癫痫患者全夜自然睡眠结构的研究

目的　观察癫痫患者发作间期全夜自然睡眠结构特点 ,并评价其与正常对照组睡眠结构的差异 ;评价发作类型、用药情况及是否记录到发作间电发放对睡眠结构的影响。方法　对 2 0名癫痫患者及 11名对照进行全夜自然睡眠多导监测 ,并结合患者的发作类型、是否记录到发作间电发放 (IIDs)及服用 AEDs的情况进行分组统计分析 ,评价各组患者与正常对照间各睡眠参数的差异。结果　癫痫患者组 ,记录到 IIDs组 ,及该组患者中部分性发作者和未服 AEDs者均较正常对照 TRT、RL 显著延长 (P<0 .0 5)。记录到 IIDs的患者睡眠效率显著下降 (P≤0 .0 5) ,其中部分性发作者入睡后觉醒次数较全身性发作者显著增多 (P<0 .0 5)。部分性发作者较全身性发作者NREM睡眠期转换次数有增高的趋势。不同用药癫痫患者睡眠脑电图较正常对照组睡眠破碎性增加。结论　癫痫患者与正常对照比较 RL延长 ;睡眠破碎性增加 ;记录到 IIDs的患者睡眠效率降低 ;部分性发作患者较全身性发作患者有 NREM期转换次数频繁的趋势 ;记录到 IIDs患者中服用 AEDs的情况对其睡眠结构无显著影响。     

Adjuvant occupational therapy for work-related major depression works: randomized trial including economic evaluation

BACKGROUND: Major depression has far-reaching consequences for work functioning and absenteeism. In most cases depression is treated by medication and clinical management. The addition of occupational therapy (OT) might improve outcome. We determined the cost-effectiveness of the addition of OT to treatment as usual (TAU). METHOD: Sixty-two adults with major depression and a mean absenteeism of 242 days were randomized to TAU (out-patient psychiatric treatment) or TAU+OT [6 months, including (i) diagnostic phase with occupational history and work reintegration plan, and (ii) therapeutic phase with individual sessions and group sessions]. Main outcome domains were depression, work resumption, work stress and costs. Assessments were at baseline and at 3, 6, 12 and 42 months. RESULTS: The addition of OT to TAU: (i) did not improve depression outcome, (ii) resulted in a reduction in work-loss days during the first 18 months, (iii) did not increase work stress, and (iv) had a 75.5% probability of being more cost-effective than TAU alone. CONCLUSION: Addition of OT to good clinical practice does not improve depression outcome, improves productivity without increasing work stress and is superior to TAU in terms of cost-effectiveness.     

Psychometric properties of the Tampa Scale for kinesiophobia and the fear-avoidance beliefs questionnaire in acute low back pain

The transition from acute to chronic low back pain (LBP) is influenced by many interacting factors. Pain-related fear, as measured by the Tampa Scale for Kinesiophobia (TSK) and the Fear-Avoidance Beliefs Questionnaire (FABQ), is one of these factors. The objectives of this study were to investigate, in a population with acute LBP, the reliability of TSK and FABQ through evaluation of the internal consistency, the test-retest reliability, and the concurrent validity between TSK and FABQ. One hundred and Seventy-Six patients suffering LBP for no longer than 4 weeks completed a Visual Analogue Scale for pain (VAS), the TSK, the FABQ, and a socio-demographic questionnaire. Each patient completed the VAS, TSK, and FABQ twice within 24 h. Internal consistency of TSK and FABQ scores range from alpha=0.70 to 0.83. Test-retest reliability ranges from r(s)=0.64 to 0.80 (P<0.01). Concurrent validity is moderate, ranging from r(s) =0.33 to 0.59 (P<0.01). It may be concluded that in a population with acute LBP, both the TSK and the FABQ are reliable measures of pain-related fear. In the clinical setting they may provide the practitioner a means of identifying pain-related fear in a patient with acute LBP.     

Low dietary iron intake restrains the intestinal inflammatory response and pathology of enteric infection by food‐borne bacterial pathogens

Orally administrated iron is suspected to increase susceptibility to enteric infections among children in infection endemic regions. Here we investigated the effect of dietary iron on the pathology and local immune responses in intestinal infection models. Mice were held on iron‐deficient, normal iron, or high iron diets and after 2 weeks they were orally challenged with the pathogen Citrobacter rodentium. Microbiome analysis by pyrosequencing revealed profound iron‐ and infection‐induced shifts in microbiota composition. Fecal levels of the innate defensive molecules and markers of inflammation lipocalin‐2 and calprotectin were not influenced by dietary iron intervention alone, but were markedly lower in mice on the iron‐deficient diet after infection. Next, mice on the iron‐deficient diet tended to gain more weight and to have a lower grade of colon pathology. Furthermore, survival of the nematode Caenorhabditis elegans infected with Salmonella enterica serovar Typhimurium was prolonged after iron deprivation. Together, these data show that iron limitation restricts disease pathology upon bacterial infection. However, our data also showed decreased intestinal inflammatory responses of mice fed on high iron diets. Thus additionally, our study indicates that the effects of iron on processes at the intestinal host–pathogen interface may highly depend on host iron status, immune status, and gut microbiota composition.     

机器人辅助腹腔镜下根治性膀胱切除加尿流改道术的临床分析

目的 探讨采用da Vinci S机器人系统完成机器人辅助腹腔镜下根治性膀胱切除(robotic-assisted laparoscopic radical cystectomy,RARC)加尿流改道术的临床可行性,并总结技术特点和临床效果. 方法 2007年12月至2012年3月膀胱尿路上皮癌患者22例,男20例,女2例.年龄37～ 72岁,平均62岁.体质指数22.5 ～ 30.1 kg/m2,平均26.1 kg/m2.麻醉评分1～2分.术前肿瘤活检病理诊断为浸润性或高危的非肌层浸润性膀胱尿路上皮痛,术前检查均未发现有其他邻近脏器浸润、盆腔淋巴结转移或远处转移,临床分期均低于T2N0M0.全麻下行RARC加尿流改道术,其中行体外尿流改道术15例(原位新膀胱2例,回肠膀胱术13例),行完全腹腔镜下尿流改道术7例(回肠膀胱术2例,原位新膀胱5例). 结果 本组22例手术均获得成功.手术时间300 ～ 667 min,平均480 min;出血量100 ～ 1200 ml,平均550 ml;淋巴结清扫数目6～ 25枚,平均15枚.术后2～3d下地活动,3～4d肠功能恢复,术后住院时间8～35 d,平均16d.行原位新膀胱的患者术后1个月行膀胱造影确定无吻合口漏后拔除尿管和双侧输尿管支架管.术后随访4 ～ 49个月,平均32个月,复发2例,死亡1例,出现肾积水2例,其余病例肾功能均正常,尿控较满意. 结论 根据初期的手术操作过程和随访结果,RARC加尿流改道术在临床上是可行的.更多的操作经验、长期和随机的对照研究将有助于对这一技术进行评估和推广.     

Amifostine (WR-2721) shortens the engraftment period of 4- hydroperoxycyclophosphamide-purged bone marrow in breast cancer patients receiving high-dose chemotherapy with autologous bone marrow support

4-Hydroperoxycyclophosphamide (4-HC), a commonly used marrow-purging agent, is active against many tumors, but is also toxic to normal marrow progenitors. Amifostine (WR-2721) is a sulfhydryl compound with chemoprotectant activity. Preclinical studies using suspensions of bone marrow and breast cancer cells demonstrated that ex vivo treatment with amifostine followed by 4-HC resulted in protection of marrow progenitors, with no compromise in the antitumor effect of 4-HC. This fact stimulated the development of a clinical trial. Bone marrow was harvested from 15 poor-prognosis breast cancer patients and randomly assigned to ex vivo treatment with amifostine followed by 4-HC (amifostine + 4-HC), or treatment with 4-HC alone. High-dose chemotherapy was then administered followed by infusion of the purged autologous bone marrow support (ABMS). Leukocyte engraftment, defined as a white blood cell count > or = 1 x 10(9)/L, was achieved in an average of 26 days for patients whose marrow was purged with amifostine + 4-HC versus 36 days for patients whose marrow was purged with 4-HC alone (P = .032). The average number of platelet transfusions (12 v 29; P = .017) and days of antibiotic therapy (28 v 40; P = .012) were significantly less for patients whose marrow was exposed to amifostine + 4-HC, compared with 4-HC alone. Unpurged backup marrow fractions were infused into three patients whose marrow was purged with 4-HC alone, because of inadequate marrow recovery. None of the patients who received amifostine + 4-HC-purged marrow required a backup marrow fraction. Complete remissions were achieved in 83% of patients with measurable disease, with no difference between the two cohorts. Forty- three percent of patients remained alive and progression-free at a mean of 13 months posttransplant. There was no significant difference in the rate or pattern of relapse for patients whose marrow was purged with amifostine + 4-HC compared with those whose marrow was purged with 4-HC alone. Ex vivo treatment of marrow with amifostine significantly shortens the time to marrow recovery, thereby reducing the risk of myelosuppressive complications in breast cancer patients receiving high- dose chemotherapy and 4-HC-purged ABMS. Since supportive care requirements are also significantly decreased, amifostine may reduce the cost of such therapy.     

Modified sharp method: factors influencing reproducibility and variability.

BACKGROUND AND OBJECTIVES: In rheumatoid arthritis, joint radiography is still the most frequently used instrument to assess the progression of joint damage. Unfortunately, the poor quality of the radiographic scoring methods available has a negative impact on the power in clinical trials. This study focuses on the influence of the following 4 factors on radiographic scores according to van der Heijde's modification of the Sharp method: intraobserver variation, interobserver variation, follow-up time, and number of measurement occasions within a patient series. METHODS: One hundred and seventy-two patients in the early stages of rheumatoid arthritis were followed up. During the first 3 years, radiographs of the hands and feet were taken twice yearly and scored by 3 observers. The scoring process was repeated after an additional 3-year period. Correlation coefficients and differences between observers were calculated to define variability. The influence of the 4 factors on variability was studied. RESULTS: One observer assigned a significantly higher score than the other 2, who had been trained together. Interobserver variability decreased as follow-up time increased. Interobserver correlation coefficients became higher, with smaller differences between observers for progression scores than for absolute scores. Increasing the number of measurements within a patient series led to higher scores. Intraobserver correlation coefficients were high, and a training effect occurred when the time between measurements was 1 year, resulting in lower scores. CONCLUSIONS: This study demonstrates that, and shows how, the investigated factors influence the variability of the modified Sharp method. It is extremely important to take interobserver variation into account when designing protocols for multicenter clinical trials. A progression scoring method is recommended for studies assessing radiographic damage or clinical trials.     

Genetic anticipation in rheumatoid arthritis in Europe. European Consortium on Rheumatoid Arthritis Families

OBJECTIVE: To investigate whether there is evidence for genetic anticipation in rheumatoid arthritis (RA) in Europe. METHODS: Cross sectional comparison of data from all affected parent-offspring pairs identified among (1) the RA population attending our department and (2) a large cohort of families from RA probands with both parents alive recruited by the European Consortium on RA families (ECRAF) for association studies. Longitudinal comparison between probands with and without parental RA. We used prospectively collected data on disease activity, therapies, and radiological outcomes from our Dutch inception cohort of patients with early RA during the first 6 years of followup. RESULTS: From a total of 683 Dutch and 170 European patients we identified 28 Dutch and 21 European parent-offspring pairs with RA. Probands with parental RA had an earlier disease onset compared with affected parents (Dutch p < 0.002, European p < 0.0001). In Dutch patients, the prevalence of HLA-DR4, DR4 double dose, and shared epitope (SE) double dose was slightly higher in probands with parental RA than in those without [odds ratios (95% CI) 2.0 (0.7-5.8), 2.79 (0.8-9.4), and 2.12 (0.6-8.7), respectively]. The same was true for European probands concerning SE double dose [OR (95% CI) 1.76 (0.6-8.7)]. No other relevant differences in demographic or clinical indices were found between probands with affected parents and those without. Disease course (Disease Activity Score) and therapies used during the first 6 years of followup were similar in Dutch patients with and without parental RA. Radiological damage at baseline was lower in the former group and this difference persisted after 3 and 6 years. CONCLUSION: Our data suggest that genetic anticipation in RA does occur in terms of an earlier disease onset in the offspring. Despite a slightly higher prevalence of HLA alleles encoding for the SE, probands with confirmed parental RA had no worse outcome than those without.     

社会主义核心价值体系融入医学生医德教育的伦理诉求

医德修养和医德品质是医务人员必备的思想品质,是和谐医患关系的道德前提。以社会主义核心价值体系为指导,把社会主义核心价值体系融入医德教育中,是帮助医学生树立崇高的医德理想、明确医德追求、继承医德传统、锤炼医德品质和提升医德修养的重要途径和方法。