从技术创新看负压封闭引流技术的发展

负压封闭引流技术(vacuumsealing drainage,VSD)是近几年来发展起来的一项新的创口引流技术,其操作方便,应用简单,在临床各个科室得到广泛应用和发展,作者介绍了这一新的引流技术的发展历史、技术原理及临床应用情况。并对负压封闭引流技术的创新特点和创新方法进行了简要论述及展望。     

冠心病多支血管病变完全血运重建的长期疗效观察

为分析冠心病多支血管病变(MVD)患者经皮冠状动脉介入治疗(PCI)进行完全血运重建术后长期的临床疗效,我们收集了2004年5月~2008年5月589例接受PCI的冠心病患者,其中实施完全性血运重建(CRV)461例(78.3%),不完全性血运重建(IRV)128例(21.7%),对比分析两组病例PCI术后随访1年以上的结果。结果显示IRV组患者中完全闭塞病变、3支血管病变的比例均高于CRV组(P0.01);CRV组PCI成功率明显高于IRV组(94.8%vs87.5%,P0.05)。提示多支冠状动脉病变完全性血运重建能够获得更好的长期临床疗效论。     

吉备真备与唐代易学东传

吉备真备是日本奈良时期(中国唐代)著名的学者、政治家、军事家,是中日文化交流史上的重要人物。他在唐留学19年,将中国的许多重要典籍带回日本,促进了日本政治制度的建设与完善。同时,有史料证明他也是将易学传入日本的重要人物之一。本文通过日本史料解读唐代易学东传中吉备真备的作用及其对易学中占卜内容的态度等问题。     

＂I Effaced Myself＂ and ＂The Disappearance of the Subject＂： A Comparison between Zhuangzi and Jean Baudrillard＇s Anti-Subjectivism

In the chapter ＂The Adjustment of Controversies＂ in his eponymous work, Zhuangzi has the character Nanguo Ziqi declare ＂I effaced myself,＂ thereby holding that one can return to the state of naturalness only after breaking with the ＂self＂ that is in opposition to ＂objects,＂ abandoning his subject-object standpoint and entering a state of ＂effacement＂ wherein one fuses with the Dao. Coincidently, the French philosopher Jean Baudrillard also repeatedly stresses the ＂disappearance of the subject＂ in his later philosophy, trying to dissolve subject-centrism by means of a counterattack by the object wherein its logic would entrap the subject. Although they lived in different times, both Zhuangzi and Baudrillard note the same human predicament--the situation wherein the ＂I as subject＂ constantly obscures the ＂real I.＂ Their resolutions of the predicament are similar： both put their hopes in the dissolution of the ＂I＂ or self in subject-object relations, with Zhuangzi declaring ＂I effaced myself＇ and Baudrillard mooting the ＂disappearance of the subject.＂ They differ, however, on how to dissolve the ＂I＂ （myself）. Briefly, Zhuangzi advocates ＂effacing myself through the Dao,＂ that is, quitting one＇s ＂fixed mindset＂ and ＂egoism＂ and returning to the Dao by means of ＂forgetting＂ or ＂effacing＂; Baudrillard, on the other hand, proposes to ＂efface oneself through the object,＂ i.e., replace the supremacy of the subject with that of the object. Baudrillard＇s theory has often been criticized as pataphysics because of its nihilism without transcendence; in contrast, Zhuangzi＇s view, which construes the whole world as the unfolding of the Dao, seems more thought-provoking.     

The non-symbolic level of psychical reality

Freud introduced the concept of psychical reality as a consequence of abandoning the theory of seduction, and although this meant a turning point in his theoretical thinking he never defined the concept concisely and systematically. Thus it is possible to delineate at least two meanings of psychical reality that run through Freud´s writings as well as the writings of contemporary analysts. On the one hand psychical reality encompasses the whole field of subjective experiences. On the other, it is understood more narrowly as a transformation of experiences in the unconscious.

Substituting the idea of different meanings ascribed to Freud´s concept this article proposes to differentiate between levels in the psyche with the main focus on the unconscious level of the dream and of phantasy and the real unconscious. Starting from the most superficial level of subjective reality the text moves to that of fantasy formation illustrated by primarily Freud´s text on `A child is being beaten´. Adding Laplanche´s translational model the article ends up at the deepest level represented by the late Lacan and his concept of the real Unconscious.

The paper concludes that the term real points to something exceeding symbolization and the imaginary—thus escaping comprehension—and yet is absolutely indispensable to the organization of unconscious processes.     

从不规范联合用药转变为单药治疗过程分析抗癫痫药物的选择策略

单药治疗或合理的联合用药是癫痫治疗的重要原则,本文运用抗癫痫药物的药代动力学知识,分析了1例复杂不规范的联合用药导致治疗失败的原因,系统讲解了将其转变为有效的传统或新型抗癫痫药物单药治疗的理论和实践过程,并以此展示抗癫痫药物的选择策略。     

Adolescent Gender and Age Differences in Responsiveness to Functional Family Therapy

The current study contributes to a sparse literature on moderators of Functional Family Therapy (FFT) by examining whether responsiveness to FFT, measured by a broad range of outcomes, varies by adolescent gender, age, and their interaction. This study was informed by 687 families (n, adolescents = 581; n, caregivers = 933) and utilized a pre–post comparison design. Fixed-effects regressions with gender, age, and their interaction included as explanatory variables were conducted to calculate the average change in youth mental health, callous–unemotional traits, academic outcomes, substance use, and family functioning. Moderation analyses revealed that according to parent report, girls had significantly greater improvements in peer problems and family functioning, and boys benefited more in increased liking of school. There were differential effects by age, such that older youth had less beneficial mental health outcomes and a smaller decrease in frequency of hash use. The gender by age interaction was significant for adolescents’ report of mental health and family functioning outcomes, which suggests that girls benefit from FFT less than boys during early adolescence, but benefit more than boys in late adolescence. This finding adds to literature which has evidenced that family functioning is particularly important for girls by suggesting that FFT is important for improving older girls’ mental health and family functioning in particular. The study’s results expand the examination of outcomes of FFT to include academic outcomes, and provide insight into key factors that should be considered in addressing adolescent behavioral problems and family functioning.     

ERCP在十二指肠乳头旁憩室并胆总管结石诊治中的应用

通过回顾性分析237例十二指肠乳头旁憩室并胆总管结石患者行经内镜逆行胰胆管造影术（ERCP）治疗的资料,探讨ERCP治疗的临床疗效及安全性。结果显示十二指肠乳头位于憩室内41例,十二指肠乳头位于憩室旁196例;胆总管结石位于上段25例,中段131例,下段81例;胆总管直径小于1．0cm23例,1．Ocm～1．5cm89例,1．6cm～2．0cm106例,大于2．0cm19例。均经ERCP治疗成功,因此ERCP治疗十二指肠乳头旁憩室并胆总管结石,可操作性强、创伤小、并发症少,疗效确切,是安全、有效的治疗措施。     

桡骨小头粉碎性骨折的两种治疗方法比较分析

分析比较切开复位内固定和人工桡骨小头置换方法治疗桡骨小头粉碎性骨折（MasonⅢ型）的临床疗效。回顾分析2012年10月～2014年3月收治的24例桡骨小头粉碎性骨折（MasonⅢ型）的临床资料,其中切开复位内固定治疗17例;桡骨小头置换7例,平均随访12个月（6个月～18个月）。根据Broberg Morrey评分系统以及术后影像进行评价比较,同时比较两组住院天数以及费用。结果评价比较显示两者疗效均佳,术后两者活动度和功能评分相近,两组住院天数相近,内固定组费用更低。桡骨小头粉碎性骨折须尽早进行解剖复住功能重建,切开复位内固定和桡骨小头置换疗效相当。