“不能解释的躯体症状”患者医患互动的调查

目的探讨以＂不能解释的躯体症状＂就诊于综合医院的患者医患互动的特点,了解影响＂不能解释的躯体症状＂患者医患互动的相关因素。方法在综合医院心身科、中医科、神经内科、妇产科调查以躯体主诉就诊但没有发现器质性原因的患者,纳入标准为躯体形式障碍筛查量表（SOMS）≥9分且排除躯体器质性疾病及精神病性障碍者,收集到研究样本98名。对患者和主治医生分别进行问卷测评,问卷包括：治疗满意度调查、病因及治疗问卷（IPQ）、医院焦虑/抑郁情绪量表（HADS）。结果 42%的患者人均求医次数超过12次,40%的患者认为医生不理解自己;焦虑在界值分（〉9分）以上的患者比例为72.8%,抑郁在界值分（〉9分）以上的患者比例为55.4%;患者认为自己症状最可能的3个病因是情绪问题（70.1%）、过度劳累（68.4%）和年龄增长（61.2%）;患者认为最重要的3个病因是压力及担心（30.6%）,情绪问题（26.5%）,年龄增长（21.4%）;患者对于当前治疗过程的评价,好于医生认为患者对于当前治疗过程的评价,差异具有统计学意义（t=2.82,P〈0.05）;不同科室患者当前治疗满意度和治疗评价的差异有统计学意义（t=3.73,P〈0.05）。结论医患之间对患者病因的认知以及治疗过程满意度有差异;＂不能解释的躯体症状＂患者多伴有明显的焦虑抑郁症状。     

Pharmacokinetic and tissue distribution of doxycycline in broiler chickens pretreated with either: Diclazuril or halofuginone

Following IV injection of doxycycline in a dose of 20 mg kg⁻¹ b.wt., its serum concentration was best fitted in two-compartment open model in chickens fed either on control or on anticoccidials-containing rations. Diclazuril and halofuginone resulted in a significant short distribution half-life (t_½α) (7.17 ± 0.39 and 11.88 ± 1.05 min, respectively) and increased total body clearance (Cl_tot) 0.37 ± 0.024 and 0.295 ± 0.034 L/kg/h, respectively. Following oral dosing the tested drug absorbed with t_½ab of 41.38 ± 1.6, 17.48 ± 0.86 and 41.83 ± 1.8 min, respectively and their C_max values (3.18 ± 0.18, 5.425 ± 0.48 and 0.986 ± 0.037 μg/ml) were attained at 2.07 ± 0.097, 1.403 ± 0.074 and 2.55 ± 0.106 h. For doxycycline alone and in presence of diclazuril and halofuginone, respectively. Systemic bioavailability was 22.64 ± 3.46, 86.74 ± 9.23 and 22.38 ± 3.09%, respectively. Following IM injection t_½ab were 9.096 ± 1.34 for doxycycline alone, 16.24 ± 2.21 and 15.6 ± 1.7 min in the presence of diclazuril and halofuginone, respectively. C_max was 3.10 ± 0.28, 4.63 ± 0.57 and 0.55 ± 0.07 μg/ml reached at 0.8 ± 0.083, 1.13 ± 0.126 and 1.21 ± 0.105 h. For the antibiotic alone, and in presence of either diclazuril and halofuginone, respectively. Systemic bioavailability was 22.41 ± 3.86, 88.97 ± 12.9 and 12.31 ± 0.99% in chickens fed on anticoccidial-free, diclazuril- and halofuginone-containing rations, respectively. Both the tested anticoccidials induced higher doxycycline tissue residues in all tested tissue samples.     

上海市部分地区中老年人抑郁状况调查

目的了解上海市中老年人抑郁症状比例,分析其影响因素,为改善该种状况的相关工作提供参考依据。方法随机抽取790名社区和敬老院50岁及以上中老年人进行抑郁症状及相关影响因素的问卷调查。结果中老年人有抑郁症者占12.7%;其中女性、年龄偏大者、文化程度较低者、丧偶者、经济阶层低者、与家庭关系紧张者、患慢性病者的抑郁症状比例均高于其他。结论中老年人抑郁状况的严重程度不容忽视,社会和家庭应多关注中老年人的心理健康,中老年人要增强自我心理调节。     

肺部超声在支气管肺泡灌洗治疗新生儿肺不张效果评估中的应用价值

目的探讨肺部超声动态评估支气管肺泡灌洗(BLA)治疗新生儿肺不张的效果。方法收集我院新生儿重症监护室收治的60例肺不张患儿,经肺部超声标记肺不张的部位后行纤维支气管镜下BLA治疗。每次治疗后均行肺部超声检查观察肺不张恢复程度以决定是否继续进行灌洗。记录肺部啰音消失时间、机械通气时间及抗生素使用时间;比较治疗前及治疗1周后的酸碱度、动脉血氧饱和度(SaO_2)、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2);观察患儿治疗效果及不良反应发生情况。结果 60例患儿肺部啰音消失时间、机械通气时间及抗生素使用时间分别为(5.34±1.21)d、(7.15±1.30)d、(8.10±2.07)d,治愈率为86.67%、有效率为11.67%。其中灌洗4~5次患儿12例,均治愈;灌洗6~7次患儿28例,治愈25例、有效3例;灌洗8~9次患儿20例,治愈15例、有效4例、无效1例。治疗后1周SaO_2、PaO_2均较治疗前明显增高,PaCO_2较治疗前明显降低,差异均有统计学意义(均P0.05)。在治疗过程中无肺水肿、呼吸困难、气胸、心脏骤停等严重不良反应发生,出现哭声嘶哑4例、气管黏膜损伤6例、低氧血症20例,均经治疗后好转。结论肺部超声能动态评估纤维支气管镜下BLA治疗新生儿肺不张的疗效,具有重要的临床应用价值。     

Gallbladder bile: an experimental study in dogs using MR imaging and proton MR spectroscopy

Magnetic resonance (MR) imaging, proton MR spectroscopy, and biochemical analysis were performed to investigate MR signal intensity (SI) differences between concentrated and dilute gallbladder bile of seven fasting and five sincalide-treated dogs. MR images revealed high SI from bile of fasting dogs and low to medium SI in sincalide-treated dogs when spin-echo (SE) pulse sequences with repetition rates of 0.5 and 2.0 sec were used. Proton MR spectra were similar for fasting and sincalide-treated dogs. In fasting dogs, water content in the bile was slightly lower, and cholesterol, phospholipid, and bile acid concentrations were higher. More than 90% of proton signals in all Fourier transform free induction decay spectra emanated from water molecules, and no lipid proton resonances were detected in Fourier transform SE spectra after tau delays of 7 msec. These results indicate that the differences in SI are caused by alterations in relaxation times of water protons, possibly resulting from the interactions of water protons and macromolecules.     

Perirectal inflammatory disease: CT findings

The findings on computed tomographic (CT) scans were reviewed in 42 patients with perirectal inflammatory disease and suspected perirectal abscesses. CT was reliable for use in distinguishing perirectal abscesses from cellulitis and in localizing both supralevator and infralevator abscesses. CT allowed correct diagnosis of 13 surgically proved perirectal abscesses in ten patients, including three with residual abscesses after surgical drainage. In three patients with supralevator abscesses, the abscess was missed on initial surgical exploration. In patients without abscesses, CT was helpful in evaluating the extent of perirectal inflammation; however, it was not possible to determine its cause. The anatomy on CT scans of the pararectal spaces is reviewed, with emphasis on useful anatomic landmarks in the axial plane for distinguishing supralevator from infralevator abscesses.