慢性乙型肝炎患者及其配偶心理状况

目的:认识慢性乙型肝炎患者及其配偶心理健康、生活质量及心理治疗的相关研究现状。资料来源:检索维普期刊全文数据库和中国医院知识仓库(CHKD期刊全文库)1985-01/2006-01有关乙型肝炎与心理方面的文献,检索词为"生活质量,乙型肝炎,心理健康,心理干预,配偶",并限定语言种类为中文;检索Pubmed数据库同期相关文献检索词为"CHB,quality of life,psychology health",并限定语言种类为英语。其他文章查找具体书籍或杂志获得原文。资料选择:对资料进行初审,选择与乙型肝炎患者及配偶心理健康、生活质量及心理治疗等相关的文章。纳入标准:阐述详细,文章内容较新,有助于说明问题的文章。排除标准:去除重复性研究和一般了解性的文章。资料提炼:共收集到204篇文章及2本相关书籍,符合纳入标准的文章48篇,排除158篇。资料综合:慢性乙型肝炎是一种身心疾病,其发病机制复杂,除与病原和免疫因素有关外,心理社会因素起重要作用。同时,与之共同生活的慢性乙型肝炎患者配偶承受了巨大的心理压力,存在许多心理障碍,即夫妇的心理症状可交互影响。心理治疗对于乙型肝炎患者是必要的。结论:慢性乙型肝炎患者及其配偶存在严重的心理问题,心理治疗能取得一定的疗效。     

体表高频超声技术评价家兔血管成形术后再狭窄模型与病理学结果的相关性

目的:分析体表高频超声检测家兔血管内球囊成形术后再狭窄程度与组织病理学分析的相关性。评估体表超声检测的可行性、可靠性及应用价值。方法:实验于2002-03/2003-12在北京中医药大学中医内科学重点学科实验室完成。①日本大耳白兔26只,随机分为正常组10只、假手术组6只、模型组10只。②模型组电刺激兔颈总动脉,电流1.2mA,刺激12～15min,术后第2天喂饲高脂饲料共8周,假手术组仅剥离颈总动脉,不做电刺激,喂高脂饲料,正常组不施加任何干预因素。③模型组和假手术组根据B超选择颈总动脉有斑块或血流明显改变者行球囊血管内成形术。分别于电刺激后8周、血管成形术后4周行超声检查动脉内径和动脉内膜厚度。④所有动物于血管成形术后4周处死取材,进行病理学半定量分析,并与超声测量结果进行相关分析。结果:进入结果分析数量24只,正常组中途死亡1只,原因为牙齿畸型影响进食。模型组1只因电刺激8周时超声评价颈动脉未形成斑块及血流无明显改变而剔出实验。①超声检测电刺激8周时正常组内膜厚为(0.028±0.004)cm,模型组管壁明显增厚(0.043±0.014)cm,差异有显著性(P<0.05),至血管成形术后膜厚增加更明显(0.064±0.002)cm,内径稍有扩大,但差异不显著。②超声检测模型组颈动脉内径与膜厚的测量结果与病理学测量结果呈正相关关系(OR=0.361,P<0.05;OR=0.526,P<0.01),病理狭窄率与超声是否检测到斑块呈正相关关系(OR=0.796,P<0.01)。结论:体表高频超声在评价家兔颈动脉狭窄诊断中有一定应用价值,与病理学半定量分析结果相关性良好。     

Antioxidant therapy for severe cardiac failure induced by iron overload secondary to dyserythropoietic anaemia

We present a case of a patient with longstanding transfusion-dependent congenital dyserythropoietic anaemia (CDA) who developed cardiomyopathy despite iron chelation therapy. She presented with severe heart failure that responded poorly to conventional therapy, recovering only when therapy was augmented with metabolic agents including antioxidants and with increased iron chelation. The present case gives support to the concept of treating oxidatively induced heart failure with metabolic and antioxidant therapy. This therapy may have wider application in refractory heart failure and in the prevention of cardiomyopathy in patients receiving regular red cell transfusions who are at risk of transfusional haemosiderosis.     

Randomised double-blind, placebo-controlled trial of coenzyme Q, therapy in class II and III systolic heart failure

BACKGROUND: Coenzyme Q10 (CoQ10) supplementation has been reported to improve symptoms of heart failure and quality of life, and to reduce hospitalisation. Most prior trials have been open-label and in some, only 50% of patients took angiotensin converting enzyme inhibitors (ACEI). AIM: To determine the effects of CoQ10 in patients with a New York Heart Association (NYHA) Class II or III heart failure due to ischaemic or dilated cardiomyopathy who have been treated with ACEI but not beta-blockers. Methods: Thirty-nine patients in NYHA Class II or III heart failure were randomised in ad ouble-blind, placebo-controlled study with 150 mg/day of oral CoQ10 or placebo.RESULTS: Thirty-five patients completed the trial. After 3 months of therapy, the NYHA class in the CoQ10 group (n = 17) showed a significant improvement of 0.5 class compared with the placebo (n = 18) (P = 0.01). Specific Activities Scale class showed a significant (P = 0.004) improvement in the CoQ10 group, but no change in the placebo group. The C-min walk-test distance showed a significant (P = 0.047) increase in the CoQ10 group with no change in the placebo group (between-group difference P = 0.29). For the Naughton exercise test times the difference in increase in exercise time approached significance in favour of the CoQ10 group (P = 0.056). There was a correlation between the increase in exercise time and the increase in serum CoQ10 level (P = 0.024). There was a threefold increase in the CoQ10 level in the treated group (0.7 +/- 0.4 to 2.1+/- 0.3 microg/mL), but no change in the placebo group. CONCLUSIONS: This pilot study accords with published data suggesting that CoQ10 therapy improves cardiac functional status in patients with moderately severe dilated cardiomyopathy receiving maximal non beta-blocker therapy. Future multicentre studies with larger numbers are indicated.     

Outcomes of coronary artery bypass grafting: a 3 year analysis using the Society of Thoracic Surgeons Database

BACKGROUND: Accurate risk factor analysis is a critical element in contemporary cardiac surgical practice. In the USA, the Society of Thoracic Surgeons Database allows institutions and individual surgeons to carry out detailed patient risk assessment and to review their cardiac surgical outcomes in a comparative fashion. METHODS: To evaluate outcomes of isolated coronary artery bypass grafting, data from all patients operated upon at the Alfred Hospital, Melbourne, Australia, over a 3 year period were entered into the Society of Thoracic Surgeons Database. RESULTS: Our results (mortality and morbidity) compared favourably with those contained within this large international database. CONCLUSION: It is hoped that a similar Australasian database can be established to facilitate a meaningful local risk assessment and a comparative analysis of outcomes of cardiac surgical procedures.     

How to write a paper for publication

Engaging in the scientific publication process can be for both altruistic and egotistical reasons; publication advances the state of scientific knowledge while advancing your institution and your career. Writing for publication means setting aside a location and time dedicated entirely to the process of planning and writing. It is easiest to begin with the Methods section, then the Results, followed by the Discussion, which is the most challenging part of a paper. A realistic assessment of the value of the article will determine the level of journal into which it is likely to gain acceptance. If your article is rejected by a journal, be consoled by the fact that 50% of articles that are initially rejected are eventually published. Following the steps outlined here can reduce the daunting task of writing to one of manageable proportions and can help overcome the mental block and procrastination that all of us have experienced when we set out to write a scientific paper.     

阿司匹林和塞莱昔布对幽门螺杆菌的体外影响

目的:探讨阿斯匹林和选择性COX-2抑制剂塞莱昔布对体外培养的幽门螺杆菌(H pylori)生长、毒力因子及外膜蛋白的影响．方法:不同浓度的阿司匹林及塞莱昔布与H pylori共同培养,以活菌计数、分光光度计法检测H pylori的生长状态,分光光度计检测A 560nm值判断尿素酶活性,Hela细胞空泡变性实验和中性红吸收试验检测空泡毒素的活性,以SDS-PAGE电泳检测H pylori外膜蛋白的变化．结果:阿司匹林及塞莱昔布可以抑制H pylori的生长,此过程为剂量依赖性效应．阿司匹林0．5 mmol／L及塞莱昔布0．01 mmol／L时与DMSO对照相比H pylori24 h和48 h的菌落计数开始降低,随着两药剂量的加大菌落计数降低得更加明显,阿司匹林2．0 mmol/L和塞莱昔布0．04 mmol／L时H pylori被完全杀灭．阿司匹林及塞莱昔布可剂量依赖性的抑制H pylori的尿素酶活性及空泡毒素的活性．在对H pylori外膜蛋白的研究中发现,NSAIDs可能对H pylori的某种外膜蛋白表达有影响．结论:阿司匹林和塞莱昔布可抑制H pylori的生长、毒力因子的活性,并可能改变H pylori外膜蛋白的表达．     

Efficacy of morning-only 4 liter sulfa free polyethylene glycol vs 2 liter polyethylene glycol with ascorbic acid for afternoon colonoscopy

AIM:To compare the bowel cleansing efficacy of same day ingestion of 4-L sulfa-free polyethylene glycol(4-L SF-PEG)vs 2-L polyethylene glycol solution with ascorbic acid(2-L PEG+Asc)in patients undergoing afternoon colonoscopy.METHODS:206 patients(mean age 56.7 years,61%male)undergoing outpatient screening or surveillance colonoscopies were prospectively randomized to receive either 4-L SF-PEG(n=104)or 2-L PEG+Asc solution(n=102).Colonoscopies were performed by two blinded endoscopists.Bowel preparation was graded using the Ottawa scale.Each participant completed a satisfaction and side effect survey.RESULTS:There was no difference in patient demographics amongst groups.4-L SF-PEG resulted in better Ottawa scores compared to 2-L PEG+Asc,4.2 vs4.9(P=0.0186);left colon:1.33 vs 1.57 respectively(P=0.0224),right colon:1.38 vs 1.63 respectively(P=0.0097).No difference in Ottawa scores was found for the mid colon or amount of fluid.Patient satisfaction was similar for both arms but those assigned to 4-L SF-PEG reported less bloating:23.1%vs 11.5%(P=0.0235).Overall polyp detection,adenomatous polyp and advanced adenoma detection rates were similar between the two groups.CONCLUSION:Morning only 4-L SF-PEG provided superior cleansing with less bloating as compared to 2-L PEG+Asc bowel preparation for afternoon colonoscopy.Thus,future studies evaluating efficacy of morning only preparation for afternoon colonoscopy should use4-L SF-PEG as the standard comparator.     

A novel strategy to limit blood donor exposure and blood waste in multiply transfused premature infants

Small, premature infants require frequent small-volume transfusions. Traditional methods of transfusion expose these infants to multiple blood donors. It has recently been demonstrated that multiple donor exposures can be safely prevented in these infants by the assignment of fresh units to them and by the use of a sterile connecting device to remove blood for transfusion, as needed until the expiration of the unit. However, the program resulted in the wasting of approximately 60 percent of the blood in each unit. STUDY DESIGN AND METHODS: To minimize blood waste without compromising the goal of limiting donor exposure, a model designed to predict each infant's transfusion requirements was investigated. The model assigned infants predicted to have high transfusion requirements to receive blood from a unit dedicated to their individual use. All other infants were assigned to receive blood from a unit that could be shared among as many as four similar infants. Infant donor exposure and blood unit wastage after institution of the infant assignment model were compared with the same measurements obtained before the use of the model, during which time infants were assigned to dedicated units at the discretion of the physician. RESULTS: The numbers of transfusions per infant (3.5 +/− 2.3) and of donor exposures per infant (1.5 +/− 0.7) under the assignment model were unaltered from those in controls (4.1 +/− 2.9 transfusions and 1.6 +/− 0.8 donor exposures); however, there was significantly less blood wastage in the group assigned to shared units (32 +/− 28%) than in the group assigned to dedicated units (62 +/− 17%; p < 0.05) or than was seen in an earlier study (60 +/− 23% wasted; p < 0.05). CONCLUSION: Improved management of blood resources can be achieved within the context of a transfusion program designed to safely limit donor exposure in infants who require frequent transfusion.