关于慢性乙肝病毒携带者治疗问题的商榷

从乙型肝炎病毒(HBV)在体内存在的不同阶段、乙型肝炎发病机制及目前抗病毒治疗现状对慢性乙肝病毒携带者治疗问题进行了初步探讨,提出了绝大多数慢性乙肝病毒携带者不需要治疗的理由,以指导患者和医务人员解决相关问题。     

浅谈脂肪肝的诊治策略

脂肪肝已成为威胁国人健康仅次于病毒性肝炎的第二大肝病。通过对脂肪肝发病机制、发病原因、诊断方法和防治措施的深入研究,能够确定行之有效的诊治策略。针对病因和(或)诱因进行预防,走出在脂肪肝治疗上的误区,对遏制脂肪肝的日益严重的发病趋势和降低医疗费用有着十分重要的意义。     

强化降脂治疗的理性思考

他汀类药物因具有丰富的循征医学证据而成为一种不可缺少的预防和治疗冠状动脉粥样硬化性心脏病的降脂药物。近年来对高危患者提出强化降脂的概念,然而大剂量的他汀类药物的使用可能伴随着更多副作用及低效价比等问题。因此辨证地对待强化降脂的治疗策略是必要的。     

我国公共卫生中的伦理学问题

在公共卫生研究中重点探讨了伦理审查、研究对象选择、知情同意、保护研究对象隐私、对研究对象的适当补偿等方面的伦理学问题;在公共卫生实践中重点探讨了传染病防治、疾病监测、计划免疫、疾病筛查及卫生资源配置领域中的伦理学问题。重视这些问题并参照一定的伦理学原则将有助于解决问题,更好地促进公共卫生事业的发展,促进人群健康。     

Motor-Skill Learning in Alzheimer’s Disease: A Review with an Eye to the Clinical Practice

Since elderly people suffering from dementia want to go on living independently for as long as possible, they need to be able to maintain familiar and learn new practical skills. Although explicit or declarative learning methods are mostly used to train new skills, it is hypothesized that implicit or procedural techniques may be more effective in this population. The present review discusses 23 experimental studies on implicit motor-skill learning in patients with Alzheimer’s disease (AD). All studies found intact implicit motor-learning capacities. Subsequently, it is elaborated how these intact learning abilities can be exploited in the patients’ rehabilitation with respect to the variables ‘practice’ and ‘feedback.’ Recommendations for future research are provided, and it is concluded that if training programs are adjusted to specific needs and abilities, older people with AD are well able to (re)learn practical motor skills, which may enhance their autonomy.     

Early Detection of Memory Impairment in Alzheimer’s Disease: A Neurocognitive Perspective on Assessment

We propose that the earliest neuropsychological detection of Alzheimer’s disease (AD) can be informed by current views about the neuropathogenesis of AD and cognitive models of memory and its neurobiological substrates. The primary impairment in early AD is encoding/consolidation, resulting from medial temporal lobe (MTL) pathology. On theoretical and empirical grounds, paired associate learning (PAL) appears to be the ideal paradigm for detecting MTL dysfunction in early AD. It has not been embraced as a test of choice, however, and this critical review discusses why the paradigm may have not fulfilled its potential. We suggest that a new PAL variant, ‘associate-recognition’, may prove to be clinically efficacious.     

Depressed and Anxious COPD Patients: Predictors of Psychotherapy Engagement from a Clinical Trial

This study examined patient-level factors associated with engagement in mental health treatment in a sample of medically ill patients with clinically significant symptoms of depression and/or anxiety. A total of 248 patients was enlisted from a randomized controlled trial of cognitive-behavioral therapy for depression and anxiety in patients with chronic obstructive pulmonary disease (COPD). Logistic regression analysis was used to predict mental health engagement, defined as attending at least one intervention session. Results indicated that patient-perceived mastery over COPD was negatively related to mental health engagement. Further, mastery was the only significant predictor of mental health engagement after controlling for patient demographic characteristics, severity of COPD, depression, and anxiety. To improve engagement for medically ill patients with comorbid mental health difficulties, clinicians should explore patients’ attitudes about their mental health within the context of their perceived ability to cope with their medical disease.     

器官病理学的产生及哲学思考

叙述西医病理学的发展过程,分析器官病理学对医学的影响,同时指出机械唯物论的局限性,虽然西医学试图用整体医学思想来弥补自身的不足,但目前距这一目标还有相当长的距离。     

Exploring the association of the Comprehensive Trail Making Test with driving indexes in patients with Parkinson’s disease

The Trail Making test (TMT) has been identified as predictor of driving ability in patients with Parkinson’s disease (PD). However, previous research has not explored the effectiveness of an alternative version of the TMT, namely of the Comprehensive Trail Making Test (CTMT; Reynolds, 2002) to show associations with measures related to driving fitness. Main objective of the current work was to evaluate the capacity of the CTMT to detect associations with fitness to drive related measures in patients with PD. Inclusion criteria were the presence of a valid driver’s license, regular car driving, a CDR score ≤ 0.5, and a Hoehn & Yahr score between 1 and 3. Twelve individuals with PD (Age: Mean = 63.75, SD = 10.50) and 12 cognitively intact individuals (Age: Mean = 63.50, SD = 10.43) were introduced in the study. Collection of data included a comprehensive neurological/neuropsychological assessment and a driving simulation experiment. Certain subtests of the CTMT were more strongly associated with a variety of driving indexes in individuals with PD as compared to the original TMT. In addition, according to the stepwise regression models that were applied, the CTMT was recognized as a more effective predictor of driving behavior than the TMT. The pattern of findings that was observed supports the usefulness of CTMT on detecting associations with fitness to drive related-measures in patients with PD. Underlying factors that may explain the effectiveness of the CTMT could be related to the greater variety of set shifting and inhibition processes that this alternative option integrates as compared to the original TMT.     

系统生物学引导阿尔茨海默病治疗新策略

阿尔茨海默病(AD)是一种发生于中老年期的退行性脑神经变性疾病,临床上以进行性智能衰退,伴有人格改变为主要特征.其发病过程涉及许多途径和靶点.现代医学认为脑内胆碱能递质功能紊乱、β-淀粉样蛋白沉积、tau-蛋白过磷酸化、炎症反应以及基因突变等在其发病过程中起着重要作用.治疗方法从胆碱酯酶抑制剂、神经递质受体阻滞剂到补气活血、益精填髓、化痰开窍等中医药疗法不等.但抑制剂、阻滞剂等药物阻滞疗法,从单一环节阻断发病途径,忽略了AD发病的整体复杂性.中医辨证论治从整体观念出发,在宏观上治疗AD,对AD的发病缺乏微观深入研究.AD治疗需要借助于“系统生物学”理论的指导.中西医结合为AD的治疗提供了较为科学、有效的途径和发展空间.