Stress and Coping: A Comparison of Self-Report Measures of Functioning in Families of Young Children with Cerebral Palsy or No Medical Diagnosis

We analyzed data from 87 mothers of children ages 15 to 44 months with cerebral palsy (CP) or no diagnosis, who completed the Dyadic Adjustment Scale, Parenting Stress Index, Support Functions Scale, and Inventory of Social Support. Principal components analysis of the 15 subscales from the 5 measures revealed few cross-measure loadings. Mothers of children with CP (severe or mild) reported higher levels of parenting stress than did mothers of controls. However, cluster analysis of self-report measures yielded a 5-cluster solution, with no diagnostic group differences across clusters. That is, there were no overall differences in self-reported family functioning according to presence or severity of the child's disability. The results are discussed in terms of the organization of family systems and their relationship to child diagnosis. Clinical implications for assessing and working with families are noted.     

高压氧对小鼠学习记忆及脑细胞形态结构的影响

实验用两种行为模型（旷场行为模型和Ｙ－迷宫分辨学习模型）观察了幼龄小鼠在不同压力的高压氧处理后,对新异环境的探究行为和自发活动情况,以及学习记忆能力的变化;并用ＸＹ－生物医学电脑图像分析仪分析了与学习记忆相关的脑区（大脑皮层、海马）神经元密度,细胞核面积,胞核／胞浆比值的变化。结果表明：（１）与对照组相比,吸０.１ＭＰａ高压氧的幼鼠学习记忆能力明显提高,相关脑区的神经元密度、细胞核面积、胞核／浆比均显著增加。（２）吸０.２５ＭＰａ高压氧的幼鼠学习记忆能力与对照组相比无明显变化,但其在新异环境中的自发行为明显减少。提示：慢性吸入０.１ＭＰａ高压氧有利于促进幼鼠脑的生长发育,增强脑功能活动。     

浅析神经外科中的诊疗思路和思维方式

应该注重培训年轻医生在临床中学会应用哲学思想和思维方式,真正认识事物的本质。这对于诊断、治疗、科研、创新有事半功倍的作用,可避免片面性、盲目性,减少医源性偏差与失误,提高治愈率和生活质量。一般通过三种思维方式即理论、工程及评价思维思考疾病,如蛛网膜下腔出血的病因、临床特点、检查方法、诊疗思路、预后和转归,最终达到预期的疗效。     

直肠间质瘤致下消化道大出血1例报告

胃肠道间质瘤是一种发生于消化道的少见的间叶肿瘤,直肠间质瘤更为罕见,在直肠肿瘤中的发生率0．1％以下。直肠问质瘤的临床表现无特异性,与其他直肠肿瘤相似,随肿瘤逐渐增大可表现为排便习惯改变、便血、排便困难等。临床确定诊断困难。手术治疗是能够治愈直肠问质瘤的唯一方法。格列卫作为一线化疗药物对术前降期及改善预后都有良好疗效。本例患者因下消化道大出血入院,肿瘤近肛缘,术中病理考虑为直肠闻质瘤,完整切除肿瘤后行保肛术。术后应用格列卫,随诊3个月无复发、转移。     

Lower Extremity Kinetics for Balance Control in Children With Cerebral Palsy

The authors examined and compared the effect of support-surface perturbations of various magnitudes on lower extremity kinetics of 7 children with cerebral palsy (CP) and 8 typically developing (TD) children. Results showed that the highest velocity tolerated without stepping was slower in children with CP than in either age-matched TD or younger TD children. Multimodal torque profiles were more frequent in children with CP than in TD controls. TD groups temporally and spatially organized torque activation, whereas children with CP activated all joints simultaneously and showed altered torque contribution patterns among joints. Those results suggest that impairments in reactive postural control in children with CP result not only from developmental delay but also from pathology. Evidence for pathology included increased numbers of torque bursts required to regain stability and less efficient temporal and spatial organization of torque activation patterns.     

Associations of transcranial doppler velocity,age, and gender with cognitive function in children with sickle cell anemia in Nigeria

Children with sickle cell anemia (SCA) have elevated cerebral blood velocity relative to healthy peers. The primary aim of this study was to evaluate the association between cerebral blood velocity, measured by transcranial Doppler (TCD) ultrasound, age, and gender with cognitive function in children with SCA in Nigeria. Eighty-three children (M_age = 9.10, SD = 1.90 years; 55% female) with SCA in Nigeria completed cognitive assessments and a TCD ultrasound. The association between TCD velocity and measures of perceptual reasoning (Raven’s Progressive Matrices), working memory (WISC-IV Digit Span), and executive planning (Tower of London, TOL) were assessed. Results showed that elevated TCD velocity significantly predicted lower scores on TOL Time Violations and Total Problem-Solving Time when controlling for BMI, hemoglobin level, and parent education, suggesting that TCD velocity is related to the efficiency of executive function. Further, age was negatively related to children’s performance on the Ravens Matrices and TOL Total Correct, and boys showed greater deficits on the TOL Total Correct relative to girls. Moderation analyses for gender showed that there was a conditional negative association between TCD velocity and Digit Span for boys, but not for girls. Findings suggest that children with SCA in Nigeria with elevated TCD velocity are at risk for deficits in efficiency of executive planning, and boys with elevated TCD velocity are particularly at increased risk for deficits in auditory working memory. Implications of this study are important for interventions to reduce cerebral blood velocity and the use of TCD in this population.     

高渗氯化钠羟乙基淀粉40注射液对肝肿瘤并高血压患者硬膜外复合全身麻醉诱导期的脑保护作用

观察预注高渗氯化钠羟乙基淀粉40注射液对肝肿瘤合并高血压患者硬膜外复合全身麻醉诱导期的脑保护作用。选择50例患有高血压ASA分级Ⅱ级～Ⅲ级肝肿瘤手术患者,随机分为高渗氯化钠羟乙基淀粉40注射液(H)组和复方氯化钠(复方乳酸林格液R)组,每组25例。于输注前(T0)、输注完毕即刻(T1)、气管插管后即刻(T2)、气管插管后5min(T3)、气管插管后15min(T4)、气管插管后30min(T5)抽取静脉血离心后检测血清中S100B、IL-6、TNF-a的浓度。与T0点相比,H组,T5点S100B轻度降低但无统计学差异(P0.05),IL-6、TNF-a无明显变化(P0.05);R组在T5点S100B明显上升(P0.01);IL-6、TNF-a明显上升(P0.05或P0.01)。与R组相比,H组患者在T3-5时点S100B、IL-6和TNF-a均低(P0.05或P0.01)。结论为预注高渗氯化钠羟乙基淀粉40注射液在肝肿瘤合并高血压患者硬膜外复合全身麻醉诱导期具有脑保护作用。     

动脉瘤性蛛网膜下腔出血的临床诊疗决策

探讨动脉瘤性蛛网膜下腔出血的临床诊疗决策。运用循证医学对动脉瘤性蛛网膜下腔出血早期诊断,及时、合理、有效地选择个性化的治疗方案,降低动脉瘤性蛛网膜下腔出血的病残率和死亡率。     

出血性脑血管病介入治疗进展

出血性脑血管病的介入栓塞治疗由于血管内辅助技术与各种栓塞材料的综合应用取得快速发展,主要有以下三个方面：（1）生物修饰弹簧圈、封堵球囊和支架技术的应用使复杂颅内动脉瘤的介入治疗成为可能;（2）非粘附性液体栓塞剂的应用提高了脑动静脉畸形和硬脑膜动静脉瘘的单纯栓塞治愈率;（3）带膜支架在颅底部巨大动脉瘤和创伤性动静脉瘘取得开创性应用。     

高血压脑出血急诊救治现状与进展

高血压脑出血是指在高血压的情况下发生的脑实质内出血。目前急诊综合救治中内科药物和外科手术治疗为主要的两种方法。内科治疗只适用于轻度脑出血和有手术禁忌证及配合急诊外科手术的综合救治,外科手术多用在中、重度脑出血病人治疗中。近年来开展的一种在CT下三维定位脑内血肿清除术,以其定位准确,脑损伤小,在急诊救治方面取得了一定效果,有待于进一步发展。