双相情感障碍患者与健康人认知功能的比较研究

目的:应用神经心理学评估方法对双相情感障碍(BPD)认知损害特点进行研究,探讨治疗前后双相躁狂认知损害变化。方法:30例双相躁狂患者使用威斯康星卡片分类测验(WCST)、言语记忆测验(HVLT-R)、数字广度测验(DSP)、持续操作测验(CPT)、杨氏躁狂评定量表(YMRS)、临床总体映象量表-疾病严重度分量表(CGI-S),于治疗前与治疗6周末评定及比较。对照组为30名健康人。结果:患病组治疗前WCST操作的完成分类数、错误应答数、持续应答数、持续错误数以及HVLT-R、DSP、CPT的操作分均低于对照组,差异有统计学意义(P<0.01)。患者治疗6周后WCST的完成分类数、错误应答数、持续应答数、持续错误数和DSP、HVLT-R操作分仍低于对照组,差异有统计学意义(P<0.01)。而CPT的操作分两组间差异无统计学意义(P>0.05)。治疗前、后比较,患病组WCST的完成分类数增加、错误应答数、持续应答数、持续错误数减少,差异有统计学意义(P<0.01)。患病组的HVLT-R、DSP、CPT操作分与治疗前相比明显提高,差异有统计学意义(P<0.01)。结论:双相情感障碍躁狂发作时执行功能、记忆力、注意力等认知功能存在损害,病情缓解后注意力恢复正常,而执行功能和记忆力仍存在缺损。     

缓解期抑郁症患者认知功能障碍研究

目的:探讨缓解期抑郁症患者认知功能障碍的特点,为临床干预提供依据。方法:采用事件相关电位P300、韦氏记忆量表(WMS)和威斯康星卡片分类测验(WCST)对60例缓解期抑郁症患者进行认知功能评定,选用60例性别、年龄、受教育年限等均相匹配的健康对照。结果:缓解期抑郁症患者P300潜伏期延长,波幅降低;WCST六项主要指标与对照组均有显著差异,其中错误应答数、完成第一项分类所需应答数、持续性错误数及非持续错误数均高于对照组,而完成分类数项及概念化水平百分数(%)低于对照组(P<0.05);此外,WMS测定中除瞬时记忆(背数)外,其他各项指标(长时记忆、短时记忆、记忆商)均较对照组分数低(P<0.05)。结论:缓解期抑郁症患者仍存在认知功能损害,特别是记忆和执行功能。     

双相障碍II型抑郁发作患者神经认知功能损害的研究

目的探讨双相障碍II型抑郁发作患者神经认知功能损害的临床特征。方法对45例符合DSM-IV-R双相障碍II型抑郁发作患者（病例组）和45例健康者（对照组）采用威斯康星卡片分类测验（WCST）、彩色连线测验（TMT）、STROOP卡片测验（CWT）以及持续操作测验（CPT）进行认知功能评估,并对两组测试结果进行分析。结果在WCST分类测验方面,两组间正确反应数、错误总数、持续错误数、完成分类数比较差异均有统计学意义（均P＜0.01）,且病例组较对照组差。在CPT测验中,病例组在错误次数1和第2次按键数中较对照组差（P＜0.01）,其他指标第1次按键、错误次数2、第3次按键、错误次数3两组间比较差异均无统计学意义（均P＞0.05）。在TMT和CWT测验方面,病例组TMTA分测验较对照组差（P＜0.05）,CWT卡片B和卡片C分测验中两组间有统计学差异（P＜0.01）,且病例组较对照组差。结论双相障碍II型抑郁发作患者认知功能存在明显损害,主要表现为大脑执行功能、注意力、记忆力及信息的处理速度能力障碍。     

童年期虐待对首发精神分裂症患者认知功能的影响

目的 探讨童年期虐待对首发精神分裂症患者认知功能的影响。方法 选择2019年1～12月在我院诊断治疗的首发精神分裂症患者50例为研究对象,另选择同期在我院的健康志愿者50例为对照组。采用BACS SC、HVLT-R、BVMT-R、WMS-ⅢSST、Stroop色-词测验、WCST对两组认知功能进行调查。采用儿童期虐待问卷对两组儿童期不良应激事件进行调查。多重线性回归分析童年虐待对认知功能的影响。结果 (1)精神分裂症组BACS SC、HVLT-R、BVMT-R、WMS-ⅢSST、Stroop色-词测验、WCST总正确数、完成分类数得分均显著低于对照组,差异有统计学意义(P0.05)。WCST总错误数、持续错误数、持续应答数显著高于对照组,差异有统计学意义(P0.05)。(2)精神分裂症组童年虐待各维度以及总分得分均显著高于对照组,差异有统计学意义(P0.05)。(3)多重线性回归分析显示:躯体忽视、情感虐待对简易视觉空间记忆测验有负向影响(P0.05);情感虐待对霍普金斯词语学习测验有负向影响(P0.05);躯体忽视,情感虐待对空间广度测验有负向影响(P0.05);躯体忽视对Stroop-色词有负向影响(P0.05);躯体忽视对符号编码测验有负向影响(P0.05);躯体忽视与WCST错误应答数有正向关联(P0.05);躯体忽视与WCST完成分类数有负向关联(P0.05)。结论 首发精神分裂症患者存在一定程度的认知功能障碍,童年期虐待经历对患者认知功能障碍有一定的影响。     

首发精神分裂症外周血BDNF与认知功能的相关研究

目的对首发精神分裂症外周血BDNF水平与认知功能间相关性行观察与研究。方法随机选取2015年5~9月期间我院收治的首发精神分裂症患者150例为治疗组,并选择同期正常人群150例为对照组,均用ELISA测定患者外周血BDNF水平,并比较两组PANSS、CPT与WCST得分。结果与对照组相比,治疗组WCST总应答数、WCST持续错误数、WCST随机错误数均较高(P0.05),WCST正确反应数、WCST完成分类数较低(P0.05),差异具有统计学意义;患者外周血BDNF与WCST随机错误数、持续性错误和总应答数呈明显负相关,CPT指标、完成分类数与BDNF呈明显正相关(P0.05)。结论对于首发精神分裂症患者来说,具有执行功能受损与血清BDNF下降情况,患者认知功能与外周血血清BDNF水平呈现明显的正相关。     

难治性抑郁症患者症状特点与认知功能的相关性

目的 探讨难治性抑郁症患者的症状与认知功能特点以及两者的相关性.方法 对38例符合纳入标准的难治性抑郁症患者进行汉密尔顿抑郁量表(HAMD-24)、简明精神病量表(BPRS)评分,以及认知功能测验,包括数字广度测验、木块图测验、逻辑记忆测验、威斯康星卡片分类测验(WCST).结果 (1)数字广度的顺背、倒背和总分成绩均与HAMD总分、认知障碍和日夜变化因子得分呈负相关(P<0.05),而倒背成绩还与迟缓、绝望感因子分以及BPRS得分呈负相关(P<0.05);(2)木块图测验与HAMD总分、各因子分及BPRS总分无相关性;(3)逻辑记忆测验的即时记忆得分与日夜变化得分呈显著负相关(P<0.01),延迟记忆得分与HAMD总分、日夜变化、绝望感以及BPRS得分呈负相关(P<0.05),记忆差得分与认知障碍、绝望感得分呈正相关(P<0.05);(4)WCST的总应答数、错误应答数、错误思考时间与HAMD总分、认知障碍得分呈正相关(P<0.05),持续性应答数、概念化水平百分数与HAMD总分、体重因子、BPRS得分均呈负相关(P<0.05),总用时间与焦虑/躯体化因子得分呈正相关(P<0.05),完成分类数、正确应答数、持续性应答数均与认知障碍因子呈负相关(P<0.05),持续性错误数与认知障碍因子及BPRS得分呈正相关(P<0.05),总应答数、错误应答数与BPRS得分呈正相关(P<0.05).结论 难治性抑郁症患者的疾病严重程度、不同的临床症状特点与不同的认知功能损害间具有一定的相关性.     

单相抑郁与双相抑郁患者执行功能的对照研究

目的 了解单、双相抑郁患者治疗前后执行功能特点及其影响因素.方法 对27例单相抑郁和30例双相抑郁患者予以3月药物治疗,治疗前、后分别评定24项汉密尔顿抑郁量表(HAMD)、功能大体评定量表(GAF)、威斯康星卡片分类测验(WCST)、字色混淆测验(Stroop)、词汇流畅性测验,与26名正常对照进行比较.结果 词汇流畅性得分是单、双相抑郁组治疗前后[分别为(15.37±5.04)分, (16.33±4.16)分, (15.53±5.38)分, (16.47±4.99)分]都低于正常对照组[(21.62±7.80)分];Stroop-C是单相抑郁治疗前后的得分[分别为(108.78±6.61)分, (108.26±8.34)分]都低于正常对照[(111.46±1.27)分],治疗后双相抑郁[(111.20±2.78)分]高于单相抑郁;Stroop-CW得分双相抑郁治疗前[(67.53±28.87)分]低于正常对照[(84.27±26.34)分];WCST完成第一个分类所需的应答数是单相抑郁治疗前后的得分[分别为(35.44±36.03)分,(32.52±33.88)分]都高于正常对照[(18.88±11.51)分],治疗后双相抑郁[(32.30±24.09)分]高于正常对照;非持续错误数是治疗前单相抑郁[(23.33±8.66)分]高于双相抑郁[(18.03±8.95)分]和正常对照[(18.04±7.75)分].逐步多元回归分析显示,在单相抑郁组治疗前,词汇流畅性、Stroop-CW与阻滞因子分呈负相关;WCST完成的分类数与认识障碍因子得分呈负相关;WCST完成第一个分类所需的应答数与体重因子得分呈负相关;双相抑郁组治疗前,词汇流畅性与认识障碍因子得分呈负相关;WCST完成测验的总应答数与认识障碍因子得分呈正相关;WCST完成第一个分类所需应答数、非持续性错误与睡眠障碍因子分呈负相关.结论 单双相抑郁都存在执行功能障碍,均受临床症状严重程度的影响,但损害存在差异,双相抑郁的执行功能损害较单相抑郁轻.     

吡拉西坦及高压氧联合治疗对慢性精神分裂症患者记忆和执行功能的影响

目的探讨吡拉西坦及高压氧联合应用对慢性精神分裂症患者记忆和执行功能的影响,以判断吡拉西坦及高压氧联合应用对改善患者认知功能的临床价值.方法将临床疗效已达显著进步以上的65例慢性精神分裂症患者,随机分为研究组(31例)和对照组(34例),在吡拉西坦及高压氧联合治疗前、后,对两组患者分别进行韦氏记忆量表(WMS)和威斯康星卡片分类测验(WCST)评定.结果与治疗前比较,研究组WMS总记忆商数及主要因子分明显升高(P＜0.05～0.01);WCST分类数和正确应答数评分明显升高(P＜0.05～0.01),持续应答数、持续性错误数和测验总应答数评分明显下降(P＜0.05～0.01).治疗后两组在WMS总记忆商数和其主要因子,以及WCST分类数、正确应答数、持续应答数、持续性错误数和测验总应答数评分之间差异有显著性(P＜0.05～0.01).PANSS反应缺乏和阴性因子分较治疗前均明显降低(P均＜0.05),与对照组比较差异有显著性(P均＜0.05).结论吡拉西坦及高压氧联合应用改善了慢性精神分裂症患者的认知功能和部分精神症状.     

发育性运动协调障碍儿童执行功能状况初步研究

目的初步探讨发育性运动协调障碍儿童执行功能与正常对照儿童的差异。方法采用威斯康星分类卡片测验（WisconsinCardSortingTest,WCST）对37例发育性运动协调障碍儿童（观察组）和37例健康儿童（对照组）的执行功能进行评估。结果在WCST测验中,发育性运动协调障碍儿童错误应答数、持续性应答数和持续性错误数、非持续错误数、完成第一个分类所需应答数明显高于正常儿童;而完成分类数、正确应答数、概念化水平百分比均明显低于正常儿童,差异具有统计学意义。结论发育性运动协调障碍儿童可能存在执行功能缺陷,应早期干预。     

难治性抑郁症与首发抑郁症认知功能对照研究

目的 比较和分析难治性抑郁症(TRD)与首发抑郁症(FED)患者的认知功能损害特点.方法 以53例TRD患者(TRD组)和21例FED患者(FED组)作为研究对象,以20名健康志愿者作为正常对照(对照组).采用17项汉密尔顿抑郁量表(HAMD-17)、汉密尔顿焦虑量表(HAMA)、抑郁自评量表(SDS)和临床大体印象量表-病情严重程度分量表(CGI-SI)评估临床严重程度,韦氏成人智力测定(WAIS)、韦氏记忆量表(WMS)、威斯康星卡分类测试(WCST)和数字划消测验(NCT)评估认知功能,并进行组间比较和分析.结果 临床严重程度评估显示,TRD组HAMD-17躯体性焦虑因子评分明显高于FED组,其余因子评分两组间比较差异均无统计学意义.认知功能评估显示,两病例组操作智商得分、WMS记忆商数、长时记忆和短时记忆的图形拼凑和时空定向分测验评分及WCST完成分类数、总应答数、概念化水平百分数、NCT粗分和净分均明显低于对照组;而WCST总用时、错误思考时间、持续性错误数和错误率均显著高于对照组.TRD组图形拼凑、时空定向、数字顺序和视觉再生分测验评分明显低于FED组;TRD组与对照组在WCST错误思考时间、持续性错误数和错误率、概念化水平百分数以及NCT粗分和净分方面的差异较FED组更为显著.结论 临床严重程度评估并不能反映TRD的特点.想象力、抓住事物线索能力、手-眼协调能力及记忆、注意功能和工作记忆等认知功能损害可能是TRD的特征性表现.     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.