医学影像诊断报告的双重属性——现状与对策

医学影像诊断报告是重要的医疗文书,在临床诊治过程中发挥重要作用。影像报告具有客观性和主观性的双重属性。一方面,报告需要客观描述影像所见,真实地记录病变特点,而另一方面,报告中又包含根据图像做出的主观评价。如何努力化解两方面要求带来的冲突,是摆在影像医生面前需要解决的问题。     

定量组织速度成像评价酒精性心肌损害左室功能的价值

为了评估定量组织速度成像(QTVI)在评价大量饮酒后心肌损害左室功能改变方面的价值,我们对饮酒量符合酒精性心肌病诊断标准患者21例(B组,每日饮白酒≥150g或啤酒4瓶,每周6天~7天,10年以上),30例健康志愿者(A组,正常对照组)进行常规超声参数及QTVI参数测定,包括:二尖瓣环收缩期峰值速度(Vs)、舒张早期运动速度(Ve)、舒张晚期运动速度(Va)等。结果显示,B组常规各超声参数与A组比较差异有显著性统计学意义(P0.01)。QTVI参数与A组比较Va减低(P0.05),Vs、Ve、Ve/Va显著减低(P0.01)。提示QTVI技术能够有效地评估酒精性心肌损害病左室功能的改变。     

A neurodevelopmental perspective on male violence

Research is increasingly documenting a neurobiological basis to violence. This review takes a neurodevelopmental perspective on the very small group of males who grow up to become persistent violent offenders. After outlining six criteria for what constitutes a neurodevelopmental disorder, the extent to which chronic violence meets these definitional criteria is examined, covering the fields of genetics, structural and functional brain imaging, and neuropsychology. Early health risk factors for violence are then outlined, including birth complications, minor physical anomalies, prenatal smoking and alcohol exposure, poor nutrition, lead exposure, and traumatic brain injury. Persistent adult violence is argued to originate in aberrant temperamental behavior in early childhood, to have a stable developmental trajectory, and to be associated with impaired education, social, and occupational functioning. Taken together, it is argued that chronic adult violence meets criterion for being conceptualized as having neurodevelopmental origins and that an important, but not sole, source of neural maldevelopment lies in prenatal and early postnatal risk factors. This review concludes with a recognition of the sociopolitical context within which a neurodevelopmental perspective on chronic violence sits, together with directions for future research, including whether a neurodevelopmental hypothesis is best applied to reactive as opposed to proactive aggression.     

An acute application of transcranial random noise stimulation does not enhance motor skill acquisition or retention in a golf putting task

Transcranial random noise stimulation (tRNS) is a brain stimulation technique that has been shown to increase motor performance in simple motor tasks. The purpose was to determine the influence of tRNS on motor skill acquisition and retention in a complex golf putting task. Thirty-four young adults were randomly assigned to a tRNS group or a SHAM stimulation group. Each subject completed a practice session followed by a retention session. In the practice session, subjects performed golf putting trials in a baseline test block, four practice blocks, and a post test block. Twenty-four hours later subjects completed the retention test block. The golf putting task involved performing putts to a small target located 3 m away. tRNS or SHAM was applied during the practice blocks concurrently with the golf putting task. tRNS was applied over the first dorsal interosseus muscle representation area of the motor cortex for 20 min at a current strength of 2 mA. Endpoint error and endpoint variance were reduced across the both the practice blocks and the test blocks, but these reductions were not different between groups. These findings suggest that an acute application of tRNS failed to enhance skill acquisition or retention in a golf putting task.     

计算的脑机制研究进展

采用计算任务来探讨脑机制已成为国外研究大脑活动的重要领域。该文阐述了神经心理学和脑成像领域有关计算的脑机制研究。神经心理学及脑损伤的研究结果表明,大脑两侧顶下小叶和左前额叶与计算加工有关。ERP、PET和fMRI脑成像研究结果显示,数字命名与比较、心算、精算和估算等不同计算任务,其所激活的脑部位有所差异,但是大脑两侧顶下小叶和左前额叶可能是计算加工的主要脑部位。由于研究材料、方法和程序的不同,大脑皮层的广泛区域都有可能参与计算加工。     

近十年来情绪研究的回顾与展望

本文主要综述了近10年来,情绪心理学研究中所取得的进展和将来的研究趋向。首先介绍了情绪实验研究中实验材料的标准化和成像技术应用的发展概况;其次讨论了情绪智力的构成成分和情绪调节研究的进展;再次分析了情绪和认知之间的交互作用关系;最后探讨了感情系统的加工特征。     

多目标追踪的神经机制

多目标追踪任务是研究动态场景中视觉注意加工机制常用的范式。自1998年开始对多目标追踪神经机制的影像学研究以来, 研究者采用ERP和fMRI等技术对多目标注意追踪所涉及的神经电生理活动和脑功能区激活方面开展了大量研究。ERP研究发现, 追踪过程持续的ERP脑电成分如N2pc、CDA的波幅与注意追踪负荷有关, 并且出现在目标与非目标上的探测刺激诱发的脑电成分如N1、P1波幅的差异可反映注意资源的分配, 具体为目标在追踪过程中得到了激活, 而非目标受到了抑制。fMRI研究比较一致地发现了顶叶(包括前顶内沟、后顶内沟、顶上小叶)、背外侧额叶皮层等在注意追踪中的强烈激活。其中顶内沟主要与注意负荷有关, 顶内沟的活动水平直接决定了观察者注意追踪的行为表现。而顶上小叶可能更多的负责注意转移。背外侧额叶皮层可能负责追踪时的感觉运动预测过程。     

精神分裂症肠道微生物与脑影像和临床表征的关系

微生物-肠-脑轴假设在精神分裂症发病机制中的研究受到越来越多的关注。以往研究初步考察了肠道微生物的构成与精神分裂症患者脑影像和临床表征之间的联系,但具体的作用路径尚不明确。当前研究通过总结最新研究进展,并在此基础上提出肠道微生物影响精神分裂症患者大脑结构和功能的机制假设。相关内容对于进一步阐明精神分裂症的病理机制,为将肠道微生物纳入精神分裂症的评估与干预提供理论基础。     

Mind matters: A narrative review on affective state-dependency in non-invasive brain stimulation

Variability in findings related to non-invasive brain stimulation (NIBS) have increasingly been described as a result of differences in neurophysiological state. Additionally, there is some evidence suggesting that individual differences in psychological states may correlate with the magnitude and directionality of effects of NIBS on the neural and behavioural level. In this narrative review, it is proposed that the assessment of baseline affective states can quantify non-reductive properties which are not readily accessible to neuroscientific methods. Particularly, affective-related states are theorized to correlate with physiological, behavioural and phenomenological effects of NIBS. While further systematic research is needed, baseline psychological states are suggested to provide a complementary cost-effective source of information for understanding variability in NIBS outcomes. Implementing measures of psychological state may potentially contribute to increasing the sensitivity and specificity of results in experimental and clinical NIBS studies.     

Ethical Resonance

This essay defines ethical resonance through an ethnographic interlude that paves the way for a broader theorization of the concept. It begins by contextually recounting the story of an individual who had stayed at Sevagram, Mahatma Gandhi’s last ashram in 1944, shadowing Gandhi for some 20 days. The young man’s brief meeting with Gandhi in which Gandhi uttered only one sentence transformed him for his lifetime. I reflect on the experience and its narrative qualities to explore the broader question of why one is moved, and moved enough to be altered. I propose that the theorization of resonance in modern physics, in phenomenology, and in 11th‐century Sanskrit poetics is productive for understanding the subjective and the trans‐subjective elements that underlie ethical persuasion. I argue that the idea of resonance helps bridge the affective and the aesthetic in moral self‐formation that occurs in everyday life.