24/03/2023

疼痛特定穴位比憂鬱特定穴位的針灸具有更優越的鎮痛效果,且反之亦然?

特定針灸穴位對於慢性疼痛和憂鬱症的療效及其機轉研究

蘇冠賓

中國醫藥大學 安南醫院副院長
憂鬱症中心身心介面研究中心主持人
精神醫學及神經科學教授


傳統中醫學 (TCM) 是一種全人整合的醫療,根據TCM的理論,經絡流動—「氣」的失調所導致的身心疾病,可以透過針灸刺激沿著經絡的特定穴位,恢復氣的流動,促進健康。穴位的選擇基於患者症狀、病史和體質的診斷。根據TCM的理論,選擇針對疼痛的穴位通常是基於它們在筋肉系統內的位置。幾項研究表明,特定的疼痛穴位對於各種慢性疼痛具有止痛功效,同理,調節中樞和周邊神經系統的特定憂鬱穴位的針灸治療,也可以在隨機對照試驗中顯示出抗鬱的療效。

憂鬱症 (MDD) 和慢性疼痛 (Chronic Pain) 經常合併存在,除了生物學上兩者具有共同之生物學機制,治療上也常發現,針對其中一種疾病的治療也會改善另一疾病的症狀。中醫上針灸常用於治療疼痛和憂鬱症,且臨床上會選擇不同之針灸穴位來改善特定症狀,所以我很好奇:「特定的針灸穴位是否會有特定的療效和免疫效應」?

身心介面研究中心 (MBI-Lab) 團隊和中醫大針灸所林以文教授及廖先胤醫師合作,針對47位合併慢性疼痛和重度憂鬱症 (MDD) 的患者,利用雙盲隨機分配、交叉對照的試驗設計,運用針對疼痛或憂鬱症的兩組特定穴位,對同一患者交替治療,並在治療期和交替清除期 (washout) 的前後,測量臨床反應 (疼痛和憂鬱量表) 和促炎症細胞激素。


中醫認為人體經脈是疾病治療的關鍵,不同的穴位有不同的療效。本實驗中,受試者接受兩類不同的穴道治療,一類穴道專門治療疼痛,另一類專門治療憂鬱,治療憂鬱使用了:三個能開竅醒腦的穴位:百會、四神聰和攢竹;兩個行氣活血的穴位:太衝和頭臨泣;以及四個養心安神的穴位:三陰交、印堂、神門和內關。另外,為了治療不同部位的慢性疼痛,本研究選擇了十四個針對特定身體部位的痛症穴位,幫助患者舒筋活血,通關利節、補腎壯腰、疏風散邪。參與研究的患者隨機被分成兩組:(1)憂鬱症-疼痛組(23名患者接受十二次憂鬱症特定穴位治療,然後在清除期後,再接續十二次疼痛特定穴位治療)和(2)疼痛-憂鬱症組(24名患者進行相反的順序)。針灸療程共24次,每次留針20分鐘。每次治療中,醫師會請患者分別趴著或仰著接受治療,並使用34號1.5寸針針灸大部分穴位(環跳穴使用30號3寸針),針灸過程由兩位有十年以上臨床經驗的主治醫師操作至得氣,臨床療效的評估者與病患事先不知道預期的療效,對治療型態維持雙盲。

結果發現,疼痛特定穴位對疼痛並沒有比憂鬱症特定穴位更顯著地減少疼痛問卷。同樣的,憂鬱症特定穴位對於減輕漢密爾頓憂鬱量表的得分也沒有顯著優於疼痛特定穴位。疼痛特定穴位和憂鬱症特定穴位都顯著減低發炎激素 (IL-6、IL-1β & TNF-α),但兩種治療抗發炎程度沒有顯著差異。

這項研究否定了我們原本的假設,也就是沒有証實:「針對疼痛的特定穴位可能產生比針對憂鬱的特定穴位更優越的鎮痛效果,反之亦然」。抗發炎細胞因子的實驗結果,可能暗示著疼痛和抑鬱之間存在共同的生物學機制,也証明發炎反應在治療憂鬱症和慢性疼痛的重要性,因此論文得到頂尖期刊的青睞!這篇文章剛剛發表在影響係數19分的BBI (Personal Link for 50 days' free access to our article): https://authors.elsevier.com/a/1goYn3AAzzhDsZ

Clinical Efficacy and Immune Effects of Acupuncture in Patients with Comorbid Chronic Pain and Major Depression Disorder: A Double-Blinded, Randomized Controlled Crossover Study. Brain Behav Immun. 2023 Mar 20:S0889-1591(23)00073-9.

02/03/2023

ChatGPT在學習學術寫作的應用

 ChatGPT在學習學術寫作的應用 (Learning English writing with OpenAI)

蘇冠賓

中國醫藥大學 安南醫院副院長
憂鬱症中心身心介面研究中心主持人
精神醫學及神經科學教授

先說結論:

一、研究生不應該讓AI寫自己的作業,不過可以利用AI學習英語學術寫作

二、ChatGPT可以以最快速有效的方式,讓寫作能力不及格的學生變成60分及格、讓65分的論文變成75分,所以未來只有少數狀況外的學生的英文寫作會不及格


研究生論文寫作其他參考資料:



研究生不應該讓 AI 寫自己的作業,不過可以利用AI學習英語學術寫作 Don't rely on AI for homework; use it to learn English writing




Rephrase in scientific writing style: “…..”

Re-write in scientific style for publication: “…..”

  • Use the words "unmet clinical need"
  • Rephrase to fit 100 word limit
  • More concise
  • Which sentence is better: "..." OR "..."
  • You are an expert in psychiatry helping your student to re-organize the following paragraphs, which are poorly organized with FRAGMENTAL PIECES OF IDEAS WITHOUT LOGICAL CONNECTION. Re-write in scientific style for publication: "..."
  • Rewrite the paragraph. Start with the ideas that "depression is important in dementia". And conclude with the ideas that "treating depression in dementia is a challanging clinical issue..." 
在圖片的例子中,可以看到 ChatGPT 更正了明顯的文法錯誤、加深了用字,改進了寫作風格...... In the following example, you can see ChatGPT corrects the obvious grammatical mistakes, expands word usages, and improves the writing styles....

記住:不要只是“複製和貼上”,要專注於AI如何修改你的寫法,如果是寫論文,一定要檢查 Turnitin 的相似性和剽竊風險。Remember: Don't just "copy and paste", concentrate on how to improve your writing, and of course if you're writing papers, do check the Turnitin for similarity and plagiarism.



AI會「虛談 Confabulation」


對於學術或醫學的問題,ChatGPT提供的回答內容的本文不常錯誤,但其提供的參考文獻 (Reference) 有一半都是「看上去像是真的」,但是並不存在的文獻。建議使用者必須根據列出的文獻上網去一一查證!  





利用AI修改的內容,對照AI省略和疏忽的部分


在下列的例子當中,學生在不同句子中,重複相同的概念,以至於用過多冗長的文字,影響論文的精簡和精確。此時學生可以利用ChatGPT,先把段落進行精簡化,但會發現ChatGPT刪除許多重要的專有名詞、專業文字、引用出處,所以學生應該參考新的段落,對照之後再重新加入重要但被刪除的部分。



透過對話過程,不僅改善文字文法和寫作,更能精準修改段落的邏輯


以下例子是初學的學生很常犯的錯誤。

學生的研究論文是發現,某項非藥物治療對失智患者的憂鬱疾狀治療有療效且安全。所以研究背景第一段,重點通常是「探討失智患者憂鬱疾狀治療」的重要性。然而學生卻常常把教科書和論文當中讀到的重點,拼湊成研究的背景,句子跟句子當中沒有邏輯性的連結,更也沒有精準地針對該研究應該探討的重點,更缺乏較為精準的文獻回顧佐證,來引出執行該研究的目的以及需要。
  • Prompt: You are an expert in psychiatry helping your student to re-organize the following paragraphs, which are poorly organized with FRAGMENTAL PIECES OF IDEAS WITHOUT LOGICAL CONNECTION. Re-write in scientific style for publication: "..."

結果ChatGPT第一次只有修改了學生的文字文法和寫作,以及片段的文句邏輯。但「透過對話過程」,更加精準修改段落的重心。這結果真的讓人相當驚豔!!
  • Rewrite the paragraph. Start with the ideas that "depression is important in dementia". And conclude with the ideas that "treating depression in dementia is a challanging clinical issue..." 






對於學術或醫學的問題,ChatGPT提供的回答內容的本文不常錯誤,但其提供的參考文獻 (Reference) 有一半都是「看上去像是真的」,但是並不存在的文獻。建議使用者必須根據列出的文獻上網去一一查證!
我不了解AI的運作,不知道為什麼AI會說謊造假,或者應該說像是confabulation (虛談)。
所有心情:
Hsing-i Tseng、Yen-Feng Lin和其他56人
ng和其他25人

20/12/2022

熟悉WORD基本功能(範例)

 蘇冠賓

中國醫藥大學 安南醫院副院長
憂鬱症中心身心介面研究中心主持人
精神醫學及神經科學教授










Memo for MBI-Lab Postgraduates from Prof Kuan-Pin Su—Avoid Desk Rejection

Memo for MBI-Lab Postgraduates from Prof Kuan-Pin Su—Avoid Desk Rejection (Translated by Wu Suet Kei & Kai-Jie Yang) 

中文版:MBI-Lab研究生備忘錄:避免Desk Rejection(蘇冠賓)

The desk rejection rates of high-impact journals are very high currently. To avoid spending the valuable time and effort of peer review, the editors-in-chief (EIC) and associate editors often screen out the majority of the low-quality manuscripts (As the peer reviewers tend to be too busy to accept the invitation to review articles for journals). 

Here are the reasons why the EIC rejects your submission within three minutes (although it may already take two weeks to start reading your manuscript files): 

1. The main reason for Desk Rejection: No novelty can be found in the Title & Abstract. Lack of clear focus in hypothesis and the research purpose. The Abstract is vague without specific data or descriptions. In addition, the research topic does not match the journal's Aims and Scope (For example, the editors could not find all the components of of Brain(Neurosciences)/Behavior(Psychiatry or Psychology)/Immunity(Inflammation or immune) in the Title & Abstract when you actually submit to Brain Behavior and Immunity). 

2. Secondly, poor language & poor manuscript presentation. Multiple mistakes at first glance. Especially if the Abstract is not well written, it is like a "suicidal" behavior of authors. Writing that is hard to understand and frequent grammatical mistakes will cause the chief editors to subconsciously question the professionalism and reliability of the research. Moreover, you must be sophisticated with the document softwares. The improper layouts and formats will cause a bad impression. For example, you need to consider that most of the articles are now digitized as PDFs, which make the reviewers easy to read on a laptop or tablet (or even a mobile phone). The reviewers might got annoyed to read a title page that last 4-5 pages long and flipping multiple pages when reading the Abstract if you still use the double-spaced all the time. 

3. Third, the managing editors always receive the plagiarism report of the article synchronously automatically attached by the submission system. If the repetition is too much, it will be instantly rejected.

Researchers, who do not have much experience in writing papers, must face the problem of the lack of academic English ability, because "academic English ability" is different from the real "English ability". The academic writing skills are easy to improve. Under the indulged care of the supervisors, some researchers constantly rely on the supervisors to correct the most basic and common mistakes. As a result, the supervisor will become more and more reluctant of revising the papers from those students who do not put much effort into their writing, thus slowing down the productivity of the research students. Therefore, graduate students should read widely, imitate the writing of similar papers, practice writing, write a lot and bravely ask experienced teammates to make peer review, build up courage from making mistakes, and avoid the following common mistakes:

1. Don't stop with the "first draft, leave blank, unfinished" version, instead, you need to send the "submission-ready version of the manuscript" and cover letter" to the supervisors. The so-called submission-ready version means "if the professor does not edit it, the article can be immediately submitted". Students should try their best to complete the version that they think can be submitted, and then only ask the professor to revise it. (See: https://cobolsu.blogspot.com/2022/08/blog-post_14.html)

2. Abbreviation from nowhere. You need to spell it out for the first time. And the sessions of Title, Abstract, Text body, Figures, and Tables are all independent (spell out again). 



3. Making common grammatical mistakes repeatedly (Native English speakers recognize these errors at a glance, and subconsciously doubt the reliability of the research)
  • Single versus plural
  • Missing/incorrect indefinite/definite articles
  • Pronouns
  • Spelling out when first use
  • Incorrect tense, ...
  • You must know why it’s grammatically wrong, otherwise, you will make the same mistakes again and again. After that, revised the whole article carefully, make sure no similar mistakes, and send it back to the professor for revision. Please don’t rush, learning is much more important.
4. Avoid Ineffective and Meaningless Sentences: The worst situation is INEFFECTIVE and REDUNDANT SENTENCES. (Even native English speakers make such mistakes). Here is an example of INEFFECTIVE and REDUNDANT SENTENCES: 


5. Avoid poorly structured paragraphs: The first sentence is the one-sentence summary of the paragraph, and each sentence must have a complete concept. For example:  





MBI-Lab研究生備忘錄:避免Desk Rejection(蘇冠賓)

蘇冠賓

中國醫藥大學 安南醫院副院長
憂鬱症中心身心介面研究中心主持人
精神醫學及神經科學教授



現在期刊的 Desk Rejection rate 很高,優質的主編和副主編都會在第一關把守,刪除大量品質不佳的論文,以免浪費「同儕審查者」珍貴的資源(現在專家都很忙,收到太多的審查邀請多半不會接受)。

以下是主編在三分鐘內就會Desk Rejection的原因(雖然可能拖了兩週才打開你的論文檔案):

一、 Title & Abstract 看不出任何新意,看不出明確重點、或研究目的或結論很模糊不能聚焦。此外,研究題材和期刊的 Aims and Scope 相符度不高(例如:投到 Brain Behavior and Immunity,但在Title & Abstract 看不到和Brain(Neuroscience)/Behavior(Psychiatry or Psychology)/Immunity(Inflammation)的重點;又例如:Abstract描述你的論文是「台灣第一篇」,這代表你的論文主要特色和創新是「來自某區域的再現結果」,那也是高競爭期刊Desk Rejection的因素(無創新性)!要思考全世界科學家有興趣的科學問題,不是某區域又出現一篇呼應的論文。)

二、 Poor language or poor manuscript presentation 也很直接,文章看一眼就有錯誤,特別是Abstract寫不好,都是作者「自殺」的行為。閱讀上不容易了解、文法文字風格錯誤頻繁,會造成主編在潛意識中質疑研究的專業性和可靠性。此外,要把文書軟體的功能學好,編排不美觀造成印象很差(熟悉WORD基本功能)。例如現在文章都是作成PDF電子化,讓 Reviewer 在電腦或平版 (甚至手機) 上讓好讀為原則,現在還在用 double space 把 title page 搞到 4-5 頁,讀 Abstract 還要換頁, reviewer 也會不耐煩。

三、 現在主編收到文章就會自動附上plagiarism report,如果重覆性太高也沒有修稿,也是自動送死。


對一位對於沒有太多寫作論文經驗的新手研究員,要勇敢面對自己學術英文能力不足的問題,因為「學術英文能力」和真正「英文能力」不同,研究論文寫作的技巧很容易改善。有些研究人員在指導教授細心呵護下,不斷依賴指導教授去修改最基本和常見的錯誤,結果會讓指導教授愈來愈怕去修改那些不用心學習研究者的論文,以致於減緩了研究者的生產力。所以,研究生要大量閱讀,模仿同類型論文的寫法,大量寫作並大膽讓團隊有經驗的同事去做同儕修改,勇於累積錯誤經驗,並且避免以下常見錯誤:

1. 不要給指導教授「初稿、留空白、未完成」的版本:要養成交給指導教授 “Submission-ready version of manuscript and cover letter”。所謂 Submission-ready version的意思,就是「如果教授沒有改,文章馬上可以直接投稿」的意思。學生盡力獨力完成到自己認為可以投出去的版本,再讓教授修改。

2. Abbreviation from nowhere (無厘頭縮寫). You need to spell out for the first time. And the sessions of Title, Abstract, Text body, Figures and Tables are all independent (spell out again). 


 
3. Making common grammatical mistakes repeatedly (文法錯誤英美人士一眼就識出,潛意識就質疑研究的可靠性。)
  • Single versus plural
  • Missing/incorrect indefinite/definite articles
  • Pronouns
  • Spelling out when first use
  • Incorrect tense, ...
  • 這些都是英美人士反射性看出來的錯誤,必須知道為何是錯的,不然會一直犯!
  • 先了解文法錯誤的原因,把全文仔細改正過,再寄回老師修改。學習比較重要,不要急!

4. 「不明確、空泛、沒有完整概念」的句子:The worst situation is INEFFECTIVE and REDUNDANT SENTENCES. (「重覆冗長不簡捷不精確 (INEFFECTIVE and REDUNDANT SENTENCES)」的文字,即便是英美人士也常犯錯。)

這一組句子是INEFFECTIVE and REDUNDANT SENTENCES

5. 結構不佳的段落:句子結構的原則、說明和例子(句子的頭就是段落的one-sentence summary,而每個句子都要有完整的概念)