清肾颗粒合复方α 酮酸治疗慢性肾衰竭湿热证疗效观察

目的 观察清肾颗粒联合复方α-酮酸对非透析期慢性肾衰竭（chronic renal failure,CRF）湿热证患者生活质量的改善作用。方法 将102例非透析期CRF患者随机分为常规组、对照组和治疗组,分别给予基础治疗、基础治疗联合复方α-酮酸、基础治疗联合复方α-酮酸和清肾颗粒,疗程12周,观察治疗前后血清肌酐（serum creatinine,SCr）、清蛋白（albumin,Alb）、肾小球滤过率（glomerular filtration rate,GFR）及主要中医症状变化,并采用肾病生活质量简表1.3版（kidney disease quality of life short form,version 1.3,KDQOL-SF TM1.3）评价治疗前后患者的生活质量。结果 治疗组在升高Alb方面显著优于常规组（P<0.01）,在降低中医证候积分方面显著优于常规组和对照组（P<0.01）,治疗组在升高KDQOL-SF TM1.3量表各维度评分及其总分方面显著优于常规组（P<0.05,或P<0.01）,对照组仅在升高SF 36（KDQOL-SF TM1.3量表维度）评分方面显著优于常规组（P<0.05）。多元逐步回归分析发现年龄、GFR、中医证候积分和Alb对生活质量的影响较大。结论 清肾颗粒联合复方α-酮酸在延缓肾衰竭进展的同时,对CRF湿热证患者生活质量具有较好改善作用。     

慢性心衰中西医结合生存质量量表与SF-36量表的效度对比研究

目的 简明健康状况量表（以下简称SF 36量表）为标准参照,评价慢性心衰中西医结合生存质量量表的效度。方法 采用横断面调查方法,在北京市5家医院内纳入63名慢性心力衰竭住院患者,在患者知情同意基础上采用慢性心衰中西医结合生存质量量表、SF-36量表调查其生存质量,对慢性心衰中西医结合生存质量量表的效度进行评价。结果 相关系数法、逐步回归分析证实慢性心衰中西医结合生存质量量表具有较好的内容效度,因子分析显示其具有良好的结构效度,以SF-36量表作为标准参照显示其具有良好的标准效度（r=0.79,P＜0.01）。结论 慢性心衰中西医结合生存质量量表具有较好的效度,可以作为心衰中西医结合生存质量的评价工具。     

基于经络平衡的电导法经络测量分析方法对慢性肾病的诊断价值研究

目的 基于经络平衡理论,探究电导法经络测量值的分析方法,考察其对慢性肾病的诊断价值。方法 纳入健康人群82例和慢性肾病人群222例,采用电导法测量手足井穴和原穴的电阻值,分别计算原穴阴阳比值、井穴阴阳比值、原穴手足比值、井穴手足比值、原穴左右比值、井穴左右比值,采用接收者工作特征（receiver operating characteristic, ROC）曲线考察两组差异具有统计学意义的比值对慢性肾病的诊断价值。结果 两组人群在井穴阴阳比值、原穴手足比值方面比较,差异具有统计学意义（P<0.05）。ROC曲线显示井穴阴阳比值的曲线下面积（area under curve, AUC）为0.618,95% CI为［0.537,0.699］（P<0.05）,原穴手足比值的AUC为0.727,95% CI为［0.655,0.800］（P<0.01）。井穴阴阳比值的最优切点是1.16,灵敏度为0.64,特异度为0.52,原穴手足比值最优切点是1.04,灵敏度为0.68,特异度为0.72。结论 慢性肾病患者的经络平衡处于阴盛阳衰、上盛下衰状态,基于经络平衡的电导法经络测量分析方法具有较好的临床诊断效能。     

万花油外用结合物理疗法治疗慢性肾衰竭血液透析患者动静脉内瘘血肿48例

目的观察万花油外用结合物理疗法对慢性肾衰竭血液透析患者动静脉内瘘血肿的临床疗效。方法将96例慢性肾衰竭血液透析动静脉内瘘血肿患者随机分为对照组和治疗组,每组各48例。对照组给予冰敷、热敷及红外照射的物理治疗,治疗组在对照组疗法基础上加用万花油,两组均治疗至血肿消失。比较两组患者治疗3d后血肿消退情况、血肿局部疼痛评分情况及治疗结束后随访6个月时的并发症发生情况。结果治疗组血肿消退情况明显优于对照组(P0.05)。两组治疗后内瘘局部血肿疼痛均明显减轻(P0.05),但治疗组治疗后疼痛评分下降程度显著大于对照组(P0.05)。随访6个月后,治疗组患者内瘘血流不足、静脉炎、内瘘狭窄、血栓形成的发生率均明显低于对照组(P0.05)。结论万花油外用结合物理疗法可促进透析患者动静脉内瘘血肿的消退,减轻局部疼痛,减少并发症的发生。     

Subdural Hemorrhage,a Retrospective Review with Emphasis on a Cohort of Alcoholics

Subdural hemorrhage (SDH) is a common cause of death. As external evidence of injury may be absent, an autopsy is frequently needed to detect it. We conducted a 3‐year review of SDH from the New York City Office of Chief Medical Examiner, with emphasis on a cohort of alcoholics. Our study population of 1942 included 1588 alcoholics. Of the alcoholics, c. 8% had SDH (26% of the total number of SDH). Of the alcoholics with SDH, 57% had associated brain injuries. As alcohol intoxication is frequently associated with aggressive and violent behavior, we are concerned that 6% of alcoholics in our review had no autopsy or imaging studies. It is possible that a portion of these may have had a SDH due to an unrecognized inflicted injury. We recommend that autopsies be performed on all alcoholics without a clear cause or mechanism of death.     

Marshall and barbaree's integrated theory of child sexual abuse: A Critique

Abstract

The aim of the current article is to critically examine an extremely influential multi-factorial theory of child molestation, Marshall and Barbaree's (1990) integrated theory. This powerful model was developed as a general theory of sexual offending and used to explain the onset of child sexual abuse in addition to other forms of sexual deviance. Despite its prominent status the adequacy of its basic ideas have never been systematically evaluated. First, I describe the integrated theory in detail and outline its core assumptions. Next, these ideas are subject to critical analysis and I highlight its strengths and weaknesses. Finally, I conclude with some brief comments about the model and the role of theory development in the sexual offending area.     

The Impact of Gender Identity on Female Offending: A Quantitative Assessment Using the BSRI

Despite considerable research showing the importance of masculinity in male offending, the role of gender identity in female offending remains unclear. The current study explores the impact of gender identity on female offending among a sample of 843 college women using the Bem Sex Role Inventory and Multiple Problem Behavior Index. The impact of gender identity on rates of general deviance, as well as behaviors typically in high male and female participation, aggression and self-harming, respectively, were examined. Results found that women with masculine identity were more likely to engage in aggression as well as general deviance broadly. Gender identity was not found to impact rates of self-harming.     

The relationship between adverse childhood experiences,coping using sex,and adult sexual coercion in non-incarcerated,community-based females

ABSTRACT

Adverse childhood experiences have been associated with negative outcomes in adulthood, including sexual offending. Using a cross-sectional design, we investigated whether self-reported adverse childhood experiences related to the perpetration of coercive sexual acts among 250 females recruited from the community. Furthermore, we examined whether sexualised coping mediated any potential relationship between childhood experiences and sexual coercion. A Spearman’s rank order correlation revealed no relationship between adverse childhood experiences and sexual coercion. However, adverse childhood experiences were significantly correlated with sexualised coping, which in turn was correlated with sexual coercion. Additionally, there was a significant but small indirect effect of adverse childhood experiences on sexual coercion through sexualised coping. Findings may help researchers to better understand the causal relationship between childhood experiences, sexual coping, and sexual coercion in females.     

大黄泄浊颗粒保留灌肠对非透析慢性肾脏病肾性骨病湿热证患者骨密度及血清骨形成蛋白-7的影响

目的观察非透析慢性肾脏病(chronic kidney diseases,CKD)肾性骨病湿热证患者腰椎骨密度(bone mineral density,BMD)和血清骨形成蛋白-7(bone morphogenetic protein-7,BMP-7)水平及大黄泄浊颗粒保留灌肠的干预作用。方法将64例非透析CKD 3~5期湿热证患者随机分为治疗组和对照组各32例(结果每组失访2例),并设正常组20例。两组均给予基础治疗,治疗组加用大黄泄浊颗粒保留灌肠,每日1次,疗程均为8周。治疗前后分别观察两组血尿素氮(blood urea nitrogen,BUN),血清肌酐(serum creatinine,SCr)、钙(calcium,Ca)、磷(phosphorus,P)、碱性磷酸酶(alkaline phosphatase,ALP)、甲状旁腺激素(parathyroid hormone,iPTH)、BMP-7水平及第2—4腰椎BMD。结果治疗组临床疗效显著优于对照组(P0.05)。治疗4周末和8周末,两组中医证候积分均较前一时点显著降低(P0.05),且治疗组积分均显著低于对照组(P0.05)。治疗组在降低BUN、SCr和血清P、iPTH、ALP方面,以及在升高血清Ca和肾小球滤过率估算值方面均显著优于对照组(P0.05)。与正常组比较,CKD病例组BMD和BMP-7均显著降低(P0.05);两组治疗后BMD和BMP-7均显著升高(P0.05),而治疗组BMD和BMP-7升高值均显著大于对照组(P0.05)。结论非透析CKD肾性骨病湿热证患者BMD和BMP-7水平均显著低于健康人群;大黄泄浊颗粒保留灌肠可防治非透析CKD肾性骨病,其机制可能与改善肾功能及升高血清BMP-7含量有关。     

84例不同中医证型慢性乙型肝炎患者肝穿刺活检回顾性研究

目的探讨慢性乙型肝炎(chronic hepatitis B,CHB)病理分级与中医证型的关系。方法对84例经彩超引导下行肝穿刺活检的CHB患者的中医证型、肝脏病理分级、临床分级、肝功能指标进行回顾性研究。结果 84例CHB患者中,湿热蕴结证21例,肝郁气滞证34例,肝肾阴虚证7例,瘀血阻络证13例,脾肾阳虚证9例。肝脏炎症活动度与纤维化分期呈明显正相关(r=0.662,P=0.000);临床分级与病理分级呈显著正相关(r=0.556,P=0.000);不同证型CHB患者的病理分级比较,差异无统计学意义(P0.05);不同证型CHB患者血清谷丙转氨酶、谷草转氨酶、直接胆红素水平比较,差异均无统计学意义(P0.05),不同证型患者血清总胆红素水平比较,差异具有统计学意义(P0.05)。结论肝郁气滞证和湿热蕴结证是CHB患者的主要证型,病理分级和肝功能检查尚不能用于CHB的辨证分型。