慢性心力衰竭的辨证施膳研究

慢性心力衰竭证属本虚标实.心气心阳亏虚为病之本,血瘀水停乃病之标,“虚”“瘀”“水”为其病理关键,治宜标本兼顾.根据虚实主次不同,本病可分为心肺气虚、气阴两虚、气虚血瘀、痰饮阻肺、阳虚水泛、阳气虚脱等证型.心肺气虚型治宜补益心肺,方用补虚正气粥合山楂粥;气阴两虚型治宜益气养阴,方用生脉粥;气虚血瘀型治宜益气活血,方用丹参粥合山楂粥;痰饮阻肺型治宜泻肺化痰,方用葶苈子粥合白术茯苓粥;阳虚水泛型治宜温阳利水,方用参芪附子粥合参桂苈枣汤.在具体病证的药膳调理过程中,务必恪守“辨证施膳”原则,随“机”而变.对于阳气虚脱者,药膳调理无助救治.     

循证医学与早孕终止妊娠方法的选择

目的通过分析对比早孕终止妊娠的不同方法，探讨其方法选择，为临床咨询提供详实的方案。方法收集本院2008年自愿选用药物流产1013例，自愿选用无痛人流2424例，对比流产时出血量、术后流血及腹痛天数，并对两组用药方案进行研讨。结果药物流产组流产时出血量、流产后阴道流血天数及24h内的腹痛程度均大于无痛人流组，差异有显著性（P〈0．05）。结论尽管无痛人流的预后明显优于药物流产，但实施难度大，且风险也大，并基于约40％的人群选用药物流产，提示不同方法有不同的适应症。医生应按循证医学原则，充分提供咨询并与早孕妇共同确定流产方式，尽可能减少流产者的心身伤害和经济负担。     

胸部肿瘤诊疗中的伦理问题

医患之间、医生之间、医生与医疗管理部门及保险部门之间出现了许多新的矛盾,而新技术和新的诊疗方法的不断涌现也给临床实践带来了许多新的挑战,这些都是当前胸部肿瘤诊疗过程中出现伦理冲突和医疗纠纷的根源。从事胸部肿瘤诊疗的医师,应该深刻了解胸部肿瘤的特殊性和复杂性,在应用循证医学的理论和方法进行诊疗活动时,应采用预防为主的思想,从技术和道义两方面为病人负责,有效地预防和处理各种伦理矛盾。     

强迫思想不伴强迫行为的强迫症二重辨证施治

目的探讨二重辨证施治对强迫思想不伴强迫行为强迫症患者的疗效,及其在开放式心理病房的适应情况。方法将47例强迫思想不伴强迫行为强迫症患者按随机的原则在开放式心理病房分为研究组(24例)和对照组(23例)。研究组用二重辨证施治,对照组用认知疗法结合氯丙咪嗪、氟西汀等。研究时间共5个月,前2个月为积极治疗期,后3个月为自由治疗期。采用耶鲁布朗强迫症量表(YBOCS)进行评定。结果两组在积极治疗期末和自由治疗期末痊愈率均有非常显著性差异(P<0005)。YBOCS总分两组治疗前无显著性差异(t=0375,P>05);在积极治疗期末和自由治疗期末,两组有显著性差异(均P<0001)。结论二重辨证施治对强迫思想不伴强迫行为的强迫症者有良好疗效,且疗效持续。开放式心理病房可作为强迫症含强迫思想不伴强迫行为者二重辨证施治的医疗平台。     

综合提醒系统对脑卒中患者出院6个月知信行和临床结局的效果

目的 探讨健康信念综合提醒系统对脑卒中患者出院后6个月健康知识、信念、行为、卫生服务利用情况及临床结局的效果。方法 2015年2月至2016年3月,方便抽样广州市3家综合医院高血压并发缺血性脑卒中出院患者174例,分为对照组(n = 87)和干预组(n = 87)。对照组予常规健康教育;干预组在此基础上采用“基于健康信念模式的综合提醒系统”进行健康教育和延续护理。出院6个月后,采用脑卒中健康知识问卷(SKQ)、脑卒中患者健康信念简表(SF-HBMS-SP)和脑卒中健康行为量表(HBS-SP)进行调查,并记录临床结局(急诊就诊、再住院、复发和死亡)。结果 对照组75例、干预组76例完成调查。干预组SKQ (U = 903.000)、SF-HBMS-SP (t = -9.099)和HBS-SP (t = -7.786)总分均显著高于对照组(P < 0.001)。干预组门诊复诊率(97.37%)显著高于对照组(76.00%) ( P <0.001);两组急诊就诊数和再住院数无显著性差异(P > 0.05),死亡和复发率无显著性差异( P > 0.05)。 结论 健康信念综合提醒系统能提高脑卒中患者出院后健康知识、信念、行为和门诊复诊率,但尚未对临床结局产生明显效果。     

乙型肝炎病毒cccDNA巢式-实时荧光定量PCR法的建立及应用

目的建立检测HBV共价闭合环状（cccDNA）的巢式-荧光定量PCR法,检测外周血单核细胞（PBMC）及骨髓单核细胞（MMNC）中cccDNA。方法根据HBV cccDNA与松弛结构DNA（rcDNA）结构上的差异,设计2对跨缺口的特异性引物及下游的特异性TaqMan探针。根据Mung Bean Nuclease对rcDNA与cccDNA作用的不同,使cccDNA扩增而使rcDNA降解,分别用外引物及内引物进行PCR反应,再用荧光探针进行实时荧光定量PCR,根据阳性参照物,计算出检测标本定量值。结果成功建立了HBV cccDNA巢式-荧光定量PCR的检测方法,线性范围为5.0×102～3.9×107拷贝/ml。用上述方法检测25例慢性乙型肝炎（CHB）及肝硬化血清HBV DNA阳性患者PBMC中cccDNA,7例MMNC中cccDNA,21例健康献血者PBMC cccDNA,骨髓标本中有3例cccDNA阳性,25例外周血标本中有9例cccDNA阳性。结论巢式-荧光定量PCR法可检测乙型肝炎患者PBMC及MMNC中的HBV cccDNA含量。PBMC及MMNC中可检测到HBV cccDNA。     

Web-based assessment and brief intervention for alcohol use in women of childbearing potential: a report of the primary findings

Background: There is a need for more effective assessment and primary prevention programs aimed at accurately measuring and reducing alcohol consumption among women before conception in underserved, high‐risk populations. Health information technology may serve this purpose; however, the effectiveness of such tools within this population is not known. Methods: We conducted a small‐scale randomized controlled trial to test the effectiveness of an adapted web‐based alcohol assessment and intervention tool among low‐income, nonpregnant women of reproductive age who were receiving Women Infant and Children (WIC) services in San Diego County and who reported currently drinking at a moderate risk level. A total of 150 risky drinking participants completed a web‐based assessment and were randomly assigned to either receive a personalized feedback intervention or general health information about alcohol consumption and fetal alcohol syndrome. Follow‐up assessments on reported alcohol consumption were conducted via telephone at 1‐ and 2‐months postbaseline. Participants ranged in age from 18 to 44 and were predominately Hispanic/Latina (44%). Results: At baseline, all respondents reported consuming ≥3 standard drinks on ≥1 occasion in the previous month. Outcome data were available for 131 participants. The main outcome measure was reduction in the number of risky drinking occasions, which did not differ significantly between treatment conditions (odds ratio 1.200, 95% CI 0.567 to 2.539, p = 0.634). Over 70% of the participants, however, reported a reduction in risky drinking occasions regardless of treatment condition (control 43/63, 68%; experimental 49/68, 72%). Conclusions: The results of this study demonstrate that web‐based assessment of alcohol consumption among low‐income women of reproductive age, as represented by WIC clients, is feasible and acceptable. The findings also suggest that detailed and interactive assessments of alcohol consumption may be sufficient for the reduction of risky drinking within this population without personalized feedback.     

Mediterranean diet habits in older individuals: Associations with cognitive functioning and brain volumes

To examine the association between dietary habits, cognitive functioning and brain volumes in older individuals, data from 194 cognitively healthy individuals who participated in the Prospective Investigation of the Vasculature in Uppsala Seniors cohort were used. At age 70, participants kept diaries of their food intake for 1 week. These records were used to calculate a Mediterranean diet (MeDi) score (comprising dietary habits traditionally found in Mediterranean countries, e.g. high intake of fruits and low intake of meat), with higher scores indicating more pronounced MeDi-like dietary habits. Five years later, participants' cognitive capabilities were examined by the seven minute screening (7MS) (a cognitive test battery used by clinicians to screen for dementia), and their brain volumes were measured by volumetric magnetic resonance imaging. Multivariate linear regression analyses were constructed to examine the association between the total MeDi score and cognitive functioning and brain volumes. In addition, possible associations between MeDi's eight dietary features and cognitive functioning and brain volumes were investigated. From the eight dietary features included in the MeDi score, pertaining to a low consumption of meat and meat products was linked to a better performance on the 7MS test (P = 0.001) and greater total brain volume (i.e. the sum of white and gray matter, P = 0.03) when controlling for potential confounders (e.g. BMI) in the analysis. Integrating all dietary features into the total MeDi score explained less variance in cognitive functioning and brain volumes than its single dietary component meat intake. These observational findings suggest that keeping to a low meat intake could prove to be an impact-driven public health policy to support healthy cognitive aging, when confirmed by longitudinal studies. Further, they suggest that the MeDi score is a construct that may mask possible associations of single MeDi features with brain health domains in elderly populations.     

Implementation of NIAAA College Drinking Task Force Recommendations: How Are Colleges Doing 6 Years Later?

Background: In 2002, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) College Drinking Task Force issued recommendations to reduce heavy drinking by college students, but little is known about implementation of these recommendations. Current discussion about best strategies to reduce student drinking has focused more on lowering the minimum legal drinking age as advocated by a group of college and university presidents called the Amethyst Initiative than the NIAAA recommendations. Methods: A nationally representative survey of administrators was conducted at 351 4‐year colleges in the United States to ascertain familiarity with and progress toward implementation of NIAAA recommendations. Implementation was compared by enrollment size, public or private status, and whether the school president signed the Amethyst Initiative. Results: Administrators at most colleges were familiar with NIAAA recommendations, although more than 1 in 5 (22%) were not. Nearly all colleges use educational programs to address student drinking (98%). Half the colleges (50%) offered intervention programs with documented efficacy for students at high risk for alcohol problems. Few colleges reported that empirically supported, community‐based alcohol control strategies including conducting compliance checks to monitor illegal alcohol sales (33%), instituting mandatory responsible beverage service (RBS) training (15%), restricting alcohol outlet density (7%), or increasing the price of alcohol (2%) were operating in their community. Less than half the colleges with RBS training and compliance checks in their communities actively participated in these interventions. Large colleges were more likely to have RBS training and compliance checks, but no differences in implementation were found across public/private status or whether the college president signed the Amethyst Initiative. Conclusions: Many colleges offer empirically supported programs for high‐risk drinkers, but few have implemented other strategies recommended by NIAAA to address student drinking. Opportunities exist to reduce student drinking through implementation of existing, empirically based strategies.