镇静与镇痛在ICU机械通气患者中的应用变化

探讨ICU内机械通气患者应用镇痛剂、镇静剂及肌松剂的情况及其对机械通气和预后的影响。回顾性分析我院中心ICU2006年、2007年收治的244例行有创机械通气治疗超过48h患者的临床资料,并将患者分为2006年组和2007年纽,用统计软件分析患者在年龄、性别、入ICU时APACHEⅡ评分、血糖、血浆白蛋白、基础疾病,气管插管时间、机械通气时间、ICU住院天数、镇痛与镇静剂应用的时间、机械通气时是否使用肌松剂、Ramsay评分及病死率方面是否存在差别。统计分析显示2006年组和2007年组在年龄、性剐、入ICU时APACHEⅡ评分、血糖、血浆白蛋白、是否使用肌松剂及基础疾病方面无差别;与2006年组相比2007年组患者气管插管时间、机械通气时间及ICU住院天数均缩短,镇痛与镇静剂应用时间均缩短,Ramsay评分降低,病死率下降。提示对机械通气的危重症患者应合理使用镇痛剂与镇静剂。     

The Bergen left–right discrimination test: practice effects,reliable change indices,and strategic performance in the standard and alternate form with inverted stimuli

Several authors pointed out that left–right discrimination (LRD) tasks may be entangled with differential demands on mental rotation (MR). However, studies considering this interrelationship are rare. To differentially assess LRD of stimuli with varying additional demands on MR, we constructed and evaluated an extended version of the Bergen right–left discrimination (BRLD) test including additional subtests with inverted stickmen stimuli in 174 healthy participants (50♂, 124♀) and measured subjective reports on participants’ strategies to accomplish the task. Moreover, we analyzed practice effects and reliable change indices (RCIs) on BRLD performance, as well as gender differences. Performance significantly differed between subtests with high and low demands on MR with best scores on subtests with low demands on MR. Participants’ subjective strategies corroborate these results: MR was most frequently reported for subtests with highest MR demands (and lowest test performance). Pronounced practice effects were observed for all subtests. Sex differences were not observed. We conclude that our extended version of the BRLD allows for the differentiation between LRD with high and low demands on MR abilities. The type of stimulus materials is likely to be critical for the differential assessment of MR and LRD. Moreover, RCIs provide a basis for the clinical application of the BRLD.     

Mental rotation does not account for sex differences in left-right confusion

Several studies have demonstrated that women believe they are more prone to left-right confusion (LRC) than men. However, while some studies report that there is also a sex difference in LRC tasks favouring men, others report that men and women perform equally well. Recently, it was suggested that sex differences only emerge in LRC tasks when they involve mental rotation. That is, sex differences that are reported for some LRC tasks are strongly affected by the well-documented male advantage in mental rotation. To test this assumption, 91 participants were investigated on two LRC tasks: The Left-Right Commands Task and the Bergen Left-Right Discrimination Test. Additionally, participants were asked to complete an LRC self-rating questionnaire. To rule out the possibility that sex differences in LRC are confounded by sex differences in mental rotation, male and female participants were matched for mental rotation performance, resulting in a sample of 46 matched participants. These matched participants showed robust sex differences in favour of men in all LRC measurements. This suggests that pronounced sex differences in LRC are a genuine phenomenon that exists independently of sex differences in mental rotation.     

王岱舆的“天命有三品”论与儒家的天命观

王岱舆作为明末清初四教（儒、释、道、回）皆通的伊斯兰著名学者,他提出的“天命有三品”论,既适应了当时以儒家为主流文化的背景,也保持了其独特的伊斯兰性,在巧妙地处理与儒家天命观分歧的同时,又开放地拿儒家文化为己所用,从而为两种文明都赢得了宽松的环境,使得两种文明能够共存、共荣、共同发展。本文从王岱舆天命观与儒家天命观的介绍入手,分析其与儒家天命观的契合与分歧。