糖尿病与抑郁症

糖尿病和抑郁症均为比较严重的慢性疾病,不同程度地威胁着人们的健康.流行病学资料显示糖尿病合并抑郁症的人群日益增加,糖尿病患者罹患抑郁症的几率明显高于一般人群.国内外学者针对糖尿病合并抑郁症的相关危险因素、相互关系、生物学和症状相关性开展了大量的研究.该文对上述研究结果作一综述,以提高对糖尿病人群发生抑郁症的警惕性,早期...     

抑郁症合并代谢性疾病的共病机制及其治疗药物的研究进展

抑郁症是严重危害人类身心健康的常见病,随着"生物–心理–社会"的现代医学模式转变,发现其常与其他重大疾病如糖尿病、高血脂、心脏病、高血压等代谢综合征组分并存,合并疾病发病率高且预后不良,以及造成对家庭和社会的高负担,关于其发病机制和防治措施的研究方兴未艾。抑郁症和代谢性疾病的发病可能存在一定共病基础和因果关系,旨在重点探讨脂质代谢紊乱和血管内皮功能障碍在抑郁症合并代谢性疾病的病理发展和共病机制中的作用,同时归纳总结现有治疗药物对脂质代谢异常和内皮功能障碍的影响,为临床用药的优选及其共病患者的治疗方式提供综述基础。     

糖尿病共病抑郁患者尿液挥发性有机化合物分析

目的 比较糖尿病患者与糖尿病共病抑郁患者尿液挥发性有机化合物(VOCs)的差别。方法 纳入2019年11月至2020年11月在上海交通大学附属第六人民医院南院住院治疗,并符合防治指南诊断标准的2型糖尿病患者,利用PHQ9量表进行抑郁症筛查,根据评分将纳入研究的患者分为两组,分别为单纯糖尿病组和糖尿病共病抑郁组。采集患者晨尿,利用微型气体测试装置检测尿液中的挥发性有机化合物。结果 纳入研究患者合计161例,其中单纯糖尿病组141例,糖尿病共病抑郁组20例。微型气体测试装置灵敏度为80%,特异性为98%,准确性为92.8%。两组患者的尿液挥发性有机化合物存在差异。结论 糖尿病共病抑郁患者与糖尿病患者相比,尿液中的挥发性有机化合物组成可能发生改变,可为临床早期诊断抑郁症提供实验参考。     

糖尿病抑郁共病治疗管理研究进展

糖尿病患者有较高的抑郁症患病风险,可对患者的主观幸福感和生活质量产生不利影响,并可能增加降糖治疗不顺从性。糖尿病患者的抑郁可通过心理治疗及药物方式得到有效缓解,及时有效地治疗抑郁症可以显著提高糖尿病患者的生活质量,减轻患者的心理负担,促进降糖治疗的有效开展。针对糖尿病抑郁共病的相关危险因素、共病诊断、慢性病治疗管理等方面的研究进展作一综述。     

糖尿病伴发抑郁状态的病情评估与抑郁治疗现状

糖尿病伴发的抑郁状态是指与抑郁症存在相似之处,但又不同于抑郁症的一种疾病状态。在临床上,糖尿病患者需常年用药,承受巨大心理压力与经济压力,容易伴发抑郁状态。迄今为止,没有专门适用于糖尿病伴发抑郁状态的患者的用药指南,多数相关性指南仅推荐需及时关注糖尿病患者的精神状态。本文主要阐述了糖尿病与抑郁状态间的相关性,探讨了对糖尿病患者进行精神状态评分与分期的方法,以及糖尿病患者的抗抑郁的治疗药物。     

脑胰相关蛋白（BPRP）的生物学研究及药物的作用

神经系统疾病与某些内分泌系统，及其它系统的功能紊乱之间存在着复杂的关系。某些神经系统疾病，如脑缺血损伤、老年痴呆、巴金森氏病、Huntington＇s病等，均表现有神经的退行性变。而一些最新的研究表明胰岛功能与上述神经退行性疾病的发生和发展有关。另有报道认为抑郁症的病人易发生糖尿病，而糖尿病病人更易发生抑郁症。     

抑郁症与糖尿病共病的临床特征与治疗反应的对照研究

目的 探讨抑郁症糖尿病共病的临床特征以及治疗反应.方法 研究对象为2006年1月至2008年1月在河北医科大学精神卫生研究所住院的抑郁症患者,其中抑郁症合并2型糖尿病患者32例,设为共病组;并随机抽取未合并糖尿病的抑郁症患者19例,设为非共病组.疗前采用17项汉密尔顿抑郁量表(HAMD-17)评定抑郁的严重程度,并评估体重指数、血压、血脂水平.随后对两组患者采用西酞普兰片(喜普妙)进行治疗,治疗剂量和疗程均相同,治疗后采用HAMD减分率评价两组疗效.并测共病组疗后的HbA1c水平,按照HbA1c水平再将共病组分为HbA1c达标组(HbA1c＜6.5%,N＝19)和HbA1c不达标组(HbA1c≥6.5%,N＝10)两个亚组,并进行两个亚组的疗效比较.结果 ①共病组脱落3例,非共病组脱落2例.共病组的疗前体重指数、甘油三酯水平、HAMD得分[(24.10±2.08),(6.30±0.98),(32.41±9.54)]均高于非共病组[(21.57±6.24),(4.34±0.93),(22.71±10.32),P＜0.05)];②治疗后共病组有效率(65.5%)明显低于非共病组(94.1%)(χ2=7.688,P＜0.05),共病组痊愈率(41.4%)明显低于非共病组(82.4%)(χ2=5.749,P＜0.05).③共病组中HbA1c达标组有效率(68.4%)和HbA1c不达标组(70.0%)相比,没有明显差异(χ2=0.112,P=0.738),但HbA1c达标组痊愈率(63.2%)明显高于HbA1c不达标组(10.0%)(χ2=5.491,P＜0.05).结论 抑郁症糖尿病共病患者治疗前抑郁程度较重,治疗反应明显低于非共病组,血糖控制不良的共病患者治愈率低.     

磷酸二酯酶4抑制剂对阿尔茨海默病、抑郁症及二者共病的潜在治疗作用及其机制研究进展

磷酸二酯酶4(PDE4)作为PDE家族中数量最多的一类成员,特异性水解细胞内第二信使环磷酸腺苷（cAMP）,并参与多种生理功能的调节,在中枢神经系统疾病的发生发展中发挥重要作用。近年研究表明,PDE4是治疗抑郁症及记忆和认知障碍等神经精神疾患的重要靶点。通过调控PDE4的活性和表达使脑内cAMP表达水平及cAMP介导的信号通路恢复正常,将为阿尔茨海默病、抑郁症及二者共病等神经精神疾病提供重要的治疗策略。本文对PDE4与这些疾病之间关系的最新研究进展进行综述和讨论,为阿尔茨海默病、抑郁症及二者共病的预防和治疗提供新的思路及对策。     

抑郁症共病糖尿病患者的皮质醇水平与帕罗西汀治疗疗效的关系

目的：探讨抑郁症共病2型糖尿病患者血清皮质醇水平升高的相关因素及与帕罗西汀抗抑郁疗效的关系。方法选取符合抑郁症合并2型糖尿病患者212例，根据血清皮质醇水平分为皮质醇升高组（ n ＝98）和皮质醇正常组（ n ＝114），采用汉密顿抑郁量表（HAMD）评价抗抑郁程度；检测糖化血红蛋白（HbA1c）水平；通过自制调查问卷调查患者一般情况。2组患者使用抗抑郁药物帕罗西汀治疗8周后使用 HAMD 减分率评估疗效。结果 Lo-gistic 回归分析显示，抑郁症共病2型糖尿病的患者皮质醇升高的相关因素包括年龄、每周运动时间、抑郁症病程、HAMD 评分、HbA1c；帕罗西汀治疗8周后，皮质醇升高组患者的 HAMD 减分率低于皮质醇正常组（ P ﹤0.05），HAMD减分率与 HbA1c 及皮质醇水平呈负相关（ P ﹤0.05）。结论抑郁症共病2型糖尿病患者皮质醇升高的相关因素包括年龄、每周运动时间、抑郁症病程、HAMD 评分、HbA1c，血清皮质醇和 HbA1c 水平较高的患者帕罗西汀疗效不佳。     

新诊断标准下妊娠期糖尿病与HbA1c指标的相关性

全球肥胖和糖尿病的持续流行,使得越来越多的育龄妇女罹患2型糖尿病的风险增加。美国糖尿病学会(ADA)2011年对妊娠合并糖尿病(GDM)的标准更新,新标准使得人群中的GDM患病率明显增加;在新标准下研究不同生化指标与发病相关性,旨在从未病防病、已病防变的角度出发,积极预防GDM的发生,或是疾病发生后便于进行早期诊断早期干预。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.