慢性房颤的导管消融:时机已经成熟

心房解剖及电重构基础上的多发子波折返是慢性房颤的维持机制,支持线性消融策略;导管消融有关的操作逐渐标准化;盐水灌注导管和三维标测系统等新器械不断进展;慢性房颤消融策略的争议逐渐减少,采用肺静脉隔离加线性消融者越来越多;消融终点更多的以肺静脉隔离和线性阻滞为主,以直接终止心动过速为终点者减少.慢性房颤的导管消融时机已经成熟.     

慢性房颤导管消融：挑战与展望

随着对慢性房颤机制认识的深入以及消融方法不断探索,经导管消融在慢性房颤治疗的地位逐渐提高。尽管在适应证、消融策略、获益风险比及远期疗效等还存在一定争议,随着经验的积累和技术的进步,导管消融根治慢性房颤充满希望。     

从触摸的历史反思医学中触摸的应用

从触摸的定义、起源、应用发展演变阐明了其历史,并总结触摸在医学中的应用现状及特色。但由于历史、宗教、性别文化等因素的影响,触摸在医学中的应用存在一定障碍和困境,对这些应用困境进行反思,最终提出解决策略。     

Recombinative reading derived from pseudoword instruction in a miniature linguistic system

A miniature linguistic system was used to study acquisition of recombinative symbolic behavior. Three studies evaluated the teaching conditions of conditional discriminations with printed and spoken pseudowords that could potentially generate recombinative reading. Fifty-four college students across all studies learned to match 12 printed pseudowords to 12 spoken pseudowords. Some also matched pictures to the same spoken words. Each two-syllable pseudoword was formed by symbols from an arbitrarily created alphabet composed of four vowels and four consonants. Letters had univocal correspondence with phonemes. Recombinative receptive reading, comprehensive reading, and textual responding to pseudowords were periodically assessed. Experiment 1 (n = 20) showed that recombinative reading increased as the number of trained words composed of the same symbols increased. Experiment 2 (n = 14) showed that overtraining the same two words did not produce recombinative reading for most participants. Experiment 3 (n = 20), in which training with pictures was omitted, showed that elemental control by within-syllable units can develop even when the trained pseudowords are meaningless (not related to pictures). The present results support the utility of the miniature linguistic system methodology for identifying and controlling environmental determinants of rudimentary reading skills.     

Restoration process of the need for autonomy: the early alarm stage

Autonomy is described by self-determination theory as a basic psychological need, essential for individuals' well-being. While basic needs are generally thought to induce a restorative response when thwarted, evidence for such a process is lacking for autonomy. To date, most evidence indicates that autonomy deprivation leads to disaffection of this need in favor of other motives. A temporal model based on the general adaptation syndrome was adapted to reconcile this seeming contradiction. Specifically, it is hypothesized that an early alarm response aimed at restoring the satisfaction of the need for autonomy should precede the later relinquishment and compensation of this need that would result from a prolonged deprivation. Three studies provide support for this model by showing the existence of the immediate autonomy restorative response. Using a controlling situation to manipulate autonomy deprivation, the authors demonstrate in Experiments 1 and 2 that a controlling context leads to enhanced accessibility and an approach bias for autonomy-related stimuli. Experiment 3 indicates that the urge to restore autonomy can also affect personal judgment, leading individuals to make more independent judgments, exercising a nonreactive form of autonomy. Integration of this model within self-determination theory is discussed.     

A sensitive period for language in the visual cortex: distinct patterns of plasticity in congenitally versus late blind adults

Recent evidence suggests that blindness enables visual circuits to contribute to language processing. We examined whether this dramatic functional plasticity has a sensitive period. BOLD fMRI signal was measured in congenitally blind, late blind (blindness onset 9-years-old or later) and sighted participants while they performed a sentence comprehension task. In a control condition, participants listened to backwards speech and made match/non-match to sample judgments. In both congenitally and late blind participants BOLD signal increased in bilateral foveal-pericalcarine cortex during response preparation, irrespective of whether the stimulus was a sentence or backwards speech. However, left occipital areas (pericalcarine, extrastriate, fusiform and lateral) responded more to sentences than backwards speech only in congenitally blind people. We conclude that age of blindness onset constrains the non-visual functions of occipital cortex: while plasticity is present in both congenitally and late blind individuals, recruitment of visual circuits for language depends on blindness during childhood.     

What lies behind postnatal depression: is it only a mood disorder?

Postnatal depression (PND) is a common condition that has been extensively researched specifically because of its negative impact on the mother-infant relationship. Psychiatric research has looked at comorbidity of major depressive disorder and found it to be strongly associated with Axis II disorders. This study's principal aim was to investigate whether there is a greater incidence of personality disorder (PD) among a PND population than among a non-PND population at 3 months postpartum. A secondary aim was to define the different types of PD. Depression was assessed with the Montgomery and Asberg Depression Rating Scale (MADRS), and PD was assessed with the Structured Interview for DSM-IV Personality Disorders (SIDP-IV) in 109 women with their 12-week-old infants. Twice as many depressed mothers had PD. The PND group presented a greater number of severe clinical symptoms than the nondepressed group (p < .002). Further research is necessary to reexamine the heterogeneity of PND and reassess its impact on infant development.     

HBV相关肝细胞癌综合治疗中抗病毒的作用

分析抗病毒治疗在乙型肝炎病毒相关肝细胞癌的综合治疗中所起的作用.随着肝细胞癌治疗模式的转变,目前认为抗HBV治疗是HCC综合治疗的重要组成部分,应针对患者进行个体化、优化的多学科综合治疗,选择合适的高效、低耐药、低副作用的抗病毒药物,才能达到提高患者生活质量和延长生存时间的目的.     

老年人合并冠心病的血压控制

高血压病和冠心病是与年龄密切相关的心血管疾病.老年人(包括年龄在80岁以上的)同时存在此两种疾病的情况正在逐渐增加.流行病学研究已经证明,高血压和冠心病有密切的联系.老年高血压患者药物的选择仍有一定的争议,而在合并冠心病时合理治疗的临床研究也不多.本文根据目前循证医学资料提出了可用于老年高血压合并冠心病患者合适的降压策略和冠心病的药物治疗.