浙江省永嘉县桥下镇社区居民精神疾病流行病学调查分析

目的 了解浙江省永嘉县桥下镇社区居民精神疾病流行情况。 方法 采用线索调查和挨家挨户相结合的方法,以ICD-10 ,CCMD-3 为诊断标准,采用全国精神病防治康复工作统一表卡,先进行挨家挨户摸底线索调查,然后由温州市康宁医院的精神病专科医师对线索精神患者排查,确诊精神病患者及类型。 结果 永嘉县桥下镇社区居民精神疾病的患者共270例,总患病率为7.24‰。 结论 永嘉县桥下镇社区居民精神疾病患病率较高,精神分裂症、精神发育迟滞居前2位,需加强精神疾病的防治。     

社区精神病防治工作效果分析

目的了解中山市社区精神疾病防治的成效。方法对中山市社区精神病防治后的5个镇区进行精神疾病流行病学调查,统计重性精神疾病患者的患病率、就诊率、监护率、病情稳定率及住院率,并与防治前的调查结果进行对比分析。结果实施社区精神疾病防治前患病率为1．05％、就诊率为45．20％、监护率为62．70％、病情稳定率为57．19％、住院率为0．78％,防治后分别为0．91％、75．41％、95．67％、86．13％、0．85％,防治后社区精神病患者就诊率、监护率、病情稳定率均较防治前明显提高。结论社区精神疾病防治能显著提高重性精神疾病患者的就诊率、监护率及病情稳定率,有利于改善患者病情,使患者在社区内稳定地生活。     

南阳市精神卫生服务的现状与对策

目的 了解南阳市精神疾病流行病学及防治康复情况，并提出应对措施和建议。方法 采用抽样调查并结合有关文献资料进行预测评价。结果 城乡重精神病患者达11万之多，其中精神分裂症患者36000～54000人。中、重度精神发育迟滞患者20000～39000人，情感性精神病患者8000人，其它重度精神疾病患者3000余人，还有200余人流浪于社会，100余人被关锁等待救助。结论 精神疾病的防治康复现状不容乐观，政府应尽快建立和完善精神疾病防治网络，进一步开拓精神卫生服务范围，真正实现医学模式的转变，加大人才培养和经费投入力度。     

南通市精神病流行学抽样调查研究

目的了解及掌握我市精神疾病的患病水平，发病趋向，分布特征，流行规律，残疾程度。精神卫生防治工作现状，为我市制订精神疾病防治康复对策提供依据。方法采用统一的分层整群随机抽样方法，统一调查工具，对我市2个行政区，10个行政乡进行精神疾病专项流行学抽样调查。结果共调查40个样本，20000户，70132例（其中15及15岁以上人口62385例），共发现各类精神疾病患者1186例（不包括神经衰弱患者），时点患病率为16．91‰，各类精神疾病的时点患病率分别为精神分裂症3．74‰，情感障碍0．86‰，躯体疾病继发精神障碍0．44‰，脑器质性精神障碍1．04‰，人格障碍0．08‰，神经症4．12‰，偏执性精神病0．23‰，精神发育迟滞0．86‰，物质依赖0．98‰，其它4．69‰，在所抽查出的1186例患者中仅有294例（24．78％）能得到较为系统的维持治疗。社区精神防治功能非常脆弱不健全，精神疾病的致残率为78．13％（不包括神经症）。结论精神疾病依然是严重危害人们身心健康的常见病。由于认识不足及精神卫生障碍不够。因此患病后及时系统治疗率低，致残率高，应引起社会广泛高度重视。     

对精神病患者家属健康教育需求的调查研究

探讨精神病家属健康教育的需求情况。方法用自行设计的问卷对116名患者家属的精神疾病知识知晓情况及健康教育需求方式内容进行调查。结果97％的患者家属知道疾病的诊断，但如何防止精神疾病复发了解者仅3．4％，出院后如何进行家庭护理了解者6．9％，81％的患者家属希望医务人员传授健康知识，需求侧重于常用的抗精神病药物的种类、作用及副作用，精神疾病的临床症状，精神疾病预防及康复知识，日常生活护理指导等。结论精神疾病患者家属对精神卫生知识缺乏，非常需要健康教育。     

放疗固定装置对表浅剂量的影响

随着生物医学模式向生物-心理-社会医学模式的转变，精神疾病发病率有显著上升的趋势。精神疾病常表现为思维、意志、情感和行为障碍，严重影响患者的生活、工作和学习。提高精神病患者康复水平和生活质量是精神疾病康复的重点。抗精神病药物能明显提高精神病患者的临床缓解率，但并不能改变疾病进程，     

老年人首发精神疾病60例临床分析

本文分析了60例60岁以上首次发生精神疾病的临床特点,其中功能性精神病44例(73.3％),器质性精神病12例(20％),躯体疾病致精神障碍4例(6.3％),起病以急性和亚急性多见(80.1％)。在老年期精神疾病中,精神药物应用宜谨慎,同时要兼顾躯体疾病,一般老年期精神疾病愈后尚可,做好老年人的保健工作是减少老年精神疾病的重要环节。     

精神疾病社区防治与康复

山东鲁南化学工业（集团）公司是5000余名职工的大型化工企业。近几年来累计发生重症精神病患者37例，男23例，女14例。首次发病年龄最大58岁，最小17岁。37例中调出2例，死亡3例，退休3例，现住院治疗2例。按照省市精神卫生中心全面落实《全国精神病防治康复“九五”实施方案响要求，开展了社会化、开放式、综合性的精神病防治与康复工作体系，使重症精神病患者恢复社会功能并工作25例，（25／32）占78．l％。我们的体会①加强管理，建立建全组织网络，开展社会化工作体系是精神疾病社区防治与康复工作的根本保障。公司成立了由工会、劳资…     

流浪精神病人解救对策探讨

目前．随着市场经济的发展、现代生活的激烈竞争．据有关专家预测精神疾病的患病率将有上升的趋势。反过来．我国由于国力有限．精神疾病防治与康复工作还相对较迟后，致使部分精神病人的救治还不尽人意。甚至少数病人流落街头，受人凌辱．人身安全受到戚协。有的在公共场合行。     

关注精神疾病

10月10日是“世界精神卫生日”，据一项调查表明．我国精神病患者已达到1500万左右。精神病是一种常见病、多发病，并不是不治之症，只要积极求治便可治愈。目前中国精神疾病的患病率从70年代的0.32％上升至1．556％。精神疾病将是用世纪的流行病。专家惊叹：“精神疾病时代”悄然来临，人类已由躯体疾病时代进入精神疾病时代。有鉴于此，精神疾病在当今乃至以后的时期理应引起人们更多的关注。关注精神疾病     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.