冠状动脉分流术后再狭窄研究中的科学理念

随着冠状动脉分流术(Coronary Artery Bypass Grafting,CABG)的广泛开展,CABG术后再狭窄(Restenosis,RS)成为我们面对的一个重要问题.CABG术后RS的研究需要遵循综合、全面、均衡的科学理念.只有在综合、全面、均衡的科学理念指导下,才能加深人们对该问题的认识,增进研究的科学性,取得更佳的研究成果.     

冠状动脉搭桥术后再狭窄研究的思考

冠状动脉搭桥术(CABG)是目前外科治疗冠心病的成熟、定型的手术方法,但术后再狭窄影响了病人的远期疗效,其研究也越来越受到人们重视。随着生物医学模式向生物心理社会医学模式的转变,研究者对CABG术后再狭窄也有了更深入的认识,更加注重整体性、动态化和系统最优化。试用系统论方法探讨CABG术后再狭窄的防治。     

冠状动脉搭桥术后再狭窄研究的思考

冠状动脉搭桥术(CABG)是目前外科治疗冠心病的成熟、定型的手术方法,但术后再狭窄影响了病人的远期疗效,其研究也越来越受到人们重视.随着生物医学模式向生物心理社会医学模式的转变,研究者对CABG术后再狭窄也有了更深入的认识,更加注重整体性、动态化和系统最优化.试用系统论方法探讨CABG术后再狭窄的防治.     

冠状动脉旁路移植术后患者抑郁焦虑状况及对生存质量的影响

研究选取2008年至2010年在我院接受冠状动脉旁路移植术（CABG）并完整填写术后半年、1年、2年抑郁焦虑自评量表（SDS 、SAS）及 SF-36问卷的患者,得出 CABG 术后2年内抑郁的发生率为32．4％,术后半年、1年、2年分别为29．4％、27．7％、23．6％。 CABG 术后2年内焦虑的发生率为18．2％,术后半年、1年、2年分别为14．7％、16．9％、7．9％。在术后生存质量的比较中,得出术后半年、1年、2年情感障碍组患者的生存质量要明显比非情感障碍组差。抑郁焦虑症状的高发生率,及其明显地降低了 CABG 术后患者的生存质量,提示临床医生须对冠心病及 CABG 术后患者的心理健康予以足够的重视。     

性别对血运重建治疗策略选择及预后的影响

为分析性别对血运重建治疗策略及预后的影响,采用单中心注册研究(Desire)数据,对2003年7月1日至2005年9月30日在北京安贞医院接受血运重建的患者随访。纳入患者3 809例,中位随访540天,多因素分析显示,女性是选择经皮冠状动脉介入术(PCI)治疗的独立影响因素(OR=1.235,95%CI=1.009~1.511,P=0.041)。指南推荐冠状动脉旁路移植手术(CABG)治疗的患者中,男性手术比例更高(P=0.016)。COX比例风险回归提示,血运重建方式是影响主要心脑血管疾病事件(MACCE)的独立危险因素(P0.001)。校正患者基线特征后,接受CABG治疗患者无MACCE生存率更高。     

左主干合并右冠状动脉慢性阻塞性病变行PCI的有效性和安全性分析

观察左主干病变合并右冠状动脉慢性完全闭塞(CTO)的患者行个体化经皮冠状动脉介入治疗(PCI)的有效性和安全性。回顾性分析2009年1月~2014年8月,沈阳军区总医院心内科因左主干病变合并右冠状CTO病变行PCI术的患者。共入选46例患者,每位患者平均置入支架数(2.3±1.3)个,支架平均长度(29.52±6.98)mm,支架平均直径(3.61±0.42)mm。其中左主干病变行介入治疗手术成功率100%,右冠状动脉CTO病变行介入治疗手术成功率93.5%,总成功率95.7%,手术过程中无严重并发症,住院期间无急性血栓形成、无急诊冠状动脉旁路移植术(CABG)。术后心功能(左室内径、左室射血分数)较前均有改善。随访期间[平均随访时间:(14.48±15.01)个月],发生7例靶血管血运重建(其中2例CABG),主要不良心脏事件发生率15.2%。左主干病变合并右冠状动脉CTO病变采用个体化策略的冠脉介入治疗,可改善患者临床症状,同时无严重并发症发生。这提示对于左主干病变合并右冠状动脉CTO行PCI术是安全可行的。     

解释的覆盖律模型和定律

科学解释(scientific explantion)是科学哲学中的经典问题,科学就是追求对经验事实给出解释性原理的学科。科学解释也是科学哲学中的一个长盛不衰的主题。2005年《综合》杂志专门刊登整整一期来讨论科学解释问题,作者主要从认识论视角研究科学解释问题,其靶子文章就是由哈洛宁(Ilpo     

冠心病的外科治疗

首例成功的冠状动脉旁路移植术(CABG)手术完成于1960年,随着体外循环技术的成熟,CABG手术得以不断发展.20世纪90年代,以非体外循环下冠脉旁路移植术(OPCAB)为代表的微创冠脉搭桥手术逐渐应用于临床.并取得满意的临床效果.尽管冠脉介入技术(PCI)以其创伤小的优点在冠心病的治疗方面蓬勃发展,但是CABG在远期通畅性方面仍然占据优势地位,因此CABG仍然是冠心病治疗的效果确定的一种方法.     

导言:冠心病的抗血小板治疗越来越重要

正众所周知,各种类型冠心病的发病、并发症的发生以及动脉硬化的进展过程都有血小板的参与,因此冠心病的抗血小板治疗已成为冠心病尤其是急性冠脉综合征治疗的基石,抗血小板治疗的重点应是急性冠脉综合征的患者[不稳定型心绞痛(UA);非ST段抬高型心肌梗死(NSTEMI);ST段抬高型心肌梗死(STEMI)]、经皮冠状动脉介入治疗(PCI)围手术期治疗、STEMI溶栓治疗的辅助治疗、冠状动脉旁路移植术(CABG)术后的治疗结合个体参照     

初中生自我调节学习的类型及对学习的影响

自我调节学习是一种学习者主动激励自己并积极使用适当的学习策略的学习,研究利用潜在剖面分析法和辨别分析法对316名初中生自我调节学习的类型进行考察,探讨不同自我调节学习类型初中生的特点,分析自我调节学习类型对学习动机、焦虑、学习成绩的影响。结果表明:(1)初中生自我调节学习分成综合发展型、均衡调节型和策略滞后型3种。(2)综合发展型初中生的自我调节学习水平最高,策略滞后型初中生的自我调节学习水平尤其是学习策略水平最低,而均衡调节型初中生的自我调节学习水平处于综合发展型和策略滞后型之间。(3)自我调节学习类型对学习动机、焦虑、学习成绩有影响。     

冠状动脉旁路移植术研究中的哲理

冠状动脉旁路移植术被广泛用来治疗冠心病及其并发症,其发展历程体现了以人为本、全面、协调、可持续的科学发展观.科学发展观属于重要的哲学思想,它从世界现和方法论的角度认识、把握和指导发展,是顺应时代潮流的发展现.分析冠状动脉旁路移植术研究所体现的科学发展观,将对准确把握冠状动脉旁路移植术发展的趋向和特点,使我国冠脉外科的发展在21世纪赶超国际先进水平起到重要的作用.     

Health Related Quality of Life After Percutaneous Coronary Revascularisation in Patients with Previous Coronary Artery Bypass Grafts: A Two-Year Follow Up Study

Percutaneous coronary revascularisation [PCR] improves angina and health related quality of life [HRQOL] compared to standard medical therapy. It is unknown whether PCR has the same benefits for patients with a history of CABG. Over a period of 5 years, we assessed HRQOL of patients undergoing PCR using Part 1 of the Nottingham Health Profile [NHP] at baseline 3, 12 and 24 months. We compared HRQOL after PCR in 255 patients with CABG to 2680 without. There were more males [81.1% v 69.6% p = 0.002] and older patients [mean age 60.1 years v. 58.0 p = 0.03] in CABG group. Perceived HRQOL improved at 24 months for pain, energy and emotional reaction but the improvement was less in the CABG group. However, mean NHP scores at 24 months for those with CABG had returned to baseline levels for sleep [34.9] and for physical function was worse than at baseline [22.0 vs 30.7]. This relationship persisted after adjustment for male sex, history of previous MI and coronary stent usage. Patients with previous CABG had less improvement in HRQOL after PCR. Further work is needed to assess the benefits and cost effectiveness of PCR in these patients.     

Resource allocation during the rereading of scientific texts

Two experiments examined how cognitive resources are allocated to comprehension processes across two readings of the same scientific texts. In Experiment 1, readers read and later reread texts describing scientific topics. The results indicated that across readings, readers decreased resources allocated to proposition assembly, increased resources allocated to text-level integration, and expended a similar amount of resources to lexical access. Subjects who reread the texts after a week delay showed a similar pattern, except that they did not show the increase for text-level integration. Experiment 2 revealed a similar pattern of results with a moving window procedure, except that there was a significant decrease in resources allocated to lexical access across exposures. This experiment also indicated that the rereading speedup was greatest at sentence boundaries, suggesting that the prior exposure enabled readers to immediately process each word. Overall, the results are consistent with the claim that readers allocate proportionally more available resources to text-level integration during rereading because proposition assembly, which enables text-level integration, can be completed with fewer resources.     

Magic and science in the modern western tradition of the i ching

At various periods throughout the roughly two and a half millennia of its history in China, the I Ching or Book of Changes, while generally remaining grounded in a fundamentally spiritual world‐view, served as a foundational text for both magical and scientific thinking. This bivalence is reflected in some of the responses which this divinatory and philosophical system has received following its introduction to the West in the present century. The present paper looks at two such related, but contrasting responses, one emphasizing the more conspicuously magical dimension of the I Ching, the other emphasizing some of its suggested scientific implications. Both approaches take their primary inspiration from the psychological theories of C. G. Jung who was deeply engaged with the I Ching. It is suggested that part of the contemporary appeal of the I Ching in the West may derive from its serving as a symbol for the integration of scientific, magical, and spiritual thinking.     

Continuation of exchange with neighbors in later life: The importance of the neighborhood context

Relationships with neighbors are considered exchange relationships, in which the continuation of exchanges depends on balance in previous exchanges. Our study tested whether this is the case. An exchange relationship implies that neighbor relationships are isolated units. We expected, however, that neighborhood integration also affects the continuation of exchange among neighbors. Data were from a longitudinal study among 1,692 independently living Dutch adults of ages 55 to 85 years at baseline and their 7,415 relationships with proximate network members. At a four–year follow–up, both perceived balance and neighborhood integration at baseline increased the chance of instrumental support exchange occurring. We concluded that it is too limited to view relationships between neighbors as exchange relationships, as these relationships are embedded in larger communities, where such communities exist.     

Models and theories I: The semantic view revisited

The paper, as Part I of a two‐part series, argues for a hybrid formulation of the semantic view of scientific theories. For stage‐setting, it first reviews the elements of the model theory in mathematical logic (on whose foundation the semantic view rests), the syntactic and the semantic view, and the different notions of models used in the practice of science. The paper then argues for an integration of the notions into the semantic view, and thereby offers a hybrid semantic view, which at once secures the view's logical foundations and enhances its applicability. The dilemma of either losing touch with the practice of science or yielding up the benefits of the model theory is thus avoided.     

Boundaries of separability between melody and rhythm in music discrimination: A neuropsychological perspective

The detailed study of a patient who suffered from a severe amelodia without arhythmia as a consequence of bilateral temporal lobe damage revealed that the processing of melodic information is at least partially separable from the processing of rhythmic information. This dissociation was replicated across different sets of material, was supported by the presence of a reversed association, and was maintained in conditions that promote integration in the normal brain. These results argue against the view that melody and rhythm are treated as a unified dimension throughout processing. At the same time, they support the view that integration takes place after early separation of the two dimensions.