儿童支气管哮喘诊断的几点思考

支气管哮喘(以下简称哮喘)是小儿常见的慢性气道疾病.5岁及以下儿童哮喘的诊断极为困难,是富有挑战性的;因为诊断只能依靠临床判断、症状评价和体征分析.病毒感染所至的喘息在婴幼儿期很常见,与哮喘鉴别较困难.目前还没有诊断婴幼儿期哮喘的特异检测手段和方法,因此诊断需要综合考虑,包括反复喘息的类型、特异体质病史、哮喘危险因素、长期随访、广泛鉴别诊断和观察对支气管舒张剂及抗炎治疗的反应.     

《中国高血压防治指南》2005年修订版要点解析

指南是依据流行病学和大规模随机临床试验的最佳证据而修订的.指南的要点是:从110/75mmHg开始,人群血压水平与心血管病发生危险呈连续相关;正常高值血压(120～139mmHg/80～89mmHg)应改善生活方式以预防高血压发生;2002年调查我国有1.6亿高血压患者,但知晓率、治疗年和控制率很低;降低高血压患者的血压水平是预防脑卒中及心脏事件的根本.     

术后认知障碍,麻醉医生能做什么

术后认知功能障碍(POCD)是一种常见于老年患者的术后神经系统并发症,可增加术后死亡率。由于没有统一的诊断标准,报道的POCD发病率有很大差异。POCD危险因素主要包括老年、心脏手术、麻醉方式、应激反应、微血栓等。近年来,关于POCD的研究取得了很大的进展。但其发病病因和机制尚不清楚,临床仍然缺乏有效的预防和治疗手段。术前大剂量应用地塞米松、远端缺血预处理等方法对预防POCD作用不大,术前应用右美托咪定、昂丹司琼、中医中药等使POCD改善。     

青年肺癌的临床特点及预后因素分析

探索青年肺癌患者临床特点并进行预后分析。回顾分析2010年1月~2013年12月术后病理证实的63例青年肺癌患者的临床及病理资料,采用Kaplan-Meier法和Cox回归进行青年肺癌患者预后的单因素及多因素分析。结果63例青年肺癌患者5年生存率(OS)为37.4%。单因素分析发现患者的生存期与淋巴转移、胸膜侵犯、腺癌病理的亚分型、TNM分期有关;与性别、年龄分层、遗传倾向、发生部位、分化程度无关。多因素分析提示胸膜侵犯(P=0.007)、淋巴结转移、TNM分期(P0.001)为影响青年肺癌患者生存的独立危险因素。TNM分期、胸膜侵犯及淋巴结转移与青年肺癌患者预后相关。有症状出现时分期已经偏晚,早期根治治疗效果确切。     

冠脉介入术支架内血栓的危险因素和预防策略

支架内血栓形成是经皮冠状动脉介入治疗罕见但极为严重的并发症,常导致患者心肌梗死和死亡.其危险因素包括抗血小板治疗、支架因素、介入操作因素、患者及病变因素等.预防的关键在于积极防治上述危险因素.主要包括延长抗血小板治疗疗程、选择合适的支架类型和操作技术、开发新型支架和抗血小板药物,同时注意冠心病二级预防.     

《中国高血压防治指南》2005年修订版要点解析

指南是依据流行病学和大规模随机临床试验的最佳证据而修订的。指南的要点是:从110/75mmHg开始,人群血压水平与心血管病发生危险呈连续相关;正常高值血压(120～139mmHg/80～89mmHg)应改善生活方式以预防高血压发生;2002年调查我国有1.6亿高血压患者,但知晓率、治疗年和控制率很低;降低高血压患者的血压水平是预防脑卒中及心脏事件的根本。     

老年舒张性心力衰竭诊治的思考

舒张性心力衰竭在老年高血压、冠心痛患者中发病率较高,但临床症状、体征不特异,不典型,常容易漏诊.因此,临床工作中应注意发现舒张性心力衰竭相关的症状、体征,结合胸片有肺淤血、超声心动图左室射血分数(left ventricular e-jection fraction,LVEF)正常、血浆脑钠肽(brain natriuretic peptide,BNP)增高等,早期诊断及治疗,提高老年患者的生活质量,减少晚期混合型心力衰竭的发病率.     

妇科恶性肿瘤合并静脉血栓栓塞的研究进展

静脉血栓栓塞(venous thromboembolism,VTE)是妇科恶性肿瘤的常见并发症之一,与患者的病死率升高密切相关.患者自身状态、肿瘤的类型、分期及手术、放化疗等治疗手段均可构成VTE的危险因素.但目前尚缺乏专门针对妇科恶性肿瘤合并VTE的临床实验数据以及预防和诊治指南.     

甲状腺功能亢进症合并烟雾病2例报道并文献复习

探讨甲状腺功能亢进症（甲亢）合并烟雾病的发病机制、临床特点、治疗方法及预后.回顾性分析报道2例甲亢合并烟雾病患者的临床表现、诊疗经过及预后,结合文献分析.甲亢合并烟雾病较为罕见,2例患者均为青年女性,主要表现为以脑梗死为主的脑缺血症状,临床症状均发生于甲状腺毒症期,控制甲亢及血管重建术等治疗可以有效改善神经系统缺损症状,预防复发.对拟诊烟雾病患者筛查甲亢,有脑血管病症状的甲亢患者行脑血管影像学检查,以利于早期发现,综合治疗,预防复发.     

体外授精—胚胎移植后异位妊娠相关因素研究进展

近年来,随着体外授精一胚胎移植(IVF-ET)技术的蓬勃开展,IVF-ET后异位妊娠(EP)的发病率也随之升高.IVF-ET后EP发生的相关危险因素包括输卵管因素、子宫内膜异位症、授精方式、胚胎移植技术及控制性超排卵等,其中最主要的危险因素是由输卵管因素引起的输卵管功能紊乱.对具有以上危险因素的患者,在行IVF-ET治疗前,应尽量减少危险因素的影响,以提高临床妊娠率,并减少异位妊娠的发生率.本文就近年来对IVF-ET后EP发生的相关危险因素的研究作一综述.     

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.     

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.     

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.     

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.