精神分裂症患者攻击行为与血清甲状腺素睾酮水平的相关性

目的：探讨精神分裂症患者攻击行为与血清甲状腺素、睾酮水平的相关性。方法对120例精神分裂症患者采用简明精神病量表评定精神症状,依据既往暴力史及外显攻击行为量表评定攻击行为,将有攻击行为的70例患者设为研究组,无攻击行为的50例患者设为对照组。检测两组促甲状腺激素、血清游离三碘甲状腺原氨酸、血清游离甲状腺素、总三碘甲状腺原氨酸、总甲状腺激素及血清睾酮水平。对检测结果进行对比分析及相关分析。结果研究组血清总三碘甲状腺原氨酸、血清游离三碘甲状腺原氨酸水平显著高于对照组（P＜0．05）,促甲状腺激素水平显著低于对照组（P＜0．01）。研究组血清总三碘甲状腺原氨酸水平与外显攻击行为量表中言语攻击、财产攻击因子分呈正相关（P＜0．05）,与简明精神病量表中缺乏活力因子分呈负相关（P＜0．05）;血清游离三碘甲状腺原氨酸与外显攻击行为量表中财产攻击、自身攻击因子分呈正相关（P＜0．05）;男性血清睾酮水平与外显攻击行为量表中言语攻击、自身攻击因子分呈正相关（P＜0．05）,与简明精神病量表中缺乏活力因子分呈负相关（P＜0．05）;女性血清睾酮水平与外显攻击行为量表中自身攻击因子分呈正相关（P＜0．05）,与简明精神病量表中缺乏活力因子分呈负相关（P＜0．05）。结论精神分裂症患者攻击行为与血清总三碘甲状腺原氨酸、血清游离三碘甲状腺原氨酸水平及血清睾酮水平的变化呈正相关。临床上对伴有攻击行为的精神分裂症患者可定期监测甲状腺激素及睾酮水平进行预测性评估,为早期干预提供依据。     

认知行为治疗对产后抑郁症患者疗效及性激素水平的影响

目的：探讨认知行为治疗对产后抑郁症患者临床疗效及性激素水平的影响。方法将80例产后抑郁症患者分为A组与B组,将40名健康产妇设为对照组;A组与B组分别予以认知行为治疗及抗抑郁药物治疗,观察8周。于治疗前后采用汉密顿抑郁量表、副反应量表评定临床疗效及不良反应,同时检测3组被试雌二醇、孕酮及泌乳素水平。结果治疗8周末,A组痊愈率为63．2％,B组为65．8％,两组比较差异无显著性（ P＞0．05）。A组副反应量表的严重程度及痛苦感觉评分显著低于B组（P＜0．01）。入组时 A组B组雌二醇水平均显著低于对照组（P＜0．01）,孕酮水平显著高于对照组（P＜0．01）;研究8周末A组与B组雌二醇水平显著升高（P＜0．01）,孕酮水平显著降低（P＜0．01）,3组间比较差异无显著性（P＞0．05）,B组泌乳素水平显著低于A组及对照组（P＜0．01）。结论认知行为治疗对产后抑郁症患者有较好的疗效,无明显不良反应,有利于患者性激素水平恢复正常。     

草酸艾司西酞普兰与阿米替林对抑郁症认知功能及P300的影响

目的：探讨草酸艾司西酞普兰与阿米替林对抑郁症患者认知功能及P300的影响。方法将52例抑郁症患者分为A组和B组,每组26例,分别口服草酸艾司西酞普兰、阿米替林治疗,观察8周。抽取同期健康志愿者26名设为C组。A组和B组于治疗前后采用汉密顿抑郁量表评定抑郁状况,同时检测P300评价认知功能;C组于入组时检测 P300。结果治疗8周末,A组显效率69．2％、总有效率80．7％,B组分别为57．7％、76．9％,两组比较差异无显著性（χ2＝0．12、0．75,P＞0．05）。治疗后A组和B组P300的P2、N2、P3潜伏期明显低于治疗前（ P＜0．05或0．01）;A 组 P2、N2、P3波幅明显高于治疗前（ P＜0．01）,且 N2、P3波幅显著高于 B 组（P＜0．01）。结论草酸艾司西酞普兰治疗抑郁症疗效显著,总体疗效与阿米替林相当,但艾司西酞普兰能显著改善抑郁症患者的认知功能,显著优于阿米替林治疗。     

男性肝硬变"三联征"的病机探讨

目的：探讨男性肝硬变伴“三联征”（肝掌、蜘蛛痣、乳房发育）患者血清一氧化氮（NO）、雌二醇（E2）水平的变化及其与“三联征”的关系、有关机理和临床意义。方法：Griess试剂检测64例男性肝硬变（按Child-Pugh分为A组和B、C组）及36例年龄匹配男性健康体检者血清NO水平，放射免疫法检测E2水平。结果：血清NO在肝硬变各组明显高于对照组（P＜0．05），B、C组明显高于A级组（P＜0．01）B、C级组明显高于A级组和对照组，A级组与对照组之间也有显著差异。血清E2在B、C级组和A级组明显低于对照组（P＜0．01，P＜0．05）B、C级组与A级组无显著差异。（P＞0．05）。结论：男性肝硬变伴“三联征”患者血清E2水平下降，NO水平升高。男性肝硬变“三联征”并不一定是由于雌激素水平升高引起的，而有可能是升高的NO使小动脉末梢的毛细血管扩张所致。     

子宫内膜癌患者血清人附睾分泌蛋白4水平及其临床意义

【目的】探讨子宫内膜癌患者血清人附睾分泌蛋白4（H E4）水平及其临床意义。【方法】采用电化学发光法法对子宫内膜癌患者（A组）、子宫内膜增生患者（B组）及正常健康妇女（C组）各60例进行血清中HE4的含量测定,分析子宫内膜癌临床FIGO分期与血清HE4水平的关系,并对比A组治疗有效者治疗前后H E4水平。【结果】A组血清H E4显著高于B组和C组,且差异有显著性（ P＜0．01）。A组患者术前血清HE4浓度随子宫内膜癌的临床FIGO分期提高而提高,各分期之间比较差异有统计学意义（ P ＜0．01）。A组 H E4水平明显低于治疗前,且差异有显著性（ P ＜0．01）。【结论】血清 H E4水平可作为子宫内膜癌辅助诊断、判断恶性程度及是否转移、观察疗效的有效指标。     

氨磺必利对老年精神分裂症临床疗效及认知功能的影响

目的：探讨氨磺必利对老年精神分裂症患者临床疗效及认知功能的影响。方法将90例老年精神分裂症患者随机分为A组与B组,同期抽取健康体检退休职工45名设为对照组。A组与B组分别口服氨磺必利与利培酮治疗,观察12周。采用阳性与阴性症状量表、简明精神病量表评定临床疗效,副反应量表评定不良反应,采用威斯康星卡片分类测验评定认知功能。结果治疗后两组患者阳性与阴性症状量表及简明精神病量表评分均较治疗前显著下降（P＜0．05或0．01）。治疗12末两组患者威斯康星卡片分类测验的持续错误数、持续应答数、完成第1个分类所需应答数因子分均较治疗前显著下降（P＜0．05）,但仍显著高于对照组（P＜0．05）;完成分类数因子分均较治疗前显著升高,但仍显著低于对照组（P＜0．01）。两组总体不良反应发生率比较差异无显著性（χ2＝2．47,P＞0．05）。结论氨磺必利能显著改善老年精神分裂症患者的各种精神症状及认知功能,且安全性高,与利培酮相当。     

糖尿病肾病患者晚期氧化蛋白产物与超氧化物歧化酶检测的临床意义

目的：研究糖尿病肾病患者血清蛋白氧化损伤指标晚期氧化蛋白产物的改变及其与超氧化物歧化酶的关系，探讨蛋白氧化损伤与糖尿病肾病氧化应激状态的关系。方法：糖尿病患者134例，根据尿微量白蛋白排泄率和肌酐水平分为无肾病组（A组）、早期肾病组（B组）、临床肾病组（C组）、终末期肾病组（D组）。分别测定各组的血清晚期氧化蛋白产物和超氧化物歧化酶。结果：D组和C组血清晚期氧化蛋白产物显著高于A组（P〈0．01）；B组血清晚期氧化蛋白产物与A组比较差异无统计学意义。结论：临床糖尿病肾病患者的血清蛋白氧化较无糖尿病肾病患者增强，并且与糖尿病肾病氧化应激状态有关。     

急性炎症患者血清前清蛋白与RBP、CRP的联系

目的：探讨血清前清蛋白（PA）与视黄醛结合蛋白（RBP）、C 反应蛋白（CRP）间的联系。方法应用 Olympus AU-5400自动生化分析仪检测患者91例急性炎症患者血清 PA、RBP 和 CRP 水平。另选50例健康体检者为对照组。结果急性炎症组 PA 低于健康对照组（P ＜0．01）,急性炎症组血清 RBP 低于健康对照组。急性炎症组血清 CRP 高于健康对照组（P ＜0．01）。PA 与呈 RBP 正相关,相关系数（r）为0．684（P ＜0．01）,PA 与 CRP 呈负相关,相关系数为-0．559（P ＜0．01）。结论急性炎症时,患者血清 PA 水平与 RBP 和 CRP 水平呈明显相关性。     

抑郁症与血清瘦素水平相关性研究

目的探讨抑郁症与血清瘦素水平的相关性。方法将30例抑郁症患者设为患者组,30例健康成人设为对照组;患者组常规口服SSRI类抗抑郁剂治疗,观察6周。于治疗前及治疗6周末采用汉密顿抑郁量表评定抑郁状况;患者组于治疗前及治疗6周末,对照组于入组时采用放射免疫法检测血清瘦素水平,对两组检测结果进行相关分析。结果患者组治疗前血清瘦素水平显著高于对照组（t=7．172,P＜0．01）;治疗6周末较治疗前有显著性下降（t=7．007,P〈0．01）,且与对照组无显著性差异（t=0．481,P〉0．05）。患者组治疗6周末汉密顿抑郁量表总分较治疗前有显著性下降（P〈0．01）,但仍显著高于对照组（P〈0．01）。结论抑郁症患者血清瘦素水平异常增高,可能与抑郁症状有关,不同抗抑郁药物对血清瘦素水平有不同程度的影响。     

超敏C反应蛋白及脂联素与2型糖尿病大血管病变的相关性研究

[目的]分析2型糖尿病（DM）合并大血管病变及无大血管病变与血清超敏c反应蛋白（hs—CRP）及脂联素水平的相关性。[方法]79例2型糖尿病患者，按有无大血管病变分为伴大血管病变组（A组）40例，无大血管病变组（B组）39例。另选40例健康者作正常对照组（C组），均检测血清hs—CRP，脂联素及空腹血糖（FBG）、空腹胰岛素（FINS）、血脂等指标。[结果]A组血清hs—CRP高于B组及C组（P〈0．05，P〈0．01），B组明显高于C组（P〈0．01），A组脂联素水平明显低于B组及C组（均P〈0．01），B组明显低于C组（P〈0．01）。相关分析提示血清hs—CRP与脂联素有相关性（P〈0．01）。[结论]hs～CRP，脂联素对于DM患者发生大血管病变的预测具有重要意义。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.