伊曲康唑并两性霉素B治疗儿童原发性曲霉菌肺炎一例

以郑州大学第一附属医院儿科1例确诊为曲霉菌肺炎惠儿为研究对象,给予伊曲康唑针剂、两性霉素B等治疗。观察患儿临床症状、肺部影像学变化及药物副作用。结果患儿临床症状完全消失,影像学明显好转。提示伊曲康唑治疗儿童曲霉菌肺炎疗效确切,副作用少。     

Procedural learning across the lifespan: A systematic review with implications for atypical development

This systematic review aimed to investigate procedural learning across the lifespan in typical and atypical development. Procedural learning is essential for the development of everyday skills, including language and communication skills. Although procedural learning efficiency has been extensively studied, there is no consensus yet on potential procedural learning changes during development and ageing. Currently, three conflicting models regarding this trajectory exist: (1) a model of age invariance; (2a) a model with a peak in young adulthood; and (2b) a model with a plateau in childhood followed by a decline. The aims of this study were (1) to investigate this debate on procedural learning across the lifespan by systematically reviewing evidence for each model from studies using the serial reaction time task; and (2) to review procedural learning in autism spectrum disorder (ASD) and specific language impairment (SLI), two developmental disorders characterized by deficits in communication skills, in the light of these models. Our findings on typical development strongly support a model of age-related changes (Model 2a or 2b) and show that mixed findings regarding the developmental trajectory during childhood can be explained by methodological differences across studies. Applying these conclusions to systematic reviews of studies of ASD and SLI makes it clear that there is a strong need for the inclusion of multiple age groups in these clinical studies to model procedural learning in atypical development. Clinical implications of the findings are discussed. Future research should focus on the role of declarative learning in both typical and atypical development.     

On the dynamics of work identity in atypical employment: setting out a research agenda

Starting from the notion that work is an important part of who we are, we extend existing theory making on the interplay of work and identity by applying them to (so called) atypical work situations. Without the contextual stability of a permanent organizational position, the question “who one is” will be more difficult to answer. At the same time, a stable occupational identity might provide an even more important orientation to one’s career attitudes and goals in atypical employment situations. So, although atypical employment might pose different challenges on identity, identity can still be a valid concept to assist the understanding of behaviour, attitudes, and well-being in these situations. Our analysis does not attempt to “reinvent” the concept of identity, but will elaborate how existing conceptualizations of identity as being a multiple (albeit perceived as singular), fluid (albeit perceived as stable), and actively forged (as well as passively influenced) construct that can be adapted to understand the effects of atypical employment contexts. Furthermore, we suggest three specific ways to understand the longitudinal dynamics of the interplay between atypical employment and identity over time: passive incremental, active incremental, and transformative change. We conclude with key learning points and outline a few practical recommendations for more research into identity as an explanatory mechanism for the effects of atypical employment situations.     

因果论分析疾病的不典型首发症状

疾病首发症状的不典型是导致误诊误治的重要原因,本文就疾病首发症状的不典型进行哲学分析,通过举例阐述如何在临床上运用因果联系的思维方法识别不典型首发症状,以及因果联系在首发症状不典型病例应用中的注意事项。最后,文章分析了由因果理论得出的病因诊断和对因治疗医疗模式在临床运用中的重要性及其发展前景。     

新冠疫情下过度胜任教师会进行知识共享吗?角色宽度自我效能感和知识共享意愿的链式中介作用

新冠肺炎疫情之下教育部要求教师利用网络平台“停课不停学”。本文以人-环境匹配理论为基础,探讨疫情之下过度胜任教师的知识共享行为。采用126份一线教师问卷调查数据,应用bootstrap进行了中介效应的检验。结果表明,过度胜任感较高的教师会产生更多的知识共享行为; 角色宽度自我效能感和知识共享意愿在过度胜任感影响知识共享行为过程中起中介作用,且角色自我效能感和知识共享意愿还存在链式中介作用。研究成果深化了过度胜任感影响教师知识共享行为作用机制的认识,在重大社会事件下探索过度胜任带来的积极影响,并提出相应的政策建议,为学校教师提升教学水平以更好地完成教育教学目标提供理论和实践依据。     

Indications for the Use of Atypical Antipsychotics in the Elderly

There has been an expanding role for the new generation atypical antipsychotic agents (clozapine, risperidone, olanzapine, and quetiapine) in elderly patients. Their efficacy in the treatment of psychoses associated with schizophrenia is now well established. But psychoses occur in other conditions. This paper will review the current research examining the use of the atypical agents in the treatment of psychoses in the elderly in three somewhat overlapping conditions: schizophrenia, dementia, and Parkinson's disease, as well as in the amelioration of a variety of movement disorders. In the elderly, any of the atypicals can be used to treat schizophrenia, although clozapine may be a second line agent because of its side effect profile. Risperidone may be the drug of choice for the treatment of psychoses and behavioral disturbances in dementia. Clozapine is a primary choice and quetiapine an alternative for the treatment of psychoses in Parkinson's disease; while clozapine and possibly risperidone may be preferred for the initial treatment of some movement disorders. The differential effectiveness of these agents across treatment indications may, in part, be related to their differing affinities at several neurotransmitter receptors. Examination of these relationships in large scale longitudinal studies may help in the development of effective tailored treatments for the elderly.     

肺微小浸润腺癌及浸润前病变HRCT影像特征

为总结肺微小浸润腺癌(MIA)、原位腺癌(AIS)及不典型腺瘤样增生(AAH)结节的HRCT影像特征,回顾性收集43例术前2周内行HRCT检查、经胸腔镜切除、组织病理学证实的50个肺结节,分析结节大小、成分及内部特征.结果显示所有AAH表现为纯磨玻璃结节(pGGN),且≤1.0cm,空气支气管征未见,空泡征少见;86％AIS表现为pGGN,71％的AIS≤1.0cm,且空泡征常见(相对于AAH);95％的MIA表现为混合磨玻璃结节(mGGN),其余为实性结节,90％的MIA＞1.0cm,空气支气管征常见(相对于AIS).因此结节的大小、成分、空泡征及空气支气管征在一定程度上有助于MIA、AIS及AAH的鉴别.     

The use of metaphors in understanding atypical gender identity development and its psychosocial impact

Abstract

Over the years I have found a number of metaphors which have helped me to deal with particular dynamics in therapeutic work or with group and institutional conflicts involving the Gender Identity Development Service at the Tavistock Centre. This nationwide service, which is for young people with atypical gender identity development and their families, was established in 1989. In this paper I describe some of these metaphors in relation to the particular problems or conflicts which had stimulated their appearance in my mind. The emergence of these metaphors links the vicissitudes of atypical gender identity development to issues regarding symbolisation or symbolic thinking. Metaphors such as ‘working at the edge’ or ‘navigating between Scylla and Charybdis’ allow the professional to hold on to multiple perspectives and to maintain a certain degree of ambiguity in situations in which the interpersonal dynamics can be experienced as rigid and deterministic. The emergence of metaphors can then be perceived by the professional with a sense of relief and freedom of thinking. In this paper, metaphors are linked to: the model of care developed; the therapeutic stance; and the aims, risks and pressures experienced by the professional in this area of work. The association between gender dysphoria in some young people and autistic spectrum features is explored. The paper emphasises the importance of responding flexibly to individual differences and of recognising complexity.     

非典型性:后现代医学时代一个特征--非典型肺炎流行引发的一些思考

以非典型肺炎为案例,从后现代思维的角度讨论了现代医学的一些认识论问题和非典型肺炎流行引起恐慌的认识原因;提出了超越现代医学的后现代思维策略。     

ICU患者呼吸道念珠菌是否需要去定植

ICU机械通气患者肺部念珠菌定植较为常见。研究显示呼吸道念珠菌定植可促进机械通气患者呼吸机相关性肺炎（VAP）进展,是VAP患者死亡和多重耐药菌（MDR）产生的独立预测因素,对念珠菌呼吸道定植的VAP患者经验性采用抗真菌治疗可产生有益作用。本文就呼吸道念珠菌是否需要去定植这一热点话题做一聚焦以供临床参考。