血浆置换联合持续性血液滤过透析对慢性重型乙型病毒性肝炎临床症状及生化指标的影响——附87例报告

目的:探讨血浆置换联合持续性血液滤过透析治疗对慢性重型乙型病毒性肝炎(慢重肝)临床症状及生化指标的影响.方法:记录87例慢重肝患者(A组)在应用血浆置换及持续性血液滤过透析联合内科综合治疗前后临床症状和生化指标的改善情况,并与94例行血浆置换联合内科综合治疗的慢重肝患者(B组)进行对比.结果:治疗后,A组临床症状改善100%(87/87),低钾血症复常率为80%(33/41)、低钠血症复常率为93%(27/29),肝性脑病清醒率55%(12/22);B组则相应为48%(45/94)、7%(3/42)、7%(2/30)和20%(5/25),2组上述各项指标比较差异均有统计学意义(均为P＜0.05).A组近期有效率、近期生存率分别为80%、48%,B组为47%、31%,2组比较差异均有统计学意义(均为P＜0.05).不良反应以血浆过敏反应为主,均未发生低血压、肺水肿等严重不良反应.结论:血浆置换及持续性血液滤过透析联合内科综合治疗可有效纠正慢重肝患者的电解质紊乱,保持内环境平衡,且能提高其近期生存率和肝性脑病清醒率,为慢重肝的治疗提供了新的选择.     

地震医疗救援中如何做好医院的营养膳食供应体系保障工作

汶川地震医疗救援中，华西医院中央厨房在充分保障生产环境安全和食品安全的前提下，遵照标准化生产、速凉科技、网络化管理、营养指导四大理念，停止了有可能出现控制失效的食品生产，合理计划库存物资量，加强食品原料来源及品质检查；调整菜式结构；针对来自不同地区、不同民族的伤员和家属，制作特别餐；针对伤员和医护人员研发新菜品；保证轻伤员的营养供给、为重伤员提供个体化常规化的营养治疗方案。其间共为灾区70077人次（伤员36330人次，家属33747人次）、一线救护人员36273人次供餐，并完成普通病员及其他院内职工的供餐任务。最高每日供餐18372人次。     

社会支持和应对方式对女性尿失禁患者生活质量的影响

目的探讨社会支持和应对方式对老年女性尿失禁患者生活质量的相关性影响。方法2008年4—8月采用问卷对在上海2所3级甲等医院就诊的70例年龄大于60周岁的老年女性尿失禁患者进行调查。该问卷由尿失禁生活质量量表,医学应对问卷,社会支持量表和人口社会学资料组成。结果70例患者中,回避和屈服得分均高于常模（P〈0.05）;老年女性尿失禁患者的面对得分与患者生活质量中的心理影响维度、社会活动受限维度呈负相关（P〈0.05）;老年女性尿失禁患者的回避与患者生活质量中避免和限制性行为维度、心理影响维度呈负相关（P〈0.05）;老年女性尿失禁患者主观支持、社会支持利用度得分与患者生活质量的所有维度均呈正相关（P〈0.05）。结论社会支持利用度,面对,主观支持是影响老年女性尿失禁患者生活质量的3大主要因素。提高老年女性尿失禁患者健康意识,帮助患者采用积极的应对方式,有效地利用社会支持能提升老年女性尿失禁患者生活质量。     

急性心肌梗塞患者心理健康状况及人格特质研究

目的探讨急性心肌梗塞患者的心理健康水平及焦虑抑郁情绪和人格特质状况。方法将91例急性心肌梗塞患者设为研究组,抽取90例正常健康体检者设为对照组。采用症状自评量表、焦虑自评量表、抑郁自评量表、生活事件量表、社会支持评定量表及艾森克个性问卷对两组进行评定分析。结果研究组症状自评量表总分、阳性项目和阳性症状分、躯体化、强迫、人际敏感、抑郁、焦虑、敌对、恐怖、偏执因子分及焦虑自评量表、抑郁自评量表总分均显著高于对照组（P〈0．01）;1a内负性生活事件明显高于对照组（P＜0．01）,而社会支持度显著低于对照组（P〈0．01）;艾森克个性问卷评分研究组内外倾、神经质维度分均显著高于对照组（P＜0．01）,外倾性格和情绪不稳定构成比显著高于对照组（P〈0．01）。结论焦虑、抑郁、紧张、恐惧等负性情绪、负性生活事件、缺乏社会支持度以及不良性格等因素均是诱发急性心肌梗塞的危险因素,在控制其生物学病因的同时,还应调整患者的情绪,加强心理治疗,对不良性格加以矫正,有助于预防、减少和控制急性心肌梗塞的发生。     

The use of amiodarone for in-hospital cardiac arrest at two tertiary care centres

BACKGROUND: Although amiodarone significantly increases survival to hospital admission when used in resuscitation of out-of-hospital pulseless ventricular tachycardia and fibrillation, there are limited data on its utility for in-hospital arrests. OBJECTIVES: To determine whether the use of amiodarone, as recommended by the year 2000 American Heart Association Advanced Cardiac Life Support guidelines, improved survival following its introduction to the resuscitation algorithm at two tertiary care institutions. METHODS: Charts of 374 cardiac resuscitations were retrospectively studied at the two institutions. Basic survival outcomes and demographic data were recorded for cardiac arrests with ventricular tachyarrhythmias qualifying for administration of antiarrhythmic agents. RESULTS: Qualifying rhythms were present in 95 patients. Clinical uptake of amiodarone was limited. In the 36 patients who received amiodarone, survival of resuscitation was 67% versus 83% (P=0.07) in the 59 patients receiving only other antiarrhythmic agents (chiefly lidocaine [94%]), while survival to discharge was 36.1% and 55.9% (P=0.06) in these two groups, respectively. CONCLUSIONS: Following two years' experience with the introduction of intravenous amiodarone for resuscitation in the institutions, use was less than 50% and no clinically observable survival benefit could be documented. Possible explanations for the difference between this experience and that found in out-of-hospital resuscitation trials include differing patient populations and operator bias during resuscitation. These results should provoke other institutions to question whether amiodarone has improved survival of cardiac arrest under the conditions prevailing in their hospitals. A patient registry or prospective, randomized trial will be required to assess what parameters affect the success of intravenous amiodarone for resuscitation in-hospital.     

Randomized controlled trial of two forms of self-management group education in Japanese people with impaired glucose tolerance

The aim of this study was to determine the effectiveness of education on diabetes prevention in subjects with impaired glucose tolerance. A total of 100 subjects of impaired glucose tolerance with hemoglobin A1c (HbA1c) levels >/=5.5 to <6.1% were assigned randomly to either support or control groups. All subjects received education in 8 sessions over a 6-month period. The support group consisted of 10 members collaborating with a dietitian or a nurse who learned coping skills by employing a participant-centered approach. Participants in the support group were required to keep a diary that monitored weight, food intake and blood glucose levels, while the control group attended several lectures. Subjects assigned to the support group had a reduction in mean HbA1c levels from 5.77 +/- 0.36% at baseline to 5.39 +/- 0.24% at the endpoint (p<0.01). Weight, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) levels also decreased (p<0.01) in the support group, whereas subjects in the control group had no observable reduction in these indices. After intervention, participants of the support group had improvements in their 2-h post-meal blood glucose levels. Support group education can be effective for improving glycemic control in participants when carried out in collaboration with educators and other team members.     

大学生志愿行为和领悟社会支持的关系研究

目的探讨大学生的志愿行为与领悟社会支持的关系。方法采用领悟社会支持量表对广州地区的216名大学本科生志愿服务的状况进行调查。结果发生志愿行为的大学生感受到的社会支持明显高于没有发生志愿行为的大学生组(t=2.360),特别是家庭支持方面差异显著(t=3.582)。结论领悟社会支持影响着亲社会行为的发生,感受到社会支持度越高的人,越倾向于产生亲社会行为。     

蛋白亚细胞定位的预测方法研究

预测蛋白质的亚细胞定位信息对于了解其功能有重要的意义.选择氨基酸组成、氨基酸对组成、位置特异性打分矩阵三种分类特征以及模糊k近邻、支持向量机两种预测方法,分别进行了测试.对预测结果的分析显示,位置特异性打分矩阵可以提高对不同亚细胞器的可区分性;而支持向量机可以更好地利用位置特刎异性打分矩阵特征进行预测.使用氨基酸组成和位置特异性打分矩阵两种特征,并结合支持向量机,是一种有效的亚细胞定位预测方法.