Effects of aprotinin on hemorrhagic complications in ARDS patients during prolonged extracorporeal CO2 removal

The effects of aprotinin, a broad-based proteinase inhibitor, in the management of hemorrhagic complications during prolonged venovenous extracorporeal CO₂ removal in patients with adult respiratory distress syndrome are not evaluated. In two patients, aprotinin infusion was added to heparin to treat bleeding, occurring after few days of bypass and responsible for respiratory and hemodynamic deterioration. After aprotinin infusion (loading dose of 2×10⁶ kIU followed by a continuous infusion of 5×10⁵ kIU/h) combined with heparin, bleeding vanished until the end of bypass.     

The Effect of Adult Diabetes on Glucose Utilization and Esterification of Palmitate by Human Adipose Tissue

Abstract. 1. The conversion of glucose and palmitate to neutral lipid by adipose tissue has been studied in a group of 30 adult diabetics and compared to a group of 30 non-diabetic controls. — 2. Adipose tissue from both sources showed similar saturation characteristics for glucose; uptake of palmitate was linear up to 3 mM. — 3. Adipose tissue of diabetics incubated with glucose (14 mM) converted 270 ± 60 (90) mμmoles/mg protein/2 hours to neutral lipid compared to non-diabetics who converted 380 ±70 (10) mμmoles/mg protein/2 hours. Similar results were obtained with a medium glucose concentration of 8 mM. No differences were found in glucose utilization between a group of 7 lean diabetics and 6 obese diabetics. — 4. Conversion of palmitate to neutral lipid by adipose tissue was inhibited by cyanide (1.5 mM), fluoride (50 mM) and was found to be temperature dependent. — 5. Adult diabetics converted 0.36 ± 0.06 (17) mμmoles palmitate/mg protein/2 hours into neutral lipid, compared to a group of non-diabetics who converted 1.09 ± 0.35 (13) mμmoles/mg protein/2 hours.— 6. The significance of these observations is discussed in relation to the impaired glucose tolerance test of diabetes.     

HA-1A in septic patients with ARDS: Results from the pivotal trial

Objective To evaluate the effects of HA-1A, a human monoclonal antiendotoxin antibody, in septic patients with ARDS.Design Substudy of a multicenter, double-blinded, placebo-controlled trial of HA-1A in septic patients.Patients 63 septic patients with ARDS at the time of study entry.Intervention A single intravenous injection of HA-1A (100 mg) or placebo.Results A quantitative radiographic score, the PaO₂/FIO₂ ratio and an index of the severity of ARDS did not show a significant difference between the treatment and placebo groups at 3, 5 and 7 days after treatment. The duration of endotracheal intubation did not differ between the two groups. 15 of 30 HA-1A treated patients (50%) and 23 of 33 placebo-treated patients (69.7%) died within 28 days. The daily mortality was always lower in the HA-1A group, but this difference was not statistically significant at 28 days. The 28-day survival curves for the two treatment groups adjusted by covariate analysis were not significantly different (p=0.07). Using logistic regression, a significant independent effect of HA-1A treatment was detected upon the early survival rate at 7 days (p=0.03) but not at 14 and 28 days.Conclusion A single injection of HA-1A in septic patients with ARDS did not reverse acute respiratory failure or improve long-term survival.This study was supported by a grant from Centocor Inc., Malvern, PA, USA     

Identifying instruments to quantify financial management skills in adults with acquired cognitive impairments

Introduction: Financial management skills—that is, the skills needed to handle personal finances such as banking and paying bills—are essential to a person’s autonomy, independence, and community living. To date, no comprehensive review of financial management skills instruments exists, making it difficult for clinicians and researchers to choose relevant instruments. The objectives of this review are to: (a) identify all available instruments containing financial management skill items that have been used with adults with acquired cognitive impairments; (b) categorize the instruments by source (i.e., observation based, self-report, proxy report); and (c) describe observation-based performance instruments by populations, overarching concepts measured, and comprehensiveness of financial management items. Objective (c) focuses on observation-based performance instruments as these measures can aid in situations where the person with cognitive impairment has poor self-awareness or where the proxy has poor knowledge of the person’s current abilities. Method: Two reviewers completed two systematic searches of five databases. Instruments were categorized by reviewing published literature, copies of the instruments, and/or communication with instrument authors. Comprehensiveness of items was based on nine key domains of financial management skills developed by the authors. Results: A total of 88 discrete instruments were identified. Of these, 44 were categorized as observation-based performance and 44 as self- and/or proxy-reports. Of the 44 observation-based performance instruments, 8 had been developed for acquired brain injury populations and 24 for aging and dementia populations. Only 7 of the observation-based performance instruments had items spanning 6 or more of the 9 financial management skills domains. Conclusions: The majority of instruments were developed for aging and dementia populations, and few were comprehensive. This review provides foundation for future instrument psychometric and clinimetric reviews. It a necessary first step in providing information to support decision making for clinicians and researchers selecting financial management skills instruments.     

Let's talk about sex: a critical narrative analysis of heterosexual couples' accounts of low sexual desire

Background/Aims: Low desire for sex is common in the lives of women and causes distress where there is desire discrepancy in a relationship. Very little research, however, has investigated low sexual desire in the context of couple relationships. Aims of this research were to explore couples' narratives of low sexual desire and to connect these findings to therapeutic practice.

Methodology: Eight narratives were gathered individually from the members of four heterosexual couples in which the woman was experiencing low sexual desire. Narratives were analysed using critical narrative analysis.

Results: Six main themes arose from the narratives, including shared experiences of blame and problematic communication patterns. Entitlement, doubt, and conflation of love and sex emerged as men-only themes, while anxiety over abnormality and seeking causes of low sexual desire were prevalent for women. Identity-focused analysis of the narratives showed the men adopting a role of victim, with the women occupying a role of self-sacrifice. Applying a feminist critique highlighted pathologisation of normal sexual variation, and the dominance of male-centred views about sexuality.

Implications: The results underlined the importance of a systemic approach, normalisation of experience, and the importance of arriving at a shared narrative of low sexual desire.     

女性复发性抑郁症共病心境恶劣的临床特征

目的:探讨女性复发性抑郁症患者共病心境恶劣的临床特征。方法:采用复合性国际诊断用检查访谈(CIDI)将301例女性复发性抑郁症患者分为共病心境恶劣组(共病组,26例)及非共病心境恶劣组(非共病组,275例);对两组的人口学资料、抑郁症临床特征、父母亲情关系量表(PBI)、艾森克神经质量表、生活应激事件量表评分进行比较。结果:两组人口学资料比较差异无统计学意义;与非共病组的临床资料相比,共病组抑郁症总病程更长[(14.1±9.5)年vs.(10.4±8.3)年;P=0.032],起病年龄更小[(30.9±8.3)岁vs.(36.1±9.4)岁;P=0.003],发病次数更多[(5.8±5.3)vs.(4.1±4.9);P=0.047],阳性家族史及有自杀行为比率更高(34.6%vs.18.5%,P=0.049;38.5%vs.20.4%,P=0.033);艾森克神经质评分明显增高[(13.3±6.0)vs.(10.6±5.7);P=0.025];二元Logistic回归分析显示,PBI母亲保护评分、共病焦虑障碍及生活压力事件是共病心境恶劣的因素(P0.05或P0.01)。结论:共病心境恶劣的女性复发性抑郁症患者其抑郁症病情更为严重;母亲过度保护、共病焦虑障碍及生活压力事件是其相关因素。     

齐拉西酮治疗男性与女性精神分裂症的疗效与安全性对比研究

目的:比较齐拉西酮治疗男性与女性精神分裂症患者的疗效及安全性。方法:25例男性(男性组)和64例女性(女性组)精神分裂症患者均接受齐拉西酮治疗8周。于治疗前后采用阳性与阴性症状量表(PANSS)评定疗效,并通过体检、实验室和心电图检查以及其他不良事件的描述性记录资料评价其安全性。结果:总显效率男性组和女性组分别为80.0%和78.13%(P=0.53)。两组PANSS总分及各项评分治疗后均较治疗前显著下降(P0.05或P0.01);PANSS总分及一般病理症状减分值女性组较男性组明显增高(t=-2.27~-2.53;P0.05或P0.01)。女性组治疗后心电图QTc间期(t=-3.04,P=0.00)、体质量(t=-2.81,P=0.00)和三酰甘油(t=-2.82,P=0.01)明显上升;中性粒细胞(t=2.06,P=0.04)、总蛋白(t=2.10,P=0.04)、空腹血糖(t=2.34,P=0.02)明显下降。不良反应发生率男性组和女性组分别为20%和18.75%(P0.05)。结论:齐拉西酮对男性和女性精神分裂症患者均具有良好的疗效和安全性;但对女性患者QTc间期、体质量、空腹血糖及血脂的影响较大。     

男女患者静脉穿刺时疼痛程度的比较及护理

目的探讨男女患者在静脉穿刺时疼痛程度的差异。方法采用疼痛的数字评估与脸谱评估法,对204名男女患者静脉穿刺时的疼痛程度进行评估。结果男性患者在静脉穿刺时疼痛程度比女性患者更高,经统计学处理,有显著性差异,P<0.05。结论在静脉输液时要同样重视对男性患者的心理疏导,减轻其痛觉。     

女性排尿困难71例诊治体会

目的:探讨女性排尿困难的发病原因及治疗方法。方法:以排尿困难为主诉的女性患者71例,行外阴检查、膀胱尿道镜检查、尿动力学检查包括尿流率、同步膀胱压力容积流率及肛门括约肌肌电图测定,部分患者同步透视下行影像尿动力学检查。结果:膀胱出口梗阻47例(66.2%),非神经原性神经性膀胱20例(28.2%),各项检查正常4例(5.6%),分别给予手术及药物治疗。治疗前后症状评分(IPSS)平均分别为(15.4±2.3)和(7.1±0.9)(P<0.05),平均最大尿流率(MFR)分别为(9.3±5.7)mL/s、(18.5±8.0)mL/s(P<0.05)。结论:根据女性排尿困难的病因,选择相应的治疗措施,是提高疗效的关键。