P物质在老年退行性关节炎表达与临床关系

【摘要】〓目的〓探讨膝关节滑液中P物质水平在骨性关节炎(OA)发病机制中的作用及与OA患者病情严重程度、疼痛程度的相关性。方法〓2012年2月~2014年4月选取在我医院住院治疗或者门诊治疗的膝OA患者212例,诊断均符合美国风湿病学会(ARA)制定的OA分类标准。骨关节的严重程度采用Legusue分级系统评估进行评估并分组。轻度组(A1)75例,中度组(A2)87例,重度组(A3)50例。疼痛严重程度按WOMAC)疼痛评分系统评估。另选择115例来自本院健康体检者作为正常对照组。采用竞争性酶联免疫吸附试验分别测定滑液中P物质水平。结果〓滑液中P物质水平与骨关节炎患者WOMAC疼痛评分正相关(r=0.265,P<0.05)。滑液中P物质水平与Legusue等级之间正相关(r=0.785,P<0.05)。结论〓关节液中P物质的变化可作为OA病情活动的监测指标之一。     

氨磺必利治疗首次发病的精神分裂症患者的随机对照研究

目的:比较氨磺必利及利培酮对首次发病的精神分裂症患者疗效及糖脂代谢的影响。方法:采用随机双盲法将86例首发精神分裂症患者分为研究组和对照组,每组43例;分别给予氨磺必利和利培酮治疗8周。治疗前后进行阳性和阴性症状量表(PANSS)和治疗中出现的症状量表(TESS)评分;测量体质量指数(BMI)、空腹血糖(FPG)、口服糖耐量实验2 h血糖(2h PG)、血清胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、高密度脂蛋白(HDL)、三酰甘油(TG)、总胆固醇(TC)。结果:治疗后两组PANSS评分明显下降(P均0.05),两组间PANSS评分及临床总有效率差异无统计学意义;研究组不良反应发生率(25.6%)明显低于对照组(62.8%)(P0.05);研究组治疗前后糖脂代谢指标(BMI、FPG、2h PG、FINS、HOMA-IR、HDL、TG和TC)比较差异无统计学意义;对照组BMI、FPG、2h PG、FINS、HOMA-IR、TG和TC水平较治疗前及研究组明显增高(P0.05或P0.001)。结论:氨磺必利对首发精神分裂症患者的疗效与利培酮相似,不良反应少,短期治疗不影响患者的糖脂代谢。     

瑞芬太尼与硝酸甘油控制性降压对颅内动脉瘤夹闭术病人脑氧代谢影响的比较

目的 比较瑞芬太尼与硝酸甘油控制性降压,对急性高容量血液稀释(AHH)后颅内动脉瘤夹闭术病人脑氧代谢的影响.方法 颅内动脉瘤夹闭术病人30例随机等分为硝酸甘油组和瑞芬太尼组.手术开始时以15～20 ml/(kg·h)的速率输入4％琥珀酰明胶,使红细胞比容稀释为25％～32％.剪开硬脑膜后,分别泵入硝酸甘油和瑞芬太尼控制性降压,使平均动脉压(MAP)维持在60～65 mmHg.分别于降压前(T1)、降压后30 min (T2)、动脉瘤夹闭后5min (T3)抽取颈内静脉球部血和桡动脉血作血气分析,比较两组对脑氧代谢的影响.结果 血流动力学变化:与同组内T1比较,两组T2、T3的MAP和心率差异均有统计学意义(P＜0.01);两组同时间点MAP比较差异无统计学意义(P＞0.05),心率差异有统计学意义(P＜0.01).脑氧代谢的变化:与同组内T1比较,瑞芬太尼组T2、T3的静脉血氧饱和度(SjvO2)和颈内静脉氧含量(CjvO2)明显升高,动脉-颈内静脉球部m氧差[D(a-jv)O2]和氧摄取率(ERO2)明显降低(P＜0.01);两组同时间点(T2、T3)比较,SjvO2、CjvO2、D(a-jv)O2、ERO2差异均有统计学意义(P＜0.01).结论 瑞芬太尼控制性降压用于AHH后的颅内动脉瘤夹闭术病人,可降低脑氧代谢率,增强脑组织对缺氧的耐受性,比硝酸甘油控制性降压更具优越性.     

扩张性心肌病患者骨代谢指标状况及其临床意义

目的探究扩张性心肌病(dilated cardiomyopathy,DCM)患者骨代谢指标水平状况及其临床意义。方法选取2016年3月至2018年3月在我院诊治的DCM患者48例作为研究对象并归入DCM组,选择同期在我院接受健康体检的成年人30名归入健康组,测定和比较两组的血清骨钙素(BGP)、钙(ICa)、骨特异性碱性磷酸酶(BALP)、甲状旁腺激素(PTH)、25羟基维生素D_3[25(OH) D_3]等骨代谢指标水平,以及大粗隆、股骨颈、腰椎等部位的骨密度(BMD),分析骨代谢指标BGP、ICa、BALP、PTH和25(OH) D_3分别与患者年龄、DCM病程、BMI、肌酸激酶同工酶、肌钙蛋白I和心功能分级等因素的相关性。结果(1) DCM组的BGP、ICa、25(OH) D_3等水平均低于健康组,BALP、PTH水平均高于健康组,差异均有统计学意义(P均0.05)。(2) DCM组大粗隆部位的BMD与健康组比较,差异无统计学意义(P0.05); DCM组的股骨颈及腰椎部位的BMD均低于健康组,差异均有统计学意义(P均0.05)。(3) BGP、ICa和25(OH) D_3分别与年龄、DCM病程及心功能分级呈负相关,BGP与肌酸激酶同工酶、肌钙蛋白Ⅰ呈负相关; BALP与年龄、DCM病程、肌酸激酶同工酶、肌钙蛋白Ⅰ及心功能分级呈正相关,PTH与心功能分级呈正相关(P均0.05)。结论 DCM患者的血清BGP、ICa、BALP、PTH、25(OH) D_3等骨代谢相关指标水平有明显波动,且骨代谢相关指标水平与DCM患者年龄、病程、肌酸激酶同工酶、肌钙蛋白Ⅰ及心功能分级等相关,DCM可能是造成骨代谢指标水平发生异常的重要原因。     

Clinical characteristics of neonates with inborn errors of metabolism detected by Tandem MS analysis in Oman

We reviewed the clinical profile of our neonates diagnosed to have inborn errors of metabolism (IEM) by Tandem Mass Spectrometry (TMS) over a seven years period, and compared the results with published reports. We also attempted to evaluate various clinical situations wherein the screening test would yield a high pick up rate. Among the 166 neonates studied (10 aged 1 day, 79 aged 2-7 days and 77 aged 8-28 days), significant abnormalities on TMS suggestive of IEM were detected in 38 babies (23%), most common diseases diagnosed were maple syrup urine disease (10 neonates), propionic acidemia (8 neonates), urea cycle diseases (6 neonates) and isovaleric acidemia (4 neonates). The detection incidence was calculated to be one positive case out of every 4 to 5 babies tested. A high prevalence of parental consanguinity and high level of positive family history of affected siblings were the highlights of this study. The major clinical situations where testing was helpful were (a) unexplained acute neonatal encephalopathy, (b) positive family history of known or suspected IEM and (c) new born presenting with abnormal serum biochemistry suggestive of IEM.     

Provision of Mental Health Services in South African Substance Abuse Treatment Facilities

To date, South African research has not examined mental health service provision in substance abuse treatment facilities, even though these services improve client retention and treatment outcomes. To describe the extent to which substance abuse treatment facilities in Gauteng and KwaZulu-Natal provinces provide clients with mental health services during the course of treatment and to compare mental health service provision in these settings by type of facility and staff composition. Cross-sectional audits of substance abuse treatment facilities were conducted in Gauteng and KwaZulu-Natal provinces. Data were collected using the Treatment Services Audit Questionnaire. A response rate of 84% was obtained. Few treatment facilities provide clients with access to mental health services. Inpatient facilities are more likely than outpatient facilities to provide clients with access to mental health services. Facilities with for-profit ownership status are more likely than facilities with non-profit status to provide access to mental health care. Based on the above findings, a number of recommendations are made to increase the provision of mental health services during the course of substance abuse treatment.     

How representative are insomnia clinical trials?

ObjectivesTo address the question of how representative subjects studied in hypnotic clinical trials are of the broader insomnia population, this study assessed initial contact rates and reasons for inclusion and exclusion during recruitment to an efficacy trial and to a safety trial of Food & Drug Administration (FDA) approved hypnotics.MethodsOtherwise heathy persons meeting Diagnostic Statistical Manual, Fourth Edition, Revised (DSM-IVR) criteria for insomnia were recruited. In one study, persons 32–65 yrs, were invited to a 12 month trial of nightly use of zolpidem or placebo. In the other, persons 21–64 yrs with driver's licenses were recruited to test the effects of a hypnotic on live on-the-road driving ability. In both studies screening was conducted through an initial telephone interview followed by a clinic visit.ResultsIn the United States (US) study 13% (n = 410) of 3180 initial contacts and in the Netherlands (NL) study 67% (n = 53) of the 79 initial contacts proceeded to the clinic visit. Of those at clinic 25% of US and 37% of NL participants failed to meet additional insomnia criteria. Mental health exclusions accounted for 24% of US and 23% of NL participants and medical problems accounted for 23% of US and 9% NL exclusions. Finally 20% of US and 26% of NL participants were excluded for drug use/abuse histories. After all screening 4% of the initial US contacts and 0% of the NL contacts entered the study.ConclusionsThese data suggest persons entering insomnia hypnotic clinical trials are a highly selected sample that is unlikely to be representative of the broad insomnia population or the population of potential medication users.     

进行性核上性麻痹患者脑部葡萄糖代谢特征分析

目的：利用^18F-脱氧葡萄糖（^18F-FDG）正电子发射断层扫描成像（PET）分析进行性核上性麻痹（PSP）患者脑部葡萄糖代谢特征。方法：7例临床确诊的PSP患者（PSP组）和14例年龄匹配的健康对照者（对照组）行静息状态下^F—FDGPET脑成像,将两组的PET图像分别进行统计参数图（SPM）及尺度子轮廓模型／主要成分分析（SSM／PCA）研究,获得PSP患者脑部葡萄糖异常代谢图像并建立PSP脑代谢网络模式（PSPRP）。结果：SPM分析显示,与对照组比较,PSP组双侧内侧前额叶、腹外侧前额叶、尾状核、丘脑和中脑的葡萄糖代谢降低,双侧中央前回、顶上小叶、顶下小叶葡萄糖代谢增高。SSM／PCA分析显示PSPRP的特征表现为双侧内侧前额叶、腹外侧前额叶、尾状核、丘脑和中脑的葡萄糖代谢显著减低,而双侧顶叶代谢显著增高。PSP组的PSPRP表达值（1．711±1．218）明显高于对照组（0．043±O．496,t=-5．379,P=0．001）。结论：基于18F-FDGPET显像得到的脑部异常葡萄糖代谢特征可以有效鉴男IJPSP患者和健康对照者。     

Differential glutamate dehydrogenase (GDH) activity profile in patients with temporal lobe epilepsy

PURPOSE: Pathophysiologic mechanisms underlying temporal lobe epilepsy (TLE) are still poorly understood. One major hypothesis links alterations in energy metabolism to glutamate excitotoxicity associated with seizures in TLE. The purpose of this study was to determine whether changes in the activities of enzymes critical in energy and neurotransmitter metabolism contributed to the alterations in metabolic status leading to the excitotoxic effects of glutamate. METHODS: Activities of four key enzymes involved in energy metabolism and glutamate cycling in the brain [aspartate aminotransferase (AAT), citrate synthase (CS), glutamate dehydrogenase (GDH), and lactate dehydrogenase (LDH)] were measured in anterolateral temporal neocortical and hippocampal tissues obtained from three different groups of medically intractable epilepsy patients having either mesial, paradoxical, or mass lesion-associated temporal lobe epilepsy (MTLE, PTLE, MaTLE), respectively. RESULTS: We found that GDH activity was significantly decreased in the temporal cortex mainly in the MTLE group. A similar trend was recognized in the hippocampus of the MTLE. In all three patient groups, GDH activity was considerably lower, and AAT and LDH activities were higher in cortex of MTLE as compared with the corresponding activities in hippocampus (p<0.05). In the MTLE cortex and hippocampus, GDH activities were negatively correlated with the duration since the first intractable seizure. CONCLUSIONS: Our results support the hypothesis suggesting major alteration in GDH activity mainly in the MTLE group. It is proposed that significant alterations in the enzyme activities may be contributing to decreased metabolism of glutamate, leading to its accumulation.     

利培酮和氯丙嗪治疗时血糖代谢变化

目的:研究使用抗精神病药影响血糖代谢的特点。方法:198例未曾治疗或停药3个月以上的精神分裂症住院患者给予氯丙嗪或利培酮治疗。于入院时及治疗1、2、3和6个月时检测血糖浓度。结果:氯丙嗪组治疗2个月餐后2 h糖耐量试验(2hPG)、6个月后糖化血红蛋白(HbA1C)浓度均明显高于治疗前。治疗6个月血葡萄糖调节受损(IGR),氯丙嗪组有15.54%,利培酮组有7.37%;≥40岁者2hPG和HbA1C明显高于<40岁者。结论:2hPG和HbA1C浓度增高是糖代谢异常的早期表现,早期干预有利于防止IGR。