不同年龄段勃起功能障碍患者的心理状况与人格特征分析

目的探讨不同年龄段勃起功能障碍(ED)患者心理状况的差异。方法回顾性分析郑州大学第三附属医院2018年7月至2019年7月收治的401例ED患者的临床资料。年龄20~60岁。将所有患者按年龄段分为4组:A组158例,年龄20~29岁;B组182例,年龄30~39岁;C组38例,年龄40~49岁;D组23例,年龄50~60岁。基于国际勃起功能评分表(IIEF-5)评估患者的勃起功能情况。采用症状自评量表(SCL-90)评估患者的敌对、焦虑、精神病性、恐怖、偏执、强迫、躯体化、人际关系、抑郁等9项心理状况。采用状态-特质焦虑量表(STAI)区分患者是否存在状态性或特质性的焦虑情绪。采用艾森克人格问卷(EPQ)分析患者的人格类型。分析患者组与文献报道的全国常模组SCL-90、STAI和EPQ量表的差异。分析不同年龄组患者各项指标的差异。结果患者组SCL-90量表的敌对(1.64±0.67,t=4.81,P<0.001)、焦虑(1.58±0.66,t=6.83,P<0.001)、精神病性(1.62±0.68,t=11.87,P<0.001)、偏执(1.55±0.66,t=3.58,P<0.001)、强迫(1.95±0.70,t=9.56,P<0.001)、躯体化(1.43±0.58,t=2.10,P=0.036)、人际关系/敏感(1.74±0.74,t=2.79,P=0.005)、抑郁(1.66±0.74,t=4.50,P<0.001)等因子分,以及总分(1.53±0.63,t=3.07,P=0.002)均显著高于全国常模组。A、B、C、D组的人际关系/敏感得分差异有统计学意义(1.72±0.78、1.65±0.69、1.58±0.92、1.43±0.59,F=2.84,P=0.038)。患者组STAI量表的状态焦虑(t=7.35,P<0.001)、特质焦虑(t=6.31,P<0.001)等因子分和总分(t=8.41,P<0.001)均显著高于全国常模组,不同年龄组的状态焦虑(F=5.29,P=0.001)、特质焦虑(F=5.54,P<0.001)因子分和总分(F=5.66,P<0.001)差异有统计学意义。患者组的精神质(t=30.56,P<0.001)、情绪(t=45.94,P<0.001)、外倾-内倾(t=11.72,P<0.001)、掩饰性(t=29.16,P<0.001)等因子分和总分(t=30.56,P<0.001)均显著高于全国常模组。401例的人格类型分别为抑郁质183例(45.64%),胆汁质94例(23.44%),黏液质66例(16.46%),多血质58例(14.46%)。不同年龄组的抑郁质、胆汁质、黏液质、多血质人格类型分布分别为A组76、35、26、21例,B组87、40、32、23例,C组14、10、6、8例,D组6、9、2、6例,组间比较差异无统计学意义(χ^2=10.65,P=0.30)。结论ED患者存在一系列异常的情绪、躯体化的不适感,敏感的人际关系以及内向、情绪不稳定的人格特征;年龄越小的患者其焦虑情绪越严重,人际关系越敏感,可能与其内向的个性特征及情绪的不稳定性相关。     

Development and content validity of new patient-reported outcome questionnaires to assess the signs and symptoms and impact of atopic dermatitis: the Atopic Dermatitis Symptom Scale (ADerm-SS) and the Atopic Dermatitis Impact Scale (ADerm-IS)

Objectives: Atopic dermatitis (AD) is a chronic, relapsing skin condition, with signs and symptoms that impact patients’ lives and are best measured from the patient perspective. Therefore, there is a need for AD-specific questionnaires that are consistent with Food and Drug Administration guidance and best measurement practices, assessing sign and symptom severity and associated impacts, to support treatment efficacy in regulated trials. The objectives were to develop patient-reported outcome (PRO) questionnaires assessing sign and symptom severity, as well as impacts of moderate-to-severe adult AD.

Methods: A targeted literature review and meetings with clinical experts (dermatologists) were conducted to identify AD-related sign, symptom, and impact concepts. Results were harmonized and used to construct two draft PRO questionnaires: the Atopic Dermatitis Symptom Scale (ADerm-SS; 11 items) and the Atopic Dermatitis Impact Scale (ADerm-IS; 10 items). The content validity and questionnaire content were evaluated via qualitative concept elicitation/cognitive debriefing interviews with adult patients with moderate-to-severe AD.

Results: From the literature (n?=?13 articles), 13 sign and symptom and 43 impact concepts were identified, while 21 sign and symptom and 48 impacts were elicited from experts (n?=?3). During the patient interviews (n?=?15), 19 sign and symptom and 41 impact concepts were reported, the majority of which were evaluated by the ADerm-SS and ADerm-IS, thus substantiating the content of both questionnaires. Additionally, patients interpreted both questionnaires as intended by the developers.

Conclusions: The ADerm-SS and ADerm-IS can be regarded as content-valid PRO questionnaires for moderate-to-severe AD.     

Patient-reported Symptom Outcomes and Microsatellite Instability in Patients With Metastatic Colorectal Cancer

BackgroundThe survival of patients with metastatic colorectal cancer (mCRC) is influenced by the genetic and epigenetic changes that might influence the patient experience of symptom burden. Understanding the association of molecular changes with the symptom burden could help clinicians gain insight into the molecular basis of symptom burden and improve treatment tolerance. To date, no studies have compared the patient-reported symptom burden with these molecular subsets among patients with mCRC.Patients and MethodsWe recruited patients with mCRC that was refractory to ≥ 1 line of therapy who had been enrolled in the Assessment of Targeted Therapies Against Colorectal Cancer trial at The University of Texas MD Anderson Cancer Center. All patients completed a baseline gastrointestinal symptom inventory (MD Anderson Symptom Inventory, gastrointestinal). The symptom burden across key demographic variables and molecular changes, including CRC-associated mutations, microsatellite instability (MSI) status, and the CpG island methylator phenotype (CIMP) were compared using χ² tests. Association of the symptom burden with overall survival was examined using Cox regression models.ResultsPatients with an MSI-high (MSI-H) phenotype reported greater pain (odds ratio [OR], 3.06; 95% confidence interval [CI], 1.61-5.84), fatigue (OR, 2.78; 95% CI, 1.41-5.49), sleep (OR, 2.52; 95% CI, 1.32-4.08); and drowsiness (OR, 2.51; 95% CI, 1.32-4.78) compared with microsatellite stable patients. Patients with an MSI-H phenotype also had greater odds of overall symptom burden (OR, 2.48; 95% CI, 1.29-4.74) compared with microsatellite stable patients. The CIMP-high patients experienced greater odds of pain compared with the CIMP-negative patients (OR, 1.72; 95% CI, 1.06-2.80). A greater overall symptom burden was associated with poor overall survival (hazard ratio, 1.42; 95% CI, 0.98-2.06]), although the difference was not significant (P = .06).ConclusionCorrelation of MSI-H–associated tumor features with the symptom burden could help provide a better understanding of underlying mechanisms associated with our findings.     

Prostatic Artery Embolization Using 100–300-μm Trisacryl Gelatin Microspheres to Treat Lower Urinary Tract Symptoms Attributable to Benign Prostatic Hyperplasia: A Single-Center Outcomes Analysis with Medium-Term Follow-up

PurposeTo report medium-term outcomes of prostatic artery embolization (PAE) using 100–300-μm trisacryl gelatin microspheres to treat lower urinary tract symptoms (LUTS) from benign prostatic hyperplasia (BPH) and to evaluate how cone-beam computed tomography-measured prostate gland volume (PGV), median lobe enlargement (MLE), age, and Charlson Comorbidity Index (CCI) affect these results.Materials and MethodsSeventy-four consecutive patients who underwent PAE from April 2014 through August 2018 were retrospectively reviewed. Patients had International Prostate Symptom Score (IPSS) >12, Quality of Life (QoL) score >2, prostate gland volume (PGV) >40 mL, age older than 45 years, and medical therapy failure. Twelve patients were excluded for bladder pathology or prostate cancer. Patients (n = 62, age = 71.8 ± 9.3 years, CCI = 3.5 ± 1.7, PGV = 174 ± 110 mL) had pre-procedure IPSS = 22.4 ± 5.6, QoL score = 4.4 ± 0.9, and post-void residual (PVR) = 172 ± 144 mL. Post-procedure values were compared to baseline at 1, 3, 6, 12, and 24 months. Associations between outcomes and PGV, MLE, age, and CCI were evaluated. Adverse event recording used Clavien-Dindo classification.ResultsOne month after PAE (n = 37), IPSS improved to 7.6 ± 5.2 (P < .0001) and QoL score improved to 1.7 ± 1.4 (P < .0001). At 3 months (n = 32), improvements continued, with IPSS = 6.4 ± 5.1 (P < .0001), QoL score = 1.2 ± 1.2 (P < .0001), PVR = 53 ± 41 mL (P < .001), and PGV = 73 ± 38 mL (P < .0001). Results were sustained at 6 months (n = 35): IPSS = 6.4 ± 4.1 (P < .0001), QoL score = 1.2 ± 1.2 (P < .0001), PVR = 68 ± 80 mL (P < .0001), PGV = 60 ± 19 mL (P < .001). At 12 months, patients (n = 26) had IPSS = 7.3 ± 5.5 (P < .0001), QoL score = 1.2 ± 0.8 (P <.0001), PVR = 89 ± 117 mL (P < .0001), PGV = 60 ± 48 mL (P < .01). At 24 months, patients (n = 8) had IPSS = 8.0 ± 5.4 (P < .0001), QoL score = 0.7 ± 0.5 (P < .0001), PVR = 91 ± 99mL (P = 0.17), and PGV = 30 ± 5mL (P = .11). Improvements were independent of PGV, MLE, age, and CCI. Two grade II urinary infections occurred.ConclusionsPAE with 100–300-μm microspheres produced sustained substantial improvements in LUTS, PGV, and PVR, which were independent of baseline PGV, MLE, age, or CCI.     

失眠患者睡眠质量与心理健康状况的相关性研究

目的:探索原发性失眠患者睡眠质量与心理健康状况的关系。方法:采用横断面的研究方法,选取2015年7月至2017年7月北京中医药大学第三附属医院收治的符合纳入标准的原发性失眠患者308例作为研究对象,以PSQI、SCL-90采集原发性失眠患者的睡眠质量、心理健康状况等资料进行统计分析。结果:308例失眠患者的PSQI总分均值为(12.65±3.04),241例SCL-90筛选阳性。失眠患者SCL-90各因子测评结果除偏执、敌对外均与全国常模比较差异有统计学意义(P<0.01)。睡眠、饮食方面不适的患者211例,伴强迫者144例,伴焦虑者86例。睡眠质量、催眠药物、PSQI总分与SCL-90各因子显著正相关,此外强迫与睡眠障碍呈中度正相关。结论:失眠患者的心理健康水平较正常人差。失眠患者伴有最多的3种自觉症状为睡眠饮食不适感、强迫及焦虑。失眠患者的睡眠质量、药物使用情况及睡眠整体状况与其心理障碍相互影响,强迫与睡眠障碍有较强的相关性。     

小儿宝泰康颗粒治疗小儿急性上呼吸道感染的临床研究

目的:研究观察小儿宝泰康颗粒治疗小儿急性上呼吸道感染的临床疗效及安全性评价。方法:选取2018年1月至2019年1月山东省立医院儿科门诊收治的急性上呼吸道感染患儿86例作为研究对象,按照就诊先后顺序编号分为对照组和观察组,每组43例。对照组给予小儿豉翘清热颗粒治疗,观察组给予小儿宝泰康颗粒治疗。对2组患儿的临床疗效、症状消退时间、血清炎性反应因子水平、不良反应发生率等进行统计比较。结果:治疗后观察组总有效率高于对照组,差异有统计学意义(P<0.05),且观察组痊愈率高于对照组,差异有统计学意义(P<0.05),显效率低于对照组,差异有统计学意义(P<0.05);有效率2组较为相近,差异无统计学意义(P>0.05),无效率低于对照组,差异有统计学意义(P<0.05)。治疗后观察组发热、咳嗽、鼻塞流涕、咽喉肿痛、脘腹胀满、食欲不振等症状消退时间均短于对照组,组间比较,差异有统计学意义(P<0.05)。治疗后2组患儿的血清白细胞介素-6(IL-6)、血清白细胞介素-18(IL-18)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平均有显著降低,差异有统计学意义(P<0.05),且观察组各项指标水平均低于对照组,差异有统计学意义(P<0.05)。对照组发生水样便腹泻2例,腹痛1例,观察组未出现不良反应,组间比较,差异无统计学意义(P>0.05)。结论:小儿宝泰康颗粒治疗小儿急性上呼吸道感染的临床疗效显著,能够缩短患儿的症状消退时间,降低患儿自身的炎性反应水平,治疗安全性良好,值得临床推荐。     

肝包虫病的诊治方法研究进展

肝包虫病是流行于世界畜牧业发达地区的常见人畜共患性寄生虫病。文章介绍了肝包虫病的症状体征、诊断依据,以及各种治疗方法,以期对该病的防治提供参考。