低收入大学生一般自我效能感、主观幸福感研究

近年来 ,低收入大学生作为高校中的一个特殊群体逐渐受到研究者和教育者的关注。目前对低收入大学生的一般自我效能感 (generalself -efficacy)和主观幸福感的研究还不多见。一般自我效能感是指个体对各种挑战或新情境的应对能力的总体信心[1] 。一般自我效能感描述的是个体有效地应对各种紧张情境的广义而稳定的个人能力感 ,它与身心健康存在一定的关系[1- 2 ] 。主观幸福感 (subjectivewell-being)是指人们对于自己是否幸福的主观感受 ,是反应心理健康水平的重要指标之一。研究低收入大学生的一般自我效能感和幸福感的特点及其关系对于揭…     

A distinctive glomerular lesion complicating placental site trophoblastic tumor: report of two cases

Renal disease with distinctive pathologic features developed in two young women who had placental site trophoblastic tumors. The renal abnormalities were manifested by proteinuria in both cases and by hematuria in one case; blood pressure was elevated in one of the patients. Pathologic examination of the kidneys showed distinctive glomerular abnormalities, characterized mainly by the presence of occlusive eosinophilic deposits in many of the glomerular capillary lumina, most of which stained for fibrinogen-related antigens and IgM by immunohistochemical techniques. Ultrastructural examination showed the deposits to consist mainly of granular material that contained packets of fibrillar material with the appearance of fibrin. The uterine tumors were composed of mononucleated and multinucleated cells with abundant cytoplasm that infiltrated between the muscle bundles of the myometrium; in both tumors there was prominent deposition of eosinophilic material that had the tinctorial properties of fibrin and that stained for fibrinogen and IgM in immunoperoxidase studies. The renal abnormalities disappeared after hysterectomy in one case; the other patient, who was receiving chemotherapy and had disseminated intravascular coagulation, died with leukopenia and sepsis. The clinical and pathologic features in these cases suggest that the renal abnormalities were related to the uterine tumors and that the production of immune complexes and/or the activation of intravascular coagulation by the tumors were pathogenetic mechanisms.     

双相气道正压无创机械通气上呼吸道影像分析

目的应用多层螺旋CT对患者不同通气状态下上呼吸道放射性成像,证实在全身麻醉无自主呼吸的条件下,双相气道正压(bi-level positive airway pressure,BiPAP)无创机械通气能克服上呼吸道阻力,实施有效的机械通气。方法选择拟实施全身麻醉的择期手术患者10例,分别对患者清醒自主呼吸、麻醉诱导后自主呼吸停止、BiPAP无创通气时头颈部正位和侧位作螺旋CT扫描。监测扫描过程的无创血压(NIBP)、脉搏氧饱和度(SpO2)、心率(HR)、自主呼吸频率(RR)。测量上呼吸道各软组织区(软腭后区RP、舌根后区RG、会厌区EPG)的最窄气道横截面左右径、前后径线长度及相应横截面积。结果头部正位麻醉诱导后各软组织区的最窄横截面左右径、前后径线长度及相应横截面积均比清醒时缩小(P<0.05),BiPAP通气时各截面径线和面积与清醒期比较差异仍有统计学意义(P<0.05,P<0.01)。头部侧位BiPAP通气时各径线和截面积与清醒时比较,差异无统计学意义。EPG区和RG区在BiPAP通气期的侧位截面积明显比正位时增大(P<0.05,P<0.01)。诱导期正、侧位SpO2均明显下降(P<0.01);头部正位BiPAP通气时与诱导期的SpO2比较虽有改善,但差异无统计学意义(P>0.05);头部侧位BiPAP通气时SpO2较诱导期明显升高(P<0.01),基本恢复到清醒期水平(P>0.05)。结论麻醉诱导后上呼吸道的通气面积明显减少,气道通畅度下降;头颈部侧位时上呼吸道各软组织区最狭窄处的通气截面积比正位时显著改善,以会厌区最明显。无明显上呼吸道梗阻性病史的成年患者全身麻醉时,头部侧位BiPAP无创通气能克服上呼吸道阻力,实施有效的机械通气,保证通气和氧合正常。     

Inhaled lodoxamide tromethamine in the treatment of perennial asthma: a double-blind placebo-controlled study

The efficacy of lodoxamide tromethamine in the treatment of asthma was studied in a 16-week double-blind, placebo-controlled study of 68 perennial allergic subjects with asthma. Patients received either lodoxamide tromethamine, 0.25 mg four times daily, or placebo, administered by metered-dose inhaler. Response to treatment was assessed by analyzing changes in asthma symptoms, inhaled bronchodilator requirements, and pulmonary function when compared to a 2-week baseline period. Patients treated with lodoxamide tromethamine demonstrated an improvement in daytime breathing difficulty, cough, sputum production, and sleep (p less than 0.01 to 0.05), but improvement was not significantly different from that demonstrated by placebo-treated patients. Patients from both treatment groups were able to reduce their inhaled bronchodilators (p less than 0.01), but again no significant difference was apparent between lodoxamide tromethamine and placebo treatment, nor were there any differences in peak expiratory flow rate or FEV1 between the two groups. Seven patients who received lodoxamide tromethamine withdrew because of a sensation of heat and gastrointestinal symptoms. Thus, although lodoxamide tromethamine possesses potent mast cell-stabilizing activity in vitro, we have failed to demonstrate any useful long-term effect in the treatment of mild allergic asthma.     

心理弹性(resilience)研究综述

弹性（resilience）日益为心理学界所关注，已经成为心理学的一个重要研究领域。文章追溯了弹性研究的渊源，介绍了众多研究者对于弹性的认识，回顾了弹性领域研究的进展情况，对以往的研究进行了评价，对以后的研究进行了展望。     

Long-term evaluation of usefulness of skin and incremental challenge tests in patients with history of adverse reaction to local anesthetics

A variety of adverse reactions to local anesthetics has been described, some of which are thought to be allergic. Different protocols of prick and intradermal skin tests as well as subcutaneous challenge tests are used to select a local anesthetic which can safely be used. Their long-term effectiveness has not yet been assessed. Twenty-eight patients with a history of adverse reaction to local anesthetics were evaluated over a 3-year period. Loss of consciousness occurred in eight patients, skin reaction in nine, and vagal symptoms in eight. Various reactions were recorded in the remaining three patients. Rapid spontaneous recovery was the rule, suggesting that immediate allergic reaction and, in particular, anaphylactic reaction were unlikely. Investigation allowed the selection of a tolerated anesthetic in all cases. Reexposure occurred in 19 patients 16–50 months after evaluation and 6.8 ± 5.5 years after the first reaction. No patient presented a second reaction. In conclusion, adverse reactions to local anesthetics seem to be, in most cases, not allergic in nature. Evaluation protocols are effective in selecting an agent susceptible to tolerance, but are time consuming. However, they probably contribute to an important reassurance effect that is likely to increase tolerance to subsequent local anesthetic administration. Simplification of the protocols and better patient selection are proposed.     

基因组序列CGR图形表示的多重分形分析

为了更好地描述基因组序列CGR(chaos-game representation)图形的分形特征,引入多重分形理论进行分析。通过研究3种概率集对标度不变性范围的影响,选取出标度不变性最好的概率集,计算光滑的广义维数谱和多重分形谱。结果表明:以相对概率组成概率集时标度不变性最好,而且标度不变性随尺度变化可被分为3个不同的区域,这反映了基因组序列不同长度的序列片段有不同的分布规律。可见,多重分形方法可以用于描述基因组序列CGR图形的分形特征。     

总责任护士主导的医护一体化护理模式在创伤骨科的应用

目的探讨总责任护士主导的医护一体化临床护理模式在创伤骨科的应用效果。 方法选择2016年7月至2017年6月在南京大学医学院附属鼓楼医院创伤骨科行手术治疗的骨折患者200例，按照入院先后顺序分为对照组90例(实施创伤骨科常规护理)和观察组110例(实施医护一体化工作模式，包括成立医护合作小组、实施总责任护士主导的医护一体化查房、个体化诊疗方案的共同决策、疼痛管理、早期出院计划与延续护理)。比较2组患者的术后护理效果和医护合作满意度。对数据行t检验和χ²检验。 结果总责任护士主导的医护一体化模式下，观察组患者术后72 h内数字评分法(NRS)评分为(4.09±1.64)分，疼痛干预有效率为77.57%，对照组术后72 h内NRS评分为(5.15±1.69)分，疼痛干预有效率为57.95%，2组比较差异均有统计学意义(P值均小于0.05)；观察组下肢深静脉血栓、泌尿系统感染、便秘的发生例数分别为2、1、3，对照组下肢深静脉血栓、泌尿系统感染、便秘的发生例数分别为9、7、11，两组比较差异均有统计学意义(χ²＝4.486、4.296、6.812，P＝0.027、0.036、0.009)。观察组术后康复开始时间为(21.48±6.41)h，术后住院时间为(11.08±2.19)d；对照组术后康复开始时间为(36.48±10.75)h，术后住院时间为(13.95±2.93)d，2组比较差异均有统计学意义(t＝11.670、－7.616，P值均小于0.05)。2组医护合作满意度结果显示，观察组患者信息的交流得分为(3.78±0.85)分，共同参与治疗或护理决策得分为(3.86±0.87)分，医师和护士的关系得分为(4.00±0.84)分，总分为(3.87±0.67)分；对照组患者信息的交流得分为(3.32±1.00)分，共同参与治疗或护理决策得分为(3.23±0.93)分，医师和护士的关系得分为(3.45±0.96)分，总分为(3.33±0.84)分，2组比较差异均有统计学意义(P值均小于0.05)。 结论总责任护士主导的医护一体化护理模式的应用，以亚专科为核心，重新整合医护资源，共同参与制订患者的诊疗护理方案，共同聚焦患者安全与质量，加强了医护间的配合，提高了医疗护理服务质量，提升医护合作满意度。     

Orienting and classical conditioning in the rabbit (Oryctolagus cuniculus): effects of septal area lesions

Rabbits with either sham or septal lesions recieved differential classical conditioning training in which tones of different frequencies served as CSs and paraorbital shock served as the UCS. Eyeblink (EB), EMG, and heart rate (HR) CRs were concommitantly assessed. Free field activity was also studied in selected animals. Animals with septal lesions revealed an impaired EB discrimination which resulted from increased responding to the CS-. These animals showed HR CRs of greater magnitude than sham animals. The HR discrimination was, however, unimpaired by septal lesions. Differential EMG activity also occurred, but was unaffected by septal destruction. Septal lesions resulted in greater free-field activity associated with visual stimulation, but no differences were obtained between septal and sham animals in the dark. It is suggested that these results were due to an enhanced reactivity to environmental stimulation, possibly related to dysfunctions of the orienting reflex.     

Unusual reactions following insect stings. Clinical features and immunologic analysis.

Fifteen patients were studied who had unusual reactions following insect stings. These included serum sickness, neurologic disease, renal disease, and delayed hypersensitivity-type reactions. The clinical features are briefly outlined. Measurements were made of serum venom-specific IgE and IgG antibodies. These antibodies were present in some patients and in these instances suggested an immunologic pathogenesis for the reactions. Alternative etiologies for the unusual reactions are also discussed.