癫痫患者丙戊酸血药浓度监测及个体化给药

目的：为临床癫痫患者丙戊酸的合理用药提供参考。方法：采用荧光偏振免疫法对１２３ 例癫痫患者进行血药浓度监测,并对其结果及疗效进行分析总结。结果：达到丙戊酸有效血药浓度范围未有效控制的有１４ 例,占１１－４ ％ ;不在有效血药浓度范围而控制良好的有１１ 例,占８－９ ％ 。结论：丙戊酸的个体化给药必须综合考虑各方面的因素,不能仅仅以血药浓度为依据,并建议在适当情况下有必要监测游离丙戊酸血药浓度。     

Putting my glasses back on: observing the development of a little girl

Abstract

The observation of infants and children is an integral part of the training of child and adolescent psychotherapists. This article looks at one student's experience of a young child observation. It focuses on the development of a 2½-year-old girl, on the cusp of young childhood, as she negotiates her world. Alongside this the paper explores the struggles of the observer as she attempts to establish and maintain her role within the family and thinks carefully about the countertransference feelings evoked and the ways in which these feelings impact on the observer's behaviour and actions.     

Separation-individuation and identity development in at-risk youth

The relationship between separation–individuation and identity development was investigated in a sample of runaway/homeless adolescents (N?=?83). Participants were 18–21 years (M?=?19.4, SD?=?0.86). The ethnic distribution consisted of 50.6% African American, 24.1% European American, 18.1% Hispanic American and 7.2% Other. Participants provided demographic information and completed the Separation Individuation Test of Adolescence (SITA) and the Ego Identity Process Questionnaire. The hypotheses that Healthy Separation (one of the nine SITA variables) would predict Identity Exploration and Identity Commitment were not supported. Hierarchical regression analyses yielded only one statistically significant finding: Practicing Mirroring (a SITA subscale that measures narcissistic self-confidence derived from feedback from others) predicted Identity Commitment scores. These results support the importance of caregiver encouragement during the identity development process. Consideration of the separation– individuation process in this population and its role in identity development are reviewed as implications for intervention within out-of-home placements.     

丙戊酸钠血药浓度监测及意义

目的:为临床癫痫患者丙戊酸钠的合理用药提供参考.方法:采用荧光偏振免疫法对143例癫痫患者服用丙戊酸钠进行血药浓度监测,并对结果及疗效进行分析总结.结果:222例次监测结果在有效浓度范围内,占总例次的68.5%,而有6例次血药浓度在正常范围,未能控制癫痫症状,13例次出现毒性反应.血药浓度高于或低于正常浓度有102例次,占31.5%.结论:丙戊酸钠血药浓度监测对合理用药有重要的指导作用,血药浓度个体差异大,临床用药时需个体化给药.     

个体化使用呼气末正压治疗重症哮喘

目的探讨使用呼气末正压(PEEP)治疗重症哮喘的适应性及理想PEEP。方法把42例机械通气的重症哮喘患者分为A、B、C、D组,A组11例为有肺气肿且呼吸频率(RR)<35次/min,B组16例为有肺气肿且RR≥35次/min者,C组5例为无肺气肿且RR<35次/min者,D组10例为无肺气肿且RR≥35次/min者。先对4组患者使用2~3cmH2O的PEEP或不使用PEEP,然后按一定的步骤根据具体情况进行调整,直至理想PEEP。结果A组PEEP适应率为81.8%,理想PEEP平均值为(5.5±3.4)cmH2O,其变异系数(CV)为61.8%;B组PEEP适应率为75.0%,理想PEEP平均值为(4.3±3.1)cmH2O,其变异系数为72.1%;C组PEEP适应率为60.0%,理想PEEP平均值为(3.2±2.5)cmH2O,其变异系数为78.1%;D组PEEP适应率为20.0%,理想PEEP平均值为(2.6±2.1)cmH2O,其变异系数为80.8%。4组总脱机成功率97.6%。结论判别PEEP治疗重症哮喘的适应性及理想PEEP,受是否合并肺气肿和呼吸频率快慢的影响较大,但也受其他诸多因素的影响,故使用PEEP治疗重症哮喘时要高度个体化。     

Psychosomatique de l’eczéma chez l’enfant : une problématique d’indifférenciation au sein du groupe familial

Our research consisted in evaluating the interference of the image family body in families concerned by dermatitis helped by a new projective tool: the family drawing of the dream house. We compared 28 drawings from children stuck down by eczema to 28 drawings from general population. Our results show a significative diminution of individuals’ spaces and a research of intimity, which reveals a family representation of a common body. This body prevails to the detriment of individuals building their seilf-sufficiency. The identity landmarks, less clear, would explain the identity troubles found in those cases and eczema would be the symptom.     

迭代重建技术与自动毫安控制相结合降低肝脏平扫辐射剂量的效果研究

目的：研究IRIS迭代重建技术与CARE dose 4D自动毫安控制相结合在肝脏平扫中对提高图像质量、降低辐射剂量的影响。方法（1）尸体标本研究：采用130 kV,mAs为250～30（每次递减20）的扫描参数对尸体标本上腹部进行扫描,对扫描后的原始数据分别进行IRIS与FBP重建,经测量分析后选择低剂量扫描IRIS重建后图像的噪声与常规剂量扫描FBP重建噪声相等的扫描条件进行临床研究。（2）临床研究：120例进行肝脏CT平扫的患者随机分为A、B 2组,每组60例。 A组采用130 kV、图像质量控制参考毫安秒150 mAs自动毫安控制进行扫描,分别进行IRIS与FBP重建;B组采用130 kV、250 mAs进行扫描,分别进行IRIS与FBP重建。记录2组患者CT容积剂量指数（CTDIvol）及剂量长度乘积（DLP）。由3名医师采用盲法对4组图像进行噪声测量、对比噪声计算等客观评价及主观图像质量评价。结果尸体标本研究得到规律：低剂量扫描IRIS重建后图像的噪声与常规剂量扫描FBP重建噪声相等时mAs可降低至150 mAs。将其应用到临床,临床研究扫描剂量为：A 组CTDIvol 为2?．35～16．3 mGy;DLP为63．4～287．5 mGycm。 B组CTDIvol为25．7 mGy;DLP为523．8～586．6 mGycm。 A组较B组降低了50％～70％。 A1、B1、B23组图像质量均满足临床诊断要求。 B1图像质量高于B2图像质量,A1图像质量与B2差异无统计学意义（ P＞0．05）,A2图像质量最差,不能满足诊断需要。结论迭代技术与自动毫安控制相结合相同剂量条件下可以提高图像质量,在保证图像质量条件下可以降低肝脏平扫的辐射剂量,值得临床推广。     

The graphical representation of the self-image in early development: twins and singletons in comparison

The construction of self, a fundamental process for development. Twins, as they grow together, may encounter greater difficulties in individuation process. The present study aims to investigate the construction of the image of the self and of the self with its own twin/sibling through the drawing of the human figure and to highlight any differences in these representations between monozygotic twins, dizygotic twins, and non-twins. A sample of 105 children aged between 4 and 6 years participated in the research. From the analysis of the drawings of the self and of the self with the sibling, differences in self-representation and representation with the sibling have emerged and can be understood in the light of the separation and individuation process that characterizes the development of the self-image. In particular, greater tendencies have emerged for monozygotic twins to represent themselves differently from the co-twin and for dizygotic twins to show identical figures.     

Timing of muscle activation in a hand movement sequence

Recent studies have described muscle synergies as overlapping, multimuscle groups defined by synchronous covariation in activation intensity. A different approach regards a synergy as a fixed temporal sequence of bursts of activity across groups of motoneurons. To pursue this latter definition, the present study used a principal component (PC) analysis tailored to reveal the across-muscle temporal synergies of human hand movement. Electromyographic (EMG) activity was recorded as subjects used a manual alphabet to spell a list of words. The analysis was applied to the EMG waveforms from 27 letter-to-letter transitions of equal duration. The first PC (of 27) represented the main temporal synergy; after practice, it began to account for more of the EMG variance (up to 40%). This main synergy began with a burst in the 4-finger extensor and a silent period in the flexors. There were then progressively later and shorter bursts in the thumb abductor, thumb flexor, little finger abductor, and finally the finger flexors. The results suggest that hand movements may be generated by activity waves unfolding in time. Because finger muscles are under relatively direct cortical control, this suggests a specific form of cortical pattern generation.