Effort—reward imbalance,heart rate,and heart rate variability: the cardiovascular risk in young finns study

Background: Work stress indicated by effort—reward imbalance is hypothesized to cause autonomic arousal, which, if prolonged or frequent, could contribute to cardiovascular pathology. However, only limited empirical evidence on this mechanism is available. Purpose: This study examined associations between effort-reward imbalance, heart rate (HR), and heart rate variability (HRV). Method: The participants were 457 women and 406 men (mean age 32.3 years) derived from the population-based Young Finns Study. Effort—reward imbalance was defined as the ratio between effort and reward, higher efforts compared to rewards indicating greater imbalance. Results: In age-adjusted regression models, higher effort-reward imbalance was associated with lower HRV, and lower reward was associated with higher HR among women. These associations were not attenuated after additional adjustments for demographic characteristics and coronary risk factors. No significant associations of effort—reward imbalance or its components with HR and HRV were found in men. Conclusion: Our finding of lower HRV and higher HR in young healthy women with high effort—reward imbalance and low rewards provides evidence of a potential mechanism that may link effort-reward imbalance to the development of coronary heart disease (CHD) in women.     

Job stress and other working conditions: Relationships with smoking behaviors in a representative sample of working Australians

OBJECTIVES: To assess the relationships between current smoking status and psychosocial working conditions. METHODS: A cross-sectional population-based telephone survey was conducted (66% response rate, N = 1,101). Job stress was measured using the demand/control, effort/reward imbalance (ERI), and job pressure models. Multiple regression modelling was conducted for smoking status (current versus non-smokers, and a more restricted analysis of current versus former-smokers) and daily smoking intensity outcomes in relation to job stress measures, working hours, shift work, and other independent variables. RESULTS: After adjustment for age, education, martial status, and hostility, high job strain was positively associated with current smoking in men only. Employment in active jobs was associated with decreased odds of smoking among women only. High strain jobs were associated with decreased odds of current smoking compared to former smoking in women. In men, extreme and moderate job pressure were related to current smoking compared to current non-smoking, and moderate job pressure was associated with current smoking compared with former smokers. Other working conditions associated with smoking were excessive working hours in men and physical demand in women. Daily smoking intensity in current smokers was associated with high psychological demand and with ERI in women. CONCLUSIONS: These results suggest that job stress is related to smoking status at the population level, with different patterns in men and women.     

溃疡性结肠炎患者肠道菌群的变化及其与IL-23/IL-17轴的关系

目的:探讨溃疡性结肠炎(UC)患者肠道菌群分布和种类的变化及其与白细胞介素23(IL-23)/IL-17轴的关系。方法 :收集20例UC活动期患者和20例健康对照者的新鲜粪便标本,采用直接涂片镜检和传统细菌培养鉴定法分析菌群分布;利用real-time PCR检测菌群种类的变化;常规检测血红蛋白、白蛋白、血沉和C反应蛋白水平;经结肠镜活检取UC患者正常及病变肠黏膜组织,进行Mayo评分和Baron分级,HE染色观察组织病理变化;免疫组化及Western Blot观察IL-17和IL-23表达的改变。结果:(1)与对照组比,活动期UC患者菌群失调程度明显升高(P0.05);(2)需氧培养结果表明,活动期UC患者的大肠杆菌数量较正常人显著降低(P0.01),肠球菌数量明显增加(P0.01);厌氧培养结果发现,活动期UC患者的拟杆菌、双歧杆菌和乳酸杆菌数量较正常人显著减少(P0.01);(3)目标菌属定量分析表明,UC患者粪便中大肠杆菌、拟杆菌、双歧杆菌和乳酸杆菌相对定量较正常人显著降低,肠球菌数量明显升高(P0.01);(4)与对照组相比,UC患者血红蛋白无明显改变,白蛋白明显降低(P0.05),血沉和C反应蛋白明显增高(P0.01);(5)UC患者Mayo评分显著升高(P0.01),Baron分级显著增加(P0.01),结肠组织病理改变明显(P0.01);(6)与对照组比较,UC患者表达丰富的IL-17和IL-23(P0.01);(7)相关性分析表明,IL-17和IL-23表达的平均吸光度与Baron分级(r=0.717,P=0.02;r=0.849,P=0.016)和病理组织学评分(r=0.660,P=0.030;r=0.675,P=0.032)呈正相关;同时,IL-23表达的平均吸光度与大肠杆菌数量呈明显负相关(r=-0.669,P=0.025),与肠球菌数量呈正相关(r=0.872,P=0.010),IL-17表达的平均灰度值与肠球菌数量呈正相关(r=0.764,P=0.046),但二者与其它目标菌属的数量无明显相关性。结论:活动期UC患者存在明显的肠道菌群失调,改变的细菌与患者炎症程度密切相关。IL-23/IL-17轴作为UC发生发展的关键因子,与肠道菌群含量的变化可能存在一定关联,其相互作用在UC的病理过程中起到重要作用。     

结肠癌术中化疗患者症状体验与自我管理效能的相关性研究

目的：了解结肠癌术中化疗患者的症状体验与自我管理效能感水平,并分析两者的关系.方法：采用MD Anderson消化道癌症症状调查量表和中文版癌症自我管理效能感量表对97例结肠癌患者进行调查.结果：结肠癌患者术中化疗症状症状程度最严重的前4项症状依次是疲乏（6.74±2.83）分、疼痛（6.15 ±2.02）分、睡眠不安（5.69±1.53）分、口干（5.30±1.37）分;对患者生活功能造成中度及以上水平困扰,包括患者的一般活动（7.67±1.95）分、走路（6.84±2.14）分、工作（6.32±1.49）分、生活乐趣（5.12±1.37）分.本组患者自我管理效能感处于中等水平（81.68±13.44）分.症状体验各维度与总体自我管理效能感均呈负相关（P＜0.05）.结论：结肠癌术中化疗患者症状体验感较为强烈,护理人员应加强对患者症状的管理与控制,提高患者的自我管理效能感水平,改善其生活质量.     

荆州市8家医院临床护士付出-获得不平衡和工作投入的相关性研究

目的探讨临床护士付出-获得不平衡与工作投入之间的相关性。方法采用付出-获得不平衡量表和工作投入量表,对荆州市8家医院589名临床护士进行调查,采用描述性统计、相关性分析和回归分析进行数据分析。结果临床护士付出-获得不平衡比值为1.41,处于付出-获得不平衡状态的护士411名(69.8%),超负荷状态的护士430名(73.0%);工作投入总均分为(3.35±0.86)分。付出-获得不平衡中的付出、获得维度与工作投入及其活力、奉献、专注3个维度均呈正相关(P0.01),超负荷维度与其呈负相关(P0.01)。结论护士付出-获得不平衡状态及超负荷状况突出,工作投入处于中等水平;建议丰富护士的获得,平衡其付出-获得状况及减轻超负荷状况,以提高护士的工作投入。     

血清钾危急值的评价研究

目的探讨建立血清钾危急值报告制度的临床意义。方法回顾分析我院检验科2012年1—6月血清钾检测资料,以3.0 mmol/L为低血钾危急值界限值,6.0 mmol/L为高血钾危急值界限值,对报告的血清钾危急值患者进行临床追踪随访,记录患者分布情况,以及住院患者血清钾浓度分布情况、不同程度高钾血症及低钾血症患者的病死率、临床医生采取干预措施的时间。结果 114 871例次检测中共有2240例次(1.95%)血清钾检测达危急值,以住院患者为主。其中血清钾低危急值患者617例,高危急值患者201例,共死亡120例,病死率10.51%,低、高钾血症患者中分别以血清钾2.50 mmol/L和6.50 mmol/L者病死率最高;且低钾或高钾程度越严重的患者临床医生给予有效干预措施的时间越短。结论建立血清钾危急值报告制度对危险性电解质紊乱的临床救治、改善患者预后有重要意义。     

Alterations of <Emphasis Type="Italic">RB1</Emphasis> gene in embryonal and alveolar rhabdomyosarcoma: special reference to utility of pRB immunoreactivity in differential diagnosis of rhabdomyosarcoma subtype

PURPOSE: Rhabdomyosarcoma (RMS), which is the most common pediatric soft tissue sarcoma, is classified into two major histologic subtypes, embryonal RMS (ERMS) and alveolar RMS (ARMS). RMS is occasionally reported to be the second neoplasm of hereditary retinoblastoma. Osteosarcoma is known as the most common second neoplasm of hereditary retinoblastoma, and tumorigenesis of osteosarcoma has been proven in previous studies to be related to the RB gene (RB1) alteration. Therefore, there might be a correlation between the tumorigenesis of RMS and RB1 alteration. METHODS: We examined the RB protein (pRB) expression and RB1 alteration such as allelic imbalance (gain or loss) and homozygous deletion, using immunohistochemistry, microsatellite makers, and quantitative real-time PCR in 57 sporadic RMS. RESULTS: Allelic imbalance was more frequently detected in ERMS (13/27), than in ARMS (3/20) (P = 0.04). Homozygous deletion on the protein-binding pocket domain of RB1 was found in 6 of 27 ERMS and in 2 of 20 ARMS (P = 0.24). Furthermore, immunohistochemical pRB labeling indexes (LI) in 31 ERMS (median value, 31%) were significantly reduced in comparison with those observed in 26 ARMS (median value, 85%) (P < 0.0001). CONCLUSIONS: Our results support the assertion that tumorigenesis of RMS may be associated with RB1 alteration especially in ERMS, as previously reported for osteosarcoma. As for the RB pathway, each subtype of RMS may have a different tumorigenesis. In addition, immunohistochemical pRB LI may have the potential to be a useful ancillary tool in the differential diagnosis of RMS subtypes.     

Lower th-1/th-2 ratio before interferon therapy may favor long-term virological responses in patients with chronic hepatitis C

It is still controversial whether alterations in helper-T cell subpopulations contribute to the pathogenesis and clinical characteristics of chronic hepatitis C. The aim of this study was to clarify this issue, particularly in relation to interferon therapy. Thirty-one patients with histologically proven chronic hepatitis C were treated by conventional interferon (IFN) monotherapy for 6 months, and virological responses were evaluated by polymerase chain reaction 6 months later. Helper-T cell subpopulations, Th-1 and Th-2, were determined in peripheral blood by intracellular cytokine assay using flow cytometry. In chronic hepatitis C, the percentage of Th-1 and Th-2 subpopulations in peripheral blood were significantly increased, by 1.4-fold as compared with normal controls. Serum levels of ALT were inversely proportional to the percentage of Th-1 subpopulations, while directly proportional to that of Th-2 subpopulations. In nonresponders (N = 16) to interferon therapy, the percentage of Th-1 subpopulations and Th-1/Th-2 ratio were significantly higher than those in complete responders (N = 15). By multivariate logistic regression analysis, HCV genotype non-1b, HCV viral load less than 500 kilocopies/ml, and the lower Th-1/Th-2 ratio could independently merit favorable long-term virological responses. Helper-T cell subpopulations, Th-1 and Th-2, seem to contribute to progression of chronic hepatitis C in a reciprocal fashion. The imbalance between the two subpopulations may determine the final outcome of interferon therapy as one of the host factors.     

红细胞内酸碱度改变与COPDⅡ型呼吸衰竭肺性脑病关系的研究

目的：研究红细胞内酸碱度改变与COPDⅡ型呼吸衰竭肺性脑病的关系。方法：分别同步测定COPDⅡ型呼吸衰竭肺性脑病治疗前32例（A1组）、治疗后25例（A2组）,COPDⅡ型呼吸衰竭非肺性脑病42例（B组）,健康志愿者28例（C组）红细胞内血气指标,并比较各组间差别。结果：A1组、A2组及B组红细胞内PH、[HCO-3]、PCO2显著高于C组,PO2则相反（P〈0.001）。A1组的红细胞内PH、[HCO-3]、PCO2显著高于A2组及B组,PO2则显著降低,差别均有统计学意义。A2组相关指标与B组差别无统计学意义（P〉0.005）。结论：COPDⅡ型呼吸衰竭肺性脑病红细胞内相对偏碱状态,可能与肺性脑病有关,治疗缓解后,红细胞内相对偏碱状态可被纠正。