4O例皮肤恶性黑色素瘤患者生存质量的临床分期评价

皮肤恶性黑色素瘤是一种高度恶性的皮肤肿瘤,且转移早、易复发、治疗效果不理想,如何提高患者的生存质量成为医学领域一个重要的课题。本文用EORTCQLQ-C30V3．0中文版量表对40例皮肤恶性黑色素瘤患者的生命质量进行临床分期测评,采用t检验与因子分析法进行比较分析,结果发现I期、Ⅱ期患者积分公因子在疲乏、情绪低落、食欲...     

特应性皮炎的发病机制

近年来关于特应性皮炎（AD）的发病机制研究进展迅速,目前研究认为AD发病主要是皮肤屏障功能障碍、免疫应答异常和环境因素刺激共同作用的结果。遗传学研究证实,皮肤屏障功能相关基因和免疫应答及其调控基因参与AD发病。皮肤屏障功能障碍是皮肤激发和维持AD炎症的重要原因。在皮肤屏障受损的基础上,外源过敏原和微生物就很容易透过角质层进入表皮和真皮,进而引发免疫应答。AD瘙痒的病理生理学机制还不清楚,除外组胺,其他的炎症介质和致痒原等也参与介导了瘙痒发生。     

鼻烟窝皮瓣修复拇指大面积皮肤缺损的临床应用

探讨鼻烟窝皮瓣在修复拇指大面积皮肤缺损中的方法和治疗效果。从2008年1月～2013年10月间应用桡动脉在解剖鼻烟窝穿支为血管蒂的鼻烟窝皮瓣,逆行修复拇指大面积皮肤缺损26例,年龄17岁～55岁。术后平均随访时间25个月,皮瓣全部成活。皮瓣色泽及质地与健侧拇指背侧皮肤相近,拇指活动度基本正常。因此,鼻烟窝皮瓣是一种简便经济、效果理想、患者易于接受的术式,适合应用于拇指大面积皮肤缺损的治疗。     

Acting,feeling and thinking: psychoanalytic psychotherapy with Tracey

This paper consists of a case study and commentary which formed a part of the inaugural lecture in a series entitled ‘Working with Psychosomatic Issues’*. The audience consisted of psychoanalytic, body psychotherapy and integrative practitioners. The presentation was divided into three parts, (1) an outline of philosophical themes that inform perspectives on health, illness and psychosomatic phenomena, (2) the case study reproduced below and (3) a summary of Winnicott's work (1960, 1966, 1988) on ‘the indwelling of the psyche in the soma’. The case study describes work with a young woman who harms herself through self-hitting and, in addition, expresses other physical manifestations of psychological distress. The core approach of the practitioner is psychoanalytic. The work is informed also by postmodern sensibilities and phenomenological themes.     

Clinical and psychopathological research on attachment: the contribution of the psychic envelopes model

This paper proposes to put into perspective the attachment model (Bowlby) and that of psychic envelopes (Anzieu) so as to grasp the contribution of attachment theory to the field of psychopathology. Having laid the foundations of the epistemological debate between these two models, relying on a discussion of the stakes inherent in the psychoaffective development approach, the author refers to current forms of psychopathology, which draw massively on the borderline and narcissistic concepts, in order to discuss the sense and benefits of the “skin–ego” model as an alternative and complement to attachment theory. Beyond altering reference models in psychopathology, this debate and related inputs lead to consider therapeutic applications through a combination of the notion of “caregiving group” – a group version of the attachment figure – and the notion of therapeutic offer as a necessary alternative to the ideology of demand.     

The differential contribution of facial expressions,prosody, and speech content to empathy

Background: Facial expressions, prosody, and speech content constitute channels by which information is exchanged. Little is known about the simultaneous and differential contribution of these channels to empathy when they provide emotionality or neutrality. Especially neutralised speech content has gained little attention with regards to influencing the perception of other emotional cues. Methods: Participants were presented with video clips of actors telling short-stories. One condition conveyed emotionality in all channels while the other conditions either provided neutral speech content, facial expression, or prosody, respectively. Participants judged the emotion and intensity presented, as well as their own emotional state and intensity. Skin conductance served as a physiological measure of emotional reactivity. Results: Neutralising channels significantly reduced empathic responses. Electrodermal recordings confirmed these findings. The differential effect of the communication channels on empathy prerequisites was that target emotion recognition of the other decreased mostly when the face was neutral, whereas decreased emotional responses attributed to the target emotion were especially present in neutral speech. Conclusion: Multichannel integration supports conscious and autonomous measures of empathy and emotional reactivity. Emotional facial expressions influence emotion recognition, whereas speech content is important for responding with an adequate own emotional state, possibly reflecting contextual emotion-appraisal.     

双血供胸大肌皮瓣修补咽颈部缺损

探讨双血供胸大肌皮瓣修补咽颈部缺损的可行性。介绍应用双血供胸大肌皮瓣修补咽颈部缺损36例,窄蒂胸大肌皮瓣修补咽颈部缺损7例。结果前者愈合23例,出血3例,感染5例,咽瘘5例,皮瓣坏死无;后者愈合2例,出血1例,感染1例,咽瘘2例,皮瓣坏死1例。双血供胸大肌皮瓣修补咽颈部缺损更利于术后愈合、预防咽瘘。     

示中环指指尖缺损的鱼际皮瓣修复

探讨应用鱼际皮瓣修复示中环指指尖缺损的方法和效果.自2010年8月～2013年3月,应用鱼际皮瓣修复示中环指指尖缺损28例,术后评价皮瓣外观及供区愈合情况.结果术后28例皮瓣全部存活,随访时间为2个月～8个月.患指指尖皮瓣质地柔软,外形饱满,颜色与周围一致,指端无压痛,供区直接缝合,未发现刀口疲痕挛缩影响拇指及虎口功能.鱼际皮瓣修复示中环指指尖缺损手术操作简单,修复后患指指尖外观满意、供区损伤小.患者顺从性好,易于为临床医生所接受.     

Enhancing the effects of a narrative message through experiential information processing: An experimental study

First-person narratives are becoming a popular means to communicate health risk information. Although studies show they can increase risk perception and motivate health behaviours compared to statistical messages, more research on the conditions in which they are particularly likely to have effects is needed. In this study, we tested a moderator related to how information is processed. Specifically, we hypothesised that thinking in terms of emotions and personal experiences – known as experiential information processing – would increase people’s responsiveness to a narrative. Female college students (N = 138) who reported indoor tanning were randomly assigned to read a first-person narrative message or a statistical message about the risks of skin cancer. Prior to reading the message, the women received instructions that would activate either experiential or rational information processing. Participants then reported their risk perceptions of skin cancer, worry about skin cancer and behaviour intentions related to skin cancer. Analyses showed that message type and information processing interacted to influence risk perceptions and worry. Consistent with hypotheses, participants reported the highest risk perception and worry when they used an experiential information system prior to reading the narrative message. There were no effects on behaviour intentions. Implications of these findings are discussed.     

A longitudinal application of three health behaviour models in the context of skin protection behaviour in individuals with occupational skin disease

Occupational skin disease (OSD) is common, associated with poor prognosis and poses a significant burden to the individual and society. We applied the theory of planned behaviour (TPB), the prototype-willingness model (PWM) and the health action process approach (HAPA) to the prediction and explanation of occupationally relevant skin protection behaviour in individuals with OSD. We used a longitudinal design. In this study, 150 individuals participating in a 3-week inpatient tertiary prevention programme completed measures assessing the constructs of the TPB, PWM and HAPA at admission (T?0), discharge (T?1) and once the individual had returned to work and worked for 4 consecutive weeks (T?2) (n?=?117). Intention was measured at T?0 and skin protection behaviour at T?2. Path analysis was used to assess the longitudinal associations of the models’ constructs with intention and skin protection behaviour. TPB as well as PWM variables accounted for 30% of variance in behaviour, HAPA variables for 33%. While not all predictions were confirmed by the data, all three models are able to inform us about the formation of skin protection intention and behaviour in individuals with OSD. The findings are discussed in light of future interventions and research.