从比较治疗学角度看老年性黄斑变性的治疗决策

老年性黄斑变性(AMD)是发达国家中老年人群主要致盲眼病,患病率逐年上升.近年来其治疗方面取得很大进展,但治疗方法诸多,各种方案的疗效参差不齐.为了促进老年性黄斑变性治疗选择的最佳途径,本文通过利用检索国内外报道的文献,对其中老年性黄斑变性的治疗方法归纳总结,并运用比较治疗学的研究方法进行比较分析,旨在寻求最有效的治疗方案.     

黄斑变性抗VEGF药物治疗及疗效评估进展

湿性老年性黄斑变性(wAMD)是引起视力不可逆性损伤的重要原因,目前公认的一线治疗方法为抗VEGF治疗。随着抗VEGF治疗方法广泛应用,wAMD导致的不可逆盲明显下降。抗VEGF药物在近十年有了一系列进展。本文就治疗wAMD的抗VEGF药物治疗进展及疗效评估做一简要综述。     

年龄相关性黄斑变性治疗的比较分析

从治疗原理、费用、疗效、不良反应等方面对年龄相关性黄斑变性的不同治疗方法进行比较和分析,为患者进行治疗上的选择提供帮助,同时指导和规范该类疾病治疗的临床决策,以期能在目前条件下不仅提高病人的治疗效果和生活质量同时又达到降低医疗费用的目的。     

年龄相关性黄斑变性治疗的比较分析

从治疗原理、费用、疗效、不良反应等方面对年龄相关性黄斑变性的不同治疗方法进行比较和分析,为患者进行治疗上的选择提供帮助,同时指导和规范该类疾病治疗的临床决策,以期能在目前条件下不仅提高病人的治疗效果和生活质量同时又达到降低医疗费用的目的.     

光学相干断层扫描观察白内障术后黄斑区病变

通过光学相干断层扫描(optical coherence tomography,OCT)技术来早期明确白内障超声乳化术后视网膜黄斑区病变。采集我院白内障超声乳化术及人工晶状体植入术后视力改善不良的老年性白内障患者,进行OCT检查,观察其图象特征。结果提示术眼黄斑区OCT图像表现为:黄斑区视网膜水肿,视网膜厚度增加;黄斑区增生膜形成,部分伴有黄斑区视网膜水肿;黄斑区神经上皮层变薄;黄斑裂孔形成;老年黄斑变性(萎缩性),表现为视网膜色素上皮层断裂、厚薄不均;部分病例视网膜色素上皮层增殖、断裂,表现为色素上皮损害。OCT由于其独特的横截面成像技术,通过精确测量视网膜厚度及观察视网膜反射性的改变,可以在白内障超声乳化术后早期发现黄斑区视网膜的病变,定量地了解病情的变化,是一种比较理想的检测手段。     

光学相干断层扫描观察白内障术后黄斑区病变

通过光学相干断层扫描(optical coherence tomography,OCT)技术来早期明确白内障超声乳化术后视网膜黄斑区病变.采集我院白内障超声乳化术及人工晶状体植入术后视力改善不良的老年性白内障患者,进行OCT检查,观察其图象特征.结果提示术眼黄斑区OCT图像表现为:黄斑区视网膜水肿,视网膜厚度增加;黄斑区增生膜形成,部分伴有黄斑区视网膜水肿;黄斑区神经上皮层变薄;黄斑裂孔形成;老年黄斑变性(萎缩性),表现为视网膜色素上皮层断裂、厚薄不均;部分病例视网膜色素上皮层增殖、断裂,表现为色素上皮损害.OCT由于其独特的横截面成像技术,通过精确测量视网膜厚度及观察视网膜反射性的改变,可以在白内障超声乳化术后早期发现黄斑区视网膜的病变,定量地了解病情的变化,是一种比较理想的检测手段.     

老龄化社会的阵痛--老年性神经变性疾病的社会解读

随着我国老龄化社会的全面到来,以帕金森病和老年性痴呆为代表的老年性神经变性疾病的发病率及患病率也进入了前所未有的"黄金期",对患病个体乃及整个社会都产生了难以回避的挑战和影响.而单纯从医学的角度对这一问题进行解读已远远不能适应时代的发展和潮流,因此,进一步的从社会学的角度对老年性神经变性疾病进行认识和理解已刻不容缓,具有重要的现实和理论意义.     

特发性黄斑前膜应用23-G微创玻璃体切除术治疗的手术疗效分析

探讨23-G微创玻璃体切除术治疗特发性黄斑前膜的手术疗效。回顾性分析2012年1月~2014年12月治疗特发性黄斑前膜患者25例25眼,采用23-G玻璃体切割系统,行玻璃体切割、剥膜黄斑前膜,剥除或不剥除内界膜以及C3F8气体充。对患者行6m~12m的术后随访观察,进行疗效评价与分析。术中及手术后所有患者均未发生眼底出血、低眼压、高眼压、视网膜脱离、眼内炎等并发症。未出现黄斑前膜的复发。末次随访时,最佳矫正视力(BCVA)较手术前显著改善,视物变形减轻或消失,OCT检查结果提示黄斑前膜消失。23-G微创玻璃体切除术是治疗特发性黄斑前膜黄斑的一种安全有效的方法。     

糖尿病性黄斑水肿的诊疗思考

糖尿病性视网膜病变(diabetic retinopathy,DR)是糖尿病患者严重的眼部并发症之一,而黄斑水肿是导致糖尿病性视网膜病变患者视力下降的主要原因之一,其发病机制、诊断技术和治疗方法是一个辩证发展的过程。因此运用科学哲学方法来分析糖尿病性黄斑水肿(diabetic macular edema,DME)的诊断和治疗显得尤为重要。     

糖尿病性黄斑水肿的诊疗思考

糖尿病性视网膜病变(diabetic retinopathy,DR)是糖尿病患者严重的眼部并发症之一,而黄斑水肿是导致糖尿病性视网膜病变患者视力下降的主要原因之一,其发病机制、诊断技术和治疗方法是一个辩证发展的过程.因此运用科学哲学方法来分析糖尿病性黄斑水肿(diabetic macular edema,DME)的诊断和治疗显得尤为重要.     

Unrealistic representations of “the self”: A cognitive neuroscience assessment of anosognosia for memory deficit

Three cognitive components may play a crucial role in both memory awareness and in anosognosia for memory deficit (AMD): (1) a personal data base (PDB), i.e., a memory store that contains “semantic” representations about the self, (2) monitoring processes (MPs) and (3) an explicit evaluation system (EES), or comparator, that assesses and binds the representations stored in the PDB with information obtained from the environment.We compared both the behavior and the functional connectivity (as assessed by resting-state fMRI) of AMD patients with aware patients and healthy controls. We found that AMD is associated with an impoverished PDB, while MPs are necessary to successfully update the PDB.AMD was associated with reduced functional connectivity within both the default-mode network and in a network that includes the left lateral temporal cortex, the hippocampus and the insula. The reduced connectivity between the hippocampus and the insular cortex was correlated with AMD severity.     

Automatic detection and quantification of growth spurts

Growth phenomena are often nonlinear and may contain spurts, characterized by a local increase in the rate of growth. Because measurement error and noise may produce apparent spurts, it is important to identify systematic and reliable spurts. We describe a system, automatic maxima detection (AMD), for statistically identifying significant spurts and computing (1) point of maximal velocity, when the spurt was most intense; (2) start, when the spurt started; (3) amplitude, the intensity of the spurt; and (4) duration, the length of the spurt. We also introduce a software implementation of AMD in MATLAB. In growth of height data, AMD showed a reliable pubertal growth spurt for most children and a reliable prepubertal spurt for some children. In simulated growth of vocabulary, AMD showed a large global spurt and several minispurts. In real vocabulary growth, AMD showed a few spurts. Advantages of AMD include improvements in objectivity, automaticity, quantification, and comprehensiveness.     

Experiences of patients undergoing repeated intravitreal anti-vascular endothelial growth factor injections for neovascular age-related macular degeneration

Current therapy to slow disease progression in patients with neovascular age-related macular degeneration (AMD) entails regular intravitreal anti-vascular endothelial growth factor (VEGF) injections, often indefinitely. Little is known about the burden imposed on patients by this repetitive treatment schedule and how this can be best managed. The aim of this study was to explore the psychosocial impact of repeated intravitreal injections on patients with neovascular AMD. Forty patients (16 males, 24 females) with neovascular AMD undergoing anti-VEGF treatment were recruited using purposive sampling from a private ophthalmology practice and public hospital in Melbourne. Patients were surveyed using the Macular Disease Treatment Satisfaction Questionnaire (MacTSQ; Bradley, Health Psychology Research Unit, Surrey, England) and underwent semi-structured, one-on-one interviews. Interview topics were: treatment burden and satisfaction; tolerability; barriers to adherence; treatment motivation; and patient education. Interviews were audio recorded and thematic analysis performed using NVivo 10 (QSR International, Doncaster, Australia). Patients recognised the importance of treatment to preserve eyesight, yet experienced significant psychosocial and practical burden from the treatment schedule. Important issues included treatment-related anxiety, financial considerations and transport burden placed on relatives or carers. Many patients were restricted to sedentary activities post-injection owing to treatment side effects. Patients prioritised treatment, often sacrificing family, travel and social commitments owing to a fear of losing eyesight if treatment was not received. Whilst anti-VEGF injections represent the current mainstay of treatment for neovascular AMD, the ongoing treatment protocol imposes significant burden on patients. An understanding of the factors that contribute to the burden of treatment may help inform strategies to lessen its impact and assist patients to better manage the challenges of treatment.     

Enhancing Therapeutic Gains: Examination of Fidelity to the Model for the Intensive Mental Health Program

Given that the development of treatment fidelity assessment protocol is an integral but too frequently ignored aspect of clinical trials for psychological treatments, the Intensive Mental Health Program (IMHP) sought to build fidelity activities into training, program evaluation, and clinical recordkeeping from the outset of a 3 year study period. We describe (a) operational definitions and measurement of the IMHP treatment model, (b) planned fidelity-promoting activities, (c) evaluation methods, and (d) fair to appreciable accomplishment of IMHP fidelity targets. Discussion of the circumstances and processes possibly hindering better fidelity for several IMHP treatment features accompanies presentation of fidelity data. We summarize pitfalls and compensatory strategies identified during IMHP program evaluation and offer practical suggestions to enhance accountability and evaluative activity in future clinical research.     

Modeling late-life adaptation in affective well-being under a severe chronic health condition: the case of age-related macular degeneration

Age-related macular degeneration (AMD) was used as a case model to longitudinally study adaptation in affective well-being under a prevalent chronic health condition. Measures of positive and negative affect, obtained at 5 subsequent measurement occasions with 3-month intervals in between, were analyzed in 90 older adults diagnosed with AMD. The authors proposed a pattern of adaptation that shows initial decline in affective well-being after disease outbreak, followed by a turnaround into a restorative phase of increase, implying nonlinear intraindividual trajectories, with changes substantially related to disease duration. Analysis was conducted by means of a nonlinear mixed models approach. Results confirmed the hypothesized adaptation pattern for positive affect but not for negative affect, which was found more stable across measurement occasions.     

对老年性痴呆治疗研究的反思

随着世界人口逐年老化,老年性痴呆已成为全球性的社会一医学问题。神经科学及相关学科领域的内的工作者正积极地投入到对Ａｌｚｈｅｉｍｅｒ病各方面的深入研究,在预防和治疗方面的探索已取得一些阶段性的成果。然而,由于相关基础研究尚无关键性突破,临床治疗始终缺乏有效手段。     

Treatment of Panic Disorder with Agoraphobia: Randomized Placebo‐Controlled Trial of Four Psychosocial Treatments Combined with Imipramine or Placebo

Few randomized controlled trials have included panic disorder patients with moderate to severe agoraphobia. Therefore, this population was studied using pharmacotherapy as well as psychotherapy. At the time of the study, imipramine was widely used as a pharmacological treatment. Also, current practice guidelines for patients with panic disorder find selective serotonin reuptake inhibitors and tricyclic antidepressants roughly comparable in terms of efficacy. Therefore, the main objective of this study is to compare four psychosocial treatments—cognitive and graded in vivo exposure treatments, graded in vivo exposure, cognitive treatment, and supportive therapy—to evaluate the benefits of combining cognitive therapy with exposure in vivo. These treatments were combined with imipramine or placebo for a total of eight experimental conditions. Participants presented moderate to severe agoraphobia. The method involved a randomized, double‐blind, placebo‐controlled trial with 137 participants who completed a 14‐session protocol involving the treatments just mentioned. Measures were taken at baseline and posttreatment and at 3‐, 6‐, and 12‐month follow‐up. All treatment conditions were statistically and clinically effective in reducing self‐reported panic–agoraphobia symptoms over the 1‐year follow‐up. No statistical differences were observed between imipramine and placebo conditions. This study found that all treatment modalities helped reduce panic and agoraphobic symptomatology over a 1‐year follow‐up period. These surprising results support the need to document the relations among the various components of an intervention. This would make it possible to assess the relative efficacy of the treatment components rather than of the intervention as a whole.     

抑郁症计算机化治疗的效果及其影响因素：基于RCT的元分析与元回归分析

运用元分析和元回归分析的方法考察抑郁症计算机化治疗的效果及其影响因素。来源于50篇文献,42项RCT研究的67个样本满足了元分析标准（N=7920）。结果发现：（1）整体效果量为0.53,三个月追踪效果量为0.14;6个月追踪效果量为0.16;（2）在年龄段、抑郁严重程度、支持方式和测量量表四个亚组分析中,其效果量存在显著差异。干预方式、干预取向和分析方法对效果量的影响不显著;（3）出版年份显著影响治疗效果量,脱落率和干预单元数对整体效果量的影响不显著。结果表明：抑郁症的计算机化治疗具有中等的效果量;年龄段、抑郁严重程度、支持方式、测量量表和出版年份对其整体效果量有调节作用。将来抑郁症计算机化治疗的研究应重视上述调节变量对治疗效果的影响。     

Book Review

Book reviewed in this article:
J. L. AUSTIN: A CRITIQUE OF ORDINARY LANGUAGE PHILOSOPHY By Keith Graham.
RELIGION, TRUTH AMD LANGUAGE-GAMES By Patrick Sherry Library of Philosophy and Religion, John Hick.
ON THINKING By Gilbert Ryle     

Mitigating the imitation of aggressive behaviors by changing children's attitudes about media violence

A sample of 169 first- and third-grade children, selected because of their high exposure to television violence, was randomly divided into an experimental and a control group. Over the course of 2 years, the experimental subjects were exposed to two treatments designed to reduce the likelihood of their imitating the aggressive behaviors they observed on TV. The control group received comparable neutral treatments. By the end of the second year, the experimental subjects were rated as significantly less aggressive by their peers, and the relation between violence viewing and aggressiveness was diminished in the experimental group.