NEUROPSYCHOLOGICAL PROFILES OF CALCIUM ANTAGONISTS

Summary— The present study aims at reviewing the preclinical evidence suggesting that calcium antagonists exert bio-behavioural effects that may have some relevance to CNS pharmacology, and thus to psychiatry. We briefly address the question of whether calcium antagonists share the following profiles: anxiolytic, antidepressant, neuroleptic, anticonvulsant, analgesic and memory-enhancing. This survey suggests that calcium antagonists and, more especially, dihydropyridine derivatives share all these profiles together. There are, however, important limitations in the interpretation of these preclinical data. Whether the various calcium antagonists may have varying profiles, and thus varying potential psychiatric applications, cannot be explored in depth as there are few comparative data on these drugs on a large variety of animal models. In addition, the doses of calcium antagonists reported to produce behavioural responses are generally higher than the doses sufficient to produce other pharmacodynamic actions. Thus, the possibility that these former responses could be secondary to these latter actions cannot be excluded.     

CENTRAL NEUROCHEMICAL EFFECTS OF DIHYDROPYRIDINE CALCIUM ANTAGONISTS

Summary— Recent advances in central dihydropyridine (DHP)-binding sites are reviewed. DHP-binding sites are pre-synaptically and post-synaptically localized in the brain. The functional role of post-synaptic sites is still unknown, whereas pre-synaptic sites seem to contribute to the control of calcium uptake and of neurotransmitter release. DHP-binding sites may be modulated in physiological (age, sex) and pathological events (hypertension, ischaemia, neurological diseases) or after drug treatments (alcohol, morphine, etc.). The reviewed data suggest new therapeutic implications of DHP calcium channel antagonists in the treatment of other diseases and of drug withdrawal syndrome.     

ACTIVATORS AND INACTIVATORS OF CALCIUM CHANNELS: EFFECTS IN THE CENTRAL NERVOUS SYSTEM

Summary— The interactions of calcium antagonists or channel activators with the different classes of calcium channel are reviewed with particular emphasis on interactions with neuronal tissue; reasons for the failure of calcium antagonists to inhibit neurotransmitter release under normal circumstances are outlined. Calcium antagonists may be protective in several pathological situations and the possibilities of protection against ischaemic damage in the central nervous system are evaluated.     

ARTERIAL BARORECEPTOR REFLEX AND CALCIUM ANTAGONISTS

Summary— The tachycardia elicited by decreases in aortic pressure produced by various calcium antagonists, regardless of their chemical structures, is not always simply related to the reduction in pressure. Several experimental and clinical experiments have clearly demonstrated that some of these compounds interfer with the baroreceptor reflex control of heart rate. The voltage-dependent calcium channel blockade induced by these antagonists is probably not involved in the baroreceptor mechanotransduction, but central modulation of the baroreceptor reflex is probably an important site for action of these drugs at therapeutic levels. During chronic treatment of hypertension with calcium antagonists, a resetting of the reflex occurred with parallel shift of the set-point and of the baroreceptor reflex-response curve towards lower pressures, thus explaining the lack of change in heart rate despite a permanent reduction in blood pressure under these conditions. However, these effects of calcium antagonists on the baroreceptor reflex do not provide evidence that such interactions could play a role in their antihypertensive action during chronic therapy.     

小儿肠道病毒中枢神经系统感染的临床特点

目的探讨小儿肠道病毒（EV）中枢神经系统感染的临床特点。方法采用逆转录聚合酶链反应和病毒基因序列分析方法,对87例无菌性中枢神经系统感染病儿的脑脊液标本进行检测,并对其中61例EV中枢神经系统感染病儿的临床特点和预后进行回顾分析。结果无菌性中枢神经系统感染病儿中EV感染的发生率是70.10%,其中脑膜炎40例（65.57%）,脑炎21例（34.43%）。21例脑炎病儿的脑脊液标本经分型引物检测,17例（80.95%）阳性,其中埃柯病毒12型9例,柯萨奇病毒B3型5例,埃柯病毒7型1例,柯萨奇病毒B5型1例,柯萨奇病毒A9型1例。61例EV中枢神经系统感染均为急性起病,5—10月份高发（85.25%）,发病年龄高峰在3~5岁（44.26%）。EV脑膜炎的主要特征是脑膜刺激症状和脑脊液细胞数增加,主要临床表现为发热、头痛、呕吐,较大儿童可诉有乏力、畏光、肌痛,婴幼儿常伴有腹泻和皮疹。EV脑炎根据主要症状临床分型为昏迷型（3/21）、癫痫型（3/21）、精神障碍型（1/21）、小脑炎型（1/21）、脑干脑炎型（2/21）和混合型（11/21）。常规治疗后脑膜炎和大部分脑炎病儿完全恢复。4例重型柯萨奇病毒B3型脑炎病儿GLASGOW昏迷评分均〈7分,其中1例完全康复;1例运动障碍,经1年康复治疗后生活自理;1例癫痫、1例精神障碍伴癫痫,均可被药物完全控制。结论 EV是小儿中枢神经系统感染最常见的病原体之一;脑膜炎临床症状一般较轻,预后良好;大部分脑炎症状较轻,预后良好,重症脑炎可留有程度不同的后遗症。     

CALCIUM ANTAGONISTS AND THE VESTIBULAR SYSTEM: A CRITICAL REVIEW OF FLUNARIZINE AS AN ANTIVERTIGO DRUG

Summary— Flunarizine, a diphenylalkylamine, is one of the most popular antivertiginous drugs used nowadays in France. However, until now, there are very few preliminary data about the physiological or pathophysiological functions of calcium in the vestibular system. Moreover, experimental and clinical arguments are still insufficient to clearly demonstrate that 1) flunarizine is an effective antivertiginous drug and 2) this putative antivertiginous property is really due to the anticalcic action of the drug and not to a more classical antagonistic effect on Hl receptors. Much more work is needed before accepting the indication of any anticalcic drug as an effective antivertigo treatment.     

SENSITIVITY OF PANCREATIC BETA CELL TO CALCIUM CHANNEL BLOCKERS. AN ELECTROPHYSIOLOGIC STUDY OF VERAPAMIL AND NIFEDIPINE

Microelectrodes were used to study the comparative effects of 2 calcium channel blockers on glucose-induced electrical activity in mouse beta cells. In 2.8 mM glucose, verapamil (10(-5) M), but not nifedipine (10(-7) M), induces a silent depolarization. In 11.1 mM glucose, verapamil (10(-7) to 5.10(-5) M) induces continuous spike activity by a decrease in the maximum repolarization potential. Nifedipine (10(-10) to 10(-6) M) induces the same activity, but subsequent to a hyperpolarization of the cell at the maximal repolarization potential followed by a silent phase to the plateau potential. The 2 drugs induce a dose-dependent decrease in spike frequency without any change in spike amplitude. In 22 mM glucose exposure to nifedipine, but not to verapamil, induces a transient period of slow-wave activity. The 2 drugs induce a dose-dependent decrease in spike frequency. At higher concentrations (nifedipine greater than 10(-7) M; verapamil greater than 10(-6) M) they induce the disappearance of spikes through a decrease in amplitude. These results show that the beta cell is more sensitive to nifedipine (ED50 = 3 X 10(-8) M) than to verapamil, and that glucose stimulation increases the cell's sensitivity to verapamil (11.1 mM glucose: ED50 = 10(-5) M versus 5 X 10(-7) M in 22 mM glucose) but not to nifedipine.     

超声治疗中枢神经系统疾病的研究进展

目前针对中枢神经系统疾病的常规治疗方法主要为开颅手术治疗或药物治疗。近年随着超声技术的发展,超声可无创地通过人体完整的颅骨,结合组织产生的生物效应能达到治疗中枢神经系统疾病的作用。本文对近年来超声在中枢神经系统疾病治疗上的应用进展作一综述。     

EFFECTS OF CALCIUM ENTRY BLOCKERS ON BLOOD PRESSURE AND HEART RATE IN NEUROGENIC HYPERTENSIVE DOGS

The hypotensive and negative chronotropic effects of 5 calcium entry blockers (verapamil 200 micrograms/kg IV; diltiazem 300 micrograms/kg IV; nifedipine 5 micrograms/kg IV; nicardipine 50 micrograms/kg IV; and bepridil 5 mg/kg IV) were compared in control normotensive and acute neurogenic hypertensive anaesthetized dogs. Acute neurogenic hypertension was induced by sino-aortic denervation (SAD). In control normotensive dogs, all drugs (except bepridil) induced a slight and transient decrease in blood pressure. Nifedipine and nicardipine increased heart rate whereas the three other drugs remained ineffective. SAD caused a 2-2.5-fold increase in the hypotensive properties of the 5 drugs in dogs. Moreover, the duration of this induced hypotension was longer than in control normotensive animals. In SAD dogs, all calcium entry blockers significantly decreased heart rate. This study indicates that the direct cardiac inhibitory action of calcium channel blockers is modulated by baroreceptor activity in intact animals. The mechanism of the selective action of calcium entry blockers in hypertensive SAD in contrast to normotensive dogs is discussed.     

Diagnostic value of lactate dehydrogenase isoenzymes in cerebrospinal fluid

To evaluate the diagnostic value of lactate dehydrogenase (LD) isoenzymes in cerebrospinal fluid (CSF), 93 consecutive CSF specimens were analyzed. These specimens were from patients of four categories: tumors, infections, hemorrhages, and others. It was found that the isoenzyme patterns overlapped among different categories, but they differed within each category and were thus helpful in differential diagnosis. For instance, metastatic tumors showed prominent LD-5, whereas a primary brain tumor demonstrated an increase in all fractions. Viral encephalitis revealed an increase in the first three isoenzymes and bacterial meningitis, the last two. In acquired immune deficiency syndrome (AIDS) cases, however, LD isoenzyme changes were demonstrated in CSF when only cryptococcal meningitis and not when encephalitis was present. Both subdural and subarachnoid hemorrhages showed elevation of all fractions in our study. Elevation of the first three fractions was usually due to brain tissue damage or hemorrhage, as proven by our isoenzyme study of hemolysate mixed with CSF. The prominence of the last two fractions was related to anaerobic metabolism in the central nervous system or to granulocytic infiltration. In conclusion, LD isoenzyme analysis in CSF is helpful in differential diagnosis of various CNS disorders, although its sensitivity awaits further improvement.     

太极通天液与钙离子拮抗剂防治偏头痛疗效对照研究

目的对照观察太极通天液与钙离子拮抗剂防治偏头痛的临床疗效.方法将345例偏头痛患者随机分为三组太极通天液组(n=117)、钙离子拮抗剂组(n=110)和联合用药组(n=118).根据患者治疗前后头痛发作次数、头痛程度、头痛持续时间和伴随症状的变化进行疗效评定,观察期为3个月.结果(1)钙离子拮抗剂防治偏头痛的显效率为45.5%,总有效率为80.0%,与文献报告相近似;(2)太极通天液显效率为46.2%,总有效率82.9%,与钙离子拮抗剂相似;(3)联合用药组显效率63.6%,显著高于单独用药组(P＜0.01),总有效率85.6%,与单独用药组无显著差异.结论太极通天液是一种有效的偏头痛防治药物;与钙离子拮抗剂合用可提高疗效.     

1例肝移植术后中枢神经系统脱髓鞘患者的护理

<正>肝移植逐渐成为常规的治疗各种终末期肝病及肝功能衰竭唯一有效的治疗手段[1]。肝移植术后并发中枢神经系统脱髓鞘疾病(demyelinating diseases of central nervous system,DDCNS)是肝移植后常见的中枢神经系统并发症之一,发病率为8%~10%。本病多为隐匿起病,发病原因复杂,治疗棘手,疗效不佳[2]。本院2012年9月收治1例肝移植     

极后区综合征临床及MRI研究现状

极后区综合征（APS）以顽固性呃逆、恶心、呕吐为主要临床表现,可见于多种中枢神经系统疾病,已成为近年神经病学领域关注点之一。本文就APS临床及MRI研究现状进行综述。     

非洛地平对高血压患者动脉粥样硬化和血管内皮功能的影响

目的探讨非洛地平对高血压病患者颈动脉粥样硬化和内皮功能的影响。方法将高血压病患者随机分为A组n=35(非洛地平治疗组)和B组n=35(福辛普利治疗组),另设年龄、性别与之匹配的正常人为C组n=30(对照组)。用高分辨超声技术检测各组对象的肱动脉内皮依赖性舒张功能、颈动脉平均内中膜厚度、颈动脉斑块发生率及Croouse积分。对A、B组分别在治疗3个月、1年及2年后复查血压和血管超声的上述指标。结果与C组比较,A组与B组肱动脉内皮依赖性舒张功能减退,颈动脉内中膜增厚(P<0.01)。非洛地平组与福辛普利组在降低血压及改善血管内皮依赖性舒张功能方面作用相同(P>0.05),但非洛地平组在逆转颈动脉内中膜厚度、降低新的粥样斑块发生率方面优于福辛普利组(P<0.01)。结论非洛地平除能有效降低高血压患者的血压外,还有逆转大动脉功能和结构异常,延缓动脉粥样硬化发生发展的作用。