Recent advances in functional neuroimaging

Positron emission tomography (PET) and functional magnetic resonance imaging (MRI) have been introduced into the field of brain science as an noninvasive approach to visualize brain function, focusing on the regional distribution of neuronal activity and its connectivity. Measurement of regional cerebral blood flow with PET has been established for mapping human brain function covering the whole brain with various task conditions. Recently introduced functional MRI technique can also detect the signal changes due to the local increase of blood flow by brain activation. Both PET and MRI provide similar activation patterns in cerebral cortical areas, and the study should be designed by considering the characteristics of each modality. Although PET continues to play a major role in imaging of the neurotransmission process, the efforts are now being made to apply this exciting technique to clinical diagnosis by means of single photon emission computed tomography (SPECT). Neuroreceptor imaging is now applied not only for differential diagnosis of neurological diseases but also for determination of optimal dose of appropriate therapeutic drugs in psychiatric patients. Combined use of activation studies with neurotransmission imaging will provide a new insight in understanding the brain mechanism of emotion and behavior.     

功能训练对脑损伤后功能重建的临床疗效观察

目的 :探讨和观察功能训练对脑损伤后病人功能重建的临床疗效。方法 :60例脑损伤后肢体偏瘫病人随机分为功能训练组和对照组 ,两组病人均接受常规治疗 ,而对功能训练组病人同时实施功能训练。用改良爱丁堡加斯堪的那维亚卒中病人神经功能缺损评分评定病人运动功能和日常生活活动能力。对每例病人在治疗前和治疗后各测定一次神经功能缺损评分。结果 :两组病人神经功能缺损评分均有不同程度改善 ,功能训练组治疗前后比较差异有高度显著性 (P<0 001)。结论 :在脑损伤的病人生命体征稳定后 ,及早正确地予以功能训练促进功能重建的过程 ,使病人的恢复达到理想的程度 ,从而提高其生活活动能力具有重要意义     

抗抑郁药物在功能性胃肠病中的应用

功能性胃肠病（functional gastrointestinal disorders, FGIDs）指一组慢性或反复发作、不能以消化道结构或生化异常解释的症状，常规治疗方法效果不理想。研究发现，改善精神心理状态的药物对FGIDs有一定的治疗作用。最常用的为三环类抗抑郁药（tricyclic antidepressants, TCAs）和选择性5-羟色胺再摄取抑制剂（selective serotonin reuptake inhibitors, SSRIs）。新型的抗抑郁药5-羟色胺-去甲肾上腺素再摄取阻断药（serotonin noradrenalin reuptake inhibitors, SNRIs）也可能对FGIDs有效。抗抑郁药不但可以治疗同时合并的焦虑或抑郁障碍，并且本身对改善FGID患者转归有效，特别是当患者有持续性疼痛，或同时合并焦虑或抑郁障碍，抗抑郁药应作为治疗首选。     

Pharmacological treatments for functional nausea and functional dyspepsia in children: a systematic review

ABSTRACT

Introduction: Chronic idiopathic nausea (CIN) and functional dyspepsia (FD) cause considerable strain on many children’s lives and their families.

Areas covered: This study aims to systematically assess the evidence on efficacy and safety of pharmacological treatments for CIN or FD in children. CENTRAL, EMBASE, and Medline were searched for Randomized Controlled Trials (RCTs) investigating pharmacological treatments of CIN and FD in children (4–18 years). Cochrane risk of bias tool was used to assess methodological quality of the included articles.

Expert commentary: Three RCTs (256 children with FD, 2–16 years) were included. No studies were found for CIN. All studies showed considerable risk of bias, therefore results should be interpreted with caution. Compared with baseline, successful relief of dyspeptic symptoms was found for omeprazole (53.8%), famotidine (44.4%), ranitidine (43.2%) and cimetidine (21.6%) (p = 0.024). Compared with placebo, famotidine showed benefit in global symptom improvement (OR 11.0; 95% CI 1.6–75.5; p = 0.02). Compared with baseline, mosapride versus pantoprazole reduced global symptoms (p = 0.011; p = 0.009). One study reported no occurrence of adverse events. This systematic review found no evidence to support the use of pharmacological drugs to treat CIN or FD in children. More high-quality clinical trials are needed.

Abbreviations: AP-FGID: Abdominal Pain Related Functional Gastrointestinal Disorders; BART: Biofeedback-Assisted Relaxation Training; CIN: Chronic Idiopathic Nausea; COS: Core Outcomes Sets; EPS: Epigastric Pain Syndrome; ESPGHAN: European Society for Pediatric Gastroenterology Hepatology and Nutrition; FAP: Functional Abdominal Pain; FD: Functional Dyspepsia; GERD: Gastroesophageal Reflux Disease; GES: Gastric Electrical Stimulation; H₂RAs: H2 Receptor Antagonists; IBS: irritable bowel syndrome; NASPGHAN: North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition; PDS: Postprandial Distress Syndrome; PPIs: Proton Pump Inhibitor; PROMs: Patient Reported Outcome Measures; RCTs: Randomized Controlled Trials; SSRIs: selective serotonin reuptake inhibitors; TCAs: tricyclic antidepressants     

曲美布汀治疗功能性消化不良

目的 :比较曲美布汀与西沙必利、甲氧氯普胺治疗功能性消化不良的疗效及安全性。方法 :将2 80例功能性消化不良病人随机分为 3组 ,曲美布汀组 1 0 0例 [男性 3 9例 ,女性 61例 ,年龄 (4 1±s 1 4)a]给曲美布汀 2 0 0mg,po,tid;西沙必利组 90例 [男性 3 1例 ,女性 5 9例 ,年龄 (4 2± 1 3 )a]给西沙必利 1 0mg,po,tid ;甲氧氯普胺组 90例 [男性 3 0例 ,女性 60例 ,年龄 (4 3± 1 1 )a]给甲氧氯普氨1 0mg,po,tid。疗程均为2wk。结果 :总有效率曲美布汀组 85 % ,西沙必利组为 84% ,甲氧氯普胺组为 62 % ,经Ridit分析 ,曲美布汀、西沙必利 2组疗效差异无显著意义 (P >0 .0 5 ) ,曲美布汀、甲氧氯普胺 2组疗效差异有非常显著意义 (P <0 .0 1 )。不良反应曲美布汀、西沙必利 2组相近 ,曲美布汀组明显少于甲氧氯普胺组 (P <0 .0 5 )。结论 :曲美布汀治疗功能性消化不良近期疗效显著、安全 ,与西沙必利相近 ,优于甲氧氯普胺     

抗抑郁药物在功能性胃肠病中的应用

功能性胃肠病（functional gastrointestinal disorders, FGIDs）指一组慢性或反复发作、不能以消化道结构或生化异常解释的症状，常规治疗方法效果不理想。研究发现，改善精神心理状态的药物对FGIDs有一定的治疗作用。最常用的为三环类抗抑郁药（tricyclic antidepressants, TCAs）和选择性5-羟色胺再摄取抑制剂（selective serotonin reuptake inhibitors, SSRIs）。新型的抗抑郁药5-羟色胺-去甲肾上腺素再摄取阻断药（serotonin noradrenalin reuptake inhibitors, SNRIs）也可能对FGIDs有效。抗抑郁药不但可以治疗同时合并的焦虑或抑郁障碍，并且本身对改善FGID患者转归有效，特别是当患者有持续性疼痛，或同时合并焦虑或抑郁障碍，抗抑郁药应作为治疗首选。     

替加色罗治疗功能性消化不良临床研究

目的：评价替加色罗治疗功能性消化不良（FD）的疗效。方法：将98例FD患者随机分为两组。试验组49例，给予替加色罗6mg，bid；对照组49例，给予莫沙必利5mg，tid。疗程均为4周。比较两组临床症状的交化。结果：试验组与对照组用药4周后临床主要症状均明显缓解（P〈0．05）；除恶心、呕吐外，其他症状消失率试验组均优于对照组。试验组治疗总有效率为91．8％（45／49例），对照组为71．4％（35／49例），两组相比差异有统计意义（P〈0．05）。两组患者均无严重不良反应。结论：替加色罗治疗FD疗效满意，安全性好。     

抗抑郁药物在功能性胃肠病中的应用

功能性胃肠病（functional gastrointestinal disorders, FGIDs）指一组慢性或反复发作、不能以消化道结构或生化异常解释的症状,常规治疗方法效果不理想。研究发现,改善精神心理状态的药物对FGIDs有一定的治疗作用。最常用的为三环类抗抑郁药（tricyclic antidepressants, TCAs）和选择性5-羟色胺再摄取抑制剂（selective serotonin reuptake inhibitors, SSRIs）。新型的抗抑郁药5-羟色胺-去甲肾上腺素再摄取阻断药（serotonin noradrenalin reuptake inhibitors, SNRIs）也可能对FGIDs有效。抗抑郁药不但可以治疗同时合并的焦虑或抑郁障碍,并且本身对改善FGID患者转归有效,特别是当患者有持续性疼痛,或同时合并焦虑或抑郁障碍,抗抑郁药应作为治疗首选。     

Psychotropic agents in functional gastrointestinal disorders

Functional gastrointestinal disorders (FGIDs) are common conditions diagnosed by established symptom-based criteria. Dysregulation of the brain-gut axis is emerging as the primary pathophysiologic mechanism for FGIDs; this opens avenues for newer treatment modalities. Psychotropic agents act on a variety of neurotransmitter receptors in the brain-gut regulatory pathways that target serotonergic, dopaminergic, opioidergic, and noradrenergic receptor sites. The role of psychotropic agents, especially tricyclic antidepressants is fairly well established in the management of FGIDs and benefit from the newer serotonin norepinephrine reuptake inhibitors is promising. Selective serotonin reuptake inhibitors may provide benefit by reducing symptom anxiety and achieve global symptom relief. In spite of expanding research in evaluating these potential agents, there remains an unmet need in pharmacological management of these disorders, especially at the severe end of their spectrum where options for combined treatments or augmentation need to be developed. In addition, the understanding and management of these disorders hinges on a multidisciplinary biopsychosocial approach, which itself can be a challenging strategy.     

Trends in functional mimicking of metallophosphatases

The promising practical applications of the so called artificial nucleases have inspired widespreading research studies on the functional mimicking of phosphoesterases. This paper is a short summary of the strategies for the selection or design of suitable model compounds, which are derived largely from the mechanistic details of phosphoesterases.     

抗抑郁药物在功能性胃肠病中的应用

功能性胃肠病（functional gastrointestinal disorders, FGIDs）指一组慢性或反复发作、不能以消化道结构或生化异常解释的症状，常规治疗方法效果不理想。研究发现，改善精神心理状态的药物对FGIDs有一定的治疗作用。最常用的为三环类抗抑郁药（tricyclic antidepressants, TCAs）和选择性5-羟色胺再摄取抑制剂（selective serotonin reuptake inhibitors, SSRIs）。新型的抗抑郁药5-羟色胺-去甲肾上腺素再摄取阻断药（serotonin noradrenalin reuptake inhibitors, SNRIs）也可能对FGIDs有效。抗抑郁药不但可以治疗同时合并的焦虑或抑郁障碍，并且本身对改善FGID患者转归有效，特别是当患者有持续性疼痛，或同时合并焦虑或抑郁障碍，抗抑郁药应作为治疗首选。     

抗抑郁药物在功能性胃肠病中的应用

功能性胃肠病（functional gastrointestinal disorders, FGIDs）指一组慢性或反复发作、不能以消化道结构或生化异常解释的症状，常规治疗方法效果不理想。研究发现，改善精神心理状态的药物对FGIDs有一定的治疗作用。最常用的为三环类抗抑郁药（tricyclic antidepressants, TCAs）和选择性5-羟色胺再摄取抑制剂（selective serotonin reuptake inhibitors, SSRIs）。新型的抗抑郁药5-羟色胺-去甲肾上腺素再摄取阻断药（serotonin noradrenalin reuptake inhibitors, SNRIs）也可能对FGIDs有效。抗抑郁药不但可以治疗同时合并的焦虑或抑郁障碍，并且本身对改善FGID患者转归有效，特别是当患者有持续性疼痛，或同时合并焦虑或抑郁障碍，抗抑郁药应作为治疗首选。     

Tegaserod in patients with mechanical sensitivity and overlapping symptoms of functional heartburn and functional dyspepsia

ABSTRACT

Background: While functional heartburn (FH) and functional dyspepsia (FD) are recognized clinical entities, symptoms often overlap across both disorders. Despite their frequency, little is known of the underlying pathophysiology of overlapping symptoms. This study evaluated the effect of the 5-HT₄ agonist, tegaserod, on visceral sensitivity and symptom improvement in patients with overlapping symptoms of FH and FD.

Research design and methods: Patients with overlapping symptoms of FH and FD (ROME II) and mechanical hypersensitivity (Barostat examination) were randomized to tegaserod 6?mg bid or placebo for 2 weeks with treatment crossover after a 2-week washout period. Esophageal and gastric Barostat sensory tests were performed and patients rated their overall symptoms at study end. When carry-over was detected, data were presented for period 1 only. Safety was also assessed.

Results: Sixty patients were screened of whom 30 were randomized and 25 completed. Mechanical hypersensitivity was reported by 83% of 47 patients completing esophageal and gastric baseline Barostat examinations. Tegaserod did not significantly alter balloon volume to pain (primary variable); however, pressure to gastric pain increased (p?=?0.044 vs. placebo). The severity of heartburn, regurgitation, early fullness, and bloating was significantly lower following tegaserod vs. placebo treatment (p?=?0.026, p?=?0.021, p?=?0.016, and p?=?0.030). Overall symptom improvement was reported by 52% tegaserod vs. 32% placebo patients (p?=?0.275), and treatment was well tolerated.

Conclusions: Results suggest that tegaserod may increase the gastric pain threshold and decrease the severity of individual symptoms in patients with overlapping FH and FD. However, these findings must be considered within the context of the study limitations, including the small number of subjects, potential for and presence of a carry-over effect, along with the impact of Barostat balloon use on the assessment of gastric function.     

Renal functional reserve

Renal functional reserve represents the capacity of the kidney to increase its level of operation in response to certain demands. The reserve of glomerular filtration rate and of renal blood flow is discussed from the following points of view: evaluation, measurement, mechanisms involved and significance. Data from the literature are discussed which show (i) that the mechanism of the hyperfiltration seen in the early stage of diabetic nephropathy may be different from the hyperfiltration induced by infusion of amino acids, (ii) that the remaining kidney in healthy kidney donors maintains its functional reserve, and (iii) that the functional reserve is fairly well maintained as long as the glomerular filtration rate is decreased only moderately. The reserve of tubular functional capacity is discussed from the point of view of concentration and dilution and of acidification and alkalinization.