疾病谱对心肺复苏急救患者生存状况影响的研究

目的：探究疾病谱对行心肺复苏术的急救患者的生存状况的影响。方法：随机选取2012年3月至2014年3月在我院急诊手术室因发生心脏骤停实施CPR 复苏成功患者100例和复苏失败患者100例,分析两组患者的临床基本资料和直接病因。结果：复苏成功组大多为20～40岁患者（51例／100例,51％）,复苏失败组患者年龄分布集中在60岁以上（45例／100例,45％）,且差异具有统计学意义（ P＜0．05）;成功组和失败组在心肺复苏起始时间（100例／100例,100％;17例／100例,17％）、是否气管插管（91例／100例,91％;32例／100例,32％）和心电监护（79例／100例,79％;56例／100例,56％）均具有统计学意义（χ2＝12．829,P＝0．000;χ2＝10．025,P＝0．000;χ2＝4．982,P＝0．000）;直接病因主要为脑出血和梗死（44例／200例,22％）、冠心病（33例／200例,16．5％）、呼吸衰竭（40例／200例,20％）和急性心肌梗死（47例／200例,23．5％）,且两组患者间原发性疾病差异均有统计学意义（ P＜0．05）。结论：心肺复苏患者自主循环的恢复与患者年龄、原发性病、是否进行气管插管、心电监护和复苏起始时间有关。     

铜绿假单胞菌外膜蛋白F原核载体构建、表达条件优化及免疫保护作用研究

目的 构建并鉴定铜绿假单胞菌(PA)外膜蛋白F(OprF)原核表达载体,分析OprF蛋白免疫保护作用,优化OprF蛋白诱导表达条件.方法 通过分子克隆获得OprF蛋白的表达菌株.利用切胶纯化获得OprF蛋白,免疫小鼠,通过PA攻毒实验分析OprF蛋白免疫保护作用.采用正交试验,获得OprF菌株的最佳表达条件与培养条件.结果 OprF重组载体双酶切、DNA测序鉴定结果与预测一致.Western blot检测表明抗体能与OprF蛋白结合.OprF蛋白对小鼠保护率达64.29％.OprF菌株最佳诱导表达条件为:加IPTG终浓度0.1mmol/L,诱导时菌液OD600值1.0,温度32℃,诱导时间8h;最佳培养条件为:转速230 r/min,葡萄糖浓度为0％,装液量50 ml.结论 获得OprF表达菌株最佳的表达条件与培养条件;验证OprF蛋白对小鼠PA感染有免疫保护作用.     

国家早期预警评分系统对老年急危重症患者病情的评估作用

目的：应用国家早期预警评分（NEWS）系统对老年急危重症患者急诊病情进行评估,评价NEWS对老年患者病情的评估作用。方法对我院急诊抢救室收治的361例≥60岁老年急危重患者进行NEWS评分,跟踪患者24h内病情变化、急诊转归停留期以及预后,绘制受试者工作特征（ROC）曲线,寻找最佳截点。以最佳截点为界分为低分组和高分组,比较两组间24h内病情变化、入住监护病房和急诊停留期间死亡,以及30d内死亡的发生率。结果 NEWS可预测患者24h内病情变化、急诊转归、预后的ROC曲线下面积（AUC）分别为（0.776±0.043）,（0.970±0.011）,（0.861±0.039）,最佳截断点分别为7分,6分,8分。以6分为最佳截断点,分为高分组与低分组,比较两组之间24h内病情变化、入住监护病房和急诊停留期间死亡,以及30d内死亡的发生率,差异有统计学意义（P＜0.01）。结论 NEWS能有效评估老年急危重症患者病情。     

老年重型胰腺炎患者机体凝血和抗凝系统的变化情况

目的探讨老年重型胰腺炎患者机体内凝血和抗凝系统的变化情况,分析凝血、抗凝指标对疾病发展程度的意义。方法收集2009年10月-2013年10月湖北医药学院附属太和医院收治的重型胰腺炎老年患者44例作为观察组,同期选择健康人群24例作为对照A组,同期选择老年轻型胰腺炎患者24例作为对照B组,对三组入选受试者进行血液样本采集,检测和记录标本凝血酶原时间(PT)、部分活化凝血酶原时间(APTT)、纤维蛋白原(FIB)D-二聚体。结果观察组PT、APTT、FIB和D-二聚体均明显高于对照A组和对照B组(P0.05)。结论老年重型胰腺炎患者机体内的凝血和抗凝系统明显异于常态时,可以直接影响到正常的微循环,同时凝血和抗凝系统指标患者病情发展的程度,有助于评估。     

Short telomeres in an oral precancerous lesion: Q-FISH analysis of leukoplakia

J Oral Pathol Med (2012) 41 : 372–378 Objectives: A precancerous condition is a lesion that, if left untreated, leads to cancer or can be induced to become malignant. In the oral region, leukoplakia is a lesion that has been regarded as precancerous. In cases of oral carcinoma, we have frequently noticed that a type of leukoplakia histologically demonstrating hyper‐orthokeratosis and mild atypia (ortho‐keratotic dysplasia; OKD) is often associated with carcinoma, either synchronously or metachronously. Therefore, we consider OKD‐type leukoplakia to be a true precancerous lesion. Materials and Methods: In an attempt to clarify the relationship between OKD as a precancerous condition in the oral mucosa and telomere length, we estimated telomere lengths in this type of leukoplakia using quantitative fluorescence in situ hybridization, and also quantified the frequency of anaphase–telophase bridges (ATBs) in comparison with squamous cell carcinoma in situ (CIS) and the background tissues of CIS and OKD. Results: Ortho‐keratotic dysplasia was frequently associated with squamous cell carcinoma (45.0%) and showed significantly shorter telomeres than normal control epithelium, CIS, or the background of CIS or OKD. The frequency of ATBs was much higher in OKD than in control epithelium or CIS. Conclusion: Ortho‐keratotic dysplasia appears to be frequently associated with carcinoma, chromosomal instability, and excessively shortened telomeres, not only in the lesion itself but also in the surrounding background. Therefore, when this type of leukoplakia is recognized in the oral region, strict follow‐up for oral squamous cell carcinoma is necessary, focusing not only on the areas of leukoplakia, but also the surrounding background.     

“A Dignified and Caring Mother:” 1 An Examination of Munchausen Syndrome by Proxy Case Law∗

Beginning with 1990, this article identifies and comments on fifteen years of legal case law across the five national common law jurisdictions of Australia, Canada, New Zealand, the United Kingdom and the United States, addressing legal responses to Munchausen Syndrome by Proxy (MSBP). MSBP is a syndrome in which perpetrators either harm a child in their care or achieve harm through their insistence on medical tests and treatments for non-existent, fabricated or exaggerated conditions. Abuse may go on for some time, and sometimes this abuse results in the child's death. The discussion situates this body of reported cases, identified through keyword searches in the LexisNexis databases, within current academic and professional literatures. Primarily, this review finds that the open-textured attributes of syndrome evidence, coupled with the idealisation of mothering and the concomitant social revulsion and retributive impulse towards “bad mothers”, invites professionals to infuse alleged cases of MSBP with morality, gender attributions, and social judgements. While identifying and preventing child abuse is an important goal, the questions of conscious knowledge and volition in a psychiatrically disordered perpetrator and the nexus of professional expertise in attributing liability and assigning punishment and treatment options deserve a more nuanced consideration.     

Small steps: barriers and facilitators to physical health self-management by people living with mental illness

It has been established that people with mental illness experience mortality and morbidity from all the major health conditions at 2–3 times the rate of those without mental illness. One way to overcome this problem is to encourage consumers of mental health services to self-manage their physical health. The purpose of the study was to investigate the facilitators and barriers to physical health self-management by people living with a mental illness. The study was underpinned by a hermeneutic phenomenological framework and utilised focus groups for data collection. A total of 27 participants, who lived in the community, had a diagnosed mental illness and who also had a co-morbid chronic physical health condition were included in one of three focus groups. The collected data were thematically analysed to identify common experiences and difficulties. It was found that participants were well aware of the need to attend to physical health issues. However, a number of factors at the individual, social and system levels impeded their ability to do so. Barriers to self-management included the debilitating nature of mental illness, poor physical health literacy, stigma from medical staff and social isolation, which resulted in a lack of support. Whereas informal peer networks, group participation and where it was offered, the support and encouragement from healthcare professionals facilitated health self-management.     

成年唇腭裂患者社会生活状态的初步探讨

目的 了解成年唇腭裂患者社会行为、社会生活等基本情况及心理状况,为针对性给予唇腭裂患者社会支持及心理帮助提供参考.方法 采用基本信息调查表,对成年先天性唇腭裂患者社会心理、社会支持等各方面的情况进行问卷调查.所得数据资料采用SPSS软件进行统计分析.结果 唇腭裂患者的文化水平与居住地有明显相关性;成年唇腭裂患者有选择语言交流或语言表达较少或基本不与人交流的工作的倾向,这与其语音障碍有直接关系;达到已婚年龄的男性成年唇腭裂患者,结婚平均年龄较正常人群偏高(P＜0.05),而女性患者无显著差异(P＞0.1).结论 成年唇腭裂患者在择业、婚姻等方面与相应年龄的非唇腭裂对照组人群相比有明显困难,这可能与其外貌缺陷、语音障碍及心理因素有较大关系.