抑郁症和精神分裂症患者激惹症状的对照研究

目的 探讨抑郁症与精神分裂症患者激惹症状的特点.方法 使用激惹、抑郁和焦虑量表(IDA)对64例抑郁症患者,50例精神分裂症患者及67例健康人进行评定.结果 与对照组比较,抑郁症组内向性激惹因子[(5.09±2.88)分]、外向性激惹因子[(4.23±2.80)分]、抑郁因子[(8.78±3.56)分]及焦虑因子[(8.45±2.96)分]分均显著升高,差异有显著性(P＜0.01).精神分裂症组除抑郁因子分外,其余因子分与对照组差异无显著性(P＞0.05).与抑郁症组比较,精神分裂症组的内向性激惹因子、抑郁因子及焦虑因子分均显著下降,差异有显著性(P＜0.05或P＜0.01).结论 对抑郁症患者激惹症状的防治是非常有必要的.     

帕罗西汀加银杏叶提取物治疗抑郁症的疗效

目的探讨帕罗西汀加银杏叶提取物对抑郁症的治疗效果。方法抽取门诊抑郁症患者86例,按就诊及确诊顺序编号,单号为研究组,双号为对照组。治疗观察时间为6周,以汉密顿抑郁量表(HAMD)为评定工具,分别对2组的治疗前后进行比较,2组的治疗后进行比较。结果2组治疗前后分别进行比较,均有显著性差异[研究组(21．23±4．25)分,(8．17±1．68)分；对照组(20．95±3．74)分,P＜0．01]。治疗后2组比较[研究组(8．17±1．68)分,对照组(10．34±2．17)分,(10．34±2．17)分；P＜0．05]。研究组治疗后各因子分均有明显下降,尤以焦虑/躯体化[(2．98±0．54)分,(1．14±0．83)分]、体质量[(1．83±0．53)分,(0．86±0．77)分]、日夜变化、迟滞、睡眠障碍、绝望感为著。对照组治疗后部分因子分也有明显下降,以焦虑/躯体化[(3．02±0．66)分,(1．98±0．97)分]、体质量[(1．95±0．71)分,(1．24±0．84)分]、认知障碍、日夜变化为著。治疗后2组HAMD各因子分比较,研究组在各因子的减分上明显好与对照组,尤以焦虑/躯体化、体质量、迟滞、睡眠障碍、绝望感为明显。结论帕罗西汀加银杏叶提取物治疗抑郁症疗效优于单用帕罗西汀,能有效改善抑郁及相关躯体症状。     

老年期与非老年期抑郁症症状特点比较

目的比较老年期与非老年期抑郁症的临床症状特点.方法将126例首次发病的单相抑郁症患者分为2组,其中63例＞60岁者为老年组,63例＜60岁者为非老年组.在入院时和住院1个月时评定汉密尔顿抑郁量表,并比较治疗前后组内因分子的变化.同时对发病诱因、伴发躯体疾病及抑郁症状条目进行比较.结果老年组与非老年组的自杀意念(分别为45例,24例)、疑病(39例,20例)、偏执症状(20例,4例)、焦虑(48例,28例)、自杀行为(30例,13例)、心境抑郁(46例,59例)、迟缓(28例,45例)、睡眠障碍(48例,61例)、记忆力减退42例,18例)的差异有非常显著性(P＜0.01)、激越(26例,15例),昼重夜轻(13例,24例)、胃肠道症状(22例,10例)的差异有显著性,焦虑/躯体化[(8.4±2.4)分,(4.9±2.0)分]、认知障碍[(5.9±2.8)分,(3.9±1.8)分]的差异有显著性(P＜0.05);伴发躯体疾病(48列,17例)的差异有非常显著性(P＜0.01),发病诱因(23例,28例)的差异无显著性(P＞0.05).用氟西汀或帕罗西汀20mg/d治疗1个月后,2组组内抑郁症状的比较,老年组各症状的差异无显著性(P＞0.05);非老年组焦虑/躯体化[(4.9±2.0)分,(2.1±1.5)分]、日夜[(1.7±0.9)分,(0.5±0.6)分]、体重变化[(1.0±1.0)分,(0.4±0.6)分]症状的差异有显著变化(P＜0.05).结论老年期抑郁症临床症状特征明显,治疗效果差.     

抑郁症合并焦虑症患者自杀态度调查及其与病情、应对方式的关系探讨

目的 调查抑郁症合并焦虑症患者的自杀态度,并探讨其与病情、应对方式的临床关系。 方法 选取2015年6月—2018年6月上海市宝山区精神卫生中心收治的1 000例抑郁症合并焦虑症患者为合并组,另单纯抑郁症、单纯焦虑症患者各600例,为抑郁组和焦虑组。采用自杀态度调查问卷(QSA)、简易应对方式问卷(SCSQ)、抑郁自评量表(SDS)、焦虑自评量表(SAS)对患者进行调查。对比3组自杀态度、病情、应对方式得分,分析合并组自杀态度与病情、应对方式的相关性。 结果 合并组各维度自杀态度调查评分[(19.43±2.01)分、(20.07±2.11)分、(11.06±2.01)分、(11.01±1.85)分]、积极应对评分[(17.12±2.07)分],均明显低于抑郁组和焦虑组(均P＜0.05);合并组SDS[(65.85±3.95)分]和SAS[(65.38±3.37)分]评分均高于抑郁组和焦虑组(均P＜0.05),合并组消极应对评分[(13.56±1.50)分]高于抑郁组和焦虑组(均P＜0.05);合并组中F1、F2、F3和F维度自杀态度与SDS、SAS、消极应对均存在负相关性(均P＜0.05),而上述维度自杀态度与积极应对均存在正相关性(均P＜0.05)。 结论 抑郁症合并焦虑症患者对自杀行为性质的认识、对自杀者的态度、对自杀者家属的态度、对安乐死的态度排斥不明显,且与病情、应对方式呈明显相关性。      

慢性疲劳综合征患者生活方式的特征

目的探讨慢性疲劳综合征(CFS)患者生活方式的特征,为临床干预提供理论依据。方法对329例CFS患者和363例健康体检者分别采用疲劳评定量表、饮食行为量表和生活习惯调查表进行调查。结果饮食行为量表结果显示,CFS人群的代理摄食因子[(0．39±0．22)分vs(0．35±0．21)分]和饮食内容因子[(0．32±0．16)分vs(0．29±0．15)分]积分显著高于对照组(P＜0．05),而体质认识、饮食心理、满腹感、饮食方法、饮食节律等因子积分2组之间差异无显著性(P＞0．05)。生活习惯调查表显示,CFS人群的外出办事次数显著低于对照组[(0．86±0．83)分vs(1．05±1．19)分,P＜0．05],自觉体力状况良好程度[(1．26+0．64)分vs(1．41±0．60)分]和目前身体状况的良好程度[(1．16±O．70)分vs(1．28±0．65)分]显著高于对照组(P＜0．05),且CFS人群多有便秘习惯[(0．82±0．97)分vs(0．67±0．88)分,P=0．043]。结论慢性疲劳综合征多伴有对健康概念的认识不正确,存在不健康的生活习惯；采取综合干预措施将有助于控制和预防CFS的发生发展。     

原发性高血压患者自我护理与预后关系

目的评估原发性高血压患者自我护理能力与预后的关系。方法将158例原发性高血压患者随机分成干预组(78例)与对照组(80例),对照组采用一般性健康教育方式,干预组进行2年持续性个体化自我护理教育。将2组患者干预前后自我护理能力与预后指标进行统计学分析。结果2年后干预组患者自我护理能力与对照组相比有显著性差异(X~2=13．961,P＜0．01)；血压[收缩压(138．32±11．03)mm Hg,舒张压(85．94±8．24)mm Hg]、血糖[(5．41±0．91)mmol/L]、血脂[总胆固醇(5．04±1．14)mmol/L]等与对照组相应指标[分别为(147．73±11．19)mm Hg、(91．74±7．65)mm Hg、(6．86±1．78)mmol/L、(5．3l±0．74)mmol/L]相比差异具有显著性(P＜0．01或P＜0．05)；心绞痛和暂时性脑缺血发作发生率与对照组相比差异有显著性(P＜0．01或P＜0,05),其他各项比较差异无显著性(P＞0．05)。结论护理干预可提高患者自我护理能力,有效改善原发性高血压患者预后。     

2型糖尿病患者神经心理及功能磁共振的研究

目的探讨2型糖尿病患者的大脑功能状态及认知障碍的可能机制。方法对2型糖尿病患者及健康对照组进行心理学检查及磁共振波谱、功能磁共振成像(MR)检查。结果2型糖尿病患者的记忆功能总体下降,记忆商显著降低[糖尿病组(94．95±13．82)分,对照组(118．50±17．30)分,P＜0．01],手眼协调能力降低,焦虑抑郁程度较高(P＜0．05),糖尿病组fMRI成像反应时长[(1029．00±105．55)ms,(886．35±82．40)ms,P＜0．01]、正确率低于对照组,2back减去0back任务时双侧额叶、顶叶及底节小脑激活强度明显减低。结论2型糖尿病人认知功能的降低与fMRI检查结果相一致。     

高三教师心理健康水平与人格特征的相关研究

目的研究高三教师的心理健康、人格特征状况及两者关系。方法应用症状自评量表(SCL-90)、艾森克人格问卷(EPQ)测评337名高三教师。结果教师的SCL-90在躯体化[(1．54±0．58)分]、抑郁[(1．57±0．51)分]、精神病性[(1．35±0．43)分]和阳性项目数[(44．11±25．68)分]显著高于全国常模(P＜0．05,P＜0．01),人际关系敏感显著低于常模；教师EPQ中N量表与SCL-90总分及所有因子分显著正相关,P量表与SCL-90总分及7个因子分显著正相关；回归分析表明,神经质N、精神质P和掩饰度L对心理健康有预测作用。结论应对高三教师加强健全人格教育,提高其心理健康水平。     

阅读疗法对抑郁症疗效的观察

目的探讨阅读疗法对抑郁症患者的治疗效果。方法将85例抑郁症患者随机分为干预组(41例)和对照组(44例)。干预组在日常药物治疗和相应康复治疗的基础上同时使用阅读疗法进行康复干预研究,对照组仅进行相应的药物治疗及一般的康复治疗。采用24项汉密顿抑郁量表(HAMD)在干预前后对两组患者分别进行疗效评估。结果干预28d后,干预组和对照组各因子分比干预前均有显著降低(P<0.01),各项因子干预前后差异有极显著性,但干预组因子分降低幅度大于对照组,焦虑躯体化降低值[(2.46±1.95)分,(1.00±1.56)分,P<0.01]、睡眠障碍降低值[(1.00±1.18)分,(0.23±1.36)分,P<0.001]、绝望感降低值[(3.02±1.75)分,(1.50±1.79)分,P<0.01]、总分降低值[(9.59±3.91)分,(6.59±3.01)分,P<0.01]差异有极显著性。结论阅读疗法对抑郁症患者是一种有效的辅助康复治疗方法。     

认知行为治疗青少年首发抑郁症患者的临床疗效

目的探讨认知行为治疗对青少年首次发作的抑郁症患者的功能失调性认知和抑郁、焦虑等负性情绪的疗效。方法对16例青少年抑郁症患者进行4周共8次认知行为治疗合并药物治疗,对照组的16例首发的青少年抑郁症患者单用药物治疗4周,用功能失调性态度问卷(DAS)、贝克抑郁自评问卷(BDI)、焦虑自评量表(SAS)对2组的疗效进行评估。结果1.治疗后研究组的DAS总分[(149.25±14.07)分vs(138.38±9.56)分]、因子D5[(19.50±2.34)分vs(15.31±1.96)分]、D7[(19.31±3.48)分vs(15.19±2.34)分]较治疗前显著性降低,而对照组治疗前后的DAS分改变不明显;治疗后研究组的DAS总分、D1、D5、D7等因子分显著性低于对照组(P<0.05)。2.研究组和对照组相比较,BDI和SAS在治疗前后均差异有显著性。结论认知-行为治疗能显著改善青少年抑郁症患者的功能失调性认知,特别是在脆弱性、寻求赞许、自主性态度的改善上,而对于抑郁、焦虑等负性情绪的疗效则需要进一步证实。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.