Stouthard牙科恐惧量表中文版的研制及评价

目的研制Stouthard牙科恐惧量表(Stouthard's dental anxiety inventory,DAI)中文版并对其心理学性质进行检验以评价量表的可行性。方法按照心理测量学中量表的跨文化适应程序对DAI英文版进行翻译、反译、文化调试和试用建立DAI中文版;并使用了DAS牙科焦虑问卷进行验证。使用DAI中文版对940例成人患者进行牙科恐惧调查,检验量表的信度、效度等心理测量学性质,且检测与Corah牙科焦虑量表(Corah's dental anxiety scale,简称DAS)和状态特质焦虑问卷(Stale-Trait Anxiety Inventory,简称STAI)得分之间的关系。结果 DAI中文版重测信度为0.943,内部一致性Cronbach'sα系数为0.956。结构效度KMO=0.961,因子分析共选出5个公因子:害怕医生的处理方式、对就医过程焦虑、一般牙科焦虑、害怕牙医及其评论和恐惧就医过程,其累计贡献率达60.541%。其分布与理论结构假设相符;DAI中文版与DAS和STAI中的特质焦虑量表得分呈显著相关(P<0.01)。结论 DAI中文版具有良好的信度和效度,是符合中国人使用的牙科恐惧量表。     

经胸房间隔缺损堵闭术对房室瓣反流的影响

目的探讨经胸房间隔缺损封堵术对房室瓣反流的影响。方法回顾性分析2002年1月至2011年3月在南方医科大学珠江医院经胸微创房间隔缺损堵闭术患者的临床资料,其中资料完全者43例,40例在食道超声、2例在经胸超声辅助下行房间隔缺损堵闭术。患者术前、术后1个月及6个月经超声心动图检查,观察心脏各指标的变化和房室瓣反流程度。结果41例手术成功,手术成功率95．3％（41／43）;1例术中改为右侧开胸小切口体外循环下房间隔缺损修补术,1例术中并发心搏骤停。1例术后并发肾功能衰竭：12例术后即时有少量残余漏,1个月后超声复查消失。术后超声随访显示：右心室、右心房直径较前缩小,左心室直径较前增大,肺动脉瓣血流速度明显降低,差异有统计学意义（P〈0．05）;室间隔厚度、二尖瓣血流速度、主动脉瓣血流速度无明显改变,差异无统计学意义（P〉0．05）。房间隔缺损堵闭术后1个月、6个月,二尖瓣瓣膜反流程度较术前加重,差异有统计学意义（平均秩次：2．01VS．2．17vs1．77,x2=10．78,P=0．04）;而三尖瓣的瓣膜反流程度术前与术后1个月、6个月比较,差异无统计学意义（平均秩次：1．88vs2．11US．2．01,X2=4．23,P=0．134）。结论房间隔缺损封堵术后,可引起二尖瓣反流程度的加重,但对三尖瓣的反流程度近期影响不明显;二尖瓣中度以上或三尖瓣重度反流的患者或不适宜行单纯房间缺损封堵术。     

以双向阻滞作为阵发性心房颤动肺静脉电隔离终点的临床研究

目的 评价以左心房-肺静脉电联系双向阻滞作为环肺静脉消融电隔离术终点对阵发性心房颤动(房颤)导管消融疗效的影响.方法 在76例阵发性房颤患者导管消融达到左心房-肺静脉传入阻滞后,分别于每根肺静脉内起搏评价肺静脉-左心房传导情况.据此分为双向阻滞组(传入与传出均阻滞)和传入阻滞组,随访观察房颤导管消融的临床疗效.结果 76例均完成导管消融术,306根肺静脉(2例患者存在右中肺静脉)均达到左心房-肺静脉电学传入阻滞之传统终点.18例消融术后左心房-肺静脉传导呈双向阻滞,58例仅传入阻滞.平均随访(6.85±1.08)个月,1次消融成功率为77.63％.其中,双向阻滞组为83.33％,传入阻滞组为75.86％,两组相比差异无统计学意义(P＞0.05).术后房性心动过速发生率5.26％(4/76),无心脏压塞、脑栓塞、左心房食管瘘等并发症以及死亡发生.结论 以左心房-肺静脉传导双向阻滞为房颤导管消融终点治疗阵发性房颤的策略似乎临床疗效较好.     

Comparison of the Location of Slow Conduction Velocity in Cavotricuspid‐Dependent Atrial Flutter in Patients With and Without Prior Atriotomy: Different Arrhythmogenic Basis and Clinical Implications for Placement of Atriotomy

Slow Zone in CTI‐Dependent Flutter After Atriotomy. Introduction: Earlier studies have shown that the slow conduction zone in patients with cavotriscuspid (CTI)‐dependent atrial flutter without prior surgery (NS‐AFL) is the CTI. However, the location of this slow zone in patients with CTI‐dependent flutter and a prior atriotomy has not been formally studied. Identification of the slow zone in patients with prior atriotomy and CTI‐dependent atrial flutter (PA‐AFL) and comparison with NS‐AFL may have important clinical implications. Methods and Results: Seventeen consecutive patients with PA‐AFL and 17 consecutive patients with NS‐AFL were included. Conduction velocity (CV) was measured using 3‐dimensional mapping in 3 areas around the TVA. These regions were defined as the CTI area from lateral inferior vena cava orifice to coronary sinus ostium (region I), mid‐ to upper‐septum (S), and free wall (F). In region F, the CV was much slower in PA‐AFL than in NS‐AFL patients (0.43 ± 0.13 vs 0.76 ± 0.26 m/s, P < 0.01). However, region I was slower in NS‐AFL than PA‐AFL (0.57 ± 0.18 m/s vs 0.84 ± 0.24 m/s, P < 0.01). In all PA‐AFL patients, the slow zone was in region F. But in most (11/17) NS‐AFL patients the slow zone was in region I. There was no significant difference in CV in region S between the 2 groups. Conclusions: Unlike NS‐AFL, CTI in PA‐AFL displays relatively normal conduction but the slow zone is on the free wall. This arrhythmogenecity of atriotomy may perhaps be avoided if the incisional line were altered to extend to the TV. (J Cardiovasc Electrophysiol, Vol. 23, pp. 988‐995, September 2012)     

Introducing corticosteroids therapy from 1969 to 1990 at the Centre/Institute for Neuromuscular Diseases, KBC Rebro, Zagreb, Croatia

The author presents the chronological development of therapy by corticosteroids in myasthenia gravis (MG), as well as dilemmas connected to this kind of treatment at the Centre/Institute Zagreb, she founded. The improvement of postoperative prognosis of thymectomy with corticosteroids is described and transfer of positive experiences to other neurological diseases. The side effects can be reduced significantly by respecting the basic rules: the choice of corticosteroids (fluocortolone, methyprednisolone, no dexamethasone), single dose administered in the morning, not later than 8 a.m. (respecting the circadian rhythm of concentration of cortisol in blood). Initially, the high dose is administered daily, until the stabilisation of signs and symptoms improvement. Then, in my early modification, the initial dose, administered every other day, becames gradually lowered. The diet is similar to diabetic, with the potassium added. In the period from 1973 to 1990, 212 myasthenia gravis and 37 polymyositis patients were treated that way.We recommend to continue endocrinological research, on which we already reported, now with contemporary methods. The value of the "pulse therapy" should be analysed in more details, with peroral corticosteroids added afterwards.Key words: Myasthenia gravis, corticosteroids     

(踇)甲皮瓣联合第二趾胫侧皮瓣加髂骨植骨修复拇指末节缺损

目的 报告应用(踇)甲皮瓣联合第二趾胫侧皮瓣加髂骨植骨修复拇指末节缺损的手术方法和临床疗效.方法 2005年6月至2011年2月,对12例拇指末节缺损者,采用游离(踇)甲皮瓣联合第二趾胫侧皮瓣瓦合修复指甲及指腹缺损,同时髂骨植骨修复指骨缺损,足部供区采用腹部全厚皮片植皮.结果 术后患者伤口均Ⅰ期愈合,移植组织全部存活;足部供区植皮均顺利愈合.术后随访6～36个月,平均10个月.拇指末节指骨均达到骨性愈合,愈合时间为2～5个月,平均3.5个月,随访期内未出现指骨骨不连及再骨折情况,拇指外形满意,指甲生长良好,触觉满意,可协助指腹完成抓、捏、捡针等动作,均可完成对掌功能.8例保留拇指指间关节者,屈曲活动达40°～90°,平均55°;4例指间关节融合者,末节无活动度,但掌指关节活动接近正常.供足植皮区皮肤松软,质地可,行走功能无影响.结论 应用(踇)甲皮瓣联合第二趾胫侧皮瓣加髂骨植骨修复拇指末节缺损,可以较好地重建拇指的外形及功能.     

麦冬多糖的化学组成、分析方法和药理作用研究进展

麦冬具有生津解渴、润肺止咳的功效,其主要成分包括甾体皂苷、黄酮类、多糖类等,但是对其多糖类研究相对较少。主要综述麦冬多糖的化学组成、分析方法、药理作用等研究进展。麦冬多糖主要有MDG-1、Md-1、Md-2、OJP-1等;目前主要采用的分析方法有蒽酮-硫酸法、苯酚-硫酸法、3,5-二硝基水杨酸（DNS）比色法、近红外光谱结合偏最小二乘回归法等;麦冬多糖可有效地改善心血管系统疾病,具有耐缺氧、抗炎、抗肿瘤、抗氧化等多种药理作用。     

注射用益气复脉(冻干)的质量标志物研究

注射用益气复脉(冻干)是由红参、麦冬和五味子3味药材精制而成,临床上主要用于治疗冠心病劳累型心绞痛气阴两虚证及冠心病所致慢性左心功能不全II、III级气阴两虚证。根据质量标志物概念,从物质基础、药效、网络药理、药动学及药性等方面对注射用益气复脉(冻干)质量标志物进行预测分析,初步确定人参皂苷Rb1、Rg1、Rf、Rh1、Rc、Rb2、Ro、Rg3及麦冬皂苷C、麦冬苷元-3-O-α-L-吡喃鼠李糖基-(1→2)-β-D-吡喃葡萄糖苷、偏诺皂苷元-3-O-α-L-吡喃鼠李糖基-(1→2)-β-D-吡喃木糖基-(1→4)-β-D-吡喃葡萄糖苷、果糖、五味子醇甲13个成分为质量标志物,并以此为核心建立全程质量控制体系。基于质量标志物对注射用益气复脉(冻干)进行质控方法研究,可以为中药注射剂质量评价提供新的研究思路。     

细胞毒性T细胞穿入现象在原发性胆汁性胆管炎中的表现及意义*

目的:研究原发性胆汁性胆管炎(primary biliary cholangitis,PBC)中发生CD8+细胞毒性T细胞(cytotoxic T lymphocyte,CTL)穿入现象及其意义。方法:收集53例PBC患者肝穿刺标本,采用H&E染色和免疫荧光染色方法,在光学显微镜和激光共聚焦显微镜下观察PBC肝组织中CTL的穿入及穿入宿主细胞的类型,并分析与病程的关系。结果:53例PBC患者中10例(18.9%)发生淋巴细胞穿入肝细胞,15例(28.3%)发生淋巴细胞穿入胆管上皮,仅1例患者同时存在淋巴细胞穿入肝细胞和胆管上皮细胞。免疫荧光染色证实穿入的淋巴细胞是CD8阳性细胞毒性T细胞(CTL)。早期PBC患者中4例(22.2%)、晚期PBC患者中6例(17.1%)发生CTL穿入肝细胞,两组差异无统计学意义(P>0.05)。早期PBC患者中9例(50.0%)、晚期PBC患者中6例(17.1%)发生CTL穿入胆管上皮,两组差异有统计学意义(Z=2.52,P<0.05)。结论:在PBC肝组织中,CTL可穿入肝细胞和胆管上皮细胞,CTL穿入胆管上皮细胞并导致其发生凋亡可能是PBC发病过程中胆管损伤的机制之一。     

以截瘫为临床表现的弥漫性大B细胞淋巴瘤合并甲状腺肿瘤一例

弥漫性大B细胞淋巴瘤 （DLBCL） 是非霍奇金淋巴瘤 （NHL） 中最常见的一个亚型, 发病年龄范围宽, 在临床特征、 侵袭部位、 组织形态学、 分子遗传学、 免疫表型等方面均表现出明显的异质性。此外, 随着恶性肿瘤诊治水平的提高, 同一患者存在多原发性恶性肿瘤 （MPMT） 的报道呈上升趋势。本文报告我科收治的以截瘫为临床表现的 DLBCL合并甲状腺肿瘤1例。