心理咨询门诊中社交焦虑障碍的共病与功能损害情况调查

目的调查心理咨询门诊中社交焦虑障碍的共病情况及功能损害程度.方法用系统抽样法抽取494名咨客,用LSAS量表初步筛选,并按照DSM-Ⅳ的诊断标准进行诊断,功能损害情况按照患者自我评价分为有无严重影响.结果心理咨询门诊中,66%社交焦虑障碍患者共患其他精神疾病;有17%～47%的患者报告社交焦虑障碍对婚姻家庭、工作功能、和学习功能产生严重影响;合并抑郁组的患者年龄、LSAS他评分数及功能损害程度与非合并抑郁组比较差异具有统计学意义.结论心理咨询门诊中社交焦虑障碍与其他疾病共患率高,对生活质量影响较重,合并抑郁障碍者功能损害程度加重.     

社交焦虑障碍的共病情况和认知模式

社交焦虑障碍是最常见的焦虑障碍,80年代以来国外对其研究比较多,国内近几年也开始对其进行研究与探讨.美国国立共病率研究(National Comorbidity Survey,NCS)发现社交焦虑障碍的终生患病率是13.3%,是继重型抑郁(17.4%)和酒精依赖(14.1%)之后第三位常见的精神障碍.社交焦虑障碍是一种常被过低诊断的疾病,许多情况下社交焦虑障碍要早于其他精神疾病出现,通常是和其他疾病发生共病后才被人们所认识,它通常比其他焦虑障碍功能损害更严重.与社交焦虑障碍发生共病的其他精神障碍比不发生共病时病情和功能受损更严重,对治疗反应更不佳,预后更差.未治疗的社交焦虑障碍可导致社会隔离、受教育和职业功能受损、易合并其他精神障碍[1].本文针对社交焦虑障碍与轴Ⅰ和轴Ⅱ障碍的共病情况和认知模式作一概述.     

社交焦虑障碍的共病情况和认知模式

社交焦虑障碍是最常见的焦虑障碍,80年代以来国外对其研究比较多,国内近几年也开始对其进行研究与探讨。美国国立共病率研究(NationalComorbiditySurvey ,NCS)发现社交焦虑障碍的终生患病率是13 .3 % ,是继重型抑郁( 17.4% )和酒精依赖( 14 .1% )之后第三位常见的精神障碍。社交焦虑障碍是一种常被过低诊断的疾病,许多情况下社交焦虑障碍要早于其他精神疾病出现,通常是和其他疾病发生共病后才被人们所认识,它通常比其他焦虑障碍功能损害更严重。与社交焦虑障碍发生共病的其他精神障碍比不发生共病时病情和功能受损更严重,对治疗反应更不…     

焦虑和抑郁障碍共病的诊治进展

焦虑和抑郁障碍是临床上常见的两组症状，在当前的诊断分类标准中两者是相互独立的疾病单元，而在实际工作中两者常常同时存在，即焦虑和抑郁障碍共病，其是指患者同时存在焦虑障碍和抑郁障碍，且对两组症状分别考虑时均符合相应的诊断标准。据美国国家共病调查研究显示51．2％的抑郁障碍患者共病焦虑障碍，国内相关调查资料报道抑郁症出现焦虑症状的患者占67．5％，符合焦虑障碍诊断标准的患者为50％，抑郁患者与焦虑障碍共患率最高。由于焦虑抑郁共病的临床表现常不典型，症状易反复、多变，不同医师之间诊断的一致性低，诊断和医疗处理的难度增加，因此其已成为当前全球精神病学界关注的热点之一，也正逐渐引起了国内同道的重视。笔者就这一议题综述如下。     

社交焦虑障碍的共病情况及小组认知行为治疗的疗效

社交焦虑障碍（social anxiety disorder，SAD）是一种患病率较高的慢性疾病，国外报道其终生患病率高达14．4％。许多情况下社交焦虑障碍要早于其他精神疾病出现，通常是和其他疾病发生共病后才被人们所认识，比其他焦虑障碍造成的功能损害更为严重。     

基层医院心血管疾病患者就诊者中抑郁焦虑障碍的患病率调查

目的：了解基层医院心血管疾病患者抑郁和焦虑障碍的患病率。方法：采用多中心横断面设计,调查510例医院住院或门诊心血管疾病就诊者。采用医院焦虑抑郁量表（Hospital anxiety and depression scale,HADS）筛查,阳性者用Hamilton抑郁焦虑症量表诊断评估。结果：Hamilton诊断的抑郁障碍、焦虑障碍、抑郁和焦虑共病的校正患病率分别为19.10％、13.59％和10.92％;对抑郁焦虑的就诊识别率为4%。结论：心血管疾病患者中抑郁和焦虑障碍是基层医院就诊者中的常见问题,但正确识别和治疗情况不容乐观。     

抑郁共病焦虑的认知功能障碍研究

焦虑抑郁障碍共病在人群中的患病率高达25％-60％[1].研究显示,抑郁症和焦虑症患者均各自存在广泛的认知功能损害,但多数关于认知功能障碍的研究没有考虑共病的影响,个别研究发现,抑郁共病焦虑可加剧患者神经心理测试表现的损害,引起脑部的结构变化,导致注意力难以集中,增加患者对潜在刺激的反应[2],由此可见有必要关注二者共病对认知功能障碍的影响.本文拟对抑郁与焦虑共病的认知损害特点、其神经机制及抗抑郁药对共病认知的影响这三方面的最新进展进行综述.     

冠心病患者焦虑抑郁情况的临床调查

目的:了解冠心病患者抑郁和焦虑障碍的患病率。方法:调查510例医院住院或门诊冠心病疾病就诊者,采用医院焦虑抑郁量表(HADS)筛查,阳性者用Hamihon抑郁焦虑症量表诊断评估。结果:Hamilton诊断的抑郁障碍、焦虑障碍、抑郁和焦虑共病的校正患病率分别为18.20%、12.69%和11.12%。结论:冠心病患者中抑郁和焦虑障碍是常见问题,但正确识别和治疗情况不容乐观。     

社交焦虑障碍简介及治疗现状

社交焦虑障碍，西方国家资料调查显示其终身患病率为10％。15％，往往容易被人忽视，甚至认为是害羞或性格问题，因为每个人均在社交或职业场合体验过不同程度的害怕与焦虑，社交焦虑障碍患者的家人、朋友，甚至医生都认为这只是一般性问题。其实，社交焦虑障碍往往会导致严重的社交功能残疾等问题。因为社交焦虑障碍大多数起病于少年青春期（15-19岁），使其在社交、教育与职业的发展阶段受影响。据门诊临床咨询案例统计，社交恐怖症患者女性多于男性、未婚独身、教育程度低、社会阶层低及失业者居多。随着精神卫生事业的发展和服务领域的拓宽，对社交恐怖症的认识、诊断和治疗日益引起人们的重视，本文对有关问题作一简要综述。     

系统脱敏疗法联合舍曲林治疗社交焦虑障碍的临床研究

目的 探讨系统脱敏疗法对社交焦虑障碍患者的影响.方法 将60例社交焦虑障碍患者随机分为合用组(系统脱敏疗法+舍曲林)和对照组(舍曲林),每组30例.观察治疗3周,采用Liebowitz社交焦虑量表(LSAS)评定临床疗效.结果在治疗3周后,合用组临床疗效优于对照组(P<0.05).结论 系统脱敏疗法联合舍曲林治疗社交焦虑障碍效果更为明显.     

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.