Interpreting the Chinese version of quality of life questionnaire for functional digestive disorders

Background and Aim

The Chinese version quality of life questionnaire for functional digestive disorders (Chin‐FDDQL) is a useful health assessment instrument for functional dyspepsia. This study aims to identify its score interpretation for clinical practice.

Methods

Data of Chin‐FDDQL from the functional dyspepsia patients (≥ 18 years) between November 2009 and April 2013 were enrolled in the 1st and 14th day. After baseline and responsiveness analysis, the single score interpretation and percentile ranks were established. The statistically reliable change was defined with effect size, standardized response mean, minimal detectable change, and others. Then the receiver operating characteristic curve analysis for health improvement was performed to define the clinically important change.

Results

Two hundred two functional dyspepsia patients, 150 healthy participants, and 25 missing data were enrolled for analysis. Compared with the intake patients, the discharged and healthy persons have significant better health status in all domains (P < 0.001, expect discomfort in discharged people, P = 0.142), totally contrast to missing data. The reliability for single total intake and discharge were both ± 1. Based on score distribution, the 25th, 50th, and 75th percentile ranks were 49, 58, and 66 for intake scores and 59, 65, and 72 for discharge scores, respectively. The minimal detectable change and Reliable Change Index were 6 and 11 for total score. Receiver operating characteristic analyses supported that total score changes 4 or more represented minimal clinically important improvement.

Conclusions

The score interpretation system of the Chin‐FDDQL could assist clinician's decision making during the therapy practice.     

基于脑影像和机器学习的抑郁型精神分裂症早期定性诊断预测模型展望

抑郁症状可发生于精神分裂症病程的任何阶段,严重破坏精神分裂症的预后。精神分裂症中抑郁症状和单纯抑郁症的临床表现特征和疗效也存在很大差异。多种证据提示,可能存在抑郁型精神分裂症这一特殊的生物学亚型,此亚型可能存在其特异性脑神经机制,表现为多种脑影像学表征的差异;并且这种特异性机制与单纯精神分裂症和抑郁症的脑神经机制都不相同,也与抗精神病药联用抗抑郁药的疗效差异有关。鉴于抑郁症状对精神分裂症患者的极大危害性,美国和英国著名学者呼吁要充分重视,在今后几年内亟须从多个角度加强对精神分裂症患者抑郁症状的特异性神经机制及治疗靶点的研究,以提高早期疗效,降低抑郁症状对精神分裂症患者造成的危害。基于以上推论和既往的研究,笔者提出选取首发精神分裂症患者进行随访研究,建立基于基线脑表征的早期定性诊断分类器、疾病严重程度相关的客观评价指标体系和疗效预测模型,为这一亚型的早期精准诊治提供客观依据。     

High‐volume continuous venovenous hemodiafiltration plus resin hemoperfusion improves severe metformin‐associated toxicity

We present the case of a 42‐year‐old female patient who attempted suicide by taking approximately 100 tablets of metformin (500 mg). Laboratory tests revealed severe lactic acidosis with lactate levels of 24 mmol/L and pH of 7.09. The patient was treated with high‐volume continuous venovenous hemodiafiltration (CVVH) and resin‐sorbent hemoperfusion. Metformin concentrations were measured by high‐performance liquid chromatography during CVVH and hemoperfusion treatment. Before extracorporeal treatment, the plasma metformin concentration was 208.5 mg/L. After CVVH treatment for 24 h, the plasma metformin concentration had decreased to 13.9 mg/L. Resin‐based sorbent hemoperfusion plus CVVH treatment had reduced the metformin plasma concentration by 61.8% after 3 h. After 7 days, the patient's laboratory tests and clinical syndrome were improved, and she was discharged from hospital. We provide evidence that CVVH plus hemoperfusion is effective in eliminating metformins and metabolic products.     

Brain atrophy in middle‐aged subjects with Type 2 diabetes mellitus,with and without microvascular complications

Background: The rapid rise in Type 2 diabetes mellitus (T2DM) among young adults makes it important to understand structural changes in the brain at a presenile stage. This study examined global and regional brain atrophy in middle‐aged adults with T2DM, with a focus on those without clinical evidence of microvascular complications. Methods: The study recruited 66 dementia‐free middle‐aged subjects (40 with T2DM, 26 healthy volunteers [HVs]). Patients were grouped according to the presence (T2DM‐C; n = 20) or absence (T2DM‐NC; n = 20) of diabetic microvascular complications. Global brain volume (including gray matter [GM] and white matter) was calculated based on voxel‐based morphometry analysis. Regional GM volumes were further extracted using the anatomical automatic labeling template. Results: There was a significant difference in global brain volume among groups (P = 0.003, anova ). Global brain volume was lower in T2DM‐C patients than in both T2DM‐NC patients and HVs (mean [±SD] 0.720 ± 0.024 vs 0.736 ± 0.021 and 0.743 ± 0.019, respectively; P = 0.032 and P = 0.001, respectively). Regional analysis showed significant GM atrophy in the right Rolandic operculum (t = 3.42, P = 0.001) and right superior temporal gyrus (t = 2.803, P = 0.007) in T2DM‐NC patients compared with age‐ and sex‐matched HVs. Conclusions: Brain atrophy is present in dementia‐free middle‐aged adults with T2DM. Regional brain atrophy appears to be developing even in those with no clinical evidence of microvascular disturbances. The brain seems to be particularly vulnerable to metabolic disorders prior to peripheral microvascular pathologies associated with other target organs.     

组合式输尿管软镜联合钬激光治疗上尿路结石

目的评价组合式输尿管软镜联合钬激光治疗上尿路结石的安全性及临床疗效。 方法收集2015年4月至2017年4月我院采用组合式输尿管软镜治疗433例上尿路结石患者的临床资料。单发性结石178例,多发性结石255例;肾中上盏132例,肾下盏结石97例,输尿管上段及肾盂结石204例。结石直径为0.8～4.0 cm。 结果一次性进镜成功率100%,手术时间30～280 min,术后住院时间1.0～5.0 d。1例结石未寻及,改为体外冲击波碎石。3例光纤无法触及结石,均改为经皮肾镜术。其他429例均实施组合式输尿管软镜术。术后2周复查腹部平片或泌尿系CT平扫,结石排净率84.4%（362/429）,二次手术37例,最终结石清除率为89.9%（386/429）。未发生输尿管穿孔、撕脱及大出血等严重并发症。 结论组合式输尿管软镜联合钬激光治疗上尿路结石临床应用安全,疗效理想,可作为输尿管上段结石及肾结石的理想治疗方案,具有很好的临床应用价值。     

空心钉与髓内钉治疗青壮年股骨颈不稳定骨折的疗效观察

目的分析在直接前侧入路(DAA)辅助下空心螺钉与Intertan髓内固定治疗青壮年移位不稳型股骨颈骨折的临床疗效。 方法回顾分析浙江新安国际医院骨科2014年1月至2016年12月采用DAA入路切开复位治疗青壮年移位不稳定型(Garden Ⅲ、Ⅳ型)股骨颈骨折患者,资料均为GardenⅢ、Ⅳ不稳定型股骨颈骨折,24 h之内完成手术,年龄<60岁且随访资料完整;排除同侧转子间骨折、转子下骨折、股骨干骨折,长期使用大剂量激素或酗酒患者。DAA辅助空心钉螺钉内固定组(空心钉组)90例,DAA辅助Intertan髓内钉固定组(髓内钉组)89例,采用SPSS 21.0统计学软件对数据进行统计学分析。采取t检验和χ²检验比较手术时间、透视次数、出血量、住院日、骨折愈合时间、骨折不愈合及股骨头缺血性坏死率、Harris评分。 结果两组在年龄、性别、Garden分型比较上,差异无统计学意义(均P>0.05),有可比性。空心钉组在手术时间(45.4±15.6)min、透视次数(6.5±3.4)次、出血量(90.5±24.5)ml方面优于髓内钉组[分别为(75.2±12.4)min,(9.3±4.6)次,(159.7±40.2)ml](均为P<0.01);空心钉组在住院日(7.2±2.1)d方面与髓内钉组(8.2±1.3)d没有差异(t＝－1.567,P>0.05)。髓内钉组愈合时间(2.8±0.8)月,短于空心钉组[(3.8±0.7)月,(t＝5.375,P<0.01)]。髓内钉组骨折不愈合、股骨头缺血性坏死4例明显少于空心钉组15例(χ²＝6.005,P<0.05);Harris评分优良率空心钉组低于髓内钉组(χ²＝7.338,P<0.01)。 结论青壮年移位不稳定型股骨颈骨折早期采用DAA辅助入路Intertan髓内固定方法治疗可在直视下完成骨折复位,术后恢复快,骨折愈合率高,股骨头坏死发生率低,疗效满意。     

不明原因复发性流产患者的D型人格与中医证候分布研究

目的　探讨不明原因复发性流产患者的D型人格及中医证候分布情况。方法　选取2013年1月—2014年2月黑龙江中医药大学附属第一医院妇科门诊和病房收治的不明原因复发性流产患者200例（研究组）,选取同期就诊的有≥1次生育史的其他患者200例（对照组）。采用D型人格量表（DS14）评价两组的D型人格情况;查阅相关文献并咨询专家后,制定“不明原因复发性流产中医证候诊断标准”,以判断研究组的中医证候。结果　研究组的D型人格阳性率高于对照组〔59.0%（118/200）比15.5%（31/200）,P<0.05〕;且研究组DS14中消极情感、社会压抑2个人格维度得分及量表总得分高于对照组（P<0.05）。200例不明原因复发性流产患者的中医证候排在前2位的分别为单纯肾虚证101例（50.5%）、肾虚夹肝郁证39例（19.5%）;118例D型人格阳性的不明原因复发性流产患者的中医证候分别为单纯肾虚证85例（72.0%）、肾虚夹肝郁证29例（24.6）、血瘀证4例（3.4%）。结论　D型人格在不明原因复发性流产中的分布具有倾向性,且D型人格的不明原因复发性流产者中医证候以单纯肾虚证为主。     

2011-2016年郑州地区5岁以下腹泻儿童病毒检测结果分析

目的 探讨郑州地区5岁以下儿童病毒性腹泻的流行特征及病原学种类。方法 收集2011-2016年郑州地区5岁以下腹泻住院儿童粪便样本1 285份,采用ELISA法检测样本中的A组轮状病毒抗原,并对阳性者采用RT-PCR进行G/P基因分型;采用RT-PCR/PCR检测杯状病毒、星状病毒及肠道腺病毒。结果 共检出阳性样本552份,其中混合感染样本29份,总阳性率为42.96%。4种病毒阳性率分别为:31.98%、6.54%、4.20%、2.49%。A组轮状病毒和杯状病毒全年均可检出,A组轮状病毒的发病高峰为秋冬季,基因分型以G9和P[8]为主;杯状病毒季节特征不明显,6月和9月阳性率稍高,以诺如Ⅱ型为主。1岁半以内儿童4种腹泻病毒感染率分别占93.67%、94.05%、90.74%、87.50%。结论 郑州地区5岁以下婴幼儿腹泻的主要病原为A组轮状病毒和杯状病毒,1岁半以内儿童是病毒性腹泻的高发人群。