How frequent is chronic multiyear delusional activity and recovery in schizophrenia: a 20-year multi-follow-up

To determine how frequent chronic multiyear delusional activity is in modern-day schizophrenia, we studied 200 patients over a 20-year period. We also studied the relation of delusions to hallucinations and thought disorder-disorganization, to work disability, and to later periods of global recovery and assessed several protective factors against delusional activity. The sample was assessed 6 times over 20 years and includes 43 patients with schizophrenia. Participants were evaluated at each follow-up for delusions, hallucinations, thought disorder-disorganization, work disability, and global recovery. Possible protective factors were assessed prospectively at index hospitalization. Twenty-six percent of the patients with schizophrenia were delusional at all follow-ups over the 20 years. Overall, 57% had frequently recurring or persistent delusions. A subgroup of over 25% of the schizophrenia patients had no delusional activity at any of the 6 follow-ups over 20 years. Schizophrenia patients with posthospital delusional activity had increased work disability (P < .05). Delusions that persisted after the acute phase in schizophrenia patients predicted a lower likelihood of future global recovery (P < .01). In conclusion, slightly over half of modern-day schizophrenia patients are vulnerable to frequent or "chronic" delusional activity after the acute phase. Schizophreniform patients and other types of psychotic disorders are vulnerable to posthospital delusional activity, but less frequently, less severely, and more episodically. Delusional activity is associated with work disability. Internal factors such as good premorbid developmental achievements and favorable prognostic factors are protective factors that reduce the probability of chronic multiyear, delusional activity in schizophrenia (P < .01).     

国家和部分行业制定中长期战略规划的特点与启示

战略规划在国家、行业、机构发展中处于重要地位。在系统介绍了战略规划的基本理论的基础上,总结分析了国家和科技、卫生行业中长期规划的制定过程和特点,并结合“健康中国2020”的制定背景及主要内容,提出了解决全局性、根本性和前瞻性问题是制定战略规划的出发点,开展系统的战略研究是制定战略规划的科学基础,科学的决策机制是战略规划顺利实施的保证,良好的组织协调工作是战略规划高效制定的重要条件等4点启示。     

艾灸关元、神阙穴对中期妊娠引产患者阴道出血时间及血清雌二醇、孕酮的影响

目的:验证艾灸关元、神阙穴对中期妊娠引产患者阴道出血时间的疗效,并探讨其作用机制.方法:将100例中期妊娠引产患者随机分为观察组(50例)和对照组(50例).对照组引产首日上午服米非司酮,并羊膜腔内注射利凡诺,次日上午服米索前列醇,胎儿娩出后,清宫并肌注10 U缩宫素.观察组按对照组治疗的同时结合艾灸,在注射利凡诺后艾灸神阙、关元穴,每次15 min,8h1次,共治疗4次.观察两组平均阴道出血时间,分别于治疗前后检测血清雌二醇(E2)、孕酮(P)水平.结果:观察组平均阴道出血天数(8.82±2.98)天,明显短于对照组的(10.59±3.46)天(P＜0.05);治疗后两组均血清E2升高、P降低(均P＜0.01,且观察组E2升高程度优于对照组(P＜0.05).结论:艾灸关元、神阙穴可缩短中期妊娠引产患者阴道出血时间,其机制可能是通过升高血清E2、降低P含量来增加子宫有效收缩,促进胎盘绒毛及蜕膜组织的排出,从而加快子宫内膜修复.     

中期妊娠习惯性流产宫颈环扎术应用

目的 探讨中期妊娠习惯性流产的发生机理及治疗方法。方法 入院后应用镇静药、安胎丸及宫颈环扎术。结果 15例孕妇中,14例妊娠足月．1例36周分娩。结论 休息配合宫颈环扎术是治疗中期妊娠习惯性流产的可行方案。     

生长分化因子15对急性冠状动脉综合征患者中期预后的预测价值

目的评估生长分化因子15(GDF-15)对急性冠状动脉综合征(ACS)患者中期预后的预测价值。方法连续入选95例急性冠状动脉综合征患者,采用酶联免疫吸附双抗体夹心法(ELISA)测定血浆GDF-15浓度,根据GDF-15中位数分为低浓度组和高浓度组,对出院患者进行定期随访,分别计算并比较2组患者的中期生存率以及主要不良心脏事件(MACE)发生率。生存率评估采用生存分析法。使用受试者工作特征(ROC)曲线分析GDF-15浓度对ACS患者的中期预后的预测价值。结果 ACS患者GDF-15浓度为921.56±462.20 ng/L,共随访患者95例,平均随访时间33.76±6.29月,死亡4例。生存分析提示GDF-15高浓度组患者的生存率低于GDF-15低浓度组(P=0.039)。GDF-15评估ACS患者中期生存的ROC曲线下面积(AUC)为0.853(SE=0.074,P=0.017,95%CI0.708~0.998),而GDF-15在预测ACS患者中期发生MACE的ROC曲线下面积为0.805(SE=0.068,P=0.000,95%CI 0.672~0.938)。结论 GDF-15可反映ACS患者的中期预后,作为一个有潜力的新标志物,能更好地帮助ACS患者进行危险分层及评估预后。