老年阻塞性睡眠呼吸暂停低通气综合征患者精神健康状况的调查

目的探讨老年阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的心理健康状况。方法对129例老年人行多导睡眠图（PSG）检查，根据呼吸暂停低通气指数（AHI）将其分为对照组（AHI〈5）25例，轻中度OSAHS组（5≤AHI≤30）68例，重度OSAHS组（AHI〉30）36例。分别对其进行症状自评量表（SCL-90）及抑郁自评量表（SDS）、焦虑自评量表（SAS）测定，比较3组各指标的差异性。结果3组SCL-90总分有显著差异，随AHI加重而呈递增趋势（P〈0．01），在各因子中，躯体化、强迫症状、人际关系敏感、焦虑、抑郁、偏执和精神病性7个因子3组得分比较有显著差异，轻中度及重度OSAHS组均高于对照组（P〈0．01）。3组SDS评分与SAS评分比较，轻中度及重度OSAHS组均高于对照组（P〈0．01）。结论老年OSAHS患者精神健康状态差，伴随着明显的焦虑、抑郁等不良心理问题。     

负性情绪对慢性心力衰竭患者自我概念的影响

目的探讨负性情绪对慢性心力衰竭（CHF）患者自我概念的影响。方法对100例CHF患者和100例健康人群进行抑郁自评量表（SDS）和焦虑自评量表（SAS）以及田纳西自我概念量表（TSCS）的测定,将两组结果输入SPSS16．0统计软件进行对比分析。结果①CHF患者SDS、SAS评分明显高于健康人群,差异具有统计学意义（P〈0．01）。②CHF患者TSCS总分明显低于健康人群,差异具有统计学意义（P〈0．01）。③TSCS评分除自我批评与SDS、SAS评分呈正相关外（P〈O．01）,其余各项均与SDS、SAS评分呈负相关（P〈0．01）。结论CHF患者自我评价较低,其焦虑抑郁情绪可降低自我概念水平。在临床治疗中,医务工作者及患者家属应帮助患者消除负性情绪,提高自我概念水平。     

精神分裂症患者自理能力对家庭照料者心理负担的影响

目的：探讨精神分裂症患者自理能力对家庭照料者心理负担的影响。方法采用自我护理能力测定量表（ESCA）、焦虑自评量表（SAS）及抑郁自评量表（SDS）对200例精神分裂症患者及其照料者进行调查。结果不同精神分裂症患者ESCA评分存在统计学差异（ P均＜0．01）;不同自理能力精神分裂症患者的家庭照料者SDS和SAS评分存在统计学差异（ P均＜0．01）;ESCA评分与SDS、SAS评分具有负相关性（ P均＜0．01）。结论精神分裂症患者自理能力是影响家庭照料者心理负担的重要因素,提高精神分裂症患者自理能力有助于减轻家庭照料者心理负担,并能提高其生活质量。     

南京市浦口地区高血压人群抑郁和焦虑状况的病例对照研究

该文了解南京市浦口地区高血压患者的抑郁和焦虑状况。方法：采用病例对照研究，抽取35岁以上高血压患者326例，健康对照组414例；并使用Zung抑郁自评量表（SDS）和焦虑自评量表（SAS）评定调查对象抑郁和焦虑状况。结果：高血压病例组抑郁和焦虑自评量表的总积分及标准分均显著高于健康对照组（P〈0．01）。     

心理干预对高血压患者生命质量的影响

目的探讨心理干预对高血压患者心理状态和生命质量的影响。方法选择300例高血压患者随机分为两组。对照组给予常规治疗,试验组在常规组对症治疗的基础上给予心理干预,12周为1疗程。于人组时、12周末采用焦虑自评量表（sas）、抑郁自评量表（SDS）、生活质量指数问卷（QL—INDEX）对两组患者进行心理状态和生命质量评定。结果入组时两组患者SAS、SDS评分差异无统计学意义（P〉0．05）;12周末试验组SAS、SDS评分与对照组相比显著降低[分别为（34．27±8．62）分比（43．91±7．39）分,（38．67±6.59）分比（44．89±8．59）分]（P〈0．01）;12周末试验组SAS和SDS评分比人组时均显著降低[分别为（34．27±8．62）分比（45．68±7．92）分,（38．67±6．59）分比（46．81±9．68）分]（P〈0．01）。12周末生活质量总指数试验组为（8．88±1．63）分,对照组为（7．94±3．16）分,差异有统计学意义（P〈0．05）。结论心理干预有助于改善高血压患者的心理状态,提高患者的生命质量。     

综合性心理干预对高血压并脑梗塞患者负性情绪和生活质量的影响

目的：探讨综合性心理干预对高血压合并脑梗塞患者负性情绪及生活质量的影响。方法：166例高血压合并脑梗塞患者随机分为干预组和常规治疗组,各83例。常规治疗组采取常规护理;干预组在常规护理的基础上,进行心理干预。采用焦虑自评量表（SAS）、抑郁自评量表（SDS）以及症状自评量表（SCL-90）分别于人院时和人院1个月后对两组患者进行评分。结果：两组患者入院时SDS、SAS评分比较差异无显著性（P〉0．05）,1个月后,与常规治疗组比较,干预组SDS[（59．26±12．31）分比（53．64±10．73）分]、SAS[（56．28±9．59）分比（48．54±9．17）分]评分显著降低（P〈0．01）,血压及SCL-90量表中除精神病性外所有分值亦较常规治疗组显著降低（P〈0．05～〈0．01）。结论：综合性心理干预能够改善高血压合并脑梗塞患者的焦虑、抑郁情绪,还能明显提高其生活质量。     

老年抑郁患者配偶生活质量及其初步研究

目的 比较老年抑郁患者配偶与健康对照的生活质量水平,并探讨老年抑郁患者配偶生活质量与患者焦虑抑郁状况之间的关系.方法 对30例老年抑郁患者配偶和30例健康对照组分别进行生活质量综合评定问卷-74(成人用)评估,对老年抑郁患者和健康老人进行抑郁自评量表和焦虑自评量表的评定.结果 抑郁患者配偶的生活质量与对照组有显著差异,GQOLI-74躯体健康、心理健康、社会功能等三个维度的差异明显(均P<0.0001),此三个维度评分与患者SDS和SAS评分显著相关(均P<0.000 1).结论 老年抑郁患者配偶的生活质量下降,且与患者的抑郁焦虑水平密切相关.     

糖尿病患者抑郁及生活质量调查

目的调查糖尿病患者的生活质量,从而改进治疗方法,提高临床疗效。方法采用生活质量综合评定问卷（GQLI-74）,焦虑自评量表（SAS）和抑郁自评量表（SDS）对46例糖尿病患者和46例健康体检者进行对照研究分析。结果糖尿病组在躯体功能、社会功能、心理状态等评分低于对照组,差异有统计学意义（P〈0.01）,SAS及SDS评分高于对照组,差异有统计学意义（P〈0.01）。结论糖尿病患者普遍存在心理障碍应行相应的干预,提高临床疗效和改善患者的生活质量。     

脑卒中患者恢复期的焦虑和抑郁情绪

目的探讨脑卒中患者恢复期的心理健康状况。方法采用焦虑自评量表（SAS）和抑郁自评量表（SDS）对75例恢复期脑卒中患者进行测评,并与国内常模对照。结果恢复期脑卒中患者SAS和SDS评分与国内常模比较,差异均有统计学意义（P〈0．05）;患者中度以上焦虑与抑郁的发生率分别为49．3％和57．3％。结论恢复期脑卒中患者普遍存在焦虑和抑郁情绪,故在治疗脑卒中的同时,应对其进行积极的心理护理。     

综合心理干预对急性冠脉综合征患者负性情绪和生活质量的影响

目的：探讨综合心理干预对急性冠脉综合征（ACS）患者负性情绪及生活质量的影响。方法：116例ACS患者被随机分为干预组和常规治疗组,各58例。常规治疗组采取常规护理;干预组在常规护理的基础上,进行综合心理干预。采用焦虑自评量表（SAS）、抑郁自评量表（SDS）和西雅图心绞痛量表（SAQ）以及90项症状自评量表（SCL-90）分别于入院时和入院1个月后对两组患者进行评分。结果：两组患者入院时SDS、SAS评分比较差异无显著性（P〉0.05）;1个月后,与常规治疗组比较,干预组SDS[（57.41±9.10）分∶（51.34±9.02）分]、SAS评分[（53.33±8.64）分∶（45.59±8.22）分]显著降低,P均〈0.01,SAQ量表中各项分值均有显著增加,SCL-90量表中各项分值均显著降低（P〈0.05或P〈0.01）。结论：综合性心理干预能够改善急性冠脉综合征患者的焦虑、抑郁情绪,还能明显提高其生活质量。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.