Case report of comorbid schizophrenia and obsessive compulsive disorder in a patient who was tube-fed for four years by family members because of his refusal to eat

概述

在许多精神障碍中（包括强迫症和精神分裂症），拒食是常见的表现。当突然出现拒食时，这可能需要急诊处理；一旦变成慢性，它就成为一种难以改变的根深蒂固的行为。对拒食患者的诊断可能有难度，尤其是对有共病问题、智力受损或对自身状况缺乏自知力的患者。鼻饲是一种有效的短期干预方法，当患者重新进食时即可中止这一干预。然而，在某些情况下，患者可能变得依赖于鼻饲。我们介绍一个病例，报告一名患有精神分裂症、强迫症、边缘智力以及癫痫的患者由于拒绝进食而由其家庭成员用鼻饲管喂食超过三年。

中文全文

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Comparison of Cutting Balloon Angioplasty and Percutaneous Balloon Angioplasty of Arteriovenous Fistula Stenosis: A Meta‐Analysis and Systematic Review of Randomized Clinical Trials

Background

Hemodialysis (HD) access failure is a common cause of increased morbidity and healthcare cost in patients with end stage renal disease (ESRD). Percutaneous balloon angioplasty has been used to treat hemodialysis access stenosis but is complicated by a high rate of restenosis. Percutaneous cutting balloon (PCB) angioplasty is an alternative approach that has shown to reduce restenosis.

Objectives

The aim of the study is to assess the safety and efficacy of PCB angioplasty in comparison with conventional and high‐pressure balloon angioplasty in the treatment of hemodialysis access site stenosis.

Methods

We searched PubMed, EMBASE and the Cochrane Central register of controlled trials (CENTRAL) databases through August 2014 and selected studies using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) checklist. We included all randomized clinical trials with a head‐to‐head comparison between PCB and conventional or high‐pressure balloon angioplasty

Results

Three studies with 1034 participants (age 60.7 (±12.9) years and 50.1% males) with 525 in PCB and 509 in control arm were included in the analysis. The immediate procedural success rate was not significantly different in the PCB angioplasty and control arm respectively, (87.2% vs. 83.7% RD ?0.02; 95%CI ?0.06 to 0.01; P = 0.38). The six‐month target lesion patency was significantly higher in the PCB angioplasty arm (67.2% vs. 55.6% RD 0.12; 95%CI 0.05–0.19; P < 0.05) with number needed to treat (NNT) of 9. The device related complications were not statistically significant between groups (RD 0.03; 95%CI ?0.02 to 0.07; P = 0.26).

Conclusions

PCB angioplasty is effective in treatment of hemodialysis access stenosis, with significantly higher six‐month patency compared to balloon angioplasty. (J Interven Cardiol 2015;28:288–295)

     

Brief Definitive Report: Human visceral leishmaniasis is not associated with expansion or accumulation of Foxp3+ CD4 cells in blood or spleen

Natural regulatory T cells (CD4⁺ CD25⁺ Foxp3⁺), natural regulatory T cells (nTreg), play an important role in the regulation of inflammatory immune responses. However, the immunosuppressive properties of nTreg may unfavourably affect the host’s ability to clear certain infections. In human visceral leishmaniasis (VL), reports on the frequency and function of nTreg are not conclusive. A limitation of our own previous studies that did not indicate a major role for Foxp3⁺ nTreg in VL pathogenesis was that Foxp3 was measured by mRNA expression alone, as other tools were not available at the time. We have in this study assessed CD4⁺CD25⁺Foxp3⁺ cells in splenic aspirates and peripheral blood mononuclear cells (PBMC) from an extensive series of patients with VL and endemic controls (EC) by flow cytometry (FACS). The results do not show increased frequencies of Foxp3⁺ cells in patient with VL pre‐ and post‐treatment, neither were they elevated when compared to PBMC of EC. We conclude that active VL is not associated with increased frequencies of peripheral Foxp3 Treg or accumulation at the site of infection.     

Analysis of Age Dependent Effects of Heat Stress on EEG Frequency Components in Rats

Objective To demonstrate changes in different frequencies of cerebral electrical activity or electroencephalogram （EEG） following exposure to high environmental heat in three different age groups of freely moving rats. Methods Rats were divided into three groups （i） acute heat stress - subjected to a single exposure for four hours at 38 ℃; （ii） chronic heat stress exposed for 21 days daily for one hour at 38 ℃, and （iii） handling control groups. The digital polygraphic sleep-EEG recordings were performed just after the heat exposure from acute stressed rats and on 22nd day from chronic stressed rats by simultaneous recording of cortical EEG, EOG （electrooculogram）, and EMG （electromyogram）. Further, power spectrum analyses were performed to analyze the effects of heat stress. Results The frequency analysis of EEG signals following exposure to high environmental heat revealed that in all three age groups of rats, changes in higher frequency components （β2） were significant in all sleep-wake states following both acute and chronic heat stress conditions. After exposure to acute heat, significant changes in EEG frequencies with respect to their control groups were observed, which were reversed partly or fully in four hours of EEG recording. On the other hand, due to repetitive chronic exposure to hot environment, adaptive and long-term changes in EEG frequency patterns were observed. Conclusion The present study has exhibited that the cortical EEG is sensitive to environmental heat and alterations in EEG frequencies in different sleep-wake states due to heat stress can be differentiated efficiently by EEG power spectrum analysis.     

美国食品和药物管理局中草药新药临床试验申请

近年来,中草药和植物药的研发越来越受到制药工业的关注。各国的药物管理机构也在逐步完善中草药和植物药的审批要求。本文主要介绍了美国食品和药物管理局对于中草药的临床试验申请的相关问题。     

Anticancer activity of the ethanolic extract of Crateva nurvala bark against testosterone and MNU-induced prostate cancer in rats

AIM: In the present study the anticancer activity of the ethanolic extract of Crateva nurvala bark was evaluated against testosterone and N-methyl-N-nitrosourea (MNU)-induced prostate cancer in male Wistar rats. METHODS: Prostate cancer was induced in rats by the injection of testosterone for 3 d followed by injection of the chemical carcinogen MNU for 1 week. The prostate cancer-induced rats were treated with the ethanolic extract of C. nurvala bark, and testosterone injection was also continued through the experimental period of 4 months. Biochemical estimations including prostatic acid phosphatase, lipid peroxidation, enzymic antioxidants and non-enzymic antioxidants activity were done in the prostate and seminal vesicle tissue homogenate. RESULTS: There was a significant increase in the level of acid phosphatase and lipid peroxidation in prostate cancer-induced rats, and after treatment with C. nurvala extract a significant decrease in the level of acid phosphatase lipid peroxidation were observed. The enzymic and non-enzymic antioxidants were decreased in the prostate cancer induced group and after treatment they were restored to near normal values. Histopathological examination showed significant changes such as hyperplastic prostatic acini and malignant proliferation of ductal epithelial cells in the prostate and seminal vesicle of carcinogen induced rats. After treatment with C. nurvala extract normal and flow-dilated ducts and acini with regular epithelial lining were observed in the prostate and partially hyperplastic and partially flattered epithelium were observed in seminal vesicles. CONCLUSION: The ethanolic extract of C. nurvala has significant anticancer activity evaluated by in an in vivo model.     

Tracking Diabetes: New York City's A1C Registry

Context: In December 2005, in characterizing diabetes as an epidemic, the New York City Board of Health mandated the laboratory reporting of hemoglobin A1C laboratory test results. This mandate established the United States’ first population‐based registry to track the level of blood sugar control in people with diabetes. But mandatory A1C reporting has provoked debate regarding the role of public health agencies in the control of noncommunicable diseases and, more specifically, both privacy and the doctor‐patient relationship. Methods: This article reviews the rationale for adopting the rule requiring the reporting of A1C test results, experience with its implementation, and criticisms raised in the context of the history of public health practice. Findings: For many decades, public health agencies have used identifiable information collected through mandatory laboratory reporting to monitor the population's health and develop programs for the control of communicable and noncommunicable diseases. The registry program sends quarterly patient rosters stratified by A1C level to more than one thousand medical providers, and it also sends letters, on the provider's letterhead whenever possible, to patients at risk of diabetes complications (A1C level >9 percent), advising medical follow‐up. The activities of the registry program are similar to those of programs for other reportable conditions and constitute a joint effort between a governmental public health agency and medical providers to improve patients’ health outcomes. Conclusions: Mandatory reporting has proven successful in helping combat other major epidemics. New York City's A1C Registry activities combine both traditional and novel public health approaches to reduce the burden of an epidemic chronic disease, diabetes. Despite criticism that mandatory reporting compromises individuals’ right to privacy without clear benefit, the early feedback has been positive and suggests that the benefits will outweigh the potential harms. Further evaluation will provide additional information that other local health jurisdictions may use in designing their strategies to address chronic disease.     

Angiotensin converting enzyme insertion allele in relation to high altitude adaptation

Angiotensin converting enzyme ( ACE ) gene I/D polymorphism has been associated with high altitude (HA) disorders as well as physical performance. We, however, envisage that the polymorphism may be associated with adaptation to the hypobaric hypoxia of altitude, thus facilitating physical performance. For this purpose, three unrelated adult male groups, namely (1) the Ladakhis (HLs), who reside at and above a height of 3600 m, (2) lowlanders, who migrated to Ladakh (MLLs), and (3) resident lowlanders (LLs), have been investigated. The HLs had significantly ( p < 0.001) greater numbers of the II homozygotes and the ID heterozygotes than the DD homozygotes, the genotype distribution being 0.46, 0.43 and 0.11 for II, ID and DD genotypes respectively. The MLLs comprised 60% II homozygotes, which was higher ( p < 0.001) than the HLs (46%). In the LLs, the heterozygotes were greater ( p < 0.001) in number than the II and DD homozygotes. The I allele frequency was 0.72 in the MLLs, 0.67 in the HLs and 0.55 in the LLs. Polymorphism study suggested that the II genotype could be associated with altitude adaptation, which might influence physical efficiency.     

Syringocystadenoma Papilliferum: An Unusual Presentation

Abstract: An 8‐year‐old boy presented with a rapidly growing, unusually large, fleshy, lobulated, cauliflower‐like mass on the lower back. Incisional biopsy revealed the histologic picture of syringocystadenoma papilliferum. The case is reported in this study for its unusual site, very large size, and peculiar morphology.