急性腔隙性脑梗死患者血清C-反应蛋白和白介素-8水平的变化及临床意义

目的 探讨急性腔隙性脑梗死患者血清高敏C-反应蛋白(hs-CRP)、白介素-8水平(IL-8) 的变化及在发病机制中的作用.方法 分别检测36例腔隙性脑梗死、36例脑梗死和36例健康对照者血清hs-CRP和IL-8含量.结果 腔梗组和脑梗组hs-CRP含量分别为(10.42±0.68)、(18.45±1.28)mg/L,均显著高于对照组的(1.28±0.47)mg/L(P＜0.01),CI组hs-CRP含量亦显著高于健康对照组(P＜0.01);腔梗组和脑梗组IL-8含量分别为(29.65±18.24)、(36.57±19.01)ng/ml,显著高于对照组的(25.98±16.87)ng/ml(P＜0.01),在脑梗患者中,大面积脑梗死(≥9ml)hs-CRP为(21.36±1.48)mg/L,显著高于小面积脑梗死组(<9ml)的(15.30±0.97)mg/L(P＜0.01),2组IL-8含量分别为(38.1±19.87)、(33.45±18.67)ng/ml,差异亦有统计学意义(P＜0.01).结论 炎症过程参与了脑小血管病变;hs-CRP和IL-8水平与脑缺血程度以及脑的小血管病变范围密切相关.hs-CRP 及IL-8是预测脑梗死患者病情严重程度的重要生化指标.     

进展性脑梗死患者血清超敏C反应蛋白水平的变化及其临床意义

目的探讨进展性脑梗死患者血清超敏C反应蛋白(hs-CRP)水平的变化及其临床意义。方法检测63例脑梗死患者(25例进展性脑梗死、38例完全性脑梗死)和73名健康对照者(正常对照组)的血清hs-CRP含量。结果脑梗死患者的血清hs-CRP水平[(5.69±3.78)mg/L]明显高于正常对照组[(0.85±0.47)mg/L](P<0.01);进展性脑梗死组血清hs-CRP水平[(7.55±4.25)mg/L]明显高于完全性脑梗死组[(4.52±2.96)mg/L](P<0.01)。结论脑梗死患者血清hs-CRP水平明显升高,进展性脑梗死患者较完全性脑梗死患者血清hs-CRP水平升高更明显;提示hs-CRP参与了脑梗死的发生与发展过程。     

急性脑梗死患者血清可溶性CD40L与C-反应蛋白含量的改变及其意义

目的 探讨急性脑梗死(ACI)患者血清可溶性CD40L(sCD40L)和C-反应蛋白(CRP)含量的改变及其意义.方法 采用双抗体夹心酶联免疫法及比浊法检测40例ACI患者及30人正常对照者的血清sCD40L和CRP含量,比较不同病情、不同梗死面积ACI患者的血清sCD40L和CRP含量变化,对二者之间的关系进行相关性分析.结果 ACI组血清sCD40L[(3.57±0.86) ng/ml]、CRP[(17.53±7.61) mg/L]的含量明显高于正常对照组(均P<0.01),ACI病情重度组、大面积梗死组血清sCD40L、CRP的含量明显高于病情中度、轻度组和小面积、腔隙性脑梗死组,病情中度组、小面积梗死组又明显高于病情轻度组、腔隙性脑梗死组(均P<0.05).血清sCD40L与CRP含量呈正相关(r=0.817,P<0.01).结论 ACI患者血清sCD40L、CRP含量升高,并与病情严重程度和梗死面积有关.提示其可作为判断ACI病情的血清生物学指标.     

脑梗死患者的亚临床炎症及胰岛素抵抗

目的观察脑梗死患者的亚临床炎症及胰岛素抵抗(IR)情况。方法检测114例脑梗死患者(脑梗死组)血清C-反应蛋白(CRP)、白介素-6(IL-6)及空腹胰岛素(Fins)、空腹血糖(FPG)、血脂、血压水平,分析胰岛素敏感指数(ISI)与炎症指标的关系,并与70例非脑梗死患者(对照组)进行比较。结果⑴脑梗死组血清CRP水平[(2.73±0.87)mg/L]、IL-6水平[(0.14±0.03)ng/ml]明显高于对照组[(1.63±0.93)mg/L、(0.12±0.03)ng/ml](均P<0.01),ISI(-4.31±0.53)明显低于对照组(-3.92±0.43)(P<0.01);⑵脑梗死组中,CRP>8.2mg/L患者的ISI(-4.63±0.71)明显低于CRP≤8.2mg/L患者的ISI(-4.18±0.54)(P<0.05)。结论脑梗死患者存在血清炎症的证据及IR;并且IR和亚临床炎症反应水平相一致。     

拜阿司匹灵对脑梗死患者血浆血小板4因子的影响

目的观察脑梗死患者用拜阿司匹灵治疗前、后血浆血小板4因子(PF4)的变化。方法70例脑梗死患者被随机分为不用拜阿司匹灵组(n=40)和服用拜阿司匹灵组(100mg/次,睡前服用,n=30),其他治疗两组间无差异。用酶标免疫测定法测定二组治疗前、治疗后7d及30例正常对照组血浆PF4的含量。结果急性脑梗死不用拜阿司匹灵组的患者血浆PF4治疗前为15.12±6.32ng/ml,治疗后为9.83±4.93ng/ml,治疗后PF4的明显下降(P<0.01),但显著高于正常对照组(6.50±2.70ng/ml,P<0.01);服用拜阿司匹灵组的患者血浆PF4治疗前为15.48±3.16ng/ml,治疗7d后为7.66±1.47ng/ml,较治疗前明显下降(P<0.01),也明显低于不用拜阿司匹灵组的患者(P<0.01),但仍高于正常对照组(6.50±2.70ng/ml,P<0.05)。结论拜阿司匹灵能降低脑梗死患者血浆PF4含量水平,抑制血小板活性。     

NT-proBNP和D-二聚体水平变化与脑梗死损伤程度的相关性分析

目的血浆B型脑钠肽前体(NT-proBNP)和D-二聚体水平和脑梗死病情严重程度的关系。方法选取我院收治的急性脑梗死患者63例为病例组,选取同期在我院体检的35例健康人群为健康对照组,检测两组受试者的NT-proBNP和D-二聚体水平并进行对比。同时收集病例组患者的临床资料,对比不同临床资料患者NT-proBNP和D-二聚体的水平。结果病例组的NT-proBNP水平为2319.42±5687.26 ng/L,D-二聚体水平为354.57±445.08 mg/ml,均显著高于健康对照组(P<0.05);大面积脑梗死患者NT-proBNP水平为4039.12±7610.02 ng/L,D-二聚体水平为519.37±575.88 mg/ml,均显著高于非大面积脑梗死患者(P<0.05);NIHSS评分>10分患者NT-proBNP水平为3594.86±6947.46 ng/L,D-二聚体水平为483.72±513.81 mg/ml,均显著高于NIHSS评分≤10分患者(P<0.05);有意识障碍患者NT-proBNP水平为4984.37±8657.23 ng/L,D-二聚体水平为629.41±609.48 mg/ml,均显著高于无意识障碍患者(P<0.05);有高血压病患者NT-proBNP水平为4107.24±7802.16 ng/L,D-二聚体水平为544.37±569.06 mg/ml,均显著高于无高血压病患者(P<0.05);结局为死亡的患者的NT-proBNP水平为9168.32±11354.17 ng/L,D-二聚体水平为908.17±758.36 mg/ml,均显著高于存活的患者(P<0.05)。结论 NT-proBNP和D-二聚体水平的检测可反应出脑梗死患者病情的严重程度,可为临床病情的评估和预后的判断提供有价值的参考信息。     

脑梗死患者血清可溶性CD40L、白介素-18水平的变化及意义

目的 探讨脑梗死患者的血清可溶性CD40L(sCD40L)、白介素-18(IL-18)水平的变化及意义.方法 采用酶联免疫吸附法测定40例腔隙性脑梗死患者(腔梗组)、40例脑梗死患者(脑梗死组)和38名正常对照者(NC组)的血清sCD40L、IL-18水平,并对脑梗死患者进行颈动脉超声检查及美国国立卫生研究院卒中量表(NIHSS)评分.结果 与正常对照组比较,腔梗组及脑梗死组血清sCD40L及IL-18显著升高(均P＜0.01);且脑梗死组显著高于腔梗组(均P＜0.01).中、重度脑梗死患者的血清sCD40L及IL-18水平显著高于正常对照组及轻度脑梗死患者(P ＜0.05 ～0.01).与内膜正常患者比较,有稳定斑块及不稳定斑块患者的血清sCD40L及IL-18水平显著升高(均P＜0.01),内膜增厚患者IL-18水平显著升高(P＜0.05).与内膜增厚患者比较,有稳定斑块患者的血清sCD40L水平和有不稳定斑块患者的血清sCD40L及IL-18水平显著升高(均P＜0.01).有不稳定斑块患者的血清sCD40L及IL-18水平显著高于有稳定斑块的患者(均P＜0.01).脑梗死患者血清sCD40L水平与IL-18水平呈正相关(r=0.729,P＜0.01).结论 脑梗死患者血清sCD40L、IL-18水平显著升高,并能反映颈动脉粥样硬化程度及脑梗死病情.     

血浆同型半胱氨酸水平与缺血性脑卒中复发的关系

目的探讨血浆同型半胱氨酸(Hcy)水平与缺血性脑卒中(ICS)复发的关系。方法用荧光偏振免疫法检测303例初发、97例复发ICS患者[动脉粥样硬化性血栓性脑梗死173例(血栓组)、腔隙性脑梗死170例(腔梗组)、心源性脑栓塞57例(栓塞组)]及200例非脑血管病患者(对照组)的血浆Hcy水平。对ICS复发因素进行多因素回归分析。结果(1)ICS患者血浆Hcy水平[血栓组(16.17±10.83)μmol/L、腔梗组(14.64±7.71)μmol/L、栓塞组(15.75±6.8)μmol/L]显著高于对照组[(9.61±4.22)μmol/L](均P<0.01);各类型ICS组之间血浆Hcy水平差异无统计学意义(均P>0.05);(2)ICS复发患者血浆Hcy水平[(18.04±10.68)μumol/L]显著高于初发患者[(14.57±8.50)μmol/L](P<0.01),以及高Hcy血症比率(50.5%)显著高于初发患者(32.3%)(P<0.01);(3)各类型ICS复发患者之间血浆Hcy水平差异无统计学意义(均P>0.05);(4)高Hcy血症、糖尿病是ICS复发的独立危险因素(P<0.001,P...     

无症状脑梗死患者血清高敏C反应蛋白和肿瘤坏死因子-α水平的变化及其临床意义

目的：探讨无症状脑梗死（SCI）患者血清高敏C反应蛋白（hs-CRP）、肿瘤坏死因子-α（TNF-α）水平的变化及其在发病机制中的作用。方法：分别检测40例SCI、40例脑梗死（CI）患者、40例健康对照者血清hs-CRP和TNF-α含量。结果：SCI组和cI组hs—CRP含量分别为（8．86±0．96）和（16．32±1．88）mg／L，均显著高于对照组的（1．69±0．56）mg／L（P〈0．01），CI组hs—CRP含量亦显著高于SCI组（P〈0．05）；SCI组和CI组TNF-α含量分别为（1．92±0．73）和（2．56±0．91）ng／mL，显著高于对照组的（1．13±0．42）ng／mL（P〈0．01），CI组TNF-α含量亦显著高于SCI组（P〈0．05）。在SCI患者中，梗死灶数〉2个组（n=19）hs-CRP为（9．45±0．97）mg／L，显著高于梗死灶数≤2个组（n=17）的（7．21±0．75）mg／L（P〈0．01），两组TNF-α含量分别为（1．97±0．83）和（1．66±0．56）ng／mL，无显著差异。血压测定值越高，腔隙性梗死灶数量越多，未服降压药者梗死灶数量显著多于正规降压治疗者（P〈0．05）。结论：炎症过程参与了脑小血管病变；hs—CRP和TNF-α水平与脑缺血程度、神经功能缺损程度以及脑的小血管病变范围密切相关。高血压是腔隙性SCI最常见的病因，未降压治疗的重度高血压更易引起多发性腔隙性脑梗死。从预防再发的角度看，对SCI应尽早采取积极有效的治疗措施，高血压患者应尽早正规服用降压药。     

急性脑梗死患者血清IL-35、MMP-9与颈动脉粥样硬化斑块稳定性的关系

目的探讨急性脑梗死患者血清白细胞介素-35(IL-35)、基质金属蛋白酶9(MMP-9)与颈动脉粥样硬化斑块稳定性的关系。方法选择急性脑梗死患者89例,应用彩色多普勒超声检查颈动脉斑块,根据颈动脉粥样硬化斑块稳定性分为易损斑块组和稳定斑块组。采用酶联免疫吸附法检测患者血清IL-35、MMP-9水平,并分析IL-35、MMP-9与斑块稳定性的关系。结果颈动脉粥样硬化易损斑块组的患者41例,稳定斑块组的患者48例。易损斑块组血清IL-35水平(17.89±7.21 ng/ml)明显高于稳定斑块组(9.08±3.45 ng/ml)(P<0.05)。MMP-9水平易损斑块组(430.36±72.78 ng/ml)亦显著高于稳定斑块组(305.16±45.63 ng/ml)(P<0.01),差异均有统计学意义。结论脑梗死患者血清IL-35、MMP-9水平可能与颈动脉斑块稳定性有关。     

Efficacy and Effectiveness of Child and Adolescent Psychotherapy and Pharmacotherapy

Decades of intervention research have produced a rich body of evidence on the effects of psychotherapies and pharmacotherapies with children and adolescents. Here we summarize and critique that evidence. We review findings bearing on the efficacy of psychosocial treatments and medications under controlled experimental conditions. We also report evidence, where available, on the effectiveness of both classes of treatment with clinically referred youth treated in real-world clinical contexts. In general, the large body of evidence on efficacy contrasts sharply with the small base of evidence on effectiveness. Addressing this gap through an enriched research agenda could contribute importantly to linking scientific inquiry and clinical practice—to the benefit of both ventures. This is one element of a multifaceted agenda for future research and for synthesis of research, which will require the interplay of multiple disciplines related to child and adolescent mental health.     

Opiate and digitalis receptor assays distinguish between neuroexcitant and inactive organochlorines and between anesthetics and convulsants

Specific binding of [3H]naloxone to rat brain tissue in vitro was inhibited by the excitant organochlorinated insecticides (OCI), by ether (E) and octanol (OCT), and by the convulsant indoklon (IND) and its anesthetic isomer, isoindoklon (ISO). In the presence of 100 mM NaCl the inhibition of naloxone binding by E, OCT and ISO was greatly potentiated, whereas that by OCI and IND was attenuated. KCl (100 mM) was equally effective as NaCl on the action of anesthetics, but the effect of the excitant drugs was, in contrast to NaCl, unaffected by KCl. Specific binding of [3H]ouabain in the absence of Na, was depressed by anesthetics and enhanced by neuroexcitants. In the presence of NaCl, which by itself inhibits ouabain binding to brain, both anesthetics and excitants enhanced ouabain binding. DDE, a non-insecticidal analog of DDT, and the dimethyl derivative of the OCI, lindane, were inactive in the receptor assays. These observations point to a unique isolated system which responds consistently to anesthetic agents as a class and, in a different way, to neuroexcitant compounds.     

Learning and forgetting new names and objects in MCI and AD

We studied how subjects with mild cognitive impairment (MCI), early Alzheimer's disease (AD) and age-matched controls learned and maintained the names of unfamiliar objects that were trained with or without semantic support (object definitions). Naming performance, phonological cueing, incidental learning of the definitions and recognition of the objects were tested during follow-up. We found that word learning was significantly impaired in MCI and AD patients, whereas forgetting patterns were similar across groups. Semantic support showed a beneficial effect on object name retrieval in the MCI group 8 weeks after training, suggesting that the MCI patients’ preserved semantic memory can compensate for impaired episodic memory. The MCI group performed equally well as the controls in the tasks measuring incidental learning and recognition memory, whereas the AD group showed impairment in this respect. Both the MCI and the AD group benefited less from phonological cueing than the controls. Our findings indicate that word learning is compromised in both MCI and AD, whereas long-term retention of newly learned words is not affected to the same extent. Incidental learning and recognition memory seem to be well preserved in MCI.     

Necdin蛋白与神经元的生长分化

在神经系统 ,Necdin只在成熟神经元的细胞核中表达 ,可能与成熟神经元分裂静止状态的保持有关。近年的研究表明 ,Necdin是一种生长抑制蛋白 ,能与多种因子如SV4 0大T抗原 ,腺病毒E1A ,转录因子E2F1以及肿瘤抑制蛋白p5 3等结合 ,在功能上类似于成视网膜瘤蛋白Rb。necdin基因缺陷时 ,会引起脑内 ,特别是下丘脑神经元分化障碍。人类necdin基因位于PWS综合征的基因缺失区 ,可能与PWS的一些症状有关。本文从Necdin蛋白的基本概况 ,生物功能以及Necdin与疾病三个方面进行了综述     

Satellite cells and myonuclei in young and elderly women and men

The overall aim of this study was to assess the effects of aging on the satellite cell population. Muscle biopsies were taken from the tibialis anterior muscle of healthy, moderately active young (age range, 20-32 years; n = 31) and elderly (age range, 70-83 years; n = 27) women and men with comparable physical activity pattern. Satellite cells and myonuclei were visualized using a monoclonal antibody against neural cell adhesion molecule and counterstained with Mayer's hematoxylin. An average of 211 (range, 192-241) muscle fibers were examined for each individual. Compared with the young women and men, the elderly subjects had a significantly lower (P < 0.011) number of satellite cells per muscle fiber but a significantly higher (P < 0.004) number of myonuclei per muscle fiber. The number of satellite cells relative to the total number of nuclei [satellite cells/(myonuclei + satellite cells)] was significantly lower in the elderly than in the young women and men. These results imply that a reduction in the satellite cell population occurs as a result of increasing age in healthy men and women.     

Necdin蛋白与神经元的生长分化

在神经系统,Necdin只在成熟神经元的细胞核中表达,可能与成熟神经元分裂静止状态的保持有关.近年的研究表明,Necdin是一种生长抑制蛋白,能与多种因子如SV40大T抗原,腺病毒E1A,转录因子E2F1以及肿瘤抑制蛋白p53等结合,在功能上类似于成视网膜瘤蛋白Rb.necdin基因缺陷时,会引起脑内,特别是下丘脑神经元分化障碍.人类necdin基因位于PWS综合征的基因缺失区,可能与PWS的一些症状有关.本文从Necdin蛋白的基本概况,生物功能以及Necdin与疾病三个方面进行了综述.     

Retrospective and prospective design and data

The study of the presentation, symptomatology and family characteristics of an exclusively adolescent sample of patients with borderline personality disorder (BPD) was undertaken. Twenty-four cases of borderline personality disorder, 20 females, 4 males, identified using chart review and meeting the criteria of the Diagnostic Interview for Borderlines (DIB) and DSM III-R, were matched with psychiatric controls. Adolescents with borderline personality disorder were found to have high rates of affective symptomatology with Axis I diagnosis of major depressive disorder - MDD (DSM-III-R), and high rates of interpersonal psychopathology, i.e., manipulation, devaluation, and a pervasive sense of boredom. The latter seem to be characteristic as for adults with borderline personality disorder. The families were particularly angry and volatile.     

Cortisol levels and depression in men and women using heroin and cocaine

Abnormalities in the hypothalamic-pituitary-adrenal (HPA) axis are well documented in men using illicit drugs and/or infected with HIV; however, less is known about HPA function, or the health consequence of HPA dysfunction, in their female counterparts. People with depression exhibit hypercortisolemia, and depression is common in people with HIV or substance use problems. The current study investigated cortisol secretion in 209 demographically matched men and women, stratified by their HIV and drug use status. Self-reported depressive symptoms were evaluated using a standardized, validated questionnaire (CES-D). Women reported more depressive symptoms than men (p=.01). Male and female drug users exhibited higher cortisol concentrations (p=.03), and were more likely to report depressive symptoms (p=.04), than non-users. Depression was related to elevated cortisol concentrations for the study population (p=.03), and women with elevated cortisol concentrations were significantly more depressed than all other participants (p=.05). While it is unknown whether high cortisol concentrations precede depressive symptoms or vice versa, these data indicate that higher cortisol concentrations are associated with depressive symptoms in heroin and cocaine users, and that this association is more pronounced in women than men. HIV status did not act in an additive or synergistic way with drug use for either cortisol or CES-D measures in the current study. Unique therapies to treat the endocrine and mental health consequences of illicit drug use in men and women deserve consideration as depressive symptoms, and high cortisol concentrations associated with depressive symptoms, differ by gender.     

相关性和一致性：这对相仿概念和测量方法的回顾与阐明

概述：一致性(agreement)和相关性(correlation)是两个广泛使用的概念,用来评估变量之间的关联。虽然二者相似且相关,但是它们代表关联完全不同的概念。评估变量之间的一致性假设变量测量的是相同的结构,而在变量测量完全不同的结构时也可以评估它们之间的相关性。这种概念上的差异就要求使用不同的统计方法,并且当评估一致性或相关性时,统计方法根据数据的分布和研究者的兴趣可能会有所不同。例如, Pearson相关性,作为评估连续变量之间相关性的一种普遍测量方法,只有用于符合线性关系的变量时才能提供有用的信息;当用于不符合线性关系的变量时就无法提供准确信息甚至会产生误导。同样地,内部相关性,作为一种评估连续变量之间一致性的常用方法,如果一致性不好的实质正好是研究兴趣所在,那么该测量就不能为研究者提供充分的信息。本报告回顾了一致性和相关性的概念,并讨论了几种常用方法在应用中的差异。