整合临床医学的必要性、可行性及途径——以睡眠呼吸暂停防控为例

长期以来以专科划分为主的医疗发展方式确实促进了现代医学的进步。然而,人是一个整体不应该被割裂对待。所以,这种医学发展趋势应该加以控制,否则必然会阻碍医学事业的健康发展。另外,如果只关注局部治疗想要取得突破已经越来越难。因此,整合临床医学势在必行。本文分别从阻塞性睡眠呼吸暂停的病因、临床表现(包括合并症)及诊断和治疗三个方面阐述了只有全面进行医学整合才能提高阻塞性睡眠呼吸暂停的整体防控水平。     

睡眠呼吸暂停相关性高血压

睡眠呼吸暂停综合征是以睡眠过程中反复呼吸暂停进而引起慢性间歇性低氧、二氧化碳潴留为特征的常见睡眠呼吸障碍性疾病.阻塞性睡眠呼吸暂停与高血压密切相关,睡眠呼吸暂停相关性高血压为一常见的特殊患病人群,多导睡眠图是诊断睡眠呼吸暂停相关性高血压的"金标准",其治疗在一般生活方式改变基础上,持续气道正压通气治疗是其重要治疗方法.     

睡眠呼吸暂停相关性高血压

睡眠呼吸暂停综合征是以睡眠过程中反复呼吸暂停进而引起慢性间歇性低氧、二氧化碳潴留为特征的常见睡眠呼吸障碍性疾病。阻塞性睡眠呼吸暂停与高血压密切相关,睡眠呼吸暂停相关性高血压为一常见的特殊患病人群,多导睡眠图是诊断睡眠呼吸暂停相关性高血压的“金标准”,其治疗在一般生活方式改变基础上,持续气道正压通气治疗是其重要治疗方法。     

阻塞性睡眠呼吸暂停低通气综合征是引发道路交通事故的重要原因

为了分析我国道路交通事故是否与阻塞性睡眠呼吸暂停相关,以道路交通事故为主题查阅1993年~2012年万方数据库,并辅以手检同期《中华创伤杂志》和《中华流行病学杂志》,重点查阅全国性及地区性道路交通事故原因的论著,看其是否涉及阻塞性睡眠呼吸暂停问题。结果显示这期间共发表了相关论著43篇,全部论文在分析道路交通事故时均未提及阻塞性睡眠呼吸暂停这一重要原因,提示国内道路交通安全研究中忽略了一个与之关系密切的阻塞性睡眠呼吸暂停问题,建议今后将这个问题引入到道路交通安全管理项目中。     

OSAHS在2型糖尿病发病中的作用与对策

阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)是一种常见的睡眠呼吸紊乱性疾病,以睡眠时反复发作的上气道部分或完全阻塞为特征.近年发现OSAHS与2型糖尿病之间有着明显的相关性,二者均为心血管疾病的高危因素,合并存在能够严重影响生命质量与预期寿命,选择合适的治疗方案对改善患者治疗效果及改善预后具有十分重要的意义.     

阻塞性睡眠呼吸暂停低通气综合征导致高血压的机制

阻塞性睡眠呼吸暂停低通气综合征是重要的继发性高血压病因之一,该综合征导致血压增高的原因主要有睡眠分裂、频繁的低氧血症和高碳酸血症导致的高交感神经兴奋,呼吸暂停发生时胸腔负压的增加和回心血量的增加以及内分泌功能的失调如醛固酮的高分泌,超重肥胖和慢性非特异性炎症反应的参与,是多种升压机制共同参与的结果.     

OSAHS在2型糖尿病发病中的作用与对策

阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea hypopnea syndrome,OSAHS）是一种常见的睡眠呼吸紊乱性疾病,以睡眠时反复发作的上气道部分或完全阻塞为特征。近年发现OSAHS与2型糖尿病之间有着明显的相关性,二者均为心血管疾病的高危因素,合并存在能够严重影响生命质量与预期寿命...     

阻塞性睡眠呼吸暂停低通气综合征与脑卒中

阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)作为一种脑卒中独立的危险因素已经广泛受到重视,是脑卒中、冠心病、高血压、充血性心力衰竭等心脑血管疾病的一个主要发病因素.OSAHS引起的频繁血氧饱和度下降和夜间睡眠结构紊乱对心脑血管系统产生严重的危害.本综述主要讨论OSAHS对脑卒中患者的影响和对此类患者的治疗.了解OSAHS和脑卒中之间的联系对于脑卒中的一、二级预防具有重要的意义.     

睡眠呼吸暂停综合征与肺高血压

肺高血压是一类以肺血管阻力进行性升高为主要特征,并最终导致右心衰竭甚至死亡的恶性心血管疾病.多种疾病可导致肺高血压,其中第三大类肺高血压与肺部疾病及缺氧有关.已有许多研究得出结论睡眠呼吸暂停综合征是肺高血压的高危因素,但具体发病机制不详.本文目的是结合国外文献阐述睡眠呼吸暂停综合征致肺高血压的发病机制及干预睡眠呼吸暂停综合征对肺动脉高压的影响.     

临床医学本来就是整体

医学科学的发展遵循综合-分化-再综合的客观规律,多学科整合医学模式的诞生还原了临床医学整体性的特征.中西医结合体现了不同文化包容发展的精神,是传统与现代相结合的整体整合医学的典范.基于“病证结合”研究模式的血瘀证与活血化瘀系列创新性研究成果得到国际医学的广泛认同,未来中、西医学应该更加和谐统一,共同造福人类.     

Extremes of self-esteem and narcissism and the experience and expression of anger and aggression

This study examined the level of self-esteem and narcissism as personality variables involved in the disposition to experience and express anger. Three hundred thirty-eight subjects were sampled across two higher education centres and one student teaching programme in the United Kingdom. It was reasoned that individuals with both high self-esteem and narcissism would report especially high tendencies to experience and express anger and aggression and that those with high self-esteem and low narcissism would report the lowest. These predictions were influenced by theories that emphasise the role of threats to high self-esteem in the production of aggression and violence. Results indicate that groups defined by their extreme scores on self-esteem and narcissism scales produced levels of anger expression in the predicted direction. The importance of considering extreme levels of self-esteem and narcissism (in conjunction with other factors) in an analysis of anger is discussed with reference to currently influential theories in the field. Aggr. Behav. 24:421–438, 1998. © 1998 Wiley-Liss, Inc.     

Face aftereffects suggest interdependent processing of expression and sex and of expression and race

Bruce and Young (1986) proposed that functionally different aspects of faces (e.g., sex, identity, and expression) are processed independently. Although interdependent processing of identity and expression and of identity and sex have been demonstrated previously, evidence for interdependent processing of sex and expression is equivocal. Using a visual adaptation paradigm, we show that expression aftereffects can be simultaneously induced in different directions along anger–fear continua for male and female faces (Experiment 1) and for East Asian and Black African faces (Experiment 2). These findings for sex- and race-contingent expression aftereffects suggest that processing of expression is interdependent with processing of sex and race and are therefore problematic for models of face perception that have emphasized independent processing of functionally different aspects of faces. By contrast, our findings are consistent with models of face processing that propose that invariant physical aspects of faces and changeable social cues can be processed interdependently.     

Values and Beliefs of Vegetarians and Omnivores

Abstract

Following the claim by some anthropologists and sociologists that 1 symbolic meaning of meat is a preference for hierarchical domination (C. J. Adams, 1990; N. Fiddes, 1989; D. D. Heisley, 1990; J. Twigg, 1983), the authors compared the values and beliefs of vegetarians and omnivores in 2 studies conducted in New Zealand. They compared the full range of vegetarians and omnivores on right-wing authoritarianism, social dominance orientation, human values, and consumption values. The participants tending toward omnivorism differed from those leaning toward veganism and vegetarianism in 2 principal ways: The omnivores (a) were more likely to endorse hierarchical domination and (b) placed less importance on emotional states. Accordingly, the acceptance or rejection of meat co-varied with the acceptance or rejection of the values associated with meat; that finding suggests that individuals consume meat and embrace its symbolism in ways consistent with their self-definitions.     

Recognition of faces of ingroup and outgroup children and adults

People are often more accurate in recognizing faces of ingroup members than in recognizing faces of outgroup members. Although own-group biases in face recognition are well established among adults, less attention has been given to such biases among children. This is surprising considering how often children give testimony in criminal and civil cases. In the current two studies, Euro-Canadian children attending public school and young adults enrolled in university-level classes were asked whether previously presented photographs of Euro-American and African American adults (Study 1) or photographs of Native Canadian, Euro-Canadian, and African American children (Study 2) were new or old. In both studies, own-group biases were found on measures of discrimination accuracy and response bias as well as on estimates of reaction time, confidence, and confidence-accuracy relations. Results of both studies were consistent with predictions derived from multidimensional face space theory of face recognition. Implications of the current studies for the validity of children's eyewitness testimony are also discussed.     

颅内动脉瘤的诊断、治疗时机及方法

分析颅内动脉瘤各种常用诊断方法的价值以及治疗时机和方法,认为对颅内动脉瘤应该在准确、快速诊断的基础上,按照安全、有效、经济的原则进行治疗。     

Focus of attention and causal attributions of actors and observers

An experiment was conducted to test the hypothesis that actors' and observers' causal attributions are a function of their focus of attention. In the presence of observer-subjects, actor-subjects made a choice among several art works in a supposed decision-making study. The experiment was a 2 × 2 × 2 factorial design with the factors (1) source of attribution (actors, observers); (2) camera (actor videotaped, actor not videotaped); and (3) situational stability (stable, dynamic environment). As predicted by the focus of attention-causal attribution notion, it was found that actors attributed more causality to the situation than observers under normal circumstances, when the camera was not operative, but that videotaping the actor reversed the usual actor-observer pattern such that actors attributed less causality to the situation than did observers. Further, when the environment was stable, actors attributed more causality to the situation in the no camera condition than in the camera condition, while observers attributed less to the situation in the no camera conditions than in the camera conditions. Additionally, both actors and observers attributed more causality to the situation when the environment was dynamic than when the environment was stable.     

理论思维、工程思维、评价思维的界定与联系——谈对缺血性脑血管病临床实践若干问题的思考

理论思维是力求逻辑自恰、规避自相矛盾;工程思维是对逻辑地发现的属性进行非逻辑的复合;评价思维是虚体思维和筹划因素相分离所导致的思维方式。理论思维的成果必须通过工程思维付诸实践,评价思维是对实践的结果进行评价,评价的结果是对工程思维或/和理论思维的成果进行反思。对缺血性脑血管病实践中的理论思维、工程思维和评价思维的界定与相互联系进行探讨。     

Human Dignity and the Ethics and Aesthetics of Pain and Suffering

Inasmuch as unmitigated pain and suffering areoften thought to rob human beings of theirdignity, physicians and other care providersincur a special duty to relieve pain andsuffering when they encounter it. When pain andsuffering cannot be controlled it is sometimesthought that human dignity is compromised.Death, it is sometimes argued, would bepreferred to a life without dignity.Reasoning such as this trades on certainpreconceptions of the nature of pain andsuffering, and of their relationships todignity. The purpose of this paper is to laybare these preconceptions. The duties torelieve pain and suffering are clearly mattersof moral obligation, as is the duty to respondappropriately to the dignity of other persons.However, it is argued that our understanding ofthe phenomena of pain and suffering and theirrelationships to human dignity will be expandedwhen we explore the aesthetic dimensions ofthese various concepts. On the view presentedhere the life worth living is both morally goodand aesthetically beautiful. Appropriate``suffering with' another can help to maintainand restore the dignity of the relationshipsinvolved, even as it preserves and enhances thedignity of patient and caregiver alike.     

正常人以及精神障碍人群在合作与竞争中的表现

合作与竞争是社会互动的两种主要形式,也是冲突解决的两种方法,对人际交往具有重要作用,一直以来都受到研究者的广泛关注。但是从心理与社会学角度研究合作与竞争的文献却相对较少,而对于精神障碍人群在合作与竞争中异常表现的原因目前也存在争议。本文从心理与社会学的角度出发,对合作与竞争的神经机制和生物基础进行综合论述,并对精神障碍人群在合作与竞争两种社会互动中的表现进行比较,试图为精神障碍人群在人际交往中的康复训练提供理论依据。