老年糖调节受损者不同转归情况应对方式的比较研究

目的：探讨老年糖调节受损（IGR）者的应对方式特点,并比较不同转归情况的老年IGR者应对方式的差异.方法：对220例老年IGR者的空腹血浆葡萄糖（FPG）及口服葡萄糖试验2小时血浆葡萄糖（OGTT2hPG）进行测定,并用特质应对方式问卷（TCSQ）对其应对方式进行评定,对不同转归情况的老年IGR者应对方式的差异进行比较.结果：老年IGR者的应对方式总体上是比较积极的,积极应对得分高于国内常模（P＜0.001）;有27.73%～78.64%的老年IGR者采用不同形式的积极应对方式,而4.09%～18.18%采取消极应对方式;不同转归组的老年IGR者应对方式的差异无显著性（P＞0.05）.结论：在老年IGR者的心理干预中应多关注采用积极应对方式较少、消极应对方式较多的这些人群.     

Antigenic and immunologic characterization of an allogeneic colon carcinoma vaccine

In the present prospective, census-based study we have investigated the prevalence of organ-specific and non-organ-specific autoantibodies (AAb) in 152 unselected Cameroonians aged 60 years and older living in the community. AAb were detected in 49% of the participants. Non-organ-specific AAb (47%) predominated over organ-specific AAb (7%). Anti-TPO, anti-Tm, anti-Tg and anti-PC AAb were completely absent. RF was the most frequent AAb, being found in 57 (38%) cases. The prevalences of anti-SMA and RF were significantly higher in women than in men (respectively, P=0.023 and P=0.016). Higher serum concentrations of gammaglobulins were accompanied by a higher prevalence of RF (P < 0.0001) and a lower prevalence of ANA (P=0.036). The overall prevalence of AAb was higher in the filaria-infected (60%) compared to the non-infected (42%) participants (P=0.046). There was no significant influence of the vitamin D status, number of pregnancies, physical activity or medication use on the prevalence of AAb. In this study a heterogeneous pattern for the presence of the various AAb was found. Some AAb, which are commonly encountered in other studies on elderly subjects, were completely absent in this population. This diversified pattern of AAb prevalence therefore argues in favour of exogenous influences in the occurrence of AAb in elderly populations.     

Neoplasms involving the central nervous system in the older old

Geriatric cancer patients present special challenges for clinicians. Few large series have been published in the last 20 years on the types of neoplasms that involve the central nervous system (CNS) in older individuals. To review types of neoplasms involving the central CNS that are currently being encountered by pathologists and neurosurgeons, we identified from our databases for the years 1992-2002, inclusive, patients 75 years or older who had symptomatic lesions requiring neurosurgical interventions. Retrospective characterization of tumors by immunohistochemistry, in situ hybridization, and fluorescence in situ hybridization was performed whenever possible and relevant to tumor type. Neurosurgical procedures (n=125) on 119 patients were identified; 90 patients were diagnosed as having neoplasms, with clot evacuation or infections being the most frequent non-neoplastic conditions necessitating surgery. Tumor types included glioblastomas (36 patients), meningiomas (16), pituitary adenomas (12), lymphomas or other hematological malignancies (8), anaplastic gliomas (5), metastases (6), head and neck malignancies with direct intracranial extension (3), and other miscellaneous tumor types (4). Compared with older literature series, we encountered a larger number of elderly patients with CNS lymphomas and fewer who came to surgery for CNS metastatic disease. In the "older old", glioblastomas are the most frequent symptomatic tumors necessitating surgical intervention. Glioblastomas in this aged cohort display the signature features of the small cell phenotype (62%), high cell cycle labeling indices (mean MIB-1-labeling index=25.1%), and either amplification of epidermal growth factor receptor or gain of chromosome 7 by fluorescence in situ hybridization (93% of assessable cases).     

睡眠信念与态度量表在失眠患者健康教育中的应用

目的: 采用睡眠个人信念与态度量表探索患者睡眠障碍与哪些歪曲的信念有关,针对歪曲的信念进行睡眠实践教育,达到促进睡眠的目的.方法: 连续收集62例以失眠为主诉的患者,随机分成试验组与对照组,各31例,两组均在药物治疗及心理治疗基础上进行睡眠健康教育.试验组针对患者自身存在的歪曲信念态度进行健康教育,而对照组只进行常规的健康宣教.入组前及入组后每周,应用睡眠个人信念与态度量表(Dysfunctional Beliefs and Attitudes about Sleep Scale,DBAS)、匹茨堡睡眠指数量表(Pittsburgh Sleep Quality Index,PSQI)对两组进行测评,同时让患者评价睡眠时间、睡眠质量、睡眠效果和对健康教育接受程度.结果: 健康教育4周后试验组和对照组DBAS得分均高于人组时[(111.0±8.7)vs.(88.9±12.3)、(93.5±17.2)vs.(81.3±19.2),P:0.001、0.010],而PSQI得分均低于入组时[(5.5±2.1)vs.(10.9±4.4)、(9.0 ±2.1)vs.(11.5±3.6),均P=0.001];健康教育4周后对照组的DBAS得分低于实验组,而PSQI得分高于实验组.健康教育后试验组对睡眠时间、睡眠质量、睡眠效果满意的比例均明显提高,睡眠时间满意的比例由18/31到30/31,对睡眠质量满意比例由8/31变为23/31,对睡眠效果满意比例由8/31到21/31(均P＜0.05).试验组对睡眠时间满意的比例明显高于对照组(30/31 vs.14/31,P＜0.01),对健康教育的接受程度也明显高于对照组(18/31 vs.5/31,P＜0.05).结论: 试验组健康教育后患者的睡眠信念有了明显的改善,睡眠质量有了提高.     

Phenomenology and family history in DSM-III psychotic depression

Depressed inpatients with psychotic features were compared to those without them in terms of demographic features, depressive symptoms at intake and family history. These variables were then used to compare patients with mood-congruent psychotic features to those with mood-incongruent psychotic features. Patterns of familial psychopathology were similar for psychotic and non-psychotic patients. In accord with other studies, the families of mood-incongruent patients had slightly more schizophrenia and significantly less depression than did the families of mood-congruent patients. Depressive symptoms, particularly those used to define major depression and melancholia, were more severe in psychotic patients. Moreover, these particular depressive symptoms were more likely to distinguish mood-congruent from mood-incongruent patients than were other depressive symptoms. Thus mood-congruent psychotic features accompanied a more typical depressive syndrome than did mood-incongruent psychotic features.     

The significance of blood cultures positive for emerging saprophytic moulds in cancer patients

The significance of blood cultures positive for emerging saprophytic moulds (e.g., Scedosporium apiospermum, Scedosporium prolificans, Paecilomyces spp.) was evaluated in 30 cancer patients (1996-2002). Diagnostic criteria proposed previously for evaluation of aspergillaemia were used. Blood cultures positive for emerging saprophytic moulds represented 1% of all positive fungal cultures. One case of catheter-related fungaemia was excluded. The remaining 29 cases consisted of true (n = 5), probable (n = 1), indeterminate (n = 7) fungaemia, and contamination (n = 16). True fungaemia was seen only in leukaemia patients and allogeneic bone marrow transplant recipients. S. apiospermum and S. prolificans were the commonest causes of true fungaemia.     

Hepatitis C virus infection in hemodialysis patients in southern Sweden: Epidemiological,clinical, and diagnostic aspects

A prevalence of hepatitis C virus (HCV) antibodies of 12% was found in 276 patients from 11 dialysis units. Between zero and 22% of the patients in the different units were anti-HCV positive. The epidemiology of HCV was studied in two units during a 2 year period by antibody assays and the polymerase chain reaction and correlated with clinical manifestations. Two types of epidemiologic patterns were found that may explain the wide difference of HCV prevalence described in different dialysis units. In one unit there was no evidence of spread within the unit, and the prevalence of HCV was dependent on the status of the patients entering for treatment. In the other unit, a clustering of infected patients could be seen in which 13 of 36 were infected during a 3 year period. Some patients who had not received blood transfusions were among the infected. Hepatitis C infection was the most common explanation for repeated abnormal transferase levels. Most of the HCV-infected patients reacted both for anti-HCV and HCV RNA. HCV RNA was in general detected earlier than anti-HCV seroconversion. Among 20 HCV RNApositive serum samples that were anti-HCV ELISA-positive 18 had indeterminate and two negative reactions by immunoblot (RIBA 2). Thus the RIBA 2 test should be used with caution as a confirmatory antibody test in this group of patients. © 1993 Wiley-Liss, Inc.     

Intravenous and intramuscular pharmacokinetics of recombinant leukocyte a interferon

Summary Interferon is currently being evaluated for the treatment of disseminated cancer and viral diseases. Alpha interferons have shown to be effective in the treatment of a number of malignancies. Recombinant leukocyte A interferon (rIFN-A) is an alpha interferon produced by recombinant DNA techniques. A kinetic evaluation of rIFN-A following intravenous and intramuscular administration has not been adequately defined. The present study was designed to evaluate the kinetics of rIFN-A following intravenous and intramuscular administration of 3, 9 or 18×10⁶ units to patients with disseminated cancer.A preliminary report of this study was presented at the meeting of the American Society for Clinical Pharmacology and Therapeutics in San Diego, March 1983 (1).     

Plasticity of the central nervous system—a neurosurgeon's experience of cerebral compensation and decompensation

Summary Cerebral plasticity constitutes one of the most decisive factors in recovery and readaptation after cerebral lesions. In contrast to the considerable progress in current studies on normal neuronal plasticity including the idea of l'homme neuronal, the concept of plasticity postulated by Albrecht Bethe in 1929 received little attention. The author, as a neurosurgeon, has tried to describe cranial morphological plasticity, morphological and functional plasticity in infantile encephalopathies and especially in hemiatrophic lesions. It is supposed that a true morphological substrate exists due to compensatory hyperplasia of the uninvolved hemisphere.Modern neurosurgical techniques have demonstrated that the functional plastic capacity is much larger than has been supposed, even in the elderly. Some aspects of the mechanisms of compensation and decompensation of cortical and subcortical structures as well as of the central regulation systems are discussed. The full extent of the amazing recovery and functional reorganization is reached by plastic capacity, personal motivation, adequate training and sufficient time.The contribution ends with an exposition of a personal philosophy concerning psycho-somatic dualism, the body-mind problem, the future of the human brain and the ethical outlook, based on the progressive biological evolution of the basal neocortex and the immanent functional development (H. Spatz).In grateful memory of my paternal friends, the great German brain researchers Julius Hallervorden (1882–1965) and Hugo Spatz (1888–1969).     

Childless elderly: Theoretical perspectives and practical concerns

Almost nothing is concretely known about childless elderly in cross-cultural perspective. Few published papers have appeared on this social category in the West, although childless elders make up (at least) 20% of the population of elderly in many Western nations. Little is known about childless elderly in the Third World. This paper provides some theoretical background to the study of childless elderly and articulates some social policy concerns about them. It suggests that there are five important questions to examine concerning the lives of childless elderly. These include, how childless aged are or are not provided for in societies in which a great deal of the care of the aged is undertaken by children; how kinship functions as a matrix for care; how the increasingly common phenomenon of voluntary childless may give meaning to childlessness in late life; how childlessness fits with such social science models such as the developmental cycle; and, the relationship of this phenomenon to changing opportunities for women. The paper further examines how factors such as fertility, systems of caregiving, the social meaning of childlessness, alternatives to childlessness such as adoption, and educational and economic opportunities may affect the lives of childless elders.