痴呆患者和社区人群睡眠行为障碍的发生率及其相关因素

目的：调查社区人群和轻中度痴呆患者睡眠行为障碍的患病率及其相关危险因素. 方法：调查于2002-01/2003-01进行.社区人群样本来源于北京市万寿路地区和通州农村等八个城区和农村地区,年龄在40岁及其以上,无认知功能障碍的主诉,简易精神状态检查成绩在26分以上的非痴呆居民3 108人.痴呆患者来源于协作单位门诊患者373例.采用国际通用的神经精神科问卷调查其睡眠行为障碍,包括是否存在睡眠障碍及其频度和严重程度.并以频度和严重程度的乘积为调查得分,得分＞0存在睡眠障碍.同时调查了脑梗死、心脏病、糖尿病等14种疾病并计算其疾病指数,疾病指数为所患上述疾病之和,0为未患上述任何疾病,14为患有上述全部14种疾病.结果：社区人群3 108人和痴呆患者373例完成睡眠行为障碍调查,全部进入结果分析.①社区人群中8.3%主诉有睡眠行为障碍,其中29.1%的患者至少患有一种疾病,心脏、消化和神经系统疾病最常见.多因素Logistic回归分析显示,其睡眠行为障碍与年龄、教育程度、女性有关,比值比分别为1.22,1.13和1.32（P＜0.05）;85岁以上则与疾病指数（比值比=2.12）和教育（比值比=2.06）有关（P＜0.05）.②19.8%痴呆患者有睡眠行为障碍,其中的68.9%至少患有一种疾病,患3种及以上者高达23.0%,以心脏、神经、呼吸系统疾病和糖尿病最为常见,与不伴有睡眠行为障碍的患者比差异有显著性意义（P＜0.05）.主要危险因素为疾病指数和居住在城市,比值比分别为1.45和4.33（P＜0.05）.结论：睡眠行为障碍是老年人和痴呆患者常见的症状.高龄老年人和痴呆患者的睡眠行为障碍不单纯是衰老的结果,也与伴随的疾病有关.     

认知功能正常的社区老年人精神行为症状的现况调查

目的:神经精神症状是痴呆的重要临床表现之一,对其进行研究有助于痴呆症状的早期识别。但其在正常社区人群中的分布状况尚不清楚,故对其进行了研究。方法:采用国际通用的神经精神科问卷(NPI)对北京市城乡3108名认知功能正常的40岁及其以上人群的神经精神症状进行了调查,除外痴呆、精神疾病、帕金森病和严重脑血管病患者。结果:共完成NPI调查3108人,调查人群中17.2%在近1个月内出现过至少1种NPI异常,5.76%为临床显著性症状;在60岁以上人群分别为17.72%和6.25%。60岁以前抑郁最为常见,60岁以后睡眠障碍最为常见,随之为焦虑、易激惹和淡漠。情感高涨和脱抑制在3组见均较为少见。仅睡眠障碍的患病率随年龄增加明显升高(P=0.004)。多因素分析发现,高文化(OR=1.13)和女性(OR=1.25)对NPI总分有影响(P<0.05),年龄的作用接近显著性意义(OR=1.12,P=0.052)。高龄(OR=1.36),高文化(OR=1.13)和女性(OR=1.30)均对睡眠障碍有显著性作用。仅女性对抑郁有影响(OR=1.54)。结论:认知功能正常的社区老年人神经精神症状也不容忽视,在痴呆的临床诊断过程中要特别关注老年人的精神行为异常,但其确切的患病情况和相关因素尚有待进一步研究。     

慢性肾功能不全血液透析和不宁腿综合征患者的睡眠质量分析

目的:调查老年和老年前期不宁腿综合征与血液透析患者的睡眠质量,并分析影响其睡眠质量的因素。方法:以2003-07中山大学第一附属医院、广东省人民医院、中山大学孙逸仙纪念医院及中山大学第三附属医院因慢性肾功能不全进行血液透析的患者123例及广州市社区居民59人为观察对象。按年龄分为老年前期(50～59岁)70例,老年期(≥60岁)112例。每组又分3小组,分别为透析伴不宁腿综合征组(简称不宁腿综合征组),透析不伴不宁腿综合征组(简称透析组),社区人群组。采用自行设计的一般情况调查表调查性别,年龄,职业,患病病程等。不宁腿综合征的诊断采用国际不宁腿综合征研究小组制定的不宁腿诊断标准量表。睡眠质量评定采用匹茨堡睡眠质量指数量表,由23个项目7个因子构成,各因子累计得分系匹茨堡睡眠质量指数量表总分。将总分以4分,8分为界限将睡眠分为好,中,差3个级别进行分析。结果:纳入的123例透析患者及社区老年人59人,全部进入结果分析。①透析患者中不宁腿综合征者的患病率为25.2%(31/123);其中老年前期组为31%(16/52);老年组为21%(15/71);差异无显著性(χ2=1.48,P>0.05)。②不宁腿综合征组匹茨堡睡眠质量指数量表的主观睡眠质量、睡眠潜伏期、催眠药物与日间功能障碍项目分及总分均比透析组、社区人群高(P<0.05);透析组的睡眠潜伏期与催眠药物项目得分及总分比社区人群高(P<0.05)。②不宁腿综合征组的主观睡眠质量、睡眠潜伏期、睡眠持续时间、用睡眠药物、白天功能障碍和总分比透析组得分高(P<0.05);而睡眠潜伏期、用睡眠药物、睡眠总分比社区人群组高(P<0.05)。③老年前期不宁腿综合征组的主观睡眠质量、睡眠潜伏期、睡眠持续时间、用睡眠药物、白天功能障碍和总分高于透析组(P<0.05);而睡眠潜伏期、用睡眠药物、睡眠总分高于社区人群组(P<0.05)。④老年期不宁腿综合征组的睡眠潜伏期、用睡眠药物、白天功能紊乱和总分高于社区人群组,透析组也高于社区人群组,差异有显著性(P<0.05)。⑤老年前期组与老年期组不宁腿综合征患者之间仅在睡眠持续性上差异有显著(P<0.05),老年前期组与老年期组非不宁腿综合征患者仅在日间功能障碍上差异有显著性(P<0.05)。结论:透析伴不宁腿综合征对老年前期和老年期患者的睡眠质量有明显影响,透析不伴不宁腿综合征对老年前期患者的睡眠质量无影响。在肾脏血液透析的患者中,年龄因素与睡眠质量关系不明显。     

住院老年痴呆病人睡眠质量分析及护理干预

[目的]调查轻度、中度住院老年痴呆病人睡眠行为障碍的患病率及其影响因素,为提出有效护理干预提供依据。[方法]2003年1月—2006年8月采用国际通用的神经精神科问卷,调查住院老年痴呆病人睡眠行为障碍,包括是否存在睡眠障碍、频度和严重程度。同时采用自制影响睡眠因素调查表了解其影响因素。[结果]74.60%住院老年痴呆病人有睡眠行为障碍,影响睡眠主要因素为陌生环境、不良心理、日间活动及光照减少等。[结论]住院老年痴呆病人睡眠质量差,应从心理护理、改善环境、增加光照及运动等方面采取积极合理的护理措施来改善睡眠质量,提高病人的生活质量,延缓痴呆进展。     

血管性痴呆患者认知功能与心理状态和睡眠障碍的相关性研究

目的探讨血管性痴呆患者认知功能与心理状态和睡眠障碍的相关性。方法选取我院2016年4月至2019年4月收治的90例血管性痴呆患者为研究组,并选取同期非痴呆患者90例为对照组,所有患者通过简易精神状态量表、症状自评量表、匹兹堡睡眠质量调查问卷测评患者认知功能、心理状态、睡眠质量,并进行相关性分析。结果研究组经测评简易精神状态量表评分低于对照组,症状自评量表和匹兹堡睡眠质量评分高于对照组,差异有统计学意义(P<0.05);研究组血管性痴呆患者心理状态、睡眠质量与认知功能均呈正相关性(P<0.05);研究组血管性痴呆患者心理状态与睡眠质量呈正相关性(P<0.05)。结论血管性痴呆经认知功能与心理状态和睡眠障碍各自量表评分数据存在相关性,负性心理状态和睡眠障碍可增加血管性痴呆患者认知功能障碍严重程度,因此,护理人员根据患者睡眠质量和心理健康状态制定针对性干预措施。     

住院老年痴呆病人睡眠质量分析及护理干预

[目的]调查轻度、中度住院老年痴呆病人睡眠行为障碍的患病率及其影响因素，为提出有效护理干预提供依据。[方法]2003年1月-2006年8月采用国际通用的神经精神科问卷，调查住院老年痴呆病人睡眠行为障碍，包括是否存在睡眠障碍、频度和严重程度。同时采用自制影响睡眠因素调查表了解其影响因素。[结果]74．60％住院老年痴呆病人有睡眠行为障碍，影响睡眠主要因素为陌生环境、不良心理、日间活动及光照减少等。[结论]住院老年痴呆病人睡眠质量差，应从心理护理、改善环境、增加光照及运动等方面采取积极合理的护理措施来改善睡眠质量，提高病人的生活质量，延缓痴呆进展。     

社区人群对老年期痴呆风险知识的认知和疾病感知及其影响因素分析

[目的]了解社区人群对老年期痴呆风险知识的认知程度和疾病感知特点,并探讨其影响因素。[方法]采用5个老年期痴呆风险知识和疾病感知问题问卷对重庆市主城区22个社区卫生服务中心参加免费健康体检的人群进行调查。[结果]15.7%的人知道降低老年期痴呆的患病风险,12.0%的人认为自己总有一天会患老年期痴呆,23.2%的人想知道自己患该病的概率,35.1%的人害怕自己总有一天会患老年期痴呆,58.1%的人认为该疾病会给家人带来经济负担。多因素分析显示:学历、痴呆接触史是影响老年期痴呆风险知识的主要因素;性别、有痴呆接触史是痴呆担忧感知的影响因素;学历、家庭经济状况、痴呆知识接受史是痴呆易感性感知的影响因素,家庭经济状况、学历和痴呆接触史是痴呆后果感知的影响因素。[结论]社区人群对老年期痴呆风险知识的认识不足,疾病易感性感知水平偏低。应制定相关策略,有针对性地进行健康宣教,提高社区人群对老年期痴呆以及痴呆风险知识的认知。     

认知功能正常的社区老年人精神行为症状的现况调查

目的：神经精神症状是痴呆的重要临床表现之一，对其进行研究有助于痴呆症状的早期识别。但其在正常社区人群中的分布状况尚不清楚，故对其进行了研究。方法：采用国际通用的神经精神科问卷(NPI)对北京市城乡3108名认知功能正常的40岁及其以上人群的神经精神症状进行了调查，除外痴呆、精神疾病、帕金森病和严重脑血管病患者。结果：共完成NPI调查3108人，调查人群中17．2％在近1个月内出现过至少1种NPI异常，5．76％为临床显著性症状；在60岁以上人群分别为17．72％和6．25％。60岁以前抑郁最为常见，60岁以后睡眠障碍最为常见，随之为焦虑、易激惹和淡漠。情感高涨和脱抑制在3组见均较为少见。仅睡眠障碍的患病率随年龄增加明显升高(P=0．004)。多因素分析发现，高文化(OR=1．13)和女性(OR=1．25)对NPI总分有影响(P&;lt;0．05)，年龄的作用接近显著性意义(OR=1．12，P=0．052)。高龄(OR=1．36)，高文化(OR=1．13)和女性(OR=1．30)均对睡眠障碍有显著性作用。仅女性对抑郁有影响(OR=1．54)。结论：认知功能正常的社区老年人神经精神症状也不容忽视，在痴呆的临床诊断过程中要特别关注老年人的精神行为异常，但其确切的患病情况和相关因素尚有待进一步研究。     

社区老年人心脑血管疾病共病抑郁障碍流行病学特征及其影响因素分析

目的调查社区老年人心脑血管疾病患者共病抑郁障碍的现况及易感因素,为社区疾病防治提供重要依据。方法随机抽取浦东新区15个街镇在册常住老年人共调查3311名,将患有明显心脑血管疾病的574名老年人进行抑郁障碍共病调查(疾病组),574名无明显躯体和精神疾病者作对照(健康组)。调查工具包括自编"一般状况调查问卷"及"美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)轴Ⅰ障碍定式临床检查患者版(SCID-I/P)",进行多因素Logistic回归分析。结果疾病组中164例共病抑郁障碍(28.6%),高于健康组(17.1%)(χ2=21.54,P<0.01);Logistic回归分析发现,高龄、女性、家庭经济困难、家庭关系不良是共病抑郁障碍的独立相关风险因素。结论老年心脑血管疾病患者共病抑郁障碍患病率高于健康老年人群,对易感因素采取积极有效的干预方法可降低患病率,有利于提高老年人生活质量。     

睡眠障碍对慢性功能性便秘患者症状评分的影响调查

目的调查睡眠障碍对慢性功能性便秘(CFC)患者症状评分影响。方法连续选择近期来我院就诊的CFC患者79例,入选对象分别接受了"匹兹堡睡眠质量指数问卷"和"便秘症状及疗效评估问卷"测评。结果 79例CFC患者就诊时发生睡眠障碍(PSQI总分≥13)者48例(60.76%),后者的排便困难、粪便性状、排便时间、下坠和不尽感、排便频度、腹胀等症状评分均明显低于睡眠正常组(P均<0.01~0.05)。结论睡眠障碍可加重CFC患者便秘症状病情。     

Measurement of L-carnitine and acylcarnitines in body fluids and tissues in children and in adults

We have developed a reliable and validated radio-enzymatic method for the assay of L-carnitine and acylcarnitines, using a modification of existing methods. The sensitivity of the assay is 10 mumol/l using 10 microliters of plasma or urine. It is also suitable for measurements of carnitine in a 10 mg sample of liver or muscle obtained by percutaneous biopsy. The use of N-ethylmaleimide in the reaction mixture together with an excess of [1-14C]acetyl CoA ensures that the reaction proceeds to completion and a linear response is obtained. Using this method control ranges have been established for plasma and urine carnitine concentrations in healthy children and adults, and for the carnitine content of liver and muscle in adults. No significant difference was found between fasting and post-prandial plasma carnitine levels. An age-related increase was found in urinary total carnitine and acylcarnitine concentration throughout childhood. These data provide a reliable basis for studies of patients with abnormal carnitine and acylcarnitine metabolism, distribution and excretion.     

Activity of amikacin and ampicillin in succession and in combination

One strain each of Escherichia coli and Streptococcus faecalis were exposed to amikacin and ampicillin in combination as well as in succession. Exposure to ampicillin for 1 hr followed by amikacin for 3 or 4 hr had the greatest antibacterial activity when the antibiotics were applied in succession. The least effective exposures for both organisms were 1 hr to amikacin followed by 3 or 4 hr to ampicillin. Exposure to the antibiotics in combination each at 1 MIC had the overall greatest antibacterial activity. Simultaneous exposure to the antibiotic combination does not necessarily mean simultaneous activity of both ampicillin and amikacin on the E. coli. The cell wall autolytic activities produced by ampicillin are triggered within 10 min after physical contact with the bacteria. In contrast, amikacin requires at least 30 min after physical contact to manifest its activity on the ribosome. Although physical exposure to both antibiotics in the combination is simultaneous, the specific activity of each is in fact sequential, with ampicillin acting first. This explains the synergistic effect of the combination. It appears, therefore, that the synergistic or antagonistic affect of a drug combination is determined by the sequence and timing of the antibacterial manifestations of its components.     

纤维支气管镜在儿童咯血诊断与治疗中的应用

目的 评价纤维支气管镜术在儿童咯血病因诊断及治疗中的价值以及安全性.方法 应用用日本产Olympus BF 3c-40纤维支气管镜(最小外径3.6 mm)给58名咯血原因不明的患者行纤维支气管镜检查,并予镜下局部止血治疗.判断出血部位、观察病变情况和出血的原因、临床表现、其他辅助检查、治疗及转归等进行综合分析.结果 引起咯血的主要疾病为气管支气管、肺部的炎症24例(41.3%)、支气管内膜结核12例(20.7%)、支气管异物8例(13.7%)、特发性肺含铁血黄素沉着症7例(12.1%)、支气管扩张4例(6.9%)、心肺血管发育异常1例,原因不明2例.诊断阳性率为96.5%.镜下发现有活动性出血18例,镜下局部止血治疗后显效者10例,有效者8例,有效率为100%.术中并发短暂低氧血症(SaO2＜85%,＜20 s)15例,加大吸氧流量后均改善;术后发热3例均为低热,24 h后热退.结论 纤维支气管镜检查可明确出血部位及原因并可进行局部治疗,且安全的有效.     

Sites of in vivo extraction and interconversion of testosterone and androstenedione in dogs

The interconversion and extraction of testosterone and androstenedione across and within different tissues or areas have been studied by the constant infusion technique. The results were calculated using the (3)H/(14)C ratios and radioactive concentrations of testosterone and androstenedione obtained from afferent and efferent blood and tissues at equilibrium. In each tissue studied, the interconversion between testosterone and androstenedione inside the tissue was significantly higher than the corresponding interconversion across the tissue. The pulmonary contribution to the total interconversion between testosterone and androstenedione was far more important than that of any of the other tissues studied. The hepatic metabolic clearance rates of testosterone and androstenedione were not different from their metabolic clearance rates in the mesenteric area. The extraction of each of these compounds, although not negligible, was lower in the kidney and the femoral bed compared with the extraction in the liver and the mesenteric area. Finally, with the possible exception of the liver, testosterone and androstenedione were more completely metabolized when they originated from the cells than from afferent blood.The evaluation of these different tissue transfer constants provides more precise information concerning the relative importance of different sites in the metabolism of these interconverting hormones.     

Role of oxidants and antioxidants in atherosclerosis: results of in vitro and in vivo investigations

Both in vitro and in vivo studies have shown that oxidants are central in the development of atherosclerosis. Consequently, additional studies evaluated the protective effects of various natural and synthetic antioxidants, alone and in combination, with most studies focusing on alpha-tocopherol (vitamin E). Here, we summarize the role of oxidants in the pathomechanism of atherosclerosis. We also discuss epidemiological studies and others focused on the protective effect of vitamin E against atherosclerosis. Other antioxidants are also considered if they were included in studies involving vitamin E. The protective effect of antioxidants on atherosclerotic pathomechanisms has been confirmed in vitro, but only in some animal studies. Various epidemiological and observational studies have produced conflicting results on the protective effect of antioxidants. Most studies of primary or secondary prevention failed to show a protective effect. These conflicting results are biased by a number of factors, including differences between the study groups. Therefore, we describe these studies in detail.     

Pharmacokinetics and tolerance of flunitrazepam in neonates and in infants.

OBJECTIVE: To study the pharmacokinetics of flunitrazepam (used for sedation in neonates and infants), to determine the influence of both gestational and postnatal age on the pharmacokinetic parameters, and to analyze the relationship between the hemodynamic parameters and flunitrazepam plasma concentration. METHODS: Flunitrazepam was infused for 20 minutes as a single dose (0.2 mg x kg(-1)) and as multiple doses (0.1 mg x kg(-1)). Six to eight 1-mL blood samples were collected per patient. Flunitrazepam plasma concentration was measured by gas chromatography-mass spectrometry. RESULTS: Thirty-one patients (25 neonates and six infants) were included in the study. Only three of them received multiple doses. After the single dose (n = 28), half-life was 22.6 +/- 7.3 hours, clearance was 0.15 +/- 0.14 L x kg x h(-1), and volume of distribution was 4.6 +/- 4.1 L x kg(-1) (mean +/- SD). Plasma clearance and volume of distribution significantly increased with postnatal age (P < .05), but no pharmacokinetic parameter varied significantly with gestational age. Diastolic blood pressure significantly decreased with increasing flunitrazepam plasma concentrations (P < .05). CONCLUSION: Postnatal age but not gestational age influenced flunitrazepam pharmacokinetic parameters in neonates and infants. Diastolic blood pressure was inversely correlated to flunitrazepam plasma concentration.