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91.
Jin H. Han MD MSc Karen F. Miller RN MPA Alan B. Storrow MD 《Academic emergency medicine》2007,14(3):228-233
Background: Elder patients with acute coronary syndromes (ACS) are less likely to receive cardiac catheterization. The reasons for this are unclear.
Objectives: To assess whether elder patients who had a documented history of dementia, lived in extended care facilities, or had do not intubate–do not resuscitate (DNR-DNI) advance directives were less likely to receive cardiac catheterization, despite having ACS with high-risk features.
Methods: This was a medical record review conducted at an urban teaching hospital. DNR-DNI status before hospitalization, extended care facility (nursing home or assisted living) residence, and a previous diagnosis of dementia were obtained from the medical record. Patients 65 years and older who presented to the emergency department with acute myocardial infarction or with unstable angina with ST segment deviation were included. Univariate and multivariate logistic regression were performed, and odds ratios (ORs) were reported with their 95% confidence intervals (CIs).
Results: Of the 201 eligible patients, 66 (32.8%) patients did not undergo cardiac catheterization. In the univariate analysis, patients who had dementia, resided in extended care facilities, or were DNR-DNI were less likely to receive cardiac catheterization. Only extended care facility residence (OR, 0.18; 95% CI = 0.04 to 0.83) and DNR-DNI status (OR, 0.19; 95% CI = 0.04 to 0.92) remained significantly associated with decreased cardiac catheterization in the multivariate analysis.
Conclusions: Elder patients with ACS residing in extended care facilities or who are DNR-DNI are less likely to receive cardiac catheterization. Future studies concerning the quality of ACS care for elders should take these variables into account. 相似文献
Objectives: To assess whether elder patients who had a documented history of dementia, lived in extended care facilities, or had do not intubate–do not resuscitate (DNR-DNI) advance directives were less likely to receive cardiac catheterization, despite having ACS with high-risk features.
Methods: This was a medical record review conducted at an urban teaching hospital. DNR-DNI status before hospitalization, extended care facility (nursing home or assisted living) residence, and a previous diagnosis of dementia were obtained from the medical record. Patients 65 years and older who presented to the emergency department with acute myocardial infarction or with unstable angina with ST segment deviation were included. Univariate and multivariate logistic regression were performed, and odds ratios (ORs) were reported with their 95% confidence intervals (CIs).
Results: Of the 201 eligible patients, 66 (32.8%) patients did not undergo cardiac catheterization. In the univariate analysis, patients who had dementia, resided in extended care facilities, or were DNR-DNI were less likely to receive cardiac catheterization. Only extended care facility residence (OR, 0.18; 95% CI = 0.04 to 0.83) and DNR-DNI status (OR, 0.19; 95% CI = 0.04 to 0.92) remained significantly associated with decreased cardiac catheterization in the multivariate analysis.
Conclusions: Elder patients with ACS residing in extended care facilities or who are DNR-DNI are less likely to receive cardiac catheterization. Future studies concerning the quality of ACS care for elders should take these variables into account. 相似文献
92.
目的 评价特素(紫杉醇注射液)联合卡铂(伯尔定)方案治疗晚期非小细胞肺癌(NSCLC)的疗效和不良反应.方法 收集我院2004年3月~2006年12月收治的Ⅲb~Ⅳ期的NSCLC患者28例,进行特素(紫杉醇注射液)联合卡铂(伯尔定)化疗.全部患者均有可测量的指标.给药方法:特素135~175mg/m2d1+卡铂5mg·ml^-1·min^-1d2,静脉注射,28天为一周期.结果 全组总有效率50.0%,Ⅲb期有效率62.5%,Ⅳ期有效率45.0%.化疗副反应主要是骨髓抑制及消化道反应,其中Ⅲ~Ⅳ度分别为24.0%、10.7%.结论 特素联合卡铂治疗晚期非小细胞肺癌治疗有效,耐受性良好. 相似文献
93.
武汉市3~5岁儿童牙齿酸蚀症的研究 总被引:4,自引:1,他引:3
目的:调查武汉市3~5岁儿童的酸蚀症流行状况;评价儿童饮用饮料和饮食习惯、口腔卫生习惯与酸蚀症的关系。方法:随机抽样武汉市4所幼儿园3~5岁儿童共500人。对所有儿童进行酸蚀症和龋齿发病情况的临床检查以及问卷调查,问卷内容包括:儿童每天消耗饮料或食物的频率,以及口腔健康行为。收集酸蚀症儿童和无酸蚀症儿童各20人,对其唾液pH值、流速和缓冲能力进行测定和比较。结果:武汉市3—5岁儿童酸蚀症的患病率为9.3%。儿童睡觉时含奶瓶、喝饮料的习惯与酸蚀症的发生呈正相关。酸蚀症儿童和对照组儿童唾液分析结果无显著性差异。结论:预防酸蚀症应该减少酸性食物及饮料的消费量及频率。 相似文献
94.
青年维持性血液透析患者心血管疾病调查及危险因素分析 总被引:21,自引:0,他引:21
目的调查青年维持性血液透析(MHD)患者心血管疾病的发病情况和病变特点,并探讨其危险因素。方法采用横断面研究。MHD患者98例,以45岁为界分为青年组(47例)和中老年组(51例)。收集患者临床资料和生化指标。心脏超声检查测量心脏腔径及心功能参数。分析青年组患者心脏结构和功能异常的患病率、病变特点及其影响因素。结果(1)47例青年患者中有30例(63.8%)存在心脏结构异常,主要表现为左心室肥厚、左心房增大和瓣膜反流,患病率分别为61.7%、38.3%和34.0%。(2)青年组患者向心性肥厚的患病率为86.2%,离心性肥厚的患病率为13.8%,与中老年组相比,差异有统计学意义(P〈0.05)。(3)与无心脏病变青年MHD患者相比,伴心脏病变者的超滤量、收缩压、血磷和甲状旁腺激素明显增高,而Kt/V、血红蛋白和血清白蛋白明显降低,差异有统计学意义(P〈0.05)。Logistic回归分析结果显示,超滤量、收缩压、血红蛋白和血甲状旁腺激素是青年MHD患者并发心脏病变的独立危险因素。结论青年MHD患者心血管疾病的患病率较高,主要表现为左心室肥厚、左房增大和瓣膜反流。超滤量、收缩压、血红蛋白和血甲状旁腺激素水平可能是影响青年MHD患者并发心脏病变的独立危险因素。 相似文献
95.
Xiaofang Chen Yueji Sun Haiyan Liu Yunqiao Ding Shujuan Liu Jinghua Chen Xueying Wang Zhenpeng Han Fang Qu 《中国神经再生研究》2006,1(8):763-765
BACKGROUND: Cognitive impairment after stroke associates with various factors, such as age, educational years, etc. Besides concerning about the recovery of limb function after stroke, we should also focus on the rehabilitation of cognition. Moreover, we'd better pay attention to the control of all the risk factors of stroke, and improve the quality of life in stroke patients.
OBJECTIVE: To analyze the factors that affect cognitive impairment after stroke.
DESIGN: A related factors analysis.
SETTINGS: Department of Neurology of Dalian Port Hospital and Dalian Second People's Hospital.
PARTICIPANTS: Totally 148 stroke inpatients were selected from Department of Neurology, Dalian Port Hospital and Dalian Second People's Hospital from April 2004 to December 2005, including 100 males and 48 females, aging 45-75 years with an average age of (67±8) years; Their educational years ranged 2-10 years with an average of (6.1±3.7) years; The disease course ranged 15-30 days; All were right-handed. Inclusive criteria: All were accorded with the diagnostic standard set by the Fourth National Academic Meeting for Cerebrovascular Disease; Confirmed by CT or MRI; Informed consents were obtained from all the subjects.
METHODS: After the disease conditions were stable, the patients were assessed with Wechsler memory scale (WMS) and Wisconsin card sorting test (WCST). WMS included forward and backward recitation of numbers and short-term memory (verbal memory, visual recognition). The number of times for correct and wrong classifications in WCST and the time to complete the trail making tests A and B were recorded. The focal volume, area and layer were recorded at 24 hours after admission. The general data of the patients were recorded, including name, sex, age, educational years, history of hypertension, history of diabetes mellitus. Electroencepalograph (EEG) was examined to record the wave shape, blood lipids were detected, and the cognition related indexes were analyzed with the Pearson correlation analysis. The correlation between cognitive indexes after stroke and the influencing factors were analyzed with multiple linear regression analysis.
MAIN OUTCOME MEASURES: ① Correlation between cognitive indexes and imaging indexes; ② Influencing factors for cognitive indexes after stroke.
RESULTS: All the 148 stroke patients were involved in the analysis of results. ① Correlation between cognitive indexes and CT indexes: There were obvious negative correlations between numerical symbol and focal layer (r =-0.234, P < 0.05), as well as between verbal memory and the focal area and volume (r =-0.363, -0.279, P < 0.05); Trail making test A had obvious positive correlation with focal area and volume (r =0.256, 0.256, P < 0.05). Results of multiple linear regression analysis: Correct classification was correlated with triglyceride (partial wave and θ wave (partial regression coefficient=0.231-0.908, P < 0.05); Verbal memory was correlated with EEG α wave, focal volume, sex, educational years and diabetes mellitus (partial regression coefficient=0.219-1.017, P < 0.05-0.01). Visual recognition had correlation with educational years and hypertension (partial regression coefficient=0.326, -1.163, P < 0.01). Trail making tests A and B were correlated with focal volume (partial regression coefficient=4.680, -18.561, P < 0.05).
CONCLUSION: The factors that affect the cognitive function after stroke include sex, age, educational years, hypertension, diabetes mellitus, triglyceride, EEG wave shape, and the focal area, volume and layer 相似文献
96.
Toxic effects of Fusarium mycotoxin butenolide on rat myocardium and primary culture of cardiac myocytes. 总被引:1,自引:0,他引:1
Jing-Bo Liu Yi-Mei Wang Shuang-Qing Peng Gang Han Yan-Sheng Dong Hai-Ying Yang Chang-Hui Yan Guo-Qiang Wang 《Toxicon》2007,50(3):357-364
Mycotoxin toxicosis has been implicated in the etiopathogenesis of Keshan disease (KD), an endemic cardiomyopathy prevailing in some regions of China. Butenolide (4-acetamido-4-hydroxy-2-butenoic acid gamma-lactone, CAS No. 16275-44-8), a mycotoxin produced by several Fusarium species such as Fusarium tricinctum and Fusarium graminearum, is frequently detected from the cereals in the endemic areas of KD. The present study is undertaken to investigate whether this mycotoxin can induce myocardial damage. Exposure of primary culture of cardiac myocytes to butenolide resulted in significant cytotoxicity, manifested by changes in cell morphology and decreases in cell viability. Consistent with the in vitro findings, distinct myocardial toxicity in vivo was observed after administration of rats by gavage with butenolide (10 and 20 mg/kg/day) for 2 months, and the myocardial injuries were characterized by focal necrosis of myocardium and fragmentation of myofiber. Butenolide also induced significant oxidative damage to the myocardium in vitro evidenced by a concentration-dependent lipid peroxidation in the myocardial homogenates, whereas antioxidants superoxide dismutase (SOD), N-acetylcysteine (NAC) and glutathione (GSH) provided significant protections against this oxidative effect. Taken together, these results clearly reveal that butenolide possesses the potential to induce myocardial toxicity. The present findings may reinforce the hypothesis that toxicosis by mycotoxins is one of the etiological factors for KD. 相似文献
97.
韩巧云 《实用医学影像杂志》2007,8(2):135-136
目的探讨欧乃影在临床应用中不良反应的发生和预防措施。方法观察2003年10月至2006年7月所作1000例增强扫描者静脉注射欧乃影0.2mL/kg(其量浓度(c)为0.5mol/L)后,不良反应发生的情况。结果1000例患者中,出现不良反应6例,其中,非过敏反应3例,轻度过敏反应3例,无中度及重度过敏反应。结论欧乃影在磁共振增强扫描中不良反应发生率低,临床应用安全。 相似文献
98.
795例肺癌术后发生心律失常的多因素分析 总被引:1,自引:0,他引:1
目的探讨肺癌术后发生心律失常的危险因素及其防治。方法回顾分析2002年1月~2004年1月我院肺癌手术795例,其中全肺切除术176例,肺叶切除术509例,楔型切除术110例。术后发生心律失常273例,应用Logistic回归对影响术后发生心律失常可能的危险因素进行分析。结果本组病例心律失常总发生率为34.3%(273/795),多因素Logistic逐步回归分析显示高龄、吸烟史、心律失常史、全肺切除、术中心包损伤、术后肺不张是术后心律失常的主要危险因素(P〈0.05),术后镇痛是保护因素(P=0.017)。结论心脏的储备功能降低、对手术损伤及缺氧的耐受力降低是导致术后心律失常的原因,采取一些预防措施可以减少其发生率。 相似文献
99.
血管性勃起功能障碍动物模型的建立 总被引:5,自引:3,他引:2
目的探索建立血管性勃起功能障碍(ED)动物模型。方法雄性新西兰大白兔给予胆固醇及高脂饮食,同时用球囊导管损伤双侧髂内动脉内皮。测定术后4周、8周血脂并观察阴茎勃起情况、交配情况,同时用阴茎海绵体注射盐酸罂粟碱、阴茎血管双核素检查、髂内动脉数字减影造影(DSA)等方法研究勃起功能。结果与对照组相比,术后4周、8周模型组动物出现明显高脂血症,勃起程度明显下降,交配实验的各项观察指标均显著降低(P<0.01),动脉造影显示双侧髂内动脉管腔直径明显缩小,双核素检查动脉显像指数(PIA)及静脉显像指数(PIV)明显降低,但第4周的模型组与对照组PIV结果没有统计学差异(P>0.05)。结论高脂、高胆固醇饮食同时用球囊导管扩张动物髂内动脉,可以加速模型的形成,从而用于血管性ED的进一步研究。 相似文献
100.
目的 从福参Angelica morii提取分离活性成分。方法 采用乙醇提取,溶剂萃取,大孔树脂、聚酰胺、硅胶柱层析,LH-20、重结晶等纯化,对福参饮片进行系统提取分离;运用波谱学方法及理化常数对照进行结构鉴定。结果 从正丁醇和水部分分离到6个苷类化合物,分别为升麻索苷(prim-O-glucosylcimifugin,Ⅰ)、紫花前胡苷(marmesinin,Ⅱ)、芹菜素7-O-β-D-葡萄糖苷(apigenin 7-O0-β-D-glucoside,Ⅲ)、木犀草素7-O-β-D-葡萄糖苷(1ute—olin 7-O-β-D-glucoside,Ⅳ),umbeliferone 7-apiosylglucoside(V)和胡萝卜苷(daucosterol,Ⅵ)。结论 6个化合物均为首次该植物中分得;化合物Ⅲ首次从当归属中分得。 相似文献