Remission of Thyrotoxicosis during Treatment with Propranolol

Twenty-eight thyrotoxic patients were treated with propranolol. In seven patients the drug had to be discontinued after one or two months, but in the remaining 21 clinical improvement was observed. Serial clinical studies and tests of thyroid function performed at monthly intervals showed that in four patients thyrotoxicosis remitted and all indices of thyroid function returned to normal. A fifth patient shows distinct evidence of remission with the 20-minute ¹³²I uptake falling to normal, although the free-thyroxine index remains slightly raised. It is likely that these remissions reflect the natural tendency of the disease to remit since propranolol is not considered to have any direct in-vivo effect on thyroid function.However, because of failure to gain adequate control of symptoms in all patients treated, and the fact that circulating thyroid hormone levels were often not restored to normal, propranolol is considered an unsatisfactory alternative to conventional antithyroid drugs for routine treatment.     

“知己健康管理”在慢性疾病患者的应用

目的:探讨"知己健康管理"模式对社区慢性疾病患者中改变不良生活方式后所产生的效果。方法:对社区57例慢性疾病患者进行3个月的强化知己健康管理,采用自身对照方法对其管理前后的生活方式、行为改变、血压及血脂等变化进行比较。结果:管理后患者血压、体重指数、腰围、血糖、血脂等均得到改善(P<0.05)。结论:"知己健康管理"可以强化社区居民对疾病的认识,改变不良的生活方式,有利于疾病的控制及危险因素水平的降低。     

“知己健康管理”在慢性疾病患者的应用

目的：探讨“知己健康管理”模式对社区慢性疾病患者中改变不良生活方式后所产生的效果。方法：对社区57例慢性疾病患者进行3个月的强化知己健康管理,采用自身对照方法对其管理前后的生活方式、行为改变、血压及血脂等变化进行比较。结果：管理后患者血压、体重指数、腰围、血糖、血脂等均得到改善（P〈0．05）。结论：“知己健康管理”可以强化社区居民对疾病的认识,改变不良的生活方式,有利于疾病的控制及危险因素水平的降低。     

Tailored Implementation of Evidence-Based Practice for Patients with Chronic Diseases

Background

When designing interventions and policies to implement evidence based healthcare, tailoring strategies to the targeted individuals and organizations has been recommended. We aimed to gather insights into the ideas of a variety of people for implementing evidence-based practice for patients with chronic diseases, which were generated in five European countries.

Methods

A qualitative study in five countries (Germany, Netherlands, Norway, Poland, United Kingdom) was done, involving overall 115 individuals. A purposeful sample of four categories of stakeholders (healthcare professionals, quality improvement officers, healthcare purchasers and authorities, and health researchers) was involved in group interviews in each of the countries to generate items for improving healthcare in different chronic conditions per country: chronic obstructive pulmonary disease, cardiovascular disease, depression in elderly people, multi-morbidity, obesity. A disease-specific standardized list of determinants of practice in these conditions provided the starting point for these groups. The content of the suggested items was categorized in a pre-defined framework of 7 domains and specific themes in the items were identified within each domain.

Results

The 115 individuals involved in the study generated 812 items, of which 586 addressed determinants of practice. These largely mapped onto three domains: individual health professional factors, patient factors, and professional interactions. Few items addressed guideline factors, incentives and resources, capacity of organizational change, or social, political and legal factors. The relative numbers of items in the different domains were largely similar across stakeholder categories within each of the countries. The analysis identified 29 specific themes in the suggested items across countries.

Conclusion

The type of suggestions for improving healthcare practice was largely similar across different stakeholder groups, mainly addressing healthcare professionals, patient factors and professional interactions. As this study is one of the first of its kind, it is important that more research is done on tailored implementation strategies.     

无创呼吸机在慢性阻塞性肺疾病急性加重期应用的疗效评价

摘要目的：观察无创呼吸机对不伴有呼吸衰竭的慢性阻塞性肺疾病急性加重期（AECOPD）患者症状、体征、血气分析和肺功能的影响。方法：80例AECOPD患者随机分为对照组和试验组,对照组给予常规治疗,如常规抗感染、化痰、平喘等治疗。试验组在常规治疗的基础上给予无创呼吸机正压通气（NIPPV）治疗。评价两组患者治疗前和治疗一周后临床症状体征、血气分析和肺功能的变化。结果：两组患者治疗后临床症状及体征评分较治疗前均呈下降趋势（P〈0．05）,但试验组下降更为明显（P〈0．05）,并且试验组症状改善时间明显缩短（P〈0．05）;治疗后两组的pH,PO2和SaO2均较治疗前升高,PC02较治疗前下降（P〈0．05）,和对照组相比,治疗后试验组的PO：和PC02改善更明显（P〈0．05）,而pH和Sa02无显著差异（P〉0．05）;治疗后两组的FEV1,FVC,FEV1实测值／预计值和FEVI％均较治疗前升高（P〈0．05）,试验组升高更明显（P〈0．05）。结论：对不伴有呼吸衰竭的AECOPD患者早期应用NIPPV治疗能有效改善临床症状和体征,缩短症状改善时间,改善通气,缓解呼吸肌疲劳,预防呼吸衰竭的发生。     

Cardiac Autonomic Function Associated with Treatment Adherence After a Brief Intervention in Patients with Chronic Pain

The goal of this study was to investigate psychophysiological characteristics in chronic pain patients during a pain stressor (cold pressor test) and after a brief diaphragmatic breathing intervention. Laboratory procedures were designed to quantify the effects of diaphragmatic breathing training at six breaths per minute on cardiac autonomic reactivity as indexed by root mean square of successive differences (RMSSD) and sequential baroreflex sensitivity (sBRS). Participants (n = 22) completed an initial laboratory assessment including the diaphragmatic breathing training session and were instructed to practice the technique for three ten-minute sessions daily. Self-monitoring of the use of the technique along with daily pain and fatigue scores was accomplished with hand-held computers. Participants returned to the lab for a second assessment after two-weeks. Participants demonstrating improved resting physiological status as indexed by change in RMSSD and sBRS after training (improvers) were compared to those not demonstrating any change in these variables (non-improvers). After two weeks of training, the improvers showed higher tolerance (p < .05) and lower blood pressure reactivity to the cold pressor test (p < .05) compared to the non-improvers. Time spent practicing the breathing technique was significantly different between the groups with the improvers maintaining daily practice close to the intervention recommendations. These results suggest the potential for significant improvements in autonomic functioning and inhibitory response to stress after a single intervention session and two weeks of practice.     

Seed Treatment as a Means of Preventing Nematode Damage to Crop Plants

A procedure for treating crop seeds with aqueous solutions of the systemic nematicide oxamyl is described. Seedlings from treated seeds were more resistant to attack by parasitic nematodes. Leachate from treated seeds reduced the number of free-living nematodes in the surrounding soil.     

Association of Childhood Chronic Physical Aggression with a DNA Methylation Signature in Adult Human T Cells

Background

Chronic physical aggression (CPA) is characterized by frequent use of physical aggression from early childhood to adolescence. Observed in approximately 5% of males, CPA is associated with early childhood adverse environments and long-term negative consequences. Alterations in DNA methylation, a covalent modification of DNA that regulates genome function, have been associated with early childhood adversity.

Aims

To test the hypothesis that a trajectory of chronic physical aggression during childhood is associated with a distinct DNA methylation profile during adulthood.

Methods

We analyzed genome-wide promoter DNA methylation profiles of T cells from two groups of adult males assessed annually for frequency of physical aggression between 6 and 15 years of age: a group with CPA and a control group. Methylation profiles covering the promoter regions of 20 000 genes and 400 microRNAs were generated using MeDIP followed by hybridization to microarrays.

Results

In total, 448 distinct gene promoters were differentially methylated in CPA. Functionally, many of these genes have previously been shown to play a role in aggression and were enriched in biological pathways affected by behavior. Their locations in the genome tended to form clusters spanning millions of bases in the genome.

Conclusions

This study provides evidence of clustered and genome-wide variation in promoter DNA methylation in young adults that associates with a history of chronic physical aggression from 6 to 15 years of age. However, longitudinal studies of methylation during early childhood will be necessary to determine if and how this methylation variation in T cells DNA plays a role in early development of chronic physical aggression.     

Low-Vision Rehabilitation by Means of MP-1 Biofeedback Examination in Patients with Different Macular Diseases: A Pilot Study

Macular disease is one of the main causes of visual impairment. We studied the efficacy of low-vision rehabilitation by means of MP-1 biofeedback examination in patients with different macular disease. Five patients were enrolled (3 female and 2 male, mean age 53.8 years) and a total of 9 eyes was examined: 2 eyes with vitelliform dystrophy, 1 with a post-traumatic macular scar, 2 with Stargardt disease, 2 with myopic macular degeneration, 2 with cone dystrophy. All the patients underwent the following tests: visual acuity, reading speed, fixation test, MP-1 microperimetry. Low-vision rehabilitation, which lasted 10 weeks, consisted of 10 training sessions of 10 min for each eye, performed once a week using the MP-1 biofeedback examination. Statistical analysis was performed using Student’s t-test. p values less than 0.05 were considered statistically significant. After training all patients displayed an improvement in visual acuity, fixation behaviour, retinal sensitivity and reading speed. Fixation behaviour within the 2° diameter circle improved and was statistically significant for reading speed (p = 0.01). Reading speed improved from a mean value of 64.3 to 92 words/min. Our results show that audio feedback can, by increasing attentional modulation, help the brain to fix the final preferred retinal locus. Audio feedback facilitates stimuli transmission between intraretinal neurons as well as between the retina and brain, which is where the highest level of stimuli processing occurs, thereby probably supporting a “remapping phenomenon”.     

Long-term Stability of Remission in Nephrotic Syndrome after Treatment with Cyclophosphamide

Fifty-eight children with minimal-change nephrotic lesions who relapsed repeatedly and showed toxic side effects from corticosteroids were treated with cyclophosphamide for an average of 12 weeks. The initial dose was 5 mg/kg/day. Four to seven years (mean 5·8 years) later 20 remained in remission, 34 were still relapsing, and 4 had died (two during relapses, one of measles after cyclophosphamide, and one of a brain-stem astrocytoma). The half time for the relapse-free period after treatment was 2·8 years. There was no relationship between the length of treatment with cyclophosphamide and the stability of remission within the limits studied.     

长沙地区县级医院中年慢性病患者健康商数及其影响因素的研究

目的:探讨长沙地区县级医院中年慢性病患者健康商数指数及其影响因素,帮助中年人群提升健康自我管理能力.方法:采用随机抽样的方法对长沙地区4所县级医院的808名中年慢性疾病患者进行一般情况和健商问卷调查,所有资料均采用SPSS13.0统计软件进行分析.结果:(1)健康商数状况调查结果中各维度得分均较低,在相应临界值水平左右,其中自我保健、生活方式、精神状态维度未低于相应,临界值,精神状态维度得分相对较高,为24.73±5.49;健康知识维度的得分较低,为21.47±5.89,甚至低于安全健康商数维度的临界值.(2)不同年龄段、不同家庭住址、不同文化程度、不同体检频度患者在健康商数四个维度的得分均具有统计学意义(P<0.05);不同体质指数的患者在健康知识和精神状态维度的得分有统计学意义(P<0.05).结论:(1)长沙地区县级医院中年慢性病患者健康商数状况总体不容乐观,尤其是健康知识维度较为薄弱,提示此类患者应成为护理工作针对性健康教育的重点对象,而健康知识普及应成为健康教育的重点内容.(2)年龄段、家庭住址、文化程度和体检频度是住院中年慢性病患者健康商数的重要影响因素,据此可为护理工作中开展个体化的干预策略提供参考依据.     

苏尼替尼治疗46例慢性粒细胞白血病的临床分析

目的比较和评价苏尼替尼治疗慢性粒细胞白血病（CML）的临床效果。方法回顾分析近7年来收治我院的46例CML患者的临床诊疗资料,统计其完全缓解（CR）率、生存期及影响因素。结果完全缓解35例,占总病例数的76.09%;部分缓解7例,占15.22%;未缓解4例,占8.69%。统计至2010年12月,五年存活26例,五年生存率56.52%。结论苏尼替尼是早期治疗CML的有效手段,能较为明显的缓解病情,减少并发症的发生率,提高患者的生存率,治疗过程中仍需要患者及其家属的密切配合。     

妊娠期肝内胆汁淤积症的处理与预防护理研究

目的:研究妊娠期肝内胆汁淤积综合症(ICP)的产科处理及预防护理,探讨治疗对母婴预后的影响。方法:选取2009年1月至2010年1月第四军医大学西京医院妇产科收治ICP患者共67例,分为治疗组49例,经过丁烷二磺酸腺苷蛋氨酸(思美泰),对照组18例服用熊去氧胆酸治疗的孕妇。对孕妇症状、生化指标、母婴结局进行比较分析。结果:治疗组临床症状、生化指标较治疗前明显下降较对照组明显好转(p0.01),直接胆红素下降两组间无显著差异(p0.01)。将治疗组和对照组胎儿宫内窘迫率存在显著性差异(p0.01)。结论:应用丁烷二磺酸腺苷蛋氨酸(思美泰)积极正确处理ICP,可明显减轻孕妇瘙痒症状及肝功异常,同时明显降低胎儿宫内窘迫率,提高围生儿的生存质量。     

Diagnostic Confidence of Run-Off CT-Angiography as the Primary Diagnostic Imaging Modality in Patients Presenting with Acute or Chronic Peripheral Arterial Disease

Objectives

To investigate the reliability of CT-angiography of the lower extremities (run-off CTA) to derive a treatment decision in patients with acute and chronic peripheral artery disease (PAD).

Materials and Methods

314 patients referred for run-off CTA were includ-ed in this retrospective study. First, diagnostic confidence of run-off CTA to derive a treat-ment decision was assessed in an interdisciplinary vascular conference using a 2 point scale (sufficient or not sufficient diagnostic confidence) and compared with the image quality eval-uated by two readers in consensus in four different levels (abdominopelvic, thigh, calf, foot arteries). Second, reliability of treatment decision was verified in all patients undergoing re-vascularization therapy.

Results

Diagnostic confidence of run-off CTA to derive a treatment deci-sion was sufficient in all patients with acute and in 97% of patients (215/221) with chronic PAD, whereas the rate of run-off CTA with non-diagnostic image quality was considerably higher in the calf and foot level (acute vs. chronic; calf: 28% vs.17%; foot: 52% vs. 20%). Reliability of treatment decision was superior for patients with chronic (123/133 = 92%) than for patients with acute PAD (64/78 = 82%, P = 0.02).

Conclusion

Run-off CTA is a reliable imaging modality for primary diag-nostic work-up of patients with acute and chronic PAD.     

Circulating MiR-133a as a Biomarker Predicts Cardiac Hypertrophy in Chronic Hemodialysis Patients

Background

MicroRNAs (miRNAs) are small ribonucleotides regulating gene expression. MicroRNAs are present in the blood in a remarkably stable form and have emerged as potential diagnostic markers in patients with cardiovascular disease. Our study aimed to assess circulating miR-133a levels in MHD patients and the relation of miR-133a to cardiac hypertrophy.

Methods

We profiled miRNAs using RNA isolated from the plasma of participants. The results were validated in 64 MHD patients and 18 healthy controls.

Results

Levels of plasma miR-133a decreased in MHD patients with LVH compared with those in healthy controls. Plasma miR-133a concentrations were negatively correlated with LVMI and IVS. After single hemodialytic treatment, plasma miR-133a levels remained unchanged. Cardiac Troponin I and T were not associated with LVMI and IVS.

Conclusions

Our observations supplied the possibility that circulating miR-133a could be a surrogate biomarker of cardiac hypertrophy in MHD patients.