Norplant皮下埋植避孕剂与Vcu200宫内节育器5年临床对比观察

为指导育龄妇女选用适宜的避孕方法 ,采用统一的接受标准 ,共接收Norplant使用者 3 1 5例 ,Vcu2 0 0使用者 3 2 0例 ,每 6个月随访 1次 ,直至 5年使用期满或终止使用。用生命表法统计 2组间各种事件率 ,使用WHO的MDS软件统计月经日记卡并分析出血类型 ,对 2组间的差异行统计学检验。结果显示 :Norplant使用者 5年持续使用率和因妊娠、月经问题、医学问题、避孕器反应的终止率分别为 80 .0 7%、0 .3 5 %、1 3 .3 7%、6.1 2 %和 0 .46% ;Vcu2 0 0组分别为 84.42 %、9.5 0 %、1 .71 %、0 .3 7%和 4.40 %。阴道出血类型分析显示 ,Norplant组不规则出血者占 43 .1 %～5 7.6% ,使用 6个月后阴道出血基本正常者占 1 2 .9%～ 3 2 .7% ;Vcu2 0 0组出血基本正常者可达 5 4.8%～ 60 .2 %。结果表明 :Norplant埋植剂和Vcu2 0 0节育器具有相同的持续使用率 ,使用Norplant埋植剂后的妊娠率和脱出率明显低于Vcu2 0 0节育器 ,而阴道出血类型中不规则出血明显高于Vcu2 0 0节育器。提示 :2种避孕方法各有优缺点     

Evidence for curvilinear interpolation from dot alignment judgements

Visual interpolation between dots responsible for rectilinear versus curvilinear contour interpretation was examined with the psychophysical forced directional response (FDR) paradigm. Regular four-dot polygon segments, together with a target dot, were presented to the subjects for 150 ms. Subjects were required to indicate the direction of deviation of the target dot from the midpoint of the intermediate line segment. Crucial variables were the outer angle of the line segments and symmetry axis orientation of the polygon segment. Logistic regression analyses showed that curvilinear interpolation occurred for angles up to 30 degrees, but emerged more pervasively under the vertical symmetry axis orientation for angles up to 60 degrees.     

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders,Part 1: Update 2013 on the acute and continuation treatment of unipolar depressive disorders

Abstract

Objectives. This 2013 update of the practice guidelines for the biological treatment of unipolar depressive disorders was developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal has been to systematically review all available evidence pertaining to the treatment of unipolar depressive disorders, and to produce a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. The guidelines are intended for use by all physicians seeing and treating patients with these conditions. Methods. The 2013 update was conducted by a systematic update literature search and appraisal. All recommendations were approved by the Guidelines Task Force. Results. This first part of the guidelines (Part 1) covers disease definition, classification, epidemiology, and course of unipolar depressive disorders, as well as the management of the acute and continuation phase treatment. It is primarily concerned with the biological treatment (including antidepressants, other psychopharmacological medications, electroconvulsive therapy, light therapy, adjunctive and novel therapeutic strategies) of adults. Conclusions. To date, there is a variety of evidence-based antidepressant treatment options available. Nevertheless there is still a substantial proportion of patients not achieving full remission. In addition, somatic and psychiatric comorbidities and other special circumstances need to be more thoroughly investigated. Therefore, further high-quality informative randomized controlled trials are urgently needed.     

延续护理干预对改善行PCI术后老年患者自我管理行为的效果评价

目的：分析延续护理对行老年PCI术后患者自我管理行为的影响 方法：将2016年1月-2016年6月收治的108例行PCI术后老年患者随机编号分组,对照组（n=54）给予患者常规出院指导和随访;观察组（n=54）实施延续护理模式,将健康教育、电话随访、门诊随访、来院授课、定期复查等护理工作延续到家庭中。应用冠心病自我管理量表评估随访期间的延续护理效果。结果：实施延续护理后,2组患者出院后6个月实验室检查结果均有统计学意义,P值<0.05,空腹血糖（mmol/L）、总胆固醇（mmol/L）、甘油三酯（mmol/L）、低密度脂蛋白（mmol/L）、高密度脂蛋白（mmol/L）分别是：5.535±0.558;3.738±1.090;1.106±0.837;1.634±0.607;1.498±0.700;差异均有统计学意义,T值分别为4.928;4.390;2.083;8.859;-4.599。2组患者出院后3个月、6个月自我管理行为均有统计学意义,P值<0.01,其自我管理总分、不良嗜好、日常生活、症状、疾病知识、治疗依从性、急救、情绪认知管理得分分别是：97.981±10.450、97.944±10.543;15.481±2.305、15.519±2.247;16.222±3.225、16.148±3.201;12.926±2.641、12.963±2.599;19.593±3.595、19.630±3.599;7.704±1.513、7.778±1.526;10.778±1.930、10.815±1.854;15.278±2.825、15.093±3.030;T值分别是：-4.329、-6.360;-3.498、-5.101;-3.444、-3.420;-1.635、-4.594;-4.296、-6.504;0.799、-1.496;0.374、-4.165;-3.046、-4.010。结论：延续护理能提高老年PCI术后患者的自我管理行为,减少心血管不良事件的发生,提高患者的生存质量。     

Predictors of Early Discontinuation of Effective Contraception by Teens at High Risk of Pregnancy

Study ObjectiveIn the United States, teen pregnancy rates are declining. However, the United States still has the highest teen pregnancy rate among high-income countries. Understanding factors that predict discontinuation of effective contraception might help to further decrease teen pregnancy. We aimed to assess predictors of early discontinuation of effective contraception during typical use by high-risk teens.Design, Setting, Participants, Interventions, and Main Outcome MeasuresWe recruited 145 women aged 13-20 years (mean, 17.7 ± 1.8 years); 68% (99/145) Hispanic; 26% (38/145) black; 14% (20/145) ever pregnant; and 4% (6/145) high school dropouts who chose an effective contraceptive method during a health care visit and we prospectively assessed use of the method after 6 months. Contraceptive choices of the 130 participants who were reassessed at 6 months (90% retention) were: intrauterine device (IUD), 26% (34/130); depot medroxyprogesterone acetate (DMPA), 8% (10/130); combined oral contraceptives (COCs), 48% (62/130); transdermal patch (Patch), 13% (17/130); and intravaginal ring (Ring), 5% (7/130).ResultsAfter 6 months, only 49 of 130 (38%) continued their chosen method; 28 of 130 (22%) never initiated the method; and 53 of 130 (40%) discontinued. Users and nonusers at 6 months did not differ according to cultural and/or social characteristics (age, ethnicity, acculturation, education, health literacy) but differed according to contraceptive method type. For the 102 of 130 who initiated a method, 88% continued use of the IUD, 20% DMPA, 43% COC, 17% Patch and Ring (P < .001). Using Cox proportional hazards multivariable analysis, compared with IUDs, all other methods predicted discontinuation: DMPA (hazard ratio [HR], 5.6; 95% confidence interval [CI], 1.2-26.7; P < .05); COCs (HR, 6.6; 95% CI, 1.8-25; P < .01); Patch and Ring (HR, 12; 95% CI, 3.0-48; P < .001). Discontinuation was also predicted by past use of hormonal contraceptives (HR, 1.9; 95% CI, 1.0-3.6; P < .05) and high school dropout (HR, 8.2; 95% CI, 1.6-41; P < .01).ConclusionContraceptive method type is the strongest predictor of early discontinuation; compared with IUDs, all other methods are 6-12 times more likely to be discontinued. Cultural and/or social characteristics, with the exception of school dropout, are of little predictive value. Increasing the use of IUDs by high-risk teens could decrease discontinuation rates and possibly teen pregnancy rates.     

Comparison of two strategies for the administration of injectable depot medroxyprogesterone acetate: among women who returned to a family planning clinic at three- or six-month intervals

Objectives: The aim of this study was to compare the clinical performance of depot medroxyprogesterone acetate (DMPA) in women who received injections every 3 months at the Family Planning Clinic, and those who received every other injection at a health care facility near their place of residence, only returning to the clinic every 6 months.

Materials and methods: The medical charts of DMPA users from 2 January 1980 through 31 December 2012 were evaluated for this study. Two cohorts of women were created and compared: those who regularly received DMPA injections every 3 months (3-month group) at the clinic and those who received alternating 3-month injections at a health care facility near their residence house, returning to the clinic every 6 months for an injection (6-month group). In addition, effectiveness rates, reasons for discontinuation, and continuation rates were evaluated.

Results: Overall, 2637 women received all injections at 3-month intervals at the clinic, and 1190 women received every other injection at a health care facility near their residence. The women in the 3-month group had higher pregnancy rates and higher discontinuation rates (with the exception of discontinuation due to the loss of libido).

Conclusion: The women who received alternating injections near their homes were more likely to continue using DMPA as a contraception method and presented lower pregnancy and discontinuation rates (for the majority of reasons), when compared to those women who returned to the clinic every 3 months.     

One-Stage Correction with Intra- and Extraatrial Rerouting of Anomalous Systemic and Pulmonary Venous Return and Intraventricular Repair of Double Outlet Right Ventricle in a Patient with Heterotaxy Syndrome

We report a very rare case of successful intracardiac correction in a patient with heterotaxy syndrome. The cardiac malformations included dextrocardia, double outlet right ventricle, pulmonary stenosis, interrupted inferior vena cava, hemiazygos continuation and total anomalous pulmonary venous return. One-stage correction was performed. The atrial procedure consisted of intra- and extraatrial rerouting of the anomalous systemic and pulmonary venous return. The hepatic veins were detached and diverted to the left atrium via an extracardiac conduit. The correction of the double outlet right ventricle was accomplished by intraventricular redirection of the blood flow from the left ventricle to the aorta. The right ventricular outflow was ultimately remodeled using a valved conduit. For better perception of the complex morphology, a three-dimensional model was designed, using CT scan images. This proved to be very useful for surgical planning, especially with regard to the intraatrial reconstruction of the systemic and pulmonary venous rerouting.