<p>作者探討了醫療保健環境中“高科技”背景下”個人化接觸” (high touch) 的重要性。這一主題對於病人患病期間的日常體驗至關重要。醫療照顧不僅僅是對疾病或病症的回應，而是對生命整全意義的終生參與，病人越來越意識到自己需要整體性照護，研究顯示，僅靠“高科技”無法滿足精神需求，精神的危機日益凸顯在病人期間。病人不再容忍“高科技”與非接觸式醫療保健。他們想要兩全其美——“高科技”和 ”個人化接觸” (high touch) 的照護。那麼，問題是如何更好地應對未來發展的特殊挑戰和需求？“個人化接觸” (high touch) 如何在醫療保健領域採取必要的前進步驟？</p> <p> </p><p>The author explores the importance of "high touch” in the context of “high technology” in settings for medical care. This theme is crucial in the daily experi-ence of patients in their time of illness. Health care is not simply a response to ill-ness or disease. It is a holistic, lifelong engagement with the meaning of life. Pa-tients are becoming more aware of their need for holistic care. Research indicates that “high technology” alone cannot satisfy the spiritual needs, and spiritual crises which become increasingly prominent during experiences of illness. Patients no longer tolerate “high-tech," no-touch health care. They want the best of both worlds — “high-tech” and “high-touch” care. The question, therefore, is how best to face special challenges and demands in light of future development? How can "high touch" take the necessary forward steps it needs to take in medical care?</p> <p> </p>

<p>背景：邊緣性人格疾患是一種以情緒調節失功能為主要臨床特徵的人格疾患，但目前較少有文獻探討該疾患在情緒調節失功能的整體架構。本研究探討情緒敏感度和情緒調節不良可預測邊緣性人格疾患者的負面情緒，以及情緒調節不良在情緒敏感度和負面情緒之間扮演中介角色。材料與方法：參與者31名邊緣性人格疾患者，其中包括女性26名，男性5名，平均年齡33.35歲。所有參與者都完成了邊緣性人格特質問卷、社會覺察推論測驗情的緒評估分測驗、正負向情感量表以及情緒調節困難量表。結果：中介分析表明，有限的情緒調節策略在焦慮情緒敏感度和整體負向情感之間有中介效果，衝動控制困難為焦慮情緒敏感度和緊張不安的中介變項，以及不接受情緒反應中介了嫌惡情緒敏感度和罪惡。結論：本研究的發現有重要的治療意義，即在治療中，如何使該疾患學習具適應性的情緒調節策略、接納自己的情緒、與避免自毀式的衝動行為應被視為介入的首要目的，此外如何降低該疾患對他人情緒表達的敏感度亦可作為治療介入的焦點之一。</p> <p> </p><p>Objective: Borderline personality disorder (BPD) is characterized by negative affect, including hostility, jitters, distress, guilt, and scared. The present study pro-posed that emotion sensitivity and emotional dysregulation predict negative affect in patients with BPD, and that emotional dysregulation mediates the relationship be-tween emotion sensitivity and negative affect. Method: Participants 31 BPD patients include 26 female and 5 male, with average age of 33.35 years old. All participants completed the Borderline Personality Inventory, the Emotion Evaluation Subtest, Positive and Negative Affect Schedule, and Difficulties in Emotion Regulation Scale. Results: Mediation analysis indicated that limited access to emotion regulation strategies mediated the relationship between anxiety sensitivity and overall negative affect, impulse control difficulties mediated the relationship between anxiety sensi-tivity and jitters, and non-acceptance of emotional responses mediated the relation-ship between aversion sensitivity and guilt. Conclusions: This has significant treat-ment implications, highlighting that learning skills in managing and regulating emo-tions, accepting one’s emotions, and avoiding self-destructive impulse behavior should be targets of intervention. Another implication of this finding is the im-portance of providing intervention to reduce emotion sensitivity in social interac-tions.</p> <p> </p>

<p>自發性顱內低血壓頭痛(SIH)是一種體位性(姿勢性)頭痛，大多因腦脊髓液(CSF)在脊椎段發生滲漏造成，通常在核磁共振成像(MRI)可發現滲漏。本病例報告一名自發性顱內低血壓頭痛患者，在MRI上發現於胸部脊柱椎體(T1)以下後硬膜外腔腦脊髓液滲漏，並接受了腰椎穿刺以排除腦膜炎。此病患經過保守治療之後無效、在核磁共振檢查之後第5天，患者在腰椎硬膜外血液貼片(LEBP)治療時，於腰椎硬膜外腔(L3-4)中發現了一些腦脊髓液並接受腰椎硬膜外血貼片治療改善病情。我們討論了自發性低顱內壓頭痛的病理生理學、提出的病因和治療方法、腰椎硬膜外血液貼片治療的安全性以及一位在脊椎目標滲漏區間遠處發現硬脊膜外腦脊髓液滲漏之罕見病例。</p> <p> </p><p>Spontaneous intracranial hypotension headache (SIH) is a phenomenon com-bined with postural headaches, cerebrospinal fluid (CSF) leakage often at spine level on magnetic resonance imaging (MRI). We present a patient with SIH with CSF leakage blow thoracic (T1) spine vertebral level presence of posterior epidural space CSF on MRI and received lumbar puncture to excluded meningitis. The patient re-ceived conservative treatments but in vain. Some CSF was found in lumbar epidural space (L3-4) during aempiric lumbar epidural blood patch (LEBP) treatment 5 days later. The patient was pain relief immediately. We discuss the pathophysiology, pro-posed etiologies and treatments, and safety of LEBP anesthesia in spontaneous in-tracranial hypotension, and a rare case is found CSF far away to the target CSF leakage site.</p> <p> </p>

<p>蜘蛛膜囊腫是先天性且通常無症狀的顱內病灶，自行消失的案例非常罕見，已知有此病灶的病人較一般人於輕微頭部創傷後引發後續的慢性硬腦膜下血腫，若造成腦部壓迫之症狀，臨床上通常會進行顱骨鑽孔引流手術，只引流血水並不會去特別處理囊腫，但在極少數情況下，囊腫會在術後追蹤時被發現慢慢消失。我們報告一例蜘蛛膜囊腫在接受硬性硬腦膜下出血手術後消退的案例，探討其可能的病生理機轉和相關文獻回顧。</p> <p> </p><p>Arachnoid cyst (AC) is usually asymptomatic, incidentally-found, and a well-known risk factor of developing chronic subdural hematoma (CSDH) after minor head injury in young patients. Spontaneous remission or rupture of arachnoid cyst is very rare. When chronic subdural hematoma occurs, burr hole drainage is indicated if mass effect presenting. Only the hematoma is drained, where the cyst is left untouched. Although the chance of an arachnoid cyst to disappear is low, here we presents a case where the AC disappears after burr hole operation. We subsequently discuss the possible pathophysiological mechanisms and the relevant literatures.</p> <p> </p>