完全腹腔镜Roux—en—Y吻合术式应用于远端胃癌根治术20例

目的探讨完全腹腔镜Roux．en—Y吻合术式应用于远端胃癌根治术的安全性和可行性。方法回顾性分析福建省肿瘤医院腹部外科2012年8月至2013年3月对腹腔镜胃大部切除术后实施完全腹腔镜Roux．en—Y吻合术的20例胃癌患者的术中和术后临床资料。结果20例患者均成功实施完全腹腔镜远端胃癌根治术,无一例中转开腹或中转腹腔镜辅助手术。手术时间（190．8±53．6）min,术中出血量（122．4±57．7）ml,淋巴结清扫数（31．2±5．7）枚,术后病理切缘均为阴性。术后排气时间为（2．6±1．6）d,住院时间为（8．1±2．0）d。有1例术后出现肺部感染,但无吻合术相关并发症发生。结论完全腹腔镜Roux—en—Y吻合术式应用于远端胃癌根治术安全且可行。     

Effects of training in short-term psychodynamic psychotherapy: changes in graduate clinician technique

Abstract

This study investigates the effects of graduate clinician training in short-term psychodynamic psychotherapy (STPP; Book, 1998; Luborsky, 1984; Strupp & Binder, 1984; Wachtel, 1993) on the acquisition of techniques within and across two training cases. Sessions 3 and 9 from the first and second treatment cases of 15 graduate clinicians receiving structured training in STPP were examined for the frequency of psychodynamic–interpersonal (PI) therapeutic techniques. Results demonstrated that structured training in STPP led to a significantly increased use of PI therapeutic techniques both within and across cases. The authors also examined the frequency of cognitive–behavioral (CB) therapeutic techniques used by the graduate clinicians. No changes in the number of CB interventions were observed over the same set of sessions. Practical implications for the use of structured clinical training and issues pertinent to supervision in graduate education are reviewed. Finally, the impact of structured training on graduate clinicians’ ability to form positive collaborative relationships with their patients is also discussed.

Zusammenfassung

Die Effekte von Training in psychodynamischer Kurzzeittherapie: Veränderungen in der Technik bei graduierten klinischen Studenten

Diese Studie untersucht die Effekte von Training auf das Aneignen von Techniken in psychodynamischer Kurzzeittherapie innerhalb und über 2 Trainingsfälle hinweg bei graduierten klinischen Studenten. Die dritte und 9. Sitzung des ersten und 2. Trainingsfalls von 15 graduierten Klinikern, die ein strukturiertes Training für psychodynamische Kurzzeittherapie durchliefen, wurden auf die Häufigkeit psychodynamischer individueller therapeutisccher Techniken hin untersucht. Die Ergebnisse zeigten, dass eine strukturiertes Training in psychodynamischer Kurzzeittherapie zu einem signifikant häufigeren Einsatz von psychodynamisch interpersonellen therapeutischen Techniken, sowohl innerhalb eines Trainingsfalles als auch über beide Fälle hinweg, führt. Die Autoren haben auch die Häufigkeit von kognitiv-verhaltensmässigen Techniken der Auszubildenden untersucht. Hierbei gab es für die untersuchten Sitzungen keine Veränderung in den Häufigkeiten. Praktische Implikationen zur Verwendung des strukturierten klinischen Trainings und Themen, die für die Supervision der Ausbildung in der zweiten Phase relevant sind, werden durchgenommen. Schließlich wird auch der Einfluß des strukturierten Trainings auf die Fähigkeit der Auszubildenden, positive Beziehungen in der Zusammenarbeit mit ihren Patienten zu bilden, diskutiert.

Résumé

Les effets de la formation dans la psychothérapie psychodynamique brève?: changements dans la technique chez le clinicien postgradué

Cette étude investigue les effets de la formation des cliniciens postgradués en psychothérapie psychodynamique brève?(STPP?; Book, 1998?; Luborsky, 1984?; Strupp & Binder, 1984?; Wachtel, 1993) sur l'acquisition de techniques dans et entre deux cas de formation. Les séances 3 et 9 du premier et deuxième cas de formation de 15 cliniciens postgradués recevant de la formation structurée en STPP étaient examinés en fonction de la fréquence des techniques thérapeutiques psychodynamiques – interpersonnelles (PI). Les résultats ont démontré que la formation structurée en STPP a entraîné un emploi augmenté de façon significative de techniques thérapeutiques PI aussi bien dans qu'entre les cas. Les auteurs ont examiné également la fréquence de techniques thérapeutiques cognitives-comportementales (CB) utilisées par les cliniciens postgradués. Aucun changement du nombre d'interventions CB n'a été observé dans le même ensemble de séances. Des implications pratiques pour l'application d'une formation clinique structurée et des sujets en lien avec la supervision dans l’éducation postgraduée sont revues. Finalement, l'impact d'une formation structurée sur la capacité du clinicien postgradué à former des relations de collaboration positive avec leurs patients est également discuté.

Resumen

Efectos de la supervisión en psicoterapia psicodinámica breve: cambios en la técnica clínica del graduado

Este estudio investiga los efectos de la supervisión clínica del graduado en psicoterapia psicodinámica breve (STPP; Libro, 1998, Luborsky, 1984, Strupp /& Binder, 1984, Wachtel, 1993) sobre la adquisición de técnicas dentro y a través de dos casos de supervisión. Se estudiaron las 3ra. y 9na. sesiones del primero y segundo casos de supervisión de quince clínicos graduados que recibieron supervisión en STPP, para ver la frecuencia de las técnicas terapéuticas psicodinámicas-interpersonales (PI). Los resultados demostraron que la supervisión estructurada en STPP condujo a un aumento significativo del uso de técnicas terapéuticas PI tanto dentro como a través de los casos. Los autores también estudiaron la frecuencia de técnicas terapéuticas cognitivo-comportamentales (CB) usadas por los clínicos graduados. No se observaron cambios en el número de intervenciones CB en el mismo conjunto de sesiones. Se pasó revista a las implicaciones prácticas del uso de la supervisión clínica estructurada y a cuestiones pertinentes a la supervisión en la educación de los graduados. Finalmente, también se debate sobre el impacto que puede tener la supervisión estructurada sobre la capacidad de los clínicos graduados para formar relaciones colaboradoras positivas con sus pacientes.

Resumo

Efeitos do treino em psicotetrapia psicodinâmica breve: Mudanças nas técnicas de estudantes

Este estudo examina os efeitos do treino clínico de estudantes graduados em psicoterapia psicodinâmica breve (PPB; Book, 1998; Luborsky, 1984; Strupp & Binder, 1984; Wachtel, 1993) em termos de aquisições das técnicas durante e entre dois casos de treino. Foi analisada a frequência de técnicas terapêuticas de psicoterapia interpessoal (PI), nas sessões 3 e 9 do primeiro e do segundo caso de treino de 15 estudantes graduados que estavam recebendo formação estruturada em PPB. Os resultados demonstraram que o treino estruturado em PPB conduzia a um aumento significativo no uso de técnicas terapêuticas de PI durante e entre os casos. Os autores analisaram também a frequência das técnicas terapêuticas cognitivo-comportamentais (CC) utilizadas pelos estudantes. Não se verificaram mudanças no número de intervenções CC durante o mesmo conjunto de sessões. São revistas as implicações práticas para a utilização de treino clínico estruturado e aspectos pertinentes para a supervisão de estudantes graduados. Finalmente, será também discutido o impacto do treino estruturado sobre as capacidades dos estudantes para estabelecerem relações terapêuticas positivas com os seus pacientes.

     

Combined activities of secretory phospholipases and eosinophil lysophospholipases induce pulmonary surfactant dysfunction by phospholipid hydrolysis

BACKGROUND: Surfactant dysfunction is implicated in small airway closure in asthma. Increased activity of secretory phospholipase A(2) (sPLA(2)) in the airways is associated with asthma exacerbations. Phosphatidylcholine, the principal component of pulmonary surfactant that maintains small airway patency, is hydrolyzed by sPLA(2). The lysophosphatidylcholine product is the substrate for eosinophil lysophospholipases. OBJECTIVE: To determine whether surfactant phospholipid hydrolysis by the combined activities of sPLA(2)s and eosinophil lysophospholipases induces surfactant dysfunction. METHODS: The effect of these enzymes on surfactant function was determined by capillary surfactometry. Thin layer chromatography was used to correlate enzyme-induced changes in surfactant phospholipid composition and function. Phosphatidylcholine and its hydrolytic products were measured by using mass spectrometry. RESULTS: Eosinophils express a 25-kd lysophospholipase and group IIA sPLA(2). Phospholipase A(2) alone induced only a small decrease in surfactant function, and 25-kd lysophospholipase alone degraded lysophosphatidylcholine but had no effect on surfactant function. The combined actions of sPLA(2) and lysophospholipase produced dose-dependent and time-dependent losses of surfactant function, concomitant with hydrolysis of phosphatidylcholine and lysophosphatidylcholine. Lysates of AML14.3D10 eosinophils induced surfactant dysfunction, indicating these cells express all the necessary lipolytic activities. In contrast, lysates of blood eosinophils required exogenous phospholipase A(2) to induce maximal surfactant dysfunction. CONCLUSION: The combined activities of sPLA(2)s and eosinophil lysophospholipases are necessary to degrade surfactant phospholipids sufficiently to induce functional losses in surfactant activity as reported in asthma. CLINICAL IMPLICATIONS: The phospholipases and lysophospholipases expressed by eosinophils or other airway cells may represent novel therapeutic targets for blocking surfactant degradation, dysfunction, and peripheral airway closure in asthma.     

Effects of Estrogen Replacement on Bone Geometry and Microarchitecture in Adolescent and Young Adult Oligoamenorrheic Athletes: A Randomized Trial

Oligoamenorrheic athletes (OAs) have lower bone mineral density (BMD) and greater impairment of bone microarchitecture, and therefore higher fracture rates compared to eumenorrheic athletes. Although improvements in areal BMD (aBMD; measured by dual-energy X-ray absorptiometry) in OAs have been demonstrated with transdermal estrogen treatment, effects of such treatment on bone microarchitecture are unknown. Here we explore effects of transdermal versus oral estrogen versus no estrogen on bone microarchitecture in OA. Seventy-five OAs (ages 14 to 25 years) were randomized to (i) a 100-μg 17β-estradiol transdermal patch (PATCH) administered continuously with 200 mg cyclic oral micronized progesterone; (ii) a combined 30 μg ethinyl estradiol and 0.15 mg desogestrel pill (PILL); or (iii) no estrogen/progesterone (NONE) and were followed for 12 months. Calcium (≥1200 mg) and vitamin D (800 IU) supplements were provided to all. Bone microarchitecture was assessed using high-resolution peripheral quantitative CT at the distal tibia and radius at baseline and 1 year. At baseline, randomization groups did not differ by age, body mass index, percent body fat, duration of amenorrhea, vitamin D levels, BMD, or bone microarchitecture measurements. After 1 year of treatment, at the distal tibia there were significantly greater increases in total and trabecular volumetric BMD (vBMD), cortical area and thickness, and trabecular number in the PATCH versus PILL groups. Trabecular area decreased significantly in the PATCH group versus the PILL and NONE groups. Less robust differences between groups were seen at the distal radius, where percent change in cortical area and thickness was significantly greater in the PATCH versus PILL and NONE groups, and changes in cortical vBMD were significantly greater in the PATCH versus PILL groups. In conclusion, in young OAs, bone structural parameters show greater improvement after 1 year of treatment with transdermal 17β-estradiol versus ethinyl estradiol–containing pills, particularly at the tibia. © 2019 American Society for Bone and Mineral Research.     

Right and left ventricular dysfunction in patients with chronic obstructive lung disease: Assessment by first-pass radionuclide angiography

To evaluate the relationship between right and left ventricular function in patients with obstructive lung disease, we studied 10 normal subjects (group 1) and 37 patients with chronic obstructive pulmonary disease by first pass radionuclide angiography. These 37 patients were divided into three groups: nine with mild chronic obstructive pulmonary disease (group 2), 20 with severe chronic obstructive pulmonary disease (group 3) and eight with severe chronic obstructive pulmonary disease and primary left ventricular disease (group 4). In each subject right ventricular ejection fraction (RVEF), left ventricular ejection fraction (LVEF) and ejection fraction during first third of systole (first third LVEF) were calculated. LVEF RVEF First-Third LVEF Group 1 0.60 ± 0.05 0.52 ± 0.03 0.29 ± 0.04 Group 2 0.61 ± 0.08 0.52 ± 0.03 0.29 ± 0.02 Group 3 0.58 ± 0.09 0.46 ± 0.091 0.24 ± 0.061 Group 4 0.51 ± 0.061 0.44 ± 0.091 0.20 ± 0.031 1 p < 0.05 versus 1. All subjects in group 2 had normal left ventricular and right ventricular function. In group 3,11 of 10 (55 per cent) had a low RVEF and three of 20 (15 per cent) a low LVEF. However eight of 20 in this group (40 per cent) had a depressed first-third LVEF. The correlation between decline in RVEF and first-third LVEF was good r = 0.73. We conclude that (1) certain indices of early systolic left ventricular ejection are abnormal in many patients with chronic obstructive pulmonary disease and correlate with the decline in right ventricular function; (2) this is not seen in patients with mild chronic obstructive pulmonary disease and is worse in patients with underlying left-sided heart disease.