卡托普利异氟醚联合预处理对心脏瓣膜置换术患者的心肌保护作用

探讨卡托普利与畀氟醚联合预处理对心肌缺血再灌注损伤的保护作用。选择100例瓣膜置换术患者分为五组,分别给以不同的药物预处理。观察各组心肌酶、心肌蛋白、炎症因子的变化,以及心脏复跳率和血管活性药物使用。结果显示,卡托普利与异氟醚联合处理组的心肌酶、心肌蛋白、炎症因子以及心脏复跳率和血管活性药物用量与其他三组相比有显著性差异（P〈0．05）。认为卡托普利延迟相或早期相复合异氟醚预处理对心脏瓣膜置换术患者的心肌缺血再灌注损伤均具有更强保护作用,并以卡托普利延迟相组为优。     

Working memory outcomes following traumatic brain injury in children: A systematic review with meta-analysis

The aim of this review is to systematically examine the literature concerning multicomponent working memory (WM)—comprising a central executive (CE), two storage components (phonological loop, PL and visuo-spatial sketchpad, VSSP), and episodic buffer (EB)—in pediatric traumatic brain injury (TBI). Electronic searches were conducted of MEDLINE, PsychINFO and EMBASE up to October 2014 with the inclusion criteria of children and adolescents with TBI, and quantitative methods to assess at least one component of WM. Meta-analytic procedures calculated pooled effect sizes for WM outcomes. Of the studies examined, 27 met the inclusion criteria. Children with TBI exhibited deficits in the CE and PL, but not in the VSSP, and no study could be found which examined the EB. Qualitative analysis found that greater TBI severity was associated with poorer CE functioning in five out of nine studies. Differences in patterns of brain activation were evident in four out of five fMRI studies that examined WM in TBI children and controls. Deficits in CE were associated with poorer mathematical skills in the only study that examined relations between WM and academic deficits. Notwithstanding the heterogeneity of the studies reviewed, TBI places children at risk of WM deficits. Moreover, this meta-analysis suggests that various components of WM have differential vulnerability to pediatric TBI, with significant deficits found in the CE and PL, but not in the VSSP (although the VSSP has rarely been examined to date). Future studies should be theoretically driven, employ tasks assessing all components of the WM model and examine the functional ramifications (including academic outcomes) of WM deficits in this population.     

Correcting Misperceptions About Cognitive Processing Therapy to Treat Moral Injury: A Response to Gray and Colleagues (this issue)

We respond to the commentary by Gray, Nash, and Litz (this issue) regarding the use of cognitive processing therapy (CPT) to address moral injury as described in our previous publication (Wachen et al., 2016). In their commentary, Gray et al. posit that CPT is inappropriate when applied to the treatment of war-related traumas involving “real moral and ethical transgressions” (i.e., moral injuries). However, Gray and colleagues’ assertions are centered on a premise that is incorrect, namely that CPT is based on the idea that “self-blame and guilt are inherently illogical or inaccurate,” and that CPT assumes that all beliefs associated with moral injury are erroneous. On the contrary, we acknowledge that self-blame and guilt may be accurate responses to warzone trauma, yet disagree that CPT is not suitable in these situations. This response serves to clarify some of the inaccurate interpretations of the treatment as stated by Gray and colleagues, and reiterates the position of CPT on many of the issues that were raised. Specifically, we discuss the use of Socratic questioning within CPT to address the issue of moral injury. Furthermore, we highlight the strong evidence base for the use of CPT in treating veterans and active military. Until it has been determined through empirical study, it is premature to assert that CPT is insufficient in addressing moral injury in combat personnel.     

Understanding injuries in sports: Self-reported injury and perceived risk of injury among adolescents

IntroductionAlthough exposure and perceived risk of injury in sports among adolescents is a well-known phenomenon today, their understanding remains poorly explored.ObjectiveThis study examines the relationships between demographics, sport motives, and sport-related characteristics in a sample of French adolescents involved in sports.MethodsThe sample included 394 adolescents involved in sports, between 13 and 19 years old. The adolescents filled out a questionnaire requesting information about their age, sex, sport motives, sport-related characteristics, the number of injuries, and perceived risk of injury in their preferred sport.ResultsThe findings showed that the number of injuries was related to age, sex, type of sport and the participant's motives. The will to play to the limit increased with the exposure to injury. Participation in risky sports and the will to play to the limit were predictors of the adolescents’ risk of exposure to sports injuries. Time devoted to sports appears to be a confounding factor. Moreover, boys exhibited higher number of injuries than girls, and they perceived their preferred sport as riskier.ConclusionExposure to the risk of injury in sports and the exacerbated perception of that risk may provide a means of enhancing one's self-image, procuring an emotional experience, and constructing one's masculinity.     

A Narrative Inquiry into a Female Athlete’s Experiences with Protracted Concussion Symptoms

This article explores a female university volleyball student-athlete’s experience with protracted concussion symptoms. Through the methodology of narrative inquiry, four salient themes became apparent related to Daphnée’s experiences: (a) “I felt so alone,” (b) “I had to make one of the hardest decisions of my life,” (c) “I feel like I’m in prison,” and (d) “There’s no light at the end of the tunnel.” Overall, this study offers a rare look into the impact of concussion on an individual’s athletic and academic identities, career progression, and in turn, her imagined stories of who she was and who she was becoming.     

Motor imagery in spinal cord injured people is modulated by somatotopic coding,perspective taking,and post‐lesional chronic pain

Motor imagery (MI) allows one to mentally represent an action without necessarily performing it. Importantly, however, MI is profoundly influenced by the ability to actually execute actions, as demonstrated by the impairment of this ability as a consequence of lesions in motor cortices, limb amputations, movement limiting chronic pain, and spinal cord injury. Understanding MI and its deficits in patients with motor limitations is fundamentally important as development of some brain–computer interfaces and daily life strategies for coping with motor disorders are based on this ability. We explored MI in a large sample of patients with spinal cord injury (SCI) using a comprehensive battery of questionnaires to assess the ability to imagine actions from a first‐person or a third‐person perspective and also imagine the proprioceptive components of actions. Moreover, we correlated MI skills with personality measures and clinical variables such as the level and completeness of the lesion and the presence of chronic pain. We found that the MI deficits (1) concerned the body parts affected by deafferentation and deefferentation, (2) were present in first‐ but not in third‐person perspectives, and (3) were more altered in the presence of chronic pain. MI is thus closely related to bodily perceptions and representations. Every attempt to devise tools and trainings aimed at improving autonomy needs to consider the cognitive changes due to the body–brain disconnection.     

亲体肝移植的伦理学问题探讨

目前,肝移植已成为治疗终末期肝病的有效手段。活体肝移植术部分解决了供肝短缺的问题,10多年来其发展迅速,并取得了良好的疗效。由于活体肝移植需从活的供体身上切取部分肝脏,且供体多为患者家属,故存在着供体的选择、供体的贡献与代价,患者的家庭、心理、社会等伦理学问题。因此在提高活体肝移植技术水平的同时,必须充分考虑活体肝移植的伦理学问题,遵守伦理原则,使活体肝移植不但能从技术上达到,在伦理学方面也是可行的。     

浅谈脂肪肝的诊治策略

脂肪肝已成为威胁国人健康仅次于病毒性肝炎的第二大肝病。通过对脂肪肝发病机制、发病原因、诊断方法和防治措施的深入研究,能够确定行之有效的诊治策略。针对病因和(或)诱因进行预防,走出在脂肪肝治疗上的误区,对遏制脂肪肝的日益严重的发病趋势和降低医疗费用有着十分重要的意义。     

原位肝移植术后细菌感染的防治策略

分析79例原位肝移植的临床资料,对感染部位、常见致病菌、导致细菌感染的危险因素进行分析。全组32例发生细菌感染,感染部位以肺部、腹腔多见。恢复饮食时间延长,术前肝功能C级、低蛋白血症、高血糖是感染的危险因素,肠道去污治疗是保护性因素。结论是尽可能的减少各种危险因素,有效的预防及早期确诊和治疗是防治细菌感染的关键。     

防范儿童意外伤害的人文策略

意外伤害是危害儿童健康的主要因素,虽然其发生具有一定的随机性和不可预料性,但仍然是可防、可控的;在掌握了儿童意外伤害的流行特征之后,我们可以采取一系列具有人文策略的干预措施,来增加儿童及家长的依从性,从而降低致残率和致死率;有关儿童意外伤害的研究工作还存在一些问题。