从2型糖尿病的发病机制谈糖尿病治疗的新策略

2型糖尿病的发病机制主要为胰岛素抵抗与胰岛β细胞分泌功能受损,二者相互依存、相互作用。2型糖尿病的治疗应以减轻胰岛素的抵抗和保护胰岛β细胞为主,以生活方式干预加二甲双胍作为基础治疗,根据不同个体在不同阶段所侧重的不同发病机制,采用联合、综合管理。     

用库恩“范式论”浅析心力衰竭的治疗进展

美国著名科学哲学家库恩认为每一个科学发展阶段都有特殊的内在结构,而体现这种结构的模型即“范式”。并认为任何科学研究都是在某一范式的指导下进行的,范式是一个科学部门达到成熟的标志,而科学革命实际上就是范式的转变,指出一种范式经革命向另一种范式逐步过渡,正是成熟科学的通常模式。本文就范式理论对心力衰竭治疗进展的影响进行探讨。     

The Therapeutic Alliance in Multicultural Practice

Abstract

The therapeutic relationship rests on both an emotional bond with the therapist and a rational, “working” connection. Both dimensions of the alliance have relevance for multicultural clinical work. There have been many contributions to multicultural practice that emphasize either cognitive or emotional levels of the alliance. This paper uses both empirical studies and clinical papers to synthesize both the emotional and the rational perspectives on the multicultural alliance. Examples are drawn from literature, published case examples, and the author's own clinical practice.     

Physical Abuse and Childhood Disability

SUMMARY

Several authors have hypothesized that children with disabilities are at increased risk for physical abuse. Such a finding would be consistent with current ecological models, which posit that certain child characteristics (e.g., behavior problems) in combination with other risk factors can lead to abuse. The paucity of research in this area makes it difficult to draw firm conclusions at this time. However, the few studies conducted suggest that child characteristics play a minor role in the etiology of abuse. Despite the lack of evidence indicating that children with disabilities are at significantly greater risk for abuse than their nondisabled peers, the presence of a disability raises some unique issues in the identification, assessment, and treatment of special needs children. This article reviews the literature linking abuse and disability as a risk factor. In addition, impediments encountered in the assessment and treatment of abused children with disabilities and their families are discussed and guidelines for practice are presented.     

Violence Exposure and PTSD Among Delinquent Girls

Summary

This study focuses on the unique trauma histories of incarcerated girls. In particular, this study draws upon data obtained from 100 incarcerated adolescent girls, highlighting areas of similarity to and difference from incarcerated boys, including: overall levels of traumatic violence exposure, exposure to unique forms of traumatic violence, psychological symptomatology, and hypothesized trajectories of involvement in serious delinquent activity. In addition, a case example is presented to illustrate our hypotheses about the trajectories of adolescent girls' involvement in serious delinquent behavior, as well as the prominent role of early trauma histories and repeat victimization in these trajectories.     

系统论视角下重型急性胰腺炎的治疗

重症急性胰腺炎(severe acute pancreatitis,SAP)是临床上常见的急腹症之一,本文试从系统生物学角度出发,探讨其在SAP营养支持治疗、抗生素的选用以及外科手术治疗中的应用。强调应用整体的、综合的、发展的观点去研究SAP的治疗,从而找到最佳治疗方案。     

骨巨细胞瘤外科治疗几个问题的思考

骨巨细胞瘤是临床上常见的骨肿瘤,其治疗方式由以前的截肢术发展到保肢术,一直到现在的多种局部切除与功能重建方式,透过其治疗理念的更新,以及手术技术的转变,不难看出临床医生应重视循证医学实践,不断更新观念,坚持个体化治疗,明确切除范围、切除方式与重建方法及肢体功能之间的关系,不断改善患者的生活质量。     

冠心病诊治中的过度医疗

近年来,过度医疗问题引起了医学伦理学界的普遍关注。过度医疗是一个经济现象,同时也是一个伦理问题．确切的说是一个医学一社会问题。结合冠心病过度医疗的特点,从医学伦理学角度剖析冠心病过度医疗的原因,并提出了医者、患者、医疗机构和社会针对冠心病过度医疗应采取的措施。     

肺动脉栓塞诊治进展

肺栓塞是常见的临床病理综合征之一。为提高对肺栓塞的认识水平,减少误诊的发生,本文介绍了肺栓塞的病因、临床表现、实验室及影像检查、诊断与治疗进展。     

Veiled Reality and Structural Realism

Abstract

The noted philosopher of science, Bernard d'Espagnat, tries to mediate between objective reality and empirical reality via the notion of veiled reality: namely, while the laws proper to things in themselves are unknown, their existence and interrelated activity can be inferred from observation and analysis of human experience. The author claims that Whiteheadian creativity offers a better candidate for the notion of veiled reality because it is a transcendent activity, not a transcendent actuality. Likewise, a revision of the Whiteheadian category of society as a structured field of activity for its constituent actual entities indirectly confirms Henri Poincaré's notion of structural realism.