缺血性卒中幸存者的行为症状研究

目的:评估卒中后行为症状特点.方法:53例卒中患者与30例正常人完成行为症状自测评分及认知测量,两组资料提供者完成行为症状与功能评估.结果:卒中幸存者比对照组更多行为症状;资料提供者比卒中幸存者更能识别症状;卒中发作程度与行为症状相关.结论:行为症状对卒中患者影响复杂,识别很重要.     

出血性脑肿瘤卒中的诊断探讨

目的探讨出血性脑肿瘤卒中的临床与CT表现。方法收集我院经CT检查并经手术病理证实的出血性脑肿瘤卒中共13例,分析其临床及CT表现。结果临床表现大多具有先兆的神经系统损害症状,发病时主要表现为意识障碍、偏瘫、瞳孔改变和脑膜刺激征;CT检查13例均见边缘清楚的高密度血肿,7例见肿瘤实体,6例未见明显瘤灶;灶周指压样水肿带8例。结论密切结合临床表现及病史,特别是先兆神经系统损害症状,询问是否有高血压病史、肿瘤史,仔细分析CT表现,增强扫描,有助于出血性脑肿瘤卒中的早期诊治。     

中青年颈动脉闭塞的临床特点与外科治疗分析

目的:探讨中青年颈动脉闭塞的发病机制,为其治疗方法的选择提供依据。方法:回顾2008年1月至2014年6月342例颈动脉闭塞病人的临床资料。结果:<65岁(中青年组)病人226例,≥65岁(老年组)病人116例。中青年组合并高血脂、吸烟、外周动脉疾病等病史的病人显著低于老年组(P<0.001)。血液分析结果表明,与炎症反应相关的C反应蛋白(CRP)、白细胞、红细胞沉降率(ESR)在中青年组中显著高于老年组(P<0.05)。术后6个月随访结果表明,中青年组病人术后再狭窄与卒中发生率显著高于老年组。预后分析结果提示,CRP与ESR高水平以及颈动脉支架成形术显著增加中青年病人术后主要并发症的发生率。结论:颈动脉内膜免疫炎症反应性增生是中青年人颈动脉闭塞发病的主要机制,颈动脉内膜剥脱术可能是其首选的外科治疗手段。     

肾移植排斥反应患者血清蛋白质谱的差异性研究

目的 研究肾移植排斥反应患者的血清蛋白质谱的差异性,检测肾移植排斥反应早期诊断的特殊血清多肽标记物.方法 将研究对象分成实验组和对照组,实验组为经肾活检确诊的10例急性排斥反应和12例慢性排斥反应患者,对照组为12例移植肾功能稳定受者和13例健康志愿者.通过ClinProt磁珠浓缩和基质辅助激光解吸电离法(MALDI)-TOF-MS分析两组研究对象的血清蛋白质谱的差异.结果 通过与健康对照组比较,筛选出18条差异性多肽作为诊断肾移植急性排斥反应的潜在生物标记物,6条差异性多肽作为诊断慢性排斥反应的潜在生物标记物.此外,还比较了急性排斥反应与慢性排斥反应患者的多肽差异,检测出了4条高表达的差异性多肽.运用快速分类算法,建立了移植排斥反应的分类模型,该模型对急性排斥反应患者的有效识别能力达到82.64%,对慢性排斥反应患者的有效识别能力高达98.96%.结论 基于功能性磁珠的样本分离法结合MALDI-TOF-MS分析的实验方法 是精确而稳定的.应用蛋白质组学技术建立了肾移植排斥反应患者的血清蛋白质谱诊断模型,为人们更好的理解肾移植排斥反应的发病机制,并将蛋白质组学技术用于排斥反应早期诊断的新技术手段提供了思路.     

青年猝死41例临床分析

目的通过对41例青年猝死患者的临床病因分析,探讨青年猝死的特点,以期提高其预防水平及抢救成功率。方法回顾性分析41例青年猝死患者的临床资料,总结其发病前的基础疾病、可能的诱因及先兆表现。结果青年猝死者猝死前基础疾病以高血压（15/41）、肥胖（12/41）居多;诱因以过量饮酒（13/41）、过度劳累（1141）、剧烈运动（5/41）相关;大多无明显先兆症状。结论青年猝死发病前多有诱因,但没有明显的先兆症状。早期识别高危人群,及时干预治疗可减少猝死发生率。     

先兆早产孕妇抑郁状况及对早产的影响

目的了解先兆早产孕妇的抑郁状况及对早产的影响,旨在为临床实施预见性干预提供参考。方法采用前瞻性队列研究方法,对2016年1~11月因先兆早产住院的138例初产妇采用爱丁堡产后抑郁量表(EPDS)进行调查,并随访其早产发生情况,分析抑郁对早产的影响。结果先兆早产孕妇抑郁症状发生率为46.38%;早产发生率62.32%;抑郁组发生早产46例,非抑郁组为40例,两组早产发生率比较,差异有统计学意义(P0.05);Logistic回归分析显示,抑郁是先兆早产孕妇发生早产的危险因素(P0.05)。结论先兆早产孕妇抑郁症状的发生率较高,是发生早产的危险因素。医护人员需要重视孕妇的抑郁状况,加强孕期健康教育及心理疏导,以缓解抑郁状况,从而降低早产发生率。     

中青年脑干梗死18例临床分析

目的分析中青年脑干梗死的临床症状、体征及致病因素,对中青年脑梗死的防治,尤其是脑干梗死有更深的认识。方法对18例中青年脑干梗死的临床资料进行回顾性分析。结果本组患者经治疗均好转。绝大多数患者有中风危险因素,脑干梗死的症状体征具有多样性和复杂性。结论中青年脑干梗死临床表现复杂多样,早期诊治效果较好,应对脑梗死的危险因素进行积极的预防和治疗,降低脑干梗死的发病。     

出血性进展性卒中的相关危险因素分析

目的 观察出血性脑卒中患者中进展性卒中的发生情况及可能的影响因素.方法 回顾性分析2008年8月～2011年8月玉林市第二人民医院收治的100例急性脑出血患者,根据欧洲进展性卒中的诊断标准判定是否进展,对可能导致卒中进展的危险因素与非进展组的进行对比分析.结果 进展性卒中患者入院时发热、头痛、血肿增大、神经功能缺损等方面与非进展性卒中患者相比差异有统计学意义（P ＜0.05）.结论 入院时白细胞数增高、发热、有头痛症状、入院后头颅CT显示血肿增大、入院时评分得分较高者、C反应蛋白增高及尿酸降低的患者较易出现病情进展.     

中青年健康饮食行为与胆结石患病风险的相关性

目的 了解中青年健康饮食行为现状及影响因素,并分析其与胆结石患病风险的相关性,为制订中青年饮食干预方案提供指导。方法 选取健康体检的中青年1 038人为调查对象,使用基本情况问卷和成年人健康饮食行为评价量表进行调查。结果 中青年健康饮食行为总分为73.93±12.85。多元线性回归分析结果显示,性别、文化程度、居住情况、胆结石既往病史和家族胆结石史是中青年健康饮食行为的影响因素(P<0.05,P<0.01)。随访1年,饮食行为不健康中青年胆结石患病率显著高于饮食行为健康者(P<0.01)。多因素Cox回归分析结果显示,年龄、胆结石既往病史、家族胆结石史、健康饮食意识、规律用餐态度、健康饮食习惯是中青年患胆结石的影响因素(HR 0.091～0.299,均P<0.01)。结论 中青年健康饮食行为处于中等水平,其健康饮食行为受多因素影响。医护人员应加强健康指导,引导其建立良好的饮食行为,以预防胆结石发生。     

护理接近失误原因分析及预防研究进展

综述护理接近失误的识别与上报现状,并引用瑞士奶酪模型对接近失误的原因分析及干预进行归纳总结,主要包括组织影响、不安全监督、不安全行为先兆、不安全的行为,以期为减少接近失误、改善患者安全提供参考.     

锦州市社区老年人骨质疏松认知状况及影响因素的调查

目的 调查锦州市社区老年人骨质疏松相关知识的认知状况及影响因素，为老年人预防骨质疏松提供依据。 方法 以锦州市60周岁及以上的社区老年人为研究对象，采用自行设计问卷对锦州市225名老年人进行调查。 结果 老年人对骨质疏松知识认知情况尚可，其中对于诊断骨质疏松的常见方法（16%）和女性绝经后激素替代治疗可预防骨质疏松（14.2%）的认知较差。获取骨质疏松知识的最常见途径为电视收音机等媒体117人（52%）；所在社区从未有过骨质疏松知识宣传为196人（87.1%）；身边有从事医疗的家人朋友的老年人为76人（33.8%）；愿意采取预防骨质疏松措施为182人（80.9%）；老年人希望了解骨质疏松知识的途径有专业人士讲授、报刊杂志、电视广播、亲朋好友讲述，分别占25.8%、8.9%、32%、3.1%。不同年龄总人群和女性的骨质疏松认知情况随着年龄的增加呈下降趋势；60~年龄组女性对骨质疏松认知情况优于男性。影响老年人骨质疏松认知情况的因素为愿意采取预防措施、社区宣传、有从事医疗的家人朋友、晒太阳、年龄。 结论 加强骨质疏松的专业健康教育，积极在社区或是电视广播等媒体上开展有针对性、简单易懂的骨质疏松健康教育活动，使老年人知晓骨质疏松的危害和正确的预防方式，能够以正确的方法和积极的心态预防和面对骨质疏松。     

Pre-hospital emergency burn management in Shanghai: Analysis of 1868 burn patients

Background

There are few studies reporting the level of pre-hospital emergency management of burn patients and related influencing factors in China. This study is a summary of our investigation on emergency education and people's awareness about pre-hospital emergency management of burn patients in Shanghai, China, and analyses key factors influencing pre-hospital emergency management of burn patients.

Methods

The survey was conducted by questionnaire in burn patients who sought initial clinical visits at the Burn Center of Changhai Hospital (Shanghai, China) between November 2009 and December 2010, including demographic data, burn conditions, pre-hospital emergency management and education about emergency burn management. Data were statistically treated by SPSS software.

Results

Altogether 1868 effective questionnaire forms were collected; 33.9% of these burn patients received cooling treatment before admission and 32.2% of them used ‘folk remedies’ or antibiotics to treat the wound surface. Only 12.2% of these burn patients had received education about the knowledge of emergency management, mainly through public media (38.2%), relatives and friends (24.6%), Internet (15.8%), workplace (11.4%) and schools (10.1%). The result of logistic regression analysis showed that emergency education, especially via Internet and workplace, played an important role in pre-hospital emergency management, and that different channels of emergency education affected different age groups of people: network and unit education mainly affected young adults, while relatives and friends mainly affected elderly people. In addition, educational level was an important factor favourably affecting ‘cooling therapy’.

Conclusions

The level of emergency burn management and related education is relatively low in China at present, and it is therefore necessary to intensify education about pre-hospital emergency management to raise the level of emergency burn management. At the same time, more attention should be paid to age- and population-specific education. Finally, universal emergency education should be included in the national basic education as a long-term strategy.     

Self-immolation a predictable method of suicide: a comparison study of warning signs for suicide by self-immolation and by self-poisoning

ObjectiveUnderstanding warning signs for suicide is a crucial aspect of suicide prevention. This study was designed to compare warning signs prior to suicide attempt by self-immolation versus suicide attempt by self-poisoning among consecutive referrals for treatment after suicide-attempt at Kermanshah Imam Khomeini Hospital, Iran.MethodsOver a 4-month period (June–September 2008), first degree relatives of 200 consecutive patients referred to Kermanshah Imam Khomeini Hospital, Iran, following a suicide attempt were interviewed. Sixty-three patients had attempted suicide by self-immolation and 137 by self-poisoning. Interviews addressed demographic characteristics (gender, age, marital status, and educational status) and three sets of psychosocial warning signs for suicide (verbal, behavioral, and environmental).ResultsFour significant differences in types of warning signs were found between the two groups. Those patients who had attempted suicide by self-poisoning were more likely to have shown seeking behavior for killing devices prior to the suicide (p < 0.001), to have shown depressed mood and severe changes in mood (p < 0.01), to have shown a lack of interest in work and education (p < 0.02), and to have shown reckless behaviors (p < 0.01). Other symptoms were not significantly different between the groups. Analyses considering warning signs in clusters of behavior patterns (verbal, behavioral, and environmental warning signs) indicated behavioral warning signs were more common in patients who had attempted suicide by self-poisoning. Further, the total number of warning behaviors was greater in the self-poisoning group (p < 0.001), indicating that the group who attempted suicide by self-poisoning seemed to do so with more substantial planning and warning than those who attempted suicide by self-immolation.ConclusionWarning signs for suicide by self-immolation were different and fewer than warning signs for suicide by self-poisoning among this sample of 200 Iranian patients who had attempted suicide. Prediction and prevention of suicide by self-immolation may be more difficult than prevention of suicide by other methods.     

Lumbar spine fusion surgery and stroke: a national cohort study

Purpose

To investigate the incidence and risk of stroke after lumbar spinal fusion surgery.

Method

Study subjects were identified from a nationwide cohort of 1 million people from 2000 to 2005 and were divided into the lumbar spinal fusion group (n = 2,015), who received posterior lumbar spinal fusion surgery, and the comparison group (n = 16,120) composed of age-, sex-, and propensity score-matched control subjects. The matching process was intended to adjust for demographics, comorbidities, and other immeasurable covariates to minimize selection bias. All subjects were followed up for 3 years for stroke, including hemorrhagic and ischemic strokes. Kaplan–Meier and Cox regression analyses were performed.

Results

The overall incidence rate of stroke in the cohort was 9.99 per 1,000 person-year. The lumbar spinal fusion group was less likely to have any stroke (adjusted hazard ratio (HR) = 0.83, p = 0.293), hemorrhagic stroke (adjusted HR = 0.74, p = 0.739) and ischemic stroke (adjusted HR = 0.81, p = 0.250) than the comparison group, but without significance.

Conclusions

Three years post-operatively, patients who received lumbar spinal fusion had stroke incidence rates similar to those without surgery. Posterior lumbar spinal fusion surgery is not associated with increased risks for any kind of stroke.     

Plötzlicher Herztod

Background

Sudden cardiac death (SCD) is the most frequent cause of out-of-hospital death in industrialized societies. In about 80?% of the victims SCD results from complications of underlying coronary heart disease, the remainder being due to a wide variety of inborn or acquired heart diseases.

Method

Analysis of clinical trials.

Results

If circumstances of SCD are analyzed in depth, an astonishing number of commonalities can be stated: about two thirds of cases occur at the home of the patient, two thirds in the presence of eye witnesses (most of them relatives), and the majority of victims has typical prodromal symptoms similar to those known from coronary heart disease. Moreover the characteristic warning symptoms are tolerated over a surprisingly long time. Patients and relatives, however, often do not understand the significance of these warning signs. In addition, bystander resuscitation rates in private surroundings are much lower compared to public places, resulting in worse survival rates.

Conclusion

These findings point out a major potential to fight SCD by information and education of patients and relatives on the impact of prodromal symptoms preceding SCD, the necessity of rapid reaction and to train basic life support.     

腹腔镜下完整肠系膜切除术与传统结肠癌根治术治疗中青年及老年Ⅲ期结肠癌的效果比较

目的探讨腹腔镜下完整肠系膜切除术与传统结肠癌根治术治疗中青年及老年Ⅲ期结肠癌的效果比较。 方法选取2013年1月至2016年6月治疗的Ⅲ期结肠癌患者153例进行回顾性分析,根据手术术式的不同分为完整肠系膜切除术(CME)组(78例,中青年34例、老年44例)和传统组(75例,中青年37例、老年38例),CME组采用腹腔镜下完整肠系膜切除术,传统组采用传统结肠癌根治术。应用SPSS 17.0统计学软件进行统计学处理,术中、术后相关指标和淋巴结清扫情况以( ±s)表示,采用独立t检验;术后并发症的发生率采用卡方检验,以P<0.05差异具有统计学意义。 结果两组患者中不同年龄段(中青年和老年)患者的术中、术后相关指标、淋巴结清扫情况和术后并发症进行组内比较,差异均无统计学意义(P>0.05);与传统组相比,CME组中青年和老年患者的术中出血量显著降低(P<0.05),手术时间、术后排气时间、留置引流管时间和住院时间均显著缩短(P<0.05);与传统组相比,CEM组中青年和老年患者的淋巴结清扫数、左、右结肠淋巴结和淋巴结阳性转移数均显著增加(P<0.05);传统组的术后并发症的总发生率为8例(10.7%),CME组为2例(2.6%),差异具有统计学意义(P<0.05)。 结论腹腔镜下完整肠系膜切除术治疗中青年和老年Ⅲ期结肠癌的临床效果较好,术中出血量少、术后恢复快,且安全性较高。     

Stroke Mimics and Chameleons from the Radiological Viewpoint of Glioma Diagnosis

Gliomas are sometimes difficult to differentiate from strokes and are often misdiagnosed on magnetic resonance imaging (MRI); thus, the terms “stroke mimics” and “stroke chameleons” have been introduced. In this study, we analyzed stroke mimics and stroke chameleons in glioma and discussed the diagnostic perplexity. We retrospectively reviewed cases that were removed from lesions that were considered to be brain tumors. This study enrolled 214 patients who underwent tumor resection for suspected glioma. Clinical characteristics and radiological findings of the patients were compared between the masquerade findings group, which was further divided into two groups: the stroke chameleons and stroke mimics according to their final diagnosis, and the intelligible findings group. Stroke chameleons and stroke mimics were significantly higher in age and smaller in lesion size than the intelligible findings group. In the multivariate analysis, the predictive factor of the masquerade finding group was higher age and smaller size. Stroke mimics group has a tendency to be higher rate of hyperintensity lesion on diffusion-weighted imaging (DWI) compared with stroke chameleons group. The average period from initial diagnosis to pathological diagnosis was 13.50 days in the stroke chameleons and 61.50 days in the stroke mimics, which proved significantly different. Proper diagnosis of glioma and stroke affects a patient’s prognosis, and should be diagnosed as soon as possible. However, stroke mimics and stroke chameleons caused by glioma can occur. Thus, the diagnosis of a stroke should take into consideration the possibility of a glioma in real clinical situations.     

La personne de confiance est-elle un témoin fiable en cas de possibilité de prélèvement d’organe sur personne décédée en vue d’un don ?

Objectives

All adults (people over the age of 18) can assign a person of trust and this person can be a parent, a partner or the treating doctor. Following the introduction of the 4^th March 2002 law, this third party is now within the doctor–patient relationship. The aim of this study is to find out who is appointed as a person of trust by patients notably concerning the level of education or medical knowledge of these people. We have equally put the person of trust to the test within the realms that they would be questioned regarding organ donation from the deceased.

Patients and methods

The included subjects were adults admitted to hospital for surgical procedures or medical biopsies that were not deemed life threatening. The data collection was done by doctors from the legal medicine department at the university hospital of Amiens over a period of 18 months. With the permission of the patient and his or her person of trust, a one-to-one discussion was held. Statistical analysis took place focusing on all the variables together and is shown by comparing the patient group versus the person of trust group. The significance threshold returned was 0.05.

Results

A total of 125 patients–persons of trust couples were interviewed. The patients and their person of trust were not different in terms of age, social status, occupational groups and education. However, a person of trust is more often a woman (64%) against 50% of patients. A person of trust more often lives as a couple than the patients. Concerning organ donation, over half of the people questioned were for donation but only a third of patients had already discussed the subject with their person of trust. The persons of trust bring in 40% of cases a response that is not concordant in the position of the patient.

Discussion

The creation of a person of trust due to the law of 4^th March 2002 brings about the opportunity for the patient to take on an approach, with the doctors, of having somebody that can advise them. Yet in this study, there is no significant evidence of a difference between the level of education of patients and that of their person of trust, or a difference in the distribution of the socio-professional categories, or specific choices for the GP. The person of trust can be used to wait on behalf of the patient whilst he or she is not able to do so. Even if the patient feels that the person of trust has come first over other close friends or relatives, the persons of trust assume this role with difficulty. Since its creation, the person of trust was presented as a response to social demand; however, it seems that patients are not sufficiently informed when it comes to the possibilities that are on offer to them.     

中青年首发脑卒中患者急性应激障碍动态列线图模型的构建

目的 探讨首发中青年脑卒中患者急性应激障碍的影响因素并构建动态列线图模型，以帮助医护人员早期识别急性应激障碍。 方法 选取锦州医科大学附属第一医院298例首发脑卒中的中青年患者为研究对象，其中建模组208例和验证组90例。以生物-心理-社会医学模式为理论指导，收集15个备选因素。使用LASSO回归和多因素logistic回归分析筛选出急性应激障碍的危险因素。基于R-shiny构建动态列线图预测模型，采用Bootstrap法分别在建模组和验证组进行验证。 结果 298例首发中青年脑卒中患者中141例发生ASD，发生率（47.32%）。筛选出心理韧性、ADL、神经受损程度、吞咽障碍、偏瘫5个影响因素构建预测模型。建模组验证AUC为0.884，验证组验证AUC为0.879，2次验证Calibration曲线均与理想曲线接近。 结论 所构建的动态在线列线图模型预测效能良好，可为首发中青年脑卒中患者急性应激障碍筛查提供借鉴。