ICU患者呼吸道念珠菌是否需要去定植

ICU机械通气患者肺部念珠菌定植较为常见。研究显示呼吸道念珠菌定植可促进机械通气患者呼吸机相关性肺炎（VAP）进展,是VAP患者死亡和多重耐药菌（MDR）产生的独立预测因素,对念珠菌呼吸道定植的VAP患者经验性采用抗真菌治疗可产生有益作用。本文就呼吸道念珠菌是否需要去定植这一热点话题做一聚焦以供临床参考。     

血清唾液酸测定对新生儿及幼儿期细菌性肺炎临床意义的比较分析

为了探讨血清唾液酸（SA）测定在新生儿及幼儿细菌性肺炎的意义,我们测定了72例新生儿及98例幼儿细菌性肺炎患者血清SA水平。结果显示幼儿肺炎组SA水平在1天~3天内增加到（782.1±16.5）,与幼儿非肺炎对照组（591.9±11.5）比较差异具有统计学意义（P〈0.001）。新生儿非肺炎组SA水平保持在（357.8±9.1）,明显低于幼儿对照组（P〈0.001）。而新生儿肺炎组在起病1天~3天内增加到（604.1±15.4）,明显高于新生儿非肺炎组（P〈0.001）,但与幼儿对照组没有差异。因此,血清SA水平在幼儿时期即已达到成人水平,而新生儿细菌性肺炎患者虽然SA在正常成人标准范围内,但明显高于非肺炎新生儿水平。     

儿童大叶性肺炎诊治中的几点认识

大叶性肺炎是儿科呼吸系统常见、且较严重的疾病之一,与成年人大叶性肺炎差异较显著,近年来发病率在逐年升高,且婴幼儿患者明显增多,因起病隐匿,极易误诊、漏诊,病原学亦发生了较大的变迁,疗程较长,极大地威胁着儿童的身心健康,这就要求儿科医师有敏锐的洞察力、不循规蹈矩,运用哲学的辩证思维来分析病例,及时作相关检查,恰到好处地把握疗程。     

气道管理与呼吸机相关性肺炎防治策略

气道管理是机械通气过程中的关键技术,人工气道管理各个环节的处理,关系到机械通气的顺利进行,对呼吸机相关性肺炎(VAP)有不同程度的直接或间接的影响。气道管理的策略应该注重局部和整体的关系,在全身调整的基础上细致地管理气道的各个环节,体现气道管理的艺术。本文结合最新的临床研究证据阐明气道管理与VAP防治的策略。     

Illustrating and evaluating the psychosexual symbolic meaning of the coprophilia through the film of Salò, or The 120 Days of Sodom

Coprophilia is a rarely discussed phenomenon although not uncommon in psychiatric intensive care units, inpatient learning disability services and on wards for older people. It evokes intense emotional reactions in those who witness and who are exposed to it. This paper gives a definition and a current diagnostic overview of this unusual phenomenon. It sums up the medical and psychoanalytic approaches, then makes an effort to illustrate and evaluates the psychosexual symbolic meaning of coprophilia through the film of Salò, or The 120 Days of Sodom.     

小儿重症肺炎的诊治策略

肺炎是儿童常见的呼吸道疾病,小儿重症肺炎及其导致的并发症特别全身炎症反应综合征和多脏器功能衰竭是严重威胁儿童健康和生命的重要原因。随着基础医学和临床医学的发展,人们的认识逐渐深入,防治水平也取得重要进展。但病原学的变迁,不恰当的临床监测和干预仍然影响着人们对该病的正确认识和处理。运用哲学的辩证思维来探讨小儿重症肺炎诊治中的若干问题,将为儿科临床工作提供新的指导。     

Intergenerational predictors of diurnal cortisol secretion in early childhood

The present study examined potential intergenerational links that may contribute to atypical patterns of diurnal cortisol secretion in early childhood. Salivary cortisol samples were collected across 1 waking day in 36 pre‐school children whose mothers are participants in an ongoing longitudinal project. Hierarchical Linear Modeling (HLM) identified statistically significant predictors of individual differences in daily cortisol trajectories. Children displayed relatively low post‐awakening values and flatter cortisol trajectories across the day as a function of unsupportive maternal behaviour, second‐hand smoke and maternal histories of social withdrawal in childhood. These results suggest that individual differences in young children's pattern of diurnal cortisol are associated with a variety of current and historical maternal characteristics and behaviours. The identification of intergenerational predictors of children's diurnal neuroendocrine functioning may provide new insights into the transfer of health and developmental risk from parent to child. Copyright © 2007 John Wiley & Sons, Ltd.     

呼吸机管路集中消毒对新生儿呼吸机相关性肺炎的影响

探讨呼吸机管路集中消毒对新生儿呼吸机相关性肺炎（VAP）的影响。将200例应用呼吸机的患儿按照时间顺序分为观察组（80例）和对照组（120例）,对照组呼吸机管路由病区采用传统消毒方法消毒,自然晾干备用。观察组呼吸机管路由消毒供应中心集中回收,全自动清洗机清洗消毒、高温高压灭菌,比较两组患儿VAP的发生率。对照组VAP发生率为31．667％,观察组VAP发生率为16．250％,两组比较差异有统计学意义（P＜0．05）。呼吸机管路集中消毒,可有效降低新生儿VAP的发生率。     

Validation of the AMBIANCE-brief: An observational screening instrument for disrupted caregiving

Resulting from a community-identified need for a well-validated indicator of caregiving difficulties for use in practice settings, a brief form of the Atypical Maternal Behavior Instrument for Assessment and Classification System (AMBIANCE) was developed for use as a screening instrument. Prior to its dissemination, this study aimed to assess the feasibility, reliability, and validity of the AMBIANCE-Brief. Adolescent mother–infant dyads (N = 69) participated in the Strange Situation Procedure, as well as play sessions with and without toys. Maternal disrupted caregiving was coded from the play sessions using the AMBIANCE and AMBIANCE-Brief. The AMBIANCE-Brief demonstrated convergent validity with the AMBIANCE in the play session with toys (r = .65, p < .001) and without toys (r = .61, p < .001). Concurrent validity of the AMBIANCE-Brief was also demonstrated in relation to infant attachment disorganization in the play session with toys (r = .36, p < .05) and without toys (r = .32, p < .01). These findings suggest a shorter protocol for assessing disrupted caregiving may be feasible and valid for use in community settings. Future studies are in progress to train community practitioners in the use of the AMBIANCE-Brief and to evaluate their reliability.     

Fragile X syndrome: Neural network models of sequencing and memory

A comparative framework of memory processes in males with fragile X syndrome (FXS) and typically developing (TYP) mental age-match children is presented. Results indicate a divergence in sequencing skills, such that males with FXS recall sequences similarly to TYP children around five and a half years of age, but the males with FXS recall significantly worse when compared to TYP children around seven and a half years of age. Performance on one working memory measure, an n-back Card Task, is modeled with a neural network. To date, no network models explicate the sequencing and memory processes in those with FXS. Noise was added to various levels (weight matrices) in the FXS model and outputs approximated human FXS performance. Three models were compared: (1) FXS; (2) younger mental age-TYP matches; (3) older reading level-TYP matches. Modeling can help to reify conceptualizations of deficits and to guide in the creation of more valid, science-based remediations. The FXS model suggested that the levels of phonological representation and sequencing in memory were candidates for targeted therapies in males with FXS.