Rh弱D(Del)检测及其临床意义

目的探讨Rh弱D(Del)的检测及其临床意义。方法采用氯仿/三氯乙烯放散法检测50份Rh(D)血清学阴性样本及PCR-SSP法分析其基因结构。结果50例Rh(D)血清学阴性样本中弱D(Del)11例,其D基因外显子均完整。结论弱D(Del)型血清学筛选容易漏检为Rh(D)阴性;弱D(Del)型如为献血员,应视为Rh(D)阳性血液用于临床输血;如为患者,应视为Rh(D)阴性,必须输注Rh(D)阴性血液。D基因外显子与D抗原表达的关系有待进一步研究。     

冠心病患者负性情绪的心理干预及其意义

目的：探讨综合性心理治疗对冠心病负性情绪的干预效果及其临床意义。方法：将５６例冠心病患者随机分为心理治疗组及对照组,评定并比较两组ＳＡＳ、ＳＤＳ、ＳＡＱ得分及其临床疗效。结果：心理治疗组ＳＡＳ、ＤＳＤ评分显著低于对照组,且临床疗效及ＳＡＱ得分显著高于对照组。结论：综合性心理治疗能显著降低冠心病患者负性情绪的严重程度,并可提高其临床疗效、躯体功能及生活质量。     

血清可溶性血管细胞粘附分子1测定在肾移植急性排斥反应中的临床意义

采用酶联免疫吸附法（ Ｅ Ｌ Ｉ Ｓ Ａ） 监测５６ 例肾移植患者术后血清可溶性血管细胞粘附分子 １ （ｓ Ｖ Ｃ Ａ Ｍ １ ） 水平的变化,旨在探讨其在肾移植术后免疫学监测中的价值。结果发现： 肾移植患者术后ｓ Ｖ Ｃ Ａ Ｍ １ 水平呈规律性变化, 急性排斥反应组ｓ Ｖ Ｃ Ａ Ｍ １ 水平明显高于移植肾功能稳定组和环胞素 Ａ（ Ｃｓ Ａ） 肾中毒组, 差异非常显著（ Ｐ＜ ００１ ） ; 与排斥反应前水平比较, 差异亦非常显著（ Ｐ＜ ００１ ） 。对激素治疗敏感的排斥反应, ｓ Ｖ Ｃ Ａ Ｍ １ 逐渐降至正常水平; 耐激素的排斥反应应用 Ａ Ｔ Ｇ 治疗后, ｓ Ｖ Ｃ Ａ Ｍ １ 在排斥反应后１ 个月内仍维持在较高水平。 Ｃｓ Ａ 肾中毒组, ｓ Ｖ Ｃ Ａ Ｍ １ 水平无明显变化。结果表明,肾移植术后动态监测ｓ Ｖ Ｃ Ａ Ｍ １ 水平的变化, 有助于急性排斥反应的诊断和鉴别诊断, 有助于指导临床治疗。     

Interleukin-13 and Its Receptors in Idiopathic Interstitial Pneumonia: Clinical Implications for Lung Function

Idiopathic interstitial pneumonia (IIP) is characterized by varying degrees of interstitial fibrosis. IL-13 and IL-4 are strong inducers of tissue fibrosis, whereas IFN-γ has antifibrotic potential. However, the roles of these substances in IIP remain unknown. IL-13, IL-4, and IFN-γ were measured in the BAL fluid of 16 idiopathic pulmonary fibrosis (IPF) patients, 10 nonspecific interstitial pneumonia (NSIP) patients, and 8 normal controls. The expression of IL-13 and IL-13Rα1/α2 in lung tissues was analyzed using ELISA and immunohistochemistry. IL-13 levels were significantly higher in IPF patients than the others (P<0.05). IL-4 levels were higher in both IPF and NSIP patients than in normal controls (P<0.05), and IFN-γ levels were lower in NSIP patients than in normal controls (P=0.047). IL-13 levels correlated inversely with FVC% (r=-0.47, P=0.043) and DLCO% (r=-0.58, P=0.014) in IPF and NSIP patients. IL-13 was strongly expressed in the smooth muscle, bronchial epithelium, alveolar macrophages and endothelium of IPF patients. IL-13Rα1, rather than IL-13Rα2, was strongly expressed in the smooth muscle, bronchial epithelium, and endothelium of IPF patients. IL-13 and its receptors may contribute to the pathogenesis of fibrosis in IIP and appear to be related to the severity of the disease.     

MGMT基因甲基化在肿瘤发生及个体性化疗中的意义

MGMT作为一种DNA修复蛋白,能够移除DNA上鸟嘌呤O6位点的能致突变毒性和细胞毒性的烷基加合物,从而保护细胞对抗烷化基团的损害,是肿瘤耐受烷化剂药物的主要原因。MGMT在不同的肿瘤和肿瘤细胞系中沉默,MGMT基因启动子CpG岛过甲基化是其表观沉默的主要机制。启动子过甲基化相关的MGMT基因沉默与很多人类肿瘤密切相关。首先,MGMT基因沉默可导致肿瘤相关基因转换突变的累积;其次,MGMT基因过甲基化与肿瘤增强对烷化剂药物敏感性之间呈正相关。这些新发现揭示了MGMT基因甲基化在肿瘤的发生、发展和肿瘤治疗中的重要作用。     

我国临床心理学工作现状调查与展望

对３０个省市和所属地市中有心理学系、心理学教研室的高等院校和精神病医院和儿保等机构共１，４３４个寄发了调查表，回收４５７份，回收率为３２％，调查心理测验、心理咨询与治疗和从业人员情况。结果表明常用心理测验共２２种，其中用得最广的前五种为ＷＩＳＣ，ＥＰＱ，ＷＡＩＳ－ＲＣ，ＭＭＰＩ和ＷＰＰＳＩ，各测验应用最多的是医院（占全体的７０．６％），用途最多的为医疗方面（５０％），其次为教育和科研（各占２３．７％）。常用心理治疗方法有行为、认知、支持、精神分析和森田疗法等９种，常治的心理障碍有强迫症、恐怖症、焦虑症等２２种。在调查４５７个单位中有３３５个开展了心理咨询服务，近一年的求助者计８８，１９０人。求助的问题计１８种，依次为个人健康问题（２１．８％），一般人际关系（１５．３％），爱情问题（１０．５％）等。现在从业人员从测验、心理治疗至咨询三项工作来看，专业原为心理学的少（分别为８．３％，２．３％和７．２％），为临床医学的占最大多数（分别为７６．３％，８７．３％和７９．４％）。接受了临床心理系统训练的人数在１０％以内，接受短期专业训练占最大多数（９０％左右）。根据调查结果对这些工作作了展望。     

Psychological dynamics affecting traumatic memories: Implications in psychotherapy

The search to understand response to trauma has turned to the contribution of personality factors. The way people process the stressor event is critical in determining whether a trauma will be configured or not. Neuroscience shows that the brain does not store memories, but traces of information that are later used to create memories, which do not always express a completely factual picture of the past experience. Whenever an event is retrieved, it may undergo a cognitive and emotional change. Psychological dynamics – emotional interpretative tendency that affects the internal dialogue related to a meaningful event – may influence the development of positive or negative outcomes after stressor events. We postulate that therapists must see beyond the traumatic event itself and work with the internal dialogues that maintain the pathological relationship with the past episode. Thus, they may better treat traumatized patients by therapeutically rebuilding the memory. A brief clinical case is presented to show how exposure‐based and cognitive restructuring therapy may help trauma victims experience psychological growth from their negative experiences, by fostering healthy psychological dynamics.