Psychosomatic medicine, behavioral medicine, just plain medicine

Neurally mediated physiologic responses fulfill all of the criteria for behavior and obey all of the laws of behavior subject to the anatomic and physiologic constraints inherent in their structures and functions. It is illogical and wrong to assert that neurally mediated responses interact with behavior. THEY ARE BEHAVIOR. These principles are a legitimate and necessary part of the training of all medical students, residents, and fellows. The conceptual basis of psychosomatic practice does not need to be derived from the dualistic notions of psychoanalysis or from the dualistic notions of biobehaviorism. Psychosomatic medicine is an integral aspect of medical practice. It needs to exist because people act and react differently from one another, and because the same person acts and reacts differently from one situation to another. Psychosomatic medicine is not psychiatry in medicine. Each of the specialties and each of the subspecialties encounters its own set of psychosomatic problems; and treatment strategies to resolve these problems need to be integrated into the clinical practice of that discipline.     

Primary preventive medicine and laboratory medicine

Nutrition plays an important role in the primary preventive medicine. In 1999, we have introduced the Dietary Reference Intakes (DRI) established by the National Academy of Sciences of U.S. into Recommended Dietary Allowances (RDAs) for the Japanese population. Where, reference intervals for the concentration of nutrient in blood are required in setting an Adequate Intakes (AI). For vitamins, also the AI is experimentally determined based on the reference intervals of healthy people, and the assessment of the nutritional status by laboratory investigations is an important part of preventive medicine. In 1997, we founded the Japan Committee for Vitamin Laboratory Standards and standardized whole blood vitamin B1 levels using HPLC method. Reference intervals for vitamin A, vitamin C and vitamin E might be presented in future report. We annually examined 15,000 participants in national nutrition survey. We proposed a use of results of this research for setting AI of vitamins. Genetic investigation should be introduced in future primary preventive medicine, and stress markers such as "biopyrrin" for oxidative stress, uropepsin, and urinary 17KS-S seems to be very important for medical examination.     

Behavioral medicine in Russian family medicine

The Russian Federation's recently adopted family medicine as a specialty, but with little or no training in psychosocial and behavioral issues, unlike many training programs in other countries. The purpose of this qualitative study was to explore the perceptions and experiences of Russian primary care physicians regarding the practice of behavioral medicine and psychosocial methods. Semi-structured in-depth interviews were conducted with ten Russian family physicians. Examination of key words, phrases, and concepts used by the physicians revealed five themes that physicians related to their incorporation of psychosocial/behavioral medicine methods: (1) factors limiting the practice of behavioral medicine (inadequate training; cultural barriers); (2) demand for behavioral medicine services; (3) patient-doctor issues related to behavioral medicine (e.g., communication); (4) physician's role strain; and (5) intuition and experience. These findings suggest that Russia's new family physicians would benefit from residency and post-graduate curricula in behavioral sciences, tailored to their unique needs.     

浅议循证医学与医学教育的关系

循证医学(EBM)思想来源于临床实践,目前已广泛深入到各种临床实践和基础研究。循证医学思想不仅对医药、卫生的各个领域产生了重大影响,也对医学教育、教学改革产生了影响。分析循证医学与医学教育的关系对于促进医学教育改革和推动循证医学发展都具有重要的现实意义。笔者从循证医学的发展概况及其基本内涵对循证医学与医学教育的关系作简要分析。     

转化医学与中医药研究实践

自转化医学的理念引入中医药领域以来,逐渐受到越来越多学者的重视。多数学者认为,转化医学理念与中医药研究的交叉融合,对传承和发展中医药事业大有裨益。本文通过回顾转化医学的内涵与发展历程,阐释了其与中医药基础理论的共通之处,并进一步描述了现今中医药转化研究的内容与实践,指出了中医药在现阶段研究基础薄弱、证据零散以及功效整体评价尚需加强等问题,最后提出了加强资源整合、聚焦优势领域、完善整体评价等加强中医药转化研究的观点与策略,以期为未来的中医药转化研究提供新的思路。     

Laboratory medicine for blood transfusion and transplantation medicine

We discussed the usefulness of routine technologies of laboratory medicine in blood transfusion and transplantation medicine. New parameters that can be measured by automated hematology analyzers have been clinically evaluated and proven to be useful so far. Based on our experience, detection systems for fragmented red cells (FRC), immature platelets (immature platelet function, IPF), and hematopoietic progenitor cells (HPC) are useful for the diagnosis of thrombotic microangiopathy, differential diagnosis of thrombocytopenia, and decision regarding the optimal timing to collect peripheral stem cells, respectively. Moreover, IPF were suggested to be an indicator of the platelet transfusion requirement. The establishment of non invasive assaying technology has been eagerly anticipated. We evaluated a hemoglobin measurement tool, and revealed that it might be applicable in predeposited, autologous blood donation. Some adverse transfusion reactions are related to neutrophil activation. Thus, we investigated the effects of serum from patients and blood donors, in the context of adverse reactions, on adhesion molecule expressions of neutrophils from volunteers using flow-cytometry. This kind of simple technology is expected to be useful in future studies to clarify the mechanisms and prevent adverse reactions.     

Neo-Lamarckian medicine

Darwinian medicine is the treatment of disease based on evolution. The underlying assumption of Darwinian medicine is that traits are coded by genes, which are often assumed to be sequences of DNA nucleotides. The quantitative genetic ramification of this perspective is that traits, including disease susceptibility, are either caused by genes or by the environment, with genotype-by-environment interactions usually considered statistical artefacts. I emphasize also examining those epigenetic signals that can be altered by environmental perturbations and then transmitted to subsequent generations. Although seldom studied, environmentally-alterable meiotically-heritable epigenetic signals exist and provide a mechanism underlying genotype-by-environment interactions. Environment of a parent can affect its descendants by heritably altering epigenetic signals. Neo-Lamarckian medicine is the application of these evolutionary epigenetic notions to diseases and could have enormous public health and environmental policy implications. If industrial contaminants adversely affect organisms by meiotically-heritably altering their epigenetic signals, then cleaning up these contaminants will not remedy the problem. Once contaminants have adversely altered an individual's epigenetic signals, this harm will be transmitted to future generations even if they are not exposed to the contaminant. Exposure to environmental shocks such as free radicals or other carcinogens can alter cytosine methylation patterns on regulatory genes. This can cause cancer by up-regulating genes for cell division or by down-regulating tumour suppressor genes. Environmentally-alterable meiotically-heritable epigenetic signals could also underlie other diseases, such as diabetes, Prader-Willi syndrome, and many complex diseases. If environmentally-altered meiotically-heritable epigenetic effects are widespread - which is an important open empirical question - they have the potential to alter paradigmatic views of evolutionary medicine and the putative dichotomy of nature versus nurture. Neo-Lamarckian medicine would thereby shift emphasis from cure to prevention of diseases.