The White Man in the Room: Finding My Position as a White Therapist

This paper explores the discomfort that resulted from a brief exchange between a white male therapist and a black male patient. The discomfort is understood as pointing towards an absence of racial understanding in the therapist, which contributed to a breakdown in empathic communication. This absence is explored in relation to the concept of internal racism and used to highlight an inequality in the subjective experience of race between the therapist and patient (Davids, 2011; Internal Racism: A Psychoanalytic Approach to Race and Difference). The notion of white privilege is introduced and considered as a useful counterpart to internal racism for thinking about white racial experience. White privilege is viewed as a useful concept for making present what is often missing from discussions of race and difference. It is suggested that until white experience acquires racial meanings, the burden of thinking about race will be placed upon the racial other (Davids, 2011). These themes are considered from within a psychoanalytic framework, but significant use is made of ideas from outside psychoanalytic theory to demonstrate the complex interplay of internal and external forces that give shape to unconscious racism. It is suggested that further exploration of these ideas in relation to the superego could be especially useful for clinical understanding.     

Takayasu Arteritis: Diagnosis,Treatment and Prognosis

Takayasu arteritis (TA) is a chronic nonspecific granulomatous vasculitis affecting aorta and its main branches, coronary and pulmonary arteries. TA often occurs in young women and has a characteristic heterogeneity depending on ethnicity and geographical location. Although the pathogenesis of TA remains unclear, the interaction of many factors, such as autoimmunity, inflammation, genetic and environmental factors and so on, is involved in the occurrence and development of TA. Angiography, which is recognized as the gold standard in evaluating vascular lesions in TA, combined with computer tomography angiography (CTA), magnetic resonance angiography (MRA), ultrasonography, ¹⁸Fluorodeoxyglucose positron emission tomography (¹⁸F-FDG-PET) could not only provide important information for early diagnosis but also detect disease activity, and thus further guide the treatment in TA. In addition, beside the commonly used corticosteroids, immunosuppressive agents, percutaneous transluminal angioplasty (PTA) and surgical revascularization, anti-tumor necrosis factor (TNF) agent has been more widely used in refractory cases of TA. The objective of this review is to systemically describe the pathogenesis, clinical characteristics, diagnosis, treatment and prognosis of TA.     

The Pathophysiology, Diagnosis and Treatment of Allergic Rhinitis

Treatment of AR requires a stepwise approach depending on the severity and duration of symptoms. Treatment options for AR consist of allergen avoidance, pharmacotherapy, immunotherapy and surgery. For the mechanisms of AR, anti-IgE antibody and specific antibody to cytokines such as IL-4 or IL-5 that correlate with allergic inflammation have recently emerged. SLIT is currently widely used due to its efficacy, safety and convenience, which replaces subcutaneous immunotherapy. Although allergen avoidance and immunotherapy are theoretically ideal, antihistamines and intranasal corticosteroids will play the main role in the management of AR until an innovative treatment develops. However, patients'' main symptom, the duration and severity of AR, patients'' compliance, safety of medication and cost-effectiveness should be considered when treatment options are chosen. In conclusion, physicians should be aware of etiology, pathophysiology, symptoms, signs and diseases related to AR in order to make a correct diagnosis and choose a proper treatment option for each patient.     

The Case for Borderline Personality Disorder as an Emotional Disorder: Implications for Treatment

The goal of this article is to advance understanding of borderline personality disorder (BPD) as an emotional disorder and to use this information as a heuristic for reconceptualizing targeted treatment approaches. The first section reviews evidence that BPD is characterized by the hallmark of emotional disorders, frequent intense negative emotions, and adverse reactions to them. Next, overlap between BPD and other emotional disorders is described, followed by a section delineating how these similarities can be largely accounted for by a shared underlying vulnerability, namely, high levels of neuroticism. Finally, we discuss the treatment implications of this conception of BPD in the context of recent transdiagnostic approaches to emotional disorders.     

Congenital Athymia: Genetic Etiologies,Clinical Manifestations,Diagnosis, and Treatment

Congenital athymia is an ultra-rare disease characterized by the absence of a functioning thymus. It is associated with several genetic and syndromic disorders including FOXN1 deficiency, 22q11.2 deletion, CHARGE Syndrome (Coloboma, Heart defects, Atresia of the nasal choanae, Retardation of growth and development, Genitourinary anomalies, and Ear anomalies), and Complete DiGeorge Syndrome. Congenital athymia can result from defects in genes that impact thymic organ development such as FOXN1 and PAX1 or from genes that are involved in development of the entire midline region, such as TBX1 within the 22q11.2 region, CHD7, and FOXI3. Patients with congenital athymia have profound immunodeficiency, increased susceptibility to infections, and frequently, autologous graft-versus-host disease (GVHD). Athymic patients often present with absent T cells but normal numbers of B cells and Natural Killer cells (T^?B⁺NK⁺), similar to a phenotype of severe combined immunodeficiency (SCID); these patients may require additional steps to confirm the diagnosis if no known genetic cause of athymia is identified. However, distinguishing athymia from SCID is crucial, as treatments differ for these conditions. Cultured thymus tissue is being investigated as a treatment for congenital athymia. Here, we review what is known about the epidemiology, underlying etiologies, clinical manifestations, and treatments for congenital athymia.

     

胸膜结节病的诊断及治疗

胸膜结节病(pleuropulmonary sarcoidosis,PPS)是一种相对少见的病因未明的非干酪性上皮样肉芽肿性疾病,组织病理学活检可见胸膜非干酪样肉芽肿浸润,伴或不伴肺实质浸润.PPS临床表现、实验室检查及影像学等缺乏特异性,易误诊为结核性胸膜炎等胸膜疾病,早期正确诊断及治疗PPS十分重要.     

Beyond Depression: Towards a Process-Based Approach to Research, Diagnosis, and Treatment

Despite decades of research on the etiology and treatment of depression, a significant proportion of the population is affected by the disorder, fails to respond to treatment and is plagued by relapse. Six prominent scientists, Aaron Beck, Richard Davidson, Fritz Henn, Steven Maier, Helen Mayberg, and Martin Seligman, gathered to discuss the current state of scientific knowledge on depression, and in particular on the basic neurobiological and psychopathological processes at play in the disorder. These general themes were addressed: 1) the relevance of learned helplessness as a basic process involved in the development of depression; 2) the limitations of our current taxonomy of psychological disorders; 3) the need to work towards a psychobiological process-based taxonomy; and 4) the clinical implications of implementing such a process-based taxonomy.     

D.W. Winnicott and Religion: The Intermediate Area of Experiencing as a Dissociative Phenomenon

Winnicott's concept of an ‘area of intermediate experiencing’ is a very important component of his understanding of religious and cultural practices. It is nonetheless a term that seems to have created considerable confusion and uncertainty among analysts and others. In this paper, I suggest, through a discussion of Winnicott's own work, a review of dissociative phenomena and a selection of illustrations, that the intermediate area of experiencing can be understood best when considered within the framework of a normal, voluntary dissociative or near-dissociative process that is characteristic of many religious experiences generally. This approach suggests that religious practices and expressions need not be understood primarily on the basis of factual truth as Freud would have done. They also need to be considered on the basis of their meaning or value for the individual or society, as Winnicott suggests. Religious practices and expressions often can be understood as dissociative or near-dissociative processes that have their own unique properties and characteristics that are separate from but related to the more usual expressions of logical, goal-directed mental activity that are so valued in modern societies.     

血清AFU、AFP、TSGF联合检测对PHC的诊断及治疗意义

目的：探讨α-L-岩藻糖苷酶(AFU)、甲胎蛋白(AFP)及恶性肿瘤特异性生长因子(TSGF)3种指标联合应用对诊断原发性肝癌(PHC)的应用价值。方法2012年1月~2013年12月我院肿瘤科、肝病科及体检中心病例作为研究对象,根据病例临床诊断结果分为三组：PHC组36例,良性肝病组40例,健康对照组40例,比较三组AFU、AFP、TSGF水平和3项指标单独与联合应用的阳性率。结果 PHC组AFU、AFP和TSGF水平均显著高于良性肝病组和健康对照组,数据间比较差异具有统计学意义(<0.05)。AFU+AFP+TSGF联合检测的阳性率显著高于3种指标单独检测或双指标检测结果,数据间比较差异具有统计学意义(<0.05)。结论 AFU、AFP和TSGF联合检测应用于PHC的临床诊断具有较高的应用价值,3种指标可互为补充,综合提高阳性率,减少漏误。     

胰腺囊性肿瘤10例诊治体会

目的:探讨胰腺囊性肿瘤诊治方法.方法:手术治疗胰腺囊性肿瘤10例,其中8例肿瘤切除完整,1例行内引流术,1例行开关腔术.结果:本组8例肿瘤完整切除的病例中,有7例生存良好,随访11月～8 a无复发,另1例术后9个月死于复发;1例行内引流术者18个月后死于肝转移;1例因广泛转移自动出院.结论:加强对本病的认识和熟悉其病理学特点、以及术前对影像学资料进行认真地分析是提高诊治率的关键;本病手术切除率较高,完全性手术切除是唯一的治疗方法.     

WBC、CRP和PCT在急诊发热患者诊治中的应用

目的 探讨WBC、CRP和PCT在急诊发热患者诊治中的应用效果。方法 选用2015年11月~2017年11月中山市人民医院救治的119例急诊发热患者为研究对象,给予患者实施WBC、CRP和PCT检测和病因学检查,依据诊断结果中是否感染细菌分为对照组和观察组,对照组32例为非细菌感染患者,观察组87例为细菌感染患者,对比两组WBC、CRP、PCT诊断情况。结果 观察组的WBC、CRP、PCT水平高于对照组,血液WBC、CRP、PCT的指标中,敏感度、特异度等进行比较,三种联合检测的敏感度和准确度最高。结论 WBC、CRP和PCT在急诊发热患者诊治中的应用效果显著,细菌感染发热患者WBC、CRP和PCT水平明显提升,PCT的特异性更优,CRP敏感度更优,联合检测的应用价值最高。