慢性阻塞性肺病患者生存质量状况的调查分析

目的对慢性阻塞性肺病(COPD)患者的生存质量进行全面评价,并分析影响COPD患者生存质量(QOL)的各种因素,以提供改善COPD患者QOL的依据.方法应用COPDQOL测评表,随机选择60例住我院老年病房的缓解期COPD患者,自行填写问卷,根据患者填写情况进行评分.结果COPD患者QOL的各个方面都有下降,尤以日常生活能力下降最为明显.心理障碍中忧郁症状比焦虑症状多见.影响COPD患者生存质量的因素主要是年龄、吸烟量、病情的严重程度、卧床时间、心率等.结论对COPD患者应积极进行卫生宣教,实施包括健康教育、营养支持、康复锻炼一体化综合治疗,最终使COPD患者的QOL得以改善.     

综合护理干预对老年慢性阻塞性肺疾病患者治疗依从性的影响

目的探讨综合干预对老年慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）患者治疗依从性的影响。方法自制调查问卷对80例COPD患者治疗中存在的问题进行调查,对调查发现的COPD患者存在的认知误区及健康教育的难点采取针对性的综合干预。结果综合干预后COPD患者急性发作次数、感冒次数、生存质量评分均明显下降,差异有统计学意义（P〈0.01）;吸烟人数、行炊人数明显减少;康复治疗、家庭氧疗、吸入治疗等人数明显增加,差异有统计学意义（P〈0.01）。结论 积极综合护理干预可提高COPD患者治疗依从性,改善生存质量,减少复发。     

康复护理对COPD患者稳定期肺功能及生活质量的干预作用

目的 探讨康复护理干预对慢性阻塞性肺疾病(COPD)患者稳定期肺功能和生存质量的影响.方法 将60例COPD稳定期患者随机分为对照组和观察组各30例.对照组采用常规护理方法,观察组在此基础上进行护理干预,包括健康教育、心理干预、呼吸功能训练及营养干预,6个月后测定患者肺功能,并采用St.George's呼吸问卷(SGRQ)及健康状况调查表(SF-36)对患者生存质量进行评估.结果 干预组患者肺功能指标有明显改善(P＜0.05),生存质量评分显著高于对照组(P＜0.05).结论 康复护理干预可改善COPD患者肺功能,提高其生存质量.     

康复护理对COPD患者稳定期肺功能及生活质量的干预作用

目的 探讨康复护理干预对慢性阻塞性肺疾病(COPD)患者稳定期肺功能和生存质量的影响.方法 将60例COPD稳定期患者随机分为对照组和观察组各30例.对照组采用常规护理方法,观察组在此基础上进行护理干预,包括健康教育、心理干预、呼吸功能训练及营养干预,6个月后测定患者肺功能,并采用St.George's呼吸问卷(SGRQ)及健康状况调查表(SF-36)对患者生存质量进行评估.结果 干预组患者肺功能指标有明显改善(P＜0.05),生存质量评分显著高于对照组(P＜0.05).结论 康复护理干预可改善COPD患者肺功能,提高其生存质量.     

康复护理对COPD患者稳定期肺功能及生活质量的干预作用

目的 探讨康复护理干预对慢性阻塞性肺疾病(COPD)患者稳定期肺功能和生存质量的影响.方法 将60例COPD稳定期患者随机分为对照组和观察组各30例.对照组采用常规护理方法,观察组在此基础上进行护理干预,包括健康教育、心理干预、呼吸功能训练及营养干预,6个月后测定患者肺功能,并采用St.George's呼吸问卷(SGRQ)及健康状况调查表(SF-36)对患者生存质量进行评估.结果 干预组患者肺功能指标有明显改善(P＜0.05),生存质量评分显著高于对照组(P＜0.05).结论 康复护理干预可改善COPD患者肺功能,提高其生存质量.     

慢性阻塞性肺疾病稳定期自我管理的疗效分析

目的 研究慢性阻塞性肺疾病(COPD)稳定期自我管理的重要性.方法 60例COPD稳定期患者根据依从性分为试验组和对照组,试验组进行集体和个别患者相结合的宣传教育,讲解康复治疗的重要性.入组时和1年后进行呼吸问题生活质量调查问卷(SGRQ)调查.结果 与对照组比较,治疗后试验组SGRQ的活动受限评分与总分改善更多(P<0.05).结论 对COPD患者进行自我管理教育能有效提高生活质量.     

慢性阻塞性肺病患者生存质量状况的调查分析

目的 对慢性阻塞性肺癌（COPD）患的生存质量进行全面评价,并分析影响COPD患生存质量（QOL）的各种因素,以提供改善COPD患QOL的依据。方法 应用COPD QOL测评表,随机选择60例住我院老年病房的缓解期COPD患,自行填与问卷,根据患填写情况进行评分。结果 COPD患QOL的各个方面都有下降,尤以日常生活能力下降最为明显。心理障碍中忧郁症状比焦虑症状多见,影响COPD患生存质量的因素主要是年龄,吸烟量,病情的严重程度,卧床时间,心率等。结论 对COPD患应积极卫生宣教,实施包括健康教育,营养支持,康复锻炼一体化综合治疗,最终使COPD患QOL得以改善。     

早期肺康复治疗对急性加重期COPD患者远期生存质量的影响

目的:探讨早期肺康复治疗对急性加重期COPD(AECOPD)患者远期生存质量的影响。方法:将2014年1~8月我院呼吸内科重症监护病房收治的AECOPD患者80例随机分为肺康复组42例和对照组38例,对照组给予常规治疗;肺康复组在常规治疗基础上接受为期6周的早期肺康复治疗。测量两组患者的肺功能、6 min步行测试,同时评估患者体力活动情况、呼吸困难程度、焦虑抑郁情绪、生活质量,治疗6个月后随访全部患者并进行再评估。结果:治疗6个月后随访两组患者6 min步行测试、体力活动活跃程度均高于基线,而改良m MRC呼吸困难指数得分、焦虑及抑郁得分以及COPD评估问卷得分均较基线降低(P0.05)。肺康复组患者6 min步行测试距离、体力活动活跃程度均高于对照组(P0.05),而改良m MRC呼吸困难指数、焦虑、抑郁以及COPD评估问卷得分均低于对照组患者(P0.05)。结论:COPD患者早期肺康复治疗可以提高患者体力活动水平,降低焦虑、抑郁情绪,提高患者的生存质量。     

慢性阻塞性肺疾病病人生存质量及其影响因素分析

[目的]探讨慢性阻塞性肺疾病(COPD)病人生存质量及其影响因素。[方法]采用生活质量问卷对101例COPD病人进行调查,并用单因素分析和多元逐步回归方法对COPD病人生存质量的影响因素进行分析。[结果]COPD病人的生存质量普遍下降,年龄和主要照顾者对COPD病人的生存质量有重要影响,而文化程度、婚姻状况、经济情况、居住情况存在一定的影响。[结论]加强COPD病人的健康教育、心理疏导和社会支持,特别是对病人主要照顾者进行疾病相关知识指导,将有助于提高病人的生存质量。     

SF－36量表在COPD患者生存质量评估中的应用

目的:以医学结局研究简明调查表(中文版SF-36)评价慢性阻塞性肺病(COPD)患者的生存质量,并分析相关因素对生存质量的影响。方法:采用医学结局研究简明调查表(SF-36)对COPD患者的生存质量进行横断面研究,并使用自编的患者一般状况调查表记录患者年龄、教育年份、身高、体重和FEV1/FVC的信息,分层比较这些因素对COPD患者的生存质量的影响。结果:COPD患者在SF-36各维度的生存质量与我国正常人比较显著下降,尤其是活力(54.52±30.31)、总体健康(35.50±31.86)、生理职能(34.13±47.53)下降最为显著。不同年龄、教育年份、FEV1/FVC和体重指数(BMI)的患者生存质量某些维度之间的差别有显著性意义。该表在多个维度存在地板效应和天花板效应。结论:对COPD患者生存质量的评价说明COPD对患者的生存质量有一定的影响,且对不同方面的影响程度不相同,提示在对COPD患者进行干预治疗时应有不同的侧重点,并应考虑到年龄、教育、肺功能、体重指数对COPD患者生存质量的影响。同时建议在用SF-36评估极轻或重度COPD患者生存质量时最好联合应用其他合适量表。     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.