慢性心力衰竭患者及家庭照顾者疾病管理和生活质量现况

目的了解慢性心力衰竭(CHF)患者及其家庭照顾者的疾病管理和生活质量情况。方法选取2010年2月至2013年9月CHF患者及其家庭照顾者各89例,采用心力衰竭患者自我护理行为量表(SCHFI)及明尼苏达州心力衰竭生活质量量表(MLHFQ)对CHF患者进行调查,采用疾病管理行为问卷及家庭照顾者生活质量量表(FAMQOL)对CHF患者家庭照顾者进行调查。结果 CHF患者SCHFI得分为(39.66±5.42)分,自我护理行为执行良好占8.99%,执行一般者占39.33%,执行较差者占51.69%;家庭照顾者疾病管理行为分数(56.27±13.81)分,其中家庭照顾者疾病管理行为执行良好者占15.73%,执行一般占37.08%,执行较差占47.19%。Pearson相关性分析显示,CHF患者自我护理行为得分与家庭照顾者疾病管理行为得分呈正相关(P<0.05),CHF患者生活质量评分与其家庭照顾者生活质量评分呈正相关(P<0.05)。结论 CHF患者和家庭照顾者对该病管理现状不合理,二者的生活质量均受损,临床上应采取措施进行干预,建立并完善CHF家庭康复体系,培养具备高水平疾病管理能力的家庭照顾者,切实改善CHF患者生活质量。     

慢性心力衰竭患者认知功能与生活质量的相关性

目的了解慢性心力衰竭(CHF)患者认知功能、生活质量状况并探讨二者间的关系。方法采用自行设计的一般资料调查表、蒙特利尔认知评估(Mo CA)量表和明尼苏达心力衰竭生活质量问卷对152例CHF患者进行调查。结果 CHF患者的认知功能总分为(25.03±2.95)分,生活质量总分为(53.07±13.16)分。Pearson相关分析显示:认知功能总分与生活质量总分呈显著的负相关(P0.05)。与认知功能正常患者相比,认知功能障碍患者的生活质量总分及各维度得分明显较高(P0.05)。结论CHF患者的认知功能越差,生活质量就越差。因此,医务人员应关注CHF患者的认知功能,早期识别认知功能障碍的患者并对其优先实施针对性的干预措施,改善其认知功能,提高其生活质量。     

老年慢性心力衰竭患者心理健康与生活质量的影响因素

目的 探讨老年慢性心力衰竭(CHF)患者的心理健康和生活质量,并分析其影响因素.方法 选取2018年1月-2020年2月川北医学院附属医院收治的226例老年CHF患者为研究对象,用抑郁自评量表(SDS)评估患者抑郁程度,用简明健康调查量表(SF-36)评估患者生活质量.收集患者的临床资料,分析导致患者抑郁症状和影响患者...     

运动疗法配合药物治疗对老年慢性心力衰竭患者生活质量的影响

慢性心力衰竭(CHF)是一种复杂的临床综合征,是各种心脏病的严重阶段,在老年人中较常见.CHF发病率高,死亡率高,严重影响老年人的生活质量[1],预后不良.为探讨运动疗法配合药物治疗对老年CHF患者生活质量的影响,本文观察了在中西医结合药物治疗的基础上应用运动疗法的疗效.     

长期口服雷米普利对老年慢性心力衰竭的影响

血管紧张素转换酶抑制剂(ACEI)对慢性心力衰竭(CHF)患者有改善预后和提高生活质量的作用.但由于ACEI对血钾及肾功能的影响,使这类药物在老年CHF患者中的使用受到限制,为此我们观察了长期使用雷米普利对老年CHF患者心功能、血钾及血肌酐的影响.     

心力衰竭患者心脏康复应关注呼吸肌肌力

慢性心力衰竭(CHF)是各种心脏病的终末阶段,心脏康复治疗可以使CHF患者的症状减轻、生活质量及预后改善。近年来国外一些研究显示,CHF患者易合并存在吸气肌无力(IMW),可导致患者的运动耐量及生活质量的进一步下降,出现预后恶化。本文旨在总结国内外关于CHF患者合并IMW的相关研究报道,并阐明针对此类患者行吸气肌训练的益处。     

坎地沙坦酯联合卡维地洛治疗充血性心力衰竭55例

多数心血管疾病最终可能发展成为慢性心力衰竭(CHF),CHF也是现代社会心血管疾病的主要死因[1].临床试验表明β受体阻滞剂能够有效降低CHF患者病死率,并帮助患者提高生活质量[2].因此,本文在应用血管紧张素Ⅱ(AngⅡ)受体拮抗剂基础上,联合β受体阻滞剂卡维地洛治疗CHF,进一步阐述联合用药的临床效果.     

认知行为干预对慢性心力衰竭患者生活质量的影响

慢性心力衰竭(CHF)是一种渐进性致残和致命综合征,有高住院率、高发病率、高死亡率的特点〔1,2〕。患者心衰后心搏出量减少,造成心肌缺血,容易出现心悸、气短、活动无耐力等症状,严重影响CHF生活质量。有文献报道〔3〕,在慢性疾病之中,CHF患者生活质量更差。而近些年的医疗服务着重提高患者整体生活质量,把生活质量作为判断临床试验成效的标准〔4〕。本研究拟采用认知行为干预(CBI)提高患者生活质量,改善患者的错误认知,并结合行为训练方法,达到缓解病情、提高生活质量的目的〔5〕。     

促红细胞生成素对慢性心力衰竭患者生活质量和住院时间的影响

目的:观察促红细胞生成素（erythropoietin,EPO）对慢性心力衰竭（chronic heart failure,CHF）患者生活质量和住院时间的影响。方法:将80例CHF患者随机分成常规治疗组(对照组)和试药组（各40例）,记录治疗前后患者的明尼苏达心力衰竭生活质量评分,分析比较住院时间和再住院率。结果:试药组治疗前后生活质量评分的改善显著优于对照组(P<0.05), 住院时间和再住院率均少于对照组(均P<0.05)。结论: EPO治疗CHF能显著提高患者生活质量,减少住院时间。     

运动康复改善慢性心力衰竭患者心功能、运动耐量和生活质量的研究

210例慢性心力衰竭(CHF)患者,随机分为康复组116例和对照组94例,康复组给予常规药物治疗加康复运动训练指导,对照组按常规药物治疗.6个月后观察两组心功能、运动耐量的改变,并对其生活质量进行评定.发现康复组心功能和生活质量明显提高,左室射血分数、E/A比值、6 min步行距离均明显增加.认为运动康复可以改善CHF患者的心功能,提高患者的运动耐量和生活质量.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.