Hyponatremia, serum sodium 〈 135 mEq/L, is themost common electrolyte abnormality and is in a state of flux. Hyponatremic patients are symptomatic and should be treated but our inability to consistently determine the...Hyponatremia, serum sodium 〈 135 mEq/L, is themost common electrolyte abnormality and is in a state of flux. Hyponatremic patients are symptomatic and should be treated but our inability to consistently determine the causes of hyponatremia has hampered the delivery of appropriate therapy. This is especially applicable to differentiating syndrome of inappropriate antidiuresis （SIAD） from cerebral salt wasting （CSW） or more appropriately, renal salt wasting （RSW）, because of divergent therapeutic goals, to water-restrict in SIAD and administer salt and water in RSW. Differentiating SIAD from RSW is extremely diffcult because of identical clinical parameters that defne both syndromes and the mindset that CSW occurs rarely. It is thus insuffcient to make the diagnosis of SIAD simply because it meets the defned characteristics. We review the pathophysiology of SIAD and RSW, the evolution of an algorithm that is based on determinations of fractional excretion of urate and distinctive responses to saline infusions to differentiate SIAD from RSW. This algorithm also simplifes the diagnosis of hyponatremic patients due to Addison’s disease, reset osmostat and prerenal states. It is a common perception that we cannot accurately assess the volume status of a patient by clinical criteria. Our algorithm eliminates the need to determine the volume status with the realization that too many factors affect plasma renin, aldosterone, atrial/brain natriuretic peptide or urine sodium concentration to be useful. Reports and increasing recognition of RSW occurring in patients without evidence of cerebral disease should thus elicit the need to consider RSW in a broader group of patients and to question any diagnosis of SIAD. Based on the accumulation of supporting data, we make the clinically important proposal to change CSW to RSW, to eliminate reset osmostat as type C SIAD and stress the need for a new defnition of SIAD.展开更多
The cannabinoid （CB） receptors, endocannabinoids （eCB） and their synthesizing and catabolizing enzymes and the proteins involved in their transport, constitute what is now recognized as the eCB system. The eCBs ar...The cannabinoid （CB） receptors, endocannabinoids （eCB） and their synthesizing and catabolizing enzymes and the proteins involved in their transport, constitute what is now recognized as the eCB system. The eCBs are a class of lipids that have been identifed as retro-grade messengers and produce their effects via presyn-aptic CB receptors. The major function of the eCBs has been suggested to be that of modulating the release of several neurotransmitters implicated in a number of biological functions that include reward and reinforce-ment. There is now significant evidence to suggest that the eCB system plays an important role in the development of alcohol tolerance, dependence and relapse. Recent studies suggest that the pharmacological manipulation of the eCB system has the potential not only to block the direct reinforcing properties of alcohol but also alleviate behavioral abnormalities associated with relapse. There is also accumulating evidence that points to the possible utility of the eCB system targeted drugs in the treatment of alcoholism-related behavioral disorders. The agents that block CB1 receptor function or inhibit the synthesis of eCBs are attractive candidate drugs that need to be explored. Further understanding of the role of the eCB system in molecular mechanism/s that underlies alcoholism-related behaviors should lead to a better treatment of this devastating disorder.展开更多
Object: To investigate the relationship between chlamydiatrachomatis (CT) and urogenital infection. Method Positive rate of CT in patients with inflammationof urogenital tract was significantly higher than those witho...Object: To investigate the relationship between chlamydiatrachomatis (CT) and urogenital infection. Method Positive rate of CT in patients with inflammationof urogenital tract was significantly higher than those withoutinflammation(P<0.05). Result: There was statistical difference in the males nomatter they were patients with inflammation of urogenitaltract or not (P>H0.05), while there was no statistical differencein females (P>0.05). The incidence of the infection was highamong those aging from 21-50 years old. Conclusion: The clinical manifestations of CT infectionwere obscure, so we should examine CT in patients who haveno symptoms, especially in females and those of high-riskpopulation.展开更多
文摘Hyponatremia, serum sodium 〈 135 mEq/L, is themost common electrolyte abnormality and is in a state of flux. Hyponatremic patients are symptomatic and should be treated but our inability to consistently determine the causes of hyponatremia has hampered the delivery of appropriate therapy. This is especially applicable to differentiating syndrome of inappropriate antidiuresis （SIAD） from cerebral salt wasting （CSW） or more appropriately, renal salt wasting （RSW）, because of divergent therapeutic goals, to water-restrict in SIAD and administer salt and water in RSW. Differentiating SIAD from RSW is extremely diffcult because of identical clinical parameters that defne both syndromes and the mindset that CSW occurs rarely. It is thus insuffcient to make the diagnosis of SIAD simply because it meets the defned characteristics. We review the pathophysiology of SIAD and RSW, the evolution of an algorithm that is based on determinations of fractional excretion of urate and distinctive responses to saline infusions to differentiate SIAD from RSW. This algorithm also simplifes the diagnosis of hyponatremic patients due to Addison’s disease, reset osmostat and prerenal states. It is a common perception that we cannot accurately assess the volume status of a patient by clinical criteria. Our algorithm eliminates the need to determine the volume status with the realization that too many factors affect plasma renin, aldosterone, atrial/brain natriuretic peptide or urine sodium concentration to be useful. Reports and increasing recognition of RSW occurring in patients without evidence of cerebral disease should thus elicit the need to consider RSW in a broader group of patients and to question any diagnosis of SIAD. Based on the accumulation of supporting data, we make the clinically important proposal to change CSW to RSW, to eliminate reset osmostat as type C SIAD and stress the need for a new defnition of SIAD.
基金Supported by Funds from the National Institute of Health,Bethesda,United StatesAmerican Foundation for SuicidePrevention
文摘The cannabinoid （CB） receptors, endocannabinoids （eCB） and their synthesizing and catabolizing enzymes and the proteins involved in their transport, constitute what is now recognized as the eCB system. The eCBs are a class of lipids that have been identifed as retro-grade messengers and produce their effects via presyn-aptic CB receptors. The major function of the eCBs has been suggested to be that of modulating the release of several neurotransmitters implicated in a number of biological functions that include reward and reinforce-ment. There is now significant evidence to suggest that the eCB system plays an important role in the development of alcohol tolerance, dependence and relapse. Recent studies suggest that the pharmacological manipulation of the eCB system has the potential not only to block the direct reinforcing properties of alcohol but also alleviate behavioral abnormalities associated with relapse. There is also accumulating evidence that points to the possible utility of the eCB system targeted drugs in the treatment of alcoholism-related behavioral disorders. The agents that block CB1 receptor function or inhibit the synthesis of eCBs are attractive candidate drugs that need to be explored. Further understanding of the role of the eCB system in molecular mechanism/s that underlies alcoholism-related behaviors should lead to a better treatment of this devastating disorder.
文摘Object: To investigate the relationship between chlamydiatrachomatis (CT) and urogenital infection. Method Positive rate of CT in patients with inflammationof urogenital tract was significantly higher than those withoutinflammation(P<0.05). Result: There was statistical difference in the males nomatter they were patients with inflammation of urogenitaltract or not (P>H0.05), while there was no statistical differencein females (P>0.05). The incidence of the infection was highamong those aging from 21-50 years old. Conclusion: The clinical manifestations of CT infectionwere obscure, so we should examine CT in patients who haveno symptoms, especially in females and those of high-riskpopulation.
