Neurological status predicts response to alpha-blockers in men with voiding dysfunction and Parkinson's disease

OBJECTIVES:To evaluate predictors of the response to doxazosin, a selective alpha-adrenoceptor antagonist, when used for the treatment of lower urinary tract symptoms in men with Parkinson''s disease.METHODS:In a prospective study, 33 consecutive men (mean age 59.2±7.0 years) with Parkinson''s disease and lower urinary tract symptoms were evaluated. Neurological dysfunction was assessed with the Unified Parkinson''s Disease Rating Scale. Urological assessment was performed at baseline and after 12 weeks of treatment with 4 mg/day of extended-release doxazosin, including symptom evaluation with the International Continence Society male short-form questionnaire, an assessment of the impact of lower urinary tract symptoms on quality of life and urodynamics. Clinical and urodynamic predictors of response were specifically evaluated.RESULTS:Compared with the score at baseline, the total International Continence Society male short-form score was reduced after doxazosin administration, from 17.4±7.5 to 11.1±6.9 (p<0.001). The impact of lower urinary tract symptoms on quality of life was also significantly reduced, from 1.8±1.1 to 1.0±1.0 (p<0.001) and the maximum urinary flow varied from 9.3±4.4 to 11.2±4.6 ml/s (p = 0.025). The severity of neurological impairment was the only predictor of the clinical response. Additionally, patients with a Unified Parkinson''s Disease Rating Scale score lower than 70 had a significantly higher chance of clinical improvement with doxazosin treatment than those with higher Unified Parkinson''s Disease Rating Scale scores did (RR = 3.10, 95% CI = [1.15 to 5.37], p = 0.011).CONCLUSIONS:Doxazosin resulted in the improvement of lower urinary tract symptoms and the maximum flow rate and was well tolerated in men with Parkinson''s disease. The response to treatment is dependent on the severity of neurological disability.     

Do persons with schizophrenia who have better metacognitive capacity also have a stronger subjective experience of recovery?

Research suggests that persons with schizophrenia experience deficits in the ability to synthesize complex and integrated representations of themselves and others. While impairments in these metacognitive capacities are hypothetically related to the ability to make sense of the challenges of schizophrenia, little is known about their relationship with the subjective experience of recovery from mental illness. To examine this question, this study investigated whether persons with stronger self-reported recovery had better metacognitive capacity, after controlling for severity of psychiatric symptoms. Forty-six outpatients with schizophrenia spectrum disorders who were taking part in a study of the Illness Management and Recovery program were concurrently administered the Recovery Assessment Scale, the Positive and Negative Syndrome Scale, and the Indiana Psychiatric Illness Interview which was scored using the Abbreviated Metacognitive Assessment Scale. Analysis of covariance revealed that metacognitive capabilities reflecting self-reflectivity and decentration were differentially related to several components of recovery beyond the effects of psychiatric symptoms. The metacognitive abilities to think about oneself in a sophisticated way and form integrated ideas about oneself and others within the larger world, understanding that none are the metaphorical center are present in individuals holding strong perceptions of recovery.     

An examination of the synergistic interaction of ethanol and thiamine deficiency in the development of neurological signs and long-term cognitive and memory impairments

BACKGROUND: The prolonged and heavy consumption of ethanol has been associated with thiamine deficiency and a wide range of cognitive and memory impairments. The present study was undertaken to test the hypothesis that ethanol and thiamine deficiency act synergistically, producing more severe clinical neurological disturbances and cognitive and memory impairments than either thiamine deficiency or chronic ethanol alone. METHODS: The acute neurological and long-term behavioral consequences of combined chronic (32 weeks) ethanol consumption (20% v/v in drinking water) and three separate 4-week long episodes of dietary thiamine deficiency (ET/TD) versus ethanol (ET) or thiamine deficiency (TD) treatments alone were examined in male Sprague Dawley rats aged 12 weeks at the start of treatment. RESULTS: The ET/TD group lost less weight than the TD group during each episode of thiamine deficiency. Contrary to expectations, the progression and severity of ataxia, impaired righting reflexes, and opisthotonic posturing were similar in the ET/TD and TD groups. None of the ET animals displayed any neurological or behavioral symptoms during treatment. After withdrawal from ethanol and a 7-week recovery period, none of the groups differed in spontaneous activity. On subsequent testing, the ET group displayed a significant increase in perseverative responding in a spontaneous alternation task. A small but significant proportion of ET/TD (23%), ET (17%), and TD (8%) animals were unable to reach criterion on an initial nonmatching-to-position task (NMTP) or in two subsequent reversals of the matching and NMTP tasks, which indicated persistent learning impairments. A large proportion of animals in each of the three groups demonstrated significantly reduced accuracy compared with controls at longer delays of matching-to-position tasks (MTP), but only the ET group was consistently impaired at the shorter delays. There were no significant correlations between blood ethanol concentration and any of the learning and memory measures. CONCLUSIONS: These results indicate that the interaction of chronic ethanol consumption and bouts of TD is both domain specific and not always synergistic. Learning and reference memory appear to be sensitive to a synergistic interaction of ET and TD, whereas short-term working memory disturbances are most affected by ET and neurological symptoms are most associated with TD. Furthermore, neither the presence of neurological symptoms nor blood ethanol concentrations appear to be good predictors of learning and memory deficits.     

略论证候辨证的多维复杂性

证候是辨证的依据,每个临床表现对多项证素或证型具有不同的诊断价值,对于某证素或证型的诊断,各证候所起的作用并不均等。根据病理信息的辨证意义,可将症状区分为必有症、特征症、常见症、一般症、或见症、否定症等。根据证候的不同属性,可拟定各证素所见证候的权重分配,确定各症状对各证型的贡献度。     

中国妇女多囊卵巢综合征的临床特征

目的:调查多囊卵巢综合征(PCOS)妇女临床特征的民族及种族差异性。方法:从1985—2003的中文文献和会议记录中挑选出2461例具有PCOS表现的中国妇女,以及2003年4月—2004年5月期间在中山大学附属第一医院就诊的94例PCOS妇女作为研究对象。结果:中国PCOS患者的临床表现和体征表现出与高加索人群不同的特点。中国的PCOS患者有黄体生成激素(LH)水平升高的趋势,月经不规则的发生率更高,而肥胖的发生率则相对较低。结论:通过比较亚洲/中国和高加索PCOS妇女的临床特征发现两者有明显差异,我们需要一种更适用于中国的PCOS的诊断标准。     

音乐声波按摩治疗改善功能性消化不良患者心身症状的临床探讨

目的:探讨音乐声波按摩治疗对功能性消化不良(functional dyspepsia,FD)患者心身症状的改善作用。方法:选取消化内科门诊符合RomaⅡ标准并签署知情同意书的FD患者23例,停药后,采用两周6次的音乐声波按摩治疗进行干预。干预前后应用症状自评量表(SCL-90)和功能性消化不良症状自测量表进行量化评估。结果:治疗后FD症状量表和SCL-90总分显著低于治疗前(P<0.01),FD症状量表的总有效率为82.61%,SCL-90的总有效率为60.87%。除反酸症状外,干预后FD患者其他胃肠道症状评分较干预前明显降低(P<0.01或P<0.05)。SCL-90因子分测评结果显示,除恐惧因子外,干预后FD患者心理症状评分明显低于治疗前(P<0.01或P<0.05)。结论:音乐声波按摩治疗可改善FD患者的心身症状。     

老年慢阻肺合并肺结核感染68例临床分析

[目的]了解老年慢阻肺合并肺结核患者的症状隐匿,X线表现多样性及不典型性的特点,治疗中应注意的问题,分析老年慢阻肺患者易罹患肺结核的原因。[方法]对2002～2005年老年慢阻肺合并肺结核患者的症状,胸片特点及治疗经过进行分析。[结果]老年慢阻肺合并肺结核患者发热,盗汗,消瘦,食欲不振等结核中毒症状发生率低,结核病变以中下肺发生率高,易合并空洞,排菌者多。[结论]老年慢阻肺患者合并肺结核时易误诊、漏诊。应引起临床重视。     

因子分析在艾滋病中医证候研究中的应用

目的探讨因子分析在艾滋病中医证候研究中的应用,为艾滋病的中医证侯分类和艾滋病中医量表的制定提供科学依据。方法采用多阶段整群随机抽样的方法,在某中部省份抽取HIV/AIDS患者1279例进行问卷调查,对中医四诊信息共40个指标进行因子分析,比较不同证候人群因子得分。结果特征根为1时,提取出12个公因子,累计贡献率为52.39%;艾滋病患者的主要症状是全身皮肤异常(r=0.636)、神疲乏力(r=0.589)、胸闷胸痛(r=0.570)、纳呆食少(r=0.569)等;调查对象综合因子得分最低为-0.567,最高为3.018,平均因子得分-0.082;多个独立样本的秩和检验表明:不同中医实证和虚证的人群,其因子得分也不同(H=183.867,P<0.001;H=210.643,P<0.001)。结论因子分析方法在一定程度上揭示了艾滋病中医证候的主要特点,在艾滋病中医证侯研究中有很好的应用前景。     

体育院校学生教学能力形成的基本因素研究

从对当前体育院校学生素质的调查分析入手，提出改善体育院校学生素质的对策，以达到提高体育院校学生体育教学能力的终极目标。