垂体腺瘤患者围术期促肾上腺皮质激素与皮质醇变化的研究

为观察垂体腺瘤患者围术期促肾上腺皮质激素 (ACTH)与皮质醇 (COR)的变化 ,选取 2 8例择期脑瘤切除患者 ,分为非垂体瘤组 (Ⅰ组 ,n =7)、生长激素 (GH)升高垂体瘤组 (Ⅱ组 ,n =9)和泌乳素升高垂体瘤组 (Ⅲ组 ,n =1 2 ) ,采用静吸复合全麻。抽取围术期不同阶段的静脉血标本 ,用放免法检测ACTH及COR。结果显示 ,术毕停麻醉2 0min时的ACTH和COR与入院后基础值相比差异显著 (P <0 .0 5) ,且Ⅱ、Ⅲ组与Ⅰ组间差异显著 (P <0 .0 5)。提示 :垂体腺瘤患者术毕时ACTH及COR水平明显高于术前 ,这不同于其他神经外科患者。     

Physiological Stress Elicits Impaired Left Ventricular Function in Preterm-Born Adults

Background

Experimental and clinical studies show that prematurity leads to altered left ventricular (LV) structure and function with preserved resting LV ejection fraction (EF). Large-scale epidemiological data now links prematurity to increased early heart failure risk.

The Commerce and Crossover of Resources: Resource Conservation in the Service of Resilience

Conservation of resources (COR) theory was originally introduced as a framework for understanding and predicting the consequences of major and traumatic stress, but following the work of Hobfoll and Shirom (1993), COR theory has been adopted to understanding and predicting work‐related stress and both the stress and resilience that occur within work settings and work culture. COR theory underscores the critical role of resource possession, lack, loss and gain and depicts personal, social and material resources co‐travelling in resource caravans, rather than piecemeal. We briefly review the principles of COR theory and integrate it in the crossover model, which provides a key mechanism for multi‐person exchange of emotions, experiences and resources. Understanding the impact of resource reservoirs, resource passageways and crossover provides a framework for research and intervention promoting resilience to employees as well as to organizations. It emphasizes that the creation and maintenance of resource caravan passageways promote resource gain climates through resource crossover processes. Copyright © 2014 John Wiley & Sons, Ltd.     

枣仁安神胶囊联合唑吡坦治疗失眠症的临床研究

目的探讨枣仁安神胶囊联合唑吡坦治疗失眠症的临床疗效。方法选取2017年6月—2018年6月在沈阳市安宁医院诊治的失眠症患者86例,根据用药差别分为对照组(43例)和治疗组(43例)。对照组患者睡前口服酒石酸唑吡坦片,10 mg/次,1次/d;治疗组在对照组基础上睡前口服枣仁安神胶囊,5粒/次,1次/d。两组患者均经4周治疗。观察两组患者临床疗效,同时比较治疗前后两组患者PSQI、HADS、PHQ-9、中医症状总积分、QLQ-C30和WEMWBS评分、睡眠质量和血清学指标。结果治疗后,对照组临床总有效率为81.40%,显著低于治疗组的95.35%,两组比较差异具有统计学意义(P0.05)。经治疗,两组PSQI、HADS、PHQ-9、中医症状总积分均显著降低(P0.05),QLQ-C30、WEMWBS评分显著升高(P0.05),且治疗组患者这些项目评分明显好于对照组(P0.05)。治疗后,两组患者总睡眠时间、REM睡眠时间及睡眠效率明显提高(P0.05),睡眠潜伏期和觉醒时间明显缩短(P0.05),且治疗组睡眠质量明显好于对照组(P0.05)。治疗后,两组患者血清5-羟色胺(5-HT)水平显著升高(P0.05),定皮质醇(COR)、白细胞介素-2(IL-2)、食欲素A(Orexin-A)、白细胞介素-6(IL-6)水平显著降低(P0.05),且治疗组患者血清5-HT、Orexin-A、COR、IL-2、IL-6水平明显好于对照组(P0.05)。结论枣仁安神胶囊联合唑吡坦治疗失眠症可有效改善患者相关症状,提高睡眠质量和生活质量,有利于患者焦虑抑郁状态和心理健康状态改善。     

血清皮质醇、醛固酮水平在男性伪装精神病司法鉴定中的变化特点

目的:探讨血清皮质醇(COR)、醛固酮(ALD)水平在暴力违法精神疾病司法鉴定中对伪装精神病(诈病)的诊断与鉴别作用。方法:将男性暴力违法(被控故意杀人和伤害)者作为研究对象,分别比较完全责任能力伪装精神疾病组(简称诈病组)、无精神病无诈病表现完全责任能力组(简称完全组)、精神分裂症限定责任能力组(简称限定组)、精神分裂症无责任能力组作为对照组(简称对照组)血清COR、ALD水平。结果:(1)鉴定前后COR、ALD水平自身对照比较:诈病组COR、ALD水平差异均有极显著性(P<0.001);完全组COR有差异(P<0.05),ALD降低但无统计学意义(P>0.05);限定组COR有差异(P<0.05),ALD差异有显著性(P<0.01);对照组COR、ALD均降低,但无统计学差异(P>0.05)。(2)诈病组血清COR、ALD水平下降率高于其他组,差异均有显著性(P<0.001)。(3)鉴定前诈病组COR、ALD水平与其他组比较差异均有极显著性(P<0.001);完全组与限定组比较COR无差异(P>0.05),ALD有差异(P<0.05);完全组与对照组比较COR无差异(P>0.05),ALD差异有极显著性(P<0.001);限定组与对照组比较COR无差异(P>0.05),ALD差异有显著性(P<0.01)。(4)鉴定后诈病组与完全组比较:COR高于完全组差异有极显著性(P<0.001);ALD高于完全组,但差异无显著性(P>0.05)。诈病组与限定组比较:COR高于限定组差异有显著性(P<0.01);ALD高于限定组差异有极显著性(P<0.001)。诈病组与对照组比较:COR高于对照组,差异有显著性(P<0.05);ALD高于对照组,差异有极显著性(P<0.001)。结论:血清COR、ALD水平在应激层面对伪装精神疾病的诊断与鉴别以及对不同责任能力的判定具有一定的客观参考价值。     

卡络磺钠联合雷贝拉唑治疗溃疡性上消化道出血的临床研究

目的 探讨卡络磺钠联合雷贝拉唑治疗溃疡性上消化道出血的临床疗效。方法 选取2018年1月—2021年12月在梧州市工人医院住院治疗的74例溃疡性上消化道出血患者,按照随机数字法将所有患者分为对照组和治疗组,每组各37例。对照组早晨口服雷贝拉唑钠肠溶胶囊,20 mg/次,1次/d。治疗组在对照组的基础上静滴滴注注射用卡络磺钠,60 mg加入0.9%氯化钠注射液250 mL中稀释,1次/d。两组均连续用药7 d。观察两组的临床疗效,比较两组腹胀、腹痛、头晕、烧心症状缓解时间及治疗前后血清丙二醇（MDA）、抗利尿激素（ADH）、皮质醇（COR）、白细胞介素6（IL-6）、白细胞介素17（IL-17）、肿瘤坏死因子α（TNF-α）、C反应蛋白（CRP）水平的变化情况和不良反应。结果 治疗后,治疗组总有效率是97.29%,显著高于对照组的81.08%（P＜0.05）。经治疗,治疗组腹胀、腹痛、头晕、烧心症状缓解时间均显著短于对照组（P＜0.05）。治疗后,两组MDA、ADH、COR水平均较治疗前显著降低（P＜0.05）,且治疗后治疗组MDA、ADH、COR水平低于对照组（P＜0.05）。治疗后,两组血清IL-6、IL-17、TNF-α、CRP水平均较治疗前显著降低（P＜0.05）,且治疗后,治疗组血清学指标水平低于对照组（P＜0.05）。治疗组患者不良反应发生率是8.11%,显著低于对照组患者的18.92%（P＜0.05）。结论 卡络磺钠联合雷贝拉唑治疗溃疡性上消化道出血可有效提高治疗效果,并能极大地缓解患者临床症状,改善机体氧化应激反应,降低炎性因子水平,具有一定的临床推广应用价值。     

重复电针镇痛效应的观察及其对血浆β-EP、ACTH及COR变化的影响

目的:观察不同时程电针(EA)镇痛的累积效应,及其与血浆促肾上腺皮质激素(ACTH)、β-内啡肽(EP)及皮质醇(COR)含量变化的关系。方法:Wistar雌鼠110只,随机分为正常对照组(n=10)、CCI组(n=10)、CCI+EA组(n=30)、去卵巢(OVX)+CCI组(n=30)、OVX+CCI+EA组(n=30),后3组又各分为EA 2次(2 t)、2周(2 w)和3周(3 w)亚组(时程),各10例。上述后3组动物去除双侧卵巢45 d后进行水迷宫测试,检查动物学习记忆能力。结扎坐骨神经造成慢性疼痛模型。电针双侧"足三里"-"阳陵泉"穴(2/15 Hz,1 mA,30 min),1次/d,不同组分别电针2 t、2 w、3 w。用辐射热刺激测定大鼠缩腿潜伏期(PWL)作为痛阈,用健侧和患侧PWL的差值做组间比较。深度麻醉断头采血,用放射免疫法测定ACTH、β-EP及COR的含量。结果:与正常对照组比,CCI各组PWL差值均明显较大(P<0.05);与CCI组比较,CCI+EA组3 w时段差异有显著性意义(P<0.05),接近正常对照组。与OVX+CCI组比较,OVX+CCI+EA组2 w、3 w的PWL差值均明显减小(P<0.05),疼痛减轻。CCI+EA和OVX+CCI+EA两组比较,前者多数时程的PWL差值显著低于后者(P<0.05),说明没有去卵巢大鼠电针的镇痛效果明显较优。在单纯CCI模型上,CCI后,血浆-βEP、ACTH及COR含量均没有明显改变;给予电针后,-βEP、ACTH的水平没有明显改变,COR含量明显增加(P<0.05)。在OVX+CCI复合动物模型上,血浆-βEP的浓度2 w和3 w时均明显高于正常对照组(P<0.05),ACTH含量没有明显变化,COR含量减低或明显增加(P<0.05);与OVX+CCI组比,OVX+CCI+EA组电针2 t2、w组其-βEP浓度明显下降(P<0.05),3 w也有所减少,ACTH的水平电针2 t和3 w明显增加(P<0.05),2 w组明显下降(P<0.05),COR的浓度2 w明显降低(P<0.05)。说明在单纯CCI模型上,当出现明显针刺镇痛效应时,仅血浆COR的浓度增加;在OVX+CCI复合动物模型上,当出现明显针刺镇痛累积效应时,血浆-βEP的水平下降或明显下降,COR的浓度降低,血浆ACTH含量的增、减变化不规律。结论:血浆-βEP和COR参与针刺镇痛的累加效应;神经记忆力的减退在一定程度上减弱针刺镇痛的累积效应;血浆-βEP和COR水平变化与大鼠痛行为学改善没有明确的相关关系趋势。     

肺心病患者心电图的变化与肺动脉压的关系

目的:探讨肺心病患者心电图表现与肺动脉压力的关系。方法:对肺心病103例,慢性阻塞性肺疾病（COPD）30例,进行心电图与血流动力学检查。按心电图表现分为4组,A组19例,B组28例,C组31例,D组25例,COPD为对照组30例。观察各组心电图改变与肺动脉压力的关系。并对各组患者随访5年,对所存活患者,重复首诊的各项检查。结果:①各组患者肺动脉平均压（mPAP）,A组22.1土1.6 mmHg,B组23.8土2.7 mmHg,C组31.4土9.1 mmHg,D组45.9土9.2 mmHg,对照组14.5土2.4 mmHg（1 mmHg=0.1333 kPa）。②103例肺心病5年死亡56例（54.4%）,其中D组5年死亡25例（100%）。5年存活47例,其中23例mPAP上升≥5 mmHg者,其心电图变化亦较前加重。③P波振幅与右心房平均压（mRAP）、mPAP相关性差（r=0.13、r=0.15）。结论:①胸前导联呈QS波形、右侧胸前导联呈高大R波等,其mPAP多在30 mmHg以上,且预后差。②单独P波振幅≥0.22 mV特异性差。③心电图动态观察时,图形变坏常伴有肺动脉压力的升高。     

2019 HRS expert consensus statement on evaluation,risk stratification,and management of arrhythmogenic cardiomyopathy

Arrhythmogenic cardiomyopathy (ACM) is an arrhythmogenic disorder of the myocardium not secondary to ischemic, hypertensive, or valvular heart disease. ACM incorporates a broad spectrum of genetic, systemic, infectious, and inflammatory disorders. This designation includes, but is not limited to, arrhythmogenic right/left ventricular cardiomyopathy, cardiac amyloidosis, sarcoidosis, Chagas disease, and left ventricular noncompaction. The ACM phenotype overlaps with other cardiomyopathies, particularly dilated cardiomyopathy with arrhythmia presentation that may be associated with ventricular dilatation and/or impaired systolic function. This expert consensus statement provides the clinician with guidance on evaluation and management of ACM and includes clinically relevant information on genetics and disease mechanisms. PICO questions were utilized to evaluate contemporary evidence and provide clinical guidance related to exercise in arrhythmogenic right ventricular cardiomyopathy. Recommendations were developed and approved by an expert writing group, after a systematic literature search with evidence tables, and discussion of their own clinical experience, to present the current knowledge in the field. Each recommendation is presented using the Class of Recommendation and Level of Evidence system formulated by the American College of Cardiology and the American Heart Association and is accompanied by references and explanatory text to provide essential context. The ongoing recognition of the genetic basis of ACM provides the opportunity to examine the diverse triggers and potential common pathway for the development of disease and arrhythmia.     

Prevalence and factors affecting underweight,overweight and obesity using Asian and World Health Organization cutoffs among adults in Nepal: Analysis of the Demographic and Health Survey 2016

ObjectiveThere is a little published data on prevalence and determinants of underweight, overweight and obesity among adults in Nepal. This study analysed the cross-sectional Nepal Demographic and Health Survey (NDHS) 2016 to obtain these using the World Health Organization (WHO) and Asian-specific cutoffs of body mass index (BMI).MethodsThe 2016 NDHS used a multistage cluster-sampling design to obtain data on major health indicators in Nepal. The BMI cutoffs for underweight was <18.5 kg/m². The BMI cutoffs for overweight/obesity as per the Asian and WHO classifications were ≥23, and ≥25 kg/m², respectively. After reporting the prevalence according to sex and background characteristics, multilevel logistic regression was conducted to estimate odds ratios.SubjectsThis analysis included 12,652 adults (5283 males and 7369 females) with a median age of 40 years (interquartile range [IQR]: 28–54).ResultsThe overall median BMI was 21.5 kg/m² (IQR:19.3–24.3). The overall prevalence of underweight was 16.7% (15.1% among males and 17.1% among females). The Asian-specific BMI cutoffs found the prevalence of overweight and obesity as 26.4% (27.4% among males and 25.6% among females) and 11.0% (7.7% among males and 13.3% among females), respectively. The WHO-recommended BMI cutoffs found 18.2% people overweight (16.7% among males and 19.3% among females) and 4.3% (2.5% among males and 5.6% among females) people obese. The prevalence and odds of extreme body weight categories (i.e., underweight, overweight and obesity) varied according to age, sex, education level, household wealth status, place, ecological zone and provinces of residence as per both recommended cutoffs. Overall, higher education level and wealth status were positively associated with overweight/obesity and inversely associated with underweight as per both cutoffs.ConclusionA large proportion Nepalese adults have either underweight, overweight or obesity, and could be at a greater risk of mortality and morbidity due to these extreme body weight categories. It is essential to address the factors or characteristics that are associated with the higher prevalence and likelihood of these extreme body weight categories to reduce the overall burden of underweight and overweight/obesity in Nepal.