Assessment and characterization of phenotypic heterogeneity of anxiety disorders across five large cohorts

To achieve sample sizes necessary for effectively conducting genome‐wide association studies (GWASs), researchers often combine data from samples possessing multiple potential sources of heterogeneity. This is particularly relevant for psychiatric disorders, where symptom self‐report, differing assessment instruments, and diagnostic comorbidity complicates the phenotypes and contribute to difficulties with detecting and replicating genetic association signals. We investigated sources of heterogeneity of anxiety disorders (ADs) across five large cohorts used in a GWAS meta‐analysis project using a dimensional structural modeling approach including confirmatory factor analyses (CFAs) and measurement invariance (MI) testing. CFA indicated a single‐factor model provided the best fit in each sample with the same pattern of factor loadings. MI testing indicated degrees of failure of metric and scalar invariance which depended on the inclusion of the effects of sex and age in the model. This is the first study to examine the phenotypic structure of psychiatric disorder phenotypes simultaneously across multiple, large cohorts used for GWAS. The analyses provide evidence for higher order invariance but possible break‐down at more detailed levels that can be subtly influenced by included covariates, suggesting caution when combining such data. These methods have significance for large‐scale collaborative studies that draw on multiple, potentially heterogeneous datasets. Copyright © 2016 John Wiley & Sons, Ltd.     

Concern or confidence? Adolescents' identity capital and future worry in different school contexts

This present study investigated the roles identity capital and school's socio-economic status have on adolescent worry about future education, employment, and social status. The 354 participants were 14- to 15-year-old students from affluent (56.8%) and disadvantaged (43.2%) Finnish lower secondary schools. Structural equation modelling was used to test the hypothesis that a higher level of family-related identity capital is connected to a lower level of future worry, and that this connection is mediated through intrapersonal forms of identity capital, specifically academic self-concept and general self-efficacy. Adolescent future worry was also examined across school status with an independent samples t-test. The findings suggest that, in the relatively equal societal context in Finland, adolescents are rather confident about their future education, employment, and social status regardless of the socio-economic status of the school they attend, and when their level of identity capital is high the future worry decreases further.     

Assessment of postural sway with a pendant-mounted wearable sensor

BackgroundBody-worn inertial measurement unit (IMU) sensors have been widely used in postural stability and balance studies because of their low cost and convenience. In most of these studies, a single IMU sensor is attached to a waist belt near the body’s center of mass. Some populations such as pregnant women, however, may find a waist belt challenging in terms of fit and comfort. For this reason it may be useful to identify an alternative location for placement of an IMU and a more comfortable means for attaching the sensor to the body.Research questionDoes placing an IMU sensor in a pendant worn around the neck permit discrimination between conditions with varying postural stability?MethodsTwenty-six healthy participants performed three standing tasks (double-leg, tandem, and single-leg standing) under eyes-open and eyes-closed vision conditions to preliminarily assess the ability of the pendant sensor to discriminate between balance conditions. Discrimination based upon data from a belt-mounted IMU was assessed in the same trials. Differences in standard deviation of acceleration components, sway area, and jerkiness due to trial condition and sensor were evaluated using analysis of variance followed by post hoc comparisons. These data were also incorporated into receiver-operator characteristic (ROC) curve analysis to assess the effectiveness of each sensor at discriminating between conditions.ResultsStability was found to vary across conditions, but there was no interaction between stability and sensor location (all p ≥ 0.323). ROC curve analysis showed that sensors in both locations were good discriminators between conditions.SignificancePlacing an IMU in a pendant may be feasible for studying and monitoring postural instability. This approach may be especially valuable when considering populations for which wearing a belt is uncomfortable.     

Intraprostatic testosterone and dihydrotestosterone. Part I: concentrations and methods of determination in men with benign prostatic hyperplasia and prostate cancer

Owing to inconsistencies and methodological differences, the present peer-reviewed literature lacks conclusive data on the intraprostatic levels of androgens, in particular dihydrotestosterone (DHT), in untreated benign prostatic hyperplasia (BPH) and prostate cancer. To date, no difference has been shown between DHT concentrations in normal prostatic tissue and BPH, and nor has a difference been shown in DHT concentrations between the histologically distinct regions of the prostate. Recent literature has also failed to show a consistent difference in androgen level between BPH and prostate cancer. The role of intraprostatic DHT in the pathogenesis of BPH and in the initiation and progression of prostate cancer thus remains to be established. Increased knowledge of the mechanisms of the androgenic steroid pathways in prostatic diseases, with a special focus on intraprostatic androgen levels may lead to more optimized and more personalized forms of treatment, and probably new therapeutic targets as well.     

经坐骨结节至髋臼后柱置钉安全区域的CT测量研究

目的探讨利用CT测量经坐骨结节至髋臼后柱置钉的安全范围。方法收集60例正常成人骨盆的螺旋CT扫描数据,在扫描结果中包含股骨头最大界面的扫描平面,进行二维及三维重建,然后进行有效切割,获得内平面、外平面及后平面,分别测量经坐骨结节至三个平面的最大角度（α、β、γ）,测量获得髋臼后柱三角形内切圆面积及直径。结果坐骨结节至内平面的最大角度α约8．1°,坐骨结节至外平面的最大角度β约23．5°,坐骨结节至后平面的最大角度1约32．2°,髋臼1／2高度处后柱骨质最狭小（内切圆直径最小）,是判断置钉安全性的关键位置。结论经坐骨结节至髋臼后柱置钉的安全范围较小,有必要在置钉时精确量化与精确操作,严格按照个体化进行置钉。     

《2018年欧洲高血压管理指南》解读

随着心血管病的防治理念逐渐由被动防治转向主动预防,高血压作为心血管病的首要危险因素,也越来越受到重视,近年来有关降压治疗带来心血管病获益的临床循证医学证据不断积累,2018年欧洲心脏病学会年会上发布的《2018年欧洲高血压管理指南》,较《2013年欧洲高血压管理指南》在高血压的管控方面有较大更新,既沿用了以往的一些理念,又更新了许多新的内容,新版高血压管理指南在高血压诊断、血压测量、高血压的风险分层、降压治疗的启动时机、降压治疗的目标值变化、高血压的治疗、难治性高血压与继发性高血压的处理等方面均进行了全面而详细的阐述,其在高血压防控方面加大了力度,尤其在高血压的启动治疗时机、启动治疗的血压阈值、治疗药物的起始联合用药及对单片固定复方制剂的优先推荐以及高血压患者的血压监测及综合管理的治疗理念方面,值得临床借鉴与学习。     

对接应用型护理人才培养的融通式教学模式下教育环境评估

目的比较和分析对接应用型护理人才培养的融通式教学模式和“以学科为中心”传统教学模式下的教育环境的差异。方法选择2017级护理本科生57人为实验组,实施融通式教学模式;选择2016级护理本科生44人为对照组,开展“以学科为中心”的传统教学模式。采用教育环境评估量表(dundee ready education environment measure,DREEM)评估两种教学模式下护理教育环境。结果两组教育环境评价总分都达到较好的标准:实验组教育环境评价总分(144.67±23.16)高于对照组(135.30±16.12),且差异具有统计学意义(P=0.019);在教育环境的5个维度中,实验组学习知觉、环境知觉和社交知觉维度得分均高于对照组,且差异具有统计学意义(P<0.05)。结论对接应用型护理人才培养的融通式教学改革可有效改善教育环境,增强学生自主学习能力,显著提高教学效果。     

剖宫产术后子宫瘢痕妊娠动脉血管网数字化三维重建及测量

目的:探讨利用数字化三维重建技术及Mimics10.01、UGNX11.0软件建立剖宫产术后子宫瘢痕妊娠(CSP)动脉血管网并测量相关数据的可行性。方法:选取2016年10月至2018年10月就诊于乌鲁木齐市妇幼保健院、新疆维吾尔自治区人民医院、深圳市宝安区沙井人民医院的20例CSP患者,利用CT薄层扫描及CT血管成像技术采集断层图像数据集,借助相关软件重建患者骨盆、盆腔动脉血管网,并测量腹主动脉分叉角度、髂总动脉长度、髂内动脉长度、子宫动脉开口角度,并进行描述性分析。结果:测量的20例CSP患者其腹主动脉分叉角度为45.29°±10.22°,左侧子宫动脉开口角度为64.97°±24.52°,右侧子宫动脉开口角度为58.07°±27.84°;左侧髂总动脉长度为(44.47±15.68)mm,右侧髂总动脉长度为(43.89±15.78)mm,左侧髂内动脉长度为(46.18±13.98)mm,右侧髂内动脉长度为(47.45±13.95)mm。结论:借助数字化三维重建技术结合适当软件可以重建CSP数字化三维模型,并精确测量相关数据,为该疾病的个体化治疗尤其是血管性介入治疗提供了解剖学依据及相关数据支撑。     

重复测量血压有无间隔时间对血压值的影响

目的探讨重复测量血压时有无间隔时间对血压值的影响。方法将 32 0例健康体检者随机分为实验组和对照组各 16 0例 ,均测量两次血压。实验组重复测量血压时无间隔时间 ;对照组重复测量血压时间间隔 5min。结果两组组内两次收缩压、舒张压值比较 ,均P >0 .0 5 ,差异无显著性意义。结论重复测量血压时待第 1次汞柱降至“0”后测量第 2次血压勿需间隔时间。     

Association of Multimodal Pain Control with Patient-Reported Outcomes in Children Undergoing Surgery

IntroductionOur aim was to describe practices in multimodal pain management at US children's hospitals and evaluate the association between non-opioid pain management strategies and pediatric patient-reported outcomes (PROs).MethodsData were collected as part of the 18-hospital ENhanced Recovery In CHildren Undergoing Surgery (ENRICH-US) clinical trial. Non-opioid pain management strategies included use of preoperative and postoperative non-opioid analgesics, regional anesthetic blocks, and a biobehavioral intervention. PROs included perioperative nervousness, pain-related functional disability, health-related quality of life (HRQoL). Associations were analyzed using multinomial logistic regression models.ResultsAmong 186 patients, 62 (33%) received preoperative analgesics, 186 (100%) postoperative analgesics, 81 (44%) regional anesthetic block, and 135 (73%) used a biobehavioral intervention. Patients were less likely to report worsened as compared to stable nervousness following regional anesthetic block (relative risk ratio [RRR]:0.31, 95% confidence interval [CI]:0.11–0.85), use of a biobehavioral technique (RRR:0.26, 95% CI:0.10–0.70), and both in combination (RRR:0.08, 95% CI:0.02–0.34). There were no associations of non-opioid pain control modalities with pain-related functional disability or HRQoL.ConclusionUse of postoperative non-opioid analgesics have been largely adopted, while preoperative non-opioid analgesics and regional anesthetic blocks are used less frequently. Regional anesthetic blocks and biobehavioral interventions may mitigate postoperative nervousness in children.Level of evidenceIII.