麦考酚酸酯及其临床应用进展

目的:麦考酚酸酯(MMF)是一种新型的免疫抑制剂.在临床应用中,MMF的使用也越来越广泛,已不仅仅局限于器官移植,还涉及到系统性红斑狼疮(SLE)、自体免疫风湿性疾病的治疗,以及在糖尿病,肺部血管高压的辅助治疗等诸多方面.肠包衣麦考酚酸钠,是一种新的可抵抗胃溶作用的麦考酚酸肠包衣剂型,药物在肠内释放,可以降低胃肠道(GI)不良反应的发生.     

卡维地洛配伍螺内酯治疗老年难治性高血压的临床观察

目的：评价卡维地洛联合螺内酯对老年难治性高血压的临床疗效及安全性，以指导临床工作。方法：老年难治性高血压患者200例分成两组，观察组（120例）经安慰剂洗脱2周后口服卡维地洛配伍螺内酯治疗，对照组（80例）在原有用药基础上加用螺内酯，治疗后共观察8周，探讨疗效。结果：观察组不良反应发生少，且观察组总有效率明显高于对照组，观察组对改善左心室射血分数和左心室舒张末期内径效果明显。结论：卡维地洛联合螺内酯对老年难治性高血压控制较好，并能改善心室结构，临床应用效果好。     

亚低温治疗高温高湿环境下重型颅脑损伤的临床护理

目的 探讨亚低温治疗高温高湿环境下重型颅脑损伤的护理方法。方法 高温高湿环境下的重型颅脑损伤患者60例，随机分为亚低温治疗组和对照组。规范护理程序，严密观察病人生命体征变化，采取积极护理措施，减少并发症。结果 亚低温治疗24h后颅内压逐渐下降，脑组织PO2逐渐上升，伤后3个月亚低温治疗组的良好率明显高于对照组（P〈0.05），而死亡率明显低于对照组（P〈0．01）。结论 精心护理有助于改善亚低温治疗的高温高湿环境下重型颅脑损伤病人的预后。     

Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial.

BACKGROUND: We tested whether transcranial magnetic stimulation (TMS) over the left dorsolateral prefrontal cortex (DLPFC) is effective and safe in the acute treatment of major depression. METHODS: In a double-blind, multisite study, 301 medication-free patients with major depression who had not benefited from prior treatment were randomized to active (n = 155) or sham TMS (n = 146) conditions. Sessions were conducted five times per week with TMS at 10 pulses/sec, 120% of motor threshold, 3000 pulses/session, for 4-6 weeks. Primary outcome was the symptom score change as assessed at week 4 with the Montgomery-Asberg Depression Rating Scale (MADRS). Secondary outcomes included changes on the 17- and 24-item Hamilton Depression Rating Scale (HAMD) and response and remission rates with the MADRS and HAMD. RESULTS: Active TMS was significantly superior to sham TMS on the MADRS at week 4 (with a post hoc correction for inequality in symptom severity between groups at baseline), as well as on the HAMD17 and HAMD24 scales at weeks 4 and 6. Response rates were significantly higher with active TMS on all three scales at weeks 4 and 6. Remission rates were approximately twofold higher with active TMS at week 6 and significant on the MADRS and HAMD24 scales (but not the HAMD17 scale). Active TMS was well tolerated with a low dropout rate for adverse events (4.5%) that were generally mild and limited to transient scalp discomfort or pain. CONCLUSIONS: Transcranial magnetic stimulation was effective in treating major depression with minimal side effects reported. It offers clinicians a novel alternative for the treatment of this disorder.     

One-year follow-up of the outcome of a randomized controlled trial of a home-based intervention programme for children with autism and developmental delay and their families

Introduction There is debate about the type and intensity of early childhood intervention that is most helpful for children with developmental problems. The aim of the study was to determine whether a home‐based programme provided over 12 months resulted in sustained improvement in development and behaviour 12 months after the intervention ceased. The characteristics of the children and families who benefited most from the intervention were also studied. Method Randomized controlled trial. Participants A total of 59 children, aged 3–5 years, attending two early childhood intervention centres in Melbourne, Australia. Intervention Half of the subjects received an additional home‐based programme consisting of 40 weekly visits. Main outcome measures Bayley Scales of Infant Development and Wechsler Preschool and Primary Scale of Intelligence Revised, Preschool Behaviour Checklist, Bayley Behaviour Rating Scale and Behaviour Screening Questionnaire. All tests administered pre‐intervention, following the intervention and 12 months later. Secondary outcome measures Family stress, support and empowerment. Results Fifty‐four children completed the assessments 12 months after conclusion of the intervention. Compared with the control group, improvement in aspects of cognitive development in the children who received the extra intervention was sustained 1 year later (P= 0.007) while significant behavioural differences post intervention were not. Analyses of the data by the Reliable Change Index indicated improvement of clinical significance occurred in non‐verbal areas. In contrast to the control group who deteriorated, language skills in the intervention group remained stable. Improvements were significantly associated with higher stress in the families. Conclusion Improvements following the provision of a home‐based programme to preschool children with developmental disabilities were sustained 1 year later. Children from highly stressed families appeared to benefit most, reinforcing the importance of involving families in early childhood intervention programmes.     

Does Supplementary Prenatal Nursing and Home Visitation Support Improve Resource Use in a Universal Health Care System? A Randomized Controlled Trial in Canada

ABSTRACT: Background: The addition of supplementary prenatal support may improve the health and well‐being of high‐risk women and families. The objective of this randomized controlled trial was to examine the impact of supplementary prenatal care on resource use among a community‐based population of pregnant women. Methods: Pregnant women from three urban maternity clinics were randomized (a) to current standard of physician care, (b) to current standard of care plus consultation with a nurse, or (c) to (b) plus consultation with a home visitor. Participants were 1,352 women who received 3 telephone interviews. The primary outcome was resource use (e.g., attended prenatal classes, used nutritional counseling). Results: Overall, those in the nurse intervention group were more likely to attend an “Early Bird” prenatal class and parenting classes, and to use nutrition counseling and agencies that assist with child care. Women provided with extra nursing and home visitation supports were more likely to use a written resource guide, nutrition counseling, and agencies that assist with child care. Among women at higher risk (e.g., language barriers, young maternal age, low income), the nurse intervention significantly increased use of early prenatal classes, whereas the nurse and home visitor intervention significantly increased use of the written resource guide and nutrition counseling. The intervention substantially increased the amount of information received on numerous pregnancy‐related topics but had little impact on resource use for mental health and poverty‐related needs. Among those with added support, resource use among low‐risk women was generally greater than among high‐risk women. Conclusions: Additional support provided by nurses, or nurses and home visitors, can successfully address informational needs and increase the likelihood that women will use existing community‐based resources. This finding was true even for high‐risk women, although this intervention did not reduce the difference in resource use between high‐ and low‐risk women. (BIRTH 33:3 September 2006)     

努力提高严重多发伤的基础研究和临床救治水平

目的:探讨提高严重多发伤的基础研究和临床救治水平。方法:结合我们的有关研究和参加抢救的临床救治体会,并引用国内外公开发表的相关论文及著作进行分析研究。结果:善于应用现有的先进科技手段,提高严重多发伤的基础研究和临床救治水平。降低伤残率和死亡率。结论:严重多发伤具有脏器损伤率高、出血性休克率高、感染率高、MODS发生率高、死亡率高等“五高”特点,所以其诊治的复杂性、紧迫性远远超过其他许多疾病。因此努力提高我国严重多发伤的基础研究及诊断和救治水平已是当务之急。     

建立具有中国特色的临床医学工程体系势在必行

我们提出了一个建立具有中国特色的临床医学工程体系新理念，并且提出了一些具体建设性的意见。它涉及到政府行政管理、医学院校教育、医院科室人员配置以及传统观念的管理模式等，由于理念新、涉及面广，会有许多问题，仅供各界人士共同去探讨。     

实习期医学生心理健康状况、应对方式及压力状况的调查

目的探讨实习期医学生心理健康状况、应对方式及压力状况。方法将进入临床实习期的364名临床医学生作为研究组,而选取379名非实习期的临床医学生作为对照组,问卷评定采用症状自评量表(SCL-90)、应对方式问卷及心理身体紧张松弛测试表。结果研究组SCL-90的人际关系敏感、强迫、抑郁、焦虑、敌对因子得分显著高于对照组(t=2.25~5.17,P<0.05);与对照组相比,研究组的应对方式中解决问题因子分有显著性降低,自责、退避因子分则有显著性增高(t=-1.97~2.89,P<0.05);研究组的心理压力状况明显差于对照组,且差异具有显著性意义(χ2=56.03,P<0.05)。结论实习期的临床医学生存在不同程度的心理问题,应予以足够重视。