浅析隐喻手法在插图创作中的运用

认知语言学认为"人类的思维很大程度上是隐喻性的,人类认识和理解事物是对事物进行概念化、范畴化的过程,隐喻是其重要的工具。"隐喻的实质是要以一种事物来理解和经历另一种事物,在彼类事物的暗示之下感知、体验、想象、理解、谈论此类事物的心理行为,语言行为和文化行为;是从一个具体的概念域向一个抽象的概念域的系统映射。     

医生的探索与发现

临床工作中有着许多未知、疑难问题,这就是医生们探索与发现的起点。通过对桂希恩等多位医学专家临床探索发现事例的分析,得到许多启示,指出临床探索发现是一个系统的科学活动过程,也是临床决策的重要组成部分;找到客观存在的事物或规律,有利于疾病的诊治,充满了大医精诚精神;有利于人才培养,医学创新和进步,应予大力提倡和鼓励。     

医生的探索与发现

临床工作中有着许多未知、疑难问题,这就是医生们探索与发现的起点.通过对桂希恩等多位医学专家临床探索发现事例的分析,得到许多启示,指出临床探索发现是一个系统的科学活动过程,也是临床决策的重要组成部分;找到客观存在的事物或规律,有利于疾病的诊治,充满了大医精诚精神;有利于人才培养,医学创新和进步,应予大力提倡和鼓励.     

脑血管病诊断的思维特点

脑血管病是由于脑循环功能障碍导致脑损害的一组临床常见病 ,其特点是发病率高、死亡率高、致残率高、复发率高 ,严重威胁中老年人的身心健康和生命安全。这组疾病的治疗效果如何 ,首先取决于疾病诊断的正确性 ,而后者主要依赖于对疾病临床表现的科学观察 ,对疾病所导致一系列病理生理变化的深刻认识以及临床思维方法的合理运用。1　从现象中认识疾病的本质现象和本质是揭示客观事物的外部表现和内部联系相互关系的一对范畴。现象是事物的表面特征以及这些表面特征之间的外部联系 ;本质是事物的根本性质 ,是指事物的内部联系[1] 。现象和本…     

宗喀巴《缘起赞》思想解析

正缘起是佛教的根本教理,是宇宙人生本来的必然的普遍的存在,也是宇宙人生的自然法则。缘起的意思是说,一切事物现象的产生和存在是一种相互依存、互为因果、互为条件的关系或过程。或者说,一切现象的存在都是各种条件和合而成。如果从空间方面说没有自性,从时间方面说则无常性,无自性即空,空是一切事物生起的条件。佛教一般将《中阿含经》所说的"若此有则彼有,若此生则彼生,若此无则彼无,若此灭则彼灭"视为对缘起的最早解     

医学影像学诊断思维中若干问题的思考

医学影像中涉及项目繁多的影像技术和复杂的影像学诊断,各类影像技术在不断发展,推动了影像诊断水平的提高,从而促进了临床治疗水平的提高;疾病的发展和转归是一个动态的过程,疾病的影像学诊断更是一个错综复杂的认识过程,在日常影像诊断工作中遇到的"同病异影"、"异病同影"等各类影像学疾病诊断难点,需要影像科医师用客观的、辩证的思维看待疾病发展变化过程中所产生的各类影像学表现,以及影像学新技术的应用,做到选择合理的影像检查项目,并给出可靠的影像学诊断。     

科学表征:问题、争论与解决路径

科学表征是用一个人工设计的事物(如模型)描述另一个相关的事物(如自然现象),其结果是形成科学知识或理论,它蕴含了构成、划界和规范问题,已经成为各种实在论与反实在论争论的焦点。早期的图像论认为表征就是心理图像,后来的相似论主张表征是两个不同事物之间的相似,同构论认为表征是两个不同事物之间具有相同的数学的或者物理的结构,指代论认为表征是一个事物替代另一个事物,推理观认为表征是一种推理力和认知能力。这些观点表现为科学理论的句法观与语义观之争、建模与理想化之争,形成了表征的紧缩观和实质观,以及分析方法和实践方法。     

IgG4相关性胆胰疾病的诊断和治疗

近年来发现,IgG4相关性疾病可累及全身多系统多器官,目前研究提示IgG4相关性胆胰疾病主要有IgG4相关性硬化性胆管炎和自身免疫性胰腺炎（AIP）.前者是一种免疫发病机制未明、生化学特点以及胆管影像学表现与原发性硬化性胆管炎（PSC）相似,对糖皮质激素应答良好的疾病.后者临床表现为复发性胰腺炎、梗阻性黄疸,伴胆管、涎腺等其他器官受累.实验室检查血清和组织学IgG4明显升高.影像学表现为胰腺呈“腊肠样”外观,伴主胰管弥漫不规则狭窄,同样对激素治疗敏感.二者常同时受累、关系密切,易误诊为胆管癌、硬化性胆管炎或胰腺癌,本文将当前国内外研究现状做一介绍,供临床诊治参考.     

论疾病诊治中的“过度”和“适度”

做任何事情都有一个"度"的问题,治疗疾病更需要掌握"度"。药物治疗是否适度不仅要从治疗的角度分析,更需要从病情和患者的特点加以分析。即治疗的付出与治疗的收获是否相适合、治疗的得失与疾病的度是否相适合及治疗的得失与患者的度是否相适合。过度是指超过限度。过度治疗即治疗超过了应有的限度或程度。过度治疗主要表现在疾病治疗总体安排的过度、具体治疗方案过度和治疗监护或预期结果不当引起的过度三方面。     

关于事物感知与价值感受的奠基关系的再思考——以及对佛教“心-心所”说的再解释

西方哲学中的意识分析传统和佛教唯识学的心识分析传统,在知、情、意三分及其奠基关系问题上有共通之处。但在现象学中,胡塞尔和舍勒在"事物感知"与"价值感受"的奠基关系问题上产生分歧和对立。通过对佛教唯识学的"心-心所"说的重新考察和理解,作者在此提出一种立足于现象学直观的知、情、意三分及其奠基关系的新的解释方案:"事物感知"与"价值感受"不应被视作一个复合行为中两个彼此间有奠基关系的行为,而只能被理解或被诠释为一个行为的两个彼此间有主从关系的部分或要素。这里只有一个意识行为,它以不同的模式进行:感知的模式、感受的模式和意欲的模式。当其中一种模式起主导作用或发挥主导功能时,这个意识行为就表现为突显这种模式的意识行为,如感知活动、感受活动和意欲活动,而它们各自所构造的对象或客体也会相应地发生变化。在此意义上,存在一种"动态的奠基",一种不同于"发生的奠基"和"结构的奠基"的奠基关系或奠基秩序。     

骨科急诊患者诊治中的决策问题

在骨科急诊患者的诊治过程中,骨科医师应该区分病情的轻重缓急,抓住重点进行处理。采集和分析临床资料时,应把病史、理学检查结果与检验及影象检查所见结合起来。这样才能作出准确的诊断。在诊断或/和治疗中选定任何一项措施,首先要从病人的情况出发,应尽可能减轻患者的经济负担。总之,为了提高临床决策的效率和准确性,减少或避免各种失误,需要建立起一套合理的临床思维方法和科学的处理程序。     

Where should we draw the line between quality of care and other ethical concerns related to medical registries and biobanks?

Together with large biobanks of human samples, medical registries with aggregated data from many clinical centers are vital parts of an infrastructure for maintaining high standards of quality with regard to medical diagnosis and treatment. The rapid development in personalized medicine and pharmaco-genomics only underscores the future need for these infrastructures. However, registries and biobanks have been criticized as constituting great risks to individual privacy. In this article, I suggest that quality with regard to diagnosis and treatment is an inherent, morally normative requirement of health care, and argue that quality concerns in this sense may be balanced with privacy concerns.     

Reconstructing with trace information: Does rapid identification information lead to better crime reconstructions?

Currently, promising new tools are under development that will enable crime scene investigators to analyze fingerprints or DNA‐traces at the crime scene. While these technologies could help to find a perpetrator early in the investigation, they may also strengthen confirmation bias when an incorrect scenario directs the investigation this early. In this study, 40 experienced Crime scene investigators (CSIs) investigated a mock crime scene to study the influence of rapid identification technologies on the investigation. This initial study shows that receiving identification information during the investigation results in more accurate scenarios. CSIs in general are not as much reconstructing the event that took place, but rather have a “who done it routine.” Their focus is on finding perpetrator traces with the risk of missing important information at the start of the investigation. Furthermore, identification information was mostly integrated in their final scenarios when the results of the analysis matched their expectations. CSIs have the tendency to look for confirmation, but the technology has no influence on this tendency. CSIs should be made aware of the risks of this strategy as important offender information could be missed or innocent people could be wrongfully accused.     

人文关怀在喉癌治疗和康复中的重要意义

临床医生在治疗疾病的过程中,需要医学人文精神。这种精神提倡对人的理解和关怀,以人为中心的医学人文理念。这一精神尤其体现在喉癌的治疗中。在提高生存率的同时,改善患者的生活质量显得尤其重要。人文精神要求医生有针对性地做好喉癌患者的健康指导,让患者从医生的言谈举止中感受到人道主义的关怀。     

骨科疾病诊治中的临床思维

医学哲学是对医学科学成就总的概括,并以此为基础探讨生命活动和病程的一般规律,研究医学科学的思维方式,直至疾病预防、诊断治疗。同时研究辩证规律和范畴在医学科学中的表现,从而指导骨科医师解决在骨科疾病诊治中遇到的诸多问题,并有助于形成正确的临床思维。结合临床工作体会,探讨医学哲学在骨科疾病诊治临床思维中的应用。     

Genomic Counseling: Next Generation Counseling

Personalized medicine continues to expand with the development and increasing use of genome-based testing. While these advances present new opportunities for diagnosis and risk assessment, they also present challenges to clinical delivery. Genetic counselors will play an important role in ushering in this new era of testing; however, it will warrant a shift from traditional genetic counseling to “genomic counseling.” This shift will be marked by a move from reactive genetic testing for diagnosis of primarily single-gene diseases to proactive genome-based testing for multiple complex diseases for the purpose of disease prevention. It will also require discussion of risk information for a number of diseases, some of which may have low relative risks or weak associations, and thus, may not substantially impact clinical care. Additionally, genomic counselors will expand their roles, particularly in the area of health promotion to reduce disease risk. This additional role will require a style of counseling that is more directive than traditional counseling and require greater knowledge about risk reducing behaviors and disease screening.     

Assessment of Biopsychosocial Risk Factors for Medical Treatment: A Collaborative Approach

There is a growing body of evidence that psychosocial variables have a significant ability to predict the outcome of medical treatment procedures, especially when the procedure is performed to reduce pain. The study described in this paper serves as an illustration of the valuable role psychologists can play in dealing with the challenges of biopsychosocial assessment of patients who are candidates for medical treatments, especially elective, invasive procedures. Based on a convergent model of risk factors that can potentially influence outcomes from spinal surgery and spinal cord stimulation, exclusionary and cautionary risk factors were identified, and the BHI 2 and BBHI 2 tests were used to assess them. An estimate of the prevalence of these risk factors was calculated using data obtained from 1,254 patient and community subjects gathered from 106 sites in 36 US states. Standardized Cautionary Risk and Exclusionary Risk scores demonstrated a test-retest reliability of .85 to .91. Evidence of validity of these scores was also provided based on subjective and objective criteria, using multiple groups of patients and community subjects. Recommendations are made regarding how biopsychosocial assessments could be used in collaborative settings for presurgical candidates to identify risks that could compromise a patient’s ability to benefit from other medical treatments as well. Once identified, appropriate interventions could ameliorate these risks, or lead to the consideration of other treatments that are more likely to be effective. Methods of refining this approach for specific clinical applications are also discussed.     

Conflict of interest in the procurement of organs from cadavers following withdrawal of life support

The University of Pittsburgh policy for procuring organs from non-heart-beating cadaver donors recognizes the potential for conflicts of interest between caring for a "hopelessly ill" patient who has forgone life-sustaining treatment and caring for a potential organ donor. The policy calls for a separation between those medical personnel who care for the gravely ill patient and those involved with the care of transplant recipients. While such a separation is possible in theory, it is difficult or impossible to attain in practice. However, such a separation of duties would be unnecessary if an arbitrator were appointed to monitor the proceedings as they take place on a case-by-case basis. In this way, the biases--real or potential--of the individuals involved could be identified, and the harmful effects of the unavoidable conflicts of interest could be minimized.     

男科临床工作中的人文关怀

随着现代医学模式的转化和男科学诊治技术的发展,在男科临床工作中应该注重树立人文关怀理念和强化人性化服务意识。实施人文关怀的方法包括：重视心理应激,应用心理疗法;关注患者生活,有效预防疾病;营造人文环境,提供人性化服务;遵循最优化原则,做到适度医疗;关心老年人健康,关注社会特殊群体。在男科临床工作中应提高人文关怀的自觉性。