青年颈心综合征避免误诊为冠心病的临床诊疗策略

通过对临床收集的187例青年(≤45岁)颈心综合征患者的临床资料进行分析。探讨青年颈心综合征临床误诊为冠心病的原因及避免误诊的诊疗策略。目的在于帮助临床医师对青年颈心综合征进行识别,注意如何与冠心病心绞痛相鉴别,对防止病情延误,尽早明确诊断积极治疗,排除冠心病,减少诊疗费用及避免冠脉造影的风险意义很大。     

冠心病多支血管病变完全血运重建的长期疗效观察

为分析冠心病多支血管病变(MVD)患者经皮冠状动脉介入治疗(PCI)进行完全血运重建术后长期的临床疗效,我们收集了2004年5月~2008年5月589例接受PCI的冠心病患者,其中实施完全性血运重建(CRV)461例(78.3%),不完全性血运重建(IRV)128例(21.7%),对比分析两组病例PCI术后随访1年以上的结果。结果显示IRV组患者中完全闭塞病变、3支血管病变的比例均高于CRV组(P0.01);CRV组PCI成功率明显高于IRV组(94.8%vs87.5%,P0.05)。提示多支冠状动脉病变完全性血运重建能够获得更好的长期临床疗效论。     

重视终末期肾病患者的心理治疗

心理治疗在终末期肾病(ESRD)治疗中的作用非常重要,不但可缓解患者的心理压力,还可改善患者的生理障碍、减少并发症,因此重视对ESRD患者的心理治疗,可使患者保持良好的生理、心理状态,并能提高患者的生活质量,改善预后。     

重症手足口病的早期识别与处理

手足口病(hand-foot-mouth disease,HFMD)是由肠道病毒[以柯萨奇A组16型(Coxsackievirus A16,CoxA16)、肠道病毒71型(Enterovirus 71,EV71)多见]引起的急性传染病,而重症多由EV71感染引起。由于EV71的高度嗜神经性,重症者可合并中枢神经系统(central nervous system,CNS)损害、急性肺水肿/出血等。现就重症手足口病的早期识别与处理进行简要综述。     

急性肾损伤肾脏替代治疗模式的临床决策

急性肾损伤是指病程3个月内的,包括血、尿、组织学及影像学检查所见的肾脏结构与功能异常。目前,急性肾损伤肾脏替代治疗的模式尚无明确定论。常用的模式有间断性血液透析、持续性肾脏替代治疗、杂合式肾脏替代治疗、腹膜透析。临床上应根据患者的年龄、病因、病情危重程度、所在医院的条件和经济状况等选择合适的治疗模式。     

肾移植患者生存质量及影响因素分析

探讨肾移植患者的生存质量及影响因素。采用健康状况调查问卷(SF-36)调查广州地区医疗机构145例肾移植受者移植前和移植后6个月的生存质量。移植后6个月患者的生存质量评分较移植前有明显提高。文化程度、有无配偶、经济状况、肾源、健康知识掌握程度等因素对患者的生存质量影响较大。医护人员应为肾移植患者提供个性化护理,以提高患者的生存质量。     

轻度阿尔茨海默症患者的前瞻记忆

轻度阿尔茨海默症往往伴随着不同程度的前瞻记忆衰退。已有研究以轻度阿尔茨海默症与前瞻记忆衰退的关联程度为主线, 对比了这一关联与“其他认知缺陷疾病-前瞻记忆衰退”、“轻度阿尔茨海默症-回溯记忆衰退”以及“轻度阿尔茨海默症-遗传表达”这三种关联的类似程度。此外, 也有研究涉及到了如何促进轻度阿尔茨海默症患者的前瞻记忆。将来的研究应引入病情程度、前瞻记忆任务类型等变量, 深入探讨轻度阿尔茨海默症与前瞻记忆衰退的关联, 并使用ERP、fMRI等神经生理技术确定轻度阿尔茨海默症患者前瞻记忆衰退的机制。     

Preserved metamemorial ability in patients with mild Alzheimer's disease: shifting response bias

Patients with mild Alzheimer's disease (AD) display a greater tendency to endorse unstudied items as "old" on memory tests than healthy older adults. This liberal response bias may result in mistaken beliefs about the completion of common tasks. This research attempted to determine whether it was possible to shift the response bias of mild AD patients to be more conservative on a recognition memory test through behavioral intervention. Patients with mild AD and matched controls were evaluated with two almost identical paradigms, separated by about one week. For each session, 30 words were studied and 60 words (half studied, half novel) were shown at test. During one session participants were told that 30% of words were old, and at the other session that 70% were old. We found that both groups were able to shift their response bias between the two conditions. That patients with mild AD were able to successfully shift their response bias demonstrates that--despite their overall liberal response bias and poor memory relative to controls--one component of metamemorial ability is preserved in patients with mild AD.     

"I know what I like": stability of aesthetic preference in Alzheimer's patients

Two studies explored the stability of art preference in patients with Alzheimer's disease and age-matched control participants. Preferences for three different styles of paintings, displayed on art postcards, were examined over two sessions. Preference for specific paintings differed among individuals but AD and non-AD groups maintained about the same stability in terms of preference judgments across two weeks, even though the AD patients did not have explicit memory for the paintings. We conclude that aesthetic responses can be preserved in the face of cognitive decline. This should encourage caregivers and family to engage in arts appreciation activities with patients, and reinforces the validity of a preference response as a dependent measure in testing paradigms.     

Neural substrates of cognitive skill learning in Parkinson's disease

While cognitive skill learning is normally acquired implicitly through frontostriatal circuitry in healthy individuals, neuroimaging studies suggest that patients with Parkinson's disease (PD) do so by activating alternate, intact brain areas associated with explicit memory processing. To further test this hypothesis, 10 patients with PD and 12 healthy controls were tested on a modified, learning version of the Tower of London task while undergoing positron emission tomography at four different time points over the course of learning. Despite having less accurate problem solving abilities than controls, PD patients were able to acquire the skill learning task. However, as compared to controls, they maintained higher levels of cerebral blood flow activity in the dorsolateral prefrontal cortex and hippocampus and showed an increase in activity in the frontopolar cortex and posterior cingulate over the course of learning. These findings reflect a shift to the explicit memory system in PD patients, enabling them to learn this cognitive skill, which is normally acquired by control subjects using implicit learning strategies and frontostriatal circuitry.