Occupational attainment and depressive symptoms in young adulthood

Past studies have shown that various aspects of occupational attainment (unemployment, job instability, low occupational status, and low earnings) are associated with poor mental health, but each of these studies focused on one or two aspects of occupational attainment. Consequently, it remains unclear whether their associations are independent of each other. Further, little is known about whether negative self‐assessments of occupational attainment are linked to poor mental health. We sought to overcome these limitations of past research while focusing on depressive symptoms as a mental health outcome and young adulthood as a life stage context. The study analysed U.S. data from the National Longitudinal Study of Adolescent to Adult Health (n = 13,178) using ordinary least square models. The analysis showed that all aspects of occupational attainment were associated with depressive symptoms in the expected directions. Further, unemployment, job instability, and negative self‐assessment of career progress showed stronger associations, and those associations were independent of other occupational attainment variables. Overall, the results suggested that understanding the association between occupational attainment and mental health requires close attention to the life stage context.     

Relationship among Cervical Spine Degeneration,Head and Neck postures,and Myofascial Pain in Masticatory and Cervical Muscles in Elderly with Temporomandibular Disorder

ObjectivesThe aim of the study was to verify associations among degenerative changes in the cervical spine, head and neck postures, and myofascial pain in the craniocervical musculature in elderly with myofascial temporomandibular disorders (TMDs).MethodsA total of 120 participants (mean age, 68.3 ± 7.5 years) were included: 45 participants had no signs of orofacial or cervical pain, 26 participants had myofascial TMD only (mTMD), and 49 participants had both myofascial TMD and cervical pain (cerTMD). Participants were diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders. Cervical spine degeneration and head and neck postures were identified using the lateral cephalogram. Myofascial trigger points (TrPs) were evaluated in the temporalis, masseter, trapezius, sternocleidomastoid, sub-occipitalis, and splenius capitis muscles. Relationships among number of TrPs, head postures, and cervical degeneration were investigated using repeated-measure analysis of variance and Pearson’s correlation coefficient.ResultsThe cerTMD showed higher number of active TrPs in the masticatory and cervical muscles, greater forward head posture, and more severe degenerative changes in the cervical spine than mTMD did. The degenerative changes in each level of the cervical spine had complex interactions with head postures. Cervical degeneration, particularly at level of second to third vertebra appeared to be linked to the development of active TrPs in the masticatory and cervical muscles.ConclusionsThe results of this study demonstrated that degenerative changes in the cervical spine were related to altered head postures and the development of active TrPs in the craniocervical musculature in elderly with myofascial TMD.     

Integrating multiple-domain rules for disease classification

In psychiatry, clinicians use criteria sets from the Diagnostic and Statistical Manual of Mental Disorders to diagnose mental disorders. Most criteria sets have several symptom domains, and in order to be diagnosed, an individual must meet the minimum number of symptoms required by each domain. Some efforts are now focused on adding biomarkers to these symptom domains to facilitate the detection of and highlight the neurobiological basis of psychiatric disorders. Thus, a new criteria set may consist of both clinical symptom counts in several domains and continuous biomarkers. In this paper, we propose a method to integrate classification rules from multiple data sources to estimate an optimal criteria set. Each domain-specific rule can be counts of symptoms, a linear function of symptoms, or even nonparametric. The overall classification rule is the intersection of these domain-specific rules. Based on examining the expected population loss function, we propose two iterative algorithms using either support vector machines or logistic regression to fit intersection rules consistent with the Diagnostic and Statistical Manual of Mental Disorders. In simulation studies, these proposed methods are comparable with the true decision rule. The methods are applied to the motivating study to construct a criteria set for complicated grief. The developed criteria set shows a substantial improvement in sensitivity and specificity compared to the current standards on an independent validation study.     

13例新生儿红斑狼疮的临床特征、皮损后遗表现

【摘要】 目的 探讨新生儿红斑狼疮（NLE）的皮损后遗表现，分析可能的相关因素。方法 回顾2016—2020年首都儿科研究所附属儿童医院皮肤科收集并长期随访的13例NLE，分析患儿及母亲临床特征、患儿皮损后遗表现。结果 13例皮损发病时间为出生后0 ~ 120 d，平均15 d，随访时间15 ~ 43个月，皮损形态主要为环状红斑、斑丘疹、鳞屑，皮损消退时间2 ~ 18个月（平均7.4个月）。6例皮损消退后出现色素异常表现，3例同时出现色素减退和色素沉着，2例仅有色素减退，1例仅有色素沉着，1例色素减退患儿在随访18个月后色素减退复色，未见毛细血管扩张以及萎缩或瘢痕。8例患儿母亲孕前无异常，4例患儿母亲抗ANA、抗SSA/Ro、抗SSB/La抗体均阳性。结论 NLE的皮肤受累可出现后遗皮肤表现，常见为色素异常，多数长期未消退，应注意患儿母亲可能存在的潜在性免疫系统异常。     

Hypoglycemia unawareness in type 1 diabetes patients using intermittent continuous glucose monitoring: Identification of risk factors and glycemic patterns

BackgroundHypoglycemia unawareness designates failure to detect eminent hypoglycemia. Clarke's questionnaire is one of the most used systems to evaluate this problem.AimsTo relate Clarke's questionnaire (QQ) results with continuous glucose monitoring data.MethodsApplication of the questionnaire in a sample of type 1 diabetes mellitus (T1DM) patients using intermittent continuous glucose monitoring (iCGM).Results111 T1DM patients were evaluated, 56.8% female, mean age 35.0 ± 12.4 years and mean disease duration 18.8 ± 10.5 years.According to CQ, 13.5% had unawareness, 76.6% awareness and 9.9% indeterminate awareness to hypoglycemia. Those with unawareness had longer disease duration (25.1 ± 10.4 vs 18.2 ± 10.3 for awareness and 14.9 ± 9.9 for indeterminate awareness, p = 0.047), more time below range (10.3 ± 4.9% vs 6.3 ± 5.1 and 6.3 ± 4.8; p = 0.009) and higher mean duration of hypoglycemia (131.7 ± 38.6 vs 116.6 ± 49.6 and 131.7 ± 38.6; p = 0.008). In multivariate analysis, mean duration of hypoglycemia was an independent predictor of CQ results. In a receiver operating curve (AUC 0.746; p = 0.004) a mean duration of hypoglycemia ≥106.5 min showed 84.6% sensitivity/64.4% specificity for unawareness.ConclusionsOur sample had a significative prevalence of hypoglycemia unawareness which increased with longer diabetes duration. iCGM data can be indicative of this problem, with a mean hypoglycemia duration ≥106.5 min being suggestive, albeit unspecific.     

Input representations and classification strategies for automated human gait analysis

BackgroundQuantitative gait analysis produces a vast amount of data, which can be difficult to analyze. Automated gait classification based on machine learning techniques bear the potential to support clinicians in comprehending these complex data. Even though these techniques are already frequently used in the scientific community, there is no clear consensus on how the data need to be preprocessed and arranged to assure optimal classification accuracy outcomes.Research questionIs there an optimal data aggregation and preprocessing workflow to optimize classification accuracy outcomes?MethodsBased on our previous work on automated classification of ground reaction force (GRF) data, a sequential setup was followed: firstly, several aggregation methods – early fusion and late fusion – were compared, and secondly, based on the best aggregation method identified, the expressiveness of different combinations of signal representations was investigated. The employed dataset included data from 910 subjects, with four gait disorder classes and one healthy control group. The machine learning pipeline comprised principle component analysis (PCA), z-standardization and a support vector machine (SVM).ResultsThe late fusion aggregation, i.e., utilizing majority voting on the classifier's predictions, performed best. In addition, the use of derived signal representations (relative changes and signal differences) seems to be advantageous as well.SignificanceOur results indicate that great caution is needed when data preprocessing and aggregation methods are selected, as these can have an impact on classification accuracies. These results shall serve future studies as a guideline for the choice of data aggregation and preprocessing techniques to be employed.     

咪达唑仑联合不同剂量盐酸纳布啡用于 重度肥胖患者无痛胃镜检查的效果

〔摘 要〕 目的：探讨咪达唑仑联合不同剂量盐酸纳布啡用于重度肥胖患者无痛胃镜检查的效果。 方法：选择南昌市 第五医院 2018 年 1 月至 2020 年 7 月期间接受无痛胃镜检查的 126 例重度肥胖患者，按随机数字表法分为对照组和观察 组，各 63 例。观察组应用 2.5 mg 纳布啡复合咪达唑仑；对照组应用 5 mg 纳布啡复合咪达唑仑。比较两组患者的镇痛与镇 静情况、苏醒时间、体动与并发症。 结果：两组患者在苏醒后 5 min 的视觉模拟评分法（VAS）评分、麻醉诱导后 2 min 的 Ramsay 镇静评分比较，差异无统计学意义（P ＞ 0.05）；在苏醒后 30 min 两组患者的 VAS 评分较苏醒后 5 min 下降，差 异具有统计学意义（P ＜ 0.05）；但苏醒后 30 min 两组患者的 VAS 评分比较，差异无统计学意义（P ＞ 0.05）。内镜入喉时， 两组患者的的 Ramsay 镇静评分均较麻醉诱导后 2 min 升高，差异具有统计学意义（P ＜ 0.05）；但内镜入喉时两组患者的 Ramsay 镇静评分比较，差异无统计学意义（P ＞ 0.05）。观察组患者的完全苏醒时间为（5.03 ± 1.04）min，短于对照组的 （5.50 ± 1.20）min，差异具有统计学意义（P ＜ 0.05）。两组患者均无严重体动发生，且一般体动的发生率比较，差异无 统计学意义（P ＞ 0.05）；观察组患者的并发症发生率为 7.94 %，低于对照组的 20.63 %，差异具有统计学意义（P ＜ 0.05）。 结论：重度肥胖患者行无痛胃镜检查应用 2.5 mg 或 5 mg 的盐酸纳布啡复合咪达唑仑均可有效镇静镇痛，体动发生情况少， 但低剂量的盐酸纳布啡可减少并发症的发生，且利于患者苏醒。