小剂量氨磺必利联合利培酮治疗首发精神分裂症阴性症状随对照研究

目的 比较小剂量氨磺必利联合利培酮和单用利培酮治疗精神分裂症阴性症状的疗效.方法 住院首发精神分裂症患者,经利培酮治疗6周后使用阳性和阴性症状量表(PANSS)评定,阴性症状量表分≥20分78人,被随机分为小剂量氨磺必利联合利培酮治疗组(联用组)和利培酮治疗组(对照组).于基线和治疗8周后评定PANSS量表、卡尔加精神分裂症抑郁量表(CDSS)评定临床疗效,Simpson锥体外系副反应评定量表(SEPS)评定锥体外系副反应.结果 治疗8周后两组有效率分别为94.6％和77.8％,差异有统计学意义(x2＝4.365,P=0.037),实验组PANSS阴性量表减分(P=0.000)、CDSS减分(P=0.019)大于对照组,差异有统计学意义,两组SEPS无明显差异.结论 小剂量氨磺必利联合利培酮治疗精神分裂症阴性症状疗效更好.     

精神分裂症患者及其健康同胞脑白质密度研究

目的:观察精神分裂症患者及其健康同胞脑白质密度的特点.方法:用基于像素的形态学测量法比较三组的白质密度.结果:在左侧前额叶和胼胝体膝部,患者及同胞的白质密度值显著小于正常对照组,患者和同胞之间的差异未达到统计学意义水平.结论:左侧前额叶和胼胝体膝部白质密度值降低可能与精神分裂症的患病风险有关.     

左额叶CT值在偏执型精神分裂症患者中的变化及临床意义

目的:探讨左额叶CT值在偏执型精神分裂症患者中的变化及临床意义。方法:选取2014年6月—2016年6月于我院就诊的偏执型首发精神分裂症患者共120例作为观察组,取120例正常的头部CT患者作为正常组,测量其脑部CT图像上大脑左侧额叶CT值,分析偏执型精神分裂症患者患者大脑左侧额叶CT值与临床资料的关系。结果:观察组患者的平均左额叶CT值低于正常组(t=17.286,P0.05),PANSS评分阴性症状的CT值与阳性症状的CT值差异无统计学意义(t=0.309,P=0.758),不同的教育程度和是否具有职业的患者的CT值比较差异无统计学意义。左额叶CT值与PANSS评分呈负相关(r=-0.455,P=0.024),左额叶CT值与病程时间分评分呈负相关(r=-0.406,P=0.035)。结论:偏执型精神分裂症患者的左侧额叶CT值显著降低,与精神分裂症状的程度和病程时间呈负相关,左侧额叶CT值降低是偏执型精神分裂症的重要影像依据。     

首发精神分裂症患者的运动协调功能与前额叶白质及皮质脊髓束完整性

目的:应用弥散张量成像(DTI)探讨首发精神分裂症患者神经系统软体征中的运动协调功能与前额叶白质及皮质脊髓束各向异性比值(FA)的关系。方法:纳入42例符合美国精神障碍诊断与统计手册第4版(DSM-IV)诊断标准的首发精神分裂症患者和46例年龄、性别及受教育年限相匹配的健康对照。两组研究对象均用剑桥神经科检查(CNI)评定神经系统软体征,并接受头颅磁共振成像检查。用阳性与阴性症状量表(PANSS)评估患者组基线和半年后的临床症状。用感兴趣区测定的方法,分析患者组和对照组神经系统软体征中的运动协调领域分与前额叶白质及皮质脊髓束各层面(内囊、大脑脚、小脑中脚水平)FA值间的关系。结果:神经系统软体征中的运动协调领域分在患者组中与前额叶白质FA值呈正相关(r=0.35,P0.05),在健康对照中则与小脑中脚水平皮质脊髓束FA值呈正相关(r=0.34,P0.05)。将患者按半年后阴性症状分为高分组和低分组,高分组运动协调领域分与前额叶白质(r=0.68,P0.05)呈正相关,与小脑中脚水平皮质脊髓束(r=-0.67,P0.05)FA值呈负相关;低分组则与内囊FA值呈正相关(r=0.60,P0.05)。结论:本研究提示首发精神分裂症患者半年后阴性症状高分组、低分组及正常人群中,运动协调功能相关的脑区分别为前额叶、内囊和小脑中脚层面的皮质脊髓束,提示有必要进一步研究运动协调功能相关的脑区不同对患者预后的预测意义。     

利培酮联合小剂量阿立哌唑治疗精神分裂症的临床对照研究

目的探讨利培酮联合小剂量阿立哌唑治疗精神分裂症的临床疗效及对血清泌乳素的影响。方法将58例精神分裂症随机分成试验组28例(利培酮+阿立哌唑5mg/d)和对照组30例(单用利培酮),共治疗8周,于治疗前后进行PANSS评定、外周血泌乳素浓度测定,比较两组间上述指标的差异。结果①根据PANSS减分率,试验组治疗有效率为89.3%,对照组为86.7%,组间差异无统计学意义(χ2=0.312,P0.05)。治疗末试验组PANSS阴性症状因子分低于对照组(t=2.252,P0.05);②试验组治疗前后血清泌乳素水平无明显变化(t=0.611,P=0.546),对照组治疗后泌乳素测值较治疗前明显升高(t=9.997,P=0.000),且显著高于试验组(t=10.501,P=0.000)。结论利培酮联合小剂量阿立哌唑治疗精神分裂症的疗效肯定,在改善阴性症状方面可能比单用利培酮效果更佳,且不易引起高泌乳素血症。     

不同重复经颅磁刺激模式对慢性精神分裂症阴性症状的疗效及安全性

目的：比较不同重复经颅磁刺激（ rTMS）模式对慢性精神分裂症阴性症状的疗效及安全性研究。方法：将90例慢性精神分裂症患者随机分为5Hz组、10Hz组、伪刺激组,每组30例。3组在维持原有抗精神病药物种类及剂量不变的基础上,刺激部位均选择左侧前额叶背外侧皮质区（ DLPFC）,刺激强度为80％运动阈值,每天1次,每周5次,共2周。治疗前后采用阳性与阴性症状量表（ PANSS）和阴性症状量表（ SANS）量表评定疗效。结果：3组治疗后比较,PANSS总分、阴性因子分、SANS评分差异有统计学意义（F＝22．99,39．73,31．90;P均＜0．05）,10Hz组较伪刺激组PANSS总分、阴性因子分、SANS评分低,差异有统计学意义（ q＝－5．60,－5．70,－7．67;P均＜0．05）;10Hz组较5Hz组PANSS总分、阴性因子分、SANS评分低,差异有统计学意义（ q＝－4．97,－5．80,－7．40;P均＜0．05）。与治疗前比较,10Hz组PANSS总分、阴性因子分、SANS评分降低,差异有统计学意义（ t＝－5．45,－7．03,－7．23;P均＜0．05）;5Hz组和伪刺激组PANSS总分及各因子分、SANS评分差异无统计学意义（P均＞0．05）。结论：10Hz rTMS模式能改善慢性精神分裂症患者阴性症状,有较好的安全性。     

阴性和阳性症状为主型精神分裂症患者脑部质子波谱与症状相关性

目的探讨阴性和阳性症状为主型的精神分裂症患者脑部磁共振质子波谱(1H-MRS)与临床症状之间的相关性。方法对住院诊治的89例精神分裂症患者采用阳性与阴性症状量表(PANSS)评定症状,用1H-MRS测定患者前额叶及丘脑生化代谢物N-乙酰基天门冬氨酸(NAA)、肌酸复合物(Cr),计算NAA/Cr值。结果阴性组阴性症状(29.03±7.13)分、阳性症状(20.43±4.46)分、一般病理(40.21±5.43)分、总分(90.24±8.87)分;阳性组阴性症状(20.12±3.64)分、阳性症状(30.31±3.55)分、一般病理(40.76±5.54)分、总分(89.98±9.23)分,两组患者阴性症状及阳性症状分值之间比较存在显著性差异(P0.05);NAA/Cr值阴性组前额叶左侧(1.34±0.35)、右侧(1.38±0.37),丘脑左侧(1.45±0.36)、右侧(1.46±0.37);阳性组前额叶左侧(1.37±0.36)、右侧(1.40±0.37),丘脑左侧(1.49±0.36)、右侧(1.64±0.39),丘脑右侧NAA/Cr值在两组间比较存在显著性差异(P0.05);阴性组患者左侧前额叶NAA/Cr值与PANSS总分、阴性症状总分之间均具有负相关(r=-0.34,-0.36;P0.05),阳性组患者左侧前额叶NAA/Cr值与PANSS总分之间具有负相关(r=-0.35,P0.05)。结论精神分裂症阳性与阴性为主型的患者前额叶及丘脑均存在NAA/Cr值变化,前额叶NAA/Cr值与阴性症状的严重程度密切相关。     

联用文拉法新改善精神分裂症阴性症状的临床研究

目的探讨联用文拉法新治疗精神分裂症阴性症状的临床疗效和安全性。方法将60例以阴性症状为主的精神分裂症患者随机分为实验组和对照组,分别给予利培酮合用万拉法新及单用利培酮治疗,疗程12周,用阳性和阴性症状量表(PANSS)评定其疗效,用副反应量表(TESS)评定其药物的安全性。结果疗后4周实验组PANSS总分、阳性因子分、阴性因子分、一般精神病理分以及对照组PANSS总分、阳性因子分与疗前比较差异有显著性(t=2.02～2.2,P<0.05);疗后8、12周两组PANSS总分和各因子分与疗前比较差异有极显著性(t=3.45～20,P<0.01)。治疗后4、8、12周两组间比较阴性因子分差异有极显著性(t=4.44～11,P<0.01)。两组药物副反应(TESS)比较无显著差异性。结论在利培酮基础上联用文拉法新治疗精神分裂症阴性症状起效快,显示较好的临床疗效,无明显药物副作用。     

艾司西酞普兰联合利培酮治疗精神分裂症阴性症状的疗效

目的:探讨艾司西酞普兰联合利培酮治疗精神分裂症阴性症状的疗效及对社会功能的影响。方法:选择2017年10月至2019年6月在普陀区精神卫生中心门诊或住院的精神分裂症患者为研究对象,将其随机分为研究组和对照组。研究组44例患者采用艾司西酞普兰联合利培酮治疗;对照组35例患者采用单一抗精神病药物利培酮治疗。观察12周,两组分别于治疗前、治疗10天、4周、8周、12周采用阳性与阴性症状量表(PANSS)及阴性症状评估量表(SANS)评定疗效;于治疗12周前后,采用个人和社会功能量表(PSP)评定社会功能。结果:两组PANSS、SANS、PSP评分治疗后均较治疗前明显改善(P0.05)。两组比较,PANSS、SANS评分在治疗前及治疗10天时差异无统计学意义(P0.05);在治疗4周、治疗8周及治疗12周时差异有统计学意义(t=-2.246,-2.209,-2.384,-2.121,-2.603,-3.368;P0.05)。两组比较,PSP评分在治疗前差异无统计学意义(P0.05);在治疗后差异有统计学意义(t=3.158,P0.01)。结论:艾司西酞普兰联合利培酮治疗与利培酮单一治疗对精神分裂症阴性症状及社会功能均有改善,但联合治疗疗效更优。     

阿美戈拉汀合并利培酮治疗以阴性症状为主的慢性精神分裂症的临床研究

目的:探讨阿美戈拉汀合并利培酮治疗慢性精神分裂症患者(以阴性症状为主)的疗效,同时对比治疗前后的生存质量和主观幸福感。方法:采用随机单盲对照研究,将明确诊断且连续收集的为以阴性症状为主的102例精神分裂症患者随机分为研究组(利培酮合并阿美戈拉汀治疗,52例)和对照组(单用利培酮治疗,50例);用阴性症状量表(SANS)判定疗效;用WHO生存质量测定量表简表(WHOQOL-BREF)判定生存质量;人际反应指针量表(IRI-C)评定患者的共情能力;用药物副作用(TESS)判定治疗中的不良反应,治疗随访8周。结果:两组治疗前基线信息无统计学差异。治疗8周后,研究组疗效(87.23%)显著高于对照组(66.67%)(χ~2=5.65,P0.05);研究组在SANS总分、情感迟钝、抽象思维障碍、刻板思维因子分改善程度优于对照组(t=-7.6127,-2.1017,-2.4293,-6.4975;P0.05);WHOQOL-BREF量表研究组在生理领域、心理领域、社会关系领域均较对照组有统计学差异(t=6.3395,11.7905,3.9233;P0.05);研究组IRI-C量表在总分、观点选择、共情性关心、个人痛苦维度均较对照组改善明显(t=2.1860,3.9076,2.8223;P0.05);两组药物副作用发生率差异无统计学意义。结论:利培酮合并阿美戈拉汀对精神分裂症阴性症状疗效好,能明显提高患者的生存质量和主观幸福感,具有较好的临床应用价值。     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.     

Der Einfluß von Nahrungsmitteln und Rauchen auf die klinisch-chemische Diagnostik von Phäochromozytom,Neuroblastom und Karzinoid-Syndrom

Zusammenfassung Der Einfluß von verschiedenen Nahrungsmitteln auf Methoden zur Bestimmung von Adrenalin (AD), Noradrenalin (NA), Vanillinmandelsäure (VMS), Metanephrinen (MN), Homovanillinsäure (HVS) und 5-Hydroxyindolessigsäure (5-HIE) im 24 h-Harn zur Diagnose des Phäochromozytoms bzw. Karzinoid-Syndroms wurde untersucht. Die in die Untersuchung einbezogenen Nahrungsmittel waren: Tee, Kaffee, Mandeln, Ananas, Käse, Walnüsse, Vanillepudding, Bananen, Tomaten und Milchschokolade. Außerdem wurde der Einfluß des Zigarettenrauchens auf die Bestimmung von AD, NA, VMS und MN untersucht.Walnüsse führten zu einer starken Erhöhung der 5-HIE-Ausscheidung. Bananen erhöhten die Ausscheidung von AD, NA, VMS, MN und 5-HIE. Kaffee und Ananas bewirkten eine geringe Zunahme der MN-Werte. Rauchen von 20–30 Zigaretten/Tag beeinflußte keine der vier Variablen.Wenn die beschriebenen Methoden benutzt werden, sollte lediglich auf den Verzehr von Bananen und Walnüssen vor und während der Harnsammelperioden verzichtet werden, da die oberen Normgrenzen im Harn überschritten werden könnten. Ein Verzicht auf Kaffee und Ananas in normalen Mengen ist nicht erforderlich. Es besteht kein Anlaß, weiterhin die bisherigen umfangreichen Restriktionen der übrigen Nahrungsmittel beizubehalten.