抗原变异可使得多种致病微生物易于逃避宿主免疫应答。表达在感染红细胞表面的恶性疟原虫红细胞表面蛋白1（PfPMP1）与感染红细胞、内皮细胞、树突状细胞以及胎盘的单个或多个受体作用，在黏附及免疫逃避中起关键的作用。每个单倍体基因组var基因家族编码约60种成员，通过启动转录不同的var基因变异体为抗原变异提供了分子基础。

疟原虫var基因转换速率变化导致抗原变异[英]／Paul H, Robert P, Christodoulou Z, et al//Proc Natl Acad Sci U S A

Mindfulness is an attribute of consciousness long believed to promote well-being. This research provides a theoretical and empirical examination of the role of mindfulness in psychological well-being. The development and psychometric properties of the dispositional Mindful Attention Awareness Scale (MAAS) are described. Correlational, quasi-experimental, and laboratory studies then show that the MAAS measures a unique quality of consciousness that is related to a variety of well-being constructs, that differentiates mindfulness practitioners from others, and that is associated with enhanced selfawareness. An experience-sampling study shows that both dispositional and state mindfulness predict self-regulated behavior and positive emotional states. Finally, a clinical intervention study with cancer patients demonstrates that increases in mindfulness over time relate to declines in mood disturbance and stress. Many philosophical, spiritual, and psychological traditions emphasize the importance of the quality of consciousness for the maintenance and enhancement of well-being (Wilber, 2000). Despite this, it is easy to overlook the importance of consciousness in human well-being because almost everyone exercises its primary capacities, that is, attention and awareness. Indeed, the relation between qualities of consciousness and well-being has received little empirical attention. One attribute of consciousness that has been much-discussed in relation to well-being is mindfulness. The concept of mindfulness has roots in Buddhist and other contemplative traditions where conscious attention and awareness are actively cultivated. It is most commonly defined as the state of being attentive to and aware of what is taking place in the present. For example, Nyanaponika Thera (1972) called mindfulness “the clear and single-minded awareness of what actually happens to us and in us at the successive moments of perception” (p. 5). Hanh (1976) similarly defined mindfulness as “keeping one’s consciousness alive to the present reality” (p. 11). Recent research has shown that the enhancement of mindfulness through training facilitates a variety of well-being outcomes (e.g., Kabat-Zinn, 1990). To date, however, there has been little work examining this attribute as a naturally occurring characteristic. Recognizing that most everyone has the capacity to attend and to be aware, we nonetheless assume (a) that individuals differ in their propensity or willingness to be aware and to sustain attention to what is occurring in the present and (b) that this mindful capacity varies within persons, because it can be sharpened or dulled by a variety of factors. The intent of the present research is to reliably identify these inter- and intrapersonal variations in mindfulness, establish their relations to other relevant psychological constructs, and demonstrate their importance to a variety of forms of psychological well-being.

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The Benefits of Being Present: Mindfulness and Its Role in Psychological Well-Being

XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

Co-Planar Stereotaxic Atlas of the Human Brain—3-Dimensional Proportional System: An Approach to Cerebral Imaging, J. Talairach, P. Tournoux. Georg Thieme Verlag, New York (1988), 122 pp., 130 figs. DM 268

EASL-EORTC clinical practice guidelines : management of hepatocellular carcinoma

Initiating a community-based cancer supportive care program

Self-regulation skills training for adults, including relaxation

Breast cancer is a public health problem in the United States, with an estimated 182,000 new cases occurring in women in 1994. For most women, a diagnosis of breast cancer marks the beginning of a lifelong struggle. The disease and treatments become physical-psychological stressors whose effects linger long after the individual is tumor-free. This chapter examines the inherent psychosocial stressors that accompany a cancer diagnosis and the psychophysiologic effects that may occur as a result of these stressors. The physiologic and psychological stressors have been shown to profoundly influence neuroimmunoendocrine functioning. Some recent evidence indicates that psychosocial interventions designed to alleviate the cancer patients distress may affect disease progression and survival time, as well as improve quality of life. Three domains that may play a role in moderating health outcome are personality and coping characteristics, level of emotional expression, and social support.

Women's Health: The psychophysiology of breast cancer: Disease, hormones, immunity, and stress

As advances in medical treatment extend life with cancer, converting it from a terminal to a chronic disease, problems in coping with the illness and its treatment become more important. Finding means of helping people live with a chronic life threat, cope with the side effects of arduous treatments, and manage the personal, social and vocational consequences of disease-related disability is of growing importance. These encouraging trends have brought problems with them, however. Growing interest in the mind/body connection in the popular literature has fueled a growing appetite for complementary and alternative treatments and ideas, some of which are useful, while others are potentially harmful (Spiegel, Stroud et al. 1998). Recent studies show that more than forty percent of Americans utilize complementary treatments, and most do so in addition to rather than in place of conventional medical care (Eisenberg, Davis et al. 1998). However, two-thirds of patients who utilize such treatments do not tell their physicians that they are doing so (Eisenberg, Kessler et al. 1993). This has the potential to undermine the doctor-patient relationship (Spiegel 1999).

David Spiegel

Papers

Initiating a community-based cancer supportive care program

Self-regulation skills training for adults, including relaxation

Women's Health: The psychophysiology of breast cancer: Disease, hormones, immunity, and stress

Mind/Body Interactions in Cancer: Myths, Methods and Evidence

Pierre janet and the concept of dissociation. Author's reply