An American validation study of the Newcastle scale. III. Course during index hospitalization and six-month prospective follow-up

One hundred and fifty-two depressed inpatients were classified endogenous or neurotic according to the Newcastle Diagnostic Scale. Endogenous depressives were significantly more likely than neurotic depressives to be treated with electroconvulsive therapy (ECT). Newcastle subtyping was not associated with response to ECT; however, neurotic depressives not treated with ECT were more symptomatic at hospital discharge than endogenous depressives not treated with ECT. A prospective 6 month follow-up interview was completed with 85% of the patients. There was no association between Newcastle subtyping and follow-up outcome.     

Definition and classification of eczemas--a pertinent challenge to dermatologists

Since, in dermatological literature, the term ‘dermatitis’ is frequently confused with ‘eczema’, is has to be unequivocally stated that ‘dermatitis’ is a generic term covering very different patterns of dermal inflammation, whereas ‘eczema’ (or ‘eczematous dermatitis’, resp.) represents a distinct pattern of superficial dermatitis histologically characterized by spongiotic dermo-epidermitis. Eczemas can be defined as inflammatory, non-infectious intolerance reactions of the epidermo-papillary skin compartment with reversible epidermotropic exudation caused by an immense variety of external and/or internal agents combined with increased individual susceptibility to respond. As current classifications only partially reflect the complex causative conditions involved in the etiology and pathodynamics of eczematous disease, the author proposes to classify eczemas according to the following major categories: 1) Mainly exogenous eczemas including those of contact-induced non-allergic, allergic and photo-allergic origin, 2) mainly endogenous (or atopic, resp.) eczemas, and 3) eczemas of combined dysregulatory-microbial origin. The latter group comprises eczemas caused by various functional and/or structural derangements of epidermal protective properties (summarized by the term ‘dysregulation’) which in turn permit the resident and/or transient microflora of the damaged horny layer to induce eczematous inflammatory responses. Since topical and morphological attributes may change during the course of the very same eczema, they are inappropriate for basic classification and should be used only as minor criteria for characterizing the sites and predominant lesional type of the respective eczema. The possible combination of eczemas representing two or even three major categories in one patient leads to intermediate forms entirely in keeping with the division into three principal groups. The proposed classification is aimed at eliminating the terminological confusion of eczemas as well as enabling reliable documentation for statistics which can be used in computer-aided comparisons of multicenter studies on etiology or epidemiology of eczemas.     

Contrasting effect of a brain supernatant extract on neuronal vs neuromuscular α-bungarotoxin receptors

The effects of a rat brain supernatant extract and a partially purified supernatant preparation from bovine brain were determined on the binding of [¹²⁵I]α-bungarotoxin (α-BGT) to muscle membranes, as well as to membranes prepared from brain. In agreement with previous work, the supernatant preparations inhibited α-BGT binding to brain membranes in a dose-dependent fashion, (Brain Research, 245 (1982) 57–67); however, no significant effect of either of the preparations was observed on the binding of the toxin to muscle membranes. As well, the supernatant preparations did not affect binding of radiolabelled α-BGT to muscle cells in culture in competition binding experiments. The effect of long-term incubation of cells in culture with the supernatant preparations was subsequently determined. These studies showed that the binding of [¹²⁵I]α-BGT increased markedly (300%) in the presence of a crude rat brain supernatant preparation, while incubation of the muscle cells in the presence of the partially purified bovine supernatant extract had no significant effect on radiolabelled toxin binding. In contrast, both the rat and bovine supernatant preparations significantly decreased (up to 65%) radiolabelled toxin binding to a cultured neuronal cell population, adrenal medullary chromaffin cells. These results suggest that an endogenous factor(s), present in brain extracts, differentially regulates the neuronal as compared to the neuromuscular nicotinic α-bungarotoxin binding sites.     

大麻类物质与胃肠运动

大麻类物质在临床的应用已有多年,但迄今为止对大麻素系统的作用机制,尤其对内源性大麻素系统参与胃肠运动调节的机制并不明了.本文介绍大麻类物质的种类,其受体、同类物、拮抗剂以及它们对胃肠运动的影响等,以望为大麻素类物质在临床的应用提供理论基础及实验依据,并为进一步开展对大麻素系统的探讨与研究提供近期的资料和信息.     

The interaction between endogenous opioid peptides and GABA in lower brain stem

Summary The interaction between endogenous opioid peptides and GABA in lower brain stem in cardiovascular regulation was investigated. The results of our experiments suggested that endogenous opioid peptides and GABA in lower brain stem can reinforce each other in their inhibitory effect on blood pressure, but the mechanism of the interaction remains to be elucidated.     

High thrombin generation measured in the presence of thrombomodulin is associated with an increased risk of recurrent venous thromboembolism

Summary.  Background:  The assessment of the risk of recurrent venous thromboembolism (VTE) is important to determine the optimal duration of secondary prophylaxis. The risk can be estimated by measuring individual parameters reflecting hypercoagulability. Because of the large numbers of such putative parameters, the assessment in individual patients is complex. Application of global assays reflecting the pro-/anti-coagulant balance in vivo would be desirable. Objectives:  To investigate the relationship between recurrent VTE and thrombin generation (TG). Patients-methods:  Two hundred and fifty-four patients were followed-up after a first episode of unprovoked, objectively documented VTE for a period of 2.7 years after discontinuation of treatment with vitamin K antagonists. TG was measured 1 month after discontinuation of treatment as endogenous thrombin potential (ETP), peak thrombin and lag-time in the presence or absence of thrombomodulin. The study outcome was objectively documented symptomatic recurrent VTE. Results:  Patients with ETP or peak (measured in the presence of thrombomodulin) of >960 n m _*min or >193 n m had hazard ratios (HR) (95% CI) for recurrent VTE of 3.41 (1.34–8.68) or 4.57 (1.70–12.2) as compared with those with an ETP <563 n m _*min or peak <115 n m . Patients with lag-time <14.5 min had HR of 3.19 (1.29–7.89) as compared with those with lag-time >20.8 min. HR for ETP, peak or lag-time measured in the absence of thrombomodulin were smaller than those measured in the presence of thrombomodulin. Conclusions:  The measurement of TG helps to identify patients at higher risk of VTE recurrence. The increased risk may be better appreciated if the test is performed in the presence of thrombomodulin.     

骨折后深静脉血栓形成患者的内源性抗凝能力评价

目的观察骨折后下肢深静脉血栓形成(DVT)患者的内源性抗凝能力及其在DVT形成中的作用。方法选择北京积水潭医院骨折后下肢DVT患者95例作为DVT组,体检健康者100例作为健康人对照组。收集患者术后第3天枸橼酸钠抗凝血浆标本,检测纤维蛋白降解产物(FDP)和D-二聚体(DD);用Thrombopath发色底物显色法检测内源性抗凝能力指标Protac凝血抑制率(PICI);收集患者血清检测高密度脂蛋白胆固醇(HDL-C)。结果 DVT组FDP、DD均高于健康人对照组,差异均有统计学意义(P均0.01),DVT组PICI(%)低于健康人对照组(82.8±7.2 vs 87.8±3.6,P0.01);DVT组≥65岁患者较65岁患者PICI下降约4.8%(P0.05);当PICI的cut-off值为84.2%时,卡方检验显示,DVT与健康人对照组PICI阳性率差异有统计学意义(P0.01);相关性分析显示PICI与FDP、DD呈负相关,与HDL-C呈正相关(r分别为-0.318、-0.336和0.284,P均0.01);Logistic回归分析显示PICI是静脉血栓的危险因素,OR值为1.243(P0.01)。结论骨折后血栓患者的内源性抗凝能力降低。     

Natriuretic factors and lithium clearance in patients with the syndrome of inappropriate antidiuretic hormone (SIADH)

Because the syndrome of inappropriate antidiuretic hormone (SIADH) is a state of disturbed body fluid volume regulation and altered sodium balance we sought to determine if recently described volume regulatory factors were stimulated in SIADH. We measured atrial natriuretic peptide (ANP), endogenous digitalis-like natriuretic factor (EDNF) and urinary free dopamine in SIADH (n = 27). We also determined fractional clearance of lithium (FCLi). The data obtained in SIADH were compared with similar measurements performed in sodium retaining hyponatremias, such as those of heart failure (n = 26), liver cirrhosis (n = 19) and volume contraction (n = 28). We observed: ANP was 19.5 +/- 2.7 fM/ml in SIADH; it was significantly lower than ANP in cardiac failure, but no different from ANP in volume contraction. Urinary free dopamine was 2.2 +/- 0.8 microM/24 h in SIADH; this was significantly higher than in volume contraction and liver cirrhosis. EDNF (259 +/- 42 nM/24 h) and FCLi (21.4 +/- 2%) were both numerically higher in SIADH than in other hyponatremic disorders; however, the differences did not achieve significance. In conclusion, our observations did not establish a specific role of ANP in chronic stable SIADH. As to the importance of EDNF, dopamine and proximal tubular fluid reabsorption (FCLi) additional work using acute volume changes may demonstrate their participation in the renal sodium handling of SIADH more clearly than our study did.     

“星级护士”两种评选方法的效果与体会

目的了解不同“星级护士”评选方法对护理行为的影响。方法2003年1~6月以病人满意度为标准进行“星级护士”评选;2003年7月~2005年3月以病人、医生、护士3方面满意度为标准进行“星级护士”评选。结果以病人满意度为标准的“星级护士”评选方法部分地调动了护士工作的积极性;以病人、医生、护士3方面满意度为标准的“星级护士”评选方法较全面地调动了护士工作的积极性。结论以病人、医生、护士3方面满意度为标准的“星级护士”评选方法比单纯以病人满意度为标准的“星级护士”评选方法更能调动护士工作积极性。     

Influence of Perchlorate on the Secretion of Non-Thyroxine Iodine by the Normal Human Thyroid Gland

Abstract. Several authors have postulated that endogenous iodide produced by the deiodination of iodotyrosines in the thyroid feeds into a different thyroidal iodide compartment than transported iodide which enters the gland from outside. One argument for the existence of two separate iodide compartments is the observation that under certain experimental conditions perchlorate completely discharges transported iodide from the thyroid, while it has no such effect on endogenous iodide. This latter observation however has not been confirmed by all studies and remained controversial. – We therefore reinvestigated the effect of perchlorate on the secretion of endogenous iodide by a new, sensitive method. Five normal volunteers received tracer amounts of iodide-¹²⁵I p.o. and 11 days later thyroxine-¹³¹I I.V. Two days later the following serial measurements were started: serum protein-bound labelled iodine (PB¹²⁵I, PB¹³¹), serum total thyroxine and urinary excretion of ¹²⁵I, ¹²⁷I and ¹³¹I. – In the control period the non-thyroxine iodine secretion calculated from the above measurements was 40 μg/day. Under perchlorate 200 mg three times daily this value rose significantly to 66 μg/day. Non-thyroxine iodine comprises the secreted triiodothyronine plus the secreted endogenous iodide. Assuming that the former value remained constant, our data show that perchlorate indeed discharges part, though not all, of the endogenous iodide. These data do not rule out a second iodide compartment, but they are also compatible with a simple one compartment model.