纳络酮对血管性痴呆认知功能改善的临床观察

目的：观察纳络酮治疗血管性痴呆后对认知功能改善的作用。方法：将72例血管性痴呆患者随机分为纳络酮治疗组和常规药物治疗组，治疗前和治疗后2周、5周分别进行MMSE和MBI评分，进行对比分析。结果：两组治疗后MBI评分比治疗前提高，但差异无统计学意义（P〉0．05）。两组治疗2周后MMSE评分对照无明显提高（P〉0．05），治疗组显著提高（P〈0．05），但与对照组治疗后比较，差异无统计学意义（P〉0．05），5周后两组与治疗前比较，对照组具有统计学意义（P〈0.05），治疗组具有统计学意义（P〈0．01），且与对照组治疗后比较，差异亦有统计学意义（P〈0．05）。结论：应用纳络酮治疗血管性痴呆可显著提高MMSE评分，改善认知功能，作用快，安全，疗效显著。     

针刺配合康复训练治疗脑卒中上肢功能障碍的队列研究

目的:探讨针刺配合康复训练对脑卒中上肢功能障碍患者神经功能特异性烯醇化酶(NSE)、硫化氢(H_2S)、神经营养因子(NGF)与脑血管动力学的影响。方法:选取2016年5月至2017年10月空军军医大学唐都医院收治的脑卒中上肢功能障碍患者198例进行回顾性分析。将患者分为针刺配合康复训练治疗观察组100例,单纯依靠康复训练治疗对照组98例。比较与分析2组治疗前后的NSE、H_2S、NGF与脑血管动力学等。结果:观察组治疗后NSE(12. 36±6. 35)μg/L,H_2S(52. 19±3. 77)μmol/L,NGF(152. 94±32. 67) pg/m L。对照组治疗后NSE (16. 28±7. 45)μg/L,H_2S (36. 67±6. 95)μmol/L,NGF(129. 81±33. 02) pg/m L。观察组治疗后颈动脉血流速度平均值(V_(mean))(26. 45±3. 79) cm/s,血流量(Q_(mean))(18. 52±3. 32) cm~3/s,外周阻力(RV)(82. 37±22. 39) k Pa·s/m,舒张压与临界压差值(DP)(0. 45±0. 08) k Pa. s/m,动态阻力(DR)(32. 36±10. 08) k Pa。对照组治疗后V_(mean)(19. 86±3. 73) cm/s,Q_(mean)(14. 79±2. 72) cm3/s,RV(95. 31±30. 45)k Pa·s/m,DP(0. 63±0. 14) k Pa·s/m,DR(42. 37±9. 67) k Pa。观察组治疗前FMA评分为(38. 41±7. 52)分,治疗后FMA评分为(54. 61±5. 34)分,改善值(16. 22±6. 46)分。MBI指数治疗前为(36. 75±6. 87),治疗后为(60. 33±12. 73),改善值为(23. 58±9. 34)。观察组中医证候积分治疗前(16. 52±0. 68)和治疗后(4. 60±0. 22)。对照组中医证候积分治疗前(16. 95±0. 83)分和治疗后(8. 72±0. 27)分。结论:针刺配合康复训练能够有效的帮助脑卒中上肢功能障碍患者的恢复神经功能,加速脑血管血流速度,减少压强阻力,从而达到治疗患者上肢及手功能,恢复日常生活活动能力的效果。     

Facteurs associés au burnout en anesthésie–réanimation. Enquête 2009 de la Société française d’anesthésie et de réanimation

Objective

To assess factors related to burnout in anesthesia and intensive care.

Design

National prospective observational study.

Materials and methods

Questionnaire posted on the French Society of anesthesia website from 3rd June 2009 to 27th August 2009: Maslach Burnout Inventory (MBI), Fast Alcohol Consumption Evaluation (FACE) and The Harvard National Depression Screening Day Scale (HANDS) scales and questions to assess health, work and personal life.

Results

One thousand six hundred and three questionnaires returned: 1091 anesthetists (67.6%), 241 intensivists (14.9%), 204 nurses (12.6%), emergency physicians (2.8%), supervisor nurses (0.9%). Seven hundred and sixty three in a university hospital (47.3%), 259 in a regional hospital (16.1%), 405 in a private structure (25.1%), 71 in a non-lucrative private structure (4.4%), 75 in a military hospital (4.6%). Rest of safety: 69.2% of institutions. Depression: 38.7%. Drug or chemicals addicted: 10.6%. Alcohol addicts: 10.6%. Among them, 62.3% of individuals were in burnout. Burnout was linked to fragmented sleep (P < 0.00001), interpersonal conflicts (P < 0.00001), perception of rest of safety (P < 0.02), mental history (P < 0.00001), suicidal ideations (P < 0.00001), depression (P = 0.00001), alcohol (P < 0.002), drug consumption (P < 0.00002), and accidents after a nightshift (P < 0.05). Subjects in burnout intended more frequently to leave the profession (P < 0.00001). Leaving in couple had a protective effect (P < 0.005). The logistic regression model retained seven covariates independently associated with burnout: quality of work, of personal life, of fatigue, depression, conflicts with colleagues and patients, regretting the choice of specialty.

Conclusion

This study of the largest cohort of anesthesia personnel performed in France detects a high proportion of burnout. It highlights links with tensors that may constitute possibilities of prevention of the burnout syndrome.     

Identification and analysis of the reactive metabolites related to the hepatotoxicity of safrole

1.?Safrole is the main component of the volatile oil in Xixin, which has a strong antifungal effect. However, safrole has been shown to be associated with the development of hepatocellular carcinoma. Methylenedioxyphenyl and allyl-benzene substructures of safrole may cause a mechanism-based inhibition (MBI) of CYP450 enzymes (CYPs) and produce reactive metabolites (RMs), resulting in inhibition of enzyme activity and toxic effects.

2.?Based on the experiments of CYPs cocktail screening, glutathione (GSH) capture and the IC₅₀ data, we found that safrole had an inhibitory effect on CYP1A2. The test of enzyme activity recovery when adding GSH may help to verify the MBI of safrole.

3.?Two metabolites, 1,2-dihydroxy-4-allylbenzene (M1) and 1′-hydroxy safrole (M2) could be captured by GSH. The ultra performance liquid chromatography - tandem mass spectrometer (UPLC-MS/MS) method was used to identify the RMs through a detailed characterization of the safrole cleavage processes and the GSH-M1 adduct. The RMs identified are quinone and its tautomer. Thus, preliminary conclusion can be obtained that safrole is a mechanism-based inhibitor of CYP1A2.

4.?The cleavage process of the GSH-M1/M2 adduct was analyzed in further detail. We believe the safrole hepatotoxicity mechanism is related to the RMs mediated by CYP1A2. This work provides important information on predicting in vivo drug induced liver injury.     

Changes in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2017

ObjectiveTo evaluate the prevalence of burnout and satisfaction with work-life integration among physicians and other US workers in 2017 compared with 2011 and 2014.Participants and MethodsBetween October 12, 2017, and March 15, 2018, we surveyed US physicians and a probability-based sample of the US working population using methods similar to our 2011 and 2014 studies. A secondary survey with intensive follow-up was conducted in a sample of nonresponders to evaluate response bias. Burnout and work-life integration were measured using standard tools.ResultsOf 30,456 physicians who received an invitation to participate, 5197 (17.1%) completed surveys. Among the 476 physicians in the secondary survey of nonresponders, 248 (52.1%) responded. A comparison of responders in the 2 surveys revealed no significant differences in burnout scores (P=.66), suggesting that participants were representative of US physicians. When assessed using the Maslach Burnout Inventory, 43.9% (2147 of 4893) of the physicians who completed the MBI reported at least one symptom of burnout in 2017 compared with 54.4% (3680 of 6767) in 2014 (P<.001) and 45.5% (3310 of 7227) in 2011 (P=.04). Satisfaction with work-life integration was more favorable in 2017 (42.7% [2056 of 4809]) than in 2014 (40.9% [2718 of 6651]; P<.001) but less favorable than in 2011 (48.5% [3512 of 7244]; P<.001). On multivariate analysis adjusting for age, sex, relationship status, and hours worked per week, physicians were at increased risk for burnout (odds ratio, 1.39; 95% CI, 1.26-1.54; P<.001) and were less likely to be satisfied with work-life integration (odds ratio, 0.77; 95% CI, 0.70-0.85; P<.001) than other working US adults.ConclusionBurnout and satisfaction with work-life integration among US physicians improved between 2014 and 2017, with burnout currently near 2011 levels. Physicians remain at increased risk for burnout relative to workers in other fields.     

Longitudinal factorial invariance of the Maslach Burnout Inventory‐General Survey among employees with job‐related psychological health problems

The study provides new knowledge about the longitudinal factorial invariance of the Maslach Burnout Inventory‐General Survey (MBI‐GS). In order to investigate the factor structure of the MBI‐GS and its invariance across time, a full panel data with two measurements gathered among employees with job‐related psychological health problems was used. Consistent with previous study findings, the results indicated that the correlated three‐factor model of the MBI‐GS (i.e. exhaustion, cynicism and professional efficacy) showed a better fit with the data than the alternative factor models. The correlated three‐factor structure was invariant across time, indicating that the scale has good construct validity, thus producing evidence that the MBI‐GS is a valid scale to measure job burnout. The novel finding of the study was that the professional efficacy dimension was a more central symptom of the burnout syndrome than previous research evidence among healthy employees has established. Copyright © 2011 John Wiley & Sons, Ltd.     

康复训练对脑卒中患者肢体瘫痪后遗症的疗效观察

目的观察康复训练对脑卒中患者肢体瘫痪后遗症疗效,以探讨康复训练的治疗意义。方法 72例脑卒中患者采用常规治疗（对照组）,83例患者在常规治疗基础上进行康复训练（康复训练组）,在康复训练前以及训练1、3个月时对两组患者进行Fugl-Meyer评价法（FMA）进行运动功能评定以及采用改良Barthel指数评分法（MBI）日常生活能力评定,3个月后对患者疗效进行评价,并观察患者并发症发生情况。结果训练1个月和3个月时,两组FMA评分和MBI评分较训练前有明显变化（P〈0.05）,两组间比较差异有统计学意义（P〈0.05）。康复训练组总有效率为84.3%,明显高于对照组（59.7%）,两组比较差异有统计学意义（P〈0.01）;康复训练组废用综合征、误用综合征、肩手综合征并发症的发生率均明显低于对照组（P〈0.05）。结论康复训练能够促进恢复期脑卒中患者运动功能的恢复,提高ADL能力,对减少脑卒中引起的残障发生以及提高患者今后的生活质量有着十分重要的意义。     

Burnout intervention among Dutch dentists: long-term effects

The aim of the present study was to determine the long-term effects of a burnout-intervention program among Dutch dentists using a longitudinal design. Using the Maslach Burnout Inventory (Dutch version: MBI-NL), at the initial measurement in 1997 a 'burnout risk group' (n = 171) was identified. This group received feedback on their scores and was invited to participate in an intervention program. Of the total group. 19 dentists participated in an intervention program. After the end of the intervention program, 92 dentists (the 19 participants and a control group) responded to a post-intervention survey in 1998. These dentists were approached once more 1 yr later, and this time 78 dentists (84.8%) returned a questionnaire. While demonstrating an improvement on all subscales of the MBI-NL at the first post-test, results show that the program participants showed a relapse at the second post-test. Controls who took action on their own initiative, on the other hand, reported a beneficial effect in the long run. Finally, controls that did not take any preventive action showed little or no progress. Possible causes for these findings are discussed, including the influence of coping style. perceived control, confounding factors, demand characteristics, and the necessity of post-intervention follow-up.     

中文版工作疲溃感问卷在中国护理人员中的测试研究

目的测试中文版工作疲溃感问卷(Maslach Burnout Inventory,MBI)在中国护理人员中使用的信度和效度,为中国护理人员工作疲溃感的测评提供有效工具。方法翻译国外的工作疲溃感问卷,将所形成的中文版问卷在476名护士中使用,评价其信度和效度。结果因子分析结果显示,情绪疲倦感、工作冷漠感、工作成就感3个维度的条目因素负荷与原量表结构基本一致;全量表同质信度为0.823,3个维度Cronbach's a系数在0.770~0.888之间;重测信度在0.806~0.887之间;其中各条目与其所属维度之间相关较强,而与其他维度相关较弱;独立样本t检验证实量表区分效度好。结论工作疲溃感问卷中文版信度及效度较好,符合心理测量学要求。     

美沙酮戒毒安全剂量的研究

目的：制定美沙酮戒毒的安全剂量范围。方法：检测男性（女性）戒毒人员体重指数（BMI）,计算出戒毒者服用美沙酮的剂量,按吸食毒品的类别和剂量换算美沙酮用量,检测2位死亡者生化指标和尿美沙酮含量,分析死亡原因。结果：两例死亡病例尿美沙酮含量为300ng／ml即0．3mg／L。肝脏是美沙酮代谢的主要场所,从尿中和大便中排出未经变化的药量小于血药量的10％左右。美沙酮的治疗血浓度为0．48—0．86mg／L,中毒血药浓度为2．0mg／L,致死血浓度〉4．0mg／L。故可推算出两例病例血中美沙酮含量在3mg／L左右,已达中毒剂量。结论：美沙酮替代疗法给药剂量应个体化,防止诱发死亡。