Objective:To describe and analyze suicide risk of patients with schizophrenia,major depressive disorder,and bipolar disorder.Methods:A total of 2 016 patients with schizophrenia,903 patients with major de-pressive disorder,and 381 patients with bipolar disorder from inpatients,clinics,or communities who met the diag-nostic criteria of the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition were recruited.All patients were interviewed by psychiatrists using the Mini International Neuropsychiatric Interview to diagnose mental disor-ders and assess suicide risk,as well as Clinical-Rated Dimensions of Psychosis Symptom Severity(CRDPSS)to as-sess symptoms.Differences and risk factors of suicide risk among three types of mental disorders were explored u-sing multivariate logistic regression analysis.Results:In the past one month,37 patients with schizophrenia(1.8％),516 patients with major depressive disorder(57.1％),and 102 patients with bipolar disorder(26.8％)had suicide risk.Compared with patients with schizophrenia,suicide risk in patients with major depressive disorder(OR=36.50)and bipolar disorder(OR=20.10)increased.Female(OR=1.87),smoking(OR=1.76),family history of suicide(OR=5.09),higher score of CRDPSS hallucination(OR=1.80),and higher score of CRDPSS depression(OR=1.54)were risk factors of suicide risk of patients.Conclusions:Suicide risk of patients with ma-jor depressive disorder and bipolar disorder is higher than that of patients with schizophrenia.In clinical practice,it is important to regularly assess suicide risk of patients.Patients who experience symptoms of hallucination and de-pression should be paid more attention to.

Objective:To explore the changes of intracranial pressure in intensive care unit (ICU) patients during the occurrence and evolution of delirium by using bedside ultrasound to measure the optic nerve sheath diameter (ONSD) to evaluate intracranial pressure.Methods:A retrospective observational study was conducted. Adult patients who developed delirium during hospitalization in the general ICU of Beihai People's Hospital from October 2020 to November 2021 were enrolled, and patients who did not have ultrasonographic ONSD records within 24 hours after the diagnosis of delirium were excluded. The ONSD measured before delirium was recorded as ONSD 0, the ONSD measured within 24 hours of the onset of delirium recorded as ONSD 1, and the ONSD reexamined after ONSD 1 recorded as ONSD 2. Patients were divided into intracranial hypertension group (ONSD 1 > 5 mm) and normal intracranial pressure group (ONSD 1 ≤ 5 mm) according to the size of ONSD 1. According to the outcome of delirium, the patients were divided into cured, improved, and non-improved groups. The reduction ratio of ONSD 2 to ONSD 1 in the three groups were calculated and compared. Pearson correlation test was used to analyze the correlation between fluid balance and ONSD changes after delirium. Results:There were 43 patients, including 40 cases in the intracranial hypertension group (the incidence rate was 93.0%), 3 cases in the normal intracranial pressure group, 23 cases were cured, 13 cases were improved, and 7 cases were not improved. In the intracranial hypertension group, 11 cases had ONSD 0 and ONSD 1 records, and ONSD 1 was significantly higher than ONSD 0 [mm: 5.88±0.61 vs. 5.34±0.57, 95% confidence interval (95% CI) -0.85 to -0.23, P = 0.003]. The reduction ratio of ONSD 2 to ONSD 1 in the cured group was significantly higher than that in the improved group and the non-improved group [(12.04±6.20)% vs. (5.68±4.10)%, (0.17±3.96)%; 95% CI were 2.37 to 10.33, 6.41 to 17.31, P values were 0.003 and 0.000, respectively]. The correlation analysis showed that the reduction ratio of ONSD 2 to ONSD 1 was negatively correlated with fluid balance ( r = -0.42, 95% CI was -0.66 to -0.10, P = 0.012). Conclusions:The incidence of intracranial hypertension in ICU delirium patients is high. A more pronounced decrease in intracranial pressure predicts a better delirium outcome. Dynamic ONSD measurement can provide valuable information for the prevention and treatment of delirium.

Objective:To investigate the effect of thromboelastography (TEG) combined with point-of-care ultrasound (POCUS) guidance on the prevention of internal jugular vein catheterization related thrombosis.Methods:The patients who required internal jugular vein catheterization admitted to the department of critical medicine of Beihai People's Hospital from December 2018 to April 2020 were enrolled. Patients were divided into two groups according to the random number table method. For the combined cathetherization group, ultrasound was used to examine bilateral internal jugular veins before catheterization. The larger diameter and better filled vein and site were selected for puncture. If both internal jugular veins were not fulfilled well, puncture were performed after fluid administration. At the same time, anticoagulant, antiplatelet or reducing blood viscosity drugs were used according to coagulation function and bleeding risk under the monitoring of TEG. The hemodynamic state of the internal jugular vein was monitored by ultrasound every day. If the vein collapsed or the blood flow was slow, the cause should be tried to be found and improved. Once thrombosis was found, the catheter should be removed. For the routine cathetherization group, the right side internal jugular vein was prior to be punctured according to body surface symbols. The other treatment of the two groups were the same as routine treatment. The conditions of thrombosis and bleeding were recorded.Results:Ninety-seven patients were selected, 51 cases in the combined cathetherization group and 46 cases in the routine cathetherization group. There was no significant differences in gender, age, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), risk of deep vein thrombosis score (Caprini), CRUSADE bleeding risk score, the proportion of high bleeding risk, disease types, the proportion of coagulation disorder and catheterization time between the two groups, but the anticoagulation treatment proportion in the combined cathetherization group was higher than that in the routine cathetherization group (66.7% vs. 30.4%, P < 0.01). The incidence of thrombosis in the combined cathetherization group was lower than that of the routine cathetherization group (39.2% vs. 78.3%, P < 0.01), and the thrombus of the combined cathetherization group was smaller than that of the routine cathetherization group [cm 3: 0.077 (0.047, 0.089) vs. 0.341 (0.070, 0.378), P < 0.01]. There were no major bleeding events in the two groups. Conclusion:Based on TEG and POCUS, the antithrombotic bundles can reduce the incidence of thrombosis after internal jugular vein catheterization and the thrombus size, and does not increase the risk of bleeding, which is worthy of clinical application.

Hypothyroidism is a common adverse reaction in clinical multi-target tyrosine kinase inhibitor (TKI) and may be used as a predictor of efficacy of TKI drugs.Studies show that hypothyroidism is significantly associated with good prognosis in patients with renal cell carcinoma treated with multi-target TKI,which may be related to inhibition of vascular endothelial growth factor receptor pathway,potential off-target effects and inhibition of cell proliferation.Whereas in the patients with hepatocellular carcinoma who received multi-target TKI therapy,hypothyroidism is an indicator of poor prognosis,which is related to the T3/TR pathway regulating liver cancer growth and invasion.The predictive function and mechanism of thyroid hormone levels in different tumor patients receiving multi-target TKI drugs are different,and further research is still needed.

OBJECTIVETo analyze the clinical characteristics and causative mutation in an ethnic Han Chinese family affected with punctate palmoplantar keratoderma (PPPK).

METHODSClinical characteristics and inheritance pattern of the family were analyzed. Two seriously affected individuals from the family were investigated by whole exome sequencing. Three healthy individuals from the family and 120 non-PPPK individuals were evaluated to validate the result.

RESULTSThe family was characterized by keratotic papules on the palms and soles, which gradually increased in size and number with age and coalesced with each other, particularly over the pressure part of the palms and soles. The family has featured autosomal dominant inheritance. A heterozygous frameshift variant c.419delC in exons of the CELA1 gene was identified in all affected individuals but not among non-affected members.

CONCLUSIONA heterozygous frameshift variant c.419delC in CELA1 gene probably underlies the disease in the family affected with PPPK.

Adult ; Base Sequence ; Female ; Frameshift Mutation ; Heterozygote ; Humans ; Keratoderma, Palmoplantar ; genetics ; Male ; Middle Aged ; Molecular Sequence Data ; Mutation ; Pancreatic Elastase ; genetics ; Pedigree ; Young Adult

Objective To evaluate the clinical efficacy of acupuncture plus acupoint application in treating irritable bowel syndrome with diarrhea (IBS-D).Method Sixty patients were randomized into two groups, 30 cases in each group. The acupuncture group was intervened by acupuncture at Neiguan (PC6), Zhongwan (CV12), and Zusanli (ST36), etc, plus application withBai Jie Zi(Semen Brassicae) powder at Qihai (CV6), Guanyuan (CV4), and Tianshu (ST25), etc; the medication group was prescribed with oral administration of Trimebutine maleate capsules (0.2 g each dose, 3 times a day). Four-week treatment was taken as a course. The symptoms score and quality of life (QOL) scale were evaluated prior to and after the treatment.Result The clinical symptoms were significantly improved in the acupuncture group, and the total effective rate was89.3%, significantly higher than 63.0% in the medication group (P<0.05). After 4-week treatment, the clinical symptoms scores of the two groups were analyzed by rank-sum test (Z=-19.627,P=0.000<0.05), revealing a significant difference between the two groups and indicating that the improvements of clinical symptoms in the acupuncture group were more significant than those in the medication group. After 4-week treatment, the general QOL scores of the two groups were examined by rank-sum test (Z=-10.039, P=0.000<0.05), revealing a significant difference between the two groups and indicating that the improvement of QOL in the acupuncture group was superior to that in the medication group.Conclusion Acupuncture plus acupoint application can obviously mitigateabdominal pain and discomfort.

A 70-year-old female patient with motor neuron disease was given an IV infusion of ciprofloxacin 0.4 g once daily because of acute exacerbation of chronic bronchitis. On day 10,she developed hypokalemia(blood potassium 2.7 mmol/L)and potassium supplement was given. On day 11,the patient experienced loss of consciousness and cardiac arrest. The patient was given chest compression instantly and regained consciousness in three minutes. Electrocardiogram showed torsades de pointes ventricular tachycardia. Her QT corrected by heart rate(QTc)was 546 ms and blood potassium was 3.4 mmol/L.Potassium supplement was given again. On day 13,the patient′s QTc was 561 ms and blood potassium was 3.2 mmol/L. Ciprofloxacin induced QT interval prolongation was considered. On day 6 of ciprofloxacin withdrawal,the patient′s QTc was 460 ms and blood potassium was 3.9 mmol/L.

A 70-year-old female patient with motor neuron disease was given an IV infusion of ciprofloxacin 0.4 g once daily because of acute exacerbation of chronic bronchitis. On day 10,she developed hypokalemia(blood potassium 2.7 mmol/L)and potassium supplement was given. On day 11,the patient experienced loss of consciousness and cardiac arrest. The patient was given chest compression instantly and regained consciousness in three minutes. Electrocardiogram showed torsades de pointes ventricular tachycardia. Her QT corrected by heart rate(QTc)was 546 ms and blood potassium was 3.4 mmol/L.Potassium supplement was given again. On day 13,the patient′s QTc was 561 ms and blood potassium was 3.2 mmol/L. Ciprofloxacin induced QT interval prolongation was considered. On day 6 of ciprofloxacin withdrawal,the patient′s QTc was 460 ms and blood potassium was 3.9 mmol/L.

Background:High-fat diet leads to intestinal mucosa barrier dysfunction,but the mechanism is not clear. High-fat diet can induce increase of bile acid. Aims:To investigate whether the high bile acid induced by high-fat diet could act on intestinal stem cell to disrupt stem cell differentiation and imparing the intestinal mucosa. Methods:Twenty-four rats were divided into 3 groups:fed with regular diet,high-fat diet and high-fat diet + cholestyramine,respectively,for 2 weeks. Serum bile acid was detected by ELISA. Ileal diameter was measured and HE staining was performed to observe histology of intestinal mucosa. Expression of Lgr5 gene was determined by RT-qPCR. Ileal tissue fed with regular diet was cultured with deoxycholic acid(DCA)or DCA + cholestyramine for 24 hours in vitro,expression of Lgr5 gene was determined by RT-qPCR. Results:Compared with control group,serum bile acid was significantly increased(P < 0. 05),ileal diameter was significantly decreased,height of intestinal crypts and villus was significantly decreased(P < 0. 05),and expression of Lgr5 gene was significantly decreased in high-fat diet group(P < 0. 01). All the above-mentioned indices were significantly ameliorated in high-fat diet + cholestyramine group(P < 0. 05). In vitro study showed that expression of Lgr5 gene was significantly decreased in DCA group than in control group(P < 0. 01),and cholestyramine could significantly increase expression of Lgr5 gene(P < 0. 05). Conclusions:High-fat diet induced increasing of circulatory bile acid can cause injury of intestinal mucosa by inhibiting stem cell function,which can be ameliorated by cholestyramine.

Objective:To observe the clinical efficacy of warm needling plus acupoint sticking therapy for primary dysmenorrhea.
Methods:A total of 60 eligible cases were randomly allocated into a treatment group (n=30) and a control group (n=30) according to their sequence of consultation. Patients in the treatment group were treated with warm needling combined with acupoint sticking therapy, whereas patients in the control group were treated with oral Ibuprofen (Fenbid) capsules. After two menstrual cycles, the visual analogue scale (VAS) score, COX menstrual symptom scale (CMSS) and clinical efficacy were compared between the two groups.
Results:After treatment, the VAS and CMSS scores were significantly reduced in both groups, indicating that both treatment protocols can remarkably alleviate pain. There was a between-group statistical difference in comparing the CMSS score (P<0.05), but no between-group statistical difference in the VAS score (P>0.05). However, the follow-up visit showed between-group statistical differences in comparing VOA and CMSS scores (bothP<0.01). The clinical effect, relapse rate and long-term efficacy in the treatment group were better than those in the control group.
Conclusion:Warm needling plus acupoint sticking therapy is a simple but effective therapy for primary dysmenorrhea. In addition, it causes fewer cases with relapse.