电针治疗抑郁障碍：与药物治疗的效果比较

目的：介绍国内近20年来电针治疗抑郁障碍的临床研究概况,以期进一步了解电针治疗抑郁障碍的有效性和安全性.资料来源：应用计算机检索中国生物医学文献数据库PubMed数据库1984/2004期间的相关文章,限定文章语言种类为中文,检索词为“电针,抑郁症”. 资料选择：对资料进行初审,选择临床试验研究文献查找全文.纳入标准：①有明确诊断标准.②随机对照实验或对照试验.③治疗组干预措施为电针或电针合并抗抑郁药物或电针合并安慰剂;对照组干预措施为抗抑郁药物、抗抑郁药合并模拟电针、单纯电针或不采用抗抑郁措施.排除标准：①非对照研究.②治疗组或对照组的干预措施不符合纳入标准.③机制研究.④重复研究.资料提炼：共收集到相关文献99篇,按上述标准纳入15篇,其余文献均被排除.资料综合：15篇文章中12篇为随机对照研究,3篇为对照研究,各研究的试验期为1～1.5个月,试验地点都在中国.各研究所纳入的病例数量为30～241例.其中6个研究对比了电针与传统抗抑郁药治疗抑郁症的疗效及安全性,2个研究进行了电针与新型抗抑郁药疗效的比较,4个研究观察了针药结合与单纯药物或单纯电针对抑郁症的疗效,1个研究比较了电针与西药治疗抑郁性神经症的疗效,2个研究观察了电针对脑卒中后抑郁的治疗作用.结论：电针治疗抑郁障碍可以取得与西药抗抑郁剂相似的疗效,且具有副作用少,安全性高,易被患者接受等优势.但由于大样本的严格执行随机对照盲法原则的临床研究数量较少,今后还需要有高质量的临床研究来提供更加有力的证据.     

激光治疗瘢痕的特征

目的:介绍国内近20年来激光治疗瘢痕的临床研究概况,以期进一步了解激光治疗瘢痕的新进展。资料来源:应用计算机检索Pubmed和中国生物医学文献数据库1983/2006的相关文章,限定文章语言种类为英文和中文,检索词为“cicatrices(瘢痕),laser(激光)”。资料选择:对资料进行初审,选择临床试验研究文献查找全文。纳入标准:①有明确诊断标准。②随机对照实验或对照试验。有无随访,是否采用盲法不限制。③治疗组干预措施为激光或激光联合药物;对照组干预措施为曲安奈德、冷冻联合曲安奈德或不采用药物措施。排除标准:①非对照研究。②治疗组或对照组的干预措施不符合纳入标准。③机制研究。④重复研究。资料提炼:共收集到相关文献120篇,按上述标准纳入31篇,其余文献均被排除。资料综合:31篇文章中11篇为随机对照研究,10篇为对照研究,各研究的研究期为1～6个月。各研究所纳入的病例数量为10～50例。其中6个研究对比了激光与传统药物治疗瘢痕的疗效及安全性,2个研究进行了激光治疗瘢痕基础研究机制比较,10个研究观察了激光结合与单纯药物或单纯激光对瘢痕的疗效,4个研究比较了激光联合西药治疗瘢痕的疗效,2个研究观察了激光治疗瘢痕的副作用。7篇介绍国内或国外瘢痕治疗的研究情况。结论:激光治疗瘢痕的疗效可靠,具有副作用少,方法简单,安全性高,易被患者接受等优势。但由于激光治疗瘢痕还存在着一定的局限性,今后还需要在激光的穿透深度方面研究。     

慢性疼痛与情绪障碍及其干预治疗效应

目的:分析慢性疼痛与情绪障碍之间的关系,探讨心理及药物治疗对慢性疼痛的干预作用。资料来源:应用计算机检索Medline1989-01/2004-05和Embase1989-01/2004-05有关慢性疼痛与情绪障碍关系的文献,检索词“Chronicache,emotionaldisorder,treament”,并限定文章语言种类为English。观察对象为疼痛持续时间超过6个月以上的患者。资料选择:选取有关慢性疼痛与情绪障碍关系及其治疗干预的文献,进行初审,删除陈旧及重复的文献,然后查找余下的文献全文。质量评价主要考察资料的真实性,调查设计是否严密,实施过程是否严格,统计学处理是否合理。资料提炼:共检索到20篇关于慢性疼痛与情绪障碍关系及其治疗干预的文献,11篇文献符合纳入标准。排除的9篇试验中,7篇系重复的同一研究,2篇是Meta分析。资料综合:11篇文献均包括观察组和对照组,其中观察组应用镇痛药合并心理治疗及抗抑郁药,对照组应用镇痛药但未合并心理治疗及抗抑郁药,对两组患者的疗效进行比较分析。结论:慢性疼痛与情绪障碍同时存在,应用镇痛药合并心理治疗及抗抑郁药可以显著缓解患者的疼痛,干预效果优于单纯应用镇痛药者。     

心理干预合并电针治疗精神分裂症后抑郁

目的探讨心理干预合并电针治疗精神分裂症后抑郁的疗效和安全性。方法将符合CCMD-3诊断标准的86例精神分裂症后抑郁患者随机分成两组，在原抗精神病药不变的基础上加用心理干预、电针疗法和只用原抗精神病药进行对照，评定6周，用HAMD评定疗效，用TESS评定不良反应。结果心理干预合并电针治疗组有效率87％，对照组有效率为27％，两组有显著性差异。结论心理干预合并电针治疗精神分裂症后抑郁有效，且不增加抗精神病药不良反应。     

慢性疼痛与情绪障碍及其干预治疗效应

目的：分析慢性疼痛与情绪障碍之间的关系，探讨心理及药物治疗对慢性疼痛的干预作用。资料来源：应用计算机检索Medline 1989—01／2004-05和Embase 1989-01／2004-05有关慢性疼痛与情绪障碍关系的文献，检索词“Chronicache．emotional disorder，treament”，并限定文章语言种类为English。观察对象为疼痛持续时间超过6个月以上的患者。资料选择：选取有关慢性疼痛与情绪障碍关系及其治疗干预的文献，进行初审，删除陈旧及重复的文献，然后查找余下的文献全文。质量评价主要考察资料的真实性，调查设计是否严密，实施过程是否严格，统计学处理是否合理。资料提炼：共检索到20篇关于慢性疼痛与情绪障碍关系及其治疗干预的文献，11篇文献符合纳入标准。排除的9篇试验中，7篇系重复的同一研究，2篇是Meta分析。资料综合：11篇文献均包括观察组和对照组，其中观察组应用镇痛药合并心理治疗及抗抑郁药，对照组应用镇痛药但未合并心理治疗及抗抑部药，对两组息者的疗效进行比较分析。结论：慢性疼痛与情绪障碍同时存在，应用镇痛药合并心理治疗及抗抑郁药可以显著缓解患者的疼痛，干预效果优于单纯应用镇痛药者。     

针灸治疗抑郁发作性心境障碍的方法特征

目的:阐明针灸治疗抑郁发作的有效性、安全性,进而寻求有效的治疗方法,增加患者的依从性,减少复发率。资料来源:应用计算机检索中国期刊全文数据库、万方数据库1999-01/2005-12期间的相关文章,检索词“抑郁症”,或“抑郁发作”或“抑郁性神经症”和“针灸”或“针刺”或“电针”或“穴位注射”或“毫针”或“头针”或“耳针”和“治疗”,限定文章语言种类为中文。资料选择:对资料进行初审,选取有关针刺治疗抑郁发作性心境障碍的基础理论及临床观察的文献,对基础理论的文献进行观点归纳,以及对非随机临床试验的研究进行筛除,对剩余的文献开始查找全文,把属于随机对照临床试验的研究作为纳入标准。资料提炼:概述中引用2篇关于抑郁发作的背景文章,未算入收集文献。共收集到87篇关于针灸治疗抑郁发作的文献,10篇为基础理论,选取论述病因病机的文献6篇,论述治则治法的3篇;其中属于电针疗法的临床研究有17篇,选取了4篇;属于头针疗法的临床研究有10篇,选取了2篇;属于毫针疗法临床研究有24篇,选取了6篇;属于穴位注射疗法的临床研究有2篇,选取了2篇;属于耳针疗法的临床研究有2篇,选取了1篇;属于综合疗法的临床研究有22篇,选取了3篇。共纳入27篇,排除60篇。资料综合:①祖国医学中没有“抑郁发作”的名称。根据其临床表现,结合古代医籍,大多把它归属于中医学中的“郁病”范畴。《内经》中首先提出了情志内郁致病的思想。肝失疏泄,脾失运化,心神失养,脏腑阴阳气血失调是郁病总的发病机制。②现代学者以“行气、调中”、“调理脑神”、“调神疏肝法”为主要治则治法,还有学者采用了分期治疗的方法,即早期行气解郁、中期下气开结和后期益气宁神。③抑郁发作中医疗法主要有电针疗法、头针疗法、毫针疗法、穴位注射疗法、耳针疗法、运用针刺和中药结合心理疗法综合疗法。④近年来针灸治疗抑郁发作性心境障碍方法各异,有一定的临床疗效,但存在诊断标准不统一、不明确,针灸治疗机制研究较少,多数的临床研究缺乏规范化设计,操作方法缺乏规范等问题。结论:针灸治疗抑郁发作性心境障碍的有一定疗效,且具有副作用少、安全、经济、易被患者接受等优点。通过对针灸治疗抑郁发作进行研究,寻求一种安全、简便的治疗方法,将会在提高患者的生活质量,降低抑郁的社会经济负担方面具有重大的医学和社会意义。     

针灸治疗抑郁发作性心境障碍的方法特征

目的：阐明针灸治疗抑郁发作的有效性、安全性，进而寻求有效的治疗方法，增加患者的依从性，减少复发率。 资料来源：应用计算机检索中国期刊全文数据库、万方数据库1999—01／2005—12期间的相关文章，检索词“抑郁症”，或“抑郁发作”或“抑郁性神经症”和“针灸”或“针刺”或“电针”或“穴位注射”或“毫针”或“头针”或“耳针”和“治疗”，限定文章语言种类为中文。 资料选择：对资料进行初审，选取有关针刺治疗抑郁发作性心境障碍的基础理论及临床观察的文献，对基础理论的文献进行观点归纳，以及对非随机临床试验的研究进行筛除，对剩余的文献开始查找全文，把属于随机对照临床试验的研究作为纳入标准。 资料提炼：概述中引用2篇关于抑郁发作的背景文章，未算入收集文献。共收集到87篇关于针灸治疗抑郁发作的文献，10篇为基础理论，选取论述病因病机的文献6篇，论述治则治法的3篇；其中属于电针疗法的临床研究有17篇，选取了4篇；属于头针疗法的临床研究有10篇，选取了2篇；属于毫针疗法临床研究有24篇，选取了6篇；属于穴位注射疗法的临床研究有2篇，选取了2篇；属于耳针疗法的临床研究有2篇，选取了1篇；属于综合疗法的临床研究有22篇，选取了3篇。共纳入27篇，排除60篇。 资料综合：①祖国医学中没有“抑郁发作”的名称。根据其临床表现，结合古代医籍，大多把它归属于中医学中的“郁病”范畴。《内经》中首先提出了情志内郁致病的思想。肝失疏泄，脾失运化，心神失养，脏腑阴阳气血失调是郁病总的发病机制。②现代学者以“行气、调中”、“调理脑神”、“调神疏肝法”为主要治则治法，还有学者采用了分期治疗的方法，即早期行气解郁、中期下气开结和后期益气宁神。③抑郁发作中医疗法主要有电针疗法、头针疗法、毫针疗法、穴位注射疗法、耳针疗法、运用针刺和中药结合心理疗法综合疗法。④近年来针灸治疗抑郁发作性心境障碍方法各异，有一定的临床疗效，但存在诊断标准不统一、不明确，针灸治疗机制研究较少，多数的临床研究缺乏规范化设计，操作方法缺乏规范等问题。 结论：针灸治疗抑郁发作性心境障碍的有一定疗效，且具有副作用少、安全、经济、易被患者接受等优点。通过对针灸治疗抑郁发作进行研究，寻求一种安全、简便的治疗方法，将会在提高患者的生活质量，降低抑郁的社会经济负担方面具有重大的医学和社会意义。     

精神分裂症患者康复的一体化模式

目的：介绍国外一些发达国家关于精神分裂症一体化康复的理论与措施,以期推广国际先进的康复理念和方法.资料来源：应用计算机检索gov/PubMed网站1999/2005期间的相关文章,限定文章语言种类为英文,检索词为“精神分裂症,康复”.资料选择：对资料进行初审,选择临床试验研究文献查找全文.纳入标准：①有明确诊断标准.②纵向对照试验与非对照研究.有无随访、是否采用盲法不限制.③治疗组干预措施为一体化康复措施和单一康复方法;对照组干预措施为抗精神病药物或无药物治疗.排除标准：①治疗组或对照组的干预措施不符合纳入标准.②机制研究.资料提炼：共收集到相关文献45篇,按上述标准纳入14篇,其余文献均被排除.资料综合：14篇文章中3篇为随机对照研究,8篇为对照研究,1篇为非对照研究,1篇为荟萃分析,1篇为长期随访研究.试验地点包括中国香港、日本、印度、匈牙利、瑞典、澳大利亚、加拿大.各研究所纳入的病例数量为6～980例.随访时间最长达20年.其中6个研究对比了一体化康复措施的疗效,6个研究进行了单一康复措施与常规应用抗精神病药疗效的比较,1个荟萃分析比较了新型抗精神病药物与传统抗精神病药物对精神分裂症康复的影响.结论：精神病学治疗和康复治疗是一个无间隙的整合治疗.典型的整合治疗包括药物治疗、支持性就业、社会技能培训、家庭心理教育、肯定的社区治疗,以及对双重诊断患者的整体规划.它对于改变精神分裂症患者长期住院模式具有积极意义.     

经颅磁刺激在癫痫研究中的应用

目的:对经颅磁刺激技术在癫痫中的研究与应用的国内外近况做一介绍,以期为癫痫临床治疗开阔思路。资料来源:应用计算机检索中国医院知识仓库1994/2004期间的相关文章,限定文章语言种类为中文,检索词为“经颅磁刺激,癫痫”,同时应用计算机检索Journals@OvidFullText1980/2004期间的相关文章,检索词“Transcranialmagneticstimulation,epilepsy”,并限定文章语言种类为English。资料选择:对资料进行初审,选择临床或动物试验研究以及综述文献查找全文。纳入标准:①有明确诊断标准。②随机对照实验或对照试验。③治疗组干预措施为经颅磁刺激或经颅磁刺激合并抗癫痫药物或经颅磁刺激合并安慰剂;对照组干预措施为抗癫痫药物、抗癫痫药合并模拟经颅磁刺激、单纯经颅磁刺激或不采用抗癫痫措施。④综述文献为近5年来经颅磁刺激技术在神经精神病学方面研究的综述全文。排除标准:①非对照研究。②治疗组或对照组的干预措施不符合纳入标准。资料提炼:共收集到相关文献113篇,按上述标准纳入26篇,其余文献均被排除。资料综合:26篇文章中12篇为综述全文,7篇总结了经颅磁刺激在神经精神科学方面的应用及进展,5篇经颅磁刺激在癫痫领域的研究。4篇为动物试验研究。8篇为临床随机对照研究,2篇为对照研究。结论:经颅磁刺激在癫痫研究中是一种安全有效而可靠的非侵入性的新方法,为临床研究和治疗癫痫开辟了一条新途径。目前虽然存在一定副作用,但相信随着磁刺激设备和刺激技术的进一步改进,此技术将会有一个很好的发展前景。     

中老年患者抑郁症康复治疗观察

目的观察抗抑郁药联合心理治疗与单纯心理治疗对中老年患者抑郁症状的,临床疗效。方法63例合并抑郁症的中老年患者分两组，单纯心理治疗组30例，抗抑郁药联合心理治疗组33例，两组均在治疗原发症基础上进行心理治疗，综合组同时应用抗抑郁药物治疗，治疗前后两组均进行Zung抑郁量表评分，并对主要症状改善情况进行统计。结果综合治疗组显著优于心理治疗组（P〈0.05）：结论中老年患者合并抑郁症应在心理治疗基础上适时积极应用抗抑郁药物可显著改善抑郁症状，提高生活质量，值得临床推广。     

电针治疗更年期抑郁症的临床疗效观察

目的:观察电针治疗女性更年期抑郁症的临床疗效。方法:将符合标准的60例女性更年期抑郁症患者按就诊先后顺序随机分为电针组和西药对照组 (每组各30例)。电针组取电针百会、印堂、四神聪穴辅以针刺配穴治疗,西药对照组口服百忧解治疗,均以6周为1疗程。2组患者分别于治疗前和治疗后2周、4周、6周采用汉密尔顿焦虑、抑郁量表(HAMA、HAMD)进行积分评定,并于治疗6周后通过HAMD量表总分的减分率评定2组治疗有效率。结果:电针组与西药对照组在第4周末、第6周末具有很好的抗抑郁效果,2组疗效比较无显著性差异(P>0.05),通过HAMA积分评定,发现电针组在抗抑郁的同时还有抗焦虑作用(P<0.05),而西药对照组则无抗焦虑的作用。电针组患者的治疗总有效率为90.0%,高于西药对照组的73.3%,差异有统计学意义。(P<0.05)。结论:电针对女性更年期抑郁症有良好的抗抑郁作用,电针治疗女性更年期抑郁症疗效可达到百忧解的临床治疗作用,且安全无副作用;并且发现电针有百忧解没有的抗焦虑作用。     

Gender differences in depression and antidepressant pharmacokinetics and adverse events

OBJECTIVE: To review data generated by studies examining gender differences in the prevalence of depression, as well as in antidepressant pharmacokinetics, pharmacodynamics, and adverse events. DATA SOURCES: Published articles and abstracts were identified through MEDLINE (January 1966-April 1999) using the following search terms: antidepressant, response, gender, pharmacokinetic, pharmacodynamic, female, side effect, and adverse events. All articles that assessed gender differences in antidepressant response, pharmacokinetics, and adverse events, as well as articles that evaluated postulated mechanisms for these differences, were reviewed. Additional articles were identified from bibliographies of retrieved articles. STUDY SELECTION AND DATA EXTRACTION: All relevant abstracts, studies, and review articles were evaluated. DATA SYNTHESIS: Gender differences in the prevalence of depression have been reported and may result from the interaction of several factors. Women have been shown to have a higher incidence of depression, which may be due to artifact, social, or biologic reasons. Studies suggest that the pharmacokinetic disposition of popular antidepressants varies between men and women, and women taking antidepressants may exhibit a different adverse event profile. Only one study specifically evaluated gender differences in antidepressant treatment response. CONCLUSIONS: Further research elucidating gender differences in response to antidepressant treatment and on depression prevalence is needed. Some studies report that the pharmacokinetics of antidepressants may vary between men and women. Therefore, clinicians should be aware that potential differences in antidepressant pharmacokinetics may exist, and a dosage adjustment may be necessary for women to ensure a favorable drug response, compliance, and decreased incidence of adverse events.     

银杏叶提取物对老年性疾病的治疗作用

目的介绍近几年银杏叶提取物治疗老年病的概况,为其进一步的临床应用和科研设计提供参考资料.资料来源检索清华全文数据库1994-01/2005-10.关于银杏叶提取物和老年疾病、心脑血管相关的文章,限定文章语言种类为中文,检索词"银杏叶提取物,老年,心脑血管".资料选择对资料进行初审,选取包括处理组和对照组的文献,筛除明显不随机的研究,对剩余的文献开始查找全文.纳入标准为①随机对照研究.②实验或临床研究包含平行对照组.③处理组为应用银杏叶制剂.排除标准重复性研究.资料提炼共收集到221篇关于银杏叶提取物治疗老年性疾病的随机和未随机研究文章,25个动物实验或临床研究符合纳入标准.排除的196篇文章,175篇为未随机研究或重复性研究,2l篇为综述类文章.资料综合25个试验包括约1 099例患者和355只实验动物,证实了银杏叶提取物在糖尿病治疗方面具有调节血脂水平,从而改善胰岛抵抗作用;在高血压方面有效地改善老年高血压患者的高凝状态并改善血液流变性;在心脑血管方面能保护缺血性心肌,提高大鼠脑去甲肾上腺素、5-羟色胺含量,可通过上调Bcl-2蛋白表达,下调Bax蛋白表达,对脑缺血再灌注损伤起保护作用,能够明显改善脑梗死伴糖尿病患者的各项血液流变学特性;在抗衰老、老年痴呆方面能保护脑组织ATP酶的活性,抑制氧自由基对线粒体核糖核酸的损害而延缓老年大鼠脑衰老的进程,改善老龄大鼠的学习和记忆功能.银杏叶提取物已用于高血压、糖尿病、脑衰老、老年痴呆、心脑血管等疾病的治疗;无副性事件报道.结论银杏叶提取物是一种很有前途和价值的药物,在老年病的治疗领域中具有广阔的应用前景.     

A critical review of selected pharmacoeconomic analyses of antidepressant therapy

OBJECTIVE: To evaluate the pharmacoeconomic benefits of treating depression and compare the available therapies by reviewing the current literature on economic analyses of depression. DATA SOURCES: A MEDLINE search (January 1966-June 1998) of English-language literature relating to economic analyses of depression was conducted. Key search terms included depression, antidepressant, economics, pharmacoeconomics, outcomes, and costs. Additional literature was collected from reference lists of articles found through the MEDLINE search. STUDY SELECTION AND DATA EXTRACTION: A MEDLINE search was performed using the above key words. Search and evaluation were limited to pharmacoeconomic evaluations of major depressive disorder. All available studies were considered for inclusion in the review. DATA SYNTHESIS: The advent of newer, brand-name antidepressants as well as increased concern regarding healthcare costs has raised interest in the costs associated with treating depression. Although the selective serotonin-reuptake inhibitors (SSRIs) and other newer antidepressants have higher acquisition costs, both modeling and naturalistic studies have shown that the total cost of treating depression is no higher with SSRIs than with the tricyclic antidepressants. These differences are primarily due to increased patient adherence with the newer agents and lower costs secondary to physician visits, laboratory monitoring, and hospitalization. CONCLUSIONS: The economic aspects of treating depression are becoming more frequently evaluated as newer antidepressant medications become available and as healthcare entities attempt to address increasing costs. In general, most pharmacoeconomic research on depression has been conducted on one of the SSRIs in comparison with various tricyclic antidepressants. These studies frequently use simulation techniques and rely heavily on data from clinical trials. Few studies have compared the newer antidepressants, and no clear evidence exists that any one of these agents is more cost-effective than others. Even fewer studies have addressed the pharmacoeconomics of medication management of depression in various healthcare environments (e.g., public mental health care vs. private psychiatry vs. primary care).     

Impact of nonsteroidal antiinflammatory drugs on the cardioprotective effects of aspirin

OBJECTIVE: To examine the evidence of a pharmacodynamic interaction between aspirin and nonsteroidal antiinflammatory drugs (NSAIDs); specifically, to determine whether a deleterious relationship exists with respect to the cardioprotective effects of aspirin. DATA SOURCES: Primary articles were identified by a MEDLINE search (1966-May 2004). Search terms included aspirin, nonsteroidal antiinflammatory drug, drug interaction, mortality, myocardial infarction, and stroke. STUDY SELECTION AND DATA EXTRACTION: All prospective and retrospective studies conducted in human subjects and investigating the potential interaction between aspirin and NSAIDs were included. DATA SYNTHESIS: Several controlled pharmacodynamic studies indicate that the sustained inhibition of cyclooxygenase activity by aspirin is blunted in the presence of some NSAIDs. While these data are fairly consistent, they are limited in that they rely on surrogate markers and not clinical outcomes. Observational studies have shown conflicting results regarding the effect of combination NSAID and aspirin therapy on mortality risk and incidence of myocardial infarction. CONCLUSIONS: Pharmacodynamic data indicating an interaction between aspirin and NSAIDs have not translated to a consistent clinical effect in observational studies. In the absence of a randomized, controlled, clinical outcomes study, there is insufficient evidence to dictate a change in therapy.     

Citalopram in the treatment of depression

OBJECTIVE: To review the efficacy and safety of citalopram in the treatment of depression. DATA SOURCES: MEDLINE search (1966-April 2000), Current Contents search, additional references listed in articles, and unpublished data obtained from the manufacturer were used to identify data from scientific literature. Studies evaluating citalopram (i.e., abstracts, clinical trials, data on file with the manufacturer) were considered for inclusion. STUDY SELECTION: English-language literature was reviewed to evaluate the pharmacology, pharmacokinetics, therapeutic use, and adverse effects of citalopram. DATA EXTRACTION: Controlled animal and human clinical studies published in the English-language literature were reviewed and evaluated. Clinical trials selected for inclusion were limited to those in human subjects and included data from animals if human data were not available. DATA SYNTHESIS: Citalopram is an antidepressant belonging to the class of selective serotonin-reuptake inhibitors (SSRIs) available for the treatment of depression. Citalopram offers therapeutic efficacy similar to that of the other SSRIs and a more favorable adverse effect profile than that of the tricyclic antidepressants (TCAs). Citalopram does not cause anticholinergic or cardiovascular adverse effects associated with the TCAs. Citalopram is the most selective SSRI and, unlike other SSRIs, seems to be relatively free of interaction mediated by the cytochrome P450 system. Citalopram is also the least expensive antidepressant available to date. This review of citalopram includes data from clinical trials comparing safety, tolerability, efficacy, and pharmacoeconomics with TCAs and SSRIs. CONCLUSIONS: Clinical trials demonstrate that citalopram's therapeutic efficacy is significantly greater than that of placebo and is comparable with that of other antidepressants. Citalopram has a favorable adverse effect profile, and thus may be useful in treating depressed patients who cannot tolerate anticholinergic or cardiovascular adverse effects associated with TCAs. It may also be useful in patients with comorbid illnesses requiring concomitant medicines.     

不同针灸方法治疗神经根型颈椎病效果的系统评价

目的:运用cochrane评价系统的方法评价当前国内针灸疗法对神经根型颈椎病的有效性与安全性.资料来源:计算机检索CBM(1978-01/2008-10)、CNKI(1979-01/2008-10)、VIP(1989-01/2008-10)3个数据库,辅以手工检索.资料选择:纳入针灸疗法治疗神经根型型颈椎病的随机对照试验并对其进行质量评价.文献来源为随机对照和半随机对照.采用随机方法一选择性偏倚评估、隐蔽分组一选择性偏倚评估、盲法一实施偏倚与测量偏倚、剔除、失访、退出损耗性偏倚评价.结局评价指标:①腹针与常规针灸相比较其有效率.②电针加絮刺火罐与常规针灸相比较其有效率.③腹针与牵引相比较其有效率.④颈椎牵引、电针结合穴位注射与牵引结合推拿比较其有效率.⑤牵引、电针、推拿、TDP结合导引与牵引、理疗、TDP结合运动疗法相比较其有效率.⑥电针结合醋离子导入与单纯电针相比较有效率.⑦仰针灸结合龙氏手法与单纯针灸相比较其有效率.⑧不良反应.结果:选择其中7篇(1416例观察对象),采用随机分组的文章.所有研究均有选择性偏倚、实施测量性偏倚、损耗性偏倚的高度可能性,质量等级均为"C"级.且只有1个研究证明实验组的有效率优于对照组.研究1表明,无足够证据证明腹针治疗神经根型颈椎病的有效率优于常规针灸疗法.研究2表明,无足够证据证明电针加絮刺火罐治疗神经根型颈椎病的有效率优于常规针灸疗法.研究3表明,无足够证据证明腹针疗法治疗神经根型颈椎病有效率优于牵引疗法.研究4表明,颈椎牵引、电针结合穴位注射治疗神经根型颈椎病的有效率优于牵引结合推拿疗法.研究5表明,无足够证据证明牵引、电针、推拿、TDP结合导引治疗神经根型颈椎病的有效率优于牵引、理疗、TDP结合运动疗法.研究6表明,无足够证据证明电针结合醋离子导入治疗神经根型颈椎病的有效率优于单纯电针疗法.研究7表明,无足够证据证明针灸结合龙氏手法治疗神经根型颈椎病的优于单纯针灸疗法.7个研究均未出现不良反应而终止试验.结论:所纳入的7个研究中,由于目前针灸疗法的不统一,质量不高,诊断标准、随访时间、结果测量标准不一致,因此需要开展大样本、多中心,方法学规范的高质鼍随机对照试验进一步验证.     

Lamotrigine update and its use in mood disorders

OBJECTIVE: To provide a qualitative, systematic update and review of the pharmacology, pharmacokinetics, efficacy in mood disorders, adverse effects, and costs of lamotrigine. DATA SOURCES: Citations obtained from MEDLINE searches (1985-September 2001) using lamotrigine as a text word, articles identified in reference lists of pertinent articles, abstracts presented at conferences, and research data from GlaxoSmithKline. DATA EXTRACTION: English-language articles were considered for possible inclusion. Each title and abstract was examined to determine whether the publication contained up-to-date information relevant to the objective. Twenty clinical trials that provided data on response rates in mood disorders were tabulated. DATA SYNTHESIS: Lamotrigine's primary action is to modulate voltage-gated sodium channels. Evidence suggests that it decreases glutamate transmission, directly reduces calcium influx, mildly blocks transmitter reuptake, and alters intracellular mechanisms of resting transmitter release. The average half-life of lamotrigine is approximately 24 hours, but decreases to approximately 7.4 hours when used concurrently with phenytoin, and increases to approximately 59 hours with valproic acid. Seven of the 20 clinical trials were randomized, double-blind, and controlled. Existing data are inadequate to evaluate lamotrigine use in major depression. The pooled response rates for patients with depressed, manic, mixed, and rapid cycling bipolar disorder were similar, ranging from 52% to 63%. Adverse effects are infrequent when the drug is used alone, but become more frequent when lamotrigine is combined with other anticonvulsants. While most rashes are mild, approximately 1 in 500 patients develops exfoliative dermatitis. A slow upward dose titration is recommended to reduce the incidence of serious rash, but this may delay the attainment of adequate dosage for 6 weeks. Lamotrigine has positive effects on cognitive function, but occasionally produces insomnia. Lamotrigine costs 2-4 times more than lithium, carbamazepine, and generic valproic acid. CONCLUSIONS: When efficacy, adverse effects, and cost are considered, lamotrigine should probably be reserved as a second-line agent for bipolar depression.     

血管内皮祖细胞在人工血管移植后内皮化中的作用及其机制

目的:阐述近年来国内外关于血管内皮祖细胞促进人工血管移植后内皮化进程的机制, 以期为临床解决人工血管移植后血栓形成和内膜增生提供新的思路。资料来源: 应用计算机检索 Medline、PubMed、Ovid及 MD Consult 数据库 2000-01/2006-12 期间与血管内皮祖细胞以及人工血管移植后内皮化相关的文章, 检索词为 "endothelial progenitor cells , vascularprosthesis, endothelialization",限定文章语言种类为 English, 同时检索 CNKI 数据库 2000- 01/2006- 12 相关文章, 检索词为"内皮祖细胞,人工血管, 内皮化", 限定文章语言种类为中文。必要时向前追溯查找相关文献。资料选择: 对资料进行初选, 选择与内皮祖细胞和人工血管移植后内皮化相关的文章, 入选标准: 随机对照试验, 包括基础试验、临床试验以及临床药物试验, 筛除明显不随机或无对照组的试验研究, 对剩余文献查找全文。排除标准: 重复性研究以及综述类文献。资料提炼: 共收集到 115 篇相关文章, 选择与内皮祖细胞和人工血管移植后内皮化的关系这一主题最为相关的 30 篇文章。资料综合: 近年来的研究表明: ①血管内皮祖细胞不仅具有高度的分化增殖能力, 而且具有横向分化的能力。②快速内皮化是解决小口径人工血管移植后血栓形成和内膜增生的主要途径。③血管内皮祖细胞可以通过不同途径加速人工血管移植后内皮化进程。结论: 内皮祖细胞可以促进人工血管移植后的内皮化进程进而减少血栓形成和内膜增生的发生。     

Antidepressant-induced sexual dysfunction

OBJECTIVE: To review the evidence regarding antidepressant-induced sexual dysfunction and address implications for treatment strategy and health plan coverage policies for antidepressant medications. DATA SOURCES: Primary articles were identified by a MEDLINE and HealthSTAR search to identify English-language studies published between January 1986 and July 2000. Search terms included sexual dysfunction or sexual function and antidepressants, fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, venlafaxine, nefazodone, bupropion, and mirtazapine. A cross-check of references cited in 10 published reviews yielded additional in-scope articles. STUDY SELECTION AND DATA EXTRACTION: Approximately 200 articles were identified, including 8 randomized controlled trials and numerous open-label studies, case series, and case reports. Of the randomized controlled trials, only 5 were designed to evaluate the incidence of sexual dysfunction associated with antidepressant treatment. Three additional randomized controlled trials included a structured assessment of sexual dysfunction within an efficacy trial. Data extraction excluded case reports, letters, and other limited study designs. A panel survey augmented published reports. DATA SYNTHESIS: Sexual dysfunction is a relatively common adverse effect of many of the antidepressants in common use today. Rates of sexual dysfunction observed in clinical practice may be higher than those reported in the product information for several agents. Selective serotonin-reuptake inhibitors (SSRIs) appear to be the class of antidepressants most likely to cause sexual dysfunction. Published studies suggest that between 30% and 60% of SSRI-treated patients may experience some form of treatment-induced sexual dysfunction. Bupropion and nefazodone appear to be much less likely to cause sexual dysfunction (相似文献