Approach to a normotensive patient with primary aldosteronism / 中华内分泌外科杂志

The typical manifestations of primary aldosteronism (PA) are hypertension with or without hypokalemia, high aldosterone, and low renal level. However, PA with normal blood pressure is rare in clinical practice. This article reported the diagnosis and treatment of a patient with subclinical PA, admitted for "adrenal accidental tumor" with normal blood pressure and serum potassium. We summarized and analyzed the clinical characteristics and treatment strategies, in order to provide some reference for clinicians.

Correlation between heart rate variability and symptom severity in patients with somatic symptom disorder / 中华行为医学与脑科学杂志

Objective:To investigate the correlation between heart rate variability (HRV) and symptom severity in patients with somatic symptom disorder (SSD).Methods:Thirty-three patients with somatic symptom disorder (SSD group) who were outpatients or inpatients in Sichuan Provincial People′s Hospital from May 2020 to December 2020 and thirty-three gender-and age-matched healthy controls (HC group) were selected. The patient health questionnaire (PHQ-9), generalized anxiety disorder scale (GAD-7), patient health questionnaire PHQ-15 were applied to assess the severity of depression, anxiety and somatic symptoms in both groups. The somatic system disorder-B criteria scale (SSD-12) and the Whiteley-8 Scale (WI-8) were selected to assess the severity of symptom in SSD. All subjects underwent HRV measurement within one week of enrollment. The differences of HRV between the two groups were compared and the correlation between HRV and symptom severity were analyzed. Independent samples t-test was used for comparison between groups, and Pearson correlation analysis was used for correlation analysis between HRV index and symptom severity. Results:The levels of GAD-7, PHQ-9 and PHQ-15 in SSD group(5.0(2.0, 10.5), 8.0(3.5, 13.0), 11.0(8.0, 15.0)) were significantly higher than those in HC group (1.0(0, 2.0), 0(0, 2.0), 3(0, 6.0)), and the differences were statistically significant (all P<0.05). The SDNN ((25.41±11.24)ms), lnLF ((1.91±0.50)ms 2) and lnTP ((2.65±0.43)ms 2) in the SSD group were lower than those in the HC group ((32.87±12.01)ms, (2.27±0.43)ms 2, (2.93±0.32)ms 2), and the differences were statistically significant( t=-2.605, -3.160, -2.883, all P<0.05). RMSSD of SSD patients was negatively correlated with GAD-7, PHQ-9, and behavioral and cognitive factor scores of SSD-12 ( r=-0.360--0.404, P<0.05), lnHF was negatively correlated with GAD-7, PHQ-9 and behavioral factor scores of SSD-12 scores ( r=-0.491--0.402, all P<0.05), and lnLF/HF was positively correlated with PHQ-9 ( r=0.413, P<0.05) and lnTP was positively correlated with GAD-7 ( r=0.383, P<0.05). Conclusion:HRV is reduced in SSD patients and correlated with symptom severity, indicating the clinical potential of HRV index as a biological marker of SSD.

Association of attentional bias with negative cognition and childhood trauma in somatic symptom disorders / 中华行为医学与脑科学杂志

Objective:To investigate whether attentional bias exists in somatic symptom disorders and its correlation with negative cognition and childhood trauma.Methods:Totally 33 patients with physical disorder (physical disorder group) and 33 healthy controls (healthy control group) who met the inclusion and exclusion criteria in the outpatient or inpatient department of Sichuan Provincial People's Hospital were collected as the research objects.The patient health questionnaire (PHQ-15) and somatic system disorder-B criteria scale (SSD-12) were used to evaluate the severity of the disease, the childhood trauma scale (CTQ) was used to evaluate the childhood trauma experience, and the dot probe task edited by E-prime software was used to measure the reaction time.The repeated measurement variance analysis and independent sample t-test were used to compare the attention bias of the two groups, and the Pearson correlation analysis was used to analyze the correlation between attention bias, disease severity and childhood trauma. Results:The reaction time to negative pictures((510.86±124.72)ms) was longer than that to positive pictures ((504.21±117.21)ms, F=9.10, P<0.05) for physical disorder group and healthy control group, and the negative orienting index(5.22±28.02) in physical disorder group was significantly higher than that in healthy control group(-12.62±32.33)( t=2.397, P<0.05). Disengaging index to positive emotions in SSD patients was positively correlated with their negative cognition of the disease ( r=0.403, P<0.05), and the disengaging index to negative emotions in SSD patients was negatively correlated with emotional neglect ( r=-0.399, P<0.05). Conclusion:Reducing the occurrence of childhood trauma and correcting patients' negative cognition may help to improve the attention bias of somatic symptom disorders.

Review analysis of reported cases of myocarditis induced by immune checkpoint inhibitors / 中国医师杂志

Objective:To explore the clinical characteristics and influencing factors of myocarditis induced by immune checkpoint inhibitors (ICIs).Methods:Using programmed death receptor-1 (PD-1), nivolumab, pembrolizumab, programmed cell death receptor ligand-1 (PD-L1), atezolizumab, durvalumab, avelumab, cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), ipilimumab, tremelimumab as keywords respectively, we combined these words with myocarditis or the corresponding Chinese to search.Results:A total of 49 articles were reported, including 64 patients. Nivolumab was the most reported, followed by pembrolizumab and ipilimumab. The average age was (65.47±13.24)years, mainly elderly patients; 37 cases (57.81%) were male; the overall mortality rate was 31.25%(20/64). The clinical symptoms were diverse and nonspecific, with dyspnea being the most common (39/64, 60.94%). Heart biomarkers were elevated in 94.64%(53/56) of the patients. 35 patients (54.69%, 35/64) developed myocarditis after 1-2 doses and 17 patients died. 60 patients received steroids as initial treatment, and immunosuppressive therapies such as infliximab, intravenous immunoglobulin, antithymic globulin, and/or plasmapheresis were used in 25 patients, symptoms improved in 17 cases (68.00%).Conclusions:ICIs can cause myocarditis, with high mortality, and should be closely monitored and timely treatment. Steroids can be used as initial first-line therapy and immunosuppressants and/or plasmapheresis may improve clinical symptoms and survival rate.

Illness perception in patients with somatic symptom disorder:a qualitative study / 中华行为医学与脑科学杂志

Objective To explore the perception and evaluation of patients with somatic symptom disorder about their own diseases and treatment,and to provide theoretical basis for design of illness percep-tion questionnaire for patients with somatic symptoms disorder. Methods A semi-structured interview was conducted among 15 initial and untreated patients with somatic symptom disorder using the descriptive quali-tative study. The data were sorted,encoded,classified,summarized and refined using MAXQDA10 software. Results Three main themes and six sub-themes of illness perception in patients with somatic symptom dis-order were analyzed and sorted out:(1) symptom recognition:including three sub-themes,low understanding of the disease and denial of somatic symptoms as mental illness;(2)drug taking concerns:including two sub-themes worrying about side effects of drugs,drug addiction and having difficulty to stick to the long-term reg-ular medication;(3)emotional reaction:including the obvious negative emotions of depression and helpless-ness sub-theme. Conclusion Patients with somatic symptom disorder have a general bias in illness percep-tion,which has a potential adverse effect on treatment compliance. Therefore,it is necessary for clinical med-ical staff to early estimate patients’illness perception,and carry out mental health education and rational e-motional behavior therapy.

The relationship of peripheral blood single uncoding RNA-25-3p expression level and the sertraline efficacy in patients with panic disorder / 中华行为医学与脑科学杂志

Objective@#To identify potential relationship between single uncoding RNA-25-3p (miR-25-3p) expression level and the sertraline efficacy in patients with panic disorder.@*Methods@#Sixty cases of patients with panic disorder(case group) and sixty healthy-controls(control group) were collected with demographic data and peripheral venous blood before and after treatment.All the patients were evaluated using the 14-item Hamilton Anxiety Rating Scale (HAMA) and Panic Disorder Severity Scale (PDSS) at baseline, and then received sertraline treatment for 6 weeks.After six-week treatment, each patient was evaluated again with HAMA and PDSS.RT-PCR was used to detect the level of miR-25-3p expression.@*Results@#There was no significant difference in the miR-25-3p levels between control group (1.27±0.32) and case group (1.73±1.09) before treatment(t=1.53, P=0.14), but the levels in case group were much higher than that in control group after the treatment (5.72±4.13 vs 1.73±1.09, t=-2.15, P=0.04). Besides, the changes of the miR-25-3p levels were positively related with both the changes of PDSS3 and PDSS7 items before and after the treatment (r=0.60, P=0.02 for PDSS3 and r=0.61, P=0.02 for PDSS7).@*Conclusions@#miR-25-3p is associated with the drug efficacy and the outcome of some clinical symptoms of panic disorder.These findings might provide some evidence for the individualized treatment of patients with panic disorder according to regulation of gene expression in the future.

Illness perception in patients with somatic symptom disorder: a qualitative study / 中华行为医学与脑科学杂志

Objective@#To explore the perception and evaluation of patients with somatic symptom disorder about their own diseases and treatment, and to provide theoretical basis for design of illness perception questionnaire for patients with somatic symptoms disorder.@*Methods@#A semi-structured interview was conducted among 15 initial and untreated patients with somatic symptom disorder using the descriptive qualitative study. The data were sorted, encoded, classified, summarized and refined using MAXQDA10 software.@*Results@#Three main themes and six sub-themes of illness perception in patients with somatic symptom disorder were analyzed and sorted out: (1) symptom recognition: including three sub-themes, low understanding of the disease and denial of somatic symptoms as mental illness; (2)drug taking concerns: including two sub-themes worrying about side effects of drugs, drug addiction and having difficulty to stick to the long-term regular medication; (3)emotional reaction: including the obvious negative emotions of depression and helplessness sub-theme.@*Conclusion@#Patients with somatic symptom disorder have a general bias in illness perception, which has a potential adverse effect on treatment compliance. Therefore, it is necessary for clinical medical staff to early estimate patients’illness perception, and carry out mental health education and rational emotional behavior therapy.

The relationship of peripheral blood single uncoding RNA-25-3p expression level and the sertraline efficacy in patients with panic disorder / 中华行为医学与脑科学杂志

Objective To identify potential relationship between single uncoding RNA-25-3p (miR-25-3p) expression level and the sertraline efficacy in patients with panic disorder.Methods Sixty cases of patients with panic disorder(case group) and sixty healthy-controls(control group) were collected with demographic data and peripheral venous blood before and after treatment.All the patients were evaluated using the 14-item Hamilton Anxiety Rating Scale (HAMA) and Panic Disorder Severity Scale (PDSS) at baseline,and then received sertraline treatment for 6 weeks.After six-week treatment,each patient was evaluated again with HAMA and PDSS.RT-PCR was used to detect the level of miR-25-3p expression.Results There was no significant difference in the miR-25-3p levels between control group (1.27±0.32) and case group (1.73±1.09) before treatment(t=1.53,P=0.14),but the levels in case group were much higher than that in control group after the treatment (5.72±4.13 vs 1.73±1.09,t=-2.15,P=0.04).Besides,the changes of the miR-25-3p levels were positively related with both the changes of PDSS3 and PDSS7 items before and after the treatment (r=0.60,P=0.02 for PDSS3 and r=0.61,P=0.02 for PDSS7).Conclusions miR-25-3p is associated with the drug efficacy and the outcome of some clinical symptoms of panic disorder.These findings might provide some evidence for the individualized treatment of patients with panic disorder according to regulation of gene expression in the future.

Relationship between serum bilirubin and serum C-peptide levels in patients with type 2 diabetes mellitus / 中华内分泌代谢杂志

[Summary] The relationship between serum bilirubin and serum C-peptide levels in patients with type 2 diabetes mellitus was investigated. The clinical and laboratory data of 206 healthy subjects and 271 type 2 diabetic patients were collected. The partial correlation analysis and multiple linear regression analysis showed that serum bilirubin was positively correlated with fasting C-peptide, postprandial C-peptide, and the difference between postprandial C-peptide and fasting C-peptide levels(β=0. 171, 0. 111,0. 052,P<0. 05 or P<0. 01).