The mediating role of Mediterranean diet on the association between Lp(a) levels and cardiovascular disease risk: A 10-year follow-up of the ATTICA study

ObjectiveΤo evaluate the combined modifying effect of dietary habits and/or features of healthy aging, on the lipoprotein-alpha [Lp(a)] and CVD risk association.Design and MethodsΤhe ATTICA is a prospective, population-based study conducted in the greater metropolitan area of Athens (Attica, Greece). During 2001–2002, 3042 CVD-free adults (men/women: 1514/1528, 18–89 years) agreed to participate. In 2011–2012, the 10-year study follow-up was performed, recording the fatal/non-fatal CVD incidence in 2020 participants (mean follow-up: 8.41 years). Various bio-clinical characteristics [including low-density lipoprotein-cholesterol (LDL-C), Lp(a)] were derived through standard procedures. Dietary habits were assessed through the MedDietScore (an index assessing adherence to the Mediterranean diet with theoretical range 0–55). A validated successful aging index (SAI), ranging from 0 to 10, was used to assess healthy aging.ResultsLp(a) levels were positively associated with 10-year CVD incidence (Hazard Ratio: 1.02, 95%CI 1.01–1.04); when MedDietScore was included in the model the observed association between Lp(a) levels and CVD risk disappeared (1.00, 95%CI 0.98–1.01), and a mediating effect of Mediterranean diet was revealed (Sobel's test p < 0.001). In the model that included both MedDietScore and SAI, the interaction effect of these two features on 10-year CVD risk was highly protective (p < 0.001), whereas the association between Lp(a) levels and CVD risk was further mediated (Sobel's test p < 0.001).ConclusionsAdherence to a healthy dietary pattern, like the Mediterranean diet seems to mediate the association between Lp(a) with CVD risk whereas a successful aging together with a healthy diet seems to further explain the previously mentioned association.     

精神药物所致口吃的识别与处理

口吃是精神药物罕见的不良反应,为了提高临床医师的认识,本文对口吃的定义及分类、精神药物所致口吃的诊断、发病机制及处理等作一综述。     

氯氮平撤药致谵妄2例

2例双相障碍患者长期应用氯氮平(分别为100 mg/d,150 mg/d)维持治疗,在骤停氯氮平1天后出现谵妄状态,复用氯氮平后症状迅速缓解。     

首发抑郁症患者肠道菌群与认知情绪调节关系研究

背景　近年来抑郁症和肠道菌群的相关研究大多集中于动物实验,而人体肠道菌群的相关研究相对较少,结合心理特征的研究则更少。目的　了解首发抑郁症患者与健康人群在肠道菌群、认知情绪调节方面的差异,进一步探讨抑郁症、肠道菌群及认知情绪调节之间的关系。方法　选取2017年1-12月就诊于宁夏医科大学总医院心理卫生中心门诊的首发抑郁症患者30例（抑郁症组）,同期选取宁夏“十三五”科技重大项目流调体检健康志愿者31例（对照组）。完成一般情况调查问卷、汉密尔顿抑郁量表、认知情绪调节量表（CERQ）的评定与粪便的收集;采用高通量测序及生物信息学方法分析微生物群落多样性和丰度变化;探讨情绪调节策略、抑郁严重程度与肠道菌群的相关性。结果　抑郁症组和对照组一般情况（年龄、性别、BMI、吸烟、文化程度）比较,差异无统计学意义（P>0.05）。本研究以97%的相似性将所有样本的有效序列聚类为Operational Taxonomic Units（OTUs）,所得稀释曲线趋向平坦,说明测序数据量合理。抑郁症组与对照组肠道菌群多样性指数比较,差异无统计学意义（P>0.05）。与对照组相比,在门水平,抑郁症组厚壁菌门、放线菌门、柔壁菌门丰度降低,拟杆菌门丰度增高（P<0.05）;在属水平,抑郁症组Ruminococcus、Subdoligranulum、Enterobacter、Coprococcus、Bifidobacterium、Lactobacillus菌属减少,而Klebsiella、Flavonifractor、Bacteroides菌属增多（P<0.05）。LEfSe分析显示,抑郁症组肠道菌群中主要以拟杆菌、产碱菌科（Alcaligenaceae）,伯克菌目（Burkholderiales）,Β-变形菌纲、Erysipelotrichaceae、幽门螺杆菌等致病菌为主;对照组以厚壁菌门、双歧杆菌、Subdoligranulum、乳酸杆菌等有益菌为优势菌。抑郁症组自我责难、沉思、灾难化、责难他人分量表得分高于对照组,积极重新评价、理性分析分量表得分低于对照组（P<0.05）。CERQ分量表中自我责难得分与Enterobacter菌属呈正相关,与Odoribacter、Alistipes菌属呈负相关（P<0.05）;沉思分量表得分与Subdoligranulum、Alistipes、Faecalibacterium、Odoribacter菌属呈负相关（P<0.05）;重新关注计划、积极重新评价分量表得分与Weissella菌属呈正相关（P<0.05）;灾难化分量表得分与Dialister菌属呈负相关（P<0.05）。抑郁严重程度与拟杆菌门及Flavonifractor菌属呈正相关（P<0.05）,与Ruminococcus、Subdoligranulum、Coprococcus、Dialister、Odoribacter、Faecalibacterium、Butyricimonas菌属呈负相关（P<0.05）。结论　抑郁症患者与健康对照者在肠道菌群、认知情绪调节策略方面均有较大差异,情绪调节策略自我责难、沉思、灾难化,肠道菌群条件致病菌的增多及丁酸盐产生菌、益生菌的减少与抑郁症密切相关。     

童年期虐待、应对方式、自尊与青少年社交恐惧症的相关研究

目的 探讨童年期虐待、应对方式、自尊与青少年社交恐惧症的相关性,并探讨其与青少年社交恐惧症的起病年龄、病程及严重程度的关系.方法 对符合CCMD-3诊断标准的110例青少年社交恐惧症患者(病例组)以及142例健康对照(对照组)进行童年期虐待问卷(Childhood Trauma Questionnaire-28 item Short Form,CTQ-SF)、简易应对方式量表(Simplified Coping Style Questionnaire,SCSQ)、自尊量表(Self-Esteem Scale,SES)评估,并对青少年社交恐惧症患者进行临床资料、社交回避及苦恼量表(Social Avoidance and Distress Scale,SAD)的评定.结果 相对于对照组,病例组CTQ-SF总分及其各维度分、积极应对和消极应对分更高(P＜0.05),SES 评分更低(P＜0.05).相关分析结果表明:青少年SAD分与CTQ-SF总分及其各维度分、消极应对分存在显著正相关(P＜0.01),与积极应对分、SES分呈显著负相关(P＜0.01).非条件Logistic回归分析发现,童年期虐待水平、情感虐待(EA)、情感忽视(EN)、消极应对、自尊为影响青少年社交恐惧症发病的因素,且CTQ-SF总分、EA分、EN分与青少年社交恐惧症患者的起病年龄成显著负相关(P＜0.01),EA、EN的严重程度与病程呈显著正相关(P＜0.05).结论 青少年社交恐惧症患者有更多的童年期虐待经历.童年期虐待水平、情感虐待、情感忽视、消极应对、自尊为影响青少年社交恐惧症发病的危险因素,积极应对是青少年社交恐惧症发病的保护因素,且童年期虐待经历越多,其起病年龄越早,经历的情感虐待、情感忽视越多,其病情越严重、病程越长.     

Intestinal Conditioning After Cardiac Arrest: The Use of Normothermic Extracorporeal Membrane Oxygenation in the Non‐Heart‐Beating Animal Model

The effect of normothermic extracorporeal membrane oxygenation (NECMO) on small bowel preservation in a clinically relevant large animal model of expected donation after cardiac death (eDCD) was evaluated. Thirty domestic crossbred donor pigs were divided into five groups. The first group served as the live donation (LD) group, the second group served as the donation after cardiac death (DCD) group, and the remaining were further assigned into three subgroups: E1 group (1 h NECMO support), E3 group (3 h NECMO support), and E5 group (5 h NECMO support). Pathology, electron microscopy, energy metabolism, cell apoptosis, and tight junction (TJ) protein expression level of intestinal mucosa and the level of plasma d ‐lactic acid were evaluated in normal, cardiac death and at the end of extracorporeal support, respectively. The mean arterial pressure and PaO₂ were maintained over 60 and 267 mm Hg during NECMO support, respectively. One hour of extracorporeal support could improve the energy status in intestines of the DCD group. Although the histologic damage and apoptosis of the E1 group had no significant difference with those of the LD and DCD groups (P > 0.05), the levels of intestinal mucosa TJ protein decreased (P < 0.05), and plasma d ‐lactic acid increased progressively (P < 0.05). With the extension of extracorporeal support, the degree of intestinal mucosa damage and intestinal permeability gradually increased, as well as the content of adenosine triphosphate in intestinal mucosa. The normothermic extracorporeal support for 1 h in DCD is beneficial for improving the energy status and viability of the bowel. However, the integrity of intestinal mucosa was destroyed gradually as extracorporeal support time went by. And the activation of intestinal epithelial apoptosis and hyperoxia might be the factors that lead to intestinal mucosa injury.     

艾司西酞普兰与氟西汀治疗老年抑郁症疗效对照研究

目的 比较艾司西酞普兰与氟西汀治疗老年抑郁症的疗效和安全性.方法 将70例老年抑郁症患者随机分为观察组和对照组各35例.观察组给予艾司西酞普兰治疗,对照组给予氟西汀治疗.用汉密顿抑郁量表（HAMD）评定其疗效,采用副反应量表评价安全性,分别在治疗0、1、2、4、6周末评定疗效和不良反应.结果 观察组痊愈率为68.57%高于对照组的65.71%,有效率为82.86%高于对照组的80.00%,但2组差异无统计学意义（P〉0 05）.HAMD评分2组治疗第1、2、6周均低于治疗前,观察组治疗第1周HAMD总分和睡眠障碍因子分值低于对照组,差异有统计学意义（P〈0.05）.2组不良反应的发生率比较差异无统计学意义（P〉0.05）.结论 艾司西酞普兰治疗老年抑郁症有效且安全,且起效时间早于氟西汀.     

精神药物所致色素沉着108例文献分析

目的探讨精神药物所致色素沉着的一般规律和特点，为临床合理用药提供参考。方法检索“PubMed”系统、中国期刊全文数据库（CNKI）及万方数据库报道的107例及作者所见1例精神药物所致色素沉着病例，对患者的一般情况及临床资料进行统计与分析。结果精神药物所致色素沉着108例病例中，男性63例（58．33％），女性45例（41．67％）。引起色素沉着的精神药物以抗精神病药物及抗抑郁药居多。在有具体发生时间描述的72例中，色素沉着出现时间最短5h，最长为23年，用药5年以上发生者占41．67％。色素沉着部位由高到低依次为：角膜或晶状体（30．56％）、面颈部及四肢（25．93％）、面颈部（16．67％）、面颈部、四肢、角膜及晶状体（12．96％）、面颈部、角膜及晶状体（6．48％）、全身（5．56％）、四肢（0．93％）、注射部位（0．93％）。经停用致病药物，色素沉着恢复者65例（63．73％）、减轻13例（12．04％）。结论临床医师、药师应了解精神药物所致色素沉着的规律和特点，加强用药监测，及时发现、及时处理。     

脑卒中后抑郁症临床症状特征分析

目的探讨脑卒中后抑郁症临床症状特征。方法采用17项版本HAMD量表对19例脑卒中后押郁症和23例抑郁症病人分别进行抑郁症状调查，并进行对照分析。结果脑卒中后抑郁症与抑郁症病人比较在工作兴趣和自杀有极显著性差异（P〈0．01），忧郁情绪、阻滞、精神焦虑、自知力及体重减轻差异有显著性（P〈0．05）。结论脑卒中后抑郁症临床症状特征主要表现在工作和兴趣减退、自杀、忧郁情绪、阻滞、精神性焦虑等精神方面，并较相对保持完整自知力。     

心理认知护理疗法在抑郁症中的作用

目的探讨心理认知护理疗法在抑郁症中的作用。方法将76例抑郁症患者随机分为研究组和对照组，对照组采用单纯药物治疗研究组在药物治疗同时联合心理认知护理疗法，两组分别于观察前及治疗8周后进行Hamilton抑郁量表（HAMD）和简易应对方式问卷（SCSQ）评定抑郁症患者的心理状况。结果两组Hamilton评分前后分别比较差异有显著性（P〈0．01），而组间比较差异无显著性。研究组治疗后积极应对因子（PC）分高于对照组，而消极应对因子（NC）分低于对照组，差异均有显著性（P〈0．05）。结论实施心理认知护理对抑郁症患者有较好的效果。