家庭功能状况对产妇抑郁的影响

目的探讨家庭功能状况对产妇抑郁的影响,为实施针对性心理护理提供依据.方法对100例初产妇,采用Smilk-stem家庭功能评估问卷及自评抑郁量表(SDS)调查分析其家庭功能及抑郁症状发生情况.结果家庭功能状态中高功能家庭80例(80.00%),发生抑郁27例(33.75%);一般家庭18例(18.00%),发生抑郁4例(22.22%);失职家庭2例(2.00%),发生抑郁1例(50.00%).32例抑郁产妇中轻度抑郁状态21例(65.60%),中度11例(34.40%).结论需加强对高功能家庭、产妇抑郁状态、相关因素的认识和教育,为产妇创造轻松愉快、和谐的家庭环境,促进产妇的身心健康.     

家庭功能对产妇分娩方式及产程进展的影响

目的了解产妇家庭功能与产妇分娩方式及产程进展的关系。方法对168例住院初产妇采用家庭功能量表评估其家庭功能，并观察产妇分娩方式及产程进展情况。结果168例产妇家庭功能中，114例（67．9％）认为家庭功能良好；54例（32．1％）认为家庭功能障碍；家庭功能良好者要求剖宫产率、第一产程时间显著高于、短于家庭功能障碍者（均P〈0．01），产后2h出血量少（P〈0．01）。结论强化产妇家庭功能及家庭成员对产妇心理支持，有利于产程进展，减少产后2h出血量，促进产妇身心健康。     

老年高血压患者家庭功能与抑郁的对应关系研究

目的探讨老年高血压患者家庭功能与抑郁的对应关系。方法采用家庭关怀度指数量表和老年抑郁量表（GDS）对整群便利抽样法抽取的莆田市415例老年高血压患者进行调查。结果家庭功能良好、一般和障碍者分别占58．07％、29．16％和12．77％，抑郁发生率为42．17％；家庭功能良好者GDS得分显著低于家庭功能一般和障碍者（均P〈0．01）；抑郁和家庭功能呈正相关（P〈0．01）。对应分析显示中重度抑郁对应家庭功能障碍，轻度抑郁对应家庭功能一般，无抑郁对应家庭功能良好。结论家庭功能越低，老年高血压患者抑郁发生率越高；应采取相应措施提高家庭功能，降低老年高血压患者抑郁发生。     

妊娠晚期胎死宫内对孕妇心理状态的影响

目的探讨妊娠晚期胎死宫内对孕妇心理状态的影响，为制定临床护理措施提供依据。方法应用抑郁自评量表（SDS）、焦虑自评量表（SAS）采用观察和交谈的方式对18例妊娠晚期胎死宫内孕妇的心理状态进行评估。结果18例孕妇中抑郁症状发生率83．33％，其中SDS评分〉60分占40．00％；焦虑症状发生率94．44％，SAS评分〉60分占41．18％；不同年龄、学历、家人关心程度的患者其抑郁、焦虑状态比较，差异有显著性意义（均P〈0．05）。结论医护人员应重视妊娠晚期胎死宫内孕妇这一特殊人群的心理问题，有针对性地制定护理对策，加强心理护理。     

凋亡抑制蛋白FLIP在肝癌组织中的表达和意义

目的检测凋亡抑制蛋白FLIP在人肝癌不同分化组织中的表达并揭示其在肝癌发生发展中的意义。方法采用免疫组织化学技术，分析86例肝癌标本（采用经典的Edmondson四级分级法，Ⅰ级18例，Ⅱ级25例，Ⅲ级21例，Ⅳ级22例），肝癌Hepg2细胞系1株细胞爬片的10样本中FLIP蛋白的表达并进行统计学分析比较。结果凋亡抑制蛋白FLIP在86例肝癌标本中有72例阳性表达（83．72％），Ⅰ级13／18（72．22％），Ⅱ级20／25（80．00％），Ⅲ级18／21（85．71％），Ⅳ级21／22（95．45％）（P〈0．05）；在肝癌Hepg2细胞系细胞爬片10个样本中全部阳性表达（100％），（P〈0．01）。结论凋亡抑制蛋白FLIP在肝癌组织中呈阳性表达；不同分化的肝癌组织其表达阳性率不同，分化越差其阳性表达率越高；这可能为揭示肝脏恶性肿瘤的发生、发展提供新的理论依据，并为肝癌的有效治疗提供新的思路。     

脑卒中患者抑郁状态与生活自理能力相关性调查

目的探讨脑卒中患者抑郁状态与生活自理能力的相关性。方法对100例脑卒中患者采用脑卒中后抑郁多模式诊断量表、功能独立性评定量表（FIM）及照顾者情况问卷进行调查。结果59．0％患者存在不同程度的抑郁；抑郁程度越重，FIM评分越低（均P〈0．01）；亲属照顾者抑郁发生率及抑郁程度显著低于和轻于护工照顾者（均P〈0．05）。结论脑卒中患者抑郁发生率高，抑郁越重生活自理能力越差，亲属照顾可有效预防或减轻抑郁的发生及其程度。     

采用HAD量表评价不孕症妇女心理状态

目的探讨简便可行的不孕症妇女心理状态的评价方法。方法采用医院焦虑及抑郁量表（HAD）测试不孕症妇女（观察组，64例）及正常育龄妇女（对照组，66例）的心理状态。结果观察组抑郁37例．发生率57．8％；对照组14例，发生率21．2％，两组比较，差异有显著性意义（P〈0．01）。观察组中原发不孕与继发不孕妇女抑郁评分显著高于对照组。结论HAD量表测试不孕症妇女心理状态具有科学性，其操作简便、患者易接受。     

恶性肿瘤患者家庭功能与应对方式调查

目的探讨恶性肿瘤患者的家庭功能状态和应对方式特点，以及二者之间的相互关系，为实施针对性家庭指导及护理干预提供依据。方法对107例恶性肿瘤患者采用医学应对方式问卷（MCMQ）和家庭功能评估问卷（APGAR）调查其家庭功能及应对方式。结果APGAR评分7．75±2．38，良好、一般及障碍家庭分别为69．16％、24．30％及6．54％；不同家庭功能恶性肿瘤患者应对方式评分除屈服外，面对及回避差异显著（均P〈0．01）。结论恶性肿瘤患者家庭功能总体水平较高，家庭功能良好患者较多采用面对疾病的应对方式。医护人员应针对低功能家庭较多采取回避的应对方式特点进行指导与帮助，使之能以积极的态度和行为面对疾病。     

高龄膀胱癌患者急性大出血的介入栓塞治疗

目的：评价高龄膀胱癌患者急性大出血介入栓塞术的安全性及疗效。方法：2007年6月～2010年6月对18例80岁以上高龄膀胱癌急性大出血患者进行介入栓塞治疗,并对术后并发症、血尿情况进行观察和随访。结果：全部18例患者共进行22例次介入治疗,双侧髂内动脉插管成功率100％（22／22）。血尿于术后数小时开始变淡,术后24、48及72h肉眼血尿消失分别为15（68．2％）、5（22．7％）及2（9．1％）例次。术后主要不良反应为臀部皮肤及软组织疼痛不适18（81．2％）例次,发热15（68．2％）例次,食欲不振4（18．2％）例次。结论：对于高龄膀胱癌患者出现的急性大出血,介入栓塞治疗是安全有效的方法。     

膀胱内不同化疗药物灌注预防浅表型膀胱肿瘤复发的临床观察

目的观察不同化疗药物膀胱内灌注预防浅表型膀胱肿瘤复发的疗效。方法将154例膀胱肿瘤术后患者分成表阿霉素组（EPI）、米托蒽醌组（MTZ）、吡柔比星组（THP）、丝裂霉素组（MMC）、羟基喜树碱组（HCTP），进行膀胱内灌注并随访观察3年。结果表阿霉素组、米托蒽醌组、吡柔比星组、丝裂霉素组、羟基喜树碱组无瘤生存率1年为80．6％（25／31），79．3％（23／29），80．6％（25／31），71．9％（23／32），71．0％（22／31）；2年为73．3％（22／30），72．4％（21／29），71．0％（22／31），64．5％（20／31），71．0％（22／31）；3年为60．0％（18／30），62．1％（18／29），61．3％（19／31），60％（18／30），61．3％（19／31）。结论五种药物膀胱内灌注预防浅表膀胱肿瘤复发3年无瘤生存率无显著性差异。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.