The Evidence Base Supporting the Subtyping of Gamblers in Treatment

Introduction Recent reviews found problem gamblers are heterogeneous and recommended subtyping gamblers in treatment studies. Objective Review factors (stage of change, preferred gambling activity, co-occurring disorder, and temporal instability of symptoms) for subtyping by evaluating the evidence for their effects on gambling treatment. Methods Literature review, evidence grading. Results Evidence is limited that any of the reviewed factors affects gambling treatment. Substantial evidence from prospective studies and other evidence from cross-sectional studies and the strong placebo response among pathological gamblers support the temporal instability of gambling symptoms. Conclusions Multiple studies are needed to develop the evidence base needed to subtype gamblers in treatment. Changes in the diagnostic criteria of pathological gambling may be necessary, especially to specify the persistence of gambling-related symptoms.     

Congenital quadricuspid aortic valve with tetralogy of Fallot and pulmonary atresia

We report the case of a 4-year-old girl who had quadricuspid aortic valve regurgitation with tetralogy of Fallot and pulmonary atresia. This combination is very uncommon. Aortic valve replacement was performed successfully due to aortic regurgitation which had progressed one year after the total repair. The dilated aortic annulus plus quadricuspid aortic valve may result in progressive aortic regurgitation for a short period.     

Outcomes of low-vision services using optometric and multidisciplinary approaches: a non-randomized comparison

Consecutive patients (n = 215) who were referred to optometric (55%) or multidisciplinary (45%) low-vision services and above 50 years of age were recruited from four hospitals in the Netherlands. They completed two vision-related quality of life questionnaires, the Vision Quality of Life Core Measure (VCM1) and the Low Vision Quality of Life Questionnaire (LVQOL), before their first visit with low-vision services and 1 year later. At follow-up, patients referred to multidisciplinary low-vision services had lower scores on the mobility subscale of the LVQOL than patients referred to optometric low-vision services [5.3 points; 95% confidence interval (CI): 0.2-10.5]. Paired sample t-tests for the two groups of patients taken together show improvement for the VCM1 (3.1 points; 95% CI: 0.6-5.6) and deterioration for the basic aspects of vision (3.5 points; 95% CI: 1.1-5.9) and the mobility (6.6 points; 95% CI: 3.7-9.5) subscales of the LVQOL. In conclusion, people referred to optometric services showed less deterioration in mobility than those referred to multidisciplinary services. No differences were observed for any of the other subscales of the LVQOL and the VCM1. Future research in this field should include randomized controlled designs comparing low-vision services with no treatment or placebo.     

数字减影血管造影与介入治疗在胃肠道动脉性出血中的应用价值

目的 探讨数字减影血管造影(DSA)诊断与介入治疗在胃肠道动脉性出血中的应用价值.方法 回顾性总结78例消化道动脉性出血患者的DSA表现和动脉栓塞、药物灌注的治疗经验.结果 本组患者十二指肠溃疡15例,胃溃疡5例,胃癌2例,Dieulafoy病1例,血管畸形和发育不良9例,胃肠术后吻合口出血8例,肝胆疾患术后肝动脉破裂出血10例,Crohn病5例、肠道憩室出血6例、小肠炎或溃疡6例,小肠息肉3例,小肠中度恶性间质瘤1例,小肠高分化平滑肌肉瘤2例,直结肠癌5例.74%(58/78)的患者DSA造影阳性,造影剂外溢直接征象者33%(26/78),术后吻合口出血直接征象者83%(15/18).介入治疗的病例中动脉药物灌注15例,技术成功率60%(9/15),临床成功率40%(6/15);栓塞36例,技术成功率86%(31/36),临床成功率72%(26/36);介人治疗后再出血率16%(8/51),其中1例栓塞后再呕血经胃镜治疗无效死亡.DSA造影和介入治疗后手术者27例,造影与术后病理诊断的符合率为78%(21/27).随访时间2个月至3年,未发生胃肠道缺血坏死等并发症.结论 DSA对消化道动脉性出血的定位、定性有着重要价值,选择性动脉栓塞及药物灌注止血安全有效,有助于择期手术和并发症处理.     

慢性肺心病哮喘持续状态218例临床分析

目的探索治疗慢性肺心病哮喘持续状态的方法。方法回顾性分析1983年10月～2005年3月收治的218例慢性肺心病哮喘持续状态患者的临床资料。结果哮喘持续状态在48h以内被控制的62例（28．4％）；在72h以内控制的56例（25．7％）；在120h以内控制的25例（11．5％）；在168h以内控制的34例（15．6％）；痊愈出院177例（81．2％）；死亡41例（18．8％）。结论（1）治疗慢性肺心病哮喘持续状态．根据患者的病理变化．综合治疗．效果显著。（2）在治疗过程中．要恰当选择抗生素和平喘药；对那些血液黏滞度增高的患者．要加用血液稀释疗法。（3）测定血液黏滞度和氧饱和度．可以指导治疗、估计预后．应当列为常规检查。     

Gastrointestinal stromal tumor in ileal neobladder

Abstract  Gastrointestinal stromal tumor (GIST) is a recently described mesenchymal tumor that can develop in any portion of the gastrointestinal tract. The occurrence of a GIST in the urinary tract is rare, but GIST can present as tumor of the urinary tract or invade the urinary tract. This is the first reported case of GIST in the ileal neobladder, which presented as a submucosal tumor. The patient underwent an open exploration and partial resection of the neobladder pouch.     

应用秩和比法研究门诊人数增长与门诊医疗质量因子的关系

目的研究医院门诊人数增长与门诊医疗质量因子的关系,找出影响门诊人数增长的主要门诊医疗质量因子。方法利用秩和比法对实例进行分析。结果影响门诊人数增长的门诊质量因子,首先是高中级职称比(χ2=32.43,P<0.05),其次是副高以上职称的坐诊工时比(χ2=31.91,P<0.05),再次是新技术项目或重大改革(χ2=28.54,P>0.05)。结论研究医院门诊人数增长与门诊医疗质量因子的关系时,秩和比法有应用推广的价值。     

粉防己碱对野百合碱致大鼠肺动脉构形重建的逆转作用

以野百合碱复制Ｗｉｓｔａｒ大鼠肺动脉高压模型，用特殊染色方法观察粉防已碱对野百合碱致大鼠肺动脉构形重建的逆转作用，结果表明粉防已碱可选择性的降低野百合碱诱导的大鼠肺动脉高压的作用，并明显地逆转肺血管及肺组织损伤，降低肺动脉高压和右心室肥大，对体循环压力无影响     

Effect of norethisterone acetate on serum lipid and lipoprotein parameters as well as on blood coagulation in female monkeys (M. fascicularis)

The effects of daily oral administration of a high dose of 10 mg norethisterone acetate (NET-Ac.)/kg/day over 14 weeks on serum lipid and lipoprotein parameters as well as on blood coagulation were investigated in female monkeys (M. fascicularis). Measurements of lipids and lipoprotein cholesterol were performed in weeks —5 and — 1 before treatment and in weeks 4, 8 and 12 after treatment. In addition, various blood coagulation and fibrinolytic parameters were determined in weeks 11–14 after treatment with NET-Ac. Furthermore, the serum levels of norethisterone (NET) were determined in order to monitor the real systemic compound exposure and revealed that C_max and AUC (0–3 h) values reached for norethisterone in this experiment in monkeys were about 25 times higher than those obtained after an oral contraceptive dose of NET-Ac. in women.

The results of lipid and lipoprotein cholesterol determinations showed decreases in serum total lipids, phospholipids, triglycerides and total cholesterol associated with similar decreases in HDL-, LDL- and VLDL-cholesterol fractions after NET-Ac.-treatment in monkeys. These effects were observed from week 4 onwards and maintained their magnitude up to week 12 after treatment. Since both HDL- and LDL-cholesterol fractions decreased, the HDL/LDL-ratio remained almost unchanged. Thus, the results obtained in this study after high-dose treatment with NET-Ac. in monkeys did not indicate any changes of lipid and lipoprotein parameters which in humans are supposed to be associated with an increased risk of cardiovascular lesions, namely a decrease in HDL- and increase in LDL-cholesterol fractions.

The results of blood coagulation and fibrinolytic parameters showed increased antithrombin-III and plasminogen levels besides minor changes in other parameters, thus indicating that NET-Ac. -treatment does not contribute to an increased risk of cardiovascular thrombotic events in the cynomolgus monkey.