VALIDITY AND RELIABILITY OF MEASURES OF OCCUPATIONAL AND ROLE STRESS USING SAMPLES OF AUSTRALIAN MANAGERS AND PROFESSIONALS

Reviews of the literature show that there is inadequate attention to the development of appropriate measures for the impact of stress on women's health. The present study sought to (1) construct a new measure of occupational role stress which sourced categories of stress in the broad range of experienced female roles; (2) assess the validity and reliability of the new measure; (3) obtain discriminant validity with reference to another measure of occupational stress (the Occupational Stress Indicator); and (4) report on demographic differences in occupational stress. Two hundred and forty working managerial and professional women from different industries, educational backgrounds and marital and parental status took part in the study. Results of analyses revealed that the new role stress measure had good validity and internal consistency (reliability) and that it could be discriminated from other measures of occupational stress. Four scales were derived in exploratory factor analyses: organizational and task grievances, role conflict and self-misgivings, role excess and overload, responsibilities and commitments. Analyses of these factors by demographic variables such as marital status, education and number of children suggest that marriage and family were not a major stressor and in some cases were actually a positive feature of job satisfaction. The most significant factors in women's stress were those which appeared to come from their own desires and wants—to be promoted.     

眼部整形美容的现状和前景

眼部整形美容是整形美容外科医疗范围内最为常见的手术,就发展而言,眼部整形美容还是整形美容外科最具有研究和发展前景的领域之一.同时,眼部整形美容又是整形美容外科发生并发症最多的手术,也是常见的用虚假名词做广告的一类手术.因此,每位整形美容外科医师应坚持正确方向,应十分重视眼部的整形美容的研究工作和临床实践.     

COMPARISON OF THE ANAESTHETIC AND HAEMODYNAMIC EFFECTS OF CHLORMETHIAZOLE AND THIOPENTONE

Two groups of eight women (60 – 85 yr) undergoing gynaecologicaloperations of 50 to 130 min duration were compared. Anaesthesiawas induced with either thiopentone (mean 4.5mg kg^–) orchlormethiazole(mean 6.0 ing kg^–1) and maintained withnitrous oxide and pethidine in combination with the drug usedfor the induction. The hourly maintenance dose and the plasmaconcentration determined at equilibrium were greater for chlormethiazole(means 4.7mg kg^–1 h^–1 and 27(µmol litre^–1)compared with 1.3 mgkg ^–1h ^–1 (P< 0.01) and 16µmollitre^–1 respectively for thiopentone (P< 0.02). Impedancecardiography showed that cardiac output was decreased by 30–40%in the thiopentone group (P < 0.01), whereas ho significantchange was observed in the chlormethiazole group. Chlormethiazoleanaesthesia was followed by a significant increase (P<0.02)in stroke volume. No correlations were found between the plasmaconcentrations and changes in the haemodynamic indices for eitherof the drugs.     

低温性血管收缩的机制及防治措施的研究

目的 探讨低温性血管收缩的机制和防治措施。方法 采用内皮细胞培养,扫描电镜,离体血管舒缩功能实验技术,观察血管低温性收空与内皮细胞释放血管舒缩因子的关系。结果 低温使内皮完整或去内皮血管环均明显收缩,务砭张力随着温度的下降而增高,去内皮后血管低温性收缩减弱。低温组牛主动脉内皮细胞茶件培养液能使离体大鼠颈总动脉环产生明显收缩反应,提示牛主动脉内皮细胞向培养液向释放了血管收缩因子。３７℃复温或血管舒张     

骨膜成骨细胞的分离培养及其成骨作用的放射自显影研究

取４只家兔胫前骨膜进行成骨细胞分离培养，用３Ｈ－ＴｄＲ标记，然后回植于同一供体的皮下、耳软骨缺损处及挠骨缺损处。分别在２周和４周后处死动物，原位取材，用放射自显影方法观察种植细胞的转归。结果表明，种植的细胞在皮下转化为类骨组织；在软骨缺损处转化为软骨组织；而在骨缺损处则转化为典型的骨组织。提示用骨膜分离培养成骨细胞，回植体内，有可能用于骨缺损和软骨缺损的修复。     

COMPARISON OF THE SEDATIVE AND AMNESIC EFFECTS OF MIDAZOLAM AND PROPOFOL

We have compared the sedative and amnesic effects of midazolamand propofol in 35 volunteers. Sedation was measured by simplereaction time immediately before and after a bolus injectionand 1 h after the commencement of a subsequent continuous infusion.Memory was measured three times using two memory tests: perceptualfacilitation provided an implicit memory measure and recognitionprovided an explicit memory measure. Propofol and midazolamhad similar sedative effects both immediately after bolus dosesand after 1 -h continuous infusions of the drugs. In contrast,midazolam had a more profound amnesic effect than propofol onthe recognition memory test. The drugs had little effect onperformance with the implicit memory test. Performance on thememory tests was unrelated to sedation. (Br. J. Anaesth. 1993;70: 612–616)     

甲状腺癌诊断和治疗的现状与展望

随着医疗技术的提高 ,癌瘤普查的开展以及检测手段的改善 ,其发现率有明显增加 ,在肿瘤专科医院中 ,甲状腺癌占头颈部肿瘤的首位 ,但在人体全部恶性肿瘤中仅占 0 .86% ,加上甲状腺癌中 75%以上为分化性癌 ,其恶性程度低 ,病程发展慢 ,早期易被忽视 ,以致延误诊断 ,影响预后。另一方面 ,分化性甲状腺癌手术方式虽不同 ,但短期疗效 ( 5年生存率 )却无显著差异。因而长期以来国内外学者对于甲状腺癌的手术方式、切除范围、术后放疗 /化疗的应用均有争论。其实这是一认识与技术水平的差异 ,所得出的结论必然会不一致。鉴于此 ,本期重点之一为甲…     

胰腺十二指肠损伤的诊治体会

目的探讨胰腺、十二指肠损伤的诊断及治疗经验。方法回顾性分析45例胰腺、十二指肠损伤患者,包括26例胰腺损伤、13例十二指肠损伤及6例胰十二指肠复合伤的临床资料。结果45例患者中33例（73．3％）合并伴发伤;CT诊断符合率为72．7％（8／11）;4例保守治疗,41例行手术治疗;共21例（46．7％）出现并发症,其中胰瘘9例;治愈38例（84．4％）,7例死亡（15．6％）。结论本病早期诊断困难,伴发伤多,并发症发生率及死亡率高。剖腹探查是诊断胰十二指肠损伤的主要方法,根据损伤部位、程度及全身情况选择合理术式,术后积极防治并发症是提高治愈的关键。     

手前臂背侧复合软组织缺损的修复与功能重建

目的探讨手及前臂背侧复合软组织缺损的修复与功能重建. 方法 2001年5月～2003年11月,对8例前臂及手部背侧复合软组织缺损患者一期采用胸腹部带蒂皮瓣修复缺损,二期采用肌腱移位加多条同种异体肌腱移植重建伤手功能,皮瓣范围为9 cm×15 cm～12 cm×38 cm,异体肌腱移植最多6条. 结果术后8例皮瓣均成活,外形好,异体肌腱移植效果满意,伤手功能恢复良好. 结论胸腹部带蒂皮瓣加多条同种异体肌腱移植修复手及前臂背侧复合软组织缺损,具有损伤小、皮瓣外形好、方法简便及伤手功能恢复满意等优点.     

大鼠及人肝枯否细胞的分离纯化和培养

目的 改进大鼠肝枯否细胞分离、纯化和培养技术,探讨从人体肝脏手术标本中分离、纯化和培养枯否细胞的可行有效方法.方法 32只SD大鼠肝脏及9例人体肝脏手术标本用于本实验.大鼠肝脏经门静脉、人体肝组织通过肝静脉灌注预灌流液,灌注后肝脏标本采用离体胶原酶灌注消化获得细胞悬液,差速离心获得富含KC的肝非实质细胞.改传统PBS重悬肝非实质细胞为25%percoll重悬,形成新percoll梯度由上向下为:PBS、含肝非实质细胞的25%percoll、50%percoll,不连续密度梯度离心分离获得枯否细胞,最后选择性贴壁进一步纯化.应用吞噬功能实验对KC进行鉴定,台盼蓝拒染实验判定细胞活力.结果 最终获得的枯否细胞的产量分别为:大鼠3.1±0.5×106/g肝脏,人体肝脏组织为2.3±0.4×106/g肝脏,细胞活力和纯度均达90%.结论 本实验建立的大鼠及人体肝脏枯否细胞分离方法,简便经济,效果稳定,获得的枯否细胞可用于进一步的实验研究.     

穿支皮瓣在组织器官缺损修复和再造中的应用

目的介绍5种穿支皮瓣在乳房、舌等器官再造,肿瘤切除或外伤等缺损修复中的应用。方法2005年6月～2006年6月,应用游离或带蒂的穿支皮瓣修复组织缺损和器官再造31例。其中采用股前外侧穿支皮瓣（anterolateral thigh flap,ALT）修复头颈部恶性肿瘤16例,包括恶性黑色素瘤9例,鳞癌4例,基底细胞癌2例,恶性纤维组织细胞瘤1例;肿瘤累及舌并行3/4舌切除再造舌3例;最大供瓣范围为26cm×15cm。腹壁下动脉系统穿支皮瓣（deep inferior epigastric perforator flap,DIEP）乳房再造10例,游离横形腹直肌肌皮瓣（free transverse rectus abdominis myocutaneous flap,FTRAM）2例,其中9例为单侧,3例为双侧;择期再造9例,即期3例,即期再造者行保留皮肤的乳腺切除术。臀上动脉穿支皮瓣（superior gluteal artery perforator flap,SGAP）、臀下动脉穿支皮瓣（inferior gluteal artery perforator flap,IGAP）再造乳房各1例。胫后动脉比目鱼肌带蒂穿支皮瓣（posterior tibial artery perforator flap,PTA）15cm×5cm修复小腿中下段缺损6cm×4cm伴骨外露1例。供瓣区直接缝合27例,3例ALT皮瓣和1例PTA皮瓣应用刃厚皮片覆盖供瓣区。结果应用游离皮瓣30例,带蒂皮瓣1例。皮瓣完全坏死1例,为ALT皮瓣修复肿瘤切除后颈部缺损,吻合血管为旋股外侧动脉降支与甲状腺上动脉,术后6d行坏死皮瓣清除,应用右侧胸大肌肌瓣加游离植皮术修复创面。1例双侧DIEP者部分脂肪液化,2例FTRAM乳房再造者术后2周腹部疼痛。PTA带蒂皮瓣远端静脉回流障碍,皮瓣远端2cm×1cm坏死,经换药愈合。所有患者获随访3～6个月,余各皮瓣成活良好,质地柔软,供区无并发症,供区植皮均成活。结论尽管穿支皮瓣存在血管变异,对解剖及手术操作技术要求高等不足,但在修复重建外科中仍代表最重要的进步,能以最小的供瓣区代价达到最高效的修复再造。     

脐血间充质干细胞的分离扩增及向成骨及脂肪细胞的分化

目的探讨新生儿脐血间充质干细胞（mesenchymal stem cells，MSCs）体外分离、纯化、扩增，以及向成骨及脂肪细胞定向诱导分化的方法与条件。方法无菌条件下收集新生儿脐血60～120ml，枸橼酸钠抗凝，以Ficoll—Hypaque淋巴细胞分离液密度梯度法、沉降红细胞后密度梯度法及CD34^＋免疫磁珠负选法分离单个核细胞（mononuclear cells，MNCs）。分离获得的MNCs采用L—DMEM培养基或Mesencult^TM培养基／10％胎牛血清进行MSCs培养传代，获得第3代集落生长细胞作流式细胞仪表面抗原测定，并向成骨及脂肪细胞定向诱导分化，成骨细胞钙沉积经茜素红染色鉴定，脂肪细胞胞浆油滴经油红染色鉴定。结果经沉降红细胞后分离的MNCs，使用Mesencult^TM培养基／10％胎牛血清培养成功率高，第3代可出现明显的集落生长，而另两种方法分离培养的细胞则难以形成集落；集落细胞表面抗原测定表达CD29、CD59、CD71而不表达CD34、CD45及HLA—DR等分子。成骨定向诱导分化的集落细胞经茜素红染色胞浆中出现有大量的钙沉积；成脂肪定向诱导分化的集落细胞油红染色示胞浆充满油滴空泡。结论新生儿脐血中可分离出MSCs，并可在体外进行培养扩增。以甲基纤维素沉降红细胞后密度梯度离心分离的MNCs培养较为有效，集落细胞表达基质细胞表面抗原，能够向成骨细胞及成脂肪细胞定向诱导分化。     

COMPARISON OF THE EFFECTS OF PANCURONIUM AND TUBOCURARINE ON DIFFERENT MUSCLES OF YOUNG AND OLD MICE

In order to evaluate the sensitivity of different muscle typesto neuromuscular blocking drugs, a system using mouse musclesin vitro was developed and applied to detect changes in drugsensitivity in relation to age. The effect of pancuronium andtubocurarine on initial twitch and on the ratio of fourth twitchto first twitch (T4/T1) of a train-of-four at 2 Hz were comparedin fast-twitch, slow-twitch and respiratory muscles in the mouse.The muscles used were: extensor digitorum longus (EDL), soleus(SOL) and diaphragm (DIA). For both drugs the order of decreasingsensitivity was EDL > SOL > DIA. This result was the samewhether first twitch or T4/T1 was used, although the latterwas a more sensitive indicator. The sensitivity of neuromuscularblock was less in muscles from old (30–33 month) animalsthan in the equivalent muscles from young (8–12 month)animals.     

两种胆道重建术犬模型的建立及近期疗效比较

目的　探讨肝管胆囊吻合术 (hepaticocholedochostomy,HC)和肝管空肠吻合术 (hepaticojejunostomy,HJ)两种胆道重建术的动物模型建立方法 ,并比较其近期疗效。方法　健康成年杂种犬 2 9只 ,随机分为对照组 (5只 )和不全梗阻模型组 (2 4只 )。不全梗阻 7周后随机分为 HC组 (n=12只 )和 HJ组 (n=12只 ) ,分别实施 HC和 HJ。观察其术中情况及术后 1个月疗效。　结果　不全梗阻后肝管直径明显扩张 ;HC组手术时间、术中出血量及术后 1个月体重下降均低于 HJ组 ,差异有统计学意义 (P<0 .0 5 ) ;HC和 HJ术后 1个月时 ,肝功能各项指标均恢复正常。　结论　在不全梗阻的基础上建立胆道重建动物模型是可行的 ;HC较 HJ术中损伤小 ,术后恢复好。     

急性胃粘膜病变的诊治现状与展望

急性胃粘膜病变(ａｃｕｔｅｇａｓｔｒｉｃｍｕｃｏｓａｌｅｓｉｏｎ,ＡＧＭＬ)系指机体在严重创伤、感染、休克等应激状态下,发生以胃粘膜损害为主的病理改变和上消化道出血为特征的临床病征。临床上曾有许多不同命名,如急性出血性胃炎,急性糜烂性胃炎,急性药物性胃炎,急性胃十二指肠溃疡,应激性胃炎,应激性溃疡等。目前认为,从病理学的角度,将各种应激因素引起的急性胃粘膜损害和浅表性溃疡统称为ＡＧＭＬ更为合适。但“应激性溃疡”一名,人们熟知并使用已久,冠以“应激”一词反而比较能够反映其病因和发病机理,现许多文献仍沿用“应激性…     

STRUCTURE AND QUANTIFICATION OF A PHYSIOLOGICAL MODEL OF THE DISTRIBUTION OF INJECTED AGENTS AND INHALED ANAESTHETICS

Mapleson's (1973) physiological, circulation-time model of thedistribution of inhaled anaesthetics has been elaborated tobe suitable for modelling agents in which hepatic metabolismand renal excretion are important factors; as well as the obviousimprovement of providing separate compartments for liver andkidney, the arterial and portal supplies to the liver are separatelyrepresented, as is the portal blood pool. The separate portalpool also leads to a more realistic total circulation time forthe majority of the cardiac output. The quantification for a"standard man" is fully documented and makes use of the latest(1975) report of the International Commission on RadiologicalProtection, Reference Man, and includes data on the water, fatand protein composition of each tissue compartment. Suggestionsare included on adapting the quantification to non-standardmen and to other species.