Differences in brain glucose metabolism between responders to CBT and venlafaxine in a 16-week randomized controlled trial

OBJECTIVE: Neuroimaging investigations reveal changes in glucose metabolism (fluorine-18-fluorodeoxyglucose positron emission tomography [PET]) associated with response to disparate antidepressant treatment modalities, including cognitive behavior therapy (CBT), antidepressant pharmacotherapies, and deep brain stimulation. Using a nonrandomized design, the authors previously compared changes following CBT or paroxetine in depressed patients. In this study, the authors report changes in fluorine-18-fluorodeoxyglucose PET in responders to CBT or venlafaxine during a randomized controlled trial. METHODS: Subjects meeting DSM-IV-TR criteria for a major depressive episode and a diagnosis of a major depressive disorder received a fluorine-18-fluorodeoxyglucose PET scan before randomization and after 16 weeks of antidepressant treatment with either CBT (N=12) or venlafaxine (N=12). Modality-specific and modality-independent regional brain metabolic changes associated with response status were analyzed. RESULTS: Response rates were comparable between the CBT (7/12) and venlafaxine (9/12) groups. Response to either treatment modality was associated with decreased glucose metabolism bilaterally in the orbitofrontal cortex and left medial prefrontal cortex, along with increased metabolism in the right occipital-temporal cortex. Changes in metabolism in the anterior and posterior parts of the subgenual cingulate cortex and the caudate differentiated CBT and venlafaxine responders. CONCLUSIONS: Responders to either treatment modality demonstrated reduced metabolism in several prefrontal regions. Consistent with earlier reports, response to CBT was associated with a reciprocal modulation of cortical-limbic connectivity, while venlafaxine engaged additional cortical and striatal regions previously unreported in neuroimaging investigations.     

Medical comorbidity in bipolar disorder: re-prioritizing unmet needs

PURPOSE OF REVIEW: The aim of this review is to synthesize results from extant investigations which report on the co-occurrence of bipolar disorder and medical comorbidity. RECENT FINDINGS: We conducted a MEDLINE search of all English-language articles published between January 2004 and November 2006. Most studies report on medical comorbidity in bipolar samples; relatively fewer studies report the reciprocal association. Individuals with bipolar disorder are differentially affected by several 'stress-sensitive' medical disorders notably circulatory disorders, obesity and diabetes mellitus. Neurological disorders (e.g. migraine), respiratory disorders and infectious diseases are also prevalent. Although relatively few studies have scrutinized the co-occurrence of bipolar disorder in medical settings, individuals with epilepsy, multiple sclerosis, migraine and circulatory disorders may have a higher prevalence of bipolar disorder. A clustering of traditional and emerging (e.g. immuno-inflammatory activation) risk factors presage somatic health issues in the bipolar disorder population. Iatrogenic factors and insufficient access to primary, preventive and integrated healthcare systems are also contributory. SUMMARY: Somatic health issues in individuals with bipolar disorder are ubiquitous, under-recognized and suboptimally treated. Facile screening for risk factors and laboratory abnormalities along with behavioral modification for reducing medical comorbidity are warranted.     

Maintenance treatment in bipolar disorder: a focus on aripiprazole

Bipolar disorders (BD) are chronic medical syndromes heterogeneous in phenomenology, pathophysiology and treatment. The longitudinal course of bipolar disorders is often characterized by nonrecovery, subsyndromal symptoms, enduring cognitive deficits and impairment in psychosocial function. The risk for premature mortality from unnatural (e.g., suicide) as well as natural causes (e.g., cardiovascular disease) is significantly higher than the general population. The therapeutic objectives of maintenance therapy are to prevent relapse/recurrence, reduce the risk for premature mortality, promote functional restoration and enhance quality of life. A chronic disease management model, which includes pharmacologic and manual-based psychosocial interventions as paradigmatic components, provides a framework for best practice and optimal patient outcome. This article provides a succinct review of treatments approved by the US FDA for maintenance in bipolar disorders, with a focus on the most recently approved atypical antipsychotic, aripiprazole.     

Volumetric neuroimaging investigations in mood disorders: bipolar disorder versus major depressive disorder

BACKGROUND: As patients with mood disorders manifest heterogeneity in phenomenology, pathophysiology, etiology, and treatment response, a biological classification of mental disease is urgently needed to advance research. Patient and methodological variability complicates the comparison of neuroimaging study results and limits heuristic model development and a biologically-based diagnostic schema. OBJECTIVE: We have critically reviewed and compared the magnetic resonance neuroimaging literature to determine the degree and directionality of volumetric changes in brain regions putatively implicated in the pathophysiology of major depressive disorder (MDD) versus bipolar disorder (BD). METHODS: A total of 140 published magnetic resonance imaging investigations evaluating subjects with BD or MDD were selected to provide a summary and interpretation of volumetric neuroimaging results in MDD and BD. Further commentary on the pathophysiological implications, and putative cellular and pharmacological mechanisms, is also provided. RESULTS: While whole brain volumes of patients with mood disorders do not differ from those of healthy controls, regional deficits in the frontal lobe, particularly in the anterior cingulate and the orbitofrontal cortex, appear to consistently differentiate subjects with mood disorders from the general population. Preliminary findings also suggest that subcortical structures, particularly the striatum, amygdala, and hippocampus, may be differentially affected in MDD and BD. CONCLUSIONS: Structural neuroimaging studies have consistently identified regional abnormalities in subjects with mood disorders. Future studies should strive to definitively establish the influence of age and medication.     

Effects of SIRPalphal on liver regeneration after partial hepatectomy in rat

BACKGROUND：SIRPalphal is well known as a negative regulator for cell proliferation through the regulation of the activity of receptor tyrosine kinase with ITAM motif. No investigation to data was undertaken on SIRPalphal involving liver regeneration. MATERIALS AND METHODS: Adult male Sprague-Dawley rats underwent approximately 700% partial hepatectomy (PH) or sham operation (SO). Liver specimens were collected at 2，6，12，24，30，48，72，120，168,and 240 h after PH or SO.     

职业技术学院学生生活方式健康测评与心理健康水平的相关性

目的:调查、测评职业院校学生生活方式,并测试和分析其与心理健康的关系。方法:于2006-05整群随机分层抽取湖南环境生物职业技术学院医学、药学、护理3个医学专业系在校学生10个班级466名作为调查对象。采用梁静的健康生活方式测验量表改进版和症状自评量表(SCL-90)进行团体测评和比较分析。健康生活方式测验量表包括16个问题,每个问题有3个回答选项以供选择,每个选项得分为0,10,20,30分不等。此量表系在梁静生活方式测验量表的原则和基础上,根据学生的学习和生活特点,在个别问题和个别回答选项的词句表达上进行了适当的变更和调整。调整后未影响信度和效度。将“健康生活方式测验量表”16组问题的回答选项结果进行计分,16个得分数字相加即为健康评分总分。临床症状自评量表包含躯体化、强迫症状、人际关系、抑郁、焦虑、敌对、恐怖、偏执、精神病性等10个因子共90个条目。结果:发放问卷466份,回收合格问卷450份,有效率96.57%。①70.67%学生的生活方式健康评分在280～<400分的较高分区,属非常健康、文明生活方式型;24.22%在160～<280分中游区,属黄灯警示生活方式型。②不同类别学生生活方式评分比较,男生与女生差异显著(333.4±51.9,305.5±56.7,P<0.05);城市生源高于农村生源,差异显著(314.4±56.2,297.4±56.5,P<0.05);不同年龄段比较和不同专业比较,差异均无显著性意义。③生活方式健康评分与SCL-90各因子均呈负相关(r=-0.246,-0.174,-0.190,-0.269,-0.282,-0.279,-0.201,-0.229,-0.236,P<0.01)。④与国内常模比较,生活方式健康评分<400分以下的学生躯体化、强迫症状、抑郁、焦虑、敌对、恐怖、偏执、精神病性等8个因子分显著增加,差异显著(P<0.05或P<0.01)。结论:有近1/4的学生生活方式健康红灯开始报警。生活方式文明健康状况与心理健康水平高度相关。     

先天性髋脱位Salter截骨术髋臼角的矫正及预测

目的：研究Salter截骨术术中定量地改变髋臼对髋臼角的影响。方法：用多元分析方法分析髋臼前旋，ACM角（Idelberger角）减少及髋臼外旋与末梢骨片外移，髂骨张角和Y状软骨间距离增加的关系，及其对髋臼角的作用。结果：Y状软骨间增加的距离与末梢骨片外移，髋臼前旋和外旋正相关，髂骨张角与髋臼前旋和ACM角减少正相关，与髋臼外旋负相关，髋臼前旋，ACM角减少和髋臼外旋对髋臼角减少作用显著，并且增加髋臼外旋可提高髋臼角一次改善率，增加髋臼前旋可提高二次矫正率。结论：定量地旋转和移动髋臼可预期矫正髋臼角。     

高正加速度环境对猴翼外肌c-jun表达的影响

目的:观察高正加速度环境对猴翼外肌组织病理学及c-jun表达的影响。方法:实验于2005-12/2006-12在解放军第三○六医院和航天医学工程研究所完成。①实验动物:健康雄性恒河猴9只,随机数字表法分为4组: 1加速度300s对照组2只、 15加速度200s组2只、 18加速度165s组2只、 21加速度140s组3只。②实验方法:采用改造后的五八型动物离心机模拟飞船升空和返回时产生的超重,各组动物分别承受相应的胸-背向超重作用及持续时间。③实验评估:离心超重作用结束后,解剖取猴翼外肌组织,光学显微镜下观察翼外肌组织病理学变化。采用免疫组化PicTureTM两步法观察翼外肌细胞c-jun的表达,细胞核呈棕色为c-jun阳性反应。结果:9只恒河猴均进入结果分析。① 1加速度300s对照组翼外肌无明显变化,表现为正常的肌组织特征。其余3组翼外肌组织局部间质充血和出血。② 1加速度300s对照组翼外肌细胞核不着色或呈淡黄色,为c-jun阴性或弱阳性表达,细胞质着色不明显。其余3组翼外肌细胞核和细胞质均呈深棕色,为c-jun强阳性表达,3组间无明显差别。结论:超过 15加速度环境可引起猴翼外肌组织局部间质充血和出血,增强肌细胞c-jun基因的表达。     

超短波并音频电治疗盆腔炎性包块60例临床分析

目的:研究超短波并音频电治疗盆腔炎性包块的疗效。方法:120例盆腔炎性包块的患者分两组,60例为抗炎治疗无效的患者(治疗组),采用大功率超短波治疗,输出电流为80毫安,音频电流为20微安,均每日一次,每次20min,10d为一疗程;60例为单纯抗炎药物治疗(对照组),静点甲硝唑0.5g,先锋V号5.0g,每日一次,10d为一疗程。结果:60例治疗组治愈显效率为85%,60例对照组治愈显效率为65%,经统计学检验,U=2.12,P<0.05,故两组盆腔炎性包块患者差异有显著性。结论:超短波并音频电是治疗盆腔炎性包块有效的治疗方法之一。