2型糖尿病患者的抑郁症状与人格特质和运动行为的关系

目的:分析2型糖尿病患者的抑郁症状及其与人格特质、运动行为的关系。方法:选取2型糖尿病患者718人,基于病人健康问卷抑郁自评量表(PHQ-8)、大五人格量表简式版(CBF-PI-B)建立logistic模型,分析抑郁症状与人格特质的关系及运动行为的调节作用。结果:存在抑郁症状的患者161人(22.4%)。神经质与宜人性得分与抑郁症状正向关联(OR=1.08、1.08)。已经开始锻炼、男性、诊断时间较长的患者抑郁症状比例较低(OR=0.44、0.47、0.62),已使用药物/胰岛素的患者抑郁症状比例较高(OR=2.23);参与锻炼会降低神经质与抑郁症状之间的关系(OR=0.95),但对宜人性与抑郁之间的关系无影响(P>0.05)。结论:糖尿病患者的神经质、宜人性与抑郁症状关系密切;参与运动可以有效减弱神经质对抑郁的影响。     

PCI术后并发抑郁症患者血清BDNF、MPO和LP水平变化及意义

目的探究PCI术后并发抑郁症患者血清BDNF、MPO和LP水平变化及其临床意义。方法前瞻性选取2016年4月至2018年3月唐山市第五医院和华北理工大学附属医院救治的124例冠心病患者为研究对象。根据PCI术后是否并发抑郁症将其分为PCI术后抑郁组和PCI术后非抑郁组。检测124例受试者血清BDNF、MPO和LP水平。分析影响冠心病患者PCI术后并发抑郁症的危险因素并探讨血清BDNF、MPO和LP在PCI术后抑郁患者疗效评估中的价值。结果 PCI术后非抑郁组患者血清BDNF、LP水平和受教育时间均高于PCI术后抑郁组患者,血清MPO水平低于PCI术后抑郁组患者,差异均有统计学意义(P <0. 05)。通过二元Logistic回归分析得知,BDNF <5.63ng/mL、LP <9. 83μg/L和受教育时间<9.22年为影响冠心病患者PCI术后并发抑郁症的危险因素。PCI术后抑郁患者血清BDNF、LP水平与HAMD评分均呈负相关。治疗有效组患者血清BDNF、LP水平高于治疗无效组患者,血清MPO水平低于治疗无效组患者,差异均有统计学意义(P<0.05)。BDNF和BDNF+MPO+LP评估PCI术后抑郁患者疗效的价值较高。结论 BDNF、MPO、LP和受教育时间与冠心病患者PCI术后并发抑郁症密切相关。检测血清BDNF、MPO和LP水平有助于了解PCI术后并发抑郁症患者疗效。     

依从性好与依从性差的抑郁症患者对抑郁症人群的外显与内隐刻板印象

目的：探讨依从性好与依从性差的抑郁症患者关于抑郁症人群的外显刻板印象与内隐刻板印象的特征及其关系。方法：选取符合入组条件的依从性好与依从性差的抑郁症患者各40人,所有被试均接受关于抑郁症人群的外显抑郁刻板印象与内隐抑郁刻板印象的测验。结果：①对于依从性好的抑郁症患者,积极外显的刻板印象强度显著高于依从性差的抑郁症患者（F＝6．77,P＜0．01）;消极的外显刻板印象显著低于依从性差的抑郁症患者（F＝10．08,P＜0．01）;②依从性好的抑郁症患者内隐刻板印象显著高于依从性差的抑郁症患者的内隐刻板印象（F＝11．73,P＜0．01）;③相关分析表明,依从性好的患者内隐刻板印象与其积极的外显刻板印象存在统计学差异（r＝0．38,P＝0．02）;依从性差的患者内隐刻板印象与其积极的外显刻板印象存在统计学差异（ r＝0．57,P＝0．00）。结论：依从性好的抑郁症患者存在积极的外显抑郁刻板印象与积极的内隐抑郁刻板印象,依从性差的抑郁症患者存在消极的外显抑郁刻板印象及消极内隐抑郁刻板印象。     

氟西汀在非专科医院的使用

正非专科医院慢性疾病患者抑郁症的比例较高,部分以躯体症状为表现形式的抑郁患者或者否认情绪症状的抑郁患者,大量就诊于非专科医院~([1])。对于非专科医院的患者,未能或者延迟识别抑郁症,会延缓本科疾病的康复与缓解,导致患者频繁就诊﹑误诊及依从性较差,加剧医患之间的紧张关系。所以,必须同时治疗抑郁症,通常可采用药物治疗或药物与心理联合治疗。治疗抑郁症可减少总     

妄想、抑郁与自杀行为的关系

目的：探讨妄想、抑郁与自杀行为的关系。方法：对100例妄想性抑郁症与198例非妄想性抑郁症自杀行的相对危险性是非妄想性抑郁症的3．45倍。结论：妄想性抑郁症的自杀行为较非妄想性抑郁症多见。     

抑郁症患者的述情障碍与焦虑、抑郁的相关性研究

目的 探讨抑郁症患者的述情障碍以及与焦虑、抑郁的关系.方法 采用多伦多述情障碍量表(Toronto Alexithymia Scale, TAS)、Hamilton焦虑量表(Hamilton Anxiety Scale,HAMA)及Hamilton抑郁量表(Hamilton Depression Scale,HAMD)对100例抑郁症患者和100例正常自愿者进行测评,并对述情障碍与焦虑、抑郁作相关分析.结果 抑郁症组TAS评分显著高于正常对照组0=6.86,P＜0.01);其述情障碍的发生率为43%,亦显著高于对照组的11%(x2=25.98,P＜0.01).抑郁症患者的TAS总分及因子Ⅰ、Ⅱ、Ⅳ评分与HAMA及HAMD评分均呈显著性正相关.结论 抑郁症患者存在着明显的述情障碍,并与焦虑、抑郁有关.     

抑郁症患者的成人依恋类型研究

目的:探讨抑郁症患者的依恋类型及其与抑郁情绪之间的关系。方法:对抑郁症门诊医生诊断推荐的抑郁症病人进行国际神经精神科简式访谈问卷(MINI)诊断评估之后,采用贝克抑郁量表(BDI)和亲密关系体验问卷修订版(ECR-R)进行调查。结果:①抑郁症患者依恋类型分布为安全型37例(44%),迷恋型26例(31%),淡漠型15例(17.9%),恐惧型6例(7.1%),ECR-R依恋焦虑维度得分显著高于正常对照组和焦虑障碍组;依恋回避维度得分显著高于正常对照组,与焦虑障碍组无差异。②不安全依恋类型者罹患抑郁症的风险是安全型的3.909倍,其中恐惧型风险最大,是安全型的6.486倍,迷恋型者是5.622倍,淡漠型是2.317倍。③不同依恋类型的抑郁症患者BDI分值差异显著,不安全依恋类型的BDI分值显著高于安全型依恋的BDI分值。结论:抑郁症患者中不安全依恋类型占多数,不安全依恋类型是罹患抑郁症的重要危险因素,其中恐惧型的风险最大。     

米氮平配伍雌激素与单纯雌激素补充治疗更年期抑郁症的对照研究

目的探讨米氮平与雌激素联合治疗更年期抑郁症的疗效.方法更年期抑郁症患者60例,随机分为两组,分别使用米氮平联合雌激素（倍美丽）治疗（观察组）,单用雌激素（倍美丽）治疗（对照组）,疗程8周.采用汉密顿抑郁量表（HAMD）评定疗效.结果治疗8周后观察组HAND评分显著低于对照组;观察组显效率显著高于对照组.结论米氮平联合雌激素治疗更年期抑郁症起效快,效果好.     

生活事件与老年抑郁症复发的关系

目的 探讨生活事件与老年抑郁症复发的关系。方法 对51名首次发作老年抑郁症恢复期患者（首发抑郁组）以及45名非首次发作老年抑郁症恢复期患者（复发抑郁组）使用自制一般情况调查表、老年抑郁量表（GDS）和生活事件量表评定。结果首发老年抑郁组负性生活事件数、负性生活事件总值、家庭有关问题得分、社交及其他问题得分明显高于复发老年抑郁组。工作学习问题两组无显著差异。结论生活事件与老年抑郁症的发病有关,而与复发无关。     

抑郁症患者生活质量与非理性信念

目的 探讨抑郁症患者的非理性信念等因素与生活质量的关系.方法 共入组(40例)抑郁症患者,及与之相匹配的正常对照组40人,对两组均进行生活质量综合评定问卷(GQOLI-74)、非理性量表(第2版)、Beck焦虑量表(BAI)与Beck抑郁问卷(BDI)评定.结果 ①抑郁症患者躯体功能维度、心理功能维度、社会功能维度、生活质量总体评价、生活质量总分研究组显著低于对照组(t=-7.594～-2.433,P＜0.001),物质生活维度分研究组与对照组无明显差异(t=0.628,P=0.532);②抑郁症患者在抑郁焦虑情绪上研究组与对照组存在显著差异(t=8.72、7.18,P＜0.001),在非理性信念中低挫折耐受、概括化评论及糟糕至极3个维度上研究组与对照组存在显著差异(t=4.40、4.80、3.46,P＜0.01);③抑郁、焦虑症状与躯体功能维度,心理功能维度,社会功能维度,生活质量总体评价,生活质量总分存在显著负相关(r=-0.814～-0.684,P＜0.01);非理性信念中糟糕至极、低挫折耐受、概括化评论3个维度均与生活质量中的躯体功能维度,心理功能维度,社会功能维度,生活质量总体评价,生活质量总分存在显著负相关(r=-0.523～-0.382,P＜0.01);④抑郁、焦虑症状与非理性信念中糟糕至极、低挫折耐受、概括化评论3个维度存在显著正相关(r=0.300～0.456,P＜0.01).结论 抑郁症患者生活质量明显低于对照组,患者的某些非理性信念与抑郁焦虑症状以及生活质量的某些维度密切相关.     

Pain and Effusion and Quadriceps Activation and Strength

Context:

Quadriceps dysfunction is a common consequence of knee joint injury and disease, yet its causes remain elusive.

Objective:

To determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion affect the magnitude of quadriceps dysfunction.

Design:

Crossover study.

Setting:

University research laboratory.

Patients or Other Participants:

Fourteen (8 men, 6 women; age = 23.6 ± 4.8 years, height = 170.3 ± 9.16 cm, mass = 72.9 ± 11.84 kg) healthy volunteers.

Intervention(s):

All participants were tested under 4 randomized conditions: normal knee, effused knee, painful knee, and effused and painful knee.

Main Outcome Measure(s):

Quadriceps strength (Nm/kg) and activation (central activation ratio) were assessed after each condition was induced.

Results:

Quadriceps strength and activation were highest under the normal knee condition and differed from the 3 experimental knee conditions (P < .05). No differences were noted among the 3 experimental knee conditions for either variable (P > .05).

Conclusions:

Both pain and effusion led to quadriceps dysfunction, but the interaction of the 2 stimuli did not increase the magnitude of the strength or activation deficits. Therefore, pain and effusion can be considered equally potent in eliciting quadriceps inhibition. Given that pain and effusion accompany numerous knee conditions, the prevalence of quadriceps dysfunction is likely high.Key Words: arthrogenic muscle inhibition, central activation failure, voluntary activation, muscles

Key Points

• Knee pain and effusion resulted in arthrogenic muscle inhibition and weakness of the quadriceps.
• The simultaneous presence of pain and effusion did not increase the magnitude of quadriceps dysfunction.
• To reduce arthrogenic muscle inhibition and improve muscle strength, clinicians should employ interventions that target removing both pain and effusion.

Quadriceps weakness is a common consequence of traumatic knee joint injury^1,2 and chronic degenerative knee joint conditions.^3,4 Arthrogenic muscle inhibition (AMI), a neurologic decline in muscle activation, results in quadriceps weakness and hinders rehabilitation by preventing gains in strength.⁵ The inability to reverse AMI and restore muscle function can lead to decreased physical abilities,⁶ biomechanical deficits,⁷ and possibly reinjury.⁵ Furthermore, researchers^8,9 have suggested that quadriceps weakness resulting from AMI may place patients at risk for developing osteoarthritis in the knee. In light of the substantial influence of quadriceps AMI on these clinically relevant outcomes, we need to improve our understanding of the factors that contribute to this neurologic decline in muscle activity so efforts to target and reverse it can be implemented and gains in strength can be achieved more easily.Joint injury and disease are accompanied by numerous sequelae (ie, pain, swelling, tissue damage, inflammation), so ascertaining which one ultimately leads to neurologic muscle dysfunction is difficult. Whereas a joint effusion can result in AMI,^10–12 the effects of pain are less understood despite many clinicians attributing AMI to pain. Using techniques that introduce knee pain without accompanying injury may provide insights into the role of pain in eliciting AMI.The degree of knee joint damage may play a role in the quantity of AMI that manifests. Hurley et al^13,14 demonstrated that quadriceps AMI, measured using an interpolated-twitch technique, was greater in patients with extensive traumatic knee injury (eg, fractured tibial plateau, ruptured medial collateral ligament, and medial meniscectomy) than patients with isolated joint trauma (ie, isolated anterior cruciate ligament [ACL] rupture). Similarly, patients with more knee joint symptoms (ie, greater number of symptoms and increased severity of symptoms) may present with greater magnitudes of quadriceps inhibition. Recently, investigators¹⁵ have suggested that patients with more pain display less quadriceps strength, supporting this tenet. Given that effusion and pain often present simultaneously with joint injuries and diseases, such as ACL injury and osteoarthritis, examining both the isolated and cumulative effects of these sequelae appears warranted to determine if they influence the magnitude of muscle inhibition.Experimental joint-effusion and pain models are safe and effective experimental methods that allow for the isolated examination of their effects on muscle function. The effusion model, whereby sterile saline is injected directly into the knee joint capsule,⁷ produces a clinically relevant magnitude of the joint effusion that may be present with traumatic injury. Effusion is thought to activate group II afferents responding to stretch or pressure,^16–18 which in turn may facilitate group Ib interneurons and result in quadriceps AMI.⁵ The pain model involves injecting hypertonic saline into the infrapatellar fat pad to produce anteromedial knee pain similar to that described in patients with patellofemoral pain syndrome.¹⁹ Pain is considered to initiate AMI through activation of group III and IV afferents that act as nocioceptors to signal damage or potential damage to joint structures.^16–18 The firing of these afferents then may lead to facilitation of group Ib interneurons, the flexion reflex, or the gamma loop, ultimately resulting in quadriceps inhibition.²⁰ Thus, these models allow us to create symptoms that are associated with knee injury and have the added benefit of providing a way to examine their effects in isolation.Therefore, the purpose of our study was to determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion would affect the magnitude of quadriceps dysfunction. We hypothesized that pain alone would result in quadriceps inhibition and that the magnitude of inhibition would be greater when effusion and pain were present simultaneously.     

即早基因c-fos与脑血管病及学习记忆

即早基因c-fos是广泛存在于原核细胞和真核细胞的高度保守基因.在正常情况下,c-fos基因参与细胞生长、分化、信息传递、学习和记忆等生理过程,而在病理情况下c-fos基因表达及调控变化与多种疾病的发生和发展有关.C-fos在中枢神经系统的某些部位可有基础水平的表达,但表达很低,当受到如脑缺血、脑出血、痫性发作、应激等刺激后,其在数十分钟内做出反应,在对外界刺激-转录耦联的信忠传递过程中起着核内第三信使的重要作用.     

Opportunities and challenges in the prevention and control of cancer and other chronic diseases: children's diet and nutrition and weight and physical activity

OBJECTIVE: The purpose of this article is to review the role of behavioral research in disease prevention and control, with a particular emphasis on lifestyle- and behavior-related cancer and chronic disease risk factors--specifically, relationships among diet and nutrition and weight and physical activity with adult cancer, and tracking developmental origins of these health-promoting and health-compromising behaviors from childhood into adulthood. METHOD: After reviewing the background of the field of cancer prevention and control and establishing plausibility for the role of child health behavior in adult cancer risk, studies selected from the pediatric published literature are reviewed. Articles were retrieved, selected, and summarized to illustrate that results from separate but related fields of study are combinable to yield insights into the prevention and control of cancer and other chronic diseases in adulthood through the conduct of nonintervention and intervention research with children in clinical, public health, and other contexts. RESULTS: As illustrated by the evidence presented in this review, there are numerous reasons (biological, psychological, and social), opportunities (school and community, health care, and family settings), and approaches (nonintervention and intervention) to understand and impact behavior change in children's diet and nutrition and weight and physical activity. CONCLUSIONS: Further development and evaluation of behavioral science intervention protocols conducted with children are necessary to understand the efficacy of these approaches and their public health impact on proximal and distal cancer, cancer-related, and chronic disease outcomes before diffusion. It is clear that more attention should be paid to early life and early developmental phases in cancer prevention.