脑梗塞的神经保护治疗

近年来缺血半暗带和再灌注损伤理论的提出,更新了急性脑梗塞的临床治疗观念:神经保护治疗和溶栓治疗.但神经保护治疗的临床试验失败迫使我们不得不从整体、综合、多元化的角度重新思考这一措施,提出要辩证认识其与溶栓治疗的关系,采取个体化治疗和"鸡尾酒疗法".     

急性脑干梗死的治疗进展

脑干梗死为脑梗死中较为少见的一种,病死率和残疾率均较其他部位高。近年来,随着医学的不断发展,尤其是循证医学证据的增多,急性脑干梗死的治疗方法有了许多新的进步。本文就近年来国内外急性脑干梗死治疗方面的最新进展进行综合性介绍,内容涉及静脉溶栓、动脉溶栓、动静脉联合溶栓、超声辅助溶栓、抗血小板治疗、抗凝治疗、脑保护治疗、卒中单元等,以期为-临床医生的治疗决策提供参考。     

急性脑干梗死的治疗进展

脑干梗死为脑梗死中较为少见的一种,病死率和残疾率均较其他部位高.近年来,随着医学的不断发展,尤其是循证医学证据的增多,急性脑干梗死的治疗方法有了许多新的进步.本文就近年来国内外急性脑干梗死治疗方面的最新进展进行综合性介绍,内容涉及静脉溶栓、动脉溶栓、动静脉联合溶栓、超声辅助溶栓、抗血小板治疗、抗凝治疗、脑保护治疗、卒中单元等,以期为临床医生的治疗决策提供参考.     

帕金森病神经保护治疗的困境与思考

帕金森病(PD)神经保护策略存在的困惑,是迄今还未找到一种药能确切的保护神经元,推迟发病或延缓疾病的进展。因此,有学者提出“多重靶标治疗神经退行性疾病的多功能药物”的设想。同理,中医复方通过多种有效成分对人体有多环节、多层次、多靶点的整合调节作用,可能对PD神经保护治疗有一定的优势。最后,从现代医学在高度分化的基础上呈现高度综合的发展趋势,对PD的神经保护治疗进行哲学思考并提供方法论。     

溶栓后PCI,从不行到可行

再灌注治疗STEMI的方法有直接PCI和溶栓。我国各地医疗条件差别较大,只有12%的STEMI患者能够及时接受直接PCI,超过半数的患者仍行溶栓治疗,故溶栓在我国再灌注策略中占有重要地位。虽然溶栓后即刻PCI即易化PCI被证实不如直接PCI,但溶栓并非STEMI治疗的终点。目前国外循证证据显示溶栓后早期转运PCI优于溶栓失败后再转运行补救PCI,值得我国借鉴学习。     

溶栓后PCI,从不行到可行

再灌注治疗STEMI的方法有直接PCI和溶栓.我国各地医疗条件差别较大,只有12%的STEMI患者能够及时接受直接PCI,超过半数的患者仍行溶栓治疗.故溶栓在我国再灌注策略中占有重要地位.虽然溶栓后即刻PCI即易化PCI被证实不如直接PCI,但溶栓并非STEMI治疗的终点.目前国外循证证据显示溶栓后早期转运PCI优于溶栓失败后再转运行补救PCI,值得我国借鉴学习.     

海绵窦区病变外科处理策略

为探讨海绵窦区病变的外科治疗策略,回顾性分析了58例不同性质的海绵窦病变病例的临床资料、治疗方法和治疗效果,发现根据病变的不同性质和不同的生长方式个性化地采用不同的治疗方法可在最大限度治愈病变的同时,保护颅神经的功能,获得良好的治疗效果。     

海绵窦区病变外科处理策略

为探讨海绵窦区病变的外科治疗策略,回顾性分析了58例不同性质的海绵窦病变病例的临床资料、治疗方法和治疗效果,发现根据病变的不同性质和不同的生长方式个性化地采用不同的治疗方法可在最大限度治愈病变的同时,保护颅神经的功能,获得良好的治疗效果.     

脑梗死的溶栓治疗——离我们到底有多远？

急性脑梗死是我国的常见病、多发病,目前最有效的药物治疗手段是进行溶栓治疗.但我国的溶栓率还比较低,与发达国家相比仍有很大差距.主要原因为老百姓知晓率低、院前延误、城市急救系统运力不足、卒中中心的建设不够及医源性因素等几个方面,以后应该加强溶栓宣传、加强城市急救中心建设、加强卒中中心建设及对各级医院的神经科医生进行相关培训,提高接受溶栓患者的比例,从而让更多的患者受益.     

发热伴阵发性呼吸困难——感染继发肺栓塞4例临床治疗观察并文献复习

为总结感染继发肺栓塞的临床特点和处理,回顾性分析4例感染继发肺栓塞患者的诊治经过。结果4例患者在强力有效抗感染治疗基础上溶栓并序贯抗凝治疗后均获得康复。提示有明确肺梗塞病灶及明显低氧血症存在的感染继发肺栓塞患者,在充分抗感染治疗基础上进行抗凝治疗的同时,必要时可以慎重溶栓治疗。     

Does Estrogen Protect Against Cognitive Aging in Women?

ABSTRACT— Although there is evidence from randomized controlled trials that estrogen therapy protects against aspects of cognitive decline that occur with normal aging in women, findings from the Women's Health Initiative Memory Study and from some cross-sectional and longitudinal studies failed to find neuroprotective effects of estrogen in older women. There is growing empirical support for the critical-period hypothesis, formulated in the attempt to resolve these discrepancies. It holds that estrogen therapy has protective effects on verbal memory and on working memory only when it is initiated closely in time to menopause, whereas starting treatment many years following menopause does not protect and may even be harmful. Supporting evidence for this hypothesis from basic neuroscience and from animal and human studies is evaluated for its ability to explain the inconsistencies and to describe the conditions under which estrogen may protect cognitive function in aging women.     

Family therapy training: Current issues,future trends

This article extends the previous literature review of the family therapy training and supervision field (Liddle & Halpin, 1978) by organizing and discussing some of the dimensions most relevant to family therapy teachers. The five domains of focus include: (1) Personnel: who should teach and be taught family therapy? (2) Content and skills: what should be taught? (3) Methodology: how should the content and skills be taught? (4) Context: how do the setting and the training enterprise influence each other? (5) Evaluation: how should training be assessed? Finally, the article brings into focus several key aspects of family therapy training likely to have relevance for current and future trainers.     

系统论指导个体化肿瘤综合治疗

从系统论的理论出发,指出对于肿瘤的综合治疗,应该强调整体性和个体化的原则,在进行恶性肿瘤的综合治疗中,必须考虑具体患者的具体病情。     

Behandlungsleitlinie Persönlichkeitsstörungen

The S2 guidelines for the treatment of personality disorders (PD) are summarized. In the diagnostic assessment of personality disorders a clinical interview should be supplemented by (semi-) structured clinical interviews and self-report measures for the categorical and dimensional assessment of PDs. The results of the assessment process should be communicated to the patient based on a psycho-educational framework. The diagnosis should always be linked to the patient’s individual history. Psychotherapy is the treatment of choice for personality disorders. A detailed analysis of the patient’s problems as well as the definition of a hierarchy of treatment goals are part of the process of treatment planning. For three PDs empirical evidence for treatment approaches is available: (1) dialectical behavior therapy, mentalization-based therapy, schema focused therapy and transference focused therapy all proved beneficial in the treatment of borderline personality disorder. Cognitive-behavior therapy proved helpful in the treatment of (2) dissociative personality disorder and (3) avoidant personality disorder. There is limited evidence for interpersonal therapy and psychodynamic therapies in the treatment of avoidant personality disorder.     

创伤后应激障碍与物质使用障碍共病的病因学及其启示

创伤后应激障碍与物质使用障碍共病率高,现有的治疗方法疗效差,总结20年来创伤后应激障碍与物质使用障碍共病研究中病因学方面的新认识,通过对病因的哲学思考可以为今后的治疗方向提供一条思路:两病同治;应提倡药物治疗、认知干预和社会支持综合的治疗手段.     

精神疾病时代心理治疗的哲学反思

在精神疾病时代,心理治疗家应增强心理治疗的文化敏感性,关注心理治疗对象的个体性,将目标和价值作为关注焦点的同时重视哲学引导在心理治疗中的作用.     

A link between stress and depression: shifts in the balance between the kynurenine and serotonin pathways of tryptophan metabolism and the etiology and pathophysiology of depression

Alteration of tryptophan (TRP) metabolism elicited by proinflammatory cytokines has gained attention as a new concept to explain the etiological and pathophysiological mechanisms of major depression. The kynurenine (KYN) pathway, which is initiated by indoleamine 2,3-dioxygenase (IDO), is the main TRP metabolic pathway. It shares TRP with the serotonin (5-HT) pathway. Proinflammatory cytokines induce IDO under stress, promote the KYN pathway, deprive the 5-HT pathway of TRP, and reduce 5-HT synthesis. The resultant decrease in 5-HT production may relate to the monoamine hypothesis of major depression. Furthermore, metabolites of the KYN pathway have neurotoxic/neuroprotective activities; 3-hydroxykynurenine and quinolinic acid are neurotoxic, whereas kynurenic acid is neuroprotective. The hippocampal atrophy that appears in chronic depression may be associated with imbalances in neurotoxic/neuroprotective activities. Because proinflammatory cytokines also activate the hypothalamo-pituitary-adrenal (HPA) axis, these imbalances may inhibit the hippocampal negative feedback system. Thus, changes in the TRP metabolism may also relate to the HPA axis-hyperactivity hypothesis of major depression. In this article, we review the changes in TRP metabolism by proinflammatory cytokines under stress, which is assumed to be a risk factor for major depression, and the relationship between physiological risk factors for major depression and proinflammatory cytokines.     

Medikamentöse Behandlung von Adoleszenten mit paraphiler Symptomatik und einem Risiko für die Begehung von Sexualstraftaten

The diagnostics and treatment of adolescents who show paraphilic symptoms should be approached with extreme caution. The aim of this paper is to present and discuss the recently published World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the treatment of adolescents with paraphilic disorders and a risk for committing sexual offences. The basis of therapy is always a thorough diagnostic procedure and an estimation of the risk of behavior harmful to others. The basis of treatment is formed by psychosocial interventions. The indications for pharmacological therapy, in particular for antiandrogens and gonadotropin-releasing hormone (GnRH) agonists are closely controlled (e.g. only one adolescent treated with GnRH agonists was found in a study of German forensic psychiatry hospitals). The indications are guided by a high risk of substantial danger to others and with respect to the stage of puberty reached by the adolescent person. The therapy should only be carried out in collaboration with specialized pediatric endocrinologists. Administration of therapy should be regularly checked at short intervals with a strict control of the risk/benefit ratio. The guidelines also illustrate the contraindications to pharmacological treatment of adolescents with paraphilic symptoms.     

药物治疗的风险及其处理

造成药物治疗风险的因素包括药物因素、病情因素、患者因素、用药因素及管理因素等。通过对药物进行严格监管,对医药从业人员加强培训和教育,对民众开展科普教学和用药指导,可以降低药物治疗的风险。风险事件主要表现为用药差错、药物不良反应或药物治疗无效。在药物治疗中,首先必须时刻警惕和及时发现风险;其次需要全面评估风险,还要对疾病风险和药物治疗风险进行比较。应尽可能避免药物治疗的风险,对于必须承受的风险,需采取相应措施,减少风险事件发生的概率和严重程度。如果存在较大风险,务必同时设计处理风险事件的预案,并与患者及其家属保持良好的交流和沟通。