孤独症谱系障碍共患注意力缺陷多动障碍的研究进展

研究发现,很多孤独症谱系障碍(autism spectrum disorders,ASD)儿童伴有不同程度的注意力缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)的症状.与单纯ASD儿童相比,共患病儿童的ASD症状更明显,认知功能也受损更严重,其生活也会受到影响.该文对目前共患ADHD的ASD儿童临床表现以及执行功能的相关研究做出综述.     

Carbon dioxide induction of panic anxiety in schizophrenia with auditory hallucinations

Panic is commonly co-morbid with schizophrenia. Panic may emerge prodromally, contribute to specific psychotic symptoms, and predict medication response. Panic is often missed due to agitation, impaired cognition, psychotic symptom overlap and limited clinician awareness. Carbon dioxide exposure has been used reliably to induce panic in non-psychotic panic subjects, but has not been systematically studied in schizophrenia. Eight inpatients with schizophrenia, recent auditory hallucinations, none preselected for panic, all on antipsychotic medication, received a structured Panic and Schizophrenia Interview (PaSI), assessing DSM-IV panic symptoms concurrent with paroxysmal auditory hallucinations. On that interview, all eight subjects reported panic concurrent with auditory hallucinations. At one sitting, subjects were exposed, in random order, to 35% carbon dioxide and to placebo room air, blinded to condition. All subjects experienced panic to carbon dioxide, one with limited symptoms. Only one subject panicked to placebo. One subject (one of only two without antipanic medication) had paroxysmal voices concurrent with induced panic. With added adjunctive clonazepam, that patient had marked clinical improvement and no response to carbon dioxide re-challenge. This first systematic examination offers preliminary evidence that carbon dioxide safely induces panic symptoms in schizophrenia. Panic may be prevalent and pathophysiologically significant in schizophrenia with auditory hallucinations.     

Computer technologies to integrate medical treatments to manage multimorbidity

The high prevalence of multimorbid cases is a challenge for Health-Care Systems today. Clinical practice guidelines are the means to register and transmit the available evidence-based medical knowledge concerning concrete diseases. Several computer languages have been defined to represent this knowledge in a way that computers could use to help physicians in the daily practice of medicine. The generation of guidelines for all possible multimorbidities entails several issues that are difficult to address. Consequently, numerous medical informatics technologies have appeared merging computer information structures in a way that the treatment knowledge about single diseases could be combined in order to deliver health-care to patients suffering from multimorbidity. This paper proposes a classification of the most promising current technologies addressing this issue and provides an analysis of their maturity, strengths, and weaknesses. We conclude with an enumeration of ten relevant issues to consider when developing such technologies.     

A prospective single-center study evaluating the efficacy of the stomach,intestinal, and pylorus-sparing procedure

BackgroundThe stomach, intestinal, and pylorus-sparing (SIPS) procedure is a single-anastomosis duodeno-intestinal bypass used in obesity management.ObjectiveWeight and metabolic outcomes in patients with severe obesity who underwent the SIPS procedure were evaluated in a community hospital–based study.SettingCommunity hospital.MethodsThis single-site prospective study of patients who underwent the SIPS procedure evaluated outcomes at 12 and 24 months. Mean changes in total weight loss and body mass index (BMI) and resolution of gastroesophageal reflux disease (GERD), obstructive sleep apnea (OSA), hypertension, type 2 diabetes (T2D), and hyperlipidemia were evaluated.ResultsAt baseline, 185 patients were enrolled; mean weight and BMI were 144.0 kg and 52.2 kg/m², respectively. Data for 88 (47.6%) and 29 (15.7%) patients who completed follow-up at 12 and 24 months, respectively, were available. At 12 months, mean total weight loss was 35.6% (weight reduction of 51.3 kg) and BMI reduction of 17.8 points were achieved and were maintained for the 29 patients who completed 24-month follow-up. No leaks or infections occurred. Complications occurred in 8 patients (.4%) and were not serious. Resolution of GERD, OSA, hypertension, T2D, and hyperlipidemia achieved in 87.1%, 59.2%, 32.7%, 93.1%, and 87.6% of patients, respectively, at 12 months was maintained at 24 months. Nutritional deficiency was absent.ConclusionsPatients who underwent the SIPS procedure had meaningful reductions in weight and BMI, and many had resolution of metabolic co-morbidities; procedural complication rates were low. Our results support that the SIPS procedure is a safe and effective primary treatment for clinically severe obesity in a community-based hospital setting.     

The study of co-morbid conditions in children with allergic rhinitis, from Mumbai, Maharashtra, India

Allergic rhinitis (AR), an allergen-induced inflammation of the nasal mucosa, is frequently associated with co-morbid conditions. It is important to recognize the onset and existence of these co-morbid conditions, for adequate treatment and prevention of the development of new allergen sensitizations and air-way hypersensitivities. The aim of our study was to determine the prevalence of co-morbid conditions associated with AR, in Indian children. We selected 65 consecutive children below the age of 18 years, who attended the Allergy and Asthma Clinic of our hospital, between March 1, 2005 to November 30, 2006 and compared them with the available literature. The most common co-morbid condition with AR was asthma (75.4%), followed by urticaria (33.9%), conjunctivitis (29.2%) and sinusitis (23.1%) in that order. Two patients (3.1%) each, had adenoid hypertrophy and nasal polyps. Psoriasis was seen in 4/65 (6.2%). Four patients (6.2%) were free from any co-morbid conditions as opposed to 61/65 (93.8%), who suffered from one to three co-morbid conditions each. Co-morbid conditions are a rule rather than an exception, the most common association being asthma. Asthma often is asymptomatic and routine PFT testing is valuable. The association of psoriasis is interesting.     

A two-year prospective study on the frequency and co-occurrence of insomnia and sleep-disordered breathing symptoms in a primary care population

ObjectiveWe aimed to evaluate frequency and co-occurrence of insomnia and sleep-disordered breathing (SDB) symptoms and potential co-morbidity (complex insomnia).MethodsA prospective self-assessment was conducted for adult patients with no prior sleep issues who presented to community-based primary care clinics for nonsleep-related complaints between November 2009 and June 2012.ResultsA brief sleep health survey (SHS) assessed insomnia and SDB symptoms. Of 801 patients, 660 (82.4%) reported at least one insomnia symptom, and 289 (36.1%) reported an insomnia disorder (Insomnia Severity Index [ISI] >7 and self-reported daytime impairment due to insomnia). At least one SDB symptom was reported by 478 (59.7%) patients, and 177 (22.1%) reported two or more symptoms. Co-occurrence of insomnia and SDB symptoms (minimum of one symptom each of insomnia and SDB) occurred in 50.8% of the sample. Using liberal criteria to assess potential co-morbid disorders (complex insomnia), 187 (23.4%) patients reported an insomnia disorder and at least one SDB symptom. With more stringent criteria, including only those patients with moderate or severe insomnia disorders plus two SDB symptoms, 48 patients (6.0% of the sample or 16.6% of all patients with insomnia disorders) indicated potential complex insomnia.ConclusionsCo-occurrence of insomnia and SDB symptoms as well as the rate of potential complex insomnia was common among a moderately large sample of primary care patients without prior evaluations or diagnoses of sleep disorders. Clinical and research implications are discussed.     

Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 5-year results of a prospective randomized trial

BackgroundTo perform a prospective, randomized comparison of laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB).MethodsLAGB, using the pars flaccida technique, and standard LRYGB were performed. From January 2000 to November 2000, 51 patients (mean age 34.0 ± 8.9 years, range 20–49) were randomly allocated to undergo either LAGB (n = 27, 5 men and 22 women, mean age 33.3 years, mean weight 120 kg, mean body mass index [BMI] 43.4 kg/m²; percentage of excess weight loss 83.8%) or LRYGB (n = 24, 4 men and 20 women, mean age 34.7, mean weight 120 kg, mean BMI 43.8 kg/m², percentage of excess weight loss 83.3). Data on the operative time, complications, reoperations with hospital stay, weight, BMI, percentage of excess weight loss, and co-morbidities were collected yearly. Failure was considered a BMI of >35 at 5 years postoperatively. The data were analyzed using Student’s t test and Fisher’s exact test, with P <.05 considered significant.ResultsThe mean operative time was 60 ± 20 minutes for the LAGB group and 220 ± 100 minutes for the LRYGB group (P <.001). One patient in the LAGB group was lost to follow-up. No patient died. Conversion to laparotomy was performed in 1 (4.2%) of 24 LRYGB patients because of a posterior leak of the gastrojejunal anastomosis. Reoperations were required in 4 (15.2%) of 26 LAGB patients, 2 because of gastric pouch dilation and 2 because of unsatisfactory weight loss. One of these patients required conversion to biliopancreatic diversion; the remaining 3 patients were on the waiting list for LRYGB. Reoperations were required in 3 (12.5%) of the 24 LRYGB patients, and each was because of a potentially lethal complication. No LAGB patient required reoperation because of an early complication. Of the 27 LAGB patients, 3 had hypertension and 1 had sleep apnea. Of the 24 LRYGB patients, 2 had hyperlipemia, 1 had hypertension, and 1 had type 2 diabetes. Five years after surgery, the diabetes, sleep apnea, and hyperlipemia had resolved. At the 5-year (range 60–66 months) follow-up visit, the LRYGB patients had significantly lower weight and BMI and a greater percentage of excess weight loss than did the LAGB patients. Weight loss failure (BMI >35 kg/m² at 5 yr) was observed in 9 (34.6%) of 26 LAGB patients and in 1 (4.2%) of 24 LRYGB patients (P <.001). Of the 26 patients in the LAGB group and 24 in the LRYGB group, 3 (11.5%) and 15 (62.5%) had a BMI of <30 kg/m², respectively (P <.001).ConclusionThe results of our study have shown that LRYGB results in better weight loss and a reduced number of failures compared with LAGB, despite the significantly longer operative time and life-threatening complications.