非瓣膜性心房颤动合并重度三尖瓣反流的危险因素分析

目的:探讨非瓣膜性心房颤动(NVAF)合并重度三尖瓣反流(TR)患者的临床特征及危险因素。方法:连续入选2016年1月至2019年12月就诊于我院的290例合并TR的NVAF患者,87例NVAF合并重度TR患者为重度TR组,男性35例,平均年龄(73.5±9.0)岁;203例NVAF合并轻-中度TR患者作为对照组,男性114例,平均年龄(66.2±10.9)岁。比较两组的临床特征,采用Logistics回归分析评估重度TR的危险因素。结果:290例NVAF患者中,30.0%合并重度TR,41.0%合并中度TR,29.0%合并轻度TR。与对照组相比,重度TR组年龄大[(73.5±9.0)岁vs(.66.2±10.9)岁]、心房颤动病程长[4.5(2.0,10.0)年vs.3.0(2.0,7.0)年]、心功能差、持续性心房颤动(96.6%vs.73.4%)及女性(59.8%vs.43.8%)比例高,同时心房扩大、肺动脉压升高及二尖瓣反流更明显(P均<0.05)。Logistics多因素回归分析显示,重度TR与年龄(OR=1.060,95%CI:1.020~1.102)、女性(OR=4.727,95%CI:1.977~11.306)、持续性心房颤动(OR=6.873,95%CI:1.419~33.297)、右心房左右径(OR=1.202,95%CI:1.117~1.293)相关(P均<0.05)。右心房左右径≥45.5 mm可预测重度TR,诊断敏感度为0.712,特异度为0.697;ROC曲线下面积为0.763(95%CI:0.696~0.831,P<0.001)。结论:NVAF合并重度TR的危险因素包括老年、女性、持续性心房颤动、右心房左右径扩大。     

Attentional Bias in specific symmetry and cleaning dimensions of obsessive-compulsive disorder

Attentional bias (AB) refers to increased allocation of attention on threat stimuli when compared to neutral stimuli. It is not clear if AB occurs in subjects with obsessive-compulsive disorder (OCD). We tested AB for symmetry and cleaning symptoms of OCD. Sixty-two patients with OCD and 40 healthy controls matched by gender, age and IQ, completed a computerized dot-probe task where two pictures (with symmetry or cleaning related content) were shown. The probe appeared in the location previously occupied by one of the pictures. Within-subjects linear mixed-effect models were used to investigate the effects of the factors: group (patients vs controls), OCD dimension (cleaning vs symmetry), task condition (neutral, congruent and incongruent), and the interaction among them. We also correlated AB scores with the clinical and demographic variables. No positive interaction resulted among the factors, but positive results were observed in group and condition, separately. Patients were significantly slower than controls (p-value = 0.014) (an effect that was accounted for by depression and anxiety symptoms and comorbidity) and the neutral condition was significantly faster when compared the other two conditions (congruent and incongruent, p-value = 0.013). No association was found between AB scores and clinical symptoms. There was no AB toward specific, content-related, stimuli in this sample of OCD patients.     

牙列重度磨耗患者咬合重建前、后颞下颌关节的线性测量

目的 对牙列重度磨耗患者垂直距离进行恢复后,研究颞下颌关节间隙与垂直距离增高之间的相关性,探讨恢复髁突位置对咬合重建的影响。方法 纳入 30 例牙列重度磨耗行咬合重建的患者,在恢复垂直高度前后,对其双侧的颞下颌关节进行锥形束CT（cone-beam CT,CBCT）扫描,测量颞下颌关节前、上、后间隙大小,分析髁突位置;比较垂直距离恢复前、后的关节间隙等指标,分析患者恢复垂直距离前、后髁突位置的变化。采用SPSS 19.0软件包对颞下颌关节前、上、后间隙进行统计学分析。结果 30 例牙列重度磨耗患者颞下颌关节各间隙两侧之间差异无统计学意义（P>0.05）,故将两侧颞下颌关节间隙合并统计。治疗前关节前、上、后间隙分别为（2.01±0.52）mm、（3.15±0.94）mm、（2.70±0.98）mm;治疗后关节前、上、后间隙分别为 （2.03±0.35）mm、（3.46±0.74）mm、（2.79±0.58）mm。通过计算 In（P/A）值和线性比率（linear ratio,LR）得出重度磨耗患者治疗前 52%髁突前移位;咬合重建治疗后,治疗前髁突前移位的患者复位率达 86.7%。结论 重度磨耗患者除了恢复其垂直距离外,还应诱导髁突回到正常位置,避免产生关节症状。