胸腺五肽在中毒患者治疗中疗效观察

观察胸腺五肽在中毒患者治疗中的效果.选取ICU中毒患者共40例.分为试验组和对照组,试验组23例,对照组17例.试验组在基础治疗同时加用胸腺五肽,对照组只对症治疗.观察比较两组患者D1、3、5、7天的体温、白细胞计数、中性粒细胞计数、呼吸机辅助呼吸时间、镇静镇痛药物应用时间、C反应蛋白水平、病原学结果.两组D1体温、白细胞计数、中性粒细胞计数和CRP指标比较,差异无统计学意义(P＞0.05);在治疗D3、D5和D7两组白细胞计数比较,在治疗D3和D5两组中性粒细胞计数比较,在治疗D5和D7两组体温比较,在治疗D5两组CRP比较,差异有统计学意义(均P＜0.05).试验组应用呼吸机辅助呼吸时间短于对照组,差异有统计学意义(P＜0.001).试验组发生相关性感染例数少于对照组,差异有统计学意义(P＜0.05).胸腺五肽在中毒患者治疗的应用中,可调节患者细胞免疫功能,减轻炎症活动,联合应用并未增加药物副反应,并能最终改善预后.     

ERAS理念在老年股骨转子间骨折围手术期的应用

探讨与传统的围手术期干预方式相比,ERAS理念在老年股骨转子间骨折围手术期的应用效果。取自2017年1月～2018年1月,12个月内我院60例老年股骨转子间骨折经PFNA内固定手术治疗患者。经签署知情同意书,利用随机数表将患者随机分成试验组和对照组,每组30例,并做术前疼痛指标的评估笔记。随后对两组分别采用ERAS指导下的围手术期干预以及传统理念下的围手术期干预。两组患者术后6小时、24小时、3天、5天的疼痛情况进行VAS评分。对出院的患者进行术后为期1年的随访,评价髋关节的功能,并记录相关的数据信息。结果,试验组术后6小时、24小时、3天的VAS疼痛评分明显优于对照组(P0.05),5天的VAS评分两组无明显差距。试验组的术后卧床时间、住院时间、住院费用均明显少于对照组(P0.05),试验组术后一年髋关节Harris显著高于对照组评分(P0.05),ERAS理念指导下的围手术期干预术后效果优于传统方法,对减少患者术后痛苦,减轻患者及社会医疗负担有一定的意义。     

女性冠心病患者并发焦虑和抑郁的个性化干预效果评价及影响因素

评价女性冠心病患者伴焦虑抑郁的个性化干预效果并探讨影响因素.试验组进行个性化干预,对照组不做任何特殊处理.干预后试验组的焦虑自评量表和抑郁自评量表分数明显低于试验前(P＜0.01),而对照组无显著变化(P＞0.05);试验组的平均住院时间为11.36天,低于对照组的15.42天(P＜0.01);文化程度、公费比例、疾病认知和病程影响焦虑的干预效果,疾病认知和单身年限会影响抑郁的干预效果.采取个性化干预的综合治疗效果显著.     

高维持量氯吡格雷对急性冠脉综合征患者介入治疗后血小板功能的影响

探讨不同维持量氯吡格雷和替罗非班联用对急性冠脉综合征患者冠脉介入后血小板功能、疗效和安全性的影响.选择120例急性冠脉综合征(ACS)行冠脉介入治疗患者随机分为A组(n=60)和B组(n=60),B组在常规治疗的基础上给予氯吡格雷150mg/d 1个月.结果显示术前和术后1天A组和B组血小板聚集率和最大聚集时间、P选择素(P-sel)、可溶性CD40L(sCD40L)比较均无统计学意义,而术后3天、5天、7天B组显著降低(P＜0.05);出血发生率B组增高,但无统计学意义(P＞0.05),主要心血管不良事件(MACE)发生率B组显著性降低(P＜0.05).以此较高维持剂量氯吡格雷和替罗非班联用,不增加出血风险,提高疗效.     

术前定位对膀胱癌尿流改道腹壁造口患者生命质量的影响

探讨术前定位与膀胱癌尿流改道腹壁口患者生命质量及并发症的的影响。将2014年8月~2015年8月在昆明医科大学第二附属医院实施根治性膀胱全切+尿流改道腹壁造口术的82例患者随机分为试验组和对照组,试验组40例,对照组42例。对照组未行术前定位,试验组术前一天由国际造口师、责任护士、主管医生、患者共同行术前定位,对照组采用常规方法,麻醉后医生术中定位。采用患者生命质量测定量表体系之QLICP-BL(V2.0)、并发症发生率评价两组患者者术前、术后3个月、6个月生活质量及并发症。术后干预组患者心理功能(PSD)、社会功能(SOD)和尿路症状(UTS)、尿袋问题(BBP)得分均优于对照组,差异有统计学意义(P0.05);并发症发生率低于对照组。术前造口定位可降低膀胱癌尿流改道腹壁造口患者并发症的发生率,提高生命质量。     

高血压脑出血患者术后实施镇痛镇静治疗的临床效果

探讨高血压脑出血术后镇痛镇静治疗的临床疗效。将218例高血压脑出血患者随机分为两组,试验组患者术后应用舒芬太尼+地佐辛+咪达唑仑镇痛镇静,对照组单纯应用咪达唑仑,观察两组治疗效果。试验组患者术后镇静-躁动评分、血压达危险值例数、颅内压监测值、72h的NIHSS值、48h内再出血率、7d病死率、不良反应发生率均明显低于对照组,差异均有统计学意义(P0.05)。高血压脑出血患者开颅术后应用舒芬太尼+地佐辛+咪达唑仑镇痛镇静,可减少患者术后躁动,稳定血压及颅内压,保护神经功能,降低颅内再出血率、病死率、不良反应发生率,值得临床应用和推广。     

血清Cys C的检测对肾移植术后患者肾功能评价的临床意义

探讨分析血清胱抑素C(Cys C)水平在肾移植术后患者肾功能监测中的应用价值.对25例肾移植成功患者在术前、术后第1、3、5、7、10天的血清Cys C、Scr、β2-MG、BUN水平进行动态监测,同时随机抽取健康体检者中的20例作为对照组.发现移植组的Cys C、Scr、β2-MG、BUN水平在术前均明显高于健康对照组(P＜0.01).这四项指标在手术后第一天都有所下降,且术后第1、3、5、7、10天的水平都比术前低(P＜0.01).四项指标与GFR的关系均为显著性负相关(P＜0.01),其中血清Cys C与GFR的相关性最好.Cys C、Scr、β2-MG、BUN检测后的ROC曲线下面积分别是:0.937、0.838、0.798、0.772,其差异都具有统计学意义(P＜0.05).血清Cys C优于Scr、β2-MG、BUN,在肾移植患者术后的动态监测中具有重要的临床应用价值.     

高凝状态肿瘤患者抗凝联合化疗的临床观察

观察伴高凝状态恶性肿瘤患者抗凝联合化疗的临床疗效.观察组68例,给予一线标准方案化疗,同时给予低分子肝素钙6 000U,1次/d,皮下注射,阿司匹林100mg口服,1次/d,21d为1个周期,共2个周期.对照组56例,给予一线标准方案化疗.结果显示,治疗组和对照组有效率分别为23.69％和19.44％,两组比较,差异无统计学意义(P＞0.05);治疗组和对照组生存状态评分(KPS)改善率分别为64.71％和35.39％,两组比较,差异有统计学意义(P＜0.05).治疗组出现了纤维蛋白原(Fbg)、组织因子(TF)和D-二聚体(D-D)含量的降低,与对照组相比差异有统计学意义(P＜0.01).从而得出伴高凝状态恶性肿瘤患者进行抗凝联合化疗,临床疗效较好,同时可以降低血液高凝状态和血栓形成的风险.     

加压空心钉固定技术对比锁定钢板技术治疗桡骨远端骨折的疗效分析

对比不同手术方法对桡骨远端骨折的疗效.收集我院自2008年10月到2012年12月桡骨远端骨折患者86例,双盲随机分成试验组和对照组,试验组采用无头加压空心钉内固定,对照组采用锁定钢板内固定,比较两组的平均手术时间和平均术中出血量.术后12个月采用Jakim标准进行腕关节功能评定,同时对随访患者的腕关节功能进行临床评分.试验组平均手术时间为（30.45±5.14）min,显著低于对照组的（63.42±8.14）min（P＜0.05）,而试验组平均术中出血量为（23.67±6.14）ml,少于对照组的（83.12±10.47）ml（P＜0.05）.术后随访试验组腕关节功能优良率为87.5%;对照组则为87.1% （P＞0.05）,试验组和对照组腕关节在功能、握力活动范围等方面评分存在显著差异,在疼痛评分上两组无明显差异.采用无头加压空心钉治疗桡骨远端骨折可以显著减少手术时间及术中出血,提高腕关节功能而且在疗效上与传统锁定钢板治疗桡骨远端骨折相比无明显差异.     

高通量血液透析对老年患者并发症的临床观察

研究高通量血液透析对老年透析患者常见并发症治疗的疗效.通过前瞻性试验研究,试验组为18例老年透析患者采用高通量血液透析,对照组为28例老年透析患者采用常规维持性血液透析.试验1年后分别测定顽固性高血压、症状性低血压、肌痉挛、心律失常、心绞痛及皮肤搔痒的发生率.结果试验组透析患者并发症明显缓解,对照组发生率明显上升(P＜0.05).因此,高通量血液透析可以明显降低透析相关并发症的发生,改善患者生活质量和生存质量.     

Together – apart: in touch in a time of separation

This paper explores the experience of working as a Jungian analyst through the various phases of the global COVID-19 pandemic, examining the importance of the physical containing space alongside the analyst’s internal mind and how technology can both help and hinder understanding. A number of clinical vignettes illustrate the challenge of communicating over a distance, paying particular attention to the way countertransference phenomena can become re-attuned. Reference is made to mythology and symbols of hope, and consideration given to the meaning and purpose of the pandemic.     

Language,politics and dreams: the challenges of building resilience in refugees

This paper describes a case study of a 60-year-old Peruvian refugee in some detail, focusing on the importance of building emotional resilience in a patient in Spanish in order to create a space for learning the English language – the patient did not speak English after 20 years of living in Britain. The work was carried out with an interpreter and some of the literature on working with interpreters is referred to. The paper also briefly outlines the refugee journey in broad terms, which is a journey from the culturally known to the culturally unknown. The question of how well the literature on resilience, which sits firmly within a Western developmental perspective, can be applied to refugees, most of whom come from group and family-based cultures dominated by ideas of honour and shame, is discussed. The paper also touches on the importance of the receiving country enabling or not, as the case may be, a transitional space for refugees who have lost their home and are seeking to find a safe haven in a strange culture.     

Phenotypic plasticity and archetype: a response to common objections to the biological theory of archetype and instinct

Since Jung’s death in 1961, scholars have attempted to integrate growing biological science data into Jungian concepts such as the collective unconscious, instincts and the archetypes. This enterprise has been challenging due to persistent false dichotomies of gene and environment occasionally arising. Recent works by Roesler (2022a, 2022b) for example, have raised objections to the biological theory of archetypes, but the objections are plagued by such dichotomies. The concept of phenotypic plasticity, however, helps to both avoid this problem as well as bridge the gap between competing theories into a more integrated model with solid biological foundations.     

The Possibility of Meaning in Human Evolution

Science undermines the certitude of non-naturalistic answers to the question of whether human life has meaning. I explore whether evolution can provide a naturalistic basis for existential meaning. Using the work of philosopher Daniel Dennett and scientist Ursula Goodenough, I argue that evolution is the locus of the possibility of meaning because it has produced intentionality, the matrix of consciousness. I conclude that the question of the meaning of human life is an existentialist one: existential meaning is a product of the individual and collective tasks human beings undertake.     

When is it time to stop? When good enough becomes bad enough

This article draws on Winnicott’s concept of the good enough mother to discuss how to know whether a therapeutic situation is good enough to continue or bad enough to end. This dilemma is explored in terms of clinical syndromes, such as anorexia and pathological gambling, but focuses mainly on analyst-initiated endings, which are termed the ‘Casablanca dilemma’, based on an amplification of the ending of the film Casablanca. The author goes on to discuss such one-sided endings, drawing on interviews with 40 analysts and therapists about their clinical experience. A typology of bad enough endings is presented. The psychological differences between a good enough analysis as opposed to a bad enough one are explored through the ideas of Winnicott and Neumann.     

Seeing in the Dark: A View into Dissociation and Healing

In this paper, I will explore the role of art-making, the experience of trauma and dissociation, and the process of working with self-states from an analytic and creative frame. Relevant literature on dissociation, trauma, and the use of art will be discussed. A case involving my work with an adolescent girl who had experienced sexual abuse from a family member will be shared, with an emphasis on the meaningful role images played during the therapeutic process. Both Jungian and psychoanalytic models of conceptualizing and working with dissociation are included, following Donald Kalsched’s (2013) recommendation for a “binocular stance” to treatment, including both a focus on the inner, intrapsychic world and the interpersonal, relational realm, and how art images both illuminated and expressed these realms. Within the therapeutic process, art images allowed the therapist a view into the client’s unconscious process, and created a meeting ground for dissociative barriers to be gradually seen, felt and known, by both therapist and client. The experience of dissociation, in images and in session, provided a reference point for myself and my client, Taylor, to develop a shared understanding and a framework for growth.     

The transcendent function in Spitteler’s Prometheus and Epimetheus

In August 2020, John Beebe and Steve Myers met via Zoom to discuss their differing interpretations of psychological typology and the different sources within Jung’s writings that influenced their books: Integrity in Depth: Energies and Patterns in Psychological Type (Beebe), and Myers-Briggs Typology vs Jungian Individuation (Myers). The discussion centred on Spitteler’s epic poem Prometheus und Epimetheus, which forms the basis of chapter V of Psychological Types. This is both the largest chapter and one of two chapters that Jung highlighted in the Argentine foreword as containing the essence of the book. Jung’s book is primarily about the transformation of personality rather than the categorization of people. Although it contains a critical psychology that deconstructs the nature of consciousness, that is only one half of the book and a stepping-stone to the other half, which is the reconciliation of opposites with particular emphasis on the relation of consciousness and the unconscious. Jung assumed that readers were already familiar with Prometheus und Epimetheus, an understanding of which sheds light on the nature of the transformation that Jung described – the development of a new attitude towards attitude itself.     

Kann Es Ein Argument Für Den Skeptizismus Geben? Das Epistemische Problem Der Irrtumsmöglichkeit

Summary  Is there any argument for scepticism? The epistemic problem of the possibility of error. Arguments for scepticism rest on the assumption that knowledge claims are fallible. For this reason the concept of knowledge appears to be questionable. Since it is necessary to distinguish doubts from possible doubts, the arguments for scepticism appear to be unconvincing. If we take it into account that we know something that is immune to doubt, we should draw the conclusion that, contrary to scepticism, knowledge claims have to be compatible with being fallible. Thus any knowledge claim is capable of being doubted.     

Chapter 6: Biblical Foundations for a Practical Theology of Aging

SUMMARY

This article reviews Biblical sources pertaining to the elderly, particularly the frail elderly. Founded on these sources, implications for elderly with Alzheimer's Disease and other forms of dementia are addressed through a personal perspective informed by writings of Christian mystics.