靶向神经小胶质细胞的戒毒治疗策略

鸦片用于镇痛治疗有千余年历史, 其滥用导致药物成瘾, 带来严重的社会和医学问题。关于鸦片等精神活性物质的研究主要围绕 神经元,当前的戒毒药物作用于神经元的阿片受体或离子通道受体,然而其戒毒效果非常有限。神经元不是中枢神经系统中调节神经信号 转导的唯一组分,神经小胶质细胞占中枢神经系统的 10%~15%,然而其作用和功能在很长一段时间被忽视。鸦片、可卡因、冰毒及其他 精神活性物质激活 Toll 样受体 4 (TLR4),活化小胶质细胞,产生大量炎症因子,从而调节奖赏信号通路,增加神经元的兴奋性,导致药物 依赖和成瘾,因而 TLR4 是开发新型戒毒药物的靶点。综述药物成瘾的小胶质细胞分子机制以及靶向小胶质细胞的治疗药物成瘾的药物发现。     

Quelques considérations sur l'enseignement de la médecine physique et de la réhabilitation

Particularly since World War II physical medicine and rehabilitation have assumed a growing importance. The efforts of the Canadian Association of Physical Medicine and Rehabilitation, following a survey of Canadian universities, to increase the theoretical and practical teaching of physiatrics are emphasized. It is considered important that the teaching of physical medicine and rehabilitation should be carried out concurrently with other medical and surgical teaching programs. Paramedical and auxiliary rehabilitation personnel should participate in the teaching program. The number of hours devoted to physiatrics should be increased, and the medical student should be permitted to choose physical medicine and rehabilitation as a part of his internship program.     

"A disease of frozen feelings": ethically working on emotional worlds in a Russian Orthodox Church drug rehabilitation program

In a Russian Orthodox Church drug rehabilitation program in St. Petersburg, drug addiction was often described as a disease of frozen feelings. This image suggests that rehabilitation is a process of thawing emotional worlds and, thus, allows the emotions to flow once again. In this article I argue that "frozen feelings" is better understood as the unsocial emotional worlds many drug users experience, and that rehabilitation in this church-run program particularly focuses on the cultivation of an emotional world that supports sociality. This is done, I argue, by means of ethically training rehabilitants to learn how to control and manage their emotional worlds, and in so doing, rehabilitants become new moral persons better able to live in the social world.     

Rehabilitation of the Aged

The rehabilitation needs and goals of older people differ in many respects from those of the young. In younger individuals a crippling condition may affect an otherwise healthy body, while in an older person it may be superimposed on other pre-existing degenerative diseases. Thus, in older patients the restorative or rehabilitative phase rarely can be separated from the phase of definitive medical treatment.The primary goal of rehabilitation of younger individuals is usually vocational. In the older group this goal or objective is, by and large, secondary. This does not minimize, however, the value of medical and social services in the rehabilitation of older persons. The simple ability to care for his own personal needs can do much to help the elderly disabled patient regain his dignity and self-respect and remove his fears of becoming a burden on his family or society.     

The bacteriophage, its role in immunology: how Macfarlane Burnet's phage research shaped his scientific style

The Australian scientist Frank Macfarlane Burnet-winner of the Nobel Prize in 1960 for his contributions to the understanding of immunological tolerance-is perhaps best recognized as one of the formulators of the clonal selection theory of antibody production, widely regarded as the 'central dogma' of modern immunology. His work in studies in animal virology, particularly the influenza virus, and rickettsial diseases is also well known. Somewhat less known and publicized is Burnet's research on bacteriophages, which he conducted in the first decade of his research career, immediately after completing medical school. For his part, Burnet made valuable contributions to the understanding of the nature of bacteriophages, a matter of considerable debate at the time he began his work. Reciprocally, it was while working on the phages that Burnet developed the scientific styles, the habits of mind and laboratory techniques and practices that characterized him for the rest of his career. Using evidence from Burnet's published work, as well as personal papers from the period he worked on the phages, this paper demonstrates the direct impact that his experiments with phages had on the development of his characteristic scientific style and approaches, which manifested themselves in his later career and theories, and especially in his thinking regarding various immunological problems.     

Teaching bioethics as a new paradigm for health professionals

In The Clouds by Aristophanes, Strepsiades brings his son before Socrates so that he could learn Philosophy for he has heard that this science teaches how to overcome the most difficult causes with reasons. And Strepsiades wants his son to learn the art of failing to pay debts. Regarding medical education in our time, Edmund Pellegrino has noted that the educational philosophy of medical schools determines what a "good" physician is. Thus, teaching bioethics to future health professionals makes us face old problems now: What teaching method to choose among all the possible various ones? What should teaching aim at? Which will be our educational philosophy? Therefore I shall introduce here the epistemological basis of our Bioethics teaching program in Argentina and its implementing strategies in the undergraduate curriculum and the post-graduate level.     

Teaching of Rehabilitation Medicine

Physical medicine and rehabilitation embrace a wide spectrum of activities in both the medical and surgical fields. Possibly more than any other physician, the physiatrist must participate in teamwork with paramedical personnel.Departments of Physical Medicine and Rehabilitation must be established in all university faculties of medicine to provide training at both pre- and postgraduate levels.Medical students should receive at least 25 hours of lecture-demonstrations in appropriate centres. Composite case presentations to students, which would allow the physiatrist and the paramedical personnel each to discuss their role in diagnosis, prognosis and treatment, are advocated.Vocational considerations for the future physiatrist, including the duration of his training, the program of study and the type of examinations proposed, are discussed briefly.     

Labors of love: the transformation of care in the Non-Medical Attendant program at Walter Reed Army Medical Center

In this paper, we explore the Non-Medical Attendant program at Walter Reed Army Medical Center in Washington, DC, which subsidizes the presence of war-injured soldiers' family members as they live for months or even years at Walter Reed during treatment and rehabilitation. We elaborate the ambiguities of the program and draw on ethnographic research to demonstrate how the program's vagaries combine with the context of an overburdened military medical system and the more familiar strains of family caregiving to place family members in a gray zone of care where the line between labors of love and institutionally compensated work is blurred.     

Approche cognitivo-comportementale de l’addiction à la cocaïne

Cocaine addiction has medical, psychological, cognitive, social, and legal consequences. For a while confined to a targeted audience, epidemiological data show that cocaine addiction considerably “increases” in Europe and reaches all social categories, including socialized people. The cognitive-behavioral approach provides a conceptual frame allowing a better understanding of the mechanisms involved in at the beginning and all along the cocaine addiction. Consumption and addiction to cocaine are then considered learned behaviors. Cognitive-behavioral therapies applied to the treatment of cocaine addiction include different therapeutic techniques that modify maladjusted behaviors, thoughts, and feelings leading to consumption. On a pharmacologic point of view, there is no drug treatment for this disorder, even though promising tracks emerged, especially the N-acétylcystéine.     

The Educationally Handicapped Child—The Physician's Place in a Program to Overcome Learning Disability

Under California Assembly Bill 464, special classes may be provided by school districts for children designated as educationally handicapped. An educationally handicapped child is not mentally retarded or physically disabled. He may have neurological handicap or emotional disorder, but he must show impaired achievement in relation to his tested abilities.A physician may be asked to participate in the program, either as a specified member of the admissions committee of the school district or to provide a medical clearance for entrance of one of his own patients into the program.He does a thorough history and physical examination but adds special examination of attention, activity, coordination and attitudes.The educationally handicapped child is helped most by the physician who does not reject the idea of educational handicap even if the medical examination is negative; who treats his minor ills; who medicates, when it is indicated, for hyperactivity, distractibility or extreme anxiety; who cooperates with parents and school personnel.     

脑血管病的康复治疗疗效观察

目的：探讨早期康复治疗在脑血管病康复中的应用及疗效观察早期康复治疗对脑血管病患者功能重建是否有效,是否值得推广。方法：选取本院神经科2009年6月至2010年3月住院40例脑血管病患者,随机分为康复治疗组和对照组（每组20例）,康复治疗组在进行常规治疗的同时,进行早期康复训练,并且在康复治疗前后分别进行Barthel指数（ADL）评分,以量化分析治疗前后的效果。结果：经康复训练后,康复治疗组治疗前与治疗后比较,ADL评分有明显的增高,二者的差异具有显著性（P〈0．01）;康复治疗组与对照组在神经功能恢复方面,有明显的好转,二者的差异具有显著性（P〈0．01）。结论：脑血管病患者早期进行常规治疗,同时行康复训练治疗,有助于神经功能的恢复,提高自理能力及生活质量,此治疗方案对脑血管患者的康复有积极的作用,疗效满意,方法值得在康复相关科室长期应用推广。     

What Bateson had in Mind About ‘Mind’?

G. Bateson believed that the scientific school of the future would be ‘ecology of mind’. The first aim of this paper is to understand what he meant by ‘mind’, and the other is to understand how this concept emerged in his thought, i.e., how its meaning would become more flexible throughout his life and work. Furthermore, we will approach the epistemological implications of ecology of mind for scientific education in the West. Bateson’s concept of mind emerged when he became aware (in 1926) of his own way of thinking, i.e., of his immense abductive capacity. This led him to search for patterns of similarity and difference between organisms (like in homology). Later, he identified this thought process as being abstract and formal, relating not just facts but also ideas. Afterwards, Bateson developed criteria for us to consider a system as being mental, with special emphasis on living and cybernetic systems.     

Effects of Compound 511 on BDNF-TrkB Signaling in the Mice Ventral Tegmental Area in Morphine-Induced Conditioned Place Preference

Cellular and Molecular Neurobiology - Compound 511 (511) is specially developed for opioid addiction treatment based on the Ancient Chinese drug rehabilitation literature, and its composition has...     

Personality Type Influences Attentional Bias in Individuals with Chronic Back Pain

Attentional biases reflect an individual’s selective attention to salient stimuli within their environment, for example an experience of back pain. Eysenck suggests that different personality types show different attentional biases to threatening information. This study is the first to test Eysenck’s theory within a chronic back pain population by investigating the attentional biases of four different personality types using a back pain specific dot-probe paradigm. Participants were 70 volunteers (45 female) recruited from a back rehabilitation program at an NHS Trust. The four groups were selected on their trait anxiety and defensiveness scores: defensive high-anxious; high-anxious; repressor and non-extreme. Participants completed a dot probe task comprising 20 practice trials and 250 experimental trials. The experimental trials contained 100 threat-neutral pairs, 100 positive-neutral pairs and 50 neutral-neutral image pairings. The threat images were taken from the Photograph Series of Daily Activities (PHODA) and the neutral and positive images from the International Affective Picture System (IAPS) image bank. The results provided partial support for Eysenck’s theory; defensive high-anxious individuals showed an attentional bias for threatening information compared to high-anxious individuals who demonstrated no bias. Repressors showed an avoidant bias to threatening images and an attentional bias to positive stimuli relative to neutral images. The clear difference in responses demonstrated by high-anxious individuals who vary in defensiveness highlight the need for separate investigation of these heterogeneous groups and help to explain the cognitive processes of defensive high-anxious individuals within a pain population. The demonstration of an attentional bias in this group to threatening information could explain why defensive high-anxious individuals are more likely to re-present for treatment.     

The Short-Doyle Act; California community mental health services program: background and status after one year

The Short-Doyle Act seeks to encourage the treatment of a patient suffering from a psychiatric disorder in his home community, with the assistance of local medical resources. One corollary of this program is the closer working together of the psychiatrist and the rest of the medical profession.A second goal of the act is the application of the public health principles to mental illnesses and mental retardation. Educational and consultative services provide implementation of these principles.     

THE SHORT-DOYLE ACT—California Community Mental Health Services Program: Background and Status After One Year

The Short-Doyle Act seeks to encourage the treatment of a patient suffering from a psychiatric disorder in his home community, with the assistance of local medical resources. One corollary of this program is the closer working together of the psychiatrist and the rest of the medical profession.A second goal of the act is the application of the public health principles to mental illnesses and mental retardation. Educational and consultative services provide implementation of these principles.     

Carcinoma of the Larynx: Results of Therapy

Prognosis of laryngeal carcinoma varies considerably, depending on its site and stage of development. In the past, laryngectomy was considered the treatment of choice for all but very early lesions. Results of therapy and five-year survival rates were relatively good, but the patient deprived of his larynx frequently presented difficulties in rehabilitation.Recent advances in radiotherapy techniques have permitted treatment of a greater proportion of patients with laryngeal carcinoma by this means, with encouraging results. Results of a survey in the Toronto area suggest that radiotherapy should be used as primary treatment in early and intermediate stages of the disease; radical excision combined with radiotherapy is indicated for treatment failures among early cases and for those with far-advanced disease or carcinoma outside the larynx proper. With this program five-year survival rates are comparable to those achieved when laryngectomy is the primary treatment used, and two-thirds of those who survive maintain laryngeal function.     

The confederation worm token.

To an increasing degree the psychiatrist is oriented to the community and general hospital either as consultant, therapist, or collaborator in overall patient management. In these new roles, he becomes a more comprehensive physician and also conveys psychiatric insights to his colleagues.Psychological factors and the patient''s personality “style” influence the development and course of every disease, complicating diagnosis and effective treatment. It is a basic requirement that a good working alliance be established between patient and physician. This is assisted by comprehensive history taking, which clarifies the lifesetting in which the illness began, the patient''s personality and his habitual reactions of emotional regression under stress. It will also point up errors introduced by the patient, omissions, and distortions in offering the subjective data which the physician must evaluate.Seven major personality types and appropriate physician responses are outlined: the dependent demanding oral patient, the orderly controlled obsessive, the dramatic seductive hysteric, the long-suffering masochist, the querulous paranoid, the overbearing narcissist and the aloof withdrawn schizoid.The non-psychiatrist can resolve complex and puzzling medical problems if he has an increased awareness of how emotional forces complicate illness and if he can exploit comprehensive history taking to the full.     

Effective Therapeutic Relationships Using Psychodynamic Psychotherapy in the Face of Trauma

The case of Xiang as described by Jane Carroll is indeed disconcerting well beyond the immediately apparent factors contained within the article. While Xiang’s direct medical expenses are excessive and his inability to pay for those expenses and further support his noncustodial family seem to be the main issues up for debate, Xiang, however, is likely going to need much more psychosocial support if he is to regain his previous independent functionality or retain any aspect of a quality of life whilst continuing his indefinitely isolated treatment. In this response, I briefly outline the probable effects of Xiang’s current situation on his social identity and mental health as well as a potential way that we can minimize these adverse effects.     

Listen to one another and act in concert (the Renewal Project)

The organization of work on the project "Harm Reduction for Intravenous Drug Users in Kazan" is substantiated. Difficulties in the realization of such projects due to the lack of coordination between different services, also taking part in controlling the spread of drug addiction and ensuring the treatment of addicts, are emphasized. The coordination of actions of various state structures will make it possible to enhance the effectiveness of programs of harm reduction. The expediency of the development of the general state program of primary prophylaxis, realized by trained specialists with the use of effective technology, is discussed.