结防机构与医疗机构合作提高肺结核患者发现率

目的了解目前医疗机构与结防机构间合作提高肺结核患者发现方法的实施效果及存在问题。方法采用回顾性调查方法,调查各县区结防门诊根据转诊登记资料、追踪登记表和日常对医疗机构的督导记录;搜集综合医疗机构结核患者发现、报告以及转诊情况数据,搜集医疗机构发现患者到结防机构后诊断复核情况。结果①城市和农村地区医疗机构发现肺结核患者的报告和转诊情况有差异,报告情况城市好于农村,转诊情况农村好于城市;②医疗机构发现肺结核患者的查痰率低仅为13.3%;③结防机构对医疗机构发现未到结防机构就诊肺结核患者的追踪率为94.1%,不同追踪方式追踪到位情况有差异,结防机构医生追踪到位情况最好,到位率为74.2%。追踪未到位原因主要是报告卡姓名或地址等信息有误和患者住院治疗;④实施医疗机构与结防机构间合作措施后,被调查地区结防机构的就诊人数和发现的活动性肺结核患者数均较去年同期增加。结论医疗机构与结防机构间合作实施结核病控制,可提高肺结核病患者发现数量和治疗管理质量。     

托吡酯和丙戊酸钠治疗特发性全面性强直阵挛发作的临床疗效比较

目的:探讨中等剂量托吡酯(商品名:妥泰)200mg对特发性全面性强直阵挛(GTCS)发作的疗效。方法:64例GTCS患者分成三组,妥泰单药治疗21例,妥泰联合丙戊酸钠治疗22例,另外21例采用丙戊酸钠治疗作对照。结果:妥泰单药组及联用药组治疗GTCS有效例数明显高于单用丙戊酸钠组,差异显著(P<0.05);同时单用妥泰组与联用丙戊酸钠组疗效相近(P>0.05)。结论:妥泰治疗GTCS疗效优于丙戊酸钠,且妥泰单一用药与联用丙戊酸钠治疗疗效相近。     

Responsiveness and calibration of the general well-being adjustment scale in patients with hypertension

We examined the discriminant ability and responsiveness of the General Well-Being Adjustment Scale in patients enrolled in a randomized clinical trial of antihypertensive therapy. We also tried to translate the effects of physical symptoms on general well-being. This secondary analysis used demographic, clinical, physical symptom, and general well-being data for 545 white, male hypertensive patients. General well-being was measured by the General Well-Being Adjustment Scale (GWB) collected on 2 occasions over 8 weeks of treatment. Patients with any one of 14 physical symptoms or problems, compared to those without symptoms, had lower GWB scores (p < 0.003 to p < 0.0001). Decreases of 2.83–8.76 points in GWB scores were observed in patients developing physical symptoms over the 8 week study period (p < 0.05 to p < 0.0001). These effects were demonstrated in patients developing cold sensitivity, sexual problems, chest pain, shortness of breath, loss of taste, nausea, hot or cold spells, numbness and tingling, dry mouth, blurred vision, and dizziness. We conclude that the GWB is responsive to clinically meaningful changes in symptoms and may provide a more complete evaluation of the effects of medical treatment. The GWB is a valid and responsive measure of health status outcomes in the evaluation of antihypertensive treatment.     

Demand patterns for HIV-tests in general practice: Information collected by sentinel networks in 5 European countries

This study describes a p. year international data collection on the demand pattern for HIV-antibody tests in general practice recorded by 6 sentinel networks in 5 European countries. The purpose of the recording was to evaluate the use of HIV-antibody testing by general practitioners and the demand for testing among the general population. Sentinel networks of general practitioners are a possible and available instrument for monitoring the perception of the HIV-test, and indirectly of the threat of the HIV-epidemic by the public and by the general practitioners (GPs). Differences were found between the countries in the frequency of testing, the person asking the test and the reason for testing. Possible explanatory factors, such as differences in the routine testing of specific groups, differences in the training and in the role of the GP, differences in the characteristics of prevention policy, are discussed. The European comparison also offers the opportunity to reflect on common medical practice in dealing with demands for HIV-tests.     

美托洛尔预防老年围拔管期心血管反应的临床观察

目的探讨美托洛尔用于预防老年患者围拔管期心血管反应的方法。方法40例全身麻醉行择期手术的老年患者随机分为A组20例,B组20例,A组围拔管期分次静注美托洛尔0.06~0.1 m g/kg,B组以生理盐水分次静注。观察手术结束时、拔管前5分钟、拔管时、拔管后5、20分钟的心率(HR)、收缩压(SBP)、舒张压(DBP)及心率收缩压乘积(RPP)的变化。结果A组拔管时、拔管后5、20分钟的HR、RPP与手术结束时比较,差异无统计学意义,用药后最慢心率53次/m in,围拔管期血压维持平稳,RPP保持在较低值;B组拔管前5分钟、拔管时、拔管后5分钟的各参数与手术结束时比较明显升高(P<0.01);两组间比较,B组拔管前5分钟、拔管时、拔管后5分钟的HR、SBP、RPP明显高于A组(P<0.01)。结论老年患者小剂量分次静注美托洛尔可以安全地预防围拔管期心血管反应。     

Functional outcome and general health status in patients after arthroscopic release in adhesive capsulitis

Frozen shoulder is said to be a self-limiting entity but full recovery often takes more than 2 years. For that, most patients are unwilling to tolerate painful restriction while awaiting resolution. We prospectively investigated 30 patients (16 women, 14 men) for the outcome of arthroscopic capsular release in idiopathic frozen shoulder. Results were determined by the assessment of subjective and objective parameters to estimate both shoulder function and general health status. Symptoms persisted without improvement for a minimum of 6 months of conservative treatment. Preoperative average American shoulder and elbow surgeons score (ASES) was 35, visual analog scale (VAS) to measure pain was 7, and simple shoulder test (SST) was 4. Mean scores of the physical component of SF-36 were considerably reduced. Mean forward elevation was 85°, average abduction was 70°, mean internal rotation was 15°, and mean external rotation was 10°. Patients were followed-up at 6 weeks, 3, 6, 12 months and by a mean of 36 months. Range of motion for all planes improved (P < 0.05). Median VAS reduced to 2, average ASES increased to 91, and SST enhanced to a mean of 10 (P < 0.05). We stated improvement of the physical components in the SF-36 questionnaire in particular bodily pain and the role-physical score. There were no significant differences between the measurements in the early postoperative phase compared to the mid-term follow-up (P > 0.05). Our results demonstrate that arthroscopic release of refractory idiopathic frozen shoulder combined with a gentle manipulation provides reliable expectations for improvement in both clinical and general health status for most patients. We recommend the use of a limb-specific and a general-health-status questionnaire to conclude the benefit of the surgical intervention and contribute the optimization of a therapy concept more effectively.     

全凭静脉麻醉老龄大鼠海马tau蛋白磷酸化水平与认知功能的关系

目的 探讨咪唑安定、芬太尼、丙泊酚联用对老龄大鼠认知功能的影响以及这种影响是否与海马tau蛋白磷酸化水平有关.方法 雄性18月龄SD大鼠40只,随机分成全麻组和对照组,每组20只.每组分别于处理后第1和第7天各断头处死10只,HE染色光镜下观察海马神经元结构,免疫组化染色法检测海马tall蛋白Thr231和Ser404位点磷酸化蛋白的表达水平.其中后处死大鼠于处理后第1周行水迷宫实验.结果 处理后第1天,全麻组大鼠寻找平台的时间明显长于对照组(P＜0.01),但第2～7天与对照组比较差异无统计学意义.处理后第1天,全麻组海马tau蛋白Thr231位点的磷酸化水平高于对照组(P＜0.05).第7天,两组Thr231、Ser404位点的磷酸化水平差异无统计学意义.光镜下各组大鼠海马神经元结构未见明显异常.结论 咪唑安定、芬太尼、丙泊酚联用可引起老龄大鼠麻醉后第1天出现短暂的认知功能减退,海马tau蛋白Thr231位点的过度磷酸化可能与其有关.