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【Objective】 To investigate the association of depressive symptoms with the predicted risk of coronary heart disease in middle-aged and elderly Chinese based on a large community study. 【Methods】 A total of 2532 cases in the group without depression and 2758 cases in the group with depression were included. We compared the two groups in general demographics, information related to coronary heart disease risk, and physical function and ability to perform daily living. We also analyzed the factors associated with coronary heart disease risk by linear regression. 【Results】 ① Demographic information: The group with depression had a higher mean age, a higher proportion of women, more people with poor marital status, and a higher number of comorbid chronic diseases compared with the group without depression (all P<0.05). ② Risk indicators related to coronary heart disease: The group with depression had more people with diabetes and a significantly higher systolic blood pressure compared with the group without depression (P<0.05). The two groups did not significantly differ in the proportion of smokers, diastolic blood pressure, LDL-C, or HDL-C (all P>0.05). The risk of coronary heart disease was significantly higher in the group with depression than in the group without depression (P<0.05). ③ Physical function and ability of daily living: The physical function score, physical self-care score, and instrumental daily living ability were significantly higher in the group with depression than in the group without depression (all P<0.001). ④ Linear regression showed that except for gender, age, marital status, comorbid diabetes, smoking, systolic and diastolic blood pressure, HDL-C and LDL-C were associated with risk of coronary heart disease (P<0.05); CESD was the only factor associated with the risk of coronary heart disease [B=0.019, 95% CI: (0.015, 0.032), P=0.032]. 【Conclusion】 The risk of coronary heart disease is higher in middle-aged and elderly people with depressive symptoms than in those without depressive symptoms. Having depressive symptoms is one of the risk factors for coronary heart disease in middle-aged and elderly people.
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Objective:To evaluate the reliability and validity of Chinese version of Glasgow antipsychotics side-effect scale (GASS).Methods:Totally 200 patients diagnosed as schizophrenia following the criteria of DSM-IV were enrolled in the study.Cronbach’s α was used to investigate the internal consistency of GASS.Exploring factor analysis was used to examine the construct validity.Pearson correlation analysis between GASS and TESS and CGI sub-scale of side effect were conducted to evaluate the criterion validity.Based on clinical criteria, the sensitivity and specificity and ROC curve was calculated so as to establish the cut-off point of the scale and test discrimination validity.Results:For reliability, Cronbach’s α ws 0.926, indicating that GASS had a good internal consistency.Four main factors were extracted by exploratory factor analysis which were extrapyramidal side effect factor, genitourinary side effect factor, anticholinergic side effect factor, over sedation and cardiovascular side effect factor.For validity, exploring analysis demonstrated that nineteen item of the scale has relatively higher factor load on the principal factor (0.531-0.972), suggesting that the scale had a good construct validity.The total score of the GASS was positively correlated with that of TESS and CGI subscale of side effects( r=0.90, P<0.05; r=0.87, P<0.05). The cut-off point of experimental validity of GASS for mild antipsychotics side effects was determined as ≥1.With this cut-off point, GASS had both high sensitivity (96.3%) and high specificity (70.7%), area under curve (AUC) were 0.78.The cut-off point of GASS for moderate antipsychotics side effects was determined as ≥20, with the sensitivity and specificity of GASS were 86.3% and 84.7%, AUC were 0.92.When the cut-off point of GASS for severe antipsychotics side effects was determined as ≥41, GASS had both high sensitivity (92.1 %) and high specificity (96.3 %), AUC were 0.96. Conclusion:GASS has good reliability and validity and can reflect the side effects of antipsychotics, and it can be adopted as a useful instrument to evaluate the severity of side effects of antipsychotics.
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Objective To discuss the ethical necessity and feasibility of implementing multiple comprehensive psychological intervention measures in intensive care unit (ICU), and to investigate the effect of the measures on treatment compliance. Methods The conscious adult patients hospitalized in emergency ICU (EICU) of the Second Affiliated Hospital of Xi'an Jiaotong University from 2015 to 2017 were enrolled, and divided into control group and intervention group according to random number table, with 40 patients in each group. Patients in control group were treated with routine care and routine diagnosis and treatment, and patients in intervention group were treated with the help of psychologists and with multiple comprehensive psychological intervention measures (including nursing care, medical treatment, family and management) based on routine care and routine diagnosis and treatment. After 5 days of intervention, the treatment compliance, the medical coping attitude and the mental health were assessed respectively using the Treatment Compliance Scale, the Medical Coping Modes Questionnaire (MCMQ) and the Symptom Checklist Scale (SCL-90), and then comparation were done between the two groups. Results After 5 days of intervention, 3 patients in the control group and 4 patients in the intervention group withdraw the study because of the change of illness, and at last 37 patients in the control group and 36 in the intervention group were enrolled. There was no significant difference in basic data such as gender, age, education level, disease, course of disease, the length of EICU stay, and acute physiology and chronic health evaluationⅡ (APACHEⅡ) score between the two groups. The scores of treatment compliance in intervention group was significantly higher than that in control group (2.89±0.67 vs. 2.32±0.91, P < 0.01). Compared with the control group, the "confrontation" dimension score of the MCMQ questionnaire in intervention group was significantly increased (19.75±2.08 vs. 18.62±2.65, P < 0.05), while the "avoidance" and"surrender" dimensions scores were significantly decreased (14.22±1.91 vs. 15.14±1.92, 8.83±1.54 vs. 9.73±2.10, both P < 0.05). In the SCL-90 scale, the scores of the 5 factors such as "somatization", "interpersonal sensitivity","depression", "anxiety" and "photic anxiety" in intervention group were significantly less than those in control group (1.59±0.38 vs. 1.81±0.37, 1.72±0.40 vs. 1.93±0.42, 1.76±0.32 vs. 1.92±0.29, 1.82±0.40 vs. 2.14±0.40, 1.44±0.30 vs. 1.60±0.38, all P < 0.05), while there was no significantly difference in the scores of the other 4 factors as "obsessive-compulsive symptoms", "hostile", "bigotry" and "psychoticism" between the two groups (all P > 0.05). Conclusion The multiple comprehensive psychological intervention measures used for ICU conscious patients could improve the treatment compliance, make the patients' medical coping attitude more active and improve the mental health of the patients, so it has ethical necessity and certain feasibility.
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Objective To examine the effects of participating in Balint group ( PBG) for reducing occupational burnout among primary care physicians (PCPs). Methods In this randomized controlled trial, 240 PCPs were randomly assigned to PBG (n=70) and control group (n=240) in propotion of 1 ∶ 2. Sub-jects of PBG received Balint group intervention for one year,while control group received natural observation. Maslach Burnout Inventory ( MBI) was used to assess the severity of occupational burnout. Results At baseline all three subscales of MBI had no significant difference between PBG and cotrol group(P>0. 05). After the intervention,PBG had statistically lower subscale scores in emotional exhaustion ((20. 1±8. 3) vs (22. 6±8. 7),t=1. 993,P=0. 048) and depersonalization (( 6. 8± 4. 9) vs ( 10. 8 ± 5. 2),t=5. 355,P<0. 001) than the control group, while had statistically higher score in personal accomplishment subscale ((38. 3±7. 5) vs (34. 6±7. 7),t=3. 311,P=0. 001) than the control group. Conclusions PBG is effective in reducing occupational burnout among PCPs.
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Objective To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on the negative symptoms of chronic schizophrenia and on the P300 component of schizophrenics' event-related potentials (ERPs).Methods Ninety convalescing schizophrenia patients were randomly divided into a 5 Hz group,a 10 Hz group and a 15 Hz group,each of 30.The three groups were treated with the corresponding 5 Hz,10 Hz or 15 Hz rTMS once a day,five times a week for five consecutive weeks.The P300 ERPs of all three groups were tested before and after the treatment.Any curative effect was evaluated using the scale for the assessment of negative symptoms (SANS).Results After the treatment,the average SANS score of the 10 Hz group was significantly different from that before the treatment and also from those of the other two groups after the treatment.After the treatment,significant improvement was also observed in the amplitude of P300 in the 10 Hz group.The treatment's effectiveness was negatively correlated with age and longer course of the disease.Conelusion rTMS at 10 Hz is the most effective of the protocols tested for improving the negative symptoms of schizophrenia and improving cognitive functioning.
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<p><b>Background</b>Risperidone and paliperidone have been the mainstay treatment for schizophrenia and their potential role in neuroprotection could be associated with brain-derived neurotrophic factor (BDNF) and N400 (an event-related brain potential component). So far, different effects on both BDNF and N400 were reported in relation to various antipsychotic treatments. However, few studies have been conducted on the mechanism of risperidone and paliperidone on BDNF and N400. This study aimed to compare the effects of risperidone and paliperidone on BDNF and the N400 component of the event-related brain potential in patients with first-episode schizophrenia.</p><p><b>Methods</b>Ninety-eight patients with first-episode schizophrenia were randomly divided into the risperidone and paliperidone groups and treated with risperidone and paliperidone, respectively, for 12 weeks. Serum BDNF level, the latency, and amplitude of the N400 event-related potential before and after the treatment and Positive and Negative Syndrome Scale (PANSS) scores were compared between the two groups.</p><p><b>Results</b>A total of 94 patients were included in the final analysis (47 patients in each group). After the treatment, the serum BDNF levels in both groups increased (all P < 0.01), while no significant difference in serum BDNF level was found between the groups before and after the treatment (all P > 0.05). After the treatment, N400 amplitudes were increased (from 4.73 ± 2.86 μv and 4.51 ± 4.63 μv to 5.35 ± 4.18 μv and 5.52 ± 3.08 μv, respectively) under congruent condition in both risperidone and paliperidone groups (all P < 0.01). Under incongruent conditions, the N400 latencies were shortened in the paliperidone group (from 424.13 ± 110.42 ms to 4.7.41 ± 154.59 ms, P < 0.05), and the N400 amplitudes were increased in the risperidone group (from 5.80 ± 3.50 μv to 7.17 ± 5.51 μv, P < 0.01). After treatment, the total PANSS score in both groups decreased significantly (all P < 0.01), but the difference between the groups was not significant (P > 0.05). A negative correlation between the reduction rate of the PANSS score and the increase in serum BDNF level after the treatment was found in the paliperidone group but not in the risperidone group.</p><p><b>Conclusions</b>Both risperidone and paliperidone could increase the serum BDNF levels in patients with first-episode schizophrenia and improve their cognitive function (N400 latency and amplitude), but their antipsychotic mechanisms might differ.</p>
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Female , Humans , Male , Antipsychotic Agents , Pharmacology , Brain-Derived Neurotrophic Factor , China , Electroencephalography , Evoked Potentials , Paliperidone Palmitate , Pharmacology , Risperidone , Pharmacology , Schizophrenia , Drug TherapyABSTRACT
<p><b>BACKGROUND</b>Repetitive transcranial magnetic stimulation (rTMS) and event-related potentials (ERPs) are a noninvasive technique that widely used in neurophysiological field. Although rTMS has shown clinical utility for a number of neurological conditions, Recently,there was little understanding of the the efficacy of rTMS on Schizophrenia(SZ) and the change of ERP between before and after rTMS treatment. The objective of this study was to investigate the characteristics of N400, mismatch negativity (MMN), and P300 before and after treatment with rTMS in SZ.</p><p><b>METHODS</b>One hundred and twenty-seven SZ patients hospitalized in Shanghai Mental Health Center from March 2015 to July 2017, divided into two groups (85 patients were recruited as rTMS group and 42 were recruited as sham rTMS [ShrTMS] group) and 76 normal controls (NCs) who were the staff and refresher staff in our hospital were recruited at the same time. A Chinese-made rTMS and a Runjie WJ-1 ERPs instrument were used in the present experiment. N400 was elicited by congruent and noncongruent Chinese idioms. After rTMS treatment, N400, P300, and MMN characteristics were compared with those before treatment and NC group.</p><p><b>RESULTS</b>Compared with NC, the SZ patients exhibited delays in N400, P300, and MMN latency and decreased N400, P300, and MMN amplitudes in their frontal area (P < 0.05). After 25 rTMS treatments, N400 amplitudes in the frontal area (elicited by idioms with same phonic and different shape and meaning and with different phonic, shape, and meaning) were increased in the SZ patients (P < 0.05). However, there was no significant change in N400 before and after treatment with ShrTMS in SZ patients (P > 0.05). Amplitudes for MMN and target P300 also increased in SZ patients after rTMS treatment (P < 0.05).</p><p><b>CONCLUSIONS</b>Based on our preliminary findings, we believe that the combined usage of N400, MMN, and P300 could be a valuable index and an electrophysiological reference in evaluating the effects of rTMS treatment in SZ patients.</p>
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<p><b>OBJECTIVE</b>To investigate the effects of low molecular peptide of Mycobacterium tuberculosis heat-resistant antigen (Mtb-HAg-10k) on the production of tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ) in peripheral blood T cells and test the feasibility of differential diagnosis between pulmonary tuberculosis (PTB) and latent tuberculosis infection (LTBI) by assessing the number of Mtb-HAg-10k-stimulated IFN-γ-producing T cells.</p><p><b>METHODS</b>Peripheral blood mononuclear cells (PBMCs) were separated from the peripheral blood of 10 healthy adults, 6 individuals with LTBI and 13 patients with PTB. The PBMCs were cultured in the presence of Mtb-HAg-10k obtained by ultrafiltration centrifugation, with Mtb-HAg and phytohaemagglutinin (PHA) as the controls. The proportions of TNF-α- and IFN-γ-producing cells in the T cell subsets were detected by flow cytometry (FCM), and the number of IFN-γ-producing cells from patients with PTB and LTBI was detected with ELISPOT.</p><p><b>RESULTS</b>Flow cytometry showed that Mtb-HAg-10k exposure resulted in a significantly higher proportion of TNF-α-producing γδT cells than that of IFN-γ-producing γδT cells in the PBMCs (P<0.01). Compared with the PBMCs exposed to PHA, the PBMCs exposed to Mtb-HAg-10k exhibited a significantly greater proportion of γδT cells that produced both TNF-α and IFN-γ (P<0.01) but a significantly lower proportion of αβT cells producing both TNF-α and IFN-γ (P<0.01). Mtb-HAg-10k exposure of the PBMCs caused a significant reduction in the number of IFN-γ-producing cells as compared with Mtb-HAg and PHA treatments (P<0.01), and this reduction was more obvious in PBMCs from patients with PTB than in those from individuals with LTBI (P<0.01).</p><p><b>CONCLUSION</b>Mtb-HAg-10k can markedly induce γδT cells in the PBMCs to produce TNF-α and IFN-γ, and detection of the number of IFN-γ-producing cells in the PBMCs following Mtb-HAg-10k stimulation helps in the differential diagnosis between pulmonary tuberculosis and latent tuberculosis infection.</p>
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Objective To explore the relationship between job burnout feeling and sleep quality in psychiatric female medical staff.Methods 100 female medical staff were randomly selected from two mental hospitals in Wenzhou,and the Pittsburgh sleep quality index was used to evaluate and Maslach burnout inventory;and the relation-ship between sleep quality and job burnout was analyzed.Results Female psychiatric and medical personnel to the personality dimension score was (10.84 ±4.75)points,which was higher than Maslach norm (7.12 ±5.22)points;emotion exhaustion scores of (14.44 ±6.38)points,low achievement sense score of (15.07 ±6.89)points,below the Maslach often die emotion exhaustion scores of (22.19 ±9.53)points and low achievement sense scores (36.54 ± 7.34)points.The differences were statistically significant (t =-12.15,7.84,-31.15,all P <0.01).Job burnout and there were significant correlations between sleep quality and the emotional exhaustion and personification and PQSI seven dimensions and the total score was a positive correlation,low sense of achievement and PQSI total score and negatively correlated with seven dimensions.Conclusion Wenzhou psychiatric female medical staff burnout is significantly higher than the general population,there is a correlation between staff burnout and sleep quality,and the more serious burnout,poorer quality of sleep.Improving the quality of sleep of medical staff is one of the ways to relieve job burnout.
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Objective To analyze the condition and characteristics of hand-foot-mouth disease ( HFMD) from 2010 to 2012 in Renqiu city.Methods Surveillance and detecetion of HFMD was collected according to Renqiu city system for diseases control and prevention .The pathogen of HFMD severe case was deteceted .Results 12 293 cases including 735 severe cases were recorded in Renqiu city from 2010 to 2012,The highest of the resident population was in 2012 and the lowest one was in 2010(r=0.47,P<0.05).The total morbidity presented the obvious seasonal char-acteristic,which reached the summit in June ,July,August.The population morbidity was the clustered children .The average incidence rate of severe cases was 5.98%.The incidence rate in 2012 and 2011 was higher than that in 2010 (r=0.43,0.39,all P<0.05).There was significant difference of the pathogens types in severe cases among three years with the pathogen of CoxA 16 in 2010,2011 and humantero virus 71 viruses in 2012.Conclusion The inci-dence of HFMD presents the increasing and seasonal characteristics with the prevalence in the scattered children and the pathogens of CoxA16 in 2010,2011,humantero virus 71 in 2012.
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Objective To investigate the influence of non-dipper blood pressure rhythm on peripheral atherosclerosis in elderly hypertensive patients.Methods The 199 elderly hypertensive patients with 24-hour average systolic blood pressure＜140 mmHg were selected.Body mass index (BMI),glycosylated hemoglobin,blood lipids,uric acid,creatinine,Brachial ankle pulse wave velocity (baPWV),ankle arm index(ABI) and 24-hour ambulatory blood pressure monitoring were tested and calculated.The elderly patients were divided into dipper hypertensive group (n=95),and non-dipper hypertensive group (n=104).The relationships of arteriosclerosis with lifestyle and the circadian rhythm of blood pressure (non-dipper hypertension) were analyzed.Results Circadian blood pressure rhythm,age,levels of total cholesterol,triglyceride and serum creatinine,nocturia times,and smoking index were significantly related with atherosclerosis.There was a relationship between circadian blood pressure rhythm and baPWV,with the greatest standardized regression coefficient of 0.439.There were obviously linear relationships between levels of serum creatinine,nocturia times,age and ABI.There were significant differences in baPWV,ABI and smoking index between dippers and non-dippers groups [(1746.0±246.9) vs.(2115.7±321.8),(1.14±0.10) vs.(1.11±0.18),(251.8±272.8) vs.(368.5±339.9),P＜0.05 or 0.001].The multiple linear regression analysis showed that smoking index was significantly correlated with baPWV,but not correlated with blood pressure rhythm.In the ROC curve of MAP difference percentage and baPWV diagnosis result,the area under the curve was 0.8188,the optimal cut-off was 10.9％,the sensitivity was 62.5％ and the specificity was 85.7％.In the ROC curve of MAP difference percentage and AMI diagnosis result,the area under the curve was 0.7589,the optimal cut-off was 8.1％,the sensitivity was 88％,and the specificity was 61％.These results reflected that there were better consistences between MAP difference percentage and baPWV,ABI,and indirectly indicted that there was a relationship between MAP difference percentage and atherosclerosis.Conclusions We advise the elderly patients to give up the bad habits,help them control the systolic blood pressure,and advise them to adjust the medication time according to the circadian rhythm of blood pressure of every elderly hypertensive patient in order to restore the normal circadian blood pressure rhythm and delay the atherosclerotic process.
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Objective To explore the morphological changes of the brain structure in youngsters first-episode depression.Methods Collecting 1 6 youngsters patients with first-episode depression and 1 6 healthy volunteers,separately examining morphological changes in their brain regions by MRI,and then analyzing data by Voxel-Based Morphometry in order to observe the damaged brain areas in depression patients.Results Comparing with control group,gray mater volume of the left dorsolateral prefrontal cortex and right fusiform gyrus decreased in depression patients.The gray matter density of left dorsolateral prefrontal cortex showed negative correlation with HAMD scores.Conclusion The gray matter decreased in left dorsolateral prefrontal cortex and right fusiform gyrus in youngsters first-episode depression patients.In addition,the gray matter density of left dorsolateral prefrontal cortex had negative correlation with HAMD scores.
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Objective To investigate the etiology and treatment of severe infection after ureteroscopic holmium laser lithotripsy. Methods Seven cases (2 men and 5 women) of severe infection after holmium laser lithotripsy under ureteroscope were treated.Their mean age was 44 years (range,37-56 years). The patients were characterized by a temperature over 39 ℃,a heart rate over 110 BPM,and a blood pressure below 80/50 mm Hg (1 mm Hg=0.133 kPa) within 1-12 hours after the operation.The diagnosis of septic shock caused by gram negative bacteria was suggested by the clinical manifestation and the urine culture. Anti-shock therapy was conducted with rapid supplement of colloidal and crystalloid solution of 3000-4000 ml.The vasoactive drugs,dopamine (2-5 ?g/kg per minute) or norepinephrine (4-8 ?g/kg per minute) were used for the establishment of stable circulation,and the third generation cephalosporins for the control of infection empirically.Low dose corticosteroids (dexamethasone,10-20 mg) were administered if the patients had adrenocortical insufficiency or significant intoxication. Results All patients were treated successfully within 8 to 48 hours,then the hypertensors were gradually stopped.Their temperature and blood routine tests returned to normal 3 days later.. Conclusions The causes of severe infection after holmium laser lithotripsy under ureteroscope are preoperative urinary tract infection,high perfusion pressure or postoperative urinary tract obstruction.Peri operative anti infection and appropriate operation skill can effectively prevent the infection.
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Objective To explore the personality characters of patients with mental disorders and to determine the differences of dimension,trait level and model of personality between patients and normal subjects.Methods The patients with mental disorders(n=376) and normal subjects(n=368) were assessed with revised NEO personality inventory(NEO-PI-R).Results The mean scores of extroversion(E) and conscientiousness(C) of five-factor personality model of NEO-PI-R in patients were significant lower than those in normal group((P