慢性房颤导管消融：挑战与展望

随着对慢性房颤机制认识的深入以及消融方法不断探索,经导管消融在慢性房颤治疗的地位逐渐提高。尽管在适应证、消融策略、获益风险比及远期疗效等还存在一定争议,随着经验的积累和技术的进步,导管消融根治慢性房颤充满希望。     

慢性前列腺炎的诊治思考

慢性前列腺炎是男科的中青年十分常见的疾病,其病因和发病机制尚未完全明了,严重影响患者的身心健康;随着慢性前列腺炎的诊治规范相继出台,有利于规范慢性前列腺炎的诊治;中医药对慢性前列腺炎的治疗有一定的优势,但仍存在许多问题,应进一步建立中医药对慢性前列腺炎的诊治规范,本文探讨中外对前列腺炎的诊治方案,特别强调中西医结合治疗慢性前列腺炎的良好疗效。     

慢性前列腺炎的诊治思考

慢性前列腺炎是男科的中青年十分常见的疾病,其病因和发病机制尚未完全明了,严重影响患者的身心健康;随着慢性前列腺炎的诊治规范相继出台,有利于规范慢性前列腺炎的诊治;中医药对慢性前列腺炎的治疗有一定的优势,但仍存在许多问题,应进一步建立中医药对慢性前列腺炎的诊治规范,本文探讨中外对前列腺炎的诊治方案,特别强调中西医结合治疗慢性前列腺炎的良好疗效.     

论慢性痛心理

一、慢性痛的本质日常生活中的疼痛是众所周知的,但在所有的疼痛中与个体的心理社会因素联系最大的乃是慢性痛(Chronic pain)。Ghadiali对慢性痛下定义为:“慢性痛通常是指至少持续6个月的疼痛,此疼痛行为与个体的感觉和情绪因素相伴。”近年来,人们发现从心理社会方面来解释和对慢性痛是极为重要的,其原因有二。①慢性痛的医学处理模式的失败。随着慢性痛患者就医次数的增多,他们对医学模式的失望感加强,各种药物对他们的疼痛似乎毫无作用。②人们发班许多慢性痛患者并无病理学根源。一般情况     

慢性心房颤动导管消融的若干争议

随着房颤消融技术的迅速发展和提高,阵发性房颤射频消融已列入I类推荐,慢性房颤射频消融也列入Ⅱa类适应证。肺静脉电隔离仍是慢性房颤消融的基石。但由于慢性房颤病因不一,机制更加复杂,除了肺静脉电隔离外,还需进行心房基质改良,其消融策略、术式、终点还存在若干争议。     

切不可轻视精神和心理性疾病

许多证据表明,精神和心理性疾病将成为21世纪的主要健康主题;相应的精神和心理治疗、康复将成为继外科手术和抗菌素之后的又一次医学革命.     

耳科学的发展与展望

耳科学在人类与耳部疾病的斗争中兴起了１９世纪,在本世纪随科学技术的发展而获得迅速发展,特别是抗菌素和手术显微镜的出现,使耳显同外科技术不断提高,不仅能彻底地祛除耳部感染,而且可以有效地提高听力,耳科学家在聋病的治疗过程中,已能够有效地治疗传导性耳聋,但仍面临着治疗神经性耳聋的挑战,在现代科学技术革命的推动下,随着分析子生物学,细胞生物学等新技术的发展,在２１世纪,人类必定能够彻底治疗聋病。     

慢性心房颤动导管消融的若干争议

随着房颤消融技术的迅速发展和提高,阵发性房颤射频消融已列入Ⅰ类推荐,慢性房颤射频消融也列入Ⅱa类适应证.肺静脉电隔离仍是慢性房颤消融的基石.但由于慢性房颤病因不一,机制更加复杂,除了肺静脉电隔离外,还需进行心房基质改良,其消融策略、术式、终点还存在若干争议.     

难治性丙型肝炎研究新进展

随着聚乙二醇化干扰素（IFN）的普及应用和慢性丙型肝炎规范化治疗的开展,其治愈率不断提高.但疗效不佳的慢性丙型肝炎患者不断积累,难治性慢性丙型肝炎患者成为临床医生必须面对的挑战.难治性丙型肝炎患者应当分为两类,第一类为“难治疗”性慢性丙型肝炎患者,该类患者由于宿主条件限制,不能耐受IFN联合利巴韦林（RBV）的标准治疗,如儿童和老年人、慢性肾功能衰竭患者等.第二类为“难治愈”性慢性丙型肝炎患者,该类患者可以耐受标准治疗方案,但按照应答指导的治疗原则（RGT）治疗后,效果仍然不佳或复发.本文就近年关于难治性丙型肝炎的研究进展,从难治性丙型肝炎的定义、机制、治疗诸方面作一综述.     

难治性丙型肝炎研究新进展

随着聚乙二醇化干扰素(IFN)的普及应用和慢性丙型肝炎规范化治疗的开展,其治愈率不断提高.但疗效不佳的慢性丙型肝炎患者不断积累,难治性慢性丙型肝炎患者成为临床医生必须面对的挑战.难治性丙型肝炎患者应当分为两类,第一类为“难治疗”性慢性丙型肝炎患者,该类患者由于宿主条件限制,不能耐受IFN联合利巴韦林(RBV)的标准治疗,如儿童和老年人、慢性肾功能衰竭患者等.第二类为“难治愈”性慢性丙型肝炎患者,该类患者可以耐受标准治疗方案,但按照应答指导的治疗原则(RGT)治疗后,效果仍然不佳或复发.本文就近年关于难治性丙型肝炎的研究进展,从难治性丙型肝炎的定义、机制、治疗诸方面作一综述.     

艰难梭菌感染：ICU中如何处理

艰难梭菌相关性腹泻（CDAD）是重症患者非常重要的院内感染性疾病之一,常与广谱抗菌药物的广泛应用有关,其中肠道菌群失调是重要的因素之一。虽然艰难梭菌感染（CDI）仅占抗菌药物相关性腹泻中的10％～20％,但是目前CDAD的发生率呈明显升高趋势,且根据研究显示,重症患者CDAD的30天病死率已达36．7％。CDAD的临床...     

Syndrome of inappropriate antidiuretic hormone associated with escitalopram therapy

Escitalopram is the selective serotonin reuptake inhibitor (SSRI) most recently approved for use in the United States. It is structurally related to citalopram, but is felt to have a more tolerable side-effect profile than its parent compound. Side effects are not generally serious and include headache, diarrhea, and nausea. While hyponatremia and the syndrome of inappropriate antidiuretic hormone (SIADH) have been associated with treatment with other SSRIs, there has only been one case of escitalopram-induced SIADH reported in the literature to date. We now report another case of a patient who developed SIADH after being treated with escitalopram for 4 weeks. The patient's hyponatremia improved following the discontinuation of escitalopram. Clinicians should be aware of this uncommon but significant side effect of SSRIs and monitor high-risk patients for the development of SIADH.     

Preliminary results of imurek treatment of multiple sclerosis]

The authors, after presenting a survey of the literature on the treatment of multiple sclerosis with immunosuppressants, report their experience with Imurek. Of 53 patients with a chronic and progressive course of the disease, objective improvement could be observed in 17. In 20 patients the symptomatology remained unchanged, although 4 of them reported subjective improvement. In 16 patients, progression of the disease could not be stopped. Better results of treatment could be obtained for those forms of the disease where the course was, first, in the form of what may be referred to as outbursts and, later, in a chronic and progressive form. -Possible side effects are pointed out.     

Alleviation of Side Effects and Distress in Breast Cancer Patients by Cognitive-Behavioral Interventions: A Systematic Review and Meta-analysis

Cognitive and behavioral interventions (CBI) have been used for breast cancer patients with various stages of the disease or undergoing different treatments. However, no quantitative review has summarized their efficacy on the side effects of treatment, distress, and quality of life in the acute treatment setting after diagnosis. This meta-analysis synthesizes data from 19 randomized clinical trials in order to: (a) provide an estimation of overall effect of CBI in breast cancer patients during treatment for breast cancer, i.e., neo-adjuvant and adjuvant treatment; (b) provide average effect sizes on side effects of treatment, distress, and quality of life; and (c) test possible moderators of effect size. The results show that CBI yielded a small effect size overall, specifically on general side effects of treatment, nausea, vomiting, distress, and quality of life. Individual and behavioral interventions seem to elicit better results on distress and on general side effects of treatment, respectively. While more studies are needed with regard to specific side effects (i.e., fatigue, pain, and sleep disturbance), the overall results clearly support the use of CBI in breast cancer patients during treatment.     

小剂量TED方案治疗高龄多发性骨髓瘤的临床研究

为了观察小剂量TED化疗方案治疗高龄（≥65岁）多发性骨髓瘤（multiple myeloma,MM）患者的临床疗效和不良反应,对13例经血常规、骨髓细胞学检查和免疫固定电泳等确诊的MM患者,给予小剂量沙利度胺（T,Thalidomide）、依托泊苷（E,Etoposide）、地塞米松（D,Dexamethasone）化疗方案治疗13例高龄MM患者2～4疗程,观察疗效和不良反应。结果显示,13例高龄MM患者中完全缓解（CR）1例,非常好的部分缓解（VGPR）3例,部分缓解（PR）6例,疾病稳定（SD）1例,疾病进展（PD）2例。不良反应有乏力,嗜睡,便秘,感染等,均可耐受。提示小剂量TED化疗方案治疗高龄MM患者有效,且较安全。     

慢性肾脏病患者心理状态研究进展

慢性肾脏病是一种很难治愈的一种疾病,绝大多数的患者需要中西医结合治疗。患有慢性肾脏病的患者最终需要肾脏替代疗法来缓解症状,如透析治疗或选择肾脏移植。巨大花费同疾病本身使患者身心均受到很大的压力,CKD患者抑郁、焦虑情况普遍存在,影响患者生存质量、营养状态和治疗配合性及疾病的预后,因此解决其心理问题至关重要。     

各种传统医学在高血压治疗中的应用

高血压痛作为最常见的慢性病,其并发症具有较高的致残率及致死率。本文综述近年来各种传统医学在高血压病治疗中的应用,包括传统中医对高血压痛的病因机的阐述,应用中药内服、外服、针灸等临床效果观察,蒙医辨证分型论治高血压病;藏医对高血压病的认识及临床采用的金针疗法治疗高血压病;壮医特色壮药内服,壮医药线点灸刺血疗法对高血压病的临床疗效评价。以此说明传统医药治疗方法对改善高血压病症状较明显,其治疗手段多样,副作用较小,降压效果平稳持久,有效减少并发症的优势。     

异维A酸组和维胺酯组治疗痤疮的比较

为了比较分析异维A酸组和维胺酯组治疗痤疮的临床疗效、费用和不良反应,于服药前后观察疗效、不良反应和相关费用。结果显示,异维A酸组治疗痤疮起效快。在治疗中度痤疮,两组总体疗效、医疗费用相当,但维胺酯组不良反应较轻。而在治疗重度痤疮方面,异维A酸组临床疗效较维胺酯组高,且医疗成本较低。     

Reminders of an agentic ingroup buffer disease uncontrollability

Chronic illness has negative impacts beyond those on physical health. In particular, because it is often experienced as uncontrollable, chronic illness might reduce people's general sense of personal control and, subsequently, personal well-being. Drawing on recent theory and research, we proposed and tested in four experiments (N_total = 1323) a potential buffer to these negative effects: thinking about an agentic social ingroup in one's life. In Study 1, patients suffering from a chronic illness that was either high or low in medical disease controllability were asked either to think about an agentic ingroup or a personal issue. Low perceived disease-related control was associated with low perceived personal control only when participants' personal self, but not when their ingroup, was salient. In three follow-up vignette studies, we asked participants to take the perspective of a person who suffered from a health problem of low medical disease controllability and attended a self-help group that was described as either high or low in agency. The findings supported the predicted buffering effect: participants who reflected on a target suffering from a low control disease thought that the target would experience more personal control when the agentic (vs. the nonagentic) self-help group was salient. These findings suggest ingroups can serve as a source of personal control in the context of health-related threats to the extent that they are perceived as agentic. Thus, focusing on agentic properties of (health-related) ingroups might be a promising novel strategy when designing effective group-based interventions to cope with chronic illness.     

Illness perception patterns in patients with Coronary Artery Disease

The purpose of this study is to identify patterns of illness perception in patients with angiografically verified Coronary Artery Disease. A total of 166 patients (age: 64.4 ± 12.1, 80.7% male) were recruited after angiography. Cluster analysis on the items of the Brief Illness Perception Questionnaire was used to identify patterns of illness perception. The resulting groups were characterized with regard to Quality of Life (MacNew), anxiety and depression (GAD-7 and PHQ-9) and resilience (RS-13). The analysis revealed 4 distinct groups differing with regard to the items covering the perception of the physical and emotional impact of disease. Stronger perceptions in these domains were associated with lower Health Related Quality of Life and higher levels of emotional distress. Group 1 (33.1%) reported the strongest perceptions of the physical and emotional impact of disease and expressed low treatment control, high chronic timeline and significantly higher levels of depression than the other groups. Group 2 (27.7%) was characterized by more moderate perceptions of the emotional and physical impact of disease together with low scores on illness coherence and chronic timeline. Groups 3 (25.3%) and 4 (13.9%) reported smaller physical and emotional impact of illness but differed in chronic timeline. Our results correspond largely to recent findings in patients with other chronic diseases. Further research is needed to explore if stratification of patients according patterns of illness perception can help to inform patient–physician communication strategies.