Prevalence of prolonged grief disorder and its symptoms among bereaved individuals in China:a systematic review and meta-analysis

Background The prevalence of prolonged grief disorder(PGD)and its symptoms among the bereaved population in China vary considerably.Aims This meta-analysis aims to estimate the prevalence of PGD and its symptoms among bereaved individuals in China.Methods We conducted a literature search in major Chinese and English databases from their inception to 4 October 2023,for cross-sectional studies on the prevalence of PGD or its symptoms in bereaved Chinese individuals.The risk of bias of the included studies and certainty of the evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data(‘JBI checklist’)and the Grading of Recommendations,Assessment,Development and Evaluations(GRADE),respectively.The‘metaprop’package in R V.4.1.2 was used to synthesise the prevalence.Results A total of 28 studies involving 10994 bereaved individuals were included in the analysis,with JBI checklist scores between 3 and 7.The combined prevalence(95%confidence interval)of PGD and its symptoms was 8.9%(4.2%to 17.6%)and 32.4%(18.2%to 50.8%),respectively.PGD and its symptoms were most prevalent among those who had lost their only child(22.7%)and those bereaved by earthquakes(80.4%),respectively.The GRADE system assigned a very low certainty level to the evidence for the pooled prevalence of PGD and its symptoms.Conclusions The pooled prevalence of PGD and its symptoms indicate a potential high need for grief counselling services among bereaved individuals in China.This need is particularly pronounced in those who have lost their only child and those bereaved due to earthquakes.Further methodologically rigorous studies are needed to provide more accurate prevalence estimates.PROSPERO registration number CRD42023432553.

Do adjunctive art therapies reduce symptomatology in schizophrenia? A meta-analysis

BACKGROUND Art therapies are advocated by national bodies,such as the United Kingdom’s National Institute for Health and Care Excellence,to alleviate the negative symptoms associated with schizophrenia.The last decade has however,seen several new larger well-controlled trials published suggesting an update is timely.AIM To asses randomised controlled trials(RCT)of art therapies for reducing the symptoms of schizophrenia–particularly negative symptoms.METHODS Searches of PubMed and Scopus were conducted until May 2019 for RCTs examining the impact of art therapies on psychosis(positive,negative and total)symptoms in people diagnosed with schizophrenia.Study quality was assessed using the Cochrane risk of bias tool.Random effects meta-analyses were used to derive overall effect sizes.Moderator analyses were conducted using both metaregression and categorical comparisons.RESULTS We identified 133 articles,of which 9 RCTs involving 948 participants(475 assigned to art therapies and 473 controls)met our inclusion criteria.Using random effects models,we calculated pooled effect sizes(Hedges g)for end-oftrial symptomatic outcomes.Effect sizes both for total symptoms[g=-0.27,95%confidence interval(CI)-0.60 to 0.05,k=6]and for positive symptoms(g=-0.10,95%CI-0.35 to 0.15,k=6)were non-significant;however,we did find significant reduction of negative symptoms(g=-0.42,95%CI-0.70 to-0.14,k=9).Metaregression revealed that negative symptom reduction was larger in trials with a greater proportion of women and in trials with younger patients.Crucially,the negative symptom reduction following art therapies was limited to lower quality trials and did not emerge in trials that used blind assessment of outcomes.CONCLUSION This review presents a comprehensive meta-analysis of art therapies in schizophrenia in terms of both studies included and participant numbers.We found that art therapies did not significantly reduce total or positive symptoms.A"small"therapeutic effect was found for negative symptoms,but we show that the effect is not present in blind trials and may be subject to publication bias.

Disagreement between symptom-reflux association analysis parameters in pediatric gastroesophageal reflux disease investigation

AIM: To assess the agreement within 3 commonly used symptom-reflux association analysis (SAA) parameters investigating gastroesophageal reflux disease (GERD) in infants. METHODS: Twenty three infants with suspected GERD were included in this study. Symptom index (SI), Symptom sensitivity index (SSI) and symptom association probability (SAP) related to cough and irritability were calculated after 24 h combined pH/multiple intraluminal impedance (MII) monitoring. Through defined cutoff values, SI, SSI and SAP values are differentiated in normal and abnormal, whereas abnormal values point towards gastroesophageal reflux (GER) as the origin of symptoms. We analyzed the correlation and the concordance of the diagnostic classification of these 3 SAA parameters.RESULTS: Evaluating the GER-irritability association, SI, SSI and SAP showed non-identical classification of normal and abnormal cases in 39.2% of the infants. When irritability was taken as a symptom, there was only a poor inter-parameter association between SI and SSI, and between SI and SAP (Kendall’s tau b = 0.37, P < 0.05; Kendall’s tau b = 0.36, P < 0.05, respectively). Evaluating the GER-cough association, SI, SSI and SAP showed non-identical classification of normal and abnormal cases in 52.2% of the patients. When cough was taken as a symptom, only SI and SSI showed a poor inter-parameter association (Kendall’s tau b = 0.33, P < 0.05). CONCLUSION: In infants investigated for suspected GERD with pH/MII-monitoring, SI, SSI and SAP showed a poor inter-parameter association and important dis-agreements in diagnostic classification. These limitations must be taken into consideration when interpreting the results of SAA in infants.

Factor analysis identifies subgroups of constipation

AIM:To determine whether distinct symptom groupings exist in a constipated population and whether such grouping might correlate with quantifiable pathophysiological measures of colonic dysfunction.METHODS:One hundred and ninety-one patients presenting to a Gastroenterology clinic with constipation and 32 constipated patients responding to a newspaper advertisement completed a 53-item,wide-ranging selfreport questionnaire.One hundred of these patients had colonic transit measured scintigraphically.Factor analysis determined whether constipation-related symptoms grouped into distinct aspects of symptomatology.Cluster analysis was used to determine whether indi-vidual patients naturally group into distinct subtypes.RESULTS:Cluster analysis yielded a 4 cluster solution with the presence or absence of pain and laxative unresponsiveness providing the main descriptors.Amongst all clusters there was a considerable proportion of patients with demonstrable delayed colon transit,irritable bowel syndrome positive criteria and regular stool frequency.The majority of patients with these characteristics also reported regular laxative use.CONCLUSION:Factor analysis identified four constipation subgroups,based on severity and laxative unresponsiveness,in a constipated population.However,clear stratification into clinically identifiable groups remains imprecise.

Semen analysis in chronic bacterial prostatitis： diagnostic and therapeutic implications

The significance and diagnostic value of semen analysis in chronic bacterial prostatitis has been extensively debated and remains controversial. To investigate the diagnostic relevance of semen culture in the bacteriological workup of prostatitis patients, we retrospectively analyzed a clinical database of 696 symptomatic patients. All patients were routinely subjected to a four-glass test, followed by semen culture and analysis. This allowed to dissect from the database three different diagnostic scenarios, and to compare the ＇two-glass＇ pre-/post- massage test and the standard ＇four-glass＇ test with a ＇five-glass＇ test （four-glass plus post-VB3 semen culture）. The ＇five-glass＇ test showed 3.6- or 6.5-fold increases in relative sensitivity and lesser reductions （-13.2% or -14.7%） in relative specificity for traditional uropathogens （TUs） compared with the four-glass or two-glass test, respectively. The area under the ROC curve and Jouden＇s index were increased, whereas positive and negative likelihood ratios were lower than comparators, indicating that the ＇five-glass＇ assay may be superior in confirming the negative outcome of both standard tests. The five-, four-, and two-glass tests detected TUs （Enterobacteriaceae, Enterococci, etc.） in 120, 33, and 20 patients and unusual pathogens （Streptococci, other Gram-positive species, Mycoplasmata, and others） in 130, 56, and 45 patients, respectively. When patients were subjected to pharmacological treatment, including a combination of a fluoroquinolone and a macrolide, no differences in eradication rates were observed between groups diagnosed with different tests, irrespective of pathogen category. Eradication was associated with long-term sign/symptom remission; no significant intergroup differences in sign/symptom scores were observed throughout a 24-month off-therapy follow-up period. In conclusion, our data support the usefulness of semen analysis in the diagnostic workup ofprostatitis patients when this test is used to complement the four-glass Meares and Stamey test. Improvement of microbiological assays conveys important diagnostic and therapeutic implications.

Analysis on the law of differentiating and treating insomnia by physicians based on cluster analysis of drug syndrome

Objective:To explore the general differentiation and treatment of insomnia by Professor Gao Ying through drug clustering and group correspondence analysis,and provide reference for clinical diagnosis and treatment.Methods:Collect retrospective case data from outpatient system,use SPSS20.0 software to perform frequency and cluster analysis on high-frequency symptoms and drug data,and perform corresponding analysis on the clustered drug syndrome groups.Results:A total of 349 consultations in 204 patients were included.Cluster analysis of 35 symptoms and 40 flavors with a frequency of more than 10%resulted in a corresponding relationship between 7 symptom groups,6 drug groups and 5 drug syndrome groups.The medicine symptom group has a high degree of matching;the doctors distinguish and tre at insomnia with calming,clearing heat,nourishing yin,liver,spleen,qi and phlegm as the core treatment,with consistent decoction,two to pill,lily ground Huang Tang,Lily Zhimu Decoction,Wendan Decoction,Sini San,Xiao Chai Hu Tang,Xiaoyao San,etc.are commonly used prescriptions;the physician's experience is to add or subtract Danshen and Zao Ren drink,which has a wide range of applicability to various insomnia syndrome.Conclusion:Based on the cluster analysis of drug symptoms and group correspondence analysis,it can reveal the pathogenesis,treatment and class information hidden in the data of drug symptoms,which can reflect the general law of physicians'syndrome differentiation and treatment of insomnia.This method has a reference for the exploration of TCM clinical experience significance;The results of this study can provide feedback to guide the clinical diagnosis and treatment of insomnia.

Repetitive transcranial magnetic stimulation for hallucination in schizophrenia spectrum disorders A meta-analysis

OBJECTIVE： This study assessed the efficacy and tolerability of repetitive transcranial magnetic stimulation for treatment of auditory hallucination of patients with schizophrenia spectrum disorders. DATA SOURCES： Online literature retrieval was conducted using PubMed, ISI Web of Science, EMBASE, Medline and Cochrane Central Register of Controlled Trials databases from January 1985 to May 2012. Key words were ＂transcranial magnetic stimulation＂, ＂TMS＂, ＂repetitive tran- scranial magnetic stimulation＂, and ＂hallucination＂. STUDY SELECTION： Selected studies were randomized controlled trials assessing therapeutic ef- ficacy of repetitive transcranial magnetic stimulation for hallucination in patients with schizophrenia spectrum disorders. Experimental intervention was low-frequency repetitive transcranial magnetic stimulation in left temporoparietal cortex for treatment of auditory hallucination in schizophrenia spectrum disorders. Control groups received sham stimulation. MAIN OUTCOME MEASURES： The primary outcome was total scores of Auditory Hallucinations Rating Scale, Auditory Hallucination Subscale of Psychotic Symptom Rating Scale, Positive and Negative Symptom Scale-Auditory Hallucination item, and Hallucination Change Scale. Secondary outcomes included response rate, global mental state, adverse effects and cognitive function. RESULTS： Seventeen studies addressing repetitive transcranial magnetic stimulation for treatment of schizophrenia spectrum disorders were screened, with controls receiving sham stimulation. All data were completely effective, involving 398 patients. Overall mean weighted effect size for repeti- tive transcranial magnetic stimulation versus sham stimulation was statistically significant （MD = -0.42, 95%C/： -0.64 to -0.20, P = 0.000 2）. Patients receiving repetitive transcranial magnetic stimulation responded more frequently than sham stimulation （OR = 2.94, 95%C/： 1.39 to 6.24, P =0.005）. No significant differences were found between active repetitive transcranial magnetic stimulation and sham stimulation for positive or negative symptoms. Compared with sham stimulation, active repeti- tive transcranial magnetic stimulation had equivocal outcome in cognitive function and commonly caused headache and facial muscle twitching. CONCLUSION： Repetitive transcranial magnetic stimulation is a safe and effective treatment for auditory hallucination in schizophrenia spectrum disorders,

A Meta-analysis of Mood Stabilizers for Alzheimer's Disease

The objective of this study was to assess the clinical evidence for or against mood stabilizers as a treatment for Alzheimer’s disease (AD).We searched 5 databases from their inception to January 2010.Five randomized clinical trials of mood stabilizers to treat human patients suffering from AD were included.These trials assessed the effectiveness of mood stabilizers as an adjunct treatment to conventional anti-dementia drugs on behavioral and psychological symptoms, especially on agitation.Methodological quality was assessed using the Jadad score.The results suggested a significant effect in favor of placebo on the Mini-Mental Status Examination [n=270, weight mean difference (WMD), -0.89; 95% confidence intervals (CIs) -1.69 to -0.09, P=0.03] and on the Neuropsychiatric Inventory total (NPI total) (n=51, WMD, 3.71; 95% CIs 0.15 to 7.26, P=0.04).There were no significant differences in change scores on total Brief Psychiatric Rating Scale (BPRS total), NPI/BPRS agitation, Cohen-Mansfield Agitation Inventory total and Physical Self Maintenance Scale between mood stabilizers and placebo.Only one of these studies was free of methodological limittions (Jadad score=5).In conclusion, based on the existing evidence, mood stabilizers are ineffective or even harmful as a treatment for AD.

Network analysis of the relationships between depressive symptoms and social participation activities among Chinese older adults and its implications for nursing

Objective:Network analysis was used to explore the complex inter-relationships between social participation activities and depressive symptoms among the Chinese older population,and the differences in network structures among different genders,age groups,and urban-rural residency would be compared.Methods:Based on the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey(CLHLS),12,043 people aged 65 to 105 were included.The 10-item Center for Epidemiologic Studies Depression(CESD)Scale was used to assess depressive symptoms and 10 types of social participation activities were collected,including housework,tai-chi,square dancing,visiting and interacting with friends,garden work,reading newspapers or books,raising domestic animals,playing cards or mahjong,watching TV or listening to radio,and organized social activities.R 4.2.1 software was used to estimate the network model and calculate strength and bridge strength.Results:21.60%(2,601/12,043)of the participants had depressive symptoms.The total social participation score was negatively associated with depressive symptoms after adjusting for sociodemographic factors.The network of social participation and depressive symptoms showed that“D9(Inability to get going)”and“S9(Watching TV and/or listening to the radio)”had the highest strength within depressive symptoms and social participation communities,respectively,and“S1(Housework)”,“S9(Watching TV and/or listening to the radio)”,and“D5(Hopelessness)”were the most prominent bridging nodes between the two communities.Most edges linking the two communities were negative.“S5(Graden work)-D5(Hopelessness)”and“S6(Reading newspapers/books)-D4(Everything was an effort)”were the top 2 strongest negative edges.Older females had significantly denser network structures than older males.Compared to older people aged 65e80,the age group 81e105 showed higher network global strength.Conclusions:This study provides novel insights into the complex relationships between social participation and depressive symptoms.Except for doing housework,other social participation activities were found to be protective for depression levels.Different nursing strategies should be taken to prevent and alleviate depressive symptoms for different genders and older people of different ages.

维持性血液透析患者症状困扰的多维同期症状网络分析

目的调查维持性血液透析(maintenance hemodialysis,MHD)患者症状困扰现况,并构建多维同期症状网络。方法采用便利抽样法选取2023年6-9月上海市和浙江省共3家医院的512例MHD患者为研究对象,采用透析患者症状负担调查表(dialysis frequency,severity,and symptom burden index,DFSSBI)对MHD患者30项症状的发生频率、严重程度和困扰程度进行调查。使用R软件qgraph包构建多维同期症状网络模型。结果发生率排名靠前的症状分别是瘙痒(64.45%)、皮肤干燥(64.06%)、口干(56.64%)、乏力(51.76%)、入睡困难(51.37%)。症状网络分析的结果显示,症状困扰总体焦虑的强度中心性(r_(S)=8.04)、紧密中心性(r_(C)=0.0078)和桥梁症状强度(r_(bs)=5.58)最大,中介中心性最大的症状是入睡困难(r_(B)=38)。在发生频率、严重程度和困扰程度3个维度,强度中心性最大的症状均是焦虑(r_(S)=7.62、7.83、8.02);紧密中心性最大的症状分别是焦虑(r_(C)=0.0073)、烦躁(r_(C)=0.0077)、焦虑(r_(C)=0.0080);中介中心性最大的症状分别是头晕(r_(B)=52)、入睡困难(r_(B)=38)、入睡困难(r_(B)=44)。结论焦虑是MHD患者的核心症状,最容易影响其他症状,且5个心理症状(担心、悲伤、烦躁、焦虑、紧张)之间的关联性最强,入睡困难则在症状网络中起到关键的桥梁作用,提示医护人员应提高对MHD患者心理症状的关注度并关注患者自我报告症状,同时在制定护理方案时应综合评估患者的整体情况。

女性绝经相关症状特点及绝经激素治疗认知状况的调查分析

目的 调查更年期女性绝经相关症状的特点及对绝经激素治疗(MHT)的认知状况。方法 选择就诊于西安交通大学第一附属医院有绝经相关症状的619例更年期女性为研究对象,采用调查问卷的方式收集资料,分析绝经相关症状的特点,探讨更年期女性对MHT的认知状况及疗效。结果 371例围绝经期女性中绝经相关症状发生率位于前3位的分别是:疲乏(69.81%)、失眠(66.85%)、潮热出汗(58.22%),248例绝经后女性中绝经相关症状发生率位于前3位的分别是:潮热出汗(64.11%)、骨关节痛(60.89%)、疲乏(56.85%)。绝经后女性的失眠、疲乏发生率显著低于围绝经期女性(P<0.01),而骨关节痛、泌尿系感染、阴道干涩性交痛的发生率显著高于围绝经期女性(P<0.01)。围绝经期和绝经后女性的Kupperman评分比较无统计学差异(P>0.05),但评分程度分布比较有统计学差异(P<0.05);围绝经期女性轻度占比最高,绝经后女性中度占比最高。绝经后女性的不同绝经年龄、绝经年限、绝经方式之间Kupperman评分比较有统计学差异(P<0.05);绝经年龄越早、绝经年限越短Kupperman评分越高;手术绝经者Kupperman评分显著高于自然绝经者(P<0.05)。多因素Logistic回归分析结果显示,年龄45~54岁、退休或无业、配偶疾病或去世、性生活不正常、文化程度高是绝经相关症状发生的危险因素(P<0.05),家庭收入高、>3次/周的运动是绝经相关症状发生的保护因素(P<0.05)。更年期女性对MHT了解途径占比最高为网络(39.92%),对MHT的担忧占比最高为肿瘤(33.67%)。465例(89.77%)无MHT禁忌证的更年期女性,治疗后症状显著改善(P<0.05)。结论 更年期女性绝经相关症状显著,年龄越早、绝经年限越短及手术绝经者症状更为严重,应关注绝经对更年期女性健康的影响并增加专业医师指导,提高MHT使用率以改善更年期女性的生活质量。

炎症性肠病患者疲乏现况及影响因素路径关系

目的:调查炎症性肠病(Inflammatory Bowel Disease,IBD)患者疲乏的现况及其影响因素,探索运动、睡眠质量、抑郁、疲乏和疾病感知之间的路径关系,为IBD患者疲乏的管理提供科学依据。方法:采用便利抽样法调查北京市和青岛市消化科门诊289例IBD患者的疲乏现状,采用分层回归分析影响因素,并基于不悦症状理论,采用最大似然法进行疲乏相关路径分析。结果:259例(89.6%)IBD患者存在不同程度的疲乏症状。分层回归分析显示,BMI、激素治疗、疾病活动、运动、抑郁和睡眠质量是IBD患者疲乏的影响因素(P<0.05)。路径分析显示,运动、抑郁和睡眠质量可对疲乏产生直接效应,并通过疲乏的完全中介效应间接影响IBD患者的疾病感知。结论:IBD患者疲乏的发生率高,医护人员可通过有针对性的干预措施缓解IBD患者的疲乏症状,降低其负性疾病感知水平,提升其生活质量。

儿童药物超敏反应30例分析

目的:评估儿童药物超敏反应综合征(DRESS)在药物暴露后发生的时间特点以及可疑致敏药物种类。方法:对近十年来在我院诊断为DRESS的患儿病例进行回顾性分析。结果:30例患儿中17例为快速发作组(<15 d),13例为延迟发作组(≥15 d)。DRESS平均发生时间为(11.13±8.69)d,小于15 d。停药后,DRESS平均持续时间为(22.80±19.65)d,两组间没有差异。致敏药物中抗菌药物占43.3%,其中多数抗菌药物为快速发生组;抗癫痫药物占比32.3%,其中6例为延迟发生组。结论:药物超敏反应综合征多数发生在可疑药物暴露后15天以内,也可发生在可疑药物暴露后15天以上。研究还发现儿童药物超敏反应主要致敏药物为抗菌药物与抗癫痫药物。

“双减”背景下河北省中小学生焦虑抑郁症状现状

目的:调查“双减”背景下河北省中小学生焦虑抑郁症状的影响因素、关键症状及容易导致共病的症状,为制定中小学生焦虑抑郁症状预防与干预工作提供参考依据。方法:使用一般资料调查表、抑郁症状群量表(PHQ-9)、广泛性焦虑量表(GAD-7)对河北省6个地区48所的4413名中小学进行问卷调查。结果:中小学生焦虑和抑郁症状检出率分别为13.7%、10.4%,共病检出率为6.3%。二元Logistic回归结果显示,焦虑和抑郁症状的共同危险因素为女生、住宿、感到学习压力大、受过欺凌和睡不着觉(P<0.05),其中焦虑症状的危险因素为初中和独生子女(P<0.01),抑郁症状的危险因素为城镇、双亲家庭、每日上网时间>2小时和对学校感到不适应(P<0.05)。网络结构中预期影响较高的症状为GAD4“很难放松”(Z=1.09)、PHQ6“感觉自己糟糕或让其他人失望”(Z=1.06)、PHQ1“兴趣下降”(Z=1.05);桥梁预期影响较高的3个症状分别为PHQ9“存在消极观念”(Z=0.54)、PHQ1“兴趣下降”(Z=0.53)、GAD7“害怕将有可怕的事发生”(Z=0.46)。结论:“双减”背景下河北省焦虑和抑郁症状的检出率较低,但仍有待进一步降低。二者共同危险因素为女生、住宿、感到学习压力大、受过欺凌和睡不着觉,其中焦虑症状的危险因素为初中和独生子女,抑郁症状的危险因素城镇、双亲家庭、每日上网时间>2小时和对学校感到不适应。焦虑抑郁症状网络中的关键症状为GAD4、PHQ6、PHQ1,传递风险较高的桥梁症状为PHQ9、PHQ1、GAD7。

帕金森病、特发性震颤患者的震颤分析及非运动症状差异

目的:分析帕金森病、特发性震颤患者震颤分析、非运动症状差异及其影响因素。方法:将2022年3月~2023年3月我院收治的帕金森病患者82例纳入帕金森组,特发性震颤患者68例纳入特发性震颤组,回顾性收集患者临床资料。分析两组一般资料、震颤分析及非运动症状差异,并分析其影响因素。结果:年龄>60岁、震颤部位单侧肢体、谐波现象、嗅觉减退为帕金森病的危险因素(P<0.05),姿势震颤频率、周围波为帕金森病的保护因素(P<0.05)。结论:帕金森病、特发性震颤患者震颤分析、非运动症状存在差异,其影响因素较多,可为其临床鉴别提供依据。

基于网络分析维持性血液透析患者症状群及桥梁症状研究

目的 探索维持性血液透析患者不同症状群间的关联关系,识别连接不同症状群的桥梁症状。方法 采用便利抽样法,使用透析症状指数量表对480例维持性血液透析患者进行问卷调查。基于网络分析识别症状群间的桥梁症状。结果 维持性血液透析患者经历着6个症状群,分别为皮肤症状群、尿毒症症状群、胃肠道症状群、情绪症状群、水电解质症状群与性功能障碍症状群。桥梁中心性指标显示桥梁强度最大的症状是担心(r_(bs)=7.946)和皮肤干燥(r_(bs)=7.800);桥梁紧密中心性最大的症状是担心(r_(bc)=0.331)和伤心(r_(bc)=0.322);桥梁中介中心性最大的症状是性欲减退(r_(bb)=12.000)和入睡困难(r_(bb)=7.000)。结论 维持性血液透析患者受多个症状群困扰,担心和皮肤干燥是连接不同症状群的桥梁症状。针对桥梁症状进行精准干预,有利于阻断其在不同症状群间的桥接作用,提高症状管理效能。

中西医结合治疗腰椎间盘突出术后残余症状临床疗效的Meta分析

目的:应用Meta系统评价在常规西医治疗(抗感染、消肿、营养神经等)基础下加入中医疗法对腰椎间盘突出症(lumbar disc herniation,LDH)患者术后残余症状的临床疗效。方法:检索知网、万方、维普、Pubmed等中英文数据库中有关中西医结合对治疗腰椎间盘突出术后残余症状临床疗效的相关文献,研究方法均为随机对照试验(randomized controlled trial,RCT),检索时间2018年1月1日至2023年9月1日。文献质量评估依照Cochrane偏倚风险评价工具,RevMan5.3软件进行分析。结果:共纳入10篇文献,737例患者,Meta分析结果示:治疗组的总体临床疗效高于对照组(RR=1.19,Z=5.22,P<0.00001),疼痛视觉模拟评分(visual analogue scale,VAS)、腰椎功能障碍评分(oswestry dability index,ODI)均低于对照组(SMD=-1.30,Z=14.29,P<0.00001;SMD=-1.71,Z=12.40,P<0.00001),日本骨科协会腰痛疾病疗效评分高于对照组(SMD=1.66,Z=15.74,P<0.00001)。结论:中西医结合治疗能够改善腰椎间盘突出患者的术后残余症状,进一步减轻疼痛,改善生活质量。

帕金森病患者症状网络分析及核心症状识别

目的探索帕金森病(Parkinson's disease,PD)患者症状群的种类并通过构建症状网络分析其核心症状。方法采用便利抽样法,应用一般资料问卷、PD患者症状经历量表,对2022年12月-2023年5月在河南省某三级甲等医院住院的285例PD患者进行问卷调查。采用探索性因子分析提取症状群,运用R语言构建网络布局描述症状间的关系,并计算中心性指标。结果在症状网络分析中,节点强度前3的症状是失眠(r_(s)=2.00)、尿频(r_(s)=1.66)和疲乏(r_(s)=1.64),桥梁强度前3的症状是失眠(r_(s)=0.19)、疼痛(r_(s)=0.18)和尿急(r_(s)=0.17)。结论PD患者会同时出现多种症状,症状之间相互联系,构成症状群,其中失眠是PD患者最核心的症状。医护人员在制定症状管理策略时,应综合考虑患者的整体症状表现,有针对性地采取综合干预措施。

识别脑卒中恢复期患者症状群及核心症状——一项同期症状网络分析

目的调查脑卒中恢复期患者症状发生情况,识别症状群,并构建同期症状网络,探索症状网络中的核心症状。方法采用便利抽样法,选取2022年5月—2023年9月在四川省某三级甲等医院康复中心、神经内科住院治疗的脑卒中恢复期患者250例,采用一般资料调查表和脑卒中症状体验量表进行横断面研究,通过探索性因子分析提取症状群,采用R语言构建同期症状网络并分析中心性指标。结果自理能力下降和肢体无力是脑卒中恢复期患者发生频率较高、最严重的症状;共提取4个症状群,分别是躯体活动相关症状群、认知障碍症状群、情绪相关症状群、协调-平衡症状群,累计方差贡献率为66.41%;在症状网络中,自理能力下降的强度(rS=1.67)和预期影响(rE=1.67)均最高,是脑卒中恢复期患者的核心症状。结论脑卒中恢复期患者存在多种症状群(躯体活动相关症状群、认知障碍症状群、情绪相关症状群和协调-平衡症状群),自理能力下降是脑卒中恢复期患者的核心症状,医护人员应综合考虑症状的发生情况和核心症状,制订科学精准的症状管理措施。

良性阵发性位置性眩晕的临床特征及心理因素对复位后残余症状的影响研究

背景良性阵发性位置性眩晕(BPPV)是以具有自限性、易反复发作为特点的临床常见病,手法复位治疗可以取得较好疗效,复位后部分患者会出现残余症状。近年来对BPPV治疗效果影响因素的研究较多,但对具体病因间的治疗效果比较及残余症状发生的影响因素仍有待探讨。目的分析继发性BPPV的临床特征,探讨BPPV的病因分类对疾病复发率的影响及BPPV复位后发生残余症状的影响因素。方法选取2019年4月—2021年4月就诊于吉林大学第一医院耳鼻咽喉头颈外科眩晕门诊及耳内科住院患者中确诊为BPPV的患者共340例,患者均同意行手法复位治疗。按是否存在原发病将患者分为原发性BPPV(原发组)、继发性BPPV(继发组)。继发组再按病因的不同分为5个亚组,主要病因包括突发性聋(SSNHL)、前庭性偏头痛(VM)、梅尼埃病(MD)、前庭神经炎(VN)、其他(如颅脑及耳部手术、Hunt综合征、颞骨骨折等)。比较原发组、继发组之间的临床特征及预后情况。随访至首次复位后3个月,再按患者随访期内有无残余症状发生将患者分为出现残余症状组、未出现残余症状组。比较两组间临床特征及不同时段(诊断时、治疗后4周、治疗后3个月)焦虑自评量表(SAS)、抑郁自评量表(SDS)评分的差异,分析BPPV复位后发生残余症状的独立影响因素。结果340例患者中,原发组184例(54.1%)、继发组156例(45.9%)。继发组较原发组患者发病年龄小,经2次以上复位治疗所占比例高,一次复位成功率低,3个月内复发率、残余症状发生率、诊断时SAS评分、诊断时SDS评分高(P<0.05)。继发性BPPV患者中不同病因患者年龄比较,差异有统计学意义(P<0.05);其中其他(如颅脑及耳部手术、Hunt综合征、颞骨骨折等)病因患者年龄小于SSNHL、VM、MD、VN患者(P<0.05)。继发性BPPV患者中不同病因患者性别、受累半规管、复位次数、一次复位成功率、3个月内复发率、残余症状发生率及各时段SAS、SDS评分比较,差异无统计学意义(P>0.05)。首次复位后3个月,出现残余症状组133例,未出现残余症状组207例。残余症状主要表现为头部昏沉感(59.40%,79/133)、不稳感(24.06%,32/133)及头颈部不适(9.77%,13/133),出现两种及以上症状者占6.77%(9/133)。出现残余症状组继发性病因所占比例、复位次数>2次所占比例高于未出现残余症状组(P<0.05);出现残余症状组伴随疾病复发所占比例少于未出现残余症状组,诊断时、治疗后4周、治疗后3个月SAS、SDS评分高于未出现残余症状组(P<0.01)。多因素Logistic回归分析结果显示,诊断时SAS评分(OR=1.231,95%CI=1.117~1.357,P<0.001)、SDS评分(OR=1.209,95%CI=1.113~1.314,P<0.001)是BPPV患者复位后残余症状发生的影响因素。结论继发性BPPV具有复位后残余症状发生率较高、复发率高的特点,焦虑、抑郁情绪会影响复位后残余症状的发生。