The Biological Actions of Dehydroepiandrosterone Involves Multiple Receptors

Dehydroepiandrosterone has been thought to have physiological functions other than as an androgen precursor. The previous studies performed have demonstrated a number of biological effects in rodents, such as amelioration of disease in diabetic, chemical carcinogenesis, and obesity models. To date, activation of the peroxisome proliferators activated receptor alpha, pregnane X receptor, and estrogen receptor by DHEA and its metabolites have been demonstrated. Several membrane-associated receptors have also been elucidated leading to additional mechanisms by which DHEA may exert its biological effects. This review will provide an overview of the receptor multiplicity involved in the biological activity of this sterol.     

内分泌激素水平与垂体瘤手术远期疗效相关性分析

[目的]通过临床对垂体瘤手术患者给予内分泌激素水平检测,分析其与患者远期治疗效果的相关性以及观察意义。[方法]选取某院2008年1月～2010年1月所收治的垂体瘤临床经显微外科手术治疗的患者274例进行回顾性分析,动态观察患者手术前后血清泌乳素、甲状腺功能(促肾上腺皮质激素和血皮质醇)以及生长激素的水平变化,并对所有患者给予1年的随访观察,分析其远期治疗效果。[结果]274例垂体瘤手术患者在术后1周内血清泌乳素、生长激素水平相较于手术前明显下降,并且术后随访观察一直维持。274例患者中有68例垂体生长激素腺瘤患者,患者在术后有22例患者生长激素下降到0.34nmol/L,46例患者生长激素下降程度未达到0.34nmol/L以下,术后随访观察有26例患者有病情复发的表现。[结论]患者在手术后以生长激素下降到0.34nmol/L以下为治愈,而内分泌激素水平的检测能够有效判断垂体瘤患者术后的治疗效果,在临床具有非常高的诊断意义与价值。     

云南省抗结核二线药物使用现状调查报告

目的调查云南省各级医疗机构二线抗结核药物(second-line anti-tuberculosis drugs,SLD)的使用情况,为制定合理使用SLD的相关政策提供依据。方法省级、州(市)及县(市、区)级疾控中心结防门诊、结核病治疗定点医院、医疗机构及乡镇卫生院进行问卷调查,并将问卷调查进行汇总分析。结果调查的558个医疗机构中,76.95%的机构使用了SLD。各级SLD使用率分别为:省级100%、州(市)级61.7%、县级72.98%、乡镇级74.95%。不同类型的机构使用SLD的比例不相同,综合医院较高为88.46%,乡镇卫生院次之77.34%。结防机构相对较低53.42%。只有0.72%单位开展一线抗结核药物敏感试验。结论 SLD在各级医疗机构使用很普遍,而药物敏感性试验很少开展,应制定相关政策规范SLD的使用。     

Treating Fragile X syndrome with the diuretic bumetanide: a case report

We report that daily administration of the diuretic NKCC1 chloride co‐transporter, bumetanide, reduces the severity of autism in a 10‐year‐old Fragile X boy using CARS, ADOS, ABC, RDEG and RRB before and after treatment. In keeping with extensive clinical use of this diuretic, the only side effect was a small hypokalaemia. A double‐blind clinical trial is warranted to test the efficacy of bumetanide in FRX. Conclusion: This single case report showed an improvement of the scores of each test used after 3 months of treatment. Double‐blind clinical trials are warranted to test the efficacy of bumetanide in FRX.     

The clinical use of plasma clozapine levels in a maximum security setting

Background. Research suggests a correlation between clozapine dose, plasma level and therapeutic response. Plasma clozapine levels may, therefore, be useful in practice. Little evidence exists, however, on the indications for, and outcome of, levels being undertaken or their use in maximum security settings. Objective. To determine if plasma clozapine levels are useful in clinical practice by analysing their use at the maximum-security State Hospital, Carstairs. Methods. All plasma clozapine levels (until March 2004) undertaken at the State Hospital, clinical indication and outcome were analysed by retrospective case note analysis. These results were compared with the published literature. Results. A total of 140 plasma clozapine levels were analysed. The average level was 0.61 mg/l and dose was 622.9 mg/day. The indications for and consequences of levels are demonstrated. A positive correlation of 0.217 was calculated. Conclusion. This paper shows that plasma clozapine levels are most useful in managing side effects and suspected non-compliance. Plasma clozapine levels are, therefore, useful in clinical practice.     

Simultaneous inference of a binary composite endpoint and its components

Binary composite endpoints offer some advantages as a way to succinctly combine evidence from a number of related binary endpoints recorded in the same clinical trial into a single outcome. However, as some concerns about the clinical relevance as well as the interpretation of such composite endpoints have been raised, it is recommended to evaluate the composite endpoint jointly with the involved components. We propose an approach for carrying out simultaneous inference based on separate model fits for each endpoint, yet controlling the familywise type I error rate asymptotically. The key idea is to stack parameter estimates from the different fits and derive their joint asymptotic distribution. Simulations show that the proposed approach comes closer to nominal levels and has comparable or higher power as compared to existing approaches, even for moderate sample sizes (around 100-200 observations). The method is compared to the gatekeeping approach and results are provided in the Supplementary Material. In two data examples we show how the procedure may be adapted to handle local significance levels specified through a priori given weights.     

Transferring psychiatric specialist services to local authorities—Characteristics of the patients involved

Background: To obtain more co-ordinated services, better co-operation between the services and more efficient use of resources, a pilot project for transferring some district psychiatric centres (DPCs) to large municipalities is planned by the Norwegian government. Systematic knowledge about the patients involved is needed when clinical needs and standards, funding, and political agendas are discussed. This study identifies the clinical, socio-demographic, and behavioural characteristics of patients who need services from both the municipality and the DPC.

Method: A national mapping of patients in specialist mental health services was conducted in 2012/2013, including 65% of all inpatients (n?=?2358) and 60% of all outpatients (n?=?23?124). The need for services was assessed by each patient’s clinician.

Results: It was found that 74% of inpatients and 43% of outpatients needed one or more services from the municipality, usually involving housing, mental health treatment/therapy, or economic support according to their clinicians. These were typically patients with severe mental illness, young inpatients, older outpatients and persons with low education and weak social networks. Only small differences in the need for municipal services were found between patients in hospitals and DPCs.

Conclusions: Many of the patients in specialist mental health services, especially the inpatients, needed services from municipal social and health services. Because these patients had the most severe mental illnesses and were the most socially deprived, a stronger integration of service levels would potentially benefit these patients most. The pilot project should be evaluated to identify the consequences for patients, staff, quality of services, and costs of transferring services to a lower system level.