急性重症脑卒中患者非感染性发热的危险因素

目的：探讨急性重症脑卒中患者非感染性发热的危险因素。方法：对湘雅三医院2006年3月至2007年10月神经重症监护病房（NICU）中住院的急性重症脑卒中患者进行观察。把2次测量体温高于37.5 ℃或1次测量体温高于37.8 ℃者确定为发热；没有查到感染证据的发热患者判定为非感染性发热。对非感染性发热患者的危险因素首先进行单因素分析，然后进行多因素logistic回归分析，确定高危因素。结果：206例患者中有95例患者出现发热，其中非感染性发热33例。单因素分析结果表明，意识障碍、脑干卒中、蛛网膜下腔出血、入院72 h内出现发热、脑中线移位、入院时血糖、入院时白细胞计数、出现应激性溃疡的患者易于出现非感染性发热（P<0.05）；多因素logistic回归分析结果表明，蛛网膜下腔出血、72 h内出现发热、脑中线移位是非感染性发热的高危因素。结论：在蛛网膜下腔出血和脑中线移位的急性重症脑卒中患者中，早期发热多数是非感染性发热。     

Knee joint dysfunctions that influence gait in cerebrovascular injury

INTRODUCTION: There is still no consensus among different specialists on the subject of kinematic variation during the hemiparetic gait, including the main changes that take place during the gait cycle and whether the gait velocity changes the patterns of joint mobility. One of the most frequently discussed joints is the knee. OBJECTIVES: This study aims to evaluate the variables found in the angular kinematics of knee joint, and to describe the alterations found in the hemiparetic gait resulting from cerebrovascular injury. METHODS: This study included 66 adult patients of both genders with a diagnosis of either right or left hemiparesis resulting from ischemic cerebrovascular injury. All the participants underwent three-dimensional gait evaluation, an the angular kinematics of the joint knee were selected for analysis. RESULTS: The results were distributed into four groups formed based on the median of the gait speed and the side of hemiparesis. CONCLUSIONS: The relevant clinical characteristics included the important mechanisms of loading response in the stance, knee hyperextension in single stance, and reduction of the peak flexion and movement amplitude of the knee in the swing phase. These mechanisms should be taken into account when choosing the best treatment. We believe that the findings presented here may aid in preventing the occurrence of the problems found, and also in identifying the origin of these problems.     

An analysis of factors that influence the ASCUS/SIL ratio of pathologists

In pursuit of physician-specific performance data in cytology, we have been calculating the ASCUS/SIL (atypical squamous cells of undetermined significance/squamous intraepithelial lesion) ratio of cytopathologists (CPs) and providing confidential feedback every 6 months. At the same time, thin-layer technology was introduced as an alternative to conventional smears. Thus we analyzed factors that may influence the ASCUS/SIL ratio, particularly the effect of periodic feedback on outliers (defined by a professional benchmark). For 3 years, the mean ASCUS/SIL ratio for all CPs decreased significantly from 2.92 to 1.87. There was great variability in the mean ASCUS/SIL ratio among 12 CPs (range, 1.11-5.89). Of the 6 CPs who worked continuously during this time, 2 showed a statistically significant decrease in their ASCUS/SIL ratio, including the CP with the highest ratio; 1 showed a significant increase. The mean ASCUS/SIL ratio did not correlate well with years of CP experience or with individual annual case volume. The ASCUS/SIL ratio of some CPs can decrease significantly over time. Whether it was due to feedback or the introduction of thin-layer preparations could not be determined.     

The correlation between F-wave motor unit number estimation (F-MUNE) and functional recovery in stroke patients

The aim of this study was to follow up the changes in the number of motor units according to the Brunnstrom stage through a motor unit number estimation of the Fwave (F-MUNE) after a stroke, and to identify the functional significance of F-MUNE. Twenty-five patients (15 men, 10 women) with a first unilateral stroke were recruited. The maximal M-potential was evoked by the supramaximal stimulation of the median nerve at the wrist, and the maximal stimulation intensity was determined on both hemiplegic and unaffected hands. The reproducible all-or-none F-wave was evoked in 30% of the maximal stimulation intensity and was constantly stimulated at that level. The prototypes of the F-wave were chosen, and the values of F-MUNE were calculated by dividing the amplitude of the maximal M-potential by the mean amplitude of the F-prototype. The changes in F-MUNE were compared according to the progression of the Brunnstrom stage and correlated with those of the functional scales. The mean motor unit numbers decreased significantly in the hemiplegic side compared with the unaffected side. According to the progression of the Brunnstrom stage, the values of F-MUNE were reduced significantly by increasing the amplitude and recruitment of the F-prototype, and the functional scores also improved. These results show that the F-MUNE equation did not show a functional recovery related increase in stroke patients.     

Host factors that influence the behaviour of bacterial pathogens in vivo

Interest is increasing in how bacteria behave and produce virulence determinants within the infected host. There are three aspects of this process; observations on the bacteria themselves, recognition of host factors that affect them and investigation of metabolic interactions between the two. The first aspect is relatively easy to investigate and attracts much interest. The second and third are difficult to work on and hence understudied. The review aims to stimulate interest in them by indicating methods of investigation and describing some successful studies. After discussing host factors that determine growth in vivo consideration is given to factors that influence the production of the determinants of mucosal colonization, penetration, interference with host defence and damage to the host. The final section deals with the influence of host-derived cytidine 5'-monophospho-N-acetyl neuraminic acid and lactate on the pathogenicity of gonococci, meningococci and Haemophilus influenzae.     

Identification of factors that influence conscious sedation in gastrointestinal endoscopy

Although several studies examined factors that influence conscious sedation, investigation was limited into the gender and age. The aim of this prospective study is to identify the clinical variables of successful conscious sedation during gastrointestinal endoscopy. A total of 300 subjects who underwent gastrointestinal endoscopy were enrolled in a prospective fashion. They completed a questionnaire to assess height, weight, drinking, smoking, education level, recent medication, past medical history, previous experience of conscious sedation, preprocedural anxiety, and apprehension about the procedure. Efficacy of sedation and amnesia were evaluated by the subject and the endoscopist. Amnesic and sedative effects were proportionally related with age (p<0.0001). Preprocedural anxiety level was higher in women (p=0.0062), younger subjects (p=0.035), slender subjects (p=0.041), and in those without previous experience of conscious sedation (p=0.0034). This anxiety level was also related to increased pain (p=0.0026) and alertness (p=0.0003) during the procedure. Lower dose of midazolam is needed for sedation in older subjects. Subjects with a high level of preprocedural anxiety such as women, younger subjects, slender subjects, and those without previous experience of conscious sedation should be sedated with great caution because generally, they complain of much more severe pain and alertness during the procedure.     

Quantification of the factors that influence discharge correlation in model motor neurons

The purpose of this study was to quantify the influence of intrinsic properties, active dendritic conductances, and background excitation and inhibition on measures of discharge correlation in the time and frequency domains with known levels and patterns of common synaptic input. The study involved a computer simulation of a population of neurons with a range of input resistances (0.54-3.7 MOmega) and surface areas (407,000-712,000 microm(2)). The neurons were simulated with no, moderate, or high levels of active dendritic conductances and were activated with either excitatory input only or excitatory and inhibitory inputs. The patterns of common input, either branched common input or common modulation, were tested with 0, 30, 60, and 90% common input. The results confirm previous findings of an exponential relation between the level of common input and indexes of synchronization; only when the common input comprised >/=60% of the total excitatory input was there a significant effect on discharge correlation. Synchronization was greatest in models that had passive dendrites. Active dendritic conductances caused the discharge rate of the neuron to saturate and decreased motor-unit synchronization. However, the addition of 10% background inhibitory input increased synchronization in these models. In contrast, common rhythmic modulation of inputs at 24 Hz usually decreased synchronization. Significant coherence at the modulated frequency occurred in the commonly modulated neurons when >/=60% of the inputs were modulated. Furthermore, active dendritic conductances decreased coherence. Branched common input caused high levels of coherence across a broad spectrum and when combined with active dendritic conductances caused significant frequency peaks in the 30- to 50-Hz band. In conclusion, the level of inhibitory input and active dendritic conductances interact with the amount of common input to determine time- and frequency-domain discharge correlation.     

An investigation into the relationship between attachment,gender and recovery from psychosis in a stable community‐based sample

The current study sought to investigate how men and women who experience psychosis represent early bonding experiences, current attachment style and the recovery style adopted. Seventy‐three participants (18 women and 55 men) with a diagnosis of psychosis completed the Parental Bonding Instrument, the Attachment Style Questionnaire and the Recovery Style Questionnaire. Differences were observed between men and women in relation to the nature of insecure attachment styles demonstrated. Significant associations were found between perceptions of parents as uncaring and insecurity in adult attachment style. A greater number of significant associations were found between recollections of early bonding and attachment styles amongst women than men. Men and women did not differ significantly in terms of the recovery style adopted, nor were significant differences found in relation to perceptions of early bonding experiences. Methodological and theoretical issues were considered and directions for future research were suggested. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message:

• Individuals with psychosis are more likely to have lower levels of parental care than the general population.
• This lower parental care is likely to be associated with insecure adult attachment relationships but not recovery style.

     

精神发育迟滞致病危险因素的调查研究

本文以济南市两所弱智儿童辅读学校117名精神发育迟滞(MR)患儿作为研究对象,利用1∶1配对的病例对照研究与多因素分析相结合的方法,探讨了致病危险因素。逐步回归分析((α=0.05)揭示 MR 的主要致病危险因素为婴幼期疾病、精神病家族史、母亲孕期毒害因素、母亲文化程度低、出生时家庭人口数多。父亲文化程度低、母亲孕期有精神冲突、新生儿期疾病和异常妊娠。研究结果为该病的综合性防治和有关策略的制定提供了科学依据。     

我国烧伤康复的现状与展望

本文回顾我国烧伤康复的发展历程,理解烧伤康复的现状,分析制约康复治疗的问题所在。比较我国与国外康复治疗的差距,介绍国内开展康复治疗较好的单位的做法和经验。提出了预防为主的康复理念,康复治疗不是始自瘢痕增生后,而是从入院便开始,在烧伤治疗的全过程始终贯穿康复的综合疗法,包括体位摆放、体疗按摩、主动与被动锻炼、加压疗法、瘢痕内注射、可塑夹板、浸浴疗法、涂擦外用药、皮肤护理、心理疏导等,都对减轻瘢痕增生和改善功能发挥了重要作用。近年来我国的烧伤康复取得了明显进展,展望未来仍然任重道远,需要所有医务工作人员为烧伤康复医学的发展继续奋斗。     

影响冻融胚胎临床结局的因素分析

目的探讨影响冻融胚胎移植结局的相关因素。方法收集我中心2009年570个行冻融胚胎移植周期,回顾性分析患者年龄,移植冻融胚胎质量及数量,内膜厚度对临床妊娠率、种植率、多胎率的影响。结果 Logistic回归分析表明:女方年龄、移植数、移植优质胚胎数与临床妊娠显著相关(P<0.01);多胎与女方年龄和移植数相关(P<0.01;P<0.05)。年龄<35岁的妊娠率(49.4%)明显高于≥35岁的妊娠率(37.9%)(P<0.05);移植2个胚胎的临床妊娠率(49.3%),明显高于移植1个胚胎的临床妊娠率(15.4%)(P<0.05),但与移植3个胚胎的临床妊娠率(50.0%)无差异(P>0.05);移植至少1个优胚组妊娠率(58.0%)较无优胚移植组临床妊娠率(37.5%)显著高(P<0.01)。结论女方年龄及移植的胚胎质量是影响移植后妊娠结局的关键因素。     

Sleep duration and history of stroke among adults from the USA

Although short sleep duration is related to chronic conditions, such as hypertension, diabetes and obesity, the association with stroke is less well known. Using 2006–2011 National Health Interview Surveys, we assessed the association between self‐reported duration of sleep and prevalence of stroke stratifying by age and sex. Of the 154 599 participants aged 18 years or older, 29.2%, 61.8% and 9.0% reported they sleep ≤6, 7–8 and ≥9 h per day, respectively. Corresponding age‐standardized prevalence of stroke were 2.78%, 1.99% and 5.21% (P < 0.001). Logistic regression models showed a higher prevalence of stroke among those who slept ≤6 or ≥9 h a day compared with those who slept 7–8 h, after adjusting for sociodemographic, behavioural and health characteristics. Further stratifying by age and sex showed that the association of duration of sleep and stroke differed among different age or sex groups. Among young adults (18–44 years), a higher prevalence of stroke was found among women with short sleep. Higher prevalence of stroke was found among middle‐aged men and women reporting short or long sleep duration. Among older adults (≥65 years), higher prevalence of stroke was found only among those who slept ≥9 h. In this national sample of adults, the association between duration of sleep and stroke varied by sex and age. Although there was an association of short sleep duration with stroke, we also observed the association of long sleep duration with stroke, especially among those aged 65 years or older.     

An investigation of the factors affecting development of frontal cortex self-stimulation

Intracranial self-stimulation (ICSS) of the medial prefrontal cortex (MFC) is acquired gradually, taking 4 or more days to establish. One explanation for this finding is that the stimulation becomes more rewarding with repetition. Four experiments were conducted to test this hypotheses. In Experiment 1, the MFC ICSS frequency thresholds remained constant over the first 3 weeks of testing while the rate of lever pressing response increased. In Experiment 2, it was found that acquisition of MFC ICSS was much more rapid when a motorically simpler response (nose-poking) was employed. Similarly, Experiments 3 and 4 further demonstrated that response factors such as task complexity may ultimately determine the rate of development of frontal cortex ICSS. Overall, these data suggest that independent of the rewarding effects of MFC stimulation there are other effects that initially interfere with learning of complex operant responses.     

An exploratory investigation of the influence of publication on translational medicine research

Background  

Changes in clinical practice are brought about by the weight of clinical evidence for and against an intervention. Clinical evidence of efficacy relies on the dissemination of research results, usually by publication in medical journals which is often seen as a pre-requisite for progression of an intervention through further clinical trials or implementation studies.     

The role of selective prescribing in the increased risk of VTE associated with third-generation oral contraceptives

In the early 1960s, it became apparent that oral contraception (OC) with oestroprogestogens increased the cardiovascular, venous thromboembolic (VTE), myocardial infarction (MI) and cerebrovascular accident (CVA) risk. The change in medical prescribing patterns, the reduction in ethinyloestradiol dosage and the use of less androgenic progestogens made prescribers confident that the risks would subsequently decrease. At the end of 1995 and early 1996, four publications called into question that optimism by showing that third-generation pills induced a two-fold increase in VTE risk compared with second-generation pills. A biological rationale was due to be announced later. Since then, re-analysis of the data has shown that the thrombotic risk factors are increased in third-generation OC users but, more importantly, that those users (unlike those using second-generation pills) are the women who have not had the opportunity of revealing a latent thrombophilia and are, therefore, at a greater risk of expressing it during third-generation OC intake. When these data are considered, the difference between second- and third-generation OC users in terms of VTE risk is completely destroyed. In addition and although the risk factors (smoking in particular) are concentrated in third-generation OC users, the MI risk is less in those users than in second-generation pill users. This is particularly true in the presence of a risk factor such as smoking. No difference in risk has been observed for CVA in the general population between second- and third-generation OC users, but once more among smoking women the risk is lower with third-generation OC.     

Chronic inhibition of cyclooxygenase-2 induces dendritic hypertrophy and limited functional improvement following motor cortex stroke

The cyclooxygenase-2 (COX-2) enzyme is part of the inflammatory pathway and is induced within the brain by a variety of pathological events, including ischemia. Pharmacological agents that inhibit COX-2 have been found to be neuroprotective in a number of injury models, and long-term administration of these drugs has been shown to induce plastic changes in the brain. In the current experiment, we investigated the effectiveness of stimulating cortical plasticity following stroke injury through the administration of the COX-2 inhibitor drug NS398. Furthermore, we determined whether the induced plastic changes improved functional outcome following motor cortex stroke. Chronic drug administration was found to induce dendritic hypertrophy in cells in the parietal cortex, and this anatomical change was associated with the animals making significantly more reach attempts, as well as successful reaches during a skilled reaching task. Additional motor tests however revealed that the treatment did not affect the level of motor recovery, as the animals showed chronic impairments in the Schallert cylinder, and the forepaw inhibition tasks. Short-term administration of the drug, immediately following the stroke did not induce any dendritic changes, nor was it found to improve behavioral performance on any of the motor tasks. Based on these results we conclude that the plastic changes that are induced by long-term COX-2 inhibitor administration provide some benefit to functional outcome following ischemic cortical injury.     

A longitudinal investigation of the influence of psychological factors on nausea and vomiting in early pregnancy

Archives of Women's Mental Health - The purpose of this study was to elucidate psychological factors that may influence nausea and vomiting during pregnancy (NVP) progression in early pregnancy...     

Psychosocial factors in the rehabilitation of elderly amputees

Fifty amputation patients, primarily elderly, were interviewed on admission to, and discharge from, an amputee rehabilitation unit. The patients were found to experience regular stages of psychological reaction to amputation. The authors draw several implications for intervention, including the need for realistic communication, provision of emotional and peer support at a time when patients are receptive to such help, and attention to practical concerns of the amputee.