肠易激综合征：罗马III标准与我国共识意见解读

肠易激综合征在我国的发病率逐年升高,2003年我国制定的IBS的共识意见已不适用,因此2007年我国肠易激综合征共识意见进行了重新修订,称为长沙共识意见。长沙共识意见借鉴了国际公认的罗马III标准,在IBS的诊断所需的时间,IBS的亚型分型等方面做了较大的修订。并强调了随诊在IBS诊断中的重要性。长沙共识意见同时指出罗马III标准是基于西方国家的研究资料制定的,并不完全适用于我国。我国在IBS的诊断中应结合国人的发病特点进行诊断。长沙共识意见在IBS的治疗方面就我国现状提出了治疗流程。     

微创技术在脑血管病诊治中的应用与存在的问题

脑血管病是危害人类健康的三大疾病之一.随着CT、,MRI、DSA等先进设备的应用,脑血管病的诊治水平进入一个新的阶段.显微手术、血管内栓塞、γ-刀或X-刀等很多微创技术不断应用于脑血管病的治疗.由于各地区发展不平衡,微创技术的应用尚存在不少问题.因此,必须积极稳妥地开展脑血管病诊治中的微创技术.     

“逆临床思维”与新型疾病发现方法的探讨

目的 初步总结发现新型疾病的方法和医学思维方式。方法 研究30余种疾病发现的过程。结果 新型疾病的发现过程和判断的思维方式似可初步总结为以下几个方面：（1）以疾病的异常特征为发现新型疾病的线索,包括流行病学、临床、实验室三个方面。（2）发现线索后从以上三个方面全面系统收集资料。（3）运用宏观思维寻找群体的共同特征,排除个体差异。（4）不仅收集与已知疾病相同的特征,而且还应注意与已知疾病不同的特征,然后综合分析判断。结论 发现新型疾病的方法与思维方式不同于经典的临床思维模式。     

Are General Practitioners Willing and Able to Provide Genetic Services for Common Diseases?

Primary care in the United Kingdom has been advocated as an optimal location for the provision of genetic services for common diseases. Little, however, is known about general practitioners' own views toward this suggestion or the possible demand for such services from patients. To assess general practitioners' attitudes to providing genetic services for common diseases, and to estimate the demand from patients for these services, we used a single-page postal questionnaire survey of all 359 general practitioners registered with the Oxfordshire Health Authority; 339 (94%) responded. These physicians reported that a mean 4.1 patients (95% CI, 3.3–4.9) out of every 1,000 consulting them were concerned about their own risk of a common disease associated with a diagnosis in a family member. Half of the general practitioners (95% CI, 45–56%) counseled about genetics in the last year. A majority of general practitioners accept the need to provide genetic services, but far fewer are competent to do so. Although 60% (95% CI, 55–65%) believed they should be involved with genetic screening for common diseases, only 29% (95% CI, 24–34%) felt sufficiently prepared to take family histories and draw pedigrees, and only 15% (95% CI, 11–19%) felt sufficiently prepared to counsel patients about their genetic test results. Given the necessary training and information, 63% (95% CI, 58–68%) and 64% (95% CI, 59–69%) were willing to provide these services. Even with training and information, not all would be willing to provide these services, and lack of time may be a major deterrent. Practice-enabling strategies, such as computerized aids in genetics, may be useful.     

IgG4相关性胆胰疾病的诊断和治疗

近年来发现,IgG4相关性疾病可累及全身多系统多器官,目前研究提示IgG4相关性胆胰疾病主要有IgG4相关性硬化性胆管炎和自身免疫性胰腺炎（AIP）.前者是一种免疫发病机制未明、生化学特点以及胆管影像学表现与原发性硬化性胆管炎（PSC）相似,对糖皮质激素应答良好的疾病.后者临床表现为复发性胰腺炎、梗阻性黄疸,伴胆管、涎腺等其他器官受累.实验室检查血清和组织学IgG4明显升高.影像学表现为胰腺呈“腊肠样”外观,伴主胰管弥漫不规则狭窄,同样对激素治疗敏感.二者常同时受累、关系密切,易误诊为胆管癌、硬化性胆管炎或胰腺癌,本文将当前国内外研究现状做一介绍,供临床诊治参考.     

自身抗体检测新技术及其临床应用

自身抗体的检测在自身免疫性疾病（A ID ）的诊断,判断疾病的严重程度及评价疗效方面拥有十分重要的临床意义。随着免疫检测技术的进步,新的自身抗体特异性靶抗原被发现,自身抗体的检测技术也越来越多,出现如何评估自身抗体检测方法及诊断价值的新问题。本文介绍自身抗体检测的新技术及自身抗体检测技术的发展趋势,评估自身抗体检测方法应用现状,分析了临床自身抗体检测技术的优缺点,让临床实验室更加合理有效选择自身抗体检测技术。     

心血管病患者择期介入手术前后焦虑抑郁及影响因素分析

探讨择期介入治疗心血管病患者术前术后焦虑抑郁水平及其影响因素。连续调查我院心内科行择期介入治疗的住院患者100例,分别于术前及术后记录患者静息血压和心率,填写贝克抑郁量表、状态焦虑量表、自制担心评定量表、SF-36生活质量调查问卷;SPSS 17．0软件对焦虑抑郁影响因素进行了统计分析。介入患者术后血压（141．2＆#177;10．6）mmHg /（75．1＆#177;11．9）mmHg 较术前（145．4＆#177;18．0）mmHg/（79．8＆#177;12．2）mmHg 显著下降,心率（72．1＆#177;11．6）次/分也较术前（78．2＆#177;12．9）次/分显著降低;术前患者普遍存在焦虑情绪（43．4＆#177;8．4）,焦虑水平与学历、血压及心率均呈正相关（P＜0．05）,与年龄、生活质量呈负相关（P＜0．05）;介入术后患者焦虑水平显著下降（41．2＆#177;7．6,P＜0．03）;抑郁水平在手术前后无明显变化。本结果提示择期介入治疗心血管病患者术前存在明显焦虑,焦虑水平与年龄、学历、血压、心率及生活质量密切相关。     

论疾病诊治中的顾此失彼

"顾此失彼"指在疾病的诊治中发现、意识或处理了事物的一个方面或一个事物,而遗漏、忽视了事物的另一个方面或另一个事物。首先,表现在没有全面地收集和分析相关的临床资料。其次,表现为疾病诊断的不全面。再次,表现为疾病治疗的总体安排、治疗方案或药学监护等方面的顾此失彼。与疾病诊断和治疗有关的"彼"是必须被发现和意识的。但在处理时,则根据"彼"与诊断或治疗关系的程度分别对待。为减少或减轻疾病诊治中"顾此失彼"的不良后果,需要采取一系列相应对策,如实施毕业后规范化培养、学习诊治指南和临床路径、重视疾病诊治的程序、提高临床技能、积累临床经验、丰富相关知识、培养临床思维、提高职业素养等。     

Psychologists' perspectives on the diagnostic classification of mental disorders: Results from the WHO‐IUPsyS Global Survey

This study examined psychologists' views and practices regarding diagnostic classification systems for mental and behavioral disorders so as to inform the development of the ICD‐11 by the World Health Organization (WHO). WHO and the International Union of Psychological Science (IUPsyS) conducted a multilingual survey of 2155 psychologists from 23 countries, recruited through their national psychological associations. Sixty percent of global psychologists routinely used a formal classification system, with ICD‐10 used most frequently by 51% and DSM‐IV by 44%. Psychologists viewed informing treatment decisions and facilitating communication as the most important purposes of classification, and preferred flexible diagnostic guidelines to strict criteria. Clinicians favorably evaluated most diagnostic categories, but identified a number of problematic diagnoses. Substantial percentages reported problems with crosscultural applicability and cultural bias, especially among psychologists outside the USA and Europe. Findings underscore the priority of clinical utility and professional and cultural differences in international psychology. Implications for ICD‐11 development and dissemination are discussed.     

Behavioral Effects of Chronic Melatonin and Pregnenolone Injections in a Myelin Mutant Rat (taiep)

The taiep (tremor, ataxia, immobility, epilepsy, and paralysis) myelin mutant displays a number of locomotor deficits. Taiep rat gait is characterized by shorter stride and step lengths as well as by larger stride widths. Thirty-day-old taiep mutants were placed under a regimen of daily hormone injections for 60 days. Animals in Condition 1 received melatonin, those in Condition 2 received pregnenolone sulfate, and those in a third control condition received injections of saline. Following the injections, each taiep mutant's gait was analyzed. The animals that received melatonin and pregnenolone displayed significantly larger stride and step lengths than did the controls. In addition, the animals that received hormones displayed shorter stride widths than did the controls. These experimental effects are consistent with a normalization of gait. Possible cellular mechanisms of this behavioral effect are discussed.