原发灶切除在转移性乳腺癌治疗中的地位

无论是国内还是世界其他国家,乳腺癌近年来已成为女性常患恶性肿瘤之首。早期乳腺癌通过手术、化疗、放疗及内分泌治疗等综合治疗后可以达到长期生存。然而对于晚期乳腺癌,特别是伴有远处转移的乳腺癌,疗效却不尽如人意。对于转移性乳腺癌,目前治疗优先选择毒性尽可能小的全身系统性治疗方案;而对于需要缓解症状或避免即将发生并发症（如皮肤溃疡、出血、真菌感染以及疼痛等）的情况可于全身治疗后行相应手术。然而对于转移性乳腺癌是否手术切除原发灶以及是否可从手术中获益,仍然充满争议。     

抑郁和焦虑与心血管疾病

抑郁焦虑与心血管疾病的关系最能体现身与心两者相互影响、不可分割的特点。但临床上,心血管疾病患者抑郁焦虑的诊疗率不足1％。这说明现有的诊疗理念和方式没有将心血管疾病和精神障碍联系起来,给患者全面全程的干预和管理。这样的缺陷不仅增加患者的痛苦和功能障碍,也增加心血管疾病的发病率和病死率,还增加患者及社会的医疗负担。本文结合临床经验,从心身一体的诊疗理念,谈谈抑郁焦虑与心血管疾病。     

Association between intimate partner violence during pregnancy and maternal pregnancy complications among recently delivered women in Bangladesh

Intimate partner violence (IPV), an actual or threatened physical, sexual, or psychological abuse by a current or former partner or spouse, is a common global public health issue. Understanding both the prevalence of IPV during pregnancy and its potential impact on the health of pregnant women is important for the development and implementation of interventions to prevent maternal morbidity and mortality. The purpose of this study was to explore the association between maternal experiences of IPV during pregnancy and pregnancy complications. A health‐facility‐based cross‐sectional study was conducted from July 2015 to April 2016 among 400 randomly selected women who were admitted to the postnatal wards of Rajshahi Medical College Hospital for delivery. Data were collected through face‐to‐face interviews using a structured questionnaire. Multivariable logistic regressions were performed to assess relationships between variables of interest after controlling for potential confounders. Results indicated that 39.0% of women reported physical IPV and 26.3% of women reported sexual IPV during pregnancy. Additionally, 69.5% of women experienced medical complications (MCs); of this group, 44.3% experienced obstetric complications (OCs) and 79.3% experienced any pregnancy complication (AC) during their last pregnancy. The experience of physical IPV during pregnancy was significantly associated with the experience of MCs (adjusted odds ratio (AOR): 2.05, 95% confidence interval (CI): 1.15–4.01), OCs (AOR: 4.23, 95% CI: 2.01–7.12) and AC (AOR: 5.26, 95% CI: 2.98–10.52). Women who experienced sexual IPV during pregnancy were also at increased risk of suffering from any MC, any OC, and AC. Maternal experience of IPV during pregnancy is positively associated with pregnancy complications. Preventing IPV directed at pregnant women might reduce maternal morbidity and mortality in Bangladesh.

     

人与自然和谐的道德基础——古代"天人合一"思想的现代生态伦理启示

人与自然的和谐有着道德基础。古代的“天人合一”思想为我们从道德的视角研究人与自然的和谐,以及建构现代生态伦理观提供了一定的帮助。从道德的意义上,人与自然的和谐中人是道德主体,承担着全部道德责任,其行为是道德评价的对象。人对自然的适应与改造、尊重与利用是辩证的统一。     

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.     

Systems of Quantum Logic

Logical implications are closely related to modal operators. Lattice-valued logic LL and quantum logic QL were formulated in Titani S (1999) Lattice Valued Set Theory. Arch Math Logic 38:395–421, Titani S (2009) A Completeness Theorem of Quantum Set Theory. In: Engesser K, Gabbay DM, Lehmann D (eds) Handbook of Quantum Logic and Quantum Structures: Quantum Logic. Elsevier Science Ltd., pp. 661–702, by introducing the basic implication → which represents the lattice order. In this paper, we fomulate a predicate orthologic provided with the basic implication, which corresponds to complete ortholattices, and then formulate a quantum logic which is equivalent to QL, by using a modal operator instead of the basic implication.     

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.     

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。