正畸患者牙科焦虑症的调查分析

目的:调查正畸患者治疗前的焦虑状况,为正畸治疗前进行心理治疗和心理护理提供指导.方法:采用改良Corah牙科焦虑量表(MDAS)、状态-特质焦虑问卷(STAI)和视觉模拟量表(VAS)对65例患者进行横断面调查和统计分析.结果:明显患有牙科焦虑症的患者占30.77%(MDAS评分值≥11),疼痛的耐受程度差、心情紧张程度高者的MDAS评分较高(P＜0.01).MDAS与不同分组因素相关关系的逐步回归分析,结果有"对疼痛的耐受程度"、"心情紧张程度"、"接受治疗最担心疼痛"、"接受治疗最担心影响发音"四个变量入选;S-AI与不同分组因素相关关系的逐步回归分析,结果有"对疼痛的耐受程度"、"心情紧张程度"、两个变量入选.结论:正畸患者治疗前的焦虑状况普遍存在,并和多种因素相关.正畸治疗前的心理治疗和护理是必要的.     

心理干预和布洛芬治疗牙科焦虑症患者正畸疼痛的对比研究

目的 探讨心理干预和布洛芬对牙科焦虑症患者正畸疼痛的治疗效果.方法 通过改良牙科焦虑量表筛选出60例牙科焦虑症患者,按每组20例患者随机分为空白组(对照组)、心理干预组和布洛芬组,通过100mm视觉模拟评量表对患者5d内的疼痛水平(咀嚼痛、咬(牙合)痛)进行评分,对比其治疗效果.结果 心理干预组和布洛芬组正畸疼痛水平(咀嚼痛、咬(牙合)痛)均明显低于对照组,差异有统计学意义(P＜0.05);布洛芬组正畸疼痛水平低于心理干预组,差异有统计学意义(P＜0.05).结论 心理干预和布洛芬对牙科焦虑症患者正畸疼痛(咀嚼痛、咬(牙合)痛)的缓解均有较好的效果;布洛芬对牙科焦虑症患者正畸疼痛的缓解优于心理干预治疗.     

微种植体支抗不同植入部位对患者牙科焦虑症和疼痛的影响

目的 探讨微种植体支抗(MIA)不同植入部位对患者术前焦虑水平和术后疼痛程度及持续时间的影响.方法 选择需在上颌前牙区,上颌磨牙区,下颌磨牙区需植入MIA患者每组各40例,在术前采用改良牙科焦虑量表(MDAS);术后应用视觉模拟量表(VAS)进行调查和统计学分析.结果 接受MIA植入术的患者,术前焦虑的评分值为(10.44±3.54)分,有51.6%的患者评分高于11分,为高焦虑患者.患者术前焦虑程度与植入部位并无明显相关性(P>0.05).但植入后疼痛程度与植入部位呈明显相关性,前牙区组和上颌磨牙区组疼痛程度较重,下颌磨牙区组较轻,三个区域在术后6、12、24 h差异均有统计学意义(P<0.05).高焦虑组与低焦虑组疼痛的高峰均出现在术后6~12 h期间,疼痛高峰强度大小差异均有统计学意义(P<0.05).疼痛开始的强度及疼痛持续的时间差异无统计学意义(P>0.05).结论 不同植入部位与患者术前焦虑水平并无明显相关性,但和术后疼痛强度具有明显的相关性.植入术前焦虑的严重程度与术后疼痛高峰强度亦具有明显的相关性.提示临床上应考虑MIA的直径,头部的圆滑程度,所选择植入部位与周围组织黏膜的关系等,并且应在植入术前对患者进行一定的心理行为干预,以降低患者恐惧的心理,进而减少患者术后的疼痛程度.     

成人牙科焦虑症及其相关因素的临床研究

目的了解口腔门诊成人患者牙科焦虑症的情况及探讨焦虑程度与人口统计学因子、自评口腔状况的关系。方法采用Coach’s牙科焦虑症量表(dental anxiety scale,DAS)在230名门诊患者中进行调查,采用自填方式填写量表,同时记录调查对象的人口统计学指标、自评口腔状况及自我感觉牙齿的治疗需要。结果230名研究对象DAS得分的平均分为(8.20±3.14)分,得分最高分为17分,最低分为4分。牙科焦虑症与性格、自评口腔健康状况有关;与文化程度高低及自我感觉牙齿的治疗需要无关。同时,本研究未发现焦虑的程度与年龄有关。最能造成患者焦虑及害怕的事件是拔牙。比较能够造成患者焦虑及害怕的事件是把探针深入牙龈或龋洞进行检查、在进行麻醉处理后还觉得疼痛、给你进行注射以及看到医生长时间的考虑等4个事件。结论人群总的牙科焦虑的状态并不严重,但存在对牙科治疗极度焦虑的患者。牙科焦虑症与性格、自评口腔健康状况有关;与年龄、文化程度高低及自我感觉牙齿的治疗需要无关。能造成患者焦虑及害怕的牙科治疗事件有多种,临床医生应注意观察及与患者进行沟通,从而帮助患者克服牙科焦虑症。     

青少年儿童正畸患者的牙科焦虑、社交焦虑及其心理行为干预的作用

在牙科诊治过程中患者表现出不同程度的紧张、害怕、焦虑,严重者在行为上表现为敏感性增高,耐受性降低,甚至躲避或拒绝治疗,被称为牙科焦虑症(dental anxiety,DA),又称牙科畏惧症.国内刘艺敏等[1]报告成人牙科患者轻度牙科畏惧症检出率为86.15%,钱虹等[2]报告口腔疾病初诊患儿,畏惧发生率男童46.03%,女童50.88%;奉晓斌[3]使用改良的牙科焦虑量表(DAS≥11分标准)评定正畸拔牙患者,10.26%有明显的牙科焦虑.     

复合心理干预下拔牙对心血管患者畏惧心理血压和心率影响的效果观察

目的 探讨复合护理干预下拔牙对心血管患者焦虑状态血压和心率影响的效果观察.方法 筛选需拔牙心血管患者356例,应用牙科焦虑量表(MDAS)进行焦虑程度测评,分别在术前30分钟、10分钟接受复合护理干预,术后进行焦虑程度测评;术前10分钟、心理干预后和术后10分钟分别测取血压和心率,分析其牙科焦虑程度和心血管指数的波动.结果 患者术前30分钟焦虑程度明显低于术前10分钟(P＜0.05),显示术前10分钟是患者最焦虑状态.在拔牙过程中,心血管患者接受心理干预后他们的牙科焦虑指数,血压和心率均有较大的下降(P＜0.05).结论 复合心理干预能有效地缓解心血管患者的焦虑情绪,提高拔牙术的安全性.     

音乐干预对固定正畸初始疼痛的影响

目的 探讨音乐干预对固定正畸初始疼痛的影响.方法 选取非拔牙固定正畸治疗的患儿200例,随机分为四组,每组50例,其中两组使用Tomy自锁托槽,另两组使用新亚传统直丝弓托槽.抽取使用Tomy自锁托槽与新亚传统直丝弓托槽各一组为观察组,其余两组为对照组.观察组的患者在每次填写问卷前听音乐20min,对照组的患者不听音乐.采用视觉模拟评分法(visual analogue scales,VAS)记录初次放入矫治弓丝后2h、6h、24h、3d及7d的疼痛强度,对结果进行统计分析.结果 进行音乐干预的患者正畸初始疼痛程度低于无音乐干预的患者疼痛,差异有统计学意义(P＜0.05).结论 音乐干预对固定正畸初始疼痛的缓解有较好的临床效果.     

牙髓炎患者牙科焦虑心理分析

目的 研究牙髓炎患者牙科焦虑心理产生的原因.方法 治疗前对100例牙髓炎患者完成问卷,用改良的牙科焦虑量表(corah dental anxiety scale,DAS)和类视力表(visual anxiety scale,VAS)划界分为高牙科焦虑组和低牙科焦虑组.结果 患者对疼痛的期待存在较大的偏差,高焦虑组更明显.结论 疼痛是患者最恐惧的因素,消除疑虑和减轻疼痛是牙髓炎治疗术中首要解决的问题.     

杭州市某社区老人牙科焦虑现状及影响因素分析

采用汉化Coarh＇s牙科焦虑量表对多阶段分层整群随机法抽取的杭州市拱墅区600名社区老人牙科焦虑现状进行问卷调查.其牙科焦虑量表得分为（7.51±3.18）分,牙科焦虑发生率为34.9%;牙科焦虑发生率在不同性别、不同年龄组、对疼痛的不同耐受程度、自己的不同看牙经历、亲友的不同看牙经历的社区老人之间差异有统计学意义（均P＜0.05）;女性、60-69岁年龄组、疼痛耐受程度越差和看牙经历痛苦的社区老人牙科焦虑发生的风险更高.提示性别、年龄、疼痛耐受程度和看牙经历是社区老人牙科焦虑发生的影响因素.     

正畸牙周联合治疗对中重度牙周炎患者骨钙素水平的影响

目的 探讨正畸牙周联合治疗对中重度牙周炎患者骨钙素水平的影响及临床意义.方法 选择2011年6月至2014年6月30例中重度牙周炎患者为观察组,选择同期牙周健康的需作正畸治疗患者30例为对照组.统计菌斑指数(PLI)、龈沟出血指数(BI)、牙周袋探诊深度(PD)及骨钙素水平.结果 牙周治疗前观察组PD、BI、PLI均高于对照组(P＜0.01);观察组正畸治疗前及正畸治疗后1、2个月PD、BI、PLI均较牙周治疗前降低(P＜0.05);观察组不同时间点骨钙素水平均高于对照组(P＜0.01),观察组加力后1d骨钙素水平达峰值,以后开始回落.结论 正畸牙周联合治疗可以有效改善中重度牙周炎患者的牙周状况,检测患者龈沟液中的骨钙素水平可能反映出牙周炎患者的牙周炎症反应及牙槽骨改建过程.     

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.