慢性心力衰竭的病因学演变

慢性心力衰竭(CHF)是一个发病率不断增加且具有高病死率的临床症候群.尽管几十年来,药物及器械治疗取得了较大的进展,预后有所改善,但病因学组成一直发生着变化.冠心痛及高血压病成为中老年人CHF的主要病因.贫血、肾功能不全、慢性阻塞性肺疾病及糖尿病常与CHF并存并加重其预后.CHF的各种指南不断为心力衰竭的诊治提供新的信息并使预后进一步改善.     

《孟子》对戴震《原善》的影响

《孟子》在义理和话语两方面深深影响到戴震的《原善》。戴震将《易传》的“继善成性”与孟子的性善论区别为两个问题,前者是泛论,后者专论人性。受孟子断言“天之生物使之一本”的鼓舞,戴震严厉批评宋儒所谓性分义理、气质两种的学说犯了“二本”的错误。《原善》关于心的论述,关于“仁义礼智圣”和“条理”话语的使用,都鲜明表现出《孟子》的启发和影响。     

Near-term fetal response to maternal spoken voice

Knowledge about prenatal learning has been largely predicated on the observation that newborns appear to recognize the maternal voice. Few studies have examined the process underlying this phenomenon; that is, whether and how the fetus responds to maternal voice in situ. Fetal heart rate and motor activity were recorded at 36 weeks gestation (n = 69) while pregnant women read aloud from a neutral passage. Compared to a baseline period, fetuses responded with a decrease in motor activity in the 10 s following onset of maternal speech and a trend level decelerative heart rate response, consistent with an orienting response. Subsequent analyses revealed that the fetal response was modified by both maternal and fetal factors. Fetuses of women who were previously awake and talking (n = 40) showed an orienting response to onset of maternal reading aloud, while fetuses of mothers who had previously been resting and silent (n = 29) responded with elevated heart rate and increased movement. The magnitude of the fetal response was further dependent on baseline fetal heart rate variability such that largest response was demonstrated by fetuses with low variability of mothers who were previously resting and silent. Results indicate that fetal responsivity is affected by both maternal and fetal state and have implications for understanding fetal learning of the maternal voice under naturalistic conditions.     

On the Ethics of Facial Transplantation Research

Transplantation continues to push the frontiers of medicine into domains that summon forth troublesome ethical questions. Looming on the frontier today is human facial transplantation. We develop criteria that, we maintain, must be satisfied in order to ethically undertake this as-yet-untried transplant procedure. We draw on the criteria advanced by Dr. Francis Moore in the late 1980s for introducing innovative procedures in transplant surgery. In addition to these we also insist that human face transplantation must meet all the ethical requirements usually applied to health care research. We summarize the achievements of transplant surgery to date, focusing in particular on the safety and efficacy of immunosuppressive medications. We also emphasize the importance of risk/benefit assessments that take into account the physical, aesthetic, psychological, and social dimensions of facial disfiguration, reconstruction, and transplantation. Finally, we maintain that the time has come to move facial transplantation research into the clinical phase.     

Adverse childhood experiences and autonomic regulation in response to acute stress: the role of the sympathetic and parasympathetic nervous systems

Background and objectives: After a previous report demonstrated blunted heart rate (HR) reactivity in association with adverse childhood experiences (ACEs) [Voellmin, A., Winzeler, K., Hug, E., Wilhelm, F. H., Schaefer, V., Gaab, J.,?…?Bader, K. (2015). Blunted endocrine and cardiovascular reactivity in young healthy women reporting a history of childhood adversity. Psychoneuroendocrinology, 51, 58–67. doi:10.1016/j.psyneuen.2014.09.008], the present analysis aimed at clarifying the role of the sympathetic and parasympathetic branches of the autonomic nervous system in this relationship.

Design and Methods: One hundred eighteen healthy young women provided data on ACEs and underwent psychosocial stress testing. Systolic blood pressure (SBP) and respiratory sinus arrhythmia (RSA, quantified by high-frequency HR variability) were assessed as measures of sympathetic and parasympathetic cardiovascular activity, respectively. A mediation model was calculated to test the indirect effects of ACEs on HR via SBP and RSA.

Results: The effect of ACEs on HR reactivity was mediated by SBP reactivity but not by RSA reactivity. ACEs were associated with reduced SBP at rest.

Conclusions: ACEs were associated with down-regulation in a measure of sympathetic but no alteration in a measure of parasympathetic cardiovascular stress reactivity in adulthood. Future research will need to clarify whether this indicates risk or resilience.     

A New CBT Model of Panic Attack Treatment in Comorbid Heart Diseases (PATCHD): How to Calm an Anxious Heart and Mind

Treating anxiety comorbid with heart disease is challenging due to (a) diagnostic overlap between anxiety and heart disease, (b) the high risk associated with ignoring chest pain symptoms and delaying seeking medical attention, (c) that cognitive-behavioral therapy based on catastrophic misinterpretation of bodily symptoms requires adaption to incorporate the element of risk, and (d) that certain interoceptive symptom induction experiments may be harmful and are therefore fraught with liability. We describe Panic Attack Treatment in Comorbid Heart Diseases (PATCHD) that is based on enhancing coping skills, performing safe interoceptive exposures and supervised exercise, and countering avoidance to reduce panic attack frequency. Pre- and posttreatment data from 18 patients shows a significant reduction in cardiovascular hospital admissions and length of stay, panic attacks, general anxiety, and depression (all p < .05). Because of the complex nature of panic disorder comorbid with heart disease, health professionals should familiarize themselves with several necessary CBT adaptions.     

166例冠心病患者活动平板试验中室性心律失常的分析

探讨冠心病患者冠状动脉狭窄程度与室性心律失常的关系,用Mar-quette Case16型活动平板系统测试,采用改良的Bruce方案。结果显示,偶发室早在单支狭窄和多支狭窄中无明显差异,恶性室性心律失常发生率在多支狭窄中较单支狭窄明显增高。冠心病患者出现的恶性室性心律失常提示病变严重或预后较差。     

PCI术后患者的血糖管理

经皮冠状动脉介入治疗(PCI)已成为冠心病治疗及急性心肌梗死(AMI)血运重建的有效手段。取得令人满意的效果,而被临床广泛接受和应用。在冠心病患者中糖代谢异常发生率显著高于一般人群。有研究显示高血糖是引起冠状动脉支架再狭窄的独立危险因素。因此糖尿病患者PCI术后必须进行严格的血糖管理。根据目前研究结果,可能血糖目标定为餐前血糖7.8mmol/L,且随机血糖10.0mmol/L较为合适。     

应激干预对不同行为类型大学生心率血压手指温度的影响

探讨应激干预对心率、血压、手指温度的影响及不同行为类型的差异。被试为河北师范大学本科生72人(A、B型各36人),应激干预为音乐放松、腹式呼吸和静坐休息,实验包括基线期-干预期-应激期-恢复期四个阶段,在观看紧张性影片前进行应激前干预,记录被试的心率、血压、手指温度。结果发现,就缓解应激所产生的交感神经活动增强来说,音乐放松效果较好,腹式呼吸也明显优于自然休息;行为类型（A、B）和应激干预大多表现出来交互作用;个体生理反应的性别差异与生理指标有关,基线值的性别差异较大时,男女生的生理数据不宜混合在一起,基线值相差不大时,可以用相对值（如变化值或变化率）进行统计处理。说明行为类型（A、B）对于应激而言是一种微调变量,在自然休息状态或者低应激水平下作用更明显,应激水平较高时,行为类型的调节作用会显著降低;不同应激干预适用不同行为类型个体     

X线伤害:先天性心脏病介入治疗知情同意的盲点

随着先天性心脏病介入治疗快速发展,受X线照射的患儿日益增多。而X线照射的危害并未受到临床医生的重视,家属也没有充分的知情同意。