指动脉背侧支皮瓣在手指末节皮肤缺损治疗中的临床应用

分析指背动脉背侧支与其血管网联合供血滋养皮瓣在指末端皮肤缺损的修复中的应用效果。取中节手指固有动脉的背侧支为蒂血管,逆行切取指背皮瓣31例共35指,移植修补位于远端指间关节或其远端的皮肤缺损。若同时伴有骨、关节、肌腱等的损伤,则予以同期修复。本研究中最大切取皮瓣1.5cm×3.5cm,平均随访6±0.5个月(3至9个月),皮瓣成活率100%,皮瓣两点辨别觉9±0.2mm,95%的患者具有良好的指间关节活动能力。因此,指动脉背侧支皮瓣手术操作简单,术后成功率高且患者恢复效果好。     

人文医学的视角：裘法祖误诊误治思想初探——兼论医学伦理道德

本文结合裘法祖的相关论述,对裘法祖的误诊误治思想进行梳理勾连。认为裘法祖这一重要医学思想内涵是要勇于总结医学当中的误诊误治、老专家要“真心帮助青年人”,要学习国外经验,但也不能枉自菲薄,这一思想在当代医学医德教育当中有重要的启示意义。     

Excuse inference modification in children and adults

The ability of first- and third-grade children and college adults to make excuse inferences about a speaker's use of an utterance and to modify those inferences appropriately upon receiving later information was examined in four experiments. Short stories containing an utterance by a speaker were read aloud. Utterances in the story were preceded by contextual information that suggested either that the speaker was truthful or making an excuse. Utterances were followed by information that confirmed or disconfirmed the excuse interpretation. The results of Experiment 1 indicated that even first and third graders can make excuse inferences, but these children rarely modify these interpretations upon receiving disconfirming information. In Experiments 2–4 possible reasons for the children's interpretive inflexibility were examined by varying the difficulty of relating the excuse interpretation and succeeding information. Results suggested processing difficulty, as well as an interpretive “set,” contributed to the children's inflexibility.     

胃肠道肿瘤的分子靶向治疗:未来的方向?

分子靶向治疗是这几年来消化道肿瘤治疗领域的热门话题.这类新一代的分子靶向生物治疗模式,将在临床治疗肿瘤实践中具有广阔的应用前景.从事肿瘤研究的临床医务人员需要综合归纳这些信息,融汇入自己的认知将之合理应用于患者.我们将真正进入传统的细胞毒性药物攻击与非细胞毒性靶向性药物相结合使用的时代,真正实现延长患者的生命,改善其生活质量的目标.     

Regional brain activity change predicts responsiveness to treatment for stuttering in adults

Developmental stuttering is known to be associated with aberrant brain activity, but there is no evidence that this knowledge has benefited stuttering treatment. This study investigated whether brain activity could predict progress during stuttering treatment for 21 dextral adults who stutter (AWS). They received one of two treatment programs that included periodic H₂¹⁵O PET scanning (during oral reading, monologue, and eyes-closed rest conditions). All participants successfully completed an initial treatment phase and then entered a phase designed to transfer treatment gains; 9/21 failed to complete this latter phase. The 12 pass and 9 fail participants were similar on speech and neural system variables before treatment, and similar in speech performance after the initial phase of their treatment. At the end of the initial treatment phase, however, decreased activation within a single region, L. putamen, in all 3 scanning conditions was highly predictive of successful treatment progress.     

The Blood of Jesus in revival theology and the contemporary Church with particular reference to the East African Revival and Roy Hession

One of the most common phrases heard in testimony, preaching, and song during the East African Revival (EAR) was the phrase ‘The Blood of Jesus Christ’. Taken from a rich biblical heritage, this phrase encapsulates a wide range of ideas concerning the work of the cross and the power of forgiveness in a believer's life. Whilst, as will be noted, the use of The Blood has been common to many revivals, this article examines especially the theology behind this phrase by looking at the most prominent of the EAR authors – Roy Hession. It investigates seven different applications of The Blood in a believer's life: The Blood as a testament that sin is forgiven, The Blood as cleansing the conscience, The Blood as victory over despair, The Blood as the remover of shame, The Blood as washing away sin, The Blood as the gateway of the Holy Spirit, and finally The Blood as the source of true fellowship. The theology of The Blood has a long history of use in the Church but it also comes with difficulties. To this end the article will investigate the legitimacy of the practice often found in Africa and some Pentecostal circles of invoking The Blood as protection against the demonic. The article closes by considering the reasons why speaking of The Blood in church can be uncomfortable yet is paradoxically of vital importance to revival.     

The Acceptability of Computer-Aided Cognitive Behavioural Therapy: A Pragmatic Study

The clinical and cost-effectiveness of a computer-aided cognitive behavioural therapy (CCBT) programme, Beating the Blues, is indicated by a number of studies, but relatively little is known about its acceptability for patients with depression, anxiety, or both. This study investigated the acceptability of Beating the Blues offered on eight scheduled clinic visits with brief face-to-face support. Pre and posttreatment measures explored the relationship among programme acceptability, treatment continuation, and outcomes for people accessing the programme in routine care. Two hundred and nineteen patients with depression, anxiety, or both were offered Beating the Blues in 11 primary and secondary care practices. One hundred and ninety-one (87%) completed the pretreatment measures and 84 (38%) completed a treatment feedback questionnaire. Analysis of treatment acceptability for CCBT indicated a positive patient experience with the programme. Pretreatment expectancies predicted CCBT treatment completion but not outcomes. No differences were found between men and women on pretreatment measures. Posttreatment, women reported more favourable responses to the therapy, finding the programme more helpful and more satisfactory, than did men. No relationship between treatment acceptability and age was found. Study limitations, including research methods and attrition rates, and implications for future research are discussed. It is concluded that the Beating the Blues CCBT programme is an acceptable treatment for common mental health problems in routine care.     

Infantile bisexuality and the 'complete oedipal complex': Freudian views on heterosexuality and homosexuality

In the psychoanalytical discussion of what is 'mature' sexuality we speak of the 'genital' stage and the 'resolution' of the oedipal complex in the form of identification with the parent of the same sex and a heterosexually-directed object choice. A close reading of Freud's texts about sexuality shows that such a normative view cannot be corroborated by his viewpoint. He suggests that infantile sexuality is bisexually orientated, the final object choice due to repression of either homosexual or heterosexual desires. As Freud puts it, genital heterosexuality occurs out of necessity for procreation. In order to enrich the present psychoanalytical discussion about homosexuality and bisexuality the author returns to Freud's theories in this context.     

Ecological issues of justice

In the first part of this article the author explores the implications for justice of the wider range of parties holding moral standing that environmental ethics has recently disclosed. These implications concern the equitable treatment of future generations and nonhuman creatures, and are relevant both to policies, such as approaches to global warming, and procedures, which may need to be revised to give an equitable voice to unrepresented interests. Later the author considers some radical implications of regarding humanity as stewards of the planetary environment, a view defended in his recent book Creation, Evolution and Meaning. If all adult humans have this role, but many are prevented from discharging it by poverty and related constraints, then those who are thus disempowered need to be empowered to exercise this role. This requirement of equity would arise not from their moral patienthood but from what is involved in respecting them as moral agents. Some approaches to tackling global warming are considered in this connection.     

Why Not Now? Karlstadt's Whether We Should Proceed Slowly and Avoid Offending the Weak in Matters that Concern God's Will (1524)

Abstract

Andreas Bodenstein von Karlstadt's Whether We Should Proceed Slowly [Ob man gemach faren soll] in 1524 was no best seller, and the work is often overlooked today. However, its author was a prolific publisher, especially of German tracts, in the early sixteenth century. His influence upon other so-called radical reformers remains yet to be measured adequately. Despite the fact that Gemach was written shortly before Karlstadt's expulsion from Electoral Saxony, its thesis resonated strongly with other writers who were disenchanted with the trajectory of reforms in Wittenberg after 1522. A careful analysis of Karlstadt's argumentation reveals a rigorous reliance upon Old Testament texts, and it represents the development of a position that holds the Christian congregation responsible for implementing reforms in worship that are mandated in God's commands. As Karlstadt's response to Luther's Invocavit Sermons (preached in March 1522 and published outside Wittenberg in 1523), Gemach shows what Gordon Rupp called Karlstadt's ‘best polemical writing.'