老年高血压病患者脉压与脑卒中的相关性研究

目的　探讨脉压与脑卒中的相关性。方法　对 85例急性脑卒中患者临床资料进行回顾性分析。按病变性质分为脑出血组 (4 5例 )和脑梗死组 (4 0例 ) ,对照组 36例为非脑卒中高血压患者 ,比较分析不同年龄高血压患者脉压异常情况。结果　①脉压在脑卒中组与对照组之间有显著性差异 (P <0 .0 1) ,脑出血组和脑梗死组之间脉压亦有显著性差异 (P <0 .0 5 )。②随着年龄增长、脉压 70mmHg异常率在各组均逐渐增加 ,脉压异常率与年龄之间存在一定的正相关。结论　高血压病患者脉压增宽与脑卒中危险性密切相关 ,脉压是老年人心脑血管意外的一个良好的预测因子。     

原发性高血压与再发脑卒中关系的随访研究

目的探讨原发性高血压与再次发生脑卒中的关系，寻找脑卒中再发的危险因素。方法随机收集200例脑梗死患者、100例脑出血患者，进行1年血压水平检测随访。观察脑卒中再发与高血压的关系。结果脑卒中原发性高血压组平均收缩压、舒张压水平及脉压差明显高于非高血压病组（P〈0．05）。脑卒中高血压组1年随访结果，再发脑卒中28例（13．86％）。脑卒中非高血压组有2例再发脑梗死发生（2．04％），两组差异有显著性（P〈0．01）。85．71％再发脑梗死者、100％再发脑溢血者血压控制不理想。结论对脑卒中患者的1年随访发现脑卒中的再发与原发性高血压及高血压控制不理想有明显关系。     

血压指标与脑卒中发生相关性分析

目的 通过对高血压病伴脑卒中患者的血压分析,探讨血压指标与脑卒中发生的关系.方法 选取高血压性脑卒中患者289例,测定各种血压指标,与另选取的100例非脑卒中高血压病患者作对照.结果 脑卒中组的脉压水平明显高于对照组,两者比较差异有统计学意义(P<0.05);出血性与缺血性脑卒中的血压指标差异无统计学意义(P>0.05);再发脑卒中组收缩压与脉压高于初发脑卒中组,两者比较差异有统计学意义(P<0.05).结论 脉压增大与脑卒中的发生有关,是引起脑卒中发生及再发的重要危险因素和良好的预测因子.     

老年高血压患者与脑卒中的关系

目的：探讨老年高血压与其并发脑卒中的关系。方法：共分析98例高血压病患者，年龄59～82岁。其中单纯高血压病50例，高血压并发脑卒中者48例。探讨收缩压、舒张压、平均血压、脉压与脑卒中的关系。结果：收缩压、平均血压、脉压脑卒中组与单纯高血压组比较差异有显著性（P〈0．05，P％0．01）；舒张压脑卒中组与高血压组比较差异无显著性（P〉0.05）。结论：老年高血压病患者，收缩压、平均血压、脉压与脑卒中的发生有显著相关性，舒张压与脑卒中的发生无显著相关性。     

再发脑卒中患者医院感染分析与对策

目的:分析再发脑卒中患者医院感染相关因素及预防对策.方法:对280例住院脑卒中患者医院感染情况进行回顾性调查分析,分为初发组(164例)和再发组(116例),在医院感染发生率及医院感染易发部位上进行临床比较分析.结果:再发组与初发组之间在医院感染易发部位上无显著性差异(P＞0.05),而在医院感染发生率上再发组与初发组之间有显著性差异(P＜0.05).结论:再发脑卒中患者较初发者更易发生医院感染,高度重视患者的治疗和护理是预防感染发生的关键.     

高血压病患者动态脉压与年龄及左心室肥厚的关系

目的　探讨高血压病患者动态脉压随年龄的变化趋势及其与左心室肥厚的关系。方法　选择 3 3 7例初诊的轻 中度高血压病患者 ,对所有入选病例进行 2 4h动态血压监测和超声心动图检查。①根据动态脉压水平分为 4组 ,即A组 :2 4hPP <40mmHg ;B组 :40mmHg≤ 2 4hPP <5 0mmHg ;C组 :5 0mmHg≤ 2 4hPP <60mmHg ;D组 :2 4hPP≥ 60mmHg。②根据左室重量指数分为左室肥厚组和非左室肥厚组。③根据年龄分 3组 ,Ⅰ组 :40≤年龄 <5 0岁 ;Ⅱ组 :5 0≤年龄 <60岁 ;Ⅲ组 :年龄≥ 60岁。结果　动态脉压与年龄 (r =0 .42 3 ,P <0 .0 1)、动脉僵硬度指数 (r =0 .670 ,P <0 .0 1)、左室重量指数 (r=0 .2 77,P <0 .0 1)和 2 4h平均心率 (r =-0 .168,P <0 .0 1)均呈非常显著的相关性。随着年龄增长 ,高血压病患者的动态脉压呈早期轻度升高 ,60岁以后加速上升趋势。动态脉压和 2 4hSBP在左室肥厚组均明显高于非左室肥厚组 (4 9.0±10 .2mmHgvs 44 .7± 8.9mmHg ,P <0 .0 0 1和 13 2 .1± 13 .1mmHgvs 12 6.5± 12 .7mmHg ,P <0 .0 0 1)。 结论　高血压病患者随着年龄增长 ,特别是 60岁以后 ,脉压呈加速升高趋势 ,大动脉僵硬度的进展是导致脉压升高的主要原因 ;脉压升高是高血压病患者左室肥厚的重要危险因素。     

糖尿病与再发脑卒中的关系

目的：探讨糖尿病及血糖水平与再发脑卒中的关系。方法：收集脑卒中患者240例进行血糖和糖化血红蛋白检测并随访1 a,观察脑卒中再发与糖尿病及血糖水平的关系。结果：脑卒中组1 a随访再发脑卒中38例（16.24%）,对照组有2例发生脑梗死（0.86%）,两组差异有显著性（P〈0.05）。再发脑梗死者有93.55%,再发脑出血者有71.43%存在未坚持降糖治疗或血糖控制不良情况。结论：脑卒中再发与糖尿病及高血糖有关。     

冠心病房颤患者不同伴发病变血清脂蛋白(a)的改变

目的观察冠心病房颤患者不同伴发病变血清脂蛋白 (a) [Lp(a) ]的变化。 方法采用ELISA法检测冠心病患者(44例 ,Ⅰ组 )、冠心病房颤伴发糖尿病 (40例 ,Ⅱ组 )或伴发高血压病 (41例 ,Ⅲ组 )或伴发慢性支气管炎 (慢支 )患者 (37例 ,Ⅳ组 )血清Lp(a)。 结果冠心病房颤伴糖尿病组血清Lp(a)水平显著高于冠心病组、冠心病房颤其他各组及正常对照组 (P <0 .0 1) ;冠心病组、冠心病房颤各组血清Lp(a)水平均显著高于正常对照组 (P <0 .0 1) ,而冠心病组及冠心病房颤伴发高血压病或伴慢支 3组患者血清Lp(a)水平无差异 (P >0 .0 5 )。 结论血清Lp(a)的增高可能是导致冠心病房颤血栓形成及脑梗死等并发症发生的原因之一 ,在冠心病房颤常见伴发病中 ,尤应注意伴发糖尿病时Lp(a)的变化。     

高血压病合并糖尿病的动态脉压与心率变异性

目的 :探讨高血压病合并糖尿病患者的动态脉压 (APP)与心率变异性 (HRV)分析的临床意义。方法 :对 43例健康者、64例原发性高血压 (EH)患者、2 6例糖尿病 (DM )和 30例EH +DM患者的APP和HRV进行对比研究。结果 :①EH +DM组APP≥ 5 0mmHg者 ,例数多 ,年龄偏大 ,LVH、心电图异常、CVD发生率高 ,与EH组、对照组相比差异显著 (P <0 0 1) ;②EH +DM组APP≥ 5 0mmHg组与 <5 0mmHg组之间 2 4h平均SBP、DBP比较无差异 ,但前者LVH、心电图异常 ,CVD增高明显 (P<0 0 5 ) ;③ 2 4h平均脉压较偶测脉压更能反映患者平时真正脉压水平 ;④EH与DM的HRV均低于正常人 ,以EH +DM患者减低最明显 ;⑤在EH、EH +DM患者中 ,APP≥ 5 0mmHg组较 <5 0mmHg组HRV明显减低。 结论 :①动态脉压是心脑血管疾病的发生和死亡的独立危险因子 ;②APP比偶测脉压更适宜用于临床研究 ;③高血压病、糖尿病的自主神经活动受损 ,EH+DM患者更加明显 ;④APP与HRV参数密切相关 ,组合指标测定 ,有助于识别高危人群。     

健康教育对高血压患者治疗依从性和治疗效果的影响

目的 :探讨健康教育是否可以改善患者对长期抗高血压治疗的依从性 ,端正患者对高血压病的正确认识。方法 :采取面谈、发放高血压病常识手册和电话随访等措施 ,以高血压病健康常识问卷为测量工具 ,观察比较上述措施对高血压患者的有关高血压病健康常识水平、依从性及疗效的影响。结果 :两组病人的年龄、性别、收缩压及舒张压值等一般情况进行均衡性检验 ,无显著性差异 (P >0 .0 5 ) ;干预前两组高血压病常识分数无显著性差异 (P>0 .0 5 ) ;干预后实验组的高血压病常识问卷得分显著高于对照组 ,有显著性差异 (P <0 .0 5 ) ;两组依从性比较显示实验组的依从性明显高于对照组 (P <0 .0 5 ) ;两组疗效比较 ,提示干预组高血压治疗效果明显高于对照组有显著性差异 (P <0 .0 5 )。结论 :上述干预简单可行 ,不但能明显提高高血压患者的健康常识水平 ,同时也明显提高了患者对治疗的依从性 ,从而间接地改善了高血压患者的治疗效果     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.