从医学整合的角度谈现代肺癌的防治

肺癌是严重影响群众健康的常见恶性肿瘤,当前肺癌防治工作中面临一系列由于分科过细、欠缺协作等导致的问题。加强肺癌防治领域中学科、技术、资源的整合,才能够有效应对越来越严峻的肺癌防治形势。建立以疾病为中心的肺癌整体防治模式,对于其他单一重大疾病的防治也有重要参考意义。     

消化性溃疡的外科治疗

消化性溃疡(PUD)是世界范围内的一个重要公共健康问题,近年来认识到幽门螺杆菌和非甾体抗炎药的致病作用。在临床使用H2组胺受体拮抗剂和质子泵抑制剂后,手术治疗已常用。但PUD的并发症仍较高,约在10%～20%。故外科治疗仍保留使用。外科治疗PUD的指征有出血、穿孔、胃出口梗阻、难治性PUD和恶变危险等。外科治疗PUD的目的是使溃疡愈合、治疗并发症、治疗各种病因和减少术后后遗症。外科治疗PUD的主要术式有迷走神经切除术、近胃迷走神经切除术、胃引流术、胃窦部切除术后胃部分切除术等。     

炭疽的早期识别及处理

炭疽是一种自古以来一直威胁着人类和动物健康的动物源性传染病。多年来人类炭疽在世界各地散发或局部地方性流行从未间断,我国广大农牧区也常有病例报道。炭疽的致病菌——炭疽芽孢杆菌,主要以芽孢的形式通过皮肤接触、饮食或吸入的方式感染人类和动物。其中皮肤炭疽最为常见,而肺炭疽因致死率极高、近年来成为潜在的生物恐怖袭击工具而引起高度的重视。目前的研究证实早期识别炭疽感染、及时有效的抗菌素治疗可大大降低炭疽的死亡率。本文根据近年来炭疽研究进展,对炭疽病原学特点及炭疽的早期识别和处理做一简要综述,供同道参考。     

抑郁症的诊断与治疗

抑郁症已成为全球第四大致残疾病,我国北京、上海的抑郁障碍患病率分别为2.5%和1.7%。本文阐明抑郁症发病危险因素、临床表现、自我识别、抑郁症的识别率及诊断率低的原因,并提出了抑郁症的新型抗抑郁剂治疗、物理治疗、心理治疗方法。     

Good Workers and Crooked Bosses: The Effect of Voice Suppression by Supervisors on Employees’ Populist Attitudes and Voting

This study is the first to explore the effect of political socialization in the workplace on populist attitudes. We investigate the effect of workplace voice suppression on employees' populist attitudes and voting. We expect employees who were suppressed by supervisors to hold more populist attitudes and to be more likely to vote for a populist party than employees who were not. We argue that some employees experience voice suppression by supervisors as stressful, so splitting is likely to be employed as a defense mechanism. Splitting is achieved through cognitive distinction and antagonism between “the good workers” and “the crooked bosses.” Such a split mental framework can generalize into a worldview that contrasts “the pure people” and “the corrupt elite,” a core characteristic of populism. We predict that the extent to which suppression triggers splitting and consequentially incites populist attitudes and voting depends on employees' acceptance of power distance. We test our hypotheses using SEM on survey data from 2990 members of the Dutch labor force. Our results show that experiences of voice suppression are positively related to populist attitudes and populist voting. As expected, this effect is stronger for employees who are less accepting of power distance.     

风湿性心脏病瓣膜置换术后抗凝治疗中“度”的把握

风湿性心脏瓣膜病在世界范围内发病率极高,瓣膜置换术是目前治疗该病的主要方法,根据不同的病情及需要可置换机械瓣或生物瓣,我国患者更常选择机械瓣置换,术后生物瓣置换需抗凝3个月～6个月,而机械辩置换者需终身抗凝,故抗凝治疗非常关键。本文从辨证思维的角度分析如何在瓣膜置换术后把握好抗凝治疗。     

冠心病调脂治疗过程中的哲学思考

他汀广泛用于冠心病的一级预防和二级预防,普遍源于循证医学的证据。首先,他汀治疗冠心病是从疾病的本质出发,采取有效方法稳定斑块、缓解缺血。调脂治疗中,以降低低密度脂蛋白胆固醇为主要目标,体现了抓主要矛盾和矛盾的主要方面的思路。调脂强调联合治疗,个体化治疗,同时一分为二看待药物的作用,适时减量或停药。     

Treatment manuals and the advancement of psychoanalytic knowledge: The Treatment Manual of the Tavistock Adult Depression Study

This paper has two aims: first, it seeks to understand the absence of treatment manuals in psychoanalysis. Secondly, it summarizes the treatment manual of the Tavistock Adult Depression Study, which describes the form of psychoanalytic psychotherapy whose effectiveness has been evaluated both in the Tavistock Adult Depression Study (TADS); and in the German Die Langzeittherapie bei chronischen Depressionen (LAC) Studie. Throughout the history of psychoanalysis, opinions about treatment manuals, empirical research and their antecedents have been deeply divided. After tracing the often polarized unfolding of these matters, the paper proposes that emotional and cognitive difficulties as well as scientific ones underpin their persistence. It is suggested that greater familiarity with them may lead to better combinations of outcome research and psychoanalysis: for example, the Tavistock manual seeks to match one account of the objects, aims, values, spirit and methods of psychoanalysis (as well as of connected forms of psychoanalytic psychotherapy); and also to meet what is required of treatment manuals by random allocation controlled trials. It has been a crucial element in the above studies of the outcome of long‐term psychoanalytic psychotherapies with chronically depressed patients. After describing the Tavistock Manual, the paper concludes suggesting that, if appropriately constructed, treatment manuals can make a contribution to the advancement of specifically psychoanalytic knowledge.