脑卒中幸存者家庭关怀度与反刍性沉思的相关分析

目的:调查脑卒中幸存者家庭关怀度和反刍性沉思现状,并进一步探讨两者间的相关性。方法:运用便利采样法,选择入住常熟市第二人民医院神经内科的脑卒中幸存者82例。通过病人一般情况调查表、家庭关怀度指数量表(APGAR)和事件相关反刍性沉思问卷(ERRI)对病人进行调查。结果:脑卒中幸存者家庭关怀度得分为(6.55±2.31)分,处于中等水平;反刍性沉思得分为(25.31±10.36)分,处于中等偏下水平;相关分析示,家庭关怀度和反刍性沉思总分及目的性反刍呈显著正相关(r=0.501~0.601,P<0.05)。结论:脑卒中幸存者的家庭关怀度和反刍性沉思均需提升;临床医护人员可通过增强家庭关怀度来改善反刍性沉思水平。     

两种不同灌注方法对肩关节镜下手术出血与视野显露的影响

目的探讨改良加压灌注和常规重力灌注对肩关节镜下手术出血与视野显露的影响。方法选取我院2018-01/2019-07期间因肩袖撕裂收住我院骨科拟行肩关节镜手术治疗的患者60例,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为观察组(n=30)和对照组(n=30)。观察组应用改良气压止血仪加压灌注,对照组应用常规重力灌注,监测并记录关节腔压力(mmHg)、关节腔灌注引流液中红细胞计数(个)、灌注液总量(L)、手术时间(min)、术后肩关节肿胀度(cm)。结果观察组第1次更换灌注液时关节腔压力高于对照组,关节腔灌注引流液中的红细胞计数及手术时间少于对照组,差异有统计学意义(P<0.05);2组灌注液总量及术后肩关节肿胀度无统计学意义(P>0.05)。结论在肩关节镜手术中使用改良加压灌注法,具有操作简便、压力稳定、视野清晰、手术时间短等优点,值得临床推广使用。     

Recent clinical features of Wilson’s disease with hepatic presentation

Background We carried out this study to evaluate recent clinical features of Wilsons disease (WD) with hepatic presentation, especially in terms of age, degree of liver injury, and association with hepatocellular carcinoma (HCC).Methods Sixteen patients with hepatic manifestations were diagnosed with WD in the period 1976–2003. We divided this period into two periods, past and recent. The diagnosis was based on the presence of Kayser-Fleisher rings, low serum copper levels, low serum ceruloplasmin levels, increased urinary copper concentrations before or after D-penicillamine challenge, and increased hepatic copper concentrations. This retrospective study was done at Ehime University Hospital.Results Four patients, including a pair of siblings, had a family history of WD. Four patients had parental consanguinity. There were 6 patients aged over 40 years in the recent period, whereas no patients in the past period were over 40. Four patients had neurological manifestations. Ten patients had liver cirrhosis and 5 had chronic hepatitis. Two had fatty liver without obesity. All patients in the past period had liver cirrhosis. Three patients with liver cirrhosis were found to have HCC during the follow up. All patients were treated with either D-penicillamine or trientine chloride, or both. However, four patients had to discontinue these agents due to the side effects.Conclusions Recently, the number of patients diagnosed with WD has been increasing, not only in terms of those with classical-type WD but also in terms of elderly patients or patients with non-cirrhotic liver injury such as fatty liver and chronic hepatitis. The various clinical features of WD should be recognized and particular attention should focus on HCC as a complication.     

慢性乙型肝炎患者血清e抗原及病毒载量和肝损伤的相关性研究

目的观察慢性乙型肝炎(CHB)患者不同乙型肝炎e抗原(HBeAg)状态与HBV-DNA载量及肝脏损伤的关系。方法分别采用实时荧光定量PCR法及速率法对258例慢性乙型肝炎进行血清HBV-DNA定量和丙氨酸氨基转移酶(ALT)检测。以ALT水平对肝脏损伤程度进行分型,对不同HBeAg状态、病毒载量、肝损伤程度进行分析。结果 HBeAg阴性组年龄大于HBeAg阳性组,其血清HBV-DNA载量低于HBeAg阳性组(P0.01),肝损伤程度两组比较差异无统计学意义(P0.05)。HBeAg阴性组随血清HBV-DNA载量增加,肝损伤程度明显升高(P0.05),HBeAg阳性组则无相关性。结论 HBeAg阳性是判断HBV复制的良好指标,HBeAg阳性CHB患者体内DNA载量与肝内炎症损伤无关。而HBeAg阴性CHB患者体内HBVDNA与肝脏损伤相关,应重视对HBeAg阴性患者的随访和治疗。     

家庭关怀度对慢性肾功能衰竭患者发生抑郁的影响

目的 探讨家庭关怀度对慢性肾功能衰竭患者发生抑郁的影响.方法 选取我院收治的慢性肾功能衰竭患者120例,随机分为观察组和对照组,每组50例.对照组患者采用药物治疗和常规性护理,观察组在此基础上增加家庭关怀护理内容.干预10、30、60d后,对两组患者采用HAMD进行抑郁评分,同时采用自测健康评定量表(SRHMS)对患者的健康状况进行评估.结果 干预后两组患者HAMD评分均较干预前降低(均P＜0.05);与对照组同期比较,观察组患者HAMD评分减少更为明显(P＜0.05).患者在自测健康中生理、心理、社会三个健康维度的自测分和总得分均明显高于对照组(均P＜0.01),患者不良症状发生率均明显低于对照组(均P＜0.05).结论 家庭关怀度对慢性肾功能衰竭患者发生抑郁的影响积极的,能缓解患者的心理压力,减低患者抑郁情绪的产生,同时有利于患者症状的缓解.     

高温高压对壳聚糖／甘油磷酸钠温敏凝胶释药性能的影响

目的：研究高温高压后的壳聚糖／甘油磷酸钠凝胶温敏、释药性能。方法：观察不同比例的壳聚糖和甘油磷酸钠混合液的凝胶时间、pH值变化。粘度测试比较不同比例壳聚糖／甘油磷酸钠混合液粘度变化。在37℃形成凝胶后,观察该体系作为奥硝唑药物模型载体的释药性能。结果：随着壳聚糖／甘油磷酸钠混合液中甘油磷酸钠的比例增加,溶液pH值增加,在37℃下,壳聚糖／甘油磷酸钠凝胶时间缩短,但当壳聚糖／甘油磷酸比例为2：1、1：1时,溶液不凝胶。粘度实验表明,4种比例（9：1、8：1、7：1、6：1）壳聚糖／甘油磷酸溶液随着时间增加,粘度明显增加,到10 min后粘度基本不变化,9：1比例组粘度最大为（53±0．9）Pa·s。药物释放实验表明,以奥硝唑为释药模型,该凝胶可持续释放200 min以上。结论：改进消毒方法后的壳聚糖／甘油磷酸钠,增加甘油磷酸钠比例可以提高溶液pH值,可在37℃下快速形成凝胶。该凝胶具有温敏性,具有缓慢释放药物能力。     

冲洗液对环氧树脂基根管糊剂材料聚合影响的体外研究

目的：体外研究不同根管冲洗液润湿环境下环氧树脂基根管糊剂材料的聚合转化。方法：在直径2 cm的圆形聚酯薄片上制备AH Plus树脂薄膜,置于不同冲洗液润湿环境的50 mL离心管内聚合。利用傅里叶变换红外光谱仪检测树脂聚合反应前和反应24 h后的聚合转化率。结果：除对照组与95％乙醇之间、两实验组H2O和17％EDTA之间的差异无统计学意义外,两两之间的差异均有统计学意义（P＜0．05）。结论：95％乙醇对AH Plus聚合无影响;而H2O、17％EDTA、2．5％NaOCl显著降低了AH Plus的聚合度,其中2．5％NaOCl降低作用影响最大,H2O和17％EDTA的影响作用其次且相同。临床上应谨慎选择最终根管冲洗液,以避免牙本质残留冲洗液对AH Plus材料的聚合转化的影响。     

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.     

急性冠脉综合征并发2型糖尿病患者血清脂蛋白磷脂酶A2浓度及其与冠状动脉病变程度的相关性

目的探讨急性冠状动脉综合征(acute coronary syndrome,ACS)并发2型糖尿病(type 2 diabetes mellitus,T2DM)患者血清脂蛋白磷脂酶A2(lipoprotein phospholipase A2,Lp-PLA2)浓度及其与冠状动脉病变程度的相关性。方法选择佛山市第一人民医院禅城医院2017年8月至2018年10月106例ACS患者为研究对象,其中53例无并发糖尿病为对照组,53例并发T2DM为观察组,另选择同期健康体检人群60名为正常组。检测3组受试者血清Lp-PLA2浓度及肱动脉血流介导的血管内皮舒张功能(flow mediated dilation,FMD);计算3组受试者冠状动脉病变Gensini积分;超声检测3组受试者冠状动脉病变程度。结果观察组血清Lp-PLA2浓度、冠状动脉病变Gensini积分明显高于对照组和正常组,差异有统计学意义(P<0.05)。观察组FMD明显低于对照组和正常组,差异有统计学意义(P<0.05)。观察组超声检测参数明显比对照组和正常组差,差异有统计学意义(P<0.05)。与观察组单支或双支冠状动脉病变血管患者比较,冠状动脉病变3支及以上患者血清Lp-PLA2浓度明显上升,差异有统计学意义[(510.64±46.93)ng/mL vs.(443.36±44.58)ng/mL,P<0.05;vs.(510.64±46.93)ng/mL vs.(397.25±38.42)ng/mL,P<0.05]。观察组血清Lp-PLA2浓度与FMD呈负相关,与冠状动脉病变Gensini积分呈正相关。结论ACS并发T2DM患者血清Lp-PLA2浓度增高并与冠状动脉病变程度有关。