Apolipoprotein E polymorphisms and mortality in Italian type 2 diabetic patients

AIMS: To determine if apolipoprotein E polymorphism is associated with cardiovascular or all-cause mortality in Italian Type 2 diabetic patients. METHODS: A prospective study of mortality in Type 2 diabetic patients (n = 433) as a function of apolipoprotein E phenotype, which was assessed at entry into the study. During follow up (10 years), 110 (25.4%) patients died of which 66 (15.2%) were the result of cardiovascular causes. Cause of death was established from death certificates and clinical records. The clinical status of the survivors was determined at the end of the study. RESULTS: Apolipoprotein E polymorphisms were not associated with excess cardiovascular or all-cause mortality in the Italian Type 2 diabetic patients either in univariate or multivariate analyses. Age, duration of diabetes and glycated haemoglobin levels at entry were the primary determinants of premature mortality in the diabetic population. CONCLUSIONS: Apolipoprotein E polymorphisms are not markers for premature mortality in Italian Type 2 diabetic patients. The impact of apolipoprotein E mutations may be attenuated by environmental factors, notably a healthier diet, in Italian patients.     

高功率微波辐射对小鼠心肌氧化应激及ATPase的影响

目的观察高功率微波辐射(high power microwave radiation,HPM)对小鼠心肌氧化应激及ATPase活性的影响。方法雄性ICR小鼠32只,随机分为4组(n=8):假照组、微波辐射10 min组、微波辐射20 min组、微波辐射30 min组。采用S波段,平均表面功率为10 mW/cm2微波;照射时间分别为0,10,20,30 min/次,每周2次,共2周。末次辐射完毕,立即处死小鼠,取心脏、冰冷生理盐水冲洗后,加入匀浆液制作匀浆。采用试剂盒测定超氧化物歧化酶(SOD)活性、谷胱甘肽过氧化物酶(GSH-px)活性、总抗氧化能力(T-AOC)、谷胱甘肽(GSH)及丙二醛(MDA)的含量以及Na+K+-ATPase和Ca2+Mg2+-AT-Pase活性。结果微波辐射后,与假照组比,微波辐射20 min组和微波辐射30 min组SOD活性降低(P<0.05)、GSH-px活性增加(P<0.05);而微波辐射20 min组GSH含量明显增加(P<0.01);微波辐射30 min组Ca2+Mg2+-ATPase活性明显降低(P<0.01),其他指标变化无明显统计学差异。结论微波辐射可能引起小鼠心脏氧化应激平衡状态以及Ca2+转运的改变。     

Children of the mentally ill: a qualitative focus group approach

Children of the mentally ill constitute a group neglected by mental health care providers. Increased rates of psychopathology, impaired attention processes, disturbances in interpersonal relationships, and reduced overall adaptive functioning are reported as significant outcomes for offspring of parents with a mood disorder. While epidemiological studies underscoring the risks from a hereditary standpoint are many, there are few studies examining the subjective experience of living with a depressed parent. Findings from this pilot study elucidate the subjective experience of preadolescents/adolescents living with an affectively ill parent, applying a qualitative focus group design. Videotaped sessions were analysed using methods consistent with qualitative research. 'Struggle to understand the illness', 'managing the illness', 'recognizing the signs', and 'impact of parent's hospitalization' emerged as central themes, capturing the essence of participants' experiences. The first two themes were further divided into subthemes. Findings illuminate the need to broaden nursing interventions and research, to include family perspectives, particularly when parental mental illness is a factor.     

和谐管理理论应用于医疗风险管理的启示

阐述了医疗风险管理的特点和目前我国医疗风险管理的现状，提出运用和谐管理理论的思想与风险管理相结合、利用双规则的互动耦合机制丰富医疗风险管理的思想，并论述了和谐管理理论对医疗风险管理的指导意义，为医疗风险管理的深入研究奠定了基础。     

宏观环境改变对构建高等护理教育培养目标的启示

综述了20世纪以来,高等护理教育宏观环境的变化对高等护理人才培养的要求和挑战。提出以学生为本,加强专业核心能力的培养、重视专业价值观与职业道德的建立和培养、良好心理素质培养;以社会需求为导向,调整人才定位、培养宽厚的知识和能力,适应护理角色的多元化;从国际化的人才培养来思考建构适应时代需求的高等护理教育培养目标。     

外科术后患者发生压疮的危险因素分析

目的 分析外科术后患者发生压疮的危险因素，探讨有效的预防措施。方法对211例择期手术患者的一般资料，术前、术中和术后相关指标进行非条件Logistic回归分析。结果年龄、术前血红蛋白、淋巴细胞总数和术后首次下地时间是外科术后患者发生压疮的危险因素，OR值分别为0．950、0．952、0．288、1．021。结论术前的营养状况与术后压疮的发生密切相关，术前应对患者的营养状况进行全面评估，并进行有针对性的干预；术后在病情允许的前提下应鼓励患者尽早下地活动。     

A Risk Score to Predict Arrhythmias in Patients with Unexplained Syncope

OBJECTIVES: To develop and validate a risk score predicting arrhythmias for patients with syncope remaining unexplained after emergency department (ED) noninvasive evaluation. METHODS: One cohort of 175 patients with unexplained syncope (Geneva, Switzerland) was used to develop and cross-validate the risk score; a second cohort of 269 similar patients (Pittsburgh, PA) was used to validate the system. Arrhythmias as a cause of syncope were diagnosed by cardiac monitoring or electrophysiologic testing. Data from the patient's history and 12-lead emergency electrocardiography (ECG) were used to identify predictors of arrhythmias. Logistic regression was used to identify predictors for the risk-score system. Risk-score performance was measured by comparing the proportions of patients with arrhythmias at various levels of the score and receiver operating characteristic (ROC) curves. RESULTS: The prevalence of arrhythmic syncope was 17% in the derivation cohort and 18% in the validation cohort. Predictors of arrhythmias were abnormal ECG (odds ratio [OR]: 8.1, 95% confidence interval [CI]=3.0 to 22.7), a history of congestive heart failure (OR: 5.3, 95% CI=1.9 to 15.0), and age older than 65 (OR: 5.4, 95% CI=1.1 to 26.0). In the derivation cohort, the risk of arrhythmias ranged from 0% (95% CI=0 to 6) in patients with no risk factors to 6% (95% CI=1 to 15) for patients with one risk factor, 41% (95% CI=26 to 57) for patients with two risk factors, and 60% (95% CI = 32 to 84) for those with three risk factors. In the validation cohort, these proportions varied from 2% (95% CI=0 to 7) with no risk factors to 17% (95% CI=10 to 27) with one risk factor, 35% (95% CI=24 to 46) with two risk factors, and 27% (95% CI=6 to 61) with three risk factors. Areas under the ROC curves ranged from 0.88 (95% CI=0.84 to 0.91) for the derivation cohort to 0.84 (95% CI=0.77 to 0.91) after cross-validation within the same cohort and 0.75 (95% CI=0.68 to 0.81) for the external validation cohort. CONCLUSIONS: In patients with unexplained syncope, a risk score based on clinical and ECG factors available in the ED identifies patients at risk for arrhythmias.     

The transfer factor (diffusing capacity) as a predictor of hypoxaemia during exercise in restrictive and chronic obstructive pulmonary disease

Summary. Thirty patients (17 with restrictive, eight with chronic obstructive pulmonary disease and five with combined pulmonary changes) were studied. Ordinary pulmonary function tests were made and in addition the transfer factor (diffusion capacity) was measured at rest and compared to the arterial oxygen tension at rest and during maximal exercise. There was a significant correlation (r = 0–89) between the transfer factor at rest and the oxygen tension during maximal exercise in both the patients with restrictive and those with obstructive lung disease, but no correlation was found between the transfer factor and the resting oxygen tension. Exercise induced hypoxaemia (Po₂< 8-8-5 kPa) occurred in some patients and this could be predicted with an excellent sensitivity and specificity if a discrimination point for the transfer factor of 50 per cent of predicted or less was chosen. Determination of the transfer factor at rest is thus a good screening test for exertional hypoxaemia and can be used to select patients for exercise testing when the purpose is to detect hypoxaemia.