慢性心力衰竭患者临床管理与评估

尽管近年来在慢性心力衰竭(CHF)的治疗方面取得了较大的进展,但CHF患者仍有较高的住院率及病死率.CHF临床实践指南的发布促进了规范化治疗.为了取得良好的医疗效果,临床医生必须对心力衰竭患者提供一系列复杂的药物治疗及严格的自我控制措施.随着医学的不断发展,出现了包括心脏再同步化起搏、左心室辅助装置或心脏移植等治疗,而这些手段常需要在对患者进行危险性评估的基础上进行.严格遵循指南并使CHF患者出院后的教育与各种支持项目相结合才能够在一定程度上减低患者的再住院率及病死率.     

Projective identification as a communication its grammar in borderline psychotic children

This paper distinguishes between the grammar of wishes in neurotic patients and the grammar of imperative needs in borderline patients. The treatment of a borderline psychotic boy 30 years ago was uninformed by subsequent developments in technique arising from the theory of projective identification as a communication rather than as an attack or a defense. Issues that need addressing in borderline patients, especially those who are children, include (a) developmental delay, (b) the distinction between defenses and overcomings in the paranoid position, (c) rectification fantasies of vengeance, and (d) rectification fantasies of justice and other moral imperatives.     

Behavioral Skills Training With Teachers: Booster Training for Improved Maintenance

Behavioral skills training (BST) has been employed within many different populations for the reduction of problem behaviors and acquisition of new skills; however, these changes have not always maintained over time. This study evaluated the effects of a booster training for re-establishing the classroom management proficiencies that teachers had acquired previously, but had declined over a 12-month period. The single-subject experimental results showed the booster training to be effective in re-establishing teacher performance of skills as measured by both analogue role-play and in situ postassessments within the classroom. These findings suggest that a booster training utilizing BST may be an important strategy for maintaining skill performance over time.     

Transpersonal Psychology: Defining the Past,Divining the Future

Retrospective analysis of definitions published over some 35 years suggests the major subject areas of the field can be summed up in three themes: beyond-ego psychology, integrative/holistic psychology, and psychology of transformation. Theme frequency analysis reveals that early emphasis on alternative states of consciousness has moderated into a broader approach to human transcendence, wholeness, and transformation. This expanded definition of transpersonal psychology suggests the field has much in common with integral psychology. As a comprehensive, historically based content summary, this tripartite definition contributes a small but vital piece to the foundation of a transpersonal vision that is spreading across the globe. While transpersonal psychology still needs to embody the inclusiveness and diversity that it represents, its vision is one of great relevance to the contemporary human condition.     

Charting the Developmental Trajectories of Attention and Executive Function in Chinese School-Aged Children

Attention is a complex domain that has reawakened research interest in recent years. There are relatively few studies that have examined age-related changes across different attention subcomponents, such as selection, maintenance, and control, using large samples covering a wide age range. The present study assessed performance in 466 participants in order to identify the ages at which mature performance was reached across differing attention subcomponents. Furthermore, we investigated whether the nature of the attentional demands or task difficulty predicted the age at which stable levels of performance were reached. The results supported the former rather than the latter alternative.     

伤害回避的脑机制及其生物基础

伤害回避是指个体对厌恶刺激信号做出强烈的反应,并学会被动地回避惩罚的一种倾向,这一倾向使得个体反复思考未来的结局,并谨慎小心地对待不确定情景中的事件,进而更有可能诱发情感障碍。伤害回避涉及的神经网络包括三个子网络,即额顶叶-前扣带皮层的连接、皮层-杏仁核的连接和白质通道的结构性连接,这三个子网络分别与羞怯感-易疲劳性、预期担心以及不确定环境中的害怕情绪有关。而其生物基础则包括单一基因多态性和基因多态间的交互作用。今后的研究应该集中在深化伤害回避神经网络与生物基础间的联合机制、研究三种及以上基因多态间的交互作用、考察其他因素对基因效应的调节作用、注重伤害回避四种亚型相关神经网络之间的连接、探讨5-HT4等其他几种5-羟色胺受体多态性与伤害回避的关系以及分析伤害回避内部机制在抗抑郁治疗中的作用等方面。     

The Role of Attachment Styles and Interpersonal Problems in Suicide‐Related Behaviors

The relationships among adult attachment styles, interpersonal problems, and categories of suicide‐related behaviors (i.e., self‐harm, suicide attempts, and their co‐occurrence) were examined in a predominantly psychiatric sample (N = 406). Both anxious and avoidant attachment styles were associated with interpersonal problems. In turn, specific interpersonal problems differentially mediated the relations between attachment style and type of suicide‐related behaviors. These findings suggest the importance of distinguishing between these groups of behaviors in terms of etiological pathways, maintenance processes, and treatment interventions.     

Comparison of the Effects of Telephone Suicide Prevention Help by Volunteers and Professional Paid Staff: Results from Studies in the USA and Quebec,Canada

Research since the 1960s has consistently found that lay volunteers are better at helping suicidal callers than professionals. Yet, professional degrees are increasingly becoming requirements for helpline workers. In our first study, we conducted post hoc comparisons of U.S. helplines with all professional paid staff, all lay volunteers, and a mix of both, using silent monitoring and standardized assessments of 1,431 calls. The volunteer centers more often conducted risk assessments, had more empathy, were more respectful of callers, and had significantly better call outcome ratings. A second study of five Quebec suicide prevention centers used silent monitoring to compare telephone help in 1,206 calls answered by 90 volunteers and 39 paid staff. Results indicate no significant differences between the volunteers and paid employees on outcome variables. However, volunteers and paid staff with over 140 hours of call experience had significantly better outcomes. Unlike the United States, Quebec paid employees were not required to have advanced professional degrees. We conclude from these results and previous research that there is no justification for requiring that suicide prevention helpline workers be mental health professionals. In fact, the evidence to date indicates that professionals may be less effective in providing telephone help to suicidal individuals when compared to trained lay volunteers.     

为医学"会诊”-当代医学的主要缺憾

现代医学发展迅速,方兴未艾,由于技术主义抬头,认识局限与医学发展水平的制约。出现某些缺憾性倾向。主要有：破足的医学、分裂的医学。被动的医学、治标的医学、人性淡漠的医学、不公正的医学等。在对上述进行分析与评论的基础上,对医疗服务变革真挚进行了预测与展望。     

非小细胞肺癌 EG FR 基因突变检测与临床意义

采用荧光PCR法对199例晚期非小细胞肺癌（NSCLC ）组织进行表皮生长因子受体（EGFR ）基因突变检测,分析EGFR基因突变的分布特征及其与临床病理特征的相关性。结果显示56例（28．1％）存在EGFR基因突变,其中27例（13．6％）为外显子19突变,25例（12．6％）为外显子21突变,2例为外显子18突变,1例外显子20突变,1例外显子18和20的共突变。另外,除广东及安徽省铜陵市外,辽宁地区NSCLC患者EGFR基因突变率及主要突变类型与其他地区相符,常见于外显子19、21突变,其中腺癌、不吸烟患者突变率更高,更适宜EGFR-TKI靶向治疗。