精神分裂症患者氯氮平使用现况调查

目的:了解精神分裂症患者氯氮平的使用现状。方法:按一定的抽样比例,抽取10个省市46家专科医院或综合医院精神科,于2002年4月22日至24日,采用自制问卷对4779例门诊和住院精神分裂症患者进行氯氮平使用情况调查。结果:39.0%(1863/4779)的患者使用氯氮平治疗,平均剂量为(216±133)mg/d;其中41.2%的患者为联合用药,合并使用抗胆碱能药物者为19.2%。与未使用氯氮平的患者比较,使用氯氮平的患者病程较长、家庭收入较低;男性及住院患者更多使用氯氮平,氯氮平治疗者疗效指数低于非氯氮平治疗者。患者的性别、就诊部门、家庭收入和是否首次住院以及抑郁和攻击症状为是否使用氯氮平治疗的影响因素。结论:精神分裂症患者氯氮平使用率为39.0%,其中41.2%为联合用药。是否使用氯氮平治疗与患者的经济状况和临床特征等因素有关。     

32项轻躁狂症状清单划界分高低人群的临床特征

目的:了解32项轻躁狂症状清单(HCL-32)划界分值高低人群的临床特征。方法:对1726例精神科门诊和住院部连续就诊的抑郁障碍患者采用HCL-32、简明国际神经精神访谈(MINI)进行评估。根据HCL-32得分结果,将患者分为HCL-32≥14且MINI单/双相、10≤HCL-32<14且MINI单/双相和HCL-32<10且MINI单相共5组,进行临床特征的分析。结果:有效完成问卷评分1487例,MINI诊断为双相障碍者360例(24.2%),以HCL-32≥14为划界值诊断为双相障碍者532例(35.8%),两种诊断方法差异有统计学意义(P<0.05)。各组间在性别、文化程度、婚姻状况、工作状况、首次发病年龄上差异均有统计学意义(P<0.05);10≤HCL-32<14且MINI单相组和HCL-32<10且MINI单相组在年龄、性别、婚姻状况、首次发病年龄上差异无统计学意义。HCL-32阳性回答条目数从高到低依次为HCL-32≥14且MINI双/单相组、10≤HCL-32<14且MINI双/单相组、HCL-32<10且MINI单相组。HCL-32≥14且MINI单/双相组抑郁发作更频繁、伴有更多的不典型特征、自杀观念行为、精神病性症状和具有周期性/季节性特点,有更多阳性家族史、既往曾被诊断过双相、目前更多使用抗抑郁剂以及情感"高涨"状态持续时间长于HCL-32<10且MINI单相组。结论:HCL-32≥14且MINI单/双相患者较HCL-32<10且MINI单相患者具有更多的临床特征,双相障碍的可能性更大。     

误诊为抑郁症的双相障碍Ⅱ型患者自杀风险的危险因素分析

目的探讨误诊为抑郁症的双相障碍Ⅱ型患者自杀风险的社会人口学及临床特征方面的危险因素。方法通过简明国际神经精神访谈(the Mini International Neuropsychiatric Interview,MINI)5.0中文版,对来自全国13个中心的1478例最初诊断为抑郁症的患者进行重新诊断,其中190例被诊断为双相障碍Ⅱ型,将这190例误诊患者按照有无自杀风险进行分组,从性别、年龄等社会人口学资料及起病年龄、是否伴有自杀观念等临床特征方面探讨被误诊患者自杀风险可能的危险因素。结果有自杀风险组共74例患者,无自杀风险组共116例。有自杀风险组与无自杀风险组相比,年龄更小[(34.45±11.18)vs.(37.23±13.22)],起病年龄更早[(26.20±9.16)vs.(30.37±11.59)],更常伴有自杀观念(82.4%vs.53.4%),差异均具有统计学意义(P<0.05)。Logistic回归分析显示,年龄(OR=0.969,95%CI:0.945~0.993)、伴有自杀观念(OR=4.129,95%CI:2.030~8.397)与误诊为抑郁症的双相障碍Ⅱ型患者发生自杀风险相关联(均P<0.05)。结论年龄小、伴有自杀观念可能是误诊为抑郁症的双相障碍Ⅱ型患者自杀风险的独立危险因素。     

AGI-1067: a multifunctional phenolic antioxidant,lipid modulator,anti-inflammatory and antiatherosclerotic agent

To explore the therapeutic efficacy and potential mechanisms of action of a new class of antiatherosclerotic drugs, AGI-1067 [mono[4-[[1-[[3,5-bis(1,1-dimethylethyl)-4-hydroxyphenyl]thio]-1-methylethyl]thio]-2,6-bis(1,1-dimethylethyl)phenyl] ester] (butanedioc acid) was tested in several animal models of atherosclerosis. AGI-1067, a novel phenolic antioxidant, was well tolerated in a 1-year study in hypercholesterolemic cynomolgus monkeys. It lowered low-density lipoprotein cholesterol (LDLc) by 41 and 90% at oral doses of 50 and 150 mg/kg, respectively and increased high-density lipoprotein cholesterol (HDLc) by 107% at the higher dose. In contrast, another phenolic antioxidant, probucol, had a modest LDLc-lowering effect (15% at 250 mg/kg) while decreasing HDLc (37% at 150 mg/kg). Histopathology of the aortas and coronary arteries revealed no atherosclerosis in the AGI-1067 (150 mg/kg) group and minimal-to-moderate atherosclerosis in the vehicle and probucol (150 mg/kg) groups. AGI-1067 also inhibited atherosclerosis in LDL receptor-deficient (LDLr -/-) mice and apolipoprotein E-deficient (ApoE -/-) mice even in the absence of a lipid-lowering effect. In LDLr -/- mice, AGI-1067 reduced aortic atherosclerosis by 49%. In ApoE -/- mice, AGI-1067 reduced atherosclerosis by 25, 41, and 49% in the arch, thoracic, and abdominal regions of the aorta. AGI-1067 also reduced vascular cell adhesion molecule-1 (VCAM-1) and monocyte chemoattractant protein-1 (MCP-1) mRNA levels in lungs of lipopolysaccharide-stimulated mice. At the cellular level, AGI-1067 inhibited tumor necrosis factor-alpha-inducible expression of VCAM-1, MCP-1, and E-selectin in human aortic endothelial cells (IC50 values = 6, 10, and 25 microM, respectively). These data show that AGI-1067 can inhibit atherosclerosis not only via its lipid-lowering effects but also by having direct anti-inflammatory effects on the vessel wall and suggest that it may be a novel therapeutic agent for coronary artery disease.     

Supporting patients through genetic screening for cancer risk.

A format for obtaining a genetic family health history is presented, along with a discussion of the importance of psychosocial support surrounding the genetic screening process and the responsibility for the maintenance of the privacy of medical records of patients who elect to undergo genetic screening, are presented.     

重T2WI和增强T1WI MRI联合评估泪囊鼻泪管的优势

目的探讨MRI重T2WI(h-T2WI)和增强T1WI(Ce-T1WI)组合序列对正常和阻塞的泪囊鼻泪管的显示能力。材料与方法在脂肪抑制的基础上,用hT2WI和Ce-T1WI序列,薄层连续扫描正常和有阻塞的泪囊鼻泪管,扫描方位是轴面(AP)和冠状面(CP),用静态和动态两种扫描方式。结果静态扫描正常泪囊鼻泪管23例46侧,其中24侧用h-T2WI+Ce-T1WI+AP+CP组合,6侧用hT 2 W I+C e-T 1 W I+A P组合,8侧用h-T 2 W I+A P+C P组合,8侧用C eT1WI+AP+CP组合。动态轴面扫描正常泪囊鼻泪管10例20侧,均用hT2WI+AP组合。静态扫描阻塞的泪囊鼻泪管9例10侧,均用h-T2WI+CeT1WI+AP+CP组合。正常和有阻塞的泪囊鼻泪管均能被良好显示。(1)正常的泪囊鼻泪管:静态扫描见泪囊鼻泪管的管腔狭小,鼻泪管更小,并且形态多样;动态扫描见部分节段的管腔可自主性增大或变小。横断面上泪囊呈长椭圆形(16侧)或裂隙状(30侧),移行部均呈半月形,鼻泪管呈短椭圆形(28侧)或类圆形(18侧)。用静态h-T2WI序列,轴面图像上94.7%(36/38侧)的泪囊鼻泪管呈现了3层信号结构,冠状面图上31.2%(10/32侧)呈现了3层信号结构;这3层信号结构分别代表了管腔内容物、管壁内1/4和管壁外3/4;管腔内的泪液、泪膜和空气分别呈最高信号、高信号和最低信号;管壁内1/4呈低信号,管壁外3/4呈高信号。在Ce-T1WI序列上,管壁可以被明显强化。(2)有阻塞的泪囊鼻泪管:梗阻部位和病变的范围均被精确显示,其中管腔狭窄1侧,闭塞9侧;梗阻点以上管腔积液(脓)扩张,管壁变薄;梗阻点管腔消失或明显狭小,在h-T2WI上丧失3层信号结构。结论 h-T2WI结合Ce-T1WI序列的MRI,可以清晰的显示正常生理状态下的泪囊鼻泪管的管腔、管壁的层次和行经;也能够精确显示有梗阻的泪囊鼻泪管的梗阻部位、病灶范围,区分有血供和无血供的组织结构。动态h-T2WI发现正常管腔的大小有自主性变化。     

Functional antagonism by salbutamol suggests differences in the relative efficacies and dissociation constants of the peptidoleukotrienes in guinea pig trachea

To assimilate information about the relative efficacies and affinities of the peptidoleukotrienes, the ability of the beta adrenoceptor agonist salbutamol to antagonize functionally contractions produced by leukotrienes (LT)C4, LTD4 and LTE4 was examined in the guinea pig trachea. There was a marked gradation in the sensitivity of LT-induced responses to antagonism by pretreatment with salbutamol (0.01-1.0 microM): LTC4 less than LTD4 less than LTE4. These data suggest marked differences in the receptor reserve for the LTs. However, this postulate is not supported by the finding that the magnitude of the ratio for the estimated dissociation constant, KA, and EC50 values, which provides an indirect measure of the relative receptor reserve, were similar: LTC4 = 4.50, LTD4 = 10.54 and LTE4 = 3.18. Substantial differences were apparent in the estimated KA values: LTC4 = 2.88 nM, LTD4 = 11.8 and LTE4 = 46.4 nM. In the presence of a maximally effective concentration of LTE4 (1 or 10 microM), addition of LTD4 (1 or 10 microM) produced further contraction of the tissue whereas the reverse was not the case. Furthermore, in the presence of salbutamol (70 nM), LTE4 (0.1 microM) produced a 3.6-fold rightward shift in LTD4 concentration-response curves with no effect on the maximum contractile response; a pKB of 7.42 was calculated for LTE4. The results suggest that the large differences in the ability of pretreatment with salbutamol to inhibit contractions produced by LTC4, LTD4 or LTE4 are not attributable solely to corresponding differences in receptor reserve for the individual LTs.(ABSTRACT TRUNCATED AT 250 WORDS)     

护士服务态度在医院效益中的作用

目的 确定护士服务态度在医院效益中的作用,以便更好地提高护理服务质量.方法 采用问卷调查法,根据冈谷惠子的"护患关系信任度量表"及自行设计问卷,对162名住院患者进行调查,并对结果进行分析.结果 患者对护士服务态度的需求高于真实体验;患者对医生的服务态度认可高于对护士服务态度;患者对护士服务态度满意度低于对护理技术的满意度.结论 护士服务态度在医院效益中起保健因素作用.