脑梗死急性期血清铁蛋白和心肌酶谱水平的变化及其临床意义

目的　探讨脑梗死患者急性期血清铁蛋白、心肌酶谱水平的变化及其临床意义。方法　检测30例脑梗死急性期(发病7d内)患者(脑梗死组)的血清铁蛋白、心肌酶谱[天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、α- 羟丁酸脱氢酶(α- HBDH)、肌酸激酶(CK)、心肌型肌酸激酶同工酶(CK MB) ],并与正常对照组比较。结果　脑梗死组血清铁蛋白浓度明显高于正常对照组(P<0. 001),血清AST、LDH、а- HBDH、CK水平均高于正常对照组(P<0. 05~0 .001)。结论　脑梗死患者急性期存在明显的血清铁蛋白及心肌酶谱水平升高,观察其变化有助于对病情的判断。     

女性精神分裂症首次发病患者血清心肌酶的临床研究

目的:探讨女性精神分裂症首次发病患者血清心肌酶水平与病情的关系。方法:对63例首次发病的女性精神分裂症患者采用简明精神病评定量表(BPRS)、阳性症状量表(SAPS)及阴性症状量表(SANS)评估病情;同时测定血清乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(α-HBDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)水平。根据心肌酶是否高于正常值分为:观察组(心肌酶增高组)30例和对照组33例(心肌酶正常组)。观察组于治疗4周后复查心肌酶和量表再次评估。结果:治疗前观察组血清LDH、α-HBDH、CK及CK-MB水平均显著高于对照组(P均0.01),其中以CK、CK-MB值增高显著(P均0.001);治疗后明显下降(P均0.01)。治疗前观察组SAPS评分较对照组显著增高,SANS评分较对照组明显降低(P均0.01),BPRS评分两组间差异无统计学意义;治疗后BPRS、SAPS评分显著下降(P均0.01)。观察组SAPS评分与血清CK、CK-MB水平呈正相关(r=0.42,P=0.02;r=0.37;P=0.04)。结论:女性精神分裂症首次发病患者血清心肌酶水平升高,并与病情严重程度及阳性症状密切相关。     

急性CO中毒后迟发性脑病患者脑脊液酶类活性测定的临床意义

目的探讨急性CO中毒后迟发性脑病(DEACMP)患者脑脊液(CSF)酶类变化及临床意义.方法对49例DEACMP患者均在急性期入院3d内抽取CSF标本进行丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶(CK)和神经元特异性烯醇化酶(NSE)活性测定,并与对照组比较.对其中34例于治疗30d后再次采取标本复查,对比分析治疗前后上述酶类的变化.结果患者组急性期CSF LDH、CK、NSE水平均明显高于对照组(P＜0.05,P＜0.01);治疗后明显下降,与治疗前比较均有明显差异(P＜0.05,P＜0.01).患者组与对照组及患者组治疗前后CSF ALT、AST水平无明显差异(P＞0.05).结论结果提示CSFLDH、CK和NSE水平可作为DEACMP病情判断的有效指标.     

急性脑血管病患者的心肌酶谱分析

目的:探讨急性脑血管病患者的心脏损害。方法:对50例急性脑血病患者和25例健康体检者静脉血清天门冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶(CK)、α羟丁酸脱氢酶(α-HBDH)于病后2天内进行检测。结果:血清AST、LDH、cK、α-HBDH水平,急性脑血病组高于对照组(P<0.01).而脑出血组与脑梗死组的患者血清心肌酶水平无明显差异(P>0.05).有意识障碍与无意识障碍患者血清心肌酶谱有显著性差异(P<0.05),CK有非常显著性差异(P<0.01)。结论:急性脑血病患者有心肌酶谱变化,其程度与病变范围及意识障碍程度相一致,与病变的性质无关。     

小儿病毒性脑炎与血清心肌酶谱的相关性分析

目的探讨小儿病毒性脑炎与血清心肌酶谱的相关性。方法选择58例病毒性脑炎患儿为观察组,58例正常儿童为对照组,检测并记录2组血清天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶心型同工酶(CK-MB)及A-羟丁酸脱氢酶(α?HBDH)水平。再分析比较观察组急性期组与恢复期组、轻型脑炎组与重型脑炎组、丙球治疗组与常规治疗组,以及2组心肌酶谱差异。结果病毒性脑炎患儿心肌损害程度不同,病情严重者心肌酶水平越高。本组经丙种球蛋白治疗的丙球组总有效率为94.1%显著高于常规治疗组,差异具有统计学意义(P0.05)。结论临床治疗病毒性脑炎患儿期间可将心肌酶活性作为判定病情与转归的重要指标,可根据患儿心肌酶活性值变化给予针对性治疗。     

脑梗死患者心电图QT离散度和血清心肌酶谱的变化及其意义

目的　探讨脑梗死患者心电图QT离散度 (QTd)和血清心肌酶谱的变化及其意义。方法　对 4 8例脑梗死患者及 4 0例健康者的心电图QTd及血清天冬氨酸转氨酶 (AST)、乳酸脱氢酶 (LDH)、肌酸磷酸激酶(CK)等心肌酶谱进行检测 ,并作对照分析。结果　脑梗死患者QTd明显增加 ,心肌酶谱各指标显著高于对照组 (P <0 0 1或P <0 0 5 )。QTd增加与心肌酶谱多项指标升高呈正相关 (r值分别为 0 375、0 4 2 2、0 6 4 6、0 5 6 9及 0 4 36 )。结论　脑梗死患者心电图QTd及心肌酶谱显著增高。QTd及心肌酶谱检测有助于了解脑梗死病情及心脏受累程度 ,有利于对患者病情的全面评价。     

血清肌酶谱在不同类型肌肉病中的鉴别诊断价值

目的探讨血清肌酶谱在不同类型肌肉病与病毒性肝炎之间的表达差异。方法选择2018年1-9月确诊的578例肌肉病和51例病毒性肝炎患者,检测其血清肌酶谱[肌酸激酶(CK)、乳酸脱氢酶(LDH)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、AST/ALT比值]变化,并比较不同类型肌肉病,以及肌肉病与病毒性肝炎患者血清肌酶谱表达的差异性。结果不同类型肌肉病患者CK(χ~2=107.710,P=0.000)、LDH(χ~2=36.382,P=0.000)、AST(χ~2=47.608,P=0.000)和ALT(χ~2=31.722,P=0.000)差异均有统计学意义,其中,肌营养不良症患者CK和LDH高于炎性肌肉病(Z=9.297,P=0.000;Z=2.475,P=0.040)和代谢性肌肉病(Z=6.765,P=0.000;Z=5.983,P=0.000),AST高于代谢性肌肉病(Z=-5.363,P=0.000),ALT高于炎性肌肉病(Z=5.619,P=0.000);代谢性肌肉病患者LDH亦高于炎性肌肉病(Z=4.590,P=0.000)。肌肉病与病毒性肝炎血清肌酶谱比较,前者CK(Z=-10.975,P=0.000)、LDH(Z=-6.967,P=0.000)和AST/ALT比值(Z=-5.605,P=0.000)升高、ALT降低(Z=3.949,P=0.000);ROC曲线提示,CK、LDH、AST、ALT、AST/ALT比值曲线下面积分别为0.943(95%CI:0.919～0.966,P=0.000)、0.818(95%CI:0.756～0.881,P=0.000)、0.446(95%CI:0.350～0.542,P=0.217)、0.323(95%CI:0.224～0.422,P=0.000)、0.745(95%CI:0.671～0.819,P=0.000),其中CK和AST/ALT比值鉴别诊断肌肉病与病毒性肝炎的灵敏度为0.880和0.512、特异度0.961和0.882、最大Youden指数0.841和0.394。结论不同类型肌肉病患者血清肌酶谱表达变化存在一定规律性,可为肌肉病临床分型提供线索。AST/ALT比值对鉴别诊断肌肉病与病毒性肝炎具有一定提示意义,不明原因肝酶谱升高者应测定血清CK。     

脑膜炎患者脑脊液中肿瘤坏死因子α、乳酸脱氢酶及其同工酶检测的临床意义

目的 探讨脑膜炎患者脑脊液(CSF)中肿瘤坏死因子α(TNF-α)、乳酸脱氢酶(LDH)及其同工酶检测的临床意义.方法 收集53例化脓性脑膜炎患者(化脑组)、58例病毒性脑膜炎患者(病脑组)、49例结核性脑膜炎患者(结脑组)、60例非神经系统感染性疾病患者(对照组)的CSF样本,采用酶联免疫吸附法(ELISA)测定TNF-α水平,采用酶测速率法测定LDH的活性,采用琼脂糖凝胶电泳法测定LDH同工酶含量,并进行比较.结果 3组脑膜炎患者CSF TNF-α含量明显高于对照组[(25.64±20.08)pg/L],其中化脑组[(462.24±368.13)pg/L]明显高于病脑组[(73.47±68.74)pg/L]及结脑组[(62.97+40.58)pg/L](均P＜0.01),病脑组与结脑组间差异无统计学意义.化脑组CSF LDH水平[(201.37±148.06)U/L]显著高于其他各组(均P＜0.01),结脑组[(170.32±86.45)U/L]明显高于病脑组[(79.54±43.71)U/L](P＜0.01);但病脑组[(79.54±43.71)U/L]与对照组[(64.56±49.68)U/L]间差异无统计学意义.化脑组LDH4[(22.83±2.08)U/L]、LDH5[(35.26±2.18)U/L]明显高于其他各组,LDH1[(7.84±1.15)U/L]、LDH2[(13.01±1.46)U/L]明显低于其他各组(均P＜0.01);结脑组LDH3[(29.48±3.24)U/L]较对照组[(16.13±3.95)U/L]明显升高(P＜0.01);而病脑组同工酶谱与对照组比较差异无统计学意义.结论 CSF中TNF-α、LDH及LDH同工酶水平检测有助于不同类型脑膜炎的鉴别诊断.     

多发性硬化患者脑脊液和血清中髓鞘碱蛋白和白介素-16的相关研究

目的　了解多发性硬化 (MS)患者脑脊液 (CSF)和血清髓鞘碱性蛋白 (MBP)和白介素 16 (IL 16 )的水平 ,探讨两者之间的相关性 ,及其在MS发病过程中的作用。方法　采用ELISA法对 31例MS患者CSF和血清的MBP和IL 16进行测定 ,并与 2 4例炎性脱髓鞘性多发性神经病 (IDP)、2 2例对照者进行比较。结果　MS组CSF和血清中的MBP水平均显著高于IDP组及对照组 (均P <0 .0 1) ;CSF中的IL 16的水平显著高于对照组 (P <0 .0 1) ,而血清中IL 16水平与对照组相比无明显差异 (P >0 .0 5 )。MS组中CSF的MBP水平与IL 16水平显著相关 (r=0 .4 6 8,P <0 .0 1) ,但血清中MBP的水平与IL 16水平无相关性 (r=- 0 .131,P >0 0 5 ) ;CSF中MBP水平和血清中MBP的水平有相关性 (r=0 .5 0 5 ,P <0 .0 1) ,CSF中IL 16和血清中IL 16的水平无相关性 (r=0 .0 2 2 ,P >0 .0 5 )。结论　MBP是诱导MS发病的主要自身抗原之一 ,MBP可能主要在中枢神经系统中刺激IL 16的产生 ;而IL 16主要在中枢神经局部产生并起作用     

心肌酶水平检测在成人颅内感染并发癫痫患者中的意义

目的分析成人颅内感染并发癫痫患者的心肌酶含量,探讨其临床价值。方法选取我院收治的癫痫患者150例,颅内感染109例为观察组,其中病毒性脑膜炎46例为观察A组,隐球菌脑膜炎31例为观察B组,结核性脑膜炎32例为观察C组;非颅内感染41例为对照组。检测各组血清心肌酶含量。结果观察组血清AST、CK-MB、LDH、LDH-1、α-HBDH均高于对照组(P0.05);观察A组CK-MB、LDH与B组比较差异无统计学意义(P0.05);观察C组AST、CK-MB与B组比较差异无统计学意义(P0.05)。结论成人颅内感染并发癫痫心肌酶含量与非感染者有所差异,临床检测心肌酶含量对疾病诊治有一定指导作用。     

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.