BACKGROUND Hypertensive cerebral hemorrhage(HCH),the most common chronic diseases,has become a topic of global public health discussions.AIM To investigate the role of rehabilitative nursing interventions in optimizin...BACKGROUND Hypertensive cerebral hemorrhage(HCH),the most common chronic diseases,has become a topic of global public health discussions.AIM To investigate the role of rehabilitative nursing interventions in optimizing the postoperative mental status recovery phase and to provide clinical value for future rehabilitation of patients with HCH.METHODS This randomized controlled study included 120 patients with cerebral HCH who were contained to our neurosurgery department between May 2021–May 2023 as the participants.The participants have randomly sampled and grouped into the observation and control groups.The observation group received the rehabilitation nursing model,whereas the control group have given conventional nursing.The conscious state of the patients was assessed at 7,14,21,and 30 d postoperatively.After one month of care,sleep quality,anxiety,and depression were compared between the two groups.Patient and family satisfaction were assessed using a nursing care model.RESULTS The results showed that the state of consciousness scores of the patients in both groups significantly increased(P<0.05)after surgical treatment.From the 14th day onwards,differences in the state of consciousness scores between the two groups of patients began to appear(P<0.05).After one month of care,the sleep quality,anxiety state,and depression state of patients were significantly better in the observation group than in the control group(P<0.05).Satisfaction with nursing care was higher in the observation group than in the control group(P<0.05).CONCLUSION The rehabilitation nursing model has a more complete system compared to conventional nursing,which can effectively improve the postoperative quality of life of patients with cerebral hemorrhage and improve the efficiency of mental state recovery;however,further analysis and research are needed to provide more scientific evidence.展开更多
Objectives 1） To explore the relationship between RTIs and mental status of Naxi women; 2） to compare the differences of depression ＆ anxiety between Naxi women who have and not have RTIs; and 3） to put forward so...Objectives 1） To explore the relationship between RTIs and mental status of Naxi women; 2） to compare the differences of depression ＆ anxiety between Naxi women who have and not have RTIs; and 3） to put forward some suggestions for improving Naxi women＇s reproductive health in psychological point of view. Methods A cross-sectional survey was adopted, 280 married Naxi female volunteers who aged above 20 years old were selected by cluster random sampling from the two selected villages of Lugufu Township of Yanyuan county in Sichuan. Two self-reporting scales, CES-D and SAS were used for assessment of depression and anxiety of the subjects. Results The facts of mental status of Sichuan Naxi women brook no optimism. Among 280 Naxi reproductive age women who were investigated in current study, only 74 （26.4%） have no depression symptoms, and 116 （41.4%） have no anxiety symptoms. For the study population, the average total scores （TS） of CES-D was 20.1, and the average total index scores （TIS） of SAS was 50.2, and both of them were above a minimum value doubted to have symptoms. There were big differences of both average TS of CES-D and TIS of SAS between Naxi women who have and not have RTIs. Further analysis revealed that RTI was a main risk factor influencing women＇s mental status （OR = 16. 043 for depression, and OR = 12.954 for anxiety）. In addition, Naxi women＇s depression and anxiety were related to order births （≤2, OR=3.149, 95% CI： 1.228, 8.076）, sex debut was younger （≤17, OR=3.043, 95% CI： 1.895, 4.884）, and multiple pregnancy （≥ 3, OR=2.728, 95% CI： 1.990, 4.173）, etc. Conclusion For improving Naxi women＇s mental status, a pressing matter of the moment is for local medical persons to gain the knowledge about mental health and the diagnosis and treatment levels of psychological disorders. At the same time, pssychological counselling should become a main activity of reproductive health services.展开更多
BACKGROUND Intravascular large B-cell lymphoma(IVLBCL)is a rare and aggressive subtype of non-Hodgkin lymphoma with a varied presentation and no pathognomonic findings.Early diagnosis is critical to altering the disea...BACKGROUND Intravascular large B-cell lymphoma(IVLBCL)is a rare and aggressive subtype of non-Hodgkin lymphoma with a varied presentation and no pathognomonic findings.Early diagnosis is critical to altering the disease course as early treatment with chemoimmunotherapy is required to prevent a rapidly fatal outcome.Strategies including improved awareness of this clinical entity through publication of cases with unique presentations are essential to prompt consideration of IVLBCL early in the disease workup.Here,we present a case of IVLBCL presenting with altered mental status and systemic organ dysfunction.CASE SUMMARY A 61-year-old male patient presented with flu-like symptoms and a high fever.He experienced rapid clinical deterioration with liver,kidney failure,and shock despite rapid antibiotic administration and supportive care.A broad infectious workup was negative.Intracranial imaging revealed nonspecific changes to the corpus callosum suspicious for vasculitis.Renal biopsy was non-diagnostic.After further progression of his symptoms,the family elected to withdraw care and the patient died shortly thereafter.Post-mortem analysis revealed clear multi-organ involvement by IVLBCL,prompting re-examination of the ante-mortem renal biopsy that also identified IVLBCL involvement.CONCLUSION IVLBCL is a rare disease.Communication with specialties and early biopsy is critical to establishing the diagnosis and initiating therapy.展开更多
BACKGROUND： Altered mental status （AMS） is a very common emergency case, but the exact etiology of many AMS patients is unknown. Patients often manifest vague symptoms, thus, AMS diagnosis and treatment are highly ...BACKGROUND： Altered mental status （AMS） is a very common emergency case, but the exact etiology of many AMS patients is unknown. Patients often manifest vague symptoms, thus, AMS diagnosis and treatment are highly challenging for emergency physicians. The aim of this study is to provide a framework for the assessment of AMS patients. This assessment should allow providers to better understand the etiology of mental status changes and therefore improve diagnostic skills and management.METHODS： This is a prospective cohort observational study. We recruited all adult patients with undifferentiated AMS at a single center tertiary care academic emergency department over 24 months （June 2009 to June 2011）. Demographic characteristics, clinical manifestations, assessment approaches, causative factors, emergency treatments and outcomes were collected prospectively.RESULTS： In 1934 patients with AMS recruited, accounting for 0.93% of all emergency department （ED） patients, 1 026 （53.1%） were male, and 908 （46.9%） female. Their average age was 51.95±15.71 years. Etiologic factors were neurological （n=641; 35.0%）, pharmacological and toxicological （n=421; 23.0%）, systemic and organic （n=266; 14.5%）, infectious （n=167; 9.1%）, endocrine/metabolic （n=145; 7.9%）, psychiatric （n=71; 3.9%）, traumatic （n=38; 2.1%）, and gynecologic and obstetric （n=35; 1.9%）. Total mortality rate was 8.1% （n=156）. The death rate was higher in elderly patients （≥60） than in younger patients （10.8% vs. 6.9%, P=-0.003）.CONCLUSION： Patients with AMS pose a challenge for ED physicians. The most frequently encountered diagnostic categories causing AMS were primary CNS disorders, intoxication, organ system dysfunction, and endocrine/metabolic diseases. AMS has a high fatality rate in the ED. AMS is an important warning signal for ED patients because of its potentially fatal and reversible effects. Prompt evaluation and treatment are essential to decreasing morbidity and mortality associated with AMS.展开更多
Objective:The study aimed to assess medication management compliance and mental health in elderly patients with hypertension.Method:The study evaluated medication compliance and mental health status of elderly hyperte...Objective:The study aimed to assess medication management compliance and mental health in elderly patients with hypertension.Method:The study evaluated medication compliance and mental health status of elderly hypertensive patients in China using simple random sampling.Data was collected using the Morisky Medication Compliance Questionnaire,Hospital Anxiety and Depression Scale,and a checklist.Ethical practices were strictly observed.Results:A study of 100 elderly hypertensive patients found poor drug management compliance,with female patients showing worse compliance.Female patients were more vulnerable to anxiety and depression.The study also found no significant association between gender,age,education level,marital status,living standards,and medication compliance.Barriers to medication management included food and daily necessities,lack of awareness about the importance of drug treatment,and basic family needs.The lowest-ranked barriers were lack of support from government health clinics,low income,and lack of family support.Conclusion:Based on the results,the study proposes an educational plan for elderly hypertensive patients and their families,to be evaluated and implemented by the hospital and township community service center.The plan aims to improve medication management and lifestyle modification compliance,encourage active participation,and provide access to medical and mental health clinics,support groups,and counseling services.展开更多
Introduction: Herpes simplex virus is the most common etiology for life-threatening sporadic encephalitis worldwide. Antiviral therapy with acyclovir has been shown to reduce mortality and should be started promptly i...Introduction: Herpes simplex virus is the most common etiology for life-threatening sporadic encephalitis worldwide. Antiviral therapy with acyclovir has been shown to reduce mortality and should be started promptly in patients with clinically suspected viral encephalitis before serological confirmation of the diagnosis. Despite antiviral treatment, it is associated with significant mortality and a wide range of neurologic sequelae or neuropsychiatric disorders. Clinical presentation includes fever, headache, altered mental status, and focal or generalized seizures. In some cases, it can present with focal neurological deficits, such as an acute stroke. The aim of this study is to identify rare complications of HSVE. Presentation: We present a case of a 71-year-old female patient with herpes virus encephalitis and an ischemic cerebral accident. The findings of CT scan of the brain revealed an extensive right temporal hypodensity. CSF findings include an elevated protein level, normal glucose level and pleocytosis with lymphocyte predominance. The lumbar tap confirmed the presence of herpes simplex virus type 1 with polymerase chain reaction (PCR) in the CSF. Neurological manifestations include focal neurological deficit with left-sided hemiparesis and coma. After 40 days of complex therapy, an improvement in the mental state was observed. Conclusion: There are varying degrees of neurologic sequelae among survivors in children and adults despite the antiviral treatment. Herpes simplex encephalitis has significant morbidity and high mortality due to the lack of prophylactic treatment and preventable strategies.展开更多
Irritable bowel syndrome(IBS)is a common chronic functional gastrointestinal disorder affecting 10%-22%of adults.Its development is closely related to the gut microbiota,and the inflammatory and immune responses trigg...Irritable bowel syndrome(IBS)is a common chronic functional gastrointestinal disorder affecting 10%-22%of adults.Its development is closely related to the gut microbiota,and the inflammatory and immune responses triggered by the gut microbiota can lead to IBS.Vitamin D(VD)effectively treats IBS with fewer side effects by improving gut microbiota,immune regulation,and anti-inflammatory effects.In the future,it is necessary to carry out epidemiological studies on the relationship between VD and IBS,clinical studies on the efficacy of supplementing VD to improve IBS,and animal studies on the mechanism of VD improving IBS.Therefore,this paper discussed the relationship between VD and IBS.展开更多
BACKGROUND The coronavirus disease 2019(COVID-19)epidemic disrupted education systems by forcing systems to shift to emergency online leaning.Online learning satisfaction affects academic achievement.Many factors affe...BACKGROUND The coronavirus disease 2019(COVID-19)epidemic disrupted education systems by forcing systems to shift to emergency online leaning.Online learning satisfaction affects academic achievement.Many factors affect online learning satisfaction.However there is little study focused on personal characteristics,mental status,and coping style when college students participated in emergency online courses.regression analyses were performed to identify factors that affected online learning satisfaction.RESULTS Descriptive findings indicated that 62.9%(994/1580)of students were satisfied with online learning.Factors that had significant positive effects on online learning satisfaction were online learning at scheduled times,strong exercise intensity,good health,regular schedule,focusing on the epidemic less than one hour a day,and maintaining emotional stability.Positive coping styles were protective factors of online learning satisfaction.Risk factors for poor satisfaction were depression,neurasthenia,and negative coping style.CONCLUSION College students with different personal characteristics,mental status,and coping style exhibited different degrees of online learning satisfaction.Our findings provide reference for educators,psychologists,and school adminis-trators to conduct health education intervention of college students during emergency online learning.展开更多
BACKGROUND： Alcohol-based hand sanitizers （ABHSs） have been widely used in homes, workplaces and schools to prevent the spread of infectious diseases. We report a young child unintentionally ingested ABHS at a scho...BACKGROUND： Alcohol-based hand sanitizers （ABHSs） have been widely used in homes, workplaces and schools to prevent the spread of infectious diseases. We report a young child unintentionally ingested ABHS at a school, resulting in intoxication. METHODS：The child was a 6-year-old girl who had been brought to the emergency department （ED） for hypothermia, altered mental status （AMS）, periods of hypoventilation, hypothermia and vomiting. Computed tomography of her head revealed nothing abnormal in intracranial pathology. Urine drug screening was negative. Alcohol level was 205 mg/dL on admission. Other abnormal values included potassium of 2.8 mEq/L, osmolality of 340 mOsm/kg and no hypoglycemia. Further investigation revealed that the patient had gone frequently to the class restroom for ingestion of unknown quantities of ABHSs during the day. The patient was admitted for one day for intravenous fluid hydration and close observation of her mental status. RESULTS：The patient was discharged from the hospital the next day without any complications. CONCLUSION： Despite the large safety margin of ABHSs, emergency physicians need to be aware of the potential risk of ingestion of a large amount of such products in children and consider it in the assessment and management of school-age children with acute AMS.展开更多
BACKGROUND Hepatic encephalopathy(HE)is a neurocognitive condition in cirrhosis leading to frequent hospitalizations.Nonselective beta-blockers(NSBBs)are the mainstay of pharmacologic treatment in cirrhotic patients.W...BACKGROUND Hepatic encephalopathy(HE)is a neurocognitive condition in cirrhosis leading to frequent hospitalizations.Nonselective beta-blockers(NSBBs)are the mainstay of pharmacologic treatment in cirrhotic patients.We hypothesized that since NSBBs decrease cardiac output and portal flow,the decreased metabolic filtering process of liver parenchyma may lead to increased HE-related hospitalizations.AIM To evaluate the impact of NSBB administration on HE-related readmissions in cirrhotic patients.METHODS In this retrospective cohort study,we included 393 patients admitted to Baylor University Medical Center for liver-related portal hypertension indications between January 2013 and July 2018.Independent predictors of the first HErelated readmissions were identified using Cox proportional hazards analysis.The cumulative incidence of the first HE-related readmissions between patients receiving NSBBs and not receiving NSBBs was examined using Fine-Gray modeling to account for the competing risk of death or liver transplantation.RESULTS The mean age was 58.1±10.2 years and most patients fell into Child class C(49.1%)or B(43.8%).The median Model for End-Stage Liver Disease-Sodium score was 22(IQR:11).The cumulative incidence of the first HE-related readmissions was significantly higher in patients taking NSBBs compared to patients not receiving NSBBs(71.8%vs 41.8%,P<0.0001).In multivariate analysis,after adjusting for demographics,markers of liver disease severity,selective beta-blocker,lactulose and rifaximin use,NSBB use[Hazard ratio:1.74(95%CI:1.29-2.34)]was independently associated with the first HE-related readmissions over a median follow-up of 3.8 years.CONCLUSION NSBB use is independently associated with increased HE-related readmissions in patients with cirrhosis,regardless of liver disease severity.展开更多
BACKGROUND: Non-convulsive seizure(NCS) is an underdiagnosed, potentially treatable emergency with significant mortality and morbidity. The objective of this study is to examine the characteristics of patients with NC...BACKGROUND: Non-convulsive seizure(NCS) is an underdiagnosed, potentially treatable emergency with significant mortality and morbidity. The objective of this study is to examine the characteristics of patients with NCS presenting with altered mental status(AMS) and diagnosed with electroencephalography(EEG), to identify the factors that could increase the pre-test probability of NCS.METHODS: Retrospective study using the data collected prospectively. Inclusion criteria: patients older than 13 years with AMS. Exclusion criteria:(1) immediately correctable AMS(e.g., hypoglycemia, opiod overdose);(2) inability to undergo EEG;(3) hemodynamic instability. Outcomes compared between NCS and non-NCS cases: vital signs, lactate level, gender, witnessed seizure, use of anticonvulsive in the field or in the ED, history of seizure or stroke, head injury, abnormal neurological finding and new abnormal findings on head CT. Data presented as medians and quartiles for categorical and percentages with 95%CI for continuous variables. Univariate analyses were performed with Man-Whitney U and Fisher's Exact tests. A multivariate analysis model was used to test the predictive value of clinical variables in identifying NCS.RESULTS: From 332 patients(median age 66 years, quartiles 50–78), 16 were diagnosed with NCS(5%, 95%CI 3%–8%). Only age was signifi cantly different between the NCS vs. non-NCS groups in both univariate(P=0.032) and multivariate analyses(P=0.016).CONCLUSION: Other than age, no other clinically useful variable could identify patients at high risk of NCS. ED physicians should have a high suspicion for NCS and should order EEG for these patients more liberally.展开更多
Objective： To observe the clinical efficacy of electroacupuncture（EA） on Alzheimer＇s disease（AD）.Methods： A total of 50 AD patients were randomly allocated into a Western medication（WM） group（n=25） and an a...Objective： To observe the clinical efficacy of electroacupuncture（EA） on Alzheimer＇s disease（AD）.Methods： A total of 50 AD patients were randomly allocated into a Western medication（WM） group（n=25） and an acupuncture plus medication（APM） group（n=25）. Patients in the WM group took oral huperzine A capsules. In addition to huperzine A capsules, patients in the APM group also received EA at Shenting（GV 24）, Baihui（GV 20）, Dazhui（GV 14）,Fengfu（GV 16）, Mingmen（GV 4） and Yongquan（KI 1）. The needles on the above points were connected to G6805-Ⅱelectric stimulator [3 pairs： Shenting（GV 24） and Baihui（GV 20）; Dazhui（GV 14） and Fengfu（GV 16）; and bilateral Yongquan（KI 1）]. The needles were retained 25 min. The treatment was done once a day, and 10 times made up a course of treatment.The patients received a total of 3 treatment courses. There was a 3-day interval between two courses. The mini-mental state examination（MMSE） and Hasegawa dementia scale revised（HDS-R） were conducted before and after treatment. The clinical efficacies were evaluated when the treatment was completed.Results： Before treatment, there were no between-group statistical differences in MMSE and HDS-R scores（both P〈0.05）.After treatment, the MMSE and HDS-R scores in the APM group were significantly higher than those in the WM group（both P〈0.05）. The total effective rate in the APM group was 88.0%, versus 76.0% in the WM group, showing a statistical difference（P〈0.05）.Conclusion： EA is effective for AD and can improve clinical symptoms in AD patients.展开更多
Objective：To observe the clinical effects of tuina plus Western medication for functional dyspepsia （FD） due to liver qi stagnation and spleen deficiency.Methods：A total of 72 patients in conformity with the inclu...Objective：To observe the clinical effects of tuina plus Western medication for functional dyspepsia （FD） due to liver qi stagnation and spleen deficiency.Methods：A total of 72 patients in conformity with the inclusion criteria of FD were randomly divided into an observation group and a control group based upon the random number table,36 cases in each group.The control group was treated with mosapride citrate dispersible tablets,and the observation group was treated with the same tablets plus tuina.Before the treatment and 4 weeks after the treatment,the clinical symptoms,quality of life （QOL） and depression severity were observed by the scale,and were followed up two months later after the treatment for assessment of the clinical effects.Results：After the treatment and at the follow-up,the symptom scores of FD and the sores of Hamilton depression rating scale （HAMD） in both groups decreased,and the scores in Chinese version of quality of life questionnaire for functional digestive disorders （Chin-FDDQL） increased,with statistically significant differences in comparison with the same group before the treatment （all P〈0.05）.In comparison between the two groups at the same time point after the treatment,the scores of FD symptoms,HAMD and Chin-FDDQL were improved better in the observation group than those in the control group,with statistically significant differences （all P〈0.05）.The total effective rates at the follow-up were 91.7% in the observation group and 75.0% in the control group,without statistical difference between the two groups （P〉0.05）.The rate of clinical cure and remarkable effect was 66.7% in the observation group,higher than 41.7% in the control group,it is higher in the observation group than that in the control group,with a statistically significant difference between the two groups （P〈0.05）.Conclusion：Tuina plus Western medication is precise in the therapeutic effects for FD due to liver qi stagnation and spleen deficiency and can effectively relieve clinical symptoms,elevate the QOL and alleviate depression severity of the patients.Moreover,it＇s better than the treatment by Western medication alone in the long-term therapeutic effects.展开更多
Objective:To observe the clinical efficacy of heat-sensitive moxibustion for vascular dementia and explore its mechanism.Methods:A total of 70 patients with vascular dementia were randomized into an observation group ...Objective:To observe the clinical efficacy of heat-sensitive moxibustion for vascular dementia and explore its mechanism.Methods:A total of 70 patients with vascular dementia were randomized into an observation group and a control group,with 35 cases in each group.The control group was treated with piracetam,and the observation group was treated with heat-sensitive moxibustion on the basis of the treatment of the control group.The treatment lasted for 8 weeks.Before and after the treatment,the mini-mental state examination(MMSE),activity of daily living(ADL)and traditional Chinese medicine(TCM)symptom scores were assessed,and the levels of acetyl choline(Ach)and homocysteine(Hcy)were measured.The efficacy was evaluated after treatment.Results:The total effective rate of the observation group was significantly higher than that of the control group(P<0.05).After treatment,the MMSE and ADL scores in the observation group decreased significantly,and were lower than those in the control group(all P<0.05);the TCM symptom score of the observation group decreased significantly(P<0.05),while that of the control group had no significant change(P>0.05);the plasma Ach level in the observation group increased significantly(P<0.05),and the Hcy level decreased significantly(P<0.05),which were statistically different from those in the control group(both P<0.05).Conclusion:Heat-sensitive moxibustion plus piracetam is effective in treating vascular dementia.It can significantly improve dementia symptoms and ADL,which may be related to the correction of plasma Ach and Hcy levels.展开更多
Objective:To observe the clinical efficacy of heat-sensitive moxibustion for adjuvant treatment of depression in Parkinson disease and explore its mechanism.Methods:A total of 80 patients with Parkinson disease couple...Objective:To observe the clinical efficacy of heat-sensitive moxibustion for adjuvant treatment of depression in Parkinson disease and explore its mechanism.Methods:A total of 80 patients with Parkinson disease coupled with depression were randomized into an observation group and a control group,with 40 cases in each group.The control group was treated with levodopa and benserazide hydrochloride tablets and paroxetine tablets,while the observation group was treated with heat-sensitive moxibustion on the basis of the medications in the control group.The treatment course was 2 months.The Hamilton depression scale-17(HAMD-17),unified Parkinson's disease rating scale(UPDRS)and Parkinson's disease quality of life questionnaire-39(PDQ-39)were scored before and after the treatment,and the efficacy was evaluated after treatment.Levels of patients'serum dopamine(DA),5-hydroxytryptamine(5-HT),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)were detected before and after the treatment.Results:After treatment,the total effective rate of the observation group was higher than that of the control group(P<0.05).The HAMD-17 scores in the two groups decreased significantly after treatment(both P<0.05),and the score in the observation group was obviously lower than that in the control group(P<0.05).The component scores and total scores of UPDRS in both groups decreased significantly(all P<0.05),and the scores in the observation group were lower than those in the control group(all P<0.05).The score of PDQ-39 in the observation group decreased significantly(P<0.05),and was lower than that in the control group(P<0.05).After treatment,the serum DA and 5-HT levels in the observation group increased significantly(both P<0.05)and the TNF-αand IL-6 levels decreased significantly(both P<0.05),which were statistically different from those in the control group(all P<0.05).Conclusion:Heat-sensitive moxibustion has certain auxiliary effect in treating depression in Parkinson disease,significantly improving clinical symptoms and the quality of life,which may be related to the up-regulation of DA and 5-HT levels and down-regulation of TNF-αand IL-6 levels.展开更多
文摘BACKGROUND Hypertensive cerebral hemorrhage(HCH),the most common chronic diseases,has become a topic of global public health discussions.AIM To investigate the role of rehabilitative nursing interventions in optimizing the postoperative mental status recovery phase and to provide clinical value for future rehabilitation of patients with HCH.METHODS This randomized controlled study included 120 patients with cerebral HCH who were contained to our neurosurgery department between May 2021–May 2023 as the participants.The participants have randomly sampled and grouped into the observation and control groups.The observation group received the rehabilitation nursing model,whereas the control group have given conventional nursing.The conscious state of the patients was assessed at 7,14,21,and 30 d postoperatively.After one month of care,sleep quality,anxiety,and depression were compared between the two groups.Patient and family satisfaction were assessed using a nursing care model.RESULTS The results showed that the state of consciousness scores of the patients in both groups significantly increased(P<0.05)after surgical treatment.From the 14th day onwards,differences in the state of consciousness scores between the two groups of patients began to appear(P<0.05).After one month of care,the sleep quality,anxiety state,and depression state of patients were significantly better in the observation group than in the control group(P<0.05).Satisfaction with nursing care was higher in the observation group than in the control group(P<0.05).CONCLUSION The rehabilitation nursing model has a more complete system compared to conventional nursing,which can effectively improve the postoperative quality of life of patients with cerebral hemorrhage and improve the efficiency of mental state recovery;however,further analysis and research are needed to provide more scientific evidence.
文摘Objectives 1） To explore the relationship between RTIs and mental status of Naxi women; 2） to compare the differences of depression ＆ anxiety between Naxi women who have and not have RTIs; and 3） to put forward some suggestions for improving Naxi women＇s reproductive health in psychological point of view. Methods A cross-sectional survey was adopted, 280 married Naxi female volunteers who aged above 20 years old were selected by cluster random sampling from the two selected villages of Lugufu Township of Yanyuan county in Sichuan. Two self-reporting scales, CES-D and SAS were used for assessment of depression and anxiety of the subjects. Results The facts of mental status of Sichuan Naxi women brook no optimism. Among 280 Naxi reproductive age women who were investigated in current study, only 74 （26.4%） have no depression symptoms, and 116 （41.4%） have no anxiety symptoms. For the study population, the average total scores （TS） of CES-D was 20.1, and the average total index scores （TIS） of SAS was 50.2, and both of them were above a minimum value doubted to have symptoms. There were big differences of both average TS of CES-D and TIS of SAS between Naxi women who have and not have RTIs. Further analysis revealed that RTI was a main risk factor influencing women＇s mental status （OR = 16. 043 for depression, and OR = 12.954 for anxiety）. In addition, Naxi women＇s depression and anxiety were related to order births （≤2, OR=3.149, 95% CI： 1.228, 8.076）, sex debut was younger （≤17, OR=3.043, 95% CI： 1.895, 4.884）, and multiple pregnancy （≥ 3, OR=2.728, 95% CI： 1.990, 4.173）, etc. Conclusion For improving Naxi women＇s mental status, a pressing matter of the moment is for local medical persons to gain the knowledge about mental health and the diagnosis and treatment levels of psychological disorders. At the same time, pssychological counselling should become a main activity of reproductive health services.
文摘BACKGROUND Intravascular large B-cell lymphoma(IVLBCL)is a rare and aggressive subtype of non-Hodgkin lymphoma with a varied presentation and no pathognomonic findings.Early diagnosis is critical to altering the disease course as early treatment with chemoimmunotherapy is required to prevent a rapidly fatal outcome.Strategies including improved awareness of this clinical entity through publication of cases with unique presentations are essential to prompt consideration of IVLBCL early in the disease workup.Here,we present a case of IVLBCL presenting with altered mental status and systemic organ dysfunction.CASE SUMMARY A 61-year-old male patient presented with flu-like symptoms and a high fever.He experienced rapid clinical deterioration with liver,kidney failure,and shock despite rapid antibiotic administration and supportive care.A broad infectious workup was negative.Intracranial imaging revealed nonspecific changes to the corpus callosum suspicious for vasculitis.Renal biopsy was non-diagnostic.After further progression of his symptoms,the family elected to withdraw care and the patient died shortly thereafter.Post-mortem analysis revealed clear multi-organ involvement by IVLBCL,prompting re-examination of the ante-mortem renal biopsy that also identified IVLBCL involvement.CONCLUSION IVLBCL is a rare disease.Communication with specialties and early biopsy is critical to establishing the diagnosis and initiating therapy.
文摘BACKGROUND： Altered mental status （AMS） is a very common emergency case, but the exact etiology of many AMS patients is unknown. Patients often manifest vague symptoms, thus, AMS diagnosis and treatment are highly challenging for emergency physicians. The aim of this study is to provide a framework for the assessment of AMS patients. This assessment should allow providers to better understand the etiology of mental status changes and therefore improve diagnostic skills and management.METHODS： This is a prospective cohort observational study. We recruited all adult patients with undifferentiated AMS at a single center tertiary care academic emergency department over 24 months （June 2009 to June 2011）. Demographic characteristics, clinical manifestations, assessment approaches, causative factors, emergency treatments and outcomes were collected prospectively.RESULTS： In 1934 patients with AMS recruited, accounting for 0.93% of all emergency department （ED） patients, 1 026 （53.1%） were male, and 908 （46.9%） female. Their average age was 51.95±15.71 years. Etiologic factors were neurological （n=641; 35.0%）, pharmacological and toxicological （n=421; 23.0%）, systemic and organic （n=266; 14.5%）, infectious （n=167; 9.1%）, endocrine/metabolic （n=145; 7.9%）, psychiatric （n=71; 3.9%）, traumatic （n=38; 2.1%）, and gynecologic and obstetric （n=35; 1.9%）. Total mortality rate was 8.1% （n=156）. The death rate was higher in elderly patients （≥60） than in younger patients （10.8% vs. 6.9%, P=-0.003）.CONCLUSION： Patients with AMS pose a challenge for ED physicians. The most frequently encountered diagnostic categories causing AMS were primary CNS disorders, intoxication, organ system dysfunction, and endocrine/metabolic diseases. AMS has a high fatality rate in the ED. AMS is an important warning signal for ED patients because of its potentially fatal and reversible effects. Prompt evaluation and treatment are essential to decreasing morbidity and mortality associated with AMS.
文摘Objective:The study aimed to assess medication management compliance and mental health in elderly patients with hypertension.Method:The study evaluated medication compliance and mental health status of elderly hypertensive patients in China using simple random sampling.Data was collected using the Morisky Medication Compliance Questionnaire,Hospital Anxiety and Depression Scale,and a checklist.Ethical practices were strictly observed.Results:A study of 100 elderly hypertensive patients found poor drug management compliance,with female patients showing worse compliance.Female patients were more vulnerable to anxiety and depression.The study also found no significant association between gender,age,education level,marital status,living standards,and medication compliance.Barriers to medication management included food and daily necessities,lack of awareness about the importance of drug treatment,and basic family needs.The lowest-ranked barriers were lack of support from government health clinics,low income,and lack of family support.Conclusion:Based on the results,the study proposes an educational plan for elderly hypertensive patients and their families,to be evaluated and implemented by the hospital and township community service center.The plan aims to improve medication management and lifestyle modification compliance,encourage active participation,and provide access to medical and mental health clinics,support groups,and counseling services.
文摘Introduction: Herpes simplex virus is the most common etiology for life-threatening sporadic encephalitis worldwide. Antiviral therapy with acyclovir has been shown to reduce mortality and should be started promptly in patients with clinically suspected viral encephalitis before serological confirmation of the diagnosis. Despite antiviral treatment, it is associated with significant mortality and a wide range of neurologic sequelae or neuropsychiatric disorders. Clinical presentation includes fever, headache, altered mental status, and focal or generalized seizures. In some cases, it can present with focal neurological deficits, such as an acute stroke. The aim of this study is to identify rare complications of HSVE. Presentation: We present a case of a 71-year-old female patient with herpes virus encephalitis and an ischemic cerebral accident. The findings of CT scan of the brain revealed an extensive right temporal hypodensity. CSF findings include an elevated protein level, normal glucose level and pleocytosis with lymphocyte predominance. The lumbar tap confirmed the presence of herpes simplex virus type 1 with polymerase chain reaction (PCR) in the CSF. Neurological manifestations include focal neurological deficit with left-sided hemiparesis and coma. After 40 days of complex therapy, an improvement in the mental state was observed. Conclusion: There are varying degrees of neurologic sequelae among survivors in children and adults despite the antiviral treatment. Herpes simplex encephalitis has significant morbidity and high mortality due to the lack of prophylactic treatment and preventable strategies.
文摘Irritable bowel syndrome(IBS)is a common chronic functional gastrointestinal disorder affecting 10%-22%of adults.Its development is closely related to the gut microbiota,and the inflammatory and immune responses triggered by the gut microbiota can lead to IBS.Vitamin D(VD)effectively treats IBS with fewer side effects by improving gut microbiota,immune regulation,and anti-inflammatory effects.In the future,it is necessary to carry out epidemiological studies on the relationship between VD and IBS,clinical studies on the efficacy of supplementing VD to improve IBS,and animal studies on the mechanism of VD improving IBS.Therefore,this paper discussed the relationship between VD and IBS.
基金The study protocol was approved by the Ethics Committee of Hebei General University and complied strictly with ethical requirements.Ethics Review No.2020 scientific ethics No.30.
文摘BACKGROUND The coronavirus disease 2019(COVID-19)epidemic disrupted education systems by forcing systems to shift to emergency online leaning.Online learning satisfaction affects academic achievement.Many factors affect online learning satisfaction.However there is little study focused on personal characteristics,mental status,and coping style when college students participated in emergency online courses.regression analyses were performed to identify factors that affected online learning satisfaction.RESULTS Descriptive findings indicated that 62.9%(994/1580)of students were satisfied with online learning.Factors that had significant positive effects on online learning satisfaction were online learning at scheduled times,strong exercise intensity,good health,regular schedule,focusing on the epidemic less than one hour a day,and maintaining emotional stability.Positive coping styles were protective factors of online learning satisfaction.Risk factors for poor satisfaction were depression,neurasthenia,and negative coping style.CONCLUSION College students with different personal characteristics,mental status,and coping style exhibited different degrees of online learning satisfaction.Our findings provide reference for educators,psychologists,and school adminis-trators to conduct health education intervention of college students during emergency online learning.
文摘BACKGROUND： Alcohol-based hand sanitizers （ABHSs） have been widely used in homes, workplaces and schools to prevent the spread of infectious diseases. We report a young child unintentionally ingested ABHS at a school, resulting in intoxication. METHODS：The child was a 6-year-old girl who had been brought to the emergency department （ED） for hypothermia, altered mental status （AMS）, periods of hypoventilation, hypothermia and vomiting. Computed tomography of her head revealed nothing abnormal in intracranial pathology. Urine drug screening was negative. Alcohol level was 205 mg/dL on admission. Other abnormal values included potassium of 2.8 mEq/L, osmolality of 340 mOsm/kg and no hypoglycemia. Further investigation revealed that the patient had gone frequently to the class restroom for ingestion of unknown quantities of ABHSs during the day. The patient was admitted for one day for intravenous fluid hydration and close observation of her mental status. RESULTS：The patient was discharged from the hospital the next day without any complications. CONCLUSION： Despite the large safety margin of ABHSs, emergency physicians need to be aware of the potential risk of ingestion of a large amount of such products in children and consider it in the assessment and management of school-age children with acute AMS.
文摘BACKGROUND Hepatic encephalopathy(HE)is a neurocognitive condition in cirrhosis leading to frequent hospitalizations.Nonselective beta-blockers(NSBBs)are the mainstay of pharmacologic treatment in cirrhotic patients.We hypothesized that since NSBBs decrease cardiac output and portal flow,the decreased metabolic filtering process of liver parenchyma may lead to increased HE-related hospitalizations.AIM To evaluate the impact of NSBB administration on HE-related readmissions in cirrhotic patients.METHODS In this retrospective cohort study,we included 393 patients admitted to Baylor University Medical Center for liver-related portal hypertension indications between January 2013 and July 2018.Independent predictors of the first HErelated readmissions were identified using Cox proportional hazards analysis.The cumulative incidence of the first HE-related readmissions between patients receiving NSBBs and not receiving NSBBs was examined using Fine-Gray modeling to account for the competing risk of death or liver transplantation.RESULTS The mean age was 58.1±10.2 years and most patients fell into Child class C(49.1%)or B(43.8%).The median Model for End-Stage Liver Disease-Sodium score was 22(IQR:11).The cumulative incidence of the first HE-related readmissions was significantly higher in patients taking NSBBs compared to patients not receiving NSBBs(71.8%vs 41.8%,P<0.0001).In multivariate analysis,after adjusting for demographics,markers of liver disease severity,selective beta-blocker,lactulose and rifaximin use,NSBB use[Hazard ratio:1.74(95%CI:1.29-2.34)]was independently associated with the first HE-related readmissions over a median follow-up of 3.8 years.CONCLUSION NSBB use is independently associated with increased HE-related readmissions in patients with cirrhosis,regardless of liver disease severity.
基金supported by NIH grant 1RC3NS070658 to Bio-Signal Group Inc
文摘BACKGROUND: Non-convulsive seizure(NCS) is an underdiagnosed, potentially treatable emergency with significant mortality and morbidity. The objective of this study is to examine the characteristics of patients with NCS presenting with altered mental status(AMS) and diagnosed with electroencephalography(EEG), to identify the factors that could increase the pre-test probability of NCS.METHODS: Retrospective study using the data collected prospectively. Inclusion criteria: patients older than 13 years with AMS. Exclusion criteria:(1) immediately correctable AMS(e.g., hypoglycemia, opiod overdose);(2) inability to undergo EEG;(3) hemodynamic instability. Outcomes compared between NCS and non-NCS cases: vital signs, lactate level, gender, witnessed seizure, use of anticonvulsive in the field or in the ED, history of seizure or stroke, head injury, abnormal neurological finding and new abnormal findings on head CT. Data presented as medians and quartiles for categorical and percentages with 95%CI for continuous variables. Univariate analyses were performed with Man-Whitney U and Fisher's Exact tests. A multivariate analysis model was used to test the predictive value of clinical variables in identifying NCS.RESULTS: From 332 patients(median age 66 years, quartiles 50–78), 16 were diagnosed with NCS(5%, 95%CI 3%–8%). Only age was signifi cantly different between the NCS vs. non-NCS groups in both univariate(P=0.032) and multivariate analyses(P=0.016).CONCLUSION: Other than age, no other clinically useful variable could identify patients at high risk of NCS. ED physicians should have a high suspicion for NCS and should order EEG for these patients more liberally.
基金supported by Key Research Project of Science and Technology Bureau of Leshan Town,No.15ZDYJ0150~~
文摘Objective： To observe the clinical efficacy of electroacupuncture（EA） on Alzheimer＇s disease（AD）.Methods： A total of 50 AD patients were randomly allocated into a Western medication（WM） group（n=25） and an acupuncture plus medication（APM） group（n=25）. Patients in the WM group took oral huperzine A capsules. In addition to huperzine A capsules, patients in the APM group also received EA at Shenting（GV 24）, Baihui（GV 20）, Dazhui（GV 14）,Fengfu（GV 16）, Mingmen（GV 4） and Yongquan（KI 1）. The needles on the above points were connected to G6805-Ⅱelectric stimulator [3 pairs： Shenting（GV 24） and Baihui（GV 20）; Dazhui（GV 14） and Fengfu（GV 16）; and bilateral Yongquan（KI 1）]. The needles were retained 25 min. The treatment was done once a day, and 10 times made up a course of treatment.The patients received a total of 3 treatment courses. There was a 3-day interval between two courses. The mini-mental state examination（MMSE） and Hasegawa dementia scale revised（HDS-R） were conducted before and after treatment. The clinical efficacies were evaluated when the treatment was completed.Results： Before treatment, there were no between-group statistical differences in MMSE and HDS-R scores（both P〈0.05）.After treatment, the MMSE and HDS-R scores in the APM group were significantly higher than those in the WM group（both P〈0.05）. The total effective rate in the APM group was 88.0%, versus 76.0% in the WM group, showing a statistical difference（P〈0.05）.Conclusion： EA is effective for AD and can improve clinical symptoms in AD patients.
文摘Objective：To observe the clinical effects of tuina plus Western medication for functional dyspepsia （FD） due to liver qi stagnation and spleen deficiency.Methods：A total of 72 patients in conformity with the inclusion criteria of FD were randomly divided into an observation group and a control group based upon the random number table,36 cases in each group.The control group was treated with mosapride citrate dispersible tablets,and the observation group was treated with the same tablets plus tuina.Before the treatment and 4 weeks after the treatment,the clinical symptoms,quality of life （QOL） and depression severity were observed by the scale,and were followed up two months later after the treatment for assessment of the clinical effects.Results：After the treatment and at the follow-up,the symptom scores of FD and the sores of Hamilton depression rating scale （HAMD） in both groups decreased,and the scores in Chinese version of quality of life questionnaire for functional digestive disorders （Chin-FDDQL） increased,with statistically significant differences in comparison with the same group before the treatment （all P〈0.05）.In comparison between the two groups at the same time point after the treatment,the scores of FD symptoms,HAMD and Chin-FDDQL were improved better in the observation group than those in the control group,with statistically significant differences （all P〈0.05）.The total effective rates at the follow-up were 91.7% in the observation group and 75.0% in the control group,without statistical difference between the two groups （P〉0.05）.The rate of clinical cure and remarkable effect was 66.7% in the observation group,higher than 41.7% in the control group,it is higher in the observation group than that in the control group,with a statistically significant difference between the two groups （P〈0.05）.Conclusion：Tuina plus Western medication is precise in the therapeutic effects for FD due to liver qi stagnation and spleen deficiency and can effectively relieve clinical symptoms,elevate the QOL and alleviate depression severity of the patients.Moreover,it＇s better than the treatment by Western medication alone in the long-term therapeutic effects.
文摘Objective:To observe the clinical efficacy of heat-sensitive moxibustion for vascular dementia and explore its mechanism.Methods:A total of 70 patients with vascular dementia were randomized into an observation group and a control group,with 35 cases in each group.The control group was treated with piracetam,and the observation group was treated with heat-sensitive moxibustion on the basis of the treatment of the control group.The treatment lasted for 8 weeks.Before and after the treatment,the mini-mental state examination(MMSE),activity of daily living(ADL)and traditional Chinese medicine(TCM)symptom scores were assessed,and the levels of acetyl choline(Ach)and homocysteine(Hcy)were measured.The efficacy was evaluated after treatment.Results:The total effective rate of the observation group was significantly higher than that of the control group(P<0.05).After treatment,the MMSE and ADL scores in the observation group decreased significantly,and were lower than those in the control group(all P<0.05);the TCM symptom score of the observation group decreased significantly(P<0.05),while that of the control group had no significant change(P>0.05);the plasma Ach level in the observation group increased significantly(P<0.05),and the Hcy level decreased significantly(P<0.05),which were statistically different from those in the control group(both P<0.05).Conclusion:Heat-sensitive moxibustion plus piracetam is effective in treating vascular dementia.It can significantly improve dementia symptoms and ADL,which may be related to the correction of plasma Ach and Hcy levels.
文摘Objective:To observe the clinical efficacy of heat-sensitive moxibustion for adjuvant treatment of depression in Parkinson disease and explore its mechanism.Methods:A total of 80 patients with Parkinson disease coupled with depression were randomized into an observation group and a control group,with 40 cases in each group.The control group was treated with levodopa and benserazide hydrochloride tablets and paroxetine tablets,while the observation group was treated with heat-sensitive moxibustion on the basis of the medications in the control group.The treatment course was 2 months.The Hamilton depression scale-17(HAMD-17),unified Parkinson's disease rating scale(UPDRS)and Parkinson's disease quality of life questionnaire-39(PDQ-39)were scored before and after the treatment,and the efficacy was evaluated after treatment.Levels of patients'serum dopamine(DA),5-hydroxytryptamine(5-HT),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)were detected before and after the treatment.Results:After treatment,the total effective rate of the observation group was higher than that of the control group(P<0.05).The HAMD-17 scores in the two groups decreased significantly after treatment(both P<0.05),and the score in the observation group was obviously lower than that in the control group(P<0.05).The component scores and total scores of UPDRS in both groups decreased significantly(all P<0.05),and the scores in the observation group were lower than those in the control group(all P<0.05).The score of PDQ-39 in the observation group decreased significantly(P<0.05),and was lower than that in the control group(P<0.05).After treatment,the serum DA and 5-HT levels in the observation group increased significantly(both P<0.05)and the TNF-αand IL-6 levels decreased significantly(both P<0.05),which were statistically different from those in the control group(all P<0.05).Conclusion:Heat-sensitive moxibustion has certain auxiliary effect in treating depression in Parkinson disease,significantly improving clinical symptoms and the quality of life,which may be related to the up-regulation of DA and 5-HT levels and down-regulation of TNF-αand IL-6 levels.
