血清FT3水平与急性脑梗死患者颅内外动脉粥样硬化及狭窄的关系

目的 探讨FT3 水平与急性脑梗死患者颅内外动脉粥样硬化及狭窄的关系。方法 选择 急性脑梗死148 例为试验组，同期入院非急性脑梗死无脑动脉硬化97 例为对照组，比较组间一般临床 特征，将P＜ 0.05 各变量纳入回归分析。据动脉硬化部位、程度将试验组分为不同亚组，比较组间FT3 水平。结果 急性脑梗死患者FT3、TSH水平明显低于对照组（P ＜ 0.05）； Logistic 回归分析结果显示， FT3 为急性脑梗死的保护性因素（OR=0.060，95%CI=0.019～0.191，P＜ 0.001）及急性脑梗死动脉硬化的 独立保护性因素（OR=0.049，95%CI=0.015~0.157，P＜ 0.001）。颅内不同动脉硬化部位以及程度、颈动脉 不同动脉硬化程度组间比较，差异无统计学意义（P＞ 0.05），随着颈动脉狭窄程度越重，FT3 水平有下降 的趋势。结论 急性脑梗死患者FT3 水平下降，FT3 是急性脑梗死的保护性因素；FT3 水平与急性脑梗 死颅内狭窄部位、程度以及颈动脉狭窄程度无关。     

老年脑梗死患者颅内外大动脉粥样硬化性狭窄与不同血糖水平代谢综合征的相关性

目的：评价老年脑梗死患者颅内外动脉粥样硬化性狭窄与不同血糖水平代谢综合征（metabolic syndrome , MetSyn）的相关性。方法收集461例老年脑梗死患者,依据磁共振血管成像（MRA）和（或）经颅多普勒超声（TCD）查看颅内外动脉粥样硬化有无狭窄分为狭窄组、非狭窄组。按照IDF的诊断标准明确MetSyn各组的发生率,根据糖耐量试验（OG‐TT）分为伴糖尿病（DM）、高血糖和糖耐量正常的MetSyn ,分析不同血糖水平MetSyn与老年脑梗死患者颅内外动脉粥样硬化性狭窄的相关性。结果狭窄组老年脑梗死患者MetSyn的发生率61.36％,高于非狭窄组的50.00％（P＜0.05）。Logis‐tic回归分析显示：MetSyn增加老年脑梗死患者颅内外动脉粥样硬化性狭窄病变的风险（OR＝1.56,P＜0.05）;但在调整MetSyn各组分危险因素,MetSyn与之无相关性（OR＝1.07,P＝0.731）,而与之相关的独立危险因素依次是DM、高血压、低高密度脂蛋白血症（OR分别为1.62、1.58、1.56,P均＜0.05）。不同血糖水平MetSyn分别进行Logistic回归分析,伴DM 的MetSyn与老年脑梗死患者颅内外动脉粥样硬化性狭窄相关（OR＝1.74,P＜0.05）;伴糖耐量正常的 MetSyn、伴高血糖的MetSyn不增加颅内外动脉粥样硬化性狭窄的风险（OR＝1.80、0.084,P＝1.34、0.189）。结论 MetSyn通过DM、HT、低HDL‐C血症等增加老年脑梗死患者颅内外动脉粥样硬化性狭窄的风险,而不是其独立的危险因素。伴DM 的MetSyn是颅内外动脉粥样硬化性狭窄脑梗死患者的独立危险因素。     

急性缺血性卒中患者颅内动脉粥样硬化性狭窄与不同血糖水平代谢综合征的相关性分析

目的 探讨急性缺血性卒中患者颅内动脉粥样硬化性狭窄与不同血糖水平代谢综合征的相关性。 方法 选取2013年6月-2016年6月入住本院神经内科的急性缺血性卒中患者352例为研究对象,根 据颅内血管狭窄情况分为狭窄组227例和非狭窄组125例;选取同期非颅内动脉粥样硬化性狭窄体检 者310例为对照组。研究对象中合并代谢综合征的患者分为3个亚组：糖耐量正常组、伴糖尿病组、伴 高血糖组（包括空腹血糖受损、糖耐量降低）。同时测定代谢综合征患者血脂水平,分析不同血糖 水平代谢综合征与颅内动脉粥样硬化性狭窄的相关性。 结果 352例急性缺血性卒中患者共确诊代谢综合征195例（55.39%）,其中狭窄组和非狭窄组代谢 综合征的发生率均明显高于对照组,比较差异有显著性（P <0.05）;狭窄组代谢综合征的发生率明显 高于非狭窄组,比较差异有显著性（P <0.05）。狭窄组中伴糖尿病的代谢综合征患者比例明显高于非 狭窄组和对照组,比较差异有显著性（P <0.05）;狭窄组中伴高血糖和糖耐量正常的代谢综合征患 者比例与非狭窄组比较,差异均无显著性（P＞0.05）。Logistic回归分析显示：代谢综合征与颅内动脉 粥样硬化性狭窄存在明显相关性;代谢综合征伴糖尿病、伴低高密度脂蛋白（high density lipoprotein, HDL）、高甘油三酯（triglyceride,TG）与颅内动脉粥样硬化性狭窄发生风险呈明显正相关。 结论 在急性缺血性卒中患者中,代谢综合征尤其是糖尿病、高TG血症及低HDL血症和颅内动脉粥 样硬化性狭窄密切相关。     

血清CysC对缺血性卒中患者颅内外动脉粥样硬化性病变的影响

目的探讨血清胱抑素C(CysC)与缺血性卒中患者颅内外动脉粥样硬化性病变的关系。方法选取2013-03—2014-09于我院住院治疗的缺血性卒中患者130例,均行头颅高分辨CT血管造影(CTA)、胱抑素C和常规生化检查。根据血管病变程度、部位及斑块性质进行分组,分别比较各组间血清CysC水平。根据血清CysC水平分为血清CysC正常组和高血清CysC组,将2组间颅内外动脉发生狭窄的例数进行比较。结果颅内外动脉狭窄组血清CysC水平显著高于无颅内外动脉狭窄组(P<0.05);与重度狭窄及闭塞组相比较,轻度狭窄组及中度狭窄组CysC水平较低,差异有统计学意义(P<0.05);与无斑块组相比,稳定斑块及不稳定斑块组的血清CysC值显著升高(P<0.05)。与CysC正常组相比,高CysC组中颅内外动脉狭窄率为87.18%,较正常CysC组(57.14%)显著升高(P<0.05)。Logistis多元回归分析显示,CysC水平升高是颅内外动脉粥样硬化性病变的独立危险因素。结论血清CysC水平升高与颅内外动脉粥样硬化的严重程度密切相关,是颅内外动脉粥样硬化性病变的独立危险因素。     

Lp-PLA2对颅内外动脉粥样硬化性狭窄的预测价值

目的 研究脂蛋白相关磷脂酶A2(Lp-PLA2)对急性脑梗死患者合并颅内外动脉粥样硬化性狭窄的预测价值。方法 回顾性收集2019年5月至2022年4月就诊于山东省千佛山医院神经内科的1 045例急性脑梗死患者的临床资料，根据患者的性别及血管狭窄部位分为男性无血管狭窄组(n=282)、男性颅内动脉狭窄组(n=265)、男性颅外动脉狭窄组(n=105)、女性无血管狭窄组(n=173)、女性颅内动脉狭窄组(n=156)、女性颅外动脉狭窄组(n=64)。采用多因素Logistic回归分析Lp-PLA2与颅内外血管狭窄的相关性。结果 不同年龄、性别、卒中史、冠心病史、同型半胱氨酸水平患者的Lp-PLA2水平比较，差异均有统计学意义(均P<0.05)。3组男性患者的不同Lp-PLA2水平的患者占比比较，差异有统计学意义(χ²=65.276,P<0.01)。3组女性患者的Lp-PLA2水平患者占比比较，差异无统计学意义(χ²=7.061,P>0.05)。多因素Logistic回归分析结果显示，Lp-PLA2水平为520.3～606.5 I...     

急性脑梗死患者血清氧化型低密度脂蛋白水平变化及其与TOAST分型的关系

目的：探讨脑梗死患者血清氧化型低密度脂蛋白（oxLDL）水平变化及其与脑梗死的TOAST病因学分型之间的关系。方法：应用酶联免疫吸附法（ELISA）检测70例急性脑梗死患者血清oxLDL水平，按TOAST分型进行分组，对各亚组与52例健康对照组进行比较。结果：所有急性脑梗死患者、大动脉粥样硬化性卒中组及小动脉闭塞性卒中组血清oxLDL均较对照组显著增高（P均〈0．01）；大动脉粥样硬化性卒中组血清oxLDL水平显著高于其他亚组（P均〈0．01）。结论：血清oxLDL在脑梗死急性期升高，并与TOAST分型中的大动脉粥样硬化性卒中等类型关系紧密，可作为脑梗死急性期的血清标志物之一，提示斑块不稳定。     

缺血性卒中患者颅内外动脉狭窄与高血压、糖尿病的研究

目的 探讨缺血性卒中患者的颅内外动脉狭窄特点及程度与高血压病、糖尿病的病史及控制水平的 关系。 方法 回顾性分析住院治疗的存在颅内外动脉狭窄且并发高血压或糖尿病的大动脉粥样硬化性急 性缺血性卒中患者资料。将高血压患者分为高年限组（病史>5年）和低年限组（病史≤5年）,血压 控制良好组和不良组;将糖尿病患者也分为高年限组（病史>5年）和低年限组（病史≤5年）,血糖 控制良好组和不良组。比较不同组间颅内外动脉狭窄分布情况、血管狭窄程度。 结果 共入组216例急性缺血性卒中患者,其中57例颅外动脉狭窄,105例颅内动脉狭窄,54例颅内 外动脉均狭窄。轻度狭窄发生73例,中度狭窄发生101例,重度狭窄及闭塞发生42例。高血压病患者 共140例,高年限组动脉狭窄最常见于颅内动脉（54.5%）,低年限组血管狭窄的部位多见于颅外动脉 （51.3%）,差异有统计学意义（P＜0.001）。两组间动脉狭窄程度差异也有统计学意义。糖尿病患者共 76例,高年限组发生动脉狭窄最常见于颅内动脉（72.2%）,低年限组血管狭窄的部位多见于颅外动脉 （65%）,差异有统计学意义,两组间动脉狭窄程度差异也有统计学意义。高血压控制不良组发生重度 狭窄或闭塞的概率高于血压控制良好组（20.7% vs 8.6%）;血糖控制情况不良组发生重度狭窄或闭 塞的概率高于血糖控制良好组（40.9% vs 6.3%）。 结论 随着高血压病年限的增长,急性缺血性卒中患者颅内动脉狭窄的发生率增高,其中以中度狭 窄程度多见;血压控制不良的患者发生重度狭窄或闭塞的比率高。随着糖尿病年限的增长,颅内动 脉狭窄的发生率增高,其中以中度狭窄程度多见,血糖控制不良者发生重度狭窄或闭塞的比例高。     

动脉粥样硬化性脑血栓形成患者调节性T细胞和转化生长因子-β1水平测定及临床意义

目的 探讨动脉粥样硬化性脑血栓形成患者的外周血CD4＋CD25＋T细胞数目变化及血清转化生长因子-β1（TGF-β1）的可能关系.方法 行头颅CT或MRI,根据Pullicino公式（长×宽×CT或MRI扫描阳性层数/2）计算脑梗死体积.将152例患者分为大面积脑梗死组（≥10 cm3）48例;小面积脑梗死组（＜10 cm3）82例;短暂性脑缺血发作（TIA）组22例;同时选取健康志愿者52例为对照组.采用流式细胞仪检测发病48 h内（急性期）患者的外周血调节性T细胞;酶联免疫吸附法（ELISA）检测血清TGF-β1浓度.比较各组调节性T细胞和TGF-β1水平差异.结果 大面积脑梗死组TGF-β1和调节性T细胞水平较小面积脑梗死组、TIA组和对照组明显降低（P＜0.05）;小面积脑梗死组TGF-β1和调节性T细胞水平明显低于TIA组及对照组（P＜0.05）; TIA组与对照组比较差异无统计学意义（P＞0.05）.美国国立卫生研究院卒中量表评分≥7分组血清TGF-β1和调节性T细胞水平明显低于＜7分组（P＜0.05）.结论 TGF-β1和调节性T细胞与脑梗死面积有关,急性期梗死面积越大的患者TGF-β1和调节性T细胞越低.     

缺血性卒中患者左心室质量指数与颅内、外动脉狭窄的相关性

目的 探讨左心室质量指数（left ventricular mass index,LVMI）与颅内外动脉粥样硬化狭窄程度的 关系。 方法 从东部战区总医院南京卒中登记系统纳入2017年1-10月间进行超声心动图和DSA检查的缺血 性卒中患者。对颅外和颅内动脉粥样硬化性狭窄程度进行评估,分为动脉轻度狭窄组和动脉中重度 狭窄组。LVMI根据美国超声心动图协会标准计算。在颅外和颅内动脉粥样狭窄患者中分别比较动脉 轻度狭窄和中重度狭窄组传统脑动脉粥样硬化的危险因素,如年龄、性别、高血压、糖尿病、冠状动 脉硬化心脏病、血脂及左心室质量（left ventricular mass,LVM）和LVMI。单因素分析及二元回归分析 影响颅内外动脉粥样硬化狭窄程度的独立危险因素并对LVMI与颅内外动脉狭窄率进行相关性分析。 结果 169例登记患者中,85例（50.3%）为颅外动脉粥样硬化性狭窄,84例（49.7%）为颅内动 脉粥样硬化狭窄。在颅外动脉粥样硬化性狭窄患者中,中重度狭窄患者年龄比轻度狭窄患者大 [（64.3±12.4）岁 vs（56.0±13.2）岁,P =0.001],LVMI较轻度狭窄患者高[（43.6±10.3）g/m2.7 vs （36.6±7.2）g/m2.7,P <0.001]。在颅内动脉粥样硬化性狭窄患者中,轻度狭窄患者LVMI低于中重度狭 窄患者（[ 36.5±7.2）g/m2.7 vs（46.1±13.6）g/m2.7,P <0.001]。Spearman相关分析结果表明LVMI与颅内 外动脉狭窄率呈正相关（r=0.553,P<0.001）。二元回归分析发现LVM（I OR 1.13,95%CI 1.05～1.21）、 年龄（OR 1.06,95%CI 1.01～1.11）是颅外动脉粥样硬化性重度狭窄的独立危险因素。 结论 缺血性卒中患者LVMI与颅内外动脉粥样硬化性狭窄率正相关,LVMI是颅外动脉粥样硬化性重 度狭窄的独立危险因素。     

非高密度脂蛋白胆固醇(non-HDL-C)与颅内外动脉硬化狭窄的关系

目的探讨中国人群非高密度脂蛋白胆固醇(non-HDL-C)与颅内外动脉硬化狭窄的关系。方法选急性脑梗死266例为实验组,同期入院无脑动脉硬化65例为对照组,比较组间一般临床特征,将P0.05各变量纳入多元回归分析。据动脉硬化部位、程度及斑块类型将实验组分为不同亚组,比较组间non-HDL-C水平。结果颅内外动脉硬化各组non-HDL-C与对照组比较P0.05,差异具有统计学意义;多元Logistic回归分析,nonHDL-C在校正其它相关危险因素后(OR值=3.8,95%CI:2.21-6.54,P0.001);不同动脉硬化部位、硬化程度组间non-HDL-C比较P0.05,差异无统计学意义;颈动脉不同斑块类型组间non-HDL-C比较P0.05,差异具有统计学意义。结论 non-HDL-C是颅内外动脉硬化的危险因素,可能成为颅内动脉硬化的独立危险因素;non-HDL-C与颅内外动脉硬化部位及程度无相关性;non-HDL-C与颈动脉硬化斑块稳定性有关。     

Physical and Sexual Abuse and Neglect and Eating Disorder Symptoms

For eating-disordered patients with a history of post-traumatic stress, childhood abuse and neglect, and dissociative disorder, eating behavior symptoms may function as a rational response to unmetabolized traumatic experiences. This paper will review trauma-based theory, dissociation, abreactive, and ego-states therapy as they apply to eating disorder patients.     

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.     

Presence and severity of anorexia and bulimia among male and female Omani and non-Omani adolescents

OBJECTIVE: The population of Oman is a heterogeneous mix of nationalities providing a natural setting for studying the cross-cultural differences in the presence and severity of eating disorders as well as an opportunity for evaluating the performance of measurement instruments for these disorders. METHOD: Disordered eating screening instruments (the Eating Attitude Test and the Bulimic Investigatory Test) were administered to Omani teenagers, non-Omani teenagers, and Omani adults. RESULTS: On the Eating Attitude Test, 33% of Omani teenagers (29.4% females and 36.4% males) and 9% of non-Omani teenagers (7.5% of males and 10.6% females) showed a propensity for anorexic-like behavior. On the Bulimic Investigatory Test, 12.3% of Omani teenagers showed a propensity for binge eating or bulimia (13.7% females and 10.9% males). Among the non-Omani teenagers, 18.4% showed a tendency toward bulimia, with females showing a slightly greater tendency than males. In contrast, barely 2% of Omani adults showed either a presence of or a severity of disorderly behavior with food. CONCLUSION: Omani teenagers scored significantly higher than other ethnic groups and Omani adults. This finding is discussed in the light of emerging evidence from many parts of the world suggesting that cultural transition, compounded by demographic constraints, plays a significant role in abnormal eating attitudes.     

Physical and Sexual Abuse and Neglect and Eating Disorder Symptoms

Abstract

For eating-disordered patients with a history of post-traumatic stress, childhood abuse and neglect, and dissociative disorder, eating behavior symptoms may function as a rational response to unmetabolized traumatic experiences. This paper will review trauma-based theory, dissociation, abreactive, and ego-states therapy as they apply to eating disorder patients.     

Micro-affirmations and Recovery for Persons with Mental Health and Alcohol and Drug Problems: User and Professional Experience-Based Practice and Knowledge

Recurrent factors contributing to a recovery process from co-occurring mental health and addiction problems mentioned by users and professionals have been analyzed as part of working alliances and helpful relationships. Still, we lack knowledge about how helpful relationships are developed in daily practice. In this article, we focus on the concrete construction of professional helpful relationships. Forty persons in recovery and fifteen professionals were interviewed. The interviews were analyzed according to thematic analysis, resulting in three themes presented as paradoxes (1) My own decision, but with the help of others; (2) The need for structures and going beyond them; and (3) Small trivial things of great importance. Micro-affirmations have a central role in creating helpful relationships by confirming the individuals involved as more than solely users or professionals. More attention and appreciation should be paid to practices involving micro-affirmations.

     

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.