自我效能增强干预护理与配偶亲情支持对年轻乳腺癌女性患者自我感受负担及生活质量的影响

目的 探讨自我效能增强干预护理与配偶亲情支持对年轻乳腺癌女性患者自我感受负担及生活质量的影响.方法 选取100例已婚,年龄≤40岁,有一定文化水平的女性乳腺癌患者为研究对象.对照组常规护理,不包括对配偶的健康宣教,可自行陪护.观察组在对照组的基础上,发放自制SPB原因调查表,针对引起负担感受的集中因素,与患者共同制定健康促进计划,增加自我效能干预,并对配偶健康教育,要求其全程亲情支持,共同实施护理干预,干预过程均贯穿住院全程.SPBS量表评价入院时及出院后1个月SPB程度,同时出院6个月采用FACT-B4.0量表测定生命质量.结果 观察组出院后1个月SPB总分、身体因素评分、社会因素评分、情感因素评分分别为(18.22±1.10)、(8.55±1.02)、(6.48±0.85)、(5.42±1.00),均显著低于对照组的(36.26±2.20)、(12.88±2.86)、(10.78±2.48)、(12.26±2.20)分,且出院后6个月,生理情况、家庭功能、社会功能、情感功能、乳腺附加关注维度评分为(24.55±3.02)、(20.88±0.85)、(20.56±2.85)、(24.42±1.80)、(24.42±2.78),显著优于对照组的(20.25±2.35)、(10.78±2.48)、(14.78±2.22)、(14.86±2.40)、(18.26±2.30),总体生活质量较高,组间差异有统计学意义(均P＜ 0.05).结论 在常规护理的基础上,增加自我效能干预与配偶的全程亲情支持护理,可充分发挥有力的社会-家属-患者合力效应,对青年乳腺癌女性患者的自我疾病起到正性恢复作用,消除自我负罪感,改善负性情绪,提高疾病应对能力,改善预后的生命质量.     

女性乳腺癌患者自我感受负担与生活质量的相关性研究

目的 调查女性乳腺癌患者自我感受负担和生活质量状况,并探讨两者之间相关性。 方法 采用便利抽样法选取2014年1月至2016年12月在南京市第一医院肿瘤内科住院的120例女性乳腺癌患者作为研究对象,采用一般资料调查表、自我负担量表及乳腺癌患者生活质量量表进行问卷调查。 结果 乳腺癌患者的自我感受负担总分为(31.36±10.21)分,生活质量总分为(64.68±11.47)分,患者自我感受负担总分及各维度得分与生活质量总分及各模块得分均呈负相关,均差异有统计学意义(均P<0.05)。 结论 女性乳腺癌患者普遍存在着自我感受负担,生活质量水平较低。降低患者自我感受负担有助于提高患者生活质量。     

照顾负荷水平对脑卒中病人主要照顾者创伤后成长水平的影响

目的探讨脑卒中病人主要照顾者照顾负荷水平对创伤后成长水平的影响。方法采用便利抽样法,抽取 2014年 12月至 2016年 12月首都医科大学附属北京友谊医院收治脑卒中病人的主要照顾者 170名作为研究对象,收集其一般资料,采用 Zarit负荷量表( ZBI)和创伤后成长评定量表( PTGI)评价照顾负荷和创伤后成长水平。以 Pearson相关性分析主要照顾者创伤后成长与负荷水平的相关性。并多元线性回归分析脑卒中病人主要照顾者创伤后成长的影响因素。结果 ZBI总分为(43.87±6.12)分,个人负担和责任负担两个维度得分为( 27.76±4.30)分和( 16.38±4.26)分, PTGI总分为( 61.08±9.66)分, 5个维度条目平均分最高的为新的可能性( 3.40±0.73)分; Pearson相关分析显示,主要照顾者照顾负荷总分及 2个维度评分与创伤后成长水平总分及新的可能性、个人力量及欣赏人生 3个维度评分呈正相关( P＜0.05);不同性别、年龄、文化程度、家庭人均月收入、与病人关系、医保报销比例及照顾时长的主要照顾者创伤后成长水平比较,差异有统计学意义( P＜0.05);多元线性回归分析显示,年龄、文化程度、照顾时长,及照顾负担、个人负担是脑卒中病人主要照顾者创伤后成长水平的影响因素( P＜0.05)。结论脑卒中病人主要照顾者创伤后成长水平与照顾负荷存在明显的相关性,同时创伤后成长水平会受负荷水平、年龄、文化程度和照顾时长所影响。     

H型高血压病人心率变异性与临床特征分析

目的 探讨H型高血压病人心率变异性与临床特征。方法 前瞻性收集四川省达州市中心医院2016年1月至2017年3月收治的高血压病人147例,根据病人入院时同型半胱氨酸水平,将病人分为观察组63例(H型高血压,同型半胱氨酸≥10 mmol/L)和对照组84例(同型半胱氨酸<10 mmol/L)。观察两组病人24 h心率变异性,同时分析心率变异性与病人靶器官功能损伤的相关性。结果 与对照组比较,观察组病人24 h全部窦性R-R间期标准差(SDNN)显著降低[(89.75±18.28)比(104.38±22.71) ms,P=0.000];每5分钟窦性R-R间期均值的标准差(SDANN)显著降低[(92.47±13.47)比(101.72±15.28) ms,P=0.000];24 h连续5 min窦性R-R间期标准差的均值(SDNN-Index)显著降低[(33.29±8.73)比(40.67±10.38) ms,P=0.000];所有临近窦性R-R间期差值的均方根(rMSSD)显著降低[(27.48±9.12)比(31.84±10.55) ms,P=0.010];所有相邻两个窦性R-R间期差值大于50 ms的心搏数占全部心搏数的百分比(PNN50)显著降低[(9.21±5.38)比(15.38±8.91)%,P=0.000];颈动脉内膜中膜厚度显著增加[(0.97±0.12)比(0.89±0.14)mm,P=0.000];左室质量指数显著增加[(132.48±21.48)比(122.48±22.72) g/m²,P=0.008]。SDNN、SDNN-Index和PNN50与颈动脉内膜中膜厚度显著负相关(P<0.05),SDNN、SDANN、SDNN-Index、rMSSD和PNN50与左室质量指数显著负相关(P<0.05)。结论 H型高血压病人心率变异性显著降低,与靶器官功能损害有关。     

叙事医学对乳腺癌根治手术病人病耻感的影响

目的 探寻叙事医学对乳腺癌根治术后病人病耻感的作用及影响,以期为改善病人生活质量提供理论依据和临床循证途径。 方法 采用分级抽样法从2016年1月至2017年12月在西安交通大学第一、二附属医院及陕西省肿瘤医院乳腺病科选取住院期间行乳腺癌根治手术病人489例,2017年1—12月收治的乳腺癌根治手术病人244例设为观察组,行叙事医学式护理干预;2016年1—12月收治的乳腺癌根治手术病人245例设为对照组,给予常规式护理干预,两组均采用社会影响量表(SIS)于出院后第1、3、6、12个月进行病耻感评定。 结果 两组出院时和出院后1个月的SIS得分均差异无统计学意义(P＞0.05);但是,在出院第3、6、12个月时,对照组SIS得分[(62.5±10.4)、(58.2±11.2)、(55.2±11.3)分]高于观察组[(67.9±11.2)、(67.3±11.1)、(67.1±11.4)分],差异有统计学意义(P＜0.05)。 结论 叙事医学通过科学的方法诱导乳腺癌根治术病人宣泄不良情绪,从而改善了病人的身心状况,提高了病人的生活质量。     

自我感受负担在社区康复期精神分裂症患者社会支持与生活质量间的中介作用

目的:探讨自我感受负担(SPB)在社区康复期精神分裂症患者社会支持与生活质量间的中介作用。方法:采用随机结合便利抽样的方法,调查2020年7—12月成都市6个社区卫生服务中心的240例康复期精神分裂症患者,调查工具为一般资料调查表、SPB量表、社会支持评定量表及精神分裂症患者生活质量量表中文版。结果:社区康复期精神分裂症患者SPB得分为(32.19±9.48)分、社会支持得分为(33.88±7.26)分、生活质量得分为(37.98±19.92)分;SPB与社会支持得分呈负相关(r=-0.412,P<0.01),与生活质量得分呈正相关(r=0.613,P<0.01);社会支持与生活质量得分呈负相关(r=-0.375,P<0.01);SPB在社会支持与生活质量间起中介作用,中介效应占总效应的54.98%。结论:社会支持可直接影响或通过SPB间接影响社区康复期精神分裂症患者的生活质量。可给予患者更多的社会支持以减轻SPB,进而改善其生活质量。     

乳腺癌术后放疗病人生活质量的影响因素分析

目的 研究乳腺癌病人术后放疗期间生活质量及影响因素.方法 运用乳腺癌病人生活质量测定量表 FACT-B(V4.0)中文版,对47例乳腺癌术后放疗病人行调查研究,统计量表得分,运用多元线性回归方法分析影响病人生活质量的因素.结果 手术方式、家庭年收入、医保类型、病理类型与乳腺癌术后放疗期间生活质量有相关性,而病人年龄、TNM分期、化疗方案、化疗周期、ECOG评分等因素与放疗期间生活质量无相关性.结论 手术方式、家庭年收入、医保类型及病理类型与乳腺癌病人术后放疗期间生活质量有关.     

奥氮平联合艾司西酞普兰治疗难治性强迫症的疗效分析

目的 探讨奥氮平联合艾司西酞普兰治疗难治性强迫症的疗效。 方法 前瞻性收集内蒙古自治区精神卫生中心收治的难治性强迫症患者88例,将患者采用随机数字表法分为观察组和对照组,观察组给予奥氮平联合艾司西酞普兰治疗,对照组给予艾司西酞普兰,共治疗8周,比较两组患者临床疗效。 结果 两组患者入院时和治疗后2周时Yale-Brown强迫症量表评分、汉米尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)均差异无统计学意义 (P>0.05)。与对照组比较,治疗后8周时观察组Yale-Brown评分显著降低[(22.64±6.53)分 比(27.57±7.54)分,P=0.001];HAMA评分显著降低[(14.34±4.59) 分 比 (16.70±5.55)分,P=0.032];HAMD评分显著降低[(12.75±3.28)分 比 (17.93±4.07)分,P=0.000]。两组患者入院时Marks强迫恐怖量表(MSCPOR)评分差异无统计学意义[(71.43±9.11)分 比 (70.86±9.00)分,P=0.769]。治疗后第2周和第8周时观察组患者MSCPOR均显著低于对照组[(61.91±9.11)分 比 (67.52±8.84)分,P=0.004]和[(55.43±6.20)分 比 (59.50±6.61)分,P=0.004]。 结论 奥氮平联合艾司西酞普兰可显著改善难治性强迫症患者临床症状。     

集中式护理干预对脑梗死病人独立生活能力和白介素-6 及肿瘤坏死因子-α水平的影响

目的 探讨集中式护理干预对脑梗死病人独立生活能力、白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)水平的影响。方法 选取郑州大学附属洛阳中心医院2016年3月至2017年3月间收治的122例脑梗死病人作为研究对象。按照随机数字表法将病人分为对照组和观察组,各61例。两组病人均给予抗血小板、改善脑循环、营养神经及相关合并症等常规治疗,对照组病人给予常规护理干预,观察组病人给予集中式护理干预。观察两组病人护理干预3个月后病人独立生活能力、血浆白介素-6及肿瘤坏死因子-α水平情况。结果 观察组病人护理干预后简式Fugl-Meye肢体评分(63.57±12.53)分、改良Barthel指数(MBI)(83.07±9.21)分明显高于对照组Fugl-Meye(57.33±11.44)分、MBI(72.11±8.27)分(t/P=2.872/0.005,6.915/0.000)。观察组病人护理干预后血清IL-6[(28.53±5.37) pg/mL]、TNF-α[(1.53±0.67) pg/mL]均明显低于对照组IL-6[(37.34±4.84) pg/mL]、TNF-α[(2.47±0.71) pg/mL](t=9.518,7.520,均P=0.000)。观察组病人总有效率91.80%明显高于对照组77.05%(χ²=5.050,P=0.024)。结论 集中式的护理干预对于提高脑梗死病人的运动功能、独立生活能力、降低病人血浆IL-6及TNF-α水平有一定的促进作用,对促进脑梗死病人的康复具有一定的应用价值。     

不同证型功能性消化不良与焦虑抑郁状态的相关性

目的 探讨不同证型功能性消化不良(FD)与焦虑、抑郁状态的相关性。方法 采用随机数字表法,选取2015年1[KG-*3]～12月就诊于武汉市中西医结合医院消化内科,经罗马Ⅲ标准确诊的FD病人60例(FD组),招募同期健康志愿者22例(HS组)。将FD组中医辨证分型,脾虚气滞型28例,脾虚湿阻型17例,脾阳虚型15例,并对受试者进行症状量表评分及医院焦虑抑郁量表(HAD量表)积分评定。结果 (1)FD组焦虑、抑郁状态评分[(9.31±2.23)分、(10.17±2.30)分)]均高于HS组[(8.22±2.07)分、(8.63±1.81)分],差异有统计学意义(P=0.049,0.015)。(2)辨证为脾虚气滞型FD病人焦虑状态评分(10.59±2.01)分高于脾虚湿阻型(9.40±1.72)分(P=0.048)及脾阳虚型(9.27±1.23)分(P=0.033);抑郁状态评分(10.75±2.65)分高于脾虚湿阻型(9.24±1.75)分(P=0.014)。(3)辨证为脾虚气滞型及脾阳虚型FD病人症状积分与焦虑、抑郁状态呈显著性正相关(r_s= 0.61、0.53、0.63、0.57,P＜0.05)。结论 功能性消化不良病人大多伴有焦虑、抑郁状态,脾失健运是其致病关键,临证中辨证基础上应注重健脾理气、养心安神之法的应用。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.