软骨发育不全的指南变迁与多学科诊疗建议

软骨发育不全是最常见的骨骼发育不良,以短肢、大头畸形、面中部发育不良和三叉戟手为特征。软骨发育不全相关的潜在并发症包括下肢长骨弯曲、中耳功能障碍、阻塞性睡眠呼吸暂停,以及更罕见的颈髓压迫、脑积水和胸腰椎后凸。软骨发育不全的管理是多方面的,需要在整个生命过程中多个学科共同参与。该文重点介绍了国内外近年来发表的软骨发育不全患者治疗和护理方面的指南或共识,旨在为临床医疗提供指导,以帮助识别软骨发育不全疾病有发生严重后遗症的高风险患者、并在并发症出现之前进行干预。     

Health literacy and cancer communication with older adults

OBJECTIVE: The physiological, cognitive, language and communicative changes that take place as we enter into old age have become quite well documented within the social scientific literature. Many of these changes lead in some way to a lessening of previous interactive abilities and competencies. The new mantra for gerontologists attempting to help older adults compensate for these potential losses is to develop strategies to maintain existing abilities as long as possible. METHODS: A literature review using online databases was performed. RESULTS: Older adults who are diagnosed with cancer or help care for an individual coping with cancer must confront a health care system that demands a high level of health literacy to successfully manage the disease. Older adults may be at a distinct disadvantage in their ability to successfully cope with cancer because of age-related physiological, cognitive, psychological and communicative factors. CONCLUSION: This paper highlights the relevant research findings and theoretical positioning that points not only to possible pragmatic dilemmas faced by those adapting to cancer but also highlights streams of research that scholars may wish to focus upon to better understand how older adults and their formal and informal caregivers can improve their cancer health literacy. PRACTICE IMPLICATIONS: Providers, patients, and caregivers must all participate in creating a health care environment of shared meaning and understanding of health messages tailored to the aging patient diagnosed with cancer. Health communication scholars have various theoretical, methodological, and pragmatic communication-based approaches that provide important contributions to the complexities of caring for the aging patient.     

The effects of organophosphate pesticide exposure on Hispanic children's cognitive and behavioral functioning

OBJECTIVE: This study investigates the effects of Organophosphate (OP) pesticides exposure on the cognitive and behavioral functioning of Hispanic children living in an agricultural community. METHODS: Forty-eight children were administered a battery of cognitive measures, and their parents and teachers completed behavior rating scales. Children provided a urine sample for analysis of OP pesticides metabolites. RESULTS: All children had a detectable level of at least one OP pesticide metabolite. Higher OP pesticide metabolite concentration levels were significantly correlated with poorer performance on some subtests of the Wisconsin Card Sorting Test. However, the significance of this association was dependent upon the inclusion of two samples with noticeable higher OP pesticide metabolite concentration levels. CONCLUSIONS: Short-term OP pesticide exposure seems to have deleterious effects on children's speed of attention, sequencing, mental flexibility, visual search, concept formation, and conceptual flexibility. This study is among a relatively small number of studies investigating an extremely complex problem. Limitations and suggestions for future studies are discussed.     

流动与非流动初中生积极心理品质的比较

目的对流动与非流动初中生积极心理品质:自立人格、心理韧性、正性-负性情绪进行比较,为推动流动初中生心理健康发展提供依据。方法采用青少年自立人格量表、青少年心理韧性量表、正性-负性情绪量表对深圳某中学658名初中1～3年级的学生进行抽样调查,以筛选出的392名流动初中生为研究组,其他学生为对照组。利用SPSS16.0统计软件对调查结果进行统计分析。结果①流动与非流动初中生在自立人格各因子及正性-负性情绪上无显著差异;②流动初中生在心理韧性的积极认知上得分显著高于非流动初中生(F=4.078,P<0.05),其它因子无显著差异。结论流动对流动初中生积极心理品质发展的影响并不明显,可通过教育发挥流动的积极意义。     

Prenatal hypoxia may aggravate the cognitive impairment and Alzheimer’s disease neuropathology in APP/PS1 transgenic mice

Most cases of Alzheimer's disease (AD) arise through interactions between genetic and environmental factors. It is believed that hypoxia is an important environmental factor influencing the development of AD. Our group has previously demonstrated that hypoxia increased β-amyloid (Aβ) generation in aged AD mice. Here, we further investigate the pathological role of prenatal hypoxia in AD. We exposed the pregnant APP^Swe/PS1^A246E transgenic mice to high-altitude hypoxia in a hypobaric chamber during days 7–20 of gestation. We found that prenatal hypoxic mice exhibited a remarkable deficit in spatial learning and memory and a significant decrease in synapses. We also documented a significantly higher level of amyloid precursor protein, lower level of the Aβ-degrading enzyme neprilysin, and increased Aβ accumulation in the brain of prenatal hypoxic mice. Finally, we demonstrated striking neuropathologic changes in prenatal hypoxic AD mice, showing increased phosphorylation of tau, decreased hypoxia-induced factor, and enhanced activation of astrocytes and microglia. These data suggest that although the characteristic features of AD appear later in life, hypoxemia in the prenatal stage may contribute to the pathogenesis of the disease, supporting the notion that environmental factors can trigger or aggravate AD.     

心脏射频消融术中心包压塞的临床诊治特点分析

目的：探讨心脏射频消融术中心包压塞的临床特点以及诊治过程。方法：对射频消融术中出现心包压塞的21例病例的病历资料及填塞时临床表现、诊断和处理、预后情况等进行回顾性分析,分析出现心包压塞患者的临床特点。结果：随着术者学习曲线的延伸,房颤和室性心律失常术中心包压塞发生率逐渐减低;女性患者心包压塞的发生率高于男性(5.4‰ vs.1.2‰,P<0.05),尤其在室性心律失常的射频中更为明显(9.0‰ vs.1.2‰,P<0.05);射频消融患者中,心包压塞患者年龄可能更大,尤其是室性心律失常患者中(P<0.05);心包压塞发生时,最先出现的、容易观察到的临床表现多为心率加快和血压下降(76.2%);心包压塞患者中,穿刺引流后痊愈者平均出血量(297.6±270.7) mL,需行外科手术患者的平均出血量更多,为(1570.0±720.5) mL (P<0.05)。结论：射频消融术中心包压塞的发生与学习曲线、性别、年龄均相关,应通过临床表现、X线透视等及早发现心包压塞并及时治疗。     

Molecular typing and in vitro resistance of Cryptococcus neoformans clinical isolates obtained in Germany between 2011 and 2017

Cryptococcosis is a fungal infection of the central nervous system predominantly caused by Cryptococcus neoformans in immunocompromised patients. In several countries worldwide, up to 50% of isolates show in vitro resistance to clinically used antifungals including fluconazole. No prospective data on susceptibility to antifungal drugs are available for Germany. In this study, we characterised all C. neoformans isolates collected from individual patients’ samples at the German reference laboratory for cryptococcosis 2011 and 2017 (n = 133) by multi-locus sequence typing and phenotypic drug susceptibility testing. We identified serotype A/genotype VNI isolates belonging to clonal complexes previously described from Europe, Africa, Asia and South America as the most prevalent agents of cryptococcosis in Germany. Overall, we observed minimal inhibitory concentrations (MICs) above the epidemiological cut-offs (ECVs) in 1.6% of isolates regarding fluconazole and 2.3% of isolates regarding 5-flucytosine. Here, two C. neoformans var. grubii isolates displayed decreased drug susceptibility to fluconazole, one of them additionally to 5-flucytosine. We also found 5-flucytosine MICs above the ECV for two C. neoformans var. neoformans isolates. We identified a novel mutation in the ERG11 gene which might be associated with the elevated fluconazole MIC in one of the isolates. The clinical importance of the detected in vitro resistance is documented by patient histories showing relapsed infection or primary fatal disease. Of note, sertraline demonstrated antifungal activity comparable to previous reports. Systematic collection of susceptibility data in combination with molecular typing of C. neoformans is important to comprehensively assess the spread of isolates and to understand their drug resistance patterns.     

An improved autoradiographic technique for the detection of antibody-forming cells

An autoradiographic technique for the detection of antibody-forming cells has been developed for the assay of anti-DNP responses. The lymphoid cells suspension to be assayed was allowed to sediment on to a glass slide coated with DNP-conjugated gelatin to which the secreted antibody bound during subsequent incubation. The bound antibody and its Ig class was revealed by a second incubation using ¹²⁵I-anti-immunoglobulin reagents followed by autoradiography. Studies on the sensitivity and specificity of the method are presented and its advantages over other techniques described. The technique should be readily applicable to other haptens.     

南沙守礁官兵身心健康状况及医疗卫生保障研究

目的探讨南沙守礁官兵健康干预前后身心状态变化。方法2002年1月-2006年12月对南沙守礁官兵进行综合干预,在干预前后采用症状自评量表（SCL-90）对干预对象进行测评,同时调查2周患病率、膳食营养、体质指数．测定血清总甲状腺素（TT4）、总三碘甲状腺原酸（TT3）、睾酮、皮质醇、维生素A及尿液维生素B1、B2、C含量。结果2周患病率干预前为32．21％,干预后为23．37％,P〈0．05;体质指数正常率由干预前的51．84％升至干预后的70．66％,P〈0．05;干预后膳食能量、三大产能营养素及维生素摄入量趋于合理,体内维生素B1、B2低于正常标准的检出率分别由干预前的85．56％和72．78％降至11．11％和9．44％,P〈0．01;SCL-90各因子分、总均分和阳性项目数均明显低于干预前（均P〈0．001）,TT4水平显著高于干预前（P〈0．01）,睾酮、皮质醇水平显著低于干预前（P〈0．001）。结论综合性的干预措施,强有力的医疗卫生保障．能提高守礁官兵身心健康水平。