干细胞移植治疗冠心病的现状与未来

冠心病仍然是全球的主要死亡原因。其所造成的心肌梗死及慢性心力衰竭对生活质量的影响和由此造成的高额医疗费用促使我们不断寻求新的医疗措施。近几年有关干细胞用于心肌梗死后心肌再生、心肌内新生血管形成,可能还会改善梗死后的心功能的研究成为心脏病学研究的最热门领域。尽管干细胞治疗有可能使心力衰竭的治疗得到彻底的革命,但仍有部分问题需要澄清。已发表的各个研究结果设计不尽相同,致使对该项治疗的效果较难得出一致的结论。但这些研究都强调干细胞治疗在未来心血管疾病的治疗中可能会发挥较大的作用。干细胞治疗与药学、外科及介入治疗的结合会显著改善冠心病患者的预后。     

骨髓间充质干细胞移植治疗对心肌梗死后心功能的影响

目前心肌梗死常规治疗不能修复已死亡或者濒死的心肌,应用干细胞替代受损或死亡的心肌细胞来改善心功能,已成为近年来国内外研究的热点。骨髓间充质干细胞通过修复坏死心肌、促进血管新生等改善心梗后心功能,其移植治疗有望成为治疗心肌梗死的一个全新方法。     

冠心病介入治疗过度应用的分析和对策

介入治疗是冠心病治疗的重要进展和手段之一,可以改善急性心肌梗死患者的生存率.但目前也出现了过度使用的问题.冠心病本身的特点、医生对冠心病治疗认识不全面和现行医疗制度的不合理部分是其产生原因;建立正确的冠心病诊治策略,深入改革医疗体制,加强医师职业道德培养,同时注意辩证分析过度医疗才能科学合理的应用介入治疗造福冠心病患者.     

急性心肌梗死治疗的临床试验分析

急性心肌梗死是冠心病中的危重症,病死率高。为在现有基础上进一步降低病死率,临床开展了众多针对各治疗策略的大型试验研究。在分析这些临床试验的基础上,从提高梗死血管开通率、改善心肌微循环灌注、挽救心肌和休克治疗四个方面综述了各种治疗策略的优势及不足,以期对临床治疗方案的选择起到借鉴作用。     

心力衰竭的药物及非药物治疗

神经内分泌激活、心室重构是收缩性心力衰竭进展的关键机制,针对上述机制的生物学治疗包括血管紧张素转换酶抑制剂、β受体阻滞剂、盐皮质激素受体拮抗剂等可显著改善心力衰竭患者预后,利尿剂、洋地黄等常规药物治疗可改善心力衰竭症状、降低心力衰竭住院风险,为神经内分泌拮抗剂的应用奠定基础;近年来,从阻断心力衰竭发生机制方面研发了很多新药,但尚没有一种能对长期生存率有显著改善.器械治疗(植入型心脏复律除颤器、心室再同步和心室再同步心脏复律除颤器)可降低特定心力衰竭患者病死风险,预防猝死发生,显著改善预后;心室辅助装置及干细胞治疗则为心力衰竭治疗带来新的曙光.     

2010年我国急性ST段拾高型心肌梗死诊断与治疗指南解读评析

近年来我国急性心肌梗死的发病率一直呈明显上升趋势,已接近国际平均水平.对于STEMI版早期诊断并及时开通梗死相关动脉、增加心肌再灌注、防止心肌进一步坏死,可显著降低心血管事件的发生.本文从STEMI的诊断、早期医疗、再灌注治疗、辅助治疗及二级预防等几个方面对2010年我国急性ST段抬高型心肌梗死的诊断与治疗指南进行了详细解读分析.     

从指南看冠心病降脂治疗的现状及分析

层出不穷的试验研究和不断更新的指南使人们对冠心病防治的认识不断加深,但指南的实施和普及却不理想,大多数冠心病患者并未真正受益于降脂治疗.现就NCEP-ATP指南的更新和目前冠心病患者降脂治疗的现状、主要影响因素(患者的依从性、医务工作者的医疗质量、药物有效性以及效价比与经济条件)及可能的改善措施做一综述.     

心力衰竭治疗中的个体化和系统论原则

心力衰竭治疗中的个体化和系统论原则中国中医研究院西苑医院心血管科（北京１０００９１）徐凤芹虽然利尿剂、洋地黄制剂、血管扩张剂是治疗的“三大法宝”，但不问病因，一律采用强心、利尿、扩血管治疗，会造成许多不良后果。洋地黄类制剂能直接增强心肌收缩力，提高心...     

2010年我国急性ST段抬高型心肌梗死诊断与治疗指南解读评析

近年来我国急性心肌梗死的发病率一直呈明显上升趋势,已接近国际平均水平。对于STEMI版早期诊断并及时开通梗死相关动脉、增加心肌再灌注、防止心肌进一步坏死,可显著降低心血管事件的发生。本文从STEMI的诊断、早期医疗、再灌注治疗、辅助治疗及二级预防等几个方面对2010年我国急性ST段抬高型心肌梗死的诊断与治疗指南进行了详细解读分析。     

肥胖致心肌脂毒性的机制的研究进展

肥胖是体内脂质过度沉积的一种状态,其不仅可引起糖脂代谢紊乱、胰岛素抵抗,从而继发糖尿病、高血压、冠心病等疾病,而且当脂质水平超过脂肪细胞的储存容量及出现胰岛素抵抗时,血液中游离脂肪酸含量会随之升高,进而可引起脂质在心脏的异位沉积.沉积于心肌细胞的脂质可进一步通过神经酰胺、内质网应激等机制影响心肌细胞的结构和功能,最终导致心力衰竭的发生.但肥胖所致心肌脂毒性具体机制不明,本文就肥胖所致心肌脂毒性可能机制做一综述.     

Make New Friends but Keep the Old: The Sisterhood Bonds that Have Shaped Me

The relationships in an Asian American psychologist's life have helped to shape her as a person as well as a professional. Specifically, a review of significant female relationships indicates that they have contributed to the author's therapeutic style. In this article, the author explores some of the relationships with other women in her life and illustrates how they have informed her role as a therapist. She concludes with a case vignette illustrating how some of these concepts were applied to a long-term therapy client.     

归因疗法——一种重要的心理治疗方法

归因疗法是心理治疗的重要方法之一。迄今为止 ,人们已经发展了运用归因理论于治疗实践的两种一般模式 :“真归因疗法”引导患者用准确的归因代替错误的归因 ,“误归因疗法”引导患者用不准确而有益的归因代替准确而有害的归因。归因疗法受到了其他心理治疗理论的怀疑和批评。     

Three Contributions of Personal History

SUMMARY

Who we are becomes manifest as we conduct therapy. Much of the flavor and strength of our therapeutic style, as well as our errors, can be traced to our personal history. This history provides us a storehouse of memories which enrich our sessions. It also helps determine our chosen therapeutic stances. One of the dilemmas for all therapists is the extent to which we will use transparency and self revelation as an ingredient in our work. The final section of this paper explores the pros and cons of sharing our life stories with our clients.     

An Integration of Feminism into Experiential Psychotherapy

Abstract

Feminist therapy altered how marriage and family therapists conceptualized their clients’ realities and psychopathology. Upon an extensive search of the literature, there is a sparse amount of literature regarding the integration of feminist therapy with experiential therapy. The authors discuss feminist and experiential therapy models, propose a model of feminist-experiential therapy, and highlight the need and fit of these theories. A discussion on giving space to silenced voices, establishing an egalitarian relationship, expanding the definition of deviance, and exploring the importance of language will be done to aid the experiential therapist in their work and expand their client’s experience.     

The Process of Systemic Change in Filial Therapy: A Phenomenological Study of Parent Experience

This phenomenological study represents the first qualitative exploration of parents’ experiences of the process of filial therapy from a systemic lens. Filial therapy is a treatment approach that teaches parents how to conduct weekly thirty minute play times with their target child at home in an effort to improve the parent–child relationship. Previous research has focused almost exclusively on the impact of this model on this relationship; however, the results from this focus group study (n = 8) indicate several relational shifts that occur within the greater family and societal contexts and suggest potential reasons for treatment gain maintenance over time.     

What Are the Main Differences Between Behavioral and Systems Therapy with Couples? A Critical Account

This paper describes the main differences between behavioral and systems therapy with couples. To improve clinical decision making for a given case, the theoretical assumptions of the chosen treatment approach need to be clearly understood. Contrasting the two approaches will assist couple therapists in providing clinical services that better reflect the chosen theoretical framework. This paper reviews the common elements that can be found across models. A case example is presented to demonstrate the use of the therapy's theories and techniques.     

David and Judith

SUMMARY

This paper begins with a discussion of Dialogicai Psychotherapy-that “healing through meeting” which comes when the relation between therapist and patient is central-and explores inclusion, making present, confirmation, and the “normative limitation of mutuality.” Secondly, it discusses a Dialogicai Psychotherapy particularly important for couples therapy-Ivan Bos-zormenyi-Nagy's Contextual (intergenerational family) Therapy with its emphases on multidirected partiality, trustbuilding, rejunction, and the intergeneration merit ledger. The third part of the paper applies Dialogicai and Contextual therapy to the case of David and Judith, a couple who show clearly the importance of families of origin.     

Continued Evolution of Family Therapy: The Last Twenty Years

There have been numerous accounts of the history and major trends and issues in family therapy during the field's first three decades in the literature (see for example: Broderick & Shrader, 1981; Framo, 1972; Guerin, 1976; Kaslow, 1973, 1977, 1980; Nichols, 1986, 1999 for some varied depictions, written from each respective author's unique lens). Viewed as a set, packaged with different, yet interrelated contents, they offer a multihued portrait of the emerging field during its infancy, childhood, and adolescence. Now it is time to move on and look at the adulthood era as it has unfolded.     

A Cognitive-Behavioral Approach to Family Therapy

Although cognitive behavioral spectrum approaches with individual children are plentiful and demonstrate effectiveness, cognitive behaviorally oriented clinicians are frequently left to their own devices when it comes to treating families. Cognitive behavioral family therapy is a relatively recent development and there are precious few reports of its clinical use. This article presents a conceptual foundation and clinical rubrics for the practice of cognitive behavioral family therapy. Basic theoretical background information is presented and places the therapeutic processes and procedures in a proper context. Session structure in cognitive behavioral therapy is illustrated and the way it propels therapeutic momentum and adds focus to each session is explained. Rudimentary processes of self-monitoring, self-instruction, rational analysis, and behavioral enactment are described and augmented with case material. Finally, the conclusion offers directions for further theory building, research, and clinical practice.     

Systems and Solutions: The Discourses of Brief Therapy

The author describes how brief therapy has evolved in the past 10 to 15 years from ecosystemic to solution-focused brief therapy. SFBT is characterized as a radically constructivist approach to personal problems which emphasizes how troubles and solutions are socially constructed realities.