系统论方法在糖尿病性视网膜病变危险因素及治疗研究中的应用

全球糖尿病患者人数在不断的增多,大约10％的Ⅰ型糖尿病患者在10年后可出现糖尿病性视网膜病变,而大约95％的Ⅱ型糖尿病患者在20年后可出现糖尿病性视网膜病变。目前,糖尿病性视网膜病的发病机制尚不明确,影响其发生发展的因素也很复杂,因此,对糖尿病性视网膜病的发病危险因素及其诊治的研究,具有相当重要的意义。系统论,研究各种物质运动形态所共有的系统联系和关系,具有普遍的方法论意义,为现代医学的进步提供了全新的思维方式和科学方法论原则。本文试用系统论的整体性、优化原理阐述糖尿病性视网膜病变发病的危险因素与治疗进展,为对其深入研究提供方法论依据。     

糖尿病性黄斑水肿的诊疗思考

糖尿病性视网膜病变(diabetic retinopathy,DR)是糖尿病患者严重的眼部并发症之一,而黄斑水肿是导致糖尿病性视网膜病变患者视力下降的主要原因之一,其发病机制、诊断技术和治疗方法是一个辩证发展的过程.因此运用科学哲学方法来分析糖尿病性黄斑水肿(diabetic macular edema,DME)的诊断和治疗显得尤为重要.     

糖尿病性视网膜病变的个体化治疗

糖尿病性视网膜病变(DRP)是糖尿病患者致盲的一个主要原因.其发病的多样性决定了对其治疗应该个体化.就其个体化治疗的依据、方法的研究及具体的措施运用哲学原理加以综述.     

糖尿病性黄斑水肿的诊疗思考

糖尿病性视网膜病变(diabetic retinopathy,DR)是糖尿病患者严重的眼部并发症之一,而黄斑水肿是导致糖尿病性视网膜病变患者视力下降的主要原因之一,其发病机制、诊断技术和治疗方法是一个辩证发展的过程。因此运用科学哲学方法来分析糖尿病性黄斑水肿(diabetic macular edema,DME)的诊断和治疗显得尤为重要。     

2型糖尿病大血管病变机理和糖尿病治疗

2型糖尿病大血管病变与代谢综合征密切相关.现代医学认为两者的根本原因是胰岛素抵抗,导致糖耐量下降,血脂紊乱,高胰岛素血症,高血压和高凝状态等.从系统论的观点阐述了代谢综合征的相互关系和2型糖尿病大血管病变发病机理,并进一步从该观点阐明2型糖尿病的防治策略.     

用现代系统思维方式探讨糖尿病肾病发病机制

随着科技进步、生产发展、生活模式的改变及社会老龄化进程 ,糖尿病发病率正在逐年增加 ,我国的糖尿病患病率 1980年为 0 .6% ,1998年全国部分省市人群糖尿病普查 ,发现糖尿病患病率上升为3 2 1% ,糖耐量减退为 4 67%。糖尿病患病人数的剧增 ,随之而来的是糖尿病慢性并发症 ,如糖尿病肾病、视网膜病变、神经病变及心血管并发症的猛增 ,在 1型和 2型糖尿病中糖尿病肾病分别占 30 %～4 0 %与 15%～ 2 0 %左右 ,糖尿病肾病已成为导致慢性肾衰的首要病因。深入系统及全面探讨糖尿病肾病的发病机制是指导治疗的关键。近年来随着对糖尿病肾病发病…     

糖尿病性视网膜病变的个体化治疗

糖尿病性视网膜病变(DRP)是糖尿病患者致盲的一个主要原因。其发病的多样性决定了对其治疗应该个体化。就其个体化治疗的依据、方法的研究及具体的措施运用哲学原理加以综述。     

胱抑素C水平与糖尿病足病病变发展的临床研究

为了探讨糖尿病足病(DF)患者胱抑素C(CYS-C)水平与病变发展的关系,对2型糖尿病(T2DM)、T2DM合并DF患者实验室指标进行回顾性研究,并用Logistic多元回归分析影响DF发展的危险因素。结果显示,DF较轻组、DF较重组与T2DM组相比,HDL-C、CYS-C、FIB的差异均有统计学意义,DF较重组与其余组比较UACR明显升高,差异且亦有显著性;Logistic多元回归分析结果显示CYS-C、FIB是DF病程进展的危险因素,CYS-C与FIB、UACR呈正相关,与HDL-C呈负相关。因此,T2DM中CYS-C是DF病程进展的独立危险因素,CYS-C水平的变化对DF病变发展及诊治具有一定的指导意义。     

将糖化血红蛋白控制在7.0%以下是否更安全

2008年一项针对2型糖尿病强化血糖控制对心血管病变研究(ACCORD)发现,对于病程在10年左右,30%存在心血管疾病的2型糖尿病人群,利用现有手段努力实现血糖"正常化",即糖化血红蛋白(AIC)<6.0%并没有减少糖尿病全因死亡.人们开始重新思考对2型糖尿病是否还需要强调强化血糖控制、血糖控制的目标多少为宜.中华医学会糖尿病学分会也在今年重新修订了其<中国2型糖尿病防治指南>的AIC控制目标,AIC目标由原来的6.5%提高到7.0%.那么这一改变对2型糖尿病患者来讲到底有多大意义呢?ACCORD强化降糖治疗终止后的随访研究发现强化组患者在血糖控制目标与标准治疗组相似的情况下,全因死亡串并没有随之减少.因此,需要重新检视2型糖尿病防治策略.     

基于利益相关者视角的糖尿病视网膜监测服务探析

糖尿病性致盲已成为成年人首要致盲因素之一,通过早期糖尿病视网膜监测和系统治疗可以有效地降低糖尿病视网膜病变发生的几率,因此有效的监测手段对于科学规范管理糖尿病是十分有必要的。由于血糖的正常值和糖代谢异常的诊断切点主要依据血糖值与糖尿病视网膜病变和糖尿病发生风险的关系来确定,因此糖尿病视网膜监测可能会更加精确地监测糖尿病的变化。本文应用利益相关者分析对糖尿病视网膜监测服务开展过程中涉及的各主体利益及存在问题进行探讨,为进一步有效管理糖尿病提供相关建议。     

Determinants of the magnitude of willingness to accept relative to willingness to pay

In this paper we test two hypotheses that stem from the work of Mellers, Chang, Birnbaum and Ordonez ( 1992 ). The first hypothesis is that in a binary gamble, the ratio of WTA to WTP is decreasing in the probability attached to a nonzero event. The second hypothesis is that this ratio is independent of the size of stakes. We find support for the first hypothesis, but mixed support for the second. The second hypothesis holds in the case of gains, but not in the case of losses. Copyright © 2001 John Wiley & Sons, Ltd.     

From Freud to Gehrig to Rapaport to DiMaggio

Lacking the size, talent, and speed to play shortstop for the New York Yankees, I chose instead to become a psychologist/psychoanalyst. Yet, baseball and psychoanalysis share much in common. Each is played in the inner diamonds of one's mind, values the past and what is passing, and requires a strong work ethic. Both are timeless and involve an almost boring leisureliness between occasional moments of crisis. Then too, each calls for an attitude of consistency and patience and a responsibility to do one's best. From my parents and brother to my wife and son and his family, from my teachers and supervisors to my colleagues, and from Menninger to the Society for Personality Assessment (SPA), I feel deeply grateful for the partners and teammates I have and have had.     

Comparison of dual discrepancy criteria to assess response to intervention

Much of the research regarding diagnosing children as LD with responsiveness-to-intervention (RTI) has examined methods to identify children as non-responsive. The current study examined the dual discrepancy (DD) definition in which children score low on a post-intervention reading measure and score below their peers in reading growth rates. Four definitions of DD were compared, student growth below the 25th percentile, 33rd percentile, 50th percentile, and less than one standard deviation below the mean. Participants were 151 children in grades 1 through 3 who were identified as experiencing reading difficulties. Results suggested that the three percentile groups significantly differentiated reading scores between DD and non-DD children, but the one standard deviation group did not. No ethnic or gender biases were noted and the 25th and 33rd percentile criteria closely matched estimates of LD prevalence. Implications for future research are included.     

Transfer of pigeons' matching to sample to novel sample locations

This study examined the conditions under which conditional stimulus control by the sample stimuli in three-key matching-to-sample paradigms would generalize across the different possible sample locations. In Experiments 1 and 2, the samples appeared on the left and right side keys during initial training and then on the center key during testing. Transfer of pigeons' matching performances to the center-key samples was evident after both identity and symbolic matching training. In Experiment 3, pigeons trained on symbolic matching with two side-key samples or with a side-key and a center-key sample generally transferred their learned matching performances to those samples when they subsequently appeared in the remaining (novel) location. These results indicate that, when two-choice conditional discriminations are learned with more than one sample location, the visual characteristics of the sample per se predominantly come to control the pigeons' comparison choices. This finding encourages the use of the multiple-location training procedure as a way of reducing control by location, thus providing a more discriminating test of symmetry in animals.