不同体质量指数男性不育患者心理评估

目的：探讨不同体质量指数男性不育症患者的心理健康状况,为临床干预提供依据。方法将292例男性不育患者按照体质量指数分为3组,正常组84例,超重组117例,肥胖组91例。对3组患者应用症状自评量表进行测评分析。结果超重组和肥胖组症状自评量表总分及强迫、人际关系、抑郁、焦虑因子分均显著高于常模（P＜0．05）,总分及强迫因子分显著高于正常组（P＜0．05或0．01）;正常组总分及抑郁、焦虑因子分显著高于常模（P＜0．05）;入组被试体质量指数与强迫、抑郁、焦虑因子分呈显著正相关（P＜0．05）。结论肥胖和超重男性不育患者存在不同程度的心理问题,应对其予以有针对性的心理干预。     

青少年强迫症患者生活质量与家庭环境相关性研究

目的：探讨青少年强迫症患者生活质量与家庭环境的相关性。方法对48例青少年强迫症患者（强迫症组）和50名健康中学生（对照组）采用儿少主观生活质量问卷及家庭环境量表进行测评分析。结果强迫症组儿少主观生活质量问卷评分和家庭环境量表的6个分量表评分均显著低于对照组（P＜0．05或0．01）,矛盾性分量表分显著高于对照组（P＜0．01）;儿少主观生活质量问卷总分及家庭生活、生活环境、自我认知、抑郁体验、焦虑体验、躯体情感6维度分与家庭环境量表的亲密度、情感表达、知识性、娱乐性、组织性5个分量表分呈显著正相关（ P＜0．05或0．01）,与矛盾性分量表分呈显著负相关（ P＜0．05或0．01）。结论青少年强迫症患者生活质量明显低于正常人群,家庭环境较差,患者的生活质量与家庭环境关系密切。     

青少年强迫症患者焦虑状况与生活质量及家庭环境的相关性研究

目的：探讨青少年强迫症患者焦虑状况与生活质量及家庭环境的相关性。方法对100例青少年强迫症患者采用zung氏焦虑自评量表、生活质量问卷和家庭环境量表进行测评分析。将zung氏焦虑自评量表总分≥50分者设为焦虑组,＜50分者设为对照组,并进行对比分析。结果焦虑组zung氏焦虑自评量表评分和家庭环境量表矛盾性分量表评分显著高于对照组（ P＜0．05）,生活质量问卷评分和家庭环境量表的9个分量表评分均显著低于对照组（ P＜0．05或0．01）;焦虑组zung氏焦虑自评量表评分与生活质量问卷、家庭环境量表多数因子评分呈显著负相关（ P＜0．05或0．01）,与家庭环境量表的矛盾性因子呈显著正相关（ P＜0．05或0．01）。结论高焦虑水平青少年强迫症患者生活质量、家庭环境功能均较差,其焦虑水平与生活质量、家庭环境功能呈显著负相关。     

医学生焦虑水平与社会支持的相关性研究

目的：探讨医学生焦虑水平与社会支持的相关性。方法对350名医学生采用焦虑自评量表、领悟社会支持量表进行测评分析。结果不同性别、生源地、恋爱状况医学生焦虑自评量表总分比较差异无显著性（P＞0．05）;女生领悟社会支持量表评分显著高于男生（P＜0．01）,恋爱学生领悟社会支持量表总分及其他支持维度分显著低于未恋爱学生（P＜0．01）。医学生焦虑自评量表总分与领悟社会支持量表总分及家庭支持、朋友支持、其他支持维度分呈显著负相关（P＜0．01）。结论医学生焦虑水平与社会支持状况存在显著负相关。     

失眠症患者心理健康状况调查

目的：了解失眠症患者的心理健康状况,为临床开展有针对性的心理干预提供依据。方法对58例失眠症患者（研究组）和54名健康志愿者（对照组）采用艾森克个性问卷、抑郁自评量表、焦虑自评量表、生活事件量表及社会支持评定量表进行测评分析。结果研究组艾森克个性问卷的内外向维度分显著低于对照组（P＜0．01）,神经质维度分显著高于对照组（P＜0．01）;抑郁自评量表、焦虑自评量表评分和生活事件量表的负性生活事件评分显著高于对照组（P＜0．01）;社会支持评定量表3个维度分均显著低于对照组（P＜0．01）。结论失眠症患者性格内向,存在抑郁、焦虑情绪,且负性生活事件较多,社会支持度较低,应对其予以有针对性的心理干预。     

重性精神病患者家属焦虑抑郁情绪影响因素调查

目的：探讨重性精神病患者家属焦虑抑郁情绪的相关影响因素。方法采用自拟一般家庭状况调查问卷、疾病家庭负担量表、焦虑自评量表、抑郁自评量表对265名重性精神病患者家属进行测评分析。结果本组患者家属焦虑自评量表、抑郁自评量表总分均显著高于中国常模（P＜0．01）。患者病前病后家庭经济状况、家庭年人均收入、患者治疗费用报销比例均与家属抑郁严重度指数、焦虑自评量表总分呈显著负相关（ P＜0．05或0．01）,患者病程、住院次数均与家属抑郁严重度指数、焦虑自评量表总分呈显著正相关（P＜0．01）;家属受教育年限与其焦虑自评量表总分呈显著负相关（P＜0．01）,患者病情不稳定程度、患者年均治病费用与家属焦虑自评量表总分呈显著正相关（ P＜0．05或0．01）。疾病家庭负担量表总分及各维度分与家属抑郁严重度指数、焦虑自评量表总分呈显著正相关（P＜0．01）。结论重性精神病患者家属存在有明显的焦虑抑郁情绪问题,疾病家庭负担,尤其是经济负担是影响家属焦虑抑郁情绪的主要因素。     

青少年情绪障碍患者心理健康状况及其与家庭功能的相关性研究

目的探讨青少年情绪障碍患者心理健康状况及其与家庭功能的相关性。方法将30例青少年情绪障碍患者设为研究组,同期随机选取31名在校中学生设为对照组,采用症状自评量表、家庭功能评定量表对两组进行测评分析。结果研究组症状自评量表各因子分及家庭功能评定量表问题解决、沟通、情感反应、情感介入、总的功能因子分显著高于对照组（P〈0．05或0．01）;研究组症状自评量表人际关系、抑郁、恐惧、偏执因子阳性检出率显著高于对照组（P〈0．05或0．01）;研究组家庭功能评定量表问题解决、沟通因子分与症状白评量表各因子分呈显著正相关（P〈0．05或0．01）,情感反应因子分与躯体化因子分呈显著正相关（P〈0．05）,情感介入因子分与躯体化、人际关系、恐惧、偏执因子分呈显著正相关（P〈0．05）,行为控制因子分与抑郁、焦虑因子分呈显著正相关（P〈0．05）,总的功能因子分与除精神病性因子分外的其他因子分呈显著正相关（P〈0．05或0．01）。结论青少年情绪障碍患者心理健康状况较差,并且存在家庭功能失调现象,其情绪障碍与家庭功能相互影响。     

农村留守儿童情绪行为及个性特征调查

目的：了解农村留守儿童情绪行为及个性特征的相关因素。方法将100名留守儿童设为研究组,100名非留守儿童设为对照组,采用焦虑自评量表、抑郁自评量表、Achenbach儿童行为量表、艾森克个性问卷进行测评分析。结果研究组焦虑、抑郁情绪、行为问题检出率均显著高于对照组（P＜0．05）,焦虑自评量表、抑郁自评量表评分和艾森克个性问卷的 P、N分量表得分均显著高于对照组（P＜0．01）,男生、女生Achenbach儿童行为量表总分均显著高于对照组（P＜0．05）;研究组焦虑自评量表、抑郁自评量表、Achenbach儿童行为量表评分与艾森克个性问卷评分存在显著相关性（ P＜0．05或0．01）。结论农村留守儿童存在明显的情绪、行为及性格缺陷问题,有针对性的心理干预能显著提高其心理健康水平。     

药物治疗联合道家认知疗法治疗中老年失眠症对照研究

目的：探讨药物治疗联合道家认知疗法治疗中老年失眠症的临床疗效。方法将101例中老年失眠症患者随机分为两组。两组均口服佐匹克隆治疗,研究组予以道家认知治疗,对照组予以常规健康教育。观察12周。于治疗前后采用匹兹堡睡眠质量指数评定睡眠状况,症状自评量表、社会支持量表、特质应对方式问卷评定临床症状、社会支持状况及应对方式。结果治疗6周末起两组匹兹堡睡眠质量指数总分较治疗前显著降低（P＜0．01）,研究组显著低于对照组（P＜0．01）;治疗12周末研究组症状自评量表评分较治疗前显著降低（P＜0．01）,社会支持量表主观支持、支持利用度维度分较治疗前显著升高（P＜0．01）,特质应对方式问卷积极应对维度分较治疗前显著升高（P＜0．01）,消极应对维度分较治疗前显著降低（P＜0．01）,与对照组比较差异均有显著性（P＜0．05或0．01）。结论药物联合道家认知疗法能显著改善中老年失眠症患者的睡眠状况和躯体症状,对提高社会支持利用度,改善积极应对方式具有重要作用,显著优于单用药物治疗。     

中学生心理问题及其影响因素研究

目的探讨中学生心理健康状况及其影响因素。方法采用症状自评量表、青少年生活事件量表对桐乡市两所中学370名初二学生的心理健康状况进行调查分析。结果症状自评量表测评,5．67％的中学生存在明显的心理问题,主要表现为强迫症状、人际关系敏感、偏执、敌对、焦虑与抑郁等;女生恐怖因子分显著高于男生（P〈0．01）,城镇与农村及男生与女生各因子分比较均无显著性差异（P〉0．05）。青少年生活事件量表测评,城镇中学生受惩罚因子分显著高于农村（P〈0．05）,丧失因子及健康适应因子分显著低于农村（P〈0．05或0．01）;男生受惩罚因子分显著高于女生（P〈0．01）,人际关系因子分显著低于女生（P〈0．05）。症状自评量表总分与青少年生活事件量表应激总分和各因子分呈正相关。结论中学生的心理健康状况较差,需要社会各界的关注和支持。     

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.     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.