Identification of Emotionally Ambiguous Interpersonal Stimuli Among Dysphoric and Nondysphoric Individuals

This study examined whether dysphoria influences the identification of non-ambiguous and ambiguous facial expressions of emotion. Dysphoric and non-dysphoric college students viewed a series of human faces expressing sadness, happiness, anger, and fear that were morphed with each other to varying degrees. Dysphoric and non-dysphoric individuals identified prototypical emotional expressions similarly. However, when viewing ambiguous faces, dysphoric individuals were more likely to identify sadness when mixed with happiness than non-dysphoric individuals. A similar but less robust pattern was observed for facial expressions that combined fear and happiness. No group differences in emotion identification were observed for faces that combined sadness and anger or fear and anger. Dysphoria appears to enhance the identification of negative emotion in others when positive emotion is also present. This tendency may contribute to some of the interpersonal difficulties often experienced by dysphoric individuals.

个体预后与诊断预测模型研究报告规范——TRIPOD声明解读

近年来,人们逐渐认识到临床大数据的潜在价值,疾病预测模型也开始成为临床研究的热点。不同种类疾病的预测模型在个体风险评估中发挥着越来越重要的作用。但由于一直没有针对疾病预测模型研究的报告规范,相关研究的报告结构和报告质量大多参差不齐。2015年BMJ发表了《Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis(TRIPOD):the TRIPOD statement》,即TRIPOD声明,对疾病诊断和预后的预测模型研究的报告做了统一的规范。本文就TRIPOD声明的重点内容进行解读,以期促进理解和使用该报告规范。     

Working to Understand Our Role in the Patient's Mind: Countertransference and the Problems of Immersion

To be fully helpful, in a way that respects both the internal and external needs and conflicts of our patients in analytic treatment, we must become immersed in their emotional perspective and have a feel for how they view and value themselves and their objects. Allowing ourselves to be carried into their inner phantasies and to be in touch with their strivings towards and away from love, hate, and knowledge is important in the analytic process. Countertransference is unavoidable but, if properly monitored and contained, it can provide a beneficial therapeutic device. However, when treating disturbed patients who draw us into more paranoid transference states or primitive depressive position conflicts, we are often involved in various degrees of enactment. Even then, the countertransference, if carefully studied, can help us rebalance ourselves therapeutically and start to better understand how the patient is using us in their internal world and why they need to or desire to organize their object relational world in such terms. We cannot help but be immersed within the patient's unconscious belief system but, by being aware of our thoughts and feelings and reactions, we can keep our head above the choppy countertransference waters enough to act out less and offer constant interpretations that are more informed and focused on the patient's unique and personal object relational conflicts and internal belief system. From an object relational, post‐Kleinian tradition, the author examines one case in depth. The patient consulted the analyst with concerns about her grown children and her perception of how damaged they were emotionally. The subsequent meetings involved intense transference and countertransference experiences that are explored. The author's approach builds on prior clinical understanding based on the Kleinian method (Waska, 2002, 2004, 2012, 2013).     

Reappraising Winnicott's The Piggle: A Critical Commentary

This is the second part of an extended paper reviewing the nature of the messages Winnicott wished to communicate to his audience through the psychoanalytic case of The Piggle. ‘Introduction and the Treatment’ (published in BJP 31[2]) set out the work in its theoretical and historical context and reviewed the dialogue which serves as the material for the work. This part provides a discussion and a critical analysis of the case, and an examination of both explicit and less worked‐out conclusions which can be drawn from it. The author considers the case as evidence that therapy with a child can be intensive without being extensive. He highlights Winnicott's emphasis on the importance of play for working through internal conflicts, not merely as providing material for interpretation. Whereas Winnicott held firmly to the efficacy of his commotional interpretations, and the notion that Gabrielle's unconscious dispositions were agentive and intentional, the author argues for an alternative to Winnicott's interpretation, highlighting the use of make‐believe play, the irregular timing of the sessions and the child's own maturational processes as being important elements in her recovery. He suggests that, for Winnicott, these factors were intuitively, rather than conceptually worked out, and, in so being, contribute to the enigmatic nature of the original work.     

荧光原位杂交技术在临床实验室应用的现存问题和对策

FISH的技术在临床的应用日渐广泛,成为快速诊断和确诊宫颈癌、乳腺癌、白血病等疾病的一项分子诊断技术。但是,到目前为止国家相关部门尚未出台相应的实验室条件要求、人员培训以及标准的操作流程,同时该技术实验操作和结果判断等环节较多,对临床结果影响较大,鉴于此,我们就目前临床实验中尚未解决和需要关注的地方进行阐述,以便更好地改进和规范实验技术步骤,有效减少临床检验的误诊。     

Accesibilidad y utilización de la espirometría en los centros de atención primaria de Cataluña

ObjectiveExamine the accessibility and use of forced spirometry (FS) in public primary care facilities centers in Catalonia.DesignCross-sectional study using a survey.ParticipantsThree hundred sixty-six Primary Care Teams (PCT) in Catalonia. Third quarter of 2010.MeasurementsSurvey with information on spirometers, training, interpretation and quality control, and the priority that the quality of spirometry had for the team. Indicators FS/100 inhabitants/year, FS/month/PCT; FS/month/10,000 inhabitants.Main resultsResponse rate: 75%. 97.5% of PCT had spirometer and made an average of 2.01 spirometries/100 inhabitants (34.68 spirometry/PCT/month). 83% have trained professionals. > 50% centers perform formal training but no information is available on the quality. 70% performed some sort of calibration. Interpretation was made by the family physician in 87.3% of cases. In 68% of cases not performed any quality control of exploration. 2/3 typed data manually into the computerized medical record. > 50% recognized a high priority strategies for improving the quality.ConclusionDespite the accessibility of EF efforts should be made to standardize training, increasing the number of scans test and promote systematic quality control.     

The variability in likelihood ratios due to different mechanisms

Recently there has been a drive towards standardisation of forensic DNA interpretation methods resulting in the uptake of probabilistic interpretation software. Some of these software solutions utilise Markov chain Monte Carlo techniques (MCMC). They will not produce an identical answer after repeat interpretations of the same evidence profile because of the Monte Carlo aspect. This is a new source of variability within the forensic DNA analysis process. In this paper we explore the size of the MCMC variability within the interpretation software STRmix™ compared to other sources of variability in forensic DNA profiling including PCR, capillary electrophoresis load and injection, and the makeup of allele frequency databases. The MCMC variability within STRmix™ was shown to be the smallest source of variability in this process.     

美国卫生和公众服务部《成人和青少年HIV-1感染者抗逆转录病毒药物使用指南(2014版)》更新的解读

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《骨髓增生异常综合征诊断与治疗中国专家共识(2014年版)》解读

对中华医学会血液学分会制订的《骨髓增生异常综合征诊断与治疗中国专家共识(2014年版)》进行解读,针对其科学性、合理性进行探讨,并提出一些看法和建议,期望对中国骨髓增生异常综合征诊疗提供帮助.     

《高血压性脑出血中国多学科诊治指南》急救诊治解读

自发性脑出血(spontaneous intracerebral hemorrhage,SICH)因发病率、病死率、致残率长期居高不下,而造成严重的家庭社会负担。其中高血压性脑出血(hypertensive intracerebral hemorrhage,HICH)是最常见的一种,占SICH的50%~70%。继2015年由中华医学会神经外科分会、中国医师协会急诊医师分会、国家卫生和计划生育委员会脑卒中筛查与防治工程委员会制定《自发性脑出血诊断治疗中国多学科专家共识》[1],以及2019年由中华医学会神经病学分会、中华医学会神经病学分会脑血管病学组发表《中国脑出血诊治指南(2019)》[2]后,结合近年来研究进展,在2020年针对我国SICH中最常见的HICH发表了最新的《高血压性脑出血中国多学科诊治指南》[3]。该版指南就HICH的急救处理、影像学检查、诊断与鉴别诊断、非手术与手术治疗、术后康复等相关问题做了详细的介绍。本文针对2020年该版指南的急救诊治部分进行解读,以期规范HICH早期救治,从而改善预后。