Screening of depression in patients with chronic medical diseases in a primary care setting

BACKGROUND: Patients with chronic medical diseases may have depression that is not recognized by their primary care physicians. OBJECTIVES: We aimed to examine the application of Zung's Self-Rating Depression Scale (SDS) in the screening of depression in primary care patients with chronic medical diseases in a Chinese population. METHODS: We studied 268 patients with chronic medical diseases in the Family Medicine Outpatient Clinic using a structured questionnaire including basic demographic data, a Chinese version of the SDS and a rating for the self-perceived severity of physical condition. The severity of chronic medical diseases was assessed by the authors using the Duke University Severity of Illness Scale from a chart audit. Fifty patients were randomly selected for a diagnostic interview according to the DSM-IV criteria. The construct validity and internal consistency reliability, sensitivity and specificity of the SDS were examined. RESULTS: The results revealed that the SDS has good construct validity and internal consistent reliability in the evaluation of depression in Chinese patients with chronic medical diseases. A cut-off point of 55 had a sensitivity of 66.7% and a specificity of 90.0%. Depressed patients reported more cognitive symptoms than depressed affect and physical symptoms. Female patients had more severe depressed affect than male patients, but males had more prominent diurnal variation of mood than females. CONCLUSIONS: We concluded that SDS can be a good screening tool for depression in Chinese patients with chronic medical diseases. Owing to constraints in the expression of sexual desire in the Chinese, elderly subjects tended to report loss of libido in the response to the SDS.      

丁基苯酞对脑卒中型自发性高血压大鼠寿命及卒中后神经症状的影响

本实验研究了dl-3-正丁基苯酞(NBP)在高盐负荷下,对卒中型自发性高血压大鼠(SHRsp)寿命及卒中后存活时间和神经症状的影响。实验证明NBP能延迟脑卒中发生;能延长脑卒中发作后的存活时间和减轻神经症状。NBP对SHRsp大鼠的血压和心率无明显影响。     

Serum creatinine levels in the US population: third National Health and Nutrition Examination Survey

This report describes the distribution of serum creatinine levels by sex, age, and ethnic group in a representative sample of the US population. Serum creatinine level was evaluated in the third National Health and Nutrition Examination Survey (NHANES III) in 18,723 participants aged 12 years and older who were examined between 1988 and 1994. Differences in mean serum creatinine levels were compared for subgroups defined by sex, age, and ethnicity (non-Hispanic white, non-Hispanic black, and Mexican-American). The mean serum creatinine value was 0.96 mg/dL for women in the United States and 1.16 mg/dL for men. Overall mean creatinine levels were highest in non-Hispanic blacks (women, 1.01 mg/dL; men, 1.25 mg/dL), lower in non-Hispanic whites (women, 0.97 mg/dL; men, 1.16 mg/dL), and lowest in Mexican-Americans (women, 0.86 mg/dL; men, 1.07 mg/dL). Mean serum creatinine levels increased with age among both men and women in all three ethnic groups, with total US mean levels ranging from 0.88 to 1.10 mg/dL in women and 1.00 to 1.29 mg/dL in men. The highest mean creatinine level was seen in non-Hispanic black men aged 60+ years. In the total US population, creatinine levels of 1.5 mg/dL or greater were seen in 9.74% of men and 1.78% of women. Overall, among the US noninstitutionalized population, 10.9 million people are estimated to have creatinine values of 1.5 mg/dL or greater, 3.0 million have values of 1.7 mg/dL or greater, and 0.8 million have serum creatinine levels of 2.0 mg/dL or greater. Mean serum creatinine values are higher in men, non-Hispanic blacks, and older persons and are lower in Mexican-Americans. In the absence of information on glomerular filtration rate (GFR) or lean body mass, it is not clear to what extent the variability by sex, ethnicity, and age reflects normal physiological differences rather than the presence of kidney disease. Until this information is known, the use of a single cutpoint to define elevated serum creatinine values may be misleading.     

经皮椎体注入骨水泥剂量与老年骨质疏松压缩性骨折椎体高度的恢复：1年随访验证

目的:应用经皮椎体注入骨水泥的方法治疗老年骨质疏松压缩性骨折,观察术后椎体形态学改变与疗效的关系,骨水泥注入量与疗效的关系,骨水泥渗漏后宿主的生物相容性反应以及1年后疗效变化。方法:①实验对象:于2002-10/2006-03在广西医科大学第五附属医院骨科行椎体成形术82例患者(114个椎体)中,选取获得1年以上随访患者50例(68个椎体),年龄60～92岁,平均71岁。其中椎体上终板骨折塌陷型25个椎体,椎体中央骨小梁断裂塌陷型10个椎体,椎体下终板骨折塌陷型33个椎体。②实验材料:低黏度骨水泥Corinplasty3(英国Corin MedicalLtd),造影剂碘海醇(江苏扬子江制药),自行调制的骨水泥为骨水泥粉末:单体:造影剂按3g∶2mL∶1mL的比例。③实验方法:在C臂机透视下,将穿刺针尖置于病椎椎弓根的外上缘(左侧为10点钟位置,右侧为2点钟位置),所有类型的骨折穿刺针与身体矢状位呈10°～15°(如遇椎体有旋转,根据具体情况选择角度),与冠状位(椎体水平位)的夹角根据骨折类型不同而不一样(上终板骨折者针尖略靠近上终板,下终板骨折者针尖略靠近下终板,中央压缩性者针尖位置在中部)。经椎弓根或椎弓根旁,将穿刺针抵达椎体侧位前1/3,正位靠近中线为理想位置。行椎体静脉造影后调制骨水泥,到第2阶段拉丝期时用压力注射器注入椎体内。骨水泥注射量为3.0～7.0mL,平均(5.5±1.5)mL。结果:①50例(68个椎体)获得1年以上随访,随访1年者38例,1.5~2年12例。②术后疗效:术后即刻优良率(94%)与术后1年优良率(90%)对比差异无显著性意义。③术后椎体高度恢复增加9.42%,但椎体高度恢复率与疗效无明显相关性。④骨水泥注入每个椎体3mL以上即可获得良好临床疗效,增加骨水泥量并不能提高临床优良率。⑤术中并发症以骨水泥漏较常见(17个椎体,25%),无肺栓塞及穿刺损伤发生。⑥术中及术后宿主无特殊不良反应。结论:①经皮椎体成形术可适度改善椎体高度,骨水泥注入量在3mL左右即可达到良好临床疗效,术后1年疗效仍可肯定。②但存在骨水泥渗漏率发生较高,术后不能明显改善后凸畸形等相关问题。③临床结果证实骨水泥与宿主生物相容性较好,发生渗漏时亦无特殊宿主的不良反应。     

延胡索对未孕大鼠离体子宫平滑肌运动的抑制作用

目的:观察延胡索乙素对未孕大鼠离体子宫平滑肌条运动的抑制作用。方法:实验于2003-11/2004-03在兰州大学医学院生理学教研室进行。①成年未孕Wistar大鼠90只,于实验前72h皮下注射乙烯雌酚0.5mg/kg,造成人工动情期以提高子宫对药物的敏感性。②猛击大鼠头部致昏,取卵巢及子宫分叉处之间的中段子宫,制成8mm×2mm的肌条,将肌条安置在恒温平滑肌肌槽中,每个肌槽中分别盛有5mL37℃Krebs液。③肌条在1g的前负荷下温育,每20min更换一次5mL新鲜的Krebs液(37℃),待肌条的自发活动平稳后加入不同剂量的延胡索乙素(2×10-5,2×10-4,4×10-4,8×10-4,1.6×10-3kg/L),观察延胡索乙素对大鼠离体子宫平滑肌条收缩活动的影响。④分别加入不同的受体拮抗剂5min后(2×10-6mol/L酚妥拉明,2×10-7mol/L异搏定,2×10-5mol/吲哚美辛和2×10-6mol/L苯海拉明),再加入8×10-4延胡索乙素,观察使用拮抗剂后延胡索乙素对大鼠离体子宫平滑肌条作用的影响。⑤计算给药前5min和给药后5min子宫平滑肌条的收缩波的频率、平均振幅和收缩波间隔平均持续时间。结果:①不同浓度的延胡索乙素均能抑制子宫平滑肌收缩运动,可使子宫平滑肌收缩波的频率减慢,在延胡索乙素浓度8×10-4kg/L,1.6×10-3kg/L时为其抑制作用差异具有显著性(P<0.01);延胡索乙素各浓度虽可以降低子宫平滑肌收缩波的振幅但差异无显著性(P>0.05);而当延胡索乙素浓度为4×10-4,8×10-4,1.6×10-3kg/L时,可显著延长收缩波的间歇时间(P<0.01)。②在加入H1受体阻断剂苯海拉明后延胡索乙素使子宫平滑肌的收缩频率降低(P<0.05),收缩波间隔的持续时间延长(P<0.05),而收缩振幅增高(P<0.05);在加入α受体阻断剂酚妥拉明后,延胡索乙素抑制子宫平滑肌的作用与单独使用延胡索乙素组相比差异无显著性(P>0.05);在加入吲哚美辛抑制前列腺素合成酶合成和释放后,延胡索乙素抑制子宫平滑肌的作用与延胡索乙素组相比仍然可以使收缩波的频率降低(P<0.05),振幅减小(P<0.05),收缩波间隔持续时间延长(P<0.05)。加入L型Ca2 通道阻断剂异搏定后延胡索乙素对未孕大鼠离体子宫平滑肌的运动有抑制作用,收缩间隔时间延长(P<0.05),但振幅不变(P<0.05)。结论:延胡索乙素抑制大鼠子宫平滑肌收缩运动的部分作用可能与L型电压依从性Ca2 通道使平滑肌细胞内Ca2 浓度降低有关,也可能与前列腺素的合成与释放有关。     

Enhancing Web-Based Mindfulness Training for Mental Health Promotion With the Health Action Process Approach: Randomized Controlled Trial

Background

With increasing evidence demonstrating the effectiveness of Web-based interventions and mindfulness-based training in improving health, delivering mindfulness training online is an attractive proposition.

Objective

The aim of this study was to evaluate the efficacy of two Internet-based interventions (basic mindfulness and Health Action Process Approach enhanced mindfulness) with waitlist control. Health Action Process Approach (HAPA) principles were used to enhance participants’ efficacy and planning.

Methods

Participants were recruited online and offline among local universities; 321 university students and staff were randomly assigned to three conditions. The basic and HAPA-enhanced groups completed the 8-week fully automated mindfulness training online. All participants (including control) were asked to complete an online questionnaire pre-program, post-program, and at 3-month follow-up.

Results

Significant group by time interaction effect was found. The HAPA-enhanced group showed significantly higher levels of mindfulness from pre-intervention to post-intervention, and such improvement was sustained at follow-up. Both the basic and HAPA-enhanced mindfulness groups showed better mental well-being from pre-intervention to post-intervention, and improvement was sustained at 3-month follow-up.

Conclusions

Online mindfulness training can improve mental health. An online platform is a viable medium to implement and disseminate evidence-based interventions and is a highly scalable approach to reach the general public.

Trial Registration

Chinese Clinical Trial Registry (ChiCTR): ChiCTR-TRC-12002954; http://www.chictr.org/en/proj/show.aspx?proj=3904 (Archived by WebCite at http://www.webcitation.org/6VCdG09pA).     

小檗碱对大鼠肝硬化肝组织IFNγ表达与端粒酶活性的影响

目的探讨小檗碱抑制血吸虫肝硬化组织恶性变潜能的作用及其机制。方法将80只大鼠感染日本血吸虫尾蚴,随机分为A、B、C、D组,每组20只。模型对照组（A组）不作任何治疗;吡喹酮组（B组）感染尾蚴6周后给予吡喹酮500 mg·kg－1·d－1灌胃2 d;小檗碱组（C组）感染尾蚴6周后给予小檗碱150 mg·kg－1·d－1灌胃6周;小檗碱＋吡喹酮组（D组）在感染尾蚴6周后给予吡喹酮500 mg·kg－1·d－1灌胃2 d,再以小檗碱150 mg·kg－1·d－1灌胃6周。另取10只大鼠作为正常对照组（E组）。第12周末分别留取各组大鼠肝组织,检测肝脏Ⅰ、Ⅲ型胶原及干扰素 γ（IFN γ）含量、端粒酶活性与端粒酶反转录酶（TERT）表达情况。结果与A组比较,B组和C组肝纤维化程度均减轻,肝组织IFN γ含量显著升高,端粒酶活性与TERT表达水平降低（P＜0.05）。与B组比较,C组大鼠肝纤维化程度、IFN γ含量及端粒酶活性、TERT表达水平无明显差异（P＞0.05）。与B组、C组比较,D组大鼠肝纤维化程度进一步减轻,肝组织IFN γ含量显著升高（P＜0.05）,端粒酶活性及TERT表达水平显著降低（P＜0.05）。结论小檗碱可通过调节大鼠肝组织内免疫应答,促进IFN γ表达,抑制肝组织TERT表达及端粒酶活性,可配合吡喹酮对大鼠晚期血吸虫肝硬化起协同、增效作用。     

大鼠骨髓间充质干细胞分离培养及其生物学特性观察

目的:分离和培养大鼠骨髓间充质干细胞并观察其生物学特性。方法:实验于2004-05/2006-04在武装警察部队医学院细胞生物学实验室进行。在无菌条件下分离大鼠胫骨、股骨,用预冷磷酸盐缓冲液冲出骨髓,经Percoll梯度分离方法获得骨髓单个核细胞,接种含体积分数为0.10胎牛血清的IMDM培养基中。对单个核细胞行贴壁培养后,通过倒置光显微镜和透射电子显微镜进行细胞形态学观察,流式细胞术进行细胞周期分析,细胞计数法测定细胞生长曲线,免疫细胞化学染色显示c-kit表达。结果:①倒置光显微镜下观察采用Percoll(1.073g/mL)分离的骨髓间充质干细胞大小较为均匀,基本上呈梭形或星形的上皮样细胞,传代培养后的细胞体积增大,成纤维样细胞逐渐增多。②透射电子显微镜下观察骨髓间充质干细胞的核质比例较大,核仁大而明显,细胞表面有微绒毛,胞浆内可见核糖体和线粒体,其他细胞器较少,表现出未分化细胞的特征。③细胞生长曲线测定表明接种后第4天细胞进入指数增生期,至第7天进入平台期。④流式细胞术证明G2 S期细胞为11.8%。⑤体积较大的多角形细胞为c-kit阳性,体积较小的成纤维样细胞为阴性细胞,阳性颗粒主要分布在细胞膜和细胞质,细胞核未见表达,阳性细胞比率为55.3%。结论:成功地建立了一种分离培养大鼠骨髓间充质干细胞的方法,获得的细胞生长稳定,增殖活跃,可作为组织工程的种子细胞。     

导引手法治疗青少年特发性脊柱侧凸症:多中心、分层随机区组化对照

目的:青少年特发性脊柱侧凸症,严重者可致畸形。采用多中心,临床随机对照试验方法,验证导引手法综合方案治疗轻度青少年特发性脊柱侧凸症的有效性和安全性。方法:①对象:源于2005-05/2006-07上海中医药大学附属龙华医院、复旦大学附属华东医院、苏州市中医医院3个研究中心对青少年特发性脊柱侧凸流行病学调查基础上的筛选病例共120例。②分组:采用多中心、单盲、随机、对照研究方法,随机分为导引手法组90例和对照组30例,性别、年龄差异无显著性。两组受试者对治疗知情同意。③干预:导引手法组,予脊柱平衡导引术(1次/d,40min/次)和脊柱平衡手法(20min)治疗,10次为1疗程,治疗1个疗程;对照组予以观察随访。④评估:有效性指标:治疗前后侧凸Cobb角改善情况;安全性指标:治疗中血压、心率、心律、呼吸变化;不良反应如骨折、脱位、晕厥、病情变化;并进行两组患者疗效比较。结果:①有效性评价:对照组前后Cobb角无显著改善(P>0.05);导引手法组在治疗后Cobb角比治疗前显著减少(P<0.01)。②安全性评价:在临床试验过程中,未发现所采用的治疗方法对呼吸、脉搏、心律、血压等有不良影响。③两组临床疗效比较:导引手法组痊愈率24.44%,总有效率85.56%,对照组痊愈率6.67%,总有效率23.33%,导引手法组疗效优于对照组(P<0.01)。结论:导引手法治疗轻度青少年特发性脊柱侧凸症疗效较好、安全,且操作简便。