Problem‐maintaining circles: Case illustrations of formulations that truly guide therapy

The cognitive behaviour therapy (CBT) emphasis on treatment relevance in assessment, and on evidence‐based intervention, has led to an increasing focus on problem maintenance factors (vs. precipitants) in both its models of psychopathology and in its individual case formulations. This article describes the reasons for this growing focus, and presents a generic CBT model based on the functional analysis of “problem‐maintaining circles” (PMCs) of causes. Some samples of the profuse literature implicating PMCs in many psychological disorders are presented, and the utility of PMC‐based functional analysis, case formulation, or modelling of psychopathology is advanced, not only as a guide to selection of therapeutic interventions, but as an alternative to standard psychiatric diagnosis. A sampling of a taxonomy of such PMCs is presented. And finally, the clinical application of PMC‐based functional analysis, case formulation, and treatment selection is illustrated in five case illustrations drawn from a recent clinical caseload.     

Rapid microassays of phagocytosis, bacterial killing, superoxide and hydrogen peroxide production by human neutrophils in vitro

Simple, rapid microassays for simultaneous measurement of phagocytosis, bacterial killing, superoxide and hydrogen peroxide production by human neutrophils in vitro are described. All assays employ 96-well flat bottom tissue culture plates which were incubated on a microtitre plate shaker at 37 degrees C. The separate evaluation of ingestion and intracellular killing of E. coli and S. aureus was based on the incorporation of [3H]uridine into viable extracellular bacteria. There was good correlation between plate counts of viable bacteria and amount of radiolabel incorporation. Phagocytosis and killing can be measured in a maximum of 100 microliter reaction mixture, requiring only 2.5 X 10(5) neutrophils per test and the assay is complete within 60 min. Assay of superoxide production by stimulated neutrophils was based on superoxide-dependent reduction of ferricytochrome c as measured spectrophotometrically at 550 nm in wells of tissue culture plates containing 150 microliter of reaction mixture. The assay requires only 1.25 X 10(5) neutrophils per test and is complete within 50 min. Quantitation of hydrogen peroxide was based on horseradish peroxidase-dependent oxidation of phenol red. The technique is as for superoxide detection except that the reaction must be terminated by the addition of 1 M NaOH at the desired time intervals. None of the assays require sampling during the incubation period. The principal advantages of the described techniques are increased simplicity and speed, requirement of low numbers of neutrophils and applicability to analysis of large number of samples in parallel.     

Hormonally Functional Ovarian Neoplasms

Hormonally functional ovarian neoplasms are those tumors that secrete one or more hormones that are clinically manifested in the patient. The hormone production may have implications for the diagnosis, management, or treatment of the patient. Hormonally functional ovarian neoplasms include tumors that belong to various histologic categories and produce a variety of hormonal effects. Functional ovarian tumors most commonly produce steroid hormones, and such tumors frequently belong in the sec cordstromal and steroid cell categories. In addition, a wide variety of peptide hormones may be produced by ovarian tumors. Although in most instances the neoplastic cells themselves produce the hormones, a wide variety of tumors may induce their stroma to produce steroid hormones. The stroma of ovarian tumors is derived from the ovarian stroma and may, on occasion, resemble specialized ovarian stroma and its derivatives. Cells resembling luteinized stromal cells or luteinized theca cells may be present and appear to be responsible for the resultant hormone secretion.     

Effekte einer Captopriltherapie auf die Natrium- und Wasserausscheidung bei Patienten mit Leberzirrhose und Aszites

Summary Ascites in patients with cirrhosis of the liver frequently is refractory to diuretic treatment. It was postulated that vasoconstriction of the renal cortex, mediated by activation of the renin-angiotensin-aldosterone-system (RAAS), may be one course of the disturbed sodium- and water-excretion in these patients. We therefore investigated in 14 cirrhotic patients with ascites under constant diuretic treatment the effects of low-dose captopril therapy on urinary sodium- and potassium-excretion, body weight, abdominal girth, serum-sodium,-potassium, creatinine-clearance, plasma-renin-activity (PRA), plasma-aldosterone (PA) and mean arterial pressure (MAP). After a control period of 4 days the patients received 2 × 6.25 mg/d captopril for 5 days and 4 × 6.25 mg/d for further 5 days. Treatment was followed by a second control period without captopril.PRA increased significantly after 2 days of captopril treatment. 2 × 6.25 mg/d captopril induced a significant increase in sodium excretion and a significant decrease of body weight. MAP decreased slightly but significantly without clinical signs of hypotension. 4 × 6.25 mg/d captopril resulted in a further reduction of body weight and a further enhancement of sodium excretion. Three days after withdrawal of captopril sodium output was significantly reduced again. Conclusion: In cirrhotic patients low-dose captopril seems to be efficient in the treatment of ascites resistant to diuretics without causing major side effects.

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Abkürzungen ACE Angiotensin-Converting-Enzym - A-II Angiotensin II - C_{H 2 O} Frei-Wasser-Clearance - C_Krea Kreatinin-Clearance - C_Osmo Osmolale Clearance - g Gramm - h Stunde - kg Kilogramm - l/d Liter pro Tag - MAP Mittlerer arterieller Blutdruck - mg Milligramm - mg/d Milligramm pro Tag - ml/min Milliliter pro Minute - mmHg Millimeter Quecksilbersäule (Torr) - mmol/d Millimol pro Tag - NaCl Natriumchlorid - ng/ml/h Nanogramm pro Milliliter und Stunde - PA Plasma-Aldosteron - pg/ml Picogramm pro Milliliter - PRA Plasma-Renin-Aktivität - RAAS Renin-Angiotensin-Aldosteron-System - SEM Standardfehler des Mittelwertes - S_Krea Kreatininkonzentration im Serum - S_Osm Serum-Osmolalität - U_Krea Kreatininkonzentration im Urin - U_Osm Urin-Osmolalität - V Urinminutenvolumen - vgl. vergleiche - µmol/l Micromol pro Liter     

新兵训练后功能性闭经女兵的心身症状与激素水平

目的:探讨新人伍女兵功能性下丘脑性闭经(FHA)者与月经正常者激素水平及心理健康状况的差异。方法:在某部队新人伍女兵98人接受了为期近4个月的体能训练之后,有54人出现闭经.其中闭经3个月以上者有35人(研究组)。训练后月经正常、在采血时月经周期处于第5～11天者有26人(对照组)。分别测定她们血清中的促卵泡生成素(FSH)、黄体生成素(LH)、雌二醇(E_2)、孕酮(P)、泌乳素(PRL)、睾酮(T)、ACTH、T_3、T_4的水平,并用SCL-90分别评定她们的心理健康状况。结果:FHA 者血清FSH 值为4.96±1.73 mIU/ml,LH 值为2.63±1.78 mIU/ml,E_2的值为7.23±5.37 pg/ml,对照组血清相应值为10.73±2.30mIU/ml、12.31±2.15mIU/ml、41.67±6.13pg/ml,差异有统计学意义(P<0.01),闭经组低于对照组。FHA 组SCL-90的躯体化、人际敏感、抑郁、焦虑及其他因子分大于2的比率分别为:51.4%、42.9%、48.6%、51.4%及37.1%;而对照组这5项分值大于2的比率分别为15.4%、15.4%、19.2%、21.3%及11.5%,两组间这5个因子大于2的人数差异有统计学显著意义(P<0.05),闭经组高于对照组。结论:诊断为FHA 的女兵与月经正常女兵的激素水平有差异,闭经组心身症状的发生率也高于对照组。     

模拟退火算法在图像配准中的应用

近年来 ,脑功能成像技术发展迅速 ,已在脑科学研究中占有重要地位。研究中通常需要将同一被试的多种模式成像结果或同一模式的时间序列结果结合起来分析 ,首先要解决的问题就是几幅图像的严格对齐问题 ,即所谓的图像配准。在模拟退火算法和其它工作的基础之上 ,较好的解决了图像配准中的连续变量全局优化问题 ,通过基于点的配准方法 ,实现了时间序列脑功能图像的高精度配准。     

基因功能预测问题中的样本不平衡处理

应用机器学习进行分类是基因功能预测的一种重要手段。但是许多预测集中的阳性样本过少，会降低功能预测的效果。针对此问题，本研究对结合支持向量机（SVM）算法的几种常用非平衡数据分类方法进行实验比较，包括投票整合分类器和移动分类面等。在此基础上提出通过加权修正投票的整合策略，以提高预测效果。实验结果显示，结合多数类样本限数取样及整合思想的投票整合法预测效果优于移动分类面法，而在投票整合法基础上的加权修正整合方法在所有方法中获得更好更稳定的结果。     

炎症介导的外周神经致敏在感染后肠易激综合征发病中的作用研究

目的： 应用实验性结肠炎动物模型探讨炎症介导的外周神经致敏在肠易激综合征（IBS）内脏高敏感状态发生中的作用。 方法： 应用三硝基苯磺酸（TNBS） 灌肠造成实验性结肠炎动物模型，在炎症的不同时期（灌肠后7 d，21 d,42 d），用免疫组织化学法测定支配远端结肠的脊髓背根神经节初级传入神经元上感觉性神经递质CGRP和感受伤害性刺激的受体VR1的表达,比较炎症不同阶段降钙素基因相关肽（CGRP）和香草酮受体1(VR1) 阳性神经元的比例，以期验证炎症介导的外周神经致敏是否肠易激综合征内脏高敏感状态发生的重要机制。 结果： 炎症急性期（给予TNBS后7 d），支配炎症肠段的脊髓背根神经节初级传入神经元上CGRP和VR1的表达明显高于生理盐水对照组（P<0.05）；而且这种异常增高的表达可以持续存在至炎症消退后,即灌肠后21 d和42 d CGRP和VR1的表达仍高于生理盐水对照组（P<0.05）。 结论： 炎症介导的外周神经致敏是内脏高敏感状态发生的机制之一,这种高敏感状态在炎症消退后一定的时间内可以持续存在,因此炎症介导的外周神经致敏在感染后IBS的发生中具有重要的作用。     

Altered EphA5 mRNA expression in rat brain with a single methamphetamine treatment

Methamphetamine is a potent and indirect dopaminergic agonist which can cause chronic brain dysfunctions including drug abuse, drug dependence and drug-induced psychosis. Methamphetamine is known to trigger molecular mechanisms involved in associative learning and memory, and thereby alter patterns of synaptic connectivity. The persistent risk of relapse in methamphetamine abuse, dependence and psychosis may be caused by such alterations in synaptic connectivity. EphA5 receptors constitute large families of tyrosine kinase receptor and are expressed almost exclusively in the nervous system, especially in the limbic structures. Recent studies suggest EphA5 to be important in the topographic projection, development, and plasticity of limbic structures, and to be involved in dopaminergic neurotransmission. We used in situ hybridization to examine whether methamphetamine alters EphA5 mRNA expression in the brains of adult male Wister rats. EphA5 mRNA was widely distributed in the medial frontal cortex, cingulate cortex, piriform cortex, hippocampus, habenular nucleus and amygdala. Compared to baseline expression at 0 h, EphA5 mRNA was significantly decreased (by 20%) in the medial frontal cortex at 24 h, significantly increased (by 30%) in the amygdala at 9 and 24 h, significantly but transiently decreased (by 30%) in the habenular nucleus at 1 h after a single injection of methamphetamine. Methamphetamine did not change EphA5 mRNA expression in the cingulate cortex, piriform cortex or hippocampus. Our results that methamphetamine altered EphA5 mRNA expression in rat brain suggest methamphetamine could affect patterns of synaptic connectivity, which might be responsible for methamphetamine-induced chronic brain dysfunctions.