优拓用于包皮环切术后伤口换药的效果观察

目的 观察优拓用于包皮环切术后伤口换药的效果.方法 将740例成人包皮环切术患者随机分为观察组和对照组.观察组术后用优拓覆盖手术伤口后再包扎无菌纱布,对照组直接用无菌纱布包扎,手术第3日第1次换药,并对换药时是否黏贴伤口、有无疼痛、出血以及伤口换药次数、伤口愈合时间、是否感染等进行观察比较.结果 观察组在是否黏贴伤口、有无疼痛、出血以及换药次数、伤口愈合时间、感染率等方面明显优于对照组,有显著性差异,具有统计学意义.结论 优拓用于包皮环切术后伤口换药能减轻疼痛、防黏连、防出血、防感染、缩短伤口愈合时间、减少换药次数等,具有优越性,值得推广应用.     

Changes in physiological and behavioural pain indicators over time in preterm and term infants at risk for neurologic impairment

Background

Approximately 10% of infants admitted to a Neonatal Intensive Care Unit (NICU) are at risk for Neurological Impairment (NI). While we have limited knowledge on the influence of NI risk on pain responses, we have no knowledge of how these responses change over time.

Objective

To compare physiological and behavioural pain responses of infants at three levels of NI risk during the NICU neonatal period (Session 1) and at 6 months of age (Session 2).

Design/methods

Prospective observational design with 149 preterm and term infants at high (Cohort A, n = 54), moderate (Cohort B, n = 45) and mild (Cohort C, n = 50) risks for NI from 3 Canadian tertiary level NICUs. Infants were observed in the NICU during 3 standardized phases of a heel lance: baseline, stick and return-to-baseline. At 6 months, infants were observed during the same three phases during an intramuscular immunization injection. Physiological (heart rate, oxygen saturation) and behavioural (9 facial actions, cry) responses were continuously recorded.

Results

A significant interaction of Phase by Session was found with less total facial activity observed during Session 2 (all p values < 0.04). A significant interaction for Session by Cohort was found, showing that infants in Cohort A had significantly more change from baseline-to-stick phase for brow bulge, eye squeeze, nasolabial furrow and open lips between sessions with less facial actions demonstrated at Session 2 (all p < 0.02). There were significantly lower mean and minimum heart rate (all p < 0.02) and higher minimum and maximum oxygen saturation (p < 0.04) at Session 2. Significantly higher mean and minimum fundamental cry frequencies (pitch) in Cohort B (p < 0.04) were found in Session 1. Cohort A had significantly longer cry durations, but no significant differences in cry dysphonation.

Conclusions

Behavioural and physiological infant pain responses were generally diminished at 6 months of age compared to those in the neonatal period with some differences between NI risk groups in cry responses. Future exploration into the explanation for these differences between sessions and cohorts is warranted.     

Paroxetine,but not Vortioxetine,Impairs Sexual Functioning Compared With Placebo in Healthy Adults: A Randomized,Controlled Trial

IntroductionSexual dysfunction is prevalent among patients with depression, but assessment of treatment-emergent sexual dysfunction (TESD), a common side effect of antidepressants, can be confounded by the treatment of depressive symptoms in some patients.AimTo evaluate sexual functioning in healthy volunteers administered vortioxetine compared with paroxetine, an antidepressant known to cause sexual dysfunction, and placebo.MethodsThis phase 4, multicenter, randomized, double-blind, placebo-controlled, 4-arm, fixed-dose, head-to-head study compared sexual functioning in healthy volunteers administered vortioxetine (10 and 20 mg once daily [QD]), paroxetine (20 mg QD), or placebo for 5 weeks. Approximately equal numbers of men and women ages 18–40 years with normal sexual functioning (self-reported Changes in Sexual Functioning Questionnaire Short-Form [CSFQ-14] score > 47 for men; > 41 for women) were enrolled. Two modified full analysis sets adjusting for treatment non-compliance were prespecified.Main Outcome MeasureThe primary endpoint was change in CSFQ-14 total score for vortioxetine (10 and 20 mg) vs paroxetine after 5 weeks. Additional endpoints included CSFQ-14 change scores vs placebo, CSFQ-14 subscales, and patient global impression.ResultsOf the 361 subjects enrolled (mean age, 28.4 years), approximately 57% were white, 34% black/African American, and 4% Asian. Vortioxetine 10 mg was associated with significantly less TESD than paroxetine (mean difference, +2.74 points; P = .009). Although vortioxetine 20 mg was associated with numerically less TESD than paroxetine (mean difference, +1.05 points), this difference did not reach statistical significance. Non-compliance appeared to influence results, particularly the paroxetine and vortioxetine 20 mg arms. Paroxetine, but not vortioxetine, was associated with statistically significantly more TESD vs placebo. Vortioxetine also had better outcomes than paroxetine in the 3 phases and 5 dimensions of sexual functioning measured by CSFQ-14.Clinical ImplicationsThese data establish that vortioxetine is associated with less TESD than paroxetine in healthy individuals, suggesting that vortioxetine may be a drug of choice in managing depressive disorders when sexual functioning is a concern.Strengths & LimitationsConducting the study in healthy adults mitigated the risk of an underlying condition (eg, depression) confounding the results. Assay sensitivity was demonstrated by statistically significant TESD with paroxetine vs placebo. The single comparator, paroxetine, and short study duration limit the generalizability of these results.ConclusionVortioxetine is associated with less TESD than paroxetine in healthy adults across all phases and dimensions of the sexual response cycle. Vortioxetine was not significantly different from placebo on sexual functioning; however, the difference was significant between paroxetine and placebo, validating study results.Jacobsen P, Zhong W, Nomikos G, et al. Paroxetine, but not Vortioxetine, Impairs Sexual Functioning Compared With Placebo in Healthy Adults: A Randomized, Controlled Trial. J Sex Med 2019; 16:1638–1649.     

Diet and Physical Activity in Relation to Weight Change among Breast Cancer Patients

Background: This study aimed to provide an overview of lifestyle changes after breast cancer diagnosis andto examine the relationship between dietary and physical activity changes with weight changes in breast cancerpatients. Women with breast carcinomas (n=368) were recruited from eight hospitals and four breast cancersupport groups in peninsular Malaysia. Dietary and physical activity changes were measured from a yearpreceding breast cancer diagnosis to study entry. Mean duration since diagnosis was 4.86±3.46 years. Dietarychanges showed that majority of the respondents had decreased their intake of high fat foods (18.8-65.5%), addedfat foods (28.3-48.9%), low fat foods (46.8-80.7%), red meat (39.7%), pork and poultry (20.1-39.7%) and highsugar foods (42.1-60.9%) but increased their intake of fish (42.7%), fruits and vegetables (62.8%) and wholegrains (28.5%). Intake of other food groups remained unchanged. Only a small percentage of the women (22.6%)had increased their physical activity since diagnosis where most of them (16.0%) had increased recreationalactivities. Age at diagnosis (β= -0.20, p= 0.001), and change in whole grain (β= -0.15, p= 0.003) and fish intakes(β= 0.13, p= 0.013) were associated with weight changes after breast cancer diagnosis. In summary, the majorityof the women with breast cancer had changed their diets to a healthier one. However, many did not increasetheir physical activity levels which could improve their health and lower risk of breast cancer recurrence.     

1978—1997年我国卫生资源与综合卫生实力变化趋势分析

本文对1978～1997年20年间卫生资源总量、不同专业卫生机构分布、卫生机构规模变化趋势进行分析,并引入功能、规模、结构和水平(FDSL)综合实力评价方法对卫生资源变化引起的综合卫生实力变化进行评价分析。结论:卫生资源增长速度快于人口增长速度,人均卫生资源占有水平提高;卫生防疫、妇幼保健人力资源增长速度快于医疗增长速度,所占卫生资源比重呈逐年加大趋势;卫生资源增长不平衡,农村卫生院变化不大;卫生资源增长与其产出不同步;综合卫生实力从总体上说来逐步增强。针对有关问题,作者提出几点建议。     

心电图T波改变联合针刺治疗耳聋耳鸣患者的临床诊断及对患者康复情况的影响

目的分析心电图T波改变联合针刺治疗耳聋耳鸣患者的临床诊断的有效性及疗效。方法选取2019年1月~2020年1月我院门诊收治的耳聋耳鸣患者30例作为研究对象,利用动态心电图对患者进行检查,之后进行针刺治疗。结果对照组总有效率70.00%,联用组总有效率93.33%,联用组的症状体征改善时间明显短于对照组。结论患者治疗后纯音听阙测试(pure tone audiometry,PTA)、耳鸣评价量表(tinnitus evaluation questionnaire,TEQ)评分明显低于治疗前(P<0.05);针刺治疗耳聋耳鸣患者的有效率高达92.11%,心电图检查结果表明有40.00%(12/30)的患者心电图T波发生了改变,显示有心血管方面的疾病。结论心电图检查T波的改变能够帮助诊断患者的心血管疾病,联合针刺治疗对患者有较好的疗效,值得推广使用。     

妊娠期糖尿病孕妇血小板活化指标变化研究

目的:研究分析妊娠期糖尿病孕妇血小板活化指标的变化情况。方法:选取2011年7月~2013年8月本院的52例妊娠期糖尿病孕妇为观察组,并以同期同龄的52例健康孕妇为对照组,然后将两组孕妇的血小板活化指标进行比较,并比较不同糖化血红蛋白水平孕妇的检测水平。结果:观察组孕妇的血小板活化指标均高于对照组孕妇,且观察组孕妇中糖化血红蛋白≥8.0%者的检测水平高于糖化血红蛋白<8.0%者,P均<0.05,均有显著性差异。结论:妊娠期糖尿病孕妇的血小板活化指标呈现异常升高的状态,且糖化血红蛋白较高者的血小板活化指标水平也较高。     

Associations between recent and established ophthalmic conditions and risk of Alzheimer's disease

Introduction

Identifying ophthalmic diseases associated with increased risk of Alzheimer's disease (AD) may enable better screening and understanding of those at risk of AD.