辩证思维在重症急性胰腺炎治疗中的运用

重症急性胰腺炎的治疗水平在近几十年已有了很大的发展,但是SAP的死亡率依然居高不下,严重威胁患者生命.这类惠者的病情复杂,需要运用多种治疗方法进行综合救治.从多种治疗方法中选择合适的方法并进行合理的治疗很难准确把握,需要我们用哲学的思维来看待胰腺炎的诊治,辩证地对其进行有针对性的治疗,从而提高重症急性胰腺炙的治疗水平.     

液体潴留量与重症急性胰腺炎早期并发ARDS相关性临床分析

探讨48h液体潴留量〉4000ml与重症急性胰腺炎（SAP）早期并发急性呼吸窘迫综合征（ARDS）的临床相关性,为进一步指导11盏床SAP患者早期液体复苏治疗并预防急性肺损伤提供科学依据。回顾性分析我院2012年1月至2014年1月收治的43例SAP患者临床资料,并进行统计学处理。分析结果表明48h液体潴留量〉4000m1与sAP早期并发ARDS呈现出明显的正相关,48h液体潴留量〉4000ml的sAP患者早期并发ARDs的危险性是48h液体潴留量〈4000ml的SAP患者的14．4倍,48h液体潴留量〉4000ml是重症急性胰腺炎早期并发ARDS的高危险因素。对于SAP患者在早期临床治疗过程中应密切注意液体潴留量,通过合理补液可降低sAP并发ARDS的发生率和病死率。     

急性重症胰腺炎的抗生素治疗策略

继发性感染是导致急性重症胰腺炎(severe acute pancreatitis,SAP)高病死率最重要的因素。继发感染的微生物多为革兰阴性菌。选用抗菌药物需兼顾病原菌敏感性及抗菌药物穿透血胰屏障能力,合理选择用药方式;对于CT证实有胰腺坏死的急性重症胰腺炎,可预防性使用抗生素;氟康唑可作为经验性抗真菌治疗的首选药物。     

急性重症胰腺炎的抗生素治疗策略

继发性感染是导致急性重症胰腺炎(severe acute pancreatitis,SAP)高病死率最重要的因素.继发感染的微生物多为革兰阴性菌.选用抗菌药物需兼顾病原菌敏感性及抗菌药物穿透血胰屏障能力,合理选择用药方式;对于CT证实有胰腺坏死的急性重症胰腺炎,可预防性使用抗生素;氟康唑可作为经验性抗真菌治疗的首选药物.     

乌司他丁在ICU中的临床应用进展

乌司他丁具有抑制胰蛋白酶等胰酶的活性、稳定溶酶体膜以抑制溶酶体酶的释放及抑制心肌抑制因子的产生而常应用于重症急性胰腺炎及其他危重症的抢救治疗.     

重症急性胰腺炎预防抗生素治疗的争议

重症急性胰腺炎伴随高病死率,细菌和真菌感染是其导致死亡的主要原因之一。目前治疗一般采取预防性抗生素治疗,但预防性抗生素治疗又可能会加重二重感染。目前研究结果数量有限,结果不一。是否应该应用预防抗生素治疗仍然存在争议,期待更多设计合理的随机对照试验。     

系统论视角下重型急性胰腺炎的治疗

重症急性胰腺炎(severe acute pancreatitis,SAP)是临床上常见的急腹症之一,本文试从系统生物学角度出发,探讨其在SAP营养支持治疗、抗生素的选用以及外科手术治疗中的应用。强调应用整体的、综合的、发展的观点去研究SAP的治疗,从而找到最佳治疗方案。     

系统论视角下重型急性胰腺炎的治疗

重症急性胰腺炎(severe acute pancreatitis,SAP)是临床上常见的急腹症之一,本文试从系统生物学角度出发,探讨其在SAP营养支持治疗、抗生素的选用以及外科手术治疗中的应用.强调应用整体的、综合的、发展的观点去研究SAP的治疗,从而找到最佳治疗方案.     

急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南(2006)

急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)是一种常见危重症,病死率极高,严重威胁重症患者的生命并影响其生存质量.尽管我国重症医学已有了长足发展,但对ALI/ARDS的认识和治疗状况尚不容乐观.中华医学会重症医学分会以循证医学证据为基础,采用国际通用的方法,经广泛征求意见和建议,反复认真讨论,达成关于成人ALI/ARDS诊断和治疗方面的共识,以期对成人ALI/ARDS诊断和治疗进行规范.中华医学会重症医学分会以后还将根据循证医学证据的发展及新的共识对ALI/ARDS诊断和治疗指南进行更新.     

急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南（2006）

急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)是一种常见危重症,病死率极高,严重威胁重症患者的生命并影响其生存质量。尽管我国重症医学已有了长足发展,但对ALI/ARDS的认识和治疗状况尚不容乐观。中华医学会重症医学分会以循证医学证据为基础,采用国际通用的方法,经广泛征求意见     

Consider the source: One step in assessing premise acceptability

Premise acceptability is conceptually connected to presumption. To say that a premise is acceptable just when there is a presumption in its favor is to give a first approximation to this connection. A number of popular principles of presumption suggest that whether there is a presumption for a premise, belief, or claim depends on the sources which vouch for it. Sources consist of internal belief-generating mechanisms and external testimony. Alvin Plantinga's notion of warrant lays down four conditions upon a source for the belief which it generates to be warranted. We argue that there is a presumption for a premise, belief, or claim if and only if there is a presumption of warrant for that premise,belief or claim. This amounts to the thesis that there is a presumption for a belief from a challenger's point of view if and only if there is a presumption from that person's point of view that her cognitive faculties which have generated the belief have been functioning properly, in an appropriate cognitive environment, in accord with a segment of her design plan aimed at the truth, and that these faculties are reliable. In light of our argument for this thesis, we may legitimately claim that one way to determine that there is a presumption for a belief is to determine that there is a presumption of warrant for that belief, and thus that in determining whether there is a presumption for a belief or premise, we may consider the source.     

Instrumental Values – Strong and Weak

What does it mean that an object has instrumental value? While some writers seem to think it means that the object bears a value, and that instrumental value accordingly is a kind of value, other writers seem to think that the object is not a value bearer but is only what is conducive to something of value. Contrary to what is the general view among philosophers of value, I argue that if instrumental value is a kind of value, then it is a kind of extrinsic final value.     

Implicit action encoding influences personal-trait judgments

When an observed action (e.g., kicking) is compatible to a to be produced action (e.g., a foot-key response as compared to a finger-key response), then the self-produced action is more fluent, that is, it is more accurate and faster. A series of experiments explore the notion that vision-action compatibility effects can influence personal-trait judgments. It is demonstrated that when an observed individual carries out an action that is compatible with the participants' response, (1) this individual is identified more fluently, and (2) the observed individual's personality is attributed with the properties of the observed action. For example, if it is easier to identify one individual with a foot-response when he is seen kicking a ball, as compared to typing, he is perceived to be more 'sporty'. In contrast, if it is easier to identify one individual with a finger response when he is seen typing as compared to kicking a ball, he is associated with the 'academic' trait. These personal-trait judgment effects can be observed with explicit measures, where participants are asked to rate the sporty/academic nature of the person on a scale. They are also obtained when implicit measures are taken in a priming task, where participants are never explicitly asked to rate the personalities of the individuals. A control experiment rules out that these personal-trait effects are merely due to an association of motor responses (foot, finger) to individuals while identifying them, but that these effects depend on a prior manipulation of vision-action fluency.     

Premissary relevance

Premissary relevance is a property of arguments understood as speech act complexes. It is explicable in terms of the idea of a premise's lending support to a conclusion. Premissary relevance is a function of premises belonging to a set which authoritatively warrants an inference to a conclusion. An authoritative inference warrant will have associated with it a conditional proposition which is true— that is to say, which can be justified. The study of the Aristotelian doctrine of topoi or argument schemes may contribute to the task of identifying authoritative warrants.     

Less willing to pay but more willing to buy: How the elicitation method impacts the valuation of a promotion

Willingness to pay (WTP—how much one is willing to pay for something) and willingness to buy (WTB—whether one is willing to buy something at a given price) are two common methods to elicit valuations and normatively should yield the same valuation order between two options. However, this research finds that WTP and WTB can yield opposite valuation orders between the regular offer and the promotional offer of a product. Specifically, it demonstrate that, (a) if the valuation of a product is only elicited with WTP, consumers value the product less when it is offered with a price promotion than when it is not; (b) if the valuation of a product is only elicited with WTB, consumers value the product more when it is offered with a price promotion than when it is not; and (c) if the valuation of a product is first elicited with WTP and then elicited with WTB, consumers always value the product less when it is offered with a price promotion than when it is not. A value‐inference account is proposed for the above findings, according to which, consumers infer the value of a promoted product differently when the valuation is elicited only with WTP or only with WTB. Theoretically, this research extends prior literature on sales promotion, showing that the valuation of a promotion is subject to the elicitation method. Practically, this research suggests how to help consumers manage their purchase intentions for promoted products.     

The morality of weapons research

I ask whether weapons research is ever justified. Weapons research is identified as the business of the engineer. It is argued that the engineer has responsibility for the uses to which the tools that he designs can be put, and that responsibility extends to the use of weapons. It is maintained that there are no inherently defensive weapons, and hence there is no such thing as ‘defensive’ weapons research. The issue then is what responsibilities as a professional the engineer has in regard to such research. An account is given to ground the injunction not to provide the means to harm as a duty for the engineers. This account is not, however, absolutist, and as such it allows justifiable exceptions. The answer to my question is thus not that weapons research is never justified but there must be a strong assurance that the results will only be used as a just means in a just cause.     

存在三议

存在是毋庸置疑的事实,存在在其存在过程中显现为由低到高的四重境界。存在也是一个从无到有到无的过程,存在之和谐在这一过程中得以彰显。哲学就是对存在之和谐的反思。哲学对存在之和谐的反思也应遵循从无到有到无的逻辑历程。这样的哲学才是和谐之路,这样的反思才是和谐的反思,这样的反思指导下的人的存在才是和谐的存在。     

Message therapy: Language approach to stuttering therapy with children

Message therapy is a clinical procedure designed to be used as a carry-over technique with school-age stutterers or as a sole technique with the preschooler. The focus of therapy is on a unit of communication rather than on the moment or place of stuttering. One of the basic assumptions of the procedure is that the child is beginning to monitor how he/she is speaking rather than what is being communicated (i.e., the “message”)—each task requiring a different cognitive process. The emphasis of the therapy is to redirect the child's attention to “what he/she is saying.” The clinical procedures are discussed as they relate to the specific population.     

Disentangling perceptual and motor components in inhibition of return

Following an abrupt onset of a peripheral stimulus (a cue), the response to a visual target is faster when the target appears at the cued position than when it appears at other positions. However, if the stimulus onset asynchrony (SOA) is longer than approximately 300 ms, the response to the target is slower at the cued position than that at other positions. This phenomenon of a longer response time to cued targets is called "inhibition of return" (IOR). Previous hypotheses propose contributions of both response inhibition and attentional inhibition at cued position to IOR, and suggest that responding to the cue can eliminate the component of response inhibition. The current study uses tasks either executing or withholding response to the cue to investigate the relative contributions of response and attention components to IOR. A condition with bilateral display of the cue is also chosen as a control condition, and eight different SOAs between 1,000 and 2,750 ms are tested. Compared to the control condition, response delay to the target at a cued position is eliminated by responding to the cue, and a response advantage to the target at an uncued position is not affected by responding to the cue. Furthermore, both response delay at a cued position and response advantage at an uncued position decrease with SOA in the time window tested in these experiments. The results reported here indicate a dominant response inhibition at a cued position and a primary attentional allocation at an uncued position for IOR. Nonsignificant perceptual/attentional suppression at a cued position is argued to be a benefit for visual detection in a changing world.