绝经后妇女雌激素变化与冠心病致病因子的相关性研究

目的探讨绝经后妇女雌激素变化与冠心病(CAD)致病因子之间的相关性。方法选择绝经后CAD稳定型心绞痛(SA)患者40例做为实验组(SA组),选择绝经后健康女性30例做为对照组,分别取血测定其血清C反应蛋白(CRP)、纤维蛋白原(FIB)、内皮素1(ET-1)及雌二醇(E2),比较CAD组与对照组之间E2、CRP、FIB、ET-1水平并且分析其相关性。结果①SA组E2水平明显低于对照组,(95.71±6.49)pmol/L vs(132.31±9.49)pmol/L(P<0.01);②SA组血清CRP、FIB、ET-1水平[(3.99±0.50)mg/L、(3.44±0.35)g/L、(63.45±5.01)ng/L],明显高于对照组,(3.19±0.43)mg/L、(2.97±0.2)g/L、(57.45±4.86)ng/L(P<0.05,<0.05,<0.01);③在SA组患者中,E2水平与CRP、FIB、ET-1呈负相关(R=-0.683,-0.649,-0.620,均P<0.01)。结论①绝经后CAD妇女E2水平明显低于正常对照组,表明绝经后妇女E2水平下降与CAD发病密切相关;②CAD组妇女血清CRP、FIB、ET-1明显增高,表明此几项指标确系CAD的致病因子;③在SA组患者中,E2水平与CRP、FIB、ET1等CAD致病因子的水平呈负相关,说明绝经后妇女雌激素水平降低可能通过影响CAD致病因子而导致CAD的发生。     

H.E.L.P.治疗急性脑梗塞的护理

H.E.L.P.治疗急性脑梗塞有确切的疗效.本文强调了血管通路的护理、抗凝方法、血压动态监测、健康宣教在治疗过程中的重要作用.     

脑蛋白水解物联合高压氧用于血肿清除术后高血压脑出血患者治疗效果分析

目的探讨脑蛋白水解物联合高压氧用于血肿清除术后高血压脑出血患者治疗临床效果。方法研究对象选取重庆市双桥经济技术开发区人民医院2011-08—2014-08收治行血肿清除术高血压脑出血患者共78例,采用随机数字表法分为对照组(39例)和试验组(39例),对照组采用单纯高压氧治疗,试验组在对照组治疗基础上加用脑蛋白水解物辅助治疗;比较两组患者临床疗效,治疗前后CSS评分、ADL评分及血清S100-β蛋白水平等。结果试验组患者临床疗效87.18%显著优于对照组53.85%,差异有统计学意义(P0.05);试验组患者治疗后CSS评分(8.14±1.54)分和ADL评分(87.97±15.20)分均显著优于对照组治疗后(15.38±3.84)分和(75.25±10.69)分(P0.05);试验组患者治疗后血清S100β水平(0.02±0.01)μg/m L显著低于对照组治疗前(0.28±0.09)μg/m L(P0.05)。结论脑蛋白水解物联合高压氧用于血肿清除术后高血压脑出血患者治疗可有效促进神经功能恢复,改善日常生活质量,并有助于降低血清S100β水平。     

综合干预策略对老年稳定期慢性阻塞性肺疾病患者肺功能及生活状态的影响

目的研究综合干预策略对老年稳定期慢性阻塞性肺疾病(COPD)患者肺功能及生活状态的影响。方法选择2018年12月至2019年12月在本院就诊的120例老年稳定期COPD患者,根据患者干预意愿分成对照组和观察组,每组各60例。对照组予以止咳化痰、解痉平喘等对症治疗,观察组在对症治疗基础之上予以综合干预策略。分别在干预后第1、3、6个月随访,观察2组患者营养状况(MNA)、日常生活能力(ADL)、衰弱状况(MFS)及肺功能的改变。结果观察组患者干预前和干预后1、3、6个月的MNA评分分别为(20.48±0.83)、(21.81±1.28)、(23.39±1.03)、(24.32±0.91)分,干预后6个月与干预前比较差异具有统计学意义(P<0.05),且观察组患者干预后MNA评分均较对照组明显升高(P<0.05)。观察组患者干预前和干预后1、3、6个月的ADL评分分别为(68.50±5.77)、(73.20±5.60)、(85.00±7.07)、(89.58±6.20)分,干预后6个月与干预前比较差异具有统计学意义(P<0.05),且观察组患者干预后ADL评分均较对照组明显升高(P<0.05)。观察组患者干预前和干预后1、3、6个月的MFS评分分别为(38.67±7.97)、(32.75±0.96)、(26.33±8.78)、(18.17±9.61)分,干预后6个月与干预前比较差异具有统计学意义(P<0.05),且观察组患者干预后MFS评分均较对照组明显下降(P<0.05)。干预后2组患者FVC值均有轻微升高,但2组相比差异无统计学意义(P>0.05),观察组患者FEV1由干预前(2.46±0.45)L改善为干预后(2.84±0.26)L,FEV1%由干预前(57.68±12.73)%改善为干预后(77.05±5.92)%,差异具有统计学意义(P均<0.05)。结论综合干预可显著改善老年稳定期COPD患者肺功能水平、日常生活能力、衰弱及营养状况,从而改善患者的生活状态。     

高压氧治疗对脑卒中后抑郁状态和神经功能康复的影响

目的探讨高压氧 (HBO)治疗对脑卒中后抑郁状态 (PSD)和神经功能康复的影响。方法 60例PSD患者随机分为治疗组和对照组 ,在常规治疗基础上 ,治疗组加用HBO治疗 ,观察并评价两组治疗前后的汉密顿抑郁量表 (HAMD)评分、临床神经功能缺损评分 (CSS)和日常生活活动能力 (ADL)评分变化。结果 1个月后 ,治疗组的HAMD评分和CSS、ADL评分均较治疗前有明显改善 (P <0 .0 1) ,而对照组治疗前后则无明显差异 (P >0 .0 5 )。结论HBO治疗可以促进PSD患者抑郁症状和神经功能的康复。     

高压氧治疗脑梗死后抑郁的疗效观察

[目的]观察高压氧(HBO)治疗对脑梗死后抑郁(PID)及神经功能康复的影响.[方法]将80例PID患者随机分为治疗组和对照组,在常规治疗基础上,治疗组加用HBO,每日1次,每次120 min,观察两组治疗前、后汉密顿抑郁量表(HAMD)评分,中国卒中量表(CSS)和日常生活活动能力(ADL)评分变化.[结果]一个月后治疗组HAMD评分,CSS评分及ADL评分均较治疗前和对照组同期有明显改善(P＜0.01),而对照组无明显变化(P＞0.05).[结论]HBO可明显改善脑梗死后抑郁程度并能促进神经功能康复.     

急性心肌梗死溶栓治疗时抗凝血酶和纤溶功能的关系

目的探讨急性心肌梗死(AMI)溶栓治疗时抗凝血酶(AT)与纤维蛋白溶解系统的变化.方法32例急性心肌梗死患者,进行尿激酶溶栓治疗,分别于溶栓治疗前、后0.5h、1h、2h、4h、8h采血.采用发色底物法测定AT、纤溶酶原(PLG)活性,凝固法测定纤维蛋白原(FIB)含量,动态观察AT、PLG和FIB在溶栓治疗时的变化.结果AMI溶栓治疗前AT:A(83.2%±14.8%)明显低于对照组(102.4%±10.4%)(P＜0.01),而溶栓前FIB(4.436±1.201)g/L、PLG:A(107.2%±10.3%)均显著高于对照组HB(2.883±0.74)g/L、PGL(95.6%±8.2%),(P＜0.01);溶栓治疗后0.5h,FIB含量和PLG:A均逐渐下降(P＜0.01).4h时最低,[FIB(1.373±0.951)g/L、PGL(57.9%±8.6%)];AT:A在溶栓治疗前后各时间段变化不明显(P＞0.05).结论急性心肌梗死患者抗凝血酶呈消耗性下降,纤维蛋白溶解功能受抑制;采用尿激酶溶栓治疗对抗凝血酶影响不明显.     

性激素与脑梗塞患者关系的研究

目的　研究性激素与脑梗塞发病的关系。方法　应用放射免疫分析法测定了 48例男性脑梗塞患者及 30例健康男性血清孕酮 (P)雌二醇 (E2 )和睾酮 (T)水平。结果　脑梗塞患者血清 P较对照组显著降低 ,P<0 .0 1,血清 E2 在脑梗塞患者较对照组显著升高 ,P<0 .0 5 ,血清 E2 在 3个月随访期间趋于正常水平 ,血清 P在 3个月随访期间略高于急性期 ,两者相比无显著差异 ,P>0 .0 5 ,但于正常对照组相比有显著差异 ,P<0 .0 1。血清 T在脑梗塞组和对照组无明显差异。结论　性激素比例失衡与脑梗塞的发病有密切关系。     

吡拉西坦联合尼莫地平对脑梗塞后血管性痴呆的治疗效果观察

目的研究吡拉西坦联合尼莫地平治疗脑梗塞后血管性痴呆(VD)的临床效果。方法选取我院2016年11月～2017年11月收治的98例脑梗塞后血管性痴呆患者。根据治疗方法分为对照组和研究组各49例,对照组单独使用尼莫地平进行治疗,研究组在此基础上联合吡拉西坦治疗,观察对比两组患者治疗前后ADL、MoCA、ADAS-Cog、MMSE评分与生活质量评分情况。结果治疗前,两组患者ADL、MoCA、ADAS-Cog各项评分比较,无显著差异(P0.05);治疗后,研究组ADL、MoCA、ADAS-Cog各项评分均优于对照组,差异有统计学意义(P0.05)。治疗前与治疗1个月时,两组患者MMSE评分比较,无显著差异(P0.05);治疗3个月、治疗半年后研究组MMSE评分均优于对照组,差异有统计学意义(P0.05)。治疗前,两组患者生活质量评分比较,无显著差异(P0.05);治疗后,生活质量评分均显著高于对照组,差异有统计学意义(P0.05)。结论针对脑梗塞后血管性痴呆患者采取吡拉西坦联合尼莫地平治疗,患者认知功能得到明显改善,生活质量出现提高,临床治疗效果显著,值得应用。     

芍药甘草汤结合运动训练治疗脑卒中后肌痉挛的临床疗效及表面肌电图分析

目的 观察芍药甘草汤结合运动训练治疗脑卒中后肌痉挛的临床疗效,并对其表面肌电图(sEMG)指标进行分析.方法 选取脑卒中后肌痉挛患者60例,按随机数字表法将其分为治疗组和对照组,每组30例.对照组采用常规运动训练,治疗组在此基础上加用芍药甘草汤治疗.分别于治疗前、治疗1个月后采用Ashworth量表、综合痉挛量表(CSS)、Fugl-Meyer运动功能评定量表(FMA)对患者的上、下肢痉挛情况及运动功能进行评定,并采用sEMG对患者肱二头肌、胫骨前肌及腓肠肌的表面肌张力进行测定.结果 治疗组治疗1个月后Ashworth分级为0级、Ⅰ级的患者数目分别为6例、8例,CSS分级为0级、Ⅰ级的患者数目分别为9例、11例,与治疗前相比,差异有统计学意义(P＜0.05),且治疗组治疗1个月后疗效优于对照组(P＜0.05).对照组治疗1个月后上、下肢FMA评分分别为(73.63 ±27.49)分和(69.56±28.83)分,与组内治疗前比较,差异有统计学意义(P＜0.05);治疗组治疗1个月后上、下肢FMA评分分别为(82.40±31.53)分和(79.58 ±26.34)分,与组内治疗前相比,差异亦有统计学意义(P＜0.05),且治疗组治疗1个月后上肢及下肢的FMA评分高于对照组(P＜0.05).治疗组治疗1个月后肱二头肌、胫骨前肌、腓肠肌的IEMG分别为(32.32±12.58)μV·s、(19.72-±7.61)μV·s和(43.85 ±6.63)μV·s、RMS分别为(1.91±0.33) μV、(3.03±0.86) μV和(8.95 ±0.77) μV,与治疗前相比,差异均具有统计学意义(P＜0.05);对照组治疗1个月后仅胫骨前肌和腓肠肌的RMS[(6.27±1.56)μV和(5.13±0.72) μV]较治疗前有统计学意义(P＜0.05).与对照组治疗1个月后相比,治疗组IEMG及RMS值的变化均优于对照组,差异有统计学意义(P＜0.05).结论 在常规运动治疗的基础上辅以芍药甘草汤治疗,可明显改善脑卒中后肌痉挛,值得临床推广、应用.     

Reduction of hepatitis C virus load by H.E.L.P.-LDL apheresis

The association of HCV with apolipoprotein B containing lipoproteins has been observed and this led to the assumption that the LDL receptor may also serve as a candidate receptor for HCV. H.E.L.P.-LDL apheresis is suggested to be an effective and rapid tool to safely eliminate apolipoprotein B containing lipoproteins. In this pilot study, we have investigated whether H.E.L.P. treatment would reduce HCV load in five patients, all infected for more than 4 years with HCV and resistant against established anti-HCV therapy (interferon, ribaverin). HCV-RNA was determined by RT-PCR in plasma immediately before the start of apheresis (SA) and after treatment of 2500 mL plasma (AA). H.E.L.P. apheresis led to a mean decrease of 77.3% (16th percentile 36.5%, 84th percentile 89.6%) of HCV-RNA when AA values were compared to SA values. This decline was reproducible during nine treatment procedures, but was not correlated to the decrease in LDL cholesterol. This investigation shows for the first time that HCV load can be reduced by H.E.L.P. apheresis, which is an established and approved therapy for hypercholesterolemia. Even though the efficiency of viral load reduction varied between single procedures and did not correlate to LDL removal, this extracorporeal therapy opens the possibility to treat patients with established immune modulatory and antiviral therapy in the interval between two apheresis procedures.     

Defective erythrocyte pyruvate kinase.

A defective pyruvate kinase (EC 2.7.1.40) is described. The abnormal PK is characterized by a shift in the R in equilibrium T equilibrium to the T-state. The Ko.5 for the substrate phosphoenol pyruvate is about 6 times higher than for the normal enzyme, while the KM value for the positive effector Fru-1, 6-P2 is increased. In agreement with a shift to the T-state is the increased affinity of the abnormal enzyme for the negative effectors ATP and alanine. The results are discussed in relation to other abnormal pyruvate kinases.     

Celiac axis compression syndrome. A critical review : L.J. Brandt and S.J. Boley,Amer. J. digest. Dis., 23 (1978) 633–640

The present report describes the application of self-regulation techniques (progressive muscle relaxation, meditative breathing, and guided imagery) to the management of bleeding and arthritic pain and analgesic dependence in a 9-year-old hemophilic child with factor VIII inhibitor. Self-regulation training was effective in decreasing pain intensity and analgesic dependence, with a 1-year follow-up demonstrating substantial improvements across both medical and psychosocial parameters.     

Opiate pharmacology and individual differences. I. Psychophysical pain measurements

A new electric stimulation pain assessment technique using the Tursky electrode and a non-parametric analysis of subjects ratings was found sensitive to aspirin, morphine and opiate antagonists in a series of double-blind cross-over trials in normal adults. Stable individual differences in pain sensitivity (off medication) were maintained on two testing sessions 7 months apart. Older individuals were less pain sensitive than younger individuals. Men were more insensitive than women under age 30. Together, these results suggest the empiric usefulness of this pain measurement technique.     

护理特需患者真实体验的质性研究

目的深入了解和探索上海市8所医院护士在照顾特需患者过程中的真实感受及经验,为临床护士提高多元文化护理水平提供培训课程及管理借鉴。方法通过访谈形式,访问了11位护理特需患者的护士,将获得的资料进行分析、整理、提出主题。结果得到护士在护理特需患者照顾中及照顾后的各种不同感受、照顾患者的新理念及护理后的新需求。结论加强护理特需患者前的多元文化护理培训及护理中的指导,需要对护士做出广泛而持续的培训及支持,使她们更了解并熟悉如何应用多元文化护理理念于工作之中,以应对她们不确定和难以预料的护理旅程。     

免疫荧光法在检测分泌物淋病奈瑟氏球菌、沙眼衣原体中的应用价值

目的:探讨免疫荧光法在检测分泌物淋病奈瑟氏球菌、沙眼衣原体中的价值。方法:选取2019年3月?2019年8月在本院妇产科,男科,皮肤性病科就诊的疑似泌尿生殖道感染的患者600名为本次研究对象。样本取尿道分泌物或宫颈口分泌物送检。分别采用常规PCR法、免疫荧光法、培养法进行淋病奈瑟氏球菌、沙眼衣原体的检测。以培养法作为金标准,统计并比较免疫荧光法、常规PCR法对淋病奈瑟氏球菌、沙眼衣原体检测结果的诊断效能。结果:免疫荧光法对淋病奈瑟氏球菌、沙眼衣原体检测的准确度、敏感度、特异性、阳性预测值、阴性预测值均明显高于常规PCR法,差异有统计学意义(P<0.05)。免疫荧光法对淋病奈瑟氏球菌、沙眼衣原体检测的曲线下面积均明显高于常规PCR法,经比较差异有统计学意义(P<0.05)。结论:免疫荧光法检测淋病奈瑟氏球菌、沙眼衣原体快速、准确、灵敏,临床应用价值优于常规PCR法。     

改进耳鼻喉科门诊护理教学方法的效果

目的探讨一种新的更有效的护理教学方法。方法将64例实习护士随机分为2组,采用对照研究的方法。甲组在护理教学中采用耳鼻咽喉专科门诊各种规章制度、工作流程、基本语言沟通技巧及“10项专科技术操作”标准讲解、发放法,课后熟记程序并运用于实际工作中。乙组在护理教学中采用上述内容讲解法,缺少课后熟记与思考的过程,比较2组教学方法的效果。结果护理教学中采用各种规章制度及工作流程基本语言沟通技巧及“10项专科技术操作”标准讲解法和发放法使实习护士进入工作状态加快,提前了解掌握了各班工作,经过统计学处理有显著性意义（P〈0.01）。结论护理教学中应采用耳鼻咽喉专科门诊各种规章制度、工作流程基本语言沟通技巧及“10项专科技术操作”标准讲解、发放法。     

Enzyme-linked immunoassay of thyrotropin.

A method was developed for immunoassay of thyrotropin after its conjugation with alkaline phosphatase using the double antibody technique. The dilution of serum resulted in curves parallel to those obtained for standard thyrotropin. The mean recovery of thyrotropin (TSH) added to serum was 97%, and values for serum TSH determined by this method correlated well with those determined by radioimmunoassay. The coefficients of variation were 2 to 7% (within assay) and 10 to 15% (between assay). The method requires minimal equipment, and is less expensive than radioimmunoassay, so it should be useful as a screening test for primary hypothyroidism in cases with above the maximum normal serum TSH level (10 muH/ml).     

Simultaneous estimation of urinary steroids by semi-automated gas chromatography. Investigation of neo-natal infants and children with abnormal steroid synthesis.

Development of a method for multicomponent analysis of urinary steroids on open-tubular columns is described. The urinary steroid conjugates were hydrolysed enzymatically, extracted on Amberlite XAD-2 columns, purified on columns of Sephadex LH-20, then analysed as methyloxime trimethylsilyl ethers on a gas chromatograph on which up to 24 samples may be automatically injected. All major urinary steroids from 17-oxosteroids to cortisol metabolites were analysed and these were quantified relative to internal standards, 5alpha-androstane-3alpha, 17alpha-diol and cholesteryl butyrate added to the samples prior to derivatisation. The precision of the full technique and reproducibility of repetitive automatic solid injection was found to be acceptable for the purpose of profile analysis. Examples of urinary steroid profiles in normal infants and infants with disorders of adrenal steroid production and excretion are given.     

S.T.O.N.E评分系统及其改良对经皮肾镜碎石取石术后结石清除状态的预测研究

目的探讨S.T.O.N.E肾结石评分系统对预测经皮肾镜碎石取石术后结石清除状态的利用价值并改进。方法对符合纳入条件的经皮肾镜碎石取石术患者进行术前S.T.O.N.E肾结石评分,分析S.T.O.N.E评分系统及其所包含的各子项因素与术后结石清除状态的相关性,并进行改进。结果 146例患者结石清除率为73.97%。二元Logistic回归分析S.T.O.N.E总评分(O^R=2.033,95%CI:1.469～2.814,P=0.000)与结石残留显著相关。多因素Logistic回归分析S评分(OR^=4.003,95%CI:1.930～8.300,P=0.000)和N评分(O^R=2.159,95%CI:1.042～4.476,P=0.038)是结石残留的显著影响因子。T、O、E评分未见相关性(P0.05)。剔除T评分,引入结石的位置(L)信息。结石没有累及肾上极得1分,累及到肾上极得2分,称作L评分。改进O评分方法,积水程度反映了手术可操作空间(I)的大小,规定轻度积水和中度积水评1分,无积水和重度积水评2分,称作I评分。改良后的S.T.O.N.E肾结石评分与结石残留显著相关(OR^=2.400,95%CI:1.730～3.328,P=0.000)。多因素Logistic回归分析L评分(OR^=4.421,95%CI:0.989～19.757,P=0.052)、I评分(O^R=2.726,95%CI:1.119～6.642,P=0.027)和S评分(O^R=3.962,95%CI:1.903～8.247,P=0.000)与结石残留显著相关,N、E评分未见相关性(P0.05)。改良的S.T.O.N.E(L.I.N.E.S)和S.T.O.N.E评分预测结石残留的受试者工作特征曲线(ROC)下面积(AUC)分别为0.7997(SE=0.043,95%CI:0.716～0.884)和0.7483(SE=0.047,95%CI:0.656～0.840),差异具有统计学意义(χ2=4.81,P=0.028)。结论改良的S.T.O.N.E(L.I.N.E.S)评分和S.T.O.N.E肾结石评分系统均可用来预测术后结石清除状况,改良的S.T.O.N.E评分操作更简便,预测准确性更高。