6个“松手”智慧

独立性包括独立的意识和独立的做事能力,它是一个人安身立命的基础素质,也是一个生命证明自己存在的第一要素,只有在独立自主的活动中,宝宝才能充分体验自身的存在与价值,并在这个基础上获得更好的发展。如果说家庭教育的最高境界是让宝宝成为最好的自己,那么,培养宝宝独立自主的品质,就是帮助宝宝成长的第一步。那么,妈咪要如何培养宝宝的独立性呢？     

Probiotics in dietary guidelines and clinical recommendations outside the European Union

Fermented foods have been consumed for centuries across many geographical locales and have traditionally been considered healthy foods,partly because of the live microbes contained in them.The concept of“probiotics”further requires that the microbes be defined and their health effects be demonstrated through human intervention studies or other suitable investigations before marketing with corresponding health messages.Here,we review recommendations for fermented foods and probiotics in several countries outside the EU,focusing on food-based dietary guidelines.We emphasize recommendations on yoghurt and probiotics made by expert bodies.We found that dietary guidelines commonly advocate the consumption of yoghurt or similar products,but specific comments on probiotics are rare.Further,we reviewed guidelines from clinical associations.In general,they acknowledge the beneficial effects of probiotics,but often suggest the need for further research.This is true despite good quality evidence supporting the role of probiotics for certain health effects,such as prevention of eczema in infants,management of side effects from antibiotics and alleviation of functional bowel symptoms.Additional research to support future dietary recommendations should focus on determining effect size,identifying responders and non-responders,clarifying strain-specificity of effects and confirming mechanisms.     

卒中后抑郁美国心脏协会/美国卒中协会对医疗卫生专业人员发布的科学声明

卒中后抑郁(poststroke depression,PSD)是一种常见病,可发生于卒中后的任何时间,影响约1/3的卒中存活者.PSD患者面临更高的恢复欠佳、复发性血管事件、生活质量差和死亡风险.尽管PSD非常普遍,但其诱发因素以及最佳预防和治疗策略仍不明确.本文是美国心脏协会(American Heart Association,AHA)针对PSD发布的首份科学声明.写作组成员由AHA卒中委员会的科学声明监督委员会和AHA手稿监督委员会任命,负责与其专业领域相关的主题,进行适当的文献回顾,并参考已发表的临床和流行病学研究、临床和公共卫生指南、权威声明和专家意见.这份多学科声明提供了对PSD流行病学、病理生理学、转归、管理以及预防方面当前证据的全面回顾,指出了现有知识的不足,并提供了对临床实践的意义.     

Evaluation of the prognostic value of liver stiffness in patients with hepatitis C virus treated with triple or dual antiviral therapy:A prospective pilot study

AIM:To evaluate the association between liver stiffness(LS) prior to the initiation of dual/triple therapy and viral response.METHODS:LS was measured in all patients before treatment was administered.The therapeutic approach was based on hepatic,virological,and immunological evaluations and considered the fact that patients with severe fibrosis(F3)or compensated cirrhosis(F4)in Child-Pugh class A are the primary candidates for triple therapy.In total,65 hepatitis C virus(HCV)patients were treated with Peg-interferon/ribavirin(Peg-IFN/RBV);24patients were classified as genotypes 1/4(36.92%),and41 patients were classified as genotypes 2/3(63.08%)(dual therapy).In addition,20 HCV treatment-experienced genotype 1 patients were treated with Peg IFN-RBV and boceprevir(triple therapy).Wilcoxon rank-sum tests were used to compare the groups.RESULTS:LS significantly differed between dual therapy and triple therapy(P=0.002).The mean LS value before dual therapy treatment was 8.61±5.79k Pa and was significantly different between patients achieving a sustained virologic response(SVR)24weeks after therapy and those who did not(7.23±5.18 k Pa vs 11.72±5.99 k Pa,respectively,P=0.0003).The relative risk of non-response to therapy was 4.45(95%CI:2.32-8.55).The attributable risk of non-response to therapy was 49%.The mean LSvalue before triple therapy treatment was 13.29±8.57k Pa and was significantly different between patients achieving and not achieving SVR24(9.41±5.05 vs19.11±9.74,respectively;P=0.008).The relative risk of non-response to therapy was 5.57%(95%CI:1.50-20.65).The attributable risk of non-response to therapy(70%)was increased compared with dual therapy patients.Pre-treatment stiffness12 k Pa was significantly associated with non-SVR(P0.025)in both groups.CONCLUSION:Pre-treatment liver stiffness may be useful for predicting the response to treatment in patients treated with either dual or triple anti-HCV therapy.     

我想和你拥有一样的天空——关注儿童糖尿病：听妈妈讲糖宝宝的故事

“妈妈，我要上幼儿园”；“妈妈，我也要在幼儿园吃饭”。对于绝大多数孩子．上幼儿园是再平常不过的事儿．甚至许多孩子哭着闹着不想去幼儿园．需要大人们哄着骗着才去。而对于有些孩子，即使他们多么渴望上幼儿园，多么渴望和别的小朋友一样在一起玩耍游戏．但由于疾病的原因却不能去幼儿园或不被幼儿园接纳。     

以家庭为中心护理模式的探讨及安全管理

郑显兰主任护师在重庆医科大学附属儿童医院主办的“儿科护理发展论坛”上，来自美国辛辛那提儿童医院的3位护理专家，Hoying、Workman和Allen博士做了精彩的学术报告，参加会议的相关护理人员受益匪浅。     

Hepatitis C virus syndrome: A constellation of organ-and non-organ specific autoimmune disorders,B-cell nonHodgkin’s lymphoma,and cancer

The clinical course of chronic hepatitis C virus(HCV)infection is characterized by possible development of both liver and extrahepatic disorders. The tropism of HCV for the lymphoid tissue is responsible for several immune-mediated disorders; a poly-oligoclonal B-lymphocyte expansion, commonly observed in a high proportion of patients with HCV infection, are responsible for the production of different autoantibodies and immune-complexes, such as mixed cryoglobulins. These serological alterations may characterize a variety of autoimmune or neoplastic diseases. Cryoglobulinemic vasculitis due to small-vessel deposition of circulating mixed cryoglobulins is the prototype of HCV-driven immune-mediated and lymphoproliferative disorders; interestingly, in some cases the disease may evolve to frank malignant lymphoma. In addition, HCV shows an oncogenic potential as suggested by several clinicoepidemiological and laboratory studies; in addition to hepatocellular carcinoma that represents the most frequent HCV-related malignancy, a causative role of HCV has been largely demonstrated in a significant percentage of patients with isolated B-cells nonHodgkin’s lymphomas. The same virus may be also involved in the pathogenesis of papillary thyroid cancer, a rare neoplastic condition that may complicate HCVrelated thyroid involvement. Patients with HCV infection are frequently asymptomatic or may develop only hepatic alteration, while a limited but clinically relevant number can develop one or more autoimmune and/or neoplastic disorders. Given the large variability of their prevalence among patients’ populations from different countries, it is possible to hypothesize a potential role of other co-factors, i.e., genetic and/or environmental, in the pathogenesis of HCV-related extra-hepatic diseases.     

Risk profiling in patients undergoing penile prosthesis implantation

Penile prosthesis implantation is the gold standard of surgical therapy for patients with medication-refractory erectile dysfunction.However,this umbrella definition includes significant heterogeneity and associated risk profiles that should be candidly discussed and addressed perioperatively.Factors associated with operative success and patient satisfaction are often surgery specific;however,risk profiling via patient selection,preoperative optimization,proper device selection,and intraoperative consideration are highly correlated.Some examples of common risk profiles include comorbidity(ies)such as cardiovascular disease,diabetes mellitus,prior abdominal surgery,Peyronie's disease,and psychological risk factors.Similarly,integration of surgeon-and patient-amenable characteristics is key to decreasing risk of infection,complication,and need for revision.Finally,patient risk profiling provides a unique context for proper device selection and evidence-based intraoperative considerations.     

如果我老了

晚饭后。月亮开始淡淡发黄，淡淡发光，一天中最悠闲的好时光开始啦。我在沙发前的地上看报纸，小宝和爸爸在玩魔方。 忘了是怎么开始了。总之，今晚我和小宝讨论的话题是：如果我老了。下面是我的问题和小宝的回答的原话实录。