慢性乙肝治疗路线图和HBV DNA、HBeAg、HBsAg定量的监测意义

慢性乙型肝炎病毒感染呈世界分布并且引起不良结局,是极为严重的健康问题。慢性乙型肝炎治疗最重要的目标是长期抑制病毒以改善预后,防止出现肝硬化、肝衰竭和肝癌。目前,抗病毒药物主要有干扰素和口服核苷（酸）类似物,核苷（酸）类似物的缺点主要在于长期治疗中出现耐药。路线图概念被用于监测耐药预测疗效。HBV DNA定量水平被作为路线图较好的监测指标。由于血清转换率及清除率过低,HBeAg、HBsAg定量检测不适合用于路线图监测,但对于使用聚乙二醇干扰素的慢性乙肝患者,可作为预测治疗应答的指标。     

内质网应激和胰岛素抵抗

2型糖尿病的发病机制主要涉及胰岛素抵抗,近年来研究表明内质网应激可诱导胰岛素抵抗的形成,并使与改善胰岛素受体敏感性相关的内质网应激标志物分子氧调节蛋白150和转录因子X盒结合蛋白-1表达增强,表明内质网应激对细胞具有双重作用,一方面可诱导胰岛素抵抗,另一方面激发对应激的适应反应。     

腹内脂肪与胰岛素抵抗

腹内脂肪与胰岛素抵抗的关系密切,它在形态、脂解等方面不同于皮下脂肪。脂肪细胞分泌的细胞因子在胰岛素抵抗的发生发展中有着重要的作用。明确腹内脂肪致胰岛素抵抗的机制有益于代谢综合征的防治。     

细菌耐药性的产生及预防对策

细菌耐药性的产生是当今医学界所普遍面临的严重问题,危害着人类的健康和生存。通过透析细菌耐药的根源和机制,使人们认清细菌耐药性问题的实质,为制定出合理使用抗菌药物的原则和预防细菌耐药性的措施提供一些理论依据。     

细菌耐药性与抗菌药物的合理应用

面对细菌耐药性的客观存在,分别从四个方面讨论抗菌药物的合理应用,即首先是人类如何对待细菌、真菌等微生物,第二是人类如何对待抗菌药物,第三是人类如何认识细菌耐药性,第四是临床医师如何合理应用抗菌药物以确保最佳疗效及遏制细菌耐药性。笔者提出“六化”,即做到用药适应证规范化,做到感染性疾病病原学诊断常规化,提倡感染性疾病病原学治疗选药合理化,逐步做到推广病原菌耐药性信息监测与反馈制度化,强调抗感染治疗用药方案个体化,评价疗效制度日常化。它是追求抗感染疗效最佳化,遏制病原菌耐药性有效化,力争抗菌药物不良反应最小化的基本措施。     

Postponing trauma: The dangers of telling

Surviving a major historical trauma has consequences that are difficult to live with. Survivors who remain silent are often condemned to a desiccated existence, a dried‐out life, a death in life. Survivors who speak out run an even greater risk. Telling their ghastly tale may trigger somatic consequences, psychotic episodes, or even suicide. As to the psychoanalytic cure, the free association it requires carries its own danger: negative therapeutic reaction in sometimes extreme forms. Avoidance of horror may turn into avoidance of life itself. Awful as it may seem, this avoidance of life may represent a victory over a menacing chaos. Should we as analysts accept the risk of endangering such a victory, no matter how unsatisfactory? The psychoanalytical injunction to speak out may trigger an upsurge of shame and terror. Is subjectivation always possible? This paper is about what happens when denial and splitting strategies are suspended, when ‘crypts’ are opened. Is there an analytic ‘poros’ allowing for a controlled return of affects? Is there a therapeutic solution to the problem of telling a wreckage without being caught in it? The dangers of ‘telling’ will be discussed in regard to new analytic strategies and new interpretive registers. When the ‘silent psychic sharing’ proves insufficient, some analysts go so far as to take part in the shame, share the grief, ‘lend their own psyche’, become a ‘double’ of the analysand, accept the existence of ‘sanctuaries’. To what effect?     

Plasma BDNF is reduced among middle-aged and elderly women with impaired insulin function: Evidence of a compensatory mechanism

Brain-derived neurotrophic factor (BDNF) plays a regulatory role in neuronal differentiation and synaptic plasticity and has been linked to glucose regulation and cognition. Associations among plasma BDNF, cognition, and insulin function were explored. Forty-one participants with impaired insulin function (IIF), ranging from insulin resistance to type 2 diabetes mellitus (T2DM), were matched with 41 healthy controls on gender, age, education, and IQ. Participants received complete medical, neurological, psychiatric, and neuropsychological evaluations. IIF individuals had significantly lower plasma BDNF levels than controls, particularly females, and higher BDNF levels were associated with poorer explicit memory in IIF females, suggesting that higher levels within this group may reflect the body’s efforts to respond to damage. After accounting for age, education, and HbA1c, BDNF significantly predicted 13.1–23.5% of the variance in explicit memory in IIF women. These findings suggest that BDNF elevations within diseased groups may not always be a marker of health.     

The Church: Intransit and Intransigent

In this essay, I revisit James E. Dittes' first book, The Church in the Way, and discuss its most salient points. Of particular interest is the view that parish ministers should adapt concepts from psychoanalysis for their ministry, especially as concerns the phenomenon of resistant behavior on the part of parishioners. Dittes' central claim is that resistance is a sign of vitality and thus should be embraced and exploited as a resource for ministry. Evaluating that claim alongside the enduring value of the book as a whole, I suggest three ways the work remains contemporarily relevant.     

Listening to the Nos

In Re-Calling Ministry (1999), James E. Dittes offers a collection of fourteen poetic essays on the predictable crises of Christian ministry, which he treats not as impediments but as boons to that ministry. A student of Dittes' at Yale Divinity School in the 1970's, I reflect on the truth-telling of my former teacher through the lens of my own twenty years in parish ministry.     

Creative Writing as Resistance and Discovery in an Analysis

This paper was originally written as a graduation paper for the completion of adult analytic training. In this paper I trace and explore multiple uses of creative writing in my personal analysis, illuminating the development of analytic phases and process. The creative writing used in this paper is primarily from the first three and a half years of my analysis, well before entering analytic training. It is an eventual interpretation on the part of my analyst, as well as the rest of my analysis and analytic training, that allow me to realize that while my writing felt like self-discovery, it also served as resistance, defense against the entirety of my affective world and internal conflicts. A poem written much later in the analysis is included, as it reveals the integration of struggled with concepts, as well as the pain of the inevitable separation of termination.