轻度认知损害向老年性痴呆转化的临床研究

目的 研究轻度认知损害(mild cognitive impairment,MCI)向痴呆自然转化过程及多奈哌齐对转化的干预影响.方法 总结98例MCI患者情况,将服用多奈哌齐和未服用任何胆碱酯酶抑制剂的遗忘型MCI(aMCI)及非aMCI患者按年龄、性别、认知减退程度及ApoEε4携带情况分层配对研究,分析各组向痴呆转化率以及MMSE、阿尔茨海默病(AD)评定量表(ADAS-Cog)和aMCI组修订韦氏记忆量表(WMS-R)变化.结果 由aMCI向AD转化率,服用和未服用多奈哌齐组于1年时分别为15.1%和8.3%(P＜0.05),2年时分别为24.2%和12.5%(P＜0.01).由非aMCI向AD转化率,服用和未服用多奈哌齐组,于1年时分别为13.0%和5.5%(P＜0.05),2年时分别为21.7%和16.6%(P＜0.05).服用多奈哌齐6个月时,aMCI组MMSE提高(0.1±1.3)分,对照组下降(0.3±2.4)分;ADAS-Cog下降(1.4±4.7)分,对照组升高(0.03±4.55)分;WMS-R改善(4.8±4.1)分,对照组下降(3.7±5.2)分,治疗组与自然病程对照组比较差异有统计学意义(P＜0.01),并可维持1～2年.多奈哌齐还能延缓携带ApoEε4的MCI患者向AD转化,但与自然病程组比较无统计学意义(P＞0.05),尚有待扩大样本量继续研究观察.多奈哌齐对认知相关区脑萎缩有减缓趋势.结论 本组资料提示,多奈哌齐能推迟MCI向AD转化.     

小儿乙状结肠冗长症病理特点分析

目的 探讨小儿乙状结肠冗长症的病理特点，以提高对该症病理特点的认识。方法 分析我科1993～2002年间经手术治疗12例小儿乙状结肠冗长症的临床病理资料。结果 小儿乙状结肠冗长症病理特点与先天性巨结肠同源病相似。主要表现为乙状结肠肠壁肥厚，部分肌纤维变性。结肠黏膜萎缩，黏膜下充血水肿；肌间神经丛减少，均可见神经节细胞发育幼稚，且数量减少或体积变小，呈固缩或空泡变性。结论 小儿乙状结肠冗长症大多有肠神经元发育异常。     

Detecting pediatric autoimmune neuropsychiatric disorders associated with streptococcus in children with obsessive-compulsive disorder and tics.

BACKGROUND: A subgroup of children with obsessive-compulsive and tic disorders are proposed to have an infectious trigger. The purpose of this study was to investigate the relationship between group A streptococcal titers and symptom fluctuations in children with a clinical course resembling that described for pediatric autoimmune neuropsychiatric disorders associated with streptococcus. METHODS: Twenty-five children with obsessive-compulsive disorder and/or tic disorder were evaluated for neuropsychiatric severity and group A streptococcal antibody titers (streptolysin O, deoxyribonuclease B, and carbohydrate A) at 6-week intervals for > or = six consecutive evaluations (total visits=277). RESULTS: Children with large symptom fluctuations (n=15) were compared with children without dramatic fluctuations (n=10). Co-movements of obsessive-compulsive/tic severity and group A streptococcal antibodies were assessed. In subjects with large symptom changes, positive correlations were found between streptococcal titers and obsessive-compulsive severity rating changes (p=.0130). These subjects were also more likely to have elevated group A streptococcal titers during the majority of observations (p=.001). Tic symptom exacerbations occurred more often in the fall/winter months than spring/summer months (p=.03). CONCLUSIONS: Patients with marked obsessive-compulsive/tic symptom changes may be characterized by streptococcal titer elevations and exhibit evidence of seasonal tic exacerbations.     

Adipokines in cord blood and risk of wheezing disorders within the first two years of life

BACKGROUND: Adipokines are involved in the regulation of many inflammatory processes and are present at very high concentrations in cord blood of term infants. OBJECTIVE: We analysed data of a large prospective birth cohort study to examine whether adiponectin and leptin concentration in cord blood are determinants of wheezing disorders in children within the first 2 years of life. METHODS: Seven hundred and forty mothers and their newborns were included in this analysis. Adiponectin and leptin concentrations were measured in cord blood. The cumulative incidence of physician-reported asthma or obstructive bronchitis was recorded during a 2-year follow-up. RESULTS: During the first 2 years of life, asthma or obstructive bronchitis was reported by the caring paediatricians for 157 (19.6%) of the children. We found a strong interaction of cord blood adiponectin and history of atopic disease in the mother with respect to the risk of physician-reported asthma or obstructive bronchitis (P=0.006). Compared with children with cord blood levels in the middle quintile (reference category), the odds ratios for physician-reported asthma or obstructive bronchitis in the bottom quintile and top quintile were 0.14 [95% confidence interval (CI) 0.02-0.90] and 2.12 (95% CI 0.67-6.66), respectively (P for trend=0.0003), among children of mothers with a history of atopy. This association was independent of other established risk factors. Leptin levels in cord blood were not associated with risk of asthma or obstructive bronchitis. CONCLUSIONS: In children of mothers with a history of atopy, concentrations of adiponectin in cord blood could play an important role in determining risk of wheezing disorders in early childhood.     

损毁下丘脑不同脑区对折断腿骨所致血浆皮质酮变化的影响

清醒sprague-Dawley雄性大鼠64只,以折断胫腓骨造成应激。观察非内侧基底下丘脑脑区损毁对应激前(Bo)、后(Bs)血浆皮质酮变化的影响。以Bs/Bo及Bs-Bo的值衡量应激反应的大小。根据所损毁脑区的部位及范围将动物分为6组:假手术组、室旁核损毁组、室旁核部分损毁组、室旁核少量损毁组、下丘脑前部—视前区损毁组、下丘脑后部损毁组。用统计学方法比较了6组动物的Bs/Bo及Bs-B0值,以及根据4例室旁核完全损毁动物仍保持有应激反应的事实,我们得出结论:(1)在清醒大鼠的损伤性应激反应中,下丘脑室旁核较其他非基底内侧下丘脑区具有较重要的作用。(2)室旁核以外的促肾上腺皮质激素释放因子神经元可能也参与应激反应。     

Applying item response theory to enhance health outcomes assessment

Background Health-related quality of life (HRQL) is an accepted outcome measure in patients with mood and anxiety disorders. Yet, surprisingly little attention has been paid to the determinants. In this paper we test the hypothesis that it is associated with personality traits while controlling for mental disorders. Methods A large sample of outpatients (n=640) with mood and anxiety disorders was studied. The empirically supported five factor model of normal personality traits was assessed using the NEO-FFI and includes: neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness. Mental disorders were assessed with the CIDI, and HRQL with the SF-36. Results Regression analyses revealed that the NEO-FFI scores, with the exception of conscientiousness, were significantly associated with SF-36 subscales and summary scores, independently from the mental disorders. The percentage of explained variance due to the personality traits was highest for the subscales Vitality (10.0%), Mental Health (13.3%) and the Mental Health Summary Score (9.5%). Furthermore, specific personality traits were related to specific SF-36 subscales. Conclusions A low HRQL of patients with mood or anxiety disorders is not only determined by the disease or the current health but is also shaped by personality traits that are relatively stable throughout an individual's life time.     

精神科护士的职业压力调查

目的调查精神科护士在工作中面临的职业压力。方法采用问卷调查法,对贵州省贵阳市两所医院精神科61名护士与贵州省贵阳市多所医院173名护士的职业压力进行调查分析。结果精神科护士职业压力处于较高水平,其他科护士压力处于中等水平。结论建议从管理角度减轻精神科护士工作压力,并对精神科护士进行减轻工作压力的训练。