不同机械通气模式下吸痰对ARDS患者肺通气及顺应性的影响

为探讨不同机械通气模式下吸痰对ARDS患者肺通气及顺应性的影响。选择20例ARDS机械通气患者,随机分为A/C组与SIMV组;分别给予开放式吸痰,记录吸痰前后肺通气指标及呼吸系统顺应性指标的变化。结果吸痰后各时间点呼吸频率均显著增加(P0.01);潮气量、分钟通气量在0s显著降低,吸痰后15s、1min显著增加(P0.01);两通气模式比较SIMV组呼吸频率、分钟通气量增加显著(P0.01)。吸痰前后动静态顺应性、动态P-V曲线斜率差异不显著(P0.05),通气模式之间亦无统计学差异。提示开放式吸痰引起呼吸频率显著增加,潮气量及分钟通气量先是下降然后显著增加;SIMV模式呼吸频率、通气量增加较为显著。不同通气模式下吸痰对呼吸系统顺应性影响不显著。     

青年颈心综合征避免误诊为冠心病的临床诊疗策略

通过对临床收集的187例青年(≤45岁)颈心综合征患者的临床资料进行分析。探讨青年颈心综合征临床误诊为冠心病的原因及避免误诊的诊疗策略。目的在于帮助临床医师对青年颈心综合征进行识别,注意如何与冠心病心绞痛相鉴别,对防止病情延误,尽早明确诊断积极治疗,排除冠心病,减少诊疗费用及避免冠脉造影的风险意义很大。     

Perceptual grouping and distance estimates in typical and atypical development: comparing performance across perception, drawing and construction tasks

Perceptual grouping is a pre-attentive process which serves to group local elements into global wholes, based on shared properties. One effect of perceptual grouping is to distort the ability to estimate the distance between two elements. In this study, biases in distance estimates, caused by four types of perceptual grouping, were measured across three tasks, a perception, a drawing and a construction task in both typical development (TD: Experiment 1) and in individuals with Williams syndrome (WS: Experiment 2). In Experiment 1, perceptual grouping distorted distance estimates across all three tasks. Interestingly, the effect of grouping by luminance was in the opposite direction to the effects of the remaining grouping types. We relate this to differences in the ability to inhibit perceptual grouping effects on distance estimates. Additive distorting influences were also observed in the drawing and the construction task, which are explained in terms of the points of reference employed in each task. Experiment 2 demonstrated that the above distortion effects are also observed in WS. Given the known deficit in the ability to use perceptual grouping in WS, this suggests a dissociation between the pre-attentive influence of and the attentive deployment of perceptual grouping in WS. The typical distortion in relation to drawing and construction points towards the presence of some typical location coding strategies in WS. The performance of the WS group differed from the TD participants on two counts. First, the pattern of overall distance estimates (averaged across interior and exterior distances) across the four perceptual grouping types, differed between groups. Second, the distorting influence of perceptual grouping was strongest for grouping by shape similarity in WS, which contrasts to a strength in grouping by proximity observed in the TD participants.     

Effects of the premenstrual syndrome on facial expressions of sadness

This study examined the relationship between PMS and emotion-related electromyographic facial activity at different phases of the menstrual cycle. Twenty-four women of reproductive age (12 with PMS, 12 controls) participated in two EMG sessions (T1 and T2) in which they were shown photographic images that can elicit various emotions (IAPS stimuli). T1 took place in the follicular phase, T2 in the luteal phase. The activity of the musculus depressor anguli oris ("depressor", expression of sadness) was measured. Depressor activity was compared to activity of musculus orbicularis oculi ("orbicularis"; expression of joy). ANOVA yielded a significant increase of the activity of the depressor at T2 in the PMS group. The PMS group showed more frequent depressor activity during the luteal than the follicular phase. Orbicularis activity did not change from T1 to T2. Conclusions: The PMS group experienced various visual stimuli in a more depressed way during the luteal phase.     

IABP在心脏直视手术围术期低心排的应用

为了探讨主动脉内球囊反搏（IABP）治疗心脏手术围术期低心输出量综合征（LCOS）的临床疗效,对16例心脏手术围术期LCOS患者,经过股动脉放置IABP导管于降主动脉内进行左心辅助治疗,IABP治疗前、后监测患者连续有创动脉收缩压（SABP）、有创平均动脉压（MABP）、中心静脉压（CVP）、动脉血氧分压（PaO2）、心率（HR）、尿量和血管活性药物的使用。结果显示,IABP辅助治疗时间25h～116h,平均（78．5±40．5）h。行IABP治疗后,SABP、MABP、PaO2较术前明显提高（P〈0．05）,HR、CVP明显下降（P〈0．05）,尿量增加,血管活性药物使用量明显减少（P〈0．05）,12例患者心功能好转而脱离IABP,11例（69．3％）存活,4例死于心源性休克,1例死于多器官功能不全综合征（MODS）。提示正确及时地使用IABP能明显改善心脏手术围术期LCOS患者的血流动力学指标,减少血管活性药物的使用,建议对有适应证者应尽早应用,适时撤离。     

Terrorism Between "Syndrome" and "Tool"

ABSTRACT— Two psychological views of terrorism are described, approaching it as a "syndrome" and as a "tool" respectively. Research thus far found little support for the syndrome view. The heterogeneity of terrorism's users is consistent with the tool view, affording an analysis of terrorism in terms of goal–means psychology.     

慢性腹痛

慢性腹痛病史较长,性质不定。引起慢性腹痛的原因很多,除器质性疾病外,一些功能性疾病也引起,如最终找不出具体原因,则可称之为功能性腹痛综合征。诊断比较困难,也容易误诊,甚至误治,外科医生应特别慎重。误诊的思维原因包括对引起慢性腹痛的原因认识不全面,思维惰性,辩证思维不周密和思维简化等。     

呼吸危重症临床决策中的若干问题

在临床实践中,呼吸危重症的诊断和治疗存在着一些不同的观点。就其中某些热点问题,如慢性阻塞性肺疾病合并哮喘的诊断和机械通气的指征、肺栓塞的诊断、急性呼吸窘迫综合征的治疗、呼吸重症监护病房的建设和呼吸危重症的伦理学问题进行阐述,以期提高对呼吸危重症的认识。     

低出生体重与代谢综合征

低出生体重是发生成年期代谢综合征的高危因素。“代谢程序化”与“营养程序化”概念的提出对人们从多层面认识该现象的内在机制有重要指导作用。随着对发生机制研究的深入,人们终将找到预防低出生体重发生成年期代谢综合征的早期干预措施。     

Exaggerated leftward bias in the mental number line of patients with schizophrenia

Several visuo-motor tasks can be used to demonstrate biases towards left hemispace in schizophrenic patients, suggesting a minor right hemineglect. Recent studies in neglect patients used a new number bisection task to highlight a lateralized defect in their visuo-spatial representation of numbers. To test a possible lateralized representational deficit in schizophrenia, we used the number bisection task in 11 schizophrenic patients compared to 11 healthy controls. Participants were required to orally indicate the central number of an interval orally presented. Whereas healthy subjects showed no significant bias, schizophrenic patients presented a significant leftward bias. Therefore, these results suggest an impairment in higher order representations of the number space in patients with schizophrenia, an impairment that is qualitatively similar to the deficit described in neglect patients.