Prescription of psychotropic drugs in patients with chronic renal failure on hemodialysis

Objective: Patients on hemodialysis commonly have comorbid depression and require treatment with psychotropic drugs. This study aimed to investigate the prevalence of the use of psychotropic drugs among patients on hemodialysis and to elucidate the factors associated with use of each class of psychotropic medication. Methods: This cross-sectional study enrolled 195 hemodialysis patients with a mean age of 58.5 years. Patients were assessed using the Mini International Neuropsychiatric Interview, Hospital Anxiety and Depression Scale, Chalder Fatigue Scale and Short-form Health-related Quality of Life. We analyzed the frequency of psychiatric outpatient department visits within six months prior to interview and psychotropic drugs use within one month prior to interview, including antidepressants, antipsychotics, mood stabilizers, benzodiazepines (BZDs) and hypnotics. Results: Of the 195 patients, 47 (24.1%) fulfilled the DSM-IV criteria for major depressive disorder (MDD). Only 6.4% of patients diagnosed with MDD visited the psychiatry outpatient department within six months prior to interview. Of the total patients, the proportions with use of antidepressants, antipsychotics, mood stabilizers, BZDs and hypnotics were 5.6%, 1.0%, 3.1%, 42.6% and 20.0%, respectively. Having MDD was an independent factor associated with taking antidepressants (adjusted OR?=?3.98, p?=?0.036) and taking hypnotics (adjusted OR?=?2.75, p?=?0.011). Conclusions: Depression is generally undetected or not well-managed among hemodialysis patients in the clinical setting. Only a small proportion of depressed patients received antidepressant treatment. BZDs and/or hypnotics might be exorbitantly prescribed. Clinicians should pay more attention to patients’ emotional distress and provide appropriate treatment.     

Urinary netrin-1 and KIM-1 as early biomarkers for septic acute kidney injury

Background: Acute kidney injury (AKI) during sepsis is associated with poor outcome. However, diagnosis of AKI with serum creatinine (SCr) level change is neither highly sensitive nor specific. Therefore, identification of novel biomarkers for early diagnosis of AKI is desirable. Aims: To evaluate the capacity of combining urinary netrin-1 and human kidney injury molecule type 1 (KIM-1) in the early diagnosis of septic AKI. Methods: We prospectively recruited 150 septic patients from Jun 2011 to Jun 2013 at Zhejiang Provincial People's Hospital, China. SCr, urinary netrin-1, and KIM-1 levels were recorded at 0, 1, 3, 6, 24, and 48?h of ICU admission and compared between AKI and non-AKI patients. In addition, we investigated the prognostic value of netrin-1 and KIM-1 between non-survivors and survivors in septic AKI patients. Results: SCr levels started to show elevation after 24?h of ICU admission. However, netrin-1 levels increased significantly as early as 1?h, peaked at 3–6?h and remained elevated up to 48?h of ICU admission in septic AKI patients. KIM-1 increased significantly by 6?h, peaked at 24?h and remained significantly elevated until 48?h of ICU admission. Furthermore, we observed significant higher urinary KIM-1 levels at 24?h and 48?h in non-survivors compared to survivors in AKI patients. Conclusions: Our results suggest that both netrin-1 and KIM-1 are clinically useful as early biomarkers in the diagnosis of septic AKI. In addition, persistent elevation of urinary KIM-1 level may be associated with poor prognosis.     

婴幼儿营养发育与喂养行为的关系

背景目前探讨喂养行为与婴幼儿发育相关性的研究相对较少.目的探讨喂养行为与婴幼儿营养发育的相关性.设计横断面调查研究. 单位西安交通大学第一医院妇幼保健中心.对象该研究于2000-01/2002-12由西安交通大学第一医院妇幼保健中心完成.采取分层整群抽样的方法,抽取渭南地区富平县和澄城县0～18个月婴幼儿346人.本项研究的纳入标准无明显疾病,胎龄大于37周且≤42周,无先天异常的婴幼儿;排除标准患各种先天性疾病及异常的婴幼儿.符合上述标准的共有324人,按月龄分为5组.方法采用自编的"婴幼儿营养调查表"对婴幼儿的养护人进行访谈.主要观察指标①不同月龄婴幼儿营养发育稍差现状分析;②4个月内不同喂养方式婴幼儿的营养发育状况分析;③辅食添加时间、辅食添加质量及辅食添加频度对婴幼儿营养发育的影响.结果在出生后4个月内母乳喂养率高,婴幼儿营养状况良好.4个月后营养发育正常的婴幼儿与营养发育稍差婴幼儿相比较,在辅食添加时间上及添加的种类上差异均有非常显著性意义(P＜0.01).结论婴幼儿的营养发育与喂养行为有着密切的联系.     

基层医院腹腔镜胃肠肿瘤手术应用分析

目的：通过腹腔镜技术在我院胃肠肿瘤手术中的大量应用,评价其安全性、疗效性、优越性及经济性,以探究其推广应用价值。方法回顾性分析我院2009年12月－2013年12月263例使用腹腔镜技术诊治胃肠肿瘤患者的临床资料。结果263例手术中成功242例。术中平均失血量100．5 ml,平均手术时间160．8 min,术后平均离床活动时间26．4 h,术后平均52．4 h 胃肠功能恢复,术中、术后未出现严重并发症,疗效满意。结论腹腔镜胃肠肿瘤手术在基层医院安全可行、疗效确切,且具有创伤小、出血少、疼痛轻、恢复快等优势,经济学评价良好,值得在基层医院推广开展,以提升广大患者的生活质量。     

氧疗加鱼肝油治疗新生儿中、重度尿布皮炎的效果观察

目的 观察氧疗加鱼肝油治疗新生儿中重度尿布皮炎的效果。方法 对60例中度和40例重度尿布皮炎的新生儿采用在传统护理的基础上，加用直接吹氧和涂抹鱼肝油，并观察其疗效。结果 中度有效55例（91．7％），无效5例（8．3％）；重度有效33例（82．5％），无效7例（17．5％）。结论 氧疗加鱼肝油可保持新生儿臀部皮肤干燥清洁，加促皮炎消退，促进创面愈合，增加患儿的舒适感，对促进患儿的生长发育有重要意义。     

髋关节置换术后并发症的特征

目的:全髋关节置换术后发生感染、脱位、静脉栓塞等并发症仍是影响术后效果的主要原因,如何治疗和预防这些术后并发症是提高全髋关节置换术远期疗效的重要手段。资料来源:应用计算机检索PubM ed2000-01/2004-12期间相关文章,检索词为“totalhip arthroplasty(replacement),com plication orinfection,ordislocation,or throm boembolism”,限定文章语言种类为“English”。资料选择:对资料进行初审,选择髋关节置换术后与并发症有关的临床论著,排除综述类文章及未提供摘要类文章。资料提炼:共收集到214篇有关髋关节置换术后与并发症有关的论著,通过阅读摘要或全文对文章内容进行分类整理,83篇与本文综述内容有关,排除131篇。资料综合:83篇论著中包括感染、静脉栓塞、脱位、应力遮挡等术后并发症有关的文献。其中感染并发症主要为人类免疫缺陷病毒感染或毒品注射这一特殊人群。结论:随着对全髋关节置换术后各种并发症的认识水平不断提高,可望将其发生控制在最低限度,但对这些并发症的预防和治疗的研究观察,仍需作大量的工作。尤其对特殊人群的关节置换术,仍需继续积累经验。     

心肌梗死大鼠血管生成过程中血管生成素1及其Tie2受体的表达

目的:通过检测正常心肌组织及心肌梗死后血管生成素1及其受体Tie2受件mRNA的表达水平,探讨其在心肌梗死后的血管新生过程的作用.方法:实验于2006-04/2007-04在北京大学医学部生物化学与分子生物学基因组实验室完成.将40只雄性SD大鼠随机分为急性心肌梗死组和假手术组,急性心肌梗死组通过结扎前降支建立心肌梗死模型,假手术组只穿线不结扎.于术后3,7,14,28d旭个时间点,每组取5只处死,取心脏左室裁壁同一部位,提取总RNA,用RT-PCR的力法,以GAPDH基因为内参,进行半定量分析检测正常心脏及梗死后血管生成素Ⅰ及Tie2 mRNA的表达;同时用免疫组化的方法检测各时间点梗死区域以及梗死周边区域血管数量.实验过程中动物处置符台动物伦理学标准.结果:40只大鼠进入结果分析.血管生成素1及Tie2在正常心肌组织中均有所表达.在心肌梗死后的28d内,血管生成素1维持在相对不变的水平,而ne2的表选在心肌梗死后3 d略有升高,于7 d后达顶峰,14 d后恢复正常;急性心肌梗死后7 d,梗死区及梗死周边区域的血管数量均明显增多,并不随时间的延长而改变,维持在同一水平.结论:心肌梗死后Tie2受体的表达上调,与血管生成的时间相吻合,提示其在心肌梗死后的血管生成和稳定过程中起了一定的作用.     

Searching health information via the web: Hong Kong chinese older adults' experience

OBJECTIVE AND SAMPLE: This paper reports on the learning experience of 88 Chinese older adults who attended a health Web-navigating workshop. DESIGN: Through a 3-hr training workshop, participants were guided to browse through seven health Web sites that provide authoritative health information by the Hong Kong government, academic institutions, or professional bodies. METHODS: Upon completion of the workshop, an evaluation was made of the participants' confidence in navigating health Web sites by themselves at home and in utilizing the health information sources. RESULTS: The findings indicated that participants' confidence in seeking health information via the Internet was not associated with their age, educational level, or experience of using computers before the workshop but was significantly associated with their satisfaction with the workshop (p<.05). Significant change of source of health information was noted at follow-up, suggesting that the workshop was successful. CONCLUSIONS: Implications of the results for running health Web-navigating programs among Chinese older adults are discussed.     

莫沙必利治疗肝硬化胃排空延迟临床观察

目的 :观察莫沙必利对肝硬化胃排空延迟的疗效。方法 :6 0例肝硬化胃排空延迟的患者随机分为A、B两组 ,A组 30例 ,每日 3餐前 30min口服莫沙必利 5mg;B组 30例 ,3餐前 30min口服多潘立酮 10mg。采用B超测定胃排空机能。治疗 2周后了解病人上消化道症状改善情况 ,并复查B超了解胃液体排空情况。结果 :两组病人服药后上消化道症状均有所改善 ,莫沙必利对早饱、腹胀的总有效率高于多潘立酮 ,有显著差异 (P <0 .0 5 ) ;两组治疗后胃排空率较治疗前显著增加 (P <0 .0 1) ,且A组高于B组 ,有显著差异 (P <0 .0 5 )。结论 :莫沙必利是治疗肝硬化胃排空延迟的有效、安全药物 ,疗效优于多潘立酮。