"治脾以安五脏"学术思想的临床应用佐证

祖国医学认为,脾胃是后天元气之根本,调理脾胃,既可治好脾胃病,更为重要的能治好各种脾胃以外的疾病,所以有“久病不愈,治脾以安五脏”的说法。通过5则病案的分析对此理论加以讨论。     

Temporal trends in the proportion cured for cancer of the colon and rectum: a population-based study using data from the Finnish Cancer Registry

Colorectal cancer is the third most common cancer worldwide and the second most common cancer in Europe. Cumulative relative survival curves for both cancer of the colon and cancer of the rectum generally plateau after approximately 6-8 years. When this occurs, "population" or "statistical" cure is reached. We analyzed data from the Finnish Cancer Registry over a 50-year period using methods that simultaneously estimate the proportion of patients cured of disease (the cure fraction) and the survival time distribution of the "uncured" group. Our primary aim was to investigate temporal trends in the cure fraction and median survival of the uncured by age group for both cancer of the colon and rectum. For both cancers, the cure fraction has increased dramatically over time for all age groups. However, the difference in the cure fraction between age groups has reduced over time, particularly for cancer of the colon. Median survival in the uncured has also increased over time in all age groups but there still remains an inverse relationship between age and median survival, with shorter median survival with increasing age. The reasons for these impressive increases in patient survival are complex, but are highly likely to be strongly related to many improvements in cancer care over this same time period.     

Update: medical treatment of onychomycosis

The diagnosis of onychomycosis should be made clinically and mycologically: clinically, by one of seven subtypes of onychomycosis, and mycologically, by evidence of dermatophytes or verified presence of molds and/or yeasts. Dermatophytes are usually considered as pathogens, whereas non‐dermatophyte molds and yeasts are saprophytes. Basic anamnesis and close inspection should be performed to eliminate combined diseases (e.g., onychomycosis and trauma). The gold standard treatment for onychomycosis is basically systemic. Combination with topical agents, such as nail lacquer and/or chemical nail avulsion, produces better results than systemic treatment alone. Topical treatment as monotherapy is not efficient, excluding minor cases. Terbinafine is superior to itraconazole for dermatophyte onychomycosis. Evaluation of the outcome of clinical cure, mycological cure and total cure should be based on the well‐defined worldwide criteria; otherwise, comparison of results is impossible due to lack of uniformity in different studies. In case of treatment failure, the reasons for each failure should be carefully considered.     

A Soft,Flexible Stent/Bung for Marsupialisation

A soft flexible stent or bung for marsupialisation using putty elastomeric impression material rather than an acrylic bung.     

A listening perspective in psychotherapy with suicidal patients: Establishing convergence in therapists and patients private theories on suicidality and cure

Objective: To explore ways that psychotherapists and suicidal patients handle suicidality as a topic, and how it impacts the bond between them. Method: Nineteen suicidal patients and their therapists participated in a naturalistic study. Patients were interviewed before they started in therapy, and both patients and therapists were interviewed after three sessions and after one year. Results: Whether suicidality was frequently or seldomly addressed during the sessions did not bear any direct influence on the establishment of a working alliance. Rather, the sense of being engaged in a process of change followed from the therapist’s capacity to establish a wide listening perspective, with sensitivity towards their own uncertainties, as well as to implicit and explicit messages about the patient’s state of mind. The “private theories” of suicidality and cure that were held by the two parties tended to converge as a result of their work together. If convergence was not established early on, what mattered was their capacity to detect and work on their divergences. Unaddressed divergences led to vicissitudes and eventually resignation. Conclusions: Listening and exploring divergences in private theories of cure mattered for the creation of a viable working alliance directed at the patient’s efforts to live their life.     

Narcissistic Personality Disorder and Pathological Mourning

This paper describes an approach to psychoanalysis conducted as a “talking cure” whereby the analyst privileges the patient's maturational capacity for speaking about experience. An optimal analytic process becomes a method of exploration and investigation through inquiry rather than interpretation. Interpretations facilitate talking, particularly those thoughts and feelings that are unwanted and unbidden. Accordingly, the analyst's chief concern is the resolution of resistances to speaking in contrast to an effort that aims to resolve resistances to insight or understanding. Insight, when it occurs, is a result of the change process and one's burgeoning capacity for talking with another who is interested in understanding. In this way making the unconscious conscious is worked through progressive speech and the enrichment of experience that results. Complementary to this effort is the analyst's subjective reflection on and use of countertransference states. Several features of the analytic process are described and elaborated: the centrality of the patient's voice, the value and function of inquiry, the analyst's crucial function as the sentient other for the patient's unconscious processes, and the leverage provided by the analyst's living into the transference experientially accompanied by personal acts of emotional freedom. A case example is provided to illustrate this approach.     

高技术条件下战场救治的特点及医德要求

高技术条件下战争的特殊性给战场救治带来了新的挑战。通过分析高技术条件下的战场救治的特点,提出了要圆满完成战场救治任务,军队医务人员必须承担的医德责任和应具备的身心素质。     

复合树脂的不同固化方法对抗压强度影响

目的 探讨不同固化方法处理后对复合树脂抗压强度的影响。方法 采用光固化、光固化＋光固化、光固化＋热固化,3种不同固化方法处理3M和贺利氏复合树脂,在万能验试机上测试抗压强度。结果 2次处理的复合树脂抗压强度均比1次处理的复合树脂有较大提高,范围在51.8%-91.6%之间。不同的2次固化方法相比,统计学无显著差异。结论 复合树脂经2次固化方法处理,其抗压强度高于1次光固化方法的处理。