Modifier le comportement alimentaire : mission impossibles ?

Is it possible to modify intake behaviors for body weight control purposes? Over the last 40 years, dozens of international, peer-reviewed articles have described behavior modification approaches aiming at body weight reduction. The present article first presents a historical account of behavioral methods and their results. From the early therapies exclusively addressing behaviors (excluding restrictive diets) until the recent cognitive-behavioral treatments, published studies have reported modest weight losses associated with numerous metabolic, nutritional and psychological benefits whose maintenance, beyond the treatment duration, appear reasonably good. Recent studies specifically address the conditions of long-term maintenance. The main elements of behavioral-cognitive treatments are described briefly. Finally, the particular problems associated with these approaches in the French context are underlined.     

复方积雪草有效组分对人肾小管上皮细胞补体C3表达的影响

目的：探讨复方积雪草有效组分——积雪草苷／大黄素干预肿瘤坏死因子-α（TNF-α）诱导的人肾近曲小管上皮细胞（HPTEC）补体C3 mRNA及蛋白的表达水平。方法：采用HPTEC，模型组TNF-α 10ng／ml诱导，治疗组在TNF-α诱导的同时，以不同浓度的积雪草苷、大黄素以及积雪草苷合大黄素进行干预，于24h后分别提取细胞RNA及上清，应用逆转录-聚合酶链反应（RT—PCR）和酶链免疫方法（ELISA）分别检测HPTEC C3 mRNA和蛋白的表达。结果：正常HPTEC具有C3 mRNA和蛋白表达，经TNF-α诱导后G表达明显上调，用不同浓度的积雪草苷、大黄素以及积雪草苷合大黄素干预后，C3 mRNA及蛋白水平表达出现不同程度的下调，呈一定的剂量依赖关系和协同作用。结论：复方积雪草有效组分能够抑制炎性细胞因子TNF-α上调所致的肾局部G过度产生。     

晕可宁颗粒对急、慢性梅尼埃病模型的影响

目的　探讨晕可宁颗粒的主要药效学 ,为临床提供药效学资料及治疗学基础。方法　采用三氯甲烷破坏豚鼠一侧膜迷路感受器模型 ,探讨受试药对眼震颤、摆头及旋转的影响 ;采用内淋巴囊和内淋巴管阻塞手术复制豚鼠膜迷路实验性膜迷路积水模型 ,研究内耳组织平均中阶面积 (SMA)增加率及形态学的变化。结果　抑眩宁阳性对照组、晕可宁颗粒 (8、16g/kg)模型给药组豚鼠眼球震颤次数减少 ,差异有显著意义 (P <0 .0 5 )。成功复制了不同程度膜迷路积水豚鼠模型 ,表现为前庭膜重度膨出 ,前庭阶缩小 ,膜蜗管增大 ,SMA增加率变大 ,差异有显著意义 (P <0 .0 1) ;晕可宁颗粒灌胃后可减轻豚鼠实验性膜迷路积水的程度 ,差异有显著意义 (P <0 .0 1) ;但与空白对照组比较SMA增加率差异无显著意义 (P >0 .0 5 )。结论　晕可宁颗粒可以减轻内淋巴囊积水程度 ,对梅尼埃病症状有对抗治疗作用。     

兔实验性上颌窦炎模型的制备和扩大上颌窦自然开口的疗效

目的 探讨实验性上颌窦炎动物模型的制备方法，并在此基础上讨论扩大兔上颌窦自然开口对慢性上颌窦炎的治疗效果。方法 40只新西兰大白兔分为6组；空白对照组(5侧)，假手术对照组(10侧)、窦口阻塞组(13侧)，仅注入细菌组(10侧)窦口阻塞加注入金黄色葡萄球菌组(20侧)，窦口阻塞加注入肺炎链球菌组(22侧)；将鼻窦炎模型再分为窦口开放和窦口扩大两组，观察术后不同时间的窦腔脓性分泌物和细菌培养情况。结果 对照组(空白对照组 假手术对照组)细菌培养阳性率为13．3％(2／15侧)，窦口阻塞组为84．6％(1l／13侧)，仅注入细菌组为10．0％(1／10侧)，窦口阻塞加注入金黄色葡萄球菌和肺炎链球菌组均为100．0％(20／20侧，22／22侧)。扩大上颌窦自然开口对实验性上颌窦炎的有效率达80.8％(21／26侧)，开放上颌窦窦口对实验性上颌窦炎的有效率达50．0％(8／16侧)。结论 窦口阻塞加注入细菌的方法可成功制造实验性上颌窦炎模型，窦口扩大术对实验性上颌窦炎的疗效较窦口开放术好。     

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.     

纤维支气管镜在急危重病人气道管理中的应用

目的 探讨纤支镜在急危重病人气道管理中的作用。方法 回顾性总结支气管镜对34例重症病人进行气道管理中的清理作用及治疗咯血，肺炎及肺不张等临床经验。结果 10例肺部感染患者，经纤维支气管镜治疗后感染均得到不同程度的控制，其中6例痊愈出院；7例肺不张者，4例行纤支镜1次肺复张，1例行纤支镜2次后复张，余2例配合其它治疗措施后复张；大咯血9例患者，经纤支镜局部应用肾上腺素及凝血酶，6例咯血立即停止，3例明显减轻；机械通气患者4例，2例痰栓致肺不张，其中1例左肺不张纤支镜吸引冲洗后复张2例诊断气管插管球囊滑脱／破裂，指导换管成功。困难气管插管患者均因常规方法失败后经纤支镜引导插管成功。结论 支气管镜是对急危重症病人进行气道管理的极有价值的工具，即可用于协助气管插管，又可胜任气道的清理作用及诊治大咯血，难治性肺部感染及急性肺不张等。     

La douleur peut-elle être perçue et cherchée plus « vivement » dans une culture postmoderne en perte de sens ?

The perception of the pain, and the “work of pain” which ensues from it, bound to the notion of trauma-hurt to subjects presenting a thought operating and a depression main part, sign a physical fixation for an object psychically not representable. These subjects have a real incapacity to perceive and symbolize the affect of psychic suffering as well borderline teenagers (self-harm). Having reminded the Freudian and psychoanalytical conceptions on the pain, the operating functioning and the self-harm behaviour, the authors will refer to certain sociological works describing certain characteristics of our post-modern social, cultural and linguistic organization to underline the impact of these in the increase of the behaviour of search for the pain to borderline patients or with the perception of the pain as only sign of a mental suffering impossible to symbolize. So, we notice that the loss of symbolic structuring of our post-modern civilization, the ascent in power of the thought operating, the social and domestic disorganizations, have a real cost on our contemporaries psychic and somatic health, particularly on the most numerous among them as teenagers.     

La fonctionnalité alimentaire : illusion aujourd’hui, réalité demain

Foods have always been considered by man as a means of ensuring his physiological needs, allowing the growth, development and preservation of the body and its tissues (nutritional value of food). To this can be added the feelings of satisfaction and well-being that food gives to its consumer, thus constituting an element that is fundamental for our physiological and mental balance (the sensorial value of food).Nevertheless, recent scientific studies have shown that over and above the ensuring of nutritional needs, eating habits can also adjust certain functions of the human organism and thus play a beneficial or harmful role on one's health (the functional value of food).The whole concept of nutrition has been enriched by the notion that eating is not only a survival reflex (satisfaction derived through eating and the avoidance of harmful effects due to eating deficiencies or excesses): eating aims to improve one's health and well-being and to reduce the risk of developing various pathologies. These new data open interesting new horizons in today's context where health is increasingly expensive and people are increasingly concerned to improve their quality of live.     

A selective modulation of the olfactory bulb electrical activity in relation to the learning of palatability in hungry and satiated rats

We attempted to determine whether a neutral odor which had become palatable as a result of learning had also acquired the property of activating the mitral cells of the olfactory bulb of hungry rats to the same extent as the odor of their usual nutriment. Male Wistar rats have been accustomed for various times to eat, during a single daily meal, exclusively a synthetic diet, either flavoured or not with eucalyptol. The mitral cell multiunit electrical activity was recorded in chronically implanted hungry and satiated animals. It was shown that: (1) in the rats having received the flavoured diet for one month when grown up, eucalyptol behaved as a nonalimentary odor towards mitral cells; (2) in the rats having received the flavoured diet (already given to the mothers) from weaning to the test period, eucalyptol behaved as a food odor at the mitral cell level, but amyl acetate, a control odor, did not activate mitral cells in hungry animals; (3) the odor of the diet with or without eucalyptol activated mitral cells at first in hungry rats, and this property was reinforced, for either diet, by its consumption beginning early and maintained continuously. It was concluded that palatability is dynamically related to the animal's previous experience, and that its modifications induce various degrees of mitral activation in hungry rats. This property allowed an electrophysiological measure of odor palatability to be proposed. The results are discussed in relation to the behavioral and neurophysiological maturation of animals.     

以人为本的医院总务保障体系

邵逸夫医院的总务工作在借鉴国外先进管理模式,改变传统观念,建立强有力的后勤保障体系方面做了大量卓有成效的工作。从医院建筑平面布置、确保医院设施正常运作,营造整洁舒适医院环境和引进全程服务机制等方面介绍了建立以人为本、以病人为中心的总务保障体系的做法。