氯氮平50年

上个世纪后半叶,有两种抗精神病药物的发现对精神病治疗学的发展起着里程碑作用。一种药物是20世纪50年代初在法国发现的“氯丙嗪”;另一种就是1958年由瑞士科学家发明的“氯氮平”。与氯丙嗪的经历不同,氯氮平自发明直至被批准上市,对粒细胞缺乏致死的恐慌,对抗精神病药物治疗机制存在争议,对医药公司垄断谋利的谴责等,其发展历史比其他的抗精神病药物都要曲折漫长。     

Diffuse and diffuse-plus-focal uptake in the thyroid gland identified by using FDG-PET: prevalence of thyroid cancer and Hashimoto's thyroiditis

Objective To investigate and evaluate the prevalence of incidental thyroid diffuse and diffuse-plus-focal fluorine-18 fluorodeoxyglucose (FDG) uptake in healthy subjects who underwent cancer screening on positron emission tomography (PET) scan, and also to evaluate the prevalence of thyroid cancer and Hashimoto's thyroiditis. Methods We carried out a retrospective review of 1626 subjects who underwent PET scanning at our institution. Diffuse uptake was defined as FDG uptake in the whole thyroid gland, whereas diffuse-plus-focal uptake was defined as a thyroid lesion with both diffuse uptake and focal FDG uptake. The maximum standardized uptake value of the thyroid lesions was recorded and reviewed. In each selected subject with positive thyroid FDG uptake, serum thyroid-stimulating hormone, thyroid hormone, and thyroid antibodies were measured. Fine needle aspiration cytology was performed on patients with a definite nodule using ultrasonography. Results Twenty-nine subjects (1.78%) were identified as having either diffuse FDG uptake (n = 25, 1.53%) or diffuse-plus-focal FDG uptake (n = 4, 0.24%). All subjects with diffuse FDG uptake were diagnosed as having Hashimoto's thyroiditis. In 1 of the 25 subjects with diffuse FDG uptake and two of the four with diffuse-plus-focal FDG uptake, histopathologic diagnosis showed papillary thyroid carcinoma associated with Hashimoto's thyroiditis. However, PET scan did not detect papillary carcinoma associated with Hashimoto's thyroiditis in one of the three subjects. Conclusions Our results suggest that although diffuse FDG uptake usually indicates Hashimoto's thyroiditis, the risk of thyroid cancer must be recognized in both diffuse FDG uptake and diffuse-plus-focal FDG uptake on PET scan.     

情感性障碍与单胺氧化酶基因的遗传关联性分析

目的 探讨单胺氧化酶（ＭＡＯＡ）和ＭＡＯＢ型基因多态性与情感性障碍（双相型和单相型）间的遗传关联性。方法 应用聚合酶链反应（ＰＣＲ）扩增片段长度多态性（Ａｍｐ－ＦＬＰ）研究１３２例情感性障碍患者的ＭＡＯＡ（ＣＡ）Ｎ，ＭＡＯＢ（ＧＴ）ｎ和ＭＡＯＢ（ＴＧ）ｎ基因座的基因型分布。结果 在１３２例患者中观察到ＭＡＯＡ（ＣＡ）ｎ，ＭＡＯＢ（ＧＴ）ｎ和ＭＡＯＢ（ＴＧ）ｎ基因座的等位基因数目分别为８，１２和９个     

Perceptions of HIV and Fertility Among Adolescents in Soweto, South Africa: Stigma and Social Barriers Continue to Hinder Progress

The scale up of highly active antiretroviral therapy (HAART) for the treatment of HIV has raised new concerns relating to fertility desires and outcomes. Among these concerns is social stigma surrounding HIV and childbearing. High rates of infection and patterns of high fertility make adolescents a crucial demographic to qualify perceptions of HIV and fertility. We conducted two focus groups (n = 11 males, n = 8 females) with participants ascertained from an HIV adolescent community advisory board in Soweto, South Africa. Adolescents raised concern over re-infection by HIV positive couples attempting to conceive. They also used this concern to justify their attitudes that HIV positive couples should adopt when faced with the desire to have children. Lastly, participants spoke of a need to revise adolescent sexual and reproductive health services to make them more youth-friendly where users could avoid stigma generated by community healthcare workers. This study adds to the growing literature that calls for an evaluation of adolescent HIV educational programs and a healthcare worker intervention that specifically targets stigma surrounding HIV and childbearing.     

Colour‐opponent mechanisms are not affected by age‐related chromatic sensitivity changes

The purpose of this study was to assess whether age‐related chromatic sensitivity changes are associated with corresponding changes in hue perception in a large sample of colour‐normal observers over a wide age range (n = 185; age range: 18–75 years). In these observers we determined both the sensitivity along the protan, deutan and tritan line; and settings for the four unique hues, from which the characteristics of the higher‐order colour mechanisms can be derived. We found a significant decrease in chromatic sensitivity due to ageing, in particular along the tritan line. From the unique hue settings we derived the cone weightings associated with the colour mechanisms that are at equilibrium for the four unique hues. We found that the relative cone weightings (w_L/w_M and w_L/w_S) associated with the unique hues were independent of age. Our results are consistent with previous findings that the unique hues are rather constant with age while chromatic sensitivity declines. They also provide evidence in favour of the hypothesis that higher‐order colour mechanisms are equipped with flexible cone weightings, as opposed to fixed weights. The mechanism underlying this compensation is still poorly understood.     

单相抑郁症中5-HT2A受体基因及MAOA型 基因的相互影响

目的探讨单相抑郁症病因中５－ＨＴ２Ａ受体基因与ＭＡＯＡ型基因的相互影响。方法在７２例单相抑郁症患者和８１例正常健康人中,采用ＰＣＲ－ＲＦＬＰ和Ａｍｐ－ＦＬＰ技术检测５－ＨＴ２Ａ和ＭＡＯＡ型的等位基因和基因型分布。结果单相抑郁症与５－ＨＴ２Ａ基因间无遗传关联,但是具５－ＨＴ２Ａ的Ａ２／Ａ２基因型患者与ＭＡＯＡ型的１１４ｂｐ等位基因呈强烈关联（ＲＲ＝６．２５,Ｐ＜００５）。结论５－ＨＴ２Ａ受体基因和ＭＡＯＡ型基因在单相抑郁症发生中可能起有一定相互作用。     

Dopamine D4 receptor polymorphism modulates cue-elicited heroin craving in Chinese

Rationale Subjective craving, which contributes to the continuation of drug use in active abuser and the occurrence of relapse in detoxified abusers, is considered to be a central phenomenon in addiction. Dopamine pathway has been implicated in the mechanism underlying the cue-elicited craving for a variety of addictive substances.Objectives The objective of this study was to test the hypothesis that heroin addicts carrying D4 dopamine receptor gene (DRD4) variable number tandem repeat (VNTR) long type allele would have higher craving after exposure to a heroin-related cue.Materials and methods Craving was induced by a series of exposure to neutral and heroin-related cue and were assessed in a cohort of Chinese heroin abusers (n=420) recruited from the Voluntary Drug Dependence Treatment Center at Shanghai.Results Significantly stronger cue-elicited heroin craving was found in individuals carrying DRD4 VNTR long type allele than the non-carriers (F=31.040, p<0.001). As for baseline craving and mean change in craving responding to neutral stimuli, no significance was found (1.06±0.34 vs 1.07±0.36, F=0.067, p =0.797 and 0.42±0.34 vs 0.45±0.37, F=0.277, p=0.599, respectively).Conclusions The results of our study suggest that DRD4 VNTR polymorphism contributes to cue-elicited craving in heroin dependence, indicating DRD4 VNTR represents one of potential genetic risk factors for cue-induced craving.Li Jin and Min Zhao contributed to the work equally. Chunhong Shao and Yifeng Li contributed to the work equally.     

Perceived sleepiness of non-shift working men in two different types of work organization

Increased sleepiness at work is increasingly being focused on as a safety and health issue. However, research on workers' sleepiness is very limited in scope and the characteristics of work organization, including the impact of job stress, have not been fully addressed. A questionnaire survey was conducted to investigate the prevalence of daytime sleepiness and its associated factors among non-shift working men at two manufacturing businesses: Company A, having a rapid rate of development and growth, with 564 workers (19-61 yr old, mean age: 32.7, response rate: 81.4%); and Company B, long established, possessing a huge production facility, with 1,654 workers (20-63 yr old, mean age: 37.1, response rate: 78.2%). The prevalence of daytime sleepiness was 11.3% in company A and 16.8% in company B. Multivariate logistic regression analysis revealed that, in company A, perceived sleepiness was associated with long sleep duration on non-working days and high cognitive demands and, in company B, with insufficient daily sleep, single, and depression. Psychosomatic exhaustion resulting from jobs requiring high adaptivity due to rapid frequency of operational change as in company A may have the potential to become an important factor in perceived sleepiness. However, in a comparatively stable work organization, as in company B, increased sleepiness may be mainly linked to factors outside work. It is suggested that not only lifestyle and sleep habits, but also the characteristics and dynamics of a work organization should be a focus of attention when planning measures to prevent sleepiness at work.