应用超声生物显微镜观察白内障超声乳化人工晶状体植入术后前房容积的改变

目的 应用超声生物显微镜(ultrasound biomicroscopy UBM)量化观察具有浅前房、窄房角结构和正常前房深度、宽房角结构的白内障患者在行了白内障超声乳化人工晶状体植入术后前房容积的改变,旨在探讨白内障手术对前房容积的影响,对手术时机的选择提供安全有效的临床依据.方法 选取具有浅前房、窄房角结构和正常前房深度、宽房角结构的白内障患者作为对照组,每组患者各40例(40只眼),均采用透明角膜切口白内障超声乳化后房型人工晶状体植入术,于术前和术后1个月用UBM观测前房深度(ACD)、小梁虹膜夹角(TIA)、房角开放距离(AOD250、AOD500)、小梁睫状体距离(TCPD)、虹膜睫状体距离(ICPD)、虹膜晶状体接触距离(ILCD)和前房角隐窝面积(ARA),同时记录眼压的变化和各级房角的人数构成比,对结果进行比较分析.结果 全部患者术后除ILCD值比术前明显减小以外,其余各项值ACD、TIA、AOD250、AOD500、TCPD、ICPD、ARA均较术前明显增加,差异具有统计学意义(P <0.001).术后眼压平均下降(3.77143±1.84368)mmHg,较术前差异有统计学意义(P<0.001).对宽房角组患者进行手术前后的比较,各测量值均较术前明显增加,差异有统计学意义(P<0.001),术后眼压平均下降(2.49714±1.05482)mmHg,较术前明显下降(P<0.001).对窄房角组患者进行手术前后的比较,术后各测量值比术前大大增加,差异具有显著统计学意义(P<0.001),术后眼压较术前明显降低,平均下降(5.04571±1.56287)mmHg,差异有统计学意义(P<0.001 ).分别对窄房角组和宽房角组患者进行术前结构的比较和术后结构的比较,除ICPD值外,其余各值二组间均存在显著性差异有统计学意义(P<0.001).将二组患者手术前后的变化程度进行比较,窄房角组ACD、AOD250、AOD500、TIA、ARA值的变化程度显著大于宽房角组,差异具有显著统计学意义(P<0.01).手术前后的房角构成差异有统计学意义(P <0.001),术后宽角显著增多.结论 白内障超声乳化吸除人工晶体植入术后,前房加深,房角增宽,前房容积显著增加,眼压也有一定程度的下降.具有浅前房、窄房角结构的白内障患者,手术前、后的变化程度更为显著.UBM可以明确有无晶体因素引起的瞳孔阻滞,当发现此情况时,可以将白内障手术时机提早,使具有窄房角解剖因素的白内障患者避免因晶体膨胀、瞳孔阻滞而引起的青光眼的发生,在一定程度上起到预防的作用.

Abstract：

Objective To study and analyze the changes of anterior chamber cubage of senile cataract patients before and after the surgery of phacoemulsification and foldable IOL implantation with ultrasound biomicroscopy quantitatively, to explore the influence of anterior chamber angle and anterior chamber cubage caused by senile cataract, and to provide safe and effective basis of cataract surgery options.Methods Small-incision phacoemulsification and foldable IOL implantation start from transparent cornea were performed in 80 eyes of 80 senior patients whom were divided into two groups: one group with normal anterior chamber structure, another group of shallow anterior chamber and narrow anterior chamber angle, measured numerical values of ACD (anterior chamber distance), AOD250 (angle-opening distance at 250μ m from the scleral spur)and AOD500 (angle-opening distance at 500μ m from the scleral spur), TIA500 (trabecular iris angle at 500μ m from the scleral spur), Trabecular ciliary processes distance (TCPD), iris ciliary body distance (ICPD),iris lens contact distance (ILCD) and angle recess area (ARA).At the same time, the intraocular pressures were also recorded.The number of people at all levels of composition ratio of angle and intraocular pressure by using ultrasound biomicroscopy before operation and one month later to analysis.Results In all patients, the measurements of ACD, AOD250, AOD500, TIA, TCPD, ICPD, and ARA were increased significantly after the operation except for ILCD after the operation.The intraocular pressure was also reduced to some extent after the operation.There were significant differences between two groups in ACD, AOD250, AOD500, TIA, TCPD,ICPD, and ARA except for ICPD before and after the surgery.The measurements and the intraocular pressure change more in the group of shallow anterior chamber caused by senile cataract.To compare the extent of change in two groups, the degree of change in group with narrow anterior chamber angle was significantly greater than in normal eyes group.The composition of angle had statistically significant difference pre-operation and post-operation (P<0.001), and wide-angle increased significantly after surgery.Conclusions Small incision phacoemulsification and foldable IOL implantation surgery deepens the anterior chamber, widens anterior chamber angle and increases anterior chamber cubage significantly compared with the preoperative patients,and it also reduces intraocular pressure to some extent after the operation.The added value of anterior chamber cubage is more prominent in the patients with narrow anterior chamber and shallow anterior chamber angle.Ultrasound biomicroscopy can confirm the situation of crystal-induced pupillary block.The study indicates that small incision phacoemulsification and foldable IOL implantation surgery in an early stage of senile cataract with anatomical factors of narrow angle can be effective in reducing intraocular pressure, preventing the occurrence of glaucoma caused by crystal expansion and pupillary block, which plays a role in the prevention and treatment in a certain extent.     

剖宫产的社会因素分析及对策

目的探讨影响剖宫产率上升的社会因素并采取对策控制剖宫产率上升。方法采用问卷调查方法对本院2006年1月至2007年12月间的1100例社会因素所致剖官产进行原因分析。结果社会因素所致剖宫产占手术分娩率62．7％,而因错误观念和孕妇心理状态占社会因素的主要部分,医务人员对孕妇分娩方式选择也有着重要影响。结论剖宫产率的上升应该作为一个社会问题来整体看待;要从根本上改变社会因素对剖宫产的影响,必须从社会、家庭和个人观念三个方面进行变革。     

不同职业入伍的新兵社会状况及心理素质的研究

目的 研究不同职业入伍新兵的社会状况和心理素质特点.方法 整群抽取某部2630名集训新兵进行社会状况分析,并应用症状自评量表(SCL-90)、艾森克成人个性问卷(EPQ)、自我和谐量表(SCCS)、简易应对方式问卷(CSQ)、社会支持量表(SSRS)进行心理调查.结果 收回有效问卷2599份,城镇入伍、双亲家庭、高中以上文化、主动入伍、要求进步的新兵中入伍前职业是学生者较多;农村入伍、单亲家庭、初中以下文化、被动入伍的新兵中其他职业入伍者较多(P<0.05).SCL-90:学生新兵强迫、人际关系敏感、抑郁、焦虑、敌对、精神病性因子得分低于其他职业新兵(P<0.05,P<0.01);EPQ:学生新兵内外向因子得分高于其他职业新兵,而神经质和精神质得分低于其他职业新兵(P<0.01);SCCS:学生新兵自我不和谐、自我刻板性因子得分低于其他职业新兵,而自我灵活性得分高于其他职业新兵(P<0.01);CSQ:学生新兵积极应对得分高于其他职业新兵(P<0.01);学生新兵SSRS各因子得分均高于其他职业新兵(P<0.01).结论 学生新兵心理素质较好,可塑性强,入伍前职业是影响新兵心理素质的重要因素之一;新兵入伍后应结合入伍动机、目的、家庭状况,从自我和谐、积极应对、主动寻求支持等方面加强新兵的个性塑造.     

叙事医学模式在与低学历癌症患者沟通中的应用

目的 探讨叙事医学模式在与低学历癌症患者沟通中的应用价值.方法 回顾性分析2019年3月-2020年4月在四川大学华西医院住院的低学历癌症患者80例,采用随机数字表法分为观察组和对照组各40例.对照组接受常规护理干预,观察组接受叙事医学护理模式干预,两组均连续干预6个月.于干预前后对两组患者进行焦虑自评量表(SAS)、...     

精神运动康复对住院青壮年精神分裂症患者康复的效果

背景 精神分裂症患者的康复主要依靠药物治疗,然而,单纯药物治疗对患者社会功能和生活质量的改善难以达到预期效果。近年来,非药物康复措施越来越多地应用于精神障碍的治疗中,但关于精神运动康复对住院青壮年精神分裂症患者康复效果影响的研究有限。目的 探讨精神运动康复对住院青壮年精神分裂症患者康复效果的影响,以期为住院青壮年精神分裂症患者的康复治疗提供参考。方法 选取2021年6月—2022年6月在芜湖市第四人民医院住院治疗的、符合《国际疾病分类（第10版）》（ICD-10）精神分裂症诊断标准的104例青壮年患者为研究对象,采用随机数字表法分为研究组和对照组各52例。研究组和对照组均接受利培酮（2~4 mg/d）治疗及常规护理,研究组此基础上接受为期12周、每周2~3次、每次45~55 min的精神运动康复,对照组在研究结束后接受相同干预。于干预前、干预第4、8、12周接受阳性和阴性症状量表（PANSS）、 住院精神病人社会功能评定量表（SSPI）和自知力与治疗态度问卷（ITAQ）评定。结果 PANSS阳性症状分量表评分、阴性症状分量表评分、一般精神病理分量表评分、总评分、SSPI评分以及ITAQ评分的时间效应均有统计学意义（F=33.989、204.245、82.817、279.596、26.144、7.463,P均<0.01）;PANSS阴性症状分量表评分、一般精神病理分量表评分、总评分和SSPI评分以及ITAQ评分的组间效应均有统计学意义（F=30.053、5.306、33.417、33.013、18.608,P<0.05或0.01）;PANSS阳性症状分量表评分、阴性症状分量表评分、一般精神病理分量表评分、总评分和SSPI评分的时间与组间交互效应均有统计学意义（F=3.472、9.798、3.843、14.390、20.661,P<0.05或0.01）。干预第12周,研究组PANSS总评分及各分量表评分均低于干预前,SSPI评分高于干预前,差异均有统计学意义（P均<0.01）,且研究组PANSS总评分及各分量表评分均低于对照组,SSPI评分高于对照组,差异均有统计学意义（P均<0.01）。结论 精神运动康复可能有助于改善住院青壮年精神分裂症患者的精神病性症状和社会功能,提高康复效果。     

How the war on drugs impacts social determinants of health beyond the criminal legal system

There is a growing recognition in the fields of public health and medicine that social determinants of health (SDOH) play a key role in driving health inequities and disparities among various groups, such that a focus upon individual-level medical interventions will have limited effects without the consideration of the macro-level factors that dictate how effectively individuals can manage their health. While the health impacts of mass incarceration have been explored, less attention has been paid to how the “war on drugs” in the United States exacerbates many of the factors that negatively impact health and wellbeing, disproportionately impacting low-income communities and people of colour who already experience structural challenges including discrimination, disinvestment, and racism. The U.S. war on drugs has subjected millions to criminalisation, incarceration, and lifelong criminal records, disrupting or altogether eliminating their access to adequate resources and supports to live healthy lives. This paper examines the ways that “drug war logic” has become embedded in key SDOH and systems, such as employment, education, housing, public benefits, family regulation (commonly referred to as the child welfare system), the drug treatment system, and the healthcare system. Rather than supporting the health and wellbeing of individuals, families, and communities, the U.S. drug war has exacerbated harm in these systems through practices such as drug testing, mandatory reporting, zero-tolerance policies, and coerced treatment. We argue that, because the drug war has become embedded in these systems, medical practitioners can play a significant role in promoting individual and community health by reducing the impact of criminalisation upon healthcare service provision and by becoming engaged in policy reform efforts.

KEY MESSAGES

• A drug war logic that prioritises and justifies drug prohibition, criminalisation, and punishment has fuelled the expansion of drug surveillance and control mechanisms in numerous facets of everyday life in the United States negatively impacting key social determinants of health, including housing, education, income, and employment.
• The U.S. drug war’s frontline enforcers are no longer police alone but now include physicians, nurses, teachers, neighbours, social workers, employers, landlords, and others.
• Physicians and healthcare providers can play a significant role in promoting individual and community health by reducing the impact of criminalisation upon healthcare service provision and engaging in policy reform.

     

从宏观结构及微观分布揭示医学学科发展战略情报

选择ESI免疫学高被引论文为数据源,对高频主题词与来源文献进行双聚类分析,绘制战略坐标图谱和社会网络图谱并将两者结果相互融合嵌入。社会网络分析嵌入战略坐标,从宏观结构和微观分布揭示全球免疫学领域热点结构与内部主题分布情况,为该领域发展方向提供参考。     

Chronic Δ9-Tetrahydrocannabinol in rats: Effect on social interactions,mouse killing,motor activity,consummatory behavior,and body temperature

Behavioral and physiologic effects of daily administration of ⁹-tetrahydrocannabinol (THC) were assessed over a 60-day period, investigating different dose levels (10, 20, 50 mg/kg), routes of administration (i.p., p.o.), drug vehicles [5%–18% propylene glycol(PG)/1% Tween 80-saline; sesame oil], and rat strains (Sprague-Dawley, Wistar, Long-Evans, Fischer). All THC-treated rats showed compulsive motor routines (i.e., forepaw treading, rhythmic jaw movements, prolonged head grooming, and biting of cage wires) after 3–4 weeks. Whether maintained on a restricted feeding regimen or not, three was no evidence for increased aggressive behavior between cagemates in any of the treatment groups. Mouse killing was induced in 70%–75% of all Sprague-Dawley (i.p., PG/Tween 80-saline vehicle) and Fischer rats (p.o., sesame oil vehicle), but not in the other THC-treated groups. Rearing activity was greatly decreased in all THC-treated groups throughout the treatment period. Food and water intake decreased by approximately 40% during the first 2–6 days of THC administration. Growth rate was reduced for the entire treatment period in THC-treated rats. THC decreased rectal temperature on the 1st day, and also on the 2nd day in Fischer rats receiving the drug in sesame oil, but not thereafter. This pattern of effects shows that tolerance develops rapidly to THC's effects on body temperature and consummatory behavior, but not to changes of certain motor activities.     

个性化的健康指导及技能训练对康复期精神分裂症患者的影响

目的 探讨健康指导及技能训练对康复期精神分裂症患者的影响.方法 对自愿入组的50例患者,每月进行1次健康指导及技能训练,共6次,每次1h.在入组时与入组6个月末分别采用生活质量综合评定问卷(GQOLI)、社会功能缺陷筛选量表(SDSS)及患者服药依从性调查表进行评价和比较.结果 患者入组6个月后生活质量综合评定显著高于入组时(P＜0.05),尤其在躯体功能和社会功能方面,改善更为明显(P＜0.01);SDSS 6个月后评分显著低于入组时(P＜0.05);患者的服药依从性入组后6个月明显优于入组时(P＜0.01).结论 健康指导及技能训练可提高康复期精神分裂症患者的生活质量,进一步改善患者的社会功能,对提高患者的服药依从性,促进患者早日回归社会具有重要作用.     

社会支持对精神分裂症患者生活质量和康复效果的影响

目的 探讨社会支持对精神分裂症患者生活质量和康复效果的影响.方法 选取华北理工大学附属开滦精神卫生中心于2014年2月-2015年8月收治的慢性精神分裂症278例,按照干预方法分成观察组和对照组,每组139例.对照组给予常规康复干预,观察组在对照组基础上实施社会支持模式干预.采用社会支持评定量表(SSRS)、精神分裂症患者生活质量量表(SQLS)评分和简明精神病评定量表(BPRS)评估干预后患者的生活质量和康复效果.结果 观察组干预后SSRS评分高于干预前和对照组,SQLS和BPRS评分均低于干预前和对照组(P＜0.05).观察组SQLS总均分与SSRS中主观支持、客观支持和总均分呈负相关,BPRS总均分与SSRS中客观支持、支持利用度和总均分呈负相关(P＜0.05).结论 社会支持能明显改善精神分裂症患者生活质量和康复水平,应重视社会支持对精神分裂症预后的影响.