生脉注射液治疗血管迷走性晕厥的临床研究

目的：探讨生脉注射液治疗血管迷走性晕厥临床疗效。方法：选取血管迷走性晕厥的患者60例。随机分为治疗组织及对照组,对照组采取常规治疗,治疗组在基础治疗上加生脉注射液。结果：治疗组有效率90％,无不良反应。结论：生脉注射液治疗血管迷走性晕厥使用安全,疗效可靠,具有一定的临床应用前景。     

直立倾斜试验对不明原因头晕与晕厥患者诊断比较

目的探讨直立倾斜试验(HUTT)对不明原因头晕与晕厥患者诊断上的差异。方法对头晕组(n=35)进行HUTT检查,并选择同期晕厥组(n=303)的HUTT结果为对照,HUTT采用基础直立倾斜试验(BHUT)及舌下含服硝酸甘油倾斜试验(SNHUT)。结果①头晕组与晕厥组患者在BHUT、SNHUT时收缩压、舒张压、心率比较差异无显著性意义(P>0.05),阳性结果反应类型比较差异亦无显著性意义(P>0.05)。②阳性率:HUTT时头晕组31.43%(11/35),晕厥组42.90%(130/303)。其中BHUT时头晕组28.57%(8/28),晕厥组33.82%(70/207);SNHUT时头晕组42.86%(3/7),晕厥组62.50%(60/96)。阳性率在头晕组和晕厥组比较差异无显著性意义(P>0.05)。两组SNHUT阳性率较BHUT均明显提高(P<0.05)。③出现阳性结果时间:BHUT时头晕组(29.13±11.01 min)仅比晕厥组(23.52±12.80 min)稍长,SNHUT时在舌下含服硝酸甘油后也是头晕组(6.00±3.61 min)比晕厥组(4.98±3.51 min)稍长(P均>0.05)。结论临床上部分不明原因头晕患者由VVS所致,但并不出现晕厥发作,这类患者应重视倾斜试验检查。     

The efficacy of midodrine hydrochloride in the treatment of children with vasovagal syncope

OBJECTIVE: To determine whether midodrine hydrochloride therapy can prevent vasovagal syncope (VVS) in pediatric patients. STUDY DESIGN: Children with recurrent syncope (n = 26) were randomly assigned into 2 groups. Group I comprised children given midodrine hydrochloride as first-line therapy in addition to conventional therapy, and group II comprised patients receiving conventional therapy only. Repeat head-up tilt (HUT) testing and follow-up of least 6 months were conducted to evaluate the therapeutic effectiveness and side effects of midodrine in treating VVS in children. RESULTS: The HUT-based effective rate was significantly higher in group I than in group II (75% vs 20%; P < .05). During the follow-up period, the recurrence of syncope was significantly lower in group I than in group II (P < .05). CONCLUSIONS: Midodrine hydrochlorate is effective in treating VVS in children, especially in preventing recurrent episodes. Few side effects were observed in the present study.     

Somatization and psychological distress among women with vulvar vestibulitis syndrome

Objective

To investigate the distribution of psychological characteristics and pain reporting among women with vulvar vestibulitis syndrome (VVS).

Methods

In this exploratory study, 109 women with VVS completed a battery of questionnaires to assess pain with intercourse and psychological characteristics (e.g. somatization, anxiety, distress). The distribution of these characteristics was compared, first with a conventional binary classification schema (primary and secondary) and subsequently with a 3-category schema (primary, latent primary, secondary).

Results

Severity of pain with intercourse did not differ among the subgroups using either classification schema. Women with primary VVS consistently showed higher levels of somatization, anxiety, and distress compared with those with secondary VVS. Using a 3-tiered classification system, we found no difference between latent primary diagnosis and the other 2 groups (primary and secondary).

Conclusion

This study highlights the critical need for research on subtype definition and the role of psychological factors in VVS.     

血管迷走性晕厥患者行直立倾斜试验与治疗的护理

总结86例血管迷走性晕厥患者在作直立倾斜试验前后以及治疗过程中的护理经验，以减少意外伤害及再次发作的次数。护理要点：(1)试验前作好准备工作，包括环境、药物、监护仪器、患者的心理准备；(2)试验中密切观察患者的症状及生命体征，出现阳性反应及时处理，鉴别药物反应及阳性反应；(3)试验结束后，指导阳性患者服药或倾斜台治疗。经过有效的护理，本组无1例患者发生意外伤害。     

不同角度直立倾斜试验对儿童血管迷走性晕厥诊断的影响

目的探讨不同角度直立倾斜试验(HUTT)对儿童血管迷走性晕厥(VVS)诊断的影响。方法2001-01~2005-12在中南大学湘雅二医院晕厥专科门诊就诊或住院的儿童不明原因晕厥(UPS)患者进行HUTT检查226例次,年龄4~18岁,平均(12.12±3.17)岁,男93例,女133例。倾斜角度在2001-01~2005-05采用70°[n=182,平均(12.19±3.20)岁],在2005-06~2005-12采用60°[n=44,平均(11.82±3.02)岁]。根据临床症状分偶发晕厥(n=66,晕厥发作仅1次)与反复晕厥(n=160,晕厥发作≥1次)。HUTT采用基础直立倾斜试验(BHUT)及舌下含服硝酸甘油倾斜试验(SNHUT)。结果倾斜角度、儿童患者性别及试验方式对UPS儿童血流动力学无影响(P>0.05),UPS儿童诊断阳性率及反应类型分布与倾斜角度、儿童患者性别、试验方式及晕厥频次亦无明显关系(P>0.05)。儿童倾斜70°体位感到欠舒适,倾斜60°体位无明显不适感。结论倾斜70°和60°对受试者血流动力学及阳性率无影响,倾斜60°体位较70°感到舒适。推荐临床上在进行儿童HUTT时选择倾斜60°较合适。     

血管迷走性晕厥儿童心率变异性的年龄和性别差异

目的探讨血管迷走性晕厥(VVS)儿童心率变异性(HRV)的年龄和性别差异。方法2003—01～2007—05在中南大学湘雅二医院晕厥专科诊治的不明原因晕厥(UPS)儿童54例(晕厥组),其中<12岁儿童22例,直立倾斜试验(HUTF)全部为阳性反应。匹配48例健康儿童为对照(对照组)。晕厥组和对照组儿童均行24 h动态心电图(Holter)检查,数据经TLC3000A 12通道动态心电图分析系统自动分析结合人工干预生成HRV时域指标和频域指标。结果①晕厥儿童HRV性别比较:与男性儿童相比,女性儿童各项时域指标和频域指标均偏低,其中时域指标总体标准差(SDNN)、均值标准差(sDANN)和频域指标总功率(TP)、低频功率(LF)、极低频功率(VLF)降低显著(P<0.01或P<0.05)。②健康儿童HRV性别比较:女性儿童时域指标SDNN、差值均方根(rMSSD)、差值>50 ms的百分比(pNN50)和频域指标TP、VLF、LF低于男性儿童,其中差异有统计学意义的是频域指标VLF(P<0.01)和LF(P<0.05)。③晕厥儿童HRV年龄比较:与≥12岁儿童相比,<12岁儿童时域指标SDNN、SDANN、pNN50和频域指标TP、LF稍降低(均P>0.05)。④健康儿童HRV年龄比较:与≥12岁儿童相比,<12岁儿童时域指标rMSSD、pNN50和频域指标LF、高频功率(HF)偏高,其中差异有统计学意义的是HF(P<0.05),其余指标稍偏低(均P>0.05)。结论VVS儿童自主神经功能异常,其自主神经变化规律的年龄和性别差异与健康儿童不同。     

Prevalence of human papillomavirus (HPV) infections in sexually active adolescents and young women in England, prior to widespread HPV immunisation

Introduction

The introduction of an HPV immunisation programme in England should result in a significant reduction in the prevalence of vaccine type infections in young women. Here we describe type-specific HPV prevalence in three samples of the young female population in England, prior to the beginning of mass immunisation in 2008.

Methods

Residual vulva-vaginal swab samples from females aged under 25 years undergoing chlamydia testing as part of the National Chlamydia Screening Programme (NCSP) or Prevention of Pelvic Infection (POPI) trial were collected from sites across England, together with available demographic and sexual behaviour data. Residual samples were screened for HPV infection using the Hybrid Capture 2 (hc2) HPV DNA Test, including the high-risk (HR) and low-risk (LR) probes. Hc2 positive samples were genotyped using the Roche Linear Array (LA) HPV Genotyping Test.

Results

A total of 3829 samples were included: 2369 from 16 to 24 year old NCSP participants, 275 from 13 to 15 year old NCSP participants and 1185 from 16 to 24 year old POPI participants. Variations in HPV prevalence between and within the different samples followed a pattern largely consistent with differences in sexual behaviour. The prevalence of total HR HPV infection, of HPV 16 and/or 18 (16/18) infection and of five HR HPV types closely related to HPV 16/18 (HPV 31, 33, 45, 52 or 58) amongst 16–24 year old NCSP participants was 35% (95% CI 33–37%), 18% (95% CI 16–19%), and 16% (95% CI 14–18%), respectively. Risk of HR HPV infection increased with age during the teen years and was higher in women who reported two or more sexual partners in the last year and in women with chlamydia infection. Approximately half of women with HPV 16/18 infection also had another non-vaccine HR HPV type present.

Conclusions

Prior to HPV immunisation, there was a high prevalence of HPV infections in the lower genital tract of young, sexually active females in England. The overall, type-specific, and multiple infection prevalence closely reflected age and sexual activity. These data provide a baseline against which the early impact of HPV immunisation on the prevalence of HPV 16/18 and closely related types in young women can be measured, in order to inform immunisation and cervical screening policies.     

Behavioral models for anxiety and multisensory integration in animals and humans

Complaints related to dizziness, balance problems and spatial disorientation in psychiatry have seldom been considered as a possible manifestation of a distorted multisensory integrative ability. Several kinds of mismatches among simultaneous sensory information are encountered in everyday life but despite these, the central nervous system usually manages to update the internal representation of the body in the surrounding space. In some cases, a sensory mismatch may elicit an erroneous perception of the body in space, resulting in anxiety, dizziness and balance problems.As vestibular system dysfunction leads to dizziness and disorientation, it has been hypothesized that a peripheral vestibular abnormality could explain the presence of certain symptoms related to sensory mismatches in anxiety disorders. Several studies tried to find a link between panic disorder with or without agoraphobia and vestibular system dysfunction. Yet, even though some vestibular abnormalities have been demonstrated in these patients, it is difficult to demonstrate a cause-and-effect relationship between panic disorder and vestibular dysfunction. However, this does not rule out a possible influence of anxiety on normal vestibular function. The study of the relation between vestibular system and anxiety has to take into account that the vestibular system has three main functions: to maintain equilibrium through the vestibular spinal reflexes; to stabilize the visualization of the world through the vestibular-ocular reflex; to contribute to perception and orientation in space.We will review different studies in humans, which have particularly paid attention to the third function and its relation to anxiety. Animal experiments offer possibilities to more precisely analyze the different parameters underlying the behavioral results, as well as possible pharmacological actions on them. Two attempts have been made by our group to model, in mice, the preceding human data on integrated functional sensory relations of the body to space in anxiety disorders: the rotating beam and the rotating tunnel. We summarize here the main results obtained.     

Reduction in HPV 16/18 prevalence in sexually active young women following the introduction of HPV immunisation in England

Background

Reduction in the prevalence of vaccine type HPV infection in young women is an early indication of the impact of the HPV immunisation programme and a necessary outcome if the subsequent impact on cervical cancer is to be realised.

Methods

Residual vulva-vaginal swab (VVS) specimens from young women aged 16–24 years undergoing chlamydia screening in community sexual health services (formerly known as family planning clinics), general practice (GP), and youth clinics in 2010–2012 were submitted from 10 laboratories in seven regions around England. These specimens were linked to demographic and sexual behaviour data reported with the chlamydia test, anonymised, and tested for type-specific HPV DNA using a multiplex PCR and Luminex-based genotyping test. Estimated immunisation coverage was calculated and findings were compared to a baseline survey conducted prior to the introduction of HPV immunisation in 2008.

Results

A total of 4664 eligible specimens were collected and 4178 had a valid test result. The post-immunisation prevalence of HPV 16/18 infection was lowest in this youngest age group (16–18 years) and increased with age. This increase with age was a reversal of the pattern seen prior to immunisation and was inversely associated with estimates of age-specific immunisation coverage (65% for 16–18 year olds). The prevalence of HPV 16/18 infection in the post-immunisation survey was 6.5% amongst 16–18 year olds, compared to 19.1% in the similar survey conducted prior to the introduction of HPV immunisation.

Conclusions

These findings are the first indication that the national HPV immunisation programme is successfully preventing HPV 16/18 infection in sexually active young women in England. The reductions seen suggest, for the estimated coverage, high vaccine effectiveness and some herd-protection benefits. Continued surveillance is needed to determine the effects of immunisation on non-vaccine HPV types.