冠心病理想治疗方式的选择

冠心病的治疗包括针对高危因素病因和临床并发症的综合治疗。其中,药物治疗主要包括：抗凝／抗血小板、控制血压和调脂等。血管重建术主要包括：介入、搭桥、“杂交”手术和分子生物学治疗。药物治疗是冠心病各种治疗方法的基础,而血管重建术是现代治疗冠心病的重要手段。如何合理地选择治疗方案是临床医师面临的重要课题。     

稳定性冠心病介入治疗的理性思考

介入治疗是冠心病治疗的重要手段之一.但目前在稳定性冠心病的治疗中出现了过度使用的问题.因此我们必须理性地认识到,包括冠脉介入治疗(PCI)在内的血运重建措施只是重要的治疗手段之一,而绝非其全部.在稳定性冠心痛治疗中,健康教育、改变生活方式、充分的药物治疗也是不可或缺的部分.     

冠心病调脂治疗过程中的哲学思考

他汀广泛用于冠心病的一级预防和二级预防,普遍源于循证医学的证据.首先,他汀治疗冠心痛是从疾病的本质出发,采取有效方法稳定斑块、缓解缺血.调脂治疗中,以降低低密度脂蛋白胆固醇为主要目标,体现了抓主要矛盾和矛盾的主要方面的思路.调脂强调联合治疗,个体化治疗,同时一分为二看待药物的作用,适时减量或停药.     

慢性心力衰竭的病因学演变

慢性心力衰竭(CHF)是一个发病率不断增加且具有高病死率的临床症候群.尽管几十年来,药物及器械治疗取得了较大的进展,预后有所改善,但病因学组成一直发生着变化.冠心痛及高血压病成为中老年人CHF的主要病因.贫血、肾功能不全、慢性阻塞性肺疾病及糖尿病常与CHF并存并加重其预后.CHF的各种指南不断为心力衰竭的诊治提供新的信息并使预后进一步改善.     

β受体阻滞剂是冠心病中的重要一线治疗药物

冠心病的治疗包括三个层面:血管重建治疗解决局部狭窄;改善生活方式是基础;全面合理的药物治疗是核心.而β受体阻滞剂又是重要的一线治疗药物,不仅能降低动脉粥样硬化及急性冠脉综合征的发生发展,还能有效预防、缓解心绞痛发生,改善梗死后左室重构和心功能;降低心肌再梗死率,降低心性猝死和病死率.临床上应用β受体阻滞剂的时机和剂量非常重要.     

C-反应蛋白与动脉粥样硬化——谁才是始作俑者

C-反应蛋白可用于监测冠心痛患者病情变化、预测冠心病的预后以及预报健康人群冠心病的发病风险.最近的研究显示,C-反应蛋白可能是动脉粥样硬化的始动因子.药物干预可以通过降低C-反应蛋白发挥抗动脉粥样硬化作用.本文分析了C-反应蛋白与动脉粥样硬化的因果关系及其在临床工作中的重要意义.     

亚临床甲状腺功能减退与冠状动脉粥样硬化性心脏病

对冠心病高危因素积极地预防及治疗,可降低冠心痛的患病率和病死率.已经得到公认的临床甲状腺功能减退通过引起代谢及血流动力学紊乱而参与了冠状动脉粥样硬化的发生与发展.目前,国内外许多临床研究显示亚临床甲状腺功能减退通过多种途径参与冠心病的发生和发展,是冠心病的重要危险因素之一.     

冠脉介入治疗合理临床应用的思维基础

冠心痛的发病率逐年升高,死亡率居高不下,成为威胁人类健康的重要疾病.人们为了攻克这一难题进行了不懈的工作,溶栓、监护及介入治疗的出现挽救了众多生命.随着冠状动脉介入治疗方法的不断完善和广泛开展,冠状动脉介入治疗越来越成为冠心病治疗的主要临床手段.但随之而来的手术并发症、支架在狭窄等问题成为不得不考虑的问题.治疗策略的选择成为治疗成败的关键.如何通过合理的思维方式采取正确治疗策略成为临床医生必须面对的问题.有进行深入探讨的必要.     

稳定型冠心病治疗方案的临床抉择

由于医疗技术水平的发展,稳定型冠心痛的治疗方案在不断地更新与变化。以往,经皮冠状动脉介入术被广泛应用到稳定型冠心痛的治疗上。但最近的COURAGE试验（the clinical outcomes utilizing revascularization and aggressive drug evaluation trial）使得这一治疗手段的合理性和必要性被质疑。我们必须重新考虑稳定型冠心病治疗方案的临床抉择。     

倡导科学决策建立医患诚信

本期"临床决策研究"栏目由陶贵周等撰写的"从冠心痛主要危险因素的流行特点谈医学模式的转变"通过大量的数据资料,对冠心病危险因素的流行特点及危害、危险因素的控制情况、干预冠心病危险因素效益评估及医疗经济学与冠心病的预防进行了论述.     

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.     

Phenotypic plasticity and archetype: a response to common objections to the biological theory of archetype and instinct

Since Jung’s death in 1961, scholars have attempted to integrate growing biological science data into Jungian concepts such as the collective unconscious, instincts and the archetypes. This enterprise has been challenging due to persistent false dichotomies of gene and environment occasionally arising. Recent works by Roesler (2022a, 2022b) for example, have raised objections to the biological theory of archetypes, but the objections are plagued by such dichotomies. The concept of phenotypic plasticity, however, helps to both avoid this problem as well as bridge the gap between competing theories into a more integrated model with solid biological foundations.     

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.     

Seeing in the Dark: A View into Dissociation and Healing

In this paper, I will explore the role of art-making, the experience of trauma and dissociation, and the process of working with self-states from an analytic and creative frame. Relevant literature on dissociation, trauma, and the use of art will be discussed. A case involving my work with an adolescent girl who had experienced sexual abuse from a family member will be shared, with an emphasis on the meaningful role images played during the therapeutic process. Both Jungian and psychoanalytic models of conceptualizing and working with dissociation are included, following Donald Kalsched’s (2013) recommendation for a “binocular stance” to treatment, including both a focus on the inner, intrapsychic world and the interpersonal, relational realm, and how art images both illuminated and expressed these realms. Within the therapeutic process, art images allowed the therapist a view into the client’s unconscious process, and created a meeting ground for dissociative barriers to be gradually seen, felt and known, by both therapist and client. The experience of dissociation, in images and in session, provided a reference point for myself and my client, Taylor, to develop a shared understanding and a framework for growth.     

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.