1例直肠癌患者术后继发腹壁多处坏死性软组织感染的护理

总结1例直肠癌患者术后继发腹壁多处坏死性软组织感染的护理经验。护理要点：感染性休克的早期识别和有效控制;坏死性软组织感染的识别及护理,控制全身性感染再次发生;分阶段落实个体化镇痛,改善疼痛症状;分阶段动态落实营养支持方案;实施全程心理干预。经过122 d的精心护理,8处伤口全部愈合,患者恢复良好。     

前瞻性护理干预在急性心力衰竭患者中的应用

目的探讨前瞻性护理干预在急性心力衰竭患者中的应用效果。方法选取2018年4月—2020年5月河南省某医院收治的122例急性心力衰竭患者为研究对象,采用随机数字表法分为观察组与对照组,每组61例。对照组患者采用常规护理,观察组患者采用前瞻性护理,比较2组患者的干预效果、并发症发生情况,干预前后焦虑自评量表(SAS)、抑郁自评量表(SDS)评分及护理满意度。结果观察组患者干预总有效率为95.08%,高于对照组的75.41%,差异有统计学意义(χ²=9.385,P=0.002)。观察组患者并发症发生率为3.28%,低于对照组的18.03%,差异有统计学意义(χ²=6.974,P=0.008)。2组患者干预后SAS及SDS评分均低于干预前,且观察组低于对照组,差异均有统计学意义(P<0.05)。观察组患者护理满意度为98.36%,高于对照组的86.89%,差异有统计学意义(χ²=4.319,P=0.038)。结论前瞻性护理干预用于急性心力衰竭患者,有助于改善患者负性情绪及减少并发症的发生。     

认知重构干预对急性心肌梗死介入手术患者不良情绪及疾病感知的影响

目的探讨认知重构干预对急性心肌梗死(AMI)介入手术患者不良情绪及疾病感知的影响。方法72例AMI介入手术患者随机分为两组各36例,对照组给予常规护理干预,研究组在对照组基础上给予认知重构干预,比较两组的不良情绪、疾病感知以及治疗依从性。结果干预后,研究组的HAMA、HAMD评分均低于对照组,疾病感知各项评分均高于对照组(P<0.05)。研究组的治疗依从性为94.44%,高于对照组的75.00%(P<0.05)。结论认知重构干预对急性心肌梗死介入手术患者的不良情绪及疾病感知均有积极的影响,可提升患者的治疗依从性。     

Contemporary Epidemiology of and Risk Factors Associated with Removal of a Pathologically Normal Appendix in Children with Suspected Appendicitis

BackgroundThe goal of this study was to characterize contemporary performance benchmarks and risk factors associated with negative appendectomy (NA) in children with suspected appendicitis.MethodsA multicenter retrospective cohort analysis of children undergoing appendectomy for suspected appendicitis was performed using data from the 2016–2021 NSQIP-Pediatric Appendectomy Targeted Public Use Files. Multivariable regression was used to evaluate the influence of year, age, sex, and WBC count on NA rate, and to generate rate estimates for NA based on different combinations of demographic characteristics and WBC profiles.Results100,322 patients were included from 140 hospitals. The overall NA rate was 2.4%, and rates decreased significantly during the study period (2016: 3.1% vs. 2021: 2.3%, p < 0.001). In adjusted analyses, the highest risk for NA was associated with a normal WBC (<9000/mm³; OR 5.31 [95% CI: 4.87–5.80]), followed by female sex (OR 1.55 [95% CI: 1.42–1.68]) and age <5 years (OR 1.64 [95% CI 1.39, 1.94]). Model-estimated risk for NA varied significantly across demographic and WBC strata, with a 14.4-fold range in rates between subgroups with the lowest and highest predicted risk (males 13–17 years with elevated WBC [1.1%] vs. females 3–4 years with normal WBC [15.8%]).ConclusionsContemporary NA rates have decreased over time, however NA risk remains high in children without a leukocytosis, particularly for girls and children <5 years of age. These data provide contemporary performance benchmarks for NA in children with suspected appendicitis and identify high-risk populations where further efforts to mitigate NA risk should be targeted.Level of EvidenceIII.     

痛情绪相关神经递质及神经环路研究进展＊

痛情绪是指因疼痛引发的情绪和情感体验，是疾病过程中最常见的一种情绪。痛情绪相关神经机制非常复杂，但主要与单胺类神经递质、神经肽和某些神经环路有关，笔者将结合目前研究现状分别从以上两方面展开，就痛情绪相关单胺类神经递质和神经肽在受体分类、脑区通路、共疾病以及各神经递质之间的联系和痛情绪相关神经环路中各个蛋白的作用机制等方面进行探讨。     

放疗前后规范化心理护理干预对头颈部肿瘤患者负性情绪的调节作用

目的:探讨放疗前后规范化心理护理干预对头颈部肿瘤患者负性情绪的调节作用。方法:以2016年3月至2018年3月四川大学华西医院头颈部肿瘤科收治的头颈部肿瘤患者86例为研究对象，其中将2016年3月至2017年3月期间收治的42例患者作为对照组，2017年4月至2018年3月期间收治的44例患者作为研究组。研究组患者在常规护理基础上采用规范化的心理护理干预。比较两组患者入院后24 h、出院前24 h、出院后3个月负性情绪的得分情况。结果:研究组患者出院前24 h心理状态总得分显著降低（P＜0.05）。研究组患者出院后3个月焦虑、抑郁、愤怒、总得分均显著降低（P＜0.05）。结论:有针对性的、规范化的心理护理干预能有效改善头颈部肿瘤患者的负性情绪，这为临床中头颈部肿瘤患者的护理工作提供了新的思路。     

White matter correlates of different aspects of facial affect recognition impairment following traumatic brain injury

Although facial affect recognition deficits are well documented in individuals with moderate-to-severe traumatic brain injury (TBI), little research has examined the neural mechanisms underlying these impairments. Here, we use diffusion tensor imaging (DTI), specifically the scalars fractional anisotropy (FA), mean diffusivity (MD), and radial diffusivity (RD), to examine relationships between regional white-matter integrity and two facial affect sub-skills: perceptual affect recognition abilities (measured by an affect matching task) and verbal categorization of facial affect (measured by an affect labeling task). Our results showed that, within the TBI group, higher levels of white-matter integrity in tracts involved in affect recognition (inferior fronto-occipital, inferior longitudinal, and uncinate fasciculi) were associated with better performance on both tasks. Verbal categorization skills were specifically and positively correlated with integrity of the left uncinate fasciculus. Moreover, we observed a striking lateralization effect, with perceptual abilities having an almost exclusive relationship with integrity of right hemisphere tracts, while verbal abilities were associated with both left and right hemisphere integrity. The findings advance our understanding of the neurobiological mechanisms that underlie subcomponents of facial affect recognition and lead to different patterns of facial affect recognition impairment in adults with TBI.     

Cognitive regulation of ventromedial prefrontal activity evokes lasting change in the perceived self‐relevance of persuasive messaging

Persuasive messages can change people's thoughts, feelings, and actions, but these effects depend on how people think about and appraise the meaning of these messages. Drawing from research on the cognitive control of emotion, we used neuroimaging to investigate neural mechanisms underlying cognitive regulation of the affective and persuasive impact of advertisements communicating the risks of binge drinking, a significant public health problem. Using cognitive control to up‐regulate (vs. down‐regulate) responses to the ads increased: negative affect related to consequences of excessive drinking, perceived ad effectiveness, and ratings of ad self‐relevance made after a one‐hour delay. Neurally, these effects of cognitive control were mediated by goal‐congruent modulation of ventromedial prefrontal cortex and distributed brain patterns associated with negative emotion and subjective valuation. These findings suggest that people can leverage cognitive control resources to deliberately shape responses to persuasive appeals, and identify mechanisms of emotional reactivity and integrative valuation that underlie this ability. Specifically, brain valuation pattern expression mediated the effect of cognitive goals on perceived message self‐relevance, suggesting a role for the brain's valuation system in shaping responses to persuasive appeals in a manner that persists over time.     

Source imaging of seizure onset predicts surgical outcome in pediatric epilepsy

ObjectiveTo assess whether ictal electric source imaging (ESI) on low-density scalp EEG can approximate the seizure onset zone (SOZ) location and predict surgical outcome in children with refractory epilepsy undergoing surgery.MethodsWe examined 35 children with refractory epilepsy. We dichotomized surgical outcome into seizure- and non-seizure-free. We identified ictal onsets recorded with scalp and intracranial EEG and localized them using equivalent current dipoles and standardized low-resolution magnetic tomography (sLORETA). We estimated the localization accuracy of scalp EEG as distance of scalp dipoles from intracranial dipoles. We also calculated the distances of scalp dipoles from resection, as well as their resection percentage and compared between seizure-free and non-seizure-free patients. We built receiver operating characteristic curves to test whether resection percentage predicted outcome.ResultsResection distance was lower in seizure-free patients for both dipoles (p = 0.006) and sLORETA (p = 0.04). Resection percentage predicted outcome with a sensitivity of 57.1% (95% CI, 34–78.2%), a specificity of 85.7% (95% CI, 57.2–98.2%) and an accuracy of 68.6% (95% CI, 50.7–83.5%) (p = 0.01).ConclusionIctal ESI performed on low-density scalp EEG can delineate the SOZ and predict outcome.SignificanceSuch an application may increase the number of children who are referred for epilepsy surgery and improve their outcome.