我学会了宽容

在医保商会全国信息员工作会议上，我认识了哈药集团进出口公司的王秀岩。会议间歇，我们聊起了孩子，她有个儿子9岁，我有个儿子11岁。她的儿子很懂事，作文写得很好；我的儿子也很懂事，钢琴弹得不错。相约什么时候让孩子们见个面，好好玩一玩。 会议结束，我们各奔东西，忙于各自的事务。12期心理版块的文章我还没有着落，约来的稿件总觉得大同小异，似曾相似。心理健康太重要了，大家都知道的，但却写不出来，好像很难交流。 一天早晨上班打开信箱，就看到一封信，原来是哈药的秀岩发来的。把附件存下来，打开一看，是一篇小学生的作文。拜读作文，我心潮起伏，一个小学生说“我学会了宽容”，稚嫩的话语，像一条小溪，流过心田，沁人心脾。“宽容是温暖明亮的阳光，可以融化内心的冰点，让这个世界充满着浓浓的暖意。”他说得多好啊! 把排好版的文章撤下来，把小学生史晟宇的作文发表，作为心理健康的一篇范文。宽容是一种态度，是健康心理的基础。我们成年人读读孩子的文章吧，干涸的心灵也许早就需要这样一条清澈的小溪了。 今天是感恩节，感谢小朋友史晟宇，感谢他的老师辛勤的培育，感谢他的父母爱心浇灌。     

中医养生与保健

顺应自然养生首先应顺应自然界阴阳的变，化规律，人的活动应与自然界的规律相协调，养成良好的生活习惯，科学地安排作息时间。春夏时节，阳气在外，万物欣欣向荣，自然界一片生机，人们应晚睡早起，长庭漫步，舒缓身心，保养生气。秋冬季节是万物生长收藏的季节。此时，秋高气爽，地气清：肃明朗，此时应早卧晚起，陵精神内守而不外露，以顺应秋冬阳气叙藏的趋势。     

解析口渴，透视健康

读者来信求救，求救，口渴难受，喝水不管用!我17岁，男，老是口渴嗓子干，嘴不干，还老是感觉胸闷难受，喝好多水也不管用，查过了，血糖不高，不能吃油大的，吃凉的没事，但风一吹就不舒服了，请您帮我诊断一下!医生说我是咽炎，但输了一星期水也不管用。热心读者：马宁     

专注发明，只因心中装满患者——访著名呼吸病学专家白春学教授

近郊的一片白杨林，由于地处郊区，鲜有人光顾，实在是一个无人打扰的修身养性的“天堂”，经常有附近的老人来这里晨练。一日，一位老人正在慢跑，忽然感到呼吸急促，忙停下脚步，原地坐下休息。然而，情况并没有好转，随着越来越严重的窒息感，死亡的恐惧迅速弥漫全身。这样的“荒郊野外”，呼救明显是徒劳。一闪而过的恐慌过后，他迅速拿出随身携带的一个小巧的仪器，对着仪器吹了一口气……     

高血压用4种枕心，2种不能用

高血压患者，还有一件重要的事情，就是晚间睡眠的枕头。最好是用绿豆的壳作为枕心。切不可用木棉枕心，最可怕的，是西方人所用的野鸭绒枕头，应该绝对禁用。因为晚间睡眠之后，脑后着枕，最接近神经中枢大脑后叶和延髓部位，用热性的木棉枕心，对患者的神经影响最大，所以必须改用别种枕心，方能应用。野鸭绒的性质更热，有人在外国旅店中，用了一夜野鸭绒枕被，第二天就鼻孔或牙龈出血，所以对血压高患者，是绝对不宜的。     

对服毒轻生精神病患者的心理护理

心理护理是指在护理过程中，护士以心理学的理论为指导，以良好的人际关系为基础，积极影响和改变病人不健康的心理状态和行为，促进其疾病的康复或向健康发展的手段和方法。由于服毒轻生患者的心理活动复杂，急性中毒发病急剧，症状严重，变化迅速，因此，护士必须具备良好的护理素质，具有扎实过硬的基本功，在抢救服毒病人的过程中，突出一个“急”字，强调一个“快”字，分秒必争地进行抢救工作，服毒者被送进医院时，     

重型颅脑损伤恢复期患者的家庭护理

重型颅脑损伤，为广泛性脑挫裂伤，合并脑干，丘脑下部损伤，患者长时间昏迷，生活不能自理，经过医院系统的治疗，费用较高，经济负担过重，待病情平稳，回家进行恢复期护理尤为重要。正确而得力的家庭护理是减少并发症，挽救患者生命，提高生存质量的关键。     

小暑

公历每年7月6～8日是小暑的交节，为二十四节气的第十一个节气、《历书》记载：“斗指辛为小暑，斯时天气已热，尚未达于极点，故名小暑也”，《月令七十二候集解》记载：“六月节……暑，热也，就热之中分为大小，月初为小，月中为大，今则热气犹小也”，这两段文献是说，小暑，是说天气已经很炎热了，但尚未达到最炎热的时候，气温还在上升，小暑节气处于初伏前后，植物生长旺盛，目光所及，到处绿树浓荫，芳草菁菁，     

高血压脑出血28例护理体会

影响高血压脑出血（HICH）预后的因素很多，如年龄，血肿量，出血部位，病情进展速度，术前状态等。这些都是人们主观上所不能控制的因素，但是对同一病例来说，抓住抢救时机，采取有效的抢救方法，严密的病情观察和有效的护理措施，能提高生存率，降低致残率，促进临床康复，现将护理措施介绍如下。     

去表皮乳晕三角皮瓣支撑法矫正乳头内陷42例疗效观察

成年女性的乳头不凸出乳晕平面，甚至凹入乳晕皮两之下，称为乳头内陷，乳头内陷的程度有的较松，表现为乳头退缩，有的较重，表现为乳头凹入甚至翻转。乳头凹陷者由于清洁不便，易产生异味，常致乳头反复感染，给患者日常生活带来不便，同时产后不易正常哺乳。一对丰满的乳房若乳头是内陷的，显然是美中不足，会给患者带来极大的心理压力。轻度乳头内陷者，     

缺血性心脑血管事件高危因素的中医干预研究

目的近30年,我国人群心脑血管病的发病率和病死率呈现逐年上升趋势,且发病年龄提前。现代医学已进入"强化降脂、降压、降糖"时代,并已经成为新的研究热点。随着大量缺血性心脑血管事件危险因素的发现,对其防治的重点"前移"成为心脑血管疾病防治的重要研究课题之一。本课题旨在探讨缺血性心脑血管事件高危因素的中医证候特点,为早期干预治疗提供依据。方法中老年人群是多重危险因素聚集发生率较高的特定群体,对该人群进行横断面调查问卷研究并进行前瞻性追踪分析,对比分析观察缺血性心脑血管病人群体与健康人群所合并危险因素的数目,症候学特点以及舌象,脉象特点。经多元回归统计分析,得出结论。结果本课题组目前阶段研究结果表明,急性缺血性心脑血管事件发生前"有征可循",中医证候出现相关规律和特点,其发生存在共同的发病病机"风"痰"瘀"。结论对"风"痰"瘀"三要素进行中医早期的综合干预,在辨证治疗基础上及早给予熄风、化痰、活血干预,可望起到"既病防变"的作用。     

Endothelial progenitor cells in prehypertension

Blood pressure within prehypertensive levels confers higher cardiovascular risk. As prehypertension is also an intermediate stage for full hypertension, a precocious intervention with lifestyle changes or drugs is therefore appealing. Endothelial injury and dysfunction are thought to contribute to cardiovascular risk in prehypertension. Endothelial progenitor cell impairment has been linked to endothelial dysfunction, atherosclerotic disease progression and cardiovascular events. A potential mechanism contributing to the heightened cardiovascular risk in prehypertension may be linked to abnormalities in endothelial progenitor cell number and/or function. Aim of this review is to be up to date about the recent work on the correlation between endothelial progenitor cells and prehypertension and the possible prevention, treatment, and control of this pathology. The effect of an approach based on dietary intervention on both blood pressure and endothelial progenitor cells will be also shown.     

阿托伐他汀钙预防造影剂肾病的研究进展

在冠脉造影及经皮冠状动脉介入术(PCI)领域,造影剂造成的肾损伤成为心血管医生不容忽视的一大困扰,已引起越来越多的心血管介入医生的关注。阿托伐他汀作为心血管疾病基本治疗药物,其作用及应用范围被不断挖掘及扩大。该文就目前造影剂肾病的相关研究及阿托伐他汀对造影剂肾病预防的作用机制、临床证据及不足之处分别作一综述,探讨阿托伐他汀对预防造影剂肾病新领域的应用前景。     

大气污染与人体健康的关系及预防

大气污染是全球范围内的一个重要的公共卫生问题,在我国近年来日益严重,国内外的大量研究表明,大气污染可对人体呼吸、免疫、心血管等多个系统产生不良影响,造成肺功能下降、心血管疾病发生率和死亡率升高。严重的空气污染,威胁到身体健康。为了尽量控制大气污染对公众健康的危害,有必要加强预防和控制工作。     

2型糖尿病糖耐量正常一级亲属心血管危险因素的干预研究

目的探讨糖耐量正常的2型糖尿病(T2DM)患者一级亲属(FDRs)群体心血管危险因素干预策略,为其心血管病(CVD)的早期预防提供参考依据。方法将60例糖耐量正常T2DM的FDRs随机分为干预组40例,对照组20例。两组均给予糖尿病、心血管疾病健康知识讲座,合理运动指导,定期门诊及电话随访,危险因素监测,信息化动态管理等,干预组在上述基础上予以相对固定的营养餐,进行个体化干预。比较干预前后两组的体质量指数(BMI)、腰臀比、血压、空腹血糖、血胰岛素水平、胰岛素抵抗指数(HOMA-IR)、血脂、尿微量白蛋白、C反应蛋白等指标,根据"缺血性心血管病(ICVD)10年发病危险评估量表",对所有研究对象干预前后进行ICVD危险评分,评估CVD发病风险。结果干预后6、12、24个月,相比对照组,干预组多重危险因素明显回归,心血管绝对风险度明显降低。结论 T2DM糖耐量正常FDRs存在CVD的多重危险因素,合理的营养综合干预可使CVD获益最大化;对心血管高危群体应选择个体化预防方案,加强长期的一级预防。     

Prevention of cardiovascular events in elderly people

BACKGROUND AND OBJECTIVE: Cardiovascular disease has been identified as the leading cause of morbidity and mortality in developed countries. Given the increase in life expectancy and the development of cardiovascular preventive measures, it has become increasingly important to detect and prevent cardiovascular diseases in the elderly. We reviewed the scientific literature concerning cardiovascular prevention to assess the importance of cardiovascular preventive measures in old (> or =65 years of age) individuals. METHODS: We undertook a systematic search for references relating to prevention of cardiovascular disease in the elderly, mainly ischaemic stroke, coronary artery disease and heart failure, on the MEDLINE database 1962-2005. For cardiovascular prevention by drugs or surgery, emphasis was placed on randomised controlled trials, review articles and meta-analyses. For cardiovascular prevention by lifestyle modification, major cohort studies were also considered. RESULTS: Stroke, coronary heart disease and heart failure were found to be the main targets for cardiovascular prevention in published studies. Antihypertensive treatment has proven its efficacy in primary prevention of fatal or nonfatal stroke in hypertensive and high-risk patients >60 years of age, particularly through treatment of systolic hypertension. Systolic blood pressure reduction is equally important in the secondary prevention of stroke. Similarly, in nonvalvular atrial fibrillation, an adjusted dose of warfarin with a target International Normalized Ratio (INR) of between 2 to 3 prevents ischaemic stroke in elderly patients with an acceptable haemorrhagic risk but is still under prescribed. Antiplatelet agents are indicated in elderly patients with nonembolic strokes. Few large-scale studies have investigated the effect of HMG-CoA reductase inhibitors (statins) on stroke prevention in old individuals. To date, the largest trials suggest a beneficial effect for stroke prevention with use of statins in high-risk elderly subjects < or =82 years of age. Carotid endarterectomy is indicated in carotid artery stenosis >70% and outcomes are even better in elderly than in younger patients. However, medical treatment is still the first-line treatment in asymptomatic elderly patients with <70% stenosis. In ischaemic heart disease, different trials in elderly individuals have shown that use of statins, antithrombotic agents, beta-adrenoceptor antagonists and ACE inhibitors plays an important role either in primary or in secondary cardiovascular prevention. Hormone replacement therapy has been used to treat climacteric symptoms and postmenopausal osteoporosis and was thought to confer a cardiovascular protection. However, controlled trials in elderly individuals changed this false belief when it was found that there was no benefit and even a harmful cardiovascular effect during the first year of treatment. Smoking cessation, regular physical activity and healthy diet are, as in younger individuals, appropriate and effective measures for preventing cardiovascular events in the elderly. Finally, antihypertensive treatment and influenza vaccination are useful for heart failure prevention in elderly individuals. CONCLUSIONS: Cardiovascular prevention should be more widely implemented in the elderly, including individuals aged > or =75 years, and this might contribute to improved healthy status and quality of life in this growing population.     

Vitamin E-related inhibition of monocyte 5-lipoxygenase and cardiovascular outcome in maintenance hemodialysis patients

A daily supplement of vitamin E is recommended for the secondary prevention of cardiovascular events in end-stage renal disease patients on maintenance hemodialysis. Vitamin E has been entrusted with therapeutic properties against cardiovascular disease for more than 60 years. Several epidemiological studies and intervention trials have been performed with vitamin E, and some of them showed that it prevents atherosclerosis. For a long time, vitamin E was assumed to act by decreasing the oxidation of low-density lipoproteins, a key step in atherosclerosis initiation. However, at the cellular level vitamin E interferes with smooth muscle cell proliferation, platelet aggregation, monocyte adhesion, and oxidized low-density lipoproteins uptake and cytokine production, all reactions implied in the progression of atherosclerosis. Recent research points out that these effects may be not only the result of the antioxidant activity of vitamin E but also of its distinct molecular actions. These biological properties of vitamin E may allow to design better strategies for primary and secondary prevention of cardiovascular disease, with a potential exploitation of vitamin E supplements in primary and secondary prevention of major adverse cardiovascular events in all uremic patients. In this review, we also outline relevant patents on vitamin E and lipoxygenase inhibitors.     

Role of SR-BI in regulating lipoprotein structure and metabolism

The scavenger receptor class B type I (SR-BI) is a cell surface lipoprotein receptor that mediates physiologically relevant selective cholesteryl ester uptake from high-density lipoprotein (HDL). SR-BI appears to be required for the maintenance of reverse cholesterol transport, normal HDL levels and HDL structure by means of hepatic-selective HDL-cholesterol and phospholipid uptake in mice. SR-BI can also promote the selective uptake of cholesteryl ester from apoB-containing lipoproteins; however, unlike the effect of SR-BI on HDL-cholesterol, the effect on low-density lipoprotein is limited in vivo. Furthermore, SR-BI plays a protective role against atherosclerotic development. A pharmacological agent that increased reverse cholesterol transport by targeting SR-BI could become a powerful tool for prevention of or therapeutic intervention in atherosclerotic cardiovascular diseases.     

Controversy of hormone treatment and cardiovascular function: need for strengthened collaborations between preclinical and clinical scientists

Over the last five years, there have been several major randomized clinical trials assessing the use of hormone therapy as an adjunct treatment for primary and secondary prevention of cardiovascular disease. Results of these trials have called into question existing dogma from epidemiological and basic science studies that estrogen provides protection against development of cardiovascular disease. When studies are evaluated for design, type and duration of hormone treatment, and outcomes, directions for future research become apparent. Improved hormone formulations and selective estrogen receptor modulators that help to maintain vascular function and limit progression of cardiovascular occlusive disease need to be developed. This will depend upon improved understanding of: (i) the distribution and regulation of estrogen receptors in vascular tissue, (ii) genomic interactions of estrogens and progestins, (iii) association of the estrogen receptor and other genetic polymorphisms with particular vascular functions, and (iv) better definition of timing and dosing for therapeutic intervention. The mechanisms of interactions between coagulation proteins, inflammatory cytokines, platelets and the vessel wall should be defined so that the thrombotic risk for an individual woman can be identified and reduced, and progression of chronic disease processes associated with loss of ovarian hormones can be slowed.     

Compliance with lipid-lowering therapy and its impact on cardiovascular morbidity and mortality

Background: Hypercholesterolemia is a major risk factor for cardiovascular disease. Objective: Treatment with hypolipidemic agents reduces the risk of vascular events both in primary and secondary prevention. Although compliance with lipid-lowering therapy is an important determinant of cardiovascular clinical outcomes, relatively little attention is being paid to this issue by physicians. Methods: We searched the literature using Pubmed up to 5 August 2008. Results: Compliance with lipid-lowering therapy is poor in clinical practice, especially in primary prevention. As many as 6 out of 10 patients may stop taking statins during the first 6 months following initiation of treatment. Poor compliance has been associated with worse clinical outcome and increased cardiovascular morbidity and mortality. Importantly, statin withdrawal may be even worse compared with not taking statins at all. Several strategies may increase treatment adherence. Conclusions: Poor compliance with lipid-lowering treatment is an important health issue that has been associated with unfavorable cardiovascular outcome. Increasing adherence rates should become a major concern for physicians.