双相气道正压无创机械通气上呼吸道影像分析

目的应用多层螺旋CT对患者不同通气状态下上呼吸道放射性成像,证实在全身麻醉无自主呼吸的条件下,双相气道正压(bi-level positive airway pressure,BiPAP)无创机械通气能克服上呼吸道阻力,实施有效的机械通气。方法选择拟实施全身麻醉的择期手术患者10例,分别对患者清醒自主呼吸、麻醉诱导后自主呼吸停止、BiPAP无创通气时头颈部正位和侧位作螺旋CT扫描。监测扫描过程的无创血压(NIBP)、脉搏氧饱和度(SpO2)、心率(HR)、自主呼吸频率(RR)。测量上呼吸道各软组织区(软腭后区RP、舌根后区RG、会厌区EPG)的最窄气道横截面左右径、前后径线长度及相应横截面积。结果头部正位麻醉诱导后各软组织区的最窄横截面左右径、前后径线长度及相应横截面积均比清醒时缩小(P<0.05),BiPAP通气时各截面径线和面积与清醒期比较差异仍有统计学意义(P<0.05,P<0.01)。头部侧位BiPAP通气时各径线和截面积与清醒时比较,差异无统计学意义。EPG区和RG区在BiPAP通气期的侧位截面积明显比正位时增大(P<0.05,P<0.01)。诱导期正、侧位SpO2均明显下降(P<0.01);头部正位BiPAP通气时与诱导期的SpO2比较虽有改善,但差异无统计学意义(P>0.05);头部侧位BiPAP通气时SpO2较诱导期明显升高(P<0.01),基本恢复到清醒期水平(P>0.05)。结论麻醉诱导后上呼吸道的通气面积明显减少,气道通畅度下降;头颈部侧位时上呼吸道各软组织区最狭窄处的通气截面积比正位时显著改善,以会厌区最明显。无明显上呼吸道梗阻性病史的成年患者全身麻醉时,头部侧位BiPAP无创通气能克服上呼吸道阻力,实施有效的机械通气,保证通气和氧合正常。     

Inhaled lodoxamide tromethamine in the treatment of perennial asthma: a double-blind placebo-controlled study

The efficacy of lodoxamide tromethamine in the treatment of asthma was studied in a 16-week double-blind, placebo-controlled study of 68 perennial allergic subjects with asthma. Patients received either lodoxamide tromethamine, 0.25 mg four times daily, or placebo, administered by metered-dose inhaler. Response to treatment was assessed by analyzing changes in asthma symptoms, inhaled bronchodilator requirements, and pulmonary function when compared to a 2-week baseline period. Patients treated with lodoxamide tromethamine demonstrated an improvement in daytime breathing difficulty, cough, sputum production, and sleep (p less than 0.01 to 0.05), but improvement was not significantly different from that demonstrated by placebo-treated patients. Patients from both treatment groups were able to reduce their inhaled bronchodilators (p less than 0.01), but again no significant difference was apparent between lodoxamide tromethamine and placebo treatment, nor were there any differences in peak expiratory flow rate or FEV1 between the two groups. Seven patients who received lodoxamide tromethamine withdrew because of a sensation of heat and gastrointestinal symptoms. Thus, although lodoxamide tromethamine possesses potent mast cell-stabilizing activity in vitro, we have failed to demonstrate any useful long-term effect in the treatment of mild allergic asthma.     

心理弹性(resilience)研究综述

弹性（resilience）日益为心理学界所关注，已经成为心理学的一个重要研究领域。文章追溯了弹性研究的渊源，介绍了众多研究者对于弹性的认识，回顾了弹性领域研究的进展情况，对以往的研究进行了评价，对以后的研究进行了展望。     

基因组序列CGR图形表示的多重分形分析

为了更好地描述基因组序列CGR(chaos-game representation)图形的分形特征,引入多重分形理论进行分析。通过研究3种概率集对标度不变性范围的影响,选取出标度不变性最好的概率集,计算光滑的广义维数谱和多重分形谱。结果表明:以相对概率组成概率集时标度不变性最好,而且标度不变性随尺度变化可被分为3个不同的区域,这反映了基因组序列不同长度的序列片段有不同的分布规律。可见,多重分形方法可以用于描述基因组序列CGR图形的分形特征。     

总责任护士主导的医护一体化护理模式在创伤骨科的应用

目的探讨总责任护士主导的医护一体化临床护理模式在创伤骨科的应用效果。 方法选择2016年7月至2017年6月在南京大学医学院附属鼓楼医院创伤骨科行手术治疗的骨折患者200例，按照入院先后顺序分为对照组90例(实施创伤骨科常规护理)和观察组110例(实施医护一体化工作模式，包括成立医护合作小组、实施总责任护士主导的医护一体化查房、个体化诊疗方案的共同决策、疼痛管理、早期出院计划与延续护理)。比较2组患者的术后护理效果和医护合作满意度。对数据行t检验和χ²检验。 结果总责任护士主导的医护一体化模式下，观察组患者术后72 h内数字评分法(NRS)评分为(4.09±1.64)分，疼痛干预有效率为77.57%，对照组术后72 h内NRS评分为(5.15±1.69)分，疼痛干预有效率为57.95%，2组比较差异均有统计学意义(P值均小于0.05)；观察组下肢深静脉血栓、泌尿系统感染、便秘的发生例数分别为2、1、3，对照组下肢深静脉血栓、泌尿系统感染、便秘的发生例数分别为9、7、11，两组比较差异均有统计学意义(χ²＝4.486、4.296、6.812，P＝0.027、0.036、0.009)。观察组术后康复开始时间为(21.48±6.41)h，术后住院时间为(11.08±2.19)d；对照组术后康复开始时间为(36.48±10.75)h，术后住院时间为(13.95±2.93)d，2组比较差异均有统计学意义(t＝11.670、－7.616，P值均小于0.05)。2组医护合作满意度结果显示，观察组患者信息的交流得分为(3.78±0.85)分，共同参与治疗或护理决策得分为(3.86±0.87)分，医师和护士的关系得分为(4.00±0.84)分，总分为(3.87±0.67)分；对照组患者信息的交流得分为(3.32±1.00)分，共同参与治疗或护理决策得分为(3.23±0.93)分，医师和护士的关系得分为(3.45±0.96)分，总分为(3.33±0.84)分，2组比较差异均有统计学意义(P值均小于0.05)。 结论总责任护士主导的医护一体化护理模式的应用，以亚专科为核心，重新整合医护资源，共同参与制订患者的诊疗护理方案，共同聚焦患者安全与质量，加强了医护间的配合，提高了医疗护理服务质量，提升医护合作满意度。     

Orienting and classical conditioning in the rabbit (Oryctolagus cuniculus): effects of septal area lesions

Rabbits with either sham or septal lesions recieved differential classical conditioning training in which tones of different frequencies served as CSs and paraorbital shock served as the UCS. Eyeblink (EB), EMG, and heart rate (HR) CRs were concommitantly assessed. Free field activity was also studied in selected animals. Animals with septal lesions revealed an impaired EB discrimination which resulted from increased responding to the CS-. These animals showed HR CRs of greater magnitude than sham animals. The HR discrimination was, however, unimpaired by septal lesions. Differential EMG activity also occurred, but was unaffected by septal destruction. Septal lesions resulted in greater free-field activity associated with visual stimulation, but no differences were obtained between septal and sham animals in the dark. It is suggested that these results were due to an enhanced reactivity to environmental stimulation, possibly related to dysfunctions of the orienting reflex.     

Unusual reactions following insect stings. Clinical features and immunologic analysis.

Fifteen patients were studied who had unusual reactions following insect stings. These included serum sickness, neurologic disease, renal disease, and delayed hypersensitivity-type reactions. The clinical features are briefly outlined. Measurements were made of serum venom-specific IgE and IgG antibodies. These antibodies were present in some patients and in these instances suggested an immunologic pathogenesis for the reactions. Alternative etiologies for the unusual reactions are also discussed.     

关于孔子心理学思想的认识

本文根据心理学的基本观点，讨论了孔子的心理学思想，着重讨论了孔子学习心理学思想，普通心理学的思想，社会心理学的思想，建议我们应继承和发扬我国优秀的文化遗产和传统，挖掘其积极价值，促进我国心理学的发展。     

综合性医院冠心病病人抑郁/焦虑现况研究

目的：了解综合性医院冠心病患者抑郁和／或焦虑症状患病率及既往诊治情况。方法：采用现况研究方法，于2004年6月1日到12月1日在北京、上海、广州和成都的7家综合性医院的心内科连续收集确诊的冠心病患者359例。由经培训的调查员用统一的调查表进行面对面调查，同时使用综合医院焦虑抑郁量表（HAD）、Hamilton焦虑量表和Hamilton抑郁量表进行心理测评。结果：冠心病患者的抑郁症状、焦虑症状、抑郁合并焦虑症状以及合计的抑郁和／或焦虑症状患病率分别为19．8％，16．7％，13．6％和22．8％；在具有抑郁和／或焦虑症状的非首诊患者中，冠心病患者既往被诊断为抑郁和／或焦虑障碍和接受抗抑郁和／或焦虑治疗的比例均低于4％：住院患者在本次住院期间的抑郁焦虑诊治率低于1％。结论：综合医院冠心病病人具有较高的抑郁和／或焦虑症状和抑郁和／或焦虑障碍患病率．且既往诊治率较低。     

Studies of the antigenicity and allergenicity of phospholipase A2 of bee venom.

The antigenic and allergenic properties of phospholipase A2 (PLA2) and whole bee venom were compared by measuring the IgG and IgE antibody responses in animals and man. Precipitating antibodies raised in rabbits and reaginic and other antibodies raised in mice reacted about equally with both bee venom and PLA. The majority of human sera containing bee venom-specific IgE also contained PLA-specific IgE, although in somewhat lower titers. Similarly, most human sera with significant amounts of total antibodies reacting with bee venom also had antibodies reacting with PLA. Histamine and SRS-a release from leukocytes of sensitive patients followed challenge with whole bee venom and PLA in the majority of instances. However, mediator release from several patients' cells was obtained with bee venom only. These studies suggest that although PLA is a major allergen and antigen in bee venom, significant exceptions in patients' reactivity may limit its potential diagnostic and therapeutic usefulness.