Identification of Distinct Latent Classes Related to Sleep,PTSD, Depression,and Anxiety in Individuals Diagnosed With Severe Alcohol Use Disorder

Objective/Background: Alcohol use disorders (AUDs) are often accompanied by comorbid physiologic and psychosocial conditions, including sleep disturbances. Sleep disturbances in these individuals may be associated with increased risk of relapse to drinking following detoxification and rehabilitation. Participants: The sample of inpatient treatment-seeking individuals with AUDs (N = 164) was 70.1% male and 47.6% African American with a mean age of 45.6 years (±9.5 years). Methods: Latent class analysis (LCA) was used to identify unmeasured class membership based on seven indicators: maximum Clinical Institute Withdrawal Assessment (CIWA) scores; sleep efficiency (actigraphy); sleep disturbances (Pittsburgh Sleep Quality Index-PSQI); anxiety or depression (Comprehensive Psychopathological Rating Scale [CPRS]); and current and lifetime posttraumatic stress disorder (PTSD). Results: The average number of drinking days in the 90 days preceding admission was 72.0 (±22.0 days), with an average of 13.16 drinks per day (±5.70 drinks). Nearly one quarter (24.4%) of respondents reported lifetime PTSD. Three latent classes were identified: Sleep Disturbance (SD); Sleep Disturbance, Anxiety and Depression (SD/AD); and Sleep Disturbance, Anxiety and Depression, and PTSD (SD/AD/PTSD). Members of the SD/AD/PTSD group were more likely to be female and had the highest withdrawal and sleep disturbance scores of all three groups. Conclusion: Findings support the use of LCA to identify subgroups of individuals with AUDs and accompanying sleep disturbances. Class identification may provide clinicians with insight into the integrative tailoring of interventions that meet the varied needs of individuals with AUDs, accompanying comorbidities, and sleep disturbances.     

急性肾梗死临床诊治分析

目的探讨急性肾梗死的临床特点、鉴别诊断及治疗要点。方法对本院收治的2例急性肾梗死的临床资料进行回顾性分析。结果1例表现为无痛性全程肉眼血尿,腹部CT平扫及强化提示左肾实性占位,考虑肾癌,经手术治疗确诊;另1例表现为左腰部胀痛不适,在外院按输尿管结石予抗感染、解痉治疗无效,后于本院行腹部B超、强化CT检查诊断为急性右肾后下部梗死,予尿激酶、静脉滴注溶栓治疗,同时予抗凝、抗感染、扩血管、止痛等对症治疗,症状逐渐治愈出院。结论急性肾梗死临床少见,且表现也各不相同,对临床表现可疑者,及时行相关检查以尽早诊治。     

Livin和Survivin在弥漫性大B细胞淋巴瘤组织中的表达及临床意义

目的探讨Livin和Survivin在弥漫性大B细胞淋巴瘤组织中的表达及临床意义。方法收集初治的弥漫性大B细胞淋巴瘤组织标本40例作为实验组,同期收集21例反应性淋巴结炎患者的组织标本作为对照组,采用免疫组化PV-6000法检测Livin和Survivin的表达,并探讨Livin和Survivin与影响弥漫性大B细胞淋巴瘤预后因素的关系。结果实验组Livin的表达阳性率为62.5%(25/40),对照组为14.3%(3/21),两组比较,差异有统计学意义(P<0.05)。实验组Survivin的表达阳性率为67.5%(27/40),对照组为19.0%(4/21),两组比较,差异有统计学意义(P<0.05)。Livin和Sur-vivin均与淋巴瘤患者的体力状态ECOG(美国东部肿瘤协作组)评分、低密度脂蛋白水平、患者是否伴有B组临床症状及国际预后指数有关,与患者性别、年龄、临床分期及结外受累无关。Livin与Survivin在弥漫性大B细胞淋巴瘤组织中的表达无明显相关性(P>0.05)。结论 Livin和Survivin均与弥漫性大B细胞淋巴瘤的发生和发展有关,二者可作为评价弥漫性大B细胞淋巴瘤预后的生物学指标,调节Livin和Survivin的表达和功能可能成为治疗弥漫性大B细胞淋巴瘤的新途径。     

经尿道电汽化切除术治疗前列腺增生症

目的探讨经尿道前列腺电汽化切除术的特点。方法采用经尿道前列腺电汽化切除术治疗前列腺增生症(BPH)68例。结果平均手术操作时间86min,平均失血量65.6ml,平均切割前列腺组织重量36.8g,术后保留导尿管3～5d,无TUR综合征发生,术后3个月尿流率、剩余尿、国际前列腺症状评分(IPSS)、生活质量评分(LQS)均明显改善。结论经尿道前列腺电汽化切除术是一种安全性高、并发症少、疗效确切的新方法,更适合高龄、高危和抗凝治疗的BPH患者。     

急诊专科护士核心能力评价指标体系的构建

目的通过专家咨询及文献查阅构建出符合我国急诊专科护士核心能力评价的指标体系。方法本次研究主要通过对20名专家进行2轮问卷调查,定量分析各指标的比重。从而判断出评价专科护士核心能力的指标体系。结果专家权威系数为0.90,判断系数为0.86,熟悉程度为0.94;一、二级指标协调系数为0.34和0.73,专家咨询的结果可信。结论文献查阅及专家咨询方法对于急诊专科护士核心能力评价指标体系的构建,临床可信度较高,可以成为较为客观的评价体系。     

红光治疗带状疱疹后遗神经痛70例疗效观察

目的：观察红光照射对带状疱疹后遗神经痛的治疗效果。方法：选择带状疱疹后遗神经痛患者70例,随机分为红光组和对照组两组各35人,对照组给予常规的止痛和营养神经药物治疗;红光组除给予常规治疗外每日红光照射,比较两组疗效。结果：两组患者疼痛缓解总有效率红光组100%,对照组71.4%,经检验,差异有显著意义。结论：红光照射是治疗带状疱疹后遗神经痛的一种安全有效的治疗方法。     

内镜标本端粒酶定量检测对良恶性梗阻性黄疸的诊断价值

目的　为探讨胆胰系统恶性肿瘤组织与端粒酶表达的关系 ,并在术前找出一种简便、安全、快速的早期诊断及鉴别良、恶性梗阻性黄疸的方法。方法　对梗阻性黄疸病例于术前行内镜逆行胰胆管造影 (ERCP)检查 ,于造影前抽取胆汁或胰液、部分病例取活检组织 ,并于开腹手术当中再次切取癌组织标本 ,所有标本进行端粒酶活性的定量检测 ,所得数据进行统计学处理。结果　 (1)恶性梗阻性黄疸组织标本中端粒酶表达阳性率为 87 5 0 % (2 8/ 32 ) ,良性梗阻性黄疸组织标本中端粒酶表达阳性率为 3 33% (1/ 30 ) ;(2 )恶性梗阻性黄疸体液标本中端粒酶表达阳性率为 71 88% (2 3/ 32 ) ,良性梗阻性黄疸体液标本中端粒酶表达阳性率为 3 33% (1/ 30 ) ,恶性梗阻性黄疸内镜下钳取的活检组织 ,其端粒酶阳性率为 83 33% (10 / 12 )。结论　在术前通过十二指肠镜采集患者的胆汁和胰液 ,并钳取活检组织 ,分别进行端粒酶活性的定量检测 ,这是一种简便、安全、快速的早期诊断及鉴别良、恶性梗阻性黄疸的方法。     

Systematic review of basic oral care for the management of oral mucositis in cancer patients

Purpose

The purpose of this project was to evaluate research in basic oral care interventions to update evidence-based practice guidelines for preventing and treating oral mucositis (OM) in cancer patients undergoing radio- or chemotherapy.

Methods

A systematic review of available literature was conducted by the Basic Oral Care Section of the Mucositis Study Group of MASCC/ISOO. Seven interventions—oral care protocols, dental care, normal saline, sodium bicarbonate, mixed medication mouthwash, chlorhexidine, and calcium phosphate—were evaluated using the Hadorn (J Clin Epidemiol 49:749–754, 1996) criteria to determine level of evidence, followed by a guideline determination of one of the following: recommendation, suggestion, or no guideline possible, using Somerfield’s (Classic Pap Cur Comments 4:881–886, 2000) schema.

Results

Fifty-two published papers were examined by treatment population (radiotherapy, chemotherapy, and hematopoietic stem cell transplant) and by whether the intervention aimed to prevent or treat OM. The resulting practice suggestions included using oral care protocols for preventing OM across all treatment modalities and age groups and not using chlorhexidine mouthwash for preventing OM in adults with head and neck cancer undergoing radiotherapy. Considering inadequate and/or conflicting evidence, no guidelines for prevention or treatment of OM were possible for the interventions of dental care, normal saline, sodium bicarbonate, mixed medication mouthwash, chlorhexidine in patients receiving chemotherapy or hematopoietic stem cell transplant, or calcium phosphate.

Conclusions

The evidence for basic oral care interventions supports the use of oral care protocols in patient populations receiving radiation and/or chemotherapy and does not support chlorhexidine for prevention of mucositis in head and neck cancer patients receiving radiotherapy. Additional well-designed research is needed for other interventions to improve the amount and quality of evidence guiding future clinical care.