L’espace de la santé mentale : un paysage discursif et clinique en remaniement

Objectives

This paper introduces some epistemology about mental health developments and how it leads to reconsider the landscape of clinical practices.

Développement du tissu adipeux : importance des lipides alimentaires

A well-balanced development of white adipose tissue (WAT) is physiologically important. Longitudinal studies indicate that excess of adipose tissue at early age is predictive of subsequent overweight and obesity, emphasizing infancy as a critical period for WAT development. In this respect, in response to a positive energy balance, its expansion takes place from adipocyte precursor cells which remain present throughout life. Moreover, lipoatrophy and lipodystrophy on one hand, overweight and obesity on the other hand, lead to the metabolic syndrome. In obese patients, the earlier is the obesity onset, the higher is adipocyte size and even more so adipocyte number. As adipocytes do not divide, this observation indicates that excessive proliferation of adipocyte precursor cells is a critical issue, hampered by the lack of specific markers of these cells which represent the true potential of WAT development.In animals and humans, both cross-sectional and longitudinal studies have shown that a caloric excess, i.e. fat-enriched foods in most cases, is associated to enhanced fat mass. The role of dietary fat as a major player in adult human obesity remains controversial because the prevalence of overweight and obesity has increased dramatically over the last decades despite no recent major change in the amount of ingested fats. However the importance of qualitative changes in the fatty acid composition of fats has been largely disregarded despite a dramatic alteration over decades of the balance of essential polyunsaturated fatty acids (PUFAs). There is evidence from animal and human studies that changes in the balance of ω6 and ω3 PUFAs may alter the early stages of adipose tissue development. Under isonenergetic conditions, pups from wild-type mother mice fed a linoleic acid (LA)-enriched diet were 40% heavier 1 week after weaning than those from mothers fed a LA/α-linolinenic acid (LA/LNA) diet, and the weight difference is maintained at the adult age. The LA-induced enhancement of fat mass is abolished in mice invalidated for the cell surface prostacyclin receptor (ip ^-/- mice), demonstrating the critical role of arachidonic acid and prostacyclin in excessive adipose tissue development. Changes observed in the past decades in the fatty acid composition of dietary fats observed in breast milk and formula milk, i.e. an increase in LA with slight or no change in LNA content, acting in concert with a positive energy balance, may be responsible at least in part for the dramatic rise in the prevalence of childhood overweight and obesity. The significant change in the composition of PUFAs in most consumed foods can be traced to changes in human food habits but, quite importantly, also in the feeding pattern of breeding stock. Since prevention of obesity appears critical to avoid difficult if not insurmountable health problems in the future, and in addition to a better control of energy balance, the composition of dietary lipids should be reconsidered from the very beginning of the food chain.     

Les tissus articulaires sous la contrainte

Mechanobiological data from “in vivo”and “in vitro” studies attest that tissues modify their metabolism in relation to mechanical stress they experiment and its parameters. The central target of these modifications are local chimiomediators, which modulate contents of tissular biomaterials, specially collagen and proteoglycans, by regulating their synthesis and degradation by specific enzymes. Biomaterial histological organization is also affected.Finally, these biochemical and histological modifications provide tissu with mechanical properties appropriate to in situ stress.     

马桑内酯诱导惊厥发作海马结构内神经元损伤的观察

目的：观察国产中药制剂马桑内酯诱导惊厥发作后，海马结构内神经元损害的范围和特征。方法：采用SD大鼠，马桑内酯单次腹腔内注射诱发惊厥，在发作后不同时间点取脑，行H＆E染色和GFAP免疫组化染色观察海马结构内神经元和神经胶质细胞的改变。结果：海马结构内有显著的神经元损伤。其损伤次序表现为：齿状回、门区和CA3区、CA1区，损伤区周围有反应性星形胶质细胞增生。结论：马桑内酯致惊厥发作后海马神经元的损害与兴奋性细胞毒制剂海仁酸致惊厥具有相似的病理学改变特征，提示国产中药制剂马桑内酯致惊厥与兴奋性细胞毒有关。     

Neue Untersuchungen zur Typus-melancholicus-Struktur bei Migränikern

In an earlier published study [16, 17, 18], it was demonstrated that migraine sufferers have personality traits significantly more strongly associated with the typus melancholicus than healthy individuals and patients with other mental and physical illnesses. They display a fixation on tidiness which manifests itself in an excessive striving for quality and quantity in performance-oriented situations. The main features of their social relationships are excessive helpfulness combined with an exaggerated tendency towards guilt avoidance and symbiotic attachment to their own families. They do not differ from unipolar depressives in these respects. The major aim of the new study is to examine whether the concept of the typus melancholicus in relation to migraine sufferers as proposed in the first study is adaptable to explaining the personality characteristics of migraine sufferers ("typus migraenicus"). Age-matched samples of 42 female migraine sufferers, 40 female patients with unipolar depression, and 41 female control subjects took part in the new study. The test instruments used were von Zerssen's Munich Personality Test (MPT) and a questionnaire specially designed by the first author for assessing the typus migraenicus (German "Fragebogen zur Erfassung des Typus migraenicus," or FETM). The results obtained using univariate and multivariate analyses demonstrate a confirmation of the typus migraenicus concept, although to a less pronounced degree than the previous study. This can be seen as supporting evidence that, independently of the study sample and the investigators, migraine sufferers display with higher random frequency a personality profile very similar to the premorbid personality structure in unipolar depressives.     

纳洛酮治疗急性脑梗死的临床有效性分析

目的探讨纳洛酮治疗急性脑梗死的临床疗效.方法将122例急性脑梗死病人随机分为纳洛酮组(62例)和对照组(60例).纳洛酮组用5% GS 250 ml+纳络酮注射液 0.8 mg 静滴,每日2次;对照组用5% GS 250 ml+复方丹参 16 ml 静滴,每日1次.疗程均为 14 d,在1个疗程后进行疗效和起效时间比较.结果纳洛酮组总有效率为 93.5%,对照组为 76.7%,两组比较有显著性差异(P<0.05);纳洛酮组的起效时间明显快于对照组(P<0.05).结论纳洛酮治疗急性脑梗死临床疗效显著.