认知-运动干预对大学生心理健康多维度的影响

目的:考察结合认知干预进行的体育锻炼对大学生心理健康多维度的影响。方法:于2004-03采用整体分层抽样方法抽取江西师范大学在校学生心理症状自评量表调查中排名前4位的“强迫症状”“人际敏感”“抑郁”“敌意”因子得分≥3分的学生23名作为被试,依据其“运动兴趣”、“运动项目的选择情况”,将其分入篮球组7名、健美操组8名和对照组8名。以篮球和健美操作为实验手段分别对被试进行认知-运动干预。篮球组认知干预强调成员之间的愉快合作性及合理的行为,以此改变对自我、行为和他人的认知,运动干预以篮球练习及教学比赛为主;健美操组注重引导学生的自我激励作用,即通过自我锻炼体验,来获得自我和他人的认同,以自编健美操套路锻炼为主。对照组不从事体育活动。实验时间8周,2次/周,30min/次。干预前后采用症状自评量表调查心理健康状况。该量表含有躯体化、强迫症状、人际敏感、抑郁、焦虑、敌意、恐怖、偏执、精神病性9个因子90个项目,以5级评分制计分,得分越高,表明心理健康水平越低。当心理因子得分≥2时,表明在此因子有轻度心理问题;当心理因子得分≥3时,表明在此因子上有中度以上心理问题。结果:23名被试自始至终参与整个实验干预过程,全部进入结果分析。①干预前各组学生症状自评量表的总均分及各项因子分差异均无显著性意义。说明各组被试干预前各心理因子的方差齐性检验呈现一致性,表明干预前各组样本较为均衡。②经过认知-运动实验干预后被试的心理因子产生积极变化,干预后各组间总均分、人际敏感因子分差异有显著性意义(P≤0.05),躯体化、抑郁、敌意因子分的差异有极显著性意义(P≤0.01)。③对照组实验后绝大多数的心理因子平均得分相对于实验前都有升高,其中躯体化和敌意因子得分差异有显著性意义[躯体化:(2.50±0.52),(1.95±0.65),P=0.046];[敌意:(2.65±0.71),(2.04±0.66),P=0.041]。与干预前比较,健美操组干预后强迫、偏执性因子得分降低,差异有显著性[强迫:(2.88±0.73),(2.15±0.52),P=0.052];[偏执:(2.58±0.83),(2.02±0.31),P=0.027]。篮球组干预后抑郁、敌意因子得分降低,差异有显著性[抑郁:(2.19±0.68),(1.58±0.38),P=0.012];[敌意:(2.33±0.95),(1.36±0.24),P=0.034]。干预后干预组其余各项因子的平均得分较之干预前也都有一定幅度的下降,差异无显著性。结论:以篮球和健美操作为实验手段的认知-运动干预能对大学生的心理健康具有较明显的改善作用,可促使其心理健康总体水平发生积极变化。     

Diagnosis of solid breast lesions by elastography 5-point score and strain ratio method

Purpose

To compare the diagnostic performance of 5-point scoring system and strain ratio by sonoelastography in the assessment of solid breast lesions.

Material and methods

One hundred and eighty-seven solid masses in 155 patients were scanned by two-dimensional ultrasonography and sonoelastography. Elasticity scores were determined with a 5-point scoring method, and the strain ratio was based on the comparison of the average strain measured in the lesion with the adjacent breast tissue in the same depth. Pathological results were taken as gold standards to compare the diagnostic efficacy of two methods with clinical diagnostic test and receiver operating characteristic (ROC) curves.

Results

Among 187 lesions, 130 were benign and 57 were malignant. The mean scores (1.62 ± 0.69 vs 4.07 ± 0.26, P < 0.05) and strain ratios (2.06 ± 1.27 vs 6.66 ± 4.62, P < 0.05) were significantly higher of malignant than benign lesions. The area under the curve for the 5-point scoring system and for strain ratio-based elastographic analysis was 0.892 and 0.909, respectively (P > 0.05). For 5-point scoring, sonoelastography had 84.2% sensitivity, 84.6% specificity, 84.5% accuracy, 70.6% positive predictive value and 92.4% negative predictive value. When a cutoff point of 3.06 was used, sensitivity, specificity, accuracy, positive and negative predictive values were 87.7%, 88.5%, 88.2%, 76.9% and 94.3%, respectively for the strain ratio (P > 0.05).

Conclusions

The 5-point scoring system and strain ratio has similar diagnostic performance, and the strain ratio could be more objective to differentiate the masses when those masses were difficult to be judged by using 5-point scoring system in sonoelastographic images.     

低氧诱导因子-1α和血管内皮生长因子在玉树地震救援人员急性高原反应低氧性肺动脉高压发生中的作用

目的 观察低氧诱导因子-1α(HIF-1α)和血管内皮生长因子(VEGF)在急性高原反应(AHAR)低氧性肺动脉高压(HPH)发生中的作用及返回低海拔后的变化。方法 选择2010年4月14日青海玉树大地震后由低海拔(1 500m)快速进入高海拔地区(3 700m)并从事重体力劳动的18～35岁男性官兵96名,根据AHAR症状评分分为无AHAR组(25名)、轻中度AHAR组(47名)和重度AHAR组(24名);在高海拔地区停留50 d后下撤前及返回低海拔地区后12h、15d分别测定平均肺动脉压(mPAP)和血清HIF-1α、VEGF水平。同时选择低海拔地区50名健康官兵作为对照。结果 高海拔无AHAR组mPAP(mm Hg,1 mm Hg=0.133 kPa)和血清HIF-1α(pg/L)、VEGF(ng/L)水平（分别为24.23±1.56、68.80±7.52、82.56±6.32）明显高于低海拔对照组(18.50±1.30、50.95±3.33、65.78±4.03);且随AHAR加重,各指标进一步升高,高海拔轻中度AHAR组分别为28.42±1.32、88.10±9.20、104.82±10.36,重度AHAR组分别为34.70±2.94、117,93±13.46、136.77±12.03,组间两两比较差异均有统计学意义(均P＜0.01)。高海拔AHAR总计分与mPAP、血清HIF-1α、VEGF水平均呈显著正相关(r值分别为0.672、0.737、0.634,均P＜0．01);mPAP与血清HIF- 1α、VEGF水平呈显著正相关(r值分别为0.706、0.638,均P＜0.01)。与低海拔对照组比较,96名官兵进入高海拔地区50 d时mPAP (mm Hg)和血清HIF- 1α (pg/I)、VEGF (ng/L)水平（分别为29.08±4.22、91.16±20.58、107.11±10.32）显著升高(均P＜0.01),返回低海拔地区12 h(分别为23.05±3.18、70.99±8.22、78.65±6.47)、15 d（分别为18.96±1.75、52.31±4.92、63.08±4.55）时各指标显著下降,且15d明显低于12 d(均P＜0．01),15d时各指标与低海拔对照组比较差异均无统计学意义(均P＞0.05)。结论 人体在高海拔低氧地区并从事重体力劳动时,AHAR越重,mPAP和血清HIF-1α、VEGF水平就越高,说明HPH与HIF-1α、VEGF水平升高有密切关系;返回低海拔地区后12h上述指标有显著改善,15d可恢复到正常水平。     

Clofazimine analogs with efficacy against experimental tuberculosis and reduced potential for accumulation

The global tuberculosis crisis urgently demands new, efficacious, orally available drugs with the potential to shorten and simplify the long and complex treatments for drug-sensitive and drug-resistant disease. Clofazimine, a riminophenazine used for many years to treat leprosy, demonstrates efficacy in animal models of tuberculosis via a novel mode of action. However, clofazimine's physicochemical and pharmacokinetic properties contribute to side effects that limit its use; in particular, an extremely long half-life and propensity for tissue accumulation together with clofazimine's dye properties leads to unwelcome skin discoloration. We recently conducted a systematic structure-activity study of more than 500 riminophenazine analogs for anti-Mycobacterium tuberculosis activity. We describe here the characteristics of 12 prioritized compounds in more detail. The new riminophenazine analogs demonstrated enhanced in vitro activity compared to clofazimine against replicating M. tuberculosis H37Rv, as well as panels of drug-sensitive and drug-resistant clinical isolates. The new compounds demonstrate at least equivalent activity compared to clofazimine against intracellular M. tuberculosis and, in addition, most of them were active against nonreplicating M. tuberculosis. Eleven of these more water-soluble riminophenazine analogs possess shorter half-lives than clofazimine when dosed orally to mice, suggesting that they may accumulate less. Most importantly, the nine compounds that progressed to efficacy testing demonstrated inhibition of bacterial growth in the lungs that is superior to the activity of an equivalent dose of clofazimine when administered orally for 20 days in a murine model of acute tuberculosis. The efficacy of these compounds, along with their decreased potential for accumulation and therefore perhaps also for tissue discoloration, warrants further study.     

Electrophysiologic and electrocardiographic characteristics of focal atrial tachycardia arising from superior tricuspid annulus

Objectives: This study describes the electrophysiologic and electrocardiographic characteristics of focal atrial tachycardia (AT) arising from superior tricuspid annulus in six (1.9%) patients of a consecutive series of 320 patients. Methods: Six patients (mean age 42 ± 22 years) with a mean cycle length of 326 ms of a consecutive series of 320 patients undergoing radiofrequency ablation for focal AT were mapped. Results: During electrophysiologic study, tachycardia could be induced in five patients with programmed atrial extrastimuli while a spontaneous onset and offset with ‘warm‐up and cool‐down’ phenomenon was seen in the other patient. During tachycardia, P‐wave morphology in Lead I, II, III and aVF was upright in all the six patients. The precordial leads were dominantly negative or isoelectric in V₁–V₂ and positive in V₅–V₆ with a transition at V₃ or V₄. Moreover, the tachycardia was sensitive to intravenous administration of adenosine triphosphate in five of six patients. Conclusions: Radiofrequency ablation was performed successfully in all patients (mean 4.5 ± 1.2 applications). No recurrence of AT was observed after a mean follow‐up of 8 ± 6 months. Thus, AT arising from superior tricuspid annulus is rare. Radiofrequency ablation of this kind of AT is safe and effective.     

The stem cell niches in bone

The stem cell niche is composed of a specialized population of cells that plays an essential role in regulating adult stem cell self-renewal and differentiation. In adults, osteoblasts, responsible for osteogenesis, and hematopoietic cells, responsible for hematopoiesis, are closely associated in the bone marrow, suggesting a reciprocal relationship between the two. It was recently discovered that a subset of osteoblasts functions as a key component of the HSC niche (namely, the osteoblastic niche), controlling HSC numbers. HSCs interact not only with osteoblasts but also with other stromal cells, including endothelial cells. Sinusoidal endothelial cells in bone marrow have been revealed as an alternative HSC niche called the vascular niche. In this Review we compare the architecture of these 2 HSC niches in bone marrow. We also highlight the function of osteoblasts in maintaining a quiescent HSC microenvironment and the likely role of the vascular niche in regulating stem cell proliferation, differentiation, and mobilization. In addition, we focus on studies of animal models and in vitro assays that have provided direct insights into the actions of these osteoblastic and vascular niches, revealing central roles for numerous signaling and adhesion molecules. Many of the discoveries described herein may contribute to future clinical treatments for hematopoietic and bone-related disorders, including cancer.     

急诊科急救药品管理登记簿的临床应用

随着人们物质需求和生活质量的不断提高，国家对法制化建设也更加重视和完善。在药品有效期的管理上，1985年7月1日施行的原《药品管理法》中对产品时间规定了注明“产品批号”；2001年12月1日起施行的新修订的《药品管理法》中在此基础上又做出了明确的增补性修订，规定药品标签或说明书上必须注明产品批号、生产日期、有效期等内容。这就说明识别药品的有效期、失效期对保证消费者用药的安全有效至关重要。但在急救工作中发现，急救药品的取用需要更为有效的方案，来保证取用及时、如数补齐，避免使用失效药品。我们在急诊护理工作中实行了急救药品管理登记簿制度，有效地减少了差错事故的发生，保证了用药安全。现将使用情况介绍如下。     

Short-term Safety and Efficiency of Cryoablation for Renal Sympathetic Denervation in a Swine Model

Background:

Renal sympathetic nerves are involved in the reflective activation of the sympathetic nervous system in circulatory control. Catheter-based renal denervation (RDN) ameliorated treatment-resistant hypertension safely, but 10%–20% of treated patients are nonresponders to radiofrequency denervation. The purpose of this study was to investigate the safety and efficiency of cryoablation for sympathetic denervation in a swine model and to explore a new way of RDN.

Methods:

Seven swines randomly assigned to two groups: Renal cryoablation (CR) group and control group. The control group underwent renal angiogram only. The CR group underwent renal angiogram plus bilateral renal cryoablation. Renal angiograms via femoral were performed before denervation, after denervation and prior to the sacrifice to access the diameter of renal arterial and the pressure of aorta abdominalis. Euthanasia of the swine was performed on 28-day to access norepinephrine (NE) changes of the renal cortex and the changes of renal nerves.

Results:

Cryoablation did not induce severe complications at any time point. There was no significant change in diameter of renal artery. CR reduced systolic blood pressure (BP) from 145.50 ± 9.95 mmHg at baseline to 119.00 ± 14.09 mmHg. There was a slight but insignificant decrease in diastolic BP. The main nerve changes at 28-day consisted of necrosis with perineurial fibrosis at the site of CR exposure in conjunction with the nerve vacuolation. Compared with the control group, renal tissue NE of CR group decreased by 89.85%.

Conclusions:

Percutaneous catheter-based cryoablation of the renal artery is safe. CR could effectively reduce NE storing in the renal cortex, and the efficiency could be maintained 28-day at least.     

Spinal Cord Kinking in Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum

Background:

Ossification of the ligamentum flavum (OLF) is being increasingly recognized as a cause of thoracic myelopathy. This study was to describe a rare clinical entity of spinal cord kinking (SK) in thoracic myelopathy secondary to OLF.

Methods:

The data of 95 patients with thoracic myelopathy secondary to OLF were analyzed retrospectively. The incidence and location of SK were determined using preoperative magnetic resonance imaging (MRI). The clinical presentation and radiological characteristics in patients with SK were analyzed. Posterior en bloc laminectomy with OLF was performed, and the surgical results were evaluated.

Results:

SK was found in seven patients (7.4%) based on preoperative MRI. The patients included one male and six females with an average age of 55.6 years (range, 48–64 years). Five patients presented with radiculomyelopathy and two presented with typical thoracic myelopathy of spastic paraparesis. In all cases, the kinking was located just above the end of the spinal cord where the conus medullaris (CM) was compressed by the OLF. The degree of SK varied from mild to severe. The tip of the CM was located between the upper third of T11 to the lower third of L1, above the lower edge of L1. With an average follow-up of 30.4 months, the modified Japanese Orthopedic Association score significantly improved from 5.7 ± 1.8 preoperatively to 8.9 ± 1.4 postoperatively (t = 12.05; P < 0.0001) with an improvement rate of 63.1 ± 12.3%.

Conclusions:

SK is a rare radiological phenomenon. It is typically located at the thoracolumbar junction, where the CM is compressed by the OLF. Our findings indicate that these patients may benefit from a posterior decompressive procedure.     

不同剂量芬太尼麻醉对小儿唇腭裂手术中平均动脉压及心率的影响

目的:研究不同剂量芬太尼麻醉对小儿唇腭裂手术患儿血流动力学参数及苏醒过程的影响。方法:随机选取60例先天性唇腭裂手术患儿,平均分为A、B、C三组,每组20例,分别给予芬太尼3、5、7μg/kg,观察患儿心率(HR)、平均动脉压(MAP)、苏醒时间以及嗜睡、躁动、恶心呕吐等不良反应情况。结果:3组中,B组患儿在麻醉过程中血流动力学参数(HR和MAP)最稳定,不同时点间差异无统计学意义(P<0.05);B组患儿苏醒时间平均(18.9±5.6)min,居A、C两组之间,不良反应较少,其中嗜睡1例,躁动2例,恶心呕吐病例1例。结论:小儿唇腭裂手术麻醉诱导时用5μg/kg剂量的芬太尼,可以维持稳定的血流动力学,更安全。