脑卒中病人的康复护理

脑血管病是一类严重危害中老年人生命的疾病。近年来 ,随着医学科学的进步 ,脑卒中病人抢救成活率不断提高 ,但常留有神经系统后遗症。脑卒中病人及早实施康复护理可提高病人的生活质量。如果早期的医疗方案缺乏康复措施 ,容易引起肌肉萎缩和关节孪缩变形 ,造成不可逆的继发性残疾。我们对 80例脑血管病人实施了综合康复护理 ,取得了较满意的效果。现介绍如下。1　资料和方法1.1　临床资料　 80例病人经CT扫描均确诊为脑血管病 ,其中男 68例 ,女 12例 ,年龄 42岁～ 70岁 ,平均 5 6岁。在常规治疗护理的同时进行康复护理。1.2　康复护理方法…     

浙江大学生人际交往素质的调查分析

目的:应用美国人际交往素质问卷调查分析中国浙江大学生人际交往素质。方法:于2004-09/10选择浙江台州学院2004年度参加《公共关系学》全院公共选修课的本科一、二、三年级学生163人。采用人际交往问卷(有40个测题,分主动交往、适当拒绝、自我表露、冲突管理与情感支持共5个维度,每一维度各有8个测题)评估大学生人际交往能力水平。结果:发放问卷163份,全部回收。剔除废卷8份,获规范答卷155份。①研究工具的探索性因素分析:以人际反应性指标为效标,分析问卷的效标效度。结果发现,问卷与人际反应性指标(IRI)的总分相关值为0.85。②问卷信效度的验证性因素分析:χ2/df接近2,其他拟合指数GFI(拟合优度指数)、NFI(标准拟合指数)、AGFI(调整的拟合优度指数)、NNFI(非正态化拟合指数)、CFI(相对拟合指数)数值局限于0～1之间,平均在0.80以上,RMSEA(近似误差均方根)为0.055。③当代大学生人际交往素质特点:男女大学生仅在适当拒绝维度上存在显著差异;干部学生与非干部学生在冲突管理维度存在显著差异。此外,经多元方差分析检查交互作用,发现各自变量在5个维度上均不存在显著交互作用。如以人际交往能力问卷的主动交往、适当拒绝、自我表露、冲突管理与情感支持5个维度的百分常模比较,在5个维度上得分在30,31,31,32,37以上(15%的人高分常模,得此分比85%的人得分高),在主动交往上得高分的人数大概占总样本人数的1/4,在适当拒绝和自我表露及情感支持上得高分的人数大概占总样本人数的1/10,在冲突管理上得高分的人数大概占总样本人数的1/5。在5个维度上得分在23,24,23,24,30以下(30%的人低分常模,得此分比70%的人得分低),主动交往和冲突管理维度占总样本人数的1/3,适当拒绝和自我表露维度占总样本人数的1/2,情感支持维度占总样本人数的1/4。结论:该问卷具有基本符合心理测量学要求的信度和效度,适合在中国借鉴用来评估人际交往素质;被调查的大学生样本,大都能主动交往,但缺乏交往技巧与冲突处理技巧,关心他人不足,应该引起学校和老师的足够重视。     

血管紧张素Ⅰ转换酶基因多态性与2型糖尿病心血管并发症关联研究

背景糖尿病晚期并发症的发生与遗传因素有关.有报道血管紧张素Ⅰ转换酶(angiotensin Ⅰ-converting enzyme,ACE)基因是糖尿病心血管并发症发生的风险因子.目的探讨ACE基因多态性与2型糖尿病心血管并发症之间的相关性.设计以2型糖尿病患者为研究对象的病例-对照研究.单位一所医学院的生物科学系普通生物学教研室.对象本研究于2001-02/2002-06在华北煤炭医学院分子生物学实验室完成.研究对象均为本医学院附属医院门诊及住院2型糖尿病患者,根据是否合并心肌梗死分为两组.心肌梗死患者组68例,其中男29例,女39例,年龄(65±3)岁;非心肌梗死组190例,其中男161例,女29例,年龄(60±1)岁.纳入标准均符合1985年WHO 2型糖尿病诊断标准,心肌梗死诊断根据MRI确诊;排除标准资料不完整或不合作者.方法按常规酚/氯仿法提取基因组DNA,扩增产物用20 mL/L琼脂糖凝胶电泳分析,溴化乙锭染色观察结果.对不同患者组等位基因和基因型频率进行比较.主要观察指标两组患者ACE基因的等位基因和基因型分布比较.结果2型糖尿病心肌梗死患者(64.7%)与非心肌梗死患者(55.0%)比较,DD纯合子频率显著增高(41.2%vs33.2%),差异具有显著性意义(x2=0.833,P＜0.05),D等位基因频率也显著增高,差异也具有显著性意义(x2=3.8491,P＜0.05).结论D等位基因和DD基因型是2型糖尿病心肌梗死发生的风险因子,这些指标的监测为糖尿病心肌梗死患者的二级康复预防和提高远期生活质量提供理论参考.     

The efficacy of probucol combined with hydration in preventing contrast-induced nephropathy in patients with coronary heart disease undergoing percutaneous coronary intervention: a multicenter,prospective, randomized controlled study

Purpose

To investigate the preventive effect of probucol combined with hydration on contrast-induced nephropathy (CIN) in patients with coronary heart disease undergoing percutaneous coronary intervention (PCI).

Methods

A total of 641 patients undergoing PCI were randomly assigned to either a probucol group (probucol 500 mg twice daily and hydration; n = 321) or a control group (hydration only; n = 320). The primary endpoint was the incidence of CIN, defined as an increase in serum creatinine (Scr) by ≥ 44.2 μmol/L or ≥ 25% within 72 h after the administration of contrast agent. Secondary endpoints were changes in Scr, cystatin-C (Cys-C), creatinine clearance rate (Ccr), C-reactive protein (CRP), superoxide dismutase (SOD), and glutathione (GSH) within 72 h, and major adverse events during hospitalization or the 14-day follow-up period.

Results

The incidence of CIN was 4.0% (13/321) in the probucol group and 10.9% (35/320) in the control group. The probucol group had lower Cys-C and higher Ccr at 48 and 72 h after PCI compared with the control group. At 48 and 72 h following the operation, Cys-C and CRP were lower in the probucol group compared with the control group, but Ccr, SOD, and GSH were higher. There were no differences in the incidence of major adverse events during hospitalization or the 14-day follow-up between the groups. Multivariate logistic regression analysis showed that probucol was an independent protective factor for CIN.

Conclusions

Probucol combined with hydration more effectively decreased the incidence of CIN in patients with coronary heart disease undergoing PCI compared with hydration alone.

     

Radical prostatectomy or radiotherapy reduce prostate cancer mortality in elderly patients: a population-based propensity score adjusted analysis

Purpose

Contemporary data regarding the effect of local treatment (LT) vs. non-local treatment (NLT) on cancer-specific mortality (CSM) in elderly men with localized prostate cancer (PCa) are lacking. Hence, we evaluated CSM rates in a large population-based cohort of men with cT1-T2 PCa according to treatment type.

Methods

Within the SEER database (2004–2014), we identified 44,381 men ≥ 75 years with cT1-T2 PCa. Radical prostatectomy and radiotherapy patients were matched and the resulting cohort (LT) was subsequently matched with NLT patients. Cumulative incidence and competing risks regression (CRR) tested CSM according to treatment type. Analyses were repeated after Gleason grade group (GGG) stratification: I (3 + 3), II (3 + 4), III (4 + 3), IV (8), and V (9-10).

Results

Overall, 4715 (50.0%) and 4715 (50.0%) men, respectively, underwent NLT and LT. Five and 7-year CSM rates for, respectively, NLT vs. LT patients were 3.0 and 5.4% vs. 1.5 and 2.1% for GGG II, 4.5 and 7.2% vs. 2.5 and 2.8% for GGG III, 7.1 and 10.0% vs. 3.5 and 5.1% for GGG IV, and 20.0 and 26.5% vs. 5.4 and 9.3% for GGG V patients. Separate multivariable CRR also showed higher CSM rates in NLT patients with GGG II [hazard ratio (HR) 3.3], GGG III (HR 2.6), GGG IV (HR 2.4) and GGG V (HR 2.6), but not in GGG I patients (p = 0.5).

Conclusions

Despite advanced age, LT provides clinically meaningful and statistically significant benefit relative to NLT. Such benefit was exclusively applied to GGG II to V but not to GGG I patients.

     

Lack of experience is a significant factor in the missed diagnosis of perilunate fracture dislocation or isolated dislocation

Objective

The aim of this study was to analyze the risk factors contributing to the misdiagnosis of perilunate injuries.