The Role of Instructional Set on Alcoholic Performance

This study was conducted to determine whether alcoholic and control subjects respond differently to manipulations that either enhance personal involvement (PI) or reduce negative affect (R, relaxation) on tests of neuropsychological function. In Phase 1, 48 male alcoholics and 36 male control subjects completed neuropsychological tasks under standard instructional sets. In Phase 2, subjects completed equivalent forms of these tests under one of three randomly assigned conditions; the PI condition in which subjects were encouraged to identify specific ways of improving their performance, the R condition in which subjects participated in a short relaxation exercise designed to reduce anxiety, or a No Treatment (NT) condition in which no attempt to manipulate the subjects' involvement or affect was made. Alcoholics were inferior to controls in both Phase 1 and Phase 2 [Fs (1,82) > 5.03, ps < 0.03]. The experimental manipulation differentially affected measures of negative affect and effort in the predicted direction. There were no group x condition interactions. Alcoholic and control subjects responded comparably to the experimental manipulations. This investigation, in combination with others using related manipulations, reinforces the hypothesis that alcohol-related cognitives dysfunction reflects an underlying deficit in brain states.     

女性乳头湿疹样癌与乳腺癌浸润乳头之间区别的探讨

本文对１９８０～１９８２年间．天津肿瘤医院收治可手术原发女性乳腺癌７１５侧重新复习。根据镜下在乳头皮肤见到ｐａｇｅｔ细胞以及癌直接浸润（或累及）乳头，确定乳头湿疹样癌２０例，乳腺癌浸润乳头６９例。比较两组在临床表现、病理形态和预后的差异。结果发现，乳头湿疹样癌的临床表现以乳头糜烂，结痂为主，而乳腺癌浸润乳头则以乳头凹陷、皮肤粘连、桔皮样变和乳头抬高为主；镜下形态，乳头湿疹样癌主要是在乳头表皮内见到Ｐａｇｅｔ细胞，晚期亦可浸及乳头基质。乳腺癌浸润乳头主要特点是癌细胞浸润乳腺导管，管壁可完整或被浸破，癌亦可直接浸润乳头基质，绝大多数皮肤正常，直接累及皮肤少见，均无Ｐａｇｅｔ细胞。通过本文研究，作者认为乳头湿疹样癌为乳腺癌的独立类型，其在临床表现、病理形态及预后等方面，均与乳腺癌浸润乳头有显著区别。     

狼疮性肝损害的临床和免疫学特点(附32例临床分析)

目的：研究系统性红斑狼疮（ＳＬＥ）性肝损害的发生率,临床表现及免疫学特点,方法：对符合ＳＬＥ诊断的５２０例病人的肝损害进行回顾性调查分析。结果：５２０例病人中狼疮性肝损害者有３２例（６．１％）,其中７５％病人无肝损害的临床症状,主要表现为轻、中度的转氨酶升高,４例出现黄疸;狼疮性肝损者血清抗核糖体Ｐ蛋白抗体（抗Ｒｉｂ－Ｐ）阳性率显著高于无肝损者,而ＡＮＡ、抗Ｓｍ抗体、抗ｄｓＤＮＡ抗体等自身抗体阳性     

浙江省某医院护士家庭关怀对其工作投入的影响

目的：探讨浙江省某医院护士家庭关怀度对其工作投入的影响.方法：对浙江省某医院护士的家庭关怀度和工作投入情况进行问卷调查,采用Pearson相关分析法和分层回归分析法探讨两者间的关系.结果：家庭关怀度总分为（5.89±1.12）分,工作投入总分为（85.95±9.54）分;家庭关怀度各因子与工作投入各因子均显著正相关（P＜0.05）;分层回归分析显示,职称、家庭结构及家庭关怀度中的合作度、适应度、亲密度、成长度和情感度均为护士工作投入水平的影响因素.结论：家庭关怀度是影响护士工作投入的重要因素.     

Nipple-sparing Mastectomy in Breast Cancer: From an Oncologic Safety Perspective

Objective:

To evaluate the oncologic safety of nipple-sparing mastectomy (NSM) for breast cancer patients based on current literature.

Data Sources:

A comprehensive literature search of Medline, Embase databases was conducted for studies published through March 2014.

Study Selection:

Our search criteria included English-language studies that focused on NSM at nipple-areola complex (NAC) involvement, patient selection, and recurrence. Prophylaxis NSM, case series or reports that based on very small population were excluded. In the end, 42 studies concerning NSM and oncological safety were included into the review.

Results:

NSM is a surgical procedure that allows the preservation of the skin and NAC in breast cancer patients or in patients with prophylactic mastectomy. However, the oncologic safety and patient selection criteria associated with NSM are still under debate. The incidence of NAC involvement of breast cancer in recent studies ranges from 9.5% to 24.6%, which can be decreased through careful patient selection. Tumour-nipple distance, tumour size, lymph node involvement and molecular characteristics can be evaluated preoperatively by clinical examinations, imaging studies and biopsies to predict the risk of NAC involvement. Currently, there is no available standard protocol for surgical approaches to NSM or pathological examination of NSM specimens. The local recurrence (ranges from 0% to 24%) of NSM is not significantly higher than that of traditional mastectomy in selected patients based on long-term follow-up. The role of radiotherapy in NSM is still controversial and is not universally accepted.

Conclusions:

NSM appears to be oncologically safe following careful patient selection and assessment of margins.     

Right ventricular involvement in anterior myocardial infarction: a tissue Doppler-derived strain and strain rate study

OBJECTIVE:

Strain and strain rate imaging is currently the most popular echocardiographic technique that reveals subclinical myocardial damage. There are currently no available data on this imaging method with regard to assessing right ventricular involvement in anterior myocardial infarction. Therefore, we aimed to evaluate right ventricular regional functions using a derived strain and strain rate imaging tissue Doppler method in patients who were successfully treated for their first anterior myocardial infarction.

METHODS:

The patient group was composed of 44 patients who had experienced their first anterior myocardial infarction and had undergone successful percutaneous coronary intervention. Twenty patients were selected for the control group. The right ventricular myocardial samplings were performed in three regions: the basal, mid, and apical segments of the lateral wall. The individual myocardial velocity, strain, and strain rate values of each basal, mid, and apical segment were obtained.

RESULTS:

The right ventricular myocardial velocities of the patient group were significantly decreased with respect to all three velocities in the control group. The strain and strain rate values of the right mid and apical ventricular segments in the patient group were significantly lower than those of the control group (excluding the right ventricular basal strain and strain rate). In addition, changes in the right ventricular mean strain and strain rate values were significant.

CONCLUSION:

Right ventricular involvement following anterior myocardial infarction can be assessed using tissue Doppler based strain and strain rate     

硬膜外两间隙麻醉对兰尾炎手术脐部牵涉痛的影响

目的：观察硬膜外两间隙麻醉对兰尾炎手术脐部牵涉痛的抑制效果。方法60例ASAⅠ～Ⅱ级硬膜外麻醉下兰尾炎手术病人随机分为两间隙麻醉（A组）和-间隙麻醉（B组）两组，每组30例。A组与T12～L1和T9～T10分别给予1．8％的利多卡因18ml和1％的利多卡因8ml。B组与T12～L1给予1．8％的利多卡因20ml，麻药中加入1：20万的肾上腺素。术中吸氧，监测MAP、HR、RR、SPO2；观察脐部牵涉痛（VAS）程度，麻醉范围（T～L）以及辅助镇痛药等情况。结果两组MAP、HR、RR、SPO2无显著变化；A组脐部牵涉痛（VAS）评分（2．8±0．8）与B组（6．6±1．6）比较，P〈0．05。麻醉范围A组（T5～L2）与B组（T8～L2）比较，P〈0．05。辅用镇痛药A组【4例（13．3％）】与B组【14例（46．6％）】比较，P〈0．05。结论硬膜外两间隙麻醉使麻醉阻滞范围扩大，从而有效减轻了阑尾炎手术时脐部牵涉痛的程度，且无明显不良反应发生。     

Angiomyolipoma of the kidney with lymph node involvement in a 17-year old female mimicking renal cell carcinoma: A case report

Angiomyolipoma with extrarenal involvement is very uncommon. Herein we report a case of angiomyolipoma with lymph node involvement in a 17-year-old female. The diagnosis and treatment of the case is discussed.     

动脉闭塞性疾病血管内急诊介入治疗临床研究

目的评价探讨动脉闭塞（包括动脉栓塞和动脉狭窄伴血栓形成）疾病急诊介入治疗的临床意义。方法①导管内灌注尿激酶等溶栓药物或留置导管持续溶栓治疗；②机械导管碎栓负压抽吸伴药物溶栓治疗；③对局限狭窄采取经皮球囊扩张（PTA）和支架成形术。其中锁骨下动脉1例，骼动脉6例，股动脉5例，胭动脉2例，胫前、胫后及腓动脉和足部动脉2例。结果咒～（球囊扩张成形）或支架置入术后狭窄段的血管腔复通率100％，溶栓术后，血栓完全或大部分消失。患肢远端血运明显改善或恢复，临床症状好转或消失。DSA或B超随访，动脉均保持通畅。其中1例介入术后1周，因高血压病脑干出血死亡；3例脉管炎血栓坏疽者；2例截肢。结论采用急诊机械性和药物性溶栓术，结合PTA和支架治疗动脉闭塞性疾病，可有效地解除动脉闭塞，降低截肢率和致残率。     

支气管动脉解剖与介入放射学治疗中晚期肺癌疗效评估

目的研究支气管动脉解剖，提高介入放射学治疗中晚期肺癌疗效水平。方法对100例中晚期肺癌，经256次支气管动脉数字减影进行回顾性总结。结果多数支气管动脉为左右各两支，共干较常见，右上及右下共干显现率较高。左右共干、肋间共干多见，左至右上、下共干少见，肺内可交叉分布。结论支气管动脉解剖学概念，根据支气管动脉数字减影所见，并非为机械性解剖学概念，有极大的变异性。应提高认识，有利于介入放射学发展和水平的提高，对中晚肺癌介入治疗效果的提高具有十分重要意义。