从气机升降探讨胃癌的病机治则

胃癌是因外邪侵袭、情志内伤、饮食失调等,致气机升降失调,气血津液运化失常,气滞、血瘀、痰浊及癌毒内生,日久积聚于胃脘而成。脾胃为气机升降之枢纽,脾不升清,胃不降浊,则精微不能濡养,浊液不能排出,影响体内正常气机升降。肝主疏泄,调节全身气机的条达,肝之疏泄功能失常,气机升降失调,则影响气血运行。气机升降关系在胃癌形成中起关键作用,气机升降失调,气血津液不能正常输布运行,则气凝血滞,痰浊内停,甚则癌毒内生,发为癌瘤。故在临床治疗中注重恢复脾胃的升降功能,辛开苦降,调畅气机,恢复脾胃的正常升降功能,为胃癌的治疗提供临床指导。     

Racialized Risk in Clinical Care: Clinician Vigilance and Patient Responsibility

Racial/ethnic identity is contingent and arbitrary, yet it is commonly used to evaluate disease risk and treatment response. Drawing on open-ended interviews with patients and clinicians in two US clinics, we explore how racialized risk is conceptualized and how it impacts patient care and experience. We found that racial/ethnic risk was a common but poorly defined construct for both patients and clinicians, who intermingled concepts of genetics, biology, behavior, and culture, while disregarding historical or structural context. We argue that racializing risk embodies social power in marked and unmarked bodies, reinforcing inequality along racial lines and undermining equitable health care.     

生理学教学核心理念变革的探讨

医学教育改革更多的是热衷于授课形式和方法的改革，而忽视了真正能够渗透到教学各方面的教学理念的改革。结合对生理学教学目标的反思和“岗位胜任力”培养的需求，将生理学教学的核心理念总结为四个方面：“三观”要正，帮助学生树立平衡观、辩证观和整体观；“三基”要牢，培养学生掌握基本的知识架构体系、基本的知识获取能力、基本的操作技能；重视学以致用和强化人文素养。上述核心理念在教学实践中得到学生的广泛认可，临床医学专业学生对核心理念的评价明显高于护理专业。下一步教学改革的方向是在教学理念的指导下如何细化授课内容，以适应专业设置越来越细化的现状。     

反流性食管炎中医学研究进展

反流性食管炎(RE)是由于胃或十二指肠的内容物反流入食管,而引起食管组织黏膜炎症、糜烂和纤维化等病变。属于胃食管反流病(GERD)的范畴,临床上以反酸、烧心、灼热、疼痛、嗳气等为主要表现,常见的并发症为食管狭窄、出血、Barrett食管及食管腺癌等。中医学中没有反流性食管炎的病名,但根据其临床表现,可以归属于“吞酸”、“吐酸”、“嘈杂”、“胃脘痛”等范围。中医对反流性食管炎的认识逐渐完善,治疗上以“和法”为主,并取得了良好的疗效。但因在中医病名、辨证和治疗上缺乏统一标准,有待临床进一步研究。本文通过查阅相关文献,概括出反流性食管炎的中医病因病机、辨证分型、治则治法及常用方药,探讨反流性食管炎的中医学研究进展。     

Sentencing Offenders with Foetal Alcohol Spectrum Disorder (FASD): The Challenge of Effective Management

The criminal justice system in Australia is increasingly being required to deal with offenders exhibiting the symptomatology of Foetal Alcohol Spectrum Disorder (FASD). Disproportionately they are indigenous. Diagnosis of the disorder is challenging and too frequently still not being made accurately. More challenging still is responding to it in the forensic system so that options for provision of suitable support are availed of, and thereby the risk of ongoing offending which puts the community at risk is minimised. This paper reviews the creative and compassionate judgment of the Western Australian Court of Appeal in Churnside v The State of Western Australia [2016] WASCA 146. It argues that the decision constitutes a model for the efforts that can and should be made by sentencing judges and magistrates required to deal with recidivist offenders with FASD.     

Responsabilidad social corporativa en los centros de la red hospitalaria de utilización pública de Cataluña

The adoption of a management approach that integrates corporate social responsibility in organizations is an increasing trend that responds to the demands of society related to sustainability, ethics and transparency. Health organizations are adopting corporate social responsibility asymmetrically, which raises the analysis of the implementation models and the developed initiatives. Through qualitative research, with four in-depth case studies of the Catalan health sector, this article analyzes the need to address this new approach and to identify good practices and the challenges for its implementation.     

Du parricide rêvé à l’infanticide réel,ou l’expertise mentale dans tous ses états

The authors describe at length the case of a 33-year-old woman who shot and killed her 9-year-old daughter and attempted suicide immediately afterwards. The judicial inquiry revealed that this infanticidal mother originally intended to kill her own father, who she accused of having sexually abused her in her own childhood and now her daughter, but that unforeseen circumstances changed the mode of operation. She was the subject of seven more or less contradictory psychiatric experts opinions over a period of more than three years before finally being found criminally irresponsible by the court of assizes. She was suffering from delusional psychotic mental disorders at the time of the homicide-suicide. The authors discuss and criticize the conclusions of the experts opinions and instead recommend a multidisciplinary criminological analysis that takes all the objective ans subjective aspects on the case into account.     

Personal responsibility modulates neural representations of anticipatory and experienced pain

An individual's sense of personal responsibility is crucial for adaptive functioning in ever‐changing social situations. This study investigated how the sense of personal responsibility affected the neural dynamics of anticipating one's own pain and another person's pain, using EEG. Participants played a cooperation game in which either the participant (self‐context) or the confederate (other‐context) received a mild electric shock whenever one of them erred. At the anticipatory stage of pain, feedback‐related negativity (FRN) and P300 were sensitive to the degree of responsibility in both contexts. The FRN was more negative when the participant had full responsibility (only the participant had erred) than when the participant shared responsibility with the confederate (both had erred) or had no responsibility (only the confederate had erred), and shared responsibility elicited more negative FRN than no responsibility. Having no responsibility produced larger P300 amplitudes than having shared or full responsibility, whereas there was no significant difference in P300 amplitude between the shared responsibility and the full responsibility conditions. When the shock was delivered to the participants, the P2 was smaller when there was no responsibility than when there was shared or full responsibility. When participants observed the painful facial expressions of the confederates, the P300 was not sensitive to responsibility level. Our results suggest that responsibility level modulates FRN and P300 in anticipation of pain experienced by both self and others, reflecting the attentional and affective experiences in both pain‐ and empathy‐related processes.     

卢尚岭对高血压的病机认识与临证经验总结

总结卢尚岭教授对髙血压病机的理论认识及临证经验。髙血压发病之本在气机失调,气机失调先责肝脾二脏。由此引起诸多病机变化,如,情志所伤,肝气郁结,诸郁遂生;饮食失节,损伤脾胃,导致中焦壅滞,气机不利,日久必然损伤血脉,危害脏腑。据此,卢老强调肝脾气机失调、升降之机失常、脏腑功能紊乱存在于髙血压全过程,进而提出调治髙血压以斡旋气机,调整脏腑功能,藉以恢复阴平阳秘之常态为主导。认为临证应首辨气机失调及病变脏腑,治以调气为先,兼顾化痰、活血、疏肝清火、平肝潜阳、滋补肝肾、滋阴和阳、扶阳镇水等,同时强调外治,善用足浴。