平原人群进入中度海拔地区发生急性脑梗死相关危险因素变化的探讨

目的:探讨平原世居人群进入中度海拔(西宁地区,海拔高度2 260m)地区发生急性脑梗死(acute cerebral ischem,ACI)患者血浆同型半胱氨酸、血脂、血糖及血尿酸的变化.方法:对世居中度海拔地区99例ACI患者与73例进入中度海拔地区的世居平原人发生ACI患者,以及64例进入中度海拔地区的世居平原人未发生ACI人群的血浆同型半胱氨酸、血脂、血糖、血尿酸含量行测定、分析.结果:三组血糖(Glu)、血清胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)、载脂蛋白A(Apo-A)、载脂蛋白B(Apo-B)含量均无显著性差异(P＞0.05),而吸烟史、血浆同型半胱氨酸(Hcy)、高密度脂蛋白(HDL-C)、血尿酸(UA)含量有显著性差异(P＜0.001或P＜O.01).结论:Hcy、HDL-C的水平变化、吸烟史与世居平原人群进入中度海拔地区发生急性脑梗死密切相关,而HDL-C水平升高具有保护作用.     

Discovery of a new waveform for intraoperative monitoring of hemifacial spasms

Background

Surgeons often rely on intraoperative electrophysiological monitoring to determine whether decompression is sufficient during microvascular decompression surgery for hemifacial spasms. A new monitoring method is needed when an abnormal muscle response is occasionally not available or is unreliable. This study was an observational clinical trial exploring a new waveform recorded from the facial muscles while the offending artery wall was electrically stimulated.

Methods

Thirty-two patients with typical hemifacial spasm and 12 with trigeminal neuralgia as a control were included. The facial muscle response was recorded during microvascular decompression surgery while the offending artery wall was stimulated (2?mA?×?0.2?ms). The latency, amplitude, and effective refractory period were analyzed.

Results

A waveform was recorded from the facial muscles of patients with hemifacial spasm when the offending artery wall was stimulated and was named the “Z-L response.” The latency was 7.3?±?0.8?ms, the amplitude was 0.08?±?0.02?mV, and the effective refractory period was 3.5–4?ms. The Z-L response disappeared immediately after microvascular decompression. No waveform was recorded from the facial muscles of patients with trigeminal neuralgia while the anterior inferior cerebellar artery, which adheres to the facial nerve, was stimulated (2?mA?×?0.2?ms).

Conclusion

We found a new waveform for intraoperative monitoring of hemifacial spasm. The Z-L response was useful when the abnormal muscle response was absent before decompression or persisted after all vascular compressions were properly treated. Particularly, the Z-L response may help neurosurgeons determine the real culprit when multiple offending vessels exist.     

The limited effect of omega-3 polyunsaturated fatty acids on cardiovascular risk in patients with impaired glucose metabolism: A meta-analysis

Objectives

The impacts of marine-derived n − 3 polyunsaturated fatty acids (n − 3 PUFAs) on cardiovascular risk are not well known. We conducted this meta-analysis to determine the effects of n − 3 PUFAs on cardiovascular outcomes and cardiovascular risk markers in patients with impaired glucose metabolism (IGM).

Design and methods

We searched PUBMED, EMBASE, The Cochrane Library and reference lists of relevant papers for high quality randomized controlled trials comparing dietary intake of n − 3 PUFAs with placebo in IGM patients. Data was extracted and quality assessed independently by two reviewers. Authors were contacted for missing information. Overall estimates were calculated using a random-effects model or a fixed-effects model, and the possibility of publication bias was examined using a funnel plot. Subgroup analyses were conducted to explore the association between the risk markers and study characteristics.

Results

Our meta-analysis included 19 studies, 24,788 patients. Compared with placebo, n − 3 PUFAs had no statistically significant reduce effect on cardiovascular mortality, major cardiovascular events, all-cause mortality or composite endpoint of all-cause mortality or hospitalization for cardiovascular cause, however it can significantly reduce the level of triglycerides (weighted mean difference [WMD] − 0.25 mmol/L; 95% CI − 0.37 to − 0.13: p < 0.001; 12 trials, 13,921 patients).

Conclusion

Marine-derived n − 3 polyunsaturated fatty acids have no protective effect on cardiovascular mortality, major cardiovascular events, all-cause mortality and composite endpoint of all-cause mortality or hospitalization for cardiovascular cause in IGM patients, but can reduce triglyceride level.     

Association of the six transmembrane protein of prostate 2 gene polymorphisms with metabolic syndrome in Han Chinese population

AimThe six-transmembrane protein of prostate 2 (STAMP2) has been demonstrated to play a potential role in the pathogenesis of metabolic syndrome (MetS). The present study was designed to investigate the association of STAMP2 gene polymorphisms with MetS in Han Chinese population.MethodsA case-control study enrolled 350 Han Chinese subjects in two groups: 182 MetS patients and 168 control subjects. The clinical and biochemical characteristics were determined. Three single nucleotide polymorphisms (SNPs), rs1981529, rs12386756 and rs10263111 in STAMP2 gene were genotyped. The association of STAMP2 gene polymorphisms with MetS was analyzed.ResultsSNPs rs1981529 and rs10263111 were found to be significantly associated with MetS phenotype in male population (P = 0.014 and 0.025). Moreover, SNP rs1981529 was found to be associated with high density lipoprotein-cholesterol in male cases and with body mass index in female cases (P = 0.014 and 0.049). SNP rs10263111 was found to be associated with both waist circumference and diastolic blood pressure in total cases (P = 0.044 and 0.033). Haplotype analysis yielded significant association of STAMP2 gene with MetS in total (global P = 0.0109) and male population (global P = 0.0004).ConclusionOur findings revealed that STAMP2 gene polymorphisms are likely to significantly contribute to the risk of MetS in male Han Chinese population.     

Arterial stiffness evaluation by cardio-ankle vascular index in hypertension and diabetes mellitus subjects

Arterial stiffness is an independent predictor for vascular diseases. Cardio-ankle vascular index (CAVI) is a new index of arterial stiffness. In the present study, we investigated the possible risk factors involving CAVI in hypertension and diabetes mellitus (DM) subjects. One thousand sixty-three subjects (M/F 533/530) from Shougang Corporation Examination Center were divided into four groups: healthy group (n = 639); hypertension group (n = 312); DM group (n = 58); and hypertension with DM group (n = 54). CAVI was measured by VS-1000 apparatus. Our results showed that CAVI was significantly higher in hypertension subjects with DM than in healthy and hypertension group, respectively (8.59 ± 1.08 vs 7.23 ± 1.10; 8.59 ± 1.08 vs 7.94 ± 1.33; both P < .05). CAVI was positively correlated with age, systolic blood pressure, diastolic blood pressure, pulse pressure, fasting plasma glucose, HbA1c, uric acid, total cholesterol, triglycerides in the entire group (r = 0.633, 0.280, 0.172, 0.269, 0.209, 0.254, 0.176, 0.129, 0.175; all P < .05, respectively). There was negatively correlation between CAVI and high-density lipoprotein cholesterol in the entire group (r = ?0.167; P < .05). Multivariate analysis showed that age, body mass index, HbA1c, and high-density lipoprotein cholesterol were independent associating factors of CAVI in all subjects (β = 0.699; P < .001, β = ?0.189; P = .001, β = 0.144; P = .015, β = ?0.136; P = .019, respectively). Our present study suggested that CAVI was significantly higher in hypertension subjects with DM compared with healthy and hypertension groups.     

循证护理在早产儿胃食管反流护理中的应用

胃食管反流是指由于全身和局部原因引起食管括约肌功能不全,胃内容物反流入食管的一种临床表现[1],呕吐是最常见的症状。90%以上的患儿生后第1周即可出现[1],表现为溢乳,轻度呕吐或喷射性呕吐,呕吐较顽固,常伴发精神运动发育迟缓;易发生于新生儿期,尤其是早产儿更多见。轻度反流发病率高     

国内外护理侵权行为的研究进展

提高护理质量、保障病人权利正日益成为全球医疗管理领域最重视的议题之一。本研究介绍了护理侵权行为及病人权利的概念和内涵,在分析护理侵权行为的现状后,介绍了国内外关于预防护理侵权行为的做法和先进理念,以供护理工作人员参考。     

截瘫患者直接照顾者照护体验的质性研究

目的深入了解截瘫患者直接照顾者照护过程的真实体验及需求,为提高截瘫患者家庭的生活质量提供帮助。方法采用立意抽样法选择17名截瘫患者直接照顾者作为研究对象,进行深入访谈,采用Colaizzi分析法对资料进行分析、整理并提炼主题。结果截瘫患者直接照顾者的照护体验包括以下7个方面:极度震惊和无法接受;心存侥幸;持续的身心疲惫;羞耻感;经济负担过重;缺乏经验;渴望社区服务。结论截瘫患者直接照顾者的体验受疾病进程的影响,且其社会支持体系不够完善;医护人员及社会机构除了关心患者外,还应主动关心其直接照顾者,帮助他们解决照护过程中的需求和困难。