Getting to Dissemination

The combination of a stage model of psychotherapy and treatment manualization has been a major step forward in treatment development and efficacy testing, but not in dissemination. I argue that the technological model of treatment development makes research on the practical application of these technologies difficult. If we continue on our present course, research on dissemination will be uncommon, expensive, and largely irrelevant to the practical issues that need to be faced. It makes more sense to proceed directly to dissemination research. Alternative methods, including manipulated training designs, will permit this, but these fundamentally challenge the implicit assumptions of the stage model.     

第2产程剖宫产术对母婴的影响

本文对我院近 4年来第 2产程 (以下简称 2程 )剖宫产 6 1例进行回顾性分析。资料表明 :第 2产程剖宫产术易合并羊水污染及术时并发症 ,新生儿Apgar氏评分低 ,术后并发症高于对照组 (P <0 .0 5 ) ,提示第 2产程剖宫产术比一般头位急症剖宫产术对母婴不利 ,其并发症的发生与第 2产程的延长相关 (P <0 .0 1) ,故应把握时机尽量减少宫口开全后施行剖宫产。     

Bent knees and tiptoeing: late manifestations of end-stage Parkinson's disease.

We describe a unique gait phenomenon of bent knees in 9 patients with idiopathic Parkinson disease (mean age, 73.1 +/- 11.1 years), 3 of whom also manifested tiptoeing. The bent-knee posture appeared only during ambulation; in the recumbent position, full or nearly full extension was possible in all patients. The abnormality emerged after long-standing disease (6-23 years from onset) and failed to respond to dopaminergic treatment. Most of the patients also had bent spine (camptocormia). The pathogenesis of these phenomena are unknown, but they might represent a rare type of dystonia.     

抑郁症的睡眠脑电图与人脑兴奋守恒假说

目的　探索抑郁症状与睡眠脑电图参数的相关性。方法　对 18例抑郁症和 10例正常人评定汉密尔顿抑郁评定量表 (HAMD)和检测睡眠脑电图。结果　HAMD总分与觉醒次数及REM密度分别呈显著正相关 (r分别等于 0 .4 0 8和 0 .4 4 5 ,P均 <0 .0 5 )。结论　抑郁症和正常人的白天中枢抑制与夜间中枢兴奋相关 ,从而支持人脑兴奋守恒假说。     

硕士生睡眠质量状况及其与心理健康的相关研究

目的了解硕士生睡眠质量状况及其与心理健康的关系;为提高硕士生的睡眠质量和心理健康水平提供参考。方法采用匹兹堡睡眠质量指数(PSQI)和症状自评量表(SCL-90)对高校298名硕士生进行睡眠质量和心理健康调查。结果①以PSQI总分≥8作为判断睡眠质量问题的标准,27.4%的硕士生存在睡眠质量问题,睡眠质量不佳主要体现在日间功能障碍(58.4%)、入睡时间(38.6%)、睡眠质量(31%)和睡眠障碍(19.3%)。②一、二年级与三年级在入睡时间上存在显著差异(P<0.05)。公费和自费硕士生在PSQI总分和睡眠效率上存在显著性差异。文科和理科硕士生在催眠药物和日间功能障碍上存在显著性差异。年龄≥30岁和年龄<30岁的硕士生在睡眠效率上存在显著性差异。③硕士生PSQI总分及大多数成份与SCL-90各因子呈显著正相关(P<0.05)。④不同睡眠质量硕士生的心理健康状况分析显示,睡眠质量好、一般和差的硕士生在SCL-90均分及各因子得分上存在显著性差异。结论研究生睡眠质量不尽人意;睡眠质量与心理健康高度相关。各个部门及研究生自身应该引起高度重视,保证良好睡眠,促进身心健康。     

病理性近视眼的研究进展

通过复习近年来相关文献,对近视眼发生发展机制与形觉剥夺之间的关系进行综合评述。认为近视眼的发生及眼轴延长与形觉剥夺有一定关系,深入研究其相关机制,对近视眼的早期防治具有重要意义。     

舒利迭加无创通气治疗稳定期慢性阻塞性肺疾病的临床研究

目的探讨舒利迭(吸入型肾上腺皮质激素与长效β2-受体激动剂的预混制剂)联合双水平气道正压通气(B iPAP)对稳定期慢性阻塞性肺疾病(COPD)的治疗作用。方法稳定期COPD病人52例,舒利迭TM50/250,1吸/次,2次/d;B iPAP,吸气压力(IPAP)10~20cm H2O,呼气压力(EPAP,也称PEEP)3~6cm H2O,吸氧浓度(FiO2)3L/m in,每天夜间通气6~8h。观察治疗前、治疗后12周病人临床症状、生活质量、健康状态和肺功能。结果治疗前、治疗后12周病人的临床症状、急性加重次数及严重程度、健康状态和生活质量、肺功能等指标比较差异有统计学意义(P<0.05)。结论舒利迭联合B iPAP治疗稳定期COPD病人能够明显改善其症状,提高生活质量,有一定的临床应用价值,对减缓COPD病人肺功能下降有积极意义。     

Misoprostol in preventing postpartum hemorrhage: a meta-analysis.

OBJECTIVE: To assess misoprostol's ability to prevent postpartum hemorrhage (PPH) where no alternatives exist. Comparison to oxytocics demonstrates how similarly misoprostol achieves a level of effectiveness-obtainable only in hospitals-in remote locations around the world. METHOD: Using the Mantel-Haenszel fixed-effects model and the DerSirmonian and Laird random-effects model, summary statistics indicated that misoprostol's excess risk of PPH was only 4% when compared to oxytocics. RESULT: This risk difference was well within the range of expected results for all uterotonic agents and does not warrant branding misoprostol as an inferior drug. CONCLUSION: Conventional uterotonic drugs should not be used to set the lowest-accepted level of effectiveness in settings where they are entirely unsuitable. Continuing to weigh the benefits of one effective drug against another only delays the distribution of misoprostol in countries where it is the only feasible choice and must be measured against no treatment at all.     

Integrated plasma cortisol concentration in children with asthma receiving long-term inhaled corticosteroids.

We assessed the effect of long-term therapy with inhaled beclomethasone dipropionate (BDP) on the pituitary-adrenal axis, by measuring the integrated concentration (IC) of plasma cortisol in eight children with asthma (age, 6-16 years) who regularly used inhaled BDP in doses ranging from 8 to 26.5 micrograms/kg (200-450 micrograms/day) for 6 months to 4 years. The control group included six children (age, 6-16 years) who had the IC of plasma cortisol measured as part of an endocrinological evaluation and were found to be healthy. Cortisol concentration was measured in blood samples collected continuously over a 24-hr period. Mean IC of plasma cortisol in the study group was significantly lower than in the healthy controls (mean +/- SD, 4.9 +/- 3.3 vs 9.1 +/- 1.9 micrograms/mL; P less than 0.02). Cortisol response to 0.25 mg ACTH (iv) was abnormal in one of the eight BDP-treated patients. No correlation was found between IC of plasma cortisol and the BDP dose, severity of asthma, height percentile, or the Tanner stage. We conclude that long-term therapy, even with relatively conventional doses of inhaled BDP may cause reduction in the normal physiological secretion of cortisol. The clinical relevance of low IC of plasma cortisol is not clear, but it may reflect partial suppression of the pituitary-adrenal axis.     

Involvement of prolactin in the REM sleep-promoting activity of systemic vasoactive intestinal peptide (VIP)

The involvement of pituitary prolactin (PRL) in systemic vasoactive intestinal peptide (VIP)-induced sleep was studied. Male rats were implanted with electrodes for EEG-recording, with brain thermistors to record cortical temperature (T_crt) and with chronic intracardial catheters to obtain blood samples and to deliver substances. One group of rats (n = 8) received normal rabbit serum (NS) + physiological saline (SAL) on the baseline day and was injected with NS + VIP on the experimental day. In the other group of rats (n = 6), the baseline day was followed by administration of PRL-antiserum (PRL-AS) + VIP on the experimental day. The sera and VIP or SAL were injected 30 min before and at light onset, respectively. Sleep-wake activity was then recorded for the next 12-h light period. Systemic VIP-stimulated PRL secretion as measured by RIA in serial samples obtained hour 1 postinjection. VIP also elicited selective increases in REM sleep (REMS) in the rats pretreated with NS. T_crt was not affected by VIP. Administration of PRL-AS blocked the increase in circulating levels of free (non-IgG-bound) PRL and prevented VIP-enhanced REMS. Comparisons of the sleep effects of PRL-AS + VIP with the previously reported changes in sleep after PRL-AS alone indicate that PRL has a major role in the mediation of the REMS-promoting activity of systemic VIP. The results suggest that an increased release of endogenous pituitary PRL modulates REMS.