The breakpoint cluster region gene on chromosome 22q11 is associated with bipolar disorder.

BACKGROUND: Although the pathogenesis of bipolar disorder remains unclear, heritable factors have been shown to be involved. The breakpoint cluster region (BCR) gene is located on chromosome 22q11, one of the most significant susceptibility loci in bipolar disorder linkage studies. The BCR gene encodes a Rho GTPase activating protein, which is known to play important roles in neurite growth and axonal guidance. METHODS: We examined patients with bipolar disorder (n = 171), major depressive disorder (n = 329) and controls (n = 351) in Japanese ethnicity for genetic association using eleven single nucleotide polymorphisms (SNPs), including a missense one (A2387G; N796S), in the genomic region of BCR. RESULTS: Significant allelic associations with bipolar disorder were observed for three SNPs, and associations with bipolar II disorder were observed in ten SNPs including N796S SNP (bipolar disorder, p = .0054; bipolar II disorder p = .0014). There was a significant association with major depression in six SNPs. S796 allele carriers were in excess in bipolar II patients (p = .0046, odds ratio = 3.1, 95% CI 1.53-8.76). Furthermore, we found a stronger evidence for association with bipolar II disorder in a multi-marker haplotype analysis (p = .0002). CONCLUSIONS: Our results suggest that genetic variations in the BCR gene could confer susceptibility to bipolar disorder and major depressive disorder.     

Feasibility of bipolar radiofrequency ablation in patients with parathyroid adenoma: a first evaluation

Aim: The aim of this study was to first assess the feasibility of bipolar radiofrequency ablation in patients with parathyroid adenoma.

Material and methods: Bipolar RFA was performed in 9 patients with primary parathyroid adenoma in one single session. Measured parameters were PTH and calcium serum levels prior to and after bRFA. Furthermore, using an NRS pain scale (1–10), the individual, subjective maximum sensation of pain was documented.

Results: The bRFA resulted in a highly significant (p?=?.003906) decrease of serum PTH levels (median 67?ng/l) in comparison to those prior to the intervention (median 199?ng/l). Regarding calcium levels, there was no statistical significance (p?=?.460938), with a decrease of median serum levels comparing pre- and post-bRFA values from 2.82?mmol/l to 2.66?mmol/l. The evaluation of the individual pain sensation during the procedure was assessed by the patients with a median of 5/10 on the NRS scale. In none of the 9 cases complications such as infections, persisting pain or nerve injury occurred.

Conclusion: For the first time, it was possible to depict the successful therapy of parathyroid adenoma by means of bRFA. This work thus proves bRFA to be an effective, safe, applicable and, concerning sensation of pain, very well tolerable thermoablative technique in the treatment of parathyroid adenoma.     

双极电凝在脾门淋巴结清扫中的应用

目的 :探讨既能彻底清除脾门淋巴结又能保留脾脏的方法。方法 :充分游离脾胰体尾部 ,然后使用双极电凝及组织剪交替分离 ,使该区血管骨骼化。结果 :2 2例行贲门癌根治术患者无一例切除脾脏且清扫彻底。结论 :运用双极电凝协助清扫脾门区淋巴结 ,具有出血少、清扫彻底的优点 ,值得推广应用     

Diagnosis, Treatment, and Six-Month Outcome Status in First-Admission Psychosis

Six-month outcome status was examined in 202 first-admission inpatients with DSM-III-R schizophrenia spectrum (N = 96), psychotic bipolar disorder (N = 64), and psychotic depression (N = 42) drawn from 10 facilities in Suffolk County, New York. Schizophrenics fared significantly worse on all outcome variables except rehospitalization, which ranged from 17.7 to 23.4%. Bipolars had good psychosocial outcomes regardless of clinical outcome, while the two outcome domains were uncorrelated among schizophrenics and psychotic depressed. Schizophreniform patients had significantly better outcome than those with schizophrenia or schizoaffective disorder. Posthospital treatment was generally unrelated to outcome except that fewer rehospitalized schizophrenics received continuous treatment, and patients with psychotic depression with poorer psychosocial outcome received medication less frequently. These findings highlight the different treatment needs of these diagnostic groups, especially as regards the provision of more intensive rehabilitation for schizophrenic patients and the poor-outcome psychotic depressed.     

滴水双极电凝镊在甲状腺全切术中的临床应用

目的:探讨滴水双极电凝镊在甲状腺全切术中对甲状旁腺和喉返神经的保护作用.方法:将70例择期行甲状腺全切手术治疗的患者分为研究组和对照组,应用超声刀结合滴水双极电凝镊对研究组患者实施治疗,应用超声刀结合电刀及传统结扎方法对对照组患者实施治疗,对比两组患者手术时间、出血量、喉返神经损伤、术后甲状旁腺激素水平和血清钙值.结果:研究组患者的手术时间和出血量与对照组患者比较无明显差异,P>0.05.术后研究组患者的暂时性甲状旁腺功能低下和暂时性喉返神经麻痹的发生率分别为2.8%和5.7%,低于对照组的14.3%和17.1%,P<0.05,均无永久性甲状旁腺功能减低和永久性喉返神经麻痹的发生.结论:滴水双极电凝在甲状腺手术中应用,能够有效降低组织周围温度,有利于保护甲状旁腺血运和喉返神经.     

Pharmacotherapy of mood disorders and psychosis in pre- and post-natal women

Introduction: Untreated mood and psychotic disorders can have substantial adverse impacts on the patient, the fetus and the family, while treatment can ameliorate such problems. To address concerns by clinicians about the risks of psychotropic medications, this review addresses the risk/benefit analysis of somatic therapies for psychiatric disorders during pregnancy and lactation.

Areas covered: All available research was reviewed on the impact on pregnancy and breastfeeding of mood and psychotic disorders, and of antidepressants, mood stabilizers, antipsychotic drugs, and electroconvulsive therapy. References cited in other reviews, case series, formal studies, pharmacologic discussions, and theoretical pieces were added. Available case control and other studies were critically reviewed and diverse explanations for their findings were considered.

Expert opinion: The potential benefits of treatment of mood and psychotic disorders often outweigh the risks after alternative therapies have been considered. Some medications, particularly paroxetine and valproate, pose greater risks during pregnancy, while the teratogenic risks of lithium have probably been overstated. There is more experience with first than with second generation antipsychotic drugs during pregnancy and lactation. Nursing an infant is possible while taking a number of antidepressants, mood stabilizers or antipsychotic drugs.     

喹硫平或奥氮平联合丙戊酸钠缓释片治疗维族双相障碍精神病的疗效研究

目的 探讨喹硫平、奥氮平联合丙戊酸钠缓释片对维族双相障碍精神病临床疗效的影响。方法 选择2015年6月—2016年6月在乌鲁木齐市第四人民医院治疗双相障碍精神病的患者100例,随机分为2组,每组50例,对照组患者服用奥氮平联合丙戊酸钠缓释片,观察组患者服用喹硫平联合丙戊酸钠缓释片,服药1、4、8周时患者于医院进行复查,填写17项HMDM评分表、BRMD评分表以及GSI-IS评分表评估两组患者在不同时间的抑郁、躁狂情况和临床疗效。结果 两组患者在治疗期间,临床症状减轻,治疗1、4、8周时HMDM评分、BRMD评分以及GSI-IS评分均显著低于治疗前（P＜0.05）,且随疗程的延长,症状趋于减轻甚至消失;观察组各量表评分比对照组低,但是统计学分析无显著差异。记录两组患者治疗过程中发生不良反应的情况,结果显示观察组患者不良反应的总发生率和头晕嗜睡的发生率较对照组明显降低（P＜0.05）。结论 奥氮平或喹硫平联合丙戊酸钠缓释片可以有效控制维族双相障碍患者抑郁、躁狂症状,且奥氮平联合丙戊酸钠缓释片可以显著降低不良反应发生率,值得临床推广应用。     

西酞普兰联合丙戊酸钠对复发双相障碍抑郁发作患者认知功能及血清炎症因子的影响

目的 探讨氢溴酸西酞普兰片联合丙戊酸钠对复发双相障碍抑郁发作患者认知功能及血清炎症因子的影响,分析其可能作用机制。方法 选择2014年7月-2015年12月收治的复发双相情感障碍抑郁发作患者104例为研究对象,采用随机数字表法分为观察组和对照组各52例,对照组给予丙戊酸钠治疗,观察组给予氢溴酸西酞普兰片联合丙戊酸钠治疗,治疗8周后,比较两组情绪状态、认知功能、血清炎症因子等指标。结果 治疗前,两组患者HAMD评分、BPMS评分比较无统计学意义;治疗8周后,两组患者的HAMD评分、BPMS评分均明显低于同组治疗前,差异有统计学意义（P<0.01）;且观察组HAMD评分、BPMS评分明显低于对照组,差异有统计学意义（P<0.01）。治疗前,两组患者TMT-A、TMT-B时间比较统计学意义;治疗8周,两组患者的TMT-A、TMT-B时间均明显短于同组治疗前,差异有统计学意义（P<0.05）;观察组患者TMT-A、TMT-B时间明显短于对照组,差异有统计学意义（P<0.05）。治疗前,两组患者血清中MIF、IL-1β、IL-6的含量比较无统计学意义;治疗8周,两组患者血清中MIF、IL-1β、IL-6的含量均明显低于同组治疗前,差异有统计学意义（P<0.05）;观察组血清中MIF、IL-1β、IL-6的含量明显低于对照组,差异有统计学意义（P<0.05）。结论 氢溴酸西酞普兰片有助于缓解复发双相障碍抑郁发作患者临床症状,改善认知功能,可能与抑制血清炎症因子表达有关。