条件化恐惧记忆消退的神经振荡机制

恐惧作为个体应对内外界危险因素形成的自我保护机制的一部分,在生物体的生存中发挥着重要作用.但过度的恐惧不仅对个体生存无益,反而易引发创伤后应激障碍、焦虑等精神疾病,严重影响个体生活质量.临床上通常采用基于行为学研究结果的暴露疗法对恐惧相关疾病进行治疗,然而在患者处于治疗环境之外的时候,上述症状经常会复发.因此,解析恐惧记忆相关神经环路内信息处理的神经机制,对于理解这些疾病的发生发展,寻求切实有效的治疗方案至关重要.大量研究表明与恐惧记忆消退相关的脑区主要涉及杏仁核、内侧前额叶和海马.在恐惧消退的过程中,这3个脑区表现出特定的神经振荡模式,而且这些活动也具有同步性,构成了恐惧记忆成功消退的神经基础.未来可利用基于神经神经振荡的无创性脑刺激手段干预恐惧记忆消退的神经环路,以促进恐惧记忆的消退并避免复发,为恐惧相关障碍的临床治疗提供重要的科学依据.     

三阶梯疗法及护理干预对癌痛患者生活质量的影响

目的:研究癌痛患者的理想护理模式,并探讨三阶梯疗法以及心理护理干预对于癌痛患者生活质量的影响.方法:以我院2010年10月-2012年4月期间共收治的500例癌痛患者为研究对象,并运用随机分组的方式将所有的患者分成两组,即治疗组和对照组分别由250例癌痛患者组成,对照组的患者运用常规的止痛及护理方式即可,而治疗组的患者则运用三阶梯疗法及护理干预的方式来进行护理,对比两组患者的临床止痛效果以及生活质量的改善情况.结果:治疗组患者的癌痛治疗效果及生活治疗改善情况明显优于对照组患者,治疗组的250例癌痛患者中,显效的为187例,有效的为51例,治疗的总有效率为95％,而对照组的250例癌痛患者中,显效的为137例,有效的为68例,治疗的总有效率为82％,对比P＜0.05,具有显著的统计学意义.结论:运用三阶梯疗法并配合必要、科学的护理干预的护理方式来治疗癌痛患者不仅非常的安全和有效,且对于提高患者的生活治疗亦具有显著意义,值得在临床中进行大力的推广与应用.     

蒙药结合放血疗法治疗风湿热的临床效果分析

目的:对蒙药结合放血疗法在治疗风湿热疾病的临床效果进行研究,以便能够更好的揭示蒙药在治疗风湿热的作用。方法:对2010年7月至2013年7月在我院接受治疗的风湿热疾病患者进行分类筛选,选择100例患者通过蒙药结合放血疗法进行综合治疗,治疗时间为一个月,对治疗的效果观察析。结果本组患者经过精心的治疗,有效和显著效果的患者共计97例,无效患者3例,患者的治疗有效率达到了97%,总体而言治疗的效果较好。结论:蒙药结合放血疗法具有副作用小,疗效确切等一些优势,值得在临床上推广和应用。     

光动力疗法在治疗消化道肿瘤中的应用与研究进展

光动力疗法是目前临床上出现的一种新型治疗肿瘤的方法,利用光敏剂吸收可见-近红外光并在组织氧的参与下发生光化学反应,产生活性氧物质进而诱导肿瘤细胞凋亡或坏死。光动力疗法对肿瘤侵袭性低,具有较高的选择性和良好的患者依从性,因此被广泛用于各种消化道恶性肿瘤的姑息性治疗和挽救性治疗。本文对近年来国内外应用光动力疗法治疗消化道肿瘤的文献进行综述,对所报道的疾病类型、治疗病例数、光敏剂和光源、疗效和安全性等信息进行分类整理,并对所面临的挑战和近期的研究进展进行了汇总,以期全面和客观地了解光动力疗法在治疗消化道肿瘤中的应用和研究进展,探讨目前的新应用及存在的问题和可能的发展方向。     

城市绿地暴露与人群健康效应研究

城市绿地是城市绿色基础设施和基于自然解决方案的主要载体,为人群提供了多种生态系统服务,关注人群健康和绿地布局的城市绿地暴露研究已经成为城市生态学、城市可持续发展等学科的前沿热点。目前国内外城市绿地暴露与人群健康研究仍处在兴起的初步发展状态,缺乏有效和公认的研究范式。尝试通过暴露科学的视角,研究城市绿地暴露及其人群健康效应的研究的热点领域:(1)从城市人群的绿地暴露特征来看,绿地暴露研究与现有旨在预防和减少环境污染暴露风险的传统环境健康研究的视角有显著不同,其目标是充分理解人群的绿地暴露特征及其产生健康效应的机制,鼓励和提高人群与绿地的有效和有益接触,服务于城市绿地和健康社区营造的科学规划和决策。(2)从城市绿地暴露的量化表征来看,现有的多种绿地暴露评价指标包括绿地可得性、绿地可及性和绿地可视性等多是表征了绿地的供给状况,并非直接的绿地暴露过程描述,未来可以结合城市人群的绿地暴露时空动态模式,参照总暴露数学方程来综合量化不同途径、访问周期、暴露时长等因素。(3)从城市绿地暴露的人群健康效应机制来看,现有绿地暴露的健康效应机制研究获得的通用理论性成果还不多,面临的挑战主要是:不同绿地健康效应研究采用的暴露特征指标不同,绿地暴露特征影响人群健康存在显著的尺度性,以及缺乏统一的绿地暴露健康效应调查方法。绿地在城市规划和建设中的作用尤其突出,但绿地的人群健康促进功能在我国城市规划和建设中还鲜有应用,作为城市生态学与环境风险、公共健康以及可持续发展的交叉前沿领域,相关成果将为指导健康导向的可持续城市/社区规划与建设提供直接的科学依据与理论支撑。     

HSV-1溶瘤病毒在肿瘤治疗研究中的新进展

基因工程改造的Ⅰ型单纯疱疹病毒(HSV-1)对肿瘤具有特异的靶向性和显著的杀伤能力,已经成为肿瘤治疗研究的热点。HSV-1类溶瘤病毒在临床上对多种肿瘤表现出良好的治疗效果,也被证实能够刺激机体产生较强的抗肿瘤免疫应答。2015年,Amgen公司的T-VEC被美国FDA批准用于治疗恶性黑色素瘤。溶瘤病毒疗法联合放、化疗等治疗方式能进一步提高肿瘤治疗效果。更重要的是,靶向免疫检查点疗法在肿瘤免疫治疗中有着巨大的应用前景,有望与溶瘤病毒疗法联用,成为未来肿瘤治疗的新方向。     

磁场疗法治疗阴茎硬结26例

作者采用磁场疗法治疗阴茎硬结 2 6例 ,治愈 1 2例 ,显效 8例 ,好转 4例 ,无效 2例。是一种安全有效的治疗方法 ,具有较好的临床应用价值 ,与病情相似的 2 4例阴茎硬结患者 ,用超声波治疗进行了疗效比较 ,经统计学处理 ,差异均无显著性 (P >0 .0 5 )。结果表明 ,磁场疗法与超声波疗法疗效近似。     

光动力学疗法治疗肝胆肿瘤的研究现状

介绍了光动力学疗法治疗肝胆肿瘤的实验室和临床研究现状,提出了光动力学疗法在治疗肝胆肿瘤面临的问题,并建议在腹腔镜手术中引入光动力学疗法,认为随着新型光敏剂及光源的开发应用,PDT将会成为治疗肝胆肿瘤的切实可行方法。     

狂犬病免疫球蛋白应用研究进展

中国是全球第二大狂犬病流行国家,每年有数以百万计的狂犬病Ⅲ级暴露案例需要联合应用狂犬病免疫球蛋白和狂犬病疫苗。狂犬病免疫球蛋白价格较昂贵,使用方法较复杂,在狂犬病Ⅲ级暴露后处置中使用率长期以来偏低。降低狂犬病免疫球蛋白的使用剂量可以减少狂犬病Ⅲ级暴露后处置费用。简化狂犬病免疫球蛋白的使用方法可以使狂犬病Ⅲ级暴露后处置更加便于实施。降低狂犬病免疫球蛋白的使用剂量和简化狂犬病免疫球蛋白的使用方法有助于提高狂犬病Ⅲ级暴露后处置中狂犬病免疫球蛋白的使用率。狂犬病免疫球蛋白对狂犬病疫苗免疫效果的影响研究中存在矛盾的结论,探索狂犬病免疫球蛋白影响狂犬病疫苗免疫效应的机制有助于解释狂犬病免疫球蛋白对狂犬病疫苗免疫效果影响的复杂性。本文系统回顾关于狂犬病免疫球蛋白应用研究的进展,以期为制订新的具备实际操作可行性的狂犬病免疫球蛋白应用准则提供参考。     

牙科焦虑症治疗方法综述

牙科焦虑症主要是对疼痛的恐惧、对未知的恐惧、对机体受到伤害的恐惧等因素导致的焦虑症状。临床中80%的口腔疾病患者都对治疗心存恐惧,因此在很大程度上不能配合医生的治疗甚至逃避治疗。随着生活水平的不断提高,人们要求在舒适的心理环境中接受治疗,因此牙科焦虑症就成为口腔医护工作者必须面对的问题。治疗牙科焦虑症的方法主要分为行为学,药理学和有机放松法三个大类,在实际使用的过程当中往往是各种方法配合使用,而不是单一使用。随着人们研究的逐步深入,提出的具体治疗方法也越来越多,本文就牙科焦虑症目前所使用的治疗方法做详细的介绍及分类,帮助口腔医护工作人员理清治疗思路,为正确的诊断、干预和治疗牙科焦虑症提供治疗方法。     

Telemental health: A status update

A rather large body of literature now exists on the use of telemental health services in the diagnosis and management of various psychiatric conditions. This review aims to provide an up‐to‐date assessment of telemental health, focusing on four main areas: computerized CBT (cCBT), Internet‐based CBT (iCBT), virtual reality exposure therapy (VRET), and mobile therapy (mTherapy). Four scientific databases were searched and, where possible, larger, better‐designed meta‐analyses and controlled trials were highlighted. Taken together, published studies support an expanded role for telepsychiatry tools, with advantages that include increased care access, enhanced efficiency, reduced stigma associated with visiting mental health clinics, and the ability to bypass diagnosis‐specific obstacles to treatment, such as when social anxiety prevents a patient from leaving the house. Of technology‐mediated therapies, cCBT and iCBT possess the most efficacy evidence, with VRET and mTherapy representing promising but less researched options that have grown in parallel with virtual reality and mobile technology advances. Nonetheless, telepsychiatry remains challenging because of the need for specific computer skills, the difficulty in providing patients with a deep understanding or support, concerns about the “therapeutic alliance”, privacy fears, and the well documented problem of patient attrition. Future studies should further test the efficacy, advantages and limitations of technology‐enabled CBT, as well as explore the online delivery of other psychotherapeutic and psychopharmacological modalities.     

A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders

In virtual reality exposure therapy (VRET) for anxiety disorders, sense of presence in the virtual environment is considered the principal mechanism that enables anxiety to be felt. Existing studies on the relation between sense of presence and level of anxiety, however, have yielded mixed results on the correlation between the two. In this meta-analysis, we reviewed publications on VRET for anxiety that included self-reported presence and anxiety. The comprehensive search of the literature identified 33 publications with a total of 1196 participants. The correlation between self-reported sense of presence and anxiety was extracted and meta-analyzed. Potential moderators such as technology characteristics, sample characteristics including age, gender and clinical status, disorder characteristics and study design characteristics such as measurements were also examined. The random effects analysis showed a medium effect size for the correlation between sense of presence and anxiety (r = .28; 95% CI: 0.18–0.38). Moderation analyses revealed that the effect size of the correlation differed across different anxiety disorders, with a large effect size for fear of animals (r = .50; 95% CI: 0.30–0.66) and a no to small effect size for social anxiety disorder (r = .001; 95% CI: −0.19–0.19). Further, the correlation between anxiety and presence was stronger in studies with participants who met criteria for an anxiety disorder than in studies with a non-clinical population. Trackers with six degrees of freedom and displays with a larger field of view resulted in higher effect sizes, compared to trackers with three degrees of freedom and displays with a smaller field of view. In addition, no difference in effect size was found for the type of presence measurement and the type of anxiety measurement. This meta-analysis confirms the positive relation between sense of presence and anxiety and demonstrates that this relation can be affected by various moderating factors.     

Mechanisms of Virtual Reality Exposure Therapy: The Role of the Behavioral Activation and Behavioral Inhibition Systems

J. A. Gray’s (1975) theory distinguishes between two motivational systems, which he refers to as the behavioral activation system (BAS) and the behavioral inhibition system (BIS). D. C. Fowles (1980) has shown that heart rate responses reflect activity of the BAS, and electrodermal responses reflect activity of the BIS. Both BAS and BIS are reliably activated during in-vivo exposure to fearful situations (F. H. Wilhelm & W. T. Roth, 1998). However, due to the constraints imposed by virtual reality (VR), we hypothesized that VR exposure to fearful situations would activate the BIS alone. To test this hypothesis, a VR free-standing elevator simulation was presented to participants selected for high and low fear of heights. As predicted, the high-anxious group strongly responded electrodermally (effect size d = 1.53), but showed only minimal HR elevations during exposure (d = 0.12), and little other cardiovascular or respiratory changes. The low-anxious control group showed little electrodermal and HR reactivity (d = 0.28 and 0.12). A comparison with data from a previous study demonstrated that this pattern was in stark contrast to the large electrodermal and cardiovascular response observed during situational in-vivo exposure outside the laboratory. We conclude that the BIS, but not BAS, is selectively activated during VR exposure, causing discordance between self-report and commonly used physiological measures of anxiety. Results are discussed within the framework of E. B. Foa & M. J. Kozak’s (1986) emotional processing theory of fear modification, suggesting different mechanisms underlying VR and in-vivo exposure treatments.     

虚拟现实技术在健康医疗领域的应用

介绍虚拟现实技术的发展历程及基本概况,综述VR/AR技术在临床技能培训与教育、康复治疗、心理治疗及远程医疗等方面的应用研究,提出健康医疗领域虚拟技术的应用还处于起步阶段,未来将在疾病诊疗、手术模拟、远程医疗、健康管理监测等方面不断发展,对提高医护工作人员的服务水平、改善患者就医体验有重大的意义。     

Virtual reality and music therapy as distraction interventions to alleviate anxiety and improve mood states in breast cancer patients during chemotherapy

Psychological distress is a common consequence of breast cancer diagnosis and treatment and could further exacerbate therapy side effects. Interventions increasing treatment tolerance are crucial to improve both patients' quality of life and adherence to therapies. Virtual reality (VR) has emerged as an effective distraction tool for different medical procedures. Here, we assessed the efficacy of immersive and interactive VR in alleviating chemotherapy-related psychological distress in a cohort of Italian breast cancer patients, also comparing its effects with those of music therapy (MT). Thirty patients were included in the VR group, 30 in the MT group, and 34 in the control group, consisting of patients receiving standard care during chemotherapy. Our data suggest that both VR and MT are useful interventions for alleviating anxiety and for improving mood states in breast cancer patients during chemotherapy. Moreover, VR seems more effective than MT in relieving anxiety, depression, and fatigue.     

Evaluation of Exploration and Monitoring Methods for Verification of Natural Attenuation Using the Virtual Aquifer Approach

Though natural attenuation (NA) is increasingly considered as a remediation technology, the methods for proper identification and quantification of NA are still under discussion. Here the "Virtual Aquifer" approach is used to demonstrate problems which may arise during measurement of concentrations in observation wells and for interpolation of locally measured concentrations in contaminated heterogeneous aquifers. The misinterpretation of measured concentrations complicates the identification and quantification of natural attenuation processes. The "Virtual Aquifer" approach accepts the plume simulated with a numerical model for a heterogeneous aquifer as "virtual reality". This virtual plume is investigated in the model with conventional methods like observations wells. The results of the investigation can be compared to the virtual "reality", evaluating the monitoring method. Locally determined concentrations are interpolated using various interpolation methods and different monitoring set-ups. The interpolation results are compared to the simulated plume to evaluate the quality of interpolation. This evaluation is not possible in nature, since concentrations in a heterogeneous aquifer are never known in detail.     

Recognition profile of emotions in natural and virtual faces

Background

Computer-generated virtual faces become increasingly realistic including the simulation of emotional expressions. These faces can be used as well-controlled, realistic and dynamic stimuli in emotion research. However, the validity of virtual facial expressions in comparison to natural emotion displays still needs to be shown for the different emotions and different age groups.

Methodology/Principal Findings

Thirty-two healthy volunteers between the age of 20 and 60 rated pictures of natural human faces and faces of virtual characters (avatars) with respect to the expressed emotions: happiness, sadness, anger, fear, disgust, and neutral. Results indicate that virtual emotions were recognized comparable to natural ones. Recognition differences in virtual and natural faces depended on specific emotions: whereas disgust was difficult to convey with the current avatar technology, virtual sadness and fear achieved better recognition results than natural faces. Furthermore, emotion recognition rates decreased for virtual but not natural faces in participants over the age of 40. This specific age effect suggests that media exposure has an influence on emotion recognition.

Conclusions/Significance

Virtual and natural facial displays of emotion may be equally effective. Improved technology (e.g. better modelling of the naso-labial area) may lead to even better results as compared to trained actors. Due to the ease with which virtual human faces can be animated and manipulated, validated artificial emotional expressions will be of major relevance in future research and therapeutic applications.     

A model of NSCLC microenvironment predicts optimal receptor targets

Background: Tumor microenvironment plays an essential role in the growth of malignancy. Understanding how tumor cells co-evolve with tumor-associated immune cells and stromal cells is important for tumor treatment. Methods: In this paper, we propose a logistic population dynamics model for quantifying the intercellular signaling network in non-small-cell lung cancer (NSCLC). The model describes the evolutionary dynamics of cells and signaling proteins and was used to predict effective receptor targets through combination strategy analysis. Then, we optimized a multi-target strategy analysis algorithm that was verified by applying it to virtual patients with heterogeneous conditions. Furthermore, to deal with acquired resistance which was commonly observed in patients with NSCLC, we proposed a novel targeting strategy — tracking targeted therapy, to optimize the treatment by improving the therapeutic strategy periodically. Results: The synergistic effect when inhibiting multiple signaling pathways may help significantly retard carcinogenic processes associated with disease progression, compared with suppression of a single signaling pathway. While traditional treatment (surgery, radiotherapy and chemotherapy) tends to attack tumor cells directly, the multi-target therapy we suggested here is aimed to inhibit the development of tumor by emasculating the relative competitive advantages of tumor cells and promoting that of normal cells. Conclusion: The combination of traditional and targeted therapy, as an interesting experiment, was significantly more effective in treatment of virtual patients due to a clear complementary relationship between the two therapeutic schemes.