液体潴留量与重症急性胰腺炎早期并发ARDS相关性临床分析

探讨48h液体潴留量〉4000ml与重症急性胰腺炎（SAP）早期并发急性呼吸窘迫综合征（ARDS）的临床相关性,为进一步指导11盏床SAP患者早期液体复苏治疗并预防急性肺损伤提供科学依据。回顾性分析我院2012年1月至2014年1月收治的43例SAP患者临床资料,并进行统计学处理。分析结果表明48h液体潴留量〉4000m1与sAP早期并发ARDS呈现出明显的正相关,48h液体潴留量〉4000ml的sAP患者早期并发ARDs的危险性是48h液体潴留量〈4000ml的SAP患者的14．4倍,48h液体潴留量〉4000ml是重症急性胰腺炎早期并发ARDS的高危险因素。对于SAP患者在早期临床治疗过程中应密切注意液体潴留量,通过合理补液可降低sAP并发ARDS的发生率和病死率。     

急性冠脉综合征患者血液Rho激酶活性分析

探讨 Rho 激酶（ROCK）活性与急性冠脉综合征（ACS）患者冠状动脉狭窄程度及预后的关系。选取2012年6月至2013年3月住院的129例患者,其中急性心肌梗死（AMI）组68例、不稳定型心绞痛（UA）组30例、对照（CON ）组31例。Western Blot 检测血液白细胞中 ROCK 、ROCK1、ROCK2活性,同时根据冠状动脉的狭窄程度及是否发生心血管意外分组再次比较。 AMI 组和 UA 组 ROCK 、ROCK1、ROCK2活性均增高;且 AMI 组高于 UA 组;三支、双支、单支病变组活性依次减低,Gensini 评分≥20分组及发生心血管意外组均高于 Gensini 评分＜20分组及未发生心血管意外组,差异均有统计学意义（P＜0．05）。 ROCK 活性可能对 ACS 患者预后观察、评估有重要意义。     

急性应激对工作记忆的影响受工作记忆负荷调节:来自电生理的证据

急性应激如何影响工作记忆还不清楚。采用电影片断诱发被试的急性应激或中性状态后,让其完成数字N-back任务并同时记录脑电。结果发现,低负荷工作记忆诱发的P3显著大于高负荷工作记忆;在0-back任务中,急性应激组诱发的P3显著大于控制组;而在2-back任务中,这种差异不显著。这些结果表明急性应激对工作记忆的影响受工作记忆负荷调节,支持了双竞争理论模型。     

DS14 is more likely to measure depression rather than a personality disposition in patients with acute coronary syndrome

It has been suggested that Type D Personality is a risk factor for acute coronary syndrome (ACS) and the DS14 has been developed for its assessment. However, some of the items on the DS14 seem to evaluate depressive symptoms rather than personality features. Therefore, the present study aims to verify whether an overlap exists between the constructs of Type D Personality and depression. Three‐hundred‐and‐four consecutive patients who were both presenting their first ACS and had no history of major depression completed the Hospital Anxiety and Depression Scale (HADS) and the DS14 to assess Type D personality at baseline and have been re‐evaluated at 1, 2, 4, 6, 9 and 12‐month follow‐ups. Out of 304 subjects (80.6% males), 40 were diagnosed as depressed. An exploratory factor analysis of HADS and the DS14 in the second month revealed that four out of seven items on the depressive subscale of HADS (HADS‐D) and six out of seven items on the Negative Affectivity (NA) subscale of the DS14 segregated on the same factor. Results were verified by a Partial Confirmatory Factor Analysis performed at the twelfth month when most of the patients achieved complete remission from the depressive episode. Temporal stability was poor for NA and Type D Personality and these construct co‐vary with HADS‐D over time. Our data suggests that NA and depression are overlapping constructs, supporting the idea that the DS14 measures depressed features, rather than a personality disposition.     

Perseverative thoughts and subjective health complaints in adolescence: Mediating effects of perceived stress and negative affects

Stable tendency to perseverative thoughts such as trait rumination and worry can influence somatic health. The purpose of the study was to investigate the relationship between perseverative thoughts and somatic complaints, and the possible mediating effects of perceived stress, negative and positive affectivity in adolescence. Having an acute or a chronic condition was also assessed to be controlled for and to reveal their effects on symptom reporting. Three hundred and six adolescents from 7th to 12th grade with mean age of 16.33 (SD = 1.29) participated in the study. Mediation analysis suggested that impact of trait-like perseverative thoughts on complaints were mediated by perceived stress and negative affectivity. Having an acute condition had also an effect on symptom reporting through increased negative affectivity. Our results highlight that ruminations or worry as stable intrapersonal characteristics are relevant processes in health and can be potential targets in prevention programmes in adolescence.     

The psychosocial predictors of long-term distress in partners of patients with acute coronary syndrome

Objective: Partners of acute coronary syndrome (ACS) patients are at risk of experiencing long-term distress and the purpose of this study was to identify its predictors.

Design: Using an observational design, 80 partners of ACS patients completed validated questionnaires at three time points. The predictor variables, marital satisfaction and optimism were assessed three weeks after patient hospital discharge (T1). The outcomes, depressive symptoms and physical health status (from a quality of life scale) were measured 6 (T2) and 12 (T3) months post-discharge, and scores were combined to indicate the long-term response.

Main outcome measures: Depressive symptoms and physical health status.

Results: Partner depressive symptoms increased and physical health status deteriorated over the months following the patients’ ACS. After controlling for demographics, clinical severity of ACS and T1 levels of the outcome variable, partners’ long-term depressive symptoms were predicted by poor marital satisfaction and low optimism at T1, and poor physical health status was predicted by low T1 optimism.

Conclusion: Psychosocial factors are predictors of long-term distress for ACS partners. Partners in an unhappy marriage or with low optimism after ACS are at an increased risk of depression and low physical health status, and should be the target of additional support.     

Cognitive predictors of posttraumatic stress symptoms six months following acute coronary syndrome

This study examined patients’ illness representations assessed shortly after an acute coronary syndrome (ACS) as predictors of posttraumatic stress symptoms six months later. Illness representations were assessed in ACS patients using standard measures at a home visit three weeks after discharge from hospital. Posttraumatic stress symptoms were assessed at the same time, and again six months later. Patients were aged 61 years on average, the majority being men (89.8%) of white European decent (89%). Greater posttraumatic symptoms at six months were associated with beliefs that the illness would last a long time (timeline), that it had an unpredictable time course (timeline – cyclical), greater consequences, less personal and treatment control, poorer illness coherence and stronger negative emotional representations (emotional upset relating to the illness; p?<?0.05). In multiple regression analyses, controlling for demographic, clinical and psychological factors (age, gender, ethnicity, social deprivation, ACS severity, negative affectivity and cardiac symptom recurrence), more intense emotional representations (β?=?0.146, p?=?0.041) and reduced illness coherence (β?=??0.133, p?=?0.029), emerged as independent predictors of posttraumatic symptom severity at six months. There was a near significant effect for personal control (β?=??0.113, p?=?0.058). These results demonstrate the importance of illness representations of ACS in predicting longer-term posttraumatic stress symptoms.     

The role of social support as a moderator of the acute stress response: In Situ versus empirically-derived associations

Abstract

This investigation was designed to (1) evaluate the role of social support during an acute naturalistic stressor i.e., emergency dental treatment, (2) assess whether an in situ and an empirical measure of support exhibited consistent relationships with anxiety and (3) examine the relationship between the in situ and empirical measures of support. All participants completed a measure of social support prior to treatment and an anxiety measure prior to and following treatment. The effect of support on pre-treatment anxiety, post-treatment anxiety and change in anxiety during the treatment process was assessed. According to the in situ support measure, individuals high in support were accompanied to the clinic, and individuals low in support were unaccompanied. According to the empirical support measure, individuals high in support had actual support scores above the sample median. Individuals low in support had actual support scores below the sample median. Individuals high in in situ support were found to have significantly higher levels of pre-treatment anxiety. No other effects of support were observed for either support measure. Furthermore, while there was some evidence that the in situ and empirical measures of support were associated with consistent outcomes, in the main, they exhibited independence.     

A biopsychosocial model for depressive symptoms following acute coronary syndromes

A partial latent structural regression analysis was used to evaluate the influence of perceived stress and coping resources on depression following acute coronary syndromes (ACS) in a sample of 113 participants (25 females and 88 males with a mean age of 57.61 years (SD = 12.63). Out of them, 55 participants were Australian born and 48 were born elsewhere, with 53 of the patients scoring in the mild to high depression range on the Beck Depression Inventory and the Cardiac Depression Scale. Perceived stress and coping resources, after controlling for age and smoking explained 89% of the variance in the latent variable depression. Higher perceived stress levels and fewer coping resources predicted higher levels of depression. Higher levels of perceived stress predicted fewer coping resources and fewer coping resources predicted higher levels of depression. There was a significant direct and indirect effect of perceived stress through coping on depression. Cognitive and physical coping resources were the best predictors of the depression construct. These results have potential implications for the treatment of depression post-ACS. In particular, cognitive and physical coping mechanisms and perceived stress reduction need to be addressed when treating depression post-ACS.     

J波、fQRS、Tp-ec对ST段抬高性心肌梗死溶栓治疗后恶性心律失常的预测价值

探讨ST段抬高性心肌梗死(STEMI)患者成功溶栓治疗后J波、校正Tp-e间期(Tp-ec)、碎裂QRS波(fQRS)对恶性心律失常事件(MAE)的预测价值及其相关性.选择STEMI患者108例,成功溶栓治疗后随机分为MAE组(29例)和非MAE(NMAE)组(79例),72例正常人的心电图作为对照组.结果示MAE组J波阳性、fQRS阳性、Tp-ec≥100ms显著高于NMAE组(P＜0.05);STEMI患者Tp-ec较对照组显著延长(P＜0.05),经溶栓治疗后,Tp-ec1周和1个月时逐渐恢复,但Tp-ec仍较对照组显著延长(P＜0.05);J波阳性(OR=3.612)、fQRS阳性(OR=2.905)、Tp-ec≥100ms(OR=3.226)(均P＜0.05)与MAE的发生独立相关.以此认为J波、Tp-ec、fQRS和MAE正相关,对溶栓后MAE有预测作用.