Getting nervous about immunity

Twenty-five years ago, immunologists and neuroscientists had little science of mutual interest. This is no longer the case. Neuroscientists now know that the first formally defined cytokine, IL-1, activates a discrete population of hypothalamic neurons. This interaction leads to the release of glucocorticoids from the adrenal gland, a hormone that has a long history in immunoregulation. Immunologists have been surprised to learn that lymphoid cells synthesize acetylcholine, the first formally recognized neurotransmitter. This neurotransmitter suppresses the synthesis of TNF. These discoveries blur the distinction of neuroscience and immunology as distinct disciplines. There are now 37 formally recognized cytokines and their receptors, and at least 60 classical neurotransmitters plus over 50 neuroactive peptides. These findings explain why both immunologists and neuroscientists are getting nervous about immunity and highlight a real need to apply integrative physiological approaches in biomedical research.     

622例急性肺栓塞患者的临床特点分析

目的:分析急性肺栓塞(Acute pulmonary embolism,APE)患者的临床特征、危险因素、心电图和实验室检查等特点,提高对这种常见的致死性疾病的诊断意识。方法:连续入选2007年1月至2013年12月,在我院经影像学方法诊断的急性肺栓塞患者622例,记录临床特征、危险因素、影像学及实验室检查结果。结果:患者平均年龄(66.4±17.4)岁,女性占54.0%。常见症状是呼吸困难、胸痛和咳嗽,分别占75.4%、37.5%、13.5%和96.1%的PE患者存在三种最常见的症状。常见呼吸急促、心动过速和深静脉血栓形成(DVT)的体征,分别占16.4%、16.1%和15.9%。常见的危险因素是既往深静脉血栓史[肺栓塞(PE)和/或DVT]、恶性肿瘤、外科手术和制动,分别占21.0%、11.3%、13.8%和14.0%。心电图异常的患者占42.9%,包括窦性心动过速、心房颤动、SIQIIITIII、右束支传导阻滞和胸前导联T波明显倒置,分别为15.1%、6.2%、14.3%、4.7%和22.2%。患者入院科室为呼吸科47.9%,心内科40.4%,血管外科5.1%,其他外科3.9%。21.2%的患者接受静脉溶栓,介入溶栓和外科取栓手术患者占10.3%;71.9%单纯抗凝治疗。患者院内死亡21例(3.4%)。结论:PE症状缺乏特异性,很容易与其他疾病误诊,尤其是心内科疾病。危险因素的识别、心电图和超声心动图的表现以及实验室检查结果有助于PE的诊断。     

全科专业住院医师规范化培训学员职业倦怠及其影响因素研究

背景　全科医师是初级医疗保健体系和分级诊疗的重要支点,全科专业住院医师规范化培训（以下简称全科住培）是培养高素质全科医师最重要的渠道,但目前我国的执业现状使学员易产生职业倦怠,分析其职业倦怠影响因素可为完善全科住培管理和壮大全科医师队伍提供依据。目的　了解全科住培学员职业倦怠现状,并分析其影响因素。方法　2019年3-4月,从江苏省13个市各抽取1家国家级全科住培基地,基地内全科学员全样本调查,共抽取682名学员。采用自制社会人口学调查表、职业倦怠普适量表调查学员的职业倦怠情况,采用多元线性回归分析探讨全科住培学员职业倦怠的影响因素。结果　共发放问卷682份,回收有效问卷604份,有效问卷回收率为88.6%。职业倦怠3个维度情绪耗竭维度得分为（15.34±7.02）分、去个性化维度得分为（9.17±6.36）分、个人成就感低落维度得分为（13.61±8.12）分。零倦怠检出率为43.7%（264/604）,轻度职业倦怠检出率为27.3%（165/604）,中度职业倦怠检出率为21.5%（130/604）,重度职业倦怠检出率为7.5%（45/604）。体育锻炼次数、睡眠时长是全科住培学员情绪耗竭的影响因素（P<0.05）;学历、体育锻炼次数、睡眠时长、参加住培年度、收入水平是全科住培学员去个性化的影响因素（P<0.05）;性别、身份归属和体育锻炼次数是全科住培学员个人成就感低落的影响因素（P<0.05）。结论　全科住培学员职业倦怠检出率较高。体育锻炼次数、睡眠时长、参加住培年度、收入水平、学历、性别、身份归属是全科住培学员职业倦怠的影响因素。建议加强全科住培学员体育锻炼和心理建设、探索构建“行业社会人”的培养模式、夯实基层基地的建设、提高全科住培学员薪资待遇等,来缓解或降低其职业倦怠程度。     

Malaria infection in children in tropical rainforest: assessments by women of Ugbowo Community in Benin City,Nigeria

ObjectiveTo examine how mothers recognize malaria infection in children aged less than five and five years, frequency and duration of the infection in these children as well as measures used to reduce exposure of children to mosquito bites, and to discuss the possibilities of designing a strategy that involves mothers in management and control of malaria infection.MethodsThe data were originated from personal interviews which involved mothers in the Ugbowo Community in Benin City, Nigeria who were selected using multi-stage systemic random sampling technique. The data were analyzed qualitatively and by use of percentages, arithmetic mean and bar chart.ResultsThe results showed that all the interviewees believed that children got malaria infection along with fever or fever and other symptoms. Approximately 30% of interviewee recognized malaria infection through fever and cough while 1% by fever and vomiting. Approximately 72% of the interviewees claimed that their children had malaria infection every three months and 16% claimed that their children had the infection every month. Most of the interviewees reported that the length of time from recognition of malaria symptoms on their children to treatment was between one and three days. Most of the interviewees used insecticide treated bed nets to reduce their children's exposure to mosquito bites and few used mosquito repellent ointment.ConclusionsFor malaria management strategy to be effective and sustainable, it is important to empower women with more knowledge on detection of malaria symptoms and they should be involved in planning and designing the strategy.     

重度腺病毒肺炎儿童临床症状、血生化指标及影像学表现分析

目的分析重度腺病毒肺炎儿童临床症状、血生化指标及影像学表现。方法回顾性分析我院2012年7月-2018年3月收治的100例重症腺病毒肺炎患儿的入院记录、病例、影像学表现等资料,分析其特征。结果患儿入院时均伴不同程度发热、呼吸系统症状,其中39℃~41℃占比80.00%,呼吸系统症状中以咳嗽(96.00%)、呼吸气促(86.00%)为主;肺部可闻及湿罗音(89.00%)、哮鸣音(67.00%),部分兼并发生;并发症以呼吸系统(100.00%)、循环系统(64.00%)为主;C反应蛋白(CRP)及肌酸激酶混合同工酶(CK-MB)升高比重均高达60.00%;其次为白细胞计数(WBC)升高(52.00%);CT影像均提示肺实变,其中双肺受累80.00%,76.00%受累肺叶数≥3个,多呈向心性分布,以团簇状影最常见,实变部位均匀强化占比48.00%;另有28.00%检出淋巴结肿大,但大多强化均匀;71.00%患儿伴小气道改变,其中充气不均匀占比84.51%、其次为支气管壁增厚(61.97%)、支气管扩张(40.85%)、马赛克征(33.80%)。结论重度腺病毒肺炎儿童易累及肺外器官组织,并发症较多,应重视血生化指标检测,警惕CT小气道改变征像。     

MFI-20应用于脑卒中后疲乏(PSF)的诊断价值

目的 探索多维疲乏目录（Multidimensional Fatigue Inventory,MFI-20）对脑卒中后疲乏（post-stroke fatigue,PSF）的诊断价值。方法 采用方便抽样法抽取328例脑卒中患者作为研究对象,以疲乏严重度量表（Fatigue Severity Scale,FSS）结果为诊断标准,评估MFI-20诊断PSF的效能。结果 328例患者中,136例使用FSS诊断PSF（41.5%）,153例应用MFI-20诊断PSF（46.6%）。以FSS为标准,MFI-20对PSF的诊断符合率为91.8%,Kappa值为0.833,灵敏度为96.3%,特异度为88.5%,阳性预测值为85.6%,阴性预测值为97.1%。MFI-20诊断PSF的ROC曲线下面积为0.924。结论 MFI-20具有良好的诊断价值,其多维的特点与PSF的复杂性相契合,可作为PSF的诊断工具。     

Deformation and retentive force following in vitro cyclic fatigue of cobalt-chrome and aryl ketone polymer (AKP) clasps

ObjectiveTo compare the retention force of individual clasps made from cobalt chromium (CoCr) or new aryl ketone polymer (AKP) material, Ultaire™ AKP, following prolonged fatigue testing along ideal and non-ideal paths of removal and to assess 3D deformation of the active and passive clasp tips.MethodsCoCr and AKP clasps were manufactured in their standard, respective processes, digitally scanned prior to testing, then cycled 15,000 times over an e.max analogue crown in artificial saliva. Retentive load was measured in situ, as a function of cycles. Clasps were rescanned to assess deformation and along with their antagonists subjected to SEM to assess localised wear.ResultsDistortion of the CoCr clasps was consistently larger than Ultaire™ AKP clasps, irrespective of removal path. CoCr clasps had significantly higher retentive forces than AKP clasps, for both removal paths. Ultaire™ AKP clasps showed a lower but relatively constant retentive force. The non-ideal path of removal affected retentive forces for both clasp materials. SEM showed localised removal of glaze for e.max crowns used with CoCr clasps.SignificanceUltaire™ AKP clasps showed significantly less permanent deformation and lower retentive force than CoCr clasps. Unlike CoCr, the Ultaire™ AKP clasps did not work harden, nor had as large a reduction in retentive force and accompanying permanent deformation; the retentive force for the Ultaire™ AKP clasps was consistent over 15,000 cycles of fatigue mimicking prolonged clinical use. The AKP material was more robust; showing minimal deformation even in non-ideal paths of removal, as many patients would routinely use.     

Randomized controlled trial of aripiprazole versus risperidone for the treatment of amphetamine-induced psychosis

Background: Lifetime prevalence of amphetamine-induced psychotic disorder is reported as being up to 23% for methamphetamine (MA) abusers. Approximately 25% of those with a baseline DSM-IV diagnosis of substance-induced psychosis are diagnosed with primary psychosis at one-year follow-up. Evidence on the treatment of amphetamine psychosis is very limited. Objectives: To investigate the efficacy of risperidone versus aripiprazole in treatment of amphetamine-induced psychotic symptoms. Methods: In a double-blind study, 45 participants were randomly allocated to either aripiprazole 15?mg or risperidone 4?mg daily over a six-week trial. Positive and negative symptoms of psychosis were assessed using the Scale for Assessment of Negative Symptoms (SANS) and the Scale for Assessment of Positive Symptoms (SAPS) at baseline and completion of the trial. Results: SANS and SAPS scores decreased significantly in both groups. Mean SAPS score reduction in risperidone and aripiprazole group was 16.20 and 10.80, respectively, after trial course (p?p?=?0.08). Conclusions: Both aripiprazole and risperidone were effective for patients diagnosed with amphetamine-induced psychotic disorder. However, risperidone had the greater effect on positive psychotic symptoms while patients with negative symptoms may respond better to aripiprazole. There is a case for further studies evaluating the efficacy of atypical antipsychotics in this disorder.     

Fatigue in inflammatory arthritis

Fatigue is highly prevalent in inflammatory arthritis, and people living with the symptom have described it as overwhelming and a challenge to manage. In this article, we explore the experience, impact and non-pharmacological management of fatigue from a multi-disciplinary perspective. We start by presenting qualitative evidence from people living with fatigue, including the physical, cognitive and emotional nature of the symptom and its impact on daily life. This is followed by discussion of current conceptual models of mechanisms and factors that may cause and maintain fatigue, within and between individuals. We then address the issue of fatigue measurement and modes of assessment, which is an integral aspect of management and evaluating support provision. This leads to a review of the research evidence for non-pharmacological interventions to reduce fatigue severity and impact. Finally, we consider implementation of this evidence in clinical practice and we introduce some key practical tools and techniques.