地震灾区医务人员述情障碍及应对方式与心理健康的相关性研究

目的：探讨震后2a灾区医务人员心理健康状况与述情障碍以及应对方式的相关性。方法对174名灾区医务人员采用症状自评量表、多伦多述情障碍量表和特质应对问卷进行测评分析。结果灾区医务人员症状自评量表总分与积极应对、消极应对及多伦多述情障碍量表评分呈显著正相关（P＜0．01）;多伦多述情障碍量表总分与消极应对评分呈正显著相关（P＜0．01）;症状自评量表总分与多伦多述情障碍量表总分及消极应对分量表评分呈显著正相关（P＜0．01）。结论述情障碍和应对方式是影响地震灾区医务人员心理健康的重要因素,消极应对方式在述情障碍中发挥重要的中介作用。     

精神分裂症患者述情障碍与病耻感相关性研究

目的探讨精神分裂症患者述情障碍与病耻感体验的相关性。方法对245例精神分裂症患者（研究组）及213名健康体检者（对照组）采用多伦多述情障碍量表、中文版精神疾病患者病耻感量表、阳性与阴性症状量表进行测评分析。结果研究组多伦多述情障碍量表总分及各因子分均显著高于对照组（P〈0．01）;经Pearson相关分析,研究组阳性与阴性症状量表总分、阳性症状分及阴性症状分与中文版精神疾病患者病耻感量表因子3评分均呈显著正相关（P〈0．05或0．01）,而与多伦多述情障碍量表评分无显著相关性;研究组多伦多述情障碍量表总分及各因子分与中文版精神疾病患者病耻感量表总分及多项因子分呈显著正相关（P〈0．05或0．01）。结论精神分裂症患者存在述情障碍,述情障碍越明显其病耻感体验越强。     

脑卒中患者心理状况与述情障碍研究

目的探讨脑卒中患者的心理及述情障碍状况。方法对80例脑卒中患者采用症状自评量表和多伦多述情障碍量表进行评定,并与国内常模进行对比分析。结果脑卒中患者症状自评量表躯体化、人际关系、抑郁、焦虑、偏执因子评分均显著高于全国常模（P〈0．01）;女性患者躯体化、人际关系、抑郁、焦虑、恐怖因子评分显著高于男性（P〈0．01）,强迫因子评分显著低于男性（P〈0．01）。多伦多述情障碍量表总分及Ⅰ、Ⅱ、Ⅲ、Ⅳ因子评分均显著高于常模（P〈0．01）,男性患者总分及因子Ⅰ、因子Ⅱ分均显著高于女性（P〈0．01）。结论脑卒中患者存在明显的心理障碍和述情障碍,在进行常规治疗的同时实施早期心理干预,有利于患者的全面康复。     

中职学生述情障碍与功能性躯体不适相关性研究

目的：探讨中职学生述情障碍与功能性躯体不适的相关性。方法对158中职学生采用多伦多述情障碍量表和病人健康问卷进行测评分析。将多伦多述情障碍量表总分≥58分者设为述情障碍组（45名）,＜58分者设为对照组（113名）。结果述情障碍组多伦多述情障碍量表评分和病人健康问卷总分及5种症状分均显著高于对照组（ P＜0．05或0．01）。中职学生多伦多述情障碍量表总分与9种躯体不适症状分呈显著正相关（ P＜0．05或0．01）,识别情感障碍因子分与10种躯体不适症状分呈显著正相关（ P＜0．05或0．01）,描述情感障碍因子分与6种躯体不适症状分呈显著正相关（ P＜0．05或0．01）,回归分析显示识别情感障碍和年龄为功能性躯体不适的预测因素（R2＝0．246）。结论中职学生述情障碍者功能性躯体不适主要表现为疼痛及睡眠障碍,识别情感障碍与这些不适症状关系密切,可作为青少年功能性躯体不适症状的预测因素。     

精神分裂症患者述情障碍与自动思维相关性研究

目的 探讨精神分裂症患者述情障碍与负性自动思维的相关性,为临床治疗提供依据.方法 将72例精神分裂症患者设为研究组,抽取同期健康志愿者66名设为对照组,采用自拟一般资料调查表、多伦多述情障碍量表和自动思维问卷对两组进行测评,同时采用阳性与阴性症状量表对研究组进行评定,对上述评定结果进行对比分析及相关分析.结果 研究组多伦多述情障碍量表总分及各因子分和自动思维问卷总分均显著高于对照组(P＜0.05或0.01),阳性与阴性症状量表总分和阳性症状、阴性症状因子分及抑郁症状项目分与多伦多述情障碍量表、自动思维问卷评分均无显著相关(P＞0.05),自动思维问卷评分与多伦多述情障碍量表总分及描述自身情感的能力、认识和辨别情感和躯体感受的能力因子分呈显著正相关(P＜0.05或0.01).结论 精神分裂症患者存在较高水平的述情障碍和负性自动思维,述情障碍与自动思维存在相关,提示在认知治疗的过程中,开展述情能力的情绪加工能力训练治疗,对患者的功能康复具有积极意义.     

精神分裂症患者述情障碍与生活质量和精神症状的相关性研究

目的 探讨精神分裂症患者述情障碍与生活质量和精神症状的相关性,为药物治疗和心理干预提供依据.方法 将170例精神分裂症患者设为研究组,同期随机选取170名身心健康者设为对照组,对两组采用多伦多述情障碍量表和生活质量综合评定问卷-74进行测评分析,对研究组采用阳性与阴性症状量表评定精神症状.结果 研究组多伦多述情障碍量表总分及各因子分显著高于对照组(P＜0.01),生活质量综合评定问卷-74总分及各维度分显著低于对照组(P＜0.01);研究组多伦多述情障碍量表总分和因子III与生活质量综合评定问卷-74总分、心理功能、社会功能和物质生活状态维度呈显著负相关(P＜0.05或0.01),因子II与生活质量综合评定问卷-74总分、社会功能和物质生活状态维度呈显著负相关(P＜0.01);研究组多伦多述情障碍量表总分和因子II与阳性与阴性症状量表总分、阳性症状和阴性症状因子分呈显著正相关(P＜0.05或0.01),因子I与阳性与阴性症状量表总分和阳性症状因子分呈显著正相关(P＜0.01),因子III与阳性与阴性症状量表总分和阴性症状因子分呈显著正相关(P＜0.05或0.01).结论 精神分裂症患者的述情障碍与生活质量和精神症状存在一定的相关性,精神症状越严重,述情障碍越明显,生活质量越低.     

强迫症患者述情障碍与临床症状相关性研究

目的探讨强迫症患者的述情障碍状况与临床症状严重程度的相关性。方法对43例强迫症患者和38名健康志愿者采用多伦多述情障碍量表和YALE-BROWN强迫量表进行评定。结果强迫症患者多伦多述情障碍量表总分及F1、F2因子分均高于健康对照组（P〈0．05）;总分及各因子分均与YALE—BROWN强迫量表分呈正相关（P〈0．05）。结论强迫症患者存在明显的述情障碍,主要表现为感受辨认和感受描述能力方面。     

抑郁症患者不成熟心理防御方式相关因素分析

目的：探讨抑郁症患者不成熟心理防御方式的相关因素。方法对42例抑郁症患者采用防御方式问卷、多伦多述情障碍量表、症状自评量表、汉密顿抑郁量表、汉密顿焦虑量表、蒙哥马利抑郁量表进行测评分析。结果抑郁症患者不成熟防御方式评分与述情障碍识别情绪和躯体感受的能力缺乏因子分呈显著正相关（P＜0．05）,与幻想性缺乏因子分呈显著负相关（P＜0．01）,回归分析显示其解释变异率分别为13．2％和19．3％;与症状自评量表的人际关系敏感、敌对、偏执、精神病性因子分呈显著正相关（ P＜0．05或0．01）,与汉密顿抑郁量表总分及焦虑/躯体化、迟缓、睡眠障碍因子分呈显著正相关（ P＜0．05或0．01）,与汉密顿焦虑量表总分及躯体性焦虑、精神性焦虑因子分呈显著正相关（P＜0．01）,与蒙哥马利抑郁量表总分呈显著正相关（P＜0．01）。结论抑郁症患者不成熟防御方式的使用,可能与识别情绪和躯体感受的能力缺乏、幻想性高有一定关联,与患者临床症状的产生具有较大关联性。     

抑郁症患者的述情障碍程度与社会支持状况的相关分析

目的了解抑郁症患者的述情障碍程度与社会支持的关系。方法应用多伦多述情障碍量表（TAS）和社会支持评定量表（SSRS）对86名抑郁症患者进行调查研究。结果抑郁症患者（75．22±13．93）分在多伦多述情量表上的得分明显高于正常组得分（60．19±9．27）分（P〈0．01）,抑郁症患者在因子1描述情感能力和因子2区别情感和躯体感受能力方面的得分最高,明显高于中间值,除了主观支持与述情障碍量表的各个因子都无相关（P〉0．05）之外,描述情感的能力与社会支持总分和其他因子的得分均呈显著的负相关（P〈0．01）,幻想与社会支持总分和其他因子的得分均呈显著的正相关（P〈0．01）。结论抑郁症患者的述情障碍程度与其社会支持状况有关,可以通过解决抑郁症患者的述情问题,来提高其社会支持情况。     

糖尿病患者述情障碍临床研究

目的研究糖尿病患者述情障碍的主要特征。方法采用多伦多述情障碍量表对70例糖尿病住院患者和70例健康志愿者进行对照评定分析。结果糖尿病患者多伦多述情障碍量表因子1、2、3、4及总分均显著高于对照组．差异均有极显著性（P〈0．01）．糖尿病不同性别患者间上述各因子分均无显著性差异（P〉0．05）。结论糖尿病患者常伴有述情障碍,在药物治疗的同时应给予恰当的心理支持治疗。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。