药物性肝损伤的诊断思维

药物性肝损伤（DILI）是指由于药物或其代谢产物引起的肝脏损害。DILI的诊断尚无金标准,目前国际上比较常用的诊断标准分别从数个不同方面各自进行量化评分,根据得分情况做出诊断。本文归纳DILI的产生机制、诊断标准、临床分型及病理类型,总结推论其临床诊断思维与决策,以供临床医生参考,提高诊断水平。     

急性肾损伤肾脏替代治疗模式的临床决策

急性肾损伤是指病程3个月内的,包括血、尿、组织学及影像学检查所见的肾脏结构与功能异常。目前,急性肾损伤肾脏替代治疗的模式尚无明确定论。常用的模式有间断性血液透析、持续性肾脏替代治疗、杂合式肾脏替代治疗、腹膜透析。临床上应根据患者的年龄、病因、病情危重程度、所在医院的条件和经济状况等选择合适的治疗模式。     

Functional analysis and treatment of inappropriate sexual behavior

The results of a functional analysis showed that inappropriate sexual behaviors exhibited by a 9-year-old boy who had been diagnosed with traumatic brain injury were maintained by positive reinforcement in the form of social attention. An intervention consisting of functional communication training and extinction resulted in reduced levels of inappropriate sexual behaviors.     

心理学视角下的极端膜拜伤害问题

对极端膜拜团体造成身心伤害现象的科学研究, 集中在对极端膜拜伤害的界定、测量和机制三个方面。本文的目的, 是梳理这三个主题上的研究脉络, 明晰其中的争议之处和取得的成绩。文本分析表明, 对极端膜拜伤害的界定从“洗脑”转向了“心理虐待”, 对这类伤害的经验观察由个体症状转向了群体行为和经历的描述, 测量方法由传统心理测试工具变成了新型团体心理虐待量表, 膜拜伤害的心理机制研究在综合环境和个人精神特质两种因素的基础上建立了二者交互的病理模型, 表观遗传学和人际神经生物学用于极端膜拜伤害的生理机制研究已见端倪。但是, 迄今对于极端膜拜伤害的学术研究尚未形成范式。     

彰显道德韧性：应对疫情中的道德创伤

道德韧性是成功应对道德逆境的高尚道德操守。面对新型冠状病毒感染的肺炎疫情,中华民族的道德韧性得以彰显,有效地遏制了道德创伤的发生;但社会个体道德韧性的缺失,也使得部分道德创伤不容忽视,如果任其恣意蔓延必将消解和冲击人们抗击疫情的道德情感和道德意志。抵御疫情中的道德创伤,必须在坚定文化自信中传承道德韧性,在应对道德逆境中塑造道德韧性,在探寻生命意义中升华道德韧性,在领导和权威人士履职尽责中激发道德韧性。     

An examination of muscle force control in individuals with a functionally unstable ankle

Previous studies suggest that functional ankle instability (FAI) may be associated with deficits in the ability to sense muscle forces. We tested individuals with FAI to determine if they have reduced ability to control ankle muscle forces, which is a function of force sense. Our test was performed isometrically to minimize the involvement of joint position sense and kinesthesia. A FAI group and a control group were recruited to perform an ankle force control task using a platform-based ankle robot. They were asked to move a cursor to hit 24 targets as accurately and as fast as possible in a virtual maze. The cursor movement was based on the direction and magnitude of the forces applied to the robot. Participants underwent three conditions: pre-test (baseline), practice (skill acquisition), and post-test (post skill acquisition). The force control ability was quantified based on the accuracy performance during the task. The accuracy performance was negatively associated with the collision count of the cursor with the maze wall. The FAI group showed reduced ability to control ankle muscle forces compared to the control group in the pre-test condition, but the difference became non-significant in the post-test condition after practice. The change in performance before and after practice may be due to different degrees of reliance on force sense.     

Construct validity for the verbal associated pairs screen

The present study introduces the Verbal Associated Pairs Screen (VAPS) as a new measure for assessing performance validity in pediatric populations. This study presents initial data on psychometric properties and establishes construct validity for the VAPS in a sample of 30 adolescent healthy controls and 206 youths with traumatic brain injury (TBI: moderate/severe, N = 30; mild, N = 176). The control group’s age (M = 14.93, SD = 1.8) was significantly higher than the moderate/severe TBI (M = 13.9, SD = 2.8), t(68.508) = ?3.038, p = .003, and mild TBI (mTBI) groups (M = 14, SD = 2.8), t(54.147) = 2.038, p = .046. The TBI groups were administered the VAPS in accord with other established performance validity tests (PVTs) and well-established memory tests as part of routine clinical evaluations. The healthy control group was administered the VAPS only. VAPS score distributions for the control group were negatively skewed and highly kurtotic. VAPS scores from the moderate/severe TBI and control groups were indistinguishable for Trial 2 (U = 274, p < .01) and the Delay (U = 396, p = .218). In the mTBI group, convergent and divergent validity was established with other well-validated PVTs and memory tests, respectively. ROC curve analyses identified optimal cutoff scores for the VAPS Total Score, with acceptable sensitivity (55%) and excellent specificity (100%), as well as strong detectability (AUC = .829, 95% CI: 0.731 – 0.928, p < .001). Clinical applications, limitations, and directions for future research with the VAPS are discussed.     

Moral transgression during the Vietnam War: a path analysis of the psychological impact of veterans’ involvement in wartime atrocities

Background and Objectives: Involvement in wartime combat often conveys a number of deleterious outcomes, including posttraumatic stress disorder (PTSD), depression, hostility, aggression, and suicidal ideation. Less studied is the effect of engagement in wartime atrocities, including witnessing and perpetrating abusive violence.

Design and Methods: This study employed path analysis to examine the direct effects of involvement in wartime atrocities on hostility, aggression, depression, and suicidal ideation independent of combat exposure, as well as the indirect effects via guilt and PTSD symptom severity among 603 help-seeking male Vietnam War veterans.

Results: Involvement in wartime atrocities was predictive of increased guilt, PTSD severity, hostility, aggression, depressive symptoms, and suicidal ideation after controlling for overall combat exposure. Combat-related guilt played a minor role in mediating the effect of atrocity involvement on depression and suicidal ideation. PTSD severity had a larger mediational effect. However, it still accounted for less than half of the total effect of involvement in wartime atrocities on hostility, aggression, and suicidal ideation.

Conclusions: These findings highlight the heightened risk conveyed by involvement in wartime atrocities and suggest that the psychological sequelae experienced following atrocity involvement may extend well beyond guilt and PTSD.     

The hippocampus facilitates integration within a symbolic field

This paper attempts to elaborate a fundamental brain mechanism involved in the creation and maintenance of symbolic fields of thought. It will integrate theories of psychic spaces as explored by Donald Winnicott and Wilfred Bion with the neuroscientific examinations of those with bilateral hippocampal injury to show how evidence from both disciplines sheds important light on this aspect of mind. Possibly originating as a way of maintaining an oriented, first person psychic map, this capacity allows individuals a dynamic narrative access to a realm of layered elements and their connections. If the proposed hypothesis is correct, the hippocampus facilitates the integration of this symbolic field of mind, where narrative forms of thinking, creativity, memory, and dreaming are intertwined. Without the hippocampus, there is an inability to engage many typical forms of thought itself. Also, noting the ways these individuals are not impaired supports theories about other faculties of mind, providing insight into their possible roles within human thought. The evidence of different systems working in conjunction with the symbolic field provides tantalizing clues about these fundamental mechanisms of brain and mind that are normally seamlessly integrated, and hints at future areas of clinical and laboratory research, both within neuroscience and psychoanalysis.     

Subtle Motor Findings During Recovery from Pediatric Traumatic Brain Injury: A Preliminary Report

Pediatric traumatic brain injury (TBI) is a heterogeneous condition, varying in both severity and sequelae. The long-term motor deficits following severe TBI requiring inpatient rehabilitation are better established than those following milder forms of TBI. The authors examined motor performance 2 and 12 months postinjury in children without overt motor impairment using standard measures of upper limb function and the Physical and Neurological Examination for Subtle Signs (PANESS). The PANESS was sensitive to differences between children with TBI and uninjured children as well as to changes in children with TBI over time. These data suggest that subtle motor deficits are present after milder forms of TBI and, particularly those related to balance and gait, may persist even 12 months postinjury.