心理危机评估与干预软件的研制与测试

目的评估心理危机中自杀的危险程度,为基层心理医生预防自杀提供实用和有效的辅助软件。方法研制由4个国际通用的自杀评估量表和1个自杀行为观察他评量表模块构成的心理危机评估体系,并设有1项干预模块引导使用者进行专业干预。结果软件能快速给出测评结果并自动显示危险程度和处理意见;对超过中等危险度的数据,能给予屏显和声响2种方式报警。经对680名大学生进行自杀意念筛选,有较高的特异性。对30例有自杀意念者进行测评表明,自评量表评分与他评量表中相对应因子分呈明显正相关,r为0.55~0.72(P0.05,P0.01)。对113例心理疾病患者进行测评,软件测评的自杀意念阳性率为53.5%,明显高于访谈测评结果(34.5%)(P0.01)。结论软件设计合理,可以对自杀意念作出较准确的评估,对专业化开展心理危机干预有较大帮助。     

暴露疗法在下肢损伤皮瓣转移术后患者创面护理中的应用

目的：探讨暴露疗法在下肢损伤伴组织缺损行皮瓣转移修复术后创面护理中的应用效果。方法选择2012年1—8月住院行下肢损伤伴组织缺损皮瓣转移修复术,术后创面采用传统纱布包扎疗法的43例患者为对照组;选择2012年9月—2013年4月住院行下肢损伤伴组织缺损皮瓣转移修复术,创面于术后6～8 h拆除包扎敷料采用暴露疗法的42例患者为观察组。观察两组患者术后转移皮瓣的血液循环、皮瓣存活率、创面感染及医疗成本4方面指标,评价创面包扎疗法和暴露疗法的应用效果。结果术后,观察组患者的转移皮瓣肤色、肿胀、充盈度情况均优于对照组,差异有统计学意义（Z值分别为5．63,6．47,6．48;P＜0．01）。观察组患者转移皮瓣皮温正常率、皮瓣存活率分别为83．33％和97．62％,均高于对照组,差异有统计学意义（χ2值分别为7．40,5．91;P＜0．05）。观察组的创面感染率低于对照组,差异有统计学意义（ Z＝5．29,P＜0．01）。两组患者医疗成本比较,观察组的住院天数、换药次数、护理工时均低于对照组,差异有统计学意义（ t值分别为2．44,32．78,22．44;P＜0．05）。结论下肢损伤伴组织缺损行皮瓣转移修复术后创面护理实施暴露疗法,能有效降低创面感染的发生率,便于及时观察转移皮瓣的血液循环,并能早期发现转移皮瓣血管危象的征象,提高皮瓣的存活率。     

An Extension and Moderational Analysis of the Family Stress Model Focusing on African American Adolescents

This study focuses on 422 African American families with two caregivers as children transition into adolescence. The family stress model was tested longitudinally using structural equation modeling. Results showed that economic stress was associated with economic pressure and depressive symptoms among caregivers, which in turn was related to caregiver conflict. Higher levels of conflict had a negative influence on parenting quality at Wave 2, and this was linked to adolescent functioning. The depressive symptomology of secondary caregivers (SCs) exerted a greater indirect effect in the models than that of primary caregivers (PCs) and had a direct relationship to adolescent's positive adjustment. Moderational effects of caregiver conflict on the link between economic pressure/adolescent outcomes and economic pressure/hostile parenting were also tested. The case for the importance of including PCs and SCs of children and adolescents in future research focusing on African American families facing economic hardship is made.     

Single serum cortisol values at 09:00 h can be indices of adrenocortical function in children with Kawasaki disease treated with intravenous immunoglobulin plus prednisolone

Combination treatment with intravenous immunoglobulin (IVIG) plus prednisolone is effective for prevention of cardiovascular complications in children with Kawasaki disease (KD). However, administration of prednisolone for approximately 20 d in this regimen causes adrenocortical suppression in a high proportion of treated children. To establish a simple method to screen for this suppression, we performed a prospective study on 72 children with KD treated with this regimen in our institution from February 2012 to March 2014. By performing ROC analysis of 21 initial patients treated between February and June 2012, a serum cortisol value at 09:00 h of 5 mcg/dL was established as a threshold for intact adrenocortical function, which is equivalent to a peak serum cortisol value of higher than 15 mcg/dL in the CRH stimulation test. Then, we applied this screening test to 51 subsequent patients treated between July 2012 and March 2014. Approximately 90% of the patients with morning serum cortisol values above 5 mcg/dL 2 to 6 mo after the cessation of initial prednisolone treatment had peak serum cortisol values exceeding 15 mcg/dL, suggesting the efficacy of this approach.     

因预防接种诱发急性脑病的甲基丙二酸尿症cblA型一例

目的 报道1例因预防接种诱发急性脑病的中国甲基丙二酸尿症的cblA型病例.方法 就病例临床、血液酯酰肉碱谱、尿有机酸、甲基丙二酸尿症相关基因等特点进行分析.结果 患儿男,1岁3个月时因“间断呕吐、酸中毒、发育落后8个月”就诊.患儿生后7个月内发育正常,7个月时接种乙肝疫苗后lh出现呕吐、昏迷.临床诊断“中度脱水,电解质紊乱,代谢性酸中毒”,经补液等治疗后好转.此后,患儿发育落后,间断呕吐.1岁3个月时接种百白破疫苗,接种3h后再次出现呕吐,嗜睡,静脉补液后未见好转,7d后喘憋、呼吸困难、昏迷.患儿血液丙酰肉碱16.3μmol/L(参考值1.0 ～ 5.0μmol/L)、丙酰肉碱/游离肉碱0.27(参考值0.03 ～0.25)增高,尿甲基丙二酸(388.21 mmol/mol肌酐,参考值0.2～3.6 mmol/mol肌酐)及其代谢产物浓度显著增高,血浆总同型半胱氨酸浓度正常,符合单纯型甲基丙二酸血症,MMAA基因存在c.650 T＞A(p.L217X)和c.742 C＞T(p.Q248X)复合杂合突变,确诊为cblA型.经羟钴铵肌内注射、左卡尼汀、低蛋白饮食及特殊配方奶粉治疗后,患儿病情逐渐好转.患儿现2岁7个月,智力运动正常.结论 报道我国首例因预防接种诱发急性脑病的cblA型甲基丙二酸尿症.对疑似遗传代谢病患儿,预防接种前的代谢筛查是减少意外的关键.     

重视容易被误诊的内分泌疾病

内分泌疾病常导致多个系统器官功能异常，可首诊于医院各科室，由于缺乏特异性临床症状，使得相关疾病诊断过程疑难，易于误诊。但是，一些疾病有迹可循，误诊是可以减少或避免的。如糖尿病酮症酸中毒、甲状腺功能减退症、肾上腺皮质功能减退症，在平时多积累、多学习，在接诊患儿时认真询问病史、全面细致地查体以便发现蛛丝马迹，在进行鉴别诊断时仔细严密推理，不迷信实验室检查检查结果，注重整体而非局部，将有助于减少表现为普通常见症状的内分泌疾病误诊率。     

新型冠状病毒肺炎心理危机与中医药干预策略

新型冠状病毒肺炎(简称新冠肺炎)作为突发公共卫生安全事件,在给人民群众和医务人员造成机体生理损害的同时,也给心理平衡造成了一定的刺激。突发事件的心理危机包括急性应激障碍(ASD)和创伤后应激障碍(PTSD),对其进行干预是十分必要的。中医药对新冠肺炎造成的心理危机能够起到一定的干预作用。文章就突发事件后的心理危机发生机制以及中医药的干预措施及进展进行简述,希冀能够为临床治疗此类病证提供依据。     

How Much Drool Is Too Much?

A 3-year-old boy presented to the emergency department with a chief complaint of “lethargy” and was found to have ptosis with eventual respiratory failure and need for emergent intubation. There is a broad differential for a patient with respiratory failure, and careful physical examination and history are imperative to reduce morbidity and prevent mortality. After further evaluation and workup, the diagnosis is ultimately revealed.     

Hypothalamic insulin and glucagon-like peptide-1 levels in an animal model of depression and their effect on corticotropin-releasing hormone promoter gene activity in a hypothalamic cell line

Background

In depression, excessive glucocorticoid action may cause maladaptive brain changes, including in the pathways controlling energy metabolism. Insulin and glucagon-like peptide-1 (GLP-1), besides regulation of glucose homeostasis, also possess neurotrophic properties. Current study was aimed at investigating the influence of prenatal stress (PS) on insulin, GLP-1 and their receptor (IR and GLP-1R) levels in the hypothalamus. GLP-1 and GLP-1R were assayed also in the hippocampus and frontal cortex – brain regions mainly affected in depression. The second objective was to determine the influence of exendin-4 and insulin on CRH promoter gene activity in in vitro conditions.