原发性醛固酮增多症的临床实践与分析

探讨原发性醛固酮增多症(原醛)临床特点及诊治方面的经验,以早期诊断、根治,改善预后。对确诊的原醛53例临床资料(临床特征、实验室检查、影像学检查、病理类型、治疗情况)进行回顾性研究。男女比为1：1.65,30～49岁年龄段最多。50.9%高血压首发,15.1%低钾血症首发,并发高心痛9.4%,尿毒症1.9%,脑卒中13.2%。肾素-血管紧张素-醛固酮(RAA)系统激素检查,血浆醛固酮/血浆肾素活性比值(ARR)＞200者80.7%,ARR＞400者占半数,血浆醛固酮(PAC)＞140pg/ml者占84.6%。CT及MRI阳性率高。术后病理肾上腺皮质腺瘤占85%,结节性增生占15%(其中原发性肾上腺增生占12.5%)。手术后血压及血钾均较前改善,非手术者口服安体舒通有效。原醛是可治性内分泌性高血压之一,建议高血压和/或低血钾者应常规检查RAA系统激素,并争取行影像学检查,以使原醛得到早期诊治,改善预后。     

Cyborgs, uploading and immortality — Some serious concerns

Transhumanism and Extropianism are two recent ‘movements’ which aspire to transcend the perceived limitations of human biological evolution. This paper takes a critical look at two of the most controversial aspects of Extropianism—Uploading and Immortality. Uploading is the process by which a human will be able to transfer the entire contents of their brain to a more suitable supercomputational medium. When the newentity exist as software, immortality is virtually assured. This should be possible, it is claimed, within the next fifty years! From both a pragmatic and philosophical perspective, I argue that these claims are at best misguided and at worst absurd.     

Fernando Pessoa’s Art of Living: Ironic Multiples,Multiple Ironies

In The Art of Living, Alexander Nehamas argues that Michel de Montaigne, Friedrich Nietzsche, and Michel Foucault undertook a particularist art of living—a unique project of self‐construction. In so doing, argues Nehamas, they based their lives on the life of Socrates, that quintessentially ironic character. To this list of self‐fashioning philosophers, I add Fernando Pessoa, the twentieth‐century Portuguese writer. I argue that Pessoa, via the writings of his heteronyms, also took Socrates as the model for constructing a self. Moreover, Pessoa employed all three kinds of irony that Nehamas argues is present in Plato’s writing, and did so not just to investigate the nature of the self, but to question its very existence. This is Pessoa’s formulation of the problem of the self. But Pessoa also borrowed from Nietzsche’s views on multiplicity, redeploying them in order to fabricate multiple selves. Pessoa’s solution to the problem of the self thus consists in the heteronymic device, which acts as a deus ex machina, unifying the disparate fictional voices and establishing Pessoa as a new, authentic self. Accordingly, Pessoa borrows from both Platonism and anti‐Platonism, distinguishing himself from both, so as to contrive—and simultaneously exemplify—an original art of living.     

Social identity theory: A conceptual and empirical critique from the perspective of a behavioural interaction model

After a conceptual and methodological critique of Social Identity Theory (SIT), it is argued, in sharp contrast to SIT but consistent with a Behavioural Interaction Model (BIM), that the allocations in the standard Minimal Group Paradigm (MGP) —which provide the main evidence for SIT— can be best reinterpreted as instrumental, rational behaviour aimed at maximizing the economic self-interests of the subjects rather than efforts on their part to strive for a positive social identity as SIT has claimed. Explicit social categorization appears to be only one of the many unit-forming factors which may affect allocations within and between group boundaries in the MGP. Group polarization effects indicate that groups, guided by their perceived interdependence on the recipients of their allocations seem more rational and effective than their individual members prior to the group discussion in maximizing their economic outcomes. Finally, it is concluded that BIM provides probably a more parsimonious explanation of all the usualfindings obtained by the standard MGP than SIT.     

Does Maternal Prenatal Stress Adversely Affect the Child’s Learning and Memory at Age Six?

Prenatal maternal stress has been shown to affect postnatal development in animals and humans. In animals, the morphology and function of the offspring’s hippocampus is negatively affected by prenatal maternal stress. The present study prospectively investigated the influence of prenatal maternal stress on learning and memory of 112 children (50 boys, 62 girls, Age: M=6.7 years, SD=8.4 months), with the Test of Memory and Learning (TOMAL). Maternal stress levels were determined three times during pregnancy by self-report questionnaires. Furthermore, maternal saliva cortisol samples were used as a measure of hypothalamus-pituitary-adrenal axis functioning. Results of hierarchical multivariate regression analyses showed that maternal life events measured during the first part of pregnancy were negatively associated with the child’s attention/concentration index, while controlling for overall IQ, gender, and postnatal stress. No associations were found between prenatal maternal cortisol and the offspring’s learning and memory.     

People as intuitive prosecutors: The impact of social-control goals on attributions of responsibility

Three experiments explored determinants of punitive character attributions to norm violators. Experiment 1 showed that ideological conservatism and manipulated threat to society increased anger and attributional punitiveness when there was ambiguity about culpability. Experiment 2 showed that informing observers that norm violations were widespread and rarely punished increased attributional punitiveness by activating anger-charged retributive goals. Experiment 3 showed that liberals and conservatives alike felt justified in assigning greater blame to high-status perpetrators who commit acts of negligence with more severe consequences but that only conservatives felt justified in doing so for low-status perpetrators. Overall, the results reinforce the hypothesis that societal threat activates a prosecutorial mindset identifiable by a correlated cluster of attributions, emotions, punishment goals and punitiveness.     

Who are you and what do you want? Life aspirations,personality, and well-being

In two studies with undergraduate samples, we investigated the relations between life aspirations and personality and evaluated whether aspirations added to the prediction of psychological well-being and sexuality. Within the HEXACO framework, aspirations were highly related to Honesty–Humility. Within the Big Five framework, intrinsic aspirations were related to high Conscientiousness and Agreeableness, and extrinsic aspirations were most related to low Openness and Agreeableness. Aspirations did not add to the HEXACO’s prediction of well-being in study one, but in study two, aspirations added to the prediction of sexuality variables beyond the two personality frameworks. These results suggest that aspirations may account for beyond personality in explaining specific types of well-being.     

Medically Documented Suicide Ideation Among U.S. Army Soldiers

We used administrative data to examine predictors of medically documented suicide ideation (SI) among Regular Army soldiers from 2006 through 2009 (N = 10,466 ideators, 124,959 control person‐months). Enlisted ideators (97.8% of all cases) were more likely than controls to be female, younger, older when entering service, less educated, never or previously deployed, and have a recent mental health diagnosis. Officer ideators were more likely than controls to be female, younger, younger when entering service, never married, and have a recent mental health diagnosis. Risk among enlisted soldiers peaked in the second month of service and declined steadily, whereas risk among officers remained relatively stable over time. Risk of SI is highest among enlisted soldiers early in Army service, females, and those with a recent mental health diagnosis.     

An exploration of spiritual superiority: The paradox of self‐enhancement

Spiritual training is assumed to reduce self‐enhancement, but may have the paradoxical effect of boosting superiority feelings. It can thus operate like other self‐enhancement tools and contribute to a contingent self‐worth that depends on one's spiritual accomplishments. In three studies (N = 533, N = 2,223, N = 965), a brief measure of spiritual superiority showed good internal consistency and discriminant validity. As predicted, it was distinctly related to spiritual contingency of self‐worth, illustrating that the self‐enhancement function of spirituality is similar to other contingency domains. It was correlated with self‐esteem and, more strongly, with communal narcissism, corroborating the notion of spiritual narcissism. Spiritual Superiority scores were consistently higher among energetically trained participants than mindfulness trainees and were associated with supernatural overconfidence and self‐ascribed spiritual guidance. Our results illustrate that the self‐enhancement motive is powerful and deeply ingrained so that it can hijack methods intended to transcend the ego and, instead, adopt them to its own service.