Patterns and 14-year trends in mortality among illicit drug users in Finland: The HUUTI study

BackgroundAlthough mortality is a known complication of illicit drug use, robust epidemiological studies on drug-related mortality in Finland are scarce. We examined all deaths, specific causes of death, and trends in mortality among a large number of illicit drug users in Finland during a 14-year period.MethodsDetails of 4817 clients who sought treatment for drug use at Helsinki Deaconess Institute between 1997 and 2008 were linked to national cause of death register to identify all deaths and causes of death. Standardised mortality ratios (SMRs) were calculated to compare all-cause deaths in our study cohort with those in the general population. Trends in mortality rates were assessed using Poisson (log-linear) regression.ResultsA total of 496 deaths occurred during 41,567.5 person-years with crude mortality rate of 1193.2 per 100,000 person-years. Mean follow-up was 8.6 years and the mean age at death was 33.8 years. Most deaths (84.1%) occurred among male clients, 189 deaths occurred in the 25–34 age-group and all-cause SMR was 8.9 [95% confidence interval (CI) = 8.1–9.7]. Two-thirds (64.9%) were deaths from external causes and 35.1% from disease-related causes. The four leading causes of death were accidental poisoning/overdose (n = 165), suicide (n = 108), mental and behavioural disorders (n = 49) and circulatory system diseases (n = 45). Younger clients died from acute effects of drug use while older clients died more from chronic health conditions. A decline in annual rates was noted for all-cause mortality (P = 0.01), deaths from mental and behavioural disorders (P < 0.001) and suicides (P < 0.001).ConclusionThe four leading causes of death among illicit drug users are preventable. Overdose management training, drug education and other preventive measures could help reduce mortality.     

A 25-year follow-up of patients admitted to methadone treatment for the first time: mortality and gender differences

Introduction

We conducted a follow-up study to evaluate the outcome of a heroin-dependent population 25 years after their first enrollment in methadone maintenance treatment (MMT). We assessed mortality in the sample plus actual drug use, treatment, and medical factors associated with drug dependence, focusing on possible gender differences.

Methods

Prospective follow-up study of 214 heroin-dependent patients consecutively admitted for MMT between 1980 and 1984 in the Asturias Public Health Service. The standardized mortality ratio (SMR) and 95% confidence interval (CI) were calculated. An ad-hoc protocol on drug misuse and treatment, drug-related morbidity and Clinical Global Impression (CGI) scores were assessed in the survivors' sample.

Results

Information was received on 159 subjects, 106 of whom were deceased. Men accounted for 76.2% of the study cohort. Over the 25-year follow-up period, the SMR was 22.51 (95% CI = 22.37–22.64). In the survivors sample, 39.6% were still enrolled in MMT; human immunodeficiency virus (HIV) was diagnosed in 47.2% and hepatitis B/C in 81.1%; current heroin use was reported by 22.6%. There were no gender differences in mortality or HIV and hepatitis B/C status. None of the female survivors were using heroin at the 25-year follow-up compared with 31.1% of males.

Conclusions

This study confirms the high mortality of heroin addicts even after enrollment in MMT. Severity of the addiction in terms of mortality was similar in both genders. Women who survived the 25-year follow-up were more likely to have stopped using heroin than men.     

乌司他丁对感染性休克患者炎症反应、血流动力学、PaO2/FiO2及预后的影响

目的 研究乌司他丁注射液对感染性休克患者炎症反应、血流动力学、氧合指数（PaO₂/FiO₂）及预后的影响。方法 回顾性分析2017年1月至2019年12月感染性休克患者127例临床资料,按照治疗方案分为观察组73例以及常规组54例,两组均按相关指南给予抗休克治疗,观察组另加用乌司他丁治疗,比较两组治疗前后炎症因子、血流动力学参数和PaO₂/FiO₂变化及恢复情况。结果 治疗7 d时两组IL-6、TNF-α以及PCT水平明显降低（P<0.05）,且观察组IL-6、TNF-α及PCT水平低于常规组,差异有统计学意义（P<0.05）;治疗12 h、24 h和72 h时,两组MAP、CI及PaO₂/FiO₂明显升高（P<0.05）,EVLWI和SVRI明显降低（P<0.05）,且同一时间观察组MAP和PaO₂/FiO₂高于常规组,EVLWI低于常规组,差异有统计学意义（P<0.05）;观察组治疗7 d时APACHE-Ⅱ评分、机械通气时间及ICU住院时间均低于常规组,两组MODS发生率分别为4.11%和14.81%（P<0.05）,病死率分别为1.37%和7.41%（P>0.05）。结论 乌司他丁治疗感染性休克有利于减轻炎症反应,改善血流动力学指标和微循环灌注,对促进患者康复和改善预后具有积极作用。     

不同照护模式对脑卒中恢复期患者心理状况及生活质量的影响

目的　分析居家和机构照护模式下老年脑卒中恢复期患者心理状况、生活质量,比较2种照护模式的优势和缺陷。方法　选取2019年1月至2021年3月连云港市确诊脑卒中后1～3个月的老年人314例,按照护模式不同分为居家照护组和机构照护组,机构照护组患者来自于连云港市多家养老机构、社会福利院。居家照护组169例,男88例、女81例,年龄（75.64±6.15）岁;机构照护组145例,男70例、女75例,年龄（73.71±6.70）岁。12个月后对两组患者进行焦虑、抑郁、生活质量等量表评估,比较两组患者心理状态、生活质量。计数资料采用χ²检验,计量资料采用t检验。结果　城镇居民选择机构照护服务的比例为53.7%（109/203）,显著高于农村居民的32.4%（36/111）,差异有统计学意义（P<0.05）。居家照护组焦虑、抑郁评分分别为（10.35±2.62）分、（12.15±4.85）分,均低于机构照护组［（15.81±5.22）分、（17.65±5.88）分］,差异均有统计学意义（均P<0.05）。机构照护组日常生活能力、记忆思维能力评分分别为（58.98±7.09）分、（78.19±7.85）分,均高于居家照护组［（44.43±10.21）分、（67.62±9.58）分］,感觉和情感控制力、参与能力、手功能评分分别为（32.98±4.23）分、（12.67±5.74）分、（49.62±3.68）分,均低于居家照护组［（40.91±6.65）分、（20.96±3.56）分、（51.85±6.02）分］,差异均有统计学意义（均P<0.05）。两组不良风险事件比较发现,机构照护组坠积性肺炎、压疮、管路脱落发生率均明显低于居家照护组,差异均有统计学意义（均P<0.05）。结论　机构照护在城镇居民比例较高,在焦虑、抑郁等情感状态、感觉和情感控制力、参与能力等方面劣于居家照护。在日常生活能力、记忆思维能力,避免坠积性肺炎、压疮、管路脱落发生率等方面,机构照护优于居家照护。     

Effects of a fungicide formulation on embryo-larval development,metamorphosis, and gonadogenesis of the South American toad Rhinella arenarum

Sublethal toxicity of the formulated fungicide Maxim^® XL on embryonic, larval and juvenile development of Rhinella arenarum was evaluated by means of standardized bioassays. Maxim^® XL, one of the most used fungicides in Argentina, is based on a mixture of two active ingredients: Fludioxonil and Metalaxyl-M. Maxim^® XL exposure induced severe sublethal effects on the embryos, expressed as general underdevelopment, axial flexures, microcephaly, cellular dissociation, abnormal pigmentation, underdeveloped gills, marked edema and wavy tail. As the embryo development advanced, alterations in behavior as spasmodic contractions, general weakness and inanition were observed. Maxim^® XL did not affect neither the time required to complete metamorphosis nor sex proportions, but gonadal development and differentiation were impaired. Gross gonadal analysis revealed a significant proportion of exposed individuals with underdevelopment of one or both gonads. Histological analysis confirmed that 18% and 10% of the individuals exposed to 0.25 and 2 mg/L Maxim^® XL, respectively, exhibited undifferentiated gonads characterized by a reduced number (or absence) of germ cells. Taking into account the risk evaluation performed by means of Hazard Quotients, this fungicide could be a threat to R. arenarum populations under chronic exposure. This study represents the first evidence of toxic effects exerted by Maxim^® XL on amphibians. Finally, our findings highlight the properties of this fungicide that might jeopardize non-target living species exposed to it in agricultural environments.     

新型冠状病毒肺炎疫情期间器官移植受者随访与免疫抑制方案调整建议

目的： 探讨新冠肺炎（COVID-19）疫情期间，器官移植受者如何随访，如何调整免疫抑制方案。方法： 查阅文献、指南及咨询器官移植医生，提出器官移植受者在COVID-19疫情期间的随访注意事项和免疫抑制方案调整建议。结果： 特殊时期鼓励病情稳定受者通过互联网随访，适当延长门诊随访时间，根据病情适当调整免疫抑制剂种类、用量，避免免疫抑制过度而诱发感染。结论： 本文可帮助器官移植医护工作者、患者及其家属积极应对疫情，对减少器官移植受者的感染风险，降低病死率等具有重要意义。     

血清中性粒细胞 /淋巴细胞比值、可溶性髓系细胞触发受体 1、降钙素原预测老年重症肺炎死亡风险的价值

目的 评估血清中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、可溶性髓系细胞触发受体1(soluble triggering receptor expressed on myeloid cells-1,sTREM-1)、降钙素原预测老年重症肺炎病人30 d死亡风险的临床应用价值.方法 回顾性分析2016年10月至2019年6月遂宁市中心医院收治的148例老年重症肺炎的临床资料.收集病人的年龄、性别、基础疾病,以及入院24 h内血常规、sTREM-1、降钙素原、C反应蛋白(C-reactive protein,CRP)、肝肾功能、D-二聚体、血乳酸、动脉血氧分压(PaO2)资料,计算NLR、氧合指数及急性生理学和慢性健康状况评分Ⅱ(acute physiology and chronic health evalua-tionⅡ,APACHEⅡ).根据30 d生存情况将病人分为存活组和死亡组,并采用多因素logistic回归分析筛选老年重症肺炎病人30 d死亡的高危因素;绘制受试者工作特征(ROC)曲线,评估NLR、sTREM-1、降钙素原对老年重症肺炎病人30 d死亡风险的预测价值.结果 148例病人中存活92例,死亡56例.死亡组病人入院时白细胞总数、中性粒细胞(neutrophil,NEU)绝对值、淋巴细胞(lymphocyte,LYM)绝对值、NLR、sTREM-1、降钙素原、CRP、血乳酸、D-二聚体及APACHEⅡ评分与存活组比较均差异有统计学意义[白细胞:(15.01±4.59)×109/L比(12.37±2.69)×109/L,NEU绝对值:(12.02±3.87)×109/L比(9.46±2.52)×109/L,LYM绝对值:(1.00±0.17)×109/L比(1.38±0.54)×109/L,NLR:(11.96±2.87)比(7.61±2.59),sTREM-1:(64.75±5.55)ng/L比(55.01±6.73)ng/L,降钙素原:(5.33±2.81)mg/L比(2.39±1.10)mg/L,CRP:(101.66±48.90)mg/L比(66.73±43.35)mg/L,血乳酸:(3.02±1.27)mmol/L比(1.57±0.71)mmol/L,D-二聚体:(2.90±1.69)mg/L比(1.56±0.58)mg/L,APACHEⅡ评分:(30.51±6.90)分比(24.24±3.71)分,均P<0.05].而两组在年龄、性别、基础疾病、肝肾功能、氧合指数比较中差异无统计学意义(均P>0.05).多因素lo-gistic回归分析显示,NLR[OR=2.129,95％CI:1.233～3.677,P=0.007]、sTREM-1(OR=1.277,95％CI:1.086～1.502,P=0.003)、降钙素原(OR=1.769,95％CI:1.166～2.683,P=0.007)和APACHEⅡ评分(OR=1.327,95％CI:1.119～1.575,P=0.001)为老年重症肺炎病人30 d死亡的独立危险因素.ROC曲线显示,NLR、sTREM-1、降钙素原对老年重症肺炎病人30 d死亡均具有很好的预测价值,三者联合检测时曲线下面积(AUC)升高,为0.951,灵敏度和特异度均较高,分别为96.43％、79.35％.结论 入院时NLR、sTREM-1、降钙素原增高可以作为老年重症肺炎病人死亡的高危因素,且对30 d死亡风险有一定的预测价值,联合检测较单一指标预测价值更高.     

Atypical antipsychotics for the treatment of behavioral and psychological symptoms in dementia,with a particular focus on longer term outcomes and mortality

Importance of the field: Many people with Alzheimer's disease (AD) and other dementias are prescribed atypical antipsychotics for behavioral and psychiatric symptoms such as aggression and psychosis. Recent evidence has highlighted safety concerns regarding antipsychotics in these individuals.

Areas covered in this review: We summarize the evidence pertaining to efficacy and safety from short-term randomized controlled trials (up to 12 weeks), key findings from case-register studies and more detailed discussion of longer term outcome studies, including longer term mortality risk of antipsychotics in AD.

What the reader will gain: The review aims to provide a balanced and up to date overview of the efficacy and safety concerns related to atypical antipsychotics in people with AD, in particular providing a detailed overview of mortality risk, and a personal interpretation of the implications and recommendations for the way forward.

Take home message: Atypical antipsychotics confer modest benefits for short-term (up to 12 weeks) treatment of aggression and psychosis in AD. These benefits have to be balanced against the risk of serious adverse events including 1.5 – 1.8-fold increased mortality. The benefits are less clear-cut with longer term prescribing, but the mortality risk remains significantly elevated. Pharmacogenetics may provide an opportunity to more effectively focus prescribing in the future.     

氯沙坦、螺内酯及二者联用对心肌梗死大鼠早期基质金属蛋白酶抑制剂的影响

目的观察氯沙坦、螺内酯及其二者合用对急性心肌梗死早期基质金属蛋白酶抑制剂的影响,探讨其作用机制,为临床提供依据。方法建立大鼠的心肌梗死模型,早期应用醛固酮受体拮抗剂螺内酯20mg.d-1.kg-1,血管紧张素-ⅡATI受体拮抗剂氯沙坦10mg.d-1.kg-1及其二者合用进行干预与心肌梗死组比较,利用逆转录-PCR技术（RT-PCR）的方法,观察心肌基质金属蛋白酶抑制剂（TIMP-1）mRNA的表达。结果急性心肌梗死后7d氯沙坦螺内酯及二者联用组心肌基质金属蛋白酶抑制剂（TIMP-1）mRNA表达较心肌梗死组及假手术组明显升高（P〈0.01）。结论氯沙坦、螺内酯及其二者联用有助于改善急性心肌梗死预后。     

急诊护理中运用损伤控制理论对骨盆骨折病人预后的影响

目的 探讨急诊护理中运用损伤控制理论对骨盆骨折病人降低并发症、病死率和改善生活质量的影响。方法 选择2013年1月至2016年10月无锡市第九人民医院骨盆骨折病人104例,按先后顺序分为对照组和观察组,各52例。对照组采用常规护理,观察组采用损伤控制理论护理。记录并比较两组骨盆骨折病人的预后效果、并发症发生率、病死率和生活质量评分。结果 观察组住院时间、下床活动时间及骨折愈合时间均短于对照组,差异有统计学意义(P＜0.05)。观察组总并发症发生率为5.77%,低于对照组的23.08%;观察组病死率为1.92%,低于对照组的19.23%,差异有统计学意义(P＜0.05)。观察组护理后心理健康、社会功能、情感角色、生命力、躯体疼痛、角色、躯体功能、一般健康状况评分分别为(80.89±5.36)分、(88.79±2.46)分、(72.51±4.37)分、(79.96±5.89)分、(74.26±4.51)分、(68.85±5.03)分、(63.56±4.75)分和(89.92±5.32)分,均高于对照组,差异有统计学意义(P＜0.05)。结论 损伤控制理论应用于骨盆骨折病人急诊护理中效果显著,可明显提高骨盆骨折恢复效果,降低并发症发生率和病死率,改善生活质量,值得推广。     

A Simple and Powerful Method for the Estimation of Intervention Effects on Serological Endpoints Using Paired Interval-Censored Data

Clinical trials often use a binary “fold increase” endpoint defined according to the ratio of interval-censored measurement at end-of-study to that at baseline. We propose a simple yet principled analytic approach based on the linear mixed-effects model for interval-censored data for the analysis of such paired measurements. Having estimated the model parameters, the risk ratio can be estimated by explicit composite estimand and the variance is estimated using the delta method. The estimation can be implemented using the existing procedures in popular statistical software. We use antibody data from the Chloroquine for Influenza Prevention Trial for illustration.     

基于 GM(1，1)模型的江苏省淮安市 5岁以下儿童死亡预测分析

目的分析 2008年 1月 1日至 2021年 12月 31日淮安市 5岁以下儿童死亡现状,构建灰色 GM(1,1)预测模型预测 2022— 2025年淮安市 5岁以下儿童死亡变化趋势。方法数据来源于江苏省妇幼卫生信息系统监测数据。采用描述流行病学方法综合分析 2008—2021年淮安市 5岁以下儿童死亡死因并评估失能调整寿命年(DALY)损失,用 R3.6.2软件构建灰色 GM(1,1)预测模型预测淮安市 2022—2025年不同年龄段儿童死亡率和非故意伤害死亡发生率。结果 2008—2021年淮安市共报告 5岁以下儿童死亡 3 315例,平均死亡率为 4.44‰,总体呈下降趋势。 5岁以下儿童主要死因为意外窒息、先天性心脏病、早产或低出生体质量、出生窒息、溺水。 14年间因 5岁以下儿童死亡共损失 111 141.98个 DALY。GM(1,1)模型结果显示,除了交通意外的模型精确等级结果为 3级,其他指标的预测模型拟合效果均较好。 2022—2025年预测结果显示,除交通意外死亡率呈逐年上升趋势外,不同年龄段 5岁以下死亡和非故意伤害死亡率均呈下降趋势。结论 GM(1,1)对 5岁以下儿童死亡预测的拟合效果较好,可以应用于预测。灰色 GM(1,1)预测模型预测 2022—2025年淮安市 5岁以下儿童死亡率总体呈下降趋势,政府相关部门应进一步加强儿童早产、先天性心脏病及非故意伤害的防控和救治工作,把 5岁以下儿童死亡率控制在更低的水平。     

58例青年缺血性脑卒中病因及诊疗分析

目的探讨青年缺血性脑卒中的病因及诊疗方法。方法选择2003年12月～2010年12月收治的58青年脑卒中患者(观察组)及同期收治的老年脑卒中(对照组)患者为研究对象,比较两组患者的发病危险因素及临床特点。结果两组患者在高血压、缺血性心脏病、高脂血症、肥胖、吸烟、血管病家族史、睡眠障碍、发病部位、血压改变和颈部血管杂音、心电图ST-T改变和颈动脉狭窄症的发生率、治疗效果方面差异有统计学意义(P<0.05)。结论高血脂、睡眠障碍和肥胖是青年脑卒中的危险因素,应采取积极的防治措施,指导青年患者合理饮食,改变不良的生活习惯。     

转化糖电解质注射液对胃肠道肿瘤患者围术期血糖及电解质的影响

目的观察转化糖电解质注射液对于胃肠道肿瘤患者围术期血糖及电解质的影响。方法将116例胃肠道手术患者完全随机分为观察组和对照组,各58例,分别给予转化糖电解质和10％葡萄糖注射液500ml静脉滴注,观察2组患者给药前及给药后0、1、2h的血糖、电解质及血尿酸水平,并记录并发症发生率。结果①观察组患者给药后0、1h血糖[分别为（6．7±1．1）、（6．0±0．9）mmol／L]均较给药前[（4．9±0．5）mmol／L]明显升高（P〈0．05）;给药后2h血糖[（5．1±0．7）mmol／L]接近给药前水平（P〉0．05）;对照组患者给药后0、1、2h血糖[分别为（9．8±1．9）、（8．3±1．3）、（6．9±1．1）mmol／L]均较给药前[（5．0±0．5）mmo]／L]明显升高（P〈0．05）;给药后0、1、2h,观察组血糖水平均明显低于对照组同时间点,组间差异均有统计学意义（均P〈0．05）。②观察组给药后血K＋、Na＋、Cl-、Ca2＋水平与给药前的差异无统计学意义（P〉0．05）,对照组给药后0、1、2h血K＋水平[分别为（3．7±0．4）mmol／L、（3．7±0．4）mmol／L、（3．7±0．3）mmol／L]均低于给药前[（3．9±0．4）mmol／L],（P〈0．05）;2组Na＋、Cl-、Ca2＋水平与本组给药前的差异均无统计学意义（P〉0．05）;观察组给药后0、1、2h血K＋水平[分别为（4．1±0．4）、（4．0±0．5）、（4．0±0．5）mmol／L]均高于对照组同时间点水平（P〈0．05）。2组患者血尿酸水平差异无统计学意义（P〉0．05）。结论转化糖电解质注射液对于胃肠道肿瘤患者围术期血糖稳定以及补钾的疗效更优,且安全可靠。     

Effects of propofol and midazolam on lipids, glucose, and plasma osmolality during and in the early postoperative period following coronary artery bypass graft surgery: a randomized trial

It is not clear how levels of serum lipids and glucose and plasma osmolality change during propofol infusion in the pre- and postoperative period of coronary artery bypass graft surgery (CABG). This prospective, randomized, controlled trial evaluated changes in these parameters during propofol or midazolam infusion during and in the early postoperative period following surgery. Twenty patients undergoing CABG were randomized preoperatively into two groups: 10 patients received propofol (induction 1.5 mg/kg, maintenance 1.5 mg kg(-1) h(-1)) and 10 patients received midazolam (induction 0.5 mg/kg, maintenance 0.1 mg kg(-1) h(-1)). Both groups also received fentanyl (induction 20 mug/kg, maintenance 10 microg kg(-1)). Serum lipids, glucose, and plasma osmolality were measured preinduction, precardiopulmonary bypass, at the end of cardiopulmonary bypass, at the end of surgery, and 4 and 24 h postoperatively. In the propofol group, we observed a significant increase in triglycerides and very low-density lipoprotein levels 4 h postoperatively. In the midazolam group, we observed a significant decrease in low-density lipoprotein, cholesterol at the end of cardiopulmonary bypass, end of surgery, and 4 and 24 h postoperatively and significant increase in osmolality at the end of cardiovascular bypass. Changes in glucose levels did not differ significantly different between the two groups. In patients with normal serum lipids, glucose, and plasma osmolality undergoing CABG, propofol infusion for maintenance anesthesia is not associated with dangerous changes in serum lipids, glucose, and plasma osmolality compared with midazolam. A propofol infusion technique for maintenance of anesthesia for cardiac surgery where serum lipids and glucose may be of concern could be recommended as an alternative to midazolam.     

Effects of zopiclone and temazepam on sleep,behaviour and mood during the day

Summary Over a 3 week period the hypnotic effect of zopiclone 7.5 mg, temazepam 20 mg and placebo was investigated in a double-blind, cross-over study in 60 out-patients.The hypnotic effect, subdivided in the parameters sleep quality, latency of sleep onset and status after awaking, was scored daily by the patient after arising. The results showed that zopiclone 7.5 mg and temazepam 20 mg were almost equally effective. In sleep quality and latency of sleep onset, there appeared to be a non-significant trend favouring zopiclone. Both hypnotics differ significantly from placebo.Mood and behaviour during the day, as well as somatic symptoms and side-effects, were also scored daily and showed no significant differences between the treatments.The third week, which was a placebo week for all patients, showed a gradual improvement in sleep quality. It supports the case for not prescribing hypnotics for more than 2 weeks.