“八胞胎”事件引发的伦理思考

震惊全国的广州“八胞胎”事件逐渐淡出公众的视野,但它带给我们的思考并未结束.从伦理视角对该事件中暴露出的亲子关系的界定、“子宫”商品化、公平公正、多胎妊娠、代际伦理等问题进行了深入思考,并针对ART技术自身特点,从强化医疗机构和ART技术从业人员的职业道德和法律意识;加强卫生行政部门的监管;加强顶层设计,完善ART技术的法律法规;提高不孕症患者对辅助生殖知识的认知,加强生殖伦理教育等方面提出了探讨性建议.     

纳米炭在分化型甲状腺癌再手术中应用价值的研究

探讨在分化型甲状腺癌（DTC）再手术中应用纳米炭对甲状旁腺保护和引导颈淋巴结清扫的作用与价值。选取2011年2月至2014年2月湖南省人民医院乳腺甲状腺外科116例D T C再手术患者,随机分为观察组（纳米炭组）64例和对照组52例,试验组在术中先向残余甲状腺或癌灶或肿大淋巴结内注射纳米炭0．1ml～0．3ml不等,对照组不使用纳米炭。观察两组辨别甲状旁腺的个数与准确性,以及在颈淋巴结清扫个数的差异。同时观察两组术后常见并发症有无差异。观察组使再手术的D T C患者的甲状旁腺识别率为92．2％,辨别出3个及以上甲状旁腺比率为75％,均明显高于对照组的28．8％、36．5％,两组比较有显著性差异（ P＜0．05）。中央区与侧颈区淋巴结清扫的个数比较,观察组明显多于对照组（P＜0．05）。观察组不增加术后并发症,而且,其一过性的甲状旁腺功能减退的并发症尚有下降趋势（P＜0．05）。纳米炭对DTC再手术中的甲状旁腺的识别率和区域淋巴结的黑染,使甲状旁腺易于识别和保护,有利于更为彻底清扫中央区和侧颈区淋巴结,尚可降低一过性甲状旁腺功能减退的并发症。     

处理好心血管手术中体外循环的几个关系

随着医学技术的进步,近年来通过手术来解除患者心血管方面的疾患已成为一种有效的方法。开展心血管手术离不开体外循环,然而,体外循环是一门交叉学科,它涉及医学和非医学等多方面的知识,实施过程中还会对患者机体产生不同程度的影响。从非医学方面的哲学角度来看,体外循环的整个过程中都包含有丰富的唯物辩证法观点,用联系的、矛盾的、辩证的哲学思维去看待体外循环中的相关问题,有助于提高体外循环灌注技术的质量,减少对患者机体的损伤。     

Introduction： The Ghost of Baudrillard

Baudrillard is a foreigner as well as familiar name to Chinese academia. The familiarity is due to ＂post-modern＂ misunderstandings; the foreignness, on the other hand, consists in the ignorance, in the true sense of the word, of the origin of Baudrillard＇s thought. The effect is akin to when people see the movie Avatar, and do not know the original metaphor of the blue-faced Navi tribe.     

Effects of telephone support on exercise capacity and quality of life in patients with chronic obstructive pulmonary disease: a meta-analysis

The aim of this meta-analysis was to evaluate the effects of disease education or pulmonary rehabilitation programs assisted with telephone support on physical capacity and quality of life (QOL) in chronic obstructive pulmonary disease (COPD) patients. A systematic search of PubMed, Embase, Web of Science and The Cochrane Library was conducted until May 2017. Randomized controlled trials (RCTs) examining the effects of telephone-assisted intervention versus a control group on exercise tolerance and QOL in patients with COPD were included. Two independent authors assessed the methodological quality of the trials using the Cochrane risk of bias tool. A meta-analysis was conducted with the Revman5.3 to quantify the effects of telephone-assisted interventions on walking capacity and QOL. In total, 10 studies involving 1037 participants were included. Due to the effect of telephone-assisted interventions, statistically significant results were found on Saint-George’s Respiratory Questionnaire (SGRQ) symptom scores [standard mean difference (SMD) ?.18, 95% confidence interval (CI) ?.33, ?.03, p-value .02)], SGRQ impact scores [SMD ?.35, 95% CI ?.60, ?.10, p-value .006)], SGRQ activity scores [SMD ?.30, 95% CI ?.45, ?.15, p-value < .0001)], SGRQ total score [SMD ?.36, 95% CI ?.51, ?.21, p-value < .00001)]. The effects on 6-min walk test (6MWT) and all Chronic Respiratory Questionnaire (CRQ) subscales were not significant (p > .05) based on the insufficient evidence. In conclusion, the role of telephone-assisted interventions in the management of COPD remains equivocal. Some encouraging results were seen with regard to SGRQ symptom, SGRQ impact, SGRQ activity and SGRQ total score. We believe that more methodologically rigorous large-scale randomized controlled trials are necessary to answer this study question.     

Health-Related Quality of Life in a Low-Socioeconomic Status Public Rental-Flat Population in Singapore

Health-related quality of life (HRQoL) is a well-established measure of health and general well-being. Socioeconomic status (SES) can affect HRQoL. We sought to determine whether there were differences in HRQoL between low versus higher area-SES flat communities in Singapore. Residents in two integrated public housing precincts comprising of rental-flat blocks (low area-SES neighborhood) and neighboring owner-occupied blocks (higher area-SES neighborhood) were asked to rate their self-perceived HRQoL using the EuroQol Group five dimensions (EQ-5D) instrument. The EQ-5D assesses HRQoL in five domains (mobility, self-care, usual activities, anxiety/mood and pain) and with a global visual analogue scale (EQ-VAS). We evaluated differences in HRQoL between the rental and owner-occupied neighborhoods, and factors associated with anxiety/depression in the rental-flat neighborhood using multivariate logistic regression. The participation rate was 89.1% (634/711). In the owner-occupied neighborhood, 56.7% (216/381) were in full health, compared with 54.2% (137/253) in the rental-flat population (OR = 0.90, 95%CI = 0.66–1.24, p = 0.568). Across the five domains, staying in a rental-flat neighborhood was independently associated with anxiety/depression (adjusted odds ratio [aOR] = 1.79, 95%CI = 1.10–2.92, p = 0.019). In the rental-flat population, having anxiety/depression was independently associated with minority ethnicity, problems with self –care, pain/discomfort, difficulty with healthcare costs, and not being on subsidized primary care (p < 0.05). There was no significant difference on the EQ-VAS between the two neighborhoods (p = 0.627). Staying in a low area-SES neighborhood was associated with more mental health problems. In the rental-flat population, self-reported anxiety/depression was associated with minority ethnicity, physical health problems, and financial disadvantage in healthcare.     

我国贫困大学生心理健康变迁的横断历史研究:1998~2015

为探讨自1999年高校国家助学贷款政策出台以来,我国贫困大学生心理健康状况的变迁,本研究对106篇1998至2015年间采用SCL-90量表的研究进行了横断历史元分析,考察了贫困大学生心理健康状况随年代的变化趋势。结果表明：（1）SCL-90量表中9个因子的分数均值均与年代呈负相关,年代对各因子变异的解释在4%至16%之间;1998年到2015年这18年来,各因子均值平均下降范围（效果量d）在0.24至0.55个标准差之间,其中强迫、抑郁和精神病3个因子均值变化尤为明显。这表明贫困大学生整体心理健康的状况在缓慢提升。（2）与中部地区相比,东部和西部地区贫困大学生心理健康水平18年来提高更明显。（3）虽然不同性别贫困大学生各因子历年变化差异并不明显,但女生抑郁和精神病两方面改善略快。此外,普通元分析结果表明总体上贫困男大学生比女大学生心理健康状况要好。     

教师支持与心理素质对中学生学业成绩的影响

采用学生感知教师支持行为问卷和中学生心理素质问卷,对西南地区两所中学7~12年级的824名在校中学生进行调查研究,探讨教师整体支持和不同类型支持与中学生学业成绩的关系及心理素质在其中的中介作用。结果发现：（1）教师整体支持与中学生心理素质、学业成绩间存在显著正相关;教师情感支持与中学生心理素质、学业成绩间存在显著正相关,教师学习支持、能力支持与中学生心理素质存在显著正相关,但与学业成绩相关均不显著;（2）控制性别和年龄后,心理素质在教师整体支持与学业成绩的关系中起完全中介作用;心理素质在教师情感支持与学业成绩关系中起部分中介作用,在教师学习支持与学业成绩、教师能力支持与学业成绩关系中均起完全中介作用。     

乡镇小学生的数学焦虑与数学成绩:数学自我效能感和数学元认知的链式中介作用

采用儿童数学焦虑量表、小学生数学学习自我效能感量表和小学生数学元认知问卷,对508名乡镇中、高年级小学生进行测量,并运用结构方程模型探讨数学焦虑影响数学成绩的内在作用机制。结果发现：（1）数学焦虑显著负向预测数学自我效能感、数学元认知和数学成绩,数学自我效能感显著正向预测数学元认知和数学成绩,数学元认知显著正向预测数学成绩;（2）在数学焦虑对数学成绩的预测中,数学自我效能感和数学元认知均发挥了部分中介作用;（3）数学自我效能感和数学元认知在数学焦虑和数学成绩之间起链式多重中介的作用。因此,数学焦虑除了直接作用于小学生的数学成绩,还可通过数学自我效能感或数学元认知间接影响数学成绩,而且可通过数学自我效能感进而通过数学元认知间接影响数学成绩。文章讨论了上述发现的理论及教育实践含义。     

交流语境对学习双方语言准确性的影响

研究安排了交流任务和个人迁移任务,创设了三种交流语境,比较不同语境下交流学习双方的语言准确性。结果显示：（1）三种语境中仅语言交流时语言准确性水平最高,交流语境中的对象可视性阻碍了语言准确性提高的速率,表情可视性降低了语言准确性水平;交流语言相似性水平高的被试,语言准确性水平提高的效率和效果均高于低的一方;（2）交流任务中仅语言交流时语言准确性最高,个人任务中对象可视语境下准确性最低;和交流任务相比,高相似被试个人任务中的准确性更高。表明：语言认知不完全代表交流认知,对象可视性阻碍语言认知和交流认知水平,表情可视性辅助语言共同提高交流认知水平。