高尿酸血症认知功能障碍模型大鼠皮层和海马的代谢组学研究

目的基于核磁共振氢谱(1H-NMR)代谢组学方法研究高尿酸血症诱发大鼠认知功能障碍模型的皮层和海马的内源性差异代谢物变化。方法采用含2%尿酸和2%氧嗪酸钾的高尿酸复合饲料饲喂大鼠12周,Morris水迷宫测定大鼠认知功能,并利用1H-NMR分析大鼠皮层和海马中的差异代谢物。结果高尿酸血症大鼠显示较长的逃逸潜伏期,表现出认知功能障碍;且大鼠的皮层和海马中分别筛选出27和18种差异代谢物,其中共有6种差异代谢物。γ-氨基丁酸、谷氨酸、谷氨酰胺、乳酸、甘露醇、牛磺酸和谷胱甘肽均有显著变化,可能作为高尿酸血症认知功能障碍的特征生物标志物,与学习、记忆功能损伤的发生和发展密切相关。结论高尿酸饮食可干扰机体的正常代谢,其诱发认知功能障碍机制可能与能量代谢的糖酵解和三羧酸循环、氨基酸代谢、氧化应激、神经递质转化以及细胞膜功能的紊乱等有关。     

Incidence rate of prostate cancer in men treated for erectile dysfunction with phosphodiesterase type 5 inhibitors: retrospective analysis

The purpose of this study was to determine the incidence rate of prostate cancer among men with erectile dysfunction (ED) treated with phosphodiesterase type 5 inhibitors (PDE-5i) over a 7-year period vs. men with ED of the same age and with similar risk factors who were not treated with PDE-5i. In a retrospective review of electronic medical records and billing databases between the years 2000 and 2006, men with ED between the ages of 50 and 69 years and no history of prostate cancer prior to 2000 were identified. These individuals were divided into two groups: 2362 men who had treatment with PDE-5i, and 2612 men who did not have treatment. Demographic data in each group were compared. During the study period, 97 (4.1%) men with ED treated with PDE-5i were diagnosed with prostate cancer compared with 258 (9.9%) men with ED in the non-treated group (P<00001). A higher percentage of African Americans were treated with PDE-5i vs. those who were not (10.5% vs. 7.1% P<0.0001). The PDE-5i group had lower documented diagnosis of elevated prostate-specific antigen (10.0% vs. 13.1% P=0.0008) and higher percentage of benign prostatic hyperplasia (38.4% vs. 35.1% P=0.0149). Men with ED treated with PDE-5i tended to have less chance (adjusted odds ratio: 0.4; 95% confidence intervals: 0.3–0.5; P<0.0001) of having prostate cancer. Our data suggest that men with ED treated with PDE-5i tended to have less of a chance of being diagnosed with prostate cancer. Further research is warranted.     

Change in quality of life of medically hospitalized patients – A one-year follow-up study

Objectives: To examine changes in quality of life (QOL) among elderly medically hospitalized patients one year after hospitalization, and to explore factors associated with the changes.

Methods: A one-year follow-up study included 363 (175 men) medical inpatients with age range 65–98 (mean 80.2, SD 7.5) years. Information was collected at baseline and follow-up using the WHOQOL-BREF questionnaire assessing the physical, psychological, social and environment domain of QOL as the dependent variable, and the Mini-Mental State Examination, Lawton and Brody's scales for physical self-maintenance and instrumental activities of daily living, the Hospital Anxiety and Depression scale and assistance in living as the independent variables.

Results: The mean score of the physical domain of QOL had increased (mean change 0.6, SD 2.5; p?p? Conclusion: Good cognitive, physical and emotional health at baseline and follow-up were associated with improved QOL in previously hospitalized elderly patients independent of their need for assistance in living.     

Identifying an optimal treatment for schizophrenia: A 2-year randomized controlled trial comparing integrated care to a high-quality routine treatment

Abstract

Objective. This study used repeated outcome measures over a 2-year period to compare the clinical and social benefits of routine schizophrenia treatment with those of evidence-based pharmacological and psychosocial treatment strategies. Method. One hundred patients who were diagnosed with schizophrenia according to DSM-IV criteria were randomly assigned to 24 months of either optimal case management (OCM) or routine case management (RCM). OCM involved minimally effective doses of antipsychotic medication with compliance training, an identical treatment programme with the addition of manual-based communication and problem solving training to help patients and caregivers manage stress, social skills training, supported employment, cognitive-behavioural strategies for residual psychotic and non-psychotic symptoms, as well as anger management and substance use counselling. RCM involved minimally effective doses of antipsychotic medication with compliance training, the monitoring of side effects, education about schizophrenia and its optimal treatment, detection of early warning signs and supportive psychotherapy to address practical problems. The symptoms, impairment, disability, unmet needs, quality of life of the patients were examined by blinded researchers every 6 months. Results. Statistically and clinically significant advantages were observed for OCM versus RCM on all measures. Most of these advantages increased throughout the 24-month period. Conclusions. This study helps demonstrate the importance of psychosocial interventions in the treatment of schizophrenia. Recent advances in evidence-based psychosocial strategies can be implemented into routine clinical practice with additional clinical and social benefits.     

Significant junctures on the way towards becoming a user of assistive technology in Alzheimer's disease

Abstract

Objective: The aim of this study was to describe how persons in the early stages of Alzheimer's disease (AD) became users of assistive technology (AT), and what the use of AT came to mean to these users and, when relevant, their significant others. Methods: Persons with AD were provided with individually chosen AT during a six-month period. Semi-structured interviews were conducted during the intervention period. The data were analysed with a constant comparative approach. Results: On the way towards becoming a user of AT, four junctures were identified, at which significant decisions were made by the participants. These decisions influenced whether to become a user or not and related to how the initial decision was made, how the routines to incorporate the AT were adjusted, whether the participant trusted the AT, and whether the participants felt an increased sense of capacity when using the AT. As users, the participants perceived how time and effort was saved, how worries and stress decreased, and how their sense of safety increased, which enabled them to perform valued activities, e.g. health-promoting and social activities, to a greater extent and in a more relaxed way than before. Conclusions: The findings support the view that AT can positively affect the activity performance of people with AD when the potential user can identify difficulties and needs and is motivated and able to make changes to overcome them, given that appropriate human support is available.     

Hyperpolarized 13C magnetic resonance evaluation of renal ischemia reperfusion injury in a murine model

Acute kidney injury (AKI) is a major risk factor for the development of chronic kidney disease (CKD). Persistent oxidative stress and mitochondrial dysfunction are implicated across diverse forms of AKI and in the transition to CKD. In this study, we applied hyperpolarized (HP) ¹³C dehydroascorbate (DHA) and ¹³C pyruvate magnetic resonance spectroscopy (MRS) to investigate the renal redox capacity and mitochondrial pyruvate dehydrogenase (PDH) activity, respectively, in a murine model of AKI at baseline and 7 days after unilateral ischemia reperfusion injury (IRI). Compared with the contralateral sham‐operated kidneys, the kidneys subjected to IRI showed a significant decrease in the HP ¹³C vitamin C/(vitamin C + DHA) ratio, consistent with a decrease in redox capacity. The kidneys subjected to IRI also showed a significant decrease in the HP ¹³C bicarbonate/pyruvate ratio, consistent with impaired PDH activity. The IRI kidneys showed a significantly higher HP ¹³C lactate/pyruvate ratio at day 7 compared with baseline, although the ¹³C lactate/pyruvate ratio was not significantly different between the IRI and contralateral sham‐operated kidneys at day 7. Arterial spin labeling magnetic resonance imaging (MRI) demonstrated significantly reduced perfusion in the IRI kidneys. Renal tissue analysis showed corresponding increased reactive oxygen species (ROS) and reduced PDH activity in the IRI kidneys. Our results show the feasibility of HP ¹³C MRS for the non‐invasive assessment of oxidative stress and mitochondrial PDH activity following renal IRI.     

北京市城区与郊区中老年男性性功能的现状调查

目的:调查并比较北京市城区与郊区中老年男性勃起功能障碍(ED)、性欲低下和射精障碍的患病情况。方法:采用分层多阶段整群不等比例随机抽样方法选择北京市15个社区1 656例年龄≥50岁男性作为调查对象,分别记录国际勃起功能问卷(IIEF-5)评分及男性性功能问卷(O'Leary 1995),应用SPSS 17.0对结果进行统计学分析。结果:符合标准的调查对象共1 644例,城区1 244例,郊区400例。IIEF-5评分、性欲评分和射精评分的中值,城区为5、2和4,郊区为13、2和5,城区与郊区间相比的差异有统计学意义(P<0.01)。城区与郊区间IIEF-5评分的差异与年龄、糖尿病和心脑血管疾病的患病情况、是否饮酒和服用5α还原酶抑制剂相关(P<0.01)。结论:郊区中老年男性性功能优于城区。郊区中老年男性的总体年龄小、心脑血管疾病和糖尿病的患病率低,以及较少应用5α还原酶抑制剂和适量的饮酒可能是造成勃起功能优于城区的原因。