Severe neuroexcitatory symptoms after anaesthesia--with focus on propofol anaesthesia

Delayed neuroexcitatory symptoms after an uneventful anaesthesia are uncommon, although described in many reports. We want to report on two cases. The first patient developed muscle hypertonicity, jerky movements and unconsciousness after an uneventful anaesthesia with propofol, and later the same thing happened after anaesthesia with thiopentone. The second patient developed similar symptoms after an uneventful anaesthesia with propofol, but she never recovered completely after this and is now severely disabled. A search of the literature and the Swedish adverse drug reactions register revealed many similar cases. In both our patients the causal relationship between propofol and the neuroexcitatory symptoms remains uncertain, but we want to alert readers about this possible adverse reaction.     

私立学校初一新生焦虑和抑郁状况

目的探讨私立学校初中新生的情绪状况及性别差异,为开展心理健康教育提供依据.方法采用Zung氏焦虑自评量表(SAS)和抑郁自评量表(SDS),对青岛市某私立学校初一新生228人进行整群抽样测查,匹配市区公立学校初一新生239人作同期对照,并做统计分析.结果观察组有15.79%处于焦虑状态(女生检出率较高),高于对照组(9.21%),差异有显著性(χ2=4.65,P＜0.05);观察组SAS均分高于对照组及常模,其中独生子女SAS均分高于对照组(P＜0.05).观察组中23.25%处于抑郁状态(男生检出率高),明显低于对照组(32.22%)(χ2=4.67,P＜0.05),但SDS均分不低于对照组.焦虑和抑郁同时存在率也以观察组较高(12.28%),与对照组差异有显著性(χ2=4.27,P＜0.05).结论私立学校初一新生存在以女生为主的较高焦虑检出率、以独生子女为主的较高焦虑水平以及以男生为主的抑郁检出率和较高抑郁水平,社会、学校和家庭要根据中学生的年龄和性别特点开展心理健康教育工作.     

Comparison of cystoscopic and histological findings in patients with suspected interstitial cystitis

PURPOSE: Although the exact etiology of interstitial cystitis remains elusive, bladder inflammation appears to be common in many patients. The National Institutes of Health (NIH) have established diagnostic criteria for interstitial cystitis based on the presence of irritative voiding symptoms in the absence of other identifiable pathology. Cystoscopic examination with hydrodistention performed in patients under anesthesia is part of the NIH diagnostic criteria. We determine if the severity of cystoscopic findings correlated with histological evidence of inflammation in patients with suspected interstitial cystitis. MATERIALS AND METHODS: A total of 69 patients who met NIH symptom criteria for interstitial cystitis and underwent cystoscopy, hydrodistention and bladder biopsy under anesthesia were reviewed. There were 2 investigators blinded to the histological data who independently reviewed operative reports. A urological pathologist blinded to the clinical data reviewed biopsies for inflammation severity. Cystoscopic and histological findings were then converted to a numeric scale. Numeric data were analyzed using the Pearson correlation coefficient. RESULTS: Cystoscopic examination revealed no evidence of interstitial cystitis in 6 patients (9%), mild changes in 27 (39%), moderate changes in 23 (33%) and severe changes in 13 (19%). Histological examination revealed no inflammation in 21 patients (30%), mild inflammation in 28 (41%), moderate inflammation in 11 (16%) and severe inflammation in 9 (13%). Histological scores correlated poorly with total and scaled cystoscopic severity scores (r = 0.295 and 0.349, respectively). CONCLUSIONS: Severity of cystoscopic findings observed during hydrodistention with anesthesia does not appear to correlate with the degree of inflammation identified histologically in patients with suspected interstitial cystitis.     

Scoring the short form ICSmaleSF questionnaire. International Continence Society

PURPOSE: The International Continence Society (ICS) ICSmale questionnaire was devised to provide a thorough evaluation of the occurrence and bothersomeness of lower urinary tract symptoms and their impact on the lives of men with benign prostatic disease. This report completes the developmental work on the questionnaire, producing the concise short form instrument, ICSmaleSF, with a valid, reliable and scientifically justified scoring system. MATERIALS AND METHODS: Two data sets were used. The short form version of the questionnaire was devised and initially evaluated using data on men with uncomplicated lower urinary tract symptoms who were involved in the CLasP randomized controlled trial comparing laser therapy with transurethral prostatic resection and conservative management or monitoring without active intervention. External validation of the scoring system was undertaken using data from phase II of the ICS benign prostatic hyperplasia (BPH) study, an observational study of outcome in men with lower urinary tract symptoms related to benign prostatic enlargement. All patients completed the developmental version of the ICSmale questionnaire. Parallel analysis on the CLasP data set identified items that were responsive to change or highly problematic, allowing other redundant and overlapping items to be eliminated. Factor analysis and Cronbach's alpha coefficients were used to examine the clustering of items. Regression models were used to investigate the validity of followup scores within and across treatment groups in the CLasP and ICS/BPH studies. RESULTS: The questionnaire, which originally comprised 22 items, was shortened to 11 items in the 2 distinct factors of voiding (ICSmaleVS) and incontinence (ICSmaleIS) symptoms. Cronbach's alpha coefficients were high at 0.76 for ICSmaleVS and 0.78 for ICSmaleIS. A simple additive score was calculated by adding the 5 items in ICSmaleVS and 6 in ICSmaleIS. ICSmaleVS and ICSmaleIS detected expected improvement in the laser therapy and transurethral prostatic resection groups, and stability in the conservative management group within CLasP. Similarly each subscore but particularly ICSmaleVS was sensitive to differences in the outcome of the range of treatments in the ICS/BPH study. While frequency and nocturia were highly problematic and sensitive to change individually, they did not load into the other main factors or correlate with each other. It is suggested that these symptoms should be evaluated separately with the additional inclusion of a single item measure of the impact of lower urinary tract symptoms on daily life. CONCLUSIONS: The ICSmaleSF represents a comprehensive, concise, valid and reliable instrument for evaluating men with lower urinary tract symptoms. Unlike other questionnaires in the field it contains subscores for the domains of voiding and incontinent symptoms as well as the separate consideration of frequency, nocturia and impact on daily life. We hope that it will become the tool of choice for the comprehensive evaluation of treatment of men with lower urinary tract symptoms associated with benign prostatic disease.     

军人家属及部分女兵下尿路症状调查分析和防治

目的 调查军人家属及女兵的下尿路症状发病情况。方法在某部及其下属的3个团的家属及部分女兵进行体检的同时进行问卷调查。采用布里斯托女性下尿路症状调查问卷，问卷由被调查者独立填写，个别不能独立完成问卷的被调查者，由调查员对其进行解释，再由其完成。结果 91人完整回答了问卷，其中尿频、尿急、膀胱疼痛、夜尿、压力性尿失禁、排尿时需要用力、捧尿延迟、排尿中断、排尿力量发生变化和感觉总是不能完全排空膀胱的患病率分别是：9．9％、58．2％、37．4％、24．2％、34．1％、22％、28．6％、31．9％、16．5％和53．8％。夜尿对生活质量影响最大。结论 军人家属及部分女兵中下尿路症状很常见，48岁以上家属基本都存在这种或那种下尿路症状。     

Behavioural inhibition: A predictor of anxiety

Anxiety disorders are prevalent and contribute to emotional suffering and significant economic loss. Early identification and treatment are essential, not only to reduce the associated morbidity, disability and mortality of the anxiety disorders themselves, but also to minimize development of frequent comorbidities such as depression and substance abuse. To understand the factors that increase susceptibility to developing anxiety disorders, a temperamental construct called behavioural inhibition, which refers to the consistent tendency of some children to demonstrate fear and withdrawal in novel situations, has been developed. The present article reviews studies investigating this model as a premorbid predictor of those at risk for developing anxiety disorders, including prospective studies of children at risk as well as retrospective and family studies. In summary, these data suggest the usefulness of this model and a need for further research to determine the optimal management of behaviourally inhibited children as a potential way to prevent adult psychopathology.     

62例双侧脑挫裂伤双侧开颅手术治疗分析

目的:总结62例双侧脑挫裂伤的临床特点、CT检查和手术治疗.方法:对62例双侧脑挫裂伤患者的手术治疗进行回顾性分析.结果:均行CT检查,以额颞叶脑挫裂伤多见,多并发外伤性蛛网膜下腔出血、硬膜下血肿和脑内血肿.病例全部行双侧开颅手术,其中双侧开颅手术手术一次的治愈率、致残率、病死率分别为75.0%、12.5%、12.5%;手术两次的治愈率、致残率、病死率分别为31.6%、21.0%和47.4%.手术一次组的治愈率高于手术两次组、病死率低于手术两次组,有显著性差异(P＜0.05),而致残率无显著性差异(P＞0.05).结论:双侧脑挫裂伤有其一定的临床特点,对该病的演变与发展做出早期预判、掌握手术指征,及时行一次性双侧开颅手术治疗是预后的关键.     

The Influence of Physical Distancing,Sense of Belonging,and Resilience of Nursing Students on Their Viral Anxiety During the COVID-19 Era

ObjectiveWe aimed to explore how nursing students’ adherence to physical distancing, sense of belonging, or resilience may be associated with viral anxiety during the coronavirus disease (COVID-19) era in South Korea. MethodsWe conducted an online survey among nursing students from December 8–10, 2021. The survey gathered participants’ age, sex, grades, living area, and responses to questions on COVID-19. In addition, responses to Stress and Anxiety to Viral Epidemics-6 items (SAVE-6), adherence to physical distancing, Sense of Belonging Instrument, Calling and Vocation Questionnaire, Patient Health Questionnaire-9 items (PHQ-9), and Connor-Davidson Resilience Scale-2 (CD-RISC2) items were gathered. ResultsThe SAVE-6 score was significantly correlated with adherence to physical distancing (r=0.29), PHQ-9 (r=0.26), and CD-RISC2 (r=-0.34, all p<0.01) similar to partial correlation analysis adjusting participants’ group (freshmen and sophomores vs. juniors and seniors). A linear regression analysis revealed that viral anxiety of nursing students was predicted by sex (female, β=0.20, p=0.001), adherence to physical distancing (β=0.25, p<0.001), sense of belonging (β=0.16, p=0.014), and CD-RISC2 score (β=-0.32, p<0.001) (adjusted R²=0.24, F=10.01, p<0.001). ConclusionWe observed that adherence to physical distancing, sense of belonging, and their resilience influenced nursing student’s viral anxiety. An appropriate support system to manage viral anxiety is needed for nursing students during the COVID-19 pandemic.     

Analysis of Esophageal Motility and Reflux Characteristics in Patients with Gastroesophageal Reflux Disease With or Without Extraesophageal Symptoms

Background: The pathogenesis of extraesophageal symptoms of gastroesophageal reflux disease is complex, and esophageal motility and reflux may be involved in it. In this study, we aimed to compare esophageal motility and reflux characteristics in gastroesophageal reflux disease patients with and without extraesophageal symptoms by high-resolution manometry and multichannel intraluminal impedance-pH monitoring.Methods: We retrospectively studied gastroesophageal reflux disease patients between January 2014 and December 2018. All patients had undergone high-resolution manometry and multichannel intraluminal impedance-pH monitoring. The results were compared and analyzed.Results: A total of 59 patients were included in this study. Patients were divided into 3 groups according to their main complaint: only typical symptoms (group A, n = 11), both typical and extraesophageal symptoms (group B, n = 33), and only extraesophageal symptoms (group C, n = 15). Compared with group A, the lower esophageal sphincter basal pressure, integrated residual pressure, and lower esophageal sphincter length were lower, and the proximal reflux percentages of a weak acid and non-acid reflux were higher in group B and group C (P < .017). The positive rate of esophageal motility disorders was lower in group A than in other groups (P < .05). The proportion of patients with multiple rapid swallows/single swallow—distal contractile integral ratio greater than 1—was higher in group A than in other groups (P < .05).Conclusions: Decreased lower esophageal sphincter pressure and lower esophageal sphincter length, increased proximal esophageal reflux of weak acid and non-acid reflux, esophageal motility disorders, and decreased peristaltic reserve are involved in the pathogenesis of extraesophageal symptoms of gastroesophageal reflux disease.