基于"湿性愈合"理论的新型敷料在糖尿病足溃疡创面处理中的应用

目的:观察基于"湿性愈合"理论的新型敷料用于糖尿病足溃疡创面的处理的治疗效果。方法:首先评估糖尿病足溃疡创面,然后根据不同情况采用不同新型敷料,应用湿性伤口愈合理论对48例糖尿病足溃疡的患者进行临床研究,选取48例传统方法处理的同类患者作为对照。结果:结果显示湿性愈合组患者出院时的创面愈合率较对照组明显提高,治疗周期明显缩短(P<0.05),换药次数明显减少(P<0.05)。结论:基于"湿性愈合"理论的新型敷料在糖尿病足溃疡创面的处理中取得了良好效果,值得进一步研究与应用。     

Parent-offspring conflicts, "optimal bad motherhood" and the "mother knows best" principles in insect herbivores colonizing novel host plants

SPECIALIZATION OF INSECT HERBIVORES TO ONE OR A FEW HOST PLANTS STIMULATED THE DEVELOPMENT OF TWO HYPOTHESES ON HOW NATURAL SELECTION SHOULD SHAPE OVIPOSITION PREFERENCES: The "mother knows best" principle suggests that females prefer to oviposit on hosts that increase offspring survival. The "optimal bad motherhood" principle predicts that females prefer to oviposit on hosts that increase their own longevity. In insects colonizing novel host plants, current theory predicts that initial preferences of insect herbivores should be maladaptive, leading to ecological traps. Ecological trap theory does not take into account the fact that insect lineages frequently switch hosts at both ecological and evolutionary time scales. Therefore, the behavior of insect herbivores facing novel hosts is also shaped by natural selection. Using a study system in which four Cephaloleia beetles are currently expanding their diets from native to exotic plants in the order Zingiberales, we determined if initial oviposition preferences are conservative, maladaptive, or follow the patterns predicted by the "mother knows best" or the "optimal bad motherhood" principles. Interactions with novel hosts generated parent-offspring conflicts. Larval survival was higher on native hosts. However, adult generally lived longer on novel hosts. In Cephaloleia beetles, oviposition preferences are usually associated with hosts that increase larval survival, female fecundity, and population growth. In most cases, Cephaloleia oviposition preferences follow the expectations of the "mothers knows best" principle.     

"The Key to Human Psychology"

This article investigates the notebook kept by Lev Vygotsky during the first half of 1926. In addition to discussing the notebook's structure, content, and time frame, the article analyzes its significance within the context of the development of Vygotsky's ideas. Among the notebook's content discussed here are: supplementary material to The Psychology of Art; a preliminary outline for "The Historical Meaning of the Crisis in Psychology"; the first propositions of cultural-historical theory associated with the idea of sign mediation; an outline for the unwritten monograph "Zoon politikon"; as well as thoughts on a general psychological theory of consciousness that assigns a key role to speech and communication in the genesis of consciousness. Particular attention is paid to Vygotsky's remarks on the ontological status of mental reality and the problem of the psychophysical.     

论“风邪犯肺”的肺微生态失调与中医药干预

肺为"娇脏",易受风邪侵袭而出现咳嗽喘息等症状。研究发现,微生态的平衡对人体健康的保持意义重大。在本文中我们解释了中医病机"风邪犯肺",并从微生态失衡的角度来思考"风邪犯肺"的科学内涵,探讨风邪犯肺与微生态失衡的联系。认为中医药主要通过直接作用于微生物、改变机体内部环境以及肺—肠轴这三种途径来调整风邪犯肺导致的微生态失衡。旨在将现代研究理论与中医理论相结合,挖掘中医药在调整微生态失衡方面的可能作用机制和潜力,深入探讨中医认识疾病、治疗疾病的本质和优势,以期为微生态学的研究和中医药的现代化开拓思路。     

Epigenetic "bivalently marked" process of cancer stem cell-driven tumorigenesis

Silencing of tumor suppressor genes (TSGs), by DNA methylation, is well known in adult cancers. However, based on the "stem cell" theory of tumorigenesis, the early epigenetic events arising in malignant precursors remain unknown. A recent report demonstrates that, while pluripotent embryonic stem cells lack DNA methylation and possess a "bivalent" pattern of activating and repressive histone marks in numerous TSGs, analogous multipotent malignant cells derived from germ cell tumors (embryonic carcinoma cells) gain additional silencing modifications to those same genes. These results suggest a possible mechanism by which aberrant differentiation, mediated by histone and DNA methylation, instigates tumor progression.     

Evidence against the presence of "inhibitors" in coumarin treated patients.

Coumarin drugs or vitamin K absence cause a decrease of factor II, VII, IX and X activities and the appearance of pre-factors into the circulation. Such pre-factors have been postulated to inhibit thrombin conversion. The current of research on the alleged activity of such "inhibitors" is taken into consideration. Thrombotest discrepancy, mixing experiments etc.) speak against the inhibitor theory. So far the only sure demonstration of the presence of coumarin induced pre-factors has been obtained by immunological means. However, this does not say anything about their biological activity. These pre-factors could well be "inert" as far as clotting is concerned. Until new, unequivocal data on the subject will be available, any method or technique claiming to be able to detect or monitor the "inhibitory" effect should be accepted with extreme caution. Too many unjustified views have been put forward in recent years.     

The "Moi-peau"

To construct a coherent identity, humans must distinguish what belongs to the external, perceived world from what belongs to their own inner world and the inner world of other individuals. Based on the theory developed by S. Freud and on work by ethologists, a number of psychoanalysts (J. Bowlby, R.A. Spitz, D.W. Winnicott, etc.) have underlined the importance of early tactile exchanges with the mother if a child is to become an autonomous individual who feels secure within what he or she perceives to be sound and reliable mental and physical boundaries. More recently, other psychoanalysts (E. Bick, W.R. Bion, etc.) have studied the fantasized mental structures that form the limits between an individual's inner mental space and the external world (including other individuals). As part of this theoretical psychoanalytical movement, Didier Anzieu, a French psychoanalyst, started to develop the concept of the "Moi-peau" in 1974. The "Moi-peau" designates a fantasized reality that a child uses during its early development to represent itself as "me", based on its experience of the body surface. The child, enveloped in its mother's care, fantasizes of a skin shared with its mother: on one side the mother (the outer layer of the "Moi-peau"), and on the other side the child (the inner layer of the "Moi-peau"). These two layers must separate gradually if the child is to acquire its own me-skin. D. Anzieu's work allowed dermatologists and other specialists, such as pediatricians, to focus on the quality of early tactile exchanges between a mother and her child, including the child with a chronic skin disorder. It also helped dermatologists to recognize patients with "borderline" states, which are particularly frequent in dermatology (ereutophobia, dysmorphophobia, tattooing, self-mutilation, artefacta dermatitis). These borderline patients are adults who, as a result of their mental conflicts, adopt defense mechanisms derived from both neurotic and psychotic functioning. Their complaints reflect difficulties with the solidity of their mental and physical limits: their real skin is metaphorically linked to the fantasized mental structure that delimits the individual mental space. Among other clinical characteristics, they have a "pathology of action" and frequently attack their own skin, paradoxically, in order to test the solidity and reliability of their own limits. Finally, D. Anzieu's work encouraged dermatologists to use psychotherapeutic approaches in parallel to classical dermatologic approaches, when necessary, and helped them better understand how psychoanalysts work with patients who have not yet acquired their own "Moi-peau". As a result, D. Anzieu was among the first to reconcile dermatologists and psychoanalysts.     

Consciousness enigma: the "hard problem"--binding problem entanglement, "extra ingredient" and field principle

The "Hard problem" of consciousness relates to the perplexing emergence of consciousness as a result of the brain activity. The binding problem concerns separate processing of perceived data in functionally and topographically segregated cortical areas and functional integration of such locally disjoined operations into coherently perceived images and events. The existing field-grounded theories of consciousness fall into two groups: (i) those based on the physical (electromagnetic) field, and (ii) those grounded on autonomous fields irreducible to the established physical fundamentals. The critical analysis of the existing theories results in formulation of the extra ingredient and a novel irreducible field-based theory of consciousness.     

Medical concepts related to individual risk are better explained with "plausibility" rather than "probability"

Background

The concept of risk has pervaded medical literature in the last decades and has become a familiar topic, and the concept of probability, linked to binary logic approach, is commonly applied in epidemiology and clinical medicine. The application of probability theory to groups of individuals is quite straightforward but can pose communication challenges at individual level. Few articles by the way have tried to focus the concept of "risk" at the individual subject level rather than at population level.

Discussion

The author has reviewed the conceptual framework which has led to the use of probability theory in the medical field in a time when the principal causes of death were represented by acute disease often of infective origin. In the present scenario, in which chronic degenerative disease dominate and there are smooth transitions between health and disease the use of fuzzy logic rather than binary logic would be more appropriate. The use of fuzzy logic in which more than two possible truth-value assignments are allowed overcomes the trap of probability theory when dealing with uncertain outcomes, thereby making the meaning of a certain prognostic statement easier to understand by the patient.

Summary

At individual subject level the recourse to the term plausibility, related to fuzzy logic, would help the physician to communicate to the patient more efficiently in comparison with the term probability, related to binary logic. This would represent an evident advantage for the transfer of medical evidences to individual subjects.     

微生态学与中医“心与小肠相表里”新论

本文阐述了中医"心与小肠相表里"的理论内涵。中医"心与小肠相表里"与现代医学提出的"脑-肠轴"理论是相通的,具体可理解为中枢神经系统与肠道菌群的密切关系。脑与肠道菌群是相关的,二者在生理上相互配合、在病理上互相影响。同时探讨了微生态学与中医"心与小肠相表里"的相关性,阐述了脑对肠道菌群的调控和肠道菌群对中枢神经系统疾病的发生、发展的影响。依据中医"心与小肠相表里"理论和微生态学的临床应用,提出了用改善肠道菌群的微生态方法治疗和预防一些神经系统疾病的新理念。     

The philosophical "mind-body problem" and its relevance for the relationship between psychiatry and the neurosciences

Parallel to psychiatry, "philosophy of mind" investigates the relationship between mind (mental domain) and body/brain (physical domain). Unlike older forms of philosophy of mind, contemporary analytical philosophy is not exclusively based on introspection and conceptual analysis, but also draws upon the empirical methods and findings of the sciences. This article outlines the conceptual framework of the "mind-body problem" as formulated in contemporary analytical philosophy and argues that this philosophical debate has potentially far-reaching implications for psychiatry as a clinical-scientific discipline, especially for its own autonomy and its relationship to neurology/neuroscience. This point is illustrated by a conceptual analysis of the five principles formulated in Kandel's 1998 article "A New Intellectual Framework for Psychiatry." Kandel's position in the philosophical mind-body debate is ambiguous, ranging from reductive physicalism (psychophysical identity theory) to non-reductive physicalism (in which the mental "supervenes" on the physical) to epiphenomenalist dualism or even emergent dualism. We illustrate how these diverging interpretations result in radically different views on the identity of psychiatry and its relationship with the rapidly expanding domain of neurology/neuroscience.     

The monovalent cation "leak" transport in human erythrocytes: an electroneutral exchange process.

The mechanism of the "ground permeability" of the human erythrocyte membrane for K+ and Na+ was investigated with respect to a possible involvement of a previously unidentified specific transport pathway, because earlier studies showed that it cannot be explained on the basis of simple electrodiffusion. In particular, we analyzed and described the increase in the (ouabain+bumetanide+EGTA)-insensitive unidirectional K+ and Na+ influxes as well as effluxes (defined as "leak" fluxes) observed in erythrocytes suspended in low-ionic-strength media. Using a carrier-type model and taking into account the influence of the ionic strength on the outer surface potential according to the Gouy-Chapman theory (i.e., the ion concentration near the membrane surface), we are able to describe the altered "leak" fluxes as an electroneutral process. In addition, we can show indirectly that this electroneutral flux is due to an exchange of monovalent cations with protons. This pathway is different from the amiloride-sensitive Na+/H+ exchanger present in the human red blood cell membrane and can be characterized as a K+(Na+)/H+ exchanger.     

从"诸躁狂越，皆属于火"谈甲亢的中医药治疗

"诸躁狂越,皆属于火"是《黄帝内经》中病机十九条其中的一条,至今仍是分析疾病病机的重要依据。甲状腺功能亢进症(甲亢)是临床上常见的甲状腺疾病,其病机与脏腑之火密切相关,使用"诸躁狂越,皆属于火"的理论指导辩证论治甲亢在临床上广泛使用。脏腑气机不疏、情志不遂,内火遂生,可导致狂、躁等症状,火热日久可耗伤气阴,并可产生痰热、瘀血,但贯穿疾病始终的仍为火热,是疾病的起始因素,临床上从火论治甲亢,使用清热法、清热药治疗甲亢,在临床及动物实验方面均取得了明显的效果,再次证明了从"诸躁狂越,皆属于火"治疗甲亢的有效性。     

根据“肠-肾轴”理论治疗慢性肾脏病的研究进展

有研究报道在慢性肾脏病的发生发展过程中可发现一系列肠道变化,并有学者用"肠-肾轴"理论阐述肾脏病中肠道的变化以及疾病过程中肾脏与肠道之间的联系,提示调节肠道菌群或可成为治疗慢性肾脏病的新方法。本文根据"肠-肾轴"理论,综述了在慢性肾脏病发展过程中肠道出现的变化,如肠内代谢物异常、肠道损伤以及肠道菌群失调等。以慢性肾脏病发生发展过程中肠道的异常变化为治疗切入点,总结了以大黄为主的中药在调节肠道功能、修复肠道屏障、纠正肠道代谢物异常等方面具有的显著疗效,为治疗慢性肾脏病及减少并发症等提供新的治疗思路和新方法。     

Conception of P.V. Simonov about and "altruists" and "egoists" to 80th anniversary of P.V. Simonov (20.04.1926-06.06.2002)

Academician P.V. Simonov is known, first of all, as the founder of "Information theory of requirements and behaviour". He was the first, who declared that requirements are the main original source of behaviour's activity, evolution's regulator, the origin of creation and motive power of individual and collective actions of human beings and animals. In our paper we analyze some positions of Simonov's conception about "agoists" and "altruists", which has the grate practical value and are very actual today.     

Aging mechanism as the "down side" of adaptation: a network approach

Many diverse hypotheses on aging are in play. All from "aging genes" over decreasing telomere length to increased level of gene mutations has been suggested to determine an organism's lifespan, but no unifying theory exists. As part of a growing interest toward more integrative approaches in the field we propose a simplistic model based on the "use-it-or-lose-it" concept: we hypothesize that biological aging is a systemic property and the down side of adaptation in complex biological networks at various levels of organization: from brain over the immune system to specialized tissues or organs. The simple dynamical model undergoes three phases during its lifetime: (1) general plasticity (childhood), (2) optimization/adaptation to given conditions (youth and adolescence) and (3) steady state associated with high rigidity (aging). Furthermore, our model mimics recent data on the dynamics of the immune system during aging and, although simplistic, thus captures essential characteristics of the aging process. Finally, we discuss the abstract model in relation to current knowledge on aging and propose experimental setups for testing some of the theoretical predictions.     

Hans Driesch and the problems of "normal psychology". Rereading his Crisis in Psychology (1925)

In 1925, the German biologist and philosopher Hans Driesch published a booklet entitled The Crisis in Psychology. It was originally published in English and was based on lectures given at various universities in China, Japan and the USA. The "crisis" in psychology of that time, in Driesch's opinion, lies in the necessity to decide about "the road which psychology is to follow in the future". This necessity refers to five "critical points", namely (1) to develop the theory of psychic elements to a theory of meaning by phenomenological analysis, (2) the overcoming of association theory, (3) to acknowledge that the unconscious is a fact and a "normal" aspect of mental life, (4) to reject "psychomechanical parallelism" or any other epiphenomenalistic solution of the mind-body problem, and (5) the extension of psychical research to new facts as described by parapsychology, for instance. Driesch saw close parallels between the development of modern psychology and that of biology, namely in a theoretical shift from "sum-concepts" like association and mechanics, to "totality-concepts" like soul and entelechy. The German translation of 1926 was entitled Grundprobleme der Psychologie (Fundamental Problems of Psychology) while "the crisis in psychology" forms just the subtitle of this book. This underlines that Driesch's argumentation--in contrast to that of Buehler--dealt with ontological questions rather than with paradigms.     

Reticulocytopenia and "absence" of red cell autoantibodies in immune haemolytic anaemia.

A raised reticulocyte count is common in patients with immune or autoimmune haemolytic anaemia, and the result of the direct antiglobulin test (DAGT) is usually positive because of IgG or IgG and complement components on the red cells. We report on three patients who had low reticulocyte counts when they were most anaemic, and in whom no red cell autoantibodies could be detected by the DAGT. We postulate that reticulocytes may be selectively destroyed if antibodies are directed against antigenic sites on these young red cells, thus giving rise to a population of cells whose antigenic sites are poorly expressed. This theory might explain the low reticulocyte counts and the "absence" of antibodies (as tested by the DAGT) in such patients. Radioisotopic studies with 51Cr and 59Fe may provide useful information on the rate and sites of red cell destruction.