Measurement of subjective quality of life of elders

There are two aims in this article, to define subjective quality of life and to suggest a way to standardize its measurement to enable comparisons to be made across studies. One of the unresolved issues in gerontological research has concerned the definition and measurement of quality of life (Lawton, 1991). This article focuses on subjective well-being, one of the four components proposed by Lawton (1991). There seems to be a growing consensus that most scales of well-being have at least two concepts in common, positive and negative affect. To test this hypothesis, two well-being scales, the Philadelphia Geriatric Center Morale Scale (Lawton, 1975) and the Center for Epidemiological Studies-Depression Scale (Radloff, 1977), were subjected to confirmatory factor analyses, using data on 1717 participants in the Australian Longitudinal Study of Ageing aged between 70 and 103 years. Each scale was shown to contain factors of positive and negative affect. The article concludes with a suggestion that the measurement of quality of life in elders should include, at a minimum, scales of positive and negative affect as well as other measures relevant to the aspect of quality of life under consideration.     

Mechanisms of action of antiresorptive therapies of postmenopausal osteoporosis

In the treatment of osteoporosis, the aim of the antiresorptive therapy is to restore bone density by decreasing bone remodeling. The process of bone remodeling plays a role in plasma calcium homeostasis and serves to modify bone architecture in order to meet changing mechanical needs, to maintain osteocyte viability, and to repair microdamage in bone matrix. Estrogen deficiency results in a number of detrimental effects on bone, including suppression of osteocyte survival as well as impairment of osteoblast response to mechanical stimuli and repair of ageing bone. In this review, effects of available antiresorptive therapies on endocrine regulations of bone metabolism in postmenopausal osteoporosis are compared. The aim of antiresorptive treatment is to ensure adequate bone remodeling, reparation of microdamage of bone, and increased bone strength. Ideally, this effect should be maintained long-term. Several agents are approved for the treatment of osteoporosis. Calcitonin transiently inhibits osteoclast activity without decreasing osteoblast collagen synthesis. Aminobisphosphonates decrease bone remodeling by decreasing osteoclast activity and by inducing osteoclast apoptosis. This allows more time for secondary mineralization to proceed to completion in the existing bone tissue mass, so increasing the mechanical resistance of bone to loading. Estrogens and raloxifene (a selective estrogen receptor modulator that acts as an estrogen agonist in bone) suppress bone remodeling to the premenopausal range, maintaining the function of osteoblasts and osteocytes. In the placebo-controlled osteoporosis treatment trials, all the above treatments reduced the risk of fractures. Raloxifene therapy was also associated with a favorable or neutral effect in the cardiovascular system, and a reduced incidence of breast cancer. Selection of appropriate drug for treatment of postmenopausal osteoporosis should take into account the long-term effect of the antiresorptive agent on bone. Moreover, the effects on other tissues ++should also be considered, and this encompasses both safety concerns, as well as the potentially beneficial effects on other tissues. Further investigation is needed to evaluate the different modes of action of these agents, and their long-term effects on bone and other tissues.     

矽肺患者生存质量调查分析

目的评价并分析矽肺患者生存质量状况及其影响因素。方法采用WHOQOL．100量表调查150例矽肺患者及150例未患矽肺工人,将调查结果用sPSs11．0统计软件进行分析。结果矽肺患者生存质量较对照组明显减低,特别是在躯体疼痛、精力、睡眠、信心、负性情感、行动能力、日常生活能力、依赖性、获取信息、休闲活动、信仰,总体健康等方面与未患矽肺工人比较,差异有显著性（P〈0．01或P〈0．05）。矽肺患者并发症的多少、期别的高低、年龄、婚姻状况、参与休闲娱乐的机会及参与程度、人际关系的满意度等对生存质量均有影响。结论在对矽肺及并发症进行治疗的同时,重视健康教育,提供心理治疗,鼓励参加休闲活动和社会交往．有利于提高矽肺患者的生存质量。     

Preparation of stabilized solutions of hemoglobin

It is possible to prepare self-stabilizing solutions of hemoglobin from humanerythrocytes by the use of dextrose, nicotinic acid amide and ammonia during thepreparation and in the final solutions themselves. Co⁺⁺, Mn⁺⁺ and Mg⁺⁺ ions,nile blue and hexose diphosphate contribute to the speed of stabilization of thesesolutions. Stabilization is obtained by the faculty of the solutions, presumablyby enzymic action, to convert the hemoglobin to the reduced form and to maintainit in this form. The hemoglobin solutions described are suitable for intravenousadministration.

Note: ACKNOWLEDGMENTWe wish to acknowledge our deep indebtedness to Miss Lois Priester and to Mr. Edward Smith fortheir technical assistance in this work. We wish also to express our gratitude to the Biological ProductionDivision and to the Biological Control Division of Sharp and Dohme for assistance in many phases of thework.

     

Management of disorders of cardiac rhythm

Dr. Gold: The treatment of disorders of cardiac rhythm was explored in this conference. This was a very large undertaking. There are several types of disorders of rhythm; there are various devices for distinguishing one from another. It is important to do so for there are significant differences in the treatment of each, and the most successful results depend on the use of measures specifically suited to the particular problem. A special conference could be profitably devoted to any one disorder of rhythm.There has been no attempt to exhaust the subject, but many points of practical interest have been brought out in the account of experience and opinion by the various participants. Many of the details cannot be satisfactorily summarized without repeating the conference. The following disorders of rhythm received attention: premature contractions, auricular and nodal tachycardia, auricular flutter, auricular fibrillation, ventricular tachycardia and heart block. There was some discussion of the management of congestive failure in the course of a paroxysm of abnormal rhythm and the problem of ectopic rhythms occurring in the hyperthyroid state. It was pointed out that three distinct problems prevail in cases of disordered rhythm, namely, those in whom the disordered rhythm is a chronic phenomenon and is to be allowed to continue, those in whom an acute paroxysm needs to be terminated and those in whom the problem is essentially one of preventing recurrences. Means for differential diagnosis were described, namely, certain clinical features, the electrocardiogram, carotid sinus pressure and various devices exerting similar effects.The application of several drugs was discussed in some detail, such as quinidine, digitalis, magnesium sulfate, procaine, mecholyl, ipecac, ephedrine, morphine and other sedatives. In a patient with a paroxysm of rapid heart action which does not appear to be damaging the circulation unduly, there are some who prefer to give a dose of morphine to make the patient more comfortable and let the problem rest until the abnormal rhythm ceases spontaneously. Digitalis appears to be the drug of choice for the paroxysm of auricular and nodal tachycardia. While mecholyl is very effective, it is so apt to produce disturbing symptoms that it is best to keep it in reserve for use when other measures fail. Quinidine is the standard remedy for an attack of ventricular tachycardia; and when for one reason or another it proves inadequate, an intravenous injection of magnesium sulfate is sometimes effective. There are risks involved in the use of all these drugs to abolish a paroxysm of abnormal rhythm, and technics were described for reducing the hazards to a minimum.Attention was called to the fact that there are many situations in which a differential diagnosis among the disorders of rhythm is difficult or impossible to make, but that even under those conditions, a specific form of therapy is still available; for quinidine is highly effective against five of the more common disorders of rhythm: premature contractions, paroxysmal auricular tachycardia, auricular flutter, auricular fibrillation and ventricular tachycardia. Strong emphasis was placed, however, on the desirability for making every effort to establish the precise mechanism before treatment is started, for only then is the most rational and effective plan of therapy possible.Finally, the point was made that one should always bear in mind the underlying state of the heart in which a rapid ectopic rhythm has suddenly appeared. The abnormal rhythm is a dramatic event and may engage the attention of the examiner to the exclusion of other factors of far greater importance than the abnormal rhythm, such as Graves' disease or an acute coronary thrombosis.     

治疗高血压药物的经济学评价

重视高血压治疗中的经济学评价,对利用我国有限的卫生资源来遏制高血压对人民群众的危害有着重要的现实意义。药物经济学对于药物治疗的成本和治疗的结果给予同样的关注。因为治疗高血压的费用,不仅涉及药物价格,还包括患者的危险水平,降压疗效和对临床终点事件的影响,以及治疗的依从性和安全性。因此药物经济学更强调整体成本和价-效比。低危病人,若非药价低廉,治疗的价-效比不够理想。而在高危的患者,价-效比越小越经济而不是药费越便宜越好。     

铜绿假单胞菌113株的耐药性分析

目的：分析铜绿假单胞菌对常用抗菌药物的耐药性,以指导临床对铜绿假单胞菌的合理用药。方法采用湖南天地人公司生产的TDR．200B细菌分析系统对临床标本中分离出的铜绿假单胞菌进行药敏试验,分析我院2010-02～2012-02分离的113株铜绿假单胞菌的耐药性。结果铜绿假单胞菌对19种常用抗菌药物的耐药率以亚胺培南最低（10.6％）,其次为阿米卡星（12.4％）;其中敏感株7株（6.2％）,多重耐药株25株（22.1％）,泛耐药株8株（7.1％）,其余耐药株73株（64.6％）。结论铜绿假单胞菌对19种常用抗菌药物存在不同的耐药性,应加强铜绿假单胞菌的耐药性监测,为临床合理选用抗菌药物提供依据。同时应对多重和泛耐药铜绿假单胞菌采取有效的预防措施,避免多重和泛耐药株的暴发流行。     

Results of treatment of fistula-in-ano

To evaluate the application of Parks' classification in the management of patients with fistula-in-ano, a study was undertaken to assess the outcome of surgery, especially with respect to the recurrence rate and alteration of continence. A retrospective analysis of 160 consecutive patients who were classified at the time of operation was conducted. The distribution of fistulas was as follows: intersphincteric, 41.9 percent, transsphincteric, 52.1 percent, suprasphincteric, 1.3 percent, extrasphincteric, 0. A horseshoe extension occurred in 8.8 percent of the fistulas and 3.8 percent did not exactly conform to the classification as they were either complex or combinations of more than one type of fistula. The sole immediate postoperative complication was bleeding, which occurred one week postoperatively and ceased spontaneously (0.7 percent). Alteration in continence occurred in 6 percent of patients with 2.6 percent experiencing temporary incontinence to flatus, 1.3 percent to liquid stool, and 0.7 percent to solid stool. Permanent loss of control for flatus occurred in one patient (0.7 percent) and for liquid stool in one patient (0.7 percent). No patients suffered loss of control for solid stool. Recurrence developed in 6.3 percent of patients, all between five and 25 months postoperatively. Classifcation was found to be a useful guide in the operative management of patients with fistula-in-ano. Read at the joint meeting of the American Society of Colon and Rectal Surgeons with the Section of Colo-Proctology, Royal Society of Medicine, and the Section of Colonic and Rectal Surgery, Royal Australasian College of Surgeons, New Orleans, Louisiana, May 6 to 11, 1984.     

38例主动脉窦瘤破裂的外科治疗

目的 :通过研究 38例主动脉窦瘤破裂治疗经过 ,总结主动脉窦瘤破裂外科治疗经验。方法 :1987年 1月至 2 0 0 1年 9月 ,对 38例主动脉窦瘤破裂病人行手术治疗 ,及时准确闭合主动脉窦瘤及矫正合并的心脏畸形。对于合并主动脉瓣关闭不全病例 ,轻度不予处理 ,中度行成形术 ,重度行主动脉瓣置换术。结果 :早期死亡 1例 ,死亡率为 2 6 %。术后随访 2个月～ 14年 ,随访者心脏功能恢复到Ⅰ～Ⅱ级 (NYHA)。结论 :主动脉窦瘤破裂一经诊断 ,应及早手术 ,同时矫正合并的心脏畸形 ,可获得满意的近期和远期效果。     

Diagnosis of achalasia--comparison of methods for the evaluation of severity

To determine the value of endoscopy, manometry, and scintigraphy in predicting the severity of achalasia, 25 patients with primary achalasia of the esophagus were posprectively studied; 17 patients could be examined prior and post pneumatic dilatation. According to the symptoms, the severity was graded from I to IV. While endoscopic findings did not well correlate with the symptom score, the lower esophageal sphincter pressure and the resting pressure in the esophageal body were significantly correlated with the severity of the disease (p less than 0.01). The esophageal retention of radioactivity rose parallel to the symptom score (p = 0.07). Both manometric and scintigraphic findings changed significantly after therapy (p less than 0.01). Manometry and scintigraphy of the esophagus can be used to measure treatment related effects in patients with primary achalasia. Endoscopic findings are not related to subjective complaints, but an endoscopic examination should always be performed to exclude malignancies of the esophago-gastric junction.     

Measurement of frequency of ciliary beats of human respiratory epithelium

A method for accurate measurement of beats on ciliated respiratory epithelial cells in vitro is described. The technique allows the frequency of ciliary beats to be recorded directly on minute specimens of human respiratory epithelium obtained by bronchoscopic brushing. A "hanging-drop" preparation of the scraped material is placed on a thin, flat welled slide and is viewed with a phase-contrast microscope at a magnification of x450. Light transmitted through the specimen is deflected in varying intensities due to the beating action of the cilia and is detected by a photomultiplier cell, amplified and transduced as peaks on an oscilloscope. Due to the relatively high magnification, a small group of cilia may be focused upon and their activity measured. Specimens from two groups totaling 53 patients were measured; in the first group the frequency of ciliary beats was measured at 23 degrees C and ranged from 9.1 to 12.9 beats per second with a mean and standard deviation of 11.0 +/- 1.3 beats per second. The second group was measured at 37 degrees C, and values ranged from 10.3 to 16.8 beats per second, with a mean and standard deviation of 13.8 +/- 1.8 beats per second. These values are interpreted to reflect the autonomous frequency of ciliary beats of the isolated respiratory cells. This simple method may be applied to screen for abnormalities of ciliary beating in patients with altered respiratory mucous clearance, as well as to examine the specific effects in vitro of chemicals, drugs, or pollutants on human ciliary activity.     

Simulation of transcapillary exchange of liquids

The transcapillary exchanges of liquids between vascular and interstitial sections can be described with the help of a mathematical model describing variation in filtration, reabsorption, plasmatic flux and lymphatic flow in relation to the different active pressures, that is to say the arteriolar and venular pressures, the oncotic pressures of the proteins, and interstitial pressure. Also taking into account the modifications of the volemia in relation to blood loss and perfusions, modifications of the essential haemodynamic variables and diuresis, it is possible to reproduce various situations following the reduction in venous or lymphatic return, hypovolemia, and hypoproteinemia. The advantages in these simulations is demonstrated by the example of a blood depletion, compensated or otherwise, as follows: volemia, proteinemia, lymphatic flow. These simulations permit us to follow the sequence of events accompanying haemodilution, and to assess the qualities of a plasmatic substitute: oncotic strength, demi-vie, effect on the extravascular mobilisation of proteins. They also provide a reflexion tool permitting a better comprehension of transcapillary exchanges and the optimisation of strategies of vascular refill.     

Mechanisms of action of nitrates

Summary Glyceryl trinitrate, isosorbide dinitrate, and isosorbide-5-mononitrate are organic nitrate esters commonly used in the treatment of angina pectoris, myocardial infarction, and congestive heart failure. Organic nitrate esters have a direct relaxant effect on vascular smooth muscles, and the dilation of coronary vessels improves oxygen supply to the myocardium. The dilation of peripheral veins, and in higher doses peripheral arteries, reduces preload and after-load, and thereby lowers myocardial oxygen consumption. Inhibition of platelet aggregation is another effect that is probably of therapeutic value. Effects on the central nervous system and the myocardium have been shown but not scrutinized for therapeutic importance. Both the relaxing effect on vascular smooth muscle and the effect on platelets are considered to be due to a stimulation of soluble guanylate cyclase by nitric oxide derived from the organic nitrate ester molecule through metabolization catalyzed by enzymes such as glutathione S-transferase, cytochrome P-450, and possibly esterases. The cyclic GMP produced by the guanylate cyclase acts via cGMP-dependent protein kinase. Ultimately, through various processes, the protein kinase lowers intracellular calcium; an increased uptake to and a decreased release from intracellular stores seem to be particularly important.     

Endocrinology of anorexia of ageing

Appetite and food intake decrease with normal ageing, predisposing to the development of under-nutrition. Under-nutrition is common in older people and has been implicated in the development and progression of chronic diseases commonly affecting the elderly, as well as in increasing mortality. An understanding of the factors that contribute to the physiological and pathological declines in food intake in older people is likely to aid in the development of effective forms of prevention and treatment. Ageing affects many of the endocrine factors involved in the control of appetite and feeding but few studies have been performed in humans to clarify these changes. Possible hormonal causes of the anorexia of ageing include increased activity of cholecystokinin, leptin and various cytokines and reduced activity of ghrelin and testosterone.     

糖尿病肾病血液透析护理效果分析

目的 探讨糖尿病肾病血液透析中不同护理模式的护理效果.方法 选择该院2018年3月—2019年3月收治的糖尿病肾病患者72例.该次选取的病例均拟行血液透析治疗,按照随机数表将患者分为对照组(35例)和观察组(37例),其中对照组在患者血液透析期间行常规基础护理,观察组行优质护理干预,观察两种不同的护理模式对患者血液透析...     

Cost of care of haemophilia with inhibitors

Summary.  In Western countries, the treatment of patients with inhibitors is presently the most challenging and serious issue in haemophilia management, direct costs of clotting factor concentrates accounting for >98% of the highest economic burden absorbed for the healthcare of patients in this setting. Being designed to address questions of resource allocation and effectiveness, decision models are the golden standard to reliably assess the overall economic implications of haemophilia with inhibitors in terms of mortality, bleeding-related morbidity, and severity of arthropathy. However, presently, most data analyses stem from retrospective short-term evaluations, that only allow for the analysis of direct health costs. In the setting of chronic diseases, the cost-utility analysis, that takes into account the beneficial effects of a given treatment/healthcare intervention in terms of health-related quality of life, is likely to be the most appropriate approach. To calculate net benefits, the quality adjusted life year, that significantly reflects such health gain, has to be compared with specific economic impacts. Differences in data sources, in medical practice and/or in healthcare systems and costs, imply that most current pharmacoeconomic analyses are confined to a narrow healthcare payer perspective. Long-term/lifetime prospective or observational studies, devoted to a careful definition of when to start a treatment; of regimens (dose and type of product) to employ, and of inhibitor population (children/adults, low-responding/high responding inhibitors) to study, are thus urgently needed to allow for newer insights, based on reliable data sources into resource allocation, effectiveness and cost-utility analysis in the treatment of haemophiliacs with inhibitors.     

Paradox of the evolution of communication and of social interactivity.

Communication between individuals of a species is likely to increase the capacity to acquire skills useful for survival and propagation and thus may confer important selective advantages. Since interaction occurs between two or more individuals, the selective process is frequency dependent, and the analysis shows that communication cannot initially increase at a reasonable rate when it is limited to random unrelated individuals, so that it is likely to abort for stochastic reasons. However, this bottleneck is removed if the communication process takes place in the nuclear family or among close relatives or if aggregation of communicators occurs because of assortative mating or meeting. Use of the individual conditional fitnesses we have introduced earlier permits an exact analysis. We show that, in general, the initial rate of increase can be geometric if and only if, in the class of selective models considered, the conditional probability of a communicator interacting with another contains a positive constant term. In our discussion of communication, cost factors for the act of communication have been omitted. However, the model has been generalized to include cooperativeness, and also altruism, or competition, by introducing costs. There is a close relationship among these situations, and the same considerations about the initial bottleneck and its resolution also extend to them. The models given here are for haploids but they extend to diploids and the conclusions are similar.     

云南省地方性猝死的死因调查分析

目的调查云南省地方性猝死(亦称云南省地方性爆发性心肌炎,曾称云南省爆发性病毒性心肌炎)的死亡性质,为有效防治该病提供依据。方法以临床医学检查及现场流行病学调查为主要方法,调查15例死者的发病与死亡经过,并对5例死者做尸解,进行病理诊断以确定死因;同时对死者所在病区居民157人进行查体、心电图、X线检查、心肌酶学检查及现场流行病学调查,以确定各调查点的现有患者,为分析死亡原因提供重要依据。结果2004年调查的15例死者中,死因为克山病者10例,疑似克山病者2例,死于肺性脑病者2例,无法确定死因者1例;检诊病区居民共计157例,查出克山病现患5例,其中3例为新检出者。在所检查的死者和居民中均未发现可以诊断病毒性心肌炎或爆发性病毒性心肌炎的患者。结论在2004年所调查的15例云南省地方性猝死死者中有10例死者的死因确定为克山病。     

Management of failures of first line treatments

Up to 70% of the patients treated to prevent rebleeding will experience a bleeding episode within 2 years. The response should be adapted to the delay after the index bleed, the source and the severity of the haemorrhage, the underlying liver disease and the initial treatment to prevent rebleeding. Bleeding can be caused by endoscopic techniques themselves, which should incitate to complete obliteration rather than to switch to another therapy. Failure of drug therapy can be secondary to ineffectiveness, to a lack of compliance, or to an insufficient dosage. The two latter conditions may be corrected. Whenever a patient rebleeds in spite of optimal treatment, liver transplantation should be considered. When such a procedure is contra-indicated and in patients on the waiting list, a Transjugular intra-hepatic porto-systemic shunt (TIPS) should be performed.