Effects of haemophilic arthropathy on health-related quality of life and socio-economic parameters

Summary. Although prophylactic treatment is advised for all children with severe haemophilia, the optimal regimen is still under discussion. Should all joint bleeds be prevented, or can a limited amount of arthropathy be tolerated in adulthood without loss of quality of life? To answer this question, the effect of haemophilic arthropathy on health‐related quality of life (HRQoL) needs to be quantified. In a retrospective study, the effect of arthropathy on HRQoL and socio‐economic parameters was assessed in a single‐centre cohort of 96 patients with severe and moderate haemophilia with a minimum age of 13 years. Arthropathy was measured by the radiological Pettersson score of the elbows, knees and ankles (maximum: 78 points). HRQoL was assessed by the Short Form 36 (SF36), measuring eight domains of health. Labourforce participation and medical consumption were assessed using a separate questionnaire. Patients were studied at a mean age of 28.6 years (range: 13–54), the mean time between evaluation and the last Pettersson score was 0.4 years (SD: 1.1). The overall median Pettersson score was 13 (range: 0–78). There was a trend towards lower quality of life with increasing Pettersson scores and age, especially in the physical domains of the SF36. An age‐adjusted analysis showed that arthropathy had a small but significant effect on HRQoL in the domain of ‘physical function’ of the SF36, but not on its other domains, or on labourforce participation and medical consumption. Thus suggesting that the SF36 can be used to assess the effects of haemophilic arthropathy, especially in the domain of ‘physical function’.     

老年心脑血管疾病患者血清铁蛋白和β2-微球蛋白含量测定的临床价值

目的 探讨老年心脑血管疾病患者血清铁蛋白（SF）和β2-微球蛋白（β2-GM）测定的临床价值。方法 用电化学发光法和免疫比浊法分别对60岁以上的56例冠心病、75例高血压、38例脑梗死患者的血清测定SF、β2-GM，并同时测定尿素氮（Urea）和肌酐（Cr），与正常健康对照组进行对比。结果 老年冠心病、高血压、脑梗死患者血清SF、β2-GM的含量均明显高于健康对照组，有显著性差异（P〈0．01）。结论 SF、β2-GM参与了老年心脑血管疾病的病理生理过程，为老年心脑血管疾病的诊断、治疗和判断预后提供了参考指标。另外β2-GM为老年心脑血管疾病早期肾损伤的敏感指标。     

Proximal vs Distal Approach of Ultrasound-guided Suprascapular Nerve Block for Patients With Adhesive Capsulitis of the Shoulder: Prospective Randomized Controlled Trial

ObjectivesTo evaluate the early clinical outcomes of ultrasound (US)-guided suprascapular nerve block (SSNB) using a proximal approach compared with a distal approach for outpatient treatment of adhesive capsulitis.DesignRandomized controlled trial.SettingOutpatient clinicParticipantsParticipants (N=47) with symptomatic adhesive capsulitis.InterventionsParticipants were randomly assigned to either US-guided SSNB using a proximal approach (n=23, proximal group) or a distal approach (n=24, distal group).Main Outcome MeasuresThe primary outcome measure was the visual analog scale (VAS) for pain at week 12. Secondary outcomes included the American Shoulder Elbow Surgeon’s (ASES) score, University California Los Angeles score, Short Form-36 mental and physical component summaries, and range of motion. All patients completed clinical follow-up at 2, 6, and 12 weeks after treatment. On US images, depth and insertion angle of needle during injection were measured.ResultsThe VAS significantly improved in both groups at week 12. After treatment, no significant differences were found in early clinical outcomes (weeks 2, 6, and 12) between groups (all P>.05), except that ASES at 2 weeks showed a significantly higher score in the distal group than in the proximal group (87.1±4.8 and 83.0±6.3, respectively; P=.014). The mean depth and insertion angle of needle was significantly lower (depth: 13.4±3.9 and 30.6±4.3 mm, respectively; P<.001; insertion angle: 19.6°±6.4° and 38.7°±5.8°; P<.001) in the proximal group than in the distal group.ConclusionsThis study demonstrated that proximal approach of US-guided SSNB provided favorable short-term outcomes of pain and functional improvement and that outcomes were comparable to those of the distal approach in adhesive capsulitis. The suprascapular nerve was located more superficially and easily identified in the proximal approach, suggesting that this method might improve the accuracy of injection.     

Plasma linoleic acid partially mediates the association of bipolar disorder on self-reported mental health scales

We have shown that bipolar individuals have reduced quality diets, including lower intake of polyunsaturated fatty acids (PUFA). We have also reported reduced plasma levels of the n-6 PUFA, linoleic acid (LA), and the n-3 PUFA, eicosapentaenoic acid (EPA) in bipolar subjects. In the current analysis we hypothesized that LA and EPA plasma levels would mediate lower self-reported mental health and life functioning scores in bipolar subjects. In a cross-sectional study, we collected a 7-day diet record in bipolar (n = 56) and control subjects (n = 46) followed by a fasted blood draw. We used structured equation modeling path analysis to test for mediating effects of dietary intake and plasma levels of LA and EPA on self-reported mental health questionnaire scores, including the Life Functioning Questionnaire (LFQ), the Patient Health Questionnaire (PHQ9), and the Short Form Health Survey (SF12), extracting the mental health component summary score (SF12-MH). We adjusted for age, gender, psychiatric medication use, body mass index (BMI), and total caloric intake as covariates with bipolar disorder as the primary predictor. We found a significant path association from bipolar disorder to lower plasma LA levels (p = 0.03) and significant paths from plasma LA to PHQ9 (p = 0.05), LFQ (p = 0.01) and SF12-MH (p = 0.05) scores, such that lower plasma LA predicted worse outcomes. We found no significant paths from plasma EPA levels to any of the outcome measures. These findings suggest that plasma LA levels partially mediate the effect of bipolar disorder on self-reported measures of mental health and life functioning.     

上海市浦东新区产后半年内妇女生命质量影响因素分析

[目的]了解上海市浦东新区产后半年内妇女生命质量的主要影响因素。[方法]应用健康调查简表(SF-36)对浦东新区产后半年内妇女进行生命质量影响因素分析,对15个人口社会学因素和17个医学因素进行单因素方差分析,在此基础上对8个维度逐一进行多重逐步回归分析。[结果]产后半年内妇女生命质量的危险因素有:距离分娩时间短、缺乏社会支持、夫妻感情不良、由丈夫单独照顾产妇、初诊建卡时间晚、产妇有尿失禁、产妇文化程度高、婴儿出生评分异常和婴儿人工喂养,各影响因素作用于生命质量的不同维度。[结论]距离分娩时间长短是产后半年内妇女生命质量最大的影响因素,医务人员及相关部门应从个人、家庭、社会各个层面给予相应的关注及支持。     

肾性贫血患者血清铁蛋白与叶酸检测的价值

目的探讨肾性贫血患者血清铁蛋白与叶酸检测的价值。方法抽样选取该院诊治的肾性贫血患者75例（观察组）,再选取同期健康志愿者75例（对照组）进行对比分析,分别于治疗前后对两组进行血清铁蛋白于与叶酸的检测。结果观察组患者在治疗前的血清铁蛋白与叶酸含量明显低于对照组,差异有统计学意义（P〈0.01）。但是治疗后,观察组患者的血清铁蛋白含量略低于对照组,差异无统计学意义（P〉0.05）;而叶酸含量,观察组却仍远低于对照组,差异有统计学意义（P〈0.05）。结论对于肾性贫血患者的血清铁蛋白、叶酸含量变化进行有效的掌握,为其具体的诊治极具指导意义。     

肺癌术后监测血清铁蛋白、癌胚抗原的临床价值

本文测定3o例术后复发或转移的肺癌病人和25例术后未复发的肺癌病人血清铁蛋白和癌胚肮原水平，并以7o例正常人血清铁蛋白、癌胚抗原为对照组。结果显示：复发组血青铁蛋白、癌胚抗原为对照组、结果显示：复发组血清铁蛋白、癌胚抗原明显高于未复发组和对照组（P＜0．01）和（P＜0.05）。本文提示：联合检测血清铁蛋白和癌胚抗原对监测肺癌术后复发和转移有一定临床价值。