Volume 128 · Issue 14 · 2015

Optimizing treatment outcomes for depression requires understanding of how evidence-based treatments are utilized in clinical practice. Antipsychotic medications concurrent with antidepressant treatment are frequently used in major depression, but few studies have investigated trends and patterns of their use over time. This study aimed to examine the prescription patterns of antipsychotic medications for major depression in China from 2002 to 2012 and their association with treatment satisfaction and quality of life (QOL).

A total of 3655 subjects with major depression treated in 45 Chinese psychiatric hospitals/centers nationwide were interviewed between 2002 and 2012. Patients’ socio-demographic and clinical characteristics including psychopathology, medication side effects, satisfaction with treatment and QOL were recorded using a standardized protocol and data collection.

The frequency of antipsychotic use was 24.9% in the whole sample; the corresponding figures were 17.1%, 20.3%, and 32.8% in 2002, 2006, and 2012, respectively (χ² = 90.3, df = 2, P < 0.001). Multiple logistic regression analyses revealed that patients on concurrent antipsychotics had significantly more delusions or hallucinations, longer illness duration, greater side effects, and more likely to be treated as inpatients and in major hospitals (i.e., Level-III hospital). Antipsychotic use was associated with lower treatment satisfaction while there was no significant difference with respect to physical and mental QOL between the antipsychotic and nonantipsychotic groups.

Concurrent antipsychotic use was found in about one in four treated depressed patients in China, which has increased over a 10-year period. Considering the association of drug-induced side effects and the lack of patients’ and relatives’ satisfaction with antipsychotic treatment, further examination of the rationale and appropriateness of the use of antipsychotics in depression is needed.

Although coronary heart disease (CHD) is one of the major cardiovascular diseases, risk factors associated with the health-related quality of life (HRQoL) of CHD patients remain unclear. The present study was designed to determine the profile and significant factors of the HRQoL in CHD patients.

A cross-sectional study was conducted in rural communities of Fangshan District, Beijing, China. Socio-demographic, lifestyle, and comorbidity information of CHD patients were collected by a structured questionnaire and medical records. HRQoL was measured using European Quality of Life 5-dimensions (EQ-5D) scale and EQ Visual Analog Scale (EQ-VAS). Multiple linear and logistic regressions were performed to explore the association of potential risk factors with HRQoL scores and each EQ-5D, respectively.

Totally, 1928 CHD patients (mean age 61.64 ± 9.24 years; female:male = 2.4:1) were enrolled in the study. The mean score of EQ-5D index and EQ-VAS were 0.889 ± 0.172 and 71.56 ± 17.65, respectively. Multiple linear regression revealed that marital status, physical activity, moderate alcohol drinking, and family’s population were positive independent correlates of EQ-VAS, whereas diabetes mellitus and stroke were negative independent correlates (all P < 0.05). Age and stroke were negatively while physical activity, moderate alcohol drinking, family’s population and household income were positively correlated with EQ-5D index (all P < 0.05) independently. In addition, each of the five HRQoL dimensions had various specific determinants, including obesity, underweight, smoking or education.

Findings of the study highlight certain socio-demographic, lifestyle factors, and comorbid stroke or diabetes mellitus as correlates of HRQoL in Chinese CHD patients. Large-scale cohort studies should be carried out to confirm our results in the future.

Myocardial infarction is an important cause of mortality after carotid endarterectomy (CEA). Sevoflurane provides myocardial protection to patients undergoing coronary surgery, but whether it also reduces the incidence of myocardial injury in CEA patients is unclear. In this study, we evaluated the cardioprotective effect of low-dose sevoflurane with propofol in patients undergoing CEA.

This was a single-center, prospective, randomized study conducted between November 2011 and December 2013. The study population of 122 patients who underwent CEA were randomly assigned to two groups. Group A (n = 62) received propofol for anesthetic maintenance, and Group B (n = 60) additionally received 0.8% end-tidal sevoflurane. The bispectral index was kept at 40–60. Myocardial injury, defined as cardiac troponin I (cTnI) levels >0.04 ng/ml, was the primary end-point. Levels of cTnI were measured before anesthesia, and at 4, 24, and 72 h after surgery. Perioperative hemodynamic parameters and adverse cardiovascular events after surgery were also recorded.

Myocardial injury was detected in 18 patients in Group A and 7 in Group B. The difference was statistically significant (29.0% vs. 11.7%, P = 0.018). The hemodynamic parameters were comparable between the groups, as were adverse cardiovascular events (P = 0.619).

Low-dose sevoflurane inhalation along with propofol reduces the incidence of myocardial injury in symptomatic patients after CEA.

Cirrhosis is a common complication of chronic hepatitis B. It remains unclear if viral and biochemical parameters at baseline affect virological response to entecavir and therefore warrant investigation. In the present study, we aimed to evaluate the efficacy of entecavir therapy by monitoring virological response at the end of the 3^rd month of treatment and try to figure out whether baseline factors could help predict it in a cohort of hepatitis B virus (HBV) compensated cirrhosis patients and to determine the cut-off value of a predicting parameter.

A total of 91 nucleos(t)ide-naïve patients with HBV induced cirrhosis (compensatory stage) were enrolled in a prospective cohort. HBV DNA and alanine aminotransferase (ALT) were tested at baseline and monitored every 3–6 months after starting therapy.

Of all 91 patients, the median follow-up time was 12 (9–24) months. Overall, 64 patients (70.3%) achieved virological response in the 3^rd month. Univariate analysis showed that the 3^rd month virological response can be predicted by baseline HBV DNA levels (P < 0.001, odds ratio [OR]: 2.13, 95% confidence interval [CI]: 1.44–3.15), ALT value (P = 0.023, OR: 1.01, 95% CI: 1.00–1.01) and hepatitis B e antigen (HBeAg) negativity (P = 0.016, OR: 0.30, 95% CI: 0.11–0.80). Multiple regression analysis showed baseline HBV DNA level was the only parameter related to full virological response. Higher baseline HBV DNA strata indicated a higher probability that HBV DNA remains detectable at the 3^rd month (P = 0.001). Area under receiver operating characteristic curve for determining the 3^rd month virological response by baseline HBV DNA was 77.6% (95% CI: 66.7–85.2%), with a best cut-off value of 5.8 log₁₀.

Baseline HBV DNA, HBeAg negativity, and ALT were independent factors contributing to virological response at the 3^rd month. Further, multiple regression showed that HBV DNA level was the only parameter predicting full virological response as early as the 3^rd month, in this cirrhosis cohort.

Fetal insulin hypothesis was proposed that the association between low birth weight and type 2 diabetes is principally genetically mediated. The aim of this study was to investigate whether common variants in genes CDKAL1, HHEX, ADCY5, SRR, PTPRD that predisposed to type 2 diabetes were also associated with reduced birthweight in Chinese Han population.

Twelve single nucleotide polymorphisms (rs7756992/rs10946398 in CDKAL1, rs1111875 in HHEX, rs391300 in SRR, rs17584499 in PTPRD, rs1170806/rs9883204/rs4678017/rs9881942/rs7641344/rs6777397/rs6226243 in ADCY5) were genotyped in 1174 unrelated individuals born in Peking Union Medical College Hospital from 1921 to 1954 by TaqMan allelic discrimination assays, of which 645 had normal glucose tolerance, 181 had developed type 2 diabetes and 348 impaired glucose regulation. Associations of these 12 genetic variants with birthweight and glucose metabolism in later life were analyzed.

Birthweight was inversely associated with CDKAL1-rs10946398 (β = -41 g [95% confidence interval [CI]: -80, -3], P = 0.034), common variants both associated with increased risk of impaired glucose metabolism and decreased insulin secretion index later in life. After adjusting for sex, gestational weeks, parity and maternal age, the risk allele of CDKAL1-rs7756992 was associated with reduced birthweight (β = -36 g [95% CI: -72, -0.2], P = 0.048). The risk allele in SRR showed a trend toward a reduction of birthweight (P = 0.085).

This study identified the association between type 2 diabetes risk variants in CDKAL1 and birthweight in Chinese Han individuals, and the carrier of risk allele within SRR had the trend of reduced birthweight. This demonstrates that there is a clear overlap between the genetics of type 2 diabetes and fetal growth, which proposes that lower birth weight and type 2 diabetes may be two phenotypes of one genotype.

Obesity has become a major health problem among children and adolescents worldwide. This study aimed to examine the trends of overweight and obesity among childhood in China and assess their associations with family income, dietary intake, and physical activity (PA) between 1997 and 2009.

Two waves of cross-sectional data of Chinese children and adolescents aged 7–17 years from the China Health and Nutrition Survey were used. Weight and height were measured following standardized procedures. Dietary intake was assessed by 3 consecutive 24-h recalls. Childhood overweight and obesity were defined using the International Obesity Task Force-recommended body mass index cut-offs. Multivariate linear regression analysis was used to examine the associations of family income with diet intakes and PA. Multivariate logistic regression analysis was conducted to assess the associations of overweight and obesity with family income, dietary intake, and PA.

The prevalence of childhood overweight and obesity increased from 12.6% in 1997 to 22.1% in 2009, particularly in the medium- and high-family income groups, which increased by 102.7% and 90.3%, respectively. Higher fat intake (% energy), and moderate and vigorous PA were significantly associated with overweight and obesity in final model (odds ratio [OR] = 1.01, 95% confidence interval [CI]: 1.00–1.02, P = 0.004; and OR = 0.99, 95% CI: 0.98–1.00, P = 0.036, respectively).

The prevalence of overweight and obesity among Chinese children and adolescents has increased between 1997 and 2009. Reducing fat intake and increasing PA may help obesity prevention.

In qualitative diagnosis of bile duct stenosis, single diagnostic measure is difficult to make a correct diagnosis, to combine several diagnostic techniques may be helpful to make an accurate diagnosis. The aim of this study was to evaluate the value of intraductal ultrasonography (IDUS), endoscopic brush cytology and K-ras, P53 gene mutation in the early diagnosis of malignant biliary stricture.

From February 2012 to February 2013, 84 patients with suspected malignant biliary stricture were performed IDUS firstly, then endoscopic brush cytology and finally K-ras, P53 gene mutation detection, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of all above ways were evaluated and compared.

Of 84 patients, 52 cases were ultimately diagnosed malignant biliary stenosis; of which, 9 cases had no recurrence or metastasis to other organs after radical operation during the follow-up period. IDUS combined with brush cytology and K-ras + P53 gene mutation detection had obvious advantage in the sensitivity, accuracy and negative predictive value than any other joint detection and single detection (the advantage was more significant compared with IDUS + brush cytology or any single detection P < 0.01). There were obvious statistical significance in the sensitivity and accuracy between IDUS + brush cytology + P53 or IDUS + brush cytology + K-ras and IDUS + brush cytology or IDUS (P < 0.05). There was no statistical significance in the sensitivity, specificity, positive predictive value, negative predictive value and accuracy between IDUS + brush cytology + P53 and IDUS + brush cytology + K-ras (P > 0.05).

IDUS combined with brush cytology and K-ras, P53 gene mutation detection is better than the separate detection and contribute to the early diagnosis of malignant biliary stricture. Its more widespread use is recommended.

This study evaluated the efficacy of percutaneous nucleoplasty using coblation technique for the treatment of chronic nonspecific low back pain (LBP), after 5 years of follow-up.

From September 2004 to November 2006, 172 patients underwent percutaneous nucleoplasty for chronic LBP in our department. Forty-one of these patients were followed up for a mean period of 67 months. Nucleoplasty was performed at L3/4 in 1 patient; L4/5 in 25 patients; L5/S1 in 2 patients; L3/4 and L4/5 in 2 patients; L4/5 and L5/S1 in 7 patients; and L3/4, L4/5, and L5/S1 in 4 patients. Patients were assessed preoperatively and at 1 week, 1 year, 3 years, and 5 years postoperatively. Pain was graded using a 10-cm Visual Analogue Scale (VAS) and the percentage reduction in pain score was calculated at each postoperative time point. The Oswestry Disability Index (ODI) was used to assess disability-related to lumbar spine degeneration, and patient satisfaction was assessed using the modified MacNab criteria.

There were significant differences among the preoperative, 1-week postoperative, and 3-year postoperative VAS and ODI scores, but not between the 3- and 5-year postoperative scores. There were no significant differences in age, sex, or preoperative symptoms between patients with effective and ineffective treatment, but there were significant differences in the number of levels treated, Pfirrmann grade of intervertebral disc degeneration, and provocative discography findings between these two groups. Excellent or good patient satisfaction was achieved in 87.9% of patients after 1 week, 72.4% after 1 year, 67.7% after 3 years, and 63.4% at the last follow-up.

Although previously published short- and medium-term outcomes after percutaneous nucleoplasty appeared to be satisfactory, our long-term follow-up results show a significant decline in patient satisfaction over time. Percutaneous nucleoplasty is a safe and simple technique, with therapeutic effectiveness for the treatment of chronic LBP in selected patients. The technique is minimally invasive and can be used as part of a stepwise treatment plan for chronic LBP.

Although the early clinical outcomes of total knee arthroplasty (TKA) using minimally invasive surgery techniques have been widely described, data on the mid- to long-term outcomes are limited. We designed a retrospective study to compare the two most common TKA techniques - The modified quadriceps-sparing (m-QS) approach and the mini-medial parapatellar (MMP) approach - In terms of the clinical and radiographic parameters, over a minimum follow-up period of 5 years.

The m-QS approach was used in 31 knees and the MMP approach, in 36 knees. Knees in both groups were compared for component position and alignment, knee alignment, length of the skin incision, range of motion, Visual Analog Scale score, muscle torques, Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index, and number of complications.

There were no major intergroup differences in any of the clinical and radiographic outcomes assessed at the final follow-up examination.

On the basis of numbers studied, the m-QS group, which requires more technique, showed equivalent results with the MMP group in the postoperative 5 years. Preservation of the extensor mechanism in the m-QS approach could not ensure any improvement in the clinical outcomes during the mid-term follow-up duration.

To evaluate whether serotonin (5-HT), 5-HT2A receptor (5-HT2AR), and 5-HT transporter (serotonin transporter [SERT]) are associated with different disease states of depression, myocardial infarction (MI) and MI co-exist with depression in Sprague-Dawley rats.

After established the animal model of four groups include control, depression, MI and MI with depression, we measured 5-HT, 5-HT2AR and SERT from serum and platelet lysate.

The serum concentration of 5-HT in depression rats decreased significantly compared with the control group (303.25 ± 9.99 vs. 352.98 ± 13.73; P = 0.000), while that in MI group increased (381.78 ± 14.17 vs. 352.98 ± 13.73; P = 0.000). However, the depression + MI group had no change compared with control group (360.62 ± 11.40 vs. 352.98 ± 13.73; P = 0.036). The changes of the platelet concentration of 5-HT in the depression, MI, and depression + MI group were different from that of serum. The levels of 5-HT in above three groups were lower than that in the control group (380.40 ± 17.90, 387.75 ± 22.28, 246.40 ± 18.99 vs. 500.29 ± 20.91; P = 0.000). The platelet lysate concentration of 5-HT2AR increased in depression group, MI group, and depression + MI group compared with the control group (370.75 ± 14.75, 393.47 ± 15.73, 446.66 ± 18.86 vs. 273.66 ± 16.90; P = 0.000). The serum and platelet concentration of SERT in the depression group, MI group and depression + MI group were all increased compared with the control group (527.51 ± 28.32, 602.02 ± 23.32, 734.76 ± 29.59 vs. 490.56 ± 16.90; P = 0.047, P = 0.000, P = 0.000 in each and 906.38 ± 51.84, 897.33 ± 60.34, 1030.17 ± 58.73 vs. 708.62 ± 51.15; P = 0.000 in each).

The concentration of 5-HT2AR in platelet lysate and SERT in serum and platelet may be involved in the pathway of MI with depression. Further studies should examine whether elevated 5-HT2AR and SERT may contribute to the biomarker in MI patients with depression.

在《中华医学杂志》第128卷第10期第1336-1339页的文章“一名中国H综合征患者溶质载体家族29成员3的新突变的鉴定”中^[1]，全篇“c.1269_1270delinsa”一词应写成“c.1269_1270delinsT”。

Recent observational studies have shown that patients with higher Killips score (>I) have higher risk of new-onset atrial fibrillation (NOAF) following acute myocardial infarction (AMI), while others drew a neutral conclusion. The ultimate predictive value of high Killips class on NOAF remained obscure.

PubMed, Web of Science, China National Knowledge Infrastructure, and the Cochrane Controlled Trials Register Databases were searched until February 2015. Of the 3732 initially identified studies, 5 observational studies with 10,053 patients were analyzed.

The meta-analysis of these studies showed that higher Killips score on admission was associated with higher incidence of NOAF following AMI (odds ratio = 2.29, 95% confidence interval 1.96–2.67, P < 0.00001), while no significant differences exist among individual trials (P = 0.14 and I² = 43%).

Killips class >I was associated with the higher opportunity of developing NOAF following AMI.

To review the origin, diagnosis, treatment and public health concern of New Delhi metallo-β-lactamase (NDM)-producing bacteria. Data Sources: We searched database for studies published in English. The database of PubMed from 2007 to 2015 was used to conduct a search using the keyword term "NDM and Acinetobacter or Enterobacteriaceae or Pseudomonas aeruginosa."

We collected data including the relevant articles on international transmission, testing methods and treatment strategies of NDM-positive bacteria. Worldwide NDM cases were reviewed based on 22 case reports.

The first documented case of infection caused by bacteria producing NDM-1 occurred in India, in 2008. Since then, 13 blaNDM variants have been reported. The rise of NDM is not only due to its high rate of genetic transfer among unrelated bacterial species, but also to human factors such as travel, sanitation and food production and preparation. With limited treatment options, scientists try to improve available therapies and create new ones.

In order to slow down the spread of these NDM-positive bacteria, a series of measures must be implemented. The creation and transmission of blaNDM are potentially global health issues, which are not issues for one country or one medical community, but for global priorities in general and for individual wound care practitioners specifically.

全髋关节置换术（THA）和全膝关节置换术（TKA）是目前治疗髋关节和膝关节多种疾病的两种有效方法。尽管能够最大限度地减少术中失血，但预计术后血红蛋白（Hgb）损失，许多研究报告了THA和TKA后的隐性失血。^[1,2]

急性间歇性卟啉症（AIP）是一种常染色体显性先天性代谢错误，由卟啉原（PBG）脱氨酶缺乏引起，也称为羟甲基胆碱合酶（HMBS），血红素生物合成途径中的第三种酶。AIP的临床特征归因于血红素耗竭和血红素中间体PBG和氨基乙酰丙酸（ALA）在缺陷附近的积累。^[1]AIP患者可影响多个器官系统。典型的卟啉症发作以胃肠道症状、交感神经过度活动、神经系统表现和心理症状为特征。大多数患有AIP典型症状的患者是成年女性。我们报告了一名成年男性患者，在复发性腹痛10年后发现HMBS基因突变，诊断为AIP。

致编者：我们报告了两例使用领状吻合技术进行弓置换联合冷冻象鼻植入术治疗巨大弓和胸主动脉扩张的病例。

编者：腹腔镜单部位手术（LESS）已被广泛用于各种泌尿系统疾病，以提高安全性、结果和美容，并进一步减少侵入性。^[1]在这里，我们报告了在一家市立医院使用自制单端口装置进行腹腔镜单部位腹膜后肾上腺部分切除术的初步经验。

致小编：今天要给大家介绍一个很不寻常的案例。一名24岁男性因体力消耗后心悸气短2年病史咨询我们。体检发现心率80次/分，血压150/70 mmHg。心脏听诊显示舒张期和收缩期（VI类）杂音3^研发和4^th左侧胸骨边缘的肋骨。他的纽约心脏协会功能分级为III级。超声心动图显示左心室轻度增大（57 mm），主动脉根部明显增宽，右冠状窦变薄，延伸至右心室远端流出道，流出道上部有直径1.4 cm的缺损。经食管超声心动图显示主动脉根部直径为46.2 cm。有轻度主动脉瓣反流，主动脉瓣面积2.24 cm²多普勒超声显示右室流出道缺损处有持续的舒张期和收缩期血流，流速4.49 m/s，压差80 mmHg；以及肺动脉瓣口处的血流速度增加。患者被诊断为瓦尔萨尔瓦动脉瘤窦破裂（RSVA）。由于患者强烈要求采取微创治疗，我们选择了经导管封堵。此外，患者签署了使用动脉导管未闭（PDA）封堵器的同意书。

编辑：免疫球蛋白G4（IgG4）相关疾病（IgG4-RD）是一种多系统自身免疫性疾病，可累及胰腺、肝脏、唾液腺、眼附件和其他器官。^[1]最近，已经在眼部、甲状腺、硬脑膜和其他组织中描述了IgG4阳性粘膜相关淋巴组织(MALT)淋巴瘤。^[2]然而，仍不清楚IgG4-RD是否使患者易患MALT淋巴瘤。本文记录了一例罕见的泪腺IgG4阳性MALT淋巴瘤，有12年良性炎性病变病史。一名56岁的中国男性在12年前因右眼持续缓慢突眼到我们眼科就诊。他于10年前在另一家医院接受了右眼眶活检，诊断为右眼眶良性炎性病变。他当时没有接受IgG4染色或血清IgG4检查。他没有复视、干眼症或口干症。他没有注意到其他肿块，其他方面都很好。经检查，右眼表现为眼球突出（Hertel眼球突出测量法测量右侧角膜表面位置为22mm，左侧为17mm）。无浅表淋巴结病。胸部是安全的。眼眶磁共振成像（MRI）检查显示右侧泪腺增大，边缘明显。在T1加权像和T2加权像上以等信号为主。在对比增强MRI图像上可见轻度不均匀增强[图1].血清IgG4为43 mg/dl（正常：<135 mg/dl)。建议患者接受眼眶活检。据报告，术中冰冻切片与低恶性度肿瘤一致。进行了完全切除。组织病理学检查显示小的弥漫性浸润淋巴细胞[图2a].在免疫组织化学检查时，这些小的单调淋巴细胞用CD20和Bcl2染色阳性，而对CD3、CD5、CD10和CD23染色阴性。浆细胞表达IgG并显示κ轻链限制。显著比例的浆细胞和小淋巴细胞表达IgG4。在许多区域，每个高倍视野有超过40个IgG4+细胞[图2b].在这些地区，IgG4/IgG比率超过40%。在IgG4+细胞浓度最高的区域中观察到κ轻链限制，这意味着IgG4在轻链限制的浆细胞中表达。一部分小淋巴细胞也显示弱IgG4表达。卵泡外的Ki-67表达约为10%。诊断为右泪腺IgG4阳性MALT淋巴瘤。患者手术后出院，并接受25 mg/d泼尼松治疗4周，之后每2周将剂量减少5 mg/d。他的症状逐渐好转。2个月后血清IgG4水平降至89 mg/dl。在12个月的定期随访中，没有复发的迹象。