成人气管、支气管异物误诊原因之辩证分析

气管、支气管异物是耳鼻喉科常见疾病,但成人气管、支气管异物较少见,因异物吸入史不明确、临床表现不典型,常易误诊。利用哲学原理辩证分析其误诊的主客观原因,以提高对成人气管、支气管异物认识,减少误诊,防止误治。哲学对于当前临床医学是十分重要的。     

儿童支气管异物32例误诊分析

支气管异物系儿科常见病,误诊原因很多,如病史陈述不详细、辅助检查的干扰等,更重要的一个原因就是异物的不典型位置。传统观念中,右下肺异物高发,实际上,受气流及异物体积的影响,轻而小的塑料可被回吸进入左上肺,而较大的异物受自身重力影响多进入右下肺。异物进入体内,引起的·临床表现多种多样,咳嗽、咯血、喘息甚至呼吸困难等,诸类症状在呼吸系统疾病中较为常见,因此这些症状的鉴别就显得尤为重要。在治疗方面,突破传统的支气管镜技术,提倡可以首先采取保守治疗,给予拍背、体位引流等手段,部分患儿可自行咳出异物,这样就避免了手术的风险,在保守治疗无效的情况下可转入外科通过纤维支气管镜取出。     

七氟醚与丙泊酚麻醉诱导用于小儿支气管异物取出术的比较

小儿气管或支气管异物取出术是临床常见的急症手术。本研究比较了七氟醚与丙泊酚应用于小儿支气管异物取出术的麻醉效果及不良反应。70例全麻下支气管异物取出术患儿,随机分为七氟醚组（S组）和丙泊酚组（P组）。两组分别接受瑞芬太尼静脉输注合并七氟醚吸入或丙泊酚静脉注射进行麻醉。记录诱导前、下镜前、下镜时以及下镜后1、3、5、7、10min时的HR和SBP,记录术中、术后不良反应的发生情况及手术医师对操作条件的满意程度。两组患儿各时点的HR和SBP无显著差异,仅在下镜时及下镜后1min时HR和SBP发生明显变化。所有患者均未发生喉痉挛或支气管痉挛,呼吸抑制的发生率两组无显著差异;P组呛咳反射发生率较高而S组苏醒期躁动发生率较高;S组手术医师的满意度较高。七氟醚或丙泊酚麻醉后不良反应的发生率各不相同,七氟醚能为支气管镜手术提供更好的操作条件。     

小儿支气管哮喘和胃食管返流关系的哲学思考

支气管哮喘是当今世界上最常见的气道慢性炎症性疾病,运用哲学的观点认识小儿支气管哮喘与胃食管返流之间的关系,对于支气管哮喘合并胃食管返流的临床治疗非常重要.     

预防性气管切开在上段食管癌手术中的效用

探讨预防性气管切开在伴慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)且长期大量吸烟的上段食管癌术后的应用,分析其对患者术后肺部感染、低氧血症、心律失常的影响.回顾性分析我科2011年6月~2013年1月伴有COPD及长期大量吸烟的上段食管癌行手术切除颈部吻合的病例,并分为预防性气管切开组和非预防性气管切开组.统计并分析两组术后肺部感染、低氧血症、心律失常等并发症的发生情况.结果对于上段食管癌行根治手术的患者,尤其是伴有长期大量吸烟及COPD的患者来说,预防性气管切开可以起到预防术后呼吸道并发症的发生,并能减少术后心律失常的发生的作用,其可以做为上段食管癌重症患者的一种预防围手术期并发症的方式.     

中心气道狭窄的诊断及介入治疗

中心气道狭窄可由多种原因引起。由于其部位在气管、隆突、左右主支气管及中间段支气管,因此可造成严重呼吸困难。近年来,围绕中心气道狭窄的处理,出现了很多介入治疗的方法,包括电刀、冷冻、氩气刀、激光、光动力、支架置入、球囊扩张及近距离照射等。如何合理应用这些技术是呼吸内科临床医生面临的一项重要课题。     

麻醉方式的临床决策

外科手术的进步离不开麻醉的配合,麻醉方式的抉择非常重要.如果麻醉达不到预期效果,不仅可以导致手术失败、也会给患者的身心带来伤害、甚至会由此引起医疗纠纷.科技进步、社会发展应运而生微创医学、医学人文学,这是社会的进步和必然趋势,也是麻醉方式选择的理论依据.     

麻醉方式的临床决策

外科手术的进步离不开麻醉的配合,麻醉方式的抉择非常重要。如果麻醉达不到预期效果,不仅可以导致手术失败、也会给患者的身心带来伤害、甚至会由此引起医疗纠纷。科技进步、社会发展应运而生微创医学、医学人文学,这是社会的进步和必然趋势,也是麻醉方式选择的理论依据。     

超滤在小儿体外循环心脏手术中应用的临床决策

体外循环(CPB)技术的运用,使心脏直视手术的安全开展成为可能,但是体外循环可造成患者心肺功能的损伤,这种表现对心肺尚未发育成熟的婴幼儿的影响尤为严重。超滤已经成为低体重和危重患儿体外循环心脏手术中的一项重要技术,对患儿术后心肺功能的改善起着重要的作用。不同的超滤技术有各自的优缺点,需要我们在临床工作中合理应用。     

整形外科的临床治疗决策分析

在生物心理社会医学模式下,以循证医学为基础的共享型临床决策成为主导。整形外科疾病有着诊断容易、治疗方法多样、效果不一、患者年龄小、心理脆弱、大众认知有一定误区等特点,更需要在情感和实践上体现对患者的理解和尊重,真正实现医生患者共同参与的共享型临床决策。     

Bodies and things in the forest of symbols

Taking Manuel Vásquez's book as its point of departure, this essay explores what a truly materialist history of materiality for the study of religion might look like, in contradistinction to idealist histories of materiality. It then mounts a defense of Clifford Geertz as a pioneering scholar of material and embodied religion, against the positions taken by Vásquez and, earlier, by Talal Asad, applying a critique that has by now become overly entrenched and unquestionable.     

Decision-making and the Backward Induction Argument

The traditional form of the backward induction argument, which concludes that two initially rational agents would always defect, relies on the assumption that they believe they will be rational in later rounds. Philip Pettit and Robert Sugden have argued, however, that this assumption is unjustified. The purpose of this paper is to reconstruct the argument without using this assumption. The formulation offered concludes that two initially rational agents would decide to always defect, and relies only on the weaker assumption that they do not believe they will not be rational in later rounds. The argument employs the idea that decisions justify revocable presumptions about behavior.     

判断与决策中的锚定效应

versky和Kahneman提出锚定与调整启发式以来,锚定效应在不同领域判断与决策研究中得到广泛验证,提出了不同类型的锚定效应、多种研究范式、心理机制的不同理论观点,以及锚定效应作为有关心理现象的内在作用机制。文章阐述了锚定效应的最新研究进展,提出应深化对锚的种类和形态研究,以丰富的技术手段发展锚定效应神经心理机制研究,系统地进行锚定效应影响因素研究,深入探讨锚定现象对人的心理与行为的正负面影响以及锚定效应与其他有关心理现象间的关系     

风险决策与博彩行为的眼动特点

为了探索博彩行为与风险决策的特点,采用眼动研究方法对博彩行为中的风险决策任务进行了实验,结果发现:(1)外部框架表征虽影响决策者的内部表征,但决策者的内部表征方式表现出稳定的规律;(2)参与者在博彩中面对损失时,认知加工的决策时间比在面对收益的博彩任务的决策时间长,凝视次数也多比较多,决策者的瞳孔直径比面对收益任务下更大;(3)博彩参与者的内部表征方式,随博彩任务的外部表征的框架,金额、概率、备择项间倍数的改变而发生变化.结论:概率信息是博彩任务中的决策者稳定的决策权重;决策者在面对损失时会更加敏感,导致在决策过程中给予更多的加工负荷;博彩任务的外部表征对参与者内部表征有显著影响.     

Experience-Expectant Plasticity in the Mushroom Bodies of the Honeybee

Worker honeybees (Apis mellifera) were reared in social isolation in complete darkness to assess the effects of experience on growth of the neuropil of the mushroom bodies (MBs) during adult life. Comparison of the volume of the MBs of 1-day-old and 7-day-old bees showed that a significant increase in volume in the MB neuropil occurred during the first week of life in bees reared under these highly deprived conditions. All regions of the MB neuropil experienced a significant increase in volume with the exception of the basal ring. Measurement of titers of juvenile hormone (JH) in a subset of bees indicated that, as in previous studies, these rearing conditions induced in some bees the endocrine state of high JH associated with foraging, but there was no correlation between JH titer and volume of MB neuropil. Treatment of another subset of dark-reared bees with the JH analog, methoprene, also had no effect of the growth of the MB neuropil. These results demonstrate that there is a phase of MB neuropil growth early in the adult life of bees that occurs independent of light or any form of social interaction. Together with previous findings showing that an increase in MB neuropil volume begins around the time that orientation flights occur and then continues throughout the phase of life devoted to foraging, these results suggest that growth of the MB neuropil in adult bees may have both experience-expectant and experience-dependent components.     

论个体差异与诊疗决策

诊疗决策最优化的过程,本质上是针对特定的患者,制定最适合其个体差异的决策过程.对个体差异认知方式,经验医学基于对个体的不完全归纳,循证医学基于对群体随机、双盲、对照、大样本,人类基因组学基于对人类基因的差异表达、单核苷酸多态和复制变异的研究.最优化的治疗方案应体现关注患者心理、社会差异、关注生命质量、远离趋利性等人文特征;体现针对个体病患生物学特性差异、个体病程病期和个体最佳疗效差异等科学特征.     

Reconfiguring Older Bodies in the Prison Time Machine

It is by mapping an area that the geographer comes to understand the contours and formations of a place. The place in this case is the prison world. This article serves to map moments in prison demonstrating how old female bodies are performed under the prison gaze. In this article I will illustrate how older women subvert, negotiate, or invoke discourse as a means of reinscribing the normalizing discourses that serve to confine and define older women's experiences in prison. Female elders in prison become defined and confined by regimes of femininity and ageism. They have to endure symbolic and actual intrusions of physical privacy, which serve to remind them of what they were, where they are, and what they have become. This article will critically explore the complexity and contradictions of time use in prison and how they impact on embodied identities. By incorporating the voices of elders, I hope to draw out the contradictions and dilemmas which they experience, thereby illustrating the relationship between time, their involvement in doing time, and the performance of time in a total institution (see Goffman, 1961), and the relationship between temporality and existence. The stories of the women show how their identities are caught within the movement and motion of time and space, both in terms of the time of the real on the outside and within prison time. This is the in-between space of carceral time within which women live and which they negotiate. It is by being caught in this network of carceral time that they are constantly being remade as their body/performance of identities alters within it. While only a small percentage of the female prison population in the United Kingdom are in later life, one has to question why criminological and gerontological literature fail to address the needs of a growing significant minority.