Objective To study on the cross-cultural adjustment and application of the Death Anxiety Scale based on the national culture and establish the Chinese version of this scale.Methods Through cross-cultural adaptation and formal investigation,the Chinese version of Death Anxiety Scale was established.A cross-sectional study was conducted among 450 medical college students and 50 hospice workers with multiple diagnoses to validate the Chinese version of the Templer's Death Anxiety Scale (T-DAS),after 7to 10 days,60 of them were retested.Reliability and validity of the Chinese version of Templer's Death Anxiety Scale (T-DAS)were evaluated according to the data.Results The Chinese version of the Templer's Death Anxiety Scale(T-DAS)was easy to understand.Most respondents finished the whole scale in 5 to10 minutes,and the effective recover rate of the scale was 97.4％.The correlation between the T-DAS and the single item test for the death anxiety was 0.516.Structural equation models and factor analysis displayed good construction of the T-DAS.The internal consistency reliability evaluated by Cronbach'α was 0.71 for the whole 15 items.The retest reliability was 0.831.Conclusions Based on the analysis,the Chinese version of the T-DAS has good reliability and validity,and should be a good instrument for the evaluation of the death anxiety.

Objective To prospectively observe the changes of amplitude-integrated electroencephalogram(aEEG) in neonates with hypoxic-ischemic encephalopathy (HIE).Methods Thirty-five HIE neonates with gestational age of 37 ～ 41 weeks were chosen as HIE group,and all of them were hospitalized in neonatal intensive care unit of Bethune International Peace Hospital from Aug 2011 to Jan 2012.At the same time,40 healthy term neonates were chosen as control group.aEEG monitoring was done within 24 ～ 48 hours after birth with cerebral function monitor (CF3000) and each recording last at least 8 hours.The continuity,sleep-wake cycle,voltage of every aEEG tracing were analyzed.Results (1) The maximal voltage of aEEG tracing in control group was 30 μV,while that in HIE group was 16 μV.The minimal voltage of aEEG tracing in control group was 13 μV,while that in HIE group was 7 μV.The aEEG tracing amplitude both in highest and lowest in HIE group were significantly lower than those in the control group.There were significant differences between them (P ＜ 0.05).(2) There was significant difference of sleep-wake cycling between HIE group and control group[20％ (7/35) vs 100％ (40/40),x2 =51.064,P ＜ 0.05].While there was also significant difference of the continuity of the amplitude between HIE group and control group[31％ (11/35)vs 100％ (40/40),x2 =40.336,P ＜0.05].Conclusion aEEG has some specific changes in neonates with HIE,possiblility it can be used for earlier predicting the occurrence of brain damage after asphyxia and provides good evidence for the early diagnosis and treatment of HIE.

Objective To investigate the correlation and clinical diagnosis significance between ultrasound elastography and the distribution of myofibroblast in breast tumor.To assess the value of ultrasonic elastography and myofibroblast in the diagnosis of breast cancers.MethodsThree-hundred and fifteen patients recruited from May 2009 to November 2010 were divided into benign group and malignant group according to postoperative pathological diagnosis results considered as gold standard.The clinical value of the score of ultrasonic elastography was evaluated.The expression levels of CD34 and α-SMA protein in breast tissues were examined by immunohistochemistry.ResultsThe difference was statistically significant for the expression level of CD34 and α-SMA between malignant breast tumor patients compared with benign ( P ＜0.05).The expression level of CD34 was lower,but α-SMA was higher in the patients of breast cancer compared with benign tumor.However,the expression level of CD34 and α-SMA was just the opposite in the patients of benign tumor.The expression level of CD34 was the negative correlation with the elastography score ( P ＜0.05) in the breast tumor,but α SMA just the opposite situation.Conclusions The score of ultrasound elastography can represent MFS distribution characteristics in breast tumors in the result that α-SMA +/CD34- can determine the existence of myofibroblast.

Objective·To investigate and compare the clinical characteristic of non-organic dyspnea and asthma both with complaint of dyspnea.Methods·Seventy-four consecutive patients with non-organic dyspnea,and 74 age-,height-,weight and sex-matched patients with asthma were recruited for investigation in the study.The self-assessment surveys were conducted for the two groups by means of Hospital Anxiety and Depression Scale,Nijmegen Questionnaire and Athens Insomnia Scale.The words for describing dyspnea,clinical symptoms,effective sleep hours and items of pulmonary function test were collected and analyzed Results·Non-organic dyspnea patients tended to describe psychogenic aspects.Asthma patients tended to describe airflow limitation.Non-organic dyspnea group mainly performed psychogenic symptoms.The sleeping time in non-organic dyspnea group was significantly lower than that in asthma group(P＜0.05).The score of anxiety,depression,Nijmegen Questionnaire,Athens Insomnia Scale,FEV1,FEV1％Pred,FVC％Pred,FEV1/FVC in non-organic dyspnea group were significantly higher than those in asthma group (P＜0.05).There was no significant difference in FVC between two groups(P＞0.05).Conclusion·The non-organic group feel more anxiety,depressed and insomnic than the asthma group.Lung function test of asthma group is often abnormal.To discriminate non-organic dyspnea with asthma,clinicians should pay more attention to emotion,sleep,somatoform symptoms,medical history and so on,and do pulmonary function test,improve the understanding of the characteristics of the two diseases,decrease misdiagnosis and wrong diagnosis.

Background Conventional studies showed that the primary pathological change of diabetic retinopathy (DR) is retinal microangiopathy.However,recent studies found that the disorder of visual function appears prior to retinal microangiopathy in diabetic patients.Thereby,this findings can not be explained by conventional view.Objective The aim of the study was to find the change of retinal nerve fiber layer (RNFL) by frequency domain optical coherence tomography(OCT) in the diabetic patients without retinal microangiopathy and with non-proliferative DR (NPDR) and investigate the relationship between the change of RNFL thickness and DR.Methods Sixty eyes of 56 patients with 2 type diabetes mellitus were enrolled in Shanxi Eye Hospital from October 2012 to September 2013.The patients were divided into the non-diabetic retinopathy (NDR) group (30 eyes of 26 patients) and NPDR group (30 eyes of 30 patients) depending on the findings of fundus fluorescine angiography (FFA) according to the DR International Clinical Classification System.Thirty normal eyes of 30 age-and gendermatched healthy volunteers were included as controls.RNFL thicknesses around optical disc and macular zone were measured by OCT,including average RNFL thickness in 360°,superior nasal,superior temporal,temporal,inferior temporal,inferior nasal and nasal RNFL thicknesses.The measuring results were compared between the three groups.Results The total average thickness values of RNFL around the optic disc for the NDR group,NPDR group and the control group were (97.46-± 8.65) μm,(100.69 ± 16.35) pm and (109.22 ± 8.69) μm,respectively,and the parameters in the NDR group and NPDR group were significantly lower than those in the normal control group (P=0.001,0.006).The RNFL thicknesses were thinning at the superior temporal,temporal,inferior temporal,inferior nasal quadrants around optical disc in NDR group compared with the normal control group (P=0.001,0.001,0.001,0.010),and RNFL thickness values of all the quadrants were decresed in the NPDR group compared with the normal control group,and significant differences were seen in superior temporal and nasal quadrants (P =0.001,0.046).The total average thickness values of RNFL around macular zone for the NDR group,NPDR group and the normal control group were (33.47±3.39),(36.81±3.21) and (38.18±2.16) μm,and parameters in the NDR group was significantly lower than that in the normal control group (P =0.001).The RNFL thicknesses of all the quadrants around macular zone in the NDR group were thinned in comparison with the normal control group (all at P＜0.01),and the RNFL thicknesses at the superior nasal,superior temporal and temporal quadrants were significantly decreased in comparison with the normal control group (P=0.026,0.015,0.001).Conclusions The thinning of the RNFL thickness occurs prior to retinal microangiopathy in diabetic patients,and it may be an early pathological stage for DR.

BACKGROUND: Morphine is the first choice for the pain of medium and advanced degrees due to cancer. This is advocated in the Pain Relieving Guide of the WHO. Controlled-release morphine sulfate tablets(CRM) and sustained-release morphine sulfate tablets (SRM) all belong to oral long-acting morphine. It plays an important role in relieving cancer pain effectively and improving their quality of life(QOL).OBJECTIVE: To observe the analgesic effect of CRM and SRM and to observe how they improve the QOL of the cancer patients with severe cancer pain.SETTING: Department of oncology, department of surgery, department of internal medicine and department of traditional chinese medicine in the first affiliated hospital of a university.PARTICIPANTS: During October 1995 to June 1998, all inpatients that were pathologically proved to suffer from malignant tumor with severe pain were recruited into our study.METHODS: There were 182 patients with severe pain due to advanced cancers pathologically proven. They all met the entry criterion of the study. Totally 95 patients were treated with CRM, of which 12 cases were lost in follow-up due to side effects, death, or discharge from the hospital, and the rest 83 cases entered the stage of clinical trial. Eighty-seven patients were treated with SRM. Of them 25 cases were lost in follow-up due to side effects, death, or discharge from the hospital, and the rest 62 cases entered the stage of clinical trial. The recommended initial dosage of CRM or SRM was 30 mg every 12 hours for all patients, and then the dosage was regulated according to the effects until the ideal anesthesia was achieved.MAIN OUTCOME MEASURES: Assessments included pain severity, the effective rate, complete remission rate, remission time, adverse reactions, and the QOL before and after the treatment.RESULTS: The effective rates of CRM and SRM were 95% and 94%respectively. The complete remission rates were 82% and 80% respectively, and the remission time was(9.1 ±4.1) hours and (8.7±4.4)hours respectively. Statistically, there was no significant difference in analgesic effect and remission time between CRM and SRM. QOL was elevated for a higher degree in 62(75% ) and 47(76% ) patients after the treatment. QOL scores of CRM were (34.6 ± 11.5 ) points before treatment and (52.6 ± 13.0) points after the treatment( P = 0. 000), while QOL scores of SRM were(37.7 ± 9.7) points before the treatment and points (49.8 ± 12.9) points after the treatment (P = 0. 000). There was significant difference in QOL after the treatment. They could relicve osteocope,visceral pain, soft tissue infiltrative pain more effectively than they do about neurological pain.CONCLUSION: Oral treatment with CRM and SRM for the patients with server cancer pain shows a similar analgesic effect. They are effective, safe,and convenient, and can improve the QOL.

Objective To compare the impact of anterior and inferior-posterior regional wall motion abnormalities on the vortex in systolic phase by vector flow map(VFM) technique.Methods Sixty patients with myocardial infarction were divided into 2 groups:the left anterior descending artery single branch lesion group (LAD group) and the left circumflex artery and/or right coronary artery lesion group (LCX/RCA group).By VFM technique,left ventricular systolic blood flow field was observed.Parameters such as the vortex duration were calculated and compared between two patient groups and also with healthy control group.Results LAD group did not show significant difference from the control group in isovolumic systolic vortex,this group was characterized with large size of vortex and usually forming local vortex at the apex in early ejection.On the contrary,LCX/RCA group had small isovolumic systolic vortex,the early ejection vortex of this group was significantly smaller than that of LAD group and larger than that of control group.The phenomenon was usually observed in the center of the lumen.Both LAD and LCX/RCA group had longer total vortex duration and vortex collapse time than the healthy control group,these differences were not significant between LAD and LCX/RCA group.There were no significant differences in isovolumic vortex duration among the three groups.Conclusions Anterior wall infarction had more impact on systolic blood flow field than inferior-posterior wall infarction.The VFM technique could be applied for observation and evaluation of the changes in vortex characteristics.

Objective To observe the serum levels of high mobility group box-1 protein (HMGB1)in patients with acute cholangitis (AC) and to investigate contributions of HMGB1 in AC.Methods Serum HMGB1 concentrations were determined by an enzyme-linked immunosorbent assay in 30 patients with AC of severe type (ACST) and 42 patients with mild acute cholangitis at the time of admission (within 72 h after the onset).A total of 50 healthy subjects were recruited as the control group.Fluorescent quantitative PCR (FQPCR) was used to detect the HMGB1 mRNA expression and the relationship between serum HMGB1 levels and clinical factors was analyzed.Results The serum HMGB1 levels in healthy control group,mild group and ACST group were (1.82 ± 0.64) μg/L,(10.46 ± 3.75) μg/L,(18.89 ± 6.86) μg/L,respectively.The mean value of serum HMGB1 level in mild group was significantly higher than that in control group,while significantly lower than that in ACST group (P ＜ 0.05).Compared to the control group,the HMGB1 mRNA level in patients of AC increased significantly and the level of ACST group was higher than that of mild group.The serum HMGB1 levels of patients with positive bile or/and blood cultures were higher than that of negative.After emergency endoscopic nasal biliary drainage,the serum HMGB1 levels of patients significantly decreased compared to preoperational (P ＜ 0.05).The HMGB1 levels were significantly positively correlated with white cell counts,C-reactive protein (CRP),total serum bilirubin,direct bilirubin and alkaline phosphatase (ALP).By logistic regression analysis,serum HMGB1 levels had correlation with severity of disease.Conclusion Serum HMGB1 levels significantly increased in patients with AC and the serum concentrations of ACST group were higher than those of mild group.Serum HMGB1 level has a correlation with sepsis.ENBD could lower its serum levels.Serum HMGB1 has predictive value to severity of disease.

Objectives To investigate the clinical characteristics of hypoglycemic brain damage, and to assess the ifndings of amplitude-integrated electroencephalography (aEEG) and its predictive value in hypoglycemic brain damage. Methods Twenty-four neonates diagnosed with hypoglycaemia were selected. 12-hour continuous aEEG recordings were performed on the day when hypoglycaemia was diagnosed and second aEEG tracings was performed on the same day or the day after. The variability of aEEG background, appearance of sleep-wake cycling, bandwidth span and amplitude of lower border were analysed and compared with the results of brain MRI. Results Different degrees of epileptic seizures were found in neonates with severe hypoglycemic brain damage and were persisted after the blood sugar was corrected. aEEG in hypoglycemic brain damage was characterized by calyptriform or jagged epileptiform activity, disappearance of the sleep-wake cycle, but little impact on amplitude of lower border and bandwidth span. The recovery of sleep-wake cycle was a sign of brain function recovery. The aEEG and MRI had a good consistency in monitoring the hypoglycemic brain damage. Conclusions aEEG have signiifcant changes in hypoglycemic brain damage and can be used to monitor dynamically hypo-glycemic brain damage.

Objective To evaluate the dynamic changes of left ventricular systolic blood flow hemodynamics in patients with acute myocardial infarction(AMI) before percutaneous coronary intervention (PCI) and short-term after PCI by vector flow mapping (VFM).MethodsTwenty-five patients with AMI were examined by color Doppler two-dimensional echocardiography respectively before PCI and three days and one month after PCI.The standard apical three-chamber color images in three sequent cardiac cycles were acquired and analyzed on off-line by VFM.In systole,the parameters of vortex including horizontal length,longitudinal length,transverse position,vertical position,and maximum vector velocity were measured respectively,and all parameters three days and one month after PCI were compared with those before PCI respectively.Results In systole,there were not statistically significant differences between parameters three days after PCI and those before PCI( P ＞0.05).Compared parameters one month after PCI with those before PCI,horizontal length was longer( P ＜0.05),longitudinal length was shorter (P ＜0.05),the transverse position was closer to anterior ventricular septum( P ＜0.05),and the maximum vector velocity of vortex was increased ( P ＜ 0.05).Conclusions VFM may serve as an ideal tool to quantitatively evaluate the blood flow hemodynamics of left ventricle in patients with AMI after short-term therapy by PCI.