肢体严重毁损伤保留与否的循证思考

肢体严重毁损伤的修复是当今医学领域的一个研究热点.从循证医学角度对肢体严重毁损伤的保肢与截肢提出思考并加以阐述,同时结合当前我国医疗环境提出一些这方面的倡议.     

儿童创伤截肢

儿童意外伤害在国内外一直是受到普遍重视的问题,我国在这这方面的研究不多。严重肢体创伤的处理无论从专业理论还是在手术技巧上均要求很高,尤其对儿童肢体的毁损性创伤的治疗往往使临床医师常需在截肢与肢体挽救二者之间作出困难的选择。如何确定急诊截肢和保留肢体,国内外目前尚未有一个客观合理权威的标准。本文主要综述儿童截肢的标准和方法,以供参考。     

肢体延长与美容增高的启示

美容医学持续升温,“美容增高”即“肢体延长术”被越来越多的爱美男女所尝试。纵观其发展经历了许多挫折与失败,并发症多且严重,应慎重认识其实际效果。如不加选择地运用美容医学,是对医学核心价值体系的扭曲和嘲弄。只有坚持运用正确的哲学思维进行引导,肢体延长术才会健康发展。     

肢体延长与美容增高的启示

美容医学持续升温,"美容增高"即"肢体延长术"被越来越多的爱美男女所尝试.纵观其发展经历了许多挫折与失败,并发症多且严重,应慎重认识其实际效果.如不加选择地运用美容医学,是对医学核心价值体系的扭曲和嘲弄.只有坚持运用正确的哲学思维进行引导,肢体延长术才会健康发展.     

关于手术戒毒规范化开展的思考

吸毒成瘾是严重的医学和社会学问题.国内、外对吸毒成瘾采取的治疗方案由脱毒、防复吸和回归社会三个相互关联的方法构成.但收效甚微,复吸率居高不下.西安第四军医大学唐都医院神经外科在动物实验和借鉴以往经验的基础上,将立体定向技术用于毁损脑内与毒品心理依赖密切相关的关键位点的异常部分,对其异常功能进行调整,从而达到彻底戒毒的目的,取得了良好的疗效.本文介绍了手术戒毒在我国的发展历史,提出了规范化开展手术戒毒的建议.     

关于手术戒毒规范化开展的思考

吸毒成瘾是严重的医学和社会学问题。国内、外对吸毒成瘾采取的治疗方案由脱毒、防复吸和回归社会三个相互关联的方法构成。但收效甚微,复吸率居高不下。西安第四军医大学唐都医院神经外科在动物实验和借鉴以往经验的基础上,将立体定向技术用于毁损脑内与毒品心理依赖密切相关的关键位点的异常部分,对其异常功能进行调整,从而达到彻底戒毒的目的,取得了良好的疗效。本文介绍了手术戒毒在我国的发展历史,提出了规范化开展手术戒毒的建议。     

导言：创伤性截肢术简介

汶川大地震造成突发性、群体性肢体毁损。在救治工作中,为挽救部分患者的生命,接受伤员的医院对他们施行了截肢术。为配合医治此类伤员的需要,编辑部委托本刊编委秦泗河教授就此组织了一组文章。我们对秦泗河教授和各位撰文的专家表示衷心的感谢!     

论医学人文属性复归的途径

医学本是自然科学和人文社会科学的统一体,但因历史和现实的诸多原因,导致医学中人文属性的严重缺失.分析了人文缺失的直接原因和深层根源,强调了医学人文社会属性的不可缺失性,提出了医学人文属性复归之途径.     

国外伊斯兰学者对医学变性手术的看法

国外伊斯兰学者对医学变性手术的看法从恩霖编译随着医学科技的迅猛发展，很多疑难杂症患者都能得到治疗，恢复健康。特别是技术精湛的外科手术师们使许多残疾者的肢体得以恢复正常，为人类创造着一个个医学奇迹。医学领域的整形手术为诸多自卑、失望的畸形人带来了福音。...     

纳米医学的哲学迷思

1 纳米医学带来对医学技术本身的反思 纳米医学带来人们对医学技术本身的反思。纳米机器可以奇迹般地自组装生物制品和医药,进行人体血管的清洗和介入治疗,修复损坏的器官、进行人体肢体再生、人体整容等,这将大大改变医疗和生物技术的现状;模拟生物系统的各种各样的智能材料,这类材料能够适应变化的环境,     

试论“肝病传脾”的诊断及治疗思路

《金匮要略》中“肝病传脾”的思想,广泛应用于临床诊断与治疗,本文以脏腑经络辨证论治思想为依据,探讨中医诊断肝痛的思路：根据症状判断病位深浅,肝病见四肢疲乏为病轻、肝病见食不消化甚至不思饮食为病重。由此判断病情轻重,为临床提供治疗依据。     

临床外伤性视神经病变过度医疗的探讨

外伤性视神经病变是一类严重损害视功能的疾病,临床治疗上普遍存在着过度治疗的问题。原因是多样的,治疗标准不统一是主要原因。依据循证医学的成果,对临床外伤性视神经病变现阶段存在的过度医疗进行分析探讨,并提出了医者针对外伤性视神经病变过度医疗应采取的措施,获得最优化的诊疗方案。     

Commentary: Reintegrating psychology into an expanded biopsychosocial model of severe acute respiratory syndrome

The Special Issue highlights the importance of psychology in the research agenda on severe acute respiratory syndrome (SARS). The five articles examined relevant theories on social cognition and coping in the ecological context of the SARS outbreak. They provide preliminary tests to current psychological principles of coping and health psychology in a real crisis. The limitations of the studies are recognized. Other areas of psychological research on SARS are suggested. It is proposed that the biopsychosocial model of behavioral medicine could be expanded as a paradigm in public health to study and prepare for future emerging epidemics.     

高血压脑出血急诊救治现状与进展

高血压脑出血是指在高血压的情况下发生的脑实质内出血。目前急诊综合救治中内科药物和外科手术治疗为主要的两种方法。内科治疗只适用于轻度脑出血和有手术禁忌证及配合急诊外科手术的综合救治,外科手术多用在中、重度脑出血病人治疗中。近年来开展的一种在CT下三维定位脑内血肿清除术,以其定位准确,脑损伤小,在急诊救治方面取得了一定效果,有待于进一步发展。     

Ipsilateral eye contributions to online visuomotor control of right upper-limb movements

A limb’s initial position is often biased to the right of the midline during activities of daily living. Given this specific initial limb position, visual cues of the limb become first available to the ipsilateral eye relative to the contralateral eye. The current study investigated online control of the dominant limb as a function of having visual cues available to the ipsilateral or contralateral eye, in relation to the initial start position of the limb. Participants began each trial with their right limb on a home position to the left or right of the midline. After movement onset, a brief visual sample was provided to the ipsilateral or contralateral eye. On one third of the trials, an imperceptible 3 cm target jump was introduced. If visual information from the eye ipsilateral to the limb is preferentially used to control ongoing movements of the dominant limb, corrections for the target jump should be observed when movements began from the right of the body’s midline and vision was available to the ipsilateral eye. As expected, limb trajectory corrections for the target jump were only observed when participants started from the right home position and visual information was provided to the ipsilateral eye. We purport that such visuomotor asymmetry specialization emerges via neurophysiological developments, which may arise from naturalistic and probabilistic limb trajectory asymmetries.     

Evaluation of upper limb movements in children with Down’s syndrome: A systematic review

The aim of the present study was to perform a review of the literature on current quantitative clinical methods for the evaluation of upper limb movements in children and adolescents with Down syndrome, with a focus on describing the variables, protocols, motor function and motor control.MethodsA survey of PubMed, Scielo, BVS Bireme and PEDro databases using the following key words: upper limb and EMG and Down syndrome; upper limb and kinematics and Down syndrome; upper limb and motion analysis and Down syndrome; movement and upper limb and Down syndrome; upper limb and Down syndrome; reach and Down syndrome.ResultsIn all, 344 articles and five were selected to compose the present systematic review. No standardization was found among the studies analyzed with regard to data collection, data processing or procedures for the evaluation of the variables.ConclusionA kinematic evaluation is effective for the discussion of the results, but methodological differences among the studies and inconsistent results exert a negative influence on clinical interpretations and the possibility of reproducibility. The standardization of an upper limb movement evaluation protocol using kinematic analysis is important, as it would provide the basis for comparable, reproducible results and facilitate the planning of treatment interventions.     

Dissociations of writing and praxis: Two cases in point

For normal writing it is essential that both motoric and linguistic competence be present; disruption of one or the other of these faculties may result in qualitatively different types of agraphia. Two right-handed patients became agraphic after left hemisphere lesions; pure apraxic agraphia in the absence of limb apraxia developed in one patient and pure linguistic agraphia in association with severe ideomotor limb apraxia in the other. The performance of these patients not only serves to illustrate the dissociation between the motoric and linguistic faculties that underlie writing but also confirms that ideomotor limb apraxia and apraxic agraphia are distinct and dissociable entities.     

Ipsilesional Arm Aiming Movements After Stroke: Influence of the Degree of Contralesional Impairment

The authors examined the effects of the degree of impairment of the contralesional upper limb and the side of the hemispheric damage on ipsilesional upper limb performance in chronic stroke individuals. Right- and left-side stroke resulting in mild-to-severe impairment and healthy participants took part in simple and choice reaction time tasks involving aiming movements. The stroke individuals performed the aiming movements with the ipsilesional upper limb using a digitizing tablet to ipsi- or contralateral targets presented in a monitor. The global performance of the group with severe right hemispheric damage was worse than that of the other groups, indicating that the side of hemispheric damage and degree of motor impairment can adversely affect aiming movement performance.     

医院临床药学管理要注重药物经济学评价与研究

通过对医院临床药学管理的药物经济学评价与研究的重要性、药物经济学评价与研究的基本方法和技术的论述,提出在进行临床药学管理的同时,应注重和开展药物经济学评价与研究,使之成为医院临床药学管理重要方面。目前医院临床药物管理中需关注的评价与研究项目,包括医院药品费用评价和控制研究、医院用药目录评价和规范医生行为研究、药物的适用范围评价与科学合理性研究、患者选择药物行为评价和正确帮助择药研究。