warranting further longitudinal investigations.     

Prevalencia y mortalidad de pacientes con necesidades paliativas en una planta de Neumología. Estudio prospectivo

IntroductionNECPAL is a tool for identification of patients with advanced chronic disease in need of palliative care. The main objective of the study is to know the prevalence of patients with palliative needs in an acute respiratory ward in a Spanish tertiary hospital using NECPAL. A second objective of the study is to know the annual mortality rate of these patients.Materials and MethodsCross sectional study and prospective monitoring of a cohort identified as palliative patients with the NECPAL tool for 12 months. Patient identification was performed in patients admitted to the respiratory ward of our hospital for longer than 3 days. We have assessed the annual vital status (deceased or not deceased) of patients and have recorded demographics, clinical and functional data, as well as the use of healthcare resources.ResultsWe monitored a cohort of 363 patients. Of them, 87 patients (24.3%) (IC 95% 19-30) were identified as NECPAL positive. 60% of patients (n = 64) died within 12 months of their admission. There was no significant difference in the mortality ratio of oncologic versus non oncologic patients. In a multivariable analysis, mortality was associated with demand by patients or relatives for palliative care and with the presence of specific disease progression markers or indicators.Conclusionsprevalence of patients with palliative needs in acute respiratory wards is high (one out of four patients). 60% of the patients identified as NECPAL positive in our cohort died in the first 12 months. Training of healthcare professionals as well as availability of appropriate resources are indispensable factors to improve care of this population.