以腹腔镜手术为代表的微创技术在泌尿外科的应用

随着科学技术的进步,微创医学正在形成和发展。泌尿外科是微创医学最活跃的专业之一。腹腔镜手术已被公认是现代微创外科技术的代表,正逐渐走向成熟,趋于标准化和规范化。目前多种泌尿外科腹腔镜手术已成为首选治疗方法。近年出现的机器人手术、计算机辅助外科与虚拟现实技术被认为是在腹腔镜手术基础上产生的第3代手术,正在走向现实。我们要对微创泌尿外科有一个再认识,更加准确把握微创泌尿外科的适应证,促进微创泌尿外科更加健康地发展。     

中医理念在拇趾外翻临床中的运用

探讨运用中医治病求本、阴阳学说、筋束骨、小夹板纸压垫原理、辨证施治等中医理论,构筑的中西医结合微创技术治疗拇外翻畸形的诊疗体系。从拇外翻畸形的病因、病理、矫形手术、手法复位、生物固定、术后康复等几方面,阐述对拇外翻畸形的新的矫形理念。     

脊柱手法治疗的规范与模糊

脊柱手法治疗风险很大,手法规范化呼声日高,但实施颇难,各种措施均不理想。作者对此做了概要分析。提出手法治疗主要依靠施术者的临床经验和施术技巧而达到治疗目的。其中许多因素都不单纯是技术的规范化问题,而是医学原则的模糊把握问题。提出要区分"脊柱手法技术"和"脊柱手法治疗"两个不同的概念。技术是可以具体和规范的,是动作操作层面的概念;而治疗则包括更多内涵,是医学层面上的综合概念。     

Can research influence clinical practice?1

After briefly reviewing the unfavourable reception accorded empirical research by parts of the psychoanalytic community, as well as some of the benefits to clinical practice of analysts being involved in research activities, the author examines whether the findings of process and outcome research in psychotherapy and psychoanalysis can help identify the most appropriate forms of intervention for producing therapeutic change, given the specific condition of the patient and the relationship that the individual establishes with the analyst. He argues that research findings can influence clinical practice on various levels and in different areas, and goes on to examine a number of related issues: the specificity of therapeutic interventions versus the relevance of common curative factors; the dyadic conception of technique and ways of understanding the therapeutic action of the treatment alliance; and the strategic or heuristic conception in psychoanalytic therapy. Finally, the author presents clinical material with the aim of illustrating how the knowledge acquired through research can be applied to psychoanalytic treatment.     

Differences in feedback- and inhibition-related neural activity in adult ADHD

The objective of this study was to examine response inhibition- and feedback-related neural activity in adults with attention deficit hyperactivity disorder (ADHD) using event-related functional MRI. Sixteen male adults with ADHD and 13 healthy/normal controls participated in this study and performed a modified Go/NoGo task. Behaviourally, attention and inhibition problems in the ADHD group were observed; no feedback-related differences between the groups were detected. The neuroimaging data showed that the ADHD group displayed more activation in the inferior frontal gyrus and putamen during response inhibition. During feedback-related processes, the ADHD group displayed less activation in the inferior frontal/orbitofrontal cortex, hippocampus/nucleus accumbens, and caudate nucleus, but more activity in the inferior frontal gyrus. These results indicate that at least two distinguishable underlying brain networks related to response inhibition and feedback are altered in adults with ADHD.     

外科决策的理念、技巧与艺术

影响外科决策的因素很多,每个因素都存在不确定性。在这诸多不确定中作出正确的决、策绝非易事。本文提出决策者要有正确的理念,要具备八个要素,要掌握决策的技巧与艺术,才能做好外科决策。为了便于理解,以一个决策案例来说明上述这些问题。     

小学五年级学生汉语阅读知觉广度的眼动研究

采用"呈现随眼动变化技术"对小学五年级学生的阅读知觉广度进行了眼动研究.结果发现,(1)小学五年级学生的阅读知觉广度具有不对称性.(2)小学五年级学生的阅读知觉广度为注视点左侧一个汉字到注视点右侧两个或三个汉字的空间.     

Neural functional organization of hallucinations in schizophrenia: Multisensory dissolution of pathological emergence in consciousness

Although complex hallucinations are extremely vivid, painful symptoms in schizophrenia, little is known about the underlying mechanisms of multisensory integration in such a phenomenon. We investigated the neural basis of these altered states of consciousness in a patient with schizophrenia, by combining state of the art neuroscientific exploratory methods like functional MRI, diffusion tensor imaging, cortical thickness analysis, electrical source reconstruction and trans-cranial magnetic stimulation. The results shed light on the functional architecture of the hallucinatory processes, in which unimodal information from different modalities is strongly functionally connected to higher-order integrative areas.     

“Hearing voices”: Auditory hallucinations as failure of top‐down control of bottom‐up perceptual processes

Auditory hallucination is a key characteristic of schizophrenia that seriously debilitates the patient, with consequences for social engagement with others. Hallucinatory experiences are also observed in healthy individuals in the general population who report “hearing voices” in the absence of an external acoustic input. A view on auditory hallucinations and “hearing voices” is presented that regards such phenomena as perceptual processes, originating from speech perception areas in the left temporal lobe. Healthy individuals “hearing voices” are, however, often aware that the experience comes from inner thought processes, which is not reported by hallucinating patients. A perceptual model can therefore, not alone explain the difference in the phenomenology of how the “voices heard” are attributed to either an inner or outer cause. An expanded model is thus presented which takes into account top‐down cognitive control, localized to prefrontal cortical areas, to inhibit and re‐attribute the perceptual mis‐representations. The expanded model is suggested to be empirically validated using a dichotic listening speech perception paradigm with instructions for top‐down control of attention focus to either the right or left side in auditory space. It is furthermore suggested to use fMRI to validate the temporal and frontal lobe neuronal correlates of the cognitive processes involved in auditory hallucinations.     

无聊倾向与大学生认知失败的关系:意志控制的调节与中介作用

以510大学生为被试,采用无聊倾向量表、意志控制问卷和认知失败问卷考察无聊倾向对认知失败的影响机制。结果发现：（1）意志控制在无聊倾向与认知失败间起到显著的调节作用,在低意志控制水平下无聊倾向能够显著正向预测认知失败,而在高意志控制水平下无聊倾向对认知失败的预测作用不显著;（2）无聊倾向能间接地通过意志控制对认知失败产生影响,意志控制起到完全中介作用。