肝硬化门脉高压症断流术后感染的防治策略

肝硬化门脉高压症断流术后感染的防治策略可概括为:增强机体免疫力,重视无菌操作,预防性使用抗生素,积极治疗出现的感染。常见术后感染包括:膈下积液、脓肿,自发性腹膜炎(SBP)或腹水感染,门静脉血栓性静脉炎,切口及其他部位感染,真菌感染,脾切除术后爆发性感染和脾热。     

Glimmers of the infinite: The tragedy of moral injury

Moral injury is a complex wound of the soul affecting many veterans returning from combat. One dimension of moral injury is the shattering of faith, in which service members invest their all into a cause in hope for ultimate fulfillment, only to be morally disappointed by the gruesome reality of warfare. This article will explore the transcendent values that attract service members to military service, and the shattering of faith that can happen during combat, and then suggest an approach for church members to support veterans as they journey on the path to regaining their faith and healing their soul.     

The Role of Political Practices in Moral Injury: A Study of Afghanistan Veterans

While much research has been conducted on military trauma, conceptualizations of deployment‐related suffering have been predominantly approached through a medical, individual‐focused lens. Since the military is an instrument of the state, it is crucial to expand the conceptual scope to include political processes, particularly for the fast‐growing literature on “moral injury,” which refers to the emotional impact of perpetrating, witnessing, or falling victim to perceived wrongdoing. This article examines the role of political practices in the onset of moral injury as well as the micropolitical responses of morally injured veterans. A study of the Dutch mission in Uruzgan, Afghanistan, shows that decisions and frames at the political level helped create distressing quandaries on the ground and that in all the ways the political leadership acknowledged the problems that veterans subsequently developed, it also maintained a silence on its direct contribution to these problems, as such perpetuating them. Consequently, veterans tried to make the political leadership take a material and symbolic share in their burden. Clearly, moral conflict may exist both in the veteran and between the veteran and the political domain, and therefore, experiences of institutional betrayal and a resultant search for reparations should be included in theory on moral injury.     

Anticipating ankle inversion perturbations during a single-leg drop landing alters ankle joint and impact kinetics

Anticipatory responses to inversion perturbations can prevent an accurate assessment of lateral ankle sprain mechanics when using injury simulations. Despite recent evidence of the anticipatory motor control strategies utilized during inversion perturbations, kinetic compensations during anticipated inversion perturbations are currently unknown. The purpose of this investigation was to examine the influence of anticipation to an inversion perturbation during a single-leg drop landing on ankle joint and impact kinetics. Fifteen young adults with no lateral ankle sprain history completed unanticipated and anticipated single-leg drop landings onto a 25° laterally inclined platform from a height of 30 cm. One-dimensional statistical parametric mapping (SPM) was used to analyze net ankle moments and ground reaction forces (GRF) during the first 150 ms post-landing, while peak GRFs, time to peak GRF, peak and average loading rates were compared using a dependent samples t-test (p ≤ 0.05). Results from the SPM analysis revealed significantly greater plantar flexion moment from 58 to 83 ms post-landing (p = 0.004; d = 0.64–0.77), inversion moment from 89 to 91 ms post-landing (p = 0.050; d = 0.58–0.60), and medial GRF from 62 to 97 ms post-landing (p < 0.001; d = 1.00–2.39) during the unanticipated landing condition. Moreover, significantly greater peak plantarflexion (p < 0.001; d = 1.10) and peak inversion moment (p = 0.007; d = 0.94), as well as greater peak (p = 0.002; d = 1.03) and average (p = 0.042; d = 0.66) medial loading rates, were found during the unanticipated landing condition. Our findings suggest alterations to ankle joint and impact kinetics occur during a single-leg drop landing when inversion perturbations are anticipated. Researchers and practitioners using drop-landings onto a tilted surface to assess lateral ankle sprain injury risk should consider implementing protocols that mitigate anticipatory responses.     

Restoring More than Smiles in Broken Homes: Dental and Oral Biomarkers of Brain Injury in Domestic Violence

ABSTRACT

While much of the focus on brain injury has centered on athletes and military veterans, victims of domestic violence (DV) comprise an under-represented cohort. Epidemiological studies show that a majority of domestic violence cases have a history of trauma to the head or neck resulting in both TBI and oral maxillofacial damage. However, distinctive oral injuries that are sustained simultaneously with brain trauma as a result of DV have yet to be fully elucidated. If a correlation can be made between specific oral injuries and TBI, then dentition may serve as a reliable biomarker for TBI. Specific dental biomarkers of injury would improve identification, diagnosis, and prognosis of TBI regardless of patient declamation. Dentists have the opportunity and obligation to add significantly to the body of knowledge regarding the frequency, presentation, profile, and characteristics of head and neck injuries of TBI in victims of DV. In so doing, the effort will fill the knowledge gaps and clarify misinformation in the lay, clinical, and scientific communities regarding the impact of TBI in DV events. The dental field can become a leader in branding the procedures, protocols, and clinical practices in the recognition and intervention against TBI in the DV population.     

Moral injury,coherence, and spiritual repair

In the PTSD literature, moral injury represents dissonance between a person’s beliefs about how they and the world should function, and the trauma event(s) they experienced. Given the association of moral injury with the assumptive world, it is not surprising the concept is closely intertwined with spiritual concerns. This paper reports on a spiritually integrated group intervention designed to help veterans with PTSD in the process of moral and spiritual repair. Qualitative findings are shared from interviews conducted with 18 participants who completed the intervention. Themes are centred around participants’ overall response to their experience in the group; where they are at regarding feelings such as guilt, shame, anger, trust, sense of betrayal, and desire for forgiveness; changes in religious/spiritual beliefs and practices and the experience of moral injury; and if they now find meaning in the trauma. The findings support the need for additional treatment options that address the moral and spiritual aspects of trauma.     

A New Theological Anthropology for Developing Resiliency and Healing from Combat*

Moral injury is a complex wound of the soul affecting many veterans returning from combat. This article will propose that a blended theological anthropology, which incorporates Irenaeus’s understanding of spiritual growth and Augustine’s focus on individual accountability and sin, will better foster healing and growth from morally traumatic experiences. In order to do so, I will introduce elements of the psychological paradigm of posttraumatic growth with a theological anthropology I develop in order to propose a mindset which I believe will increase resiliency to the morally challenging environment of combat.     

Nonsuicidal Self‐Injury,Stress, and Self‐Differentiation

The authors surveyed 458 young adults and examined the relationships among stress, self‐differentiation, and nonsuicidal self‐injury (NSSI). They conducted multiple regression analyses to explore whether characteristics of self‐differentiation (i.e., emotional reactivity and “I position”) were related to NSSI after controlling for the effects of stress, as well as whether emotional reactivity and I position served as mediators in the stress–NSSI relationship. I position and emotional reactivity both contributed statistically significant variance to NSSI after accounting for stress. Moreover, both I position and emotional reactivity served as partial mediators in the stress–NSSI relationship. The authors discuss counseling and research implications.     

Predictive factors of quality of life in acquired brain injury

Background/ObjectiveThe sequelae and the disability and dependence that follow an acquired brain injury (ABI) may result in a significant reduction in the quality of life (QoL) of those affected. The objective was to assess the QoL of a sample of Spanish patients with an ABI and analyze the influence of certain sociodemographic and injury-related variables on their QoL. Method: The sample comprised 421 adults (60% male; M_age = 53.12; SD = 14.87). Professionals and relatives assessed the patients’ QoL through the CAVIDACE scale, an ABI-specific tool based on the eight-domain QoL model. Results: Univariate analyses showed statistically significant differences in the QoL scores in several sociodemographic (age, civil status, education level, prior employment status, type of home, level of supports, loss of legal capacity, recognized dependence, and degree of dependence) and injury-related (time since the injury, location of the injury, and presence of post-traumatic amnesia) variables. The multiple linear regression showed that loss of legal capacity, time since the injury, prior employment status, location of the injury, and degree of dependence were significant QoL predictors. Conclusions: These findings provide knowledge for the development of programs aimed at reducing the negative impact of ABI on QoL.     

Neurotherapy with Adults

Several possible conceptualizations of neurotherapy are discussed: EEG operant conditioning; EEG homeostatic normalization; and utilization of EEG biofeedback as a means of accessing particular states of consciousness. Attention is given to how neurotherapy is actually done and when it may be a useful adjunct to psychological or medical therapies. Integration of neurotherapy with the larger framework of cognitive behavior therapy and the biopsychosocial model is discussed. Three case studies of adults involving the use of neurotherapy are described.