试论进化论思想对近代中西医论争的影响

进化论在近代中国得到广泛传播后,对东西方文化的评判产生重要影响,作为当时中西文化论争一部分的中西医论争自不可避免。进化论思想使中医得到“落后”的价值评价,在现实中给予了批判中医论者政治上的正当性,并成为他们废止中医的思想来源之一;同时,由于被评价为“落后、迷信、不科学”,中医表达自身的话语权也逐渐发生了转移,造成了中医的“失语”。     

中医药学应当融入现代医学

中医药目前生存状态堪忧。中医药由于缺乏吸纳一切科学成就、校正自身差错的结构体制,缺乏坚持实证主义科学精神的价值取向,缺乏将经验认识转变为科学认识的线路,因而使其远远落后于现代医学。中医药只有融入现代医学才有出路。     

RNA干扰现象研究获诺贝尔奖的启示

RNA干扰现象是目前生命科学领域的研究热点。由于RNA干扰具有十分重要的理论和应用价值,因此该现象在揭示后仅8年其研究者就获得了诺贝尔生理与医学奖。通过回顾RNA干扰现象的发现历程,可以为今后的科研探索过程提供许多有益的启示。     

Assessing the Ethics of Medical Research in Emergency Settings: How Do International Regulations Work in Practice?

Different ethical principles conflict in research conducted in emergency research. Clinical care and its development should be based on research. Patients in critical clinical condition are in the greatest need of better medicines. The critical condition of the patient and the absence of a patient representative at the critical time period make it difficult and sometimes impossible to request an informed consent before the beginning of the trial. In an emergency, care decisions must be made in a short period of time, and the more time is wasted, the more the risk of death or severe tissue damage and incapacity increases. Consent requests take time, and so the time period before treatment might put the patient’s life in jeopardy. Not requesting consent before a trial is also contradictory. A person should not be forced to participate in a trial against his or her will. Due to the dark history of medical research previously, international declarations and conventions have set up ethical principles for medical research. They emphasize the autonomy of the research participant—or his or her legal representative—to give a free and informed consent prior to the initiation of research. In the case of a critical emergency, the unconscious state of the patient, the emotional stress of family members or the lack of time to start life-sustaining measures may often restrict the possibilities of communicating with the patient or his/her representative. Therefore, written informed consent is difficult to achieve, and its voluntariness in emergency situations is, at best, open to question. The mortality of patients is high without clinical interventions in emergency research. Random selection of patients is difficult and requires extra work from personnel in the emergency rooms. Recruitment, information and asking for consent may also take time, postpone the initiation of treatment and increase the risk of death and irreversible tissue and organ damage, and therefore be risky for the patient. It is therefore essential that the health care professionals recruiting suitable research participants are well motivated and well trained. Medical research in an emergency setting should always be regarded as an exceptional situation requiring special provisions. Only such research should be done as cannot be done in other conditions. An independent body must approve the research protocol and the ways in which the consent of the participant or proxy are to be sought. In addition, the trial must be expected to result in direct and significant benefit for the research participants. If research without prior consent is not approved, the development of emergency care is threatened. On the other hand, if prior consent is not required, a person could be recruited into a clinical trial against his or her will. Doing good and avoiding harm, and respecting the autonomy of the patient are in conflict in the context of emergency medical research. To develop better medicines for patients experiencing acute medical emergencies, research into such conditions should be allowed. Research participants should have the possibility to participate or refuse to participate in research that may benefit them and other patients. The risk of irreversible damage occurring as the consequence of time delays for seeking consent is unacceptable. A prior wish about participation in clinical trials should be respected, if known. The conditions under which medical research in emergencies can be considered acceptable can be determined and agreed upon nationally and internationally. An earlier version of this paper was presented at The 7th International Conference on Bioethics on “The Ethics of Research in Emergency Medicine”, held on June 2, 2006, Warsaw, Poland.     

European starlings are capable of discriminating subtle size asymmetries in paired stimuli

Small deviations from bilateral symmetry (fluctuating asymmetries) are cues to fitness differences in some animals. Therefore, researchers have considered whether animals use these small asymmetries as visual cues to determine appropriate behavioral responses (e.g., mate preferences). However, there have been few systematic studies of animals' abilities to visually discriminate such minor asymmetries. If the asymmetries cannot be discriminated, fluctuating asymmetry can not be a visual cue. Here, we report an investigation of European starlings' (Sturnus vulgaris) abilities to discriminate small size asymmetries. We trained starlings, through operant conditioning in a free-flight aviary, to discriminate achromatic, symmetric paired stimuli from size-matched asymmetric stimuli. By starting the learning process with a large asymmetry and progressing through sequential trials of decreasing asymmetry, we elucidated a behavioral limit to asymmetry discrimination. We found that starlings are capable of discriminating a 10% size asymmetry. There was weaker evidence for discrimination of 5% asymmetry but no evidence for signal discrimination at 2.5% size asymmetry. This level of asymmetry discrimination suggests that many size asymmetry cues in nature can be discriminated by birds. At each level of asymmetry discrimination, we also tested whether starlings could generalize their learned symmetry preference to unreinforced novel images. Consistent with previous findings, we found that starlings could generalize their symmetry preferences.     

中医药临床实践的价值

把现代病因病理医学作为参照物,通过比较,指出中医的证是病人的全身综合反应状态,是病因病理医学之外的另外一个临床医学范畴。状态与病因病理是人类疾病的两个不同方面。从单纯状态病,西医难治和不治的疾病,常见病的治疗,中医药的近期疗效和远期疗效等方面阐述了中医药的临床价值。     

Extensions and Mechanisms of Mindfulness‐based Cognitive Therapy: A Review of the Evidence

Mindfulness‐based cognitive therapy (MBCT) was originally developed to prevent depressive relapse and recurrence and has also been widely extended to new patient populations and target problems over the last 14 years. We provide a comprehensive review of this literature, examining the strength of the evidence base for specific populations and target problems and identifying questions for future research to address. Specifically, we review studies addressing the use of MBCT for depressive disorders (prevention of depressive relapse and treatment of residual and current depressive symptoms), the use of MBCT in the treatment or management of other mental disorders (bipolar disorder, anxiety disorders, mixed anxiety and depression symptoms, disordered eating, personality disorders, and psychosis), and the use of MBCT in behavioural medicine contexts. Additionally, we discuss the extension of MBCT during specific developmental periods, like childhood, pregnancy and post‐partum, and adult caregiving, and, finally, we address the use of MBCT among clinical health‐care providers. In the second section, we review hypothesised mechanisms of change in MBCT and reflect on implications for theories of how MBCT works in the application to various patient populations and target problems. We also consider research addressing active ingredients and what is known about the “dosage” of meditation practice. We conclude with a summary of recommendations for future research.     

Effects of Adlerian Play Therapy on Reducing Students' Disruptive Behaviors

This randomized controlled study examined the effectiveness of Adlerian play therapy (AdPT) with 58 elementary school students (48% Latino, 33% European American, 19% African American) exhibiting disruptive classroom behaviors. Teachers and raters blinded to treatment group assignment reported that children in the experimental group demonstrated a statistically significant reduction in behavior problems and that AdPT demonstrated moderate to large treatment effects. Teachers also reported a statistically significant reduction in stress in their relationships with students receiving AdPT.     

A Protective Factors Model for Alcohol Abuse and Suicide Prevention Among Alaska Native Youth

This study provides an empirical test of a culturally grounded theoretical model for prevention of alcohol abuse and suicide risk with Alaska Native youth, using a promising set of culturally appropriate measures for the study of the process of change and outcome. This model is derived from qualitative work that generated an heuristic model of protective factors from alcohol (Allen et al. in J Prev Interv Commun 32:41–59, 2006; Mohatt et al. in Am J Commun Psychol 33:263–273, 2004a; Harm Reduct 1, 2004b). Participants included 413 rural Alaska Native youth ages 12–18 who assisted in testing a predictive model of Reasons for Life and Reflective Processes about alcohol abuse consequences as co-occurring outcomes. Specific individual, family, peer, and community level protective factor variables predicted these outcomes. Results suggest prominent roles for these predictor variables as intermediate prevention strategy target variables in a theoretical model for a multilevel intervention. The model guides understanding of underlying change processes in an intervention to increase the ultimate outcome variables of Reasons for Life and Reflective Processes regarding the consequences of alcohol abuse.     

医学伦理审查如何适应转化医学的要求

随着转化医学的兴起,医学伦理审查面临前所未有的机遇与挑战.如何使医学伦理审查工作更好地适应转化医学发展的需要,提高审查质量,成为亟需解决的问题.在分析当前我国医学伦理审查工作现状和主要问题的基础上,进一步探讨了可行的解决方法,如进一步明确和强化管理部门服务功能、保证伦理委员会成员多样性和重视伦理审查多视角、强化伦理委员会后续跟踪审查、规范伦理审查委员的培训与继续教育等,为我国医学伦理审查工作的规范化发展和医学伦理审查质量的进一步提高提供参考.