发挥中药在肿瘤症状处理中的作用——兼谈结直肠癌的中医“病证结合辨治”

改善症状是中医治疗晚期恶性肿瘤的优势,但简单的对症治疗显然体现不了中医的特色;辨证论治虽然是中医治疗的核心,但在对癌病本质的把握上缺乏理论和实践的支撑;单一的辨病论治强调以毒攻毒,却不能改善症状及预后。本文作者以对结直肠癌的治疗为例,认为抓主症,将病证与辨治相结合,有望较好地解决“症”“证”“病”三者的关系,在改善症状...     

The effects of angle-arm length on judgments of angle magnitude and orientation contrast

Acute angles frequently are overestimated, an effect that has been attributed to lateral inhibitory mechanisms. It can be derived from such theories that lengthening the arms of an angle should either reduce or not affect its judged subtense. However, in Experiments 1 and 2, it was found that angles with longer arms were judged larger. In Experiment 3, direct measures of anglearm orientation indicated that orientation contrast does not increase with angle-arm length, that it decreases with distance from the angle vertex, and that these effects are not averaged along the entire length of the arm. It follows that inhibitory mechanisms alone cannot explain why longer armed angles appear larger or why angle arms appear straight rather than bowed. It is suggested that a distinction is required between the orientation and the angular domains and that the latter judgments depend, at least partially, on the space or area within an angle. The fact that angles appear unbowed may reflect the fact that perceived orientation differences occur along an angle’s arm only when matches are made to small segments of the arm.     

Apparent size as a function of vertical gaze direction: new tests of an old hypothesis

The hypothesis was tested that the decline of apparent size with elevated gaze results from a latent tendency of the eyes to diverge and thus increased vergence effort. Through the use of a method of category estimation, the decline of apparent size on elevation or depression of gaze was found not to be different between subjects with larger or smaller changes of dark vergence and thus vergence effort. In a 2nd experiment, vergence effort was varied by varying gaze elevation and the angle of convergence. With vergence effort constant, apparent size was dependent on the angle of convergence rather than being constant. It is concluded that apparent size does not depend on vergence effort and that the effect of gaze elevation on apparent size cannot be attributed to its concomitant effect on dark vergence.     

Form perception at birth: Cohen and Younger (1984) revisited

Cohen (1988; Cohen & Younger, 1984) has suggested that there is a shift in the perception of form sometime after 6 weeks of age. Prior to this age infants can remember the specific orientations of line segments, but cannot process and remember the angular relations that line segments can make. Experiment 1 used simple line stimuli with newborn infants to test this suggestion. Following habituation to a simple two-line angle the newborns dishabituated to a change of orientation but not to a change in angle, confirming Cohen and Younger's suggestion that orientation is a powerful cue in early shape perception. In Experiments 2 and 3 newborns were familiarized either to an acute or to an obtuse angle that changed its orientation over trials. On subsequent test trials the babies gave strong novelty preferences to a different angle. Alternative interpretations of the results are discussed, but these experimental findings are compatible with the suggestion that newborns can quickly learn to process angular relations, and that rudimentary form perception may not be dependent on a lengthy period of learning and/or maturation for its development.     

Geometrical illusions in solid objects under ordinary viewing conditions

The Müller-Lyer and Ponzo illusions were obtained under free binocular viewing of three-dimensional objects, and the function relating magnitude of illusion to fin angle, characteristic of converging-line versions of the Müller-Lyer pattern, was closely paralleled by volumetric (three-cone), line-free objects (but not with an erect, planar “walk-through” construction and moving observers). Illusions cannot be dismissed as artifacts of static, impoverished viewing, therefore, but must be explained within any general theory of perception. Perspective explanations have difficulties with such three-dimensional manifestations, and seem completely inapplicable to our further finding that approximately the same amount of illusion occurred in objects and patterns with no oblique lines or edges. Confusion or averaging theories, not themselves tested here, remain unthreatened by these data.     

Geometrical illusions in solid objects under ordinary viewing conditions.

The Müller-Lyer and Ponzo illusions were obtained under free binocular viewing of three-dimensional objects, and the function relating magnitude of illusion to fin angle, characteristic of converging-line versions of the Müller-Lyer pattern, was closely paralleled by volumetric (three-cone), line-free objects (but not with an erect, planar "walk-through" construction and moving observers). Illusions cannot be dismissed as artifacts of static, impoverished viewing, therefore, but must be explained within any general theory of perception. Perspective explanations have difficulties with such three-dimensional manifestations, and seem completely inapplicable to our further finding that approximately the same amount of illusion occurred in objects and patterns with no oblique lines or edges. Confusion or averaging theories, not themselves tested here, remain unthreatened by these data.     

The Rorschach and traumatic loss: can the presence of traumatic loss be detected from the Rorschach?

Loss, an expected part of everyone's life, can be a catalyst promoting significant growth. But all losses are not the same or affect everyone in like manner. Some losses are of such magnitude and intensity that individuals cannot cope, and, therefore, they keep reliving them (posttraumatic stress syndrome) as if through repeated attempts (Freud, 1923-1922/1961) they might master what had been initially so overwhelming. This study, using an inpatient hospital sample, examines the Rorschach protocols of individuals who had experienced traumatic loss in childhood or early adolescence and compares them with a control group of individuals who appear to have no such history. Our hypotheses that victims of early trauma have a distinguishing Rorschach profile was validated in the exploratory study. Further study is needed to clarify whether factors other than traumatic loss may be contributing to this profile.     

The Rorschach and Traumatic Loss: Can the Presence of Traumatic Loss Be Detected From the Rorschach?

Loss, an expected part of everyone's life, can be a catalyst promoting significant growth. But all losses are not the same or affect everyone in like manner. Some losses are of such magnitude and intensity that individuals cannot cope, and, therefore, they keep reliving them (posttraumatic stress syndrome) as if through repeated attempts (Freud, 1923-1922/1961) they might master what had been initially so overwhelming. This study, using an inpatient hospital sample, examines the Rorschach protocols of individuals who had experienced traumatic loss in childhood or early adolescence and compares them with a control group of individuals who appear to have no such history. Our hypotheses that victims of early trauma have a distinguishing Rorschach profile was validated in the exploratory study. Further study is needed to clarify whether factors other than traumatic loss may be contributing to this profile.     

Vascular (arteriosclerotic) and Alzheimer's dementia in neurologic-psychiatric patient sample

Despite the obviously more important degeneratively conditioned dementias, particularly of the Alzheimer-type, dementias due to vascular disorders are still of considerable relevance. They are even predominant among autopsies in a neurological-psychiatrical hospital, showing, however, a decreasing tendency. Though this cannot reflect the real incidence of a disease, because many cases of dementia die in geriatric or nursing homes, mostly not autopsied, exact epidemiological examinations of autopsy-cases seem to be advisable, limited temporarily and locally for economic reasons. Topographical specialities and modern methods of investigation in living persons increasingly enable a differentiation of vascular and degenerative dementias and thus frequently an effective treatment.     

Gerstmann syndrome without aphasia: a longitudinal study

A case of "pure" and complete Gerstmann syndrome resulting from a focal vascular lesion in the posterior parietal area of the left hemisphere and not associated with aphasic disorder or general mental impairment is described. The initial symptom presentation of this patient supported the concept of the autonomous nature of the Gerstmann aggregate but longitudinal findings suggested that these symptoms did not in fact represent a coherent syndrome.     

God’s moral goodness and supererogation

What do we understand by God’s goodness? William Alston claims that by answering this question convincingly, divine command theory can be strengthened against some major objections. He rejects the idea that God’s goodness lies in the area of moral obligations. Instead, he proposes that God’s goodness is best described by the phenomenon of supererogation. Joseph Lombardi, in response, agrees with Alston that God does not have moral obligations but says that having rejected moral obligation as the content of divine goodness, Alston cannot help himself to supererogation as a solution to the content of God’s moral goodness. If God has no moral obligations and does not perform supererogatory acts, Lombardi suggests that God’s goodness may be explicated through concentrating on God’s benevolence, but he does not develop this theme. I propose that Alston’s idea of divine supererogation without obligation is sustainable, but that a reshaping of the concept of supererogation is required; one in which love, rather than benevolence, plays an important part. If the love associated with supererogation is characterised in a certain way, I suggest this adds a new angle to the understanding of divine goodness.     

Aortic isthmus stenosis from a neurological viewpoint

The etiology, pathogenesis, and clinical treatment of stenoses of the isthmus aortae are outlined. Following this, the particular case of a 41-year-old patient with typical stenosis of the isthmus of the aorta is reported. The course of disease required the need for a surgical operation, which had not initially been taken into consideration, to be reexamined. The patient, after performance on him of vascular restoration, is now on a part-time job. Using age as the sole circumstance indicating the inadvisability of performing a surgical operation in the case of stenosis of the isthmus aortae cannot any longer be considered justifiable.     

Psychotherapie chronischer Erschöpfungszustände

Chronic fatigue is common. Since fatigue has little specificity, it can be the consequence of many different somatic diseases and psychiatric disorders. Therapy needs to be individually tailored with regard to the underlying or assumed causes. When objective and established causes cannot be identified or cannot adequately explain the symptoms experienced, the diagnosis of chronic fatigue syndrome (CFS) is possible. But what is CFS? Is it a valid diagnosis? How can the chronic fatigue patient be treated? Based on an integrative understanding, a psychobiological etiological and psychotherapeutical model of chronic fatigue will be developed and described.     

用现代医学理论阐明阴虚证的本质和发病学机理

用现代医学理论阐明阴虚证的本质具有重大科学意义,但我国半个世纪的研究未能取得根本突破。用现代医学理论阐述了阴虚证的本质和发病学机理,即阴虚证的本质是细胞因子,其发病学机理是由于机体在各种致病因素的作用下,白细胞介素1和肿瘤坏死因子等炎性细胞因子基因的表达水平增强、生物学活性相对升高,引起细胞因子网络紊乱的结果。     

Pheochromocytoma as a catecholamine producing tumor: implications for clinical practice

Pheochromocytomas are catecholamine-producing tumors presenting with various clinical symptoms, but mostly with headache, sweating, palpitations and hypertension. If not properly diagnosed, secretion of catecholamines may lead to fatal cardiovascular consequences. Biochemical testing for pheochromocytoma should be performed not only in symptomatic subjects or in subjects with adrenal incidentaloma but also in subjects with a genetic predisposition for pheochromocytoma (multiple endocrine neoplasia type 2, Von Hippel-Lindau (VHL) syndrome, neurofibromatosis type 1 (NF 1)and mutations of succinate dehydrogenase (SDH) genes). Once a pheochromocytoma is proven, computed tomography (CT), magnetic resonance imaging (MRI) and functional imaging with [(123)I]-MIBG may be used for tumor localization. Adequate medical pre-treatment is essential for successful operation which is performed in most cases by laparoscopy. After tumor removal, further follow-up is necessary due to possible recurrence. Although prognosis after tumor resection is excellent, a significant proportion of pheochromocytomas recur, some as metastases. Thus, appropriate follow-up is mandatory.     

Does delayed onset muscle soreness affect the biomechanical variables of the drop vertical jump that have been associated with increased ACL injury risk? A randomised control trial

IntroductionDelayed onset muscle soreness (DOMS) and Anterior Cruciate Ligament (ACL) injuries are both prevalent in sport. It is currently unknown whether DOMS increases ACL injury risk.AimThis study aimed to provide preliminary insight on whether DOMS affects ACL injury risk by investigating whether DOMS affects the biomechanical variables of the DVJ that have been identified as risk factors for future ACL injury.MethodsThis was a randomised control trial involving 32 active individuals aged 18–35 years, with no history of ACL injury. Participants underwent two sessions of force-plate testing and 3D motion analysis of the drop vertical jump (DVJ). The DVJ was chosen as it has been investigated prospectively for association with future ACL injury. Initial testing was followed by randomisation to DOMS or control group. The DOMS group underwent a DOMS-inducing exercise protocol, the control group did not. Both groups were re-tested 48 h after initial testing. Five variables of the DVJ that have been associated with future ACL injury were chosen for analysis - peak knee flexion angle, peak vertical ground reaction force, ground contact time, peak knee abduction angle & peak knee abduction moment. Between-group differences were compared using a two-way mixed analysis of variance; alpha level set to 0.05.ResultsDOMS was successfully induced in all participants of the DOMS group however no statistically significant group x time interactions were found for any of the five variables analysed.ConclusionsDOMS did not affect the biomechanical variables of the DVJ that have been associated with future ACL injury. By extension, this may suggest that DOMS might not affect ACL injury risk. However, it is also possible that certain attributes of the DVJ meant that any effect of DOMS was simply unable to be quantified, even if an effect existed. All considered, our position is that conclusion cannot be drawn from this study alone on whether DOMS affects ACL injury risk. Further research is required.     

Criticism of the Theory of Motivation

The theory of motivation is a theory which takes the executora＇s motivation as the basis of moral judgment. One presupposition of the theory is that motivation can be a common object of understanding. However, motivation exists only in the heart of the executor, and cannot be known exactly by others, so motivation cannot be perceived like a common object, and thus, logically, cannot be the basis of moral judgment. Even if the executor＇s motivation is accepted by others and turned into a common object, the motivation still cannot become the valid basis of a moral judgment. This is the dilemma of the theory of motivation. In practice, the dilemma appears as follows： if one insists on the theory of motivation, one can be led to the result that people do evil with good intentions. However, just because motivation cannot be the basis of moral judgment does not mean that motivation is of no significance. Good motivation is always better than evil motivation. Therefore, in moral education we should carry out motivation education and teach people to strive to have good motivations for their behavior. This is the value of motivation theory.     

老龄患者人工关节置换术时骨水泥反应综合征的危害及其应对策略

人工关节置换术在老龄化社会中的客观需求性愈来愈突出,而老龄患者在人工关节置换术时发生的骨水泥反应综合征是一个不容忽视的严峻问题。笔者指出了老龄患者人工关节置换术时骨水泥反应综合征的严重危害性,剖析了这种并发症的可能原因,并且对它的有效预防措施和急救处理策略进行了深刻的思考。