高原人体左心室舒张功能和顺应性的改变

应用同步描记心电图、心音图、颈动脉搏动图和心尖搏动图以测定高原人体的左心室舒张功能和顺应性。在4个不同海拔高度进行实验,即76m(海平对照)、2161m、3270m和4179m,每一高度40名健康男性青年,高原3组世居、移居各20名。结果显示:随着海拔增高,主动舒张时间指数(TRTI)有减小趋势,RF波相对振幅(F/H)逐渐降低,A波相对振幅(A/D)则渐趋增大,3270m以上增大明显(p<0.05),舒张振幅时间指数(DATI)逐渐降低,3270m以上差异极显著(p<0.001)。高原世居与移居者相比,在海拔4179m出现明显差别,移居组TRTI、DATI、F/H较低而A/D较高(D<0.05)。测定射血前期与左室射血时间比值(PEP/LVET)、射血分数(EF)及左室周径纤维平均缩短速度(mVcf)3项指标作对照,显示在此高度左室收缩功能仍能保持。高原慢性心肌缺氧可能是导致左室舒张功能和顺应性轻度降低的原因。     

布南色林联合团体心理治疗慢性精神分裂症的疗效及对认知功能、社会功能和服药依从性的影响

摘要 目的：探讨布南色林联合团体心理治疗慢性精神分裂症（SZ）的疗效,分析其对认知功能、社会功能和服药依从性的影响。方法：选取124例慢性SZ患者随机分为对照组和观察组,对照组口服布南色林治疗,观察组在对照组基础上加以团体心理治疗,疗程均为2个月。治疗后,采用阳性与阴性症状量表（PANSS）和临床疗效总评量表-疾病严重程度（CGI-SI）评估两组患者治疗后的疗效,采用威斯康星卡片分类测验（WCST）评估两组患者治疗前后的认知功能,采用个人和社会功能量表（PSP）评估两组患者治疗前后的社会功能,评定两组患者治疗后的服药依从性。结果：治疗后,两组患者PANSS阳性症状、阴性症状、一般精神病理评分以及总评分均低于治疗前,且观察组低于对照组（P＜0.05）;两组患者CGI-SI评分均低于治疗前,且观察组低于对照组（P＜0.05）;两组患者WCST总应答数评分均高于治疗前,且观察组高于对照组（P＜0.05）;两组患者PSP总评分均高于治疗前,且观察组高于对照组（P＜0.05）;观察组服药依从性优于对照组（P＜0.05）。结论：布南色林联合团体心理治疗较单一布南色林治疗慢性SZ的治疗效果更好,能更好地提高患者的认知功能、社会功能以及服药依从性,值得临床借鉴推广。     

Improving medication adherence in chronic obstructive pulmonary disease: a systematic review

Adherence to medication among individuals with chronic obstructive pulmonary disease (COPD) is suboptimal and has negative impacts on survival and health care costs. No systematic review has examined the effectiveness of interventions designed to improve medication adherence. Electronic databases Medline and Cochrane were searched using a combination of MeSH and keywords. Eligible studies were interventions with a primary or secondary aim to improve medication adherence among individuals with COPD published in English. Included studies were assessed for methodological quality using the Effective Practice and Organisation of Care (EPOC) criteria. Of the 1,186 papers identified, seven studies met inclusion criteria. Methodological quality of the studies was variable. Five studies identified effective interventions. Strategies included: brief counselling; monitoring and feedback about inhaler use through electronic medication delivery devices; and multi-component interventions consisting of self-management and care co-ordination delivered by pharmacists and primary care teams. Further research is needed to establish the most effective and cost effective interventions. Special attention should be given to increasing patient sample size and using a common measure of adherence to overcome methodological limitations. Interventions that involve caregivers and target the healthcare provider as well as the patient should be further explored.     

International Courts and State Compliance: An Investigation of the Law of the Sea Cases

This article investigates the effect of dispute settlement decisions under the 1982 United Nations Convention on the Law of the Sea (UNCLOS) and whether and how states, particularly great powers, comply with these decisions. State practice suggests that an overwhelming majority of the decisions by UNCLOS dispute settlement bodies have been implemented. Significantly, not only small states but also the permanent members of the United Nations Security Council have complied with UNCLOS dispute settlement decisions even when they “lost” in the proceedings that were unilaterally initiated against them.     

Relations of APOE promoter polymorphisms to LDL cholesterol and markers of subclinical atherosclerosis in young adults

The common apolipoprotein E (apoE) gene (APOE) epsilon2/epsilon3/epsilon4 polymorphism explains part of serum lipid variation, and polymorphisms in the APOE promoter region have been proposed to participate in the regulation of serum lipid levels within the most common APOE epsilon3/epsilon3 genotype group. We determined APOE -219G/T and +113G/C promoter genotypes and estimated APOE haplotypes in 525 participants of the Cardiovascular Risk in Young Finns Study. We studied the associations of the APOE promoter polymorphisms and their haplotypes with cross-sectional and longitudinal serum lipid and apolipoprotein concentrations as well as with flow-mediated dilatation (FMD), carotid artery compliance (CAC), and intima-media thickness (IMT) within the APOE epsilon3/epsilon3 carriers. We found no significant association between the APOE promoter genotypes and serum lipids [low density lipoprotein-cholesterol (LDL-C), HDL-C, and triglycerides], apolipoproteins (apoA-I and apoB), or brachial artery FMD, CAC, or carotid IMT in either men or women. In longitudinal analyses in males, the carriers of heterozygous genotypes (-219G/T or +113G/C) and, furthermore, carriers of the -219T/+113C/epsilon3 haplotype had significantly higher LDL-C and total cholesterol concentrations throughout the 21 year follow-up period compared with homozygous G allele carriers or noncarriers of the -219T/+113C/epsilon3 haplotype. Such associations were not found in females. In summary, the APOE promoter polymorphisms -219G/T and +113G/C as well as their haplotype are associated with longitudinal changes in LDL-C and total cholesterol concentrations in young Finnish males but do not seem to be major determinants for FMD, CAC, or carotid IMT in males or females.     

2型糖尿病合并高血压患者个性化延续护理研究

为探讨个性化延续护理对2型糖尿病合并高血压患者生活质量及服药依从性影响,本研究选取2015年6月至2017年1月在哈励逊国际和平医院治疗的150例2型糖尿病合并高血压患者,随机分组,对照组患者应用常规护理,试验组患者给予个性化延续护理,观察比较两组患者血糖、血压、焦虑自评量表(self-rating anxiety scale, SAS)、抑郁自评量表(self-rating depression scale, SDS)、自尊量表(self-esteem scale,SES)、依从性差异。结果显示,12个月后试验组患者空腹血糖(7.59±1.26) mmol/L,糖化血红蛋白(glycated hemoglobin, HbAIC)(5.62±1.28)%较对照组明显下降(p<0.05);12个月后试验组患者收缩压(116.08±9.41) mmHg、舒张压(90.35±6.92) mmHg明显低于对照组(p<0.05);试验组患者SAS (35.13±4.27)分、SDS (31.42±2.09)分、SES (25.01±5.85)分同对照组比较明显改善(p<0.05);试验组患者依从性97.33%、不良生活习惯改善94.67%、健康知识掌握98.67%同对照组比较显著升高(p<0.05)。本研究结论初步表明针对2型糖尿病合并高血压患者应用个性化延续护理可改善患者血糖和血压水平,提高患者生活质量和治疗依从性,值得推广应用。     

Arterial stiffness is inversely associated with a better running record in a full course marathon race

[Purpose]

Arterial stiffness is an independent predictor of cardiovascular risk and may contribute to reduced running capacity in humans. This study investigated the relationship between course record and arterial stiffness in marathoners who participated in the Seoul International Marathon in 2012.

[Methods]

A total of 30 amateur marathoners (Males n = 28, Females n = 2, mean age = 51.6 ± 8.3 years) were assessed before and after the marathon race. Brachial-ankle pulse wave velocity (ba-PWV) was assessed by VP-1000 plus (Omron Healthcare Co., Ltd., Kyoto, Japan) before and immediately after the marathon race. Pearson''s correlation coefficient was used to determine the relationship between race record and ba-PWV. In addition, Wilcoxon signed rank test was used to determine the difference in ba-PWV between before and after the race.

[Results]

There was no significant change in the ba-PWV of marathoners before and after the race (1271.1 ± 185 vs. 1268.8 ± 200 cm/s, P=0.579). Both the full course record (Pearson''s correlation coefficient = 0.416, P = 0.022) and the record of half line (Pearson''s correlation coefficient = 0.482, P = 0.007) were positively related with the difference in ba-PWV, suggesting that reduced arterial stiffness is associated with a better running record in the marathon.

[Conclusion]

These results may suggest that good vascular function contributes to a better running record in the marathon race.     

肱动脉内皮依赖性舒张功能鉴别左室舒张功能假性正常化的价值

目的:研究冠心病患者左室舒张功能假性正常化与肱动脉内皮依赖性舒张功能的关系。方法:将75例行选择性冠状动脉造影的患者按冠状动脉病变程度分为单/双支病变组和三支病变组两组,选取48例健康志愿者作为对照组。检测左室舒张功能指标二尖瓣口血流频谱E峰、A峰、E/A比值,同时观察休息时肱动脉反应性充血后内径变化率。结果:单/双支病变组(第一组)E峰、E/A比值下降,肱动脉反应性充血后内径变化率低于正常对照组(P<0.05);三支病变组(第二组)E峰、E/A值无明显改变,肱动脉反应性充血后内径变化率明显低于对照组(P<0.01)。结论:肱动脉内皮依赖性舒张功能可作为鉴别冠心病左室舒张功能假性正常的指标。     

Rethinking historical controls

Inference from traditional historical controls, i.e. comparing a new treatment in a current series of patients with an old treatment in a previous series of patients, may be subject to a strong selection bias. To avoid this bias, Baker and Lindeman (1994) proposed the paired availability design. By applying this methodology to estimate the effect of epidural analgesia on the probability of Cesarean section, we made two important contributions with the current study. First, we generalized the methodology to include different types of availability and multiple time periods. Second, we investigated how well the paired availability design reduced selection bias by comparing results to those from a meta-analysis of randomized trials and a multivariate analysis of concurrent controls. The confidence interval from the paired availability approach differed considerably from that of the multivariate analysis of concurrent controls but was similar to that from the meta-analysis of randomized trials. Because we believe the multivariate analysis of concurrent controls omitted an important predictor and the meta-analysis of randomized trials was the gold standard for inference, we concluded that the paired availability design did, in fact, reduce selection bias.