白介素与溃疡性结肠炎

近年来对白介素(interleukin,IL)和溃疡性结肠炎(ulcerative colitis,UC)的研究取得了很大进展,我们通过总结整理以前有关IL和UC的文献,概括出IL的产生和在UC发病及病理变化中的作用机制:IL-1直接介导了UC初期阶段炎症的发生:IL-8、IL-6直接促进炎性细胞过度分泌和/或抑制了炎性细胞的凋亡,IL-2分泌减少导致免疫系统内细胞间网络调节失衡, 使局部炎症介质和自由基释放,引起细胞毒作用,IL主要通过影响机体整体和/或局部免疫系统的功能介导UC的产生,并与UC的迁延难愈和反复发作有关．     

The Stressful Caregiving Adult Reactions to Experiences of Dying (SCARED) Scale: a measure for assessing caregiver exposure to distress in terminal care.

OBJECTIVE: The authors evaluated the performance of the Stressful Caregiving Adult Reactions to Experiences of Dying (SCARED) scale, a new tool to assess caregiver exposure to patient distress, and the fear and helplessness evoked by these experiences. METHODS: The SCARED was administered to 76 hospice-patient caregivers (e.g., family members). Major depressive disorder (MDD) was diagnosed with the Structured Clinical Interview for the DSM-IV; complicated grief (CG) "caseness" was diagnosed with the Inventory of Complicated Grief-Caregiver items, and quality-of-life domains were assessed with the Medical Outcomes Survey Short Form-36. RESULTS: Respondents endorsed frequent exposure to each SCARED experience-from 30.3% who mistakenly thought the patient had died, to 80.3% who witnessed the patient in severe pain. Adjusted analyses revealed that the odds of MDD increased by 3.08 for each standard-deviation increase in the SCARED event frequency score and that higher SCARED scores were positively associated (p <0.05) with social and role impairment, less energy, and more negative health perceptions. CONCLUSION: The SCARED may be a clinically useful tool for identifying caregivers at risk for MDD and quality-of-life impairments, as well as potential aspects of caregiving to target for treatment.     

Religious coping,health, and health service use among bereaved adults

OBJECTIVE: This report examined associations between religious coping, health, and health service use among a sample of 265 recently bereaved adults. METHOD: Participants were interviewed an average of 6.3 (SD = 7.4) months after their loss and again 4 months later. Multivariate regression models and repeated measures ANOVA analyses estimated the influence of religious coping on health and health service use at baseline and follow-up, controlling for significant confounding influences, such as health promoting behaviors. RESULTS: At baseline, those high on religious coping had significantly more functional disabilities than did those low on religious coping. Controlling for health status, participants with higher religious coping scores were significantly less likely to visit their doctor during the 60 days prior to the baseline interview. Despite worse health and less health service use at baseline, those high on religious coping had equivalent health status to those low on religious coping at follow-up. CONCLUSIONS: Greater use of religious coping is associated with more functional disabilities and fewer outpatient physical health care visits at baseline, but a lack of decline in health at 4-month follow-up among the bereaved, a sub-group at risk for numerous health impairments. Possible reasons for this association and its implications are discussed.     

Perceived needs and service use of Spanish speaking monolingual patients followed at a Hispanic clinic

This study compared Spanish speaking monolingual patients at a Hispanic Clinic, with Hispanics and non-Hispanics at a conventional mental health center. A questionnaire in English and Spanish surveyed sociodemographic characteristics and subjectively reported health needs. The monolingual Hispanic Clinic patients perceived a significantly greater need for help with health and benefits, and better access to physical health care providers. Hispanics seen at the Hispanic Clinic report more difficulties managing medications than the other groups suggesting that this problem is not adequately addressed by receiving services in a culturally sensitive clinic, possibly due to the persistent effect of language barriers and low level of education. Additional interventions may be needed to address this problem.     

Perspectives on care at the close of life. Caring for bereaved patients: "all the doctors just suddenly go"

Despite the frequency with which physicians encounter bereaved patients, medical training offers little guidance in the provision of bereavement ("after") care. Physicians are often uncertain of how to distinguish between normal and pathological grief reactions in their bereaved patients, and how to manage their health care. Bereavement is associated with declines in health, inappropriate health service use, and increased risk of death. Identifying and intervening on behalf of bereaved patients could help address those increased risks. We examine the experience of a woman widowed for 2 years to illustrate distinctions between symptoms and outcomes of uncomplicated and complicated grief, recommend approaches to physician interactions with bereaved patients, and offer guidelines for professional intervention in aftercare.     

Advanced dementia research in the nursing home: the CASCADE study

Despite the growing number of persons with advanced dementia, and the need to improve their end-of-life care, few studies have addressed this important topic. The objectives of this report are to present the methodology established in the CASCADE (Choices, Attitudes, and Strategies for Care of Advanced Dementia at the End-of-Life) study, and to describe how challenges specific to this research were met. The CASCADE study is an ongoing, federally funded, 5-year prospective cohort study of nursing [nursing home (NH)] residents with advanced dementia and their health care proxies (HCPs) initiated in February 2003. Subjects were recruited from 15 facilities around Boston. The recruitment and data collection protocols are described. The demographic features, ownership, staffing, and quality of care of participant facilities are presented and compared to NHs nationwide. To date, 189 resident/HCP dyads have been enrolled. Baseline data are presented, demonstrating the success of the protocol in recruiting and repeatedly assessing NH residents with advanced dementia and their HCPs. Factors challenging and enabling implementation of the protocol are described. The CASCADE experience establishes the feasibility of conducting rigorous, multisite dementia NH research, and the described methodology serves as a detailed reference for subsequent CASCADE publications as results from the study emerge.     

Effect of white cells on platelets during storage

White cells (WBCs) present in stored platelet concentrates have adverse effects on platelet function and on posttransfusion recovery. Although these effects have been attributed to the fall in pH that results from active WBC metabolism, platelets stored in gas-permeable storage bags still exhibit abnormalities, despite maintenance of a stable pH of greater than 6.0. The changes in platelet proteins and function brought about by storage with a controlled number of WBCs were studied. Twelve platelet-pheresis specimens were centrifuged at 180 x g to achieve a WBC count of less than 2 x 10(5) per mL (which contained less than 10% granulocytes). These specimens were split into two aliquots and placed in platelet bags for storage at 22 degrees C with constant horizontal agitation. Neutrophils, obtained from the same donor by centrifugation of 50 mL of whole blood through a discontinuous ficoll gradient, were added to one of the two platelet storage bags to achieve a final neutrophil count of 1 x 10(6) per mL. Platelet aliquots were removed and studied on Days 3 and 5. In platelets stored without neutrophils, the average response to ristocetin, using the mean slope as an index of platelet responsiveness, was 10.3 (n = 9, SD = 11) on Day 3, whereas for the platelets stored with neutrophils, it was 1.25 (n = 12, SD = 0.9, p less than 0.01). Significant differences were also seen on Day 5 (slope = 4.5 for platelets stored without neutrophils, slope = 0.3 for platelets stored with neutrophils, p less than 0.01). Platelet aggregation with 8 microM ADP and 1.5 mg per mL of collagen did not differ significantly.(ABSTRACT TRUNCATED AT 250 WORDS)