从循证医学看目前冠心病的药物治疗

为使冠心病患者尽可能达到最优化的药物治疗,结合最近几年出现的大型临床研究,分析了不同冠心病患者应采取的合理药物治疗措施及可能带来的益处,并针对我国现状,提出了相应的解决方案。     

Some Diagnostic Observations of Post-September 11, 2001 Crisis Groups

Crisis groups following the September 11 attack in New York were an opportunity to learn about people in crisis. The many groups that were formed to assist individuals' return to work, school, and home offered opportunities to observe how people managed their personal crises. While diagnoses such as Post-traumatic Stress Disorder were used, they offer no help in understanding group dynamics and individual behavior in groups. In this paper a psychoanalytic group orientation is offered to help learn about the impact of such terrible crises on individuals and the use of psychoanalytically oriented groups to aid in their path to recovery.     

急性应激与风险倾向：兴奋易感性的调节作用

为探索应激对决策的作用机理及其个体差异,减少工程作业中因应激导致的决策失误,本研究采用特里尔社会应激测试和气球模拟风险任务考察应激反应与应激下风险倾向的关系,并探索兴奋易感性在其中的调节作用。研究结果表明,应激下个体的皮质醇反应越大,行为越冒险。且这一作用受到兴奋易感性的调节：兴奋易感性较高的个体,应激下皮质醇反应越大,行为越冒险;而兴奋易感性较低的个体,其皮质醇变化不能预测风险倾向。该发现提示了兴奋易感性在应激影响中的重要作用,也为高压岗位的人员选拔提供了科学启示。     

从中西医学的竞争和渗透谈现代中医临床思维的变革

现代中医的临床思维正在发生着变革,一个以辨病为纲,辨证为目,辨病论治为经,辨证论治为纬的临床思维新模式,已经呼之欲出。这正是２１世纪中医学发展的必由之路,学术界必从唯物辩证法的角度来审视这场变革,并因其势而利导之。     

Cholesterol and Aggression: An Ethnocultural Perspective

Although serum cholesterol has for several decades been linked to atherosclerosis and coronary heart disease, cardiovascular primary prevention studies that have resulted in low or lowered cholesterol have not reduced total mortality. This finding may be due in part to an increase in mortality from suicides, homicides, and accidents among people with low or lowered serum cholesterol. This article attempts to review the literature on cholesterol and aggressive behavior, examines possible links connecting the two, and suggests an ethnocultural perspective to these connections.     

预期错误与急性应激对不同强度恐惧记忆提取消退的影响

在条件性恐惧记忆再巩固模型下, 预期错误被证明是引发记忆不稳定的必要条件, 但其在不同强度恐惧记忆下的作用尚不明确。对于高强度可能导致的提取无效, 缺乏相应的探索以寻找解决办法, 而应激(stress)在其中发挥的作用值得探索。本研究考察人类被试中, 预期错误在不同强度恐惧记忆下的作用, 以及提取之后施加外源性应激对于消退进程的影响。结果发现, 对于较弱的恐惧记忆, 单个预期错误提取后消退可显著抑制恐惧自发恢复; 而对于较强恐惧记忆, 单个预期错误不能提取恐惧记忆进入再巩固, 已消退的记忆还会复发; 且在该种情况下, 如果在提取后施加外源性急性应激, 会进一步增大恐惧恢复。     

Reperfusion of Specific Brain Regions by Raising Blood Pressure Restores Selective Language Functions in Subacute Stroke

We report a series of six single subject studies examining the effects of pharmacological blood pressure elevation on regional brain perfusion and language function. Previous reports indicate that hypoperfusion of specific brain regions, as delineated by magnetic resonance perfusion weighted imaging (PWI), is associated with disruption of selective lexical functions. On this basis, we hypothesized that reperfusion of the same regions, in the absence of infarct in that region, would restore the associated lexical function. We present five patients with impaired lexical-semantics associated with poor perfusion, but not infarction, of Brodmann's area 22 (BA 22), and one patient with impaired lexical-semantics and a superimposed deficit in retrieving the phonological representations of words, associated with poor perfusion Brodmann's area 37 (BA 37) as well as BA 22. Each patient was treated with induced blood pressure elevation to increase perfusion of the ischemic and dysfunctional tissue. Daily testing of naming and comprehension, with stimulus sets matched for frequency, familiarity, and length, showed improved lexical-semantics in the patients who showed reperfusion of BA 22 and improved oral naming (but not lexical-semantics) in the patient who showed reperfusion of BA 37. These cases illustrate that loss of function with hypoperfusion of a circumscribed area of the brain, and recovery of the same function with improved perfusion of that brain region, can reveal brain/language relationships prior to reorganization after brain injury.     

CysC在肾移植后急性排斥反应诊断中的价值

探讨CysC在肾移植术后诊断急性排斥反应中的价值。63例肾移植患者分为肾功能稳定组（49例）和排斥组（14例）,选10例单纯感染患者为对照组,检测CysC值,并与正常对照组（60例）比较。术后监测稳定组和排斥组CysC、BUN、SCr及CCr,对排斥组排斥前后CysC浓度变化以及CysC与SCr、CCr关系进行分析。结果为排斥组排斥前与排斥时CysC浓度差异有统计学意义（P〈0.01）;CCr在稳定组和排斥组与SCr、CysC均呈直线相关;感染组CysC与正常对照组差异无统计学意义（P〉0.05）。说明CysC可以用于肾移植术后急性排斥反应的早期诊断及与单纯感染鉴别诊断。     

β受体阻滞剂是冠心病中的重要一线治疗药物

冠心病的治疗包括三个层面：血管重建治疗解决局部狭窄;改善生活方式是基础;全面合理的药物治疗是核心。而β受体阻滞剂又是重要的一线治疗药物,不仅能降低动脉粥样硬化及急性冠脉综合征的发生发展,还能有效预防、缓解心绞痛发生,改善梗死后左室重构和心功能;降低心肌再梗死率,降低心性猝死和病死率。临床上应用β受体阻滞剂的时机和剂量非常重要。     

遵循指南，恰当进行冠心病的介入治疗

如何遵循指南,结合冠心痛患者实际情况和具体病变,恰如其分地为患者实施经皮冠状动脉介入治疗（PCI）,使获益最大化,而风险最低化,是每一位心血管介入医生的追求和面临的问题。应正确和严格选择冠心病患者PCI适应证,合理运用PCI的各种手段,牢固树立冠心病全面治疗观念。PCI仅仅是冠心病全面治疗的一个组成部分,必要的介入、外科治疗和合理药物治疗的联合应用,是心血管疾病治疗的发展方向。