临床整合医学的必要性及实施中存在的问题——以慢性阻塞性肺疾病及其合并症的诊治为例

近年来人们逐渐认识到慢性阻塞性肺疾病(COPD)是一种全身性疾病,即COPD不仅会影响到气道和肺,还会引起一系列合并症,包括心血管疾病、骨质疏松、焦虑和抑郁、癌症、感染、代谢综合征和糖尿病等。这些合并症会显著地影响COPD疾病严重程度和预后,因而必须对COPD进行整体防控,然而COPD的上述合并症的诊治分属不同学科,所以要做好COPD的整体防控就需要相关学科进行医学整合。     

P16、CyclinDl和CDK4在结直肠癌组织中表达及意义

细胞周期过程中癌基因的激活与抑癌基因的失活等是造成细胞恶性增殖、转化的重要因素。细胞周期G1／S期各调节因子的异常改变与细胞癌变关系尤为密切。P16、CyclinDl和CDK4均为重要的细胞周期调控蛋白,任何原因导致这些蛋白异常表达时,将引起细胞周期调节失控,导致肿瘤的发生和恶性演进。结直肠癌的发生发展同上述三者关系密切。本实验通过免疫组化方法进行检测结直肠癌组织中P16、CyclinDl和CDK4三者的表达及其与结直肠癌临床指标的关系,为揭示三者在结直肠癌发生发展中的作用提供一定的实验依据。     

The metaphorical,the metonymical and the psychotic aspects of obsessive symptomatology

This paper is an attempt to suggest an integrative formulation of obsessive symptomatology, based on the integration of Lacanian and object‐relations points of view. This formulation manifests a singular interaction between three aspects of obsessive symptomatology, which I call “the metaphorical aspect”, “the metonymical aspect” and “the psychotic aspect”, and which are intertwined with a varying degree of dominance. The singular interaction between them has crucial influence on the capacity for symbolization and reflection, and therefore has immense implications concerning analytical work. The theoretical formulation will be followed by a detailed analytical illustration.     

Dielectric and thermodynamic behaviour of binary mixtures of anisole with o-chlorophenol and with o-cresol

The molecular interactions in binary mixtures of anisole with o-chlorophenol and o-cresol have been studied at three different temperatures using dielectric measurements. The static permittivity and the permittivity at optical frequency have also been determined and used to obtain the Kirkwood correlation factors, the Bruggeman parameter, the excess permittivity and the excess free energy for different concentrations of two binary mixtures, namely (1) anisole + o-chlorophenol and (2) anisole + o-cresol. Using the effective Kirkwood correlation factor, parallel and anti-parallel alignments among the dipoles are identified. The corrective Kirkwood correlation factor, the excess permittivity and the Bruggeman parameter are used to explain the interaction between unlike molecules. The temperature dependences of the above parameters are also reported. The investigation shows systematic changes in the dielectric behaviour with variations in concentration and temperature.     

GIRK1在宫颈癌组织细胞中的表达

探求内向整流型钾离子通道1（GIRK1）与宫颈癌发生发展的关系.利用RT-PCR及免疫组织化学技术检测GIRK1 mRNA及蛋白在15例正常宫颈和30例宫颈癌组织细胞中的表达.GIRK1 mRNA在宫颈癌组织中的表达高于在正常宫颈组织中的表达,差异有统计学意义（P〈0.01）;GIRK1蛋白在宫颈癌组织中的阳性表达率为100%,在正常宫颈组织中的阳性表达率为20%,两者差异有统计学意义（P〈0.01）.GIRK1 mRNA及蛋白在宫颈癌组织中呈高表达,可能与宫颈癌的发生及发展有关.     

严格掌握使用粒细胞集落刺激因子的适应证

粒细胞集落刺激因子（G—CSF）可以作用于粒系前体造血干细胞和外周成熟的效益细胞,促进其增殖、分化。G—CSF促使组织修复和血管生成的效能使其在临床上得到广泛使用,与此同时,G—CSF及受体在肿瘤中的表达及该药物的不良反应也引起了关注,本文旨在探讨G—CSF功效及副作用,引起临床医师的重视,把握适应证,指导合理用药。     

关于内科临床技能培训教学课程设置的探讨

通过对参加内科临床技能培训的大连医科大学2007级、2009级五年制及七年制临床医学专业学生进行问卷调查及客观结构化临床考试（OSCE）,探讨内科临床技能培训课程的学时及课程内容等设置.100%的学生认为有开设临床技能培训课的必要,50%以上的学生认为在大学4年级开设本课程较合适,50%以上的学生认为12学时的设置较合理,80%以上的学生认为应每4人共用一名模拟人.OSCE证实毕业前12学时培训组成绩优于实习前8学时组.     

ICU向患者家属开放的理论研究

ICU实行的基本是封闭式管理,这不仅带来了一些伦理问题,也容易引发医疗纠纷,从伦理学的需要、预防医疗纠纷、改善医患关系等方面探讨ICU向患者家属开放的必要性,分析开放存在的问题,论证了ICU向患者家属开放的可行性。     

Knowing hatred2,3

Hatred is known to be a common phenomenon and a lot has been written about this affect. However, the author believes that the more we read and write about hate the further away we find ourselves from a real sense of understanding of this so familiar and yet so elusive experience. She feels that using a single concept to describe ‘hatred’ seems to be a simplification of the matter, since it consists of a chain of affects that does not lend itself to easy theoretical or experiential distinction. In this paper the author aims at ‘knowing’ the experience of hatred as the individual's reaction to an unbearable existential excess, that is, as the psychic attempt to handle an emotional profusion in the context of human relation and in relation to it. The emotional abundance that the psyche cannot contain and process by itself is dealt with by the defensive use of simplification, detachment and distancing. An attempt is made to understand the relation between psychic existing and hatred, between craving, desiring and hate, between passionate aliveness‐or a passion to live‐ and the difficulty in containing the excessive dimension of it. The author illustrates her thesis through a reading of Tolstoy's ‘Kreutzer sonata’ as a monologue of hatred.     

Excess disability and malignant social psychology: A case study of Alzheimer's disease

An in-depth case study was undertaken to assess the effects of what Kitwood has termed ‘malignant social psychology’ on the observed behaviour of an Alzheimer's disease sufferer. Interviews were conducted with the spouse and observations were made in an adult day-care centre, where staff members were also interviewed. Abilities that the spouse reported to be absent at home were readily observed at the day-care centre, lending support to Brody's idea of excess disability, i.e. disability not due to disease alone. Furthermore, forms of malignant social psychology existed in the home environment but did not exist in the day-care centre. Excess disability and its absence coincided with the presence and absence of aspects of malignant social psychology. The sufferer's behaviour was found to be affected not only by the extant neuropathology, but also by social relationships.