老年抑郁症与生活事件及社会支持的关系

目的：探讨老年抑郁症与生活事件及社会支持的关系。方法：对44例60岁以上首次发作患者(抑郁组)、42名健康老年人(对照组）使用自制调查表、生活事件量表和社会支持评定量表评定。结果：抑郁组精神疾病家族史（x^2=6．157，P=0．026)、现患躯体疾病(x^2=11．993，P=0．001)和长期困境(x^2=23．242，P=0．000)明显高于对照组。抑郁组负性生活事件总分(19.2&;#177;15．9)高于对照组(10．1&;#177;7．0)(u=2．531，P=0．011)。抑郁组社交问题得分(3．4&;#177;6．9)高于对照组(1．1&;#177;3．5)(u=2．226，P=0．026)。两组负性生活事件数的差异无显著性意义(P&;gt;0．05)。抑郁组社会支持总分(38．9&;#177;6．6)明显低于对照组(43．5&;#177;4．9)(u=3．308，P=0．001)。抑郁组对支持利用度(5．9&;#177;2．7)明显低于对照组(8．4&;#177;1．7)(u=4．444，P=0．000)。两组客观支持分和主观支持分的差异无显著性意义(P&;gt;0．05)。结论：阳性家族史、慢性应激和社会支持不足是老年抑郁症发病的重要危险因素：     

生活事件、社会支持及防御方式在精神分裂症发生中的作用

目的：从生活事件、社会支持和防御方式3个方面来探讨精神分裂症发生的个体易感素质和心理社会因素。方法：采用生活事件量表、社会支持调查表和防御方式问卷对45例首次发作的康复期精神分裂症患者进行测试，并与42名正常人做对照研究。结果：研究组的生活事件负性刺激量(23．58&;#177;16．37)和总刺激量(37．31&;#177;32．87)较高，社会支持总分(32．78&;#177;8．33)、客观支持分(9．94&;#177;3．16)、主观支持分(17．82&;#177;5．20)及支持利用度(5．02&;#177;1．98)得分明显较低，与对照组比较，差异有显著性意义(t=2．59～4．88，P&;lt;0．05～0．01)；防御方式在不成熟(4．75&;#177;1．38)和神经症性(4．98&;#177;1．42)方面高于对照组，差异有显著性意义(t=3．44，2．88，P&;lt;0．01)。结论：精神分裂症的发生与负性生活事件、社会支持系统缺乏以及防御方式的不成熟和神经症性密切相关。     

理疗对高血压病患者调温反应的影响

目的　观察老年高血压病患者在不同理疗作用下体温调节反应和皮肤对温度刺激的反应的变化。资料与方法　观察老年高血压病Ⅱ期患者2 2 2例,男1 0 8例,女1 1 4例;平均年龄(6 7.3±1 .9)岁,其中6 0～6 7岁1 1 8例,6 8～74岁1 0 4例。将患者分为7组:第1组38例,平均年龄(6 7 1±1 6 )岁,给予半身氯化钠矿水浴;第2组32例,平均年龄(6 8 0±2 3)岁,用四槽氯化钠矿水浴;第3组2 8例,平均年龄(6 5 9±1 5 )岁,给予干二氧化碳空气浴;第4组30例,平均年龄(6 8 2±2 2 )岁,不用理疗(含矿泉) ,作为对照组;第5组34例,年龄(6 7 2±1 7)岁,给予全身磁疗…     

超声心动图对急性右室心肌梗塞急诊再灌注治疗的对照研究

目的 :超声心动图对比观察研究急诊再灌注治疗对急性右室心肌梗塞 (RVMI)心功能及其预后的影响。方法 :临床确诊急性心肌梗塞患者 86例 ,其中 5 8例进行了冠状动脉造影。超声心动图检查平均 (6 .1±2 .6 )天。符合 WHO关于急性心肌梗塞标准 ,所有病例均合并左室下壁心肌梗塞 ,其中同时合并左室前壁和前间壁心肌梗塞 2 3例。将 86例患者分为两组 ,急诊再灌注治疗成功患者为组 A (n=2 8例 ,11例急诊 PTCA,17例急诊溶栓 ) ;常规治疗为组 B (n=5 8例 )。结果 :两组患者冠状动脉造影平均病变血管支数无明显差异 (组 A平均 1.5 7支 ,组 B平均 1.36支 )。分别计算两组左、右心室异常节段室壁运动记分 (L VWMS,RVWMS) ,组 A和组 B有显著差异 (RVWMS:4 .0± 2 .7和 4 .3± 4 .3,P<0 .0 5 ;L VWMS:8.9± 6 .1和 10 .0± 7.3,P<0 .0 5 )。右室舒张末期和收缩末期容积 (RVEDV和 RVESV) ,组 A与组 B存在显著差异性 (32 .8± 17.0和 4 2 .4± 2 6 .7;13.8± 6 .7和 2 2 .3± 17.6 ,P<0 .0 1)。右室射血分数组 A大于组 B(5 3.6± 18.1和 4 5 .6± 18.6 ,P<0 .0 1)。左心各项指标 (左室舒张末期和收缩末期容积、左室射血分数 )组 A亦明显好于组 B(P值均 <0 .0 1)。近期临床恶性并发症 ,组 A无一例发生。组 B发生率 8% ,     

莫沙必利治疗反流性食管炎的近期疗效

A组 5 3例 ,给莫沙必利 5mg ,日服 4次 ;B组 31例 ,给奥美拉唑 2 0mg ,日服 2次 ,疗程均 8周。结果 :A组主要临床症状积分由 (6 6± 5 )分降至 (14 .1± 0 .9)分 ,食管炎程度积分由 (2 .8± 0 .6 )降至 (1.4± 0 .7)分 (P <0 .0 1)。B组分别由 (6 8± 5 )降至(16 .2± 1.1)分和 (2 .7± 0 .6 )降至 (1.4± 0 .7)分 ,两组疗效无显著差异。说明莫沙必利能明显地缓解胃食管反流症状 ,治疗反流性食管炎疗效较好 ,并能治愈或减轻内镜下食管炎程度莫沙必利治疗反流性食管炎的近期疗效@王海勇…     

Cerebrolysin改善缺血性脑卒中患者神经功能和生活能力的随机双盲研究

目的：评价Cerebrolysin对缺血性脑卒中后早期，恢复期的临床疗效。方法：对60例缺血性脑卒中患者在早期恢复期行随机、双盲及安慰剂对照的前瞻性研究。分为Cerebrolysin组(A组)和安慰剂组(B组)，以临床神经功能缺损量表(CSS)、简易智力状态量表(MMSE)、日常生活能力量表(ADL)、总的生活能力状态(TLS)的变化为评价指标；并以副反应量表(DOTES和TWIS)评定药物的副反应。结果：60例患者脱落2例(脱落率3％，2／60)，剔除1例(剔除率2％，1／60)。治疗后两组问比较，MMSE评分治疗组优于对照组(22.2&;#177;5．6比22．0&;#177;6.6，P=0．0314)。其他3项量表差异无显著性意义。组内治疗前后比较：CSS(A组：23．7&;#177;6．3比15．1&;#177;8．8；B组：25.2&;#177;6．8比16．0&;#177;8．1)；ADL(A组：46．3&;#177;7．0比39．6&;#177;12．8；B组：45.7&;#177;9．4比39．7&;#177;11．6)；TLS(A组：4．4&;#177;0．8比3.7&;#177;1．3；B组：4．5&;#177;0．8比3.5&;#177;1．3)；MMSE(A组：1.78&;#177;5.2比22．2&;#177;5.6；B组22．0&;#177;7．0比22．0&;#177;6．6)，差异均有非常显著性意义。结论：Cerebrolysin对缺血性卒中后早期恢复期的认知功能的恢复有益。     

生活事件、社会支持及防御方式在精神分裂症发生中的作用

目的:从生活事件、社会支持和防御方式3个方面来探讨精神分裂症发生的个体易感素质和心理社会因素。方法:采用生活事件量表、社会支持调查表和防御方式问卷对45例首次发作的康复期精神分裂症患者进行测试,并与42名正常人做对照研究。结果:研究组的生活事件负性刺激量(23.58±16.37)和总刺激量(37.31±32.87)较高,社会支持总分(32.78±8.33)、客观支持分(9.94±3.16)、主观支持分(17.82±5.20)及支持利用度(5.02±1.98)得分明显较低,与对照组比较,差异有显著性意义(t=2.59～4.88,P<0.05～0.01);防御方式在不成熟(4.75±1.38)和神经症性(4.98±1.42)方面高于对照组,差异有显著性意义(t=3.44,2.88,P<0.01)。结论:精神分裂症的发生与负性生活事件、社会支持系统缺乏以及防御方式的不成熟和神经症性密切相关。     

冠脉慢性完全闭塞66例左室结构及疗效分析

目的　研究和探讨冠脉慢性闭塞后对左室结构的影响。方法　对冠脉慢性闭塞的不稳定心绞痛病人 66例回顾分析 ,其中单纯心绞痛为A组 (3 6例 ) ,伴有陈旧心梗为B组 (3 0例 ) ,正常对照为C组 (5 0例 )。分析各组超声心动结果和疗效。结果　①超声心动结果 :左室舒张末容积 (EDV ) :B组 (15 4.43± 5 0 .5 3 )ml >A组 (12 9.5 7± 3 2 .3 5 )ml >C组(98.3 9± 19.3 1)ml,组间有显著差异 (P <0 .0 5 ) ;左室舒张末内径 (LVEDD)B组 (5 .5 9± 0 .75 )cm >A组 (5 .18± 0 .5 7)cm >C组 (4 .6± 0 .3 9)cm ,组间有显著差异 (P <0 .0 5 )。②疗效 :治疗后院内无心脏事件发作A组 3 1/3 6(86.1% ) >B组 18/3 0(60 .0 % ) ,组间有显著差异 (P <0 .0 5 )。结论　冠脉慢性完全闭塞引起左心室扩大 ,心室重构 ,提示对此类病人应进行血管重建治疗。     

氨基酸对大鼠肾缺血-再灌流损伤保护作用的研究

目的　探讨八种L 支链氨基酸合剂对肾脏热缺血 再灌流损伤的保护作用。方法　采用大鼠急性缺血性肾损伤模型 ,肾缺血 4 5min、再灌流 180min。 2 4只大鼠随机分成 3组 ,A组 :假手术组 (缺血前 60min及再灌流全程输注生理盐水 ) ;B组 :对照组 (生理盐水 ,同A组 ) ;C组 :治疗组 (缺血前 60min及再灌流全程输注氨基酸合剂 ) ,观察缺血后肾功能和肾脏组织学改变。结果　该氨基酸合剂增加大鼠缺血 再灌流后肾小球滤过率 ,180minCcrB组 (2 2 7± 2 7 0 ) μl/min、C组 (471 0± 12 1 5 ) μl/min ,P <0 0 1;增加尿量 ,90minB组 (2 4 3 7± 7) μl/min、C组 (63 6± 15 2 ) μl/min ,P <0 0 1;减缓血肌酐、尿素氮升高 ,2 4h时B组血Cr (112 71± 9 5 ) μmol/L、血BUN (2 0 7± 6 6)mol/L ,C组血Cr (85 0± 7 7) μmol/L、血BUN (11 4± 3 9)mol/L ,P <0 0 5 ;减轻肾小管的损伤程度 ,Paller评分B组 (168 8± 14 8) ,C组 (10 8 7± 15 7) ,P <0 0 1。结论　该氨基酸合剂对大鼠肾脏缺血 再灌流损伤有明显的保护作用。     

经鼻无创压力支持通气辅助COPD呼吸衰竭插管机械通气撤机观察

目的 :探讨无创压力支持通气辅助撤机的价值。方法 :把有创机械通气的COPD呼吸衰竭患者中 ,首次撤机失败的 2 9例分为经鼻无创压力支持通气组 (A组 )和对照组 (B组 )。比较两组机械通气时间、住呼吸疾病加强监护病房(RICU)时间、医疗费用及病死率。结果 :机械通气时间 :A组 (2 5± 6)天 ,B组 (5 4± 12 )天。住RICU时间 :A组 (18± 6)天 ,B组 (5 4± 12 )天。医疗费用 :A组 (5 3 4 78± 414 7)元 ,B组 (1163 14± 62 63 )元。病死率 :A组 2 0 % ,B组 85 .7%。两组间比较差异均有显差性。结论 :感染有效控制后仍不能成功撤机的COPD呼吸衰竭患者 ,应用双水平气道正压无创通气(BIPAP) ,可避免再插管 ,减少医疗费用 ,改善预后。     

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.     

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.     

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.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

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.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.