辩证思维在重症急性胰腺炎治疗中的运用

重症急性胰腺炎的治疗水平在近几十年已有了很大的发展,但是SAP的死亡率依然居高不下,严重威胁患者生命。这类患者的病情复杂,需要运用多种治疗方法进行综合救治。从多种治疗方法中选择合适的方法并进行合理的治疗很难准确把握,需要我们用哲学的思维来看待胰腺炎的诊治,辩证地对其进行有针对性的治疗,从而提高重症急性胰腺炎的治疗水平。     

急性肺损伤生物标志物研究进展

急性肺损伤是临床常见的呼吸系统急危重症,是多个危险因素直接或间接引起肺部损伤的连续病理过程,低氧血症为其特征,其发病机制复杂,病亡率高,目前临床上仍缺乏有效的早期诊断方法,严重影响了疾病的预后,因此需寻找一个简单有效的诊断方法,如血清生物标志物的测定等来帮助本病的诊断以取得更好的疗效。     

合理应用运动平板试验与冠脉CT诊断冠心病临床策略分析

本文针对临床诊断冠心病的两种常用手段即运动平板试验和冠脉CT进行分析,鉴于目前临床普遍存在重视采用冠脉CT,甚至达到滥用的地步,而逐渐忽视平板运动试验的现象,紧密结合临床,客观分析两者的特点,阐述各自优缺点。希冀通过本文以帮助临床医师正确选择应用,避免偏颇,最终达到将两者有机的结合,真正适合临床需要,提高冠心病患者的检出率,有利于更好地对冠心病进行二级预防。     

An Exercise in Psychological Growth*

The author presents a case report followed by a self- assessment exercise which was generated spontaneously in collaboration with the patient herself during the treatment process. The lists of questions, designed to provoke thought and stimulate maturation, were found to be quite helpful especially in making important life decisions. It is proposed as a learning tool and template for use by those confronting similar issues. Lois Gerby, MA, is a psychologist and family therapist in private practice, 32 Hapalmach St., Suite 32/7, Jerusalem, Israel 92542 (jack.friedman@mail.mcgill.ca). *Translation by Yacov Friedman and Haim Sherrf.     

急性重症胰腺炎的抗生素治疗策略

继发性感染是导致急性重症胰腺炎(severe acute pancreatitis,SAP)高病死率最重要的因素。继发感染的微生物多为革兰阴性菌。选用抗菌药物需兼顾病原菌敏感性及抗菌药物穿透血胰屏障能力,合理选择用药方式;对于CT证实有胰腺坏死的急性重症胰腺炎,可预防性使用抗生素;氟康唑可作为经验性抗真菌治疗的首选药物。     

Seek,and You Will Find: The Influence of Expectations on Evaluations of Physical Activity

Despite hundreds of studies on the effects of expectations on evaluations, few commentaries have focused on summarising the relevance of these findings for physical activity pursuits. Moreover, a parsimonious framework on the nature of these relationships in physical activity is yet to be developed. Such a framework is important given the significance of physical activity evaluations in predicting future physical activity participation. Based on existing models on persuasion, it is premised that the self can be persuaded by one's own expectations about physical activity and that such persuasion can support or refute those expectations. Which of these effects are created, and the extent of one's psychological and physical involvement in the creation of physical activity evaluations, is likely to hinge on motivation and ability to confirm or disconfirm expectations. Evidence from related bodies of literature is presented to support the primary tenets of the model, which is termed the expectation‐to‐evaluation model, and recommendations for practitioners and future research are offered.     

DS14 is more likely to measure depression rather than a personality disposition in patients with acute coronary syndrome

It has been suggested that Type D Personality is a risk factor for acute coronary syndrome (ACS) and the DS14 has been developed for its assessment. However, some of the items on the DS14 seem to evaluate depressive symptoms rather than personality features. Therefore, the present study aims to verify whether an overlap exists between the constructs of Type D Personality and depression. Three‐hundred‐and‐four consecutive patients who were both presenting their first ACS and had no history of major depression completed the Hospital Anxiety and Depression Scale (HADS) and the DS14 to assess Type D personality at baseline and have been re‐evaluated at 1, 2, 4, 6, 9 and 12‐month follow‐ups. Out of 304 subjects (80.6% males), 40 were diagnosed as depressed. An exploratory factor analysis of HADS and the DS14 in the second month revealed that four out of seven items on the depressive subscale of HADS (HADS‐D) and six out of seven items on the Negative Affectivity (NA) subscale of the DS14 segregated on the same factor. Results were verified by a Partial Confirmatory Factor Analysis performed at the twelfth month when most of the patients achieved complete remission from the depressive episode. Temporal stability was poor for NA and Type D Personality and these construct co‐vary with HADS‐D over time. Our data suggests that NA and depression are overlapping constructs, supporting the idea that the DS14 measures depressed features, rather than a personality disposition.     

Positive affect and physical activity: Testing effects on goal setting,activation, prioritisation,and attainment

Objective: The present research tested whether incidental positive affect promotes pursuit of physical activity goals. Four key features of goal pursuit were examined – setting physical activity goals (Study 1), goal activation (Study 2), and goal prioritization and goal attainment (Study 3).

Design: Participants (N_s = 80, 81, and 59, in Studies 1–3, respectively) were randomized to positive affect (joy, hope) or neutral affect (control) conditions in each study.

Main Outcome Measures: Questionnaire measures of goal level, goal commitment, and means selection (Study 1); a lexical decision task indexed goal activation (Study 2), a choice task captured goal prioritization and MET minutes quantified goal attainment (Study 3).

Results: Study 1 showed that positive affect led to a greater number of intended physical activities, and that joy engendered greater willingness to try activities. In Study 2, a positive affect induction led to heightened activation of the physical activity goal compared to the control condition. The joy induction in Study 3 led to greater physical activity, and a trend towards greater goal prioritization.

Conclusion: These findings suggest that positive affect enhances the pursuit of physical activity goals. Implications for health behavior theories and interventions are outlined.     

Effects of a single bout of moderate-to-vigorous physical activity on executive functions in children with attention-deficit/hyperactivity disorder: A systematic review and meta-analysis

ObjectivesThe aim of this study was to systematically review the literature investigating the acute effects of moderate-to-vigorous physical activity (MVPA) on executive functions (EFs) in children with attention-deficit/hyperactivity disorder (ADHD) and perform a meta-analysis of the effects of MVPA on task components that require lower and higher EF demand in this population.MethodsThe systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Six electronic databases, i.e., PubMed, Scopus, Web of Science, Embase, SPORTDiscus, and Education Resources Information Center (ERIC), were searched for eligible studies. Random-effects weights were used to pool the effect sizes. Publication bias was assessed by Egger’s regression test and Rosenthal’s fail-safe N. This study is registered on PROSPERO, number CRD42020184082.ResultsThe electronic database search yielded 12 studies, which met the inclusion criteria, comprising a total of 375 participants. Eleven studies with data from 275 participants were included in the meta-analysis to examine the acute effects of MVPA on tasks with lower and higher EF demand. A single bout of MVPA had a small positive effect on tasks with lower (n = 10, g = 0.32, 95% CI = 0.123–0.517) and higher (n = 10, g = 0.25, 95% CI = 0.13–0.371) EF demand. No publication bias was found.ConclusionsA single bout of MVPA may have a general facilitative effect on cognition, indicating that acute MVPA may be a transient nonpharmacological adjunctive treatment for childhood ADHD.     

Patient preferences for medicine administration for acute agitation: results from an internet-based survey of patients diagnosed with bipolar disorder or schizophrenia in two Nordic countries

The objective was to elicit patient preferences for medicine administration method in the management of acute agitation episodes among patients diagnosed with bipolar disorder or schizophrenia. The patients’ experiences of acute agitation episodes and their management of episodes were also explored. Data were collected via an anonymous, internet-based survey of residents in Denmark or Sweden with schizophrenia or bipolar disorder (October 2014 to December 2014). Inclusion criteria were having a diagnosis of schizophrenia or bipolar disorder, and being above 18 years of age. The questionnaire included questions about preferences for medication attributes, experiences with pharmacological treatment for agitation and involvement in treatment plans. A total of 237 diagnosed patients (61 with schizophrenia; 176 with bipolar disorder) completed the questionnaire. Agitation episodes were experienced by 90% of the respondents. In total, 83% of the respondents reported having received treatment with tablets. When patients were presented with the attributes of an inhalation method, respondents stated that the fast onset of action, low risk of adverse reactions and least invasive form of drug delivery were positive attributes of treatment with inhalation. Inhalation is a new delivery route for treatment of acute agitation in patients diagnosed with bipolar disorder or schizophrenia. Inhalation is the preferred treatment method for acute agitation among Danish and Swedish patients with bipolar disorder or schizophrenia.