Editorial Commentary: Imaging of the Anterolateral Ligament of the Knee: The MR(eye) Sees What the Brain Knows…

Significant focus has recently been placed on the contribution of the anterolateral ligament (ALL) to controlling anterolateral rotatory laxity of the anterior cruciate ligament (ACL) injured knee. Many recent studies have investigated the use of magnetic resonance imaging and ultrasound on determining the degree of ALL injury and whether this is correlated to high-grade rotatory laxity. Unfortunately, most studies lack a reference standard, and as such it is challenging to determine whether it truly is the ALL that is injured or if the capsule-osseous layer and deep iliotibial band are involved. Historic literature has demonstrated the importance of these other structures having been noted to be injured at the time of ACL reconstruction. As such, it is clear that high-grade rotatory laxity does not result from an isolated ACL injury. We therefore must remain open to the idea that it is not just the ALL that may cause this injury pattern, and optimal solutions to address this patholaxity have yet to be fully determined.     

Vers une psychiatrie énactive et computationnelle

IntroductionPsychiatry is challenged by a plurality of complementary approaches. These challenges stem from the existence of multiple levels of understanding, i.e. systems of representations, tools, methodologies and objectives in psychiatry–ranging from computational approaches and systems dynamics to the multiplicity of emerging nosographies, such as the NIMH Research Domain Criteria project or staging models. In this plurality, a significant number of clinicians have adopted the biopsychosocial model. However, such a model has been widely criticized for more than twenty years. In parallel, science has declined a set of different pluralistic frameworks. Thus, through the challenges of computational modeling in psychiatry, we will see how the enactive approach of psychiatry could respond to this multiplicity. Indeed, such an enactive approach considers that perception is a (predictive) activity, which gives sense to the environment (i.e., sense making). Perception and, by extension, cognitive processes are not internal representations of the outside world, but they are deployed according to the 5E approach, i.e., an embodied, embedded, enacted, emotive and extended approach.MethodsIn this article, we first study the pluralist framework in psychiatry, in order to show its contributions in the clinical practice. Secondly, we analyze the contributions of the enactive approach for clinical practice in psychiatry.ResultsTwo forms of pluralisms can be described: a non-integrative pluralism and an integrative pluralism. The first examines the coexistence of different potentially incompatible or untranslatable systems in the scientific or clinical landscape. The second proposes the development of a general framework, bringing together the different levels of understanding and systems of representations. However, pluralism has many pitfalls and limitations. Especially by allowing computational modeling, the enactive framework, anchored both in cognitive sciences, theory of dynamic systems, systems biology and phenomenology, has recently been proposed as an answer to the challenge of integrative psychiatry.ConclusionsA significant number of mental health professionals are already working accepting such a variety of clinical and scientific approaches. We show that the enactive approach allows psychiatry: (1) to consider the subjectivity and the patient's experience, (2) to articulate different “granularities” within the clinical consultation, (3) to explain the benefits the creation of meaning for the patient, (4) to provide concrete models, (5) to support pedagogy in psychiatry. The enactive approach provides a conception for understanding psychiatric disorders as embodied, embedded, enacted, emotional and extended. In that way, the manifestations experienced by the patients are sense making experiences and can be conceived according to various levels of granularity.     

Jean Garrabé et l’histoire de la psychiatrie dans les Annales Médico-Psychologiques

Jean Garrabé has published about 40 historical articles in the Annales Médico-Psychologiques. He has written on the history of the classifications, on the evolution of clinical entities (bipolar disorders) and of theoretical matters (psychopathology, politics, mondialization, antipsychiatry), on the relationships of psychiatry with artistic, literary and musical creation. But he has above all written many biographical notices of practitioners of mental medicine in France from the beginning of the 17th century (Montalto) to the end of the 20^th (Ey, Lacan). The personage of Pinel often appears in his papers like a central figure of the psychiatry, analyzed far from both hagiography and demolition. Garrabé can be considered like a “psychiatrist-historian”, erudite as well as critical.     

以问题为基础的学习联合以案例为基础的学习在脊柱外科实习生临床带教中的应用

目的 探讨以问题为基础的学习（problem-based learning,PBL）联合以案例为基础的学习（case-based learning,CBL）在脊柱外科医学生带教中的教学意义及优势。方法 选取2021年3月至2021年9月在我院脊柱外科实习的53名2017级本科生,随机将其分为传统教学组（简称传统组,28例）和教学方法联合组（简称联合组,25例）进行实习带教,其中传统组男15人,女13人,年龄为（22.04±0.58）岁。联合组男13人,女12人,年龄为（22.36±0.64）岁。实习结束后通过出科考核的方式对学生理论知识及临床实践能力进行考核。同时派发问卷调查,评价老师教学水平及对课程设计满意情况。结果 联合组理论知识及临床实践能力均优于传统组,两组间差异有统计学意义（P＜0.05）。另外,从学生反馈来看,联合组学生对老师教学形式及课程设计的满意度更高。结论 教学方法的组合更有利于调动学生主观能动性及主动学习的积极性,培养学习兴趣,提高学习效率。从而更好地掌握脊柱外科专业知识及临床技能,提高本科生及规培生培养质量。