十二味疏肝利胆冲剂联合ERCP治疗胆总管结石30例临床分析

目的观察十二味疏肝利胆冲剂联合ERCP治疗胆总管结石的临床疗效。方法将60例胆总管结石的患者采用随机按数字表法分成对照组30例和研究组30例,对照组予以ERCP治疗,术后常规抑酶、抑酸、抗感染;研究组在对照组治疗的基础上给予十二味疏肝利胆冲剂口服。观察比较2组患者右上腹部疼痛、发热和黄疸的临床症状积分的改善情况及治疗前后血常规指标（白细胞、中性粒细胞、中性粒细胞百分比）、肝功能指标（谷丙转氨酶、谷草转氨酶、AKP）、血淀粉酶（AMY）、血清胆石形成生化指标（总胆汁酸、总胆红素、直接胆红素、间接胆红素）、鼻胆管引流量的变化。结果2组的症状积分较治疗前均明显好转（P<0.05）,研究组优于对照组（P<0.05）;2组能降低血常规指标、肝功能指标、血清胆汁生化指标和提高胆汁引流量,均较治疗前明显好转（P<0.05）,研究组较对照组差异显著（P<0.05）。结论疏肝利胆冲剂联合ERCP治疗胆总管结石可以明显改善临床症状、控制术后胆总管炎症、促进肝功能早日恢复、降低术后淀粉酶和增加胆汁引流量,防治术后结石再生。     

TNF-alpha suppresses the expression of clock genes by interfering with E-box-mediated transcription

Production of TNF-alpha and IL-1 in infectious and autoimmune diseases is associated with fever, fatigue, and sleep disturbances, which are collectively referred to as sickness behavior syndrome. In mice TNF-alpha and IL-1 increase nonrapid eye movement sleep. Because clock genes regulate the circadian rhythm and thereby locomotor activity and may alter sleep architecture we assessed the influence of TNF-alpha on the circadian timing system. TNF-alpha is shown here to suppress the expression of the PAR bZip clock-controlled genes Dbp, Tef, and Hlf and of the period genes Per1, Per2, and Per3 in fibroblasts in vitro and in vivo in the liver of mice infused with the cytokine. The effect of TNF-alpha on clock genes is shared by IL-1beta, but not by IFN-alpha, and IL-6. Furthermore, TNF-alpha interferes with the expression of Dbp in the suprachiasmatic nucleus and causes prolonged rest periods in the dark when mice show spontaneous locomotor activity. Using clock reporter genes TNF-alpha is found here to inhibit CLOCK-BMAL1-induced activation of E-box regulatory elements-dependent clock gene promoters. We suggest that the increase of TNF-alpha and IL-1beta, as seen in infectious and autoimmune diseases, impairs clock gene functions and causes fatigue.     

Targeting the dopamine system in the treatment of attention-deficit/hyperactivity disorder

Attention-deficit/hyperactivity disorder (ADHD) is a highly heritable condition that affects a significant number of children and adults worldwide. During the past 30 years, the diagnosis and treatment of ADHD has relied on clinical assessment and empirical experience with stimulant medications. More recently, advances in family genetic studies, molecular genetic studies, preclinical research, radiographic imaging techniques and neuropsychological evaluation have significantly enhanced our understanding of the neurobiology of ADHD. This review highlights the current central role of dopamine in the pathophysiology and treatment of ADHD and implications for future advances in diagnosis and treatment.     

How Should Psychiatrists Dress?—A Survey

Personal attire is an important part of being a professional. This survey is an attempt to determine the patient’s and psychiatrists view point about how a psychiatrist should dress to work. A human subjects research board approved survey of seven questions was offered to patients and a similar survey of nine questions was offered to psychiatrists. The replies obtained were combined and tabulated. One hundred patients and 77 psychiatrists responded to the survey. Both the patients and psychiatrists considered dress to be an important part of the doctor–patient relationship. The psychiatrists appear to be more concerned and critical about their dress as compared to patients.Nikhil D. Nihalani is affiliated with the Department of Psychiatry, Upstate Medical University, Synracuse, NY, USA.Arun Kunwar and Jud Staller are affiliated with the Department of Child and Adolescent Psychiatry, Upstate Medical University, Synracuse, NY, USA.Steve Lamberti is affiliated with the Department of Psychiatry, Strong Memorial Hospital, Rochester, NY, USA.     

Quality of life in maltreated children and adult survivors of child maltreatment: a systematic review

Purpose

To review data on health-related quality of life (HRQoL) in individuals with childhood trauma, including psychological maltreatment, physical maltreatment, sexual abuse, and neglect.

Methods

The literature search was conducted with pre-defined keywords using the following electronic bibliographic databases: EMBASE, PubMed, MEDLINE, CINAHL, PsyINFO, PSYNDEX, and Cochrane Database of Systematic Reviews. Further databases were searched for relevant dissertations. Study selection and data extraction were completed by two independent reviewers.

Results

The literature search yielded 1568 entries. Nineteen articles met all inclusion criteria and were retained for further analysis. Findings quite consistently showed significant negative associations between child maltreatment and both self- and proxy-rated HRQoL. Effect sizes range from small to large. Number of types of maltreatment and HRQoL were found to be negatively related.

Conclusion

Data on HRQoL for maltreated children are still rare. Studies often investigate adult survivors of child maltreatment. Considering HRQoL in children and adolescents who suffered maltreatment would allow the planning of effective interventions and the evaluation of treatments to improve HRQoL of these children.