护理干预对输尿管镜钬激光碎石术患者生活质量的影响

目的:探讨护理干预对输尿管镜钬激光碎石术患者生活质量的影响。方法:采取前瞻性随机对照的方法,从2008年5月到2010年12月,共有123例接受输尿管镜钬激光碎石术的输尿管结石患者被随机分成对照组和护理干预组。使用世界卫生组织生存质量测定量表简表评价输尿管镜钬激光碎石术对患者生活质量的影响。结果:非护理干预组和护理干预组的世界卫生组织生存质量测定量表简表的生活质量评分手术后比手术前有明显改善(P<0.05)。输尿管镜钬激光碎石术后,护理干预组患者的生活质量优于非护理干预组。结论:护理干预能明显改善输尿管镜钬激光碎石术患者的生活质量。     

急诊PCI 治疗中应用血栓抽吸术及主动脉内球囊反搏术 与血浆脑钠肽水平、心功能参数的关系

目的:观察血栓抽吸术与主动脉内球囊反搏术(IABP)联用在急诊冠状动脉介入治疗(PCI)的疗效。方法:ST段抬高型急性心肌梗塞(AMI)行急诊冠状动脉造影提示大量血栓征象、并行血栓抽吸术患者98例,随机分为实验组和对照组,实验组术前行IABP后联合血栓抽吸;对照组仅进行血栓抽吸。观察两组患者的BNP及心功能参数。结果:术后24小时两组BNP有普遍升高趋势,对照组升高更明显(P<0.01),术后2周普遍回降,实验组下降更明显(P<0.01);2周后实验组的心脏指数(CI)、每搏指数(SI)、混合静脉血氧饱和度(SvO2)均高于对照组(P<0.01)。结论:对于行急诊冠状动脉介入治疗的患者联合使用主动脉内球囊反搏术和血栓抽吸术,可以明显改善患者的心肌缺血情况,增加冠脉灌注,有利于患者心功能的恢复。     

家庭干预对喉癌患者术后生活质量的影响

目的:探讨家庭干预对喉癌术后患者生活质量的影响。方法:将66例喉癌术后患者随机分为干预组和时照组,两组病人均进行常规治疗和护理,干预组在此基础上对患者实施针对性家庭干预。采用Terrell生活质量调查表分别在实施干预前及实施干预后进行评估。结果:干预组患者干预后对健康知识掌握率显著高于对照组(P<0.05),生活质量明显高于对照组(P<0.05)。结论:对喉癌术后病人实施针对性家庭干预,可以提高喉癌术后病人生活质量。     

Early intervention in psychosis: concepts,evidence and future directions

The rise of the early intervention paradigm in psychotic disorders represents a maturing of the therapeutic approach in psychiatry, as it embraces practical preventive strategies which are firmly established in mainstream health care. Early intervention means better access and systematic early delivery of existing and incremental improvements in knowledge rather than necessarily requiring dramatic and elusive breakthroughs. A clinical staging model has proven useful and may have wider utility in psychiatry. The earliest clinical stages of psychotic disorder are non-specific and multidimensional and overlap phenotypically with the initial stages of other disorders. This implies that treatment should proceed in a stepwise fashion depending upon safety, response and progression. Withholding treatment until severe and less reversible symptomatic and functional impairment have become entrenched represents a failure of care. While early intervention in psychosis has developed strongly in recent years, many countries have made no progress at all, and others have achieved only sparse coverage. The reform process has been substantially evidence-based, arguably more so than other system reforms in mental health. However, while evidence is necessary, it is insufficient. It is also a by-product as well as a catalyst of reform. In early psychosis, we have also seen the evidence-based paradigm misused to frustrate overdue reform. Mental disorders are the chronic diseases of the young, with their onset and maximum impact in late adolescence and early adult life. A broader focus for early intervention would solve many of the second order issues raised by the early psychosis reform process, such as diagnostic uncertainty despite a clear-cut need for care, stigma and engagement, and should be more effective in mobilizing community support. Early intervention represents a vital and challenging project for early adopters in global psychiatry to consider.     

Self‐Efficacy as a Predictor of Weight Change in African‐American Women

Objective: Although self‐efficacy has received increasing attention for its role in weight loss, there is less research examining this relationship in minority samples. The purpose of this study was to determine whether self‐efficacy for weight loss was predictive of weight change in a sample of African‐American women. Research Methods and Procedures: Subjects were 106 overweight or obese, low‐income African‐American women participating in a weight management intervention that involved either personalized monthly sessions with their primary care physician or standard care. Weight and self‐efficacy for weight loss were assessed at baseline and at the end of the 6‐month treatment. Results: For subjects in the personalized intervention, baseline self‐efficacy was predictive of subsequent weight change, such that higher levels of self‐efficacy before treatment were associated with less weight loss. In contrast, improvements in self‐efficacy during treatment were associated with greater weight loss for the personalized intervention group. Discussion: Results suggest high self‐efficacy for weight loss before treatment may be detrimental to success, whereas treatments that improve participants’ self‐efficacy may result in greater weight loss. High pretreatment self‐efficacy may be indicative of overconfidence or lack of experience with the difficulties associated with weight loss efforts. Whereas replication is needed, our results suggest that self‐efficacy is an important variable to consider when implementing weight loss interventions.     

干预措施对噪声污染大鼠脑组织基因表达及去甲肾上腺素水平的影响

为了探索干预措施对噪声污染大鼠脑组织基因表达水平的影响, 将50只SPF级Wistar大鼠随机分为空白对照组、噪声污染组(分为30、60、80 dB三个组)、干预组(利血平+80 dB), 每组10只动物。每天刺激1次, 每次刺激30 min, 连续刺激15 d。第16天解剖出脑组织用酶联免疫吸附法(ELISA)检测基因表达水平。结果发现, 噪声污染组大脑前额叶皮质(PFC)和海马(Hipp)组织中去甲肾上腺素(noradrenaline,NA)水平比对照组分别升高了22.87%、50.35%、94.65%和 12.00%、31.76%、61.83%; 干预组NA水平比对照组分别降低了33.66%和52.06%; 去甲肾上腺素转运蛋白(noradrenaline transporter, NAt)水平比对照组分别升高了22.87%、50.35%、94.65%和12.00%、31.76%、61.83%, 干预组NAt水平比对照组分别降低了33.66%和52.06%; 脑源性神经营养因子(brain derived neurotrophic factor, BDNF)水平比对照组分别升高了24.87%、39.27%、67.41%和44.97%、80.81%、95.84%, 干预组BDNF水平比对照组分别升高了16.36%和14.34%, 升高程度明显低于噪声污染组; 酪氨酸激酶受体B(Tyrosine kinase B, TrkB)水平比对照组分别升高了32.64%、59.95%、82.64%和31.02%、57.31%、80.23%, 干预组TrkB水平比对照组分别升高了4.75%和10.52%, 升高程度明显低于噪声污染组。结果显示, 噪声污染使动物体内去甲肾上腺素等水平升高, 去甲肾上腺素是噪声污染引起组织器官损伤的主要因素, 脑源性神经营养因子和酪氨酸激酶受体B防止神经元受损死亡, 改善神经元的病理状态, 利血平使去甲肾上腺素耗竭, 保护组织器官免受噪声污染的损伤。     

Relationship between time of day and periprocedural myocardial infarction after elective angioplasty

Objectives: To test if the time of day significantly influences the occurrence of type 4A myocardial infarction in elective patients undergoing percutaneous coronary intervention (PCI).

Background: Recent studies have suggested an influence of circadian rhythms on myocardial infarction size and mortality among patients with ST-elevation myocardial infarction. The aim of the study is to investigate whether periprocedural myocardial infarction (PMI) is influenced by the time of day in elective patients undergoing PCI.

Methods: All consecutive patients undergoing elective PCI between 2007 and 2011 at our institutions with known post-interventional troponin were retrospectively included. Patients (n?=?1021) were divided into two groups according to the starting time of the PCI: the morning group (n?=?651) between 07:00 and 11:59, and the afternoon group (n?=?370) between 12:00 and 18:59. Baseline and procedural characteristics as well as clinical outcome defined as the occurrence of PMI were compared between groups. In order to limit selection bias, all analyses were equally performed in 308 pairs using propensity score (PS) matching.

Results: In the overall population, the rate of PMI was statistically lower in the morning group compared to the afternoon group (20% vs. 30%, p?<?0.001). This difference remained statistically significant after PS-matching (21% vs. 29%, p?=?0.03). Multivariate analysis shows that being treated in the afternoon independently increases the risk for PMI with an odds ratio of 2.0 (95%CI: 1.1–3.4; p?=?0.02).

Conclusions: This observational PS-matched study suggests that the timing of an elective PCI influences the rate of PMI.     

Early liraglutide treatment is better in glucose control, β-cell function improvement and mass preservation in db/db mice

Glucagon-like peptide-1 (GLP-1) has been proved to have effects of anti-hyperglycemia and β-cell preservation. However, it is still unclear whether there are differences between early and late GLP-1 intervention in type 2 diabetes mellitus (T2DM). We divided the mice into 5 groups: early treated group (n = 7, 8-week old, fasting glucose > 10 mmol/l), late treated group (n = 7, 10-week old, fasting glucose > 20 mmol/l), early control group (n = 7), late control group (n = 7) and wild type group (n = 7). Treated group was injected with liraglutide (a GLP-1 analog) 300 μg/kg bid for 4 weeks, while control group was given saline at the same time. The results showed that compared with control group, food intake and body weight gain were reduced in both early and late treated group (p < 0.05), and there was no significance between the two treated groups. Early liraglutide intervention showed better improvements in glucose control, acute insulin response to glucose (AIRg) and disposition index (before vs. after treatment, AIRg 1.01 ± 0.53 vs. 2.98 ± 0.63, disposition index 10.81 ± 0.89 vs. 27.4 ± 2.15) than late intervention (AIRg 0.99 ± 0.02 vs. 1.41 ± 0.32, disposition index 3.47 ± 0.38 vs. 6.43 ± 1.62, p = 0.001). The histopathology of the pancreas showed the estimated β-cell mass (BCM) was increased more in early treated group than that in late one (0.03 vs. 0.01 g). Expressions of the proliferation related genes PDX-1, MafA and GLP-1 receptor (GLP-1R) in early treated group were 1.81, 2.57 and 1.59 times as much as that in late treated group. In conclusion, early liraglutide intervention was better in glucose control, β-cell function improvement and β-cell mass preservation.