室间隔缺损部分修补的大动脉调转术的护理配合

总结了5例室间隔缺损部分修补的大动脉调转术的护理配合经验。洗手护士熟悉手术方法及步骤，充分准备所需器械和缝线，熟练配合；巡回护士注意手术进展，按要求配置心血管活性药物，正确使用降温厦复温辅助设施，预见可能出现的问题并做好应急准备，才能确保手术顺利进行。     

The Influence of Autonomic Neuropathy on Mortality in Insulin-dependent Diabetes

Five-year survival was investigated in 506 randomly selectedpatients with insulin-dependent diabetes mellitus screened forautonomic neuropathy with a series of cardiac autonomic functiontests. Of the 484 diabetics traced, 44 (9 per cent) had died. The cumulative 5-year mortality rate was increased more thanfive-fold in those with autonomic neuropathy: 27 per cent vs.5 per cent in those with normal autonomic function. Discriminantanalysis of survivors and non-survivors showed that autonomicneuropathy was the most important independent predictor of death.Among those who died, autonomic neuropathy was associated withan increased frequency of retinopathy and peripheral neuropathyand a slightly lower frequency of macrovascular disease. Autonomicneuropathy was associated with an increased mortality rate fromrenal failure, but not from any other causes.     

Early and late components of error monitoring in violent offenders with psychopathy

BACKGROUND: One of the most recognizable features of psychopathy is the reduced ability to successfully learn and adapt overt behavior. This might be due to deficient processing of error information indicating the need to adapt controlled behavior. METHODS: Event-related potentials (ERPs) and behavioral components of error-monitoring processes were investigated in 16 individuals with psychopathy and in 18 healthy subjects. A letter version of the Eriksen flanker task was used in two conditions. The first condition (normal condition) required participants to press one of two buttons depending on the identity of the target stimulus. The second condition (signaling condition) required them to signal each time they had committed an error by making a second press on a signaling button. Early stages of error monitoring were investigated by using the error-related negativity (ERN/Ne) and post-error slowing as indexes. Later stages were explored by examining the error positivity (Pe) and signaling rates. RESULTS: Both groups showed similar ERN amplitudes and amounts of post-error slowing. The psychopathic group exhibited both reduced Pe amplitudes and diminished error-signaling rates compared with the control group. CONCLUSIONS: Individuals with psychopathy show intact early error processing and automatic behavioral adaptation but have deficits in later stages of error processing and controlled behavioral adaptation. This is an indication that individuals with psychopathy are unable to effectively use error information to change their behavior adequately.     

以眼部症状为首发的额、筛囊肿16例临床分析

目的：探讨以眼部症状为首发的额、筛囊肿的诊断及经鼻内镜手术治疗的疗效。方法：回顾性分析2006—02—2008—03期间收治的16例额、筛囊肿患者的临床资料。结果：16例患者中鼻窦MRI及CT检查诊断符合率为100％。14例患者经鼻内镜手术治疗后眼部症状消失,2例好转。随访3～6年,至今均无复发,疗效满意。结论：鼻窦与眼眶关系密切,鼻窦病变患者常首诊于眼科;MRI及CT检查结果对确诊很有价值。对于以眼部症状为主症的额、筛囊肿患者应及早确诊;鼻内镜手术治疗是安全有效的首选治疗方法。     

Birth weight,childhood body mass index,and height in relation to mammographic density and breast cancer: a register-based cohort study

Introduction

High breast density, a strong predictor of breast cancer may be determined early in life. Childhood anthropometric factors have been related to breast cancer and breast density, but rarely simultaneously. We examined whether mammographic density (MD) mediates an association of birth weight, childhood body mass index (BMI), and height with the risk of breast cancer.

Methods

13,572 women (50 to 69 years) in the Copenhagen mammography screening program (1991 through 2001) with childhood anthropometric measurements in the Copenhagen School Health Records Register were followed for breast cancer until 2010. With logistic and Cox regression models, we investigated associations among birth weight, height, and BMI at ages 7 to 13 years with MD (mixed/dense or fatty) and breast cancer, respectively.

Results

8,194 (60.4%) women had mixed/dense breasts, and 716 (5.3%) developed breast cancer. Childhood BMI was significantly inversely related to having mixed/dense breasts at all ages, with odds ratios (95% confidence intervals) ranging from 0.69 (0.66 to 0.72) at age 7 to 0.56 (0.53 to 0.58) at age 13, per one-unit increase in z-score. No statistically significant associations were detected between birth weight and MD, height and MD, or birth weight and breast cancer risk. BMI was inversely associated with breast cancer, with hazard ratios of 0.91 (0.83 to 0.99) at age 7 and 0.92 (0.84 to 1.00) at age 13, whereas height was positively associated with breast cancer risk (age 7, 1.06 (0.98 to 1.14) and age 13, 1.08 (1.00 to 1.16)). After additional adjustment for MD, associations of BMI with breast cancer diminished (age 7, 0.97 (0.88 to 1.06) and age 13, 1.01 (0.93 to 1.11)), but remained with height (age 7, 1.06 (0.99 to 1.15) and age 13, 1.09 (1.01 to 1.17)).

Conclusions

Among women 50 years and older, childhood body fatness was inversely associated with the breast cancer risk, possibly via a mechanism mediated by MD, at least partially. Childhood tallness was positively associated with breast cancer risk, seemingly via a pathway independent of MD. Birth weight was not associated with MD or breast cancer in this age group.     

Impact of bowel obstruction at the time of initial presentation in women with ovarian cancer

Objective  To determine whether the presence of bowel obstruction at the time of initial presentation has any prognostic significance in these women.
Design  Retrospective cohort study.
Setting  Dedicated gynaecological oncology service of a large tertiary institution.
Population  Women who had a bowel obstruction as part of their initial presentation of ovarian cancer were identified between 1995 and 2007. Each woman was matched with four control women (with disease but no obstruction).
Methods  Women with disease were compared with controls to determine the impact, if any, of bowel obstruction at presentation. Several prognostic variables including bowel obstruction were also evaluated in a Cox proportional hazard model.
Main outcome measures  Progression-free survival (PFS) and overall survival (OS).
Results  Forty-eight women with disease and 192 controls were identified during the study period. The median follow-up period was 19 months among women with disease versus 20 months in controls. No differences were seen in demographics and clinical characteristics of the women. Optimal cytoreduction rate was similar between the two groups (75% versus 78%, P  = 0.7). Patients with bowel obstruction had a shorter PFS and OS compared with controls [19 months versus 21 months ( P  = 0.01) and 22 versus 35 months ( P  = 0.008)], respectively. Bowel obstruction at presentation was an independent prognostic variable with a hazard ratio of 1.5 ( P  = 0.009). Other prognostic variables were age, stage and extent of surgical cytoreduction.
Conclusions  Bowel obstruction at the time of initial presentation is an adverse prognostic factor in women with ovarian cancer.     

荔湾区2010～2013年艾滋病自愿咨询检测结果及影响因素分析

目的探讨艾滋病自愿咨询人群血清学检测结果及其影响因素,为荔湾区今后更好的开展VCT服务提供依据。方法以2010~2013年在荔湾区各VCT门诊接受VCT服务并登记上报的求询者作为研究对象,按照《全国艾滋病检测技术规范(2009)》要求开展HIV抗体初筛检测,阳性标本合做梅毒、丙肝、乙肝检测。采用非条件Logistic回归分析影响艾滋病自愿咨询人群艾滋病感染的相关因素。结果共调查艾滋病自愿咨询检测者6 423人,其中男性2 787人,占43.4%,女性3 636人,占56.6%;年龄集中在(32.4±10.8)岁。HIV抗体阳性98例,占1.5%,其中1例同时呈HIV、梅毒、丙肝、乙肝阳性,合并四重感染率为1%;HIV、丙肝合并感染者有42例,双重感染率为42.9%;HIV、梅毒合并感染有20例,双重感染率为20.4%;HIV、乙肝合并感染有8例,双重感染率为8.16%。经Logistic回归分析显示:对艾滋病自愿咨询检测人群艾滋病感染的影响因素是年龄、职业和人群特征。年龄段在21~60岁,吸毒者、同性恋、阳性配偶者为艾滋病感染的风险人群。结论政府组织与各部门共同担责,改进并完善自愿咨询检测服务,加强对艾滋病感染风险人群检测,向"零"艾滋迈进。     

Antidiarrhoeal activity of leaf methanolic extract of Rauwolfia serpentina

Objective

To evaluate the antidiarrhoeal property of methanol extract of the leaves of Rauwolfia serpentina (R. serpentina) in experimental diarrhoea induced by castor oil in mice.

Methods

Doses of 100, 200 and 400 mg/kg R. serpentina leaf methanol extracts were administered to castor oil induced diarrhoea mice to determine its antidiarrhoeal activity.

Results

All doses of the extract and the reference drug atropine sulphate (3 mg/kg, i.p.) produced a dose-dependent reduction in intestinal weight and fluid volume. The extracts also significantly reduced the intestinal transit in charcoal meal test when compared to diphenoxylate Hcl (5 mg/kg, p.o.).

Conclusions

The results show that the extract of R. serpentina leaves has a significant antidiarrhoeal activity and supports its traditional uses in herbal medicine.     

A new technique for repair of aortic coarctation. Subclavian flap aortoplasty with preservation of arterial blood flow to the left arm

From February 1984 to March 1986, 28 patients underwent a new technique of coarctation repair. This technique consists of a complete mobilization of the left subclavian artery extended to the origin of its first branches. The aorta need not be extensively mobilized and the intercostal arteries are individually controlled with snares. After all the proper clamping, the left subclavian artery is detached from the aorta at its origin and is opened longitudinally on its posterior aspect. The anterior wall of the aorta is then incised, beginning with the opening at the origin of the left subclavian artery and extending distally to the descending aorta 12 to 15 mm past the coarctation. The coarctation membrane is excised and the ductus is ligated and divided. The opened left subclavian artery, now forming a flap, is pulled down and sutured to the edges of the aorta, widening the coarctation site and also preserving the blood flow to the left arm. The ages of the patients ranged from 2 months to 25 years (mean 4.24 +/- 4.9 years) and their weights ranged from 2.8 to 52 kg (mean: 14.8 +/- 10.0 kg). There were no hospital deaths and the mean follow-up was 9.6 months (+/- 4.9 months). Recatheterization of four patients from 4 to 12 months postoperatively showed adequate correction and strongly suggested normal growth of the aorta at the site of coarctation, as well as preservation of the blood flow through the left subclavian artery. Doppler measurements showed normal flow to the left arm and no gradients through the isthmic area. Our experience indicates that this technique is not only feasible but is the procedure of choice in most cases of discrete isthmic coarctation and in some cases of long narrowing of the isthmus in patients with a wide range of ages and weights.     

Arterial or mixed venous lactate measurement in critically ill children. Is there a difference?

Seven critically ill children had simultaneous measurement of whole blood lactate concentrations obtained from a systemic arterial and mixed venous (pulmonary artery) site. An excellent correlation was found ( r = 0.995). The mean difference between arterial and mixed venous values was 0.02 mmol/ 1 and the limits of agreement (±0.22) were —0.20 to 0.24. The differences found were clinically insignificant (two-tailed paired Student's t -test; p = 0.36) and therefore support the continued use of arterial sampling for blood lactate measurement.