β3肾上腺素能受体基因第190位点T/C多态性与中国人2型糖尿病相关性的系统评价

目的系统评价β3肾上腺素能受体(β3-AR)基因第190位点T/C多态性与中国人2型糖尿病(T2DM)的相关性。方法计算机检索Pub Med、EMbase、Cochrane图书馆数据库(2012年第8期)、维普数据库、中国生物医学文献数据库、万方数据库、中国知网数据库,收集国内外关于β3-AR基因第190位点T/C多态性与T2DM相关性的病例对照研究,检索时限均为1980年10月-2013年10月。由2位评价者根据纳入与排除标准独立筛选文献、提取资料并评价质量后,采用Rev Man 5.0和Stata 12.0软件进行Meta分析,采用Egger线性回归法分析发表偏倚。结果共纳入11个研究,包括T2DM患者1 602例及对照1 773例。Meta分析结果显示:对于中国人群,T2DM病例组比对照组TC基因型比例更高,差异有统计学意义[OR=1.19,95%CI(1.01,1.40),P=0.04];T2DM病例组比对照组CC+TC基因型比例更高,差异有统计学意义[OR=1.23,95%CI(1.05,1.45),P=0.01];T2DM病例组比对照组具有等位基因C的比例更高,差异有统计学意义[OR=1.24,95%CI(1.08,1.43),P=0.003]。结论中国人群β3-AR基因第190位点等位基因C与T2DM发病有关。受纳入研究数量及质量所限,上述结论尚待进一步研究加以验证。     

Obsessive compulsive symptoms in bipolar disorder patients: a comorbid disorder or a subtype of bipolar disorder?

概述

在过去十年中，人们越来越关注同时符合两种或两种以上精神障碍诊断标准的患者。上述共病情况之一就是双相障碍合并强迫症，这在以双相障碍为主要诊断的患者中比较常见。但是，关于这种共病的诊断和治疗的研究很少，在中国尤为如此。现有的研究主要集中在小样本的横断面研究，因此它们在对理解这种共病情况的病因和病程作用有限。对有限的文献进行回顾发现这是双相障碍中一种相对严重的、难治性的亚型，只有少数情况可以被认为是一种共病障碍。要阐明这种共病的病因、预后以及合适的治疗方法，则需要大样本的前瞻性研究。

中文全文

本文全文中文版从2015年10月26日起在http://dx.doi.org/10.11919/j.issn.1002-0829.215091可供免费阅览下载 The Forum by Peng and Jiang[1] highlights the lack of literature about comorbid bipolar disorder and obsessive compulsive (OCD) disorder. To provide a preliminary summary of the available English-language literature, a search of PubMed using three relevant keywords (‘bipolar disorder’, ‘obsessive compulsive disorder’, and ‘comorbidity’) was conducted in July 2015. Only a few of the 176 papers retrieved by this search were directly related to the topic of interest: most of the relevant papers described the incidence and clinical features of comorbid bipolar disorder and OCD in relatively small samples of patients; some discussed the etiology and treatment of the comorbid condition; and a few reported on prospective, multi-center studies with relatively large samples. Bipolar-OCD comorbidity was first reported in a 1995 study from Germany[2] which found that more than half of all patients with bipolar disorder had experienced other mental disorders, including OCD, during the course of the bipolar disorder. The study reported that the prevalence of comorbid OCD was higher in patients with unipolar depression than among patients with bipolar disorder. A subsequent systematic review[3] of 64 relevant articles in 2014 reported that from 11 to 21% of persons with bipolar disorder experience comorbid OCD at some time during the course of their bipolar disorder. Most reports indicate that comorbid OCD exacerbates the symptoms of bipolar disorder and makes the diagnosis and treatment of bipolar disorder more difficult. Compared to OCD patients and bipolar disorder patients without other comorbid conditions, bipolar patients with comorbid OCD have: a) higher rates of obsessive ideas about sex and religion and lower rates of ritual checking;[4] b) higher rates of substance abuse (including use of alcohol, sedatives, caffeine, etc.);[5,6] more episodes of depression, higher rates of suicide, and more frequent admissions to hospitals;[7] and d) more chronic episodes and residual symptoms.[8,9] There were no differences between bipolar patients with and without comorbid OCD in age, gender, education, marital status, age of onset of bipolar disorder, personality, prevalence of psychotic symptoms or rapid cycling, history of suicide attempts, the type of initial bipolar episode (i.e., depressed or manic), and the type of episode that was most prevalent throughout the course of bipolar disorder.[9] The systematic review by Amerio and colleagues[3] found that compared to bipolar patients without comorbid OCD, patients with bipolar disorder with comorbid OCD were more likely to experience OCD symptoms during an affective disorder episode (75% v. 3%), had a higher mean (sd) number of depressive episodes (8.9 [4.2] v. 4.1 [2.7] episodes), and were more likely to experience an antidepressant-induced manic episode (39% v. 9%). They also found that among patients with comorbid bipolar disorder and OCD, OCD symptoms were more like to occur during depressive episodes than manic episodes (78% v. 64%). Based on their findings, these authors argue that the obsessive-compulsive symptoms observed in these patients were secondary to bipolar disorder, not a co-occurring independent disorder.[3] Following this logic, I recommend that the occurrence of obsessivecompulsive symptoms during the depressive (or manic) episodes of a bipolar disorder should not be sufficient to merit a diagnosis of comorbid bipolar disorder and OCD; this comorbid diagnosis should be restricted to situations in which a patient with bipolar disorder also meets the full OCD symptomatic and duration criteria when the patient is not experiencing a depressive or manic episode. There are only a few articles about the possible etiology of bipolar-OCD comorbidity. A long-term family study based on a multi-generational dataset[10] (cases registered from January 1969 to 2009 included 19, 814 with OCD, 58, 336 with schizophrenia, 48, 180 with bipolar disorders, and 14, 904 with schizoaffective disorder) found familial associations among individuals with bipolar disorder, OCD, and schizophrenia spectrum disorders. There are also few reports about the long-term prognosis of comorbid bipolar disorder and OCD. One study[11] that followed 20 patients with bipolar disorder without comorbid disorders and 20 patients with comorbid bipolar disorder and OCD for 4 years found no significant differences in the long-term outcomes between the two groups. The treatment of bipolar-OCD comorbidity is difficult because the use of antidepressants to treat obsessive compulsive disorder may induce manic episodes. The existing literature about the treatment is primarily composed of case reports, retrospective cross-sectional studies, and a few treatment studies with small samples. A recent systematic review that combined the results of four treatment studies[12] found that 42% of patients with comorbid bipolar disorder and OCD were simultaneously treated with multiple mood stabilizers and another 10% needed combined treatment with mood stabilizers and anti-psychotic medications. One of the four studies reported that the combined use of antidepressants and mood stabilizers was effective and another study reported that some patients benefitted from the combined use of mood stabilizers and psychological therapy.[11] Based on currently available information, I recommend that patients with comorbid bipolar disorder and OCD be initially treated with mood stabilizers; if mono-therapy with mood stabilizers is ineffective, adjunctive treatment with selective serotonin reuptake inhibitor antidepressants (which are less likely to induce mania) should be considered. In my opinion, the basic treatment for bipolar-OCD is mood stabilizers and could be combined with antidepressants if the patients do not respond to the single treatment (ineffective). Despite ongoing debates about the etiology, diagnosis, and treatment of comorbid bipolar disorder and OCD, the clinicians who regularly treat bipolar patients need more high-quality, evidence-based information to improve their identification and management of this relatively severe and refractory subgroup of bipolar patients. Well-designed prospective studies with relatively large samples that are specifically focused on this important subgroup of bipolar disorder patients are needed.     

龙须草中1个新的二氢菲类化合物

目的研究龙须草Juncus setchuensis茎髓中的菲类化学成分。方法采用多种柱色谱方法分离纯化,通过理化性质及波谱分析技术鉴定化合物的结构。结果从龙须草茎髓的乙醇提取物中分离得到5个菲类化合物,分别鉴定为8-羟甲基-2-羟基-1-甲基-5-乙烯基-9,10-二氢菲(1)、4-ethenyl-9,10-dihydro-1,8-dimethyl-2,7-phenanthrenediol(2)、厄弗酚(3)、去氢厄弗酚(4)、4-ethenyl-9,10-dihydro-7-hydroxy-8-methyl-1-phenanthrenecarboxylic acid(5)。结论化合物1为未见文献报道的具有二氢菲类结构母核的新化合物,命名为龙须草醇A。     

刮痧配合放痧治疗轻度高血压临床观察

目的:观察刮痧配合放痧对轻度(Ⅰ级)高血压病的即刻降压作用。方法:本组轻度(Ⅰ级)高血压患者30例与正常血压者30例进行对照,两组均选取督脉、足太阳经、手阳明经、足阳明经的相关区域和穴位进行3遍刮痧之后再放痧,记录每次刮痧及放痧后的血压值以及每次刮痧后大椎穴区的皮肤温度变化。每周治疗1次,共治疗4次。结果:第1遍、第2遍刮痧和第3遍刮痧以及放痧后均有明显的降压作用(均P<0.01);且刮痧配合放痧的降压作用最为显著(P<0.01);3遍刮痧后的大椎穴区皮肤温度均有显著性升高(均P<0.01)。结论:单纯刮痧或配合放痧对轻度(Ⅰ级)高血压具有较好的降压作用,刮痧的这种降压效应可能与其对体表经络、穴位的温热刺激有关。     

蛋白质含量测定方法对乌司他丁比活的影响

目的考察2种不同蛋白质含量测定方法对乌司他丁比活的影响。方法分别采用凯氏定氮法和福林酚法对乌司他丁原料药中的蛋白质含量进行测定,再结合效价计算比活。结果由凯氏定氮法得到的比活分别为4 035、3 933和4 010mg·mg-1;由《日本药局方》福林酚法得到的比活分别为3 472、3 360和3 423 mg·mg-1;由《中国药典》2010年版福林酚法得到的比活分别为3 621、3 503和3 570 mg·mg-1。结论由《日本药局方》和《中国药典》福林酚法测得的蛋白质含量结果差异较小,但与凯氏定氮法测得的蛋白质含量差异较大。     

2010-2013年西安市手足口病流行病学特征分析

目的了解西安市手足口病流行特征,为制定手足口病防控策略提供科学依据。方法采用描述流行病学方法,对2010-2013年西安市手足口病发病情况及流行特征进行统计分析。结果 2010-2013年西安市累计报告手足口病82 892例,年平均发病率为251.32/10万,其中死亡15例。每年出现两个发病波峰,5月份达到发病高峰,10-11月份又出现一个小波峰。患者主要分布在西安市城乡结合的地区,男女性别比例为1.48∶1;以4岁以下年龄发病为主,占总病例数的91.31%。发病以散居儿童和托幼儿童为主,占总病例数的97.18%。病毒分型2010年主要为Cox A16(44.29%);2011和2012主要为EV71(分别为65.13%和63.30%);2013年则以其他肠道病毒为主(66.18%)。结论手足口病发病有明显的季节性和人群特点,加强以散居儿童为主的重点人群和以托幼机构为主的重点场所的监测管理、健康教育和消毒处理工作是预防控制手足口病的关键措施。     

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??OBJECTIVE To evaluate the safety and tolerability of baicalein chewable tablets and establish the maximum tolerated dose in healthy volunteers. METHODS A randomized, double-blind, dose-escalating, single-center, phase I clinical trial was conducted in 70 healthy male and female subjects. Each subject received oral baicalein only once. Adverse events were identified either by subject self-reporting or evaluation based upon vital signs, physical examination and laboratory parameters. The study was conducted from low to high dose, and the dose escalation was performed only after the safety and tolerability were confirmed favorable. RESULTS Baicalein chewable tablets were well tolerated and had an acceptable safety profile up to the highest dose of 2 800 mg. The vital signs of all subjects were stable, and no QTc interval prolongation was observed during the trial. A total of 11 mild adverse events were reported in 8 subjects. There were no severe adverse events in the study, and none of the adverse events led to withdrawal. CONCLUSION This study suggests that the innovative drug baicalein chewable tablets are well tolerated in healthy Chinese volunteers within the dose range of 100 to 2 800 mg.
     

鼠带毒指数预测肾综合征出血热发病率的探讨

目的探讨用鼠带毒指数预测肾综合征出血热发病率的科学性,为制定防治措施提供科学依据。方法根据《全国肾综合征出血热监测方案(试行)》进行监测,运用Spearman相关分析和χ2检验方法对2005~2012年安徽省人间和鼠间肾综合征出血热的发病率与带毒指数进行相关性分析。结果安徽省肾综合征出血热监测点的平均发病率为0.523/10万,非监测点发病率为0.215/10万,差异均有统计学意义(P0.05);根据鼠带毒指数与人间肾综合征出血热发病率,建立线性回归方程模型:带毒指数=0.010+0.087×发病率,预测2013年监测点发病率为0.676/10万,95%的可信区间[0.642/10万,0.709/10万],实际值为0.689/10万。结论根据鼠带毒指数预测人间肾综合征出血热发病水平具有可靠性,对肾综合征出血热疫情的预测预警提供参考。     

预防医学专业学生关于问卷调查技术的相关态度及其影响因素

目的 从问卷调查技术认知、实践的角度,探讨预防医学专业学生调查问卷技术相关态度的影响因素,从而为有针对性地进行预防医学专业有关问卷调查技术教学改革提供参考.方法 对河北省2所高校公共卫生学院的预防医学专业五年级全体本科生进行调查,共计141人.自行设计调查问卷.影响因素分析采用Logistic多元回归模型.结果 调查对象认为问卷调查技术在获取人群疾病和健康信息方面的作用“很大”或“较大”者占75.17％,认为问卷调查研究结果“真实”或“较真实”者占65.25％,有58.87％认为调查问卷的科学性“很高”或“较高”,有62.41％认为开展问卷调查“很难”或“较难”.预防医学专业学生对问卷调查技术作用的态度与其调查问卷测量属性知晓情况、问卷调查基本原则的知晓情况有关,对问卷调查研究结果真实性的态度与问卷调查基本原则的知晓情况、参加问卷调查设计次数有关,参加问卷调查设计次数与学生对调查问卷工具科学性态度有关,学校、性别、调查问卷测量属性知晓情况与问卷调查研究难度态度有关.结论 预防医学医学生对问卷调查技术的认知、实践水平对其问卷调查技术相关态度有影响.建议高校加强问卷调查技术跨学科综合理论与实践教学,提升学生对问卷调查技术的正向态度.