Bone Mass,Bone Microstructure and Biomechanics in Patients with Hand Osteoarthritis

The impact of primary hand osteoarthritis (HOA) on bone mass, microstructure, and biomechanics in the affected skeletal regions is largely unknown. HOA patients and healthy controls (HCs) underwent high-resolution peripheral quantitative computed tomography (HR-pQCT). We measured total, trabecular, and cortical volumetric bone mineral densities (vBMDs), microstructural attributes, and performed micro–finite element analysis for bone strength. Failure load and scaled multivariate outcome matrices from distal radius and second metacarpal (MCP2) head measurements were analyzed using multiple linear regression adjusting for age, sex, and functional status and reported as adjusted Z-score differences for total and direct effects. A total of 105 subjects were included (76 HC: 46 women, 30 men; 29 HOA: 23 women, six men). After adjustment, HOA was associated with significant changes in the multivariate outcome matrix from the MCP2 head (p < .001) (explained by an increase in cortical vBMD (Δz = 1.07, p = .02) and reduction in the trabecular vBMD (Δz = −0.07, p = .09). Distal radius analysis did not show an overall effect of HOA; however, there was a gender-study group interaction (p = .044) explained by reduced trabecular vBMD in males (Δz = −1.23, p = .02). HOA was associated with lower failure load (−514 N; 95%CI, −1018 to −9; p = 0.05) apparent in males after adjustment for functional status. HOA is associated with reduced trabecular and increased cortical vBMD in the MCP2 head and a reduction in radial trabecular vBMD and bone strength in males. Further investigations of gender-specific changes of bone architecture in HOA are warranted. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.     

Unpleasant Bodily Odour in a Psychoanalytic Treatment: Bridge or Drawbridge to a Troubled Past?

In this paper, I explore the topic of primitive bodily communications and countertransference enactments, with a particular focus on the part played by bodily odour. To explore this topic, I discuss a two-year treatment with a patient who presented with a mix of borderline and narcissistic diagnostic features. I describe meaningful aspects of the difficulties faced in countertransference work when receiving and making sense of the patient's use of primitive defences and I highlight their expression through a very uncomfortable symptom: an extremely unpleasant bodily smell. My thesis is that the smell communicated preverbal and unsymbolized experiences of early physical and emotional neglect, as well as evacuating the toxicity of those experiences. In this way the smell acted both as a bridge, which could help me reconstruct my patient's early traumatic past, and as a drawbridge, to keep me at distance and maintain his past dissociated. The invasive and aversive nature of the smell can also be seen as representing the approach-avoidance dilemma typical of a disorganized attachment state of mind, acting both as a bridge and as a drawbridge to attachment and relating.     

新生鼠胰岛干细胞分离、培养和分化的实验研究

目的　探索新生鼠胰岛干细胞体外分离鉴定、培养以及体外分化的方法。方法　用胶原酶消化新生大鼠胰腺 ,将消化的组织碎片在pH7.4～ 7.6条件下经含血清RPMI 164 0及无血清RPMI164 0 (添加bFGF ,EGF ,N 2 )培养液中培养 ,观察形成类胰岛样细胞团的全过程。用胰岛素释放实验检测胰岛功能 ,免疫荧光法检测nestin的表达。结果　胰腺消化碎片培养 3 6h内 ,可见nestin阳性细胞贴壁 ,添加bFGF ,EGF ,N2后nestin阳性细胞快速增长 ,18～ 2 4d形成类胰岛样细胞团 ,并可表达胰岛素。结论　胰腺细胞中nestin阳性细胞具有胰岛干细胞特点 ,经体外培养可获得类胰岛样细胞团     

全层缝合在预防阑尾炎术后切口感染中的应用

目的：探讨全层缝合在预防阑尾炎术后切口感染的治疗效果。方法：将皮肤、皮下组织、腹外斜肌腱膜全层褥式缝合(腹膜不予缝合)。结果：56例患者无一例感染，也未发现近期并发症。结论：此方法对预防切口感染有较好疗效，且能缩短手术时间，操作简单，建议值得临床应用。     

面对《医疗事故处理条例》的实施医院应采取的对策

为实施《医疗事故处理条例》,必须加强医院自身建设,规范管理。并从强化教育、严格准入制度、健全规章制度,规范病案与物证管理,尊重患者知情同意权,及时化解纠纷,分摊风险责任,维护合法权益等八个方面进行研讨提出对策。     

必须重视中药新药质量标准和制剂稳定性的研究

从审评工作的角度,提出我国要研制出在世界上有竞争力、安全有效的中药新药,必须重视中药新药质量标准和制剂稳定性的研究。同时,应加强新药审批办法的学习,以提高中药新药的申报水平。     

On ‘The Hatred of Learning from Experience’: A Work Journal Revisited

In January 1999, I started a two-year course in psychodynamic counselling. One of the course requirements was to produce several work journals each term. They could be on any topic the student wished to think about or explore that pertained to the course, be it clinical or theoretical work, or professional/personal development. Three months later, I wrote one on Bion's (1962) concept of ‘the hatred of learning from experience’, after a seminar on his work. In Section 1, I present the work journal itself, in which I described my difficulties with anxiety about the course in relation to this concept: how I felt I needed to be a perfect student who ‘knew everything’; my intolerance of making mistakes; and my hatred of not knowing; in tandem with my envy of others' knowledge. In Section 2, I describe my current understanding of what I was rather desperately attempting to work out in the journal – taking into consideration both my emerging feelings, in light of my own history and state of mind, together with what I had come to understand – that the course was poorly structured and did not provide an adequately safe framework for clinical work and learning. This resulted in my decision to leave. In Section 3, I write about the arduous but ultimately rewarding process of returning to training, eventually culminating in my qualification as a psychodynamic psychotherapist. My final thoughts are presented in Section 4.     

The So-Called Borderline Patient: Aetiology,Diagnosis, and Treatment

This short paper examines the relationship between borderline psychopathology and various theories regarding the aetiology of this disorder. In the formation of borderline personality organization, distinct structural alterations in personality development are thought to arise from both genetic/neurobiological and environmental/trauma factors. We concur that these variables are instrumental in the formation of borderline personality organization. However, we believe that genetic/neurobiological variables are more closely related to developmental deficits, whereas environmental/trauma factors are primarily associated with either arrested development or regressive phenomenon. Regardless of aetiology, the resultant borderline personality organization disorders may present with comparable symptoms. Further, we hypothesize that the prognosis for response to treatment is related primarily to whether the borderline disorder arises from developmental deficits, arrested development, or regressive phenomena. Diagnostic indicators and treatment considerations for each of the borderline aetiologies are presented.     

中医药抗消化性溃疡复发的机理研究思路

从溃疡愈合质量（QUH）,以及QUH与表皮生长因子、前列腺素、热休克蛋白、免疫功能（T细胞和IL－8）和HP等方面关系,探讨消化性溃疡（PU）复发机制;并从中医药抗PU的复发,改善胃粘膜血流,增强胃粘膜屏障,根除HP,提高QUH等方面阐述了抗PU复发的具体思路。