舍曲林对脑卒中后抑郁及神经功能康复影响的临床研究

目的观察舍曲林对脑卒中后抑郁及神经功能康复程度的影响。方法将176例脑卒中后抑郁的患者随机分为:舍曲林治疗组89例和对照组87例。于治疗前后,采用汉密尔顿抑郁量表、神经功能缺损评分量表及日常生活能力Barthel指数量表进行分析。结果与对照组比较,治疗组汉密尔顿抑郁量表和神经功能缺损评分明显降低,日常生活能力Barthel指数量表评分明显增高(P0.05)。结论舍曲林治疗脑卒中后抑郁效果明显,并可促进脑卒中后神经功能的康复。     

中风后抑郁症状影响因素的研究

目的 了解中风后抑郁(PSD)的发生率及影响因素。方法 121例中风后患者进行汉密顿抑郁量表(HAMD)检查，以CSS评分评定神经功能缺损程度，日常生活能力量表(ADL)评定患者的日常生活能力。应用单因素分析和多因素logistic回归分析对16个自变量进行筛选。结果 121例中有59例发生了抑郁，发生率为48．76％。单因素分析结果可见性别、病程、日常生活能力减退程度、神经功能缺损程度可影响抑郁的发生。用上述4个因素作为自变量，以抑郁发生作为因变量，进行多因素logistic回归分析，结果见中风后6个月内的患者、神经功能缺损程度严重者抑郁的发生率高。结论 中风后抑郁的发生率为48.76％，中风后的病程和神经功能缺损严重程度与抑郁的发生有关。     

脑卒中后抑郁相关因素分析

目的探讨脑卒中后抑郁的发生率及相关致病因素。方法选取2006年1月-2009年1月在我院住院后明确诊断为脑卒中的患者,采用抑郁自评量表（SDS）、汉密尔顿抑郁量表（HAMD）、改良的爱丁堡斯堪的那维亚神经功能缺损评分表（MESSS）及日常生活能力量表（ADL）进行评定。结果脑卒中后抑郁的发生率为42．20％。抑郁的发生与额叶、左侧大脑半球、基底节区病灶及卒中次数有关,并与性别、年龄、神经功能缺损有显著相关性（P〈0．05）,伴高血压、糖尿病、冠心病的卒中患者PSD发病率明显高于无危险因素患者（P〈0．05）。结论脑卒中后抑郁是脑卒中的常见并发症,且与多种因素相关。     

邢台县农村老年脑卒中恢复期患者抑郁情况及相关因素分析

目的 探讨邢台县山区农村脑卒中恢复期老年患者抑郁发生情况及其影响因素.方法 在邢台县山区农村随机抽取320例老年脑卒中恢复期患者,采用老年抑郁量表(GDS)将其分为抑郁组及非抑郁组.分别进行一般情况调查、神经功能缺损程度评分量表(CSS)评分、改良巴氏指数评定量表(ADL)评分,计算发病率及相关因素分析.结果 320例脑卒中恢复期老年患者中抑郁发生率42.5%;抑郁组及非抑郁组在经济状况及家庭支持度方面有统计学意义,抑郁组CSS评分高于非抑郁组(P＜0.05),抑郁组ADL评分低于非抑郁组(P＜0.05).结论 邢台县山区农村老年脑卒中恢复期患者抑郁发生率较高,影响因素有经济状况、家庭支持度、神经功能缺损程度、日常生活能力依赖程度.     

脑卒中后抑郁的相关因素研究

目的研究脑卒中后抑郁症（PSD）的相关因素。方法对386例脑卒中患者进行评定,包括抑郁程度及神经功能缺损程度,并对其结果进行统计学分析。结果脑卒中后抑郁症的发生率为31．35％。与年龄、文化程度无明显相关,与性别、合并基础病、再卒中、病灶部位、神经功能缺损程度有一定相关性。结论脑卒中后抑郁症发生率高,应对PSD的相关因素予以高度重视,以降低PSD对脑卒中康复及预后的影响。     

老年卒中后抑郁与急性期神经功能缺损程度的相关研究

目的探讨老年脑卒中后抑郁（PSD）发生率以及与急性期神经功能缺损程度的关系。方法对292例住院诊断为脑卒中的老年患者，用改良的爱丁堡斯堪的那维亚神经功能缺损评分表（SSS）对卒中急性期进行评分，根据急性期神经功能缺损情况分为三组。用汉密尔顿抑郁量表进行随访调查抑郁评分。结果老年PSD的发生率在随访1年期间中随着时间的延长逐渐增加；老年PSD的发病率和重度PSD的发生率随神经功能缺损程度的加重而增加；老年PSD的程度随着神经功能缺损程度增加而加重。结论PSD是老年脑卒中后的常见并发症，卒中后1年中发病逐渐增加，其严重程度与卒中急性期的神经功能缺损程度一致。     

帕罗西汀对脑卒中后抑郁的干预作用

目的探讨帕罗西汀对脑卒中后抑郁患者的疗效及其对神经功能康复的影响。方法将69例脑梗死后抑郁患者随机分为对照组和治疗组,均给予神经内科常规药物治疗及心理治疗,治疗组同时给予帕罗西汀抗抑郁治疗。分别于治疗前、后采用Hamilton抑郁量表、改良爱丁堡-斯堪的那维亚评分量表（UESSS）、简易精神状态评定量表（MMSE）和日常生活活动量表（ADL）对患者抑郁程度、神经功能缺损程度、认知功能及日常生活活动能力进行评定。结果经3、6个月的治疗后,治疗组患者在抑郁、神经功能缺损程度、认知功能及ADL能力方面的改善幅度均优于对照组。结论帕罗西汀治疗脑卒中后抑郁具有良好的效果,在抑郁症状改善的同时,还能促进患者神经功能、认知功能和日常生活能力的恢复。     

脑卒中与卒中后抑郁的相关性研究

目的探讨脑卒中患者卒中后抑郁（PSD）的发生率及原因。方法使用汉密顿抑郁量表评定224例住院卒中患者1个月后的抑郁状态,分析其与神经功能缺损程度的关系。结果本组PSD发生率为63.4%（141例）且直接与神经功能缺损严重程度有关。结论 脑卒中神经功能缺损程度重,卒中的抑郁发生率高、程度重。     

脑卒中后抑郁临床研究

目的探讨脑卒中后抑郁（post-stroke depression,PSD）的发病特点及相关因素。方法选择近几年我院诊治的脑卒中后并发抑郁症病人的临床资料进行调查分析。结果卒中后抑郁与患者的年龄、文化程度、病变部位、神经功能缺失程度和日常生活活动依赖程度等因素密切相关。结论卒中后抑郁早发现、早诊断和早治疗对改善患者功能缺损至关重要。     

315例脑卒中后抑郁的临床研究

目的研究脑卒中后抑郁(PSD)的发生率及其与脑血管病危险因素、神经功能缺损等的相关性。方法选择脑卒中患者315例,通过头颅CT或MRI进行脑卒中病灶定位,并采用问卷调查的方法评估患者的抑郁状态,根据诊断分为PSD组101例,非PSD组214例,同时对每例患者行汉密尔顿抑郁量表评分、神经功能缺损评分、改良Rankin量表(mRS)评分、日常生活活动能力Barthel指数(BI)评分。结果 PSD组大动脉粥样硬化比例明显少于非PSD组,未能确定病因和心源性栓塞比例明显高于PSD组,差异有统计学意义(P<0.05,P<0.01)。PSD组mRS评分>2分和神经功能缺损6¹3分比例明显高于非PSD组,mRS评分≤2分、神经功能缺损013分比例明显高于非PSD组,mRS评分≤2分、神经功能缺损0⁵分比例和BI评分明显低于非PSD组,差异有统计学意义(P<0.01)。结论 PSD的发生与脑卒中后急性期神经功能缺损程度的评分明显相关,功能障碍越重,发生率越高,且程度越重;患者的生活能力评分和预后与抑郁的严重程度相关。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.