The Widget Syndrome

There has been a recent tendency in Manpower to view human services in mechanistic terms. This tends to cause an emphasis on large numbers of transactions as a guide to effectiveness. An alternative method of evaluating manpower services is offered.     

论"证"的性质、结构及证研究

证是中医理论中的一个十分重要的概念。在中医现代研究中 ,证的研究乃是最为重要的课题之一。不少学者认为 ,中医的现代化可能会在证实质的研究中得到实现。然而 ,证是什么 ?近年来人们对此问题做过不少讨论 ,见仁见智 ,或说证是证据 ,或说证是症候群 ,或说证是证型 ,或说证是疾病在阶段上的病机 ,或说证是疾病时机体在整体层次上的反应状态 ,或说证是疾病阶段病变在人们认识上的反映。在证实质研究已经经历了相当长时间后的今天 ,我们对证为何物还没一个统一的认识 ,这种状况值得深思。笔者在此就证的性质、证的结构以及证研究问题 ,谈谈自…     

The Gnostic Syndrome: Anorexia nervosa

‘The Gnostic Syndrome’ discusses anorexia nervosa in terms of its poetics and in the context of a developmental object-relations theory. One case is used to illustrate the problems of therapy and the antecedents of the anorexia in childhood and adolescence. The paper forms an investigation into pre-moral states and the interaction of anorexia with character structure.     

Bartter综合征的研究进展

Bartter综合征（BS）是一种内分泌与肾脏功能紊乱的遗传代谢性疾病,分子遗传学表明为离子通道基因突变所致,各年龄段均可发病,主要见于儿童时期,临床罕见。因为许多临床医师对本痛缺乏认识而易延误诊治。若能及时治疗,可较好地控制病情,改善患儿生活质量,减少后遗症的发生率和病死率。近年来,BS的发病率有逐渐上升趋势。因此,本文对BS的发病机制、临床表现、诊断与治疗的研究现状做一总结,旨在提高临床医师对本病的认识,争取做到早诊断早治疗,改善患儿预后。     

The Evolution and Treatment of Korsakoff's Syndrome

Wernicke's Encephalopathy is an acute neuro-psychiatric condition caused by an insufficient supply of thiamine (Vitamin B1) to the brain. If undiagnosed or inadequately treated, it is likely to proceed to Korsakoff's Syndrome. Wernicke's Encephalopathy can result from dietary deficiency alone and this form is usually successfully treated, with little chance of Korsakoff's Syndrome supervening. On the other hand, thiamine deficiency associated with alcohol misuse/dependence may require up to 1 gram of thiamine IV in the first 24 hours to be treated successfully. The reasons for this difference in treatment will be discussed. Thiamine diphosphate acts as a co-factor for a number of thiamine-dependent enzymes. Thiamine deficiency leads to a reduction in the activity of these enzymes, and this leads to alterations in mitochondrial activity, impairment of oxidative metabolism, decreased energy status and eventually selective neuronal death. The damage caused by the combination of thiamine deficiency and alcohol metabolism probably interferes with adequate thiamine transport at a number of sites in the body, including the blood-brain barrier, as well as causing damage to the apoenzymes which then require higher concentrations of thiamine to work normally. The accumulated damage is likely to render the use of oral thiamine therapeutically inadequate since the body is unable to produce high enough concentrations of thiamine in the blood to traverse the blood-brain barrier. Some individuals are probably genetically predisposed to develop Wernicke's. Long before individuals with alcohol misuse or dependence develop Wernicke's Encephalopathy the neurons and other cells of the body are functioning sub-optimally because of the inadequate supply of thiamine and the neurotoxic effect of alcohol. This relative deficiency initiates a series of pathological changes which accumulate and further interfere with the supply of thiamine and its utilisation at a time when the requirements are increased. The best treatment for Korsakoff's Syndrome is timely recognition of Wernicke's Encephalopathy and appropriate intervention and prevention.     

NCCN成人临床癌痛指南中心理问题、精神症状和精神用药的解读

疼痛的体验是主观的,疼痛与痛苦相伴而行。NCCN成人癌痛指南对癌痛的评估和治疗中涉及大量的心理问题与干预、精神症状评估和精神药物应用,本文力求对这方面进行解读,以揭示癌痛治疗中对人的尊重和对“总疼痛”的理解。     

代谢综合征与遗传

代谢综合征是指一组与糖尿病和心血管疾病发病风险增加相关联的症候群。不同学术组织对于代谢综合征的定义有所不同,但其基本要素主要包括胰岛素抵抗、异常葡萄糖代谢、高血压、致动脉粥样硬化的脂代谢紊乱、肥胖等。家系研究以及双生子研究显示遗传因素在代谢综合征中各个组分中都扮演着不同程度的重要角色。在代谢综合征患者中有一部分是由于单基因突变所导致的特殊类型的代谢综合征,这些患者的共同特点包括脂质萎缩以及严重的胰岛素抵抗等。导致这些特殊类型代谢综合征发生的单基因突变包括AKT2R274H,PPARs家族的PPARγF388L基因突变、PPARγArg397Cys基因突变、PPARγP467L与PPARγV290M基因突变,核纤层蛋白A／C基因的lamin A G602S突变、LMNA R482W突变等。此外,由于对代谢综合征的定义和理解不同,在代谢综合征的遗传学研究中造成了很大困难。     

多囊卵巢综合征与代谢综合征

高胰岛素血症和高雄激素血症是多囊卵巢综合征(PCOS)的两大基本特征,共同参与了PCOS的发生与发展,胰岛素抵抗是连接PCOS和MS的纽带.本文阐述了PCOS和MS的相互重叠、PCOS产生胰岛素抵抗的机制、胰岛素抵抗对PCOS的作用.指出早期识别PCOS,有利于及时纠正、阻断其内分泌紊乱,防止MS的发生.提高胰岛素敏感性的治疗措施包括生活方式调整和药物治疗,生活方式的调整主要是控制饮食、运动和改变生活方式,包括戒烟、戒酒;药物治疗主要是使用二甲双胍和噻唑烷二酮类药物,其他药物如右旋肌醇、N-乙酰半胱氨酸、生长抑素类似物、α糖苷酶抑制剂、内腓肽受体抑制剂也具有增强胰岛素敏感性的作用.     

多囊卵巢综合征与代谢综合征

高胰岛素血症和高雄激素血症是多囊卵巢综合征（PCOS）的两大基本特征,共同参与了PCOS的发生与发展,胰岛素抵抗是连接PCOS和MS的纽带。本文阐述了PCOS和MS的相互重叠、PCOS产生胰岛素抵抗的机制、胰岛素抵抗对PCOS的作用。指出早期识别PCOS,有利于及时纠正、阻断其内分泌紊乱,防止MS的发生。提高胰岛素敏感性的治疗措施包括生活方式调整和药物治疗,生活方式的调整主要是控制饮食、运动和改变生活方式,包括戒烟、戒酒;药物治疗主要是使用二甲双胍和噻唑烷二酮类药物,其他药物如右旋肌醇、N-乙酰半胱氨酸、生长抑素类似物、α糖苷酶抑制剂、内腓肽受体抑制剂也具有增强胰岛素敏感性的作用。     

The False-Hope Syndrome: Unfulfilled Expectations of Self-Change

Why do people persist in attempting to change themselves, despite repeated failure? Self-change is often perceived as unrealistically easy to achieve, in an unreasonably short period of time. Moreover, embarking on self-change attempts induces feelings of control and optimism that supersede the lessons of prior experience. Finally, people tend to expect an unrealistically high payoff from successful self-change. Some sorts of self-change are feasible, but we must learn to distinguish between realistic and unrealistic self-change goals, between confidence and overconfidence. Overconfidence breeds false hope, which engenders inflated expectations of success and eventually the misery of defeat.     

Being Approximate: The Ganser Syndrome and Beyond

The Ganser syndrome, or “talking past the point,” (originally identifying symptoms of inmates on remand when questioned by prison doctors), is explored as a form of insubordination against the stigmatizing effects of overdetermined diagnostic categories. The strategies of approximation that characterize the syndrome are likened to comedy routines/vaudeville styles and to their employment of punning, clownery, and ambiguity to challenge the more privileged cultural values of clarity, literalness, and precision. The seeming craftiness of Ganserians is related to the aesthetic tactics of the trickster figure and to the physical buffoonery of hysterics. Stylistically, this paper synthesizes the languages of critical theory, Gracie Allen routines, personal narrative, jokes, and poetic reflections on the notion of being approximate.     

The Lost Parents' Perspective on Parental Alienation Syndrome

This study examined five alienated fathers' and one alienated mother's perception of parental alienation syndrome (PAS). The data were collected via semistructured, open-ended interview questionnaires to determine if there were shared characteristics among alienated families, common issues in the marital conflicts that contributed to the marriage dissolution, the nature of the participants reports of alienation, similarities in the experience of alienation, and what things a lost parent might do differently. The findings are discussed along with limitations of the study.     

Chronic Fatigue Syndrome: The Need for Subtypes

Chronic fatigue syndrome (CFS) is an important condition confronting patients, clinicians, and researchers. This article provides information concerning the need for appropriate diagnosis of CFS subtypes. We first review findings suggesting that CFS is best conceptualized as a separate diagnostic entity rather than as part of a unitary model of functional somatic distress. Next, research involving the case definitions of CFS is reviewed. Findings suggest that whether a broad or more conservative case definition is employed, and whether clinic or community samples are recruited, these decisions will have a major influence in the types of patients selected. Review of further findings suggests that subtyping individuals with CFS on sociodemographic, functional disability, viral, immune, neuroendocrine, neurology, autonomic, and genetic biomarkers can provide clarification for researchers and clinicians who encounter CFS characteristically confusing heterogeneous symptom profiles. Treatment studies that incorporate subtypes might be particularly helpful in better understanding the pathophysiology of CFS. This review suggests that there is a need for greater diagnostic clarity, and this might be accomplished by subgroups that integrate multiple variables including those in cognitive, emotional, and biological domains.