脑血管病后抑郁的发生及相关因素调查分析

目的调查脑血管病后抑郁的发生率及影响抑郁发生的相关因素。方法采用Zung氏抑郁自评量表（SDS）、日常生活能力量表（ADL）Barthel指数及人口社会学调查表对88例脑血管病住院患者进行调查及评分。结果脑血管病后抑郁总发生率为33.58%。抑郁的发生与性别、年龄、文化程度无关（P〉0.05）,而与婚姻状况、日常生活能力有关（P〈0.05）。结论脑血管病后抑郁发病率较高,直接影响疾病的预后,应重视脑血管病后抑郁症的早期预防和诊治,护理人员应采取针对性的护理措施,尽量避免或减少脑血管病后抑郁症状的发生率。     

脑卒中后抑郁症对偏瘫康复的影响

应用美国流行病学调查中心的抑郁量表（CES－D）对脑梗塞1个月后的119例患者进行了抑郁发生率的调查，并分别于脑卒中后1、3和6个月时评定抑郁组和对照组患者神经功能缺损积分、肢体功能及日常生活活动能力，以探讨抑郁症对偏瘫康复的影响。结果显示：①脑梗塞后1个月时抑郁症的发生率为44％。②脑梗塞后3和6个月时，抑郁组患者神经功能缺损、偏瘫肢体功能和ADL能力的恢复均低于对照组，（P＜0．01，0．05）。研究表明，抑郁症是影响脑卒中后偏瘫康复的一个重要的因素。     

高血压病并发抑郁症的调查及帕罗西汀的疗效观察

【目的】调查高血压病患者中抑郁症的患病率及应用帕罗西汀（赛乐特）的疗效。【方法】对2003年1月至2005年6月本院高血压专科门诊及住院的1080例高血压患者并发抑郁症情况调查分析，对并发抑郁症者采用帕罗西汀进行为期四周的治疗。采用Hamilton抑郁量表（HAMD）进行评估。【结果】1080例高血压患者中，并发抑郁症113例，患病率10．46％，女性76例，占67．25％；并各种早搏62例中抑郁症16例，占25．81％；高血压分级越高抑郁症的患病率越高；应用帕罗西汀治疗后，Hamilton抑郁量表评分明显下降（P〈0．01）。【结论】高血压患者并发抑郁症应引起重视；合并各种早搏及分级较高的高血压患者应作为关注的重点。应用帕罗西汀治疗可取得明显疗效。     

老年冠心病患者抑郁状态与社会心理因素的相关性研究

目的观察社会心理因素与老年冠心病患者抑郁状态之间的关系。方法对200例老年冠心病患者进行社会心理因素、自评抑郁量表、社会支持评定量表、日常生活能力量表调查,然后进行Logistic回归分析及Pearson相关分析。结果老年冠心病患者抑郁症发病率为53.65%;Logistic回归分析教育程度低、病程长、发作次数多增加了患者的抑郁状态发生的危险性(OR值分别为0.44、0.304、7.308,P<0.05);SDS与客观支持、主观支持、支持利用度动能力呈负相关,其关联性具有统计学意义(P<0.05或P<0.01),与躯体生活自理能力、工具性生活能力呈正相关,其关联性具有统计学意义(P<0.01).结论老年冠心病患者抑郁状态发生率高;与社会心理因素密切相关。     

慢性乙型肝炎患者抑郁状况的调查分析

【目的】调查慢性乙型肝炎患者的抑郁状况及相关因素，为临床开展心理护理和心理治疗提供依据。【方法】应用抑郁自评量表（SDS）及自编简易问卷对110例慢性乙型肝炎患者进行问卷调查。【结果】慢性乙型肝炎患者SDS总标准分均值显著高于国内常模（P〈0．01），48．2％的患者存在不同程度的抑郁障碍。【结论】慢性乙型肝炎患者的抑郁发生率明显高于一般人群，应针对患者抑郁发生的相关因素，实施进一步的医疗护理干预，提高患者的心理健康水平，促进患者身心全面康复。     

西酞普兰合用喹硫平治疗难治性抑郁症的随机对照研究

【目的】探讨西酞普兰合用喹硫平治疗难治性抑郁症的疗效和安全性。【方法】将符合《中国精神障碍分类与诊断标准》第三版（CCMD-3）抑郁症诊断标准的82例门诊及住院患者随机分为两组,研究组（n=42）给予西酞普兰合用喹硫平治疗,对照组（n=40）给予西酞普兰治疗,疗程12周,于治疗前和治疗后2、4、6、8、12周分别使用汉密顿抑郁量表（HAMD）、临床疗效总评量表的病情严重程度（CGI-SI）和不良反应量表（TESS）评定疗效和不良反应。【结果】治疗前研究组和对照组HAMD评分差异无统计学意义（P〉0．05）。治疗12周后,研究组和对照组的HAMD评分均低于治疗前（P〈0．05）;研究组6、8、12周HAMD评分均低于对照组（P〈0．05）;研究组有效率高于对照组（73．8％VS47．5％,P〈0．01）;治疗12周后两组CGI-SI评分比治疗前显著下降（P〈0．01,P〈0．05）,治疗组下降幅度较对照组更为显著（P〈0．05）。两组间不良反应发生率差异无统计学意义（78．5％vs75％,P〉0．05）。【结论】西酞普兰合用喹硫平治疗难治性抑郁症疗效较好,安全性高。     

急性脑卒中后睡眠障碍及相关因素研究

【目的】探讨急性脑卒中患者的睡眠障碍情况及其影响因素。【方法】采用匹兹堡睡眠质量指数问卷（PSQI）、神经功能缺损程度评分（NDS）、汉密尔顿抑郁量表（HAMD）对298例急性脑卒中住院患者进行调查【结果】脑卒中急性期睡眠障碍发生率为45．97％；对患者不同性别、年龄、卒中部位、NDS和HAMD评分等方面进行比较，睡眠障碍发生率的差异均具有统计学意义（P〈0．01或P〈0．05）。【结论】急性脑卒中后患者睡眠障碍的发生率较高，与患者年龄、性别、卒中部位、神经功能缺损程度及抑郁状态等因素相关。临床工作中应积极改善睡眠以提高患者生活质量。     

未绝经女性冠心病患者临床特点分析

【目的】分析未绝经女性冠心病患者的临床特点。【方法】对136例女性冠心病患者分为未绝经女性冠心病组（29例）与已绝经女性冠心病组（107例）,分析两组患者的冠心病危险因素、临床发病及冠脉造影特点。【结果】未绝经冠心病组高血压、糖尿病、高脂血症的发生率及冠心病传统危险因素个数均显著低于已绝经冠心病组（P〈0．05）;未绝经冠心病组6．9％的患者只合并抑郁;未绝经冠心病组以急性冠脉综合征（ACS）起病比例显著高于已绝经冠心病组（72．4％比30．8％,P〈0．01）;未绝经冠心病组单支病变比例高于已绝经冠心病组（65．5％比28．0％,P〈0．05）,且以前降支更容易受累。【结论】未绝经冠心病组冠心病传统危险因素少于已绝经冠心病组,抑郁情绪可能与冠心病的发病有关,多以ACS起病,临床工作中,应注意避免未绝经女性冠心病患者的漏诊。     

基于人类作业模式的康复训练对抑郁症患者抑郁程度、日常生活能力及社交技能的影响

目的探讨基于人类作业模式(MOHO)的康复训练对抑郁症患者抑郁程度、日常生活能力及社交技能的影响。方法选取我院2018年1月至2019年5月收治的124例抑郁症患者,按照随机数字表法等分为对照组和观察组,对照组给予常规药物与工娱治疗,观察组在对照组基础上实施基于人类作业模式的康复训练。采取汉密尔顿抑郁量表(HAMD)、Barthel指数(BI)评估量表、社交技能评估工具(SSC),比较两组患者干预前后抑郁程度、日常生活能力及社交技能评分。结果干预后4,8周,观察组患者HAMD评分显著低于对照组(P 0. 05); BI指数评分显著高于对照组(P 0. 05); SSC评分低于对照组(P 0. 05)。结论基于人类作业模式的康复训练应用于抑郁症患者,可有效降低其抑郁程度,改善其日常生活能力,提高其社交技能。     

脑卒中患者抑郁程度与配偶压力水平的相关性研究

【目的】探讨脑卒中患者的抑郁程度与配偶压力水平的相关性。【方法】选择182例脑卒中患者及其配偶,运用照顾者中文版压力量表（CSI）与抑郁自评量表（SDs）调查脑卒中患者家属的压力负荷水平及脑卒中患者的抑郁程度。【结果】脑卒中患者抑郁状态评分（40．51±8．25）分;配偶压力冰平总分为（38．95士9．24）分显著高于国内常模（P〈0．05）。脑卒中患者抑郁程度与配偶压力水平呈正相关（r=0．88,P〈0．05）。照顾者压力负荷,其中心理压力最大。【结论】脑卒中患者的抑郁状态与配偶压力水平明显相关,在临床护理工作中正确评估配偶的压力水平,给予个性化的护理干预,降低配偶压力,对于减轻患者的抑郁程度,提高患者生活质量有着重要的意义。     

Ultrasonic study of venous patterns in the right hypochondrium: An anatomical approach to differential diagnosis of obstructive jaundice

Through real time ultrasonography, it is possible to display the splenic vein, the superior mesenteric vein, the vena porta, and the intrahepatic portal and systemic veins. In jaundice, it is of the utmost importance to carefully identify the vena porta before making a diagnosis of common bile duct enlargement. It is also necessary, when confronted with a pattern of apparently enlarged intrahepatic ducts, to conduct a thorough study of possible confluences of the ducts with the vena porta or vena cava to be certain that the ducts are not part of the portal or systemic venous network. Without such differentiation, portal enlargement caused portal hypertension, systemic venous enlargement caused cardiac insufficiency, or even nonpathological wide veins may lead to an erroneous diagnosis of obstructive jaundice.     

The clearance of Procalcitonin (PCT) during continuous veno-venous hemodiafiltration (CVVHD)

Objective. To evaluate the Procalcitonin (PCT) clearance during continuous veno-venous hemodiafiltration (CVVHD).?Design. Case report?Setting. Surgical intensive care unit?Patient. 51-year-old man, who had undergone total thyroidectomy about ten years before owing to multiple endocrine neoplasia 2 (MEN 2), suffering from multiple organ dysfunction syndrome (MODS) with acute renal failure after severe trauma caused by a traffic accident.?Measurements and main result. The samplings of prefilter (afferent) and post-filter (efferent) blood and of ultradiafiltrate were 6 times performed during 24 h of CVVHD to calculate the PCT clearance of hemdiafiltration.?During the first half period of CVVHD the serum PCT concentration did not decrease, though PCT had been eliminated from serum. On the other hand during the latter half period of it the serum PCT value decreased (from 46.8 ng/ml to 29.4 ng/ml) and the amount of the eliminated PCT from serum was about 100 ng per minute and its clearance was 2.3 ∼ 3.4 ml/min.?Conclusion. The CVVHD could eliminate PCT from serum. First it was brought about by the adsorption by the filter menbrane and then by ultradiafiltration. Received: 25 February 1999/Final revision received: 31 May 1999/Accepted: 9 June 1999     

Quality management of potential chemotherapy-induced neutropenic complications: evaluation of practice in an academic medical center

Goals

Management of the risk of potential chemotherapy-induced neutropenic complications such as febrile neutropenia (FN) and severe neutropenia (SN) is a quality of care priority. How frequently does care at our institution conform to established guidelines?

Materials and methods

This retrospective chart review study included a random sample of 305 cancer patients receiving care at a single US academic medical center. Abstracted data included demographics, risk factors, and outcome variables (e.g., development of FN/SN, administration of myeloid growth factors). To evaluate quality of care, we assessed conformance between actual practice and established clinical practice guidelines for the use of myeloid growth factors from the National Comprehensive Cancer Network (NCCN).

Main results

Of the 305 cases reviewed, 8% were classified as low risk (<10%), 48% as intermediate risk (10–20%), and 44% as high risk (>20%), using the risk classifications in the NCCN guidelines modified to accommodate illness and other risk factors. Thirty-four percent received prophylactic administration of myeloid growth factors. Half of the cases had adequate documentation of mid-cycle absolute neutrophil count to determine whether FN/SN developed. Among these cases with adequate documentation, 21% developed FN/SN. Use of growth factors did not conform to established quality guidelines. Overall, 77 of 133 (58%) high-risk cases received myeloid growth factors, whereas six of 25 (24%) low-risk cases received myeloid growth factors.

Conclusions

Routine clinical practice in this academic oncology setting was poorly aligned with established guidelines; there is substantial opportunity to standardize clinical strategies and increase conformance with evidence-based guidelines.     

新生儿缺氧缺血性脑病NO、GSH—PX和TNF的含量测定及其临床意义

目的探讨新生儿缺氧缺血性脑病(HIE)血浆和脑脊液(CSF)中的一氧化氮(NO)和谷胱甘肽过氧化物酶(GSH-PX)和肿瘤坏死因子(TNF)含量变化及其与HIE不同时期和不同程度间的相关关系.方法对HIE患儿第3天的CSF和出生初入院(HIE2h内)、第1天、第2天、恢复期的血浆中NO、SOD进行检测,并与正常对照组比较;分析NO、GSH-PX、TNF的变化原因和意义.结果HIE患儿血浆中第1天的NO含量最高,而GSH-PX相反;初入院、第1天、第3天的血浆中NO、GSH-PX含量与正常对照组对比均有显著性差异(P＜0.01),而恢复期中NO、GSH-PX含量与正常对照组对比无显著性差异(P＞0.05),血浆和HIE第3天的CSF中NO和GSH-PX水平均呈负相关;病情越重NO浓度越高,GSH-PX越低.急性期血浆TNF显著高于对照组(P＜0.01),恢复期两组无显著性差异(P＞0.05).结论NO、GSH-PX和TNF参与HIE的发病过程,在HIE的发病过程中起着重要作用;检测血浆和CSF中NO、GSH-PX、TNF含量有助于判断HIE患儿病变程度和病情进展.     

Comparison of two methods based on photoplethysmography for the diagnosis of peripheral arterial disease

Aim. To examine the interchangeability of two methods for distal pressure measurement based on photoplethysmography using a truncated or full display of the arterial inflow curve, respectively. Methods. Toe and ankle pressures were obtained from 69 patients suspected of peripheral arterial disease (PAD). Observer reproducibility of the curve readings was examined by blinded reassessment of the pressure curves in a randomly selected subgroup (60 limbs). Results. There were no significant differences in mean pressures between the two methods (p for all >?.455). The limits of agreement for the differences were ?15.0–15.4?mmHg for right toe pressures, ?16.3–16.2?mmHg for left toe pressures, ?14.2–15.7?mmHg for right ankle pressures, and ?18.3–17.7?mmHg for left ankle pressures. Correlation analysis revealed intraclass correlation coefficients ≥0.960 for all measuring sites. Cohen’s Kappa showed excellent agreement in diagnostic classification, with κ?=?0.930 for the diagnosis of PAD and perfect agreement in the diagnosis of critical limb ischemia (κ?=?1.000). The analysis of intra-observer variation for curve reading showed limits of agreement of ?3.9–4.0 for toe pressures and ?7.6–7.7 for ankle pressures for the method involving truncated display and ?3.1–3.2 for toe pressures and ?6.3–8.6 for ankle pressures for the method involving full display of the signal. Conclusion. The present study shows minimal differences in diagnostic classification, as well as in ankle and toe pressures, between the full display and the truncated display of the photoplethysmographic pulse signal. Furthermore, the inter-observer variation was low for both of the photoplethysmographic methods investigated.     

电磁脉冲照射对小鼠脑组织氧化状态的影响及姜黄素的治疗作用

目的观察电磁脉冲（EMR）照射后小鼠脑组织超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-Px）、丙二醛（MDA）的变化及姜黄素的防护作用。方法40只小鼠随机分为空白对照组、单纯EMR组、EMR＋姜黄素低剂量（20mg／kg／d）组、中剂量（40mg／kg／d）组、高剂量（80mg／kg／d）组，每组8只。EMR组和EMR＋姜黄素组小鼠接受200kV／m的EMR照射，EMR＋姜黄素组小鼠同时每日给予不同剂量的姜黄素，5d后停止照射及给药，测定小鼠脑组织中SOD、GSH-Px、MDA的变化。结果与空白对照组比较，EMR照射组小鼠脑组织SOD与GSH-Px活性及MDA含量上升（均P〈0．05）；与单纯EMR组比较，EMR＋姜黄素中、高剂量组小鼠脑组织SOD与GSH-Px活性及MDA含量下降（均P〈0.05）。结论200kV／m的EMR照射可导致小鼠脑组织过氧化，姜黄素可通过其抗氧化作用有效治疗这种损伤，且效应呈一定的剂量依赖关系。     

动脉瘤性蛛网膜下腔出血病人血清FSH LH PRL GH的浓度变化

目的　研究动脉瘤性蛛网膜下腔出血 (SAH)病人血清卵泡刺激素 (FSH)、黄体生成素 (LH)、泌乳素 (PRL)、生长激素 (GH)的浓度变化规律。方法　对 35例动脉瘤性SAH病人发病后 1～ 3、7～ 9、13～ 15d血清FSH、LH、PRL、GH的浓度进行动态观察 ,用TCD检测大脑中动脉血流速度 (VMCA)。结果　动脉瘤性SAH病人血清FSH、LH、PRL、GH浓度在发病后 1～3、7～ 9d各均值明显高于对照组 ,尤以发病后 7～ 9d变化最明显 ;术前、术后有脑血管痉挛 (CVS)组和非CVS组也有明显差异。结论　动脉瘤性SAH病人血清FSH、LH、GH、PRL含量与SAH的病情演变、CVS程度有关 ,并可判断预后。     

Effects of anticancer agents on cell viability,proliferative activity and cytokine production of peripheral blood mononuclear cells

We investigated the effects of anticancer agents on peripheral blood mononuclear cells for the purpose of providing data to support new translational chemoimmunotherapy regimens. Peripheral-blood mononuclear cells were treated with one of four anticancer agents (5-fluorouracil, irinotecan, cisplatin, and gemcitabine) for 2 h, after which cell viability was determined. For assessment of effects of each drug on proliferation and cytokine production, cells were stimulated with phytohemagglutinin for 48 h. As a result, the anticancer agents did not affect cell viability. Cell proliferation was unaffected by 5-fluorouracil and irinotecan but inhibited by cisplatin and gemcitabine. Treatment with gemcitabine enhanced the production of IFN-γ and decreased the number of regulatory T cells. gemcitabine treatment increased IFN-γ production among CD4 T cells but not among CD8 T cells. The results indicated that GEM had immunoregulatory properties that might support immune response against cancer. This finding has implications for designing chemoimmunotherapy strategies.     

The utility of < or =3-day-old whole-blood platelets in reducing the incidence of febrile nonhemolytic transfusion reactions

BACKGROUND: Febrile nonhemolytic transfusion reactions (FNHTRs) to platelet transfusions have been linked to the presence of cytokines in supernatant plasma. Cytokine concentration is directly related to WBC content and storage time. This study evaluated the effect of limiting the storage time of random-donor platelet concentrates on the FNHTR rate. STUDY DESIGN AND METHODS: FNHTR rates were calculated retrospectively for single-donor apheresis platelet (SDP) and pooled random-donor platelet (PP) transfusions given during three consecutive 5-month study periods (November 1995 to February 1997) to patients on a single hematology/oncology/bone marrow transplant unit. Transfusion practice policies were: Baseline Period, SDPs preferred; Study Period A, PPs preferred; and Study Period B, < or =3-day-old PPs preferred. FNHTR rates were calculated from physicians' interpretations of reported reactions and the total number of SDP and PP transfusions in each period. SDPs were collected on two cell separators. All platelet components were filtered at issue in the laboratory by WBC-reduction filters. RESULTS: FNHTR rates for PP transfusions were: baseline, 11.1 percent (3/27); Study Period A, 4.6 percent (22/481); and Study Period B, 1.1 percent (3/282). The rates for SDP transfusions were 0. 15 percent (1/650), 0.75 percent (2/267), and 0.36 percent (1/273), respectively. The FNHTR rate for < or =3-day-old PPs was significantly less than the rate for older PPs (p = 0.0086 for Study Period A vs. Study Period B), and was not significantly different than that for SDPs (p = 0.33 for PPs vs. SDPs in Study Period B). CONCLUSION: Limiting transfusion of PPs to those stored 相似文献   

Individual patient diagnosis of AD and FTD via high-dimensional pattern classification of MRI

The purpose of this study is to determine the diagnostic accuracy of MRI-based high-dimensional pattern classification in differentiating between patients with Alzheimer's disease (AD), Frontotemporal Dementia (FTD), and healthy controls, on an individual patient basis. MRI scans of 37 patients with AD and 37 age-matched cognitively normal elderly individuals, as well as 12 patients with FTD and 12 age-matched cognitively normal elderly individuals, were analyzed using voxel-based analysis and high-dimensional pattern classification. Diagnostic sensitivity and specificity of spatial patterns of regional brain atrophy found to be characteristic of AD and FTD were determined via cross-validation and via split-sample methods. Complex spatial patterns of relatively reduced brain volumes were identified, including temporal, orbitofrontal, parietal and cingulate regions, which were predominantly characteristic of either AD or FTD. These patterns provided 100% diagnostic accuracy, when used to separate AD or FTD from healthy controls. The ability to correctly distinguish AD from FTD averaged 84.3%. All estimates of diagnostic accuracy were determined via cross-validation. In conclusion, AD- and FTD-specific patterns of brain atrophy can be detected with high accuracy using high-dimensional pattern classification of MRI scans obtained in a typical clinical setting.