特应性皮炎过敏原的确定

据估计大约50％婴幼儿特应性皮炎和35％成人特应性皮炎患者对常见过敏原过敏。气源性过敏原、食物过敏原和小分子接触性过敏原是特应性皮炎发病的主要环境诱发因素。临床可通过皮肤点刺试验、斑贴试验、特应性斑贴试验等体内试验并结合外周血过敏原特异性IgE检测进行过敏原诊断。当明确与发病相关的过敏原后,回避治疗是首要的原则,对于尘螨等难以完全回避的过敏原,特异性免疫治疗是有可能改善病情并达到长期缓解的治疗手段。     

湿疹？还是特应性皮炎？

特应性皮炎（AD）是一种慢性复发性、瘙痒性、炎症性皮肤疾病,常自幼时发病,可持续终生,严重影响患者的生活质量。目前尚无单一特异性的,洛床表现或实验室检查指标可以鉴别诊断AD与湿疹。然而,与湿疹相比较,AD患者常伴有血清免疫球蛋白IgE增高,个人及家族遗传性AD、过敏性哮喘和／或过敏性鼻炎的病史,且皮疹及瘙痒更为严重,还可合并皮肤感染及皮肤屏障功能的损害。因此,区分湿疹还是AD,对于正确诊断及采取合适的治疗方案具有重要意义。     

特应性皮炎与过敏进程

过敏性疾病已成为备受关注的社会问题,包括特应性皮炎、食物过敏、过敏性鼻炎、过敏性哮喘等,其发生和发展一直是学术界和社会公众高度关注的话题。变态反应症状可表现在皮肤、胃肠道、鼻腔、支气管等不同部位,流行病学研究发现各类过敏性疾病的出现呈现从儿童湿疹、食物过敏逐渐向过敏性鼻炎、过敏性哮喘发展的过程,婴儿或儿童早期出现的伴高IgE的特应性皮炎往往预示着未来会发生其他过敏性疾病,这种现象被称为变态反应性疾病的自然进程又称过敏进程,即“AllergyMarch”。本文就特应性皮炎与过敏进程的相关研究进行回顾与讨论,以期引起社会各界对特应性皮炎的重视。     

特应性皮炎的治疗

特应性皮炎（AD）是一种以瘙痒和湿疹为主要特征的慢性炎症疾病,严重影响患者的生活质量。由于病因和发病机制至今尚未完全明确,其治疗在临床上仍然是一个挑战。大多数患者可通过避免激发因素、基础皮肤护理和外用抗炎药得到较好的疗效,少部分患者皮损广泛且对常规治疗抵抗,需要系统药物治疗。由于患者的病情严重程度、合并的病变及发病年龄变异很大,在治疗上应遵循按照疾病严重程度进行个体化的阶梯治疗方案的原则。在选择系统治疗时,在考虑其治疗收益的同时应考虑其安全性和副反应。     

中西医结合治疗特应性皮炎的Meta分析

系统评价中西医结合治疗特应性皮炎的治愈率、有效率、复发率和不良反应。计算机检索Cochrane、PubMed、CNKI、维普和万方数据库,结合手检7种核心期刊,查找中西医结合治疗特应性皮炎的随机对照试验(RCT)。治疗组为在西药治疗基础上加上中药治疗(包括中医的内服方剂、外用中药药浴),对照组为单一的西药治疗。由2名研究者独立进行文献质量评价和数据提取后,应用Review Manager 5.2软件进行分析评价,给出文献质量评分结果,并根据文献数据绘制森林图和漏斗图,对文献中的异质性进行检验和合并效应量检验。共纳入14篇文献,计976例患者,其中中西医结合治疗组540例患者中,治愈率40.87%,有效率91.50%,西医对照组436例患者中,治愈率18.78%,有效率71.47%。中西医结合治疗组复发率低,无明显不良反应。中西医结合组稳定率总优势比(OR)为4.86,95%置信区间(CI)为(3.13~7.56),两者间差异有统计学意义(P0.05)。目前临床证据表明,中西医结合治疗特应性皮炎具有良好疗效,不良反应发生率低,但尚需更多RCT证实。     

严重烧伤后应激性溃疡的发病机制及防治策略

在事物发展的过程中,主要矛盾处于支配地位、对事物发展起决定作用,次要矛盾处于从属地位、对事物发展起次要作用.烧伤后应激性溃疡的发病机制如:神经-内分泌失调、胃黏膜屏障功能减弱、感染和心理应激等,以及防治方法,如:抗休克治疗、积极处理创面,改善胃黏膜缺血,早期肠内营养和防治感染等是这一原理的具体体现.     

中国古代等级秩序的特分序维

中国古代社会秩序是典型的等级秩序,为了高效地安排并维护社会成员在等级社会中的序位,中国传统社会形成了体系化的排序序维。所谓序维即秩序存在和被认识的维度,这些序维主要有神人序维、天君序维、君臣序维、父子序维、夫妻序维、兄弟序维、妻妾序维、贤与不肖序维、华夷序维、官民序维、主奴序维、师生序维、长幼序维等社会排序序维。这些序维都具有安排其中每一位社会角色的特别的权利与特别的义务的意义,而特别的权利与特别的义务可被称为"特分"。各具体的序维往往还被概括为人天秩序、人伦秩序以及人际秩序等。     

肿瘤疫苗治疗肿瘤的前景

肿瘤疫苗的发展已经历了一个多世纪,20世纪50年代,人们开始了自体肿瘤疫苗的研究.使肿瘤疫苗(主动性免疫治疗)成为继手术、放疗、化疗之后的肿瘤治疗方法.肿瘤疫苗作为主动特异性免疫治疗,在临床中起到越来越重要的作用,人们开始尝试利用多种方法制备肿瘤疫苗并利用其促进机体免疫应答,从整体细胞,分子水平调控机体对肿瘤的免疫.目前肿瘤疫苗的研制已取得很大进展,给人类战胜肿瘤提供很大希望.     

肿瘤疫苗治疗肿瘤的前景

肿瘤疫苗的发展已经历了一个多世纪,20世纪50年代,人们开始了自体肿瘤疫苗的研究.使肿瘤疫苗(主动性免疫治疗)成为继手术、放疗、化疗之后的肿瘤治疗方法.肿瘤疫苗作为主动特异性免疫治疗,在临床中起到越来越重要的作用,人们开始尝试利用多种方法制备肿瘤疫苗并利用其促进机体免疫应答,从整体细胞,分子水平调控机体对肿瘤的免疫.目前肿瘤疫苗的研制已取得很大进展,给人类战胜肿瘤提供很大希望。     

阿尔茨海默病发病机制的研究进展

阿尔茨海默病是一种起病隐匿,进行性发展的神经系统退行性疾病。临床上以记忆障碍、失语、失用、失认、视空间损害、执行功能障碍以及人格和行为改变等全面性痴呆表现为特征,病因迄今未明,发病机制复杂。本文对可能的发病机制：遗传因素（包括ApoE基因、早老素-1和早老素-2基因,APP基因、α2巨球蛋白基因、TOMM40基因、COL25A1基因）;Aβ代谢（合成、分解、转运）;神经递质学说;自由基与氧化应激学说;金属离子学说等进行综述。     

心理社会应激的免疫反应规律与机制

心理社会应激会引起免疫系统发生免疫防御、免疫自稳和免疫监视方面的功能变化, 并随着应激刺激的时间和强度的变化而发生着异常与正常之间的动态转变。其机制与遗传、神经内分泌、自由基代谢和肠道菌群变化等生物学因素相关, 且小胶质细胞可能在其中起着重要的中介作用。诸多的生物学因素与年龄、性别和经济地位等人口学因素共同决定着心理社会应激的免疫反应发生发展。在其干预中, 运动疗法中的体育锻炼是极为值得重视的一种手段。     

医学免疫学中的哲学思维

创造性思维与主观能动性推动了现代免疫学理论的建立和发展。免疫器官、免疫细胞、免疫分子的相互联系、相互作用为免疫耐受和免疫应答储备了物质基础;免疫调节过程中活化与抑制的对立统一,免疫、神经、内分泌系统之间整体调节的精细准确为免疫自稳创造了条件。正确地运用哲学思维,有助于揭示掩映在诸多免疫学现象之中的本质内涵。     

免疫反应影响动脉粥样硬化进程的两面性

大量研究表明,动脉粥样硬化的发生和发展过程中,能观察到许多免疫反应。然而,免疫反应对动脉粥样硬化的作用却呈现为两面性;免疫系统的激活可加速动脉粥样硬化的形成和发展,也可表现出抗动脉粥样硬化功效。所以,适当的免疫调节干预,有望成为动脉粥样硬化的预防及治疗的新途径。     

Exposure-based cognitive behavior therapy for atopic dermatitis: an open trial

Atopic dermatitis (AD) is a common and debilitating inflammatory dermatological disorder and is marked by itch and inflamed skin. Scratching, sleep loss, and avoidance of situations associated with more AD symptoms are central hypothesized mechanisms that perpetuate the disorder and cause reduced quality of life. We developed an exposure-based cognitive behavioral treatment (CBT) that entailed mindfulness practice as a means to increase tolerance for aversive experiences during exposure. The aim of the present study was to test the treatment’s acceptability and preliminary efficacy in adults with AD. We used an uncontrolled pretest-posttest design and recruited participants (N = 9) from a university hospital dermatological clinic. The treatment comprised 10 weekly sessions over 10 weeks and assessments of AD symptoms as well as psychiatric symptoms and quality of life were conducted at baseline, posttreatment and 6-month follow-up. The results showed significant and large baseline to posttreatment improvements on self-reported measures of AD symptoms (p = .020) and general anxiety (p = .005), but there was no significant improvement in depression or quality of life. Treatment satisfaction was high and a majority of participants (67%) completed the treatment. We conclude that exposure-based CBT for adult AD can be feasible, acceptable, and potentially efficacious.     

The role of autonomic arousal in feelings of familiarity

Subjective feelings of familiarity associated with a stimulus tend to be strongest when specific information about the previous encounter with the stimulus is difficult to retrieve (e.g., the butcher-on-the-bus phenomenon; [Mandler, G. (1980). Recognizing: The judgment of previous occurrence. Psychological Review, 87, 252-271.]). When a stimulus has been encountered previously and the circumstances of the encounter cannot be recollected, additional cognitive resources may be directed toward recollection processes; this resource allocation is accompanied by autonomic arousal [Dawson, M. E., Filion, D. L., & Schell, A. M. (1989). Is elicitation of the autonomic orienting response associated with allocation of processing resources?. Psychophysiology, 26, 560-572]. One easily measurable index of autonomic arousal is the skin conductance response (SCR). In the present study, participants studied lists of words and then gave recognition ratings to briefly displayed and masked studied and nonstudied test words while their SCRs were monitored. Results revealed a relationship between recognition ratings and the temporal characteristics of the SCR, supporting the idea that feelings of familiarity are indeed "feelings" in that they stem from autonomic arousal associated with cognitive resource allocation.     

Stimulus significance effects in habituation of the phasic and tonic orienting reflex

Phasic and tonic measures of electrodermal activity were examined in a simple habituation paradigm, using innocuous visual stimuli. Separate groups were used to investigate the effects of stimulus significance, as manipulated by instructions. One group had no stimulus-related task (indifferent group), while the other was asked to silently count the stimuli to report to the experimenter later (significant group). Prestimulus skin conductance levels were considered as measures of the arousal level at each stimulus presentation, and the subsequent electrodermal responses were taken as the phasic orienting reflex (OR) elicited by each stimulus. Changes in prestimulus arousal were taken as measures of the tonic OR to the experimental series. Marked group differences were found in both phasic and tonic components of the OR. Some, but not all, of the significance effects in the phasic OR were attributable to differences in arousal. The results are discussed in the context of theoretical accounts of the OR.