脑缺血海马透析自由基活性研究

研究脑反复缺血再灌流羟自由基活性动态变化，探讨脑缺血损伤的病理生理机制。方法采用Ｐｕｌｓｉｎｅｌｌｉ和Ｂｒｉｅｆｌｅｙ４血管关闭方法，５ｍｉｎ×３次缺血，用微透析针植人右侧海马ＣＡ１区，用水杨酸盐捕获生成稳定的加合物２，３和２，５二氧苯甲酸（２，３和２，５ＤＨＢＡ）。用高压液相（ＨＰＬＣ）电化学检测。结果腹腔内注射水杨酸盐和微管透析针内注射水杨酸盐，２，３和２，５ＤＨＢＡ出现相似变化。缺血期２，３和２，５ＤＨＢＡ稍降低，灌流２０ｍｉｎ显著增高，灌流１ｈ升高至顶峰，持续３ｈ。证明脑反复缺血后再灌流羟自由基显著增高，并且不是一个暂时的现象。结论自由基在脑缺血损害中起重要作用。     

大鼠脑缺血再灌流时检测血中脑细胞胞浆酶的意义

研究大鼠脑缺血灌流时脑细胞浆酶含量的变化及其临床意义。方法：采用全自动生化分析仪检测血清肌酸激酶（ＣＫ）、肌酸激酶脑型同工酶（ＣＫ－ＢＢ）、乳酸脱氢酶（ＬＤＨ）以及天门冬氨酸氨基转换酶（ＡＳＴ）的含量。结果：脑缺血２０ｍｉｎ,血中ＣＫ、ＣＫ－ＢＢ和ＬＤＨ的含量明显高于假手术组（Ｐ〈０．０５或Ｐ〈０．０１）。脑缺血再灌注后血中ＣＫ、ＣＫ－ＢＢ、ＬＤＨ和ＡＳＴ的含量明显高于假手术组和脑缺血组。结论：脑     

甘露醇在脑缺血动物实验中的治疗作用

观察甘露醇对脑缺血鼠脑组织羟自由基的清除作用。方法采用线栓法制成大脑中动脉脑缺血模型，利用高压液相色谱技术测定脑组织中羟自由基的含量。结果脑缺血组鼠脑皮层及纹状体内２，３－二羟基苯甲酸（２，３－ＤＨＢＡ）、２，５－ＤＨＢＡ的水平较对照组增高３～４倍。甘露醇能有效地降低局灶性缺血脑皮层及纹状体２，３－ＤＨＢＡ及２，５－ＤＨＢＡ的水平，改善缺血后神经功能损害，且甘露醇持续慢滴组较快滴组效果明显。甘露醇快速滴注组能减轻缺血脑组织的水肿，而甘露醇慢滴组作用不明显。结论甘露醇的脑保护作用不完全与脱水降颅压有关，可能是通过清除羟自由基而发挥重要的脑保护作用     

脑缺血再灌注后脑内脑源性神经营养因子的基因表达与调节

探讨：探讨脑缺血再灌注损伤后脑内脑源性神经营养因子（ＢＤＮＦ）ｍＲＡＮ水平的变化,推测ＢＤＮＦ对损伤病理的影响。方法线栓法制作大鼠脑缺血再灌注模,原位交检测大鼠海马神经元内ＢＤＮＦｍＲＮＡ,图像分析间接定量ＢＤＮＦｍＲＮＡ水平。结果（１）脑缺血及缺血再灌注均能诱导双侧海马神经元ＢＤＮＦｍＲＮＡ水平增高;（２）缺血损伤过重后海马神经元ＢＤＮＦｍＲＮＡ水平增高的程度反而小;（３）再灌注后ＢＤＮＦｍＲＮ     

GM_1对大鼠全脑缺血再灌注中钙平衡紊乱、氧自由基代谢异常以及病理损伤的影响

目的　研究单唾液酸四已糖神经节苷脂（ＧＭ１）对大鼠全脑缺血再灌注中钙平衡紊乱、氧自由基代谢异常以及病理损伤的影响。方法　运用大鼠全脑缺血再灌注模型（４ＶＯ）,观察假手术组、脑缺血３０ 分钟再灌注６０ 分钟生理盐水（ＮＳ）处理组（ＮＳ组）和缺血３０ 分钟再灌注６０ 分钟ＧＭ１ 处理组（ＧＭ１ 组）的脑海马组织线粒体钙（ＭＣａ）、钙调素（ＣａＭ）、丙二醛（ＭＤＡ）及海马ＣＡ１ 区病理改变。结果　ＮＳ组海马组织ＭＣａ、ＣａＭ、ＭＤＡ含量显著升高（Ｐ＜ ０．０１）,海马ＣＡ１ 区神经元呈较严重缺血损伤性改变,而ＧＭ１ 组较ＮＳ组生化和病理变化明显改善。结论　ＧＭ１ 能改善脑缺血再灌注中钙平衡紊乱和氧自由基代谢异常,减轻脑缺血再灌注病理损伤。     

红景天保护缺血再灌注损伤鼠脑细胞的作用及机理研究

目的研究红景天对大鼠脑缺血再灌注损伤的作用。方法４ＶＯ法复制缺血再灌注动物模型;放免法及化学发光法测定乙酰胆碱（Ａｃｈ）、一氧化氮（ＮＯ）及内皮素（ＥＴ）含量;细胞培养观察红景天对神经细胞的作用。结果（１）缺血再灌注组（ＩＲ）Ａｃｈ含量显著低于假手术组（ＳＡＭ）,药物预防后缺血再灌注组（Ｒ＋ＩＲ）及缺血再灌注后药物治疗组（ＩＲ＋Ｒ）较ＩＲ组显著升高。（２）ＩＲ组ＮＯ含量显著高于ＳＡＭ组,Ｒ＋ＩＲ组及ＩＲ＋Ｒ组ＮＯ含量显著降低。（３）ＩＲ组ＥＴ含量显著高于ＳＡＭ组而Ｒ＋ＩＲ组显著降低。（４）红景天甙培养组细胞存活率及ＬＤＨ含量明显高于对照组,ＮＭＤＡ损伤＋红景天甙组细胞存活率明显高于ＮＭＤＡ损伤组,ＬＤＨ含量却明显降低。结论红景天对大鼠脑缺血再灌注损伤时脑神经细胞具有保护作用。     

脑缺血选择性海马CA1区神经元损害的实验研究

采用Ｐｕｌｓｉｎｅｌｉ－Ｂｒｉｅｒｌｅｙ４血管阻塞脑缺血模型观察了大鼠全脑缺血２０ｍｉｎ再灌流８ｈ，ｃ－ｆｏｓ基因表达及再灌流７ｄ海马ＣＡ１区迟发性神经元损害。在缺血再灌流早期（８ｈ）海马ＣＡ１区极少ｃ－ｆｏｓ表达，而齿状回、海马ＣＡ３区、杏仁核大量ｃ－ｆｏｓ表达。缺血再灌流晚期（７ｄ）镀银染色显示海马ＣＡ１区神经元及其突触终末带呈黑色溃变相，而齿状回、海马ＣＡ３区、杏仁核呈金黄色正常相。相邻切片ＨＥ染色示缺血组海马ＣＡ１区核完整的锥体细胞数（５±２．６个／２００μｍ）与对照组（４０±２．９个／μｍ）比较差异有显著意义（Ｐ＜０．０１）。脑缺血诱导的ｃ－ｆｏｓ基因表达对于缺血易损海马ＣＡ１区迟发性神经元坏死可能起直接的调控作用。     

鼠脑反复缺血再灌注海马6种氨基酸、单胺递质及其代谢产物变化的研究

目的：研究脑反复缺血后海马细胞外液氨基酸和单胺递质及其代谢产物的变化规律。方法：采用Ｐｕｌｓｉｎｅｌｌｉ和Ｂｒｉｅｒｌｅｙ４血管闭塞的方法,使鼠脑反复缺血,海马微管透极与高压液相电化学检测,观察细胞外谷氨酸（Ｇｌｕ）,天门冬氨酸（Ａｓｐ）,谷氨酰胺,牛磺酸、丙氨酸,丝氨酸,多巴胺（ＤＡ）,５－羟色胺（５－ＨＴ）及其代谢产物浓度的变化。结果：缺血期,Ｇｌｕ和Ａｓｐ骤然增高５０倍和３０倍。缺血期ＤＡ和５－ＨＴ含量分别增加３０倍和５０倍,随后逐渐下降,再灌注１００ｍｉｎ恢复到基线水平,与此同时,其酸性代谢产物３,４－二羟苯乙酸（ＤＯＰＡＣ）,高香草酸（ＨＶＡ）,５－羟吲哚乙酸（５－ＨＩＡＡ）在缺血期明显下降。结论：缺血期海马细胞外液兴奋性氨基酸和单胺递质急剧大量释放并触发膜离子通道改变。Ｃａ＾＋超载,自由基反应,共同     

活体溶出伏安法测定鼠脑缺血时纹状体单胺神经递质的含量变化

应用活体溶出伏安法（ＩＶＶ）连续测定沙土鼠脑缺血再灌流模型纹状体单胺类神经递质多巴胺（ＤＡ）５－羟吲哚乙酸（５－ＨＩＡＡ），并同期测定鼠脑皮质灌流量、脑电活动及腐胶含量。结果发现：１、脑缺血期纹状体ＤＡ与５－ＨＩＡＡ显著增高；再灌流期ＤＡ明显下降，５－ＨＩＡＡ仅在１５ｍｉｎ时有一过性降低，但两者均明显高于缺血前水平。２、脑缺血时脑皮质灌流量显著下降（下降９５％），相应时间的脑电活动明显抑制；再灌流期皮质灌流量有所恢复，但仍明显低于缺血前（约为其３０％），脑电活动亦无恢复。３、脑缺血时脑皮质腐胺含量下降，而再灌流３０ｍｉｎ时显著增高，在９０ｍｉｎ时恢复至正常水平。     

脑缺血纹状体细胞外液单胺类介质及其代谢物的微透析研究

目的观察脑缺血再灌注时鼠脑纹状体区细胞外液（ＥＣＦ）多巴胺（ＤＡ）、去甲肾上腺素（ＮＥ）、５－羟色胺（５－ＨＴ）及其代谢产物高香草酸（ＨＶＡ）和５－羟吲哚乙酸（５－ＨＩＡＡ）的动态变化。方法采用脑内微透析技术，用高压液相色谱测定了前脑缺血３０ｍｉｎ、再灌注１２０ｍｉｎ时ＥＣＦＤＡ、ＮＥ和５－ＨＴ的变化。结果脑缺血１０ｍｉｎ时ＥＣＦＤＡ、ＮＥ迅速升高为缺血前的２８２和９１４倍，持续整个缺血期，再灌注后迅速下降达缺血前水平。脑缺血期ＨＶＡ、５－ＨＩＡＡ迅速下降，在缺血３０ｍｉｎ时达缺血前的４５％和５２％，再灌注后升高并在再灌注后６０ｍｉｎ，９０ｍｉｎ达缺血前的１５０％、１１３％。结论单胺类介质代谢紊乱参与了缺血性神经元损害     

The neuroendocrinology of stress and the pathophysiology and therapy of depression and anxiety

Clinical and preclinical studies have gathered substantial evidence that stress response alterations play a major role in the development of major depression, panic disorder, and post-traumatic stress disorder. The stress response, the hypothalamic pituitary adrenocortical (HPA) system and its modulation by corticotropin-releasing hormones (CRH),corticosteroids,and their receptors, and the roles of natriuretic peptides and neuroactive steroids are described. We review the role of the HPA system in major depression, panic disorder, and post-traumatic stress disorder and its possible relevance for treatment. Impaired glucocorticoid receptor function in major depression is associated with an excessive release of neurohormones such as CRH, to which a number of signs and symptoms characteristic of depression can be ascribed. In panic disorder, a role of central CRH in panic attacks has been suggested. Atrial natriuretic peptide (ANP) is causally involved in sodium lactate-induced panic attacks. Furthermore, preclinical and clinical data on its anxiolytic activity suggest that nonpeptidergic ANP receptor ligands may be potentially useful in the treatment of anxiety disorders. Post-traumatic stress disorder is characterized by a peripheral hyporesponsive HPA system and elevated CRH concentrations in the CSF. This dissociation is probably related to an increased risk of this disorder. We further review recent data that describe an important role of GABA(A)-receptor modulatory,3 alpha-reduced neuroactive steroids in major depression, anxiety, and its treatment. Antidepressants are effective in both depression and anxiety disorders and have major effects on the HPA system,especially on glucocorticoid and mineralocorticoid receptors. Normalization of HPA system abnormalities is a strong predictor of the clinical course, at least in major depression and panic disorder. Currently,CRH-R1 or glucocorticoid receptor antagonists and ANP receptor agonists are being studied and may provide future treatment options more closely related to the pathophysiology of these disorders.     

Polymorphisms of DRD4 and DRD3 and risk of avoidant and obsessive personality traits and disorders

We investigated whether polymorphisms of the dopamine D4 receptor (DRD4) and polymorphisms of the dopamine D3 receptor (DRD3) were associated with personality disorder symptomatology rather than with personality traits such as novelty seeking. DNA was obtained from 145 depressed patients in a clinical trial. These patients were assessed for the presence of personality disorder symptoms and disorders. The 2-repeat allele of the DRD4 exon III polymorphism was associated with increased rates of avoidant and obsessive personality disorder symptomatology. The T,T genotype of the DRD4 -521 C>T polymorphism was also associated with increased rates of avoidant and obsessive personality disorder symptomatology. The Gly9,Gly9 genotype of the DRD3 Ser9Gly polymorphism was associated with increased rates of obsessive personality disorder symptomatology. None of these three polymorphisms were associated with novelty seeking or other temperament traits on the Temperament and Character Inventory. Our results suggest that genetic polymorphisms of DRD4 and DRD3 may well be associated with personality traits, and that conflicting findings to date may arise from the problem of phenotype definition.     

沙盘游戏疗法在地中海贫血患儿心理干预中的应用

本文目的是对沙盘游戏疗法在地中海贫血患儿心理干预中的应用进行综述,以期为地中海贫血患儿的心理康复提供参考。地中海贫血是以珠蛋白生成障碍为主要特征的遗传性疾病,由于长期输血治疗,患儿存在较多的心理和行为问题。沙盘游戏疗法作为一种有效、实用的儿童心理治疗方法,对提高地中海贫血患儿的康复效果、改善生存质量有重要的临床意义。     

癫痫共病抑郁的机制及临床诊疗

本文目的是探讨癫痫共病抑郁的可能机制及临床诊疗。癫痫是一种常见的、慢性的、致残性的神经疾病,癫痫患者生活质量下降,存在明显的负性情绪,常伴发各种精神疾病。癫痫与抑郁具有共同的神经生物学基础,可能存在共同的发病机制。本文从癫痫共病抑郁的发病机制、临床诊断及治疗方面予以总结归纳。     

Efficacy and Effectiveness of Child and Adolescent Psychotherapy and Pharmacotherapy

Decades of intervention research have produced a rich body of evidence on the effects of psychotherapies and pharmacotherapies with children and adolescents. Here we summarize and critique that evidence. We review findings bearing on the efficacy of psychosocial treatments and medications under controlled experimental conditions. We also report evidence, where available, on the effectiveness of both classes of treatment with clinically referred youth treated in real-world clinical contexts. In general, the large body of evidence on efficacy contrasts sharply with the small base of evidence on effectiveness. Addressing this gap through an enriched research agenda could contribute importantly to linking scientific inquiry and clinical practice—to the benefit of both ventures. This is one element of a multifaceted agenda for future research and for synthesis of research, which will require the interplay of multiple disciplines related to child and adolescent mental health.     

Seclusion and restraint and prediction of violence

The authors studied the use of seclusion and restraint on an inpatient unit in a state psychiatric hospital. Of 69 randomly selected inpatients, 51% experienced seclusion or restraint at least once. More psychotic than nonpsychotic patients required seclusion or restraint. However, neither psychosis/nonpsychosis nor voluntary/involuntary admission status predicted the likelihood of violent threats or actions. Patients experiencing seclusion and restraint showed a nonsignificant trend toward longer mean length of stay in the hospital. The frequency of patient behavior leading to seclusion or restraint appeared to be directly related to the stimulation caused by the presence of many staff members and other patients.     

Comparison of trigeminal and spinal modulation of pain and nociception

Modulation of pain and nociception by noxious counterstimulation, also called "diffuse noxious inhibitory controls" or DNIC-like effect, is often used in studies of pain disorders. It can be elicited in the trigeminal and spinal innervation areas, but no study has previously compared effects in both innervation areas. Therefore, we performed a study comparing DNIC-like effects on the nociceptive flexion reflex (NFR) and the nociceptive blink reflex as well as the respective pain sensations. In 50 healthy volunteers, the blink reflex elicited with a concentric electrode and the NFR were recorded before and after immersion of the contralateral hand in cold water. Responses were recorded as the subjective pain sensation and the reflex size. The cold water immersion of the contralateral hand elicited a reduction of both subjective pain sensation and reflex amplitude following the stimulation of both reflexes. However, there were no strong correlations between the individual reductions of both subjective pain sensation and reflex amplitude for both reflexes, and neither when results of the two reflexes were compared with each other. The dissociation between DNIC-like effects on pain and on nociception, which had been found previously already for the NFR, implies that both effects need to be studied separately.