内质网应激在三种常见精神疾病中的研究进展

精神疾病常常表现为慢性病程,具有反复发作、慢性迁延及致残的特点,是严重影响人类健康的疾病之一.近年来精神疾病的患病率逐年升高,给社会带来了严重的疾病负担.但是,目前大部分精神疾病的发病机制尚未完全阐明.不断增加的研究证据表明,内质网应激(ERS)与精神疾病的发生发展有着密切联系,这些疾病以精神分裂症、双相障碍及抑郁障碍这三种常见精神疾病为代表.同时,研究也发现一些相关药物可能通过靶向ERS而发挥作用,提示ERS可能是精神疾病的潜在作用靶点.因此,未来深入探讨ERS在精神疾病中的具体作用机制,可为精神疾病的治疗提供新的思路.     

The forced swim test has poor accuracy for identifying novel antidepressants

Despite the prevalence of treatment-resistant depression, many pharmaceutical companies have abandoned the development of new antidepressants. Experts have attributed this, in part, to the low quality of preclinical tests available in this field, often citing over-reliance on animal behavioral screens, such as the forced swim test (FST). This retrospective review assessed whether compounds tested in the FST by major pharmaceutical companies were shown to have antidepressant effects in humans. Of 109 compounds identified, only 28% had been explored for antidepressant effects in humans. Of these, there were only three for which the FST appeared to positively predict antidepressant efficacy, but none are currently approved to treat any type of depression. With such poor accuracy for identifying novel antidepressants, the FST might not be a useful screening tool for this purpose.     

移植物抗宿主病的口腔表现与研究进展

异基因造血干细胞移植(allo-HSCT)是治疗恶性血液病最为有效的方法 ,移植物抗宿主病(GVHD)是移植术后的主要并发症,也是患者死亡的主要原因。口腔是常见的受累器官之一,最常累及口腔黏膜、唾液腺、肌肉骨骼系统等。本文将从移植物抗宿主病的发病机制,口腔临床表现、诊断及治疗进展进行综述。     

肺移植患者术后症状群研究的范围综述

目的 对肺移植患者术后症状群研究文献进行范围综述,为完善肺移植术后患者症状群管理提供参考。方法 检索国内外9个数据库建库至2022年3月10日收录的肺移植患者术后症状群相关研究。结果 共纳入11篇文献。提取9个症状群,频次排在前3位的分别是心理、神经肌肉、胃肠道症状群。症状群评估工具包括单一症状评估量表和多症状评估量表;症状群的影响因素主要包括性别、免疫抑制剂不良反应、并存疾病等。结论 肺移植患者术后症状群随时间变化,受多种因素影响,特异性测评工具有待开发。     

Systematic review with meta-analysis: Stress-management interventions for patients with irritable bowel syndrome

Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disorder of unknown pathological origin that is associated with psychological distress and reduced health-related quality of life (HRQoL). We investigated the effects of stress-management for adults with IBS on typical symptoms, HRQoL and mental health. With predefined criteria (patients: adults with IBS; intervention: stress-management; control: care as usual or waitlist; outcome: patient-relevant; study-type: controlled trials), we registered the study with PROSPERO (168030) and searched the main medical databases. Two researchers independently reviewed the publications and assessed the risk of bias using the Scottish Intercollegiate Guidelines Network checklist. We performed meta-analysis with homogeneous trials of acceptable quality. After screening 6656 publications, ten suitable randomized trials of acceptable (n = 5) or low methodological quality (n = 5) involving 587 patients were identified. Our meta-analysis showed no effect of stress-management on IBS severity 1–2 months after the intervention (Hedges' g = −0.23, 95%-CI = −0.84 to −0.38, I² = 86.1%), and after 3–12 months (Hedges' g = −0.77, 95%-CI = −1.77 to −0.23, I² = 93.3%). One trial found a short-term reduction of symptoms, and one trial found symptom relief in the long-term (at 6 months). One of two studies that examined HRQoL found an improvement (after 2 months). One of two studies that examined depression and anxiety found a reduction of these symptoms (after 3 weeks). Stress-management may be beneficial for patients with IBS regarding the short-term reduction of bowel and mental health symptoms, whereas long-term benefits are unclear. Good quality RCTs with more than 6 months follow-up are needed.     

Treating laryngopharyngeal reflux: Evaluation of an anti-reflux program with comparison to medications

Objective

To determine if an anti-reflux induction program relieves laryngopharyngeal reflux (LPR) symptoms more effectively than medication and behavioral changes alone.

Ryan指数与反流症状指数量表、反流体征量表在咽喉反流性疾病诊断中的相关性分析

目的 探讨Ryan指数与反流症状指数量表(RSI)、反流体征量表(RFS)在咽喉反流性疾病诊断中的相关性。 方法 回顾性分析以咽喉部不适症状就诊,病程1个月以上的行咽部pH检测的230例患者临床资料。所有患者均同时行电子喉镜检测,并行RSI、RFS评估。 结果 Ryan指数阳性率为15.2%(35/230)。RSI、RFS、RSI或RFS及RSI且RFS阳性率分别为46.5%、28.7%、60.9%、13.9%。Ryan指数阳性组患者RFS评分高于Ryan指数阴性组患者,RSI评分与Ryan指数阴性组患者差异无统计学意义。RFS阳性,RSI或RFS,RSI且RFS阳性组Ryan指数阳性率高于RFS阴性,RSI或RFS,RSI且RFS阴性组。Ryan指数阳性与RSI、RFS、RSI或RFS及RSI且RFS阳性的一致性检验的kappa值分别为-0.06,0.394,0.116和0.172。以pH监测作为金标准时,RSI、RFS、RSI或RFS及RSI且RFS的敏感性分别为37.1%,74.3%,82.9%,28.6%;特异性分别为51.8%,79.5%,43.1%,88.2%;阳性预测值分别为12.1%,39.4%,20.7%,30.3%;阴性预测值分别为82.1%,94.5%,93.3%,87.3%。RSI与直立位及平卧位Ryan指数的相关系数分别为-0.056和-0.083;RFS与直立位及平卧位Ryan指数的相关系数分别为0.425和0.166。 结论 咽部pH检测是直接反映咽喉部反流的客观、无创的检测方法。RFS与Ryan指数有一定的正相关性,但量表与Ryan指数一致性差。尚需进一步研究更准确的、反映咽喉反流的量表及pH诊断指数。     

End-of-life care in the intensive care unit

The transition from active, invasive interventions to comfort care for critical care patients is often fraught with misunderstandings, conflict and moral distress. The most common issues that arise are ethical dilemmas around the equivalence of withholding and withdrawing life-sustaining treatment; the doctrine of double effect; the balance between paternalism and shared decision-making; legal challenges around best-interest decisions for patients that lack capacity; conflict resolution; and practical issues during the limitation of treatment. The aim of this article is to address commonly posed questions on these aspects of end-of-life care in the intensive care unit, using best available evidence, and provide practical guidance to critical care clinicians in the UK. With the help of case vignettes, we clarify the disassociation of withdrawing and/or withholding treatment from euthanasia; offer practical suggestions for the use of sedation and analgesia around the end of life, dissipating concerns about hastening death; and advocate for the inclusion of family in decision-making, when the patient does not have capacity. We propose a step-escalation approach in cases of family conflict and advocate for incorporation of communication skills during medical and nursing training.     

埃索美拉唑与奥美拉唑治疗反流性食管炎临床对比观察

目的分析研讨埃索美拉唑与奥美拉唑治疗反流性食管炎的临床效果。方法随机从本院2016年2月—2018年12月期间收治的反流性食管炎患者中抽取80例,按治疗方式分对照组(40例接受奥美拉唑治疗)和研究组(40例接受埃索美拉唑治疗),比较治疗效果。结果研究组治疗疗效95.00%高于对照组75.00%,差异有统计学意义(P<0.05)。治疗前组间食管动力学指标差异无统计学意义(P>0.05),治疗后,研究组蠕动性收缩比、立位反流时间百分比、卧位反流时间百分比低于对照组,肌静息压力高于对照组,差异有统计学意义(P<0.05)。治疗前症状评分差异无统计学意义(P>0.05),治疗后,研究组症状评分低于对照组,差异有统计学意义(P<0.05)。研究组不良反应总发生率5.00%低于对照组7.50%,但数据差异无统计学意义(P>0.05)。结论埃索美拉唑治疗反流性食管炎,其疗效比奥美拉唑所获疗效更良好,患者症状、食管动力学指标等改善明显。     

女性急诊规培医师职业倦怠及心理状况分析

目的研究女性住院医师在急诊科规范化培训(规培)期间职业倦怠及心理健康情况。方法选取2018年12月至2019年10月在西安交通大学第一附属医院急诊科参加住院医师规培的124名女性住院医师为研究对象,采用问卷调查的形式了解其存在的心理问题,问卷内容包括职业倦怠问卷量表(MBI-HSS)及症状自评量表(SCL-90),并对量表结果进行分析。结果①女性规培医师在急诊科期间存在较高的职业倦怠发生率,情感衰竭阳性发生率为40.35%(46/114),去人格化阳性发生率为37.72%(43/114);②女性规培医师心理状况阳性总检出率为41.23%(47/114),SCL-90评分中躯体化、强迫症、抑郁、焦虑、恐怖的因子得分均高于全国常模正常水平,经比较差异均有统计学意义(t值分别为2.336、2.792、2.574、2.295、2.183,均P <0.05);其余4个因子得分与全国常模相比差异均无统计学意义(均P>0.05)。结论女性规培医师在急诊科轮转期间存在较为严重的职业倦怠;心理状况评测较全国常模发生率高。在规培管理工作中应给予更多的关注。