Le surgissement de l'originaire et le « retrait hallucinatoire » dans les formes délirantes de l'éveil de coma

The clinical investigation of delirious and hallucinatory states during the awakening from a coma reveals hallucinated representations of a polymorphic nature. The diversity of their contents suggests the implication of differentiated etio-pathogenic processes. The assumption followed here, based on the conceptualizations of P. Aulagnier, is that the emergency care awakening traumatism causes a prevailing reinvestment of various operating modes, from the recovery of a “pictographic production” due to the abolition of conscience, to the fantastical scenario characterising primary education that remobilises and upsets the identity bearing layers in which the essential moments of the instinctual history were elaborated. These symptomatic constructions thus express this “in-more” generated by the psychotic processes which combine the double movement of a regression and of a “redeployment” of the traces of the Primal. This second period fulfils the paramount requirement of a primitive development of the coma awakening experience following the “postulate” of the dominance of the Primal according to which any psychic object is seen initially metabolized in a pictographic representation. The stratification noted within these dreamlike formations reveals: on the one hand modes of composition of images similar to those of the night dream; and on the other a deployment of various imagos of archaic states of the parcelled out body; and finally “psychic residues” that re-appear in the form of “parasitic” reminiscences, analysable as resurgences of psychic activities resulting from the coma phase. Thus a representation of the data of the Primal is then generated and although these data are psychic they remain forever heterogeneous and external to the Unconscious and to the I. The common clinical term which supports this analysis is “hallucinated feeling” which, according to Aulagnier, emerges sometimes within a schizophrenic patient which could be understood as equivalent to an autistic withdrawal which we suppose to be here at the heart of the deliriousness of the awakening from the coma. Thus the proposal that two etio-pathogenic logics are at work in these acute episodes: 1/ one that is initiated in a movement of decomposition of the I, due to the multiple traumatic effects of the primary affection and of the emergency care awakening process, balanced by the variations of the state of consciousness of the patient. At the time of this regression the projective mechanism, combined with other defences such as rejection or cleavage, reveals scenarios in the psychic space which mobilize images of the body and perceptive or mnemonic fragments. 2/ the other trajectory is comparable to this dynamics of the “withdrawal in the hallucination”. The re-establishment of the specific processes of the primary and secondary agencies imposes a requirement of specific psychic work consisting in metabolizing this resurgence of the pictographic representations that originate in the (quasi) nothing of the coma.     

用PowerPoint XP设计幻灯片元素动画效果的实践

PowerPoint XP新特性中突出的就是其动画设计功能的加强。文中对新增加的与动画没计相关的功能使用要点结合实际作了较详细的叙述。     

Inbreeding Affects Female Preference for Symmetry in Computer-Animated Sticklebacks

Fluctuating asymmetries are small random deviations from perfect symmetry in bilateral traits caused by the inability of individuals to cope with stress during development. The degree of asymmetry of secondary sexual characters is supposed to convey information about a male's phenotypic and/or genetic quality, and females are thus expected to use bilateral symmetry as a cue in mate choice. We offered female three-spined sticklebacks (Gasterosteus aculeatus L.) that had been inbred for one generation and outbred control females the choice between computer-animated male models differing exclusively in the symmetry of their pelvic spines. Inbred females exhibited a significantly stronger preference for the symmetric model than outbred females, suggesting that females of relatively poor quality are more prepared to pay the costs of choosiness and obtain higher marginal benefits from their discrimination than females of better quality.     

任务的呈现方式对孤独症儿童误念理解的影响

目的:探讨一种更适于测试孤独症儿童误念理解能力的方法.方法:2(呈现方式)×2(被试类型)设计,采用经典误念任务,使用计算机多媒体动画呈现方式与传统图片-实物呈现方式,分别测试20名孤独症儿童和言语能力(PPVT-R)匹配的正常儿童.结果:呈现方式的主效应非常显著(P<0.001),动画呈现方式使正常儿童和孤独症儿童的误念理解成绩都有提高,孤独症儿童的提高更大.结论:孤独症儿童的误念理解能力在误念任务的传统呈现方式之下可能被低估了.充分考虑孤独症认知缺陷的多样性,使用恰当的任务方式,可能会更真实地反映他们的心理理论发展水平.     

关于心律失常教学课件的设计制作构想

介绍了一种基于计算机动画和视频剪辑技术的心律失常教学课件的设计思想、课件内容及演示特点。     

Paradoxical brain embolism shadowing massive pulmonary embolism

Patent foramen ovale is frequently observed in the general population. In case of massive pulmonary embolism, the sudden increase in the right heart cavity's pressure may cause a right-to-left shunting across this foramen, which could be associated with conflicting outcomes. Herein, we report a case of reversible cardiac arrest preceded by seizures, and followed by hemodynamic stability without any vasopressor. A brain CT-scan showed a limited ischemic stroke. Initial echocardiographic assessment revealed an acute cor pulmonale and a right-to-left intracardiac shunt across a large patent foramen ovale, suggesting the diagnosis of massive pulmonary embolism that was lately confirmed by a multidetector CT-angiography. Anticoagulation therapy was rapidly complicated by a hemorrhagic transformation of the ischemic stroke leading to a fatal outcome. This case illustrates the double-edged circulatory effect of shunting across a patent foramen ovale in case of massive pulmonary embolism: it may have limited circulatory failure but caused in the meanwhile a fatal paradoxical brain embolism.     

Pression tissulaire cérébrale en oxygène : pour quoi faire et pour qui ?

The main purpose of neurointensive care is to fight against cerebral ischaemia. Ischaemia is the cell energy failure following inadequacy between supply of glucose and oxygen and demand. Ischemia monitoring starts with a global approach, especially with cerebral perfusion pressure (CPP) determined by mean arterial pressure and intracranial pressure (ICP). However, global monitoring is insufficient to detect “regional” ischaemia, leading to development of local monitoring such as brain oxygen partial pressure (PtiO₂). PtiO₂ is measured on a volume of a few mm³ from a probe implanted in the cerebral tissue. The normal value is classically included between 25 and 35 mmHg and critical ischemic threshold is 10 mmHg. Understanding what exactly is PtiO₂ is still a matter of debate. PtiO₂ is more an indicator of oxygen diffusion depending of oxygen arterial pressure (PaO₂) and local cerebral blood flow (CBF). Increase PaO₂ to treat PtiO₂ would hide information about local CBF. PtiO₂ is useful for the detection of low local CBF even when ICP is low as in hypocapnia-induced vasoconstriction. PtiO₂-guided management could lead to a continuous optimization of arterial oxygen transport for an optimal cerebral tissue oxygenation. Finally, PtiO₂ has probably a global prognostic value because studies showed that hypoxic values for a long period of time lead to an unfavourable neurologic outcome. In conclusion, PtiO₂ provides additional information for regional monitoring of cerebral ischaemia and deserves more intensive use to better understand it and probably improve neurointensive care management.     

计算机动漫技术展现中医诊治机理探讨

中医不能象现代医学那样,向病家展现疾病发生发展的状态和疾病的实质变化,依中医学的理论和术语解释病情对方听不懂,甚至误认为中医说不清。其实不是说不清,是中医循中国传统文化的认知规律从事诊治活动的本质不为现代人所知、所理解。中医事业的发展需要向社会展现中医诊治的机理,完成这个任务的希望在于借助现代计算机动漫技术。笔者提出这个问题,意在引起中医同仁和计算机动漫专业人员的关注,如果两者结合起来,必将为中医文化的社会化开创一条新路,这是值得思考和实践,而且关系到中医事业前途的大问题。