不同喉罩对右颈内静脉穿刺点的影响

观察三种常用喉罩置入后对右颈内静脉解剖位置及其本身的影响,选择最佳的穿刺位置.90例患者随机分为:Proseal组(P组,n=30)和Supreme组(S组,n=30)和SLIPA组(A组,n=30),使用多普勒超声在低位(锁骨上窝2cm水平)、中位(胸锁乳突肌三角顶点水平)及高位(胸锁乳突肌前缘中点),观察喉罩置入前后颈内静脉前后直径、横截面积、同颈总动脉间距离及二者重叠率的变化.结果在低位穿刺点三组喉罩置入前后各指标组内及组间比较均无显著性意义(P＞0.01);在中位穿刺点喉罩置入前后A组各指标差异组内比较无显著性意义(P＞0.01),S组和P组患者的各指标差异组内及组间比较均有显著性意义(P＜0.01);在高位穿刺点三组患者喉罩置入前后各指标差异组内比较有显著性意义(P＜0.01).使用三种喉罩时,对低位右颈内静脉解剖特点及位置无影响,可作为使用喉罩时右颈内静脉穿刺首选解剖位置.     

小儿支气管哮喘和胃食管返流关系的哲学思考

支气管哮喘是当今世界上最常见的气道慢性炎症性疾病,运用哲学的观点认识小儿支气管哮喘与胃食管返流之间的关系,对于支气管哮喘合并胃食管返流的临床治疗非常重要.     

视觉思维在机器人甲状腺手术中功能保护的探索

甲状腺癌是增长速度最快的恶性肿瘤之一,经过外科等有效治疗患者5年无病生存率高达98%。甲状腺手术中对邻近器官的功能保护效果对于患者长期生命质量非常重要。"视觉思维"指视觉信息结合和其他知觉,经高级神经中枢处理,形成思维及创造的活动。由于机器人外科系统技术革新,外科医生获得全新的视觉图像和操作方式,应用视觉思维可以对甲状旁腺、喉返神经等邻近器官的处理做到更好的功能保护。在甲状腺外科中,临床医生应训练"视觉思维",首先打牢局部解剖知识和开放、腔镜手术图像基础,了解并掌握机器人的新技术与传统开放及腔镜手术的不同特点,提高手术效果,特别是功能保护方面进行创新和探索。     

心肌桥-壁冠状动脉的研究进展

心肌桥—壁冠状动脉是一种常见的先天性冠状动脉解剖变异.本文对心肌桥-壁冠状动脉的解剖学、生理学、临床特点、影像学诊断以及临床治疗的进展进行综述.     

老年甲状腺结节的诊治经验

介绍笔者及科室老年甲状腺结节的诊治经验,对2003年1月至2009年12月期间共收治的144例年龄大于60岁的老年甲状腺结节患者进行分析和总结.老年甲状腺结节以多发为主;压迫症状、异物和不适感、继发性甲状腺功能亢进是老年甲状腺结节患者主要的手术指证;术中发现喉返神经和甲状旁腺有脂肪沉着;病理方面良性结节的钙化率较高;患者术后切口水肿比较明显;暂时性低钙血症的发生率较高;虽然术前麻醉ASA评分较低,但术后心肺并发症的发生率并未上升.老年甲状腺结节患者以全麻为宜,最好采用双甲近全切除术,这不仅可避免术后复发和再次手术率,更可减少甲状腺素制剂的用量,减少药物副作用.     

“钩子”假说:一种发展神经心理学假设

功能脑与解剖脑相对独立发展.解剖脑不断发展完善解剖结构单元,功能脑不断产生并发展新的功能结构单元.每一个新产生的功能结构单元通过一把“钩子”钧连到相应的解剖结构单元上,功能脑与解剖脑通过“钩子”钩连在一起.这种钧连关系是功能脑发展过程中逐渐产生发展的.若在一种钩连关系产生时,功能结构单元对应的解剖结构单元已经损失,则功能结构单元会寻找并钩连另外的解剖结构单元,而不影响此钩连关系的产生.     

扩散张量成像在弱视中应用的探讨

弱视是儿童常见眼科疾病,发病机制目前尚不完全清楚.扩散张量成像(diffusion tensor imaging,DTI)是MRI技术的一个新应用,将DTI引入弱视发病机制的研究使人们能更加直观地研究弱视患者视路相关结构有否解剖改变.正确运用哲学观点、充分发挥创新能力并灵活选用适宜技术与高新技术以期达到弱视诊断的最优化.     

从六朝上清经看文化对文献用语的影响

语言与文化交互影响,彼此渗透,文献的用语可能受到它所蕴涵的思想文化的影响,东晋南朝上清经中的一些词语即有很深的宗教文化印痕.文章考察了道家思想及道派文化对上清经用语构造及意义的影响.研究表明,从文化的角度解剖这些语词,对治宗教学、语言学、文化学都有作用.     

周围神经损伤治疗的过去和未来

周围神经损伤治疗的过去和未来西安第四军医大学研究生（７１００３２）王树森导师黄耀添周围神经损伤治疗的发展走过了漫长而曲折的道路，从周围神经损伤后被旷置不顾到１３世纪Ｓａｌｉｃｅｔｏ最早进行神经外膜缝合术，人类踏上了征服周围神经损伤的征途。周围神经损伤...     

婴幼儿喘息的分类和小儿哮喘的鉴别诊断

喘息是小儿时期常见的症状,尤其是婴幼儿.婴幼儿喘息分为三种类型:一过性的早期喘息,只发生在3岁以前的喘息.无家族的哮喘病史,与过敏原的致敏无关,与父母吸烟有关.持续性的早发的喘息,即非过敏的喘息,与病毒感染诱发有关.晚发的喘息/哮喘,即过敏性的喘息.有湿疹和哮喘的气道病理特点.在诊断支气管哮喘前,还必须排除以下疾病:先天性气道和肺的发育异常,先天性心、血管异常,异物吸入,胃食管返流,支气管结核,纤毛不动综合征,免疫缺陷病等.     

The role of centrality to self-concept in moderating the associations between injury perceptions and outcomes

Abstract

Objectives: To test the centrality of injury to self-concept as a moderator of the associations between injury perceptions and outcomes.

Methods: Two concurrent studies on samples of injured individuals.

Measures: The centrality of injury to one’s self concept was measured by the degree of self-injury separation (PRISM); injury perceptions were measured by the injury perception questionnaire; and outcomes by standard scales of self-assessed health, physical, emotional and social functioning, vitality, depression, anxiety and somatisation. Regression analyses examined the significance of adding the interactions between injury centrality and injury perceptions to explained outcome variance, beyond their separate contributions.

Results: Both injury centrality and injury perceptions significantly explained variance in patients’ functioning and well-being. Injury centrality moderated the associations between various injury perceptions and outcomes, especially pronounced for emotional representations of the injury. As hypothesised, the effects of injury perceptions on outcomes were stronger among patients for whom the injury was central to their self-concept compared to patients who perceived the injury as peripheral to their self-concept.

Conclusions: ‘Centrality to the self’ is a moderator of the impact of perceptions on outcomes of injuries. The findings suggest ways to tailor interventions to sub-groups of injured patients based on injury centrality to their self-concept.     

Spatial grouping activity in young children with congenital right or left hemisphere brain injury

Spatial grouping abilities were examined in 20 preschool-aged children with right or left hemisphere congenital focal brain injury, and a group of age-matched normal control children. Children were presented with a series of spontaneous grouping tasks in which they were given small sets of blocks and asked to play with them. Although the children with focal brain injury played as actively with the blocks as normal children, the constructions they produced differed systematically. Across eight measures of spatial grouping both children with right and left hemisphere injury were delayed compared to normal children. In addition, the behavioral profiles for the two groups of children with focal brain injury were qualitatively different. Data for the children with RH injury suggested difficulty organizing objects into coherent spatial groupings, while data from the children with LH injury suggested difficulty with local relations within the spatial arrays. These findings are consistent with data reported for adults on spatial construction tasks. Developmental trajectories in the 3- to 4-year age period suggest, further, that the spatial integrative deficits observed in the children with RH injury are persistent. When the children began to produce spatial constructions using complex grouping procedures, those constructions were heaps or disordered clusters. In contrast, when children with LH injury began to use complex procedures, they generated the types of constructions usually associated with those procedures in normal children, e.g., arches, enclosures, and symmetries. These data were found within a cross-sectional study of 20 children and confirmed in a series of six longitudinal case study reports of three children with RH and three with LH injury. The data confirm our previous reports of spatial integrative deficit associated with early RH injury and present the first indication of spatial encoding deficits in children with LH injury.     

128例重型颅脑损伤患者的临床治疗体会

探讨重型颅脑损伤的治疗方法与经验。观察128例重型颅脑损伤患者的脑部受伤情况,合并伤以及受伤到入院期间的病情变化。临床治愈113例,其中能生活自理者87例,留有后遗症者26例,死亡15例,病死率为11.72%。重型颅脑损伤病死率高,入院后重点合理的检查,积极有效的救治以及规范的康复护理是降低病死率、提高临床治愈率的关键。     

Children's memory for medical emergencies: 2 years later

Long-term recall of medical emergencies (including both injury and hospital treatment) by 2- to 13-year-olds was assessed 2 years after injury. Event identity was important: Children recalled injury details better than hospital treatment. Ninety-six children were interviewed 3 times prior to the 2-year recall; amount recalled decreased only for hospital treatment details, although accuracy of recall decreased for both injury and treatment. Twenty-one children were interviewed only twice prior to the 2-year interview. An extra interview 1 year after their injury had little effect on how much older children recalled about both injury and treatment or how much younger children recalled about injury details, but it helped younger children recall the less memorable hospital event. The extra interview also helped all children maintain accuracy when recalling hospital details but was unnecessary for the more memorable injury event. Implications for children's testimony are discussed.     

脑外伤患者内隐记忆康复护理可行性研究

探讨脑外伤患者在高强度练习和准确反馈条件下,内隐学习知识效应和底层规则迁移易化能力。结果发现：①脑外伤患者在汉字整体偏好深加工的非显著特征学习与对照组一样有效;在笔划浅加工的显著特征学习,明显低于对照组;在自由回忆和再认的重复测验中,患者组与对照组存在显著性差异。②脑外伤患者学习记忆具有整体性、直观性、模糊抽象性、无意识性等特点。③脑外伤患者存在着内隐学习知识效应和内隐知识学习效应,且随着训练强化和训练方法的改进,有增强和外显记忆转化的趋势。     

Correlates of Suicidal Ideation in Physically Injured Trauma Survivors

Epidemiologic studies have documented that injury survivors are at increased risk for suicide. We evaluated 206 trauma survivors to examine demographic, clinical, and injury characteristics associated with suicidal ideation during hospitalization and across 1 year. Results indicate that mental health functioning, depression symptoms, and history of mental health services were associated with suicidal ideation in the hospital; being a parent was a protective factor. Pre‐injury posttraumatic stress disorder symptoms, assaultive injury mechanism, injury‐related legal proceedings, and physical pain were significantly associated with suicidal ideation across 1 year. Readily identifiable risk factors early after traumatic injury may inform hospital‐based screening and intervention procedures.     

Neuropsychological function in a group of patients 25 years after sustaining minor head injuries as children and adolescents

Previous studies suggest that neuropsychological impairment following mild to moderate pediatric head injury may become persistent and interrupt the normal course of intellectual development. In this study 45 subjects were assessed with a standardized neuropsychological test battery 25 years after sustaining mild to moderate head injury as children. Although the group scores in the normal range, significant relations between head injury severity and current neuropsychological function were found. The most important predictor of poor outcome was length of PTA at injury, EEG pathology, and loss of consciousness at injury. No significant influence of pre- and post-injury risk factors on current neuropsychological function was evident. The findings support the view that complicated mild and moderate paediatric head injury may heighten the risk of developing subtle neuropsychological problems later in life.     

Evaluation of an arm‐splint belt to reduce self‐injury

After a functional analysis yielded undifferentiated results, a subsequent assessment suggested self‐injury exhibited by a young boy with autism was sensitive to physical restraint. Canvas arm splints with metal stays were initially effective to reduce self‐injury. Although we successfully faded the number of stays in each sleeve to 3, self‐injury reemerged. We then used a withdrawal design to evaluate a behind‐the‐back belt connected to the arm splints. When the belt and splints were on, self‐injury did not occur. When the belt was removed, self‐injury increased, even though the splints remained intact. Finally, we faded the length of the belt to allow increased range of motion, and rates of self‐injury remained low.     

Predictors of perceived susceptibility to sport-related injury

Little is known about factors associated with perceptions of susceptibility to sport-related injuries. The purpose of the present study was to examine previous experiences with injury and personality factors as predictors of rugby players’ perceived susceptibility to injury. In line with an individual-based approach, it was hypothesized that neuroticism and global self-esteem would be related to perceived susceptibility to sport injuries over and above previous experiences with injuries. Rugby players (N = 235) were asked to report about previous experiences with injury and were administered measures of neuroticism and global self-esteem. Multiple regression analysis revealed that previous experiences with injury were positively related to perceived susceptibility to sport-related injuries. Analyses also supported that neuroticism and global self-esteem are of crucial importance in colouring perceptions of susceptibility to sport-related injury, while statistically controlling for previous injuries. Of particular interest, neuroticism predicted perceived susceptibility, over and above global self-esteem and previous experiences with injury. This study is the first to focus on determinants of perceived susceptibility to sport-related injury and supports the potential role of personality factors and individual dispositions in shaping perceived susceptibility to health problems.     

Gender biases in children's appraisals of injury risk and other children's risk-taking behaviors

Children ages 6, 8, and 10 years were given tasks designed to assess their beliefs about risk of injury from activities. Children were asked to appraise the risk of injury for boys and girls engaging in various play behaviors and to judge the sex of the character in stories about children engaging in activities that result in injuries. Results revealed gender biases in children's appraisals of injury risk: Both boys and girls rated boys as having a lower likelihood of injury than girls even though the boys and girls were engaging in the exact same activities. Children also showed higher accuracy in identifying the sex of the character in stories of boys' injuries than girls' injuries, and accuracy improved with the participant's age. Overall, the results indicate that by the age of 6 years children already have differential beliefs about injury vulnerability for boys and girls. Although boys routinely experience more injuries than girls, children rate girls as having a greater risk of injury than boys. With increasing age, school-age children develop a greater awareness of the ways in which boys and girls differ in risk-taking activities that lead to injury outcomes.