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

Growing concerns related to the potential hazards of erythropoiesis stimulating agents have led to downward adjustment in hemoglobin targets for patients with chronic kidney disease, including patients with ESRD on dialysis. These concerns, coupled with economic pressures and shifting cost structures in dialysis funding, have prompted new strategies directed toward the optimal management of anemia, including the call for more liberal use of intravenous iron (1). This article highlights the limited evidence base in support of alternative anemia management strategies and cautions against the injudicious use of iron in this patient population in the absence of sufficient data on long-term safety.

/pdf/lost-without-directions-lessons-from-the-anemia-debate-and-3sk809wh95.pdf

Lost Without Directions: Lessons from the Anemia Debate and the Drive Study

CONTEXT
Focused hypnotic concentration is a model for brain control over sensation and behavior. Pain and anxiety can be effectively alleviated by hypnotic suggestion, which modulates activity in brain regions associated with focused attention, but the specific neural network underlying this phenomenon is not known.


OBJECTIVE
To investigate the brain basis of hypnotizability.


DESIGN
Cross-sectional, in vivo neuroimaging study performed from November 2005 through July 2006.


SETTING
Academic medical center at Stanford University School of Medicine.


PATIENTS
Twelve adults with high and 12 adults with low hypnotizability.


MAIN OUTCOME MEASURES
Functional magnetic resonance imaging to measure functional connectivity networks at rest, including default-mode, salience, and executive-control networks; structural T1 magnetic resonance imaging to measure regional gray and white matter volumes; and diffusion tensor imaging to measure white matter microstructural integrity.


RESULTS
High compared with low hypnotizable individuals had greater functional connectivity between the left dorsolateral prefrontal cortex, an executive-control region of the brain, and the salience network composed of the dorsal anterior cingulate cortex, anterior insula, amygdala, and ventral striatum, involved in detecting, integrating, and filtering relevant somatic, autonomic, and emotional information using independent component analysis. Seed-based analysis confirmed elevated functional coupling between the dorsal anterior cingulate cortex and the dorsolateral prefrontal cortex in high compared with low hypnotizable individuals. These functional differences were not due to any variation in brain structure in these regions, including regional gray and white matter volumes and white matter microstructure.


CONCLUSIONS
Our results provide novel evidence that altered functional connectivity in the dorsolateral prefrontal cortex and dorsal anterior cingulate cortex may underlie hypnotizability. Future studies focusing on how these functional networks change and interact during hypnosis are warranted.

Functional Brain Basis of Hypnotizability

This article reports on the planning, development, and implementation of a large national Internet-based panel study of how Americans are coping with the terrorist attacks of September 11, 2001 The study was designed to determine predictors and correlates of risk and resilience, both cross-sectionally and longitudinally In order to acquire timely and meaningful data, we developed/adapted an extensive set of measures, obtained human subjects approval, and posted a research Web site just 17 days after the attacks This article describes the major hurdles we confronted and the guidelines we recommend regarding these topics, including the methodological trade-offs inherent in Internet-based research, information technology requirements and tribulations, human subjects issues, selection of measures and securing permission for their use, and the challenges of participant recruitment We also discuss issues that we did not anticipate, including the survey intervention We focus not on findings, but on the concrete procedural, administrative, technical, and scientific challenges we encountered and the solutions we devised under considerable time and resource pressures

How to Launch a National Internet-Based Panel Study Quickly: Lessons From Studying how Americans are Coping With the Tragedy of September 11, 2001

This study ex am ined the prev a lence of acute dissociative re ac tions to a re cent stress ful event among 102 male Viet nam vet er ans seek ing help for posttraumatic stress dis or der (PTSD) at a Vet erans Affairs treat ment cen ter. Prior to treat ment, pa tients com pleted a bat tery of ques tion naires, in clud ing the Stan ford Acute Stress Re ac tion Ques tion-naire to assess acute dissociative experiences in reaction to a recent stress ful event. Most (80%) com bat vet er ans re ported ex pe ri enc ing five acute dissociative symptoms in the previous month in reaction to this event. These symp toms were pos i tively as so ci ated with be ing Af ri can American or Hispanic/Latino, hav ing been phys i cally abused in childhood, choosing acom bat-related intrusion ex peri ence as themost stressful re cent event, com bat-re lated trau matic stress symp toms, and hav ing service connected disability. These results have both theoretical and clinicalimplications.

David Spiegel

Papers

Lost Without Directions: Lessons from the Anemia Debate and the Drive Study

Functional Brain Basis of Hypnotizability

How to Launch a National Internet-Based Panel Study Quickly: Lessons From Studying how Americans are Coping With the Tragedy of September 11, 2001

Acute Dissociative Reactions in Veterans with PTSD

Treatment of Panic Disorder: A Consensus Development Conference