浅析骨关节炎的几个认识误区

骨关节炎(osteoarthritis,OA)的病因复杂,不只是老年人才患的疾病.骨质增生作为OA的继发性改变,已经明确,不应误解甚至误导患者滥施治疗.运动损伤可以促成OA;运动疗法又可以改善OA的症状和功能,有益于身体健康.要立足于现代医学、循证医学,以客观的立场辩证的角度去看待OA,才能不断提高对此类疾病的认识和诊治水平,更好地服务于人民群众.     

骨性关节炎治疗现状

骨性关节炎（OA）也称骨关节病或退行性骨关节病。是中老年常见病。以关节软骨退行性改变为核心,累及骨质并包括滑膜、关节囊及关节其它结构的全方位、多层次、不同程度的慢性炎症。主要症状为关节疼痛,活动时加重,晨间起床时发生,稍活动后反而减轻,活动过度又加重。随着我国人口老龄化时代的到来,OA发病日趋增多,据统计,50岁以上人群中50％患有OA,65岁以上人群中90％的女性和80％的男性,70岁以上约100％有这种关节退行性改变,目前我国OA患者约有1亿以上,门诊的膝痛患者一多半是骨性关节炎。OA作为一种最常见的关节疾息,是影响老年人生活质量的最常见原因之一,其中髋膝骨性关节炎对老年人的生活起居影响最明显,其发生率约为3％～9％。本文就髋膝骨关节炎为例探讨骨关节炎发病原因及治疗现状。     

如何看待腹腔镜阑尾切除术

随着微创技术的发展,腹腔镜阑尾切除术（1aparoscopic appendectomy,LA）正逐渐被广大医务工作者所接受,但现在仍然有很多人认为LA与传统开腹阑尾切除术（open appendectomy,OA）相比没有优势,而且LA价格昂贵,不适合推广。但是作为正在发展完善的新技术,很多证据表明LA与OA相比优势正在逐步增强。     

如何看待腹腔镜阑尾切除术

随着微创技术的发展,腹腔镜阑尾切除术(1aparoscopic appendectomy,LA)正逐渐被广大医务工作者所接受,但现在仍然有很多人认为LA与传统开腹阑尾切除术(open appendectomy,OA)相比没有优势,而且LA价格昂贵,不适合推广.但是作为正在发展完善的新技术,很多证据表明LA与OA相比优势正在逐步增强.     

如何看待腹腔镜阑尾切除术

随着微创技术的发展，腹腔镜阑尾切除术（1aparoscopic appendectomy，LA）正逐渐被广大医务工作者所接受，但现在仍然有很多人认为LA与传统开腹阑尾切除术（open appendectomy，OA）相比没有优势，而且LA价格昂贵，不适合推广。但是作为正在发展完善的新技术，很多证据表明LA与OA相比优势正在逐步增强。     

儿童对疾病的认知

儿童对疾病和健康的认知是一个长期以来受到关注的课题。对儿童疾病概念的研究可以使我们了解儿童对疾病的认识,从而帮助儿童保持身心健康,有效地预防或治疗疾病。从理论上讲,疾病认知研究是解决儿童是否有独立朴素生物学理论之理论争论的一个重要概念领域。     

影响诊断的主客观因素分析

由于受到客观因素及主观因素的影响,医务工作者对疾病的诊断可以发生偏差。客观因素是医疗行为主体不能把控的,包括疾病、病情与患者因素;主观因素是行为主体可以把控和提高的,包括医务工作者的临床知识、临床技能、临床思维、临床经验等。因此,临床工作中,医务人员必须充分认识影响疾病诊断的客观因素,并不断改善或积累临床知识、临床技能、临床思维和临床经验,才能提高对疾病的诊断能力。     

自身抗体与疾病预测

研究显示,在一些自身免疫性疾病出现临床症状之前,患者血液内就会出现某些自身抗体,检测这些自身抗体可以预测机体日后的患病几率,在疾病的预防和控制等方面具有重要意义。本文将对部分疾病中预示性自身抗体的研究进展及用自身抗体预测疾病的价值和面临的挑战等问题作一综述。     

内表型方法在精神疾病研究中的应用

精神疾病在很大程度上受到遗传的影响,而对疾病的遗传学研究却没有得到一致的结论,内表型正是在这一背景下提出。内表型是可以通过生化测试或显微镜检查发现的内在的表现型,即内表型不是很明显的、外在的而是微观的、内在的,内表型比疾病的外在表现更接近疾病的生物学基础,更少受到外在因素的影响,因而通过内表型来研究疾病的遗传基因有着显著的优势。现有的精神疾病诊断和分类标准都是以临床症状和行为描述为基础的,缺少生物学基础,基于内表型的分析对建立疾病的诊断和分类的生物学基础是非常重要的。内表型可以是神经生理的,生物化学的,神经解剖的,认知的,神经心理学的测量。作为内表型需要满足与疾病共同存在,可遗传,状态独立,在家庭中和疾病共分离,在病人未发病亲属中比一般人群的比率要高等标准。该文在介绍了内表型的概念,说明了内表型的原理,优点与用处,以及作为内表型需要满足的标准之后,进而以几种常见的精神疾病（多动症、精神分裂症、抑郁症）为例说明了目前认知内表型研究的进展,其中反应抑制和工作记忆可以作为多动症的内表型,注意、言语记忆和工作记忆可以作为精神分裂症和抑郁症的内表型,文章回顾了它们作为内表型所满足的标准的相关文献。最后对内表型的研究做出了展望     

自身抗体与疾病预测

研究显示,在一些自身免疫性疾病出现临床症状之前,患者血液内就会出现某些自身抗体,检测这些自身抗体可以预测机体日后的患病几率,在疾病的预防和控制等方面具有重要意义.本文将对部分疾病中预示性自身抗体的研究进展及用自身抗体预测疾病的价值和面临的挑战等问题作一综述.     

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.     

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.     

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.     

Mythological Underpinnings of Feminine Development

In the manner of Oedipus Rex, the myth of Myrrha—a story about a daughter's initiation of sex with her father—promises to divulge insights about feminine development. Given parallels between these two myths, the author asks why Jung identified Electra rather than Myrrha as the feminine counterpart to Oedipus, and revisits Freud's and Jung's differing interpretations of the incest theme in personality development. To break open the metaphor of Myrrha's incest, the author analyzes a similar account of incest in the Old Testament story of Lot and his wife and finds that they share a theme of female bitterness related to wounding of the mother and its arresting effect on the daughter's maturation. The article then considers the Demeter-Persephone myth, a tale not of incest but rape in Persephone's initiation into womanhood. In contrast to Myrrha, Persephone's development unfolds with strong maternal support tempered by the opposing claims on her by the masculine. The article draws these stories together to illuminate the archetypal forces that drive feminine development as well as the human affairs that resist and complicate them. The article concludes with a case study of a client whose developmental “stuckness” follows the contours of the Myrrha myth.     

Order,disorder, and the absolute: An experiment in dialogue

The first section of this dialogue is excerpted from an edited conversation between Sean Kelly and the late David Bohm, and focuses on the concepts of order, disorder, and the Absolute. The second section explores these concepts in greater depth, with Bohm maintaining the impossibility of absolute knowledge and the fundamental unintelligibility of the concept of disorder, preferring instead to speak of “orders of infinite degree” which emerge out of an “unknown ground.” Kelly responds by proposing the concept of “absolute knowing” as the cognitive process within which the concepts of order and disorder, the known and the Unknown are seen as dialectically related moments of the Absolute as complex whole. The third section is Edgar Morin's response to the preceding dialogue. He begins by outlining his views on the nature and limits of rationality, maintaining, with Bohm, the superiority of the “negative modality” of speaking about “being” or “reality.” In the second part, however, he proposes the notion of nature as “chaosmos,” which he understands as a creative “dialogic” of order, disorder, and organization.