度洛西汀与氟西汀治疗抑郁症并发慢性疼痛的疗效比较

［摘要］目的比较度洛西汀与氟西汀治疗抑郁症并发慢性疼痛的疗效和不良反应。方法同时符合抑郁症及慢性疼痛诊断标准的门诊及住院患者68例，分为治疗组36例，对照组32例。入组前及治疗后的第1，2，4周分别对患者进行汉密尔顿抑郁量表（HAMD）评分、汉密尔顿焦虑量表（HAMA）评分、不良反应量表（TESS）评分、疼痛视觉模拟评分（VAS）评定。治疗组给予度洛西汀，起始剂量60 mg•d 1，平均剂量（85.00±30.00） mg•d 1；对照组给予氟西汀，起始剂量20 mg•d 1，平均剂量（42.19 ±7.06） mg•d 1。两组皆为早餐后一次口服，1周后可根据实际情况调整剂量，疗程4周。结果治疗后第1周，治疗组的HAMD、HAMA、VAS评分均迅速下降，与治疗前比较均差异有极显著性（均P＜0.01），并显著低于对照组（P＜0.05）。治疗第4周两组HAMD、HAMA、VAS评分与入组时比较均差异有极显著性（均P＜0.01）。但两组间比较差异无显著性（P＞0.05）。两组患者TESS总分、有效率均差异无显著性（P＞0.05）。结论度洛西汀治疗抑郁症并发慢性疼痛患者，能迅速控制抑郁和焦虑症状，起效时间比氟西汀快，能有效地改善或者消除疼痛症状，并且不良反应较轻。     

米氮平治疗老年脑卒中后抑郁临床对照研究

目的探讨米氮平（商品名：瑞美隆）治疗老年脑卒中后抑郁的有效性及安全性。方法收集我院老年病房脑卒中后抑郁患者77例,随机分为米氮平组和阿米替林组治疗6周,采用汉密尔顿抑郁量表（HAMD）、抑郁自评量表（SDS）和副反应量表（TESS）于治疗前和治疗后1、2、4、6周末分别评定疗效和不良反应。结果两组治疗后各周HAMD、SDS评分均较治疗前下降（P均〈0.05）,其中治疗后1周末米氮平组评分下降较阿米替林组更明显,两组比较差异有显著性（P〈0.05）,但治疗老年脑卒中后抑郁2、4、6周末,差异均无显著性（P〉0.05）。米氮平组不良反应较阿米替林组少而轻。结论米氮平治疗老年脑卒中后抑郁疗效与阿米替林相当,但起效快,安全性高,不良反应轻微。     

帕罗西汀联合阿米替林治疗抑郁焦虑状态的对照研究

目的观察帕罗西汀联合阿米替林治疗抑郁焦虑状态的临床效果。方法 78例抑郁焦虑状态患者随机分为两组各39例,研究组口服帕罗西汀联合阿米替林,对照组口服帕罗西汀,观察8周。于治疗前及治疗第2周、4周、8周末采用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）评定临床疗效,副反应量表（TESS）评定不良反应。结果研究组有效率为84.6%,对照组为83.8%,两组无显著性差异（P〉0.05）。两组治疗后HAMD/HAMA评分均较治疗前有显著下降（P〈0.01）,且随着治疗时间的延续呈持续性下降;研究组治疗第2周末较对照组下降更显著,其他时点评分两组均无显著性差异（P〉0.05）。两组副反应TESS评分比较有显著性差异。结论帕罗西汀联合阿米替林治疗抑郁焦虑状态疗效肯定,不良反应较少且轻。     

米氮平与阿米替林治疗老年期抑郁症对照研究

目的比较米氮平和阿米替林对老年期抑郁症的疗效和不良反应.方法将60例老年期抑郁症患者随机分为米氮平组和阿米替林组,进行为期6周的对照治疗,采用汉密尔顿抑郁量表(HAMD)、不良反应量表(TESS)评定疗效和不良反应.结果米氮平与阿米替林显效率分别为76.7%和80.0%.二者疗效相近(P＞0.05).两组HAMD评分在治疗2、4和6周末时均较治疗前呈显著性下降,两组间无显著性差异,两组间TESS评分在治疗各期均存在显著性差异,米氮平较阿米替林不良反应少而轻.结论米氮平是治疗老年期抑郁症安全有效药物.     

慢性疼痛患者精神状态及睡眠质量的临床分析

目的:观察慢性疼痛患者精神状态及睡眠质量,了解其相巨关系及影响.方法:对入选病例分别采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑最表(HAMA)及匹兹堡睡眠质量指数(PSQI)进行测评,并通过t检验对结果进行统计学分析.结果:慢性疼痛患者与健康对照者的HAMD、HAMA和PSQI评分比较,差异有显著性(P＜0.05),说明慢性疼痛患者焦虑及抑郁程度明显高于健康对照者,睡眠质量与之相比亦有差异.进一步分析慢性疼痛患者治疗前后的HAMD、HAMA及PSQI评分,结果显示慢性疼痛患者经疼痛专科治疗后精神状态明显改善,睡眠状况明显改善,治疗前后差异有显著性(P＜0.05).结论:长期的慢性疼痛不仅给患者带来身体的不适,也会影响患者的精神状态,导致焦虑和及抑郁状态出现,且影响睡眠质量,因此,对于各种病因引起的慢性疼痛应积极有效地及早进行专科治疗.     

米氮平与阿米替林对照治疗酒依赖戒断后情感障碍

目的：观察米氮平与阿米替林治疗酒依赖戒断后情感障碍的临床疗效。方法：将63例符合中国精神障碍分类与诊断标准（CCMD-3）诊断为酒依赖的患者随机分为米氮平治疗组32例和阿米替林治疗组31例。应用HAMD、HAMA、TESS量表于治疗开始0、2、4周进行情绪障碍及不良反应评定。结果：米氮平与阿米替林治疗组HAMD、HAMA总分及因子分,治疗4周时与0周均明显低于常规治疗组（P〈0．05或P〈0．01）。副反应评定,阿米替林组口干、便秘、嗜睡明显高于米氮平组。结论：米氮平与阿米替林治疗酒依赖者情感障碍均有效,但米氮平的副反应明显少于阿米替林。     

利培酮联合米氮平治疗精神分裂症后抑郁症状的临床分析

目的:了解利培酮联合米氮平治疗精神分裂症后抑郁症状的疗效和安全性.方法:将符合人组标准的住院患者随机分为研究组(利培酮联合米氮平)和对照组(利培酮),治疗6周,在治疗前、治疗第二、六周进行阳性与阴性症状量表(PANSS)和汉密尔顿抑郁量表(HAMD)评分,不良反应评定采用不良反应量表(TESS)评定.结果:治疗第二周末,PANSS总分两组相比差异有统计学意义(t=2.45,P＜0.05),阴性症状评分两组相比差异有统计学意义(t=3.22,P＜0.01),HAMD评分在治疗第六周末时两组评分差异有统计学意义(t=4.32,P＜0.01),治疗期间未见明显不良反应.结论:利培酮联合米氮平治疗精神分裂症后抑郁症状是安全、有效.     

米氮平联合认知行为治疗神经性厌食症的疗效观察

目的 探讨米氮平联合认知行为治疗神经性厌食症的疗效.方法 采用随机分组的方法将32例符合中国精神障碍分类与诊断标准第3版（CCMD-3）的神经性厌食症患者分成2组,一组米氮平联合认知行为治疗（研究组）,另一组单用米氮平治疗（对照组）.比较两组治疗后体重及汉密尔顿抑郁量表（HAMD）评分的变化,按服药和复诊情况评定治疗依从性.出院1年时跟踪随访统计复发率.结果 在治疗12周及治疗结束后12周时,研究组体重分别为（48.6±5.2）kg和（49.9±4.9）kg,对照组体重分别为（44.1±5.1）kg和（45.0±5.2）kg,差异有统计学意义（P＜0.05,P＜ 0.01）；治疗12周末,研究组HAMD评分为（6.3±3.3）,对照组为（10.6±3.7）,差异有统计学意义（P＜ 0.01）；出院1年末,治疗依从性比较,研究组（62.5％,62.5％）明显高于对照组（43.8％,31.3％） （P＜0.05,P＜ 0.01）；出院1年末,研究组病情复发率（6.25％）明显低于对照组（25.00％）.结论 米氮平联合认知行为治疗能明显增加神经性厌食症患者的体重,改善其抑郁情绪,并能提高其治疗依从性,降低复发率.     

氟西汀对抑郁症迟滞与精力缺乏症状的改善作用

［摘要］目的比较氟西汀与阿米替林对抑郁症迟滞与精力缺乏症状的疗效。方法抑郁症患者55例，分为氟西汀组29例，给予氟西汀20 mg, po ，qd; 阿米替林组26例，给予阿米替林75 mg，po ,bid。6周为1个疗程。以汉密尔顿（HAMD）迟滞因子评分为依据，将患者按基线评分水平划分为低迟滞亚组（HAMD评分＜8分＝和高迟滞亚组（HAMD评分≥8分）。采用HAMD迟滞因子评分以及SCL 58 中有关精力项目评价精力的改变。结果两组治疗6周后，HAMD总分、迟滞因子以及SCL 58 中有关精力项目评分均显著下降，而氟西汀组下降较阿米替林组更为明显，且在治疗1，2周末差异即有显著性（P＜0.05或0.01＝。氟西汀组中高迟滞与低迟滞两亚组疗效比较差异无显著性（P＞0.05），而阿米替林组中高迟滞亚组疗效较低迟滞亚组差（P＜0.05＝；与阿米替林组相比，高迟滞亚组接受氟西汀治疗效果更佳（P＜0.05＝。结论早期应用氟西汀能有效改善抑郁症的精力缺乏症状，对HAMD迟滞因子分高的患者具有更明显的镇静作用。     

米氮平和阿米替林治疗脑卒中后抑郁临床对照观察

目的:比较米氮平和阿米替林治疗脑卒中后抑郁的疗效和安全性。方法:48例脑卒中后抑郁患者,随机分成两组,分别用米氮平与阿米替林治疗8周,采用汉密尔顿抑郁量表(HAMD)、抑郁自评量表(SDS)和不良反应量表(TESS)于治疗前和治疗1、2、4、6、8周末分别评定疗效和不良反应。结果:两组治疗后各周HAMD和SDS均较治疗前下降(P均＜0．05);其中治疗1周、2周末米氮平组评分下降较阿米替林组更明显,两组比较差异有显著性(P＜0．05),但治疗4、6、8周末比较,两组比较差异均无统计学意义(P＞0．05);米氰平组不良反应较阿米替林组少而轻。结论:米氮平治疗脑卒中后抑郁疗效与阿米替林相当,但起效较快,安全性高,不良反应轻微。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.