曝露与反应预防疗法在强迫性障碍患者中的临床应用研究

选择我院样本数据展开分组对比研究以得出强迫性障碍患者采用曝露与反应预防疗法的具体临床效果。方法 随机地从我院2023年2月至2024年2月之间接诊治疗的强迫性障碍患者群体中选取60例作为本次的研究对象,使用计算机随机数字表方法,将患者平均分为两组,每组包含30名患者,分别命名为实验组和对照组。对照组患者仅接受常规临床使用的氟西汀治疗,而实验组则在氟西汀治疗的基础上加入了曝露与反应预防疗法,经过治疗后,对两组患者的疗效、Y-BOCS评分、SAS、SDS及GWB评分等指标进行比较分析。结果 采用不同治疗方法后,实验组的治疗效果优于对照组,且在Y-BOCS评分、SAS、SDS、GWB评分等方面均显著优于对照组(P<0.05)。结论 针对强迫性障碍患者的治疗,曝露与反应预防疗法有着明显地增效,患者的各项指标均明显好转,因此可将该方法在临床中推广使用。

运用暴露反应预防疗法治疗强迫症1例报告

目的探讨暴露反应预防(ERP)疗法治疗强迫症(OCD)患者的有效性和起效因素。方法根据治疗手册采用ERP疗法治疗OCD患者,总计8周,每周1次,每次1 h;用耶鲁-布朗强迫量表定期评估疗效。结果经过8周治疗,患者症状严重程度减分率为40%。结论采用ERP疗法治疗OCD患者是有效的,起效因素与患者、治疗师与治疗联盟有关。

偏头痛的预防疗法

偏头痛预防疗法目的是减少发作频率和减轻发作程度,最终改善偏头痛患者的生活质量。该疗法主要用于发作频率较高的患者,但患者是否愿意进行预防治疗与急性期治疗的有效性紧密关联。目前,日本预防疗法主要是普奈洛尔、阿米替林、丙戊酸和洛美利嗪,而血管紧张素Ⅱ受体阻断剂和肉毒素(BTX)有望成为新的偏头痛预防药物。

强迫症的诊断和治疗

强迫症是一种难治性的精神障碍,其发病率高、治愈率低、致残率高。在诊断上,常被误诊为焦虑症或抑郁症。在治疗上,仅采用药物治疗,往往难以取得满意的疗效。本文将介绍强迫症的诊断和治疗,并结合当前治疗的新理念阐述笔者的经验和体会,为强迫症的诊治提供新的思路。

剖宫产手术后下肢血栓性静脉炎死亡1例

下肢血栓性静脉炎是妇产科术后较严重并发症,可引起血栓后综合征和肺血栓栓塞等严重并发症的发生,因此,不容忽视,应加强护理及预防措施。

治疗偏头痛:用较新的药品和用药方式所作的药理分析(Barry Baumel MD May 1994 NEUROLOGY 44 (Suppl3))

对偏头痛的处置方式通常主要有两种,即预防疗法和阻断病程疗法。预防疗法用来降低发病频率,缩短发病时减轻发作强度。

儿童肿瘤治疗的分寸:权衡毒性与治愈

我们如何权衡延长肿瘤患儿存活期与治疗引起的长期副作用呢?关键是看人们如何定义治疗成功。三十年前认为存活就是治疗成功,但最近治疗许多肿瘤患儿所取得的进步,使我们开始考虑还有必要检查存活期的质量。对于急性淋巴母细胞白血病患儿,通过运用各种药物的化疗、更好的支持疗法以及关键地增加了中枢神经系统(CNS)预防疗法。

Mechanisms of action of leptin in preventing gastric ulcer

To investigate the effects of leptin （1-20μg/kg） on acidified ethanol （AE）- and indomethacin （Indo）-induced gastric lesions in rats and compare it with ranitidine, lansoprazole, and omeprazole and to determine its mechanisms of actions.METHODS： Gastric ulcers, which were approximately 1 mm in width, formed in the glandular portion of the gastric mucosa produced by oral administration of either AE or Indo were taken as ulcer index. The inhibitory effect of subcutaneous administration of leptin, two proton pump inhibitors （PPIs） lansoprazole and omeprazole, or H2-receptor antagonist ranitidine 30 min before AE or Indo was evaluated.A radioimmunoassay was used to determine the PGE2 concentration in the homogenate of the glandular portion of the stomach. We performed histological study of the glandular stomach for the evaluation of total, acidic, and sulfated mucus content.RESULTS： Subcutaneous administration of leptin, two PPI slansoprazole and omeprazole or H2-receptor antagonist ranitidine 30 min before AE or Indo produced a dosedependent and reproducible inhibition of gastric ulcers （GUs）. This inhibition was found to be more potent than other antagonists used. In N^G-nitro L-arginine methyl ester （L-NAME）-pretreated animals, the ulcer prevention ability of leptin in AE-induced ulcer was significantly reduced,compared to rats without L-NAME pretreatment. However,the ulcer prevention ability of leptin was not altered by L-NAME treatment in Indo-induced ulcers. Leptin produced a dose-dependent increase in PGE2 level in the gastric glandular tissues. Leptin also increased mucus secretion.CONCLUSION： The results of the present study show that leptin inhibits GU formation by AE or Indo in a dosedependent and reproducible manner in rats. The results also suggest that leptin prevents ulcer formation by increasing the activities of the cyclo-oxygenase and/or nitric oxide pathways and by increasing mucus secretion.

Study of virtual reality for mild cognitive impairment:A bibliometric analysis using CiteSpace

Objectives Non-invasive and low-cost virtual reality(VR)technology is important for early evaluation and intervention in mild cognitive impairment(MCI).This study aimed to demonstrate the current status of overseas and domestic research as well as the focus and frontier of VR technology among individuals with MCI through a bibliometric analysis.Methods Studies from the core collection of Web of Science™between 1995 and 2020 were used;furthermore,CiteSpace 5.7 R3 was utilized to analyse information on authors/cited authors,keywords,burst words,and cited references.Results In total,230 publications were identified.Most studies were published in the USA(45 publications)and Italy(41 publications),where Guiseppe Riva ranks first(14 publications),and Tarnanas I is the author with the highest centrality(0.44).The hot topics in VR applications in the MCI population are‘physical activity,’‘people,’‘single-blind,’‘disease,’‘walking,’‘technology,’‘working memory,’and‘risk’in recent years.The keyword‘mild cognitive impairment’has attracted extensive attention since 2012,showing the strongest citation outbreak(8.28).The clustering results of the literature show the research types and emerging trends,including‘exergame,’‘serious games,’‘spatial navigation,’‘activities of daily living,’‘exercise,’‘enriched environment’and‘wayfinding.‘Conclusions Cognitive assessment and nonpharmacological intervention research on patients with MCI have become the focus of dementia prevention in recent years.Virtual technology,combined with traditional methods such as exercise therapy,provides new ideas for innovative cognitive evaluation and cognitive intervention.

Human herpesvirus 6 infections after liver transplantation

Human herpesvirus 6(HHV-6) infections occur in > 95% of humans.Primary infection,which occurs in early childhood as an asymptomatic illness or manifested clinically as roseola infantum,leads to a state of subclinical viral persistence and latency.Reactivation of latent HHV-6 is common after liver transplantation,possibly induced and facilitated by allograft rejection and immunosuppressive therapy.Since the vast majority of humans harbor the virus in a latent state,HHV-6 infections after liver transplantation are believed to be mostly due to endogenous reactivation or superinfection(reactivation in the transplanted organ).In a minority of cases,however,primary HHV-6 infection may occur when an HHV-6 negative individual receives a liver allograft from an HHV-6 positive donor.The vast majority of documented HHV-6 infections after liver transplantation are asymptomatic.In a minority of cases,HHV-6 has been implicated as a cause of febrile illness with rash and myelosuppression,hepatitis,pneumonitis,and encephalitis after liver transplantation.In addition,HHV-6 has been associated with a variety of indirect effects such as allograft rejection,and increased predisposition and severity of other infections including cytomegalovirus(CMV),hepatitis C virus,and opportunistic fungi.Because of the uncommon nature of the clinical illnesses directly attributed to HHV-6,there is currently no recommended HHV-6-specific approach to prevention.However,ganciclovir and valganciclovir,which are primarily intended for the prevention of CMV disease,are also active against HHV-6 and may prevent its reactivation after transplantation.The treatment of established HHV-6 disease is usually with intravenous ganciclovir,cidofovir,or foscarnet,complemented by reduction in the degree of immunosuppression.This article reviews the current advances in the pathogenesis,clinical diagnosis,and therapeutic modalities against HHV6 in the setting of liver transplantation.

Hepatocellular carcinoma prevention:A worldwide emergence between the opulence of developed countries and the economic constraints of developing nations

Hepatocellular carcinoma (HCC) is the fifth most common neoplasm, the major cause of death in patients with liver cirrhosis, and the third most common cause of cancer-related death in the world. The geographic distribution of HCC varies significantly and 80% of cases occur in developing countries (Far East and South Asia) where the prevalence of viral hepatitis is higher. The treatment of HCC is difficult because most patients are diagnosed when the tumour is in an advanced stage and is not amenable to potential curative therapy, thus prevention is the key to reducing HCC and its related morbidity and mortality. HCC is unique among cancers, occurring mostly in patients with a known risk factor. Ninety percent of HCCs develop in the context of chronic liver diseases and mainly in patients with cirrhosis. Viral hepatitis is the most common cause of HCC worldwide, followed by alcoholic liver disease (ALD) and other causes such as non-alcoholic fatty liver disease (NAFLD), genetic haemocromatosis (GH) and primary biliary cirrhosis in an advanced stage (Ⅲ- Ⅴ). In certain areas of the People’s Republic of China, exposure to aflatoxin and HBV infection are thought to be responsible for the extraordinary high risk of HCC. Substantial progresses in the prevention of virusl-related hepatitis (screening of blood units, use of disposable sanitary tools, HBV vaccination) have been achieved in developed countries, but in the same areas, alcohol- and dysmetabolism-related HCCs are emerging problems which require specific interventions in terms of public health measures. In developing countries, economic constraints limit the development of any program for the prevention of viral hepatitis transmission (including health education campaigns, healthcare politics, primary prevention and the improvement of hygienic and sanitary conditions). When viral liver disease is established, only a minority of patients are treated worldwide and benefit a possible preventive effect of medical treatment onHCC development. Thus the real contribution of medical treatment to HCC prevention in patients with chronic viral hepatitis is small. Great efforts are needed to identify more effective medical measures for primary and secondary prevention of HCC.

Positive Selection Analysis of VP1 Genes of Worldwide Human Enterovirus 71 Viruses

Human enterovirus 71 viruses have been long circulating throughout the world. In this study, we performed a positive selection analysis of the VP1 genes of capsid proteins from Enterovirus 71 viruses. Our results showed that although most sites were under negative or neutral evolution, four positions of the VP1 genes were under positive selection pressure. This might account for the spread and frequent outbreaks of the viruses and the enhanced neurovirulence. In particular, position 98 might be involved in neutralizing antibodies, modulating the virus-receptor interaction and enhancing the virulence of the viruses. Moreover, both positions 145 and 241 might correlate to determine the receptor specificity. However, these positions did not display much difference in amino acid polymorphism. In addition, no position in the VP1 genes of viruses isolated from China was under positive selection.

Survivin:Potential role in diagnosis,prognosis and targeted therapy of gastric cancer

Survivin is a protein that is highly expressed in a vast number of malignancies,but is minimally expressed in normal tissues. It plays a role as an inhibitor of cell death in cancer cells,thus facilitating the growth of these cells. In the case of gastric cancer,survivin is over-expressed in tumor cells and plays a role in the carcinogenesis process. Several studies on gastric cancer have indicated that there is a relationship between survivin expression and the ultimate behavior of the carcinoma. Since the expression pattern of survivin is selective to cancer cells,it has been described as an "ideal target" for cancer therapy. Currently,several pre-clinical and clinical trials are on-going to investigate the effects of interfering with survivin function in cancer cells as a biologic therapy. Survivin is a potentially significant protein in the diagnosis,prognosis and treatment of gastric tumors.

Prevention of hepatotoxicity due to anti tuberculosis treatment: A novel integrative approach

AIM： To evaluate the ability of Curcuma Ionga （CL） and Tinospora cordifolia （TC） formulation to prevent anti-tuberculosis （TB） treatment （ATT） induced hepatotoxicity. METHODS： Patients with active TB diagnosis were randomized to a drug control group and a trial group on drugs plus an herbal formulation. Isoniazid, rifampicin, pyrazinamide and ethambutol for first 2 mo followed by continuation phase therapy excluding Pyrazinamide for 4 mo comprised the anti-tuberculous treatment. Curcumin enriched （25%） CL and a hydro-ethanolic extract enriched （50%） TC 1 g each divided in two doses comprised the herbal adjuvant. Hemogram, bilirubin and liver enzymes were tested initially and monthly till the end of study to evaluate the result. RESULTS： Incidence and severity of hepatotoxicity was significantly lower in trial group （incidence： 27/192 vs 2/316, P 〈 0.0001）. Mean aspartate transaminase （AST） （195.93 ± 108.74 vs 85 ± 4.24, P 〈 0.0001）, alanine transaminase （ALT） （75.74 ± 26.54 vs 41 ± 1.41, P 〈 0.0001） and serum bilirubin （5.4 ±3.38 vs 1.5 ±0.42, P 〈 0.0001）. A lesser sputum positivity ratio at the end of 4 wk （10/67 vs 4/137, P = 0.0068） and decreased incidence of poorly resolved parenchymal lesion at the end of the treatment （9/152 vs 2/278, P = 0.0037） was observed. Improved patient compliance was indicated by nil drop-out in trial vs 10/192 in control group （P 〈 0.0001）. CONCLUSION： The herbal formulation prevented hepatotoxicity significantly and improved the disease outcome as well as patient compliance without any toxicity or side effects.

Selection Pressure on Haemagglutinin Genes of H9N2 Influenza Viruses from Different Hosts

Positive selection and differential selective pressure analyses were carried out to study Haemagglutinin (HA) genes of H9N2 influenza viruses from different hosts in this paper. Results showed that, although most positions in HAs were under neutral or purifying evolution, a few positions located in the antigenic regions and receptor binding sites were subject to positive selection and some of them were even positively selected at the population level. In addition, there were always some positions differentially selected for viruses from different hosts. Both selection pressure working on HA codons and positions differentially selected might account for the extension of the host range and adaptations to different hosts of H9N2 influenza viruses.

Operable Breast Cancer： a Clinical Analysis of 6,263 Cases

OBJECTIVE In Europe and America breast cancer commonly occurs in women of middle and old age, with a median age of about 57 years. Modified radical mastectomy now called standard radical mastectomy, has taken the place of traditional radical mastectomy. Patients with breast cancer at an early stage commonly receive BCT （breast conservative therapy）. The TNM stage （especially the lymph node status） affects the prognosis, and adjuvant therapy can improve survival. In China, only a few reports have been published studying large numbers of breast cancer patients. This study was designed to analyze the clinical features, surgical pattern and treatment outcome of resectable breast cancer, as well as to explore the prognostic factors and the effect of adjuvant therapy, with a goal to improve the level of diagnosis and treatment. METHODS Records of the 6,263 patients with resectable breast cancer who had been admitted into our hospital from June 1964 to June 2003 were analyzed retrospectively. RESULTS Of the 6,263 cases, 98.8% were female. Breast cancer occurred most frequently in patients of ages 40-49 years （41.0%）, especially in patients 45-49 years old （25.2%）. A breast lump, which occurred in 96.2% of the patients, was the main clinical manifestation. The overall 5- and 10-year survival rates were 75.16% and 40.44%. Of the patients in TNM stages 0-1, Ⅱ, and Ⅲ, the 5-year survival rates were 96.8%, 73.7% and 46.4% respectively and the 10-year survival rates were 78.7%, 64.6% and 33.5% respectively. The 5-, and 10-year survival rates were higher in the lymph node negative group than in the lymph node positive group （80.3% vs. 55.6%, and 59.2% vs. 31.9%, P〈0.01）. Since the 1980s there was no significant difference in survival rates of patients who received a radical mastectomy compared to a modified radical mastectomy（P〉0.05）. Of the 73 patients who underwent breast conservative therapy, no local recurrence or metastasis occurred during a maximal follow-up of 17 years. Of the patients in stage T2- T4, the 5-, and 10-year survival rates were significantly higher in the group treated with adjuvant chemotherapy compared to the non-chemotherapy group （78.2% vs. 60.1%, and 48.9% vs. 30.7%, P〈0.01 ）. CONCLUSION According to our data, breast cancer most frequently occurred in patients of ages 45-49 years. The TNM stage （especially the lymph node status） relates to breast cancer prognosis. The prognosis was worse in patients with positive lymph nodes compared to the patients with negative lymph nodes. The efficacy of a modified radical mastectomy is equal to that of a radical mastectomy, and breast conservative therapy can be applied to patients in an early stage. Adjuvant chemotherapy and endocrine therapy can improve the survival of resectable breast cancer patients.