乳房根除术对乳腺癌妇女人格影响的多因素Logistic分析

目的研究影响乳腺癌妇女心理障碍和人格障碍的潜在危险因素,为心理干预和临床治疗提供理论依据.方法乳腺癌妇女心理状态和人格评定采用临床晤谈、MMPI和生活事件量表以及基本情况问卷的方法和途径,以SPSS10.0软件为工具进行统计学处理.结果多因素logistic分析研究发现,乳房根除术使Ma量表得分显著降低,OR=0.22(P=0.01); 却使Si量表增高,OR=2.77(P= 0.03).同时Ⅱ期乳腺癌Ma量表降低,与Ⅰ期相比OR=0.61(P<0.05); Ⅲ、Ⅳ期乳腺癌Ma量表增高,OR=2.89和1.99(P<0.05);患病前身体状况良好的患者Ma量表增高,OR=3.53(P=0.003).而乳房根除术对MMPI其它任何量表的分值没有影响;其它因素如乳腺癌左右分布位置,婚姻状况、婚姻质量等因素对MMPI的结果没有影响.结论乳房根除术可使乳腺癌妇女产生严重的心理障碍,使其人格特点发生改变,即使MMPI量表的Ma量表降低,Si量表升高.这些危险因素有助于我们预防和识别乳腺癌患者的心理障碍和人格障碍,以便提供有效的心理支持.     

影响老年髋部骨折患者围术期及术后生存期的高危因素分析

目的：分析影响老年髋部骨折患者围术期及术后生存期的高危因素。方法对2010年11月至2013年11月进行手术治疗的97例老年髋部骨折患者的临床资料回顾性分析，分析高危因素，包括：性别、年龄、髋部骨折类型、术前合并内科疾病及数目、麻醉方式、手术时机、ASA分级、围术期内输血量、术后并发症、术后下地负重时间及出院时间。所有患者进行电话随访2年或随访至患者死亡，记录患者的生存情况及死亡的原因。采用Logistic回归分析各高危因素与围术期并发症及术后2年死亡率的相关性。结果年龄（ P＝0．040，OR＝8．317）、术前合并症（ P＝0．001，OR＝14．872）、手术时机（ P＝0．042，OR＝6．270）、ASA分级（P＝0．034，OR＝12．299）、输血量（P＝0．049，OR＝4．650）及下地负重时间（P＝0．001，OR＝16．752）差异有统计学意义（P＜0．05），是影响围术期并发症的高危因素；年龄（P＝0．047，OR＝5．374）、术前合并症（P＝0．001，OR＝17．324）及ASA分级（P＝0．02，OR＝13．491）差异有统计学意义（P＜0．05），是影响术后2年生存率的高危因素。结论对于老年髋部骨折患者，加强围术期的管理，术前全面系统评估，积极治疗合并症，制定适宜的手术方案，术后采取有效的预防和控制并发症的措施，争取早期下地活动，能提高手术疗效。     

双相障碍与单相抑郁防御机制与人格特征的关系

目的：通过防御机制和MMPI测试的研究发现双相障碍与单相抑郁两组疾病的异同。方法：对37例双相障碍患者和31例单相抑郁患者进行防御机制（DSQ）和明尼苏达多相人格测定（MMPI）,并进行相关分析。结果：MMPI两组在量表HY（t=2．033,P〈0．05）、PT（t=2．371,P〈0.05）、SC（t=2．545,P〈0．05）、Ma（t=2．648,P〈0．05）,PD（t=3．101,P〈0．01）,双相障碍组高。DSQ与MMPI相关分析,双相障碍组MMPI中的Pa、Pt、Sc、Ma、Si分与不成熟因子显著正相关,与成熟因子负相关,而单相抑郁组仅有Pa、Sc、Ma与不成熟因子极显著负相关。结论：双相障碍组发病年龄更早,与单相抑郁比有人格特征的区别,表现的更不成熟、更不稳定,这与他们较多使用不成熟防御机制、较少使用成熟防御机制可能有关。     

乳腺癌乳房Ⅰ期再造治疗中的心理状况观察

目的探讨乳腺癌根治术后乳房Ⅰ期再造治疗中的心理状况变化。方法对2003年9月～2004年12月26例行乳腺癌乳房Ⅰ期再造治疗及全身辅助治疗的患者，在术后随访期闻进行心理状态调查分析，随机抽取符合相似条件同期进行乳腺癌改良根治术患者进行心理状态对照研究。结果随访1年所有病例均无局部复发，26例乳房再造美容效果良21例，中5例。有5例（19％）乳房再造术后患者存在不同形式的心理障碍，对照组有20例（77％），2组差异有显著意义（P〈0．01）。其中对肿瘤复发恐惧感，再造组4例，对照组3例，2组差异无显著意义（P〉0．05）。结论乳房切除术后的女性患者较普遍存在心理缺失。乳腺癌根治术乳房Ⅰ期再造治疗替代改良根治术治疗无法保留乳房的女性患者，不但能取得满意的美容效果．而且能维护患者的心理健康，提高生活质量。     

农村节育妇女节育措施认知现状及其心理健康状况的调查

目的 探讨农村节育妇女对不同节育措施的认知状况及其心理健康状况间的关系。方法 采用自拟节育妇女对节育措施认知状况问卷和症状自评量表（SCL－90）对济宁市农村465例节育妇女进行问卷调查。结果 放环和结扎者对节育所持态度不同（X^2＝6．119，P＝0．047），对节充有无危害的认识程度亦不同（X^2＝69．885，P＝0．000）；节育方式对节育妇女的性欲有一定影响（X^2＝4．905，P＝0．027）；对节 育有无危害认识程度不同的妇女性欲下降发生率不同，而且不同认识程度的妇女心理健康状况具有显著性差异。结论 加强计划生育宣传工作，普及有关生殖保健科学知识，并加强绝育妇女的心理支持。     

慢性酒精中毒患者人格特征对照研究

为探讨慢性酒精中毒形成的心理原因，对54例慢性酒精中毒者（研究组）和54例正常者（对照组）进行MMPI调查比较。结果显示研究组人格偏离等分量表分数明显增高，MMPI剖析图为4．7．1图形，而对照组则呈常态分布。研究发现慢性酒精中毒者具有较明显的人格特征方面的异常。     

颞下颌关节综合征患者人格、应对与唾液中IgA含量的研究

目的：研究颞下颌关节综合征患者的人格，应对方式与免疫功能的关系。方法：采用明尼苏达多项人格调查表（MMPI），生活事件量表，特质应对问卷对确诊患者31例和匹配对照组30例进行个别心理测验，以放射免疫法测定两组被试唾液中IgA含量。结果：颞下颌关节综合征患者MMPI诸指标明显高于正常对照组（P＜0．05，P＜0．01），其中有10例患者的临床量表高于全国常模正常值，患者组的正性生活事件明显低于对照组，负性生活事件明显高于对照组（P＜0．05，P＜0．01），患者组正性应对方式得分低于对照组，负性应对方式得分高于对照组（P＜0．05），患者组唾液中IgA含量明显低于对照组（P＜0．05），结论：颞下颌关节综合征患者所具有的人格偏离，不良生活事件和负性应对导致的更强，更持久的应激与免疫功能紊乱是疾病的重要原因。     

整形美容手术接受者50例心理状态解析

目的：探讨整形美容手术对受术者心理状态的影响。方法：采用焦虑自评量表、抑郁自评量表、自尊量表、体像障碍自评量表及艾森克人格问卷的方法，对50例受术者进行问卷调查，并进行结果分析。结果：在50例整形美容受术者中，术前焦虑、抑郁状态者分别为57％和27％。受术者术后自尊量表分值较术前上升2．631（P＜0．01），体像障碍及精神质量表、神经质量表和掩饰程度分值分别下降6．131（P＜0．01）、1．966（P＜0．05）、3．458（P＜0．01）和2．829（P＜0．01）。术前受术者体像障碍与抑郁状态相关性r＝0．193（P＜0．05），回归方程为y＝0．125x＋30．278。结论：受术者的自尊和体像障碍状态在整形美容手术术后有明显的改善。     

195例牙科患者焦虑症现状及影响因素调查研究

目的：本论文旨在调查牙科患者焦虑症（DA ）现状及影响因素,找出减轻牙科焦虑症的方法。方法采用便利抽样方法选取辽宁省朝阳市中心医院口腔科患者195例,通过基本资料、改良的牙科焦虑量表（MDAS）、状态焦虑量表（S‐AI）和两个自制的量表进行调查。结果牙科焦虑组中女性的比例高于非焦虑组（60％ vs ．40％,P＝0．008）。多因素Logistic回归分析发现：担心医技（OR＝2．247）,口内喷水（OR＝2．151）,影响正常功能（OR＝2．589）,听负面经历（OR＝2．825）,缺乏口腔知识（OR＝2．539）,害怕疼痛（OR＝2．074）是DA的独立危险因素;掌握口腔知识（OR＝0．374）,听音乐（OR＝0．279）,打麻药（OR＝0．305）,多用鼓励语言（OR＝0．460）是缓解DA的独立保护因素。结论担心医技、口内喷水、影响正常功能、听负面经历、缺乏了解口腔知识、害怕疼痛都是引起DA的常见原因,学习口腔知识、听音乐、打麻药、医护人员多用鼓励的语言是有效缓解牙科焦虑症的方法。     

抑郁症患者的人格特征研究

目的:探讨抑郁症患者的人格特征,为临床心理干预提供参考依据。方法:采用MMPI量表对100例抑郁症患者进行测试并与中国常模进行比较。结果:抑郁症患者的MMPI分值以D为最高,其次伴有Hy、Pd、Pt、Hs、Pa、Sc、Si的增高,均高于中国常模(P<0.05,P<0.01);Ma、Mf无显著性差异(P﹥0.05)。结论:抑郁症的发生与个性基础有关,MMPI对评价抑郁症患者的个性和临床特征有重要意义。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.