腹膜透析86例护理体会

1临床资料本组患者86例,年龄40~74(平均56)岁,急性肾功能衰竭15例,慢性肾功能衰竭62例,严重的水电解质紊乱、酸碱失衡和不宜行血液透析9例,行腹膜透析2mo4a.     

差分回归分析技术在嗅觉磁共振功能成像研究中的价值

目的:差分回归分析技术适用于生理学相关函数未知的复杂脑高级功能的功能磁共振成像研究,实验应用差分回归分析技术观察人脑嗅觉活动时相关中枢的动态激活区。方法:实验于2005-11/2006-01完成。选择对13例右利手、无嗅觉障碍的健康志愿者进行嗅觉刺激功能磁共振成像实验。①实验方法:刺激方式采用组块设计,先给予30次Scan(S)刺激,再给予第二次刺激15次S,之间有55次S作为控制任务;每位被试先给予愉快气体(乙酸戊酯),间隔足够长时间后,再给非愉快气体(吡啶)。采用GE Signa 1.5T echospeed MR/i磁共振成像系统进行功能图像扫描。②数据分析:在AFNI平台上,数据经头动校正、空间标准化、空间平滑等处理后,再用差分回归分析技术进行数据处理和分析获得嗅觉实验脑激活图。阈值P=0.005。结果:11例受试者的数据进入结果分析。①嗅觉实验激活脑区(双侧皆有)为海马、眶额回、丘脑背内侧核、扣带回的背侧及喙、杏仁核、前额叶及额内侧回、颞叶、岛叶、枕叶、脑干和小脑,各脑区反应时间均较刺激时间有不同程度的延后。②愉快气体与非愉快气体激活的脑区无显著差异(P>0.005),均以右侧大脑半球激活明显(P<0.005)。结论:差分回归分析技术是嗅觉等复杂的脑功能研究可行的实验分析方法,人脑嗅觉刺激是复杂的延迟反应过程,右侧大脑半球为嗅觉"优势半球"。     

New variant of von Willebrand disease type II with markedly increased levels of von Willebrand factor antigen and dominant mode of inheritance: von Willebrand disease type IIC Miami

A variant of von Willebrand disease (vWD) was identified in six members of a kindred spanning four generations. The proband was a 46-year-old woman with a lifelong history of bleeding, a prolonged bleeding time (> 15 minutes), markedly elevated von Willebrand factor (vWF) antigen (vWF:Ag = 2.09 U/mL), slightly reduced ristocetin cofactor activity, and a plasma vWF multimer pattern similar to that of vWD type IIC. Similar findings were observed in her three children, mother, and brother. In affected family members, platelet and plasma vWF multimer patterns were discrepant with higher molecular weight multimers observed in platelet vWF. Following a 1-Des-amino-8-D-arginine vasopressin (DDAVP) challenge, the proband failed to normalize her bleeding time even though vWF: Ag rose by 70% and higher molecular weight multimers were increased slightly. Genetic studies were consistent with autosomal dominant inheritance of a mutation within the vWF gene. By sequencing of cloned genomic DNA, mutations were excluded in exons 4, 5, 14, and 15, which encode regions of the vWF propeptide proposed to be important in multimer biosynthesis. Mutations also were excluded in exons 28 to 31, which encompass the known mutations that cause vWD types IIA, IIB, and B. This new variant of vWD, characterized by autosomal dominant inheritance, a qualitative defect that resembles vWD type IIC, and increased plasma vWF:Ag, was tentatively designated vWD type IIC Miami.     

Obsessive-compulsive disorder in children and adolescents

Children and adults with OCD have similar obsessions and compulsions, as well as a similar response to most psychotherapeutic and pharmacotherapeutic interventions. A large proportion of adults with OCD, perhaps as high as 80%, have their onset during childhood or adolescence. The prevalence estimate of OCD in children is at least 2-4% and an even larger number may have subclinical OCD. Recent gains in OCD research have consisted in differentiating normal ritualistic behavior in children from OCD symptoms, realizing a more systematic assessment of OCD symptoms in children, refuting the impression that OCD in children is a rare condition and developing psychological and pharmacologic treatment strategies. Controlled studies of the phenomenology of OCD in children have been conducted. The vast majority of children with OCD have concurrent neuropsychiatric disorders including mood, tic, other anxiety and neurologic disorders, as well as pervasive developmental disorders. Recent investigations show that risk to relatives for OCD or subthreshold OCD is significantly higher in relatives than controls. Earlier age of onset also seems to be related to degree of familiality of OCD. The management of OCD in children entails an integrated approach of available behavioral, pharmacological, family therapy and supportive interventions. Illness education should be a major component of management and individualized treatment is important. Further research in OCD should serve to improve the prognosis of this mostly chronic condition in children.