弓形虫感染精神分裂症患者心理行为障碍比较研究

目的探讨弓形虫感染精神分裂症患者心理行为特征,了解弓形虫感染对精神分裂症症状的影响。方法采用症状白评量表（SCL一90）和住院患者观察量表（NOSIE）对100例弓形虫感染精神分裂症患者和100例未感染弓形虫精神分裂症患者的心理行为障碍进行比较,所有数据均用SPSSl6．0统计学软件进行处理。结果I）感染弓形虫精神分裂症患者在躯体化、抑郁、人际关系、敌对、恐怖等因子评分分别为1．68±0．44、1．61±0．43、1．64±0．45、1．80±0．72和i．57±0．36,未感染弓形虫精神分裂症患者分别为1．47_4-0．41、i．80±0．59、I．85±0．51、I．48±0．56和1．4I±0．4I差异均有统计学意义（P均〈0．01）;2）感染和未感染弓形虫精神分裂症患者在社会兴趣、激惹和退缩等因子评分分别为16．05±3．63、5．69±2．57和7．60±2．98,未感染弓形虫精神分裂症患者分别为18．69±4．12、4．06±2．08和9．28±3．51,差异均有统计学意义（P均〈O．01）。结论弓形虫感染精神分裂症患者的心理、行为障碍程度与未感染弓形虫精神分裂症患者比较存在差异,表明弓形虫感染可能影响精神分裂症患者的心理和行为症状。     

Preliminary Investigation of Swallowing Apnea Duration and Swallow/Respiratory Phase Relationships in Individuals with Cerebral Vascular Accident

Swallowing apnea duration (SAD) and swallow-respiratory phase relationships were examined in individuals with cerebral vascular accident (CVA) and dysphagia who aspirated (n = 11) and did not aspirate (n = 15). Simultaneous videofluoroscopic and respiratory measures were recorded across 5-, 10-, 15-, and 20-ml thin and thick liquid bolus trials. These data were also compared with that previously acquired with healthy older adults (n = 20). A moderate amount of systematic missing data was evidenced in the individuals who were dysphagic and especially those who aspirated subsequently limiting inferential analyses. Only 1 of the 11 participants who aspirated and 7 of the 15 who did not aspirate completed all 16 conditions. Six of the remaining ten who aspirated had missing data subsequent to termination of trials due to aspiration risk. The remaining four and seven of the eight who did not aspirate had missing data due to poor respiratory waveforms. From the remaining data, it was found that SAD and respiratory phase relationships differed among individuals with dysphagia and CVA (i.e., those who aspirate vs. those who do not aspirate) and healthy older adults. SAD was found to be longer for those who aspirated versus those who did not for all bolus viscosities and volumes with the exception of thick-liquid 10-ml boluses. In addition, SAD from those that aspirated was twice as long as that found in healthy older adults for all conditions. Regarding respiratory phase relationships, there was a difference between the proportions of respiratory patterns in those who aspirated versus those who did not. Those who aspirated demonstrated a markedly greater percentage of swallows that interrupted inhalation. In addition, the inhale-swallow-inhale pattern occurred with a greater frequency as swallowing severity increased. Healthy older adults, those who did not aspirate, and those who aspirated used the inhale-swallow-inhale pattern 0.1%, 3.0%, and 9.0%, respectively.     

Efficacy and safety of sildenafil citrate in men with erectile dysfunction and chronic heart failure

Chronic heart failure (CHF) is an increasingly common cardiovascular disorder. Many patients who have CHF report moderate to marked decreases in the frequency of sexual activity, and up to 75% of patients report erectile dysfunction (ED). There are few controlled clinical data on the efficacy and safety of sildenafil citrate in men who have ED and CHF; thus, we evaluated these parameters in patients who had stable CHF. This was a double-blind, placebo-controlled, flexible-dose study. Men who had ED and stable CHF were randomized to receive sildenafil or placebo for 12 weeks. Primary outcomes were questions 3 and 4 of the International Index of Erectile Function. Secondary outcomes included the 5 functional domains of the International Index of Erectile Function, 2 global efficacy assessment questions, intercourse success rate, the Erectile Dysfunction Inventory of Treatment Satisfaction, and the Life Satisfaction Checklist. By week 12, patients who received sildenafil (n = 60) showed significant improvements on questions 3 and 4 compared with patients who received placebo (n = 72; p <0.002). Larger percentages of patients who received sildenafil reported improved erections (74%) and improved intercourse (68%) compared with patients who received placebo (18% and 16%, respectively). Intercourse success rates were 53% among patients who received sildenafil and 20% among those who received placebo. Patients who received sildenafil were highly satisfied with treatment and their sexual life compared with patients who received placebo. Sixty percent of patients who received sildenafil and 48% of patients who received placebo developed adverse events, including transient headache, facial flushing, respiratory tract infection, and asthenia. The incidence of events related to cardiovascular effects was low. Sildenafil is an effective and well-tolerated management of ED in men who have mild to moderate CHF.     

Levels of matrix metalloproteinase-1 in patients with and without coronary artery disease and relation to complex and noncomplex coronary plaques

We investigated the association between serum levels of matrix metalloproteinase-1 (MMP-1) and coronary artery disease (CAD) in 185 patients who underwent elective coronary angiography. MMP-1 levels did not differ between patients who had CAD and those who did not and did not correlate with the number of >50% stenotic vessels or segments, but MMP-1 levels were significantly higher in patients who had CAD and complex coronary lesions than in those who did not have such lesions and those who did not have CAD. High serum levels of MMP-1 were associated with the presence of complex lesions in patients who had CAD.     

Condom use and 'withdrawal': exploring gay men's practice of anal intercourse

Some gay men who have unprotected anal intercourse avoid ejaculation-they practise 'withdrawal'. Using data collected in 1997 from a sample of Sydney gay men (n=625), we explored the relation between men's practice of ejaculation and their use of condoms. We also investigated whether men who had unprotected withdrawal but not unprotected ejaculation were more likely to think unprotected withdrawal was safe, liked condoms less, liked anal intercourse more, or were more sexually adventurous. Considering separately insertive and receptive anal intercourse with regular and with casual partners, we found that the majority of men who practised unprotected withdrawal also practised unprotected ejaculation. Of those whose only unprotected sex was withdrawal ('true withdrawers'), most never used condoms (they did not also have protected sex with ejaculation). True withdrawers were compared with men who had unprotected ejaculation, who always used condoms, who had no anal sex and who had no partners. Those who were true withdrawers with casual partners were more likely to believe withdrawal was safe; no group effects were found with regular partners. No significant differences in condom attitudes were found. True withdrawers with regular partners liked anal intercourse less than other men, but true withdrawers with casual partners were indistinguishable from those who had unprotected ejaculation. True withdrawers did not differ in sexual adventurousness from other men who had anal intercourse. Most withdrawers avoided anal sex with ejaculation rather than use condoms. Converting them into reliable condom users may be a considerable challenge for health promotion.     

Comparison of mental stress-induced myocardial ischemia in coronary artery disease patients with versus without left ventricular dysfunction

To examine the susceptibility to myocardial ischemia with mental stress in patients who have coronary artery disease and normal left ventricular (LV) function versus those who have impaired LV function, we examined 58 patients who had coronary artery disease, including 22 who had normal LV function (ejection fraction >/=50%), 16 who had mild to moderate LV dysfunction (ejection fraction 30% to 50%), and 20 who had severe LV dysfunction (ejection fraction 3. At comparable double products across the 3 groups, ischemia was induced with mental stress more frequently in patients who had severe LV dysfunction (50%) than in those who had normal LV function (9%; p <0.01). The frequency of exercise-induced ischemia was different only between those who had mild/moderate LV dysfunction and those who had normal LV function (56% vs 18%, respectively, p <0.05). The pattern of mental stress versus exercise ischemia differed between groups (p <0.02): there was a higher prevalence of mental stress ischemia versus exercise ischemia in patients who had severe LV dysfunction (p = 0.06), a marginally higher prevalence of exercise versus mental stress ischemia in those who had moderate LV dysfunction (p = 0.07), and no difference in mental stress versus exercise ischemia in those who had normal LV function. Thus, at comparable double products during mental stress and similar extent of coronary artery disease, ischemia with mental stress was induced more frequently in patients who had severe LV dysfunction than in those who had normal LV function. These data suggest that mental stress ischemia may be of particular clinical importance in patients who have coronary artery disease and LV dysfunction.     

Modulators of “Activated Motivation”: Event-Specific Condom Use by Drug Injectors Who Have Used Condoms to Prevent HIV/AIDS

Since sexual transmission of HIV among and from drug injectors is a frequent source of infection, condom use by them is important for prevention. This paper focuses on predictors of condom use at last sex by drug injectors with activated motivation, that is, by those who already are trying to use condoms to reduce HIV risk. Principal subjects are 1,240 drug injectors who report activated motivation to use condoms to prevent HIV and who had had sex within 6 months before the interview. Many used condoms at last sexual event with primary partners (65%) and with casual partners (80%). Condom use with primary partners increased over time, and was higher among those who knew they were HIV-positive or who talked about AIDS with sexual partners, but was lower among those who knew they were HIV-negative, who were Black, Hispanic, women, younger, or high school graduates, or who used crack with their partners at the sexual event. Condom use with casual partners was lower among women, older drug injectors, and those who were high on alcohol along with their partners, and tended to be more likely among those who know they are infected. Condom use with both primary and casual partners was greater with partners who did not themselves inject drugs. Programs should urge drug injectors who are trying to use condoms to avoid HIV transmission that having sex while using psychoactive substances may be a barrier to their doing so even if they want to use condoms and have done so in the past. Finally, research should be conducted to determine if persons with activated motivation should receive HIV prevention assistance that is different from that offered those who lack risk-reduction motivation or those who want to reduce their risk behaviors, but have been unable to implement the desired changes.Correspondence should be addressed to Samuel R. Friedman, National Development and Research Institutes, Inc., Two World Trade Center, 16th floor, New York, New York 10048     

Significance of occult gastrointestinal bleeding during anticoagulation therapy

A prospective study was undertaken to determine the effect of anticoagulation therapy on the prevalence of occult gastrointestinal bleeding and to ascertain the causes of bleeding. During a six-month period, 256 patients who had received anticoagulants were screened for occult bleeding with guaiac-impregnated cards. Twenty-one (12 percent) of the 175 patients who had received anticoagulants and who voluntarily completed the cards had occult gastrointestinal bleeding compared with only two (3 percent) of 74 control patients who had not received anticoagulants. The mean prothrombin time and partial thromboplastin time did not differ significantly in the patients who had received anticoagulants with and without subsequent bleeding. Fifteen of 16 patients who had received anticoagulants and who underwent diagnostic evaluation had previously undiagnosed lesions in the intestinal tract. These results indicate that occult gastrointestinal bleeding in a patient who has received an anticoagulant should not be attributed to the anticoagulant; instead, such bleeding often indicates the presence of significant intestinal disease.     

Maintaining antiretroviral therapy reduces the risk of AIDS-defining events in patients with uncontrolled viral replication and profound immunodeficiency.

BACKGROUND: The benefits of continuing antiretroviral therapy are questionable in human immunodeficiency virus (HIV) type 1-infected patients with profound immunodeficiency and multiple treatment failure due to viral resistance. METHODS: From the French Hospital Database on HIV, we selected 12,765 patients with a CD4(+) cell count <200 cells/mm(3) who received a combination antiretroviral therapy (cART) during 2000-2005. Three groups of patients were defined: patients who interrupted cART at least once, patients who had at least 2 consecutive detectable viral loads (VLs) while receiving cART, and patients who had undetectable VL during treatment with cART. Incidence rates and risks of new acquired immunodeficiency syndrome-defining events (ADEs) were assessed among the 3 groups of patients, overall and after CD4(+) cell count stratification (<50 and 50-200 cells/mm(3)). RESULTS: The estimated incidence rates +/- standard deviation of ADEs were 18.5+/-1.9, 14.5+/-0.7, and 4.9+/-0.5, respectively, for patients who interrupted cART, patients who had detectable VL during treatment with cART, and patients who had undetectable VL during treatment with cART. These differences were observed in both CD4(+) cell count strata. Overall, after adjustment, risks of a new ADE in patients who had detectable VL and in patients who had undetectable VL while receiving cART were 22% and 62% lower, respectively, than in patients who stopped cART. Among patients with CD4(+) cell count <50 cells/mm(3), the risk of a new ADE was 22% lower in patients who continued to receive a failing cART regimen than in patients who stopped treatment with cART. Likewise, among patients with a CD4(+) cell count of 50-200 cells/mm(3), the risk was 34% lower in patients who continued to receive a failing cART regimen than in those who stopped taking cART. CONCLUSIONS: Even when effective virological control is no longer achievable, cART still reduces the risk of ADEs in profoundly immunodeficient HIV-infected patients.     

Impact on mortality and incidence of end-stage renal disease of education and treatment at a diabetes center among patients with type 1 diabetes: comparison of two subgroups in the Japanese DERI cohort

The aim of this study was to compare mortality and incidence of end-stage renal disease (ESRD) in patients with type 1 (insulin-dependent) diabetes who had attended a diabetes center with those who had not. The cohort consisted of a total of 1430 patients diagnosed with Type 1 diabetes at 18 years or younger, and between 1965 and 1979. This population-based cohort in Japan was subdivided into two groups: patients who had visited a large diabetes center in Tokyo (n=162) and those who had not (n=1212). Mortality and incidence of ESRD were compared between the two subgroups as of January 1, 1990. Crude mortality was 1.95 per 1000 person-years (95% CI: 0.49-5.06) for those who had visited the center and 6.05 (4.86-7.41) for those who had not. A multivariate Cox proportional hazard model showed that the patients who had visited the center were three times less likely to die (hazard ratio: 0.31, 95% CI: 0.10-0.98) than those who had not. Crude incidence of ESRD was 1.32 (0.22-4.09) and 5.86 (4.65-7.26) for those who had visited the center and for those who had not, respectively. After adjusting for covariates, the patients who had visited the center were five times less likely to develop ESRD (hazard ratio: 0.19, 0.05-0.78) than those who had not. Education and treatment of type 1 diabetes with an integrated management system under specialists and a multidisciplinary team appears to be associated with a better prognosis.     

Systemic treatment of patients who have colorectal cancer and inflammatory bowel disease

Colorectal cancer is the most common malignant complication in patients who have IBD. The disease is difficult to diagnose because there is an overlap in symptoms in patients who have colon cancer and those who have IBD. Much has been learned about the incidence of colorectal cancer in patients who have IBD and its correlation with disease activity, duration, and anatomic location; however, almost no data are available regarding specific therapeutic considerations during adjuvant or palliative chemotherapy for these patients with respect to their underlying disease. Patients who have IBD who develop colorectal cancer are at higher risk for developing severe diarrhea during chemotherapy that may be due to the toxic effects of cytotoxic drugs or a flare of the IBD. Continuous infusional 5-FU alone, in combination with leucovorin, or in combination with oxaliplatin (FOLFOX) seems to be tolerated best. Bolus infusions of 5-FU (Roswell Park or Mayo regimens) and combination therapy of irinotecan with 5-FU should be avoided because of severe diarrhea and the possibility of sepsis. When diarrhea develops or worsens, empiric aminosalicylates may be given. Although it is theoretically possible that anti-EGFR therapies could affect IBD activity adversely, clinical experience with cetuximab in patients who have colorectal cancer has not shown any significant gastrointestinal side effects. Therefore, it seems reasonable to use it in patients who have colorectal cancer and IBD. The administration of bevacizumab has been associated with rare episodes of intestinal perforation; it should be used with great care in patients who have IBD. More studies and an integrative, multidisciplinary approach from oncologists and gastroenterologists are needed to provide optimal care for patients who have IBD during chemotherapy for colorectal cancer     

Cardiac events after non-cardiac surgery in patients with previous coronary intervention in the drug-eluting stent era

The peri-operative risk for patients with coronary drug-eluting stents (DES) who subsequently have non-cardiac surgery (NCS) is unclear. We performed this retrospective study of all patients in our institution who had coronary intervention and subsequent NCS from 2003 through December 2008 to evaluate the incidence of major adverse cardiac events (MACE) in patients who received DES compared to those who received bare-metal stents (BMS) or had percutaneous transluminal coronary angioplasty (PTCA) during the same time period. The main outcome measures were 30-day post-operative myocardial infarction, stent thrombosis, target vessel revascularization (TVR) and cardiac death. During the 6-year study period, 1,770 coronary interventions were performed and 238 patients subsequently had NCS in 8 days to 49 months. Eighteen patients had PTCA, 79 BMS and 141 DES. Acute myocardial infarction occurred in 1 patient who had PTCA, 2 who had BMS and 14 who had DES (p = 0.10). Stent thrombosis occurred in 6 patients who had DES and none who had BMS (p = 0.09). Seven patients who had DES had TVR compared to 1 patient who had BMS and none who had PTCA (p = 0.41). Cardiac mortality occurred in 2 patients who had DES and none who had PTCA or BMS (p = 0.35). In conclusion, the 30-day MACE in patients who received coronary DES and undergone NCS were not significantly different compared to those who received BMS or had PTCA only, with a trend toward higher stent thrombosis in the DES group.     

Management of treatment failures in thrombotic thrombocytopenic purpura

The prognosis and optimal management of patients with thrombotic thrombocytopenic purpura (TTP) who fail initial therapy with plasmapheresis or splenectomy are unclear. We report our experience with eight patients with TTP who did not respond to initial therapy. Seven patients achieved complete remission when alternate therapy was started soon after the recognition of initial treatment failure. One patient who received no alternative therapy died of progressive TTP. Our cases combined with those in the literature indicate a 74% salvage rate for patients who fail initial treatment for TTP. The combination of splenectomy, dextran, and steroids appears to be an effective treatment for patients with TTP who fail to respond adequately to plasmapheresis.     

Who are the "occasional" snorers?

STUDY OBJECTIVES: To assess the prevalence of occasional snoring in a group of middle-aged men, and to compare anthropometric variables and prevalence of sleep-related symptoms of subjects who occasionally snore with those of other snoring categories. DESIGN: A field survey of a sample of middle-aged men in France. PARTICIPANTS: Male employees of a local university and subjects from the community attending a preventive medicine center. Participation rate was 93.5%. MEASUREMENTS: Anthropometric variables were recorded in 499 subjects aged 23 to 66 years (mean, 44.3 years). The subjects completed a standard sleep questionnaire and were classified according to the snoring frequency as never, rarely, sometimes, occasional, several nights per week, and every night. The subjects who snore occasionally represented 8.6% of the total. RESULTS: The anthropometric data of subjects who snore occasionally were similar to those of subjects who habitually snore. When compared with subjects who do not snore, older age and a larger neck girth were significant. Subjects who snore occasionally were also significantly more often subjects who snore loudly, and tended more frequently to have breathing stops during sleep. CONCLUSIONS: Our epidemiologic study shows that approximately 9% of a sample of middle-aged men snore occasionally. Subjects who snore occasionally have anthropometric characteristics close to those of subjects who snore habitually. The prevalence of the main sleep-related symptoms is between that of subjects who do not snore and of subjects who snore habitually. In an epidemiologic setting, inclusion of subjects who snore occasionally as subjects who do not snore or subjects who snore habitually will lead to bias. The present results suggest they should be identified and considered as a separate category.     

Marital status and living situation during a 5-year period are associated with a subsequent 10-year cognitive decline in older men: the FINE Study

We investigate the association between marital status and living situation (over 5 years) on 10-year subsequent cognitive decline. The study population consisted of 1,042 men aged 70-89 years in 1990, who participated in the longitudinal Finland, Italy, the Netherlands Elderly (known as FINE) Study. We measured cognition by using the Mini-Mental State Examination, and we assessed marital status (married vs unmarried) and living situation (living with others vs living alone) with a standardized questionnaire. We performed repeated measurement analyses and made adjustments for age, education, country, smoking, alcohol, chronic diseases, marital status or living situation, and baseline cognition. Men who lost a partner, who were unmarried, who started to live alone, or who lived alone during the 5-year period had at least a two times stronger subsequent cognitive decline compared with men who were married or who lived with someone in those years.     

Analysis of induced sputum for the diagnosis of recurrent Pneumocystis carinii pneumonia.

We studied the sensitivity of ISA for diagnosis of second-episode PCP in AIDS patients. We induced sputum in 218 patients who had known or suspected AIDS and who had a presentation suggestive of PCP. All patients with negative sputum smear for PCP underwent BAL. Twenty-five patients were identified who had second-episode PCP at least 30 days after initial diagnosis. Chest roentgenographic infiltrate patterns for these 25 patients were blindly scored as normal, diffuse, upper lobe or focal non-upper lobe. The sensitivity of ISA was 72 percent for the first episode of PCP, 72 percent for the second episode of PCP, 72 percent for patients with second-episode PCP who had initial PCP detected by ISA and 71 percent for patients with second-episode PCP whose first episode of PCP was missed by ISA. Of the ten patients who were treated with AP, only one had a false-negative sputum analysis. A comparison of patients who had second-episode PCP diagnosed by ISA with those who had false-negative sputum analysis showed no difference in time to relapse, chest x-ray film pattern (all diffuse) or use of AP.     

Association of myocardial viability on nitrate-augmented technetium-99m hexakis-2-methoxylisobutyl isonitrile myocardial tomography and intermediate-term outcome in patients with prior myocardial infarction and left ventricular dysfunction

Seventy-eight patients with prior myocardial infarction and left ventricular dysfunction who underwent nitrate-augmented myocardial tomography were followed for 23 +/- 14 months. Event-free survival was 100% in 34 patients with myocardial viability who underwent coronary artery bypass grafting (CABG) and 53% in those who received medical therapy (p = 0.0008). Of the 44 patients without myocardial viability, event-free survival was not significantly different between patients who underwent CABG and those who received medical therapy (96% vs 90%, p = NS).     

Heart rate variability differences in post-myocardial infarction patients based on initial treatment during acute phase of disease

The aim of study was to asses the heart rate variability (HRV) differences in 128 post-myocardial infarction (MI) patients based on initial treatment during acute phase of disease. The patients were divided into groups: group 1 patients who underwent primary PCI, group 2 patients who received fibrinolysis and group 3 patients who were treated conservatively. In comparison with groups 2 and 3, group 1 patients had all HRV analyzed parameters higher except for LF/HF ratio. The results of study suggest that patients who were treated by primary PCI had better preserved autonomic cardiac function compared with patients who received fibrinolysis or those who were treated conservatively in the acute phase of MI.     

系统性红斑狼疮患者血脂的变化及其临床意义

目的 探讨系统性红斑狼疮患者血脂的变化及其临床意义.方法 回顾性分析85例初诊未用激素治疗、56例已用激素治疗的系统性红斑狼疮患者和60例正常健康体检者的血脂变化.结果 已用激素治疗的系统性红斑狼疮患者甘油三酯、总胆固醇、低密度脂蛋白胆固醇与正常对照者和未用激素治疗的系统性红斑狼疮患者比较均明显增高（P＜0.05）;未用激素治疗的系统性红斑狼疮患者与正常对照者比较则无明显差异,但血脂异常患者占51.8%（44/85）,其中25例狼疮肾炎患者22例血脂异常,且与正常对照者比较有明显差异（P＜0.05）.结论 系统性红斑狼疮患者血脂异常主要与肾脏损害和大剂量激素使用有关,血脂检测对系统性红斑狼疮患者预防和治疗高血脂症所引起的各种并发症有一定的临床意义.