国产卡维地洛治疗高血压病的临床研究

采用开放试验与随机、双盲、双模拟平行对照方法观察国产卡维地洛（Ｃｖ）对原发性高血压病人的疗效,并与国产阿替洛尔（Ａｔ）作对比。Ｃｖ开放试验组３０例中显效２０例（６６７％）,有效６例（２００％）,总有效率２６例（８６７％）;随机双盲双模拟组中Ａ组（Ｃｖ组）２５例中总有效２１例（８４０％）,Ｂ组（Ａｔ）２５例中总有效１８例（７２０％）。治疗４周前后血压下降幅值各组差异均有显著性（Ｐ＜０．０１）。不良反应少而轻。提示国产Ｃｖ系一安全有效的抗高血压病药物。     

椎管内肿瘤296例分析

作者报告椎管内肿瘤２９６例。肿瘤主要发生于胸段,占４１．９％,其次为腰骰和颈段,分另占２５％和２４．３％。病理学分类以神经纤维瘤最多,占１２２例,其次为脊膜瘤和先天性脊髓肿瘤。早期临床表现：髓内肿瘤以肢体麻木无力为主：而髓外肿瘤则以根性神经痛为主：硬脊膜外转移性肿瘤多以突发疼痛起病。早期诊断,尽早手术切除,是治疗本病最有效的方法。     

Multisystemic Treatment of Substance-Abusing and -Dependent Delinquents: Outcomes,Treatment Fidelity,and Transportability

The effectiveness and transportability of multisystemic therapy (MST) were examined in a study that included 118 juvenile offenders meeting DSM-III-R criteria for substance abuse or dependence and their families. Participants were randomly assigned to receive MST versus usual community services. Outcome measures assessed drug use, criminal activity, and days in out-of-home placement at posttreatment (T2) and at a 6-month posttreatment follow-up (T3); also treatment adherence was examined from multiple perspectives (i.e., caregiver, youth, and therapist). MST reduced alcohol, marijuana, and other drug use at T2 and total days in out-of-home placement by 50% at T3. Reductions in criminal activity, however, were not as large as have been obtained previously for MST. Examination of treatment adherence measures suggests that the modest results of MST were due, at least in part, to difficulty in transporting this complex treatment model from the direct control of its developers. Increased emphasis on quality assurance mechanisms to enhance treatment fidelity may help overcome barriers to transportability.     

Gabapentin in the acute treatment of refractory bipolar disorder

Background: Gabapentin, a new anti-epileptic agent, has been anecdotally reported to be effective in the treatment of mania. We systematically assessed the response rate in bipolar patients being treated adjunctively with gabapentin for manic symptoms, depressive symptoms, or rapid cycling not responsive to standard treatments.
Method: Twenty-eight bipolar patients experiencing manic (n=18), depressive (n=5), or rapid-cycling (n=5) symptoms inadequately responsive to at least one mood stabilizer were treated in an open fashion with adjunctive gabapentin. Illness response was assessed using the Clinical Global Impression Scale modified for bipolar disorder (CGI-BP). A 'positive response' was operationalized as a CGI response of much or very much improved.
Results: Fourteen of the 18 (78%) treated for hypomania or mania had a positive response to a dosage range of 600–3600 mg/day. Patients with hypomania responded fastest, with a positive response achieved in 12.7±7.2 days. Patients with classic mania had a mean time to positive response of 25±12 days, and in patients with mixed mania it was 31.8±20.9 days. All of the five patients treated for depression had a positive response within 21±13.9 days. Only one of five patients with rapid cycling had a positive response. Gabapentin was well tolerated by all patients, with the most common side-effect being sedation.
Conclusions: Gabapentin appears to have acute anti-manic and anti-depressant properties as an adjunctive agent for refractory bipolar illness. Prospective double-blind studies are needed to further delineate its acute efficacy when used as monotherapy and its prophylactic efficacy as monotherapy or in conjuction with other mood stabilizers.     

中药复方对卧床模拟失重引起"血淤"的对抗效果

目的观察中药对卧床模拟失重引起血淤证改善的效果。方法１０名被试者随机分为中药组和对照组。两组均头低位－６°卧床７ｄ,中药组卧床中服中药复方,对照组服安慰剂。结果中药组的血淤证较对照组有明显减轻,某些生理指标维持卧床前状态,即血压平稳;心功能（每搏量、心肌收缩力、每搏功指数等）、尿量,与卧床前比较基本保持不变,而对照组比中药组血淤证较重。结论提示中医药可能成为防治短期航天失重时对机体影响的的一种选择措施     

Radiation and Local Control in Early Invasive Breast Cancer

▪ Abstract: Local control in the breast after breast-conserving surgery and radiation for the treatment of early invasive breast carcinoma has long been viewed as important to the patient to avoid later need for mastectomy. Now several studies support the hypothesis that local control is related to and impacts upon a patient's survival as well. The factors that predict for local control with this treatment are reviewed. The recent studies that support the link between local breast failure and distant disease are also discussed. ▪     

Chronic intracerebroventricular administration of orexin-A to rats increases food intake in daytime, but has no effect on body weight

Orexins are recently identified neuropeptides, and have been shown to increase food intake when administered intracerebroventricularly. We examined the effects of chronic administration of orexin in rats by continuous intracerebroventricular administration by means of an osmotic minipump. Continuous administration of orexin-A (0.5 nmol/h) for 7 days in rats resulted in a significant increase in food intake in the daytime. Daytime food intake increased to 180% of the control value. However, it resulted in a slight decrease nighttime food intake as compared with vehicle-treated rats. The total amount of food intake per day was almost comparable with that of vehicle-administered rats. The gain of body weight and blood glucose, total cholesterol and free fatty acid levels were normal. Chronic orexin-A treatment did not cause obesity in rats. We observed abnormal behavior during the daytime after starting administration of orexin-A; these rats kept awake during the daytime. Our present observation showed that continuous administration of orexin-A could not overcome the regulation of energy homeostasis and body weight. However, orexin-A might be implicated in short-term, immediate regulation of feeding behavior.     

Early postnatal treatment with peptide preparations influences spatial navigation of young and adult rats

The brain derived peptidergic drug Cerebrolysin has been found to support the survival of neurons in vitro and in vivo. Positive effects on learning and memory have been demonstrated in various animal models and also in clinical trials. In the present study the effects of early postnatal administration of Cerebrolysin (Cere, 10 mg/ml peptides) or an enriched peptide fraction of Cere (E021, 80.6 mg/ml peptides) were investigated in young, young adult, and old adult rats. Rat pups received the drugs or saline for control on postnatal days 1–7. The animals were tested in the Morris water maze (MWM) either in the 5th week, in the 3rd or the 16th month of life for 6 consecutive days (test days 1–6), eight trials per day. In order to prevent the chance finding of the hidden platform, the rigid underwater platform was replaced by a collapsible island, resting at the bottom of the pool. The platform was raised when the animal stayed in the target area for 2 s. In the young and young adult rats both Cere and E021 treated rats showed shorter escape latencies than saline treated controls on all 6 test days. No significant differences in the swimming speed were evaluated for the young rats, although in 3-month-old drug-tested animals a moderate increase of the swimming speed was investigated. For 16-month-old animals no significant differences in either escape latencies or swimming speed was found. Summarizing, early postnatal application of Cere or E021 improved the spatial learning and memory of young rats and led to long-lasting behavioural effects at least up to 3 months after treatment.     

Vascular depression: a new view of late-onset depression

We have suggested that cerebrovascular disease may predispose, precipitate, or perpetuate some late-life depressive syndromes. The mechanisms of "vascular depression" include disruption of cortico-striato-pallido-thalamo-cortical (CSPTC) pathways or their modulating systems. This view is supported by the presentation of vascular depression, which consists of depressive symptoms, cognitive abnormalities, as well as neuroimaging findings that may result from CSPTC impairment. Moreover, clinical and electrophysiological evidence of CSPTC impairment, an abnormality frequently found in patients with vascular depression, appears to be associated with poor response to antidepressant treatment and early relapse and recurrence. The vascular depression hypothesis provides the conceptual background for studies that may have clinical and theoretical impact. Agents influencing dopamine, acetylcholine, and opioid neurotransmitters may be studied in vascular depression, since these are essential neurotransmitters of the frontostriatal circuitry. Drugs used for prevention and treatment of cerebrovascular disease may be shown to reduce the risk for vascular depression or improve its outcomes. The choice of antidepressants in vascular depression may depend on their effect on neurological recovery from ischemic lesions. Finally, identification of specific relationships between specific symptoms, cognitive deficits, and disability may lead to interventions that target the patients' deficits as well as their interactions with psychosocial factors known to contribute to depression. Research can clarify the pathways to vascular depression by focusing on the site of lesion, the resultant brain dysfunction, the presentation of depression and time of onset, and the contribution of nonbiological factors.     

International comparison of the treatment of polytraumatized patients

Summary Worldwide there will be an increase in polytraumatized patients. The number of death after trauma will increase from 5,1 Mill. to 8,4 Mill. The reason is the technical progress in the third world. In western countries there was a decrease in trauma death, in Germany below 8.000 due to traffic accidents in 1998. In most countries the paramedic system and ATLS are established (USA, South Africa). Long rescue times and inadequate shock treatment preclinically are the bigest problems in Russia and Greece. Worldwide the institution of trauma centers (Level I, II, III) has brought much better results comparing to nontrauma centers but is economically expensive. The annual number of polytraumatized patients (Level I 600–1.000 severe trauma, > 65 personal experience) is essential for the success rate. Infrastrucure, Algorithmus and the personal experience of the trauma leader are the keys for optimal results. One parameter for Quality measurement is the number of potentially preventable deaths. Retrospective analysis of treatment protocols and pathological results by an expert team is the best practical way. The results of level I trauma teams reach between 1 and 2 % preventable deaths. A further instrument of quality improvement are Trauma registers like in US and England (MTOS) and the German Trauma register of the German Society of Trauma. The Trauma register in Germany contents till now 2.069 polytraumatized patients.The lethality is 18,6 % (ISS 21 ± 13), comparing to MTOS (ISS 12,8 ± 11,3, lethality 9,2 %). The differences in injury pattern show in the US three times more penetrating injuries than in the German Traumaregister (21,1 % versus 7,2 %).