Effects of L-5HTP with and without carbidopa on plasma β-endorphin and pain perception: possible implications in migraine prophylaxis

L-Tryptophan (L-TP) has been used in migraine and other pain conditions. The mechanism underlying the analgesic effect is still partly undefined. In this study the effects of subchronic administration of L-5-hydroxytryptophan (L-5HTP) (with and without carbidopa) on plasma beta-endorphin (beta-EP) levels and subjective pain threshold and tolerance were investigated in seven healthy volunteers. To measure also an objective indicator of pain, the nociceptive flexion reflex threshold was studied. L-5HTP treatment with and without carbidopa administration increased beta-EP levels significantly (p less than 0.05). L-5HTP plus carbidopa induced an increase in beta-EP significantly (p less than 0.05) greater than that induced by L-5HTP alone. Neither the subjective pain threshold and tolerance nor the RIII threshold was modified by either treatment. Our data seem to point to the existence of a complex linkage between plasma opioid levels and pain perception.     

L-5-Hydroxytryptophan in the prophylaxis of chronic tension-type headache: a double-blind, randomized, placebo-controlled study. For the Portuguese Head Society

A parallel, randomized, double-blind trial is reported, in which 78 patients with chronic tension-type headaches were treated with L-5-hydroxytryptophan (5-HTP) (n = 43) or placebo (n = 35) for 8 weeks, after a washout period of 2 weeks and with a follow-up period of a further 2 weeks. Five patients dropped out (1 with placebo and 4 with 5-HTP), 1 was excluded due to noncompliance, and in 7 treatment was suspended due to adverse events (3 with placebo and 4 with 5-HTP), yielding a final number for evaluation of 65 patients. In comparison with the group treated with placebo, there was no statistically significant change in the number of days with headache or in headache intensity in the group treated with 5-HTP, 300 mg per day; however, there was a significant decrease in the consumption of analgesics. During the 2 weeks after treatment, there was a significant decrease in the number of days with headache. Subjective opinion during this latter period was also favorable to 5-HTP.     

帕罗西汀治疗原发性早泄后血浆5-羟色胺浓度的变化

目的了解帕罗西汀治疗原发性早泄后血浆5-HT浓度的变化以及此种变化和临床症状改善程度之间的可能关系。方法筛选本院门诊原发性早泄患者81例,根据患者近3次性生活阴道内射精潜伏期(intra-vaginal ejaculation latency time,IELT)的平均值将入选样本分为两组:A组(IELT≤30s),B组(30sIELT≤60s)。同时对每一个患者予以提取血浆冻存。两组患者均口服帕罗西汀20mg/d,连用8周。治疗8周后再次予以同样的方法记录IELT,提取患者血浆。采用5-HT ELISA试剂盒测定所收集的血浆样本。运用SPSS16.0软件统计分析所得数据。结果研究初始,研究终点时,共计125例患者获得了可靠随访数据及血样信息,其中A组41例,B组40例。研究发现,研究初始时,A组患者血浆5-HT浓度显著低于B组(P0.001),治疗后,血浆5-HT浓度及IELT均显著增加(P0.001),A组IELT均值的增加以及5-HT浓度的增加均显著高于B组,(P0.001)。结论原发性早泄患者血浆5-HT浓度越低的患者表现出了越严重的早泄症状。原发性早泄患者在通过帕罗西汀治疗后5-HT浓度显著增高且治疗前5-HT浓度越低的患者治疗后其5-HT浓度增高越明显,且其临床症状改善越明显,5-HT浓度的提高与患者早泄症状的改善之间具有明显的一致性。     

无痛内镜下冷切除术在老年患者5～9 mm扁平无蒂结直肠息肉治疗中的临床应用价值

目的 探讨无痛内镜下冷切除术在老年患者5～9 mm扁平无蒂结直肠息肉治疗中的临床应用价值。方法 选取在开封市人民医院内镜中心行无痛肠镜检查,发现扁平无蒂结直肠息肉且直径在5～9 mm的124例老年患者为研究对象,按照随机数表法分为研究组（n=64）和对照组（n=60）。研究组应用圈套器对息肉行冷切除治疗,对照组给予黏膜下注射使息肉抬举后,应用圈套器行高频电切除治疗。比较两组患者手术时间、术中出血量、一次性完整切除率、标本回收率、息肉病理类型、术后并发症及手术费用。结果研究组手术时间较对照组短,手术费用较对照组少,术后并发腹胀的情况较对照组少,差异均有统计学意义（P <0.05）;两组患者术中出血例数、一次性完整切除率、标本回收率、术后并发腹痛和出血比较,差异均无统计学意义（P> 0.05）。结论 无痛内镜下应用圈套器对5～9 mm扁平无蒂结直肠息肉行冷切除术,手术时间短,安全性高,并发症少,费用低,且避免了高频电对周围正常黏膜的损伤。     

G5呼吸系统物理治疗仪治疗老年病人术后尿潴留的效果观察

[目的]观察G5呼吸系统物理治疗仪治疗老年病人术后尿潴留的效果。[方法]将96例术后尿潴留的老年病人随机分为观察组和对照组,每组48例,对照组采用热敷＋诱导排尿法,观察组应用G5呼吸系统物理治疗仪进行膀胱按摩。比较两组病人的治疗效果。[结果]观察组总有效率为93.8%,对照组为72.9%,观察组优于对照组（P〈0.05）。[结论]G5呼吸系统物理治疗仪可有效缓解老年病人术后尿潴留,效果优于热敷＋诱导排尿法。     

Platelet met-enkephalin immunoreactivity and 5-hydroxytryptamine concentrations in migraine patients: effects of 5-hydroxytryptophan, amitriptyline and chlorimipramine treatment

In thirty patients with common migraine the platelet concentrations of met-enkephalin immunoreactivity (ME) (76 ± 9 pg/mg protein) were similar to those in 23 healthy volunteers (77 ± 5), suggesting that there is no alteration in the ME pool in this biochemical compartment in migraine. Chronic treatment (4 weeks) with drugs that interfere with 5-hydroxytryptamine (5-HT) synthesis or uptake induced the expected changes in platelet 5-HT levels, i.e. a rise following administration of the 5-HT precursor 5-hydroxytryptophan (daily dose: 300–500 mg, n = 9) and a decrease after amine uptake inhibition by amitryptyline (30–75 mg, n = 7) and even more by chlorimipramine (30–50 mg, n = 9). Platelet ME concentrations rose by up to ∼90% over the basal values after either 5-hydroxytryptophan (significantly from week 2) or amitriptyline (at week 2) and were unchanged after chlorimipramine, indicating that 5-HT and ME concentrations in platelets can vary independently. The high platelet ME levels following 5-hydroxytryptophan and amitriptyline cannot be explained at present. They might be due either to increased ME synthesis, possibly in the megakaryocyte, or to decreased utilization by platelets or both.     

Nursing assessment as an effective tool for the identification of delirium risk in older in‐patients: A case–control study

Aims and objectives

To evaluate the usefulness of comprehensive nursing assessment as a strategy for determining the risk of delirium in older in‐patients from a model of care needs based on variables easily measured by nurses.

Background

There are many scales of assessment and prediction of risk of delirium, but they are little known and infrequently used by professionals. Recognition of delirium by doctors and nurses continues to be limited.

Design and methods

A case–control study. A specific form of data collection was designed to include the risk factors for delirium commonly identified in the literature and the care needs evaluated from the comprehensive nursing assessment based on the Virginia Henderson model of care needs. We studied 454 in‐patient units in a basic general hospital. Data were collected from a review of the records of patients’ electronic clinical history.

Results

The areas of care that were significant in patients with delirium were dyspnoea, problems with nutrition, elimination, mobility, rest and sleep, self‐care, physical safety, communication and relationships. The specific risk factors identified as independent predictors were as follows: age, urinary incontinence, urinary catheter, alcohol abuse, previous history of dementia, being able to get out of bed/not being at rest, habitual insomnia and history of social risk.

Conclusions

Comprehensive nursing assessment is a valid and consistent strategy with a multifactorial model of delirium, which enables the personalised risk assessment necessary to define a plan of care with specific interventions for each patient to be made.

Relevance to clinical practice

The identification of the risk of delirium is particularly important in the context of prevention. In a model of care based on needs, nursing assessment is a useful component in the risk assessment of delirium and one that is necessary for developing an individualised care regime.     

四川省首起三例严重急性呼吸综合征(SARS)的发现与治疗

目的 在经济欠发达地区，能否成功诊治防SARS。方法 对三例SARS患的诊断、治疗预防全过程进行回顾性的分析。结果 三例患痊愈，无一例医护人员感染，无二代病人发生。结论 在经济欠发达的地区，只要思想重视，平时工作落实到位，发现疫情，做到四早，紧急启动应急机制，操作规范，积极治疗，面对突然发生的疫情，同样也能以较小的代价，成功地扑灭疫情。     

Structural and oxidative modifications of erythrocyte ghosts in patients with primary biliary cirrhosis: relation with the disease stage and effect of bile acid treatment

BACKGROUND: Erythrocyte membrane modifications in patients with cholestasis are supposed to reflect those of hepatocytes. METHODS: Erythrocyte membrane composition (cholesterol, phospholipids, fatty acids, protein sulphydrils and carbonyls) was assessed and related to the stage of liver disease in patients with primary biliary cirrhosis before and after 1 year of ursodeoxycholate treatment. RESULTS: Compared with controls, patients showed lower levels of protein sulphydrils (28.9 +/- 7.1 vs. 65.6 +/- 1.8 nmol mg(-1) prot) and accumulation of carbonyls (4.7 +/- 1.7 vs. 1.4 +/- 0.1 nmol mg(-1) prot). Phosphatidylethanolamine level was lower in stage III-IV cirrhosis while phosphatidylcholine and cholesterol levels were higher; as a consequence the phosphatidylcholine/sphingomyelin ratio was higher than in controls (4.25 +/- 0.55 in the I-II stage and 2.89 +/- 0.44 in the stage III-IV vs. 1.61 +/- 0.30). These changes were particularly evident in patients with more advanced stages of liver disease. Protein sulphydrils and carbonyls, phosphatidylethanolamine and cholesterol levels correlated (P<0.05) with the histological stage of the liver disease, serum and membrane cholesterol levels were significantly related (r=0.66, P<0.05). One year of ursodeoxycholate administration was accompanied by major changes of the membrane lipid composition, partial reversal of protein oxidation, and improvement of serum parameters. CONCLUSIONS: This study indicates that major alterations in protein status and lipid composition occur in erythrocyte membrane of patients with primary biliary cirrhosis. These changes were more pronounced in patients with advanced liver disease. Ursodeoxycholate was able to revert in part serum and erythrocyte alterations, especially in patients with early stages of liver disease.