Lung function,sociodemographic characteristics,and psychological reaction to transplant associated with chronic stress among lung recipients

Abstract

Patterns of coping, defined as complex sets of coping strategies, were identified in a group of surgical patients awaiting surgery. The patterns were labelled as asthenic, problem-oriented, active and avoidant. The four patterns consisted of different combinations of eight forms of coping, measured by the Ways of Coping Questionnaire. The obtained results show that—compared to the coping strategies analysed separately—those coping patterns were poorer predictors of the emotional outcome. Patients assigned to groups representing particular coping patterns showed different levels of anxiety measured at the beginning of hospitalization; however, no differences or changes in emotions were observed after a one-week lapse. More relationships were found between the coping strategies and measures of negative emotions (anxiety and anger) and their changes.     

Right hemisphere appreciation of prosodic and linguistic indications of implicit attitude

Appreciation of attitudes conveyed through prosodic cues and lexical content was examined in subjects with temporal lobe seizure foci. One task involved auditory judgments of the consistency of verbal and intonational meaning of sentences. Errors on judgments of consistent verbal and prosodic stimuli were not only more frequent in the right temporal group than in left temporals or controls but were strongly related to neuropsychological indices associated with extent of right temporal involvement. Answering questions based on written narratives in which multiple attitude markers were either redundant or conflicting comprised the second task. Right temporal patients as a group had difficulty in answering inferential questions about paragraphs with inconsistent indicators of attitude. Even low-scoring right temporals were able, however, to answer inferential and factual questions when the verbal context markers consistently reinforced a particular attitude.     

随机化临床试验在外科领域的困惑与出路

临床科研方法一直受到流行病学理论的影响。在临床流行病学提出随机化临床试验（ＲＣＴ）的理论之后，许多临床领域的比较研究如筛选诊断技术、评价治疗效果和估计预后等，均广泛采用了这一科学的论证方法。但ＲＣＴ在外科领域却走入了困境。本文综合分析了在外科领域开展ＲＣＴ的困惑、外科临床研究方法的现状，并提出了提高外科临床研究科学性的可行途径。     

Cerebral organization of oral and signed language responses: case study evidence from amytal and cortical stimulation studies

A normally hearing left-handed patient familiar with American Sign Language (ASL) was assessed under sodium amytal conditions and with left cortical stimulation in both oral speech and signed English. Lateralization was mixed but complementary in each language mode: the right hemisphere perfusion severely disrupted motoric aspects of both types of language expression, the left hemisphere perfusion specifically disrupted features of grammatical and semantic usage in each mode of expression. Both semantic and syntactic aspects of oral and signed responses were altered during left posterior temporal-parietal stimulation. Findings are discussed in terms of the neurological organization of ASL and linguistic organization in cases of early left hemisphere damage.     

Acceptably aware during general anaesthesia: ‘Dysanaesthesia’ – The uncoupling of perception from sensory inputs

This review makes the case for ‘dysanaesthesia’, a term encompassing states of mind that can arise in the course of anaesthesia during surgery, characterised by an uncoupling of sensation and perceptual experience. This is reflected in a macroscopic, functional model of anaesthetically-relevant consciousness. Patients in this state can be aware of events but in a neutral way, not in pain, sometimes personally dissociated from the experiences. This makes events associated with surgery peripheral to their whole experience, such that recall is less likely and if it exists, makes any spontaneous report of awareness unlikely. This state of perception–sensation uncoupling is therefore broadly acceptable (a minimum requirement for acceptable anaesthesia) but since it is likely a dose-related phenomenon, may also represent a precursor for awareness with adverse recall. This hypothesis uniquely explains the often inconsistent responses seen during the experimental paradigm of the ‘isolated forearm technique’, wherein apparently anaesthetised patients exhibit a positive motor response to verbal command, but no spontaneous movement to surgery. The hypothesis can also explain the relatively high incidence of positive response to relatively direct questions for recall (e.g., using the Brice questionnaire; ∼1:500; the vast majority of these being neutral reports) versus the very low incidence of spontaneous reports of awareness (∼1:15,000; a higher proportion of these being adverse recollections). The hypothesis is consistent with relevant notions from philosophical discussions of consciousness, and neuroscientific evidence. Dysanaesthesia has important implications for research and also for the development of appropriate monitoring.     

The contribution of functional near-infrared spectroscopy (fNIRS) to the presurgical assessment of language function in children

Before performing neurosurgery, an exhaustive presurgical assessment is required, usually including an investigation of language cerebral lateralization. Among the available procedures, the intracarotid amobarbital test (IAT) was formerly the most widely used. However, this procedure has many limitations: it is invasive and potentially traumatic, especially for children. To overcome these limitations, neuroimaging techniques such as functional magnetic resonance imaging (fMRI) have been used. Again, these methods are difficult to use with children, who must remain motionless during data acquisition. Functional near-infrared spectroscopy (fNIRS) is a noninvasive functional imaging technique that is easily applied to pediatric and cognitively limited patients. It has been used recently in epileptic children for presurgical assessment of expressive and receptive language brain lateralization. The aim of this review is to present the contribution of fNIRS to the presurgical assessment of language function in children with neurological diseases.     

Psychological aspects of orthognathic surgery

Abstract

With the dramatic growth in the number of adults undergoing orthodontics to correct malocclusion, and those undergoing surgical orthodontics or orthognathic surgery to correct skeletal discrepancies in the orofacial region, it is important to examine the psychological characteristics of these patients before and after treatment is completed. This paper serves as a general review and summarizes the findings of two major longitudinal studies of patients seeking surgical correction and compares them with people who underwent conventional orthodontics, those who rejected any treatment, and those who sought cosmetic surgery. Both studies revealed that most women seeking surgical orthodontics focused on aesthetic improvement as a motive, whereas men sought to improve their appearance and mastication. Women were also more likely to report problems with the temporomandibular joint as a motive. Men and women scored similarly on a measure of body image, although women reported lower facial image presurgically and higher postsurgically than did men. The greatest gains following surgery were in facial and profile image for both men and women. Orthodontic patients showed less improvement, while those rejecting treatment experienced a decline in body image. Many functional improvements did not occur until 24 months postoperatively; lingering paraesthesia was described by 49% of the sample. Emotional reactions included anxiety preoperatively, and depression postoperatively, especially among patients scoring high on neuroticism and those experiencing other major life events. These studies reveal that people seeking surgical orthodontics are within the normal range of most personality measures and experience greater gains psychologically than do conventional orthodontic patients.     

The factor structure and psychometric properties of the Italian version of the Acceptance of Cosmetic Surgery Scale

The current study examined the validity of the Italian version of the Acceptance of Cosmetic Surgery Scale (ACSS; Henderson-King & Henderson-King, 2005) in a sample of 378 Italian adult women. A series of confirmatory factor analyses were conducted. A three-factor solution provided the best fit to the data and confirmed the Intrapersonal, Social, and Consider dimensions. The three factors were strongly inter-correlated. Cronbach's alphas were high (all alphas > .86). The scale showed good convergent and discriminant validity (estimated by Composite Reliability and the Average Variance Extracted). The nomological validity of the Italian version of the ACSS was confirmed by its significant correlations with participants’ body dissatisfaction and sociocultural influences (internalization of thin ideals and perceived media pressure). The ACSS seems to be a useful measure of acceptance of cosmetic surgery in the Italian context. This instrument can be used with Italian speakers for research, health promotion, and preventive interventions.     

Physical recovery in Arthroscopic knee surgery: unique contributions of coping behaviors to clinical outcomes and stress reactivity

Few studies have examined whether certain coping behaviors are associated with physical outcomes following surgery. This prospective, longitudinal study investigated the effect of active and avoidant coping behaviors on two physical outcomes over time, pain and knee function, in a group of patients experiencing knee arthroscopic surgery (n = 81). Structured interviews and physician clinical assessments were conducted preoperatively and at 3 and 24 weeks postoperatively. Coping behavior was assessed during the preoperative interview, and patients were divided into high and low avoidant and active coping groups. Using repeated measures MANCOVA/ANCOVA, avoidant coping was significantly associated with knee pain and active coping was associated with knee function. Serum cortisol levels were available for a patient subset (n = 16); higher cortisol was related to both avoidant coping and poorer functioning during early recovery. Results suggest that these divergent coping behaviors are differentially associated with stress reactivity and physical outcomes in healthy patients undergoing minor knee surgery.     

外科决策：险中求胜

外科决策是一项高风险的事情,在当前医患关系紧张的环境下,尤其突出。如何险中求胜,具有重要的现实意义。本文提出科际整合,将军事学、谋略学、决策学、管理学在哲学层面有机地结合在一起,将做人、做事、做决策与临床密切联系在一起,开创一个全新的决策思路、方法和技巧,在实践中已突显其优越性。