失眠患者睡眠质量与心理健康状况的相关性研究

目的:探索原发性失眠患者睡眠质量与心理健康状况的关系。方法:采用横断面的研究方法,选取2015年7月至2017年7月北京中医药大学第三附属医院收治的符合纳入标准的原发性失眠患者308例作为研究对象,以PSQI、SCL-90采集原发性失眠患者的睡眠质量、心理健康状况等资料进行统计分析。结果:308例失眠患者的PSQI总分均值为(12.65±3.04),241例SCL-90筛选阳性。失眠患者SCL-90各因子测评结果除偏执、敌对外均与全国常模比较差异有统计学意义(P<0.01)。睡眠、饮食方面不适的患者211例,伴强迫者144例,伴焦虑者86例。睡眠质量、催眠药物、PSQI总分与SCL-90各因子显著正相关,此外强迫与睡眠障碍呈中度正相关。结论:失眠患者的心理健康水平较正常人差。失眠患者伴有最多的3种自觉症状为睡眠饮食不适感、强迫及焦虑。失眠患者的睡眠质量、药物使用情况及睡眠整体状况与其心理障碍相互影响,强迫与睡眠障碍有较强的相关性。     

脑状态指数联合中枢神经系统感染评分表在重型脑外伤并发颅内感染患者中的应用

目的探讨脑状态指数(CSI)联合中枢神经系统(CNS)感染评分表在重型脑外伤并发颅内感染患者病情监测中的应用。方法选取2018年6月至2019年6月开封市中心医院神经外科收治的重型脑外伤患者78例,采用CSI评分及CNS评分对患者病情进行评估。结果CSI评分10~30分组、31~50分组、51~80分组、CNS评分0~13分组、14~26分组、27~39分组在性别、年龄、脑挫裂伤、颅内血肿等方面比较差异均无统计学意义(均P>0.05),而CSI评分10~30分组、31~50分组、51~80分组在颅内感染发生率、死亡率、格拉斯哥预后评分(GOS)、Barthel指数差异均有统计学意义(均P<0.05)。CNS评分0~13分组、14~26分组、27~39分组颅内感染发生率及死亡率差异均有统计学意义(均P<0.05)。经Pearson单因素分析可知,CSI评分与CNS评分呈负相关(P<0.05)。结论CSI评分联合CNS评分对重型脑外伤并发颅内感染患者病情判断及预后有重要的价值,可为患者实施预见性护理提供指导,从而降低重型脑外伤患者颅内感染率及死亡率,提高患者临床治疗效果。     

Evaluation of contingency management as a strategy to improve HCV linkage to care and treatment in persons attending needle and syringe programs: A pilot study

BackgroundA greater proportion of HCV-infected people who inject drugs (PWID) need to be linked to care for HCV antiviral treatment. This study sets out to evaluate the efficacy of contingency management (CM) for improving HCV linkage to care, treatment initiation, adherence, and cure for PWID recruited from a needle and syringe program.MethodsBetween March 2015 and April 2016, 20 participants were enrolled into the CM arm, and then subsequently enrolled 20 participants in the enhanced standard of care (eSOC) arm. Participants in the eSOC arm received an expedited appointment and a round-trip transit card. Participants enrolled in the CM arm received eSOC plus $25 for up to ten HCV clinical visits and $10 for each returned weekly medication blister pack. Adherence was measured via electronic blister packs.ResultsOverall the median age was 47 years; most were men (67%) and Hispanic (69%). There were no significant differences in demographic characteristics between participants in the study arms. In the CM arm 74% were linked to HCV care, compared to 30% in the eSOC arm (p = 0.01). In the CM arm, 75% (9/12) of treatment eligible participants initiated treatment, compared to 100%(4/4) in the eSOC arm (p = 0.53). All patients (9/9) achieved cure in the CM arm, as compared to 75% (3/4) of patients in the eSOC arm. There were no differences in adherence between study arms.ConclusionsIn this pilot study, contingency management led to higher rates of HCV linkage to care for PWID, as compared to standard of care. CM should be considered as a possible intervention to improve the HCV treatment cascade for PWID.     

The Preventable Productivity Burden of Kidney Disease in Australia

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A long-term follow-up study of non-submerged ITI implants in the treatment of totally edentulous jaws. Part I: Ten-year life table analysis of a prospective multicenter study with 1286 implants

In this prospective multicenter study, non-submerged ITI implants were followed in order to evaluate their long-term prognosis in fully edentulous jaws. A total of 1286 implants were inserted in 233 consecutive patients and, after a healing period of three to six months, the successfully integrated implants were restored with 163 overdentures and 95 fixed full-arch bridges. This prospective study not only calculated the 10-year cumulative survival and success rates for the 1286 implants by life table analysis, but also evaluated the actual survival and success rates for 498 implants after at least five years of functional loading. In addition, cumulative success rates were calculated for implant subgroups according to implant length and location. Additional analyses were performed to evaluate the estimated and actual survival and success rates of the implants in relation to various prosthetic rehabilitation techniques. The 10-year cumulative survival and success rates were 95.9% and 92.7%, respectively. The actual 5-year survival and success rates of the first 498 implants that were inserted were 97.7% and 95.0%, respectively. The analysis of implant subgroups showed slightly more favourable cumulative success rates for 12 mm long implants (93%), in comparison to 10 mm and 8 mm long implants (91.6% and 89.6%, respectively). The cumulative success rate for mandibular implants (approximately 94%) was also more favourable than that for maxillary implants (approximately 91%). Patients who were loaded with both maxillary and mandibular prostheses maintained success rates well above 90%; while only implants that were inserted to support maxillary overdentures that were retained by Dolder bars showed a success rate below 90%.     

妇科千金片联合克罗米芬治疗多囊卵巢综合征合并不孕的疗效观察

目的:观察妇科千金片联合克罗米芬治疗多囊卵巢综合征(Polycystic Ovarian Syndrome,PCOS)合并不孕的疗效及对炎性反应及氧化应激反应的影响。方法:选取2014年1月至2016年6月西南医科大学附属中医院收治的PCOS合并不孕患者96例,随机分为观察组和对照组,每组48例,对照组给予克罗米芬治疗,观察组在对照组基础上给予妇科千金片治疗,疗程为3个月经周期。观察2组治疗前后临床症状体征、卵巢变化、机体性激素水平、月经恢复、排卵及妊娠情况;记录2组治疗前后炎性反应及氧化应激反应相关指标的变化。结果:观察组治疗后体质量指数(BMI)、腰臀比(WHR)、多毛评分及卵巢体积均较治疗前显著降低(P0.05),观察组改善情况均显著优于对照组(P0.05);2组治疗后血清睾酮(T)、促黄体生成素(LH)、促卵泡刺激素(FSH)以及LH/FSH比值均显著降低,观察组上述指标均低于对照组(P0.05);观察组治疗后月经恢复情况、宫颈黏液评分、子宫内膜厚度、排卵及妊娠率均优于对照组、流产率低于对照组(P0.05)。2组治疗后血清白细胞介素-6(IL-6)、白细胞介素-17(IL-17)、超氧化物歧化酶(SOD)活性、谷胱甘肽过氧化物酶(GSH-Px)和丙二醛(MDA)水平均显著改善,观察组改善情况优于对照组(P0.05)。结论:妇科千金片联合克罗米芬治疗能够显著PCOS患者的临床症状体征,调节机体性激素,并促进排卵及妊娠,其机制可能与抑制机体炎性反应及氧化应激反应有关。     

In a long-term experimental demography study,excluding ungulates reversed invader's explosive population growth rate and restored natives

A major goal in ecology is to understand mechanisms that increase invasion success of exotic species. A recent hypothesis implicates altered species interactions resulting from ungulate herbivore overabundance as a key cause of exotic plant domination. To test this hypothesis, we maintained an experimental demography deer exclusion study for 6 y in a forest where the native ungulate Odocoileus virginianus (white-tailed deer) is overabundant and Alliaria petiolata (garlic mustard) is aggressively invading. Because population growth is multiplicative across time, we introduce metrics that correctly integrate experimental effects across treatment years, the cumulative population growth rate, λ_c, and its geometric mean, λ_per-year, the time-averaged annual population growth rate. We determined λ_c and λ_per-year of the invader and of a common native, Trillium erectum. Our results conclusively demonstrate that deer are required for the success of Alliaria; its projected population trajectory shifted from explosive growth in the presence of deer (λ_per-year = 1.33) to decline toward extinction where deer are excluded (λ_per-year = 0.88). In contrast, Trillium’s λ_per-year was suppressed in the presence of deer relative to deer exclusion (λ_per-year = 1.04 vs. 1.20, respectively). Retrospective sensitivity analyses revealed that the largest negative effect of deer exclusion on Alliaria came from rosette transitions, whereas the largest positive effect on Trillium came from reproductive transitions. Deer exclusion lowered Alliaria density while increasing Trillium density. Our results provide definitive experimental support that interactions with overabundant ungulates enhance demographic success of invaders and depress natives’ success, with broad implications for biodiversity and ecosystem function worldwide.Steadily increasing pressure by invasive plant species on native biodiversity (1) disrupts both community and ecosystem function (2) and results in staggering economic costs worldwide (3, 4). A major goal in ecology is to understand how changes over time in species interactions affect invasion success of exotic species (5–8). According to ecological theory, the ability of the resident community to limit the success of invading exotics [biotic resistance (9, 10)] will depend upon ecological context that includes the suite of local interactors (11–15). The abundance of herbivores and their local impacts (11, 14, 16) can play a prominent role in how fast plant populations grow or shrink and how much the relative abundance of plant species changes over time (5, 15), including changes associated with plant invasions (11, 16–19). Recently, increased browsing pressure by overabundant ungulate herbivores on native plant communities has been proposed as a fundamental cause of a shift from native to exotic plant domination in forests and rangelands worldwide (11, 16, 20). Wild and domesticated ungulates (e.g., deer, elk, goats, sheep, horses, cows) that are either native or introduced have all been implicated in this process (11, 16, 20).Overabundant ungulates may change the success of invading exotics in numerous ways. Ungulate browsing on natives may depress their abundance and ability to compete (21–24) and increase abiotic resources available to invaders (11, 25, 26), which can act synergistically to decrease communities’ ability to resist invasion (biotic resistance; refs. 8 and 10). Ungulates disperse exotic seeds (27, 28) and create novel abiotic conditions with respect to soil disturbance, soil quality, and light availability (21, 22, 26), which may enhance exotic establishment and growth. Moreover, although ungulates are considered diet generalists, in fact, they frequently behave as selective foragers (21–24, 29), preferring natives to exotics. In this circumstance, unpalatable invaders can have a double advantage over natives—both release from historic enemies (20) and inedible to new potential enemies in the invaded range (30, 31). Together, these mechanisms not only implicate overabundant ungulates in their direct impact on the rate at which populations of palatable native species grow or shrink, but point to their potentially pivotal role in reducing the biotic resistance of the native community to favor invaders (13, 14).To determine how ungulate herbivores affect the fitness of invaders and natives, field experiments that manipulate herbivore access for several years and are spatially well replicated are required (11, 32, 33). The multiyear, population-level demographic data gained in such experiments can be used to estimate the ultimate metric of fitness: population growth rate (λ). However, despite the widespread use of manipulative experiments that alter herbivore access to plants, we still lack appropriate demographic data (i.e., complete schedules of fertility, mortality and growth for all stages) in invaded systems (2, 14, 17, 32, 33). Instead, herbivore–plant invader experiments typically report simple metrics of plant success (e.g., percent cover or counts of individuals) at a single time point. For example, the metric “percent cover” estimates the total leaf area of a species, often relative to other species. Lower leaf area of native plants where ungulates have access could merely be the result of leaf tissue lost to herbivory, with no actual change in invader or native numbers. Likewise, “snapshot counts” of invaders often leave out critical life cycle stages and do not provide information on rates of survival, reproduction, or growth, without which population dynamics cannot be analyzed. Thus, it is not surprising that ungulate exclusion experiments that apply such metrics provide no unified answer regarding exotic invaders [effect on invasion success: none (34–36); mixed (37, 38); positive (39–41; reviewed in ref. 16)] because these studies cannot address population viability of invaders or natives. Also, although evidence of ungulates’ influence on native plant population dynamics from exclusion experiments has been previously demonstrated (e.g., refs. 42 and 43), our study is distinct. We know of no other such experiments testing the link between ungulates and invasive exotic population growth rate in invaded systems.Here, we use experimental demography and stage-based data (rates of survival, fertility, and growth) collected over multiple years to test the hypothesis that an overabundant native ungulate herbivore drives positive population growth of invaders (11, 16). We emphasize that in herbivore removal experiments the fitness of plant populations, which is measured by population growth rate, is predicted to rebound with persistent, multiplicative beneficial effects over time. What has not previously been recognized in such experiments is that treatment effects accumulate over the span of an experiment (44), necessitating a quantitative metric that integrates fitness over the entire life cycle and over time. Moreover, population growth is a process that is multiplicative across time. Thus, we introduce the use of cumulative population growth rate, λ_c, at the end of a multiyear experiment as the metric that correctly integrates experimental effects across the observed sequence of demographic changes across time. Our multiyear demographic projection and the corresponding multiyear retrospective sensitivity analysis provide fresh insights. To facilitate comparisons of our results with studies that estimate λ from single-year transitions, we present λ_per-year, the geometric mean of λ_c. Our retrospective sensitivity analyses [similar to life table response experiment analysis for periodic matrices (45, 46)] of λ_c reveal how each part of the life cycle contributes to overall differences in cumulative population dynamics caused by an experimental manipulation. We conclusively show that overabundant deer create conditions favorable for explosive exponential population growth of an exotic plant invader, but that when deer are excluded, populations of the invader are projected to decline exponentially.We focus on the native ungulate Odocoileus virginianus (white-tailed deer; hereafter, deer) and the exotic herbaceous understory invader Alliaria petiolata (Brassicaceae; garlic mustard; hereafter, Alliaria), which both present serious management concerns in North American forests. Relative to historical records, deer densities are currently 4–10 times higher than pre-European settlement densities across North America (47). Overabundant native deer in forests exert the same kinds of pressures as other ungulates (native and nonnative, wild and domesticated) globally, including perturbation of understory communities (22, 27, 39), exotic seed dispersal (27), and alteration of abiotic conditions (21, 39). Likewise, Alliaria ranks among the most problematic forest invaders in North America (48). Introduced by early colonists, it was naturalized on Long Island, New York, by 1868 (reviewed in ref. 48). In its native Eurasia, Alliaria grows in edge or disturbed habitats, whereas in North America it increasingly occupies forest interiors (48). Relative to the slow-growing, long-lived understory community it invades, Alliaria has a rapid, biennial life cycle: spring seedlings form overwintering rosettes by autumn. In their second year, plants reproduce, disperse seeds, and die. In its invaded range, Alliaria has high population growth rates (λ = 1.4–3.4) (48), which project annual increases in numbers of 40–240%. Alliaria’s invasive success has been hypothesized to result from various factors. These include the following: novel allelopathic weapons, enemy release, positive soil feedback, taxonomic novelty, high competitive ability, and specific phenotypic traits. No single factor has yet to explain the broad reach of this tenacious exotic (reviewed in ref. 48). Here, we investigate what has not been previously explored: the role of ungulate disruption of native community biotic resistance (13) on Alliaria’s invasion success. To date, deer and Alliaria have been foci of intense, largely separate, research efforts. Our approach uses experimental demography to jointly examine these two issues. Together, they constitute an ideal system to investigate ungulate–exotic plant invasion linkages (11, 16).Our experiment was conducted in a beech–maple forest in southwestern Pennsylvania (Trillium Trail Nature Reserve, Allegheny County, Pennsylvania: 40° 52′ 01.40″ N; 79° 90″ 10.75″ W). Winter aerial flyovers of this area performed between 1993–2004 revealed overabundant deer: currently 20–42 deer per km² compared with an historic density of 10–12 deer per km² (Fig. S1). In a different area in this same forest, Knight et al. (39) used an indirect metric of plant performance and found that relative percent cover of Alliaria was lower and that there was significantly less bare ground where deer were excluded relative to sites where deer were present (39). However, in that study Alliaria nevertheless remained abundant (the second most abundant species) even where deer were excluded. That study (39), which used relative percent cover as a response metric, left several questions unanswered, including the following: Was Alliaria’s relative decline due to the native species increasing in cover with no actual change in cover of the invader? Did the tenacious invader’s population growth rate actually decline? Given these unanswered questions from the earlier study, the Trillium Trail forest was an ideal location to address these questions and to conduct a definitive demographic experiment that could distinguish among these mechanisms. In 2002, we established paired plots (n = 6 pairs of 14 × 14-m plots) with one plot per pair randomly assigned to a fenced treatment that excluded deer (see Materials and Methods for details). The other plot in each pair remained unfenced and experienced ambient levels of deer and other animals. We compared population-level responses of native understory herbaceous perennial species and Alliaria between treatments for 6 y. For three focal native herbs that are palatable to deer (e.g., ref. 49) and the unpalatable Alliaria, we quantified reproductive success each year. For Alliaria and one of the natives, Trillium erectum (Melanthiaceae, hereafter Trillium), we additionally quantified the complete schedule of survival, fertility, and growth rates each year. We selected Trillium as a counterpoint to Alliaria as it is the most common flowering herbaceous species found at Trillium Trail Nature Reserve. Moreover, Trillium species are a preferred food source for deer (49) and well-known phytoindicators of deer browse (e.g., ref. 49; but see ref. 50). In a nonexperimental study, deer browse levels within a population were negatively correlated with population growth rate for another species in the genus, Trillium grandiflorum (51). Accordingly, Trillium represents a model for understanding the impact of deer on native species, and the loss of such browse-sensitive species can be a metric of decline in forest integrity (52). We predicted that, if ungulates disrupt the native community and enhance exotic invasion success, then in plots experimentally protected from deer: (i) native species would have higher reproductive success, (ii) Trillium fitness would increase and its density would increase, (iii) Alliaria fitness would decrease and its density would decline. Meanwhile, in plots where deer were allowed access, we expected either the opposite trends or no change from initial conditions. Alternatively, if any of the other previously hypothesized mechanisms for Alliaria’s success (e.g., novel weapons, enemy release) are at play and more important than herbivore impacts, then we would expect Alliaria’s population growth rate to remain high despite deer exclusion, while predictions for the effects of deer on the natives remain the same.In brief, from 2003 to 2008 at annual censuses, we scored reproduction and survival of individuals of Alliaria and of the three native perennials that are preferred food sources for deer (49): Trillium, Maianthemum racemosum (Ruscaceae), and Polygonatum biflorum (Ruscaceae). In plots accessible to deer, we also scored deer browse. To assess the effect of deer exclusion on the fitness of Trillium and Alliaria, we implemented our multiyear matrix projection analysis to calculate cumulative population growth rates from 2003 to 2007 for each treatment. To construct matrices, we defined five life cycle stages for the perennial Trillium (germinant bank, seedling, one-leafed juvenile, three-leafed nonflowering, and three-leafed flowering; Fig. S2A) and three life cycle stages for Alliaria (dormant seed in the seed bank, rosette, and fruiting adult; Fig. S3A). Matrix elements were calculated as a function of the vital rates associated with each stage transition (Figs. S2A and S3A). We captured cumulative effects of deer exclusion or continued deer overabundance over time, parameterizing multiyear projection matrix models B, for each species and treatment by multiplication of annual projection matrices A_{YEAR-TREATMENT} (e.g., B_DEER = A_2006-DEER A_2005-DEER A_2004-DEER A_2003-DEER). The matrix B, at the heart our analyses, contains the rates at which individuals that were at a given stage at the beginning of the experiment will have either become or produced individuals of each stage after four transition years. Our analyses of multiyear matrices provide integrative measures of plant fitness over the time frame of the experiment, including treatment-specific cumulative population growth rates (λ_c, the dominant eigenvalue of B), time-averaged λ’s (λ_{per-year-TREATMENT} = the fourth root of the dominant eigenvalue, λ_c, of B), and an overall measure of the effect of protecting plants from deer on plant fitness Δλ_per-year = λ_{per-year-NO_DEER} – λ_{per-year-DEER}. [Note: Pooled plot data (Trillium) and individual plot data (Alliaria) were used. See Materials and Methods, Matrix Construction for Each Species and Treatment.] Finally, to uncover mechanistic differences between the response of the native and the exotic to deer exclusion, we use a life table response experiment retrospective sensitivity analysis (45, 46). The analysis shows how important each of these 4-y demographic rates is to differences in λ_c between treatments, quantified by contributions made during transitions from stage j to stage i, c_ij.     

护理质量反馈追踪表的设计与应用效果

目的完善护理质量控制反馈追踪机制，降低护理质量问题重复发生率，提高护理质量。方法运用自行设计的护理质量反馈追踪表，对检查出的质量问题持续进行反馈追踪管理，并形成动态循环。使用3个月后，对照护理质量评价标准进行全面或专项护理质量检查，统计全院各护理单元护理质量控制综合得分、护理质量问题年发生次数、重复发生次数及重复发生率，与使用前的相应指标进行对照分析。结果使用反馈追踪表后，护理质量控制综合得分高于使用前，护理质量问题发生次数及重复发生率低于使用前。结论使用护理质量反馈追踪表后，完善了护理质量反馈追踪机制，强化了护理人员质量管理意识，体现了以人为本的管理理念，有助于护理质量动态优化和持续改进。     

高密度多孔聚乙烯结合自体颅骨外板在眶颧骨折继发畸形修复中的应用

目的 探讨高密度多孔聚乙烯材料(Medpor)结合自体颅骨外板在眶颧骨折继发畸形修复重建术中的应用.方法 将骨折错位愈合的眶颧骨截骨复位进行可靠的内固定后,采用Medpor填充缩孔扩大的眶腔容积,治疗复视,利用自体颅骨外板修复眶壁及眶周的骨质缺损区,恢复眶区外形.结果 自2007年1月至2010年12月,共收治眶颧骨折13例.扩大的眶容积得到缩小,眶下缘抬高至对侧水平,眼球内陷明显改善,复视消失或减轻,面部畸形明显好转,自体颅骨外板及Medpor应用无并发症发生.结论 在复杂眶颧骨折中联合应用Medpor及自体颅骨外板可修复大部分眶颧骨折后继发畸形,尤其是合并骨质缺损患者,可有效解决眶内容物移位、复视,减少自体组织再损伤及排异反应.