腺鼠疫患者血清抗体谱的研究

目的检测腺鼠疫患者血清抗体谱及抗体随时间变化趋势。方法利用一包含145个鼠疫耶尔森氏菌毒力相关蛋白质的蛋白芯片检测云南腺鼠疫患者血清抗体谱及抗体随时间变化趋势。结果在腺鼠疫患者体内检测到32种蛋白相应的抗体。结论FI抗体产生的速度最快、幅度最高、持续的时间最长;YopM、YopH、YopE抗体升高不明显;V抗体在患者体内未检测到;在发病后14 d才检测到pH6抗原的抗体,3个月时抗体荧光值没有下降,可持续半年。YopD的抗体在部分患者体内明显升高,但在半年后下降到正常水平。     

Indicators of myocardial dysfunction and quality of life, one year after acute infarction

BACKGROUND: There remains controversy concerning the association between myocardial dysfunction diagnosed soon after acute myocardial infarction (AMI), and subsequent quality of life. AIMS: We searched for a correlation between criteria of myocardial dysfunction assessed within the first month after AMI, and quality of life perceived 1 year later. METHODS: Six hundred and seventy-one patients were followed up and quality of life was assessed using the Nottingham Health Profile. Spearman correlation was used for univariate analyses. A logistic regression identified independent predictors of impaired quality of life. RESULTS: Patients perceiving inferior quality of life were 61% for energy, 61% for sleep, 49% for physical mobility, 49% for pain, 63% for emotional reactions, and 28% for social isolation. Impaired quality of life was not associated with the initial Killip class. A low ejection fraction was associated with impaired physical mobility (OR=1.21, 95% CI=1.05-1.39). Presence of abnormally contracting myocardial segments was associated with impaired mobility (1.40, 1.09-1.80) and with increased pain (1.30, 1.02-1.66). The presence of diseased coronary vessels was associated with pain (1.25, 1.06-1.46). CONCLUSION: Myocardial dysfunction was generally associated with impaired quality of life. This has to be considered when assessing improvement of quality of life after medical or surgical treatment of AMI.     

Nevos melanocíticos con atipia relacionada con su localización: presentación de una serie de casos y caracterización de su perfil inmunohistoquímico

BackgroundNevi of special sites (NOSS) are benign melanocytic lesions that occur at particular sites. Although the histological features of NOSS have been described, their immunophenotypic features have not been fully characterized.AimsTo present the clinicopathological characteristics of a case series of NOSS and to characterize their immunohistochemical profile.Materials and methodsThirty-five NOSS were assessed using immunoperoxidase staining techniques for the melanocytic (S100, Melan-A, and HMB45) and proliferation (Ki-67) markersResultsAll of the cases of NOSS showed concerning architectural changes (prominent lentiginous melanocytic proliferation, irregularities, crowdedness, and dyhesiveness of the nests), and cytological atypia (large nevomelanocytes with vesicular nuclei, clear cytoplasm, and dusty melanin pigment) that can lead to a misdiagnosis of atypical nevi or even melanomas. All of the cases of NOSS showed diffuse expression of S100 and Melan-A proteins. Ki-67 labeling index of the nevomelanocytes was extremely low. HMB45 protein expression was limited to the junctional and superficial dermal nevomelanocytes.ConclusionsNOSS can show histological features that can easily mimic atypical nevi or melanomas and this diagnostic consideration should be kept in mind to avoid their misdiagnosis. The expression of HMB45 protein in NOSS indicates that their nevomelanocytic cells have an activated phenotype. The decreased HMB45 protein expression following a gradient from junctional to deeper dermal localization in NOSS is indicative of their immunohistochemical maturation.     

恶性肿瘤患儿家庭管理特征的潜在剖面分析

目的 基于潜在剖面分析识别恶性肿瘤患儿家庭管理特征的类别,分析不同类别的影响因素,为制订针对性干预措施提供依据。 方法 采用便利抽样法,选取2021年7月—12月在重庆市某三级甲等儿童医院血液内科、肿瘤外科及神经外科住院的230例恶性肿瘤患儿及其照顾者作为调查对象,采用一般资料表、中文版家庭管理测量量表对其进行调查。采用潜在剖面分析识别恶性肿瘤患儿家庭管理特征的类别,采用多元Logistic回归分析不同类别的影响因素。 结果 恶性肿瘤患儿家庭管理特征分为3个类别：低效应对型（49.57%）、有效应对型（43.91%）、挣扎应对型（6.52%）。多元Logistic回归结果显示,住院次数少、确诊时长在1~<7个月、现居住地为城镇、家庭平均月收入在 5 000~10 000元、家庭收入来源为其他收入、申请经济救助的恶性肿瘤患儿家庭管理特征类别归属为低效应对型的可能性较大;骨恶性肿瘤患儿的家庭管理特征类别归属为有效应对型的可能性较大;家庭收入来源为工资性收入、白血病患儿的家庭管理特征类别归属于挣扎应对型的可能性较大,差异均具有统计学意义（P<0.05）。 结论 恶性肿瘤患儿家庭管理特征存在异质性,医护人员应根据其家庭管理特征,实施针对性干预,以提高其家庭管理水平。     

Mortality impact of thoracic aortic disease in S?o Paulo state from 1998 to 2007

Background

The epidemiological characteristics of thoracic aortic diseases (TAD) in the State of São Paulo and in Brazil, as well as their impact on the survival of these patients have yet to be analyzed.

Objectives

To evaluate the mortality impact of TAD and characterize it epidemiologically.

Methods

Retrospective analysis of data from the public health system for the TAD registry codes of hospitalizations, procedures and deaths, from the International Code of Diseases (ICD-10), registered at the Ministry of Health of São Paulo State from January 1998 to December 2007.

Results

They were 9.465 TAD deaths, 5.500 men (58.1%) and 3.965 women (41.9%); 6.721 dissections (71%) and 2.744. aneurysms. In 86.3% of cases the diagnosis was attained during autopsy. There were 6.109 hospitalizations, of which 67.9% were males; 21.2% of them died (69% men), with similar proportions of dissection and aneurysm between sexes, respectively 54% and 46%, but with different mortality. Men with TAD die more often than women (OR = 1.5). The age distribution for deaths and hospitalizations was similar with predominance in the 6^th decade. They were 3.572 surgeries (58% of hospitalizations) with 20.3% mortality (patients kept in clinical treatment showed 22.6% mortality; p = 0.047). The number of hospitalizations, surgeries, deaths of in-patients and general deaths by TAD were progressively greater than the increase in population over time.

Conclusions

Specific actions for the early identification of these patients, as well as the viability of their care should be implemented to reduce the apparent progressive mortality from TAD seen among our population.     

Characterization of the spectrum of hemodynamic profiles in trauma patients with acute neurogenic shock

Objective

Neurogenic shock considered a distributive type of shock secondary to loss of sympathetic outflow to the peripheral vasculature. In this study, we examine the hemodynamic profiles of a series of trauma patients with a diagnosis of neurogenic shock.

Methods

Hemodynamic data were collected on a series of trauma patients determined to have spinal cord injuries with neurogenic shock. A well-established integrated computer model of human physiology was used to analyze and categorize the hemodynamic profiles from a system analysis perspective. A differentiation between these categories was presented as the percent of total patients.

Results

Of the 9 patients with traumatic neurogenic shock, the etiology of shock was decrease in peripheral vascular resistance (PVR) in 3 (33%; 95% confidence interval, 12%-65%), loss of vascular capacitance in 2 (22%; 6%-55%) and mixed peripheral resistance and capacitance responsible in 3 (33%; 12%-65%), and purely cardiac in 1 (11%; 3%-48%). The markers of sympathetic outflow had no correlation to any of the elements in the patients' hemodynamic profiles.

Conclusions

Results from this study suggest that hypotension of neurogenic shock can have multiple mechanistic etiologies and represents a spectrum of hemodynamic profiles. This understanding is important for the treatment decisions in managing these patients.     

新疆克拉玛依地区抽样人群中胆囊结石危险因素流行病学研究

目的了解新疆克拉玛依地区胆囊结石流行病学的特点。方法依据该地区人口学资料，计划调查8257人，按规模大小成比例概率抽样（PPS）的方法随机抽样以确定抽样人群。对象均接受人户问卷调查及物理查体，同时预约行胆囊B超和空腹血糖血脂检查。SPSS11．0软件进行统计学处理，Logistic回归分析得出危险因素。结果调查的应答率为92．4％。胆石症患病率为l5．45％。在众多危险因素中，贡献最大的依次为性别、胆总管内径和民族（OR值分别为1．92，1．83，1．4）。结论胆结石的形成是多因素作用的结果，其中性别、民族差异和胆总管内径对胆结石形成有一定的影响。     

Sleep patterns in anxiety and depression associated with stress

Of 31 patients with anxiety and 44 with depression attending the Maudsley Stress Clinic, only one of the former and two of the latter did not suffer from sleep disturbance. Severity of impairment of five sleep factors was greater in depression than in anxiety, statistically significantly so in the case of delayed sleep onset (p < 0.01), early morning walking (p < 0.01) and impaired state on walking (p < 0.05). The type of sleep disorder in these conditions has important implications for choice of treatment.     

Hypoactive Sexual Desire Disorder in Postmenopausal Women: Quality of Life and Health Burden

ObjectivesTo describe the health-related quality of life (HRQOL) implications of hypoactive sexual desire disorder (HSDD) in a national sample of postmenopausal women ages 30–70.MethodsThe Nationwide Survey of Female Sexual Health, a random-digit telephone survey of US households, collected information on female sexual function, demographic characteristics, HRQOL, and the presence of specific medical disorders from 1189 naturally or surgically postmenopausal women in stable relationships of ≥3 months duration. HSDD was defined as <40 on the Profile of Female Sexual Function© scale and <60 on the Personal Distress Scale©. Short Form-12 Health Survey (SF-12) summary and domain scores, and EuroQol (EQ-5D) index score and dimensions were compared with population-based norms for healthy individuals and selected chronic conditions.ResultsHSDD was associated with significant HRQOL decrements, with the largest SF-12 score differences in mental health (HSDD: 45.4 [standard error 1.9] vs. no HSDD: 51.0 [0.6], P < 0.01), vitality (HSDD: 47.7 [1.3] vs. no HSDD: 52.0 [0.7], P < 0.01), social function (HSDD: 47.3 [1.4] vs. no HSDD: 50.9 [0.7], P < 0.05), and bodily pain (HSDD: 41.4 [2.2] vs. no HSDD: 46.7 [0.9], P < 0.05). EQ-5D index was 0.08 points lower (HSDD: 0.76 [0.03] vs. no HSDD: 0.84 [0.02], P < 0.05) for those with HSDD compared with those without. HSDD was associated with a 0.1-point decrement in naturally menopausal women (HSDD: 0.78 [0.03] vs. no HSDD 0.88 [0.01], P < 0.01). Women with HSDD showed more HRQOL impairment than healthy population norms but were similar to adults with other chronic conditions such as diabetes and back pain.ConclusionsWomen with HSDD showed substantial impairment in HRQOL. Given a prevalence of 6.6% to 12.5% among US women, HSDD represents an important burden on quality of life.