临床应用抗菌药物的干预措施及其效果分析

目的:探讨干预措施在抗菌药物临床应用中的有效性和可行性。方法:以随机抽样法抽取2008年住院病历1 224份和2009年住院病历1 893份进行统计分析。结果:抗菌药物使用率、联合用药、围术期预防用药等方面在干预前后的差异有统计学意义。结论:加强对抗菌药物临床应用的考核,将考核结果公示并与质控挂钩,对规范临床医生选择抗菌药物有一定作用。     

经颈内动脉骨髓干细胞移植治疗脑梗死后遗症

目的:探讨骨髓干细胞移植治疗脑梗死后遗症的临床疗效与可行性。方法:病人9例,平均60.5岁。脑梗死发生后2wk～22mo。50岁以下取自体骨髓血120～150mL,50岁以上(含50岁),取胎儿脐带血约80mL。实验室即刻分离,分离后的骨髓干细胞(混于10mL生理盐水中)。经股动脉穿刺,以Seldinger氏方法,送入5.0F猎人头导管,导管尖端置于颈内动脉处缓慢注入。结果:移植术后2wk～3mo观察。肢体运动,痛温感觉语言功能。明显改善6例,改善2例,无变化1例。总有效率89%。结论:经颈内动脉骨髓干细胞移植治疗脑梗死后遗症方法近期有效,安全性目前可靠。     

Estimating fall risk with inertial sensors using gait stability measures that do not require step detection

Falls have major consequences both at societal (health-care and economy) and individual (physical and psychological) levels. Questionnaires to assess fall risk are commonly used in the clinic, but their predictive value is limited. Objective methods, suitable for clinical application, are hence needed to obtain a quantitative assessment of individual fall risk. Falls in older adults often occur during walking and trunk position is known to play a critical role in balance control. Therefore, analysis of trunk kinematics during gait could present a viable approach to the development of such methods. In this study, nonlinear measures such as harmonic ratio (HR), index of harmonicity (IH), multiscale entropy (MSE) and recurrence quantification analysis (RQA) of trunk accelerations were calculated. These measures are not dependent on step detection, a potentially critical source of error. The aim of the present study was to investigate the association between the aforementioned measures and fall history in a large sample of subjects (42 fallers and 89 non-fallers) aged 50 or older. Univariate associations with fall history were found for MSE and RQA parameters in the AP direction; the best classification results were obtained for MSE with scale factor τ = 2 and for maximum length of diagonals in RQA (72.5% and 71% correct classifications, respectively). MSE and RQA were found to be positively associated with fall history and could hence represent useful tools in the identification of subjects for fall prevention programs.     

Validity and reliability of the modified John Hopkins Fall Risk Assessment Tool for elderly patients in home health care

This prospective cohort study was conducted to evaluate the validity and reliability of the modified Johns Hopkins Fall Risk Assessment Tool (mJH-FRAT) among elderly patients receiving home health care visits. Out of 107 patients, 33 (30.8%) had one or more falls and seven (6.5%) experienced falls with injury. Receiver Operating Characteristics of the tool in predicting falls showed an Area Under Curve (AUC) of 0.66 (p = 0.011) with sensitivity and specificity of 72.5% and 52.2% at the cutoff score of 14. For predicting falls with injury, the AUC was 0.82 (p = 0.016) with sensitivity and specificity of 100% and 65.9% at the cutoff score of 17. Inter-rater reliability of the tool was 85.7% agreement with Cohen's kappa of 0.714 (p < 0.001). The mJH-FRAT is a simple and easy-to-use multi-factor fall risk assessment tool with promising sensitivity, specificity and inter-rater reliability for prospectively identifying patients at risk of falls with injury among community-dwelling elderly populations.     

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No abstract available for this article.     

中国8个省份50岁及以上人群跌倒伤害及其危险因素横断面研究

目的 估计中国8个省份≥50岁人群跌倒伤害发生率和人群分布情况,分析跌倒伤害相关的生理、心理和社会危险因素。方法 WHO“全球老龄化与成人健康研究”（SAGE）中国项目第一轮横断面数据,采用两水平（个体层面和社区层面）logistic模型按城乡进行分层分析相关因素与跌倒伤害的关系。结果 本研究推算中国8个省份≥50岁老年人群中,跌倒伤害的发生率为3.2%。多元分析发现在城市地区,增龄、罹患≥3种的慢性病（OR=2.55,95% CI：1.41～4.64）可以增大跌倒伤害的发生危险;在农村地区,罹患抑郁（OR=4.33,95% CI：2.52～7.42）和罹患≥3种慢性病（OR=2.46,95% CI：1.37～4.41）也可以增大跌倒伤害的发生危险。结论 本研究提供了一个基于中国8个省份≥50岁抽样人群跌倒伤害发生率。此外,本研究还发现增龄和共患多种慢性病会增大跌倒伤害的风险,提示采取措施防止和延缓老年人群慢性病发病可能有助于降低跌倒伤害的发生的概率。     

经皮冠状动脉介入治疗术后患者血浆可溶性Fas因子改变及他汀类药物干预

目的探讨经皮冠状动脉介入治疗术后6个月再狭窄患者和术后早期患者血浆可溶性Fas的改变及短期阿托伐他汀治疗对其的影响。方法选择29例经皮冠状动脉介入治疗术后再狭窄患者和无再狭窄患者,以及20例术后早期短期应用阿托伐他汀治疗的患者,均设立正常对照组。采用酶联免疫吸附测定法检测其血浆可溶性Fas水平。结果经皮冠状动脉介入治疗术后再狭窄组血浆可溶性Fas(469±126 ng/L)显著高于正常对照组(43±9ng/L)、冠心病组(123±23 ng/L)和无再狭窄组(132±30 ng/L)(P均<0.01);冠心病组和无再狭窄组血浆可溶性Fas也高于正常对照组(P均<0.01);而冠心病组和无再狭窄组之间血浆可溶性Fas差异无显著性。择期冠状动脉介入治疗术后6 h血浆可溶性Fas水平急剧增高;术后3天对照组血浆可溶性Fas升高达最高峰,阿托伐他汀治疗组则显著降低(分别为2 036±422和1 157±268 ng/L,P<0.01);术后7天对照组仍维持在高水平,治疗组下降至最低水平(分别为1 460±266和798±111 ng/L,P<0.01)。结论经皮冠状动脉介入治疗术后再狭窄患者血浆可溶性Fas高于无再狭窄患者,血浆可溶性Fas持续增高可能成为预测再狭窄的有效指标;阿托伐他汀干预可使血浆可溶性Fas水平显著降低,可能是阿托伐他汀防治再狭窄的机制之一。     

中医药通过肺淋巴管系统干预间质性肺疾病的研究进展

间质性肺疾病(ILD)是一种以弥漫性肺实质的炎症和肺纤维化改变为特征的疾病。淋巴管系统在炎症和纤维化疾病中发挥重要作用。已知在炎症性疾病和纤维化疾病中淋巴管系统具有重要功能。但在间质性肺疾病中淋巴管系统作用的相关研究较少,随着科技的进步,逐渐发现了间质性肺疾病中肺淋巴管系统发挥作用的重要机制。且近年来运用中药疗法干预淋巴管系统来治疗疾病成为研究热点。现将基于肺淋巴管系统与间质性肺疾病中的相关性来探讨中医药对间质性肺疾病的干预作用。     

精神分裂症患者精神残疾的影响因素研究进展

精神分裂症是一种常见而严重的精神疾病之一,其患病率约为1%,无文化、地区差异[1].精神残疾是指各类精神障碍(尤指精神分裂症)患者予抗精神病药物(如氯氮平)持续治疗一年无效,以致对其日常生活和社会功能造成严重影响的状态[2].第二次残疾人抽样调查结果显示,精神残疾率高达45.0%,且近半数(48.4%)的精神残疾由精神分裂症所致[3].精神残疾不仅严重危害个人健康及社会安定,而且加重了社会医疗负担[1,4].故本文对近几年国内外学者对精神分裂症患者精神残疾的影响因素(包括药物治疗、人口社会因素、疾病特征和精神症状等)和干预措施等研究现况进行总结,旨在深入研究精神分裂症患者精神残疾的影响因素,并为干预措施提供依据,以便进一步改善精神分裂症患者的社会功能,提高其生活质量,促进其早日回归社会.