对肝纤维化的中西医治疗认识

肝纤维化是由于细胞外基质（ECM）的合成大于降解导致过度沉积,是纤维增生与纤维分解不平衡而引起的病理过程。是各种慢性肝病发展的必经阶段,由于多种致病因素引起肝脏的损伤和炎症所共有的病理特征,也是向肝硬化等进一步发展、恶化的重要中间环节。祖国医学认为肝纤维化是由于情志不舒、肝气郁结或酒食不节,痰湿内生,外感湿热毒邪,邪去未尽,留着肝体,致使气滞血瘀、痰瘀凝结、壅塞肝络而成。     

Effect of the novel direct factor Xa inhibitor DX-9065a on thrombin generation and inhibition among patients with stable atherosclerotic coronary artery disease

INTRODUCTION: Thrombin, a pluripotential effector enzyme with prothrombotic, proinflammatory, and mitogenic properties, plays a pivotal role in the pathobiology and clinical expression of atherothrombotic coronary artery disease. Existing anticoagulant drugs have not been shown to attenuate thrombin generation or activity consistently. We sought to investigate the effect of DX-9065a on thrombin generation and inhibition in patients with stable CAD. DX-9065a is a small-molecule, synthetic, direct inhibitor of factor Xa. MATERIALS AND METHODS: Peripheral venous blood samples were collected serially during and after administration of either placebo or 1 of 4 weight-adjusted regimens of DX-9065a, in 73 patients with stable CAD participating in the XaNADU-1B study. RESULTS AND CONCLUSIONS: At baseline, the median (25th, 75th) prothrombin activation fragment 1.2 (F1.2) level was 2.56 (2.05, 3.20) nmol/L, and the median d-dimer level was 0.26 (0.19, 0.38) mug FEU/L. There were significant relationships between measured plasma DX-9065a concentrations and both F1.2 (4.9% decrease for each doubling of DX-9065a) (P<0.0001) and d-dimer (5.5% decrease for each doubling of DX-9065a) (P=0.001). F1.2 was suppressed (below baseline) at 96 h after administration of DX-9065a. Coronary thrombotic events did not occur during or after study drug administration. DX-9065a, the first in a class of small-molecule, direct, selective and reversible factor Xa inhibitors, reduces thrombin generation and fibrin formation among patients with stable CAD. The effect is concentration-dependent and persists for at least 96 h following drug cessation, without biochemical or clinical evidence of rebound.     

对《金匮要略》中肝实证 肝虚证治法的理解与思考

通过对《金匮要略》"夫治未病者,见肝之病,知肝传脾,当先实脾……"及"夫肝之病,补用酸,助用焦苦,益用甘味之药调之"条文的分析,运用五行传变规律进行剖析和思考,运用中医知识进行综合分析、仿效,做到灵活运用,执古而不泥古,既更好地理解了经典,又提高了临床技能。     

临床口腔健康教育对口腔保健知识知晓率和口腔卫生行为的影响

目的探讨临床口腔健康教育对患者口腔保健知识、口腔卫生行为和口腔卫生状况的影响。方法随机选择本院口腔科门诊初诊病例200例进行口腔健康检查,并通过口腔卫生知识讲座、技能培训等进行为期6个月的口腔健康教育及干预。结果健康教育后病人对口腔疾病的危害及有关病因的认识有明显提高;对刷牙与牙齿保护关系的知晓率也有一定程度的提高,其中,对定期作口腔检查的认识率提高最为明显;而对牙膏、牙刷如何选择改善不明显;健康教育后掌握正确刷牙方法、时间、坚持饭后漱口的人数均有明显提高;健康教育前菌斑染色指数为1.99±0.12,健康教育后为1.15±0.06,前后有显著性差异(P<0.05)。结论经过口腔健康教育干预,200例患者在口腔卫生保健知识、态度、行为方面的认识有了明显改善,口腔卫生状况也有显著提高,表明在临床普及口腔健康知识和开展口腔健康教育对社会各个层次的人群都是适宜和必要的。     

荷兰社区预防跌倒损伤的考察体会

本文介绍了荷兰在社区开展老年跌倒预防工作的相关调查以及对跌倒病人的处理措施;借鉴荷兰的工作方法,提出了在我国社区开展预防老人跌倒的工作思路,分析了存在的困难。     

莱州市农村部分HBV携带者对乙型病毒性肝炎认知情况的调查

[目的]了解我市农村HBV携带者对乙型病毒性肝炎相关知识的认知情况,为今后农村乙肝的防控工作提供可靠的科学依据。[方法]从2002年3月至2006年3月,对农村人口就职查体而检出的HBsAg阳性者进行问卷式调查。[结果]共调查HBsAg阳性1 278人,2人拒答,实际调查1 276人。对乙型病毒性肝炎相关知识比较了解的占16.38%,一般了解的占24.61%,不太了解的占51.80%,不了解的占7.21%。学历越高知晓率越高不同学历的人群对乙型病毒性肝炎相关知识的知晓率差异有统计学意义(P<0.01)。[结论]莱州市农村部分HBV携带者对乙型病毒性肝炎相关知识认知程度较低。     

Interventions to support risk and benefit understanding of disease-modifying drugs in Multiple Sclerosis patients: A systematic review

ObjectiveThe present review evaluates interventions that have been designed to improve understanding of the complex risk-benefit profiles of disease-modifying drugs (DMDs) in patients with Multiple Sclerosis (MS).MethodsA systematic search conducted using PubMed, Embase, Google Scholar and PsycINFO identified 15 studies. Interventions which provided treatment information were present across a range of study designs. A narrative synthesis was conducted due to heterogeneity of research findings.ResultsInterventions providing treatment information ranged from comprehensive education programmes to booklets of a few pages. MS patients favoured the interventions they received. Understanding of overall treatment information and treatment risks specifically, generally improved following interventions. Yet overestimation of treatment benefits persisted. There was no conclusive effect on DMD decisions. No superior intervention was identified.ConclusionInterventions designed to improve understanding of DMD risk and benefit information are moderately successful.Practice implicationsAdditional support provided to MS patients beyond routine healthcare can generally improve understanding of the complex risk-benefit profiles of DMDs. Future interventions need to ensure that patients with symptoms that may confound understanding can also benefit from this additional information.     

体检者对正常高值血压与高血压前期理解及重视程度的调查

目的探讨受检者对“正常高值血压”、“高血压前期”的理解与重视程度的差异，以便能更有效地进行血压健康教育。方法对202例（男性144例，女采用自行设计横断面问卷调查202名受检者对血压的理解和重视程度。结果受检者认为“高血压前期”将来可发展为高血压的人比“正常高值血压”可发展为高血压的人多，差异有统计学意义（127比72；χ^2=79．414，P〈0．01）。受检者回答对“高血压前期”重视的人比回答对“正常高值”重视的人多（163比97；χ^2=47．504，P〈0．01）。结论在血压的健康教育中，对120～139／80～90mmHg范围的血压以术语“高血压前期”进行宣教可能更能引起受检者重视预防发生高血压。     

护患双方对基础护理认识的误区及原因和对策分析

随着医药卫生体制改革的深入,加强基础护理工作,开展优质护理服务,成为临床护理工作重点。在临床工作中,护患双方对基础护理的认识存在误区,影响基础护理工作的开展,已成为突出问题,亟待解决。分析了临床基础护理过程中常见的一些认知误区、不良现象、存在的问题、产生的原因,并提出相应的改善对策,以便护患相互理解,促进基础护理工作的顺利开展。     

The use of virtual reality in patient education related to medical somatic treatment: A scoping review

ObjectiveTo map the available evidence on the context, content and outcome of VR in patient education in situations related to preparation for medical somatic treatment.MethodsA Scoping review. In October 2020, the Embase, CINAHL, MEDLINE and PsycINFO databases were searched with the terms ‘Virtual Reality’ and ‘Patient Education’. The literature was synthesised and mapped with a narrative approach.Results17 studies published between 2015 and 2020 were included in the qualitative synthesis.VR was applied in (paediatric) surgery and radiation therapy treatment. VR interventions were heterogeneous regarding technical applications, context of implementation, guidance by healthcare professionals and integration in education sessions. Anxiety reduction was demonstrated significantly in some studies. Patients experienced VR education useful; it enhanced understanding, improved communication with healthcare professionals and encouraged treatment compliance.ConclusionsThe application of VR in patient education is a promising technology. Patients are highly satisfied and experience enhanced understanding. VR education was not effective in reducing all anxiety, pain and stress and improving preparedness for treatment.Practice implicationsIt is important to develop VR interventions profoundly. The application of a methodological framework for VR development is recommended. Involve patients, educationalists and technology professionals in the development of technology interventions.