牙科焦虑状况对正畸治疗疼痛的影响研究

目的 研究正畸患者治疗前焦虑水平对其治疗过程中疼痛的影响,为正畸矫正过程中进行心理治疗和护理以缓解甚至消除牙科焦虑提供指导依据.方法 选择进行正畸治疗的患者65例,治疗前由患者填写个人情况,并完成牙科焦虑量表;戴矫治器后填写疼痛的开始时间及强度、高峰时间及强度、消失时间.对结果进行方差分析.结果 牙科焦虑分高者比牙科焦虑分低者的疼痛评分高(P＜0.01);而治疗前焦虑水平不影响疼痛持续的时间(P＞0.05).结论 在正畸治疗中,牙科焦虑水平会影响患者的疼痛主诉程度;治疗前应对焦虑患者进行必要的心理指导,减轻焦虑程度,以利于患者的健康与合作.     

养老机构内老人牙科焦虑症流行病学调查

[目的]调查养老机构内老人牙科焦虑症(DA)的流行情况。[方法]采用改良的牙科焦虑量表(MDAS)对养老机构140位老人的DA发生情况进行问卷调查和统计分析。[结果]养老机构内老人MDAS平均得分为(6.80±3.28)分;DA发生率为7.86%;MDAS得分在不同文化程度、对疼痛的不同耐受程度以及不同的看牙经历间有显著性差异;对MDAS得分的影响因素前5项为:疼痛的耐受程度、年龄、当天精神状态、文化程度、性格,其中疼痛的耐受程度有非常显著性影响(P=0.001)。[结论]养老机构内老人DA发生率较低,疼痛的耐受程度和年龄对DA的发生有显著性影响。     

牙周炎患者牙科焦虑症的心理行为干预研究

目的 调查口腔门诊牙周炎患者龈上洁治及龈下刮治过程中牙科焦虑症(DA)严重程度,探讨心理及行为干预在其中的应用效果.方法 将84例牙周炎伴DA患者分为4组:对照组、心理治疗组、行为治疗组及心理-行为治疗组,分别采取不干预、心理治疗、行为治疗、心理加行为双重治疗的方法 .治疗前问卷调查患者牙科焦虑症的主要原因,并在龈上洁治前30 min、龈上洁治后即刻及龈下刮治前30 min记录改良Corah's牙科焦虑量表(CDAS)评分.对调查结果 进行统计分析.结果 "担心疼痛"是产生DA最常见的原因,心理治疗组、行为治疗组及心理-行为治疗组龈上洁治后即刻、龈下刮治前30 min较龈上洁治前30 min的焦虑得分值低(P<0.05),且心理-行为治疗组焦虑改善最为显著(P<0.05),对照组3个时间点焦虑得分差异无明显变化(P>0.05).结论 DA与多种因素相关,临床口腔医生应及时对患者进行心理及行为双重疏导,以减少牙科焦虑症的发生,促进牙周治疗的顺利进行.     

牙科焦虑症对心血管病患者开髓过程心率和血压的影响

目的:研究牙科焦虑症(DA)对心血管病患者开髓过程心率及血压的影响,为术前进行心理治疗和护理提供指导.方法:采用改良的牙科焦虑量表(MDAS)对136例心血管患者开髓前的DA进行调查,对开髓全过程进行心电监护,对MDAS得分与心率及血压变化的相关性进行统计学分析.结果:MDAS得分与心率增幅相关系数r=0.07,p=0.89;与收缩压增幅r=0.22,p=0.01;与舒张压增幅r=0.18,p=0.03.结论:对于心血管病开髓患者,需在术前进行心理治疗,以减轻DA,避免或减少开髓时血压升高,确保手术安全.     

大学生牙科焦虑症调查分析

目的：了解大学生牙科焦虑症情况。方法：利用改良牙科焦虑量表（MDAS）与牙科焦虑症相关因素对432例大学生口腔拔牙患者进行问卷调查，并进行牙科焦虑症患病率因素比较与MDAS得分影响因素逐步回归分析。结果：牙科焦虑症的发生率为48．4％，有11项因素对牙科焦虑症的患病率有影响，差异有统计学意义（P〈0．01），其中5项因素对MDAS得分影响较大。结论：牙科焦虑症在临床中常见，有多种因素对牙科焦虑症的发生有影响。     

皖南医学院学生牙科恐惧症调查分析

目的研究皖南医学院在校生牙科恐惧症的发病情况、临床表现和影响因素,为牙科恐惧症的预防、治疗提供依据。方法采用自制调查问卷、改良牙科焦虑量表(MDAS)、牙科畏惧量表(DFS)对皖南医学院580名在校生进行问卷调查。结果皖南医学院在校生牙科恐惧症发病率为29.31%;最常见的生理反应为感到肌肉紧张、心跳加快和呼吸加快;引起牙科恐惧症最常见的治疗行为是牙钻磨牙时、看到钻牙时、听到牙钻声、注射麻药时。学生的性别、家庭月收入、家庭所在地、对口腔科医生的信任度、自身牙科经历、亲友牙科经历、疼痛耐受度、专业不同,牙科恐惧症患病率组间比较差异有统计学意义(P<0.05)。不同性格与就诊目的对牙科恐惧症患病率影响比较差异无统计学意义(P>0.05)。口腔专业是出现牙科恐惧症的保护因素,而痛苦的自身牙科经历、痛苦的亲友牙科经历、较差和一般的疼痛耐受度是出现牙科恐惧症的危险因素。结论牙科畏惧症的临床表现及影响因素较多,需从多方面对其预防和治疗。     

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.     

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.     

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.     

心理行为干预对成人牙科畏惧症患者情绪及心理健康状况的影响

目的 探讨心理行为干预对成人牙科畏惧症患者情绪及心理健康状况的影响.方法 对68例2007年6～12月在济宁市中区卫生防疫站口腔科治疗的各类成人牙科疾病患者,以随机数字表法将患者分为干预组、对照组,每组34例.干预组在常规治疗的基础上进行心理行为干预,对照组仅进行常规治疗.用改良牙科焦虑量表(MDAS)、疼痛视觉模拟评分表(VAS)、症状自评量表(SCL-90)评定其临床效果.结果 两组治疗前MDAS评分及DF的发生率,差异无显著性(P>0.05).而治疗后干预组MDAS评分较对照组显著下降,差异有显著性(P<0.01);干预组治疗后MDAS评分显著降低,与治疗前比较差异有显著性(P<0.01).而对照组治疗前后差异无显著性(P>0.05).两组治疗前后DF发生率比较,干预组治疗后DF发生率显著下降(P<0.01).两组治疗前VAS评分差异无显著性(P>0.05),而治疗后十预组VAS评分较对照组显著下降,差异有显著性(P<0.05);干预组治疗后VAS评分显著降低,与治疗前比较差异有显著性(P<0.01),而对照组治疗前后差异无显著性(P>0.05).两组治疗前SCL-90各因子分比较,差异无显著性(P>0.05).治疗后两组比较,干预组SCL-90躯体化、强迫症状、人际关系、抑郁、焦虑、敌对及恐怖因子分,较对照组显著下降,差异有显著性(P<0.01 或P<0.05).结论 心理行为干预能有效降低牙科畏惧症的发生率,减轻疼痛,改善心理健康状况.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.     

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.