老年慢性阻塞性肺疾病稳定期患者焦虑和抑郁症状的调查结果

慢性阻塞性肺疾病（chronic obstractive pulmonary disease,COPD）是一种慢性呼吸系统常见病。这类患者不仅要承担躯体疾病带来的痛苦,同时还存在着焦虑、抑郁、无助和恐惧等负性情绪,这些情绪对COPD的反复发作和发展有着重要的影响。为此,我们调查了198例稳定期COPD患者的肺功能及其焦虑、抑郁情绪,旨在为临床心理干预提供参考。现报告如下：     

肺康复对慢性阻塞性肺疾病稳定期患者预后及焦虑 抑郁情绪的影响

目的 观察肺康复对慢性阻塞性肺疾病（COPD）稳定期患者预后及焦虑、抑郁情绪的影响。方法 将126例COPD稳定期患者按随机数字表法分为对照组和观察组各63例,对照组给予布地奈德/福莫特罗吸入剂治疗,观察组在药物治疗基础上联合肺康复治疗,6个月后结束观察,对比2组治疗前后预后及焦虑、抑郁情绪等指标。结果 2组观察结束时肺功能均较观察前轻度下降,差异无统计学意义（P〉0.05）,观察组体重指数、6min步行试验距离观察结束时较观察前明显升高,呼吸困难程度、汉密尔顿焦虑/抑郁量表评分较观察前明显降低,且均较对照组观察结束时改变更为显著,差异均有统计学意义（P〈0.05）。结论 肺康复可综合改善COPD稳定期患者预后,减轻焦虑、抑郁情绪,建议临床推广应用。     

肺康复对慢性阻塞性肺疾病稳定期患者预后及焦虑抑郁情绪的影响

目的：观察肺康复对慢性阻塞性肺疾病（COPD）稳定期患者预后及焦虑、抑郁情绪的影响。方法将126例COPD稳定期患者按随机数字表法分为对照组和观察组各63例,对照组给予布地奈德／福莫特罗吸入剂治疗,观察组在药物治疗基础上联合肺康复治疗,6个月后结束观察,对比2组治疗前后预后及焦虑、抑郁情绪等指标。结果2组观察结束时肺功能均较观察前轻度下降,差异无统计学意义（P＞0.05）,观察组体重指数、6 min步行试验距离观察结束时较观察前明显升高,呼吸困难程度、汉密尔顿焦虑／抑郁量表评分较观察前明显降低,且均较对照组观察结束时改变更为显著,差异均有统计学意义（P＜0.05）。结论肺康复可综合改善COPD稳定期患者预后,减轻焦虑、抑郁情绪,建议临床推广应用。     

健康教育对慢性阻塞性肺病患者情绪、不良认知及社会功能的影响

目的分析慢性阻塞性肺疾病患者应用健康教育模式干预后效果。方法将我院95例慢性阻塞性肺疾病患者依据患者入院先后顺序进行分组,对照组47例患者应用常规对症治疗,观察组48例患者增加健康教育进行干预,对比两组患者干预后肺功能、焦虑抑郁情绪、认知行为及社会功能变化。结果干预后,观察组肺功能及SAS、SDS、SF-36、COPD问卷评分高于对照组(P0.05)。结论健康教育能够有效改善慢性阻塞性肺疾病患者的认知程度,减轻焦虑、抑郁,促进肺功能恢复,提升患者社会功能。     

文拉法辛对慢性阻塞性肺病合并抑郁焦虑患者的治疗作用

目的：研究文拉法辛对慢性阻塞性肺疾病（COPD）合并抑郁焦虑患者生活质量的影响。方法：采用汉密尔顿焦虑量表（HAMA）及汉密尔顿抑郁量表（HAMD）（17项）测量心理状况,将存在轻中度焦虑、抑郁症状的48例COPD患者随机分为文拉法辛组（26例）及对照组（22例）,治疗4周。治疗前后检测患者COPD的各项肺功能指标并用圣乔治呼吸问卷（SGRQ）评价生活质量,应用治疗中出现的症状量表（TESS）评定不良反应。结果：文拉法辛组治疗4周时有效率100%,HAMA及HAMD评分显著降低（P〈0.05）,肺功能均有明显改善（P〈0.05）。结论：文拉法辛能改善COPD患者的焦虑及抑郁症状,提高生活质量。     

正念减压疗法对新冠疫情期间医务人员主观压力及焦虑抑郁的影响

目的 新冠肺炎具有传染性强、传播速度快、人群普遍易感等特点。医务人员在高风险、高压力的环境下工作,极易出现焦虑和抑郁等心理问题,亟待有效的心理干预。方法 研究共招募到510名一线抗疫医务人员,有44名最终完成研究,其中干预组20名,对照组24名。对干预组进行8周的线上正念减压训练（Mindfulness-Based Stress Reduction,MBSR）,对照组予以心理支持。采用焦虑自评量表（Self-rating Anxiety Scale,SAS）、抑郁自评量表（Self-rating Depression Scale,SDS）、和压力知觉量表（Chinese Perceived Stress Scale,CPSS）对参与者进行测评,评估干预效果。结果两组医务人员的SDS、SAS、CPSS评分均显著下降（P值<0.001）;干预组下降较对照组更明显（P值<0.001）。结论 正念减压疗法能有效降低新冠疫情期间医务人员焦虑、抑郁和压力水平。     

艾司西酞普兰治疗稳定期慢性阻塞性肺疾病合并抑郁症的疗效

目的探讨艾司西酞普兰治疗稳定期慢性阻塞性肺疾病(s COPD)合并抑郁症的疗效及对患者心肺运动功能的影响。方法随机将78例s COPD合并抑郁症患者分为2组:对照组(n=39)予以常规治疗,观察组(n=39)在常规治疗基础上加用艾司西酞普兰。比较两组治疗前后汉密尔顿抑郁量表(HAMD)评分、汉密尔顿焦虑量表(HAMA)评分、COPD疾病测试(CAT)评分、6min步行距离(6MWD)、静息肺功能及心肺运动试验(CPET)结果。结果治疗前,两组患者各项指标均无显著差异(P0.05),且治疗6个月后两组患者上述指标均有了显著改善(P0.05)。治疗后,观察组的HAMD、HAMA、CAT评分均显著低于对照组(P0.05),6MWD、FEV1、FEV1%pred、FEV1/FVC及CPET结果均显著高于对照组(P0.05)。结论艾司西酞普兰辅助治疗s COPD,能够减轻患者的焦虑、抑郁情绪,改善患者的心肺运动功能,值得在临床推广。     

氟哌噻吨美利曲辛联合个性化心理干预治疗对COPD合并抑郁患者的影响

目的研究氟哌噻吨美利曲辛联合个性化心理干预治疗对慢性阻塞性肺疾病(COPD)合并抑郁患者焦虑抑郁情绪、肺功能及生活质量的影响。方法选取我院从2015年4月至2016年3月收治的100例COPD合并抑郁患者,随机分为观察组(50例)和对照组(50例);两组均予以COPD的相关治疗,此外对照组采取氟哌噻吨美利曲辛进行治疗,观察组在此基础上采取为个性化心理干预治疗,将两组患者的肺功能情况、汉密尔顿焦虑量表(HAMA)评分与汉密尔顿抑郁量表(HAMD)评分、生活质量进行对比分析。结果两组患者治理前肺功能、焦虑抑郁评分及生活质量评分,组间无明显差异(P0.05);治疗后观察组的HAMA评分与HAMD评分低于对照组,生活质量评分高于对照组且肺功能各项指标均优于对照组(P0.05)。结论 COPD合并抑郁患者应用氟哌噻吨美利曲辛联合个性化心理干预治疗可有效缓解患者的抑郁焦虑情绪,改善患者的肺功能和生活质量,因此值得在临床上推广应用。     

团体式呼吸康复操对类风湿关节炎合并肺间质纤维化患者焦虑、抑郁及肺功能的作用

目的 探讨团体式呼吸康复操对类风湿关节炎（RA）合并肺间质纤维化（IPF）患者焦虑、抑郁及肺功能的改善作用。方法 本研究对象为我院2019年3月～2021年3月我院76例RA合并IPF患者,且具有明显的焦虑或抑郁情绪,数字表法随机分为对照组与观察组,两组均进行常规药物治疗,对照组开展阻力呼吸训练器训练,观察组采用团体式呼吸康复操训练。比较干预前后焦虑自评量表（SAS）、抑郁自评量表（SDS）、1秒用力呼气量（FEV1）、肺活量（FVC）、FEV1/FVC、圣·乔治医院呼吸调查问卷（SGRQ）以及RA活动性评价表（DAS28）。结果 干预后两组SAS评分、SDS评分、SGRQ评分均显著降低,且干预后观察组显著低于对照组（P<0.05）;干预后两组患者FEV1、FVC、FEV1/FVC均显著增加,且干预后观察组肺功能指标显著高于对照组（P<0.05）,两组治疗后DAS28评分均显著降低（P<0.05）,但干预后差异无统计学意义（P>0.05）。结论 团体式呼吸康复操不仅能够提升RA合并IPF患者肺功能以及生活质量,还能降低患者的焦虑、抑郁等负性情绪。     

家庭行为认知干预用于COPD合并抑郁焦虑情绪患者的疗效

目的探讨家庭行为认知干预用于慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)合并抑郁焦虑情绪患者的效果。方法选择2015年1月至12月在我院接受治疗的140例合并抑郁焦虑情绪的COPD患者,用随机数表法分为对照组和干预组,每组各70例。对照组给予常规的COPD护理干预,干预组在对照组的基础上给予家庭行为认知干预。结果干预前两组患者的焦虑自评量表(SAS)和抑郁自评量表(SDS)评分组间对比无明显差异(P0.05),干预后两组患者的SAS和SDS评分均出现明显下降,且干预组患者的SAS和SDS评分低于对照组,上述差异均有统计学意义(P0.05)。干预前两组患者的第1秒用力呼气量(FEVl)、第1秒用力呼气容积占预计值百分比(FEVl/FVC)和用力肺活量(FVC)等肺功能指标比较,差异无统计学意义(P0.05),干预后两组患者的肺功能指标与干预前相比均明显改善,且干预组患者的肺功能指标明显优于对照组,差异有统计学意义(P0.05)。干预前两组患者的圣乔治呼吸问卷(SGRQ)评分中症状部分、活动能力、疾病影响和总分组间差异无统计学意义(P0.05),干预后两组患者的上述指标评分均明显下降,且干预组患者的评分低于对照组,生活质量更高,差异有统计学意义(P0.05)。干预前两组患者缩唇呼吸、腹式呼吸和全身性呼吸体操等康复训练的依从性相近(P0.05),干预后两组患者的依从性均出现提高,且干预组患者的依从性高于对照组,差异有统计学意义(P0.05)。结论在常规护理干预措施的基础上增加家庭行为认知干预,可以更明显改善COPD合并抑郁焦虑情绪患者的不良情绪,提高康复训练依从性,从而提高肺功能和生活质量。     

Neuroimaging in epilepsy in tropics

Epilepsy is a major public health problem in many tropical countries. Also, some of the tropical diseases are major contributors to the higher prevalence of epilepsy in these countries. The etiologic factors responsible for epilepsy in these countries are quite different from those in the developed world. This article discusses the etiologic factors and neuroimaging of epilepsy in light of the conditions in these tropical countries.     

癫痫与抑郁关系的研究进展

抑郁是癫痫患者中常见的精神障碍,严重地影响了患者的生活质量。传统的观点认为癫痫患者因为存在着诸多社会学问题易出现抑郁倾向,癫痫和抑郁是单向的联系,但大量的研究已经证明癫痫和抑郁之间存在双向的联系,一种异常状态的存在可能易转化为另一种异常状态的发展。癫痫和抑郁存在着共同的发病机制。本文主要就癫痫和抑郁的双向联系以及抗抑郁药物在癫痫患者中的应用进行阐述。     

Sudanophilic lipid accumulation in astrocytes in periventricular leukomalacia in monkeys

Summary Sudanophilic lipid accumulation is a characteristic feature of periventricular leukomalacia (PVL) of infants. At least two types of lipid-containing cells have been identified, one being the macrophage, the other the pre-myelin glial cell. A third type of lipid-containing cell has been seen in two monkeys with spontaneous PVL. Electron microscopically this cell appears to be an astrocyte. This probably represents a reaction of the astrocyte to hypoxia and may be the equivalent of the hypertrophic astrocytes found in human infants.Supported in part by NIH grant HDO 8633 and the Regional Primate Research Center Grant RR-00166     

Increase in cathepsin D activity in rat brain in aging

Cathepsin D-like activity in homogenates of five brain areas of 3-month-old and 24-month-old Fischer 344 rats was measured. With hemoglobin as substrate at pH 3.2, more than 90% of the activity was inhibited by pepstatin. In each area studied, activity was more than twice as high in the old rat brain: 140-160% higher in the cortex, cerebellum, pons-medulla, and striatum and 90-100% higher in the hippocampus and spinal cord. The greatly increased metabolic capacity in the absence of an increase in protein turnover may have a role in age-related pathological degeneration in the brain.     

Characteristics of nociceptors in the periodontium--an in vitro study in rats

Recent studies have indicated that nociceptors can be classified into various types according to their physiological properties. These studies have clarified that the frequency distribution of various nociceptor types is different among body sites and animal species. In the present study, we investigated the physiological properties of rat's periodontal nociceptors in an in vitro jaw-nerve preparation. Responses were recorded from functional single filaments in the inferior alveolar nerve. To determine the nociceptor type, calibrated von Frey filaments, heat, and bradykinin (BK) stimuli were used. We found five subtypes of nociceptors in the periodontal ligaments of the lower incisor: Adelta-high threshold mechanonociceptors (Adelta-HTM, n=28), Adelta-mechanoheat nociceptors (Adelta-MH, n=6), Adelta-polymodal nociceptors (Adelta-POLY, n=26), C-high threshold mechanonociceptors (C-HTM, n=3) and C-polymodal nociceptors (C-POLY, n=4). Most nociceptors were Adelta-innervated, while only a small number of C-innervated nociceptors were found. The present results suggest that periodontal nociceptors transmit mainly fast pain, and may thus play a role in rapid detection of injure-related stimuli during mastication.     

Gender in Voice Perception in Autism

Deficits in the perception of social stimuli may contribute to the characteristic impairments in social interaction in high functioning autism (HFA). Although the cortical processing of voice is abnormal in HFA, it is unclear whether this gives rise to impairments in the perception of voice gender. About 20 children with HFA and 20 matched controls were presented with voice fragments that were parametrically morphed in gender. No differences were found in the perception of gender between the two groups of participants, but response times differed significantly. The results suggest that the perception of voice gender is not impaired in HFA, which is consistent with behavioral findings of an unimpaired voice-based identification of age and identity by individuals with autism. The differences in response times suggest that individuals with HFA use different perceptual approaches from those used by typically developing individuals.     

Defects in Bioenergetic Coupling in Schizophrenia

Synaptic neurotransmission relies on maintenance of the synapse and meeting the energy demands of neurons. Defects in excitatory and inhibitory synapses have been implicated in schizophrenia, likely contributing to positive and negative symptoms as well as impaired cognition. Recently, accumulating evidence has suggested that bioenergetic systems, important in both synaptic function and cognition, are abnormal in psychiatric illnesses such as schizophrenia. Animal models of synaptic dysfunction demonstrated endophenotypes of schizophrenia as well as bioenergetic abnormalities. We report findings on the bioenergetic interplay of astrocytes and neurons and discuss how dysregulation of these pathways may contribute to the pathogenesis of schizophrenia, highlighting metabolic systems as important therapeutic targets.     

Ethnic disparities in problem behaviour in adolescence contribute to ethnic disparities in social class in adulthood

BACKGROUND: It is important for prevention of social class disparities to know how ethnic disparities in social class arise among migrant children. We contribute to this understanding by examining the role of problem behaviour in adolescence. METHODS: Prospective observational study with 753 Dutch native and 217 Turkish migrant adolescents (11-18 year) followed for 10 years. Internalising and externalising problems were assessed in adolescence and employment status and occupational level were assessed in adulthood. The difference in odds ratios (OR) before and after adjustment for internalising and externalising problems was an indication of the predictive value of disparities in internalising and externalising problems for the development of social class disparities. RESULTS: A total of 135 (62%) of the Turkish and 602 (80%) of the Dutch adults were employed. Internalising and externalising problems were not associated with employment status. Of the employed, 65 (48%) Turkish and 179 (30%) Dutch adults worked in low-level occupations (p < 0.0001). Internalising and externalising problems were associated with both ethnicity and occupation. The OR for low-level occupation for Turkish adults was 1.78 (1.19-2.65), indicating ethnic disparities. Adjustment for internalising problems lowered the OR with 36% to 1.50 (0.97-2.31), and adjustment for externalising problems lowered it with 8% to 1.72 (1.15-2.57). Findings were similar for men and women and did not vary by age. CONCLUSIONS: Ethnic disparities in occupational level in adulthood could partly be attributed to disparities in mental health between Turkish migrants and Dutch natives in adolescence. Prevention of ethnic disparities in mental health at young age may therefore also contribute to the prevention of occupational differences in adulthood.     

Progress in neuroprotection in Parkinson's disease

Slowing or aborting the progress of neurodegeneration in Parkinson's disease (PD) remains the most important unmet need of this disorder. There are several recent developments in trial design and also in drugs under investigation for possible neuroprotective effect. Emphasis has been placed on clinical as opposed to imaging end-points and these include change in a clinical rating scale, e.g. United Parkinson's disease Rating Scale (UPDRS), or time to additional therapy. The introduction of the delayed-start, or wash-in, trial design adds an additional dimension to drug evaluation for neuroprotection. Compounds that have been recently tested in clinical trial include the monoamine oxidase-B inhibitor rasagiline, the anti-apoptotic agents TCH346 and CEP1347, and the promitochondrial agent creatine. The dopamine agonists have been evaluated for a neuroprotective effect using imaging end-points. Perhaps the most important and simplest concept for neuroprotection has been the theory that early dopaminergic support for the degenerating dopaminergic system per se provides significant long-term clinical benefit for PD patients.     

Changes in parasympathetic system in medulla oblongata in male pigs in the course of tachycardia-induced cardiomyopathy

Background

Autonomic imbalance constituting a fundamental feature of heart failure (HF) has been assessed mainly at the periphery. Changes in the functioning of autonomic centers in the brain remain unclear. We investigated the molecular elements of parasympathetic system, i.e. α7 nicotinic acetylcholine receptor (α7nAChR) and enzymes metabolizing acetylcholine (acetylcholinesterase, AChE, choline acetyltransferase, ChAT) in medulla oblongata (MO) of male pigs with chronic tachycardia-induced cardiomyopathy.

Methods

The mRNA levels of AChE, ChAT, α7nAChR and X-box binding protein 1 (spliced form, XBP1s) in MO were analyzed using qPCR, AChE and ChAT activities using spectrophotometry, proteasome activity using fluorometry, and the protein level of α7nAChR using Western blotting.

Results

The development of systolic HF was accompanied by an increase in circulating catecholamines, a decrease in the AChE and α7nAChR mRNA in MO, an increase in AChE activity (all p < 0.05), and no change in either the mRNA or activity of ChAT. Both circulating catecholamine levels and AChE activity were inversely related to systolic function of left myocardial ventricle (p < 0.05). The level of α7nAChR protein in MO and its cytoplasmatic fraction were higher in pigs with moderate and severe HF as compared to the other animals (p < 0.01). There was no difference in proteasome activity in MO between diseased and healthy animals, whereas the XBP1s mRNA decreased during HF progression (p < 0.05).

Conclusions

Molecular elements of parasympathetic system are changed within the medulla oblongata during the progression of systolic non-ischemic heart failure in male pigs, indicating a functional link between MO and heart in HF.