ERCP在十二指肠乳头旁憩室并胆总管结石诊治中的应用

通过回顾性分析237例十二指肠乳头旁憩室并胆总管结石患者行经内镜逆行胰胆管造影术（ERCP）治疗的资料,探讨ERCP治疗的临床疗效及安全性。结果显示十二指肠乳头位于憩室内41例,十二指肠乳头位于憩室旁196例;胆总管结石位于上段25例,中段131例,下段81例;胆总管直径小于1．0cm23例,1．Ocm～1．5cm89例,1．6cm～2．0cm106例,大于2．0cm19例。均经ERCP治疗成功,因此ERCP治疗十二指肠乳头旁憩室并胆总管结石,可操作性强、创伤小、并发症少,疗效确切,是安全、有效的治疗措施。     

桡骨小头粉碎性骨折的两种治疗方法比较分析

分析比较切开复位内固定和人工桡骨小头置换方法治疗桡骨小头粉碎性骨折（MasonⅢ型）的临床疗效。回顾分析2012年10月～2014年3月收治的24例桡骨小头粉碎性骨折（MasonⅢ型）的临床资料,其中切开复位内固定治疗17例;桡骨小头置换7例,平均随访12个月（6个月～18个月）。根据Broberg Morrey评分系统以及术后影像进行评价比较,同时比较两组住院天数以及费用。结果评价比较显示两者疗效均佳,术后两者活动度和功能评分相近,两组住院天数相近,内固定组费用更低。桡骨小头粉碎性骨折须尽早进行解剖复住功能重建,切开复位内固定和桡骨小头置换疗效相当。     

急性胰腺炎临床决策中的辩证思维观

急性胰腺炎（AP）是临床常见危重症。近年来AP诊断和治疗取得了令人瞩目的进展,及早诊断和恰当、合理的生命支持治疗极大改善了AP患者的预后。临床上AP患者病情往往复杂多变,要求在极短时间内做出正确的临床决策,科学理性的临床决策思维对AP患者的合理诊治起着非常重要的指导作用。临床医师应努力学习和充分灵活地运用辩证思维,为对AP进行科学的临床诊疗决策提供合理的思路。     

急性心肌梗死患者小动脉弹性指数水平与各项危险因素的关系

探讨急性心肌梗死（AMI）患者小动脉弹性指数（C2）水平与各项风险因素的关系。纳入我院心血管内科于2010年1月～2013年7月间收治的AMI患者,并纳入同期入院的不稳定心绞痛（UA）患者作为对照组,收集相关临床资料,比较不同C2水平与相关指标的关联性发现：C2等11项危险因素存在显著差异,经多因素Logistic回归...     

急性应激障碍（ASD）研究述评

急性应激障碍是个体在亲历、目击或面临一个对自己或他人具有死亡威胁、严重伤害的创伤事件后的2天至4周内所表现的应激反应。急性应激障碍的症状主要表现为分离、再历、回避和过度警觉。文章回顾了以往的相关研究,从急性应激障碍的测评方法、发生率、与创伤后应激障碍和创伤记忆的关系、心理治疗和干预等方面进行了综述。最后对未来可能的研究方向提出了展望     

急性缺血性卒中机械取栓术在患者获益中的实践与思考

在急性缺血性卒中的机械取栓治疗中,如何珍视与保护患者生命,使患者真正获益,成为目前社会关注的伦理问题。医疗人员需要切实遵从知情同意原则、严格把控手术指征与禁忌、审慎对待超时间窗治疗、正确规避手术风险与并发症、及时给予补救措施等。结合我国社会、经济、医疗、医患关系现状,分析这些环节中可能影响患者获益的因素与存在的医患问题,并结合多年的临床取栓体会,倡导医疗人员继承发扬传统医德,践行以人为本、德艺双馨准则,有助于使该项技术的应用更加切合我国实际、和谐医患关系。

     

论严重精神障碍患者非自愿入院的危险性标准

实践中精神障碍患者权益难以得到保障的根源在于非自愿住院的“危险性”标准的判断困境。这一困境出现的原因在于：一是“危险性”的判断过于模糊,易被扩张;二是“危险性”的判断具有终局性,缺乏监督;三是“危险性”标准属医学标准,易被滥用。如何完善“危险性”判断标准？首先要厘清“危险性”标准形成的理论基础：“危险性”标准的理论基础是家长权。其次,基于家长权,“危险性标准”应当从“危险性”的行为类型、属性和程序综合判断。只有这样,才能更好地保障严重精神障碍患者的权益,使我国精神卫生工作走上光明的康庄大道。

     

Coping Style Following Acute Stress in Competitive Sport

Abstract

The purpose of this study was to ascertain coping styles among competitive athletes in response to various acute stressors. Specifically, the authors used a 134-item survey to measure approach and avoidance coping styles, with task-focused and emotion-focused coping tendencies nested hierarchically as subdimensions under each. Australian and U.S. college-aged participants indicated the extent to which they used approach, avoidance, task-focused, and emotion-focused coping strategies (a 4-factor model) in response to selected acute stressors experienced during sport competition. The authors computed confirmatory factor analysis to test the theoretically driven model. The criterion loading of .30 and above for each of the factors reduced the survey to 65 items. Findings indicated stronger links between the 2 approach constructs of task- and emotion-focused coping than between the 2 avoidance constructs of those subdimensions. The goodness-of-fit indices for the 4-factor model were 0.58 and 0.57 for Australian and U.S. samples, respectively, and .71 overall. Concomitant low correlations between the 2 approach (0.18) and the 2 avoidance dimensions (0.43) reflected relatively high residuals between stressors. In general, psychometric analyses suggest that coping style may be more prevalent in some situations than others, lending partial support for the transactional model of coping.     

Tensile behaviour of submicrocrystalline ferritic steel processed by large-strain deformation

Mechanical tests have been carried out on Fe–15%Cr ferritic stainless steel with various microstructures. Ultrafine-grained microstructures with grain sizes of 0.2–0.3 µm were developed by large-strain cold-working and light annealing. The effects of severe deformation on the mechanical behaviour of as-processed and recovered steel were evaluated with reference to the same material having conventional work-hardened and recrystallised microstructures. Despite the low dislocation density in the fine grain interiors in the as-processed state, the samples with strain-induced submicrocrystalline structure were characterised by high internal stresses that resulted in a higher strength than could be expected from simple grain-size strengthening. These internal stresses were associated with a non-equilibrium state of strain-induced grain boundaries after severe deformation.     

GIRK1在宫颈癌组织细胞中的表达

探求内向整流型钾离子通道1（GIRK1）与宫颈癌发生发展的关系.利用RT-PCR及免疫组织化学技术检测GIRK1 mRNA及蛋白在15例正常宫颈和30例宫颈癌组织细胞中的表达.GIRK1 mRNA在宫颈癌组织中的表达高于在正常宫颈组织中的表达,差异有统计学意义（P〈0.01）;GIRK1蛋白在宫颈癌组织中的阳性表达率为100%,在正常宫颈组织中的阳性表达率为20%,两者差异有统计学意义（P〈0.01）.GIRK1 mRNA及蛋白在宫颈癌组织中呈高表达,可能与宫颈癌的发生及发展有关.