肺保护与肺开放通气策略对急性呼吸窘迫综合征家兔血管外肺水的影响

目的探讨肺保护与肺开放通气策略对急性呼吸窘迫综合征(ARDS)血管外肺水(EVLWI)的影响。方法以肺泡灌洗法复制家兔ARDS模型,分为中等潮气量(VT)零呼气末正压(PEEP)组(MVZP组)、小VT零PEEP组(LVZP组)、小VT最佳PEEP组(LVBP组)和小VT最佳PEEP+控制性肺膨胀(SI)组(LVBP+SI组)。采用单指示剂热稀释法测定EVLWI。观察在不同通气条件下0、1、2和3h EVLWI的变化。结果MVZP组、LVZP组、LVBP组和LVBP+SI组EVLWI在基础时分别为(11.3±2.4)、(10.2±2.4)、(10.3±4.6)和(9.7±2.3)ml/kg,达到ARDS模型(0h)时显著升高[(22.3±5.6)、(20.0±3.8)、(25.7±9.7)和(22.5±6.2)ml/kg,P均<0.05]。在实验观察3h中,MVZP组在2、3h EVLWI[(32.0±12.2)、(36.2±12.4)ml/kg]显著高于0h[(22.3±5.6)ml/kg,P均<0.05]。LVZP组在2、3h EVLWI[(27.8±12.9)、(30.3±13.0)ml/kg]也显著高于0h[(20.0±3.8)ml/kg,P均<0.05];LVBP组1h时EVLWI为(18.5±8.1)ml/kg,与0h[(25.7±9.7)ml/kg]比较差异有统计学意义(P=0.027)。LVBP+SI组在1、2、3h各时点EVLWI分别为(16.8±6.5)、(18.0±7.1)、(15.7±2.7)ml/kg,与0h[(22.5±6.2)ml/kg]比较显著降低(P均<0.05)。与MVZP组比较,1、3h时LVBP组与LVBP+SI组EVLWI显著降低(P均<0.05)。3hLVBP+SI组EVLWI显著低于LVZP组(P<0.05)。结论肺保护与肺开放通气策略可降低EVLWI,增加肺水清除。     

父母不同教养倾向对高中生心理健康的影响

目的探讨父母积极教养倾向和消极教养倾向对高中生心理健康的影响。方法采用中学生心理健康量表和父母教养方式评价量表(EMBU)对开封某重点高中二年级177名学生进行调查,并对结果进行了相应的处理分析。结果父母的情感温暖、理解是保护其子女免受抑郁和焦虑侵扰的有效方法;父母对子女过多的拒绝否认、过分干涉、过度保护、惩罚、严厉、偏爱被试是导致其子女形成偏执、敌对、人际关系敏感与紧张、学习压力感、适应不良、情绪不稳定和心理不平衡等不健康心理品质的主要因素。结论高中生的心理健康水平欠佳;父母应给予子女多一些情感温暖和理解,少一些惩罚严厉、拒绝否认和过分干涉过度保护,父母应公平对待自己的每个子女。     

广州地区首次参加无偿献血人群HCV感染的流行病学调查

目的了解广州地区首次参加无偿献血人群HCV的感染状况。方法抗-HCV检测采用酶联免疫吸附实验(使用2种不同厂家的试剂盒),HCV RNA检测采用荧光定量PCR法,ALT检测采用速率法。结果2004—2007年在广州血液中心首次参加无偿献血的559890名献血者中,1617名经双试剂检测抗-HCV阳性,阳性率为0.289%。随机选取435名双试剂检测抗-HCV阳性血液标本进行RNA检测,266名阳性,占61.15%,男女(P<0.01)HCV RNA阳性率有统计学意义(P<0.01)。266名抗-HCV检测阳性献血者中,ALT升高(>40U)的为18名(其中男性17名),不合率为6.77%,男女ALT的不合格比有统计学意义(P<0.01)。结论随着无偿献血的开展,献血人群中HCV的阳性率不断下降;不同性别的个体清除HCV的能力不同,女性高于男性。     

积极共情反馈联合视听转移干预对甲状腺功能亢进患儿焦虑情绪及治疗依从性的影响

目的:探讨积极共情反馈联合视听转移干预对甲状腺功能亢进(甲亢)患儿焦虑情绪及治疗依从性的影响.方法:选取2019年6月1日～2020年12月31日收治的108例甲亢患儿为研究对象,采用随机数字表法分为对照组和研究组各54例,对照组采用常规干预,研究组在常规干预基础上实施积极共情反馈联合视听转移干预,均干预1个月;比较两...     

脊髓损伤患者主要照顾者照顾负担与积极感受的相关性研究

目的了解脊髓损伤患者主要照顾者照顾负担与积极感受的现状及其相关性。方法以脊髓损伤患者的主要照顾者作为研究对象,采用"Zarit照顾负担量表"和"照顾者积极感受量表"对他们进行问卷调查,分析他们的照顾负担与积极感受及其相关性。结果 120例脊髓损伤患者主要照顾者的照顾负担总分为(38.770±13.050)分,积极感受总分为(26.031±6.447)分,责任负担与生活展望呈显著负相关(P0.01),照顾负担总分与积极感受总分呈负相关(P0.01)。结论脊髓损伤患者照顾者负担处于中度水平,积极感受处于轻偏中度水平。医护人员应全面认识照顾者的照顾感受,对其进行个体化干预,以提高他们的积极感受水平,降低照顾负担,最终提高脊髓损伤患者及其主要照顾者的生活质量。     

Positive experiences associated with acquired hearing loss,Ménière's disease,and tinnitus: A review

Objective: It is common to study and understand how various illness and disorders result in negative consequences. However, positive experiences have been reported in a range of disabling conditions including multiple sclerosis, heart disease, physical and sensory disabilities. This paper presents a literature review of studies that have explored positive experiences associated with acquired hearing loss, Ménière's disease, and tinnitus. Design: A review of the peer reviewed scientific literature. Study sample: A comprehensive search strategy identified 15 articles after applying inclusion criteria. Results: A range of positive experiences have been reported by patients with hearing and balance disorders and by their significant others. Associations between demographic variables (e.g. age, gender), audiological variables (e.g. severity of the condition, duration) and the reported positive experiences are low. In Ménière's disease, self-reported positive experiences can predict the impact of the condition. However, this phenomenon has not yet been demonstrated in relation to hearing loss and tinnitus. Conclusions: Positive experiences associated with audio-vestibular disorders have been demonstrated. Further research is needed on the long-term benefits of the encouragement of such experiences and positive attitudes in persons with hearing loss, tinnitus, and imbalance.     

Psychological factors in retrograde amnesia: Self-deception and a broken heart

The psychoses of epilepsy are well recognized complications of seizure disorders, diagnosed easily from the history. However, in the absence of recognized seizures, the diagnosis can be challenging.

We present a 27-year-old female, who suffered a treatment refractory psychosis for 6 years. She did not report, or display, any seizure activity, and extensive investigation was unremarkable. The onset of new symptoms prompted a repeat work-up which clinched the diagnosis of psychosis of epilepsy.

Treatment with Lamotrigine and Amisulpiride achieved an excellent response, and she has remained symptom free for 7 months.

We conclude with a brief literature review.     

Electrical impedance tomography to evaluate air distribution prior to extubation in very-low-birth-weight infants: a feasibility study

OBJECTIVES:

Nasal continuous positive airway pressure is used as a standard of care after extubation in very-low-birth-weight infants. A pressure of 5 cmH₂O is usually applied regardless of individual differences in lung compliance. Current methods for evaluation of lung compliance and air distribution in the lungs are thus imprecise for preterm infants. This study used electrical impedance tomography to determine the feasibility of evaluating the positive end-expiratory pressure level associated with a more homogeneous air distribution within the lungs before extubation.

METHODS:

Ventilation homogeneity was defined by electrical impedance tomography as the ratio of ventilation between dependent and non-dependent lung areas. The best ventilation homogeneity was achieved when this ratio was equal to 1. Just before extubation, decremental expiratory pressure levels were applied (8, 7, 6 and 5 cmH₂0; 3 minutes each step), and the pressure that determined the best ventilation homogeneity was defined as the best positive end-expiratory pressure.

RESULTS:

The best positive end-expiratory pressure value was 6.3±1.1 cmH₂0, and the mean continuous positive airway pressure applied after extubation was 5.2±0.4 cmH₂0 (p = 0.002). The extubation failure rate was 21.4%. X-Ray and blood gases after extubation were also checked.

CONCLUSION:

This study demonstrates that electrical impedance tomography can be safely and successfully used in patients ready for extubation to suggest the best ventilation homogeneity, which is influenced by the level of expiratory pressure applied. In this feasibility study, the best lung compliance was found with pressure levels higher than the continuous positive airway pressure levels that are usually applied for routine extubation.     

Anatomy of sodium hypochlorite accidents involving facial ecchymosis—A review

Objectives

Root canal treatment forms an essential part of general dental practice. Sodium hypochlorite (NaOCl) is the most commonly used irrigant in endodontics due to its ability to dissolve organic soft tissues in the root canal system and its action as a potent antimicrobial agent. Although NaOCl accidents created by extrusion of the irrigant through root apices are relatively rare and are seldom life-threatening, they do create substantial morbidity when they occur.

Methods

To date, NaOCl accidents have only been published as isolated case reports. Although previous studies have attempted to summarise the symptoms involved in these case reports, there was no endeavour to analyse the distribution of soft tissue distribution in those reports. In this review, the anatomy of a classical NaOCl accident that involves facial swelling and ecchymosis is discussed.

Results

By summarising the facial manifestations presented in previous case reports, a novel hypothesis that involves intravenous infusion of extruded NaOCl into the facial vein via non-collapsible venous sinusoids within the cancellous bone is presented.

Conclusions

Understanding the mechanism involved in precipitating a classic NaOCl accident will enable the profession to make the best decision regarding the choice of irrigant delivery techniques in root canal débridement, and for manufacturers to design and improve their irrigation systems to achieve maximum safety and efficient cleanliness of the root canal system.