基于自我调节模型的围绝经期妇女认知及影响因素研究

[目的]探讨基于自我调节模型的围绝经期妇女对绝经的认知情况及影响因素。[方法]采用一般情况调查表和改编的围绝经期妇女认知量表对417例围绝经期妇女进行调查。[结果]大多数围绝经期妇女认为记忆减退(61.2%)和情绪波动(59.5%)是由绝经引起,而典型的绝经症状潮热却只有38.4%人认为是由绝经引起,且大多数人对绝经持中立态度。家庭关系、有无事件突发是影响绝经认知4个方面(症状识别、结果、原因、时间、应对)的共同因素。此外,影响绝经症状识别的因素还有痛经与否、是否绝经及绝经状态,影响绝经应对认知的因素还有教育水平、职业、户口、收入、是否绝经。[结论]认知会影响绝经症状与管理,针对绝经认知的影响因素对围绝经期妇女实施个性化干预,提高和转变其认知,可改善其症状。     

基于自我调节模型的围绝经期妇女认知及影响因素研究

[目的]探讨基于自我调节模型的围绝经期妇女对绝经的认知情况及影响因素.[方法]采用-般情况调查表和改编的围绝经期妇女认知量表对417例围绝经期妇女进行调查.[结果]大多数围绝经期妇女认为记忆减退（61.2%）和情绪波动（59.5%）是由绝经引起,而典型的绝经症状潮热却只有38.4%人认为是由绝经引起,且大多数人对绝经持中立态度.家庭关系、有无事件突发是影响绝经认知4个方面（症状识别、结果、原因、时间、应对）的共同因素.此外,影响绝经症状识别的因素还有痛经与否、是否绝经及绝经状态,影响绝经应对认知的因素还有教育水平、职业、户口、收入、是否绝经.[结论]认知会影响绝经症状与管理,针对绝经认知的影响因素对围绝经期妇女实施个性化干预,提高和转变其认知,可改善其症状.     

湘潭地区妇女围绝经期症状与影响因素的调查分析

[目的]对湘潭地区1816例40-60岁妇女的围绝经期症状及影响因素进行调查。[方法]采用抽样调查方案分析,并进行统计学处理。[结果]妇女平均绝经年龄为47岁,更年期症状的发生率为74％,出现症状的平均年龄为44岁,持续时间约4年。职业、生活环境、精神创伤、夫妻关系、初潮及经济状况与围绝经期症状的发生密切相关。[结论]应加强妇女围绝经期保健工作,且要在40岁以前开始。     

2300例南通市围绝经期妇女保健现状分析

[目的]调查南通市地区围绝经期妇女的健康状况及保健需求.[方法]采用随机抽样的方法,对南通市崇川、启东、如东三地区40～65岁围绝经期2 300名妇女进行面对面问卷调查,了解其自然绝经年龄、保健知识掌握及保健需求、通过Kupperman评分对绝经综合征进行评估.[结果]本地区妇女平均自然绝经年龄为50.02岁;围绝经期保健知识77.34％不了解或了解很少;保健知识需求88.74％.绝经综合征1 714例,占74.52％.绝经综合征症状发生率前三位为失眠、性生活障碍、疲乏.[结论]了解南通市地区围绝经期妇女的健康状况及保健需求,有利于提高围绝经期妇女的生活质量.     

女性围绝经期综合征影响因素调查研究

[目的]了解更年期妇女围绝经期综合征发生情况及其影响因素.[方法]在全国22个省市随机选取1051名45岁～55岁女性进行一般情况、Kupperman评分和抑郁自评量表(CES-D)调查.[结果]1051名更年期妇女中,围绝经期综合征发生率为91.9％,围绝经期综合征的症状在婚姻质量、工作压力、与子女邻里同事关系、睡眠等方面比较差异有统计学意义(P＜0.01).[结论]更年期妇女更年期综合征发生率高,且更年期症状越严重,抑郁的发生率越高.     

围绝经期妇女焦虑状态及其影响因素的研究

目的：调查围绝经期妇女的焦虑状态,并探讨其主要影响因素。方法：对400例40～60岁妇女,采用一般情况调查表、家庭APGAR问卷、Zung焦虑自评量表（SAS）调查分析其焦虑状态及影响因素。结果：400例调查对象中,84例有焦虑症状,焦虑发生率达21％。围绝经期妇女焦虑症发生的影响因素与夫妻关系、绝经状况、家庭功能有关。结论：护理人员应高度重视围绝经期妇女心理健康,全面评估围绝经期焦虑影响因素,给予综合性心理支持与干预。     

上海市南京东路社区妇女围绝经期症状分析

目的：了解黄浦区社区围绝经妇女围绝经期症状的发生情况。方法：采用2个阶段随机抽样方法,选取南京东路社区40~60岁妇女作为调查对象,进行问卷调查。结果：被调查677例妇女中自然绝经者386例,平均绝经年龄为49.36±3.71岁。围绝经期症状发生率70.3%。在13项症状中,出现频率最高前5位症状依次为潮热出汗（53.2%）、骨关节痛（47.6%）、性生活障碍（45.2%）、眩晕（41.5%）、疲乏（41.2%）。围绝经期症状的严重程度随年龄的增长而加重。经多元线性回归分析显示,是否工作、性生活满意度及是否患有慢性病与围绝经期症状有相关性。结论：绝大多数妇女在围绝经期存在围绝经期症状,其发病与雌激素水平降低有关。依托社区,加强健康教育;针对病因进行预防,可降低围绝经期症状的发生率,提高妇女生活质量。     

围绝经期综合征高校知识妇女的社区护理干预

[目的]总结围绝经期综合征高校知识妇女的社区护理干预。[方法]126例围绝经期综合征高校知识妇女进行社区护理干预,加强健康教育、心理护理、用药指导、饮食和运动干预、督促定期体检等。[结果]126例病人均能认识到绝经是女性正常生理过程,能正确用药、自觉采取保健行为、建立健康的生活方式,113例病人自觉症状改善和消失。[结论]对围绝经期综合征高校知识妇女进行社区护理干预,可改善更年期症状、提高生活质量。     

护士围绝经期综合征与抑郁的相关性研究

[目的]探讨护士围绝经期综合征常见症状分布情况及其与抑郁的相关性。[方法]采用一般资料问卷、改良Kupperman评分量表及抑郁自评量表(SDS)对唐山市10所二级、三级医院40岁～55岁的540名围绝经期护士进行调查。[结果]围绝经期护士抑郁症状和围绝经期综合征的发生率分别为50.00%和63.70%,其中疲乏无力、肌肉及骨关节疼痛、失眠的发生率明显高于其他项目,分别为92.73%,80.52%,77.91%,且围绝经综合征程度越重,中重度抑郁的发生率越高,且各种症状与抑郁均具有相关性(P<0.05),差异有统计学意义。[结论]护士围绝经期综合征与抑郁有一定的相关性,在积极缓解症状的同时,应广泛开展围绝经期护士的心理保健工作,从而提高护理人员的生存质量。     

围绝经期妇女的自我管理现状及影响因素调查

[目的]了解围绝经期妇女的自我管理现状及影响因素。[方法]应用一般情况调查表和自行设计的围绝经期妇女自我管理量表对417例围绝经期妇女进行调查。[结果]经常或总是使用激素占1.2%,经常或总是使用其他保健品、中药、推拿按摩及放松疗法或瑜伽分别占9.1%、4.3%、7.4%,经常或总是补充维生素D、维生素E及钙剂者分别占14.4%、15.8%、24.5%;经常或总是食用豆制品、牛奶分别占45.8%、33.8%;自我监测率较低,均不超过40%。影响围绝经期妇女自我管理的主要因素为教育水平、户口所在地及活动情况。[结论]围绝经期妇女自我管理状况不容乐观,应针对其影响因素采取相应干预措施,提高其自我管理水平。     

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.     

VEGF和NSE在良恶性嗜铬细胞瘤中的表达及意义

目的探讨肿瘤标志物血管内皮生长因子（VEGF）和神经元特异性烯醇化酶（NSE）在良、恶性嗜铬细胞瘤组织中的表达,分析其可能的临床价值及病理学意义,为临床鉴别良、恶性嗜铬细胞瘤提供辅助依据。方法应用免疫组化（SP法）检测16例恶性嗜铬细胞瘤、18例良性嗜铬细胞瘤及17例正常肾上腺髓质组织中细胞因子VEGF和NSE表达情况,显微镜下判断组织切片的染色结果。结果①恶性嗜铬细胞瘤VEGF表达明显强于正常肾上腺髓质和良性嗜铬细胞瘤（P〈0.01）。良性肿瘤和正常肾上腺髓质的VEGF表达差异无统计学意义（P〉0.05）。恶性嗜铬细胞瘤强阳性率明显高于良性嗜铬细胞瘤（P〈0.01）。②良、恶性嗜铬细胞瘤NSE表达差异有统计学意义（P〈0.05）,良性嗜铬细胞瘤NSE的表达高于正常肾上腺髓质的NSE表达（P〈0.05）。恶性嗜铬细胞瘤强阳性率高于良性嗜铬细胞瘤（P〈0.05）。③VEGF和NSE共同阳性表达在良、恶性嗜铬细胞瘤之间差异有统计学意义（P=〈0.01）。结论临床上检测VEGF和NSE可能为鉴别良、恶性嗜铬细胞瘤提供辅助依据,共同检测VEGF和NSE可能提高良、恶性嗜铬细胞瘤鉴别的敏感性。