脑梗死不同病因亚型同血浆同型半胱氨酸浓度的关系研究

为探讨脑梗死患者血浆同型半胱氨酸（HCY）水平同病因分型及疾病严重程度的关系,选择首发脑梗死急性期患者73例,对照组30例,进行TOAST病因分型、NIHSS神经功能缺损评分、血浆HCY检测。结果显示,病例组血浆HCY升高率、水平比对照组显著增高;大动脉粥样硬化亚型病例组血浆HCY水平比对照组明显增高;病例组血浆HCY水平同NIHSS评分呈正相关,提示高HCY血症是脑梗死发病及大动脉粥样硬化亚型脑梗死发病的高危因素,血浆HCY水平同神经功能缺损程度正相关。     

急性脑梗死早期OCSP分型的临床应用评价

为了研究急性脑梗死早期OCSP(Oxfordshire Community Stroke Projet)分型的应用价值,连续收集首次发病的脑梗死患者326例,按OCSP分型分为完全前循环梗死(TACI)、部分前循环梗死(PACI)、腔隙性脑梗死(LACI)、后循环梗死(POCI),入组后各亚型比较急性期神经功能缺损评分和结构影像学特征,3个月的病死率和日常生活活动(ADL)能力评分.显示,TACI大面积脑梗死占74.4%,PACI中等面积脑梗死占64.5%.LACI腔隙灶脑梗死占90%,POCI大面积脑梗死占22.7%,中等面积脑梗死占40.9%,小梗死占36.4%.急性期神经功能缺损以TACI最严重,PACI和POCI次之,LACI最轻,TACI与其他各型之间,PACI和POCI与LACI之间的差异均有极显著性意义(P＜0.0005),PACI和POCI之间差异无显著性意义(P＞0.05).TACI的病死率为44.2%,PACI为10.2%,POCI为18.2%,LACI为2.6%,TACI病死率与各型比较有极显著性意义(P＜0.01).TACI3个月的ADL为重度依赖,POCI为中度依赖,另2个亚型均为轻度依赖,有极显著性意义(P＜0.005).由此得出结论,OCSP分型与影像学有良好对应关系.不同的OCSP分型可以反映脑梗死急性期神经功能缺损的严重程度,OCSP分型有利于脑梗死急性期个体化治疗选择.     

急性脑梗死早期OCSP分型的临床应用评价

为了研究急性脑梗死早期OCSP（Oxfordshire Community Stroke Projet）分型的应用价值,连续收集首次发病的脑梗死患者326例,按OCSP分型分为完全前循环梗死（TACI）、部分前循环梗死（PACI）、腔隙性脑梗死（LACI）、后循环梗死（PCI）,入组后各亚型比较急性期神经功能缺损评分和结构影像学特征,3个月的病死率和日常生活活动（ADL）能力评分。显示,TACI大面积脑梗死占74．4％,PACI中等面积脑梗死占64．5%。LACI腔隙灶脑梗死占90％,POCI大面积脑梗死占22．7％,中等面积脑梗死占40.9％,小梗死占36.4％。急性期神经功能缺损以TACI最严重,PACI和POCI次之,LACI最轻,TACI与其他各型之间,PACI和POCI与LACI之间的差异均有极显著性意义（P〈0．0005）,PACI和POCI之间差异无显著性意义（P〉0．05）。TACI的病死率为44．2％,PACI为10．2%,POCI为18．2%赫,LACI为2．6％,TACI病死率与各型比较有极显著性意义（P〈0．01）.TAC13个月的ADL为重度依赖,POCI为中度依赖,另2个亚型均为轻度依赖,有极显著性意义（P〈0．005）。由此得出结论,OCSP分型与影像学有良好对应关系。不同的OCSP分型可以反映脑梗死急性期神经功能缺损的严重程度,OCSP分型有利于脑梗死急性期个体化治疗选择。     

色素上皮源性因子在心脑血管疾病检测中的意义

为研究颈动脉粥样硬化斑块稳定性及血清中色素上皮源性因子水平与脑梗死的关系,检测不同类型脑梗死患者组、慢性脑供血不足组以及对照组的血清色素上皮源性因子水平.发现颈动脉粥样硬化斑块及其稳定性与脑梗死发生有密切关系,具有不同性质颈动脉斑块的脑梗死患者的血清色素上皮源性因子水平存在差异,色素上皮源性因子可能是不稳定性粥样硬化斑块及脑梗死的一个潜在的血清标志物.     

血清胆红素水平与原发性高血压患者动脉粥样硬化关系的探讨

为探讨原发性高血压患者颈动脉粥样硬化斑块形成与胆红素水平的关系,对156例原发性高血压男性患者进行颈动脉彩色多普勒超声检查,根据有无颈动脉粥样硬化斑块将其分为颈动脉粥样硬化斑块组74例,正常对照组82例,对两组的年龄、体重指数、血脂及胆红素水平进行比较。原发性高血压患者颈动脉粥样硬化斑块组总胆红素及间接胆红素水平显著低于正常对照组（P〈0.05）,原发性高血压患者颈动脉粥样硬化斑块形成与总胆红素及间接胆红素水平呈负相关。     

血糖水平与急性脑梗死入院时神经功能的关系

为了观察血糖水平与急性脑梗死患者入院时神经功能的关系,我们对192例资料完整的首次发生急性脑梗死的患者进行临床研究。记录：年龄、性别、腰臀比、体重指数、血压、脑CT或MRI、空腹血糖、糖化血红蛋白、血脂、纤维蛋白原、C-反应蛋白、尿酸,入院时进行神经功能损伤评分。我们用欧洲卒中量表（ESS）、Barthel指数来评价脑梗死患者的神经功能。我们将血糖与ESS评分、Barthel指数纳入一元、多元线性回归分析。同时进行糖尿病组与非糖尿病组的梗死类型与梗死部位的比较。结果显示血糖水平与ESS评分、Barthel指数进行一元及多元线性回归分析,线性回归方程不成立。两组梗死类型及部位无差异性。结论为血糖水平与入院时患者神经功能损伤的严重程度无关。     

降纤酶治疗急性脑梗死的临床疗效评价

采用随机同期对照的临床研究方法,对发病在24h内的90例急性脑梗死患者,分别进行降纤酶与常规治疗方法的治疗,观察其疗效,应用Logistic回归分析方法进行评价。结果显示,降纤酶可降低血浆纤维蛋白原的水平,有效地促进神经功能恢复,改善急性脑梗死患者的临床症状,有着与常规治疗方法相同的临床疗效。     

降纤酶治疗急性脑梗死的临床疗效评价

采用随机同期对照的临床研究方法,对发病在24h内的90例急性脑梗死患者,分别进行降纤酶与常规治疗方法的治疗,观察其疗效,应用Logistic回归分析方法进行评价.结果显示,降纤酶可降低血浆纤维蛋白原的水平,有效地促进神经功能恢复,改善急性脑梗死患者的临床症状,有着与常规治疗方法相同的临床疗效.     

皮层多点记录体感诱发电位检测方法对痉挛性斜颈的研究价值

应用皮层多点记录的体感诱发电位检测方法研究痉挛性斜颈可能的发病机制。选择我科就诊的扭转型痉挛性斜颈患者60例与60例正常对照行皮层多点记录的正中神经体感诱发电位检测,观察病例组及对照组皮层成分峰峰幅度变化情况。病例组对侧皮层记录到的P22/N30峰峰幅度明显高于同侧皮层,病例组对侧皮层记录到的P22/N30峰峰幅度明显高于对照组对侧皮层,差异有统计学意义(P0.05)。扭转型痉挛性斜颈患者头部扭转方向对侧辅助运动皮层兴奋性增高,该检测方法有助于痉挛性斜颈的诊断及发病机制的研究。     

高尿酸血症与急性脑梗死患者病情严重程度和预后的相关性研究

文章探讨高尿酸血症与急性脑梗死患者病情严重程度和预后的相关性.选择急性脑梗死患者198例,男性115例,女性83例,以前瞻性病例对照的研究方法,分析高尿酸血症与急性脑梗死患者入院时、住院10天时的病情严重程度和90天预后的相关性.高尿酸血症与急性脑梗死患者入院时病情严重程度无关（P＆gt;0.05）,与住院10天时病情严重程度呈负相关（P=0.003）,与10天时的美国国立卫生研究院卒中量表（NIHSS）转归分数呈正相关（P=0.002）,与90天预后呈正相关（P=0.001）.笔者认为高尿酸血症与急性脑梗死患者住院10天时的病情严重程度和90天预后具有独立的相关性.     

The Return Of The Religious

Recents discussions of expansion in the European Union and the possibility of envisioning a Muslim country in it has exacerbated the deep-seated anxiety about Islam among the liberal and extreme right in Europe. This paper suggests that there are recurring elements in the discourse of European cultural identity and one of these elements is the representation of Islam in its alterity to European identity and civilization. Questioning the thesis of a radical break with the Christian past, this paper questions whether the European cultural identity which is being formed today signifies a break with a religious form of identification. The liberal and extreme right opposes Turkish membership on the grounds that the differences between ‘European values’ and ‘European culture and lifestyle’ and Turkey's culture are what makes the latter essentially and fundamentally external to the essence of Europe. Tracing the remnants of Christian discourse in the contemporary fashioning of European identity, this paper discusses how Christianity, with its secularized versions, which are now displaced to culture and lifestyle, still holds a privileged position as a unifying theme in Europe. It suggests that one of the tests that awaits Europe is whether it will be capable of articulating a new but democratic identity for Europe, one that is responsive to the differences of the other or whether it wants to continue to be European by way of its old methods of exclusion.     

The Red and The Real

It is often claimed that principles of individuation imply essential properties of the things individuated. For example, sets are individuated by their members, hence sets have their members essentially. But how does this inference work? First I discuss the form of such inferences, and conclude that the essentialist inference is not a purely formal matter: although there is a form which all principles of individuation have in common, it is not true that any statement of that form is a principle of individuation, and hence there is no valid inference based purely on that form. However, I argue that there is a viable version of the essentialist inference nonetheless. The resources for a proper reconstruction of this type of inference can be gathered from reflections upon the role principles of individuation play in the project of the ontologist: such principles turn out to carry a modal weight similar to that of definitions or conceptual truths. It follows that, no matter how austere the ontology, some portion of essentialist modality is inevitable.     

医学教育人文精神缺失的弊端及对策

人文精神本是医学学科的根本要旨之一,然而,目前医学教育中普遍存在着人文精神缺失的状况.从医学教育的宗旨、医学模式的转变、医学生的综合素质、医患关系方面剖析了人文精神缺失的弊端并提出了相应对策.     

The Activities of The Scandinavian Societies

Freud's concept of the death instinct has given rise to many different interpretations which have often been contradictory. It is in fact already possible to discern two diametrically opposite meanings of this concept in Freud's work from 1920—Beyond the Pleasure Principle—in which he first introduced the concept of the death instinct. In this paper, it is argued that both these meanings are relevant in describing psychical life, although only one of these meanings actually qualifies for the concept “death instinct”. Beyond the Pleasure Principle was written in order to try to understand some everyday, as well as clinical phenomena which could not be explained by the so-called pleasure principle. Freud postulated something beyond the pleasure principle, which initially seemed to have to do with binding energy. I will preserve this idea and attempt to develop it within the context of a phenomenological analysis of time. The temporalization of the subject involves a very basic affirmation of existence, in that the subject experiences something constant, something that can be said to possess the quality of a gestalt. I propose that that which is beyond the pleasure principle—this binding of energy—should be understood as the opposite of the idea of a primordial death instinct striving towards death. In this case, that which is beyond the pleasure principle reflects an original affirmation of existence, which could be said to correspond to Freud's first meaning of the death instinct. The second meaning—for which the name “death instinct” seems to be applicable—concerns the discharge of energy, which from a temporal point of view shows itself as a tendency to dissolution. The concept of the death instinct in its various meanings is discussed in connection with phenomenological reflections on time, which is a different approach from Freud's attempt to ground the death instinct in biology.     

The neglected bulimic: The nonpurger

For nearly 10 years bulimia has been recognized officially as a distinct eating disorder, and yet in that time only minimal attention has focused on the nonpurging subtype. The present investigation compared 21 DSM-III-R diagnosed nonpurging bulimics with 22 non-eating-disordered controls on three standardized questionnaires and during a unique assessment task. In this procedure subjects imagined that they were the character in a series of slides and audiotaped flooding scenes. The content of the stimuli ranged from food and weight cues to issues hypothesized to play a role in the development or maintenance of bulimia (e.g., rejection or loss of control fears). A MANOVA conducted on the three questionnaires was highly significant, with the Beck Depression Inventory and the Restraint Scale being responsible for the elevated bulimic scores. A repeated-measures ANOVA performed on the self-report ratings during the exposure task also achieved significance, as the bulimics reported higher anxiety reactions than controls to each experimental stimulus. Significant skin conductance reactions were detected when a group of only the most psychophysiologically responsive bulimics and controls were compared. The importance of continued comprehensive evaluations with DSM-III-R nonpurging bulimics was emphasized.This research was supported by grants both from the University of New Mexico's Research Allocation Committee and the Biomedical Research Support Grant committee. Portions of this paper were presented at the Association for the Advancement of Behavior Therapy annual conference, Boston, November 1987.     

The Logic of The Goldhagen Debate

Since Daniel J. Goldhagen's Hitler's Willing Executioners: Ordinary Germans and the Holocaustattempts to show that the Holocaust is explicable and can be understood largely in terms of a single cause, “eliminationist anti-Semitism”, it is not surprising that the book has generated an international debate. What is surprising is the magnitude and emotional intensity of the debate. This article argues that the deepest flaws in it Hitler's Willing Executioners,as well as the chasm of disagreement between Goldhagen's detractors and defenders, have as much to do with reasoning and concepts as with matters of fact. It concludes that Goldhagen's central argument is stronger than many of his critics claim, but that the inadequacy of his cognitive interpretation of anti-Semitism and his unexamined psychological assumptions weaken his attempt to explain the Holocaust. This revised version was published online in August 2006 with corrections to the Cover Date.