The incidence of narcolepsy in Europe: Before,during, and after the influenza A(H1N1)pdm09 pandemic and vaccination campaigns

Background

In August 2010 reports of a possible association between exposure to AS03 adjuvanted pandemic A(H1N1)pdm09 vaccine and occurrence of narcolepsy in children and adolescents emerged in Sweden and Finland. In response to this signal, the background rates of narcolepsy in Europe were assessed to rapidly provide information for signal verification.

Methods

We used a dynamic retrospective cohort study to assess the narcolepsy diagnosis rates during the period 2000–2010 using large linked automated health care databases in six countries: Denmark, Finland, Italy, the Netherlands, Sweden and the United Kingdom.

Results

Overall, 2608 narcolepsy cases were identified in almost 280 million person years (PY) of follow up. The pooled incidence rate was 0.93 (95% CI: 0. 90–0.97) per 100,000 PY. There were peaks between 15 and 30 year of age (women > men) and around 60 years of age. In the age group 5–19 years olds rates were increased after the start of pandemic vaccination compared to the period before the start of campaigns, with rate ratios (RR) of 1.9 (95% CI: 1.1–3.1) in Denmark, 6.4 (95% CI: 4.2–9.7) in Finland and 7.5 (95% CI: 5.2–10.7) in Sweden. Cases verification in the Netherlands had a significant effect on the pattern of incidence over time.

Conclusions

The results of this incidence study provided useful information for signal verification on a population level. The safety signal of increased narcolepsy diagnoses following the start of the pandemic vaccination campaign as observed in Sweden and Finland could be observed with this approach. An increase in narcolepsy diagnoses was not observed in other countries, where vaccination coverage was low in the affected age group, or did not follow influenza A(H1N1)pdm09 vaccination. Patient level analyses in these countries are being conducted to verify the signal in more detail.     

磷酸肌酸联合脑循环治疗仪治疗急性脑梗死疗效观察

目的观察磷酸肌酸联合脑循环治疗仪治疗急性脑梗死的有效性。方法218例急性脑梗死患者随机分为治疗组（n=109）和对照组（H=109）,治疗组在常规治疗基础上加用磷酸肌酸钠1g,每日两次,脑循环治疗仪治疗每日1次,疗程均为14d,观察两组治疗前后神经功能缺损评分。结果两组治疗后神经功能缺损评分均有改善,治疗组优于对照组,两组比较差异有统计学意义（P〈0．01）;治疗组有效率为90．8％,对照组有效率为75．2％,两组有效率比较,差异有统计学意义（P〈0．01）。结论应用磷酸肌酸联合脑循环治疗仪治疗急性脑梗死有明显疗效。     

白细胞介素33水平对于急性缺血性脑卒中的临床意义

目的研究白细胞介素33（IL-33）在急性缺血性脑卒中患者中的水平变化及其与脑卒中患者临床预后的关系。 方法选择开平市中心医院内三科及江门市人民医院神经内科自2017年1月至2019年6月收治的192例急性缺血性脑卒中患者作为研究对象,并随机选择100例健康成年人作为对照组,比较缺血性脑卒中患者在治疗前和治疗后第1、3、7天时与健康成年人外周血IL-33的变化及差异,并将脑卒中患者根据IL-33水平从低到高排序,比较IL-33低水平组（四分位数P25以下）和IL-33高水平组（四分位数P75以上）患者治疗后第3个月的改良Rankin量表（mRs）评分、日常生活能力评分（ADL）评分不良事件发生率,同时通过受试者工作特征（ROC）曲线分析IL-33对缺血性脑卒中患者临床预后的预测价值。 结果IL-33在急性缺血性脑卒中患者中表达水平升高,入院时平均水平（575.36±200.75）pg/mL,入院后第1天平均水平（727.13±204.96）pg/mL,入院后第3天平均水平（647.92±228.41）pg/mL,入院后第7天平均水平（639.02±185.29）pg/mL,而健康成年人平均水平为（410.32±145.58）pg/mL,差异均有统计学意义（P<0.05）;IL-33高水平组患者在mRs评分、ADL评分中不良事件发生率均高于IL-33低水平组患者,差异有统计学意义（P<0.05）;mRs评分、ADL评分标准下IL-33作为临床预后评价指标的ROC曲线下面积分别为0.847和0.727。 结论急性缺血性脑卒中患者外周血清中IL-33的水平显著升高,并对患者的临床预后有较好的预测价值,IL-33水平升高越显著,患者的临床预后越差。     

Bmi1在舌鳞状细胞癌组织中的表达及其与临床病理特征和预后的关系

目的探讨Bmi1在舌鳞状细胞癌（TSCC）发生、发展过程中的作用。 方法采用免疫组化法对收集的77例TSCC组织、22例舌癌前病变（白斑）以及12例正常舌组织中Bmi1表达水平进行检测。应用SPSS 17.0对数据进行处理分析。组间比较采用t检验和单因素方差分析。Bmi1的表达与TSCC患者临床病理因素间的相关性分析采用Pearson和Spearman相关检验。TSCC患者的Bmi1生存曲线分析采用Kaplan-Meier法,曲线间比较采用Log-rank检验。以P<0.05为差异有统计学意义。 结果白斑和TSCC组织中Bmi1的表达水平显著高于正常舌组织（白斑与正常舌组织对比的P= 0.014;TSCC与正常舌组织对比的P= 0.036）;中、重度白斑中Bmi1的表达水平明显高于轻度白斑（P= 0.014）。颈淋巴结转移阳性的TSCC患者标本的Bmi1表达水平显著高于颈淋巴结转移阴性患者（P= 0.006）;同时,晚期患者的组织标本中Bmi1的表达水平亦明显高于早期患者（P= 0.004）。TSCC组织标本中的Bmi1表达水平与患者的年龄、性别、肿瘤大小无明显相关性,但与颈淋巴结转移阳性和临床分期呈显著正相关,差异具有统计学意义（P<0.05）。同时Bmi1与SOD2和Ki67的表达水平呈正相关（P<0.05）。Bmi1高表达组的5年生存率低于Bmi1低表达组,二者之间差异具有统计学意义（P<0.001）。 结论TSCC和白斑患者的组织标本中Bmi1的表达水平增加,表明在舌恶性肿瘤发生的早期阶段已存在Bmi1的表达,并对TSCC的发生、发展和预后产生重要影响。