丙型肝炎相关的基因表达模式与肝移植受体早期进展为肝纤维化有关

背景与目的：感染丙型肝炎病毒（HCV）的肝移植受体在肝移植术后很快进展为复发性肝炎，其中一些患在术后2年内即进展为肝纤维化。该项研究目的是识别影响肝脏疾病进展的分子机制，并寻求早期肝纤维化可能的基因标志物。方法：作对13例（11例感染和2例非感染）肝移植受体，分别在其移植术后1年之内的0、3个月、6个月和12个月对其肝活检标本进行连续性基因表达分析。将所得数据与临床观察结果进行比较，并与从55例非移植的丙型肝炎感染和非感染的肝脏活检标本获得的基因表达数据库进行比较。结果：识别出一些特殊的基因表达模式。第1种模式是移植受体所特有的，而与其是否存在感染无关，其相应的基因编码应激反应蛋白和涉及凝血的血蛋白，在移植术后移植物的恢复中有差异性表达；第2种模式为HCV感染所特有的，包括编码干扰素介导的抗病毒反应和免疫系统（抗原递呈，细胞毒反应）基因编码元件上调，而这些上调表达在进展为早期纤维化的患体内缺失或被抑制，从而提示患疾病的进展可能是由于肝脏对感染的反应受损所致；最后一种基因表达模式，是4例感染了HCV并进展为早期肝纤维化的患第12个月的肝活检标本所特有的。     

Quality of life and control of allergic rhinitis in patients from regions beyond western Europe and the United States

There is comparatively little information on health‐related quality of life (HRQoL) in subjects with allergic rhinitis (AR) or allergic rhinoconjunctivitis (AR/C) in countries beyond western Europe and North America. The primary aim of this investigation was therefore to review and assess the information in the public domain on HRQoL in AR/C patients from diverse regions of the world, represented by different countries, including Argentina, Australia, Brazil, Russia, Singapore, South Africa and Turkey. Second, in view of the absence of a standardized definition for ‘AR control’, the review aimed to determine whether a working definition of AR/C can be inferred from validated tests or other instruments documented to date. Despite the comparatively low number of studies, this review demonstrated that overall the symptoms of AR/C impair the HRQoL of patients in these regions by adversely impacting sleep, daily activities, physical and mental status and social functioning, similar to that demonstrated in much larger numbers of studies of AR/C patients in Europe and the United States. Furthermore, the findings of the review suggest that ‘overall’ control of the disease should encompass reduction of nasal and ocular symptoms, as well as improvements in HRQoL, comorbid conditions and cognition. Although some instruments are currently available for measuring control of AR, none are capable of assessing all these aspects, emphasizing the need to develop appropriate new instruments.     

A Survey of Practicing Sleep Coaches

Background: Sleep coaches are individuals of various backgrounds who offer services to families struggling with behavioral childhood sleep problems. We conducted a survey of coaches to further elucidate scope of practice, practice patterns, geographic distribution, education, training, and beliefs regarding qualification requirements. Methods: A Web-based survey was completed by 142 individuals who identified as a sleep coach. Results: Coaches were distributed across 17 countries and 5 continents. Overall, 65% of coaches served clients in countries beyond their home country. Within the United States, coaches were generally located in more affluent and well-educated zip codes near large metropolitan centers, 91% served clients beyond their home state, and 56% served clients internationally. Educational background varied across coaches (12% high school degree, 51% bachelor’s degree, 32% master’s degree, 2% doctoral degree, 1.5% JD degree). Few coaches (20%) were or had been licensed health care providers or carried malpractice insurance (38%). Coaches usually provided services for children < 4 months of age to about 6 years of age, and were much less likely to provide services for children with comorbid neurodevelopmental (32%) or significant medical disorders (19%). Coaches reported an average of 3 new and 6 total clients per week and working 20 hr per week on average. Most coaches (76%) felt that a formal sleep coach training program was the most important qualification for practice. Conclusions: These results highlight a diversity of background, training, and geographical distribution of sleep coaches, and may help inform discussions regarding guidelines for training and credentialing of sleep coaches.     

Sexual difficulties within a group of patients with vulvodynia

Dyspareunia, caused by vulvodynia, has, like other sexual problems, evolved from being conceptualized as a psychological problem through a period when it became viewed by the medical world as a physical problem. It is now seen as being a combination of psychological and physical factors. However, no research to our knowledge has explored in depth the level of sexual and relationship difficulties of this population. This investigation involved 172 women (85 suffering with vulvodynia and 87 women in a control group with general dermatology conditions) to establish the prevalence of relationship and sexual difficulties, using validated questionnaires, a newly devised symptom checklist and a structured interview. The results demonstrated increased levels of sexual and relationship difficulties within the vulvodynia group that need further exploration.