Augmentation with sulpiride for a schizophrenic patient partially responsive to clozapine

OBJECTIVE: Schizophrenic patients who are only partially responsive to clozapine pose a therapeutic challenge. In these circumstances some clinicians would consider adding in a second antipsychotic. We present a case report and review evidence for the efficacy of such augmentation strategies. METHOD: Single case report and literature review. RESULTS: The total number of patients in studies and case reports of combining clozapine with other antipsychotics is small. There has been only one randomized controlled trial. This found the addition of sulpiride to clozapine resulted in clinical improvement in some patients. CONCLUSION: Further randomized controlled studies of augmentation of clozapine therapy are needed to provide scientific justification for this clinical practice.     

黄芪注射液临床应用进展

目的：对黄芪注射液临床应用及其疗效进行综述。方法：通过查阅近期国内部分期刊杂志，对黄芪注射液在肺心病、老年肺结核、脑中风、冠心病、流行性出血热、病毒性心肌炎、甲亢、肝病及肾病等临床应用新进展进行综述。结果：黄芪注射液辅助治疗上述疾病疗效满意。结论：黄芪注射液是治疗心脑血管疾病、肾病、肝病等的有效药物。     

干预CD86协同刺激信号在诱导母胎界面Th2型免疫偏倚中的作用

目的 :探讨干预CD86协同刺激信号在诱导母胎界面局部形成Th2型免疫偏倚中的作用。方法 :将正常妊娠模型 (CBA×BALB/c)和自然流产模型 (CBA×DBA/ 2 )CBA孕鼠均分为两组 ,于孕第 4、6、8天 ,对照组腹腔注射大鼠IgG ,实验组腹腔注射大鼠抗小鼠CD86mAb ;孕第 9天 ,ELISA测定母胎界面组织培养上清中Th1型 (IFN γ、TNF α) /Th2型(IL 4、IL 10 )细胞因子表达水平 ,并计算IL 4 /IFN γ、IL 10 /IFN γ比值 ;孕第 12天比较两种模型各组的胚胎吸收率。结果 :正常妊娠模型中 ,干预CD86协同刺激信号对母胎界面原有的Th2型免疫偏离及妊娠预后均无显著影响。自然流产模型中 ,干预CD86协同刺激信号能够诱导母胎界面局部形成Th2型免疫偏倚并显著改善其妊娠预后。结论 :于孕早期 ,干预CD86协同刺激信号能够改善母胎界面局部细胞因子微环境 ,形成维持正常妊娠所需的Th2型免疫偏倚 ,诱导母胎免疫耐受     

肺癌流行病学和早期诊断新技术

肺癌是当今世界各国常见的恶性肿瘤 ,并已成为癌症死亡的主要原因。 2 0 0 0年美国新发病例达 16 94万人 ,近年来通过采用控制吸烟及大气污染等措施 ,发达国家的肺癌发病率有所下降 ,但我国肺癌发病率及死亡率仍占据首位。原发性肺癌的早期诊断非常重要 ,临床诊疗技术和先进仪器的使用有助于早期发现肺癌。就低剂量螺旋CT、荧光支气管镜、CT PET等在肺癌早期诊断中的应用及进展。     

放射治疗中的摆位误差

随着放射治疗向高精度方向发展 ,研究放射治疗中的摆位误差具有重要意义。就摆位误差的定义、来源、表示方法、测量予以综述 ,并总结了以往的研究数据 ,提出临床工作中需注意的问题。     

Cognitive disorders in patients with occlusive disease of the carotid artery: a systematic review of the literature

We present a systematic review of the literature on the prevalence, nature, severity, course, and causes of cognitive deficits in patients with occlusive disease of the carotid artery prior to surgery (if surgery was under discussion). Searches were carried out on Medline and Psychlit from 1980 to 1999 using neurovascular and psychological index terms, and papers and books were checked for further references. Studies describing neuropsychological assessment of groups of patients with carotid obstruction were included. Eighteen studies were found. We extracted from the papers data on study design, demographic characteristics of patients, clinical diagnosis, carotid obstruction, cerebral imaging, time interval between ischemic episode and neuropsychological assessment, neuropsychological asessment procedures, integration and interpretation of test performances, and conclusions of authors. Fourteen studies concluded that there are cognitive deficits both in patients with symptomatic and in those with asymptomatic carotid obstruction; four studies denied cognitive impairment. There were no differences in patient characteristics, study design, or neuropsychological assessment procedures between the 14 studies that found deficits and the 4 that did not. There are indications for a mild, diffuse, detrimental effect of carotid occlusive disease on cognitive functioning. However, methodological problems prevent a definitive conclusion. Further research is needed to confirm these findings and to ascertain the neurovascular risk factors for and the natural course of cognitive impairment in patients with carotid occlusive disease. Received: 12 July 1999/Received in revised form: 10 November 1999/Accepted: 26 January 2000     

易黄汤临床新用的文献研究

笔者通过对近年有关易黄汤临床应用文献的研究发现,易黄汤不止限于治疗带下病,也被灵活运用于临床其他各种疾病的治疗中。文章对临床应用易黄汤治疗各种疾病进行概括总结,对其病机和作用机理进行了分析,并报道了易黄汤治疗的相关病例。     

White patients’ physical responses to healthcare treatments are influenced by provider race and gender

The healthcare workforce in the United States is becoming increasingly diverse, gradually shifting society away from the historical overrepresentation of White men among physicians. However, given the long-standing underrepresentation of people of color and women in the medical field, patients may still associate the concept of doctors with White men and may be physiologically less responsive to treatment administered by providers from other backgrounds. To investigate this, we varied the race and gender of the provider from which White patients received identical treatment for allergic reactions and measured patients’ improvement in response to this treatment, thus isolating how a provider’s demographic characteristics shape physical responses to healthcare. A total of 187 White patients experiencing a laboratory-induced allergic reaction interacted with a healthcare provider who applied a treatment cream and told them it would relieve their allergic reaction. Unbeknownst to the patients, the cream was inert (an unscented lotion) and interactions were completely standardized except for the provider’s race and gender. Patients were randomly assigned to interact with a provider who was a man or a woman and Asian, Black, or White. A fully blinded research assistant measured the change in the size of patients’ allergic reaction after cream administration. Results indicated that White patients showed a weaker response to the standardized treatment over time when it was administered by women or Black providers. We explore several potential explanations for these varied physiological treatment responses and discuss the implications of problematic race and gender dynamics that can endure “under the skin,” even for those who aim to be bias free.

The face of medicine is changing. Women and people of color make up an increasing percentage of health care providers (1–3). In 2017, for the first time in history, women were the majority of accepted medical school applicants in the United States and the number of non-White accepted applicants rose to above 50%. Here, we ask whether this recent demographic shift in the race and gender of doctors is also shifting long-held, societally pervasive notions of what a doctor “looks like.”Despite the increasing diversity of the medical field, for most people in most contexts, the association between “doctor” and “White man” is still likely strong and pervasive. This is hardly surprising. For most of medical history in North America, the majority of physicians fit this profile (see Fig. 1 A and B), and even now the majority of practicing physicians are still men and nearly half are White (see Fig. 1 C and D). Consequently, the emerging links between “Doctor and Woman” and between “Doctor and Black person,” for example, are likely weak. Moreover, to the extent that those associations exist, they are likely to have to compete for attention with an array of strong, frequent, and negative associations that undermine the links between women and competence and African Americans and competence (4–6).Open in a separate windowFig. 1.The change in the representation of women (A) and people color (B) in the number of accepted applicants to US medical schools, as well as the current representation of professionally active women physicians (C) and physicians of color (D). (A and B) From the Association of American Medical Colleges (AAMC). (C) From the Henry J. Kaiser Family Foundation. (D) From 2013 from the Association of American Medical Colleges (AAMC). AAMC data on race/ethnicity were not available for 2013 or 2014, hence explaining the gaps in the graph around these years in B.In patient–provider interactions, as in every social encounter, people bring with them a set of learned associations about social groups that have been formed by their various life experiences (e.g., personal interactions, media exposure) (6–12). Mirroring the historical representation of doctors in actual medical practice, representations of doctors in popular media have overwhelmingly been as White men (13–15). Patients who have learned this societally pervasive “Doctor = White man” association through their actual encounters with physicians as well as through movies, television, books, and advertising may respond less positively to care from Black and women providers. These associations may exist at an implicit level even in the context of positive explicit attitudes toward Black doctors and women doctors (16, 17), and they are potentially powerful, influencing the course of medical care. Also, while it is clear from past research that being a target of bias can be harmful to health (e.g., people who face race-based discrimination face adverse physical and mental health consequences) (18), it is unclear whether viewing another social group in light of societally pervasive associations (e.g., about doctors on the basis of gender and race) can be harmful to the health of the perceiver.Here, we focus on how the race and gender of doctors may impact patients’ responses to the expectations doctors set about medical treatment. Previous research shows that a provider’s expressed expectations for a medical treatment (i.e., that it will benefit patients) can improve patient engagement, adherence, and physiological responses to treatment (19–25). Based on these findings, we anticipate that patients who interact with a doctor whose personal characteristics (e.g., race, gender) do not conform to dominant societal representations of what a doctor looks like may be less responsive to such expectations. We hypothesize that patients may be less responsive to the exact same medical treatment when the doctor who sets expectations that this treatment will be beneficial is not a White man.This hypothesis draws on a large and growing body of research suggesting that the total effect of a healthcare treatment depends on the social context in which that treatment takes place (25–29). The realization that the social context can influence treatment and medical outcomes is bolstered by a large body of research on the placebo effect (26). Although people may sometimes assume that actual pharmaceutical properties of a medication or treatment are solely responsible for its total benefit, placebo paradigms show that the total effect of treatment is in fact a combined product of the drug and their medical properties (e.g., acetaminophen, antihistamines), the body’s natural healing abilities (e.g., endogenous opioids and antihistamines), and the psychological and social context (e.g., what a patient believes about treatment and the qualities of the person who administers the treatment) (SI Appendix, Fig. S1). For example, past research suggests that a physician’s characteristics, such as their projected warmth and competence, influences how much a patient improves in response to treatment. In one recent study (22), the researchers independently manipulated whether a provider acted more or less warm, and more or less competent, toward a patient during an allergy skin prick test that induced a mild allergic reaction. The provider set positive expectations about a placebo cream (i.e., unscented hand lotion) placed on the reaction, informing patients that this cream was an antihistamine that would reduce the reaction. When the provider was both warm and competent, patients showed a stronger physiological response to the placebo treatment over time; their allergic reaction decreased the most rapidly in size, in response to the positive expectations that the provider had set. Thus, aspects of social interactions with providers can influence the degree to which the positive expectations that a provider sets about treatment ultimately influence physiological treatment response.As in most social interactions in the United States, race and gender are likely salient aspects of the social context in patient–provider interactions (30, 31, 32). Previous research has found, for example, that patient race can influence the quality of care received from doctors in myriad ways (33–36). Here, we focus on provider race and provider gender as features of the social context that can influence patients’ response to treatment. Specifically, we ask the following: will White patients exhibit a weaker physiological response to the expectations set about treatment by doctors who are not White and men?     

A sewing needle in the liver in children: A case report and literature review

Rationale:In clinical practice, foreign bodies (FBs) in the digestive tract are more common in children, but intrahepatic FBs are rare, especially those that can cause infection, bleeding, bile leakage, and other complications. However, there is no consensus on its diagnosis and treatment due to the lack of large-scale cohort studies.Patient concerns:Case 1 is a 4-years 8-months-old girl, who at the age of 10 months, showed an X-ray finding of a striped FB in her liver, with no symptoms. However, the patient’s parents refused surgery. After nearly 4 years of active surveillance, the patient visited our hospital for surgery. Case 2, a 2-year-old male, reported a sewing needle that completely pierced into the right upper abdomen due to an accidental fall that took place half-a-day before admission. He only had right upper abdominal pain. CT showed a striped FB in the liver.Diagnosis:FB in the liver (sewing needle).Interventions:Both the patients were injected with human tetanus immunoglobulin and underwent surgical removal.Outcomes:Both patients recovered smoothly and had no complications during follow-up.Lessons:Active surveillance might be considered for cases with no symptoms or complications and no displacement of the FB, but surgery should be the first choice. If the patient’s condition is complicated, it is recommended to use ultrasound or X-ray to help decision-making during the operation. Additionally, tetanus, child safety, and family education are important supportive measures.     

142例头孢菌素肾损害分析

目的 :探讨头孢菌素类抗生素致肾脏不良反应的发生规律。方法 :以《中国药学文摘》1992年1月～2000年12月9年间发表的有关头孢菌素致肾损害文摘为线索 ,检索原刊文献 ,进行统计分析。结果 :142例肾损害涉及5种药品 ,分别为头孢拉定111例 ,头孢哌酮13例 ,头孢唑啉13例 ,头孢氨苄4例 ,头孢曲松1例。临床主要表现分别为血尿122例 ,肾功能衰竭7例 ,尿潴留6例 ,急性肾炎5例。结论 :惟有合理应用头孢菌素类药才能减少药物不良反应