准确把握微创外科的适应证

分析了以腔镜手术为代表的微创外科在疾病治疗中的地位和适应证,指出微创手术不应当只是切口的减小,应该综合降低各种创伤因素;在"后腔镜时代",要注意发现因腔镜技术而带来的疾病诊疗原则和手术适应证上的新变化,努力从不断发展的新兴科技中从寻找新的技术增长点,以此扩大微创外科的适应证;也要看到微创手术还不能完全取代传统开放手术,不要盲目扩大微创手术的适应证,更不能企望微创手术能完成传统手术不能治疗的疾病.     

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.     

腔镜在分化型甲状腺癌手术中的应用

作为一种新的术式,完全腔镜下甲状腺手术(TET)是不是微创手术,该选择何种入路,对甲状腺癌手术是否合适等问题仍然存在争议.本文就这些问题进行详细的阐述.完全腔镜治疗甲状腺癌手术的适应证是:有美容要求的女性或者肿瘤直接≤2cm;手术方式:腺叶全切加中央区淋巴结清扫或者加侧区清扫.手术前应该评估淋巴结转移情况,术后要严密随访.TET手术技术日趋成熟,而且是安全、可行;但要完成TET甲状腺癌根治术,术者除了具有娴熟的腔镜下手术操作技能,还要有丰富的开放甲状腺手术的经验.     

小儿肾结石微创治疗研究进展

近年来小儿肾结石的发病率逐渐升高,体外冲击波碎石(ESWL)、经皮肾镜碎石取石术(PCNL)、输尿管软镜碎石取石术(FUL)等微创治疗技术已逐步取代开放性手术成为小儿肾结石的主要治疗手段。ESWL操作方便、创伤小及花费相对较少,但治疗体积较大和复杂性肾结石的清石率明显降低;PCNL治疗复杂性肾结石有较大的优势,但其并发症(如大出血、肾及周围脏器损伤等)的发生却不容小觑;FUL有更加微创、并发症少、可反复治疗等优点,但由于设备昂贵、易损耗、治疗成本高等原因限制了其在临床的推广应用。本文主要对微创治疗在小儿肾结石中的应用做一综述。     

对西方艺术中维纳斯形象“对镜”的图式探究

古希腊文化是西方文明的土壤,其艺术代表着一种美学典范与古典原则,作为希腊神话中的维纳斯形象,是西方众多绘画名家所描绘的对象,不同流派的绘画大师以不同的风格、不同的形态、不同的角度来阐释着维纳斯的女性美。采用艺术史图式分析的方法,以西方艺术中维纳斯形象的"对镜"为着眼点,把韦切利奥·提香(Tiziano Vecellio,1490—1576)的《镜前的维纳斯》(Venus with a Mirror,1555)作为个案,对比分析与之有渊源关系的维纳斯"对镜"题材,从绘画的内容、构图、表现手法等入手,探究西方艺术中维纳斯形象"对镜"图式的渊源,深层剖析其相互间的继承与发展。     

准确把握微创外科的适应证

分析了以腔镜手术为代表的微创外科在疾病治疗中的地位和适应证,指出微创手术不应当只是切口的减小,应该综合降低各种创伤因素;在“后腔镜时代”,要注意发现因腔镜技术而带来的疾病诊疗原则和手术适应证上的新变化,努力从不断发展的新兴科技中从寻找新的技术增长点,以此扩大微创外科的适应证;也要看到微创手术还不能完全取代传统开放手术,不要盲目扩大微创手术的适应证,更不能企望微创手术能完成传统手术不能治疗的疾病。     

重症急性胰腺炎感染性胰腺坏死经皮肾镜微创治疗进展

当前,微创手术已逐步成为重症急性胰腺炎合并感染性胰腺坏死外科治疗的标准化手术方式。经皮肾镜腹膜后入路胰腺坏死组织清除术是其中的一种微创技术,该技术具有操作简单、创伤小、可重复性高、不干扰腹腔脏器等特点,本文就这一手术方式的技术演变及进展做一综述。     

北京微创医院建设的初步实践--从微创医学理论到具体实践

创建微创医院是发展我国微创医学的首要和必需条件.微创医院是一类以微创理念为指导、以微创医学体系为主导、以整合的微创技术为特色、以"医疗中心"为基本临床结构系统的现代化、数字化的综合性医院.建设微创医院的目的在于验证微创医学理论体系,探索新的医学智慧.     

"结合美学"对审美无功利命题的批判浅论

柏林特在哲学基础、审美模式、审美感官三个层面上对审美无功利命题进行了批判,主张建立一种新的美学理论,即他所说的"介入美学".不过,这种新的美学理论与审美无功利命题在根本上是兼容的.审美无功利命题在"结合美学"中得以保留的价值在于它能为"介入美学"提供一条限制"介入"深度的底线.     

达芬奇手术机器人系统在普通外科的应用

20世纪80年代腹腔镜的出现使微创技术的发展取得了长足的进步,在此基础上,手术机器人的研发和应用开启了微创外科新纪元.本文通过达芬奇手术机器人系统在普通外科各类手术中的具体运用,分析了手术机器人对比传统腔镜技术的技术优势,及当前临床应用的瓶颈,并对高新技术的发展进行了点滴思考.     

The Red and The Real

It is often claimed that principles of individuation imply essential properties of the things individuated. For example, sets are individuated by their members, hence sets have their members essentially. But how does this inference work? First I discuss the form of such inferences, and conclude that the essentialist inference is not a purely formal matter: although there is a form which all principles of individuation have in common, it is not true that any statement of that form is a principle of individuation, and hence there is no valid inference based purely on that form. However, I argue that there is a viable version of the essentialist inference nonetheless. The resources for a proper reconstruction of this type of inference can be gathered from reflections upon the role principles of individuation play in the project of the ontologist: such principles turn out to carry a modal weight similar to that of definitions or conceptual truths. It follows that, no matter how austere the ontology, some portion of essentialist modality is inevitable.     

The Return Of The Religious

Recents discussions of expansion in the European Union and the possibility of envisioning a Muslim country in it has exacerbated the deep-seated anxiety about Islam among the liberal and extreme right in Europe. This paper suggests that there are recurring elements in the discourse of European cultural identity and one of these elements is the representation of Islam in its alterity to European identity and civilization. Questioning the thesis of a radical break with the Christian past, this paper questions whether the European cultural identity which is being formed today signifies a break with a religious form of identification. The liberal and extreme right opposes Turkish membership on the grounds that the differences between ‘European values’ and ‘European culture and lifestyle’ and Turkey's culture are what makes the latter essentially and fundamentally external to the essence of Europe. Tracing the remnants of Christian discourse in the contemporary fashioning of European identity, this paper discusses how Christianity, with its secularized versions, which are now displaced to culture and lifestyle, still holds a privileged position as a unifying theme in Europe. It suggests that one of the tests that awaits Europe is whether it will be capable of articulating a new but democratic identity for Europe, one that is responsive to the differences of the other or whether it wants to continue to be European by way of its old methods of exclusion.     

医学教育人文精神缺失的弊端及对策

人文精神本是医学学科的根本要旨之一,然而,目前医学教育中普遍存在着人文精神缺失的状况.从医学教育的宗旨、医学模式的转变、医学生的综合素质、医患关系方面剖析了人文精神缺失的弊端并提出了相应对策.     

The neglected bulimic: The nonpurger

For nearly 10 years bulimia has been recognized officially as a distinct eating disorder, and yet in that time only minimal attention has focused on the nonpurging subtype. The present investigation compared 21 DSM-III-R diagnosed nonpurging bulimics with 22 non-eating-disordered controls on three standardized questionnaires and during a unique assessment task. In this procedure subjects imagined that they were the character in a series of slides and audiotaped flooding scenes. The content of the stimuli ranged from food and weight cues to issues hypothesized to play a role in the development or maintenance of bulimia (e.g., rejection or loss of control fears). A MANOVA conducted on the three questionnaires was highly significant, with the Beck Depression Inventory and the Restraint Scale being responsible for the elevated bulimic scores. A repeated-measures ANOVA performed on the self-report ratings during the exposure task also achieved significance, as the bulimics reported higher anxiety reactions than controls to each experimental stimulus. Significant skin conductance reactions were detected when a group of only the most psychophysiologically responsive bulimics and controls were compared. The importance of continued comprehensive evaluations with DSM-III-R nonpurging bulimics was emphasized.This research was supported by grants both from the University of New Mexico's Research Allocation Committee and the Biomedical Research Support Grant committee. Portions of this paper were presented at the Association for the Advancement of Behavior Therapy annual conference, Boston, November 1987.     

The Logic of The Goldhagen Debate

Since Daniel J. Goldhagen's Hitler's Willing Executioners: Ordinary Germans and the Holocaustattempts to show that the Holocaust is explicable and can be understood largely in terms of a single cause, “eliminationist anti-Semitism”, it is not surprising that the book has generated an international debate. What is surprising is the magnitude and emotional intensity of the debate. This article argues that the deepest flaws in it Hitler's Willing Executioners,as well as the chasm of disagreement between Goldhagen's detractors and defenders, have as much to do with reasoning and concepts as with matters of fact. It concludes that Goldhagen's central argument is stronger than many of his critics claim, but that the inadequacy of his cognitive interpretation of anti-Semitism and his unexamined psychological assumptions weaken his attempt to explain the Holocaust. This revised version was published online in August 2006 with corrections to the Cover Date.     

现代视域下传统和谐思想的价值转换

中华传统和谐思想丰富多彩,它是维护中华民族统一的重要法宝,是推动中华民族文化发展的思想源泉。但是,传统和谐思想中也存在着消极的东西,特别是以等级划分为特征的历史局限。继承传统和谐思想的合理内核,并对传统和谐思想进行现代价值转换,对建构社会主义和谐社会具有重要的理论和现实意义。     

骨折治疗方法与原则的最优化历程

多年来骨折治疗,新旧技术、新旧理论相互融合,相互碰撞,产生了新的理论和方法,使得临床疗效显著提高,现阶段理智的临床医生应该融汇各家之长,多方互补,对每一位骨折患者的治疗都应该按照最优化的原则进行.但是在医疗过程中总存在着如方法选择不当或者错误,过度治疗,医患信任危机,医疗伦理道德的丧失等情况,我们应该用矛盾分析的方法来思考这些问题.     

The Activities of The Scandinavian Societies

Freud's concept of the death instinct has given rise to many different interpretations which have often been contradictory. It is in fact already possible to discern two diametrically opposite meanings of this concept in Freud's work from 1920—Beyond the Pleasure Principle—in which he first introduced the concept of the death instinct. In this paper, it is argued that both these meanings are relevant in describing psychical life, although only one of these meanings actually qualifies for the concept “death instinct”. Beyond the Pleasure Principle was written in order to try to understand some everyday, as well as clinical phenomena which could not be explained by the so-called pleasure principle. Freud postulated something beyond the pleasure principle, which initially seemed to have to do with binding energy. I will preserve this idea and attempt to develop it within the context of a phenomenological analysis of time. The temporalization of the subject involves a very basic affirmation of existence, in that the subject experiences something constant, something that can be said to possess the quality of a gestalt. I propose that that which is beyond the pleasure principle—this binding of energy—should be understood as the opposite of the idea of a primordial death instinct striving towards death. In this case, that which is beyond the pleasure principle reflects an original affirmation of existence, which could be said to correspond to Freud's first meaning of the death instinct. The second meaning—for which the name “death instinct” seems to be applicable—concerns the discharge of energy, which from a temporal point of view shows itself as a tendency to dissolution. The concept of the death instinct in its various meanings is discussed in connection with phenomenological reflections on time, which is a different approach from Freud's attempt to ground the death instinct in biology.