1例妊娠合并急性白血病患者带来的分析与思考

通过对1例妊娠合并急性白血病患者的病例资料进行回顾分析,从孕期化疗的特点来探讨其终止妊娠及进一步化疗治疗的时机与方式,以及从该患者治疗和妊娠之间的矛盾来讨论医生在母体和婴儿生存权益的重要性,总结出医护人员的人性化与职责,深入伦理学思考临床医生对类似患者的最佳治疗应该作出的判定与决策,从而有利于构建和谐社会。     

非ST段抬高急性冠脉综合征药物治疗规范化分析

回顾性分析我院收治的129例非ST段抬高急性冠脉综合征患者的临床资料。对比在非ST段抬高急性冠脉综合征诊治上与最新指南的差距,找出改进措施。结果表明我院的临床实践与最新指南存在较大差距,在强化抗栓,调脂治疗,B受体阻滞剂及血管紧张素转换酶抑制荆类药物使用上均有待提高。今后应采取更加积极的措施,规范用药,以达到更好的预后和转归效果。     

急性应激障碍（ASD）研究述评

急性应激障碍是个体在亲历、目击或面临一个对自己或他人具有死亡威胁、严重伤害的创伤事件后的2天至4周内所表现的应激反应。急性应激障碍的症状主要表现为分离、再历、回避和过度警觉。文章回顾了以往的相关研究,从急性应激障碍的测评方法、发生率、与创伤后应激障碍和创伤记忆的关系、心理治疗和干预等方面进行了综述。最后对未来可能的研究方向提出了展望     

THE IMPACT OF FUNCTIONAL ANALYSIS METHODOLOGY ON OUTPATIENT CLINIC SERVICES

The impact of the article by Iwata, Dorsey, Slifer, Bauman, and Richman (1982) on research in severe behavior disorders has been impressive. Equally impressive, however, but not as fully recognized, has been the impact of this methodology on the routine professional activities of those who employ functional analysis methods in their daily work. As one example of this impact, we describe the evolution of assessment procedures based on “brief functional analysis” methodology in our outpatient clinics. Less apparent have been the collateral effects that occur from using these procedures. Interactions with clients and colleagues have changed in ways that result in increased positive reinforcement. In this article, we briefly discuss the positive impact functional analysis has had on one specific work behavior—outpatient clinic assessment—and describe some of the generalized effects we have experienced in related aspects of our daily professional activities.     

Gender differences in acute and chronic stress in Wistar Kyoto (WKY) rats

While females are considered more susceptible to depressive behavior, this assertion is not strongly supported by the experimental literature. Since stress contributes to depressive behavior, male and female Wistar Kyoto (WKY) rats were exposed to either one session (acute stress) or 5 sessions (chronic stress) of restraint plus cold in order to study depressive behavior in male and female rats. After their respective treatment exposure, rats were tested in the open field test (OFT) and for retention of a passive-avoidance (P-A) task. One stress session resulted in significant immobility in the OFT for males, whereas 5 sessions were required to produce similar immobility in female rats. Acute stress interfered with the retention of the P-A response for males, while both acute and chronic stress produced poor P-A responses in female rats. Food consumption decresed, progressively, as a function of stress sessions, in female rats, whereas feeding in males returned to control levels after five stress days. Both acute and chronic stress exacerbated the stress ulcer response in male rats, but not in female rats. Chronic, but not acute, stress resulted in an increase in serotonin transporter mRNA levels in the dorsal raphe nucleus of both male and, female rats. The general consensus from these data suggested that female rats were more vulnerable to chronic stress and consequently supported the notion that females may be more susceptible to stress induced behavioral depression.     

Stress and coping in mothers caring for a child with severe learning difficulties: A test of Lazarus' transactional model of coping

The literature on psychological stress among women consistently points to the adverse effects of child rearing on mothers, particularly those caring for children with physical or mental handicaps. Early studies of the effects on family functioning of caring for a child with severe learning difficulties adopted a pathological approach in which it was assumed that psychological distress was inevitable among family members, particularly mothers. Recent research has emphasised that many families cope with and adapt to the stress they experience, and seeks to discover how they do so. The paper reports on a study of 166 mothers caring for a child with severe learning difficulties. The aim of the study was to investigate both the factors associated with maternal stress and those which might mediate or buffer the effects of stress. The study used the Folkman and Lazarus' (1979) transactional model of stress. Stress is the condition that results when person/environment transactions lead the individual to perceive a discrepancy between the demands of a situation and his/her resources or ability to cope with those demands. The nature and type of coping generated by a person will be determined by the coping resources in the person's environment. The model identifies five categories of coping resource: utilitarian resources, health/morale, social networks, general and specific beliefs, and problem solving skills. In our study, the five coping resources were represented by the mother's social class and appraisal of her financial worries, physical health, social support, acceptance of and adjustment to the child, and assessment of coping skills. Stress was measured by the Malaise Inventory (Rutter, 1970). Four of the five coping resources were found to be significant contributors in a hierarchical regression analysis of stress scores, contributing additional variance beyond that of behavioural and other child characteristics. Altogether, 55% of the variance in stress scores was explained.     

Adult Influence on the Participation of Peers Without Disabilities in Peer Support Programs

Three peers without disabilities who volunteered to serve as peer supports and were identified by general education teachers as having academic difficulties were studied across three conditions. In baseline, a peer without disabilities worked alone, while the student with severe disabilities was supervised by an adult. In the Peer Support condition, peers without disabilities worked with the student with severe disabilities, and both individuals were supervised by an adult. In the Adult Involvement condition, peers without disabilities were supervised by an adult as in the Peer Support condition, but peers worked separately from the student with severe disabilities. Dependent measures included the active engagement of peers without disabilities and students with severe disabilities, and social interactions between students and peers. Our data indicate that the Peer Support and Adult Involvement conditions resulted in higher, but similar, levels of active engagement for two of three peers without disabilities when compared to baseline. For the third peer, high levels of active engagement occurred across all conditions. Active engagement varied across students with severe disabilities, but was typically highest in conditions where peers without disabilities were involved. For all students with severe disabilities, social interactions were more frequent and longer in the Peer Support condition.     

突发公共卫生事件下心境障碍的特点与应对

突发公共卫生事件会给较大范围的人群造成相当的心理压力和情绪问题。突发事件发生时,社会心理因素对突发事件控制效果和进程的影响越来越显著,因疫情、疾病、生活、工作以及社会和人际关系等因素而致的情绪问题非常突出。突发事件时情绪问题的表现有疑病、恐慌、焦虑、抑郁和强迫心理等,对此应采取相应的对策,而不同群体如罹患人群、隔离人群、家属、普通就医者及一般公众的情绪问题有其独特的表现和应对措施。突发事件为情绪问题的研究提供了广阔的前景。     

急性情绪应激对大鼠行为和脑神经颗粒素磷酸化水平的影响

为探讨急性情绪应激对大鼠旷场行为的影响,以及脑神经颗粒素（Neuroganin,NG）变化与应激性行为效应之间的相互关系。以急性不确定性空瓶刺激,建立情绪应激动物模型。将40只雄性SD大鼠随机分为情绪应激组1（ES1,接受情绪应激和旷场测试）、情绪应激组2（ES2,只接受情绪应激）、正常对照组1（C1,无情绪应激,但接受旷场测试）和正常对照组（C2,无情绪应激,也无旷场测试）（n=10）。以旷场行为和高架十字迷宫任务来评定大鼠应激后的行为变化,Western印迹杂交法（Western blotting）测定海马和前脑皮层中的NG含量和磷酸化水平。结果表明：（1） 应激后ES1组的水平活动增加,与C1组比较,差异有显著性, p<0.01;（2）ES1组海马和前脑皮层的NG磷酸化水平高于C1和C2组,差异有显著性, 均为p<0.05; ES2组的前脑皮层NG的磷酸化水平高于C1组,差异有显著性,为p<0.05;（3） 海马的NG磷酸化水平与水平活动之间的相关达显著水平。提示急性情绪应激能导致动物明显的行为改变如焦虑,这种行为改变可能与脑内NG磷酸化水平的变化有关。水平活动可能是反映急性情绪应激的较敏感行为指标,海马NG磷酸化水平可能是预测急性情绪应激所致焦虑或抑郁行为的较敏感生物学指标