手术治疗2型糖尿病的利弊

外科手术治疗重度肥胖由来已久.近年来观察发现,同样的手术对糖尿病预防率和"治愈率"非常理想.目前我国这方面的工作如火如荼.今年世界糖尿病联盟专门在纽约开会,宣布将外科手术治疗肥胖、糖尿病作为糖尿病防治的手段之一.本文简述了外科手术发展史、手术治疗的疗效及并发症.辩证看待手术治疗2型糖尿病,正确把握手术适应证和熟练掌握手术操作至关重要,我们仍然需要正视外科手术治疗2型糖尿病所存在的一些问题,如是否具备手术指征、可能出现一定的并发症、术后未必能够完全治愈等等,不宜盲目推广.关于其是否能够完全颠覆糖尿病的传统治疗模式,现在就下结论还为时尚早,尤其是现在糖尿病的內科治疗新方法层出不穷,尚需要进行大规模的临床研究来对各种內外科疗法进行评估和对照.     

早期胃癌的治疗

目前,早期胃癌(early gastric cancer,EGC)的治疗仍以开放性手术治疗为主,其预后明显优于进展期胃癌.近年来,随着对EGC浸润与转移规律的深入认识和新技术的应用,其治疗中微创外科的应用更为广泛和合理,并重视患者术后的生活质量.本文结合国内外的研究进展,深入探讨EGC的治疗方法及应用指征,特别是微创外科的应用,如内镜下治疗和腹腔镜(辅助)手术等.     

2009年-2011年广州市甲型H1N1流感监测定量研究

本文对广州市2009年7月～2011年1月的发热呼吸道监测数据进行了定量分析,并在此分析的基础上提出了相关政策建议,比如加强人群分类管理、加快疫苗研制、避免抗病毒药物的滥用、重视健康管理和健康教育以及遵循预防控制原则等。     

The Use of Psychoeducation for a Patient with Hepatitis C and Psychiatric Illness in Preparation for Antiviral Therapy: A Case Report and Discussion

The standard of care treatment for chronic hepatitis C viral infection (HCV) is a combination of pegylated interferon alfa and ribavirin for 24-48?weeks according to the virus genotype. This therapy is known to have multiple neuropsychiatric side effects. A major concern when evaluating a patient for HCV treatment with a known history of a psychiatric disorder is the risk that the patient's psychiatric disorder will flare or become unmanageable. The possibility of precipitating depression, confusion, mania, psychosis, hallucinations, or suicidal ideation or attempt is frequently an obstacle to treatment. We present the case of a 50?year-old man with HCV and an extensive psychiatric history involving alcoholism, depression, and suicidality who participated in a psychoeducation group to help prepare him for treatment with pegylated interferon alfa/ribavirin therapy. Though the patient derived much benefit from the psychoeducation group, by the time of evaluation for HCV treatment two months after the group ended he had relapsed back into a depressive episode with suicidal thoughts. His acute psychiatric status made him unacceptable for pegylated interferon alfa/ribavirin therapy. Psychoeducation groups show promise for helping patients with chronic medical illness to be ready for and endure intensive medical treatment that has substantial psychiatric side effects. The challenge is to help patients overcome barriers to treatment, particularly psychosocial problems, because available treatments are increasingly effective.     

The impact of task-irrelevant emotional stimuli on attention in three domains

Whether task-irrelevant emotional stimuli facilitate or disrupt attention performance may depend on a range of factors, such as emotion type, task difficulty, and stimulus duration. Few studies, however, have systematically examined the influence of these factors on attention performance. Sixty-three adults, scoring within a normative range for mood and anxiety symptoms, completed either an easy or difficult version of an attention task measuring three aspects of attention performance: alerting, orienting, and executive attention. Results showed that in the easy task only, threatening versus nonthreatening task-irrelevant emotional faces facilitated orienting regardless of stimulus duration. These effects were no longer significant during the difficult condition. When the easy and difficult conditions were examined together, duration effects emerged such that stimuli of longer durations lead to greater interference, although effects were nonlinear. Findings illustrate that threat-relevant emotional stimuli facilitate attention during tasks with low cognitive load, but underscore the importance of considering a range of task parameters. Results are discussed in the context of adaptive and maladaptive emotion-attention interactions.     

对恐怖情绪的调节:认知重评和表达抑制的差异——一项ERP研究

本研究采用事件相关电位(ERP)技术,通过测量由视觉诱发的脑电成分晚正波(LPP)来比较情绪调节策略在生理电特征上的差异,探讨认知重评和表达抑制的优劣。实验结果表明:(1)从波幅的角度来比较:在400—600ms时间窗口内,认知重评条件下恐怖图片诱发的LPP波幅显著小于在自由观看条件下的波幅,而表达抑制和自由观看组所诱发的LPP波幅差异较小。(2)从时间进程的角度来比较:认知重评与自由观看组的差异发生在400ms并持续到600ms;而表达抑制和自由观看之间的差异发生在450ms但是只持续到550ms。这表明认知重评相较于表达抑制,对负性情绪起调节作用开始较早,并且持续时间较长。这为认知重评优于表达抑制策略提供了神经生理学上的证据。     

中学生自我提升的特点及其与人际适应的关系

采用自编自我提升领域问卷考察中学生自我提升的特点,并探讨自我提升与同伴接纳和友谊状况的关系。结果发现:(1)中学生在个体领域和人际领域(除道德行为维度)表现出自我提升倾向。(2)男生比女生、初中生比高中生表现更强的自我提升倾向。(3)同伴接纳度低的中学生身体与运动技能和一般认知能力维度自我提升程度较高,互选好朋友数量较少的中学生一般认知能力、个体心理特质、人际心理特质和道德行为维度的自我提升较高。     

Risk factors for disordered eating during early and middle adolescence: prospective evidence from mainland Chinese boys and girls

Despite evidence that sociocultural and psychological factors contribute to disordered eating, researchers have yet to examine the extent to which putative risk factors influence vulnerability for girls versus boys within and across phases of adolescence, particularly in non-Western cultures. In this study, early and middle adolescent samples from China (N = 2,909) completed measures of eating disorder pathology and putative risk factors at baseline and were reassessed 12 months later. Among both younger and older girls, elevations in appearance-focused interactions with friends, negative affect, and body dissatisfaction predicted increases in symptomatology at follow-up. In contrast, there was more discontinuity in risk factors relevant to samples of boys. Although media and friendship influences contributed to later disturbances among early adolescent boys, psychological factors, including body dissatisfaction and negative affect, had stronger effects in the multivariate model for older boys. Implications of finding are discussed in relation to adolescent development and a Chinese cultural context.     

负性情绪干扰行为抑制控制:一项事件相关电位研究

以往研究提示,行为抑制控制与视觉情绪加工的神经活动存在交互作用,而视觉材料诱发的正、负情绪如何影响行为控制加工过程尚不清楚。采用双选择情绪oddball范式与事件相关电位(ERP)技术,本研究假设视觉情绪刺激的呈现对个体的行为控制能力具有显著影响。实验要求被试对标准刺激与偏差刺激(85%vs.15%)分别做不同的按键反应。偏差刺激由正、负、中三种来自中国情绪图片系统的情绪图片组成。行为结果发现,负性条件下的反应时间显著长于中性与正性条件,而三类偏差刺激的反应时均显著长于标准刺激的反应时。ERP结果显示,不论效价,在240～300ms与350～550ms两个时间窗口,偏差刺激与标准刺激诱发的平均波幅差异显著,表明本研究条件下行为抑制控制效应显著。在代表行为控制加工的偏差-标准差异波中,在上述两窗口内分别出现显著的N2与P3成分。负性条件下N2及P3潜伏期显著长于中性条件;而负性条件下N2波幅显著大于而P3波幅显著小于中性条件。相反,正性条件下N2波幅显著小于而P3波幅显著大于中性条件。因此,本研究从行为与脑电两个层面揭示了情绪对行为控制过程的影响:负性情绪减弱个体的行为控制能力,从而导致个体对反应冲突的觉察变慢及对优势反应的抑制过程更长。相反,正性情绪对行为控制过程可能具有促进作用。     

我国肝移植肝源的困局及其化解方略

肝移植是目前拯救良性终末期肝痛患者生命的唯一方法,也是治疗原发性肝癌的最好方法.伴随经济的发展、肝脏移植技术的成熟与规范,等待肝移植的庞大人群与供肝的严重不足形成了巨大冲突,矛盾的焦点是肝源的紧缺.化解这一困局的方法是"开源"与"节流"并举,即扩大供肝的数量和合理利用好已得到的肝源.