疏肝解郁内外合治对黄褐斑患者心理状况的影响

目的 探讨疏肝解郁内外合治对黄褐斑患者心理状况的影响。方法 选取2018 年1 月～2019 年12 月浙江中医药大学附属第三医院皮肤科门诊就诊的78 例气滞血瘀型黄褐斑患者,随机分观察组和对照组,治疗过程中脱落7 例,实际完成观察组35 例,对照组36 例,观察组给予疏肝活血汤联合外用中药祛斑霜,对照组给予氨甲环酸片联合外用维A 酸乳膏,治疗12 周进行皮损变化、临床疗效、不良反应、焦虑自评量表（SAS）及抑郁自评量表（SDS）评定。结果 基于皮损评分两组疗效比较,差异无统计学意义（P＞0.05）;两组治疗后皮损评分显著低于治疗前（P＜0.01）,且治疗后观察组SDS、SAS 评分显著低于对照组（P＜0.01）;观察组无明显不良反应。结论 两组治疗黄褐斑疗效相当,但疏肝解郁内外合治能显著改善患者心理状况,而且不良反应明显少于使用西药组。     

The paradoxical effect of medical insurance on delivery of surgical care for infants with congenital anomalies

Objective

Caring for neonates with major congenital anomalies has significant financial implications for the treating institution, which can be positive or negative depending on whether the patient has insurance. We hypothesized that insured affected neonates born in non-children's hospitals would be more likely to be treated on site, whereas uninsured neonates would be more likely to be transferred.

Patients and Methods

We used the Kids' Inpatient Database to study neonates with congenital anomalies who were born in US non-children's hospitals. We performed bivariate analysis using the χ² test and adjusted for covariates with multiple logistic regression.

Results

Uninsured patients were 2.57 (95% confidence interval, 1.83-3.62) times more likely to be transferred compared with patients with private insurance or Medicaid, after adjusting for patient and hospital characteristics. This trend increased over time between 1997 and 2006.

Conclusions

The current reimbursement structure in the United States incentivizes non-children's hospitals to retain insured patients with congenital anomalies and transfer uninsured patients with these same anomalies. This places a disproportionate financial burden on children's hospitals while paradoxically causing insured infants to be cared for at hospitals that may not be best equipped to provide complex care.     

The combined use of non-radioactive in situ hybridization and real-time RT-PCR to assess gene expression in cryosections

Gene expression changes in pathophysiological states can be spatiotemporally monitored by in situ hybridization and reliably quantified by real-time RT-PCR. Here we developed a new method whereby adjacent slides of frozen sections can be used for gene expression analysis by in situ hybridization and real-time RT-PCR. We applied this method to assess the mRNA expression of connexin 43 (Cx43), the major astrocytic connexin, after kainate-induced seizures in rat hippocampus. Gap junction-building connexins play a role in the pathogenesis of several diseases of the brain, including epilepsy. The number of Cx43 mRNA-positive cells in the hippocampus of kainate-treated and control rats was automatically quantified by computerized image analysis of brain sections hybridized with DIG-labeled RNA probes. In parallel, real-time RT-PCR was used to examine the relative Cx43 mRNA levels in hippocampal tissue from adjacent brain sections. Applying these two very sensitive methods we showed that kainate induced seizures do not affect hippocampal connexin 43 mRNA expression.     

残余肾功能对维持性血液透析患者营养状况及左心功能的影响

目的探讨残余肾功能（residual renal function,RRF）对维持性血液透析（MHD）患者营养状况及左心功能的影响。方法选择52例MHD患者,按RRF分为2组：有RRF组（A组）29例,RRF≥2．0ml／mim无RRF组（B组）23例,RRF〈2．0ml／min。比较2组观察开始时及观察1年后RRF、营养指标及左心功能指标。结果观察开始及1年后,A组RRF高于B组（P〈0．05）;观察开始及1年后体质量标准化蛋白质代谢率（nPCR）、血浆白蛋白、转铁蛋白、血红蛋白,A组均显著高于B组（P〈0．01或P〈0．05）;观察1年后A组的左心室射血分数（LVEF）和左心室短轴缩短率（LVFS）均高于B组（P〈0．05）。结论RRF对MHD患者营养状况及左心功能有显著影响。随着透析时间的延长,保护和监测RRF对促进MHD患者营养不良的改善及左心功能的保护均具有重要意义。     

Differences in Long-term Outcome and Prognostic Factors According to Viral Status in Patients with Hepatocellular Carcinoma Treated by Surgery

Long-term postoperative survival and prognostic factors were examined retrospectively in patients with hepatocellular carcinoma (HCC) with serum hepatitis B surface antigen (HBsAg) or hepatitis C antibody (HCVAb) and in those without virus infection. Subjects were 265 consecutive HCC patients treated surgically at one institution during the period 1990 to 2006. Postoperative survival was analyzed and compared between HBsAg-positive (B-HCC), HCVAb-positive (C-HCC), and hepatitis B- and C-negative (NBNC-HCC) patients. Prognostic factors for overall and recurrence-free survival were also analyzed. Overall and recurrence-free survival rates were significantly higher in the NBNC-HCC group than in the C-HCC group. Significant prognostic factors for overall survival identified by univariate and multivariate analyses were age, serum alkaline phosphatase (ALP) level, tumor multiplicity, portal vein invasion (Vp), hepatic vein invasion (Vv), and operative blood loss in the B-HCC group; serum albumin level, ALP level, tumor size, and Vv in the C-HCC group; and tumor multiplicity in the NBNC-HCC group. Significant factors for recurrence-free survival were age, ALP level, tumor multiplicity, Vp, and operation time in the B-HCC group; ALP level, prothrombin time, tumor size, Vv, and width of the surgical margin in the C-HCC group; and age, tumor size, tumor multiplicity, and Vp in the NBNC-HCC group. Thus, postoperative survival and prognostic factors in cases of HCC differ according to the presence of serologic viral markers.     

慢性乙型肝炎患者病毒e系统状态与肝纤维化关系的研究

目的:观察慢性乙型肝炎患者乙型肝炎病毒e系统状态和复制指标在肝纤维化发生过程中的变化及其与血清纤维化标志的关系,探讨它们在肝纤维化发生过程中的作用及其可能的临床意义.方法:188例慢性乙型肝炎患者根据肝纤维化程度分为S0～S4期等5组,分别用定量PCR及放免法检测患者血清中HBV-DNA及肝纤维化标志透明质酸、Ⅳ型胶原、Ⅲ型前胶原和层粘连蛋白的含量;HBeAg和抗-HBe采用酶联免疫吸附法(ELISA)检测,并观察其在不同肝病理纤维化分期时的变化.结果:随着肝纤维化程度加重,血清HBV-DNA含量逐渐升高,从S1期开始显著增加(P＜0.01);而HBeAg阳性率逐渐降低,S3、S4期较S0显著减少(P＜0.05和P＜0.01);抗-HBe阳性率呈相反的变化趋势,在S3和S4期的阳性率明显高于S0期(P＜0.05和P＜0.01).血清HBV-DNA( )HBeAg( )组血清纤维化标志最低,HBV-DNA(-)抗-HBe( )组最高,两者差异有显著性(P＜0.01).结论:HBV复制和e系统状态的改变与肝纤维化程度密切相关,肝内病毒复制标志与血清纤维化标志联合检测,对于判断肝纤维化程度和指导抗病毒治疗有重要的价值.     

初诊高血压病患者心理、个性和行为特征对控烟效果的影响

目的 观察初诊高血压病患者心理、个性和行为特征对控烟效果的影响.方法 对84例初诊高血压病吸烟患者行控烟治疗,连续3个月后评价控烟效果,并采用A型行为问卷、艾森克个性问卷(EPQ)及症状自评量表(SCL-90)对其进行测评.结果 控烟效果佳者38例,占45.24%;控烟效果差者46例,占54.76%.前者A型行为问卷、EPQ问卷(除外内外向性维度)评分均显著优于后者(P＜0.05,P＜0.01);SCL-90除偏执、阴性项目外,其余项目评分均显著优于后者(P＜0.05,P＜0.01).结论 A型行为类型、神经质和精神病性人格特征及负性情绪是影响控烟效果的重要因素,对此类患者实施控烟的同时予以针对性心理干预可望获得事半功倍的效果.     

普通外科住院患者心理状态与影响因素调查

目的了解普通外科患者的心理状态及其影响因素，为临床实施心理护理提供指导和依据。方法通过对2所综合医院的普通外科住院患者和资深护士的访谈以及参考以往的心理量袁，自行编制普通外科患者心理状况调查问卷，对306例普通外科住院患者进行问卷调查。结果普通外科患者的心理问题主要来自5个方面，即焦虑与抑郁状态、对手术与治疗的恐惧、机体功能下降、逃避现实和对预后的忧虑。其中对预后的忧虑评分最高；女性对手术与治疗的恐惧程度显著高于男性（P〈0.01）；癌症患者的焦虑与抑郁程度显著高于非癌症患者（P〈0．01）。结论影响普通外科患者心理状态的首要因素是对预后的忧虑，女性患者对手术或治疗的恐惧体验比男性强烈，癌症患者更为焦虑、抑郁。需针对不同人群采取相应的心理干预措施。     

An early intervention programme had no detectable influence on the health status of people with musculoskeletal injuries following road traffic crashes: Comparative study

Objective

To compare the health status of people with minor injuries from road traffic crashes that are exposed to an early, active intervention programme (intervention group) with those receiving usual care (control group) over a 12 month period.

Design

Prospective comparative study using sequential cohorts.

Subjects

People presenting to hospital emergency departments with mild to moderate musculoskeletal injuries following road traffic crashes.

Main outcome measures

Physical Component Score (PCS) and Mental Component Score (MCS) of the Short Form 36 (SF-36) health status measure; Hospital Anxiety and Depression Scale (HADS) and the Functional Rating Index (FRI) recorded immediately post-crash, at 6 months and at 12 months after injury.

Results

There were 95 participants allocated to the control group and 98 allocated to the intervention group. Participants were enrolled at a mean of 9.3 days following the crash. There were no significant differences in baseline health measures between the groups. Apart from a small improvement in anxiety for the intervention group, there were no significant differences in health status between the groups. Twenty percent of participants in the intervention group received treatment from external healthcare providers that was inconsistent with the recommendations of the intervention programme.

Conclusions

The intervention programme failed to result in a clinically significant improvement in health outcomes compared with usual care. There is some evidence to suggest that the intervention had some psychological benefits, as evidenced by the small improvement in anxiety levels. Limited adherence, frequent use of co-interventions, or other factors (such as intervention content or intensity) may have reduced its effect.