Roles of perinatal problems on adolescent antisocial behaviors among children born after 33 completed weeks: a prospective investigation

Background: There is uncertainty about the extent to which mildly sub‐optimal perinatal characteristics among individuals born near‐term (>33 weeks of gestation) are associated with various subsequent childhood problems, including antisocial behavior. There is even more uncertainty about whether the pathway to antisocial behavior differs by gender. Methods: A sample of 1689 infants, born near‐term, was followed from birth for over 30 years. Using structural equation modeling (SEM), the study evaluated hypothesized mechanisms linking perinatal problems to antisocial behavior, mediated through the following variables in early and later childhood: neurological abnormalities at age 1; hearing, speech, and language problems at age 3; cognitive function at age 4; and academic performance at age 7. Childhood problems were assessed by trained research clinicians, blind to perinatal status. An ‘antisocial behavior’ variable was created, based on retrospective self‐report of six antisocial incidences assessed in adulthood. Results: Path coefficients showed that birthweight, head circumference, and Apgar scores were indirectly associated with antisocial behavior in the presence of one or more of the following: neurological abnormalities, abnormality in language, speech, and hearing, cognitive function, or academic performance. We found gender differences only in the associations between hearing and IQ and between language perception and IQ. Poor academic performance was associated with antisocial behavior in both boys and girls. Conclusion: Our hypothesis, that perinatal problems may progress to antisocial behavior when mediated by various markers of early childhood problems, was confirmed. Adverse perinatal events need to be considered in identifying infants who are at risk for academic problems and antisocial behavior, even when the infant is born relatively close to term (i.e., >33 weeks). Poor academic performance, which is indirectly influenced by a variety of neurological and cognitive problems during the perinatal period, infancy, and early childhood appear to increase antisocial behavioral problems in both girls and boys.     

Contrast-enhanced ultrasonography could be a non-invasive method for differentiating none or mild from severe fibrosis in patients with biopsy proven non-alcoholic fatty liver disease

Objective: The gold standard for diagnosing fibrosis stage in non-alcoholic fatty liver disease (NAFLD) is liver biopsy. The aim of this study was to determine whether contrast-enhanced ultrasonography (CEUS) with transit time measurements could be a non-invasive alternative for differentiating none or mild from severe fibrosis in NAFLD patients. Various serum markers and clinical variables were also evaluated.

Materials and methods: Fifty-eight patients with NAFLD underwent CEUS prior to liver biopsy. All patients were also evaluated according to the Göteborg University Cirrhosis Index (GUCI), the AST-Platelet Ratio Index (APRI), the NAFLD fibrosis score, and the FIB-4 and BARD score.

Results: The hepatic vein arrival time (HV) was shorter in patients with severe fibrosis (25.9?±?4.8 vs 29.5?±?4.7?s, p?=?0.023), and the difference between the hepatic and portal vein (ΔHV–PV) was shorter (2.3?±?2.8 vs 6.4?±?2.8?s, p?p?Conclusions: CEUS and non-invasive scoring systems could exclude severe fibrosis in NAFLD patients.     

体外冲击波治疗中老年女性膝关节炎的疗效观察

 目的 观察体外冲击波治疗中老年女性膝关节炎的疗效。方法 将2014-08至2014-12收集到的65例女性膝关节炎患者随机分为两组,氨糖组给予硫酸氨基葡萄糖胶囊口服, 1～2粒(0.314～0.628 g)/次,连续服用8周。冲击波组给予冲击频率为7 Hz,能量1～2 bar的发散式体外冲击波治疗,每个部位冲击2000下,1次/周,8次为一疗程。对两组患者治疗前及治疗一疗程后行视觉模拟疼痛评分(visual analog scale,VAS),膝关节功能评分(Western Ontario and McMaster University Osteoarthritis Index,WOMAC)及测量50 m快速走时间。结果 两组患者均未见严重不良反应,体外冲击波组患者疼痛缓解,平均VAS疼痛评分(3.2±2.4)较治疗前(6.8±2.2)明显下降,差异有统计学意义(P<0.05)。膝关节功能WOMAC指数均较治疗前有改善(P<0.05)。 50 m快速走平均时间(37.0±6.3)s较治疗前(39.9±7.7)s明显缩短,差异有统计学意义(P<0.05)。对照组VAS疼痛评分,膝关节功能WOMAC指数,50 m快速走时间变化无明显统计学意义。结论 相对于口服氨基葡萄糖,体外冲击波疗法治疗中老年女性膝骨关节炎无不良反应,能缓解疼痛,恢复关节功能,可作为治疗骨关节炎的新选择。     

Composite risk scores and depression as predictors of competing waiting‐list outcomes: the Waiting for a New Heart Study

We evaluated two composite risk scores, (Heart Failure Survival Score, HFSS; German Transplant Society Score, GTSS), and depression as predictors of mortality and competing waiting‐list outcomes [high‐urgency transplantation (HU‐HTx), elective transplantation, delisting because of clinical improvement] in 318 heart transplant (HTx) candidates (18% women; aged 53 ± 11 years) from 17 hospitals and newly registered with Eurotransplant. Demographic variables and depression (Hospital Anxiety and Depression Scale, HADS) were assessed using questionnaires. Variables to compute HFSS and GTSS, age, medications, and outcomes were provided by Eurotransplant. At 12 months, 33 patients died, 83 received urgent HTx, 30 elective HTx, and 17 were delisted because of improvement. Applying cause‐specific Cox regressions, only the HFSS was significantly associated with 1‐year mortality [HR = 0.64 (95% CI = 0.43–0.95), P = 0.029]. The GTSS was the strongest predictor of HU‐HTx [HR = 1.02 (95% CI = 1.01–1.02), P < 0.001]. Low depression scores contributed significantly to clinical improvement, even after adjusting for age and risk scores [HADS: HR = 0.12 (95% CI = 0.02–0.89), P = 0.039]. These findings confirm the usefulness of composite risk scores for the prediction of mortality and HU‐HTx, validating both scores for their intended use. The finding that depression was an independent predictor of the waiting‐list outcome clinical improvement suggests that considering patients’ psychological attributes in addition to their medical characteristics is advisable.     

癫痫持续状态预后评分进展

癫痫持续状态具有较高的死亡率,是神经内科常见的危急重症。对患者预后风险进行评 估,对其病情严重程度进行准确分级将有助于临床医师制定个体化的治疗方案,最大限度地使癫痫 持续状态患者获益。目前国际上共有4个癫痫持续状态预后风险的评分：癫痫持续状态严重程度评 分（status epilepticus severity score,STESS）、基于流行病学死亡率的癫痫持续状态评分（epidemiology based mortality score in SE,EMSE）、改良癫痫持续状态严重程度评分（modified STESS,mSTESS）以 及END-IT评分[包括脑炎与否（Encephalitis）、是否合并非惊厥性癫痫持续状态（Nonconvulsive status epilepticus,NCSE）、是否有地西泮抵抗（Diazepam resistance）、神经影像学特征（Image）以及是否进行 气管插管（Tracheal intubation）]。本文回顾了癫痫持续状态预后评分的进展,简述了每个评分的建立 过程及其优势和局限性,以期增强临床医师对癫痫持续状态预后评分的认识、裨益临床研究。     

The role of barium esophagogram measurements in assessing achalasia patients after endoscope-guided pneumatic dilation

Only a few studies have been performed comparing subjective symptom improvements with objective improvement in esophageal emptying after pneumatic dilation (PD), and discrepancy existed. We evaluated whether esophagogram measurements adds to the traditional subjective symptoms scores in assessing achalasia patients after PD. We enrolled 32 new patients with achalasia who received endoscope-guided PD treatment between January 1998 and June 2004. Postdilation investigations were performed by using esophageal emptying on esophagogram prospectively in a blinded manner, along with symptom scores before and after PD at the initial investigation, 6 weeks later, and every 1 year thereafter. Our results showed that seven patients who noted complete relief showed less than 50% improvement in barium column height and esophageal diameter. There was no linear correlation between the degree of patient symptom improvement and esophageal emptying measured by esophagogram ( r  = 0.181, P  = 0.322). A trend of association existed in the relationship between clinical remissions and initial post-PD esophageal emptying improvement ( P  = 0.067). In summary, the association between the post-PD symptom score improvement and degrees of esophageal emptying may be hampered by the small sample size in the current study. An additional objective parameter like esophagogram to the subjective symptom scores may be more optimal in assessing clinical remissions.     

The use of risk scores for stratification of non-ST elevation acute coronary syndrome patients

OBJECTIVE:

To review the methods available for the risk stratification of non-ST elevation (NSTE) acute coronary syndrome (ACS) patients and to evaluate the use of risk scores for their initial risk assessment.

DATA SOURCES:

The data of the present review were identified by searching PUBMED and other databases (1996 to 2008) using the key terms “risk stratification”, “risk scores”, “NSTEMI”, “UA” and “acute coronary syndrome”.

STUDY SELECTION:

Mainly original articles, guidelines and critical reviews written by major pioneer researchers in this field were selected.

RESULT:

After evaluation of several risk predictors and risk scores, it was found that estimating risk based on clinical characteristics is challenging and imprecise. Risk predictors, whether used alone or in simple binary combination, lacked sufficient precision because they have high specificity but low sensitivity. Risk scores are more accurate at stratifying NSTE ACS patients into low-, intermediate- or high-risk groups. The Global Registry of Acute Cardiac Events risk score was found to have superior predictive accuracy compared with other risk scores in ACS population. Treatments based according to specific clinical and risk grouping show that certain benefits may be predominantly or exclusively restricted to higher risk patients.

CONCLUSION:

Based on the trials in the literature, the Global Registry of Acute Cardiac Events risk score is more advantageous and easier to use than other risk scores. It can categorize a patient’s risk of death and/or ischemic events, which can help tailor therapy to match the intensity of the patient’s NSTE ACS.     

多项指标对慢性持续期哮喘联合治疗方案调整效果评价

目的:评价哮喘患者气道反应性(AR)〔以第1秒用力呼气容积(FEV1)比基础值下降≥20%时的组胺剂量(PD20FEV1)为代表〕,哮喘控制测试(ACT)评分、血嗜酸细胞计数(EOS)、血清免疫球蛋白E(IgE)及哮喘症状评分、FEV1占预计值的百分比(FEV1%pred)、晨间呼气流量占预计值百分比(PEF%pred)的动态变化等指标,对哮喘患者应用吸入性糖皮质激素(ICS)+长效β2受体激动剂(LABA)联合治疗方案调整的指导作用。方法:对34例门诊慢性持续期轻、中度哮喘患者应用ICS+LABA进行联合治疗,并应用上述指标进行治疗方案的调整。结果:1.经ICS+LABA联合治疗,症状评分、FEV1%pred、PEF%pred值、ACT评分、AR程度及血嗜酸粒细胞(EOS)计数均明显改善。9个月、12月、15个月及18个月完全控制率分别为26.4%、42.8%、58.8%和60%。2.共有30例进行了降级治疗,7例因症状复发恢复原治疗级别,其中应用AR、血EOS计数监测的患者仅有2例出现反复,1例停药6个月复查AR、血EOS计数值仍正常。结论:运用上述指标调整治疗方案可使门诊慢性持续期轻、中度哮喘患者达到哮喘最佳控制研究(GOAL)研究相似的疗效。