Problems in the "evidence" of "evidence-based medicine"

The potential influence of racially or ethnically diverse cultural perspectives on patient compliance with post-transplant treatments is discussed. Domains of competency regarding culturally sensitive clinical practice are outlined to assist providers in better understanding the perspectives that may influence the views and behavior of culturally diverse patients.     

从权势和等同关系看"小姐"一词在社会称谓中的应用

称谓语是说话人用来称呼与其对话者的用语."小姐"一词是当代汉语语言生活中的一个极为常见的称谓语,因此在"权势"和"等同"语义对立模式基础上,分析"小姐"称谓语的历史演化、语用特点以及交际功能.     

"集体智慧的结晶"与"马克思主义"的界定

马克思主义是社会主义革命和建设的指导思想,更是全人类理论发展的瑰宝.从马克思等人创建基本理论伊始,各学者就对如何定义该理论进行了探索.将马克思主义定义为集体智慧的结晶,不仅突出了马克思的个人贡献,更肯定了马克思主义研究者对马克思主义理论做出的努力和成就,也能够消除个人崇拜和教条主义,坚持人民群众是历史的创造者,并且坚持与时俱进.     

《诗经·关雎》英译之我见——兼论语篇把握在汉诗英译中的重要性

<诗经>是我国文学史的光辉起点,也是我国现实主义文学的开端.作品以抒情诗为主流,开拓性地运用了赋、比、兴等表现手法,具有很高的艺术成就,对后世文学创作产生了重大而深远的影响.<关雎>是<诗经>中具有代表性的作品,是汉文化文学宝库中的珍品,因此,翻译工作者都不遗余力地将它译介国外.许渊冲先生、韦利先生是<诗经>翻译的佼佼者,分析研究他们的译诗策略,对于总结汉语古典文学西译的经验,构建现代翻译理论,自然有着不可忽略的益处.     

图像中的"他者"

"自我"与"他者"所标榜的二分逻辑结构在本质上是同一性恩雏使然的结果,由此决定了文明与蒙昧、正统与异端、男人与女人的差异被确立并延续了下来,它们作为同一性思维在种族、信仰、性别层面上的具体衍生物,经由视觉图像获得了不同程度地传播与表征.鉴于此,本文着力从上述三个方面,就图像与同一性观念的内在相关性分层加以评述,旨在强调图像作为由来已久的一种视觉符号,持续不断地与意识形态、政治权力、性别身体等范畴发生着关联,是我们解读"自我"与"他者"关系的重要凭据.     

Tackling the "dropped nucleus"

The ability of male rats to accumulate menaquinone-4 (MK-4) in tissues when fed a vitamin K-deficient diet supplemented with intraperitoneal phylloquinone (K) as the sole source of vitamin K for 14 d was assessed. In both conventionally housed controls and gnotobiotic rats, supplementation with the equivalent of 1500 microg vitamin K/kg diet increased (P < 0.001) tissue MK-4 concentrations above those of controls fed a vitamin K-deficient diet. MK-4 concentrations were approximately 5 ng/g (11 pmol/g) in liver, 14 ng/g in heart, 17 ng/g in kidney, 50 ng/g in brain and 250 ng/g in mandibular salivary glands of gnotobiotic rats. MK-4 concentrations in conventionally housed rats were higher than in gnotobiotic rats in heart (P < 0.01), brain (P < 0.01) and kidney (P < 0.05) but lower in salivary gland (P < 0.05). Cultures of a kidney-derived cell line (293) converted K to the expoxide of MK-4 in a manner that was dependent on both time of incubation and concentration of vitamin K in the media. A liver-derived cell line (H-35) was less active in carrying out this conversion. These data offer conclusive proof that the tissue-specific formation of MK-4 from K is a metabolic transformation that does not require bacterial transformation to menadione as an intermediate in the process.     

Psychology and "the Babe"

Along with the rapid biomedical development of prenatal screening tests, target groups' attitudes and decision-making about, and the acceptance of, screening procedures have come into focus. To understand users' decision-making, it is essential to understand users' knowledge and perceptions of a procedure. The aim of this study was to examine Finnish women's knowledge and perceptions of, and stated reasons to participate in, two prenatal screening tests: serum screening and mid-trimester ultrasound screening. Subjects (n=1035) for the serum screening survey were catered for in the maternity care centres of two Finnish towns, where serum screening is available for all pregnant women. After one reminder, 88 per cent returned the questionnaire. Subjects (n=497) for the mid-trimester ultrasound screening survey were catered for in the obstetrical and gynaecological outpatient clinic of the city hospital of another town; the response rate was 85 per cent. Women's perceptions of the studied prenatal screening tests, serum screening and mid-trimester ultrasound screening, differed significantly, even though both are used to detect fetal malformations. Serum screening was far more often perceived to be connected with finding diseases or abnormalities than ultrasound screening. Another interesting finding was that the stated reasons for screening in general and the subjective reasons for participation were different. Reassurance was the personal reason most often mentioned in both the serum screening and the ultrasound group. Almost all women had the most superficial knowledge about serum screening; they knew whether it had been offered and that it is done to screen for Down syndrome. The greatest gaps in knowledge concerned the sensitivity of serum screening, its use in screening for congenital nephrosis, and diagnostic tests and their risks. Knowledge was poorer among women without a high school education. When counselling women about prenatal screening tests, more emphasis should be given to the sensitivity of serum screening, all of its screening uses, and the possible diagnostic tests and their risks. The fact that ultrasound screening can detect conditions which may lead to the possibility of a selective abortion should also be explained more fully.     

社会(society)还是社会性(the social)?——社会学学科的再定位

用研究对象来进行学科界定,是社会学的传统做法.这种方法存在诸多问题:宏观与微观的二难;学科史书写中"社会"的强势;以及将社会学理解为研究"社会"所带来的学科边界的模糊性.更值得注意的是,"社会"本身在许多社会学家那里遭到了挑战.这些问题引发了对社会学学科定位的重新思考.社会学区别于其他学科的根本之处就在于它独特的方法论--社会性地看待问题.比起从研究对象出发,从研究方法来界定社会学更具有可取之处.这种对社会学的再界定,必然要求用"社会性"(the social)替代"社会"(society),并将之作为社会学的核心概念.     

"Born from the flank"--discussion concerning "cesarean section" in animals in the Talmud

We determined growth hormone (GH) and insulin-like growth factor I (IGF-I) levels after a 3 h infusion of escalating doses of growth hormone-releasing hormone (GHRH(1-29)) followed by a bolus injection in hypopituitary patients with marked differences in pituitary features at magnetic resonance imaging (MRI) in order to evaluate further the contribution of MRI in the definition of pituitary GH reserve in GH-deficient patients. Twenty-nine patients (mean age 14.5 +/- 4.0 years) were studied. Group I comprised 13 patients: seven with isolated GH deficiency (IGHD) (group Ia) and six with multiple pituitary hormone deficiency (MPHD) (group Ib) who had anterior pituitary hypoplasia, unidentified pituitary stalk and ectopic posterior pituitary at MRI, Group II consisted of eight patients with IGHD and small anterior pituitary/empty sella, while in group III eight had IGHD and normal morphology of the pituitary gland. Growth hormone and IGF-I levels were measured during saline infusion at 08.30-09.00 h, as well as after infusion of GHRH (1-29) at escalating doses for 3h: 0.2 micrograms/kg at 09.00-10.00 h, 0.4 micrograms/kg at 10.00-11.00 h, 0.6 micrograms/kg at 11.00-12.00 h and an intravenous bolus of 2 micrograms/ kg at 12.00 h. In the group I patients, the peak GH response to GHRH(1-29) was delayed (135-180 min) and extremely low (median 2mU/l). In group II it was delayed (135-180 min), high (median 34.8 mU/l) and persistent (median 37.4 mU/l at 185-210 min). In group III the peak response was high (median 30.8 mU/l) and relatively early (75-120 min) but it declined rapidly (median 14.4 mU/l at 185-210 min). In one group I patient, GH response increased to 34.6 mU/l. The mean basal value of IGF-I levels was significantly lower in group I (0.23 +/- 0.05 U/ml) than in groups II (0.39 +/- 0.13U/ ml, p < 0.01) and III (1.54 +/- 0.46 U/ml, p < 0.001) and did not vary significantly during the GHRH(1-29) infusion. The present study demonstrates that the impaired GH response to 3 h of continuous infusion of escalating doses of GHRH(1-29) was strikingly indicative for pituitary stalk abnormality, strengthening the case for use of GHRH in the differential diagnosis of GH deficiency. The low GH response, more severe in MPHD patients, might be dependent on the residual somatotrope cells, while the better response (34.6 mU/l) in the group Ia patients might suggest that prolonged GHRH infusion could help in evaluating the amount of residual GH pituitary tissue. Pituitary GH reserve, given the GH response to GHRH infusion in GH-deficient patients with small anterior pituitary/empty sella, seems to be maintained.     

Workshop "Radio-oncology and the Law"

From 25 to 27 Sept 1997, a workshop was organized at the Essen Medical School (Universit?tsklinikum Essen), at which radiooncologists and jurists from universities and courts as well as lawyers contributed their views on mutual problems. The following topics were discussed by papers and in round table meetings: "Requirements on the patient's information", "definition of therapeutic guidelines-limits of clinical research and standard treatments", "treatment documentation", "liability of the physician for treatment faults" and "technical standard and preserve of quality". The consensual guidelines to the topics "patient's information", "therapeutic guidelines" and "liability" are presented here.     

"Superstition" in the Skinnerian.

In the case of some tasks, implicit responses produce better results than overt ones. Overt responding is not an essential feature of programmed instruction and, in fact, may even be a deleterious one in some cases. Being informed of the correctness of response before making it resulted in more efficient learning than being informed after making the response. "This story has three morals, but they are all very simple. The first is that not all the features of a gadget are dictated by theoretical principles. The second is that what works beautifully in one context may not work so beautifully in another. The third moral is that superstitious behavior is not restricted to pigeons." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Extension of the "elephant trunk" technique in complex aortic pathology: the "bidirectional" option

BACKGROUND: The "elephant trunk" technique, using a free-floating vascular prosthesis, was originally described to facilitate a subsequent operation on the downstream aorta. We developed an additional refinement of this technique, called the "bidirectional elephant trunk." This option may represent an interesting tool in more complex aortic operations, especially when the descending aorta has to be replaced first in patients with concomitant pathology of the ascending aorta or of the aortic arch. METHODS: The initial operation is performed through a left thoracotomy. The proximal elephant trunk is created by invaginating the future aortic arch graft into the descending aortic graft. The proximal anastomosis between the doubled graft and the proximal descending aorta is performed first. During construction of the distal anastomosis, a distal elephant trunk may be inserted likewise. If the aortic arch and ascending aorta have to be replaced later, this second step is performed through a median sternotomy. The free-floating arch graft is pulled out of the proximal descending aorta with a nerve hook, unfolded, and used for total arch replacement. RESULTS: This technique was used successfully in 3 patients without mortality. No major complications were observed excepted persistent hoarseness in a patient with preoperative paresis of the recurrent nerve. No perfusion problems due to the unfolding of the free-floating graft occurred during the second operation. CONCLUSIONS: The bidirectional elephant trunk technique is an interesting option that may be suitable for patients presenting with a complex pathology of the whole thoracic aorta when the descending segment has to be replaced first.