The causal role of negative imagery in social anxiety: a test in confident public speakers

This study tests the causal role of negative self-imagery in social anxiety. Low public-speaking anxious volunteers rehearsed a negative self-image, a positive self-image or a control image prior to giving a speech. As predicted, the negative image group felt more anxious, believed they performed less well and reported more negative thoughts than the positive image group. These findings do not appear to be due to changes in state anxiety, since they remained unchanged when anxiety was controlled in an analysis of covariance. The negative image group also reported more anxiety than the control group. Given that participants do not currently have anxiety problems, the findings are consistent with the idea that negative self-imagery has a causal role in the development and maintenance of social anxiety.     

Atteintes rénales du lupus

Systemic lupus erythematosus is the most characteristic of auto-immune disorders that can lead to tissue damage in many organs, including kidney. Lupus nephritis occurs in 10 to 40% of lupus patients. Its clinical hallmark is the appearance of a proteinuria as soon as a 0.5 g/g or 0.5 g/d threshold, which calls for a renal histological evaluation in order to determine the lupus nephritis severity and the need for specific therapy. More than half of renal biopsies lead to the diagnosis of active lupus nephritis–class III or class IV A according to the ISN/RPS classification–that are the most severe in regards to renal prognosis and mortality. Their treatment aims to their clinical remission and to the prevention of relapse with minimal adverse effects for eventually the preservation of renal function, the prevention of other irreversible damage, and the reduction of risk of death. The remission is obtained through induction therapies of which the association of high dose steroids and cyclophosphamide is the most experienced. When this association must be challenged by the prevention of side-effect, in particular infertility, mycophenolate can be given instead of cyclophosphamide. Maintenance therapy, for the prevention of relapse, consists in mycophenolate or in azathioprine, mycophenolate being the most efficient however associated with a high risk of teratogenicity. Withdrawal of maintenance therapy is possible after two to three years in absence of high risk factors of relapse of lupus nephritis, however a reliable assessment of the risk of relapse is still lacking. Only pure membranous lupus nephritis (pure class V) associated with high level proteinuria requires specific therapies that usually associates steroids and an immunosuppressive drug. However, their choice hierarchy and even the use of less immunosuppressive strategies remain to be determined in terms of benefice over risk ratios. In spite of its trigger effect on lupus activity, pregnancy can be safe and successful if scheduled in the lowest risk periods with close multidisciplinary monitoring before, during and after. When necessary, renal replacement therapy does not require specific adaptation, renal transplantation is the best option when possible, as early as possible.     

延长维护间隔时间对非治疗期患者输液港并发症影响的Meta分析

目的 评价延长维护间隔时间对非治疗期患者输液港相关并发症的影响.方法 检索中国知网、维普数据库、万方数据库、中国生物医学文献数据库、PubMed、Cochrane Library、Embase、Web of Science数据库中关于延长非治疗期患者输液港维护间隔时间的文献,检索时限为建库至2021年10月6日.由2名...     

The complications of vasculitis and its treatment

Survival following a diagnosis of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) has improved since the introduction of cyclophosphamide-based immunosuppressive regimens and is now almost 80% at 5 years. However, mortality remains 2.6 times greater in the population with AAV than in an age- and sex-matched general population. The greatest risk of harm for patients with AAV is during the first year of diagnosis and from the adverse events associated with treatment rather than with active vasculitis. Infection, cardiovascular disease (CVD) and malignancy are the most common causes of death during follow-up. New regimens including rituximab, although with an efficacy similar to that of cyclophosphamide, have not yet shown a clear reduction in adverse events. Therapy for AAV must currently encompass a much greater focus on preventing harm from treatment through vaccination, Pneumocystis jirovecii pneumonia (PJP) prophylaxis, CVD risk assessment and bone protection measures.     

A case of a patient with both chorea and restless legs syndrome

The patient was a 44-yr-old man with end-stage renal disease who had developed chorea as a result of hypoglycemic injury to the basal ganglia and thalamus and who was subsequently diagnosed with depression and restless legs syndrome (RLS). For proper management, the presence of a complex medical condition including two contrasting diseases, chorea and RLS, had to be considered. Tramadol improved the pain and dysesthetic restlessness in his feet and legs, and this was gradually followed by improvements in his depressed mood, insomnia, lethargy, and feelings of hopelessness. This case suggests that the dopaminergic system participates intricately with the opioid, serotoninergic, and noradrenergic systems in the pathophysiology of RLS and pain and indirectly of depression and insomnia.     

Efficacy and safety of quetiapine in combination with lithium or divalproex for maintenance of patients with bipolar I disorder (international trial 126)

BACKGROUND: This study examined the efficacy and safety of quetiapine in combination with lithium or divalproex compared with placebo with lithium or divalproex in the prevention of recurrent mood events in bipolar I patients, most recent episode mania, depression, or mixed. METHODS: Patients received open-label quetiapine (400-800 mg/day; flexible, divided doses) with lithium or divalproex (target serum concentrations 0.5-1.2 mEq/L and 50-125 microg/mL, respectively) for up to 36 weeks to achieve at least 12 weeks of clinical stability. Patients were subsequently randomized to double-blind treatment with quetiapine (400-800 mg/day) plus lithium/divalproex or placebo plus lithium/divalproex for up to 104 weeks. The primary endpoint was time to recurrence of any mood event. RESULTS: Treatment with quetiapine in combination with lithium/divalproex significantly increased the time to recurrence of any mood event compared with placebo plus lithium/divalproex. The proportion of patients having a mood event was markedly lower in the quetiapine than in the placebo group (18.5% versus 49.0%). The hazard ratio for time to recurrence of a mood event was 0.28 (P<0.001), a mania event 0.30 (P<0.001), and a depression event 0.26 (P<0.001) corresponding to risk reductions of 72%, 70%, and 74%, respectively. During the randomization phase, the most common adverse events occurring in > or =5% in the quetiapine group were somnolence, nasopharyngitis, and headache. Insomnia was more common in the placebo group. During the randomization phase, there was an increase in weight of 0.5 kg in the quetiapine group and a reduction of 1.9 kg in the placebo group. The incidence and incidence density of a single emergent fasting blood glucose value> or =126 mg/dL was higher with quetiapine than with placebo (9.3% versus 4.1%; 17.6 versus 9.5 patients per 100 patient-years). LIMITATIONS: This was an enriched sample of patients with bipolar I disorder responding to treatment with quetiapine plus lithium/divalproex. CONCLUSIONS: Maintenance treatment with quetiapine in combination with lithium/divalproex significantly increased time to recurrence of any event (mania, depression, or mixed) irrespective of the polarity of the index episode compared with placebo with lithium/divalproex. Long-term treatment with quetiapine was generally well-tolerated. Quetiapine with lithium/divalproex can provide an effective long-term treatment option for bipolar I disorder to prevent recurrences not only of mania but also depression.     

强制戒毒机构至美沙酮门诊转介机制的建立与实施体会

目的探讨建立强制戒毒机构至美沙酮门诊转介机制的工作模式。方法与强制戒毒机构进行合作,建立面向工作人员的政策开发、宣传教育,面向吸毒人群的艾滋病防治与美沙酮维持治疗宣传教育工作等为主的转介工作流程,促进美沙酮门诊覆盖面的提高。结果初步建立了转介机制,确定转介对象200人,转介成功46人,转介成功率23%。结论开展强制戒毒机构至美沙酮门诊的转介工作是可行有效的。     

左旋卡尼汀在维持性血液透析患者中的应用

目的探讨静脉补充左旋卡尼汀对慢性肾衰竭维持性血液透析患者肉碱缺乏症的治疗效果并评价其药物不良反应。方法将78例维持性血液透析患者随机分为治疗组和对照组。治疗组患者在血液透析结束后接受左旋卡尼汀1.0 g,静脉注射,每周2~3次,疗程12周。对照组注射生理盐水。结果静脉注射左旋卡尼汀可显著提高维持性血液透析肉碱缺乏患者的血浆游离肉碱水平(P<0.01);治疗组患者精神状态、食欲、透析中肌痉挛和低血压等症状的改善率明显高于对照组(P<0.01);与对照组比较,疗程结束后治疗组患者血红蛋白、血浆总蛋白、白蛋白和转铁蛋白升高更为显著(P<0.05)。结论维持性血液透析患者静脉补充左旋卡尼汀可明显改善患者的营养不良状况,纠正贫血,降低透析中肌痉挛和低血压的发生率;不良反应轻微,安全可靠。     

Effective Maintenance Leukocytapheresis for Patients with Steroid Dependent or Resistant Ulcerative Colitis

Abstract: We prospectively examined the effect of leukocytapheresis (LA) on the maintenance of remission in 7 patients with ulcerative colitis (UC) who were initially refractory to corticosteroid therapy (steroid resistant or steroid dependent). The patients with refractory UC had been in remission due to LA (induction LA) in combination with the steroid therapy. They were then treated with LA once or twice a month for the purpose of maintaining remission (maintenance LA). The maintenance LA was performed by either a centrifuge method in 5 patients or a polyester adsorbent column method in 2 patients. Steroid dosage was gradually tapered as little as possible without recurrence based on clinical and/or colonoscopical judgments. Four patients were maintained in remission without steroids over 12 months. Recurrence was observed in 3 patients at 3, 3, and 6 months after the beginning of the maintenance LA, respectively. Two of the 3 patients were again conducted to remission by the second induction LA and maintained in remission by the second maintenance LA. Two patients finally underwent total colectomy because of recurrence of UC in a severe form. It is concluded that the maintenance LA therapy might be effective in some patients with steroid dependent or resistant UC for the maintenance of remission without steroids.     

维持性血液透析患者心外膜脂肪组织与冠状动脉钙化、趋化素的关系

目的探讨维持性血液透析患者心外膜脂肪组织与冠状动脉钙化、趋化素的关系。方法选取天津市第五中心医院维持性血液透析患者90例,依据Framingham危险评分分为低危组(10%)、中危组(10%~20%)和高危组(20%)。选取60例健康体检者作为对照组。检测血趋化素、C反应蛋白、血常规、血生化,对维持性血液透析患者行胸多层螺旋CT检查,飞利蒲工作站软件测量心外膜脂肪组织体积和冠状动脉钙化评分。分析维持性血液透析患者心外膜脂肪组织体积与冠状动脉钙化评分、趋化素、C反应蛋白、Framingham危险评分等之间的关系。结果维持性血液透析组血趋化素、C反应蛋白、血中性粒细胞与淋巴细胞比率较对照组升高(P0.01);维持性血液透析高危组、中危组心外膜脂肪组织体积、冠状动脉钙化评分、趋化素明显高于低危组(P0.05或P0.01),高危组心外膜脂肪组织体积、趋化素明显高于中危组(P0.05);维持性血液透析患者冠状动脉钙化评分、趋化素、C反应蛋白及Framingham危险评分为心外膜脂肪组织的影响因素(P0.05或P0.01)。结论维持性血液透析患者血趋化素、C反应蛋白、血中性粒细胞与淋巴细胞比率升高,维持性血液透析患者存在微炎症状态。维持性血液透析患者高危组、中危组心外膜脂肪组织体积、冠状动脉钙化评分、趋化素均高于低危组,心外膜脂肪组织与维持性血液透析患者冠状动脉钙化评分、趋化素及Framingham危险评分相关,心外膜脂肪组织可预测维持性血液透析患者心血管疾病发生风险。