肥胖和/或NAFLD患者的药物性肝损伤

与药物有关的肝毒性是一个严重的健康问题,广泛影响着患者、医疗机构和政府监管机构.另外,由于久坐的生活方式和热量过度摄取,我们还面临着肥胖和非酒精性脂肪性肝病（NAFLD）的流行和困扰,因为肥胖和/或NAFLD提高各种疾病的风险,成为影响公众健康的又一个主要问题,这些患者平均使用药物的量远高于非肥胖患者.越来越多的证据表明,某些药物能够增加肥胖和NAFLD患者药物诱发肝损伤（DILI）的风险.因此,我们应该重视和防治肥胖和NAFLD患者DILI的发生.     

Sense of Coherence and Gender as a Predictor of the Effect of Laboratory Induced Stress on Cognitive Performance

ABSTRACT. The current experimental study examined sense of coherence (SOC) as a predictor of the effect of induced stress (time limit and posing a threat) on the level of overall cognitive performance (based on three subscales: mathematics, shapes, and analogies). Results indicated the following: (a) induced stress (experimental group, n = 80) scored lower on the overall cognitive score, compared to the no-stress (control group, n = 81); (b) subjects in the stress group with higher SOC performed better on the overall cognitive score, compared to subjects with lower SOC; however, in the no-stress group there was no significant effect of SOC on cognitive performance; (c) females performed lower on the overall cognitive performance, compared to males regardless of type of group; and (d) SOC predicted equally for males and females overall cognitive performance.     

Asynchrony in Attitudes Toward Abortion and Gay Rights: The Challenge to Values Alignment

Political commentators tend to assume that Americans who share a particular religious affiliation think similarly about values issues and that values questions are aligned. Although religious affiliation is a strong predictor of attitudes toward abortion and gay rights, there is differentiation within denominational subgroups with respect to both; for example, while majorities of mainline Protestants and Catholics favor gay marriage, many of their respective co‐religionists do not. Further, aggregate survey data shows asynchrony in within‐group attitudes on abortion and gay rights; for example, whereas Hispanic Catholics are more likely to support gay marriage than legal abortion, black Protestants are more likely to support legal abortion than gay marriage. Abortion and gay equality are discrete issues and give rise to divergent attitudes based on the lived reality of different ethnoreligious groups. These findings challenge the utility of the construct of the “values voter,” and underscore that abortion and gay rights should be recognized as separate public policy domains.     

药物成瘾者相关线索反应的自动化用药行为特征及其消退

采用ERP技术考察海洛因成瘾者相关线索下的用药行为的性质和神经机制, 在此基础上结合虚拟现实技术(VR)和途径偏向矫正训练(AAT), 探究基于“相关线索-习惯性用药”联结的自动化用药行为的动作消退、替代训练的有效性。研究发现, (1)相比对照线索, 成瘾者在相关线索下的反应时更长, N1波幅更小, N1潜伏期更短; 相比对照组被试, 成瘾者在相关线索下的行为任务的正确率更低, 反应时更长, N1波幅更小; N1波幅的组间组内差异和潜伏期的组内差异主要集中在中央区。(2)结合VR技术的途径偏向矫正训练后, 训练组被试的生理指标和途径偏向系数显著降低, 且显著低于对照组被试; 追踪测试中, 训练组被试的分数显著低于对照组。这表明相关线索下成瘾者的用药行为具有自动化、无意识的性质, 感觉运动区N1的异常活动是其神经机制之一。VR提取用药动作记忆-AAT消退替代训练, 可以有效削弱或消退成瘾者的成瘾动作倾向, 而且训练效果持续性较好, 可达到减少或停止现实情境中的用药和复吸行为的目的。     

围手术期应激性高血糖管理

由于手术应激原影响,外科大手术围术期发生应激性高血糖屡见不鲜。围手术期血糖监测与控制对临床治疗意义重大。本文概括了围手术期应激性高血糖的发病机制、主要危害,从辩证思维的角度,归纳出灵活掌握控制标准,注意“度”的原则、整体性原则及动态性原则,从而有效控制围手术期发生的应激性高血糖。     

MUST ETHICS BE THEOLOGICAL? A CRITIQUE OF THE NEW PRAGMATISTS

In the last decade there has been a pragmatic turn in the work of those doing Christian ethics, especially as represented by the work of Jeffrey Stout and Franklin Gamwell. The pragmatic turn represents a critique of the highly influential work of Stanley Hauerwas and Alasdair MacIntyre, which argues for a strongly intra-church ethics. The pragmatists are correct in arguing that Christian ethics must engage the public sphere. However, I argue that they are deeply mistaken in their claim that this engagement must rest on a weak or non-existent theology. I show that the claim that robust theology adds nothing to ethics, and that we can get along without it, is unsustainable.     

The Seminal Contribution of Rabbi Moshe Feinstein to the Development of Modern Jewish Medical Ethics

The purpose of this essay is to show how, on a wide variety of issues, Rabbi Moshe Feinstein broke new ground with the established Orthodox rabbinic consensus and blazed a new trail in Jewish medical ethics. Rabbi Feinstein took power away from the rabbis and let patients decide their treatment, he opened the door for a Jewish approach to palliative care, he supported the use of new technologies to aid in reproduction, he endorsed altruistic living organ donation and recognized brain death (thus laying the groundwork for Orthodox Jewish acceptance of heart transplantation), he downplayed the value of social worth in triage decisions, and was a fierce defender of the rights of the fetus. I develop broader theological principles from Rabbi Feinstein's ethical positions and compare them to those of his Jewish and Christian contemporaries.