急性ST段抬高型心肌梗死患者急诊PCI术后无复流相关因素分析

探讨急性ST段抬高型心肌梗死患者急诊PCI术后发生无复流的相关因素。2015年1月~2017年11月在我院因急性ST段抬高型心肌梗死接受急诊PCI手术的患者453名,根据TIMI血流分级和MBG分级标准将患者分为正常血流组和无复流组,比较这两组患者基本临床资料、造影结果和手术相关资料的差异。通过单变量分析,症状至PCI时间、血糖、Killip分级、干预前血流TIMI分级、血栓负荷程度、病灶血管长度与急诊PCI术后发生无复流有关(P0.05),通过二分类Logistic回归分析,确定症状至PCI时间(OR:1.20;95%CI:0.90~1.54)、血糖(OR:1.08;95%CI:1.03~1.39)、干预前血流TIMI分级(OR:0.92;95%CI:0.79~1.07)、血栓负荷程度(OR:1.40;95%CI:0.96~1.87)、病灶血管长度(OR:1.18;95%CI:1.02~1.37)是急诊PCI术后发生无复流的独立预测因素。     

冠脉内联合注射罂粟碱和替罗非班对PCI术中无复流的疗效观察

为了评价PCI中冠状动脉内联合应用罂粟碱及替罗非班与维拉帕米及替罗非班对急性心肌梗死无复流的疗效及安全性。选择2014年1月~2016年7月笔者所在科室收治的急性ST段抬高心肌梗死行急诊PCI,梗死相关动脉开通后无复流患者108例,随机分为观察组和对照组各54例。两组患者手术方法相同,出现无复流现象后给予替罗非班,观察组给予罂粟碱,对照组给予维拉帕米。观察两组注射药物后无复流恢复时间、TMPG分级、术后1小时心电图ST段回落、左心功能及住院期间的主要心血管事件。观察组无复流恢复时间、TIMI血流分级、TMPG分级、心电图ST段回落、左室射血分数均优于对照组(P0.05),观察组住院期间的MACE发生率低于对照组(P0.05)。研究表明AMI行急诊PCI出现无复流给予罂粟碱和替罗非班,可以增加STEMI患者PCI术中发生无复流现象后冠状动脉血流和心肌组织灌注,减少术后心绞痛及MACE的发生率,且未增加围手术期不良事件的发生。     

急性ST段抬高型心肌梗死直接PCI术后无复流的相关因素分析

确定急性ST段抬高型心肌梗死直接经皮冠状动脉介入治疗术后无复流的相关因素。根据入选及排除标准,连续选取锦州医科大学附属第一医院2014年5月~2015年5月的急性ST段抬高型心肌梗死患者203例,38例(18.7%)发生了无复流现象,分析正常血流组和无复流组的临床及造影资料,发现年龄、白细胞计数、术前血糖、ST段抬高幅度、梗死相关血管开通时间、术前收缩压、高敏C反应蛋白、术前killip分级、血栓负荷量及犯罪血管长度十个因素差异显著(P0.05),单因素及多因素分析发现其中五个因素为无复流的危险因素(P0.05)。这为急性ST段抬高型心肌梗死直接PCI时机的选择提供了临床参考。     

盐酸替罗非班联合硝普钠、硝酸甘油和维拉帕米治疗STEMI急诊PCI术后无复流的疗效研究

探讨盐酸替罗非班联合硝普钠、硝酸甘油或维拉帕米经冠脉给药治疗急性ST段抬高型心肌梗死(STEMI)PCI术中无复流(NR)的疗效。选择急诊PCI术中出现NR的患者68例,随机分为盐酸替罗非班分别联合硝普钠组、硝酸甘油组及维拉帕米组,复查冠脉造影,观察冠脉TIMI血流状况、校正血流TIMI帧数以及术后不良事件的发生率。盐酸替罗非班联合硝普钠组冠脉TIMI血流达3级约82.6%,盐酸替罗非班联合维拉帕米组约78.3%,两组均高于盐酸替罗非班联合硝酸甘油组约31.8%(P0.05),三组在住院期间均未发生死亡,各组不良反应的发生率两两之间差异无统计学意义(P0.05)。盐酸替罗非班联合硝普钠或维拉帕米相较于盐酸替罗非班联合硝酸甘油对PCI术NR的疗效更显著。     

急诊PCI术前大剂量瑞舒伐他汀治疗对冠状动脉血流的影响

探讨PCI术前给予大剂量瑞舒伐他汀对急性ST段抬高型心肌梗死患者冠脉血流的影响.入选2010年1月至2011年6月因急性ST段抬高型心肌梗死于大连医科大学附属第二医院行急诊PCI术的患者120例.随机分为试验组,即术前给予瑞舒伐他汀20mg口服,及对照组,即术前不给予瑞舒伐他汀口服.通过TIMI帧数法比较冠脉血流情况.结果两组患者临床特点、罪犯血管、疼痛到球囊扩张时间、多支病变比例、支架类型及大小均无统计学差异.术后TIMI3级血流的比例虽无统计学差异,但试验组比对照组有增加趋势(93.5％比89.7％).PCI术后试验组与对照组相比校正TI-MI帧数明显减低(26.2±11.52比34.3士18.11),数据比较有统计学差异.急诊PCI术前给予大剂量瑞舒伐他汀对于改善急性ST段抬高型心肌梗死患者术后的冠状动脉血流是有益的.     

PAPP-A水平及IVS6＋95多态性在预测PCI术后再狭窄的价值

对超敏C反应蛋白（hs-CRP）、妊娠相关蛋白A（PAPP-A）及IVS6＋95（C／G）基因多态性预测不稳定型心绞痛（UAP）患者经皮冠状动脉成形术（PCI）术后再狭窄的意义进行探讨。UAP患者行PCI术（TIMI血流达到3级），3个月-9个月复查冠脉造影，选取血管腔内径狭窄≥75％者（再狭窄组）86例、无再狭窄组（...     

PAPP-A水平及IVS6+95多态性在预测PCI术后再狭窄的价值

对超敏C反应蛋白(hs-CRP)、妊娠相关蛋白A(PAPP-A)及IVS6+ 95 (C/G)基因多态性预测不稳定型心绞痛(UAP)患者经皮冠状动脉成形术(PCI)术后再狭窄的意义进行探讨.UAP患者行PCI术(TIMI血流达到3级),3个月～9个月复查冠脉造影,选取血管腔内径狭窄≥75％者(再狭窄组)86例、无再狭窄组(对照组)152例,测定术前术后24 hPAPP-A、hs-CRP水平.采用基因测序法分析IVS6+ 95多态性.再狭窄组术后血清PAPP-A、hs-CRP水平较本组术前明显增高(P＜0.001).对照组术后血清PAPP-A、hs-CRP水平较本组术前明显下降(P＜0.001).再狭窄组IVS6+ 95中CC基因频率明显高于未发生组(P＜0.05),而等位基因C频率无明显差异.PCI术后PAPP-A、hs-CRP血清水平可作为预测冠脉再狭窄的指标,IVS6+95(C/G)多态性可能与术后再狭窄有关,其中基因型CC是致病的基础.     

延迟支架置入在高血栓负荷急性STEMI老年患者中的临床分析

探讨延迟支架置入在高血栓负荷急性ST段抬高型心肌梗死(STEMI)老年患者中的临床应用价值。选取笔者所在医院发病12h内的老年高血栓负荷STEMI患者81例,罪犯血管行血栓抽吸后前向血流达TIMI 2级~3级且血栓积分≤2分的患者随机分为常规治疗组(33例)和延迟治疗组(28例)。比较两组患者术后慢血流/无复流发生率、心肌灌注呈色分级、术后6月心功能及术后6月内复合终点事件发生率。延迟组支架置入后慢血流/无复流发生率显著低于常规治疗组(P0.05),心肌呈色分级、术后6个月LVEF改善幅度明显高于常规组(P0.05),左心室舒张末期内径明显低于常规组(P0.05),6个月内复合终点事件发生率延迟组高于常规组,差异无统计学意义(P0.05)。血栓抽吸后延迟支架置入可显著减少老年高血栓负荷急性STEMI患者慢血流/无复流发生率,提高心肌灌注,改善老年患者心功能。     

骨桥蛋白与高敏C反应蛋白对冠状动脉介入治疗后再狭窄的预测价值

探讨血浆高敏C反应蛋白(hs-CRP)及骨桥蛋白(OPN)对冠状动脉介入治疗(PCI)后患者冠状动脉支架内再狭窄(ISR)发生的预测价值,并比较二者对ISR预测的准确性。收集2014年5月~2015年5月于笔者所在医院成功施行PCI并自愿随访冠状动脉造影(CAG)的患者206例,术后随访1年,根据复查CAG的结果将入选者分为再狭窄组(n=28)和无再狭窄组(n=178),复查CAG时检测两组患者血浆hs-CRP、OPN等生化指标,进行统计分析。再狭窄组患者hs-CRP及OPN水平均高于无再狭窄组,Logistic分析结果显示hs-CRP及OPN水平对PCI后发生ISR有独立的预测价值,当hs-CRP及OPN取最佳临界值时OPN对IRS诊断的特异性、准确性及阳性预测值均高于hs-CRP。相对于hs-CRP,OPN对PCI后发生ISR具有更好的预测价值,尤其是其诊断的特异性、准确性及阳性预测值更具优势,值得推广。     

经皮冠状动脉介入治疗(PCI)后无复流现象的综合解析

现已证明无复流现象的发生会明显降低经皮冠状动脉介入治疗(PCI)效果,影响患者近、远期预后.应用综合思维探讨无复流现象发生的机理、制定预防策略至关重要.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.