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.     

Experimental and Analytical Performance Evaluation of Short Circular Hydrodynamic Journal Bearings Used in Rotary Blood Pumps

Rotary blood pumps (RBPs) have demonstrated considerable promise while treating heart failure patients, such that they are being placed at an earlier stage of the disease. These devices may therefore be required to operate for prolonged durations which yields the need for RBPs exhibiting high durability, reliability, and blood compatibility. Noncontacting bearings, utilizing magnetic and/or hydrodynamic suspension techniques, appear to provide a suitable solution to these challenges. Hydrodynamic suspension has the advantage that it does not need feedback control systems. Among various hydrodynamic bearing types, the circular journal bearing has the particular benefit of easy manufacturing. This study presents methods to evaluate the performance of short (length to diameter ratio <1) circular hydrodynamic journal bearings (HJBs) for RBPs. Analytical calculations with specific boundary conditions are presented to predict the rotor's eccentricity under equilibrium states and thus the related performance parameters such as load capacity, power loss, and shear rates. These results and boundary conditions were confirmed experimentally in a specially designed test set‐up. The bearing performance was found to correlate to analytical solutions using the full Sommerfeld boundary condition instead of the half Sommerfeld condition conventionally used for such applications. Geometrical and operational parameter variations showed that HJB designs with a short Sommerfeld Number S_S >0.02 can provide sufficient fluid film thicknesses and low shear rates. The measurements were further used to evaluate the bearings' stability. The estimation of the stability threshold drawn in relation to a modified stability index and the equilibrium eccentricity of the rotor allows the prediction of stability for short circular HJB designs under full Sommerfeld condition.     

三峡工程对库区重庆段钉螺生长条件影响研究

目的了解三峡工程建成以后,库区气候、植被、淹没等条件变化对钉螺孳生的可能影响。方法利用ArcGIS软件的空间分析功能,结合气象资料及重点研究区1:1万和库区重庆段1:5万数字高程模型(DEM)就阶段性淹没区的气候条件、淹没时间、淹没区植被情况以及阶段性淹没可能对钉螺生长的影响进行综合分析。结果三峡库区淹没时间、气温、降水、日照时间、植被种类及覆盖度均适合钉螺,但其冬季蓄水、夏季放水的特点对钉螺的生长不利。结论三峡库区形成的"冬水夏陆"的洲滩环境不适于钉螺孳生,如能从源头上控制钉螺的外来输入问题,库区可避免成为钉螺孽生区。