耳鸣的心理学问题

目的：分析耳鸣的心理原因和结果，以期引起临床医生的重视和研究。方法：对225例以耳鸣为第一主诉的主观耳鸣患者，采用唔谈，耳鸣分类调查表，耳鸣问卷，Zuang抑郁量表等进行心理问题评定，结果：全部患者均存在明显的心理问题，心理因素引起的耳鸣占21.0%，耳鸣引起的心理反应占67.7%，分不清先后（混合性）占11.3%。结论：耳鸣与心理因素密切相关，耳鸣问卷和耳鸣习服疗法能较好地测量和治疗患者的心理问题。     

我国胆道外科发展现状及专科医师管理培训的意义

我国是一个胆道疾病高发的国家，随着时代发展，胆道外科疾病的结构发生了明显变化，胆囊结石、胆道恶性肿瘤发生率明显上升；科学技术的发展给胆道外科带来了新的气象，腹腔镜技术、内镜微创技术、机器人辅助外科系统的应用及三维影像重建技术等影像学的发展，使胆道外科手术方式出现了巨大变化，胆道疾病外科诊治观念面临着更新和拓展。因此，胆道外科专科医师的规范化管理培训显得格外重要。     

Quantified self and human movement: A review on the clinical impact of wearable sensing and feedback for gait analysis and intervention

The proliferation of miniaturized electronics has fueled a shift toward wearable sensors and feedback devices for the mass population. Quantified self and other similar movements involving wearable systems have gained recent interest. However, it is unclear what the clinical impact of these enabling technologies is on human gait. The purpose of this review is to assess clinical applications of wearable sensing and feedback for human gait and to identify areas of future research. Four electronic databases were searched to find articles employing wearable sensing or feedback for movements of the foot, ankle, shank, thigh, hip, pelvis, and trunk during gait. We retrieved 76 articles that met the inclusion criteria and identified four common clinical applications: (1) identifying movement disorders, (2) assessing surgical outcomes, (3) improving walking stability, and (4) reducing joint loading. Characteristics of knee and trunk motion were the most frequent gait parameters for both wearable sensing and wearable feedback. Most articles performed testing on healthy subjects, and the most prevalent patient populations were osteoarthritis, vestibular loss, Parkinson's disease, and post-stroke hemiplegia. The most widely used wearable sensors were inertial measurement units (accelerometer and gyroscope packaged together) and goniometers. Haptic (touch) and auditory were the most common feedback sensations. This review highlights the current state of the literature and demonstrates substantial potential clinical benefits of wearable sensing and feedback. Future research should focus on wearable sensing and feedback in patient populations, in natural human environments outside the laboratory such as at home or work, and on continuous, long-term monitoring and intervention.     

分期双调转解剖矫治术治疗左心室退化的矫正型大动脉转位的临床疗效分析

目的评价分期双调转解剖矫治术治疗先天性左心室退化矫正型大动脉转位（CCTGA）的临床疗效。方法回顾性分析2005年5月至2011年5月北京阜外心血管病医院14例左心室退化CCTGA患儿经手术治疗的临床资料,男8例,女6例;年龄2．5～72．0（34．4-24．0）个月;体重5．1～23．0（12．7±4．9）kg。术前经超声心动图、心血管造影或心导管检查确诊。主要合并畸形：三尖瓣关闭不全13例,限制型室间隔缺损10例,房间隔缺损或卵圆孔未闭7例,动脉导管未闭4例,肺动脉瓣轻度狭窄4例,Ⅲ度房室传导阻滞1例。在全身麻醉下完成一期左心室训练术,在体外循环下完成二期心房大动脉双调转术,平均间隔时间0．67～34．0（10．23±9．47）个月。结果一期左心室训练术后无住院死亡,随访结束时形态左心室舒张期末内径（mLVEDd）及形态左心室（mLV）后壁厚度均较术前显著增加（P〈0．05）,室间隔位置较术前略向形态学有心室侧（mRV）移位,三尖瓣关闭不会（TR）较术前减轻,跨肺动脉环缩带压差显著增加（P〈0．05）,左心室射血分数（LVEF）无显著变化;形态左心室压力与形态右心室压力比值（PmLV／PmRV）显著增大（P〈0．05）。二期心房大动脉双调转术住院死亡2例,死亡率14．3％（2／14）;死亡原因：严重心律失常、循环衰竭、猝死。术后早期并发症：肺部感染6例,房性心律失常2例,胸腔积液2例,气胸、膈肌麻痹行膈肌折叠术、气道出血、主动脉瓣轻度关闭不全、腹膜透析、体外膜肺氧合辅助、二次气管内插管各l例。生存患者均痊愈出院。术后随访12例,随访时间2～8年。随访期间死亡1例,死亡率8．33％（1／12）,死亡原因：严重心律失常、循环衰竭。心功能I级8例,Ⅱ级3例。主要晚期并发症：左心功能不全3例,主动脉瓣中度关闭不全3例,二尖瓣中度关闭不全1例。结论分期双凋转解剖矫治术治疗左心室退化CCTGA早期临床疗效满意,中远期疗效尚需进一步随访观察,但术后左心功能不良和新出现的主动脉瓣关闭不全应值得关注。     

Retraining automatic action‐tendencies to approach alcohol in hazardous drinkers

Aims The main aim of this study was to test whether automatic action‐tendencies to approach alcohol can be modified, and whether this affects drinking behaviour. Design and participants Forty‐two hazardous drinkers were assigned randomly to a condition in which they were implicitly trained to avoid or to approach alcohol, using a training variety of the alcohol Approach Avoidance Test (AAT). Participants pushed or pulled a joystick in response to picture‐format (landscape or portrait). The pictures depicted alcoholic or non‐alcoholic drinks. Participants in the avoid‐alcohol condition pushed most alcoholic and pulled most non‐alcoholic drinks. For participants in the approach‐alcohol condition these contingencies were reversed. After the implicit training, participants performed a taste test, including beers and soft drinks. Automatic action tendencies at post‐test were assessed with the AAT, including both trained and untrained pictures, and with a different test (Implicit Association Test, IAT). We further tested effects on subjective craving. Results Action tendencies for alcohol changed in accordance with training condition, with the largest effects in the clinically relevant avoid‐alcohol condition. These effects occurred outside subjective awareness and generalized to new pictures in the AAT and to an entirely different test using words, rather than pictures (IAT). In relatively heavy drinking participants who demonstrated changed action tendencies in accordance with their training condition, effects were found on drinking behaviour, with participants in the approach‐alcohol condition drinking more alcohol than participants in the avoid‐alcohol condition. No effect was found on subjective craving. Conclusions Retraining automatic processes may help to regain control over addictive impulses, which points to new treatment possibilities.     

Anticholinergic drugs,bladder retraining and their combination for urge urinary incontinence: a pilot randomised trial

Bladder retraining and anticholinergic drugs in women with urge urinary incontinence need to be compared. Women with urge urinary incontinence were recruited by advertisements, from primary care and from a urogynaecology clinic. Women were randomised using a web page to bladder retraining, anticholinergic drugs or both and followed up at 3 and 12 months. No blinding was attempted. The primary outcomes were the trial process and the Overactive Bladder Questionnaire (OAB-q) quality-of-life measure. Recruitment was much slower than anticipated. There were no differences in the OAB-q at 12 months (87.9 SD 11.6 bladder retraining, 81.6 SD 19.3 drug therapy and 88.9 SD 9.9 combination) but dry mouth was more common in those taking drugs. It is feasible to run a pragmatic randomised trial with 12-month follow-up for women with urinary urge incontinence. This will require about 500 participants per arm. Trial registration  This trial was registered as ISRCTN 66713401.