活体器官移植中的矛与盾

随着临床医学的发展和免疫隔离技术的开发利用,器官移植目前已经被公认为是治疗终末期疾病的一个临床选择,本文综述器官移植中供体短缺与活体器官移植的优势与风险、活体器官移植后抗排斥与防治感染的问题以及哲学思想在器官移植诊疗过程中的指导作用.     

活体器官移植中的矛与盾

随着临床医学的发展和免疫隔离技术的开发利用,器官移植目前已经被公认为是治疗终末期疾病的一个临床选择,本文综述器官移植中供体短缺与活体器官移植的优势与风险、活体器官移植后抗排斥与防治感染的问题以及哲学思想在器官移植诊疗过程中的指导作用。     

移植排斥反应中若干问题的思考

随着器官移植术和免疫抑制药物的发展,器官移植已成为挽救各类终末期器官功能衰竭患者的最有效手段。然而,移植排斥反应依然是困扰移植学界的难题。移植排斥反应的发生机制和治疗过程中体现了矛盾的普遍性和特殊性,用辩证思考的方法可以有效地指导移植排斥反应机制研究和临床治疗。     

异种器官移植及其伦理问题

目前,开展的异种移植研究主要以猪为供体源,面临的主要障碍是宿主抗移植物的免疫排斥反应(超急性排斥、急性排斥和慢性排斥)和猪内源性反转录病毒感染,并已取得一定进展.但异种移植引发的伦理问题也不容忽视,主要有跨物种感染、卫生资源分配、动物的权利和人格同一性等问题.     

农民工社会排斥的制度内与制度外分析——杭州市的个案研究

本文通过对杭州市农民工的实地访谈发现,移徙工人在城市就业过程中不仅面临着制度性的排斥,而且也遭到非制度性的排斥.这种制度性的社会排斥主要表现为体制性的排斥、规范性的排斥和执行性的排斥;非制度性的排斥既来自于城市市民,也源自于农民工群体内部的竞争性排斥和强权性排斥.在上述发现的基础上,文章讨论了西尔弗提出的社会排斥范式的表现形式.作者认为,中国农民工在城市就业过程中受到的社会排斥符合垄断性排斥范式的特点,但是又有自己独特的表现形式,类似于费孝通所说的差序格局.     

Cys C在肾移植后急性排斥反应诊断中的价值

探讨Cys C在肾移植术后诊断急性排斥反应中的价值.63例肾移植患者分为肾功能稳定组(49例)和排斥组(14例),选10例单纯感染患者为对照组,检测Cys C值,并与正常对照组(60例)比较.术后监测稳定组和排斥组Cys C、BUN、SCr及CCr,对排斥组排斥前后Cys C浓度变化以及Cys C与SCr、CCr关系进行分析.结果为排斥组排斥前与排斥时CysC浓度差异有统计学意义(P＜0.01);CCr在稳定组和排斥组与SCr、CysC均呈直线相关;感染组CysC与正常对照组差异无统计学意义(P>0.05).说明Cys C可以用于肾移植术后急性排斥反应的早期诊断及与单纯感染鉴别诊断.     

保护胰岛移植物的基因治疗策略

胰岛移植是一种有望治愈糖尿病的方法,但胰岛进入体内后,由于排斥反应和其他刺激因素而使大量胰岛遭破坏,因此,减少胰岛破坏对保证移植成功非常重要.作为细胞移植物的胰岛非常适合在体外进行基因修饰,移植前对胰岛进行基因治疗以减轻局部免疫反应或增强胰岛细胞抗凋亡能力是一种极具吸引力的方法.基因转移载体及靶基因的选择是基因治疗中的关键策略.     

肺移植术治疗终末期肺淋巴管平滑肌瘤病临床探讨

探讨肺移植治疗终末期肺淋巴管平滑肌瘤的手术适应证、手术方式和术后并发症.回顾性分析1例肺淋巴管平滑肌瘤终末期患者行右侧单肺移植术的临床资料.术后患者恢复良好,未出现支气管、肺动静脉吻合口并发症,肺功能明显改善,顺利出院.术后生存3年,死于对侧肺过度膨胀,移植肺感染.肺淋巴管平滑肌瘤终末期行肺移植术能明显改善肺功能,但单肺移植术后易出现对侧自体肺过度膨胀,尽可能选择双肺移植.     

构建职场排斥三方互动的理论模型——社会平衡理论的视角

职场排斥是一个多方互动的过程, 不仅牵涉到被排斥员工, 其他参与方对于职场排斥的产生和发展也能起到关键的作用。然而, 以往的研究大多采用被排斥者的视角, 研究职场排斥对其造成的影响, 未能全面揭示职场排斥的互动过程。从社会平衡理论的视角出发, 职场排斥可被视为被排斥者、排斥者及第三方互动的结果, 排斥者特点、第三方道德判断、排斥者与第三方交互作用都将影响职场排斥的发生及发展。由此, 职场排斥的理论视角能够得到有效拓展, 管理实践也能从中获得抑制职场排斥行为的启示。     

中国心脏移植的现状与未来

1967年 12月 3日南非的Ｂａｒｎａｒｄ医生成功地完成第一例同种异体原位心脏移植 ,此后的几年间全世界每年心脏移植病例不超过 5 0例 ,80年代逐渐增加 ,到 1990年每年即达到并维持于 35 0 0例 ,其中有数百例为儿童心脏移植。国内张世泽 1978年进行了首例心脏移植 ,目前施行过此手术的医院并不多 ,且未作为常规手术。同国外相比 ,国内有以下特点。1　经费问题国外 1例心脏移植约需 5万～ 6万美元 ,国内所需费用更高。因为费用的高低和经验的多少有一定的关系 ,经验的积累在一定程度上可以减少医疗费用的支出[1] 。中国的一般家庭难以承担如…     

Religion and the Catholic Church’s View on (Heart) Transplantation: A Recent Statement of Pope Benedict XVI and its Practical Impact

Heart transplantation is performed on approximately 4,000 patients per year worldwide and is considered the last resort for treatment of end-stage heart diseases. Due to persistent organ shortage, resources are limited, waiting periods are extensive, and patients still die while being on a waiting list for transplantation. The role of all churches and the support of the representatives of the churches are critical for the spiritual wellbeing of patients awaiting heart transplantation as well as for prospective individual organ donors and their families. The supportive role of the Roman Catholic Church and the recent statement of Pope Benedict XVI on organ donation are discussed.     

Retraction Note: Globalization and vulnerable populations in times of a pandemic: A Mayan perspective

Understanding representations of disease in various art genres provides insights into how patients and health care providers view the diseases. It can also be used to enhance patient care and stimulate patient self-management. This paper reviews how cardiovascular diseases are represented in novels, films, and paintings: myocardial infarction, aneurysm, hypertension, stroke, heart transplantation, Marfan’s disease, congestive heart failure. Various search systems and definitions were used to help identify sources of representations of different cardiovascular diseases. The representations of the different diseases were considered separately. The Common Sense Model was used a theoretical model to outline illness perceptions and self-management in the various identified novels, films, and paintings. Myocardial infarction followed by stroke were the most frequently detailed diseases in all three art genres. This reflects their higher prevalence. Representations ranged from biomedical details through to social and psychological consequences of the diseases. Artistic representations of cardiovascular diseases reflect cognitions, emotions, and images of prevalent disease. These representations shape views and behaviour of ill and healthy persons regarding heart diseases. As these representations are amenable to change, they deserve further research, which may be instrumental in improving the quality of life of persons struck by cardiovascular diseases. Changing illness perceptions appears to be a method to improve self-management and thereby quality of life in patients with various cardiovascular diseases.     

Transplantation: Biomedical and Ethical Concerns Raised by the Cloning and Stem-Cell Debate

Transplantation is becoming an increasingly more common approach to treatment of diseases of organ failure, making organ donation an important means of saving lives. Most world religions find organ donation for the purpose of transplantation to be acceptable, and some even encourage members to donate their organs as a gift of love to others. Recent developments, including artificial organs, transplants from nonhuman species, use of stem cells, and cloning, are impacting the field of transplantation. These new approaches should be discussed with bioethical considerations in mind, particularly the notion of human beings as a unity of body and spirit.     

The five elements and Chinese-American mortality.

D. P. Phillips, T. E. Ruth, and L. M. Wagner (1993) reported that 1969-1990 California mortality data show that Chinese Americans are particularly vulnerable to diseases that Chinese astrology and traditional Chinese medicine associate with their birth years. For example, because fire is associated with the heart, a Chinese person born in a fire year (such as 1937) is more likely to die of heart disease than is a Chinese person born in a nonfire year. However, many diseases were excluded from this study, some diseases that were included have ambiguous links to birth years, and the statistical tests were indirect. A more complete statistical analysis and independent California mortality data for the years 1960-1968 and 1991-2002 did not replicate the original results.     

肝移植的伦理学问题

肝脏移植和其它器官移植一起实现了人类长期以来渴望生命再生的梦想,并成为终末期肝病的有效治疗方法。器官移植也面对许多伦理道德方面的难题。供体,特别是活体器官的摘取,受体的选择等,都受到社会道德观的制约。从伦理道德角度来分析如何制定相关的法律法规,成为当前社会关注的热点。从受体的利益、人体科研的道德规范以及相关制度的伦理学要求等方面,较为详细的阐述肝移植伦理学的基本原则。     

关于异种器官移植的问题

随着器官移植的广泛开展,器官短缺的问题日渐突出,８０年代末起异种器官移植的应用引起人们的重视,并形成热潮。但研究表明,克服异种移植排斥非易事,异种器官移植可能引起的病毒性疾病的传播,以及异种器官分子不相容性造成的种属屏障,都使异种器官移植的前景难料。     

活体肝移植应用及其伦理学思考

目前,肝移植已成为治疗终末期肝病的有效手段。活体肝移植术部分解决了供肝短缺的问题,10多年来发展迅速,并取得了良好的疗效。但开展这一技术时务必需要遵循知知情自愿原则和利益和风险并存等原则,注意活供体肝移植在伦理学方面尚未解决的问题。     

Maximal care considerations when treating patients with end-stage heart failure: ethical and procedural quandaries in management of the very sick

Deciding who should receive maximal technological treatment options and who should not represents an ethical, moral, psychological and medico-legal challenge for health care providers. Especially in patients with chronic heart failure, the ethical and medico-legal issues associated with providing maximal possible care or withholding the same are coming to the forefront. Procedures, such as cardiac transplantation, have strict criteria for adequate candidacy. These criteria for subsequent listing are based on clinical outcome data but also reflect the reality of organ shortage. Lack of compliance and non-adherence to lifestyle changes represent relative contraindications to heart transplant candidacy. Mechanical circulatory support therapy using ventricular assist devices is becoming a more prominent therapeutic option for patients with end-stage heart failure who are not candidates for transplantation, which also requires strict criteria to enable beneficial outcome for the patient. Physicians need to critically reflect that in many cases, the patient’s best interest might not always mean pursuing maximal technological options available. This article reflects on the multitude of critical issues that health care providers have to face while caring for patients with end-stage heart failure.     

Reactions to Patients' Self-or Chance-Blaming Attributions for Illnesses Having Varying Life-style Involvement

The effects of the perceived accuracy of attributions of self blame and chance blame were examined in the context of health care. Health practitioners ( N = 147) rated interviews in which patients made self-or chance-blaming attributions for diseases with high (heart attack, stroke), or low (cancer, arthritis) life-style involvement, or acidental injuries. Three discriminant analyses yielded p < .001. Self-blaming heart and stroke patients were rated as coping better and acting more appropriately and typically than chance blamers. Other self blamers were rated as more depressed, poorly adjusted, coping poorly, not accepting disability, needing counselling and information. Additionally, self-blaming accident victims were judged as more dependent, less likeable, and having poorer prognoses than chance blamers. Realistic self blame for life-style diseases did not lead to victimization, but other self-blaming patients were stigmatized and the adaptiveness of self blame as a coping strategy was unrecognized.