一期前后联合入路治疗上颈椎畸形

回顾9例因颅底凹陷症合并其它畸形在我科接受一期经口咽齿状突切除、后路枕骨大孔减压、寰枢椎或枕颈融合术治疗的,临床资料,观察该术式对脊髓功能、枕颈部稳定性的影响及其临床疗效。本组术前诊断均为颅底凹陷症合并邻近结构畸形。所有患者均接受前后联合入路手术。末次随访JOA评分15±1分。影像学检查示齿状突残留基底部均位于钱氏线以下,脊髓减压充分,寰枢间、枕颈间植骨均获坚强融合,融合时间平均3．9±1.1个月。因此一期前后路联合手术治疗颅底凹陷症,脊髓减压充分,重建稳定性后骨融合好,治疗效果满意。     

一期前后联合入路治疗上颈椎畸形

回顾9倒因颅底凹陷症合并其它畸形在我科接受一期经口咽齿状突切除、后路枕骨大孔减压、寰枢椎或枕颈融合术治疗的临床资料,观察该术式对脊髓功能、枕颈部稳定性的影响及其临床疗效.本组术前诊断均为颅底凹陷症合并邻近结构畸形.所有患者均接受前后联合入路手术.末次随访JOA评分15±1分.影像学检查示齿状突残留基底部均位于钱氏线以下,脊髓减压充分,寰枢间、枕颈间植骨均获坚强融合,融合时间平均3.9±1.1个月.因此一期前后路联合手术治疗颅底凹陷症,脊髓减压充分,重建稳定性后骨融合好,治疗效果满意.     

关于血管紧张素转换酶抑制药＋β受体阻断药组合的重新审视

采取联合用药方案治疗高血压已成为近年来临床用药的总体趋势。临床用药情况调查结果表明,血管紧张素转换酶抑制药＋β受体阻断药的联合用药组合占有一定的使用率,分析两类药的降压作用以及对高血压常见并发症和对代谢、心率等的影响,可见这个组合是合理的。     

本土化意义治疗法的建立及对晚期癌症患者治疗作用的初步评价

通过参考国内外的意义治疗研究并总结前期经验,构建了＂意义治疗三步骤法＂的本土化意义治疗方法.应用＂意义治疗三步骤法＂对符合要求的50名宁养院晚期癌症患者进行治疗,并于治疗前后分别应用生命态度剖面图量表和McGill生活质量问卷进行评估.经过治疗后,94%的患者能有效心灵沟通,患者治疗后的生命意义感和生活质量明显提高,焦虑和抑郁情绪明显改善.因而＂意义治疗三步骤法＂是一种有效的本土化意义治疗工具,值得进一步研究与临床推广应用.     

人工关节置换治疗老年股骨粗隆间骨折

老年股骨粗隆间骨折发病率越来越高,其治疗方法也多种多样,人工关节置换作为其中的一种治疗方法,随着它的优势越来越明显,逐渐受到关注.本文通过对国内外人工关节治疗老年粗隆间骨折的研究进行综述,为临床治疗老年股骨粗隆间骨折的方法提供选择.     

功能性内窥镜鼻窦外科应用的情况及问题

20世纪70年代,以慢性鼻窦炎/鼻息肉为主要治疗对象的功能性内窥镜鼻窦外科的创立和发展,开辟了鼻窦外科的新领域。功能性内窥镜鼻窦外科技术把鼻窦外科推向了新的阶段,使鼻窦炎临床治愈率提高到80%~90%,已成为国内外鼻窦炎外科治疗的主要方式。回顾功能性内窥镜鼻窦外科的发展历史,分析了鼻腔-鼻窦病变中应用的情况,并提出了应用中应处理好的两个问题,对准确把握功能性内窥镜鼻窦外科发展的趋势和特点具有重要的作用。     

计算机自适应测验中测验安全控制方法评述

计算机自适应测验在实际应用中曾经受到了测验安全问题质疑。国内外学者主要从两种研究思路提出了测验安全控制的方法：一是控制项目的最大曝光率, 沿着这个思路发展出来的方法有SH法、项目合格方法、多重最大曝光率法等; 二是改进选题策略, 沿着这个思路发展的方法主要是 分层法及其变式。此外, 近年来出现了测验安全控制方法之间相结合的研究思路。本文从均方误差、项目曝光率、题库利用率等指标论述了测验安全控制方法的优缺点, 并概述了这些测验安全控制方法的研究发展历程与发展思路, 展望了今后的研究趋势。     

功能性内窥镜鼻窦外科应用的情况及问题

20世纪70年代,以慢性鼻窦炎/鼻息肉为主要治疗对象的功能性内窥镜鼻窦外科的创立和发展,开辟了鼻窦外科的新领域.功能性内窥镜鼻窦外科技术把鼻窦外科推向了新的阶段,使鼻窦炎临床治愈率提高到80%～90%,已成为国内外鼻窦炎外科治疗的主要方式.回顾功能性内窥镜鼻窦外科的发展历史,分析了鼻腔-鼻窦病变中应用的情况,并提出了应用中应处理好的两个问题,对准确把握功能性内窥镜鼻窦外科发展的趋势和特点具有重要的作用.     

电针疗法联合膀胱功能训练对脊髓损伤后神经源性膀胱尿动力学的影响

观察电针疗法联合膀胱功能训练对脊髓损伤后神经源性膀胱患者尿动力学的影响。采用试验性研究方法,将60例患者随机分为对照组和试验组各30例,对照组采用常规膀胱功能训练进行治疗,试验组在对照组的基础上加用电针疗法进行干预,对比治疗前和治疗1个月后两组患者尿动力学指标及临床疗效。治疗后试验组最大膀胱容量、膀胱排尿压力、残余尿量改善优于对照组;两组临床疗效比较,试验组优于对照组,差异均有统计学意义(P0.05)。电针疗法联合膀胱功能训练能有效改善脊髓损伤后神经源性膀胱的尿动力学指标,具有良好的疗效。     

目标导向-习惯学习系统的神经机制

行为学习双系统模型认为行为习得涉及两个系统:目标导向学习系统与习惯学习系统,前者是对行为反应与结果之间的联结进行动态加工的学习系统,与尾状核、腹内侧前额叶皮质、眶额叶皮质相关;后者是对刺激-反应关系自动化加工的学习系统,与壳核、辅助运动区相关。这两种行为学习系统的研究范式主要有结果贬值范式和偶然性降低范式。大量研究发现强迫症、自闭症、成瘾等心理、精神疾病均表现出目标导向学习系统与习惯学习系统缺损,且这种缺损在患病不同阶段呈现动态变化过程。     

The effect of moving and static trans-scleral illumination of visual afterimages

The inside of the eye was illuminated by shining a small light through the upper eyelid and the sclera. After viewing a bright light flash, Ss closed their eyes and reported the duration of the afterimage under the following conditions: the light on and moving across the S’s eyelid (moving trans-scleral illumination), the light on but stationary (static trans-scleral illumination), and two corresponding control conditions in which the light was turned off (darkness). Results indicate that when the trans-scleral light is moving, afterimages are seen clearly for periods of approximately the same duration as those seen in complete darkness. However, when the trans-scleral illumination is stationary, the duration of the afterimages is significantly reduced. These results are compatible with other afterimage data that suggest that changes within the field after initial stimulation are needed to prolong afterimages.     

An electrode hookup for eyelid conditioning

A method for recording eyelid CRs, using skin electrodes rather than the usual mechanical connection to the S’s eyelid, is described. Data are presented to show the comparability of the two recording systems.     

A novel blink detection method based on pupillometry noise

Pupillometry (or the measurement of pupil size) is commonly used as an index of cognitive load and arousal. Pupil size data are recorded using eyetracking devices that provide an output containing pupil size at various points in time. During blinks the eyetracking device loses track of the pupil, resulting in missing values in the output file. The missing-sample time window is preceded and followed by a sharp change in the recorded pupil size, due to the opening and closing of the eyelids. This eyelid signal can create artificial effects if it is not removed from the data. Thus, accurate detection of the onset and the offset of blinks is necessary for pupil size analysis. Although there are several approaches to detecting and removing blinks from the data, most of these approaches do not remove the eyelid signal or can result in a relatively large amount of data loss. The present work suggests a novel blink detection algorithm based on the fluctuations that characterize pupil data. These fluctuations (“noise”) result from measurement error produced by the eyetracker device. Our algorithm finds the onset and offset of the blinks on the basis of this fluctuation pattern and its distinctiveness from the eyelid signal. By comparing our algorithm to three other common blink detection methods and to results from two independent human raters, we demonstrate the effectiveness of our algorithm in detecting blink onset and offset. The algorithm’s code and example files for processing multiple eye blinks are freely available for download (https://osf.io/jyz43).     

31例眼睑恶性肿瘤切除后Ⅰ期修复的总结

眼睑恶性肿瘤切除术后,眼睑修复时机的选择,对保持眼睑功能和美容的效果起着十分重要的作用,术式的选择是决定手术成功关键。采用眼睑全层缺损行异体巩膜片移植,替代睑板、滑行球结膜瓣前徙替代睑结膜的眼睑再造术,对31例眼睑恶性肿瘤切除,同时进行眼睑再造术。术后无排斥反应,眼睑闭合良好,外形满意。结论认为,较大范围的眼睑恶性肿瘤切除的患者,采用异体巩膜片移植、滑行结膜瓣前徙眼睑再造术能达到保持眼睑功能和美容的效果,是理想的眼睑恶性肿瘤切除后Ⅰ期修复临床决策。     

Cognitive factors in the concurrent differential conditioning of eyelid and skin conductance responses

The objectives of the study were to (1) determine if differential conditioning of eyelid responses ocurs only among subjects who accurately report knowledge of the CS-UCS relations, (2) assess whether differentially conditioned eyelid responding occurs only after the initial accurate interrial report, and (3) explore characteristics of differentially conditioned skin conductance responses (SCRs) obtained in an eyelid conditioning paradigm, with special attention to whether eyelid and SCR conditioning are similarly related to the subjects’ knowledge of the stimulus relations. Fifty-one male subjects were administered 80 differential eyelid conditioning trials, the CSs consisting of the 1,200-msec illumination of slides containing either grammatically correct or grammatically incorrect phrases. Significant differential SCR and eyelid conditioning was obtained for both V- and C-form eyelid responders, but only for subjects who accurately reported the CS-UCS relations. The initial appearance of SCR and eyelid differentiation was related within the trial sequence to subjects’ recognition of the stimulus relations. Eyelid and SCR conditioning were related similarly to knowledge of the stimulus relations, the exception being that subjects who recognized the stimulus relations late in the trial sequence did not develop reliable eyelid differentiation.     

Evaluation of informational control and preparatory response factors in classical aversive conditioning

Subjects performed in a differential eyelid conditioning paradigm with either airpuff or infraorbital shock as the UCS. The trial series included interpolated UCS-alone presentations, and subjects rated UCS aversiveness on all trials. Ratings of the airpuff, but not the shock UCS, were negatively correlated with the magnitude of anticipatory eyelid CRs, as predicted by preparatory response or law-of-effect models of classical conditioning. However, subjects showed no tendency to rate signaled (CS-UCS) trials as less aversive than unsignaled (UCS-alone) trials, and showed no significant preference for the signaled ucs. These results suggest that the operation of informational control and preparatory response factors is more complex than is assumed by available theories. Also, instrumental shaping and preparatory response mechanisms may not be involved in the acquisition of CRs.     

Classical discrimination conditioning of the rabbit's eyelid response using pontine stimulation as a conditioned stimulus

Classical discrimination conditioning of the nictitating membrane/eyelid response was performed on seven rabbits using stimulation of the pontine nuclei or middle cerebellar peduncle as the conditioned stimulus (CS) and an air puff as the unconditioned stimulus (US). The rabbits learned to discriminate between a CS paired with a US and delivered to one pontine nucleus (the CS+) and a CS presented alone and delivered to the contralateral pontine nucleus (the CS-). Subsequent reversal of the discrimination was also achieved when the CS+ and CS- stimulation sites were interchanged. The results are interpreted as support for the idea that essential plasticity for classical eyelid conditioning occurs efferent to the pontine nuclei, possibly in regions of the cerebellum.     

Vague Expectation Value Loss

Vague subjective probability may be modeled by means of a set of probability functions, so that the represented opinion has only a lower and upper bound. The standard rule of conditionalization can be straightforwardly adapted to this. But this combination has difficulties which, though well known in the technical literature, have not been given sufficient attention in probabilist or Bayesian epistemology. Specifically, updating on apparently irrelevant bits of news can be destructive of one’s explicitly prior expectations. Stability of vague subjective opinion appears to need a more complex model.     

Eyelid conditioning and concomitant GSR activity

The purpose of these experiments was to investigate an aspect of autonomic activity (namely, skin resistance) during the course of eyelid conditioning, as a check on those theories which postulate that ‘arousal’ or ‘emotionality’, as measured by autonomic activity, is related to the level of conditioning.

Although many measures of skin resistance were obtained (including both basal levels and responses), the results were with one exception entirely negative in showing no significant correlations between the autonomic variables and eyelid conditioning. The exception was a significant correlation between skin resistance change to a test-trial puff of air (the UCS) and the level of eyelid conditioning reached by the subject; this result supports predictions made by Spence about the role of a hypothetical emotional response in conditioning, but was obtained in only one of the two studies.

The generally non-significant relationship between skin resistance and eyelid conditioning is discussed with respect to response specificity, and also to a postulated specificity in conditioning such that a subject who conditions well in one modality does not necessarily condition well in another modality. This specificity is considered in the light of the physiological mechanisms involved in each response system.     

Classical conditioning of the eyeblink response in the delay paradigm in adults aged 18-83 years

To determine if age differences in classical conditioning of the eyelid response begin to appear in middle age in humans as they do in animals, adult subjects aged 18-83 years were trained in the delay conditioning paradigm. Large age effects occurred. Statistically significant differences first appeared in the decade of the 40s. Within-age-group variability was large. To reduce variability, subjects were classified by the magnitude of their unconditioned response (UR). Regardless of age, subjects with low amplitude URs conditioned poorly. In the normal UR amplitude group, the correlation between age and total percentage conditioned responses (CRs) was -.58. Eyeblink rate and voluntary responding did not account for age differences in conditioning, and it was unlikely that hearing acuity or corneal sensitivity caused the differences. Parallels between human and animal eyelid conditioning are considered, and it is suggested that age changes in the cerebellum may affect conditioning in aging mammals, including humans.