药物治疗的风险及其处理

造成药物治疗风险的因素包括药物因素、病情因素、患者因素、用药因素及管理因素等。通过对药物进行严格监管,对医药从业人员加强培训和教育,对民众开展科普教学和用药指导,可以降低药物治疗的风险。风险事件主要表现为用药差错、药物不良反应或药物治疗无效。在药物治疗中,首先必须时刻警惕和及时发现风险;其次需要全面评估风险,还要对疾病风险和药物治疗风险进行比较。应尽可能避免药物治疗的风险,对于必须承受的风险,需采取相应措施,减少风险事件发生的概率和严重程度。如果存在较大风险,务必同时设计处理风险事件的预案,并与患者及其家属保持良好的交流和沟通。     

Type D personality,but not Type A behavior pattern,is associated with coronary plaque vulnerability

Personality traits are associated with major adverse coronary events (MACE) in patients with coronary artery disease (CAD). However, the link between personality traits and intravascular morphology in CAD patients is poorly understood. This study investigated the relationship between personality traits, specifically Type A behavior pattern and Type D personality, and plaque vulnerability. After adjustment for demographic and clinical factors, multivariable regression analysis showed no association between Type A and optical coherence tomography indices. However, Type D personality was independently associated with lipid plaque, thin cap fibroatheroma (TCFA), and fibrous cap thickness. More specifically, negative affectivity of Type D was related to lipid plaque, TCFA and fibrous cap thickness, and social inhibition was associated with plaque rupture. Our results show that Type D personality was associated with plaque vulnerability, independent of clinical factors. Measurement of negative affectivity and social inhibition will increase our understanding of the progressive phase of the plaque vulnerability, which can contribute to the early identification of high risk patients and reduce the incidence of MACE.     

音乐对希望感的影响

过去的研究发现,在经历挫折后,相比于不听音乐,听积极音乐能提升人们的希望感。然而,研究者并不清楚积极音乐和消极音乐在提升希望感上是否存在差异,也不清楚这种差异是否由于两种音乐在诱发的积极情绪或消极情绪的差异造成的。文章通过三个实验来考察这些问题。实验一发现,在无挫折的情况下,积极音乐相比消极音乐诱发了更强的希望感。实验二发现,这种效应同样存在于人们回忆挫折之后,并且是积极情绪在其中起中介作用。实验三则通过设置控制组进一步发现,这种效应是由积极音乐对希望感的提升作用和消极音乐对希望感的降低作用共同引起的。文末讨论了该发现的意义。     

Serotonin transporter 5-HTTLPR genotype is associated with intrusion and avoidance symptoms of DSM-5 posttraumatic stress disorder (PTSD) in Chinese earthquake survivors

Background and Objectives: Prior studies have found that the serotonin transporter gene-linked polymorphic region (5-HTTLPR) interacts with trauma exposure to increase general risk for Posttraumatic Stress Disorder (PTSD). However, there is little knowledge about the effects of the interaction on distinct symptom clusters of PTSD. This study aimed to investigate the relation between the interaction of 5-HTTLPR and earthquake-related exposures and a contemporary phenotypic model of DSM-5 PTSD symptoms in a traumatised adult sample from China.

Design: A cross-sectional design with gene-environment interaction (G?×?E) approach was adopted. Methods: Participants were 1131 survivors who experienced 2008 Wenchuan earthquake. PTSD symptoms were assessed with the PTSD Checklist for DSM-5 (PCL-5). The 5-HTTLPR polymorphism was genotyped with capillary electrophoresis (CE) in ABI 3730xl genetic Analyzer.

Results: Although there was no significant interaction between 5-HTTLPR and traumatic exposure on total PTSD symptoms, respondents with the LL genotype of 5-HTTLPR who were highly exposed to the earthquake experienced lower intrusion and avoidance symptoms than those with the S-allele carriers.

Conclusions: The findings suggest that the 5-HTTLPR may have an important impact on the development of PTSD and add to the extant knowledge on understanding and treating of posttraumatic psychopathology.     

Bi-Directional Relationship Between Self-Regulation and Improved Eating: Temporal Associations With Exercise,Reduced Fatigue,and Weight Loss

ABSTRACT. Severely obese men and women (body mass index ≥ 35 ≤ 55 kg/m²; M_age = 44.8 years, SD = 9.3) were randomly assigned to a 6-month physical activity support treatment paired with either nutrition education (n = 83) or cognitive-behavioral nutrition (n = 82) methods for weight loss. Both groups had significant improvements in physical activity, fatigue, self-regulation for eating, and fruit and vegetable intake. Compared to those in the nutrition education group, participants in the behavioral group demonstrated greater overall increases in fruit and vegetable intake and physical activity. These group differences were associated with changes that occurred after Month 3. Increased physical activity predicted reduced fatigue, β = ?.19, p =.01. A reciprocal relationship between the mediators of that relationship, which were changes in self-regulation and fruit and vegetable intake, was identified. There was significantly greater weight loss over six months in the behavioral nutrition group when contrasted with the nutrition education group. Self-regulation for eating and fruit and vegetable intake were significant predictors of weight loss over both three and six months. Findings enabled a better understanding of psychosocial effects on temporal aspects of weight loss and may lead to more effective behavioral treatments for weight loss.     

论病历所有权归属与所有权行使

在现行法律框架下,通过文献检索、走访调研以及比较法研究方法探讨我国病历的所有权归属与所有权行使问题.本文认为病历具有物的属性,这是本文展开探讨的前提.基于对患者与医疗机构之间的空白病历买卖合同关系、医疗服务合同关系、医疗机构与医务人员之间的雇佣关系等多重法律关系的分析以及出于对患者隐私权等权利保护的考虑,认为病历所有权应归属于患者.同时,在病历私有说的基础上,分析了病历所有权行使、病历所有权的限制以及病历所有权受侵害时的救济等问题.     

阿尔茨海默病生物学标志物研究进展

阿尔茨海默病（AD）是常见的中枢神经系统变性疾病,是痴呆最常见的病因,发病率高.病理特征为老年斑及神经元纤维缠结.AD的确诊有赖病理学,临床诊断极其耗时.由于尚无准确的早期诊断方法,常使AD患者错过早期治疗的时机,这成为制约有效防控AD的瓶颈问题.因此寻找高敏感性、特异性、无创性的生物学标志物对AD的早期诊断至关重要.本文仅将目前较为广泛研究的生物学标志物及其研究现状作一概述.分别对脑脊液、血液、尿液及唾液中的AD标志物作逐一介绍.     

女性盆腔脏器脱垂的传统手术治疗

对于女性盆腔脏器脱垂的手术治疗,传统的手术方式包括阴道封闭术、曼氏手术和阴式全子宫切除术.阴道封闭术操作相对简单,适用于无性生活要求的、合并症较多的年老体弱者,但术后可能存在新发压力性尿失禁,并且导致性功能障碍,术中是否切除子宫尚有争议.曼氏手术保留子宫、操作简单,但术后脱垂复发及妊娠后宫颈机能不全问题仍有待研究.阴式全子宫切除术对于POP-Q评分II期及以内的脱垂患者,治疗效果最佳,期别高的患者术后复发仍可使用保守或再次手术治疗补救,本手术方式术后较少出现性交痛.总而言之,选择适当的适应证并积极与患者沟通后,女性盆腔脏器脱垂的传统手术治疗仍为不错的治疗方式.     

医学人文学科创新成果的展示——评《医学与语言》

《医学与语言》是邱鸿钟教授集20余年心血完成的一部对“医学的历史、主体文本和临床的语言观”进行系统研究的学术专著,是一部具有一定理论深度和强烈实践精神的原创性论著.《医学与语言》开辟了医学人文研究的新领域;拓展了医学人文研究的新视野;提升了理论服务社会的新境界.     

辩证情绪:研究方法及展望

有关辩证情绪的实证研究已经成为情绪研究中的一个新的热点问题,并从一个本土心理学的研究领域演变为主流心理学的研究课题。辩证情绪是指积极和消极情绪的共存。文章对辩证情绪的研究方法进行了回顾,主要包括辩证情绪研究范式的演变、辩证情绪的诱发方法、辩证情绪的测量方法以及辩证情绪的计算方法,并对不同的研究方法的优缺点及其贡献进行了比较和分析。最后,文章对辩证情绪研究方法的未来发展提出了展望。