开展老年偏瘫患者康复护理的体会

急性脑卒中是致残率极高的疾病,约3/4患者留有残疾,肢体运动功能障碍是最常见的后遗症之一.由于恢复慢严重影响患者生活质量,给家庭及社会带来沉重负担.     

Chondrocyte cytokine and growth factor expression in murine osteoarthritis

Eighty-five percent of male STR/ort mice develop osteoarthritic lesions of the knee joint by 35 weeks of age. We have developed a non-radioactive in-situ hybridization method using digoxigenin-labeled oligonucleotide probes to study the expression of the cytokines interleukin (IL) 1 alpha, Il-1 beta and IL-6 and the growth factors insulin-like growth factor-1 (IGF-1) and transforming growth factor beta (TGF beta 1) during the development of osteoarthritis (OA) in this model. Age- and sex-matched CBA mice, which do not develop OA, showed no detectable expression of any of the cytokines or growth factors studied. In contrast, 20-week-old STR/ort mice with no OA lesions showed positive expression [positive: (+)] for all the cytokines and growth factors studied. At 35 weeks of age, STR/ort mice with varying grades of OA showed positive (+) or strong (++) signals for both cytokines and growth factors throughout the tibial articular cartilage. The strongest signal was seen in areas where OA lesions were present. In areas of histologically-normal cartilage adjacent to the lesions, the signals were still positive but weaker. Fifty-week-old STR/ort mice with OA lesions showed a similar pattern of expression to 35-week-old mice. Thirty-five or 50-week-old STR/ort mice with no OA lesions had much reduced expression compared with those with OA lesions. These mice may be indicative of those STR/ort mice which do not develop OA. The results seen in the STR/ort together with previous biochemical analyses are consistent with an up-regulation of anabolic growth factors and catabolic cytokines in the prelesional stages of OA with anabolic effects predominating. At later stages of OA, the effects of catabolic factors appear to predominate and osteoarthritic lesions become evident.     

Perspectives on the nursing management of osteoarthritis

Osteoarthritis is a daily presence in the lives of almost 16 million older people. Without expert nursing care, functional health status and the ability to manage independently may be dramatically altered. Nursing parameters include pain control, medication assessment, use of exercise, diet, joint protection, and attention to the psychosocial factors that affect both pain and disability. Patient education with regular, periodic follow-up is a vital part of successful long-term management.     

The relationship between osteoarthritis and osteoporosis in the spine

We report on the case of a man, whose psychopathological symptoms markedly varied during different phases of his illness, causing difficulties in applying common diagnostic criteria for schizophrenia. Depending upon each of the predominant symptoms, this resulted in different diagnoses and therapeutic strategies. We also discuss the importance of obsessions and compulsions in differential diagnosis in this case.     

The impact of depression on the outcome of addictions treatment

Choosing the correct equipment for moving and handling patients is essential to prevent injuries among health-care staff and patients' carers. It is vital, however, that a thorough needs and risk assessment is undertaken before equipment is purchased.     

The impact of mastectomy on the lives of women.

Maintains that professional and lay approaches toward breast cancer patients often focus on describing ways in which women should respond and adjust to the disease and its treatments. Because these attitudes tend to stress either the tremendous emotional effects that women should experience or the ways in which women should cope, adopting either approach to excess is considered a disservice to women. It is suggested that psychologists be aware of both the common reactions to the stresses of mastectomy and the abilities of women to cope with these stresses. Strategies that promote increased sense of self-control for the patient are advocated. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The treatment of osteoarthritis of the knee with pulsed electrical stimulation

OBJECTIVE: The safety and effectiveness of pulsed electrical stimulation was evaluated for the treatment of osteoarthritis (OA) of the knee. METHODS: A multicenter, double blind, randomized, placebo controlled trial that enrolled 78 patients with OA of the knee incorporated 3 primary efficacy variables of patients' pain, patients' function, and physician global evaluation of patients' condition, and 6 secondary variables that included duration of morning stiffness, range of motion, knee tenderness, joint swelling, joint circumference, and walking time. Measurements were recorded at baseline and during the 4 week treatment period. RESULTS: Patients treated with the active devices showed significantly greater improvement than the placebo group for all primary efficacy variables in comparisons of mean change from baseline to the end of treatment (p < 0.05). Improvement of > or = 50% from baseline was demonstrated in at least one primary efficacy variable in 50% of the active device group, in 2 variables in 32%, and in all 3 variables in 24%. In the placebo group improvement of > or = 50% occurred in 36% for one, 6% for 2, and 6% for 3 variables. Mean morning stiffness decreased 20 min in the active device group and increased 2 min in the placebo group (p < 0.05). No statistically significant differences were observed for tenderness, swelling, or walking time. CONCLUSION: The improvements in clinical measures for pain and function found in this study suggest that pulsed electrical stimulation is effective for treating OA of the knee. Studies for longterm effects are warranted.     

The impact of a relaxation technique on the lipid profile

In this study, a more subtle animal model of Menière's disease is investigated by damaging the distal portion of the endolymphatic sac by dissection or cauterization to produce mild dysfunction of endolymphatic outflow. Cauterization resulted in low degrees of hydrops without any correlation with the inflicted damage. Total dissection of the distal portion of the sac adjacent to the sigmoid sinus produced moderate to severe endolymphatic hydrops with interanimal variation. The consequences of these relatively severe effects, in relation to the mild damage of the endolymphatic sac, and the influence on damaged and undamaged parts of the endolymphatic sac will be discussed.     

The impact of health policy on chiropractic

BACKGROUND: The presence of a genetic factor in the determination of leprosy has long been debated. This study tests whether the HLA-linked control of susceptibility to leprosy and/or for the types of leprosy could be confirmed. MATERIALS AND METHODS: In 15 multicase families, the method of DeVries et al., 1976, was used to detect nonrandom segregation of parental HLA haplotypes in their affected and healthy siblings. Linkage analyses, for two and three alleles were performed by the computer program LIPED: RESULTS: For the affected siblings, the segregations of the parental HLA haplotype were significantly nonrandom from the healthy parents and random from the affected parents, indicating that affected siblings were sharing their HLA haplotypes (segregated from the healthy parents) more than expected. The segregations to the healthy siblings from both the healthy and affected parents were random. Healthy siblings inherited the haplotypes shared among the leprosy siblings randomly as expected. There were excess DR2/DR2 homozygote individuals among tuberculoid siblings. The highest lod score was achieved when we considered our suggested three-alleles model for the susceptibility to the different types of leprosy. CONCLUSIONS: A closely HLA-linked gene on chromosome number 6 with multiple alleles (3 or more) in recombination fraction between 0.05 and 0.1 with 70 to 100% penetrance may be responsible for the susceptibility to the different types of leprosy, whereas the susceptibility to leprosy per se maybe the responsibility of non-HLA linked gene/s. DR2/DR2 homozygote individuals may be relatively at high risk of developing leprosy or tuberculoid leprosy.     

The impact of hypothermia on dilutional coagulopathy

The control of hemorrhage in hypothermic patients with platelet and clotting factor depletion is often impossible. Determining the cause of coagulopathic bleeding (CB) will enable physicians to appropriately focus on rewarming, clotting factor repletion, or both. Objective: To determine the contribution of hypothermia in producing CB and ascertain if simultaneous hypothermia and dilutional coagulopathy (DC) interact synergistically. Method: Prothrombin time, partial thromboplastin time, and platelet function were determined at assay temperatures of 29 degrees to 37 degrees C on normal and critically ill, noncoagulopathic (NC) individuals. Dilutional coagulopathy was created using buffered saline and the assays repeated. Results: Hypothermic assay at < or = 35 degrees C significantly prolonged coagulation times. The effect of hypothermia on NC and DC samples was not different. Conclusion: Assays performed at 37 degrees C underestimate coagulopathy in hypothermic patients. The effect of hypothermia on NC and DC is not different, indicating the lack of a synergistic effect. Normalization of clotting requires both rewarming and clotting factor repletion.     

The impact of genetic markers on selection

Genetic marker technologies, such as marker-assisted selection, parentage identification, and gene introgression can be applied to livestock selection programs. Highly saturated genetic maps are now available for cattle, swine, and sheep to provide the genetic framework for developing MAS programs. These programs rely on three phases for commercialization of the technology: the detection phase, in which quantitative trait loci are located and their effects on the phenotype measured; the evaluation phase, in which the markers are evaluated in commercial populations; and the implementation phase, in which markers are combined with phenotypic and pedigree information in genetic evaluation for predicting the genetic merit of individuals within the population. Predicting the economic impact of genetic technologies is a complex process that requires quantitative prediction and economic analysis. Evaluating the impact of these benefits across an industry can be achieved through a process in which gains from implementation of a genetic technology are assessed at the individual, enterprise, and industry levels. A pattern of annual benefits and costs can be predicted using gene flows that can be evaluated by conventional economic analysis.     

The impact of liposuction on body fat

Routine liposuction has very low perioperative complication rates and is thus considered to be innocuous. Some authors have even proposed that large-volume liposuction could be therapeutic. However, because subcutaneous adipose tissue has nutritional and thermodynamic metabolic functions proportional to the absolute amount and the distribution of fat, it is possible that removal of subcutaneous adipose tissue might be detrimental. We measured the amount of fat removed by large-volume (>1000 cc) liposuction and expressed the results in terms of absolute and relative changes in total body fat and in visceral adipose tissue (nonsubcutaneous adipose tissue) in 63 normal weight to mildly obese women (n = 51) and men (n = 12). Aspiration of 1.5 +/- 0.7 kg (mean +/- SD) of lipid in women removed 9.2 +/- 3.2 percent of body fat or 10.5 percent of subcutaneous adipose tissue corresponding to a 12-percent increase in the ratio of visceral to subcutaneous adipose tissue. One third of the women (n = 17) had a mean increase of 16 percent (range 13 to 21 percent) in the proportion of visceral fat. In the 12 men, aspiration of 1.7 +/- 0.6 kg of lipid removed 9.8 +/- 2.9 percent of body fat or 12.7 +/- 3.6 percent of subcutaneous adipose tissue, resulting in a 14-percent increase in the ratio of visceral to subcutaneous fat. The correlation between aspirate and body mass index was 0.57 (p < 0.001). Although large-volume subcutaneous liposuction removed relatively little body fat, it led to significant increases in the proportion of visceral adipose tissue. Because the proportion of visceral adipose tissue is a risk factor for metabolic complications of obesity, the metabolic effects of large-volume liposuction need to be evaluated.     

The impact of breast cancer on sexuality

An eleven year old boy presented with sudden onset right-sided hemiplegia and ipsilateral lower facial weakness. Two-dimensional echo revealed the diagnosis of idiopathic dilated cardiomyopathy with multiple intracardiac clots. MRI scan of head showed infarctions in the area of caudate nuclei, putamen, brain stem and cerebellum. On anticoagulation therapy, all thrombi, except one, disappeared. The child died 2.5 months later due to resistant cardiac failure.     

The impact of organizational downsizing on the job satisfaction of nurses

Professional nurses across Canada are being affected by health reform initiatives designed to deinstitutionalize the health care system. This panel study examined the impact this restructuring has had on nurses' overall job satisfaction as well as their satisfaction with various aspects of their job and work environment. The participants consisted of 345 nurses employed in 3 community hospitals in southwestern Ontario. Hospital downsizing had relatively little effect on overall job satisfaction, satisfaction with kind of work, amount of work, and physical work conditions. However, compared to before the downsizing, nurses reported a significant deterioration in satisfaction with their career future, hospital identification, supervision, and co-workers following the implementation of restructuring initiatives. We discuss the organizational and management implications of these findings and suggest ways that hospital administrators can minimize the negative effects of downsizing on nursing professionals.     

The impact of postoperative pain on the development of postoperative delirium

We performed a prospective observational study to examine the role of postoperative pain and its treatment on the development of postoperative delirium. Pain was measured in direct patient interviews using a visual analog scale (VAS) and was assessed for pain at rest, pain with movement, and maximal pain over the previous 24 h. Postoperative delirium was diagnosed during these interviews by using the confusion assessment method (CAM) and/or by using data from the medical record and the hospital's nursing intensity index. The method of postoperative analgesia, type of opioid, and cumulative opioid dose were also recorded. After controlling for known preoperative risk factors for delirium (age, alcohol abuse, cognitive function, physical function, serum chemistries, and type of surgery), higher pain scores at rest was associated with an increased risk of delirium over the first 3 postoperative days (adjusted risk ratio 1.20, P = 0.04). Pain with movement and maximal pain were not associated with delirium. Method of postoperative analgesia, type of opioid, and cumulative opioid dose were not associated with an increased risk of delirium. We conclude that more effective control of postoperative pain reduces the incidence of postoperative delirium. Implications: We performed daily interviews in a large population of patients undergoing noncardiac surgery to measure their level of pain and development of delirium. We found an association between higher pain levels at rest and the development of delirium. Our results suggest that better control of postoperative pain may reduce this serious complication.     

The impact of cooling rates on the microstructure of Al-U alloys

The impact of cooling rates on the microstructure of Al-U alloys was studied by optical, scanning electron, and transmission electron microscopy. A variety of solidification techniques were employed to obtain cooling rates ranging between 3 × 10⁻² and 10⁶ K/s. High-purity uranium (99.9 pct) and high-purity aluminum (99.99 pct), or “commercially pure” type Al-1050 aluminum alloys were used to prepare Al-U alloys with U concentration ranging between 3 and 22 wt pct. The U concentration at which a coupled eutectic growth was observed depends on the cooling rates imposed during solidification and ranged from 13.8 wt pct for the slower cooling rates to more than 22 wt pct for the fastest cooling rates. The eutectic morphology and its distribution depends on the type of aluminum used in preparing the alloys and on the cooling rates during solidification. The eutectic in alloys prepared from pure aluminum was evenly distributed, while for those prepared from Al-1050, the eutectic was unevenly distributed, with eutectic colonies of up to 3 mm in diameter. Two lamellar eutectic structures were observed in alloys prepared from pure aluminum containing more than 18 wt pct U, which solidified by cooling rates of about 10 K/s. One structure consisted of the stable eutectic between UAl₄ and Al lamella. The other structure consisted of a metastable eutectic between UAl₃ and Al lamella. At least three different eutectic morphologies were observed in alloys prepared from Al-1050.     

Relative impact of HLA phenotype and CD4-CD8 ratios on the clinical expression of hemochromatosis

A "minizyme" is a smaller version of the hammerhead ribozyme, in which stem-loop II has been replaced by a short linker. Here, we have synthesised a DNA-containing minizyme and a ribozyme, which are designed to cut within a 15-nucleotide sequence in human interleukin-2 mRNA, and have tested for their activity in vitro and in cells. In vitro at 37 degrees C, a minizyme with linker of sequence d(GTTTT) cleaves a 15-ribonucleotide synthetic substrate 5-fold slower than does the full-sized ribozyme. In human cells, the minizyme inhibits the production of interleukin-2 protein to a similar extent as does the ribozyme. Also, the minizyme and the ribozyme are more effective in cells than any of three controls: an inactive minizyme, a 15-nucleotide antisense DNA, or DNA of random sequence. The positive effect observed in cells indicates that minizymes may be useful as pharmaceuticals.