逍遥散治疗肝郁气滞症候乙型肝炎的近远期疗效研究

目的 探究逍遥散治疗肝郁气滞症候乙型肝炎的近远期临床疗效,为临床研究提供参考依据.方法 选择2011年4月-2014年3月期间我院收治的82例乙型肝炎患者,按照随机数字法分为实验组和对照组,分别为40例与42例.对照组患者给予西利宾胺治疗实验组患者则服用逍遥散治疗.比较两组患者治疗前后肝功能指标的变化,分析两组患者治疗以后近远期临床疗效的差别.结果 治疗前,两组患者的ALT、AST以及TBIL的水平无差异性(P＞0.05).治疗后,两组患者的ALT、AST以及TBIL的水平较治疗前均显著性降低,具有显著性差异(P＜0.05),但实验组患者的三项生化指标的水平较对照组患者治疗后的水平降低更为明显,具有统计学意义(P＜0.05);治疗后,实验组患者显效21例,有效16例,无效3例,总有效率92.5％,显著高于对照组患者的57.1％的总有效率,具有明显差异性(P＜0.05);治疗前,两组患者的症候积分无显著差异(P＞0.05).治疗0.5年、2年、3年后,两组患者的症候积分均降低,但实验组患者的症候积分与治疗前以及对照组患者治疗后,降低更为明显,均具有显著性差异(P＜0.05).结论 使用逍遥散治疗肝郁气滞证侯乙型肝炎患者,能够显著降低ALT、AST以及TBIL的水平,提高乙型肝炎患者近期临床疗效,改善患者的远期中医证候积分,值得在临床上广泛推广.     

Assessment of family history of colorectal cancer in primary care: Perceptions of first degree relatives of people with colorectal cancer

Objective

First degree relatives (FDRs) of someone with colorectal cancer (CRC) are at increased risk of the disease. In this study we examine the factors associated with discussing family history of CRC with a health professional.

Methods

People with CRC, recruited through the population-based Victorian Cancer Registry in Australia, were asked to refer FDRs to the study. Eight hundred and nineteen FDRs completed a telephone interview.

Results

Thirty-six percent of FDRs recalled ever being asked about their family history of bowel cancer by a health professional. Factors associated with having this discussion were being aged 50–60 years, having a university education, being in the potentially high risk category, being very worried about getting bowel cancer and knowing that family history increases risk through discussions with family, friends or their own education.

Conclusion

Despite evidence that doctor endorsement is a key factor in the uptake of CRC screening, our study shows that the majority of FDRs do not recall being asked by a health professional about their family history.

Practice implications

There is a need to identify the most appropriate method to improve rates of health professional discussion of family history with relatives of CRC patients in order to improve screening rates.     

Estimated contribution of hemoglobin and myoglobin to near infrared spectroscopy

We calculated the light absorbing potential (LAP) of hemoglobin (Hb) and myoglobin (Mb) in mammalian skeletal muscle at rest based on analysis of published chemical and morphometric data (Part 1), interpreted changes in total[Hb + Mb] from NIRS during exercise (Part 2), and estimated the potential contribution of Hb and Mb to changes in NIRS from rest to exercise (Part 3). Part 1: [Hb] in skeletal muscle was estimated from microvascular volume, systemic blood [Hb], and microvascular hematocrit and saturation at rest and during exercise. Part 2: Changes in total[Hb + Mb] (as t[Hb + Mb]) during cycling or knee extension exercise were interpreted using the results of Part 1. Part 3: Using estimates of mean microvascular PO₂, Hb and Mb contribution at peak exercise was estimated. Across several species, [Mb] contributed ∼50–70% of the total LAP to NIRS at rest in skeletal muscle. With exercise, increases in t[Hb + Mb] of up to 30% could be entirely explained by the predicted increase in microvascular hematocrit with exercise. Finally, Mb was estimated to contribute ∼70% of the changes in NIRS from rest to peak exercise.     

Errors and near misses in digestive endoscopy units

Background

Not much is known about errors and near misses in digestive endoscopy.

Aims

To verify whether an incident report, with certain facilitating features, gives useful information about unintended events, only excluding errors in medical diagnosis.

Method

Nine endoscopy units took part in this cross sectional, prospective, multicentre study which lasted for two weeks. Members of the staff were required to report any unintended, potentially dangerous event observed during the daily work. A form was provided with a list of “reminders” and facilitators were appointed to help.The main outcome measurements were type of event, causes, corrective interventions, stage of occurrence in the workflow and qualification of the reporters.

Results

A total of 232 errors were reported (two were not related to endoscopy). The remaining 230 amount to 10.3% of 2239 procedures; 66 (29%) were considered errors with consequences, 164 (71%) “near misses”. There were 150 pre-operative errors (65%), 22 operative (10%) and 58 post-operative (25%). Corrective interventions were provided for 60 cases of errors and 119 near misses. Most of the events were reported by the nurses (106 out of 232, 46%).

Conclusions

Short-term incident reporting focusing on near misses, using forms with lists of “reminders”, and the help of a facilitator, can give useful information on errors and near misses in digestive endoscopy.     

Sustained outcomes of a peer‐taught family education program on mental illness

Objective: This study examines 6‐month follow‐up data from participants in a randomized trial of a peer‐driven 12‐session family support and education program, called family‐to‐family (FTF) and offered by the US National Alliance on Mental Illness, to determine whether improvements in distress, family functioning, coping and empowerment were sustained. Method: Individuals randomized to the FTF condition were assessed after program completion and then 3 months later on measures of distress, family functioning, coping, and empowerment. We used a multilevel regression model (sas proc mixed ) to test for significant changes over time (baseline, 3 and 9 months). Results: All significant benefits that FTF participants gained between baseline and immediately post‐FTF were sustained at 9 months including reduced anxiety, improved family problem‐solving, increased positive coping, and increased knowledge. Greater class attendance was associated with larger increases in empowerment and reductions in depression and displeasure with ill relative. Conclusion: Evidence suggests that benefits of the FTF program were sustained for at least 6 months without any additional boosters or supports. Peer‐based programs may produce sustained benefits for individuals seeking help in addressing challenges and stresses related to having a family member with a mental illness.     

精神分裂症患者健康一级亲属的认知功能研究

目的：探讨精神分裂症患者健康一级亲属的认知功能特点。方法：对72例精神分裂症患者健康一级亲属（研究组）以及与其人口学资料相匹配的31名健康对照（对照组）进行2-back测验、Go／No．go测验、Stroop测验、修订版韦氏成人智力量表的数字符号、连线测验分量表等认知功能的评定。结果：研究组在2-back测验反应时（t=7．749）和错误数（t=2．432）、Go／No·go测验反应时（t=4．147）以及数字符号测试（t=-2．248）成绩上均差于对照组（P〈0．05或P〈0．001）。多发病家系组在2-back测验反应时（t=3．233）、Go／No-go测验反应时（t=2．981）以及数字符号测试（t=2．041）成绩上均差于单发病家系组（P〈0．05或P〈0．01）。结论：精神分裂症患者健康一级亲属存在不同程度的认知功能损害;认知功能损害可能是精神分裂症的遗传易感性指标。     

Continuous Metabolic Monitoring in Infant Cardiac Surgery: Toward an Individualized Cardiopulmonary Bypass Strategy

Cardiopulmonary bypass (CPB) in infants is associated with morbidity due to systemic inflammatory response syndrome (SIRS). Strategies to mitigate SIRS include management of perfusion temperature, hemodilution, circuit miniaturization, and biocompatibility. Traditionally, perfusion parameters have been based on body weight. However, intraoperative monitoring of systemic and cerebral metabolic parameters suggest that often, nominal CPB flows may be overestimated. The aim of the study was to assess the safety and efficacy of continuous metabolic monitoring to manage CPB in infants during open‐heart repair. Between December 2013 and October 2014, 31 consecutive neonates, infants, and young children undergoing surgery using normothermic CPB were enrolled. There were 18 male and 13 female infants, aged 1.4 ± 1.7 years, with a mean body weight of 7.8 ± 3.8 kg and body surface area of 0.39 m². The study was divided into two phases: (i) safety assessment; the first 20 patients were managed according to conventional CPB flows (150 mL/min/kg), except for a 20‐min test during which CPB was adjusted to the minimum flow to maintain MVO₂ >70% and rSO₂ >45% (group A); (ii) efficacy assessment; the following 11 patients were exclusively managed adjusting flows to maintain MVO2 >70% and rSO2 >45% for the entire duration of CPB (group B). Hemodynamic, metabolic, and clinical variables were compared within and between patient groups. Demographic variables were comparable in the two groups. In group A, the 20‐min test allowed reduction of CPB flows greater than 10%, with no impact on pH, blood gas exchange, and lactate. In group B, metabolic monitoring resulted in no significant variation of endpoint parameters, when compared with group A patients (standard CPB), except for a 10% reduction of nominal flows. There was no mortality and no neurologic morbidity in either group. Morbidity was comparable in the two groups, including: inotropic and/or mechanical circulatory support (8 vs. 1, group A vs. B, P = 0.07), reexploration for bleeding (1 vs. none, P = not significant [NS]), renal failure requiring dialysis (none vs. 1, P = NS), prolonged ventilation (9 vs. 4, P = NS), and sepsis (2 vs. 1, P = NS). The present study shows that normothermic CPB in neonates, infants, and young children can be safely managed exclusively by systemic and cerebral metabolic monitoring. This strategy allows reduction of at least 10% of predicted CPB flows under normothermia and may lay the ground for further tailoring of CPB parameters to individual patient needs.     

神经介入治疗缺血性脑血管疾病的近远期疗效及并发症观察分析

【摘要】目的：对神经介入治疗缺血性脑血管疾病的近远期疗效及并发症进行观察分析。方法：选取2013年5月～2015年9月在我院收治的148例缺血性脑血管疾病患者,随机分为观察组和对照组（每组各74例）,观察组患者给予静脉溶栓治疗,对照组患者给予动静脉联合溶栓神经介入治疗。对比分析两组患者治疗前后血管再通情况、神经功能缺损评分（NIHSS）及并发症发生情况。结果：观察组患者病变血管再通人数明显优于对照组（P＜0 . 05）,观察组患者治疗后1个月、6个月、1 2个月的NIHSS评分均明显优于对照组（P＜0.05）,观察组患者并发症人数明显低于对照组（P＜0.05）。结论：神经介入治疗缺血性脑血管疾病近远期效果明显,可有效使患者病变血管得到改善,恢复受损神经功能,安全有效并发症少,提高患者术后生活质量。