心肌梗死发作期与血清C反应蛋白关系的探讨

目的探讨血清C反应蛋白(CRP)水平与心肌梗死(MI)发作期的相关性及其与不良心血管事件之间的关系。方法用全自动生化分析仪对40例体检正常者和50例MI发作期(14d内)患者进行血清CRP水平检测,并及时随访不良心血管事件的发生情况。结果入院时MI发作期患者CRP水平为(23.83±6.25)mg/L显著高于正常人的(6.53±3.25)mg/L,差异有统计学意义(P<0.05);MI发作期患者不同时间血清CRP水平与对照组比较,差异均有统计学意义(P<0.05);CRP与不良心血管事件之间的相关系数(r)=0.933。结论 MI发作期患者血清CRP水平明显高于正常对照组,其升高与MI的发作明显相关,可作为急性心肌梗死发作期危险性的一种敏感和可靠的预测因子,另外在临床上血清CRP水平作为MI及心血管意外事件的预报因子也有其敏感性和可靠性。     

The Enlightenment of Evidence and the Leap in the Dark

This article is a free inspiration following R.D. Hinshelwood's ‘Intuition from beginning to end?’. The author tries to show Bion's Kleinian skill to listen to every detail of the clinical hour, picking up clues and putting them together to render meanings and presenting them to the patient. While doing so, Bion created a richness of concepts for analysts to try out as tools for observation and understanding of their patients’ mental functioning. Several of these concepts along with the clinical inspirations are described here. The author believes, therefore, that even during his ‘loyalty to Klein’ period, Bion was also extremely creative though inspired by Klein. When it comes to intuition, the author prefers to be modest, listen to the patient's free associations and allow intuitions to mate with concepts before getting back to the patient.     

Legal factors associated with change in alcohol use and partner violence among offenders

Intimate partner violence (IPV) is a pervasive social concern that may be exacerbated by high rates of alcohol dependence among perpetrators. Society has attempted to combat IPV through various legal interventions, but the effects of specific legal factors on behavioral change and treatment compliance remain largely unexamined. The primary focus of the current study was to comprehensively evaluate the impact of various legal factors (i.e., judicial mandate, judicial monitoring, stage of change, and stake in conformity) on mandatory treatment compliance and behavioral change over a 12 week post-adjudication period among a high-risk sample of alcohol dependent IPV offenders (N = 60). Growth curve analyses revealed effects of judicial monitoring and stage of change such that participants reporting low perceived judicial monitoring and early stages of change reported higher initial levels and a more rapid reduction in IPV than those reporting high perceived judicial monitoring and late stages of change, who reported consistently low IPV. Although we found that legal factors were poor predictors of treatment compliance and alcohol use during treatment, the association between alcohol and IPV was moderated by the legal factors. Stake in conformity was negatively associated with IPV among low alcohol users and positively associated among high alcohol users whereas stage of change was negatively associated with IPV among high alcohol users. The current results suggest that pretreatment legal factors may represent an important consideration in reducing IPV among alcohol dependent offenders. Further research is required to determine the efficacy of legal factors in isolation of treatment as well as methods of manipulating these factors to optimally compliment a prescribed course of treatment.     

保留晶状体的玻璃体切除术治疗4A期早产儿视网膜病变

目的 评价保留晶状体的玻璃体切除术治疗4A期早产儿视网膜病变后视网膜解剖复位情况以及视功能情况.方法 回顾性病例研究.15例20只4A期早产儿视网膜病变患眼经确诊后均在全麻下施行了保留晶状体的玻璃体切除术.术后随访通过间接检眼镜以及RetCamⅡ成像系统检查视网膜解剖复位情况,使用条栅视力(Lea gratingTM)检查来评估视功能的情况.结果 所有20只患眼术后随访中视网膜解剖均完全复位.其中3只患眼伴有黄斑部的变形或牵引(占15％),其余17只患眼术后眼底检查黄斑部结构正常(占85％).共9例患儿12只眼完成了条栅视力的检查,平均条栅视力值为(6.4±.2.5)c/d(2～12 c/d),转换为五分视力值平均为4.29±0.20 (3.82～4.60).其中1只患眼视力为3.82,1只患眼视力为4.0,其眼底检查都发现有黄斑部的变形以及牵引;其余10只患眼视力都优于4.3(4.30～4.60).结论 通过保留晶状体的玻璃体切除术治疗4A期早产儿视网膜病变,能够使视网膜解剖复位成功,并达到良好的视功能预后.     

探讨喉癌患者气管导管的阶段性护理

目的 探究喉癌患者气管导管的阶段性护理,为医院的临床护理工作提供参考依据。方法 抽取2010年1月~2013年1月收治的42例喉癌患者作为研究对象,给予气管导管的阶段性护理,并结合其临床护理资料进行回顾性分析。结果 42例患者中,有2例出现并发症（内套管脱管、气管黏膜损伤）,发生率为4.7%（2/42）。结论 给予喉癌患者气管导管方面的阶段性护理,能够保证患者的临床治疗效果,提高治愈率,并将并发症的发生率控制在最低,具有重要的临床应用价值,值得推广。     

阶段性健康教育在S3～5双开门手术入路行骶前病变手术患者的应用

目的:探讨阶段性健康教育在S3～5双开门手术入路行骶前病变手术患者护理中的应用效果.方法:将28例骶前病变患者随机分为2组,其中:观察组18例,对照组10例.对照组采用常规健康教育方法,针对患者现有和潜在的健康问题给予健康指导；观察组实施阶段性健康教育处方,在入院时、术前、术后及出院前,针对患者不同时期的不同需要,采取阶段性、目的明确且持续的健康教育方法.结果:观察组患者对健康教育知晓率明显高于对照组(P＜0.01),满意度高于对照组(P＜0.05).结论:阶段性健康教育可强化在S3～5双开门手术入路行骶前病变手术患者的遵医行为,建立良好的护患关系,提高患者对健康教育知晓率和满意度,从而促进患者心理和机体功能的早日康复,减少并发症的发生.     

Physical conflict as a means to access and structure psychological conflict: An exploration into the therapeutic abilities of martial activity

Drawing on a psychoanalytic framework, it is possible to understand how immersing the body in conflict within a martial art therapy can access both conscious and unconscious affect in relation to conflict. In a martial therapy, the body becomes responsible for the word. This is a positive option with which to access the psyche and the body to subjects whose relationship to ‘normal’ therapy may not be an option, especially in the case of troubled and problematic youths. This is a case for the promotion of therapies that work with and through the body by means of a bodily intervention but more significantly it is to reveal that a martial art carries a more primitive structure revealing a natural inclination towards fighting as a remedial structure and not necessarily an expression of destruction.     

Multi-Center Analysis of Liver Transplantation for Combined Hepatocellular Carcinoma-Cholangiocarcinoma Liver Tumors

1. Download : Download high-res image (269KB)
2. Download : Download full-size image

     

Nutrition assessment in patients undergoing liver transplant

Liver transplantation (LT) is a major surgery performed on patients with end stage liver disease. Nutrition is an integral part of patient care, and protein-energy malnutrition is almost universally present in patients suffering from liver disease undergoing LT. Nutrition assessment of preliver transplant phase helps to make a good nutrition care plan for the patients. Nutrition status has been associated with various factors which are related to the success of liver transplant such as morbidity, mortality, and length of hospital stay. To assess the nutritional status of preliver transplant patients, combinations of nutrition assessment methods should be used like subjective global assessment, Anthropometry mid arm-muscle circumference, Bioelectrical impedance analysis (BIA) and handgrip strength.