What is Mentalizing? An Overview

This paper attempts to summarize the evolution of interest in the concept of mentalization which has been researched and enriched by the linking of many disciplines alongside that of psychoanalysis and attachment theory. Taking into account the work of Professors Fonagy and Target and many others, the paper describes factors that enable the development of the capacity to mentalize and those that interfere. It will consider how the quality of attachment affects the transformation of pre‐mentalized modes of experience to the recognition of psychic reality of self and other. While mentalizing is part and parcel of all therapies, a mentalization‐based therapy was developed in the context of treatment of borderline personality disorder patients by Professors Bateman and Fonagy. The paper will illustrate key concepts in the theory of mentalization with the vignette taken from clinical practice.     

What is the MHC?

The major histocompatibility complex (MHC) has been studied for many years, but it still continues to puzzle geneticists and immunologists alike. Nevertheless, the study of MHC evolution is providing insights into some of its enigmas, and these were discussed at a recent meeting.¹     

What is the Practical Significance of Antibodies to Interferons?

Interferons are generally recognised as the treatment of choice in some infectious diseases, such as chronic hepatitis B and C. Since the early clinical trials it was documented that the therapeutic use of interferons could be complicated by the development of antibodies able to neutralise or to bind to the interferon molecule. This finding is not surprising if one considers that natural or therapy-induced antibodies to interleukin (IL)-1, IL-2, IL-6, IL-10, granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor, insulin and recombinant factor VIII have been reported in humans. Since hormones, cytokines, biological response modifiers and homeostatic agents are being used for the therapeutic management of many infectious, autoimmune and neoplastic diseases, the possibility that therapy-induced antibodies can develop in humans should be considered. In this article we summarise what is currently known about the clinical significance of antibodies to interferons in interferon-treated patients. The presence of circulating antibodies may affect the response to interferon. Antibody development may be clinically significant, depending on the titre and the time of appearance. In particular, the response to interferon therapy may be affected by antibodies when they appear early in therapy and at high titre.     

Shared decision making: What is the work?

Cooperation has emerged as a fundamental characteristic of human society, and many argue that this ability is the basis for the phenomenal development in our capability as a species. When we focus our attention to the interactions that occur in healthcare, we inevitably notice power asymmetry due to unequal knowledge, experience, and status. However, as many have argued since the 1970s, there is an ethical imperative to respect the agency of individuals, offer information, collaborate, and support deliberation when difficult decisions arise. This process is particularly important when reasonable alternative courses of action exist and where the priorities and preferences of individuals would be expected to sway such decisions. This position article argues that this process, commonly described as shared decision making, involves work that is cognitive, emotional, and relational, and, particularly if people are ill, should have the underpinning goal of restoring autonomy. It covers the origin of the term and describes the core components; it describes how to do the cognitive, emotional, and relational work that is required, and offers a model to guide the process.     

What is the arcuate eminence?

A study was made of 100 homogeneous CT scans of the petrous part of the temporal bone to determine whether or not the arcuate eminence (AE) is a good landmark for the superior semicircular canal (SSCC) in the suprapetrous approach to the internal acoustic meatus which is used in the extirpation of acoustic neuromas. Direct measurements were made on consecutive coronal sections, 1 mm thick. The AE was absent from the petrous surface in 15% of cases. It corresponded to the relief of the SSCC in 37% of cases; laterally, however, it was separated from the petrous cortex by bone whose thickness varied from 0.5 to 5 mm. Finally, in 48% of cases, the AE was not a good landmark for the canal although nonetheless it participated in the development of this bulge in 46% of cases, always lying towards the medial border of the pneumatized eminence. In addition, study of the coronal sections with MRI allowed us to confirm that the AE does not routinely correspond to the imprint of a temporal sulcus. The AE, whose presence on the petrous surface is due to the combined effects of the SSCC, the air cells of the petrous part of the temporal bone and the temporal sulci, is only a good guide to the SSCC in 37% of cases and should not be considered as a reliable surgical landmark.     

What is the systematic review?

Systematic reviewing provides a major backbone for evidence-based laboratory medicine(EBLM). Compared with a usual review paper, a systematic review is characterized by pursuing both the most comprehensive search for available evidence and the highest level of scientific quality. The word of 'scientific' does not mean a scientific truth but means a reliable result proven by a scientific method. According to the best effort policy of EBM, a result including some statistical bias may be adopted as the current best evidence if better ones are not available. In addition, EBLM requires specialized approaches because of the following reasons. (1) Many factors, such as analytical errors or lack of standardization may cause various statistical biases in the laboratory data. (2) Unlike the effectiveness of therapeutic measures that can be evaluated by comparing only two groups, there are almost infinite combinations of diagnostic tests and phases of clinical courses, and it is hardly possible to statistically match the patient group with the control group at any of those combinations. (3) Unlike medication, which has direct effects on a patient's outcome, many steps must be taken to analyze the effects of laboratory tests. From now, more effort should be dedicated to promoting systematic reviewing in laboratory medicine.     

Adenomatoid odontogenic tumor: What is the true nature?

The Adenomatoid odontogenic tumor (AOT) is one of the most controversial benign odontogenic tumor, which has been known to the pathologists for the past 100 years. Since then the history, histogenesis and histopathologic designation of AOT remains a matter of debate. Some authors consider it as a true benign neoplasm while others consider it as a hamartoma and still others as an odontogenic cyst. Here we propose that the AOT should not be considered as a cyst because its true cystic nature remains questionable. We hypothesize that when the AOT arises from a change in REE covering of the impacted tooth, then it appears as cystic in nature & certainly not a true cyst by origin. Further studies on the histogenesis are required to change the nomenclature of AOT to adenomatoid odontogenic cyst (AOC).     

Migraine and motion sickness: What is the link?

The brainstem is a structurally complex region, containing numerous ascending and descending fibres that converge on centres that regulate bodily functions essential to life. Afferent input from the cranial tissues and the special senses is processed, in part, in brainstem nuclei. In addition, brainstem centres modulate the flow of pain messages and other forms of sensory information to higher regions of the brain, and influence the general excitability of these cortical regions. Thus, disruptions in brainstem processing might evoke a complex range of unpleasant symptoms, vegetative changes and neurovascular disturbances and that, together, form attacks of migraine. Migraine is linked with various co-morbid conditions, the most prominent being motion sickness. Symptoms such as nausea, dizziness and headache are common to motion sickness and migraine; moreover, migraine sufferers have a heightened vulnerability to motion sickness. As both maladies involve reflexes that relay in the brainstem, symptoms may share the same neural circuitry. In consequence, subclinical interictal persistence of disturbances in these brainstem pathways could not only increase vulnerability to recurrent attacks of migraine but also increase susceptibility to motion sickness. Mechanisms that mediate symptoms of motion sickness and migraine are explored in this paper. The physiology of motion sickness and migraine is discussed, and neurotransmitters that may be involved in the manifestation of symptoms are reviewed. Recent findings have shed light on the relationship between migraine and motion sickness, and provide insights into the generation of migraine attacks.     

It's the law. What is?

The New York State Partner Notification law is expected to go into effect in late spring or summer 1999. Residents who choose to be tested for HIV and test positive are required to have their names reported to the State Department of Health. The second part, requesting the names of all recent sexual and needle-sharing partners, is voluntary. Efforts will be made to inform partners who may have been exposed to HIV. All names will be kept in confidence within the department. Persons tested at anonymous testing sites or those who tested positive before the law was passed are exempt, but if medical care involving HIV is sought, the names of HIV-positive people will be reported. Medical practitioners are required to report any "known contacts" listed on any form viewed by the practitioner; for example, a spouse listed on an insurance form would be a known contact. Contact information for two AIDS policy groups is provided.     

What is the real cardiac anatomy?

The heart is a remarkably complex organ. Teaching its details to medical students and clinical trainees can be very difficult. Despite the complexity, accurate recognition of these details is a pre‐requisite for the subsequent understanding of clinical cardiologists and cardiac surgeons. A recent publication promoted the benefits of virtual reconstructions in facilitating the initial understanding achieved by medical students. If such teaching is to achieve its greatest value, the datasets used to provide the virtual images should themselves be anatomically accurate. They should also take note of a basic rule of human anatomy, namely that components of all organs should be described as they are normally situated within the body. It is almost universal at present for textbooks of anatomy to illustrate the heart as if removed from the body and positioned on its apex, the so‐called Valentine situation. In the years prior to the emergence of interventional techniques to treat cardiac diseases, this approach was of limited significance. Nowadays, therapeutic interventions are commonplace worldwide. Advances in three‐dimensional imaging technology, furthermore, now mean that the separate components of the heart can readily be segmented, and then shown in attitudinally appropriate fashion. In this review, we demonstrate how such virtual dissection of computed tomographic datasets in attitudinally appropriate fashion reveals the true details of cardiac anatomy. The virtual approach to teaching the arrangement of the cardiac components has much to commend it. If it is to be used, nonetheless, the anatomical details on which the reconstructions are based must be accurate. Clin. Anat. 32:288–309, 2019. © 2019 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.