临床痊愈在抑郁症治疗中的意义及用药选择

抑郁症是一种常见、慢性且容易复发的精神疾病,发病率较高,在全世界范围内8％～12％在一生中会患有抑郁症。抑郁症会给患者带来极大的健康负担和经济负担,同时也会严重影响患者的社会功能和生活质量。世界卫生组织预计,至2020年抑郁症会成仅次于缺血性心脏病的全球第二大影响伤残调整生命年（disability—adjusted lif eyear,DALY）的疾病。     

230例垂体ACTH微腺瘤经蝶手术治疗经验总结

目的 回顾分析垂体促肾上腺皮质激素(ACTH)微腺瘤诊断和手术治疗结果.方法 1983年9月至2009年12月经蝶手术治疗ACTH微腺瘤230例.术前内分泌学检查患者均见血尿皮质醇水平增高,昼夜节律消失;地塞米松抑制试验:小剂量(2 mg)不抑制97％(223/230例);大剂量(8 mg)抑制89.5％(220/230例).术前影像学(CT/MRI)检查结果:阳性占67％(154/230例),阴性占33％(76/230例).结果 随访2～26年,平均6.7年.其中根治196/230例(85％),未根治34例(15％)结论 垂体微腺瘤0级(≤4mm)在CT/MRI上多未能发现.大部分病例可在术中探查到肿瘤,其中最小者仅2mm大小.术中冰冻切片示垂体增生者可行垂体次全切除术.     

Post-cure depth of cure of bulk fill dental resin-composites

Objectives

To determine the post-cure depth of cure of bulk fill resin composites through using Vickers hardness profiles (VHN).

Methods

Five bulk fill composite materials were examined: Tetric EvoCeram^® Bulk Fill, X-tra base, Venus^® Bulk Fill, Filtek™ Bulk Fill, SonicFill™. Three specimens of each material type were prepared in stainless steel molds which contained a slot of dimensions (15 mm × 4 mm × 2 mm), and a top plate. The molds were irradiated from one end. All specimens were stored at 37 °C for 24 h, before measurement. The Vickers hardness was measured as a function of depth of material, at 0.3 mm intervals. Data were analysed by one-way ANOVA using Tukey post hoc tests (α = 0.05).

Results

The maximum VHN ranged from 37.8 to 77.4, whilst the VHN at 80% of max.VHN ranged from 30.4 to 61.9. The depth corresponding to 80% of max.VHN, ranged from 4.14 to 5.03 mm. One-way ANOVA showed statistically significant differences between materials for all parameters tested. SonicFill exhibited the highest VHN (p < 0.001) while Venus Bulk Fill the lowest (p ≤ 0.001). SonicFill and Tetric EvoCeram Bulk Fill had the greatest depth of cure (5.03 and 4.47 mm, respectively) and was significant's different from X-tra base, Venus Bulk Fill and Filtek Bulk Fill (p ≤ 0.016). Linear regression confirmed a positive regression between max.VHN and filler loading (r² = 0.94).

Significance

Bulk fill resin composites can be cured to an acceptable post-cure depth, according to the manufacturers’ claims. SonicFill and Tetric EvoCeram Bulk Fill had the greatest depth of cure among the composites examined.     

Spee曲线高度与咀嚼效率的相关性研究

目的:研究Spee曲线高度与咀嚼效率的相关关系.方法:测量203名在校大学生的咀嚼效率和Spee曲线高度,将结果进行Pearson相关性检验,以P＜0.05为差异有统计学意义.结果:Spee曲线高度在0到2mm范围内与咀嚼效率呈显著正相关,r=0.631,P＜0.01;Spee曲线高度在2到5mm范围内与咀嚼效率呈显著负相关,r=-0.759,P＜0.01.结论:当Spee曲线高度在2-2.5mm范围内时,咀嚼效率最大,过大或者过小的Spee曲线高度都有可能降低咀嚼效率.     

专业防治宣教与高知人群血管性痴呆疾病负担的相关性

目的：研究专业防治宣教与高知人群血管性痴呆疾病负担的相关性。方法300例高知血管性痴呆者作为调研对象。评价其认知功能、日常生活的能力、伤残和存活年限,将患者分为A、B、C3组,A组接受宣教0次,B组接受宣教1～3次,C组接受宣教≥4次。计算出DALY（即伤残调整寿命年）的数值。结果3组DALY值中,A组为7·63±2·37,B组为7·51±1·75,C组为4·93±0·48,3组差异有统计学意义（均 P＜0·05）。结论专业化防治宣教和高知人群的血管性痴呆疾病负担相关,随着宣教次数（≥4次最佳）的增多,DALY值逐渐减小。     

甲状腺髓样癌手术切除范围及预后影响因素研究

目的 分析甲状腺髓样癌（MTC）手术切除范围及预后影响因素。方法 回顾性分析2015年1月至2017年6月期间首诊于天津医科大学肿瘤医院MTC病人的临床资料。分析临床病理特征与中央区、侧颈区淋巴结转移及生化治愈的关系;探讨影响病人无进展生存期的危险因素。结果 77例病人,术前降钙素水平正常者5例,升高者72例。行全甲状腺切除28例,单侧腺叶切除49例。仅行中央区淋巴结清扫39例,中央区及患侧侧颈淋巴结清扫38例。MTC病人中央区淋巴结转移与性别、侵出腺叶、肿瘤直径、TNM分期、术前降钙素、降钙素水平/肿瘤直径具有相关性（P＜0.05）。侧颈淋巴结转移与年龄、TNM分期具有相关性（P＜0.05）。生化治愈率66.1%（39/59）,与中央区淋巴结转移、TNM分期、肿瘤直径、术前降钙素水平及降钙素水平/肿瘤直径具有相关性（P＜0.05）。中位随访时间35（7~69）个月。侵出腺叶、中央区淋巴结转移、淋巴结转移、淋巴结切除范围、TNM分期、术前降钙素水平和生化治愈是MTC病人无进展生存期的影响因素（P＜0.05）。结论 MTC病人建议至少行患侧腺叶切除及中央区淋巴结清扫,必要时行全甲状腺切除,根据超声、CT及降钙素水平等检查结果行预防性/治疗性侧颈淋巴结清扫。规范化的手术治疗是达到较高生化治愈率,减少复发的关键。     

引流加肛管直肠黏膜固化治疗肛周脓肿的临床观察

为探讨引流加肛管直肠黏膜固化治疗肛周脓肿的临床疗效,回顾分析采用引流加肛管直肠黏膜固化治疗（治疗组,120例）或单纯引流治疗（对照组,60例）的肛周脓肿患者资料,对比分析两组患者疗效。结果显示,治疗组平均治疗操作时间为（10．0±2．6）min,2h微痛,平均治愈时间为（6．0±1．3）d,治愈率为100％,无并发症,近期未见无效及肛瘘形成者。随访1年,成功随访65例,未见无效、复发、肛瘘形成及有后遗症者。对照组治愈时间（19．0±2．7）d。两组治愈时间比较差异具有统计学意义,P〈0．05。结果表明,引流加肛管直肠黏膜固化治疗肛周脓肿操作简单、疗程短、治愈率高、无复发及肛瘘形成、患者痛苦小,值得临床推广。     

Curing efficiency and ocular hazards of dental photopolymerization sources

The spectral distributions of a range of dental photocuring sources were measured at the exit window and at a distance of 10 cm. The former enabled the evaluation of a newly proposed photocuring efficiency index which correlates well with the depth of cure of the photopolymerized resins, thus providing a basis for the comparison of different photocuring sources. The spectral irradiante of the sources obeyed the inversesquare law, allowing a comparison with the ACGIH threshold limit values. According to these criteria, no ocular hazard is posed to the patient or clinician by u.v.-A or u.v.-B radiation nor to the patient by the visible light when momentarily exposed to the sources. Similarly the ACGIH criterion indicates that the clinician does not risk chorioretinal injury provided the exposure is restricted to less than 140 s in a 3 h period.     

息风止痛颗粒防治急性高原病的临床观察

目的：观察息风止痛颗粒防治急性高原病（AMS）的临床效果。方法：对急进4 300m高原的118名官兵分别口服息风止痛颗粒（A组,10g/次）、复方红景天胶囊（B组,0.38g/粒,2粒/次）和安慰剂（C组）,每天早晚各服1次。药物干预时间为进驻高原前3d,进驻高原途中及进驻后12d,共服药15d。进驻高原后1d、3d、5d、7d以《我国高原病命名、分型及诊断标准》随访记录受试者每天的AMS症状,然后分度评分,并检测Sa O2。结果：A组和B组较C组第1d、3d、5d、7d AMS症状评分和发病率均降低,Sa O2增高,有显著性差异（P〈0.05~0.01）;A组对急性缺氧所致头痛、心慌、气短、食欲减退、疲劳、眩晕、手足发麻、失眠、精神不振等AMS症状较B组和C组明显降低（P〈0.05~0.01）。结论：息风止痛颗粒防治AMS早期效果显著,对缺氧所致头痛、心慌和气短等症状防治优于复方红景天。     

Wilmss' tumor: The northern israel oncology institute experience

Between 1971 and 1992, 42 children (median age = 2 years) with histologically proven Wilms' tumor were evaluated at the Northern Israel Oncology Institute. Most patients were staged according to National Wilms' Tumor Study (NWTS) criteria by which 18 were clinical stage I-II and 24 were III-IV. Combined therapy (surgery, chemotherapy, and radiotherapy) was given with a change to lower dose radiotherapy (<2,000cG) after 1981. The pre-1981 group (13 patients) suffered six relapses, most of which were pulmonary, whereas the 1981-1992 group (29 patients) had three relapses. The actuarial 5-year survival rate using Kaplan-Meier tables was 79% for the entire group but 100% for the 1981-1992 group and 38% for the 1971-1980 group. One case of immediate hepatic toxicity and one sudden death, unknown cause, of a patient in remission occurred in the group. Late deleterious effects were seen in five other patients; four had scoliosis and one developed osteoid osteoma of a rib. Despite these encouraging results, the necessity of ongoing monitoring for further longterm toxicities is apparent.