不同年龄2型糖尿病患者维生素D水平与糖尿病周围神经病变的相关性

目的 探讨不同年龄组2型糖尿病患者25-羟维生素D[25(OH)D]与糖尿病周围神经病变(diabetic peripheral disease,DPN)的相关性.方法 选取589例2型糖尿病患者进行横断面研究,按年龄将入组患者分为青年组(24~44岁)、中年组(45~64岁)、老年组(≥65岁),收集所有患者年龄、性别、病程、吸烟史、家族史、体重指数(BMI)、空腹血糖、空腹胰岛素、三酯甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(HbA1c),25(OH)D等临床资料,根据密歇根神经病变评分系统(MNSI)结合神经电生理检查诊断DPN,并进行统计学分析.结果 3组之间性别、体重指数、吸烟史、家族史、HbA1c、TG、LDL-C、空腹血糖、空腹胰岛素差异均无统计学意义(P>0.05).25(OH)D水平随2型糖尿病患者年龄的增加逐渐下降.青、中年组非DPN患者25(OH)D水平均较DPN患者显著升高(P=0.013;P=0.043),老年组患者DPN与非DPN组之间25(OH)D水平比较差异无统计学意义(P>0.05).二元Logistic回归分析显示低25(OH)D为青、中年2型糖尿病患者DPN的危险因素,在老年患者中差异无统计学意义(P<0.05).结论 25(OH)D是青中年2型糖尿病患者DPN的保护因素,由于25(OH)D在老年组DPN患者中水平较低,未发现维生素D对老年DPN患者存在保护作用.     

帕罗西汀单用及与阿普唑仑联用治疗糖尿病合并焦虑抑郁的对照研究

目的:比较帕罗西汀单用及与阿普唑仑联用治疗糖尿病合并焦虑抑郁的疗效及安全性。方法:选取糖尿病合并焦虑抑郁患者86例,随机均分为观察组和对照组。观察组患者服用帕罗西汀20 mg,qd,并服用阿普唑仑0.4 mg,tid;对照组患者单独服用帕罗西汀。两组患者疗程均为8周。比较两组患者治疗前后空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(Hb A1c)、皮质醇、促肾上腺皮质激素(ACTH)水平及汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评分,并观察不良反应情况。结果:治疗后,观察组患者FPG、2 h PG、Hb A1c、皮质醇、ACTH水平及HAMA、HAMD评分均显著低于对照组及本组治疗前,差异有统计学意义(P<0.05)。两组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论:帕罗西汀联用阿普唑仑治疗糖尿病合并焦虑抑郁相比单用帕罗西汀可更好地改善患者的血糖、内分泌水平及不良情绪,且安全性相当。     

米氮平联合重复高频经颅磁刺激治疗抑郁焦虑共病患者的临床疗效观察

目的探讨米氮平联合重复高频经颅磁刺激(rTMS)治疗抑郁焦虑共病患者的临床疗效。方法 88例抑郁焦虑共病患者,随机分为对照组与研究组,每组44例。对照组给予米氮平治疗,研究组给予米氮平联合重复高频经颅磁刺激治疗。比较两组临床疗效、治疗前后汉密尔顿抑郁量表(HAMD)评分和汉密尔顿焦虑量表(HAMA)评分、不良反应发生情况。结果研究组患者总有效率为90.91%,高于对照组的75.00%,差异具有统计学意义(P<0.05)。治疗后,两组患者HAMD、HAMA评分均低于本组治疗前,且研究组HAMD评分(10.70±1.23)分、HAMA评分(7.46±0.95)分低于对照组的(15.57±2.16)、(11.91±1.44)分,差异具有统计学意义(P<0.05)。两组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论米氮平联合重复高频经颅磁刺激对抑郁焦虑共病患者的抗抑郁焦虑疗效较单独应用米氮平显著,值得广泛推广应用。     

奥氮平联合帕罗西汀治疗产后精神障碍患者的临床疗效

目的:探讨奥氮平联合帕罗西汀对产后精神障碍患者的临床疗效.方法:选取本院2011年8月—2016年8月的56例产后精神障碍患者进行研究,根据数字随机方式分为试验组和对照组,每组28例.对照组给予奥氮平2.5 mg/d,1次/d,治疗1个月,试验组在对照组的基础上加用帕罗西汀20 mg/d,1次/d,治疗1个月,采用汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)对患者的疗效进行评价,采用副反应量表(TESS)评价患者的不良反应,观察两组患者的HAMD、HAMA评分及不良反应.结果:试验组的总有效率(96.4%)明显高于对照组(78.6%),差异具有统计学意义(P<0.05);试验组治疗后的HAMA(10.1±0.2)分、HAMD(11.6±2.5)分,评分明显低于对照组(14.9±2.1)分和(19.3±4.3)分,差异具有统计学意义(P<0.05);试验组发生不良反应率(7.1%)明显低于对照组(17.9%),差异具有统计学意义(P<0.05).结论:奥氮平联合帕罗西汀治疗产后精神障碍患者可以有效改善患者的焦虑和抑郁,安全可靠.     

初发脑梗死后伴发抑郁和焦虑程度与血清中Hcy及IL-2水平的相关性研究

目的 检测初发脑梗死伴抑郁焦虑病人血清血浆同型半胱氨酸(Hcy)、白细胞介素-2(IL-2)水平,分析其相关性.方法选取在该院住院的脑梗死病人200例,采用汉密尔顿焦虑抑郁/焦虑量表(HAMD/HAMA)评价,分为抑郁焦虑组、非抑郁焦虑组,另取健康体检者作为对照组.病人均行常规脑血管病治疗,在此基础上,抑郁焦虑组病人每天口服氟哌噻吨美利曲辛片.酶联免疫吸附法检测入组病人血清Hcy、IL-2水平及HAMD评分,分析抑郁焦虑的严重程度与血清Hcy、IL-2水平的相关性.结果 抑郁焦虑组病人治疗前血清Hcy、IL-2水平、HAMD评分高于非抑郁焦虑组及空白对照组(P<0.05);治疗后抑郁焦虑组及非抑郁焦虑组的血清Hcy、IL-2水平、HAMD评分均较治疗前有所降低,抑郁焦虑组治疗后血清Hcy、IL-2、HAMD评分与非抑郁焦虑组无明显差异(P>0.05);初发脑梗死抑郁组病人的抑郁焦虑严重程度与血清Hcy、IL-2水平呈正相关(P<0.05).结论 初发脑梗死伴焦虑抑郁的病人血清Hcy、IL-2水平明显升高,抑郁焦虑的严重程度与血清Hcy、IL-2水平呈正相关.     

分阶段个体化健康教育在改善骨折患者焦虑抑郁状况中的作用

目的 探讨分阶段个体化健康教育在改善骨折患者焦虑抑郁状况中的作用.方法 选择120例骨折患者,采用随机数字表法分为观察组和对照组各60例,观察组应用分阶段个体化健康教育,对照组应用传统健康教育,应用汉密尔顿焦虑量表（HAMA）和汉密尔顿抑郁量表（HAMD）比较两组患者入院和出院时焦虑和抑郁状况.结果 观察组入院时HAMA评分为（17.12±4.56）分、HAMD评分为（19.67±6.74）分,对照组入院时HAMA评分为（17.08±4.37）分、HAMD评分为（19.35±7.02）分,差异均无统计学意义（t=0.049 1、0.254 7,均P＞0.05）.观察组出院时HAMA评分为（4.57±2.63）分、HAMD评分为（4.31±2.29）分,对照组出院时HAMA评分为（11.28±3.96）分、HAMD评分为（11.56±5.08）分,差异均有统计学意义（t=-10.933 5、-10.078 1,均P＜0.01）.结论 骨折患者入院后均有不同程度焦虑和抑郁情绪,应用分阶段个体化健康教育对于改善骨折患者焦虑抑郁状况具有重要作用,值得临床推广应用.     

补心丸对糖尿病伴抑郁焦虑症患者抑郁症状的影响

目的:观察补心丸对糖尿病伴抑郁焦虑症患者抑郁症状的影响。方法:45例糖尿病伴抑郁焦虑症患者按随机数字表法分为试验组(25例)和观察组(20例)。试验组给予补心丸9 g,口服,tid;观察组患者给氟伏沙明d1-325 mg,d4-650 mg,d775 mg,每晚饭后服用,qd。两组患者疗程均为30 d。另选择20名健康志愿者作为对照组。观察两组患者治疗前后汉密尔顿抑郁量表(HAMD-17)评分、汉密尔顿焦虑量表(HAMA)评分、匹兹堡睡眠质量指数(PSQI)、简易智力状态检查表(MMSE)评分、血清褪黑素水平及不良反应发生情况,并与对照组进行比较。结果:治疗前两组患者HAMD-17评分、HAMA评分、PSQI、血清褪黑素水平比较,差异均无统计学意义(P>0.05),但HAMD-17评分、HAMA评分、PSQI均显著高于对照组,血清褪黑素水平显著低于对照组,差异有统计学意义(P<0.05);治疗后两组患者HAMD-17评分、HAMA评分、PSQI均显著低于同组治疗前,血清褪黑素水平显著高于同组治疗前,差异有统计学意义(P<0.05),但三组间比较除血清褪黑素水平显著高于对照组外(P<0.05),HAMD-17评分、HAMA评分、PSQI、MMSE评分比较,差异均无统计学意义(P>0.05)。试验组患者不良反应发生率显著低于观察组,差异有统计学意义(P<0.05)。结论:补心丸可显著增加糖尿病伴抑郁焦虑症患者血清褪黑素水平,改善患者的抑郁症状,且安全性较好。     

谷维素联合运动疗法治疗神经衰弱患者的临床效果分析

目的 探讨谷维素联合运动疗法治疗神经衰弱患者的临床效果.方法 选取2014年3月至2015年3月我院收治的78例神经衰弱患者,随机分为对照组与观察组,每组39例,对照组给予单纯的心理疏导,观察组在对照组的基础上给予谷维素联合运动疗法治疗.治疗30天后,比较两组的总有效率、汉密尔顿焦虑量表(HAMA)与汉密尔顿抑郁量表(HAMD)评分.结果 观察组的总有效率(93.5％)高于对照组(75.4％),差异具有统计学意义(P＜0.05);治疗前,两组患者的HAMA与HAMD评分差异不具有统计学意义(P＞0.05),治疗后观察组的HAMA(18.21±5.36)与HAMD(20.46±5.62)评分低于对照组的HAMA(23.68 ±4.36)与HAMD(24.41±6.24)评分,差异具有统计学意义(P＜0.05).结论 谷维素联合运动疗法治疗神经衰弱优于单纯的心理治疗,临床效果显著,减少神经衰弱患者的抑郁与焦虑程度,值得在临床上推广使用.     

脑源性神经营养因子基因多态性对帕罗西汀治疗2型糖尿病伴抑郁、焦虑症状患者疗效的影响

目的:探讨脑源性神经营养因子(BDNF)基因多态性对帕罗西汀治疗2型糖尿病伴抑郁、焦虑症状患者疗效的影响。方法:选择52例血糖控制不理想的2型糖尿病伴有抑郁、焦虑症状的患者,测定其BDNF基因类型,并按照基因类型分组,各组患者均在常规降糖治疗基础上使用帕罗西汀,每日晨服1次,每次20 mg,疗程4周。观察并比较各组患者治疗前后汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评分和血糖水平。结果:携带Met/Met基因患者12例,占23.08%;Val/Val基因患者15例,占28.85%;Val/Met基因患者25例,占48.08%。不同基因组患者治疗后抑郁、焦虑症状均有改善,HAMD、HAMA每周的评分与上一周比较,差异均有统计学意义(P<0.01),但组间同期比较差异无统计学意义(P>0.05)。治疗后各组血糖均较治疗前显著下降(P<0.05),但各组间比较差异无统计学意义(P>0.05)。结论:帕罗西汀能有效改善2型糖尿病患者的抑郁、焦虑症状,促进血糖的控制,BDNF基因多态性与帕罗西汀疗效可能无相关性。     

利培酮对焦虑抑郁共病的疗效比较

目的观察利培酮联合氟西汀对焦虑抑郁共病的疗效和安全性。方法86例焦虑抑郁共病患者随机分为研究组(利培酮 氟西汀)44例、对照组(氟西汀)42例,治疗8周。于治疗前、治疗后每2周测评汉密尔顿抑郁量表(HAMD)24项、汉密尔顿焦虑量表(HAMA)、治疗中需处理的不良反应量表(TESS)。疗效评价以HAMD减分率为标准,不良反应以TESS评分为标准。结果两组HAMD、HAMA评分组间比较从第2周周末开始差异有显著性(P<0.05、P<0.01),两组疗效比较差异有显著性(P<0.05),各时期TESS评分比较差异无显著性(P>0.05)。结论利培酮联合氟西汀治疗焦虑抑郁共病的疗效和安全性较好。     

Affective and Anxiety Disorders and Alcohol and Drug Dependence:

Depression and anxiety frequently coexist in patients with substance use disorders. This clinically-oriented article examiens the relationship between these conditions and emphasizes data showing that substances of abuse can cause signs and symptoms of both depression and anxiety. These substance-related syndromes appear to have a different course and prognosis than uncomplicated, independent anxiety and major depressive disorders, and clinicians should consider the role of alcohol and other drugs in all patients presenting with these complaints. The authors will also outline an approach for diagnosing and managing patients with the combination of a substance use and depressive or anxiety disorder.     

Synthesis and anti-nociceptive and anti-inflammatory effects of gaultherin and its analogs

The synthesis of gaultherin (1) and its analogs was carried out to provide 11 glycosides under phase-transfer catalytic conditions. The activities of all synthesized compounds were evaluated by nitric oxide production inhibitory assay in vitro. Methyl 2-O-(4-O-β-d-galactopyranosyl)-β-d-glucopyranosylbenzoate (5f) showed significantly anti-nociceptive and anti-inflammatory effects by the evaluation in vivo. Structure–activity relationships within these compounds were discussed.     

Modelling and simulation of variability and uncertainty in toxicokinetics and pharmacokinetics

Two important methodological issues within the framework of the variability and uncertainty analysis of toxicokinetic and pharmacokinetic systems are discussed: (i) modelling and simulation of the existing physiologic variability in a population; and (ii) modelling and simulation of variability and uncertainty when there is insufficient or not well defined (e.g. small sample, semiquantitative, qualitative and vague) information available. Physiologically based pharmacokinetic models are especially suited for separating and characterising the physiologic variability from the overall variability and uncertainty in the system. Monte Carlo sampling should draw from multivariate distributions, which reflect all levels of existing dependencies in the intact organism. The population characteristics should be taken into account. A fuzzy simulation approach is proposed to model variability and uncertainty when there is semiquantitative, qualitative and vague information about the model parameters and their statistical distributions cannot be defined reliably.     

成骨细胞的功能与损伤和骨质疏松的防治

骨质疏松是一种全身性骨骼疾病,导致骨折风险增加。成人的骨量通过破骨细胞的骨吸收和成骨细胞的骨形成作用来维持动态平衡,治疗骨质疏松症的理想策略是抑制破骨细胞的骨吸收和/或增强成骨细胞的骨形成功能。目前针对保护成骨细胞及增强其功能的骨质疏松疗法相对较少。因此,本文针对成骨细胞相关功能蛋白、各种细胞损伤机制（内质网应激、氧化应激、机械过载、微小RNA和长链非编码RNA的影响等）及骨质疏松的治疗与预防作一综述,以期为针对增强成骨细胞功能的骨质疏松治疗策略提供新思路。     

益生菌与肿瘤防治

益生菌广泛存在于自然界中,通过维持宿主体内菌群平衡、影响肠屏障功能和调节免疫应答等作用,提高宿主健康水平,被公认为"肠道健康卫士".一些益生菌可以增强机体的免疫功能,抑制致癌物质,影响肿瘤细胞的基因表达,对肿瘤具有拮抗作用.大量研究表明,益生菌在未来的肿瘤防治中有很好的应用和发展前景.     

Self-stimulation and amphetamine: Tolerance to d and l isomers and cross tolerance to cocaine and methylphenidate

The effects of the d and l isomers of amphetamine on self-stimulation responding were tested following acute and chronic administration. Tolerance and post-drug depression of responding occurred in tests with both isomers, indicating no role for p-hydroxynorephedrine (PHN) which is one of the metabolites of d-amphetamine. In the second experiment, d-amphetamine, methylphenidate and cocaine all produced quantitatively and qualitatively similar effects on self-stimulation responding following acute administration. Following chronic administration of d-amphetamine, animals showed tolerance to all three drugs, indicating cross-tolerance among them. These data are consistent with an hypothesis that tolerance and post-drug depression following chronic amphetamine treatment are the result of decreases in postsynaptic receptor sensitivity, which would lead to a decreased effectiveness of all three drugs, regardless of their pre-synaptic mechanisms.     

Acamprosate and naltrexone treatment effects on ethanol and sucrose seeking and intake in ethanol-dependent and nondependent rats

Rationale  Two pharmacotherapies are approved for treating alcohol craving (acamprosate and naltrexone), but both have shown mixed findings in animals and humans. Objectives  The present experiments utilized a “reinforcer blocking” approach (i.e., rats were able to consume ethanol during treatment) to better understand the efficacy of these treatments for ethanol seeking and drinking using ethanol-dependent and nondependent rats. Materials and methods  In “nondependent” experiments, drugs (acamprosate 50, 100, and 200 mg/kg; naltrexone 0.1, 0.3, and 1.0 mg/kg) were administered over 3-week periods prior to operant sessions with a low response requirement to gain access to reinforcers for 20 min. For “dependent” experiments, rats were made dependent in vapor/inhalation chambers. Results  Acamprosate and naltrexone had similar effects on intake in nondependent and dependent rats; neither drug was selective for ethanol over sucrose drinking. In nondependent animals, naltrexone was more efficacious at more doses than acamprosate, and acamprosate’s effects were limited to a dose that also had adverse effects on body weight. Both pharmacotherapies showed more selectivity when examining reinforcer seeking. In nondependent rats, acamprosate and naltrexone had response-attenuating effects in ethanol, but not sucrose, groups. In dependent animals, acamprosate had selective effects limited to a decrease in sucrose seeking. Naltrexone, however, selectively decreased ethanol-seeking in nondependent rats. Conclusions  The naltrexone-induced decreases in seeking suggested a change in incentive motivation which was selective for ethanol in nondependent rats. The “nondependent” paradigm may model early stages of “problem drinking” in humans, and the findings suggest that naltrexone could be a good intervention for this level of alcohol abuse and relapse prevention.     

Antiinfective and encrustation-inhibiting materials--myth and facts

Catheters, urethral and ureteral stents and other urological implants are frequently affected by encrustration and infection due to their permanent contact with urine. Indwelling urinary catheters provide a haven for microorganisms and thus require extensive monitoring. Several surface modification techniques have been proposed to improve the performance of devices including the immobilization of biomolecules, the incorporation of hydrophilic grafts to reduce protein adsorption, the creation of hydrophobic surfaces, the creation of microdomains to regulate cellular and protein adhesion, new polymers and antimicrobial coatings. Physico-chemical explanation to elucidate the mechanism of such encrustation or infection inhibiting materials is still not available. Our series of experiments showed a marked decrease of silver-activity in biological fluids which corresponds with the controversial clinical results obtained with silver coated urinary catheters. Rifampicin/minocycline coated catheters had very low activity against Gram-negative rods, enterococci and Candida spp., the main causing organisms of urinary catheter infection. Surface engineered materials and antimicrobial drug delivery systems will be the next generation of sophisticated urinary catheters and stents, if both efficacy as well as efficiency has been proved clinically.     

Alprazolam and lorazepam single and multiple-dose effects on psychomotor skills and sleep

Summary The effects of alprazolam 0.5 mg and lorazepam 2 mg on cognitive and psychomotor skills were assessed in twelve normal volunteer subjects in a randomised, double-blind, crossover design. Single and multiple dose effects were monitored using a battery of tests comprising critical flicker fusion threshold (CFFT), choice reaction time (CRT), simulated car tracking, and subjective ratings of perceived sedation (LARS) and of sleep behaviour (LSEQ). Compared with placebo baseline scores, treatment with lorazepam 2 mg (both single and multiple doses) resulted in a widespread impairment of CRT, tracking accuracy, and CFFT. Single doses of alprazolam 0.5 mg reduced CFFT with respect to the placebo baseline. Single and multiple dose treatment with both drugs resulted in subjective reports of sedation, a reduction of sleep onset latency, and improved sleep quality. Only lorazepam 2 mg significantly disrupted the integrity of behaviour on waking from sleep. These results suggest important pharmacodynamic differences between the two drugs in the doses used.