发作性睡病的药物治疗进展

发作性睡病是致残性白天睡眠增多的最常见原因之一，其治疗旨在减少白天睡眠增多和猝倒，改善夜间睡眠紊乱、睡眠瘫痪及与睡眠有关的幻觉。2019年，组胺H3受体拮抗剂替洛利生（Pitolisant）和多巴胺及去甲肾上腺素再摄取抑制剂索利氨酯（Solriamfetol）分别在欧盟和美国上市，前者具有促醒和抗猝倒作用，后者也有促醒作用，且戒断症状和滥用的发生率更低。目前，控释型羟丁酸钠（FT218）、低钠型羟丁酸盐（JZP-258）、选择性去甲肾上腺素再摄取抑制剂（瑞波西汀，又称AXS-12）以及莫达非尼联合氟卡尼制剂（THN102）等药物仍在开发和测试中，均可作为治疗发作性睡病相关白天睡眠增多和猝倒的潜在药物。本文重点介绍这些最近研发的发作性睡病治疗药物。     

Computed tomography coronary angiography accuracy in women and men at low to intermediate risk of coronary artery disease

Objectives

To investigate the diagnostic accuracy of CT coronary angiography (CTCA) in women at low to intermediate pre-test probability of coronary artery disease (CAD) compared with men.

Methods

In this retrospective study we included symptomatic patients with low to intermediate risk who underwent both invasive coronary angiography and CTCA. Exclusion criteria were previous revascularisation or myocardial infarction. The pre-test probability of CAD was estimated using the Duke risk score. Thresholds of less than 30?% and 30–90?% were used for determining low and intermediate risk, respectively. The diagnostic accuracy of CTCA in detecting obstructive CAD (≥50?% lumen diameter narrowing) was calculated on patient level. P?<?0.05 was considered significant.

Results

A total of 570 patients (46?% women [262/570]) were included and stratified as low (women 73?% [80/109]) and intermediate risk (women 39?% [182/461]). Sensitivity, specificity, PPV and NPV were not significantly different in and between women and men at low and intermediate risk. For women vs. men at low risk they were 97?% vs. 100?%, 79?% vs. 90?%, 80?% vs. 80?% and 97?% vs. 100?%, respectively. For intermediate risk they were 99?% vs. 99?%, 72?% vs. 83?%, 88?% vs. 93?% and 98?% vs. 99?%, respectively.

Conclusion

CTCA has similar diagnostic accuracy in women and men at low and intermediate risk.

Key Points

? Coronary artery disease (CAD) is increasingly investigated by computed tomography angiography (CTCA). ? CAD detection or exclusion by CTCA is not different between sexes. ? CTCA diagnostic accuracy was similar between low and intermediate risk sex-specific-groups. ? CTCA rarely misses obstructive CAD in low–intermediate risk women and men. ? CAD yield by invasive coronary angiography after positive CTCA is similar between sex-risk-specific groups.     

肠内序贯营养支持在重症卒中患者中的应用研究

目的：探讨肠内序贯营养支持对重症卒中患者营养状况及并发症的影响。 方法：将符合入组标准的49例患者随机分为序贯营养组（n=24）和常规营养组（n=25）。序贯营养组先采用短肽型肠内营养制剂,并逐步过渡到整蛋白型肠内营养制剂;常规营养组直接采用整蛋白型肠内营养制剂;比较两组患者的营养指标及并发症发生率。 结果：住院期间两组患者各项营养指标均有下降,但与常规营养组相比,序贯营养组血红蛋白及血清白蛋白下降程度较轻,差异有统计学意义（P<0.05）。体重、体重指数、三头肌皮褶厚度、上臂围及上臂肌围两组之间无明显差异（P>0.05）。在并发症发生率方面,序贯营养组较常规营养组的感染率有下降,差异有统计学意义（P<0.05）,胃肠道出血率亦有下降趋势。 结论：与常规营养支持相比,肠内序贯营养支持可减轻重症卒中患者的营养状况恶化,降低感染等并发症的发生率,可能是重症卒中患者理想的营养支持方案。     

模拟计算椎管扩大率对颈椎双开门手术效果的影响和意义

目的 通过椎管扩大面积的理论计算和调查实际椎管扩大率与术后效果的关系,为手术的术式提供技术性依据.方法 设计对椎管扩大面积进行理论计算的方法,对630椎的理想椎管扩大率进行测量和模拟计算.回顾126例施行颈椎双开门手术病例和影象资料,调查人工椎弓和侧沟的位置,榷管扩大率,好转率,根据人工椎弓的不同位置将126例分为3群并进行比较.结果 在人工椎弓宽度10mm时平均理想扩大率为49.6%;宽度12mm时为58.5%;宽度14mm时为69.1%.A群56例人工椎弓位置平均值为1.2mm±0.6;B群42例为2.8mm±+0.6;C群28例为5.6mm±1.4.各群平均值间有明显差异(P＜0.05).平均改善率A群70.4%,B群58.5%,C群43.3%,各群间有明显差异(P＜0.05),扩大率与改善率成正相关关系.结论 使用12mm人工椎弓,且人工椎弓位置值在2mm以下的病例手术效果良好.人工椎弓位置对椎管扩大率的影响较大.骨化占据率60%以上的病例,应使用14mm人工椎弓或采用其他术式.     

Augmentation in patients with restless legs syndrome receiving pramipexole therapy: a retrospective study in a single center from China

Sleep and Breathing - Augmentation is a major complication of long-term pramipexole treatment of restless legs syndrome (RLS). However, there have been no studies on augmentation in Chinese...     

缺血性脑卒中患者合并不宁腿综合征的特点和临床意义

目的研究缺血性脑卒中患者不宁腿综合征（RLS）的患病率、危险因素、临床特点以及对缺血性脑卒中的影响。方法收集2016年1月至2018年6月在浙江大学医学院附属邵逸夫医院神经内科住院的缺血性脑卒中患者199例。所有患者接受了多导睡眠监测。RLS采用国际RLS研究组制订的标准确诊。收集患者住院期间的临床资料进行危险因素分析。用Epworth嗜睡量表（ESS）评估患者的睡眠质量，简易智力状态检查评估患者的认知功能，患者的健康问卷（PHQ-9）评估患者的抑郁症状，采用美国国立卫生院卒中量表（NIHSS）评估患者的神经功能。选取年龄和性别匹配的原发性RLS患者，评估缺血性脑卒中合并RLS患者的多导睡眠监测特征。结果199例缺血性脑卒中患者中有22例存在RLS（11.1%）。广义线性模型和Logistic回归分析提示血清铁蛋白水平下降（ β=-133.3 mg/L，95% CI：-200.4~-70.1， P < 0.01），皮层下梗死（ OR=4.05，95% CI：1.15~14.18， P < 0.05）和女性（ OR=2.54，95% CI：1.04~6.23， P < 0.05）是缺血性脑卒中合并RLS的危险因素。与不合并RLS的缺血性脑卒中患者比较，合并RLS的缺血性脑卒中患者ESS值升高4.37分（95% CI：2.33~6.41， P < 0.01），PHQ-9分值增加2.17分（95% CI：0.39~3.94， P < 0.05），中重度抑郁风险增加4.27倍（95% CI：1.40~13.10， P < 0.05），NIHSS减分值减少0.97分（95% CI：-1.79~-0.15， P < 0.05）。与原发性RLS患者相比，合并缺血性脑卒中的RLS患者伴微觉醒的周期性腿动指数增加（ β=12.85，95% CI：2.04~23.67， P < 0.05）。 结论RLS在缺血性脑卒中患者中较常见，且对缺血性脑卒中患者造成不利影响，应重视筛查和治疗。     

EDTA-K2抗凝剂对PLT检测结果的影响

目的探讨EDTAK2抗凝剂对PLT读数的影响。方法用CD1700全自动血细胞分析仪检测EDTAK2抗凝静脉血的PLT结果与显微镜镜检不符个别患者,EDTAK2抗凝静脉血的PLT同时动用CD1700全自动血细胞分析仪预稀释功能及人工计数末梢血的PLT。结果用t检验方法得出EDTAK2组与预稀释组、人工计数组之间有极其显著性差异(P<0.01),而预稀释组、人工计数组之间则无显著性差异(P>0.05)。结论EDTAK2抗凝剂致偶见患者PLT假性降低。应用直接取末梢血,进行人工计数或动用CD1700预稀释功能,确保结果的准确性。而动用CD1700预稀释功能更方便、快速。     

Identification of 17 hearing impaired mouse strains in the TMGC ENU-mutagenesis screen

The Tennessee Mouse Genome Consortium (TMGC) employed an N-ethyl-N-nitrosourea (ENU)-mutagenesis scheme to identify mouse recessive mutants with hearing phenotypes. We employed auditory brainstem responses (ABR) to click and 8, 16, and 32 kHz stimuli and screened 285 pedigrees (1819 mice of 8–11 weeks old in various mixed genetic backgrounds) each bred to carry a homozygous ENU-induced mutation. To define mutant pedigrees, we measured 12 mice per pedigree in 2 generations and used a criterion where the mean ABR threshold per pedigree was two standard deviations above the mean of all offspring from the same parental strain. We thus identified 17 mutant pedigrees (6%), all exhibiting hearing loss at high frequencies (16 kHz) with an average threshold elevation of 30–35 dB SPL. Interestingly, four mutants showed sex-biased hearing loss and six mutants displayed wide range frequency hearing loss. Temporal bone histology revealed that six of the first nine mutants displayed cochlear morphological defects: degeneration of spiral ganglia, spiral ligament fibrocytes or inner hair cells (but not outer hair cells) mostly in basal turns. In contrast to other ENU-mutagenesis auditory screens, our screen identified high-frequency, mild and sex-biased hearing defects. Further characterization of these 17 mouse models will advance our understanding of presbycusis and noise-induced hearing loss in humans.