【摘要】 目的 探討輕度認知功能障礙的心理學特點及其危險因素。 方法 由神經專科醫生采集2009年9-12月在神經內科門診就診患者106例的臨床資料，進行簡易智能量表（MMSE）、聽覺詞語測驗（AVLT）、畫鐘測驗（CDT）、日常生活功能量表（ADL）、Hamilton 抑郁量表（HDRS）及臨床癡呆評定量表（CDR）等神經心理測試。根據檢查結果分為MCI組與對照組。 結果 MCI組受教育年限低于對照組（Plt;0.05），高血壓病、糖尿病、腦卒中史高于對照組（Plt;0.05）。Logistic多因素回歸分析顯示受教育年限和高血壓病史與MCI密切相關。MCI組MMSE總分、CDT得分、AVLT即刻記憶、延遲記憶及長時延遲再認顯著低于對照組，ADL評分及HDRS評分高于對照組（Plt;0.05）。 結論 高血壓病是MCI的危險因素，較高的受教育年限是MCI的保護因素。MCI患者在多個神經心理學領域受損。【Abstract】 Objective To investigate the neuropsychological characteristics of mild cognitive impairment (MCI) and its risk factors. Methods The clinical data of 106 patients in our neurologic department from september to December 2009, were collected by neurologists,and tested them by Chinese version of the mini-mental state examination (MMSE) , auditory verbal learning test (AVLT) , clock drawing test (CDT)、activities of daily living (ADL)、Hamilton depression rating scale (HDRS) and clinical dementia rating scale (CDR). All subjects were divided into MCI patients group and the control group. Results Educational level was significantly lower and hypertension, diabetes mellitus and stroke history were significantly more in patients with MCI than the control. The factors associated with MCI in logistic regression analysis were lower educational level and hypertension. The scores of MMSE、CDT and AVLT of MCI were significantly lower than those of the control, and the scores of ADL and HDRS were significantly higher than those of the control (Plt;0.05). Conclusion Hypertension is the risk factor and high educational level is the protective factor for MCI. MCI patients are impaired in multiple neuropsychological domains.
Objective To investigate the feasibility and clinical outcomes of minimally invasive sternal depression by autologous force for the correction of pectus carinatum. Methods Between October 2011 and September 2015, 22 pectus carinatum patients underwent minimally invasive surgical correction of pectus carinatum in Tongji Hospital. Clinical data of 22 patients were retrospectively analyzed. There were 19 males and 3 females with a mean age of 12.00±2.87 years, ranging from 6 to 15 years. Among them, 17 patients were symmetric malformation, and the others were asymmetric. Preoperative chest CT scan was performed on 14 patients. Haller index was 1.65-2.23 (1.97±0.15). All the patients underwent the minimally invasive surgical correction of pectus carinatum with a NUSS bar via sternal depression by autologous force. Results All the operations were completed successfully. The mean operation time was 55-120 (83.73±16.62) min and blood loss volume was 10-50 (28.18±11.63) ml. The mean postoperative hospital stay was 3-6 (4.23±1.17) d. Postoperative complications included wound infection in 2 patients, minor pneumothorax in 3 patients, who were cured by conservative treatment. One patient suffering postoperative hydropneumothorax received drainage. All the patients were followed up for 6-48 months after discharge and very satisfied with the chest appearance following surgery. No patient complained of persistent pain. There was no displacement of the bar or the stabilizers. Nine patients underwent the removal of the NUSS bar without pectus carinatum recurrence. Conclusion Minimally invasive sternal depression by autologous force simplifies the procedure of correction of pectus carinatum with reliable and satisfactory outcomes.
【摘要】 目的 通過比較遺忘型輕度認知障礙（amnestic mild cognitive impairment，aMCI）和血管性認知障礙非癡呆型（vascular cognitive impairment-no dementia，VCI-ND）患者及正常老年人群在簡易智能精神狀態檢查量表（mini mental state examination，MMSE）、聽覺詞語學習測驗（auditory verbal learning test，AVLT）、畫鐘試驗（clock drawing test，CDT）及臨床癡呆評定量表（clinical dementia rating scales，CDR）中的表現，進一步分析aMCI和VCI-ND在認知損害方面的不同特點。 方法 選取首都醫科大學宣武醫院神經內科門診收治aMCI患者23例及VCI-ND患者27例（CDR＝0.5分），同時選取40名正常老年人（CDR=0分）作為對照組。每位受試者均進行MMSE、AVLT、CDT及CDR等神經心理學量表測查，分析以上3組被試各項神經心理學測查得分之間的差異。 結果 各組受試者的年齡、性別及受教育程度差異無統計學意義（Pgt;0.05），具有可比性。aMCI和VCI-ND組在MMSE、CDT、即刻記憶、延遲記憶及延遲再認檢測中的平均值均低于對照組，且差異均具有統計學意義（Plt;0.05）。aMCI和VCI-ND兩組除延遲再認檢測外，其余各項測查的平均分均無統計學意義（Pgt;0.05）。在延遲再認檢測中，aMCI組（6.65±4.00）較VCI-ND組（8.67±2.76）再認詞語數量少，兩組延遲再認的得分均低于對照組（12.83±1.77），差異有統計學意義（Plt;0.05）。 結論 aMCI和VCI-ND在記憶力、執行能力和信息處理能力方面較正常老年人均有所損害。由于aMCI和VCI-ND不同的病理改變，導致患者存在不同類型的記憶儲存和提取機制。【Abstract】 Objective To investigate the different patterns of cognitive impairment in patients with amnestic mild cognitive impairment (amci), vascular cognitive impairment-no dementia (VCI-ND) and normal elder people. Methods A total of 23 patients with aMCI and 27 patients with VCI-ND (CDR＝0.5) and another 40 healthy elder people (CDR=0) were selected. Each individual underwent the neuropsychological tests, including mini mental state examination (MMSE), auditory verbal learning test (AVLT), clock drawing test (CDT), clinical dementia rating scales (CDR) and hamilton rating scale for depression (HAMD). The differences between the three groups were analyzed. Results The differences in age, sexes, and the education background among the three groups were not significant (Pgt;0.05) which meant comparability. The mean scores of MMSE, CDT, instant memory and delayed awareness in aMCI and VIC-ND group were much lower than that in the control group (Plt;0.05). The differences in all the test items except for delayed awareness between aMCI group and VCI-ND groups were not significant (Pgt;0.05). However, in the recall recognition test, these three groups had significant differences: the score in patients with aMCI (6.65±4.00) was much lower than that in patients with VCI-ND (8.67±2.76; Plt;0.05), and the scores of the two groups were both lower than that in the normal aging group (12.83±1.77; Plt;0.05). Conclusion Compared with normal elder people, the cognition of aMCI and VCI-ND patients is impaired severely. The memory tests suggeste that compared with aMCI patients, VCI-ND patients may have different neuropathological changes leading to different mechanism of memory encoding and retrieval.
Objective To investigate the awareness of diabetes complications in outpatients with diabetes. Methods A total of 300 cases of diabetic were collected from Department of Endocrinology between September 1st and October 10th, 2016. The awareness of diabetes complications in patients with diabetes was investigated by a self-made questionnaire, and the influencing factors on the awareness rate of diabetes complications were analyzed. Results The awareness rates of acute and chronic complications were all low. The awareness rate of hypoglycemia was the highest (59.0%) and the chronic pyelonephritis was the lowest (22.0%). In addition, the difference in awareness rate between different sexes was not significant (P>0.05). Educational extent had significant influence on the awareness rate of chronic pyelonephritis, retinopathy, glaucoma, myopia or hyperopia, iridocliory lesions, polyneuropathy, oculomotor and abducens nerve paralysis, vegetative nerve lesion, skin, muscle, and joints lesions, and infection complications (P<0.05). Occupation had significant influence on the awareness rate of ketoacidosis, diabetic hyperosmolar coma, hypoglycemia, diabetic cardiopathy, iridocliory lesions, polyneuropathy, oculomotor and abducens nerve paralysis, vegetative nerve lesion, skin, muscle, and joints lesions, and infection complications (P<0.05). Conclusions The awareness of diabetes complications in outpatients with diabetes is low. It is needed to strengthen the health education of diabetes complications and improve the awareness rate of complications.
Clinical practice guidelines are decision-making tools for bridging the gap between current best evidence and clinical practice. Studies have shown poor clinical applicability of existing guidelines, which may not be solved by improving the quality of guidelines alone. National medical management service guidance center is developing clinical practice guidelines of clinical evaluation system of construction projects, based on evidence-based method formulated by the target users of clinical guidelines evaluators’ applicability evaluation system of clinical practice guidelines. It aims to identify guidelines with high clinical applicability and provide the evaluation results of clinical applicability to developers and revisers of clinical guidelines, and then optimize the development and update, eventually improving the clinical applicability of guides and promote Chinese clinical guidelines in clinical application.