Daily stress and anxiety and their relation to daily fluctuations of symptoms in asthma and chronic obstructive pulmonary disease (COPD) patients

Although stress and anxiety have long been assumed to play an exacerbatory role in asthma, no study has systematically documented that daily exacerbations of asthma symptoms are related to stress and/or anxiety. In this study, 24 airways obstruction patients (12 asthmatics and 12 chronic obstructive pulmonary disease patients) were instructed to monitor the severity of daily respiratory symptoms. In addition, subjects recorded their daily anxiety level and the number and perceived impact of daily stressors. The results showed that although there were differences between high- and low-stress days for both groups, there were no differences between groups on symptom severity or between high- and low-anxiety days, as measured by the State-Trait Anxiety Inventory (STAI). Thus, although the number and impact of daily stressors were found to be directly associated with the severity of asthma symptoms, anxiety does not appear to have a direct role in the exacerbation of asthma. The findings failed to support the anxiety theory of asthma but provided an explanation for the poor results obtained in previous treatment studies which employed anxiety management with asthmatics.     

Experimental assessment of tinnitus aurium

A 32-year-old male volunteer with an eight year history of chronic unilateral tinnitus (ear-ringing) participated in a behavioral assessment strategy that included a series of measurement and modification procedures. A psychophysical matching technique was employed throughout a planned combination of procedures to assess and manipulate the intensity or loudness of tinnitus responses. Following baseline assessment, measurements were conducted at varying times of the day, concomitant with exposure to music, during progressive relaxation training, and under conditions of caffeine consumption. The value of careful assessment to describe cues and conditions associated with tinnitus and its reduction are discussed with implications for behavior treatment design and evaluation.     

难治性丙型肝炎研究新进展

随着聚乙二醇化干扰素(IFN)的普及应用和慢性丙型肝炎规范化治疗的开展,其治愈率不断提高.但疗效不佳的慢性丙型肝炎患者不断积累,难治性慢性丙型肝炎患者成为临床医生必须面对的挑战.难治性丙型肝炎患者应当分为两类,第一类为“难治疗”性慢性丙型肝炎患者,该类患者由于宿主条件限制,不能耐受IFN联合利巴韦林(RBV)的标准治疗,如儿童和老年人、慢性肾功能衰竭患者等.第二类为“难治愈”性慢性丙型肝炎患者,该类患者可以耐受标准治疗方案,但按照应答指导的治疗原则(RGT)治疗后,效果仍然不佳或复发.本文就近年关于难治性丙型肝炎的研究进展,从难治性丙型肝炎的定义、机制、治疗诸方面作一综述.     

逆行性肾盂造影联合输尿管软镜在诊断小肾盏癌中的价值

探讨逆行性肾盂造影联合输尿管软镜在诊断小肾盏癌中的价值。回顾分析5例小肾盏癌临床资料,术后病理检查结果均提示尿路上皮癌I级（Ta-G1）,术后定期行膀胱内灌注化疗药物,且均未出现肿瘤其他部位转移等并发症发生。对5例患者均进行随访,1年期间每3个月行尿常规及B超检查均正常,1年生存率达100％。患者出现血尿症状,虽然常规检查（尿常规、B超、IVU、CT或MRI等）诊断不明确者,都可行逆行性肾盂造影检查。一旦逆行性肾盂造影检查提示异常图像,均可提示肾盏癌,使误诊率及漏诊率降至最低程度,尽可能阻断早期肿瘤的发展。故逆行性肾孟造影联合输尿管软镜可提高早期小肾盏癌的术前诊断率。     

肾移植受者 BK 病毒感染的诊治进展

BK病毒（BK V ）是人类多瘤病毒的一个亚群,有很高的隐性感染率,研究显示全球超过80％的人口BK V血清学阳性。随着移植后强效免疫抑制剂的使用,BK V感染正成为移植肾失活的重要原因。据统计,约1％～10％的肾移植受者在免疫抑制状态下,可因BKV激活而引起BKV肾病（BKVN）,而BKVN可引起约45％的远期移植肾失活。由于目前缺乏明确有效的抗病毒药物,早期监测病毒载量、减少免疫抑制剂对控制BKVN、保留移植肾功能至关重要。本文就肾移植相关的BKV感染概况及BKVN的诊断、治疗进展进行综述。     

农村与城镇终末期肾病患者临床状况比较分析

时比分析农村与城镇终末期肾病患者的临床状况,旨在了解新农合政策带给农村终末期肾病患者的益处及今后还需完善和努力之处.对广西壮族自治区人民医院血液净化治疗中心2007年新增的238例终末期肾病患者按农村与城镇进行分组对比分析.96例农村患者,88例选择血液透析,8例放弃治疗;142例城镇患者,23例选择腹膜透析,108例血液透析,11例放弃.无论是城镇还是农村患者慢性肾炎为主要的原发病、都存在透析过晚、并发症发生率高、急诊透析率高的现象.与城镇组相比,农村组患者平均年龄、肾痛知晓率、残余肾功能、血红蛋白、二氧化碳结合力、尿素清除指数低于城镇组(P<0.05);梗阻性肾病发病率、并发症发生率、急诊透析率、死亡率、失访率高于城镇组(P<0.05).新农合的实施使农村终末期肾病患者获得了治疗的机会,针对农村患者肾病知晓率低、临床状况差的特点,需加强农村慢性肾病的防治工作.     

单纯性肾囊肿外科手术适应证的选择

单纯性肾囊肿是临床常见的肾脏疾病之一,临床常采用去顶减压术治疗,但外科治疗的适应证目前尚不统一。除症状性肾囊肿及由囊肿引起尿路梗阻外,对于高血压病合并肾囊肿者,如囊肿直径大于5cm,考虑囊肿有可能对高血压产生影响,因此,有必要采取外科治疗措施;但如果不合并高血压,是否一定需要治疗有待进一步探讨。肾囊肿对肾功能影响目前尚无定论,对于小于60岁的肾囊肿患者其肾功能下降可能与肾脏原发病变有关,应积极查找病因并密切随访。对于肾囊肿Bosniak分型为Ⅰ、Ⅱ、ⅡF型的患者,可以不需要手术治疗,密切随访;对于Ⅲ、Ⅳ型患者,应进行外科手术治疗。     

Effects of Different Telephone Intervention Styles with Suicidal Callers at Two Suicide Prevention Centers: An Empirical Investigation

To determine the relative effectiveness of telephone intervention styles with suicidal callers, researchers listened unobtrusively to 617 calls by suicidal persons at two suicide prevention centers and categorized all 66,953 responses by the 110 volunteer helpers according to a reliable 20-category checklist. Outcome measures showed observer evaluations of decreased depressive mood from the beginning to the end in 14% of calls, decreased suicidal urgency ratings from the beginning to the end in 27% of calls, and reaching a contract in 68% of calls, of which 54% of contracts were upheld according to follow-up data. Within the context of relatively directive interventions, a greater proportion of Rogerian nondirective responses was related to significantly more decreases in depression. Reduction in urgency and reaching a contract were related to greater use of Rogerian response categories only with nonchronic callers.     

乙酰肝素酶剪接变体T5mRNA在肾癌中的表达

探讨乙酰肝素酶（Hpa）剪接变体T5mRNA在肾癌（RCC）组织中的表达,分析其与RCC发生发展及预后的关系。采用逆转录-聚合酶链反应（半定量RT—PCR）方法检测RCC组织标本及癌旁正常组织标本中T5mRNA的表达。结果RCC组织中T5mRNA阳性率高于癌旁正常组织（P〈0．05）;T5mRNA阳性表达率与RCC病理...     

慢性乙型肝炎合并妊娠患者的抗病毒治疗

母婴垂直传播是我国乙型肝炎病毒（HBV）感染的主要传播方式,新生儿标准的主动一被动免疫即高效价乙肝免疫球蛋白联合乙肝疫苗大大降低了母婴垂直传播的比例,但母体高HBVDNA水平可以增加胎儿宫内感染HBV的风险,导致HBV母婴垂直传播。因此,妊娠期抗病毒治疗尤为关键。计划妊娠的育龄期的慢性乙型肝炎患者应尽可能在妊娠前完成抗...