炎症性肠病的药物治疗现状及进展

炎症性肠病（IBD）病程迁延反复,影响患者生活质量,耗费卫生资源。虽然传统药物如5-氨基水杨酸、糖皮质激素、免疫抑制剂等仍是目前治疗主流,但是大量有关发病机制的研究以及循证医学的发展对IBD的治疗产生了积极的推进作用。IBD的治疗正步入免疫调节的生物学时代,多种新型生物制剂的出现为IBD的治疗提供了新的策略和选择。现就目前IBD药物治疗现状以及最新进展进行综述,以期对临床IBD治疗提供参考。     

Narcotrend监测下右美托咪定对冠心病患者麻醉诱导期血流动力学的影响

观察Narcotrend监测下右美托咪定联合丙泊酚靶控输注用于冠心病患者非心脏手术麻醉诱导时对血流动力学的影响.合并冠心痛行非心脏手术患者40例,随机分为两组：Dex组（n=20,患者在诱导前静脉泵注右美托咪定0.5μg/kg,15min内输注完毕）,对照组（n=20,等量生理盐水,方法同Dex组）.记录给药前后及诱导期间患者的血流动力学变化.对照组在气管插管即刻以及气管插管3min后血流动力学指标值均高于插管前,气管插管5min后平均动脉压（MAP）低于插管前（P＜0.05）,Dex组无明显差异.麻醉诱导前15min静脉注射0.5μg/kg右美托咪定可以使冠心病患者丙泊酚靶控输注诱导期间血流动力学更加平稳.     

阿尔茨海默病的诊治新进展

流行病学数据的更新表明阿尔茨海默病（A D ）已成为全球健康问题。早期应用生物标志物的AD新诊断标准广泛应用和临床试验不断失败的鲜明反差提示AD治疗的艰巨性。AD和其他慢性疾病的共病研究不断深入。生活方式干预作为非药物治疗备受重视。     

基层医院实施《诊疗与防控手足口病指南》的困境

探讨实施卫生部所颁发的手足口病诊疗与防控指南存在的难点.通过实践,依据指南,笔者将近几年工作中所遇到处理各种肠道病毒感染病例存在的问题加以分析,列出实施指南存在诸多临床及非临床的影响因素,包括：（1）上报、隔离引起的矛盾;（2）诊断、治疗、转诊引起的矛盾;（3）处理肠道病毒71型（EV71）感染、疱疹性咽峡炎等与手足口病的矛盾.较多的矛盾令基层医院依照目前的指南难以良好地开展工作,期待更完善的指南以及各地医疗主管部门制定切合实际的、可行的、各种具体的防控预案.     

Effects of telephone support on exercise capacity and quality of life in patients with chronic obstructive pulmonary disease: a meta-analysis

The aim of this meta-analysis was to evaluate the effects of disease education or pulmonary rehabilitation programs assisted with telephone support on physical capacity and quality of life (QOL) in chronic obstructive pulmonary disease (COPD) patients. A systematic search of PubMed, Embase, Web of Science and The Cochrane Library was conducted until May 2017. Randomized controlled trials (RCTs) examining the effects of telephone-assisted intervention versus a control group on exercise tolerance and QOL in patients with COPD were included. Two independent authors assessed the methodological quality of the trials using the Cochrane risk of bias tool. A meta-analysis was conducted with the Revman5.3 to quantify the effects of telephone-assisted interventions on walking capacity and QOL. In total, 10 studies involving 1037 participants were included. Due to the effect of telephone-assisted interventions, statistically significant results were found on Saint-George’s Respiratory Questionnaire (SGRQ) symptom scores [standard mean difference (SMD) ?.18, 95% confidence interval (CI) ?.33, ?.03, p-value .02)], SGRQ impact scores [SMD ?.35, 95% CI ?.60, ?.10, p-value .006)], SGRQ activity scores [SMD ?.30, 95% CI ?.45, ?.15, p-value < .0001)], SGRQ total score [SMD ?.36, 95% CI ?.51, ?.21, p-value < .00001)]. The effects on 6-min walk test (6MWT) and all Chronic Respiratory Questionnaire (CRQ) subscales were not significant (p > .05) based on the insufficient evidence. In conclusion, the role of telephone-assisted interventions in the management of COPD remains equivocal. Some encouraging results were seen with regard to SGRQ symptom, SGRQ impact, SGRQ activity and SGRQ total score. We believe that more methodologically rigorous large-scale randomized controlled trials are necessary to answer this study question.     

Support groups for parents with an adult child suffering from bipolar disorder

Confronted with the disconcerting behaviour exhibited by their children, parents of bipolar patients are in severe distress. Research focuses on the study of the ‘burden’ that the pathology puts on caregivers, owing to their experience of depression, sometimes combined with the presence of hostile attitudes and negative affects. In France, parents of adult patients encounter an initial specific difficulty: they are not systematically included in the care management system. Thanks to the initiative of an association of psychiatrists and psychoanalysts, the authors set up a psychoanalytic support group for the parents of ‘bipolar’ adults. The diagnosis of a bipolar disorder is established by a psychiatrist within a medical structure. Support groups for parents do exist in France, but their experiences have not led to scientific publications on this specific topic. Existing publications focus on other types of pathology and other therapeutic approaches. In this article, we will highlight how this type of psychoanalytic support group, with operating rules based on the theoretical work of Anzieu, can help parents of patients with bipolar disorders. Group participants accepted the principle of a research study that maintained their anonymity. We collected and analysed qualitative data from the first year of the group, so we highlight the specific difficulties of these parents, faced with chronic disease. The relevance of our qualitative study also resides in the data collected over a period of time, enabling us to see the progress made, and encouraging us to reflect on the place of psychoanalytic groups for parents, as well as on the care management of this pathology.     

Who victimizes whom and who defends whom? A multivariate social network analysis of victimization,aggression, and defending in early childhood

The aim of this research was to investigate the interplay between victim‐aggressor relationships and defending relationships in early childhood to test the proposition that young aggressors are less selective than older children in their choice of vulnerable targets. Cross‐sectional multivariate statistical social network analyses (Exponential Random Graph Models) for a sample of 177 preschoolers from seven classes, 5‐ to 7‐years‐old, revealed that boys were more aggressive than girls, toward both boys and girls, whereas defending relationships were most often same‐sex. There was significant reciprocity in aggression, indicating that it was more often bidirectional rather than unidirectional. In addition, aggressors clearly defended each other when they shared their targets of aggression, whereas a marginally significant trend appeared for defending between victims who were victimized by the same aggressors. Furthermore, teacher‐rated dominance was positively associated with children's involvement in both aggression and victimization, and teacher‐rated insecurity was associated with less aggression, but not with victimization. These findings suggest that those who are reported as being victimized may retaliate, or be aggressive themselves, and do not display some of the vulnerabilities reported among older groups of victims. The findings are in line with the proposition that young aggressors are less strategic than older children in targeting vulnerable victims. The network approach to peer victimization and defending contributes to understanding the social processes facilitating the development of aggression in early childhood.