乳腺癌术后患者创伤后成长与心理弹性和生命质量的相关性研究

摘要 目的：探讨乳腺癌术后患者创伤后成长（PTG）的影响因素,并分析其与心理弹性和生命质量的关系。方法：选择2020年1月~2021年8月在山东省立第三医院接受手术治疗的乳腺癌患者80例作为研究对象。采用创伤后成长量表（PTGI）评价乳腺癌术后患者PTG情况。采用乳腺癌患者生命质量测定量表（FACT-B）评价生命质量。采用心理弹性量表（CD-RISC）评价心理弹性。采用单因素及多因素Logistic回归分析乳腺癌术后患者PTG的影响因素,采用Pearson相关性分析PTGI评分与CD-RISC评分和FACT-B评分的关系。结果：乳腺癌术后患者PTGI评分为（50.38±13.39）分,根据PTGI评分将其分为PTG高分组（n=32）和PTG低分组（n=48）。乳腺癌术后患者PTG水平与文化程度、家庭月收入、疾病发现方式、工作状况、手术方式、临床分期、术后并发症、基础疾病有关（P<0.05）。多因素Logistic回归分析结果显示：家庭月收入<3000元、临床分期为II期、文化程度为小学及其以下、手术方式为乳房切除、有术后并发症、有基础疾病均是乳腺癌术后患者PTG的危险因素（P<0.05）。PTG高分组患者的CD-RISC、FACT-B评分高于PTG低分组,组间对比有统计学差异（P<0.05）。Pearson相关性分析结果显示,PTGI评分与CD-RISC评分、FACT-B评分呈正相关（P<0.05）。结论：乳腺癌术后患者PTG水平一般,受到临床分期、文化程度、手术方式等多种因素的影响,临床工作中应对相关因素予以重视并及时干预。同时PTG会影响患者的心理弹性和生命质量,PTG水平越高,心理弹性越好,生命质量亦越高。     

De novo balanced translocation (2;10)(q24;q22) associated with mental retardation

We report a case of a reciprocal translocation between the long arms of the 2 and 10 chromosomes observed in a 14-year-old male with mild mental impairment, compulsive and obsessive behavior. The apparently balanced translocation was characterized by fluorescence in situ hybridization and the karyotype was 46, XY, t(2;10)(q24;q22). The way by balanced chromosomal translocations can lead to a disease phenotype are reviewed and discussed.     

心理干预联合氟哌噻吨美利曲辛片对老年高血压伴焦虑抑郁患者血压的影响

目的:研究心理干预联合氟哌噻吨美利曲辛片对老年高血压伴焦虑抑郁患者的血压影响。方法:选取2013年4月到2014年4月某院收治的老年高血压伴焦虑抑郁的患者110例,按照随机数字表法将患者分为研究组和对照组,每组55例,对照组给予常规降压治疗,研究组在对照组的基础上给予心理干预,同时服用氟哌噻吨美利曲辛片,治疗时间均为8周,应用抑郁自评量表(HAMD)和汉密尔顿焦虑自评量表(HAMA)的评分来评价患者的抑郁状态,比较两组降压疗效、HAMD评分、HAMA评分以及不良反应。结果:研究组降压总有效率94.5%(52/55),对照组降压总有效率为67.3%(37/55),两组比较差异具有统计学意义(x2=12.952,P=0.013);研究组治疗后HAMA评分和HAMD评分分别为(10.5±0.6)分、(11.9±1.1)分显著低于治疗前的(20.8±0.4)分、(31.2±0.7)分,与治疗前比较差异具有统计学意义(t=9.923,10.628,P=0.025,0.019),与对照组比较差异具有统计学意义(t=9.823,11.628,P=0.023,0.016);两组不良反应比较差异无统计学意义(x2=5.492,P=0.072)。结论:心理干预联合氟哌噻吨美利曲辛片治疗老年高血压伴焦虑抑郁者具有较好的降压效果,能改善患者焦虑抑郁状态,且无严重不良反应。     

Global analysis of an epidemic model with nonmonotone incidence rate

In this paper we study an epidemic model with nonmonotonic incidence rate, which describes the psychological effect of certain serious diseases on the community when the number of infectives is getting larger. By carrying out a global analysis of the model and studying the stability of the disease-free equilibrium and the endemic equilibrium, we show that either the number of infective individuals tends to zero as time evolves or the disease persists.     

临床医生在基因检测咨询中面对伦理两难问题态度与选择 ——基于情景案例分析

目的 通过情景案例分析,聚焦基因检测咨询中的伦理两难事件,探究临床医生的伦理道德抉择及可能的影响因素。 方法 采用分层随机抽样方法,对624名临床医生进行了匿名问卷调查。 结果 对于XY染色体女性案件,88%的应答者选择告知敏感性信息;对于父系信息的披露,近60%的应答者选择单独告诉母亲;对于是否告知患儿其他亲属相关遗传病信息的案件,应答者的意见则相对分散。 结论 针对三个典型的基因检测咨询中的伦理两难问题,应结合国际相关指南的要求,进一步加大相关的法律与伦理理念、知识的教育与普及。     

Human teratogens: update 2010

A wide variety of human teratogens have been identified. The characteristics of human teratogens can be used in the assessment of apparent “new” teratogens, when postulated. Information is available through online databases, such as TERIS and Reprotox, telephone‐based counseling resources (e.g., Organization of Teratogen Information Systems [OTIS] and European Network Teratology Information Services [ENTIS]), reference books, annual meetings of the Teratology Society, and published articles. There are significant deficiencies in the information available: (1) lack of knowledge about the molecular and cellular basis for most teratogenic effects; (2) the inability to genetically identify more susceptible women before pregnancy; (3) little information is available on dermal and airborne exposures during pregnancy; and (4) most clinicians receive little, if any, training in the identification of or counseling for exposure to potential teratogens. There are many current dilemmas in counseling about exposures in pregnancy, including: (1) Is exposure to specific drugs, such as selected serotonin re‐uptake inhibitors (SSRIs) and the inhibitors of tumor necrosis factor‐alpha, teratogenic in the first trimester of pregnancy? (2) Are the increased risks of birth defects associated with assisted reproductive technology due, in part, to epigenetic effects? (3) What are the “safe” levels of exposure to the plasticizers phthalates during pregnancy? (4) How do we convince busy physicians, nurses, and pharmacists not to use the drug categories A, B, C, D, and X in counseling and to use more accurate sources? There is a need for a national advisory center for pregnancy registries to provide guidance when new registries are being developed. Birth Defects Research (Part A), 2011. © 2011 Wiley‐Liss, Inc.     

基于NR2B基因探讨疏肝与补肾法对吗啡精神依赖的调节作用及机制

目的：探讨补肾法与舒肝法对大鼠吗啡精神依赖的调节作用及机制。方法：使用盐酸吗啡建立大鼠精神依赖模型（conditioned place preference,CPP）,采用Obersiver5．0行为学软件分析大鼠的CPP效应,并利用RealtimePCR方法测定伏核和前额叶皮质内NR2B亚基的mRNA含量。结果：与对照组相比,模型组大鼠在白侧累积停留时间极显著长于对照组（P〈0．01）,同时伏核与前额叶皮质中NR2B的mRNA水平也显著升高（P〈0．01和P〈0．05）;与模型组相比,补肾组和舒肝组大鼠在白侧的累积停留时间显著下调（P〈0．05）,疏肝组NR2B的mRNA也显著下降（P〈0．05）,而补肾组变化不显著。结论：①补肾法与舒肝法对吗啡引起的精神依赖均有调节作用。②舒肝法的作用机制可能在于通过影响伏核和前额叶皮质中NR2B亚基的mRNA表达进一步调节精神依赖的相关神经通路。③补肾法的作用机制与NR2B亚基的mRNA表达关系不密切,其调节的具体机制尚有待研究。     

团体咨询改善小学生社会技能的实验研究

目的:通过实验研究表明团体咨询对改善小学生社会技能方面有重要作用。方法:某小学四年级一个班作为实验组,共41人(其中男生23人,女生18人)。采用前后测设计。对实验组进行十二次团体心理咨询,采用社会技能等级评定表进行前后测,以前后测结果的对照及受欢迎程度的改变值和喜欢他人程度的改变值作为效果指标。结果:在受欢迎程度上,前后测得分在受欢迎组、被拒绝组、低接纳组和女生中差异显著,被拒绝组学生团体咨询效果要优于受欢迎组的;在喜欢他人程度的改变上,低接纳组学生的团体咨询效果要优于高接纳组的;在受欢迎程度的改变上,女生的团体咨询效果要优于男生。结论:团体心理咨询对小学生社会技能的干预有效;采取班级团体心理咨询的方式,团体咨询的效果在人际关系不良的学生及女生中表现得更为明显。     

Psychological stress induces chemoresistance in breast cancer by upregulating mdr1

Psychological distress reduces the efficacy of chemotherapy in breast cancer patients. The mechanism may be related to the altered neuronal or hormonal secretions during stress. Here, we reported that adrenaline, a hormone mediating the biological activities of stress, upregulates mdr1 gene expression in MCF-7 breast cancer cells via alpha(2)-adrenergic receptors in a dose-dependent manner. Mdr1 upregulation can be specifically inhibited by pretreatment with mdr1-siRNA. Consequently, adrenergic stimulation enhances the pump function of P-glycoprotein and confers resistance of MCF-7 cells to paclitaxel. In vivo, restraint stress increases mdr1 gene expression in the MCF-7 cancers that are inoculated subcutaneously into the SCID mice and provokes resistance to doxorubicin in the implanted tumors. The effect can be blocked by injection of yohimbine, an alpha(2)-adrenergic inhibitor, but not by metyrapone, a corticosterone synthesis blocker. Therefore, we conclude that breast cancers may develop resistance against chemotherapeutic drugs under psychological distress by over-expressing mdr1 via adrenergic stimulation.     

大学生A我心理治疗的过程、评定和原则

本文论述了大学生自我心理治疗一般过程中的四个阶段,自我心理治疗效果的评定方式、指标和评定依据,以及自我心理治疗的七个原则。