小剂量万拉法新治疗精神分裂症后抑郁临床观察

目的 探讨国产万拉法新(博乐欣)治疗精神分裂症后抑郁的临床疗效和不良反应。方法30例门诊入组病人均符合《中国精神障碍分类与诊断标准》第三版(CCMD-3)精神分裂症后抑郁诊断,且服用非典型抗精神病药物治疗效果欠佳。入组病人在原抗精神病药物剂量不变的基础上加服万拉法新,剂量25mg～50mg·d～1,早、晚PO,治疗时间6w。分别于治疗前及治疗2、4、6w末应用HAMD、BPRS、SANA、TESS评定疗效与副反应。结果治疗后病人自觉症状显著改善。HAMD平均总分各周下降明显,差异极显著(P<0.01),总有效率达87％。头昏(10％)、恶心(3％)、口干(6％)、嗜睡(3％)等不良反应少且轻微,无须处理,数日后自行缓解。抑郁症状改善的同时BPRS、SANS量表显示,精神病性阴性症状亦有所减轻。结论小剂量万拉法新治疗精神分裂症后抑郁有较好的疗效,不良反应轻微,药物的依从性好。     

瑞波西汀治疗脑卒中后抑郁症疗效及安全性评价

目的观察瑞波西汀治疗脑卒中后抑郁症的疗效与安全性。方法选取卒中后抑郁患者85例,随机分成治疗组51例,对照组34例,治疗4周、8周、16周时观察症状改善适度及药物的不良反应。结果治疗组症状改善明显高于对照组,不良反应轻微。结论瑞波西汀治疗脑卒中后抑郁症疗效确切、不良反应少。     

文拉法新和西肽普兰治疗精神分裂症阴性症状的临床观察

目的:观察西肽普兰和文拉法新合并抗精神病药物治疗精神分裂症阴性症状的疗效和不良反应。方法:精神分裂症患者80例,随机分为文拉法新组和西肽普兰组各40例,分别给予文拉法新或西肽普兰治疗12周,在治疗前和治疗后第4、8、12周以阳性症状和阴性症状量表(PANSS)和不良反应量表(TESS)评定疗效和不良反应。结果:治疗12周文拉法新组阴性因子分减分率显著高于西肽普兰组(P<0.01),阴性因子症状评分低于西肽普兰组(P<0.05)。文拉法新组胃肠道不良反应发生率与西肽普兰组比较有差异(P<0.05)。结论:西肽普兰和文拉法新治疗精神分裂症的阴性症状安全有效,协同抗精神病药物治疗精神分裂症可增加疗效,文拉法新略优于西肽普兰。     

艾司西酞普兰与氟西汀治疗精神分裂症后抑郁对照研究

目的 探讨艾司西酞普兰与氟西汀治疗精神分裂症后抑郁的疗效和安全性以及对认知功能的影响.方法 将60例精神分裂症后抑郁患者随机分为两组,每组30例,在维持原用抗精神病药物治疗的基础上,研究组晨口服艾司西酞普兰治疗,对照组晨口服氟西汀治疗,观察8周.于治疗前及治疗1周、2周、4周、6周、8周末采用汉密顿抑郁量表评定抑郁症状...     

氟西汀合并支持性心理治疗对精神分裂症后抑郁的疗效观察

目的探讨氟西汀合并支持性心理治疗对精神分裂症后抑郁的疗效及安全性。方法将96例精神分裂症后抑郁患者随机分为氟西汀联合支持性心理治疗组(研究组)48例和支持性心理治疗组(对照组)48例。两组在保持原治疗药物不变的基础上,研究组加用氟西汀治疗。两组均于治疗前及治疗第4、8w末采用汉密顿抑郁量表、简明精神病量表评定临床疗效,采用副反应评定量表评定不良反应。结果两组治疗8w末汉密顿抑郁量表、简明精神病量表评分均较治疗前显著下降(P<0.01或0.05;汉密顿抑郁量表评分及减分率研究组较对照组下降明显,差异有显著性(P<0.05;简明精神病量表总分研究组较对照组下降明显,但差异无显著性(P>0.05)。研究组有3例出现轻度恶心、呕吐,2例出现焦虑、睡眠差,经对症处理1w内缓解。结论氟西汀治疗精神分裂症后抑郁疗效好、安全性高、服药依从性好。     

氟西汀与阿米替林改善精神分裂症后抑郁的对照观察

将符合中国精神疾病分类与诊断标准第二版修订版精神分裂症后抑郁诊断标准的66例患者随即分为两组,分别给予氟西汀和阿米替林治疗,疗程6周。采用汉密顿抑郁量表(HAMD)评定疗效,副反应量表(TESS)评定副反应。结果表明两组间治疗前后HAMD评分及减分比较差异均无显著性意义(P>0.05)。两组疗效接近,氟西汀组的副反应明显小于阿米替林组。     

瑞波西汀与帕罗西汀治疗抑郁症疗效比较

目的比较瑞波西汀与帕罗西汀治疗抑郁症的疗效和安全性。方法将84例抑郁症患者按照随机数字表随机分为2组各42例,瑞波西汀组给予瑞波西汀,初始剂量4 mg/d,2周内渐增至12 mg/d;帕罗西汀组给予帕罗西汀,初始剂量20 mg/d,2周内渐增至50 mg/d,疗程均为6周。采用汉密尔顿抑郁量表(HAMD)评定临床疗效,不良反应量表(TESS)评定不良反应。结果瑞波西汀组有效率为88.0%、显效率为76.1%;帕罗西汀组有效率为90.4%、显效率为78.5%,2组显效率比较差异无统计学意义(P0.05)。结论瑞波西汀与帕罗西汀治疗抑郁症均有疗,依从性好,且瑞波西汀起效较帕罗西汀快。     

氟西汀与阿米替林改善精神分裂症后抑郁的对照观察

将符合中国精神疾病分类与诊断标准第二版修订版精神分裂症后抑郁诊断标准的66例患者随即分为两组，分别给予氟西汀和阿米替林治疗，疗程6周。采用汉密顿抑郁量表(HAMD)评定疗效，副反应量表(TESS)评定副反应。结果表明两组间治疗前后HAMD评分及减分比较差异均无显著性意义(P&;gt;0．05)。两组疗效接近，氟西汀组的副反应明显小于阿米替林组。     

利培酮治疗精神分裂症60例分析

目的：探讨利培酮治疗精神分裂症患者的临床疗效和安全性。方法：对60例精神分裂症患者给予利培酮治疗,疗程12周。分别于治疗前及治疗第2周、4周、6周、8周、12周末采用阴性和阳性症状量表、简明精神病评定量表、不良反应量表评定临床疗效和不良反应。结果：治疗12周末,研究组总有效率为96.7%,利培酮治疗各时点阴性和阳性症状量表及简明精神病评定量表评分均呈持续性下降（P〈0.01）,不良反应轻微。结论：利培酮治疗精神分裂症疗效显著,安全性高,不良反应轻微。     

瑞波西汀合并氯氮平对精神分裂症阴性症状和社会功能的影响

目的 观察瑞波西汀合并氯氮平对精神分裂症患者阴性症状与社会功能的改善状况。方法 采用随机法，将114例慢性精神分裂症患者分为研究组（瑞波西汀+氯氮平）和对照组（氯氮平+安慰剂）。在治疗前及治疗后12周末以阳性和阴性症状量表（PANSS）、住院精神病人社会功能评定量表（SSPI）和不良反应量表（TESS）进行评定。结果 治疗12周末，研究组的PANSS总分、阴性因子分均低于治疗前，与对照组比较，差异有统计学意义（ｐ<0.05或p<0.01），研究组在住院的职业技能、社会性退缩、病室内活动及对外界的兴趣和关心方面优于对照组（p<0.05或p<0.01）。结论 瑞波西汀合并氯氮平有助于增强治疗精神分裂症阴性症状的疗效及提高社会功能。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.