脑梗塞患者血浆内皮素与肾素──血管紧张素系统动态观察

本文动态观察４０例脑梗塞（ＣＩ）患者血浆内皮素（ＥＴ）及血管紧张素Ⅱ（ＡⅡ）、醛固酮（ＡＬＤ）的变化。结果表现：病程３天内及１０～１４天血浆ＥＴ、ＡⅡ、ＡＬＤ明显高于病程２５～２８天、脑动脉硬化组及正常对照组。病程２５～２８天者与脑动脉硬化组无差异，但二者均高于正常对照组。血浆ＥＴ、ＡⅡ在ＣＩ伴高血压者高于无高血压者，有糖尿病史者高于无糖尿病史者，病情重型者高于病情轻、中型者。病程３天内，血浆ＥＴ与ＡⅡ呈直线正相关。     

载脂蛋白E与脑动脉硬化症

本文观察７８例脑动脉硬化症患者与对照组４４例，对其血清载脂蛋白Ｅ（ＡＰＯＥ）和高密度脂蛋白（ＨＤＬ－Ｃ）、低密度脂蛋白（ＬＤＬ－Ｃ）、胆固醇（ＴＣ）、甘油三脂（ＴＧ）、载脂蛋白ＡＩ（ＡＰＯＡＩ）、载脂蛋白Ｂ（１００）（ＡＰＯＢ（１００））进行含量测定，并将ＡＰＯＥ与ＨＤＬ－Ｃ、ＬＤＬ－Ｃ、ＴＣ、ＴＧ、ＡＰＯＡＩ、ＡＰＯＢ（１００）逐一进行相关比较，结果发现：脑动脉硬化症病人（ＣＡＳ）血清ＡＰＯＥ、ＬＤＬ－Ｃ、ＴＣ、ＴＧ、ＡＰＯＢ（１００）明显高于正常对照组（Ｐ＜０．０１），ＨＤＬ－Ｃ显著低于正常对照组（Ｐ＜０．０１），ＡＰＯＡＩ无明显变化（Ｐ＞０．０５），且ＡＰＯＥ与ＨＤＬ－Ｃ呈负相关；与ＬＤＬ－Ｃ、ＴＣ、ＴＧ、ＡＰＯＢ（１００）呈正相关；与ＡＰＯＡＩ无直线相关关系。提示ＡＰＯＥ可做为诊断脑动脉硬化症的重要指标。     

实验性癫痫大鼠海马结构内一氧化氮-环磷酸鸟苷途径的研究

目的研究实验性癫痫发作大鼠海马结构内一氧化氮（ＮＯ）环磷酸鸟苷（ｃＧＭＰ）信使机制及其意义。方法雄性ＳＤ大鼠４１只，随机分为对照组（５只）、红藻氨酸（ＫＡ）１０、３０、６０分钟组（每组６只）和Ｌ硝基精氨酸甲酯（ＬＮＡＭＥ）＋ＫＡ１０、３０、６０分钟组（每组６只）。用放射免疫法测定ＫＡ诱导性癫痫发作中各时点海马结构内ｃＧＭＰ含量及ＬＮＡＭＥ的干预效应。结果ＫＡ注射引起大鼠海马结构内ｃＧＭＰ浓度升高，并加重大鼠癫痫发作（湿狗样摇动提早出现和发生次数增多）；ＫＡ注射前３０分钟给予ＬＮＡＭＥ可明显抑制ＫＡ１０、３０分钟组ｃＧＭＰ浓度的升高，但ＬＮＡＭＥ对ＫＡ６０分钟组ｃＧＭＰ的抑制作用不显著。结论在ＫＡ发作早期，ｃＧＭＰ浓度升高与内源性ＮＯ有关；ＮＯ的抗发作效应可能与ｃＧＭＰ信使机制存在某种联系。     

兔蛛网膜下腔出血模型内皮素、一氧化氮、环磷鸟苷的测定

研究蛛网膜下腔出血（ＳＡＨ）后血浆中内皮素（ＥＴ）、一氧化氮（ＮＯ）、环磷鸟苷（ｃＧＭＰ）的含量变化。方法用单次杭大地注血法制成兔ＳＡＨ模型。采用生物化学法和放射免疫法，对免ＳＡＨ后１～４ｄ血浆中ＥＴ、ＮＯ、ｃＧＭＰ的含量进行了测定。结果兔ＳＡＨ后２、３、４ｄＥＴ的含量升高，第３天达峰值。ＮＯ含量在ＳＡＨ后第３、４天下降。ＳＡＨ后第４天ＣＧＭＰ含量与正常相比相差显著。结论ＥＴ、ＮＯ、ｃＧＭＰ的含量在ＳＡＨ后发生变化，它们可能参与ＳＡＨ后脑血管痉挛的发生。     

GMP—140与脑血栓形成的关系研究

目的探讨急性脑血栓形成不同时期ＧＭＰ－１４０含量的变化。方法测定３２例急性脑血栓患者病后３ｄ内血浆中ＧＭＰ－１４０、ＳＯＤ和ＭＤＡ的含量，其中２５例患者于病程第１０～１４ｄ再次抽血复查。另选２８例性别、年龄组成相似的动脉硬化患者作为对照。结果与动脉硬化组比较，脑血栓患者急性期血浆中ＧＭＰ－１４０和ＭＤＡ含量显著增高（Ｐ＜０．０５），ＳＯＤ含量显著降低（Ｐ＜０．０５）；至稳定期，脑血栓患者血浆中ＧＭＰ－１４０、ＭＤＡ和ＳＯＤ含量与脑动脉硬化组无显著差异（Ｐ＞０．０５）。结论急性脑血栓形成时ＧＭＰ－１４０含量增高与脑组织损伤有关     

血清ApoE对脑动脉硬化症的诊断价值

本文观察４２例脑动脉硬化症患者与正常对照组４４例，对其血清ＡｐｏＥ和ＨＤＬ－Ｃ、ＬＤＬ－Ｃ、ＴＣ、ＴＧ、ＡｐｏＡＩ、ＡｐｏＢ１００２６含量进行测定，并将ＡｐｏＥ与ＨＤＬ－Ｃ、ＬＤＬ－Ｃ、ＴＣ、ＴＧ、ＡｐｏＡＩ、ＡｐｏＢ１００逐一进行相关比较，结果发现：脑动脉硬化症病人血清ＡｐｏＥ、ＬＤＬ－Ｃ、ＴＣ、ＴＧ、ＡｐｏＢ１００明显高于正常对照组（Ｐ〈０．０１），ＨＤＬ－Ｃ显著低于正常对照组（Ｐ〈０．０１）     

红景天保护缺血再灌注损伤鼠脑细胞的作用及机理研究

目的研究红景天对大鼠脑缺血再灌注损伤的作用。方法４ＶＯ法复制缺血再灌注动物模型;放免法及化学发光法测定乙酰胆碱（Ａｃｈ）、一氧化氮（ＮＯ）及内皮素（ＥＴ）含量;细胞培养观察红景天对神经细胞的作用。结果（１）缺血再灌注组（ＩＲ）Ａｃｈ含量显著低于假手术组（ＳＡＭ）,药物预防后缺血再灌注组（Ｒ＋ＩＲ）及缺血再灌注后药物治疗组（ＩＲ＋Ｒ）较ＩＲ组显著升高。（２）ＩＲ组ＮＯ含量显著高于ＳＡＭ组,Ｒ＋ＩＲ组及ＩＲ＋Ｒ组ＮＯ含量显著降低。（３）ＩＲ组ＥＴ含量显著高于ＳＡＭ组而Ｒ＋ＩＲ组显著降低。（４）红景天甙培养组细胞存活率及ＬＤＨ含量明显高于对照组,ＮＭＤＡ损伤＋红景天甙组细胞存活率明显高于ＮＭＤＡ损伤组,ＬＤＨ含量却明显降低。结论红景天对大鼠脑缺血再灌注损伤时脑神经细胞具有保护作用。     

高血压脑动脉硬化大鼠内皮素及一氧化氮变化的研究

目的　探讨高血压脑动脉硬化时（ Ｅ Ｔ 与 Ｎ Ｏ）变化的特点以及 Ｅ Ｔ、 Ｎ Ｏ 对脑动脉硬化的影响。方法　用双肾双夹法复制出高血压 Ｓ Ｄ 大鼠，持续 １４ 周比较实验组与对照组大脑中动脉及基底动脉的平滑肌厚度，以及测定 Ｅ Ｔ、 Ｎ Ｏ 在血浆中的含量。结果　肾血管狭窄后血压持续升高，至 １４ 周时血压至 ２７．５±３３．５ｋ Ｐａ。大鼠的大脑中动脉及基底动脉平滑肌增厚、管腔狭窄，血管壁有重构。血浆 Ｅ Ｔ 水平明显高于对照组（ Ｐ＜ ０．０１），血浆 Ｎ Ｏ 水平与对照组无显著性差异（ Ｐ＞ ０．０５）。结论　肾脏缺血可引起 Ｅ Ｔ 和 Ｎ Ｏ 合成、分泌明显的不平衡， Ｅ Ｔ 分泌增多、 Ｎ Ｏ 相对分泌不足。这种变化可能是致使长期高血压、脑血管平滑肌增厚及脑动脉硬化的重要因素。     

伴有皮层下梗死和白质脑病的常染色体显性遗传性脑动脉病：附一个家系临床

目的 探讨伴有皮层下梗死和白质脑病的常染色体显性遗传性脑动脉病（ｃｅｒｅｂｒａｌ ａｕｔｏｓｏｍｅ ｄｏｍｉｎａｎｔ ａｒｔｅｒｉｏｐａｔｈｙ ｗｉｔｈ ｓｕｂｃｏｒｔｉｃａｌ ｉｎｆａｒｃｔｓ ａｎｄ ｌｅｕｋｏｅｎｃｅｐｈａｌｏｐａｔｈｙ,ＣＡＤＡＳＩＬ）患者的临床特点和诊断方法。方法 对１例ＣＡＤＡＳＩＬ患者及其亲属的临床表现、影像学（ＭＲＩ、ＣＴ）特点及基因改变等方面进行了系统研究,并针对性地进行了肌肉及神经活检。结果 患者的临床表现为记忆力减退,有脑卒中发作;ＭＲＩ、ＣＴ检查可见多发性梗死、脑白质变性、脑组织活检示小血管玻璃样变、嗜锇颗粒;ＮＯＴＣＨ３第４外显子错义突变以及明确的家族史,没有高血压、动脉硬化,故符合ＣＡＤＡＳＩＬ的诊断标准。结论 本病通过临床特点、影像学改变、基因检测及皮肤活检,可在生     

皮层下动脉硬化性脑病患者免疫功能的变化

采用全血形态法、致敏羊红细胞花环直接法、琼脂单扩散法、死活菌鉴别染色法及聚乙二醇浊度法，对３４例皮层下动脉硬化性脑病（ＳＡＥ）患者及４０例脑动脉硬化症患者进行免疫学研究。结果表明，ＳＡＥ患者及脑动脉硬化症患者外周血ＰＨＡ淋巴细胞转化率及辅助性Ｔ细胞（ＣＤ４）显著降低；ＳＡＥ患者外周血中性粒细胞吞噬率显著降低，而血清ＩｇＡ、ＩｇＭ、Ｃ３、Ｃ４、ＣＩＣ水平显著升高；脑动脉硬化症患者血清ＩｇＧ、ＩｇＡ、Ｃ３、Ｃ４水平亦显著增高。结果提示ＳＡＥ及脑动脉硬化症患者确实存在免疫紊乱现象，且ＳＡＥ患者较脑动脉硬化症患者紊乱更为显著。     

The neuroendocrinology of stress and the pathophysiology and therapy of depression and anxiety

Clinical and preclinical studies have gathered substantial evidence that stress response alterations play a major role in the development of major depression, panic disorder, and post-traumatic stress disorder. The stress response, the hypothalamic pituitary adrenocortical (HPA) system and its modulation by corticotropin-releasing hormones (CRH),corticosteroids,and their receptors, and the roles of natriuretic peptides and neuroactive steroids are described. We review the role of the HPA system in major depression, panic disorder, and post-traumatic stress disorder and its possible relevance for treatment. Impaired glucocorticoid receptor function in major depression is associated with an excessive release of neurohormones such as CRH, to which a number of signs and symptoms characteristic of depression can be ascribed. In panic disorder, a role of central CRH in panic attacks has been suggested. Atrial natriuretic peptide (ANP) is causally involved in sodium lactate-induced panic attacks. Furthermore, preclinical and clinical data on its anxiolytic activity suggest that nonpeptidergic ANP receptor ligands may be potentially useful in the treatment of anxiety disorders. Post-traumatic stress disorder is characterized by a peripheral hyporesponsive HPA system and elevated CRH concentrations in the CSF. This dissociation is probably related to an increased risk of this disorder. We further review recent data that describe an important role of GABA(A)-receptor modulatory,3 alpha-reduced neuroactive steroids in major depression, anxiety, and its treatment. Antidepressants are effective in both depression and anxiety disorders and have major effects on the HPA system,especially on glucocorticoid and mineralocorticoid receptors. Normalization of HPA system abnormalities is a strong predictor of the clinical course, at least in major depression and panic disorder. Currently,CRH-R1 or glucocorticoid receptor antagonists and ANP receptor agonists are being studied and may provide future treatment options more closely related to the pathophysiology of these disorders.     

Polymorphisms of DRD4 and DRD3 and risk of avoidant and obsessive personality traits and disorders

We investigated whether polymorphisms of the dopamine D4 receptor (DRD4) and polymorphisms of the dopamine D3 receptor (DRD3) were associated with personality disorder symptomatology rather than with personality traits such as novelty seeking. DNA was obtained from 145 depressed patients in a clinical trial. These patients were assessed for the presence of personality disorder symptoms and disorders. The 2-repeat allele of the DRD4 exon III polymorphism was associated with increased rates of avoidant and obsessive personality disorder symptomatology. The T,T genotype of the DRD4 -521 C>T polymorphism was also associated with increased rates of avoidant and obsessive personality disorder symptomatology. The Gly9,Gly9 genotype of the DRD3 Ser9Gly polymorphism was associated with increased rates of obsessive personality disorder symptomatology. None of these three polymorphisms were associated with novelty seeking or other temperament traits on the Temperament and Character Inventory. Our results suggest that genetic polymorphisms of DRD4 and DRD3 may well be associated with personality traits, and that conflicting findings to date may arise from the problem of phenotype definition.     

沙盘游戏疗法在地中海贫血患儿心理干预中的应用

本文目的是对沙盘游戏疗法在地中海贫血患儿心理干预中的应用进行综述,以期为地中海贫血患儿的心理康复提供参考。地中海贫血是以珠蛋白生成障碍为主要特征的遗传性疾病,由于长期输血治疗,患儿存在较多的心理和行为问题。沙盘游戏疗法作为一种有效、实用的儿童心理治疗方法,对提高地中海贫血患儿的康复效果、改善生存质量有重要的临床意义。     

癫痫共病抑郁的机制及临床诊疗

本文目的是探讨癫痫共病抑郁的可能机制及临床诊疗。癫痫是一种常见的、慢性的、致残性的神经疾病,癫痫患者生活质量下降,存在明显的负性情绪,常伴发各种精神疾病。癫痫与抑郁具有共同的神经生物学基础,可能存在共同的发病机制。本文从癫痫共病抑郁的发病机制、临床诊断及治疗方面予以总结归纳。     

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.     

Seclusion and restraint and prediction of violence

The authors studied the use of seclusion and restraint on an inpatient unit in a state psychiatric hospital. Of 69 randomly selected inpatients, 51% experienced seclusion or restraint at least once. More psychotic than nonpsychotic patients required seclusion or restraint. However, neither psychosis/nonpsychosis nor voluntary/involuntary admission status predicted the likelihood of violent threats or actions. Patients experiencing seclusion and restraint showed a nonsignificant trend toward longer mean length of stay in the hospital. The frequency of patient behavior leading to seclusion or restraint appeared to be directly related to the stimulation caused by the presence of many staff members and other patients.     

Comparison of trigeminal and spinal modulation of pain and nociception

Modulation of pain and nociception by noxious counterstimulation, also called "diffuse noxious inhibitory controls" or DNIC-like effect, is often used in studies of pain disorders. It can be elicited in the trigeminal and spinal innervation areas, but no study has previously compared effects in both innervation areas. Therefore, we performed a study comparing DNIC-like effects on the nociceptive flexion reflex (NFR) and the nociceptive blink reflex as well as the respective pain sensations. In 50 healthy volunteers, the blink reflex elicited with a concentric electrode and the NFR were recorded before and after immersion of the contralateral hand in cold water. Responses were recorded as the subjective pain sensation and the reflex size. The cold water immersion of the contralateral hand elicited a reduction of both subjective pain sensation and reflex amplitude following the stimulation of both reflexes. However, there were no strong correlations between the individual reductions of both subjective pain sensation and reflex amplitude for both reflexes, and neither when results of the two reflexes were compared with each other. The dissociation between DNIC-like effects on pain and on nociception, which had been found previously already for the NFR, implies that both effects need to be studied separately.