肺移植受者痰标本细菌培养和药敏试验结果：12例特点分析

目的:了解肺移植受者感染病原菌的分布及其对抗菌药物的耐药情况,为临床合理使用抗生素提供依据。方法:选择2003-06/2005-05在江南大学附属无锡市第五人民医院进行肺移植的受者12例,术前均知情并签署手术同意书。其中双肺移植3例(男1例,女2例),单肺移植9例(均为男性)。在肺移植前后分别对受者深部脓性痰标本镜检筛选合格标本,将合格标本接种于平板培养基培养,对可疑菌落进行分离,采用法国梅里埃公司VITEK-32全自动微生物分析系统各种细菌鉴定卡和药敏试验卡进行细菌鉴定和药敏试验。结果:①12例肺移植受者移植前后痰标本中分离出各种细菌14种,肺移植前培养出阳性标本8例,其中2例为1种细菌,6例为2种以上的细菌混合感染。移植术前,对培养出阳性的肺移植受者抗感染治疗至痰培养阴性。在移植后3d内,每天连续培养均未检出阳性标本,第4天起开始有阳性标本出现。肺移植后培养出阳性标本10例,其中4例为1种细菌,6例为2种以上的细菌混合感染。②肺移植前后共分离出菌株48株,G 菌28株,占58.3%(28/48);G-菌9株,占18.8%(9/48);真菌11株占22.9%(11/48)。感染的主要病原菌除对磷霉素、万古霉素较为敏感外,其他均有多药耐药性。结论:在肺移植前后受者痰内均可培养分离出多种致病菌,肺部感染是普遍存在的问题。药敏试验结果表明,多数菌株具有多药耐药性。因此,分析肺移植受者痰液标本的细菌种类及耐药性情况对临床合理选择抗菌药物,避免盲目经验用药,及时控制感染有重要意义。     

肾性高血压大鼠血压升高与主动脉肥厚及牛磺酸的干预

目的:观察肾血管性高血压大鼠的血压变化、主动脉肥厚情况及牛磺酸干预后血压及血管重构的变化。方法:实验于2005-06/12在咸宁学院医学院生理教研室完成。①选用60只Wistar大鼠,采用抽签法随机分为3组(n=20),即假手术组、高血压模型组和牛磺酸治疗组。后两组制备两肾一夹肾血管性高血压大鼠模型;假手术组大鼠除左肾动脉不放置银夹外,余下操作与模型组相同。②假手术组分笼喂养至第12周末;牛磺酸治疗组分笼喂养至第4周末,于术后第5周开始给予牛磺酸50mg/(kg·d)灌胃,1次/d,连续给药8周;高血压模型组以相同容积的蒸馏水替代牛磺酸灌胃给药,余同牛磺酸治疗组。③给药8周后,测量各组大鼠体质量和血压后处死,分离其胸主动脉以用于检测主动脉质量/体质量比值、胸主动脉的血管紧张素Ⅱ含量,应用石蜡切片的彩色图像分析技术测量胸主动脉中膜厚度及中膜截面积。结果:60只大鼠全部进入结果分析。①给药8周后,高血压模型组大鼠的血压、主动脉质量/体质量比值、胸主动脉的血管紧张素Ⅱ含量、胸主动脉中膜厚度及中膜截面积均显著高于假手术组(P<0.01)。②给药8周后,牛磺酸治疗组大鼠的血压、主动脉质量/体质量比值、胸主动脉的血管紧张素Ⅱ含量、胸主动脉中膜厚度及中膜截面积均显著低于高血压模型组(P<0.01)。结论:长疗程牛磺酸干预在抗高血压的同时具有抑制主动脉肥厚形成等血管重塑过程的作用。     

脑卒中生活质量影响量表3.0代理人版中文版的编译及其性能测试

目的:编译脑卒中生活质量影响量表3.0代理人版本,考察中文版的信度、效度和反应度,探讨代理人代替患者测试生活质量的可行性。方法:①选择2003-06正在中山大学附属第一医院神经内科住院患者及其代理人10对,回访2002-06/09入院并住院患者及其代理人共231对,患者符合世界卫生组织脑卒中诊断标准,并经CT或MRI确诊;代理人认识患者至少1年。分别用于脑卒中生活质量影响量表3.0代理人版本中文版初试和正式测试。②应用59个条目(分属力气、记忆和思维、情绪、交流、日常活动能力、行动能力、手功能和社会参与8个方面)构成的脑卒中生活质量影响量表3.0代理人版中文版进行调查,另外,使用公认量表:健康状况调查问卷的中文版、Barthel指数、简明精神状态检查量表、汉密顿抑郁量表考察各个领域的标准效度;使用牛津残障评分作为分组(分4组:0～1,2,3,4～5分,分值越高,残疾程度越重)依据来考察脑卒中生活质量影响量表3.0代理人版本中文版的反应度。③使用量表完成率和完成时间考查初试量表的可行性;使用分半信度、克朗巴赫系数(α)考察信度;通过专家评审和测定维度相关系数考察内容效度,测定量表各个领域与公认量表(金标准)的相应领域的相关系数来考察标准效度、使用因子分析考察结构效度。通过比较不同残疾程度的患者的评分考察反应度。④分领域比较患者同代理人得分的差异,用配对t检验和测定组间相关系数评价代理人代替患者进行生活质量测定的可行性。结果:①可行性:量表完成率为91.2%;时间15～20min,表明可行性好。经专家讨论后,对部分条目进行了文化调试。②信度:分半信度和α系数均大于0.8。③效度:量表各条目与所属领域总分的相关系数>0.6,因子分析结果表明结构效度好;各领域与已知公认量表的相应领域高度相关(r=0.515～0.872,P<0.01)。④反应度:牛津残障评分分组下的单因素方差分析显示各组间得分不全相等(F=8.983～130.284,P<0.01)。⑤患者与代理人测试结果:患者和代理人脑卒中生活质量影响量表3.0得分比较,差异不明显(相关系数=0.757～0.964,P>0.05)。结论:脑卒中生活质量影响量表3.0代理人版中文版的信度、效度和反应度是满意的,用代理人代替患者进行生存质量研究是可行的。     

Carrier testing of children for two X linked diseases in a family based setting: a retrospective long term psychosocial evaluation

The question of whether genetic carrier testing should be performed on children has been the subject of much debate. However, one important element has been lacking from this debate. There has been practically no knowledge of how those tested in childhood have experienced carrier testing. Twenty three subjects in families affected by Duchenne muscular dystrophy and 23 in families affected by haemophilia A, all of whom had been tested during childhood for carriership in the Department of Medical Genetics, University of Helsinki, from 1984 to 1988, participated in our study. We investigated long term psychosocial consequences of carrier testing in childhood. A questionnaire relating to sociodemographic background and life situation was used, together with assessment of health related quality of life (HRQOL) using the RAND 36 item Health Survey 1.0 (RAND). RAND results showed that the emotional, social, and physical well being of the young female subjects was not statistically different from those of control female subjects at a similar age. We also found no statistically significant differences in means in any RAND dimension (p<0.146) between carriers, non-carriers, and a group in which carrier status was uncertain. However, two out of seven carriers reported that they were worried and three that they were slightly worried about the test result. Four out of 22 young female subjects in the uncertain group reported being worried and 11 reported being slightly worried.


Keywords: carrier testing in childhood; health related quality of life; psychosocial consequences; RAND     

HER-2 and topo-isomerase IIalpha as predictive markers in a population of node-positive breast cancer patients randomly treated with adjuvant CMF or epirubicin plus cyclophosphamide.

BACKGROUND: The predictive role of HER-2 in node-positive breast cancer patients receiving CMF or an anthracycline-based adjuvant therapy remains unclear. In addition, topo-isomerase II alpha (topo IIalpha), as the cellular target of anthracyclines, might have value as a predictive marker. PATIENTS AND METHODS: Four hundred eighty-one archival primary tumor samples were collected among 777 patients entered into a multicenter phase III trial comparing classical CMF with epirubicin cyclophosphamide (HEC) as adjuvant therapy of node-positive breast cancer. HER-2 was evaluated by immunohistochemistry (IHC) using different antibodies (Abs). Topo IIalpha was evaluated by IHC using the Ab KiS 1. In each subgroup of patients identified by HER-2 and topo IIalpha, adjusted hazard ratios for event-free survival (EFS) and the corresponding 95% confidence intervals have been calculated for the different study comparisons. An interaction test has been performed to investigate the role of HER-2 and topo IIalpha as predictive markers. RESULTS: When HER-2 was evaluated by CB-11 and 4D5 mAbs, the EFS adjusted hazard ratios (HR) for the main study comparison HEC vs. CMF were: HER-2 positive: 0.33 (95% confidence interval (95% CI): 0.09 1.27, P = 0.08), HER-2 negative: 1.16 (95%, CI: 0.71-1.90, P = 0.56); the P-value for the interaction test was 0.10. When HER-2 was evaluated by TAB-250 + pAbl Abs, the adjusted HR for the same comparison were: HER-2 positive: 1.06 (95% CI: 0.45-2.52, P = 0.90), HER-2 negative: 0.99 (95% CI: 0.58-1.68, P = 0.97); the P-value for the interaction test was 0.84. With regard to topo IIalpha, the adjusted HR for the EFS comparison HEC vs. CMF were: topo IIalpha positive: 0.66 (95% CI: 0.32-1.36, P = 0.25), topo IIalpha negative: 1.26 (95% CI: 0.63-2.50, P = 0.51); the P-value for the interaction test was 0.13. CONCLUSIONS: This study suggests that in node-positive breast cancer patients randomly treated with CMF or an epirubicin-based regimen, the predictive value of HER-2 may vary according to the Abs used in the immunohistochemistry assay. In addition, the study supports the concept that topo IIalpha might be involved in the determination of tumor responsiveness to an anthracycline-based adjuvant therapy.     

Imagery elaboration and clarity in modifying college students' depression

Examined the relationship between clarity of imagery and depression reduction and determined whether Ss who elaborated on positive fantasies were more successful in therapy than those Ss who merely practiced positive daydreams. Thirty depressed college females were pretested with the Beck Depression Inventory (BDI), randomly assigned to one of three groups for a 3-week period, and then were posttested with the BDI. The groups were a no treatment control, a positive imagery group, and a positive imagery group who elaborated on their daydreams. Ss were asked to rate the clarity of imagery on a scale from 1 to 10. Analysis of covariance found no significant treatment effect, but vividness of imagery was correlated significantly with depression reduction.     

Decision analysis in the surgical treatment of patients with familial adenomatous polyposis: a Dutch-Scandinavian collaborative study including 659 patients

BACKGROUND AND AIMS: The choice of colorectal surgery in patients with familial adenomatous polyposis lies between the morbidity of proctocolectomy and ileum-pouch-anal anastomosis (IPAA) and the mortality from rectal cancer after total colectomy and ileorectal anastomosis (IRA). The aims of the present study were: (1) to assess the risk of dying from rectal cancer after IRA, (2) to compare the life expectancy between patients with an IRA and those with an IPAA, and (3) to investigate whether regular endoscopic examination of the rectum leads to detection of cancer at an earlier stage. METHODS: Clinical and pathological data on 659 patients who underwent colectomy and ileorectal anastomosis were collected from four national polyposis registries-that is, in Denmark, Finland, Sweden, and the Netherlands. Data were analysed using survival analysis methods. Decision analysis was used to compare the life expectancy between patients with an IRA and those with an IPAA. RESULTS: A total of 47 patients developed rectal cancer after IRA. The risk of dying from rectal cancer was 12.5% (95% confidence interval 7.1--17.9%) by age 65. Compared with IRA, IPAA would lead to an increase in life expectancy of 1.8 years. Seventy five per cent of patients with rectal cancer had a negative rectoscopy within 12 months before the diagnosis. CONCLUSION: IRA is associated with substantial mortality due to rectal cancer. Follow up examinations of the rectum does not have sufficient preventive effect on morbidity and mortality of rectal cancer.     

MK801慢性处理引起皮层神经元~3H－GABA释放的改变

ＭＫ８０１慢性处理引起皮层神经元￣３Ｈ－ＧＡＢＡ释放的改变施李正，钮心懿（中国医学科学院，中国协和医科大学药物研究所１０００５０，北京）某些急性和慢性神经退行性病变及精神紊乱与兴奋性氨基酸（ＥＡＡｓ）有关［１］。因此，发展专一性强、效能高并毒性低的兴...     

乙肝肝硬化并发糖尿病的健康宣教

目的探讨系统的健康宣教对乙肝肝硬化并发糖尿病患者的治疗效果及疾病控制的影响。方法通过对50例乙肝肝硬化并发糖尿病的住院患者进行回顾性总结。结果患者的心理负担减轻,对疾病的相关理论知识有所了解,对在饮食、皮肤护理以及自我监测能力等方面都有所了解和提高。结论系统的健康宣教可以对乙肝肝硬化并发糖尿病患者的治疗和疾病的控制产生非常重要的作效果。