以家庭为基地的短期结构化教育治疗儿童孤独症的疗效

[目的]为改善孤独症儿童预后,对孤独症儿童开展了为期6个月的以家庭为基地的短期结构化教育。[方法]将60例孤独症儿童随机分为治疗组和对照组。治疗组儿童在接受评估后制定训练计划,同时培训家长,之后家长根据计划在家庭进行训练,特别强调根据孤独症儿童的认知特点进行环境布置和视觉安排,按照预定的常规、程序时间表以及由上述训练要素构成的个人工作系统开展训练。要求每周7d,每天训练6h,于训练开始前以及6月后采用"孤独症治疗评估量表"进行疗效评估。[结果]与对照组相比,治疗组孤独症儿童量表的总分由训练前的76.2分下降至54.9分(P<0.01),量表的语言、社会交往、感知觉和行为四个分项目的分数也均有显著下降(P<0.05),表明通过训练在语言能力、社会交往能力得到提高,异常感知觉状态和异常行为得到减少。[结论]以家庭为基地的结构化教育能够有效地改善孤独症儿童的预后。     

Nutritional supplementation and the outcome of pregnancy. I. Birth weight.

Colombian women at risk of malnutrition were enrolled in a health care program and randomly assigned to supplementation and control groups at the beginning of the third trimester of pregnancy. The net dietary intake increments resulting from supplementation amounted to 155 cal and 20 g of protein per day. Supplementation had a significant effect on the mean birth weight of male infants, but not that of female infants; the mechanisms responsible for the sex differences remain to be elucidated. The randomized trial design of the experiment and the documented similarity between the experimental and control groups at the onset permit the conclusion that the observed differences were caused by the food supplementation program. The effect of supplementation on maternal weight gain and the association of the latter with birth weight strongly suggest that improved maternal nutrition mediated the effect on birth weight.     

Comparison of short term outcomes of open and laparoscopic cholecystectomy.

OBJECTIVE--To compare the three month outcome of open and laparoscopic cholecystectomy. DESIGN--Prospective assessment of outcome for a series of patients encompassing the introduction of the laparoscopic technique. SETTING--One teaching hospital. PATIENTS--269 patients admitted for open cholecystectomy between January 1989 and March 1992 and 122 admitted for laparoscopic cholecystectomy between January 1991 and March 1992. MAIN MEASURES--Patients' reported symptoms and self assessed scores with the Nottingham health profile before operation and at three month follow up. Incidence of complications and adverse events after discharge. RESULTS--Similar improvements in symptom rates and health scores were seen regardless of surgical technique. A lower rate of postoperative complications was seen in the patients given laparoscopic surgery (6/95(6%) v 45/235(19%)), and their mean length of stay was lower (4.5 v 9.8 days). Similar results were obtained when the analysis was restricted to a subset of fairly uncomplicated cases (patients aged 60 or less without other illnesses on admission who were not undergoing emergency or urgent surgery), which constituted a larger proportion of the group given laparoscopy (35/95(37%) v 40/235(17%)). Between these two groups no significant difference was seen in the frequency of relevant readmissions to hospital or visits to general practitioners or accident and emergency departments. CONCLUSION--Ideally, a new surgical technique would be evaluated in a randomised trial. In the absence of such a trial, this observational study provides some evidence that the switch from open to laparoscopic cholecystectomy has brought benefits, particularly in terms of reduced length of stay in hospital. A range of clinical and patient derived indicators suggests that these gains have not been associated with a reduction in the quality of the outcome at three months.     

A short term projection of HIV infection and AIDS cases in Cameroon.

By September 1991 Cameroon had reported 650 cases of the acquired immune deficiency syndrome (AIDS). The results from the sentinnel surveillance system showed a seroprevalence of human immunodeficiency virus (HIV)1 of 1.3% among pregnant women, 2.5% in people attending sexually transmitted disease clinics and 3.5% in tuberculosis patients in 1990. The estimated number of persons infected with HIV varies between 10,000 and 30,000. The World Health Organization projection model was used to make a short-term projection of HIV infection and AIDS cases; it indicated that the number of persons infected with HIV will double by the year 1995, with an estimated 8500 AIDS cases. Even in a low prevalence country such as Cameroon, the impact of the HIV epidemic is important and will result in a burden for the health care system.     

Long term radiological effects of short term exposure to amosite asbestos among factory workers.

Chest radiographs were read from a sub-cohort of 386 factory workers with short term exposure to amosite asbestos (median exposure six months) and long follow up (median 25 years). Prevalence of abnormality was determined independently by two readers from the first film available after 20 years from first employment. Serial films were obtainable for 238 men (median interval from first to last film: nine years). Progression was classified with a direct progression scoring scale. Individual dust exposure estimates were derived from dust counts from two similar plants. With as little as one month or less of employment, about 20% of the films showed parenchymal abnormality and about a third showed pleural abnormality. Those in the lowest cumulative exposure stratum (less than 5 fibre-years/ml) were similarly found to have high rates of abnormality. Dose-response relations were present in the data of both readers. Smokers had higher rates of parenchymal abnormality. On multivariate analysis, cumulative exposure was the exposure variable most closely related to parenchymal abnormality, and time from first employment was the variable most closely related to pleural abnormality. Progression (including first attacks) 20 or more years after ceasing employment occurred and was more common for pleural than for parenchymal abnormality. It is concluded that with exposure to high concentrations to amosite such as existed in this factory and with follow up for at least 20 years, (1) exposure for as little as a month was sufficient to produce radiological signs of parenchymal and pleural fibrosis, (2) no cumulative exposure threshold for parenchymal and pleural fibrosis was detectable, and (3) parenchymal and pleural progression were still detectable >/= 20 years after the end of exposure.     

Long term radiological effects of short term exposure to amosite asbestos among factory workers.

Chest radiographs were read from a sub-cohort of 386 factory workers with short term exposure to amosite asbestos (median exposure six months) and long follow up (median 25 years). Prevalence of abnormality was determined independently by two readers from the first film available after 20 years from first employment. Serial films were obtainable for 238 men (median interval from first to last film: nine years). Progression was classified with a direct progression scoring scale. Individual dust exposure estimates were derived from dust counts from two similar plants. With as little as one month or less of employment, about 20% of the films showed parenchymal abnormality and about a third showed pleural abnormality. Those in the lowest cumulative exposure stratum (less than 5 fibre-years/ml) were similarly found to have high rates of abnormality. Dose-response relations were present in the data of both readers. Smokers had higher rates of parenchymal abnormality. On multivariate analysis, cumulative exposure was the exposure variable most closely related to parenchymal abnormality, and time from first employment was the variable most closely related to pleural abnormality. Progression (including first attacks) 20 or more years after ceasing employment occurred and was more common for pleural than for parenchymal abnormality. It is concluded that with exposure to high concentrations to amosite such as existed in this factory and with follow up for at least 20 years, (1) exposure for as little as a month was sufficient to produce radiological signs of parenchymal and pleural fibrosis, (2) no cumulative exposure threshold for parenchymal and pleural fibrosis was detectable, and (3) parenchymal and pleural progression were still detectable >/= 20 years after the end of exposure.     

Nutritional status and unfavourable pregnancy outcome in Egyptian women

The nutritional status in 43 cases of repeated spontaneous (habitual and threatened) abortion with both favorable and unfavorable results was assessed by the 24-hour recall method, as compared to 19 normal terminating pregnancies, all of which were in women of low socioeconomic class and who were considered to be malnourished. All pregnant women were monitored at 2 points during gestation, namely 6-12 weeks and 12-16 weeks, by measuring human chorionic gonadotropin as the main hormonal marker in pregnancy and by total and fractional serum protein estimation as a biochemical probe to both the nutritional status and to the course and outcome of pregnancy. Chorionic gonadotropin was significantly decreased in cases of unfavorable outcome in both gestational periods. Apart from the usual physiological changes of pregnancy in total serum protein and its fractions, a significant increase of the beta globulin fraction in the earlier gestational period only was observed. This increase corresponded to and was inversely proportional to the decreased levels of hCG. The authors therefore suggest the introduction of serum protein electrophoresis as a simple routine procedure for screening high risk pregnancies and thus, the early prediction of unfavorable pregnancy outcome.     

冠心病患者抗血小板治疗短期内血小板四项参数变化趋势

目的观察不同类型冠心病患者血小板变化,比较各组间血小板四项参数差异及治疗前后变化。方法收集我院心内科2011年3月至2012年2月期间108例冠心病患者:分为稳定型心绞痛、不稳定型心绞痛、急性心肌梗死3组。按病情给予抗血小板治疗、PCI治疗及其他常规治疗,服药治疗10天后重复检查测定血小板四项参数,比较治疗前后变化及各组冠心病患者与对照组间的差异。结果①入院时UA组和AMI组血小板计数(PLT)均低于对照组(P<0.05),MPV、PDW和PCT均高于对照组(P<0.05),以AMI组更为显著。②治疗10天后UA组PDW、PCT较治疗前降低(P<0.05);AMI组MPV、PDW、PCT均较治疗前明显降低(P<0.01)。③治疗后SAP、UA、AMI组PLT均低于正常对照组(P<0.05);各组患者MPV均高于健康体检组(P<0.05)。结论血小板四项参数可作为观察冠心病病情变化、实现个体化治疗和判断预后的检查标准。     

孕妇外周血浆中高甲基化RASSF-1A基因水平与自然流产的关系研究

目的通过检测孕早期发生先兆流产孕妇血浆中高甲基化RASSF-1A水平,并随访早期妊娠结局,评估利用孕妇血浆中高甲基化RASSF-1A预测孕早期出现先兆流产的孕妇发生自然流产的临床价值。方法该研究是一项前瞻性研究,最终共有孕早期(6～11.6周)孕妇1767名,根据妊娠结局分为三组:自然流产组(A组)、先兆流产但妊娠结局正常组(B组)、正常对照组(C组)。高甲基化RASSF-1A基因用来代表胎儿DNA,应用实时定量PCR方法检测上述各实验组孕妇血浆胎儿DNA的含量。结果正常孕妇在孕早期血浆中的高甲基化RASSF-1A水平随着孕周的增长而增高;自然流产组孕妇血浆高甲基化RASSF-1A的中位数倍值是正常对照组的4.64倍,有统计学差异(P<0.01),而在有先兆流产但妊娠结局正常组与正常对照组之间无统计学差异(P>0.05);若用高甲基化RASSF-1A的4.92MoMs来预测自然流产,灵敏度为98.2%,假阳性率为1.8%,特异度为91.2%。结论对于发生先兆流产的孕妇,尤其在孕早期,孕妇血浆中的甲基化RASSF-1具有预测自然流产的临床价值,有望成为临床上预测有先兆流产症状的孕妇孕早期发生自然流产新的生物学指标。     

About a short series of Swanson arthroplasty

The authors report a series of 12 patients who underwent digital arthroplasty using a swanson implant. Six patients had the sequellae of an injured hand, and the other six patients had rheumatoid arthritis. The majority of patients were men with an average age of 33 years. The patients were examined again about 4 years later on average. The lateral stability of the operated finger was considered to be satisfactory in 11 cases. The mean movement gain was 40 degrees. There was no sign of silicone particle synovitis, because it was fixed arthroplasty.     

阴式全子宫切除术230例近远期并发症分析

目的探讨阴式全子宫切除术(transvaginal hysterectomy,TVH)术后近远期并发症的防治方法。方法对230例阴式全子宫切除术患者的临床资料进行回顾性分析。结果术后常见的近期并发症为残端出血,尿路感染,下肢深部静脉血栓形成。远期并发症为阴道残端炎性息肉,围绝经症状,阴道穹窿脱垂及残留卵巢综合征。结论行阴式全子宫切除术应严格掌握手术指征,规范操作,谨防各种近远期并发症的发生。     

Transitory postural vasomotor dysfunction in the finger after short term hand vibration.

The transitory effects of hand vibration (ah, w = 3.16 m/s2 during three minutes) on postural vasomotor functions of skin capillary blood flow rate in the finger were studied by the local 133xenon washout technique in ten men with vibration induced white finger (VWF), nine men professionally exposed to hand-arm vibration but without finger symptoms (HAV), and eight male controls (MC). The following postural vasomotor functions were measured: (a) the vasomuscular, non-neurogenic autoregulation, tested by raising the finger 20 cm; (b) the local venoarteriolar vasoconstrictor axon reflex, tested by lowering the finger 40 cm; and (c) the central sympathetic vasoconstrictor reflex elicited by central baroreceptors and tested by changing the body posture from supine to sitting upright. Before short term vibration the vasoconstriction elicited by central baroreceptors was increased in VWF (p less than 0.01) and normal in HAV (p greater than 0.10). The local axon reflex and the autoregulation functioned normally in VWF and HAV (p greater than 0.30). Three minutes after vibration, autoregulation was abolished and the functions of the central and local sympathetic vasoconstrictor reflexes were equally impaired in all three groups (p less than or equal to 0.01). All three vasomotor functions were completely restored 60 minutes after vibration in MC (p greater than 0.10) and also 30 minutes after vibration in one male control (p greater than 0.20). The results indicate a hyperreactivity of the central sympathetic nervous system in VWF, and a transitory, impaired function of digital arterioles after short term vibration in all groups.     

Nutritional supplementation and the outcome of pregnancy. II. Visual habituation at 15 days.

Colombian women at risk of mild-to-moderate malnutrition were enrolled in a health care program and randomly assigned into nutritional supplementation and control groups at the beginning of the third trimester of preganancy. One hundred unsupplemented and 144 supplemented infants were tested at 15 days of age: a 2X2 checkerboard was presented eight times followed by a single presentation of a 6X6 checkerboard. Unsupplemented infants showed less initial attention followed by slower habituation and higher levels of movement than the supplemented infants. The observed effect of maternal nutritional supplementation during the last trimester of pregnancy on new-born attention was interpreted to be maturational in nature.     

短肠综合征的营养康复治疗(附3例报告)

短肠综合征的治疗主要是营养支持和小肠移植 ,但两种疗法都有其限制和不足。本文报告对 3例短肠病人联合应用重组人生长激素、谷氨酰胺、纤维饮食行营养康复治疗 ,病人残存小肠的长度分别为 65cm、75cm、30 cm,治疗后病人残存肠管的吸收功能和营养状况均有明显改善。为短肠综合征病人提供了一个新的有希望的治疗选择     

Unusual mortality pattern among short term workers in the perfumery industry in Geneva.

A cohort of 537 workers employed for less than one year between 1900 and 1964 in the Geneva perfumery industry was followed up from entry to the end of 1983. During the period of study, 251 workers died and 41 (8%) were lost to follow up. The standardised mortality ratio (SMR) was significantly above 100 for all causes (SMR = 120), all cancers (SMR = 127), lung cancer (SMR = 186), and violent death (SMR = 179). The highest SMR from all causes was associated with the shortest period of employment (less than two months) and it decreased significantly with longer duration. Such mortality excesses had not been recorded among the 1168 workers of the same industry employed one year or more, previously studied in similar fashion. Interviews among a random sample of 52 workers employed for less than two months seem to indicate that the prevalence of smoking, exposures to asbestos, and occupational accidents in other hazardous industries were higher for these workers than for the reference population. Furthermore, unmarried men were overrepresented among the study cohort. These findings support previous observations indicating that short term workers share atypical features related to high mortality from various causes. It is suggested that mortality in this subgroup should be analysed separately in occupational studies.