多孔丝素蛋白/羟基磷灰石复合脂肪间充质干细胞修复兔关节软骨及软骨下骨缺损

背景：丝素蛋白/羟基磷灰石是细胞立体培养的良好支架,是临床常用的骨缺损修复材料,具有良好的生物相容性。脂肪干细胞具有向骨及软骨细胞分化的潜能,适合骨软骨缺损修复。 目的：观察转化生长因子β1和胰岛素样生长因子1联合成软骨诱导脂肪干细胞与丝素蛋白/羟基磷灰石复合后修复兔关节软骨及软骨下骨缺损的效果。 方法：取新西兰大白兔56只,2只用于传代培养脂肪间充质干细胞,以3×109 L-1浓度接种到丝素蛋白/羟基磷灰石。其余54只新西兰大白兔,在股骨髁间制备软骨缺损模型,随机分为细胞复合材料组、单纯材料组和空白对照组,细胞复合材料组植入复合脂肪间充质干细胞的丝素蛋白/羟基磷灰石;单纯材料组植入丝素蛋白/羟基磷灰石;空白对照组不作任何植入。从大体、影像学、组织学观察比较缺损的修复情况。 结果与结论：12周时大体观察、CT、磁共振和组织学检查细胞材料复合组软骨及软骨下骨缺损区完全被软骨组织修复,修复组织与周围软骨色泽相近,支架材料基本吸收,未见明显退变和白细胞浸润,所有标本均未见丝素蛋白残留。单纯材料组缺损区缩小、部分修复,且呈纤维软骨样修复。空白对照组缺损无明显修复。提示复合脂肪间充质干细胞的丝素蛋白/羟基磷灰石修复兔关节软骨及软骨下骨缺损能力优于单纯丝素蛋白/羟基磷灰石材料。丝素蛋白/羟基磷灰石复合脂肪间充质干细胞可形成透明软骨修复动物膝关节全层软骨缺损,重建关节的解剖结构和功能,可作为新型骨软骨组织工程支架。     

丝素蛋白/羟基磷灰石材料复合人胎盘间充质干细胞修复桡骨节段性骨缺损

摘要 背景：丝素蛋白用于骨重建和再生,表现出机械稳定性和持久性。但单纯的丝素蛋白存在一定的缺陷,在含水量极低时易于破碎,在低湿环境应用时强度不够,通过与其他多聚物的复合可以进一步改进丝素蛋白的结构和特性。 目的：观察胎盘间充质干细胞联合丝素蛋白/羟基磷灰石材料修复节段性骨缺损的效果。 方法：制作兔桡骨中段1.5 cm长骨缺损模型,以数字表法随机分为实验组(植入BrdU标记人胎盘间充质干细胞/丝素蛋白/羟基磷灰石)和对照组(植入丝素蛋白/羟基磷灰石)。植入后4,8,12周行大体、组织学与X射线观察,评分比较骨缺损修复情况。 结果与结论：胎盘间充质干细胞与丝素蛋白/羟基磷灰石材料复合培养植入后,4周时新骨已开始形成,8周时骨缺损部分修复,12周时有部分新生骨组织形成板层骨,骨小梁形成,内可见大量成骨细胞,而对照组支架材料降解较慢。植入后第12周实验组影像学检测骨缺损区完全修复,皮质连续,塑型完全,不易分辨。对照组缺损区基本修复,但塑型不佳,缺损区易分辨,实验组新骨生成优于对照组。说明丝素蛋白/羟基磷灰石材料与胎盘间充质干细胞联合移植能够较好修复兔桡骨缺损。     

丝素蛋白/羟基磷灰石材料复合骨髓间充质干细胞构建组织工程化软骨

背景：随着组织工程的兴起,软骨损伤的修复可能性显著地提高,但单一的支架材料均不能符合理想支架,有一定的局限性。 目的：观察骨髓间充质干细胞复合丝素蛋白/羟基磷灰石构建组织工程化软骨的可行性。 方法：体外分离培养骨髓间充质干细胞,并定向诱导成软骨细胞,与丝素蛋白/羟基磷灰石复合培养,构建膝关节胫骨平台全层关节软骨缺损。54只大白兔单侧膝关节全层软骨缺损模型后随机抽签法分为3组,复合组植入细胞-丝素蛋白/羟基磷灰石复合物;材料组植入单纯丝素蛋白/羟基磷灰石,对照组不行任何植入。植入后8,12周CT检查及组织学检查观察软骨缺损修复情况。 结果与结论：植入后8周,复合组关节面不平整,关节间隙增大,形成新生类软骨细胞,基质丰富。材料组关节面塌陷,软骨细胞少量增殖。植入后12周,复合组关节面平整,关节间隙如常。大量软骨细胞出现,与周边软骨色泽一样,支架材料完全降解。材料组关节面不平整,软骨细胞不完全充填,支架材料部分降解。对照组未见修复。提示用骨髓间充质干细胞复合丝素蛋白/羟基磷灰石可形成透明软骨修复动物膝关节全层软骨缺损,显示了丝素蛋白/羟基磷灰石材料作为关节软骨组织工程支架材料的良好生物相容性。     

可注射性纳米羟基磷灰石/壳聚糖复合骨髓间充质干细胞促进骨缺损的修复

背景：可注射性纳米羟基磷灰石/壳聚糖复合材料是清华大学利用仿生学原理制备的一种较理想的组织工程新型材料,经过前期体外实验证明其具有良好的生物相容性和骨传导性。 目的：观察骨髓间充质干细胞复合可注射性纳米羟基磷灰石/壳聚糖材料在促进骨缺损修复中的作用。 方法：用梯度离心和贴壁培养法收集兔骨髓间充质干细胞,分离、培养至第3代,然后与纳米羟基磷灰石/壳聚糖复合。24只新西兰大白兔双侧股骨外侧髁钻孔,制备骨缺损模型。所有兔右侧股骨外侧髁缺损以骨髓间充质干细胞-纳米羟基磷灰石/壳聚糖局部植入作为实验组,其中20只兔左侧股骨外侧髁缺损以单纯纳米羟基磷灰石植入治疗作为对照组,4只兔左侧股骨外侧髁缺损旷置为空白组,于第12周末,分别行大体、影像学观察、组织形态学、观察该复合材料对兔骨缺损的修复效果。 结果与结论：术后12周实验组植入体已与骨缺损处骨性愈合,明显见新生骨生成,骨缺损能够完全修复,对照组骨缺损处部分修复,部分骨皮质不连续。空白组缺损区尚未见修复,纤维结缔组织填充。术后12周,实验组见骨形成细胞较多,材料内见新生骨小梁相互连接成片;对照组少量骨细胞形成,骨量少,部分纤维组织填充。空白组未见骨形成细胞,纤维组织较多。结果表明,骨髓间充质干细胞-纳米羟基磷灰石/壳聚糖复合材料具有骨缺损修复能力,其疗效优于单纯纳米羟基磷灰石材料。 关键词：纳米羟基磷灰石/壳聚糖;骨髓间充质干细胞;骨缺损;兔;可注射 doi:10.3969/j.issn.1673-8225.2010.34.003     

纳米羟基磷灰石/胶原/聚乳酸复合物与骨髓间充质干细胞修复兔下颌骨缺损

背景：为颌骨缺损患者选择适宜的骨移植材料替代自体骨是当前研究的热点。 目的：观察纳米羟基磷灰石/胶原/聚乳酸与兔骨髓间充质干细胞复合物用于修复兔下颌骨缺损的能力，比较其与自体骨修复及单纯纳米羟基磷灰石/胶原/聚乳酸修复的差异。 设计、时间及地点：随机对照动物实验，于2007-03/10在锦州市中心医院动物实验室完成。 材料：40只新西兰兔随机分成纳米羟基磷灰石/胶原/聚乳酸复合骨髓基质干细胞填充组（简称复合组）、自体骨填充组、单纯支架材料填充组及空白对照组，每组10只。 方法：在兔下颌骨体部制造大小为15 mm ×15 mm的全厚骨缺损模型。复合组于缺损处植入骨髓基质干细胞与纳米羟基磷灰石/胶原/聚乳酸体外联合培养14 d的复合物；自体骨填充组于缺损处植入自体髂骨；单纯支架材料充填组于缺损处植入纳米羟基磷灰石/胶原/聚乳酸；空白对照组不作任何植入。 主要观察指标：分别于植入后1，3，6个月进行骨密度检测及组织学染色观察，根据检测结果评价骨修复效果。 结果：复合组与自体骨填充组骨密度比较，差异无显著性 (P > 0.05)，且均高于单纯支架材料充填组及空白对照组(P < 0.01)。复合组和自体骨填充组材料植入后6个月时见，新生骨组织渐成熟，呈大块状，桥接缺损断端，支架材料已所剩无几。单纯支架材料充填组植入后6个月时见，植入区骨小梁增多，但仍见较多纤维组织嵌于其中，易见未降解完全的支架材料。 结论：纳米羟基磷灰石/胶原/聚乳酸与骨髓间充质干细胞复合物修复下颌骨缺损效果与自体骨修复相似，均优于单纯支架材料修复。     

丝素蛋白/羟基磷灰石复合支架对骨髓间充质干细胞增殖分化的支持：优于胶原海绵材料吗？

背景：传统的羟基磷灰石强度低、孔隙度小、骨诱导性和传导性较差。因此,人们采用各种方法制备羟基磷灰石生物复合材料,以改进其性能。 目的：观察丝素蛋白/羟基磷灰石复合材料对骨髓间充质干细胞生物特性的影响,并与常用的胶原海绵相比较。 设计、时间及地点：重复测量观察及多样本观察实验,于2007-01/2008-06在苏州大学附属第一医院骨科实验室完成。 材料：丝素蛋白/羟基磷灰石纳米材料由苏州大学材料学院李明忠教授研制提供,胶原海绵购买于上海其胜公司。 方法：取SD大鼠股骨和胫骨分离提取骨髓间充质干细胞,进行培养,传代。取第3代骨髓间充质干细胞分别接种到丝素蛋白/羟基磷灰石复合材料及三维胶原海绵材料上进行共培养。未加材料,单独培养细胞,作为空白对照组。 主要观察指标：应用倒置显微镜观察细胞生长情况;在培养第2,4,6,8天用MTT法测定细胞增殖情况及测定碱性磷酸酶活性。 结果：①倒置显微镜显示骨髓间充质干细胞能在两种材料上良好地黏附、增殖和生长。②MTT法检测显示两种材料上的细胞增殖明显,碱性磷酸酶活性随培养时间延长而增加,均高于空白对照组。 结论：丝素蛋白/羟基磷灰石复合材料显示出良好的生物相容性,并能促进细胞生长分化,其有望成为胶原组织工程支架材料很好的补充和替代。 关键词：丝素蛋白;羟基磷灰石;组织工程;骨髓间充质干细胞;增殖分化     

生物玻璃活性陶瓷复合人骨形态发生蛋白2基因修饰骨髓间充质干细胞

摘要 背景：目前已有将体外培养的骨髓来源间充质细胞与支架复合后修复骨缺损的临床报道,但是由于该类复合材料中缺乏骨生长因子作用,其原位的成骨作用并不十分理想。 目的：观察人骨形态发生蛋白2基因修饰的骨髓间充质干细胞与生物活性玻璃陶瓷复合材料在修复兔颅骨缺损中的原位成骨作用。 方法：复苏冻存的人骨形态发生蛋白2基因修饰的骨髓间充质干细胞,与生物活性玻璃陶瓷复合培养获得人工植骨材料;制备兔双侧颅骨全层骨缺损模型,实验组将人工植骨材料植入骨缺损区,并设置空白质粒转染的骨髓间充质干细胞+生物活性玻璃陶瓷、骨髓间充质干细胞+生物活性玻璃陶瓷、空白组作对照,术后第4,8,12周对植骨区进行大体观察、X射线摄片、组织化学检测和生物化学检测。 结果与结论：转染人骨形态发生蛋白2 的骨髓间充质干细胞与生物活性玻璃陶瓷复合培养的人工植骨材料植入后第4周,骨缺损外周骨质与复合材料之间大部分被高密度阴影充填;第12周,完全被高密度阴影充填;第8周,骨小梁大部分相连成片;第12周,骨小梁粗大,骨髓再生。生物化学检测结果与组织化学检测结果一致,并且成骨效果及成骨活性明显优于对照组。说明携带人骨形态发生蛋白2基因的骨髓间充质干细胞与生物活性玻璃陶瓷复合构成的人工植骨材料基本符合骨组织工程学的要求,在骨缺损区原位具有良好的成骨作用。 关键词：骨髓间充质干细胞;基因转染;生物活性玻璃陶瓷;骨缺损;移植;兔;生物材料 doi:10.3969/j.issn.1673-8225.2010.42.005     

纳米晶羟基磷灰石胶原复合骨髓间充质干细胞修复骨缺损

背景：临床上对大范围骨缺损还没有很有效的治疗手段，而纳米晶羟基磷灰石胶原复合材料与天然骨骼的结构类似，具有较好的生物相容性，可能为修复骨缺损提供新的途径。 目的：观察纳米晶羟基磷灰石胶原材料复合骨髓间充质干细胞在修复骨缺损中的作用。 方法：分离培养人骨髓间充质干细胞，与纳米晶羟基磷灰石胶原材料于体外联合培养；通过大体观察、组织学分析及电镜观察了解成骨情况，进一步临床应用于修复骨缺损。 结果与结论：人骨髓间充质干细胞在体外可以大量扩增，复合细胞的材料植入骨缺损处后，X射线摄片动态观察可见骨缺损处连接良好。说明骨髓间充质干细胞具有成骨细胞作用，纳米晶羟基磷灰石胶原材料是一种很好的构建组织工程骨的支架材料。 关键词：骨髓间充质干细胞；羟基磷灰石；纳米材料；组织工程；骨     

肝细胞生长因子基因修饰的骨髓间充质干细胞移植治疗兔股骨头坏死

背景：课题利用实验室自主研制、已获国家SFDA批准临床试验的重组肝细胞生长因子腺病毒感染骨髓间充质干细胞,结合肝细胞生长因子的促血管新生和抗细胞凋亡以及间充质干细胞的成骨功能,通过细胞治疗的手段进行骨损伤修复。 目的：探讨肝细胞生长因子基因修饰的骨髓间充质干细胞移植对兔股骨头坏死骨缺损的治疗效果。 设计、时间及地点：细胞-材料学体内实验,于2007-09/12在北京放射与辐射医学研究所和解放军66400部队骨病专科医院完成。 材料：清洁级26~28周龄新西兰大白兔18只,由北京开源兔业养殖场提供。骨基质明胶为上海骁博科技发展有限公司产品。 方法：采用贴壁法分离培养兔自体骨髓间充质干细胞,体外鉴定成骨和成脂肪能力。18只兔均建立双侧股骨头坏死骨缺损模型,随机分为3组,6只/组,单纯材料组缺损区仅填塞骨基质明胶,细胞-材料组填塞复合骨髓间充质干细胞的骨基质明胶,基因修饰细胞-材料组填塞复合Ad-HGF感染的骨髓间充质干细胞的骨基质明胶,各组细胞用量为 107个/缺损,骨基质明胶用量为27 mm3/缺损,修复3个月后取材进行组织学检查。骨髓间充质干细胞和Ad-HGF感染的骨髓间充质干细胞经荧光染料二醋酸琥珀酰酯羟基荧光素标记后,氯化钴处理72 h,流式细胞学分析细胞增殖情况。 主要观察指标：骨髓间充质干细胞的诱导分化,骨髓间充质干细胞对兔股骨头坏死的修复效果,Ad-HGF感染的骨髓间充质干细胞抗低氧损伤能力。 结果：培养的细胞在适当诱导条件下可分化为成骨和成脂肪细胞。修复后3个月组织学分析显示,单纯材料组仅见疏松的纤维肉芽组织填充;细胞-材料组可见致密的纤维肉芽组织填充,其间有较多的新生血管,但未见新生骨组织;基因修饰细胞-材料组多为软骨样组织填充,周围可见新骨带形成。各组Lane-Sandhu骨组织学评分比较差异有非常显著性意义(P < 0.01),其中基因修饰细胞-材料组评分最高,即Ad-HGF感染的骨髓间充质干细胞具备最佳的骨修复能力。培养体系中加入氯化钴后,已增殖的Ad-HGF感染的骨髓间充质干细胞比例显著高于未感染骨髓间充质干细胞(P < 0.001)。 结论：在骨缺损模型中Ad-HGF感染的骨髓间充质干细胞具有更强的抗低氧损伤能力,其在体内成骨能力优于未感染的骨髓间充质干细胞,提示肝细胞生长因子基因修饰的骨髓间充质干细胞移植是应用于缺血性骨坏死的有效治疗途径。     

纳米羟基磷灰石/壳聚糖复合材料与兔骨髓间充质干细胞的生物相容性

背景：清华大学材料科学与工程系冯庆玲教授等采用仿生学原理,制成一种塑形简便并且具有良好骨传导、骨诱导性的纳米羟基磷灰石/壳聚糖复合骨修复材料。但制备的复合材料是否仍具良好的生物相容性尚不确切。 目的：观察纳米羟基磷灰石/壳聚糖复合材料与兔骨髓间充质干细胞的相容性。 设计、时间及地点：体外观察实验,于2008-08/11在南方医科大学珠江医院中心实验室完成。 材料：纳米羟基磷灰石/壳聚糖复合材料由清华大学材料系研制,孔隙率90%,孔径50~200 μm。骨髓间充质干细胞由2周龄健康新西兰大白兔股骨和胫骨骨髓经密度梯度离心法获得。 方法：将预湿后的纳米羟基磷灰石/壳聚糖材料置于培养板内,将第3代骨髓间充质干细胞接种于材料表面在体外复合培养。对照组为单纯骨髓间充质干细胞培养。 主要观察指标：倒置显微镜、扫描电镜观察细胞和材料复合培养后细胞生长状况,计数细胞接种后1,2,4 h在材料表面的黏附状况,CCK-8检测细胞在复合材料上的增殖状况,流式细胞仪检测种植细胞的细胞周期。 结果：骨髓间充质干细胞在复合材料表面上生长状况良好。细胞接种到复合材料1 h时黏附率低于对照组（P < 0.05）,但接种2,4 h后两组黏附率差异无显著性意义（P > 0.05）。细胞接种后,两组均保持正常的分裂增殖速度(P > 0.05) 。材料组和对照组细胞皆为正常的二倍体细胞,未见异倍体细胞形成,复合材料对兔骨髓间充质细胞的细胞周期影响不大。 结论：纳米羟基磷灰石/壳聚糖与骨髓间充质干细胞具有良好的生物相容性。     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.     

Clobazam for Treatment of Intractable Epilepsy: A Critical Assessment

Summary: Clobazam (CLB), a 1,5-benzodiazepine, is a remarkably effective add-on drug for individual patients with refractory partial epilepsy. CLB has an excellent safety record. As with all benzodiazepines used for treating epilepsy, sedation and withdrawal effects, together with the development of tolerance, limit its usefulness. Recent efforts to prevent or reverse tolerance with intermittent administration of CLB or periodic injection of a benzodiazepine antagonist, flumazenil, are encouraging and justify further investigations.     

La passion de Torquemada et le terrorisme islamique : quelques points de comparaison

This original research compares the doctrinal, psychopathological and operational standpoints of the 15th century Spanish Inquisition (Torquemada) with those of radical Islamism from 1988 to 2005 (Al-Qaeda). The following are reviewed: (a) the main texts codifying the procedure for conducting the criminal investigation of a Holy Office trial (Directorium inquisitorum); (b) the life and work of the grand inquisitor Tomás de Torquemada (1420–1498); (c) the psychopathological relations between passion (passionate psychoses, passionate idealism, paranoid personality) and fanaticism; (d) “the madmen, the enlightened and the criminals” of Islamic terrorism; (e) the cognitive and emotional motives for engagement in the jihadist radicalization of young people; (f) the common principles of monotheistic fanaticism (Inquisition, Al-Qaeda) and the particular dogmas of Islamic terrorism in our time; (g) the operating modes of the Inquisition and the Jihadist holy war. The author concludes that the rigour and seriousness of the inquisitorial judicial procedure, which was precise, individual and personalized, contrasts with the revolutionary pamphlets of Al-Qaeda, which only provide broad guidelines for the modus operandi of the fight against infidels, who are usually random victims.     

Claustration et collectionnisme : réflexions à propos d’un cas de syndrome de Diogène avec vols kleptomaniaques et vengeurs

Social withdrawal is a pathognomonic behaviour that is consistently associated with mental illnesses. Compulsive hoarding can also be interpreted as a pathological behaviour, even when it does not involve kleptomania. Diogenes syndrome (DS) was first described in 1975, and is characterized by both behaviours - social withdrawal and compulsive hoarding. Even though it is often the manifestation of a psychiatric condition, its aetiology is diverse. The most frequent ones are however: dementia, schizophrenia and mental retardation. In this study, we describe an atypical case presenting with DS. Il consists of a young man, seen in a forensic setting, who had been diagnosed with kleptomania in the past, presents with compulsive hoarding, and whose recent thefts were fuelled by revenge. Finally, to our knowledge, the way social withdrawal is viewed is seldom taken into account. We analyse its implication on social withdrawal.     

Neurological soft signs and schizophrenia: a review of current knowledge

Schizophrenia is a frequent and disabling disorder emerging during adolescence or early adulthood. The identification of underlying processes has been hampered by the complex clinical expression and the probable etiological heterogeneity. The frequency of neurological soft signs (NSS) in patients with schizophrenia and their presence early in life (during the first two years) in high risk subjects support the hypothesis that schizophrenia is a "brain disease" reflecting pre- or perinatal insults during development. The growing interest for NSS has lead to multiple studies that are often difficult to compare. The objective of this review is to summarize the current knowledge on NSS, methodological issues and the future perspectives.     

Lacan, lecteur de Minkowski : l'approche structurale

The notion of structure occupies a predominant place in the theory of Lacan. He indicates that was developed from the work of Minkowski. In fact, through his phenomeno-structural approach, Minkowski does not limit himself to purely observable phenomena, but attempts to determine the underlying structure. He refers to the comprehensive phenomenology and psychopathology, and this method provides him with clinical finesse and another means of determining a diagnosis. Thus Lacan has used this as a basis for his approach to structure to develop a theory regarding the individual. This implies that the structure of the individual is based on his relation to language. From this concept, he then develops the clinical structures of neurosis, psychosis, and perversion. These structural landmarks also have an effect on the course of treatment.