Diagnostic Accuracy of Blood-based Biomarkers for Pancreatic Cancer: A Systematic Review and Meta-analysis.

Unlabelled: Pancreatic ductal adenocarcinoma (PDAC) has a 5-year survival rate below 5%. Carbohydrate antigen 19-9 (CA19-9) is the most commonly used blood-based biomarker for PDAC in current clinical practice, despite having been shown repeatedly to be inaccurate and have poor diagnostic performance. This review aims to assess the reported diagnostic accuracy of all blood-based biomarkers investigated to date in PDAC, by directly comparing individual biomarkers and multi-biomarker panels, both containing CA19-9 and not (novel).

Flaubert's Madame Bovary: a study in envy and revenge.

Flaubert's Emma Bovary is one of the most convincingly realized characters in modern literature. Her husband, Charles, a rural doctor, loves her dearly, but he is dull, ineffectual, and boring. Emma seems to hate him with a fury that knows no bounds.

The concept of psychic reality--how useful?

The author argues that Freud coined the phrase 'psychic reality' to indicate how neurotic patients and others treat unconscious psychic concepts and fears as if they were real. They respond to the challenges of everyday life not in terms of objective reality, but rather in keeping with their inner 'psychic' reality. With the development of different schools of thought in psychoanalysis, opinions as to precisely what constitutes the contents and character of unconscious mental functioning differ enormously, to the extent that there is no general agreement as to the nature and quality of unconscious mental elements.

Stilted listening: psychoanalysis as discourse.

The search for repressed memories and a one-sided emphasis on the analysis of transference together may serve to overrride the essential task of psychoanalytic technique, which is to demonstrate to the patient how his or her mind works and how more adaptive compromise formations may be achieved. Psychoanalysis is, after all, a mode of therapy depending upon discourse, the exchange of information, and mutual influence through the process of conversation. By being sensitive to the manner in which meaning and affect in relationships are transmitted during conversation, the analyst may more easily apprehend the nature of the patient's conflicts, defenses, and transference.

Methodology and reconstruction.

The challenges presented in treating patients with so-called borderline and narcissistic personality disorders have revived interest in the subject of reconstruction, because many analysts believe that these difficulties originate in the events of the earliest preverbal phase of development. They feel that contributions from direct observation of neonates and knowledge gained from "infant psychiatry" may enable analysts to effect reconstructions that previously appeared to be only speculative. The methodological problems in applying this approach, however, may lead to foisting upon clinical observation preconceived paradigms of pathogenesis.

The psychoanalytic process.

Analysts differ in how they conceptualize the psychoanalytic process, according to their understanding of the psychoanalytic theory of mental functioning in general and the nature of pathogenesis in particular. Emphasizing that psychoanalysis is a psychology of mental conflict, the authors see the psychoanalytic process in terms of the dynamic interplay between the manifestations of the patient's unconscious and the analyst's interventions. What analysts communicate to analysands serves to destabilize the equilibrium of forces within the mind, leading to the analysands' growing understanding of the nature of their conflicts and how they deal with them.

The dynamics of interpretation.

The patient's productions are a dynamic record of the conflicts of the past as they are recapitulated and re-experienced in the present. Much can be learned by closely studying the immediate effect of the analyst's interventions. Interpretation, especially of transference phenomena, will upset the equilibrium which has been effected and will enable the patient to understand how unconscious fantasies from the past continue to influence his perception and reactions in the present.

The poet as prophet: a psychoanalytic perspective.

The poet spins a public fantasy, created from his own private daydreams and speaking to the unconscious fantasies of his audience. He presents a socially acceptable form of expression of forbidden wishes and conflicts. A process of mutual exculpation is set up between the poet and his audience.

Psychoanalysis and time.

Psychoanalysis is fundamentally related to time because it is an effort to understand how disturbances in the present are determined by events in the past. Technically, we know that the patient who is reporting immediate perceptions is not aware of the passage of time, but he becomes self-conscious as undesirable elements threaten to appear in his associations. Time is not sensed by direct awareness, nor is it an agent of action or events.

Some technical problems of countertransference.

There are several aspects of the psychoanalytic interaction that foster the emergence of countertransference. First is a persistent identification with the patient, based primarily on the sharing of unconscious fantasies. Then there is the evocative power the patient's material may have upon latent unresolved conflicts in the analyst.

Disturbances of the sense of time with special reference to the experience of timelessness.

Disturbances of the experience of time are examined, with emphasis on the effects of the vicissitudes of the sense of self, affect, unconscious fantasies, and ideas concerning death. The manifest experience is interpreted as a derivative of unconscious, conflict-laden fantasies. Disturbances of the experience of time may be regarded as specific types of affective states, pleasurable or unpleasurable, the quality of the experience being determined by the nature of the underlying unconscious ideational content.

Scientific cosmogony, mythology, and immortality.

Some current scientific theories of cosmogony demonstrate significant similarities to the cosmological theories of mythology and of certain religions. The notion that the universe originated in a specific cataclysmic explosion raises the mental construct of a center of the universe. This concept plays an important role in mythology and is related to the idea of the cyclical renewal of time.