儿童Graves’病研究进展

Grave’s病(GD)是导致儿童甲亢最常见的病因,其易感性80%决定于基因因素。ATD治疗是最常推荐的初始治疗手段,但长期缓解率仅为30%。ATD诱导儿童GD缓解的合适用药时间尚不明确。最佳治疗方式(ATD、RAI或手术)的选择还存在重大争议。药物治疗复发的预测非常重要,最近建立了一种复发风险评分,通过种族、年龄、诊断时FT4、TRAb水平、ATD预期治疗持续时间将GD儿童分成低中高三类风险人群,对其复发风险作出评估,对于确定GD儿童在初始治疗时选择何种方案更为适合意义重大。     

妊娠和Graves'病诊治

甲状腺激素是胎儿发育的重要激素,妊娠合并Graves'病(GD)使得妊娠更加复杂化,而孕期甲状腺发生生理性变化,使孕期甲状腺疾病的诊断异于非妊娠妇女。本文就妊娠对GD发生风险的影响、早孕期甲状腺功能的变化及对甲亢诊断的影响,妊娠期GD的诊断和抗甲状腺药物的选择、孕前咨询及合并GD妇女的胎儿甲亢和甲减的风险做一综述。结合最新的研究结果,尤其指出,抗甲状腺药物在特殊的早孕周使用可能增加新生儿出生缺陷风险,这对于有怀孕打算的GD患者需要考虑在内。     

学前儿童努力控制的发展轨迹与父母养育的关系：一项多水平分析

通过3年追踪研究, 采用问卷法考察了474名学前儿童努力控制发展变化的轨迹, 以及初始父母养育方式对其发展水平和发展速率的影响。多水平分析的结果表明：(1)学前儿童的努力控制呈线性增长, 其发展水平和增长速度均存在明显的个体差异, 努力控制初始水平较高的儿童, 其增长速度也较快。(2)初始的父母鼓励与接纳对儿童努力控制的最后发展水平有促进作用, 而父母的拒绝与惩罚则起反作用。(3)父亲鼓励与接纳能加速儿童努力控制的平均增长速率, 而母亲鼓励与接纳则会延缓其平均增长速率。(4)初始的父亲养育方式可分别解释儿童努力控制发展水平和发展速率10%和2%的变异, 初始的母亲养育方式可分别解释其14%和3%的变异, 父母养育方式累计可分别解释其19%和10%的变异。     

行为评价对3岁儿童掌控动机的影响

运用情境实验法,考察了71名3岁儿童掌控动机的基本特点及行为评价对其影响。结果发现:3岁儿童:(1)对新奇玩具具有强烈的掌控动机;(2)丰富的视听反馈会更加激发其探索与操控;(3)当成人对其探索行为有积极评价时,儿童获得更多愉悦感;(4)掌控成败体验出现;(5)积极评价可增强掌控成功时的兴趣感,缓解失败后的不良情绪;(6)多数(94.42%)儿童愿意尝试挑战,并能坚持较长时间以期成功,但坚持性存在个体差异。     

肠梗阻导管治疗结直肠癌根治术后早期低位小肠梗阻综合征的临床疗效

探讨肠梗阻导管治疗结直肠癌根治术后早期低位小肠梗阻综合征的临床疗效。选择结直肠癌根治术后早期低位小肠梗阻综合征患者28例,随机分成采用肠梗阻导管的研究组(n=11例)和采用鼻胃管的对照组(n=17例)。观察两组患者腹部胀痛改善程度、肠梗阻缓解时间、腹部立位片气液平面消失时间、腹围消减程度。所有患者均置管成功。研究组早期低位肠梗阻缓解率100%(11/11)。研究组腹部胀痛改善程度、肠梗阻缓解时间、腹部立位片气液平面消失时间、腹围消减程度均明显优于对照组,其差异有统计学意义(P0.05)。研究组随访6个月无一例低位肠梗阻综合征复发。肠梗阻导管治疗结直肠癌根治术后早期低位小肠梗阻综合征疗效确切,能够显著改善患者临床表现,值得临床推广。     

妊娠期甲亢诊疗决策

由于甲亢的一些症状和体征类似于正常妊娠中发生的正常生理变化,且孕期甲亢及其治疗对妊娠结果和胎儿可能的不良影响,所以给孕期甲亢的诊疗带来困难.孕期甲亢息者应尽快接受抗甲状腺药物(antitlayroid drugs,ATD)的治疗并应经常接受胎儿和孕妇甲亢及甲减征象的监测.孕妇和围产期的并发症发生率直接与母亲甲亢的控制有关,应对所有甲亢妇女进行促甲状腺受体抗体(thyrotrophin receptor antibody,TRAb)的评估.所有妊娠剧吐患者均应测定甲状腺功能,少数妊娠剧吐短暂甲亢孕妇需ATD治疗.     

重视直肠癌术后局部复发的防治

直肠癌术后局部复发是临床关注的重点与难点问题.术前准确分期、评估,选择合理治疗方案和术式,是防治局部复发的先决条件.手术遵循全直肠系膜切除(TME)原则,保证断端切缘和环周切缘完整、无癌细胞残留是防治局部复发的关键.新辅助治疗可降低T3、T4期直肠癌局部复发率.发挥直肠癌多学科综合治疗模式优势对防治直肠癌局部复发有重要作用.     

放射治疗后复发性脑转移瘤的治疗抉择

立体定向放射外科(SRS)已经成为治疗脑转移瘤的一线选择,它既可用于全脑放射治疗(WBRT)后效果的提高,也可作为独立的治疗方案。当使用SRS作为一个单一的治疗方案,局部和远端的大脑复发率从73.0%到76.4%不等;当与WBRT联合使用时,复发率从27.0%到46.8%。作为系统性疗法改善,SRS治疗后,新发或复发脑转移瘤的患者有可能增加。关于补救治疗的安全性和有效性的证据是有限的,治疗方案的选择仍有争议。在本文中,笔者分析有关SRS治疗后复发和SRS治疗后新发脑转移瘤的发展,将对患者的每一个建议性方案及潜在的治疗策略进行讨论,其中包括再次SRS,手术切除,WBRT,分次立体定向放射治疗,化疗和支持治疗。     

复方泛影葡胺在直肠癌Miles术后低位小肠梗阻治疗中的应用

评价复方泛影葡胺在直肠癌Miles术后低位小肠梗阻治疗中的作用。选择直肠癌Miles术后低位小肠梗阻患者32例,随机分成对照组和研究组,其中16例对照组经造口置入一次性吸痰管灌肠治疗,其余16例研究组在吸痰管灌肠治疗基础上联合经口服用复方泛影葡胺治疗。观察两组患者的腹围变化、肠梗阻缓解时间、住院时间及影像学肠管直径变化,并观察其疗效。研究组直肠癌Miles术后低位小肠梗阻缓解率为100%(16/16),并成功接受了保守治疗。研究组患者的腹围缩小程度、肠梗阻缓解时间、住院时间及影像学肠管直径缩小程度明显优于对照组,其差异有统计学意义(P0.05)。研究组随访6个月无一例肠梗阻复发或再手术治疗。经造口置入一次性吸痰管灌肠治疗联合经口复方泛影葡胺治疗直肠癌Miles术后低位小肠梗阻是安全、经济、有效的方法,不仅能缩短住院时间及住院费用,也能避开接受手术之苦,值得临床推广。     

对T1G3膀胱癌治疗方法的探讨

T1G3膀胱癌有高复发和进展倾向,选择恰当的治疗方法成为难题.使用BCG治疗可促肿瘤进展和转移,但可保留膀胱.膀胱切除也许提供了最好的治疗方案,但膀胱切除仍会复发且具有手术风险,且被认为是过度治疗.此文从哲学角度来探讨T1G3膀胱癌的治疗方法,以便为临床实践和进一步的研究提供思路.     

自伤青少年的冲动性

以自我报告、行为学和脑电为指标, 检验自伤青少年的冲动性。研究1, 对820名普通中学生和72名工读生进行问卷调查, 探讨自伤行为与情绪调节困难、冲动性的关系。结果表明, 冲动性能够预测自伤行为, 且预测效应量大于情绪调节困难。研究2, 采用Go/Nogo范式的ERPs实验, 检验自伤组与对照组冲动控制的行为学与脑电差异。结果表明, 自伤组Nogo正确反应的N2波幅显著高于对照组, N2潜伏期在部分电极点处高于对照组。脑电地形图显示两者的脑电差异主要体现在前额叶区。结论：自伤青少年的冲动性高于同龄普通青少年。     

Certification in Testing in Canada

This article presents a brief outline of a program developed by the Canada Employment and Immigration Commission (CEIC) for certifying employment counselors to use tests in Canada Employment Centres (CECs).     

Sex differences in relational aggression in preschool children in Iran

The purpose of this study was to compare scores on a Relational Aggression Questionnaire for preschool boys and girls in Iran. The questionnaire was developed here, and its reliability and validity were assessed. Teachers' reports of relational aggression in 258 children ages 3 to 7 years was studied. Sex differences in relational aggression were not observed and was not significantly different across age groups.     

Occupational Stress in Workers and Managers in Steelworks in China

Occupational stressors and strains of 121 Chinese steelwork employees and 122 managers were measured using the Chinese version of the Occupational Stress Indicator (OSI). It was found that factors intrinsic to the job, Type A behavior, logic, and organizational structure and climate were the main predictors of mental ill-health and physical ill-health in managers. Organizational structure and climate and relationships with other people were important predictors for workers. Management processes and organizational forces were the strongest predicting factors of job satisfaction in both samples. On certain OSI scales and subscales, managers scored statistically higher than workers. It is proposed that these results reflect the enormous economic and social changes currently taking place in China, together with certain features inherent in Chinese organizational and managerial processes.     

Ethics in Research in Mathematics Education

Most scientific domains have guidelines concerning ethics in research. These guidelines are designed to enable researchers to conduct good research while avoiding potential harm to research participants. This paper examines the bases for ethical codes in research and discusses how these codes are operationalized in research conducted in the field of mathematics education.     

Competitiveness in males and in females

Male and female undergraduates performed a task at which they either succeeded or failed in competition with either a male or female partner who subsequently either accepted or rejected them. Subjects who were rejected by a male partner following success or accepted following failure performed less well on a subsequent anagram task than did those who were accepted following success or rejected following failure. These results suggest the importance of situational factors as determinants of fear of success behavior.     

Training in group-analytic psychotherapy in Europe

Group-analytic psychotherapy focuses on the making and maintaining of close, emotionally fulfilling relationships. Its practitioners attempt to fuse an individual and a whole-group perspective, and seek to provide the enabling conditions for freer communication between group members. The group-analytic approach is widely used in the United Kingdom, and many experiential groups on psychotherapy training courses are conducted on group-analytic lines. The Institute of Group Psychotherapy in London recognizes eight one-year courses in England and Scotland specifically oriented to group-analytic theory and methods. These courses provide an introduction to group psychotherapy to over 300 professionals of varied backgrounds every year. There are also two courses in the United Kingdom that provide a full training in group-analysis and group-analytic psychotherapy, and 11 courses on the continent of Europe. The number of courses is growing and there is now a European Group-Analytic Training Network providing formal links between them. Results of a postal survey indicate that few (10%) attenders at a one-year course have a negative response and that many (85%) recommend the course to colleagues. The efficiency and therefore reduced cost of group teaching and the incorporation of a group experience may be contributing factors to the increasing demand for this type of training.This paper is based on a presentation at an Open Session on Training in Group Psychotherapy: The Quest for a Viable Model at the American Group Psychotherapy Association Annual Meeting, Boston, February 1990. This paper represents the author's own views and is not an official statement of the Institute of Group Analysis [London]. However, members and staff of the Institute have made helpful contributions to the author in preparing it. He is especially grateful for the assistance of Mrs. Liesel Hearst (Chairperson, Overseas Training Sub-Committee, Institute of Group Analysis, London), Dr. Keith Hyde (Convenor, Manchester Course in Group Psychotherapy), Fr. Jim Christie (Convenor, Glasgow Course in Group Psychotherapy), and Dr. Vivienne Cohen (Chairperson, Training Committee, Institute of Group Analysis, London, in preparing this paper. The questionnaire study was conducted with the assistance of the Training Section of the North-Western Regional Health Authority.