Potentially traumatic events and serious life stressors are prospectively associated with frequency of doctor visits and overnight hospital visits

Objective

Cumulative lifetime exposure to potentially traumatic events and serious life stressors has been linked with both mental and physical health problems; however, less is known about the association between exposure to potentially traumatic events and serious life stressors with health care use. We investigated whether a higher number of potentially traumatic events and serious life stressors were prospectively associated with an increased number of doctor visits and nights spent in the hospital.

Methods

Participants were drawn from the Health and Retirement Study, a prospective and nationally representative study of adults aged 50 + in the United States (n = 7168). We analyzed the data using a generalized linear model with a gamma distribution and log link.

Results

A higher number of potentially traumatic events and serious life stressors were associated with an increased number of doctor visits and nights spent in the hospital. On a 10-point scale, each additional potentially traumatic event or serious life stressor was associated with an 8% increase in doctor visits after controlling for sociodemographic factors (RR = 1.08, 95% CI = 1.06–1.11; p < .001). Each additional potentially traumatic event or serious life stressor was also associated with an 18% increase in the number of nights spent in the hospital after controlling for sociodemographic factors (RR = 1.18, 95% CI = 1.10–1.27; p < .001).

Conclusion

Exposure to potentially traumatic events and serious life stressors is associated with increased doctor visits and nights spent in the hospital, which may have important implications for the current standard of care.     

基层医院肺血栓栓塞症的临床诊治探讨

目的探讨基层医院对肺血栓栓塞症(PTE)病人的诊断及治疗措施。方法回顾性总结我院近6年来共收治的28例PTE病人临床资料。结果临床表现中以呼吸困难及气促为最常见82.1%,其次为烦躁不安及惊恐感53%,胸痛50%。血气分析为重要诊断筛选手段,阳性率71.4%,超声心电图及胸CT均有重要诊断意义。其中26例行低分子肝素抗凝治疗,18例应用尿激酶(UK)溶栓治疗,好转治愈率75%,症状无明显变化占7.1%,病死率17.9%。结论基层医院临床医师只要提高对PTE的认识,根据实际情况选择必要的实验室检查,掌握抗凝治疗及溶栓治疗的适应证及方法,就可明显降低PTE的病死率。     

肺血栓栓塞症的核素影像诊断及临床基础

目的:利用肺核素影像扫描检查及肺动脉造影等其它临床手段,对肺血栓栓塞症(PTE)进行明确诊断;从临床基础探讨PTE致病的危险因素。方法:对1993～2002年问,我院37例肺血栓患者进行临床资料分析。结果:在37例患者中,进行核素影像明确诊断32例(86.4％)。在21～50岁年龄段,女性发病率小于男性,有统计学意义(P<0.05);19例(51.4％)患者存在深静脉血栓。结论:核素影像仍是目前首选的诊断肺栓塞的筛选手段,其结果有较重要的诊断或排除诊断意义。女性PTE的发病年龄晚于男性,与雌激素降低胆固醇血浓度及月经周期改变凝血机制等有关。下肢深静脉血栓作为主要的危险因素,与PTE的发生密切相关。     

龟板提取物上调维生素D受体表达促骨髓间充质干细胞向成骨分化

目的 探讨龟板提取物诱导大鼠骨髓间充质干细胞 (mesenchymal stem cells, MSCs) 向成骨分化和对维生素D受体 (VDR) 表达的影响。方法 从大鼠骨髓中分离 MSCs,体外培养,利用流式细胞术检测 MSCs 表面抗原 CD44 细胞标志,体外培养 MSCs 分成不同的组观察其向成骨分化,在培养基中不加任何处理的作为对照组,培养基中加成骨诱导液诱导 MSCs 向成骨分化作为阳性对照组,龟板提取物组在培养基中加龟板提取物,诱导 7 d 后,通过免疫化学染色、Western blotting、原位杂交、RT-PCR 等方法观察龟板提取物对原代培养的 MSCs 向成骨分化的成骨分化标记分子碱性磷酸酶 (ALP)、骨桥蛋白 (OPN) 及 VDR 阳性表达及 VDR mRNA 的表达情况。结果 免疫组化染色显示,龟板提取物组成骨分化标记分子 ALP、OPN 和VDR 的阳性百分比明显高于对照组,Western blotting 结果也显示龟板提取物组的 ALP、OPN和 VDR 的蛋白表达水平高于对照组;同时原位杂交、RT-PCR 结果表明,龟板提取物诱导MSCs 向成骨分化过程可明显促进 VDR mRNA 的表达。结论 龟板提取物可促 MSCs 向成骨分化,其机制可能与 VDR 的上调有关。     

慢性阻塞性肺疾病合并肺血栓栓塞症的临床分析

目的:探讨慢性阻塞性肺疾病(COPD)合并肺血栓栓塞症(PTE)的临床特征及诊断思路。方法:回顾性分析入住我院治疗的54例COPD合并PTE患者的临床表现资料,使用16排螺旋CT机为患者进行肺动脉造影检查。结果:COPD合并PTE患者的临床突出的症状是发热、胸腔积液、咳嗽;CT诊断具有自身独特的优势。结论:CT在COPD合并PTE的诊断中具有一定的优势,值得临床应用与推广。     

On the lipolytic action of parathyroid hormone in man.

An investigation was carried out to determine whether bovine PTH stimulates lipolysis in human fat tissue, whether this action is mediated by cyclic adenosine 3', 5'-monophosphate and whether the N-terminal 1-34 peptide of bovine PTH is responsible for the lipolytic effect. Studies were also performed to determine if parathyroid extract (PTE) produces lipolysis in normal subjects and in patients with pseudohypoparathyroidism in whom there is a defect in the adenylate system in response to PTH in the renal cortex and presumably in the skeletal system as well. It was found that highly purified bovine PTH in the concentration range between 10(-9) M and 10(-5) M stimulated lipolysis in vitro by human fat in a dose-dependent manner. Significant increases in glycerol production were observed at concentrations of PTH as low as 10(-9) M and maximal increases were seen at 10(-6) M. The hormone significantly increased the concentration of cyclic adenosine 3' ,5'-monophosphate in fat tissue. The synthetic N-terminal 1-34 peptide of bovine PTH was as effective as the native hormone in stimulating glycerol production at a concentration of 10(-9) M-10(-6) M. PTE, 100 mU per kg per min for 30 min given intravenously, produced transient increases in the concentration of plasma free fatty acid in each of eight normal subjects, three patients with hypoparathyroidism and eight patients with pseudohypoparathyroidism. Purified bovine PTH also increased plasma free fatty acid in each of two normal subjects. It is concluded that PTH stimulates lipolysis in human subcutaneous fat, that this action of the hormone is mediated through cyclic adenosine 3', 5'-monophosphate and that the N-terminal 1-34 peptide portion of the hormone is responsible for this lipolytic action. Further, PTE stimulates lipolysis in vivo in man. There appears to be no defect in the adenylate cyclase system in the fat cell in response to PTH in patients with pseudohypoparathyroidism.     

Venous ablation therapy: indications and outcomes

Venous disease has long been recognized as a progressive, debilitating, and recurrent problem. Until recently, venous insufficiency was often undertreated due to a lack of therapeutic modalities. During the past decade, an explosion in the treatment options has occurred. Endovenous ablation therapy has nearly replaced the conventional surgical treatments for patients with superficial venous insufficiency. Dramatic changes in therapy are also available for deep venous thrombosis but are not the subject of this review. These newer techniques are much less invasive and consequently have reduced risks of wound complications or bleeding. In addition, they can be performed easily in the office setting with local anesthesia. Higher-risk patients can now be considered for these less invasive treatments to reduce their ambulatory venous hypertension. With the lower procedural risks and the dramatically shortened recovery times, earlier intervention can be entertained. This helps prevent the development of venous stasis ulceration and other sequelae of progressive venous insufficiency.     

Epileptic spasms in paediatric post‐traumatic epilepsy at a tertiary referral centre

Aim. To recognize epileptic spasms (ES) as a seizure type after traumatic brain injury (TBI), accidental or non‐accidental, in infants and children. In the process, we aim to gain some insight into the mechanisms of epileptogenesis in ES. Methods. A retrospective electronic chart review was performed at the Children's Hospital of Michigan from 2002 to 2012. Electronic charts of 321 patients were reviewed for evidence of post‐traumatic epilepsy. Various clinical variables were collected including age at TBI, mechanism of trauma, severity of brain injury, electroencephalography/neuroimaging data, and seizure semiology. Results. Six (12.8%) of the 47 patients diagnosed with post‐traumatic epilepsy (PTE) had ES. Epileptic spasms occurred between two months to two years after TBI. All patients with ES had multiple irritative zones, manifesting as multifocal epileptiform discharges, unilateral or bilateral. Cognitive delay and epileptic encephalopathy were seen in all six patients, five of whom were free of spasms after treatment with vigabatrin or adrenocorticotropic hormone. Conclusion. The risk of PTE is 47/321(14.6%) and the specific risk of ES after TBI is 6/321 (1.8%). The risk of ES appears to be high if the age at which severe TBI occurred was during infancy. Non‐accidental head trauma is a risk factor of epileptic spasms. While posttraumatic epilepsy (not ES) may start 10 years after the head injury, ES starts within two years, according to our small cohort. The pathophysiology of ES is unknown, however, our data support a combination of previously proposed models in which the primary dysfunction is a focal or diffuse cortical abnormality, coupled with its abnormal interaction with the subcortical structures and brainstem at a critical maturation stage.