达比加群酯在抗凝治疗中的研究进展

新型口服抗凝药达比加群酯具有强效抗凝、出血风险低、无需特殊监测、药物相互作用少等优点,能显著降低卒中和栓塞性疾病的风险,同时显著降低出血事件的发生和血管性死亡率。它的问世是抗凝治疗领域和潜在致死性血栓预防领域的一项重大进展。     

老年人心房颤动的抗凝治疗

本文简述了老年房颤的流行病学和其主要并发症.介绍了老年房颤的血栓栓塞的危险评估、抗凝治疗的循证医学证据、抗凝药物的选择、抗凝治疗的不良反应及展望等五个方面问题.     

房颤抗凝治疗问题的探讨

房颤易出现栓塞的并发症,而华法林可以明显减少血栓栓塞事件.阵发性房颤同样有血栓栓塞的危险,也应积极抗凝.具体的抗凝强度(PT INR目标值)在各个实验中差别很大,因为人种的关系,我们应该借鉴日本的研究结果.另外,许多因素会影响华法林的抗凝效果,要注意监测.     

房颤抗凝治疗问题的探讨

房颤易出现栓塞的并发症,而华法林可以明显减少血栓栓塞事件。阵发性房颤同样有血栓栓塞的危险,也应积极抗凝。具体的抗凝强度(PTINR目标值)在各个实验中差别很大,因为人种的关系,我们应该借鉴日本的研究结果。另外,许多因素会影响华法林的抗凝效果,要注意监测。     

房颤消融术后抗凝药物停止时机

心房颤动(简称房颤)导管消融损伤部位多、手术时间长,术中及术后易出现血栓栓塞等并发症。房颤消融术后短期内停止抗凝治疗将面临极大的卒中风险,而长期服药又可能会增加出血风险。因此,优化围手术期抗凝治疗是减少房颤消融术血栓栓塞和出血发生风险的关键。     

心房颤动的器械治疗评价

器械治疗虽然不能完全消除房颤,但起搏器在一定程度上能减少房颤的负荷、能够快速终止房颤发作,房室结消融+双心室起搏治疗既能缓解房颤快速心室率时的症状,也使得心室得以再同步化治疗.经皮左心耳堵闭术可以预防血栓栓塞并发症、并避免长期应用抗凝药物.在越来越多的房颤患者中,还是有一部分患者仍然有器械治疗的适应证的.     

静脉血栓栓塞症

静脉血栓栓塞症包含深静脉血栓形成和肺血栓栓塞症,是具有多种危险因素的潜在致死性疾病,其流行病学资料研究显示并非少见疾病.除检验前的临床评估和D-二聚体外,目前已有多种诊查手段用于静脉血栓栓塞症的诊断,其中螺旋CT造影已逐渐成为诊断的首选.根据病情,患者有抗凝、溶栓、手术和介入等多种选择.各医院要根据自身情况制订相应的临床策略,以最大限度提高诊治决策的成本-效益比.     

心房颤动的器械治疗评价

器械治疗虽然不能完全消除房颤,但起搏器在一定程度上能减少房颤的负荷、能够快速终止房颤发作,房室结消融＋双心室起搏治疗既能缓解房颤快速心室率时的症状,也使得·心室得以再同步化治疗。经皮左心耳堵闭术可以预防血栓栓塞并发症、并避免长期应用抗凝药物。在越来越多的房颤患者中,还是有一部分患者仍然有器械治疗的适应讧的。     

关于阵发性心房纤颤是否需要抗凝治疗的思考

阵发性心房纤颤与持续性心房纤颤同样面临着缺血性脑卒中风险,而关于阵发性房颤是否需要华法林抗凝治疗是目前争论热点问题。阵发性房颤是否抗凝治疗使患者面临着严重出血或血栓栓塞风险。循证医学论证了阵发性房颤抗凝治疗必要性及风险性,并且由于阵发性房颤患者有着不同的脑卒中及出血风险,个体差异的绝对性和多样性客观上要求对患者进行风险／效益比评估,在循证医学基础上进行个体化治疗。     

肺动脉血栓栓塞症与凝血纤溶系统失衡

在生理状态下,凝血与纤溶处于动态平衡状态;当这种平衡失衡时,便可招致出血不止或形成栓塞.体内某些抗凝途径的蛋白缺陷会使机体处于高凝状态而导致静脉血栓栓塞性疾病(VTE),已经报道有多种栓塞因素与VTE的发生有关;人们通常认为,慢性栓塞性肺动脉高压(CTE-PH)是静脉系统栓子反复脱落至肺动脉所致,很自然的会想到CTE-PH的发病可能与以上多种栓塞因素有关,然而,目前研究更倾向于CTEPH和VTE并没有直接的关系或者说是两个独立的疾病.     

From the fixity of the past to the fixity of the independent

There is an old but powerful argument for the claim that exhaustive divine foreknowledge is incompatible with the freedom to do otherwise. A crucial ingredient in this argument is the principle of the “Fixity of the Past” (FP). A seemingly new response to this argument has emerged, the so-called “dependence response,” which involves, among other things, abandoning FP for an alternative principle, the principle of the “Fixity of the Independent” (FI). This paper presents three arguments for the claim that FI ought to be preferred to FP.

     

On the interaction of the subject and the experiment in the matching model

Two types of matching designs, static and dynamic, are differentiated. While all matching designs are logically the same in terms of the probability model which determines chance level of performance, an attempt is made to demonstrate that there is an interaction between the tactics, strategies, and actual knowledge ofS and the type of design used which will, in turn, lead to different results even whenS's knowledge is held constant. It is suggested that analogous situations may exist within the framework of the traditional psychometric model.The work reported in this paper was supported by a National Science Foundation Undergraduate Research Participation Grant (NSF-G15797) to the senior author. The authors are indebted to Joel E. Greene for his advice and criticism.     

In the beginning was the doing: the premises of the practical syllogism

If practical reasoning deserves its name, its form must be different from that of ordinary (theoretical) reasoning. A few have thought that the conclusion of practical reasoning is an action, rather than a mental state. I argue here that if the conclusion is an action, then so too is one of the premises. You might reason your way from doing one thing to doing another: from browsing journal abstracts to reading a particular journal article. I motivate this by sympathetically re-examining Hume's claim that a conclusion about what ought to be done follows only from an argument one of whose premises is likewise about what ought to be done.     

城市化与道德嬗变

从 1 9世纪开始的大规模城市化进程是和工业化、商品化、市场化密不可分的。它带来了社会人际关系的变化和道德嬗变。它使业缘道德取代血缘道德成为社会道德的中心 ,并通过交换行为和交换价值促进道德发展和更新 ,还进一步确立了竭诚服务的社会理念。城市化是人类社会的进步 ,是现代社会文明。