Depression in Hepatitis C Patients and Interferon Treatm：丙型肝炎患者干扰素治疗抑郁症
护理干预对还原型谷胱甘肽治疗病毒性肝炎的影响
护理干预对还原型谷胱甘肽治疗病毒性肝炎的影响目的探讨还原型谷胱甘肽联合综合护理干预治疗病毒性肝炎的效果及应用价值。
方法回顾性分析我院130例病毒性肝炎临床资料，随机分为观察组、对照组各65例，对照组给予护肝片治疗，观察组给予还原型谷胱甘肽治疗，两组同时予护理干预。
结果观察组经治疗和护理后焦虑自评量表评分、抑郁自评量表评分、总胆红素、丙氨酸氨基转移酶、门冬氨酸氨基转移酶、白蛋白等指标均优于对照组（P＜0.05）。
观察组治疗依从性、护理满意度均好于对照组（P＜0.05）。
结论综合护理干预能够明显改善患者肝脏功能及焦虑、抑郁不良心理状态，提高临床治疗依从性和护理满意度，应予推广。
[Abstract] Objective To evaluate the effect of reduced glutathione combined with comprehensive nursing intervention in the treatment of viral hepatitis effect and application value. Methods Retrospective analysis of clinical data of 130 cases of viral hepatitis，were randomly divided into the observation group and the control group，65 cases in each group，the control group of liver protecting tablets treatment，the observation group glutathione treatment，two groups all treated with nursing intervention. Results The observation group after treatment and nursing after the self rating anxietyscale，self rating depression scale score，total bilirubin，alanine aminotransferase，aspartate aminotransferase，albumin，the indicators were better than the control group after treatment （P＜0.05）. The observation group treatment compliance，nursing satisfaction were better than the control group（P＜0.05）. Conclusion Comprehensive nursing intervention can significantly improve the liver function of patients with depression and anxiety，bad mental state，improve the clinical treatment compliance and nursing satisfaction，should be popularized.[Key words] Reduced glutathione；Viral hepatitis；Nursing病毒性肝炎（viral hepatitis）是指由多种的肝炎病毒所引起的以肝脏的炎性改变及坏死病变为主的传染性疾病，临床特点有传染性强、传播途径复杂、发病率高等[1]。
illness练习题
illness练习题一、选择题A. FeverB. DiarrheaC. DizzinessD. HeadacheA. BacteriaB. VirusC. AllergiesD. Parasites3. Which disease is characterized the presence of warts?A. ChickenpoxB. HPV (Human Papillomavirus)C. MeaslesD. Mumps4. Which of the following is a symptom of appendicitis?A. Sore throatB. NauseaC. Runny noseD. Abdominal pain5. What is the primary treatment for diabetes?A. AntibioticsB. VaccinationC. Insulin therapyD. Painkillers二、填空题1. The _______ is a small, beanshaped organ located below the liver.2. _______ is a condition where the immune system attacks the body's own cells.3. _______ is a viral infection that causes severe respiratory symptoms.4. _______ is a chronic condition characterized high blood sugar levels.三、判断题1. Allergies are caused a virus.2. The flu is more severe than a cold.4. Diabetes can be cured with a healthy diet and exercise.5. Chickenpox is a highly contagious disease that spreads through the air.四、简答题1. Describe the symptoms of a heart attack.2. Explain the difference between a cold and the flu.3. What are the risk factors for developing cancer?5. Discuss the importance of regular health checkups for early detection of diseases.五、论述题1. Discuss the impact of stress on physical health.2. Analyze the role of genetics in the development of certain diseases.3. Explore the importance of hand hygiene in preventing the spread of infectious diseases.4. Discuss the ethical considerations in medical research involving human subjects.5. Analyze the effectiveness of various methods of disease prevention and control.illness练习题（续）六、名词解释题1. Define "inflammation."2. Explain what "immunity" means in the context of medical science.3. Describe the term "pathogen."4. What is meant "symptomatology"?5. Define "chronic disease" and provide an example.七、匹配题A. HIV1. Severe weight lossB. Malaria2. Fever, chills, and sweatingC. Asthma3. Shortness of breathD. Arthritis4. Joint pain and swelling2. Match the following diseases with their causes:A. Cancer1. Genetic mutationsB. DS2. Bacterial infectionC. Tuberculosis3. Fungal infectionD. Hepatitis4. Viral infection八、问答题1. What are the primary functions of the immune system?3. How does diabetes affect the body's metabolism?5. Discuss the role of nutrition in managing and preventing chronic diseases.九、案例分析题1. A patient presents with symptoms of chronic fatigue. Discuss possible causes and diagnostic approaches.2. A child has been diagnosed with a food allergy. Explain the importance of avoiding allergens and the potential risks of an allergic reaction.3. An elderly patient is experiencing difficulty breathing. Discuss potential causes and treatment options.4. A patient is diagnosed with a mental health disorder. Explain the importance of early intervention and treatment.5. A patient has been diagnosed with a rare genetic disorder. Discuss the role of genetic counseling and support services.十、论述题1. Discuss the role of public health in disease prevention and control.2. Analyze the impact of lifestyle factors on the incidence of chronic diseases.3. Discuss the ethical and legal considerations in the use of medicinal drugs.4. Explore the challenges and benefits of telemedicine in healthcare delivery.5. Discuss the importance of health education in promoting healthy behaviors and preventing disease.illness练习题（续）十一、多选题A. Streptococcus pneumoniaeB. Influenza virusC. Herpes simplex virusD. Mycoplasma pneumoniaeE. Pneumocystis jirovecii2. Which of these are symptoms of a urinary tract infection?A. Frequent urinationB. Pain or burning during urinationC. Cloudy or bloody urineD. FeverE. Fatigue3. What are potential risk factors for cardiovascular disease?A. High blood pressureB. High cholesterol levelsC. SmokingD. ObesityE. Physical inactivity4. Which of the following are signs of a stroke?A. Sudden numbness or weakness of the face, arm, or leg, especially on one side of the bodyB. Confusion, trouble speaking, or difficulty understanding speechC. Sudden vision problems in one or both eyesD. Sudden trouble walking, dizziness, loss of balance, or coordinationE. Severe headache with no known causeA. Persistent feelings of sadness, hopelessness, or emptinessB. Changes in appetite or sleep patternsC. Feelings of worthlessness or excessive guiltD. Inability to concentrate, remember things, or make decisionsE. Physical aches or pains that do not ease with treatment十二、是非题1. A person with a fever is always suffering from an infection.2. Allergies are caused an overreaction of the immune system to harmless substances.3. It is safe to take overthecounter medications without consulting a doctor.4. A balanced diet can prevent all types of diseases.5. Mental health disorders are more prevalent in developed countries than in developing countries.十三、简答题1. What is the difference between a viral and bacterial infection?2. Explain the concept of "premature aging" and its potential causes.3. How can proper hand hygiene help prevent the spread of infectious diseases?4. What are the signs and symptoms of depression, and how can they be addressed?5. Discuss the role of vaccines in preventing infectious diseases.十四、应用题1. A patient with a history of asthma is planning to travel to a highaltitude area. What precautions should be taken?3. A patient has been experiencing chronic back pain. Discuss possible causes and treatment options.4. How can stress management techniques be applied to improve mental health?十五、论述题1. Discuss the importance of mental health screening in primary care settings.2. Analyze the impact of environmental factors on the incidence of certain diseases.3. Explore the ethical implications of genetic testing and its implications for individuals and society.5. How can health promotion strategies be effectively implemented in diverse cultural settings?illness练习题（续）十六、匹配题1. Match the following diseases with their corresponding diagnostic tests:A. HIV1. ELISAB. Tuberculosis2. PPD skin testC. Hepatitis B3. Hepatitis B surface antigen (HBsAg) testD. Mononucleosis4. Monospot test2. Match the following diseases with their typical treatment regimens:A. Migraine1. TriptansB. Epilepsy2. AnticonvulsantsC. Anxiety Disorder3. SSRIs (Selective Serotonin Reuptake Inhibitors)D. ADHD (AttentionDeficit/Hyperactivity Disorder)4. Stimulants十七、选择题1. Which of the following is a direct cause of scurvy?A. Vitamin A deficiencyB. Vitamin B12 deficiencyC. Vitamin C deficiencyD. Vitamin D deficiency2. What is the primary treatment for a severe allergic reaction?A. AntihistaminesB. SteroidsC. EpinephrineD. Antibiotics3. Which disease is characterized periodic episodes of inflammation, pain, and swelling in the joints?A. ArthritisB. GoutC. OsteoporosisD. FibromyalgiaA. Lung cancerB. Prostate cancerC. Colorectal cancerD. Pancreatic cancer5. Which vitamin is crucial for bone health and can lead to osteoporosis if deficient?A. Vitamin AB. Vitamin B6C. Vitamin DD. Vitamin K十八、简答题1. Describe the process of how a vaccine works to prevent disease.2. What are the stages of the HIV/DS infection, and how does it progress?3. How can obesity contribute to the development of type 2 diabetes?4. What are the signs and symptoms of a heart attack, and what should be done immediately if someone is experiencing these symptoms?5. Discuss the role of physical activity in the prevention and management of mental health disorders.十九、案例分析题1. A patient with a history of asthma experiences an attack after a long period of inactivity. Discuss potential triggers and management strategies.2. A pregnant woman is diagnosed with gestational diabetes. Explain the implications for both the mother and the ba, and discuss management options.4. A child is diagnosed with ADHD. Discuss the importance of a multidisciplinary approach to treatment, including medication, behavioral therapy, and educational support.5. An elderly patient is experiencing falls and confusion. Discuss the potential causes and steps to prevent futurefalls.二十、论述题1. Discuss the ethical considerations in clinical trials for new medications and treatments.3. Explore the challenges and benefits of telehealth in rural and underserved areas.4. Discuss the role of public health campaigns in promoting health literacy and behavior change.5. How can healthcare systems adapt to the increasing prevalence of chronic diseases and the aging population?答案：一、选择题1. A. Fever2. B. Virus3. B. HPV (Human Papillomavirus)4. D. Abdominal pain5. C. Insulin therapy二、填空题1. Spleen2. Autoimmune disease3. Influenza4. Diabetes mellitus5. Eczema三、判断题1. False2. True3. True4. False5. True四、简答题3. Risk factors for cancer include genetics, lifestyle (smoking, diet, physical inactivity), and environmental factors.五、论述题1. Public health plays a crucial role in disease prevention and control through vaccination programs, health education, and environmental regulation.2. Lifestyle factors such as diet, physical activity, and smoking contribute significantly to the incidence of chronic diseases.3. Medicinal drugs can have serious side effects, and their use requires careful consideration of the benefits and risks.4. Telemedicine can enhance healthcare delivery providing remote access to care, especially in underserved areas.5. Health promotion strategies should be culturally sensitive and tailored to the specific needs and preferences of diverse populations.。
医学人文Chapter4基础医学
医学人文Chapter 4基础医学您的姓名：［填空题］*1.It is a ____ that the French eat so much rich food and yet have a relatively low rate of heart disease.（）［单选题］*A.dilemmaB.paradox（正确答案）C.pinnacleD.affluence2.After a long struggle against cancer, her condition began to _______ further.（）［单选题］*A.deteriorate（正确答案）B.defineC.detectD.decline3.She was ____ with her daughter for behaving so awkwardly.（）［单选题］*A.glimpsedB.elicitedC.rumpledD.irritated（正确答案）4.Hewas the only person who understood all the ______ details of the agreement.（）［单选题］*A.erraticB.harshC.arcane（正确答案）D.intractable5.The state of the economy has _____ all the other issues as the major item of current public concern.（）［单选题］*A.suppliedB.supportedC.supplanted（正确答案）D.submitted6.In future the authorities will not tolerate any ______ of the safety regulations.（）［单选题］*A.breach（正确答案）B.banishC.branchD.brink7.He had an ____ childhood because it was during the war and there were no luxuries then.（）［单选题］*A.abundant8.austere（正确答案）9.aortic10.audible8.Hosting the Olympic Games added to our country’ in s ternational _______ .（）［单选题］A.privilegeB.perfectionC.perceptionD.prestige（正确答案）9.The poison produced by the spider’ sk s in is so _______ t hat it will paralyze a bird or a monkey immediately.（）［单选题］*A.lethal（正确答案）B.legalC.staggeringD.brooding10.She seems completely unaware of the contradictions in her professed point of view. （）［单选题］*A.inheritedB.inherent（正确答案）C.intravenousD.intimate11. A significant proportion of what medical students are studying at college will be out ofwithin a few years.（）［单选题］*A.dataB.availabilityC.date（正确答案）D.accessibility12.This is not all your fault; the responsibility was ______ mine.（）［单选题］*B.in relation toC.in regard toD.in part（正确答案）13.The law will apply equally to men and women except in the _______ of maternity leave. （）［单选题］*A.studyB.case（正确答案）C.situationD.example14.Technology is advancing at such a staggering pace that it is difficult to keep _________ of it.（）［单选题］*A.abreast（正确答案）B.aboveC.asideD.across15.He was far too _____ w ith his own marital difficulties to give any thought to his friend’ pr s oblems.（）［单选题］*A.precautiousB.preoccupied（正确答案）C.preliminaryD.prescribed16.In the ____ of her research she discovered some important facts about the flu pandemic.（）［单选题］*B. causeC.caseD. caution17.His decision to move overseas has a lot to do _______ his financial problems.（）［单选题］*A.onB.ofC.aboutD.with（正确答案）18.What we did in the previous case is no guide to what we ought to do in this, as the two are not .（）［单选题］*A.on the contraryB.on purposeC.on a par（正确答案）D.on the whole19.____ the patients r’esentment and complaints, the U.S. medical profession is tryinghard to get back to a principle as old asHippocrates.（）［单选题］*A.In generalB.Instead ofC.For all（正确答案）D.For instance20.Economic growth must not be pursued at the _______ of environmental pollution.（）［单选题］*B.extinctionC.expectationD.expense（正确答案）21.Each visitor expects not only medical care but comfort, sympathy, relief, reassurance and ___.（）［单选题］*A.solace（正确答案）B.pinnacleC.paradoxD.quantum22.It is a situation that both ______ the patient and worries the medical profession.（）［单选题］*A.deterioratesB.elicitsC.irritates（正确答案）D.supplants23.Because the patient is increasingly _______ about medicine, thanks to better reportage of medical advances, he is also likely to demand more of his doctor.（）［单选题］*atoseB.preoccupiedC.ingrainedD.sophisticated（正确答案）24.One result of all this change is a growing _________ in the practice of medicine that has created a breach in the traditional doctor-patient relationship.（）［单选题］*A.impersonality（正确答案）B.predecessorC.affluenceD.absurdity25.Doctors can point out that their fees have risen just about ________ with the general cost of living in recent years.（）［单选题］*A.on a par（正确答案）B.in partC.for allD.as a whole26.Today's patient, who is ________ enough to realize his doctor's limitations, is willing to extend that trust.（）［单选题］*A.staggeringB.austereC.obsoleteD.sophisticated（正确答案）27.The patient’co s ncern, his uneasiness, about doctors and doctoring is deeply _________ . （）［单选题］*A.lethalB.self-anointedC.ingrained（正确答案）D.arcane28.Over the ages, doctors have compounded both the awe and the anxiety by acting as apriesthood whose rites and methods were beyond the understanding of any outsider.（）［单选题］*A.lethalB.self-anointed（正确答案）C.ingrainedD.arcane29.The commonest complaint is about the doctor’ in s creasing _______________ .（）［单选题］*A.absurdityB.priesthoodC.inaccessibility（正确答案）D.panjandrum30.In return he wants some understanding and sympathy, the vital _________ t hat nowadays are too often missing.（）［单选题］*A.prestigeB.ingredients（正确答案）C.absurdityD.quantum。
乙肝后肝硬化患者焦虑抑郁状态及相关因素的调查分析
肝硬化是一种 常见 的慢性 、进行 性 、弥漫 性肝病 ，其 病程 （５７．８５±１１．２５）岁 ；文化程度 ：大专及 以上 ６例 ，高中 １２例 ，
ｔｉｏｎｎａｉｒｅ ｓｕｒｖｅｙ ｏｎ ６０ ｈｏｓｐｉｔａｌｉｚｅｄ ｐａｔｉｅｎｔｓ ｗｉｔｈ ｃｉｒｈｏｓｉｓ ｄｕｅ ｔｏ ｈｅｐａｔｉｔｉｓ Ｂ． Ｒｅｓｕｌｔｓ：４５ ｐｅｒｃｅｎｔ ｏｆ ａ ｌｌ ６０ ｐａｔｉｅｎｔｓ ｓｕｆｅｒｅｄ ｆｒｏｍ ａｎｘｉｅｔｙ ｏｒ ｄｅｐｒｅｓｓｉｏｎ；３３ ｐｅｒｃｅｎｔ ｏｆ ｔｈｅ ｔｏｔａｌ ｐａｔｉｅｎｔｓ ｈａｄ ｂｏｔｈ ａｎ ｘ ｉｅｔｙ ａｎｄ ｄｅｐｒｅｓｓｉｏｎ．Ｔｈｅ ｌｅｖｅｌ ｏｆ ａｎｘｉｅｔｙ ａｎｄ ｄｅｐｒｅｓｓｉｏｎ ｏｆ ｔｈｅ ｐａｔｉｅｎｔｓ ｈａｓ ｓｏｍｅｔｈｉｎｇ ｔｏ ｄｏ ｗｉｔｈ ｔｈｅ ｄｕｒａｔｉｏｎ ｏｆ ｔｈｅ ｄｉｓｅａｓｅｓ，ｃｏｍｐｌｉｃａｔｉｏｎ，ｅｄｕｃａｔｉｏｎａ ｌ ｂａｃｋｇｒｏｕｎｄ ａｎｄ ｓｏｃｉａｌ ｓｕｐｐｏｒ ｔ；ｔ ｈｅ ｐａ－
齐鲁 护理 杂志 ２０１０年 第 ｌ６卷第 ３期
乙肝 后 肝 硬化 患者 焦 虑 抑郁 状 态 及 相 关 因素 的调查 分 析
Байду номын сангаас
陈 芳 （上 海交通 大 学医学 院附属仁 济 医院 上海 市 ２００００１）
摘 要 目的：探讨 乙肝后肝硬化 患者 的焦虑抑郁水平及与相关 因素的关 系，以期为 临床护理提供 依据。方 法：采 用综合性 医院焦虑抑郁量表 （ＨＡＤ）和基 本资料 问卷表及领 悟社会 支持量表 （ＰＳＳＳ）对 ６０例住 院 乙肝后肝硬 化 患者进 行 问卷调查 。结果 ：６Ｏ例 患者 中存在焦虑或抑郁状况的各 占４５％ ，同时伴有焦虑抑郁状况的 占 ３３％ ；患者的 焦虑抑郁 水平与经济状况 、病程长短 、有无并发症、有无接 受健康教 育以及社会 支持度等 因素相 关；乙肝后肝硬 化患者的 家庭 内支持度 高于家庭外 支持（朋友 支持及其他 支持 ）（Ｐ＜０．０１）。结论 ：肝硬化 患者 易发 生 焦虑抑 郁状 态，并 与诸 多因素 有 关，且 患者受到 的家庭 内支持 明显 高于家庭外 支持。－临床 护理人 员应给 予有 效的心理 支持 ，做好 健康 宣教 ，构建起 家 庭外社会 支持的平 台和 网络 ，减轻 患者不 良心理状态。
聚焦解决模式在高校教育教学中的应用进展
聚焦解决模式在高校教育教学中的应用进展作者：张一波于桂云郭晓敏来源：《现代职业教育》2021年第23期[摘要] 介绍聚焦解决模式的相关知识，对聚焦解决模式在国内高校教育教学领域的应用及不足进行综述。
[关键词] 聚焦解决模式;高校;教育[中图分类号] G712 [文献标志码] A [文章编号] 2096-0603（2021）23-0132-02Solution Focused Approach 被国内学者译为聚焦解决模式或焦点解决模式。
该模式是由焦点解决短期治疗（Solution-focused BriefTherapy）这种积极心理治疗方法不断发展而形成的，是一种充分尊重个体、相信个体自身资源和潜能的心理干预模式[1]。
其核心要素是非专家立场;强调个体的语言，要求交流次数保持在所需的最低限度以及认可问题与解决办法没有联系[2]。
换句话说，该模式不局限向个体探求问题发生的深层原因，对问题进行解决，而是将重点放在帮助个体发掘自身潜能和资源，建构解决问题的方法上[3]。
在国外，聚焦解决模式广泛应用在家庭问题[4]、心理健康问题[5]和行为问题[6]的处理上，均取得较好的结果。
由于该模式具有正向性、积极性、易掌握等特点，现已被国内多个行业领域关注和应用。
现将有关该模式在我国高校教育教学领域的研究进行综述如下。
一、聚焦解决模式的实施步骤及技巧聚焦解决模式的实施包括描述问题、构建具体目标、寻找例外、给予反馈、评价进步五个基本步骤[7]（见表1）。
在实施的过程中，为了更好地将干预的核心聚焦在有效“解决问题”这个目标上，De Shazer等人以语言为载体，设计了13项询问技术（见表2）：正常化技术、咨询前改变询问技术、预设性询问技术、刻度化询问技术、振奋性鼓舞技术、赞许技术、改变最先出现的迹象技术、奇迹询问、关系询问、例外询问、应对询问、任务作业、EARS询问。
其中前7项技术属于赋能技术，其目的是发现个体自身潜能和资源;其余6项技术属于解决建构技术，目的是建构问题解决的过程和方法[8-9]。
医学英语分类词汇—常见疾病名称
医学英语分类词汇—常见疾病名称The field of medicine is vast and complex, encompassing a wide range of specialties and disciplines. One of the most fundamental aspects of medical terminology is the classification of common diseases and their associated symptoms. Understanding this vocabulary is crucial for healthcare professionals, students, and even patients, as it facilitates clear communication, accurate diagnosis, and effective treatment.In the realm of medical English, the vocabulary related to common diseases can be divided into several broad categories. These categories encompass a diverse array of conditions, ranging from infectious diseases to chronic illnesses, and from mental health disorders to genetic disorders.Infectious Diseases:Infectious diseases are caused by pathogenic microorganisms, such as bacteria, viruses, fungi, or parasites, and can be transmitted from one individual to another. Some of the most prevalent infectious diseases include influenza (the flu), COVID-19, pneumonia,tuberculosis, HIV/AIDS, and hepatitis. These conditions often present with symptoms such as fever, cough, fatigue, and in some cases, more severe complications.Chronic Diseases:Chronic diseases are long-term, non-communicable conditions that often require ongoing management and treatment. Examples of common chronic diseases include heart disease, stroke, cancer, diabetes, and chronic respiratory diseases like asthma and chronic obstructive pulmonary disease (COPD). These conditions typically involve a gradual onset, persistent symptoms, and the potential for complications if not properly managed.Mental Health Disorders:Mental health disorders encompass a wide range of conditions that affect an individual's emotional, psychological, and behavioral well-being. Some of the most prevalent mental health disorders include depression, anxiety disorders, schizophrenia, bipolar disorder, and post-traumatic stress disorder (PTSD). Symptoms can vary greatly, ranging from mood disturbances and cognitive impairments to changes in behavior and social functioning.Genetic Disorders:Genetic disorders are conditions caused by abnormalities in an individual's genetic makeup. These can be inherited or arise fromnew genetic mutations. Examples of common genetic disorders include cystic fibrosis, sickle cell disease, Down syndrome, and Huntington's disease. Symptoms and severity can vary widely depending on the specific genetic mutation and the affected body systems.Musculoskeletal Disorders:Musculoskeletal disorders are conditions that affect the bones, muscles, joints, tendons, and ligaments. These can include injuries, such as sprains and fractures, as well as chronic conditions like arthritis, osteoporosis, and back pain. Symptoms often include pain, stiffness, swelling, and reduced mobility.Neurological Disorders:Neurological disorders are conditions that affect the nervous system, which includes the brain, spinal cord, and peripheral nerves. Examples of common neurological disorders include Alzheimer's disease, Parkinson's disease, epilepsy, multiple sclerosis, and stroke. Symptoms can range from cognitive impairments and movement disorders to sensory disturbances and paralysis.Gastrointestinal Disorders:Gastrointestinal disorders are conditions that affect the digestive system, including the esophagus, stomach, intestines, liver, and pancreas. These can include conditions such as gastroenteritis,irritable bowel syndrome (IBS), Crohn's disease, ulcerative colitis, and liver cirrhosis. Symptoms often involve abdominal pain, diarrhea, constipation, nausea, and changes in bowel habits.Skin Disorders:Skin disorders are conditions that affect the skin, hair, and nails. These can include infectious conditions like acne, eczema, and psoriasis, as well as more serious conditions like skin cancer. Symptoms may include rashes, lesions, discoloration, and changes in the appearance or texture of the skin.Respiratory Disorders:Respiratory disorders are conditions that affect the lungs and the airways. These can include infectious conditions like influenza and pneumonia, as well as chronic conditions like asthma, chronic obstructive pulmonary disease (COPD), and lung cancer. Symptoms often involve coughing, wheezing, shortness of breath, and chest pain.Cardiovascular Disorders:Cardiovascular disorders are conditions that affect the heart and the blood vessels. These can include conditions like hypertension (high blood pressure), coronary artery disease, heart failure, and stroke. Symptoms may include chest pain, shortness of breath, irregular heartbeat, and fatigue.In conclusion, the medical English vocabulary related to common diseases is a vast and complex field, encompassing a wide range of conditions and their associated symptoms. By understanding the classification and terminology of these diseases, healthcare professionals, students, and patients can improve communication, facilitate accurate diagnosis, and ensure effective treatment strategies. Mastering this vocabulary is a crucial step in the pursuit of better health outcomes and the advancement of medical knowledge.。
2006丙肝治疗(英文)-AGA
American Gastroenterological Association Medical Position Statement on the Management of Hepatitis CH epatitis C accounts for a sizable proportion ofcases of chronic liver disease,liver disease deaths,and cases of hepatocellular carcinoma and rep-resents the most common indication for liver trans-plantation.Projections based on the current preva-lence of infection and anticipated rates of progression suggest that the morbidity and mortality,as well as the medical care costs attributable to hepatitis C virus (HCV)infection,will escalate alarmingly during the next2decades.The substantial clinical and economic impact of hepatitis C focuses attention on the critical need to prevent and control HCV infection.Public health measures,changes in behavior to avoid blood-borne infections,and screening of donated blood and organs for HCV have reduced dramatically the frequency of new infections,and substantial progress has been achieved in antiviral therapy for hepatitis C.Applied effectively,contemporary antiviral therapy can pre-vent chronic infection in almost all persons with acute hepatitis C and can cure chronic liver disease associ-ated with HCV infection in as many as half of patients with compensated,HCV-associated liver disease.In short,hepatitis C is an important public health prob-lem whose consequences can be reduced by appropri-ate application of antiviral therapy.Because the de-mand for management of chronic hepatitis C has increased so considerably over the past decade,the American Gastroenterological Association developed a technical review1and this medical position statement. This medical position statement,which contains practice guidelines intended for physicians,nurse practitioners,physician assistants,and other health care workers who participate in the care of patients with hepatitis C,includes suggestions for preferable approaches to the management of persons with hepa-titis C.These guidelines,which are recommendations intended to assist physicians and other health care workers in arriving at reasoned patient care decisions,2 are designed to beflexible rather than rigidly inflex-ible universally applied“standards of care.”Although these recommendations should be followed in most cases,management decisions are left to the individual physician and health care worker based on the circum-stances of the individual patient.As in previous guide-lines issued by the American Gastroenterological As-sociation,specific recommendations are based on relevant published information.ScreeningRoutine screening of all asymptomatic adults, who have a low prior probability of HCV infection,is not recommended.Among high-risk groups(eg,in-jection drug users,persons who received a transfusion before1992[when donor screening for antibody to HCV was introduced],persons with hemophilia who received clotting factors before1987,persons with frequent percutaneous exposures,immigrants from countries with a high prevalence of HCV infection, and persons with clinical or biochemical evidence for chronic liver disease,even among asymptomatic per-sons),diagnostic testing for HCV infection has been recommended by the US Public Health Service,expert panels,and professional medical specialty societies. Spouses of persons with chronic hepatitis C are also candidates for HCV serologic testing.Persons in whom the diagnosis of hepatitis C is established are candidates for hepatitis A and hepatitis B vaccines.Pretreatment Diagnostic Evaluationof Patients With ChronicHepatitis CPersons with a reactive enzyme immunoassay for antibody to HCV,the presence of HCV RNA,and compensated liver disease are potential candidates for antiviral therapy.Currently,antiviral therapy is not recommended routinely for patients with hepatic de-compensation;patients with a history of severe,un-controlled psychiatric disorder;and/or patients with severe hematologic cytopenias.Elevation of alanine aminotransferase(ALT)and aspartate aminotransferase levels is not a requirement for therapy.All candidates for antiviral therapy should be tested for HCV RNA with a quantitative amplifi-cation assay and should be tested for HCV genotype. Patients in whom antiviral therapy is being considered are candidates for liver biopsy,the gold standard for ©2006by the American Gastroenterological Association0016-5085/06/$32.00doi:10.1053/j.gastro.2005.11.011GASTROENTEROLOGY2006;130:225–230determining histologic grade and stage,unless the po-tential for complications is unacceptably high.For pa-tients with moderate to severefibrosis(Ishak stageՆ3, METAVIR stageՆF2;please see technical review1for histologic scoring systems),antiviral therapy is recom-mended uniformly.For patients with milder histologic disease,progression may be sufficiently slow to justify monitoring without imminent therapeutic intervention in a proportion of these patients(see Treatment Recom-mendations).For patients with genotypes2and3,the likelihood of response is so high that the benefits of treatment may outweigh the importance of histologic considerations;therefore,some authorities forego a base-line liver biopsy in patients with genotypes2and3.Data to support routine ultrasonography for localization of the liver before liver biopsy are insufficient to justify man-dating prebiopsy ultrasonography in all cases and for all practitioners regardless of levels of skill and experience.Treatment of Chronic Hepatitis CThe current standard of care for the treatment of previously untreated patients with chronic hepatitis C is combination pegylated interferon(PEG-IFN)alfa by subcutaneous injection once a week and oral riba-virin daily.For patients with contraindications to ribavirin but who have indications for antiviral ther-apy,PEG-IFN represents the best available treatment. Two PEG-IFN alfa preparations are available:(1) PEG-IFN alfa-2b,administered at a weight-based, 1.5-g/kg dose,and(2)PEG IFN alfa-2a,adminis-tered at afixed,180-g dose.Randomized controlled trials(RCTs)have shown that combination PEG-IFN alfa and ribavirin therapy can achieve a sustained virologic response(SVR)in54%–56%of patients: 42%–52%of patients with genotype1and76%–84% of those with genotypes2and3.Whether one of these PEG-IFN/ribavirin regimens or weight-based modifi-cations of the2regimens will prove to be superior is the subject of ongoing trials.Predictors of response to therapy in these large RCTs are displayed in Table 1. The results of a single,large RCT support a recom-mendation that patients with genotype1require48 weeks of therapy with higher daily doses of ribavirin (1000–1200mg,depending on weightϽ75orՆ75 kg)(some clinicians may wish to adhere to the Food and Drug Administration–approved800mg daily dose of ribavirin when used with PEG-IFN alfa-2b, especially in patients who weighϽ65kg),while patients with the more treatment-favorable genotypes 2and3can be treated for only24weeks and with only 800mg of ribavirin daily.Moreover,12weeks of therapy suffices in patients with genotypes2and3in whom HCV RNA levels are undetectable at week4.In the group of patients with genotypes2and3,patients with genotype2are more likely than those with genotype3to achieve an SVR;for patients with genotype3who have high levels of HCV RNA or advancedfibrosis on liver biopsy,many authorities recommend treatment for48weeks.Pending addi-tional data,in patients with genotypes2and3,cli-nicians may wish to consider higher doses of ribavirin or a longer duration of therapy on an individual basis, taking into account considerations such as high viral level,cirrhosis,or delayed response to therapy.For patients with genotype4,48weeks of treatment with PEG-IFN alfa plus full-dose(1000–1200mg)ribavi-rin is recommended.The potential added benefit of a broader range(800–1400mg)of ribavirin weight-based dosing as part of combination therapy with PEG-IFN is currently being studied.Therapy is indicated for previously untreated pa-tients with chronic hepatitis C,circulating HCV RNA,elevated aminotransferase levels,evidence on liver biopsy of moderate to severe hepatitis grade and stage(METAVIR stageՆF2,Ishak stageՆ3,septal or bridgingfibrosis),and compensated liver disease. Patients with milder histologic changes(META-VIR stage F1,Ishak stageϽ3)(and normal serum aminotransferase activity;see following text)appear to respond as well as patients with more advanced his-tologic changes;such patients can be counseled about the reduced risk of disease progression but still can be offered therapy.If a decision is made to defer therapy in patients with mild disease,periodic laboratory and histologic monitoring should be pursued;however, data to support a recommendation on the frequency of histologic monitoring are wanting.Table1.Predictors of Response to PEG-IFN Plus Ribavirin Therapy in RCTs Conducted in PreviouslyUntreated,Immunocompetent Patients WithCompensated Chronic Hepatitis CNon-genotype1Low HCV RNA levelsAbsence of cirrhosis/bridgingfibrosisDuration of therapy(for genotype1)Age40years or youngerLighter body weightNonblack ethnicityAdherenceAbsence of steatosis on liver biopsyNOTE.Non-genotype1is the most influential predictor of response to standard of care therapy with combination PEG-IFN plus ribavirin.The relative weighting of variables analyzed in RCTs of PEG-IFN/ribavirin combination therapy is presented in the technical review.1226AMERICAN GASTROENTEROLOGICAL ASSOCIATION GASTROENTEROLOGY Vol.130,No.1Current contraindications to therapy include de-compensated cirrhosis(see following text),pregnancy, uncontrolled depression or severe mental illness,ac-tive substance abuse in the absence of concurrent participation in a drug treatment program,advanced cardiac or pulmonary disease,severe cytopenias,poorly controlled diabetes,retinopathy,seizure disorders,im-munosuppressive treatment,autoimmune diseases,or other inadequately controlled comorbid conditions.Monitoring Response to Antiviral TherapyBaseline and12-week monitoring of HCV RNA levels should be performed with the same quan-titative amplification assay.An early virologic re-sponse(EVR),defined as aՆ2-log10reduction in HCV RNA levels during thefirst12weeks of therapy, is a valuable clinical milestone.In the absence of an EVR,the likelihood of an SVR is0–3%.If the only goal of therapy is to achieve an SVR,therapy can be discontinued after12weeks if an EVR is not achieved. Potentially,histologic benefit can accrue even in the absence of an SVR;therefore,some authorities treat beyond12weeks even in patients who have not achieved an EVR.For documentation of a virologic response at the end of therapy(end-of-treatment re-sponse)or an SVRՆ6months after completing ther-apy,a more sensitive quantitative assay with a lower limit ofՅ50IU/mL,if available,or a qualitative HCV RNA assay is recommended.Clinical and virologic monitoring during therapy should be conducted at intervals ranging from once a month to once every3months.Frequent hematologic monitoring is necessary to identify marked anemia,neu-tropenia,and thrombocytopenia;monitoring of thyroid-stimulating hormone level is indicated to identify hypo-thyroidism or hyperthyroidism.Management of Side Effects of AntiviralTherapySide effects of antiviral therapy are listed in Table 2.Flu-like side effects of IFN can be managed with acetaminophen or nonsteroidal anti-inflammatory drugs,sleep-promoting agents can be used for insom-nia,and antidepressants can be used for depression. For management of neutropenia,dose reduction suf-fices,and the addition of granulocyte colony-stimu-lating factor is generally not recommended,although it may be considered in individual cases of severe neutropenia.Ribavirin is contraindicated in pregnancy,necessi-tating strict precautions and contraception in women of childbearing age and their sexual partners and in HCV-infected men with female partners of childbear-ing age.Treatment with ribavirin should be avoided in patients with ischemic cardiovascular and cerebro-vascular disease and in patients with renal insuffi-ciency.If anemia occurs,options include ribavirin dose reduction or the addition of erythropoietin.Approach to Other Patient PopulationsNormal aminotransferase activity.Patients with persistently normal ALT levels generally do not progress histologically,while responses to combina-tion antiviral therapy in patients with normal ALT levels are indistinguishable from response rates in patients with elevated ALT activity.Patients with normal ALT activity are candidates for antiviral ther-apy or for monitoring without intervention,as deter-mined on an individual basis and as influenced by patient factors such as motivation,genotype,histo-logic activity,andfibrosis.Cirrhosis.Patients with compensated cirrhosis who can tolerate therapy are candidates for treatment. In patients with decompensated cirrhosis,antiviral therapy is not recommended;instead,referral for liver transplantation is indicated.Although patients with decompensated cirrhosis are not routine candidates for Table2.Side Effects of Antiviral TherapyRelated to IFNFlu-like symptomsMarrow suppression(especially leukopenia andthrombocytopenia)Emotional effects(irritability,difficulty concentrating,memorydisturbances,depression)Autoimmune disorders(especially thyroiditis)Hair lossRashDiarrheaSleep disordersVisual disorders(rarely retinal hemorrhages,especially in diabetic patients and hypertensive patients)Weight lossSeizuresHearing lossPancreatitisInterstitial pneumonitisInjection site reactionsRelated to ribavirinHemolytic anemiaChest congestion,dry cough,and dyspneaPruritusSinus disordersRashGoutNauseaDiarrheaTeratogenicityJanuary2006AMERICAN GASTROENTEROLOGICAL ASSOCIATION227IFN-based antiviral therapy,attempts to eradicate hepatitis C viremia with progressively escalated,low-dose antiviral therapy before transplantation have met with limited,early success;however,data supporting this approach are insufficient to justify its adoption outside of clinical trials conducted at established cen-ters by experienced investigators.Previous relapsers and nonresponders.Patients in whom HCV RNA is undetectable during and at the end of therapy but reappears again after completion of therapy(relapsers)are likely to respond and experience a relapse again with a subsequent course of the same therapy.The chance of achieving an SVR in relapsers, however,may be as high as40%–50%if re-treatment is pursued with more effective therapy.If this group of patients is to be re-treated,ideally,a different,more effective regimen should be used.Therapy with PEG-IFN and ribavirin should be strongly considered for patients who experienced a relapse after a course of standard IFN/ribavirin combination therapy,while a longer duration of therapy in patients who experienced a relapse after12months of treatment with PEG-IFN plus ribavirin is of unproven efficacy.For nonresponders to a previous course of standard IFN monotherapy,re-treatment with PEG-IFN plus ribavirin can increase the frequency of responsiveness to approximately20%;for nonresponders to a previ-ous course of standard IFN plus ribavirin,re-treat-ment with PEG-IFN plus ribavirin can increase the frequency of responsiveness to approximately10%. Expectations for responsiveness to re-treatment are lower in patients with genotype1,cirrhosis,high baseline HCV RNA levels,and black ethnicity.Such factors,in addition to a patient’s tolerance to previous therapy and severity of underlying liver disease, should be taken into consideration when making in-dividualized decisions about the re-treatment of prior nonresponders.Given the difficulty of clearing hepatitis C viremia, nonresponder patients have been considered as candi-dates for long-term maintenance therapy.Hypotheti-cally,maintenance IFN alfa therapy in prior nonre-sponders might retard the progression offibrosis and limit the progression of cirrhosis to end-stage liver disease and hepatocellular carcinoma.Therefore,sev-eral large,multicenter RCTs of long-term(2–4years) therapy with low-dose PEG-IFN are in progress to assess the effect of maintenance therapy on histologic and clinical end points in patients with chronic hep-atitis C and advancedfibrosis.The results of these trials will be required before recommendations can be made for chronic maintenance therapy in those with advanced histologicfibrosis who fail to achieve an SVR.Acute hepatitis C.The risk of HCV infection after an accidental needlestick is sufficiently low to delay antiviral therapy until HCV infection is docu-mented virologically and biochemically.Patients with acute hepatitis C are candidates for antiviral therapy after a period of observation to allow for potential spontaneous clearance.Case series have focused pri-marily on IFN or PEG-IFN monotherapy adminis-tered for12–24weeks.Although combination IFN or PEG-IFN/ribavirin has not been shown to be superior to IFN monotherapy,conventional doses of PEG-IFN/ ribavirin combination therapy may represent a reason-able approach to treatment of patients with acute hepatitis C.In fact,the optimal regimen,dose,time to initiate therapy,duration of therapy,or benefit of adding ribavirin to IFN therapy has not been estab-lished,and the infrequency of acute hepatitis C will likely confound the prospective comparison of differ-ent treatment regimens.Based on available data,most authorities would initiate treatment no later than2–3 months after presentation with acute hepatitis and would extend therapy for at least24weeks.Injection drug or alcohol use.Therapy is recom-mended for recovered drug users,including those on methadone maintenance,and,based on a case-by-case review,for active drug users,especially when in con-junction with drug treatment programs.Additional randomized trials will be required to evaluate the following:the safest and most effective treatment regimens;the levels of and factors favoring compli-ance;the risk of recidivism;side effect profiles,in-cluding the risk of depression;and the effect of anti-viral therapy on methadone requirements. Abstinence should be recommended before and during antiviral treatment in alcoholic persons,and treatment of alcohol abuse should be linked with efforts to treat hepatitis C in alcoholic patients.A safe level of alcohol consumption in patients with hepatitis C has not been established.Hematologic disorders.The therapeutic ap-proach in this group of patients may depend on the underlying hematologic disorder.For example,in thalassemic patients,primary therapy should be fo-cused on reducing iron overload.Chronic hepatitis C may be treated with PEG-IFN plus ribavirin,al-though data supporting the safety and efficacy of ribavirin,at full or reduced doses,in these populations are limited,because registration trials of PEG-IFN plus ribavirin excluded patients with these disorders specifically.In patients with a genetic predisposition228AMERICAN GASTROENTEROLOGICAL ASSOCIATION GASTROENTEROLOGY Vol.130,No.1to anemia,ribavirin-associated hemolysis would be predicted to be more severe,transfusion requirements may increase during antiviral therapy,and data pro-viding guidelines for ribavirin dosing are unavail-able.Treatment guidelines for hemophiliac patients are the same as those in the nonhemophiliac popula-tion.The risk of pretreatment liver biopsy is higher but can be minimized by coordination with hemato-logic expertise.Children.For children,the general principles of management are the same as those for adults,except that treatment is not recommended for children younger than 3years.End-stage renal disease.Currently,ribavirin is contraindicated in patients with renal failure;how-ever,clinical trials are in progress to assess the safety and efficacy of low-dose ribavirin combined with PEG-IFN.At present,the role of antiviral therapy in patients with end-stage renal disease remains unde-fined.For individual patients,the potential benefit of therapy should be weighed against the higher risk of toxicity,and treatment should be undertaken in cen-ters with experienced clinicians,ideally in clinical trials.For PEG-IFN alfa-2a,a dose reduction from 180to135g is recommended by the manufacturer for patients with renal failure;for PEG-IFN alfa-2b, the manufacturer makes no specific recommendation about dose reduction for patients with renal failure, but50%dose reductions are recommended for other clinical indications(eg,hematologic).Patients with end-stage renal disease and chronic hepatitis C who are candidates for kidney transplantation should be evaluated for advanced hepaticfibrosis,which is asso-ciated with reduced graft and patient survival.Extrahepatic disease.In patients with cutaneous vasculitis and glomerulonephritis resulting from HCV-associated mixed essential cryoglobulinemia,indefinite maintenance therapy may be required.Hepatitis C–as-sociated B-cell lymphoma may respond to antiviral therapy.Human immunodeficiency virus and HCV coinfec-tion.All patients with human immunodeficiency virus (HIV)infection should be screened for HCV infection; among those with HCV infection,evaluation of candi-dacy for antiviral therapy should be undertaken(includ-ing liver biopsy).Ideally,the HIV infection should be well controlled with antiretroviral therapy before treat-ment of the HCV infection is initiated.Optimal therapy consists of PEG-IFN alfa at the routine weekly dose plus ribavirin at a daily dose of600–800mg(higher if tolerated)for48weeks,regardless of genotype.Because of potential drug-drug interactions in patients on HIV treatment regimens that include didanosine,HIV regi-mens should be altered in those starting combination therapy for HCV infection.If didanosine is critical to the HIV regimen,ribavirin should be avoided.Liver transplantation.Results of antiviral therapy for hepatitis C after liver transplantation have been dis-appointing,and results of clinical trials are mixed at best. Whether begun prophylactically immediately after transplantation to prevent reinfection or initiated to treat established posttransplantation hepatitis C,antiviral therapy,even with combination PEG-IFN alfa and riba-virin,may suppress HCV replication but results in an SVR inϽ20%of treated patients.Moreover,IFN,PEG-IFN,and ribavirin have not been well tolerated after liver transplantation,necessitating dose reductions for adverse events such as anemia and serious infections.Therefore, after liver transplantation,the risks and benefits of anti-viral therapy should be weighed carefully for each pa-tient,and treatment should be initiated with caution by transplantation teams experienced in the treatment of hepatitis C.Because immunosuppression increases HCV replication,which is associated with increased HCV-associated liver injury and may contribute to disease progression,doses of immunosuppressive drugs should be kept to a minimum in patients who undergo liver transplantation for chronic hepatitis C.Other TherapiesClinical trials have failed to demonstrate the ef-ficacy of phlebotomy,amantadine,IFN gamma,inter-leukin-10,or thymosin␣-1in patients with chronic HCV infection,although additional trials for some of these agents are continuing.IFN beta offers no advantage over IFN alfa and is not approved for the treatment of hepatitis C.Currently,none of these can be recom-mended.Similarly,alternative and complementary ther-apies have not been proven to be effective in clinical trials and are not recommended.JULES L.DIENSTAGJ.G.McHUTCHISONReferences1.Dienstag JL,McHutchison JG.American Gastroenterological Asso-ciation technical review on the management of hepatitis C.Gas-troenterology2005;129.2.American Gastroenterological Association.Position and policystatement:policy statement on the use of medical practice guide-lines by managed care organizations and insurance carriers.Gas-troenterology1995;108:925–926.Address requests for reprints to:Chair,Clinical Practice and Eco-nomics Committee,AGA National Office,c/o Membership Depart-January2006AMERICAN GASTROENTEROLOGICAL ASSOCIATION229ment,4930Del Ray Avenue,Bethesda,Maryland20814.Fax:(301) 654-5920.The Medical Position Statements(MPS)developed under the aegis of the American Gastroenterological Association(AGA)and its Clinical Practice and Economics Committee(CPEC)were approved by the AGA Governing Board.The data used to formulate these recommendations are derived from the data available at the time of their creation and may be supplemented and updated as new information is assimilated. These recommendations are intended for adult patients,with the intent of suggesting preferred approaches to specific medical issues or problems.They are based upon the interpretation and assimilation of scientifically valid research,derived from a comprehensive review of published literature.Ideally,the intent is to provide evidence based upon prospective,randomized placebo-controlled trials;however, when this is not possible,the use of experts’consensus may occur.The recommendations are intended to apply to health care providers of all specialties.It is important to stress that these recommendations should not be construed as a standard of care.The AGA stresses that thefinal decision regarding the care of the patient should be made by the physician with a focus on all aspects of the patient’s current medical situation.This document presents the official recommendations of the Amer-ican Gastroenterological Association(AGA)on“Management of Hep-atitis C.”It was approved by the Clinical Practice and Economics Committee on September17,2005,and by the AGA Governing Board on November6,2005.230AMERICAN GASTROENTEROLOGICAL ASSOCIATION GASTROENTEROLOGY Vol.130,No.1。
sufferer例句
sufferer例句1. The accident caused him to become a sufferer of chronic pain.2. She is a sufferer of anxiety and often struggles with panic attacks.3. As a sufferer of migraines, she often has to retreat to a dark, quiet room to find relief.4. The young girl became a sufferer of bullying, causing her to struggle with self-esteem issues.5. He is a sufferer of insomnia, often struggling to fall asleep at night.6. The elderly woman became a sufferer of lonelinessafter her husband passed away.7. He is a sufferer of depression and has to rely on medication to manage his symptoms.8. The athlete became a sufferer of a career-ending injury, leaving him feeling lost and uncertain about his future.9. She is a sufferer of allergies and has to be careful about what she eats and touches.10. The young boy became a sufferer of ADHD, making it hard for him to focus and concentrate in school.11. The war left him as a sufferer of post-traumatic stress disorder, causing nightmares and flashbacks.12. She is a sufferer of an autoimmune disease, causing chronic fatigue and joint pain.13. The accident left him as a sufferer of a traumatic brain injury, affecting his cognitive abilities.14. As a sufferer of claustrophobia, she often avoids small, enclosed spaces.15. He is a sufferer of heart disease and has to follow a strict diet and exercise regimen.16. The tragic loss of her child turned her into a sufferer of grief, struggling to come to terms with her loss.17. She is a sufferer of an eating disorder, battling with body image issues and unhealthy relationships with food.18. The survivor of abuse became a sufferer of post-traumatic stress disorder, causing her to experience frequent nightmares and anxiety attacks.19. He is a sufferer of chronic fatigue syndrome, often experiencing extreme fatigue and muscle weakness.20. The accident left her as a sufferer of a spinal cord injury, leading to paralysis in her legs.21. She is a sufferer of diabetes, requiring dailyinsulin injections to manage her condition.22. The child became a sufferer of neglect and abuse, leading to developmental delays and emotional trauma.23. He is a sufferer of substance addiction and has to attend therapy and support groups to maintain sobriety.24. The survivor of a natural disaster became a sufferer of post-traumatic stress disorder, struggling with nightmares and hypervigilance.25. She is a sufferer of chronic kidney disease,requiring dialysis treatments multiple times a week.26. The victim of a car accident became a sufferer of chronic pain, often relying on medication for relief.27. He is a sufferer of dyslexia, causing difficulties with reading and spelling.28. The elderly man became a sufferer of dementia, often struggling with memory loss and confusion.29. She is a sufferer of endometriosis, experiencing extreme pain and menstrual irregularities.30. The veteran became a sufferer of hearing loss, requiring hearing aids to communicate effectively.31. He is a sufferer of multiple sclerosis, experiencing fatigue, muscle weakness, and balance problems.32. The survivor of a violent crime became a sufferer of post-traumatic stress disorder, living with constant fear and anxiety.33. She is a sufferer of frequent migraines, often causing her to miss work and social activities.34. The survivor of a house fire became a sufferer of burns, requiring frequent medical treatments and surgeries.35. He is a sufferer of agoraphobia, often avoiding crowded or public places due to fear and anxiety.36. The child became a sufferer of autism, requiring specialized education and therapies to develop social and communication skills.37. She is a sufferer of fibromyalgia, experiencing widespread pain and fatigue.38. The survivor of domestic abuse became a sufferer of post-traumatic stress disorder, struggling with nightmares and flashbacks.39. He is a sufferer of hepatitis C, requiring ongoing medical treatments and monitoring.40. The victim of a dog attack became a sufferer of physical and emotional scars, requiring therapy and support to heal.41. She is a sufferer of irritable bowel syndrome, often experiencing stomach pain and digestive issues.42. The survivor of a natural disaster became a sufferer of survivor's guilt, struggling with feelings of shame and sorrow.43. He is a sufferer of chronic obstructive pulmonary disease, experiencing difficulty breathing and frequent lung infections.44. The survivor of a plane crash became a sufferer of survivor's guilt, struggling with feelings of responsibility and loss.45. She is a sufferer of rheumatoid arthritis, often experiencing joint pain and stiffness.。
化肝解毒汤联合复方甘草酸苷对慢性乙型病毒性肝炎患者肝功能及血清HA、LN水平的影响
光明中医2021年5月第36卷第9期CJGMCM May 2021. Vol 36.9• 1379•化肝解毒汤联合复方甘草酸苷对慢性乙型病毒性肝炎 患者肝功能及血清h a、l n水平的影响王波1林建霞2王鹏3摘要：目的探讨化肝解毒汤联合复方甘草酸苷对慢性乙型病毒性肝炎患者肝功能及血清HA、LN水平的影响。
方法选取2018年7月一2019年7月收治的180例慢性乙型病毒性肝炎患者，以随机数字表法分为对照组（90例）和观察组（90例）。
对照组 给予复方甘草酸苷注射液治疗，观察组在对照组基础上加用化肝解毒汤治疗。
30 d为一个疗程,2组治疗周期均为3个疗程。
对比 2组治疗前后胸肋不适、情绪抑郁、胃脘胀满积分，血清ALT、TBil、Alb及HA、LN水平。
结果与治疗前比较，治疗后2组胸肋不 适、情绪抑郁、胃聣胀满积分及血清六1^、丁8丨1、1^、1^水平均降低，且观察组低于对照组；而血清六113水平升高，且观察组高于对照 组（均P<0.05)。
结论化肝解毒汤联合复方甘草酸苷对慢性乙型病毒性肝炎有临床治疗意义，其可改善患者临床症状及肝功 能，同时通过降低血清HA、LN水平，缓解肝纤维化,且疗效显著。
关键词：肝著；慢性乙型病毒性肝炎；化肝解毒汤；复方甘草酸苷；中医药疗法doi：10.3969/j.issn.1003-8914.2021.09.004 文章编号：1003-8914(2021)-09-137943Effect of Huagan Jiedu Decoction Combined with Compound Glycyrrhizin on Liver Functionand Serum HA and LN Levels in Patients with Chronic Hepatitis BWANG Bo1LIN Jianxia2WANG Peng3(1. Ward One of Internal Medicine, Xinxiang Infectious Disease Hospital, Henan Province, Xinxiang 453000，China；2. Department of Internal Medicine, the Third Affiliated Hospital of Xinxiang Medical College, Henan Province,Xinxiang 453000, China；3. Ward Three of Internal Medicine, Xinxiang Infectious Disease Hospital,Henan Province, Xinxiang 453000, China)Abstract ：Objective To investigate the effect of Huagan Jiedu decoction combined with compound Glycyrrhizin on liver function and serum HA, LN levels in patients with chronic hepatitis B. Methods 180 patients with chronic hepatitis B in our hospital from July 2018 to July 2019 were randomly divided into control group (n= 90) and observation group ( n= 90). The control group was treated with compound glycyrrhizin injection, and the observation group was treated with Huagan Jiedu decoction on the basis of the control group. 30 d was a course of treatment, and the treatment cycle of both groups was 3 courses. The chest and rib discomfort, depression, epigastric fullness score, serum ALT, TBIL, ALB, HA and LN levels were compared between the two groups before and after treatment. Results Compared with before treatment, the chest rib discomfort, emotional depression, epigastric fullness score and serum ALT, TBIL, Ha, LN levels of the two groups were decreased, and the observation group was lower than the control group. The serum ALB level was increased, and the observation group was higher than the control group ( All P < 0. 05). Conclusion Huagan Jiedu decoction combined with compound Glycyrrhizin has clinical significance in the treatment of chronic hepatitis B. It can improve the clinical symptoms and liver function of patients, and alleviate liver fibrosis by reducing the levels of serum HA and LN.Key w ords： liver fixity；chronic hepatitis B；Huagan Jiedu decoction；compound Glycyrrhizin；therapy of traditional Chinese medicine慢性乙型病毒性肝炎是感染科的常见疾病，潜作者单位：1.新乡市传染病医院一病区内科（河南新乡453000);2.新乡医学院第三附属医院内科（河南新乡453000);3•新乡市传 染病医院三病区内科（河南新乡453000)通讯方式：E-mail:940780480@ 伏期为最短6周，最长6个月，其临床表现主要为乏力、恶心、腹胀、肝疼痛等，严重者可导致肝功能异常[1]。
双相障碍与免疫
双相障碍与免疫柳绪珍;孙静【摘要】本综述介绍了细胞因子在双相障碍发病中作用及相关研究.【期刊名称】《临床精神医学杂志》【年(卷),期】2011(021)001【总页数】2页(P67-68)【关键词】双相障碍;细胞因子;免疫反应【作者】柳绪珍;孙静【作者单位】210029,南京医科大学;南京医科大学附属脑科医院【正文语种】中文【中图分类】R749.4情感障碍的发病机制，过去50年里普遍认为是单胺类递质功能障碍，治疗上也以改善或调理其平衡为主。
随着神经-免疫-代谢网络及影像学在双相障碍研究的深入，免疫反应在双相障碍疾病中的作用逐步得到认识。
作为调节神经元与神经胶质细胞功能平衡的细胞因子可能为完善双相模型提供了方向。
本文介绍细胞因子在双相障碍发病中的作用，并就近年来细胞因子及免疫反应在双相障碍中的研究作一综述。
双相障碍患者的尸检显示前额叶神经胶质细胞数目减少，形态变小或细胞核变大，可以推断这些是对胶质细胞减少的代偿反应。
而且这可以与神经元数目减少神经胶质细胞增多的神经退行性病变相区别［1］。
随着影像学技术的发展发现双相障碍患者脑灰质容量减少、白质呈高密度，区域性脑血流和糖代谢异常，神经元细胞结构及其可塑性发生改变。
神经元、神经胶质细胞的改变是单胺类递质模型无法解释的，这为寻找新的疾病模型提供了生物学依据［2-5］。
可以推测，双相障碍与脑内胶质细胞功能变化密切相关，胶质细胞是脑内免疫反应发生的关键细胞，免疫反应与双相障碍是否存在关联，目前已有相关研究。
1 免疫反应与双相障碍的发生免疫反应异常可导致多种疾病的发生，免疫相关疾病与双相障碍密切相关。
流行病学研究提示，免疫相关疾病与双相障碍患病率密切相关［6-9］，如与双相障碍共病的疾病中，肥胖病、代谢综合征、2型糖尿病比率明显增高。
基因关联研究显示，双相障碍与一些免疫相关疾病有相同的易感区域;双相障碍先证者其子代炎性基因异常表达的mRNA可以作为双相障碍的识别信号［10］。
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• No large case-controlled studies to date • Suicide probability and depression similar in HCV +ve and HCV –ve intravenous drug users
– Grassi, L, et al. J Affect Disord 2001;64:195-202
Cognitive Impairment
• Impairment of attention, concentration, and psychomotor speed in the presence of minimal hepatitis (Forton, DM, et al. Hepatology 2002) • Impairment is similar to other liver disease (Hilsabeck,
» Coughlan B et al Br J Health Psychology 2002;7:105
Quality of Life Studies
• QOL is lower in HCV independent of the severity of liver disease (Ware, 1999; Bonkovsky 1999) • QOL is lower in HCV compared to HBV, and it is unrelated to the mode of infection (Foster, 1998) • QOL improves after viral eradication (Ware, 1999;
Common Neuropsychiatry Symptoms
Fatigue Impaired quality of life Cognitive impairment Depression
Fatigue
• Common in HCV – 20 to 80% (versus 20-30% with general population), but similar in HCV positive and negative blood donors • No clear relationship between severity of liver disease and depression • Conflicting data on improvement after HCV clearance
RC, et al. Hepatology 2002)
• Cerebral choline to creatine ratio elevated in basal ganglia and white matter on MRS in the presence of minimal liver disease (Forton, DM, et al. Lancet 2001) • Mechanism unknown: HCV negative strand identified in brain; immune mediated upregulation of neuroinhibitory pathways?
Depression
• Depression is common in patients with HCV
– – – – Dwight, MM, et al. J Hepatol 2002;36:401-7 Forton, DM, et al. Hepatology 2002;35:433-9 Zdilar, et al. Hepatology 2000;31:1207-11 El-Serag, HB. Gastroenterology 2002;123:476-82
– 35% (29 of 83) improvement in responders vs. 22% (75 of 348) in non-responders
» Cacoub P et al J Hepatol 2002;37:545
– No difference between those who had spontaneous clearance vs. chronic carriers
Bonkovsky, 1999 QOL is better in those who are unaware of HCV diagnosis (Rodgers, 1999) • No difference in QOL in Irish women with HCV RNA positive or negative (Coughlan, 2002)
Depression in Hepatitis C Patients and Interferon Treatment
Paul J. Thuluvath, MD, FRCP The Johns Hopkins University School of Medicine
Outline
1. Evidence for increased prevalence of depression or associated symptoms (fatigue, reduced quality of life) in patients with HCV 2. Incidence of depression with interferon treatment and its potential impact on successful outcome of treatment for HCV 3. Pathophysiology of interferon (and HCV) induced depression 4. Current role of anti-depressants in interferon related depression