急性有机磷农药中毒救治中的几个问题

解决急性有机磷农药中毒病死率居高不下的问题,必须提高救治中的辩证思维。正确理解标本兼治的含义,外周性、中枢性抗胆碱药物和复能剂联合应用,合理维持阿托品化,积极应用机械通气进行必要的呼吸支持治疗和适时行血液灌流治疗是救治有机磷农药中毒的有效保证。     

低出生体重与代谢综合征

低出生体重是发生成年期代谢综合征的高危因素。“代谢程序化”与“营养程序化”概念的提出对人们从多层面认识该现象的内在机制有重要指导作用。随着对发生机制研究的深入,人们终将找到预防低出生体重发生成年期代谢综合征的早期干预措施。     

医疗保险费用控制的临床路径研究——胰腺炎医疗保险费用结算标准的确定

临床路径是现代医院管理的前沿技术之一,对于提高医疗服务质量和降低医疗费用具有现实意义。通过对急性胰腺炎病人的临床路径研究,探讨了我国临床实践中临床路径的实施方法,并在此基础上进一步研究了该疾病医疗保险费用结算标准的分类标准。     

Exaggerated leftward bias in the mental number line of patients with schizophrenia

Several visuo-motor tasks can be used to demonstrate biases towards left hemispace in schizophrenic patients, suggesting a minor right hemineglect. Recent studies in neglect patients used a new number bisection task to highlight a lateralized defect in their visuo-spatial representation of numbers. To test a possible lateralized representational deficit in schizophrenia, we used the number bisection task in 11 schizophrenic patients compared to 11 healthy controls. Participants were required to orally indicate the central number of an interval orally presented. Whereas healthy subjects showed no significant bias, schizophrenic patients presented a significant leftward bias. Therefore, these results suggest an impairment in higher order representations of the number space in patients with schizophrenia, an impairment that is qualitatively similar to the deficit described in neglect patients.     

Cognitive-behaviour therapy for chronic fatigue syndrome: comparison of outcomes within and outside the confines of a randomised controlled trial

Outcomes for cognitive-behaviour therapy (CBT) in randomised controlled trials (RCTs) have rarely been compared to those in routine clinical practice. Taking the case of CBT for chronic fatigue syndrome (CFS), we evaluated the results of a successful RCT against those of the same treatment given in the same setting as part of routine practice. Fatigue and social adjustment scores were compared for patients who received CBT for CFS as part of a RCT (N=30) and patients who received CBT as part of everyday clinical practice (N=384). The results in the RCT were superior to those in routine clinical practice. Between pre-treatment and 6-month follow-up, the RCT showed a larger reduction in fatigue and greater improvement in social adjustment than those in routine treatment. The changes in fatigue scores were similar for both groups during treatment but were greater in the RCT between post-treatment and follow-up. Potential reasons for the superior results of the RCT include patient selection, therapist factors and the use of a manualised treatment protocol. Practitioners need to pay particular attention to relapse prevention and ensuring adequate follow-up in addition to encouraging patients to continue with cognitive-behavioural strategies once treatment has ended.     

活性蛋白C：想说爱你不容易

重组人类活性蛋白C（rhAPC）为治疗重症脓毒症的药物,目前有证据表明rhAPC的市场策略有可能已经影响到专业机构诊治指南的制定与执行;rhAPC的临床疗效亦未能被大型临床试验继续证实,因此目前rhAPC的临床应用以及疗效评价要慎重进行。同时,有必要深入反思药品生产商与专业组织的利益关系,并制订对策以加强监管。     

Attitudes Toward Fragile X Mutation Carrier Testing from Women Identified in a General Population Survey

Fragile X syndrome is primarily due to a CGG repeat expansion found in the FMR1 X-linked gene. In a previous study, we conducted focus groups with women to assess their attitudes towards fragile X carrier screening. In this follow-up study, we conducted in-depth interviews of general population reproductive-age women who were identified as carriers. We explored their attitudes toward testing for carrier status of the fragile X mutation. These women underwent screening primarily to participate in a research project rather than in search of a diagnosis for specific symptoms. As such, these women were wholly unprepared for positive carrier results. Their responses about their results and carrier screening, in many cases, were being worked out over the course of the interview itself. The most salient finding of this work is the apparent lack of relevance of carrier status to these women. Many expressed that although the information could be relevant in the future, it is not relevant at this stage of their lives in terms of family planning (either with respect to having unaffected offspring or to premature ovarian failure) and personal relationships. Although issues of abortion seemed prominent in the focus groups, we found that carrier status did not have an apparent effect on women’s attitudes about termination. We hypothesize this may be related to the fact that women had not processed their new carrier status and had not related it to previously-formed personal opinions. The findings of this work have significant implications for genetic counseling and population screening. Genetic counselors should be mindful that general population women may not recognize the immediate importance of their carrier status even when literature is provided and discussed prior to providing a sample. As part of comprehensive genetic counseling, counselors should identify the reproductive life stage of the woman receiving the new information and help her identify when this information would be more meaningful in her life. Counselors can assist in setting up a personalized road map with specific types of services that will be more applicable to the woman as her carrier status becomes more relevant.     

Offspring Effects of Prenatal Alcohol Exposure from Birth to 25 Years: The Seattle Prospective Longitudinal Study

Before alcohol was generally known to cause birth defects, NIAAA in 1974 began funding a population-based Seattle study on alcohol use and pregnancy outcome. Women receiving prenatal care by mid-pregnancy were recruited (N = 1,529) and interviewed at home. Approximately 500 offspring exposed to a range of alcohol levels were examined on 11 occasions between day 1 and 25 years. Neuropsychological and neurobehavioral performance measures are correlated with prenatal alcohol dose, without substantial confounding by socio-demographic or rearing conditions, smoking, nutrition, or other drugs. Deficits in attention, arithmetic skill, spatial-visual memory, and IQ, as well as increased alcohol problems and psychiatric disorders are among offspring outcomes correlated at several ages with maternal drinking during and before pregnancy recognition. Findings are not confined to women who believed they had alcohol problems. Not all exposed offspring appear affected.     

多元论生命价值观与唐氏综合征患者的人文关怀

唐氏综合征是智力低下最常见的原因,目前无法治愈。在传统功利主义生命价值观影响下,患者被主流社会忽视和歧视,其生存环境不容乐观。本文从价值多元论的角度探讨了对唐氏综合征患者进行人文关怀方面的依据,并就如何对唐氏综合征患者进行人文关怀提出建议。     

重症急性胰腺炎并发急性呼吸窘迫综合征危险因素的分析

为了探讨重症急性胰腺炎（SAP）并发急性呼吸窘迫综合征（ARDs）的危险因素,回顾性分析了我院76例SAP患者入ICU时的年龄、血糖、APACHEⅡ评分等17项指标,根据是否合并ARDS对各项指标进行单因素及多因素Logistic回归分析。单因素分析显示两组在年龄、呼吸频率、血糖、感染、APACHEⅡ评分、Ranson评分、CT评分、ICU住院日方面差异有显著性（P〈0．05）,多因素Logistic回归分析显示年龄、血糖、感染、APACHEⅡ、Ranson、CT评分与SAP并发ARDS有关。故得出结论,年龄、血糖、感染、APACHEⅡ、Ranson与CT评分是SAP并发ARDS的独立危险因素。