应用myPKFiT解析药代动力学指导血友病A患者个体化用药的进展

myPKFiT是药代动力学(pharmacokinetic,PK)指导下的A型血友病管理工具,能够快速准确地输出患者PK参数和给药方案供临床参考.目前血友病A的标准治疗手段为预防治疗,然而由于个体间差异的影响,仅以体重为参考来计算凝血因子Ⅷ(FⅧ)的用量,并不能满足血友病A患者的个体化治疗需求.PK参数可以协助临床医生...     

脊柱结核个体化药物治疗的临床效果观察

目的 探讨药敏试验指导下的脊柱结核个体化药物治疗的临床效果.方法 选择2005年8月至2010年1月诊治的132例脊柱结核手术患者进行结核分枝杆菌培养和药敏试验,随访超过12个月者62例纳入本研究,其中男性37例,女性25例;年龄4～67岁,平均33.6岁.患者均接受手术治疗,术中收集脓液、干酪样组织,常规处理后接种培养液,使用BACT/ALERT 3D细菌自动培养分析系统快速培养,培养阳性者采用改良罗氏培养液按绝对浓度法进行药敏试验,并根据结果制定抗结核化疗方案.术后1、3、6、9、12个月复查各1次,以后每6个月复查1次,观察临床表现及红细胞沉降率、X线片、三维CT、MRI的变化,分析局部及全身结核病转归、术区骨性融合等情况.结果 检测耗时28～58 d,平均42 d;培养阳性率45.2%(28/62).耐药率达24.2%,其中异烟肼12.9%、利福平4.8%、乙胺丁醇3.2%、链霉素9.7%、帕司烟肼6.4%、左氧氟沙星14.5%、利福喷汀1.6%.随访时间12～44个月,平均21个月.术后2周内切口愈合率98.4%(61/62).椎间植骨均获Ⅰ级骨性融合,融合时间8～12个月.结论 耐药结核形势严峻,药敏试验指导下的脊柱结核个体化药物治疗是减少复发、复治的关键.     

老年女性前盆腔器官脱垂行个体化经阴道手术的疗效

目的 评价老年妇女前盆腔器官脱垂行个体化经阴道手术治疗的安全性及疗效,为个体化盆腔重建手术对老年妇女生活质量的研究提供临床基础.方法 90例60岁以上前盆腔器官脱垂患者即个体化组,行个体化经阴道手术,观察手术安全性、疗效及泌尿、盆底功能生活质量的改变.并与同期对照组60例60岁以上前壁脱垂患者,经传统Kelly-Kennedy修补术进行比较.结果 老年妇女前盆腔器官脱垂行个体化经阴道手术治疗安全,术后恢复快,疗效好,复发率低(P＜0.05),生活质量高(P＜0.05).结论 老年妇女前盆腔器官脱垂行个体化经阴道手术疗效显著,术后生活质量明显提高.     

马万千老中医基于体质辨识运用食疗方治疗便秘临床经验总结

便秘是临床常见病证,马万千名老中医认为便秘与体质因素关系密切,通过长期临床发现,便秘患者体质多为气虚质、阳虚质、阴虚质、气郁质和湿热质,马万千老中医根据其临床经验,运用药食同源的药物,综合考虑口味等因素,针对不同的体质制定不同的食疗方,不仅治疗便秘,同时改善患者体质,取得了良好的临床疗效,值得临床推广。     

De l’incestuel à l’enfant-sorcier : des mots pour le dire

Aims

This paper sets out to explore the unconscious meanings and functions of the “witch-child” aetiology appearing in the discourse of families from sub-Saharan Africa (in the present instance Bamileke), and its possible links with an “incestuel” (as opposed to incestuous) family dynamic. We have sought to show the possible points of transition between concepts that belong to different resisters, using a singular clinical situation which is nevertheless just one of the possible manifestations of the link between the witch-child and an “incestuel” family climate. From this particular issue, we also seek to show the permanent articulation between psyche and culture, and the way each casts light on the other. This dimension appeared to us to be particularly important for the reflection of the clinician, for a finer understanding of the clinical setting, and thus for the psychotherapeutic process enacted with these families.

Temporal limits of long-range phase discrimination across the visual field

When two flickering sources are far enough apart to avoid low-level motion signals, phase judgment relies on the temporal individuation of the light and dark phases of each source. The highest rate at which the individuation can be maintained has been referred to as Gestalt flicker fusion [Van de Grind, W. A., Grüsser, O. -J., & Lunkenheimer, H. U. (1973). Temporal transfer properties of the afferent visual system. Psychophysical, neurophysiological and theoretical investigations. In R. Jung (Ed.), Handbook of sensory physiology (Vol. VII/3, pp. 431-573). Berlin: Springer, Chapter 7] and this has been taken as a measure of the temporal resolution of attention [Verstraten, F. A., Cavanagh, P., & Labianca, A. T. (2000). Limits of attentive tracking reveal temporal properties of attention. Vision Research, 40, 3651-3664; Battelli, L., Cavanagh, P., Intriligator, J., Tramo, M. J., Henaff, M. A., Michel, F., et al. (2001). Unilateral right parietal damage leads to bilateral deficit for high-level motion. Neuron, 32, 985-995]. Here we examine the variation of the temporal resolution of attention across the visual field using phase judgments of widely spaced pairs of flickering dots presented either in the upper or lower visual field and at either 4 degrees or 14 degrees eccentricity. We varied inter-dot separation to determine the spacing at which phase discriminations are no longer facilitated by low-level motion signals. Our data for these long-range phase judgments showed that temporal resolution decreases only slightly with increased distance from center of gaze (decrease from 11.4 to 8.9 Hz between 4 degrees to 14 degrees ), and does not differ between upper and lower visual fields. We conclude that the variation of the temporal limits of visual attention across the visual field differs markedly from that of the spatial resolution of attention.     

B超测量值拟合数学模型监测胎儿个体生长的探讨

目的 探讨监测胎儿个体生长的方法。方法 根据孕18－39周胎儿双顶径、头围、腹围及股骨长等的超声测量值拟合Rossavik数学模型[P＝c(t)^k s(t)]建立胎儿个体生长曲线（回归法和两点简化法）。结果 20例正常单胎的超声参数与Rossavik模型的拟合效果好（R^2：99．5％－99．7％）。孕33周和39周胎儿各项参数的回归法及两点简化法预测值与实测值比较均无显著差异。前瞻性分析30例胎儿各项参数的两点简化法预测值与实测值，亦无显著性差异。结论 根据孕28周前胎儿超声测量值拟合Rossavik数学模型建立的个体生长曲线可以预测孕晚期胎儿个体化正常生长的趋势。     

循证健康教育对精神分裂症患者日常生活能力及满意度的影响 蒋玲芳 邓燕 (重庆医科大学附属大学城医院 重庆 40030)

目的：探讨采用循证健康教育对提高患者日常生活能力及满意度的影响。方法：将纳入研究的80例研究对象随机分为对照组（40人）和试验组（40人）,对照组按常规方法进行健康教育,实验组通过循证支持提出问题,收集相关文献及证据,结合患者的实际情况,制定出个体化的健康宣教方案,并在实践过程中根据健康教育效果及时进行调整,每周对患者日常生活能力、阳性及阴性症状量表进行评定,出院时采用患者满意度调查问卷,包疾病相关知识、健康教育方式满意度、最满意护士填写对两组患者的满意度进行比较,对数据使用SPSS18.0软件进行数据统计分析。结果：实施循证健康教育后,试验组PANSS量表第二周开始,评分明显低于对照组,结果有统计学意义（P<0.05）,ADL量表试验组于第三周达到正常水平,与对照组相比,结果有统计学意义（P<0.05）,疾病相关知识得分实验组明显高于对照组,结果有统计学意义（P<0.05）,健康教育方式得分实验组明显高于对照组,结果有统计学意义（P<0.05）,最满意护士填写情况实验组明显高于对照组,结果有统计学意义（P<0.05）。结论：对精神分裂症患者实施循证健康教育,可有效改善患者日常生活能力、提高患者对疾病相关知识的掌握程度及患者的满意度,值得推广应用。     

临床药师参与1例利奈唑胺个体化治疗的药学实践

摘要：目的 探讨利奈唑胺个体化给药治疗策略，为优化利奈唑胺给药方案积累经验。方法 介绍临床药师参与1例利奈 唑胺治疗化脓性链球菌脓毒症合并骶髂关节感染患者的案例。临床药师通过血药浓度监测，结合利奈唑胺的药动学特点以及文 献阅读结果，为临床提供超说明书增加利奈唑胺给药剂量的建议，并进行药学监护。结果 增加利奈唑胺给药剂量后，患者感 染得到了有效控制，未出现药物不良反应，病情好转出院。结论 该案例为国内首例利奈唑胺超说明书剂量治疗化脓性链球菌 脓毒症致多器官功能障碍合并骶髂关节感染对于部分特殊人群治疗，利奈唑胺的说明书剂量不足问题应受到关注。     

A Jungian Approach to Analytic Work in the Twenty‐First Century

In Part 1 of this paper the authors summarize those key concepts in Jungian analytic theory which differentiate it from a psychoanalytic approach. To illustrate these perspectives and their application in clinical work, a patient is introduced. The authors elaborate on a particular dream with the proposition that it holds within it both an image of the internal world of the patient's personal psyche and something which might be viewed as archetypal and emerging from the collective unconscious. Part 2 focuses on more recent developments in Jungian analytic thinking. Michael Fordham's important work in extending Jungian theory into an understanding of infant development is summarized and illustrated by a clinical example. This is followed by a brief summary of how contemporary debate within the Jungian analytic community has been much affected by recent developments in areas outside the analytic discourse which have offered both a challenge to and an affirmation of certain Jungian concepts. Examples given are from emergence theory and neuroscience. The Jungian interest in such phenomena stems from a view of the human psyche as rooted in a wider world of matter, culture, history and an unconscious that is not only personal but also collective.