住院痴呆患者照料者心理健康状况及相关因素研究

目的探讨住院痴呆患者照料者的心理健康状况及其相关因素。方法采用症状自评量表（SCL-90）作为评定工具,对住院痴呆患者照料者的心理健康状况进行调查。结果（1）住院痴呆患者照料者的SCL-90总分及抑郁因子分与国内常模比较,差异无统计学意义（P〉0.05）：躯体化因子分显著高于常模,其他因子评分显著低于国内常模,差异有统计学意义（P〈0．01）。（2）SCL．90总分显示,女性、高龄、受教育水平低、身体健康状况差、收入较低、照料人数多、照料时间长的照料者心理健康状况较差,差异有统计学意义（P〈0．05）。（3）男性、低年龄、病程长、痴呆程度较严重、躯体疾病较多对照料者心理健康影响更明显,差异有统计学意义（P〈0.01）。（4）照料者年龄、文化水平、过去经历、身体状况、亲子关系、照料时间及患者病程进入回归方程．决定系数为0．599。结论住院痴呆患者照料者心理健康受多方面因素的影响．要提高照料者的心理健康水平,必须从多个方面综合考虑并采取措施。     

Head Computed Tomography Is Not Useful for Evaluating Patients Change in Mental Status Following Total Joint Arthroplasty

We retrospectively reviewed 187 patients who presented with neurologic abnormality after total joint arthroplasty to establish the incidence of diagnosed organic brain disorders in these patients and determine the utility of advanced head imaging studies. 139 of 187 (74.3%) patients underwent imaging for altered mental status (AMS) and 48 patients for a focal neurologic deficit (FND). Acute findings on head imaging were more common in the FND group. The incidence of stroke and transient ischemic attack was significantly lower in the AMS group compared to FND group (Stroke: 0% vs 12.5%, p < 0.001; TIA: 0% vs. 16.7%, P < .001). Advanced head imaging for evaluation of TJA patients with a change in mental status is of low yield. An algorithm for evaluation of these patients is proposed.     

健康老人认知功能和海马体积相关性的横断面研究(英文)

背景:在中国老年人认知功能障碍及痴呆是一个紧迫的公共卫生问题,但对认知能力下降的生物学指标的研究极其有限。目的:探索健康老人多个领域的认知功能与左右侧海马体积之间的关系。方法:使用配有MPRAGE序列的西门子3.0 T Trio Tim磁共振扫描仪对65名65至75岁的社区健康受试者进行结构成像扫描。采用Freesurfer软件来确定左右侧海马的体积。使用可重复的神经心理状态成套检查(Repeatable Battery for the Assessment of Neuropsychological Status,RBANS)对认知功能进行评价。评估海马体积与认知功能之间未调整和调整后的相关性。结果:在这一相对狭窄的年龄段中,女性的年龄与大多数认知功能评估结果显著相关,但男性中年龄与任何认知评估结果都不相关。无论是男性还是女性,右侧海马体积与延迟记忆呈正相关,而左侧海马体积与即刻记忆和延迟记忆均呈正相关(虽然在女性中与延迟记忆只有相关的趋势)。经调整年龄、性别和受教育年数(该变量与所有认知评估结果的相关性最强)后,左右侧海马体积均与延迟记忆呈正相关,但与即刻记忆无关联。有趣的是,左右侧海马的体积之差与RBANS注意分量表得分呈负相关,女性中该相关性要强于男性。结论:本研究证实了先前关于海马体积和记忆之间相关性的研究工作,提出了注意力和两侧海马体积差异可能存在关联,并表明海马体积和记忆的相关性存在一些性别差异。     

Role of in vitamin D in irritable bowel syndrome

Irritable bowel syndrome (IBS) is a common chronic functional gastrointestinal disorder affecting 10%-22% of adults. Its development is closely related to the gut microbiota, and the inflammatory and immune responses triggered by the gut microbiota can lead to IBS. Vitamin D (VD) effectively treats IBS with fewer side effects by improving gut microbiota, immune regulation, and anti-inflammatory effects. In the future, it is necessary to carry out epidemiological studies on the relationship between VD and IBS, clinical studies on the efficacy of supplementing VD to improve IBS, and animal studies on the mechanism of VD improving IBS. Therefore, this paper discussed the relationship between VD and IBS.     

原发性脑桥出血的预后因素分析

目的探讨原发性脑桥出血患者的预后及影响因素。方法连续登记2009年1月至2013年3月云南省玉溪市人民医院收治的发病后24 h内入院的原发性脑桥出血患者83例,失访7例,完成随访76例,其中男性45例(59.2%),女性31例(40.8%)。随访患者,记录发病后1年的生存状态(生存组和死亡组)。应用Cox比例风险模型对影响患者1年生存率的因素进行分析。结果原发性脑桥出血患者76例中,死亡32例,总病死率为42.1%;1个月内死亡28例,1个月病死率为36.8%。存活组平均血肿体积(2.58±2.18)mL,死亡组平均血肿体积(11.02±8.33)mL,两组比较,t=5.625,P=0.000。不同部位的原发性脑桥出血患者1年病死率比较,被盖型(4/26例)与混合型(21/29例)比较(χ2=17.983,P=0.000)。存活组入院时格拉斯哥昏迷(GCS)评分(13.27±3.19)分,死亡组GCS评分(6.13±3.66)分,两组比较(t=9.055,P=0.000)。Cox比例风险模型显示,影响原发性脑桥出血患者1年死亡的主要因素有:血肿体积(RR=1.061,95%CI:1.013~1.111),入院时GCS评分(RR=0.825,95%CI:0.738~0.922)。结论 GCS评分和血肿体积是原发性脑桥出血预后的临床和影像学预测指标,GCS评分低、血肿体积大提示预后差。     

10例新发难治性癫持续状态患者的临床分析

目的总结并分析新发难治性癫持续状态(NORSE)的临床特点及预后。方法采用回顾性研究分析2011至2013年收治的10例NORSE患者的临床资料,并对其预后进行随访,平均随访时间1.5年。结果 9例患者发热后出现难治性癫持续状态(RSE)。急性期癫发作以部分发作为首发表现8例,继发全面性发作6例。急性期头颅MRI未见异常4例,颅内囊肿2例,余4例提示颅内信号异常。所有患者均接受正规抗癫药物治疗(3~9种),其中使用大剂量苯巴比妥4例、咪达唑仑7例、激素5例、静脉注射免疫球蛋白5例、生酮饮食治疗3例。随访期内仅1例应用3种抗癫药物14个月后无明确临床发作,7例仍有临床发作;1例处于植物状态,1例死亡。格拉斯哥预后评分5分1例,4分6例,3分1例,2分1例,1分1例。结论 NORSE是一组病因不明易发展为RSE的疾病,多种治疗常无效,预后多不良并遗留认知行为障碍。     

Surgical Treatment for Women with Breast Cancer in Relation to Socioeconomic and Insurance Status

Based on the National Breast Cancer Audit of the Royal Australasian College of Surgeons an association between patient age and type of breast cancer surgery received has already been demonstrated. The aim of this study is to assess the patterns of surgical treatment for women with early breast cancer in relation to socioeconomic and insurance status. Data on patient demographics, diagnostic, and surgical procedures and cancer characteristics in 115,872 episodes of early breast cancer reported to the National Breast Cancer Audit between 1998 and 2012 is used for this study. Tumor size, histologic grade, number of tumors, lymph node positivity, and lymphovascular invasion are the major prognostic factors adjusted for. Reconstruction following mastectomy is the most likely surgical procedure for the higher socioeconomic and privately insured patients. Mastectomy alone is the most likely surgical procedure for the lower socioeconomic and for public patients. No surgery is the most likely surgical outcome for the lower socioeconomic and the least likely for the higher socioeconomic population. Open biopsy is the most likely diagnostic procedure for the lower socioeconomic and fine needle aspiration for the higher socioeconomic population. Socioeconomic and insurance status, are both independently associated with the types of treatment and diagnostic procedure for women with breast cancer. Opportunities present to investigate an association of these factors with morbidity and survival outcomes.